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ARMED FORCES MEDICAL LIBRARY




       Washington, D. C.

/ 
 
 
 
 
                 VIEW

                   OF THE

    NERVOUS TEMPERAMENT j

                   BEING  A
PRACTICAL INQUIRY INTO THE INCREAS-
  ING PREVALENCE, PREVENTION, AND
     TREATMENT OF THOSE DISEASE'S
              COMMONLY CALLED
 NERVOUS, BILIOUS, STOMACH y LIVER
   COMPLAINTS; IJVJDIGES? .'J.Y; LOW
            SPIRITS, GOUT, iSc.

     BY THOMAS TROTTER, M. D.

Late Physician to His Majesty's  fleet under the com-
  mand of Admiral Earl Howe, k. g. ; and to the squa-
     drons commanded by  Admiral Lord Brid-
      port, k. b. Admiral Earl St. Vincent, k. b.
         and the Hon. Admiral Cornwallis ;
Member of the Royal Medical Society of Edinburgh ;
  an Honorary Member of the Royal Physical Soci-
     ety of Edinburgh, of the Medical Society of
        Aberdeen; and formerly Physician to
          the Royal Hospital at Haslar,
                    Sec.  Sec.
   Boundless intem/ierance
   In nature is a tyranny : it hathjbe~?n .,
   The untimely emptying of th^'/tapfCy throne,
   And fall of many kings. A■''    Shakespeare.



                 TROY, K.Y+lJftfSrp
PUBLISHED BY WRIGHT, GOODENOW, Sc STOCKWELLj
   AND FOR SALE AT THE RENSSELAER BOOK-
     STORE, Sc AT THEIR STORE  IN BOSTON.

                    1808. 
 
DEDICATION.
       TO  JAMES GREGORY, M. D.
 PROFESSOR  OF THE PRACTICE OF MEDICINE 1U
   THE UNIVERSITY OF EDINBURGH, &C. &C.

    MY DEAR SIR,

 IN requesting the sanction of your name to
the present work, with honest pride I acknow-
ledge the many and great obligations you have
conferred on the profession of medicine by
your estimable talents ;  but still more, by the
manly spirit and dignified independence with
which, on all occasions, you have defended its
rights, and  maintained its honours. At a time
when  avarice is making rapid advances to nar-
row its benevolence, and a servile compliance
with the  frivolous forms of fashionable life is
degrading its  duties, it must  be  grateful to
every generous mind, to behold a nobler exam-

^
^
$
^
^ 
IV
DEDICATION.
 pie from the practical chair of the University   '
 of Edinburgh.   And should any merit be due
 to the  following pages, it will be derived from
 the humble imitation of your  zeal, integrity,
 and  candour.   Mankind have  seldom  been
 delighted with a picture  of their infirmities;
 and  the  physician who warns his fellow mor-
 tals how to evade  them,  is liable to be consi-
 dered  rather as an  officious adviser, than  a
 welcome  monitor.    But if it is  true,  as  I
 have said, that nervous diseases make up two-
 thirds  of the whole with  which civilized soci-
 ety is infested, and are tending fast to abridge
the physical strength and mental capacities of
the human race, it must be the duty of some
person to sound  the  alarm,  and  to  announce
the danger, however unprofitable the task.
   The work which I have now the honour
to lay before the public, was written eighteen
months ago :  and though several authors  have
appeared on the same subject, since that time,
 I do  not find my labours anticipated.   The
ground which I have taken in  the discussion,
 is in many respects new.   This  View of the
 Nervous Temperament may  therefore be con-
 sidered as the result of a more extensive field 
               DEDICATION.               V

for experience, than generally  falls to the lot
of every physician ;  for it has  been  acquired
by attendance on some thousands of cases, in
both  sexes, under all the varieties of rank,
employment, age, situation, climate, &c.
    I  well remember, when I was  young ia
the profession,  no  diseases puzzled me  so
much as  those of the nervous kind.  I was
every day committing blunders :  in vain  I
had recourse  to  books, for books  could  not
supply  the deficiency, and  I was frequently
mortified with seeing my patients get worse
under my treatment.   Time, and much expe-
rience, only,  were capable of  correcting  my
errours.  What first gave my practice corsis-
tency, was the  careful study of  the  ner\ ous
temperament; to  mart: what were its original
peculiarities; what  its1* propensities ; *i,d by
what  causes its diseases /ere drawn forth.   I
am rather apt to believe, that most  young
men,  in  beginning their nodical  caieer, run
great  hazard of mistak'n g thesr complaints ;
as they only become apparent by  a concourse
of symptoms, that is exrremely irreguV.r and
equivocal.  An 1  I  have know> more than
one instance of nervous females having been 
VI
DEDICATION.
treated for typhus fever, to the great alarm of
their  families, when they were labouring un-
der debility  of body and  mind, widely diffe-
rent in nature ; and attended too by men who
called themselves seniors in the practice.   A
prevailing contagion  must  be  badly  under-
stood, when both  physician and patient  be-
come dupes of such unnecessary fears.   I am,
therefore, in hopes that the method which I
have taken in the following investigation, will
somewhat contribute to familiarize the  junior
members of the  profession with the  genius of
nervous disorders, and to guard them against
mistakes in the treatment.
    But I have no hesitation in thinking, that
my enquiry may be useful to general readers.
We meet with  numbers  of persons  in  the
world, who, though obstinate in refusing ad-
vice for their own  health, are nevertheless ve-
ry ready to comply with every precept that
may correct the hereditary predisposition to
disease in their  offspring.   Much of my ani-
madversions on these  disorders,  is  with a
view  to  the prevention ;  and  if parents  and
guardians will only Interest themselves in the
business, my trouble cannot be in vain.  It is 
DEDICATION.             VII
 indeed a task, in the present stage of society,
 that  well  deserves the  attention  of  every
 friend of his fellow-creatures, and his country.
 Great Britain has outstripped rival states in
"her commercial greatness:  let us  therefore
 endeavour to preserve  that ascendancy,  which
 is so essential to our welfare in the convulsed
 condition of Europe,  by the only means that
 can  do it effectually.   That is, by recurring
 to simplicity of living and manners, so as to
 check  the increasing  prevalence  of nervous
 disorders;   which, if not  restrained soon,
 must inevitably sap our physical strength of
 constitution ; make us an easy  conquest to
 our invaders ;  and ultimately convert us into
 a nation of slaves and idiots.
     It  has been  customary  with  writers on
 these diseases, to  illustrate their subject with
 the  anatomy and physiology of the  parts con-
 cerned.  But  I  see no necessity for this in
 the present inquiry ; and my sheets have un-
 expectedly swelled to a size that  precludes
 the  introduction  of such matter.   I must
 therefore  refer  my  young readers to  Dr.
  Whytt on nervous disorders, and to the valu-
  able  volume  of Dr.  Saunders on  the liver, 
yiii            DEDICATION.        4

for what they may not find explained in com-
mon elementary treatises of anatomy and phy-
siology.
   My plan is briefly this : a cursory view is
given of the health of the savage state, in  or-
der that the contrast with civilized  mankind
may  appear more striking.   The inhabitants
of a large town  are  next described ;  which
may  be construed into a kind of medical anal-
ysis of society;  and this leads to an account
of the  remote causes, as found among refined
modes of life and luxurious  habits.   A chap-
ter follows on the  influence which these disor-
ders  have on national character and domestick
happiness.  The history and progress of ner-
vous  diseases,  with  a general doctrine, or
summary of the  pathology,  precede the pre-*
vention and method of treatment.
   On the whole,  there will be found little of
what is called theor)', in this discussion :  un-
shackled by  any  attachment to system, and
unseduced by the love of novelty, I  have  en-
deavored to delineate the Nervous Tempera-
ment, as I have seen it in actual practice, and
in a large intercourse with mankind.   But in
treating of a class of diseases out of the usual 
DEDICATION.             IX
tract of enquiry, I am willing to confess, that
many peculiarities may be-observed, and some
obscurities detected.    I  will make no apolo-
gies to my countrymen, for offering  them my
advice, on matters that so nearly concern their
health : if the title of my book excites dislike,
let them  remember the perusal of it is volun-
tary.   Nor will I insult their discernment, by
any fulsome justification  of my own motives
and disinterestedness.  If  I have acted  the
part of an honest man, that must answer for
itself.
    But, sir, should you recognize any thing
in these labors worthy of the medical  school of
Edinburgh, I shall be greatly overpaid.  And
as this may be the last time  I shall appear be-
fore the publick, as an author, gratitude com-
pels me to thank the profession, both in this
country and on the continent, for the kind re-
ception of my former studies, and the nume-
rous testimonies given in their favour.
     I remain, my dear sir,
        With the utmost regard,
          Your most  faithful humble servant,
                        T. TROTTER.
Newcastle on Tyne, >
   Nov. 8,  1806.  > 
 
INTRODUCTION.
      THE last century has been remarkable
for the increase of  a  class of diseases, but
little  known  in  former times,  and what had
slightly engaged the study of physicians prior
to that  period.  They have been designated
in common language,  by the terms, nervous,
spasmodick, bilious, indigestion, stomach com-
plaints, low spirits, vapours, Esfc.  A gencrick
definition of them, from their protean shape
and multiform appearance, is almost imprac-
ticable.   They  vary in  every constitution j
and assume,  in the same  person, at different
times of  life, an  inconstant assemblage of
symptoms. ^
   In another work, when cursorily treating
of these diseases,  I  have attempted to give a
general character of them, and for want of a 
XII
INTRODUCTION.
better, I shall insert it here.  " Nervous feel-
" ings, nervous affections, or weak nerves,
** tho' scarcely to be resolved into  technical
" language1, or reduced to a generick defini-
" tion, are  in the present day terms  much
" employed by medical  people,  as well as
" patients ;  because the expression  is known
c* to comprehend what  cannot be so well ex-
" plained.   An inaptitude to muscular action,
" or  some pain in  exerting it;  an  irksome-
" ness, or dislike to attend to business and
" the common affairs of life ; a selfish desire
" of  engrossing the sympathy and  attention
" of  others to the narration of their own suf-
" ferings ; with fickleness and unsteadiness
" of  temper,  even to  irrascibility ; and ac-
" companied  more  or  less  with dyspeptick
" symptoms,  are  the leading characteristicks
" of  nervous disorders ; to be  referred in ge-
" neral, to debility, increased sensibility, or
"■-torpor of the alimentary canal."*
    In the present day, this class of diseases
forms by far  the  largest proportion of the
whole, which  come under the treatment of

   * Medicina Xcutica, vol. 3, Spasmodic^ Affections. 
              INTRODUCTION.           Xlll

the physician.  Sydenham,  at the conclusion
of the seventeenth century,  computed fevers
to  constitute two-thirds  of the diseases  of
mankind.  But, at the beginning of the nine-
teenth century,  we do not hesitate to affirm,
that nervous disorders  have now taken the
place of  fevers,  and may be justly reckoned
two thirds of the whole, with  which civilized
society is afflicted.   Dr.  Cheyne, who wrote
about 'the year 1733, in his work entitled the
u  English Malady,"  makes nervous disorders
almost one third  of  the complaints of people
of condition in England : from which we are
led to believe  they were then little known
among the inferiour orders.  But from caus-
es, to  be hereafter  investigated, we shall find
that nervous ailments are no longer confined
to the better ranks in life, but rapidly extend-
ing to  the poorer classes.   In  this neighbour-
hood,  as far as I am able to  judge from my
own experience, they are by no means limited
to the  rich :  and it  affords a melanch -ly pic-
ture of the  health of the  community, to ob-
serve  this  proportion  so  very large.   It  is
probable the other  countries  of Europe do
not exhibit  such general examples  of these 
Xiy           INTRODUCTION.

diseases ; as many of their causes are to be
traced to the peculiar situation of Britain ; its
insular varieties of climate and atmosphere ;
its political institutions and  free government;
and above  every thing,  its  vast  wealth, so
diffused among all ranks of people. 
            VIEW
              OF THE
NERVOUS TEMPERAMENT,
            &c. &c. &c.
              CHAPTER  I.

 The health of the  savage state compared with
               modern times.

        THE savage and civilized states of
man,  as  may  be  observed  in the earliest ac-
counts of history, have been marked by phy-
sical traits of character, as well as moral: and
though  his diseases and  his  vices  may be
smaller  in number  in the one condition than
in the other, they have nevertheless exhibited
signs and dispositions peculiar to themselves. 
16
Our rude ancestors, born and brought up  in
a hut or a hovel, almost  naked from  infancy
to manhood, and constantly exposed  to th*
weather, whether  employed in  agriculture,
tending herds and flocks, or the  more  labori-
ous pursuits of hunting and fishing, had few
bodily disorders.   Death, under such modes
of living, is to be considered as the decay  of
nature  : some may  fall by war, and a few by
accidents ; but none are brought to the grave
by excess or debauch.  It is notorious that all
the savage tribes of the new continent, when
compared with  European  manners,  are ob-
served to be chaste, temperate,  and  abstemi-
ous.*   Tacitus, speaking of the manners  of
the Germans in his days, describes the convi-
vial assemblies of that people, where drinking
fermented liquors was carried to the most fe-
rocious degree of ebriety ;  but no where does
he mention their diseases  as having  sprung
from this cause.    The favourite beverage
among them was beer, which, when duly pre-
pared, is a wholesome drink.  But their man-
 ner of living must  in a great measure have
    * The  inhabitants of some of the South Sea isl-
ands are examples to the contrary. 
17
counteracted the effects of intoxication : such
as the robust exercises, and their simple food,
" consisting of  wild  apples,  fresh venison,
curds, and cream,"  and the like, none of
M'hich were calculated to oppress the stomach
and hurt digestion,  as we observe among full
livers in modern times.  Indeed it is  to be
remarked every where, how much longer the
laborious porter  and drayman, who get often,
drunk, will continue their career, than the less
exercised  gentleman : a proof that labour, by
invigorating and hardening the body,  makes
it resist even  the effects of  debauch.   How
soon would the  morning dram of a Billings-
gate fish-wife  destroy one of our high bred
women of fashion I
   The virtue of chastity was-general among
the Germans : matrimony, it is said, was  se-
verely kept; and the mixture of the  sexes,
before the body was  full grown, was strictly
prevented.  Here was  one of the  strongest
securities of health  ; a3 a contrary practice in
this age, i3 one of the great causes of  bodily
decay.  We are also told, that the large limbs
and muscular form of the parents, were  ex-
pressed in the shape of the children.  Anc*
                   B2 
13
ther proof of bodily  health was, that every
mother was able to nurse her own child ; the
opposite  to this parental office,  is one of the
lamentable failings  of modern constitutions.
It was part of the matrimonial contract, for
the wife to share with the husband his labours
and  dangers ;   and to be his companion in
peace and war.   This custom, of course, pre-
vented all the  evils of a sedentary life.  In a
country that held the marriage vow so sacred,
adultery was seldom found ; and it was consi-
dered in so heinous a light, that neither beauty
nor wealth could ever find the adulteress ano-
ther spouse.   Such  was the  healthful system
of manners practised in the woods of Germa-
ny, which were the cradle of those laws that
now govern this land of freedom.
   The feudal system which succeeded to the
age which Tacitus describes, and which spread
over Europe, v/as highly favourable to vigour
of body, and by consequence to health.  The
women were then accustomed to attend their
husbands to the field,  and to  remain in sight
of the battle ; not  only with  a view to load
them with praises and caresses at the conclu-
sion j  but to remind them of the protection 
10
due to wives and children.   Courage and
valour, with such  incentives,  would  become
invincible.  All the pastimes and tournaments
of those days, were only kinds of palaestrae for
exercising the body so as to inure it to martial
fatigues.   The  females were constant specta-
tors of these tilts and feats, and their presence
did not fail  to animate the brave ;  and it was
the province of  the fair to reward  the victor,
and confer  the prize on the successful candi-
date.  Now in the woods of Germany, where
mothers of families shared with  their hus-
bands  all the toils  and privations of the  field,
such complaints as  bilious and nervous  must
have been unknown, because all  the causes
which  render them prevalent in this age, did
not  then  exist.    They are the  progeny  of
wealth, luxury, indolence, and intemperance,
as they now appear.
    In  the eighteenth  chapter of Genesis,  we
meet with some fine  proofs of the simplicity
of living among the patriarchs, which may be
called  the earliest stage of civilized society.
When  Abraham entertained the three angels,
in the  plains of-  Manure, he hastened  towel-
come them with all the tokens of a kind hos- 
20
pitality.  Sarah his wife kneaded three  mea-
sures of fine meal into cakes, and baked  them
upon the hearth.   Abraham himself went to
the herd, and fetched a calf, tender and good,
and  gave it unto a  young  man  to dress it.
And he took butter and milk,  and the calf
which he had dressed, and set  it before them,
and  they did eat: and  he stood by under a
tree, as if  to watch when they  wanted any
thing.  Again,  when Lot entertained two an-
gels, it is said he made a feast, and baked un-
leavened bread.   These banquets for angels,
so simply detailed  in holy writ, would be con-
sidered  poor fare  for the  epicures and glut-
tons of our times, who dine at a lord mayor's
feast, if we are to judge from a list of dain-
ties, just published, of one of these entertain-
ments.  We are farther  told in the sacred vo-
lume, that Boaz invited Ruth to come at meal
time, and eat bread, and  dip her morsel in the
vinegar With the.reapers  ; and  he reached her
parched corn to eat.   Our present  labourers
in the harvest would be sadly pinched with
hunger before they would content themselves
with such  simple  fare.     In  the Iliad  and
Odyssey of Homer, we  meet every where 
2*
 accounts  of  the  like simplicity  of  food  and
 manners.   When the foreign ambassadours*
 came to treat with the Roman  consul  Denta-
 tus, they found him at his farm dressing  tur-
 nips :  a species  of amusement and  economy
 that does not  enter  the  budget of   British
 statesmen.   Where  the earth is thinly peo-
 pled, and when commerce has  made no pro-
 gress, mankind live chiefly in families ;  and
 their habits and employments uniformly incul-
 cate temperance and sobriety.  Society  and
 population must  be far advanced, before luxu-
 rious living,  and vicious customs, attain such
 growth as to  enervate the human frame.
    The nervous system,  that organ of sensa-
 tion, amidst the untutored  and illiterate inha-
 bitants of a forest, could receive none of those
 fine impressions, which, however they may
 polish the mind and enlarge its capacities, ne-
 ver fail to induce a delicacy of feeling, that
 disposes alike to more accute pain, as to more
 exquisite  pleasure.   The timid  dispositions
are apt to increase in proportion to delicacy of
 feeling  and debility of  frame.  We see  the
 truth of this  fully exemplified, as we  recede
 from the country  to the town ; from the occu- 
2i
pntion of the husbandman and farmer, to that
of the  artisan and  manufacturer; and  from
the rustick, exposed to all the vicissitudes of
weather and  season, to the recluse life of the
citizen.   The physician of a cultivated under-
standing,  who knows how to appreciate  the
resources of  his  art, in approaching  the sick
bed of any of these persons,would endeavour
to investigate the  marks  and dispositions of
body and mind,  that give the peculiar cast of
character to each, before he would attempt to
prescribe  for their diseases.  He  would  not
confound the complaint of the slim soft-fibred
man-milliner, with that of the firm and brawny
ploughman ;  nor would he mistake  the  ner-
vous cramp of the  delicate lady,  for the in-
flammatory pleurisy of a nut-brown country
girl.  If  both  expressed pain on the  same
spot or organ, he would, in consideration of o-
riginal temperament, along with the concourse
of symptoms, resolve into first principles what
belonged to each constitution ; and thus  ana-
lyze the  morbid phenomena, so as  to give a
degree of certainty to his indications  of  cure,
and a decision to  his practice, that would insure
success, if the. disease was at all remediable. 
23
   As the human being, in a state of progres-
sive  improvement and civilization, quits his
earthern-floored,  straw-clad cottage,  on  the
skirts of the forest, or a creek of the ocean,
where his time had been spent in hunting and
fishing, for the town, where he is to turn him-
self  to trade and manufacture, he necessarily
undergoes a prodigious change of circumstan-
ces.   He forsakes  a' mode of life that had
been presented to him  by nature ;  and  in
adopting a new situation he becomes the crea-
ture of art.  When occupied in hunting and
Ashing for  support, exposure to the external
air in winter and summer, gradually  endued
him with such hardihood and torpor, as to
make him proof against the extremes of either
cold or beat.  His  diet, well suited  for  the
purposes of nourishment, was sufficiently pa-
latable, without any of those adventitious lux-
uries which cookery supplies.  His blood and
juices were not, therefore, inflamed or vitiated
"by highly seasoned  dainties j  and his  sentient
system,  while  it  was fully excited for all the
movements of  vital energy, was never raised
to  excess  by  inordinate  stimulation.   By
spending so large a portion of the day out of 
24
floors, he enjoyed the full benefit of a pure
and  unpolluted  atmosphere.   The  muscular
parts of the body becoming thus firm and flex-
ile from constant exercise,  all his motions are
performed with  strength,  ease, and agility.
His walk is marked by stability, and his run-
ning by  swiftness.  Having  few avocations
to engage his attention,  he soon acquires un-
common dexterity in all his gestures and ac-
tions.  He ascends  the  mountain and  preci-
pice, or climbs the tree and rock, with equal
safety and speed : the  arrow from his bow  is
discharged with force, and sure of its mark :
the dart and the  javelin are alike unerring  in
his hands.   He manages his hook and tackle,
as well as his skiff, with surprising knowledge
and address ; and in the various attitudes  of
swimming he  is  accomplished, graceful  and
unrivalled.  Though in  his  domestick trans-
actions, he exemplifies all the relative duties  of
husband*,  father,  and son, he seems exempted
from the turmoils and cares which  these con-
nections necessarily bring with them in civil-
ized society.   The child is early instructed  to
follow and imitate his parent in the sports and
toils of the field, and soon learns to earn his 
2J
Own subsistence.   No  painful emotions  for
his success in a busy world, harass or perplex
the minds  of the  father and mother, for it
does  not depend on uncertain patronage or
capricious friendships.   But the young savage
considers it a par: of his filial engagements to
share his board with his parents, when age
and infirmity have unfitted them for labour.
His passion for the sex is temperate, because
it meets with  no  refined allurements,  from
dress, manners or fashion, to inflame it beyond
bounds.  Tacitus,  speaking  of the  manners
of  the Germans, says :  " They behave them-
" selves with the strictest modesty, being  de-
" bauched  with no alluring objects, with no
"provocatives  in  banqueting."    Revenge
seems the only  passion carried to extremes, to
be attributed  chiefly to a solitary life.  When
the savage  makes love, he is almost sure of a
return : he is neither perplexed with doubts
nor fears,  nor  tantalized by false hopes and
promises.  The damsel of the forest is a stran-
ger to those airs and duplicities^" the coquet
and the prude, which characterise  some of the
sisterhood  in every great town.   Hence the
uncivilized being is free from all those mental
                    C 
26
disquietudes, as well as bodily ailments, which -
are frequently brought  on in both sexes by
disappointed love, and an ill-requited passion.
Thus health and vigour of body, with insensi-
bility or passive content of mind, are the inhe-
ritance  of the untutored savage ;  and if his
enjoyments  are limited, his  cares, his pains,
and his  diseases are also few.
  If then it is certain that  the rude conditions
of society furnish mankind with a hardihood
of frame that is susceptible of few diseases ;
let us examine  man in the polished circle of
life, occupied  by pleasure, or busy in  trade
and manufacture.  His modes of living are la
every respect the reverse of the savage  state :
nis  body and mind are enervated by debilita-
ting powers, that render him unfit for labour
or great privations j  and his  diseases acquire
a more  diversified train of phenomena.   The
husbandman, in point of constitution, may be
considered as a medium between the two ex-
tremes.  By his active  occupation, his labour
and cxposurWHo the external  air, he partakes
of  the strength of the  barbarian ; and  a cor-
responding  tone  is  given  to his'nervous sys-
tem : his mind is not debauched by efTemina- 
ar
  cy ; while his temperance and moderation se-
  cure  him against the disorders which prevail
  in fashionable life.
     But as we pursue our enquiry among the
  inhabitants  of large cities,  we shall observe
  mankind  divided  into an immense variety of
  persons ; nil distinct by  fortune, by business,
  and by modes of living ; and again, all these
  greatly influenced by original constitution and
  education.  Among rusticks, and still more
  among savages, there is an universal sameness
  of character.  For  as  the  ambition or inge-
  nuity of man finds out for him  new employ-
  ments ; these, while they draw forth latent ta-
  lents, call forth also  new passions and desires ;
  so that however much  he  may  be styled the
  creature of habit, he is  in  many respects the
  creator of his own temperament.   The Indian,
  paddling in his canoe j or the Norwegian scul-
  ling his skiff, remain unchanged in their man-
  ners ; because  they return at night to their
'  family, and to intercourse with their kindred.
  But embark man at an early age in a large
  ship, such as an East or a West Indiaman, to
  traverse the deep as a navigator and seaman,
  and you  soon  find  that he changes to a diffe- 
28
 rent species of  being,  and exhibits traits of a
 profession,  of the  most singular kind, which
 differ from all others.*  This new occupation,
 while it distinguishes him from all the world
 beside, in gesture, manner, and address, be-
 stows also  a new disposition on his morbid
 state.  His  diseases, therefore, show a parti-
 cular genuis and feature,  such  as  are found
 only among his  own class, and  which spring
 from causes peculiar to the sea life,  as scur-
 vy,  &c.
    It has been remarked,  by some acute  poli-
 tical arithmeticians', particularly the famous;
 Gregory King, that the marriages in London
 and other Q-reat towns, produce fewer children
 than those in the country.  The reasons for'
 this difference are very obvious ; he gives ex-
 amples of the fact, and then enumerates the
 causes, which are the following ;f

   * Compare the  character which I have drawn of
the British seaman,  in my preliminary discourse,  in the
first volume of Mcdicina Miutica, with the Indian, in
Robertson's or Raynal's History of  America ; or with
the Bond-street lounger, as pourtrayed in any modern
comedy or novel.
berkSESttaa,e.0Uti5al C™1"»™>  (*« - Cham. 
29
    1. The  more  frequent  fornications  and
adulteries.
    2. A greater luxury and intemperance.
    3. Greater intenseness to business.
    4. Unhealthfuiness of the coal smoke.
    (He ought to have added, impure air, from
hot and crowded rooms.)
    5. Greater inequality of age between hus-
bands and wives.
    All these causes, beside many others, still
hold good in the present times.  His first and
fifth reasons require  some explanation, which
can be done best at this  part of my work.   It
will be  allowed on all hands, to be the inten-
tion of nature, that years nearly equal should
be joined in marriage ; and were mankind left
to themselves this would be the case.   But
art and fashion have  become dictators to mat-
rimony in this venal  age.  The young man of
the present day must begin the world for him-
self; and,  like a  knight errant in  romance,
must  fight his way  to  a fortune,  before  he
dares to take a wife.   It is  too often the case,
that the sordid parent winks  at the son's indis-
cretions with the ssx, rather than consent that
he should marry the woman he loves, without
                     C2 
                    30
a rich dower.   And while, by this growing
custom,  a  certain number of defenceless fe-
males are doomed to all the horrours of pros-
titution, in order to gratify the passions of the
young, and the avarice of the old, it is one
grand step  to the  degeneracy of the species.
It is thus the best  years of manhood pass away
before marriage  is thought of: it then  be-
comes a  convenience,  more than an equal at-
tachment of the  parties ;  and hence we fre-
quently observe a difference of thirty years
and upwards, when the lady may be said to be
rather the  mistress, than the wife of her hus-
band.  Amidst theee unnatural unions,  it is
pleasing to mention some exceptions.   Many
of the old  noble  families  of the nation have,
within these few years, married at the  prime
©f life.  And it is to be remarked,  that these
marriages have all been noted for happiness
and reciprocal affection :  the men being all
distinguished  by  worth and sobriety ;  as the
ladies are  by  their virtues, accomplishments
and beauty.
   When Gregory King  made h't3 observa-
tions, about the year 1696, London contained
little more  than qne half the inhabitants  it 
                    31

does at this day.  Other great towns through-
out the kingdom, have  increased in  like pro-
portion.   Now if  such effects  followed  the
city and  town  life  in those times, how much
greater must they be in the present.   Certain
it is, the physician of the seventeenth century
had not the multitude of nervous  cases  to
treat, which now occupy the profession.   It is
probable aho, as far as experience goes, that
the proportion of marriages, without  children,
and the number of miscarriages in married
life, are greatly  increased ;   and these  are
chiefly confined to the town lady, or at least to
people of better condition.   It was  a remark
of the sagacious King, that the system of ag-.
riculture in his day, was  advancing to dimi-
nish the number of  cottagers  ; but to increase
the village,  and still more the town.   If such
was the case a hundred years ago, how much
more  reason must there be now for the obser-
vation, when it is notorious, that  some  over-
grown farmers possess capitals of twenty or
thirty  thousand pounds,  and engross  lands
that formerly supported twenty or thirty fami-
lies ?   The middling class of  countrymen are,
by this practice, annihilated, forced to betake 
                     32
themselves to trade, and there is no degree of
rank  left between the affluent farmer, and his
menial servants :  thus,

   ----a bold peasantry, their country's pride,
   When once  destroy'd, can never be supplied,
                              GOLDSMITH.

   The lying-in  state exhibits  some  of the
great disadvantages of refined life.  To the
delicate well bred woman, it is always attend-
ed with danger ;  and the diseases  which im-
mediately follow, even a fortunate delivery,
are often fatal.   The rude  conditions are ex-
empted from all  these.   The nervous system
rendered strong and resisting, surmounts the
various  changes and evolutions of the  birth,
and subsequent lactation, without being much
harassed or weakened in the struggle.   Boun-
tiful  nature unfettered in her operations, and
left to herself,  easily  accomplishes her pur-
pose.  The  robust rustick therefore attends
her husband in the field in a few days ;  while
the genteel  lady  is  stretched on  her  couch,
often a  prey to  some nervous affection, but
always slow in convalescence. 
                    33

   Again,  the wives of the countryman and
savage seldom  fail in being mothers of a nu-
merous offspring.   But sterility, or  what is
next to it, premature birth, are common evils
in towns and cities.  Ninety-nine cases of a-
bortion, out of the hundred, may be imputed
to a relaxed nervous frame ;  either from here-
ditary  debility, an  improper education  in
childhood, or other causes that are known to
weaken the nervous system.   Does  not every
woman known how quickly flights and alarms
bring on  miscarriages ?  In a vigorous consti-
tution, accompanied with a  healthful set  of
nerves, such  causes can  do no harm ; but
where the sensibility trembles at every breath,
the state  of pregnancy  is attended with con*
stant terrour and dread% 
               CHAPTER II.

The Medical description of the  inhabitants  of a
   town or city ; being an analysis of society.

        IN order to bring detached facts into
 a general view, I shall  divide  the inhabitants
 of a large town  into the following classes, and
 give a concise history of each, so far as it may
 be necessary to shew how business, customs,.
 and manners, influence health.
 Class 1.  Literary men.
      2.  Men of business.
      3.  The idle and dissipated.
      4.  The artificer and manufacturer.
      5. Those  employed in drudgery.
      6. Persons returned from the colonies.
      7. The female sex ;• consisting of the
          higher, middling, and lower orders
          of women.
   1.  Literary  Men.—The philosopher and
man of letters,  who devote most of their  time
to study,  must  lead a  sedentary life.   The 
35
person who thinks and  reflects much, must
retire ; and retirement necessarily abstracts
from exercise and amusement.  To be shut
up in a close room, little exposed to a free and
pure air out of doors,  soon induces a sallow-
ness of countenance ; and as want of exercise
accompanies this  confinement, the muscular
power is  diminished,  the  fleshy parts grow
soft and flabby, and  general debility  is the
consequence.   Few men attached to literary
pursuits are active, strong and athletick :  as if
study was incompatible with bodily exertion,
-the  gesture of a thoughtful man is always so-
lemn ; and his pace and  motions are  measu-
red and uniform when he walks abroad.  The
posture of the body in a studious man at his
desk, is  unfavourable to health.  The lungs
are  seldom expanded by full inspiration ; and
while the bronchial cells are not duly stimulated
by the powerful influx of an oxygenized atmos-
phere, the whole pulmonary organs lose their
vigour, and the blood that floridity which is ne-
cessary for vital energy & agio vvingcomplexion.
All  the secretions, and their excretories, fall
into inaction from want of muscular motion.
By little recreation, and no change of objects 
3G
to relieve  the attention, the whole  nervous
system sinks into  listlessness and inactivity*
The  mind itself,  by  pursuing one  train  of
thought, and pouring  too  long over the same
subject,  becomes  torpid to external agents ;
and  an undue  mental exertion seems to sub-
tract from the body much of that  stimulation
which is required  for many operations in the
animal economy, particularly what belongs  to
emotion and  passion.  The  powers of diges-
tion,  with  all  the  viscera  subservient   to
them,  partake in a particular  manner of this
derangement, and grow unequal to their office.
The debility  and inactivity which take place
in the  chylopoeitick organs, react  on the ner-
vous part of the frame ; and the  faculties of
intellect, as  sympathizing in a great degree
with all these highly sensible bowels, arc in-
fluenced by the general disorder.  Hence the
numerous instances of dyspepsia, hypochon-
driasis, and melancholia, in the literary cha-
racter.
   But it is to be supposed, that all men who
possess genius, and those ment;d qualifications
which  prompt them to literary attainments and
pursuits, arc endued by nature with more than 
37
tisnal sensibility of  nervous  system.   And
there are moral causes to  which they are exi-
sed beyond others,  that  may have  a large
share in the production of their indispositions.
The man who studies and writes for his bread
often depends  on a  precarious subsistance ;
sometimes the cold charity  of  an insolent
bookseller: a mind of  fine feeling, under the
pressure of  these  circumstances,  must  fre-
quently undergo the most poignant sufferings.
Such seem to be the chief causes which  give a
decided character to the predisposition  &  dis-
eases of literary men.  To this class properly
beloiig  all the learned professions ;  and all
those who cultivate  the fine arts, either for a
livelihood or amusement.
    2. Men of business.—The  subjects of  this
class are very numerous in all  our great towns.
It includes all  those engaged in trade :  many
of them, no doubt, have  much active bodily
exercise ; but that part of them  confined to
the counting-house and shop,  cannot be said
to enjoy the advantages of  air and activity, as
requisite for  vigour of body.  The posture of
leaning over  a desk, contrancts the motion of
the  lungs, and impedes the  functions of the
                     D 
               1
                    38

stomach.   These persons are commonly pale
and sallow, soft fibred, and of a slender make.
Not a few of them behind the counter, ap-
proach in external  form towards the female
constitution j  and they seem to borrow from
their fair customers an effeminacy of manners,
and a smallness of voice, that sometimes make
their  sex doubtful.   Such degeneracies in
corporeal structure, cannot fail of engendering
a predisposition to  diseases of the nervous
kind.   It  is  surprising to see and hear  with
what address  and loquacity some of these little
beings in London  set  off their wares ; as if
there were a necessity for a vender of si^k and
muslins to be soft as the commodity he deals
in.   You will*perceive them to wheedle the
buyers of goods out of their money, by a kind
of fascination.  Yet it  has often been matter
of wonder  to me, how a lady of spirit can lis-
ten to the prattle  of these manikins without
disgust; more especially when it is consider-
ed that they  have  supplanted the  sex, in an
employment  which is  their birth-right,  and
are devouring that bread which  belongs to
thousands  of poor  women, who  are thereby
consigned  to a life of drudgery, if not of
wretchedness. 
39
   But the mar; of business, in this  commer-
cial age, is not always to be estimated a cor-
rect  liver :  luxury follows  hard upon gain*
However punctually  the  ledger may be kept
in the fore part  of the  day, the tavern too
often has its share of the evening.   The per-
son who has any thing to sell, very naturally
praises the quality of his goods ; and as he has
daily to dispose of the  like assortment, he
soon acquires a kind  of  phraseology and  elo-
quence in  making a bargain.  This sort of
conversation is always enlivened by something
to drink  ; the  vender knows well how liquor
dilates the  heart, so  that if he  can persuade
his customer to drink a bottle of wine, he is
almost sure of getting his price . This is what
makes the trading towns so full of taverns :
hence those frequent instances of nervous and
bilious  complaints which follow habitual ine-
briation, to be daily met with in medical prac-
tice.
    Mankind when in pursuit of money, do not
give themselves much trouble about  intellec-
tual attainments.  The man of business, how-
ever fortunate he may have been in the  acqui-
sition  of wealth,  is therefore little fitted to 
40
enjoy retirement ? for riches do not bring con-
tent.  When he comes to retire, he  is  of all
men the least satisfied ;  for his  easy  circum-
stances  become the root of all his evils j  and
from having no longer any motive for  action,
he falls  a certain prey to low  spirits.   These
are the persons in this age, when riches are so
generally diffused, that  makeup the bulk of
hypochondriacks in this  country.  So certain
it is, that happiness in this state of being,  ra-
ther consists  in the  pursuit,  than in the pos=*
session of our object.
    All those employed in the public offices of
government,   and in the houses of  trading
companies and banks, come within this class :
they are all  distinguished by a sedentary  me-
thod of life within doors ; and when they pass
the middle age, are often troubled with indi-
gestion and low spirits.
    3. The idle and dissipated.—This is also  a
numerous class in every great town.  These
persons are the subjects of diseases which ori-
ginate chiefly from excess and debauch ;  and
not unfrequently  spectacles   of  misery  the
most humiliating to human nature.   Such dis-
orders appear especially in the prime of life ; 
41
often in early youth ; and if they are not fatal
before  forty, they  introduce premature senili-
ty, decrepitude  and fatuity.  A  large city or
town may be  truly called a hot-bed  for the
passions ; all the vices that more particularly
enervate the constitution  and injure health,
can  be there practised long without suspicion
or restraint, and indulged to the utmost: thus
the young and inexperienced are quickly ini-
tiated  into every fashionable folly,  and a vor-
tex  of dissipation.   The  sexual  appetite  is
prematurely excited by the numerous hordes
of  unfortunate  women that are permitted to
range the streets..   The powers of procreation
are  thus weakened beyond  recovery, before
the  body has  acquired its. full stability and
growth j. and the vigour of constitution as well
as the  faculties of mind are shook  to the very
centre.  When such  debilitated beings have
progeny, the sins of the father are  visited up-
on the children, and they appear a race of in-
valids  from- their birth..
    But  as  there  is  a disease  the peculiar
scourge of unlawful embraces, so its effects on
health  are  equally disgusting  and  dangerous.
The inconsiderate young  man who contracts
                      d2 
42
this complaint,  from delicacy often conceals
his misfortune till it  has gained a  degree of
virulence not to be described.   This distress
is frequently aggravated by mental sensibility }
and families and connections are at once in-
volved in general calamity.   In the advanced
stage, hideous  '   rroity of body is often the
consequence ; bv  in all the gradations of this
infection, a long and rigorous course of  mer-
cury is the only remedy to be depended on.—
Mercury, rendered  anti-venereal  and poiso-
nous by oxydation with the different acids, is
considered a certain cure for syphilis ; but its
exhibition  is sometimes  fatal  to the  consti-
tution,  and  constantly  leaves behind  it a
weakened frame of nerves, and a disposition
of stomach  and bowels liable to spasmodick
affections.
   All full  livers and  drunkards come within
this class.  Frequent surfeits from  high-sea-
soned food ;  and frequent intoxication  from
vinous or spiritous potations, commit dreadful
ravages on the human body and mind.  It is
a misfortune in polished society, that many
indulge  in  these  excesses  without thinking
they are doing wrong;  and often sink into the 
43
grave by diseases of their own creating, with-
out being  warned of their misconduct.  The
disgusting propensity to luxurious eating for-
tunately is seldom the case with the fair sex ;
but where it happens, a train of nervous and
bilious complaints  are more certainly the con-
sequence.   To  devour  a large  quantity  of
food is only a bad habit;  most  persons could
be nourished with h\^'^hat they feed on ;  so
that not only temperance  as to quality, but ab*
stemiousness as  to quantity, is  one of the gol-
den rules  of health.
    4.  The artificer and  manufacturer.—The
numbers  of this class are  daily increasing j
the  natural effect  of  the  vast commercial
wealth of the united kingdoms. The artisan
and  manufacturer arc  not  confined  to  the
town ; for almost every village throughout the
country possesses some  branch of manufac-
ture.  Here again all the effects of a sedentary
life appear, the  uneasy  posture and unwhole-
some air.   But  many species of manufacture
are unhealthful  from  noxious metalick fumes
to which  the Workmen are exposed,  such fc9
those of mercury, lead, copper, &c.  The ex-
hausting heats of furnaces, smelting houses) 
44
 laboratories, ovens, boilers, Sec.  in  different
 kinds of  employments, have their diseases ;
 but the most noxious are those which  fix on
 the nervous system. Those trades also where
 the articles  wrought  give  out  considerable
 quantities of unrespira'de gases, from the de-
 composition of animal  and vegetable matter,
 are  insalubrious ;  the  workmen  commonly
 look pale, sallow, and dejected.
    Such persons as are exposed to the heat of
 large fires in their labour, and undergo sudden
 changes of temperature,  cannot fail of  being
 soon  exhausted in  constitution.   As far as I
 have obtained information, it does not appear
 they live  long.   Their profuse perspirations,
 induced by hard work, as well  as  by  great
heats, give most of them a propensity to drink-
ing.  Were they always to quench their thirst
by water only, the excessive labour might be
borne  for a length of time ;  but the strongest
malt liquors, often mixed  with spirits, are the
common drinks of men employed near fires..
    I  do not find that the pitmen in the coal
mines of this district aie liable to any particu-
lar diseases ; when temperate in drinking, they
commonly live to a  great age.. 
43
   5. Those employed in drudgery—This class
is composed of both sexes ;  they grow strong
and broad shouldered  from labour, provided
it is chiefly out of doors.  But in this class we
often observe many addicted to drunkenness ;
and I much doubt  if their  work  is ever  so
severe as to  injure health, when they are re*
gular livers.-
   It may hov/ever be considered a9*a factr
substantiated  by the daily experience of phy-
sicians, that all the diseases which are caused
by hard labor, poverty, and want, are much
easier of cure, than those which arise from in-
dolence, luxury, and debauch.   A  constitu-
tion  that has been weakened by subtraction of
nourishment, may soon have  its energies re-
stored by suitable  regimen, diet,  and  medi-
cine : but the  frame that has  been wasted of
its vital powers by excessive stimuli and de-
bilitating pleasures, has seldom or never been
brought to its former strength.
   6. Persons returned from the colonies.—-It
is very common in the  present times, for men
brought up  to business, to spend a number of
years in the colonies, till they are  able  to re-
turn with fortunes.   They  may therefore be 
46
considered as a distinct class  in this enquiry..
These  persons  bring  with  them indelible
marks of the effect of the  climates they have
lived in : dyspeptick complaints,  and all their
nervous accompaniments, are the never-failing
diseases of this enervated people.  The tropi-
cal heat, and luxurious  modes of living, are
chiefly to be blamed in the production of such
bilious and nervous ailments ; and they have
usually taken so deep a root in the constitu-
tion,  that they are rather aggravated than re-
lieved by our variable atmosphere.   The fog-
gy weather, and fickle temperature of Britain,
keep the feeble nerves of these relaxed frames
in a state of constant irritation.
   The diseases of tropical climates, but par-
ticularly the fevers of some countries, weaken
the nervous  system,  produce great mobility,
and  a disposition to spasmodick complaints.
Hence the chylopoeitick viscera become the
r.eat  of so many  painful affections ; and'th'j
word bilious  has  grown  a  theme of constant
conversation in England, as well as in the co-
lonies.
   7. The female  sex.—Nature  has endued
the female constitution  with greater delicay 
47
 and sensibility than the male, as destined for a
 different occupation in life.   But fashionable
 manners have shamefully mistaken  the pur-
 poses of nature ; and the modern system of
 education, for the fair sex,  has been to refine
 on this tenderness of frame, and to  induce a
 debility of body, from the cradle upwards, so
 as to make feeble  woman rather a subject  for
 medical disquisition, than the  healthful com-
 panion of our cares.   The  medical literature
 of the present day, affords abundant, but me-
 lancholy proofs of the justness  of this remark.
 Their whole tenor of living, and domestic eco-
 nomy, are at variance with health.   The  fe-
 male infant  before she can well crawl along
 the floor, is taught some employment that will
-encourage her to sit,  to stoop, or to walk two-
 fold.   That it should be rude for an innocent
 young girl to run about  with  h:jr brother, to
 partake of his sports, and to exercise herself
 with equal freedom, is a maxim  only worthy
of  some insipid gossip, who has the emolu-
ment of the  family physician and apothecary
solely in view.  A man of fortune and wealth,
when he builds a stable or a dog-kennel for his
horses or hounds, takes care that these compa- 
48
titons  of his field-sports shall He duly preser-
ved sound in wind and limb, by frequent exer-
cise out of doors, when he does not hunt.—
But in no part of his premises do  you see a
gymnasium for his children.   It the inge-
nious arts are chiefly to be valued as they in*
crease the sum of human happiness, we thus
make it  a misfortune by having a house over
our heads, though it may shelter us  from the
frost, the tempest and the rain ; for it too ok
ten becomes the  means of  depriving us of
health, when it prevents exercise and excludes
pure  air.   But we indulge our boys to yoke
their go-cart9, and to ride on long rods, while
little miss must have her more delicate limbs
crampt by sitting the  whole day dressing a
doll.   Ancient custom has been pleaded in fa-
vour of these amusements for boys, as we read
in Horace :  Vut it is no where recorded, that
the infancy  of  Portia, Arria, and Agrippina
was spent in fitting clothes  for a  joint-baby.
    All female employments that are  perform-
ed  in the sitting posture, injure health ; and
are hurtful  in  proportion to the early age  in
which  they are  begun.   Few of the sex are
entirely free from this habit. 
49
   Women of very moderate fortune, and the
•wives and daughters of all reputable trades-
men,  in this country, maybe said to indulge
in most of the follies of their superiors.  They
can have their hot close rooms, drink strong
hyson, and keep late hours, as well as a dutch-
ess.   The female constitution, therefore, fur-
nished by nature with  peculiar delicacy and
feeling, soft in its muscular fibre, and easily
acted upon  by stimuli,  has all its native ten-
derness increased by  artificial  refinements.
Hence the diseases of which we now treat, are
in a manner the  inheritance of the fair sex ;
when to these we superadd all the preposte-
rous customs of fashionable life, need we won-
der at the numerous instances of bad health
and feeble existence so often to be met  with
among them ?
    One of the curses which was pronounced
against some of the Jewish mothers,  is unfor-
tunately realized among many of our fair coun-
try women.—u The tender and  delicate wo-
" man among you, which would not venture
" to set the sole of her foot upon the ground,
" for  delicateness and tenderness,  her eye
" shall be evil towards the husband of her
                     E 
50
 <l bosom, and towards  her son, and towards
 " her daughter."*
    No text in scripture, or any other book,
 ever conveyed a more just censure on the in-
-discreet conduct of a parent to the offspring.
 From having injured her  own frame, by re-
 finements in living, the mother thus sows the
 seeds  of disease in  the constitutions of  her
 children : hence a weak body, delicate nerves,
 and their  consequences, a sickly existence,
 become hereditary.   Such may be here called
 a fair interpretation of those emphatick  ex-
 pressions : " Her eye shall be evil towards the
 " husband of her bosom, and towards her son,)
 " and towards her daughter .'"
* Deuteronomy, chap, xxxviii, v. 56. 
51
             CHAPTER III.

   Remote causes of nervous diseases, &?c.

        THE remote causes of nervous dis-
eases are chiefly to be  sought in populous
towns ;  and increase in proportion to the  de-
viation  from simplicity of living.   The state
of civilized mankind is thus exposed to causes
of bad  health, which have no  power among
rude nations,  viz. in
        1. Air.
        2. Exercise.
        3. Food.
        4. Cloathing.
        5. Passions of the mind.
        6. Intense  study.
        7. Lactation.
        8. Miscarriages   a£d   premature  la*
            hours,  &c.
        9. Climate.
      10. Medicine.
   1. Air.—A pure atmosphere is of the first
importance to sustain animal life in full health 
52
and perfection.  Mankind in the earliest ages
of  the world must have soon learned this.—
Although they had no knowledge ofeither the
chemical qualities or the mechanical  proper-
ties of common air, some particular deviation
from  the usual standard, was  reckoned the
chief cause of epiden.ick fevers.  The senses
in a great measure were the best tests of a
tainted  atmosphere, especially that of smcil :
and where large collections of animal and ve-
getable  filth  were found in a state of  corrup-
tion, offensive effluvia would be  quickly detec-
ted, and would  be avoided.   But a more cor-
rect method of judging of the  medium in
which we breathe is now obtained from che-
mical philosophy  ;  for independent  of any
noxious substance which may "impregnate the
atmosphere, as arising from the decomposition
of animal or vegetable matter, or other sour-
ces, it is liable to  become  noxious to life, by
whatever means tile oxygen or respirable por-
tion is destroyed, lessened, or  abstracted.—
Such is  the case wnen a number  of persons are
confined in  a small  place ;  or where  large
fires are kept, and  the doors  and windows
made too close.  It is thus the city or popu- 
53
lous town is rendered less salubrious than the
country.   Narrow lanes, high buildings and
houses, filthy kennels, small apartments, huge
warehouses,  manufacturing   establishments,
cellars under ground, consumption of fuel, and
a  large  population,  are  so many  sources
whence the air is contaminated.   The  sun-
shine scarcely beams on any window  of a
house in  town : the ventilation of the upper
parts of  the  building  is imperfect; but the
lower  stories, particularly   what  is under
ground, can receive no pure portion  at all.—
The business of the whole inhabitants almost
confines them within  doors ;  so that the very
complexion and countenance discover a citi-
zen.  It  is familiar to people bred  in great
towns to remark, how imperfectly all the  trees
and shrubs grow in their little gardens.  No-
thing but the foul atmosphere is to be blamed
for this ;  for the richest soil cannot correct or
prevent such  rickety productions.   Animal
growth labours under the same disadvantages
as the vegetable tribe.   A deficiency of colour,
in old times,  suggested to  physicians the pre-
dominance of some humour in the body :  and
from this  cause particular names of tempera-
                     E2 
54
ment were assigned to different people.   But
we now impute a delicate look, Sc a pale face,
to confinement with indoors, &  to breathing an
impure air.-  That  portion of the atmosphere
which tinges the skin  with a lively hue, and
the blood with a florid colour, is known to be
oxygen.  Yet so unnatural and perverted are
fashionable opinions  on  this subject,  that a
blooming complexion is  thought to  indicate
low life and vulgarity  in  breeding.  What a
depraved mode of thinking !   What a false
standard for beauty ; to prefer a sickly sallow
hue of the countenance to the roses of health!
And yet. seek  to  imitate them by  artificial
means.   This wan and pallid  complexion, or
negation of colour, is always an indication of
debility, and usually accompanies bad health,
from whatever  cause, but  chiefly imperfect
action of the  digestive powers.   The  func-
tions of respiration and digestion  have there-
fore some dependence on one another.   Some
persons give the name of bilious to these  sal-
low looks  : but they  certainly often appear
 where  there is no suffusion of bile ;  and in
 this stage  are to be imputed to deficient oxy-
 genizement of the  blood. 
55
   But it is the known effect of the oxygenoua;
principle of the atmosphere, when duly inhaU
ed from a current breeze, not only, to saturate
the blood with floridity, but to exhilirate tha
spirits in a high  degree ; invigorate and red*
den  the muscular  fibre j  bestow energy oa
every nerve, and call forth at once mental and
corporeal strength..  Most persons must have
taken notice of that langour, drowsiness, and
dislike  to motion,, which are  felt in a close,
warm,  and  crowded  room.  Instances  have
come within  our own observation, where the
candles seemed  scarcely to burn, and where
half of the company was yawning at the other,
without knowing the cause.  Should any phi-
losopher,, who might  pity the  somnolency of
the party, attempt to open a  sash by way of
correcting the air,  his politeness would be apt
to give offence.  What effect the popular lec-
tures of Mr. Davy, and those delivered in pro-
vincial  towns, may have on such assemblies,
time only can shew.   A modern  rout is cer-
tainly one  of the  completest  examples of a
warm crowded  house.   The good lady, who
entertains for the evening, commonly thinks
herself honoured in proportion to the  number 
56
 of visitors;  and  the  guests  find  themselves^
 supplied  with every elegance, except a pure,
 cool zephyr.   The warm  full theatre, or dan-
 cing  assembly, if not duly perflated, like  the
 rout, are  so many marts of bad health.*  Im-
 pure  air  saps the  constitution by slow  ap-
 proaches  ; but no miner  more certainly car-
 ries his point at last.   I hope Mr, Davyt is
 duly attended by all those matrons  who keep
 boarding  schools for young ladies, in and near
 London.
    One of the great misfortunes which some
 species of manufacture have brought on this
 country,  is the  employment of children,  be-
 fore the  body has attained  its  full growth.
 During infancy and childhood, and till the  hu-
 man frame has  acquired its full  stature, it
 would appear, that  more pure air is required

   •Persons who are fond of frequenting those un-
wholesome  crowds ought to be informed, that nothing
is so indelicate as to breathe respired air. To drink of
the same cup,  is the height of politeness, compared
with this custom.
   f Lecturer on Chemistry, at the New Institution,
and highly celebrated for his  discoveries in  the sci--
ence* 
57
 for the purposes -of health than at a remoter
 period of life.   The heart of  the  child much
 surpasses that of the adult in the frequency of
 its pulsations ;  and every  movement of  the
 body  is more constant and quicker, so that it
 seems to be  never at rest, but during sleep.
 Hence the  greater expenditure of vital air.
 The child who is early employed in a woollen
 or cotton manufactory, is to the village plough-
 boy, what the town lady is to the country girl.
 They  are both  examples  of nature's precepts
 being  disobeyed :  for to be  stewed  in foul
 air,  is the  same in effect, wherever  it hap-
 pens.
    A  warm  unventilated nursery is  a nui-
 sance  of the  first  magnitude.  Nurses and
 servants have too often  the sole  superinten-
 dance  of these  apartments : fashionable mo-
 thers at  least, as some may be justly called,
 seldom visit nurseries.  Bad health, particu-
 larly among the  delicate children, is too often.
 brought  on  by a close sleeping place.   It is
 only when the weather is  extremely cold, that
 a  fire  should  be permitted in those apart-
 ments  ; for during the sleeping state, the body
is not  sensible of the deficient  purity of  air ; 
58
and  it may be subtracted altogether, without
any struggle being observed, and  without the
body being waked.   It is thus infants are so
easily  suffocated or overlaid :  as the air be-
comes more  impure the stupor increases, till
respiration stops;  and the child  is always
found in the sleeping posture.*   Sleep is not
only the  image of death, but it seems  a step
towards it.
    The modern practice of confining children
to slep in  a crib,  till  they are three or four
years of age,  is highly commendable ;  it has
thus all the advantages of the breast to  put it


   * In 1801, while I resided at Plymouth Dock, a
house adjoining took, fire,  in an upper  apartment of
which, that had no chimney, a poor woman with eight
children perished. They were all found in bed, in the
sleeping posture; and had been suffocated, from the
Same surrounding the room,  and exhausting  the air,
for no part of them was scorched.  During the alarm
no person thought of this poor  family, otherwise the
whole of them mi^M have been easily rescued, for on-
ly a portion of the premises was consumed. It is pro-
bable that none of them waked, as their cries would
have been heard, the house being only of two  low sto-
 ries, and this garret room. 
                     59

to sleep, and is in no danger of being overlaid.
The size of the bed afterwards should still be
proportioned to the child ; and they should
never be permitted  to lie with a grown person.
The convulsions of infants, which are purely
a nervous affection,  we  know  to be  often
brought on by want of ventilation ;  and we
naturally expose them at a window for reco-
very, as we do with a lady fainting in a crowd-
 ed room.
    A few  years ago, the  numerous deaths
 which  happened  in a foundling hospital in
 Dublin, made a great noise  in this country.
 On inquiry,  it was found that foul air had the
 chief share  in  this   uncommon mortality.
 Some hospitals in  Paris, about the same time,
 were scenes of  the like tiestruction to  infant
 life.  Now children who survive  these nurse-
 ries and hospitals, or dungeons as they  may
 be called,  are so stinted in their health,  that
 they are  unfit  for every occupation that re-
 quires strength ; and should  they have fami-
 lies, hereditary debility and deformity are the
 lot of the offspring.   Of such vast importance
  is pure atmospherick air to  the  growth and
  health of the human body. 
€0
    2. Exercise.—This assistant of health can-
not well be said  to  form a part of the recrea-
tions or amusements of a great town.   The
inhabitants have neither been taught to wish
for it, nor how to enjoy it.  A formal walk
before dinner, to oall on  a fewHfriends,  or to
make some purchases at a  shop, bound the
travels and excursions of thousands of women
in London and other populous cities.   If the
streets are disagreeable to walk, or should the
least fatigue he felt, the remainder of the jour-
ney is performed in a coach.  The  male part
of the community  do not much avail  them-
selves  of greater  advantages.   Can  a few
strides  to  the  office  or counting-house be
deemed exercise ?   Or, can a lounge in Bond-
street be  considered as  a parade for mascu-
line  health ?   The whole business of a town-
life is  transacted within doors  ; scarcely a
house in London has  an area attached  to it
sufficient for the sports  of a child, where it
may stretch  its  limbs, and  ramble  about.—
Where there is  no  space out of  doors appro-
priated  for  the  play  and diversions of chil-
dren, such as running, leaping, and  wrestling,
a manly vigor of body  can never be acquired. 
61
The stature may, no doubt, attain its common
height; but can there be firmness of muscle,
or energy  of nerve, in such a frame ?  Like
the plant that is reared in a hot  house, it may
grow tall and  look fair,  but  the  first gale  of
wind lays  it low.  The city child like the
dwarf, being  denied the free  motion of its
limbs, is secluded  from play-mates of its own
age, and soon  imitates the manners of its se-
niors.   It thus insensibly acquires a volubility
of tongue, and fluency of speech, that appear
like premature talent of mind.  But this early
show of intellect is not stable in its growth j
and such a youth seems to learn nothing after
fourteen.   But  the child  educated in the
country, who  has no bounds set  to his walks
and sports, is indifferent to  study  and all men-
tal  acquirements :   his great flow  of spirits
gives him constant amusement, and his good
health keeps his limbs in continual motion.—
The body  having  thus copied the dictates  of
nature to its full growth, will be better prepa-
red by the  soundness of  its texture for  those
intellectual recreations,  of  either elegance or
utility, that are to be the future employment
of life.   The  town and  the  country in this
                     F 
62
 respect may be said to exchange commodities,
 The youth  bred in the village will  have the
 best chance  for sound health and pure morals,
 and will find the city the  best mart  for these
 virtues.   But as a vigorous  corporeal struc-
 ture, as well as intellectual excellence,  cannot
 remain long in  the town without degeneracy,
 perhaps  not more than three  generations ; so
 if these endowments are to  be  preserved in
 the same family, they are  only to be recruited
 by resuming the habits  and amusements of a
 country life,
    Broad shoulders, a full chest, and muscu*
 lar limbs, are concomitants of exercise and la*
 bour ;  they  mark what is called the brawny
form.   The limb or muscle that is often exer-
 cised and put in motion, expands from the in-
 flux of blood that is thereby directed to its
 vessels ; which  increased influx of blood dis-
 tends  the arteries and veins;   supplies the
 fleshy  parts with a larger proportion  of nutri*
 ment,  and ultimately adds bulk, firmness and
 strength to the moving fibre.  During active
 muscular exercise there is a great expenditure
 of the fluids : the more aqueous  and volatile
 are thrown off or exhaled, by  sweat and insen. 
63
sible perspiration ; while an increase of appe-
tite to supply the wasted juices, is a necessary
effect of this expenditure.  The organs of di-
gestion also  gain new  vigour,  and perform
their office with more facility and expedition :
the food assimilates  more readily with the o-
ther secretions, and  is propelled with greater
rapidity along the intestinal tube.
   By competent exercise, the blood that re-
turns to the heart from the extremities, is duly
liberated of certain parts intended to be thrown
off; and acquires in the lungs fresh qualities
from the inspired atmosphere.   It is probable
this  function of the pulmonary organs could
not go on in a manner consistent with health,
without some  degree of agitation, such as we
observe during the increased motion of the
chest.   It  is thus exercise out of  doors, bes-
tows on the countenance the animated bloom
of health.   The mental faculties receive alike
degree of energy from  active bodily motion ;
it shifts the train of thought from one object
to another, forces new  impressions on sensa-
tion, and a change of ideas is the consequence.
    All the  nations of antiquity of which we
read, who trusted to the art of  war for safety, 
64
found it expedient to train their  youth to har-
dy  and active  exercises, for the purpose  of
making them soldiers.  The Olympic games,
Gymnasium, Pahestra, Campus Martius, Cir-
cus and Arena, were  so many places appro-
priated to the diversions and shows of chariot-
racing, horse-racing,  running, wrestling, fen-
cing, throwing the coit, &c.  Without stated
exhibitions of this sort the inhabitants of large
cities could not be well inured  to  bodily fa-
tigue,  or become athletick.   It was also ne-
cessary to  keep  up  emulation among young
men, and to grant marks of distinction to those
who excelled in these achievements.  Xeno-
phon in  drawing the  character  of  a finished
general, lays great stress on the pains taken by
his hero to  detach his officers on hunting par-
ties, that they might learn to bear thirst, hun-
ger, inclement  weather and danger.*  He
must know little  of military life, who would
trust  the defence of a country to a sedentary
people.  All the  qualifications of a soldier are
wanting among such persons.  What drilling
or  training could ever fit such men to sleep
Cyroprojia, 
65
with impunity on  the wet turf, to bear cold,
fatigue, and  all the privations peculiar to ac-
tual war ?
   Dr.  Gillies in his animated description  of
the Olympick games and Gymnastick exer-
cises of the Greeks, says, " Bodily strength &
"  agility were accompanied by health and vi-
14  gour   of  constitution.   Their  athletick
"  hardiness bore  without  inconvenience, the
*'  vicissitudes of cold and heat.   Even in the
u  scorching  heat of July,  (for  that was the
"  season of the Olympick games) they receiv-
"  ed  bare  headed the direct  rays of the sun.
M  And  the firm organization acquired by per-
"  petual exercise,  counteracted that fatal pro-
"  pensity to vicious indulgence, too natural to
"  their  voluptuous climate, & produced those
"  inimitable models of  strength and  beauty,
"  which are so deservedly admired in the pre-
"  ciou3 remains of Grecian statuary.   There
**  is a courage depending on nerves and blood,
"  which was  improved  to the highest pitch a-
"  mong the Greeks."*


        * History of Greece, chap, vk 
66
   If therefore  exercise tends so powerfully
to strengthen the  body and exalt the courage,
how fatal to health must be the total privation
of it.   And if there is one disease more than
another that is induced by indolence, by sloth,
and want of active motion, it is  that train of
nervous weaknesses,  which puts on the form
of every other complaint, and becomes one
of the greatest stings to human happiness.
   3. Food.—Luxurious living, joined to o-
ther causes, has a manifest tendency to induce
nervous  and  bilious derangement.  When a
large  quantity of rich food  is  consumed,
heightened  to  the palate by  all  the  arts of
cookery, more than nature  demands must be
taken down.  A variety of dishes also invites
to inordinate appetite and gluttony.   The  or-
gans  of digestion are thus  oppressed  and
weakened by the surplus ; the liver in particu-
lar  is enlarged  in its volume : the blood is
charged with a richer quality, and  every ves-
sel and gland stimulated to excess.   The ner-
vous  system is  also  preternaturally  excited,
and grows  highly susceptible of stimulus, and
easily affected in mind by pleasurable sensa-
tion.   If a life of indolence is led under luxu- 
                    6?

riant diet, joined to the liberal use of ferment*
ed liquors,  together  they  form  that  habit
which  constitutes  the voluptuary.   It is cha-
racterised by  a florid complexion, sparkling
eyes, an  unmeaning simper, softness of flesh,
and fullness of blood, rather than obesity.—
The mind is light, indolent, and indifferent to
every  thing but pleasure.  A  person of this
description  is perpetually in pursuit of some
selfish indulgence  ; courts the acquaintance of
all who keep good tables ; flatters  the weak
part of the  sisterhood, but shuns  the society
of sensible women ; and calls philosophers in-
sipid companions, and disturbers of a party.
Such a man is remarkable for a great flow of
snirits, at  the convivial board : but his round
of delights is not lasting.   He that laughs and
drinks with  every -one,  grows sad  in time ;
and early decrepitude, and nervous debility,
are  his  certain portion.   As  his youth was
remarkable for good health and levity of dis-
position, so his age is tortured by low spirits
and paralitick weakness.
    There are some persons of the nervous
 temperament, that are much addicted to high
 seasoned food, which I call luxurious  living. 
66
 This custom is often fir6t acquired by indulg-
 ing in the use  of hot articles, with a view to
 obviate flatulence, and other dyspeptick feel-
 ings ; but insensibly gains ground, and by re-
 petition it is  confirmed  into habit ;  and the
 excitability  or vital power of the stomach, is
 speedily exhausted and worn out.   Such per-
 sons commonly die of apoplexy, after a vora-
 cious repast, or linger a while under incurable
 palsies of  the limbs and other organs, and
 idiotism*
   Where persons, after a course of high liv-
 ing, are compelled to feed on a less generous
 diet, we often  meet with painful stomach com-
plaints,  and low spirits.   In these cases, the
organs of digestion seem to be so much weak-
ened by the previous excess, that poor  fare is
unable to  stimulate them  to healthful action.
Under  such  circumstances  men  are  apt  to
seek  relief from  spiritous  liquors,  which
quickly terminate existence, by aggravating
all their complaints*
   The use of tea in this country, as an arti-
 cle of diet, comes under this head.   The con-
sumption  of the  Chinese plant is enormous
throughout the united kingdoms: it is a beve- 
                     69

 rage  well suited to the  taste of an  indolenj
 and voluptuous age.   To the glutton it affords
 a grateful diluent after a voracious dinner ;—
 and from being drunk warm, it gives a sooth-
 ing stimulus to the stomach of the drunkard.
 But however agreeable may be its immediate
 flavour,  the ultimate effects are debility and
 nervous diseases.  There may be  conditions
 of  health indeed where  tea can do no harm,
 such  as  in the strong  and athletick ;  but it is
 particularly hurtful to the female constitution j
 to all persons who possess the hereditary pre-
 disposition to  dyspepsia,  and all the  diseases
 with  which it is associated :  to gout, and to
 those who are naturally weak nerved.  If this
 observation is just, we may account for many
 taking it with  impunity,  and holding out the
 deleterious qualities  of tea as a medical chi-
 mera, conjured up to magnify the importance
of physick, and to frighten old women.  Fine
tea, where the narcotick quality seems to be
concentrated, when taken in a strong infusion,
by persons not accustomed to  it, excites nau-
sea and vomiting, tremors, cold sweats, verti-
go, dimness  of   sight,   and  confusion  of
thought.   In its more diluted state, sweeten- 
70
ed with sugar, and  softened by the judiciou*
mixture of bland cream, it is grateful to the
stomach, gives  a soothing  sensation as  if it
lulled pain, exhilirates the spirits,  produces
wakefulness, relieves fatigue ; and from being
taken down warm, promotes perspiration, and
acts powerfully by the kidneys.
   But I have known a number of men and
women  subject  to nervous complaints, who
could not use tea in any form, without feeling
a sudden increase of all their unpleasant symp-
toms, particularly acidity of stomach, vertigo^
and weakness of sight.  Though fond of tea
myself, I have  sometimes been obliged to
leave it off, by suspecting that it added to my
natural shortness of vision.
   As the use of this article in diet extends
among the lower orders of the community and
the labouring poor, it must do the more harm.
A man or woman  who has to  go through
much toil or hardship, has need of substantial
nourishment; but  that is not to be obtained
from an infusion of tea.   And if the humble
returns of their industry are expended on this
leaf, what remains for the purchase  of food
better adapted  to  labour ?   In this case tea 
n
comes  to  be hurtful,  not only  from its own
narcotick  quality,  but that  quality, will act
with double force in a body weakened from o-
ther causes.  This certainly is  one great rea-
son  for the  increased and increasing propor-
tion of nervous, bilious, spasmodick, and .sto-
mach complaints,  &c. appearing among the
lower ranks in life.   This fact has long been
confirmed to me in different countries, and a-
mong persons varying much in their employ-
ments.  I have lately met with many  severe
 and obstinate cases among poor tradesmen &
labourers, where-it was plain they originated
from this cause.  I also think that the use of
tea  often  paves  the  way to  habitual  dram
drinking  among this class  of  society,  more
than among the better orders.
     It is worthy of remark, that the finer the
 tea, it contains more of the pernicious quality j
 hence the greens  which  are gathered in the
bud, or before the leaves fully expand, have
with that colour the strongest flavour.   To sip
frequently of green tea, produces wakefulness
 and gaiety of spirits ;  hence some literary men
 who protract their studies to a  late hour, use
 strong tea, like  the late Dr. Johnson, to  keep 
72
them awake.   It also possesses an  emetick
quality, on which account it can seldom be ta-
ken in the quantity to induce sleep.   Dr. Cul-
len,  of Edinburgh,  who was subject to gout,
said, he  never could take  it without feeling
some arthritick affection of his stomach ; yet
many dyspeptick people find it highly agreea-
ble,  while others feel  immediate bad effects
from indulging in it.
   The nervous ailments of female constitu-
tions, which are often induced and aggravated
by tea-drinking, in advanced  age,  are apt to
terminate in palsy.   And from a concomitant
torpor of the absorbent system  of vessels, they
also  very frequently  terminate in  general
dropsy.  Coffee possesses the  narcotick prin- -
ciple ;  but in  a lesser degree than tea : the
same diseases follow its use, though its hurt-
ful quality is perhaps diminished by roasting.
How far the hot water taken with tea and cof-
fee,  increases  their deleterious effects on the
stomach and nerves, may  depend  on natural
temperament.   Some persons  are in the habit
of drinking them very wanr;, while others pre-
fer  them  at a lower temperature.   The best
degree I should think, about blood-heat. 
73
   A number of aromatick substances, which
include all the spices and peppers,  as well as
some other articles, are in  common  use as
condiments of diet.   It may be part  of natural
instinct, that food to be nourishing  and agree-
able, should be sapid.   Yet the infant at the
breast seeks no addition to his milky stream ;
and it is doubtful to me, if any of  the  warm
ingredients are  useful.   The tropical  savage
uses pepper with his vegetable meal, in great
quantity.   Now this kind of diet  is watery
and insipid.   Without  something savoury he
has no pleasure in eating it ;  and the stimulus
of seasoning  becomes  necessary.   But  the
European  who imitates this custom, with his
turtle and beef soup, while he is a resident in
the East or  West  Indies, errs egregiously
from the indications of nature.   All dyspep-
tick persons are fond of hot articles.  When I
hear them  call for Cayenne pepper at table, it
is  not difficult to find out their modes of li-
ving.   It is a key to the temperament, and fa-
cilitates the physician's enquiries.   But  plain
fare, such as all dvspepticks ought to feed on,
needs no aid of this kind : and I differ widely
from those medical authorities who inculcate
                     G 
74,
-the practice ;  the whole of them  manifestly
weaken the stomach.  All the spices owe their
warm pungency to a volatile oil: but as far as
T have correctly watched their  effect, instead
of promoting digestion, they evidently disturb
it.   They float on the surface of the food, and
irritate the cardia or upper orifice  of the sto-
mach, which has the immediate effect of in-
verting the motion of the muscular fibres, and
then the flatulence appears by rising upwards,
and producing eructation.   This  belching is
said to be  salutary,  though proved  to  be  a
symptom of  disease.   If  these  articles  are
ever admissible at all, it must be in advanced
life, when the vigour of the stomach and in-
testinal canal grow naturally torpid and slow.
Of themselves they yield nothing of the nou-
rishing principle.   Soy,  catchup,  and all the
warm sauces, increasing  daily  in number,
have the same pernicious effects.   But when
we hear of a dozen  of large bacon  hams being
melted down  into a few pint bottles of condi-
ments, that pamper and poison health, while
they destroy  what  would  have been  whole?
 some  food for numbers, it  is a moral evil of
 gteat magnitude, and ought to he prevented. 
is
   Ft is worthy of remark, that condiments of
every kind, from custom, become very desira^
Ble, till at  last no food is relished  without
them.  But it is rather  the palate than the
stomach to which they are  grateful.  Some
of the  peppers are caustick, and cannot fail of
injuring, if not corroding the coats of the first
passages.   Even mustard,  which  owes  its
warmth to a fixed thick oil, though one of the
mildest of the condiment kind, is capable in the
form of a sinapism, of vesicating the sole of the
foot, over which is spread  the thickest epider-
mis on the whole surface of the body.   Must
not such a substance be hurtful to the delicate
stomach ?  To mustard & pepper I have never
accustomed myself, from infancy  upwards ;
and I remain a proof of the truth of my own
doctrine,  few  persons  being  more  exempt
from  dyspepsia.    All these  articles  ought
therefore, to be  denied to children, which will
be one grand step to make them dislike  every
hot ingredient in  diet, when they grow up.
Should brandy,  or those waters which are im-
pregnated with  the  kernel flavour, be  mixed
with sauces of any kind,  it is evident they
must be  noxious.   They are dangerous  as be- 
                     re

 ing narcoticks the most enticing of all article
 applied to the taste ;  and  children that arc
 early accustomed to such  poisons, will run
 great hazard of ending their career as sots and
 dram drinkers.
    4. Chathing—In the present times, cloath-
 ing or dress  is to be  found in the extreme j
 either too much or too little.   It is a proof of
 the  declining vigour  of the  human  frame,
 when so many young men, in this age, are un-
 der the necessity of being swaddled in flannel.
 An enervated state of body can alone want this
 assistance.  But  many of the fair sex  have
 adopted a contrary  practice : a  few folds of
 fine muslin,  so loosely put on, that  the whole
 dress appears to be made for the purpose of
 being thrown aside in an instant,  like a cloak
 or a shawl.   Cloathing the body ought to be
 regulated  by the season :  but the  rule must
vary with  the age,  constitution, and habits of
life. There  is an intimate connection between
the stomach and the surface  of the body :  and
as the former is the chief seat of nervous af-
fections, what chills the  skin suddenly  is apt
to injure the bowels.   Eruptions on the sur-
face often  free the stomach from painful com- 
77
plaints ; and the repulsion brings them back.
This is often the case, where warm cloathing
has been hastily laid aside :  we observe this
sympathy particularly after  wet feet, a fact
which most delicate females know well.  The
lady of weak health, who may wish to display
a fine ancle, should be very guarded how she
throws off her warm socks.  Many evils befal
the  sex from cold feet ;  such as follow walk-
ing  abroad with thin shoes  in damp roads ;
sitting long inactive, as in churches and  thea-
tres, &c.  I have known some serious nervous
ailments brought  on by  a young lady eva-
ding the orders of a judicious parent;] and
after being dressed, retiring  privately to put
off the additional petticoat  and under stock-
ings, that she might'dance more lightly.  As
my plan is to make the female habit healthful
by active exercise  and pure  air, so I would
recommend in  addition  to these precautions,
the  use  of half-boots  which,  with a warm
spencer, will secure the  body, and enable the
lady  to  walk abroad in most  kinds of wea-
ther.
    A few years ago a practice prevailed much
among young women, of lacing their stays  so
                     G2 
78
tightly, as sometimes to impede the free mo-
tion of the ribs and  lungs.  I have known  in-
stances where young girls have nearly expired
in a crowded  room,  by  straight lacing, and
were only saved by the stays being suddenly
divided  by a penknife.  The modern elegant
improvements  of female dress very much cor-
rect this practice : but I doubt much of tight
lacing being entirely laid  aside.  I believe
much bad health has been induced by it :  the
stomach and other viscera have been so com-
pressed  as to  bring on  fainting fits, and the
whole process  of digestion disturbed.
   Personal cleanliness,  being preserved  by
change of cloathing, may be mentioned under
this head.  Where it is neglected, from what
has been said, it is to be reckoned among the
causes of these diseases.   That  the skin may
be pure  and pervious, it ought, to be often
washed ;  perspiration cannot make its way
through  pores obstructed with filth ;  it must
therefore be washed off.   The habit of  perso-
nal cleanliness is best established  when begun
in infancy, and kept on through childhood and
age.
    It may be worth while to observe,Hhat it is 
^
sometimes  of consequence to accommodate*
the temperature of the water to the condition
of the surface.   The face and hands will be
liable to be chopped if this is not attended to :
very cold water should not be used when the
skin is warm ; nor warm water when the skin
is chilled.  Many a polished  neck, face, and
arm, has been spoiled by not attending to this
rule.   The same holds good, in going sudden-
ly too near a fire, when coming out of a cold
wind : or going into a frosty air too suddenly
from a hot room.  These are not trifling mat-
ters : how many fine women have become ner-
vous  by having their beauty spoiled !
    5. Passions of the mind.—The intercourse
and communication bejtween our material and
immaterial parts, is a difficult and  intricate
subject to enter upon.   All philosophers who
have ventured to go beyond the threshold of
inquiry  in this department, have been  bewil-
dered, or returned no wiser  than  when they-
began.   Nature  seems to have endued  parti-
cular portions of our frame with a more  ex-
 quisite connection with our mental part j and
 subject  to a closer  sympathy with  our pas-
 sions.   Many external signs  correspond with 
80
our internal emotions.   It is a difficult task, if
at all possible, to wear the smile of gladness
when the heart is sad.   A nervous constitu-
tion is  ill  qualified to  disguise its  feelings.
Persons accustomed to study the variations of
feature  in  the human  countenance, such as
physicians,  sometimes  acquire a wonderful
expertness  in  developing the passions.   This
physiognomonick experience is of great utility
to the practice of medicine :  it is  the  gift of
genius ; and in this respect the physician, like
the poet, may be said to  be, " nascitur nonjit."
The want of this eminent quality of intellect,
makes the laborious plodder a  dangerous visi-
touratthe sickbed,particularly to the nervous
patient : nature refuses to draw her veil aside
to a  clumsy observer ;  who being denied ac-
cess to  her mysteries,  is very apt to pervert
the purpose of what she  discovers.
   But there is a species of sympathy among
certain organs of our body, that points out a
more intimate  connection with  the  mind, than
what is possessed by others.   The lungs and
heart, in the thorax : the stomach, intestines,
liver, and all the viscera subservient to  diges-
tion, have  an innate sympathy with our emo- 
                      81

 tions.    During strong  impressions on  ther
 mind,  the  heart  beats  quick and tremulous,
 and  is said to palpitate ; the motion of  the
 ribs and diaphragm grows irregular and invo-
 luntary ; and the action of the  lungs so une-
 qual  as to  make  respiration hurried and con-
 vulsed ; hence sobbing, sighing, and panting
 take  place.  The effect  of violent passions on
 the chylopoetick viscera, is to destroy  appe-
 tite,  disturb  digestion, invert the peristalick
 motion of the stomach and bowels, and render
 the alvine  discharge variable and irregular.
 The  biliary secretion is also inconstant, and
 perhaps altered in quality :  the hepatick, cys-
 tick,  and common ducts, may be affected with
 spasms, inverted and  obstructed  ; thus jaun-
 dice, and vomiting of bile are no unfrequent
 attendants of violent  emotions.   The ancients
 held  the liver  to be the seat of cholar and
jealousy, hence  the poet  says :

    Cum tu Lydia, Telephi
       Cervicem roseam, et  cerea Telephi
    Laudas brachia, vje, meum
       Fervens difficiii bili tumet jecur.
                               HORACE* 
                    82
   The kidneys, ureters, and bladder,  are ail
subject to this sympathy, from similar causes ;
as appears by violent pains, strangury, and to-
tal suppression of urine ;  the  colour  of the
urine is variable;  and the quantity  is some-
times profuse, at other times deficient.  These
affections of the urinary organs  are among the
surest diagnosticks of nervous  diseases.   On
the whole  all  the  more  violent   emotions
strongly effect all these organs, which form a->
chain of feeling with one another, of  a more
exquisite kind than  is  to  be found in  any
other part of the system,  or from  any other
disease.  The  degree of the effect on these
parts, will be in proportion  to the sensibility
of the temperament; and in many subjects we
find hysterick fits, epilepsy,  and other  convul-'
sions, tetanus, menorrhagia,  amenorrhea, &c.
take place in an instant, from  mental sympa--
thy.
     One  of the  most common  causes of
nervous, bilious,  and stomach complaints,  is
excessive or long protracted grief.  Mothers
who have lost children, particularly suffer un-
der these painful affections.  I believe the at-
tachment of a mother to the infant, is by far 
€3
the strongest of all human passions.   Medical
attendants are  in the daily practice of seeing
these  parental  feelings, exemplified.   We
read in Tacitus of  a Roman mother dying by
the rack, rather than discover the place where
her son was concealed, during the contest be-
tween Otho and Vitellius.  In some instances
of maternal affliction, we have observed the
faculties  so powerfully oppressed by sorrow.;
so absorbed in the contemplation of one ob-
ject, that the mind appeared almost or wholly
.unconscious of its own existance, and scarcely
attended  to a single external impression.   In
such  cases the intervals  of reason, or con-
sciousness, were only to be marked by sighs,
groans, and tears, as the expressions of grief.
Shakespeare has beautifully painted this  pas-
sion, in the lamentation of  Constance for her
son, in King John :
   ■Grief fills the room up of my absent child,
   Lies in  his bed, walks up and down with me,
   J'uts on his pretty looks, repeats his words,
   Remembers me of all his gracious parts,.
   Stuffs out his vacant garments with his form ;
   Then have I reason to be fond of grief ?
   O Lord I my boy, my Arthur, my fair son !
   My life, my joy, my food, my all the world. 
84
    Some  such  expressions  as these might
have been  uttered  by the mother of Sisera,
when  she heard of his death,  if it did not at
once deprive her of life.  The sacred histo-
rian describes in such glowing language her
expectation  of  his  return, that he  probably
withheld the rest of the narrative, from  find-
ing  terms  unequal  to express  the struggle of
maternal feelings, in the transition from  hope
to despair,*  When  David  received the ac-
count  of Absalom's death, he appears to  have
been so overwhelmed by it, as  to be insensible
tp a victory that secured  both his life and his
crown.  Was  ever grief depicted  in  more
plaintive measure  than in his exclamation  on


   *The mother of Sisera looked out at a window, and
cried through the  lattice, why is his chariot so long in
coming ?  Why tarry the wheels of his chariots ?
   Her wise ladies answered  her ;  yea, she returned
answer to herself,
   Have  they not sped ? * Have they not  divided the
prey, to every man a  damsel or two ?  To Sisera a
prey of divers colours, a prey of divers colours of nee-
dle-work, of  divers colours of needle-work on both
sides, meet tor the necks of them that take the spoils ?
Judges, v. ^B-~S0. 
85
this occasion ?   0 my son Absalom, my son,
my son Absalom :  would to God I had died for
thee, 0 Absalom, my son, my son .'*
   We cannot contemplate  such violent in-
stances of natural affection without suspicion
of health being injured thereby ; and though
not immediately apparent, the effect will strike
a quick observer in the event of disease.
   Next  to  these heart-rending emotions of
parental sorrow, may be reckoned the effects
of disappointed love,  on the  sensible  female
frame.  In the male  sex, the active pursuits
of business or pleasure, more  quckly supplant
tender  impressions :  and men  much  sooner
regain that mental tranquility which fits them
for the busy scenes of  life.  This is not the
case with  the  fair sex ; for  the influence on
both body and mind, seems to be in propor-
tion to the concealed  struggle of  attachment.
The heart obtains relief in pouring forth its
complaint, and acquires resolution when this.
is done :  but the hidden  passion burns  the
fiercer by being suppressed.'!;  The separation

   * 2 Samuel, viii, 33.
 j--------She never told her love ;
   But let concealment, like a worm in the bud,
                       H 
- ft
                     66
rof the parties, and long engagements that pro-
 crastinate  marriage,  are  often fatal to health.
 The condition of mind, alternately, passed be-
 tween  hopes and fears, is worse than certain
 disappointment; hence the  state of suspence,
 to persons of nice sensibility, is always deem-
 ed the most tormenting.
    It is this conflict between attachment and
-secrecy, that has often given birth to the em-
 phatick expression, " dying of a broken heart"
 But such afflictions of mind commonly, sooner
 or later, produce some disease of the  nervous
 system, which quickly draws into consent the
 digestive organs, and others  of equally acute
 sensibility.  Hence a certain hue of the  coun-
 tenance is said to mark a melancholy and des-
 pair, which is brought on by vitiated digestion
 and imperfect assimilation of the food.
    As the manners of the  age  must always
 .materially  influence  diseases of  the  nervous
 class, so among their moral causes ought to

   Prey on her damask cheek: She pined in thoughjt,
   And, with a green and yellow melancholy,
   She sat, like patience on a monument,
   Smiling at grief.                 Shades?. 
87
 be reckoned religious melancholy, and enthu-
 siasm ; jealousy, avarice, insatiable revenge,
 boundless ambition, envy, misfortunes  in bu-
 siness, and some species of pride.   All these,
 in their various operations on the human mind,
 excite extravagant hope, or abject depressions
 of spirit ;  in  the issue, harrass the nervous
 system; produce watchfulness, or unrefresh-
 ing sleep,  engender tumultuous passions, im-
 pair  the appetite,  and  disturb chylification.
 To these  succeed spasmodick, bilious,  and
 hypochondriacal  complaints;  all  of which
 center in the organs that prepare and assimi-
 late the nourishment of the body.
   Some of  the  severest instances of these
 diseases, which have  come  under my care,
 were  in officers ;  men endued with acute sen-
 sibility of mind,  of fine parts, and with high
 notions of honour.  They had been long tan-<
 talized by promises of promotion, and lived to
 see unworthy favorites put over their heads.
 Similar cases are too often  met with among
 other conditions of life;  where worth, virtue, •
 and talents, must give  place  to wealth, servi-
lity, and intrigue.
   The passion of novel reading is  entitled to 
8B-
 a place here.  In the present age it is one of
 the great causes of nervous disorders.  The
 mind that can amuse itself with the love-sick
 trash of most modern compositions  of  this
 kind, seeks enjoyment beneath  the level  of a
 rational being.  It creates for itself an ideal
 world, on the loose descriptions of romantick
 love, that leave passion without any moral
 guide in the real occurrences of  life.   To the
 female mind, in particular, as  being endued
 with finer feeling, this species of literary  poi-
 son  has  been often  fatal ; and  some  of the
.most unfortunate of the  sex have imputed
 their ruin  chiefly  to  reading novels.  How
 cautious then ought parents to be in gaurding
 against the  introduction of these romances
 among their children ;  so calculated to induce
 that morbid sensibility which is to be the bane
 of future happiness ; which to  prevent is the
 task of a correct education ; which first engen-
 ders ardent passions, and then  leaves the mind
 without  power to resist or subdue  them.   It
 is lamentable that three-fourths of these pro-
 ductions come from the pens of women ; some
 of whom are known to have drank deep of the
 fountains of pleasure and adversity. 
8S
   The drama is another hot-bed of thi3 dis-
eased sensibility.    It has been long ago re-
marked, that few English comedies were suffi-
ciently pure for the ear and eye of a chaste and
virtuous woman.   But if such scenes are to be
found  among  them, the sentiments they ex-
press  cannot  be   much improved from the
mouths of some first-rate actresses, who live
openly as kept mistresses.   We are very little
obliged by the late importation of a few loose
German  plays on the English stage.  They
are the offspring of a new school, and commu-
nicate poison in  a new way ; such poison as
has no antidote on the shelves of the apothe-
cary.-
    6. Intense study.—Severe mental applica-
tion depresses the nervous power ; and whe-
ther this arises from business or pleasure,  the
ultimate effect seems  much the same.  Intense
thought  appears  to subtract a great share of
excitement  from  many  corporeal organs :
when long  continued,  or often  indulged, it
leaves them in a state of direct debility.  Ma-
thematical studies are said  to have this effect
 more than others ; and among some intimate
friends I have known these  effects.  But it b
                      H2 
90
to be  observed,  that persons attached to the
mathematical sciences, are commonly men of
cool judgment, of deliberate modes of think-
ing, not easily diverted from  their pursuits,
and rather of a torpid nervous system.  Their
complaints therefore assume much of a hypo-
chondriacal cast.  Among  people of a more
mobile habit, severe study excites in the first
passages, a disposition to spasm and convul-
sive motions, amounting frequently to what is
called the hysterick affection, or globus hyste-
ricus.    The abdominal  viscera  particularly
feel on these occasions : the strong exertions
of  the animal functions  abstract or  expend
much of that energy or sensorial power, which
ought to be alike diffused over the natural and
vital actions.   The appetite flags ; the bowels
become slow ;  flatulence and acidity  super-
vene from imperfect digestion ; the bile is se-
creted in small quantity, and its flow into the
duodenum often obstructed ;  dyspnoea is a
common attendant;  syncope not unfrequently
happens, and degection of spirits to such a de-
gree, as to reduce the philosopher to an idiot.
.Emaciation of body quickly follows this course
of life j par.tly owing to vitiated sanguification, 
91
but perhaps also from obstructions in the lacte-
als and mesenterick glands.  The pallid colour
of a hard  thinker,  or  severe  student, may
therefore be imputed to dyspepsia, or to de-
oxygenized  blood, from confinement within
doors.   Young men who are ardent in pursuit
of knowledge, and greedy of literary fame,
often lay the  foundation for stomach  com-
plaints at the university, that are never after*
wards to be overcome.
   Persons much attached to musick, as being
furnished with acute nerves, and nice sensibi-
lity,  and of a sedentary turn, are  often harras-
sed  by these diseases.   This  remark, indeed,
applies to all who may be considered as vota-
ries  of the fine arts.  Such people, whether
male or female, have commonly a predisposi-
tion  to nervous disorders.
   I have  met with many  obstinate  cases
among schoolmasters ;  in part to be attributed
to confinement within doors, but chiefly to stu-
dious habits.    But what is still more strange,
I have even  known them among shepherds, a
class of men enjoying the purest air,  but be-
coming nervous and hypochondriacal from an
inactive solitary life, and a thoughtful mode of 
92
3pending time,  and reading abstruce subjects.-
   7. Lactation or nursing. —»T'his office of the
mother to  the child, if the  dictates of nature
deserve attention,  ought to be considered as a
very salutary duty ; for if we look to the na-
tural state of mankind,  we find every mother
able to perform it.  The child-bearing part of
life is  usually  healthy;.and  weakly females
have their health improved  by becoming mo-
thers.   It must, therefore, be owing to some
deviation from the established rules of  the
animal economy, that so many women are to'
be found unequal to this task.   It is the duty
of the husband  to  encourage the wife in  the
exercise of this  amiable attention to the infant;
and if  he prevents it, he rends asunder one of
the strongest ties of human affection.   Yet
we often see mothers-so attached to the office
of nurse, as to view the  weaning of  their child
with horrour:  such feelings dignify human
nature ;  what a pity there should be found ex-
ceptions to their being general.
   It would appear to be the indication of na-
ture, to suckle the infant  till it is nine months
eld, as corresponding with the time of gesta
lion, At this age the child is capable of takinj 
°1
 other nourishment for its support.   But when
 the mother grows  too  delicate and  weak for
 the  office, it  must be weaned sooner.   The
 complaints which are brought on by long suck-
 ling, are much the same with those that follow
 frequent abortions, and immoderate or irregu-
 lar menstruation.  They are all of the nervous
 class.   As the regular peculiarity of the sex,
 is the  best test of female health, so the vica-
 rious  lactation may be  considered as a relief
 to the other organs, and thus beneficial.  But
 when continued too long, the general frame is
 debilitated,  and particularly the uterine sys-
 tem.  The  strength of the woman is not re-
 duced by affording nourishment to the infant
 merely ; it is the sympathy which subsists be-
 tween the different  organs that give birth to
 morbid feelings,  and the stomach and intes-
 tinal canal v/ith many others are quickly drawn
into consent.
   Mothers who trust their children to hired
wet  nurses, would do well  to  inform them-
selves how far these women have weaned their
 own children with satisfaction. Few  mothers,
among the decent orders of  women, can be
supposed  to  leave  their  offspring   without 
94
regret;  and it may  happen that the health of
the other infant is  liable to suffer in the con-
flict.  Much pretended refinement often takes
place about  selecting a nurse free of disease :
but  what   scrutiny can secure the suckling
against the bad effects  of her  passions; these
must frequently sow the seeds of future indis-
position, that may not be discovered  till too
late.  A mild and  serene condition of mind
must be a valuable ingredient in the character'
of a nurse ; for which reason the nervous con-'
stitution should be avoided.  On the whole, a;
hired nurse is only  a lesser evil, that can by
no means repay the offspring for the want  o£
the mother's breast.
    But  nursing mothers  among  the lower
orders of women, if they  remain with  their
families, are often badly nourished : and if they
feed much on tea,  are subject to that  species
of consumption that is denominated nervous.
This is,  in fact,  a high degree  of nervous
exhaustion and  debility, attendedswith many
of the most painful symptoms.*  To keep the

   * All wet nurses ought to abstain from tea. Next to'
spirits and malt liquors, it is most hurtful to  the suck-
ting.. 
Q5
 child at the breast for 18 months or two years,
 cannot be done without  injury to the mother's
 health.   Yet this practice is frequent,  and
 must be considered as a sad alternative to pre-
 vent the quick increase of  a family.
    8. Miscarriages andpremature labours, &?c.
 Few  mothers who have suffered mishaps dur-
 ing pregnancy, escape with  impunity.  All
 miscarriages  are attended with some degree
 of danger, and much bad health is with justice
 imputed to them. The wife who has prospects
 of being a mother,  must  undergo much men-
 tal distress at being disappointed, independent
 of all personal hazard. This species of anxiety
 is one great cause of  one.miscarriage being so
 apt to succeed another, as the  mind is trem-
 blingly alive to every symptom that resembles
:the former.   This state  naturally  begets  a
 nervous sensibility, which too  often creates
^imaginary fears  when  there are none  real.
 Long and severe labours, to which may  be
 added some  of the diseases of  the puerperal
 season, are also to be considered as a frequent
-source of nervous disorders.  Large evacua-
 tions of  blood  at that period are known to in-
 duce  the most violent hysterick paroxysms and 
96
other convulsions ;  hence these affections  so
commonly follow floodings during labour and
after it.
    The changes which take place in the breast
and womb after the birth, very materially affect
the general system of nerves.  These evolu-
tions are marked by increased irritability, and
fevers of the most  acute kind are liable to
supervene ;  and point out the  necessity of a
soothing regimen, tranquility of mind, pure
air, mild diet,  open bowels,  &c.  If there is
a hereditary predisposition,  nervous ailments
will, of course, more readily appear, and be
aggravated by all improper treatment.
    9. Climate.—In the description of the in-
habitants of a large town, I have mentioned
persons returned from the East and West  In-
dies.   Such persons are remarkably subject to
the diseases of which we now  treat.  The
acute fevers of tropical-climates in a particular
manner affect the stomach, bowels, and biliary
secretion.   The yellow fever of the West  In-
dies derives its  name, and part of its charac-
ter, from the excessive  flow of bile ; which
not only  tinges the  serum of  the blood,  the
urine, and  skin, but in a manner inundates 
                    97
the intestines.    No  pain or tention in the
region of the liver, accompanies this unusual
secretion ;  and the bile is taken up by the ab-
sorbents, enters the circulation,  and produces
yellowness of the surface, without any obstruc-
tion of the ducts as in jaundice,  for the faeces
are highly bilious.  There seems to be little
resemblance  between  this  endemick of the
West, and the hepatitis of the East Indies.  I
would therefore call  it,  as has been done by
one of the best  writers on  the  subject,  Can-
sos.*  In  the hepatitis,  an  excessive biliary
secretion is not  mentioned.  The West India
fever is always rapid in its progress ; but the
liver  disease of the East is often so chronick
in its  form, as to steal on imperceptibly for
months, without pain sufficient to create unea-
siness or alarm, though it may  at last arrive
at suppuration.  They both affect chiefly young
robust Europeans, new-comers, who  live full,
and drink freely of vinous liquors.  The same
modes of  living, we know,  create  hepatick
diseases in England ;  and the analogy extends
to other pampered animals, as the domestick,
1  Dr. Moseley en Diseases of the West Indies.
                  i 
98
fowl, turkey,  and pig.   Both diseases leave
the digestive powers in a weakened condition;
and there are  few who  do not complain of a
degree of dyspepsia after these attacks. But in
a multitude of cases  where I have been con-
sulted, by persons returned from India, it was
doubtful to me, whether mercury exhibited aa
a remedy, or  the disease itself, were to  be
most blamed for the production of dyspeptick
affection.  As far as I have been able to learn,
from both  written or  verbal accounts, this
complaint,  so frequent on the  Coromandel
coast, ought to be treated with large bleedings,
and copious active purgatives, in the very first
attack.   The quantity of blood to be taken, I
think,  ought not to be regulated by rules laid
down by systematick writers for the inflamma-
tory fevers  of this country ;  if it  is done at
the proper  period, it ought to be  infinitely
larger.   If these evacuations have been neg-
lected,  or  sparingly  employed, suppuration,
torpor, or infraction of the liver,  to a certainty
succeed, which render the use of mercury in-
dispensible.  Where  the disease assumes at
first the chronick form,  mercury  is considered
the only  remedy.  The  phrase, " chronick in- 
99
flammation" is a new term in medicine, and
I think an improper one here.  The less active
hepatitis is still a febrile disease, only less mark-
ed ; for how can we suppose purulent matter to
be generated without those distinguishing phe-
nomena that are characteristick of it. The mer-
cury in this case, I should suppose to act partly
on the biliary pores and ducts, partly on the
circulation of the liver, but chiefly on the ab-
sorbents of that viscus.   These  effects from
mercury being  so well  known, why contend
for it as a  specifck,  in this oriental disease?
It would therefore appear, that there is a peri-
od in hepatitis, when it is indicated and safe ;
and as its stimulant powers are so evident, that
must be, when the symptoms of active inflam-
mation have subsided.  We thus see how fric-
tions in some nervous constitutions, must be
the most eligible way to direct this medicine,
as some authors contend.  Yet mercury, nev-
ertheless,  at all times has  a manifest action
immediately on the  nervous system ; and if
limits can be drawn to its exhibition in the
different stages  of hepatitis, care should be
taken that the habit is not destroyed by it, and
diseases worse than the original pne produced. 
100
But if this treatment deserve all the encomi-
ums which has been  given it, how comes it
that so many return to this country labouring
under the liver complaint, as they call it,  after
having  repeatedly  undergone  the mercurial
course.
    The consequences of  tropical  fevers will,
however, be  in a great measure prevented as
the effusion of cold water gets into universal
practice ; and employed with the precaution?
directed by two great physicians of the present
day, my late lamented  friend Dr. Currie, and
my learned friend and  neighbour Dr. Jackson
of the army.   In the acute hepatitis it promi-
ses to be an effectual remedy.   Much reason-
ing has been employed on the cause and treat-
ment of fever ; but no  certain method of cure
was ever given to mankind before the cold ef-
fusion.   We can now  readily admit, that the
sudden abstraction of a great quantity of heat,
by the shock, as it is  called,  dissevers in an
instant those associated actions which consti-
tute the febrile phenomena ;  or what is em-
phatically said, to cut the fever off at once.
    The hepatitis of  the  East Indies, as affec-
ting an organ so necessary to the cnimal eco- 
                   101

nomy, may have thus a large share in tne
duction of dyspeptick complaints.
   The effects of a warm climate on,the he-
patkk system, and producing a redundancy of
bile, admit  of much  speculation.   A  warm
summer in this country has a similar effect ;
in such  a season, cholera and dysentery are
common.   Excessive heat may be regarded
as it acts on the nervous  and sanguiferous
systems.  It powerfully increases the sensibi-
lity of every part; and renders the mind more
susceptible of pleasurable sensations.   The
muscular  fibre  becomes more irritable ;  and
what  are  called  spasmodick  complaints, are
more common in warm than in cold regions.
Fevers also are more frequent than in Europe,
in which  the stomach is much diseased,  and
bilious vomiting, with  a yellow tinge of the
tunica adnata, are attendant symptoms.  Inso-
lation is the effect of the rays of the sun in a
perpendicular direction, acting on the sensori~
urn commune.  The last degree of debility,
with bilious vomiting, indicates this  affection ;
just as we observe severe hurts or wounds of
the head  induce  the  same symptoms.  Now
we explain these symptoms from the nice con*
                     i 2
 
102
sent of parts ; they prove the strong sympathy
with which the  chylopoeitick organs, by their
office are linked with  the functions  of  the
brain.    The excessive heat  is an exhausting
power, directly acting on the sensorium com-
mune ;  for  compression of  the brain, from
blood or other causes, does not excite the same
train of symptoms.  We therefore draw  the
conclusion,  that warm climates  induce hepa-
tic and stomach diseases, by primarily affecting
the nervous system.  As far as heat affects the
circulation of the blood, it seems to have little
effect in bringing on  nervous irritability, and
is of inferiour consideration in this inquiry.
    But while we blame the'heat of the climate
for the production of  nervous and  bilious dis-
eases among Europeans, we must also  take
into account their modes of living, so injurious
to health.   The most debilitating  of all plea-
sures, is by them indulged to excess ;  and the
passion seems to grow from what it feeds on.
Highly seasoned food, the large use of vinous
liquors, and licentious manners, carry luxury
to its utmost pitch.   The warmth  of  the  cli-
mate is, therefore,  not to  be singly  blamed
in  engendering  bilious aud dyspeptick com-
plaints. 
1.03
   If persons who live in this way, remain in
a tropical country till they pass the meridian
of life, and then return to Britain, they seldom
enjoy good  health.  The cause of this is ob-
vious.   They ought therefore,  if convenient,
to pass their first winters in some of the  sou-
thern  provinces of France,  or in Spain, or
Portugal; and  thus accommodate the  consti-
tution gradually to the great change of  tempe-
rature.
i   Some districts  of  country that  are  low,
swampy, and subject to fogs, commonly disa-
gree with nervous and bilious people.   And
those seasons, when the weather  is  variable,
and liable to sudden transitions, are also hurt-
ful.  Many  of their symptoms,  particularly
depression of spirits, increase under a  cloudy
atmosphere  ; hence the  glooms of  November
are proverbial for having this effect.
   10. Medicines.—All nervous persons are
uncommonly fond  of  drugs ;  and they  are
the chief consumers of advertised remedies,
which they conceal from their medical friends.
Among some well-meaning people, this inor-
dinate desire for medicine  has frequently be-
come of itself a disease.  With many of them 
104
physick, to be useful, must be clothed in mys-
tery ; and the moment a discovery is made of
the composition, the confidence is lost.   Me-
dical attendants  have too often  brought this
punishment on themselves.  Were they unani-
mous in combatting the prejudices of mankind,
by candour and openness of  conduct, by a fair
avowal  of the imperfections of their art, and
the honest confession that articles of Materia
Medica, form but  a small portion  of its re-
sources, they would not so  frequently see
their commands disregarded,  or  learn that
their compounds have been  thrown Out of a
window.  This is the only way in which I can
account for so many persons of good sense and
discernment,  consigning themselves and  fami-
lies into the hands of impudent and illiterate
quacks.
   It was the saying of a very sagacious pro-
fessor of medicine to his pupils,  " young gen-
tlemen,  if your medicines  should do  no  good,
take care that they  do no harm."*  When ac-
tive medicines are long continued, and do not

  • The first Dr. Rutherford, professor  of medicine
in the University of Edinburgh. 
10J
cure, it is very likely they  may do mischief.
But the remedy that cures one disease, if inju-
diciously  administered, not unfrequently pre-
disposes the  body, and  paves the way to ano-
ther malady.   I shall begin with
   Emeticks.—The  exhibition of emeticks
is often taken out of the hands of the  medical
profession ;  and  every good woman thinks
herself competent to direct  a vomit.   Some
people with delicate stomachs are in the habit
of taking these articles,  for every uneasy state
of that organ,  which is  construed into.a foul
stomach.   But nothing can more certainly
tend  to  weaken, nay paralyze  that   viscus.
The operation itself is painful and unnatural ;
for the act of vomiting,  is to invert and evacu-
ate the contents  of the stomach  the wrong
way.   This cannot be done without  medicines
that are  first highly stimulating :  they pass
through  the  stimulant  stage of the  process
first; and when that is  over, the fibres of the
stomach  being exhausted for a time, sickness
is the consequence and  vomiting succeeds  it.
This nausea  is sometimes so severe as to oc-
casion fainting, and even convulsions ;  and
the frequency of the pulse during the opera- 
106
 tion is often  so reduced  as  to  give serioue
 cause  of alarm ; and is at all times slower till
 the sickness is overcome.  Such are the symp-
 toms to be marked during the emetick effects
 of tartarized antimony, vitriolated zinck, vitri-
 olated mercury, ipecacuanha, squill, &c.  If
 therefore,  this operation is too frequently re-
 sorted to,  what is to be expected but a weak-
 ened,  mobile  or torpid condition of the sto-
 mach,  and every organ that fills  a link in the
 great chain of sympathy with it ?  The hurtful
 effect  is also  much  increased by the copious
 draughts of warm water, taken to encourage
 the vomiting.
    At the time that James's Powders were in
 general use, and when families were in  the
 practice of taking that medicine as a preven-
 tive of fever, at stated periods, weakness  of
 stomach and indigestion were often traced to
 this cause.  Ignorant people are apt to consi-
 der many complaints where the pulse is quick,
 as fevers, and  fly to improper remedies.
   But antimonial  emeticks require  the  ut-
most caution  in the exhibition  to  nervous
 people, and all who possess irritable bowels ;
 •uch as dyspeptick and gouty ;  severe cramps, 
107
hystericks  and diarrhsea, too commonly fol-
low.   They  likewise encourage eructation,
and by inverting the gullets of some people, a
kind of ruminating of the food takes place, a
habit very disagreeable and disgusting.—
When we reflect what a small  portion of anti-
monial preparation is required to excite vomi-
ting, we must be convinced of its uncommon
activity, and  that it acts immediately on the
nerves of the stomach.  The same guarded
practice applies to all  the metalick  oxides,
when used as emeticks.  What may at season-
able times be a valuable remedy, may thus, by
being  improperly  directed,  have the  most
baneful effects.   Nervous patients are parti-
cularly subject to a kind of rising in the  car-
dia, or upper orifice, a sort of inverted motion
in some of the  muscular fibres, with disten-
tion, flatulence, and acidity,  that create vast
sickness.   But to have recourse to vomits for
relief, would only  aggravate the complaint.
These persons are also more easily affected by
disagreeable  objects, and bad  smells, than.
others, which harrass them not a little.   As
they grow  acquainted with this frailty  of their
stomachs,  they will  rather study to avoid the 
                    108
 causes, than trust to any article of  medicine
 for relief.  When constant vomiting has  been
 brought on, in nervous stomachs, by whatever
 means, no complaint is more difficult to be re-
 strained : some afflicting cases of this  kind
 have  come  within  my knowledge,  in young
 persons, part of which terminated fatally.
    Purgatives.—This class of medicines,
like the preceding, are too often directed by
improper  judges of  their fitness.  But the
greatest harm  is done in infancy  and child-
hood, when parents run  to the aid of physick
for every trifling complaint,  but  chiefly for
cutaneous affections.  It is immediately deci-
ded that these spots are owing  to bad humours
and foulness of the blood, and  must be carried
off by a purge.   Such reasoning as this for-
merly prevailed among medical people ;  we
cannot therefore be surprised that persons not
in the profession Should still retain a little of
the old leaven.  Purgative medicines differ
extremely from one another;  and  if it  is  a
nice point  in  medical practice to  suit  the
purge to the nature of the complaint and  pe-
culiarity  of  constitution,  it  must  be  oftea
dangerous to trust them in common hands.   I 
109
 was once called  to visit a farmer who had ta-
 ken two ounces of saltpetre, instead  of  Glau-
 ber's salt.   I found him in extreme pain about
 the stomach, with ghastly looks, an  intermit-
 ting pulse, and cold sweats.  A few minutes
 longer would have been too late to save him :
 by drinking plentifully of warm  milk and wa-
 ter, and a brisk emetick, he was recovered.
 But I  have known similar cases prove fatal.
    Confinement within doors, a uniform mode
 of living, and sedentary habits, are  so com-
 monly met with among persons of the nervous
 temperament, that a constipated state of body
 is a general condition of their disease. Hence
 the frequent recourse to medicine for opening
 the bowels.   Some of the most drastick pur-
 gatives, such as aloes and scammony, come at
 last to  be in  common use with them.  This
 custom soon  begets a habit; when  the bowels
 are brought  to that  torpour and inactivity as
 never to be moved without the aid of a drug.
 The sensibility of the intestines is thus, by de-
 grees worn out;  the lacteals which  take up
 the food, the mucous glands and exhalants that
 pour forth  fluids, as well as the nerves and
nvisouhr fibres, grow torpid : the consequence
                    K. 
116
is the loss of the peristaltick power, and the
bowels are  apt  to run  into inverted motion,
and spasmodick constriction,till a fatal cholick,
an intusception,  iliack passion, or cramp, close
the scene.   Painful  diseases of the rectum,
schirrus, hemorrhoidal tumours, and .fistula,
too often render life miserable, from this ill-
conducted practice.                         *
    But if mercury, in the form of calomel, or
any other  preparation  of that  metal, makes
part of these habitual purges, the consequences
are always to be dreaded.  Calomel is a favo-
rite article  with some physicians, as a purga-
tive and  from the minuteness of its dose, very
desirable to the patient.   It  also  operates
quickly and briskly ; which with nervous and
dyspeptick subjects, is matter of great satis-
faction ;  for their odd ■feelings and singular
sensations within, give the suspicion that they
are full  of obstructions and cannot he suffi-
ciently evacuated.  Yet such instances of slow
bowels are  not  to be considered as depending
altogether on a local affection.  They are join-
ed with a  general state of the body, and only
to be radically cured by correcting the original
evil.  Thus a long  walk out of doors, and a 
lit
 fittle active exercise and recreation ; will effect
 sometimes what large  doses of medicine are
 unable to perform.
    But mercury is the most dangerous of all
 frequent purges ; it sooner exhausts the irri-
 tability and vital power of  the intestines, thaa
 any other metalick oxide, except arsenick. It
 never fails in the end to add to the disease :  it
 is peculiarly contra-indicated in the nervous
 temperament, fronv the mobile  disposition of
 nerve ; and  its action  on  the  bowels, very
 much resembles a state of dysentery,  by pro-
 ducing the most violent gripes and tenesmus.
 It thus frequently brings on prolapsus ani, a
 complaint  to which weak  bowels are liable,
 and especially women,  who have experienced
 hard labours, and borne a number of children.
    Many volumes have been written on disea-
 ses, supposed to have originated from the use
 of  mercury, when given  for the cure of lues
 venerea : yet, strange to relate, its most com-
 mon consequences, dyspeptick  and nervous
 affections are scarcely mentioned.*   I firmly

   * A little tract, " On the Use and Abuse of Mer-
cury," has just been published by Dr. Wilson; in 
                     112
believe all  the derangements  which it occa-
sions in  the  body, are small when compared
with the injury to the nervous  system and di-
gestive powers.    Some physicians  and sur-
geons even fly, in common cases, to one of its
most dangerous preparations,   hydrar. mur,
and seem to  overlook  it3 ultimate effects on
the constitution.  It has often been  my lot to
witness these effects in the practice of others :
for of ffty thousand cases of the venereal dis-
ease, which  I have attended, I  am convinced
that not  one   of  the  number  ever  required
this acrid mercurial.  Haemoptysis, ending in
phthisis,  was a frequent  sequel to-this treat-
ment.
    It is well  known that miners and worker*
of  this metal  in  the various arts, are, after a
certain time  subject to the most violent ner-
vous afflictions, such as  cholicks, epilepsies,


which he particularly notices its hurtful effects on the
stomach and intestines.  I am glad to observe, that his
remarks are very much like my own.  This essay ap-
pears to be only a prelude to more extensive disquisii
tions on the subject.; which I hope the learned author
vill follow  up with his accustomed ability.
* 
113
cramps, tremours, &c. and  the  last stage of
these is palsy, in its most hideous form.  In
the silver mines of Spain, in South America,
where  mercury  is employed to separate the
gold,  the poor slaves seldom live three years,
from  being exposed so  much  to  its fumes.
Hence to be sent to the mines, implies the last
degree of  human punishment.  As the lues
venerea extends in society, and the exhibition
of mercury  for its cure becomes  every day
more  familiar with  medical people, there is
danger they forget they  have in their  hands
one of the most active mineral poisons, and
extend its use to all  those diseases that resist
other remedies.  In the hands of the ignorant
and indolent  of the profession, it has done in-
calculable  mischief.   The  ignorant man  is
neither capable  of selecting its  proper prepa-
rations for particular conditions of body, nor
of knowing when it is forbid ; and he is una-
able to discern when it has done harm.   The
indolent  among us,  who give  themselves no
care about the investigation of a  distemper,
cannot be  fit persons  to prescribe an article
that,  injudiciously given,  may destroy life.
This remark does  not  merely apply to the
                   k 2 
114
vender  of  advertised  remedies ; it compre-
hends many in private life, who,  from defi-
cient education, are not entitled to more confi-
dence than the itinerant tribe.
   But there is a form of the diseases of which
we now treat, in which mercury is said to act
with undeniable efficacy ; namely, in what are
called bilious complaints.
   The term belongs  to common language j
as such, I have adopted it in my title ; but it is
not correct in a medical nomenclature. Some
members of the  profession, to improve  our
vernacular idiom, have thought proper to give
these ailments the name of liver complaints, as
that organ  is said to be their seat;  but equally
undefined in a scientifick view as stomach com-
plaints, so long applied to diseases of  the di-
gestive powers.   The phrase bilious derives
its origin from that tinge of the skin so often
observed in dyspeptick persons, who also oc-
casionally  pass bile both upwards and down-
wards.    Now bile, appearing in these forms,
being a natural secretion made by the liver, is
to be considered as the effect,  rather than the
direct cause of indisposition.   In  the present
day, a dyspeptick person no sooner complain* 
115
of pain in the right hypchondrium, than the
liver is said to be diseased ;  and a bilious suf-
fusion of the surface* is considered  an infalli-
ble symptom of the same viscus being affec-
ted ; and the mercurial process is immediately
commenced.    It is disgusting to  hear this
phraseology so common in the  mouths of me-.
dical people.   It is well known that jaundice
itself  is  even  common  enough during the
mercurial treatment of lues venerea.
    We shall  learn  from a description of the
nervous temperament,  that persons subject to
indigestion, to frequent discharges of bile, and
spasmodick affections of the chylopoeitick or-
gans, are endued with uncommon delicacy and
irritability of  the first passages ;  and that this
state is generally attended with great debility.
Such a condition of the muscular fibres, in the
osophagus, stomach  and  bowels, with all the
canals  which pour  fluids into them, naturally
makes the whole subject to reversed  motions,
irregular contractions, increased sensibility in
one part,  and deficient power, or torpour in
another.   The state  of the liver  itself will
partake of all these irregularities.   Its secre-
tion will  sometimes be suspended,  sometimes 
                     116
deficient.  It will suffer stagnation in the bili-
ary pores, and in all its ducts.  Even when it
flows freely into the duodenum,  it will at one
place be collected in greater quantity than at
another; sometimes  retained, and at  others
flowing profusely ; and the slow  or quicker
-motion of  the bowels, will exhibit a proof of
mis inconstant passage of the bile in the alvine
discharge ;  in its colour, its consistence, and
fcetor ; while transient jaundice  will also ap-
pear.
    The ducts may also be obstructed by bilia-
ry calculi,  over which mercury has no power.
Indeed dyspeptick persons are very subject to
these concretions,  which are probably owing
to some disposition in the bile  itself.
    These commotions will frequently bring on
epileptick  and hysterick convulsions, violent
cramps,  and death.   The mind strongly  sym-
pathises ; it is irritable, irresolute, timid, des-
ponding, and suffers *more  or  less such de-
rangement in its relation of  things, and  in its
perceptions, as amounts to a degree of  deli-
rium.   This  constitutes  what, in common
language, some persons call a bilious or ner-
 vous attack* 
                    117
    Thi3 being our explanation of the biliary
 affection of the nervous temperament, it must
 be straining facts to the utmost, to  find any
 analogy between it  and the hepatitis of the
 eastern  hemisphere.   How  indeed can any
 qualified  observer of  the  phenomena of dis-
 ease, compare the full  robust habit of a young
 European, on the coast of Coromandel, with
 the  weakly and delicate nervous lady of out
 climate ?   Yet the analogy, monstrous as it is,
 in the practice of some  physicians,  has been
 said to be  correct ; and  dyspeptick  and hys-
 terical females, have on  the faith of this doc-
 trine,  been tortured with mercurial  courses,
 till their  very  teeth have  been in hazard of
 dropping from  their sockets ;  and this plan of
 treatment  sometimes repeated,  as the symp-
 toms were found to recur.
    I hold  it as an unquestionable fact, that a
peculiar predisposition attends both diseases j
and that local causes excite both.  It appears
from many particular symptoms, that a direct-
ly opposite state of  the  body prevails in the
two complaints.   How then can the same me-
dicine  be  indicated in  both ?  The icterus is
not characteristick of hepatitis;  nor is the ca- 
118
pricious  disposition  of  the bowels, and  the
mental disquietudes of nervous affection, ever
included in  the  account of its symptoms.-—
The analogy therefore  between the hepatitis
and the  dyspepsia of  the nervous tempera-
ment, has no foundation in pathology,  and
leads  to  no  rational method of cure.  That
the liver may be  enlarged in these diseases, as
well as from hepatitis,  I  readily admit:  but
such enlargement must be brought on in a ve-
ry different manner.   It must  be chiefly ow-
ing to the debility of the hepatick nerves ;  by
which  means a  torpor or kind of paralysis
takes  place ; effusion of some kind may then
happen in the parenchyma of the river, which
the lymphaticks  are not able  to  carry  off.—
What are called tubercles of  the liver,  are
most  likely enlarged lymphatick  glands  and
vessels ;  this may be another cause of increa-
sed size.  But it is probable also,  that the se-
creted bile itself is frequently the cause of the
great bulk, from torpor of the pari biliari and
ducts.   I believe however in  dyspeptick ha-
bits, that such increased size of the liver is a
rare disease ; and  when  it does   happen,  it
ought to be  considered  a3 an effect, not a pri-- 
1.19
mery cause of indisposition.  If  therefore,,.
there is much nervous  predisposition, mercu-
ry must do a great deal of harm, and add to
the mischief.
    Some persons have an opinion, that mer-
cury acts immediately on bilious  affection, in-
dependent  of evacuation ; but this is fanciful.
A purge, in which calomel is combined with a
cathartick, as it excites  the  duodenum in its
passage, it also urges into action the different
ducts which open into it; and the last evacua-^
tions of a  mercurial purge, are commonly bi-
lious.  This increased action may, by sympa-
thy go  farther ; the pori biliari may feel it,
 and perhaps the whole viscus*   Thus the li-
 ver maybe  purged, and excited to healthful
action.  But what one dose or two may effect,
 a third and fourth may destroy ;  and by know-
 ing the constitution of the patient,  we shall
know when to  stop.  And  as  cramps  and
spasms, of the most  painful kind, are part of
these diseases, so mercurial  purges, as  I have
often seen, run great hazard of bringing them
on.  But  there are many purgative articles,
that in these cases, have all the good effects of
 mercury, without the deleterious ones ;  and 
120
   they ought to be  preferred.  Very active ex-
   ercise will also, in  many instances supersede
   the use of medicine ;  so great is  the power of
   agitating  the abdominal viscera, in  promot-
   ing the due flow of bile.
       The hepatitis of the East Indies has been
   long  considered a serious disease, and  often
   fatal ; and as it has seldom yielded to a mild
   treatment, the  exhibition of mercury is justi-
 . fied.   But it cannot be denied, although  this
ts.t -^medicine is chiefly to be depended on, that e-
   ven in India it has done infinite  harm to the
   constitution.   I therefore  embrace the oppor-
   tunity of  quoting the following passage from
   the Edinburgh JN^edical and Surgical Journal,
   No. viii.  p.  503.  It is given without the wri-^
   ter's name, but the cautions which it inculcates
   are of such  great value  in practice, that even
   anonymous  authority renders it respectable.
       Extract  of  a letter from a surgeon on the
   Madras establishment, dated  the 22d  Octo-
   ber, 1805.—" My last letter from    —gave
   "  me sad accounts of his health.  He is suf-
   "  fering much  from excessive use of mercu-
   "  ry ; and has had, he says, spasms of the dia-
   " phragm, and excruciating pains in his skin, 
'         121
« Jen?*, W head.   It  may be news to  you,
" that mercury in this country, when given in
" too large quantity, causes  sufferings more
" dreadful  than the disease for which it is a
" specific, and  experienced surgeons are cau-
44 tious  never  to exceed  in its employment.
" You ask  me  if the  erythema mercuriale is
" frequent with us ? Very lately a brother sur-
" geon here had a case  of it in his  hospital
" which terminated fatally ;  and with the na-
" tives who never can  be  made  to  clothe
" themselves sufficiently, or almost  at all,
" when under  the use and influence of mercu-
" ry, this disease occurs frequently, and  often
" proves destructive."
    If such are  the effects of mercury in robust
constitutions, and in  a  climate peculiarly  fa-
vourable to its administration, what severities
are we  not to expect in weak nervous  bowels,
and in a condition of atmosphere, that in de-
spite of every  precaution, so often throws its
activity on the.first passages ? It is to  be hop-
ed the advice given in this extract will not be
lost on  physicians  and  surgeons, in England,
who are so apt to resolve every pathological
L 
122
difficulty, into a liver complaint; and pour in
mercury ad infinitum.
    Mercury as a  cathartick acts best in con-
junction with jalap : a pill  containing  three
grains of the latter to one sixth of a  grain of
the former, purges moderately in a hale state
of body.   I maybe told in contradiction to
this, that a dram of calomel has been given to
a child ; and half an ounce  to an adult, in a
few days, without any bad  effect.  But,  be-
cause  these patients were  not destroyed, is
the heedless administration of so active a me-
dicine to be justified by such proofs ? I havfe
seen persons survive large  doses of corrosive
sublimate mercury and arsenick ; yet no judi-
cious physician will compare these recoveries
with the limited doses of either article, adapt-
ed to the nature of temperament, and diseased
'state of his patient.
    Mercury being a medicine given in ajgreat
variety of preparations, has long been the chief
ingredient in  quack remedies.   It is  thus
vended under the form of tincture, drop, pow-
der, pill, &c.   And article  of materia medica
possessing such activity in some conditions of
the living system, may be capable of producing 
123
great and salutary changes.  But in effecting
these, certain premises and indications are to
be attended to, to justify the exhibition : and
the physician who does not  give himself the
trouble to consider these circumstances,  may
perform the. part of an executioner.   Mercury
being particularly hurtful where the stomach
and bowels are very irritable, is forbid in gout
and  in the nervous.   In  those persons, fric-
tions of  the ointment lessen  the  danger.
Hence it is improper in women and children ;
in those subject to epilepsy, or other convul-
sions ; and in every oner who may be liable to
spasmodick complaints of anyform.  In states
of torpour and strength,  it  can be given with
more safety :  it i9 supposed to be the best re-
medy in glandular obstruction, if the attendant
debility does not contra-indicate its use.  But
it is  top often to be observed, that those who
make most free with the exhibition of mercury,
are the least  qualified to guard against its bad
effects in improper cases.
   I resided a few years ago in a naval sea-
port, where I was often consulted for stomach
and nervous  complaints, by ladies, the wives
and relatives  of officers, and my other friends 
124
in the public service.  Many of these female
had  been residents in warm climates.   The
great resemblance which the cases had to one
another, excited no small degree of surprize at
first, till I learned they had been all subjected
to a similar  mode  of treatment.   In shorf,
they had been patients of a physician of exten-
sive  practice in the neighborhood, who  pre-
scribed mercury for every disease.  INIost cf
these women, among whom were some  of
great mental and  personal accomplishments,
had been kept for months  or weeks  under the
influence of the medicine ; with their throats,
mouths, and tongues so swoln and excoriated,
and the teeth so loose, as to confine  them to a
diet  of slops.  Those who had  no stomach
complaints when they began this treatment,
found them come on after it ; and such as had
been nervous and dyspeptick before, felt all
their  ailments aggravated.   This  physician
not satisfied  with  the milder  preparations,
made a common remedy of hydrar. mur.
   A practice not unlike  to what I have just
related, made some noise in our navy during
the late war.   A  physician on a foreign sta-
tion, took it into his head  that all modem dis- 
125
 eases originated from Syphilis.   It was in vain
 that officers and  seamen  pleaded  innocence :
 if they were unconscious of receiving infection
 themselves, they wTere told it must come from
 their parents, sometimes  to many generations
 back.   Few men could answer for their purity
 on these occasions :  a mercurial course  was
 therefore directed ; not  for days  or weeks,
 but for years ;  for  there was no safety  but in
 continuing  it at intervals through life.   A
 medicine of the kind, employed on such  terms,
 could not  fail to do harm : some of the most
 unfortunate stomach  affections  which ever
 came under my care, owed their cause to  this
 treatment;  a few  valuable men were  brought
 to the grave by it, in the circle of my own ac-
 quaintance, where I suspected a schirrous py-
 lorus.
    Mercury exhibited in quantity, either  by
 the mouth or by friction,  very quickly excites
 an artificial fever, ushered  in by chills, shiver-
 ing, and a hot stage.  The pulse becomes
 frequent, at first full, but latteily weaker and
 quicker: want of appetite, nausea, and  often
 vomiting, commence ; restlessness and  night
sweats supervene ;  the body bears the cold ?ir
                       L 2 
126
ill; head-ache ;  foetid breath ; the bowels are
commonly  oppressed with flatulence, severe
twitches, purging, tenesmus, and even bloody
stools ;  to these  symptoms, debility and  ema-
ciation succeed;  the tongue, mouth and throat,
inflame, swell, grow  painful, and ulcerate, and
the saliva  is poured  forth  in a  continual
stream.  During the effects of mercury on the
body, the mind becomes irritable and unequal,
but generally low spirited ;  and  after  some-
time, exhibits all those  feelings, usually called
nervous, inducing the hysterick affection, con-
vulsions, and frequently the epileptick parox-
ysm itself.   It is therefore plain, that  in the
nervous temperament,  all the phenomena now
described, must appear with greater violence,
 as  is observed  in children and  women, and in
 all who have weak bowels.
    The constitutions of children, in point of
 debility and irritability, approach to the female
 habit of body :  the nervous power is liable to
 irregular motions ; easily affected by stimuli,
 and prone to convulsions.  Hence mercury is
 apt to have dangerous  effects  upon  them.
 With some  medical people, as well as parents,
 this medicine is much employed as a vermi- 
127
fuge : it has the advantage of being easily dis-
guised,  and if joined with a purgative,  acts
very briskly,  and commonly brings away ma-
ny of those vermin.   But worms  being only
the consequence of a weak condition  of bow-
els, mercury,  instead of correcting  the  cause,
tends still more to debilitate the first passages
when continued long, and lays the foundation
for much ill health.   I shall touch on this part
further,  in the treatment, as being intimately
connected  with my inquiry.   In the  mean
time, I cannot sufficiently reprobate the con-
duct of some persons  in high life, who  permit
their names  to be  published in the  handbills
and advertisements  of  an  illiterate  quack,
whose worm  medicine is known  to be mercu-
ry, and liable to be given in very unequal do-
ses, from the nature of the composition.
    About twenty years ago, two children of a
friend of mine, took calomel from the family
apothecary,  for worms.  The exact dose in
which it was  given I do not recollect; but the
motions which it produced were innumerable.
The  family,  during  this process, were all at
once alarmed, by the  singular noise which the
children made in their throats, with an unusual
               I 
123
change of countenance and cast of the eyes ;
which were  quicklv followed  by violent agita-
tions and contortions of body, and lastly  con-
vulsions.  In a few day3 these odd complaints
disappeared, as  the  effects  of the  mercury
abated: but the apothecary thought proper to
repeat the  calomel,  obstinately  contending
that the fits were  mere affectation, and not to
be imputed to the medicine.  The same effects
however appeared after the second exhibition ;
the evacuations were not less profuse and debi-
litating, and the convulsions more frequent and
severe.   The  moment one child was seized,
the other was affected in like  manner :  so cer-
tain was this kind of nervous sympathy,  that
there was a necessity for separating them, that
they might not see or hear one another, and
the fits  went gradually off.   One of them, a
young lady,  has been long  a martyr to the
most painful nervous eomplaints; and I  can*
not help thinking that much of this indisposi-
tion was brought on by  this vermifuge  pro-
cess.
    This mineral, after  long  use, besides ex-
hausting the nervous energy, is known to af-
fect the bones, and render them friable,  just 
129
as thev are found  in rickets  and old' age.
A poison so subtle and active, thus consumes
the vigour  of body, and brings on premature
senility.  Those hidious effects are most pro-
bably produced  by the mercurial oxide first
depraving  the digestive powers,  preventing
assimilation of the chyle, and vitiating sangui-
fication.    On the whole,  while mercury is
capable of  great good in the hands  of the
sagacious  physician,  when  indiscriminately
used by the ignorant of the profession it must
do incalculable mischief.
   Bitters and aromaticks.—These arti-
cles, when well timed, and directed with judge-
ment,  are  valuable  medicines in treating the
diseases now under discussion.  But like many
of the other good things in life, are too often
misapplied, and thus tend to confirm what they
were meant to remove.   I  here use the term
bitters in a greater latitude than is commonly
done by  writers  on the materia medica, and
include the celebrated Peruvian bark, and
those substances which are allied to it,  either
in their effects or sensible qualities.   Their
office is  to strengthen and  stimulate.   The
cinchona (bark)  itself  is a  medicine,   now 
130
a days in such general use, that there are few
diseases to be met with in this country, w here
it is not given at one  period or another ; and
it is to be found  in  every  family medicine
chest.   An article possessing so much active
quality  in the  human body,  as to be capabU
of suspending a severe  ague fit, cannot be
deemed a passive remedy, or what ought to be
trusted in every  person's hands.  The phar-
macutical treatment  of cinchona is also wor-
thy of consideration.  I refer the reader to the
  comparable work, called the New Edinburgh
  ispensatory, by Dr. Duncan, junior.  When
July prepared,  and suited to  the condition of
the stomach, its powers are invaluable; where-
as administered in an improper form, it may
have most baneful  effects. It is recommended
by some authors in doses so large, that in our
practice were never  seen  expedient, or the
stomach capable  of  retaining them.   It is
therefore to be suspected, that in certain dis-
eases, pain,  sickness, and  vomiting super-
vene its use,  and that the effects of oppression
about the stomach after a large dose,  have not
unfrequently brought on such a degree of tor-
pour, as to terminate in death.  On the coast 
131
of Africa, where intermittents assume a more
aggravated form than ever seen in Europe, I
always found,  upon an avarage,  six drams of
the powder given in eight  doses, for four
hours  before the accession of the cold stage,
at half an  hour's interval, have  more effect
than eighteen  drams given  in  twenty-four
hours before the .fit.  This was a  great saving
of the medicine, which is worthy of attention
by  naval or military surgeons on foreign sta-
tions.
    Nothing in  the practice of physick can be
more irksome than to see a poor patient strug-
gling to get over his bitter potion ; it ought at
least to caution the physician against an unne-
cessary allowance of  medicine, for  it must
often defeat its purpose.   When  convalescent
myself of fever in the West Indies,  I was or-
dered a dose  of bark  every hour; but such
was my aversion to the medicine, and such the
irritable state  of my stomach, that the fourth
dose always brought on sickness and vomiting,
t>y which the  whole  was disgorged.   I tried
from day to day, to go on with my quantum;
it was all in vain ; and  at last the very sight of
•bark made me sick.  If such a school cannot 
132
teach a  physician sympathy,  I know not how
it is to be done.
    Those articles, more strictly called bitters,
require still more caution in the exhibition, as
possessing the power of exhausting the excita-
bility of the stomach by long use.   They im-
pede fermentation in the prima via;, and cor-
rect acidity ;  these they  effect chemically.
When long continued, as in the  history of the
Portland powder  for  gout, they are said  to
produce palsy and dropsy, and  every species
of nervous debility.  There must therefore be
a period when the  good  effects cease, and
which careful observers will  mark.  If  bark
and bitters are medicated by alcohol,  in the
form of tincture, it is  obvious  the  hurtful
effects, after a  certain time, must be inevita-
ble.
    The aromatic substances, among which may
be  reckoned all  the spices and volatile oils
used in either diet or medicine,  by repetition
become  hurtful to  the  stomach, whether  as
condiments, with food, or to  cover the  disa-
greeable flavour of some  articles.  These sub-
stances  have, therefore,  a limited  time to do
good, that their use may not become habitual. 
155
There  is  always something  wrong  in those
stomachs which hanker after hot ingredients :
when these persons are  served  with watery
preparations of medicine, they complain  that
they are too cold, and  disagree with them ;
but the moment a spiritous tincture is substi-
tuted, there is little danger of its being refused.
It is the duty of every honest physician to re-
sist those cravings of his patient, and to endea-
vour all in his power to correct hurtful pro-
pensities.
    Vegetable Acids.—It is a well known
fact, how much  these acids  weaken the or-
gans of digestion.    They are  often  drank
clandestinely by corpulent  young womert,  to
correct obesity, that they may preserve their
shape.    This is always accomplished at the
expence of health : cramps and pains of the
stomach,  morbid acidity, and  eructations,
bowel complaints, sallowness of complexion,
nervous head-aches, fainting fits, amenorrhea,
fluor albus,  strangury, See. follow  this prac-
tice, and death frequently happens.   All  per-
sons subject to indigestion,  the  gouty  and
hysterical, know well  from  experience, the
bad effects of native vegetable acids.  They
                    M 
134
may be supposed to act directly on the fibre*
of the stomach : but if they act chemically on
the gastrick juice and bile, they  cannot fail of
vitiating the chyle, preventing  the assimila*
tion of the different intestinal juices, and thus
depraving the nourishment.  But it may also
be  supposed, if not in some degree certified,
that in passing the glands of the mesentery,
they cause obstruction  and  enlargement of
these,  give a disposition  to  scrophula,  and
otherwise injure the whole habit.  Vegetable
acids have thus  a directly opposite tendency
to the  mineral acids, such as the sulphurick,
muriatick, and nitrick, all of which  have a
share of reputation, in states of weakened dU
gestion,
    Narcoticks.—These include ardent spl*
rits, opium, and all those  articles commonly
called  anodynes,  hypnoticks, paregoricks, &c.
such as lactuca, bang, belladonna, hyosciamus,
laurus cerasus, cicuta, &c.   Of the effects of
ardent spirits, in producing stomach and ner-
vous complaints,  I have treated largely in my
Essay  on Drunkenness,  to which I refer the
reader.*   All the  articles now  enumerated,

        * Second Edition. London, 1PG5. 
                    133

 act very much alike on the human body.   Is
 small quantities, they induce vigor, activity
 and strength, and an increase of muscular pow-
 er throughout the frame ; at the same time
 are  felt serenity, pleasure  and courage  of
 mind.  In larger  doses they bring  on sleep,
 stupor and delirium ; and when carried to the
 utmost, quantity, insensibility, apoplexy and
 death.   It is of little moment in this inquiry,
 whether narcoticks ought to be considered  as
 directly or indirectly sedative.   They are
 forbid in all  inflammatory  diseases,  where
 they certainly do harm in the first stage : they
 generally occasion constipation  but hyoscia-
 mus has a laxative quality. When long conti-
 nued, they are known to weaken the nervous
 system  in a surprising degree ; disposing  to
 amentia,  epilepsy, palsy, tremours,  convul-
 sions, melancholy, madness,  &c.  No sub-
 stances  in  nature  more certainly injure the
 powers  of digestion, and bring on all the se-
 vere symptoms of nervous  infirmity.   This
 effect of narcoticks,  is most likely primarily
 derived from the nerves of the stomach, with
 which they  come first in contact, and thence
extended to the other viscera.  Where there 
136
is  a predisposition, or  hereditary  nervous
temperament, or gout, the permanent use of
them  is still more  quickly hurtful :  in such
states of the body, they ought, like vinous spi-
rits, never to be prescribed  but  from neces-
sity.
  'Opium, the  noblest attribute of medicine,
so  calculated by  its powers  to  sweeten life,
and suspend pain,  when all  earthly  comforts
avail nothing, has its limits in doing good.  It
is a misfortune when it comes to be dispensed
by  injudicious  hands; for it is often prescri-
bed by the most ignorant, in  diseases  where  it
is  forbid.   The bodily complaints of the hu-
man race,  when enervated by luxury and re-
finement, seem to  produce more  acute  pain,
at least the temperate man is observed to bear
 sickness with more patience and  resignation,
 than those accustomed to indulgence.   The
 spirits are apt to flag, as if the  mind had no
 resting place.   Opium  alone  gives  relief,
 though it must feed the  disease.  Such  per-
 sons seem to compound  with their physician
 for sound nights and days of ease ;  and if  he
 does not comply, he must be changed.  Hard
 is  the task imposed on the medical attendant; 
137
 he must obey, or starve.  The night draught
 thus becomes familiar in the family : the ser-
 vant goes to the apothecary for it with as little
 ceremony as he buys  kitchen silt.  He sees
 the shop boy count the drops into the phial,
 and when he gets home, narrates the composi-
 tion of the placebo to the cook and the nurse-
 maid.   Not a  domestick in the  house but
 soon learns what a fine thing laudanum is ;—
 and master swears he can get no rest without
 it.
     If such things did not exist, how comes  it
 that seven young  women  in this  neighbor-
 hood, within the last three years, should have
 known that a large dose of this tincture will
 kill.  Two of the  number effected  their pur-
 pose.  I was called to visit another in con-
 junction with Mr. Elliot: she had swallowed
t twelve drams of laudanum ; but I arrived be-
 fore it had been twenty  minutes  in her sto-
 mach, and  by plentiful dilution with vinegar
 and water, followed by an active emetick, the
 bad effects were  prevented.   I remained  in
 the house till I was certain that every drop  of
 the opium  was discharged,  and she did well.
 It appeared that these poor girls had become
                     M 2 
138
the dupes of designing men, and called  for
death to end their sufferings.  Thus the dose
of opium  concludes what  was begun in  the
circulating library.   A little  more  secrecy
and discretion are certainly wanting in the ge-
neral use of this dangerous narcotick.
   But there is  reason to believe, that even
medical men themselves, have of late, entered
too  easily  into  the indiscriminate use  of
opium.  He must be  a short-sighted physi-
cian that does not calculate upon the ultimate
effects  of his prescription :  it is a weak  ex-
cuse for getting quit of the importunities  of a
patient, by  complying with  an  improper re-
quest, that may afford* temporary ease, at the
expence of permanent health.  In the nervous
temperament it is particularly hurtful.  I am
acquainted  with  numbers of ladies that  feel
such horror at taking it, as nothing can equal;
and  in  every  illness they  may labour under,
constantly warn  the medical visitor about gi-
ving it, as no disguise  can make it  agreeable
to them.   But,  when opium happens to be
soothing to weak nerved  people, from their
 quick  sensations, it is apt  to be the more
 craved for, and  converted  into habit.   The 
139
langour and dejection which follow its opera-
tion  pave the way  for the repetition  of the
dose, till general  debility succeeds.  In such
constitutions, the exhibition of opium ought
never to take place on slight occasions.   Mid-
wives, nurses,  and  other persons  out  of the
medical  profession, who dispense  laudanum
at random, ought  to be  solemnly  warned
against it.
   The  opium-eaters in Turkey, are the most
pitiable objects in society.  Their squalid looks
and  emaciated  bodies, after a long course of
this  narcotick, evince how fatal its use is to the
digestive organs, and how it prevents the due
assimilation of nourishment.   On dissection,
the  same effects appear in the stomach, liver,
and  bowels, which follow a long course of
ardent spirits.   Like the dram drinker also,
when deprived of his wonted cordial, they are
languid, faintish, low-spirited,  nervous,  and
feeble.   Their limbs totter under them ;  their
heads  and hands tremble, and the very wind
is in danger of oversetting them.  Their facul-
ties  seem  exhausted,  the  memory fails,  and
the  only remnant of intellect which they pos-
sess, appears in the frightful accounts  which 
                    140
they give of their horrors, and the hypochon-
driacal glooms with which they  are infested.
No form  of disease exhibits existence under
a more^deplorable  shape than the opium eater
and dram drinker.  There  is great reason for
suspicion, that this drug is daily getting more
iqto use as a cordial, and privately consumed
by  numbers of  persons.   It is well adapted,
fiom its preparation in tincture,  to be carried
about, and drank at pleasure.  Its exhilirating
quality creates a momentary heaven for minds
who find nothing but guilt and despair in their
own reflections: hence it has grown so general
in  fashionable circles.   I am also of opinion
that many sudden deaths  are  in the present
times, occasioned by this drug,  without excit-
ing the least suspicion of its   being taken.
Those who accustonMhemselves to the narco-
tick article called bang, in the East Indies and
in  the Turkish  dominions, are said to perish
under diseases  similar to  those of the opium
 eater.
    Tobacco is another narcotic in common use.
 Persons  who are in the  habit of   chewing,
 snuffing,  or smoking this Indian leaf, are not
 aware, that a few grains of it taken into the 
141
storciack,  cause  sudden  death.   Nay, the
smoke of  it injected' into the rectum, has fre-
quently proved fatal.  It  powerfully acts  on
the nervous system,  destroys the sensibility of
the stomach; and it is observed that those who
devour it  in great  quantity, die of  apoplexy,
palsy, and dropsy.   v
    Poisons.—All kinds of poison, so called,
whether taken from the animal, vegetable, or
mineral kingdom,  if  not immediately  fatal,
weaken or  destroy  the functions of the sto-
mach, derange the nervous system, and bring
on nervous  diseases ; so certainly are the di-
gestive organs the first to suffer, and stand
from their office as centinels of life.
    Bleeding.—Numbers of persons labour-
ing under nervous debilities, attribute the first
appearance of their malady to large bleedings,
or  evacuations  of blood  from  other causes.
No  fact is  better known  to the medical ob-
server  than that frequent convulsions  are a
common consequence  of   the  large loss  of
blood.  The nice connection between the cir-
culating and nervous systems,  cannot be well
explained, but they act reciprocally on one an-
other.  It is equally clearly ascertained, that 
                    142

men or  women of the nervous temperament,,
bear the loss of blood ill.   Indeed it seldom
or never happens, that their diseases indicate
the practice:  when done,  it has  commonly
been through  the ignorance of some stupid
attendant.  Abortions,  and severe  floodings
after child-birth, are often  traced  as  the be-
ginning of painful  and  lingering nervous af-
fections, that sometimes remain for life.
   Reflections on Medicines.—Physicians
having wisely  drawn the line between medi-
cine and diet, the former can only be indicated
in  some of the  diseased  conditions of the
body.   There are a multitude of articles  in
materia medica,  beyond what I have  thought
proper to animadvert on  here, possessing equal
activity to those enumerated.  Some of these
may be supposed to have a chemical agency
on  both the solids and fluids;  while others
appear to act more immediately on our sentient
parts.   It is evident, then,  from the most ac-
curate   observations, that  such  substances
ought to be exhibited with great caution,  and
their operations watched with the most punc-
tual attention.   Many of the metallick salts,
the mineral acids, all the alcalis, some of the 
143
tieutral salts, and many simple remedies taken
from the vegetable kingdom, are of this des-
cription.  The nicest study  of the physician
must  be that  at the bed side of his patient;
in observing the phenomena of disease;  de-
veloping the genius of a distemper ; unfolding
peculiarities of  constitution ; selecting medi-
cines for these indications of cure, and dis-
cerning [their  action and  appreciating their
power,  that he may be enabled to proceed on
the same plan of treatment, or adopt another*
Nature  has endowed  so few minds with that  „
superior intelligence of being equal to  this
task,  that we cannot be  surprized when told,
that  medicine is  still in many respects  "a
conjectural art." Where men do not all possess
the came sagacity, cultivated talents,  and ex-
tensive acquirements, they must think  and
reason  differently, on subjects which bear no
resemblance to other  human pursuits ;   and
 concerning which  no appeal  can be made,
 without overstepping the bounds  which divine
 Providence has prescribed for the ingenuity of
 mankind. 
144
             CHAPTER IV.

Influence cf  these diseases on the character of
     nations, and on Jomeitick happiness,

    IT is a fact fully  confirmed in the history
of  mankind, that a similarity-of manners has
ma'*.Led all  nations,  in  their progress from
riidtness to refinement; in their rise  and in
their  decline.   An infant state is commonly
poor :  but from  intercourse with its  neigh-
tours, it learns the advantages of a change of
produce  and commodities ;  and  this traffick
soon gives spring to  ingenuity,  and birth to
adventure.   Amidst  its  articles of utility, it
also imports some that are showy and elegant:
the arts of inventing  new sources of gain, be-
ing natural to the human mind, gradually  ex-
tend ;  till luxury in all its shapes, appears in
the manners amusements, and government of
every commer ial people The ai ms of impe-
rial Rome si   ued the world ; and made that
city the emj-.-ium of wealth and grandeur, 
145
drawn from all other nations.  Luxury, crimes
and irreligion, were soon the consequences of
power over-grown, and  riches  unbounded.
And this haughty,  wicked people, when they
had lost their moral virtue and dignity, and
with these, their physical strength, became a
prey to barbarous hordes ; who, undebauched
by refined pleasures, found the enervated Ro-
mans an easy conquest.    Let Great Britain
look to this example.  The East and West In-
dies at this moment, are St theatre of oppres-
sion and slavery, to gorge  her with commer-
cial wealth ;  and a district of Africa, larger
than Europe, is made a field of blood, to pur-
chase the natives for cultivating her colonies,
whose produce only tends to weaken "her man-
ly character, and overwhelm her with nervous
infirmities !
   The rise  and fall  of  a  large commercial
town, may be taken as an example of a nation.
From a few fishermen's huts, on some river
or arm  of the sea, it gradually  extends and
improves, till the exchange for business, and
the  theatre for amusement, become its orna-
ments.  A narrow port is by degrees, widen-
ed into a capacious harbour: and  the ware- 
146
Louse, manufactory, and shop, increase in pro-
portion, till wealth and elegance dazzle in eve-
ry lane and alley.  The coffee-house,  the inn,
and the tavern, grow necessary  appendages to
business  and pleasure :  the  morning begins
with a bargain, and the evening closes with a
banquet.   Then the rout commences, to  teach
the young the arts of gaming ; and the  mid-
night  masquerade  initiates  them  into  the
wiles of intrigue.  The  riot disturbs sleep;
the drunkard is seen staggering home, in dan-
ger of robbery and death ;  and the woman of
the town, deserted by her destroyer,  is  seek-
ing  reprisals, and looking for prey in  the
streets.  Now the hospital and  bedlam appear
:>n the suburbs ;  the first to receive the  poor,
sick, and lame ;  and the other  to confine  the
more wretched in mind.  The physician and
apothecary are seen gliding in  their chariot3,
v, ith retinues sometimes not much  like men
%vho are  conversant with human affliction, and
enriched by  the  luxuries and  vices of their
fellow mortals.   Morals and health are alike
committed in  this vortex of wealth and  dissi-
pation.   The industrious man who began  the
voild with a capital of fifty pounds, who ros« 
ur
at five, and went to bed at nine, who dined on
a plain joint and pudding, and drank nothing
stronger than table beer, does not find a for-
tune of fifty thousand pounds  exempt  him
from  gout and nervous torments.  A crowd-
ed population multiplies all contagious  mala-
dies, but especially fevers of the worst kind.
Fashionable pleasures  such as towns only ex-
emplify, are a fruitful source of weakness and
pain:  and drunkenness and  mercurial cour-
ses, of themselves, produce  more wretched-
ness and disorders, than the whole natural in-
firmities of life.   Under these circumstances,
the human frame  must degenerate in both bo-
dy  and mind, as we see  in  modern Egypt,
Turkey and Italy.  Thus flourishes the  com-
mercial town or state, till its  wealth and effe-
minacy weigh  it  down ;  when  it  falls like
Tyre or Alexandria, like Corinth  and Car-
thage, to be a retreat to robbers, and a den to
wild beasts.
   As we analyze the manners of society, and
scrutinize those causes which lead to the dis-
eases of which we treat, we observe their ope-
ration and influence  to  be very general, and
daily  increasing.   Commercial  Britain, en- 
143
riched by manufacture and colonial wealth,
when compared with her barbarous state does
not exhibit a nobler spirit of independence, or
show more fortitude in opposing French inva-
sion,  than what was done  nineteen hundred
years ago, by our  forefathers, in repelling the
Roman legions.   Our  invaders  were then
obliged to build strong walls and  ramparts to
shelter them from the Britons :* but modern
Britons have erected Martello towers, projec-
ted the  inundation of  Essex, and  hoarded up
the current gold coin, as tokens of being afraid
of the French.  These alarms are to be consi-
dered as so many symptoms of a nervous tem-
perament appearing in our national character.
Britain had no ships to oppose the landing of
Julius Caesar ; but at  this  moment she  has a
navy  capable of  fighting the whole fleets of
Europe united ; yet she trembles at a flotilla
of cock-boats.  It is  that puddle of corrup-
tion,  the  Stock  Exchange;  that  Delphi of
Plutus, where stock-brokers pay  their vows,
and expound prophecies,  that has  filled th;
nation with degenerate  fears, apprehension,

   * The walls of Adrian and Severus. 
149
 and hypochondriackism.   Europe has  been
 saved by  the British navy from the  fangs  of
 French tyranny ; yet shameful  to be told, af-
 ter the fleets of France have been annihilated,
 we are now  to  be assailed by three thousand
 wherries, manned with blue devils.*
    If I am altogether  correct in saying, that
 the nervous  temperament  is  hereditary, and
 therefore the diseases which depend upon  it,
 liable to be  extended  to  the offspring,  they
 must multiply in prodigious proportion.  They
 appear in the  present age to have  acquired
 that growth,  which  nothing but a general re-
 volution  in all ranks of society can check.   I
 may be told that these diseases are  not very
 dangerous, and very seldom produce death ;


   * The gentlemen of the Stock Exchange, as they
dcuomitate themselves, are projecting great things
from the conquest  of Buenoes Ayres.  Spain, humbled,
degraded, pillaged, by an imperial cut-throat, is almost
blotted out of the map of Europe ;  which she owes to
the gold and silver brought from the new world.  Yet
these gentlemen seem to entertain no fears for the like
fate happening to Great Britain.  Such is the patriot-
ism of money lenders!
                     N 2 
150
 and it may be added, the bills of mortality do
 not justify  my  conclusions.   These  argu-
 ments are easily answered.  It is true,  death
 is seldom put down to nervous disorders : but
 if constant pain,  mental disquietude,  and ap-
 prehension of dying, are to be considered as
 evils in this  stage of existence, then are ner-
 vous afflictions to be held  as the chief cause
 of  them.  And it is to be  remembered,  that
 the most frightful part of the catalogue of dis-
 eases, such as apoplexy, palsy, madness, me-
 lancholy, epilepsy,  convulsions, cholick, ili-
 ack, passion, atrophy and dropsy,  are  often
 ushered in by nervous affection, before they
 assume their own character and shape.   Phy-
 sickal strength of body cannot be long pre-
 served under enervating modes of living: the
 stature and the mind must both diminish and
 degenerate.   The poet says, fortes creantur
fortibus et bonis; and very aptly adds,

     ----nee imbellem feroces,
     Progenerant aquilx columbam.        Hor.
                                          V
    An eminent  senator,  Sir  John Sinclair,
 has lately made  some noble attempts to rcge- 
151
nerate the physical  strength  of the country,
by recalling mankind to agricultural life. His
institution of a society for that purpose, under
the authority  of parliament, has alread}? had
considerable effect.  Many noblemen and gen-
tlemen, of great landed property, have second-
ed these patriotick views, and turned their at-
tention to this national object: a spirit of im-
provement has appeared in every county,  and
is daily increasing.  No man who possesses
the smallest spark of love for his country, but
must wish full  success  to  the undertaking.
No truth in political  economy is better proved,
than that a nation  of sedentary people, can
never be a nation of heroes.   We might in-
deed preserve all our manufacturing establish-
ments,  and most of the fine  arts,  during the
degeneracy  of physical courage:  but could
an army of man-milliners  defend the British
islands  against the  ruffians of  Bonaparte ?*
The puny inhabitants of Italy and Indostan,
are finer spinners of  silk and cotton than Eng-
lishmen, because they are strangers to all the
masculine virtues.  Let us therefore beware
* Non Ids juventus crta parentibus, &c.  Hor. 
152
Tiow we extol too much the effeminate labours
of the spindle and the loom.   A commercial
people merely, can never be an independent
nation. They owe to foreigners the consump-
tion of their manufactures ;  and  when these
chuse to do without them, or to buy them else-
where, such a people must become bankrupts
in finance.  The glory  and security of the
United Kingdom, must be to blend these pur-
suits,  agriculture and commerce, in the na-
tional character.
    From the imperfect state  of the medical
histories, which  have come  to us, from the
early ages  of the world, we are left  much in
the dark, how far luxurious living and effemi-
nate customs,  affected the health of  nations.
We are told of their vices  and debaucheries
arising to excess ; and these  seem to have ge-
nerally been forerunners of their fall and de-
cline.  When the form of republican govern-
ment in  Rome, yielded to the tyranny of the
Csesars,  with it  the  republican virtues  gave
way to the vices  of courts ;  and the  Romans
soon after  lost their character  for  military
prowess.  It is therefore but  fair to infer, that
the faculties of soul,  and the vigour of body, 
150
 underwent immediate changes ;  and that a
 train of diseases, of a peculiar cast, sprung  up
 among  this debased people.  Hence the mo-
 dern enervated inhabitant  of Italy must  be
 very unlike the ancient warlike Roman.  The
 youth  of the one is spent in learning musick,
 painting  and frippery:  the other was early
 trained to bear fatigue, hunger,  thirst, run-
 ning, leaping,  swimming,  &c.   Diseases  of
 the same  class, could not therefore exist, in.
 constitutions so different in habit and predis-
 position.   The rural life also occupied a con-
 siderable  portion  of time  with the Roman
 worthies of the old republick.   All the Latin
 classicks  abound  with  beautiful eulogies  on
 rustick manners, scenery, and recreation, par-
 ticularly  Virgil, Horace, and Pliny the youn-
 ger.  The greatest man whom modern ages
 have produced, George Washington, Esq. was
 of this  school.   How much nobler was  it to
retire from the command of a victorious army,
 after securing the independence of his coun-
try, for the study of nature  in his own  farm,
than to live in a city to learn excise laws, and
squeeze taxes from industry, to pay profligate
favourites, and unprofitable wars.  How mean 
J5-i
and  contemptible the  upstart emperour  of
France appears, when compared with this tru-
ly christian hero, the friend and admiration of
human kind !

   The diseases of a labouring and active pea-
santry, or of those of any condition  of  man-
kind, exposed to the weather in all seasons, arc
almost confined   to the  inflammatory class ;
such as pleurisy, acute rheumatism, catarrh,
cynanche, Sec.  These  depend on a vigorous
vital power, a rigid fibre, and a  florid dense
blood :  they are  a directly opposite  state of
the system to what predisposes to nervous dis-
eases.   No kind  of diet comes wrong to the
stomach of a hale rustick ;  the unleavened fc.«
rinacious  meal, or a draught of imperfectly
fermented malt liquor,  that  would throw the
dyspeptick  and bilious  citizen into a cholick,
he takes down with impunity.  He is also ca-
pable of braving fatigue, privation of food and
sleep, and tvery  other hardship, in a manner
that would  soon destroy the town inhabitant.
A nation that cannot recruit its  soldiers from
a robust and hardy peasantry, can never bring 
155
into the field an army able to endure the tolls
and adventures of actual war.*
   Amidst the general effeminacy of manners,
that is rapidly consuming the manly spirit and
l-hysical strength of this age, and what may
ultimately annihilate  all that  is  great  in the
character of Britons, it is somewhat consoling
to observe, that the seamen of the navy, that
bulwark of  our liberties, will be the last of the
community to feel the .effect of those enerva-
ting  customs.  The naval officer and seaman
 embark in their profession while boys,  before
 they can be acquainted with the softening arts
 of the day.   Hardship, danger, and privation,
 are the lot of naval service.; to brave the wea-
 •iher, the season, and climate, is their delight
 and  their duty ; which, fortunately  for their
 country, grow into  habit.  Hence they have
 little enjoyment  among  the common amuse-
 ments of society; and feel that kind of life
 hang heavy upon them, that gives no birth to
 action and enterprize.   It is true a  species of
 nervous disease  did make its appearance du-

    * See Dr. Robert Jackson, the army physician, , s
 ■tiiiri subject. 
155
 iing the late war.    It  occurred  among  both
 officers  and men ; but was by no means a ge-
 neral malady.*   The  hard duty of a stupid
 blockade, had a chief share in its  production.
    Statesmen, I believe, seldom or never read
 the  medical  history  of  fleets  and  armies.
 They are afraid that such gloomy narratives
 would alarm  conscience, and  bring on fits of
 hypOchondriackism.f   Yet by these means,
 they might be made wiser ministers, if not bet-
 ter  men.   The practice of blockade has crept
 much into our naval system of late ; yet it was
 abhorred by Howe and Nelson, as inconsistent

          * Med. Nautica, vol. 2.
   f The fate of the cow-pock inoculation in this coun-
try,  is a proof of the indifference of politicians to the
y.iv icvcvnent of  the health and si.fcty of the communi-
ty.  It has been said, that the late minister refused  to
become a member of the society for encouraging vacci-
nation : and  his predecessor, the son  of a j hysician,
opposed the ^ift of 20,000!  to the immortal ruthmir of
this  matchless discovery,  so that the grant  vas only
10,0001.  The preccr.t ministers, it is to be hoped, will
retrieve the credit of the nation, by bestowing the me-
rited honours ar.d rewards due to Dr. Jenner. See also
the fate of this dLcnyery in a branch of publick service.
Med. ¥d'i:. vol.  J. 
15,'
with the genius of our seamanship.  But, tho'
it may be conducted with ease  in the equal
weather between the tropicks,  it can never be
effective  in  the stormy seasons of  European
seas.   Such a mode of service  is calculated to
please underwriters and stock  brokers ; but it
can never be acceptable to the officer and sea-
man.   A-duty so severe, without  variety to
give spring to adventure,  benumbs  the facul-
ties, exhausts the bodily powers, and in habits
predisposed, brings on nervous irritability that
shortens the span of life.
    It has been gravely asserted,  and with
much  probability  of truth, that during  the
reign of terrour in France, in the late revolu-
tion,  a period  marked by fury and blood be-
yond whatever was known in a civilized coun-
try, all diseases, usually  called nervous, low
spirits, or hypochondriackism, quickly disap-
peared.  These diseases are so nearly connec-
ted with the  tenor of the mind, that great com-
motions in the moral world, may both  induce
and remove  them.  But if, as we contend, they
are chiefly the offspring of a life of sloth and
inaction, violent popular  tumults, that rouse
anarch}'  and ferocious passions, and let loose
                     o 
!58
the furies among mankind, cannot fail of ma-
king strong impressions on the timid and des-
ponding.   AH  physicians conversant with
these distempers, are aware that a correspon-
ding train of thought attends the bodily disor-
der ; and that it is  a preliminary step to the
cure, to infuse activity of mind, so as to force
new ideas on the patient.   We have heard of
a fit of the gout being instantly cured by the
alarm of fire ;  and the person confined, throw-
ing his crutches away to escape from the dan-
ger.  Nervous persons in different families,
have been  suddenly relieved by  unexpected
good fortune coming upon their near relatives j
and the  indisposition has  again recurred by
the return of  a fresh disaster.
   The South Sea scheme of 1720,  that bub-
ble of commercial speculation,  gives a curious
example of the English character.  It was re-
marked at that  time, that more  instances of
madness appeared, than at any former period.
In  short,  numbers  became maniacks,  from
the sudden wealth  which fell to them; these
were probably of the nervous temperament.
The transition was too great and quick for the
sensibility  of particular constitutions.   This 
159
 scheme having soon-failed, it is likely  that
 hypochondriackism and  low  spirits,  would
 succeed  to an equally sudden reverse of for-
 tune ;  but of this we are not told.
    A naval officer, while abroad in the  late
 war, received a letter from his sister,  telling
 him, that his ticket in the lottery had come up
 a  prize of 20,000/.   He  was so elated with
 the news, that he  became instantly delirious ;
 leaped from a wardroom window into the sea,
 and was drowned.   The Athenian soldier,
 who ran to  the  city covered with  dust and
 blood, to announce the victory of Marathon,
 was so overpowered at  the event, that he
 could only call out, " Rejoice with the victors"
 and  immediately  expired.   In  like manner
 the Roman mother died suddenly, on hearing
 that her son had survived the battle of Cannae.
 It is probable all  these persons were  of the
 nervous temperament, from being  subject to
 such violent emotions.  Bad news, such as
 the death of wives and husbands, or children,
 however suddenly told, or  happening unex-
 pectedly, do .iot seem to operate like excessive
joy.   Grief is slow in producing derangement
 of mind ; and is nearer  to  what we call the 
160
mild delirium:  while the frenzy  of  joy par-
takes more of the delirium ferox.   I  have ob-
served something like temporary  insanity,  in
several  officers, who had, at once  been ele-
vated from extreme poverty  to a fortune, by
prize-money.   Men who have  been  wealthy
and  afterwards reduced to indigence,  often
sink  into despondency and low spirits.   But
it is  also true,  that persons who  have,unex-
pectedly received great riches or legacies, are
apt to turn hypochondriackal, by being lulled
into  ease and security, and having no longer
cause for action and enterprize.  I  have known
habitual drunkenness in a family, that brought
on some of the most afflicting nervous symp-
toms, completely overcome  on a signal mis-
fortune befalling a brother ;  and  nothing be-
yond water used afterwards.  Such a fact
totally disproves the reasoning of those physi-
cians, who  tell us it is dangerous to subtract
the stimulus all at once.  The mind that  is
stabL-, by a firm nervous system, is little shook
by the  incidents of  life : whereas  the fickle
constitution of nerves bears unequally  every
vicissitude ;  but sustains  sorrow and disap-
pointment, better than joy and good fortune- 
161
 Thus the moral propensities are to be learned
 from the  physickal  habit;  and the peculiar
 genius of  diseases, unfolded by the passions
 of the individual.
    The nervous temperament, abstractly con-
 sidered, is often the seat of dispositions, that
 appear in  two extremes ; and giving birth to
 passions  of the  most  opposite  kind.  Under
 the  government of  a bad  heart,  it  is fero-
 ciously cruel, or  abjectly  timid.  When men
 possessing those  traits of character, happen
 to be  armed with power,  they become the
 scourges and butchers of mankind.   Such, we
 suspect to have  been  the temperament of all
 those tyrants, whose reigns have been marked
 by murder and outrage in the  history of na-
 tions.  The present ruler  of a neighbouring
 people, appears to be a man answering to this
 description. Pie is said to  be subject, at times,
 to the deepest hypochondriackal glooms; and
while under their influence, his  temper exem-
plifies more of the demon than the human be-
 ing.   Jealous of his personal safety, even to
timidity,  because he is aware that his plans of
ambition  are to be effected by bloodj and ac-
 complished by perfidy, he knows that he can-
                    o 2 
162
not be beloved.  Through slaughter and fraud,
he has waded to a throne :  and his obtaining
the sceptre,  was the signal  to shut the gates
of mercy against his  species.  A stranger to
every domestick enjoyment ;  unsusceptible of
the tender  passion ;  and aloof from  all the
temperate   and  soothing  pleasures,  which
sweeten the slumbers of a good man in power
and prosperity,  this arch tyrant is  said nev r
to sleep two nights in the same bed, from the
 dread of assassination.  When any  sudden
 disaster befals  his projects, without a single
 virtue to cheer reflection, he becomes his own
 tormentor: his bowels are wrung with spasms;
 the biliary ducts partake  of the commotion ;
 and a jaundiced hue of the eye, indicates to
 the spectator,  the features of some devil that
 has  usurped the human  form.  Under this
 sombre cast of  countenance, his vindictive
 passions brood over crimes, and hatch plots,
 that he may find  victims to glut his desire for
 blood.  In such moods, he sends to the guillo-
 tine, incarcerates, or proscribes the devoted
  loyalists of France ; anticipates in  their fate
  the doom  of Englishmen ;  and feels in minia-
  ture that gratification, which he longs to ex- 
163
perience  by the invasion of  Great Britain.
Historv tells us  of  bad  men that were  born
with teeth in their jaws, and of others, whose
hearts were found hairy:  such relations are
amiable,  if they even arose from the folly of
superstition, as  they  imply the hidqpusness
and detestation of vice.  And future ages may
inquire with avidity,  for  the puysiologickal
structure of that breast that was so superla-
tively steeled, and possessed passions so tran-
scendently cruel above what is recorded of the
common destroyers'of mankind.
    But it must be unfortunate for any nation
to be governed  by a man of capricious tem-
per,  even though his passions are gentle and
mild.  A nervous statesman could not easily
divest his publick measures of some portion
of his constitutional dispositions.   He would
at times view  things through a false medium :
and by judging from mistaken premises, would
conduct the business  of  government with im-
becility and supineness,  and bring it into con-
tempt.  Every plan he devised, would partake
of the mood he happened to be in at the mo-
ment : it would be liable to defeat, and exposed
to opposition ; in  hazard of being divulged 
164
 before execution,  and open to derision.   The
 morbid sensibility of a  deluded hypochondri-
 ack,  might alarm a  people by imaginary dan-
 gers : and in the season of  disaster, might
 bring ruin  on affairs by irresolution and des-
 pondency.   By  such men nations  have  beeu
 plunged  into unnecessary  wars ;  and inglo-
 rious peace  concluded,  when advantageous
 terms might have been obtained. Men endued
 with  an  exquisitely  nervous  temperament,
 ought to  be banished from  the councils of all
 sovereigns, however respectable their talents ;
 for consistency and fortitude^ire incompatible
 with their physickal character.
   In the  medical profession,  the  nervous
temperament might also so affect the practice
of the physician, as to render it feeble, fluctuat-
ing and irresolute.   Diseases  often  take most
unaccountable turns,  not to  be foreseen or
prevented by human  abilities.   Such sudden
changes not only require firmness of mind and
address,  on the part of the attending physi-
cian;  but  his  conduct and example may so
affect  the patient, as to bring on a fatal des-
pondency.   Hence the value of  confidence in
the medical friend.  To a sick person,  who 
165
things  himself in  danger, nothing is-so dis-
tressing, as to behold fear and distrust in the
countenance  and deportment of his  medical
director: a nervous frame  is therefore very
inadequate to some situations of this office.
    But in  the. comrnon transactions of life*
nervous people  are  difficult  to  be managed.
Their  tempers are fickle, their spirits unequal,
and their attachments equivocal.   In business
they are indecisive, unsteady, and impractica-
ble.  Their  friendships are often puerilish,
and their resentments unmanly.   Amidst do-
mestick connections, they are apt  to teaze
their relatives by the  observance of  trifles ;
while  concerns  of importance are frequently
degraded  by  an ill-timed levity.  Much of
their time therefore is spent in making conces-
sions to others  for the  inordinate ebullitions
of  passion ; or in  torturing themselves  by
groundless fears,  or imaginary  affronts.   At
one moment  you  find them obsequious and
compliant,  grateful for correction, and gentle
on  being reminded  of their duty.   But this
even tenour seldom lasts long ;  and they grow
impatient of  contradiction, and  furious  from
restraint.   These transitions are commonly 
155
sudden ; the same wavering and  capricious
principle of action appears to direct alike the
healthful and the morbid state.   We behold
them one day taking leave of their friends,
with all the solemnity and earnestness of dy-
ing men ; and in imagination suffering worse
than death  : while on  the  next, they will be
seen plunged into dissipation,  fascinated with
pleasure, and  attending every fashionable  a-
musement.
    On the  other hand, the nervous tempera-
ment is often found to be the soil of numerous
virtues :  the  noblest  feelings  are cherished
here.  Sensibility to  excess  marks the consti-
tution  ; and affliction cannot address it with-
out meeting its sympathy.   It is this degree
of feeling that  too often makes it the sport and
victim of passion.  It loves and hates beyond
bound.  Hence those  corroding  sorrows,
which  sometimes overtake the  most tender  of
all  attachments,  and which ultimately  bring
the possessor to  the grave.  In adverse cir-
cumstances nervous  people easily despond ;
and sink under misfortunes, which if opposed
by  patience and firmness  might be  happily
overcome.   In  this  temperament of the sen- 
                    167

 tient system,  a  genius for the elegant arts
 chiefly  originates.   The poet,  painter, and
 musician, may be justly styled genus irritable
 vatum.   We here meet with the whole eccen-
 tricities of superiour endowments, often blen-
 ded with the most abject pursuits :  sublimity
 and debasement frequently mixed in the same
 character.   Cheyne, in his English Malady,
 facetiously remarks : " I seldom ever observ-
 " ed a  heavy,  dull, earthy, clod-pated clown,
 " much troubled  with nervous  disorders, or
 " at least, not to any eminent degree ; and I
 " scarcely believe the thing possible, from the
 14 animal  economy and  the present laws of na-
 " ture___p. 180.
    On  the whole, the influence of these dis-
 eases is often great on national character and
 domestick happiness.   When wealth and lux-
 ury arrive at a certain  pitch in any country,
 mankind  cannot  remain  long  stationary  in
 mental  qualifications or  corporeal  strength.
 Domestick peace  is first invaded by asperity
 of  temper and turbulent passions.   Vices and
 diseases are  close attendants on riches and
high  living.   All  these   gradually extend
among the community ; and the circle widens, 
168
till it engulphs a whole people ;  when polished
society may be said to bring on its own dotage,
and to dig its own grave ! 
169
              CHAPTER  V.

  History  and progress cf these diseases,

   A METHODICAL history of these dis-
eases, at least a narrative of the symptoms as
they appear in succession, is  almost impossi-
ble.   They assume such variety  in form and
manner, in different persons,  that we  look in
vain for regular order.  The only thing cer-
tain and peculiar in their character, is predis-
position ; which may be divided into heredita-
ry and acquired.
   1.  By  hereditary  predisposition  is to be
understood, an original conformation of body,
transmitted from the  parent to the offspring ;
by reason of which, when particular exciting
causes are  applied,  a similar train of  morbid
phenomena takes place. A predisposition may
therefore  appear long before  any symptom of
actual disease has shewn itself: as in the phthi-
sicnlly disposed, a person will be easily affec-
ted by weather and  sudden changes of tempe-
                     r 
170
 rature ;  and on  slight occasions, liable to
 cough, hoarseness, tightness or stitches of the
 breast, &c.  The hereditary disposition to the
 diseases  in question,  may  be marked in the
 first stages of infancy in many  cases; in others
 not to a later period.,  or till particular causes
 bring forth the latent peculiarity.   The child
 born of nervous parents, that is to  say, per-
 sons of weak digestive organs,  and irritable
 nervous system, subject to bilious and spas-
 modick complaints, &c. will at the breast, be
 very liable  to bowel affections, such as cardial-
 gia,  flatulence,  constipation, or  diarrhoea,
 gripes, yellow gum or  jaundice, &c.  These
 will be apt  to come on  from slight  occasions*
 as when the milk of the nurse  is affected, ei-
 ther by her passions or  improprieties of diet,
 or when any thing  has  entered its food that is
 difficult of  solution in  the  stomach.   These
 causes will-frequently operate with such effect,
 and to such a degree, as to induce convulsions
 and death.
    As  the  child grows up, the tendency to
these complaints will be more perceptible on
slight  deviations from  its regular  modes of
living.   If it meets with  badly  fermented 
171
bread, heavy pudding, eats too freely of fruit,
sweetmeats,  pye-crust, all  kinds  of  pastry,
pound cake ;  or  drinks of cyder, perry, beer,
wine, punch, &c. the stomach and bowels will
be quickly disordered.  At  the same time, a
peevishness and fretfulness of temper will ap-
pear, extreme irritability, want of sleep, sleep
disturbed, with other nervous symptomsjtillthe
offending cause has been corrected in the  firaC
passages.
    In some of the diseases of infancy, such
a child  will suffer more than other children.
At the teething period,  it will be more likely
to be  seized with bowel disorders and  convul-
sions  : in the eruptive fever  of the small pox,
it will be more prone to these fits :  and in the
hooping cough, as being a spasmodick disease,
the nervous infant  will be a severe sufferer.
Frights of all kinds, that ruffle the temper, and
impatience under bodily pain, will be attended
with irritable passions.  Worms are the  con-
sequence of weak bowels and disordered di-
gestion ; a child  of this description will, there-
fore be much troubled with worms, and gene-
rally  their most  troublesome symptoms.—
These symptoms  will sometimes put on all 
                   172

the appearance of a confirmed hydrccephalut
interims, even to the last degree of strabismus*
I have  seen so many instances of recovery
from this apparently hopeless state,that I am
disposed to refer the whole to their intestinal
vermin,  or  to some  aggravated attack of sto-
mach affection, depending on original nervous
predisposition.
    At the age of  puberty, if a female, it will
be  liable to be affected with that disease  usu-
ally called chlorosis ;  which,  besides so many
symptoms of dyspepsia, combines with it the
emansio  mensium.  The chorea, or St. Vitus's
dance, also appears about this age : and in nu»
merous  cases which I have seen of both  com-
plaints, I am disposed to think, that they never
occur without manifest predisposition, and are
 therefore to be considered rather as symptoms
 of the  nervous temperament, than  as distinct
 diseases.  The changes which bow take place
 in the   constitution, conjoined  to  the quick
 growth of the body at the same time, will ren-
 der this a most critical  period.  At this sea-
 son,  the nervous woman is first affected with
 hystericks ; these  added  to many painful
 symptoms of increased  irritability, will be agt 
                    173

to recur at distinct intervals, through life, par-
ticularly if unmarried.   Extreme delicacy of
stomach, dyspeptick  affections, and what arc
called  bilious, dysuria, leucorrhcea, hemicra-
rvia, &c. with other nervous signs, will be the
lot of this hereditary predisposition.
   The female that is born of gouty parents,
comes entirely within  this description.  The
fact  is  notorious, that what  is called regular
gout, or gout shewing itself in the extremities
of the body, seldom attacks the fair sex : and
when it happens the woman  is  marked by a
more masculine form, or other external signs
indicating this peculiarity.  But even this will
not  explain why the female is so seldom affec-
ted with arthritick inflammation.   Something
may perhaps be  sought in the generative fa-
culty :  the  castrates are said  to  be exempt
from gout : regular gout is  very rare before
the age of puberty ;  and all the women whom
I have known subject to  inflammatory gout,
except one, had never borne  children.   Gout,
in all its shapes, is preceded  by stomach affec-
tion j so also is  the period.   Again, the sto-
mach recovers as the pain and  inflammation
fix in the joints;  and if  they prematurely re*
                    p2 
174
cede, the affection of stomach returns.  It i j
the same with the period:  when one goes on
properly, the other declines in due time : and
if cold, passions of the mind,  or other causes,
bring on a sudden stoppage, all the complaint*
of the digestive powers instantly recur.
    But  as the dyspeptick symptoms which at-
tend gout,  are so much alike in both sexec,
making allowance for the greater sensibility
of the female, they strongly support the idea>,
that the chylopoeietick viscera are the original
seat of  this  disease ; and  these  the primary
symptoms  of gouty diathesis.    The child*
therefore  who is born of arthritick parents^
has in its constitution what may be  called the
predisposition to nervous and bilious diseases*
In infancy it is prone to all stomach and bowel
complaints from slight causes,  as have been
described, and  these will be its attendants
through life.  Even the man of the gouty fa-
mily will not be exempt from this disposition
to be dyspeptick and bilious, on every kind of
excess or improper indulgence.   In both sex-
es, they show a stronger tendency, as they ap-
pear early ; for that proves a  weaker structure
of  the  digestive powers,  and greater dcbiluy 
m
of frame ; just as gout is to be more dreaded
in proportion  to  its attack  at an early  age.
Thus the youngest votaries of Venus and Bac-
chus will run greater hazards of immature
gout, and premature decrepitude as a conse-
quence.
   1. The other division of predisposition to
these diseases, is the acquired predisposition i
or what may be  brought on  by causes which
especially weaken the frame of nerves, and the
chylopoeietkk  organs.  This predisposition
may take root, even during the earliest stages
of infancy, in children born of the healthiest
parents.   The effects  of the milk of an  un-
wholesome  nurse  often lay  this  foundation.
It may happen  where the  child is  not suffi-
ciently nourished ;  where the nurse is much
affected  with the  disorders herself: if she
drinks too freely  of spiritous or fermented li-
quors, or is in the  habit of taking opium, or
other drugs.   Bad lodgings ; impure air „ hot
rooms  ; chills from exposure to cold ;. wash-
ing the infant in water too cold or too hot j
want of cleanliness ; dosing it with hot things,
whether  spirits or aromaticks ; frequent  opi-
ates in any form to make it sleep ;  deficient 
176
exercise J sweetmeats ; frequent recourse to
medicines, such as emeticks and purgatives,
but particularly calomel :  and if these articles
are often repeated at any stage of  childhood,
without  competently  prescribed,  they  must
infallibly  debilitate the stomach and bowel*,
and induce the diseases  in question.   To all
these causes may be  added,  the effect which
the  furious passions of some women have on
the infant they suckle.   But even children at
an early age, are not beyond the reach of mo-
ral  causes,  particularly  females, and these
will often operate with great force on sensible
minds.
    The girl whose health has been thus ruin-
 ed, by improper  nursing in infancy, or bad
 treatment in childhood, will be apt to suffer at
puberty, and at the change of life.  At the for-
 mer period, violent hysterick and chloretick
 affections will commence,  end health w^l be
 precarious for a length of time.  Such a wo-
 man will be generally liable to  sterility from
 constitutional infirmities ; to abortion  in  the
 early months, and to premature binhs : these
 will often happen from slight  causes j and
 much danger will be encountered duriDg far- 
177
turition and  in' the  puerperal  state.   Other
diseases of equal delicacj', which are too often
the bane of female  life, will be the portion of
such a woman.   These  girls  acquire an inac-
tive sedentary  turn in early age, which is sel*
dom overcome ; they seem to vegetate, rather
than live, and  but rarely reach to fifty years.
When women of this kind of habit suckle their
own offspring,  or that of others,  they  much
injure the health of the infant as well as them*
selves: such children commonly die in great
proportion under two years ; and if they sur*
vrve that  age, it is with indellible marks of a
puny and vitiated constitution.  Among  the
poor in large towns,  the proportion of  deaths
in infancy is great,  chiefly owing to vicious
nursing;  and  much caused  by that nervous
weakness brought  onby the use  of tea and
spiritous liquors^
    The acquired predisposition  is also the fre-
quent effect of preceding diseases and confine-
ment ; such as typhusrfever, and all the fevers
of tropickal climates. \Luxurious living, and
highly seasoned food, that weaken and exhaust
the digestive  powers : excess of animal plea-
sure ; courses ©f active medicines  long eon- 
178
tinned; suckling  the  babe till weakness and
emaciation take place; severe labours ; hae-
morrhages ;  disappointed  love,  revenge or
ambition; confinement  in  impure air; want
of exercise;  intense thought; long protracted
grief; frights;  a long state  of  suspense in
waiting the decision of some important event;
the improper use of opium ; spiritous liquors,
and  other narcoticks ; poisons of every kind
in small doses ; and in short, whatever greatly
disturbs  or  debilitates the whole nervous sys-
term and abdominal viscera.
   Wounds and injuries of the head,  concus-
sions of  the brain, and  whatever may induce
effusion and compression, so as to weaken the
organs of sense  and  motion,  or render them
unequal in their action, sometimes bring on  a
nervous temperament, or at least pave the way
to these  diseases.   These incidents  are com-
mon enough among our seamen and  soldiers,
and  now  and then to be met with in private
life.*

   • Convulsions  in the form of epileptick fits, artu
common enough after organick  lesions of the brain-.
They have been frequently relieved by the trepan, 
1T9
    Having now  fully described the nature of
 predisposition under these forms,  we are pre-
 pared to relate, what, in common language,
 /goes by the name of a nervous complaint, or a
 bilious attack;  expressions frequently  heard
 among all kinds of people.  But without pre-
 disposition ia some degree,  it is to be presum-
 ed,  that no person has at once been severely
 afflicted with these diseases.  The two kinds
 of predisposition which  have  been  investi-
 gated, constitute what modern physicians have
 called the  Nervous Temperament, for it is
 not  mentioned by old writers.
    A person subject to.nervous or  bilious com-
 plaints, has commonly some warning  of an
 aggravation of the symptoms, or of an attack.
 Some uneven tenour of the spirits ; something
 to ruffle the temper or passions;  or some irre-
 gularity in  diet,  most frequently precedes
 them.  In  the sex, these complaints, for the
 most part,  commence near the period, and
when not severe, decline with it.  A frequent
desire of micturition, or a profuse discharge
of limpid urine very often ushers in the attack,
in both sexes.
   The patient himself finds it difficult to d«« 
IjSi)
tcribe  his uneasy sensations, for want of lan-
guage : he knows not with what symptom to
begin, though  he will answer the questions of
the physician with sufficient correctness.  The
physician therefore, finds advantage in putting
emeries to the patient, as  a few leading ones
will often rave both much  embarrassment and
conversation.  The  mind  is irritable, fickle
 and apprehensive;  at one moment,  tenacious
 of impressions, suspicious and jealous of con-
 tradiction :  at  another,  hurrying  from one
 thing to another.;  grave  and gay  by turns;
 with  fits of crying,  laughing and incoherent
 talking ; but seldom  indulging in conversation
 that is  unconnected with  the  consultation.
 The desire for food commonly  fails;  an un-
 pleasant taste is perceived, which excites fre-
 quent spitting; sickness at stomach sometimes
 comes  on very suddenly,  with vomiting of
 green  sour  mucus,  or  of  bilious  matter-
 What is thrown up is often found so acrid and
 corrosive as to excoriate the throat and mouth,
  and  slightly  tinge   silver;  the fauces and
  tongue  have been  blistered  from this cause,
  so as to appear full of pimples, or little ulcers,
  that render mastication of the food painful, 
ta1
tmd deglutition impracticable.   The  bowels
are generally irregular,  either constipated or
the contrary, and  oppressed  with  flatulence.
Acidity, eructations,  and  dyspncea, spasmo-
dick twitches about the breast, back and loins,
accompanying these feelings.   It is often sur-
prizing to see  the degree of inflation of the
stomach at this time ;  coming  on suddenly,
and  remaining for hours.  The skin is dry,
and  constricted,   or in  profuse sweats ; the
whole surface of  the body unusually  cold,  or
uncommonly hot by turns ; with vertigo, tre-
mours, risings in the gullet,  and vast depres-
sion of spirits.  The patients  are extremely
sensible to the changes  of weather, and bear
easterly winds ill.
    The countenance is commonly downcast
and sallow ; and the white of the eye  exhibits,
more or less, a bilious tinge.   Few  dyspep-
ticjc  persons have at all  times a clear  com-
plexion ; indeed the looks are a sure  criterion
to judge of the habit.   This suffusion of bile,
sometimes  amounts \p real jaundice,  transito-
ry, or more p<f'rnanent;  and  attended with
pain  about  the epigastrick region j extending
upwards from  the liver  to the shoulder, and 
183
 generally with constipation.  These icteritial
 symptoms are speedily moved  by laxatives,
 though brisk purges  may  be necessary, with
 which considerable quantities  of inspissated
 bile and mucus  are  brought away, and also
 biliary calculi, called  gall-stones,  which some-
 times obstruct the ducts.
    Passions of the mind, or whatever greatly
 and suddenly  disturbs the digestive powers,
 bring on jaundice.  But the sallow complexion
 of the nervous  temperament,  is not  always
 expressive of bile being carried into the blood.
 It probably originates  also from imperfect
 sanguification;   and when the florid colour is
deficient from subtraction of oxygen, or oxy-
gen not duly supplied. When the yellow tinge
of the eye proceeds from bile,  it may be de-
tected by dipping a thread or linen rag into the
urine, which will be stained  yellow.   I think
women are much more liable than men, to the
spasmodick form of  th's complaint;  which
may arise from their  weaker state of bowels,
and greater irritability of uer.vous system.
   The liver itself is capr*  ns in its office.:
we perceive at  one time, a suspension of the
biliary secretion,  when no obstruction  of \\\z 
183
ducts is to be suspected ;  and at another,  the
bile is flowing in great profusion, so as to re-
gurgitate by the pylorus, and be evacuated in
quantity by vomiting ;  while it passes by the
Other way  in increased  proportion.  Warm
seasons are known to produce  this effect on
the liver of nervous people.
   A  particular lassitude,  listlessness, and
inaptitude to all kinds of motion, are common.
attendants of all these affections. The patients
will sit for hours in the same posture, without
paying the least attention to what is going on
around  them.  Even the calls of hunger are
disregarded,  and not without  force they are
roused  from their  reverie and ennui, to take
food.
   Convulsive  asthma, often recurring perio-
dical^, is to be enumerated  among the attacks
of these diseases.   Indeed the  true asthma is
perhaps never met with, but  in constitutions of
great nervous irritability. Such to a certainty
must be that  species  of it which is induced by
particular smells.   I knew  a lady, who was
always  seized  with  asthma, whenever rad*
ipecac,  was  pounded in the  shop ; so sensible
was she of this effect, that  it was in vain to 
184
conceal from  her  what was going  on in the
mortar.
   When spasms  assail the kidneys,  there is
often much acute pain in the loins;  increased
on moving the body, and lying on  a soft fea-
ther  bed ; extending downwards by  the ureter
to the bladder, occasioning  constant  or very
frequent desire to make water; producing the
symptom called strangury ; sometimes with a
pain of the mammae in women, or  retraction
and  pain in the testes in men,  and a numbness
of the thigh and leg.  The irritability in these
parts is often so considerable, as to force blood
from the passage of the urethra: the urine is
even at times totally suppressed, and obliged
to be  evacuated  by a catheter.   When the
urine is made in  small  quantities, it is high
coloured, letting  fall a  copious muddy sedi-
ment ; but at intervals it is voided  in great
profusion, and pale as common water.*
   When great flatulence and  distention ac-
company these shades of  the complaints in the
urinary passages,  a  very uncouth appellation
has been bestowed on them,  viz. windy gravel.
* Diabetes Hystericus, 
1S£
Though an odd kind of term, it would seerri
however, to convey a very emphatick meaning
of the patient's feelings.
   Though at times the appetite for food is
deficient,  yet at  others it  is excessive, and
craving  after many  out-o'-the-way things*
Hence those longings that occasion great anx-
iety to the patients and all about them; aa
there is  commonly a necessity for indulging
them more  or less.   Deficient appetite, and
other impediments to chyiification,  sometimes
disappear on eruptions coming upon the  skin,
and  alternate with them.  It is  commonly
judged prudent not to repel these ; as it is held
dangerous to dry up issues at  once, or any
other drain.
   There is  often acute pain about the region
Of the stomach,  bending  the body forward j
it gets the  name  of  cramp,  and is  attended
with vast dejection of spirits,  and syncope.
This ought always to be considered an alarm*
ing symptom ; and I have generally found such
cases terminate  fatally  on a  sudden.  But
fainting  fits otherwise, indicate little danger 1
Women  frequently fall down   without  any
warning,  and recover in a few minutes as  is 
186
nothing had happened.  It has been  told of
different  persons  remaining  for a number of
days without external signs of life ; a situation
which never came within my  knowledge, and
almost exceeds my belief.  Dr. Cheyne relates
the case of Colonel Townshend, who had such
command over the vital functions,  that he
could suspend them  at will, or die when he
pleased, and  recover again.  In the company
of another physician, he  saw this  officer go
through the experiment and recover himself:
but Col. T.  did not long survive these  inter-
esting trials.
   Worms are common enough in all stages of
these diseases, but are particularly so among
women and children, as the consequence of a
weak condition of bowels and impaired diges-
tion.  The symptoms which point out the pre-
sence of  worms in the body, are chiefly of the
nervous kind ;  but urine of  a chylous consis-
tence and colour,  or resembling  milk, is sel-
dom  known  but from this cause.  Itching of
the nose ; gnashing  the teeth;  starting sud-
denly from  sleep;  change of colour in the
face ; foul breath, Sec. sometimes  accompanied
with fever;  all denote worms* 
187
   It is probable that the disease called cholick,
is only an attack of these affections, in a parti-
cular part of the intestines.   The  ileus, or
iliack passion,\s the last degree of this afflicting
disorder ; which consists of an inverted action
of the whole intestinal tube, so as even to eva-
cuate clysters by the mouth.
    From  the  excessive  thirst observed  in
some cases of nervous affection, it would ap-
pear there must be at times an uncommon con-
sumption of liquidinthestomach,whether from
the increased action of the absorbents, or other
causes.   This great absorption in the first pas-
sages, is one way to explain the attending con-
stipation : as the more fluid parts  being taken
up, the remainder is propelled with more diffi-
culty.   I knew a lady who was so tormented
with polydipsia,  that  a  pitcher  of water was
carried with her  in her rides.
    Uneasy flutterings,  as they are called, a-
bout  the breast, and  palpitations,  with  the
sense of  a ball rising to the throat,  and there
giving the feeling of strangulation, form what
has been named globus hystericus.   In these
the patient grows vertiginous, and blind,  and
falls down, often in vioelnt agitations and con- 
1*0
vulsions, with loud screams and looks express
sive of horrour.  This paroxism is most apt
to be brought on by surprise, a fright, or what-
ever excites strong and sudden emotions; loss
of voice, for a time, is a common consequence*
This fit was long thought peculiar to the fair
sex ; but Dr.  Sydenham mentions it as occur-
ring among men ; and it is certain  that many
males of very mobile habits,  and gouty consti*
tutions, where there is great sensibility of the
first passages, are very liable to it.   I  have
known it in numberless instances among naval
officers, especially those who had suffered  in
warm climates 3  and also  among seamen,  as
told in my 3d volume of Med. Naut,
   That species of convulsion called epilepsy^
can scarcely be said to differ  from  the hyste-
rick affection, unless  in its violence.  They
both occur in  a similar temperament of body,
and are broght on by  the same causes.  And
it is  agreed by physicians, that the necessary
steps to the cure of both  are alike> that is to
correct the predisposition.
   I have also seen a considerable number of
cases  of nervous affection, with all the signs
which are said to'mark angina pectoris.  This 
                   189

ffomplaint has been thought to accompany par-
ticular organick affections of the heart, and
large  blood vessels ;  some of  these  I  have
seen, and they proved fatal.  Of this kind was
the case of the late captain Fisher, of the  Pow-
erful.     But  these  organick  derangements
could  not be the cause of the symptoms,  in ca-
ses which quickly recovered under appropriate
treatment.   Two of these I have met with in
Newcastle.  I cannot therefore help being of
opinion  that the anomolous form of  the dis-
eases, under discussion, renders it very proba-
ble, that they have often given cause for  unne-
cessary alarm, as resembling  what has been
styled angina pectoris.
    It is not easy to combat the fancies and ap-
prehensions  of  nervous  people, when  under
strong  paroxysms of their  disease ;   while
these last,  they are to be considered as aliena-
tions  of mind,  and treated accordingly.   In
some   situations  of  this  kind, the  flatu-
lence  is unusually troublesome, and so fluctua-
ting in its movements over the  abdomen, that
the sensation of air or wind rising upwards to
the brain, is among the most solemn beliefs of
the patient.  This fanciful idea  has given birth 
190
 to the phrase vapours, a name for weak nerves*
 These vapours are therefore said to generate
 every thing in the brain that is terriflck or ri-
 diculous.  Hence blue-devils, ghosts, and hob'
goblins, have been conjured up to the affright-
 ed imagination of the patient;  and bad men
 are said to suffer under their  influence, tor-
 ments  compared with the  pains of  heU : so
 faithful and  certain  are the admonitions of
 conscience !   Sleep  disturbed and harrassed
 by dreams of the most frightful sort, such as
 falling down precipices,  suffering  shipwreck,
 being devoured  by wild beasts, are common
 enough on these unhappy  occasions.  Some
 histories of the effects of vapours, are as old
 as the days of Galen.  Arc noct-ambuli of the
 nervous temperament ?
    Another  train of tormenting  symptoms,
 are those head-aches  which accompany ner-
 vous disorders'.   Some times only one side of
 the head is affected, and the pain receives the
 name of hemicrania: when  it  is in  the fore-
 head, and  gives the  sensation of a nail being
 driven into tht bone, it has been called clavua
 hystericus, as being peculiar to the hysterical.
 But this last kind of  pain is not more peculiar 
                     191

 to women than the globus ; males are also sub-
 ject to it.   A nervous  head-ache  in the occi-
 put, is often attended with a sense of coldness ;
 as if very cold water, or a current  of cold air,
 was poured upon the part.  Vertigo, to such a
 degree as to make the patient fall down, dim-
 ness of sight, tinnitus aurium, partial or total
 deafness are associated with these complaints.
 These head-aches frequently seize persons at
 regular intervals, and have obtained the name
 of periodical head-aches.   Accessions and in-
 termissions of pain that acquire regular move-
 ments, must depend on some important law of
 the system ; and here they are probably direc-
 ted by the digestive process.
     To this  class of symptoms may also be re-
 ferred that singular and obstinate  pain of the
 face, called dolor facet, or tic doloreux, by  the
 French.  Tt is  said to have been once cured
 by  Dr. Haighton, of London, by dividing a
 branch of the fifth pair  of nerves, which was
 supposed to be the seat of the pain.  But me-
 dicine must become a bloody art indeed, if  the
 organs of sense and motion are to become sub-
jects of surgical operations.  Flatulence, con-
stipation  and nervous feelings, are known to 
192
be attendants of this pain: it affects chiefly
women, and those  above thirty ; but it is not
confined to a particular spot of the face.  It is
doubtful to me,  whether  this tormenting af-
fection is  ever met  with  but  in  the nervous
constitution ; at least in such only has it come
under my observation.   I cannot therefore
see  any reason for considering  it a  distinct
disease;  for it has always been relieved by
the  general method of cure, though it is apt
 to return.
     Pains,  cramps,  and contractions of  the
joints and muscular parts,  are  not  uncommon
 symptoms :  but the most painful are  those of
 the calves of the legs and soles of the feet.  I
 have a patient now, a man of large size, who
 is drawn to the one side, and the muscles of
 the abdomen contracted  into irregular lumps.
 This man is strongly affected  with hypochon-
 driackism ; is jealous of his safety, and  asks
 my servants if they ever hear their master
 speak of him.*   He inherits the temperament
 from his mother.
    * This poor fellow,' who lives 30  miles from New-
 castle, lately asked  me by letter, whether I thought
 he ought to go into a lunatick hospital, as he considered
 himself insane. 
193
   Persons  subject to these diseases are Very
liable, in advanced life,  to hemorrhoidal tu-
mours, andprocedentia recti; which at times
are most afflicting symptoms, as they prevent
all kinds of motion or exercise.  These are
too often the  unfortunate  consequences  of
frequent purgatives,  especially of the mer-
curial  and aloetick  kind ; which tend most
to weaken the bowels and bring on a constant
tenesmus.
    It is the nature of these diseases to invert
the  regular economy of both body and mind.
We therefore frequently  hear patients express
sensations,  as  if they had no bowels, and all
was vacuum within them.   So  sensible are
they at times  to arterial pulsation, that they
say they have pulses all over ; and count the
strokes  of  the heart without applying the fin-
gers to any  artery.
    When  dyspnoea,  with cough and hoarse-
ness, is  present,  it  is of considerable impor-
tance to distinguish how far  these form a part
 of nervous  indisposition, for phthisis frequent-
 ly supervenes  without  much cause of suspi-
 cion.   When irregularity of the period accom- ]
 panies these pectoral symptoms,  they become
                     R 
194
 still more  equivocal.  Even the expectorated
 matter only helps to create doubts.  But there
 is a kind of cough,  that has not inaptly been
 called nervous cough, which consists of a short
 hick, something approaching to  a hoop,  and
>not attended with much  fixed pain  of  the
 breast :  nor does the difficulty of breathing
 which accompanies  the  nervous cough, give
 the sensation of so much fulness of the chest,
 or oppression ; but rather  a feeling that the
 cells of the lungs refuse to admit the air.  The
 nervous cough is also more affected  by the
passions than that of phthisickal persons.  The
 family predisposition will enable the physician.
to form  a  correct prognosis on most of these.
occasions.
    I have seen some obstinate hiccups, in both
flexes, in these diseases, that resisted every
thing that  could be thought of;  nor did they
intermit, for some weeks, except during sleep.
    Hydrophobia has been met with in these
diseases, and where the dread of swallowing
liquids  was  little  short of  what has been ob-
served  in  canine madness,   I  believe in  all
situations where deglutition  is difficult, when
cot owing  to mec.hanickal compression, it is 
                    19o

found  more  painful to  swallow liquids than
solids.  The hydrophobia of Rabies, is to be
considered as a nervous symptom,  expressive
of the inverted action of the osophagus and
muscles of the pharynx.  The dread of water
is therefore  to be  explained,  from the im-
pression which the mind receives on looking
at  the water,  as associated with the act of
swallowing it under the reversed  motion of
the muscular fibres which perform deglutition..
It must be nearly allied  to the globus hysteri*
cus.  It is strange that anatomists should look
to the pharynx and gullet, for the seat of hy-
drophobia ;  which  must be imputed to the
sensorium commune, and is not to be detected
by dissection.  I have, however,  frequently
known the throat so contracted, and the tongue
so cumbersome in  the  mouth,  that nothing
tut slops was taken down for months, under
nervous indisposition.
   The state of the pulse  in these disorders,
is as variable and inconstant  as all the other-
sensations  of the  patient.   It is sometimes
regular and equal, in conditions of great pain
and  suffering:  and at other times, is found
uncommonly  qukk, unequal,  irregular  and 
196
intermitting,  when  the  symptoms  are  very
moderate.   It may be  presumed,  from these
affections being primarily seated  in the ner-
vous system, they only affect the vital functions
at intervals.  I have certainly known the pulse
remain with little  variation  from health,  in
some fatal cases, till  within a few hours of dis-
solution.   Yet nervous  persons  in  general,
have a quick  pulse ; and in some  instances it
has been noticed at  200  in a minute.  Their
senses being all uncommonly acute,  a sudden
noise or start, quickens  the pulse, and pro-
duces palpitation in an instant.
    But the most formidable aspect which these
diseases  assume,  is when they have lasted so
long, as  to bring on  fatuity,  or  imbecility of
mind,  melancholy  and   madness.   Among
drunkards in particular,  these kinds of termi-
nation are very common;   and  we  impute
them to the disorganization of the brain it-
self.*  For in these  cases, whatever causes an
increased determination of the blood to the

  • See the account of the dissection  of cnebriates,
where the cerebrum was found diseased.
        Essay  on  Drunkenness, 2d Edition. 
197
head, increases the delirium; this is observed
particularly  with regard to ardent spirit and
opium.   But nervous  people commonly  die
of apoplexy, palsy, atrophy,  dropsy or con-
vulsions.
    I  have forborne to mention many of those
idle stories, which some authors take delight
in telling,  as the effect of extravagant illusions
of fancy,  which nervous people are said to be
subject  to.  I hold their whole complaints to
have  a  real existence :  and from whatever
Cause pain may arise,  it is the province of the
physician  to employ his art to subdue it;  not
to ruffle an irritable mind by unseasonable lev-
ity, or  expose  a morbid  sensibility to insult
and reproach.
    Dissections have not forwarded our know-
ledge of these diseases :  and indeed when we
consider the nature of their symptoms, symp-
toms  flying from  one organ to another in an
instant,  and thought succeeding thought with
the rapidity of lightning, we are the more in-
clined to think that inspection of dead bodies
will not improve our  method of cure.  It i3
true,  that the stomach, liver, pyrolus, intes-
tines, mesentery,  kidneys and bladder, and
                   R2 
198
the uterine orguus in females, have at times
been found diseased: but such deviations from
the healthy state, must:n general be secondary
symptoms, the effect not the cause  of these
ailments.   In the transitory jaundice of dys-
pepticks ;  or in the migrating cramps, globus,
or strangury of the  hysterick  affection, what
physician  would  look  to  organick lesions for
their seat ?  Persons are known to die of the
most dreadful symptoms of these disorders,
where nothing could be  discovered by  the
knife :* which with all  other circumstances
attending them,  confirm the belief,  that their
pathology is to be  sought for in the nervous
system; which will be our next.task to investi-
gate.
          • Whytt on nervous diseases. 
199
             CHAPTER VI.

    The general doctrine of these diseases,

    THE most prominent parts of the charac-
ter of these diseases are, that they occur
chiefly under peculiar modes of living; are
hereditary, and affect, in a particular manner,
the organs subservient to the preparation of
nourishment.
    It appears from what has been said in the
preceding chapters of this work,  that they are
unknown in the savage state ;  but rarely met
with among rusticks ; and are to be found in
abundance in large towns, or wherever  luxu-
rious habits have displaced simplicity of liv»
ing.  They are so far to be classed among
mental  disorders, that a  disposition of mind,
not easily to  be defined, attends every degree
and stage of them ;  beginning with uncom-
mon  sensibility  to all impressions ; peevish-
ness  of  temper;  irresolution   of  conduct;
sudden^ transitions  from sadness to joy, and 
200
the contrary ; silent or loquacious ;  officiou3ly
busy, or extremely indolent; irrascible ; false
perceptions ; wavering  judgment;  melancho-
ly ; madness: exhibiting in the whole, signs
of deranged sensation.
    These diseases receive a stronger tincture
from the manners of the age, than  any others
to which the human  frame is li'abte : and when
they appear in great numbers,  as  in  the pre-
sent day, they form an  epoch in the physickal
and moral history of society; so wide is their
range,  so important their influence  on  the
state and condition of mankind. I have seldom
known  any of  those  persons denominated
Quakers,  to have been severely troubled with1
nervous complaints. This testimony is at least
honourable  to these people ; and  some proof
of the good moral conduct and sobriety which
prevail among them*
    The causes which  produce nervous disea-
 ses, may be divided into two kinds,  namely,
 those  which arise from the mind ; and those
 which arise from the body.  Of the first kind,
 are all the  disorders  of the passions : of the
 second kind, all those causes which affect par-
 ticular organs of the body, that by their office, 
120
are intimately  connected  with  the  nervous
system.  Many of these causes, of both the
mental and  corporeal class, act for a length of
time  before they bring forth  actual disease ;
but this mode of operation would seem to hap-
pen only where there was no predisposition.—
They may therefore be said first to create pre-
disposition, and when this is sufficiently done,
a train of symptoms appears which constitutes
real disease.
    To  predisposition, whether  hereditary or
acquired, I give the name of nervous tempera-
ment, which  is now to be considered as a per-
manent state of body, that cannot be easily
changed, and will commonly  remain for life.
This temperament is to be observed in  diffe-
rent  shades and  gradations,  mixed  with the
other temperaments ; but where it is exqui-
sitely formed, it is know  by the  following
signs :  a sensible, irritable, and mobile condi-
tion of nerves ; by which  different organs  of
the body, from slight causes, are urged into vio-
lent and involuntary  action; and their motions
and sympathy  often  reversed; giving birth to
false perceptions and erroneous judgment; and
sometimes accompanied with pain oftheaccutest 
203
kind.   This temperament is said to  bear ail
evacuations ill, especially the loss of blood ;
and also is easily  injured by medicines of the
rougher class ; it is not very liable to diseases
of the inflammatory kind.*
   It is evident, from the history of these dis-
eases, that where the nervous  temperament
prevails, all the causes which operate upon it,.
bring forth motions and sensations very diffe-
rent from  what is found in a healthful struc-
ture of nerves, in persons Who are without the
predisposition.   This is more exemplified in
What may be called the mental causes, than in
the corporeal.-  The moral evils of life are ve-
ry much of a relative nature ; their effects de-
pend, in a great measure, on our capacity of
feeling, for receiving them  ; or the fortitude
which  we are able to oppose to them.   Thus,
one man is condemned  for sinking under ad-
versity, as a proof of deficient  virtue and spi-
rit ;  while another is extolled for his courage,
as a token that he  possesses  nobleness of
mind.   Yet the physickal trait of their tempe-
raments, will best decide with impartiality op

   *Gregorii med. ther. conspect. vol. iL chap. xxhi. 
203
their respective merits.  The first may be a
weak nerved being, and a good man ;  and the
other, under apparent resolution of soul, may
possess nothing beyond want of feeling.
    But this even applies to the corporeal cau-
ses.  Let  the  two persons start together, to
drink a bottle of ardent spirit in the twenty-
four hours, for life.  The nervous man will,
most likely, .find his frame shook  to pieces at
the end of two weeks, or as mapy months y—■
while the other will continue his potation for
as many years. When the first  dies, of weak
,nerves  and tuberculous  liver, at  the  end of
three  months,  the  other may still  remaia
strong and hale.   It may now be said that the
first was a drunkard, and died felo do se: but
the survivour will have a chance  of preserving
his reputation for  sobriety.   Of so much im-
portance is the study of temperament in judg-
ing of the causes of these diseases-
    The living body possesses the faculty, if I
mav so call it, of receiving impressions, and
retaining them, even to the hazard of its de-
struction.  All  predispositions are of this kind.
When a person subject to gout,  undergoes
a long mercurial course for the cure of syphi- 
204
lis, he may not be always warned of the in-
crease of predisposition,  which he will infalli-
bly acquire by this process : though he may be
duly told of the necessity for mercury  to sub-
due the other disease.   And if it were left to
his choice, he would still prefer the antisyphi-
litick regimen,  and make the best he could of
his gouty  diathesis.  If besides,  he is attach-
ed to the bottle, or has contracted the habit of
taking opium jn large doses to ease his griping
pains, he  is going fast on to give the final blow
to health ; and  the last degree of this, is the
completion of predisposition, or constant gout
and nervous affliction.  So that predisposition,
in its various stages, is the  medium between
health and disease.  A gentleman subject to
gout, weak nerves, and all their horrours, con-
sulted me some time  ago.  He look his wine
freely, and an  opiate eveij ni^ht  at bed-time.
The last, he said,  w~s to ease his  spasms,  and
to give him rest.   He was also of extremely
slow bowels.    I warned him of the dangerous
habit he had got into ; and  in order to  save
the remainder  of  his constitution,   recom-
mended him to give up his bottle  and his  lau-
danum immediately.  But the conflict was too 
205
great  for his fortitude ; he  did not call upon
me a second time.  This man, I dare say, was
both able and willing to  pay  a physician, pro-
vided he  could find  one to his mind.  That
society must be undergoing the last degree of
vitiation, where the faculty of medicine re-
ceives gold, and returns poison.
   All those passions of the mind, which have
been  narrated among the causes, act imme-
diately on  the  nervous system;  whence  a
train of sympathetick affections instantly com-
mence throughout the whole body,  but espe-
cially  in  the  chylopoeietick  organs.   And
again, those causes which induce nervous dis-
orders through the body, affect first  the diges-
tive and assimilating powers ;  and  are from
them reflected on the nervous system, whence
commences a train of inverted sympathies and
false  perceptions,  which show how  far the
mental part of us is concerned in this general
tumult of sensation and motion.
    Why a station so exalted in the animal eco-
nomy was given to the chylopoeietick viscera,
we can only account for from the pre-eminence
they  occupy in preparing the nourishment of
the whole system.  The appetite for food, the
                     s 
206
 digestion  of it, chylification, sanguification,
 and the nutriment derived therefrom,  are a-
 mong the most wonderful operations of nature.
 One  of the first instincts of our existence is
 the desire  for food. Nay it is probably the firs*,
 and coeval with the rudiments  of the foetus.
 Some peculiar inherent power, not to be expres-
 sed by abstract terms, enables the  vivified germ
 to draw nourishment from its nidus, the fluid
 which surrounds it.  Every particle of the nu-
 tritive juices, elaborated by the maternal pro-
 cess, is attracted by the congenial sympathies of
 the embryo.  These juices hold in solution what
 is to be the future solid, such as cellular mem-
 brane, muscle, tendon, bone, and nerve itself.
 The nervous system, or sensorium, must be
 the basis and the prime director of  this crea-
 tive process, till the human form in all its parts
 is fully evolved. The circulation  of the blood,
 from the mother to the foetus, now commen-
 ces, and continues the supply, though not by a
 direct continuity of vessels.  And the placen-
ta, by oxygenizing the fcetal blood, supplies the
the place of  the future lungs.  When the re-
quired bulk is completed, the infant, endued
with peculiar instinct, urges the womb to ex- 
aor
pel it, which  terminates in the birth.   The
nourishment which the  child received from
its  mother before birth, is now to be prepared
in part by its own organs.   I say in part, be-
cause milk is a substance half animalized, and
nearly ready for assimilation.
    We  thus comprehend three stages in ani-
mal existence, where the manner of receiving
nourishment is varied.   The first stage is li-
mited to that early condition of the germ, be-
fore the circulation of red blood can be distin-
guished.   The second stage commences with
the circulation of red  blood, and terminates
with  the  birth.   The third stage begins with
the birth, when the nourishment of the body
is to be prepared by the chylopoeietick viscera,
which continues through life.
    The human stomach is an organ endued by
nature,  with the most  complex properties of
any in the body ;  and forming a centre of sym-
pathy between our corporeal and mental parts,
of  more  exquisite qualifications than even the
brain itself.  Yet the knife and eye of the ana-
tomist do not discover the whole  important
station it holds in the economy : we  must look
to the living sytem for  thoie nice connections 
208
of cause and  effect, and that source of asso-
ciation, which give it a relationship to so many
organs, both in the healthy and diseased state.
There are few diseases in which it  does not
participate :  even  slight  blows upon it have
proved fatal  ; but its wounds are to a certain-
ly mortal.  In all  those disorders whose seat
is the nervous system, it  particularly suffers.
In fevers of every description the stomach is
peculiarly affected ; and till the febrile move-
ments decline, the functions of this viscus arc
suspended.
   An organ intended for such important pur-
poses  in the  animal economy,  must receive
from  the hand of Nature  singular tokens of
her favour.   Hence we find  ail those viscera,
which assist in preparing the chyle, and what
is called the assimilation of the food, joined in
a circle of nervous communication, of which
the stomach is the centre.  One portion of
nerve is distributed over the whole ;  so that
while they are all employed  in  one purpose,
disorder cannot take place in any one of them,
without  the whole being thrown into confu-
sion.
    Anatomists have discovered  an unusual 
209
share of nerves about the upper orifice of the
stomach ;  from which it was thought by some
philosophers to be the seat of the souL
   These nerves of the stomach are derived
from the  par vagum,  or eighth  pair, which
communicates with the  great  intercostal  or
sympathetick ; and by it, is connected with  al-
most every other nerve of the  body.   The
semilunar ganglion of the great sympathetick,
 supplies particularly the liver;  %ftll bladder
 and ducts;  duodenum; pancreas;  spleen;
jejunum ;  ileum ; and part of the colon,  &c.»
 the  renal glands, kidneys, ureters, and  blad-
 der ;  the  womb, ovaria,  testes, &c.  are  all
 supplied  by  the  same  nerve; and joined by
 others from the lumbar  vertebra?.  The mus-
 cles of the pharynx, and trachea, those of  the
 neck and.lower extremities, are even connect-
 ed  by branches  of this nerve.   The lungs,
 heart, and   diaphragm, being all  furnished
 with  nerves,  which  communicate  with  the
 great sympathetick,  it would appear, that  this
 nerve  is the grand link or chain,  which con-
 nects  the  vital, animal, and natural functions
 with one another.
     When the great sympathetick  enjoys its
                     s2 
210
full health, all the organs to which it is distri-
buted will be found performing their different
offices  with  vigour,  accompanied with plea-
surable sensation.   When  the  stomach has
been replenished by a full meal, after tome
time,  sleep supervenes, which is easy and
sound ; and with  this commences the process
of digestion; the solution  and  expulsion  of
the food from the stomach ; its mixture after-
wards with bile, pancreatick juice, and intes-
tinal mucus.  Every pore, vessel, duct,  or
gland,  that is engaged in that great business,
contributes a share  of soothing influence to
the dormant animal functions ; and the tempe-
rate  man awakes refreshed and  invigorated
in body, with faculties equally clear and reno-
vated.   But the dyspeptick stomach exhibits a
very different  train of  phenomena.   After
the repast, sleep scarcely closes the eye-lids of
the nervous man ; a croud of unpleasing ideas
disturbs the mind; flatulence, acidity and bor-
borrigmi, torment the body ; digestion goes
on imperfectly ;  and he wakes  low, languid,
and unrecruited; sick at stomach, and with-
 out  appetite for breakfast.
    The pathology of these diseases is there-
 fore to be  chiefly sought in the functions of 
211
this nervous communication ; and most of the
symptoms  to be referred to the same.   Thus
in a dyspeptick condition of stomach, such as
attends nervous complaints, it is not the mus-
cular fibre alone  of that organ that is to be
considered as  diseased ; but every gland and
pore, exhalent or follicle, that separates either
gastrick juice or mucus ; and consequently all
the fluids are poured forth in a vitiated state.
The  appetite will  then be irregular, some-
times suppressed,  sometimes voracious ; the
acidity will increase so as  to become painful;
the food will  remain undigested,  and uneasi-
ness, and  inflation of stomach  will succeed.
Other viscera  will,  by consent of nerves, be
also deranged in their respective offices.  The
pancreas, its  juice and duct are affected.  The
liver will secrete the bile in quantity and qua-
lity,  both different from its healthy state ; and
the  ducts will be irregular in conveying it
forward.  The peristaltick motion of the in-
testines will be inverted and inconstant; and
constipation  or diarrhoea be the consequence.
Even the kidneys,  more remotely connected,
will discover indisposition, by the urine being
voided  turbid or  pale, in spare  or profuse 

quantity; sometimes with  pain  in  the loins,
ureters, bladder, testes, or mammae.  Those
uneasy sensations which rise to the throat, and
there give the idea of strangulation, often at-
tend the stomach affection.  The lungs expand
with  difficulty,  the  breast  labours,  the heart
palpitates,  the  eyes grow  dim, a  giddiness
comes on,  confusion of thought and insensibi-
lity  commence,-  and the  patient often falls
down convulsed.*  There is not a muscle or
organ of the body that  receives a single ten-
dril of  this sympathetick nerve,  without par-
taking more or less, in these diseased feelings*
    But there are  not two people who feel ex-
actly alike,  in  a disordered condition of sto-
mach ;  and this difference depends on causes
so various, that the idiosyncrasy, or peculiarity
 of constitution, in every individual, must be
 sought  for before it can  be explained.   Early
 habits, pursuits in life,  modes of living,  mo-
 ral character, preceding diseases, amusements,
 professions, seasons, climate, &c.  must all be
 taken  into the  account.  Thus one person
 suffers  by  severe and  obstinate head-aches ;

    * Hystericus, and epilepsy, cr falling sickness. 
213
another is prone to hysterick or epileptick fits ;
some are afflicted with cramps and spasms of
stomach,  others by acidity  and  flatulence.
The liver and biliary ducts, with  deficient
secretion  of bile, its  increased  quantity,  or
obstruction from spasm,  mucus or gall-stones,
and suffusion  of the skin, are peculiar to one
constitution :  while bowel complaints, nephri-
tick pains, urinary  calculi, and strangury, ha-
rass another.  Nervous  females  particularly
suffer at the period; in all irregularities of it,
from whatever cause ;  and in the  puerperat
state.   Some persons sink more under dejec-
tion of spirits ; while others exhibit  sudden
vicissitudes  from  high  to  low, and the con-
trary.   Temporary insanity is more frequent
with women than  men ; and it attends some
 of them during every  pregnancy.   Yet I hold
all these, and many  other shades of nervous
indisposition, to be still one and the same dis-
 ease.   Nay,  we frequently observe the family
 peculiarity to be  hereditary; and  often dis-
 tinguished by external signs,  as the  child hap-
 pens to be like the father or  mother.   The
 nervous power, in some persons, is precipitate
 in its movements,  tumultuous and convulsive, 
214'
and gives a hurry to all their actions.   Other*
again appear more  sluggish and deliberate,
where the nervous power is more torpid ; but
it is  at  the same time liable  to  inconstancy
when under  the influence of  different  pas-
sions.
   We  know so little of the nature of the ner-
vous  power,  that we  can only judge of the
moral causes of nervous  indisposition, from
their effects.   Some of the passions have re-
ceived  the  name of exciting, and others that
$f depressing; but their effects on the nervous
temperament, seem much alike.   The chief of
the  passions, such as  anger, joy, grief, fear,
ho.  destroy  appetite,  disturb digestion, pre-
vent sleep,  make  the breast labour, and the
heart palpitate ; render the mind fickle,  timid,
incapable of judging  accurately, &c.   Here
is no proof that any of these passions weaken
the  nervous system;  they only dissever that
 combination, or association  of ideas,  which
 impresses the mind with pleasing objects ; and
 which  dissevermcnt  to  the mind is painful,
 and  throws  all the more sensible  organs  of
 the body into immediate disorder.   The mind
 and body being connected by the nervous sys- 
•215
iem, the same train of symptoms appear, when
■those causes are applied to the body, which
-first affect the chylopoeietick viscera ; such as
a mercurial course, or a debauch with ardent
spirit or opium. Now, what can be the reason,
that these passions, or the articles just men-
tioned, have such extraordinary action on ner-
vous people, while on others they have no such
effect?   I would explaiu the fact in this man-
ner : the hereditary temperament is supposed
to inherit all the bad impressions of its pro-
genitor, hoarded as it were in the structure of
its nerves :  in like manner the acquired tem-
perament retains,  or records  as  it  may be
termed, all the effects of vicious indulgence.
So that when any fresh gust of passion arises,
or any  luxurious stimulus is applied to any
portion  of the sympathetick nerve, these ac-
cumulate the quantum of predisposition ; and
a nervous fit, or a bilious attack, is the imme-
diate consequence  of every new trouble of
mind, and of every recent debauch of the bo-
dy.  Thus the habit may become so complete-
ly nervous,  or in other words,  the predisposi-
tion may arrive at that height, that the facul-
ties of the soul will be worn  out, and fatuity 
226
 take place;  and the body will be so enervated
 as to be in a state of constant pain, tremour or
 convulsion.  Such cases, in no small numbers,
 are certainly to be seen every day, by medical
 observers who possess discernment to appre-
 ciate experience.
    The operation of ardent spirit, which in-
 cludes wine and all fermented liquors,  and
 opium,  if not all narcoticks whatever, is much
 alike on the animal  economy.  They  assail in
 the first place,  the nervous  system, and all
 other effects are  secondary.   The nerves of
 the stomach  feel  the first injury :  but so inti-
 mately are these nerves connected with the
 whole that supply the chylopoeietick  viscera,
 that they are instantly drawn into  consent.
 The stomach, intestines, pancreas, liver  and
 ducts,  become thickened, and grow-torpid by
 long indulgence in these articles, and  unequal
to their functions.  But it will not be  doubted
by any person who has attentively watched the
effects of opium and ardent spirit, that all the
early symptoms of indisposition which they
create, are purely nervous, and extended bv
 sympathy.   I was formerly  of  opinion, that
the enlarged liver v/as owing  to the constring- 
217
ing power of  the  alkohol  being  spread  from
the duodenum to that viscus through the ducts.
But this explanation  is not satisfactory : and
opium and other narcoticks,  cannot act by
hardening the fibre  or animal  solid.   The
hepatick system must be injured by nervous com-
munication and sympathy with  the  stomach.
But if it  is  common in a severe disease, and
after long continuance, for the liver of dvspep-
ticks  to  be found sometimes  enlarged, where
no vinous stimulus had been used, such a case
must have been of nervous origin to a certain-
ty ; and from this we have a right to conclude,
that the diseased  liver of drunkards  is almost
always of this kind.  When the hepatick nerves
are rendered weak,  mobile, or torpid, by the
excessive use of alkohol, it necessarily  fol-
lows that this debility is extended to the whole
substance of the liver. There is no proof that
an inflammatory  stage and fever, are always
the consequence ; on the contrary,  I believe
inflammation seldom happens.  The  hepatick
system of inebriates does not appear injured
till a very considerable degree of debility has
taken place throughout the body : there is  a
general derangement  before this  assumes any
                     T 
218
signal mark of  disease ;  and  many of  the
worst  symptoms are often present, when no-
thing beyond nervous affection can be suspect-
ed.  Jaundice has too frequently been deemed
a  sign of enlarged  liver:  but  it so  happens
that the jaundice  of  nervous  people has little
connection with the liver.*   The irritable, or
torpid state of the duodenum and ducts, just
as the  nervous power happens to be deranged
in them at the time, is the most  common cause
of biliary  obstruction, and  consequent jaun-
dice.   Nay, the appearancevof  jaundice must
often  be a proof that the secreting oflice of
the liver is perfect.  JDuring the inverted mo-
tion of the  muscular  fibres  of  the intestines.,
so peculiar to the nervous temperament,  the
opening  of the  duct that conveys the  bile,
from  its  singular form, must be very liable to
obstruction.  And  this is thought to be the
most common cause of icterus.

   * Within  these four years, of rich and poor who
have consulted me,  not less than  50 cases of supposed
diseased liver, were of the number. Yet the treatment
proved that  no fixed  hepatick affection was present.
Many of these had their complaints aggravated by the
previous -use of mercury. 
219
   But if the torpid and enlarged liver is thur
proved to arise from nervous debility, must
not the cure turn  upon an invigorating plan I
The first step to this must be to remove the
causes which brought it  on ; in the  drunkard,
let the bottle be laid aside entirely;  let such
mental and  corporeal stimuli be used as have
a restorative quality ; and health must return^
if it can be brought about by human means.
    But  these principles apply with still more
force where biliary  obstructions infest the fe-
male constitution.  The irritable nervous sys-
tem,  and  delicate bowels of most  women,
ought to make medical people consider well
before they attempt violent remedies,  to over-
come obstruction.  The true method of cure
in weakened females,  must be to  strengthen
the whole chylopoeietic viscera,  by such medi-
cines as communicate permanent energy to the
nervous system :  to obviate slow bowels or
diarrhoea,  to correct acidity and  flatulence ;
to  attend  to the  quality  and quantity of the
food ;  to  regulate  the  passions ;  to observe
strict rules of air and exercise ; to avoid cau-
tiously every excess in  stimulation,  whether
mental  or  corporeal:  in short, to reverse all 
220
established habits, and to force a new train of
actions upon  the temperament.   I speak from
much experience on this subject: and it is ad-
mitted by the advocates  for  the  mercurial
course, that they have no certainty of the sup-
posed liver affection being removed ;  but their
patients are at intervals returning to the medi-
cine ;  and we have known  some instances
where ladies of the nervous temperament were
taken very unexpectedly out of their hands,  by
what was called the cramp of the stomach ; a
symptom that sometimes follows with  a quick
pace the  exhibition of mercury.  These  gen-
tlemen must have often  met with obstruction
and suppression of urine among nervous pa-
tients ; yet it does not  appear that they consi-
der calomel the best relief to the kidneys  and
bladder.   In fact, in most cases, of both jaun-
di«e and ischuria, we are  to look  to nervous
sympathy for their cause ;  for they commence
and disappear in general  so suddenly,  that
local causes can scarcely be  suspected.   We
might as well dissect the top of the osophagus
for the cause of globus hysterickus,  as  attempt
to fix the pathology of  these  versatile move
aunts in the secreting or other organs ;  or 
221
inspect the brain of a hypochondriack for the
picture of his blue devils. The migratory pow-
er which these affections possess, of travers-
ing every part of the body, is  the  inscruta-
ble idiosyncracy  of the Nervous Tempera-
ment.
   A physician of our acquaintance, for many
years was subject to dyspepsia, and conceived
that he had a diseased liver, as he termed it.
For twenty years he took calomel  in large
doses very frequently ; and all  this time with
a manifest  increase of his  complaint.  The
bowels  however came to that torpid  state, as
to resist every common laxative ; and he at
last  got to  the  enormous  quantity of thirty
grains of calomel for a dose.  I speak fromr
his  own authority.   He became weak  and
emaciated, and  at times suffered great pain ;
and  sunk under the debility, which was to a
certainty produced by the mercurial poison ;
for when the body was opened no liver disease
appeared !
    About eight months ago a medical gentle--
man consulted me for various nervous  and
dyspeptick complaints.  He said his liver  was
affected;  and he had taken calomel, at in-
                    T2 
222
tervals, by the advice of a neighbouring phy-
sician, for the  last twelve years.  He had a
slight  bilious look,  and evidently possessed
hereditary predisposition ; was rather thin and
the bowels in a  very irregular state.  I recom-
mended the usual strengthening plan, with
horse  exercise, and abstinence from  vinous
liquors,  and opium, which he used freely. In
a few  weeks he  got well, and recovered his
flesh.   In four months he felt some return of
his  indisposition,  and resorted again to his
calomel.   3ut his bowels became  more  un-
easy,  and he felt a constant  tenesmus.   He
came again to  me, and he  suspected when  I
saw him, an incipient ascites ; nothing how-
ever appeared outwardly.  I repeated  my for-
 mer cautions to him about the use of mercury,
 for I  looked upon it as the chief cause of his
 sufferings.  He took  the advice of two emi-
 nent  physicians,  at some  distance from his
 home;  and  they prescribed  mercury.  He
 began the plan  recommended, and died in a
 few weeks; in my opinion,  with a constitu-
  tion destroyed by this medicine.
     The mistaken pathology of these diseases,
  it thus appeais,  had given birth  to  this un- 
223
warrantable use of mercury.  Such cases can-
not be made too publick, in order to caution
inconsiderate people against the indiscriminate
administration  of  medicine,  so  capable  of
doing harm :  the  bowels of these gentlemen
were  evidently reduced by it  to a state  of
palsy.
    But however afflicting  the  condition  to
which the  body is often brought by nervous
infirmity, the mental indisposition is the cause
of greater misery.  To enumerate all the de-
grees of deranged intellect  in these diseases,
would be a difficult and useless task.   They
comprehend all that is extravagant in delusion,
or absurd  in fiction.  The acute, but too of-
ten false perceptions of nervous people, are an
apology for some of the stories we hear  of ap-
paritions, of magick and  of witchcraft, that
have at different times imposed on the credul-
ity of  mankind.   Their deluded and vivid
imaginations are  capable  of believing any
thing : and instances of supposed supernatural
agency,  conceived in a dream,  have  often
made such strong impressions on the mind,  as
to be attended by  consequences of great im-
portance,  not only to the  individual, but to 
224
 the  community.   All  jugglers  and mounte-
 banks find these persons an easy prey.   The
 imposter  Mesmer, who, about twenty-three
 years ago, exhibited his talents in ani mal mag-
 netism, by exercising nervous people at a kind
 of ordeal which he had invented, found them
 answer  all the purposes  of his deceptions ;<
 and  many  well informed men believed firmly
 in the truth of his doctrines.  Yet  the effects
 which were produced,  were plainly owing to
 sympathy,  and the power of  imagination;.
just  as we observe one  nervous lady fall into a
 hysterick by looking at  another in a fit; or like
 the two children mentioned before.*
   The temper of mind with nervous people,
renders them very prone to what is called re-
 verie.   In  the  sunshine of their sensations,
much of the rime passes in contemplating  ima-
ginary pleasures; or  what in  common lan-
guage  is called,  building castles in the air*
And when they are roused from  this fool's pa-
radise,  they are very apt to fall into the other
extreme of low spirits  and apprehensions. So

  * See  the report of the Examiners appointed by the
Ring of Eranee. 
225
certainly does a corresponding train of thought
follow every  odd feeling, in these whimsical
disorders.
    In the introductory part of thrslnquiry, we
have given  a cursory view of the savage state,
so as to shew  how favourable it is to vigour
and health  of body.  We there observe man
to pass through existence, with wants so few,
that he overcomes them  by  his individual ex-
ertions.  The spot that gave him birth bounds
his travels ; and  his knowledge is confined to
the customs  of  his  own  tribe; so that if he
ha3 little call for bodily labour, he has still less
for mental acquirements.  His diseases are on-
ly the infirmities and decay  of nature ;  but of
the whole catalogue of ills which infest mortal
life,  he is least in danger of being afflicted
with those of the nervous class.
    But how different is man  in the  civilized
world !   He  is obliged  to undergo a kind of
training how  to live ; to instruct him  in what
he  owes  to  himself,  and  what  to society.
Where the  savage feels one want, the civilized
being has a thousand.  Devoted either to love
or ambition, these impress all his actions with
extraordinary vehemence, perseverance, and 
226
enterprize.  He is no sooner brought into the
world, Than he is taught to admire every thing
that dazzles, glitters, or makes a no'i3e.  His
very employment is play ; and all his toys are
either shining or  sonorous.  Flattery  is the
first expression addressed to dawning  intelli-
gence :  he is called pretty to make him a cox-
comb ;  named good  till  he becomes a hypo-
crite ; and  learns to  act  the tyrant by seeing
every person afraid to disoblige him.   Every
thing within his view is  calculated to  prompt
his desires and provoke his passions ; no anti-
dote is opposed to suppress the one or to mo-
rate  the  other : and he  finds  example every
Where at variance with precept.  If he is born
the son of a rich man, he is still more unfortu-
 nate ; as he  will  be caressed  by more syco-
 phants, and exposed to greater temptations :
 and  to  be  born a prince,  is to be the most
 unfortunate of mankind.
     The  more  complicated and various  the
 pleasures and business,  which man is  to pur-
 sue in life, he will be the more liable to defeat
 and disappointment  ; and the more ardent his
 passions, they will the sooner terminate in ex--
 haustion and disgust.  The busy scene, there*- 
527
fore, leads quickest to satiety :  the retired cir-
cle preserves the longest enjoyment.  So tha*
thousands of human beings walk the round of
gaiety and dissipation, for the  certain reward
of nervous debility.  It is only at a particular
stage of refinement, that these diseases receive
their birth :  and when they exceed the sum of
other disorders in a nation, they afford sure
tokens, that that people is passing fast into do-
tage, and even under apparent prosperity ver-
ging to decline.   They multiply in prodigious
proportion :  for besides the hereditary predis-
position  whfch taints the offspring, they ar«
daily  gaining  ground from acquired infirmi-
 ties.  When we thus contemplate with a phy-
losophick eye, the rise and progress of a na-
tion, we observe a kind of phjsickal necessity
 for the regeneration of  mankind.   A people,
polished  and improved to the utmost,  cannot
•remain long stationary ; it must degenerate in
body and  mind.  It must fall  into slavery un-
der some powerful invader; or sink by some
convulsion of nature ;   and with all the arts
and elegancies of life, return to the  barbarism
of its aborigines.   Such a change of condition
brings man back  to  pastoral and agricultural 
                    228

habits ;  with which' his sinews will  be newly
strung,  and  his  vigour  of body renovated.
And with  these acquisitions of corporeal re-
production, the faculties of mind in a latent
state, will accumulate those powers and excel-
lencies, that in a future period will  exalt hu-
man nature to civilized perfection, though still
to be exposed in its turn to a similar decline.
    Although much stress has been laid on the
imperfect  state of the digestive and assimila-
ting powers in these diseases, yet  we  often
find a  considerable degree of obesity present,
wher« the symptoms of  indigestion prevail.
But obesity is seldom a  proof of  strength ;
perhaps it  oftener  accompanies  weakness.
And the indolent inactive life so often led by
nervous people, must favour the deposition of
fat.  A spare  thin habit, is however  a more
frequent  attendant on  dyspeptick constitu-
tions.   The food may  not only be  badly pre-
pared in the stomach, or vitiated by  imperfect
bile and pancreatick juice ;  the lacteals and
mesenterick glands  must  also  be  diseased,
sometimes impermiable, and perhaps  ulcera-
ted.  The quick evolution of acidity, in some
of these cases, is surprising ; it is  no sooner 
229
 corrected by  alkalies  or  carbonate  of  lime,
 than fresh quantities are  felt.  There is even
 reason  to believe that some of the  intestinal
 secretions are so depraved at times, as to be-
 come acid  immediately,  the  accumulation is
 so rapid.   The  simple deficiency of bile can-
 not account for this, unless the bile also loses
 its alkaline  properties, which I rather suspect
 it does in part.
    Acidity is not always accompanied  with
 flatulence.  The last  symptom is peculiar to
 some constitutions ; and it is most troublesome
 where sedentary habits are carried to  excess,
 as in some females. The uncommon quantity
 of air extricated in the process  of  digestion
 sometimes, would make us  suspect  a  large
 proportion  of the  food or water to undergo
 chemical  decomposition.   Some active  exer-
 cise, or quick  agitation of the body, affords the
 most certain relief.  The  frequent micturition,
 and strangury, which attend nervous  indiges-
 tion, prevail most when the stomach is loaded
 with acidity, and this points out the method of
 cure. I have not made any experiments on the
urine in these cases ; but it is likely that the
urick  acid must, appear in large proportion at
that time.                u 
230
    All derangements of the uterine  system
exemplify in the  most   striking  manner  the
strong  sympathy between the chylopoeietick
viscera and these  organs.   This  is  observed
particularly at the age of puberty ;  at the peri-
od ; at the  beginning of pregnancy;*  in  the
puerperal state; in suckling the infant too long;


     * Many of my contemporaries at Edinburgh \\\\\
recollect a case mentioned by Dr. Cullen, in his lec-
tures on the practice of physick, that strongly proves
the power  of association  during gestation. A lady in
a hopeful way, found it necessary to have her robe
made easier, and sent for her mantau-maker.  But in
standing up to be measured, she grew so  sick, that it
was accomplished with great  difficulty.  The gown
was brought home ; and in attempting to try it on, the
lady became so squeamish, that the mantau-maker was
obliged to  desist,  and leave her work to another time.
A few days afterwards,  another attempt was made to
try it on ;  but now the very sight of the gown brought
 on sickness. It was determined to take the gown away,
 and to hang it up in a dark closet, not to be seen.  Even
 this prtcaution did not avail;  the lady could not look
at the closet, or pass near it, without feeling immediate
 bickness.  It was  therefore carried out of the house :
 aad this extraordinary  association remained till  tie
 lady got her bed. 
251
at the change of life ;  in all conditions that af-
fect the passions ;  and  more or less in every
complaint to which the female may be exposed.
It must therefore be  of great  importance in
practice,  that  the  physician should inform
himself well, with  respect  to  predisposition
and temperament.   We thus see on what  irra-
tional grounds the use of a class of  medicines
called  emenagogues, was  founded ;  and  how
necessary it must be in uterine obstructions,
to attend to the influence of that chain of  sym-
pathies on which they chiefly depend.
   How  far the class of nervous diseases is
connected with gout, may, perhaps, require
much future experience to determine.  But as
far as the inflammatory symptoms are not con-
cerned,  the  two affections appear to  be  the
same.  They  both depend on hereditary or
acquired predisposition : the causes which pro-
duce them are  entirely alike : these are chiefly
luxurious habits and the debilitating pleasures :
all the dyspeptick  ailments of  the nervous
frame, appear  in the  arthritick constitution.
Every derangement of the biliary secretions,
partakes in each, of a similar disposition  ; the
state of the  intestinal canal is subject to the 
232
like  capricious vicissitudes  in both; and also
the urinary organs.   The  irritable feelings,
and  hallucinations  of  mind, with which both
subjects  are  affected,  have an  exact  resem-
blance.   And we observe, that the prevention
and treatment  of nervous  indisposition and
gout, are to  be conducted on the same prin-
ciples.
   No  fact  in  medicine appears  more clear*
than that the female of every gouty  family,
inherits in a high degree, the nervous  tempe-
rament ; and is liable  from  the general causes
mentioned before,  to  suffer all the infirmities
to which that temperament paves the  way.
This is exemplified by the  exhibition of mer-
cury and antimony; in  the  use of narcoticks,
particularly tea, opium,  and vinous spirit ; in
every improper indulgence in food or drink,
and in the government of the passions.
   Gouty constitutions are  known to be parti-
cularly  liable to urinary calculi.   The urick
acid, which has been  found to  form  so large
a portion of  these  concretions, is most likely
evolved during  the  depraved digestion and
assimilation  of  the nourishment;  and after-
wards separated by the kidneys,  and lodged 
233
 there, or in the bladder.  It would be worth
 while  to make experiments on the  morbid
 acidity of a  dyspeptick  stomach, for there is
 great  reason to think that it does not differ
 essentially from the urick acid.   All the alka-%
 lies are given v Lh advantage in  these kinds of
 urinary  calculi ;   and it is fair  to allow their
 chief  effect to be in correcting the acid in the
 first passages.
    From what has  been said,  I shall hope to
 be justified  in not attempting to divide these
 diseases into genera and species, which have
 little foundation in nature, and are of no utility
 in a  practical view.  Combined in the defini-
 tion of  Nervous Temperament,  they bear
 a  near analogy and connection to one another.
 We  thus observe, the  person  who in youth,
 possesses a mobile condition of nervous sys-
 tem, with a temper of mind depending on that,
 making him fickle, volatile, passionate, will in
 the advance of life, be les3  irritable ; but will
 still preserve so many traits of original charac-
 ter of habit,  as still to justify the term.  The
 dyspeptick infirmities will also undergo modi-
 fication,  in proportion to the manner of living
and  moral  habits.   Hence melancholy  and
                     u2 
234
hypochondriackism seldom appear before the
meridian, but more commonly not till later in
life.
    On the whole then, it is fair to conclude,
that the pathology of these  diseases is to be
sought in the deranged sensations,  and invert-
ed sympathies of the great  sympathetick
nerve ;  and in the irregular action of all those
organs to which  it is distributed,  The causes
therefore, whether moral or physickal, exert
their influence on this portion of the nervous
system ; whose  office directs  the  most im-
portant operations in the animal  economy ;
and binds together in one  great circle of feel-
ing, actions and motions  both distant and op-
posite.   Hence  a concourse of symptoms of
the  most extraordinary  kind, that invert the
usual functions  of so many viscera ; suspend
their powers, or give to them new movements ;
by  which means a  train  of false perceptions
occupies the mind ; and ideas the most mon-
strous and incongruous, supplant for a while,
all rational thought.   In this reciprocal action
between body and mind,  in whatever part of
the  circle disease commences, it is  quickly
communicated to all  the others. For as bowel 
235
complaints speedily affect the mind and depress
the spirits ;  so all violent emotions, in their
I turn,  induce affections of the chylopoeietick
viscera,  and raise such commotion throughout
the sensitive system, as to bestow the nervous
character on these diseases. 
236
             CHAPTER VII.

         Prevention and treatment.

   IN giving a title to this  chapter, I have
been cautious in holding out too much confi-
dence in medicine.  The word cure, implies a
certain and perfect recovery, without danger
of the  disease returning, a  circumstance very
doubtful here.   But according to  what is
meant by treatment, I only lay down rules to
regulate the practice, so far as experience ha3
approved.   This has been the conduct usually
observed with  my own patients :  and as so
much depends on their own discretion, it puts
them on their guard, and reminds them how
far they are to calculate on permanent health.
   It has  been  unfortunate  for the medical
profession, as well  as patients themselves, that
persons labouring under  nervous disorders,
have too much expected from the prescription
of the physician, and the shop of the apotheca-
ry, what is only to  be obtained from their own 
23?
caution  and circumspection.   We thus find
most  of them ready,  and greedy to  swallow
every medicine  that  is recommended ;  but
stubborn and untractable in all that relates to
breaking in upon established habits  and cus-
toms  ; whether of luxurious living, depraved
appetites, indolence of body or  mind, or vi-
cious indulgence of any kind inconsistent with
health.   Many of these  habits, it is  true, are
so  far interwoven with the constitution/as to
make some changes almost impracticable : but
as  indisposition is so frequently brought on,
or aggravated, by the  improper conduct of the
patients themselves,  the physician cannot be
too much  on his guard, in demonstrating to
them all that belongs to their own government
and demeanor.   The  medical adviser there-
fore, who observes the most disinterestedness
towards his friends, will often be the  first man
to be dismissed ; while the selfish dissembler,
however  ignorant, will  become a favourite,
and engross the emolument.   On such an oc-
casion, the virtuous  mind of a liberal physi-
cian, will know where to look for approbation.
    This branch of medical practice  has com-
monly  been  reckoned one of  the most lucra- 
238
tive ;  for the subjects of it are generally found
among the  affluent:  they  are  also  seldom
without some complaint that requires assist-
ance ;  and  they measure their comforts too
often, by the quantity of medicine that is serv-
ed up.   Nervous people are  moreover, en-
dued with acute feelings ;  liable to  act from
the first impression and  impulse,  and easily
deceived  by the  designing  and  interested.
And  should they fall into the hands of a gos-
siping physician, or a wheedling apothecary,
these personages become a kind of appendage
to their  establishment, if not fixtures in their
houses.   Being  singular in the selection  of
friends, they seldom mix in company;  seden-
tary from habit, they go little  abroad ; their
amusements and recreations are thus limited,
and  such  as  possess  the   talent  of  bring-
ing  news,  and telling  a story,   are at  all
times  welcome guests.  But as  the  tale  of
their own complaints engrosses so  much  of
their conversation, a  medical gossip,  before
all others, is the most acceptable.  Neverthe-
less, let the  nervous  and valetudinary beware
how they trust their health and their purse in
such hands. 
239
   The prevention of all diseases depends on
a knowledge of their remote causes.
   If in the former part of this inquiry, it has
been found necessary to contrast the health of
the savage state with that of the civilized con-
dition  of mankind,  for  the  purpose of tra-
cing causes  from their  origin, it does  not fol-
low in prescribing regulations to the nervous
and  infirm,  that we are to imitate the robust
exercises of the barbarian,  for the  sake  of
strengthening the body  ; or to yield up the re-
finements of education and polished  society,
in order to  subdue sensibility of mind.   The
lesson  is only so far in point, as it tends  to
confirm general truths by  an appeal to facts, or
to illustrate  a precept by showing an example.
   In the present diseases, according to the
history given, we admit a predisposition of bo-
dy, without  which, it is probable, they never
appear.   This  predisposition   may be either
hereditary or acquired; to both we give the
name of nervous temperament.   What there-
fore relates to correcting  and preventing  pre-
disposition,  must begin with the  earliest sta-
ges of  infancy, and includes  the whole rules
of nursing and rearing children. 
240
    Man  is so much the creature of habit and
 imitation, particularly with what belongs to his
food, air, exercise, and cloathing, that he may
 be moulded into any form we please.  Nature
 has wisely provided milk for the infant, as best
 adapted to the delicate digestive organs and
 weak frame of early existence.   This kind of
 food ought to be continued as long as  it is ca-
 pable of giving due support to the body.   The
 mother, if possible, ought to suckle the child
 till it  is nine  months old;  when cow's milk
 may be substituted.  And it is worthy of re-
 mark, that the fodder of the cow very much
 affects the milk,  such as grains  and  turnips,
 so  much  in use near great towns.  The first
 article makes the milk disposed to acescency ;
and the turnips impregnate it with a disagree-
able flavour, which comes from an oil in  the
tops and rind.   Such  qualities are hurtful  to
the stomachs of infants  : and  grass and hay
are the natural  food of this useful animal.
    A child that is to be brought up by  the pan
and spoon, an it is called,  it is obvious, ought to
have the milk in the best perfection.   This is
a practice  which I am  sorry to observe  is
sometimes too  lightly given  into, in faoiilies. 
241
I have weighed its merits fully, in rearing my
only child^n this way, to  fulfil the  wishes of
an affectionate mother.  But, though my dar-
ling boy has surmounted his loss with the best
possible health, I would not recommend this
mode of nursing on any terms, if  it can be
avoided.   Nothing  can compensate for the
want of the breast to the infant.  About the
third month, a  little  pounded  biscuit, pre-
viously softened with a little boiling  water,
may be added  to give the  milk consistence :
and from the beginning, as  much brown sugar
may be mixed, as to give it the sweetness of
mother's milk.   Sugar, it ought to be remem-
bered, is  a bad ingredient in the  diet of in-
fants.
    The infant may be confined to milk  for the
first year; when a mess of chicken, veal, or
mutton broth, may be given once a day, taking
care to add nothing of the aromatick kind.   If
however the infant is much  harrassed with aci-
dity, animal broths,  such as gravy soups,  are
not only the best substitutes, but the best me-
dicine.   After two years, the diet may be ex-
tended to a little solid animal food, some kinds
of fish and eggs, but still with a large propor-
                     w 
242
Cionof milk. All pastry must be carefully shun-
ned : sweetmeats  of every  sort are hurtful :
every  made dish,  into which  seasonings and
sauces are put, ought to be avoided, as being a
chief cause of stomach affections.   All beer3,
ales, wines, and spirits, are excluded from this
anti-dyspeptick regimen.   Puddings made of
rice, or  light bread, may  be allowed.; but
those of unfermented flour, have all the disad-
vantages of pastry.  Cheese is gross food for
children.: and butter should be sparingly used.
Vegetables  may be eaten with animal  food ;
the child being allowed  sufficient exercise out
of doors, will always find them easy of  diges-
tion.   The object to be kept in view,  in re-
commending for infancy and childhood, a diet
sufficiently nourishing and  easy of digestion,
but at the same time, mild and bland,  is, that
the appetite  may  become accustomed to no
high-seasoned or  luscious dishes ; or the sto-
mach inured to any hot or stimulating article.
    Were these rules strictly attended  to  in
families  su'oject to gout and nervous diseases,
many scenes of misery and affliction might be
prevented.  It is  a fact, to be daily observed,
that the offsprings of these families, arc, cf all 
243
mankind, the most liable  to fall into habitual
drunkenness, and the love of luxurious  feast-
ing.   Their feelings and sensations are of that
acute kind, that they easily  receive the im-
pression of stimulating articles, and are quick-
ly susceptible of the pleasure of taking them
down.              •
    Tea and coffee are excluded from this diet,
as possessing a narcotick quality :  milk  is the
best breakfast, but those  who may incline for
more variety,  may use  cocoa.   Cocoa is 3
mild, wholesome, nutritive  food, and  after a
little perseverance very  grateful to most peo-
ple, and easy of digestion.
    From what has been just delivered on the
diet  most  proper for infants and  children,
grown-up  persons will see  reasons, why they
should prefer a similar conduct in the  choice
of their food.  This is  indeed a serious evil
with most nervous and bilious people : they
commonly indulge in high  seasoned  dishes,
and use great quantities of hot sauces or pep-
 pers, for the purpose, as it is thought, of over?
 coming the flatulent propensity of their sto-
 machs.   I have before  condemned this cus?
fom : where flatulence  prevails, the stomach 
244
 should select  plain  fare, and that in small
 quantity ;  and after a short rest take some ac-
 tive exercise, which will afford certain relief.
    The value of air and exercise to health, is
 amply pointed out in the preceding parts of
 this work :  attention  to them  ought to  begin
 with early infancy.  The child must be exer-
 cised in the open air, that is ever to attain due
 srength or stability of  frame.  The most spa-
 cious and well ventilated room cannot  supply
 the want of the external  atmosphere.  A de-
 gree of vigor and fortitude of mind is insensi-
 bly acquired by being exposed to the weather ;
 while listlessness  and depression of spirits as
 constantly  follow  confinement within  doors.
 Much of this mental exhiliration must be de-
 rived from the objects which refresh the eyes.
 The sedentary life falls more to the lot of the
 girl than the boy ; and is too often encouraged
by those preposterous modes of education to
which young  females  are exposed : but cer-
tainly a sedentary life may be considered as
the chief cause of female ill-health.  I have
heard a mother boast of  her  daughter being
attended by five masters, in different branches
of education,  in the day, besides  her task ia 
245
the boarding school.   What human body  or
mind,  at the age of fifteen, is equal to such a
trammel of study ?   Let the discerning mo-
ther therefore, reflect in time, on  the magni-
tude of the fault, if she bestows her daughter
with a sickly constitution as a dower, on her
husband.   Can any evil in this world be worse
than constant  bad health ?  How melancholy
is the  state of that family that  is daily beset
by an  attending physicLn  and apothecary;
continually served with medicine ;  and a large
proportion of income annually  consumed  la
support of its physical retinue !
    Among children descended of nervous and
bilious parents, it is a caution worthy of every
well informed physician, to be guarded in the
use of emeticks, purgatives, opiates, and worm
medicines.  The last articles require particu-
lar animadversion.  The fathers and mothers
of such families,  have too  often been in the
habit of using medical prescriptions on every
slight occasion :  and  very  naturally think a
similar  practice  necessary for the health  of
their children.  Worms can only be consider-
ed as the consequence of a weak condition  of
bowels ;  so that their prevention and cure  in
                     w 2 
246
children, must turn on strengthening the vis-
cera, and expelling the vermin.   A brisk pur-
gative is commonly employed  for dislodging
worms, and calomel has been the chief  ingre-
dient.   But calomel ought  never to be given
alone ;  it is best to join it with jalap or rhu-
barb ; though these articles by themselves are
sufficiently powerful.  I usually give mag. uff.
with the jalap or rhubarb, with a view to the
dyspeptick state  of the stomach ; and  follow
this purge with gentle doses of bark, colomba,
or any other suitable bitter.   Nothing answers
better  than the  sem.  santon.  or  common
wormseed.  With all these I combine magnes.
ust. or  cret. prepar,  as the bowels  happen to
be slow or quick.  Some chalybeate, such as
the red oxide,  carbonas  ferri, or  lematura,
may also be advantageously  added.   When
these  have been taken for eight or ten days,
the brisk purge may  be repeated.   This plan
may be  continued for two or three  weeks at a
time : it will invigourate the digestive powers,
and the  general habit: and while it enables the
bowels  to expel  the  worms,  it will prevent
their generation by removing the cause.   No-
thing can be more cruel than forcing the bow- 
247
 els of children by drastick purgatives to evacu-
 ate worms ; the  most active  will sometimes
 fail in doing this ;  whereas the invigourating
 method is sure and safe, and cures radically.
    What other precautions are necessary for
 the health of children, will appear sufficiently
 plain from what has been said on the causes of
 these diseases.  These causes must be avoi-
 ded,  to  insure success.   The inhabitants of
 towns ought if possible, to place their children
 in the country for the benefit of education.  It
 is not merely the pure air, and space for re-
 creation  and exercise, that a country situation
 affords, which make it preferable ; other con-
 siderations  of equal  weight, are to be taken
 into the  account.   The habits which we are
 now combating, are the vices of artificial life.
 And the love of nature is one of the best les-
 sons to a young  scholar ;  it checks every ex-
 cess, and prescribes nothing unwholesome  to
 either body or mind.  To see the grass spring,
 the plant shoot, and the  flower blossom,  are
 among the  finest  objects for  contemplation.
 What ingenuous youth ever heard  the  bird
 sing,  the  lamb bleat, or the heifer low, but
warmed  with  emotions of a superiour kind. 
                   248
The beauties of landscape, more  than  any
thing we  view,  purify the  heart, refine the
taste, and  warm the feelings.  All is cheerful,
active, and healthful, because all is natural and
innocent.   Youth is the season of life to leain
with advantage the value of nature's produc-
tions, and picturesque  scenery.   If neglected
then, the  soil will groan under less amiable
productions.  To what an unfortunate change
the present fashions  are conforming mankind.
The country houses of our nobility and gentry
are empty till July.  Thus the spring months,
that season of joy throughout creation, passes
unobserved  by  the  affluent and  gay.    The
souls of human beings in this age of art, would
seem  to  wish the  sun to be darkened ; they
find no pleasure but in the  light  of a lamp or
a flambeau.  I  feel  for  the rising generation,
when  I consider the effects of these over-
grown follies upon unexperienced minds.
    With  respect to the prevention of these dis-
eases, in  grown up people, or what is the same
thing, correcting the predisposition, no task in
 medicine  has more  difficulties to surmount*
 It is not that it is impracticable  ; but the pa-
 tients themselves,  are seldom willing to sub- 
249
mit to a code of rules for the direction of their
health, and view with jealousy and pain every
precept that is to subtract from their  plea-
sures.   What reward can encourage the sloth-
ful to activity ?  Who can teach the voracious
glutton moderation in eating ?  Or what elo-
quence can  persuade  the habitual inebriate to
forsake his bottle ?  Nay  how difficult the
task,  to  draw the  nervous female from her
tea!
    Where the predisposition is not hereditary,
some of the causes which have been  assigned,
will generally be found  to have brought it on.
If these causes have been owing to any indis-
cretion of the patients themselves, to counter-
act them, will be difficult in proportion to their
inveteracy ;  and  the  desires  and  passions
which give them effect.  A habit is to  break
up, without which there are no hopes of relief.
Every  nervous  person has  some  favourite
pleasure to indulge.   Articles of materia me-
dica avail little, unless the patient forms the
resolution  to obey the injunctions of his phy-
sician.  To begin new modes of living ;  to go
to bed soon and rise early ;  to drink water in-
stead of wine ; to labour and  toil, and be ex- 
250
posed to the weather after years spent in luxu-
ry and  sloth, are  changes  not likely  to be
heard with satisfaction, far less to be practised
with perseverance, by an enervated voluptua-
ry.  Yet changes equally great must be  effect-
ed, or there can be no recovery.
    The treatment of these  diseases is  a part
of the physician's duty,  that differs much from
the  experience necessary to direct with suc-
cess, the  practice  in most  other distempers.
For, however well he  may be informed  by
preparatory studies, and however stored with
the resources of his profession, something will
still be wanting  to insure a decisive method
of cure, which even the sick-bed cannot sup-
ply.  This is the knowledge of character and
of mankind,  which can  only  be  learned  by
 quick discrimination, and correct observations
formed in the busy world.  The  living man
seen in his varied pursuits, can alone bestow
that knowledge  on the physician.  Fcr this
very reason,  there are no disorders that so
puzzle  and  confound  the young and  inexpe-
rienced ;  and  none so liable to «be misunder-
stood by the ignorant, or plodding part of the
profession. 
                    25!

    The old maxim contraria contrariis medeti-
ter, is better exemplified here, than in  most
other diseases.   To change a state of body in-
duced  by long customs of living,  or derived
from nature itself, must be entered upon with
•fortitude and resolution.  But e\en where no
improper  habits have  been formed, changes
and variations of regimen that powerfully im-
press the nervous system, and call forth active
passions of a different  kind, will often be ne-
cessary to health.   To the inhabitant cf a
town, a  country life <will offer many new ob-
jects to the sense, and  »ff«>rd the most salutary
recreations.  But that this change of scene
should operate with  <lur f<ice on  the sentient
part, it is not that  a   few w t eks Or months,
should be passed in a new situ,  it,n-; it it can
possibly be done, it ought to Lt  f( r years; nay,
in some instances it must be continued iui life.
And when such transitions of living are enter-
ed  upon,  whoever intends to practise  them,
must duly weigh  the   circumstances.   The
mind must not be left in « state of inaction,
lest it should relapse into its old feelings, and
become ihe prey of former passions,  in mak-
ing this transition from the city to  the village, 
252
every person  must be satisfied first, that he
can employ his retirement without ennui, and
pass his time to advantage.  The  business of
a farm  is the natural avocation of a country
life.  Agriculture in the present day is impro-
ved to  the form  of  a science,  and requires a
regular  course of study from the books which
contain it; and when combined with the prac-
tical part, it  becomes a source of profitable
and elegant pursuit.  Every  6eason  brings
with it something to be  done ;  so that a mind
disposed  to be  active cannot want a motive :
and the sports of hunting, fowling, and fish-
ing, will  amply vary the hours which are de-
voted to relaxation.
    The  small  circle of  domestick duties,
which many persons have to go through, exhi-
bits such a sameness, that no recreation can
be derived from it; there is so little of variety,
that the mind as well as the body, dwindles in-
to  a tenour of listless inactivity.   Sufficient
stimulus is wanting to rouse the languid facul-
ties : and in such situations we meet with the
most confirmed  habits of nervous affection.
I once knew a lady,  that for twenty years was
never out oi her room; at length,  without any 
253
known cause, she  ventured abroad,  and re-
turned to the full exercise of all her former
duties of friendship and family affairs.  Such
cases are chiefly to be seen among people en-
joying easy fortunes, who had been formerly
active, but are now without any of those urgent
motives which  preserve energy of mind, so
conducive  to health.   The publick funds of
this country are one great cause of those tor-
pid  habits of living; where the security of
property is  so  complete,  that any care about
its safety is needless.   A vast capital is by this
means unproductive of any thing to the pub-
lick, but is a source of bad health to its owner.
All enterprize is thus checked among a large
part of the  community,  who become victims
to  diseased feelings,  and to those  kindred
glooms which prey on still life.  I have known
some benevolent ladies of fortune,  who, hav-
ing no busy  employment to fill up their time,
took under their protection several large fami-
lies of children, among their poor neighbours ;
and by administering to their wants, directing
their education, and dispensing cordials,  me-
dicines,  and necessaries to the sick,  made
themselves  a  blessing to society: and by the
                     X 
254
air, exercise, and recreation, which  were re-
quired for the discharge of these good offices,
they warded off all the unpleasant attacks of a
delicate frame,  and a nervous constitution.
   To the  man  of business  and the artisan,
who are necessarily confined to a  town, I
would recommend, that as much time as pos-
sible, in their leisure hours, should be spent
out of doors, in riding or rambling about the
outskirts of their residence.  This kind of ex-
ercise ought to be carried to a  much greater
length than has usually been advised ; it ought
to be continued to the breaking out  of a free
sweat.  These persons  must learn  to brave
the weather,  and sally out in pursuit of  their
health and  recreation, in despite of wind  and
rain : and  their dress may at a cheap rate, be
accommodated to the state of the atmosphere
and season.  The distance from town, which
may be necessary for these excursions,  must
be measured by the purity of the air, and the
rusticity of the  country: they must get be*
yond the effluvium of smoke and mud.
   When employed at the desk, men of  busi-
ness, and indeed all persons who write or read
much, ought to use a standing posture,  to pre- 
255
vent the body from being bent, by which means
the lungs  and stomach, as  well as the whole
abdominal viscera, will be free from compres-
sion.  Want of  exercise at all times impedes
the free circulation of the  blood,  and the re-
gular functions  of the  different bowels ; but
compression of these organs, whether by  tight
lacing and swaddling, or by any unnatural pos-
ture long  continued,  has still more pernicious
effects.
    Exercise and recreation,  of the kinds just
mentioned,  unfortunately cannot be employed
by the town-bred female.   Indeed the fashion
of a town  life, at this day, almost excludes the
lady  from every share of healthful exercise ;
for it is  not to be expected that the  fair sex
can, by themselves, frequent the publick walks,
or perambulate the adjoining fields, to breathe
a purer atmosphere.   In this age of manufac-
ture, trade,  and politicks, the morning hours
of the gentleman are commonly spent at the
counting-house, the  exchange, or  the  coffee-
house ;  so that  the  ladies must  be satisfied
with a short  visit of their male companions  at
the dinner table, which seems almost the  only
scene ef intercourse between the  sexss.   In 
256
what  manner then is the city lady to preserve
health, or regain it when lost ?   If she cannot
look to a country residence, her situation must
be pitiable.
    AS these diseases, from innate delicacy of
 frame,  fall mostly on the fair sex,  how cau-
 tious ought parents to be  in selecting proper
 seminaries of education for their daughters.
 Many fathers and mothers, I believe, still pre-
 fer a boarding-school tuition,  to private in-
 struction under  their own eye.   But  I  am
 here to speak  chiefly  as it  concerns the health
 of young ladies.   Girls are commonly sent to
 these houses,  at a period of life when the con-
 stitution is to  undergo some material changes,
 which require  the most attentive and delicate
 treatment.  Now it so happens, that many  of
 these boarding houses lodge thirty, forty, fifty,
 nay an  hundred young ladies.   I am at  a loss
to conceive how  any  mistres's of a school can
 do justice to  so   large a seminary of pupils.
 But I may be  told, assistants are kept in pro-
 portion to the  number of scholars.   This is 
                   25 7
evading the question, not answering it'. assis-
tant  teachers may answer all the purposes of
school hours ; but do all these assistants pos-
sess  the qualifications necessary for forming
young minds to be amiable wives, affectionate
mothers, and accomplished Women ?  Scarce-
lv.   A  mistress of education is in the place of
a parent: is this maternal duty then of so small
importance that it admits of being deputed to
the  third degree ?   They must  have  cold
hearts who think  so.   Every discerning mo-
ther knows well that the smaller her family is,
she can  the better attend to the  wants of her
children.   How  then  can a mistress of  a
boarding house, who officiates for a livelihood
only, do more than the natural guardian ?  The
mere acquirements of learning are  a  small
part  of female  education ; it is the domestick
virtues, and  the  retiring graces, which form
the chief excellencies of woman.  Which of
these fashionable  schools have given proofs to
the world,  that these are  the studies they in-
culcated ; and that their  matrons are models
for imitation, beyond  the  generality of mo-
thers ?
   In this country, it is little more than a cen-
                     x 2 
258
 tury, that daughters were  thought worthy of
 an  improved education.  So lately have  we
 emerged from  barbarism.   Ever blessed  be
 the memory of the amiable Mr. Adison  for
 this polish to society!   It dias not therefore
 yet crept into our customs,  to honour female
instruction with  those  marks  of  authority
which  distinguish publick  schools  for boys.
Preceptors bearing academick  degrees, and
licensed by the learned, are alone  trusted  to
conduct the education of young men.  Where-
as, any lady of  tolerable mediocrity in talents
and accomplishments, who  can meet with the
countenance and support of  a few well mean-
ing friends in her neighbourhood, is.deemed
equal to direct  a boarding school for young
girls.  Books may be multiplied without num-
ber on female manners, if some  check cannot
be given to the custom of allowing their edu-
cation to  be conducted by improper persons.
One vicious seminary  will do more  harm than
can be compensated by the whole philosophers
of the age.  Hence the necessity of qualifying
the mother to instruct her own children.
   In a publick boarding school there is a very
heterogenous concourse of  characters.  We 
259
 there behold the  daughters of persons of all
 ranks in life ; of families of the most discor-
 dant habits  and sentiments ; many of  these
 bringing abroad all the prejudices of kindred ;
 and perhaps not a few labouring under hered-
 itary diseases or imbecility of mind : all  lodg-
 ed, boarded, and trained, under one roof.  If
 imitation is one of the strongest propensities
 of our nature, is there not  great  hazard in
 such a collection  of young people ?  Every
 good mother is cautious whom her daughters
 chuse as companions  at  home; and can she
 be less jealous of their  safety when abroad I
 The best and worst  of  our habits receive a
 tincture  of our associates, but particularly du-
 ring youth.  Such a school  of young girls, all
 differing in rank, in fortune, in temper, in con-
 stitution, in passions, and in prospects in life,
 but liable to communicate follies, propensities,
 and diseases to one another, must be conside-
 red as an improper assemblage.
   All boarding schools  ought to be situated
 in the country j not only  for the sake  of air
and exercise, but that  the young ladies may be
cut off  from  gossiping  visitors.   This  will
tend to secure health, by rendering the intro- 
260
duction of contagious diseases more  difficult.
Such a space of ground ought to be laid open
as may be sufficient for  amusement and play ;
and certain portions  of the  day allotted  for
walking, or more active sports, that those who
are most sedentary may be forced  to partake.
An adjoining flower garden will be  a motive
for recreation to some,  while the taste may  be
improved  by the study of botany ; a task pe-
culiarly adapted to young ladies.  Such avo-
cations will train the female  mind to the love
of simplicity, and store it with that Species of
information which affords food for reflection
at a future day :  and will fill up much of the
leisure to be met with in the domestick scene.*
The pupil  of elegant nature  will  thus  find a
country  walk as much  the habit of lifer-as her
hours of sleep ;  and  will not be seared from it
by a dirty  road, or a lowering sky r  a portion
of time will always be due to exercise, that the

   * The  young ladies in boarding schools, in this vi-
cinity, who are instructed to the love of the animated
world, have now a rich field for contemplation in the
elegant volumes of our townsman, Mr. Bewick.  A
work that does credit, not oijly to this country, but t»
the age. 
                    261

faculties may be refreshed, and the eye feasted
by the beauties of creation.   And  while  her
nervous aunts are moping their evenings over
the card table, she  will gather health by  her
cheerful excursions ; and preserve  her bloom
of countenance  by the only  means that  can
give it an  additional charm.    These ideas
may,  by  some, be deemed a little romantick )
but when I look to the sickly frame, and mise-
rable  existence  of  a nervous  patient,  I  can
find an antidote  against this species of criti-
cism.
    The  diet  of these  schools,  I  am  much
afraid, is often exceptionable.  And if their
matrons are not too wise for advice, they  will
find many  cautions necessary with  girls, ner-
vous in themselves,  and descended from ner-
vous, bilious,  and gouty parents.  They  will
therefore find it  of  consequence to pay some
attention to the physical traits of their  pupils,.
that they may learn  how to preserve  health.
Let them beware  of encouraging hot or highly
seasoned dishes.  Tea and coffee ought to be
excluded from their bill of fare.  Plain dres-
sed meat ;   plain puddings ;  no pastry ;  no
cake nor sweetmeats ;  water, or milk and  wa- 
262
ter, with  meals ; fish with plain butter ;  n»
vinous liquors, but when prescribed medically.
A plentiful dairy, will be a most valuable  ap-
pendage to every boarding school.
   I  am one of those who consider the office
of superintending a female boarding school, as
a station of  great importance  and responsibi-
lity :  and officious friends should not be too
precipitate in recommending persons to fill it.
It appears to me of even greater moment than
a teacher of boys, let their rank  and conse-
quence be what they may.  The  boys whose
education may have been neglected, by future
attention  may be recovered :  but the young
lady,  whose  manners have once received a
wrong bias, is seldom restored to a simple and
unaffected demeanour ; and so it is with health
also.   To married women only this  business
should be assigned :  and  it ought to  be given
in preference,  to one who has educated her
own  daughters.  It  will  not  be contended in
opposition to this opinion, that any one can be
sensible  of  the mother's duties, who has not
stood in  that relation  herself.  A good temper
and  benevolent disposition must  be  essential
ingredients in this character.   These animad- 
263
 versions on female education and management
 eannot be called foreign to a treatise on ner-
 vous diseases.   They are the result of long
 observation, and of much conversation on the
 subject, in different parts of the World, wiih
 many sensible women, who had  received  a
 "boarding school instruction, and often lament-
 ed the imperfections to be found there.
    Dr. Beddoes in his-Hygeia, has lately pub-
 lished some remarks on these institutions, and
 given accounts truly frightful of their internal
 economy.  The medical  attendants of these
 seminaries have hitherto  preserved a silence,
 not always commendable, when improvements
 for the sake  of health appeared so necessary.
 Jt is fortunate for the progress of science and
 the good of human kind, that such men as Dr.
 Beddoes now and then rise up on  the theatre
 of the world.; who, above the low trammels
 that fetter selfish beings, dare to combat pre-
judice and errour,  and expose the stupidity of
 rejecting improvement.    But the first step to
 a wholesome reform in  behalf of this  most
 amiable  part of creation, must be to limit the
number  of pupils.   Patents  have  it in  their
power to effect this,  by  sending their daugh- 
264
ters to those schools only,  whose numbers ne»
ver exceed a family circle.
   When we  recommend air and exercise to
our patients, the nature of what advantage we
expect from them  ought to be explained, that
the due effect may be obtained.   A number of
people are too apt to think, that a short formal
walk out of doors, at stated hours, is sufficient
for this  purpose.   Nay there  are  hundreds
who think thi-y have done great thingb, if  they
go abr nA  for an  hour or  two  in  a  close
carriage.  Such  persons may be very much
pleased with medical admonitions ; but  they
pay  a poor  compliment  to  their physician,
when they limit his directions to such forms.
In a luxurious age, and in  a countr)  like Eng-
land, wallowing in wealth, and  rioting in in-
dulgence, I am well  aware how diffi ult and
unthankful the task to tell  people they are do-
ing wrong,  when they receive so much  plea-
sure ; .and how hopeless the prospect of bring-
ing them back to simplicity of manners and
sober modes of living, after unbounded gratifi-
cation.   I must however contend, in the pre-
vention of these diseases as depending on pre-
disposition,  that  the  exercise ought to be of 
265
the most active kind, even to laber and fatigue ;
and always till it produces a moist skin, if not
a profuse  sweat.  As these  resolutions gain
ground  in the nervous temperament, the idle
and trifling objections commonly made  against
season and weather, will soon vanish.  It is
the certain effect of  recreation out of doors, to
exhilirate the mind,  while it invigorates the
body ; which soon gives birth to new feelings,
new ideas, and active faculties.  To a person
accustomed to a warm close room, and seldom
moving beyond  the threshold, I conoeive  the
influence of the  external air, and sufficient ges-
tation at the same time, to be  a considerable
step towards a reversed method of living.
    The value of exercise on horseback, is so
well known,  that it may  seem superfluous to
mention it here.  But in the prevention and
treatment of  nervous and bilious diseases, it
is super-eminent. When it is begun with con-
fidence,  care should be taken the ride  may not
grow irksome  by being constantly over  the
same road.  A journey  should therefore be
frequently interposed;  and  some business to
be transacted, kept in view.   The motion and
action which are communicated by riding, to
                     Y 
266
the organs  of digestion and respiration, are
of the most salutary kind.  The stomach, by
being duly compressed by the abdominal mus-
cles, has its contents, after being fully dissoU
ved by the gastrick liquor, expelled at the pro-
per time.   Some persons will tell you, that it
is hurtful  to use exercise  altera full repast:
hut that is  the language of a pampered being,
and of one who  eats beyond what nature re-
quires : how otherwise could the labourer rise
to his work, with so short a rest after his din-
ger ?  But custom has made it familiar to him,
and he,is satisfied with what will support him.
Were  every lover of good eating compelled
to walk a  few miles immediately after dinner,
he would soon  learn moderation.   By riding,
the liver, with its sluggish circulation, its gall-
bladder and ducts, is well pressed and agitated;
so that the bile is secreted in proportion to the
wants of the digestive process, and all its ca*
Tials kept  pervious.   The peristaltick  motion
of the intestines is thus promoted with all the
fluids ;  and the lacteals in like manner per*
form  their  office.  The kidneys at the same
time, as well as the bladder, discharge the
urine to the last drop; and  no particle of sa- 
                    267

bulous matter is detained in either cavity, to
become the  nucleus of  a future stone, as so
often follows  a life of indolence and sloth.
The lungs being fully stretched and expanded,
by the full inspiration of a pure atmosphere,
the vivifying oxygen is  taken in, in due quan-
tity,  to afford strength and  stimulus to the
body, and activity to the intellectual faculties.
Hence the heart is  excited  by a florid dense
blood to  strong contractions ;  and the surface
and  extremities warmed  and softened  by  a
generous vital fluid ; which,  while it defends
from a cold and fickle atmosphere, keeps up a
 glowing perspiration, to the certain  relief of
 every dyspeptick symptom. From these effects
 of equitation arise cheerful spirits, acute un-
 derstanding,  good appetite, perfect digestion,
 sound and refreshing sleep,  and all the health-
 ful and pleasurable sensations which flow from
 mens sana in corpore sano.
     The  cold  bath is a common remedy with
 weakly people ; and it is often resorted  to by
 the nervous invalid. I rather wish to consider
 it as an  athletick exercise than a medicine, I
 therefore introduce  it under the prevention.
 Modern  physicians  have,  however,  made 
268
greedy attempts  to bring it  under their con-
troul, and to point out how and when it ought
to be used.  But  the  rules  which have been
laid down for the practice,  and the explana-
tions  which have been given of its  mode of
action, are alike unsatisfactory.   The recent
publication of Dr. Buchan, on cold and warm
bathing,  has treated the subject  more scienti-
fically ;  and his  book ought to  be carefully
read by every person who resorts  to a water-
ing place.
   When we look at the  subjects who flock to
the sea-side  to use  the cold bath,  we find per-
sons of every description, labouring under all
the varieties of disease.   It must therefore be
either a universal remedy,  or  no  remedy at
all.  Hence  one  speaks of it as a bracer,  and
giving tone  to the solids.   Another accounts
for the good effects  of  it,  from the shock it
gives : and a third explains it, by accumulating
tensorial power,  or excitability.   Leaving all
these  gentlemen  in  full  possession of their
theories, I must  beg  to consider it chiefly as
an exercise and amusement.  A degree of re-
solution  is  required  for  the employment of
cold bathing, which inspires courage;  for the 
269
time,  it -.hiits the train of thought, and calls
forth a considerable  muscular exertion.  On
the sudden  emmersion  of the body into the
cold water, a quantity of heat is instantly given
out, which gives what is called the shock ; and
the temperature  of  the body is for the time
reduced, at least so  long as it remains in the
water.  In order therefore to render it a salu-
tary exercise,  the  water must be  of a tempe-
rature suited to the vigour of body, or its ha-
bit of bearing cold.  We thus suppose that
the season  for cold bathing is limited to the
summer months; for in winter the degree of
cold which  we require, can be obtained from
the atmosphere.   In the act  of dressing and
undressing, the body is exposed naked to the
air ; I fancy this may be the means of harden-
ing it  a little to the weather, which is a good
effect.
    Persons who are timid at first,  if their fears
decline as  they  go  on, gain advantage from
bathing.  But those who  never surmount the
dread, cannot expect benefit from it.  Much
of the good, it would appear,  arises from the
vigour and activity it calls forth.  If the bather
can swim, and use considerable exercise in the
                    V2 
270
water he may remain in it a length of time ;
but others cannot do  this without  danger of
catarrh.   After  coming out, if the  spirits are
raised, the body agile, with a glowing warmth
speedily  succeeding on the  skin, and fitness
for muscular motion, with increase of appetite,
the bath has done good.  When a person is
extremely apprehensive,  he ought to  begin
bathing very gradually; lave the  body first
gently,  then try deeper water, till at last he
can bear a plunge.  To remain long chilly,
low spirited, and without appetite, are signs
that the bath is hurtful.   It must be  cautiously
tried by  patients much reduced: and is most
safe after  convalescence,  when  the  usual
health returns.
    I am  also of opinion, that those visits to
watering places are highly beneficial to nervous
people, by breaking in upon established habits,
that uniform  tenour  of life which they com-
monly lead ; shaking off indolent customs, and
forcing them into company  and cheerful soci-
ety.   They arc put  out of their way, as the
vulgar expression is ;  and this very change of
discipline is a  great  step to a cure  : the more
the etiquette therefore to be gone through, so
much the better. 
                   271
   In this age of  refinement, while so  many
indulgences creep in upon our domestick ar-
rangements, it is surprising that baths do  not
become appendages to our houses.  They are
never thought of till the physician orders them
for the recovery of health.  Yet there appears
nothing more likely to conduce to the comfort
of a family than a 3uit of baths ; to which all
the members of it might daily repair.
   Moderate exercise ought  to  be continued
for some time after coming out of the bath, so
as to  promote the glow and encourage perspi-
ration ; and  the  best time for using it is be-
tween breakfast  and  dinner.   Very weakly
people may begin with 72 deg. of Fahrenheit;
and reduce it as they find occasion, but it never
should be brought below 54 deg. of that scale.
The  employment of the bath was a common
ceremony  with  the ancient  Romans  ;  and
though frequently spoken of by Celsus, it does
not appear to have been much of a medical
regimen : but the cleanliness and purification
of body, which flow from it as an ablution,
must  be allowed to  be a grand defence to
health.
    The warm bath is  another remedy in ner- 
272
vous and dyspeptick cases.    In  thnt kind of
debility which is marked by a languid circula-
tion of the blood, and a dry surface ; less mo-
bility of nervous system,  or rather torpour of
it; less prone to violent emotion, and  subject
to coldness of the extremities, and general in-
activity of muscular power  ; in such cases the
warm  bath is often  a certain remedy.  It
ought to be practised twice  a day ; after which
the  body must be kept warm by such exercise
as can be taken within doors  ; so that it may
be gradually brought  to  the  common atmos-
phere.   This glow may be assisted by flannel
cloathing.  If the  warm  bath is tried in cold
weather, the transitions ought not to be great at
once, nither before nor after its use. A range
of baths of different degrees of heat,  would
best answer this purpose ;  where the patient
might begin with 84 deg. and ascend to  110, if
necessary.
   The warm bath is to  be considered as a
means for  applying the stimulus of heat by
immersion, when it would  be improper to de-
rive it from the atmosphere  ; which cannot well
be done in  our latitudes,  without at the same
time injuring  its respirable quality.   It is of 
2f3
eminent advantage in that harsh, impervious
state of the skin, which  often  accompanies
weak digestion ; where the stomach and bow-
els  become  torpid  from  sympathy with the
surface.  No relief is obtained in such cases,
if a free perspiration does not follow : so liable
is dyspepsia, and the suppression of the  cuti-
cular discharge, to alternate with one another.
The sootliing sensation which it gives, and se-J
renity of mind which it inspires, are the index
of the good effects of the warm bath.   But
where these are  not  felt, and on the contrary
an increase  of  dejection  and  weakness, they
are proofs of its doing harm, and must be giv-
en up.   When the warm bath does not agree,
it is surprising to see how quickly it debilitates,
so that it cannot be persisted in long with safe-
ty.   I do not presume to  decide, whether the
natural thermal waters, such as Bath and Bux-
ton, or  the  water heated by artificial means,
ought to have the preference.  But it ought to.
be remembered,  that  a  journey to and  from
these places of  publick resort, must be advan-
tagious to an invalid : and  the change of scene,
cheerful company, and gay amusements, which 
274
they afford, cannot but be beneficial to the bo-
dy and mind of a nervous patient.
    When employed as a physician  of  his ma-
jesty's fleet, I  made  many attempts to get our
naval hospitals furnished with suites of baths :
but all  my applications were  in vain.  Few
publick infirmaries in England,  though  some
 of them are well supported, can  boast of these
 useful  appendages.   Yet cold lavation of the
 body must be allowed one  of the best adju-
 vants to health.
     Mineral waters are another  form of water
 conveying  medicinal powers   to the  body.
 They may be considered either  under the pre-
 vention or treatment  of  nervous   diseases.
 But they are more commonly used  by the in-
 firm and convalescent, than by those labouring
 under severe disease :  they will therefore, be
 noticed  with most propriety in this place.   I
 shall have occasion to speak of some of their
 ingredients as medicines, under the treatment.
 There  can  be no  doubt  that  the  efficacy of
 mineral waters  is  very considerable in many
  case3  of indigestion,  nervous debility,  and
  those  variatious of it, usually called bilious.
  The ferruginous, or those impregnated with 
                    275

iron, are  the  most  valuable.: and where this
principle happens to be joined in the same wa>-
ter, with some salt of a purgative quality, as
that  of Cheltenham, in  certain nervous  and
dyspeptick habits  they are peculiarly useful.
Where occasional  icteritial symptoms prevail,
from obstruction of the biliary ducts, whether
from  spasm,  mucus, or other causes,  which
retard the peristaltick motion of the intestines
by the bile being deficient,, such combinations
of iron  and  purgative salt, have the best e£-
iects ; as the  laxative power of the one does
not interrupt the invigourating quality  of the
other.  Iron dissolved in water by the  chem-
istry of Nature, seems to act more powerfully
by its extreme diffusion : and as in this state of
solution, it is capable of circulating through the
minutest vessels, its  stimulant and strengthen-
ing powers are exerted on the remotest parts
of  the system.   Much of the operation of
chajyheates may  be by  chemical union with
the fluids of the body, but there can be little
doubt that they also  directly stimulate and ex-
cite the nervous substance.  In those persons
where cold extremities and  pale  complexion
indicate a languid circulation  and poor  blood, 
*. i O
 besides weak digestion, chalybeate waters of-
 ten  perform wonders.   But where there is
 much colour on the surface, and a florid blood,
 I think them improper.
    There are however many cases of nervous
 indisposition, for which the waters impregnated
 with the sulphurated hydrogenous gas, and a
 neutral salt, are to be preferred : such are those
 of Harrogate and Moffat.  Where cutaneous
 eruptions or defaedations, are troublesome,  or
 apt to alternate with the dyspeptick and bilious
 symptoms,  these hepatised, or sulphurous wa-
 ters, seem the fittest.  They may also, at the
 same time, be used as a warm bath ; and their
 efficacy in this way is known to  be  considera-
 ble.   These cutaneous diseases are probably
 much owing to the inactivity or torpor of the
 absorbents, and  perspiratory vessels  on the
 surface of  the body, over which this  kind of
 water has a manifest stimulant power.  I have
 often seen similar good effects  from  a pres-
 cription imitating the composition of these
 waters.*

  * Since writing this paragraph, I have perused a
very  sensible  pamphlet, by Mr. Peacock, surgeon in 
277
    But  while I fully  admit the medicinal ef-
 fects of mineral  waters in  these diseases,  I
 must still  reserve a share of the credit to the
 relaxation and amusement that are to be met
 with, at these healthy and fashionable resorts
 of company.   Taken together, and  properly
 employed, they form  a most important part in
 our preventive practice.  I know not  what
 would become of numbers  of families in this
 country, were it not  for the enjoyment which
 is obtained,  once in the year,  at some popular
 watering place.   The time  of leaving home is
 wished for with impatience ;  and the avoca-
 tions and engagements which delight  them
 abroad,  make up the chief theme of conver-
 sation till the season returns.


 Darlington, announcing the discovery of a sulphurous
 water, at Dinsdale, in the county  of D irham.  This
 water, from the analysis given,  contains a  very large
 proportion of sulphurated hydrogenous gas : and its
 efficacy on the  usual complaints,  for which this kind of
 water is employed, has been confirmed by many trials.
 This little work contains many able and pertinent re-
marks on cutaneous disorders  ; and some striking
facts, on their  alternating with  nervous and stomach
affections.   May, 1806.
                      z 
278
   Nervous people  ought to  clothe  rather
warm, and guard against variable weather.  If
they are  accustomed to  flannel next the sur-
face of the body, it must be often shifted: and
the body ought to be wet-spunged,  or sprink-
led with cold water every morning, then wiped
dry with  a hard towel.   Persons who practise
this mode of  lavation daily,  know that cheer-
ful spirits, an  agreeable warmth, keen appetite
and easy digestion succeed  it.  And when
through  indolence or forgetfulness they hap-
pen to leave it off, their dyspeptick  disposition
loon gains ground.  The feet of some nervous
 people are very liable to be cold; but this oc
 curs mostly with  such as use no exercise ; for
 the sitting posture checks the circulation m the
 lower extremities, and  also  disposes them to
 swell.   Stockings made of lamb's wool, laced
 stockings, or at  least flannel  socks, elastick
 gaiters,  and  hair or cork soles, make the pro-
 per defence in winter, for the heels and teet;
 and  while they prevent chilblains in frost, they
 insure the pleasure of recreation out of doors,
 when  the  ground  is damp.  But where one
 person receives an injury to health from damp
 ground  and  thick fogs, a thousand perish by
 loitering within doors to avoid them. 
^79
    To such of the nervous temperament,  as
 complain  much of head-ache and virtigo,  in
 full habits, with frequent heat and coldness  of
 the  head,  accompanied with drowsiness and
 stupour;  these symptoms in advanced life,
 are always to be dreaded.  They particularly
 attack drunkards  and great  eaters, who are
 corpulent,  have large heads  and  short necks.
 Persons of this description must correct their
 modes of living, if they wish to avoid a sudden
 death.  Low diet, with entire abstinence from
 spiritous and fermented liquors, and much ac-
 tive  exercise, is the best regimen for health.
 Bleeding,  cupping, and leeching the temples,
 are sometimes  required : but these can only
 be considered as temporary remedies, for fre-
 quenting blood-letting favours fullness of the
 vessels.  The state of the bowels must be lax ;
 the sleeping room airy and cool ; suppers must
 be avoided ; the sleep should not be long, and
 violent passions of the mind  must be guarded
 against.
   Where nervous diseases have been brought
 on by affections of the mind, misfortunes  in
life,  or affliction of any sort, it is obvious they
must be considered as partaking more of § 
2S0
mental disorder.   Change of scene in these
cases, is commonly the first step to the cure:
as by removing the distance of all objects that
have a tendencv to refresh  the memory,  or
cause  association of  ideas,  that  bring  up
gloomy reflections, you weaken the chain of
sympathy, till it is gradually broken.   It is the
duty of relations had others, who may be  in-
liinately acquainted with the patient, to inform
the physbiar. minutely of  every circumstance ;
for it must be in vain to prescribe for a mental
disease, v.here we  are kept in the dark con-
cerning the  cause. Every such case mu*t have
its appropriate management,  both on the part
of the medical attendant and inmates.   Such
hallucinations  of mind  are  always  to be re-
 garded as  threatening insanity or idiotism;
 and without a careful investigation of the an-
 tecedents,  no  physician  can direct  the treat-
 ment to  advantage, or  pronounce the issue.
 It happens  too often,  that  the  early signs of
 mental disquietude, which discover themselves
 first by peevishness of temper, and irritable
 feelings,  have been misconstrued by relations:
 and a degree of harshness sometimes has been
 exercised upon the patient from a disbelief of 
281
his disorder, and not foreseeing to what it was
tending.   The subject in all respects requires
infinite address on the part of the physician :
for petulent meddlers are more  difficult to be
managed than the deranged patient.  To treat
this  stage of a serious malady with doubts of
its existence would be deliberate cruelty.   To
mock their fears, however false, bespeaks cold-
ness  of  affection ;  and I have often seen it
bring on  intemperate sallies of rage; flattery
answers  better,  for they  have less jealousy
where there is no attempt at disputing they are
right. But there are moral and physical causes
prompting these feelings, with an impulse not
to be resisted : and while the mind is occupied
with  such sensations, it is  in vain to persuade
the patient that they have no  reality.  When
people with  low  spirits are to be cheered and
recruited  by "conversation, it ought always to
be conducted with delicacy; and this can ne-
ver be duly managed but by a person of intel-
ligence.   If  the  mind,  at  any time is ruffled
by neglect, where it expected sympathy,  we
run  the hazard of  seeing the whole regimen
of health  given  up,  and all confidence of  at-
tendance lost for ever. And when medicine is
                    z2 
282
directed, every argument must be employed to
inspire hope of its virtues, and the certainty of
its doing good.  Here,  as in maniacal cases,
subjection and restraint have been frequently
carried too  far ;  and the patients have been
driven to despair, and ended their torments by
suicide, rather than submit to the lash of their
keepers.  If insanity is purely a mental alien-
ation, the method of cure must turn chiefly on
a mode of discipline addressed to the weaken-
ed powers  of intellect.   Such persons ought
never to be left alone ; their train of thought
should be  constantly interrupted; for  by in-
dulgence it acquires growth and retention.  I
 do not  see how corporal punishment can be
 admitted,  where the reasoning faculties have
 ceas-ed to  exercise their authority, and where
 the living soul is not  conscious of moral  obli-
 gation.  A physician who has  to direct the
 treatment of  maniacks, must live among them,
 that he may learn the genius of every indivi-
 dual  case, if his discipline is to conduce  to
 their recovery.
     There  are  certain forms  and customs  of
 living, practised  by  men who are commonly
 deemed models of temperance, , The striking 
CS3
part of a regular life, is an exact and correct
division of time.   Every hour of the day has
its appropriate task ; and pleasure and dissipa-
tion never  supplant business and duty.  The
temperate man goes to bed  before a late hour,
and uniformly rises early.   Hence early hours
are another term for a regular and temperate
mode of living: as the contrary bespeaks a life
of frivolity and  insignificance.   Can any hu-
man being be in pursuit  of noble and elevated
honours, who is found in bed at  eight or nine
in the morning ?   Such a man never yet in the
world, acquired  the title of  either good or
great.   It is therefore one of the most unpar-
donable neglects  of a family, where parents
give the example of late hours to their children.
What  an insult  to nature,  to allow the sun to
shine six hours above the horizon,  before get-
ting up !  Late hours at  night, and long in bed
in the morning, are among the nursing mothers
of  nervous complaints.  A permanent and
perfect cure is never to be accomplished, with-
out forsaking these slothful habits: and to dis-
card them is always a part of my discipline.
    The diet of a temperate man, or such as
wish to be free from nervous  and bilious com- 
2*84
plaints,  is plain food, and  that in moderate
quantity.  A person ought to rise from table,
cheerful, active, and  refreshed with what he
has eaten ; not oppressed, drowsy or unfit for
motion.   Where great quantities  of  strong
malt liquor, or wine, are taken with dinner,
the stomach  becomes the more overloaded ;
and sleep is called for, to be relieved from the
burthen, as an instinct of nature.  An appetite
not accustomed  to  high seasoned  dishes, or
savoury meat,  selects  for itself  what is whole-
some and easy of digestion.  Beef or mutton
are better than veal  or lamb;  roasted meat
not overdone  is  preferable to boiled;  but
broths not too rich or  superseasoned with spi-
ces,  ought to be  a  daily part of every tempe-
rate dinner.    Nervous people  complain of
broths distending the  stomach and occasioning
flatulence ;  but this is the language of sloth ;
motion  and exercise soon correct this kind of
uneasiness ; and  when the  stomach has been
accustomed to broths,  no such effects can be
perceived.  The legumina,  such as peas and
beans, must  be sparingly used at all times;
they load the bowels  and render them slow j
and raw vegetables,  as sallad and cucumber, 
. 285
are also improper.   But pot vegetables in mo-
derate quantity,  are all mild and wholesome
to be used with meat."  Fish and poultry with-
out rich sauces, may be allowed : and game on
the same terms.   All kinds of pastry and pye-
crust are difficult of digestion, and prone to
fermentation and acidity ;   they lie heavy on
the stomach, according to the common phrase:
and bread, rice  and custard puddings, are the
only articles of  that class that should be eaten,
Sound biscuit, and light well fermented bread
are to be used ; leavened bread, or bread ba-
ked without  yeast,  ia weak  stomachs,  pro-
duces acidity, heart-burn and flatulence.  Co-
 coa or milk, forms the mildest fare for break-
 fast, which ought to be taken soon after rising,
 A very light  meat supper is often necessary to
 amuse digestion : but gruels, sago, arrow-root,
 and such like, are  improper, they run into fer-
 mentation, and partake of the unfermented
 farinacea.
    Water, or toast and water,  is the best drink
 with  meals; and  milk and water  at  other
 times:  cyder,  perry, beer or porter, create
 distention,  flatulence and heart-burn.   The
 quantity of wine at,  or after dinner,  should be 
286
   s.nal!,  and that diluted with water :  Madeira
   when genuine, is the purest wine, and best
   suited  to  a  gouty  or  dyspeptick  stomach.
   Shrub, sherbet, punch, and every thing into
i   which an unfermented acid enters, are impro-
   per drinks : liquors,  and  spirits  of every de-
   scription, are to be considered as Syrens, that
   charm the road to destruction, and ought to be
   rigidly abstained from.
       Nervous persons do best to dine off a few
   dishes ; and those of the  simplest kind ; two
   or three  articles  at  most should bound their
   repast.   They  are, of all  mankind  the most
   liable to surfeits ;  and when they reflect, that
   the very weakest  parts of their  constitutions,
   are the digestive  organs, they must either be
   sparing in  their good things at table, or expect
   to be punished for their indiscretions.  There
   arc iew of the number, who have not had ex-
   perience  of this truth.
       Having recommended a milk breakfast, I
   am aware  that many objections will be oppo-
   sed to  it.   I  have been often told the stomach
   could  not bear it.   If a  physician is pliant
   enough to yield  to such excuses,  he  runs a
   poor chance of doing any good in these disor- 
287
 ders.  This is the common language of per-
 sons  who  have worn out the excitability of
 their stomachs, by strong green tea and other
 improprieties of  diet.  The soft  bland milk
 does  not convey to them that warmth which
 they  have been  accustomed to receive from
 more stimulating fare.   But  let them  be en-
 couraged to persevere ; and  as this alteration
 of breakfast is only a part of a greater rever-
 sion in modes  of living,  it will not fail in the
 end to be agreeable.  I must on that account
 caution  them against any mixture of spirit, or
 even  spice in  their milk.   But if the  acidity
 af  rwards  should  be troublesome, they may
 with  ease correct  it by calcined magnesia, or
 fifteen grains of  prepared powder of chalk, as
 the bowels may be slow or otherwise.  To
 young women of all rank-, the milk breakfast
 is peculiarly adapted ;  and I have the authori-
 ty of Sydenham, that it is the best food for the
 gouty.
    From the experience which I have had, in
 some thousand of these  cases, under all the
 Variety in which they usually appear, I freely
 give it as my opinion, that the only means of
cwer  lie in  a total abstinence from  every 
288
species  of spirit or fermented liquor ; from
every thing that bears any analogy to them,
such as  tea, coffee, opium, and all other narco-
ticks ; and to regulate the diet, cloathing, air,
exercise,  and  passions, as becomes a rational
being.   The  improper use  of these articles
being the chief cause of nervous indisposition,
it follows that  no recovery can be perfect, till
they are in toto discontinued.
   Attention to the state of the bowels forms
an important part of the prevention : but if
due regard is had to air, exercise, and  diet,
even  habitual  constipation may be overcome.
What relates  to its relief otherwise, will be
noticed in the proper place ;  but  if the  food
can be so regulated as to supercede medicine,
it is an  important point gained.
   The whole of the precepts which have been
delivered, as the means of prevention against
this singular train of diseases,  it will be readily
perceived, turn upon a reversed mode of living,
or changes opposed  to former habits ; and to
bring our  patients back to a simple regimen of
food,  air, exercise, &c.   Our plans  compre-
hend no favourite theories,  nor any intricate
doctrines  ; they  aim at being natural, simple,
and easy to be understood. 
28£>
   Some striking instances  of the  beneficial
effects of these rules, when entered upon with
a determined spirit,  have been proved in my
own practice.  A few years ago, when it was
my good fortune to be honoured with unboun-
ded  confidence by  the naval  service, I was
consulted by some particular friends of great
affluence, on the bad health  of their wives,
who, to the regret of  all connected, had never
been in that happy way,

  " Which ladies wi$h to be, who love their lords."

These ladies, after being married for several
years, without having children, devotees of
fashionable life, and a prey  to painful nervous
disorders, are now the mothers of healthy boys
and girls, and enjoy  the best  health imagina-
ble.  All these happy changes were effeced by
little assistance from medical prescription ;
they were brought about  by reversed modes of
living.   A few visits to  their town friends,
and an equal number  to a provincial assembly,
are  all that these once gay  parties now see of
the fashionable world.  What married woman
could refuse to quit a life of late hours, insipi-
                   2 A 
                   290

dity, and dissipation, for such tokens of happi-
ness and health ?
   Change of climate is one of  those means of
relief in nervous cases,  that may sometimes
be resorted to with great advantage.  There
are nervous persons who are most sensibly af-
fected by variable weather ; where the transi-
tions are quick, particularly from settled and
clear, to damp and foggy.  The human nerves
in such patients are like barometers : it is thus
the fall of the year, in  November and Decem-
ber,  is proverbial  for lowness of spirits and
melancholy, A residence in Italy, or the south
of France, for some time,  may therefore be
useful to such as can afford it.  But it must be
remembered, if these persons return to Britain
wiihout having made great changes in the dis-
cipline  of health,  they must expect fresh at-
tacks of their complaints,  A  climate not too
warm, where  the atmosphere is clear, and the
temperature equal,  or not liable to extremes,
is chiefly  to be preferred by such  people.
Here again the change of  scene  may have a
powerful influence on the mind.
   From the effects which these  diseases are
known to produce on the  spirits, there is a mo* 
                    29X

ral regimen, as it may be called, necessary for
our  patients,  and which  must remain with
themselves.  The person  who is subject to
nervous  affections,  can seldom promise  him-
self long equality of health  and spirits :  these
vicissitudes must often  happen, from causes
which neither could be foreseen nor prevented,
and  sometimes  when least  to be suspected.
The mind however  is not slways prepared to
combat sensations that  impress it with ideas
of dissolution ; otherwise it could not so fully
believe in imaginary horrours.  It is a singu-
lar fact, that even men  whom I have known,
renowned for valour and personal courage,
and  who have  been familiar  with danger,
should sometimes be found among the number
of those who conceive such dread from indis-
cribable feelings, and torture themselves with
a phantom.  When these hallucinations come
to be  removed,  they can condemn the  imbe-
cility that  created their fears ; yet neverthe-
less  on a next attack their apprehensions are
renewed as strong  as ever.  The  judgment
being thus perverted for the time, the false per-
ception is to be considered as a degree of deli-
rium and  temporary insanity.  When the pa- 
292
tient perceives the first approach of these odd
feelings, he ought to turn his atteption instant-
ly, to the recollection  of such scenes and  ob-   •
jects, as he has been accustomed to contem-
plate  with much pleasure, and review with sa-
tisfaction :  there let  him  rivet his  memory,
and if he can raise it to extacy, he  will infalli-
bly subdue  the morbid associations, and the
frightful images which they present  to  the
mind.  This kind of  mental controul will be
difficult at first ; but we have known patients
who became quite adepts in the practice of it,
and  secured  themselves from many painful
Struggles.   It so unfortunately  happens  in
these moments, that bad actions and subjects
of affliction are most apt to occupy the memo-
ry :  hence it is that wicked men are  said to
have suffered the pains of hell in this world.
Some nervous people, in this state of derange-
ment, have so magnified their own guilt, as to
make formal confessions of crimes they never
had the most distant idea of committing.
    If when  in company,  and any thing hap-
pens  to be  said, which brings to recollection
any  distressing circumstance, the nervous in-
valid, must either retire, or  the  conversation 
293
 must be changed.  And such of them as live
 much alone, must endeavour to regulate their
 train of thinking, so as to turn it quickly, the
 moment any thing disagreeable is called up to
 memory.   I once witnessed a very affecting
 scene of this  sort: a  gentleman in company
 repeated a line from Cato,

 " Welcome my son ;  there lay him down, my friends."

 A lady in the room, who had lost an only son
 ten years before, was immediately thrown in-
 to  violent  hystericks, that had nearly proved
 fatal.   The habit of breaking up these associ-
 ations gives a new relish  to life ; while the
 want of resolution makes nervous people  so
 frequently their own tormentors.  And when
 they  acquire this manner of self-government,
 if I may so speak, it is surprising what  confi-
 dence it gives to the mind.*


   * For the  following anecdote of Dr. Cullen, I am
obliged to the late Mr. Whale, rector of the grammar
school of Kelso, an eminent scholar, who had lived in
Hamilton, where  Dr. Cullen once practised.  Dr. Cul-
len was subject to gout, and possessed thereby the pre-
                   2 A 2 
                      294

    As mankind in these diseases, are so often
 the authors of their own misery, compunctious
 visitings of nature must frequently recur.   In
 such conditions of affliction,  I do not see that
 it is at all out of character for the physician to
 administer even what is called  spiritual com-
fort.  A medical friend who may know  the
 value of religious duties in his own life, can-
 hot be an intrusive  monitour at a time when
 distress opens the avenues to the human heart;
 and  when  his professional visits necessarily
 attach confidence, which cannot be  reposed in
 a stranger, and who may be less conversant in


 disposition to nervous affection, and often  suffered
 from demisaio animi.  He had a severe attack of low
 spirits, perhaps brought on  by narrow circumstances,
 and great application to business and study ;  when he
 was surprised in his lackadasicat mood, by a friend
 coming in—" I am  very ill indeed," said the doctor.
 The gentleman endeavoured to  divert him from his
 glooms :  Do you never build castles in the air, by way
 of amusement,  Doctor ?  " O no,  I have not  even
 strength for that."  Did you never imagine yourself
 a great general, leading victorious armies to battle,
 and enjoying a triumph ?   " No, by----!  not evea
 ia imagination did I ever fancy myself a soldier l'[ 
295
those failings that sometimes bend the strong-
est.  There are also certain delicate situations
with low spirited people,  that make a formal
visit from a clergyman impracticable, however
much it  may be wished for otherwise.   I be-
lieve it is a common remark of the profession,
that on  the sick-bed, we observe more  forti-
tude of  mind among women, than  is  to be
found  among men.  We must attribute this
excellence in the sex to  superiour virtue'; and
to their being educated more in domestick life,
where religious and moral habits take deeper
root, by being less corrupted from intercourse
with the world.
    Persons liable to these diseases, must be
 cautious how they plunge themselves into any
 affairs or  business, where crosses or disap-
 pointments may irritate the temper.   As they
 are commonly subject to sudden gusts of pas-
 sion, a  prudent and guarded command over
 them, is the  only security for tranquility of
 mind, and a  smooth  passage  through life.
 The nervous  frame must, therefore,  trust to
 self-regulation, in a great measure, for exemp-
 tion from many painful affections, over which
 the powers of medicine have no controul. 
296
   Having thus finished the means of preven-
tion  for  nervous diseases ; or what  may  be
called the mode for correcting the predisposi-
tion, it will readily appear that  the whole of
our precepts have an equal ■application against
the arthritick  diathesis.   If gout  can be pre-
vented at all, it must be by a  rigid adherence
to simplicity  of living ; whether in air, exer-
cise, food, cloathing, passions  of the mind, &c.
and to avoid all excesses and debilitating plea-
sures which are known to enervate the general
frame, or weaken the chylopoeietick organs.  I
know of no distinction that can be drawn be-
tween the habits of body that give birth to gout
and nervous  diseases, beyond what has been
 said in the preceding part of this work ; and  it
appears that the most successful prevention of
 both, will much depend on its being enforced
 from the  birth, and  continued through life.
 The gouty constitution is certainly injured by
 every excess of stimulus, like  the nervous tem-
 perament, but particularly narcoticks of all de-
 scriptions.  If any fact more than another has
 been proved in my own practice, it is that spi-
 ritous liquors,  and all wines, with tea, opium,
 mercurial courses,  and  the sexual  indiscre- 
                    297
tions,  are the chief causes of the acquired
predisposition  that equally  engenders  both
these diseases.



    I come now to the  treatment, that may be
called more strictly medical.   And it is to be
remembered,  that the  whole of  the precepts,
which have been delivered under the  preven-
tion, are  to be duly attended to during the
use of medicine ;  for unless regard is paid to
them, articles of Materia Medica are not only
of no  avail,  but may sometimes  do  much
harm.
    Though I repose due confidence in medi-
cine, when well timed, it is  to be observed,
that here  the practice i^Hrected against a dis-
eased state of sensation and motion,  brought
on by causes which  exert a peculiar influence
on the  nervous  system: causes  which invert
all the regular operations of a most complica-
ted set of organs ; and in the  cure of which
the common resources of our  art seem to lose
their usual power.   Those cflfctoms and habits
which form as it  were a part of  Nature in the 
298
living body, are to be counteracted by rever-
sions in  diet, air, exercise, and even mental
regimen, great in proportion to the morbid af-
fections they are intended to overcome.  In
the body we observe symptoms, that counter-
feit every other disease, forming a part of this
assemblage ; and in  the  intellectual functions
we find  disproportionate emotions  and  the
most extravagant illusions.
    The indications of treatment may be divi-
ded into two heads :
    I.  To strengthen the constitution.
    II. To palliate particular symptoms.
    1. To presricbe  for a class  of diseases so
variable in appearance, and equivocal in their
smyptoms, requires a  full share of experience
and discernment, and not a little patience in
actual attendance.   The physician must often
take a very circuitous route to put questions to
 his patients, that he may learn  the real genius
of the distemper.  He must in many cases be
 guarded in  his  inquiries, lest he excite fears
and suspicions in the, irritable mind, which is
observant of every trifle, jealous  of a whisper,
and when once aJfermed, however falsely, not
easily quieted again. 
299
   I have generally found it the best way to be
candid and open in my opinions with nervours
people.   It is th^'conduct which will insure
most satisfaction in the end, whatever tempo-
rary embarrassment it may occasion.  And I
have never found it improper to inform them
of every article of medicine prescribed, and to
explain the effect I expected from it.  By these
means they will not be taken by surprize ; for
if they  find themselves deceivflH once, their
confidence will not be easily regained.   This
demeanour becomes the more necessary, as
they are very apt to listen to stories of won-
derful cures, and to pore over medical books,
that they may compare  the opinion of  their
physician with what they imbibe there.
    In the treatment, it is always to be consi-
dered, how  far these diseases are the primary
complaint, or idiopathick; or how far symp-
tomatick,  and excited by  another  disorder.
Wherever the body has been reduced to great
debiniy,  the  leading features of a nervous
temperament when present will  appear :  and
the method of cure for the original  disease,
must conjoin  with it the appropriate treatment
of nervous affection.   Many females, with a 
300
delicate and  irritable nervous system, at the
period, experience more or less of these com-
plaints ;  and they subside with it.   If they
were  even severe for the time, we  are  ac-
quainted with the reason :  and it would be im-
proper to harrass the patient with quantities of
medicine  for symptoms,  that we  know must
decline in a clay or two, perhaps  in as many
hours.  Similar cautions  must be used, when
from any  cause the  menses cease, and severe
nervous affections supervene.   This may hap-
 pen from pregnancy ; and the treatment must
 be guarded  accordingly ;  for all the  signs of
 breeding are from sympathy  between the ute-
 rine system, and the chylopoeietick   organs.
 The lying-in state, even under the most fortu-
 nate circumstances, will, for  the same reasons,
 be  often marked by a recurrence of nervous
 complaints.   In such situations it is impossi-
 ble to lay down rules, as the practice  must va-
 ry  according to the  peculiarities attending,
 whether from  severe and lingering  labours ;
 excessive flooding; puerperal fever; impro-
 prieties of diet or regimen; passions of the
 mind ; milk fever ;  diseases of the breast, &c.
 all of which will bring forth  nervous  affectiona 
301
of the  most afflicting kind,  such as frequent
syncope,  cramps, convulsions, delirium, &c.
I was lately called  to visit  a woman, where
the midwife had taken away sixteen ounces of
blood,  under the idea that a pain of the side
was  a pleurisy: delirium commenced imme-
diately, with violent convulsions ; and the pa-
tient died in forty-eight hours from the bleed-
ing.  In no conditions of a diseased state of
body, are mistakes  of the nature of a  com-
plaint, so liable to lead to fatal consequences
as in the puerperal patient.
    Married  women who  have  never borne
children,  it is  said, are more liable than mo-
thers to these diseases.  The nervous female
commonly finds her health improved when she
becomes a parent; from which it may be  fairly
inferred that the  child-bearing  period  is fa-
vourable  to  the constitution.   Every intelli-
gent mind knows well, whatever cares a  fami-
ly may bring with it, they are more than  over-
balanced by the sweet solicitudes of affection
which spring from them.   Hence every wife
wishes to be a  mother: the want of children
thus grows to a misfortune, and those motives
i
for energv of mind are neglected.  But if this
                    2 B 
302
misfortune has been owing to nervous indispo-
sition, brought on  by any cause  which has
been assigned in these pages, if it is at all re-
mediable, the means are obvious and easy to
be employed.
   When these diseases appear about the age
of puberty, at a season when delicate changes
take place in the system, we are then aware of
the event, and can calculate  upon  their de-
cline.   Their appearance  at this time of life,
is marked  by a singular train  of phenomena,
all depending on a mobile condition of nervous
power, as  the body acquires the possession of
new passions and  faculties.   The  generick
names of chorea and chlorosis, have been given
to these diseases;  but I  hold them  nothing
more  than traits of  the nervous temperament,
Chorea or St, Vitus^s dance, commonly begins
some  years before the age of puberty; and in
both sexes it seems to decline  as soon as the
body has acquired its stability,  and the sexual
organs are fairly evolved.  It consists of invo-
luntary motions of the extremities, and some-
times  of the muscles of the  face, appearing
like antick tricks and gesticulations ;  but there
is also more or less of dyspepsia. I have seen 
503
some instances where convulsions  and deliri-
um of a singular kind attended this disease.
   The predominant  symptoms of chlorosis
are muscular debility, sallow skin, indicating
deficient oxygen in the blood, and great de-
rangement of the chylopcsietick organs, with
other symptoms of dyspepsia and nervous af-
fection.  Thejre is commonly a desire for eat-
ing dust, chalk or lime, and probably depend-
ing on  excessive acidity in the first passages.
As this complaint chiefly appears about the
age of  puberty, it has justly been considered
as having some connection with the  evolution
of the uterine system: and years of bad health
sometimes follow, before the meustrual dis-
charge  is duly established.  With this all the
dyspeptick symptoms disappear ;  the mamma?
swell,  and the countenance resumes  its rosy
colour; the  body   recovers  its  muscular
strength, and the shape is moulded into all the
softness of form and beauty. But at the same
time, it ought to be remembered,  that the
male constitution, at puberty, is also frequent-
ly subject to chlorotick indisposition.   As cho-
rea and chlorosis, indicate the presence of the
nervous temperament, I have nothing particu- 
304
lar to offer on their treatment; it falls entirely
in with  our general plan.   These  complaints
are another confirmation of that intimate sym-
pathy which subsists  between the sexual or«
gans, and the  chylopoeietick  viscera.   There
can be nothing strange in these symptoms ap-
pearing in an aggravated  form at this  age,
where the nervous power is very mobile ; for
we find other symptoms sometimes at  an ear-
lier period,  that are usually considered as the
disease of riper years,  namely, the fluor albus.
I have at this  moment two  children of seven
years of age,  now convalescent of that com-
plaint, with all  ihe  signs  of hereditary ner-
vous predisposition.
    In directing forms of  medicine  for  our
patients, there is  one rule must be carefully
attended to, not to sicken the stomach by be-
ginning with a large dose.  If the digestive
organs in their deranged state are incapable of
acting on the  food, how much more may they
be oppressed by a nauseous medicine.   This
article,  as well as  the diet,  must undergo the
digestive process,  if  it is to be useful ;  and it
is the business of pharmacy so  to  prepare it,
that it may best answer this purpose.  It is not 
                    305
 that a medicine is to be sweetened to cover its
 bad taste, or warmed with spirits, that it may
 afford a grateful stimulus to an exhausted sto-
 mach : it must  be  exhibited in a state where
 its powers may be most effectually exerted on
 the nerves of that organ ; or so easy of decom-
 position, as to  combine readily with the ani-
 mal fluids, and yield its qualities to be convey-
 ed by the circulation to remote parts. t Cincho-
 na, or Peruvian  bark,  so often prescribed in
 nervous and dyspeptick cases, has been some-
 times given to  the amount of two ounces/in
 substance in twenty-four hours ;  and because
 the stomach did not reject this enormous load
 by vomiting,  it  has been triumphantly  ex-
 claimed, that large doses  only could do good.
 Such a quantity could only produce torpour
 and insensibility ; its active qualities could not
 be exerted as a medicine on the gastrick nerves,
 for what solvent in the stomach could effect its
 decomposition.   For my own  part, I have
 never met with patients who could retain such
 quantities of bark.   It  appears to me  much
 more rational to begin  with  small doses,  and
to watch its effects.   Hence we learn that de-
coction and infusion will sometimes succeed,
                   2b2 
30G
when the powder  has  failed.   These forms
seem to derive  still further power,  by being
conjoined with some of the alkilies, the carbo-
nate of lime,  (chalk,)  or  magnes. ust. all of
which not only increase its activity, but make
it to sit easy on  the  stomach.   The pharma-
ceutical treatment of most of the bitters more
or less resembles that of cinchona.
    It is sometimes necessary to premise ai>o*
mitor purge, or both, before the use of strength-
ening remedies,  as the stom ach and bowels in
their irreguiar state are  often  loaded  with
phlegm and mucus  to a  surprising  degree.
Besides,  the  capricious flow of the bile into
the duodenum,  is often the  means of render-
ing different portions of the intestinal tube tor-
pid, or irritable, as  it happens ; and an active
purgative will always  have considerable effect
in restoring the  equal  motion  of the bowels.
As an emetick I prefer the ipecacuanha,  to be
assisted by a weak infusion of camomile.  As
a gentle purgative I prefer rhubarb ; and when
a quicker one is required, I employ pulv. jalap.
With each of these I uniformly combine  mag-
nes. ust. kali or soda.  These  not only correct
acidity, in the first  passages, but also render 
507
the active part of the other articles  more c'e'f*
tain in their operation;  they also become sol-»
vents of  the animal mucus so often accumula*
ted there.
   After the pfimaevise are thus cleared, wc
may with safety begin the corroborant medi-
cines; being always cautious in selecting and
combining them  with such stimulant and ad-
juvant ingredients,  as may make them easy to
the stomach, and adapted  to the constitution.
It is impossible to  lay down  rules for what is
to be directed by experience in every indivi-
dual case :  but it will often happen, that the
same article which  does harm under one for*
mula,  will be eminently  useful in another.
And in suiting the  medicine  to the exact con-
dition of the stomach, the success of the prac-
tice  will be more or less complete.  The phy-
sician will but too often find reason  for remon-
strating  with his patient on neglecting his in-
junctions,  whether in  air, diet, or exercise :
a watchful eye must therefore be kept over the
regimen, that medicine may not fall into un-
merited discredit.
    The  strengthening  medicines which have
been chiefly employed in  these diseases, are 
308
iron,  Peruvian bark, and bitters; but zinck,
copper, and even silver and lead  have  been
used.  And the mineral acids, the sulphurick,
nitrick and muriatick, have on some occasions
been  deservedly praised in many  dyspeptick
stomachs.
   Iron very properly is  considered as the
first article in this class.   Its reputation is ve-
ry ancient, and physicians have been  uniform
in extolling its powers -r they are certainly in
some shades of these diseases truly wonderful-
There are few of our patients whose habits of
body  contra-indicate its exhibition ; but it is
eommonly forbid where there is much strength
and tension of  muscular fibre, and  a florid
dense blood.   Such a  state of body is seldom
met with among the  nervous, bilious and dys-
peptick ; but we have frequently been obliged
to lay aside the use of chalybeates for the very
reason just assigned.
   Sydenham, who seldom erred in practice,
preferred iron in its metalick or oxide state, to
all its other preparations.  I can  readily join
in the  praise which  the English  Hippocrates
pronounced on this  celebrated strengthener  -r
but there  are  certainly conditions of the sys- 
309
tern in nervous diseases, where some of its sa'
line  combinations  are to be preferred.   In!
some female habits where there  is vast  dispo-
sition to acidity of stomach, the limatura ferri,
and carbonas  ferri, will act most  powerfully.
And there is reason to suppose,  that this very
acidity of the primse via?, further oxydates the
metal ;  by that  means  destroys  itself,  and
leaves  the  iron  in a more  active  state to
strengthen the fibre, or to mix with the blood,
and exert its efficacy on the whole circulation.
But in cases where there is little or no acidity
in the first passages, the muriated tincture of
iron, and vitriolated iron, have appeared to me
to have manifest  advantage.  Again, in cases
where there  is much  torpor, or  as you  may
call  it,  sluggishness of fibre,  and coldness of
constitution,  with acescency, then the ferruni
ammonicale, or the tincture made from it, are
of superiour efficacy.  Some of the most for*
tunate recoveries which  ever occurred under
my own prescription, were effected by the fer-
rum  ammonicale.  In  these cases, violent  pain
of the gastrick region, occasional jaundice, fla-
tulent cholick, shifting spasms  of the  whole
abdomen, vast acidity, vertigo and head-ach, 
310
&c. were  the predominant  symptoms.   Yet
most of these cases were  reduced to  the last
degree of debility  when  I  first  saw  them.
Certainly  in  stomach and bilious  complaints
under extreme weakness, very unexpected re-
turns  to health  sometimes  take   place by a
fortunate change of medicine.   It must there-
fore be a point of nice discrimination in the
practice, to suit the preparation of this metal,
to  the exact disposition  of the disease, and
the idiosyncrasy of constitution.
    When I  employ chalybeates  of any des-
cription, it is usual with me to precede their
use, for  a few  days, with some preparation of
bark or bitters ; and to continue them for two
or three week^s with the ferruginous medicine.
After  a short interval they may be again re*
newe'd,  as  circumstances  require.  In this
manner the  two  articles will  effect what nei-
ther of them can do*alone.  But I am of opi-
nion, with many other physicians, that ferru-
 ginous medicines of all kinds, ought to be con-
 tinued for a  length of  time, if full benefit is to
 be derived from them. Even  where the  good
 effects are early apparent, they must not be too
 soon laid aside : from three to six months are 
                    311

often required to insure all the good that may
be obtained.   All the different forms of iron
are apt to make  the bowels slow ; which with
some patients is a constant objection to their
employment.  Even the sagacious Sydenham
went so far as to say that laxatives ought not
to be given  during their use, as weakening
their efficacy.  It is however to be remember-
ed,  the diet of Englishmen in his days, was
not so  full and pampering as in the present
times.  This opinion of Sydenham has howe-
ver had very little weight with me : I not on-
ly  interpose laxatives  during the use of iron,
 but sometimes  order a smart purge at inter-
 vals ;  and so far am I from thinking that  it
 weakens  the power of the other medicine,  I
 have always thought it necessary for securing
 its  best eflicacyi  The office of the intestines
 must be  preserved  regular in such patients, if
 any good is to be  done.  The  kali tartar,  is
 perhaps the best purgative article at  this sea-
 son ; and it may have some action on the cha-
 lybeate that we cannot well explain.  If, how-
 ever, our  regimen of  air  and  exercise  is
 strictly complied with, there will be the less ne-
 cessity for forcing the bowels with medicine. 
?i*!
   When iron is adapted to the case, the good
effects are first observed, in the decline of the
dyspeptick feelings :  the calls of appetite be-
come more frequent;  the  food digests  with
more ease, and acidity and flatulence cease to
be painful.   At this  time  the colour  of the
face  improves, and grows florid; and the skin
from being sallow  and dry,  becomes better
coloured, soft,  and  perspirable;  the  al.vine
faeces are commonly tinged during the  use of
iron,.  With  these  changes, strength of body
and alacrity of mind soon appear.   In delicate
females,  some weakening sexual symptoms
quickly decline.
   The  indisputable good effects, which have
so often resulted  from a trial of Bath zvaters,
in many  varieties of these  diseases, render it
almost certain,  that these have been produced
by the ferruginous  principle  which they pos-
sess  ; but which is only effectual at the foun-
tain, as it soon precipitates, and cannot be pre-
served.  As  we perceive this metal when arti-
ficially managed, to effect surprising changes
in the  animal economy, it is  but fair to allow,
that  much more  may be expected from the
fine chemistry of  nature.  It is in vain to de- 
                    313
vry this, because  the Bath water contains  an
extremely minute portion of iron, discovered
on analysis :  the effect must rest on the acti-
vity of the ingredient, whether in the state of
oxide or not, not  on its quantity.  The sensi-
ble qualities of the water, when drank on the
spot, are highly ferruginous ; and the stimu-
lant power is so  perceptible, that in  some ha-
bits of body, it is dangerous ; inducing tempo-
rary fever and vertigo, and in some  instances
apoplexy.   The   torpid  habit is,  therefore,
most relieved by them ; persons worn down
by  the diseases and  excesses of tropical cli-
mates ; and those debilitated by luxurious and
hard living at home.  The regular hours, cor-
rect manners, and  elegant pleasures of the
company at  this  fashionable place of resort,
become the  best antidotes in life, against li-
centious drunkenness :  no wonder then the
enervated debauchee should  return  healthy,
and sometimes  reformed, from a course of
Bath waters.  But when nervous, bilious, and
dyspeptick complaints depend, as they often
do, on a gouty diathesis, Bath  waters are a
sovereign remedy.  The energy which they
quickly impart  to the chylopceietick organs, is 
314
soon extended over the whole frame ;  and all
those anomalous symptoms, usually called fly-
ing gout, seem  to rally to a point, and cease
when the affection comes to be fixed in the ex-
tremeties.   I am thus induced to mention
these salutary springs, under the method of
treatment.
    With respect to the effects of the prepara-
tions of  zinck,  copper, silver, and lead, which
have been tried in these diseases, excepting
the first, I have little experience of them.   I
have frequently combined the oxide of zinck
with carbonas ferri, and other forms of iron,
certainly with great effect;  but not more than
what is daily seen of iron by itself.  A farmer
lately  brought his son to me, who by the  de-
scription, had been subject for  six weeks to
fits  three or  four times in  the day, that were
epileptick.  He said he was returning at night
to  his father's  house, and in a thunder storm
was struck down by  lightning.   He was  an
hour and  half  in  getting home,  though  not
more  than a mile  from the place ; and being
 insensible did not know where he was till mor-
 ning.   I found he  had an  hereditary  nervous
 temperament,  and  many  severe dyspeptick 
315
symptoms.  I ordered iron, ainck, and cincho-
na, in the form of electuary.  After the three
first  doses,  the convulsions ceased :  but he
took his medicine only a fortnight, and the fits
returned.   He  refused to go on with it, and I
saw him no more.   In this case I was guided
in the practice by the dyspeptick stomach and
predisposition.  Of the cuprum, argentum, et
plumbum, I have no experience.   The iron is
my grand safety.   I fancy  the  resources of
materia  medica are sufficiently  abundant at
present ; the best  physician must be he  who
can best select, and best  prepare what we now
possess.
   The  cinchona,  or Peruvian bark, stands
foremost  in our list  of  medicines taken from
the vegetable kingdom.  No article of materia
medica has  acquired equal reputation ; but it
is the fate of this medicine, to be often dispen-
sed from the hands of ignorant  people, where
neither the disease, nor the nature of the barfc,
are understood ;  and it must  frequently do
harm.  Some attention  ought certainly to h%
paid to the manner in which it can be exhibit-
ed with  most  effect.  The powder  has been
said to be the  most effectual form, but there 
316
 are many stomachs that cannot bear it in sub*
 stance.  If,  therefore,  small  doses do not sit
 easy, the infusion or decoction must be tried ;
 and it is the  best way  to begin even these in
 small quantity.   To exhibit the bark in  tinc-
 ture in these complaints, is an  inconsistency in
 practice  : it is no doubt very grau-fu! to some
 stomachs, but let us remember we are pouring
 into the  body one of those narcoticks, that is
 daily bringing nervous afflictions upon thou-
 sands.   It is, however, sometimes necessary
 to add a  small proportion, to preserve the wa-
 tery preparation from spoiling.  It frequently
 happens  that bark acts purgatively, and passes
 rapidly through the bowels ; and laudanum has
 been  the common corrector of its purgative
 quality.   But I  object to opium in any form,
 in these  diseases, unless we are compelled by
 urgent pain.   I  have always found creta pre-
parata, sufficient for this purpose: for it would
 appear that this effect of bark is chiefly to be
 met with in those subject  to great acidity.  I
 even find it necessary to combine ammonia with
 bark ;  as bbth chalk,  magnesia, and the  fixed
 alkalies,  are sometimes  incapable of subduing
 the vast acidity  in the first' passages ;  and I 
317
 think this is frequently one  of the best addi-
 tions to the other.  In my own practice I have
 long considered these anti-acids when  well
 timed,  as the cause of my success.  With re-
 spect to aromaticks, as adjuvants to either the
 bark or bitters, their  good effects are very
 doubtful  with  me.   I  wish to exclude from
 medicine, as well as diet, every thing that is
 warming ; and  I  have a strong suspicion that
 aromaticks invert the action of the fibres of the
 cardia, or upper orifice, and thereby occasion
 belching, which is falsely said to  be useful.
    When the  extract of bark is genuine and
 recently prepared, it will be found in some ca-
 ses, to succeed, where milder forms  of  the
 medicine have failed.   I have given it in both
 pill.and solution with great effect.  I combine
 the pill with a third  of gently  calcined soda ;
 and I think, by thus converting the extract in-
 to a kind of soap, the solution of it in the sto-
 mach is more certain and equal, and the effect
 much increased.  This form of  pill answers
 very well with all  the bitter extracts, such as
 gentian, chammomiie, &c.   The distilled wa-
 ter of peppermint forms a good vehicle for the
solution, and the extract mixes perfectly when
                     2c2 
318
a due quantity of kali prepar. is triturated with
it.
   When bark or bitters produce constipation,
laxatives may be aptly joined with them.  I
prefer rhubarb and jalap, though I have no ob-
jection to kali tartar.
    Next in power to cinchona I reckon angus-
 tura bark.   This  article has not been long in
 use  in this country j  it is certainly a valuable
 addition to  materia medica.  It is  a rougher
 medicine than the bark ; and ought to be given
 in  smaller  doses ;  and  in  those  stomachs
 where it sits easy, it acts  powerfully in subdu-
 ing dyspeptick symptoms.   It may therefore
 be proper to begin with infusion and decoction,
 joining to them magnesia ust. and the alkalies,
 as in the pharmaceutical treatment of bark*
 Angustura, from its  astringency,  is more apt
 to  bring  on constipation  than bark, so that
 some of the milder laxatives such as kali tar-
 tar, may be advantageously taken with it: and
 for this reason it is  better adapted to those
 pases of nervous affection, where  ft laxity of
 bowels forms part of the  disease.  It is also an
  excellent  anthelmintick, and may be given to
 children subject to worms, in the morning fas- 
319
ting, triturated with magnesia and soda, prece*
ded and followed by a brisk purge as directed
before*
   The gentian root is perhaps one of the best
pure bitters in 'this class  of diseases.   The
compound infusion of the Pharmacopeia Lon-
dinensis,  is the most  advantageous form  to
employ it, to which may be added magnes. ust*
carbonate of lime, or the alkalies.  When bit-
ters are first tried they are apt to sicken some
stomachs : but this should be remedied by les-
sening the dose.   It is true that a pill of ex-
tract of gentian and soda, as directed before, is
more easily taken ; but I think by this  change
we lose considerably in the value of the medi-
cine.  All bitters seem to act most powerfully
when largely  diffused ; where there is much
acidity as the effect of fermentation  of the
food,  with great flatulence from  the same
cause, they produce very sudden relief.  It is
known that bitters chemically check the fer»-
mentation by some antizymick power, and cor-
rect acidity by the  same means.   I never perr
mit  the use of any of them beyond sixteen days
at a time.
    Colomba root has become a favourite medi- 
320
cine in these diseases, with a number of physi-
cians in this country.  It is  certainly a very
agreeable bitter, but I  think in effect less than
gentian.  It has  been  said to be particularly-
useful in bilious cases  ; but ff does not appear
even in tha^t trait of the nervous temperament,
that it  surpasses other bitters, however suc-
cessfully given,  where there  is much  uneasi-
ness  from* indigestion, acid eructations,  and
distension.   I  would recommend the same
pharmaceutical treatment of colomba, as men-
tioned  of gentian.   Chamomile,  santonicum,
wormwood, quassia, he, are  all  of the bitter
class, and resemble one another in virtue.  It
is certainly  an  object  in practice to chuse the
most powerful,  which is gentian.   A  very
valuable addition is now made to this class by
the salix latifolia,  which  answers well in de-
coction to  be taken with  any of the ferrugi-
nous preparations.  Articles of the growth of
our own soil ought to be encouraged by all me-
dical people.  See an ingenious Essay  on this
medicine, by Mr. Wilkinson,  of  Sunderland.
   2. I come now to the second head of treat-
ment, viz.  To palliate particular symptoms.
This is  sometimes a difficult task in these dis- 
                    321  '

eases ;  as what tends most to give immediate
ease, is what must inevitably have the effect
of increasing the predisposition, and endanger-
ing the return of the cofnplaint in a more ag-
gravated form.   Such I conceive  to be the ef-
fects of ardent  spirit, opium, and  all other
narcoticks.  Tu a person who  reflects proper-
ly on the horrid  effects of dram-drinking, no-
thing can be so disgusting as to see spirits
swallowed in an  undiluted state.   It is there-
fore my solemn opinion, that they ought never
to be  resorted  to on  trifling  occasions j  for
when often repeated, even in the hands of the
most cautious, they cannot  fall of  injuring the
stomach.  They moreover undermine health
by  favouring the attachment to spirituous li-
quors.   And such is the effect of opium, that
many women subject to hysteria, are very apt
to be seized with a fit, whenever they take a
dose of laudanum.   I have  known numberless
instances of this kind ; even epilepsy is some-
times the consequence.  Other women I am
acquainted with, who never can use opium in
any form, without  a temporary  delirium of
the most disagreeable kind, and followed  by
sickness  at  stomach  still   more   distressing* 
322
These extraordinary effects chiefly arise from
great mobility of nervous system.  Too much
caution cannot therefore be bestowed, to avoid
temporary palliatives,  that must ultimately
produce permanent pain.
   In the course  of my passage through the
world, I have at different  times known some
fashionable women in high life, of the nervous
temperament,  who had got  into the baneful
habit of using opium  as a cordial.  Some of
them were so familiar with it, as to  carry a
vial  of laudanum constantly  with  them :  a
long evening could not be  passed abroad with-
out retiring  to repeat the dose.  The conse-
quence of all this, as must be readily imagined,
was  continual bad health.  Though none of
these ladies were beyond middle age, yet they
had all the looks of old women.  It must be
a grievous  stain  on  the medical character, if
such  habits  took their beginning fiom any in-
considerate  practice  of a medical attendant.
I am afraid the profession is not free from this
imputation.   A man  who carries for ever on
his face the sleek simper of  artful insignifi-
 cance ; who has a bow and a  smile ready for
 tvery person that addresses him, will be very 
323
apt to accommodate his prescription to a fa*
shionable folly.
    The first step to health is to avoid the cause
of disease.   But there are some physicians
who  contend that it is hurtful for habitual
drunkards  to leave  off the bottle  at  once.
Were the  habit  of  dram-drinking a salutary
practice, there might be some truth  in this
dictatorial prescript*   But as ardent spirit is a
strong poison to both soul and body, and forms
no part of that nourishment which can be con-
verted into  animal matter, I have never been
able,  after the most unwearied application in
 the exercise of my profession, to find a single
 fact in support of a doctrine so destructive to
 moral and physical health.  Whenever I have
 known habitual ebriety completely overcome,
 it has been  where all species  of liquors were
 given up in totofrom the first.
     The most painful symptoms which attend
 nervous indisposition, are those cramps  and
 spasms, which particularly affect the stomach,
 bowels, kidneys, ureters and bladder.   In the
 female subject they are most  apt  to occur at
 the period;  and often commence in an instant.
 Such women ought  to be carefvil  about the 
*24
♦tateof the  bowels and stomach at that time,
with  respect to the kinds of food and the al-
vine discharge; so  as to obviate acidity, fla-
tulence, &c.  the painful companions of that
state.   The  amenorrhea,  or  suppression,
from  whatever cause, is  also remarkable for
the recurrence of these  symptoms, which are
seldom fully relieved till regularity is restored.
The condition of mind is worthy of great at-
tention at that time ; for every ruffle of passion
creates mischief.
    The warm gums, as they have been called,
have  been long in use  for these troublesome
pains and  other  nervous  affections.   They
have been administered in the form of pill and
tincture; not without some  confidence being
given  to  their unpleasant flavour, a singular
way of prejudging the effects of a medicine.
In nothing have  I  been  more  disappointed,
than in the foeted  gums; and where they have
been apparently useful,  it was probably  from
the spirit taken with them.  Like aromaticks,
they  cause  eructation, which is said  to be a
good effect;  though with me an opinion that
they invert  the fibres of the  cardia,  which is
improper.   Asafociida  is the foremost of this
                 I 
32£
list; but it ought to be remembered, that its
tincture in the modern pharmacopeias, is made
with alcohol; and a teaspoonful or two, how-
ever diluted, comes  to be a tolerable  dram.
Here the alliaceous flavour is very strong and
impregnates the breath.  In the form of ene-
ma I have however known the asafcetida  very
Useful.   Castor,  ol. animale, and musk, are
prescribed for the same purpose as asafcetida :
but though they may possess a stimulant pow-
er, it is very trifling and transitory; they are
moreover, apf to disorder  the stomach  and
bring on vomiting.   Camphor and ammonia
are of  much greater value  in nervous pains ;
and their  effects more permanent.  ./Ether is
also a common remedy, and when joined with
 opium  and ammonia,  of great service.  This
 is a judicious mode for exhibiting  laudanum,
 for a smaller quantity is required than  when
 given alone.  Valerian is another of the foetid
 tribe, frequently ordered in large quantity, to
 the manifest injury of the stomach.  I believe
 it to be a very inert stimulant.   As opium  is
 known to produce a slow state of bowels, ext.
 hyosciami nigri, which has a laxative  quality,
 was long ago recommended by  Dr. Whytt in
                    2d 
326
these disorders.   We certainly by this change
get quit of some of the bad effects of the
opium ;  but  hyoseiamus extract  must be re-
cently prepared to be active ; and there is some
difficulty in ascertaining the dose at once.
    But when pain and restlessness  come to
be urgent,  and where  common harmless re-
medies  fail, there is no resource besides opium%
We know its  sovereign powers as  an  anodyne,
And we must compound with its  bad effects
in  the  best  manner we can.  We  ought to
combine it with such articles as co-operate
with it, such as aether and ammonia, and the
best vehicle  is  the mist, camphor of the dis-
pensatory.    But it often happens that the sto-
mach rejects the liquid medicine, and the dry
opium may be substituted,   I prefer  the mode
by  enema;  and we may combine diluted spirit,
or some of the  stronger white wines with it,
such as Madeira or Sherry, to great advantage,
J have never been disappointed with a clyster
of  this sort.  This also in a  great  measure
paevents sickness at stomach afterwards.
    Some other symptoms which come on sud-
denly in nervous cases, such  as vertigo and
head-ache,  palpitation and  faintness,  do not 
32?
 admit of such easy relief.   They  commonly
 attend some  disordered state of the  stomach
 and bowels,  and to these the medical regimen
 must be directed.*   The hysterick and  epi-

   *  I was lately consulted in a remarkable case of
palpitation,  in  a girl of eight years old.  The motion
 was so violent  it could be seen at a considerable dis-
 tance, and it was constant, though somewhat increased
 by violent exercise.   It  appeared hopeless from the
 idea  of organick affection  in  the heart: but the girl
 was  in general bad health, and of a strongly marked
 nervous temperament.  I therefore directed my advice
 to correct the predisposition, which was  chiefly to the
 relief of the stomach.  The  next time I saw her the
 complexion was entirely changed ; she was grown flo-
 rid and beautiful, and full  in flesh.  I now think ex-
 treme irritability in the heart, with nervous weakness,
 was the whole disease. Similar cases have come un-
 der my observation, but none so violent as this: yet it
 is surprising to see to  what a height this symptom will
 arrive in female habits.  An appeal to the ruling tem-
 perament must therefore always be a safe resource to
 the physician.   On the same principles, I have just
 dismissed, cured, a case of epilepsy, in a youth of six-
 teen,  an apprentice in this town,  which threatened to
 be permanent.  He had no fit after he began his medi-
 cines.   But in order to make  great changes in his
 modes of living, I ordered him to the  country,  with
 many alterations in diet, 8cc, during the treatment. 
                    328
                                    4
leptick paroxysms, are convulsions tha/ some-
times give alarm of their approach ; but at
other times their attack is instant.   We cer-
tainly possess no medicine that either prevents
or shortens these  convulsions.  I  have seen
epilepsy  checked by  the  ligature round the
thigh,  when  the  sense of the  aura, as  it is
called, was ascending the  thigh : but in  other
cases the ligature did  not check the aura, or
prevent the fit.  The only treatment which 1
can recommend here is the whole rules of pre-
vention ; which improve the health, by abridg-
ing the predisposition.  If as I contend, epi-
lepsy is  the  offspring of  the nervous tempe-
rament, the force of  that must be lessened ;
and all cures of this convulsion by any particu-
lar article, can have no real existence.
    Acidity and flatulence being  two of the
most painful symptoms attending these disea-
ses,  the common correctors are well known ;
they ought to be obviated  as much as possible
by diet, which has been sufficiently explained.
The  aerated soda  water has  now  become a
fashionable morning draught for the cure of
acidity, after a debauch of wine.   It is really
to be met with in coffee-houses, as if it had ne- 
                    329   .
ver been manufactured by the apothecary, and
it is humiliating to the physical vigour of Bri-
tons to see such degeneracy ; a medicine con-
verted  into  a tavern beverage !  But  it is
worth mentioning, that a long use of this water
hurts the stomach and kidneys, and produces
very serious  cutaneous  diseases,  so  as to in-
jure the skin.
    I must beg leave to caution persons subject
to nervous and stomach complaints, about re-
pelling  eruptions on the skin, especially of the
face, by any severe means.  These cutaneous
affections are  commonly associated  with the
dyspeptick disposition, and when imprudently
forced from the surface, never fail to aggra-
vate the  internal disorder.  The best way is
to leave them to the general treatment.   It is
true, they are particularly disagreeable to wo-
men ; but as they are a part  of the  original
malady, so they usually yield with it.   Of this
patients should be duly warned ; for  many
constitutions  have been ruined by the use of
those articles vended under the specious names
of creams, dews, honeys, &c. all of which con-
tain  mercury, lead, or  some powerful astrin-
gent, that repel the pimples at an improper pe-
                  2 D  2 
330
 riod.  When stomach complaints have been
 rendered more severe by this cause, the first
 and best relief is  to  recal them to the skin.
 The warm bath, particularly of salt or sulphur
 water, is one of the most effectual  means.
 But some medicines  of the sudorifick class,
 such as camphor and ammonia, joined to bark
 and iron, with warmer clothing,  and exercise
 continued to the sweating stage, will also have
 considerable effect in restoring the eruption.
    Morning sickness and vertigo are common
 with some of these patients.   They are felt
 immediately on standing erect, and sometimes
 bring on  latching and  faintness.   These symp-
 toms are chiefly to  be imputed to the  empty
 state of the stomach from long fasting.  They
 are best relieved by some tasty food, such as
 cold ham,  cold tongue, &c.  taken before get-
 ting up.  But warm tinctures and medicines
 of any sort ought never to be resorted to. By
.way of preventing  this sickness,  I  commonly
 direct  a  small supper of meat at going to bed,
 so as to amuse digestion, and breakfast  imme-
 diately on  rising.  In the early  months of
 pregnancy, morning sickness is a troublesome
 attendant:  but as the cause cannot be  correc- 
331
ted immediately the only alleviation is  watch-
ing the state of the stomach and bowels.
    Want of sleep, or wakefulness, is one of the
most distressing companions of nervous affec-
tions : indeed some persons appear scarcely to
sleep at all.   Cold ablution of the whole body
a little before, or immediately on going to bed,
is one of the best means which I know, to pro-
cure  refreshing  sleep  in  these  situations.
Some  people  find great advantage from what
has been called the air-bath ;  that is to  get out
of bed, and walk to and fro in the room, quite
naked, for  ten  or fifteen minutes.   After
growing warm in bed,  drowsiness  and sleep
soon succeed this kind  of noct-ambulation.
But sufficient bodily exercise, with moderate
mental recreation, is certainly the most saluta-
ry and natural mode of inducing sound repose.
I think opium can scarcely be admitted here.
The general warm bath,  semicupium, and pe-
diluvium, may also be tried.
    The external applications which are em-
ployed in cramps  and pains, consist of  blis-
ters ; camphorated oil;  ammoniated oil ; vit-
riolick aether;  saponaceous  liniment;  mus-
tard flour ;  warm  flannels ; bottles and blad- 
332
ders  of warm  water ; hot bricks ; friction ;
dry  cupping, &c.   The  last remedy is often
found useful, where there is  much pain, with
coldness of the part ; as by favouring the in-
flux  of blood,  and thereby  exciting  heat, it
proves  stimulant.   With the same intention,
electricity  is often employed to  advantage j
and to this we may now add galvanism.  The
warm bath may also be considered a valuable
remedy in local pain, and may  be practised
with the restrictions formerly delivered. The
vapour bath, in  effect, comes near the nature of
the warm bath : but pediluvium  being easier
accomplished,  generally  supercedes both  the
others.
   The strangury, and  other  complaints  of
the urinary passages,  are best relieved by  the
fixed  alkalies, ammonia, aether,  and camphor,
exhibited in  aq. menth. pip. with the  milder
bitters and large dilution.  These symptoms
are apt  to accompany excessive acidity and
flatulence of the first passages.   I  have known
cases  of this kind becoming truly alarming,
from  the great  delicacy of the patient.  This
symptom  is peculiarly frequent with women
subject to the hysterick affection :  active exer- 
                    333

cise in the open air is  the best preventative.
I know not if  mucilage can  have any effect
here beyond dilution  from  the water taken
with it, but even that may be useful.
   It remains for me to consider the treatment
of the  bowels, so generally slow  in persons of
the nervous  temperament.   To preserve the
alvine  discharge  regular, is  an indispensable
part of our office.   The stomach and bowels
being the chief seat of nervous and bilious com-
plaints, much of the inconvenience  and pain
occasioned by constipation is to be referred to
their weakened state ; joined  to the scanty or
vitiated bile which is sent from the liver, as
that organ partakes by association and sympa-
thy with the  intestinal tube.   By an inversion
of the action of the muscular fibres, the peris-
taltick motion is interrupted ; is torpid in one
place,  and increased in another; which irre-
gularity compresses the flatulence into particu-
lar portions of the canal ; creates distention,
uneasiness,  and pain ;   and very frequently
gives the  evacuation much difference in form,
consistence, and  colour.  These appearances
sometimes impress  the  patients  and nurses
with extraordinary dread and apprehension of
                     * 
334
the disordered state of the bowels.  While the
nervous power of the intestines  thus  acts tu«
multuously, and in  insulated portions, violent
constrictions are apt to happen, which give
birth to the symptoms of  colick : and at other
times the  mind is more  particularly alienated,
and what is  called  hypochondriacism  and va-
pours, are the consequence.
    It is devoutly to be  wished that the bowels
could be kept in due  action, by diet and exer-
cise, without the aid of medicine :  but so ma-
ny causes conspire  to defeat this purpose,  that
nothing  is so  difficult  to be accomplished.
Such patients  have generally long accustomed
themselves to some purgative medicine, often
one of the most improper kind ;  and it is not
easy  to  convince  them they have been doing
wrong.  Among these  habitual purges, calo-
mel and aloes are the most frequent in  use.
As these articles,  as well as all other cathar-
ticks, are not directed against the radical cause
of the evil, they can be considered only as gi-
ving  temporary relief.    But mercury in any
form cannot be long  used by persons of weak
viscera without harm :  and aloes is a medicine
of the drastick kind, that produces great irrita- 
335
tion in  the  Tectum, tenesmus, and is apt to
bring on  procedentia ani, piles and  fistulous
sores.   But purgatives of every description,
when frequently resorted to, exhaust the sto-
mach and bowels, and never fail in adding to
the cause  of the complaint.  It must therefore
be a great misfortune where the body is never
moved without the aid of medicine.
    Such  a  habit  as this ought to be  early
guarded against,  where the dispositicn to cos-
tiveness is hereditary.  This can be done only
by a strict attention to that regimen,  which is
enforced  in the  former  part of  this  work.
Parents alone can effect this. It must be grate-
ful to every  medical  attendant  of a family,
where it is known that a predisposition to these
diseases prevails, to remind the  father and
mother of the necessary rules of prevention.
Such an r.ffue will reflect great honour on the
professional character, as it will prove an ho-
nest disregard of  emolument, when the wel-
fare of their friends, and society itself, is so
deeply concerned.   Where medicines are re-
quired daily for children, in the state of slow
bowels, the prospect in advanced age must be
dreadful. 
336
   The diet  in  the constipated state of body,
ought to consist  of a large proportion of-fluid
aliment; in severe cases it ought to be entire-
ly of this kind, with vegetables easy of solu-
tion.   What solid  butcher-meat is taken, must
be masticated slowly before swallowed,  which
will prombte the flow of saliva, assist its com-
minution in the stomach, and facilitate its pas-
sage onwards. I am well aware that very great
obstacles will be  opposed to these precepts :
some will  speak  of their dislike  to broths ;
others  that soup disagrees with them; some
will  be afraid of  borborrigmi,  and others of
their shape.  But  for the two la3t objections,
exercise, not physick, is  a certain  cure;  and
with respect to the two former,  if health is of
so little moment that no  pleasure is to be sa-
crificed for it, things must remain as they are.
The quantity of bread to be eaten must be very
small; no pudding where flour forms a part,
can be admitted ;  custards and such like are
allowed : all  pastry is  excluded ;  and all the
legumina, such as peas and beans, are forbid.
These restrictions are directed because what-
ever increases the  bulk of the fcecal macs,  im-
poses a heavier load on the peristaltick motion 
                     337

 of the  intestines;  and consequently a slower
 action.  Where fruit agrees it may be indulged
 ad libitum.   All vinous and spiritous liquors
 are to  be  given up, in conditions of torpid
 bowels  :  they  all act by exciting the absor-
 bents in the stomach and intestines; and thus
 deprive the refuse of chylification of that fluid
■ that makes it pass equally and easily along.
    We ought to begin with  the  milder  laxa-
 tives first, and  so ascend to  the more active ;
 to reap full advantage they must also be  often
 changed.   The gentlest are manna ; tamarind
 infusion ; electuary of senna ; senna; rhubarb ;
 tartarised  kali ; jalap ;  aloes ;  scammony;
jalap and one tenth of calomel; scammony and
 one tenth of calomel, &c.
    It is sometimes observed, that nervous and
 bilious  people grow corpulent and full ; this is
 generally owing to rich food and indolence j
 and it is a bad trait of the temperament.   Such
persons however never bear bleeding  well,
 even under some apparently inflammatory dis-
position.   The best plan here, is to reduce the
body by low living  and exercise,  if these can
be  accomplished.  But nervous  persons are
the most  intractable  of all good livers, and
have  less  resolution to abridge their  enjoy. 
338
mcnts.   They not only indulge in  large quan*
tity, but  that  is  commonly seasoned to  the
highest degree of stimulus.   For my own part
I would  sooner encounter the prejudices  of
ahy sick  man, rather than those of a nervous
glutton.  Every surfeit brings additional trou-
ble to the physician ; and he will often hear the
appetite complained of, where a single dinner
ought to  have  made three.    Nothing stands
more in the way of a regular medical discipline
than errours of this kind, and it is necessary to
observe a sharp sighted jealousy over them.

   When, as has often happened,  I have been consult-
ed for cases, that seemed beyond the reach of medical
assistance, I have seen great  advantage obtained by
directing the treatment solely against the nervous pre-
disposition.  This has frequently  happened in those
desperate afflictions, the cancerous uterus and mamma ;
and I have sometimes thought, had the rules of prac-
tice been tried sooner, even in such situations, a cure
might have been effected.   A perfect knowledge of the
temperament, in my opinion, forms the only basis for a
successful  treatment of all nervous and bilious diseases
so called ;  it leads us to the fountain head ; unfolds the
source whence the evils flow, and puts us in possession.
of the only means for prevention and cure.
FIMS. 
CONTENTS.
                                            PAGE.
     DEDICATION,.....iii
     INTRODUCTION,                      xi
I.  Chap.  The health o* the savage state com-
      pared with modern times,                  15
II.  The medical description of the  inhabitants
      of a large town or city ; being an analysis
      of society,    ------    34

III.  Remote causes of nervous diseases,  -   -    50
IV.  Influence of these diseases on the character
      of nations, and on domestick happiness,     144
V.  History and progress of these diseases,      169
VI.  The general doctrine of these diseases,      199
VII. Prevention and treatment of nervous diseases, 236
      SALEM, N. Y.
PRINTED BY J. P. REYNOLDS^ 
 
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