190
45
The
Practical Course
delivered
By
Dr. John Gregory
at 
Edinburgh 1768/9
Vol. 1.  



Vol. 1 Doctor John Gregory's Lectures
1 
on 
the Practice of Physic.
Lect. 1. The business of my profession is to give an History
of all the Diseases incident to the human Body
and the proper Method of curing them; but neither
the Pathology nor Therapeuticks come within
my Province. These 2 Branches belong to another 
Professor, and I must suppose them already
Known. It is necessary before I begin my proper
subject, to explain some [cross out] general Divisions
of Diseases and the General Branches I proceed
upon in the Cure of them.
Every Animal has a certain external
and internal structure of Parts and certain
Functions natural to it's species; when this 
structure is in it's natural Condition and these
Functions are performed with Regularity, liveliness
and Ease, that Animal is said to be in health;
Any Diviation from this Condition is Disease
A Disease therefore is Shortly any Diviation of
the human Constitution from this Condition or 
it's Natural state. This Definition of a Disease
includes in it whatever is belonging to a 
Physician to Cure. My reason for making the 
Definition so general is that I may include
the Deformitates and Vetia, many of which 



3
cannot be included in Dr. Boerhaaves Definition.
The taking in the proximate Cause in the Definition
of a Disease I take to be improper tho'
Dr. Hoffman has done it. When a Disease 
does not consist of any single morbid appearance
but of many conjoin'd, the Concourse of these 
form the Disease, and each of them is call'd
a symptom. The Definition of a Disease
should be taken from these, & from such only
as most generally Accompany the Disease.
The Proximate Cause ought not to be taken in 
as this created disputes about the Definition
(owing to every Physician almost having 
a different notion of the Proximate Cause)
than which nothing is more trifling.
There are some particular Cases however, in 
which I think it's necessary even in a Definitn.
to include the Cause, but these are where the 
Cause is so perfectly evident as to create no 
Difficulty or Disputes. - As Sauvage 
follows this method & is more full than many
other authors. I shall generally follow his 
Definitions.
Diseases are distinguished from their  



5.
Origin, which Division is subdivided into 
many Branches and 
I. Into Hereditary Diseases or such as 
are transmitted from Parents to their Children
as Pth. Pulmon. Apoplexia, madness, Gout, stone
scrophula; certain Cutaneous Diseases, and a 
very great sensibility of the nervous system;
a Disposition to the Confluent kind of Small
Pox; but tho' this last is frequently the Case
there are numerous Exceptions to it.
These breakout at different Periods of Life,
some in childhood as the scrophula particularly
which seldom appears after the Age of Puberty
and often disappears at that Period; a Disease
of this kind does not seize all the Children of ye 
same Parent Promiscuously, some escape it 
altogether & it often passes a Generation & appears
in the Grand Children.
The Causes of these are very generally unknown 
and no more to be accounted for than the similitude
of features and Disposition of Children to 
their Parents; some of them indeed depend on 
the particular Conformation of the Parts as 
in the Apoplexy, Pth. Pulmonalis &c.
It has been said that these diseases which appear 



7
appear at certain periods of Life are transmitted
to the Children at the time they are begotten, but I 
think there is little foundation for this.
Hereditary Diseases are generally very difficult
or impossible to cure; what we should endeavour 
to do is to moderate the symptoms so as 
to prevent the Hereditary disposition being
communicated to the patients Children, but 
even of this I knew no Instances in Medicine;
there is a difference betwixt hereditary Diseases
and Congenite or contracted in the womb with 
out being at all communicated from the Past.
Diseases distinguished from their Origin are 
also subdivided into. 
II. Primary and Secondary; A Secondary
Disease is that which depends on another Disease
as the Primary. Thus in a Dropsy depending
on a schirrus Liver, the latter is the Primary
Disease & the former the secondary.
Secondary Diseases in reality differ from the 
symptoms but the Distinction is not easily
made.
IIId. They are divided into Diseases seizing
great numbers at once from a Common Cause 



9
Cause called Pandemics, which are again subdivided
into Endemics and Epidemics. 
Endemics are certain Diseases peculiar to the 
people of any Country arising from certain
Circumstances of Climate and situation, thus 
Intermittent fevers are endemic to all low marshy
Country's, & the Pthis. Pulmon. may be so 
to great Britain, owing principally to the great 
vicissitudes of Weather, which exposes the inhabitants
to frequent Colds. On the Continent
'tis called Tabes Anglica.
Epidemics seize a great number of people 
at once, from some general Cause the nature 
of which is often unknown, they are generally
believed to depend on some Quality of 
the Air, tho' it's not sensible; but the Air may 
rather be reckoned the medium that transmitts
the Contagion. But sensible Qualities
in the Air have great effect upon these Epidemics,
in rendering them milder or more violent.
Thus most putrid Epidemics are carried off by 
Winter and the Vernal ones checked by the 
approach of spring. There is a very important 
Distinction betwixt Vernall & Autumnal 



11
Epidemics, the first are attended with an Inflammatory 
Diathisis of the Blood & the other 
with a putrid. Epidemic Diseases have a 
great influence on the type of Sporadick Diseases 
prevailing at the same time vid. Dr. Sydenham
Epidemics may act either in consequence of a 
Contagion in the Air or an Infection propagated
from one person to another, tho' this is not always
easy to be known. In the second way 
there is great reason to think that the plague
is communicated. Epidemics mostly belong
to the Class of Acute Diseases as fevers, there 
are scarcely any Instances of Chronic Diseases
being Epidemic. There are certain
Circumstances in the Course of Epidemic
Acute Diseases that deserve a particular
Treatment, which youll see well illustrated
in Dr. Sydenhams Practice. Dr. Freind makes
very light of this, but entirely from Theory.
Most of the Epidemic Putrid Diseases appear 
to act in Consequence of an Assimulating
Ferment, but more of this here after.
IV. They are divided into Diseases peculiar
to particular Temparaments and Constitutions 



13.
Constitutions as divided into the Sanguine
Phlegmatic, Bilious, Melancholic and those 
that have a remarkable degree of sensibility
of the Nervous System.
V. Diseases peculiar to certain Trades &
ways of Life are an important Distinction
see on this Rhamazini de morbis Artificum.
These attack not only Artificers, but severall
other different ways of Life have their peculiar
Diseases; as Studious people miners accordg.
to the different Metalls they work Luxurious
people who have been used to eat & drink
high tho' of a delicate make, require a very
different management from those who have
been accustomed to life low & on plain food
& [accustomed] to much fatigue and labour 
Habit should in a particular manner be attended 
to, in acute Diseases; for a person used 
to drink largely of wine, falling into one of 
these cannot be supported with water gruel
to such wine should be allowed in a Cert. Qu.y
We know people by habit eat a great dole of 
train Oil in northern Climates, without any 
the smallest Injury, now should any one 



15
one who had not been accustomed to it
swallow this Oil, it would be sufficient to 
throw him into a fever, so that great allowance
ought to be made to habit.
VI. Diseases peculiar to certain periods of 
Life, which Distinction is of Considerable Importance
in practice. Children are peculiarly
subject to Diseases of the head, as to Epilepsies
a running behind the Ears & eruptions on the 
head. In Youth these morbid Congestions
happen in the Breast and produce Hemop.
Pthis. Pulmonal. Asthmatic Disorders &c.
In the Decline of Life Morbid Congestions in 
the Alimentary Canal are more frequent
and in the Abdominal Viscera, whence Hemorhagics
from the hemorhoidal Veins & Obstructions 
in the Abdominal Viscera. A Diarrhœa 
is natural to Infancy, those who want 
it have a very ticklish Constitution & during 
the teething Children have also a great sensibility
of the nervous System, more than at 
any other time perhaps.
VII. Diseases peculiar to the sexes from 



17.
from whence arises a considerable variation
in the method of treatment. Thus most females
either proceed from an obstruction of the menses
or from their too great Quantity, or the flu or 
Albus which is a disease very common especially
among women of Fashion. Differences
also arise from the state of Virginity, Pregnancy,
Lying in, Suckling and the coming 
on of the menses and their going off.
VIII. The last subdivision is into the Contagious
Diseases; such as the Plaque, Eruptive Fevers
and Dysentery which appear in general to be 
only communicated from those that are infected
to those that are well; some are only propagated
by immediate Contact as the Itch L.V.
It is observed that almost no Diseases are 
contagious but Acute ones except those 
only that are propagated by Contact.
It is also observed in general, that the less 
of the Inflammatory Diathesis they have they
are the more Contagious & vice versa. And the 
more putrid they are the more Contagious
but this is no certain Rule. The Contagious
Diseases of one species of Animals are generally



19.
generally not contagious to different Species
of Animals, tho' sometimes it has been
observed that a similar Contagion has raged
among the other species of Animals at the 
same time -
Putrid Diseases acquire their greatest
Virulence by crowding many sick people
together where there is not a free Circulation
of Air, as in Goals Hospital's ships & Hospitals,
and I am persuaded it would tend to save the 
lives of numbers were there no hospitals or  
Hospital ships in the Army & Navy. It is 
difficult to say whether all Contagious Diseases
can be reduced to certain Classes
They have all been comprehended under 
Exanthematous, Cattarrhal & Dysenteric.
But I have know Instances of Inflam.y
Diseases evidently contagious as of the 
Eyes [cross out] and there are several Nervous
Infectious Diseases that in my Opinion
cannot be reduced under these Divisions
of Classes -
The 2d. Division of Diseases is from 



21
is from their Seat. And these are subdivided
Ist. Into Externall and Internall. This Division
is very vague and of little Consequence in Practice
except in some few particular Cases.
IId. Into fixed or wandering as in certain species
of the Rheumatism and Gout.
III. Into Ideopathic & sympathic. The first
is when the Causes of the Disease subsists in the 
Place affected and sympathic or symptomatic
when it is not fixed in the place affected.
Thus a headach and Vertigo from the Cause being
in the Stomach is Symptomatic, but this 
Distinction is difficult to establish, a Disease
merely symptomatick should go along with 
the Primary; but if symptoms remain after 
it is then called a secondary Disease; as when 
an Ascites remains after a shirrus Liver
has been cured, which was the primary Disease.
Symptomatick Appearances are 
either Criticall or not: thus Diarrhœas in 
Fevers are often Criticall for instance, and 
this is a Distinction that deserves particular
Attention and notice. 



23. 
Lect.
2. 
You.rg. 
768 
It has been commonly imagined that the Idiopathic
& Sympathic Diseases are communicated
by the Connection of Nerves; such a Connection
that one of them being affected or rendered diseased
another part of the Body at a distance becomes
likewise affected. This has been supposed from 
the Communication of nerves with one another 
but this very evidently cannot be always the Case
This has been called sympathy of nerves; which
Term if used to explain a fact not the Cause of 
that fact maybe as proper as any other.
IV. Into Universal or such as affect the whole system
and Topical or such as affect particular places.
Thus Fever is an universal Disease properly
so called but a Pleurisy is improperly so called
because it's attended with local Inflammation
The 3d. General Division of Diseases
is according to their Course; subdivided
I.st Into those of short and long Continuance
or chronical; if those of short Continuance are 
severe and dangerous they are called Acute.
II.d Into Continued or Intermittent, and another
kind called Remittent all which may very 
easily be illustrated from Fever as is well 



25.
well known, the Periods when the fever rages
most is called it's Exacerbations, and in Intermittents
the febrile Paroxysm.
Intermittents and Remittents are also 
Regular or Anomolous; When they return at 
certain regular periods they are called Periodicall.
The Periodicall Disease are mostly
fevers, Evacuations and nervous Disorders
Examples of these are Hemorrhages, Intermitts
and Epilepsy and madness.
The Different Parts of a Disease are the 
Invasion, or first attack, the Augment, the state
or [illegible] and the Decline: in Periodicall fever
these are somtimes to the whole Course & sometimes
to particular paroxysms.
The 4th. General Division of Diseases is what 
is taken from their nature and Genuis.
Ist. subdivision into miled and severe.
Instances of the mild we have in some slight
Epidemic Cattarrhal fevers which keep the 
patient but for a few Days and seldom require
the assistance of a Physician.
Severity is to be judged of from the whole
Concourse of the Symptoms. 



27th.
II. Into Malignant Diseases which word has 
been exceedingly abused, it has been most generally
used in the three following senses.
1 Diseases beginning with very mild symptoms
and suddenly without any sensible
Cause turning violent.
2. Disease attended with unusual severity
for that Disease.
3. Diseases proving very obstinate & refractory
to all remedies.
The Cases it is most commonly applied
to now are very dangerous fevers of the Putrid
kind, as the Goal & Hospital Fever, Gangrenous
sore throat.
III Into Regular Diseases sometimes called Exquisite,
c.c where the symptoms are regular
& the Periods natural. There are some Diseases
where the symptoms are unusual to such a one 
which are called Anomolous, and are very often
occasioned by two different Diseases meeting
in the same person, as in persons subject to 
nervous Complaints seized with a fever &
worms too are often the Cause of these Anomolous
symptoms.
IV Another subdivision is into Diseases 



29.
Diseases that are active and Passive this 
is of great Consequence in Practice.
Active Diseases are such where there is a sensible
Effort made by nature for the Relief of the 
Patient. Passive where nature makes no 
Effort for her relief.
In Common Inflammatory Fevers nature
generally makes an Effort by some Evacuation
as Diarrhœa, Blooding of nose sweat &c.
And in Eruptive Fevers it is particularly
remarkable. Of the Passive kind are the Scrophula,
Lues, Cancer, &c.
There is a 5th. General Divisions of Diseases
into Curable & incurable which is Vain &
of ill Consequence.
We ought to call no Disease incurable, we 
ought rather to say, that it is a Disease we do 
not know how to cure. Indeed there are some
Diseases which we cannot have any hopes
of curing, as Gangrenes in the Rsura with
great toss of substance, but there have been 
severall Instances of Gangrenes being cured
Atltho' there has been considerable loss of substance,
and after A Gangrene goes a certain



31.
certain Length I believe it cannot be cured.
IId. Subdivision is into those Diseases that 
return but once in a Mans life. Instances of this 
we have in the measles, Small Pox, Chin cough
and 'tis said that those who have once had the 
Plague will never be infected with it again.
It has been observed that the Small Pox have 
returned again, or that a person has had them
twice, but it's very rare & I am not certain
if there bee any Instance of it well vouched.
[illegible]. Into salutary Diseases, or Diseases which 
have a proper Crisis. Instances of this we 
have in the Gout, which may rather be reckoned
the Paroxysm of a Disease, than a Disease
itself. And A Tertian Ague may be reckon'd 
a salutary Disease or rather a salutary Crisis
of [??isease], for we often find Obstructed
Viscera cured by it. There are some Evacuations
as Diarrhœa in Children, and Common
Inflammatory Fevers that are certainly
very salutary. And we find it very dangerous 
to stop accustomed Evacuations
as Cough in old Phlegmatic People by wch 
they daily Expectorate great Quantitys of tough 



33.
of tough viscid stuff. Likewise Bleeding at 
the Nose at certain times, is very salutary &
ought not to be medeled with. 
IV. Subdivision is into Criticall Diseases
and those that have no particular Crisis.
Criticall Diseases are those which have a 
particular Fermentation or Crisis whether
favourable or not, tho' most Commonly those 
to keep have a favourable Crisis.
Thus Inflammatory and Continued Fevers
have commonly a Crisis by Evacuations 
as Sweat, Blooding at the Nose and some
times Inflammations are terminated by 
a translation of the matter from the Internall
to the External Parts which trans,
[illegible] is called Metastasis & this matter
there forming Absecess. These Crisis have 
been said to happen on certain Days hence
called Criticall, but this has been of late 
looked on as Chimera, tho' there really is 
in nature a foundation for such periods
as we might almost conclude a priori 
For we see most substances have particular
& determined Periods of time, for their Alterations 



35.
Alterations as we see in the Maturation of  
fruit & fermentation of Liquors, however
many Circumstances may vary these times
And there may be a reason assigned for the 
variation of Critical Days here, because
of the Alteration of Climate, they are not so 
regular here as in more southern Climates
Hence the reason why these Days Hippoc.
called Critical are not observed here.
There is another Division of Diseases
according to their Occasional or Proximate Cause
There is no doubt but the last of this would be the 
best, but then we are for the most part Ignorant 
of this Proximate Cause. The order that is most 
natural is from the external symptoms, which 
was never done upon any regr. Plan till the time 
of Sauvage, for which he has great Merit
But even his method must labour under
many Defects since I imagine it impossible
by it to have a complete Arangement.
Sauvage geues an Artifical Arangement of Diseases
as in Bottany Plants are ordered. But the View
I have is different from this and is the following 



37
The Plan I propose to follow enclassing Diseases 
is to throw those together that Resemble one anoyr.
most in their Nature & Genues, by which Method I hope
will be the most usefull one Disease being understood
will throw light on another that resembles
it in most Respects. Sauvages's Plan is different
from mine & had Advantages which mine has not 
but then mine has several over his. & as I 
dont want to make him my Text I will follow 
my own method no system but has its particular
Advantages & inconveniences & I dont propose 
this as a perfect one 
Classification of Diseases -
Classis J.ma. Febrile Disorders
Ordo 1m. Intermittent Fevers. Or 
Fevers which alternately
cease & return at certain
regular periods -
Ordo 2. Continued Fevers or 
Fevers which from ther first
invasion to their End always
continue with nearly the 
same degree of violence 

38

39
Class. 1ma Ordo. 3. Remittent Fevers or 
Fevers which at certain 
times are much less violent
but not quite gone, & the fever
grows to the same violence
as at first when the period
arrives.
Ordo 4. Exanthematous or 
Eruptive Fevers are such 
Fevers as are attended with 
Eruptions of the skin as 
scarlet & Petechial Fevers &cc.
Ordo 5 Phlegmasia Or Fevers
attended with Topical Inflammation,
& under these I shall
put the Pthisis pulmonalis
the Rheumatism Gout & Tussis
Convulsiva
Class. II. Preternatural Evacuations
of whatever kind.
Ordo. 1. Hemorrhagies or Discharges
of Blood from any place
as the Nose, Gums, Hemorhoids &c
Ordo 2. Evacuations by Vomite or
Stool.

40

41
Class. II Ordo 3. Serous Evacuations
Class. III Paralytick Disorders &
the Debilitates
Ordo. 1. Deficiencies in the Externall
Senses as Seeing &c.
Ordo. 2. Debility in certain Organs
as loss of motion in any place
as venereal Impotency.
Ordo 3. Loss of Motion
Ordo 4. Particular Debily of the 
Vital Powers as Syncope &c
Ordo 5 Soporose Disease as 
Letharg, Apoplexy &c.
Class. IV Spasmodic Disorders
Ordo. 1. Rigidity as Tetanus
2. Stiffness accompanied
with Agitation, or working
as Epilepsy, Hysteria
Heres bring in the Asthma.
Colic & Head Ach by which 
I avoid 2 Classes of Sauvage
the Dolores &

42

43
Class V. Mental Disorders
Order 1 Deceptions of the External
Organs as Double Vision
2. Depraved Appetites.
3. Delirium 
4. Anomalous Disorders
of the Senses as loss of Memory.
Class. VI. Cachexus -
Ordo. 1. Atrophy [illegible] universal wafting
2. General Swellings as 
Anasarca, Emphysema
and Immoderate fatness:
3. Particular Dropsies
as the Ascites, Hydrocephalus,
and under this I
comprehend the Lymposy
4. Swellings of the solid parts
as the Rickets.
5. Cutaneous Diseases
as Impetigo, Itch Scurvey
Lues Venera
6. Anomalous Cachexus
as Gangrenes Chronical Ulcer 

44
Some Diseases remain that I cannot reduce to any of 
these as the Stone & Jaundice which I shall treat of together
because they resemble so much in their proximate
Causes. Worms must be treat of by themselves because
they are not so much a Disease as the proximate Cause
of one. Under the Head of Poisons I shall take in the
Hydrophobia & next to these I will treat of the Diseases
of Infants & then such as are peculiar to Women
such as those caused by the menses. Pregnancy &c.
This in general is the plan I propose to Prosecute,
& In the End I hope to have as much time 
left as will allow me to go thro the General Principles
of Surgery & the Deformitates; but you must
take Notes that I dont mean to direct th manner
of Operations, for this is quite out of [illegible]
Province
As this then is my general Plan I now
shall proceeds to lay down before you as 
exactly as I can the General Method I intend 
to treat of particular Diseases and 
1. I shall give a very exact Definition
of the Disease; by which I only mean 
an Accurate & distinct Enumeration of 
all the Symptoms that essentially constitute
this Disease & clearly distinguished 

45
it from every other disease, I shall likewise
Define the Class it belongs to as also the Order
& Genus.
2) I shall give as accurate & particular a theory
of its Symptoms from the beginning to the 
End of it as I am able. And particularly point
out the Pathognomick & Diagnostick sympts.
The Diagnostick symptoms or those which distingish
this particular Disease from every other 
require a very particular Attention & if not 
attended to sufficiently may lead people into 
fatall mistakes in Practice. Nothing is more 
common in the Country than to see Colics
or Inflammations of the Gutts prescribed for
as if they were Flatulent Complaints, they make
them swallow down large Quantities of spirituous
Liquors & Specuries, which were there 
no inflammation, perhaps might raise 
one, but in flatulent, Cases, these are not at all 
bad remedies. Here too I shall speak of the termination
of the Disease as to it's Effects on the 
Constitution, which some times are never got 

x There must be an Error here, for Gaubuis says
"59-" Oecasro est qui equid prodes ponenti super
" veniens hanc excitat, ut una morbum pariant.
" Neutra ergo, sola producendo morbo sufficit, sed
" ambauem Concursus requiretur. Rad is poseteo se 
" abist, Occasio non nocet: & vecessem se predis
" poreteo ab Occasion Caves, caues a Morbo. ,, sue
will say then x- which of themselves cannot bring
on a Disease without the Concurrence of Rad is ponent
Causes. 

47
got the Better of, at other times are very salutary.
We must do our endeavour to prevent
the Bad effects of Disease and likewise
a Relapse, for some Diseases tho' quite.
disappeared, are very apt to return again
3. I shall handle the Predisponent Cause of 
the Disease, the Cause πςΟηΥδμενη are some
particular Circumstances of a persons life
which dispose him to be susceptible of same 
particular Disorder. So Young Sanguine
persons are more subject to Inflammatory
Fevers than any other kind. The form of some 
peoples Body, as narrow chest subjects them
to particular Disorders, as Pthisis Pulmon.
x 4 Occasional Causes are certain Circumstances
existing without the Body, xwch of themselves
[cross out] immediately bring on a Disease and 
that without the Concurrence of Predisponent
Causes.
5. Prognostick or a foreknowledge of what 
will happen, that is we can fortell in what way
the Disease will terminate, as in Life Death &c.

48

49
Death &c. This knowledge is of great importance 
to a Physician, suppose some Criticall
Evacuation is about to happen, now if the 
Physician do not forsee this he probably may
give medicines that will prevent & disturb
nature, & this may be of the very worst consequence,
but if he forsee this he will let nature
alone & if she is difficulted or embarrassed
assist her; likewise if he forsee any violent
Symptoms that threaten Death, he may in 
all probability be able to prevent them or 
at least to mitigate them. However a Physician
ought to be very cautious in fortellng
any events especially to the Patients friends
because this Art is not at all brought to 
perfection, and Diseases sometimes take 
so unexpected Turns that we cannot always
fortell their Events.
6th. I shall endeavour to explain as far as I
can, the Proximate Causes of Diseases, which 
is a certain internal substance existing in
the Body, and immediately causing the Disease



51
and when removed the Disease Ceases.
It is to be obtain'd from the Antecedent Causes
and an Accurate Examination of the Symptoms
Morbid Dissections greatly assist in discovering
it, but in these we are very apt to be deceived,
for upon examining the Body of a patient
who has died of a fever we will probably find 
extravastions & Inflammations & probably
Gangrenes, but these are not the proximate
Causes of Fevers, they rather are Effects of them
The Proximate Cause of Diseases is sought 
for in the fluids of our Body, as in Plethora
or fullness, in Emptiness, in Viscidity, & when
they are dissolved, in Acrimonys of our Juices 
& these are of Different kinds, as Alkaline
Acid & muriatic Acrimonys; in Polypus
Concretions, of our Blood & Fluids.
It is sought for too in our solids, as in 
Tension, & Relaxation of them. Inflammation
Gangrene, & in Calculus Concretions; it is 
sought for in the Primæ Viæ as stomach
Intestines &c. But a disorder may be felt in 
the stomach & removed by a Vomite altho
there be nothing in the stomach either Acrid or 



53
or that could hurt it, this is owing to the connection
it has with the whole Nervous System.
This Proximate Cause is sought for in Dropsies
& other Extravasations, of serous Humors in 
whatever place of the Body, and in Worms,
on Disorders of the Secretions, in the Circulation
which when irregular is the Cause of 
Morbid Congestions is to be sought
for in the Nervous System & Sentient Pine.
Tho' this be an Inquiry of the greatest difficulty
yet it's of the greatest importance & use in 
practice & ought to be searched into with constant
& uninterupted Diligence & Application
as it is of all others what will throw greatest
light on the Cure of Diseases.
A Physician in searching into the proximate
Cause of a Disease should always do it with a 
view of being able to cure & remove it, a speculative 
Inquiry will have little Influence
on Practice. Most Systematic writers do 
with the greatest facility point out the proximate
Cause of Diseases, but then they are 
not at all to be looked on as really true but 
merely Chimerical & the offspring of their fancy 



55
Indeed the Proximate Cause of a Disease
(because, every particular Symptom may have 
a proximate Cause) is very difficult & sometimes
impossible to be found out by us.
Thus in the Jaundice, the proximate Cause of the 
Yellow Colour of the Skin is an obstruction
of the Bile. But then what is the Cause of this 
Obstruction? whether is it Calcalus, Spasm or 
Coalescence of the sides of the Ducts in consequence
of Inflammation? Allow we can 
reasonably conclude that it's a Calculus in 
the Ducts, next Question what is the Proximate
Cause of this Calculus, whether owing to a 
Cretious Diathesis in the Blood, or to the conformation
of these Ducts. At other times tho'
we may have reason to believe we have found
the Proximate Cause yet we shall not be able to 
trace it directly from the symptoms.
We will be greatly assisted in our Inquiries after 
it, to examine the Antecedent & Occassonall Causes
& to attend to morbid Dissections which if accurate
& carefully attended to may be of the greatest Service
But allowing a Physician cannot discover
the proximate Cause of a Disease yet if he has 
carefully observed it's successfull treatment before 



57
before, & often seen it treated successfully
with the same remedies, it will not be reckon'd
empiricall practice in him to exhibit those 
Remedies he has so often observed prove
Efficacious in Curing it. Thus in an Intermittent
fever, no one knows the proximate
Cause of it, & everybody knows that the Bark
will cure it. At other times tho' we may 
know the proximate Cause of a disease yet it's 
often out of our power to remove it.
7th. I shall take notice of the Indications of Cure
The first is to remove if possible the Particular
Disease under Consideration. If that cannot 
be done to alleviate or palliate the most violent
symptoms. And next to prevent the Effects
of Diseases, which sometimes, are very bad
& lay foundation for Chronicall Disorders or 
such Disorders as the Patient never gets the 
Better of. And in desperate Cases where 
there is no reason to expect a favourable
turn we must make Death as easy as possible
The Indications are to be taken from the Antecedent,
Occasional & Proximate Causes.
And from some particular Circumstances
in the Patients Case, as unusual Cravings.



59
Some Cases occur, where no Indication can 
be had or depended on, then if the Disease is not 
violent we may use the lodentia & juvantea
till nature makes some Effort that will afford
an Indication. As the Proximate Cause is the 
source whence the indication's are taken when 
it is not attainable use must reason from Analogy
or the resemblance we find betwext it &
some known Disease. It has been said that 
a Rational Physician never practises without 
a throrough knowledge of the Proximate Cause
of a Disease but as this is not always possible
I think he will be the Rational Physician
who gives the Best reason for his Practice
Francis Sylvius supposed an Acid in the Blood
to be the proximate Cause of all Diseases 
Accordingly prescribed Alkaline Volatile Salts
& Testacious Powders; this was certainly a 
bad practice & yet he was reckoned a Dogmatick
or Rational Physician.
After going thro' the Indication of Cure in particular
Diseases I shall according to the border of 
Indication mention particular Remedies
adapted to these Indications and after all give 



61
give some Account of the Authors who have 
wrote best on the Practice of Physic.
Before I enter on the treating particular Diseases,
some General Principles are necessary
to be premised with Relation to their management,
& ought to be carefully attended to.
I. We ought attentively to Observe the Progress
& Efforts of nature in every Disease.
The Word Nature is variously used & explain'd;
the most general sense in which it is applied
is that of the System or Body of Laws by which 
the Deity governs the World. The sense we take 
it in is that system of Laws by which providence
governs the Animal Machine. This machine
tho' disordered, does not cease to move, like any 
factitious one, but nature or the system of Laws
by which it moves, makes some Effort to rectify
& regulate it's movements. These Efforts however
are sometimes very irregular & not at all uniform
& sometimes so very violent as entirely to Destroy
the Machine at other times insufficient to do 
any service from their weakness. Here Art must
be called in to regulate, to restrain & assist Nature,



63
Nature, according as she shall stand in need of 
either. When Nature makes no Efforts towards
her own Relief Physicians must be guided by 
Experience & Practice.
Physicians differ in leaving Diseases to the 
Conduct of Nature, & in some slight Colds she may 
& is often left the management. Others leave
Eruptive Fevers as small Pox to nature & she 
is an admirable manager of them. Other Diseases
need particular Art, because Nature seems
to make no Efforts for them as L.V. Dropsy
& Inflammatory Disorders.
IId. We must never mistake the Effort of Nature
for a Disease itself.
For in some kinds of Fever there often comes on 
a Diarrhœa which if let alone and not stopt by 
Medicines ends the Disease & is a real Effort of 
Nature to stop the fever & cure it.
But in some Febrile Disorders there are 
Evacuations which aggravate & increase
the Disease as Diarrhœa long continued
& proceeding from some enternall Cause
as Ulcer in the Lungs &c.
Children who have been subject to Convulsions,



65
Convulsions, are generally freed from them
by an Ouzing behind their Ears, & seabed heads
these Evacuations ought by no means to be 
stopped, by astringent Applications or any 
thing that has a tendency to repell these humours:
Sordid Ulcers appearing commonly terminate
& cure several Diseases, & must not 
be dried up too soon
IIId. We should generally in the beginning of 
Acute Diseases cleanse the Primæ Viæ.
Blooding has been commonly reckoned the 
first necessary step in curing Acute Disorders
of every kind, but in nervous Fevers
at least in some stages of them a little Quany.
of Blood taken away sinks the Patients strength
surprisingly. Indeed in Inflammatory
Disorders more or less Blood may generally
be taken away, & by it we will be able to 
judge of the state of the Blood.
There are certain symptoms that indicate the 
cleansing of the P.V. by Vomite or Laxative
as Loathing of Food, Ill Taste in the the mouth
Costiveness preceeding. &c. here a Vomite shd.
be given & if it do not procure a lax stool 



67
some gentle Cathartick should succeed it, by
which means any putrid stuff in stomach
or Gutts will be evacuated & any fomes of the 
Disease removed as shall be spoke of afterwards
It was formerly a Rule among Physicians
never to blood Vomite or purge, unless at the 
very attack of the Disease, so that if a fever had
lasted 3 or 4 Days before they were called what 
ever appearances there might be of foul stomach
&c. they never ventured to exhibit Vomite
or Purge, but they should disturb the Caution
of the Morbid Matter, but sure this is a wrong 
Practice & Blooding Vomite or Cathartick
may be given at any time if indicated without 
Danger.
It was another Maxim with them, to give Physic
after every febrile disorder which was 
certainly very absurd. For if a Patient recovering
from a Fever should complain of no 
disorder of his stomach, but should have a good 
appetite, & feel no remains of his former Disease
what good Purpose could the weakening 
him with a Cathartick serve.
In Putrid Disorders there are apparent marks 



69
marks of the primæ viæ being overloaded
& in disorder, here indeed a Gentle Cathartick
should be exhibited.
And after the small Pox it is very proper to 
administrate a Cathartic, because of the Gutts
being full of them & if the patient is Costive
the hard fœces may produce very fatal Consequences,
therefore it will be necessary to 
give one, both to prevent this & carry off 
the putrid scabs & matter that may be lodged
in the Course of the Alimentary Canal.
It has often been observed that Emetics
given in the beginning of Acute Diseases
have prevented this farther progress, and 
Antimonial Emetics given in small Doses
have generally an Effect by Vomite & stool &
may sometimes remove the fomes of the 
Disease, if repeated often & in small Doses
IV. To palliate or mitigate the most [illegible]
symptoms. But sometimes we are prodigiously
nonplussed when there is a Danger
in palliating these symptoms and at some 
time a Danger in not doing, and certainly 



71
certainly of two Evils the least is to be chosen
Thus in the Pleurisy when the Cough is very
violent increasing the fever & other symptoms
if I administrate an opiate I am perhaps in 
danger of cheking the Expectoration, but then 
the Opiate quiets the Cough, & allays the Pain
but if it kinder Expectoration the matter will
be accumulated & suffocation the Consequence
so that here I am at a loss how to proceed, & think
there is more danger from the Cough which 
by increasing the Pain & of Consequence
the Inflammation may bring on a Gangrene,
than from the Administration of 
the Opiate.
V We ought to attend to the Age, Sex, Climate,
manner of Life and particular Constitution
or as it's called Idiosyncrasy of our Pat.
For it is certain that Children do not bear
bleeding so well as Adults; but we see they 
bear Serous Evacuations much better, for 
a Child will continue in a Serous Diarrhœa
for a Year together without losing any of 
its strength, which Diarrhœa would in 



73
in less than half the time killed an Adult.
And in warm Climates they bear bleeding
much better than in Colder.
We should likewise consider the manner of 
Life of our patients, for the same medicine
has generally a much greater Effect on the 
people of high Rank who have lived delicately
than on the lower sort of people who have 
lived on Coarse Victuals and taken much 
Exercise. Habits long indulged deserve particular
consideration, for persons who have 
been accustomed to drink freely of wine or 
spirits falling into a fever ought not entirely
to be prohibited their Use, but allowed
either in moderation.
And even in Chronick Diseases a sudden
Change of Diet will have very often bad 
Consequences & is very dangerous.
Some People after recovering from fevers
like to eat those things they were formerly
fond of, as Butter and bread, toasted, wch.
may be given without any hurt; tho' to a   



75.
to a person in health who had not been accustomed
to it, it would probably be too 
VII heavy + Sometimes Patients have strange
Cravings and if they are not for things evidently
hurtful they may be indulged in 
them, and indeed I never saw any bad Effects
follow.
In Fevers they are constantly crying
for Cool Air and Drink, which was denied
them till Sydenham introduced the Cool
Regimen for which we are greatly indebted
to him. Nothing is more absurd
tho' tis very common, than to load a Person
with Cloths who is already too warm
and then give him heating Bolus &c.
VIII. When there is no clear Indication
by which we may be directed & the Case is 
not very Urgent we should wait till we 
see what nature points. But sometimes if 
we prescribe nothing the Patient loses that 
Confidence he ought to have in us & thinks 
himself entirely neglected, and something
must be prescribed, to prevent this, but it 



77.
it should be something that can do no harm
if it do no good.
IX. We should hold it a maxim not to give 
strong remedies in the Paroxysm of a fever
tho' in some cases it is the only time they ought
to be given.
X. 'Tis a bad practice to give many remedies
and change them often, for we can neither know 
their Effect or force or which of them produced it 
Compound medicines [illegible] another Cause of 
our Ignorance of the Virtues or Effects of Drugs.
If possible we should prescribe one simple
Medicine only & make no additions without 
good reasons; neither change it till we are 
ascertained of it's Effects. If a medicine is Nauseous
I may add something to take this away
but it should be such a thing as will not 
change the Effects of the Remedie.
Sect. 5 Nov. 1 1768
We ought in an espiceal manner to prescribe
simple medicines to children.
But there are two Causes that hinder simplicity
of prescription.
1 There are some Countrys where Physicians
are not paid for their attendance, only for their 
Drugs, which lays them under a Necessity 



79.
of multiplying their prescriptions and giving 
compound medicines, for to get any tolerable
subsistance
2. Some people are so fond of medicines that 
they think themselves entirely neglected unless
they get something every 2 or 3 hours.
In these Cases one would need to be acquainted
throughly with a number of forms of prescription
to order things agreeable and at the same 
time that will do no hurt.
XI. In Chronical Disorders where the whole
system is disordered medicines that operate slowly
& produce their Effects gradually should
be prescribed in considerable Doses.
And in these it is of the greatest Consequence 
to observe a particular Diet, moderate Degree
of Exercise, & to Drink considerable
Quantitys of mineral waters and to keep
an Easie mind.
XII. We should endeavour to divert as 
much as possible the force of the Disease
from the Internal to the externall Parts;



81.
Parts; but we are not always able to effect
this, tho sometimes it's of the very greatest
Consequence, as in the Gout in the stomach
which soon proves fatal, if not removed;
in Erysipelatous Cases, and in the small 
Pox [cross out] we may generally
do it.
XIII. The State of the mind should be always
attended carefully to, and kept as easie as 
possible. The Vis Vita should likewise
be supported. We observe the mind & spirits
very low in all nervous Complaints and 
in Dasorders of the stomach, & a particular
attention to the state of the mind may remove
these; for Hypochondriacall people
when alone & thinking of their Complaints
will sometimes labour under most of the 
febrile symptoms, as heat, quick pulse
weariedness & Lassitude & upon any of 
their Acquaintances whom they liked or 
thought agreeable going & drinking with 
them perhaps a Bottle of Claret, they will 



83.
will forgett all their Complaints and 
have none of the foregoing symptoms left.
In fevers we should always support the Vis
Vita, & never let our patient be too depressed
but give him wine in small Quantitys
now & then.
It may be observed that the keeping the 
mind easy promotes all the secretions even
as well as riding on horseback or any other 
bodily exercise whatever.
XIV. In all Desperate Cases or such Cases
as we can have [illegible] hope of the Patients recovery,
& we know nothing that can be of any 
service, if we have known any Empiricall
remedie or heard of any, we may 
exhibit it, but I cannot lay this down 
as a general Principle, because the Physician
ventures his Reputation & runs a 
very great risk to lose it, if he do not succeed.
But Empirical Remedies ought to be examined
very carefully & have fair Tryals because
there are some of them that have been 



85.
been found very useful and efficacious when 
ordered with prudence and Caution.
And here I cannot but observe that Excess
of prudence in regular Physicians has 
[illegible] more fatal than excess of Rashness
in the Empirical Tribe.
Having premised these Generall Princls.
relating to Diseases in Generall I shall
[nex?] proceed in order of the Plan I have 
laid down to consider the particular Classes
there specified & then the particular Orders
of these Classes &c.
The first Class of Diseases I proposed to 
treat of was febrile Disorders. And Accordg.
to my plan must give a Definition of Fever
Class Ist.
Febrile Disorders.
If [cross out] any person has a quick pulse, increased
heat of his Body, with a Debility of his Limbs
and has had a preceeding [cross out] Rigor such 
a person is said to be in a fever.
This last symptom is not universally present



87.
present in all Fevers, in others it is so slight
as to pass unobserved by the Patient and in 
Children we cannot be certain of its Existence
therefore I think it should not be taken in 
as a Part of the Definition, which should always
be taken from the symptoms that 
most generally attend a Disease.
There are none of these always present thro'
the whole Course of the Disorder, except Quickness
of the Pulse and even [illegible] in some stadia
of nervous Disorders is scarce perceptibly 
quicker than in health. Heat is 
very generally present in all fevers, and 
Debility of the Limbs is univerally so except 
in one stad. vizt. Delirium, where instead
of being weakened or debilitated they 
acquire more strength & Vigor while it lasts.
The first order of Fevers I propose to treat
of is Intermittents my reason for this 
is because in the Paroxysm it exhibits
all the Phenomena of Fever in generall
in the most distinct manner.



89
Class. 1st. Order 1st
Intermittent Fevers.
Intermittent Fevers are such as continue
a certain time, then leave the patient well
a [illegible] return again.
[T??y] are variously divided and first into 
I Regular when the fever returns at regular
Periods; and Irregular when it keeps no
certain time.
I shall treat of Regular Intermittents together,
because their generall symptoms, are 
similar and the generall method of Cure
is the same however there are some specifick 
Differences, which shall be taken notice
of as we proceed. The Proximate Cause appears
to be nearly the same in all of them
as far as we can observe.
In Regular Intermittents, the Paroxysm
almost always begins with a Coldness wch.
is succeeded with heat, & that by a sweat
called απΟςε℥Ια.
The most common kinds of Regular Intermittents 
are Quotidians, Tertians, & Quartans



91
A Quotidian Ague is when the Paroxysm
returns every day at a certain time.
A Tertian when it returns every other 
Day, that is misses one Day & happens on 
the next at a certain time.
A Quartan returns every fourth Day
[illegible] misses two Days, or the Patient has 
two well Days intervening 'twixt the 2 Days
that she felt happens on.
Besides these which are the most common
there are Quintans & Sextons &c.
And Van [Swe???] gives an Instance from 
Pliny of an [Annever????] ague but these
are all very [?are] & some of them may be mistaken
[illegible] vouched.
There are other Differences to be observed in these
as when the fitt returns one Day easier & the 
next severe it is called double Tertian which 
is not otherwise distinguished from a Quot.
but by the fitts being alternately easier severe
A Double Quartan, when there is a fitt for two 
Days running, and next or third Day none at 
all. There is another Distinction of these fevers from 



93. 
State of the Blood whither it inclines most to
Inflammation or Putrefaction called the Inflammatory
and Putrid Diathesis of the Blood.
And this is a Distinction of very great Consequence
& importance in the method of Cure.
[???des] these Fevers there are under this head
other Diseases comprehended or classed, because
they have been observed to have periodicall
Returns as Sciatica and Headach by Sauvage
another reason is that they yield to the same method
of Cure and to the same medicines.
We shall now consider the generall method
[cross out] of [Progr???] of the Fevers.
Sometimes [??ey] are regular from the Beginning
i.e the paroxysm returns at regular periods
at other times they begin irregular & turn
regular very often a Vomite will have this 
Effect of making the Fitt return at the proper
period. They often are not to be distinguish'd
from a Continued fever at the beginning 
but then assume their own Type which is 
generally a very favourable issue & boads no 
danger: but when they change into a contend.
Fever they are commonly very Dangerous





95
and often in this Case they keep their Type or 
their Periods may be observed very regularly.
These Intermittents often change into one another
as a Quotidian into a Tertian &c.
It is said that during the Intervalls the Patient
is well & no mark of the Disease to be found
but, they for the most part have a yellow Complexion,
their Urine lets fall a Lateritious 
Sediment, both Active & Digestive faculties
seem considerably impaired
In Vernall Agues, the third fit is severe, the sixth
the worst & the [illegible] mild and for the most part
carries off the disease, this is observed in 
generall.
These Fevers sometimes in spite of Medicines
and bad treatment will keep their 
Type surprisingly obstinate.
Cleghorn mentions some that would not yield
to the best treatment but still kept their
Type as likewise did those who were expos'd
to the damps and night air.
When the Ague goes off entirely there is always
felt an uneasy kind of Sensation, about the 



97
the time the Paroxysm should have return'd
even tho' the Ague be entirely removed by proper
remedies. The Circumstances of Regimen
Climate, Infancy Putrid Diathisis &c. varie
the appearance of the Paroxysm and all the 
symptoms very much.
We have now seen the General Progress
of Intermittents at their Beginnings & in
their generall Course we next examine their
appearance in the Paroxysm.
At their Invasion there is a Coldness which 
is more severe than what precedes the Contd.
Fever, attended with stretching Yawning
Lassitude oppression, Anxiety Paleness of 
the Lips & Nails depressed Pulse, and some 
times A Cough, Hemoptoe, Convulsions have 
proceeded an even a Titanus, Strangury &
sleepiness have been observed. Ved. Dr. Stork
The Cold generally begins in the feet, & proceeds
gradually upwards, sometimes 'tis only partial
and is felt in the shoulders & Back as if Cold
water was pouring upon them



99.
The Cold fitt has been often observed to produce
such violent tremblings as to break the Teeth
and the patient rendered so feeble as not to be able 
to stand. The lower Extremities are cold wheters
the upper are hott, but in generall the Extremities
are Coldest.
The Duration of it is various in some it will 
continue half an hour in others longer or shorter
& it has been known to continue 2 hours wch.
is the greatest space of time I ever heard of 
It is laid down as a generall Rule that we may 
determine the length & violence of the hott
fitt from the Cold but this is not always true
because we have heard Instances where there
has been no Cold fitt at all & where the [cross out] Hot fitt
has been proportionably less violent as the 
Cold was more so which is the direct opposite
to this Rule, yet generally speaking it may 
be allowed.
There are Instances of Intermittents preceded 
by Violent Pains in different places of the Body
and sometimes by Coma, apoplexy, and one 
instance, by a fitt of Equality, instead of the 



101.
the Cold fit, which was wanting altogether.
Old People in Agues have a trembling small Pulse
Papitation of heart attended sometimes wt. syncope
Anxiety, appoplexy. In the Cold Fit there is commonly
a Dryness & parchedness of the Throat, and 
very often a Vomiting of Bilious Ropy Stuff.
During this Fitt pains are often felt over the Body
resembling Rheumatism. They often complain
of Pain in the head, attended with Delirium, and 
all the secretions are imperfect, & the Urine often
very little & perfectly limpid. There is often a 
remarkable sensibility of the Nervous System
attendent on this fitt. Patients have been cutt
way burnt with hot Iron without so much as 
feeling it & this Insensibility is not confined
to the externall parts alone for the operation
of the Catharticks has been suspended during 
the Cold fitt which proves that the Gutts have 
been incapable of Irritation. At other times
the Patient has had a Diarrhœa during it.
It has been said that during the Cold fitt the Patient
was really warm, by the Thermometer, but
this is not true always for I have seen him evidently



103
evidently colder and at other times considerably
colder than in a natural state.
Many Authors say that in generall Intermittants
observe earlier time of Day accordg.
as their Paroxysms are more frequent or at 
less Distance thus the Paroxysm of a Quotidian
happens in the Morning, of a Tertian in the 
forenoon of a Quartan in the afternoon and 
so on.
Lect. 6} We have examined some of the Appearances in the 
Nov. 15} Cold fitt, which is immediately succeed by the 
1768.} hott. This comes on gradually, after the cold one 
of which some symptoms still remain as the 
dryness of Tongue and throat, debility of Limbs
and Anxiety. The Face is much flushed and 
all the skin red, the Urine high Coloured, the heat
greater than in a continued fever, the breathing
which in the cold fitt was oppressed now becomes
freer, the pulse is full and strong.
It is generally said that Tertians and all Agues
kill in the Cold fitt but in hott Climates they are 
fatal in the hott fitt. But old People labouring
under Quartans, are most commonly carried off 
in the Cold fitt. The Daraleon of this fitt is very 



105.
very various and uncertain, tho' it is generally
said to be in proportion to the proceeding Cold fitt.
If the patient is blooded we will scarce discover any
obvious difference in it's appearance, sometimes
indeed we find it so much dissolved as not to separate
into Crassamentum and Serum.
The last stage of the Paroxysm is the sweat,
and in proportion as this spreads over the Body
the hott fitt wears off. Its duration is likewise
exceeding various for sometimes it begins with 
the hott Fitt & in Quartans the skin is often found
to be dry without any sweat succeeding the hott
fitt which is no good symptom.
The Urine is found frothy and as soap was dissolved
in it, but as the sweat advances the Febrile
symptoms wear gradually off and the Urine 
begins to lett fall a Lateritious sediment
which has been considered as a Pathognomick
symptom, however this cannot be justly said
because we find the same appearance in the Urine
of Scorbutick Patients and in some Inflammatory
Fevers especially in Pleurisies. We often find 
a Calkarious Sediment instead of this Lateritious
one especially in Vernall Agues.
The Duration of Intermittent Fevers is very 



107.
various & uncertain. Vernall Tertians are commonly 
terminated from 5 to 9 Revolutions seldom
so soon as five or more than nine.
Autumnal Quartans especially in old people generally
last till the turn of the season or spring &
when weak perhaps a whole Year, but in young
they commonly go off about the winter solstice.
Children on account of their weak lax habit continue
long in these Fevers.
It is generally said that Quartans last longest
or have the most numerous Revolutions. Some
have been said to continue 22 Years, tho' I'm apt 
to believe there have been Obstructions in the Abdominal
Viscera, which afforded a constant
Cause to the Disease.
Tis a Generall Observation that Intermittents
last in proportion to their Intervals, or that if 
Their intervals be short their Duration will 
be short. That therefore Vernal Agues as 
tertians soon go off even of themselves with 
the warm weather, where as Quartans continue
much longer commonly half a Year & somtimes
more, but then it never returns, and a man 
that has once had a Quartan will never have another 



109.
another in his Life. But this cannot be depended
on as a Generall Rule.
These Intermittents have often very Salutary
Effects on the Constitution and have been said 
to contribute very much to Longevity, and that 
People who have had a Quartan, & got well over 
it, live very long.
They have been often observed to carry off entirely
many Periodl. Nervous disorders, as 
Headachs, Pains &c. & that they had this Effect was 
plainly proved by stopping them with the 
Bark, and immediately this Disorders
returned:
Tertians have been reckoned the most salutary
in their Effects on the Constitution & seldom
prove fatal unless in very warm Climate
Nay it is said that during the Plague those
who laboured under Tertians were not infected
with the Contagion. 
Tertians are said to cure Stomachic Disorders
Obstructed Viscera, especially in Liver & Spleen
Rheumatick Complaints, Epilepsy, Palsy, Asthma,
and the Gout and stone have been observed
to be alternate with it in their Revolutions
or Periods which as it hints some sort of Connection



111.
Connection twixt these Diseases should be particularly
attended to.
Intermittent Fevers have sometimes bad Effects
on the Constitution and are the Cause of many
obstinate Diseases. In Children they frequently
occasion the Rickets by rendering them so weak
and lax, & they often leave an openness of the skin
and a Disposition to sweat which weakens 
the Patient exceedingly. They likewise have 
been said to dissolve the Blood & hence cause 
Dropsies, Leucophlegmatia, &c. Obstructed and 
enlarged Viscera, are very frequent Consequences
of these Agues, but are by some said to proceed
from the Exhibition of the Bark which is not as 
all the Three Cause of these Obstructions & Enlargements
of the Abdl. Viscera.
When Patients have suffered considerable Evacuations
before these fevers they often labour
under a Diabetes after them and sometimes
a particular sort of Madness or Idiotism wch.
however as they recruit wears off.
We shall now proceed to the Prognosis
If Autumnal Agues begin soon in the season
as in the month of June they will be very Epideml.
and in generall the sooner in the season they begin 



113.
begin the more Epidemical they are observed
to be and the more fatal, for Quartans, that begin
early carry off vast numbers, of old people.
There is a swelling of the Belly, not a Dropsical
one, that is very salutary and criticall, for as 
this advances the febrile symptoms grow less
violent and the Ague goes entirely off.
There is likewise reason to think that this 
swelling is rather owing to Flatulencies in 
the Colon than obstruction of the Viscera
We often find a particular swelling of the digs
prove a very salutary symptom.
The most fatal symptom about the end of Agues
is a sort of Angina wch. begins with an Inflammation
of the Tonsils, a Difficult Deglutition
succeeded by Facies Hippocratica. This commonly
appears about 2 or 3 Days before the Patients
Death & is a certain sign of his approaching
Fate. A natural Salivation has been known
to carry off these Diseases.
The small Pox appearing during the Course of 
an Ague very often prove a Cure for it, and some 
sorts of Itch have the same Effect. By Itch I mean
any Eruption with Itching and occuring of water 



115.
Pustular Eruptions about the mouth and nose
at the End of Intermittents, and Abscess in any
part of the Body are generally Esteemed very favourable
symptoms, but about the beginning they 
presage no good.
The most dangerous Paroxysm in Intermittents
is that which is not proceeded by a Cold Fitt.
Bleeding At nose is reckoned a very good symp.
in the hot Fitt.
If the summer has been wett we may generall
expect to find the Intermittents very obstinate
and apt to return upon the slightest Occasion
After Agues we often find swellings of the Belly
and Legs, which are not very Dangerous in 
generall; but they are more so in Quartans
than Tertians.
In Agues we often find the Pulse small and depress'd
which if attended wt. Pains in the Præcordia and 
Anxietys is very dangerous, but if these do not 
accompany it, there's little hazard as it's merely
Nervous. At other times we find the Pulse exceeding
slow and full which when the Animall on 
Vital Functions an disordered as in soporose
Cases may be generally reckon'd a fatal symptom.



117.
Intermittent Fevers are highly dangerous in warm
Climates, when connected with a putrid Diathesis 
of the Blood, which often happens if they are not timeously
stopt. It is impossible to know certainly
from the first attack of an Intermittent what particular
Genus it will be of, Galens marks are not 
at all found to hold in practice.
Antecedent Causes and Predisponent come 
next in order.
And it is observed that young people in generall
are most Subject to agues more so than
Infants, or old People. It has been said tho' it
is not certain, that Quotidians happen most
frequently to Women and Phlegmatick habits
Tertians to the Young and Active and those 
that have great sensibility of the mind.
Quartans to those advanced in Age, the Melancholy
speculative and studious. But I could 
never from my own Experience have laid 
down such observations. Debility of the 
System & extreme sensibility of nervous
Power are certain predisponent Causes of 
Agues, and a more general one than either
is a patients once having had an Ague before,



119.
before, particularly a Quotidian or Tertian
We next come to the Occasional Exciting
Causes, which I shall reduce to several heads
First Errors in Diet and Regimen, as food of 
very hard Digestion, every thing that hurts
the Digestive faculties, as hard Drinking
At same time one going into a Country where 
they are very Endemic as Holland, living a
little more fully & drinking a Glass more than
usual, tho' not to excess I know from Experience
to be very useful & the best preservative.
Among the Occasional Causes the Most Powerful
is the catching of Cold when the Body is healed
& particularly when the Cold is attended wt.
dampness as the night Air, sleeping in a 
Damp place; but simple cold Air without 
these Circumstances, will scarcely produce
an Ague. Excess of Fatigue, or watching frequently
bring it on, Excess of Drinking &
watching always tend to debilitate the Constitution,
and also Disposes to catching Cold
the one an Antecedent the oyr. an Occasional
Cause of this Disorder. I dont say that 
these Occasional Causes are of themselves sufficient



121.
sufficient to produce an Ague but only where there
is a prediposition or Epidemic Tendency to it 
in the Air.
α. Violent affections of the mind, all the Depressing
passions, as Fear, Grief, by depressing the Vis
Vita, occasion this Disease
β. Suppressions of usual Evacuations, and 
very violent Evacuations, are often Occasionall
Causes. Sometimes the Violent Action of a Cathartick,
and repelling spontaneous Eruptions when 
the skin produce it.
γ. The next Occasional Cause is a particular state
of the Air especially a Damp state and along with 
that, Putrid Exhalations. Easterly winds are apt to
induce the Ague, especially in those who have had 
it before, and they have in generall a remarkable
Effect on such. It is commonly thought that the 
Easterly wind occasion this by being more damp 
but that this is not always the Case appears by 
the Hygroscope, it having these Effects when 
it is exceedingly dry. Some say that dry seasons
induce Agues, and this may be the Case as the Air
may be very moist without rain and rainy 
weather is not always the moistest. For Air
seems to be a menstruem in which the water is 



123.
suspended, and therefore like other Menstrua
will take up more when warm. But rain stops
exhalation. Hence there will be most Dampness
in the Air in the warmest weather, and hence
too much Moisture falls in the night in 
very warm weather.
ζ. Agues are Endemic in many Countries, particularly
in fenny swampy Countrys in Scotland
called Carses. This arises from the great
exhalation of water. In some parts of England
a Quartan Ague is the most obstinate, and the 
most frequent, but in Scotland they are very 
rarely met with. Many Countrys have no 
Agues as particularly a sandy, hilly, gravellish
soil. Intermittents & Remittents are Universal
Diseases in all the warm Climates, and generally
speaking in the Autumn. It is observed they prevail
more in the East Coast than in the west of 
Great Britain, What is remarkable in some
Countries where they were formerly unknown
they are now become Endemic and the Contrary.
This can often be accounted for from the Change
in the face of the Country, as by clearing away
the woods, but it happens also independent of 
this. 



125
ε. Another Occasionall Cause is a certain Disposition
of the Air in Consequence of which the 
Disease becomes Epidemic. This has often
been referred to an Alteration in the sensible
Qualities of the Air, but this is often not the Case
They become Epidemic chiefly in Autumn &,
Spring, but in Countries subject to Inundations
they rage with greatest Violence, just when 
the water is near drained off and the Exhalations
are then exceedingly putrid from the Rotten
Vegetable & Animal Substances especially in 
warm weather.
ζ. Independent of any particular Constitution
of the air, it would appear that in some 
Cases the Disease is contagious & infectious
which is very positively asserted by many
Medicall Authors but I never saw it happen
In generall however they are not to be considered
among the Infectious Diseases.
We next come to morbid Dissections, which 
in generall throw no light at all upon the 
Proximate Cause of the Disease. They only 
shew those Alterations that have taken place
in Consequence of the Violence of the symptoms.



127.
Symptoms. They shew a great Accumulation
of Grumous Blood in the heart, Lungs,
and great Veins. The stomach & Guts are 
generally found distended and the Abdominal
Viscera obstructed and Enlarged
and often Abscesses are found in the Liver
& spleen, all which are owing to the Blood
being thrown in greater Quantities into 
the Internal parts of the Body during 
the Cold Fitt.
The Stomach & Gutts have been found 
overflowing with Bile of which in these 
Fevers there is observed to be an Immoderate
secretion



129
15. We come next to treat of the Proximate
Cause and I shall take this opportunity to 
explain my sentiments on the General
Proximate Cause of Fever. According to 
Boerhaaves Idea of Fever, which he makes 
to consist only in an increased Quickness
of the Circulation, or Contraction of 
the heart, with an increased Contraction
of the Capillaries, we should have nothing
to account for but the increased Quickness
of the heart, which might either depend 
on its increased sensibility or an 
Increased Stimulus applied to it.
But there is something more than this
there is an evident Debility of the Animal
Functions, and an increased heat of the 
Body. We must therefore be perfectly masters
of Muscular Motion, the Cause of Animal
heat & the nature of the Nervous Influence
or power, which belong to the Physiology,
but I will say that no full Account
of these things has ever been made at least
to my satisfaction.



131
α. Fever has been by many considered
as merely an Effort of nature to throw off something
morbid or hurtfull to the Contitution
which however would in many Cases appear
to be an Hypothesis not founded in 
fact; tho' in many others it's an undoubted
truth. When a fever does once subsist
that there is an Effort of Nature to throw off
this I willingly Acknowledge.
β. The Sthalians and Sauvage consider
two princples in Fever, vizt something
that has a Tendency to destroy the Nervous
Power, and the other an Effort of Nature to 
throw off this morbid Cause
γ The full promximate Cause of Fever must 
be such a one as when present, constantly
and uniformly produces its Effect; if 
not so it will be only an exciting Cause
There often appears to be a predisposition
especially in Intermittents, which lies 
long latent in the habit, here the Union of 
this with the Occasional Cause may constitute 
the Proximate Cause. But the great



133.
great Difficulty is what part of the habit
is morbid in this Case or forms the Predisposition, 
and another Difficulty is, this Cause
of the Periodicall Return of Intermit. Fevers
δ. In searching for the Cause of Fever we 
look for it in some thing whether either
in the Solids, the fluids or the Nervous System.
This includes vitiated Secretions and 
increased Determination of Blood and 
nervous power. It is never alledged that 
any visible Change in the Solids can produce
Fever. It has been sought for in 
the fluids, & the general Theory has proceeded
upon the supposition, that something
morbid here acted as a stimulus to the 
heart; We shall therefore inquire into
this supposed Vitium of the fluids which
it's necessary to do as the Practice has 
been very much adapted to it.
ε. Suposed in the first place from Lentor
because in all fevers there was a morbid
Lentor in the Blood, in consequence of 
which a Disposition in the Blood to stagnate, 



135
stagnate, or at least to move with Difficulty
thro' the Capillary Vessels, which resistance
acted as a stimulus to the heart. By Lentor
they meant too great at thickness or Cohesion
of the red Globules. This is Boerhaave's Theory
along with an Inertia Liquid. nervos.
It has been also said that the Blood is of 
different degrees of Density, in the Difft. Species
of Intermittents, that it's thickest in 
a Quortidian & most dissolved in a Quartan
ζ. This however is purely Hypothetical,
for we often find Fevers connected wt
a morbid Tenuity of the Blood as well as
with a morbid Lentor. The marks also from
which the Supposition so commonly taken
vizt the appearance of the Blood, are often
present when the Patient has no fever as 
all; as in the Chronick Rheumatism, in 
all women with Child, almost in every person
more or less, in the winter time. Yet
we dont find that people in those Circumstances
are a bitt more liable to fever than
at any oyr Period. This therefore cannot be 



137
be the full proximate Cause of Fevers fm-
the Definition of the Prox. Cause already given.
Besides Hydropic people whose Blood is 
thin and of a looser Texture are often subject
to Agues. Neither is the notion of different
States of the Blood in different species of Agues
raised on any solid foundation. For in Agues
the Blood in general does not seem to depart
very much from it's natural state, except
in several Cases a little to the Inflammay.
& putrid Diathesis. Again if Lentor were
the proximate Cause, the proper Cure of Agues
would be Deluents, and Attenuants, but 
this is not the Case. We have many Cases of 
an Ague keeping its Type, through the Course
of a mercurial Salivation.
η. One of the most common on exciting Causes
of Fevers is an Obstruction of the Perspiration,
in consequence of which they say a 
Plethora is brought upon the System and the 
retaind Acrid perspirable matter acts 
as a stimulus. That cold when a person
is heated is a very generall Cause of Fever



139.
is not to be doubted, but the above Conclusions
do not follow.
It's very difficult to form any Conclusion
with regard to perspiration, as there are certainly
vessels on the surface of the Body which 
inspire & therefore unless we know the Quy
of matter inspired, we can only know the 
Excess or difference between the Quantity perspired
& inspired. But supposing a sudden
Check is given to the Perspiration, there 
great reason to believe that it would
be increased in other parts proportionally
or if we suppose the spasmodic stricture
to be extended over the whole [cross out] surface
may we not very reasonably apprehend
that the other secretions will be increased
in proportion. But the simple Plethora
occasioned by the retain'd perspirable matter
can never be the Cause of fever by itself
as in many Cases where we know Plethora
is present it produces no Fever. Besides
it is to be observed that there is not always
that very Acrid Quality in the Perspirable 



141
persperable matter commonly supposed;
for it is very variable; greater in a warm than
cold Atmosphere & in a warm than cold Climate.
All the Year taken together, the Perspiration
& Urine ballance each other; and in 
consequence of this some medicines prove either
Diaphoretic or Diuretic according to the Degree 
of heat the Patient is in. These two Evacuas,
also resemble very much in point of Quality.
Now we know that the secretion of Urine
may be stopt a long time without any bad
Consequences, being otherwise ballanced &
that even after it is secreted into the Bladder
yet when a person is much heated as endangering,
the whole shall be observed into the mass
of Blood, and pass of by Perspiration without 
any bad Effects. We know all that the liquid
Fœces, which are of the most putrid kind may
be absorbed without any bad Consequence.
The Bile too which is one of the most Acrid
Secretions, may be reabsorbed and the mass
of Blood greatly loaded with it as in the 
Jaundice without producing any fever
Moreover in a Room full of Company, it is 



143.
is certain the perspirable matter must be very
copiously diffused in the Atmosphere an consequently
a great Quantity of it must be inspir'd
by the Vessels on the surface of the Body, yet 
no one is generally hurt from this Course.
tho' he may be going suddenly into the Cold Air
The Retention of the perspirable matter
also, cannot be the full Proximate Cause of 
Fever, particularly of Agues, because the Effect
143 does not always proceed from it and therefore 
it may only serve as an exciting Cause.
In General we ascribe too much to Perspiration
and are too much affraid of its obstruction
Sanctorius reckons it 5/8 of the Ingesta
but this is greatly too much. In severall Cold
Climates the People go almost naked, and 
yet enjoy Vigor & health and in warm Climates,
where the Perspiration is more Copious
and Acrid, it is the practice in many 
nations to cover the whole Body over wt
a very thick Paint, which must stop it 
very much, tho' it will penetrate common
oils, & yet these people do not at all 



145
all suffer in their health from this Practice
Besides the most delicate of the human 
kind the women keep their nake & great
part of their breast quite bare without
any inconvenience tho no doubt in these
Cases there is a great dole in Custom
The Prepossession with regard to Perspiration
certainly enervates the Constitution
of many in this Climate by keeping
themselves too warm & such are generally 
the most sickly -
In some fevers also we find the 
[Porestad?] open and the Patient dissolved
in sweats tho' no doubt there generally
appears to be a suppression of Perspiration
in fevers from the dry parched feel
of the skin. If it were true likewise that 
this were the most common Cause of Fever
we should find Fevers prevail most in the 
summer time because the Perspiration
is then greatest and most Acrid & the habit
more mobile, and therefore subject to 
sudden Checks of Respiration; but this
is not the Case-



147
As to any little Plethora that could be induced
thus, it must be soon removed by the Evacuations
in the beginning of Fevers and the 
Total Abstinence from food. See Remarks
on this subject in a late Essay of Dr. Chambers
of Charleston.
16 n It has been said again that Fever
is owing to Putrescence in general, this 
they prove in the first place from Agues
prevailing most in Consequence of heat &
Moisture which much increase Putrefaction.
[illegible] that any Putrid fomes acts 
as an assimilating Ferment and so produces
fever. 3d. Because Agues are cured
by Evacuating putrid humours and by 
Antiscepticks but. Putrescency alone is 
not sufficient since we sometimes as in 
Scurvey find it in the highest Degree without
fever. 2d. There are fever and Agues
without the smallest marks of Putrescency
and they often arise suddenly from violent 
affections of the mind from catching Cold
and have the Inflamy. instead of ye Putrid

148

149
Putrid Diathesis; 3 In the Island of Famosa
where the Atmosphere is moist & hott & full of putrid
Effluvia; there are no Intermittents; & intermittents
are cured by violent Passions of the 
mind by Electricity, & the Bark before any 
Aleration could be supposed to take place in 
the Alteration of the Fluids from their Putrid
state. 5th. Intermittents are cured by Testaua
which are certainly septus there for increase
Putrefaction
There have been assigned other Causes
of Fevers particularly of Intermittents as 
putrid Bile or vitiated any way; some Disorder 
of Stomach Liver or Duodenum; this is Senacs
Hypothesis his reasons were these
1. There is generally a great overflowing of 
the Byle 2dly. There is a great Secretion & Absorption
of it as appears from the Eyes Urine
& Skin. 3dly. It appears that the Liver & Abdominal
Viscera & particularly the stomach
are the seat of many of the Symptoms & in 
those that have died the Stomach has been found
morbid. But in Answer to this the Bile could
not be so soon removed by the Bark without 

150

151.
without an arconery any Evaucation & we 
do [illegible] find a Redundancy of Blood produce fever 
always; as in the Cholera Morbus & Jaundice
In the next place Emetus & Cathartcus which 
evacuate the Bile, have the Effect of rendering
Intermittents more Obstinate & the Yellowness
of the Skin & Lateritious Sediment is often
wanting; further it will appear that Obstructions
in the Liver is rather the Cause than 
the Consequence of Intermittent; turedes 
were it owing to Bile the Disease ought to 
be continued since the Cause always subsists
the Effects should always follow; however
tho' the Disorders of the P.V. be not the full
Proximate Cause of the Fever yet they may 
be reckoned [cross out] exciting Causes
Next Morbid Matter with an Assemulating
Power has also been supposed the Proximate
Cause of Fever; they also suppose a certain change
effected in this Morbid Matter preparatory to 
its Explusion, which they are pleased to call 
Coction after which it was expelled the Body
by Critical Evacuations or Abscesses because 

152


153
because when these take place the symptoms
gradually abate; This Theory at first is very
specious. And that there is such Matter no one 
can doubt as we evidently see it in the small
Pox and Contagious Diseases. Dr. Pringle
considers it as a certain degree of Putrefaction
induced on the Fluids by which they are rendered
thinner & able to pass the small vessels. But 
this Assertion of Morbid Matter is so general
& in such terms that we cannot refute it;
that there is such a thing in some fevers no 
Body can doubt; put in Intermittents particularly
& other fevers particularly been supposed
when it could not be proved; they even
went the length of determining it to be Akaline
or Acid and according to this Supposition adapted
their Practice. But I would observe that
these Evacuations which carry it off are 
Morbid; neither does it appear that the 
Matter of Criticall Abscesses is [cross out]
more morbid or Acrid, on the Contrary the 
Pus in Criticall Abscesses vizt. album lueum
es Equale. Lect. 8
#

154


154
Lect. 8 Novr. 17 1769. 
I told you before that it has been very generally,
supposed that morbid matter exciting in 
the Habit & discharged by the Secretions was 
the Proximate Cause of Fever; and that there 
was no Positive Proof of this only that these 
secretions coming on the Fever abated; & that 
in the Secretions themselves there was no 
mark of Acrimony; But there are many 
Instances of Fevers cured by Hemorhagies
now it cant be supposed that this Portion of 
Blood Evacuated contains all the morbid matter
this is altogether against the Laws of the 
Circulation; neither are Critical Diarrhœas
attended with Gripes or Critical sweats acrid
because their is no Itching on the Skin which
would be the Case if this was true; at the same 
time those are often evident marks of Acriomony
when no Fever takes place; you'll sometimes
see the Scratch of a Pin fester & become
an Obstinate Ulcer; Also in the Application
of Blisters when the serum is so acrid as 
to excorriate the neighbouring part & yet
no fever ensue; at the same time I dont pretend

156


157
pretend to assert that there is no morbid matter
exists in the Blood; but only that no particular 
matter can be condescended on that 
can furnish the best Indication of Cure 
The supporation of morbid matter has led to 
Consequences in Practice very Pernicious
first introduced by Van Helmont & his followers 
and even after the Theory was exploded the Practice
continued & a Medecine much in Repute
is the Barle Powder which to say no worse is 
very insignificant. But Sylvius in all Cases
[upo?] Theory of morbid Acid in the Blood, gave
the Testacea & Absorbents which often did 
very much hurt. Dr. Pringle again did 
not found his Practice upon his own Theory
instead of this I would recommend it as one 
of the best Practical Books I know
With regard to this Theory of Putrefaction
we may observe 1. That Critical Evacuations
exhibit no Marks of Putrefaction
2 Thinness is so farr from being a Mark
of a salutary Critical Evacuation, that the very 
opposite vizt. a Degree of Consistence & viscidity

158


159
viscidity is necessary to make a Criticall Evacuation
Salutary, instanced in a common
Callarrh Plueresies & Peripneumonies going
off when the mucus always acquires a viscidity
& Ripeness the same is true of Abscesses
Ulcers & the Gonorrhœa
3 I observe that Putrefaction induces Acrimony;
yet there are no Instances of the Fluids
becoming more Acrid as the Coction advances
4. The Bark promotes Coction or the proper
Digestion & maturation of the Matter as in 
the Small Pox Ulcers & Gangrenes where it 
promotes the suppuration & converts the matter
into laudable Pus; The Bark is Aketurra
Aptesceptuk. This Theory if just should lead
to a not very proper Practice in Fevers, vizt-
the giving Sciptus in large Quantities & keeping 
the Patient extremely hott; I do not say 
that any such Consequences are drawn by 
Dr Pringle for I think his Practice the best
to be mett with in any Author whatsoever
& which I would recommend to your Imitation -
5. All 

160


161
4. All these Opinions therefore appear to be
Hypothetical, and none of them can be considered
as the full Proximate Cause of Fever, but all of 
them may act as internal exciting Causes.
As therefore the Proximate Cause of Fever is neither
in the solids or Fluids we naturally seek for it 
in the Nervous System. I mentioned that Boerhaave 
added to his Theory the Inertea Lig. Nerbori 
but this Phase is very Ambiguaus & is not ye
full Course. For we dont find those that have it 
disposed to Agues in any remarkable manner
especially Hypochondriac People who have also
a very great Degree of Lentor in their Blood.
The Predisposition to Agues is rather connected
with too great a mobility of the nervous system
The Cause then of Fever has been referred to 
a spasmodic Constriction of the Capillary Blood
vessels by the sthaleans & Hoffman. That then is 
such a Constriction especially on the surface of ye 
Body appears perfectly evident in the Cold Fitt of 
Fever; which is said to act as a Stimulus to the 
Nervous System & produce the Hott Fitt & that the 
Continuance of this Spasmodic stricture was the 

162

163
the Proximate Cause of Fever. But still we may 
ask what Causes this spasmodic stricture, this has 
been referred to debility of the nervous Power or 
Sensorium. That Spasm is often connected at 
Debility & Alonea is very certain but I think
not inseparably. For the evident Constriction of 
the Capillaries in the Cold Fitt appears only or 
the beginning of Fever when the Patient is still
Vigorous. There is indeed a Debility of the Nervous 
power which is not connected with Bodily
weakness, for we often find people after a long 
Fever reduced to the greatest Degree of weakness
& yet enjoying very good Health. The Debility of the 
Nervous System again is particularly connected
with spasm tho it often also produces Palsy, as 
therefore Debility may exist without spasm & this 
without Debility; this cannot be the full Efficient
Cause of Fever.
But supposing this the Cause the Question still
returns what produces this Debility of the Sensorium?
but for what I know this has never been
attempted to be explained
Supposing the spasm in the beginning of the 
Fever to produce the Cold Fitt; it does not appear
that 

164

165
that the Cold Fitt produces Fever, for then there would 
be no Fever without a preeceding Coldness, but
we often find Fever begin without any preceding 
Rigor, or apparent Constriction of the Capillaries
Also if the Fever were entirely the Consequence of 
the spasm when the Cough was violent so ought
the Effect to be, but this is not the Case always for 
there are some Instances where the very Reverse
takes place particularly in some Intermittents
2 Spasm & Coldness of the surface does not of itself
produce Fever; for the Application of external Cold
evidently produces spasm, but this only an Agreeable
warmth & not Fever, as in the Case of Cold
Bathing. 3. During some Fevers there are no 
Apparent marks of spasm in any part of the 
system, except of are Consider the increased Contraction
of the Heart as such & the Patient is constantly
sweating & this in Fevers of the worst 
& most Dangerous Kind; External Cold also instead
of causing any Depressions the Nervous 
System, is one of the most powerfull Exciters of 
the Nervous Power & hence the Cold Bath in most 
people acts as an Exciters of the System as powerfully 

166


167.
powerfully as wine; but the Febrile Cold very
much Depresses the Animal Functions.
There is therefore in Fever some Cause which acts 
on the nervous System in Consequence of which the 
Heart is irritated to more frequent Contractions, which 
occasions irregular Determinations of the Blood &
Nervous Power disorders the Functions & Secretions
& produces the other Phenomena of Fever 
The Particular Reasons that shew this in Intermittent 
Fevers are as follows. 1. Because the 
Patient previous to the attack of the Paroxysm
is often sensible of no Disorder whatsoever which 
could not possibly be the Case were the Cause in the 
Fluids 2. We find that Intermittent Fevers are 
both produced & carried off by sudden Emotions
of the mind which at least is derisive that Intermittents
may be produced without any alteration
in the Fluids. Thus the Paroxysm of an Ague may 
be predented by close Attention to the mind &
may be produced by violent Emotions of the mind 
sometimes cured by plunging suddenly in Cold 
Water &c. At the same time it must be observed that 
in most of these Cases where it was produced by sudden 
Emotions of the mind the Seminium had been 
before present in the Constitution 3 Intermittent
Fevers

168

169.
are often preceded by Convulsive & Apoplectick
increases which are evidently seated in the nervous 
system. The Patient has also a most wonderfull
Degree of Acuteness during the Paroxysm. 4. An 
Intermittent sometimes seizes open on during a salivation
& Continues during the Course of it which is 
a presumption that the Cause is not sealed in the 
Fluids. 5. Intermittents are most obstinate in those 
that have the greatest mobility of the System &
hence happens to young People such as are fatigued
or have undergone great Evacuations. 6 The 
same good Effects produced by the Bark are the
in a less degree produced by it in nervous Diseases
especially Periodic ones. 7. Palsus & Epehpices
are often cured by Intermittent Fevers. 8. The Fitts
may be prevented or weakened like all other 
Convulsive Disorders by exciting a very Acute Pain
or a violent Commotion of the system from any Cause
whatever. 9 Warm Ointments applied to the Spine
often have the Effect to prevent a Paroxysm which 
could only be from their Effect on the nervous system.
In Cold Countries where the Nervous System
is less mobile Agues are less frequent but the Contrary
happens in warm Countries. 11. Intermittents
are 

170


171.
are cured by those things that have a Tendency to 
brace the general system, as the Peruvian Bark
which produces its Effects before any Change could
be induced by it on the Fluids.
The Predisposition therefore of Agues probably
less in the nervous System. This latent Semeneum
appears likewise to be the Cause that Determines the 
particular species of Intermittent; tho' the Semeneum
of all appears analogous because the Different Species
of Agues pass into one another. The Proximate
Cause of them & Continued Fever likewise appears
Analogous from their Changing into one another 
Many Nervous Diseases & some Continued Fevers
are referred to the Class of Agues because the leading
Symptoms resemble & the same method of Cure 
is successfull in both for this see Torti & Mercatus
It has of late become the Practice in some Continued
Fevers to throw in a Quantity of the Bark at the 
Exacerbation & with great success of which more 
here after.
I shall here take notice of a remarkable Analogy
twixt Intermitting Fevers and the Gout; they resemble
one another in their sudden Invasion, in the general
Irritation they bring upon the whole system in 
being often Periodic brought on by violent Affections 
of the 

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173
of the mind, Errors in diet, in Relieving the Patient
of many Diseases, and the present Paroxysms being
removed at the same time that the semeneum reamins
in the Constitution.
Ratio [Medendi]., Symptomatum.
Most of the Symptoms in the Cold Fitt may be accounted
for from the spasmodic stricture which takes place over 
the whole system & from the weakened Action of the 
Heart; such as palness dryness & Corrugation
of the skin Diminution of the Secretions & Insensibility
to Stimuli. These may be accounted for from 
the above Cause & debility of the Nervous Power
The Anxiety Oppression of the Præcordia are probably 
produced by the Accumulation of Blood in
the Internall Parts owing to the Spasmodic Stricture
externally but this cannot produce it alone else External
Cold should have the same Effect which we
know it has not. It has been thought that the 
Blood being propelled in greater Quantity makes 
it more irritable & causes it of Consequence contract
before the Ventricles are quite full by which they 
account for the weakness & quickness of the Pulse.
This was Dr Whyles Hypothesis; but I apprehend there 
is something more than the mere internal Determination
vizt. the particular Affection of the Nervous

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175.
Nervous Power. But that the external Accumulation
does take place is very clear from the Dissections
of those that have died in the Cold Fitt. In Consequence
of this there are certain Instinctive Motions excited
by Nature to relieve the Body from the Oppression
There are stretching Yawning Jactation & perhaps
Trembling. The Pain of the Back appears to be 
Nervous it generally arises where the Center of the 
Mesontery & Duodenum are tied to the Back.
The sensation of Cold itself is evidently a nervous
Symptom & is produced on several other Occasions
which shew this as by Affections of the Mind by 
the passing of Stones from the Biliary Ducts into the
Duodenum, sounding with a Catheter, all externall
suppurations, and generally speaking
always attends their breaking; by attempting 
to introduce a Glyster Puke in one affected with
the Piles. The Head Ach may be partly nervous
& partly may arise from the Stomach which in 
Agues seems principally affected. It may also
arise from morbid Congestion. The Nausea & vomiting
sometimes proceed from the Regurgitation of the 
Bile into the stomach & becoming Putrid at the same 
time they are often merely nervous Affections &

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177.
& independent of the Contents of the Stomach.
In all the Stages of Agues the Primæ viæ are the 
Seat of the Principal symptoms & in all Kinds
of nervous Complaints the Stomach indeed suffers
more or less, and all Complaints of the stomach
do affect the nervous System The Thirst seems 
to proceed from a want of secretion of that Liquor 
which continually moistens the Throat.
Lect. 9. Nov. 18. 1769.
The increased heat in the Hott Fitt has long 
been [crossed out] ascribed to the mechanical Attribution of the Fluids
against the vessels; here it would rather appear owing
to Chemical Mixture; It seems to depend on some Principle 
of the Constitution not yet explained. But what 
ever is the Cause of heat in Health; the same Acts
here only in a stronger Degree. The Fullness of the 
Pulse is owing to the Spasm being removed & the 
Rarefaction of the Blood; The Head Ach from an increased
Determination of the Blood; The Change
wrought on the Urine appears to be owing to the 
Spasm being taken off from the Organs Secreting
it.
No good Explanation has been given of the 
Secreting Fitt, because its no necessary Consequence
of Hott Fitt as has been supposed. The Infantum
dont seem to have any Connection with the 

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179
the Disease & are probably owning to the Determinatn.
of the Blood to the Viscera. & the Abdominal & Thoracic 
both are diseased from the same Cause.
As to the Regularity of the Returns of the Paroxysm
no satisfactory Account has been given. It has 
been supposed that the Morbid matter has been
expelled by the Sweat by Degrees & that the Remainder
Acted as an Assimulating Ferment but this 
is a mere Hypothesis; besides the Febrile Sympts
should be violent in proportion to the Assimulg
Cause. Many of the Phenomena have been found 
inexplicable as the missing of a Paroxysm &
returning next at its stated hour, why a Quartan
should be more obstinate than any other kind 
of Intermittent & generally only severe People
once in their Lives. I shall only observe that 
it seems to be a law of Human Constitution that 
all the Natural Appetites & Secretions should return
at Stated Times, as of Hunger Sleep, the menses 
&c. & that every person even in best Health is 
seized with a Feverish paroxysm twice in 24 hours
at midday & midnight, [cross out] at the 
same time these may be much modified by Habit 
I now shall treat of the Cure 

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181.
Cure.
This has been generally thought a very easy matter
& so it is commonly; yet they are sometimes very obstinate.
Intermittents have been cured by Remedies Dramatically
opposite. It requires great Judgement from the 
Variety of Cures to select the best
The First Question is whether the Disease is to be left
to nature for sometimes Agues are Salutary especially
Spring Tertians) or to be cured by Art? Besides when 
there is no present Disease in the Habit Vernall
Tertians go off Spontaneously about the 7th. Revolution
In Temperate Climate's Physicians d'ont Choose
to Stop Intermittents til such Time as they are quite
Formed, at the same time the longer it remains it 
often becomes the more Obstinate & its always a 
Physicians business to palliate Symptoms
Indications. There cannot arise from a full
knowledge of the Proximate Cause; as its not yet
discovered; whether we are to proceed on this Plan,
or are we to suppose it as throwing off something 
morbid from the Constitution?
If the Disease is left to nature the whole Business
of the Physician is to modifie the Symptoms assisting 
her weak endeavours & restraining her 
too violent Commotions. The first is effected by

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183.
encouraging the Hott Fitt, by Cordials
Blisters Sudoreficks Ea. 2 By Evaucants and Antispasmodicks.
The Cure of Intermittents consisted
in this before the Introduction of the Bark into 
Europe; but now we can proceed more effectually
in another way without the best Danger which is
to stop the Paroxysm at once. 
This has been attempted in a variety of Different
ways as 
1. By inducing an Artificial Hott Fitt by wrapping 
up the Patient, by warm diluent drinks & often
hot Sudorefick Medicines, Warm Bath sometimes
the Cold Bath and violent exercise; some time
before the Paroxysm should have come on 
2. By exciting violent Commotions in the system
thus disturbing the natural Course of the Disease.
This was Dr Sydenhams Plan & he sometimes gave
a violent Cathartic before the Fitt; Vomits & violent
Passions of the mind do the same; as also Cathartics
joined to Opiates & some Mercurial Preparations.
3. By the strongest Antispasmodics particularly
Opiates.
4. Bitters of various Kinds
5. Astringents.
6 By Specificks by which I mean in generall 

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185.
generall Medicines producing their Effect without 
any sensible Evaucation; but to what Quality in 
the medicine its Effect is owing we know not; as 
the Peruvian Bark which possibly deserves this name
7. By Externall Applications.
I now proceed to give you my particular sentiments
upon the venous Remedies.
Tho' the Proximate Cause is not fully Known yet 
this is not so very great a loss to Physicians in Practice
because we know how to moderate it & excite it.
The first is done by Bleeding but this in general
is not at all necessary unless to palliate the Violence
of particular symptoms. If neither stops the Paroxm.
or makes the Cold Fitt milder. In Plethoric Patients
& when the Intermittent is connected with Inflammatory
Diathesis Blooding becomes necessary to 
palliate the Symptoms of the Hott Fitt, otherwise
Inflammation might be produced in the Brain
& other fatal Effects follw. & has been observed
that in Vern. Intermitts. connected with Inflammy.
Diathesis, when the Bark has been prescribed
Antecedent to Bleeding they have Changed into
Continued Fevers. A double Tertian has been 
converted into a single Tertian by Phlebotomy

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187.
Whenever the Head and Heart are violently Affected
Bleeding becomes absolutely necessary & is most 
properly used in the Hott Fitt, the Effect of it is to  
lessen the Violence of the Fitt & make the Sweat come
out very Copiously which Effect it has likewise
in continued Fevers & often in these comes off the Fevers
wholly, but abstracting from these Circumstances
Bleeding is absolutely useless & even hurtfull especially
where there is putrid Diathesis or when 
the Fever has lasted long, perhaps its of no great
moment whether the Patient is bled in the hot 
Fitt or in the Intervalls, some advise it in the Cold 
but I can see no reason for this at all. The use 
of Bleeding has been much Questioned in Quartans
yet there are a few Cases of it being Successfully applied
in these; I should not think it a good Practice tho'.
The Evacuation that is more generally used is 
Vomites after Bleeding if necessary. Vomites
are given to cleanse the stomach but this is not 
all their Effects; they promote the Secretion by the 
skin, are Antispasmodic & prevent Obstructions
in the Abdominal Viscera; they powerfully Stimulate
the nervous System and & often carry off the 
Disease all at once. When this is their Effect its 

188 

189.
its not easy to say to which of their Operations
we may ascribe it. It is generally thought necessary
to give a Vomite before the Exhibition of the Bark
The best time for its Exhibition is that its Operation
may be over before the Febrile Paroxysm begins,
if an Opiate is given after the Fitt is often stopt; the 
Vomite should be washed off by Chamomile Tea
or Infusion of Carduus rather than by Large &
repeated Draughts of warm water than which 
nothing more we skens the Tone of the Stomach
The Practice of many has been to give the Vomite 
during the Cold Fitt; This was done by Calsus, Esilypiades
& Thomson, what has given Origin to this 
Practice is the neausea & sometimes actuall
vomiting in the Cold Fitt, This they have taken
as a Natural Indication at the same time there
have been very bad Effects from this Practice
If the Cold Fitt is very violent, delicate Habits
are very apt to be hurt by what excites a very 
violent Commotion in the system. Emetics in 
small Doses so as to excite a Degree of neausea
have prevented the Fitt. To this Purpose Emetic
Tartar has been used Also James's Powder
which has been in great Reputation, tho' the 

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191.
the Emetic Tartar is now proved to be the better
medicine. The generall Effect of this medicine in
small Doses is to operate by Vomiting Stool
& Sweat. Dehaun is a great Ennemy to Emetics 
of very Kind in Agues & continued Fevers; he considers
them only as cleaning the Stomach and 
attributes bad Effects to them in other ways from 
a false Theory of his own. A Physician is not to 
take the Indecatn. of repeating the Vomite frm- what 
is vomited for there would be no End in this as the 
stomach always appears foul & the same Serdes
would shew itself were the Patient to be vomited 
3 times a day & Repeated Vomites weaken 
the Tone of the Stomach. Its the Emetic do [illegible] not act down 
wards a gentle Laxative is necessary to cleanse
the Intestines: & more especially in warm Climates
to prevent the stagnation & consequent
Putridity of the Bile; violent Catharticks have
been exhibited sometimes & prevented the Paroxm.
altogether this was Sydenhams Muhad of 
heating vernal Agues but is now laidared
being so very rough. In Warm Climates

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193
Lect. 10 Novr. 21 1769. 
In Warm Climates Physick may be given
& is necessary to carry off the Bile & putrid Calluvies
that lurks in the P.V. which if let 
alone might bring on Inflammations in 
these Parts from it's Acrimony, & the warmness
of Country; or cause a Cholera Morbus 
which would render the Patient exceeding 
weak if it did not prove altogether fatal
In every case or Climate we should endeavour 
to keep the Belly open and prevent Costiveness,
which is very apt to turn it into a 
Continued Fever. 
If Intermittents run into Continued
Fevers, blooding and a gentle Laxative
are necessary to reduce it to it's Type again
which they seldom fail to do; but the blooding
should not be often repeated, because
it is very hurtfull by prolonging & rendering
the Disease very obstinate.
Many Authors advise to give strong Acrid Catharticks,
but these are very apt to bring back 
the Ague and make the Patient relapse,

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195
relapse, sometimes indeed in warm Climates
they become necessary. But in generall
no smart Physic should be given, in this Case
then the Belly should always be kept open
& if the Ague is stopt by the Bark its frequently
necessary to give a laxative after 
& where there is a great Tendency to Costiveness
a Laxative should be joind with 
the bark, where the Gutts are weak Rhubarb 
is very properly given along with it
in such Quantity as will keep the Belly
gently open.
We find some Instances of Agues being cured
by strong stimulating Purgatives, but this 
is a very bad practice in generall & the Effect
of this was more owing to the Peculiar
stimulus applied to nervous system.
We have undoubted instances of small 
Doses of Rhubarb and Calomel having 
cured Intermittents even when the Bark
has failed, and in some obstinate Quartans
Mineral Purging waters have been 

196


197.
been the Cure, but these are Cases where
the exciting Cause has been obstructions
in the Abdominal Viscera.
Antimonial Catharticks are certainly best
because they often operate both by Vomiting 
& stool; and James's Powder, has been generally
preferred, but we should be cautious in 
giving it because the Doses are not carefully
enough weighed some of them contain more 
than XXXIV gr. & besides when the Dose is over 
great it's operation is very violent, we shd.
therefore give it in small Quantities and gradually
increase them. If the Intermittent
begin in the form of a continued Fever this 
Antimonial medicine will reduce it to its
proper Type. But in my Opinion Emetic
Tartar is preferable to Antimonial Wine 
or James's Powder. These medicines are 
very efficacious in Cases where there is a 
violent head ach attended with stupor, Coma 
&c. when they are given in such Quantities
as produces sensible Evacuations both up 

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199.
up and down, and when given in small
Doses often repeated they seldom fail to 
do this but sometimes they produce no 
Evacuation only bring on a neausea &
act as fibrefuges, for they often carry along
with them the Disease
In Intermittment fevers where there is 
a Diarrhœa a Tartar Emetic is given with 
an Opiate, the opiate prevents the Increase
of the Diarrhœa, does not hinder the Vomiting
& promotes a Diaphoresis
alkalics, nor Absorbent Earths should
never be joined with Emetic Tartar because
they decompose it
We next come to Sudorificks, [cross out]
and they are given with two different views
either to assist nature or to prevent the 
Access of the fitt. To accomplish the first
we give the Patient plenty of Diluent Drinks
before & during the Cold fitt, as Decoction
of Bardana, Sarsparilla, but a weak
Lemonade or water & lemons with a little 

200


201.
little Rhenish wine is far more pleasant
In Phlegmatick Constitutions, and cold 
Climates a Teaspoonful of sp. C.C. among
warm drink every half hour is given
with very good success to procure a Copious
sweat, but in warm Climates
'tis too hott a medicine. The neutral salts
as sal. Ammon. Crud. Spt. Minderer. and 
saline Draughts, are exhibited successfully
to bring out a sweat in both hott &
Cold Fitt. Tis a common custom to make 
Patients drink vast quantities [cross out]
before the Fitt & in it, but nothing weakens
the stomach more than the swallowing
these deluges of fluids, it likewise
increases the Anxiety. But at same 
it is necessary they should drink very 
plentifully, or the Disease will be apt to 
run into a Continued fever or an Inflamation
be the Consequence especially in 
warm Climates, however they may 

202.


203.
take less at once and repeat it frequently
which will not hurt the stomach at all
and is easier & more agreable for the Patient.
The Spanish Physicians allow no 
drink or very little.
In Warm Climates during the hott fitt
they give cold water in little Quantities
& often to drink which proves the most 
effectual Sudorifick; but if there is any 
reason to believe the Viscera inflamed
it cannot be given. In Italy & Sicily
they drink Ice water in the hott fitt &
it proves very efficacious & highly use 
full to them. 
The other method of Sweating, with a view
to prevent the return of the Paroxysm
is this. They give them pepper and spirits
which in Phlegmatick & old people may 
have no bad effects; but in generall its
a very bad Practice, for it turns the Ague
into a continued Fever attended with 
violent Head Ach. Theriaca & serpentary

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205.
serpentary are often given with the same 
view tho not a bitt more proper, none of these
ought to be given in Infarctions of the 
Viscera. Guacacum Decoction has been 
ordered before the Accession of the fitt & during 
it, but it's too acrid to be exhibited
at all. A very great Quantity of drink
induces a habit of sweating as well as 
weakens the stomach.
Its a practice that still prevails among 
Physicians never to shift a Patient while 
he is in a sweat, but I can say from my 
own Experience it's wrong to lett them 
soak in sweaty Clothes, & they may get 
clean linnen at any time of it, provided
they be shifted with Caution. For we 
know Linnen can absorb but a certain
Quantity, therefore some of it must be 
absorbed again by the Inspiring vessels
which certainly will have no good Effect
and besides soaking in sweat relaxes the 
habit very much & increases the mobility 

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207
Mobility of the whole system, it likewise
increases cold by exhalation & impedes
instead of increasing Perspiration.
There are two kinds if sudorificks
stimulating and Antispasmodic
The stimulating sudorificks are generally
hurtfull in Fevers, & the Antispasmodick
are frequently attended with safety & 
success one of the most powerful of which 
is the warm bath Dovers Powder is one
of these. Dr. Sydenhams Practice of sweating
was too rough.
The Cold Bath has been tried & in Northern
Countries it is customary to plunge the 
Patient among snow & then immediately
to roll him up, but this is certainly a dangerous 
way of preventing the fitt.
In those Agues where there is no Cold fitt
sudorificks are found successfull & generally
are the only cure.
Dr. Boerhavve cured Vernal Quartans
with Vegetable Juices as Grass Roots, 

208.


209
Roots, what probably led him to this was 
that he observed Cattle in winter, labouring
under calealous disorders, but upon
going into fields & eating the tender Vegetables
they were purged of these & had a 
sort of Diarrhœa.
The success of alkalics and Absorbent
Earths, depends entirely on the Acid in the 
stomach, if they meet with any Quantity
of it there they are converted into neutral
salts or imbibe it.
Antispasmodicks have been tried in 
different Periods of Intermittents with 
a view either to stop or shorten the fitt
and the most powerful of these is Opium
which if given before the fitt about the time
we give a Vomite, has the effect at lest of 
making the fitt much easier if not altogether
to prevent it.
But Dr. Lind has prescribed Opiates in the 
hot fitt with the best success which I think is 

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211.
is a discovery of considerable importance
because the hot fitt is in general most dangerous,
and he says that it shortens its duration,
and abates it's violence that next it 
eases the head ach and [cross out] promotes sweating
and procures a refreshing sleep after all.
He farther says that it prevents the Jaundice
dropsy & other bad Effects of obstructed Viscera.
If there is a Delirium he advises not to give 
it till it's over, & then it's highly useful in 
removing that weakness that constantly
follows. It moreover is the best preparative
for the Exhibition of the Bark, because it promotes 
a sweat which very much disposes
to more perfect & regular Intermissions
& hence for the throwing in of the Bark.
If Costive let them take a Dose of Ra. Saen.
and the Bark & opium may be immediately
given after, for the Opium will not prevent
the operation of the Tincture and the Bark 
has a known tendency to assist it.
Dr. Stork has prescribed the Aconetum in 
Agues & I take it in under the head of Opiates.

212.


213.
We next shall speak of Diet & Regimen
proper in Intermittent fevers.
The Diet in general should be of the 
generous kind rather than the vegetable
but especially in obstinate Agues & to old People
Celsus method has been tried with very ill
success, he enjoin'd Abstinence from food
for the first 14 Days of the fever.
In general Animal food of easie Digestion
may be allowed in moderation & I never 
saw any bad Consequence from it; but 
in warm Climates, the vegetable is preferable
as it is more opposite to Putrefaction & their
fruits are excellent coolers.
When Cordials are necessary some generous 
wine with a Seville Orange is the best I know 
and the most grateful.
Under this head I may observe that change 
of air or Climate prove very effectual in 
curing the most obstinate Agues.
The Cold Bath too has been known to cure 
very obstinate Quartans & is a good prophylactick
against a Relapse. 

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215.
Under the head of sudorificks I mentioned
the warm bath & it makes the Cold fitt considerably
easier when the patient is 
put into it half an hour an hour before its attack.
Exercise makes the operation of the Bark 
surer & if so violent as to raise a sweat
will often prevent the fitt altogether
it promotes all the secretions & Excretions
Frictions have much the same Effect
with Exercise, Stork mentions two Quart
that were cured by Frictions with warm 
clothes applied to the spine.
We seldom give Blisters in Intermittents
but with a view to palliate particular
Symptoms as to remove Coma, Stupor, &
sometimes we find them cure it altogether.
All these medicines have been 
ordered with a view to palliate particular
Symptoms or to prevent a Return
of the fitt. The most powerfull of 
the latter kind is the Peruvian Bark

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217.
Bark, which has been attended with 
more success in these Fevers than Any 
Drug in any Disease I know.
It was first introduced into Practice about 
the middle of last Century, but mett with 
the strongest opposition from the faculty 
all over Europe merely from Theory wch.
is I think one of the strongest proofs that 
Hypothesis should never be depended 
on, nor blindly lead people against Experience.
We are greatly obliged to Sydenham 
for introducing it into Practice
Dr. Boerhaave who was an Admirer of 
Sydenham did not follow him here, for 
he was no friend to the Bark, & for this 
reason, because he let the fever run on 
too long before he gave it 2 or 3 weeks
& this produced Obstructions & Infarctions
in the Viscera, when ever the Bark was 
given then, it was blamed for these, but 
had he given it sooner he certainly would 
have been convinced that it was not the 

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219
the Cause of these. Before the Bark was 
introduced into Practice there was no Cure 
for Quartans and indeed it seems rather
to prevent the fitt than Cure it altogether
In every Climate the Bark may be given
with safety after the 3 or 4th Paroxysm
in generall, but in warm Climates it 
should be given immediately after the 
first fitt, because the second may carry 
off the Patient. Here again we seldom
give the Bark till the intermissions
are regular or the Ague formed, and we
have generally time to wait till that happen
without any ill Consequence.
In Cases where the Agues will remove 
other Diseases or their Effects will be Salutary
we ought not to stop them with the 
Bark, only to palliate the most violent Symptoms,
but if they are likely to come into too 
great a length or weaken the Patient too
much, then we must stop them as the 
least Evil. Its safer 

220


221.
Its safer in generall to exhibit the Bark 
before any putrid Colluvies has taken place
or been collected in the Stomach & Gutts
this prevents the Cause of such Congestion
by removing the Ague and besides the Bark 
is a good stomachic, promotes Digestion
& sweat, it's likewise antisceptick, and 
it increases the operation of Catharticks
It may be given very safely when when 
there is a Jaundice and Infarctions of the 
Viscera which it cures with the other
symptoms of Intermittents.
I shall now give some Account of the
Preparations, Doses & method of Exhibiting
this medicine, and first, of its Prepar.
We should always give the Bark in 
substance if the stomach or Age of the Patient
will allow of it but Children cannot 
take it in this form, & some weak 
Stomachs, cannot bear it, to these the 
Extract is usually given 12 Gr. of which 

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223
which is reckoned equal to one Dram
of the Powder.
There have been a number of medicines
given along with it, as Correctors, because
Physicians thought there was some noctious
Quality in it, but these are all useless 
in this Intention, however they 
may be necessary in some particular
Cases, not as Correctors because it has 
no noctious Quality, but as assistants.
That the Bark in substance is most 
efficacious appears hence, that the Residuum
after Decoctions, which has been
kept & given to poor patients has proved
more effectual than the Decoction.
When given in the form of a Bolus or Electuary
made with syrup it always requires
a larger Dose, than when you give the powder
in a liquid vehicle, the reason of this can 
hardly be given, unless that it is longer
in dissolving in the stomach. But its a 

224


225.
a certain fact that ʒVI. of the powder
has more effect than ℥I. of Electuary.
The first form the Bark was given
in in Europe was ℥I. of the powder infused 
in an English pint of red Wine 
for discovering which Sir John Talbot
got a premium from the French King
and indeed it's a very good way of Exhibiting
it, In damp seasons it should always 
be given with wine or spirits if in form 
of a Julep one fourth of it ought always 
to be spirits, & if made into an Electuary
it should be with Brandy rather than 
syrup, indeed syrup should never be used 
but mucilage, Extract of Liquorit &
covers its taste very well. It should not 
be given in too fine a powder a midling 
small powder is preferable, because it's 
chief Virtue lies in it's resinous part &
hence too the Extract ought to be made with 
Spirits. There is nothing I know covers the 

226

227.
the Taste of the Bark so well as Sourer
Milk. As Children cannot take this in 
substance by the mouth, some other way 
behoved to be fallen upon and in larger
Quantities we find it proves a Cure if 
thrown up by way of Glyster, they may 
get of the Extract ℥ss. dissolved in ℥iv. of 
water with some Olive Oil & some drops 
of Laudanum, for a Glyter But ℥ij this 
way won't have so much effect as ℥ss. taken 
by the mouth. They likewise soon weary
of this way. And some as Dr. Pye in the Lod
Med Essays have advised applying it to 
the skin in Holland cloth, and gives some 
Instances of its success this way.
Dr. Lind again and others advise fomenttations
of it or baths, he says he has cured
severals by bathing them in a Decoction of 
it which seems probable enough
When this medicine appeared, the Period
they gave it in was at the beginning of 

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229
of the Cold fitt, but this was soon discovered
to be wrong, for it produced a great uneasiness 
about the stomach, & therefore gave
place to another method vizt. immediately
after the sweat they begun to give it, and 
so continued at short Intervalls; but it 
is now universally allowed that the giving 
it 4, 5, or 6 hours before the Paroxysm
is attended with the best success & certainly
easiest for the Patient; we should never 
give it in greater Quantities, than the 
Stomach can easily bear.
In Generall the Quantity necessary to 
prevent a return of the Paroxysm of a 
Quotidian is from ℥ss. to ℥I. & sometimes
more is required, but a Tertian will require
from 1 to 2 or even three ounces.
In general 2 Drahms are sufficient for 
a Dose but it may be given in as great 
a Quantity as the stomach will bear 
even to 1 ounce at a time.
In such Vernall Intermittents as require

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231.
require Blooding we should join with 
the Bark Sal Ammon. Crud. or 
And in moist Damp weather it should
have some Aromaticks join'd with it.
Physicians made it a rule never to 
give the Bark till such time as there
appeared a Lateritious Sediment in
the Urine, but there are some Cases where
this never does appear, & in generall it 
will be proper to exhibit the Bark before 
this is observed in the Urine, lest there 
should be infarctions in the Viscera &c.
There is no general Rule that I know of 
when to give it, unless it be when the 
Ague is formed or has regular Intermission
but it is necessary to continue its Use
after the Paroxysm has been prevented lest
the Patient relapse, in Quotidians we 
should continue to give it less frequently
5 or 6 Days, & in some Obstinate Agues
two or 3 Weeks. In cases where the stopping 
of the Paroxysm would be dangerous,

232.

233.
dangerous, but a Palliation of the symptoms
is necessary we must give it in such 
Quantities and at such distances of 
time as will not prevent the Fitt altogether
but abate it's Violence considerably.
In warm Climates where Intermittents 
are apt after the first Paroxysm
to run into continued & Putrid fevers
in the first intermission we should throw 
it in, in large Quantities as soon as we 
possibly can; In these Places we find 
the Bark invigorates the Constitution
promotes sweating & Diarrhœas that are 
critical but stops colliguative evacuations
of either kind. Does not at all stop 
natural Evacuations of any kind as menses 
it renders the Urine pale without Sediment,
having a Cloud in it. 
At its first Exhibition it proves purgative,
but this is easily prevented by joining
with it 10 or 12 Drops of Laudanum

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235.
Laudanum; but sometimes we find it 
necessary to join it with Juice of Lemons
and Laudanum which should be given
during the Effervescence; we never give 
it in this form, but when it produces
a Vomiting which in some Constitutions
it does.
In warm Climates even when the 
P.V. are foul & loaded with a putrid Colluvies,
which has already produced an 
Inflammation of the Gutts, we should
here throw in the Bark as the only Remedy
because these Congestions depend wholly
on the fever & when it ceases they will 
of Course be prevented, unless we do this 
a Cholera Morbus will follow which a 
hundred to one will prove fatal.
If the Patient is of a Costive habit &
the Tone of the Intestines weak we should 
join Rhubarb to the Bark, and where 
there is a tendency to Inflammatory Diathesis, 
sal, merab Glaub. or Epsom Salts.

236 

237.
salts. And In generall I can see no 
danger attending it's Exhibition in 
all Agues, unless those where there was 
a preceeding Disease & nature has employed
the Ague as an Effort to get gutt
of this prior Disease, and here it's Effects
are generally bad & sometimes fatal for 
it causes heat, Dryness of skin, Difficulty
Breathing, swelling of Abdominal 
Viscera, Diarrhœa, loss of appetite, Epilepsy
Anxiety & Pains resembling Rheumatic 
Pains. It appears that these Effects
are justly ascribed to it, because when 
you leave it off, they disappear and the 
Ague returns again.
But there are many Cases in which Physicians 
were apprehensive, of the Barks
producing bad Effects & Boerhaave was 
one of these. Some have denied it's specifick
Quality & say that it always occasioned
a sensible Evacuation, that the Bark
does not hurt the Constitution, maybe 

238
238


239.
may be evidently proved by this that 
in a few months time a person was known 
to swallow the Quantity of 40 lib. & his Constitution
was not a bitt impaired.
It his been a general Practice among Physicians
never to give the Bark in Intermittents
attended with Infarctions of 
the Lungs and a Cough, but from my 
own Experience, I can say there needs
be no apprehension of it's having bad Effects
here; for in some Intermittents a Cough
seems to be one of the symptoms & along 
with the others it removes this too.
I shall now endeavour to give some 
reasons for the failure of the Bark in Fevers
And 1. It happens frequently that the Bark 
is bad itself or adulterated.
2. It has not been continued long enough 
to prevent a Relapse.
3. It has not been given in sufficient
Quantity at a time
4. It has been exhibited in an improper 

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241.
improper form, or preparation.
There have been other medicines given wt
an Intention to stop the return of the Paroxysm
with success, even before the Bark
was discovered, called Bitters, & these
chiefly were prescribed, vizt. Centaury
[??ian], Absynth. Chamomel. but when
we compare the Effects of these with the 
Effects of the Bark, they are not a bitt 
more certain, nay their Effect are not near 
so sure, & an objection lies again them
that they cause heat which in some 
cases as we have observed before does 
much harm.
But after all we must allow that the 
Bark has failed tho' all Caution has 
been used, and that some Quartans have
been cured by Chamomile Flowers where 
it has had a fair trial.
There was a celebrated remedy prescribed
by Dr. Morton before the Discovery of the Bark 
of Chamom. Flowers, sal. Absynth. & Ant. Diaphoreticum,

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243
Diaphoreticum, which was attended with greater
success than the Bitters alone
When we order Bitters with an Intention
to stop the Ague, they must be given in large
doses, & unless joined with opium they 
will in such Quantities prove Purgative,
and have a greater tendency this way 
than the Bark.
There is another Class of medicines
that have been successfully exhibited with 
an Intention to prevent the Return of 
the Fitt, vizt. Astringent Medicines and 
the most approved of these is Alum alone 
which in England was much used with 
very good Success. Vitriol has been used 
with success in this Intention, but it's 
not equal with Alum in efficacy.
Some have taken Cobwebs, in Pills, or Bolus
& it has been known to cure it often.
Mercury has been prescribed by some 
with very good success, but unless these are 

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245
are Obstructions in the viscera it will scarce
be proper. Indeed we have severall Instances
where Rhubarb and Calomel have cured
very obstinate Quartans. And Patients
labouring under the Lues Venerca being 
taken with an Ague, have been cured by 
a salivation, & in those Patients, it's remarkably
easily raised.- Many have used 
Arsenick with great success they say, but 
Stork affirms that it makes Patients turn 
consumptive & that of four whom he tried
with it three died of a Consumption of the 
Lungs. But certainly it ought not to be 
given in these as there are remedies of whose 
Effects we can be certain there is no danger
But it's being reckoned a Poison is not at 
all a reason why it should be excluded fm 
the number of Medicines; Many things 
that were formerly reckon'd poisonous are 
now accounted the most efficacious Remedies.
Externall Applications have been 

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247.
Preventors of the Paroxysm, among which 
is the cold Bath formerly taken notice of, and 
stimulating Medicines applied externally
as Blisters, Ranunculus pratensis; Bruis'd
Galrick, or steeped Tobacco applied to the Pitt
of the stomach, are the chief of those that have 
proved most effectual. And Ol. succin.
rubbed into the spine is one of those that 
seldomest failed.
The last of such things as prevent the 
Paroxysms are strong affections of the 
mind as violent Passion, Fear, Anger
wch. have frequently cured Agues altogether;
And the force of Imagination, to which 
only we can ascribe the Virtues of Charms 
Amulets &c. ([cross out] and there are many Instances of 
their Efficacy in these Fevers well attested)
has been often a Cure without any other medicine
being used. I would ascribe the virtues
of Spiders, Snuffs of Candles, Urine &c. to
this, & their Efficacy is well attested likewise 

248

249.
likewise by many Authors of undoubted Veracity
and Honour -
I shall now give a General Cure for 
some of the Particular Symptoms -
The Vomiting is removed, after 
cleansing the stomach with Chamomile
Tea; by the saline draughts taken during 
the Effervescence, with Laudanum if 
these fail. 
The headach is commonly carried off 
by the sweat that succeeds the hott fitt
but if this is not the Case, we ought to 
oder the Limbs to be bathed in warm 
water; & apply Cataplasms to the Feet
of some acrid substances, but if these dont 
remove it apply a Blister to the Back
Dr. Lind's method of giving Opium in the 
warm fitt will be the best prevention & it's 
certainly a great and usefull Discovery 
A Coma renders blooding necessary and 
if the Patients case will not admitt of opening 

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251.
opening a vein in the Arm, we ought to apply 
cupping Glasses, and Blisters here are excellent
Remedies and should be laid on as soon 
as possible.
Antispasmodicks as Musk, Castor, Opium,
remove a Hiccup, & if it's violent Cupping on
pitt of stomach, should be tried. 
Sometimes these Fevers are carried off by a 
Criticall Deposition of matter, in any place
which forms an Abscess, this Abscess ought 
to be promoted by all means, and they often
happen in the thigh, where the matter by 
insinuating itself among the muscles
will sometimes get into Cavity of the 
Abdomen; to prevent this dry Cupping
& Emollient Cataplasms should be applied
and the Tumor opened as soon as possible
If there is a Jaundice accompanying the Ague
& it has perfect intermissions the Bark with 
Rhubarb or Aloes will not fail to cure it.
A Diarrhœa is removed with a gentle Vomite
if the Stomach is disordered; with Rhubarb &

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253.
& with Opium, before the the Bark be given
these should be premised & the Diarrhœa
stopt by them. The Vomites given in these 
fevers should be wrought of with Carduus
Benedictus Infusion rather than warm water,
which as was before observed is one 
of the most relaxing things in nature, &
consequently very improper here.
In Flatulent Cases Aromaticks should
be joind to the Bark, cordials & Rhubarb,
may be used to advantage, & if the Patient
is sick a Vomite may be taken.
The best things for preventing a Relapse
are the Continuation of the Use of the Bark,
Change of Air, Exercise, especially riding
Minerall waters with steel, Elexn. Vitriol. &c.
When Agues are Endemic in any Country,
there are some Circumstances which if observed;
may do a great dale, in preventing the Attacks
of Agues and 
1. In all Aguish Seasons we ought to avoid 

254.


255.
avoid exposing ourselves suddenly to heat 
from Cold or from Cold to heat. because this 
is an exciting Cause of Fever, we should
likewise avoid easterly winds, marshy
damps & damp low rooms, damp Linnen
and Beds.
2 If in our power to go in such seasons
to large towns, because it has been 
observed that (ceteres paribus) these Fevers
are more frequent & more fatal too, in the 
Country than Town, whether this be owing 
to the great Fires or to what it's owing I 
cannot say, but it's a fact. And we should
always choose a dry, & Elevated situation
and to sleep in high Rooms, the windows
of which should never look to marshy
damp soils & we should burn large Fires
of resinous wood especially as Firr Pine &c.
Nothing is more apt to have bad consequence
on our health than marshy grounds as 
we may see examplified in Camps near 

256.


257.
near marshy places.
3. It would be proper not to go out in the 
morning fasting, or with an empty stomach
especially for such as are employed in ditching
marshy ground; they should before they 
go to their work take a Dram of spts. in 
which Garlick & Peruvian Bark have 
been infused, diluted with double the Quantity
of warm water.
In this seasons smoaking Tobacco is 
certainly of considerable use as a preventative,
but this is no reason for its being 
universally used by every body & that 
indiscriminately with regard to the seasons
In thin habits 'tis hurtful because they 
cannot bear such a Discharge of saliva 
4. As a preservative against Agues, a 
Generous Diet, and drinking a little
more wine than ordinary is certainly 
very good; the frequent Use of the Cold Bath 
& good Exercise, with the use of the flesh Brush,

258

259.
Brush are very proper as preservatives
& it is likewise necessary to keep the 
feet, Back & stomach pretty warm.
5. When a Stranger goes to a Country
where these are Endemic he should always 
keep an open Belly by some of the stomachic
Laxatives as Elix. sacrum [Kot.?]
Rhoi &c-.
6. A Glass of the Tincture of the Bark
twice or thrice a day diluted is a very
good Preservative both against Epidemical 
Intermittents & Remittents 
& in general is a good Preservative
against Epidemical Fevers in general.
I shall now give you a list of the Authors
who have wrote best on these Fevers.
For the Description of these (& indeed of 
every other Disease) Sydenham is the most 
accurate, and true Van Sweiten gives the 
Proximate Cause, but neither Sydenhams
nor his Practice are fitt for your Imitation 

260


261.
You may likewise consult senac defibribus
Intermittentibus, which is the best
traetise I know on the subject; Huxam
Clighorn, Monro on Camp Diseases, Torti
and Dr. Lind are all worthy to be consulted
on these Fevers.
Class 1st. Order IId. Genus Ist.
Inflammatory Fever.
I divide this into three
1 Common Continued Fever with general
Inflammation.
2. contains putrid malignant fever
which comprehend Jail & Hopsital Fevers.
3 Is the slow Nervous Fever.
The Common continued Inflammatory
Fever which was the fibres Continens or
Synochus of the Antients, is distinguished
from the fibres Continuus, by having no 
sensible Remssions, where as the fibres 
Continuus had some small Remssions
But I am of opinion that there is no Fever

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263
Fever. whatever, but has some small Remissions
& Exacerbations.
The Ephemera is a fever of this kind & from 
its name we should think it lasted only 
one Day, but it generally continues about 
3 or 4. It's very mild & mostly proceeds
from Error in Diet. The Ephemera Britannica,
which raged about 150 Years
ago is described by Dr. Cauis, & was commonly
called the Sweating Sickness.
Sauvage has distinguished these fevers from 
their Duration, which is very wrong & uncertain
There is no Physician but would know these 
from one another by their symptoms at the 
first, but it's impossible to know how long 
they will last.
My Definition of this Fever includes my 
general Definition of Class 1. and is as follows 
A Quick, full hard pulse, great thirst, little
Remissions & the Blood has generally a 
Buffy Coat.
In its symptoms it resembles the hott 

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265
hott fitt of an Ague, it commonly I believe
always begins with more or less of a Rigor,
at the beginning there is a Pain of head &
Back, a Lassitude and feeling as if bruised;
there succeeds this a red, face, full Quick pulse,
a little hardness may generally be observed
in it, Thirst, Neausea, Vertigo, high Color'd
Urine, without any Sediment, a Quickness
of breathing, & want of sleep & tho' they 
do rest its not at all refreshing, they loss
their appetite, have a general Debility, & 
an Anxiety about the Præcordia, a Castive
Belly, Parched tongue at first white &
soft then white & dry and at last brown
and dry. The Blood in generall has a Buffy
Coat. The Symptoms are generally severe
from the beginning, but the night before 
the Crises happens, they are remarkably
worse, & more violent. In this and all other 
Fevers there is a great melting down of the 
fatt about this time, & a want of sleep wch.

266

267.
which commonly continues 10 or 12 Days
after the Crisis is over.
When the fever is attended with Topical
Inflammation, blooding & a Blister
applied to the place perhaps may remove
it but the fever after 2 or 3 Days continuance
as a generall Inflammation, causes a
topical one, commonly of the Brain.
Such Continued fevers as proceed from Errors
of Diet, are generally soon over, & in Children
after the P.V. have been well cleansed, they 
go off of themselves, & have no regular Period.
The heat in these Fevers depends much on 
the natural Constitution for tho' the natl.
Heat in one patient be always pretty much 
the same, yet in different Patients it vares
very much. The same is true of the Pulse
in health 70 beats in a minute is reckoned
a mean yet in some I have seen it only 
at 50 & others do. People that have great 
mobility of the nervous system, upon litte 
occasion will have it greatly increased, 

268.


269.
increased, some Hystericall Women
in slight Ailments of the kind will have 
it at the rate of 150 in a minute. It is with 
this Fever that Hippocrates observations
agree principally.
This Fever has been carried off by Criticall
Evacuations, as Hemmorrhagie from 
the nose, but the most common are sweat
and Diarrhœa. A Spontaneous Vomiting
& a large flow of Urine with a plentifull Sediment,
have been commonly reckoned
Criticall, but I am of opinion they are rather 
to be reckoned symptoms of Convallescence 
than Critical Evacuations. 
These fevers when they run on for a 
long time, commonly end in nervous & 
in warm Climates in putrid Fevers; but 
I have seen them continue three weeks without
any appearance of changing; & sometimes
when no Crisis has appeared they 
are at last terminated by the breaking out 
of Abscesses. A Jaundice appearing 

270


271.
appearing about the Seventh Day, has carried
off this Fever and Dr. Stork gives instances
where a Copious Expectoration happening
on this Day, even where there was 
no previous Affection of the Breast, has 
cured this Fever. 
It sometimes wears off, by no sensible
Evacuation, of its self very gradually & this 
is called Resolution. An uncommon
sleeping attended with evident remission
& abatement of the symptoms, has carried
it off, after it has continued a long time
It has been observed that these Fevers
have terminated on one Day rather than 
on another, and most commoly in a favourable
manner, hence these Days have been 
named Critical, & this is certainly a fact 
tho disputed by many, and alledged that 
Hippocrates had a favour for septenary numbers.
The more remarkable of these Critical Days 
are the 7th. 9th. 11th. 14th. 17th. 20. & 21st., but in warm
Countries & when the fever runs high the 

272.


273.
the 4th. Day is often criticall.
There appears to be in Nature a real foundation
for these, & I am of opinion they 
are as well founded as any truths in 
Medicine, tho' when we exhibit Antimonl.
Medicines & such like we disturb the regular
Progress of the Periods of the Fever 
& therefore they cannot be observed; but 
when the Disease is left to nature and 
allowed to take it's own Course, they may 
be observed in general to hold, tho' with 
a great many Exceptions; however in 
these Climates they are not near so regular 
as where Hippocrates practised, Cleghorn
who was much in the same Latitude observes
an Exact Conformity with Hippocrates in 
these Critical Days. But I shall afterwards
explain the reason why they don't hold here 
Dr. Marlin in his Traetise on Crisis by 
an Induction from Facts proves this foundation
for these Days.

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275
The general Antecedent or Prædisponent
Causes to these fevers are, Youth, Sanguine 
Temperament, a state of high 
Health, full habit, a sett of Tense Fibres
resh dense Blood, the spring season
a Cold & Temperate Climate. They do 
happen in all seasons & periods of the Year
but in the Spring & Autumn are more comon 
in the Autumn Fevers of the Putrid kind
are more general.
The occasional Exciting Cause of these
Fevers is any sudden exposure of the Body
to cold, when it was warm, a suppression
of usual Evacuations especially of the Sanguine
kind; the Repulsion of the milk in lying in 
women, any violent Exercise, being over 
heated, hard drinking, a want of Exercise
when at the same time we live very full 
a want of sleep, and a particular Epidemic
Season, which may be without any sensible
or apparent change in the Air. Whatever
will occasion great irritation, as Fractures, 

276


277.
Fractures, and wounds when they suppurate 
are always attended with a Fever
In women before the coming on of the menses
there is commonly a fever for a few hours
& in some it will continue a Day or two.
As intermittents were observed to be often
very beneficial to the Constitution & employed
by nature for removing a worse malady, so 
likewise these are sometimes known to 
remove other very grievous Diseases.
An Apoplexy has often been carried off by 
a fever supervening & many other nervous
Disorders, as Convulsions, Paralysis,
and many other Diseases as Gout, Pains
of Precordia when not attended wt Inflammation.
Obstructions in Abdomenall Viscera
have all been removed & radically cured by 
a fever coming on. And in General 
a Fever of this kind when terminated by a 
favourable Crisis, removes Eruptions of 
the skin, Disorders of the stomach, and leaves
the Patient, more vigorous, & spirited, with, 

278

279.
with, better Appetite. As therefore this Fever
is often & more than any other almost, of so 
great benefiet to the Constitution, Physicians 
should give particular Attention
to the Cause of it, whether an Effort of nature;
or the Consequence of an External Cause
in the first Case to assist & cooperate with 
nature & not stop her, & in the last to 
stop the progress of the Fever as soon as 
he possibly can
The Prognosis. In this Fever it's a favourable 
symptom when Apthæ appear for 
in generall they are the Consequence of a 
Critical Deposition in the mouth & commonly
run all along the Intestinal Canal
Instances of which I have seen; that they are 
criticall appears by the fever wearing off 
as they advance, but sometimes after the 
Fever has been entirely gone the Patients
mouth & throat have been so swelled that they 
could swallow nothing & have actually
died of hunger.

280.


281.
In such cases I have experienced the good 
effects of a Vomite in my own practice,
it brought up a vast Quantity of Defluxion
and Apthous Crust, & if it purged the patient
be passed, a number of Pieces of the same 
kind which shows that the Intestines
have been in the same condition with 
the mouth & throat.
It's generally reckoned a favourable
symptom when the tongue remains
moist & soft; but for all the stress Physicians
lay on this symptom it often rather indicates 
the state of the stomach, than 
Fever.
A Pain in the Occiput & Crown of the 
head are worse than a pain in the forehead
in the forehead it's generally in all Fevers 
& very frequently indicates a foul stomach
There's little unfavourable from a Dilirim
if the Patient is young, has lived high for 
such in this Fever always have a kind fit 

282

283
But if the Eyes at the same time are inflam'd
it may be reckoned Dangerous. When the 
Urine is [pale] with a cloud in it, it is reckoned
a favourable Symptom & indicates
the fever near an End.
In Diseases there are some Symptoms
which have been observed to precede Criticall
Evacuations, & by being attended
to we may be able to presage these.
Before a hemorrhagie from the nose the 
following are taken notice of vizt an Itching
and redness about the nose, severe head ach 
redness of the face, Inflation of the Belly, the 
Quantity of Urine less, Tinnitus Aurium
Obtuse pain of the neck, and Involuntary
Fears; if these are altogether present at 
the same time we may be certain of it but
when one only or a few there is no certainty
a dropping from it on the 4th. day is said 
to presage an Hemorhagie on the 7th.
It's alledged that by observations on the 
Pulse we may arrive at great perfection

284


285.
perfection in presaging these Evacuations
Dr. Solano by Dr. Nehill gives observations
on this & in France it is cultivated much
but whether the Course of Fevers [cross out] is 
more irregular here or what is the Cause 
neither I nor any here as far as I know, have 
been able in many Cases to perceive any 
such thing; And Dr. Nehills once he came 
to Ireland has not been able to discover
these Varieties of the Pulse which he found
in Spain, but I am apt to believe his
Imagination has often assisted him
before, tho' at same time I really believe
there is a foundation for this.
A Hemorrhagic is presaged by a rebounding
pulse or when there is a doubling of the 
Strokes after every second Beat.
During the Continuance & [after] before the 
Eruption of a Criticall Sweat there is a 
particular fulness & softness of the Pulse
& besides the pulsus resiliens there is another 

286

287
another called pulsus residuus where the 
strokes rise above one another in point 
of strength as the first shall be weak 2d.
a little stronger & 3 still stronger the next 
again weak.
A Soft intermitting pulse generally precedes
a Discharge of Urine & a Diarrhœa and 
as If such pulse is hard & intermitting
it presages a Critical vomiting.
I shall now give the unfavourable
Symptoms that appear in continued Infy.
Fevers which as they are common almost
in all the other kinds I shall to prevent Repetitions,
give those that attend Fevers in 
general.
It is always reckoned an unfavourable
symptom, when the Thirst goes off and 
the tongue remains dry. Inflammatory
fevers are always attended wt. more or less
Thirst, & when this is not the Case it's a 
symptom of the very worst kind & will
always prove fatal, & this very soon,

288

289.
soon, commonly in 30 hours. 
It's unfavourable when the Urine from 
the high Colour it had suddenly turns
white & clear & perfectly limpid & is 
for common a forerunner of very violent
symptoms as Delirium, Coma, Convulsions.
But in Hysterical women & men who
have great irritability of nervous system,
no such conclusions should be made 
from this Appearance.
Sometimes we observe a very great change
in the patients Voice, not a hoarsness, but 
a loss of it's usual Tone, called Vox elangosa
so that people would not think it the same 
person did they not see him, this too is 
an unfavourable symptom.
Dilirium is surely unfavourable, but 
if it's not a constant one attended wt
difficulty of Breathing, or redness of the 
Eyes it's not so very dangerous, but 
there are various Degrees of it, as to it's
Violence, and they commonly speak 

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291
speak thro' their sleep but when wakened
are sensible enough, this is the mildest
[?ind] of it 
[illegible]. If you do not speak to them they speak
[illegible] incoherent, & if you speak to ask them 
any questions they answer very sensibly
there are many more degrees of it, but 
I shall only mention the last or higest
which is when the patient knows no 
body neither has a Connection in his Ideas
& is utterly insensible of every thing 
you say, but when there is any Connection
of Ideas the Case not so ill.
But a still more unfavourable symptom
than Delirium is Coma, I mean that 
which proceeds from a great degree of 
Oppression on the Sensorium, & not that 
mentioned as a termination of Fevers
after they had continued long, vizt. a Sleeping 
which continued 2 or three Days
but wt remission of the symptoms -
Convusions, general, Convulsions I mean 

292.

293
mean of the whole Body are fatall, In this 
Country few of these happen unless at the
[??proach] of Death. Indeed some particular
patients who have great Irritability of 
Nervous System, sometimes have these
but they are not to be reckoned so unfavourable
Subsultus Tendenum is partial convulsions
but [are] not always fatal
Coldness of the Extremities are among the 
last symptoms that attend Fevers and are 
generally fatal symptoms, this proceeds 
from two Causes 1 from a Spasmodick 
Contraction, or is a nervous complaint wch.
is not so dangerous as the 2d. Species wch.
proceeds from absolute Debility of the Vessels
to propell the Blood to those parts & this 
last is always a fatal Symptom.
Partial sweatings about the head & breast
are unfavourable, and Grasping of the Bed
Clothes, picking up straws, & lying on the back 
with the legs Stretched out at full length are 

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bad Symptoms, here we may observe that 
the Patients who are very weak always 
ly on their Backs with their limbs stretch'd
out, because the blood circulates easiest
in this posture.
A Dyspnœa is a bad Symptom in every
Fever and in Inflammatory fevers if it 
continues long indicates that the Lungs
are inflammed. Before the Patient dies
a few hours, & sometimes but a few Minutes
there is always a Dyspnœa and a collection
of [cross out] Phlegm upon the Lungs
Hiccup is in general an unfavourable
Symptom but I have seen a hiccup continue 
for 3 days in the beginning of a 
Fever without proving fatal.
Involuntary passing of Urine & Fœces
are generally very bad Symptoms but 
not absolutely fatal
Red Eyes, with an Inflamed squalid Appearance
and Sordes at the Corners, commonly
attend Delirium of a bad kind and indicates 
an Inflammation of Brain An 

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An Eruption called Purpura alba. truely
miliary is an unfavourable Symptom 
& generally the Consequence of too hott
Regimen, as I have seen for upon taking 
off some of the bed Cloths & opening the Curtains
the Patient has been greatly relieved
if Physicians consider this as an Effort  
of Nature or a Critical Eruption they will
be ready to heap on Cloths, which is in 
effect killing the Patient.
A Diarrhœa where the stools are very fœtid &
blackish, is a very unfavourable Symptom
& is called symptomatick to distinguish it 
from the Diarrhœa formerly mentioned as 
Criticall or an Effort of nature.
Petechiæ are bad symptoms & in warm Climates
continued Inflammatory Fevers if 
they last very long frequently degenerate
into putrid Fevers, attended with Petechiæ
Bloody stools and Urine, and blood issuing 
from the Gums & all the appearances of the 
bloods being greatly dissolved. But then 
these sometimes appear where there is no 

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no appearance of Putrefaction & here 
they are always the Effect of too hott a Regimen,
Sauvage is certainly wrong when 
he says they are without exception the Effect
of a hott Regimen, for in the Jail & Hospital
Fever they are evidently not owing to this. 
A weak quick irregular Pulse is a 
certain indication of approaching Death
but in some cases we find the heat greater
than the pulse would indicate to us; to judge
of the heat by the thermometer, it must be 
applied with in the Bed Clothes, & kept at the 
Body for about a Quarter of an hour or less.
Its an unfavourable appearance when 
the Patient lies quiet in bed with his Eyes
open, without sleeping, or speaking any 
thing, & when you attempt to feel his Arm
retracts it, with a trembling in his hands 
After a fever has remitted and gone a little 
off if the pulse become quick
The face flushed & the Tunica Albugenia of the 
Eye of a Shining Colour 

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there is a hectick fever come on. 
Apthæ were formerly mentioned as Criticall
in this fever, but sometimes they are only 
symptomatick, and if the Tongue becomes
suddenly clean, with a great heat of the Gum
we may expect them.
In all fevers there is a greater than ordinary
sensibility of the Eyes, but if this 
is either too great or too little tis a bad Symptom.
If the insensibility is so great 
that the Pupil when exposed to strong light
does not contract, tis a fatal symptom.
Deafness is of various imports in Fevers
if there is inflammation of the Eyes & great 
pain & disorder in the head it's a bad Symptom,
but in general when it comes on 
alone & about the End of the Fever is one
of the most universally good Symptoms I know 
A Delirium coming on suddenly is always
dangerous, but when it's progress is graduall
there is not so much danger. In Children
A Delirium soon follows the attack of the fever
which generally proceeds in them from foul

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foul stomach, but is commonly removed
by a Vomite & Laxative to cleanse the P.V.
When the Breathing becomes slow, with a 
kind of stop after every Expiration and 
of at the same time the pulse is slow soft &
full it's a very bad Case & generally precedes
a Coma, but is very apt to impose upon
a Physician & make him imagin the fever
quite gone
It's a very unfavourable Symptom when 
on the lest motion the Patient faints, and 
is a constant attendant on putrid fevers, but 
in Inflammatory fevers is a sign they 
are degenerating into a putrid Fever.
Small bleedings at nose are unfavourable
when there is no abatement of the symptoms
If after a Patient begins to recover his 
Urine lets fall no sedement it's a sign
he will relapse, tho' sometimes indeed this 
will not happen, yet I never think my Patient
out of danger of a relapse till such time as 
this sediment appear in the Urine.

304.


305
Urine. I shall now proceed to the proximate
cause of Inflammatory Fevers, but [illegible] little
to add to what I gave of Fever in general
and no person so far as I know has given a 
proximate Cause of every Different fever or 
a more satisfactory Account of it.
All I shall add here is that many symptoms
proceed from morbid affections of Brain when 
little thought of and no appearance of its being 
greatly affected, as has been made evident
by morbid Dissections, where the Brain
has been found inflamed, & suppurated
& the Ventricles distended wt fluids thus 
Neausea & vomiting may proceed from 
many different causes 1 they may proceed
from foul stomach, at other times from Nervous
affections of the stomach, and at other 
times from a morbid Topical affection of the Brain
for we see people who have gott violent strokes
on the head very often fall a vomiting & here
we could not suppose it was the foulness
of the stomach that occasioned it.
I formerly took notice of the Theorys of Putrefaction,

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307
Putrefaction Morbid Matter, &c.
The febrile heat depends on the same Cause
as the natural, only acting in a greater
degree, not on mechanical Attrition certainly
for we find that when the Pulse is 
weakest & consequently the Attrition less 
the heat is greatest as at the End of some 
Fevers, it should seem rather to depend
on Chemical Mixture.
An addition to the proximate Cause of 
Fever already given is the Appearance of 
the Blood in Inflammatory Fevers.
Dr. Pringle has given us severall observations
with respect to the Buffy coat that 
appears on it & some of its Qualities as that
it's volatile &c. but does not mention whether 
taken from a person in a fever or not 
There has been great stress laid on this Buffy
Coat of the Blood, tho' little certain can be had 
from it because it is sometimes wanting 
entirely in these fevers & sometimes persons 
in health have it & women with Child always. 

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309.
always. It likewise depends sometimes
on the Bloods flowing in a full stream
from the vain out of a large Orrifice, and we 
find the 1st & 2d Cup has it when there will 
none appear on the lost, this is owing to 
the Bloods flowing in a large stream
at first, & then trickling down the Arm
De Haine mentions many Circumstances
relative to this Coat which I have never
been able to observe, he says that at the 
same bleeding the Buffy Coat shall be most 
in the 1 & 3 Cups & list in the 2 & 4th. and 
that at same bleeding he has seen the blood
with the Buffy Coat in the one Cup & in the 
next dissolved alternately, this I cannot
believe but then he has Imagination has 
imposed on him. There are three particular
Circumstances that varie the 
Appearance of the Blood 1. Heat, 2 Exhalation
& lastly motion.
In a heat equal to 94° on Farenheits Thermometer 
there was no separation into Crassamentum

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311.
Crassamentum & serum and at the freezing
point the same happened.
The Exhalation is in proportion to the heat 
hence it's greater in different seasons and 
in large vessels than in small, and in 
blooding the Exhalation is greater if it trickled
down the Arm than if it flows in 
a full stream A Ligature on the Arm when 
strait prevents its separation Vidi. Dr.
Sanc. his Observations on this.
The Blood living suddenly exposed to 
cold in shallow Vessels or deep ones with 
small mouth is very at to deceive us with 
it's appearance, before we are aware of this 
here it does not separate in to Crassamentum
& serum.
Other Circumstances relative to the Buffy
Coat of the Blood should be attended to as 
that it appears in people in the highest
health especially those who are used to 
blood in the Spring & in winter it's commonly
to be found & if there has been a strait Ligature,
Women with Child always have it & we 
likewise find it in slow Rheumatick Complaints

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313
Complaints without fever, from this 
as was before observed we may see there
is no great stress to be laid on it as 
some pretend, yet cæteris paribus it 
is generally an Attendant on Inflammatory 
Fevers.
Lect Nov. 25 1768 
I come now to treat of the Cure of the 
Continued Inflammatory Fever, which 
as in the Cure of Intermittents, cannot be 
had or indicated by the knowledge of the 
full & immediate Proximate Cause of Fever
hence the necessity of allowing particular
Symptoms as Prox. Cause; but as in Intermittents
so here likewise Nature makes 
Fever an instrument for the Removal of 
other Diseases & to invigorate the Constitution,
we should therefore in the Cure be 
assiduous in observing whether the fever
is an Effort of this kind or one arising from 
any other Cause. There are some Epidemical
fevers of this Genus in which the symptoms
are not very violent, and commonly carried 

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315.
carried off by Nature in a week or so with 
no assistance from Medicine, & Physicians
should not medle with such only palliate
the most violent Symptoms - Sometimes
a Fever will arise from taking in too much
food at once, but is soon carried off by Evacuations.
I have reduced the generall
Indications under the following heads
1. We always should in Continued Inflammatory
Fevers endeavour to take off Plethora
if there is one, by Evacuations of Blood
by Vomite & Catharticks -
2 To moderate the Febrile heat, by a Cool
Regimen, as admitting fresh Air, by Evacuations
as blooding.
3. In fevers there is an unequal Determination
of the Blood & Nervous power to different 
parts of the Body, hence we should take 
off Spasm, & promote Secretion by Blooding
& other Evacuations by neutral salts & warm Bath
4. Where there are local Congestions in any 
particular place we are to remove these 
by topical Evacuations & Applications, to the 

316.

317.
the first belongs Blooding & Blistering and 
to the other Fomentations
5. We ought to support the Vis Vital by Cordials
& Blisters. 
6. To endeavour to mitigate the violence
of the Symptoms as want of sleep, Delirium
and such like.
You will in general find in Authors the Indications
of Cure deduced from the supposed knowledge
of the proximate Cause of Fever. And 
Lentor & Acrimony are chief that have 
been assigned. The medicines adapted to the 
former Theory were generally of no bad Consequence 
in Fevers & some were very proper
but the medicines adapted to removing
Acrimony were evidently pernicious & of 
the very worst Consequences, for by supposing 
an Acid Acrimony the Cause of Fever they were 
induced to give great Quantities of Testacious
Powders & Volatile Alkaline Salts.
Now I proceed to give my particular Observations 
on the Remedies adapted to the above 
Indications of Cure, and first of Blooding

318

319.
There are two Circumstances that render
Blooding particularly necessary in these
Fevers 1 Appearance of fulness 2 The severity
of the Febrile Symptoms.
The Effects of Blooding are that it makes the 
Pulse softer and slower, when before it was 
full tense & hard. But it often happens in 
Inflammatory fevers that the Pulse is oppressed
and small, this is very apt to impose on a young 
Physician and make him affraid of Blooding
but no case requires it more, & if he is doubtfull
there can be no matter of taking 5 or 6 Ounces
of Blood in the beginning of the fever &
if upon this the Pulse rise he may proceed
& if necessary repeat it, for the generall Effect
of Blooding is to make the Pulse Softer and a 
little slower - Another good Effect of Blooding
is to take off the heat & lessen the Anxiety about 
the Præcordia; it likewise take away 
Spasmodic Structure & promotes the different
Secretions, which in fevers are generally lessened
especially that by the skin, which blooding 
often promotes & if universally dispersed over 

320


321.
over the Body often carries off the fever entirely
especially if it proceeds from any Error
in the Non naturals.
There is another Effect of Blooding to 
remove Obstructions & morbid Congestions
in particular places, to cause a more equal
Distribution of the Blood and to make a 
Revulsion from any place where it is 
determined more than ordinary to [cross out]
hence we see Hemorrhagies from the nose
Lungs &c. stopt by blooding in the Arm.
Another Effect still is that the Blood is rendered
thinner for people who have been 
accustomed to blood often have less proportion
of Crassamentum to the Serum 
than they had before this Custom, and in Cases
not attended with Fever as well as where 
there is, the Crassamentum is less & in Fevers
what is of it is extremely Viscid & Tenacious.
I shall now mention the particular Circumstances
as to it's use & propriety.
1 Blooding is much better born by persons 
of a thin habit in general, than fatt & full.
2 Blooding is by farr better born by young, 

322.


323.
young, than either Infants or old people
the old indeed in Inflammatory Diseases do 
generally bear blooding well enough provided
you take not much away at once
which if it be done generally weakness them
very much - But Children of 5 & 6 years of 
Age bear this Evacuation very ill, & Serous
ones much better than Adults - But in some 
Cases it may be necessary where the Fever
runs high, but even here it should be gone
about cautiously - Leeches are commonly
used to such but ought to be stopt & not 
as is the common Custom allowed to blooding
10 or 12 hours - I myself have seen Instances
where this has proved absolutely the Cause
of their Death in the ensuing Disease.
It indeed does not weaknen so much, being 
taken from the surface, if they are stopt in 
time - Blooding is in generall cæteris 
paribus better born by men than women 
from whom we ought not to take it in large
Quantities - People of [cross out] tense fibres & a 
vigorous Nervous System, do in generall
bear it better than those of a Lax habit & Nervous

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325
Nervous System, but many women of a 
relaxed habit become very plethoric & we 
are obliged to take blood from them which
they will be as very well provided you do 
not take too much [cross out] at once, they indeed
labour under a venous Plethora as we may 
see by the turgid & full appearance of their veins
In generall it is better born by people
that live in a Cold temperate Climate than 
those that live in warm Climates, & is 
pernicious in putrid fevers, where a very little
Quantity sinks the Pulse very much hence
as Inflammatory Fevers in these hott Climes
are very apt to degenerate into putrid fevers
blooding should be undertaken cautiously
In Winter & Spring Blooding is better born 
than in summer or Autumn. And 
those who have been accustomed to this 
Evacuation can bear it better than those 
who have not & in slight febrile Disorders
require large Bleeding where persons who 
have not been used to it, could lose none 
at all, & would not require it. The time 

326

327.
time most proper for blooding a patient
in a fever without doubt is in the beginning
but if necessity require it, any time of the 
Disorder will do. It has been laid down 
as a Rule never to blood a woman who has 
her menses on her or her Lochia, but if symptoms
are urgent, no regard ought to be had
to these Circumstances, & blooding is not observed
to be apt to stop these Evacuations, however
as the women themselves are so prejudiced 
against this to prevent Reflexions
Physicians should make it a point of prudence 
not to be very rash, in case of Failure.
When speaking of the full proximate Cause of 
Fever I mentioned that Seizy Blood was 
not the only full Proximate Cause but where
its very much so the Patient will bear 
it better & if his pulse rise or is hard it 
may be safely repeated. It has been a Rule
to repeat the Blooding if a little after the vein
is opened it run faster & more briskly
but this can be no general Rule however
when it runs faster cæteris paribus it may be done,

328.


329.
done, pretty safely.
We find Blooding ad Animi Diliguium
prescribed by the Antients in virolent Cases
but this is very fallacious, because we 
frequently find Patients faint before they 
have lost 4 Ounces of Blood & others that 
will bear the loss of 2 or 3 lit before they faint
which Quantity taken at once from the 
most Robust & vigorous would certainly
induce great debility & particularly affect
the Nervous System. Fainting may be 
in a great measure prevented by blooding
the Patient in a recumbent posture & stopping
the Orrifice frequently. Sometimes when 
the Patient has lost so much blood as not 
to allow of opening a Vein, cupping and scarifying 
may be substituted, & they will bear the 
loss of 5 or 6 Ounces taken this way better than 
1 Ounce from a vein, but the slower the Evacuation 
the less ready is the Patient to faint
However unless when the Patient is very low 

330

331.
the Quicker ye Evacuation & larger the Orrifice so much 
the better & it's better to take a Medling
Quantity at once & repeat the Operation
if the pulse rise, than a Great Quantity
together, in general 10 or 12 Ounces may 
be reckoned a medium, but a sudden loss
of any Quantity of Blood affects the Constitution 
& Nervous System.
The Place from whence the Blood should 
be extracted has been a subject of Dispute
before the Discovery of the Circulation. And 
it was the received opinion then that some 
particular places of the Body were preferable
to others for this purpose, but since 
that Discovery the next Theory was that 
it made no manner of Odds from what 
place it was taken & the same was their
opinion with respect to the Application
of Blisters; however this is now found
to be a false notion, for in some particular
Diseases it makes a very material Difference 

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333
Difference as in particular Congestions of 
any place Cupping & scarifying, immediately
on the place affected is of the greatest Consequence
By the Laws of Hydraulicks it has been 
attempted to determine the place properest
for making this Evacuation, but this will
never be able to do it & for all the time it 
has been practiced, it still remains to 
be decided by Experience & Observation.
However in generall the nearer the place 
affected the Evacuation is made the better
but it has been said that the first blood
should be drawn as far from it as possible,
and it's said in Affections of the head
blooding in the Ankle or foot is more effectual
than in the Arm, but this should be 
no general Rule, because particular 
Circumstances may make blooding in the 
Arm preferable as small Veins in the foot
which would not make a speedy enough 
Revulsion - In treating of particular Inflammatory

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335
Inflammatory Diseases I shall mention
the particular place of the Body from 
whence the Blood should be drawn.
In France its customary to take away
a great Quantity of Blood in every
Febrile Disorder & repeat it often, but
then the inhabitants are so accustomed
with it that they bear it very well; the 
same quantity taken from a stranger
would soon dispatch him or leave him 
so weak as never to recover the Effects of 
it in his whole life again, but the French
Physicians, have now begun to be a little 
more saving of human Blood than formerly.
The next Remedy in the Cure of Fevers was
Vomites and the Circumstances indicating
these are necessary were Neausea, Anxiety,
constant Restlessness, a foul Tongue and a 
Disposition to Diarrhœa especially in the 
beginning, which if not prevented by a Vomite
proved not a Critical but Colliguative Diarrhœa

336 

337.
Diarrhœa or Symptomatic. In all continued
Inflammatory Fevers before the 
Exhibition of a Vomite the Patient should
be blooded if there is the least appearance
of Plethora or headach but in cases where 
there is no fever & the head much affected
a vomite may be taken with no risk of increasing
the headach, but if it proceed from 
sanguine Congestion blooding must be 
premised. Dr. Sydenham always after 
the Operation of a Vomite or Cathartick gave
an Anodyne Draught to quiet as he called 
it the Commotion, however in cases of 
the heads being much affected I would not 
advise it in Inflammatory Fevers but 
if the head is easie it assists the Vomite
greatly in making the Patient perspire &
sweat all over - The Effect of a Vomite is 
to cleanse the Stomach, to take off spasm
& promote sweat & cure the headach. Vomites
are particularly proper in Childrens fevers 

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339
Fevers, because they most commonly arise
from Disorders of the P.V. & nature seems
to point this to us because Children vomite
much easier than Adults & when 
they take in too much Milk they always
throw up what is superfluous, and in general
the younger Children Are the better & easier
do they vomite.
Lect: Nov. 28 1768 
Adults bear vomiting some, better than 
others, but do not vomite with such ease as 
Infants; in some grown persons the operation
of the vomite is so severe and violent as often 
to endanger a Rupture of the Vessels & in generall
long then persons, and those who have
a long neck are most distressed with this 
Operation of Vomiting so that it's proper we 
should be acquainted with this Circumstance
before we prescribe a Vomite for any body.
I formerly took notice that Vomites promoted
sweat; by which being given in the 
beginning of Fevers that come by infection
it often has the good effect to prevent the further
Advance of the fever & cures it entirely.

340

341.
entirely- It was formerly a Rule never to 
give a Vomite but in the beginning of 
fever; this is far from being well founded
and if the symptoms indicating its propriety
are present there needs be no doubt of its 
good Effects, and there will be no Danger 
in it's Exhibition. The Vomit's mostly used 
now are the Ipecacuanha and Emetic Tartar
the first of which is indeed more certain
as to it's effect of Vomiting, but the Emetic
tartar besides that it has this in general, likewise
produces a stool or so & unloads the whole
Intestinal Canal. Ipecacuanha in the Quantity
of viij or x grains will have as much
the power of Vomiting as in the old Dose of 
ʒss, but sometimes to quicken its Operation
the more may be given. Some Cathartick's
will in a less dose than is commonly given
operate sufficiently well.
Of the Use of Catharticks in Fevers
I mentioned before that in the beginning
of this Fever the P.V. should be cleansed, and 
if the Emetic has not had the Effect of producing

342.


343
producing a stool; a gentle Cathartick
should be given to evacuate the Contents
of the Gutts especially where there are Symptoms
that indicate any putrid Colluvies
in this Canal, as Anxiety of præcordia
swelling of the Stomach & bad taste of the 
mouth, accompanied with a Redundancy
of Bile, this is the practice of the followers
of Hippocrates, but they do not give either
the Vomite or Cathartick with an Intention
of removing the Fever by them at once
but to evacuate these indigested & Putrid
Contents of the Gutts - Acrid stimulating
and drastick Catharticks should not be 
allowed in Continued Inflammatory Fevers
After every Fever it was a rule to give Physick
but unless there has been any putrid Evacuations
from the Belly, no more is necessary
than to keep it gently open -
In all Inflammatory Fevers it has now 
become a practice to give an emollient Glyster
every Day, not merely to evacuate, but also
to relax the Gutts & be a kind of Fotus to the 

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345
the neighbouring Viscera, to act as a warm
bath & consequently as an Antispasmodic
& perhaps one of the best Glysters is warm
water alone - In Cases where the Patient
does not drink enough one of this kind will
if thrown up every 4 or 5 hours generally
be retained & supply the place of [drin?] in 
a great measure at least the Danger arising
from not drinking is by this means
greatly diminished -
I have seen emollient Glysters of water [cross out]
warm, or with Oil or Mucilage cure a Tinesmus
& Diarrhœa by carrying off the Acrid
stimulating colluvies that occasion'd these
Of the Regimen in Contd. Inflamy. Fevers
Patients in Fevers have in general a loss 
of Appetite, and it serves no manner of purpose
to force them to eat, but a bad one, because
after they have eaten they are never easy again 
till it is either thrown up or descend into the 
Intestinal Canal; and what they do take 
should be light of easy Digestion, Asecscent, and 
Antisceptic, the Best nourishment is Panada, 

346


347.
Panada, roasted Apples and for drink whey
Lemonade, toast and water Barley water &c.
Small beer, either alone or with spt. Nitri.
There has been a generall prejudice against
Malt Liquors in fevers, which if strong is 
indeed bad but small beer may be allowed
them especially if they have been accustomed
to it before; It was Sydenhams favorite.
Tar water was once in great Vogue and 
drunk every Day in considerable Quantity
in fevers, and a very neauseous drink it 
certainly was, & contain'd nothing but a Vegetable
Acid combined with an Empyreumatic
Oil; but a Vegetable Acid may be given 
in a much more agreeable form, and as 
patients in these fevers ought to drink
much, we should to encourage them make 
it as palatable as possible, and when they
weary with one have variety to prescribe
Weak Lemonade is indeed the most agreeable
& best I know especially if a little 
Rhenish wine is added.
It was formerly a practice to give medicated
Decoctions, as Demulcents, Attenuants

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349
Attenuants and under other names, these 
besides their disagreableness were of no Advantage
more than cold water.
It was and to this Day is a practice in Fevers
among many Physicians, to order all the 
drink to be given warm, but this is certainly
contrary to the Indications of Nature.
Indeed where there is Topicall Inflammation
there may be danger in giving the drink very 
cold, but in fevers where this is not present
the drink should be always cold, & in some 
cases we find it necessary to give & exceed
cold, which in warm Climates is often practised
with the best success
Some Authors of the best Character have
laid it down as a principle that Cold water
will not mix with the Blood unless something
saponaceous is added as Syrup fruits &c
but this is a mere piece of Theory; & they support
it upon this that the Urine grows paler
the more water they drink & that it passes
off by the Kidneys just as they took it in,
but they examined the Urine after 

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351
after drinking largely of any thing else
they would have found it grow pale in proportion
to the Quantity drunken Syrups
are a bad addition to water because they 
both increase thirst and at the same time 
the Patient loaths every thing thats sweet.
The Good Effects of Cold drink in fevers are 
principally these 1 It acts as a high Cordial
in removing neausea & raising the Spirits.
2 It acts as a powerfull Diaphoretic & even
Sudorifick. 3. It acts directly on the febrile
heat in extinguishing it, & lowing the Pulse
so that Cold Drink we see abates all the Essential
Symptoms. But we find it sometimes
necessary to regulate the Quantity, because 
when taken into the stomach at one draught
suddenly it create Neausea & Diarrhœa; tho
when you want it to act as a Sudorifick
it is necessary to give it in considerable Quantity.
Hippocrates his Practice was to give 
the water colder in proportion as the fever
grew higher, & Galen improving upon this 
never give it but upon the Critical Days. 

352.


353.
Days. Cold drink or water is certainly a more 
effectual sudorifick than warm and when people
in fevers are warm may be given to produce 
a sweat & even in the time of Sweat.
As to the nourishment in fevers of 10 or 
12 Days continuance only, tho' the Patient
take almost none at all, little harm will
be done; but in long Fevers some must
be given to support the Vis Vitæ, and in people
who have been accustomed to live high, this 
Antiphlogistick Regimen will not be proper
In great drinkers especially these drinks
will not do they must be allowed Wine or 
even spirits if they have been formerly
Accustomed to them.
Fruit is in generall exceeding proper
in these Fevers, it has a Tendency to keep the 
belly open & to quench the thirst and to correct
the Bile, Nature seems to point out [illegible] use
in Fevers, by the vast variety & profession
of them in the warm Climates, & from the 
great liking the [sul?] manifest for them. 

354


355.
them. -Cool Air is one of the most necessy.
& best things, and the greatest Improvement
I think in medicine. Before Sydenhams 
time it was thought that something 
hurtfull was to be sent off by the skin, and 
that this might be the sooner & more effectually
done they gave sudorificks and Alexiterial
Boluses & Mixtures & loaded the Patient
with Bed Clothes; but Sydenhams Judgement
informed him that this was wrong & instead
of this he introduced the Cool Regimen
which was a great merit in him & an 
Improvment in Medicine of vast Advantage
we now are presuaded of the good Effects of 
Cool Air in the small Pox, & I hope will soon
be so in most fevers. I do not mean to damn
the patient to lye in the open Air, no, but 
only to be kept in a fresh cool Air, & not 
in a Stove, some think provided the Air 
is not putrid it will do not harm, but I 
apprehend that fresh Cool Air is likewise 

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357
Under the head of Regimen: light has been
by some kept entirely from the Patient,
but provided he can be as it easily, & is 
free from Delirium; there can be no ill in 
letting him by in the same degree of it as 
when in health. But it is very necessary
to keep Patients in a fever quiet, especially
if they have any Appearance of Delirium;
and that absurd & hurtful way their
Friends have of visiting them is always 
a great means to increase the Delirium
because every object makes a greater impression
on them & disorders the Connection
of their thoughts.
In warm Climates it is customary
to sprinkle the Room floor where the Sick
ly with Vinegar and water and to straw
branches of Trees with the Dew yet upon
them which is of great service in Cooling
& freshning the Air.
Another bad Practice was keeping the 

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the Patient constantly in Bed, but they may 
be safely taken up as often and as long as they can 
be as it, & it lessens the fever & heat & likewise
allows them more fresh air - People are very 
apprehensive of getting Cold by throwing out 
their Legs and Arms, but this is a sign they are 
too warm, more clothes should not be kept on 
the bed than when they were well & seldom so many 
we see people when they get drunk & are put to 
bed always throw out their legs & arms but 
with no bad consequence to their health so 
that in fevers unless the rest of the Body is 
very warm, there will be little danger in this 
Dr. Sydenham recommends the practice
of taking the Patient frequently out of bed &
only mentions one bad effect arising from it 
which as I find no where else mentioned I am 
of opinion was merely accidental, it was that 
this practice produced some slight Rheumatick
pains and a Jaundice, but both went off upon 
the Patients being put to bed again.
In these Fevers Asclepiades for the first 10 Days 

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361.
Days allowed the Patient neither meat
nor drink, not even to wash his mouth
and if they were likely to fall asleep somebody 
that waited on them was to prevent 
them & he exposed them to the greatest Glare
of Light than which Practice of his nothing
shows more evidently how far human
reason may be perverted by Theory.
Acids are very proper, in Continued Inflammatory
Fevers, their Effects are to allay thirst
to promote secretion as by Urine & Diaporesis
but their Operation does not depend on any 
alteration induced by them, on the Texture
of the Blood, they are given in too little Quantity
for this; but it may arise from the stimulus
where with they affect these Organs
& the degree of heat of the body makes them
act as Diuretick or Diaphoreticks.
You may perceive I make a Distinction
twixt Acids & Ascesents, Acids check  
Fermentation, but Ascesents increase it 
Acids likewise remove Neausea in Fevers. 

362.

363.
Fever, and Vegetable Acids are most agreeable.
Lect. Novr. 29. 1768. 
Of the Use of Diaphoreticks in Cont. In. Fever.
It was a Practice formerly to give these
Medicines very liberally & frequently in all
Fevers, & still continues to be the Practice
in many places to this Day, but in England
is wearing out & in Scotland is quite laid 
aside. Many Medicines have been given 
for this End & the most proper are the neutral 
salts. Boerhaave recommended Nitre as 
the best, but there is an obvious Objection
to it's use, and that is, it raises a neausea
more than any one of this tribe Where the
Muriatic Salt prevails it always produces
Thirst, & therefore where the Vegetable
Acid is, the salts are best. Saline Draughts
are now most in use, of Salt of wormwood
& Juice of Lemons after the Effervescence
but more acid should be given than is 
sufficient to make it a neutral salt
Volatile alkalics act as Diaphoreticks, in  


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365
in consequence of altering the texture of 
the Blood, & they prove this by mixing them 
with blood extracted from the Body, but
then the proportion of the Alkaline mixed
with it is by far greater than we can 
suppose to enter the Blood, I rather think 
that the secretory Organs are affected by 
the stimulus these medicines have or that 
the sweat is owing to the particular way
in which they affect the stomach which is 
of so very nervous & sensible a nature;
but in so small Quantities as these are 
given nothing can alter the Texture of the 
Blood. It is observed that these medicines
increase heat much & of consequence Fever
& hence lessen all the secretions, so that these 
Forced sweats must certainly be of ill Consequence.
Dr. Freind says fevers are never 
carried off by sweats of any kind, but in 
this he is wrong, for we often find natural
sweats prove criticall 

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367
Testacia have been given with a view to promote
Diaphoresis, but their Operation entirely
depends on the Quantity of Acid they meet with 
in the stomach, where there is a natural acid
if there happens to be any quantity of it they 
then act as purgatives, but are very disagreeable
to the Patient, and in warm climates where 
such fevers are apt to degenerate into putrid
ones, even before this happen the Testacia will
tend to accelerate it, being of a seeptic nature
I do not mean that the testacia will bring
on a putrid Fever or that they will enter the 
Blood I believe they never do, but they may 
by this seeptic Quality affect the stomach &
Contents, with this Disposition.
There is a hott medicine of this kind, which 
to this day is much prescribed, & in repute
but I never saw any sensible good effect
from it, & even Physicians who do prescribe
it most frequently own the same, &c I am 
very certain it exceeding neauseous, where 
fore then should we give such Medicines as 


368

369.
as can have no good Effect, but on the Contrary
disgust the Patient & create a neausea
The Pearle Julep is a medicine that is very
frequently prescribed & is the most insignificant
of the whole tribe, but can do no harm
When Absorbents are given in any considerable
Quantity, & meet with no Acid
in the stomach, they concrete with the slime
& cause sickness & great Neausea.
Absorbents of Animal substances are worst
Of the Use of Foment & warm Bath.
The Effects of Fomentation & warm Bathing
are to take off & prevent spasm, to promote
an equable distribution to the Extremities
of the Blood, & relieve the head; whenever there 
is an increased Determination of the Blood 
to the head (which we know by redness of the 
face, Pulsation & throbing of Carotid Arteries)
occasioning Violent Headach, Delirium &c. this 
removes the headach, takes off Delirium, and 
disposes to sleep. And in cases of Delirium
where the Patient will not drink the Quantity

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371.
Quantity of Liquid absorbed by the skin is of 
very great service in preventing the bad Effects
that might ensue from not drinking.
But independent of all these Advantages
warm bathing has a certain agreeable Effect
on the nerves which we cannot account
for; if we go into a warm bath after being
fatigued we shall in a few minutes find 
as much relief & be as much refreshed as if 
we had slept 6 or 8 hours, and to this agreeable
effect on the nervous system is owing 
the refreshing Quality of 3 or 4 Cups of Tea
we cannot think it's owing to any Virtue
in the Tea, but that it acts as warm
bath to Internall parts.
There are circumstances indicating the propriety
of Pedeluvia in Fevers, as not drinking,
violent headach & Delirium from unequal
Determination of Blood to the head; a Dry
parched skin, and coldness of Extremities
on all these Cases it's of great service and 

372.

373
service and very necessary. And in Cases
where there is any Degree of oppression
on the Nervous System producing Subsultus
Tendenum & Convulsions to the Degree of making 
the limbs jump from the bed Warm bathing
& Pedeluvia is the best remedy -
But there is a certain effect from Pedeluvia
that cannot be answered either by stupes
wrung out among the water or by its steams
which does not depend on heat, or warm 
clothes dry would do, nor moisture nor 
Derivation, or wett Cloths & steams would
answer the same Intention.
We should be exact in the degree of heat
in the water for if too hott, it's found to 
encrease the fever, the proper degree of heat 
is 94 to 100 on Farenheits Thermometer
but if it exceed this & rise to 102 or 104 its
generally found hurtfull.
Temperate Baths, or such Baths as when 
the Patient is put into them he has at first
a slight sensation of Cold, but then feels it 

374


375.
it agreeably warm, have a very remarkable
Effect on the Nervous System & take 
off Anxiety & relieve the head &c.
In all high Inflammatory Fevers attended
with Delirium Subsultus Tendenum &c.
where the Patt. cannot be taken up. Cloths
wrung out of warm water, and applied to the 
Legs and Arms supply the place of warm bathing
but care should be taken to keep the Bed Cloths
dry & keep these places among the Cloths afterwards.
It would be eligible if a patient
could bear to sitt half an hour at a time
but very few can stay up so long without fainting,
& his legs among warm water up to 
the knees all this time.
In the beginning of Fevers in the Rigor or 
shivering if a patient is put into a warm 
bath, it shortens the Continence of the fitt
& if put to bed immediately brings on a 
sweat which very often cures the fever altogether.
The Circumstance of a Patients 

376


377.
Patients fainting should not alarm a
Physician, when there is Delirium, as there's 
reason to think that it will be of great service.
Where the Urine is pale and in great 
Quantity; the warm Bath lessens it &
mends it's Colour.
Where the Nervous System is much affected 
& Blisters are improper warm Bath
is the best thing that can be applied -
In Delirium & even in Comatose Cases
warm bathing is exceeding proper.
The Practice of killing & fleaing Animals
is barbarous and answers no good end 
only we are sure the degree of heat in them
is what is proper. The warm Bath was
used by the Antients, very much. Vide Dr.
Gelehrest on the use of sea Voyages.
I think it would be a good practice when 
common people come to an Hospital, to put 
them into a warm Bath, because their skin 
what with work & what with Dirt is almost 
callous in many places & will not transmitt 

378

379.
transmitt the perspirable matter 
When the head begins to be affected in fevers
it would be proper to shave it immediately
it cools, refreshes & promotes perspiration
and where Delirium or Coma are expected, it shd.
be done likewise before we apply a Blister
a considerable while about 12 hours because
in case it be any way scratched, the Blister
will more readily produce Strangury
I forgot to mention the Practice that obtains
in warm countrys of pouring cold water on 
the Patients head in great Quantitys for hours
together & even till the Pain of the head & the 
Fever cease altogether.
Of Antispasmodicks in Fevers -
The chief & most effectuall of these are Musk
and Other, which I have seen very effectual
in large Doses for this purpose. They answer 
only in subsultus Tendenum best & Delirium
& Musk given in the Quantity of ℈i. or ʒss. in 
this Case I have seen very successfull in removing 

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380
removing these Symptoms; but they seem
to have little Effect on the rest of the Febrile
Symptoms. Opiates have sometimes been 
given in Fevers but their use & proper time
of exhibition has not yet been discovered
at least is not fully as certained & in generall 
their is a very great Prejudice
among Physicians with respect to the 
administration of them at all in Inflammatory
fevers, tho' there are certain Circumstances
& symptoms in them that would 
seem to indicate their use as want of sleep
restlessness, Anxiety - In the decline of long 
continued Fevers I have given them with 
good success, & I think they ought not to 
be given in cases of Headach, Delirium, in 
Violent Inflamy. Fevers, till plentifull Evacuations
have been made & then indeed
I believe they will be of service, but till that 
is done they rather seem to increase Delirium.

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383
Delirium. There are some particular Cases
where in the strugle about the Crisis when 
all the symptoms are remarkably more 
violent; Opium acts as a powerful Cordial
& forwards the Critical Sweat - There is 
a particular sort of Delirium cured by Opium
only & it's the only medicine to which it will
yield. In some Fevers attended with 
violent Convulsions & Subsultus Tendinum
proceeding the length of Convulsions
nothing but Opium will command these 
symptoms and in small Doses it rather
increases their Violence but if given in 
large Doses perhaps 60 gts. of L.L. for a Dose
it generally quiets them; and in all highly
nervous Cases where Opium is necessary
small Doses do rather harm than good.
Cordials in very young & sanguine
habits do great hurt, unless they be
much reduced by Evacuations, but when 
Inflammatory Fevers degenerate into Putrid 

384


385.
Putrid or slow nervous Fevers, then  
Cordials are necessary and proper; the 
best Cordial I know is Wine it possesses
all the Virtues and advantages of any of the 
rest of this tribe without any of their Inconveniences
& I find Claret generally
most liked. In Inflammatory Fevers
where the patients strength is much 
exhausted, wine may be given altho' the 
Pulse be quick.
Castor and serpentary are recommended
by some but I do not think them proper
Spirituous Cordial waters I reckon no oyr
than spiced Brandy - There is a medicine
which I have not mentioned yet 
much cried up by some as a Cordial and 
Antispasmodick; but I think it's virtues
are not sufficiently ascertained yet the 
medicine I mean is Camphor. Hoffman
whose practice is very good & worthy your
Attention, cries up the wonderful Antispasmodick

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387
Antispasmodick & Cordial Qualities of 
1/2 gr. of Camphor, but he if faulty in bestowing 
too large Encomiums of medicines
which to my certain knowledge have no 
virtues at all; Camphor under the quantity
of 4 or 5 gr. has no effect at all on most 
people & if given in the Quantity 8 or 10 
produces strange & very bad effects on the 
nervous system in some people -
Under this Class of Cordials, I reckon the 
heat of a healthy human Body applied to 
the Body of the Patient, because it has a 
very remarkable Cordial & refreshing Effect
on the nerves, especially to Children.
Of the Use of Blisters.
The Effects of Blisters in general are to 
Stimulate, to quicken the Pulse and to take 
off particular or partial spasm, which they 
do in a surprising manner without causing
any great Pain. When the Mechanical Philosophy
was in vogue, they were supposed 

388

389
supposed to act by thinning the Blood and 
attenuating the Lentor.
Its a very prevailing Practice to apply Blisters
on all cases of Delirium, & high fevers
even before Evacuations have been made, but 
in my opinion it's not at all advisable to 
order them in this Case & I have always found
them, hurtfull in such Cases; and even when 
these symptoms do increase after them they 
immediately apply more sometimes to the
number of 6 or 8. I do not find it clearly proven
that the Cantharides enter the Blood, even
from the Strangury; may not this be owing 
to their effect on the Nervous System? & we 
cannot Imagine how they attenuate or thin
the Blood; but that they quicken the Pulse is an 
undeniable fact, however in some cases where 
the pulse is kept up by local inflammation
a Blister by curing this will lower the Pulse
However their general Effect is to quicken ye 
Pulse and make it a little harder.
The Cases in which Blisters are proper

390


391.
proper, after plentifull Evacuations by blooding
so as to bring down the pulse; are violent Head 
Ach, Coma, Stupor, Languor, Depression and 
Topical pain, in Phlegmatick Habits & Women
in generall bear them better than Men
and particularly Children require them & 
in these we observe they never raise a Strangury
if under 5 years of Age & are paticularly 
serviceable in removing many of their Disorders.
Lect. Novr. 30 1768 
I now come to mention the particular Cases
where these are improper, or where their Application
requires great Caution.
Early Blistering in Inflammatory Fevers
before the pulse is rendered softer by Evacuations
as blooding, is very improper & where
there is any great irritation of the Nervous
System, the warm bath is more eligible
than [Blis?ing]; but in some Cases even
where there is Irritation after Evacuation
blisters may be given; Plegmatick
people are those to whom they may be best
apllied & these bear them with very little inconvenience,


392


393
inconvenience, while there are other habits
whom they irritate terribly; which is worth
engering at the patient & of some Consequence
to be known. Blisters are 
improper wherever there is a tendency
to putrefaction or a dissolved state of ye Blood
in warm Climates they are more improper
than in temperate Climates
As to the particular Place of their Application
I shall observe that in all Cases where there
is topical Affection, they should in general
be put immediately on the place affected; &
we find their Application to local pains &
affections supersedes the repeated Bloodings
which before this Discovery was the method
practised for removing these. And I believe
it is one of the greatest Discoveries in Medicine.
But in to call Affections of the Brain as Inflammation
Blisters applied directly on the head 
rather increase the symptoms, in these Cases
I choice rather to apply them first to the Legs
& next to the Back and last of all to the Head.
[illegible]

394


395.
head. They do very well in Cases of Stupor and 
Lethargy & in the End of Fevers in these Cases
but when there is Delirium & great subsultus
Tendinum, they are very improper & do mischief.
If in the Beginning of Fevers when the 
head is confused & the Fever has not yet begun,
in the time of the Rigor, a Blister be applied to 
the head; it prevents the ensuing Fever from 
appearing, & is said to cure the Patient of it.
But in common Cases as was before observed
Blisters should not be applied to the head till
10 or 12 hours after its shaven, and Blisters
on the Legs do not so readily cause Strangury
as when on Any other place of the Body.
As for the time necessary for a Blister to 
ly on, if there's no Strangury I think it may 
be taken off in 24 hours time, tho sometimes
it will produce its Effects & be well risen
in the Space of 12 hours, but should be taken
off when they begin to cause Strangury which is 
a very troublesome Symptom; Physicians observing
this Effect of Blisters, when a Patient has 

396


397
has a Strangury before a Blister is applied
are affraid tho' the Case require it to give
one, but this fear is groundless & a Blister
in this Case always cures the preceeding
Strangury. There are some Patients who always
upon having a Blister, get a Strangury
& others whom it never affects in this way.
The best Medicines for preventing this are 
mucilaginous soft drinks as of Althæa Lentseed &c.
I know Camphor is said to be a specifick
in removing this symptom but I much
doubt of its efficacy this way & its not at all
clear that it has any virtue this way; when 
it is rubbed on the Blister it is said entirely
to prevent it, but its not generally true & in
some this might have been the Case however.
If the Strangury is violent besides
drinking these above mentioned Mucilaginous
Decoctions, they should be given by way
of Glyster & Fomentations of them applied
to the Bottom of the Belly & Perinæum, which 


398


399.
will prove very beneficial both in easing
the Pain of Strangury & abating oyr. febrile Symptoms.
The covering the Blister with Lawn
and oiled paper do not prevent Strangury
but may make it come easier off -
The Application of Blisters is but a Modern
Practice, their Effects were indeed known
to the Antients; but their Application never
became universal till about 200 years ago 
and then they met with great opposition from 
all the Regular Physicians of the Faculty, their 
great Supporters were Hyeronimus & Saxonia 
and to this day in many places of Europe
they are but little used; indeed in England they 
have been more used than anywhere else 
The Mechanical Physicians were the Persons
who brought them most into Practice and 
especially Pitcairn. They have been abused
both ways & many great men have shown
too much timidity with respect to this application
in Fevers, as shall was practice
indeed was always feeble, but his Descriptions 

400


401
Descriptions & other works are very valuable;
Hoffman too & Boerhaave were rather 
too cautious in this respect.
There are other applications that have the 
same effect with Blisters, & have some advantages
over them in some Cases, as that 
they do not raise Strangury, & their stimulus
is much quicker; a Blister will ly on 5 or 6
hours perhaps before it shall have any
sensible Effect at all but these applications
have their's very soon, and commonly composed
of Bruised Mustard Vinegar and 
Black Soap; they are applied to the soles
of the feet with success in Stupor, Coma & Violt.
Headach, if previous Evacuations have been 
made, with very good success & if they raise
Vesecations or inflammations Emollient
Poultices should be immediately applied 
in their stead.
These are the Remedies used with an Intention
to assist or moderate the Efforts of 
nature and prescribed by Hippocrate's his

402


403
his followers; but the Artificial Plan or 
when remedies are prescribed with a Design
to remove the Disease at once & put a stop
to the fever without any regard to Nature
or waiting a Crisis; we have seen successfull
or possible in Intermitting Fevers, but 
then we have here a Specifick or Medicine
that acts directly by stopping the Disease
& that without any sensible Evacuation
following it; but in Continued Fevers
there has not been any yet discovered equally
powerful with the Bark in Intermittents.
Antimonial Medicines are now prescribed
with an Intention of taking away the fever
and that with success; this indeed is no Modern
Practice, tho' their use is much more 
frequent now than before Dr. James's time
who introduced the Exhibition of an Antimonial
preparation under the name of James's 
Powder, which was a composition of Regulus 
of Antimony & Red Precipitate Mercury; as all 

404

405
All Antimonials do, it operated by Vomite
or Sweat or Stool; but the Red Precipitate
is now left out. It's effects are not always the 
same, for they varie according to the Contents
of the stomach; it is observed to succeed best 
when given in the beginning after Blooding
and the Contents of the stomach and Guts have 
been evacuated, and it's operation as a febrifuge
is most certain. It as been said 
& Dr. James himself says that it cures 
fevers tho' no sensible evacuation follow
& hence acts as a Specifick, this I never saw 
but do not deny the Fact; I have indeed
seen it procure a very remarkable Alleviation
of the Symptoms - However I know 
no advantages it possesses above other preparations
of Antimony especially Tartar Emetic
which I would rather prefers, because we have 
more the command of it in the Doses. James's
Powder in the Doses it's given in, very often
operates both by Vomite Sweat & Stool & by this 
violent operation has a very great Effect on the 

406


407
on the Nervous System; where as Emet. Tart.
is given in exceeding small Doses & in a very
timid manner by Physicians, & therefore can 
have no such force on the Nervous System
but if given in the sufficient Boldness I'm persuaded
would be as effectual. There is one disadvantage
James's Powder his under which 
is that after the Patients case grows desperate
& the Physician's hopes are gone the Friends propose
this remedy & it's accordingly given
& fails; here it's blamed innocently and without 
Cause, and I believe upon the whole the benefit
reaped from James's Powder may be greater
than from the Emetic Tartar, because the forwardness
of those that prescribe the former is not of 
so ill consequence upon the whole as the timidity
of the regular Physicians.
The Bark is a medicine which I have not 
mentioned yet in the Inflammatory Fever
As soon as we begin to perceive any remarkable
intermission of the Fever then the Bark
is given; & in warm Climates, the very first 
sensible Remission of the Symptoms, should 

408

409.
should be taken to throw in the Bark
Emetic Tartar & James's Powder are very
successfull in procuring these Remissions
and the Bark has been given, before these
Antimonials; when they did not prove effectual
in removing the Fever; with very 
good success: & sometimes when no sensible 
Remission could be observed, the Bark has 
been given & has cured the Fever -
I shall point out those Authors that
have in my opinion wrote best on this 
Disease & with respect to the Prognostic
Symptoms Prosper Alpinus may be read
as the best & Judopus Labius, you should likewise
read Huxham, Van Sweeten's Commenty.
and Dr. Sydenham. These are the best 
on this subject I know. 

410


411.
Class 1st. Order 2d. Genus. 2d.
of 
The Putrid Fever.
The Putrid Fever is attended with the general
Symptoms of Fever already mentioned and is distinguished
from the Inflammatory Cont. Fever
by a remarkable degree of Prostration of strength
& spirits in the very beginning.
It has been called by different Names as Petechial
Malignant, and Jail Fever. But there are Petechial
Fevers which are not Putrid. We do not find this 
Fever anywhere accurately described; till the time 
of Dr. Pringle & Dr. Huxham who have given a 
very full & accurate Description of it & some 
few since these have wrote on it.
The symptoms attending the Different stages
of this Fever are as follows.
Two or three weeks before the Attack of the Fever
or the Patient's being confined to Bed, there 
may generally be observed, alternate Changes
from heat to cold, and the symptoms are worst at 
night, propensity to sleep loss of appetite & 

412


413
& the sense of Anxiety & restlessness, Tongue white
thirst little; if the Patient in this Case or stage
is vomited, it generally prevents the further
progress of the Disease or if he sweat & changes
the Air or Place of the Country, he is cured.
It is not easy distinguishing this Fever at 
first from the Inflammatory; unless it 
come by infection which is reckoned one
mark, & if upon blooding the Symptoms are 
not relieved we may suspect that it's a putrid
Fever; sometimes once Blooding will sink 
the Strength & Pulse very much & few can
bear twice Blooding without the greatest
depression; the Blood taken in the beginning
is seldom sensibly altered, but in the more 
advanced stages of the Disease, is found highly
dissolved. This Fever attacks with more 
violence than the slow Nervous Fever; the Rigor
is greater, the Heats sharper & more permanent,
the pulse more tense and hard & sometimes
very irregular, being slow & small and then 
remarkable Quick, & slow again.

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415
In it's first Attack, There is a violent Headach
with the confusion of the Brain, Nausea Vomiting
Pain in & Eye Brows which reaches 
to the Bottom of the orbit. The Eyes are full, heavy
and misty, the Face blotted, livid, & sometimes Yellow,
a throbing of the Carotid Arteries, tho' the Pulse
at the wrist is at the same time feeble & small
this always either precedes or attends a Debris
& is a certain sign of a præternatural Determination
to the Brain, there is likewise a Tinnitus 
Aurium, and as the Disease advances
all the symptoms are agravated, and what
is very remarkable in this Disease, a sudden
& great Prostration of strength, even altho'
no Evacuation has been made, there is a 
sighing, sobing, Difficulty of Breathing, commonly
attended with Debris, which is different
from the Delirium that attends on Inflammatory
Fevers, & rather a kind of confusion 
of thought; the Patient seldom sleeps long 
and ye Pulse sinks the Delirium & Tremor increase,

416

417.
increase, but as the Pulserises they wear
off, which is contrary to what happens in 
Infammatory Fevers. There is sometimes
a Dullness of hearing from the beginning
& a toal Deafness has been met with; sometimes
the Voice grows very low, and they have 
often particular Cravings, but Nature points
out by this her own wants; & the most common
thing sought for is wine. In this Fever a 
Subsultus Tendinum is not so frequent a 
symptom as a Tremor, with Lassitude, Pains
of Back & Limbs, sensation of heat & pain
in the Pitt of the stomach; but when the Fever
is more advanced, a greenish black & highly
offensive mater is vomited; but this is no Essential
Symptom. As the Disease advances
the Breathing grows hott, & fœtid, the Tongue
dry & parched & sometimes grows black and furred
& sometimes is found moist with a greenish
border round it's Sides. The dryness of the Tongue
often weakens the Voice & makes the Patient
speak very inarticulate we should therefore be 

418

419.
on our guard & not mistake this inarticulation
for a Delirious symptom.
The Urine is various, in general Pale & whitish
or redish in Colour & full of Crudities.
If the Patient feels warm there is generally a 
Diaphoresis but if cold a Diarrhœa attends because 
of the stopped perspiration.
There is in this fever a heat which gives a 
very particular impression & taken Notice of 
by Galen, at first feel not very hott, but afterwards
it becomes pungent. Ths Skin is parched, & the 
Sweats are symptomatical & fœtid.
Thirst is very various at sometimes pretty
moderate & at others exceeding great & almost 
Unquenchable - In this fever when the Patient
complains not of pain, his insensibility is 
owing to Delirium & Coma; Another Symptom
of this Fever is Petechia.
Let. Decr. 2d. 1768. 
These Petechia are not a contstant symptom
or peculiar to this Fever, neither are they Criticall
but merely Symptomaticall, and are not always 
to be reckoned mortal; they do not rise above the 

420

421.
the Surface of the Skin which is what mostly
distinguishes them from the Exanthematous
Eruptions; they are sometimes so small and 
numerous as to escape the observation of the 
Physician, but when the skin is narrowly
vivid they appear clearly tho' at a very little 
distance it only seems a little reder than ordinary,
the Places of the Body on which they
are most frequently found are the Breast and 
Back, & the time or Period of the Fever in which 
they show themselves is 'twixt the 4th. & 14 Day
tho' sometimes not till the Patient is dead
It is not certain if this Fever was known to the 
Antients, but if it had their Accuracy of Description
and Observation, would certainly have 
distinguished it from other Diseases, therefore
as we find it no where in their Writing we 
may conclude they knew it not.
The first Account we find of it, is in Fracosterius
in the year 1505.
In Putrid Fevers the symptoms are always
increased at night and a Paxoxysm observed -ved

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423
observed; & indeed this may be said of Fever in generall
with few exceptions; in this Fever
there is often a partial sweat, through out the 
Day - & in general after the Pulse sinks till
Death there is less change of the Symptoms
from day to day than in any other Fever 
Worms have frequently been passed in this 
Fever, & observed sometimes to come by the Mouth,
they have by many been reckoned the Cause of the 
Disease, but this cannot always be & I believe
is very seldom, for we often find these lying in 
the Body without causing any sensible Disorder,
but I do not deny that they are sometimes
the Cause of Fever.
It is likewise often attended with Dysury &
Strangury & in some Cases the head became 
swelled & the Blood when drawn was observed
to be very fœtid and Dissolved.
I now come to mention some Symptoms
that follow this Fever.
We often find when this Disease is terminated
without any apparent or sensible Crisis 

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425
Crisis a Hectick Fever succeeds it, & Remittent
or Intermittents. After a Crisis too there is 
commonly a total want of sleep, a Vertigo
Tinnitus Aurium, and mortification in Back
these mortifications are very frequent, & not
so very Dangerous when after long Fevers
as when proceeding from any bad deposition
of Body &c I have seen severall Instances where 
there has been very large mortifications of 
this kind cured very soon.
This Fever is likewise followed by Œdematous
swellings of the Legs & Anasarca, likewise 
by Hæmorrhagies from different places
all in consequence of the Dissolution of Blood
The Diagnosis. It may be distinguished from 
the Inflammatory Fever by the smallness & feeblness
of the Pulse, the sudden prostration of Strength
& Spirits & from the slow Nervous Fever 
by the greater thirst & symptoms of Putrescency
which are not found in so great a degree here 
by much. The Duration of this Fever in general 
is 7, 14 or 20 Days but most commonly twixt 

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427
'twixt 14 and 20 Days & the 7 Day is that on
which the Change most frequently happens
The favourable terminations of this Disease
are about the state or Decline a Gentle Diarrhœa
with a mild sweat, but a Diarrhœa happening
in the beginning is reckoned bad.
2d. Turbid Urine with a gentle sweat & soft Skin
is favourable.
3d. Yellow turbid Urine with a Sediment, appearing
about the 14th. Day is good.
4. A Salivation.
5. Abscesses particularly in the Parotid Glands
Buboes in the Groin & suppurations in the 
Scrotum & Testicles, or Axillary Glands are 
all reckoned Critical. When this Fever continues
very long, if these appear no externall Abscessus,
by morbid Disections we find that 
there are internall ones allways to be seen 
Dr. Pringle mentions a Case where there was a 
large swelling of a Parotid Gland without 
any appearance of this Fever, & upon applying
emollient Cataplasms the Tumor subsided, 

428


429
subsided, but a putrid Fever immediately came
on upon it's disappearing.
6. The appearance of an Itchy red rash with 
large watery Blisters on the Back, and Eruptions
about the mouth & nose are good in the End.
7. Deafness in the Decline of the Fever.
8. When the Petechia change their Colour for 
a more lively & bright red it's a good Symptom.
Prognosis. in this Fever it is in Generall
unfavourable & the following Symptoms
are reckoned so.
1. A Violent Diarrhœa, is bad & when we 
stop it all the other symptoms are rendered
more violent; Involuntary Stools, and a hard 
swelled Belly are certain Indications of Mortification 
of the Gutts.
2. Cold clammy partial sweats, & profuse
sweating in the beginning are bad.
3. Large livid spots, called Vibirus; these are 
attended with Hemorrhagics often, and are 
real mortifications.
4. Miliary Eruptions like Measles of a dull leurid 

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431
leurid hue are bad.
5. Brown and white Apthæ in the Throat
succeeded with difficulty of swallowing &c. an ill
and in generall every Ulcer & sore, in this Fever
has a tendency to Gangrene.
6. Dark bloody fœtid Urine.
7. Hemorrhagies from any part, as Gums
Nose, bloody Urine, bloody Sweat &ca.
8. All Symptoms of Putrefactions
9. All other Symptoms mentioned as unfavourable
in the Continued Inflammatory
Fever, may be reckoned so here.
There are Particular People who are most 
subject to this Fever, another Prædisponent
Causes of it to those are. 
1. Evacuations which have weakened them 
much before, & none more than Salivation
by Mercury, which makes or disposes them
to have this Fever in a worse & more severe
Degree; & those people who have it once are
more susceptible of it again, & in this it's 
different from the Plague, which much rembles
this fever in several other particulars 

432

433
particulars as that it terminates in Buboes
but those who have mentioned this Termination
of the Putrid Fever, do not inform 
us whether such Patients ever had it again.
2. Other Contagious Diseases if they do not 
dispose to it are at least rendered worse by 
it's being near where they are as we find
examplified in the small Pox; for Patients
in them, admitted into Hospitals where 
this Fever is generally grow worse & die
even tho' the Pox were of the best & most favourable
kind.
3. Those People who are under the Influence
of the Depressing Passions, are here by made
more susceptible of this fever & hence we 
find a kind of reason why the Relations of 
people in these fevers are more apt to be infected
than any body else, even than the very
Nurses who constantly attend the Patient.
4. Along Course of Alkaline Salts & Soap
are said to cause this Fever, from the tendency
to Putrefaction they induce on the Blood, 

434

435
Blood & dissolution.
Occasional Causes.
1. Putrid Meams from diseased Bodies & foul
Air do undoubtedly act as occasion a exciting
Causes of this Fever, hence a reason why so 
frequent in crowded Jails, whence it got it's name
in Transport & hospital Ships, & in Military
Hospitals. It's not the Consequence of heat
It's first Appearance was about 200 years ago
& in the year 1758, at the Assuzes, it raged much 
& out of 6 Judges who satt on the Bench & died
The reason of this was supposed to be a stream
of Air coming right upon them thro' a window
from the Prison, loaded with the Putrid Effluvia
It has been suddenly produced by the Air of 
a morbid [Ga???] limb - And after Battles
the Air being loaded with putrid particles
of the Dead Bodies, acts as an Occasional Cause
& large Animals as dead Whales have given 
rise to it; likewise lakes full of Putrid &
Stinking waters or other Substances are 
reckoned among the Causes of it. 2d. 

436

437
2. Living entirely on Animall Food, without
Vegetables, and Antiscepticks, or without
the use of ferment Liquors, or eating 
Bread or Sugar.
3: Want of Exercise, for we know that all
Animals have a Natural tendency to Putrefaction,
and that by Exercise those particles
which are no longer necessary to nourish
are thrown off, & if not they being of a Putrescent
Nature will cause this Fever to arise.
4. A Southwind with a humid loss Constitution
of the Air, make this Fever Epidemicall;
it likewise induces Languor & Debility
on the Nervous System we know very well.
5. Contagion is the most common, even
without, any Prædisposition or Occasional
Cause this will give us the Fever -
6. This Disease is increased by heat & Moisture,
hence is so frequent in hot Climates.
From the Above observations we may 
Account for the following Phenomena and  

438


439
and 1. Why Putrid Fevers are so frequent
in Jails, vizt. fm- the Putrid foul Air
2. Why so often mett with in besieged Towns
this is from the want of Cleanliness & entire
want of Exercise
3 Why in these Suges these fevers attack
the labouring & poorer sort of people first
this is owing to their want of Exercise to 
which they were formerly more Accustomed
than the higher sort of People, and likewise
to their Want of Vegetables and Antscepticks 
and living wholly on Animal food & likewise
to their being here subjected to the 
[???ing] Passions of Fear & Grief -
[illegible] The Turks are more subject to this 
[Fev??] than any other Nation in Europe it's 
not owning to the Climate [illegible] the Effect of their
using the warm baths frequently & eating
so much Opium & want of Fermented Liquors
4. Why here the Putrid Fever is less frequent
than formerly especially here & in England
The reason is, formerly they used Animal
food mostly & very few Vegetables, and 

440

441
and then Vegetables were so scarce & of 
consequence so dear as to be above the reach
of the common people; they likewise eat
less bread, used fewer Antiscepticks &
fermented liquors & sugar very little &
they were not near so cleanly as now.
5. Why Cities in generall are less subject
to Putrid Diseases than other places, seeing
they are so nasty & have so many putrid
Substances lying in the Streets & everywhere
The Air in great Towns is kept in constant
Agitation, by the Motion of Carriages
& the vast numbers of Fires impregnate ye-
Air with an Acid in great Quantity.
Proximate Cause.
[illegible] Morbid Dissections throw no light on the 
Proximate Cause of this Fever at all, they 
[ind???] show some of it's [E???s]; and generally
the Bowels as Stomach & Intestines are 
found inflamed and gangrened, and Abscesses
inflammation or Ichor found in the 
Brain. This Ichor is found in the Ventricles
& is a particular Affection in that place. Indeed  

442

443.
Indeed the Proximate Cause of this Fever
has never been fully explained yet so far
as I know, but it's connected with the 
Proximate Cause of Fever already given
some way or other, but so modified as to 
produce a Putrid Fever. It is some sort of 
Putrid ferment, in the Constitutions in Consequence
of Putrid Miasmata, which have
an Assimilating Power, that first seems 
to affect the Nervous System, hence all the 
Symptoms at the beginning are evidently
nervous, and these appear before the 
Blood is the least hurt or diseased.
Lect. 19 Decr. 5. 1769 
The Symptoms of Putrefaction only come on 
when [illegible] Disease has continued sometime longer
The Nature of these Miasmata & Contagious Effluvia
appears to be perfectly unknown & likewise
the [???ner] in which the operate on the Nervous
System. It appears in at the Patient is at 
last killed by an Inflammation & consequent
Gangrene in the stomach & Bowels, Inflammation
& Abscess in the Head and at the same 
time independent of these it appears also to 

444


445
also to prove Fatal in Consequence of the Gradual
Extinction of the Vital Powers, upon which it 
seems to all most powerfully as a Poison from 
the first time its admitted into the Body.
From all the Symptoms of Putrid Fever
there appears to be a Redundancy of Bile wch.
in the Progress of the Disease becomes remarkably
putrid. It springs from another Organ in 
the shape of an Inflammatory Fever & in 
warm Climates Nervous Fevers often degenerate
into this. Putrid Fevers have a remarkable  
Analogy to the Plague in all 
the Nervous Symptoms, in Putrefaction, in 
[Pet??] it terminating in Abscess which in 
both are frequently Critical. It has likewise
a Resemblance to the worst kind of Bilious
Remittent Fever. Some suppose the Nervous
Symptoms to proceed from some inflammation
of the Brain, but there is no proof of this, because there
are many Cases where nothing præternatural
has been found in the Head and the same time 
all the Nervous Symptoms have taken place.
This 

446


447
This is a Theory supported by no Facts that 
Nervous Symptoms can not take place without Topical
Affection of the Head. On the Contrary Inflammation
of the Brain are often attended with a remarkable
Degree of Excitement of the Nervous Power instead
of these low Nervous Symptoms.
With regard to the Putrefaction its very seldom
that any putrid Disease is contagious unless
attended with Fever, of which we have a remarkable
Instance in the Scurvy, which in general
is not a Contagious Disease, altho' in the last Stages 
attended with the highest degree of Putrefaction
& Dissolution of the Blood, but when attended
with Fever its always more or less contagious
There have been instances of a Gangrened
Limb giving the first Rise to Putrid Fever but 
this is rare. It has been said that the putrid Effluvia
attended with a dry Air are most apt to 
produce continued Malignant Fevers of the Putrid
kind, but this is not established, & when the 
Air was moist Remittent Fevers. The Putrid
Effluvia from corrupted Blood as in Dysentery,
disposes to putrid Diarrhœas & Dysenteries
but tho' this has a foundation in Nature yet the 

448.


449.
yet the Facts are not at all sufficiently established
Dechaen denies that in the beginning of this 
Fever the Blood is ever [s??z?y]; but its pretty Evident
Dechaen never had an Opportunity of seeing this 
Fever, or of he had his Pryudius, as they often do
have misled him egregiously. There is certainly
a Distinction of Putrid Fevers from their Causes
some are produced by Putrid Effluvia, some from 
Contagious Miasmata, others are the Consequence
of inflammatory Fevers & Nervous, but the particular 
Differences are not yet Ascertained nor do
I think it very necessary as the method of Treatment
is the same, an Inquiry of this kind is 
more a matter of Curiosity than any thing Else
Ratio - Symptomatum The Nervous Sympts
do not at all appear owing to Inflammation of 
the Brain, because they take place in a certain
Degree when no Inflammation appears, but 
seem owing to some Operation of the morbific
Ferment on the Nervous Power. The Delirium
depends on two Causes very opposite in their 
nature, one the Consequence of Inflammation
from a Hott Regimen, another from a directly opposite 
Cause, vizt. being Kept on too low a Regimen
& undergoing too large Evacuations especially  

450

451.
especially Bleeding. The Tawny Colour of the 
Eyes is not always owing to Inflammation, but 
is rather the Consequence of the Dissolution of the
Red Globules. The Petechia are not always
the Consequence of a Putrid Dissolution of the Blood
tho' they are often considered to be so, they frequently
appear in merely Inflammatory Fevers, from 
too hott a Regimen, at the same Time they are
often attendant on Putrid Fever. They appear
to be immediately owing to an Effusion into
the Cellular Substance & their appearance on 
some parts more than others may be because 
of the loose Texture of the Cellular Substance there
Petechia are sometimes the Apeus of Gangrened
Parts, but this is uncommon. In some Case it
will appear that a slight degree of Gangrene will
take place & the parts become sound again, with 
out casting off but when it comes a certain
Length I apprehend the diseased parts are irrecoverable.
I have seen a Cow of Late when there 
was a universal Tendency to Putrefaction, the 
Blood issuing from the nose, Bloody stools & Urine
& ouzing from the Gums, the Blood that came 

452


453
came was black & putrid & the Flesh likewise
Petechia were over the whole Body particularly
the Breast & Back, Large Bumps on the skins
which at last became black & Rose to a point
with a small Blister at the Apex which always
precedes a Gangrene, but notwithstanding 
all this the parts heated up without any separation
indeed luckily the Patient was able to bear
large Quantitys of the Bark & wine & at last 
recovered. 
The Morbid Affection of the Head may be partly
nervous & partly owing to an increased Determination
of the Blood to it
The Affection of the Stomach & Bowels may be 
partly nervous & likewise in a great measure
owing to putrid Bile, later in the Disease to 
Putrefaction & Gangrene
The Hemorhagics & putrid Excretions are evidently
owing to the Dissolved State of the Blood.
Cure. Here the Indications are the following 
1. To mitigate in the beginning the Violence of the Febrile
Symptoms which in Plethoric & Sanguine Constitutions
are very severe, & this is principally Accomplished
by Evacuations & Antispasmodicks -

454

455
2. To promote the Excretions which Experience
teaches to afford the most relief to the Patient, particularly
gently Excretions by the Skin & Belly; this is done
by gentle Diaphoretics, Emetics, & Cathartics &
plentifull Dilution.
3. To support the Vis Vitæ & Stimulate the Nervous
Power, by proper Cordials, Diet & the use 
of Blisters & Bark.
4. To resist the Putrefactive Tendency by the 
Bark & Acids.
Bleeding only takes place in the beginning
of this Fever & only in very particular Circumstances
as of Plethora or Inflammation in the 
Beginning of the Disease. If the Disease is Contageous 
Bleeding of itself if pernicious in general
And a Repetition of it is very hurtfull. What 
indicates it in the beginning is Plethora, sanguine
Habit, quick tense Pulse, difficulty of 
Breathing, great Heat & pains in the Head
& Back. In these Cases where the Head is 
much affected with marks of great Determination
to it & on Account of the great Prostration
of Strength & Spirits of we would not chose to 
blood the Patient at the Arm, the taking away 

456


457
taking away ℥ 4 vel 5 gives great Relief by Cupping
or Scarifying [crossed out] & is perfectly safe
Dr. Pringle is more against Bleeding than Dr. Monro
but this is entirely owing to the Circumstances
attending the Disease as they describe it -
Vomites are indicated in this Disease thro
the whole Course of it from time to Time by the 
Neausea & Inclination to Vomite. If a Patient
vomites of himself it should be incouraged by 
drinking of Chamomile Tea which is preferable
to warm water, because its a powerfull Antisceptic  
& therefore in such Quantity may have considerable
Effect on the Putrid Matter of the Stomach
In the Progress of the Disease as the Bowels
often become inflamed the Exhibition of Emetics
becomes very Dangerous & generally its better to 
carry off the Colluvies of the Primæ Viæ by gentle
Cathartics.
Thro' the Course of the Disease it's particularly
necessary to keep the Belly open by gentle Laxatives
& Glysters which ought to be of the Antisceptic 
& Cooling kind as every Stimulating Medicine
exasperates the Symptoms. The most proper
Purgatives are the Neutral Salts as 

458


459
as Sal Glauberus, Tart Regenerat Crem, Tart
Decoct. Tamarind. They may be given at any 
time of the Fever and are indicated by sickness
lead Taste of the mouth, Nederose Eruptions
Costiveness turned Belly Borboregme & Gripes.
But Nature often carries off this Disease by a 
gentle Diarrhœa or at least mitigates the symptoms 
about the 8 or 9 Day; which makes Laxatives
particularly proper about this period & when
there is a Tendency to Costiveness Laxative
Glysters should be employed every Day -
Diaphoretics Upon which the Cure of fevers
formerly rested so much, of the Hott Stimulating
kind do mischief I apprehend by increasing
the Putrefactive Tendency. It may be [la??] down
as petty general Rule in all Fevers, that what 
were increases the Fever lessens the Secretions
but as the Patient finds Relief from keeping up a 
gentle moisture, this I think should be done 
by diluent & Audsilated Drinks. The Volatile
alkalic have generally been condemned as 
hurtfull from a piece of mere Theory, because they 
are the product of Putrefaction they must promote
this Entirely. But they are now allowed to 

460


461
to be Antisceptick, tho I also say that the Volable 
Alkalic on bad Medicines in Putrid Fevers 
in large Quantitys because they Stimulate
very much & Consequently increase Putrefaction
but in the small Doses its commonly given 
in it can have no Effect on the Mass of Blood
At the same time when we want a sudden Stimulus,
these may be given with propriety but their
Use should not be continued in lest they excute
to a great a Heat which promotes Putrefaction
In the Beginning of this Fever especially when 
it is the Consequence of Contagion, Diaphoretics
are found to be very usefull & sometimes to 
carry off the Fever all at once; & the best method
to remove it at this Period, is immediately
to take A Vomite upon the very first Appearance
of the Infection, then put his feet in warm 
water for a while & directly go to Bed; afterwards
taking a Dose of the shirt Mindereri 
to promote a Diaphoreses, & besides drink freely
of Diluting Liquors to keep up the Sweat or 
bring it out more effectually; & such people
as are not heated by it might take a Bolus 

462


463
a Bolus of the Theriaca & gr. 8 vel 10 sal. C.C.
which appears to be a very powerfull & effectual
Diaphoretic; but this method must only be 
tried in the very beginning, for in the more 
advanced Stages of the Disease it would be 
evidently highly improper.
The Contryeiva Powder is improper on many
Accounts; it disagrees with the Stomach
which in this Fever is of very bad Consequence
& we never should load it with such things as 
are disagreeable, unless we want to take every 
chance of life from the Patient, because it will
be the better able to bear the Bark, which in
this Fever I take to be a Medicine more to 
be depended on than any of the rest or all of
them put together. All the Testacea are improper
because they are septic, not that they 
enter the Blood but by meeting with putrid
Contents in the Stomach there increase the 
Putrefaction & foul the stomach exceedingly
Of all the Neutral Salts Nitre is the most improper
because it is so remarkably offensive

464


465
offensive to the stomach and on that Account is 
highly improper in this Fever.
The Serpentaria is a very powerfull Medicine
when we look on it as Antisceptic merely but 
if we consider its very disagreeable Bitter Taste
we must conclude it improper on that Account
and as for its Cordial Qualities I see no Advantages
it can have above wine, which has none
of its Disadvantages. But there have been some 
Cases in which the Bark has failed & the serpentaria
succeeded & likewise where the Cure has 
been affected by the use of Confect. Cardcaca
& Volatile Alkalic Instances of these we have
from Dr Pringle, but they likewise had the 
plentiful use of wine. But I have never seen 
a Case myself when Cordials were at all necessary,
in which wine did not answer all
the Purposes required, much better than there 
by itself & as in these Cases it was given along 
with these Cordials a good date of the Effect might 
be ascribed to it; however when there is a 
sudden stimulus required the Confect [crossed out] Cardiaca,
or sal. C.C. are preferable to it. 

466

467
Blisters in this fever have their Use very
much Disputed. In general during the first
Stage & in the Beginning they have often been
found rather to exasperate the symptoms
particularly the Delirium & Tremor; but yet 
when the Fever has continued long & in the 
last Stage particularly when the Vis Vitæ is much
sunk & Coma come on, Blisters may then be 
of very Considerable Service & are highly proper
unless the Putrefactive Tendency be very great 
& then they are attended with this particular 
Disadvantage among others that the parts
to which they were applied are very apt to 
gangrene; & therefore when Blisters are used
the parts should be often inspected & carefully
attended to. They are of the greatest Service
in this Fever when they occasion a 
plentifull Discharge of Serous humors, &
particularly relieve the Head; in Cases of 
Coma especially when its urgent a Blister
I think is attended with most Advantage when
applied to the Head itself - 

468

469
Lect. 20 6 Decr. 1768. 
In this Fever Antispasmodicks are given
with a view to obiviate some of the most violent
Nervous Symptoms, the most powerful of this 
Class & that are most proper Here are musk &
Camphor; which last is accounted Anodyne &
a promoter of sweat as well as Antispasmodic
It is a medicine very much cried up for these
qualities, but in my own experience I never have 
been able to ascertain the proper Dose as I before 
have observed. It sits easiest on the stomach
when joined with Vinegar in form of a Julep
Musk is a very powerful Cordial promotes
Diaphoresis & sometimes carries off Delirium
but should be given in considerable Doses
as N. or ʒss. at a time, & if this is too much
for the Stomach at once gr. xv. at least & repeated
again soon.
There is another medicine of this Class 
that is given with great Caution & timidity
in this Fever & that is opium, which of itself
acts as a powerfull Diaphoretick, but if 
joined with Camphor, it's operation as such 
is much more certain; if given at the time of 

470


471
of the Crisis when the Vis Vitæ is sunk & 
unable to throw of the Critical matter, it is a 
very powerfull Cordial; & even after the Fever
is gone, when the patient is much distressed
for want of sleep it is exceeding proper and 
may be ordered without fear. Indeed it is 
the very best Medicine, for commanding the 
very violent Nervous Symptoms & nothing
that I know will do but this in some Cases.
I now come to the last & most powerfull
medicine in this Disease, & what is worth
all the others put together I mean the Peruvian 
Bark. It was till of very late given
in small Doses at once, but now the Quantity
is greatly increased. You'll find that Dr.
Huxham gave it in but very small Quantitys 
in Tincture joind with some other substances, 
but now we can safely give larger
Doses of the Powder to the Quantity of a ʒi at once
every 2 hours. In the above Author there is a 
very remarkable Case where the Body was 
half putrid, cured by this Medicine in but  
small Quantitys. It is apt at first to run 

472

473
off by the Gutts & produce a loosness but 
this is easily prevented by joining with it 
a few Drops of Laudanum. 
There are some People, who cannot take it 
in substance; to these the next best form is 
the Extract, an Ounce of which may be taken
in a Day; when there is any Difficulty in 
Breathing, the best thing to prevent the 
Barks increasing this is syr of squells
joined with it; & if we want to procure a 
Diaphoresis, spiritus mindereri, or any 
of the Saline mixtures join'd with it, will
have the desired Effect.
Besides the Antisceptick Qualitys of the Bark
it cures the Disease even tho' the Blood is so 
far Dissolved as to produce Bloody Urine
& stools; and changes the Colour of the Petechia
into a brighter red. It checks the violent internal
heats & acts in them as a Cordial; and 
in general those people who have been cured
by the Bark are less apt to relapse than those 
who are cured by other Remedies - There are  

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475
are some particular Constitutions in which 
the Bark in substance answers much [cross out]
worse than the Decoction of it, but this is rare 
Dehean gives one instance of this; he has 
carried the use of the Bark in Fevers to a much
greater length than any other person ever did
& this is the greatest Obligation Physic owes
him, & in Exanthemalous Fevers in particular
he used it much.
There are some Stomachs to which every 
form of the Bark is exceedingly neauseous
& to these we give it in Glysters as before directed
When given in Decoction Tincture in this 
Fever we should add to it Elixir of Vitriol
as much as will Acidulate it, or if given in 
Substance 20 or 30 Drops of it along with 
it, or 4 times a Day. But as to the superiority
of Elixir of Vitriol over the Vegetable acids I
am not at all freely satisfied, I imagine Juice
of Lemons or any other Vegetable Acid to be 
better than it in this & most other Cases
where it is thought proper to join them with 
the Bark. I come now to mention of Diet,

476


477.
Diet, In this Fever should undoubtedly be 
of the Generous & nourishing kind, as we 
may certainly collect from the great Prostration
of Strength & Spirits, both which require
to be likewise supported by Cordials, and as 
the very best I can recommend Claret; but this 
is usually given in too small a Quantity
from a foolish timidity of it's increasing the 
Fever; there should be no restriction in 
it's use till the Effects of it appear, this alone shd.
limits the Quantity & untill we find the Patient
heated & the Pulse evidently quickened we 
ought not to stop. If there is any Necessity
for Dilution water is the best thing, but Sack
Whey is the very worst form it can be given
in tho it's a very common, it's disagreeable
to the Stomach when given with the heat that 
they commonly order it. One or even two 
Glasses may be given at once without doing 
any harm & a Bottle or 2 may be allowed in 
a Day; tho' formerly the Quantity ordered was 
only half an English Pint in that space
Some People are very fond of Rhenish or Moselle 

478

479.
Moselle Wine beyond any other. Wine in general
lessens the heat & lowers the Pulse.
Very remarkable Cures have been performed
in this Fever by the Patients living entirely
on Fruit, as eating Oranges in great plenty
even ad libitum, & in these Fevers I know no
ill Effect that can arise from them; only
sometimes they Cause a Diarrhœa for the 
most part very gentle, tho' sometimes it may 
become immoderate, but it maybe check'd
with opiates -
The Food should be of the Vegetable kind
light and easily digested, and Ascescent too,
but if the Patient is very desirous of weak
Broth he may be indulged in it and likewise
may have Beef Tea.
As a Cordial I mentioned wine as the very 
best, and all the rest as Theriac. Methred. Confectio
Cardiaca &c. act only as Temporary Stimulants,
but the Effects of wine are more lasting
& diffuse; It is necessary to give the Patients
a little of it very frequently every hour

480


481
hour, because in many Cases unless this is 
done they thro' the Excessive weakness will be 
very apt to faint, & here this is exceeding dangerous
because they frequently are carried off 
in these fainting Fitts. They are sometimes
so exceedingly exhausted as to be unable to 
be moved in the lest or sit up without fainting
& when it is necessary to remove such either
for the sake of better Air or making of their bed
the best way to prevent this faint is to carry
them in a horizontal Posture, by putting Towels
under them.
In Hospitals where this Fever prevails
much no Caution prevents it's great mortality
unless thinning the wards & letting in Fresh
Air, & if we can in the very beginning [cross out]
remove the Patient to a very cool Dry Air.
It is of Consequence to such as go abroad to 
the hott Climates, to know; that Sea Air has
a remarkable good effect, on this Fever and 
the Bilious Remittent.
Pedeluvia are of considerable use in removing 


482

483
removing some of the most Violent nervous Symptoms
as Subsultus Tendinum, Delirium &c. procuring
sleep, but we should be particularly Attentive 
not to make the water too warm or lett the 
Patient sitt up lest he faint, fomentations of 
it applied to the limbs & hands seem most proper
this has another good effect of promoting a Diaphoresis -
Serpentary acid Bitters are prescribed here 
as Antiscepticks, but for reasons already
given are not proper. And all Astringents
are in some measure Antisceptick. I do not 
deny this Quality in them & especially in the 
Serpentary, but then they [??cong] given in such
small Doses can make no manner of Change
on the Blood, their Action is entirely confind
to the Contents of the stomach & Intestines
which indeed they may in some measure
Change but wine enters the Blood & its effects
are much more diffuse & universall.
Of all the Neutral Salts given in Fevers nitrites
the most disagreeable to the stomach & Weakest I 

484


485.
I now proceed to the particular Cure of some 
of the most threatning Symptoms and 
1 A Violent Diarrhœa is best checked by Opiates
either by themselves or joined with Aromatiks
The Tincture of Roses is a very agreeable Medicine
& proper here; Red wine mulled with Cinnamon
may be given as a grateful Cordial & proper
Medicine in this Case; A Glyster of Theriaca
to the Quantity of ℥ss. in ℥iv. of Milk is found
very Effectual in Violent Diarrhœas. But they 
should not be entirely stopped because it is 
dangerous. Testacia are prescribed in 
Diarrhœas very often but are improper here
because they are of a Septick Quality.
2 Vomiting is most effectually checked by 
the saline draughts in State of Effervescence
if this fail Laudanum may be tried and 
providing it is not effectual by itself internally,
mixed with oleum Camphoratum
& rubbed into the Stomach it seldom fails
and a Cataplasm of Theriac applied to the Pit 
of the stomach is very good. The Terminations 

486


487.
Terminations of this Fever are sometimes
by Abscesses of the Parotid Glands, these
should be opened as soon as possible &
we ought not to wait till there is an Apparent
fluctuation of matter, because it is 
of so thick & viscid a nature as we could
not be sensible of any fluctuation, even
tho' collected in considerable Quantity, &
there is great reason to believe that their 
being not opened soon enough has been 
the Cause why these Tumors are not often 
reckoned a Critical Abscess - I believe 
Cataplasms of Milk and Bread applied
in the common way used by the Common
People is not beneficial, because they soon
grow cold, I think the warm Gum Plasters
much better - 
When the Jail Fever is joind with or terminated
in an Intermittent, it is cured by the 
Bark as in other Intermittents -
I formerly mentioned worms as an Appearance 
in this Fever, and that they were sometimes 

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489
sometimes voided by the mouth, whenever
therefore there is every great sickness & uneasiness
at Stomach & a Suspicion of worms a gentle Emetic
will be proper and then a Dose of Rhubarb
and Calomel. The general Anthelmintick Remedies
are by no means proper here, because
they distress the stomach too much, & Calomel
is in my opinion as effectual as any of them.
If the Patient is affected with a Dysury, Emollient
Fomentations applied to the Kidney &
Belly, with mucilaginous Drinks as Decoction
of Gum Arabick with Spirt. Nitr Dule.
are very proper Remedies.
Œdematous Swellings of the Legs are remov'd
by the Bark & Acids, with Diureticks & purgatives
given once or twice a week, & I have experience
of Dovers Powder acting as a sudorifick with 
great relief or any Emetic [joi??] with an Opiate
will have the same effect. When in this Case
the Patient is not very weak & under a hectick 
Fever or violent Diarrhœa Punctures in the legs
evacuate the water most effectually, but if they 

490


491.
they labour under the above Disease the 
Evaucation will be so great & sudden as to sink
their strength and bring them to the grave
because after such fevers as these the Blood
is in such a Dissolved State. Blisters applied
in these Cases to the Ankles are very apt to 
gangrene. In Consequence of the Dissolution
of the Blood the Patient after this fever for 
a considerable time is very subject to Hemorhagies,
but this is removed by the use of the 
Bark, Acidulated Drinks & Cool Air.
Preservatives against this Fever as Cool
dry Air, which is one of the best, great Cleanliness,
plenty of Exercise, a generous Diet
but avoiding Excess of drinking, because it 
subjects to the Depressing [cross out] Nervous Power & is always
followed by prostration of Strength & Spirs.
and in these Circumstances we said people
were susceptible of febrile disorders besides
after a Debauch people are very apt to 
catch Cold, both which are predisposing
Causes of the Disease - Medicall

492.
492


493.
Medicall People should never visit patients
in these fevers fasting & likewise it would be 
proper to breath thro' a sponge Dipt in Vinegar
especially if inspecting them nearly; and it 
ought to be a Rule with Physicians after [ve??ting]
such Patients always to change their Cloths
before they visit any other, because there is 
reason to believe the Infection has been communicated
this way. I have already mentioned
the method to be pursued when we perceive 
the first appearance of this Fever & for 
more Directions on this look to those given 
about Intermittents.
Authors best on this Fever are Dr. Huxham
and above all others Dr. Pringle, Dr. Monro
on Camp Diseases, Dehean on the free use of Bark 

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495
Of Cl. 1. Or. 2. Genus 3.
The Nervous Fever.
This makes the Typhus Nervosus of Sauvage
but his Description is not at all satisfactory
he says it's a Fever that lasts 2 weeks, that 
the Urine and Pulse are as in health, and that 
there is only a greater Degree of weakness
than ordinary; this surely is no good Distinction
for we always find the head Affected & a Depression
of the Nervous Power with other febrile
Symptoms; the head indeed is little more than 
Natural, but in generall a very little Quickness
may be observed in the Pulse, and there is another 
symptom that Distinguishes it both fm-
the Inflammatory & Putrid fever vizt. a 
total want of Thirst.
This Fever has never been accurately describ'd
till within these 40 years & Dr. Gelehrist
gives the best and most Accurate Account of 
it I have mett with in the Eden. Mid. Essays

496


497.
Essays and Dr. Huxham in his Treatise
on Fevers gives a very good historic of it.
I shall now mention the Symptoms that 
attend this Fever during its Progress, wch.
is divided into three Stages.
In the first Stage as the Fever attacks very 
gradually, the patient will find himself
a little out of Order for 2 or 3 Weeks before 
he is confined to Bed, his spirits during
this time are low his Appetite gone, little sleep
he loves solitude, & seems better in the cold Air
& at sometimes has a slight Delirium.
Now all these Symptoms increase and there 
comes on a great Degree of Languor of the 
Faculties, after this slight Chills & heats may 
be perceived, but not so great as to describing
name of Rigor; there is likewis a sense of Load 
or weight on the Præcordia, a Giddiness of the 
head, & frequent inclination to vomite, & when 
they do vomite nothing but inspid Phlegm
is brought up, which is one Symptom that 
helps to distinguish this Fever from the Inflammatory
& Putrid Fever, in the last of 

498


499
of these the Vomitings are highly fœtid &
bilious. There is likewise a total disrelish
of every thing, very little Thirst which is 
one of the Symptoms that chiefly distinguish
this fever from the two former; these symptoms
are not always alike or permanent but commonly
are sensibly increased towards
night - The head becomes more & more affected
there is now Delirium & Vertigo; the heat 
now becomes greater than natural, the 
Pulse which at first was not quicker them
natural now becomes weak & feeble and 
a little quicker. At this time there is often
a remarkable Difficulty of Breathing & Oppression
on the Breast with deep sighing
which may be mistaken for an Inflammation
of Lungs, & mislead the Physician
for if Blooding at this time be advised
if frequently sinks the strength so as 
never to be recovered again, this ought
carefully to be attended to. And now there 
is commonly a great Degree of Torpor &
pain of the Crown of the head, which is  

500

501.
which is succeeded by Delirium. Here
the Countenance is pale & sunk, and a great
drowsiness attacks the patient, who tho'
seemingly asleep is not at all sensible of it
At this time the Pulse becomes irregular
being quick weak & slow then fluttering
and intermitting. Flushings on the face
with Hectick like heats are common while
the Tip of the Nose & Ears are pale & Cold
& a cold sweat on the forehead. In this 
Fever the Extremities are always disposed
to be cold; the Urine is pale & limpid & of 
a whey colour without any Sediment; wch.
makes another Difference twixt this & the 
Inflammatory Fever where the Urine  
is always ceteris paribus of a high red Colour
The Tongue is moist & continues so to the 
last stage of the Fever & this likewise distinguishes 
it from the former fevers.
There is here a remarkable degree of Mobility
of the nervous system, as may be 
concluded from the uneasiness occasion'd 

502.

503
occasioned by light or a little noise, in the very
same way we see women that are highly hysterical
affected.
This Fever has been observed to come 
on like a slight Rhumatism, with fainting
& Depression of strength & Nervous
Power - There have been instances of 
it's beginning like the Inflammatory
Fever, with this Difference that the Pulse
upon the Accession of the Delirium grows
weak & contracted, where as the very opposite
happens in the Inflammatory Fever
These in general are the Appearances of this 
Fever till about the 7. day after being confin'd
to bed. There is no possibility of knowing
the Criticall Days in this Fever, because we 
cannot learn the time of it's Attack, we can
only reckon from the time of being confined
to Bed, but in the Inflammatory & other 
Fevers from the Rigor beginning.
About the 7 Day then the Giddiness
Vertigo & headach increase with great Tinnitus
Aurium and Oppression & Anxiety 

504


505
Anxiety of Stomach, and cold Sweats on the 
Face and Breast; in these Circumstances a sudden
change in the Colour of the Urine to pale
or Clear is always a forerunner of violent
Affections of the head as Universal Tremor
Convulsions, violent Subsultus Tendency
or Coma. A Delirium often comes on without 
any Inflammation of the Eyes which 
is a common appearance, I have know Delirium
proceed from a morbid affection of  
the Stomach without any Inflammation of Eyes
perhaps in this Fever there is no Inflammation
of the Brain or if it be it is removed at 
a considerable Distance from the Eyes, and 
indeed the Cerebellum here seems to be principally
affected. Now the tongue is Dry &
trembles when put out, & the Patient seldom
complains of thirst which is very 
often owing to the Torpor or insensibility
Now from the 9 to the 12 Day the Patient is subject
to profuse Sweatings & Colleguative Diarrhœas,
which are not at all Criticall but 
merely symptomatical Evacuations, 

506


507
Evacuations, because under them the Patient 
is rather worse & more uneasy.
In the last Stage of this Fever, the Extremities
become quite cold, the Pulse is quick
& intermitting, so quick as scarcely to be discerned,
there is Delirium & Coma with a very
great insensibility, & the Urine & stools
run off involuntary, likewise a very violent
Subsultus Tendenum.
The Duration of the Fever is uncertain
sometimes it will last 20 Days, but if the 
Patient survive the 14 Day from being confined
I seldom find the Disease prove Mortal
in fevers in general. If after the 14 Day
a Deafness comes on it's reckoned a favourable
Symptom, unless when the Effect of 
generall Insensibility, there it's a bad one 
There is a remarkable symptom in this 
Fever mentioned by Dr. Huxham which 
I myself have often observed that is the 
Patient wont allow himself to fall asleep
left he slip away in that state & entreats

508

509
entreats the by Standers to keep him
awake, this is a strange timidity & attended
with a very great degree of Direction
of Spirits. Deafness is apt to make the 
Physician believe the Patient more insensible
than he really is, but he should be aware
of this.- This Fever has seldom
any regular Crisis or Evacuation, but
rather by gradual remission of Symptoms
& I have seen it go off by a Comatose Disposition
or a sleeping of 2 or 3 Days Continuance
There have instances occured in my Practice
of the Patients continuing a little wild
& having a kind of Idiotical Behaviour
even when he has been able to go abroad
on horseback & some say they have continued
so always tho I never saw an Instance 
of this neither do believe it.
In this Fever there is no Judgement of the Issue of the 
Disease from the appearance of the Urine
Delirium if it come after the 9 Days is not so 
very Dangerous, but if before that it is 

510

511
is no good Symptom. This Fever has 
been observed sometimes to terminate in 
apoplexy & palsy & in some Cases we may 
observe distinct Paroxysms every 2d. 3d.
or 4th. Day, which are different from those 
exacerbations observed at night; this seems 
to indicate that the Fever will terminate 
in an Intermittent, which is farther indicated
by the Appearance of a Sediment in 
the Urine, & this makes it probable that 
the Bark may yet be given with great
success in this Disease, & has already been 
the Cause of giving it here; this Gentleman
I hope you'll attend to as I expect great
Advantage from it in the Cure
Towards the End of this Fever all the symptoms
of Putridity come on especially if it 
has lasted long especially in warm 
Climates; but here Gangrenes are more 
frequent & are brought on by the lying
wett among Fœces & Urine that run off 
involuntary, however they are seldom
attended with great Danger and are 
often Critical 

512

513
critically
There is a pretty remarkable appearance
in this and in most other fevers which I know
not how to account for it is what the Vulgar
call a lightening before their Death. I have
often observed it; the Patient recovers his 
senses entirely & speaks & acts very Sensibly
& there is a very evident Alleviation of 
all the symptoms only the Pulse is very 
low & weak. This Appearance makes [illegible]
very diffident, in cases where there is any sudden
Change of symptoms to the Better, to 
give my opinion of the Patients Case.
The favourable Symptoms in this Fever are 
when the tongue continues moist, and 
a natural Salivation comes on, when there 
is a gentle moisture on the skin & not 
a sweat for its one of the worst symptoms
when the Patient lies soaking in profuse
sweats, if this moisture is universal
it's always attended with alleviation of
the symptoms. A gentle Diarrhœa is 
good, but if violent it's very Colleguative
& bad; Absecessus of the Glands & Swellings,

514

515
swellings, especially of the Parotids &
Eruptions about mouth & nose in the Decline 
of the Fever. Miliary Eruptions are 
favourable & called criticall because they 
appear for the most part on the Criticall
Days as on the 7, 9, 11, 14 but strictly speaking
these as observed before, cannot be 
known in this Fever. I have often seen
them appear with evident alleviation of all 
the Symptoms; but very frequently
they are the Consequence of hott Regimen
& here they will suceed Course after Course
to a great number of times, profuse
sweating brings them out & I am persuaded
their appearance in lying in Women
is owing to the hott Regimen, tho' I'm not 
entirely of Deheans opinion, he says they 
never appear but in consequence of too 
hott a Regimen. These Miliary Eruptions
are very often preceded by a Remarkable
degree of Oppression & Anxiety about 
the Præcordia & Stomach, which sympts.
have enabled me often to fortell their Appearance.

516

517
Appearance. Apthæ of a brownish white
Colour are favourable, but if they are 
of a pure white colour they are bad.
I now shall mention the bad Symptoms
which attend this Fever, and a great Difficulty 
of swallowing & Gulping attended with 
Hiccup may be reckoned very unfavourable
likewise all profuse sweats, & Copious Stools
severe Diarrhœa, brown and black Apthæ
& Petechia are bad symptoms, & we may 
pronounce the Patient in a dangerous
Case when the Symptoms of Putridity
come on, and severe Pains of the Back &
Loins & Os Coxigis preceding this or any 
other Fever are bad symptoms.
Antecedent Causes of this Fever
A Weak nervous lax habit, a poor thin
Blood, & great Evacuations of any kind 
Depressing Passions, great study, or Fatigue
excessive Venery, Mercurial Saturation
all dispose to this Fever. Infants under
6 or 7 years old never have it & old people 

518

519.
people are not subject to it, but it chiefly
invades the middle Aged & youth, it is most 
prevailing in moist wett weather & in 
marishy Countrys. It is oberverable that 
where these Fevers are Epidemical the 
Common People are most apt to be 
seized with it, because they do not live 
on such generous food & drink no wine
we see the wine Drinkers escape when
this Fever is Epidemic; and this depends
sometimes on the state of the Air, tho' it 
has been certainly contagious as appears
from whole families being seized with 
it at once even when not raging in the 
Place. I do not think that the Effeminacy
of the people in high station is a Cause
of it's frequently among them, because we 
likewise find it more so among the lower
sort who live just as well & no better
than formerly. Catching Cold has been
ascribed as a Cause of this fever but it 

520

521.
it is not peculiar to it.
I shall now recapitulate these symptoms
that chiefly distinguish this fever from 
the Inflammatory Fever.
In the Inflammatory Fever the motion
of the Blood is rapid & vigorous, here it's streak
& sluggish; the heat & thirst are intense
here these are seldom more than natural
the Urine here is pale but in the other
high coloured if the patient has not drunk
a great dale. In Inflammatory Fever
there are pains in different parts of the 
Body, it's seizure is sudden, and attacks
those of rich Blood & sanguine Temperaments,
& the blood in it is seizy & dense
but; in this Fever, there are not any such
pains felt, it comes on gradually, &
attacks those of a poor thin Blood and 
lax habit & the Blood is little Altered from a 
Natural appearance. The Inflammatory
Fever is most common in dry & 
Cold Seasons, these sufficiently distinguish

522

523
distinguish it from the Inflammatory
Fever; & by the following may be well
enough known from the malignant;
in the nervous Fever there is less heat
no Symptoms of immoderate Secretion
of Bile, or of Putrefaction, as fœtid Breath
which may distinguish it, the Nervous
Symptoms, are pretty much alike in 
both, only more violent in the Putrid Fever
& the Blood is always much dissolved
in it & natural in the Nervous Fever.
Of the Proximate Cause many Theories
have been given. Because the Appearance
of the Blood was natural some have said 
it was in the Lymphaticks, but to meet 
appears to be seated somewhere else as 
in the Nervous System, but what this 
Affection of the Nervous system is I can
not pretend to say. There is in this Fever
a considerable Degree of spasmodic stricture
more than in any of the rest, yet tho
this be a pretty universall attendant on 

524

525
on it, we cannot call it the full Proximate
Cause; the Circumstances that indicate
this spasmodic Stricture, are a low weak
Pulse, small & irregular & considerably
contracted, these are in the increase of the 
Fever, but as it goes off the Pulse grows
full form strong & soft where as in Inflammatory
Fevers the Pulse at first is strong
full & firm, but in the decline small weak
and feeble.
Lect. 22 Decr. 8 1768 
I do not say, that this spasmodic stricture
is universally present, in all nervous
Fevers; or that it is the full Proximate Cause
of this Fever; because there are many 
Intances, of a universal Relaxation, as 
we may see from the heat being equally diffused
& the Skin all over soft & in a gentle
Sweat, & in profuse Sweats which have
been mentioned ahead among the bad
Symptoms, there can be no spasm present;
but when I speak of this I understand
it rather as a symptom or Fact, & not the 

526

527
the full Proximate Cause; what produces
or causes this Spasm I do not know; but we 
find it frequently connected with both Irritability
& Debility of the system & these often
without it, hence the one cannot be said 
to be the Cause of the other. There is certainly
something vitiated in the system, that has  
a great effect on Depressing the Nervous 
Power especially with respect to it's energy
on the Organs of motion, but what 
Idea to form of this Debility or vitium
I know not unless I could account for 
the method of Operation of the Nervous
Power which I do not pretend to account
for; & it's of very little Consequence in the Practice,
'tis sufficient for us if we know what 
will raise or depress it.
The Indications of Cure come next to be 
treated of, and in these we proceed upon two 
principles, and We draw our Indications

528

529
Indications from observing the Patient
relieved by certain natural Evacuations
which points to us the propriety of promoting
these, as gentle Diaphoresis or Moisture of 
the Skin, by mild Diaphoreticks; exemplified
farther in Diarrhœa & salivation both
which when mild case the Symptoms
2. From observing the symptoms, we are 
directed in our proceeding, as when we see 
a remarkable degree Depression on Vital
Powers we have and Indication here to 
support the Vis Vitæ by proper Regimen
by wines Cordials, Blisters, Stimulants &c.
3 To take off generall spasm from the system
by Antispasmodicks & Emollient Fomentations
4. To Alleviate the other general symptoms
that is those that are not so constant but 
only occasional.
This nervous Fever never of itself
requires blooding, unless it be in full &
very sanguine temperaments or where 

530

531
where there are Signs of Inflammation; for 
independent of these Circumstances it 
weakens the Patient & sinks the Vis Vitæ
This Fever has sometimes been mistaken
for a Peripneumony, the Consequence of which 
has been above observed, to be very dangerous
but may be easily distinguished by the following
symptoms, in this Fever the Pulse is small
and unequal, & the Antecedent and Predisponent
Causes are different & even opposite
to those of the Peripneumony, in this the
Smptoms are very different, especially the great 
prostration of Strength & Depression of Spirits
The breathing instead of being hot & laborious
is rather a kind of oppression occasioning
frequent sighing & sobing here the Urine
is pale & in the other high coloured, & the 
Cough does not attend the nervous Fever
Tho None of these Symptoms singles are 
enough to distinguish these Fevers yet if 
joind altogether they may be depended on as a 
sufficient Characteristick to know either 

532

533
But in doubtful Case no harm can be 
in taking ℥iv of Blood from the Patient
if he is not very weak in the beginning 
and according as the Pulse bears the Blooding
so is he to judge of the Fever
There are some Cases to be mett with of 
evident marks of Inflammation in 
the Brain, and in such Cases Cupping &
Topical Scarification do not sink the Strength
near so much as half the Quantity evacuated 
from the Arm. Vomites may be given here 
to evacuate the Glutenous matter that tis 
in the Stomach resembling whites [cross out]
of Eggs, their use is indicated by the Nausea
& reaching and Anxety, what is brought
up is a Glutenous matter entirely void
of Acrimony & Putrescency. The Effects
of Vomites here are to dislodge this matter
to promote Diaphoresis & Salivation
and to act as Antispasmodicks 
They are particularly proper in the beginning

534


535
beginning of this Fever & have commonly
the same Effect in carring of this Fever as 
they were mentioned to have in the Putrid
Fever if they are given at the time these 
said to be proper, & with the like precautions
and they may be given at anytime [cross out]
of it if the above Symptoms be present
& especially if there is a Delirium or Stupor
on which they have a remarkable good 
Effect. Sometimes there is a very great Diffusion
which endangers choaking & here a 
Vomite is very proper & when the Apthæ
disappear or are going away the Patient is 
frequently in danger of Strangulation in 
both these Cases I have seen an Emetic save
the Patients life. The sickness of the Stomach
does not always depend on the matter
contain'd in the Stomach, but is merely a 
nervous symptom.
The Proper time of giving an Emetic
is in the Evening a little before the Exacerbation
which is often prevented by it. I 

536

537
32
I mentioned that Vomites were formerly
given with a view only to promote Vomiting.
Yet Antimonials given in such small
Quantities as only to excite a Neausea, & here
[cross out] act as Antispasmodicks and Diaphoreticks 
and likewise by procuring Remissions
of the Symptoms & pave the way for the Exhibition
of the Bark.
In this Fever Patients bear the Operation
of Emeticks far better than Purgatives
which if Stimulating & hot often cause great
Depression of Strength & fainting, but in 
general mild laxatives should be given
from time to time to prevent the Accummulation
of & discharge this Glairy Colluvies
& generally one or two stools a Day will 
be enough, but the Exhibition of Emet.
Tartar in small Doses often does this &
procures a Remission of Symptoms
This Colluvies if not purged off brings on 
violent Neausea & Sickness, with reaching 

538.

539
and sometimes a severe Diarrhœa; Gentle
purgatives are most proper to carrie off this 
but Glauber's Salts are not found to answer
here so well as Small Doses of Rhubarb or 
the Bitter tincture of it, which should be 
given when Tartar Emetic is not ordered
Sometimes the Patients Stomach will not 
bear any sort of Purgatives, & in this 
Case Emollient Glysters may supply their
place of the Regimen
It is necessary that the Patient should breath 
a fresh & Cool Air, this has no tendency to 
check the moisture on the Skin as has been 
idely supposed. As this Fever is of pretty
long Continuance, it is necessary often to 
change the Patients Linnen; there is a great
and prevailing prejudice amongst people
against this Direction lest it check the moisture
on the Skin, & when Physicians tell
them that a moisture is salutary they always 
put on more cloths till they raised sweat
when is often dangerous. But the Changing 

540

541
of the Patients linnen is attended with 
no sort of Danger provided it be done with 
common Care & is particularly necessary
in this Fever because of the Involuntary
Stools & Urine, the Effluvia of which must 
certainly have a bad effect on the Patient
& are often the Cause of Gangrene in the 
Back. In the beginning of this Fever it 
is a necessary precaution to shut out the 
light and as much as possible prevent
noise, because of the great Irritability
of the nervous system especially by these.
There is no necessity for the Patients drinking
much in this Fever, however it may 
be sometimes proper to offer him one 
now & then, because he would never call
for any thing on account of the great Torpor
& insensibility; if be given in quantity
sufficient to support Vis Vitæ it's enough.
In the End of this fever if the Patients calls
for it he may be allowed weak broth,
and Beef Tea, or parts horn & Calf feet Jellies and 

542

543
& wine for a Cordial, it's the best of this Class
& it's Effects are most lasting, here it supports
the Vis Vitæ restrains Colleguative Sweats
Supports Critical & Miliary Eruptions makes 
the Pulse slower and fuller, & in general is 
rather cooling, it removes Delirium even in 
Cases where the Eyes are inflamed, it likewise
carries off the head Ach & relieves the Jactation
or tossing & procures sleep where opiates
have failed, and in Comatose Cases.
Besides all these it is the most grateful
of any to the Stomach, & in all Diseases
where the stomach is so much affected as in 
this what sitts easiest on it & is most agreable
should be well attended to by Physicians 
We are highly indebted to Dr. Gilehrest
for introducing the liberal use of wine
into Practice in these Fevers. Best form 
is plain cold Wine, which has not the lift
tendency to check the Diaphoresis & I take 
good old sound Claret to be the best.
Quantity of it should always be regulated
by the Effects it produces. I do not mean 

544.

545.
mean that wine constantly and unvariably
produces all these Effects else we shd.
be possessed of a Medicine that [cross out]
ways & in all Cases would cure this Fever
I only mean that it has been observed to 
produce all these Effects & indeed its a medicine
of the most extensive use in Practice I know 
and I presume that by the plentiful use of 
wine, Antimonials, Blisters & The Bark
we would want all other medicines in the 
Cure of this Fever. Cold water may be given
here too it acts as a powerful Cordial & Diaphoretick
and these can be no Objection against
its use as in fevers attended with Topical
Inflammation - As to Diaphoreticks
it's necessary to keep up a gentle Diaphoresis
but those that are very stimulating & hott 
as Sal. C.C. Decoct. Serpintar. Confect. Cardiac
Safron &c. are not proper here, & possess
no Advantage above wine, should never 
be given unless when a quick Stimulus
is necessary, they heat & increase the Irritation
especially in the beginning of the Fever 

546

547
and by the bys safron is the most insignificant
of the whole Class.
Antispasmodicks are Internal or External
and Musk is the most powerful I know 
when given in large Doses of ℈i & ʒss. every
3 or 4 hours it carries off Subsultus Tendinum
& Delirium, I have likewise tried the 
the Æther with success but it's not so powerfull
as the Musk. Opium is given to advantage
in the End of the Disease it cures the Restlessness
& Anxiety promotes Diaphoresis & takes off 
Spasm, but it's effects are not certain, for 
I have found it increase the Delirium and 
head ach, which wine has removed; however
Opiates are useful for Checking Violent
Diarrhœas in the beginning they abate the Anxiety
& Sighing & prevent Delirium.
External Antispasmodicks are Fomentations
they moderate Subsultus Tendinum take 
off Delirium & promote Diaphoresis, if the 
water is too warm it will make the Patient
Faint & he cannot sit in an Erect posture 

548

549
hence the necessity of taking him out of 
bed in a horizontal Posture, and a temperate
Bath acts here as the most powerful
Antispasmodick, as before observed.
Blisters are often applied in these Fevers
And as was observed before if at the first 
Attack of it a Blister is put on the head 
it prevents the fever; but after the Patient
has been Confined to Bed Blisters have a 
bad effect, they often increase the subsultus
Tendinum & head ach, but after the fever has 
continued 2 or 3 Days they may be given one 
at a time after another with good success
they are observed to ulcerate more deeply in 
this Fever than in any other which often
proves of use to the Patient. They are indicated
by Pustles breaking out about mouth 
and nose, this & the Circumstance of their 
Ulcerating has given cause to some to ascribe
this Fever to great Acrimony. During the 
time the Blister lies on I have observed the 
Pulse contracted and hard but upon removing 

550

551
removing the Blisters it became full & soft.
We should make it a Rule always to shave
the head in the beginning of this Fever &
repeat the shaving every second or third Day
and bath it frequently with Vinegar & water
I always reserve Blistering to the last & especially
in Comatose Cases find it servicable 
here it affords the greatest Stimulus I know 
The properest time for applying a Blister
is, that it may begin to operate when the 
Patient is freest of Fever, but the common
time is at bed time when the Exaccerbations
come on however this is wrong
When the Patient is very pale it indicates
the use of Cordials, & a great Depression of
the Nervous Power to be present.
Lect 23 9 Nov. 1768. 
There sometimes occur Cases where there is a sudden
Depression of strength & Blisters are indicated
here I have seen several Clapt on one after another 
but never any very good Effects from so many
at once; in such Circumstances Sinapisms applied
to the feet are much better than Blisters & 

552

553
& are attended with none of their Disadvantages
they neither increase the Subsultus Tendinum
nor do they heat so much & never produce a Strangury,
& besides they give a quicker Stimulus
But if they are long kept on they are apt to 
raise Topical Inflammation & blister the 
Place, but there is seldom danger in this altho
they do Ulcerate, because the Discharge is often
of great Service to the Patient.
In the beginning of this Fever when the head 
is much affected I have seen very good Effects
from cold Applications of Vinegar & water or 
Oxyerate, they refresh the patient are Antispasmodic,
keep off Delirium & produce sleep
& these cold Applications are particularly usefull
where there is sanguine Congestion or 
Determination of Blood to the head which 
we know from the red flushed face and the 
throbing of the Carotid Arteries, but in Cases 
of Spasmodic Stricture being the Cause of the 
Affection of the head, where the Countenance is pale 

554

555
pale & no marks of Congestion warm Applicatons 
afford remarkable relief.
I before mentioned that the Bark was given 
in the Decline when there appeared regular 
Remissions; but towards the beginning it 
has been given with success and acts as an 
Antispasmodic, & even as a febrifuge, is likewise
Antispasmodic, these are evident Effects of it 
But I [cross out] have often seen it ordered &
done so myself in the Decline when no sensible
Remissions appeared, unless those that commonly
happen at night, with very good
Success too I think I have given it too with 
wine to support the Vis Vitæ & I think there 
is no danger in giving it tho' these remissions
do not appear, and it has often been given
in continued Fevers in the Decline but seldom
in the beginning - The Bark either is Substance
or Tincture is the best & most effectual Medicine
for checking the violent & colleguative
Sweatings, & especially if a Dose of Rhubarb 
be 

556

557
be interposed to take off the Determination
of the [cross out] Humors from the Skin, the Rhubarb may 
be given by itself or out of the saline draughts
These sweatings should not be suddenly
checked, otherwise they bring on excessive
Sensation of Load on the Præcordia, and 
fainting. Indeed they are frequently the 
consequence of keeping the Patient too 
warm, & if there is any Disposition to 
sweat much observed, there should be 
few Cloths keept on & a cool Air in the room
Sometimes a Blister has stopped these 
but no symptom requires greater Delicacy
in it's management than this
A Violent Diarrhœa is checked. Opiates
and Emetics. especially if Joined together as
in Dovers Powder, but if suddenly stoped bring
on neasea, Cholick. & Delirium.
When Petechia & hemorhagics & other Sympts
of Putrescency come on, these are best check'd
by the Bark & Acids with red wine. And 

558

559
And Apthæ in the throat are cured by Gargles
of Mustard whey or Figs with honey & Vinegar
& if there is a great Quantity of Viscid mucus
a gentle Vomite is of service and for dissolving
it a little Caustick Alkali mix'd in the Gargle
which is the strongest solvent of human
mucus I know.
In order to prevent a Relapse in this Fever
the best Course is the Bark Exercise, & before 
these the Flesh Brush with Cordials & a 
Restorative Diet
The Authors I would recommend on this 
subject are Dr. Gelehrist, Dr. Huxham
Dr. Whyte
I formerly mentioned that I thought these fevers
required a very Different management with 
respect to the Cure & have therefore treated of 
them separately, but it's impossible I should 
give Directions how to manage every Combination
of these, & altho' I could the Physicians
own Judgement must be the only direction
to him & according as he finds the Disease
partake more of the one or other Genus so is 

560.

561
so is his Practice to be varied
The next Order of Febrile Diseases is Remttent 
Fevers which I now come to speak of.
Class 1st. Order III.
of 
Remittent Fevers.
These Fevers are attended with the General 
Febrile Symptoms, which at certain times
remitt of their Violence considerably but 
never so much as to make a perfect Intermission.
1st. Genus Is the Ardent Fever which 
is the Causus of the Antients. It may be distinguished
from the Inflammatory continued 
Fever, by having distinct Remissions
every third Day, & in this we find it's affinity
to the Tertian Ague; likewise by the intense
heat and extreme dry and parched skin
and the excessive Vomiting. The Duration 

562

563
Duration of it is shorter, most frequently
terminated in four Days, & seldom lasts
seven, tho' in some Cases it has been known
to continue fourteen Days, this is very rare.
It attacks with severe Chilliness succeeded
by intense heat, which is most frequently 
felt inwardly, & especially at 
the Region of the stomach, and during this 
heat the Extremities are commonly cold
The Pulse in the beginning is extremely
hard and frequent, afterwards feeble & irregular,
and the Remissions are somewhat
Analogous to the Intermissions of a double
Tertian; There is an excessive bitter taste
of the mouth, a violent head Ach & Delirium
a constant Inclination to Vomite, & what 
is brought up is exceeding Acrid Bile; which 
often is ejected by Vomite & stool [illegible] is so 
excessively Acrid as to excoriate both 
fauces & Anus & even the great gutts as 
we see from the Excrements being tinged 

564

565
tinged with Blood; However if the Patient
is costive there is still greater Danger because
of the Accumulation of this highly
Acrid and porraceous Bile; it will bring
on inflammation of the stomach & bowels
When the Vomiting & Bilious Diarrhœa
is very copious there is a great resemblance
twixt it & Cholera morbus, & these
plentiful Evacuations of it often cure it 
The Breathing is quick & very labourious
and a great tension of the Hypochondria
is observed & is sore to the touch, there is 
a Disposition to faint, & the Urine is 
yellowish & red, the Countenance is also 
tinged with yellow, it is peculiar to warm
Climates. At the End it puts on the Appearances
of the Putrid Fever, there are 
likewise universal sweats without any
relief of the symptoms, and Hemorrhagics
all the secretions appear putrid & fœtid,

566


567
fœtid and Gangrenes and Petechia appear
in different parts of the Body.
The Crisis of this Fever is most commonly
by Vomiting and purging in the beginning
& sometimes by great Hemorrhagics from 
the nose, or by gentle Sweats; when this 
runs into an Intermittent Fever all the
Violent Symptoms cease and the Danger is 
gone; in some Cases it runs into the slow
nervous kind, but this is rare; at oyr
times instead of Remissions, a Paroxysm
happens on the second Day which is 
always a very unfavourable Appearance
& not without great danger; there is often
in this Fever Topical Inflammation especially
of the Stomach & Bowels, and of the 
head. It is not common in Cold and temperate
Climates, & the places where it rages most 
are Italy and the south of France, there its the 
prevailing Disease 
The Prædisponent Causes are Plethora, sanguine 
Temparament, & Prime of Life, it seldom

568

569
seldom attacks Children or Old People
The Occasionall Causes are violent Passions
which have been known to bring it on 
in the space of one hour & we all known
that these Violent Emotions cause a very
great secretion of Bile even in these Climates,
where people are not by far solable
to them as in the Places above mentioned
it is occasioned by excessive Fatigue, and
being much exposed to the sun, but above
all by the Cold damps in the Evening; drinking
of spirituous Liquors is likewise a Cause
In the Proximate Cause all the light we 
have from morbid Dissections is inflammations
of stomach and Intestines and also 
Gangrenes in these, there is found in the 
head sanguine Congestion, & Inflammation
and Suppuration of the Brain, the heart
is considerably enlarged and full of Blood
there is sometimes Inflammations of 
the Lungs, but especially of the Liver, which 

570

571.
which is enlarged & often suppurated &
the Gall Bladder is found distended with 
Black porraceous Bile, the excessive degree
of Acrimony of which requires a quick 
discharge of it. 
The Indications of Cure, are to moderate the 
great violence of the Febrile Symptoms, &
especially the heat and thirst, this is done by 
Bleeding, by Catharticks & Vomites & Emollt.
Fomentations and Acids.
To temperate the excessive Acrimony of 
the Bile, & this is effected by Emeticks and 
Catharticks, by Acids and especially by Cold water.
Blooding in the beginning is no doubt
very necessary to take off the Plethora & mitigate
the Violence of the symptoms, but if repeated
it commonly sinks the Pulse, & besides
often causes it degenerate into a malignant
Fever, and even in Cases of Topical
Inflammation, we shall find it necessary
to use topical Bleeding & not to open a vein for 

572

573
for reasons which are needless here to repeat
and we even find natural Evacuations
of it fatal; when the fever has continued
three or four Days the Blood is always putrid
and dissolved.
We should be very Cautious in the use of Vomites
in this fever because of the great Acrimony
of the Bile & in consequence the Aptness of the 
Stomach and Intestines to inflame if any 
thing stimulating is applied to them; if 
the Patient vomite naturally we should endeavour
to promote it by giving plenty of 
diluent drink; & if we are obliged to give Vomites
Antimonials in small Doses are best
but 'twixt two Evils the left to be chosen.
There are two very good reasons for giving
Vomites here, to dicharge the Acrid Contents
of the stomach and to procure a Remission
of the symptoms, which Antimonials in small
Doses often do; but if we are afraid to give
a Vomite, or the Patient is Costive, Gentle
calling Purgatives should be ordered and 

574

575
and Fruits are extremely proper here, and 
the patient may be allowed to live on these
entirely, which will keep up a gentle Diarrhœa
and correct the Acrimony of the Bile, and Nature
seems to point out the propriety of eating
them largely as this Fever is seldom met 
with but where these are in the greatest
Plenty and Variety.
In Diarrhœa it is often found necessary
to give repeated Emollient Injections
to defend the Rectum and Anus from the 
Acrimony of the Bile and take off it's Stimulus
these should be either of warm water or with Oil
Heating Cordials are particularly bad in 
this Disease, & when any thing of this kind 
is needed wine is by far the best & Rhenish
wine or any other Acidulated wine is good.
It is in this Disease that the best Authors, of 
those Countrys where it is most common;
recommend the Use of Cold water in great
plenty, unless where the Stomach is inflam'd
or any topical Inflammation, but even in 
this Case I presume it may be allowed in 

576


577
in small Quantitys at a time, it is the 
most effectual Quencher of the Thirst, & brings
down the Febrile heat, it if likewise a powerfull 
Cordial and Diaphoretick, it checks the 
excessive Vomiting & Purging; in Italy they 
allow Iced water & Fruits, & there is an Instance
of one patients drinking 10 lit of water at once
without any bad Effect. It is a practice too 
in Italy to prescribe cold Glysters, but there 
is a very general Prejudice against their use 
here, but if there be no topical Inflammation
I can see no harm from them, they have 
likewise been observed to stop Hemorrhagics
but it's not a Practice I would recommend to 
you here.
When the Skin is very dry & parched Pedeluvia 
are very useful but the patient should be removed
in a horizontal Posture & I believe
the Semicupium would be very good -
Cold Applications to the head relieve the Pain
and carry off Delirium, split animals are 
used for this purpose especially in this Fever,

578

579
Fever, and recommended by the greatest
Authors, but they are egregiously mistaken
in the reason they give for this practice
they say the Animal draws out of the Body
all the putrid matter of the Disease, but
what they call the putrid matter is only the 
Juices of the Animal turned putrid by 
the heat of the Body of the person they are 
applied to, and not drawn out of the Body,
by them.
In this Fever the Diet should be of the 
most cooling kind, with cold and fresh Air
and the liberal use of Fruits -
The Authors I would recommend to you 
are Boerhaave with Van Sweeten's Comments.
Hoffman, Baglivi, and Ferti.

580

581
Of
The Bilious Remittent Fever
II. Genus of Remittent Fevers is the present
which I chose to describe by itself in a particular
manner, because it often proves fatal
in Camps and to Europeans when they go into
the warm Climates; It is most frequent in
Autumn sometimes it is Epidemic and it
indeed seems to be always Endemic in hot
Damp Countrys, & seems to be the true product
of heat and moisture.
I mentioned before that in Spring Disease 
generally attended with an Inflammatory
Diathesis of the Blood and in Autum so its
a Putrid in these the Stomach and Bowels
are principally affected with a great Redundancy 
of Bile very Acrid and likewise that
the head was affected, and in this season does
this Disease most prevail-
The violence of the Disease is acrid as the Situation
is dry and Elevated, and then the symptoms
are mild for the most part, but if low and 
damp they are violent and dangerous- This

582

583
This Fever begins in the Coldness Sassitude
Pains of head and Bones Pukness & Sensation
of Oppression at stomach, the fever is always
remarkably increased towards Evening
great thirst, parched, Tongue: head Ach, Restlessness
& Dilirium. Violent thirst in the night
& towards morning partial sweats, with some 
remission of the Febrile Symptoms. If it is 
neglected or offend digeneralls into the Continued
Fever without Remissions & then so 
fatal; sometimes the Fills are carried off by Diarrhœa;
and sometimes it begins in form of a 
Continued Fevers.
Lect.24 Decr.12 1768
The matter that is discharged by vomiting
and stool before the demenstration of Emetics
and Catharticks is exceedingly Acrid & Bilious
& hence the name of the Fever; they are so
violent & Copious as to resemble very much
the Cholera morbus; when they are so they 
are observed frequently to carry off the Disease
It is likewise observed to be carried of by
by a Copious sweat equally dispersed over the
Body- and by the Above Evacuations by Vomite

584

585.
Vomite and [sto?t] and even [cross out] Hamorrhagies
have a very great tendency to make the Intermissions
& remissions more perfect; but 
in hott Climates Hamorrhageis are generally
unfavourable symptoms and proceed from
a Dissolution of the Blood; the state of which 
varies considerably in this Disease
The Remissions of this Fever are not preceded
by any Chilliness as the attack of it
is; it is often attended with hard Biles
and Costiveness which are very bad Symptoms
Worms are sometimes in this Fever & 
are of the Terites or round kind, they constantly 
occasion an increased Violence of ye
symptoms, with Gripes- There is always
a Yellowness of skin more or less attends
this Fever, but not so great as in the yellow
Fever of which I shall treat separately
In general some Degree of it is favourable
if it appears about the 8 or 9th Day, but 
if sooner its not a very good Symptom 

586

587
There are no Critical Days observed in
this Fever; and the most favorable 
Termination of it is in[to] an Intermittent
or distenctly remittent to bring 
it to either of these Types should be the
Physicians chief Desegn in his Practice
The most unfavourable is when it
degenerates into a Continued Fever
this in warm Climates almost always
runs into the Putrid malignant Fever
which generally carries of the Patient
in a very few Days; If the Belly is not 
kept open there comes on a violent Dysentry
which proves fatal in 2 or 3 Days
Deafness is a favourable symptom as
will as in other Diseases.
In marshy countries the Fever is always
more violent in proportion to the
Degree of Moisture & is very apt in 2 or 3 
Days time to run into the Putrid kind, especially 
in Autumn but as Winter advances
it becomes milder. It very frequently attacks

588

589
attacks in the neighbourhood of Marishy
all of a sudden with Delerium, without
any previous notice or complaint, as
our soldiers often experienced in Flanders
when sent out a foraging near any marishy
being often immediately severed upon their
[??meny] withen reach of the Vapours of this 
marish, with a Delirium; it likewise
invades in this same manner when its
owing to Isolation; There is for 2 or 3 Days
before Death a strongly putrid smell fitt
about the Patient & a strange regularity observed
in his Pulse In warm Climates in
this Fever the great Prostration of strength
& Depression of spirits is owing to the same
Cause as the sudden attack of the Disease
vizt. to a general Disposition or Tendency
to Putrefaction. This Fever does not differ
essentially from the Ardent fever before
mentioned, but that in it the Remissions
aged tinct every 3d Day, and only arises from
Externall as conal Causes in general, but

590


591
but this is Endemic in particular Climates
& the general way of treating this the Yellow
and Ardent fever is much the same.
I now proceed to speak of the Antecedent
and Procatartick Causes of the Bilious
Fever, and in damp Countries we always
find it Endemic if they are warm, and in 
Rainy Seasons it's Epidemic once a year
always in these moist warm Climates. It 
is one of the most mortal Diseases in Camps
especially in Autumn. The Common Soldiers
have it generally in a much more violent
form than the Officers, who generally have 
it either not at all or in the shape of a Tertian
or Quotidian or at most but very mild
This is not owing to their living more so turly
than the common men, but they are less exposed
to the heat of the sun by Day and the 
Evening Foggs, they have better Quartars
& drink more wine. The Common Men again
that were exposed all Day to the heat of 

592
591

593
of the sun and then were appointed Centurys
at Night & so exposed to the Fogs
never missed to have it either in form 
of an Intermittent or Remittent Bilious
Fever; it was observed that when the 
warm weather was corrected by a freqent 
fall of showers, the fever ceased, & we 
in general see that these kind of Fevers
are much less frequent even in marishy
hott Countrys when the ground is covered
with rain than when the water is almost 
exhaled the reason is evident
because of the Putrid Vegetable & Animal
Exhalations which has been mention'd
before when on Intermitting fevers.
There are other predisposing Causes
as Excessive fatigue, and Drinking;
Gluttony likewise and Intense heat of the
Vertical sun; or a sudden Check to the Perspiration 
by putting on wett cloths when 
hott, and lying on the wett Ground. The 

594
594

595
The most frequent Cause of Mortality
among our ships to the East Indies, is the 
Sailors going ashore to water and sleeping
in woods all night, which produces
it in it's worst shape, those that do this 
service should be those that are accustomed
to the Country and it ought to be 
done in the Day time.
Not long ago there was a fever of this 
kind that raged at Lyden & proved so
mortal as to carry off at lest 2/3 of the 
Principle Inhabitants, described by 
Selveus who was at that time in high
repute but from his manner of treating
we may Account in some measure
for the mortality, his Theory of Acid did 
egregiously mislead him here to exhibit
such remedies & Regimen as in 
effect greatly added to the violence of the 
Disease by increasing Putrefaction
and so turning it into a putrid Contin. Fever.

596
596

597
Fever. His Practice was to give liberally
of Testacea & Volatile alkalics and 
to prescribe a very hott Regimen all which
are known to increase Putrefaction.
This Disease is the genuine product of heat
and moisture as we may be convinced by 
comparing the healthiness of the Country
about Rome now to what it was formerly
when it was kept clean and properly
drained & cleaned, & for this & several other
Causes consult Lancisi de Noctius Poludum
Effuviis - Sailors are particularly prædisposed
to have this Fever, especially in 
their going to the East & west Indies, in a 
worse Degree than others, because of their 
Diet being of putrid Animal Food salted
likewise the heat and bad Air in Course
Stormy weather then they are obliged to shut
the Ports, hence upon the Occasional Cause
of going ashore formerly mentioned Cooperating
the Disease will certainly be proportionably
dangerous & violent we know how 
much this salt putrid Animal food disposes 

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599
disposes them to the Scurvy, which is a 
very putrid state of the Body. There is 
another Cause that disposes them to it [cross out]
when they see the Crew so diseased and 
affected by this mortal Disorder their own 
naturall Apprehension of their own life
& likewise the Excessive Perspiration and 
sweating which Europeans have in these
warm Climates subjects them to the Depressing
Passions. The Remittent Fever of 
itself does not appear to be so very Contagious
and all those who entered to go to the Indies
should Consult Dr. Linds Elegant Thesis.
The Yellowness of the Skin is not at all 
owing to any Hepatick Obstruction, but 
entirely the Redundancy & immoderate
Secretion and Consequent Absorption of ye
Bile. There are some persons who are constantly 
exposed to putrid Effluvia both Animal
and Vegetable, without being at all affected
by this Disease, such are scavangers
and

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601
and Victualling Officers of the Navy and Anatomists
in dissecting morbid Bodies, but 
why these Effluvia have not the same effect
as those of marishy Countrys, which proceed
from the very same Substances I cannot 
explain - The Inhabitants of such Countrys
as these and Intermittents are freqt
in, are commonly healthy enough, & live
to a good old Age, but in general not quite
so healthy as those who live on high &
elevated situations, and are not by near
so subject to them as Strangers, but we 
know that whatever acts on the Constitution
loses it's effect by repetition and even Poisons
do this the Constitution can be so bent to 
them by frequent use as not to feel them
When people sleep out in the night time
they are ceteris paribus more exposed to this 
Fever than when they walk about in the 
sun on the Day time.
The sun and moon are observed to have 
a very remarkable Effect on this Disease 

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603
An Eclipse of the moon frequently causes
a relapse, and when the sun is clouded
the symptoms are generally more severe
than when he is clear; and Patients are 
worst at new and full moon and at low water
or sea more die, these are really facts which I
do not attempt to explain but may be 
of Importance to observe and we may be 
able in the Eclipse to prevent the Relapse
so frequent then by the Exhibition of the 
Bark and in full & new moon.
To Europeans there is no Employment
in these Countrys more destructive than 
cutting down woods especially in rainy
seasons, its even more mortall than 
the Plague.
I now proceed to mention in the next 
place the Indications of Cure. And 
1 We should endeavour as soon as possible
to procure an Intermission of the Fever or 
as perfect Remissions as we can.
2. To procure an Evacuation of the Redundent
and Acrid Colluvis of Bile in the P.V.

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605
3. To resist the Tendency to Putrefaction.
4. To Moderate the Violence of the Symptoms
As there is no Crisis in this Fever we 
must not depend on natures making
any Efforts for her relief, for we are very
certain the greater part of those who are 
seized with it would die if not assisted
by Art - Blooding is only Occasionally
necessary especially in Europe & here in 
case of Inflammation it may even be repeated,
but in warm Climates, blooding
once cannot be bore at all; the most proper
time when judged necessary is in the hight
of the Febrile Paroxysm - In warm Damp 
Countrys where blooding is most dangerous
when there are violent affections in the head
that require this Evacuation, Topical bloodg.
is safest & most effectual.
Evacuations are very necessary by Vomiting
in order to procure a Remission or Intermission
that the Physician may thus have an Opportunity
of throwing in the Bark, which

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607
which is the great Design of giving them &
besides they procure a Discharge of the Cured
Bile and often pass by stool - They likewise
with purgatives have sometimes the good 
Effect to stop this Fever entirely.
When we give Emetic Tartar in this Fever
& in general the Patient should not be allowed
to drink soon after it because the less they 
drink the greater Tendency has it to pass
downwards, & here Dr. Pringle says it answers 
better than Ipecacuanha, which he suspects
to be rather hurtfull. The general way of 
giving the Emetic Tartar is in small Doses
but in warm Climates there is great Caution
necessary in giving Vomits because of the 
excessive Acrimony of the Bile producing
inflammation of the Guts and stomach
which would be greatly increased by the Vomite
they may be given with much greater safety
in Europe, and in warm Climates if they 
are given soon enough there will be no Danger
because this Inflammation does not happen 

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609
happen till the 3d. or 4th Day.
Purging is certainly necessary in this 
Disease to evacuate the Redundant Acrid
Bile and likewise to assist in procuring
Remissions, but they should not be of the Acrid
Stimulating kind otherwise they will in 
danger an Inflammation, they should be of 
the cooling mild kind and Emet. Tart. dissolved
in a Decoction of Tamarinds and Solution
of Manna is one of the safest and most proper
Cream of Tartar in small Doses frequently
repeated is likewise very good and is Cooling
antisceptick & purgative.
If Emet. Tartar does not pass by stools
a Glyster will be very proper to give it 
a Determination this way.
In Warm Countries this Fever is often 
so violent as to carry of the Patient at the 
2d. Paroxysm if the first is not catched &
the next prevented by the Bark, and when 

610

611.
when the Bark is given before the 2d. the 
3d. is the most Violent, and it was this 3d
Paroxysm that carried off the Men at the 
taking of the Havannha
It has been observed that in Germany in 
high Elevated Situations, the Bark did not 
agree with the patients, but this was only
when the P.V. were not previously cleaned
& the Patient blooded - As soon as the hight
of the Paroxysm is gone we should begin
to throw in the Bark & not wait till the 
Sweat be over, but give ʒi. every hour till
we have made them take ℥i. or ℥iss.
In warm Climates the Stomach is very irritable
& will not keep the Bark, here we are obliged
to join with it 10, 12 or 15 Drops of Laudanum
and if they cannot bear it in this Form we 
must give it in Glysters. Sometimes in the west
Indies particularly the symptoms have run
so high as that no Remission could be observed
& here as soon as the P.V. were cleaned the Bark
has been ordered without waiting for Intermission

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613
Lect. 25 Decr 13 1768. 
Intermission or Remission.
In this Fever the common Febrifuges cannot
be given on account of the great Irritability of the 
Stomach and saline Draughts are liable to the same 
Objection, unless given in the Act of Effervescence
& then they stop the vomiting and are by Experiments
found to be Antisceptic; but these and all Neutral 
Salts are found offensive to the stomach & the 
more so on account of the Putrid Colluvies in 
the P.V. When Juice of Lemons cannot be had an 
easy Method of making them is by taking one
part fix'd Alkalic and 2 parts of Cream of Tartar
and putting them into water where they 
raise an Effervescence.
The Prostration of Strength & Depression of 
Spirits indicate the use of Cordials and wine
is the most proper with some Orange Juice
in it, Volatile alkalics because of their Stimulating 
the Stomach too much & not on Account
of their septic Quality which they do not at 
all have, are improper here, unless it be 
when a very sudden stimulus is wanting 
These Medicines disgust the Patients Stomach 

614


615
Stomach and prevent its bearing the Bark
which is the Medicine on which the Life depends
in this Disease. The Diet here should be 
Cooling and Ascescent, & fruits are particularly
proper, but what is of the greatest
Consequence in point of Regimen is removing
the Patient immediately into a dry cool Air
or an elevated situation, the suddenness
of the seizure shows the very quickest Contagion
and if by any means it is practicable
to remove the Patient it should be done, but
when this is impossible no Medicines
will avail; This Removal is no doubt attended
with some real Inconvenience and even danger
but if he is carried to a considerable Distance
in a horizontal posture on a little & common
care taken of him there will be little or no Danger
& Dr. Lind has seen them removed severall
miles in this way without any bad Effect at 
all, but in doing it we should be carefull to shut 
out the Light because it has a bad effect in 
encreasing the Delirium; there are very few 
places or Countrys, even the most unhealthy but

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617
but you'll find some Spots where the Endemic 
Disease does not prevail & the Inhabitants
are perfectly well. Our people are egregiously
mistaken when they say it's not the night Damps
& putrid Effluvia, but the heat that does it, this 
alone will never do it. It is found that in case
at land there be no conveniently situated Place
for removing the sick to, if they are taken aboard
a ship at such a Distance from Land as to be out 
of the reach of the Fogs, it has a remarkable
good Effect & is a Circumstance which ought to 
be well attended to & remembered by all such 
as intend to go to the West Indies, or to the 
Coast of Guinea where this often happens
& to all Europeans proves benifical.
In the Intermittents in England this same thing 
happens, for we are often obliged after giving 
Medicines to no purpose while the Patient
remains in the Marishy damp places, to 
remove him to dry Elevated Situations and 
then he will recover in a few weeks perfectly
Fresh Air and Cool with th greatest Cleanliness
are indispensible points in Regimen Blisters

618

619
Blisters in warm Climates are not proper
unless in Cases of Coma or Stupor sometimes
when applied to the Region of the Stomach this
remove the vomiting & violent pain it occasion,
in the beginning of the Disease they rather
exasperate the Symptoms.
Too soon using much Animal food causes
a Relapse, the best means of preventing of 
which is Bark, Cold Bathing & proper Regimen
of Diet; in Europe the frequent use of Greens
and other flatulent Substances, and neglect of 
the Bark bring on a Relapse.
The Best preservatives against this Fever
is a proper degree of Exercise, avoiding Night 
Damps, and sleeping in dry well Aired Room
The Authors I would recommend to you on 
this Subject are Dr. Pringle, and Dr. Morro
on Comp Diseases, but especially Dr Lind
Cleghorn on Diseases of Menorea.

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621
of 
The Yellow Fever.
III Genus of this Order is the Yellow Fever of 
the West Indies, I might have perhaps included
it as a species of the Bilious Fever
but as there are some symptoms that can 
easily distinguish them & are particular
to this Disease, and because it is so very
fatal to Europeans I chose rather to handle
them separately.
The yellow Fever begins with Anxiety, Tension
and Weight of the Hypchorid. & Præcordia, a 
burning heat of the Eyes, vomiting of Bile,
great Debility & yellowness of the Skin.
It is Divided into two stages, 1. The Ardent
and Inflammatory, 2d. The Putrid Stage.
The Ardent Stage begins with Rigor, Vertigo
Pain above the Eyes, Neausea; these are succeeded
by Ardent pungent heat, the Pulse
is full & soft, a violent Pain of the head, with 

622

623.
with great Pulsation of Carotid Arteries &
flushing of the face. There are now Pains of 
the Eyes, vomiting of Bile of various Colours
from yellow to green and Black, & so very
Acrid as to excoriate the Gullet and Anus &
bring the Blood. Now there is great Internal
heat, Tension & Swelling of the Hypochondria
the Breathing hott and difficult Jactation &
want of sleep, unquenchable Thirst, Bitterness
of the mouth very great. The Tongue yellow
but not very foul, Costiveness, Urine red
& high coloured & in small Quantity, the Skin
for the most part dry, tho' sometimes moist
On the 2d. Day there is commonly A Remission
for a few hours, but the Symptoms return
with increased Violence, and the Tongue grows
brown in the middle, but red at the Edges
the Lips are likewise red; the Tongue at the 
End of the Fever grows Black.
This is the Ardent Stage of the Disease but
after this the Symptoms of Putrefaction come 
on & hence we name it the Putrid Stage

624

625
stage; and on the 3d Day we commonly observe
a viscid Symptomatick Sweat, and the 
Pulse large soft & full, the Skin feels coldish
there is great Anxiety, with some remissions 
fainting on the least motion, Breathing deep,
the Patient Comatose, with transient fitts of 
Delirium, Yellowness over the whole Body
but very Deep in the face and Eyes.
On this 4th. Day Vomiting Continues & the Bile
thrown up is mix'd with Blood, this likewise
passes by stool & the Putrid Symptoms follow
as Hemorrhagics, cold & swelled Extremities
Hiccup, Urine bloody of a yellow Colour with
a Black Sediment, which is a very bad Symptom
but if absent all the other appearances
are exasperated, & now there appear Black
Spotts on the surface of the Body & shortly
the Patient dies either Comatose or by a sudden
and general Convulsion. The State of 
the Blood in the beginning of this fever is
always observed to be somewhat dissolved, but in 
the End is altogether [illegible] & very fœtid. This 

626

627
This Fever sometimes comes on very mild
& all of a sudden kills the Patient, when no Danger
was seemingly to be apprehended.
The Delirium is never constant, & in Cases
where there are no Remissions it proves
fatal on the 2d. Day. It sometimes runs
into an Intermittent, but tis observed
that in Barbadoes it never takes this 
turn. It is sometimes carried off by sweating
and by Diarrhœa, seldom by Vomiting, &
never by Hemorrhagics, because they always
appear in consequence of the Dissolution of 
the Blood, it is carried off too by Natural
salivation. Instead of growing pale when 
they faint here they grow more yellow.
The Yellowness appearing only about 8 or 9 Day
of the Diseases reckoned Critical.
Physicians who have not had Experience, upon
seeing a person Comatose are very apt to think
their patient out of Danger, tho' perhaps within 
a few hours of Death, because the Pulse becomes
soft, full & slow, the heat less, the Breathing full
and deep and every thing almost as in health

628


629
There is often in this fever a lightening before 
Death and recovery of the senses for a few hours
and then the Patient suddenly carried off by a 
sudden Convulsion.
In Carolina this fever is attend with a Moist
tongue, little thirst, & sweating on the 2 first
Days, Urine of various colours, from pale
and limpid to high coloured, the stools are 
bilious and after the first Day fœtid, there is 
great prostration of Strength, and the Fever
goes off on the 3d. Day, the pulse then grows
hard & slow, then soft, the heat less, Respiration
and tongue are soft; the Pulse continues to sink
the Vomiting lasts and the Bile thrown up is 
often Black and proves a mortal symptom
upon the Vomiting there is an increase of the 
putrefactive Symptoms, of the Delirium,
Jactation, there are Petechia, Black stools &
hemorrhagics, sometimes they live 7 or 8
Days and often it proves fatal in 48 hours
The greater the Sediment in the Urine for the 
first 2 days of the fever the more fatal the 
Consequence, & the sooner the Yellow Colour appears

630


631
appears the more fatal the Disease, the Pulse
is often as in health; from this Account of it 
in Carolina it appears to be the same as in the 
west Indies tho' different in some Circumstances
Antecedemt & Procalarlick Causes. It is peculiar
to strangers & seldom attacks the the Inhabitants;
those who are most subject to it are the 
young, the sanguine & plethoric, those who most 
feared it's Attack are most apt to be seized with 
it, people who come from a Cold Climate, or have 
been weakened by previous Diseases are more
subject to it than others. It's violence is greatly
increased by hott Calm weather & Putrid Exhalations,
but frequent cool Breezes contribute
to abate the symptoms and to the general
health of these places; it is likewise produced
by being much exposed to the heat of the sun
by drinking largely of fermented Liquors
& feeding much on Animals, and by the Night
Damps. In Carolina it is infectious hence
different from what it appears to be in the 
west Indies, and is a fever that seizes once
in one's life. In Carolina, the Children and 

632

633
and Negroes escaped, but were subject to 
Bilious remittent Fevers. The Contagion however
did not spread in the Country, and as 
every orther Infectious Distemper was checked
by the approach of winter; the Symptoms were
observed to be increased by very hot Days and 
by the Patient being kept in a close Room.
The Proximate Cause. In this as well as 
in the 2 former fevers there appears a very
great Redundancy Acrimony & Absorption of 
the Bile, and in the first stage there are commonly 
Local Inflammations especially of the 
Liver and stomach, which is succeeded by 
the Putrid stage.
The Reason why the Natives are not subject
to it may be that they have a laxer System and 
the vessels on the surface are always full & they 
sweat easily, but it's a considerable time before
the Skins of Europeans can be rendered so
lax by the heat, or the Cutaneous Vessels be brought
to yield to the necessary fullness for supplying
the sweat, and as there is a remarkable Degree of 
equality observed 'twixt the Injesta & Egesta,

634


635
Egesta, and a constant tendency to putrefaction
in the Animal System, if therefore the superfluous
putrid particles are not carried off this 
tendency will be increased by this besides by 
the heat of the Climate and Moisture, and if to 
this we add that the Excretions are lessened no 
wonder will remain that these places should 
produce this Disease on strangers.
I am not certain if the Yellowness be owing
to the Absorption of the Bile, because we often see 
the skin rendered yellow from other Causes
as putrid serum, & the Bite of the Viper causes
a Disease in which the skin is Yellow and 
in the Scurvey, which is a very putrid Disease
Morbid Dissections throw no light on the Proximate
Cause of this Fever, only show it's Effects
as Inflammations of stomach and Gangrene
the Liver inflamed enlarged & suppurated
& the Brain affected in the same way.
In many Circumstances it nearly resembles
the Plague, tho' essentialy & specifically Different
in others, & I do not think the Plague ever appeared
in the West Indies. I now come to mention
the 

636


637
the Indications of Cure. The 1st. is to moderate
the Inflammatory symptoms in the beginning
2d. To evacuate the Acrid Colluvies in the P.V. in order 
to procure a Remission of the Symptoms.
3 To check the Putrefactive tendency by Antiscepticks
4. To relieve the particular symptoms &
support the strength.
It is necessary in the beginning to abate the 
Inflammatory symptoms to draw some 
Blood, but this should be done with Caution
otherwise it will produce very bad Effects
and the Quantity should never exceed ℥j or ℥vvj.
where the head is very much affected, after blooding
has perhaps been premised, cupping &
Scarifying are much less dangerous & more effectual.
Blooding in the beginning moderates
the Symptoms and lessens the Putrefactive
tendency, but unless in the very beginning it 
is not att all adviseble afterwards.
Vomites in this Fever should be given with 
great Caution because of the great irritability
of the Stomach & it's being so apt to be inflamed
by the putrid Acrid Bile, but Tartar Emetic 

638

639
Emetic given in small Doses or in the Decoction
of Tamarinds recommended in the last
Disease it carries down the Putrid Colluvies
& more certainly when small Doses of Laudany
are added, Glysters likewise cause it exert
it's effects by stool, & besides the Copious Stools
& Relief of the other Symptoms it likewise
procures Remissions & so gives an Opportunity
of throwing in the Bark. If the Natural Vomiting
is violent, the Stomach may be cleared
by Chamomile Tea, and afterwards the Vomiting
stops by the saline Draughts with opiates
and a warm Cataplasm of Theriaca & Laudanum
applied to the Pitt of the Stomach proves very
servicible in this Case. It's observed when
James's Powder is given in the End it's attended
with fatal Effects, & no wonder considering 
the Case of the stomach & its violent
Operation: it may be a Question whether
the Inflammation of the Intestines & stomach
be caused by the Acrid Bile or violent Symptoms.
Lect. Decr. 5 1768

640


641
Lect. 26 Decr. 15. 1768. 
I mentioned before the Danger of giving Emetics
especially in the End of the Fever, because of the irritability
of the Stomach, and the Danger of Inflammation,
which is generally seated in the Durdeny;
likewise that the Stomach might be washed
out with Chamomile Tea, and after this 
to direct the Operation of the Tartar downwards
to join it with Tamarinds & manna, & if 
afraid to give it at all, as it's necessary to evacuate
the putrid & sharp Bilious Colluvies
either way coolling Laxatives which have this 
Effect with the least Stimulus, may be given
to great advantage, and the best of this kind 
are fruits and especially Tamarinds.
The Saline Laxatives as Glauber salts &
Regenerate Tartar, are very proper in this 
Case but the stomach rejects them, & in order
to prevent this Opiates should be joind with 
them, which is an exceeding usefull Practice
in this & many other Cases where the Stomach
is so easily irritated. It is always necessary here  

642

643
here to keep up a gentle Diarrhœa from the 
beginning of the Fever to the End lest this Acrid
Bile should be accumulated.
Diet here should certainly be of the most cooling
and Ascescent kind, & fruits if they can be 
had should be eaten freely - Cold water has 
the same good Effect here as in the Ardent fever
& checks the vomiting when nothing else will
do it, it may be made a General Rule that 
all Drink should be given in very small 
Quantities in all Cases where there is such 
Irritation of Stomach -
If Cordials are required Wine is the best mix'd
with lime or orange Juice, Rhenish wine
or old hock or Claret are most proper. The warm
Stimulating Cordials as Serpentary, Camphor,
Sal. C.C. &c. irritate the stomach prodigiously
& are directly rejected, but Dr. Hillary mentions
a Case when the Bark would not sit on the 
Stomach at all & a Decoction of Serpentary
cured the Fever, & sat easy
The dryness of the skin formerly mentioned, strongly

644


645
strongly points out the propriety & Necessity of Pedeluvia
& warm Fomentations to the Extremities, it
relaxes, promotes Diaphoresis, and acts as 
a plentiful diluter, which last is especially
necessary where by reason of the Vomiting
Proper & sufficient quantitys of liquids cannot 
be swallowed; & over and above whatever promotes
Perspiration during the vomiting soon
brings on a copious sweat, & it has been a 
successfull Practice for this Purpose to put 
on the Patient a wett shirt of flannel wrung
out of warm water, which procured a sweat
when nothing else would do it, these warm
fomentations & Bathings, are especially
usefull, in the Ardent Stage of this Fever;
but if at all used, in the Putrid state, it should
be very cautiously; because the Patients are 
exceeding apt to faint, & if in the least hott, it 
induces Depression of Strength & Spirits; but 
in generall it is most needed & most proper
in the Inflammatory Stage, of this Fever.
Blisters are in generall of no service in this 
Fever, in the Ardent Stage exasperate all 

646

647
all the symptoms, and in the latter, are of no 
manner of use, unless in Cases of Coma & Sleep or
Hillary is a great enemy to them, in this fever;
tho' on a piece of very idle Theory, the Alkaline
salts of the Cantharides, being thrown into the Blood,
says he dissolves it, & induces Putrefaction; but
this, as may be collected from what I have already
said of Blisters is erroneous.
After cleansing the P. Viæ by the Medicines already
mentioned, which have the good Effect of procuring
Remissions, & sometimes too, cary
off the Fever entirely; but as soon as the least
Remission appears, the Bark is to given
either by the mouth if the stomach will at 
all bear it, or by Glyster, and given in as 
great Quantity as the Patient can take 
because it is the only remedy to be depended
on this Fever. Some have said that it cures
the Mania that remains after Fevers, but 
I believe they would have gone off without 
it, & they often disappear in Fevers where the 
Bark had not been used. There are some 
Stomachs that reject the Bark in every  

648

649
every Form it can possibly be given in 
even in form of Gylster, but the Gylster shd.
have some Laudanum mix'd with it, and 
Opium in a Dose of gr. iss. in a pill checks the 
Vomiting better than in a liquid form, & we 
find the Stomach sooner rejects liquids with 
Laudanum than this form with no liquid
and here they must abstain from drinking
with it.
I now shall mention some Circumstances
necessary to be attended to by those 
who intend to go to these warm Climates
relative to the Prophylaxis. And when 
Young, Plethoric people & such as are subject
to Inflammatory Diseases, go to such Climates
it's proper they should lose some 
Blood, & but a small Quantity & only such 
persons should lose any & it must not be 
esteemed a general Rule, for it will not protect
them from the Fever, the Intention of it
is only to render the Symptoms more mild when
the fever begins; It's of the utmost Consequence
to keep up a due degree of Perspiration, 

650


651
Perspiration, hence Pedeluvia at night
& fomentations with frequent Bathing
are necessary to relax the skin and Dipping
in the Sea is found to be the best Cordial
and promoter of Diaphoresis that can
be taken. It is particularly necessary
to keep a very open Belly especially by eating
freely of fruit, and when these cannot be
had Cream of Tartar in small Doses must 
supply their place, and a cool vegetable Diet
should be persisted in; Animal food & much
fermented liquors are both very bad; but 
wine may be used in moderation; the heat
of the sun should be avoided; but above
everything the Exposure to Night Damps &
lying at night in the open Air these are the 
most frequent & worst Causes of this Fever
When the Fever makes it's appearance
in a damp moist Place the Patient should
be immediately removed to a high elevated
situation, which will greatly contribute 
to his recovery, in Antigua is a hill
the Inhabitants of which enjoy perfect

652


653
perfect and uninterupted health, and 
the persons removed to it generall soon
recover and do well. 
There are many Circumstances in which 
these fevers the Ardent, Bilious Remittent
& Yellow Fever are found to agree, there is 
in all of them a Disposition to remitt, in all
of them there is a Redundancy of Bile, all 
begin with Inflammatory Symptoms  
they agree in that Evacuating Medicines often
entirely carry off the Fever, and seldom miss 
of prouring a Remission of the Symptoms
or an Intermission, and the Bark cures
them all at this Period, they agree in the great
Irritability of the Stomach, and this as was 
before said should make Physicians particularly
Sollicitous not to disgust the Patient
with Drugs, & so render him unable 
to swallow the Bark, there should for this
very reason be the greatest simplicity of
Prescription observed, I apprehend none 
more are necessary here, but Antimonials
the Bark and fruits, and wine as a Cordial
The

654

655
The Authors I would recommend are Dr. Hillary
Dr. Mikketriks, Dr. Lind in the Edinburgh
Physical Essays, but you should be cautious
in following the Practice of Authors who 
wrote some years ago, because I apprehend
the method of treating the Disease now is a 
little different from what it was then and 
Now the treatment is much more simple
and better adapted to the Disease.

656










Med. Hist.
MS.
B
7