L. J. Jardine Lectures on the Institutes and Practice of Medicine delivered at Philadelphia by BENJN: RUSH M.D. 1799  1 Introduction General Observations There are 3 modes of acquiring a knowledge of the Practice of Physic-1st from Books, 2ndly from Lectures & 3dly a Careful examination of and attention to the Symptoms & changes of Diseases in sick people- (1st) Books-Practical Books cannot be read with much advantage till the Student has been familiar with Diseases-To read with the greatest possible benefit, you should read all the Books that you can meet with, which treat of diseases that you may see in public or private practice- (2) Lectures-They are advantageous by inviting regular attendance at a certain fixed hour, and by the greater interest excited by a viva voce Lecturer-To ensure the greatest possible benefit from them, when 2 or more students lodge in one House, the subject of the Lecture should be regularly talked over on their return, and they should be careful not to attend too many professors at the same time- (3) Attendance upon sick people-This is by far the most advantageous mode, and 2 for the following reasons (1st) all the old books of Medicine are exceedingly imperfect (Morton, Sydenham & a few others excepted) from their copying after ancient Authors, & not writing from actual observation- A great alteration however has taken place in this respect for the last 30 or 40 years, & Medicine during that period has undergone greater improvements than it had for a Century before-(2dly) Some things cannot be learnt from Books, no language can describe the different states of the Pulse (3dly) The facts of many Authors must be admitted with caution-Dr Cullen used to say "that there were ten false facts, (if he might use the expression) to one false theory in Medicine" Too many writers curest the Symptoms of diseases to accommodate their own particular theories- In order to render your attendance on the Sick as profitable as possible observe the following directions (1st.) Visit once a day or oftener, if the Disease be acute & dangerous-Keep an exact account of the Symptoms & of the Remedies you have prescribed, and of the probable changes produced by them in the Disease-(2) Visit exactly at the same hour-punctuality is highly advantageous-Never disappoint a Patient, if you have given him reason to expect you on a certain day or hour (3dly) Let the Patient have his Medicines as soon as possible after they are prescribed-Attention to the Pharmaceutical part four Profession is particulary 3 particulary important-as well might a man attempt to be a good General without being a Soldier, as to be a good Physician without first being an Apothecary- (4) Be not seduced by uncommon Cases from attending to such as are common-Dr Hamilton of Glasgow, Professor of Anatomy, when a Student was censured by his fellow Students for continuing by the Bed side of a Man in a Fever when a Child with 2 Heads was just brought into the Hospital "I shall probably, he replied, never again see a Child with 2 Heads, but I may meet with fevers every day of my life." Indeed he that should eradicate fevers from our Bills of Mortality would add much more to the happiness of the Community, than if he discovered a Remedy for Cancer or Aneurism- (5) Sit up with four Patients in the critical periods of the Disease, more will be learnt in one night than from many transient visits during the day-Besides we are by this means prepared from the Exacerbations which often come on in the Night, and for the great debility which often takes place in the subsequent Intermission- It will be often necessary when you sit up to examine the Pulse every hour-in order to do this with safety, accustom yourselves to habits of Self Denial with regard to Sleep- 6) Do not leave your Patient too soon-consider the Convalescent state of demanding your attention, for Diet, Dress and Exercise- 7) Let no public or private duties, pleasures or studies prevent your Attendance- 4 (8) Let every part of your Conduct & Conversation be calculated to inspire hope-Conceit can kill & Conceit can cure- (9) Public Patients are valuable on account of the regularity with which their Medicines are administered, & your absolute dominion over them- Private ones from the greater variety of Diseases, and particularly the Diseases of high life- Hospital Practice is generally the most fatal from the late period at which Patients apply for admission from noise &c &c- In visiting a private Patient, never enter ye Room without giving notice In Consultations, the first Physician called in altho' the Senior always precedes &c The consulting Physician should never visit the Patient alone- Do not feel a Pulse upon first entering the Room, your arrival may perhaps have hurried your Patient- Warm your hands and always sit down Dr Fothergill always laid his Hat aside-it gives your Patient the idea of your not being in a hurry Lay aside your great coat- When you have taken your seat ask your Patient the History of his Disease and let him tell his story without interruption-Then Question him- How long has he been ill. How, when & where affected. With Chills or Sickness. In the Day or night. At home or abroad. What cause does [crossed out] he think brought it on. To this last question an erroneous answer will sometimes be given, but often times a true one- 5 Enquire into the previous labours, diet drinks, Amusements &c for some time before, particularly the Diet for the last 24 hours, and whether any change of Dress or Bed Clothes- Inquire whether any and what Medicines have been taken-Steel will render the Stools black, Opium makes the Pulse full & slow, produces sickness, itching of the skin & sometimes Dysury- In Chronic Diseases inquire into old Habits-The Gout at 40 is often the effect of intemperance at 20- Complaints in the Stomach & Bowels often affect Women in middle life, from having in Youth eaten pickles & vinegar in excess to make themselves thin-Hurts often affect the Body after an interval of many years- a stroke on the Back produced an Abscess there 4 years after-a Gentleman in Philadelphia is much affected with a pain in his Eye, which he says was first brought on by being lifted up when a Child by the hair of his Head- Inquire whether your Patient has ever had the Disorder before-if so its duration, and what Remedies alleviated it, also what were the diseases of the former part of his Life-they often produce Diseases related to each other- A. B. in Child Bed has Chorea St. Viti on one side, at 40 she was seized with Hemiplegia- the Prognosis here unfavorably it shewed deep-seated Organic Affection-Rheumatism & Phthisis are related & frequently alternate with each other- 6 Cutancous Eruptions often lay the foundation of Visceral Affections, also Issues & Sores, when healed, they should therefore be inquired after & attended to- Above all inquire whether he has ever had a wound in his trunk, or broken & dislocated Bones or even Strains. Inquire whether the disorder be hereditary. what relieved his Parents or Ancestors. A Gentleman who had come from France to America was tormented during his stay, with a most violent and destinate Chronic Rheumatism-On his return after suffering from his disorder for some time, an old Man who had known his Grandfather, who had been troubled with the same complaint, suggested a Remedy-It consisted in producing Artificial Hæmorrhoids, by applying Leeches to the Hæmorrhoidal Vessels-This prescription has cured the Grandfather, he tried it and was cured also- Family Recipes are often valuable & beneficial from hereditary idiosycrasy-hence it would be useful for all Parents to record their diseases and their Remedies for the use of their Children- Madness, Gout & [cross out] Consumption are more difficultly curable if Hereditary- Attend to the Native Country of your Patient-The Intermittent Fever of Barbadoes frequently 7 goes off with swelled Legs, an instance of which occurred in this City, in the Case of a Servant Girl from that Gland- Much attention is to be paid to the native Country of the Patient in the Article of Bleeding Also attend to their Phraseology in describing their Diseases-Thus in describing the Oppression at the Præcordia, which takes place in Fevers the Scotchman tells you that he has a pain in his Breast, The Irishman, a pain in his heart, the Englishman a pain in his Stomach, the New Englander, an inward weakness- Inquire the seat of the principal pain when most acute. what increases what lessens it. Also the state of the Appetite for food & drinks. what of each is most agreeable what degree of thirst. Inquire into the state of the Alimentary Canal, & of the discharge from the Stomach & Bowels, also of the Excretions of Urine & Sweat Inquire into the degree of sleep & the state of the faculties of the Mind during Sleep, as in Dreams- Inquire into his habits of eating & drinking &c also whether he have suddenly left off any accustomed Stimulus, as Spirits, Tobacco &c-More Wine must be allowed to Patients accustomed to that Stimulus. In Diseases of the Mind learn the Temper of your Patient-Patients often conceal the true seat of their Disease, as in Consumption, and also the Cause, 8 as Love, Debt &c Endeavour to ascertain the longevity of the family of your Patient-Hopes of recovery may often be indulged where he has descended from long lived Ancestry- Besides these inquiries, the Physician must also make many observations without asking questions- (1st) Attend to the Tongue-White shews Fever of the common Inflammatory kind also attends Dysentery & Fevers of mixed Diathesis- Black & Dry Tonque, a tendency to the Gangrenous state of Fever-Yellow, Bilious Fever not impacted you should inquire however, whether your Patient has been taking anything which would alter the colour-Claret, Port, Liquorice, Black Currant Jelly & Tobacco will discolour the Tongue similar to the effects of a Bilious Fever- (2) [crossed out] Study the Countenance Calculus is always attended with a melancholy Countenance-Hydrocephalus Internus with a Frown-Consumption with hanging of ye Lips, paleness and the circumscribed Hectic flesh-Mania with a wild aspect-Malignant fevers with malignity in the Countenance, redness of the Eyes, a quick motion of them, languor &c- (3) Attend to the Eyes & examine the Contraction or dilatation of the Pupil-the latter generally denotes some affection of the Head-also their colour, black are said to be predisposed to Consumption & Gangrenous Sore Throat- (4) Attend to the decubitus of your Patient 9 how fat natural, whether quiet & composed, or restless & uneasy- (5) Attend to the Age of your Patient, on account of the predisposition of particular ages to particular Diseases, more particularly a Female at the periods of the flow & Cessation of the Catamenia (6) Sometimes eating with your Patient in discovering the Cause of Dyspeptic Complaints- I found out the Cause of violent Gastrodynea in a lady, by dining with her & observing the vast quantity of Mustard which she ate- (7) In females whatever be their Complaints, never lose sight of the peculiarities of the Sex (8) In Infants always keep an eye on Dentition and worms- (9) Attend to the colour of the Hair-Red haired persons are said to be liable to Pulmonary Complaints. Black haired personns are generally of an irritable habit- (10) Attend to the Teeth-Good Teeth have been said to attend Consumptive Habits-if there be any truth in the observation, I suspect it must proceed from such persons eating too fast, and thus impairing the powers of Digestion- but bad Teeth equally impede sufficiont Mastication and may also taint the food- (11) Attend to the Respiration, whether easy or laborious- (12) Attend to the state of the Skin, whether dry or moist- (13) Attend to the voice, Hoarseness or squeaking alarming 10 (14) Attend to the Nails-black indicate approaching fever or death, red, favorable-they are sometimes yellow in the yellow fever when no other part of the Body is tinged See [crossed out] Page Prognosis of Fevers Of the Pulse- The Pulse are to the Body what the Dial Plates & Hands are to a watch- Facts of its healthy State In Adults the number of strokes in a minute is from 60 to 80, medium 66-At the time of birth from 130 to 140-At one year old from 108 to 120, At 2 from 90 to 108, at 3 from 80 to 108-4, 5, & 6 are much the same, at 7 about 72-a Slow pulse in a Child e.g. 15 or 20 strokes below the above shews disease particularly of the Brain. it is best felt when they are asleep-In old age it becomes slower and fuller, probably from the same causes that it does in Sleep, viz. Unequal Excitement, or an abstraction of excitement from the Muscles (which are totally relaxed in Sleep and much weakened in old age) and a concentration of this Excitement in the Arterial System-the slowness in some cases descends to 42, 30 & even 20 according to Dr Herberden- a Pulse perfectly regular in very advanced age is a sign of Disease-its natural state is to intermit The Stimulus of Disease makes it regular- See Morgagni- 11 It is affected by (1st) Sex-weaker in women- (2ndly) State of Society & Civilization-It is slow in the savage state-the following facts were collected at my Desire by Mr. Clymer when he was framing an Indian Treaty- Morning Noon Night From 6 years to 13 64 76 7 18 30 52 69 56 30 90 56 70 76 N.B. Those between the 2 last periods were principally entertained in the European form at the Commissioners Table- It is slower in the Inhabitants of the Country than of large Cities from their being less acted upon by the Stimuli of constant business, news and conversation- (3) Size-quickest in Short men-hence Tall men are more liable to Gangrene in the extremities (4) Climate & Seasons-In Greenland it is seldom above 40-it is slower here in Winter than Summer- (5) Different times of the Day-quicker in the evening-Haller calculates the difference between morning and evening at fifteen-In some cases however there is a diminution of frequency at night, owing to exhaustion of the system which was the case in some of Mr Plymer's Experiments- (6) Sleeping & waking-slower in the former (7) Different positions of the Body or Arm, the Pulse is slow when but few muscles are in action. 12 (8) Food & Drinks- (9) Passions of the Mind- (10) Conversation- There is sometimes a deviation in the position of the Radial Artery, which should be recollected- There seems to be an Idiosynceasy in some pulses- I know a woman whose Pulse was never raised by the most violent fever beyond 70-Nedge Peter's is always 100-It would be highly advantageous to a Physician to be always acquainted with the state of his Patients' Pulses in health- Morbid States The Pulse departs from order (1) In Frequency and quickness-it has been known up at 180 down to 40, 20, 9 and in one Case of Apoplexy 7-It's frequency is occasioned by morbid irritability in the Blood Vessels-It occurs chiefly in the last stage of Fevers-It's slowness indicates pressure on the Brain, Spasm in the Heart, or defect of irritability in the Arteries, induced by the excessive force of Contagion, or other Stimuli acting upon them-The Pulsations in this slow Pulse are generally equal, but there is an Intermitting Pulse, which occurs in almost all Malignant Fevers- (2) In Regularity & force-this constitutes the jerking Pulse, resembling a shattered Quill- Morbid Pulses (1st). Synochus-Full, frequent, quick, without 13 hardness-common in violent Bilious fevers, yellow Fever, Pneumony and other Cases of great Congestion, without much Inflammation (2) Synocha-Full, frequent, quick & Tense occurs in Pneumony, Gout and sometimes in yellow Fever- (3) Synochula-Frequent, quick tense & small- occurs in mixed & Chronic Rheumatism, sometimes in Pneumonia in delicate Habits, and the second stage of many fevers- (4) Typhus or low Chronic-in the Gaol Fever and the low states of Chronic & Nervous Fever (5) Typhoid of slow Chronic-in the slow state of Chronic Fever-approaches nearer to Typhus than the Synochoid-occurs in the first stage of Nervous Fever of Scarlatina & Puerperal Fever-a knowledge of this fact explains many seemingly contradictory accounts of these Diseases and the Operation of Medicines in them- (6) Synochoid-is between Synocha & Typhoid it will in some Cases bear bleeding-it is common in the change from an acute to a Chronic State of Fever- (7) Depressed or Locked Pulse-It is sometimes scarcely perceptible-sometimes no quicker than natural-it is often as low as 40 or 30-It occurs in the malignant states of the Plague, Yellow Fever, Small Pox & Pleurisy- It is distinguished from the low Pulse by 14 by occurring in the beginning of Fevers, also by rising immediately after Bleeding or Purging in the beginning of a Disease-It sometimes however happens, that the Pulse being suddenly disengaged by bleeding, throbs so violently as again to prostrate the Arterial System from excessive action- This Pulse is sometimes distinguished by imparting a jerking sensation to the Fingers after feeling it long and attentively-A Pulse of this kind also occurs in Hydrocephalues Internus and Apoplexy-I once thought that this slow Pulse proceeded only from affections of the Head, but it occurs also from Spasm of the Heart & defect of irritability in the Blood Vessels, when such a Paralysis is induced in the Blood-vessels that the Blood when drawn appears dissolved- (8) Chorded or Catgut Pulse-synonimous with what I have elsewhere called a Sulky Pulse-it is quick but seldom frequent & occurs in all the Malignant states of fever- (9) Hectic Pulse-Quick, frequent, sometimes full-In the Paroxysm more related to the Typhoid than any other-Hence the same Medicines do harm in each, as Bark, Opium and generally Blisters-It occurs in Pulmonary Consumption, in Hectic Gout and in the waste of the Body from Ulcers-I have sometimes attempted to illustrate these various states of the Pulse by the following Comparisons- 15 Iron Pulse when it it's most tense state Shattered Quill, In Yellow Fever, Gout &c Wooden Pulse In mild Bilious fevers- Catgut Pulse, often succeeding ye Shattered Quill- Soft Silky Pulse, in Health- Some Circumstances relative to the Pulse yet remain to be mentioned- There is sometimes a full round Pulse, not very quick but with a little irregularity of Action or Jerk in it, which occur in Tonic Gout, Apoplexy, Palsy & Dropsy-it often becomes tense afterwards- There is a weak, frequent Pulse, without any irregular action in it, which occurs in all the Chronic Diseases of Debility, which affect the Nervous System- There is also a weak low, Pulse occurring in cases of mere debility, without any fever distinguished by occurring in the close of a Disease There is a Pulse which beats 2 regular strokes succeeded by an Interval of one or two irregular ones, it has been called the dicrotous Pulse- There is the Inciduous Pulse, where one Stroke rises above another like the Waves of the Sea- There is the Aneurismatic Pulse-It has a peculiar jerking sensation, which can hardly ever be mistaken after having been once felt- A little quickness of Pulse sometimes remain after fevers, owing to the great accumulation of Excitability- 16 An Absence of Pulse sometimes takes place in Acute Diseases of the Stomach & Bowels at some particular affections of them, for hours & even days without extinction of Life-A Meal of 5 hard roasted Oysters deprived a Lady in this City of pulse for 36 hours- Directions for feeling the Pulse- (1) Never feel it at first coming in for your presence may have hurried your Patient, but feel it before he gives the history of his symptoms for Conversation quickens it- (2) Let the posture of the arm be perfectly easy and disengaged - (3) Feel it before it be long exposed to the Air- (4) Feel it in both Arms for it is often different v.g. In Palsy it is fuller and harder on the affected side- (5) Do not decide before feeling 20 strokes at least I have found a pause at every 18th Stroke- (6) Shut your eyes & request silence in dubious causes (7) Never omit to feel the Pulse before prescribing Opium, Wine, Vomits, Purges, Steel, Bark, Hot or cold Bathing, Pediluvium, Stimulating Drinks or Diet- In Diseases of the Brain or Breast the Temporal Artery often gives surer Indications than the Radial, in the last case the Heart may also be felt The Pulse is very much neglected in Great Britain- 17 A Prognosis has often been attempted to be drawn from the frequency of the Pulse-It is said by Dr Haller always to indicate death when above 140-but Dr. Heberden says, that he saw a recovery from the Gaol Fever, where it was above 180-such instances however are very rare-The Doctor observed it to be more frequently fatal when above 120-it was least alarming when that number of strokes was succeeded by a Critical Swelling-In a Child dying of Hydrocephalus Internus it was once 204- To measure the frequency of the Pulse Stopwatches and Pulse Glasses have been used, but they are of little use, for all the other circumstances relating to the Pulse, are of more importance than its frequency- The Pulse is not always languid at the approach of Death-it is often hard to the last in cases of incurable Inflammation-Dr Ramsay observes that the last stroke of the Pulse in death, is generally hard- I have called the Pulse in all diseases the Dial Plate of the System but in Fevers it is the Disease itself, and all those local affections which fill our Nomenclatures are only Symptom of this Disease, as I hope to shew hereafter - The Intermitting Pulse in Acute Diseases is almost always dangerous-I once met with it in Typhoid Pneumony-It arises from a spasm of the Heart as well as the Brain-It is less dangerous in Chronic 18 Diseases, or in persons worn out with pain or want of Sleep- Do not expect to meet in actual practice with all these Pulses perfectly distinct-they frequently run into each other and change in the same day-hence the necessity of frequently visiting our Patient & frequently changing our prescriptions- The Indications of the Pulse are least certain in Affections of the Head- Physiology Chap. I. Of Animal Life See 3 Lectures published by me this Year- Of Animal Heat Upon this subject various theories have been proposed- (1st) Dr Stevenson in the Medical Essays of Edinburgh attributed it to a fermentation of the putrefactive kind-to this I object (1st) Putrefaction, as has been clearly proved by Dr. Seybert in his Inaugural 19 Essay, cannot take place in the living Body and (2dly) Putrefaction does not give out Heat a whale putrefying on the Sea Shore is no warmer than the Temperature of the surrounding Atmoshpere- (2) It has been attributed to the friction of fluids against solids-To this I object (1st) the friction of even Substances produces no heat e.g. water shaken in a Phial (2dly) No heat is produced by friction unless one Body be fixed, as in the Rope round the Pulley- (3dly) The friction is not Sufficiently speedy in the Blood vessels (4th) The heat in the Extremities where the friction is much less is nearly equal to that of any other part of the Body-The French Theory is the only satisfactory one viz, that the Oxygen received from the Atmosphere in respiration is decompounded and the Caloric which held it in, solution, disengaged-I know of but one objection to it, and that is, the Heat of a Phlegmon, or of any local Inflammation, at a distance from the Lungs-It appears in this distance to be connected with the action of the vessels and to be wholly unconnected with respiration or the external air- Perhaps in the process of Inflammation there may be an extrication of Caloric, or a conoersion of latent into sensible heat from the Air, which as I shall say hereafter enters into the Composition of the Blood- this is rendered more probable from the decomposition or the new arrangement of 20 the particles of the Blood, which takes place in local Inflammation-now, we know that an alteration in the texture or consistency of bodies, does, in many cases evolve latent heat- It is a striking fact in the heat of the Human Body that it is the same in all Climates and Seasons, viz 96 - There are on record some singular cases, of persons being burnt to ashes, from a fire kindled within their own body*-May not the heat be subject to Error Loci, as Bile or Blood? or to a destructive Excess or irregularity of action, similar to what takes place in the Arterial and Nervous Systems. * A Case of this kind occurred in N. York State some years ago and an instance of it is recorded by Haller, in a man much addicted to the use of Spiritious Liquors, See Bibliotheca Medicinæ Of Respiration Motions are Voluntary, involuntary & mixed - The Voluntary Motions are those of the Eyes, Limbs, Speech, Excretions &c-The Involuntary are the Actions of the Brain, Heart, Arteries , Lymphatics and the Secretions-the only mixed motion is Respiration, being partly Voluntary & partly Involuntary- Here is some difficulty in explaining its commencement-Berkley resolves it into the influence of the Will, which he supposes is exercised at birth-To the same Cause he refers all the involuntary motions-But all voluntary motions 21 produce fatigue, now the Heart is not fatigued in the course of the longest life-Again, if the will produced these motions, they would be suspended in Sleep-The Lungs are a hardy Viscus and possess little sensibility.- Uses of Respiration (1st) It conveys Oxygen to the Blood & thus becomes a source of heat to the Body-(2) Conveys a vapour from the Body that might be injurious (3) Propels the Circulation (4) By its constant pressure keeps up a steady action in the vessels and Muscular Fibres of the Abdomen (5) Enables the Stomach, Intestines, Gall Bladder, Receptaculum Chyli Bladder & Rectum to discharge their respective Contents (6) Assists the Uterus in Parturition (7) Conveys Odours to our sense of smell-(8) Enables us to suck and (9) forms the voice- This Function is differently performed in the 2 sexes-In Females the principal motion is that of the Breast, In Males that of the Abdomen-the former Contrivance highly useful in Pregnancy- Coughing It's use to throw off Phlegm, Mucus, Pus &c which might be collected in the Lungs- Sneezing is often a premonitory Symptom of Catarrh, & also a Symptom of tendency to Inflammation in the Pulmonary Vessels-a favorable sign in the Crisis of some Fevers- 22 Yawning Its use is to accelerate the Circulation at a time when the Body is debilitated, as late in the evening, and just after waking in the morning- Panting, Laughing, Hiccup, Crying- See Treatises of Physiology Of Voice & Speech The exercise of crying helps to form the Organs of Speech-hence the crossest Children speak soonest- Laughing is the first thing-then at about 5 Months old, Crowing-at 7 or 8 they say dad, dad, dad- at 9 or 10, pap, mam-they seem to have great pleasure in having their Lips slapt, and it teaches them sounds, as does their playing & blowing with their Lips-In a Family in this City, 2 Girls Twins, never spoke till 8 years of age, they then spoke well- I have met with another instance of the same kind more recently-In teaching them words, make them repeat any given word half a dozen times or more, and they will not forget it, otherwise they will, and sometimes will not recover it for months-To correct the faulty pronunciation of V. & W. which is to common in this Country, direct the Child to force his upper teeth against his lower lip and he will pronounce V. Circulation of the Blood It has often been objected to a new Theory, that if true, it would have been discovered long before- The recent discovery of the Circulation of the Blood, a phenomenon which appears so obvious, is the best answer to this objection-There are several peculiarities in the Structure & Situation of 23 of the Heart-It is fenced with a hard boney case - is carefully lodged in a Bag, and provided with arteries of its own-it beats near 5000 times in an hour-The Right Ventricle acts longer in a dying animal than the Left- Arteries, their Coats &c-they are stronger at a distance from the Heart than near it- Specific influence of the Blood asserted-Dr. Cullen says that if it were specific, its power would be lost by habit, but the same thing might be said with regard to food.- The powers that move the Blood are (1st) the Heart-its motions are excited by the stimulus of distention, and the specific qualities of the Blood - the constant excitability of the Heart is, I believe, Kept up by an Influx from the Brain - (2nd) The Arteries-Various facts prove their Irritability viz, their perpetual actions &c-In Palsy the Pulse is often found stronger and fuller on the affected side, which depends upon the Fibres of the Arteries of one Arm, being stimulated to more action than those of the other- In short, unequal excitement in the Arterial System so common & so puzzling in Fevers, seems to depend wholly upon the unequal action of the Muscular fibres of the Arteries, in different parts of the Body-Dr. Harvey demonstrated, that the Circulation began in the arteries of young Animals, even before the Heart was completely formed, They are the Primum Mivens & Ultimum Morions of an Animal- 24 Irritability resides also in many of the Veins see the work of Dr Vashore-The Arteries are always at work in sleep, which is an evidence of their Irritability-The Quantity of Blood in the Body of a Man of ordinary size is reckoned at about 25 lbs- Uses of the Circulation- (1st) It supports the Action of the Brain-Hence we find Syncope of Death follow the sudden or long- continued abstraction of Blood from the Head- (2ndly) It conveys heat from the Lungs to every part of the Body-(3) It conveys nourishment either directly or indirectly-(4) It conveys humidity to every part of the Body-(5) It supplies a Liquor for the Secretions-(6) It gives an equable tension to every part of the Nervous & Muscular Systems (7) It perhaps supplies the Nervous fluid- No Physician past 40 years of Age admitted the Truth of Harvey's discovery- Besides the involuntary motions of the Heart and Arteries, the Symphatics & Intestines move witht. the Concurrence of the Coill from the force of stimuli constantly acting on their irritability- Of the Nervous System- The Nervous System includes Brain, Nerves, Tendons and Muscles-On the Brain Physiology must be dumb-The use of every part of it will however one day be known-Dies Doceat-It is the seat of the Operations of the Mind &c &c The Blood vessels of the Head are very numerous-the veins there have greater density-One Fifth according to Haller 25 and one tenth according to Monro, of all the Blood in the Body is sent to the Brain- The Nerves probably end in the Brain, instead of beginning there-They appear to be continuations of the Medullary Substance, at least part of the way-They are the Media of Sensation of Motion-Ganglia are probably are fresh sources of Nervous Influence- Sympathy-Tooth Edge- The Cuticle appears to extend to the Inside of the Urethra, Vagina, Anus, and perhaps the Stomach and Bowels- For facts & Illustrations, Read Whytt on Nervous Diseases-Hunter on the Diseases of Jamaica, and Fowler on Animal Electricity Order of the Production of Actions (1st) Impression from Stimuli, (2) Sensation (3) Motion- There are some Sensations which should be called Reflex Sensations, quas volumus aut Nolumus-One Sensation alone can be excited at one and the same time-When more Stimuli than one are [crossed out] applied, the most powerful of them only excited Sensation, e.g. If a Dose of Nux Vomica be given to a Dog, and the Animal be severely whipped after it, it produces no effect upon him-and thus, if you take hold of a Hair to pluck it, and give the person at the same time a smart blow, he does not feel the plucking of the Hair- Where the Stimuli are of equal force, a Compound of them all, or one that has no relation to either will be produced- 26 Sometimes there is a translation of particular sensations from one part of the Body to another- J. Hunter mentions the Case of a Man who lost the Glans Penis by Mortification-The remaining part acquired the sensation of a Gland, and Caw Boerhaave who was deaf, had as it were a medium of sound diffused over his whole Body.- The Senses are five-Touch, Taste, Smell Sight and hearing-Blood Vessels accompanying Nerves greatly quicken their sensation e.g. Lips, Mammæ &c- Seeing hearing & tasting appear only different modifications of the same sense, viz. Touch- The delicacy of Fact is increased by Fasting- The existence of Papillæ at the extremity of the fingers, is very questionable- Taste is wonderfully sharpened by Habit- A wine Much of this City could distinguish the the flavour of the wine of every district in the Island of Madeira-Baker in his Essays on the Microscope has started on Hypothesis, that the various tasted of Salts proceed from their figure- This sense is situated on the lip and sides of the Tongue-The Tongue has an intimate connection with the whole System e.g. Lavender held in the Mouth-Hence Powders by their Action on the Tongue & diffusion in the Mouth are preferable to Pills-Taste is sometimes transferred, even after the Tongue is lost-Analogous to the translation of Sensation, which sometimes takes place after the Amputation of the Glans Penis- 27 Are there are any Original Tastes. See my 1st Vol-The Tongue abounds with Nerves and Blood Vessels-it is also furnished with Papillæ-To a dry Tongue no Taste is evident- Smelling The Influence of Smells in producing Disease from Contagion, may perhaps furnish hints with regard to the more general administration of certain Medicines-Scents have also a striking effect in recalling to the mind all the circumstances connected with them The Air is warmed in its passage thro' the Nostrils, hence there is a propriety in persons with weak Lungs stopping their Mouths with a Handkerchief in cold weather and breathing only thro' the Nose-Henry Smith of Northamptom County follows a scent at 20 miles distance-A Gentleman last August by his smell could discover in what house the Yellow Fever was-The Gentoos cannot endure the Scent of Europeans for a day on 2 after their arrival from Sea- Seeing It is a wise provision of Nature that the Inhabitants of Northern Countries have generally light and those of Southern, dark Eyes, the former being best adapted for the Scanty light of their Native Climate, the latter for the broader glare of the South-It is true that [cross out] 28 our Indians have dark eyes, but I suspect they are not the real Aborigines of our Country- Hearing Sound is propagated 1142 feet in a second of time It should seem that sounds do not excite impressions unless they meet a corresponding Chord in the Tympanum or Cochlea-Mrs Hopkinson of this City tho' she cannot hear a Cannon, can hear the Sound made by passing a pin thro' a piece of Paper- The Bones of the Ear attain their full growth abt the 6th. month of Life The Membrana Tympani is capable of upwards of 20,000 Motions- Much has been advanced about our Senses deceiving us-It is worth inquiring how far these observations are founded in fact-Their deceptions are rather owing to the imperfection of our Reason and to our trusting to the testimony of one or two without consulting all- Muscular Action in a part cut off goes on till the Nervous fluid therein contained be exhausted by repeated Stimuli- Mental Inquiries- Reid confounds together the operations & Faculties of the Mind, but they are distinct e.g. The Stomach has the faculty of Digestion-Digestion itself is the operation of that faculty- The Faculties are (1) Memory-(2) Understanding 3) Imagination, (4) Will (5) Passions (6) Moral Faculties including Moral Faculty, Sense of Deity & Conscience- 29 Each of which has perhaps its appropriate Cell in the Brain-May there not be a translation of the Mind similar to the translation of the Senses which sometimes takes place- Of Memory Distinction between Reminiscence & Memory the former is excited by the presence of the object-Perhaps the faculty of recollection which seems to be possessed by Brutes is of this kind-It has been observed by some writers that we learn more in the 2 first years than in the remaining part of it- Modes of assisting or exercising the Memory Indian method of recollecting a Speech-The Senior attends first, listens till his Memory is full & then says Hum-Many Savage nations can count only 20, corresponding to the number of their Fingers & Toes- Different Species of Memory for Numbers, for Words, for Ideas-A Lady in this City from a Paralytic affection once forgot the name of her Infant Child- Recollection is assisted by Pain-hence probably the Custom of bumping Boys on Boundary Stones in England-Hence too the Accuracy of Dates which Women possess after Pregnancy or Parturition e.g: Such a thing happened when I lay in with Johnny- Artificial Signs-e.g. a Knot in the Handkerchief, or String round the Finger- 30 Nothing ever lodged in the Memory is I believe, lost, but exists there in a latent state- The Countess of Laval who was nursed among the Welch, appeared entirely to have forgotten the Language, but long after she had grown up to Maturity, in the Delirium of a Fever, she spoke many words in a language unknown to her Attendants, but which was at length discovered to be Welch by an Old Welch Woman Of Imagination- Dugald Stewart makes a very ingenious distinction between this faculty & fancy - "It is the power of Fancy" says he, "which supplies the Poet with metaphorical Language, and with all the Analogies of his Allusions but it is the power of Imagination which creates the complex Scenes he describes, and the fictitious Characters he delineates-To Fancy we apply the Epithets of Rich & Luxuriant. To Imagination, those of beautiful and Sublime" I agree wth Mr. Stewart that they are distinct faculties of the Mind Fancy appears to be a precursor of Imagination, or a substitute for it, just as Taste is the precursor of, or substitute for Judgment, and Instinct for Reason- Pleasures derived from our Senses- [cross out] Excess of Sensation is pain, as absence of Stimuli is Death-The first Impressions on a new born Infant are probably always painful-Their Red Skin seems to be produced by Inflammation. 31 taking place from the Contact of the External Act- Pleasures of the Sense of Touch (1) The Commerce of the Sexes in (1st) Propagation (2) Kissing-(3) Pressing the Hand, the first point of Contact between 2 Lovers-See Luest's Picture of Angelica &c leddoso, which Sir Joshua Reynolds pronounced to be one of the most happy & delicate expression of Love that he has ever seen- II Even Temperature in the Air, this is particularly perceptible in Italy, as it is in most other Countries occasionally in Spring Colts, Lambs &c gambol from this source- III Breathing Oxygen IV Warm Bath, particularly in old age, The Ancients sometimes used warm Oil instead of Water- V Various Excercises, as walking after long rest, Gestation, Swimming, Sailing, Dancing and the Chace & Altho it is difficult to trace, from what sources this becomes a pleasure- VI Aerostation VII Certain Stimuli taken internally as Opium wine &c VIII Sudden Cessation of extreme pain, as Partuition, or a violent fit of the Colic- IX Certain soft or smooth substances applied to the Skin and certain Titillations-Rest after Labour or fatigue-Cool evening Breeze after a hot day &c &c a soft hand gently rubbed over an inflamed Limb 32 Some persons seem to have peculiar tastes in thier pleasures-a Lady in this City receives the highest gratification from having her head looked for Lice, altho' she has had none for many years- Females acquire a new pleasure by giving Suck Riding in a Sleigh seems an Hermaphrodite kind of pleasure, compounded of cold, & rapid motion- The Intermediate state between sleeping & waking is pleasurable-Even Dissolution has been attended with pleasureable sensation in some instances particularly in Dr Hunter-I suspect that the smile on the Lips of many persons newly departed proceeds from their last Sensations being pleasant- Judge Hopkinson once proposed the idea of a Scale of agreeable lactations- Pleasing Sensation derived from touching the Skin of an Infant 8 or 10 Months old- Pleasures of Taste Importance of the Connection of Pleasure with the gratification of the Appetite of Hunger & Thirst- Pleasures of Smell Universality of this pleasure in the Country- Scale of Odours-Rose, Pink, Tonquil, Jassamine Tube Rose, Honey-Suckle, Sweet Briar- Pleasures of Sight This Sense imbibes an Ocean of Pleasures, Light, Colour &c The Love for Gold & Jewels, is I think instinctive from their fine Colours- 33 Hogarth's Line of Beauty Man is the most beautiful Animal, having most instances of this line-the Horse is next in beauty- Waving Motions, agreeable-Prospect Height, Nastness &c- Pleasures of Hearing Conversation-Music-Gentle Breeze- Murmuring Streams-Sound of Rain upon the Roof-Rocking of the Winds &c It is a mistaken Idea that our pleasures can be increased by combining them, as music with Dinner &c, for no two Sensations of unequal force can excite at one and the same time Motion seems essential to pleasure-Each Sense excites motion in the Nerves- Causes of pain-Distention, Relaxation accompanied by Spasm &c Pleasure consists in a less degree of that excitement which produces pain-Hence Impressions originally painful, when weak from long continuance go down to the point of pleasure, e.g. Tobacco &c Haller says there is an afflux of Blood to the seat of pleasureable sensation for the time being- this is not always the Case-indeed the very reverse takes place, in rest after Labour, and after Parturition- In fine moderate Excitement produces pleasure, its excess, pain-The Gentle Debility produced by venesection and the gentle Excess from a Dose of Opium, produce, as I have often experienced, nearly the same Sensation. 34 Things at first disagreeable become by habit agreeable, e.g. Opium, Tobacco &c and the Air, wch probably at first affects the Skin of the Infant with a painful sensation becomes pleasant- Women endure pain better than Men, probably their Nerves become paralytic sooner, or, as Hartley expresses it, there is a solution of Continuity sooner- Diminution of pleasures by time & repetition- No two Actions of equal force can exist in the Mental System at one and the same time- Hence has arisen the resolution of Martyrs, the hope of future reward operating with greater force on their minds than present suffering- Pleasures from exercise of the Mind- From our own mind-From the Minds of others- Pleasures of Memory-Of the Understanding- Pleasures of the Will, consist in Liberty- Pleasures of the Passions-Ambition, Avarice, Love &c, the last when pure creates a Heaven of its own- Pleasures of the Moral Faculties- No Exertion of mind can take place independently of Stimuli-The Mental faculties act upon the Arterial System, on the Nervous & Glandular Systems & on the Intestinal Canal-hence result many striking Analogies between the Laws of their pleasures & those of the Senses- 35 Of Sleep & Dreams (1st) Sleep-This is in one respect a tendency to death, but, it restores the System by equalizing excitement and excitability- Remote Causes of Sleep (1st) Those which produce it by inducing Indirect Debility, are Labour, certain stimulating Aliments or drinks, Narcotics, certain sounds as the noise of a City to persons unaccustomed to it-Heat to the Body after Cold-Long & painful exercise of the understanding on one Subject-(2nd) Those which act by inducing Direct Debility are-The Abstraction of the Stimuli of Light, Sound & Muscular Motion-Purging, Bleeding, Cold certain sedative applications as Oil &c Gratification of the Venereal Appetite-Cessation of pain, hence sleep generally follows parturition, & sometimes sedative or debilitating passions, as Grief & despair, hence condemned Criminals generally sleep on the night before Execution- Sleep may be induced (1st) by reducing the System to the sleeping point-(2d) by raising it to the same point-This after the excitement induced by great mental exertion, a walk backwards & forwards along the Room for some time, will take it down, and that produced by heat may be taken down by removing the Bed Clothes, or exposing the Body to the cool air-This will produce Sleep in the first instance-In the second, Stimuli must 36 be used in a degree proportioned to the Debility hence the want of the accustomed Stimulus of a Supper will prevent sleep, but the deficiency may be supplied by Wine or Opium-A Person may be so little below the Sleeping point as that 5 Drops of Laudanum may raise him to it, when 20 would prevent it-but 50 or 60 might take it round and bring on Sleep from Indirect Debility- Effects of habitual Stimuli in producing Sleep. In their absence Sleep is often wanting as, in going to Bed supperless-The Inhabitants of the Country near the Falls of the Nile, when they crowd into the Cities to avoid the Inundation, often cannot sleep for want of the accustomed Stimulus of Sound-A Watchmaker of this City, who had been accustomed to take all the watches in his Shop to his Chamber past 2 sleepless nights on a Journey, for want of the accustomed Ticking- he was relieved by borrowing all the watches of the party, & setting them on the table by his Bedside Never recommend exercise to Invalids before Breakfast, for there is then such excessive excitability that the System would be under the operation of Indirect Debility, from exercise- Moderate Warmth brings on Sleep- The Gentle Stimulus of the morning light appears in some instances to produce Sleep after a restless night-With a view to this gentle Stimulus I once prescribed to a Patient to have a lighted Candle in his room-It had the desired effect 37 The System is much weakened during Sleep, a degree of cold of 12° will kill a man asleep, but not awake, hence too the general commencement of Fevers, Gout, & Epilepsy in the Night- Children sleep more than Adults, Abortive Children more than those born at full time, Old People less than those in middle life- Moderate Sleep recommended-Small portion of time allotted to Sleep by Wesley, Whitefield &c Old persons tell unintentional fibs about not having slept at all, when they have slept a good part of the night-probably, in their cases, the Act of waking, must like that of falling asleep, have been so gradual, that they had no consciousness of its having taken place-in general we awake suddenly- (2) Dreams-These depend upon irregular motion, with a degree of excitement in the Brain- Where the System is affected with too much Stimulus, the excitement and stimulus motions will be above the Sleeping point-where too much Stimulus is abstracted, the Excitement and motions will fall below it-The Motions in each case will be morbid & irregular-hence we dream alike when we eat too much supper of go to bed Supperless, if we have been in the Habit of taking that Meal- A Dream differs from Delirium in being attended with Motion only in the Brain, and no Action in consequence of it in the Tongue or Limbs- 38 Now in Delirium all Physiologists allow unequal excitement & irregular Circulation of the Blood Absurdities of Dreams-Memory frequently seems gone-thus without suprize or recollection we converse with a Friend that had been dead many years-This confirms me in the idea of there being different portions of Brain allotted to different faculties and impressions-The Moral Faculty is often imperfect in Dreams- Full Bladder excites Dreams, hence their greater frequency in the morning- Dreams are often excited by external Impressions- moderate cold gives in a Dream an Impression of severe Cold-A Methodist Preacher being asleep, a Person ran a Pin into him-now says he, I know what the Apostle meant by a Thorn in the Flesh-Dreams of all kinds, depend, I think, on a morbid State of the System- Stewart the haveller informs me that he has never dreamt since he left off Animal Food- Somnambulism In the Memories of the Academy of Science the history of a Young Man is given, who composed an Essay in his Sleep-Dr Blacklock of Edinburgh having once lain down in the Afternoon came down stairs, supp'd & conversed with his family- After Supper he suddenly started & awoke- Somnambuli, tho' they always forget the train of Actions pursued in this State, when awake, 39 often resume them the next night-a Young Man in Connecticut had a periodical fit of Somnambulism-during this state he never remembered what had happened in his waking state & vice versa-The occupations of each state appeared to him perfectly Synchronous- Vide American Museum Vol. 10. p. 151. No action of the Somnambulist appears to fatigue him-It is remarkable that when an attachment to a Sweet heart is at it's greatest height, we do not dream of her-in this case it is probable that the Memory and Imagination are worn down during the day with regard to that particular object- Dreams more terrifying than usual often portend Disease- This should be attended to by the Physician & he should take his measures accordingly They often precede Hydrocephalus in Children, who start and are distressed in their sleep some time before the disease appears- Chap. II (1st) Of Aliment. This should be of 2 kinds, vegetable & Animal I infer this from (1st) The Structure of the Teeth and Alimentary Canal-(2d) From a Diet of either alone, injuring the health-(3) From the use of both being not only permitted, but enjoined by a positive Command, both in the old and new Testaments (4) from the Example of Jesus Christ 40 The killing of Animals prevents them from suffering the Diseases of Old Age, which to them must be a state of misery, as they have not the assistance of Relations and Friends- Female Animals are better food than Males-& castrated Animals than the latter-Beef and Mutton are more easily digested than Lamb or Veal-Wild Fowl than Tame- Fruits are best taken before dinner- Fat meat better than lean-the lean of fat Meat is always most digestible-All Meat is better for being kept except Pig, Goose and Duck, which should be eaten the day after they are killed-A Cellar ventilated by a Chimney keeps Meat much the longest-If Meat be kept in Cold Water depress it with a weight-Meat should be thoroughly cooked- Animals destroyed by Electricity are remarkably tender-Importance of long Mastication- Gut your Poultry immediately, how long sooner you intend to keep it-The Relaxation of the Sphincter Ani is a sign that it has been kept long enough- The Moon has an effect upon some Animals disposing them earlier to putrefaction-Crabs are fattest at the full of the Moon-The Full Moon perhaps renders Animals more succulent, and therefore disposed to earlier putrefaction, or it is that Insects are guided thither by the Light to lay their Eggs and the Heat hatches them. 41 Invalids should take the Meat only of Meat Pies, Meat thus prepared is very digestible, but the Crust is less so than any other Pastry- Boiled Geese and Ducks are preferable to roast for Convalescents, and I think would be so to others if they were fairly tried-they are the easiest of Digestion- Soup should always be the first dish, all the Grease should be skimm'd off as it rises- Boil meat rather than roast it-the latter mode is the most stimulating-Theory of Beef Steaks-Constriction of the Outside by Heat so as to preserve the Juices-Stewed Meat is more nourishing than Boiled-Fried Meat is rendered in a considerable degree indigestible in consequence of the tendency to Rancidity in the Grease &c in which it is cooked- Fish are supposed by Haller to have been the earliest Animal Food of Man-When boiled sufficiently they float on the Surface of the water and then sink a second time-Eaten alone or with Vegetables only they seldom offend the most delicate Stomachs, but with Meat they are seldom so digestible- Lent is a wise Institution-Inflammatory Diseases are then most liable to rage and Animals are under the Venereal Ostrum- Mixed Aliment e.g Milk and Eggs-The White is the Vegetable, the yolk the Animal part 42 Condiments- A small quantity of Salt hastens putrefaction- Salt Meat should be eaten in Summer, it shd. be recommended to Aged Convalescents from Gout, and to all from Bilious Disorders- Grades of Nutriment (1) Sugar, (2) Oils, (3) Gluten or Mucilage- whatever food originally agrees with us and is not rendered agreeable by habit merely, is wholesome for us- I think that all Men should eat a little & after- Evening perhaps about 8 oClock is the fittest time for a full Meal- Bitters condemned-Eat Fruit & Gingerbread if any thing be wanted between Meals- Do not drink until you have eaten all the Animal Food you intend to do-nor drink much of any fluid, it makes your meal pass off too rapidly- Carving is a very bad Custom- What quantity of food is proper, more light food should be taken in the Summer, more solid in the Winter-8 lbs of Fluids & Solids with Labour and Exercise are sufficient-4 to 6 lbs will do in general-The Turks scarcely use more than half a pound & that of an insipid and Vegetable Nature-See Volney- Tea & Coffee alone, I believe contain no nourishment- if of a moderate strength & believe them harmless- 43 the latter seems specifically to affect the Head, the former the Nerves-They are very proper after very great fatigue of Body or Mind-also in Grief or depression of Mind-also when wakefulness is necessary, for this purpose they should be made pretty strong-Strong Coffee also helps Digestion, and fortifies the System against Cold-A Country Practitioner with whom I am acquainted uses no other means for this purpose in his Country Excursions in the Winter-I shall now say a few words on fermented Liquors-(1st) Wine- The Musk or Saccharine part alone has any Nutriment-hence the Sweet Wines are the most nutritious-In Madeira the Gout is unknown, altho' 70,000 Sips are drunk there annually-Red Wines the least wholesome- a Solution of Orpiment added to Wine turns it muddy if there be any Lead in it, but it will generally cause a precipitate whether there be lead or not- Malt Liquors are good with exercise-but are improper for Sedentary persons- Spirits reprobated-Vide Vol of Inquiries- Panegyric on Water (2nd) Of Hunger- A certain definite degree of Relaxation produces Hunger-Above or below this point it does not exist-A full Meal after long lasting sometimes destroys life-apply this Law of the System to the Regulation of the diet of Convalescents- 44 Thirst The Cause of Thirst is Acrimony general or partial stimulating the Fauces- Thirst in Fevers is an ambiguous Symptom- It is produced by Pain, Fear, Opium & other Causes of Indirect Debility Mastication-description of this Process-its importance Digestion Various Theories have been proposed upon this subject-They may be divided into the Mechanical & Chemical-The Mechanical theory supposed Digestion to depend upon trituration, and many curious Conjectures were formed upon the force exerted by the Organ in this process- the idea is refuted by a simple experiment of Spalanzani, who swallowed 14 Grapes whole and voided ten of them unbroken- The Chemical Theory embraces Putrefaction, Heat, Solution & Fermentation-The existence of the first has been completely refuted by Dr. Seybert- The 3 last are, I believe, the only agents employed Heat is essential to this process-The Gastric Juice at a heat of 44 or even 48 has scarcely more effect than common water-It is more active at 79 but its greatest force is at 112-Heat is also essential to fermentation-Spalanzani exposed two similar portions of flesh, one to a heat equal to that of the human Body, the other about 20 degrees below it-The first putrefied in 12 hours, the latter took 2 or 3 days- 45 John Hunter found that the Digestion of a Frog which went on at 60 was effectually checked at 40°. Of Solution much need not be said- Fermentation is that process by which dissimilar substances are rendered Homogeneous This is I know, rejected from most of the Systems of Physiology-I am however, still inclined to admit it and in order to establish it made many experiments upon my own Stomach after eating a hearty meal in perfect health-I took an Emetic and the Fermentative Process had evidently begun from the Acidity which was present-I also exposed flesh to an equal temperature in water and saliva-the latter dissolved in half the time of the former and turned Acid-According to Haller, ℥xii of this valuable Menstruum are secreted every day- I repeated my experiments several times, and always with the same results-It was objected that I might have been in ill health I therefore prevailed upon a Fellow Student one of the most healthy in the University to lend me his stomach-the Effect was the same Dr Gosse supposed that the Acid was produced by a Decomposition of the Tartar Emetic- Of the Chyle- The process of Chylification appears to me another proof of the Doctrine of Fermentation-It cannot proceed from simple Solution, no Chemical Menstruum has such power who can reduce Chyle to its Constituent principles? 46 Well done & well masticated food it the most easily digested- A full stomach fortifies the System against Cold, hence any one who is going to encounter the Cold should fortify himself by a full meal- Danger of eating heartily in a state of Convalescence Of the Blood Description fits Constituent Parts-&c &c The Buffy Coat on the Blood, when drawn in Disease, is supposed to be owing to the Blood becoming more Coagulable by Heat and the action of the vessels-whereas the reverse is the Case- The Lymph becomes less coagulable in consequence of Inflammatory Action-hence it suffers the Red Globules to escape to the bottom of the Bocol, by which means the Lymph appears of its natural white Colour-The Buff indicates very moderate Inflammatory Diathesis-In a more violent action of the Arteries the Lymph Coagulates so feebly, as to easily cut with a Pin-In a still more violent Action of the Blood Vessels, it refuses to coagulate altogether & appears dissolved, as is often the Case in Plague & yellow Fever, indicating the highest possible Grade of Inflammatory Diathesis- Of the Absorbent System This consists of the Lacteals & Lymphatics-they are different names for the same system of Vessels-The Lymphatics absorb moisture from the Air & open upon the skin to drink-Hence 47 Dr. Franklin's experiment of bathing to quench Thirst-Absorption is promoted by (1st) Distention (2) Pressure (3) Friction upwards and only in the morning-(4) By Vomiting-Mr. Cruikshanks in his Letter to Clare mentions a Case of a large swelling of the Knee, from a morbid collection of the Synovial Liquor, being cured in 48 Hours by means of the vomiting excited by the Exhibition of a large Dose of Emetic instead of Soluble Tartar- A Bubo was once cured in a Patient of J. Hunter by nothing but the vomiting excited by the motion of a Ship in going down the Channel-And a Man in the Edinburgh Hospital in Anasarca took by mistake 12 gr.s of Tart. Emetic instead of an Anodyne-It vomited & purged him almost incessantly for upwards of 24 hours and effectually cured his Dropsy (5) By Purging- A person weighs more after taking a Purge than before, owing to the Absorption of Moisture from the Air-Jno. Hunter ascribes the frequent & sudden change of Gonorrhœa into Lues, to the injudicious use of Purges in that disease, promoting Absorption- Absorption is also promoted by Electricity, Mercury, Heat and Moisture, bounds Diluting Drinks Abstinence from Food and Drinks and certain debilitating Passions. See the Case of Dr. Johnson as told by Sir J. Hawkins discharge of urine after fasting- Of the Secretions & Excretions The Secretions are Lymph, Saliva, Gastric Juice, Mucus, Synovia, Urine, Semen, Milk, Pancreatic Juice and Wax- 48 The Excretions are Faces, Bile, Perspiration. The Secretion of Milk is much affected by the Passions of the Mind-Children are often convulsed from sucking an Angry Nurse or Mother but strange it is to add that the Milk is seldom the vehicle of any Disease to the Child- Whilst the Lips Tongue & mouth of an Infant are sound, it often sucks the Breast of a Nurse or Mother infected with the Venereal Disease without receiving the Disorder-In the Philosophical Transactions there is an account of a Physician, who declared on the Authority of his Parents that he has sucked his Mother whilst she was ill of the Plague without taking the Disease-Where Children are infected with the Plague by their Mothers, they probably receive it only from the Breath, and the Breath will infect before the disorder is felt in the System- On the Bile I think Bile an Excretion-I adopted this opinion from reading-Mr. Ling-he thinks that the Blood has a septic tendency at all times, that its septic parts are conveyed to the Liver, where after undergoing a short process, which scarcely deserves the name of a Secretion, being performed by a Vein only, they are converted into Bile-To the Septic parts of the Blood the Lymphatics add their Impurities, absorbed from the Fœces, & probably from all the decaying parts of the System- His opinion is supported by the Increase of the 49 quantity and quality of the Bile in hot weather, and in Bilious fevers in which there is the greatest tendency in the Fluids, from violent action to putrefaction.- This Increase occurs in the Gout, and even in strong emotions of the Mind-It occurs from the increase of the Circulation from Exercise hence the bitter taste in the Mouth in the morning after a day of fatigue- The Bitterness of the Bile proves likewise its being the product of a Septic process-we find a taste like it in a rotten or putrefied Apple But further, he supposes that the Bile when formed acts as an Antiseptic upon the Fluids with which it is mixed in the Alimentary Canal, and hence it is effused in the greatest quantities in hot weather-In her forming this office the Bile partakes of the nature of a Secretion-But I consider its properties as an Excretion to predominate over those as a Secretion-In the Scuttle-Fish the Bile is discharged near the Anus here it performs none of the Offices of a Secretion This is the dark Liquor discharged by this Fish to elude the pursuit of an Enemy- May not the Pancreatic Juice when mixed with Bile serve to dilute it, and thus blunt it Acrimony, when it has absorbed too much septic matter from the Blood & Fœces- This wonderful transmutation of a Matter the offspring of putrefaction, into a Medicine to 50 obviate it has many analogies both in the Natural & Moral World-Thus Nitre is produced from putrefying Animal & Vegetable Matters-and the Green Messy Substance on the Banks & Surface of Stagnating Water in Summer is a Vegetable, and gives out pure Air, which corrects & destroys the impure Miasmata of the Stagnating Water-The diver may be compared to a Manufactory of Sal. Ammoniac The Stimulus of the Bile assists the Peristaltic Motion of the Intestines-hence we find Costiveness follow the Suppression of its discharge in Jaundice- Anger has a great effect on the Secretion of Bile- I knew a young Man in this City, who was so much irritated by receiving an affront at a Friend's house, which he could not decently resent, that he went out into an Alley, and relieved his feelings by discharging a Gill of Bile from his Stomach-Hence the Angry Man is called Choleric Of the Perspiration The notion of this being a Secretion is, I think entirely Hypothetical-It is discharged only from the extremities of the Arteries-It consists of Water, Salt, Mephitic Air & a certain Odour a Blazing Candle introduced under the Bed clothes near the Skin in a morning is suddenly extinguished by the hephitic Air- In a healthy state there is a constant harmony between these Vessels & the Kidnies & Bowels-when suddenly obstructed the Perspiable Matter passes 51 off by Stool- Supprest Perspiration is not the Cause of Colds and fevers, but the effect of general debility induced by these Causes upon the Body- Nutrition - This process is I believe, carried on by Arteries They do all the other secreting Jobs, why not secrete the Matter that nourished the Body? Chapter III Of the peculiarities of the Male & Female Body & Mind - Of the difference between the 2 sexes and the Changes that take place at Puberty- Differences between the Male & Female Body (1st) Women in all ages and Countries are less than Men & acquire their growth sooner than Men (2) The Texture of the Simple Solids is less compact in Women-hence the marks of Blood Vessels on their Bones, one of the Characteristic distinctions of a Female Skeleton- (3) The Arteries of the Female possess most Contractility, and the descending Aorta is a weaker texture (4) The Nerves of the Female are more sensible - (5) Their Brains are more subject to motion of every kind- (6) Their Pelvis is larger, hence they retain their urine longer- Differences of Minds I think there is a natural & original difference as certainly as between their Bodies- (1) The Female understanding is less vigorous & Comprehensive (2) The Female Imagination the same-Their Fancy perhaps superior- 52 (3) The Female Memory is better than the Male in retaining Words & Events worse, in retaining Ideas (4) The Taste of the Female is Superior, hence they are better ridges of propriety in Dress and Behaviour, and hence too they are more disposed to Imitation- (5) Their Moral Faculties are more acute than those of the Male, and they have a more exquisite sense of Deity-They are also more active, but more circumscribed in their Operations- They have more humanity and Charity but less Benevolence-Good Relations & kind neighbours, but how seldom do we hear of or meet with a Female Citizen of the World- (6) In Conscience they are Inferior-Perhaps Gross vicious Actions, such as they do not commit are necessary to excite this Sensation-They are not so delicate with regard to veracity. - Perhaps the Habits of dissembling their Passions which they are taught may contribute to this- (7) The Perceptions of the Female are quicker, but their Judgment & reasoning powers are less acute and extensive- (8) They have more fortitude but less Courage, the former is a passive, the latter an active quality- (9) They incline more than Men to Society & hence are more prone to Intimacies- (10) They are more communicative of Secrets, but they are those of other people not their own- Men the Reverse- (11) They are less forgiving when offended than Men- (12) Less Subject to the Venereal Appetite- 53 Of the Catamenia - They are peculiar to the human race, with the exception perhaps of the Female Monkey-They generally appear here about the age of 14-I have met with 3 Girls in this City who menstruated under 7, two of them in one Family Anomalies. In 95 A Woman in the Pennsylvania Hospital of 70 years of Age had a return of them after they had been absent for 20 Years-Also, there is a woman now living in this City who menstruated till she was 80 without the interruption of a single Month except when pregnant or giving suck-I suppose these Anomalies to be efforts of Nature towards that renewal of her powers, which protracted Life so long in the Antediluvian Ages, similar to the Cases which occur not infrequently in extreme old Age of the renewal of the Teeth and Hair - The Quantity of Blood discharges in this Climate is from three to four Ounces and the discharge continues from 2 to 4 days-It ceases (with some exceptions) during Pregnancy & Lactation-After Lactation has continued about 11 Months generally again make their appearance, which is a hint to wean the Child-It should be carefully remembered that during Menstruation women are more disposed to Inflammatory Diseases than at other times-The Discharge takes place from the Arteries only - sometimes it may be discharged in so small a quantity, that it may be taken up by the Absorbents, before it can pass thro' 54) the Vagina, and this may lead to a belief of Suppression, where it has not really existed- Theory of its use-I suppose that it helps generation by exciting that fulness, sensibility &c which promote Conception-hence Women conceive generally just after Menstruation which enables them to compute their times- Moral Application of the Venereal Appetite- One Man and One Woman their Union Physically as well as Morally proper-The Human Female only, always disposed, the Female Monkey again perhaps excepted - Universal extent of this, Passion in almost all states of the System-In Convalescents from Yellow Fever- Females at 16 or 17, Males at 21 is the earliest period when they ought to marry-The longer Marriage is delayed after that period, the less will the System be injured by Venery or Gestation, provided the Age do not exceed 24 in Women & 30 in Men- Generation The Female Ovum contains the Embryo-The Male Semen stimulates it into Life-Thus the first Evolution of Animal Life depends upon Stimulus, as well as its constant support- Symptoms of Conception Coldness succeeded by glowing Heat sickness &c a Lady at NewCastle always knows the exact period of impregnation by a desire to steal every thing-Harvey says that a 55) 6 Months Child may live- Of Parturition Is Pain necessarily connected with Parturition? I believe not-Labours are easy (1) In very hot Climates (2) In a weak habit of Body &c Why should not this state of Debility be imitated by Art. by producing direct debility by Bleeding or indirect by such an excessive Dose of Opium as would lull the whole System into Indirect Debility-2bij of Blood taken away at the Commencement of Child Birth would probably destroy pain althogether, particularly if it induced Syncope- A Patient in the Hospital had a Dislocated Humerus which could not be reduced-Dr. Physick bled him ad Deliquum and it was reduced instantly- The Turkish women have always remarkably easy Labours-They constantly use sweet Oil during the period of Pregnancy-perhaps it acts as a constant Laxative and this gradually induces a state of Relaxation and Debility- End of the Physiology 56) Pathology Chap. 1 § 1 Of Disease, & the Origin of Moral & Natural Evil The Science of Pathology contemplates the Causes Seats & Signs of Diseases-a student will derive but little benefit from the perusal of the Treatise on this Subject by Gaubius- All Diseases depend upon predisposing Debility-Wounds & some Local Diseases excepted- Even Contagious Diseases do not act till they have previously induced Debility-This Debility is of too kinds, Direct & Indirect-Both of them have improperly been considered as Diseases, but they only predispose to Disease- The Symptoms of both these states of Debility are so alike, that they can only be distinguished by a knowledge of their Cause-All Evil, whether Physical or Moral depends upon Debility-In consequence of this Debility derangement takes place-this consists in (1) Irregular Motion (2) Error Loci (3) Solution of Continuity - 57) A sudden diminution of Excitement increases the Excitability-The more sudden the Diminution, the greater the Increase- There appears to be a transmutation of Excitement into Excitability in the production of Diseases - and the cure of them in many cases consists of nothing but the Conversion of the Excitability back again into Excitement by means of Medicine - Where either direct or indirect debility has continued a great while, the Excitability is diminished-hence results the necessity of strong stimulating Powers & a frequent change of them to act upon the remains of excitability, as in Famine But further-All evil is produced from an Excess, derangement or Error Loci of what was originally good-Thus a Crumb of Bread gets into the Wind-Pipe and endangers suffocation shall we say that this is its natural effect. Thus too the Contagion of Yellow Fever is, in a small degree a wonderful Stimulus-Poisons-Opium are Medicines or otherwise according to the manner in which they are used-and Marsh and Human Miasmata are a fine nourishment to Vegetables- Moral Evil results from loss of power or strength in the will-Analogy of the destruction of a Building from the loss of its supporting Column-Nothing positive is introduced, but power is abstracted, The Evil is wholly Negative-Every Nice is but a Virtue out of Joint-Thus Envy is nothing but dislocated Emulation-Anger is only an Excess of 58) a just abhorrence of Evil- (1st) then, Debility is the universal predisposing Cause of Disease- (2nd) Debility is followed by an increased disposition to be acted upon by Stimuli- (3d) Debility is the inviting Cause of Morbid or irregular action Excitement or wrong action, and in this Species of Excitement Disease consists- Excitement may be excessive tho' not morbid as in running, Dancing and the Like- (4) Disease is always partial-I know of none which produces irregular excitement in every part of the Body-In a fever it is chiefly confined to the Blood Vessels, in Mania to the Brain &c-Equal Excitement is health, and the art of healing consists in little else but in equalizing the excitement of the System- (5) This irregular excitement discovers itself by Excess in the force or frequency of Motions-This force is sometimes so great as to render Motion stationary as in Spasm, and in those states of Malignant fever, where the Pulse is imperceptible- It sometimes discovers itself by pain, but this is far from being a universal Symptom of irregular excitement or wrong action-Pain is only a Symptom of Disease, as Heat & Thirst are of a Fever-It depends upon a certain grade of Excitement and the Excitability of the part affected- (6) There is but one Disease in the World, and that irregular excitement or wrong action- It may be objected that certain part of the Body are disordered from Obstructions, Effusions, 59) and destruction of Substance, where there is no morbid excitement or action-True-but these Phænomena are not diseases but the Consequences or effects of Diseases, which had been preceded by morbid excitement-e.g. Water in the Brain from Phrenitis-Obstruction in the Liver from Hepatitis-When they produce Death it is always from reacting & producing morbid excitement in a part, or in the whole system- Perhaps it would be more proper to call these effects of Disease, Disorder, and thereby deliver these two words from a Synonymous meaning- (7) The weak part of the System invites the Morbid Action when excited-I shall now state the difference between the System that taught by Dr. Brown- (1st) Dr Brown classes Diseases as Sthenic & Asthenic- I conceive there is no properly Asthenic Disease- (2) Dr Brown says that in Disease, Excitement and Excitability are equally diffused over the whole Body-I believe the reverse of this and my practice is formed to equalize them-hence my System of cure consists in (1st) Abstracting Stimulus from the Diseased part either directly or indirectly, and diffusing it equally thro' the whole System- (2) Exciting a stronger and healthy Action in the diseased part, or in some other part of the body- (3) Preventing the recurrence of Disease by obviating predisposing debility, as in bathing the feet, drinking White Wine Whey &c- 60) (3) Dr Brown places the Disease in Debility I consider it only as the inviting Cause of Disease- We find then 3 links in the Chain (1) Predisposing Debility-(2) Morbid Excitement or Disease (3) Effusion, Derangement & Disorganization at Disorder The Causes of Diseases have been divided into Remote, Predisposing, Occasional or Exciting and Proximate-Exemplification of these Causes in the production of a common Inflammatory Fever- (1) Cold is the Remote Cause-(2) Debility induced by this cold is the Predisposing Cause (3) The Heat of a Stove Room, or the Vernal Sun is the Occasional or exciting Cause & (4) The Proximate Cause, which is, in fact, the Disease itself is Convulsion in the Arterial System- I Of the Remote Causes of Diseases- (1) From Infancy-Many Circumstances attendant upon Children at Birth, may operate as Remote Causes of Disease-Injuries done to the Mother during Pregnancy and Parturition by ignorant or unskilful Midwives-Washing them with Wine or Soap-Their first Aliment in many Cases, also their first dress-The administration of Ardent Spirits to them as Medicines in certain diseases-The influence of the Milk of Mothers negligent or intemperate in their Diet, or wholly devoted to pleasure-I once saw Death follow Convulsions in a Child from sucking a nurse who had drunk a Pint of Rum- Premature Study-Confinement in a close school Room - Tyranny of School Masters, Nurses &c- 61) Amusements, Falls, Pushes, Thumps, Hydrocephalus from blows - I once knew Death from [crossed out] Stroke on the Head given by a passionate Mother with a Brush-All these operate at Causes of Diseases- (2) From the Sensible & Insensible Qualities of the Air- The Air acts (1) By Heat, Cold, Moisture and Dryness-(2) By certain impregnations- Heat induces indirect debility-In the Arterial System it produces Languor, great excitability &c In the Nervous System it dulls the Sensation of touch, affects the Brian with sleepiness in the Day time, and when less stimulating, so as not to produce general indirect debility, causes wakefulness at night-It acts on the Muscular fibre producing Languor & weakness- on the Stomach & Alimentary Canal producing deficiency of Appetite, with a disposition to Cholera & Dysentery-On the Skin producing Sweat, if still higher, dryness, which sometimes happens in this Country to Reapers, and if not relieved, terminates fatally.-Also Eruptions and small Boils, and disposes it to a brown colour-Invigorates the Venereal Appetite-Acts on the Blood by disposing it to putrefaction which effect is prevented by the increased Secretion of Bile-The Bile is however often vitiated by Marsh Miasmata producing Disease, in consequence of the Heat, in Countries exposed to such exhalations- It affects the Eye sight-It is less unfriendly to old than to young persons - 62) hence the Emigrations of the Old Romans and the modern Portuguese-It acts with greater force after Cold-A sudden abstraction of it often produces Disease-During the Heat of Summer, if the Heat be uniform, it is healthy if varied by cold or Moisture, unhealthy- No Climate is necessarily unhealthy if Reason be called to our Aid, in order to accommodate ourselves carefully to the Climate-The Africans live to a great age, in the neighbourhood of Factories that prove the Grave of Europeans- The Effects of Heat are various, according as it is combined with dryness or moisture- Travellers in passing over the Deserts of Nubia are obliged to carry wet Sponges to breathe through- Indeed a certain portion of Moisture seems necessary in the Atmosphere at all seasons-It is particularly useful in close Rooms heated by a Stove-Hence those who inhabit such Rooms are forced to put on the Stove a Bason of Water for the benefit of the exhalation produced- Wet Seasons [crossed out] in the West Indies are not unhealthy, where the Inhabitants are not exposed to any Morbid Exhalations- The most formidable effect of Heat is Insolation- Different Temperatures of the Air are necessary for different Ages- The Indirect Debility from Heat is counteracted by Cold-Cold however is not a Tonic-This brings us to the Effects of Cold on the various Systems- Cold in the Arterial System produces Debility 63) and Excitability and disposes to all kinds of fevers even Intermittents-In the organs of Voluntary Motion it produces Languor, and indisposition to exertion-In the Nervous System it dulls sensation and when very intense produces pain in the Head, Sleepiness and Death-It weakens the Venereal Appetite, is unfavorable to Vision from causing Snow.-Debilitates the faculties of the Mind, probably from the Languor it imposes on the Body-In reviewing these Circumstances we find (1st) That it induces general Debility upon the Body-(2) That the Pulse is rendered weak, slow, and sometimes even suspended by its action. (3) That it induces weariness, Sleepiness and Death & (4) That a striking analogy may be traced between its effects in certain Diseases, and thou of certain sedative Remedies as Bleeding &c From these circumstances we prove that Cold is a Sedative- Cold renders sweating difficult & uncommon, but when so moderate as to prompts to the use of exercise it promotes insensible perspiration- Cold acts more powerfully upon the System in a state of Inanition than when the Stomach is full-Old People suffer most from its effects- These are the Ordinary effects of Cold, but when it succeeds the Intense heats of Summer, it generally produces a train of Bilious & febrile Diseases- It is remarkable that Heat when long applied produces the same insensibility to Cold, that it does to itself-The same Rule holds with 64) regard to Cold-The West Indians endure the first Winter after their arrival in this Climate better than the Natives themselves-Probably the Sentient extremities of their Nerves are torpid from excess of the Stimulus of Heat-But perhaps their sensibility is only increased by the short duration of warm weather here, hence the Natives are more frequently attacked with Diseases-The same Rule holds with regard to the first Summer spent by those who move form a Cold Climate to a warmest one-The difference between the effects of the short or long application of Cold to the Body should be carefully attended to-The latter produces insensibility, the former an increase of Sensibility- The sudden transitions from Heat to Cold are, in general, highly unfavorable to health, hence sickness frequently follows a cold Night, succeeding a Warm day in August-but these sudden transitions do not necessarily produce these effects if the dress were with sufficient care adapted to them-In our Climate these transitions are so sudden & so great that the attempt to harden ourselves against the effects of the Climate by light clothing is in vain Warm Cloathing should be recommended-I know of numerous Diseases, produced by too thin cloathing few by its being too warm-Cold Feet are the principal Avenues to Disease-In all Chronic Diseases prescribe keeping the Feet warm- Colds are, I believe, more frequently taken from exposure to the Night Air, than in any other way-"Hence 65) says Brydone, "it is gallant in Sicily to make Love in a hoarse voice, in order that the Lover may appear to have taken cold from his frequent serenades. Our Dews in August are sometimes so plentiful as to cause Springs that have been dry for 6 weeks to flow again, altho' no Rain has fallen- The winter seems more unfavorable to human Life than the Summer-The following is the Average number of Deaths in each Month, taken from a Register kept for 7 years at Boulogne in France- Jan 142 Feb. 111 March 112 April 108 May 107 June 77 July 72 August 85 Sepr. 112 Octor. 110 Novr. 125 Decr. 112 For further observations See Dr. Hack's Inaugural Essay- Of Impregnation of the Air The Remote Causes of Disease produced by this Cause may be chiefly referred to (1st) Marsh Miasmata (2) Human Miasmata- (1) Marsh Miasmata-For these to produce all their Effect they must be acted upon for some time by a Heat above 80-This degree of Heat must also be united with moisture but not liquidity-The Meadows below this City were once overflowed in April, and altho' much Animal and Vegetable Putrefaction took place after the retreat of the Waters, no Disease followed, the 66) Heat not being sufficient to produce the Morbid Exhalation before the Putrefaction was concluded- When Seasons are so rainy as completely to overflow the Low Grounds & morasses, they are not unhealthy-Nor are very hot Summers when perfectly dry- The high Grounds are often sickly when the low ones are not and Vice Versa-The same quantity of Rain, which leaves a surface of Exhalation on the high Grounds, perfectly overflows the Marshes below- The Danger arises from such moderate degrees of Rain as may produce Moisture but not Liquidity-There are exceptions, when heavy rains prove unhealthy, e.g. when they destroy the green Pellicle on Stagnant Waters, and set afloat the Putrid Miasmata- Swamps, shaded by Trees are not unhealthy- Exhalation must take place to produce Disease- Neither the Human, nor Brute Excrements seem to produce Disease-Animal matters rarely produce Disease-Putrid Fish more frequently, Putrid Vegetables most frequently- The application of these Miasmata sometimes brings on death from excess of Stimulus-They act as a Stimulus on the Arterial System, generally directly producing fever, but sometimes indirectly- The Bile is in these Disease sometimes mixed with the Blood- These Miasmata particularly affect the Nervous System & Brain frequently producing Headach and 67) Convulsions-They act on the Stomach and Alimentary Canal, probably by the Medium of the Bile which they vitiate, and sometimes to reach a degree as to excoriate the Rectum & Fauces- The Liver seems to suffer more or less in all these cases-They produce in the Stomach & Bowels sickness, Pain and Diarrhœa- Bilious Fevers which are produced by Marsh Miasmata are generally accompanied by Inflammation or Congestion in the Liver and a preternatural secretion or Excretion of Bile- Galvani produced a similar morbid state of the Liver by injecting Hydrogene into the Œsophagus of Fowls, and afterwards tying up the Gullet till they died-Beasts killed in the Autumn when Bilious Fevers prevail have generally enlarged Livers, sometimes ulcerated-probably from inhaling the Gas of Marsh Exhalations- Do the same Miasmata ever affect the Bowels so as to produce Dysentery. Yes- The same which at the bottom of a Hill may produce a Bilious Fever, being combined with a greater degree of Cold at the top of it, may turn in upon the Bowels & produce Dysentery, constituting the Fibris Introversa of Dr. Sydenham- The Bilious Colic seems owing to the same Causes. Miasmata are said to act in some Cases upon the Blood, so as to dispose it to a Septic tendency - The Dissolution of the Blood 68) does not depend on Putrefaction but upon the violent Action of the Arteries, which, as it were, tear and send it to pieces- They act with the greatest power when combined with Cold or Moisture-hence the Morning just about Sunrise and the Evening just about Sunset are the most dangerous times to be exposed to them-In the middle of the day, the Heat rarefies them, and they ascend into ye upper Regions of the Atmosphere-In the Night they are condensed, and float near the Ground-so that it is safer to travel in the middle of the night than either morning or Evening-The Owners of the Meadow Lands below the City work in them with Impunity, provided they do not come 'till an hour or two after Sunrise and quit them an Hour before Sunset- (2) Human or Animal Miasmata-These are produced by want of Cleanliness, by Crowded Rooms, Hospitals, Gaols &c-They infect clothes, Linen Clothes are said to imbibe them sooner, but, not to retain them so long as wool or Cotton- The Plague in Egypt begins when the People crowd into the Cities to avoid the Inundation- Low, vapid, Vegetable Diet-Scanty Aliment, Putrid Animal Diet, Depression of Mind, Mixture of Strangers with each other, all are favorable to the production of these human Miasmata- 69) From all these Causes, which operate most forcibly in time of War, Famine & Pestilence are justly said to follow its course- Can a Human Body infect itself from Miasmata generated within itself? Yes- Human Miasmata are engendered more frequently and act more forcibly in Winter than in Summer, for in Summer Doors and Windows are kept open- And Dr. Blane observes, that on board the British Fleet, when they come into warm Latitudes & the Sailors keep upon Deck, the Fevers excited by these Miasmata cease, but they return when they reach the Colder Climates and the Sailors again crowd below- The Concentration of Miasmata, produced by Cold, probably renders the Yellow Fever so contagious in this City when it is so rarely the Case in the West Indies- The most strikingly beneficial effects were observed here, from opening the windows of the workhouse, which was used as a Hospital during the late War- Human Miasmata will adhere for a vast while to Clothes, particularly Woollen & Cotton- The Stocking of a Man who died of a Gaol Fever, was put [by] Accident, by a Fellow Servant, round his Neck for a Sore Throat-altho' some days had elapsed, the Man received the Disease- 70) They adhere to Stone, Wood, &c & Brick Walls-A Wooden Hospital used during the last war at the Yellow Springs infected some Soldiers who were quartered there after it had been empty for five Months, but the Contagion of Typhus never adheres to white washed walls or to Earth Floors- In this State of Fever always take down, your Patient's Curtains and draw the Bed into the middle of the Room-This last advice is of importance- An Epidemic Dysentery raged in one of our Military Hospitals during the last War, and was observed to be much more fatal to those whose Beds were ranged along the Walls than to those whose Beds were in the middle of the Room- These Miasmata do not act except upon persons previously debilitated-Vigour imparted by certain Stimuli resists them-Fear & Grief favour their Operation- Pregnant Women and Persons labouring under an Abscess attended with pain, often resists to Contagion of the Gaol Fever-altho' in some Cases it may appear after delivery or after the breaking of the Abscess- Other Animals besides Man, under the Circumstances of Confinement or bad diet, sometimes emit Miasmata, which produce fever-Dr. Fordyce mentions an instance of this-Hydrophobia perhaps proceeds from this Cause-During the Revolutionary War the British attempted to send over Sheep, Hogs, Cattle &c for fresh Meat-They generated a Fever amongst themselves and perished diseased- 71) Diseases of Human Miasmata (1) Typhus Mitior, commonly called the Aloes Nervous, Gaol, Shep and Hospital Fever-It is preceded by general debility-often comes on without Chill - affects the Brain and Nervous System with Stupor, Tremors &c The Action of the Arteries sometimes not very different from the natural state, at others weak, quick and irregular-The stomach is seldom affected with vomiting, the Bowels generally regular-no change appears in the Bile-In the most malignant Cases I have seen Buboes and Ulcers in the Throat, and Abscesses in various parts of the Body, but they are uncommon-The same Remote Causes produce Fevers of a different Type according to the previous Habits of the Patient. (2) Plague-a Warm & Moist Spring never fails to produce it in Constantinople-Similar Temperature produces it in Egypt in the Winter It's progress is assisted by filth, Predistination, and the Inactivity produced by absolute power- Though Moisture seems almost necessary to it's production, Liquidity destroys it-The water Carriers at Aleppo, who are constantly wet, escape the Plague-The Spaniards in the Island of Cuba, when exposed to such a degree of moisture as makes their Clothes considerably damp, take care for the same reason, according to Ulloa, to wet them thoroughly- 72) Typhus & Plague have a strong resemblance to each other, and appear to be only different Grades of the same Disease-The Plague produces its effects much sooner, and destroys the Patient much sooner the Indirect Debility produced by it is immense, and sometimes so sudden & so great, that a Patient is destroyed by it as if by Apoplexy- In no Gaol in Europe, except in England, however Crowded with Prisoners, did Mr Howard detect the Gaol-Fever-The reason is obvious-The great Filth &c in foreign Gaols produced a higher degree of Malignity than Typhus Mitior- Dysentery is an occasional Offspring of this Source- Influenza is probably a light degree of Gaol-Fever- Typhus does not appear to have much Remission, a very leading distinction from the Bilious Fever The leading distinctions between Diseases from human & those from Marsh Miasmata are as follows-(1) The Latter may be known from their occurrence-from their having Remissions, and discharges of Bile, from their being accompanied with Strong Action in the Arterial System-from the Vicinity or exposure of the Patient to any of the Remote Causes, and from their being checked by Cold and Rains, even altho' the Patients be crowded together- Impregnation of the Air from other unwholesome Matters- (1) Phlogistication of it-produced by various Causes- 73) by crowding persons together in close Rooms not ventilated-Black Hole at Calcutta-Epilepsy often seizes people in crowded Assemblies, hence it's name of Morbid Comitialis-The Air of crowded Rooms is worst at night owing to the Candles-By burning Pots of Coals in close Rooms without Chimnies, particularly Charcoal- (2) Vitiation of it by the Effluvia discharged from certain Manufactories which volatilize Sulphur, Arsenic &c (3) By the Noxious Air discharged by Plants, wch perhaps principally contributes to render the Night Air unwholesome- (4) From certain peculiar Matters which mix with Winds in blowing over certain tracts of Country- as the Harmattan, or Simoom, which is probably impregnated with a Volatile Sulphuric Acid, derived from the Beds of Sulphur & Bitumen over which it passes-Air impregnated with the Fumes of Sulphur is said to make people particularly vicious-Brydone attributes the extreme wickedness of the Inhabitants in the Neighbourhood of Mount Ætna to it-The Sirocco is supposed to be heated by passing over the burning Sands of Africa-See Brydone's Travels, Letter 29- (5) From the Air being too highly Oxygenated- This state of the Air tends greatly to the production of Inflammatory Diseases-This Inflammatory Constitution lasts from one to fifty Years- 74) Persons who have been in a highly Oxygenated Atmosphere, if they be afterwards exposed to the exciting Causes of Inflammatory Fever, have it in a much more violent degree, as was the case in 1794 with some who had been out to the Seashore and returned into the City- Bruce mentions a spot near a Town on the Banks of the Nile where an Air highly noxious to Animals, exhaled from the Ground - probably this was Carbonic Acid, which was fatal to Animals only because they had to seek their food near the Ground, and the Exhalation might have only risen a few Inches as in the Grotto del Cane Of particular Situations, or a Change of Situation as a Remote Cause of Disease- A new Country, however wet, is always healthy provided it be shaded with Trees-A Country when first cleared, if not cultivated, is generally unhealthy. Towns and Cities are the Gaols and Graves of the Human Species from various Manufactories, crowded Houses, increased heat, dirty Streets &c Dr. Price is of opinion that a Man diminishes both his health and life by living in London before he is Thirty- Typhus Mitior, Consumption and some previous Diseases, are Diseases of Cities-Dysentery more rarely; this with Inflammatory and Bilious Disorders are the Common Diseases of the Country- Whilst I was at Princeton College a Dysentery 75) broke out amongst the Students; but all those from Philadelphia or N. York escaped Citizens are perhaps less disposed to this Disease from their more general use of Tea, Coffee, Wine and Animal Food, than Country People-It is generally the result of Vapid, Watery, Vegetable Aliment-The Erection of a Mile Dam when a Country is cleared, is generally followed by Bilious Fevers and Intermittents-A five Years ago a Mill Dam was erected near Harrisburgh, which made a Marsh at the back of the Town-A Bilious Fever occurred there, more fatal in proportion than the yellow Fever of 1793 was in this City-The Citizens purchased the property and destroyed the Dam, since which period the Country has been healthy- Marshes also in the Vicinity of a Town render it unhealthy when the Wind blows over them towards it particularly if it be combined with Moisture-In some Cases Miasmata are conveyed for Miles-I think I have known for ten-A Copse of Trees, if planted in the direction of the Wind, intercepts them-Trees should also be planted round the Mill-Ponds- Mountainous Countries are generally healthy- Vicinity to Sandy Wastes, or to the Sea Shore affects the Air of a Situation-The Air on the Sea Shore is unfavorable in certain Diseases, as Asthma, Consumption & Rheumatism, in any part of their Inflammatory Stage-This Air however is highly beneficial in some other Diseases- 76) A Mixture of Airs as of Sea & Land is unfavorable to health-The Captain of the Ship in which I sailed to England was always seized with Catarrh before he came on soundings - The Mixture of Pure and impure Airs, produces sickness, thus a person sometimes vomits after coming out of an Offensive Hospital into the fresh Air, altho' he might have felt no sickness in it - Under Ground Kitchens are unfavorable to health- Houses may be too closely surrounded by Trees- If the Sun cannot act upon every one of them in some part of the day, they will probably prove injurious- Some Houses seem to have some occult cause of Disease attendant upon them, in so much that Families who have resided in them for years and been constantly unhealthy have, by changing their situation, suddenly became healthy- Of the Effects of changing a Situation- Persons who remove to a hotter Climate, frequently get fevers-this is called a Seasoning- Persons who remove from a marshy part of the Country to a City, are often seized with Sickness - They bring in with them those Stimuli which have lost their force from habit, till joined with the various new Impressions of Cities- Marsh Miasmata, tho' a Poison to young or middle-aged Persons may become a necessary Stimulus to the Aged-When Dock Sheet was going to be Arched over, several persons objected on acct of the number of old Persons living there, which 77) they said was a proof that the spot was not unhealthy - The Young ones had all died- Consult Gibbon's Decline &c Vol I. end of Chap. 10- I once met with a solitary instance of a Lady much afraid of Thunder and Lightning, in whom an Electrified Atmosphere, always excites Headach, so that she could tell, by its coming on, abatement or departure, the Corresponding State of the Storm- Earthquakes and Hurricanes seem to produce Diseases merely by their effects upon the Passions- Light & Darkness-many Diseases seem to exacerbate in the night for want perhaps of the gentle Stimulus of Light, which may be beneficial in diseases of moderate action- Influence of the Moon is perceptible in Fevers, See Balfour and Jackson-also in Epilepsy, in all diseases from Worms, in Madness, in Hypochondriasis, in Hæmoptysis, and according to Dr. Kirkpatrick, Births are accelerated and facilitated by the full of the Moon Of Specific Contagions, as a Remote Cause of Diseases These are so called, because they affect some parts of the Body uniformly more than others-There are much fewer of them than was once supposed-They are the Small Pox, Measles, Cynanche Maligna, Scarlatina Anginosa, Hooping Cough, Influenza & Chicken Pox- The Small Pox is known before its Eruption by a pain in the Back, soreness of the Region of the Stomach, Cough and Expectoration, for the Lungs and Throat appear to be affected in this Disorder together with the Skin-When the Contagion is received into 78) the System in the natural way, it usually lies hid for 14 or sometimes even 20 days-It adheres for a long time, even for months to clothes-I think I knew a case where it was conveyed by a Letter - It is said that Bodies which have been dug up 20 years after Interment have infected persons with this Disease- Measles-The Contagion here acts on the Skin and Lungs-more fatal & dangerous than the inoculated Small Pox-for further information consult Sydenham and my Inquirior The Cynanche Maligna & Scarlatina Anginosa do not, I think arise from the same specific Causes, altho' they are some times confounded together- The Scarlatina will infect before the Symptoms of the Disease have appeared - However the Treatment is regulated by the Symptoms- The Contagion of both seems to have a dispositon to unite with the Mucus of the Throat & Fauces, and sometimes with the Mucus of the Bowels exciting a puking of Bile- Hooping Cough-I have seen 3 Adults affected with it-it is not always attended with Fever- Influenza-This is the most universally Contagious Disease known in the World-I have sometimes suspected a local Influenza from crowded Churches, Assemblies &c It does not, I think depend upon the sensible qualities of the Air - It is propagated by Contagion & in Succession- It's appearances are uniform in different 79) Countries and Climates-The Descriptions of it in Great Britain, Philadelphia & Grenada, are exactly alike, which renders the supposition of its depending on the sensible qualities of the Air less probable- Chicken Pox-This is a mild Contagious Disease I have never seen it fatal- Miliary Fever-I do not think this Contagious- It seems now clearly proved to have been produced by the Hot Regimen- All Contagious Diseases, the Influenza excepted, partake more or less of the qualities of the Atmosphere; Their Types are Malignant & Bilious in Autumn, Inflammatory in Winter, particularly Small Pox- Measles and Cynache Maligna are not so much influenced as the Scarlatina Anginosa, which often in Winter partakes of the Inflammatory Type-It has been more Inflammatory since 1793- No two of these specific Contagions can act upon the Arterial System at one and the same time, [crossed out] The Eruption of the Small Pox and Measles may be out on the Skin at the same time, but this is the Solution of the Disease, not the Disease itself, any more than the Sediment in the Urine after fever, is the fever Power of the reigning Epidemic The Autumnal Fevers of 1783 all partook of Scarlatina Anginosa, as pains behind the Ears, sore throat, and swelling of the Hands & Foot- 80) Sydenham observes that all Fevers partook of the nature of the Small Pox, when that was Epidemic- all being accompanied by the Salivation which is peculiar to the variolous Fever - And Huxham observes that when the Ulcerous Sore throat prevailed in Plymouth, he found all fevers accompanied with some of the Symptoms of that disease- Keep your Eye steadily upon the prevailing Epidemic- Epidemics have different degrees of force, in the different periods of their duration-They come on with the fury of a Savage and retreat like a civilized Foe-Hence an Epidemic of less specific force will take place of one stronger, when that has reigned for some time, as Measles, succeeding Small Pox- The reigning Epidemic sometimes entirely chases away all other Diseases-I know of no precept more truly important than that of keeping your Eye on the reigning Epidemic- Contagions do not affect every body at the same time, but vary with varying Circumstances- Epidemics frequently [keep] vary as to their violence- & it that the Atmosphere is at such times more highly Oxygenated, or that our food &c has a greater portion of Oxygen combined with them - Contagions affect Natives of some Countries and not of others, as the French West Indians in the Yellow Fever of 1793-Sometimes they affect persons, of one Colour only-Sometimes Christians & not Jews - 81 Influence of Aliments, Condiments and Drinks in producing Diseases Aliments act by quantity and quality in producing Disease (1) Quantity (1) Excess in this respect acts by Distention-The Stomach by too frequent distention loses its tone-Too much nourishment thrown into the System disposes to all the Diseases of Plethora, particularly to Palsy, Apoplexy, Hæmorrhagy and Dropsies, also Dyspepsia - These effects are varied by the indolence or exertion succeeding Meals, most injurious in the former Case- (2) An Error on the other side produces Diarrhœa, Colic, Emaciation and Dropsical Swellings These affections often attend a Child from not being suffered to suck sufficiently-Much Mischief is, I believe, done at Boarding Schools by keeping Children on too little Food of a nourishing kind It is difficult to decide what quantity of Aliment is sufficient in a state of Health, much depends on its being stimulating or otherwise &c, Vegetable or Animal- Abstinence and famine increase the excitability of the System-Famine produces pain in the Stomach, full Gall Bladder, Acrid Excretions, even the Milk becomes so fœtid & Acrid Breath, See the case of Benjn. Lay in my Essays p. 305- want of Sleep, Hæmorrhagies from the Stomach- 82) Bowels and Nose, swelling of the Fauces, and finally Delirium and Death- Tho' the Effects of long Inanition are debilitating, certain degrees of Hunger give Strength, by the Stimuli of the desire of food and of life, acting upon the Excitability of the system accumulated by hunger-hence the increased strength of the Lion when hungry-Men also seem in some degree under the Operation of similar Causes-hence Scotchmen should fight fasting and the old saying that "Hunger breaks thro' Stone Walls" Diseases from Animal Food (1) A Diet consisting wholly of Fish- Fish yield but little nourishment, and diminish, it is said, the Venereal Appetite-Being less stimulating they were proper in Spring-Lent therefore was a wise Institution-If subsisted upon entirely they tend to produce the Itch, a Change in the colour of the Skin, Lice, Leprosy, Ulcers and Fevers of a Malignant kind- (2) A Diet consisting wholly of Land Animals- This produces fetid Breath, Sweats and Urine, Malignant Diseases, Diarrhœa, Dysentery and Hectic Fever-The Scurvy was produced in one of our Garrisons during the late war where the Soldiers had no other Provisions but fresh Beef for several weeks-Carnivorous & old Animals tend more to the production of these Diseases than Herbivorous & Young ones; and some particular Species more 83 than others, as Pork especially-Also different parts of Animals and very fat Animals- The Change of Diet which has taken place in Europe since the 15th Century, has produced a great diminution of those terrible Diseases, Plague, Leprosy &c doubtless owing to Agriculture, and the consequently greater use of a Vegetable Diet, See the Notes to Robertson's Charles V. Vol 1. (3) A Diet wholly Vegetable-Many Nations live wholly upon it-The Cerealia afford most nourishment-The Gluten of Wheat is said to be on some Analogy to the Coagulum of the Blood- Vegetables are nourishing in proportion to the Sugar they contain- Green and Acid Fruits corrode the Teeth- Ripe Fruits taken in excess produce Diarrhœa and Cholera Morbus-Stones of Fruits when swallowed sometimes produce Colic & sometimes sudden death - In general a Vegetable Diet produces universal Debility, Anasarca, Dyspepsia & Dysentery, with deficiency of the Venereal Appetite-All these Complaints were very common in England soon after the publication of Dr. Cheyne's Book - In the Mind it subdues the ferocity of the Passions, and increases the vigour of the Mental Faculties- Milk is an Aliment of a mixed nature-it sometimes produces sickness, Acidity, & Headach in persons used to City Aliments and in Dyspeptic Patients-Two of its component parts Butter 84) and Cheese often produce Diseases-Butter sometimes disorders the Stomach, and taken in too large quantities disposes to Eruptions on the Skin-Cheese taken by itself produces Heart burn and in any other way Costiveness- Circumstances affecting the wholesomeness of Aliment independently of Quantity or Quality Food should not be taken at too long Intervals- Eat a little and often- Dyspepsia from the neglect of this is common in public Junctionaries-I have often recommended to such persons the taking of Gingerbread or Raisins in their Pockets, with good effect- Preparation of Food for the Table-It should not be dressed too soon nor kept too long-should be well done and thoroughly masticated-The want of attention to this last particular is a frequent Cause of Dyspepsia-Flesh when kept too long is apt to produce Diarrhœa & Fevers- Fish when kept too long is apt to produce Eruptions & to disturb the Bowels-Oysters & Eggs should not be cooked hard- Vegetables tending to putrescency are to be avoided, also Raw or half done Vegetables- It is of consequence for the Practitioner to remark the Quantity of Grain, Fruit &c in each year in order to the History of a prevailing Epidemic- 85 Rotten Potatoes have produced Malignant Fevers- Half baked Bread produces Colic &c- Too much Food is often taken after too long intervals betwixt Meals-large Quantities of any kind of Food, taken after long fasting are injurious- Convalescents upon a Journey should always take food with them, as a little Biscuit & Ham, grated together- Sudden Changes in Aliment are injurious-But more dangerous from Vegetable to Animal than from Animal to Vegetable-But in preparation for Small Pox. I think the sudden change beneficial and therefore do no direct my Patients to make any Change in their Diet 'till the day after Inoculation-After Recovery the Patient should return to the use of Animal Food gradually-and after all Febrile Diseases, where little or no Animal Food, had been used for some time- Persons who have lived for a long time upon Vegetable Food sometimes faint from the smell of Animal Food. [crossed out] East-Indian Servants when Persons first arrive from Europe-My own case during Yellow Fever- An improper mixture of Food is injurious Hence weakly people & Convalescents should be advised to eat always of one dish-Fish and Flesh together can seldom be borne without inconvenience after forty five-See my Inquiries- Too hot or too Cold food it injurious-An Ice-Cream produced a Scirrhus in the stomach of Major Reed, late a Member of Congress for Pennsylvania, & killed him at the distance of 12 Months. 86) Novelty of Foods is injurious, and some particular ones, as Radishes, Cucumbers & Melons require a renewed acquaintance every Season, as they generally affect the Stomach unpleasantly, when first eaten in the Season-Even Butter [crossed out] tho' in itself highly wholesome, has sometimes proved injurious, when it has been left off for some time, and suddenly resumed- There is what may be called a Disease of Satiety- The Stomach rejects any Article of Food, which has once been taken in such quantities as to produce Surfeit- There are Diseases from Aliments lying for days, & even weeks undigested in the Stomach Dr Haller mentions a piece of fat Pork being thrown up by an Emetic after lying in the Stomach for 2 Months- A Young Lady of this City was affected with an obstinate Vomitting and Fever, which was at length relieved by an Emetic by the discharge of about half an Ounce of Cheese Cake, eaten two or 3 days before It had undergone no Change & all her Complaints vanished- Aliments sometimes affect the health by being prepared in Vessels of Lead & Copper, Hence when a whole Family is disordered at one time with Stomach &c Bowel Complaints, examine their Cooking Vessels- Aliments are affected by being taken in a fresh or salted state-Children in the Country are, I believe, preserved from Cholera Infantum 87) by living so much on Salted Meat- Aliments are rendered unhealthy by the mixture of Animal Excretions &c, or by the food which the Animal eaten lived upon-Sixty of the Students of Princeton College were once seized with a Diarrhœa in one night from eating a Pigeon Pye. The Birds in which had fed upon Poke Berries-Animal Food is I believe more wholesome, salted than Fresh-Fresh Meat should be eaten in Winter & Salted in Summer Salt Meat unless Vegetable be eaten with it produces Scurvy-There appears to be an Idiosyncrasy in some habits with regard to certain Aliments- Of Diseases from Condiments The Condiments are, Salt, Vinegar, Mustard, Sugar and other Saccharine Matters & certain Spices- The desire for Salt seems nearly universal tho' some whole Nations are strangers to its use as the Numidians, Carribbeans &-Some of the Indian Nations use Wood. As has as a Substitute-Some Indians who had never before tasted it, ate it during the war as a Treaty forming at Easton. They were affected in consequence with Vomiting and Purging- Scurvy is the principal Disease arising from the too great quantity of the Condiment- There was a Case of Leprosy from it in the Year 1799 in the Pennsylvania Hospital- Vinegar taken in too large quantities produces 88) Dyspepsia, Gastrodynia, and in some cases of Predisposition, Gout-It also produces paleness, but moderately used, it is wholesome- Mustard is a powerful Stimulus, used in excess it produces Gastrodynia and other affections of the Stomach, also Inflammatory Disorders See Page No. 6 Sugar is the most nutritious and delightful of all Aliments-taken in too great quantities it produces Dyspepsia-of which I knew a very obstinate Case in a Grocer of this City, brought by tasting several different kinds of Sugar in the day- Brown Sugar is gently purgative, as are also Honey and Molasses- All the Spices taken in too large quantities produce Dyspepsia-There is a monstrous enlargement and Induration of the Testicles among some African Tribes, which is described by some late Travellers into that Country, and is said to be produced by their immoderate use of Cayenne Pepper- I have heard of such a Complaint being common in the West India Islands, particularly Barbadoes probably proceeding from the same Cause- Tea & Coffee The increase of the use of Tea has been thought to produce Hysterical Affections-This Complaint is more frequent in the Kitchen than in the Parlour, 89) for servants drink it stronger-I think all it injurious effects are merely owing to it's Strength-Taken very strong it tends to produce wakefulness- Coffee should be used weak-when taken too strong it produces Vertigo-It's use should be forbidden in all cases where persons are subject to such affections-It is exhilarating to the Spirits- Linnæus says that it enfeebled the Venereal Appetite-Hoffman says that he has seldom seen Women who were very much addicted to the use of Coffee, recover from an Attack of an Acute Disease- Neither Tea or Coffee contain any actual Aliment, all the Aliment resides in the Cream and Sugar-The Changes which have been produced by their more general use have been favorable to health and Morals-They are excellent substitutes for Spirituous Liquors, and in Sweden have almost entirely superseded their use-No Cordial after severe Labour or Study is equal to Tea & Coffee, nor any Remedy so agreeable-See the former observations on Aliments- Effects of Water Praise of that Fluid-Nine Tenths of Mankind, says Haller should use no other fluid- The Diseases produced by it arise 1) from it's sensible qualities-Taken very cold it produces pain and Inflammation of the Teeth, and 90) afterwards to their decay-The Inhabitants of St. Kitts alone of all the West India Islands have bad Teeth, owing to their excessive use of Cold Water-Dr. Spence informs me he draws 3 Teeth in Summer for one in Winter, owing probably to the greater frequency of Toothach arising from the same Cause-It's effects are much influenced by the Temperature of the Body when taken when the latter is very hot and the former very cold, it produces Spasm in the Stomach, Syncope and Death-To obviate these Effects wash the Hands & Face and grasp the Vessel out of which you are going to drink, for about 5 Minutes- In the Summer, when it has stood for some time it quenches the thirst better than when fresh from the Pump- See Currie on Water- On the Effects of Ices see Dr. Stock's Inaugural Essay p. 118- (2) From the mixture of Salts & various impurities in the Water used-The Contents of Necessaries soak thro' a Clayey Soil, for about 20 feet and further still thro' a Sandy one-In Chronic Diseases especially of the Bowels the Water used by a Family should be inspected. Impregnations of Water if not obvious to the Smell & Taste are not perhaps of so much consequence as it generally imagined-Dew Water is exceedingly impure, it constitutes the richest food of Plants-Hard Spring Water is ye most impure of all-Barton Waters that flow over Beds & Lime, have generally something of a purgative quality-The Easiest Test of the purity of Water is Soap- Persons should avoid the Habit of drinking Water at going to Bed at rising, or between Meals, the Custom is highly injurious & tends to produce Dyspepsia - 91) I once attended a Gentleman who died of a Tympanites brought on wholly by frequently swallowing at one act of deglutition from a Gill to half a pint of cold Water- Effects of Wine- Its Acute effects (as I may call them) are to increase the Pulse, to produce Intoxication and finally Sleep-It's Chronic Effects are Fat, and the Gout-This last effect is produced by Wines in proportion to their Acidity- Madeira rarely produces it-The nearer it advances to maturity which is 7 years, the less likely it is to do so, for its Acidity is so much diminished- Beer contains more saccharine matter and much less spirit than Wine-Too much of it produces Gout, Colic, Diarrhœa, Palsy & Apoplexy- It has also been supposed to produce the Gravel and Stone in a peculiar Manner-But Dr. Haller says that out of 3 or 400 dead Bodies which he had dissected of persons who had drunken Beer all their lives, he found stones only in two-if it does produce Gravel or Stone, it must be by conveying too much Acid into the System- All distilled and fermented Liquors when taken in excess produce Gout- Cyder does not injure labouring people, but it often affects sedentary persons with Rheumatism 92) and Gout-If heated by a red hot Poker it loses much of that Acidity which is apt to disagree with some Stomachs- Cold Beer and Cyder taken when a person is hot produce effects equally injurious with those of Cold Water- Effects of Ardent Spirits See my Inquiries- Drunkards almost always die from Effusion after Inflammatory Diseases, with local affection- The very breath of Dram Drinkers has been known to be inflammable- Take no Bitters or other Liquors between Meals- instead of them take a little Aliment and you will not want to drink- Of Dress as a Remote Cause of Disease Dress acts in 3 ways- (1) It's quantity or disproportion to the state of the Atmosphere (2) It's fashion (3) It's Quality-Too thin is much more dangerous than too thick clothing-I have known but few persons suffer from being too warmly clothed-The only Diseases that I can recollect having been occasioned by it, were 2 cases of Hæmoptysis-The Dress should be as carefully as possible accommodated to the varying state of the weather-There are 2 sensible Spanish Proverbs which may be introduced here (1) When it is fair, take your cloak, when it rains, do as you please-(2) If you wish to be young when you are old, you must be old while you are young- (93 Evils of Dress in various periods of life-Dr Boerhaave says he knew one Case of Bloody Urine, from wearing too light clothes-Tight Night Caps, sometimes produce Vertigo, I have seen instances of it-I am disposed to believe that many Diseases of the Brain are brought on by tight shirt Collars, Stocks or Handkerchiefs-which should be carefully avoided by persons subject to such diseases- Flannel Shirts are worthy of particular recommendation- If is remarkable that Flannel retains the Heat of the Body both when wet and dry-and that if worn for 3 months next the Skin, it neither produces Vermin nor Disease - very different is the Case with regard to [crossed out] linen-It is always cold when wet, requires frequent changes to be safe, and when this cannot be done, it produces Lice and favours the production of febrile Diseases- The Exhalations from Flax rotting on the Ground once produced (according to Lancisci) a Malignant Contagious Fever in Rome- Of Poisons as Remote Causes of Disease The Term Poison is of a Relative nature-In one sense Mercury & Opium may be called Poisons- Poisons are of a relative nature, according to the parts of the Body, to which they are applied- The Poison of a Viper may be swallowed with safety, or even applied to a naked Nerve or Muscle, without producing Death-yet the smallest 94) quantity of it proves fatal when it comes in Contact with the Blood- They are divided into Animal, Vegetable, Mineral, and Aerial- The Animal Poisons are generally inflicted by a Bite, as in Snakes &c- The Vegetable Poisons are a numerous tribe-Among them may be remarked the Leaves of the Tragopyrium, or common Buckwheat when eaten green, soon after it comes out of the Ground- Of the Mineral Poisons Arsenic is the most rapid - Poisons act in different ways-some act suddenly on the Brain. these are highly dangerous, as Stammonium, Pink Root &c Some on the Mind, these are the least dangerous-Some on the Muscular Fibre, inducing in their first operation Palsy before they produce Death-others produce Palsy without death as various preparations of Lead-Some act on the Nerves, others on the Stomach, also on the Blood, changing its Consistence & Qualities, and thus affecting the whole System-Some act on the Lymphatic System, producing sudden Effusions of Water into all the Cavities of the Body, attended with [crossed out] intense Thirst and other Symptoms of Dropsy- Some on the Skin as the Cashew nut Poison vine &c Others on the Stomach & Bowels, either exciting a violent Vomiting & purging, and thereby discharging themselves, or through the medium of the Stomach and Bowels, affecting the Brain, Nerves, Muscles, Lymphatics and Skin-Some act upon two, three, four or all the Systems at once as the Contagions of the Plague & Yellow Fever, and Opium- 95) Lastly, some act specifically on the Lungs as Mephitic Air, which produces no morbid Effects when it penetrates the Nose without entering the Lungs-and in the Stomach is Medicinal- Poisons cause death by inducing in those parts which are essential to the Motions of life, an inability to transmit those Motions, either from excessive Action, inducing excessive indirect debility, or from altering the properties of the System, by forming with that System which it attacks some new Combination as the Poison of the Viper in the Blood- Of Worms as a Remote Cause of Disease- These Animals sometimes exist in the Bladder without injury-they are red, about an Inch long and are discharged without pain in the Urine- They have been found in the Liver, in the Throat, in the Maxillary & Frontal Sinuses (of which there is a remarkable Case in the 1st Vol. of the Transactions of the Philadelphia College, & after death in the Brain, but their chief seat is the Alimentary Canal- The Species are the Lumbricus or round Worm, Tænia or Tape Worm & the Ascandes-The Round Warm is perhaps useful & necessary, The Tænia & Ascarides are not so- I do not admit of the Existence of an Idiopathic Worm Fever-nevertheless I suspect them to have influence in all the Chronic Diseases of the liver 96) Of Anomalous Substances taken into the Alimentary Canal, Lungs, Nose and Skin, as Remote Causes of Disease These are very numerous-I have known 2 instances of Death from swallowing Cherry Stones- Copper when it descends into the Stomach is acted upon by it's Acid forming a Vitriol which produces Nausea vomiting and Diarrhœa-But it is remarkable that ferver Deaths occur from swallowing various Anomalous substances than might be expected- Strong Substances are sometimes received into the Lungs, as Food or drink going the wrong way- it is always followed by a violent fit of Coughing which dislodges the offending Substance-If this be not effected, sudden Death is produced-I knew an instance of the Seed of a Water Melon falling into the Glottis & producing Dyspnœa for many Months which was afterwards discharged by a violent fit of Coughing, softened and enlarged- Buttons, Grains of Corn, Coffee and the like are sometimes thrust by Children up their Noses, producing Inflammation and a tendency to Polypus- Pins perhaps are sometimes introduced in the Night without Consciousness-They often remain for a long time in the Skin & produce obstinate Ulcers 97) which are frequently incurable till the Pins be removed or discharged-They often move about the Body-I attended a Lady in this City for several months, with a pain and Swelling in the Uterus, and occasional discharge from the Vagina-She was at length relieved, not by medicine, but by the discharge of a large Pin from the vagina, which gave her great pain in it's passage out of the Body- Wounds made with Splinters, nails, or dull Instruments of any kind tend to produce the Locked Jaw-They most certainly produce this Disorder (1) When they affect Tendinous parts & (2) When they excite no Inflammation in the part wounded-The disease produced here is a partial one, and proceeds from partial Stimulus-It is confined to the Muscles only, and is cured by exciting the Nervous & Arterial Systems, so as to produce Equilibrium of Excitement and Excitability-no more happens here than happens in a Fever-It is a partial Convulsion brought on by a partial Stimulus- A Young Man of this City has been deranged nearly a Dozen times from shot working it's way out of his Foot, which was lodged there when a Boy, by a Schoolfellow-His Reason immediately returned after the Shot has worked out-This Young Man was habitually deaf, 98) an unusual Acuteness of hearing was always a premonitory sign of his derangement- of Anomalous Substances applied to the External Surface of the Body, as a Cause of Disease- Pomatum & Paint are the Chief of these Substances- The former is a frequent Cause of Head Ach, the latter of many nervous Diseases: for Lead is the Basis of nearly all the Substances which are used to improve the Complexion- Of Retained Excretions as a Remote Cause of Disease The Excretions are Fœces, Urine, Sweat, Bile &c (1) of Costiveness-There is a latitude with respect to going to Stool in many old Persons & the Female Sex-also in Sailors for sailing disposes to Costiveness-The Perspiration probably supplies the deficiency of this Evacuation, or perhaps the Lymphatics perform the Office of Divine & convey the more Acrid Parts out of the System by the Kidnies-The Diseases from Costiveness are Headach from the pressure of the distended Bowel on the descending Aorta-Piles, Colic and Inflammation of the Bowels-Ruptures, Fevers, more especially when it occurs in Children- (2) The Retention of Urine produces great pain in the Bladder, sometimes attended with an ineffectual 99) ineffectual effort to make Coater, a Tenesmus sickness of the Stomach, great distention of the Bladder, finally Hiccup, Delirium and Death- (3) Some Diseases are justly attributed to suppresst Perspiration viz-Lassitude, Coryza, Catarrh, Diarrhœa from a Mixture of the Perspiration with the Bile-Fevers, Eruptions on the Skin, an increase of the discharge from Issues & Sores & a return of Pain in any part of the Body that has been weakened by any previous Disease (4) The Obstruction of the Excretion of Bile into the Bowels produces (1) Costiveness and White Stools from the absence of it's Stimulus & colouring Matter (2) Jaundice from absorption of the Bile and a diffusion of it thro' every part of the Body-The Bile when thus diffused produces an universa itching of the Skin- (3) A Want of activity in the Body, probably from the want of it's usual stimulus in the Bowels (4) Obstructed and Schirrous Liver- (5) Dropsy from the Compression or Rupture of the Lymphatic Vessels- (6) False Vision, all objects appearing yellow, except blue ones, which appear Green to a Person in Jaundice-The Bile may however sometimes be so impacted in the Liver, as that no absorption whatever may take place, as occurs sometimes in Yellow Fever-This Obstruction brought on by three Causes (1) Spasm - 100 hence, it so often succeeds Colic-(2) Gallstones, they are called altho' they are of an oily nature and feel and burn like Sperma Ceti-(3) By [crossed out] Viscidity in the Bile, as occurs in Yellow Fever (4) The Diseases from the Retention of the Semen, when accompanied by Venereal desires, are Melancholy, Epilepsy, Madness and even Death- accompanied by Priapism, and an involuntary convulsive discharge of Semen, especially in Sleep- (5) The Diseases from Suppression of the Menses differ according as the Suppression is from an Acute or Chronic Cause-In the first case we have Fever, Hysteria & sometimes Delirium-In the tter, Hysteria, Dyspepsia, Hypochondriasis, Hæmoptysis & Phthisis Pulmonalis-Fluor Albus, Atrophy, Dropsy and Death- Of Motion & Rest, Sleep & Watchfulness in Excess, as Remote Causes of Disease Too much Motion produces Universal Indirect Debility. Too much Rest, produces Universal Direct Debility- Too much Sleep produces Obesity, and in great Excess impairs the Mental Faculties & Health- A Dutch Physician once entertained the idea that Sleep was the most natural & healthful state of Man, he tried the Experiment and died Idiotical- 101) On the Subject of Watchfulness it may be remarked that Life may be supported much longer without Sleep than is commonly imagined The French Army before the Battle of Mons in Nov. 92, it is said past 3 nights witht. Sleep - Haller relates a Case of a Woman who past 45 Days and Nights without Sleep before delivery- Boerhaave past 6 weeks without Sleep-An Hysterical Patient once past four, and a Melancholy One six Months without Sleep according to Haller- The most frequent causes of Wakefulness are deep, Grief, Care, Love, Strife or Law suits, Cold feet, confined Perspiration, a heavy Supper, or the want of a light one, in persons accustomed to that Meal- Light, Unusual horses the unequal excitement of the System in consequence of unusual exercise, and above all, a Fever of violent action in the Arterial System-This last cause of wakefulness is very happily described in an elegant Speech delivered by the Indian Chief Corn-Planter to the President of the United States on the 20th of Decr. 1790 in answer to one delivered to him by the President-"Four Speech" said the Eloquent Sachem "written on the great Paper, is to us, like the first light of the Morning Sun to a Sick Man, whose Pulse beats too strong in his Temples & prevents his sleeping - He sees it and rejoices, but is not cured"- 102) Wakefulness may be both Idiopathic and Symptomatic-It is sometimes the Precursor of one of the States of Madness Of the improper exercise of the Faculties of the Mind, of the Passions, and the Venereal Appetite, as a Remote Cause of Disease- Excessive Study is a remote Cause of Disease- Thinking is a Stimulus-where Studies are properly chosen & properly pursued they produce no Disease-But Studies may be improperly arranged, e.g. to teach a Boy under 10 years of Age the dead Languages, is about equal to giving Ham & Chickens, instead of the Breast to an Infant- The Passions are stimulating or Sedative and are Relative as Heat & Cold-Love when combined with Hope & when deprived of Hope-Joy is a most powerful Stimulus-Thirst was produced by it in Bruce the Traveller, when he arrived at the Head of the Nile-It sometimes where excessive produces Indirect Debility-The Joy of Fear is the highest species of this Emotion- Anger is a powerful Stimulus-It increases the Secretions of Saliva & Bile, causes Bleeding at the Nose, Convulsions, Hysteria, Epilepsy, Erysipelas, Abortion, Apoplexy and Death- Grief produces Syncope, Dyspepsia, Asphyxia, 103) Hypochondriasis and Death-when it attacks persons subject to Hysteria, it often changes that Disease to Hypochondriasis- Tears are signs of moderate Grief-there is a a weeping Point, like a sleeping Point-Persons under deep Grief often Sleep more soundly than usual, and often act in such a manner as to lead Superficial observes to distrust ye reality of their Sorrow-Grief changes the Countenance- Fear causes a copious discharge of pale Urine and sometimes unconscious excretions of both kinds-it produces Thirst-It perhaps affects Cancers by causing local determination to a part already debilitated-thus we know that Venereal pains are often counterfeited from this Cause-It affects the Hair of the Head- Great Exertions are sometimes witnessed under the Operation of Fear-they are produced by the operation of other Passions particularly the desire of life, upon the Excitability of the System accumulated by Fear-The Effects of Fear are least felt when least is said about them Boys whistling thro' a Church Yard, Hypochondriac, &c. The Effects of fear upon the Body are augmented in violence, in proportion as they are combined with Guilt, Shame of Debt-I have known two instances of persons falling suddenly down 104) on the floor, one in Convulsions, and the other in Syncope from being suddenly detected in stealing- The latter would probably have died, had he not taken Laudanum and other Stimulating Medicines- From these facts I am inclined to attribute the sudden death of Ananias & Sapphira to physical Causes, and not to the Miraculous powers on the Anger of the Apostle- Envy is like a perpetual Blister-I believe it to be the Cause of many of the slow Diseases of high Life- Ambition is an Inflammatory Disease of the Mind Avarice in its various gradations robs (1) The World (2) One's Country-(3) Neighbourhood (4) Remote Relations-(5) Servants (6) Wife (7) Children (8) Self- We come next to the Venereal Appetite- Danger of an Old Man marrying a young Wife Diseases from excessive tenery are, Dyspepsia, Weakness or Inflammn. of the Eyes-Defect of Memory - Epilepsy-Consumption-Pain in the Back, Gonorrhœa Mitis, Perpetual & involuntary discharge of Semen, and Impotence-I was once consulted in a singular Case of a Gentleman in Massachusetts, who was pale and languid and laboured under Morbid Venereal desire-He had been married about 3 years, and for that time had regularly performed the Act 105) four or five times in the 24 hours- His Physician first recommended him to take a Journey-but in vain-for he either embraced the Tavern Girls, are il s'amusait-He had not been guilty of Onanism in Youth, to any great excess-He described his feelings to be beyond measure horrible, and repeatedly urged his Physician to emasculate him-Nothing seemed to do him the least good, except sugar of Lead- I have not heard the Result of a Salivation, which was what I advised for him- Effects of diff.t States of Society, as Remote Causes of Disease See My Essay on Diseases among the Indians Of Different Forms of Government as Remote Causes of Disease I have found Slaves more easily destroyed by Acute Diseases than Free Men-In the equal Republic of Connecticut there is a greater proportion of longevity than in any other state of America-In Despotic Governments irritability predominates over sensibility- Of Difft. Religions, as Remote Causes of Disease The Christian Religion has the most beneficial influence upon Human Life, from the cordial Stimuli of Hope, Love and Joy-every opinion unfavorable 106) to Health should be rejected from the System as a false one-Roman Catholic Lent has a favorable effect in moderating the Inflammatory Diseases of Spring-Predestination of ye Turks favors the Spread of the Plague-Swine were forbidden and Circumcision probably enjoined on the Jews to prevent Leprosy and other Cutaneous affections in the East- Of Different Employments as Remote Causes of Disease Agriculture and Building are two of the most healthy occupations of Man-from these labours being mostly carried on in the open Air- Farmers and Carpenters are subject only to Accidents and Fevers-Day Labourers to Fevers, Ruptures, Sore Legs, obstructed Viscera and Dropsies-Soldiers to Fevers of all kinds. Chronic Rheumatism and Dysentery-Sailors to the same with the Addition of Scurvy- Servants Male and Female, particularly Coachmen to Catarrhs and Pneumony-The Servants of the King of Spain are much troubled with Nephritic Complaints, from being always compelled to stand in the presence of the King.- Weavers are subject to Dyspepsia, Costiveness, and Hypochondriasis-Dr Fothergill informed me that whilst he was a student of Medicine most of the Chronic Patients in the London Hospitals were Spitalfields' weavers- 107) Watch and Clock Makers & Silver Smiths are injured by the sedentary nature of their employments, as are also Taylors with the Additional evil of their posture, and Shoemakers from their constantly stooping, they have large foundations-Bakers are subject to Pulmonic Complaints from their Nocturnal labours in Cellars and to Malignant & Contagious Diseases- Smiths and all workers in Metals are subject to Inflammatory Diseases from their sudden transitions from heat to Cold-Painters suffer from the deleterious qualities of Lead & become Paralytic- Studious people suffer often from Gravel, and from their sedentary life are subject to Dyspepsia- Judges also are subject to the former Complaint from their retaining their Urine to long as they are frequently led to do. Lawyers and Physicians have the best chance for health from their uniting bus'ness with Study-Persons who work in the upper Stories of Houses are liable to Gravel from their being too far from a place where they may make water-Medical Practitioners who ride a good deal on Horseback are subject to Hæmorrhoids, Costiveness & Fistula- Scriveners to a Paralysis of the Right Hand Of diff Amusements as Remote Causes of Disease It is remarkable that the Indirect Debility succeeding fatigue from pleasure, exceeds that induced by Labour- Amusements are 108) particularly injurious to Women, from their standing an hour before a looking Glass, and sitting two or three under a Hair Dresser and generally in a Cold Room-From changing a thick morning Dress for a thin Afternoon one from the Crowds assembled in one Room; from this last Circumstance I believe that a mild Species of Epidemic Catarrh a Influenza is often generated Dancing also often produces Catarrh- The Theatre or rather Tragedies dispose to Nervous Diseases-Tragedies excite Emotions of the most lively kind, as Compassion and Pity without any exertion of Mind or Body to relieve the Object, hence they recoil upon ourselves-The Distress which we relieve never produces such effects - Also the mind is so highly stimulated by the highly wrought scenes of fictitious Sorrow, that real distress is too weak to awaken it's Compassion- The Sports of Boys are often dangerous as is that of Man called Hunting which disposes to Disease from the Indirect Debility induced by long continued and most violent exercise, long Inanition, long cold, long heat, Changes of weather, Ravenous Appetite after Inanition, and the increased force of the stimuli of Meat and Cordial Drink upon Bodies debilitated with fatigue-The same objections will apply in a considerable degree to Shooting- 109) Of Peculiar Customs as a Remote Cause of Disease Morning Drams, Wine and Bitters condemned also the Custom of [illegible] receiving lying in Visits- the Ringing of Bells at funerals-General use of Tobacco-N.B. a Disrelish for Tobacco is often a Precursor of Disease, as a returning relish for it, is of Recovery- Of Unhealthy Ancestors, as a Remote Cause of Disease These Diseases may be divided into hereditary and Congenial-By Hereditary Diseases I mean only hereditary predisposition from Shape & Temperament- A Narrow Chest favours consumption- Madness seldom appears before the Age of Puberty, and generally if Hereditary waits till the Age at which the Ancestors or Parents were affected- Madness was hereditary in the family of the famous Genl. Montgomery about the fortieth Year of life-He was accustomed to express 3 Wishes to his Friends-one that he might die before 40-The Second that he might die childless-the Third that he might die suddenly In each of these wishes he was gratified - There was a Boy lately in our Hospital only 10 or 12 Years of Age affected with Mania-A diposition to Consumption is said to be inherited most frequently from the Father's, to Madness from the Mother's side- 110) Gout seems to be favoured by a Sanguineous Temperament-Scrophula and Leprosy both seem to depend upon hereditary predispositon- In all Chronic Disease inquire whether the Ancestors of your Patient have ever had the Disease- From the Influence of Temperament of Shape, or from a union of both, many Diseases descend from Parents to Children, which are not enumerated among Hereditary Disorders, as Rheumatism, Colic, Hæmorrhoids, and above all, Head Ach- The Congenial Diseases are the Venereal Disease, Small Pox, Measles, Plague and Yellow Fever Of false Systems of Medicine, as a Remote Cause of Disease- These have been a fruitful Source of Injury from Hippocrates down to Dr. Brown-Practitioners however under false Systems have frequently adopted a successful Mode of Practice, thus, Persons preserve Morality under false Systems of Religion-An Injudicious reliance upon the Powers of Nature & upon Quacks has done infinite Mischief- Vis Medicatrix - Many hundreds of Children dies, I believe, from Purges in supposed Worm Fevers-There is truth however in Medicine and we should not condemn or neglect Theory- 111) Evils arising from the habitual or imprudent use of Remedies without or by the advice of a Physician- (1) Purges-The Habitual use of Aloes produces Hæmorrhoids-and Salts perpetual Relaxation, producing Colic and Diarrhœa-The Habitual use of the Butter Nut Pill disposes to Vertigo, Palsy and Apoplexy- It is obtained from a Narcotic plant-Purges are often given to Children in the Spring to prevent Eruptions- Abstinence from Animal Food would answer the end much better- (2) Vomits-The habitual use of these produces Dyspepsia, Rupture &c Persons subject to Effusions of Bile, fly most readily to this Remedy- It gives a temporary relief, but disposes to fresh Accumulations of Bile-The English are particularly partial to Vomits, probably from their over distending the Stomach more frequently than most other Nations- (3) Bitters By introducing indirect Debility, these destroy the tone of the Stomach-They are particularly injurious to Gouty Habits-No Bitters can be habitually used with safety- They render the System insensible to the operation of the Bark itself-I have known the daily use of Chamomile Tea produce Vertigo- Buckbean Tea, used instead of Tea or Coffee in a morning produced Apoplexy in a Physician in England. 112) If further proof be wanting, trace the history of the Effects of the famous Portland Powder- Aliment salted otherwise is the grand Succedanum (4) Nitre-produces Dyspepsia & Disposition to Colic- (5) Opium - In Excess this Intoxicates and produces Languor, Dyspepsia, Amnesia, and Idiotism (6) Blood letting every Spring- Disposes to Plethora and Hæmorrhagies- (7) Sweating Medicines, Wine &c I have known two instances of Death, from taking in the one Case ℔j in other ℔ij of Madeira, on the day of the Attack of a Fever-This shews the importance of marking the point in the forming state of Fever, where Wine and Sudorifics may be used with propriety- (8) Cold Bath-This should be used on the great Caution-In plethoric Habits it produces Hæmorrhages in debilitated ones the Intermitting Fever-it produced Death in one Case of Yellow Fever (9) Pediluvium- The same Rules apply to this as to Wine & Sudorifics- (10) Diet Drinks in the Spring-These are founded upon false Theories of Physic-Abstinence from Animal Food will amply supply their place (11) The Use of Quack Medicines-Godfrey's Cordial has killed many Children-Turlington's Balsam has caused Inflammation in the Bowels-Even the boasted James's Powder has puked & purged many persons to death-e.g. Goldsmith-Mr Howard- Also a Mr. Burke a West Indian, who died here of the Yellow Fever in 1794-Dolby's Carminative - 113) Cautions from particular Idiosyncrasies in the recommendation of prescriptions-Even in the Hands of Physicians the best concerted prescriptions sometimes produce unexpected & opposite Effects - hence, we [crossed out] should be candid in judging of our Brethren's Prescriptions-Vomits of a Common Dose have produced great weakness, Ruptures of the [crossed out] Blood Vessels, and even Death-Purges have induced Syncope and habitual Diarrhœa- Bleeding from the Cooperation of unexpected fear had produced a Debility which has been followed by distressing on serious consequences-Nitre has produced Cough, Colic and Strangury-Opium has caused Strangury and Dyspepsia-and 30 Drops of Laudanum always excite Colic in a Lady in this City- Of Sympathy & Antipathy, as a Remote Cause of Disease A Number of familiar instances of the effects of these appear in the Phenomena of Gaping, Sore Eyes, Laughing & Weeping being to easily communicated- Convulsions are propagated in the same way, as was the Case in the Orphan House at Haerlem, where the sight of one of the Children in Epilepsy affected near a Hundred Others-Stuttering is often communicated, particularly where there is a respect for the person so affected-The Wife frequently grows like the Husband-Servants like their Master- How shall we account for these facts. I answer Man is an imitative Animal and that as he often performs motions from Habit without consciousness, so in these Cases, his Muscles are 114) moved without the Consent of his Will- There are yet some more mysterious effects of Sympathy- as the knowledge of the Death of Relations at a great distance at the precise moment when it happened-See Johnson's Life of Lord Roscommon Affection for Ancestors at the Moment of Dissolution-Secret Sympathy of Soul at some Moments of Existence The Diseases of Antipathy are congenial & acquired- An Antipathy to certain particular foods often arises from Surfeit- Of Association of Ideas and Motions, as a Remote Cause of Diseases- Association of Motions appears in making water when going into Bed altho' the Bladder has been emptied just before going to our Chamber-A Paralytic Lady who had been accustomed to take a good deal of Snuff, during a fit in which her Senses were totally gone moved her fingers to her Nose as if taking Snuff every time Salts & other volatile Substances were applied to her Nose- The Recurrence of Intermittents belongs to this Head Recollect here the number, variety & Minuteness of the Stimuli which act upon the Body in producing Animal Life-Suppose any one of them to have been associated by Accident or Necessity with the first attack of an Intermittent or Epilepsy, or any other Periodical Disorder, and suppose the same Stimulus to act upon the System, with exactly the same degree of force, or 115) on the same Spot of the External or internal parts of the Body and you have a Theory which explains at once the recurrence of all periodical Diseases- In an Intermittent this Stimulus (predisposing Debility still existing) may be the same portions of Light and Heat, hence perhaps they recur at the same hour every day-when they do not, perhaps the portions of light and Heat may vary or perhaps they may wait for a fresh accumulation of exactly the same quantity of Bile, which existed in the Stomach or Liver, on the first Attack of the Disease- The Recurrence of Epilepsy may be explained by the Association of Motions excited in like Manner, by any of the Stimuli, which were at first connected with it, particularly a certain fulness of the Vessels of the Brain. What makes this Theory probable in both Cases is, that both Diseases have often been put off, by destroying a suspending natural and exciting some new and preternatural Motions in the System e.g. a Salivation or change of Country in Epilepsy- Riding on Horseback, Bark &c in Intermittents- A Soldier who had been trepanned by a recruiting Party deserted-after running a great way, being very thirsty he went into a Pot House to drink- whilst he was there, just as he was going to drink out of a Stone Mug, he turned his Eyes towards the Window, and saw a guard in pursuit of him approaching the House-He immediately fell down in a Fit and these fits for a long time recurred whenever he attempted to drink out of a Similar Jug- 116) of Injuries from Falls, and External Violence applied to the Body, as a Remote Cause of Disease A long period of time often intervenes between Bruises and that Effects, particularly Contusions of the Head- I have seen Hydrocephalus produced by a Blow 8 months after-I have heard of a Stroke on the Back producing Abscess there four years after-But Contusions on the Head are the most important and dangerous- I have witnessed so many facts of this kind, that I am induced never to consider a blow on the Head as trifling- Of Time, as a Remote Cause of Diseases- This brings us to a consideration of the Diseases of Old Age, for an account of which & beg leave to refer you to my 2d. Vol- Of the Predisposing Causes of Diseases- These are Natural and Artifical-The Artifical predisposition to a Disease is the Effect of ye Remote Causes which have been mentioned-The Natural occurs in all Ages and [crossed out] Conditions of the System without the Agency of Impressions from any of the External Circumstances which have been mentioned-Some of them encroach a little on the Remote Causes, such as the Predisposition to certain Diseases from unhealthy Ancestors, but in this Case the Predisposition is morbid in the other Cases the Predisposition is altogether from a Natural & Universal State 117) of the System-These Natural Predisposing Causes of Diseases occur in different Ages, as first in Infancy-This period extends from Birth to the Age of two Years-The Disproportion of the Head to the other parts of the Body and the disproportion of Blood determined to the Head tends to produce Tinea Capitis, Eruptions behind the Ears, also Hydrocephalus Internus-Another Predisposing Cause is the Openness of their Sutures-also the Disproportion between their excitability & Sensibility, the former of which greatly predominates-hence they soon cease their moaning after Falls &c &c hence also Animal Life is in them more easily supported and hence too Convulsions are often induced in them from the application of moderate Stimuli-From the Superior Irritability of their Stomach and Bowels they are convulsed sometimes in the form of Trismus, in consequence of the Acrid Meconium contained in the Bowels or from the irritation of the Wound in cutting the Navel String-The same Cause also exposes them to Cholera Infantum-Dentition produces in them Convulsions, Diarrhœa, sometimes Gonorrhœa and Swellings in the Neck-See Underwoods excellent Book-Their Passions delicacy of Skin and Worms are also predisposing Causes of their Diseases- (2) Childhood-nearly the same Causes continue to operate-The Head by contingency disproportioned still disposes to Hydrocephalus internus-There is a small increase of the proportion of Sensibility 118) The Circulation is at this period much determined to the Throat, disposing to some of the Species of Cynanche, particularly Trachealis- Dr. Physick has proved from Dissections that Lymph only is effused & not Mucus in this Disease-In consequence of the increased sensibility of the Skin at this period of Life, we often see Children affected in very hot weather with Boils in those parts of the Body which are most exposed to the Rays of the Sun- It is computed that one half of all the Children who are born, die before 7 Years of Age, and of these a greater proportion of Boys than Girls-The System of the former is more excitable and the due proportion of Stimulus and Excitability is more frequently destroyed by their violent Exercise- (3) Puberty-This period of Life is more particularly predisposed to fevers, chiefly of the Inflammatory kind, to pains in the Limbs & Joints commonly called growing pains, swellings of the Glands of the Groins & Neck, Pulmonary & Catarrhal Complaints, Epistaxis & Head-ach, with the Addition in the Female Sex of vitiated Appetite Dyspepsia, Chlorosis &c Those at this period of Life, are fluctuating and unstable in all their pursuits, and they are subject to a Plethora in consequence of more Blood being made than is necessary for the growth of the Body, which often falls on the Lungs, producing Phthisis- 119) (4) Adolescence & Manhood-This period extends from 18 or 19 to 35 or 36, and is subject still to Fevers, Pulmonary Complaints & Hæmorrhagies-the Plethora from the Cessation of Growth still continuing From the time of Birth till the Age of 35 there exists an Arterial Plethora, the Veins being more dense and tenacious than the Arteries-After this period a change takes place, the Arteries becoming more dense and tenacious than the Veins-the latter in consequence become most subject to debility, and a Plethora, whether induced by excess in eating or a suppression of the Natural Evacuations is thrown upon the Veins instead of the Arteries-This Exchange of Density and capacity of distention between the Arteries and Veins, is performed gradually- During the Exchange there is a perpetual strife between them, and according as one or the other, predominates this period of Life is marked [crossed out] by a Predisposition to many Diseases, as obstinate Headach, Colic, Diarrhœa, Hæmorrhoids and Melona-These 2 last Diseases generally make their appearance before any other; for the Venous Plethora is commonly first established in in the Vena Porta, from which it is easy to account for the Regurgitation of the Blood in ye Hæmorrhoids, and its effusion from the Liver into the Bowels in Melena-The establishment of the Venous Plethora is generally succeeded by a long period of good health-Fewer die between 40 and 57 Years 120) than in any other 17 Years of Life-This period is also happier in general than any preceding one-Excitement and Excitability are now more equally balanced- Many Constitutional Diseases also cease, as Pulmonary Affections and Head ach- The Disease of Old Age are Colic, Dysury, Vertigo, Palsy & Apoplexy-This period begins at 57- After 63 to Death the preponderancy of excitability returns as in Childhood & Excitement diminishes, hence Old Men are more easily affected by Contagious Diseases & Changes of the Air- also they are intoxicated with much smaller quantities of fermented Liquors, and are more disposed to wakefulness from any fatigue from Labour or Exercise-The Failure of the Eye Sight is the first mark of the decay of the System, The second is less command over the Sphincter of the Bladder- The Stimulability of the Arteries is great in extreme Old Age, but the sensibility of the Nervous System diminishes-the Sensibility seems transferred from all Parts of the Body to the Arteries; hence Inflammatory Diseases often occur in very old people-Dr. Franklin died of an Acute Disease (Pleurisy) at the Age of 84- Their Fluids become Acrid; hence trifling sores terminate in Cancers Bruises in Mortifications &c Their Muscular Debility is also very great, and hence they are subject to Chronic & Acute Diseases-The Chronic appears (1) In the Arterial 121) System as in Catarrhus Senilis (2) In the Nervous, as in Deafness and imperfect Vision-(3) In the Muscular fibres, as in the Sphincter of the Bladder, and the Muscles, which confine the Bowels- (4) In the Brain, as in Vertigo & Wakefulness- (5) In the Alimentary Canal as in Costiveness The Acute Diseases affect (1) The Arterial System as in Pneumonia Notha, Opthalmia, Dysury, Hæmorrhoids, and fevers of all kinds from the most Inflammatory down to a Quartan Aque- (2) The Nervous & Arterial jointly as in Palsy & Apoplexy-(3) In the Alimentary Canal, as in Colic- Of different Conditions of the System, as Predisposing Causes of Diseases- (1) Of the different Temperaments- These seldom distinguish themselves till after Puberty-The Sanguineous are most irritable in their Arterial System and hence are more disposed to Fevers and Hæmorrhagies-The Nervous in the Nervous disposing to Madness, Convulsions, Epilepsy, Hysteria and Syncope- The Bilious in the Liver & Alimentary Canal- but this Temperament includes both an Excess and deficiency of Irritability in the Liver and in consequence of this a disposition to an excessive or Defective Excretion of Bile-hence the frequency of Colic, Diarrhœa, Jaundice & Head ach in the former Case, & Costiveness, Flatulency, 122) Jaundice & obstructed Viscera in the latter- This latter state of this Temperament has been called the Atrabilious Temperament from the dark colour of the skin and from black Bile being frequently discovered in the Liver, Gall Bladder and adjoining parts-The Phlegmatic Temperament suffers under preternatural deficiency of Stimulability, more especially in the Lymphatic and Nervous Systems- It is of importance to attend the Temperaments because from them originate the different Symptoms of the same Epidemic-They are sometimes blended and sometimes change into each other in the course of life- (2) Of the Single and Married Life- Married persons are most long lived, see my Book- A Bachelor's Life has been said to be a good Breakfast, a middling Dinner, but a very bad Supper- Single Women are liable to more frequent attacks from obstruction or preternatural discharge of the Menses than married Women; also to Hysteria, Hypochondriasis & the latter Disease affects Monks also-Bachelors and Widowers, die more frequently than Widows [crossed out] and Spinsters owing to their more irregular lives- Married Men soon after Marriage are very liable to Fevers and are said to be so to Plague, but not married Women- The Mortification attendant upon barrenness 123) disposes to many Diseases-I think barren Women are more subject to Hysteria, Hypochondriasis and Fluor Albus, than Women who bear Children-The Passion for Children in Women is excessive- (3) During Pregnancy Women are particularly disposed to Inflammatory Diseases-The most acute Pleurisies that I have ever witnessed occurred in pregnant Women-It has been observed that Women during this period never die of Consumption, nay that the Consumption is suspended in them during the time of Pregnancy, The tone of the System [crossed out] in this state is such as to produce the first degree Pulmonic Inflammation, viz. Pneumony-whereas in the Intervals of Pregnancy the tone of the System is so much Conceived as to be able to produce only a Pneumonicula-Pregnancy also renders women more liable to be affected by Contagious Diseases; and these when excited in such a state require more copious depletion as in Yellow Fever &c Such treatment prevents Abortion- Pregnancy predisposes also to Colic, Vertigo, and Numbness of the Limbs, from Plethora and the pressure of the Uterus on the descending Aorta, and sometimes after Parturition has taken place, to Mania by the Debility or Collapse it leaves upon the Brain- Suckling predisposes to Pulmonary Consumption 124) The sudden Cessation of it is highly dangerous where the Milk is plentifully secreted, it has caused a morbid fulness in the Lungs and produced Pneumonicula, when it has been attended by previous debility-a Suppression of the Milk from Cold, weaning &c disposes to Abscess Cancer and Schirrus-Suckling therefore to be discontinued very gradually- (4) The Cessation of Menstruation-This disposes to all the Diseases of Venous Plethora viz Hæmorrhoids, Costiveness Colic, Vertigo, Palsy and even to Hæmorrhagies both from the Arteries and Lungs-From the stagnation and subsequent Acrimony of Blood or Lymph in the Uterus an Ulcer is often induced in that Organ, which terminates in Cancer- From the influence of the variable state of tension in the Uterus, Effusions sometimes take place in the Breasts of Women at this time of Life, which end in Schirrhi or Cancers- During the whole of this period the Nervous System is affected, hence we often find it marked by Hysteria and Hypochondriasis-The grand Rule of Practice is to obviate Plethora-use gentle Bleeding, gentle Purging & gentle Exercise- Consult Fothergills Treatise on this Subject= (5) Deformity in size of Configuration of the whole, or any part of the Body, is a predisposing Cause of Disease 125) Preternatural height disposes to every species of Debility, as does also extreme shortness- According to Dr Daignan very tall persons are calculated to live only from 25 to 27 Years- Fat is a predisposing Cause of Disease-Few seen are long lived who become fat before 40 (6) Congenial weakness of a part, or of the whole of the Body is a predisposing Cause of Disease- Seven Months Children are particularly liable to the ill effects of Congenial Weakness-But where the force of the Stimuli applied to the Body is exactly accommodated to this Congenial Weakness is does not necessarily produce Disease or a short duration of Life-George III was a seven Months Child I know a Lady of this who was likewise the offspring of an Abortion-Her Childhood, Youth and Middle Life were marked with great weakness and many attacks of Acute and Chronic Diseases- Artificial Predisposing Causes of Diseases These are the Effects of certain actual Diseases predisposing to others, e.g. Pneumony when neglected or half cured disposes to Consumption, & Intermitting Fevers to Jaundice and Dropsy-The Remitting Fever of Children disposes to Hydrocephalus Internus, and Costiveness to Colic-The Whole of this Head may be summed up in a few words, viz. Diseases are connected together by Links, and 126) The Metastases of Diseases tho' apparently subject to no Laws are nevertheless the Consequence of one Disease, disposing to another- Little need be said on the Occasional Causes-To these the Observation of Gaubius may be applied, "Causa Occasionalis non nocet, nase predispositis"- Of the Proximate Causes of Diseases- These are General and Partial- The Proximate Cause of a Disease is the Disease itself-I said formerly that Disease depended upon morbid Action and distinguished from predisposing Debility, and from those obstructions, effusions &c which are the mere effects of Disease and which I have called Disorder- Disease has received different Names according to the parts of the Body affected by it-In the Blood Vessels it is called Fever-In the Muscles Convulsion-In the Bowels Spasm &c But all the different affections of these and other parts of the Body depend upon one Cause, viz, Morbid Excitement, or irregular or wrong Action- Before I proceed to particularize any Diseases I shall divide the Body into 7 Systems (1) The Arterial (2) Nervous, including Muscles, Nerves, Brain & Mind- (3) Alimentary Canal- (4) The Glandular System- (5) Surface of the Body- (6) Blood (7) Certain secreted fluids 12) All these are so connected that a Disease in one sometimes produces a Disease in all successively but this is far from being the Case always-Some of them seem united by the closest ties-Others appear to be as little affected even with Diseases of those which are near, as if they did not belong to the same Body - Some Medicines seem to have a specific Influence upon some one of these Systems-I do not however admit of the Specific Action of Medicines upon difft. Viscera- This Bark seems to act specifically upon the Arterial System-Gentian and Colombo Root on the Alimentary Canal-Asafœtida upon the Nerves-Oil of Amber upon the Muscles- Mercury upon the Lymphatics & Glands-Champagne upon the Mind-Sulpher on the Skin- Strammonium on the Brain, and certain Elements upon the Blood-All act indirectly upon the other Systems, but so feebly as seldom to be prescribed in their Diseases with advantage. Some Medicines act on more than one of these Systems as Sal. Volatile, which affects both the Arterial and Nervous Systems, and One [crossed out] all of them at once as Opium-It's Universal influence is, I think is the Cause of its superior effects to Wine and other Stimuli There is a strong analogy between the general & partial effects of Medicines, and of the proximate Causes of Diseases upon these Systems-I was led to adopt this division of the Body into the 1.) above Systems by observing the Effects, which the Excitement or the diminution of the Excitement, same one of them, had upon another, E.G. It was [crossed out] observing the Effects produced on the Muscles by exciting the Arterial System that I was led to use Tonics, and even remedies to excite a moderate degree of Inflammatory Diathesis is the cure of Tetanus-The intimate connection of the Skin with the Bowels first suggested to me that use of Blisters in Diarrhœa, and of Tonics and Laxatives in the Diseases of the Skin, according as they were accompanied by Relaxation or Inflammation- It also led me to account for the use of Calomel in Cynanche Trachealis Humoralis-The Calomel by stimulating the Stomach & Bowels, so as to promote Secretion & Excretion in them lessens or checks both in the Trachea-The Arteries are affected in Mania, in Gout, Apoplexy and Palsy, together with the Brain, Nerves, Muscles and Alimentary Canal- Gout affects the Arteries and Nerves first, & afterwards all the Systems of the Body-It affects the Glands with a Salivation, The Skin with Ulcers and Erysipelas and lastly changes the very properties of the Blood-The Arterial System brings the Liver into Sympathy in Hepatitis, affects the Stomach with Vomiting, and the Bowels with Diarrhœa- 129) The General Causes affect the whole Body directly or indirectly- (1) Thro' the medium of the Sanguiferous System- & Thro' the medium of the Nervous System The Arteries are the Outposts of the System, the Nerves are the next Barrier- Tetanus is a Disease of the Muscular System- Sometimes it does not quicken or fill the Pulse- The Nerves are but little affected, it seems rather connected with preternatural insensibility- Debility is its great Cause, hence it comes on chiefly after hot weather and great fatigue- It follows wounds only when they do not inflame- Nervous like Arterial Diseases have different states of Action; excessive moderate and weak- Tetanus appears under two of them, strong and weak; hence I have sometimes given a Vomit before administering Tonics with evident advantage Chorea Sancti Viti is a Disease of the Muscular System [crossed out] [crossed out] it has two states of Action-Sometimes it brings the Arterial into Sympathy, making the Pulse full and tense-This Disorder frequently affects one whole side, but I have seen it affect only a single Hand, and once a Single Foot- Cramp Succeeds great indirect debility as from fatigue, or the direct debility of Sleep, it is confined chiefly to the Muscles of the lower Extremities- Convulsion-Latent Strength seems to be 130) disengaged here, and brought forward in a sensible State, or else the Excitement of the other Systems is here all absorbed in one System- Hence in some of the most violent of these Cases I have found the Pulse even weak-Bleed then here and invite Excitement to the Arterial System to equalize it- Hooping Cough affects the Muscles of the Larynx and Glottis, it sometimes brings the Arterial System into Sympathy, as appears from the full Pulse and spontaneous Hæmorrhagies which sometimes attend it- Singultus affects the Diaphragm but is often connected with morbid action in the Blood Vessels- Asthma seems originally a Disease of the Muscular Fibres-I include in it Cynanche Trachealis Spasmodica of Children-It is seated in the Trachea & Bronchial Vessels it is attended with violent & Moderate Action- In the former Case, it brings the Arterial System into Sympathy-I have seen several Cases, in which the Asthma in the evening of Life has been succeeded by occasional copious discharges of Mucus from the Bronchia-I have ascribed this change in the State of the Bronchia to their having so far lost their Excitability as to be incapable of a Spasm-we see many other instances of the Muscles losing their Contractility by the long duration of the Disease which affects them-Connected with Asthma is the 131) Angina Pectoris-which is a Spasmodic stricture of the lungs, which stops Respiration in ascending a Hill or in climbing a Pair of Stairs-To these may be added the Palpitation of the Heart, of which some remarkable Cases occurred in the late Yellow Fever-All these Diseases have been called Spasmodic-Spasms have been divided into Clonic and Tonic-The Tonic where the derangement of the Motion of a Muscle is fixed for some time-The Clonic where the derangement is alternated with order or disorder, of Contraction & Relaxation as in Colic- All these Disease hitherto named are involuntary, but there is a certain Grade in them which has not yet been attended to viz. the Cases of Involuntary Motion where the Muscles are passive until the Will acts; at which time they are moved, but in a direction contrary to the inclination of the Will-The Mind, Brain & Nerves are here in a perfect state - There is another Species of irregular action in Muscular Fibres where the Action is performed by the Will but in a Convulsive Manner, [crossed out] as in stuttering, and in certain Motions of the Hands - There are some exclusive diseases of the Nerves such as a morbid sensibility of Insensibility in them-The former often occurs in the Close of Fevers and is always a sign of an approaching Crisis-The latter occurs particularly in Leprosy- Perhaps the Fidgets may be added to this Class- 132) There are Diseases of the Brain, exclusive of the Nerves and Muscles, as Dreaming, Low Spirits, Head Ach, Vertigo, Wakefulness, and the first Stage of Hydrocephalus Internus- Some Diseases affect more than one, also the whole of the Nervous System-Hydrophobia affects the Muscles, Nerves and also the Blood Vessels Hysteria the Muscles, Nerves, Brain, but not always the Mind-Epilepsy affects the Muscles, Nerves, Brain and Mind-Hysteria, Epilepsy & Hypochondriasis appear different states of the same Disease-Thus in Epilepsy there is a morbid degree of Excitability founded upon an Excess of Sensibility & Contractility in the Muscles, Nerves and Brain-In Hysteria the same Morbid excitability occurs in the Muscles and Nerves but not so much in the Brain as in Epilepsy In Hypochondriasis this morbid excitability is exhausted and a Torpor succeeds it, in the Muscles, Nerves, Brain, Mind and even the Alimentary Canal-The same Causes may produce Hysteria in some Cases-Hypochandriasis in others-Frequently they alternate with each other like the Active and low states of fever, and the Symptoms of both are often combined- Both Epilepsy and Hysteria are frequently connected with and greatly influenced by a certain fulness and tension of the Arterial System- Hence they are often brought on by Plethora & relieved by Bleeding- 133) I have not often observed Plethora to attend Hypochondriasis but Dr Bond informed me that he had once seen it accompanied by a hard & full Pulse, and that he has relieved the Low Spirits, which were connected with it in a few Minutes by one plentiful Bleeding- Apoplexy is a Disease of the whole Nervous System, as also is Palsy - They affect the Arterial System with a temporary Depression of fulness, for which reason, I have called them together with the Gout, the Connecting Links of the Arterial & Nervous Systems- Apoplexy is some times induced by a sudden Suspension of the Excitement of the Brain, Nerves, and Muscles, from violent Emotions from certain Effusions and from Lightning-The distinction of it's names, in consequence of serous or Sanguineous Effusions, is dangerous and absurd-The Symptoms are the same and required the same treatment Hydrocephalus Internus is a Chronic Apoplexy produced by Acute Causes as Blows, Contusions &c Apoplexy in Adults is Acute & produced by Chronic Causes-Syncope is a sudden loss of Excitement in the whole Nervous System-Asphyxia may be called a Chronic Syncope- Mania generally affects the Brain with obstruction or Inflammation, the Nerves with increased or diminished Sensibility, The Muscles with preternatural strength or Torpor, and the Arterial System with morbid Action, so as 134) produce a full frequent and tense Pulse-It even affects the Glandular System, hence that constant discharge of Saliva, which takes place in some mad people, which has given them the name of Sputatores-Dyspepsia, Colic, Cholera Morbus, and Diarrhœa are diseases of the Muscular fibres and Nerves-I have introduced these in this place because I consider the Stomach and Bowels, as a part of the external surface of the Body, and they shew their Connection with the rest of the System, because in the greater part of the Diseases which have been mentioned they are affected with Costiveness-This brings us to Diseases affecting the whole System (3) Through the medium of the Stomach and Alimentary Canal-The Stomach may be compared to a Coffee Hour, where all the Systems meet-The Arterial, Nervous, Lymphatic, and Cuticular Systems maintain the most intimate connection with it and thro' it with each other- Thus the Muscular fibres are Convulsed in consequence of Worms in the Stomach-A little Accumulation of Bile there produces a great Languor in the Nerves, which is relieved by it's discharge-There is sometimes such an increased Sensibility in the Stomach that the least motion produces vomiting-There is a Dyspepsia from local Causes only, brought on by Bile, indigested Aliment, Ulcers in the Stomach, Erythrema 135) descending into the Stomach and certain acrid and poisonous Substances-Many Substances received into the Stomach act upon the Mind, as Strammonium, Opium, Champagne &c Many Substances received into the Stomach act upon the Skin-thus tainted Fish produce efflorescence there-Dysentery may in some Cases be a primary Disease of the Bowels in others of the Arteries, constituting a Febris Introversa-After existing in the Bowels for some time, it may propagate itself from Contagion generated by itself-I have seen it once disappear, and an Acute Rheumatism succeed it, which required several Reasonings to subdue it-It sometimes, as I was informed by Dr. Clarkson goes off with a Salivation, thus affecting the Glandular System- Diarrhœa is often the Effect of Gout, Hypochandriasis &c It is sometimes produced by Local Causes- I have seen 2 Cases of it's terminating a Pleurisy suddenly and favorably, which skews it's connection with the Arterial System Colic arises from (1) Gout (2) Hysteria & Hypochondriasis- (3) Affections of adjoining Viscera, particularly the Liver and Kidnies-(4) Offensive or Stimulating Substances, particularly Lead, received into the Bowels-(5) Intus Susception and Ruptures-Another Cause has been added, viz. Wind, producing what has been called the Flatulent Colic, but the Wind is not the Cause 136) of the Disease, but the Effect of the Debility induced by its-The Colic from Gout, Hysteria or Hypochondriasis arises from Affections of the Arterial & Nervous Systems- That from Intus Susception is the only primary Disease of the Bowels-It often affects the whole Muscular System, producing Contraction of ye Muscles of the Bowels and Sphincter Ani, also Convulsions- It affects the Glandular System producing obstruction in the secretion of Urine and Excretion of Bile- Tympanites is certainly a primary Disease of the Bowels-I believe, from the ill Effects of Stimulants and the good Effects of Sedatives in this Disorder, that it is often connected with [crossed out] violent Action in the Muscular fibres of the Bowels I have not observed it being the Arterial System into Sympathy but I have seen it produce the most distressing affections of the Nervous System- Hæmorrhoids may be considered as a Disease of the Bowels, and also of the Arterial System-They alternately act upon each, producing in the latter Vertigo and Fever- (4) Of Diseases affecting the whole System thro' the Medium of the External Surface of the Body- Small Pox and Measles both affect ye Arterial System with Fever and the Nervous with Convulsions- Also the Stomach with Vomiting, the Bowels with Diarrhœa, and the Mucous Glands 137) of the Throat and Salivary Glands-with preternatural Excretion-The Small Pox also affects other Glands as the Axillary- The Scarlet Fever seems a primary Disease of the Skin-It affects the Arterial System with Typhoid Fever, The Mucous Glands with preternatural Excretion, The Tonsils with ulcers, and the Liver with an Excretion of Morbid Bile-This Bile is often effused into the Stomach producing great sickness & vomiting- the last is one of it's Characteristic Symptoms- The Cynanche Maligna affects the Arterial System with Fever, The Mucous Glands of the Throat with fœtid Ulcers of a dark colour, The Bowels with Diarrhœa and the Blood with Dyscrasia or what is commonly called a putrid Diathesis- The Chicken Pox & Nettle Rash also sometimes bring the whole System into Sympathy- Sores suddenly healed sometimes produce Diseases of the Arterial and Nervous Systems- Itch suddenly cured has sometimes produced Mania, Epilepsy, Hypochondriasis &c- The Suppression of Perspiration sometimes affects the Arterial System with Fever, The Stomach with Sickness, the Bowels with Diarrhœa, The Kidnies with a preternatural Secretion of Urine and the Liver with a preternatural Secretion of Excretion of Bile- 138) The Leprosy is a Disease of the Skin accompanied with febrile Action- The Elephantiasis appears to be a high Grade of Leprosy-An Affection of this kind sometimes succeeds the intermitting Fever of Barbadoes- All Eruptions on the Skin appear to be connected more or less with Febrile Diseases, and probably are all derived from the same Causes- Dr. Hilary says that the Prickly Heat often prevents the Yellow Fever in the West Indies- Fevers of several kinds alternate with Eruptions on the Skin-Eruptions on the Skin are less frequent since the Hot Regimen in Fevers, has been abandoned Dr. Sydenham considers the Plague & Erysipelas as only different modifications of the same Disease- Why may not Eruptions on the Skin be considered as Febris Retroversæ? In all our Attempts to cure Cutaneous Diseases, we should never lose sight of Fever, paying an accurate & careful attention to the Arterial System-I shall close this head with the following singular Case-A Gentleman in Maryland after recovering from the Small Pox, had a Palsy of his lower Extremities- Three years after, a Tumour appeared in his Neck, which upon being opened, discharged a Limpid Fluid, which flowed down his Back- In a few days, a number of Pustules 139) appeared in the Course of this Fluid, which filled with Matter, and turned in the same time, & exactly in the same way as the Natural Small Pox- (5) Of Disease of the Lymphatic Vessels and Glands, affecting the whole System- The Dropsy is rarely a primary Disease, but often the Consequence of Original Morbid Action in the Arteries-The Lymphatics sometimes produce Disease from a defect of absorbing power, sometimes from Excess of it, as in Diabetes, where they are supposed to absorb moisture too plentifully from the Atmosphere-This seems probable from more water being discharged than is drunken and from it's having been cured by anointing the Body with Oil- Ricketts proceed from the Absorption of the Earthy Parts of the Bones; altho' Dr. Cullen rather supposes the Ricketts to arise from defect of nourishment- Scrophula is evidently a disease of the Lymphatic and Glandular System-It affects the Arterial System with Inflammatory Action, disposing to Effusions, especially in the Lungs, hence Consumptions sometimes follow the Disorder-It likewise affects the Skin with Ulcers and Sores, and frequently I suspect, the Bones themselves- The Ricketts are probably only a deeper seated Scrophula- 140) Lues affects the Lymphatic & Glandular System and thro' it the Arterial- Certain Affections of the Mucous Glands affect the whole Arterial System, as Catarrh for Cold or Contagion, and Fluor Albus-The Lymphatics are liable to be affected with Calcareous Matter- Dr. Monro mentions a Case, of deplorable affections of the whole System, from the Thoracic Duct being changed into Stony Matter- Of the Proximate Causes of Disease through the Medium of the Blood- The Diseases of the Blood are very limited-The Poison of the Viper when mixed with the Blood instantly produces Atony over the whole System and Death in consequence of it- The Scurvy has been supposed by some an Original Disease of the Blood, but I believe otherwise- Of the Vitiation of the Secreted Fluids as a proximate Cause of Disease- An Acrid Matter is often effused into the Trachea, exciting Cough and Fever-An Effusion of Acrid Mucus into the Bowels often produces the Sympathetic Diseases of Diarrhœa & Dysentery - The Bile is apt to become vitiated from a mixture of Marsh Miasmata or acrid Perspiration, or Blood of a Septic tendency with it, and 141) when effused in this Morbid State produces Diarrhœa, Vomiting, Fever and great Languor in the Nervous System-It's colour becomes changed in some diseases-It becomes black, green and olive coloured in Bilious Fevers-It's Qualities are likewise much changed in the Body, so much so as to excoriate the Rectum and to inflame all the external parts around it-It inflamed the Hands of Dr. Physick in the dissection of a Person who died of the Yellow Fever-It effervesced with Acids in the West Indies See Dr. Arthaud- Of Local Affections of the Viscera, as Proximate Causes of Diseases- The Liver when affected with Inflammation produces Fever in the Arterial System, Vomiting and Colic in the Alimentary Canal, a Yellowness on the Skin, and when it terminates in Abscess, a discharge from the Bowels of long continuance, called the Hepatic Flux - The Jaundice affects the Skin with Yellowness, the Nerves with great Languor, and the Bowels with Costiveness-It has reduced the Pulse to 37, Hunter-There are I believe but few cases of Idiopathic Hepatitis-It is in most cases a Symptom of the Bilious or Yellow Fever- 142) Besides the common symptoms of this Disease mentioned by Authors, I have twice observed it to be attended with Pain and Numbness in one Leg and Thigh and in one Arm- The Kidnies, when inflamed, or even irritated by Calculi, produce fever, Vomiting, Colic and Numbness of one or both Legs, or of one Arm, & in Males a Retraction of one or both Testicles- For the other Visceral Diseases See Cullen. Remember always that the Arterial System is the principal part of the Body, and that the Blood is the Ocean, on which all the other Systems trade for support and pleasure Of the translation of Diseases to different parts of the same System and to different Systems In the Arterial System we often observe Rheumatism translated from the Joints to the Lungs & vice versa- I have sometimes seen it translated to the Trachea, producing both species of Cynanche Trachealis- It is also frequently translated from one Joint to another, and from one Muscular or tendinous part to another, where it often receives new names and a new mode of treatment, I have lately read an account of it alternating with a morbid affection of the Heart, in which 143) it discovered itself by an uncommonly slow Pulse and great Oppression about the Præcordia- In Consumption the affection of the Lungs is often translated to the Head- Pneumony and Hepatitis are sometimes changed into each other- Hæmorrhagies are often translated from the Uterus to every part of the Body- There is no end to the Rambles of the Gout whether we contemplate it in the Arterial or Nervous Systems-All the Diseases of the Muscles Nerves, Brain & Mind exchange their places, and yet keep within the limits of the dominion formerly assigned them- The Diseases of the Stomach, & Bowels often exchange Situations The Affections of the skin particularly sores and Fetters of all kinds frequently appear in different seasons in different parts of the Body- Most of the Diseases of the Glands are disposed frequently to change their places, more especially Dropsies- The Diseases of the two last Systems which I have described, e.g. Blood & certain secreted Fluids afford no instances of Metastases such as have been mentioned- But again, Diseases of the same Systems differ materially in their degrees, e.g. Febris and 144) Febricula, Pneumonia & Pneumonicula &c &c in the Arterial System-There is involuntary motion and motion contrary in its direction only to the will-There is Dysenteria & Dysentericula in the Alimentary Canal-There is Hepatitis Acuta and Chronica-There is Lues and Gonorrhœa in the Lymphatic System &c &c Diseases exist in one part of the System and produce their Symptoms in another-The Debility in Tetanus is seated in the Foot, yet it appears first in the Neck-Weak Lungs excite Vomiting-A Weak Stomach a Cough- and a Stone in one Kidney has in one instance produced pain only in the other-The more you view general Diseases thro the medium of the Systems which have been enumerated the more definite and precise will be your ideas of them-It will lead to the more certain and successful use of many Remedies for they act as certainly on specific systems as those Systems act upon each other- From the above Observations we infer that (1) Debility is the Predisposing Cause of all general Diseases- (2) That increased or morbid excitability is the Universal effect of previous Debility when recent (3) That want of order in Animal Motions as to time, place and force constitutes the proximate 145) Cause of all the Primary Diseases, of the sentient and irritable parts of the Body- (4) That the great Secret of Medicine consists in the knowledge of the System which is affected of the force or degrees of Action in it anothe Choice of the Remedy suited to the System which is affected, and afterwards in the exact accommodation of the force of that Remedy to the degrees of Morbid action- (5) That the Multiplication of Diseases, wch are the effects of one or at most of two. Original Causes in Polytheism in Medicine- The Physician who considers every different affection &c as a distinct Disease, is like the Indian who should consider Dew, Water, Ice, Snow and [Water] Frost as distinct Essences- The Proximate Causes of Diseases which are partial affect (1) The Skin & Hair-(2) The Features of the Face- (3) The Cellular Membrane-(4) The Trachea, Lungs, Liver, Spleen, Omentum, Kidnies & Bladder of Urine &c &c-On these I shall not detain you at present except to remark upon the three first Classes- The Skin, Wool & features of the Negro appear to me to be the effects of Disease, and that disease I imagine is the Leprosy- The Leprosy produces Effects very similar on the Skin, Hair and Features-It is the most incurable and indestructible Disease 146) known-It happens sometimes after an Interval of many Generations-It is an infectious Disease-and the Black Colour of a Negro is some degree communicable, for Women become black by sleeping with them, as was the Case, of which I am perfectly well informed, with a young Woman of North Carolina- I concluded then that the Colour of the Negro is a disease of the Skin-Negroes have sometimes changed their Colour-This change takes place first in those parts, most exposed to Attrition by Labour or by the Pressure of the Cloaths-May not the Circumstances of these Accidental Changes be imitated by Art, and if strictly attended to, prove successful at some future period, in eradicating the black colour of the Skin of the negro- Of the Proximate Cause of Old Age Old Age is the Effect of such a decay or loss of the sensibility and contractility of the Body, as to render it incapable of receiving & propagating the Motions of Life-Such is the Change in this respect induced upon the Solids, that some of them, viz, the Arteries are sometimes converted into Bone-Excitement and Excitability are both exhausted in old Age & Death from old Age is nothing but a general Palsy-I said formerly that it began first 147) in the Eyes and Sphincter of the Bladder Of the Proximate Cause of Death- The Phenomena of Death may not be unaptly illustrated by comparing the Body to a Violin The Abstraction of the Bow prevents sound, The abstraction of Stimulus prevents ound, The abstraction of stimulus prevents Life from going on-Death takes place sometimes from the force of excessive Stimuli, and the Strings of a Violin emit no sound when excessive pressure is made upon them, or when they are overstretched- When the strings are relaxed there is no sound- When too highly strained they break or become unmusical- The Action of certain vitiated fluids destroys life, so does the wrapping of the Strings of a Violin in wax, or Grease, destroy sound- Death takes place from Error Loci-Sound is abstracted if the Bridge be placed improperly- The Convulsions and preternatural strength wch sometimes precede Death, are the effects of the unequal Action of Stimuli upon the partial Remains of Excitability in the System - Death is most painful from Diseases, (1) of the Bowels (2) of the Kidnies & Bladder- (3) Head - Least painful from those of the Lungs and Liver-Death from Old Age gives no pain- 148) Chapter 2nd- Of the Signs of Diseases They appear in (1) Partial Debility either direct or indirect-The Debility whether direct or indirect is only distinguishable by taking into consideration it's Causes, its stages, and the Habits which it attacks-The Debility is partial in most cases affecting some one of the Systems more than any other - The Morbid Excitement generally follows in that System only which has been excessively debilitated-when all the Systems have been debilitated, morbid Action takes place in them all upon the application of exciting Causes to them- Inability of Motion and pain in motion should be distinguished-The former proceeds from Debility, the latter from morbid excitement- Debility is not dangerous in the early stage of Disease-Persons sometimes die from mere debility after the Disease has been cured, their life being only supported by the Stimulus of the diseased Action-Thus people sometimes die immediately after being tapped for the Dropsy- This should teach us the necessity of exciting another action by various Stimuli. They appear (2ndly) In the Pulse-See Page 10- (14) (3) In Pain-(4) In the Heat & Coldness of the Body-(5) In the Eyes-(6) In the Countenance &c on which I shall be more copious when we come to the Prognosis of Fevers- Therapeutics- In my arrangement of this Article I have pursued a plan different from that laid down by Dr. Cullen- He begins with the Nutrientia-I pursue an order which to the Physician perhaps is more natural, vizt, first Sedative Medicines, when the Disease is worn down, come in stimulating Medicines, and after these come in those parts of the Nutrientia, which the Physician is called upon to prescribe or to regulate-My first article treats of (1) The Supposed Powers of Nature in curing Diseases- On this Head I beg leave to refer you to the 1st Vol. of my Inquiries- (2) Of Medicines which remove morbid Action, by abstracting Stimulus from the Diseased Part, either directly or indirectly and diffusing it equably throughout the whole System-These are Bleeding, Vomits, Purges, Sweats, Diuretics, Cold Air, Cold Water, Ice, low Diet, Darkness, Silence, Fear and other Sedative Passions, certain Medicines which reduce Morbid Action, as Digitalis, Nitre, & certain preparations of Lead, upon these Medicines I shall not be particular 150) at present, but defer it till I come to treat of Inflammatory Fever- (3) Of Medicines which remove Morbid action by exciting a stronger & healthy Action in the Diseased part or in some other part of the Body- These are Stimulants-They act by connecting the Excitability of the System into Excitement- I do not know what Excitability is, but it must be Matter of some kind-I prefer the term Excitability to Sensorial Power (1) Because it implies a Substance and not a Quality-(2) Because Sensorial Power implies Sensation and we know there may be a great accumulation of Excitability and even morbid Action in a part without sensation of any kind- Excitement is Water, Excitability Vapour, and they are convertible into each other- There cannot be two Morbid Actions in on and the same System at one and the same time-But there may be two morbid Actions in different Systems at the same time- e.g. Dysentery in the Blood Vessels & Bowels, Febrile Convulsions in the Blood Vessels & nervous Systems- Scrophulous State of Fever in the Blood Vessels and Lymphatics, Small Pox & Measles in the Blood Vessels and Skin-In admitting these Cases of 2 Actions, you will perceive that I differ from Dr. Brown and Mr Hunter, who deny the existence of two Morbid Actions in the 151) Body at the same time-This mistake arose from an inattention to the Division of the Body into different Systems- Two Actions of unequal force cannot exist in the same System at the same time-The Eruption of the Measles and Small Pox may be out together, but, this is the Solution of the Disease not the Disease itself- The Principles above laid down should regulate our Practice in administering Stimuli-Depletion will often be necessary before their exhibition, otherwise they increase the Morbid Action- By Depletion you abstract from you Antagonist so much power that your Stimulus transcends its force-Hence Remedies totally different natures, as Bleeding and Stimuli sometimes cure the same Disease-As in some Cases, the Morbid Action will yield to the force of Remedies of the latter kind-Depletion is further serviceable in accumulating the Excitability for the Stimuli to act upon- Medicines act specifically upon the different Systems of the Body, and more upon one part of the Body than another-And when by long application to one part they have lost their power, they will still act when applied to another-General Frelingheysen who had been accustomed to chew Tobacco for many Years on one side of his Mouth, was made sick by changing it to the other in consequence of the loss of a Tooth-Hence vary 152) the place of the application of your Stimuli, use not too many at a time-Opium when it does not affect the System by the Mouth, often will in the form of an Injection-and Bark if worn in a waistcoat will act when it cannot be taken by the Mouth-Tonics are proper in the commencement of one Disease only, viz, the Gaol Fever-In cases of great accumulated Excitability, which generally occurs in the beginning of Fevers, begin with Small Doses-5 Drops of Laudanum at the beginning of a Disease will sometimes have more effect than 50 at its close, when the Excitability is wasted - In Prescription we should attend to the Temperaments- The Sanguine requires much less Stimulus than the Phlegmatic- An Excessive Dose of Stimulus produces an injurious effect-It often happens that Medicines of feeble power produce effects, which are beyond the power of such as are more active, owing to their being better proportioned to the degree of Excitability-Thus a weak Purge often acts when strong ones fail- The former vibrate with the Fibres of the Bowels, whilst the latter destroy all their Contractibility- This circumstance has some Analogy to the Singular Case of Deafness already mentioned, 153) of Mr. Hopkinson, who, tho' she cannot hear a Cannon, can hear a Musket, and can hear a Pin stuck thro' a piece of Paper, tho' she cannot hear Conversation- (4) of Medicines which remove Morbid Action in one part of the Body, by exciting it in others less essential to Life- Practitioners have in general pursued this plan, without knowing the principles upon which they have acted-Thus they cure Head Ach, by exciting a Diarrhœa by means of a Purge-They cure morbid action in the Viscera by exciting a stronger action on the external Surface of the Body, by means of Blisters, Cataplasms &c-Not only Morbid Excitement is destroyed in one part of the Body by exciting it in another, but Pain also-hence crying in very painful cases as in Parturition, may be serviceable-Soldiers are said to mitigate the pain of a flogging by biting a Bullet which they generally put into their Mouths, for that purpose before receiving their punishment-If you give a Dog a Dose of Nux Vomica, and soon after he has taken it, whip him severely the Medicine will have no effect - Take care before administering Medicines of this Class to take down the original Morbid Action so far that the one excited by the Medicine may completely over power it- Thus reduce the 154) Blood Vessels below the state of pain excited by a Blister, before you apply one-I have called this the Blistering point-Take care that the part where you excite morbid Action be less exists-Attend also to Idiosyncrasies- Thus Mortification has succeeded a Blister, an obstinate and incurable Diarrhœa, a Purge & The force of Medicines with this indication decreases by habit, hence increase their Dose and vary them-To this and the preceding head may be referred the effects of some of the Stimulating Passions-Thus a sudden Paroxysm of Joy has often cured the Tooth Ach, and Dr. Darwin gives an account of a Man who could at any time obviate the Effects of fatigue by thinking of a Man who had greatly injured him- (5) Of the Remedies for preventing the Recurrence of Disease by removing predisposing Debility- These are Stimuli of all kinds-In the use of them under this Head observe the following Rules (1) Administer them in smaller Doses than is necessary to over come morbid action, e.g. in over coming weak morbid action in a Fever we give ℥ij of Bark in a day, but to remove simple Debility ʒss only should be 155) given 2 or 3 times a day, but persisted in for 2 or 3 Months- In the choice of stimulating Medicines to remove simple Debility, the preference is to be given to the durable Stimuli, of which Aliment is the most important-Where there is a want of [crossed out] Appetite still prescribe food-Endeavor to select such as is agreeable to the Stomach of your Patient-He should eat five or six times a day, and once or twice in the [crossed out] night, if he be sleepless-It is in this regular and persevering manner that we administer Medicine, and it is thus we may convert Diet into Medicine-The Diet should be accommodated to the excitablility of the System-A full meal should be avoided-I have already observed & must now repeat, that this Debility is not a Disease, but, only it, predisposing Cause Disease is morbid Action-The scale of Stimulus in food is as follows-Vegetables, weak Broths, Oysters, Eggs, Game, Boiled Meat, Roast Meat-Solid food is preferable to liquid and Salt to Fresh for durable Stimulus-A Lady in this City who was subject to Abortion from mere debility was cured by living during the latter months of her pregnancy upon salted meat only-The less nourishing Diet 156) should be preferred in most Cases of Debility- Certain Drinks may be considered under the Head of Aliments, they stimulate gently & durably- These are (1) Malt Liquors, (2) White wines, as Sherry, Madeira, Lisbon, Teneriffe-(3) Low Wines, as Port, Claret, Burgundy, Champagne & Cyder- I shall not add Spirits for a man had better die of his Disease - Under this Head we must next place the Cold Bath-This takes down the Excitement of the System and accumulates the Excitability - it should sometimes preceded by the Warm Bath, viz, in those Cases, where there is such a Waste of Excitability, that there is reason to fear that the Cold Bath would not accumulate enough of it to be acted upon by those Stimuli, which produce the Tonic [crossed out] Effects that follow the use of the Cold Bath-The water should then be a little tempered-The Cold Bath to be effectual should be used 2, 3 or 4 times a day-Exercise or Frictions should be used after it-It should be used in a Warm Room in Winter- Exercise deserves a very high rank as a Medicine, in all Cases of Debility-it is active & Passive- The former should precede in great debility- The scale of Exercise is (1) Friction-Some advantage may perhaps be derived from rubbing the Body 157) with a dry hand-Flesh Brush should be used, impregnate it with Medicine, with ardent Spirits or wine &c (2) Sailing-(3) Riding in a Carriage- (4) Swinging (5) Chamber Horse (6) Riding on Horseback, which should be used gently at first, and persisted in for Months, if we expect any lasting benefit from it-It has been commended above all other modes of Exercise in Pulmonary Consumption, and in the debilitated states of the Stomach and Bowels-(7) Walking-This last is proper only for slight Indispositions-it is said therefore to be rather the means of preserving than of restoring Health-In the use of all these exercises fatigue should be carefully avoided-Follow the old Rule here; accommodate them all to the Condition of the System- An Invalid should never use the exercise of walking or riding before Breakfast Travelling or change of Climate are also valuable with this indication from the variety of new Stimuli and new Associations of Ideas & Motions - Those two last Remedies are particularly useful in all Cases of Nervous Debility-Cheerful Company, light reading of pleasant stories also produce favorable effects- Night Air, Damp Air, Venery are to be carefully avoided, hence send Married Men on a Journey- Hard Bed or Mattrass to recommended, especially in Summer-Weakly people should go to Bed 158) early-The excitability of the System is wasted by sitting up-Flannel should be worn next the Skin under Small Cloaths of Men and Petticoats of Women- Tight Ligatures on any part of the Body to be avoided, especially when weakly people lie down to rest in the Day time-From the fulness of the Blood Vessels the whole Body swells- We proceed next to Medicines which overcome simple Debility-Tar, Garlic, Oil of Amber, and Turpentine are all useful under this Lead but Steel and Bark are the principal Remedies- To these may be added the Mineral Tonics and Mercury, when more agreeable Remedies have failed, especially where obstructions have taken place from the Languor of the Circulation- Tar, Garlic, Oil of Amber and Turpentine may be taken as freely and as safely as Food-In the use of all these Tonic Medicines take care to attend to the state of the System-Debility is the next door neighbour to Disease, hence we seldom find weakly people long free from Morbid Excitement in some part of the Body-In such Cases Tonics should be intermitted, till occasional morbid Symptoms are worn down- There are yet lower Stages of Debility such as Syncope and Asphyxia-when these are suddenly induced, the Excitability is much accumulated, hence use the most gentle Stimuli- 159) Be careful not to use too powerful Stimuli in recent Cases of Palsy-The gentle Stimulus of the Hand rubbing the Limb has often been more serviceable in such Cases than Nettles Cantharides and all the different Aromatic & Stimulating Liniments-But there are Cases where both Excitement and Excitability appear to be exhausted as in the last stage of Chronic Feaers & in some other Diseases-Here the Stimuli must be so strong as to excite great pain, as common Caustics Hot Coal, Red hot Iron, and Boiling Water - With the same indication, intense pain in the form of Caustics or Flagellation may be of service in Atonic Causes of Madness-But there is a Case where Sensibility and Irritability are totally gone, and in consequence of it disorganization & Death takes place in the part affected, this is called Gangrene-The Remedies here should be such as act upon the adjoining healthy parts & dispose them to throw off the dead parts-The external Remedies here are Turpentine, Fermenting Poultices and I have lately heard Tobacco-The Internal are Bark, Wine and Opium-But there may exist general Inflammation with partial Gangrene-Here Depletion is necessary- (6) Of Medicines which remove Diseases, by abstracting Redundant & foreign Matters from the Body and which offend by their Quantity or Quality- 160) These Matters are collected in the Stomach, Bowels, Liver, Bladder, Thorax & Cellular Membrane- They are Mucus, an acrid humour, Bile, Fœces, Worms, Water, Pus, Calcareous Matter & Fat- The Remedies are Vomits, Purges, Diuretics, Deobstruents, Anthelmintics & Tonics on Depleting Remedies, according to the state of the Pulse, also, certain Surgical Operations- (7) Of Medicines which remove Diseases by mixing with and thus destroying matters which offend by their quality- When Diseases were thought to depend upon Morbific Humours the Medicine of this Class were said to be very numerous-They are now very much limited-The Morbid Acid of the Stomach may be destroyed by Magnesia, Vegetable Alkali and Milk (a few Spoonfuls of which will often suddenly remove Heartburn) also by an Animal Diet-Acrid & morbid Bile may be obtainded by the plentiful use of Vegetable Acids - The Calculus in the Bladder, it has been said, may be dissolved by Vegetable Alkali & Lime Water- Mercury is said to destroy the Venereal Virus by mixing with it in the Body, this is highly probable: for we know of no evacuating medicines 161) that so speedily or certainly cure that Disorder - Certain Substances called Demulcents destroy Acrimony in the Bowels and Fauces, and thus cure Diarrhœa and mitigate a Cough-They are Bean, Flax Seed, Mallows & Comfry Teas, Barley-Water, Liquorice &c- Sulphur & Mercury are said to destroy the Itch by mixing with it- (8) of Medicines, which cure Diseases by removing Obstructions- These are Bark, Steel where [crossed out] great Morbid Action is not present- Scrophula is often cured by these Medicines- Mercury- Exercise, which has in two instances to my knowledge removed obstinate Schirrous tumours- Cold Bath, which has often cured obstinate obstructions in the Liver, Spleen and Bowels-Arsenic, Certain External applications-I have lately prescribed Local Bleeding with evident advantage- Fear has in some instances cured Scrophulous Tumours- Obstructions of all kinds are the Effects of Acute or Chronic Inflammation, & where Venesection is used at the time and in the quantity indicated, they seldom occur- (9) Of Medicines which are supposed to cure Diseases by changing the Quality of the Fluids or the Texture of the Solids- Under this Head I must refer you to the Publications of Dr. Beddoes. The Gasses certainly influence the mode of Aggregation of Animal Fluids & solids-The Subject is new & I wait for more facts to forms a Theory upon it- 162) (10) Of Medicines for relieving Pain- This should not be neglected in the Cure of Diseases, any more than Debility or Obstruction for it often destroys the Excitement of the System by it's immense force, & thus brings on Death of this there are many proofs from Dissection- Morgagni relates several instances of Death from the pain of the Colic, in which no sign of inflammation, Congestion or Gangrene appeared in the Bowels-Take notice of this fact I shall apply it more extensively here after- (1) Opium, where the Action is moderate, or even where it is violent, if it be given in such large Doses as to wear down the morbid excitement into indirect Debility-When Pain is cured in this latter way, take care that the seat of the pain be not in a part, in which Effusion will be attended with Danger, for a Large Dose by it's Stimulus disposes to Effusion- It is used safely in Rheumatism or external Phlegmon, also in Pneumony, for in this Disorder the windpipe conveys off the effused fluids: but it is always dangerous where the Pain is the effect of Inflammation in the Vessels of the Brain, In this case use (2) Venesection, it's good Effects are numberless- 163) (3) Fasting-Dr. Priestley in his travels thro' Germany heard of a Man, then under confinement, who obviated the pain of Torture by fasting 2 or 3 Days-Persons who die of Famine suffer little or no Pain after that period, their previous sufferings are very great (4) Cold Water- (5) Warm Water or Pediluvium where the Morbid Action is moderate- (6) Poultices of a Demulcent kind, as Bread and Milk with Sweet Oil - or (7) Sweet Oil used alone- (8) Gentle Friction-(9) Fear (10) Cheerful Conversation (11) Sulphur- as a Roll of Brimstone pressed between the Hands in the pain produced by Convulsions in the Muscles- It cracks in this state of the System & no other- Does the Sulphur in this case carry off the superfluous quantity of Electroid Fluid accumulated by Morbid Action? Is it in this way that it does so much more service in the Gout & Piles, than other Purges? Animal Magnetism, if ever it relieves pain, does it by Concentration of thought, which is a Sedative-Thus Grief or counting 100 backwards induces Sleep- Dr. Perkin's Metallic Point, diminish pain in the same way, for a Comb or a Point of Ivory has the same Effect - 164) (11) Of the Means of attaining Longevity The whole of the Knowledge necessary on this subject may be summed up in a few words- It consists in accommodating the force of those Stimuli which support life to the Excitement and Excitability-for a Number of Facts upon Old Age I refer you to the 2nd Vol of my Inquiries- Here then Gentlemen I close my Lectures upon Therapeutics All Books upon the Virtues and Doses of Medicines are Empirical- Medicines are only Relatively good, according as they are suited to the different States of the System e.g. Opium, Bleeding, Blisters, Mercury &c- To say that any particular Medicine is good for any particular Disease, without reference to the state of the System is for the same reason absurd- 165) Practice of Physic. Theory of Fever- Defence of Blood letting &c See my 4th. Volume of Inquiries &c Additional Observations on Fevers in general- Do not trust a Pulse with any tension in it, in cases of affection of the Head- In the Malignant states of Fever do not bleed at all unless you bleed plentifully- In Cases of great oppression & indirect debility, bleed three or four times a day, but take away but little at a time, lest the Oppression should be too suddenly taken off- A small Bleeding of about ℥ij will often turn the Scale at the Close of a Disease-The great points to be attended to in Bleeding, are Time, Quantity & Manner- Of the Use of Cold in Inflammatory Fever See Dr. Stock's Essay Page 23- Of the Use of Abstinence in Inflammatory Fevers- Toast and Water is the proper Aliment in this State of Fever-Apple Water is an excellent diluting Drink, it is made by Slicing 2 large 166) raw Apples, are pouring on them a Quart of Boiling Water, adding a Lump of Sugar. The Abstraction of Light and sound should also be attended to- Abstinence from Motion should also be enjoined- altho' sitting up in the Bed, or in an Arm Chair may be useful- Milk and water, Rice Water, Barley Water, Jelly Water made by dissolving Currant Jelly, may be all used as diluting drinks- It will often be proper to entice the Patient to drink when he has no Thirst- Cleanliness is particularly important Wash the Patient with Soap and Water, & remove all offensive Matters from his Room immediately- Nitre is a valuable Sedative Remedy is common Inflammatory Fevers; from ℈ss to ℈j may be given every 2 hours- In Bilious Fevers it is often inadmissible from its being so offensive to the Stomach- Sweet Oil has been applied in certain Inflammatory Fevers to the whole Surface of the Body particularly in the Plague, in Turkey- Wine & Sweet Oil in equal parts relieve fresh wounds- They are said to be good in external pains, and they are said particularly 167) to have relieved and removed Colic in the late King of Prussia- Oil has been very serviceable in composing the Cough attendant on Pleurisy Between Inflammatory and Typhus Fever, or Fevers of strong and weak action there is an intermediate state, which I have called the Typhoid state of Fever, or the slow Chronic fever-It is the Gaol and Hospital Fever of most Authors, and is I believe, the Puerperal Fever of all- The Fever attending Scarlatina is often of the same kind- This State of Fever often continues for 30 or even 40 Days without Remission or Intermission- This Circumstance and the season of its appearance distinguishes it from Bilious Fevers; also the Stomach and Bowels are more affected in this last- An Emetic often chokes, these Fevers in the Bud- Large Bleeding is improper- when tension predominates, bleed moderately- I have sometimes bled in these Fevers more than once-Vomits are highly useful- They should be continued till the Typhoid state be nearly worn down- I say nearly for Stimuli may be used before it is quite so- In common cases the Typhoid state of Fever will scarcely require depleting Remedies of greater force than Blisters & Emetics- The Gangrenous state of Fever is produced by the neglect of sufficient depletion- It scarcely ever succeeds Pleurisy or Rheumatism, but frequently follows Plague, Yellow Fever, Small Pox, Measles &c 168) This State will often require Tonics- They are administered with the greatest safety in the Gangrenous Small Pox & Cynanche Maligna - The determination of the Disease in these Cases being to the Skin- The Typhus or low state of Fever requires the use of internal and external Stimuli- Begin with the weakest Stimuli & Small Doses, gradually increasing them-Never use more than three at most at one time, and use them in succession- Give them constantly-They are Wine, Malt Liquors, Ardent Spirits &c Wine particularly excellent- White Wines most cordial- White Wine is to be preferred in all Cases of Acidity of the Stomach, and in the Gangrenous or Typhus state succeeding Gout- It is remarkable what quantities of Wine may be taken without intoxication in this State of Fever- Porter is preferable to other Malt Liquors- Distilled Spirits may be given to those who have been in the Habit of using them, but they are not so useful as Wine, for they act merely as Stimuli without imparting nourishment, Spirits are only admissible, when an immediate effect is desired not a durable one- Volatile Alkali has great Virtues- 5 to 10 Grains 169) every 2 Hours in Bolus or rather Pills- Oil of Amber every 2 or 3 Hours relieves the Spasmodic Symptoms [crossed out] in this State of Fever, it cannot be too highly commended, where such Symptoms are present, and when Bleeding has been used or is forbidden- It has often proved more effectual than Opium in achieving the Hiccup at the close of such Fevers- Musk & Castor I neither know nor care much about- Opium as a stimulant is Ipse Agmen it seems a universal Stimulus, whilst Spirits act specifically upon the Nerves & Alimentary Canal, Oil of Amber or the Muscles &c-In its exhibition in Fevers, observe the following Rules- (1) The less deficiency of natural force appears in the Vessels, the smaller should be the Dose, and Vice Versa-10 Drops of Laudanum often give a comfortable Sleep- (2) Increase the Dose with the progress at Debility- (3) Give it in small Doses, by day as well as night in this state of Fever, examine the Pulse frequently and if it flags, raise it by Stimulus- (4) In all Cases of sudden direct Debility, begin with small Doses of Opium on account of the accumulation of Excitability- (5) Lay it aside for 2 or 3 days, and use other Stimuli, when it loses it's power- (6) When it ceases to affect the Stomach, give it in the form of Glyster- (7) As the Patient recovers, diminish the Dose gradually- Æther may be given from 30 to 60 drops every Hour- 170) It is a good substitute when Opium loses its efficacy- Bark-Begin with the Infusion, then Bark in Substance, then Huxham-and add to this last Laudanum increasing it gradually ℥ij or ℥ij of Bark may be safely taken in a day in some of these States of fever- Mercury may be called the Sampson of the Materia Medica- Pure Air is highly proper, but cold Air should be avoided in this state of Fever- Large Rooms, and a Fire in the Chimney are very serviceable in purifying the Air-[crossed out] Fires are admissible even in Summer- Nitre sprinkled on a Censer & deflagrated produces pure Air- The Efficacy of Smoke in diminishing the force of Malignant Fevers has been found very great- Earth Floors contributed greatly to the same effect in the Military Hospitals in our late War- Stimulating Passions also operate Medicinally in this state of Fever- hence it would be useful to urge Patients to converse upon business &c where Diarrhœa is present & should be stopped, use Port-Wine instead of White- Aliments should be included under this Head in the Class of Stimulating Medicines- Animal Food may be used in the state of fever without fear, particularly if Soups prove unpleasant 171) We must not however trust implicitly to the call of the Stomach for Aliment, for it may often prompt the Patient to demand food when it would be injurious, and not to demand it when his powers of Digestion are good- Hence, Food not prompted by Appetite often proves useful- Many of the Internal Stimuli may be made use of externally, and their external application often produces the happiest effects in these fevers- The External Stimuli are, the Cold & Warm Bath, Blisters, Cataplasms of Mustard & Garlic applied to the Feet &c- Wash the Hands with Spirits & sprinkle the Room with Vinegar- ℥ss of Bark x, xx, or xxx drops of Laudanum & about a Gill of Gruel make a good Injection- A Gill is the best quantity, if made larger, they are apt to be too soon rejected- The Cold Bath may be rendered unsafe by the extreme Debility which sometimes takes place in this state of Fever- If it have ever [crossed out] done good, I believe it must have been in the beginning of the Fever- Sponging the Body may be useful- Warm Bath- Sponging is better or fomentations - The Patient has not the trouble or danger of being moved, for this is often dangerous, and the Water may be rendered more stimulating by Spirits and Bitter Herbs- 172) Cataplasms-Bread & Milk, or Bread & Beer, with Garlic and a little sweet oil make an excellent Cataplasm- To produce a sudden effect, Flour of Mustard may be used, but this should not be left above 3 Hours- Blisters- It is of great importance in this state of Fever to ascertain the Blistering point- They may be used in it too late- Cataplasms on the Contrary are safest in the more advanced stages of it- Volatile Liniments & Cataplasms may be applied with great advantage to the Stomach & Belly Cataplasms have been generally applied to the Soles of the Foot, They have a quicker effect on the Top of it- Caustics in the slow, Lethargic & Comatose States of Fever are singularly useful- Place them between the Shoulders in the place where you apply Blisters to the Neck- Boiling Water is proper in Asphyxia, and the Apoplectic state of Fever, or if Water be not at hand, a burning Coal may be applied, but only for a sufficient time to raise a Blister- Is it proper to sit up in this state of Fever- No- unless to make the Bed & change the Linen, & not this in some Cases- Patients are often injured by using to go to stool- And these are Cases of such extreme debility, that Cloths are more 173) adviseable than a Bed Pan- In Syncope and in this Fever, a Person should lie on his Back- Cold Drinks are thirsted for in its last stage- Do not purge here, unless there is reason to apprehend a morbid Secretion of Bile- Is Sleep proper? It should be regulated by the Pulse- If exceedingly low & sinking, wake the Patient every hour, to give Laudanum or a little Nutriment- From the Exhibition of the above mentioned Stimuli I have sometimes seen the Typhus State of Fever change into the Typhoid- It may even almost rise to an Inflammatory Grade- Hence is evident the great importance of attending to the Pulse- Convalescence from fever may from the great debility and excessive excitability of the System be almost called a Disease- It is often succeeded by watchfulness, sickness & vomiting in the morning- Defect or excess of Appetite- Anasarcous Legs- Obstructions of the Glands, particularly the Liver and Spleen- Ulcers from Blisters &c- Cordial Drinks- Porter, and other Malt Liquors agree best under this head- So much is the excitability accumulated, that Wine often burns the Throat of Convalescents- Cordial and Nourishing Diet should be gradually administered- Fruits of all kinds are good- 174) The various other Stimuli should be gentle at first, and applied gradually- As for instance, good news, or the unexpected sight of a long absent friend- Bus'ness should be avoided by Convalescents- They should change the Air; go abroad &c Change of Dress is of great service, also a shaved Beard & Cleanliness- All Vestiges of Sickness as Pill Boxes, Phials &c should be carefully removed- Recommend gentle Exercise in a Carriage- Warm Clothing & warm Bed Cloathes A Table Spoonful of Huxham in Wine 3 or 4 times a day- Avoid Reinfection- all Purging Medicines & a Current of cool Air- The general Effects of Convalescence above mentioned may thus be obviated- Watchfulness by a little Laudanum or Draught of Porter going to Bed- Sickness and vomiting in a Morning by taking a little Aliment before rising- Obstructed Viscera by Blood Letting general or topical, and the Application of a little Mercurial Ointment to the Part- The Faculties are often impaired- To restore them gentle Exercise is necessary- In Fevers, the Conduct of Nurses should be carefully attended to- Chronic Fevers often carry off preceding Chronic Diseases- They have also sometimes cured Barrenness- This Effect probably proceeds 175) from the increase of Excitability- Of the Prognosis of Fevers- Much has been said upon this Subject- Hippocrates has written a Volume upon it, which has been copied by Galen, Prosper Alpines &c- Not above one fourth of this Volume has any foundation in fact- Critical Days might perhaps be very exact in the uniform Climate of Greece and under the vigour imparted to the Grecian Constitution, in consequence of every Man's being a Soldier- In London & Edinburgh there is but one state of Fever, the Typhus Mitior- In this Fever there is no Critical Day and frequently even no Day of Attack- It begins & ends gradually- For the Doctrine of the Critical Days I refer you to Cullen- All Fevers appear to partake of the Intermittent Type, even the Plague itself- This Type appears frequently in the Yellow Fever from its commencement and Intermissions are often induced in it by depleting Remedies and by change of Air- Dr. Balflour rejects the Critical days of Hippocrates & substitutes critical periods, which he ascribes to the influence of the Moon-There are facts which shew it's great influence upon the parts of Nature, as on the Tides, Vegetation, Agriculture &c on 176) the Weather, on Meat disposing it to Putrefaction- when at the Full on Maniacal & Worm Cases, [crossed out] on the Bile which is most abundant at the Full of the Moon- The Doctor says that from fourteen years experience and observation in Bengal he found the Fevers of that Country attack chiefly three days before or 3 days after the full of the Moon, or change but accounted for them from the high tides at that period leaving more filth for Exhalation &c. But this explanation of the Fact has been refuted, for Dr. Pinkard informs me that Fevers are under the same Lunar Influence several hundred Miles from the Sea Shore is S. America- The Planters expect their Fevers to return on those days and guard against them accordingly Dr. Balfour says that he regulated his practice by these principles, (1) In curing fevers: if they happened in the beginning of the six days more powerful evacuants were necessary- If towards the end he waited for the Interval- Bark was then more certain in its operation- of if by any Accident they should occur in the Interval, The Bark &c should be exhibited before the 6 Days, during which time the Fever becomes more obstinate from the influence of the Moon- (2) He guarded better against Relapses- 177) (3) He [crossed out] gained Reputation by his Predictions- He thinks the day of the Full or change [crossed out] rather the worst- He says that the same influence extends over the whole of the Northern Hemisphere where Tides are known- He applies these principles extensively, even to Inoculation for the Small Pox- He was a Man of intelligence and I would recommend his opinions on this subject to further investigation- Dr. Mitchell observed critical days distinctly in the Yellow Fever of 1741 in Virginia, and all Practitioners in Philada. agree, that the Epidemics of 93 & 97, shewed under every variety of treatment a tendency to terminate on the 3d, 5th, & 7th Days- Nor should we reject Critical Days because Fevers terminate on even days, for the Crisis according to Dr. Jackson often happens on a critical day, when Death or a perceptible recovery does not take place till the next day- In the former Case the time of Death is only protracted, in the latter the recovery is imperceptible from mere debility- The danger of a Disease can seldom be known from the degree of pain- Many Diseases are painful without danger, as Toothach, and there are some pains which indicate recovery from certain Diseases- Women are said to endure pain better than Men, perhaps from their System getting sooner beyond the point of Pain- 178) Great Heat or constant Coldness of the Extremities is a sign of Malignity- Cold wrists when the Hands are warm are highly dangerous- Cold Hands and Feet without Fever denote Nervous Diseases- Preternatural Heat in the Cheeks and Palms of the Hands indicates a Hectic Diathesis Cold Breath is a bad Sign- Eyes- Red denote Congestion of Inflammation of the Brain- Muddy, great malignity- Yellow a Bilious Diathesis but not always a bad sign particularly when the Bile has been first choked up- Eyes half closed, except in Diarrhœa, one larger than the other, a very small or dilated Pupil, continual Motion in the Eyes, winking, or a defect of winking, and a glassiness in consequence of it; avoiding Light, false Vision, whence the Patient picks the Bed Clothes, or catches at supposed Motes in the Air, double vision, which arises from a Palsy in the Muscles of one of the Eyes and above all Blindness, in voluntary Tears, and a sudden appearance of wildness and vigour in the Eyes after long absence of it, highly dangerous- An Easy flow of Tears, and turning the Head & Eyes towards the Physician at his entrance, good- Ears-Tinnitus Aurium alarming- It arises from a Convulsive Motion of the Bones of the Ears- Deafness is favorable in most cases, it shews a return of Secretion & Excretion in the Meatus 179) Auditorius- Acutoness of hearing, beyond the powers possest in health, denotes a Crisis dangerous or otherwise- Strength returns in Convalescents in proportion as Excitability changes into Excitement, but previous to this the Perception of the Senses are amazingly sharpened - Insensibility to Cold, Burns or Blisters always alarming- Accumulated Sensibility and a sudden soreness of the Skin to the touch is generally favorable- Running from the Nose after it has been long dry, and a return of the sense of smelling, indicate a Crisis & mostly favorable- Tongue- When brown or black it indicates Bilious Fever unless coloured by Liquorice, Port, Claret &c White, common Inflammatory Fever, except where it occurs at it sometimes does in Yellow Fever, from the Biliary Ducts being quite choked up- A dry Tongue is alarming, unless caused by sleeping with the Mouth open - it shews the tendency of Inflammatory to low Chronic Fever- a return of moisture at the Tip and on the Edges favorable - The dark colour from Bilious Fever often continues after a critical solution of the Disease, Tumour of the Tongue, & inability to protrude it, signs of great danger 180) Teeth- a Viscid humour cleaving to the Teeth, also, a dryness of the Teeth are bad signs - Stridor Dentium alarming- It frequently however attends worms with less danger Yawning & sneezing are favorable they shew a return of suspended sensibility- Constant hawking & spitting called Screatus is always favorable- A Sore Throat at the close of an Acute Disease is sometimes favorable, in the close of Chronic Diseases it is generally fatal- A Complete Chilly Fit occurring in the close of a Chronic continued fever, argues a previous intermission, and is favorable- Voice. when quick and more acute than in health it is alarming, it shews delirium to be approaching- A weak voice and a loss of voice are alarming, altho' I have seen recoveries with both- a Drawling Voice is favorable- Priapism often accompanies the Solution of Fever- it precedes both recovery & death - In the 3d. Vol. of Haller's Bibliotheca Medicinæ a Case is recorded of a Man, in whom a Priapism continued 2 hours after Death- State of the Countenance- A Frown is always alarming- It shews Malignity in the Fever, and that the Brain is affected- It often occurs in Hydroceph. Int- The 181) Contenance sometimes suddenly resembles ancestors, from the sudden falling away of the Flesh, and Retrocession of the Blood, so as to shew the Bones projecting, by which means a new set of features, or a new species of Countenance is sometimes discovered- this is dangerous The Hippocratic Face is said to be always fatal, viz, Sharp Nose, Hollow Eyes, Fallen Temples, cold contracted Ears, Lobes inverted, Skin of the Forehead hard, stretched and dry, and the whole Face pale, livid, or Lead-coloured- Respiration, alternately quick and slow a bad sign- moaning and a hollow sound in breathing- Cold Breath, Phlegm rattling in the Throat, bad- The Muscles of the Breast and Shoulders moving so as to be perceptible under the Bed Clothes, & an expansion of the Nostrils and Cheeks generally precede Death in Fevers, but sometimes exist without danger in Asthma- Position of the Body- best on the side, next on the Back; bad when the Body slides down as it were, in the Bed, unless supported by the Limbs, and worse still, if notwithstanding this support it slides down- Tremors, startings, and what are called Subsultus Tendinum in the Limbs, are all alarming signs in Acute Diseases- 182) Good Temper, with Patience & Resignation in the beginning of Acute Diseases is a good sign, as is peevishness at the close of a Disease - Silence in Delirium is worse than talkativeness Asking for things to eat and drink, contrary to former Habits, is bad- a return of an old Habit of Body or Mind, always favorable as is also the return of an old Chronic Disease towards the Close of an Acute one- Long and deep sleep at the beginning of a fever is a bad sign, at the close of it moderate sleep is favorable- Swallowing with difficulty and Noise, and taking but one or two Swallows at a time are bad signs- Absence of Thirst in the beginning of a fever is bad, at the end of it good- but excessive Thirst at the close of a fever is very bad- it shews the retreat of the last remains of excitement to the Fauces- A vomiting for the same reason is a bad sign at the close of an acute or Chronic Disease- Return of an Appetite for old Gratifications or artifical [crossed out] articles of Diet, as Tobacco, Tea, Coffee, is a favorable sign it shews a return of the Associations of Health- 183) Signs of Disease from the Secretions & Excretions - The Suppression of Urine, without pain, which occurs in high grades of Bilious fever, is alarming- this also sometimes occurs in Gout and Small Pox, and is unfavorable- it shews Engorgement to have taken place in the Kidnies Pale Urine shews weak action or Spasm in the Kidnies- High coloured, dark and bloody Urine shew Inflammatory and Malignant fevers - Turbid Urine is favorable- Cloud, better, Sediment best of all- A frequent or involuntary discharge of Urine is unfavorable- So many Circumstances however influence the Colour, quantity and frequency of the discharge, that little dependence is to be placed on it, I seldom examine it- White Stools indicate a deficiency or Engorgement of Bile- Green & Black, Morbid Bile- Such as excoriate the Rectum, Acrid Bile- Thin Stools indicate weakness of the Bowels- Seybala, irritation and Spasmodic Contraction of the Bowels- Absence of Smell in Stools, unfavorable- Return of it after it has been some time absent, in Bilious fevers and Dysentery, is a favorable Sign. Involuntary dejections are bad- but a return of power to the Sphincter Ani, and especially, a Crepitus with Noise, good. 184) A discharge of Worms about the Crisis of a Fever is favorable- One Spontaneous Stool a day at the visual hour is a sign of returning health- An Excretion of dark coloured or black matters form the Stomach, is bad; it indicates corrupted, Acrid Bile. Partial Sweats are unfavorable; but gentle Sweats, equally diffused all over the Body & continued for 24 hours, are favorable- A Putrid Taste, and Cadaverous smell of the Sweat, it said to be generally fatal- but this is little to be depended on, since the rejection of the Humoral Pathology- Abscesses were formerly thought favorable signs in Diseases the bus'ness of Medicine is to prevent them- Old Sores and Issues, or healed up Blisters, suddenly inflaming or running, are favorable- Hæmorrhagies were also formerly thought favorable, the bus'ness of Medicine is to prevent them- they are least dangerous, from the Anus, Kidnies and Nose- Many Patients expire from mere debility, in the Arms of Victory, as it were, after the Disease has had a favorable Crisis- Hence appears the importance of narrowly watching a Patient in the Crisis & Paroxysms, since a sudden change from stimulating to depleting Remedies, or 185) Vice Versa, may often be necessary- Never desert your Patient in an Acute Disease, for many have recovered after the most unfavorable symptoms- nor predict the issue of an Acute Disease, since some have died after the most favorable Symptoms, and as has been observed, even after the Disease has been perfectly subdued- Of the Signs of Death There is only one certain Sign of it, and that is, Putrefaction, as appears from the length of time that Life has been suspended in a Trance - Hence Persons who die in the Paroxysms of Acute Diseases, should not be buried too soon. Of the Malignant State of Fever See 4 Vol. Inquiries. p. 155. This is most violent when it comes on without a Chilly fit- The Coldness of ye Limbs &c which is often mistaken for an absence of fever in fact argues, that the Fever is as it were suffocated- Patients who die of Malignant Fevers are often upon opening them found to have their Arteries turgid, whereas in common Diseases they are empty and the veins full- (1) Plague- This is more malignant than any other fever- it is only a higher grade 186) of the Ship or Gaol Fever- It is the Offspring of Human Miasmata, and generally makes its first appearance amongst poor people closely crouded together- It is highly but not universally contagious- It cannot be propagated above 8 or 10 feet, or the distance of the Breath- White washed walls will not receive its Contagion probably (1) An account of their smoothness (2) Because they absorb the Carbonic Acid which exists in Combination with the Contagion, but the Contagion adheres for Months, or even Years to Wool, Silk, Hair, cloaths, Wood &c and it may then be propagated by the fingers coming into contact with the infected Matter- It may be propagated by the Breath before it is excited into action- Dogs & Cats spread it - An Inflammatory Constitution of the Air must exist to render it Epidemic- It prevails in all kinds of weather, altho' it is often checked by very hot & dry, or very cold & dry weather- Moist weather favours it, but heavy Rains check and destroy it. e.g. The Water Carriers at Aleppo never are infected by it- They are in a constant state of Humidity- It may be taken 2 or 3 times- this proves that it does not, like Small Pox & Measles, depend upon specific Contagion- The Contagion 187) sometimes acts suddenly, producing instant death- sometimes it lurks in the System for some days waiting for exciting Causes- It suspends all Modesty - See Preface to Boccacio's Decameron The following are said to be Preventatives Vinegar to wash the Hands- Issues, Garlic, Tobacco, tho' the efficacy of the last is denied by Howard- Low Diet is the only preventative- Small and repeated Bleedings may tend to lessen it's violence - accident sometimes checks it, as an Earthquake and the fixed Air from Fermenting wines at Moselle - It may be inoculated with advantage, and should be prepared for as Small Pox- It is true, that this does not prevent it's recurrence It is a fever and appears in every possible form of fever- It chases away, or mingles with all other Diseases It's Remedies are Copious Bloodletting, sweating Salivation- The excitement of the System is often taken down by cold air & cold Rains, as in the Man travelling to Aleppo- Inaugl. Essay & 23 Bathing the Body with sweet Oil, is said to have has a wonderful effect in the cure of its- All the other Malignant states of fever are to be treated in the same mode, whether excited by the Stimulus of Yellow Fever, by the Bite of a Viper, of Rabid Animals or by Laudanum- My Pupil Mr. Allston was called to a person who had taken Laudanum, she had swallowed 188) nearly an Ounce, and when he first saw her, was stupid and drowsy- He took ℥xx of Blood from her, having previously administered a Vomit, but before it operated- The next morning he took away a small quantity of blood and gave her a Dose of Physic- She was completely cured- Two similar Cases have occurred more recently- In these Cases the Bleeding should be copious- you may sometimes excite Vomiting by tickling The Throat with a Feather- Gangrenous State of Fever I consider this State of Fever to be created by a violent Inflammation being left in the Hands of Nature, or accelerated by Stimulating Medicines - Remedies are Wine, Bark, Opium &c in large Doses, and Stimuli to the Extremities and the whole surface of the Body, as Blisters, Flour of Mustard, Spirits &c- Case of a Women in the Yellow Fever of 1797- No Blister had any effect on her- she was accidentally burnt by a Candle being left by her Side - she was either insensible of the pain or too weak to move- The burn was pretty considerable, she recovered from that Hour- After what has been said I need not detain you upon the common Synocha- 189) Bilious Fevers - On this Head I would refer you to my various publications- In the Bilious fevers of 1797 The Ice Cap was found particularly useful- They yield to Vomits, Purges, Blisters and occasional Bloodletting- All the different Grades of this Disease arise from one Remote Cause, viz Marsh Miasmata, or Contagion- Contagion is an Accidental, not an essential property of it- The following is a Case of Infection from common Bilious Fever- During the prevalance of [crossed out] a Bilious Fever in the Shenandoah Valley in 1794, a Gentleman went thither on Bus'ness, who resided on the Allegany, where a Bilious fever was never known- Shortly after his return, he had a complete Intermittent, and infected his whole Family, viz, his wife, Child, and a Maid Servant- Generous Diet will enable a person to live above the moderate Grades of it, but this is not the Case with regard to Yellow Fever- The Inhabitants of Masmah, according to Bruce, use vast quantities of Pepper, during the prevalence of Bilious fevers; perhaps the use of many aromatics, particularly Pepper, might be serviceable, even in case of Yellow Fever The Remote Cause of Yellow Fever acts with the greatest Certainly upon Bodies predisposed by direct or indirect debility- Cool & 190) moist weather favors the Contagion, but cold and Rainy Weather destroys it - It affects various parts of the Body, but especially the Stomach and Liver- It affects this last variously- sometimes it chokes it up producing a total suppression of the Secretion of Bile, this is called Engorgement, at other times it increases the Secretion: the latter is by far the least dangerous- In the Engorgement the Stools are frequently white- The Yellow Colour of the skin in the first grades of this fever, sometimes proceeds from effused Bile- It is fugitive and local in the Yellow Fever, appearing and disappearing by turns, sometimes appearing in the Paroxysm only, & sometimes only affecting some particular parts, as the Hands, Nails, Eyes &c- The worst Cases of Yellow Fever come on without any pain- When the Bile is diffused thro' the Body so as to produce the effects of colour &c above mentioned, it is less dangerous than when impacted in the Liver- Hence also a Yellow Tongue is better than a white one in high Grades of Bilious fever- There is the least danger when the Bile is discharged either upwards or downwards at the 191) beginning of a Disorder- The Black Vomit produces so much distress and alarm in the Yellow Fever, that I have often wished for a Remedy to check it, even in hopeless cases- The following Remedies have been said to check it in the West Indies, but I have not yet ascertained their effects- (1) Cayenne Pepper gr iij made into a Pill with Bread, to sheathe its action in passing over the Tongue and Throat- of Opium grs ij or iij- Evacuants are the proper Remedies for every Grade of this Fever- Calomel and Jalap are the most suitable Purges, and when the Action is sufficiently worn down, Bark & Opium may be administered The Yellow Water of Horses is a true Bilious Fever and curable by the same Remedies- Typhus Fever- The Remarks on the treatment of the low state of Fever in my general observations comprise all that I wish to say on this subject- this is the low Chronic State of Fever- The Typhoid, is the slow Chronic State of Fever- The Synochoid state of Fever requires moderate Bleeding Emetics, Purges &c- The Tynochula occurs in Gout, Calculus, and sometimes in Sores which produce much irritation, it is known by a small contracted but tense Pulse- requires Bleeding, a few Ounces at a time This should not be omitted- There was a Man in the Hospital who has this state of fever complicated with Deafness- his heaving was always improved by Bleeding but by nothing else- 192) The Hectic state of Fever- It's Paroxysms are irregular - This Symptom particularly distinguishes it from the Intermittent. The force of the Pulse is various- It seems a Disease of the Blood vessels exclusively- It occurs in Phthisis Pulmonalis, Gout, Lues, Scrophula- It is a simple Fever- The Remedies for it should be the same as for other Fevers regulated by the Pulse- After the Inflammatory Action in this state of the Fever is subdued, exercise & change of Air are highly useful- The Febricula of European Writers is called in S. Carolina the Inward Fever- it is the lowest grade of fever produced by Marsh Miasmata- It is known by a burning in the Palms of the Hands, dry Tongue in the Morning, a little Thirst, Pulse a little quicker than ordinary, but not tense- cured by a Vomit or Purge, or Bloodletting if necessary, Blisters, Bark, but Bleeding is rarely necessary, Blisters are mostly serviceable- Intermitting State of Fever- It's forms are Quotidian, Tertian, Quartan &c- However simple this appears, it often baffles the Physician, and lays the foundation of incurable obstructions and Congestions- Fevers of this Class are intermitting or Remitting, in proportion to the force of the Stimulus which produces them 193) Continued Fevers tend to a Crisis on the third day- After the 4th the Crisis of the Fever when left to itself is on the 14th, 17 & 20th day- We derive only one advantage from the knowledge of the Critical Days, viz, our Patient on these days should be narrowly watched- In Quotidians constant watching is necessary- In the Cure of Intermittents two objects presents themselves to our attention (1) To moderate the Fit, (2) To prevent it's return- In order to answer the first intention, we must pay particular attention to the Circumstances of it's coming on- During the Paroxysm, attend minutely to the Patient- It is of consequence to moderate the Chill & vomiting- This is to be effected by a Warm Bed and warm Drinks, Punch, opium and the State of Fever may be even so low as to receive Bark with advantage- XXX or XL Drops of Laudanum taken a few hours before the fit will often prevent its accession altogether- Strammonium on the Ancles, & Tobacco placed on the wrists sometimes produce a similar effect Other Remedies are Aromatics of various kinds, particularly Nutmegs, Pepper & Vinegar Bark of the Willow Tree- Spider's web made up in a Pill, or a large Spider rolled up in a Bit of Bread and baked, The Spider is then taken out, and the Bread made up into Pills- The Spider's Poison acts by it's stimulating quality- 194) Sweating before a fire & drinking hot spirituous Liquors- Riding on Horseback has been known to prevent its Recurrence- Terror has had the same effect- A Man in this City was cured of an obstinate Intermittent by the Terror occasioned by his Chimney taking fire and his Exertions in consequence- The Cold Bath has had the same effect & a man in the Edinburgh Infirmary was cured, when I was there by a stroke of Lightning, which struck the Building- The Tourniquet has sometimes [crossed out] prevented the Chilly and lessened the Hot Fit, by being applied to the lower Extremities, sometimes to the Arms and Thigh. It is left on for 4 or 5 Minutes & quickens the Circulation & Pulse, but I think this a dangerous Remedy & have never used it. The Bite of the Tarantula of which so much has been said, is now generally believed to have scarcely more effect than that of one of our Musquitoes- He appears however at the same time that the Marsh Miasmata attain their Virulence, viz, in Autumn, and hence the effects attributed to his Bite, are probably various forms of the Intermittent; hence that Music should cure it by prompting the 195) Patient to dance, it not wonderful. The Remedies above named are Palliative- The Radical ones are (1er) Bark- by possessing a bitter and Astringent quality united, it proves more efficacious, than either Bitters, or Astringents, administered singly- It should be given in large Doses, as ℥ss just before the expected accession- Tinctures are dangerous, on account of the quantity of Spirit they contain- combine it with Laudanum if it purges- If too astringent, add a little Rhubarb, if it cannot be borne in the Mouth, give it in the form of Glyster- Red Bark, when pure is the most powerful, Yellow the next so- Pale the least- If the Bark fail, give Cloves & Wine with it and Huxham; also Blisters to the Wrists- Zinc has been of great service & Arsenic by it's universal Stimulus- The last Remedy, when these fail is Mercury, till it excite Salivation, but I have not had occasion to use this or any other of the Substitutes for Bark, since I have bled in violent Cases- Are Vomits or Purges necessary previous to the exhibition of Bark in this state of fever?- A Purge is preferable to a Vomit, it may consist of a little Calomel & Jalap, salts or Castor Oil - If a Spontaneous Vomiting or purging takes place, do not give Medicines with either of those intentions- If the Pulse be not affected, the Bark may in this Case be safely administered - 196) To remove Obstructions give Calomel &c Swelled Legs rub upwards only in the morning- In every Intermittent which occurs after the middle of Winter I bleed- Sweating Stage of Fever- The Cure for this when malignant consists in Bleeding & other Depletions- The Sweating Sickness of London disappeared, when Sydenham was suffered to treat it thus- Do not trust to a Sweat, however kindly it may seem, if the Pulse have any tension in it, Let that be your guide - Fainting State of Fever- This is an alarming Symptom- it is not safe to desist from Bleeding, whilst a Patient is unable to sit up without fainting, if the Pulse have ever so little tension in it. Burning State of Fever- This is the Causus of Authors- It often goes off while the Blood is flowing- Cold Applications are another Remedy- Cold State of Fever- In this you need not wait for the Hot Stage to bleed- Bleeding in small quantities during the Cold Stage shortens its duration- Intestinal State of Fever- This includes Cholera Morbus, Diarrhœa, Dysentery & Colic- 197) Gaol Fever often appears in the forms of Diarrhœa and [crossed out] Dysentery; constituting the Febris Introversa, & in this state often appears in Transports- Cholera Morbus in a Febris Introversa, of the first Grade of Bilious Fevers- Nature attempts to cure this by most violent Depletion- More Pounds are evacuated by her, than any Physician would venture to do- Diarrhœa, Colic & Dysentery belong also the Febres Introversæ- The Remedies to be administered should be the same as those for the same fevers if Extroversæ- Colera here often requires depletion by Blood letting- After sufficient depletion Laudanum may be administered, Bran Tea, Mallows Tea and any other pleasant Demulcent is here highly useful- In curing the Febres Introversæ, attend to the prevailing Epidemic and regulate the force of your Remedies by it's violence- Dysentery is the Offspring of Miasmata- it is not always Contagious- it is produced by Cold combining with the Miasmata- hence the same fever which puts on the form of an Intermittent in the low Grounds, assumed that of Dysentery on the Hills, from the greater coolness of the Evening & Night Air This Disease is most fatal to Aged persons of hilaun- The late Dr. Clarkson informed me that he had seen a Dysentery go off with a Salivation- 198) other Physicians have made the same remain, and why not. other fevers terminate in the same way- Mercury therefore cannot be called an unnatural Remedy, since it only imitates the process of Nature in getting rid of a violent Disease- A Purge taken whilst a person is necessarily exposed to its exciting Cause from Contagion or otherwise, will generally prevent the Disease- Lenient Purges as Castor & particularly Linseed Oil have been very serviceable in this Disease, as also Sweet Oil & Mutton Fat boiled in Milk If these fail give Rhubarb &c The Juice of a Lime with Common Salt is a frequent Remedy in the West Indies- Glysters- Opiates in Moderate Doses after depletion, particularly as Bed time- Blisters are highly useful- It is amazing how much the Skin sympathizes in this Disease- By the new action induced by Blisters, the Disease is, as it were, Drawn off, as in the Nux Vomica given to a Dog &c The Pain of Dysentery sometimes returned periodically- In this Case give Bark- It seldom fails Salivation acts here by it's usual effects- Diarrhœa often succeeds Dysentery- It's Remedies are Decoction of Tormentil & other Astringents- ℥ij of Ipecacuanha, & XL Drops of Laudanum thrown up as an Enema - 199) Blisters, Salivation, Hot or Cold Baths- The Water commonly drunk should be inspected- Change of Air Travelling- Exercise- Diluting Drinks suited to the Action of the Bowels- When Languid, give Port Wine See further Page Colic- When a Symptom of Gout, Hysteria, Hypochondriasis or Bilious fever, yields to the Remedies proper for the Primary Disease- Other Remedies are Purges, Emollient Drinks, Blisters to the Thighs & Legs- Salivation- Warm Bath after moderate depletion, and opiates after every Inflammatory Symptom is subdued- It is not cured merely by opening the Bowels- In Colic from Hysteria & Nervous Affections 10 or 12 Drops of Laudanum often effect a cure- This is a valuable hint to People habitually subject to Colic from this Cause- As the first twinge take from 10 to 20 Drops, and after a few times the Disease is destroyed by it's habitual recurrence being prevented Where Debility is the Cause of the Disease, give Chalybeates and Tonics- Pulmonary State of Fever There are 5 species of Local Inflammations, as they are called (1) of Diaphanous Membranes as Pleura, Periosteum, Peritonæum, & Capsular Ligament of the Joints. (2) Mucous Membranes, as those of the Nose, Trachea, Fauces, Larynx- (3) Muscular Fibre, as in Rheumatism & Gout 200) (4) Cellular Membrane, as in Phlegmon &c (5) Skin, as in Erysipelas- They all depend on general Causes, and are changed into each other- Pneumonia or Inflammn. of the Lungs, is a Symptom only of Original Inflammatory Fever- It is also produced by Wounds- It is sometimes a Symptom of Gout- It is [crossed out] a Disease of the whole System- The Lungs are affected in a secondary manner only, and that too in consequence of their being the weakest part of the widely extended surface of the Body - That this is really the Case I infer from the Symptoms of it not appearing for several hours & sometimes even days, after the Inflammatory fever is formed, another Patient is confined to his Bed- It is remarkable that the appearance of the Symptoms of Pneumony is much influenced by V.S. The early use of this Remedy in some Cases prevents them altogether, whilst in other Cases it produces them by relaxing the Vessels of the Lungs, and thereby favouring those Effusions, which produce pain & Cough- It is from the effects of V.S. in the former Cases that I form the opinion that there is a pure Idiopathic Inflammatory fever without Local Affection- I divide Pneumonia into Vera Notha, & Typhoides, the last state of fever being accompanied by Typhus Mitior- 201) Pneumonia Vera- It's Symptoms are obtuse pain in the Breast, or Acute in the side- difficult respiration- hard quick Pulse, great Heat & painful Cough, with moist or bloody expectoration- It's Remedies are (1) Blood Letting- In the Spring this Disease generally requires more Bleeding than in the Fall- it must be regulated by the violence of the [crossed out] Exciting fever- I once drew 140 Ounces of Blood from Captn. McPherson in 5 Days- I have frequently bled 6 or 7 & sometimes 12 or 14 times in the ordinary duration of the Disease, & always with success- we should bleed after the 5th, 7th or 14th Day, if the Pulse be hard, and there be no sign of Suppuration- It is peculiar to plentiful Bleeding to cure Pleurisy, without that distressing & dangerous Symptom, a Cough, & without hazard of a Consumption succeeding it- In a violent Pleurisy, moderate Bleeding, is more hurtful than not bleeding at all- (2) Lenient Purges & Clysters, also Seneka Snake Root, made pleasant with Liquorice, Clysters of Oil & water &c The Bowels need not be opened above once a day, except in a Bilious Diathesis, which exists not unfrequently- From 10 to 20 Grains of Nitre may be given every two Hours, combined with about gr ss of Tart. Emetic & 1 Grain of Calomel- Blisters may be applied immediately after Bleeding, without 202) waiting for the Blistering Point- A Pleurisy is far from being a more Inflammatory Disorder than a Bilious Fever, nor does it require in fact so much Bleeding, the Blister being a great Evacuation from the Affected side- Demulcent Drinks should also be given, as Flax Seed Tea, Bran Tea, & Barley Water with Figs or Raisins- In Cases of great Oppression & difficult expectoration, the Vapour of boiling Water may be received into the Lungs, and 5 Grains of Volatile Salt may be administered every two hours- This stimulates the Lungs to Expectoration- Garlic Syrup is excellent in preventing Cough in the more advanced Stages of the Disease- Cold Air should generally be avoided, as should Heat also, with equal care- In the Pneumony, which sometimes occurs in Measles & Small Pox, a much colder temperature is safe and advantageous- Pneumonia Notha- This may be called an Apoplexy of the Lungs, from the suddenness of its attack, and the sameness of it's Cause, viz, Effusion of Blood & Serum- Its Symptoms are Pain in the Breast and side, difficult Inspiration- Patients cannot lie on either, or only on one side, or cannot lie down at all- no Cough- Pulse sometimes hard- more frequently soft & full- 203) Dr. Guier say, that in some Cases the Pulse was imperceptible till after Bleeding- The Fever accompanying it serves to distinguish it from Asthma- The Heat of the Body is not much more than natural- Cure- The Pulse here must not be attended to, if low, Bleeding must still be made use of- Almost the only exception to the Rule which bids us to attend to it's indications- Bleed Copiously & at once from ℥xx to ℥xxx without fear- objections to it from the Patients having been previously debilitated by Intermittent Fever, are not to be attended to- The Blood when drawn is dense, seldom sizy, but sometimes very sizy, as after Measles especially- How shall we reconcile V.S. with the Debility & defect of Action which occur in this Species of Pneumony. The Debility is partial- The Ratio between the Fluids and solids is destroyed, the former are in excess- the Latter debilitated- V.S. restores the natural Ratio and produces equable Circulation (2) Vomits- (3) Blisters to the Breast, side and wrists if necessary- (4) Vol. Alkali, and the Vapour of Boiling Water- Stimulating Drinks as Mustard Whey- Pediluvium- Opium many be given immediately after V.S.- Avoid Cold Air - Pneumonia Typhoides- This is a modification of the Pneumonia Vera running on rapidly to the Gangrenous or Typhus state- Symptoms 204) are, pain in the Sides or Breast- difficult Respiration- Humid Cough sometimes, and sometimes bloody expectoration- sometimes neither, Pulse small, at first a little Tension, but soon becoming soft & weak- This is a dangerous Disorder and requires both skill and vigilance- It is called the Bilious Pleurisy in the Southern States- It arises from Human or Marsh [crossed out] Effluvia- I have twice seen it in the Spring- It is sometimes accompanied with an Erysipelatous or Miliary Eruption- Huxham describes Pimples about the Shoulder and accompanying it- Petichiæ have likewise in some instances attended it- It generally comes on without vomiting- Sometimes green Matter is discharged, and in the close, highly fetid, Bilious Stools- It sometimes ends in a very tedious Typhus- I have seldom seen a Pleurisy come on with vomiting that was not Acute, dangerous or fatal- Blood drawn is sometimes covered with a thin livid Pellicle and below it a Cure, like Molasses, but which is confined by the Pellicle of Inflammtory Crust Remedies- Blood letting- One Bleeding generally sufficient- then the Bark, first in Infusion, afterwards in Substance- Wine and Laudanum- I shall add a few Remarks- 205) A dry Cough in Pneumonia Vera is dangerous, as are also shifting of the Pain and Delirium- Diseases of this Class terminate in Resolution Suppuration or Gangrene-Vomica is an Abscess of the Lungs: Empyema effusion between the Lungs and Pleura-For the Symptoms of Suppuration See Cullen-I have seen them all, and also a Swelling of one Leg and Thigh- It is seldom or perhaps never possible to check a tendency to Abscess when completely begun-It breaks of itself sometimes and Patients recover when not of Consumptive Habits, or when not debilitated by its long duration-It more frequently continues for Months or even Years, without breaking and ends in Death by destroying the Lungs-In this state, there is often no Cough-In Vol. 11 of the Medical Commentaries Cases are related of Tubercles being found in the Lungs, when no Cough had preceded- Pneumonicula, or Pulmonary Consumption- This Disease is preceded by general Languor, warm & dry Hands and Foot flushing, hoarseness &c The Remedies for the forming State are Gentle Exercise, Cold Bath, Bark, Riding on Horseback & Salt Meat- Sometimes a little Mercury-Bleeding in this stage is rarely necessary- It sometimes succeeds a half cured Pleurisy, or a neglected Catarrh-This Disease has comparatively disappeared from this City, since 206) Bleeding in all Pulmonary Complaints has been so generally practised- In Its progress it produces Hæmoptysis, Abscess, Ulcers, Tubercles-The latter seem to be Tumours formed from Obstruction of the Bronchial Vessels- What would be the effect of Mercury in this Stage? I have tried several times to excite a Ptyalism in vain- Remedies are V.S. governed by the Pulse-the Bleedings had better be frequent & small-I once bled Mr. Gill 6 times in six weeks-It is my first and principal Remedy in the first Stage (2) Low Diet-(3) Diluentia, Sage, Baum and Hyssop Teas-Apple Water, Barley Water when hoarseness is present-Horse Radish Syrup- (4) Demulcents, Flax Seed & Bran Teas (5) Blisters, which in winter shd. be applied to the Anus & Legs, on acct. of avoiding exposure to cold in dressing them- (6) Vapour (7) Opiates every night, and, when the Cough is very troublesome, in the day- (8) Moderate Warmth (9) Exercise in Cold Air in the first, and in warm Air in the second Stage, also Grapes, Seneka Tea & Liquorice Mixture, combined occasionally with a little Mint Water & Antimonial Wine- I have lately used the Cold Bath in many Cases of the Typhus state of this Disease with great success and Opium in large Doses-I had a most fortunate Case of Recovery, where a Man took by Mistake 2 Opium Pills of 2grs Each instead of Aloetic Pills-A Salivation is not 207) to be neglected, if it should appear necessary - The Patient should keep in a Stove Room in Winter-Should avoid Sea Air upon Land (altho' a Sea Voyage might be useful) violent exercise, or sitting up late-Should be cautious of going into Evening, Parties and particular with respect to Diet-I lost a Patient, Charlotte Mackie, by going to a Tea Party in a state of Convalescence, and eating a large quantity of a spongy kind of Cake, called Waffles- Influenza should be added here-it is the most universally Contagious Disease known in the World, it affects Adults principally- Catarrh whether from Cold or Contagion must be treated according to the Pulse- Anginose State of fever-There are 3 Species of Angina (1) Tonsillaris, affecting the Mucous Membrane of the Fauces, and especially the Tonsils, with Tumour & Redness, and sometimes one or both with Inflammation, accompanied with difficulty of Breathing or swallowing- (2) Pharyngea-affecting the Pharynx or lower part of the Fauces, accompanied with great and painful difficulty in swallowing without much difficulty of breathing-(3) Parotidea, or Mumps, affecting the Parotid & Maxillary Glands with Tumours, without pain in 208) breathing or swallowing & sometimes succeeded by a swelling in the Testicles of Males and the Breasts of Females- The Remedies for the 2 first Species are copious Bleeding from the Arm cupping to the Part affected may be sometimes necessary- Purges-These should always be Liquid- Vomits-Neutral Salts, especially Nitre-Cold Water has, I am told, been applied with advantage to the Throat, but I have not yet tried it- Gargles of Spirit & Water-Oil & Harts horn to the Throat-other Gargles-Blisters-In Cases of extreme danger I have put a Blister all round the Neck-Fumigations, warm water answers as well as any-Bronchotomy-Like other Inflammations this is apt to Suppurate, and is then painful & tedious & apt to recur upon every exciting Cause-When in the Tonsils it should be opened- The Parotidea is less distressing than the others- Remedies are a Purge or two, warm applications to the Throat, & above all a Blister-For it's History see Cullen, and a Paper in the 2nd Vol. of Edinburgh Philosophical Transactions by Dr. Hamilton of Lynn Legis-a Blister to the [crossed out] Neck prevents it's Translation to the Testicles-A Blister to the latter prevents its translation to the Brain, where it is fatal- 209) Cynanche Maligna-is as truly Inflammatory as Rheumatism, rushing at once into the Gangrenous state- Children & Women are more subject to it than Adults or Men, and, it is said, Children with black Eyes more than others- All Cutaneous Diseases, attended with fever, seem to have a tendency to the Throat & Lungs, e.g. Small Pox, Measles &c- In the West Indies the following powerful Stimulus has, it is said, been used with success, ꝶ Cayenne Pip-℥ij Salt ℥i Vinegar Lbj Coch. j quaque horâ- The Remedies principally depended on in Europe and America have been Bark, Wine, Myrrh & Fumigations-Blood letting, if used in time, particularly efficacious-I have bled in it 4 times, and with success-Bleeding prevents in many cases the Gangrenous State from being formed-When this has appeared, it may be unsafe to bleed any longer- Bark, when it cured this Disease, acts by over coming the indirect Debility induced by Contagion, but how much soever it has been celebrated, it has always been uncertain in its Operation-This, together with Wine and Opium would be much more efficacious, after Depletion in it's first stage 210) Mercury when necessary- Scarlatina is less Inflammatory than Cynanche Maligna-The Remedies for it all the same in smaller quantities proportioned to the degree of Morbid Action-Bleeding once, Vomits extremely useful, I have given them 2 or 3 times a day, where I have not thought it prudent to bleed- When the Throat is affected, Fumigations, as of Myrrh & Vinegar & a Salivation- Cynanche Trachealis - This arises from Contagion as well as from Cold, it chiefly affects Children, but sometimes Adults-divided into Humoral and Spasmodic-I have seen it accompany Measles and Small Pox, and I have seen it once alternated with Rheumatism-It may be considered as a Pneumonia Vera in the Trachea-The Membrane which is sometimes discharged there, may perhaps be absorbed by Mercury- It is a truly Inflammatory Disease-I bled a Child of 4 years old 3 times in one day in it and saved its Life-other Remedies are-Vomit 2 or 3 times a day, Purges, with each combine Mercury in large Doses-Cataplasms, Blisters, these for the Humoralis-when it is assumes the Spasmodic form, use the above Remedies moderately, with the addition of Pediluvium & opium. 211) Dr. Archer has lately discovered a more powerful Remedy for this Disease, than any that has been yet named in the Seneka Snake Root Rheumatic State of Fever. This affects Soldiers and Sailors, more than any other Class of people It is chiefly situated in the Ligaments-When it affects the Viscera, it becomes Gout-from it's not affecting the Viscera, in general it is safer than the latter Disease- It has been divided into 2 States, the Acute & Chronic, the latter may be subdivided- Remedies for the Acute are copious Blood letting Cupping to the part affected- Purges, Sweating by Dovar's Powder; or perhaps rather by Dr. Sydenham's method, in Blankets-Dovar's Powder is advantageous after sufficient depletion- Seneka Snake Root may be useful with the same Indication it seems to sweat without Stimulating-Cold to the parts affected-The Founder in Horses is of Rheumatism, and may be cured by leading him into a Swamp or Creek and leaving him tied there all night-This produces effects similar to the application of Cold, in Human Beings- Captn. Cook in his Voyages mentions an Indian Remedy-it consists in friction to a most violent degree-for slight transient pains I have recommended this Remedy with advantage, making my Patients sometimes cry out- 212) Blisters to the Part affected-where these are objected to I have known Cabbage Leaves give great relief-also rubbing the part with Molasses- The early use of the Limbs should also be attended to Chronic Rheumatism has 2 Stages, Rheumaticula and Rheumatalgia-The former is accompanied by Fever, and requires the use of the same Remedies as the former state, but in a less degree-never prescribe in Chronic Rheumatism without feeling the Pulse- In Rheumatalgia use stimulants and the Volatile Tincture of G. Guaiacum, it is rather preferable to Bark-Also Hot & Cold Baths Salivation, Friction, Electricity & Change of Climate- I have lately met with a Symptom of Inflammatory Rheumatism worth attending to- Anasarcous Legs, half way up her Thighs in a Female Patient who had formerly been troubled by Rheumatism- By bleeding her I brought back her Rheumatism, and all her Anasarcous Symptoms disappeared- Arthritic State of Fever-See Inquiries Vol. 5- Maniacal State of Fever-This Disease is seated in the Arterial System, and is the same in it's nature with the common Symptoms of Inflammation The Phenomena of Madness are analogous to 213) those of Fever (1) A sense of fulness, & sometimes pain in the head, is a very common symptom in the forming State of Madness-The Pulse is quick, full or frequent and often tense-Wakefulness Tongue white & in this Disease never dry, as is the Case also in Pulmonary Consumption-Blood when drawn is sometimes sizy-at others indicates Inflammation of a higher grade-The Serum is often Yellow-altho' it is sometimes so red as to resemble the Lotura Carnium-It is the Effect of Morbid Action in the Vessels of the Brain, and is relieved by the same Remedies as Morbid Action Elsewhere-Besides, it alternates with many other Diseases, evidently seated in the Blood Vessels, as Consumption, Dropsy, Intermitting & Puerperal Fever Every state of Febrile Pulse occurs in Mania-It is also cured by a translation of Morbid Action to other parts, as from Abscess taking place in other parts &c There is a Man now in the Hospital who has been long deranged-He attempted to destroy himself by knocking his Head violently against the Wall-the Contusion was so great as to cause a separation of the Periosteum from the skull-I bled him plentifully 2 or 3 times & desired Dr. Physick to lay open the Scalp-He found the Pericranium separated from the Bone, but no fracture-The Patient is now restored to Reason- Mania is also accompanied by Sweats, like the sweating Stage of Fever-It affects the Brain 214) with Schirrus, hardness, Tumours &c as other Viscera are by other fevers, and is, like them accompanied by Remissions & Intermissions. Again, as fevers are of a highly Acute and Inflammatory, & of a slow Chronic Nature, so is general Madness-The Acute & highly Inflammatory State of Madness I shall distinguish by the term [crossed out] Tonic- That which is accompanied by a more feeble Action in the Vessels of the Brain I shall call Atonic.- A temporary cure of Madness has been effected by compressing the Carotid Artery- A Retrocession of the Blood from the Brain often takes place after death, so that the Brain upon dissection exhibits no signs of Inflammation- This is deceitful-no more happens here than in Death from common fevers where the Face, tho' exceedingly red just before death becomes suddenly pale from the Retrocession of the Blood-Besides Morbid Action may be so violent as to transcend the common States & appearances of Inflammatory Action-other Inflammations terminate in Schirrus, Effusion &c, so also does Madness- For the different degrees & states of Madness, See Cullen The Delirium of fever is an acute affection of the Brain- Mania is a Chronic affection of the Brain, or in other words a Chronic Phrenitis- 215) The highest possible Grade of Madness, is, when it's affects perception, as Ajax & the Flock of Sleep-the second, false Judgement with right Perceptions, the third false Inferences with right perceptions- Derangement is sometimes chiefly confined to the Memory-There is derangement of the Will, and also a Paralysis of the Will, if I may so express myself-thus people have no will of their own- There is derangement also of the Moral faculties & Passions-There is a total Absence of Understanding, Will, Moral Faculties and Passions in all Cases, this is Idiocy- The Remote Causes of Madness are like the Remote Causes of other Fevers-They are long Study, intense application, Love in Excess, Debt, Loss of Property, mistaken notions of Religion, and most frequently intoxication from Ardent Spirits- In Countries where Pride is the predominant Passion, madness is frequent- It was a rare disease in the United States till lately the inordinate Passion for wealth, which has lately arisen, has rendered it more frequent- The Proximate Cause of Madness is morbid Excitement in the Vessels of the Brain induced by indirect or direct debility- Revolutions from the variety of strong Passions, wch they call forth, dispose to Madness-Under the Despotism of the East it is scarcely known, Fatuity however is frequent- 216) The predominancy of irritability over sensibility in Childhood & Early Youth prevents madness- the most frequent period of it's occurrence is from 20 to 45- I shall first speak of Hypochondriasis- This is distinguished from Hysteria (1) by the Absence of the Globus Hystericus- (2) By Affecting Men more than Women (3) From the less degree of excitability or disposition to action from the operation of Stimuli, especially such as are applied to the Mind (4) By it's chiefly affecting persons of sedentary employments (5) By being attended with alternate Diarrhœa & Costiveness- (6) By being relieved by warm & increased by Cold weather (7) By affecting the Blood Vessels of the Brain- Hysteria is more simply a Disease of the Nerves-It is true it sometimes brings the Blood Vessels of the whole Body into Sympathy, but it seldom affects the Brain so as to induce derangement- Hysteria being accompanied with more irritability of the Nervous System is relieved by Cold, but Hypoch being accompanied by an exhausted state of Irritability is removed by warmth- Hypochondriasis is induced by debilitating Passions, by Ardent Spirits, Repelled Eruptions, obstructed Menses &c It's first impression is generally on the Stomach & Bowels- Here the Morbid Excitement rests for some time, but in 217) process of time, travels upwards, affecting the Patients Conceptions, with regard to himself only- It may be called a very advanced stage of Hysteria, as the Typhus is to the Typhoid State of Fever, Dyspepsia (a Symptom common to both) seems to be the Connecting Link between these 2 Diseases- Remedies-These are (1) Such as act directly upon the Body (2) Such as act indirectly upon the Body, thro' the Medium of the Mind- The (1st) are Warm Bath- Warm Drinks as Tea, Coffee- Cold Liquors are hurtful as well as disagreeable- Their being disagreeable is sometimes one of the first Symptoms of approaching Hypochondriasis- Opium, Ardent Spirits, altho' this last Remedy is worse that the Disease- If the Patient object to Opium give Madeira and Sherry- Music, begin with plaintive tunes, gradually going on till you come to lively ones- should these fail, give Mercury, I have cured many Persons by a Salivation- Exercise- If the Disease has been connected with Cutaneous Eruptions, which have gone in, endeavour to force them out- The Itch suddenly checked has in one or two instances to my knowledge produced the Disease, which has disappeared on it's return. When the Warm Bath has been used for some time and has restored some little Excitement, 218) the Cold Bath may be used- Blood letting is rarely admissible-In general the Morbid Actions in the System and particularly in the Brain, are so weak, that they readily yield to the Stimulants which have been mentioned, altho there are some exceptions, as when a full or tense pulse occurs- If Dyspepsia accompany the Disease give Magnesia, Eggs, Oysters, Alkaline Salts, Bitters, Opium (2) Remedies which act by the Medium of the Mind This Disease affects the Mind as follows- The Patient fancies that he has every Disease in the Nosolgy, particularly if he reads Medical Books- nay even that he is dead- He is led to change his Physician constantly & his Remedies also- He sometimes thinks himself some Animal, this is an approach to Melancholy-and often that he has a living Animal in his Belly- The following is the Order of these Mental Affections- Hysteria Hypochondriasis, Melancholy, Mania- Always treat Hypochondriasis a real Disease- Suit your conduct to your Patients impressions- It will sometimes be proper to indulge him in his most extravagant whims- A man thought himself dead tell his Physician came to open him- he recovered, but for a long time believed that 219) he has been dead, and recovered only by singular skill of his last Physician- This disease often arises from false Conceptions of Religion and from Debt, & may lead to Despair & Suicide - Amusements which employ this Mind & Body without fatiguing it, are proper, but bus'ness is still preferable-Wealthy Citizens who suddenly retire from bus'ness, are subject to this Disease, Man was made to be active- The Excitement of some active Stimulating Passion, particularly Anger, may be serviceable- A German Student thought himself dead, and desired the Bell to be tolled- The Sexton who knew the error, did not toll it with sufficient solemnity- He got up, kicked the Sexton down the Belfry Stairs and tolled his own Funeral Knell so long that the Exercise cured him- I knew a person who has a peculiar aversion to a certain Theological opinion-he was subject to this Disease, and when a fit was coming on, his Friends would start this subject, which was sure to cure him- If Debt be the cause of this Disease there is a presumption that the Man is honest from being thus affected- If Grief, apply the soothing consolations of Religion- If Love, Absence and Travelling, or the binamamicam - 220) Endeavour to excite new associations of ideas- Change his Clothes, dress and shave him- Matrimony is a valuable Remedy-The Substantial Cares of a Family are a good Antidote to Hypochondriasis- Hence married Men are less subject to it than Bachelors- Gloomy ideas of Religion are to be obviated-The apprehensions about the Commission of the Mortal Sin are to be combated thus (1) No man had ever committed it who was afraid he had committed it- (2) No two Divines are agreed what it is, some of the most intelligent are of opinion it cannot now be committed- Travelling, particularly among strangers is to be recommended, & a new Companion, also a new Carriage- Even his Pockets should be emptied that all the associations with his Disease may be broken-He cannot talk of his Diseases amongst strangers, we know how much the Passions are increased by Conversation-I have even suspected the transition of Schirrous Tumours into Cancers to be hastened by the constant direction of the thoughts and Conversation to the part affected- This Disease is much assisted by Luxury- We come now to Mania- This is a false perception of Things, or a false Judgement of the Relations of things justly perceived- The Predisposing Cause of all it's different Grades is Debility- 221) Are there any premonitory Symptoms of Mania Yes, Several- They are great watchfulness, irregularity or eccentricity in Conversation or behaviour great Appetite, Costiveness, instability in all pursuits, Irascibility, Jealousy, and all without any obvious derangement of mind- Headach, Vertigo, Unusual acts of Extravagance; these are premonitory of the Tonic State of Madness- Love of Solitude, watchfulness, unusual taciturnity, paleness or dryness of the Skin, Coldness, Weak Pulse, Aversion to Exercise, Costiveness, impaired Appetite, falling away in flesh, and indifference to surrounding objects, tho' with great steadiness & perseverance in their Studies and pursuits & slow Respiration are premonitory of the Atonic state-In each [crossed out] of them morbid Action takes place in the Brain; with this difference, that the former is attended with a higher degree of it- When the Symptoms first mentioned appear, withdraw the Patient, from too long continued application and study to any employment- Long continued application to any [crossed out] one subject, is apt to produce derangement-hence Studies should be frequently changed- McLaurin relieved himself from his Mathematical Studies by reading Novels- He read all that came out, good, bad or indifferent- Reduce the Patient by Moderation & Abstinence 222) To obviate the latter Symptoms, withdraw the Patient from Solitude, and allure him into agreeable Company and Conversation-Prescribe also Exercise, Journies, Stimulating Drinks and Diet. Confirmed Tonic Madness Picture of it's Effects- A tense full Pulse generally accompanied this state- in general these symptoms go on 'till they terminate in Atonic Madness-Tho' they sometimes terminate fatally in a few days occasioned by a disorganization of the Brain, produced in the usual way by Inflammation- It has been observed that persons in the beginning of this state of Madness possess great Appetites & are disposed to eat constantly- This sensual Gratification, probably by its stimulus upon the Body diverts and relieves the Anguish of the Mind- when it goes beyond the power of Sensual pleasure to overcome, pain in resorted to for that purpose, hence probably the Cause of their mangling & lacerating their own Bodies- A London Tradesman retired from Bus'ness, in this situation his unhappiness was so great that he wished a continuance of a Fit of the Stone, by which he was attacked, that his Mind might be completely occupied-See Roswell's life of Johnson- I think it probable the Corporeal sufferings of Hell are prepared 223) in mercy to relieve the Anguish of the Mind- The Description Shakespeare gives of Madness in Lear excellent- The Symptoms of Confirmed Atonic Madness are great taciturnity, a fixed position of the Body, down cast look, in difference to any thing about them, dry Skin, Coldness of the surface of the Body, total neglect of Dress and Person, a colour on the surface of the Body, first pale but gradually changing to Yellow or a dark brown, or livid & then dark coloured with black spots- a Defect of Appetite, great attachment to Tobacco, Insensibility to Medicines, Costiveness, & obstructed secretions- they are generally in offensive- Nebuchadnezzar appears to have had this Disease- This State of Madness sometimes affects all the faculties of the Mind, but it is frequently confined only to the Understanding & Passions- The Memory is sometimes entire in the worst cases- Sometimes it affects the Moral Faculties, tho' these are sometimes unimpaired, amidst the Ruins of all the Rational faculties of the Mind- This Atonic State of Madness continues sometimes 10, 15, 20 & even 30 years, when only moderate in it's degree, but it frequently terminates in Death, by Epilepsy, Convulsions, a Retention or preternatural discharge of some of the Excretions, Hypochondriasis, and lastly Fatuity- People in this state of Madness sometimes get fat from the equanimity 224) of temper which some Patients possess, as was the case with Christopher Smart the Poet- These states do not always continue uniformly Tonic or Atonic, altho' they frequently do- They sometimes alternate with each other-thus we often see the same person, from the fresh influence of certain remote or exciting Causes, exhibit the Symptoms of Tonic or Atomic Madness, 2 or 3 times in the same year-Sometimes the 2 States are blended together-Lastly I believe that there may be great Inflammatory Action in the Brain, and little or no action induced in Consequence of it in any of the Animal Functions, just as a Chronic Inflammatory Action may occur in the Liver without bringing any part of the Arterial System into Sympathy with it- Remedies for Tonic Madness Removal from Friends to a place of Confinement- The Mad Shirt is necessary if the Patient be violent- Blood letting-I have seen the loss of ℥xx of Blood cure a Mania in one day-It is indicated by the Pulse, which is full, tense or deprest, & should be repeated whilst any tension or morbid Action continues-I have said formerly that Mania is to Phrenitis, what Pneumonicula is to Pleurisy- now as the good state of the Appetite 225) and the strength of the Muscles render more bleeding necessary in the former, than in the latter Case, so in the great strength of the Appetite & Muscles in Mania from ℥xx to ℥cc may be drawn according to the State of the Pulse, with safety & advantage-It acts so powerfully in composing the violent Commotions in the System, that it generally renders the Mad Shirt or Chain unnecessary-I only used it once during the Winter of 96 & 97 & twice during the Winter of 97 & 98-we should bleed till paleness comes on, Mrs. Hunt never mended 'till she became so- Three Cases mentioned of persons recovering from Mania by excessive bleeding from Accidents-One of these was a Man, who in a transport of Rage at being confined, dashed his Fist thro' the Window, and cut his Radial Artery with the Glass-the Hæmorrhage was profuse and effectually cured him- Cupping upon the Temples & back of the Neck, when the whole Arterial System is not yet brought into Sympathy- Vomits frequently administered when indicated- Purges 2 or 3 times a week- Blisters-These are generally applied to the Neck-more adviseable to put them on the Legs- Dr. Willis never applies Blisters to the Head, he occasionally applies them to the Os Sacrum in Females. 226) Dr. Parry recommends Compression of the Carotid Artery- Cold Air or Cold Water-A Maniac in Virginia who escaped from his Friends & lay all night in the open Air, was perfectly cured in a few days- Cold Immersion cannot be too highly commended- The Clay Cap, recommended by Dr Cullen probably acts by it's Coldness-Cold applied in any form to the Head proves highly serviceable- The best effects might be hoped from Cataplasms of snow or pounded Ice applied to the Head- Salivation-Drs. Duffield & Caldwell both mention Cases where this was alternated with Mania- Low Diet Supplanting or Diverting the Ruling Passion of our Patients- Also neutralizing the Passions (if I may be allowed the Expression) by the opposition of others equally or more powerful in their Effects- as in the Case of the Virgins of Miletus being deterred from Suicide by the apprehension of having their Bodies exposed naked after Death- In Cases of great Rage oppose Fear to it- The Physician or Keeper should address them in a stern voice- Music-In Tonic Madness this should be of the plaintive & soothing kind- 227) Solitude & Darkness- There are times when even the Physician & Keeper should visit them as seldom as possible, as was the case with Mrs. Hunt who for a time was so much irritated by my presence that I forebore to visit her- when she grew better, She was rejoiced to see me- Maniacs should never be unnecessarily opposed, nor should the Physician appear to be the Cause of any Punishment or Coercion- Camphor, Digitalis, Hellebore & Borax have been recommended in Mania, the two last do no good except they purge- Is Opium proper in Tonic Madness. I believe never when the Disease shews abatement, there should be a little Change in the Regimen-The Diet should be better-Confinement & Solitude should be gradually diminished- Cold Shower Bath should be principally depended on to complete the Cure- Exercises & Amusements of various kinds may be made use of, to prevent the Brain from recurring to it's wrong Habits- A Lady who was deranged at Chester seemed much amused by Cards- her friends by turns played with her for several days, & part of several nights together and broke the Habits of Morbid Action in the Brain Watch your Patient in this state very narrowly- they are apt to attempt to escape and to neglect your Remedies- 228) Coercion is a Remedy in Tonic Madness- It consists in binding down the Patient in a Mad Shirt, and threatening him with the Whip- This acts, I think, only by Fear- It should be used cautiously, & not 'till other Remedies fail-It in general yields more readily & speedily to kind than to severe treatment-In no one Case of recent Tonic Mania have I failed since & pursued the above System, and I have succeeded in many cases of long standing Atonic Madness Remedies for this state are warm Bath continued for many weeks & even Months- when it takes effect, apply the Cold Bath- Wine & Opium-Ardent Spirits-These sometimes act when Opium fails, altho' it's effects in Atonic Madness are in general wonderful- Henbane is recommended by Dr. Fothergill, as preferable from its having no Astringent quality- Blisters & Caustics to the Neck-The latter from their greater Stimulus are to be prefered-I am the more inclined to this from having seen one or two Patients cured by Accidental Abscesses As Dr. Parry is said to have cured Tonic Madness by Compressing the Carotid Artery-what might be the effect in Atonic Madness from compressing the Jugular Vein? 229) Excite Stimulating Passions-Use Music & Exercise Confinement is improper-Exercise the Patient in working in the Hospital, walking, riding in a Carriage &c- Salivation is always to be attempted in this State of Madness-Cleanliness, shaving &c are highly useful- Stripes, I think, might be advantageously used in this state of Madness, by exciting Anger & Pain- Persons predisposed to Madness should always be incited to undertake some more agreeable Occupation- Cooper was urged with this view to undertake the translation of Homer- As Epidemic Fever once restored almost all the Maniacal Patients in the Pennsylvania Hospital to their Reason- Reason generally returns before Death, probably from Effusion having taken place- The more completely we take the Cure of Mania out of the hands of Nature, the less danger is there of a Relapse- A Maniacal Patient has by no means so good a chance of Recovery in a public as in a private Mad House- From an opinion of the incurable nature of this Disease, Maniacs are apt to be strangely neglected by their Friends-Yet I think madness if recent, almost as much under the dominion 230) of Medicine as the Pleurisy on Intermittent - Even Madness of long standing is curable frequently, Hope therefore should not be resigned nor the attempts of Medical Aid given over in the most confirmed Cases-Even when hereditary, altho' it is generally esteemed incurable, it should not be despaired of altho' in this last Case it is more apt to return-But it may be again cured by the same Remedies, & may be prevented by carefully avoiding all the Remote, Predisposing & Exciting Causes, which I have mentioned- Madness from Fever, Parturition, Drunkenness &c readily yields to Medicine-Madness from violent Emotions yields more readily than that from violent Passions; the latter are accompanied by desire or Aversion, but not the former A return of old habits is a sign of Recovery The rapid speaking of George 3d. preceded his Convalescence- There is now a young Man in the Hospital, who has an impediment in his speech- during his derangement this disappeared- upon the return of his stuttering he grew better & is now mending-A young Lady in this City, who was accustomed to transcribe some Poetry in her Common Place Book every Sunday became deranged-After continuing so for some time she one Sunday Morning asked for her Book, intending to write as usual-from this circumstance 231) I ventured to predict her recovery, which soon followed - The return of an habitual Disease, or pain which has been suspended by a Fit of Insanity, is a sign of Recovery-Dr Monros Daughter, who is subject to a constant pain in her Head became deranged-During this time, pain left her-upon it's return she became Convalescent- A running at the Nose, picking & rubbing the Nose, Soft Hands, & moisture of the skin after being long dry, soft Skin & a regular Stool every day, Breaking out of an old Ulcer or an Abscess are favorable Signs also-A Diarrœa once cured a Mania of nine years standing in a Woman in the Pennsylvania Hospital-such Cases are however very rare- Return of Affection for old Friends & Relations is favorable- An Acute fever coming on after Madness is favorable it transfers the Morbid Excitement from the Brain to the whole System- Remission & above all Intermission of the Fever attendant upon Madness are favorable- Unfavorable Signs - Diarrhea for the most part- Convulsions from Effusions in the Brain-Sometimes however even after these Symptoms Patients have recovered-I remember to have seen 2 Cases that terminated fatally in Phthisis Pulmonalis with a previous recovery of Reason- 232) Defects of the Faculties of the Mind (1) Of Memory-They proceed from a deficiency of right, or from wrong Action in that part of the Brain, appropriated to the Function of Memory- I think that part sometimes undergoes something similar to a Paralysis- A Gentleman in the City once forgot the names of many old ideas- There are 4 Species of Memory (1) The Words- (2) Names- (3) Numbers- (4) Ideas- Each of these may perhaps occupy distinct portions of the Brain- Children & players possess the first species of Memory- Cyrus, who is said to have known the names of his whole Army is an instance of the second- Jedidiah Buxton and Thomas Fuller of the Third- The Fourth is the dignified & useful species of Memory- The Memory in old age fails (1) For Arbitrary words as Names &c- then for Things, as Faces, & last of all for Ideas- Remote Causes of defect of Memory are Drinking Excess in Venery, Grief, Fevers, Lesions of the Brain, Gout translated to the Brian- Apoplexy, Vertigo, Palsy excessive use of Snuff- Excessive Bloodletting for Epilepsy has been known in one instance to destroy Memory- also Tenor and oppressing the Memory with too many words- 233) The Revd. Mr. Tennent of N. Jersey lost his Memory entirely at the Age of 19 from a fever-he had previously made considerable progress, but was obliged to begin his Grammar again- Some weeks after recovery whilst he was repeating one of the early Grammar Rules, he suddenly stopt, and told his Master that his Knowledge was returned, and he was afterwards as well as usual- During this Fever, he lay in a Lethargy or Trance so deep that he was suspected to be dead for some days- Cure Avoid the Exciting Causes above mentioned- Form Habits of close attention- Repeat ideas frequently- Exercise the Memory frequently, which assists it greatly- Make use of Association- The effect of Repetition upon Memory is such as to make Men at last believe what they frequently relate, even if it be not true- Thus Shakespeare's Tempest Prospero says of his Brother that he made such a Sinner of his Memory, as to credit his own lie - A sensible Mother in this City for this reason, will not let her Children till their Dreams- Memory may be assisted by our calling in to our Aid more than one sense- we are seldom satisfied with hearing a newspaper read- Children and the Vulgar read aloud for this purpose, even when alone. Nothin lodged in the Memory, is, I think lost Countess Laval was nursed in Wales, when ill on the Continent she spoke a Language which could not be made out 'till An old Welch Woman came- who found it to be Welch- 234) An old Swedish Clergyman found that the original Settlers in Pennsylvania, prayed in their Native tongue, whilst dying-in many instances where, whilst in health they had entirely forgotten their Native Language See Page 29 The Memory is assisted by pain, e.g. Bumping Boys at Boundary Stones- Parturition &c- Ibid The Cure must be regulated by the state of the System for Paralysis of the Memory use Tonics, Cold Bath &c Fatuity- This consists of a total absence of the Understanding and Memory, sometimes without Passions, sometimes with them- It's proximate Cause is entire want of Action in the part of the Brain appropriated to the exercise of the impaired faculties- It is sometimes conjenial-sometimes it is produced by all the Causes of general Madness- Old Age is subject to it- The Mental Faculties appear, I think, in some degree to descend in families- I am disposed to believe that certain connections in Marriage with Women sensible or otherwise, tend to keep up or destroy a Family Character for Genius Sensus sequitur requiorem sexum- Cure Do not smile Gentleman- This has taken place- It has been cured by Nature, or more properly speaking by the Changes induced upon the System by time or Disease 235) There was an instance of such a Recovery in a Sea Captain in the lunatic Asylum at York- A woman who had been an Idiot 'till 34, was seized with a Consumption of which she died- Before her death she astonished every Body by the developement of her Faculties, which appeared from her Conversation- Fatuity has been cured by accidental Falls, by Burns &c this may lead us to speculate upon the probable Consequences of great pain inflicted in Idiocy- A Father Mabillon (if I mistake not) was an Idiot 'till 22- He then in coming down a flight of stairs, fell and fractured his skull-he was taken up & trepanned, and became a Man of great genius & excellent Memory- Remedies are, Chalybeates, Exercise, very hot Baths to awaken Sensation, then the Cold Bath- Cordials together with a Salivation & employment in Domestic Labour- This plan of Cure should be preceded by low diet, or other depletion, but particularly the former, as Idiots are in general great feeders- This plan was pursued with aspect to an Idiot in this Hospital- He was weak from his birth, but was capable of some Agicultural Labours, 'till about 4 years since, when he seemed gradually to sink to the State of a Vegetable- He was brought to the Hospital abt. 18 months since, so irrational, that if put at the top of the Stairs, he would fall down to the bottom he now speaks rationally, is useful as an 236) Assistant in the Hospital, tho' his Imbicility still continues- Are there any Medicines which exert a specific influence on the Brain? I think Strammonium would produce such an effect- What would be the effect of frequently repeated intoxication in these cases of idiocy? The temporary Fatuity succeeding fever yields to exercise and the Cold Bath- The Fatuity of Old Age cannot be cured, but it may be prevented by sensible Conversation & Reading Hence the frequent fatuity of Ignorant Country people: hence also fatuity is less frequent in Cities- Disease of Moral Faculty-On this Head I refer you to my 2d. Volume, and for a Confirmation of my Ideas, visit the new Gaol of Philadelphia- Diseases of the Passions- The Moderate exercise of the Passions is favorable to health, it invigorates the Body, promotes Circulation &c- Sometimes all the Passions exist in a perfect state of Torpor, an instance of which occurred in a Lady of this City- Cure consists in Tonics, Cold Bath, Exercise & perhaps pain of Body & a Salivation-A Lady deranged in Virginia had just lain in, but denied the Child to be her own & refused to suckle it- When the Mercury touched her Mouth she knew it & loved it- It was intermitted, and she lost 237) herself again, resumed and she got better- The Passions are contagious- hence Example is superior to Precept- They are represt by this cultivation of the Understanding, and particularly by Mathematical Studies- Love-The Excess of the Passion only constitutes disease- it accumulates excitability of the Skin and Face, hence the frequency of Blushing-If a Woman never looks at a Man or looks at him constantly, says La Bruyére, she is in love with him also, if she retire to decorate her Person, when she sees a particular Man come up- Unsuccessful Love produces fevers, Dyspepsia Hysteria, Hypochondriasis, Suicide, Madness & Death. Lovers it is said, do not dream of their Mistresses when their Passion is at the height, nor can they form a vivid & distinct idea of their persons, but this is not the Case in the incipient or declining State of the Passion- No Age is exempt from this Passion- Genl. Lee in travelling thro' Bulgaria, asked the Landlord of an Inn in a little Village, what curiosities there were- he was answered, that there was an old Man living there in good health aged 112, Genl. Lee went to the House, where he was told he resided, and asked an old Man, whom he found sitting at the Door, what was his age? 85, was his answer-I was told, said the General, that you were 112. Oh, that is my Father- 238) and where is he? said the General- Gone abroad, said the Old Man weeping bitterly, and I don't care where he goes, for he has interposed and prevented me from marrying a pretty Girl with whom I was in love- Cure- In hopeless love when attended with difficult respiration, bleeding and blistering may be of service- A Prince of Conde was once violently in love, and was seized with a violent fever, he was bled and blistered secundum Artem, & found that all his Love was abstracted by those evacuations- Travelling & absence are highly useful- The vehemence of an unfortunate Love Passion often drives the Lover to adopt the Binam Amicam- Love may be cured by exciting a stronger passion, as for instance Ambition- Perhaps Ovid's advice is not irrational- he persuades the unsuccessful Lover to dwell upon all the bad qualities of his Mistress-it she has a hoarse voice, make her sing- if she plays ill, urge her to expose herself in that way- a Voyage or Journey may be of service- Love may be more easily cured, when hope is utterly extinguished- hence the propriety & humanity of a decisive refusal, recommended by Dr. Gregory in his Legacy to his Daughters- 239) Grief-This Passion sometimes disposes to sleep- at others it rises above or below the Sleeping Point- when excessive it goes beyond tears & often produces actions, which cause it's reality to be unjustly questioned-See the instance of the Captive King of America in Cyropædia-The Custom of removing persons from the House where a Relation has died, is, I think, a bad one-The sight of the House will remove more unpleasing Sensations afterwards- Grief sometimes produces Syncope & Asphyxia but more frequently, Fevers, Dyspepsia, Hypochandriasis, Catalepsy, Mania & Death- Dissections shew the Heart to be affected by Congestions, Inflammations, & rupture of the Auricles & ventricles- To a Mother who has lost her Child it may be suggested as a topic of Consolation, that the Deity feels an infinitely greater regard for all his offspring than a Mother for a Darling Child- When the Constitution is sunk by Grief below the Sleeping point, give Opium- Anger-determines the Blood to the Brain & when excessive, produces the usual effects of such determinations- Most of the terrible effects of this Passion are produced by the cooperation of Wine or Strong Drink- a large Draught of Cold Water sometimes cures a fit of Anger- Waiting before you speak- speaking slowly & softly- No Man is allowed to speak loud in the New Gaol in this City, and it is found to prevent quarrels- 239) Fear-Never converse if possible on the Subject of fear- Genl. Miranda in prison under Robertspierre diverted the apprehensions of a Death, almost hourly expected by conversing with his Fellow Prisoner Du Chatelet on the subjects of their respective Studies, without allusions to Politics, or to their own situation- The Morbid fear of apprehended evil is cured by real evil-Thus Fidgets or uneasy irritations over the Body, rendering the Patient restless & dissatisfied are cured by a Blister-Opium conquers the fear of persons, about to speak in public- Jno. Hunter was accustomed before Lecturing to take xxx Drops of Laudanum, with this view- Inure Children to go to Bed in the dark & alone- they are often improperly menaced with Hobgolins &c It is perhaps allowable to threaten them with a visit from the Chimney Sweeper, as it will be impossible for him to inspire terror in after Life- Fear suspends all other Passions as Affection &c The Fear of Death in the last stage of all Disorders, and also that of Surgical Operations maybe obviated by Opium- Physicians are often afraid of the Consequences of attending Malignant Epidemics-This fear must be corrected by the consciousness of their performing their duty, and by cherishing a regard for their Fellow Creatures, 'till it absorb & over powers 240) that for Money- Prophylactics as Vinegar &c are bad, because they increase apprehension, and perpetually recal it to recollection- Regulate your Diet and leave the rest- Sidney's words, where danger and duty are connected, should be written in letters of Gold over every Physician's Door. "Whenever, says that illustrious Patriot, "a man is placed in a situation in which he cannot save his life without doing a mean thing, it is a proof that God calls on him to give it up." Joy- To obviate the ill effects of the excess of this Passion, take care not to impart it too suddenly, particularly where there is much excitability- The Passions already mentioned produce external effects- Envy & Malice produce internal ones- Lust- This Passion is encouraged by excess in eating and drinking, indolence & a Sedentary life- Female Weavers are said to be liable to this Passion from the peculiar motion of their lower Limbs- Convalescence from Malignant fevers disposes to it [crossed out] exceedingly- The supposed effects attributed to Eggs & Oysters with regard to this Passion, are, I believe, totally without foundation- Remedies are, Matrimony, Low Diet, Labour & Exercise- Long Journies on Horseback- But this last for men only, for it is said to excite Women more- Avoid obscene Books, Prints & Conversation 241) Dreaming-This seems nearly related to a Disease of the Mind, as well as of the Body- It's proximate Cause is probably unequal excitement in the Brain, from unequal Action in it's Vessels- From the Stimulus of a Full Bladder, Noise, Light &c we dream generally most in the morning- Somnambulism is connected with this- I have known 2 instances of its being cured by placing Pails of water in the Bed Chamber- The Patient however should be informed of it- Remedies for these Affections- Avoid heavy Suppers, or going to Bed with an empty [crossed out] Stomach- If from fulness of the Vessels of the Head, deplete, if otherwise, Anodynes- Avoid Sleeping on the Back- Apoplectic- Paralytic- Phrenitic, Lethargic, Comatose & Vertiginous States of Fever- All these States might perhaps with propriety be classed under one Head, The Cephalic State of Fever. Apoplexy- The Causes of this Disease are various- e.g. Long & painful application- Palsy, Epilepsy- Ischuria- Anasarca- Worms, intermitting Fever, translated Eruptions, Hysteria, Gout- Perhaps in Gouty Habits it always proceeds from a translation of the Arthritic Affection to the Brain- 242) It is often produced by the Remote Causes of general fever, as Contagions of the Plague, Yellow Fever, & Small Pox- The Influenza produces a tendency to Apoplexy, viz, Vertigo-Miasmata produce it, even those which produce the common Intermittent- I have seen a Patient who was Apoplectic every other day- It's proximate Cause, is pressure upon the Brain from Effusion of Blood, Serum, Matter, Water &c from Rupture, or over distinction of the Vessels of the Brain - The distinction of Apoplexy into Serous and Sanguineous, is absurd- The Pale Skin, and other symptoms of apparent weakness of Action, in what is called the Serous Apoplexy are Symptoms of the highest Grade of Apoplexy, like [crossed out] locked up fever- and these supposed Symptoms are proved by Lieutaud's dissections, to be by no means certain- Apoplexy excited by the Contagion of Bilious fever gives a Yellow Eye- To the Causes above mentioned may be added Opium in excessive Doses- ℈i of Opium injected in a Glyster once produced it according to Doleus- Fumes of Tobacco, Lead &c. Contusions on the Head- Mephitic Air- Lightning or an excessive stroke of Electricity- Insolation- Carbonic Acid Gas- breathing in crowded Assemblies. Suppressions of customary Hæmorrhagies, particularly Piles- Persons who are subject to 243) an Annual fit of the Gout, often have it when they miss their fits- Violent anger has produced it, also long & loud preaching- The same Causes, according to Predisposition produce Phrenicula, Hydrocephalus, Palsy, Phrenitis &c Tight Ligatures round the Neck, & even tight Shoes, intoxication & wet feet, also any indigestible matter in the Stomach have sometimes produced this Disease- Altho' generally speaking, this Disease attacks old people, I have known it attack persons in the middle of Life- Obstinate Headach, continuing for many years is apt to terminate in it- Premonitory Symptoms are Giddiness in the Head- long absence of Piles, when these are customary, incubus, suffusion of the Face & neck, & fuller Respiration than ordinary- Also Headach, Drowsiness, Numbness in one or both Limbs, frequent Hæmorrhagies from the Nose, dull or false Vision, or hearing of short duration, sudden darkness, a faultering of the Tongue, & loss of Memory- When these occur V.S. Low Diet- a Vomit or a Purge often prevent the Disease- There are 3 Species of Affections of the Brain- (1) Where the pressure is too great for Morbid Action- (2) Morbid Action transcending common Inflammation- (3) Inflammation- The more the Action 244) is suffocated, as it were, in the Brain, the more danger- The more evident the Fever, the less danger- The Pulse is very various, but all its States call with equal vehemence for Blood letting- The Bleeding should be copious- Dr. Dewees lost ℥120 at once- Open both the Arms in these Cases- Do not cease Bleeding even to ℥100 or ℥150, as long as morbid action appears in the Pulse, or the force of the Disease remains- More bleeding is necessary when the Disease proceeds from Contusion, than when it arises from fever, it should be done at once- When the Pulse is deprest, make a small incision, and abstract Stimulus very gradually- The stream may even be stopt occasionally, but the Bleeding must nevertheless be copious- a Person in this Disease may be bled in this Manner 15 or 20 times a day- The pressure of the Carotid Artery may perhaps be serviceable, as in Mania-When the main force of the Disease is subdued, cupping to the back of the neck may be useful- Are Vomits proper? Dr. Fothergill recommends them highly- When the Disease originates from an affection of the Stomach, and in a Patient not much debilitated previously- they may do good, but I have never used them- Sometimes where an Emetic appears to be indicated, it 245) it cannot be swallowed, in this Case put your finger, or a feather down the Throat- where the insensibility is not very great indeed, this will be effectual- Purges of a Stimulating kind are highly useful, and Clysters of the same nature, They should be repeated till all the Contents of the Bowels are evacuated- Cool and pure Air is essentially necessary- Hence unnecessary attendants should be desired to withdraw-Apply Cold Water to the Head, we see the good effects of this in a wet Napkin, checking the tendency to Apoplexy, arising from Intoxication- The position of the Patient should also be attended to- he should be seated in a Chair, head raised, and all Ligatures, especially those around the Neck, removed- In a tendency to Apoplexy fear should be excited, since Terror sobers persons intoxicated-on a new and stronger Stimulus as Anger &c If we are called late in Apoplexy, or after Sufficient Depletion, we must have recourse to Stimulants- Blisters to the Neck and Head, Actual Caustic, Sinapisms, common Salt put into the Mouth, Acrid Clysters, Electricity, Frictions & Light are all useful- 246) It is a vulgar error that People die of the third fit of Apoplexy-strict Temperance however should be enjoined, when a person has once had an attack-The contrary error of abstemiousness should be avoided-Use no excess at any Meal, particularly just before going to Bed, but do not abstain from suppers where they have been usual- Avoid indigestible food as Toasted Cheese, and Medley of Foods, as minced pies-also sudden changes of Diet-hence by the way it is a good Rule for Valetudinarians seldom to dine out of their own families-These Rules however should not be attended to by the Young, since for them the best habit, as Celsus observes, is no habit at all- Gently stimulating Drinks, as Madeira & Water are proper-Malt Liquors are too gross for persons who do not labour or use much exercise- I think I have known the habitual use of Garlic & onions useful in persons disposed to Apoplexy, or troubled with Vertigo-I have known many cases where a Clove of Garlic taken every Morning has been of singular efficacy-I have been told that a Table Spoonful of Syrup or Honey taken afterwards will hinder its affecting the Breath- A Fever following Apoplexy is generally favorable When Symptomatic of other Diseases cure those Diseases e.g. if Worms, give Anthelmintics- if Intermitting, [crossed out] Bilious or Yellow Fever, give the Remedies suitable to those Diseases- 247) To remove the stupor & loss of Memory which sometimes succeed Apoplexy, use a Seton in the Neck- The Patient who has once had an attack, should use exercise-avoid all the Remote & exciting Causes, avoid sleeping on the Back-Issues & setons are often beneficial, the last are to be preferred-Avoid great exertions, intense Study, Cold feet, large & Crowded Assemblies &c. No old Habit as smoking or snuffing is to be relinquished-nor should the discharge of an old sore be stopped-The Return of Piles or Menses should be invited- Intoxication is a sort of Apoplexy-to cure it apply cold water to the whole Body, Tickle the Throat with a feather-excite Terror- The Paralytic State of Fever is a less grade of the former, and requires Remedies of the same kind, in a proportionate degree-It is Idiopathic and Symptomatic-The former is a general Disease & may arise from all the Causes of Apoplexy-also Mineral Exhalations, especially of Lead-it sometimes succeeds Apoplexy-The Symptomatic Palsy arises chiefly from fevers, especially those of the Malignant kind-it occurred in several Cases that came under my notice in the Yellow Fever- Both Species occur after many Complaints in the Bowels, particularly Colic & Dysentery-They sometimes succeed Hysteria & Rheumatism- It is divided (1) As it affects the Head only 248) (2) As it affects the Nerves & Muscles of one side only, called Hemiplegia &c &c- Palsy is said to affect Women more than Men in consequence of their Sedentary Lifes-The Bath Hospital in 1776 furnished an exception-out of 64 Patients only 14 were Women-all Ages are subject to it, but persons beyond 50 most so-very old people most exposed to it in Cold Weather- Cure Do not attend to the Pulse if called early, but bleed as in Apoplexy-from ℥xx to ℥150 may be necessary to cure the Disease-I believe we often fail for want of sufficient depletion-Aloetic Purges are serviceable-Nitre, Tart Emetic-& frictions with the Hand preferable-when Morbid Action is diminished, or when the Action is weak stimulate internally & externally with Mustard, Cantharides, Horse Radish, Warm & Cold Bath-Topical Stimuli as Blisters to the Neck, & general ones as Vol. Tincture of G. Gaiaiacum-Tinct. Canth. & Æther āā have been recommended as a Liniment in Paralytic Cases-A Salivation has also succeeded- Precursors of Palsy are tingling on the Limbs as if they were asleep &c-Use the same Prophylactics as have been recommended in Apoplexy-If tremors only attend, the use of Tobacco must be given up-The sweating of the Limb is unfavorable- 249) Coma and Vertigo in the beginning of a Fever yield to Depletions, at the Close they require Stimuli- they are a tendency to Palsy & Apoplexy in a low degree- In morbid Wakefulness attend to the State of the System, and deplete or stimulate accordingly- I was some days ago called to a Gentleman who was troubled with an obstinate wakefulness-He had preciously been under the care of many Physicians & had spent, as he himself informed me, 270 £ in pursuit of health-As however this particular affection was [crossed out] urgent, he at length sent for me, but with violent prejudices against my system of practice, & in particular a full determination not to be bled- When I saw him, he had passed 3 nights without Sleep-His Eyes were wild & inflamed-his Pulse chorded & tense-I considered the affection as a Symptom of Gout to which he was subject-Under these Circumstances I immediately proposed bleeding, he gave a sort of assent & said he would send for a Bleeder-his manner gave me suspicions & I would not trust him, but immediately proceeded to bleed him myself-Whilst the Blood was flowing, he suddenly exclaimed that he was relieved-when I had taken about 10 ounces, I was going to tie up his Arm-"No, said he, Doctor" no" take a little more"-I took 4 more, he slept 250) four hours that night, and has been since bled once more & gently purged-He now declares he is better than he has been for many years, and is almost perfectly recovered-In some of his fits of wakefulness, he told me, he had taken gr vij of Opium at a dose without producing Sleep. I have lately advised a young Lady of this City to walk her room half an hour previously to lying down-which I have myself often done to take down the Excitement caused by Study, which often prevents Sleeping in the early part of the Night-Also at the Patient think on some uninteresting subject-bidi Vol. I-p.62 Hydrocephalic State of Fever This State of fever occurs sometimes from the Suppressions of Discharges from the Skin, also from dried up Ulcers &c- It's Characteristic Symptoms are, terrifying Dreams & starting in Sleep, Dullness in the day time, weariness, pains in the Limbs & back of the Neck-a Full Pulse often occurs in the beginning-it afterwards becomes slow, pain in the head, Dilated Pupil, Drowsiness, Costiveness, a Frown, the Intellects sometimes impaired, at other times not-It affects Children chiefly, follows Mania, Phrenitis, Contusion &c- It generally appears in the form of an Intermittent, or to speak more accurately, the Intermittent assumes the forms of Hydrocephalus- 251) The Water in this Disease is always the consequence of Inflammation- Effusion is the mode by which the Vessels relieve themselves, hence when this takes place, the Inflammation disappears, as appears from Dissections-A Membrane also is often observed there, which is another proof of Inflammation- Even if Inflammation should not always precede Effusion, the excess of Action induced in the Arterial System by the pressure of this water upon the Brain renders V.S. and the other Depleting Remedies equally necessary-But I not only believe Effusion in Hydrocephalus to be always the consequence of Inflammation, but that Dropsy in all its forms is produced by the same Cause of wch more hereafter Pain always ceases in Hydrocephalus after Effusion has taken place, hence as is observed by Dr. Fothergill, the Patient appears better- Cure In pursuing the following plan of Cure, I have been uniformly successful, when I was called in the first Stage of the Disease & suffered to use my own Judgment (1) Bleeding-this should be frequently & copiously used-(2) Purges every day-(3) Blisters to the Neck and Head-(4) Cold Water & Ice to the Head- then (5) A Salivation-Perhaps Bark would be useful after the Disease is subdued, particularly when it has been caused by an Intermittent, as also the Cold Bath, to prevent a Relapse- 252) Nephritic State of Fever This is known by pain in the Region of the Kidnies, retraction of one of the Testicles &c It is often induced by Calculi, but it also frequently occurs in Gout & Yellow Fever &c In the last it is sometimes attended with no pain, from action being suffocated, by Engorgement of the Vessels- Remedies Copious Bloodletting & pure air, purges, Clysters, a Recumbent Posture, low Diet, and after the System is sufficiently reduced, Liquid Laudanum- It is sometimes of a Chronic Nature & requires Remedies accordingly-A small bleeding will often prevent all the Paroxysms in these Cases- There is a Regimen proper in this form of the Disease, particularly avoiding acid Aliments, sleeping on the back, or riding a hard going Horse, or in an uneasy Carriage-Gentle Exercise is proper to move the Muscles of the Back, as playing at Bowls or digging in a Garden-Drink very copiously of Water a Quart or 3 pints a day or to gain the confidence and ensure the obedience of our Patient, a little Tea, or some demulcent addition may be permitted-Certain Bitters may be administered in the intervals of the Disease-Cold Bath to the Kidnies, sitting down on a stool in a Summer's Morning & wrapping wet Towels round the Back, repeating it twice or thrice-Lastly, always stand up to make Water- 253) Hydropical State of fever I believe this to be in nineteen Cases out of twenty an Arterial Disease-Scarlatina & Puerperal Fever are often accompanied by Effusion, where the necessary depleting Remedies have not been exhibited to a proper degree- Dropsies are therefore caused by indirect not direct debility-for instance, great as is the direct debility of aged persons, how rarely are they afflicted with Dropsy-When did we hear of a Dropsy succeeding Famine? It is as important to attend to the Pulse in Dropsy as in any other state of fever-In Dropsy of the Brain, it is slow & deprest- in Dropsies of the Breast and Heart it is intermitting- Remedies Blood letting-this may be used a dozen times as safely as in any Inflammatory fever, if the Pulse indicates it-Vomits-Purges-Fasting-Fear-Cold- Nitre-Digitalis & Salivation- In the Atonic State Tonics of all kinds- Dropsy should be called the Inflammatory State of Fever, attended with watery Effusion See Inquiries Vol. 2- Eruptive State of fever- This comprehends small Pox, Measles, Scarlatina, & the other Exanthemata of Dr. Cullen- 254) (1) Small Pox-I believe the Malignant form of this Disease might be prevented to a certainty by copious bleeding-In the secondary fever Mercurial Salivation, & plentiful bleeding-The Mercury protects the Breast, & Brain- Anomalies in the Eruptive fever of Small Pox- it occurs from 8 to 20 days forwards, from 8 to 5 backwards after Inoculation-In the natural way it seldom comes on before the 14th Day- Sometimes there is no Eruption at all-I have known 2 Deaths from this Cause-Sometimes when the Eruption begins, the fever ceases- I have known Angina Inflammation accompany Small Pox-I once saw the Hives succeed it, with a fatal event- I once saw a second Crop of Pustules- It is said that the Infection does not take place in the East when the Harmattan blows, I think such Winds sometimes occur here Where the Arm is very much & extensively inflamed on the 2d, or 3d. day it generally throws out all the poison-the fever takes place sometimes even when there is no sign of Inflammation- (2) Measles-For the treatment of this Disease read Sydenham-Dr. Watson describes a putrid Measles, this is only a higher Grade of Inflammatory Measles- Preparation by Diet is as useful for Measles, as for Small Pox- 255) Bleeding has wonderful efficacy in checking the troublesome Diarrhœa & Cough which succeed Measles- Hæmorrhagic State of Fever Hæmorrhagies are said to be Arterial & Venous Arterial in the prime of Life & Venous beyond 36 or 40- Tonic and Atonic Hæmorrhagies are better Names, than active & passive, both result from Morbid Action in the Blood Vessels- In two or three instances I have known peculiar Hæmorrhagies take place without fever, where from the slightest wound the Hæmorrhage could scarcely be stopt-It yields to Tonics- A Pupil of mine in this City, in consequence of the extraction of a Tooth has an Hæmorrhage that lasted 2 or 3 days; nor could it be stopt till several persons in succession held a Compress of Cork in the Socket day & night for, I think, 36 Hours- The Causes of Hæmorrhagy are sudden change [crossed out] of Air, stimulating Passions, violent Exercise, or Exertions-Cold applied to one part of the Body, determining to another intense heat, or intense Cold-Animal magnetism has produced it from it's violent effect on the Imagination- 256) Hæmorrhagy should never be trusted in the Hands of Nature- Remedies for general Tonic Hæmorrhage are Blood letting, Cold Air, Water or Ice- The efficacy of these Remedies proves the Inflammatory Nature of the Disease, and that morbid action is its proximate Cause-Also lenient Purges- and Alum, Nitre, Sugar of Lead- Atonic Hæmorrhage requires Opium, Alum, Bark, Steel, Copper, Cold Bath & Exercise- Hæmoptysis-In this Disease the Blood sometimes comes up from the Fauces only & it hawked up, not coughed up as from the Lungs-Where people spit from great exertion of Voice, they seldom spit whilst speaking, but it takes place 2 or 3 days after- Moderate use of the Lungs in speaking & singing tends to protect people from this Disease- When the Blood is discharged without Coughing or any febrile Symptom, it is not at all dangerous. Blood [crossed out] discharged by vomiting is generally black and grumous, but from the Lungs it always comes up florid & fluid-The black appearance above mentioned sometimes occurs in Yellow Fever and has been mistaken for the Black Vomit- Remedies are Blood letting-Common salt from a Tea to Table Spoonful 2 or 3 times a day during the existence of the Disease only-Cold Liquors, Cold Air, Light Dresses & Bed Clothes- 257) Dr. Bond, who was subject to this Disease used to obviate the effects of it by wrapping himself on a Cold day in a sheet dipt in Cold Vinegar- Cold Water applied to the Scrotum by means of a wet Napkin, often stops the most distressing Cases of it-other Remedies are Acids, Nitre, Alum, Vegetable Diet & Rest, also abstinence from Conversation during the actual existence of the Disease not in the intervals of it-Blisters have been very efficacious- Dr. Smith of Princeton College lost in 10 days ℥300 of Blood in an acute form of this Disease-He afterwards used Tonics with success-Bark is here valuable-Many persons who have been much afflicted with this Disease in middle life, have afterwards lived to a great age-When Morbid Action is subdued all kinds of Tonics may be used, to prevent the recurrence of that debility which predisposes to the Disease, Bark and Porter have been found singularly efficacious. Epistaxis. This is generally an Arterial Hæmorrhagy- Remedies are Cold applications to the Neck & Scrotum, & plugs in the Nostrils, made of Lint Rags rolled up & screwed into them- They must sometimes remain for 2 or 3 days- I lately applied Ice in A Napkin to the neck in a violent case of Epistaxis with success- 258) To obviate the return of the Disease prescribe Low Diet, and avoiding tight Ligatures- Hæmorrhagia Uterina-In this Disease the Patient should be constantly on her Back, & should not move even to go to Stool- Remedies-Cold Water-Vinegar, Ice, also a Pint or Quart of Flour, dashed over the external parts, has almost always succeeded in my practice- Expose the part to a stream of Cold Air from a Window Blisters to the Thighs, wch in Chronic Uterine Hæmorrhagies I have found highly serviceable- Occasional bleeding will prevent its return in Women habitually subject to it in pregnancy- I was once called to a Lady in 7th. Month of her Pregnancy who had a most profuse Hæmorrhage- she was without Pulse-I threw on it a Bowl of Flour & in 3 minutes it succeeded- When it is Atonic, give Bark & Port Wine- In Vomiting of Blood pursue the general Rules of treatment above mentioned. Hæmaturia-cure by Common Salt &c as from the Lungs- Hæmorrhage from Wounds stop by Cold, Compression, dry Lint, Rags & Flour-Avoid liquid applications of all kinds to a bleeding wound Ruspinis Styptic is an Exception-I am disposed to believe that Life has often been preserved by the Chill of the Night Air, 259) stopping the Bleeding from considerable Wounds in Soldiers who have been left all night upon the field of Battle-The Deer when wounded are said by the Hunters to betake themselves to a stream & lie down on the wounded part, till the Cold stops the Hæmorrhage- Mulana is almost always fatal- Amenorrhagic State of Fever-Never prescribe in this State of Fever without feeling the Pulse- Remedies for the Tonic State are Bloodletting-It is of no consequence to bleed in the foot, it is much more troublesome & not at all more efficacious than bleeding in the Arm-Purging especially with Aloes, because they are supposed to stimulate the Rectum specifically, and from thence extend by Sympathy to the Uterus- In the Atonic State use Tonics of all kinds, Chalybeates & Calomel- In Emansio Mensium examine the Vagina to see if there be any local obstruction- Dysmenorhagia- Here the Vessels overact- Remedies are a little Bleeding & afterwards Anodynes. Hæmorrhoidal State of Fever. This is improperly called on Hæmorrhagy by Dr. Cullen-it chiefly affects Adults, and Women more than Men- Its Remote Causes are Aloetic Purges, too plentifully used-hard riding Costiveness, Sedentary 260) Life, from which Cause Women and particularly pregnant Women are more liable to it-Long standing or walking- The proximate Cause is excess of Action in the Hæmorrhoidal Vessels, producing tension & Effusion- They are External and Internal-the last are called the blind Piles- It is frequently a Disease of Gouty Habits- Remedies-Bleeding general and Topical, Lenient Purges-Sulphur particularly valuable-A Horizontal Posture & Cold Water-This last if applied early prevents the complete formation of the Disease-When the Action in the Vessels has been taken down by Depletion, apply Ointment of Sulphur & Hogs Lard āā-burning old Leather in a Close stool Pan acts as a sedative Remedy- Sacch Saturn-Powder of Galls & opium āā ℈j ungt Strammon-℥ss is a good application in the close of the Discharge- Persons subject to Hæmorrhoids should avoid Aloetic Purges, Costiveness & long walks- Bread made of equal parts of Indian Meal & wheat Meal is an excellent preventative of Costiveness. A swelling often continues after the Disease is cured from mere Debility-It is not attended with much pain, Removed by Stimulants- Jar in various ways, also a Mixture of Sugar of Lead, or white Lead & sweet Oil Fistula might I believe be almost always 261) be prevented by treating Hæmorrhoids as a State of Fever- Opthalmic State of Fever It is often important to treat this rather as a Symptomatic than as a primary affection- It often prevails in the Autumn during the prevalence of Bilious fevers-The Pulse should always be felt in these Cases- It's Causes are all the general Causes of Fever, also Dust, Iron &c getting into the Eye- Weakness & Soreness of the Eyes & blindness of one or both Eyes are very common at Syene, from the hot wind which blows across the deserts of Nubia- Bruce was much affected with Opthalmia from this Cause-It is supposed to arise from wearing a very hot Head Dress in Grand Cairo-Out of 100 persons whom Volney met in the street 20 were blind, 10 wanted an Eye & 20 others had their Eyes red, purulent or blemished- Remedies-These are the same as for Common fever, Blood letting general and topical-Purges, Vomits, Cold applications, Blisters to the Neck & Head- Perhaps however better to the Legs-As Dr. Willis recommends in Mania & upon the same principle Particles of Iron in the Eye may be removed by a Load Stone-Sand by the Eye Stone, or putting the Head in a Bowl of Water & opening & shutting 262) the Eye frequently-Where these fail, bind the Eye closely- Sometimes a Hair of the Eyelid becomes inverted, and sticks in the Eye- When the Atonic State comes on, use Opiates & Bark, Cold Bath &c-stimulating applications of various kinds to the Eyes, as Madeira Wine, Brandy & Water-Vapour of certain Tonic Vegetables-Solution of common Peruvian Bark- Opium Solution-Lapis Calaminaris finely levigated, and Butter unsalted or Cream āā make a good Epithem-Electricity-Puncturing the Tunica Adnata or Eyelid & drawing from it a Drop or two of Blood-Sacch. Saturn-℥ss, Water lbss put on Bread & applied to the Eye- When Opthalmia proceeds from general Debility give Bark and Opium- If produced by other Diseases, cure those Diseases- If it proceed from habitual determination of Acrid humours, divert them by Seton or Issue-These however should never be tried, tell all the other Remedies above mentioned have failed-a Mr Hawkins was Supercargo of a Ship in the African Trade-on his return from the African Coast, a disorder raged on board which he thus describes "It was an Inflammatory Fever attended with Symptoms of Dysentery, in some but mostly with a violent Inflammation & 263) Swelling in the Eyes & Eyelids, with a discharge of fœtid Rheum-The Slaves were almost uniformly afflicted with this Disorder in the Eyes, even more than had seized with Dysentery- He himself was attacked & his Eyes swelled to such a degree that he could scarcely open them, he however gradually recovered-Whilst in a Convalescent state a Ship have in sight-The Crew were divided as to the colours which she carried- He took the telescope to satisfy himself and in so doing strained his Eyes, so that the Inflammn. returned, a Relapse took place & he never said more See Hawkins' Voyage P. 175- Odontalgic State of Fever- The Teeth are furnished with Arteries, and these are principally affected in all Inflammations- The same Causes generally induce Odontalgia, which induce other Inflammations-It is most common in Countries, which from the alternate Changes of Heat & Cold are most subject to Inflammatory Diseases-E.G. Norway & Russia & the West Indies are free from this Disease-with the Exception of St. Kitts, where alone the Inhabitants drink very cold Water, and where the Alternate Action of Hot & Cold Liquids brings it on- 264) It often occurs in sound Teeth for the first time- The first decay is generally perceived after a fit of the Toothach- after decay has once begun, the adjoining Teeth are affected by the Corrosive Matter which issues from the Carious Teeth- A slow Inflammation sometimes takes place which rots the Teeth without pain- It occurs chiefly in the Inflammatory periods of human life, for even decayed Teeth and all the Remote and exciting Causes of Inflammation seldom produce the Toothach in people beyond 36 or 40- Inflammatory Toothach comes on with Symptoms of general fever, continues for 3 or 4 days and ends in a swelling or Suppuration-Sometimes it extends to the Tonsils or Parotid Glands, sometimes it terminates in Abscess between the Tooth and Gum-Sometimes affects a sound [cross out] tooth remote from the affected one, frequently the corresponding one on the opposite side- Remedies-The common one is Extraction, but this is painful and even dangerous in a highly Inflammatory State- Bleed the Gum-or if the Disease be general bleed generally-Gentle Purges-Blister behind the Ear- After Depletion, Opium-also drawing applications to the Gum-a Fig roasted & opened is excellent in this Case-Poultices of Flour and Ginger to the Face-Hot Rags & Raw Spirits to excite external Inflammation- 265) When a Gum Boil appears & caries comes on extract-The usual application of Lead &c are not so good- Sometimes an Habitual swelling of the Jaw brings on an Abscess, which sometimes proves dangerous-this is produced by neglecting to extract the decayed Tooth-In the Upper Jaw it produces an Abscess in the Antrum Maxillare- In transplanting a Tooth use as old & dry one- Artificial Teeth do not unite with the Vessels but adhere to the Jaw Bone, as a Nail does in Wood-Dr. Spence once inserted a Wooden Tooth in a Dog's Jaw in a perfectly effectual hammer. Preventatives-Sleep in a Warm Light Cap- Remove Tartar from the Roots, wash your Mouth with cold water at rising & going to Bed- Avoid hot or cold liquors, suddenly applied- Brush or wash the Teeth after eating, & especially before going to Bed- There is a Chronic Rheumatism, wch sometimes affects the Jaw of persons who have sound Teeth, Remedy is Opium Plaster to the face, combined with Pepper, Ginger, Wax, Rosin and Oil- Otalgic State of Fever This Disease most commonly affects Children- Remedies-Bleed, Purge &c Blister behind the Ear-Vapour of Sugar sprinkled on hot Coals 266) received through a Funnel into the Ear is highly valuable-If it tend to suppuration use Emollient Cataplasms-Boiled Onions are commonly used-After the Abscess breaks, detergent Injections are proper- This abscess and the Deafness which follows, might, I believe, be always prevented by Bleeding- Apthous State of Fever This is a general, not a local Disease-it is very frequent & very fatal in the W. Indies- Treatment-The Throat must be kept clean by Gargles &c It sometimes accompanies Pleurisy- It has sometimes been mistaken for a Mercurial Sore Mouth-When it occurs in Children, which is frequently does, you should use Borax, Bole Armonia-Wash the Mouth frequently with Gargles of Honey & water &c Gentle opening Physic, Magnesia &c- I shall conclude this division of febrile Diseases with some general Remarks on Inflammations- Inflammations are of 2 kinds, Phlegmon & Erythema- when Phlegmon brings the whole System into Sympathy, bleed, purge &c Local applications are Cold Water, Lead Water, Oil & Emollient Poultices-Emollient Cataplams 267) Flax Seed, bruised & softened & Oil-Oil must be added after the Poultice is made, not boiled with it- Lye Poultice, composed of half a pint of Beer, a Gill of Lye [cross out] and as much Bread as will make a Poultice-Oil over it-This disposes the Phlegmon to Absorption very frequently- Tonics, if the whole System be freed from Inflammatory Action-In Gangrene of the Toes of old People Bark is efficacious, Opium must also be used- Paronychia-at its first appearance may be cured by dipping the Finger into boiling Vinegar, and scalding it, this if used early is a certain preventative-Afterwards it may be cured by a deep incision to the Periosteum- Anthrax-I have nothing new to offer on this subject- Burns-when violent often produce general fever if the whole System be affected, bleed, purge, and prescribe low Diet-Externally Cold Water Preparations & Poultices of Lead; Cold Poultices, Vinegar & water-and after the Inflammation has subsided Strammonium Ointment- Brown the Printer and his Maid had both Paraphonia, probably from having injured the Lungs by inhaling Flame- 268) Hepatic State of Fever This is always Symptomatic, when not caused by Calculi or immediate injury to the Liver I have seen a pain in the lower Limbs attend this state of fever and an inability to sneeze, altho' the strongest sternutatories were applied There is often a pain upon pressing the Region of the Liver- It is Acute & Chronic-I conceive this to be a misplaced Bilious Fever, from the similarity of the Remote & Exciting Causes of both, from both affecting the Liver-from both originating from Marsh Miasmata & appearing as the same time- also from its Symptoms & method of cure-It's Symptoms are Chills, a fever of the intermitting or remitting kind-a repugnance to Wine and Bark-It's Cure consists in Depletion Blood letting must be copious & performed in the early stage as the Disorder runs on so rapidly to Suppuration-I once took ℥150 of Blood at 15 Bleedings from a female Patient in this Complaint, yet I could not prevent suppuration, altho' I was fortunate enough to save my Patient and she is now living- Mercury in large quantities, and as expeditiously as possible to excite a Salivation-It's supposed 269) specific Action in this Disease is a mistake- It acts in this as in other dangerous Diseases be exciting another & a safer Action- Inflammation of the Liver generally terminates in Suppuration, sometimes in Schirrus, but seldom or never in general Gangrene- It sometimes terminates in the Absorption of the Liver as was the case in the Celebrated Sir Wm. Jones- The Suppuration terminates either (1) into the Duodenum, for which purpose an Emetic has been advantageously administered at (2) Externally-here it ought to be opened, not suffered to break of itself for fear of a fatal issue- In a Case of Hepatitis, where it seemed likely to end in internal Suppuration, I administered Tart-Emetic gr iij, Calomel gr xx to accelerate it's bursting & sent down one of my Pupils to watch the Event, and to give frequent small Doses of Laudanum, in order to check its too sudden discharge and support the System under it-the Event was favorable Hepatitis is sometimes a suffocated State of Yellow Fever- Same Remarks on Yellow Fever It is indigenous, and only a high Grade of [cross out] Bilious Fever The Yellow skin, Deprest Pulse, & Cool Skin, which appear on the third day where Depletion has not been used are prevented by Bleeding- 270) These appearances have been mistaken for a Remission, but the Remission is deceitful-The Fever at this Period leaves the Blood Vessels, and turns in upon the Stomach and Bowels and either carries off the Patient at once or produces Effusion- Some particulars of the Yellow Fever of 1798- A young Man in German-town broke his Leg- the irritation of his Leg produced a true yellow Fever, altho' he was not exposed by Contagion or otherwise to the sources of importation- Cleghorn remarks that the breaking of a Leg or any other important accident always induced the Bilious Fever in Minorca- The Tongue in 1793 & 1797 exhibited Signs of the Morbid Action, but in 1798, in many of the worst Cases & each after the black Vomit, it remained unattended No instance of recovery occurred after ye genuine black Vomit- A Boy in the Hospital under Dr. Physic bade pair to prove an Exception to this remark, for he seemed to mend, & survived the vomit for 9 days, on the 10th he expired- In a Journey Man Taylor the Contagion affected his Brain, and he attempted (as sometimes occurs in Hydrophobia) to bite his Attendant- The Cynanche Trachealis, violent as it is, yielded to the power of the reigning Epidemic- 271) A Child who was seized with Cynanche became quite yellow towards the close of it- Persons of all Ages & Colours were subject to the Disease, but it was less fatal to Negroes- I think I was too much disposed to admit Contagion in 1793. It seems merely an accidental property of Yellow Fever, & I believe only acts when fatigue, watching &c predispose to it-some instances seem to skew that cloaths propagate it more readily than the Breath of Excretions- The Attacks of the Disease were equally insidious with those of former Years-I had a Case where it appeared in the form of a mild Quotidian-the particulars are as follow- Returning from Kensington one morning I was requested by a Man to walk into his House and look at his Son, who, he was afraid, had a little touch of the Yellow Fever-I went in & said a Young Man standing by the Window & having himself The Young Man addressed me with a Smile, saying, I suppose, Doctor, you are surprized to be called in to a Case of Yellow Fever like this, but my Fathers is frightened, I have only an Intermittent- Upon Enquiry I found that he has a daily Paroxysm about Noon, but by no means excessive in violence- his Pulse had but little Action in it, & his System in general very little affected-I told him that 272) he had better take a Cathartic which he promised to do-I then left him-the next morning as I passed, he was standing at the door-I asked him whether he had been attacked after I left him, he said yes, but the attack was very slight, so much so that he believed he should have no more of it-I asked if he had taken the Medicine- he said no, for he found himself so well that he thought it hardly worth while-I advised him to take it, but his manner seemed to shew that he thought the Advice unnecessary-That same day about the usual hour he felt the Symptoms of the Attack as usual & said he would go & lie down; requesting the family not to call him to dinner as he should endeavour to sleep- In consequence of this he was not called till Tea-time, when he was found dead, without any Marks of Struggle or Convulsion- There was sometimes an interval of four or five days between the Causes & the Attack of the Disease- Death took place attended with the following circumstances-Convulsions, Incessant Vomiting, extreme pain, or entire want of it & easy sleep, (as was the Case with Mr. Hill, the Symptoms of whose attack were all along so moderate, that he could not be persuaded that he had anything more serious than a severe Cold) Hiccup, Delirium, 273) The Mind seemed often rendered perfectly torpid, & hence Death was met with the greatest indifference and insensibility- In Dissections the Stomach always appeared inflamed, the the Brain often, and sometimes water effused in one of the Ventricles-The Liver not so much as it was here in 1793 & in [cross out] 1798 at Boston- The Stomach exhibited the most violent marks of Inflammation, where no Vomiting had previously occurred-There are many Species of Black Vomit, e.g. Black Bile & Black Blood, but the fatal one is proved by Dr. Physic to be a morbid secretion from the Stomach and never appears 'till Death has taken place in some part of that Viscus- All great Changes in the Weather increased the Mortality of the Disease- Moist Weather favoured the Spread of the Contagion- thus Dogs hunt best in moist weather, and the Morning or Evening Dews render Miasmata more Active- Remedies- The Pulse was less active than on former occasions- but seldom so feeble as to forbid Bleeding-some open Cases bore as much as ever-Dr. Mease lost ℥162, & Warren more that ℥200-where the Vessels were prostrated below the point of Reaction, 274) and we did not bleed, Hæmorrhagies often took place from the Gums on the 3d, 4th day-In 1793 these were generally unfavorable but not so in 1798, when previous Depletion had been borne- Emetics were sometimes substituted in dubious Cases with advantage, when the Pulse seemed languid, where they were administered Mercury acted more readily-but such was the Torpor in some Cases that in one Instance grx & in another gr xxx of Tartar-Emetic were administered without the least effect- Salivation was the most effectual Remedy- I lost no one whose Salivary Glands were affected- It was in many Cases very difficult to excite it- Laudanum was often serviceable in promoting it, and restraining the Purgative Effects of Mercury- Copious Sweats succeeded in many instances, they were excited by wrapping the Patient in Blankets, and applying hot Bricks with Vinegar poured on them to various parts of the Body, continued for 6 hours at a time, & repeated four or five days. Blisters were less successful than in the Yellow Fevers of former Years-A Julep of Salt of Tartar, and Laudanum, or Milk & Lime Water were useful in restraining the troublesome vomiting which sometimes occurred- The Usual Purges were exhibited- Dr. Stewart tied Ligatures round the Limbs to prevent the troublesome pulsation in the Head &c- 275) A dry hoarse and Sore throat was always fatal in 1798, but not so in 1793 An Appetite for food, occurring about the fifth day without diminution of the fever, was unfavorable A dry Tongue was always fatal, not so in 1793, or in common fever- The Suspension of Modesty was unfavorable- A species of Derangement about returning to friends was unfavorable-Many Patients at the Hospital insisted that they were well [crossed out] & would go to their friends, and some expired in the Act of putting on their Cloaths- Scrophulous State of Fever Scrophula has been supposed to be a specific Disease of the Glands, but it soon brings the whole System into Sympathy-Hence in this as in other Diseases, attend to the Pulse- It affects the Viscera in the same manner as other febrile Diseases- The Blood drawn in this Disease generally exhibits marks of Inflammation, beyond what is called sizy Blood- If the Pulse be full & tense, and the Tumours red and painful, bleed, purge & prescribe low Diet- In the Atonic State give Stimuli-Salt Water, Sea bathing, Bandages to the Limbs affected- 276) Vary your Remedies frequently, according to the varying state of the System, whether Tonic or Atonic- Spasmodic State of Fever The following is the Scale of Affections of this Class, (1) Tremors, (2) Convulsions (3) Spasms-The last are divided into Clonic & Tonic-In the first Contraction is alternated with relaxation, and in the last Contraction is permanent- I conclude Hooping Cough & Tetanus under this Class of Diseases- Singularly good Effects are often experienced from exposing a Child in the Convulsions, sometimes excited by Small Pox, to a stream of Cold air- Similar Benefits may also be devised from the same treatment in Hooping Cough, also by carrying the Patient into a Cold Room, or in an open Carriage. I once included Hydrophobia under this head, but am rather inclined now to class it among the Malignant States of fever- For Remarks on Hydrophobia Ice Vol. 5- Tetanus-The predisposing Cause of this Disease is Debility direct or indirect- It's Exciting Causes are wounds of all kinds, and even Amputations-more common after Gun Shot Wounds than any other- 277) Where a natural degree of Inflammation takes place in a Wound Tetanus need seldom be apprehended-It's period is from one day to six weeks after a Wound- The Trismus Nascentium which seems a Disease of this Class is supposed to be sometimes excited by Retention of the Meconium, or from an injury done by cutting the Umbilical Cord- Other Causes [crossed out] of Tetanus are cold after the Body has been much debilitated by Heat, and exposure to a Current of Air during Sleep- The Crick in the Neck, as it is called, may be classed perhaps as a very feeble degree of Tetanus It has also been induced by Parturition- Remedies. When the Action is moderate, Opium- If the Wound be healed, dilate & inflame it-V.S. plentifully-I believe that this alone wd cure, if used to sufficient extent-Cold to the greatest extent, as wrapping the Patient in wet Cloths &c and dashing Cold Water upon them-This Remedy succeeded the other day in the Case of a Girl in N. Jersey-It was on the 3d day of her Disease and every other Remedy seemed ineffectual- It was plentifully-her Jaw instantly relaxed- she fainted from the Shock, but was soon recovered by Cordials & had no return of [crossed out] the Disease- 278) Vomits-these act by abstracting Morbid excitement from the Muscles, and inviting it to the Stomach and Bowels- Purges-Salivation-Also Oil of Amber, which is particularly good in Tetanus and Spasmodic Diseases in general- After Morbid Action is reduced, stimulate with Opium, Wine and Spirits to a great extent- A Quack in New England has gained much Reputation for treating this Disease successfully. This Method of Cure is to make his Patients drunk with Brandy Toddy, or Raw Spirits * Spasmodic Diseases are more common in England than in America-The Diseases of the first Stages of Civilization are mostly Arterial-in a more advanced stage they mixed, viz, Arterial & Nervous- in the most advanced Stage they are Nervous alone- The Diseases of which I am now about to treat may be called Nervous Diseases, as they principally affect the Nervous System including the Muscles- altho' the Arterial System is frequently, I may say generally brought by them into Sympathy, when they require the treatment of febrile Diseases- Catalepsy is one of the first of these, and approaches in its nature to Apoplexy-It is cured by the same Remedies, only of inferior strength- *If Intoxication be adviseable, might not Camphor be advantageously employed as it is easy to produce it by this Medicine! J.E.S. 279) Convulsions in the beginning of a Fever are not dangerous, but highly so in the end of it- Convulsions of Children may be generally prevented by Stimuli-When they occur in pregnant women they are frequently fatal-but I believe mostly for want of plentiful Bleeding, to the extent of ℥100 may be occasionally necessary- In a Case of violent Convulsive Hysteria in a Lady subject to fits I drew ℥xc of blood in one night- a Year has now elapsed since that period, and she is better than she over was before-In Chorea Sancti Viti bleed in the beginning of the Disease. Oil of Amber is valuable in it-Cold Air and gentle Exercise are also proper- Cramp. very often affects Women about a Month before their Confinement from Plethora- Tie a ligature round the Thigh just above the Knee going to bed, a Garter will do-Rise out of Bed, or press the Foot against a board-Squeeze a Role of Sulphur-Frictions-Hickup. which is sometimes Idiopathic-often Symptomatic from over distention of the Stomach-Stimulating or Sedative Passions will cure it-Hence the Effects of Fear-Also Ginger-holding the Breath, drinking a long Draught slowly-Opium, when of long continuance, and Oil of Amber- 280) Hooping Cough. Read Cullen for it's History- Where great Morbid Action takes place in the Lungs, begin the Cure by Bleeding-Vomit with Squills or Ipecacuanha repeated every day while the Disease continues-Fear will sometimes suspend the Paroxysms-When I was a Boy there was a Man in this City who kept a Boat, it was customary to take Children, who had the Hooping Cough, to ride the Boat, with this indication. Amongst others I was taken, I remember I was terribly frightened & am told I was cured- When the Atonic Stage comes on, give Moderate Doses of Opium, Oil of Amber, Garlic, Tincture of Asafœtida, external applications, rubbing the Spine with Garlic and Spirit-Cold Air- Change of Air in this Disease is particularly important-it's ordinary period of Continuance is six weeks, varied only by its mildness or obstinacy Dr. Cullen supposes that the Disease is often continued from Habit- Hysterical & Hypochondriacal States of Fever I have already treated of the higher degrees of Hypochondriasis under the Head of Mania-When Patients in fever are seized with an uncommon dread of the Disease, false opinions of it's nature &c 281) we should suspect a tendency to it and obviate is by proper Remedies- Hysteria affects Women more than Men-it seldom affects them before the Age of Puberty-however there are exceptions-Single Women, Barren Women and Widows are most subject to it-It is more common in our City in the Kitchen than in the Parlour from the excessive use of strong Tea in the former- It's Exciting Causes are, sudden surprize, heated and impure Air & fatigue- Hysteria is distinguished from Hypochondriasis (1) by facility of Motion (2) Instability and versatility of Mind, in Hypo. it is always deprest (3) In the Absence of Dyspepsia, which almost a constant attendant on Hypochondriasis (4) From the greater degree of Morbid Action, whence the Hysterical Patient is worse in Summer, better in Winter-The Hypochonoriac, the Reverse- (5) The Globus Hystericus which does not occur in Hypochondriasis, a Swelling of the Legs also occurs, but it does not fit as in Dropsy-it is worst in the Morning- Hysteria is to Hypochondriasis as Synocha to Typhus- 282) Cure- The Remedies of Fever in general should here be used, attending minutely to the Pulse-Bleed where Plethoric-Cold Bath after the Plethora has been reduced-When necessary, give those remedies which are supposed to act specifically on the Nervous System, e.g. stimulating Gums, as Asafœtida, Galbanum Plaster to the Bowels- Bandages applied to every part of the Body- Accommodate the Diet to the System-When Plethoric stimulating Aliment as Salt Meat may sometimes be allowed, but not Nutritious- Exercise particularly on Horseback-The occupation of Gardening for Women, also domestic Occupations- Excitement of some steady stimulating Passion- Cold Air-Matrimony & the Cares of a Family- the larger the better-In a fit treat as follows- If excess of Action, bleed gently, opening Clysters, if Costiveness attend-Opium, if the Pains, Spasms &c be from deficient action-Pediluvium-Stimulating applications to the Nose as Sal. Volat- Snuff and burnt Feathers-Garlic & Mustard to the Foot- Relieve flatus in the Bowels by inserting a Clyster Pipe into the Anus and letting it remain there-An Inverted state of the Peristaltic 283) motions sometimes draws in the Clyster Pipe, or snaps it off, this should be guarded against Cutaneous State of Fever- As the Intestinal State of Fever has been called a Febris Introversa, this state of fever may perhaps with equal propriety be called Febris Extroversa- Hence the frequency of the occurrence of Eruptions during the prevalence of Epidemics-The Children of Philadelphia are often troubled with small Boils during the prevalence of Colera Infantum & such Children escape the Epidemic-In the West Indies persons violently affected with the Prickly Heat escape the Yellow Fever- Leprosy in probably a misplaced Bilious fever- The Remedies administered should be as forcible as for the original Disease, when in the Blood Vessels. Tar in large Doses has been lately used with much success in this Disease by a Physician in Barbadoes. I suspect that the Radical Cure for this Disease will be found in the Lancet-I have seen Petechiæ in the Yellow Fever disappear in half an hour after Bleeding- The frequent use of the Lancet may be highly beneficial as an Alterative Remedy- Scurvy appears to arise from human Miasmata and seems a misplaced Gaol Fever- 284) The Arrangement of the Lectures here is wrong, it should be as follows- I Diseases of the Alimentary Canal, including the Stomach. (1) Dyspepsia-Page 285 (2) Colic-298. (3) Diarrhœa-300 (4) Blind Piles-301 (5) Costiveness-302- II Diseases of the Nervous System- Introduction P. 278 & 279- (1) Catalepsy-P.278- This seems an inferior degree of Apoplexy, requires the same Remedies, but of inferior force- (2) Wakefulness-often proceeds from morbid excitement in the Brain-it should always be attended to, being often a precursor of Mania- See Page 249 (3) Low Spirits. Treat according to the System- The Pulse is often active or opprest & requires the Lancet but more generally stimulus- (4) Tetanus-p.276-(5) Epilepsy-p. [crossed out] 291 (6) Hysteria. p.280-(7) Chorea St. Viti 129. often produced by worms-bleed in its first stage-purge with Calomel, then Tonics, P. Chalybis &c- (8) Cramp-p. 279-(9) Asthma-p. 304. (10) Dyspnœa, & (11) Angina Pectoris-This particularly affects the Patient going up Stairs, or up a hill, but 285) does not prevent his walking on level ground it has hitherto been considered as incurable & Idiopathic-I consider it as general, and by accommodating my practice to the state of the System, uniformly succeed-V.S. first, Then Tonics, particularly white Vitriol. Pills of 2grs each go to page 314. Dyspepsia. It is often only Symptomatic of other Diseases- it is induced by Causes acting directly upon the Stomach, or indirectly upon the whole System- Causes are Strong Tea, Coffee, Bitters, Aromatics, Opium, Acid Aliments, Tobacco, & Ardent Spirits- Frequent Repletion with gross food, also with watery liquids, hot or Cold, frequent Vomiting, & I have seen a Case where frequent Doses of Nitre taken for Phthisis had produced it- The Practice of taking a large Draught of Cold Water early in the Morning and at going to Bed, has I believe often produced it-In the morning it takes away the Appetite, and at either time debilitates the Stomach- Other Causes are Smoking and its consequent rejection of Saliva-swallowing too fast without sufficient Mastication-Inmoderate use of Sugar 286) of this I knew an instance in a Grocer in this City, produced by his tasting in the way of trade so many kinds of Sugar-Eating too fast-Excess in Eating-These Causes act directly- The more general ones, which act indirectly are Excess in Venery-Indolent Life-Vexation, Frequent Intoxication-A Moist & Cold Atmosphere- Excessive Study-Sailing & Pregnancy It's proximate Cause is Morbid Action in the Stomach, invited thither by predisposing Debility- There exists a most intimate Connection between the Stomach and the rest of the Body, and much depends upon its fulness or emptiness- Ask favours, & make an offer to a Young Lady after dinner. Excessive use of Acid Aliments & little Animal food, disproportioned to the labour performed are also Causes of Dyspepsia, & particularly Drams in the Morning. A Burning in the Hands, and Soles of the feet with sickness & vomiting in the morning, afford a presumption [crossed out] that the Patient is addicted to the use of strong Liquors- Palliative Remedies are, Magnesia Alba, Lime Water, Alkaline Salts, Volatile & fixed-Common salt in Water or with the Addition of a little lime Juice- To remove Heart burn give two or three Spoonfuls of Milk, wch often compose it instantly 287) Opium, without the use of which it sometimes happens that the Patient can neither digest nor retain his food, it may be given in Peppermint Water-Laxative Medicines, particularly Aloetic Pills- Radical Remedies-Avoid all the exciting Causes above mentioned-Be careful how you use Vomits, as Zinc Vitriol, or Ipecacuanha-Use Tonics as Zinc-Vitriol-Bitters as Camomile infused for twenty four hours only & other bitters- Nutmegs and other Spices infused in Water above a Clove swallowed occasionally- Black Pepper infused in Spirits, a Grain of Pepper swallowed whole-Garlic-Horse Radish, Gentian, Centaury, Columbo Root, Quassia Bark-Peruvian Bark I think always does harm-Elix. Vitriol- Sal. Martis in Piles-Bleeding in violent Spasms sometimes relieves them instantly-Rubigo Ferri ℈i to ℥i & gr of Columbo Root are a proper Dose every morning and evening for Months-I think the Rubigo is preferable to Sal. Martis- Accommodate the Diet of your Patient to his Complaint with regard to Quantity, Quality, Time and Manner-Beef, Mutton Venison, Wild Fowl, Raw Oysters, & Salted Meat are the proper Aliments- The Meats should be thoroughly done & kept 'till tender-they are gently Stimulating & preferable to young Meats as Veal, Lamb &c Salt Meat acts by it's stimulus, it is not so soon digested- 289) Eat Toasted Bread-Avoid both Tea & Coffee- Solid Aliment alone is proper-If the Stomach be so irritable as to reject all this, let the Patient lie in Bed- Eat little and often-use as little Drink as possible, The Smell of food is often unpleasant to persons with weak Stomachs hence they should not sit at a Table plentifully served-unexpected Dishes shd. be set before them, & small Quantities, ℥ss for instance should be sent up to their Rooms-I was once told by a Jockey that he could fatten a Horse in much less time by frequently giving him food in small quantities, than by giving him a full Manger at once- Each kind of food should be taken alone-Fish and Flesh should not be eaten together- Breakfast should be taken in Bed by breeding Women, or by any person subject to sickness at first rising- Sea Sickness might perhaps be obviated to a considerable extent by the same Rule-Lying in Bed is in all Cases of Debility highly important Where Animal Food cannot be endured, I have known Turnips to be valuable, or a Table Spoonful of Milk every hour-Potatoes seem to be better than any other Vegetable- Butter is wholesome from its stimulating and Nutritious Quality- The Stomach in this Disorder should never be 290) quite empty, for it is like an idle School Boy, when it is doing nothing, it is doing mischief- Dyspeptic Patients should when upon a Journey take Biscuit and Ham cut up together, and if they wake in the night, which they often do from the debility of their Stomachs-Food should be placed near them, that they may eat a little during the night- The Drinks should be Madeira & Sherry Wines Porter &c Porter is best-If these should turn sour a little Brandy & Water may be allowed but with great caution-Spirits if they have been the Cause of the Disease must be entirely left off - Touch not, Taste not, Handle not-Strong Bitters may be used for a time as a Substitute, also Wine and Beer- Infuse Jalap, Tart. Emetic &c in Spirits & give your Patient to drink, making use of the Law of Association Thus Moses made the Israelites drink the Golden Calf dissolved by Hepar Sulphuris, which is one of the most disagreeable Mixtures imaginable & by association would disgust them with Idolatry- I have heard of great benefit being derived from taking a Glass of Salt & Water a little warm, for some days, before getting out of Bed- There is a Headach depending upon Dyspepsia, called a Sick Headach, cured (1) By a Vomit, (2) By 291) Madeira Wine (3) By Opium- Dyspepsia from Sea Sickness may be removed by Laxatives, by always having Aliment in ye Stomach, by Cold bathing, by Opium, by lying with the Head below the Heels, by eating before rising- Pyrosis is often a Symptom of Dyspepsia, but it is sometimes a primary Disease-It is known by Heat in the Stomach accompanied with throwing off a little limpid water-It occurs chiefly from excess of Vegetable Aliment-Opium has been often of service in this Disease-It is an unfrequent Disease in this Country-I have cured it by Bitters & the use of Animal Food- Epilepsy I have thought much on this Subject, but I am sorry to say, that as yet I know very little about it- It's Remote Causes are sometimes local, and sometimes general-Those of the first kind are fratures, Mal Conformation, or Effusion of Water, Blood & Pus in the Brain-Those of the second kind are such as act upon the whole System viz. great bodily Exercise, great Mental Exertions- Extravagant Passions, particularly Anger & Fear, intemperate Eating and drinking, excessive indulgence of the Venereal Appetite-Retention of several of the Excretions, Repelled Eruptions, Sleeping in the Open Air- 292) All these Remote Causes act by inducing direct or indirect Debility, accompanied with such a degree of morbid excitability as renders the System liable to Convulsion, from the slightest exciting Cause- It is perhaps a higher grade of Hysteria, affecting the Muscles, Brain and Blood Vessels- For a Theory of it's occurrence See Page 115. Ancedote of the Soldier who had deserted-To this I will add another, which shews the strong influence of Association-A Lady in this City, who was pregnant was seized with a violent fit of Sickness and vomiting whilst trying on a new Gown- A similar Affection uniformly occurred till the time of her Recovery, upon seeing either the Gown or the Mantua Maker- Perhaps Dreams excite the fits not unfrequently, hence their occurrence in the Night- Premonitory Symptoms of a Fit of Epilepsy, Bitter taste in the Mouth 2 or 3 days before the fit, Pulse tense of preternaturally slow-Enlarged Pupil, Tumors & false vision & Dr. Cullen relates a Case of Headach, pain in the right Eye, with Inflammation of the Tunica Adnata, also a particular smell in the Breath-A Gentleman in this City whose wife is afflicted with Epilepsy, can always predict the approach of it from this Circumstance 293) where the bitter Taste exists give a Vomit, purge, bleed, or give Opium according to Circumstances, a peculiar smell in the Breath preceded it in a Patient of mine, & by Sulphur I frequently prevented it- Accidental Cures have been effected by the change of the System which takes place at puberty, by Pregnancy & Puberty-By a Change of Climate-By Age-Few Instances of Epilepsy continuing after 50, when it has been a Disease of middle life-It then frequently goes off in the form of fainting fits-It has also been cured by strengthening & nourishing Aliment, after the excitability has been accumulated by previous inanition, or scanty Aliment-hence we infer that Tonics may be useful, especially after Depletion In plethoric Cases, especially in Young & vigorous habits begin the Cure by Bleeding, then give a Milk and Vegetable Diet, to which a little Salt Meat or Salt Fish may be added as an indulgence, and Purges-After thus depleting, give astringent Vegetable & Metallic Tonics, Chalybeates, Zinc, White and blue Vitriols, Opium & Strammonum, the powdered Leaf made into Pills, also the Magistery of Bismuth made into Pills- An opium Pill administered every night has often prevented the Accession of [cross out] a fib. The Fits generally attack the Patient in the Night- 294) Prescribe Issues & Setons, particularly when the Disease has been caused by Wounds or by sores suddenly dried up- Actual Cautery applied along the Coronary & Sagittal Sutures-Ligature round the Limb to prevent the Ascension of the Epileptic Aura to the Brain, altho' it sometimes descends from thence Clysters of Tobacco- Stimulate the lower Extremities, this might be as serviceable here as in Mania- Uniformity of Impression, from Diet, Clothing &c never suffering the Stomach to be empty, & eating and drinking by weight might perhaps be advantageous- Journies-Fear-This Passion prevented the return of it for many weeks in a Girl in the Edinburgh Infirmary who was threatened with some dreadful Surgical operation in her next fit-She had previously has one every day- Change of Climate, hard Labour & a military Life, the latter cured this Disease in Julius Cæsar- Salivation has performed the only Radical Cures in my Practice, except that I once succeeded with Zinc-I have often suspended the fits by this latter Remedy- Bleed before administering the Mercury, for the purpose of a Salivation-I am sorry to say 295) that I have found it very difficult to excite a Salivation in Epileptic Patients & sometimes impossible and out of seven Cases, where I did produce it, I failed in the cure of three, In the other four I succeeded- Lastly, Epilepsy is to be cured, by avoiding all its remote and exciting Causes-Worms and Calculi must be dislodged from the Body- Where a fit is very violent, bleed- Syncope There is no Danger in the Convulsion which sometimes succeeds Syncope from Bleeding, hence do not fear it- Causes of Syncope are general, local, partial- when from local Causes as Aneurism, Polypus &c it is generally incurable- Excessive Pain, or sudden Cessation of Excessive Pain- Heat, Cold Water taken, when the Body is very warm, Disagreeable Odours &c are causes of it- Cure-Place the Patient in a Recumbent posture, Stimulate the Nostrils, & above all apply fresh Air- Dash Cold Water on them-If these fail, Clysters, stimulating Cataplasms & Blisters- In Syncope from drinking Cold Water, when the Body is heated, frictions & Liquid Laudanum, as soon as the Patient can swallow-if from excessive Heat, apply the Warm Bath, or plunge the feet into very hot Water-Prevent 296) it's return by gentle Exercise, great resolution & moderately stimulating Aliment- Syncope sometimes comes on from fears, Terrors- these should be obviated-There is no Antipathy that may not be overcome, witness the Case of Peter the Great-who in early life always fainted at the sight of a Brook, if he were obliged to cross it- Asphyxia This is a higher Grade of Syncope- It sometimes continues for a long period-Days or even a week, and is called a Trance-In this State Motions of the Brain take place, hence they dream, & often tell their Dreams as Revelations- It's Causes are Violent Emotions, sudden Impressions, from improper Aliments in Sickness, from Passion &c Certain degrees of Cold e.g Torpid Animals, and Contagions as was observed by Dr Huck at the Havanna in 1762-He found a Man in the Hold of a Ship, whom he thought to be actually dead- He revived by being rowed ashore to be buried, with a fresh breeze blowing on his Face- Lastly Carbonic Acid Gas, drowning, hanging- Cure-must be varied according to its various Causes-if from Cold, very moderate degrees of Relative Heat, as Cold Water-If from Contagion, fresh Air, Frictions-If from Carbonic Acid 297) inflating the Lungs with pure Air, and exposure to cold applications-If from drowning, inflate the Lungs-Avoid Bleeding, Vomiting or purging, for they are all improper-Recal the Heat of the Body, by gentle heat, gentle frictions, tepid Bath, Injections of tepid Water and Tobacco Smoke- If from hanging similar plans must be pursued- When Persons have died of a Fever, or died suddenly, they should not be buried too soon, or even laid out too soon-The Reason for the former advice will be sufficiently apparent as many persons after lying apparently dead for a long time have recovered-my Reasons for recommending the latter is that it is probable that hearing Continues after the apparent extinction of life, as I have known more than one instance-where the first burst of Grief at the supposed departure of a friend, has excited evident Marks of Consciousness in the dying person, tho' Death really followed- A Person lately died in this City at 80 years of Age, who was laid out as dead of the Yellow Fever in the West Indies when a young Man, he heard the Bystanders talk of this Interment, but could not move or give any signs of Existence-He requested to be kept 'till certain signs of Death should appear- There was a German in this City who was a long time in a Trance-He gave a particular 298) a particular account of his Sensations- he died from below upwards-he heard the Watchman cry Eleven, tho' he was supposed to have died about nine-His Brain retained Life, for his Mind was imprest with Visions- Colic- I have already spoken of the Febrile Colic, which may be known from occurring during the prevalence of febrile Diseases, & from it's affecting the Pulse- I shall now speak of the common Colic- Remote Causes (1) Hysteria, Hypochondriasis & Gout, often affecting the Bowels by Sympathy (2) Diseases of Contiguous parts, as the kidnies & Liver-(3) Certain improper Aliments, as Sour unripe Fruits, Honey, half fermented Drinks, fumes of Lead, & drinking from Leaden Vessels- Swallowing Cherry Stones, Eating fat Meats, as Pork and Veal, likewise Hernia & Costiveness Many of these Remote Causes sometimes become exciting to which we may add Cold, fatigue, strong Tea and Passions of the Mind-In Habits disposed to Colic, a tight Shoe has been known to produce the Disease- Proximate Cause is a Spasm, situated most frequently in the Ileum-Precursors are gentle pain, twinges, flatulency & Cold feet-In it's forming state Laudanum gt xx will often prevent a fit of it-The Pediluvium 299) will produce the same effect- I knew a Case where a Gentleman often obviated a coming fit by riding out on Horseback- Remedies- Where Plethora exists, bleed- Pain or Spasm call as loudly for the Lancet as fever- Morbid Action in this Disease sometimes transcends Inflammation- hence Patients have died of Colic where no Inflammation appeared in their bowels upon Dissection, of which Cases are related by Morgagni- Lenient Purges should be given at first- When the fœces are dislodged and descend to the lower Bowels, administer Glysters- These Clysters should in some instances be composed of Cold Water only, and in large quantities from Lbj to Lbiij- After violent action is subdued Opiates may be given in large Doses- They may be given with caution in the earlier Stages of the Disease- More Active Purges may also be given at this period, as Jalap, Rhubarb, & Calomel, joined with Asafœtida, which Dr. Quier thinks, prevents palsy of the Limbs.- I have sometimes known the Semicupium act as a Charm when large Doses of Opium had failed- Warm, oily and Stimulating applications to the Bowels- Stimulating Clysters as Turpentine and the Smoke of Tobacco- [crossed out] 300) Blisters more particularly to the Thighs- Throwing Cold Water on the Foot-The Influence of Cold feet in causing this Disease, shews the connection between them and the Bowels- A Salivation-This is almost infallible, and should not be too long neglected- A Spanish Physician has lately recommended Sugar of Lead in this Disease-I should be afraid of its disposing to a return of it- Symptoms of Recovery-A Crepitus, Copious flow of Urine, a discharge of Scybala & Worms & great Sensibility of the Skin- Colic sometimes ends in a Palsy of the Limbs- this may be cured by stimulating applications to the Belly-I believe that it seldom takes place where sufficient Depletion has been used- Avoid the Remote & Exciting Causes of this Disease, as Young Meats, Pork and Veal, Also Cyder, strong Tea &c-Avoid all Vegetables but Potatoes, avoid Costiveness by taking Pills of Asafœtida & Aloes- Avoid Cold Feet, tight Ligatures Wear Flannel Use a good deal of Oil-Use Exercise-Eat Garlic and Onions- Diarrhœa. When accompanied by Plethora, as it often is in Plethora, as it often is in pregnancy or when the Arterial yields to the Venous Plethora, bleed, Purges, except Rhubarb are improper, it is less liable to gripe when toasted- 301) Vomits of Ipecacuanha are valuable in this disease Opiates every night-Astringents, as Gum Kino, Alum, Port Wine Tormentil Root-I once knew a most obstinate Diarrhœa, cured by Pills of Rhubarb & Ipecacuanh. āā grij opii gr ss taken three times a day- Stimulating Substances Bitters of all kinds, more effectual when combined with something Aromatic, Bals. Copaiv-& Turpentines- A Wine Glass full of Brandy with several lumps of Loaf Sugar-ꝶ Pulv. Ipecac. ℥i Opii gr ij Rice Jelly Lbss ft Enema- Diluents as Peppermint, Mallow & Camomile teas- Blisters-These often succeed, when almost every thing else fails-they never fail to suspend it's violence-Apply them to the Ancles & wrists- Exercise on Horse back, Warm bath, or in Summer, the Cold one-A Sea Voyage-* For the Febrile Diarrhœa turn back to P. 135 Blind Piles-These should be examined and extirpated-I saw a Case once where this Disease produced Pneumonic Affection- * Salivation according to Dr. Clark is almost infallible in Diarrhea-change the Pump Water used in the Family-examine the working Vessels and drinks of your Patient [crossed out] 302) Costiveness- I consider this Disorder in this place as Idiopathic, not Symptomatic- It's Causes are peculiar Diet or Drinks, as Port Wine, Cheese &c sudden Change from a full to a low diet or the Reverse-Sedentary Life- Exposed or inconvenient situation of Necessaries, which operates with the greatest force with regard to Females- Negligence of the Calls of Nature-Riding on Horseback-Sailing-Certain obstructing Matters as hardened fœces, Fishbones, Nails & Toe- Remedies-Chew Rhubarb, this Is particullarly useful-Early rising-a Regular hour-Build your Necessaries in a private situation and easy of Access-Eat Indian Meal Bread-Examine whether any thing obstructs the Rectum-My friend Dr. Young of Northumberland was once called to a Child, where the obstruction proceeded from Jaw, which the Nurse has been in the Habit of stuffing into it's Mouth to keep it quiet-Use a Warm Close Stool, instead of a Cold necessary or put warm Water into the Close Stool Pan- If Indurated fœces, remove them by a Scoop, gentle Eccopastics- Young or middle-aged people do not bear Costiveness so well as old people- I had once a Case, where obstinate Costiveness & Piles produced a Cough and oppression at the Breast, resembling Phthisis Pulmonalis- 303) Ischuria Causes-(1) Affections of the Kidnies-Inflammation Calculi, Grumous Blood-Spasm-Lying on the Back, and making water in that situation, hence frequent in Gout-Hard Riding-Long Standing-Fœces in the Rectum-Retained Menses-an Imperforate Hymen-Pregnancy-Cantharides &c Remedies-Avoid all the occasional or exciting Causes above mentioned-Avoid retaining the Urine too long-From this Cause the Clergy & particularly [crossed out] Judges are often exposed to this Disease-V.S. Opium-Warm Bath, Clysters, Gentle Laxatives-An onion to the Pelvis or Perinæum-Catheter, Bladder to be filled- Particular Remedies-If from Palsy of the Neck of the Bladder, a Blister to the Perinæum-If from Imperforate Hymen, puncture with a Lancet, if from [crossed out] Pregnancy V.S. & Laxatives- Cancer- Occupies all parts of the Body, but principally Glandular Parts-It is most dangerous in the Neck, Axilla &c when internal, and completely formed they are incurable-They seldom appear before the Age of 45, more frequent in advancing Age - They are more frequent in Cold than in Warm Countries. Cancers are local or general, the latter are said to be derived from Scrophula- Remedies. Some Narcotic Substances abate pain, but I believe produce no other effect-Tonics [crossed out] 304) as Arsenic-Bark, Mercury-I do not know that any of these are of much service, except Arsenic- Just before a Schirrus Ulcerates, Arterial Action exists, & V.S. is useful- Attend to the System as in other Cases-I have heard of Signal Benefit being derived from a Salivation, continued for 2 or 3 Weeks-Dr. Tate has produced wonderful Effects in this Disease by some unknown internal Remedy- External Remedies-Excision-The noli me tangere is to be expelled from your System of Practice- They are easily and safely removed by this Remedy- Caustics-Arsenic, but in large Cancers always excite- Never dismiss a Patient from your Care, without extirpating a Tumour, which may have existed for some time- Schirrus-If External, frictions, Ungt. Hydrang- Vapour of Boiling Hot Vinegar-Mineral Waters- Exercise, Cold Bath-The latter are beneficial in internal Schirrus also- Asthma- This is distinguished from Dyspnœa by it's not being constant and from Pneumony by not being accompanied by Fever or Cough-it frequently depends upon Mal Conformation- Exciting Causes are Heat, & Cold succeeding Heat, certain Passions, odours, Repelled Eruptions, Indigestible Food lodged in the Stomach- [crossed out] 305) I once saw the Asthma produced in a Child, convalescent from the Small Pox, from eating an immoderate quantity of Buckwheat Cakes-It is sometimes a Symptom of Gout, and appears to be in some degree influenced by the Changes of the Moon Premonitory Symptoms are uneasiness in the Breast at night, Drowsiness, flatulency &c after dinner-In the forming State of fit may always be prevented by an Emetic, a little Bleeding, Pediluvium and an Anodyne at Night- When the fit occurs Bleed to ℥vij ℥x or ℥xij, if there be much Arterial Action, & admit Cold Air & Cold Drinks-Vomits-Oxymel of Squills has been particularly recommended, but it is not better than Tartar-Emetic-or Ipecacuanha- Lenient Purges, and when the Action is diminished Laudanum & Lac Ammoniac-Vapour impregnated with Scraped Horse Radish or Warm Water alone- Blisters to the Neck-Pediluvium, Acids as Elix. Vitriol-& Vinegar, Cold Drinks, Blisters to the Wrist. Dr. Cullen observes that this Disease is seldom eradicated from the System-Certain Circumstances have however occasionally produced this effect, as breeding, not breeding, Gout, Change of Climate- High and very pure Air as that on the Tops of Mountains & also Sea Air has often been injurious in this Disease-hence in Stove Rooms, a Bason of Water must be placed on the Stove in order to evaporate- 306) [crossed out] to obviate its return-avoid Plethora-Setons may be very serviceable with this indication- Avoid Indigestible Aliment, fat and full Meals & heavy Suppers-but do not abstain from the last mentioned Meal, where it has been usual- Carefully avoid Cold feet-As Pregnancy has occasionally removed it, recommend Matrimony-Labour, Sleeping on a Mattrass, particularly on the Floor- Recurring to old habits as Snuff taking, may be serviceable, also the habitual use of Garlic-lastly the Cold Bath- The Dry Asthma is a more violent Grade of the Moist Asthma-Dyspnœa differs from Asthma in being perpetual-It often arises from enlarged Viscera, particularly the Liver-from Effusion in the Lungs or Chest, & from Tumours in the Trachea, of which I had a Case in this City-Upon Dissection I found in the Trachea a Tumour about the size of a Small Hiccory nut, which upon being punctured effused a little black fœtid fluid & collapsed-I have since met with a similar instance in Morgagni-Had I known it at the time I might have saved my Patient as the tumour might have been got at-Attend to the Pulse here as in all other Diseases-If full, give Vegetable food, purge & V.S. if necessary-If low, Bark, Wine, Tonics- Cutaneous Eruptions Tinea Capitis-Use Jar Ointment-Ung Citrinum- White Precipitate-In very bad Cases of Tinea Capitis pluck out the Hair- Tetters-Wash with a weak Solution of Corrosive 301) [crossed out] Sublimate, then apply Calomel with or without Flour, and spread it over the Tetter- Ring Worm-is an Animal-Cure, Ink, Gunpowder- Nitric or Sulphuric Acid, diluted so as not to excoriate or inflame- Itch- Ung. Sulphur-to the parts affected only, not all over the Body-Mercurial Ointment with the same caution-Dry Sulphur-I have known it cured by wearing for a Week or Shirt washed in Water, in which Lbss or Lbj of Sulphur had been dissolved- Morbus Pediculosus-Merc. Ointment-Flower of the Larkspur Plant infused in Rum is an immediate Poison- Cleanliness-combing the Head- Deafness- Sometimes arises from Otalgia, from Wax, from Palsy, or Insensibility of the Drum of the Ear, from too violent sounds, from Cherry Stones, Spiders, & other Insects getting into the Ear &c Remedies-If from Inflammation, pursue the Antiphlogistic Regimen-if from Wax, extract by an Instrument, & soften & remove by means of certain Injections-Soap & Water, Milk and Water with a little Honey-persevere for three, six or even twelve months- Nineteen out of Twenty Cases I believe proceed from Wax-Sir John Pringle was of the same opinion-where from Insensibility or Paralysis of the Drum of the Ear, a little Salt has done good-Fine Powder of Spanish Flies has also in such Cases 308) [crossed out] been blown into the Ears but, this I have not tried- There are some Cases of Deafness, where it can only be obviated by stimulating the Ear by certain Sounds as in the Lady mentioned before, who could not hear unless a Drum were beaten- Cephalalgia- is partly as Nervous & partly an Arterial Disease- It is often connected with a certain figure of the Head, and is hence hereditary in certain families A Headach of long duration is seldom without danger of terminating in Palsy, Apoplexy, Amnesia, fatuity, blindness, deafness or death-Such is its usual progress and issue, but I have known two exceptions, in men who lived beyond 80, with the possession of all their faculties, who were afflicted all their lives with it- It's Causes are various (1) Febrile Diseases, or Diseases of the Arterial System-cured by V.S. Purges, Blisters, Cold Vinegar, Cold Water & Ice-If from Typhus, Wine & Opium-Headach appears sometimes instead of an Intermittent-(2) From Gout, The Remedies must be adapted to the State of the System-(3) Rheumatism Acute & Chronic-In the latter apply the Steams of hot Vinegar to the Head & wrap it up in Flannels, covering the Eyes also- (4) From the Struggle between the Arterial and Venous Plethora which takes place between 36 & 40-At this period it gradually comes in 309) [crossed out] Paroxysms, which are [crossed out] excited by Coughing, Laughing, Climbing a pair of Stairs, or stooping for any purpose-The fit goes off in 10 or 15 minutes with Cold sweats, leaving great Languor behind it-Relieved by low diet, gentle Laxatives & occasional V.S.- (5) Blows on the Head at the distance of even ten or 18 Months-this should induce us never to neglect a blow on the Head, and to guard against any ill consequences from it by V.S., & Purging-When blows produce Headach, make deep incisions in the Periosteum, over the most affected part, or it's opposite side-and if the Periosteum be detached from the Bone, the Trephine may be used with advantage-(6) From Morbid affections of the Nervous System e.g. (1st) from Dyspepsia; sometimes from peculiar Aliments as Mince Pies, suetty Puddings &c I believe however that the Stomach is often unjustly accused of being the Cause of Head Ach-We daily see both natural and Artificial Vomiting excited without producing it-I am inclined to think that in many instances the Affection of the Head is the primary Disease, and that of the Stomach secondary analogous to the Effects produced on that Viscus by Contusions of the Head-Decayed Teeth also are sometimes the Cause of long continued & distressing Head Achs- The Sick Head Ach may be prevented by taking Tinct. Opid gtt. x or xv When formed, if violent it often brings the Arterial System into Sympathy and may require Bleeding- [crossed out] 310) (2) From Hysteria & Hypochondriasis, with each of which it sometimes alternates- Obstructed Menses are another Cause of Headach, when these are set right, the Head Ach departs- I have seen it alternate with a difficulty of moving the Hands and Arms, amounting almost but not quite, to a sort of Palsy- Sometimes, it alternates with Mania, at others with tremors and a tendency to Convulsion- It is sometimes produced by Cold feet, or extreme Cold of any kind, and is readily removed by warmth-At other times by Heat, when it yields with equal readiness to cool applications. It is sometimes produced by Study, particularly after a full Meal- A particular State of the Atmosphere, or particular Winds have sometimes produced it-An Electrical State of the Atmosphere sometimes produces it-See Page Mercury lodged in the Diploe of the Brain produces very distressing Cases of it, in the Quicksilver Mines in Spain- An Increase of Appetite is often a premonitory Symptom- Remedies for Cephalalgia. Taken attended with Morbid Action, bleeding, Cupping, Gentle Laxatives-Ice-Æther-where periodical Bark, Blisters, Issues & Setons & Darkness- Resting the Head, not too low, & on a soft Pillow, avoiding loud speaking-Sleeping without a Night Cap-Women should lay aside their Head Cushion-Avoid tight Night Caps & tight Shoes Avoiding Coffee- 311) [crossed out] Emetics afford only a temporary relief and may increase the Disease-The seat of the pain is very various- When attended with weak action, it may be removed by Opium, Wine, Eating, which acts 2 ways, by the Stimulus of Mastication and that of the food itself-Certain stimulating Aliments Warm Night Caps and Wigs, & enveloping the Head in the Steam of Vinegar, poured upon a Hot Brick-Blisters behind the Ears-Sternutatories and Errhines, particularly a return to old Habits, as snuffing & the use of Pepper in Diet-Pedilivium-Coffee, Hyson Tea, Æther, and other Volatile Substances, and where every thing has failed, a Salivation,- Which On account of the unfortunate termination of Cases of long continued Headach should never be neglected- Lues Dr. Sydenham's observation, that it belonged to God alone to punish immorality by this Disease-The Physician's Duty to compassionte & relieve it- In Louvain personal Castigation was administered upon a Patient after admission into the Hospital- in the [crossed out] British Navy a Fine was imposed-both now are, I believe, abolished- It has 2 forms, Gonorrhœa & Lues- Gonorrhœa is subdivided into Benigna & Virulenta, The 1st. Arises from various Causes, as difficult 312) Coition, violence of a new impression after long Abstinence-from Gout, where films are often discharged in the Urine, which when dry have a Chalky appearance also from Dentition in Children The 2d proceeds from impure Coition, from a tainted Bed, from using an infected Necessary, from wearing a pair of Breeches, which had been infected Mouths before-It's times of appearance is various, when Chancre appears, it is generally later- Cure-Demulcent Drinks, Plentiful Diluents, Mild Injections of Gum-Arabic-& Sweet Oil, or ꝶ Calomel ss. ℈j Aq-Font ℥iv ♏︎ Injectio-or ꝶ Hyd. Ung. since Terebinth ℥ij Vitelli Ovi.s Gum. Arabic ℥ij Aq. Tepid ℥iv ♏︎-The Ointment renders this Injection inconvenient in Summer- Swelled Testicle-Vomits, especially of Turpeth- Mineral & Local Venesection- Bubo, endeavour to discuss- Phymosis-Paraphymosis-Milk & water, Lead Water, Cold Water & Taxis- Chordee-Opium-avoid a full Bladder, Sleep in tight Breeches or Drawers- Gleet-Injections of various kinds-I do not use Lead without necessity-J. Hunter thought that Strictures are more frequent than formerly in consequence of the more general use of Lead Injections. Where they are necessary I believe the following 313) [crossed out] is a tolerably good formula ꝶ Sacch. Saturn gr xij Corros. Subl. gr 1 Sp Corn. Cerv. gtt xx Aq. Fontan. ℥iv ♏︎ p. Injectio-A Gleet from mere debility may be cured by Matrimony- Stricture-Remove by Bougies, daily & careful introduced Lues-Six, eight or 10 Grains of the Simple Mercurial Pill, triturated with Molasses, and a very small quantity of Rhubarb-It seldom purges, and more can be taken without exciting a Salivation than of any other kind-I think a Salivation throws off the Mercury too soon & is never necessary- To remove obstinate Eruptions ꝶ Hyararg. ℥i Acid-Nitros ℥iij Axury. Lbj- Lues is complicated with Gout-with Scurvy, in which Case Mercury must not be administered till the Scurvy be gone-Also with Hypochondriasis, but in this latter Case it is often merely imaginary When this is the Case you must not give your Patient medicine of any kind, or he will not believe you-In this respect it differs from other Hypochondriac Affections, for you must here undeceive your Patient-Rheumatism often succeeds Lues in consequence of exposure to Cold when under the Action of Mercury- There is a Disease called Catarrh of the Bladder which is often mistaken for Gonorrhœa-The Symptoms are an involuntary discharge of Mucus, sometimes 314) accompanying the Urine, at others not Remedies are, Terebinthinates, then Bark, Tonics- If Tinct. Cantharid-. I have seen it once of service. Corns No Complaint however trifling should be thought below the Physicians notice-I believe that Corns often invite Gout in persons predisposed to it- Cure-Radically by Caustic-Blisters, Arsenic- Caustic Alkali to inflame the contiguous parts & make them throw it out-Then wear large easy shoes, or wear Plasters of Diachylon, one over the other with a Hole cut through of the size of the Corn, and raised to a level with it, to keep off the pressure of the Shoe- See Carlile's Letter-Medical facts Vol. 7 p. 29 Diseases of Old Age. See 2d Vol. Inquiries- Diseases peculiar to Women-These arise (1) From their Structure (2) From Menstruation & Parturition- In Amenorrhœa & Emansio Mensium V.S. is almost always necessary, but not in the foot, the Arm will do equally well-where the obstruction is recent & attended with fever, cure the fever- In Menorrhagia, if Sthenic, Rest, Cold Air, Cold Water, or Vinegar to the part, Flour, Cold Drinks-If Asthenic Opium-G. Kino- Prophylaxis-If sthenic, gentle V.S. Flesh Brush, Purges, avoid irritation, as getting into a Carriage, 315) [crossed out] climbing Stairs, dancing &c If Asthenic, Steel, Bark, Exercise, Cold Bath- Leucorrhœa is a disease of frequent occurrence- In Young Women it is for the most part topical, but in old ones it is a Symptom of general debility, accompanied with great pain in the Back- It is often a Cause of Barrenness-In Young Women there is sometimes a good deal of Action, and Bleeding may be necessary-in old Women seldom-but always examine the Pulse- Give Steel, Bark, Tonics, Bals. Copaiv-Terebinth- Generous Diet, Port Wine, Cold Bath, & if all these fail a Salivation-Also use an Injection of Oak Saw Dust, infused in Vinegar-The discharge in Leucorrhœa is sometimes so acrid as to excoriate the Vagina and even cause Ulcers-Here use Injections as in Lues- In Chronic Diseases I think we do not give a Patient a fair chance, if we suffer them to die without exciting a Salivation- At the time of the Cessation of Menstruation Women are subject to Menorrhagy, Dropsical Swellings, Vertigo, Schirri, Cancers, Leucorrhœa &c all which might I believe be obviated by a little bleeding frequently repeated, as ℥viij once in about a month, and gentle laxative Medicines-For further information on this subject I refer you to Dr. Fothergill's admirable Treatise upon it- Diseases of Pregnancy (1) Breeding Sickness-It is useful in preventing that Plethora which tends to produce Abortion- 316) It may be relieved by small Doses of Ipecacuanha or Opium-by lying down on the Bed, breakfasting in Bed, fresh Air, sucking Limes, Eating Biscuit almost constantly, & riding or walking out every day- This is not an universal symptom of Conception or Pregnancy-hence it is often difficult to know when this has taken place-A disposition to Syncope sometimes marks this period-I knew a Lady who was always apprized of it by a burning in one of her Legs- When Toothach occurs it may be safely extracted if necessary-if otherwise, Blisters behind the Ears, Laudanum- Costiveness-Small Doses of Rhubarb & Magnesia, or Lenitive Electuary- Ischuria is generally relieved by opening the Bowels as is also the involuntary flow of Urine which sometimes occurs- Swelled Legs, Giddiness & Numbness of the Limbs, open the Bowels and bleed- Dyspepsia which sometimes accompanies the advanced stages, relieve by the common Remedies for Dyspepsia-V.S. or Purging may be sometimes necessary-Press the Uterus down by a Bandage- Cough-When this occurs deplete copiously, for the foundation of Phthisis is often thus laid- Sometimes a discharge occurs about once a Month, something like the Menses-If not profuse it is seldom injurious, if it be, a little Bleeding easily relieves it- 317) [crossed out] Convulsion-Bleed most copiously proportioned to the state of the System to the extent of from ℥50 to ℥100- Abortion may be produced, but this is better than to risk the life of the Mother- Bleeding during Pregnancy will be always necessary unless the Patient use much exercise & low Diet- Bleeding just before Parturition makes it easier- May not the Pains of Parturition be obviated by Debility direct or indirect induced by copious Venæsection, or large Doses of Opium? a certain degree of debility favours Parturition-Hence the easy Labours in Sicily, Turkey & other warm Countries & in women after fevers & in Consumption After Delivery silence and rest are proper- No visits should be permitted-The Bandages round the Belly are often left off when the Lochia cease-They ought to be worn much longer, for 6 or 8 weeks, for they preserve the Belly- It is observed that Women recover soonest from long and tedious labours, probably from their taking more care of themselves & not venturing abroad too soon- Puerperal Fever. This is for the most part Typhoid tho' sometimes Synochoid & even Synochus.- It occurs from 20 hours to 2 or 3 Days & even six weeks-It is generally but not always preceded by a Chill-First Symptom a Pain in the Forehead, then Fever, Nausea, Vomiting, Pain in the Head, Languor, Restlessness and Thirst-Skin Dry, [crossed out] 318) or partially or universally moist-Tongue at first moist & white, then dry, rough & furred- Pulse varies, at first weak & small, then full and tense, afterwards as in Chronic fever- There is often pain in the lower part of the Belly, and the Belly swells as large as before Parturition, Legs often swell-The breathing short, Stools Green, mucous, finally very offensive & discharged involuntarily- Milk varies-Sometimes Miliary Eruptions appear- It lasts from 3 to 5 days in general-If very malignant, it terminates in 24 hours, but in this Country it is generally Chronic & goes on for a fortnight or 3 weeks-The Lochia are often supprest & when discharged, highly offensive- Remedies must be suited to the State of the System- Vomits are serviceable in the beginning when Nausea attends, especially in Autumn-Bleeding where much Inflammatory Diathesis, or when Inflammatory Diseases prevail-When Costiveness attends give gentle Laxatives, when Diarrhœa, Demulcent Drinks, but do not stop it entirely, if there be any Action in the Pulse-Blisters where the Action is at the Blistering point, and when Inflammatory Action is subdued, Opium, Bark and Wine-When the Belly is much swelled apply fomentations & volatile Liniments-Admit fresh air- Prognosis. The sooner it comes on, the more dangerous 319) [crossed out] the weaker the Pulse the more unfavorable- The Pain sometimes ceases 2 or 3 days before death, inspiring a Hope of Recovery, but the Pulse continues quick & low, the face red, and great difficulty of breathing- Great pain in the Belly with difficulty of breathing is a bad sign-Costiveness is unfavorable, as is also a sudden cessation of pain, with weak Pulse, Cold Sweats and paleness- A looseness with a moist Skin & Belly lessened by it, is favorable, but a diminution of the Swelling without a Lax, & with a dry Skin, is the reverse- A constant flux or returning of the Lochia is excellent-a moist white Tongue is good, the reverse bad-a black Vomiting is unfavorable- but a discharge of Mucus or Bile by Vomiting is favorable- Petechiæ are dangerous, as is also watchfulness- General Sweats are favorable- Abscesses, Remitting Fever, great Debility, Swelled Legs, & involuntary Stools follow recovery- The various accounts given in Books of this Disease are all right and all wrong-It is Inflammatory, Typhoid or Typhus, according to Habit Season of the Year, and previous treatment- Prophylaxis-Pure Air-Clean Linen-Moderate Diet, Rest, Silence and Darkness- Swelled Legs-V.S. Purges, Fomentations, Volatile Liniments, and gently Friction-This Disease [crossed out] 320) Sometimes ends in local Mortification-Then give the Bark- Swelled Breasts, & sore Nipples-For the former V.S. Purges, Repellents, as Vol. Liniments Solution of Sal. Ammonia-also Camphor-Laudanum- and if all these fail, the Lye Poultice & opening For the latter Sacch. Saturn-Cold Water, Turlington's Balsam- Diseases of Children Wash Children newly born with simple Water, not with Spirits-The 1st Disease is Red Gum, known by Red Eruptions on the face and Body-There is no danger in it and it goes off itself- Trismus Nascentium-This often proceeds from injuries done to the Navel, or Rupture of it-It is incurable, but may be prevented by gentle Purges, Cold Water to the Navel and a Plaster- Apthæ or sore Mouth frequently caused by retained Meconium, or heated Aliment-prevented by Purging-Cured by Molasses & Water, or Borax after a Purge-It's approach is indicated by a Sleepiness. Milk in the Breasts-It is wrong to squeeze them, repel by Spirits or a discutient Plaster- Belly Ach-From the Mother's eating too much Vegetable food, or the Child's eating it too soon-They should not do it before the 5th. Month-It is too Acescent-Weak Digestion in Children is discovered 321) [crossed out] by Coagulated Milk in the Stools, also by green Stools- It is cured by avoiding its Causes-Castor Oil- In general however Vegetable Aliment is best for Nurses-Women of higher rank require more Animal food, but it disposes them to menstruation and Conception, both of which injure the Milk as to quality and quantity- Children should suck 'till the 10th or 11th Month, not longer-It is remarkable that Milk does not communicate the Diseases of the Mother- Dry Belly Ach-Laudanum-Pepper Mint, never Spirits- Teething-This occurs from the 3d to the 12th Month it's Symptoms are Vomiting, Diarrhœa, Fever Startings, Fits, Swelled & Sore Ears & even Groins, Gonorrhœa-Give opening Medicines-Cold Air, or Laudanum & cutting the Gum across- Cutaneous Eruptions. If Sthenic, Vegetable Diet for the Nurse & Purges-If Asthenic, the Reverse, and Ungt. Citrin- Paraphymosis-from Diet, Accidents or play- Cold Bath, Cold Water-Taxis- Warts on the Tongue-Excision- Sores from Needles & Pins-Remove the offending materials Obstructed Meatus from the Prepuce growing over the Glans Penis-Circumcision- Diabetes-Bark-Steel-Cold Bath-If Morbid Action be discovered in the Pulse. V.S. Costiveness-Gentle Laxatives- [crossed out] 322 Supposed Lameness-Time, Rest, & Lint. Vol- Colera Infantum, Hydrocephalus, See Inquiries- Swallowing Buttons, Fruit Stones, Fish Bones, Coins & even Nails-They do less injury than might be expected-If it be improper or impracticable to discharge them by puking, give gentle Laxatives-Acids are sometimes given to corrode such substances-They produce sickness & pain, sometimes Death, but not so often as might be expected-If they stop in the Throat, Whale bone must be used to extract or to push them down- Insects in the Ears-Drop in Spirit or Oil- The Ears should always be examined when Children complain of pain in them- Worms-See my Essays-Symptoms are (1) [crossed out] in the Head, Apoplexy, Lethargy, Convulsions, Grinding the Teeth-Shrieks, Startings in Sleep- Tetanus-efforts to swallow especially in Sleep- Dry Cough-Obtuse pain in the side, frothy expectoration, with low unequal Pulse counterfeiting Pleurisy-Singultus-Cardialgia-Nausea, Vomiting-Colic-Colera-Costiveness-Slimy Stools-Diarrhœa-Sudden rising to Stool in the night-Night Sweats-lying much on the Belly-Handling the Belly-Picking the Nose- Sour Breath-Intermitting, slow or absent Pulse- Jaundice-Inordinate Appetite-Symptomatic Fevers of all kinds-Symptomatic Dysentery 323) flushing of one Cheek, & lastly Atrophy-Dr. Home adds one more Symptom, a swelling of the Old Nasi, Upper Lip, & often adjoining parts-This is worth attending to-he says that it never deceived him-It is not seen early but soon enough for a cure- An Idiopathic Worm Fever is I believe very rare- Tabes Infantilis-This is thus described by Dr Smith-Children at first become pale listless, and inactive, with loss of Appetite, especially when they have been recently weaned-In such as are not weaned, the Appetite is often voracious They suck immoderately, and soon after belch it up perfectly coagulated-This Symptom is succeeded by frequent liquid Dejections, by sometimes by Costiveness, accompanied by a hard, tumid Abdomen, with lean & emaciated Extremities-To these succeeds a Lientery with crude undigested Stools-The voracious Appetite still continues, attended with great Thirst, nocturnal Colliquative Sweats, especially about the Head & Breast-great Lanquor, & a face bordering upon the Hippocratic- Cure-Bark, Wine, Animal Food, Air, Exercise Cold Bath- Besides there Diseases Children have almost all the Diseases of Adults, as Bilious & yellow fevers, Catarrh, Pleurisy, Dysentery &c more strongly 324) marked, and more easily known than in Adults, because less complicated, & less affected by the Operations of the Mind- The Remedies should be the same as for the same Diseases in Adults-V.S. is highly proper in Colera, Bilious fevers, Pleurisy &c however Young the Child may be-I bled Child twice under 7 weeks, & Thos. Billington's at 3 weeks- The Blood in both Cases was sizy- Consult Underwood, it is an excellent Book Conclusion Of the Means for obviating the pain of Death It is often observed that at the period of Dissolution, the Mental & Moral faculties and the benevolent Affections appear with more force than in the previous life of the Patient-This is probably owing to the Seats of those Qualities in the Brain, concentering almost all the excitement of the Body, as in Disease Excitement is always unequal- But this Excitement, whether it appear in the Brain, the Blood Vessels, the Viscera or elsewhere, may sometimes produce Delirium, Excessive Pain & Convulsions, It is the duty of the Physician to smooth the passage out of life, be diminishing pain & especially by removing Delirium, at a period, when an hour's 325) [crossed out] enjoyment of the Mental faculties in an undisturbed state maybe of the greatest consequence, to the temporal or spiritual concerns of our Patient. Hitherto Laudanum has been principally depended on to render dissolution easy, but many Cases may exist where though the Case be hopeless V.S. only could produce these desireable effects- In this situation, it is the duty of the Physician however it may expose him to censure to diminish pain, and to restore reason by the use of Lancet. The other Remedies are Opium, Wine, Spirit and Water, Warm Bath, Warm Water to the surface of the Body, Oil, warmth to the Feet &c. Appendix Arrangement of Diseases continued from P. 285. Disease of the Nervous System (12) Hooping Cough-P. 280. (13) Palpitataion of the Heart-Remedies are occasional V.S. then Tonics-It often proceeds from Aneurism or original Malconformation-In this Case our reliance must be upon freguent V.S. this will protract life-I had a Case where from over exertion at a Ball, a Lady brought on this 326) Affection to a violent degree-She was kept alive for a long time by frequent bleeding-She was herself generally aware when it was necessary- She suddenly expired at length in the middle of the night-She had felt these premonitory Symptoms and had mentioned her intention of being bled, but unhappily deferred it-Mrs. N. was the Lady- (14) Hiccough-P. 279-(15) Syncope. P. 295. (16) Asphyxia. P. 296 (17) Deafness P. 307. (18) Cephalalgia. 308. (19) Phantasms- I mean by Phantasms those impressions made upon a Person's Brain, by which he fancies that he sees Apparitions, either of other persons, or of himself, that he is called on by dead friends &c I consider all these effects as proofs of Morbid & irregular trains of Action in the Brain, by which means certain particular portions are stimulated, which were formerly otherwise connected, and produce wrong impressions-This morbid Action often realizes the supposed predictions of Death &c Sometimes since a Sea Captain who resided near Long Branch in N. Jersey returned to his House from a solitary walk on the Sea Shore, under great apparent Agitation of Mind-He did not however communicate the Cause of it, but was shortly after taken exceedingly ill, and died in little more than a Month from that Evening. On his Death Bed he confessed that he had on that evening met his own Apparition, and that 327) he had immediately understood that he should die-Had he on that same evening considered himself as ill, and resorted to the usual modes of subduing Morbid Action, his life would have probably been prolonged- During the Yellow fever of 1793 A Gentleman with whom I am well acquainted, was lying on his Bed under the influence of an attack of the Disease-It was in the night-upon turning himself on his Bed, he saw his own Apparition laid out on the side of the Bed, in one of the common Deal shells, which were then used for the purposes of Interment-The Impression was so vivid and it's continuance so long that he had time to contemplate the exact form of his own face & Hands, & the Yellow tinge produced on them by the Disease-However as his Mind was probably stronger than that of the Person mentioned before, he considered it as the effect of the Disease and is now alive & well- A story of Berkley, Bishop of Cloyne, and the apparition of an old Woman, for which he got himself bled, taking it for a Morbid Affection, and with success- III Diseases of the External Surface of the Body. (1) Tinea Capitis P. 306 (2) Ring Worm-P. 307. (3) Itch-P. 307. (4) Morbus Pediculosus-307 (5) Corns-314. IV Diseases of the Lymphatic System & Glands (1) Lues-P. 311. (2) Cancer. P. 303 Schirrus 304. 328) Dr. Rush's division of Disease in 1807 Disease, is Morbid excitement appears in the following forms (1) Convulsions, as in Fever &c (2) Suffocated Excitement, as in Malignant fevers, Apoplexy* (3) Spasm, as in Colic, Asthma &c (4) Great heat. (5) Itching. They vary from circumstances, but sometimes appear in succession in the same part of the Body - In 1807 He divides the Temperaments (instead of 4) into 8, which he calls Predispositions-They are the Sanguineous, which he subdivides into Pulmonary & Aortic-The Nervous, the Muscular, the Cephalic, the Phrenitic-the Alimentary, which he subdivides into Stomachic & Intestinal-the Lymphatic & Hepatic.-   General Index. A Abortion, prevention of by the use of Salt Meat- 155. Absorbent system-47. Absorption, how promoted-ibid. Abstinence, use of in Inflammatory fever-165. Action morbid, sometimes transcends Inflammation 299} 214 Actions, order of the production of-25. -morbid, may exist in two different systems at the same time- } 150 cause of the mistake of Brown & Hunter. Ibid. Æther, use of in Typhus-169. Affection for relations, return of, favorable in Mania, 231. Age old, diseases of. - 120. 314. -proximate cause of -146. -of Patients should be attended to-9. Aged persons mistake the quantity of their sleep-37. Air-remote causes of Disease from it's sensible or insensible qualities-61. -from its impregnations wth marsh miasmata. 65. -animal Miasmata-68. -from its being vitiated, by the Breath, 72. by the vapours of certain manufactories, } and the air discharged by Plants in the night} 73. from blowing over particular countries from too high oxygenation- -fixed, floating near the surface of the Ground. 74. -Air, mixture of, as sea & Land, sometimes injurious-76. -change of, highly important in Hooping Cough. 280. Algernon Sidney's words, where danger & duty are connected, 240. Aliment should be of two kinds and why, -39. -what kinds most digestible-40. -what quantity of proper-42. -diseases from deficient or excessive quantity of 81. -sudden changes in-85. -lying long undigested-86. -improper mixtures of, from being too hot, or too cold, from novelty, from satiety, } 85. -the Vessels in which it is prepared, 86. -being taken fresh or salted, from being } 87. mixed with Animal excretions, or what the Animal eaten lived upon-Ibid. Alimentary Canal, diseases of the affecting the whole System-134. -treatment of the-285 Aliments proper in Inflammatory fever-165. -in Typhus, & how administered-170. Amber Oil of, acts specifically on the Muscles-169. -importance of, in Typhus-169. -use of in Tetanus &c-279. Ambition, effects of-104. Amenorrhœa, see Catamenia Amusements, diseases from, Women particularly liable to-108. Ananias & Sapphira, explanation of the death of-104. Anasarcous Legs, sometimes symptoms of Rheumatism-212. Ancestors unhealthy, remote causes of disease-109. Anecdote, of Professor Hamilton-3. -Dr Johnson-47. -Genl. Montgomery-109. -Revd. Wm.. Tenant of N. Jersey-233. -Genl. Lee-237. Anger increases the secretion of Bile-102. -morbid effects of-ibid 239 -how obviated-Ibid. Angina Pectoris, seems connected with Asthma-131. -treatment of-284. Angina Tonsillaris-Pharyngea, treatment of-207. -Parotidea, importance of Blisters in-208. Animal Life, see 3 Lectures published this year- Animal Heat, various theories of-18. -putrefaction & friction disproved, and -the French theory established-ibid. -but one objection to the French theory-ibid. -cases of persons burnt to death by,-20. -the same in all countries-ibid. Animal matters putrid, rarely produce disease-66. Animals killed in Autumn have generally enlarged Livers-67. Antediluvian life conjectures on-53. -Antipathy, a remote cause of Disease-113. -none that may not be overcome-296 -Apoplexy, a disease of the whole nervous system-133. -causes of-remote-241 -proximate-242. -distinction into serous & sanguineous improper. 133. 242 -premonitory symptoms of,-243. -treatment of, -244. -vulgar error that patients die in the 3d. fit.-246. -preventatives of-Ibid. Apparitions, accounted for,-326. Apple-water, how prepared-165. Apthæ, treatment of, -266. 320. Arteries-their importance, their muscular fibres-23. -unequal action of their fibres is the cause ibid. of unequal excitement in the Arterial System, in fever. ibid. -very irritable in extreme old age-120. Arterial plethora changes for the venous about 36-119. -system, diseases of the, affecting the whole system-129. Asafœtida seems to act specifically on the Nerves-127. Asphyxia, caution not to lay out or intern persons too soon-296. Association of ideas & motions, remote cause of disease-114. Case of a Paralytic Lady-Ibid recurrence of Intermittents explained-Ibid -Epilepsy-Ibid Case of a Desenter-115. -a pregnant Lady-292. -former, return of in Mania favorable-230. Asthma, a disease of the muscular fibre-130. -sometimes succeeded by discharge of mucus Ibid from the Bronchia in advanced life-Ibid Asthma, premonitory symptoms, & treatment of,-304 305. -seldom eradicated from the System-Ibid. Attendance on the sick, directions for,-2. Avarice, effects of,-104. B Bark seems to act specifically on the Arterial System-127. -how to be given in Typhus-170. -exhibition of in Intermittents-195. -where serviceable in Hydrocephalus Internus-251. -Quassia proper, but Peruvian not so in Dyspepsia-287. Barrenness, sometimes removed by chronic fevers-174. Bath warm, particularly grateful in old age-31. -why not recommended in Typhus-171. -cold, effects of the imprudent use of the,-171.112. -medical uses of the -156. -should in some cases be preceded by the warm one Ibid. Bathing prevents thirst-47. Beds should be drawn into the middle of the room in Typhus, and curtains taken down-} 70. Beer morbid effects of-91. doubtful whether it produces Gravel-Ibid. Bile, on excretion-product of a septic process-48. -discharged by the Scuttle fish to elude an enemy-49. -antiseptic when secreted-ibid. -analogies to this-50. -it's secretion accelerated by anger-ibid. -vitiated by Marsh Miasmata-67. 140. -obstructed, diseases from-99. -sometimes so impacted as to prevent it's absorption-ibid. -effects of, when vitiated by disease-140. Bilious diseases most frequent in the country-76. Bilious fever, difft. grades of, arise from the same source-189 -case of infection from,-Ibid. -particularly affects the Stomach & Liver, 190 Bitters should not be taken between Meals,-92. -dangerous effects from the imprudent use of,-110. Blisters may be used too late in Typhus-172. -of boiling water, where proper,-Ibid. -importance of in Dysentery-198. -to be used in Pneumonia Vera without waiting for the blistering point.-} 201 -to the neck in Angina Parotidea prevent The translation of the disease to the Testicles and to these last, to the Brain, where it is fatal } 208. -should be applied in Mania to the lower extremities 225. -in Colic to the Thighs-300. -succeed in Diarrhœa, when every thing else fails-301. Bladder Catarrh of the,-313. Blood, 25 Lbs in a man of ordinary size-24. -specific influence of the, asserted, Cullen's objection answered, 23. -afflux of, said by Haller to take place to the seat of pleasureable sensation, exceptions to this,-33. -[crossed out] the buffy coat of how produced-46. -sign of moderate Infy. action, ibid. -dissolution of, not owing to putrefaction,-67 -diseases of, affecting the whole system,-129. Blood-letting imprudently used, effects of-112. -use of, in relieving pain-162. -almost always necessary during pregnancy-317. -proper and safe in Children & Infants-324. -may be necessary to lessen the pain of death-Ibid Blood-vessels accompanying nerves increase sensation.-26. Body, divided into seven systems-126 Books practical how read with most advantage-1. Bowels, in diseases of the, examine the water & cooking vessels-199.301. Brain, diseases of the -243. -induced by tight Collars &c-93. -three species of affections of the,-243. Breakfast to be taken in bed by breeding women & Dyspeptics, 289. Bread half baked produces Colic-85. Breasts inflamed, treatment of the,-320. Breath in Plague will infect before the Disorder- is felt in the System-} 48. Cold is a bad sign in fever-178. Brown difference between his system & Rush's-59. Buckwheat, leaves of eaten green, just after they come out of the Ground are poisonous-} 94. Burning state of fever-196. Burns, treatment of, -267. Butter-nut pill, dangers, from it's use as a purge,-111 C Cabbage Leaves relief from in Rheumatism-212. Calculus imparts a settled melancholy to the Countenance, 8. -probably wrongly attributed to the use of Beer-91. Camomile-tea daily use of sometimes causes of Vertigo-111. Cancer treatment of, few tonics except Arsenic, of any advantage, -no tumour of long continuance should be disregarded-} 303. Carotid artery compression of, has cured Mania for a time,-226. Carving, a bad custom,-42. Catalepsy, treatment of,-278. Catamenia-[crossed out] 53. -durings its flow, women disposed to Inflamy Diseases-Ibid. Catamenia sometimes erroneously thought to be supprest,-54. -supprest, diseases from being,-100. -treatment of,-259. 314. -Emansio Mensium-Dysmenorrhagia,-Ibid. 314 -period of cessation of, predisposes to diseases,-124.315. -treatment-Ibid. -Menorrhagia, treatment of, - 314. Cataplasms, safest in more advanced stages of Typhus,-172 -should be applied at the top of the foot -and in some cases to the Stomach & Belly} Ibid. Catarrh, perhaps more frequently taken from exposure to the night air, hence it is gallant in Sicily to make love in a hoarse voice.-} 64 -treatment of-207. Cats & Dogs spread the Plague,-186. Caustics, See Coma-172. Cephalalgia, See Head-ach- Champagne Wine seems to act specifically on the mind,-127. Cherry-stones great danger from swallowing,-96. Chicken-pox-79.137. Children of six months, according to Harvey, may live,-55. -the passion for in Women is excessive-123. -predisposed to many diseases-one half computed to die under 7 years of age} 118 -diseases of, and their treatment-320. & seq. Chorea St: Viti, a disease of the Muscular System,-129. -often produced by worms-treatment of,-284. Chronic diseases, the feet should be kept warm in,-64. Chylification affords an argument for the Doctrine 314 of fermentation in digestion-45. Circulation of the Blood, strange that it should have been discovered so recently-22. -No Physician past 40 in Harvey's time admitted the truth of the discovery,-24. -uses of the,-24. Circumcision, why probably enjoined on the Jews,-106. Cleanliness particularly important in fever,-166. Climate, none necessarily unhealthy,-62. Cloathing warm should be recommended-Many Diseases from too cool a dress few from one too warm-} 64. -too tight should be avoided-93. Coffee alone contains no nutriment-if of moderate strength, it is very harmless-} 42. -seems to affect the head specifically, especially when strong, hence should be forbidden to Patients afflicted with Vertigo-} 43. 89. -fortifies the system against cold-Ibid. Cold, effects of-62 -a full stomach fortifies the system against 46. -when long continued produces the same insensibility with regard to heat that it does to itself-63. -feet are the principal avenues to disease-64. -drinks thirsted for in the last stage of Typhus,-173. -state of fever, bleeding admissible in the cold stage-196. -air, advantage of in Convulsions of Children-276. from Hooping Cough & Small Pox-Ibid. -Water effects of in Tetanus,-277. Cholera morbus, treatment of-197 Colic, causes and effects &c-135.298. -pain of has produced death, without marks of Inflamn.-162. -removed by Oil & Wine in the late King of Prussia-167. -treatment of,-199. 298. -when produced by Hysteria, importance of Laudanum Ibid Columbo root acts specifically on the Alimentary Canal-127. Coma, remarks on-use of Caustics in-172. -singular effects of a burn in,-188. Condiments diseases from,-42. 87. Conception symptoms of-54. Congenial weakness a predisposing cause of disease,-125. -seven months Children often liable to the effects of, Ibid. Consumption most frequent in cities-74. -sometimes translated to the head, -143. -importance of horse exercies in,-157. -rarely appears in Philadelphia, since the more general use of bleeding -remedies for, -great importance of Opium in, -general rules with regard to diet &c for-} 205. Convalescents from bilious fevers should eat Salt Meat, 42. and from Gout, if aged-Ibid. -should eat very moderately-43. 46 -should always take food with them on a journey, 85. -general rules from the treatment of-173. 154. Convalescence effects of, how obviated,-[crossed out]. 174. Contagions specific, operation of, as remote causes of disease-77 -two cannot act on the arterial System at the same time. 79. Convulsions how caused and cured.-129. 276. -preceding death how produced,-279. 147 -of Children how prevented-in pregnant fatal for want of bleeding Ibid. 317. Corns, treatment of-314. Costiveness, diseases from-98. -how obviated-302. -attendant on pregnancy, treatment of,-316. Cough, attending pregnancy-Ibid. Coughing, uses of-21. Countenance of the sick to be attended to-8 180. Country new, however wet, if shaded by trees, not unhealthy, 74. Cramp, a disease of the Muscular system,-129. 279. -treatment of the-279. Crepitus with noise favorable at the close of an acute disease, 183. Critical days, only one advantage from knowing-175. 193. Crying helps to form the organs of speech-22. Cuticle more extended than we should at first apprehend, 25. Curtains should be taken down in Typhus,-70. Customs peculiar, remote causes of disease,-109. Cutaneous eruptions,-state of fever-283. 306. Cyder, morbid effects of,-91. Cynanche maligna one of the specific contagions-77. -[crossed out] -effects of on the other systems,-137. -Women & Children most subject to-209 -West Indian & European remedies for,-Ibid. -depletion & ensure success to subsequent Stimuli, Ibid. -trachealis importance of Seneka-general treatment, 210. 211. D Dalby's Carminative fatal effects from,-112. Days critical in fever,-175. 177. Deafness, treatment of-succeeding Otalgia how prevented, 307. 265. -case of, complicated with Synochula,-191. Death most rare between 40 & 57-119. -proximate cause of, illustrated by the comparison of a Violin-147. -convulsions & pretl. strength preceding it how produced-Ibid. -from what diseases most and least painful-Ibid. Death sometimes occurs from mere debility after a disease is cured as after being tapped for a Dropsy.-} 148. 184. -signs of-but one certain,-185. -means to obviate the pain of,-324. Dead persons should not be interred or laid out too soon,-296. Debility of 2 kinds, direct & indirect-so similar as only to be distinguished by their cause-not disease 148.} but predisposes to it-56.} -is the inviting cause of morbid action-58. -indirect succeeding pleasure greater than after labour,-107. -partial, whether direct or indirect, a sign of disease, 148. -not dangerous in the early stages of disease,-Ibid. -next door neighbour to disease,-158. -indirect when excessive bleed a little at a time & often-165. Decubitus of Patients should be attended to-9 Deformity of size or conformation predisposes to disease,-124. Depletion, why useful before administering Stimuli,-151. Derangement from shot working out of the foot,-97. Despair effects of in causing sleep-35. Dews remarkably plentiful in Pennsa. in August-65. Diabetes, from a defect in the Lymphatics-139. 321. Diarrhœa, treatment of-an excellent injection for-197. 198. 300. -often the effect of Gout & Hypochondriasis-135. Diet, change of, in Europe favorable to health,-83. Digestion, various theories of-mechanical disproved, 44. -putrefactive disproved-Heat essential to it-ibid. -fermentation contended for-45. Disease, origin of, always depends on predisposing debility-56. -Division of-328. -is always partial,-58. -but one in the world & what,-Ibid. -distinguished from Disorder,-59. 126 -hereditary, family recipes often important in, - 6 Diseases, causes of, how divided-Example-60. -I remote causes of-from Infancy-60. -from the sensible & insensible qualities of the Air-61. -from Contagions, miasmata & bad air, See Air-65. 72. Diseases, remote causes of, from different situations, 74. -and change of situations-76. -from specific Contagions-77. -from Aliments, Condiments & Drinks-81. -from Dress-92. -from Poisons-93. -from Worms-95. -from anomalous substances taken into the Alimentary Canal, Lungs, Nose and Skin-96. -from the same being applied to external surface-98. -from retained exceretions-Ibid. -from motion & rest, sleep & watchfulness in excess,-100. -from improper exercise of the faculties of} the mind, and the venereal appetite-} 102. -from different states of society, Government Religions-Employments-} 105. 106. -from different amusements-107. -from peculiar customs-109. -from unhealthy ancestors-Ibid. -from false systems of Medicine, Quacks &c-110. and from the habitual & imprudent use of remedies, with or with the advice of a Physician } 111. -from Sympathy and Antipathy,-113. -from association of ideas & motion-114. -from external violence-from time-116. Diseases II predisposing causes of are natural & artificial Ibid. -natural occur in I different ages, as (1) Infancy,-117. (2) Childhood-(3) Puberty (4) Adolescency Ibid. & seq. & Manhood (4) the time when the Arterial yields to the venous plethora-} 119. (5) Old age-120. Diseases, natural predisposing causes of occur II In different conditions of the System as in (1) different temperaments-121. (2) diff.t conditions in the single & married life,-122. (3) pregnancy-suckling-123. (4) cessation of Menstruation-124. (5) Deformity in size or configuration-Ibid. (6) Congenial weakness-125. Diseases, predisposing causes of which are artificial-Ibid. -III proximate causes of are general & partial,-126 -all depend upon Morbid excitement or wrong action. Ibid. I General causes affect the whole body, directly or indirectly. 129. (1) through the medium of the sanguiferous system-Ibid. (2)-mind, Brain, nerves & muscles. Ibid. (3)-Stomach & Alimentary Canal-134. (4)-external surface of the Body, 136 (5)-Lymphatics and Glands,-139. (6)-of the Blood (7) Of the secreted fluids 140. (8) -the Viscera-141. Diseases, bilious most frequent in the country-74. -contagious partake always more or less of the qualities of the Atmosphere, except Influenza-} 79. -Chronic, in these inquire whether ancestors have had the same, and what their remedies} 6.109. -translation of to different parts of the same system & to different systems-} 142 -of the same system, differ materially in degree -exist in one part of the system, and produce their effects in another-summary of the doctrine of diseases} 144 -multiplication of absurd-145. -proximate causes of, which are partial} affect various parts of the Body-} Ibid. Diseases, stimulus of sometimes the last support of life,-148. 185. -signs of, (1) Partial Debility direct or indirect-148. -in the Tongue-the countenance,-8. -in the eyes-decubitus-8. -in the Hair, respiration, skin, voice, nails.-9. -in the Pulse-10. -Consult Prognosis of fever,- -habitual return of favorable in Mania,-231. -Chronic, salivation should always be attempted in-315. Disorder the effect of Disease-59 Distention, stimulus of, to a certain extent supports life.- Drams morning cause of Disease-109 Dreaming nearly related to a disease of the mind, Remedy 241. Dreams a stimulus to Animal Life in sleep,- -cause of,-37. -sometimes excited by external impression,-38. -more terrible than usual often protend disease-39. -always depend on a morbid state of the System. 38. Drinking rules for,-42. Dropsy, rarely a primary disease of the Lymphatic System, 139. -treatment of,-253. Dysentery more frequent in the Country than Cities.-74. -an epidemic raged in one of the Hospitals during the revolutionary war, and was most fatal along the walls of the room-application of this fact} 70. -arises from the same source as bilious fevers-67. 196 -an occasional offspring of Typhus,-72. -sometimes a primary disease of the Bowels-135. -most fatal to aged persons & Children-goes off sometimes with a salivation-prevented by a purge, when a person is exposed to it's exciting causes-} 197. 198 -treatment of-Blisters important-sometimes returns periodically-} Ibid. Dysmenorrhœa, see Catamenia- Dyspepsia, important to eat with your Patient. 9. Dyspepsia connecting link between Hysteria & Hypochondriasis-217. -causes of,-285. -palliative & radical remedies for,-286. 287. -from sea sickness how obviated,-291. -accompanying pregnancy, treatment of,-316. Dyspnœa, case of, from a Water Melon Seed in the Glottis,-96. -from a tumour in the Trachea,-306. E Ears, insects in-should be examined when painful-322. Earth floors, use of in malignant fevers,-170. Eating, rules for-42. Elephantiasis, a high Grade of Leprosy-138 Employments, remote causes of disease,-84. 106. Envy, effects of,-104. Epidemics reigning, power of-79. -chase away or mingle with all other disease-80. -vary as to violence in their different stages-Ibid. -a fever of this kind restored almost all the maniacal Patients in the Pennsylvania Hospital to their reason-} 229. Epilepsy, whence called Morbus Comitialis-73. -recurrence of explained-Case of from association-115. -Hysteria & Hypochondriasis seem difft. grades of the same disease-} 132. -causes of,-291. -premonitory symptoms of,-292. -treatment of, -293 & seq. Epistaxis, see Hæmorrhagies,- Eruptions of Measles & Small Pox may be out together,- -on the Skin, connected with febrile diseases,-138. 321 -less frequent since the hot regimen in fevers has been given up-might be called Febres Extroversa} Ibid. Evil, moral & physical, origin of-both depend on debility-56. -produced by excess or derangement of what was originally good-} 57. Excitability, remarks on,-57. 58. -probably matter of some kind,-150. -why a preferable term to sensorial power,-150. Excitement, remarks on,-57. 58. -moderate produces pleasure, excessive, pain-33. -may be excessive, but not morbid-58. -when irregular, discovers itself by excess in force or frequency of motions-} 58. -equal is health,-Ibid. -morbid generally takes place in that system of the Body which has been excessively debilitated-}148. Excrements neither human nor brute often produce disease-66. Excretions, what,-48. -retained are remote causes of disease,-98. Exercise before breakfast not to be recommended to Invalids, 36. 157. -deserves high rank as a Medicine,-156. -scale of-on horseback in pulmonary Consumption. -& in debilitated Stomach & Bowels-} Ibid -of walking proper only in slight indisposition-Ibid -fatigue in should be carefully avoided,-Ibid. -of the Limbs to be early attended to in Rheumatism-212. Extremities, constant or coldness in indicate malignity-178. -cold without fever sign of nervous diseases-Ibid. -preternatural heat in, sign of Hectic Diathesis-Ibid. Eyes, pupil of the, should be examined,-8. -generally light in Northern & dark in Southern countries-27. -prognosis of disease from,-178. F Facts medical, Cullen's observation respecting,-2. Faculty, moral, diseases of the-236. Faculties & operations of the mind distinguished,-28. -improper exercise of, remote cause of disease-102. -of the mind defects of, treatment of,-232. -perhaps influenced by matrimonial connections-234. Famine & Fasting, effects of,-162. -after long continuance of, full meal destroys life, 43 -diminishes the sensation of pain-163. Eat, few men long lived, who become fat before 40-125. Fatuity, causes & treatment of,-234. -remarkable cases of cures of,-Ibid. -temporary, succeeding fever, how cured,-236. Fear, effects of,-103.239. -morbid effects of, how obviated,-239. 240. -suspends the Paroxysms of Hooping Cough,- Febricula, treatment of-192. Feet cold a principal avenue to disease-importance of keeping them warm in all Chronic diseases.} 64. Female body and mind, peculiarities of,-51. Fermentation contended for in Digestion,-45. Fever, states of, Amenorrhagic-259. Anginose,-207. Apthous,-266. Apoplectic,-241. Arthritic-212. Bilious,-189. Burning-196. Cold & Chilly,-Ibid. Cutaneous-283. Eruptive,-253. Fainting-196. Febricula,-192 Gangrenous,-167. 188. Hæmorrhagic-,259 Hæmorrhoidal-,259 Hectic,-192. Hepatic,-268. Hydrocephalic,-250. Hydropic,-253. Hypochondriacal & Hysterical-280. 216. Intermitting,-192. Intestinal,-196. Lethargic or Comatose,-188. 249. Malignant-185. Maniacal,-212. Fever, state of, Nephritic,-252. Odontalgic,-263. Opthalmic,-261. Otalgic,-265. Paralytic,-247. Phrenitic,-241, 247. Pulmonary,-199. Rheumatic,-210. Scrophulous,-275. Spasmodic or Convulsive,-276. Sweating-196 Synocha-188. Synochoid Synochula,-191. Typhus, Typhoid,-191.168.71.167. Vertiginous,-249. -Acute after Mania favorable,-231. -following Apoplexy generally favorable, 246. -yellow suffocated state of,-269. -Puerperal, treatment of,-317. Fevers, prognosis of 175 from pain-177. -from heat & coldness-eyes-ears, 178. -from senses-tongue-teeth,- -voice and Countenance,-}179 180. -Respiration, position of the body, tremors [crossed out] 180. -Temper, Sleep, Thirst Appetite, Secretions Exceptions vomiting-Silence in Delirium asking for food} 182. 183. -general observations on,-165. -in malignant do not bleed at all unless you bleed plentifully-} 165. -Chronic often carry off preceding chronic diseases 174 -have sometimes removed barrenness,-Ibid. -of different type are produced by the same causes,-67. -often alternate with eruptions on the Skin,-138. Fires, advantage of in Typhus.-170. Fish eaten alone seldom offend the most delicate Stomach-41. -& flesh can seldom be borne together after 40-85. -together inadmissible in dyspeptic complaints, 288. -putrid produce disease more readily than putrid animals, but not so readily as putrid Vegetables } 66. Fish diseases from a diet of wholly-82. Flannel advantages of,-93. -should be worn under Breeches & Petticoats by the weak, 158. Flatus, in Hysteria, how relieved,-282. Flax, rotten produced a malignant fever in Rome, 93. Food, its Stimulus upon Animal Life, see aliment, -well done, most easily digested,-84. -animal, diseases from,-82- -should be prescribed where there is no appetite in cases of debility-but in small portions,} 171. -scale of Stimulus in,-155. -should be sent up in small quantities to Dyspeptics. 289. Founder in Horses, a true Rheumatism-how cured, 211. Friction, recommended in acute Rheumatism,-Ibid. Fruit should be eaten before dinner,-40. -morbid effects of,-83. G Gallstones, an improper term,-100. Gangrene, treatment of,-159. 267. Gangrenous state of fever, how caused & cured,-167. 188. Garlick, useful in a tendency to Apoplexy-246. -Colic,-300. -Syrup use of in Pneumony-202. Gastrodynia, from eating too much Mustard, 9. Generation, theory of,-54. Gentian acts specifically on the Alimentary Canal, 127. Gentoos find the smell of Europeans insupportable,-85. Glands, diseases of frequently change their places-143. -affecting the whole system,-139. Government, remote cause of Disease,-105. Gout affects all the systems of the Body,-128. -no end to the rambles of the,-143. -white wines important in the Gangrenous or Typhous state succeeding it-} 168. Gout, aged Convalescents from should eat salt meat,-12. Grief, effects of,-102. 239. -produces actions not readily accounted for,-Ibid. -effects of how obviated-Ibid. H -Habits, return of favorable in the close of fevers,-182. -precedes recovery in Mania,-230. Hæmatemesis, treatment of,-258 Hæmaturia, treatment of, - Ibid. Hæmoptysis, Cautions with regard to the place whence the blood comes-blood discharges from the Lungs & by vomiting distinguished-} 256. -remedies for,-Ibid. Hæmorrhagies, translation of,-143. -tonic & atonic, preferable terms to active & passive 255. -peculiar-causes of Hæmorrhagy-Ibid. -treatment of,-256. -from the nose, treatment of,-257. -Uterine, treatment of,-258. -from wounds-checked in battle by night air- Ruspini's Styptic the only liquid admissible-} Ibid. Hæmorrhoids, a disease of the Bowels & arterial System,-136. -improperly called Hæmorrhagy by Cullen,-259. -Remedies for-Fistula might almost always be prevented by treating them as a general febrile affection} 260. -blind, pneumonic affection produced by, 301. Head, injuries of, produce effects long after,-116. -in affections of, the indications of the Pulse are least sure-if tense, not to be trusted-} 165. -pulsation in, how relieved in Yellow fever,-274. Head-ach, slight, how cured by mastication- -often caused by Pomatum,-98. -from structure is hereditary-110. -constitutional often ceases between 36 & 40-119. Head-ach produced by an Electrical Atmosphere,-310. -of long duration liable to end in Apoplexy &c 308. 243. -various causes of,-308. -treatment of-310. 311. -Sick Stomach, often not the cause but effect of, 309. -should never be neglected-311. Health, good portions of between 40 & 57-119. Hearing, some peculiarities relating to, in certain individuals-analogy to these-28. 153. -pleasures of,-33. Heart, palpitation of-Case-324. Heat, effects of,-61. -if uniform, not unhealthy-62. -particularly if dry-Ibid . 66. -long applied produces the same insensibility to cold, that it does to itself-} 63. -sudden transitions of to cold, highly injurious-64. Height, excessive, unfavorable to long life,-125. Hepatitis & Pneumony change into each other,-143 -almost always a Symptomatic affection, 141. -is acute and chronic-treatment of-268. bloodletting very copious, Mercury highly valuable, but does not act specifically-} Ibid. -various termination of-Sir Mr. Jones-269. Hereditary diseases, family recipes often important in, 6. Hiccough, a disease of the muscular system but often connected with morbid action in the blood-vessels-} 130. 279 -treatment of-279. Hooping-Cough, not always attended with fever-78. -a disease of the Muscular system but sometimes brings the Arterial into Sympathy} 130. -treatment of,-280. -fear suspends the paroxysms of,-Ibid. -convulsions of, checked by cold air,-Ibid. Hippocratic Face-181. Horses fed on Corn alone lose their strength- -have a true Bilious fever, called Yellow Water 191. -fattened most readily by giving them food in small quantities-application to Dyspepsia-} 289. -age of known by the contractility of the skin,- Humerus, dislocated instantly reduced by V.S.-ad deliquim-application to parturition-55. Hunger, how produced,-43. Hunting, why unfavorable to health-108. Hydrocephalus Ints. accompanied with constant frown, 8. -from blows after a long interval,-61.116. -is a chronic Apoplexy-133. -causes & Symptoms of-259. -water in, always effect of Inflammation, 251. -pain always ceases when effusion takes place, Ibid. -Curve of,-Ibid. Hydrogene injected into thhe Esophagus of fowls affected}67. the Liver, similar to Marsh Miasmata} Hydrophobia perhaps generated by Canine Miasmata. 70 Hypochondriasis, how distinguished from Hysteria-216.281. -by what means induced,-Ibid. -remedies-corporeal & mental-217. -always to be treated as a real disease-218. -curious cases of,-219. -Matrimony, a valuable remedy-}220. -and travelling-} Hysteria how distinguished from Hypochondriasis-216. 281. -treatment of,-282. -flatus in, how relieved,-Ibid. -Hypochondriasis & Epilepsy seen}132. different grades of the same disease-} I Idiosyncrasy with regard to particular aliments,87. -peculiar renders judicious prescriptions dangerous 113. Imagination distinguished from fancy-30. Inflammations, remarks on-Phlegmon-266. -Erythema, treatment of,-266. Influenza probably a slight grade of Goal fever-72. -the most universally contagious disease-} 207 -mild, generated in crowded assemblies-} 78. -treatment of,- Injection for Typhus fever,-171. -Diarrhœa-301. Intermittents, theory of the recurrence of,-114. -treatment of-palliative-radical-192 to 196. Intermittents, vomits or purges unnecessary previous to the exhibition of Bark, if vomiting or purging occur spontaneously} 195 Intoxication, a sort of Apoplexy-how removed-247. -used as a remedy in Tetanus-278. -if it would be serviceable in Fatuity-236. Ischuria, treatment of Clergymen & Judges very liable to it-& why-} 303. -attendant on pregnancy-how relieved-} 316. Itch suddenly checked, bad effects from,-137. -treatment of-307. J Jaundice, general effects of,-141. Johnson Dr. Anecdotes of,-47. Joy is a powerful Stimulus-102. -excessive-ill effects of how obviated,-240. K Kidnies inflamed, diseases produced by-Remedies. 142. 252. Kitchens underground unfavorable to health-76. L Larkspur, infused in rum kills Lice-307. Lent, a wise institution-41-82. 106. Leprosy, a disease of the Skin, with febrile action.-138. 283. -is perhaps the cause of the dark skin and wool of the Negro-} 145. -sometimes produced by salt provision-87. -Theory and treatment of,-283. Leucorrhœa, treatment of-315. Light, the gentle stimulus of, induces sleep- Candle in a Patient's room may be useful-} 36. 77 Linen, disadvantages of as an Article of dress- Liquors all distilled or fermented produce Gout,-91. -should not be taken between meals-92. Liver suffers in all cases from Marsh Miasmata,-67. -inflamed, diseases from-141.268. -sometimes absorbed in Hepatitis-269 London, according to Dr. Price a man shortens his days who settles there before 30-74 Longevity means of attaining,-164 -of ancestry, gives some ground for hope in some Cases-} 8 Love, effects of,-102.237 -does not cause dreams of it's object, when at it's height,-} Ibid. -no age exempt from it's effects-Anecdotes-Ibid. -cure of,-238. -criterion to discover it in women,-237. Low Spirits, see also Hypochondriasis,-284. Lues, effects of-how treated-139. 311. 313. Lust, morbid effects of-how obviated-singular case, 240. 104. Lymphatics, diseases of, affecting the whole system,-139. M Madeira, Gout unknown in that island,-43. Male, body & mind, peculiarities of the,-51. Malignant state of fever-most violent when it comes on without chill-treatment of,-} 185. 187. -excited by Laudanum-how cured- 187. Malt-Liquors, improper for sedentary persons,-43. Mania, a disease of, the Brain, Nerves & arterial System,-212. -seldom appears before puberty-exception-133. -is a fever-it's analogy to other fevers,-213. -a chronic-delirium, an acute affection of the Brain 214 -is frequent in countries, where Pride is the predominant passion as in Spain-} 215. -why maniacs wound & lacerate themselves applied to illustrate the Doctrine of Hell-} 222 -atonic, symptoms of,-221. 223 -Remedies for tonic & atonic-224. 228. -return of old habits & associations favorable, 230. -an habitual disease, & of affection. 231 -unfavorable symptoms,-Ibid Marriage at what period of life most proper-54. -diseases from,-122. -cares of, prevent Hypochondriasis, and Hysteria-} Ibid. Martyrs, source of their resolution,-34. Mastication cures the sick headach if slight Marshes & Millponds, noxious unless shaded by trees 75. Measles, produced by specific contagion,-77. -eruption of & of small pox out at the same time-79. -preparation for, as useful as for small pox-254. 255 Medicine, old books of exceedingly imperfect,-1 -false systems of, remote causes of disease,-110. and the use of, without the advice of a Physician, 111. -specific influence of, on some of the systems,-151. -the most important secret of,-145. Medicines, of weak powers sometimes act when strong fail, 152. -having lost their power of acting on one part, will let on another. 150. -various classes of See Therapeutics,- -are only relatively good,-164. Melæna almost always fatal,-259. Memory distinguished from reminiscence,-29. -modes of assisting-234. ibid. -nothing lodged there appears ever totally lost,-30. 233. -remote causes of it's defects-4 species of,-232. 29 -cure of,-233. Menorrhagia, Menses, see Catamenia,- Mental inquiries,-28. Mercury acts specifically on the Lymphatics & Glands,-127. -is the Sampson of the Materia Medica, 170. Miasmata marsh, remote causes of disease,-65. -must be acted on by a heat of 80 degrees & combined with moisture, not liquidity} ibid -stimulate the arterial & nervous systems vitiate the Bile-cause Dysentery as well as fever.} 67. -act most powerfully about Sun-rise & Sunset. 68 -hence safer to travel at midnight than morning & evening ibid -human imbebed by Linen Clothes more readily than by wool or cotton, but not retained so long-} 68 -may be generated in a human body so as} to infect itself-engendered mostly in winter & concentrated by Cold-} 69 -adhere to walls of wood or stone, but not to earth, floors, or white-washed walls,- -do not act except on persons debilitated- } 70. -diseases from,-71. -how distinguished from those from marsh,-72. Miliary fever, not contagious-effect of hot Regimen-79. Milk, the secretion of, much affected by passions of the mind 48 -seldom the vehicle of disease-Ibid. -an aliment of a mixed nature,-41. 83. -diseases occasionally produced by,-83. Mill-dam near Harrisburgh produced a fatal fever,-75. Mind male & female, difference between-51. Moon, effects of the, on fish & other Animals,-40. -influence of the, in fevers & other diseases,-175. 77. Moisture, a certain portion of necessary in the Atmosphere,-62. Montgomery General, anecdote of,-109. Morasses, completely over flowed, not unhealthy,- -exhalation is the source of disease,-} 66. Motion seems essential to pleasure,-33. -inability of & pain in distinguished, their cases, 148. -excessive produces of universal indirect debility-100 Morbus pediculosus treatment of,-307. Moses, why he made the Israelites drink the Golden Calf, 290. Mountainous countries are generally healthy-75. Mustard cataplasms not to be left on above 3 hours,-172. N Nails sometimes the only part tinged in yellow fever,-10 Necessaries contents of soak thro' a clayey soil 20 feet, and further thro' a sandy one, therefore may affect the water-} 90. Negro, theory of his black colour & woolly hair,-145. Nerves seem to have some exclusive diseases-131. Nervous system includes Brain, Nerves, Tendons, Muscles,-24. -Nerves probably end in the Brain, not begin there, 25. -diseases most common in Cities-74. -affecting the whole system,-129. Nettle-rash a disease of the skin, sometimes brings} 137. the other systems into sympathy-} Night-Caps tight sometimes produce Vertigo-93. Night-mare uses of,- Nitre imprudently used, effects of,-112. -often offensive to the Stomach in Bilious fevers,-166. -deflagrated produces pure air,-170. Nutriment, scale of,-42. Nutrition, probably carried on by Arteries-51. O Odontalgic State of fever,-263. -Remedies for & preventatives, 264. 265. Odours are a stimulus to animal life,- Oil sweet, constantly used by Turkish women during pregnancy-their labours are always easy-} 55. -has been applied to the whole surface of the Body in some fevers, particularly Plague-} 166. -has been serviceable in the cough of Pleurisy,-167. -& Wine a removed Colic in the late King of Prussia, -relieve fresh wounds-} 166. Old-age, diseases from-proximate cause of,-146. Onions habitual use of, recommended in Apoplexy & Colic, 246. 300. Opthalmia should often be treated rather as a symptomatic than a primary affection-} 261. -causes of-remedies for the tonic state-Ibid. -for the atonic-case of Hawkins-262. Opium, imprudently used, effects from,-112. -acts as a stimulus to all the Systems-169. -use of, in relieving pain,-162. -praise of-rules for its exhibition-169 -excessive dose of, causes a malignant fever,-187. which must be treated as other malignant fevers, Ibid. Otalgia, treatment of,-265. -abscess & deafness succeeding it, prevented by bleeding, 266. P Pain, causes of,-33. -perhaps not necessarily connected with parturition-55. -only a symptom of disease,-58. -should not be neglected in the cure of disease,-162. -seldom a criterion of the danger of a disease,-177. -why better endured by women than men-177. 34. -habitual return of, favorable in Mania,-230. Paint, the source of many nervous diseases,-98. Palsy affects the whole nervous system-247. -in recent cases of, stimuli must be used cautiously, 159. -an inferior grade of Apoplexy-sometimes succeeds it-sometimes symptomatic-247. Palsy, women said to more liable than men to,-248. -precursors of-cure of,-Ibid. Paronychia, treatment of,-267. Parturition, means of obviating the pain of,-55. -treatment after,-317. Passions, remote causes of disease,-102. -diseases of-torpor of-how treated,-236. -singular case of a mercurial ptyalism in a Lady of Virginia, deranged after parturition-} 236. Pathology, Gaubies treatise of of little use,-56. Patient should never be deserted in an acute disease,-184. Pediluvium dangerous effects from the incautious use of, 112 Pepper, advantage of, as an article of diet during the prevalence of bilious fevers-} 189. Perspiration is an excretion,-50. -supprest, [crossed out] not the cause, but effect of cold & fever,-51. -supprest the source of some diseases,-99. 137. -further remarks on,-137. Peter the Great was born with an aversion to water-296. Phantasms, visions, apparitions &c accounted for,-326. Pins often remain long in the Body-Case of- one that came out of the Vagina,-} 97. Plague is a high grade of Typhus,-71. 185. -destroys sometimes as suddenly as Apoplexy-187. favoured by moisture, destroyed by liquidity- -not propagated by contagion above 8 or 10 foot- -spread by Dogs & Cats-} 186. -preventatives-may be inoculated.- -remedies-} 187. Pleasure, cause of-of the senses.-30. Plethora, change of the Arterial to the Venous-119. -diseases from this source-good health when established. Ibid. Pneumony & Hepatitis change into each other-143. -a symptom only of general fever,-200. -the appearance of its characteristic symptoms much influenced by Blood letting} Ibid. Pneumonia vera treatment of-no attention is to be paid to days or duration of the [crossed out] disease if the pulse indicates bleeding-} 201 -blisters without waiting for blistering point vapour of boiling water-Garlic Syrup-} 202. -notha-pulse not to be attended to V.S.-} Ibid. plentifully, then Opium, Vomits, Blisters, Vapour, stimulating drinks,} Ibid & 203 -typhoides, a dangerous disorder-treatment- -vomiting at its commencement unfavorable, -cold air improper in, except in that which succeeds Measles or Small Pox-} 203. 204 Pneumonicula, see Consumption- Pomatum, frequently a cause of Head-ach,-98. Porter preferable to other Malt Liquors in Typhus-168. Poisons, a relative term-affect one system and not another-how divided-} 93. -act in different ways & on different systems,-94 -Death how caused by,-95. Pregnancy, diseases to which it predisposes-are particularly those which are contagious & inflamy-} 123. -diseases from how treated - 315. Prickly heat often prevents Y. fever in the W. Indies-138. 283. Priapism sometimes occurs in the close of fever-180. Public & private patients comparative advantages of, Puerperal fever, symptoms of-treatment-317. -prognosis-318. Pulse, observations on the facts of it's healthy state,-10. -it's natural state in old age is to intermit,-ibid. -affected by sex-by society & Civilization-11. -by size-Climate & seasons-different times of the day-Food & drink &c &c - } ibid. -deviation of the Radial Artery to be attended to-12. -morbid states of the -ibid. -directions for feeling the,-16. -frequency, the least important point-17. -least sure indications from in affections of the Head-18. 165. Purges, dangers from the imprudent use of-kill many children in supposed worm fevers.-} 110. Purging, inadmissible in Typhus, unless a morbid secretion of Bile be apprehended,-} 173. Pyrosis, remarks on,-291. Q Quack-medicines, murders by,-112 R Rains, when moderate further the progress of Marsh Miasmata-violent destroy them-} 66. exception to this last rule,-Ibid. Reapers, a dryness on their skin, sometimes produced by excessive heat, fatal if not relieved,-} 61. Religions, remote causes of disease,-105. Respiration, the only mixed animal motion,-20. -commencement of, attributed by Berkley to the will-objection-it's uses.-} ibid. -why differently performed in the 2 sexes-21. Rest excessive produces universal direct debility-100. Rheumatism translations of-142. -is acute and chronic,-211 -remedies for the acute,-Ibid. -chronic has 2 stages-Treatment,-212 -anasarcous legs occasional symptom of, Ibid. -a chronic kind of, affects the Teeth,-265. Rickets, cause of-probably a deeper seated Scrophula, 139. Ring-worm is an animal-how destroyed,-307. S Sailors, why freest from ship fevers in warm latitudes, 69. Sal. Volatile, acts both on the arterial & nervous systems, 127. Salivation, almost infallible in Diarrhœa,-301. -should never be omitted in Chronic Diseases, 315. -may be too long neglected in Colic-300. -difficult to excite in Epilepsy,-295. -should be used in Intermittents, if they do not yield otherwise-but this is rare-} 195. Salivation, proper in Dysentery,-199. -difficult to excite in Consumption,-206. -useful in Cynanche Trachealis,-210. -in Hypochondriasis,-217. -in Tonic Mania-226. -in Atonic-229. -in torpor of the passions-a curious case-236 -in Hydrocephalus internus,-251. -in Dropsy-253. -in Small Pox,-254. -in Hepatitis,-268. -Tetanus,-278. -in Idiocy,-235. Scarlatina, distinguished from Cynanche Maligna,-210. 78. -a primary disease of the skin, but affects other systems, 136. -treatment of-210. Scrophula, a disease of the Lymphatic System, it's effects on the other systems,-} 139. 275. -treatment of, -161. 275. Scurvy seems a misplaced Gaol-fever-283. Sea-shore Air unfavorable in Asthma & Consumption,-75. Secretions, observations on,-47. -vitiated, diseases from,-140. Semen, diseases from it's retention,-100. Semicupium, good effects of in Colic,-299. Seneka, useful in pneumonicula,-206. -seems to sweat without stimulating, hence useful in Rheumatism,-} 211 -highly valuable in Cynanche Trachealis,-Ibid. -in Pneumonia Vera,-201 Sensation, laws of-25. 33. Sensations particular, are sometimes transferred,-26. Senses do not deceive us so much as they are represented sometimes to do-} 28 -pleasures of the-30. -are often sharpened about the Crisis of a disease,-} 179. Servants of the Kings of Spain and subject to Nephritic Complaints from long standing,-} 106. Shoes, tight have produced Apoplexy,-243. and Colic-298. Sight, pleasures of,-32. Single-life diseases from,-122. Sitting up with Patients highly important in -critical periods of diseases-}-3. -improper in Typhus,-172. Situations particular remote causes of Disease,-74. -changes of, their effects,-75. 76. Skin, diseases of, affecting the whole system,-136. -affections of, change their situations-143. -general affection of, in the Negro-145. Sleep, causes of-35. -effects of [crossed out] habitual stimuli in producing,-36. -renders the system less able to resist cold,- is sometimes induced by the gentle stimulus of the morning light-Error of aged persons with regard to the quantity of their sleep,} 37. -in excess, diseases from,-100. -Ancedote of a Dutch Physician,-ibid. -by what means prevented,-101. -induced both by direct & indirect debility,-35. practical application in giving Opiates,-36. -cautions with regard to in Typhus,-173. -long & deep at the beginning of fever a bad sign,-182. restores the System by equalizing excitability & Excitement. 35. Small-pox Symptoms of,-77 -& Measles may be out on the skin together,-79. -preparation for,-85. -a disease of the Skin, but affects other systems, 136. -singular case of a Gentleman in Maryland, 138. -malignant form of, may be prevented by bleeding-good effects of Mercury in.} 254. -Anomalies in the Eruptive fever of,-Ibid. -where the Arm is much inflamed, the poison is often thrown out.} Ibid. -Convulsions of, checked by a stream of cold air-276. Smell some particular instances of,-27. -pleasures of,-32. Smiles on the countenance of dead persons, probably proceed from pleasureable sensation in their last moments,- } Ibid. Smoke, efficacy of in malignant fever,-170. Sneezing often a premonitory symptom of Catarrh,-21. Somnambulism, remarks on-cases-treatment-38. 241. Sores suddenly healed sometimes affect the arterial and nervous systems,-} 137. Sounds, influence of in supporting life,- Spasmodic state of fever,-276. -diseases more common in England than America. 278. Spasms, remarks on, division of,-131. 276. Speech how formed,-22. -elegant one of Corn planter-101. Spices taken in excess produce Dyspepsia,-88. Spirits in what cases admissible as Medicines,-168 Sponging recommended in Typhus,-Ibid. Sports of boys, remote causes of disease,-108. Stimuli, general observations on,-150. -proper in the commencement of Gaol fever only- 152. -of the most gentle kind should be used in Syncope & Asphyxia,- } 158. -where they should be administered in such a degree as to produce much pain-} 159. -should be used constantly in Typhus,-168. -internal may be applied externally in Typhus with advantage,-} Ibid. -external list of-see Therapeutics- Steel, Sydenham's observation on it,- Stomach, when full, fortifies the system against cold,-46. -diseases of, affecting the whole system,-134. -may be called the Coffee House of the System,-Ibid. -& Bowels, diseases of, often change their situations,-143. Strammonium, acts specifically on the Brain,-127. Students often suffer from Gravel & Dyspepsia,-107. Study, excessive a remote cause of disease,-102. Suckling often predisposed to pulmonary Consumption. 123. -should be left off very gradually,-124. Sugar in excess produces Dyspepsia,-88. Sulphur acts specifically upon the skin,-127. -use of, in convulsions of the muscles-Theory-163. Swamps shaded by trees, are not unhealthy-66. Sweating medicines, effects of the imprudent use of,-112 -state of fever, treatment of the,-196 Sympathy & Antipathy, remote causes of Disease,-113. Syncope remarks on, treatment of,-133. 158. 295. Swelled Legs after parturition,-316. 319. -occurring in Hysteria, how distinguished from Anasarcous Legs.- } 281. System, different conditions of, as remote causes of disease,-} 121. Systems, the Body divided into seven-126. important application to practice.-127. T Talness excessive, disposes to Gangrene of Extremities-11. -unfavorable to longevity,-125. Taste, sometimes transferred after the loss of the tongue-26. -pleasures of,-32. Tarantula, observations on the,-194. Tabes Infantilis, history & treatment of,-323. Tea, observations upon,-42. 88. -morbid effects of, wakefulness &c,-43. 89. Tears, signs of moderate Grief,-103. Teeth in transplanting, use an old and dry one,-265. -sound teeth are sometimes affected by Rheumatism-Ibid. -decayed often cause Head-ach-309. Prognosis from, in fevers-180. Temperaments, remarks on-prescriptions to be adapted to-121 151 Testicles enlargemt. of, produced by Cayenne Pepper-88 Tetanus liable to be excited by wounds made with sharp Instruments-Theory of it's cure,-276. -a disease of the Muscular System,-129. -causes & cure of,-Ibid. 277. Tetters, how removed,-306. Therapeutics, difft. arrangement from Cullen's-149. -Article (1) Of the supposed powers of nature in curing diseases-} Ibid. -Article (2) Of Medicines which remove morbid action by abstracting stimulus either directly or indirectly, & diffusing it equally through the whole system,-} Ibid. -Article (3rd) Of Medicines which remove morbid action by exciting a stronger and healthy action in the diseased part, or in some other part of the Body-} 150. -Stimulants-these are Stimulants-their action-Ibid. -laws of action in the Body-applied to regulate the exhibition of stimulating medicines -cautions with regard to their exhibition-} Ibid. -when they have lost their effect on one part of the system, will act upon another,- -should be administered in small doses at the beginning of a disease and why- -excessive doses of, injurious- -of small force have produced effects in which stronger ones have failed-} Ibid. & Seq. -Article (4th.) Of Medicines which remove morbid action in one part of the Body, by exciting it in others, less essential to life-} 153. -Practice of Medicine generally founded tho' unconsciously, upon this plan- Pain as well as morbid action thus diminished. -cautions in administering such Medicines -effects of stimulating passions may be referred to this & the preceding head-} 153 &c Therapeutics Article (5th) Of Medicines for preventing the recurrence of the disease, by removing predisposing debility-} 154. -Rules for the exhibition of Stimuli under this head, durable ones, as food to be preferred, and to be prescribed even where appetite is wanting-prescribe many meals a day. full meal to be avoided-scale of Stimulus in food-drinks that stimulate durably & gently -Cold Bath-& in a warm room in winter- -Exercise-see Exercise,- -Travelling or change of Climate recommended -Night Air, damp Air & Venery to be avoided- -early going to rest important-Flannel should be worn under Breeches & Petticoats- tight Ligatures to be avoided-especially in lying down in the day time- -Of Medicines which over come simple debility- -cautions in their use when the excitability is accumulated-in Palsy &c -of the most powerful kind when excitability is exhausted-even so as to be painful- -how used in Gangrene-} 154 to 159 Article (6th) of Medicines which remove diseases by abstracting redundant & foreign matters, and which offend by quantity or quality} 159. 160. Article (7th) Of Medicines which remove diseases by mixing with, & thus destroying matters which offend by their quality-} 160. 161. Article (8th) Of Medicines which cure diseases} by removing obstructions-} 161. Article (9th) Of Medicines which are supposed to cure diseases by changing the quality of the fluids, or the texture of the solids-} Ibid. Therapeutics Article (10th) Of Medicines for relieving pain- Opium when to be used with this indication bleeding-fasting &c &c- sulphur in the pain of Convulsion-} 162. 163. Article (11th) Of the means of attaining longevity- Conclusion of the subject of Therapeutics-} 164. Thirst, causes of, ambiguous symptom in fevers-44. -prevented by bathing-47. -produced by joy in Bruce the Traveller-102. -when absent in malignant fevers, invite the Patient to drink-} 166. -absence of, at the beginning of fever, a bad sign-182. Thunderstorm, case where it always produced Headach,-77. Tinea Capitis, how cured,-306. Tobacco, disrelish for, often a precursor of Disease, & a returning relish for it, of recovery-} 109. -case of it's producing sickness, from being chewed on an unusual side of the mouth,-} 151. Tongue, signs of disease from the,-179. 8. -intimate connection with the whole system-26. Tooth-ach, see Odontalgia,- Touch, seeing, hearing & tasting perhaps only- different modifications of-} 26. -delicacy of, increased by fasting,-ibid. -Pleasures of-31. Tragedies, morbid effects of,-108. Trismus nascentium, remarks on,-277. 320. Turpentine may be taken as freely & safely as food-158. Tympanites, a primary disease of the Bowels-136. -effects of, on the other systems,-Ibid. -case of, from gulping down cold water in large quantities-} 91. Typhus mitior, description of,-71. 175 Howard met with none in the Gaols on ye Continent. 72. -is a disease of Cities-74. -in fevers of this class curtains should be taken down, & the Bed drawn into the middle of the room-} 70. -general treatment of,-168. -cautions about suffering Patients to rise 172 in this state of fever-& with regard to Sleep-173 U Urine, diseases from retention of,-98. 183. V Vegetable diet, diseases from,-83. Venereal appetite, as a remote cause of disease, 104. -singular case of a Gent.n in Massachusetts, Ibid. -moral application of,-54. Vertigo sometimes caused by tight Night Caps-93. -treatment of,-250. Viscera, diseases from local affections of,-141. Visits to lying in women censured-109. Voice & Speech-22. Volatile Liniments should be applied to the Belly in Typhus 172. -alkali valuable in Typhus & Pneumonia,-168. 202. 203. Vomit black, how checked,-191. -different species of,-273. -no instance of recover after the genuine, 270. Vomits ill effects from the imprudent use of,-111. -highly useful in the Typhoid state of fever-167. -if good in Apoplexy?-244. Vomiting at the commencement of Pleurisy is a dangerous symptom-} 204. Veins, irritability resides in many of the,-24. W Wakefulness, causes of, cases of long continuance of, -less dangerous than might be imagined-} 101. -sometimes the precursor of Madness-102. 284. -morbid, how treated-remarkable Case,-249. -further remarks on-284. Walking case of Yellow fever,-271. -exercise of, proper only in slight indisposition-157. Water, diseases produced by, from being taken when the Body is much heated-from it's sensible qualities, from mixture with Salts or other impurities-} 90 -should not be drunk going to bed, or between meals, or at rising-} ibid. -used in family, should be inspected in all chronic diseases especially of the Bowels-} ibid. -boiling, where admissible as a Blister-172. Weakness congenial predisposes to disease,-125, White limed Walls will not imbibe the Contagion of Plague-} 186. Wine sweet most nutritious-Red least wholesome-43. -test for detecting Lead in,-ibid. -morbid effects of,-91. -produces Gout in proportion to it's acidity,-Ibid- -two fatal cases from the injudicious administration of it in attacks of fever- -white, where preferable to red-} 168. Winter more unfavorable to human life than Summer. 65 Women, why they endure pain better than men,-34. 177 -peculiar diseases of,-314. Worms-remote causes of disease,-sometimes exist in the Bladder without injury-} 95. Lumbricus is perhaps useful & necessary-} -idiopathic worm fever questioned-} 323. -symptoms of,-322. Y Yawning, use of,-22. Yellow fever, remarks on,-190. 269. -of 1798 history of,-270. -yellow colour in is fugitive & local, 190. -means of checking the Black Vomit-191. Yellow water of horses in a true bilious fever-191. Z Zinc, effects of in Epilepsy-293. -vitriolated, useful in Angina Pectoris-285.