[pg 1] Clinical Lectures by Dr. Robert Whyte. Fevers in General We shall chiefly insist on the case of Eliz: Cameron. her Disorder is evidently a Continued Fever, as appears not only from the symptoms but also from the progress. These Disorders are frequent in the Winter Seasons & sometimes in the Summer from Cold; Physicians have differed considerably in their Definiti[missing] of a Fever; Some would have it consist out in a quick Pulse, but this alone does not certainly constitute a Fever, because Exercise, Eating, and Drinking do all quicken the Pulse, we must therefore add Headacks, sickness, thirst and a kind of agitude about the Pericondr[missing] But even these will not compleat t[missing] defin[missing] Definitions, as all fevers are not accompanied with Headacks, as the Hectic, but although the Headacks attend most Fevers, in some it is so slight as to escape the Patients notice. Others affirm that shuddering should be taken into the Definition, and with it quick pulse and Headacks. This however will not comprehend every fever, especially these of the slight kind in which the shuddering does not take place. Having now stated the different Opinions about it let us now attempt a true one, and [missing]ttribute it to every increased motion of the Blood, hence Eating and Drinking and Exercise produce a temporary fever, which as the Causes are not permanent [missing]m goes off, tho’ sometimes indeed they [missing]roduce a Fever which may last a Considerable time. An obstruction of the [missing]erspiration in Children may produce Fever. which for the most part goes [missing] in 24 hours. On the other hand, the same [pg 3] same Cause proceeding from relaxed Fibres or a Vitiated state of the Blood, may produce Fevers of a dangerous kind, thus much we thought necessary in the Definition of Fevers, we shall in the next place add a few observations on the Division of Fever. Most Authors divide them into the Continuall and Intermittent, these last are such as leave the Patient quite free, but return again at stated times. Again these is another Class which is commonly attended with Eruption on the skin as the Measles, small Pox, Plague &c which Another Division is into the Symptomatic and Idiopathic. The forme[missing] are such as arise from the Inflammations of particular parts of the Body, or when it is not the Original Disease, but Consequ[missing] as in an Angina, Plurisy, Peripneumony, Phrenites Hepatis, Nephritis &c but to take one as an Example of the Phrenites there the fever is not the originall Cause, but a Symptom of the Inflammation of [pg 4] of the Brain and its Membranes, the same will hold as to the rest, the Lungs, Pleura, Liver and Kidneys bring the same Cause of the Fever. Among the Symptomatic may also be reckoned the Symptomatic the Hectic Imean or such as proceed from Ulcers in any part of the Body. These fevers that attend a Diarrhæa & Dysentery & other unnatural Evacuations are of this kind, as well as those that arise from Crudities in the Primæ Vice, [missing] Worms. With regard to the Idiopathic, they are such as do not Depend on the Diseases of any particular part, but proceed from some fault in Blood, or a general Indisposition of the Body, when the fever may be reckoned original, such arise from obstructed perspiration, for this produces the quick Pulse, & without any Disorder in any particular parts. A Fever of this kind [pg 5] kind is likewise kept up by the Indisposition or acrid state of the Fluids, which may Continue for many weeks without any pain, such Cases I have frequently seen, when people have been ill of Rheumatic Fevers, & after the pains were removed, the quick pulse Continued, this was entirely owing to the bad state of the Blood, when the humours in general are irritated. The Fever which likewise attends the Measles, small Pox, and Rush may be called Idiopathic, because they do not proceed from any Disorder in any particular part of the Body, but from some acrid matter in the Blood, which may be exhaled by the skin the Heart being stimulated by it, hence the Symptoms in those Diseases are increased by a Disorder in any part, this in the Measles if the Lungs are inflamed, the Disease is reckoned more dangerous [pg 6] Dangerous. Among these last we may rank the Ardent, & common continual Fevers, such as our patient labours under, and the putrid Hospital orgaol Fever. and nervous, tho' these may be said to be symptomatic as proceeding from various affections of the Brain or its Membranes in Ardent. N.G from a Dense state of the Blood, and firmness of the solids, an obstruction of [illegible] Brain produced and a Violent fever brought on, by which the Patient is taken off in a few days. In the common Continual Fever the Obstruction is less of an Inflammatory Nature, on account of the Blood not being so Dense and the Solids less firm. In the putrid fevers the Disease is in the Brain, or its membranes, and seems to resemble that Inflammation which attends [pg 7] attends the Malignant and Gangrenous sore throat; Somewhat of this kind attends a Phrenetis, & in this state the Blood and humours have a great tendency to Putrefaction, hence these pimple spots which attend the Fever &c for as long as Health Depends on a Circulation of good Blood, so soon as it iritated the whole laconomy must be Disturbed. In these Nervous Fevers where the Patient complains little, where the pulse is not much quicker than in Health, the Heat not great with an inconsidurable thirst, in such Caves I say we may suspect obstruction in the Medullary substance of the Brain, & past in the Vessells that are much smaller than those who carry the Blood, by which means an Inflammation does not follow immediately, hence the symptoms are ruled but if it [pg 8] it grows more Violent, a larger series of Vessels may be obstructed, or affected with spasmodic Contractions, this increasing the Disease may at last bring on a true Inflammation of the Brain, and the Patient becomes highly Delirious before Death. I have often observed that 3 or 4 Days before when the patient had no considerable Headacks, and where the Eyes looked well, the Tunica Conjunctiva became red and Inflamed, therefore I was led to conclude that the Brain or its Membrane were truly inflamed; Upon the whole then. that in the ardent common Putrid Fever, that tho’ great Danger proceeds from the affection of the Brain. our principall regard therefore should be directed towards the Head, and should treat them as an Inflammation of that hurt, and besides [pg 9] besides the general Evacuations, we should apply such remedies as may tend to preserve the head and to treat it as one would do an inflamed Eye. We shall now begin the particular fever to account for its Causes & Symptoms with which our patient is affected. The Cause seems to be Cold, at this time we can scarcely impute it to any other thing. Physicians have differed greatly in accounting how an Obstruction of the perspiration should Cause Diseases. Sanctorius looked upon the obstructed perspirable matter as becoming putrid Ichor. Dr Keill differs from him and Denominates that a Cold from wet feet, but the Dr did not recollect that the perspiration obstructed in the feet may produce an Obstruction of it all over the Body merely by Sympathy, therefore [pg 10] therefore the Drs account account is not a sufficient reason to Sanctorius. The perspiration obstructed may hurt in two ways 1st by the Quantity, and next by its Quality. When obstructed it must fall in some part of the Body, if on the Nose it occasions a Coryza, on the thachea Cough,& in the Intestines purging. It may hurt by its Quality in containing particles of an acrid nature, tho’ the perspired matter that falls in a Glass seems to be mere water, yet when breathed over again it becomes putrid & poisons the Animal. This then retaind & circulating with the humours may acquire a Degree of Acrimony, of which we are not aware. Sometimes no disorder follows from a true outlet not being allowed it, by the skin, but then it is carried out of the Body by some other Evacuation. Secondly, many effects of Cold are to imputed [pg 11] imputed to an Obstruction of the perspirable matter, for there is another impossible way in which it may occasion many Disorders. E. G. When a part of the Body is exposed to Cold, and the perspirable matter obstructed in that particular part, it may produce its effects by changing the Diameter of the Cutaneous vessels, thus the pores of [illegible] skin about the neck being constringed by Cold, the Arteries and Veins come of Course to be obstructed, in that particular part it may produce its effects by Changing the Diameter of the Cutaneous Vessells, and do not receive their usuall quantity of Blood, and then being thrown upon the neighbouring parts, produces Angina Coryza &c And farther the effects of Cold may reach the innermost vessels of the Body [pg 12] Body, and we may safely conclude that a Constriction of the Cutaneous Vessells, by making a Change in the Circulation may give rise to severall Disorders. When the Nerves of the Skin are contracted & affected. [illegible] whole Body will be thereby affected, as appears from Hamorrhages being stopt by cold water applied to the part may work Changes upon others. Dr. Heill imagines that Diseases which are commonly thought to proceed from Cold, are owing to something separated from the Air of a malignant nature, this is not however probable since Epidemic fevers are observed to rage at Different Seasons of the Year, but tho’ we may in general deny this Opinion yet it is certain many Diseases are produced, from something taken in from the air & mixed with the Blood, encreasing [pg 13] encreasing the Stimulus on the Vascular System, and is evident in the small Pox, Measles, & other Epidemical Disorders that raged in this Country, the first appeared in September 1758 & it prevailed only in Scotland, it began in Edinburgh first among the Children and then among the Old people, it soon spread to Glasgow & the Eastern parts and as far North as Inverness where it was less severe. Out of 60 Boys at Dalkeith Schooll 30 were seized with it. This Epidemic Disease could not be supposed to arise from the known qualities of the Air, as the Summer was very good & not too hot & several people were seized with it who were not Exposed to the Air. I knew a Woman who was confined to her Bed after Delivery who was seized with it. The second Epidemic was a fever which appeared [pg 14] appeared last May, we had it in about a forthnight after they had it at London. It is true that when it came on we had Cold winds, which many attribute the Disease to, but many Experiments show that the Disease was not owing to this, as it did not spread suddenly over all Scotland. It is a remarkable Circumstance that Children were not seized with it. tho’ they were soonest affected with the former Epidemic Disorders. The great Influenza of 17 5 which begun in Italy about Christmass, did not reach this place till February it was likewise over the greatest part of North America. Dr. Franthline tells us it was in the Island of Boston near Madagascar, & the other hot Climates could never bear the cold of the North. The most remarkable Epidemes probably are [pg 15] are not owing to any considerable Quality of the Air but something irritable that enters the Blood, and then acting as a ferment, irritates the Humours and may fall on the Different parts, & cause topical Inflammations. Thus much with regard to fevers in general, we shall now proceed to make some remarks on the symptoms of Eliz: Cameron. She was first seized with shiverings this almost always preceeds fevers. which is owing to a Constriction of the Cutaneous Vessells in consequence of the Nervous System being Disordered. It may likewise proceed from Obstructions of the Vessells, tho’ more rarely the operation of a purge in Delicate people produces Cold. from the Sympathy between the Nerves of the Bowels & these of the skin & what lessens [pg 16] lessens the Circulation produces Cold as Heat is the Consequence of a brick Circulation. 2d Headack, this is a common symptom in almost all Fevers whatever, & arrives from the Obstructions in the Dura Mater, and from the Substance of the Brain being affected. this contrary to the Opinion of Dr. Haller who affirms that the Dura & Pia Mater have very sensibility, but we all know it is not owing to the Pericraneum being affected, as it is not sore to the touch; upon opening the Head the Vessells of the Membranes are found full of Blood, hence we may Conclude that these only are the seat of the pain, & as to Dr. Hallors Opinion there cannot be a greater Blunder than to suppose that because these Membranes are not sensible in a sound State, they should [pg 17] should be so in a Diseased State. 3d Quick Pulse, this is owing to the Blood Stimulating the Heart, more than usuall, or to the Heart being rendered more irritable, or perhaps to both; whilst the shivering continues the pulse is small, caused either by the spasm or slow motion of the Blood to the Heart when this ceases the pulse becomes stronger. – Thirst, this proceeds from a quick Circulation & great heat, which Dissipates the watery part of the blood as appears from Exercise; It is often observed in Fevers, that patients do not sweat, but tho’ they do not there is still a considerable perspiration which proved by a patients drinking 8 pints in 24 hours time, and passing only 4 by urine. The state of the Stomach too at that time may be another [pg 18] another Cause of it, for we find when the Stomach is in good order, and a free flow of the Saliva, the thirst is likewise increased in Fevers by putrid & bilous matter lodged in the firmæ vice; White tongue is owing to the imporousness of its Vessells, and its Crust, is owing to the Viscidity of the matter secreted from there. There is one symptom which she has not Viz: Vomiting This is an attendant symptom in most Fevers, & generally arises from three causes, first from acrid Stuff, or other Crude matter in the Stomach, in this case there is less Danger, for a Vomit will cleanse the Stomach. – Second from the febrile matter falling on the Stomach and irritating the nerves, This happens sometimes in the small Pox & Measles when it falls on these parts [pg 19] parts before it is exhaled by the skin. Third Cause is the worst. Viz: when it arises from an affection of the Brain, there being no Disorder in the Stomach & acting entirely by Sympathy, the Stomach in this Case will be so liable to be affected, that lying in Bed will bring on Vomiting. Disturbed Sleep and Dreams. – This is owing to an irritation of the Brain, from obstructions in the Dura Mater, when this irritation is great it occasions Delirium, when this Irritation is less & Compression more it brings on Sleep Cornea &c When our Patient came in here, her pulse was not full I did not advise her to be blooded, but ordered the Enema Dormiens; It is always proper to keep the Body open. The spt. Minderir: &c was [pg 20] was to promote sweat; The next Day her pulse was quicker, and the Clyster did not operate. I ordered a stronger on & at the same time Iulap: Diaphoretic: as her pulse was small & quick & her head affected. I ordered Leeches to each Temple, & a Vomit next morning, the reason of which is, that it is always proper to promise Evacautions, to the Exhibition of Vomits as they make a push on the head & hence would be safer when the Vessell of the Head are somewhat Emptied by Leeches. 28th . The pains in her back may be owing to something in her Stomach because after the Vomit it grew easier. The Leeches were applid to her head, from Considering that most Fevers [pg 21] Fevers proceed from an obstruction in the Brain, & therefore after Bleeding if the pulse is softened, and the Fever continues, we should apply Leeches to the Head letting them bleed long rather than open a vein in the arm then if the patient is better which seldom fails to happen, apply more Leeches on the third day. & by this means the force of the fever is checked in the beginning: I have seen, Fevers where every thing promised ill, and by applying 6 Leeches to [illegible] Temples in the first day, & the same number on the Second, the Symptoms were generally mitigated, nor was there any appearance of a proper Crisis. There is one thing worth observing which is the great utility of Leeches Viz: there is scarce an Inflammation in the Eyes happening in Fevers, but what [pg 22] what is removed by this means, which Inflammation arises from that of the Membranes of the Brain. 21st – I ordered the Puli: Febrifug: Aritim: which is something before Dr. James's Powder. 22d her head was shaved in order to apply a blister, but as she became better it was omitted, The shaving would do good by increasing the perspiration. 25th. From this time she began to grow better. 27th. Sleeps more quiet. There is one thing worth notice, that we sometimes see the first signs of Amendment by the tongue. I have seen where I could not Discover the Advantage over the Advantage (the Disorder I mean) by any other symptom. The patients Tongue is now a good Deal cleaner and Moister towards the point. Observe that she has been obstructed [pg 23] obstructed since Whitsunday and it is probable she wont have a proper recovery till she menstruate. With regard to the Febrifug: Antimon: I always prescribe it only in this Disease, and begin with small Doses I use it as a sudorific and not as a specific, it is very uncertain in its Operations on growing Persons. I begin with grvi and after that you may increase it till it threatens to Vomit or purge, but I never see it do good as a Specific, when the Fever is great & the Eyes inflamed. Eliz: Glass. This patient had a slight fever much more so than common. for by the time she came here it was greatly abated, She had the common Symptoms of a Fever besides the weight about the Cartilago Ensiformis, this last may be owing [pg 24] owing to the obstruction of the Menses & what makes that probable, she is Dismissed, freed from her Fever and the weight still Continuing. I ordered the Enema Domestica to open her Body & the Ipecacuan to remove her Complaints in the Stomach, she from the triffling quickness of her pulse, might be comited without previous Bleeding. 8th I ordered her the Iulap: Diaphor: & Laud: Liquid to promote her rest & to promote a sweat. There was no Danger in prescribing these Medicines as she was not Plethoric. 9th Sickness at her Stomach for this I ordered R Sacra. 10th Complaining of Giddiness which is owing to weakness the reason is that the Blood in the inferior Vena Cava when she is standing, does not flow so readily to the Heart and the Blood [pg 25] Blood comes down from the Head more freely it is to be accounted for in the same way as a Paracentesis. 15th Sickness, on this account I gave her the mixture. 16th NO Complaints but what proceed from the obstruction of her Menses, but the Bitters will strengthen her Stomach & produce better Blood, she took the Bitters when she went & got but one Purge. 21st. When I ordered the Extract: Hellel: as an Emmenagogue, not that it has any specific Virtues, as Dr. Mead thinks, Aloes will stimulate the Rectum & Uterus by Sympathy Sal Martis strengthens the Stomach and the rest of the Body. Saffron is a good Cordiall and promotes the Menses, she is ordered a [pg 26] a warm pediluvium and yesterday was ordered a Vomit being a good Emenagogue Rheumatism We shall begin with some Observations on the Cases of our two Patients with whom we have Dismissed as Cured the one is Jannet Gray on whose Case I insisted formerly and tho' we employed various means of formentations &c I then thought of applying a Blister to the part affected, as Stimulants must be very inconvenient. I therefore neglected it substituting a Sinapism, this thro' Mistake was allowed to by too long, & took the skin from off her hands and thus it is when quacks make surprising Cures, where a regular Bred Physician would scarce know what to do. Since [pg 27] Rheumatism Since the application of the Sinapism who has had but three slight fitts, one on the 17th which might have been owing to the irritation occasioned by the Sinapism, after this she continue free till the 23d when she had a slight one; Ever since had not the least attack. The irritation produced by the blister on her neck, put off the fits for two or three days, and then it was that led me to apply the Sinapism to the part affected. The second patient hinted at is Lilly Davie. The Disorder was the small Pox of a good kind quite Distinct, hence it is unnecessary to say any thing about them, as we have given a Lecture on this Disease before on the Case of Drummond. Lily Davies was extremely mild, and turned on the 7th or 8th Day. For the sore throat I ordered her the bily Mucilage [pg 28] Rheumatism Mucilage & Syrup, and as she did not sleep well. I prescribed an Anodyne for her, when the Pox were near withered I ordered a Dose of Rhubarb with Colomel which before her Dismission should perhaps be repeated. Jannet Tom's Case seems to accknowledge a Cold for the first Cause that brought on a Rheumatism in her head and Neck, and was probably attended with a Fever tho' she has not mentioned it, this went off in two or three days, but was succeeded with a soreness thro' her whole Body, owning to the Rheumatic humours falling back on the parts, now as persons labouring under Rheumatic Fevers have their soreness likewise, we may therefore conclude her Fever to be of the same kind or nearly so; As her pulse was soft I [pg 29] Rheumatism I did not choose to have her blooded but in order to promote sweat, which I thought necessary. I ordered a Drink with Spt. Minderer:.- 17th The Sweat and Stools were owing to the pulse, Puli: Febrifug: Antim: for the pain in her back. I ordered the Balsam: Anodyn: but this was not so necessary as the pain was owing to a Disordered State of the Stomach. 18th – Her tongue red, and for the Dryness of her mouth I ordered her to Drink plentifully of Lintseed tea, the Vinegar was merely to cool & refresh her. I prescribed a Vomit to Cleanse her Stomach, which from her tongue, I supposed to be Disordered she now recovered apace, for her weakness I ordered her the Infus: Amar: with the Aq: Aromatic: ℥iv to render it [pg 30] it more agreeable to the last and make it ly easier on the Stomach. Observations on the Different kinds of Fevers. We shall now make some observations on the Different kinds of Fevers. There is scarcely any Disease that occurs so frequent as Fevers, nor do any that go under a general name differ so much from each other. I shall here mention the symptoms common to every Fever, as well as the Circumstances in which they Differ. In every Fever there is a greater quickening of the Pulse & heat than is usual & there are the Pathognomic signs, of almost every Fever, the quick Pulse is not what we are always to judge by, for sometimes it may be not at all quicker [pg 31] Rheumatism quicker than usual, tho' the fever be very high, The heat is indeed by far a more just Criterion & this therefore we are Chiefly to attend to. There are some Case where we must attend to when the Fever is attended with a great heat and Brought, while the pulse is not in the least quickened, Fevers of this kind happen to Children when they have Collections of water in the ventricles of the Brain, and to adults who are subject to a Lethargy, here there is a manifest proof that we cannot judge by the pulse; The reason why the pulse is slow in these Diseases of the Head & the Body not, is the prepare on the Brain, for this renders all Sensation Dull, & of Consequence the Heart will not [pg 32] Rheumatism not be Excited by the returning Blood, to Contract so frequently. 2d. In other Case the Degree of fever is much less than we might have Expected from the Quickness of the Pulse, and this happens to women [crossed out] whose Nerves are very Delicate, for here the quick pulse will arise from something disagreeably affecting the Nerves of the Stomach and Intestines, or from the great irritability of the whole Nervous System, hence in some Cases where the pulse is 120, we shall find the Patient very little hot or thirsty, in forming a judgement on the Degree of a Fever we are not to Determine it by the pulse alone, but by this combined with heat, and accompanied with other Circumstances, as the quick pulse & the heat, with [pg 33] Rheumatism with the Exceptions mentioned, are to be reckoned the Pathognomic signs of a Fever, so the proximate Cause of every Fever is one and the same thing viz: a greater Stimulus affecting the heart this acid seize or putrid Blood will excite more quick Circulation, as happens in the Malignant Eruption from Rheumatic Hectic Fevers, Violent Exercise may produce the same effect, by accelerating the Motion of the Blood to the Heart, & consequently increasing the Stimulus. So likewise Inflammations of the Brain & its Membranes of the Stomach & Intestines, may occasion a fever by rendering the heart more irritable, & rriating the Blood. It is a mistake to imagine the fever is always the Cause of these locall Inflammation [pg 34] Rheumatism Inflammations, as in the Pleurisy, the pain first arises, the Fever is only Symptomatic. 3d. An uneasy Sensation in the Stomach and Intestines, from a putrid viscid matter, tough phlegm, Bile, worms & other Disorders, for these increase the sensibility of the Heart, by irritating the Nervous System. Upon the whole then it appears, that every fever is owing to a more frequent Contraction of the Heart, Depending on its greater irritability. Having said thus much on fevers in general, we shall next proceed to offer some observations on the Different kinds of Fevers; The [crossed out] Dangerous of all the Ephemera occasioned by too great Exercise or suddenly exposing the Body to Cold or errors in the Nonnaturalls, as hard drinking &c. Here there is no fault in the Blood [pg 35] Rheumatism Blood, nothing more appears than Heat, quick pulse & thirst, Children are more subject to it than adults, it goes of in 24 hours or 36 at farthest, if the Patient lies in Bed. & drinks plenty of diluting Drinks, to promote sweat; When the Causes producing it are stronger than usuall, or the patients Blood more Dense, or his Filnes more firm, the Disease may go on for Several Days, & the Symptoms are more violent, in this Case it has been called by Authors. Febris Continua Putrida, which is only an Ephemera to a greater Degree. it is cursed by lying in Bed, Diluting Drinks, that are generally acid and Bleeding. Febris Ardens. This has been called Hausa or burning Fever, there the heat & thirst are very great, perspiration very short & frequent. Tongue dry and sometimes [pg 36] Rheumatism sometimes black, great sickness, nausea and Inquietude, and the pulse is strong & quick, which indicates a violent Fever of the Blood, the persons are most subject to it, whose Blood is dense, solid, firm & Elastic, The former in this Case abound wt a greater number of Globules, hence quickly moved tho' the Vessels will acquire a greater Degree of heat, than wating Blood, especially if containing a greater quantity of Oil & Volatile Alkali, and from its greater Density not passing so freely thro' the Capillaries the pulse will be fuller & harder; In this fever the Blood is also covered with beef as appears from a Vein when opened, but this is not peculiar to this fever alone as we meet with the same appearance in Inflammatory Cases, proceeding from obstructions considerable in [pg 37] Rheumatism in any part of the Body, as in the Pleurisy Rheumatisms &c An Ardent fever is so violent it must soon end in Death or Recovery, it is often in the 4 or 5 Days and seldom passes the 7th. Cure. The proper Method of Cure is first bleed frequently, 2d to use plenty of Diluting Drinks, which should be whey made of Crem: Tart: 3d Emolient Glysters may be given twice a day with Nitre in them. The air of the Chamber should be kept cool, for which reason the Door of the Chamber should be kept open in Summer. Cloaths wrung out of warm water & vinegar should be applied to the feet and hands. No Indication for Blisters unless the Fever be complicated with some topical Inflammations or Phenzies &c as they can [pg 38] Rheumatism can otherwise do no service, but may increase the fever, nor is there any room for high Cordials or Wine. Nervous Fevers Nervous is a name given almost to every Fever now a Days, when the head is affected, or accompanied with Twitchings of the Tendons, but at this rate every fever may be called nervous as there are few dangerous when the head is not affected, but they ought to be called nervous every where when the nerves are affected, and are, the Chief cause & not the Effect. These Fevers are apt to deceive, medicall Tyro's, as they come on slowly and without shivering, the patient then finds no sickness at the Stomach but finds himself lazy, restless and unfit for Exercise & his spirits are flatter [pg 39] Nervous Fevers flatter than usuall, appetite impared tho' not destroyed, little heat or thirst the tongue for the most part moist, gets little or no refreshing sleep, the pulse never full, & never much quicker than usual, in this way it continues 7, 8, or 10 days, & the patient not finding himself greatly affected continues to go abroad as the cold air refreshes hin, & gives him spirits, after it has gone so far this way, the symptoms increase, the appetite fails thirst increases, the pulse is quicker, & now too late the Patient is obliged to keep within, & begins to take remedies, wn the humours are so far irritated, as to render his Cure almost impracticable for a Stupor or raging comes on in avery remarkable Fever. In common Continual fever Nature fortells the [pg 40] Nervous Fevers the coming on of a Delirium, from the Redness affecting the Membrana Abbuginea of the Eye, when the Vessells of the Dura mater are obstructed, but in these Nervous Cases, I have seen startings, Delirium. &c come on without any previous headacks, or Redness about the Coats of the Eye. In common fevers it is my opinion that the Dura Mater is first affected, about the time the Eyes begin to be inflamed, afterwards the Inflammation extends to the Brain but in these Nervous fevers, the inflammation seems to have its seat in the substance of the Brain first & the Membranes of the Dura Mater are affected in Consequence of this, In the Nervous fever too the Blood seems rather [pg 41] Nervous Fevers rather to be poor, and the proximate Cause is some obstructions in the Cortreall & Medullary part of the Brain, and not in these vessells which carry red Blood so this Obstruction may bring on an Inflammation. Nature does not at first produce Complaints so heavy, till by degrees it increases, & destroys all the functions & at last kills the patient. Cure. The Cure of Ardent Fevers consists in Bleeding, but as this is quite opposite to its Nature, and requires different methods of Cure, and so Bleeding is rarely made use off, except in those who are of a strong Constitution, and Plethoric, Blooding seems to be no more necessary in this Disorder, than in a Leucophlegmatic or Hydropic subject, so that it is seldom indicated. The Bleeding with Leeches in the head is of [pg 42] Nervous Fevers of Consequence, and in all Cases where the Patient (the Physician I mean) is in a doubt of this Evacuation by the arm tho' necessary he may nevertheless apply Leeches to the Temples. So likewise in Nervous Fevers if dispatch be necessary we may apply half a Dozen of Leaches to the Temples, to be indicated as necessary. They are more particularly usefull in such fevers, as will allow the Patient to be Bleeded once. 2d. Vomits are usefull in this fever, as they serve not only to Cleanse the Stomach but remove any viscid pituita which may obstruct the Brain. 3d The Belly should be kept open by gentle purges as a little of the [illegible] or emollient Laxative Glysters, may be given once in two Days the more Drastic purges are carefully to [pg 43] Nervous Fevers to be avoided, 4th Blisters are of great service in this Disease, as they serve to quicken the Circulation, & also to Drain the humours, Dr. Huxam & others advise them to be applied early & kept running thro' the whole course of the Disease, but whither or no they are of use in every stage of this Disorder is a matter of Doubt, especially so in such Cases where the patient roves much, Claeths wrung out of warm water & applied to the legs relieve the patient much & bring on Sleep, they seldom fail of Success, yet they do not compleat a Cure, they seldom fail of quieting the Symptoms. The common use of Blisters is to separate the Epidermis and inflame the Skin, I have indeed known some Patients in whom the Skin [pg 44] Nervous Fevers Skin was qite heal, which is a bad sign, in these and all the like Cases Cordials are highly indicated, for if the Stimulus of Cantharides is not sufficient to inflame the parts to which they are applied, there is little fear of inflaming the Body by Cordials, they are very proper in this fever when the pulse begins to sink, as Camphire with volatile Salts, the Musk Bolus, Puli: Contrayers: & Saffron the volatile Salts are much more proper here than in the putrid fever, as they attenuate the viscid pituita of the Blood , of all the Wines Claret is the best, either given pure or mixed with water. A Decoction of the Bark aromatised with Cinnamon water is also good, it removes obstructions attenuates viscid humours, & gives strength [pg 45] Nervous Fevers strenght, its being astringent is not to be heeded for it is very good in removing Obstructions in some Cases, as of the Glands in Scrophulous Cases. 5thly The Diet should be fuller than is generally allowed in Fevers, all Farinaceous Substances may be given & also Claret and other cooling remedies are to be prescribed. Malignant Fever The Cause of this Disease is hot, moist or Corrupt air of Hospitall, Prisons or Shops, or the use of Flesh too long kept or even Flesh meat eat in two great quantity, & with little Vegetable food. Wine Drinkers are seldom seized with this fever as it is a good Antisceptic, & it is therefore observed that Europeans who live at Aleppo, are seldom [pg 46] Malignant Fever seldom troubled with the Plague, as they drink plenty of Wine, while it rages violently among the Turks who make no use of wine; Putrid Water likewise and too great quantity of Alkaline Salts or Soap taken for a long time, Communicate such a Disposition to the Blood, that a person on catching Cold may contract malignant Fevers, The Blood drawn from the arm is of a Dense texture, & its Crasis broke or Dissolved, forming little or not Coagulum, sometimes it is a pale red, at other times of a green, which is worst, sometimes there is none at all but the Blood is thin and watery, & a great Deal of red Powder subsides to the Bottom of it, as if the red Globules [pg 47] Malignant Fever Globules were Destroyed. As for the Symptoms they may be seen in Huxam and Pringle, the great number of them may be Deduced from the putrid state of the Blood making its way thro' the small vessells. The Delirium, Stupor, sudden Prostration of Strength, are owing to the gross acrid parts of the Blood making its way to the small vessels of the Brain, which ought to carry the finer parts only, & this Causes obstructions. The Prostration of Strenght is owing to the same Causes, as the Health, strength & vigour of the Body, depends on the Vessels being filled wt. good Blood in sufficient quantity, and here the Disease is owing to a Defect in quality not in quantity, in this Case the putrid matter in [pg 48] Malignant Fever in the Blood acts as a prison, as Opium injected into the Blood kills the animal directly. This may be illustrated in mortifications. Suppose a man should break his leg in Summer, or in a hot Climate, after sometime if it is not cured a mortification ensues, which kills the patient before it has reached the vital parts, as the mortified matter is absorbed, & communicates a noxious quality to the Blood, which renders it unfit for the purpose of Life. Cure. If the Pulse be full and the heat great, a little Blood may be taken at first, but must not be repeated, as bleeding is to practised with Caution, it may be proper to advise persons against persons being too timorous in Bleeding as I am perswaded many more persons die [pg 49] Malignant Fever die for want of Bleeding, than by it, it is better to blood in every fever than in none you are chiefly to be directed by the pulse and heat of the Skin, When the heat indicate it, and the Patient is apt to faint, one should Bleed with Leeches, it is as proper to Bleed with them here as in the nervous Fever. I have seen when a patient fainted under it, and yet I found it necessary, he had a local Obstruction, & fainted every time he was blooded, & yet ℥xxxx of Blood was taken from him, tho when I was sent for, one running in great haste I was told he was a Dying (as was supposed) I ordered ℥xx to be taken away then, & as much in the Evening, he did not faint then, tho he did at [pg 50] Malignant Fever at first on ℥viy being taken away. 2d Gentle Vomits are of use to cleanse the Stomach, but purges are bad, as tending to weaken the Patient & dissolve the Blood, it is best to keep the Body open with gentle Glysters. 3d Diaphoretics of most kinds are good as Vinegar,, Camphire. & Syrup: Limon: Camphire is good, but the Volatile Salts are bad, Wine is a good Antisceptic & may be drunk here. The French & Rhenish are best. 5 Decoctions of the Bank with Elixr. Vitrol: 5th The Diet should be of the farinaceous kind & acessent. Drink should be rice Water & such like acidulated wt. Spt. Vitriol; When Petechiæ appear Blister are hurtfull, as they tend to remove the acrimony, unless when the Pulse [pg 51] Malignant Fever Pulse sinks, Sinapisms are often necessary. The air of the room should be kept clean (Cool I mean) & the Floor should be sprinkled wt. Vinegar and Water. It is to be remarked that Fevers are not always so distinct as those Described, for they run into one another, as they will be partly nervous, partly malignant and partly inflammatory. In this Case the prudent Physician will adapt his Cure to the different indications as he shall think proper. Remitting Fevers. In this the quickness of the Pulse & heat consist much, but do not wholly leave the Patient, as it would then be called an Intermittent. This fever often runs a great length and terminates [pg 52] Remitting Fevers. terminates in a Continuall Fever, or intermittent Fever, there are owing to faults in prima Via, and like Intermittents are Cured by frequent Vomits, these lengthen the remissions and bring them nearer to intermittents & besides Vomits it is good to give R. Khai amar: Tulap: Salin: and Ocul: Cancror: when these remissions are more Distinct the Bark is to be given, we are likewise to give plenty of Drink, Sweating too is not good. There are other fevers which I defer mentioning at present, one of them Viz: The Miliary fever which we shall mention by itsself, as it has something different from other fevers & requires different treatment. I shall only take Notice of one Circumstance, that [pg 53] Remitting Fevers. that in all fevers it is better to keep the Body open by Glysters, on the contrary in the Miliary Fever it would run the Patient down more than taking lli of Blood. Intermittent Fevers. This Lecture we shall begin with a review of the Case of Andrew Wright this patient came under any Care for a Quartan Ague as the quotidian and tertian generally mentioned among the Normal Disease, so the quartans are numbered among the Autumnal. The latter generally begins about the month of October & ends in the middle of Winter, from a carefull perusal of Wrights Case, we must impute the Cause of the Disorder to the moist air of Essese, this Country is low and consequently Damp, hence it [pg 54] Intermittent Fevers. it is become remarkable for the frequency of the Disorder as is the Case likewise wt. Holland, Zeland & Brabant, where intermittents of the worst kind prevail; We meet with some difficulties in attempting to account for how they are brought on in this manner, It may indeed be owing to the Fevers being relaxed by the moist air and the obstruction of the perspiration, hence the Blood & other humours are Depraved, the Stomach and Intestines are weakened, and the Bile in particular vitiated, and hence bad humours are bred in these parts and the Paxoxysms brought on, As the patient formerly has been subject to Rheumatic Complaints which Disappeared on the approach of [?] Ague, these perhaps might concurr in producing this Disease, and if they were not [pg 55] Intermittent Fevers. not the Cause of it, the quartan must have carried them off, as a lesser Herb is overcome by a greater. The cold fit is owing to a Spasmodic contraction of the Cutaneous Vessels, and this chiefly depends upon the Concord between the Nerves of the Skin & the Stomach & Bowels, Pulse quick and small this is owing to the contraction of the Heart being weaker than usuall, & it continues as long as the Cold fit, which is succeeded by a hot one. & if the Patient lyes in his Bed commonly ends in a Sweat & by this the Patient is relieved from all his symptoms. It is to be noted that during the cold fit the urine is of a high colour & deposites no Sedement owing to the Constriction [pg 56] Intermittent Fevers. Constriction of the Kidneys, but it grows afterwards pale and deposites a copious Sediment, which shows that the small Vessels are sufficiently relaxed, the cold fit is also for the most part accompanied with a headack, but that arises purely from the same cause, as in other fevers. The patient during the hot fit is sometimes apt to rove, as to the means in which the fit comes on, we shall remark that a little before it comes; some are seized with vomiting green Bilious matter, while in others as in the Case of our Patient, the fit is preceeded with languor & weariness, both wc. point out the prima via being the seat of the Disease. Breathlesness. This too was increased during the fit probably owing to an increased [pg 57] Intermittent Fevers. increased motion of the heart or a Difficulty of the Blood passage thro [?] Lungs, the Vessels of that viscus suffering perhaps that spasmodic Contraction as these on the skin, the pain in his side is perhaps owing on one to the Rheumatism, than any obstruction there. December 3d. Tongue furred, and this indicates a disordered State of the Stomach. Swelled Ankles, these are common in this Disease, as by long Continuance of it the Solids are generally weakened, and the Blood dissolved, is rendered pale & watery, the Crab's Eyes were intended to break the force of the Disease. the Bark not being so proper on account of his Cough, by the use of them even after Bark has failed I have cured an Intermittent, tho' [pg 58] Intermittent Fevers. tho' for the most part they only serve to Break the force of it. Gripes & Purging. These are only accidental and probably owing to Cold. 7th Easier perhaps from his having purged and kept his Bed, this last may have produced a sweat, and he is now Easier, I ordered a Vomit for him which is usefull in all Intermittents, as will break the force of the Disease, so as to produce Sweat, from the report it seems to have a good Effect. 10th Pain in his Side, this Pain was formerly removed by Cupping, but as it has now returned we have ordered flannels, which may be of service. I likewise prescribed this Day a Medicine which has cured Quartans before Viz: Cobwel, this he has use for some Days & it has in some Measure broke the force [pg 59] Intermittent Fevers. Force of the Disease, but as in the End they seemed to be more violent. I thought it needless to Continue them, and proceed to something more effectual: It should be observed, that as his pain increased During the time of taking the Cobwel Pills, (not on their account) I therefore ordered him a Blister, I now thought we might employ the Bark, not alone, as it has been found insufficient to cure a quartan of itself, tho' it does the other kinds. The Best Additions that we could make to it were the Aromatics, as this Species of intermittents seem to be of a Colder Nature, than the others, therefore on the 18th I prescribed the Bark & at first he took it 4 times a Day, but it was found he had no necessity to use it so often & it has now effectually cured his ague [pg 60] Intermittent Fevers. Ague, & removed the swelling in his Ankles & this last perhaps by strenghtning the Solids & making better Blood. We shall now briefly run over the Case of another Patient who seems to labour under a sort of quartan. I mean Mary Dowie, who in the Spring had a quotidian, which in the Summer became a Tertian, & in the winter a quartan. This Case at first seemed very unfavourable, from the long Continuance of the Disease, as by this she was weakened very considerably, she was besides troubled with a Cough and Difficulty of Breathing & therefore it would be improper to give her the Bark. The first thing ordered for her was a Vomit, this was not only good to Cleanse her stomach & Bowells, but in like manner for her Cough, & difficulty of Breathing, as well as to break the force of [pg 61] Intermittent Fevers. of the Disease. - 17th – The Oily Mixture is extremely good for a Cough, especially those of a dry kind, the Oil is sometimes mixed with the Mucilage of Gum Arabic, & Volatile Salts, hence the Volatile spirits are particularly of use, not only to help the Cough, but to promote sweating, & breath off the Ague, but it was not yet safe to give the Bark, and therefore ordered her some of the Aromatics, there were intended not only to strengthen the Stomach but likewise to asist Expectoration & break the force of the quartan. As her Cough continued still Bad I ordered her Gum: Ammoniac: 19th This Day we learn a particular of her Case, which was better to be concealed, Viz: a supression of her Menses for [pg 62] Intermittent Fevers. for six Months past, a circumstance that we cannot be surprised at when we consider how much her strenth has been impaired, and how much her Blood has been impoverished by the long Continuance of the Disease. 20th – Laud: Liquid: prevented the Cough & commonly made the Breathing more free. This at the first we should not have expected but as it acts by preventing the sensation, which would otherwise follow from the Rheum trickling down the Broncæ & Trachea, the first of which would produce a spasmodic Contraction, all these I say the Laud:Lig: prevented merely by diminishing the sensibility of the parts. 21st. Most persons become Easier after the fit, but she became worse, as the chief intention was to remove the Cough in order [pg 63] Intermittent Fevers. order to remove the Cough (to exhibite the Bark) I mean. I ordered on this account a Blister, to take Blood in the Case would be wrong. After this she complained of a pain in her haunch which was owing to a fall, and for which I first ordered her the Bals: Anodyn: this indeed gave her some relief, but to day as it seemed rather to increase I desired that a bag with warm water should be applied to her pained part as I have known such to be of service before now. 24th – I ordered her another Vomit, after which she found herself much better, it brought on a frequent purging but this proved Criticall in preventing a return of the quartan, since this she is very low. 27th I ordered a Mixture to correct the Sourness [pg 64] Intermittent Fevers. Sourness of her Stomach, the purging still continues without a return of the Ague. 29th Her strength seemed to sink all of a Sudden, upon this Blisters were applied to her Legs, in order to raise the Vis Vita & remove the difficulty of Breathing they seem indeed to have had good Effect, as the Pulse become more slow & full, & the Difficulty of Breathing immediately relieved. January 1st. was rather worse but on the 2d and 3d grew better she continues the Balux and Iulep twice a Day, if these strengthning remedies do not keep up the Vis Vitae, so as to enable her to shake of her Complaints, I say if these fail we can do little more for her. Having now passed over the Cases of two of [pg 65] Intermittent Fevers. of two of our patients, who laboured under quartans, we shall no make some remarks on intermittents in general. These have got different names according to the different periods of their accession as Quotidian, Tertian, Qartan, and double Tertians. With regard to this last, when in a quotidian the paroxysm of the first day answers exactly to that of the third, & the second day to that of the fourth, it is then called a double Tertian, When 36 out of 48 hours are taken up wt. the paroxysm without any perfect intermission, it is then called a Semitertian. The Intermittents invade a person with sense of Coldness, Tremor, Looseness of the nails, sickness, vomiting, small quick pulse, great thirst in the Beginning [pg 66] Intermittent Fevers. Beginning of the Cold fit, as well as the hot, the cold fit is succeeded by a hot one the Breathing more free & full, & the pulse stronger, this is soon followed by a remission of all the Symptoms. As to the proximate Cause, Boerhave makes it owing to a viscidity of the Fluids, or inertion of the Nerves producing a Stagnation of the Capillary Vessells, whence a Sense of Cold is perceived, which when by the sense of the heart the obstruction is removed, & the Circulation becomes more free, the hot fit is brought on, When we are ignorant of this inertia of the Nerves, I shall say nothing about it, only if it proceeded from this, languid persons would [pg 67] Intermittent Fevers. would have it frequently, but this does not happen. But I think it may be owing to some disorder in the Stomach or Hypocondriac viscera. 1st Because the Blood does not appear sizy. 2d when the Blood is most sizy in Pleurictic & Rheumatic cases. Intermittents ought to happen, Women with Child too ought to be subject to them as their Blood is very sizy. 3d We know that disorders in the stomach & Intestines, produce a sense of Coldness, as from strong purges. therefore it may be owing to some morbid matter affecting the prima via. 4th By the Effects of Medicines in these fevers, that act only in the prima via thus Ocul: Cancror &c. will often Cure an Ague, I mention this as I [pg 68] Intermittent Fevers. I have seen several cured this way, 14 years ago the patients troubled with vomiting were freed from it, by plenty of Chalk altho' the fit did not go off, from this it would appear. that its seat is in the prima via, as Chalk had such good effects instantaneously. 5th- The Bark which cures the fever more speedily than any thing seems to act on the prima via, and it does not on the whole of the Body. but I have known it in 5 or 6 hours time cure an Ague, in which time it would be impossible but Chyle could enter the Blood. but it seems to produce a discharge by the Nerves in the Stomach as well as the Intestines. I have been surprised to see the [pg 69] Intermittent Fevers. the sudden effect of the Bark in these Cases. A person who had vomited in the fit. but also in the Interrall, throw up a great deal of Bile which could not be all from the Gall Bladder. but from these parts of the Intestines, that are distended to receive it, thus the patient was brought very low by it, wn- I ordered him the Bark, and in 22 hour time it left him, & he had no return of the vomiting, & the urine's natural colour returned. These Effects show how remarkable the Bark act on the Stomach & Intestine in preventing any more of the morbid stuff from being Separated. Lastly vomits and Blisters show it, which act chiefly upon the Stomach and Intestines, Sailing too [pg 70] Intermittent Fevers. too is remarkable in curing it, so the English Soldiers who were affected with the Disease, were cured of it in their passage from Holland, as they had been detained at sea by contrary winds. The Effects of all medicines that produce pains or violent motions of the mind, as Terror and linger show it, by strongly affecting the nervous System, hence great heat will stop vomiting & Garlic by the pain it produces. Terror by exciting a Commotion in the Spirits, will drive away the fit, & the sight of a Rat will bring it on .. The Rat may occasion this bringing on a shuddering as it resembles that of the fit. The yellow Colour of the urine, and [pg 71] Intermittent Fevers. and bilous Vomiting, has made many imagine that the Liver was the chief Seat of the Disorder, they have likewise been led to conclude, that from the liver being found diseased in those who did. This I deny not, the Liver is in consequence of it not the cause the redundancy of the Bile cannot be owing to any fixed Disorder, otherwise the Bark would not remove it so soon. Prognosis 1st The quotidian is longer than the Tertian, 2d The more heat there is a greater tendency to a continued fever. 3d A true Tertian is the mildest of all & likewise most favourable, and very wholesome if not stopt but permitted to run out its Course [pg 72] Intermittent Fevers. Course. 4th Tertians in the Spring in young Patients will cure of themselves. 5th When treated with hot medicines in young persons, it is apt to turn into a continued or Inflammatory Fever, wn the fit anticipates the time, it shows they incline to a continued, but when later, shows they are Crising to a Termination. 6th When Quotideans & Tertians are impudently stopt, Obstructions, & Schimus, wt. a general Cachcxy & Ademalous swelling follow. 7th When the Cold fit is short, & the hot fit long it turns to a continued fever 8th Tertians happening in the Spring are more favourable, Continued fevers happening after Tertians are not so bad as after quartans. 9th swellings [pg 73] Intermittent Fevers. swellings brought on, often produce a Dropsy; 10th Quartans are most obstinate of all, & generally last till next spring it not stopped, the Vernal quotidians do not last so long, when treated with hot Medicines or Astringents, it is changed into continued and the person dies during the Cold fit is always observed. Cure. Bleeding ix not good unless the patient be Plethoric, where it may be allowed. 2d The cure should begin with attenuant Deobstruent medicines given a few hours before the paroxysm Crude Sal: Ammoniac: from ʒi to ʒij dissolved in a Lignor & swallowed in water is very good to break the force of the Fever. 3d Vomits are of use as they Clean the Stomach & remove obstructions, Ipecacuan: [pg 74] Intermittent Fevers. Ipecacuan: Vin: Emet: is the best, and the best time to give it, is three or 4 hours before the fit,/ this was looked upon as a new remedy but this is a mistake, for Healr. Fallanus mentions it./ It may not be amiss to give gr iij or gr iv every hour between the fits, as it produces a continuall Sickness, it nevertheless breaks the force of the fever. 5th After Blisters if the Patient is weak, and if the Disease does not go off, if the Bark is to be given, ℥i with Sal: Ammoniac: ʒij is to be given between the paroxysms, were we to give only ʒij they would never cure it, in a Tertian ℥i must be taken before the fit, in a quartan ℈ij must be taken every two hours. if the use of the Bark is to be suspected, then give Sal: Absynth: [pg 75] Intermittent Fevers. Absynth: For Schirrus & obstructions in the viscera, the Crust: Sal: Ammon: may be given in pills, the Decotion unless very strong is unsufficent, If the Patient should vomit up the Bark, or when it purges Laud;Liquid: must be given in every dose. If the Patient can not take it by the mouth the turbid Decoction wt. Laudanum is to be given in a Clyster in which way we cure Children, They would take it perhaps were it more agreeable in this Way 4 Cort: Peaur: ℥p misae [??] Aq: Cinnamom. s.v. ʒiij adde Syrup: Limon: ℥iij ♏︎. The patient seldom suffers a Relapse after two or 3 days. The Bark may be given alone after the paroxysms are stopt, 4 Doses in the Day will be sufficient, after that only two Doses, then after that the R Cort: Perur: with Bitters, riding [pg 76] Intermittent Fevers. riding on horseback and &drinking Claret are very good. Dr. Harris in his Dissertation proceeds to cure the Ague, by giving Ocul: Cancror: Zi two hours before the fit, and so to repeat it. I have tried it, & if the force of the Disease is broke by the Medecines, it will cur the remains. Some have cured Patients in Tertians by giving gHxxx Patients as those of a sanguineous or hot habit, it may be in Danger of Changing into Schirrus on Continued Ichor. There are some particular methods of Cure made use of, as rubbing the Skin of the Back has cured Children. Garlic applied to the wrists. Pills made of Arsenick. Cobwebs &c to the quanitity of 4th part of a grain, but these are two edged not to be made free with. Electricity has cured it by preventing the fit, of which there was [pg 77] Intermittent Fevers. was an Instance given me by a young Gentleman and inserted in the Philosophical Transactions, it arises from the shock preventing the fits, as vomits [illegible] the same and Garlic applied to the wrists by giving pain, as also Blisters, The cold Bath has the same effects before the fit us Electricity. We shall now make some remarks on the case of Eliz: Campbell, but shall previously make some observations on the cases of two our patients we formerly mentioned. The first is Christian Mcgregor. The mixture with Salt of Tartar & Mint water had good Effect in increasing her urine, which after however sometimes began to lose its Effects, as in the Case with most medicines when long continued especially purges. So I ordered her Garlic Pills which Likewise a good Effect, But these [pg 78] Intermittent Fevers. these too are lessened both as purgative & Diuretic. As she was costive I gave her the Elixr. Sacr:. This woman's Case is not an Ascites, or Dropsy, because the swelling rises & fall too suddenly, but it is owing to wind & it is of The Tympanitic kind, tho no doubt she has some water in her Abdomen, as she is weak & old there is no great hopes of her recovery. The other case is Imathan Cook in the small Pox, which we have before treated of in the case of Drummond. He has rather a worse kind than the former, being more numerous and filled worse, for while these on his face filled well, and were at the height, and began to turn, the pox in his hands had little or no matter in them & his hands did not swell which is a bad Sign, but afterwards they began to grow better, they have [pg 79] Intermittent Fevers. have been now 16 or 17 Days, and tho' there is a putrid fever yet it is to be hoped he will recover it. It is needless to account the several medicines given him, the only to be remarked is that his urine has had a great Deal of pus in it, I have observed in other Cases, a great number of pox on the surface of the Body, and it is very probable a like quantity on the several cavities of the Body, this must necessarily be absorbed, & by this the Blood becomes very purulent, therefore wn it goes into the kidneys, it will be thrown out into the urine, this matter is what keeps up the fever. I have seen the urine even more so, than in this Case, for a Lady after Child Bed, had a swelling on the side of her Belly, which I supposed to be in the Fallopian Tube & her urine was [pg 80] Intermittent Fevers. was true pus for near 3 parts. The tumor continued sometime this way then it poured outward, upon which things were applied to a bring it to a head, it broke & then the pus was Discharged outwardly by the orifice, & none of it appeared afterwards in her urine; There is also another thing to be remarked as to Cook. I bid him in a secondary fever, in this there are two things to be remarked, the patient has a strong pulse with a great heat, or not so, when the pulse is full, strong &c. Blood is to be drawn, after that to open the Body with purgatives, as Manna, Tamarinds & Glysters, with cooling things as Acids and Antisceptic Medicines. On the other hand, when there is heat with quick pulse, not strong, and vis vita weak, we then should abstain from bleeding but many open the Body with [pg 81] Intermittent Fevers. with Glysters, and give cordial Medecines as Spt. Corn: Cerr: Blisters must be applied to raise the vis vita. In the first case Bleeding is necessary, in the second, Blisters and Cordials to mend the breathing Weed We shall now consider the case of Eliz: Campbell. The patient seems to have been seized 14 days after Delivery with a weed. – The weed is a feverish attack, attended with shivering, and succeeded by a hot fit terminating in a sweat, Women in ChildBed are particularly liable to this, either from catching cold, or from surprise, fear, or other strong affections of the mind, or from disorders of the Stomach or Intestines, they are more liable to this, than women at any other time; because their [pg 82] Weed their Nervous system is rendered more sensible so that the same Cold acts as a Stimulus upon the cutaneous nerves, producing greater obstructions on them. Fevers of this kind are owing to wind or other Candidate in the primae via the first effect is it lessens the Lochea for when the Vessels of the Skin are obstructed, those of the Uterus suffer by Sympathy, an Instance of this is wet feet stopping the Menses. After the hot fit if a sweating come on, the vessells are thereby relaxed. and the Lochea flow again if they soon recover, but if no Sweat comes out. the Burning heat continues, the Lochea do not flow, & other symptoms of a fever come on, which unless a free flow of the Lochea be [pg 83] Weed be promoted, Miliary rErptions come out the Patient will be in Danger. Cure of a weed is to Drink plenty of warm Diluent drinks, and to apply hot bricks to the soles of the feet, to ly in bed, promote sweating by Volatile Drops, water Gruell, or the Iulap: Diaphoret: of the Pharmac: Pauper: But if the pulse is full and quick, the Patient strong and the Lochea stopt, let Blood freely, whatever prejudice may be against it by old Physicians & old women, yet lli of blood will do more to bring them back than any other medicine, will abate the fever and promote a sweat, but to return, the patients case seems to be owing to this, and had she managed herself properly [pg 84] Weed properly would have had nor return of it, but she drank cold water so that she had no sweat, or any proper Crisis, but had returns from time to time, keeping the periods of an Intermittent, It is Difficult to explain the reason of the periodic return of Disorders, nor shall I attempt it. It is uncertain whether this patients Disorder was owing to the passions of the mind, or to Cold, bad food, or other Disorders, but she was subject to gripes & looseness before, which might be owing either to the Disorder or to the cause of it. In this patient it would be improper to give the Bark in the beginning because her Stomach would not bear it, & it might increase her purging, so that it was proper first to begin, [pg 85] Weed begin with a Vomit which having cleansed the primae via, I ordered Infus: Chamomel: as a good bitter to strengthen the Stomach, which answers very well in Intermittents; by the Vomiting & keeping in Bed her pulse came down, there is also mentioned a pain in her back, which seems to arise from the Fluer Albus the toast and water we ordered for her loosness being much better than water gruell. Vomited her Diet but not the Chamomile Tea & I have observed in fevers where I did not give them Vomits. Vomit up whether they will or not, this Infusion generally stop it. 26th Her fits now became weaker, for she had a sort of two fits before the Iulep was ordered as [pg 86] Weed as a Cordial for her weakness 27th Here we observe that the fever came on 2 or 3 hours later than usual, and since the use of warm liquor she sweats after the fit. We mentioned that when a quotidian or Tertian comes on later it is a Sign the Disease is drawing to a period, when they come on sooner they tend to a continued Fever, the quotidian turns generally into a tertian which is the case here. 28th Her Bowells were in such a delicate state that very little purgatives would do. The swelled Legs are a necessary Consequence of the weak state of her Body, which has been increased by the long Continuance of the Disorder. 29th For pain in her side I order her Bals: [pg 87] Weed Balsam: Anodyn: & now she has the Fluox Albus, for which I which I ordered a purgative, perferring the Rhubarb to the Tinctura Sacra, as it is better in this Case. 30th It is a common Observation that a purgative will fail to purge at one time, yet the same will operate briskly at another time, for afterwards she was purged 5 times but here it had no effect. This Depends on the different state of the Bowells, and is what we often meet with, it appears it has acted by a vomit too. I am not sure it purged her more on that account, which may appear a Paradox, but is easily accounted for. I have known Children who have taken Rhubarb [pg 88] Weed Rhubard, and you would have thought vomited up the greatest part of it again and yet was purged as much by the small remainder, as they would have been by the whole Dose. This must have been owing to the remainder being pushed thro' the pylorus by the force of vomiting without being Digested, so that a small quantity in this Case would be have a good effect. 31st For her Cough and soreness of her Breast I ordered the Oily mixture with Spt. Sal: Ammon: preferring it to the Mucilage of Gum: Arab:, as I thought was adapted to her Case and would promote sweat. 2d This simple Collyrium takes away the heat in slight inflammations in the Eye, and is as good as any. 4th Now the fit is become a tertian, the [pg 89] Weed the Ocul: Cancror: was to check the looseness, & the force of the Fever, and if the keep the Type & her looseness grows better, I shall then order the Bark unless some other Symptom hinders. We shall now say something on a fever we have not mentioned before, besides hat already has been treated there is the Scarlet, Rusk &c. Miliary Fever This is very dangerous and cuts the patient off in a few days, and its appearance often deceives the Physican, these three Eruption fever are nearly altered in the Scarlet, this is one continued flush of the skin over the Body, Especially of the face neck and arms, these seem in a few days to be divided and the interstices [pg 90] Miliary fever Interstices to look heal, and redness is quite smooth and not Elevated like the skin in the sore throat; which is attended with those mentioned by Dr. Fothergill the Disease comes on like the scarlet Fever with redness of the face, neck & arms, I have observed it extend down the arms as far as the wrist, & red as scarlet, the outside of the arm rather higher Coloured than the inside, this sore throat is just a scarlet fever at a sore throat, which on account of the acrimony of the humours, is accompanied with rank ulcers, & asthous Crusts. The Rush is not sound as the scarlet Fever, but has many red pustiles rising above the surface of the Cuticles, is not so sensible and does not divide. The Miliary differs from this last as the [pg 91] Miliary fever the pustiles are large and pellucid and look as if filled wt. water, & they increase in size till they begin to scale and dry up. It is called by Fereguis, Febris alla Eruptiva Milaris, (and from the resemblance they bear to Millet seeds) The English Writers don't seem to distinguish between the Rush and Miliary Fever. The Distinction I would make between them is that every fever where the pustiles are red, it should be called the rush, when they come out pellucid it is the Miliary. When in these fevers you meet with many red pustiles mixed with the white, as is often the Case, it is then conjoined, tho' in this state it is reckoned as a Miliary fever and indeed the two are most the same Disease only [pg 92] Miliary fever only differing in the colour of the Eruption. Children are most subject to the Rush & Scarlet, few or none affected with the Miliary, which is a Disease peculiar to Adults. Women in Childbed are very subject not only in this State but in the others likewise, The red Pustules are often a sign which attend both Rush and Miliary Fever, for sometimes the pustules that rise red in the beginning during the course of the Disease change into white, which as we observed before show they are the same Disease in reality, except the colour of the Rush is more infectious than any other Disease, except the small Pox & Measles. I have known Children take it from their Mother as having communicated with the matter, as [pg 93] Miliary fever as the matter of the small Pox, by innoculation, Altho' this fever is mentioned by old Authors yet it has been more frequent within these 100 years. Symptoms are first a shivering, quick pulse. Especially in young people, when they have resembled rather the tremblings and Vibrations of a Chord, than the small beating of a pulse, attended sometimes with Vomiting, gripes & purging. Topings, with timorouness & fearfull watchings, sometimes a Stupor & Drowsiness in Children, Old People have faintness with great thirst, white tongue great and profuse sweatings and this is one of the signs by which a person may know this Disease, even before the Pustules come out, Whenever I observe [pg 94] Miliary fever observe this to happen, even without the pulse falling or the patient relieved. I suspect the Rush or Miliary Fever is at hand. The fingers and arms become sensibly swelled, tense & stiff, likewise when there is a pricking as of the thorns under the skin, I always pronouce an Eruption is coming out. It is always good to acquaint the friends for by this means you gain their Consequence, & tho' you miscarry it is not attributed to your not knowing ye Disease, or want of skill, I think the prickling pain is greater in the miliary, than Rush Eruption, In 2 or 3 Days after the shivering, small pustules of a red Colour appear, on the breast, neck, arms & fingers, these increase, & become either more red, or [pg 95] Miliary fever or are filled with a pellucid Lymph, and sometimes they are pale and approach to the colour of pus, But the time of the appearance of the pustules is not constant, for I have known patients in whom they did not appear till the 14th Day. I was called to a patient who had a fever of about a week standing. I found in appearance to be just a common fever and the Symptoms went on in the usual way. About a week after she had Eruptions on the whole Surface of her Skin, & that Blisters were applied to her Legs, and other means used by the persons attending her; she died next morning, for when the pustules do not come out properly. & in due [pg 96] Miliary fever due time, failing then in their Effects towards the Skin, they then make a push towards the head, and the patient commonly dies in 24 hours. I likewise had another patient who had likewise the appearance of a common Fever, only she had a most profuse sweat in the beginning, upon which swing the fever had not the ordinary issue, I supposed it to be of the Miliary kind, and accordingly on the 15th the pustules came out, & it was 16 more before she come out of Danger, the pustules here were greater than I ever saw them, and filled with yellow matter, they were as big about the neck as the top of ones finger & every where else like large pin heads [pg 97] Miliary fever heads. In the Scarlet Fever the Eruptions generally disappear in 4 or 5 days, like the Measles, & the same thing happens in the Red Rush, but the Miliary Eruptions last much longer, the pillucid pustules do not go off till the 14th day. When the Rush and Miliary are conjoined the red pustles come out, & the other kind appears two Days after, for the most part. The Red pustles or Rush when turning into the Miliary, are only attended with faintness and lowness of Spirits, and the patient is then relieved by the Eruption; when the red pustules become whitish, the pellucid become still Whites, and they seem filled in the end with matter, when they begin to scale off [pg 98] Miliary fever off, the patient is affected with spitting as in the small Pox. The sweat in this Disease is said to have such a particumell, as to make the fever easily distinguished from all others. But the great lowness of Spirits, Sinking and fears of Dying, are Pathognomic signs, these happen even before the Eruption. Another thing to be observed is, that the restlessness at night attending all Fever, is particularly remarkable in these, for the Patients who are ill in this [?]re generally very bad in the night, and the Difference betwixt the day and night is more remarkable in this, than in any ther, because they are tolerable easy in the day. Nor is the patient relieved from the [pg 99] Miliary fever the fever by a full Eruption, till the pustules begin to scale off, as in the Bad kind of the small pox, when the pustules do not come out properly, the patient is troubled with various Symptoms, according as the Morbid matter fills on this and that particular part when it falls on the piricordia it is attended with great anxiety, oppression, restlessness, topings &c. when on the Lung wt. difficulty of breathing, Sighs &c. When women with Child have this Difficulty of Breathing in a great Degree, & one greatly weakened, we may be pretty sure a Miliary Eruption is coming out. 2d. When the morbid matter falls on the Stomach, the patient is affected with nausea, sickness &c. which generally ends in Aphtha, with sinking of the Sprirts, flatulencies, & pain. 3d [pg 100] Miliary fever 3d When it falls on the Brain it produces Dosing, watching, Stupor, Convulsions, and sudden Death. 4th When it falls on the heart then is affected with tremblings and palpitations, & the pulse is sometimes low & and sometimes full, and more opressed, thus when there is a retraction of the morbid matter, or if the pustules, the membranes &c of the whole Body are affected, & a general numbness brought on. In this fever the urine is sometimes pale and sometimes high Coloured, where the last it is a good Sign, & when the former a bad one, & the urine is always pale when there is a sinking of the spirits and oppression about the preecordia, so that we may always know from the urine [pg 101] Miliary fever urine, what sort of a night the patient has had, if the urine is pale the rest must have been bad & vice versa, as I have often told my patients, without making any questions or so much as feeling their pulse. The Symptoms before the Eruption are owing to the morbid matter, stimulating the nervous and vascular system, it is easy to account for all these symptoms some have showed they are owing to the thick coagulated Blood, and others to be a Dissolved state of it. But as the Blood appears neither thick or dissolved we may reject both these opinions, & we may more properly ascribe the matter to the acrimony of the Blood affecting the [pg 102] Miliary fever the Vascular and Nervous Systems. Prognosis. 1st Altho many have this fever in a less degree attended with some of these Symptoms yet there is always Danger, for the matter being turned on the Brain or other parts, whereby the patient is carried off in 10 or 12 hours, tho' before there was little appearance of Danger. 2d In the Rush, the more red the Eruptions are at first, & then the white and yellower matter, but the clearer & more yellow the matter the worse, and in the Miliary the redder the worse. 3d If after the Eruption. Terrors and Anxiety happen, you are sure there will be more Eruption. 4th – Looseness sinks [pg 103] Miliary fever sinks the Patient much, and much as to be feared when attended with Coldness in the Extremities; in this Case Blistering the patient is very good. 5th When the Eruption goes forwards & Backwards there is always Danger. I remember a Lady in whom they did not come out properly, she was affected with anxiety and Hysteric fits for two or three Days, Blisters were applied to her Ankles, and Leeches to her temples without advantage, but by the application of warm fomentations to her feet she recovered. 6th There is less Danger with respect to women in Childbed where the Lochia flow properly 7th [pg 104] Miliary fever 7th A Delirium sometimes seizes the patient before the Eruption, if the pustules do not come out readily. 8th It is looked upon as a good Sign if the pustules do not recedes and the urine lets fall a light Sedement. 9th A firm pulse is better than a small one. 10th When Rasings & Convulsions happen, if the pulse keeps firm and not quick, it is good sign, but if the pulse is very quick and small, then is the greater Danger, then the next fit will carry off the patient. Lastly, faintness & difficulty of breathing, small, quick pulse, lowness, Delirium, & Coldness, if the fit is mortal, as also a Dryness of the Skin. Cure: We may Divide the fever [pg 105] Miliary fever fever into three stages. 1st That preceding the Eruption. 2d That during the Eruption. 3d When the Eruption is going off. Before the Eruption little more is to be done than to keep the patient in Bed, without too many or too few Cloaths, giving plenty of Diluting Drinks wt. Spt. Minder: & Ocul: Cancror: Bleeding is not so necessary unless the Patient is Plethoric, it may be done when the Eruptions come but half out, attended with great Sickness, and if the pulse is firm & contracted, it is of great service, as it will forward the Eruption, by lessening the Stimulus on the Nervous System, & taking off the Spasm from the Vessells as happens in the Measles & flux of the Lochea [pg 106] Miliary fever Lochea, by which means the Blood is again vented by the uterine Vessels. Bleeding is no necessary in this Care that I am sure I have Cured many by it. I have taken ℥xx from a man without lessening his pulse, but yet a laxative Glyster which only gave him two stools occasioned a fainting. It happened that another patient who had a fever and was Blooded, in a day or two after was violently Distressed, & yet I found his pulse 130 & Contracted. I Blooded him a little & finding & finding the pulse did not sink. I took away from him ℥xxij in all, and then the Miliary Eruption came out & he found himself much better, yet a laxative Glyster which produced [pg 107] Miliary fever produced but one stool made him faint, the reason of which is the Disease has a greater tending to fall on the Bowells, & occasion such an ovulation, as makes them uncapable of Bearing the operation of purging, tho' it may be made use of in some Cases where the head is affected. There are two ways in which the Disease seems to affect the Patient, in case the Eruption does not come out. One is that it is apt to fall on the head, the other where it falls on the Stomach, if it falls on this last the Patient is affected with great sickness, oppression. Anxiety, When it attakes the Head with Delirium &c. and in this Case inflammations of the Eye come on, here [pg 108] Miliary fever here we must Bleed, & if the Patient does not seem capable of bearing it being Drawnfrom the Arm, we should apply Leeches round the head, which is the last remedy I know off. In the Scarlet fever and Rush the head is not so frequently affected but there is a looseness & vomiting before the Eruption tho' they may Drink whey with the tistaceous powders in it, for the looseness, Iulap: Salin: and Rhubarb. 2d During the time of the Eruption, if they come out well, there is no need of Medicines only Diluent Drinks with vice panada &c. Every thing that tends to irritate the Intestina is Acids, Nitre &c. is bad,& we must take Care [pg 109] Miliary fever Care of purging them, tho' purging may be allowed in some patients cases, & even Glysters tho' they are to be used with great Caution.. Dr. Fordyce de Felri Miliari advises the same. I think I have found out the Criterion by which we may judge when they are to be given. If the Rush or Miliary fever does not come out it either falls on the head or Stomach, when the Miliary fever has tendency to the latter, purges or Glysters distress the Patient greatly, on the other hand when the matter has a tendency to the head, Laxative Glysters are proper & do not distress the patient. When the Rush [pg 110] Miliary fever Rush comes slowly I have given of the Pulv: e Chelio Cancror: grxv Croci grvj of Camphor: griv and a little volatile Salt with white wine. When likewise Plaisters are very properly applied to the legs and arms, rather than to the head when it is affected. Another remedy to promote the Eruption is fomenting the legs with flannels wrung out of warm water, & wrapt about them from the knee to the toe, & renewed every 1/4 of hour, for 2 or 3 hours this makes them sleep & promotes the Eruption. In great oppressions & sinkings they are relieved by Camphor: Bol: Croc: & Sal: Volat: Cordialls. Confect: [pg 111] Miliary Fever Confectio Iaponic: and spt. Vol: Oleas: 3d After the Eruption if the Symptoms abate, & the Eruption keeps out well, nothing is needfull, but Diluont Drinks with a little wine, but if they fall back or if a looseness ensues, the medicines before mentioned must be used, if the patient has a Delirium, Glysters and the Chamomile may be used, if the pain in the Legs are violent, Fomentations are proper, in all violent pains & watching Opiates are good, as Opium with Camphire promote the Expulsion of morbid matter, Fomentations are of great service, In this Case are not liable to the Objection of Opiates. The patients are very liable to faint when they sit [pg 112] Miliary Fever sit up, wherefore it is always proper to make them ly in Bed, with a high head, Gentle purges after the Disease is gone, as in the case of the small Pox, when an itching remains in the Skin, asses Milk & tepid water are proper to carry of the matter. and the Country air in Summer with [Goar] whey. When Eruptions continue out a good while, after again the Vomit, a Decoction of the Bark is good. After the Disquamation of the Pustules, a Decoction of the Bark is the best strengthner of any. I shall now make some observations, with respect to this Disease, and first people sweating in the Beginning, is of no use to lessen the fever [pg 113] Miliary Fever fever, or abate the Symptoms, & Bleeding on this account must not be neglected. There was a Case happened when the surgeon, would not Bleed thinking it unsafe to stop the sweating, which he thought of service, until it was too late & the patient Died. 2d. Patients are more uneasy in the night time. 3d. Raising or Sinking coming on after the Eruption is a bad Sign. 4th Blisters when laid on the legs & thighs are of more use than on the head, driving the humours to these parts, but in ordinary Fevers they are of most service, when applied to the head [pg 114] Miliary Fever head. Lastly when the pulse is above ninety, there is always some kind of Danger, but when it comes up to 120 we must be on our guard, we ought to Bleed early in this Disease Pleurisy I propose now to say something on the Case of Patrick Mc.kay. When this man was first received into the Infirmary, I imagined his care to be only Cough. arising from Cold, with Pleuratic pains in his side. but next Day found he had a quotidian Intermittent for eight Days returning constantly every morning, I further learned by questioning him, that he had laboured under it in England, when [pg 115] Pleurisy when it was removed by the Bark; but returned again on his way to Scotland, & it is remarked, that the pain in his side and shivering attacked him at the usual time the of the fits returning, it is probable that it was owing to his Drinking of cold Liquors, or catching Cold, by too few Bedcloaths. so that an Inflammation was thrown on his internal Muscles, from the time of the cold fit's coming on, as it may arise from the Strip of Coughing. as we know that a violent Coughing over streaches the Membrane of the Pleura. It is observed when an Intermittent is attended with a Cough, they always cough most during the Cold fit, because of the Blood being more accumulated in the Lungs. As this patient has a fever and Pleurisy. I ordered [??]i of Blood [pg 116] Pleurisy Blood to be drawn immediately, as in the inflammable cases no time was to be lost, I ordered a second Bleeding in the Evening, at the same time I ordered a Blister to be applied to the pained side which by raising an inflammation in the intercostal Muscles, was to cause a Derivation of it to the External part as the irritation and pain keep up the inflammation. A Blister by raising an Inflammation & pain in the external parts, lessens that within, and so by lessening the Cause, we contribute to cure the Disease, for his Cough he got the Bily Mixture, & Lintseed Tea. When he lyes down his breathing is worse, as any person breaths easier in an Erect posture, than a horizontal. By [pg 117] Pleurisy By the Bleeding and Blister his pulse was reduced from 120 to 76, a plentifull Bleeding does not bring down the pulse half so much as a Blister in a Pleurisy and Peripneumony. The Vessalls are first to be emptied by Bleeding, & then nothing can contribute more to lessen the Pulse than a Blister. I wrote a paper in proof of this inserted in the Philosoph: Trans: As some think that Blisters rather tend to quicken the Pulse, as Boerhave and other Physicians. & therefore they never ventured to apply them in inflammatory cases But the English were more lucky in their practice little regarding the Theory found the great service of Blistering tho' they did not pretend to explain the [pg 118] Pleurisy the matter, and I found upon Blistering the Pulse came down very fast, and if they are applied after proper Bleeding, seldom fail in producing these Effects, but if then the Pulse does not consider there are little hopes of recovery, it is observable that the patient missed the cold fit the 29th the morning that the Blisters were applied, for whatsoever causes that pain prevents the fit of an intermittent, on the 30th he had a returns of the fit which has continued regularly ever since To break the force of the Disease, I gave him a Draught of the Sal: Ammon: to prepare him for the Bark. on the 8th of January I ordered him the Bark of which he was to take such a quantity every [pg 119] Pleurisy every two hours as to consume the whole before the morning, but he took only one third of it, so that he had his fit next morning, but he had none the 10th tho' he had only taken ʒvj which I did not imagine would be sufficient to carry off the fit to day. 11th Complains of Sickness and tension over his Body for which we will give him some Diuretics &c. ------- Observations on the Pleurisy It has its name from the Pleura which was a name the Ancients gave to the side, & the Latines called it Morbus Lateratis, It gets its name from the membranes lining the Thorax. & in which it has its seat. Arteus Cappadox showed it has its Seat in the Pleura [pg 120] Pleurisy Pleura, & Intercostal Muscle, & that when one is affected, the other becomes So too, when in the internall Intercostalls, it got the name of Notha or false Pleurisy, but it is to be observed, that the Disease deserves the name of Pleurisy, whether it be situated in the side Back or Mediastinum, as the Pleura may be affected in any of these parts, but the side is only affected when it is situated in the Intercostall Muscles. When it happens in the External Intercostal Muscles there is a swelling outwardly which may be perceived by the touch, & the Breathing is not difficult, tho' it may be communicated to the internal parts. These Peripneumony when [pg 121] Pleurisy when the Lungs are inflamed, the Pleura is sometimes affected, & when the Pleura it is communicated to the Lungs & as the Intercostall Muscles are contiguous to the Pleura, when an inflammation happens in this last, they are soon affected, and vice versa. The imperfect way in which breathing is performed on account of the pain under the passage of the Blood, lies free & makes obstructions in the lungs more common, as the Pleura and lungs are contiguous, and in many people attached to each other, therefore when one is affected the other will be soon so, especially where these Adhesions are wherefore it may appear, why in the true Pleurisy. the Lungs are seldom [pg 122] Pleurisy seldom free, but in the bastard kind, the patient is often free from any Cough because the membranes cannot so easily communicate the Disease to the lungs & hence why Peripneumony often happens without a Pleurisy, & vice versa i.e. when it is sealed within the substance of the lungs. I shall observe that tho' the Lung have little Sensibility, yet the membranes surrounding them in a Diseased state are so painful, that we frequently mistake a Pleurisy for a Peripneumony which leads me to make some remarks in what the famous Dr. Haller hath said, who alledges the Pleura is not the seat of the Disease, because by Experiments made on a Dog, he could not [pg 123] Pleurisy not find by pricking it, that they should not have any nervous filaments upon it, and hence he conclude it is insensible. But he falls into a double fever; first by saying it is insensible, first he could not conclude so because it is less sensible than the Integuments, but tho' we know that membranes in a sound state possess but small degree of sensibility yet become highly so in a diseased state. 2d. By saying they had no nerves But with regard to the Nerves of the Pleura, they are fully proved by its sensibility when inflamed, for if it was a sufficient reason for him to Deny nerves to the Pleura, because they can not be sure, he might in the same way [pg 124] Pleurisy way deny there is any Nervous fluid & as a greater proof of it, he says the most part of pain is in inspiration when the Ribs approximate with each other, but he contradicts himself in another place, where he says the ribs in ordinary inspiration, are seldom moved, but the reason of it is that in the time of inspiration, the Cavity of the Thorax is increased, & the Diaphragm thrusts downwards, the Pleura must be streached, and consequently the patient feels most pain. With regard to the cause, the Antecedent cause is various 1st from cold contracting the cutaneous vessells, especially if applied to the Thorax, by which the Blood is determined in greater in greater quantities to the [pg 125] Pleurisy the small vessells of the Pleura, by which they are constricted, & so irritated & pain brought on 2d – Drinking large quantities of Cold water when the Body is warm, as it affects the internal vessells like Cold applied to the surface of the Body. 3d. The Obstructions of any of the customary evacuations as the Menses, hemorrhoids, especially in those, whose Nerves are much liable to be affected by any Cause. 4th A transition of acrid matter to the Pleura from any other parts, an instance of which in the Gout acrid matter is drawn from the Skin by a stoppage of perspiration or purulent matter absorbed in it, is an inflammation of Pleura, the prognosis must be just [pg 126] Pleurisy just the same, as in other inflammations Obstruction is not the Cause of inflammation as Boerhave & his Commentator Van Swieten alledge, for we see many and the greatest Obstructions without inflammation, after the taking of a Limb the Arteries are tied, there is the greatest obstructions, & yet no inflammation, neither is it owing to the increased motion of the heart, for we do not find that in Walking &c where the motion of the heart is increased, any inflammations are produced, on the other hand, tho' the Pulse is no ways altered yet an irritating matter is applied to any part as the Eye, it raises an inflammation which is only removed by soft [pg 127] Pleurisy soft applications as milk and water. It is not then evident that the cause of inflammation is irritation which excites the vessels into alternate contractions by which the Blood is pumped into them, & produces a greater Distension whence inflammation & pain. Irritation may proceed from acrid matter, or a distension of the Vessels, & so by irritating them pain is produced, and indolent obstructions of the Glands produce inflammations, but when the Vessells are distended & excited to contract, then follows an Inflammation. Dr. Haller concludes that the small vessells and lateral Arteries are only irritable, the only Effect of which was to empty them, but a [pg 128] Pleurisy a little more attention might have shown that they could not empty themselves like the Bladder, for since they are supplied continually from the heart with Blood, tho emptied by Force the circulation must be increased, and the small Arteries will be distended, it may be done indeed by the force of the heart, but we know many instances when the motion of the heart is not altered, as in slight inflammations, only from something occasioning an increased motion of the vessells, of the part inflamed, as when some acrid matter is applied to the Glands it increases the motion of the Blood thro’ them & consequently their Secretions. The Seat [pg 129] Pleurisy Seat of Inflammation is in the capillary vessells, by which they are much Distended above their naturall size, but this will not account for the greater degree of inflammation, for then the Blood escapes into the laterall vessells, and so from obstructions, we see in Hypochondriac men & Hysteric women, we meet with sudden swellings, which from their sudden disappearing, we think owing to wind, but it is owing to the greater motion of the Blood in the vessells of these parts and their being thereby distended. Here again it may be proper to refute an assertion of Dr. Haller's, observing the Cells of [?] Mebrana Celluaris inflated with blood concludes that inflammation consists on an Effusion [pg 130] Pleurisy Effusion of Blood in these parts, however he has mistaken the consequence of the cause for it will only make an Echymosis, unless the Redness of the part may be said to constitute an inflammation, besides in small inflammation the Effusion does not happen, because the Vessells here are not so much Dilated, & this is the case in the Alluginea & cornea in ordinary ophthalmia. In Blisters no remarkable swelling, no Effusion of Blood in the Cellular Membrane, yet there is one Inflammation consisted in an Effusion there would be no inflammation at all in Blisters in the Hemoris or most violent Inflammation of the Eye there doubtless an Effusion of Blood & so likewise in [pg 131] Pleurisy in a Peripneumony, hence we see the patient spit up Blood mixed with water all this may happen from the orifices of the vessells being Dialated, as to suffer ye Blood to escape without any rupture, This Cause of Inflammation increases ye vitratory motion of the small vessels, accelerate the motion of the Blood, whereby they are filled, Distended, and Burst, by which the Blood is pressed into the Cellular membrane, & a suppuration brought on. I shall only observe pinther that Dr. Haller is wrong and contradicts himself in denying that an Inflammation proceeds from an Errore Loci, for tho' it does not happen so often, as Boerhave would have it, yet in inflammations the Blood often enters the serous vessels [pg 132] Pleurisy Vessells, this the best Microscope does not discern one Drop of Red Blood in the Tunica Allriginea of the Eye, yet in inflammations its vessells are filled with it so, that I am surprised how he could over look this Circumstance. This a Demonstration, may happen an inflammation by Errore Loci, since the mouths of the Vessells that pass into the Cellular substance in a sound State, do not allow the Blood to pass, yet in inflammations it does get in, & consequently by Errore Loci, it is thence thrown out by the Dilatation of the mouths of the vessells that pass into the Cellular in a sound State. Thus much being said, we shall now make some observations on [pg 133] Pleurisy on the Symptoms, or Pathognomic Signs of the Pleurisy. ---------------- Symptoms. The most Distinguishing are first an acute pain in the side but not always so which is increased by inspiration. 2d. A Continued Fever. 3d. A quick Pulse, and hard. 4th A cough which seldom happens without the Lungs being affected, it is at first a dry Cough, & afterwards accompanied wt. Expectoration. We shall now account for the several Symptoms. Inflammation of the Pleura, or intercostall Muscles, the pain must be increased by inspiration, especially when the intercostal Muscles are affected, because they are then contracted & cannot act without great pain. But when the Pleura are affected [pg 134] Pleurisy affected the pain in inspiration is owing to the Distension of that membrane as all the parts of the Thorax are then inlarged, in Coughing the pain is still greater because the sudden inspiration with the convulsive Expiration affects both the Pleura and Intercostall Muscles The patient has commonly a hard, quick, pulse, which is frequent in violent pain, where the Inspiration is performed chiefly by the Diaphragm, but in this case inspiration has a much less Effect, the patient is obliged to repeat it often. 2d The continued fever which is owing to the inflammation of the part & pains in all considerable inflammation there arises a quickness of the pulse, as the pain increases the irritability of the heart, and Vascular system [pg 135] Pleurisy system whence the Blood acts as a stronger Stimulus, whereby the heart is irritated to contract more frequently, & the Blood & humours become rrtiated, & contribute to the irritation of the heart. 3d The quick pulse may be understood from what has been said with regard to the action of the heart. There [??] three kinds of quick pulse in [??]mations, 1st The h[???] quick Pulse as in inflammation of the [illegible] 2d. The small thready pulse as in inflammations of the Stomach. Intestines, & Uterus &c. 3d The soft quick pulse as in inflammations of the Lungs, Liver &c. In Pleurisies the Pulse is hard & quick, because the Vascular System has a greater Degree of Tension, so that [pg 136] Pleurisy that the Blood cannot pass so freely into the Veins. The Thready pulse is owing to the great sensibility of the Alimentary Canall, & the Sympathy betwixt it and the heart, by which it contracts itsself with less force, the whole System is affected with a Degree of Languor & thus the pulse is quick and theady but small, when we lessen the Disease by blooding the pulse become fuller, In those whose Nerves are not so sensible, this kind of Pulse is not remarkable, but in those whose sensibility is great it will be small & unequall and almost remitting. This evident from practice. I had a patient who had a Cholic pain, from which he was [pg 137] Pleurisy was greatly pained & vomited. His pulse was only 44 small & irregular after trying many things I proposed the Bath he was no sooner in the Bath than he was relieved & his pulse increased to 70, & he continued while in the water, but in a little after he came out his pain returned, & his pulse came down to 54. In an Inflammation of the Lungs & internal parts of the Lungs, the Pulse is soft & quick, because of the less sensibility of these parts, & that there is less pain. 4th The Cough commonly first Dry, but afterwards moist, & attended with Expectoration at the same time a Pleurisy may happen in the Intercostall Muscles without a Cough, & this Difference may serve to Distinguish the true from [pg 138] Pleurisy from the Bastard Pleurisy. But when the Lungs are affected there is always a Cough first Dry, & then moist, whereby Obstructions are resisted or a Supperation comes on. ------- Prognosis. First a Pleurisy seldom happen in Children, but more frequently to people about 30 years of age. As to Children this may be wisely understood from what Hippocrates says As Children have less Fibres & Vessells & thin watery Blood & humours, therfore they are less apt to be affected with this Disease, as likewise they abound with viscidities, whereas people of strong Fibres have thick Blood, ll have any acid in their Stomach, & also upon any Error of the Nonnaturalls they are very subject [pg 139] Pleurisy subject to this Disorder. 2d- When a Pleurisy is managed properly it generally yields in 7 days, & when it passes that time it generally degenerates into a Peripneumony, when it lasts till the 14th Day it ends in an Empyema. 3d- A hard Pulse like a Cord protends Danger, but when very small and quick a deadly Sign. 4th Within the first 3 or 4 days if the patient spits up a yellow concocted matter it is a good sign or even mixed with Blood it is a good Sign, & and likewise in peripneumonies, & when Viscid frothy like Chyle or the Latura Carnium it is not a good Sign, when green or Black like the grounds of Coffee, it shows a mortification when yellow like a light [pg 140] Pleurisy light R Croci it is a mortal Sign, & it shows the liver to be likewise affected 5th If the pain grows less when the spitting begins it is a good Sign, otherwise bad. 6th When the pain ceases & the Breathing easier, the Disease seizes the Brain, the Patient then becomes Delirious, or Comatous, and this is the greater Danger. 7th If it changes into a Peripneumony, it commonly suffocates the Patient, e Pleuritide superveniens Peripneumonia Malum. Hippocrat: aphor: Sect: 7th). 8th It is a bad Sign when the Patient can ly on neither Side, & the Extremities are Cold, & great heat within the Thorax. 9th It is a bad Sign if the patient spits more & worse [pg 141] Pleurisy worse if the pain in his side continues. 10th When there is a flushing of the face it shows that the Lungs are affected & the patient Hectic, owing to an absorption of the matter when it is not carried off by Expectoration. 11th When the pain ceases and the pulse is weak, & intermitting & cold sweats come on, there is either a Mortification or Suppuration. Cure. I proceed now to the Cure, and propose to treat is merely as an inflammatory Disease, & not as Degenerating into an Empyema &c. I shall make some observations on the Cure of Jane Donaldson before I began with the cure of the Pleurisy, the Patient after having had a Cough from the middle of November to the end of December, was seized with pain [pg 142] Pleurisy pain thro' the Body, or rather a sorness of the Bores, so the folks term it, and Nausea &c. From this account it was evident, her Disease was a fever from Cold constringing the cutaneous vessels & lessening the perspiration & cold Shiverings &c. show it, Nauseas, heat with quick pulse show there was a fever, but instead of the headack had pains in her side & through her Body the want of the headack shows that it was not the continuall kind as many of these fevers are accompanied with a headack are only Symptomatic of the affections of the head, but this was not of that king, neither was it a Pleurisy, altho' the pain was in her side [pg 143] Pleurisy side, because it shifted to Different parts of her Body, which shows it to be rather Rheumatic than Pleuratic & this being attended with a fever shows it to be rather of the acute, as Chronic kind. Altho’ she was Blooded two or three times before she came here, I ordered her to be blooded again but if she had no fixed pain, as in her wrist, Ankles, knees, & Shoulders. I Should have applied no Blisters only blooded her. If the pain is fixed Blisters are of most service, but if shifting, Bleeding with Diaphoretics would be much better. The Oily Mixture was for her Cough. & the Chamomile Tea for her Nausea, the injection was to cool & open her Body. 1st January. We are told she coughed less lying [pg 144] Pleurisy lying on her left side, than on the Right or Back, the Reason is that the Muscles were less affected in this situation in acting & the part of her Lungs on that side was less irritated and streached, notwithstanding this her Cough and pains continued, & therefore I ordered a second Bleeding, which was justified by the blood appearing sizy & then I ordered a Blister between her shoulders which had a good Effect in reducing her pulse from 180 to 80. and since that time she gradually minded & is now dismissed Cured. This patient's Case was first a Cough & then a Fever with what may be called Bastard Pleuratic Stitches, which was the Cause of my Bleeding and Blistering her. We shall now proceed to the Cure of [pg 145] Pleurisy of the Pleurisy something connected with this last. First thing is to remove the Obstruction, inflammation, and pain, which is done by bleeding proportionall to the greatness of the Disease, & strength of the patient in many cases where the patient is Plethoric, & the Disease acute, it is necessary to take away from ℥xvj to ℥xx of Blood, next day if the pulse continues firm & the Symptoms not abated, we may Blood again to ℥xvj & repeat it as often as there is occasion Syndenham, Boerhave, and many other of the later Physicians recommend large Bleedings in Pleurisies, but there are not wanting many who have condemned that practice, Etmullerus says it is apt to bring on as uppuration, which is just such a Paradox as to say a man saw [pg 146] Pleurisy saw as well at midnight as at Midday. Iunkerus in his Computes Medicina advices to take ℥iij or ℥vj which is a great deal for him, & throwing out reflections on Sydenham for taking away so much & at the same time it is very remarkable he contradicts himself in another place, by allowing plentifull Bleedings in inflammations of the Stomach and Hepatis. Suiland. A French Author inclines to Bleed sparingly in this Disease, which is the more remarkable as the French Physicians are very fond of Bleedings, and even in the Articula Morbus his quantity is ℥x vel ℥xij. Sydenham advises to take away ℥Lx at three different times, but even this is tos sparing, for in many cases we should take away much more, in generall if a pound be first taken away, & then ℥xij afterwards [pg 147] Pleurisy afterwards, & after which a Blister to the part affected, we should have no need of taking away more, but I knew a case where Bleeding had been used, I applied a Blister, but still found the pulse quick & other Symptoms not abated, I ordered a 2d Bleeding by which he was rendered better which shows it necessary sometimes tho’ generally there is no occasion for Bleeding after the Blister, but if the Symptoms do not abate even after the Blistering we should Bleed more.. It is hard to say why Physicians have differed so much about the utility of Bleeding, These who bleed sparingly have either formed their opinion on the prejudice of Education, or having seen more malignant Pleurisies, when it did not happen to be of any service. In many Seasons [pg 148] Pleurisy seasons they are so malignant, that they wont bear bleeding, in which case we must have recourse to Boluses of Camphire Vol. Salts & Blisters, when the Blood has a buff upon it Blooding is indicated, but not so when the Crassamentum is loose or Dissolved, or if the size is blew and greenish, or if the Pulse falls. The Size Crassamentum does not appear often till the third time of Bleeding, therefore we are not on that account to abstain from Bleeding. In Pleurisies as well as Peripneumonies the pulse is at first small from the obstruction the Blood meets with in its Passage thro' the Lungs, but after one bleeding it rises & indicates more Bleeding, (see Boerhave's Aphorisms on this subject) The fullness that Boerhave has on this subject, renders it unnecessary to be more particular [pg 149] Pleurisy particular on this subject, and therefore I shall only add a few observations which he has omitted on this subject. When I attended him I heard him say that most of what he says in the Pleurisy was taken from Hippocrates, but he imagines 100 who read Hippocrates would not find so much in him. After the 4th or 5th Day it is observed that Bleeding is hurtfull, & indeed an exquisite Pleurisy if it does not yield in 4th or 5 days begins to suppurate or mortifiy therefore it is unnecessary & if the Patient spits up any Concocted matter, which happens about the 4th or 5th day, Bleeding will only weaken the Patient, & stop the salutary Evacuation, but if the patient spits up clear, florid Blood, Bleeding is necessary, which is one Symptom for Bleeding after the 4th or 5th day, as likewise [pg 150] Pleurisy likewise when the Disease has yielded, and returns again, we should Bleed in the 6th, 7th & 8th day, as it is to be looked upon as a new disease. In a Peripneumony I was obliged to bleed the patient 12 times in 9 days, altho' the pain was removed by this, yet the pain Breathlessness &c were increased upon which I took away ℥xxx & afterwards smaller ones by which he was relieved. In the Pleurisy Hippocates recommended Bleeding if the pain is high in the Thorax, but when lower down purging which was founded on a false Theory as if purging only was founded when the pain was below the Diaphrahm, A Physician in South Carolina showed that it always yielded to cooling purges, however well this might succeed in such a warm Country, I am sure it would not do in Britian, 2d As to fament the part with emolient formentations [pg 151] Pleurisy formentations to lessen the pain by taking off the strictus from the Vessells, especially in the Bastard Pleurisy, & drawing the humours to the Integuments. The Fomentations are either of plain water, or the Emolient herb boiled in it. 3d Cupping especially with Scarification when the Patient cannot bear Bleeding, as much as is necessary this makes a great Derivation from the vessells of the affected part, it is recommended by Paulus Clgineta but not till after the 14th which is after meat Mustard. 4th Blisters applied to the part are of great service, by raising an Inflammation in the Intaguments, and drawing the humours outwards (and removed in 12 or 14 hours time) They do most good when Bleeding and other remedies are less necessary, tho sometimes the pain is not relieved till after the Blister is removed this [pg 152] Pleurisy this might be owing to the patients mistaking the pain caused by the Blisters or the Distension of the vesicated Epidermis, for the Pleuratic pains, or by removing the Blister and giving vent to the serous humours, there is a freedom given to the vessells to distend themselves, & then the Patient feels more pain. Many eminent Physicians as Boerhave have been averse to Blistering, as thinking they by a Stimulus increased the fever, which was the cause as they thought of the pain of the side not the pain the cause of the fever as it really is, therefore if you lessen the Pleurisy. You lessen the fever, Blisters are better in Pleurisies than Peripneumonies, in the last I would not apply [pg 153] Pleurisy apply a Blister, till the Patient has lost as much Blood as he can bear, but in Pleurisies after 1 or 2 bleedings a Blister should be applied, the reason of that is that in the Pleura & intercostall Muscles likewise serve the externall parts & skin with Blood, but in the Peripneumony it is not so, as the lungs have their vessells immediately from their heart, & therefore cannot be so well affected as in the other Case, hence Blisters will have more Effect in Pleurisies than in Peripneumonies. 5th Plenty of Diluent Drinks, an Arabic Emulsion, Barley water, Milk & Water, Cow Whey, so a man should not drink a small quanitity than a Gallon a Day. 6th Cooling & attenuating Medicines a Iulap: Salim & Spt. Minderer: 7th Emollient Glysters of a pint of tepid water, & laxative ones [pg 154] Pleurisy ones altermis modibus, the laxative ones should be of a pint of tepid water with soap, for while on night the Emollient Glysters threw more liquor in the blood, the other serves to relieve the head, & the same is good in Perpneumonies, they are better adapted to Pleurisies than plunges. 8th When there is a hard dry Cough, Pectorall Decoctions, as of Althea, Liquorice, Syrup: Limon: Althaea, water with Raisins or Figs, and the Mucilage of Gum: Arab: will do, but for these patients who cannot bear Oil, they are very proper, when they begin to spit, as well as when the Cough is bound, or Oxymell of Squills when the Patient is troubled with a bad Cough after Bleeding & Blistering, and Opiate with the Sal: Ammon: grviij may be given as [pg 155] Pleurisy as I ordered for Mary Davie. Some Medicines are proper when towards the end the pulse sinks, when the patient will not bear Bleeding in malignant Pleurisies, these medicines are very proper if the Patient is low. I would give Spt. Sal: or Calc: Viv: g# xvj. When nothing will cure the pain, Oily Mixtures are found to be good with Syrup: Papau relieves the Cough, & we know when the Oil is taken Externally it relaxes the parts, & lessen pain, and seems to act by relaxing the Nerves & vessells of the past to which it is applied, hence when taken inwardly the vessell will be relaxed by Sympathy. Dr. Hain recommends ℥vj of Oil to be taken, but more but German Stomachs can bear such a Dose. [pg 156] Ophthalmia I shall now proceed to the cure of Mary Stocks an Ophthalmia. This Patient has naturally weak Eyes, hence upon her being exposed to Cold was seized with an Inflammation, It is very observable that these parts of the Body that are weakest, are most liable to inflammation, when being exposed to cold, as these person who have weak Lungs to a Cough, weak kidneys to a Nephaitis &c The heat and pain in her Eyes is owing to the inflammation, the running of water to the irritation, headach to its consent between the Eyes and head, I ordered her to be blooded in the Jugular Vein which is prefesable to the arm in Ophthalmia, as the Blood returns from the face & head much easier, for it is like [pg 157] Ophthalmia like making two Jugular Veins, the Blood not only running out of the orifice, but also down to the heart. It has been Disputed whether Blooding in the feet or Jugular Vein was best, I prefer the Jugular Dr Friend does the same Dr. Languish is for the feet, the chief objection is, that the tying a Vein by a Ligature in the head, does more harm than the Bleeding does good, but here there is no occasion for a Ligature as clapping the thumb below where you strike does the Business, Another objection is that the circulation is promoted by this means, but the Depletion gives the Vessells time to contract themselves, & so no fear of a Derivation After the Bleeding I ordered Glauber Salts which is a cooling medicine I might [pg 158] Ophthalmia might have ordered the Acetum Rosaceum but I thought the water and vinegar less Astringent, after correcting the inflammation, in generall, Leeches applied to the temples are very proper tho' at first they do little good, after this I ordered a Blister to her head which is very good, after Bleeding as they make a great derivation of the humours from the eye, it may be proper to keep a piece open as big as a Crown, Heister tells us a rare instance of Blisters doing good in Opthalmia, it is somewhere near the beginning of his Cases, and was about the size of a Shilling, if it was never to be larger than this it would be no great matter whether it was applied or not, & upon this account indeed might be a very rare [pg 159] Ophthalmia rare Instance. After applying general Remedies, upon finding she was obstructed, I ordered a Mass of Deobstruent Pills, with the addition of some Calomel with a view to the state of her Eyes & to mend her Blood, & besides would not hinder the other ingredients from having this Effect. At present one of her Eyes is quite well & I hope the other will soon be in the same condition, she mentioned she perceived or felt mats, this may be owing to some of the vessells of the Cornea, being inflamed or to the drying of the Coats. There is another patient Elanor Laurie who has the same Disorder but this is the worst Case, for the Measles, after which she contracted this, laid a foundation for weak Eyes, besides there is [pg 160] Ophthalmia is a Sirophulous tending in this Girls – Consititution, The Cause of her particular Disorder was likewise cold, as she had much less Blood that the other, I ordered Leeches to be applied to her Temples, but no Bleeding in her arm, in other respects she was treated in the same way as the other, I ordered likewise the Pediluvium, which is good for the Eyes, as it procures rest & tends to draw the humors downwards, After this I put her upon a Course of the Sublimate Solution, as she was Scrophulous, I gave her a purge now and then to keep it from her Mouth then an Elect: of the Bark, for there is nothing better after the mercury, after this she got the laxative Pills & the Bark The [pg 161] Ophthalmia The generall Causes are first some acrid matter falling on the Eye, whether Scrophulous Rheumatic or Venereall. 2d Cold obstructing perspiration & determining the humours to the Eyes. 3d Any External Injury as from Lime, Snuff, Sand &c The seat of this Disease is in the Tunica Conjuctiva or that which covers the Cornea, or in the Iris or Capsula of the Crystalline humour, when this is the case objects appear reddish, It is very odd that where the Conjuctiva alone suffers, the Patient cannot bear the light, the reason is that in violent Opthalmus the inner parts suffer as well as the outer, but in slight ones the Retina is affected by Smpathy. Prognosis. Many are easily & soon cured [pg 162] Ophthalmia cured, violent opthalmics are ill to cure, especially those which came on when any of the natural Evacuations are Stopt as the Menses &c. and such often end in fatal Blindness. When the cause is removed the inflammation will also Cease, this obstructing matter will either pass through the inflammed Vessells, or be resolved, To promote resolution bleeding in the temporal Artery is proper wc. method is followed in spain, and the purging as with the Mercurial Laxative Pills, after the Evacuations, Opium or Syrup of Poppies, which act by taking off the pain, & allow the inflamed part of the Eye to heal. Blister & the Pediluvium we have mentioned as proper tho' I had one whose Case was very particular, every Blister & purgative seemed [pg 163] Ophthalmia seemed to inflame her Eyes, so that I could only give her the most gentle ones, owing to the great Sensibility of the nervous System. Besides these some have recommended Cataplasms of Bread & Milk Rotten Apples &c. I have tried one with success made of the pounded Leaves of Hemlock & Milk, tho' upon the whole they do Hurt by their Weight, & keep the Eyes too hot. Sternutatonies are good in Ophthalmics, to strenghten the patient Eyes Collyriums are good such as we ordered, or Rose water of Sacchar: Saturn:. When Inflammations in the Cornea it arises from three Causes 1st a Gelatinous matter stagnating in its Vessells or between the Lamina. 2d from the want of proper fluids, 3d from a Concretion of the Vessells [pg 164] Ophthalmia Vessells. In the first case it is caused by nature, if the inflammation keeps off, but if it comes on, Blooding, & purging are necessary, I advise to Drop the gall of Fishes into the Eye, what I use is Crude Sal: Ammon: Dissolved in water ʒi to ʒiv. When an ossification happens from an accretion it is incurable Leprosy We shall now consider the case of William Andrews a Leper. We cannot find out from any account he gives of himself what can be the Cause of it. The proximate Cause is a morbid state of the Vessells, under the Epidermis, so that instead of a clear transparent Covering as in the naturall state, there is a white opaque Crust, what is the cause we know not, I [pg 165] Leprosy I ordered for him first a purge, as it is good to begin with this first. I then gave the Solution of Corrosive sublimate wt. intermitting purges to keep it from his mouth, the Decoct: Lignor: to keep him sweating. At first it raise to his mouth so that I was obliged to omit it for some Days, since that it has not, & I have observed that at first it generally does this, tho' after a purge it will not affect the mouth, tho' I have given him double the quantity. I shall now consider this Disease, of which there are two kinds one the Lepra Graecorum, the other the Elepantiasis, the former most commonly begins in the fore arm & knee, it is Whitish, If it is noticed that a Bloody Ichor uns[??] sometimes instead of a White, it is of a Dark Bolour and [pg 166] Leprosy and then is less obstinate, This Disease is after attended with an itching which does not reach lower than the skin, as the Epidermis is nothing but the humours thrown out by the vessells of the Cutis which is the reason why in wounds there is no Epidermis, grown over them when closed, because the Vessells being destroyed there is no humours thrown out, therefore when an acrid humour falls on a cutaneous Vessells, it occasions them to throw out a great quantity of acrid matter, so instead of Cuticle there is a Whitish Crust, which [pg 167] Leprosy Menses &c. The Lepra Arabum is seldom met with in this Country, there was one indeed in this house some years ago, It was a most loathsome Disease they are full of Chaps & pressures wc. frequently Bleed, sometimes the mouth & face are affected with ulcers, so that the Ancients thought it a Cancer of the whole Body, In Arabia and those Countries it is hereditary & Dr. Mandivit says he met with some in Samaria who Derived their Disease from Gehazi mentioned in scripture. - - Prognosis. The Lepra Arabum is generally incurable. The Lepra Graeconum is cured by Mercury, but is apt to return again. The principal remedies are the warm bath to relax the skin, & keep the Body open, and Mercury given in any form, in cases [pg 168] Leprosy cases when it is confined to one part & but small, an Ointment is of use, if this mans had been of the size of my two hands. I would have ordered the Linn: Mercuriale but this could not be done here, as he had so much that it would have killed him in a Salvation, therefore it is proper to give it internally. When The Linniment is to be made use of you are to begin with rubbing the Spot this night, & so on through the whole Body returning to where you began. --------- End of Dr. Whyte's Lectures