National Library of Medicine Bethesda, Maryland Vol. 2 West Scripout 1. Gangrene When Gangrene has taken place in consequence of imflammation, we must endeavor to produce that kind of imflammation in the surrounding parts which will occasion a Destruction of the ends of the fibers connecting the living and dead part together when an Inflamed part dies it putrifies much sooner than if it was not connected with the living body and acting upon the surrounding parts, it not only produces Erisipelatous Inflammation in them, but it soon communicates it to the whole system, thus the Gangrene spreads and destroys by the irritation it produces, and not as it has frequently been afested from a putrefaction of the fluids of which there is not one symptom and it is evident that it destroys from this Irritation it produces in the System which remains after the dead part is removed, and we must therefore remove this disposition in the Symptom before the Removal of a mortified part and the most powerful Remedy which we can use is the Cortex 2. but the finer balouli require other [menstr??ms]. how are we to proceed when a patient applys for relieve [w?s?] has a Calculus? I reoom to Examine his Urine by the Experiment Aforeerelated I Hereby see what part it is most disposd to deposit & when the foreign Body is horriby inernsted over that Examin'd shows the Satire of the Stone within of believe more of the [illegible] over of Medecine that are taken by the statement enters the Bladder often is generally suppos'd I beleive if the pain of the patient would allow him to preserve a proper lens [illegible] in their use, they might be often cur'd without an Operation than is generally beliv'd Cortex Peruvianus, which tend greatly to 2 remove it and produce phlegmonous Inflammation and for this purpose it must be employed in very large Doses even in so large as the Stomach will bear; we also employ Wine & Spices, which are quick acting Substances, it will be likewise necesary to stimulate the Wound itself by Scarifi actions, warm Essential Oils beu; Mercurials are seldom used being slow in their action; it is to be observed that there is nothing of greater Consquence in avoiding this Irritation the the Patient living in a pure Air and of course are more rare in the Country and when they do take place are more easily curedinthe Hospitals or large Towns where Patient is very frequently destroyed. Some Authors have described Gangrene where ther was a hard pulse & every Symptom of General Inflammation but I have never seen it, not therefore can I believe it, for on the contrary the pulse immediately flags and the Strength of the whole Body is depressed which depending upon the diseased part in general believd for we know that sitri, can the [illegible] Jecob: V' all readily find their way into the Bladder Mr. Bride has prov'd the Mephitic air finds its way to the Bladder & thereby prevents is putre =faction that would otherwise take place in this part. fix'd air dissolves a calculus with great Rapidity under certain circumstances given to a person in health it produce a fermentation in the Urine liriirial Medecines have the incon =venionces of Empregnating & dissolving the fluids & dispusing to putrefaction, as we see in the case related by Dr Flexhams. If we would introduce a sufficient quanitity of fix'd air in the way of Diet, Drink [illegible] that Method would be much the most desirable. however I would not with to divide it 3 general go off when a Seperation has taken place, and the Ulcer remaining after the Exfolia tion of the Grangrened part is to be treated like any other. Schirrus If Inflammation goes off and leave a Schirrus behind; or if it is produced by any means whatever there is one produced, and procided it is small it is better to leave it, but if it increases it must undoubtedly be cut out; it is observed that the living power of the body prevent caustic from dissolving or decomposing so large a portion as they would do provided the same quantity of caustic was applied to a dead part. they will likewise act more forefully in a weak than in a strong Man; and if the Schirrus is not very large and should lie immediately under the Skin it is better to destroy it by Caustic, but by no means if we cannot destroy the whole as it would be more liable to produce Cancer by the use of Stimulants the Matter hav sometimes been reabsorbed and at others it has been increased and you entirely from after Lixiviam for fix'd air xx xxxxxxxxxxxxxxxxxxxxxxxx will not disolve all Calculi; nor will any other medcines we are yet acquainted therefore in some cases lixivious many be the proper remedies The best Alkali you can use is the common Caustic which you have in your hands every Day ʒi of this dissolved in ℥iij Ay Com: & a teaspoonfull of it given in Veal Broth is the best the [a?eer] waters have had good affects in some Cases where I have us'd it for the Stone. If you are called in & in the Violent paroxysms strong Opiates, Oily Chysters & the warm bath are the only remedies,in 4 and we are therefore to be cautious in there cure but provided a Cancer has taken place the patient is then to be kept as quiet as posible as nothing else can be done. some Remedies have had apparently success but very seldom as the Cicuta the Aersenic has been said to be employed also with Success, but it is a Medicine scarce to be administered in the smallest of Doses from its producing pains in the Extemities & eu and from every Medicinethat had been tried nothing seems to relieve so well as Sedatives; Opium and Preparations of Lead externally.~ of the pain is very Violent & frequent & the patient has no patience to go through a course of medecine then the Operation becomes neccesary astringents of all kinds relieve pain in the urinary passages, the more [????] is good only upon this principle Costiveness should be avoided gentle Eccoproctic purges as the Soap & Aloes, Ol Recin & Bitters pialliate allmost all Disorders if the Urinary passages Independant of Calculi Scurvy_ This is a disease but we defend every principle & deformity is call'd the Scurvy best the Scurvy is a disease but seldom met with on shore unless under particular diet & other circumstances_ The Symptoms are 5 The Doctrine of Fevers We now to treat of a Subject in which Practitioner have no ways agreed about what Disease shall be called Fever some having called all acute Diseases Fever, and others have Diseases attended with general Inflamma tion and Irritation but there is a Disease strictly called a simple Fever and it is this we are now going to treat of. ~ A Fever is a Disease affecting the whole System both of Body and Mind but not equally so in all cases; sometimes the Head being affected at another time the Trunk beu, not any one Appearance ever being constant of course there can be no Pathognominic Symptom as a frequency of the Pulse, which very often takes place in Fever and I have known a Man whose pulse was 120 and he was able to Sleep disgest his Food & perform any Exercise without 6 a general Posper Indolences & lassitude, a sense of fatigue & weakness, & torpor of the lower Extremities a short & panting Breath upon ascending any height, a tendency to anasarcous & Adematous swellings,yellowish sallow Countenence in some partly livid fetid Breath loose Spongy Gums easily Bleeding, considerable heat larcinating Pains in diff part of the Body as sides stomach Intestines, a tendency to Hemorhage from diff parts of the Body, the Urine light Colourd, Carious teeth, Exohymores & Arid Spots particulrly upon the anterior parts of the Legs. the acrimony of the Scurvy will dissolve over the Bones, they 6 without the lest inconvenciency; increased heat has been looked up as a Pathognominic Symptom but this may be increased much more by Inflamma tion, than ever it is by Fever, and it frequently happen that the heat in Fever is not greater than that of the natural Body even when the most violent Symptoms are prevent, and at some periods of Fever; for instance at the beginning the Patient is very cold, and the heat of the Body hassometimes varied the Thermometer during which time the Patient has thought himself cold, and hence some Authors have considered the Coldness on thar coming after asa Criterion but it sometimes happens that there is no cold Fit at the beginning of the Fever; and it is to be observed that a Cold Fit may take place without Fever as when a Woman quickens; so that there are no hathognomimic Sympotoms and if we wish to give a definition of Fever it must be by a Description of the whole Disease. If we consider Fever simply, it is a very short Disease never lasting more than 48 hours they are much dispos'd to dropsys & frequently are carried off by a flux, there is often Blindness from the Scurvy. sharp pains in the legs Arms & the this disorder is mostly confine to these who use a Bad Diet, yet I have known it among the Luxurious & Indolens.~ Cure is easy in the beginning, change of Air & Regimen being all that is necessary the Cure depends upon a Vegitable Diet of any kind even grass will do, nor do I believe one vegitable possesses any power._superior to others in this dis Experiments prove that an air unfit for animals Life may be corrected & made wholesome by only the Vegitation of a 7 or till the following Evening , but when a Number of Fevers follow immediately after one another so as to prolong the Disease all of which have been called a single Fever, and the single Fever of which the general one consists, we called the Paroxysm.~ We shall now show you what a Fever is simply and afterwards what it is when complicated and in describing one Paroxysm we must take it as if the whole Body was affected Simple Fever consists of three Stages; the first has been called the Cold Fit, on attack of the Disease; the 2d which has been supposed to be the natural Course we shall call the Hot Fit and the 3d consists of several Appearances which carry it off and is called the Crisis. The first of these consists of two things, first Depression of Strength, or Weakness, as it has been called; but there is a great difference between them; we may in some measure compare them to a Spring, which is pressed upon by a Weight infficient to prevents its acting by it Elasticity, and to one whose Elastic [?] Sprig of mint. but the best of Vegitables seem to be ripe fruits as Lemmons Oranges & of hence the use fullness of carrying Vegitables the sea as haft be which is a powerfull Antescor -butic not only from the fix'd Air it contains but from its Vegitable steams ad El Vitriol to check Dirrhoea._forever the smelly Vegitables afford much relief, the smooth of Gun Powder; of Far Ventilation, washing between Decks with Vinegar & keeping the ship clean all have a power full tendency to correct the Scurvy. Bark with Acids & all Vegitables_ avoiding at the same time bad meat, bad water. the Paralysis of Sonbusiefrep is 8 Elastic power is destroyed; the first of these being removed, when the Weight is taken off; so in depression of Strength, the Body not having lost its power only overcome by Disease, which when removed it is capable of such Exertions; but provided the power is lost, the weakness continues though the Disease is removed, so in violent Spasms taking place in the Intestines the powers of the Body are only oppressed and if they go off in an hour or two the Disease being then removed, the powers act equally as forcible, but when a Man is rendered weak by a long illness it requires time to recruit the Force of the powers; the next Symptoms are Languor, weariness, an indisposition to Action, and a want of power to act in every part of the System as Muscles, Mind feu the Organs of Sensation so immediately affected as you may burn the patient perceiving it; Vision almost lost, as likewise the Organs of Smell & Taste, when the Body begins to act more powerfully, that is produced, and when 9 is reliev'd by fumigating with aromatic Gases their Ulcers will not heal till the general habit is sweetened by proper Regimen Medecines I do not think that there are any particular Antiscrobutic Vegitables as Cresses,Cocklears but that these in common with all Vegitables possess highly Antiscorbutic power._ Particularly ripe Fruits, these with Exercise, Bark &c will effect a Cure if anything will- we should be particularly carefull not to expose a patient too suddenly to fresh Air,who has been long confind to one that was foul._ as the effects have been often suddenly Fatal._ 9 when less, there is Coldness, trambling and a Chillness over the whole Body, pain in the small of the Back, but why this pain should take place, we do not know; the Depresson of Strength may arise to such a degree as to prove Fatal in less than an hour, without the patient becoming hot or having Symptoms of the second Stage, but it kills in a different manner from weakness, for whena Man is destroyed by Depression the parts keep aline a long time after the Commu nication of Life is destroyed, and the Heat of the Body is kept up a long time after the different functions have ceased to act; this is one part of the Attack. The Second is [?orifilation] (for which we have no good English word) the Skin becomes of a dirty yellow, arising from the Blood in the Vessels and the Sebaceous matter which is one of the strongest Symptoms of a Fever. the Tongue dry & foul, Thirst, and all the Secretory Vessels affected, Urine transparent, Costiveness is prevalent, and in short all the Secretions stopped very frequently and if there be any Wound or Ulcer the small 10 Lecture upon Dropsy This is a disease in which there is a preternatural collection of water in the Cavities of the Body, in all the Cavities there is an Exhaling system of Vessels from which the water is constantly effused into these Cavities for Various uses, & it is as constantly absorbd in health to present accumulation_ Dropsys arise either from too much of this fluid being Exhaled or too little of it being absorbed & the causes of these may be many as [s?] an increasd impetus of the Blood upon Exhaling Vessels. for the quantity of perspi ration upon increasd Exercise proces the power of 10 Vessels being contracted they become pale; some times the pulse intermitts which is a Symptom of great Inaction and seldom takes place; pain in the forehead from the Contraction of the small Vessels, which is exernally, and this kind of pain infests the whole Body and Delirium sometimes take places most probably owing to the Contraction of the Vessels of the Brain. When the is Universal Contraction of the small Vessels, the Blood is accumulated about the large ones lying near the pracondia heace Depression & Anxiety, the Heart then being Stimulated more frequently to Action produces a quick pulse and from an Affection of the Lungs there arises a Cough with quick and laborious Respiration; whether is is a peculiar Affection of the Stomach I do not know, but a Rigour and Horor takes place giving an Idea to the Stomach of every thing liable to disorder it Spasmodic Contraction of the Stomach and Intestines arise Nausea, whether this is a separate part of the Disease or depending upon the fullness of the large Vessels I cannot pretend to say, there 11 Blood being oftener apply'd to any secretings Organ or the aperture of the Vessels being enlarg'd, or their Coats being more purious than usual, & thereby producing a greater effusion, another & g? [illegible] are the fluids that are sent to these Vessells being too fluids watery, when both the Impetus upon these Vesselss is natural. & their Coats or apertures in a health state & this may be occasion'd by too profuse [E???] =ations & all arteries terminate [with???] Veins Excretory ducts or Exhaling Vessels when the Glands are obstructed in ay particular part more blood must be sent upon the [V??????ing] Vessels which remain precious as [illegible] 11 these are the Appearances constituting the Disease, so that if these Symptoms are not all present the Fever is absent; but as far as we know Depression of Strength & Contraction of the small Vessels are intirely independant of each other and whether these two take together constitute the Disease cannot perfectly be determined. we might have before observed (that it has been an Opinion amonst Practitioners that Fever was a Disease of the Fluids, but from every Experiment, that has been made this Doctrine had been neglected as there being to a peculir State of the Blood attached Fever._The Symptoms which we have before enumerated are produced by a variety of Causes, as Passions of the Mind excited occasion a Contraction of the small Vessels and an Inaction of the Living power as Fear, Grief or Anxiety, the Second Cause is Cold, as for instance, if a Man should lay himself down upon the Cold Ground, or when he is heated by any kind of Exercise and immediately drinks a Draught of Cold Water, Fever had been instantly 12 Exhaling Vessels & Obstructed perspiration may be the cause of Dropsys if the secretion of mucus is not increas'd. suddenly cooling when much heated often for [?d??ces] Aites which is easily cur'd. whatever compresses the Veins & prevents the return of the Blood is the most frequent Cause, by causing more Blood to flow upon the Exhaling Vessells as Obstructions at the right auricle of the Heart; Obstructions in the Viscera etc. for we find that Ligatures upon the Veins obstruc =ting the course of the Blood will occasion Adematous swellings. a Ligature upon the Vena 12 instantly produced by producing Contraction and Inaction which sometimes may happen without Fever; Exposure to Moisture will have the same Effect, as the water evaporating from wet Cloaths or damp Sheets hence it is evedent that the danger arises from the Exapotarion & not Water for had he covered himself with Water, no Mischief would arise. The next Cause of Fever is particular Matter applied to the Body as putrid Vapour arising from a Number of People being confined in a small space, where there is not sufficient Respriable Air, and when this Vapour is applied it very frequently produces Fever immediately having been instance of a 100 people being affected at once; Also the Matter of the Small Pox, Measles and Chicken pox and other eruptive Matter; the Fever in these Cases is not always produced immediately nor is every Man so liable to be affected by putrid Matter an instance of this, we had in the Man, who brought the Infection to the Old Bailey where he communicated the Disease to such a Number of People and he was never affected. Certain 13 Vena Cava of a dog is seen follow'd by a Dropsy & speedy [D?ch] & from the same obstruction are produced the Hamorhoids & this is the reason they so often represention Dropsical Complaints when the liver is obstructed this the the Biles are most frequent. Hence pregnancy often occasions the Aites _ & Polyps as the Heart the [illegible] drops [?eckon] and a Ligature upong the Jugular Veins Occasions a dropsy of the Head. a long contained Erect posture Anascarous swellings upon the Legs_this thereas on they more commonly appear at Night & as a simple posture occur 13 Certain Substances retrained in the Primo Via as indigested Food or Faeces in the Intestines but these are equally liable to produce other Diesease as well as Fever; Changing the whole Habit as removing into another Climate had very frequently has very frequently produced Fever._ It very often happens that a Person is seized with Fever all at once when in an hour before they were apparently well, and the can't give the least Reason for its attacking them, we are therefore induced tot hink that there are several Causes of Fever not yet investigated. ~ There is one Material Circumstance to be attended to which is the Repetition of any of these Applica tions, as a gentle Application of any of them may produce Depression of Strength &c and immediately leaving the Patient produce no fever, so if a Man goes into a place where there is a great quantity of putrid Vapour, where upon breathing it in Anxiety &c immediately take place, and when he goes into a pure Air, they will frequently go off without any bad Conse quence, and it is necessary therefore that there shold be a permanency of these Symptoms to 14 occasions Anasarca of the Head this is the reason this Symptom is most common in the mornf._ Dropsys are often occasiond by Obstructed [Ham???] nenses & _ & the Cause of Dropsys are often so fix'd as not to yield to any methods that can be try'd. we should remember that the Operation of tapping does not Radically Cure almost all parts that are paralytic are apt to become Dropsical from Relaxation. many Dropsys depend upon the thinness of the mass of fluids occasion'd by profuse Evacuations, the Cutaneous & Urinary secretions being diminish'd are often productive of Dropsys. & whengreat quantities are drank in fever the same effecthas been [m???] less 14 to carry on Fever, when the Original cause is removed and when a Fever is once produced it is entirely inde pendant of its Cause which destroys the Old Maxim of Removing the Cause and the Effect will cease as in the Small Pox if a share hav catched them naturally it will have a very good effect inocu lating him immediately in preventing the natural Small Pox from acting and the patient will go immediately as well through the different stages as if he had been inoculated only; so when the Small Pox is going off, there is more Varicolous Matter in the Constitiution, than when first applied and if we were to REason a priori; we should then expect the Fever to go on more violently; so as a Crisis there is infectious matter producing it can never produce it again as that of the Small Pox & and a Person recovering from an infectious Disease as the Plague &c. is not so liable to receive it again as another person unless it is a long time after. this is a singularity peculiar to Fevers with other Diseases have not. Infectious Matter applied to the Body does not always produce Fever directly, that the nuance is 15 but there are more Dropsys produced by profuse Evacuations than from any other Cause. many peoples feet discharge considerable quantities of fetid sewat which when suppress'd often occasions Dropsys, when Ruptur'd Symphates is the Cause then there is no cure but in preventing the Exhalations & this is to be done by reexciting In Ham: upon the part. all pressure upon the Veins Acts by preventing absorbtion;- Inguinal Tumors by pressing uponthe Lymph returning from the thigh to the abdomen produces a dropsy of teh Leg & thigh. all the Lymphatics are Irritable & therefore when a Palsey seizes the parts from destroying their 15 in which it remain we only know in one instance which is in the small pox, first producing Inflam mation, then Suppuration and these is a pus formed similar to that first applied; it has been a dispute how infectious and putrid matter enter the System some having supposed it first entered the Blood Vessels and turned the Blood putrid, but this is not the Case for the Patient continues well for some time after the infectious matter had been applied, when he is seized suddenly with Fever, and when Bleeding instead of being putrid is is Inflammotory, sometime it is produced by a slight Headach, Languor & which hang on for 6 or 8 Days, and then the Symptoms become more violent, but the most common time in 12 or 14 Days. ~ When a Fever is produced it goes on independant of the Cause producing it as no Fever goes off simply either destroying the Patient or there arises some Natural Cure and carries it off. this Natural Cure we are induced to think is the hot Fit, as the Patient is never killed during the period unless by some Accident when the Symptoms of the 1st Stage are gone off, there ariseas a that over the whole body, but more 16 sensibility they may be unable to press on their contents & by that means a dropsy be occasion'd we have now spoke of General shall now speak of particular Dropsys,&1st of the Acites, this is a preternatural collection of water in the abdomen between the peritoneum & the Abdominal Viscera, but it is often mis =taken for the Diseases_ in the Acites the Tumor is not circumscrib'd, it begins towards the lower part of the abdomen there is a fluctuation. the true Acites never produces greater distension unless much drink it take. the Urine is in small quantity & high colour'd with a great sediment 16 more frequently irregular at the same time the Patient thinks himself colder, and even the Extremities have felt cold to Bystanders when upon applying the Thermometer, the heat of the Body was greater where it is generally about 102 or 104, violent heat about the procordia, the pulse becomes full, and strong, and frequently obstructed, though at the Beginning of the Hot Fit, it is more commonly frequent & slow; some have defined this obstructed pulse as the hard one, but there is an evident difference for the hardness indicates inflamed Blood and the obstructed does not; these are evident Marks of the Heart acting strongly, and the Heat is another Sign of then increased Circulation, the Veins are often enlarged, so the there is a greater quantity of Blood thrown into the small Vessels, yet some remain contracted, and the Skin instead of being pale is of a brownish yellow; there is great distension, which produces pain in the Head, Joints, as also in the Extrmeities similar to Rheumatism, but different from that happe ning in the First STage; the Brain becomes com pressed, in consequence of which there arises stupor 17 the Breathing is difficult particularly in a supine posture: sometimes the water is collected between the Peritoneum & the Abdominal Muscles, have the Tumor is more circumscrib'd & it does not move its situation, This is a kind of Inoisted Tomor, tis slow in its progress, there is not much thirst._ the Urine & the Breath& is as in the Acites [illegible] it is difficulty distinguishd from the true abdominal Dropsy sometimes there are large [illegible] which are very difficulty distinguish'd. the progress of all Jointed Tumors is slow, it begins in a point & then stretches out in diff. directions without any 17 Stupor and Delirium, a universal Soreness owing to the parts having been contracted, which are now distended; there is irregular fluid colour upon different parts of the Body; Tongue covered with Fur the Urine high coloured and transparent; sometimes some one of the Secretory Organs give way and there is an increased Secretion from it, which is partial as Sweating, purging & these have been called Symptomatic Evacuations; there are the symptoms of teh Hot Fit of 2d Stage, in which there is some process that takes place; which we do not under stand besides the action of the Heart and whether it is upon the Somach we will not pretend to say but the first stage is actually carried off by it. there now arives Symptoms, which we call the Crisis; the increased Action of the Heart is removed by the Universal Relaxation of the Small Vessels, hence the Skin grows moist & soft over the whole System, even that Crust which lays upon the Tongue is naturally thrown off in 3 minutes which the nicest Disector could not have seperated; the Belly become open the Skin returns to its natural Colour the Secretions become increased very much particularly those 18 fluctuations _ when there are any Cysts_ there is an unequal heat, there is more weight & uneasiness in these when in a depending Posture. than in the other, these are the Symptoms of the Dropsy of the Cranium which comes on it the advanc'd periods of Life, the disorder first begins in the side, the progress is slow & the Urinary secretion is little till the Tumor is very large. Dropsys have been taken for Pregnancy's & Pregnancys for Dropsys, when they are complicated they are difficulty distinguish in Pregnancy there is no fluctuation, the Tumor is higher & more Protuberant, is there a Change in the situation of 18 those of the kidnies, & the Urine throws down a lateritious Sediment from the universal Relaxation which permits the sperating mucilage to pass out, not as this is necessary but it is one of the most com mon appearances; this is one Natural Cure of Fever.~ The next Natural Cure of Fever is Inflammation, which ariving in some part of the Body carries off the Disease, or it is the Cause of Hamourhage, which has the same Effect: we have now shown you one Paroxysm of Fever, which when removed the Patient recovers his health but is considerably weakened; the time of a Paroxysm continuing is different; sometimes the whole is gone through in 2 hours, but very rarely generally requiring 10 hours and sometimes 20_ or 40; and I knew one instance, where one Paroxysm continued for 3 Days, without any fresh Exacer_ bation, and a Fever, which consists of one Paroxysm only we call Ephemera Simplex, in which I have seen People delirious and every violent Symptom of Fever, but it is not very common in Practice to see this; as they seldom judge it necessary to send for a Physician so early and in Consequence we loose 19 of the Tumor upon Change of Posture & the concomitant Symptoms of Pregcy should be attended to; In the Acites the Urine becomes diminish'd anasarcous swellings in the feet ancles &c preceed reaching_ gradually till it gets to the Abdomen this is great Thirst, dift Respiration, dry Cough, Costiveness, general lassitude, [illegible] of the Habit & the disease is sometimes follow'd by Hamorhages from the Lungs, Anus & which points out obstructions & resistance to the Blood in the Viscera_ the Scrotum in Men & labia in Woman are distended In the high stages of this Disorder there 19 lose the opportunity of carrying it off.~ We come now to shew you the manner in which several of those Paroxyms follow one another so as to constitute the different Fevers; it sometimes happens that the First Paroxysm shall be perfectly distinct and entirely go off before a Second takes place and there being some Interval between the two Paroxysms we call it an Intermittent Fever; sometimes the subsequent Paroxysm takes place before the Symptoms of the preceeding one have quite left the Patient, we then call is a Remittant and when the Subsequent Parox xsym takes place in the hot Fit, or before it is considerably abated, this constitutes what we call the Continued; now as the Original Cause acts no longer than we have shewn you, it therefore becomes necessary that there should be some fresh one applied to reproduce the Disease in the First place, it happens that in Intermittants tho' there is a Crisis yet there are some few Symptoms of the First Stage remain as a slight pain in the Back & Head a little [?ol?lness] of the Tongue & which continue for 4 or 5 days constantly 20 there is diffit Respiration but in an Erect Posture, the Legs become Adematous & Gangrenous, there are obstructions of the Liver & other Glands in the Body Abdomen; there are obstructions of accustom'd discharges, & the Sympathies become disorder'd in the abdomen, if a Schirrus in the Abdomen is the Cause then the disease is only to be palliated a a sallow countenance shows the Liver to be affected. Twisted Dropsys may be carried about many years till its bulk makes it troublesome, this Dropsy is not to be cur'd by Internal Remedies as the part becomes inorganic_ 20 constantly accumulating till they become sufficiently powerful of themselves to produce a Disease; and when a Fever had been carried off by a Crisis, it may return from any new Cause, a Food of difficult Digestion, and frequently when several Paroxysms having taken place it becomes habitual, these are some of the Causes, which retroproduce Fever, but the two great Causes are the natural Evening Paroxysm and particular time, which we call Types; Every Man in Health has an Evening Paroxysm, which goes off in the morning with considerable Relaxation, and in Habits naturally weak or any way affected they are very preceptible but why a Man should have a Paroxsym daily is difficult to say, but it is the Evening, that produces it independant of his Employment during the Day, as the same time in Morning, Noon & Night is different parts of the Earth, and if a Man goes to the East or to the West this Paroxysm will arise in the Evening of the place where he is, the most usual time of its beginning, [illegible; crossed out] 21 Jaundice & waisting Hamorrhages with a Dropsy are bad, but the Urine flowing freely, scant to a light Colour, the Breaths coming freer & are good Symptoms. Cure. when the Disease proceeds from an increas'd action of the Arteries, then abating this Impetus by local [illegible] is best._ when Inflam: of Liver & lungs are accompanied with anasarcous swelling then small Bleed f. with cups is proper, but we should be Extremely cautious how we take Blood from Dropsical patients, as the cause is most Commonly weakness Dropsys are best cur'd by promoting Absorption_ secretion & Evacuation or sometimes by paraaentesis_ 21 is about 5 or 6 o Clock and goes off about the same hour in the morning so as to occupy near one half of the 24 hours, coming on grdually so as to be greater about 10 o'clock at Night, and if a Paroxysms of Fever should take place in the Middle of the Day, as is frequently the Case, the natural Evening Paroxysm for that has little Effect, but if it is continued till the next day this Evening Paroxysm is encreased, which continues till the next Evening, when a new Paroxysm is produced and so the Fever goes on;-if a Fever takes place about 4 o'Clock in the morning which is very rare; if it continues till the Evening, sometimes a fresh paroxysm is brought on by the Natural Evening one; It has been an Idea amonst Physicians, that Fever terminated in a certain Number of Days, than a dispute arose, which was the First Day, we are to take the Day on which the first Paroxysm commences; if a Fever arises at 2 o'Clock in the morning then we must count the Evening before as the beginning of the Day is about 5 o'Clock in Medicine, this natural 22 absorption is principally assisted by Vomits from their shock, they act over the whole Body, purges only upon the Intestines. but caution is necessary in the use of Vomits where there are fix'd abdominal obstructions but in [illegible] Dropsys we may use them with much advantage to promote Absorption. there are many instance of Cures being perform'd by Natural Vomits_in all Dropsys in young habits where the Liver & other Viscera are not much obstructed Vomits are good._ purging us'd at the same time will Eva cuate Incredible quantities of water. Vomit 22 natural Evening Paroxysm is generally the Cause of Recurrent Fever, but why, we don't know; The other Cause of Fevers is more simple, a certain period of time having a power of reproducing Fever, the period, which has the greatest power is that at the End of 48 hours or between 46 & 50 as there are infinitely a greater Number of Fevers re curring in these 4 hours, than in any other and these are called Tertians; the next period in which Fevers are apt to recur is at the End of 24 hours and this we call Quotidians; and the next of 72 hours and are called Quartans and we have had instances of their recurring at other intervals and it happens not uncommonly that the Fever is first a Quotidian, than a Tertian, and than a Quartan; and at the beginning when they are assuming a Quatidian, there is a greater degree of Inflammation then in a Tertian or Quartan; then from these two Causes the Paroxysms always arriving, as also the period of time we might then say that a Fever would continue for ever, but on the 23 Vomits at the same time promote both Expectoration & Perspiration. for the Intention of Vomit. & Purging together I use the Tart Emet a tp. spoon: few: & sometimes the Elaterium alone to the quantity of g[??] this both Vomits & Purges. for the same purpose Tart Emet with JSalap: Ipecac Turp: him: & white Vitriol & induc'd all kinds of Vomits are good_ but if the Cavity is much distended, if there are local Hamorrhages of fix'd pains, then i would avoid Vomits. purging in Dropsys Nature points out as Nature sometimes cures by [illegible] [???aneous]Diarrhaa but purges 23 the contrary it had a Natural termination, which is of two kinds; If in a continued Fever a Paroxysm should take place, which was more violent and a Crisis be produced, so that the Patient should be free from Disease before the natural Evening Paroxysm hence it has only a power of continuing the Fever and not producing it; this likewise proces that altho they are not govern'd by Types yet they are affected by them, and if a continued Fever is not increased by the Natural Evening Paroxysm it will be either by the Terian or Quartan Type, or both. It frequently happens, that when Fevers have gone on some time that every other period shall be more violent that is in Fever recurring every 24 hours and these we call double Tertians; so in a Quartan where we have a Paroxysm every Day, but it often happens that we have 2 days on which the Paroxysms are slight, and then a violent one; these we call Triple Quartans but these Irregularities are not always the same varying 24 purges do it more effectively.___ spontaneous Vomits likewise often cures. Dropsical patients bear purging much better than people in health, & the more active the Purge the better for instead of weakening they restore the strength;-the more stimulating the Purges the more serviceable in these disorders I have begun with the most emetic but find the most drastic best as they carry off most water, jalap when it can be procur'd good is one of the best, jalap should be divided by some dry Powder, as Cream Tart, Nitri_ or sugar, to correct its Blesinous parts, & precents its Griping_the Pubris [B?si?ing?] is 24 varying in different Climates; as in warm Climates; as in warm Climates the Types are more powerful and the Consequence Intermittents and Remittents are most common, in these Countries; and in colder Climates continued Fevers are more common it is to be observed that the peculiar Effect in a strong Paroxysms is to produce a perfect Crisis, therefore on the Days of a continued Fever, where the prox syms is stronger there is a better Chance of a more perfect Crisis. ~ We have shown you that continued Fevers may terminate by a Severe and short Paroxysm which throws the Patient into great danger, so that when such a Porxsysm has taken place they thought that the matter was brought to a point as being doubtful whether we would recover or die, hence is was called the Crisis we have also observed that such Paroxsysms were more apt to take place on the Days of Types, and that in continued Fevers left to their own progress they generally happened on the 4th,5th,7th, and 21st Days, hence they have been 25 is a very good Form. I have used Elateriam with great advantage_Both have was very fond of Copper in the Volatile alkalai as a purgative & Emetic & by its use becur'd many, the humor peal as strong as the Lunar Caustic has been us'd to advantage pg a dose_ but if they do no good they must do harm, thou fond I prefer the Resinous to the Mateltic Purges_ I have seen the Express'd Juice of the Iris do good._ In fact the certain & best method is by active Evacuations from the Prim & Veg Evacuations by Moaine will do best if we could easily promote it as short but diuretics are 25 been called Critical Days; the Quotidian Type generally governs the first week, and the Tertian Type the second week. The Greek Physician had an Idea, that there was something more decisive in an odd Number than an even one, they therefore considered the 7th & 9th as the proper Critical Days. We don't know any Reason why a Fever should change on the 7th anymore than on the 6th day, as also upon the other particulr days as the 9th, 14th & but the Greeks not knowing how to make this last an off day, they called it the second Seventh. If a continued Fever runs on for a long time it scarcely observes any regular Type at all and is grandually worn out attended with imperfect critical Symptoms; an Intermittent cannot terminate by Crisis but it frequently happens, the the Disease continues in consequence of an imperfect Crisis, for provided their is a perfect Crisis the Fever never recurs; some times a continued Fever recurs on for three or 26 are the most unsteady Operations in Nature. Squills in the [illegible] call'd the acite Scillet: or Dry with Niti are the best diuretics. _ Squills do not spoil by drying as most other medecines do but 2 or 3 Gs: if the dry Squills are equal to 3fs of the Acet Scil_ Opiates added to diuretics makes them more diuretic, I therefore use the Tinct Thebair with the Acet Scillet: which is much more diuretic than when us'd by itself_ D some from Vienna has recommened the Cololineum Canlinsum its effect are similar to squills. I recommend to you to try it yourselves: Bitter infusions with Diuretic & Alkaline Salts sometimes promote Hernia [illegible] 26 or for Months, but then it is very irregular a Quotidian generally terminates in about six weeks, a Tertian in about 3 months & a quarter [crossed out] Quartan about 4 months all gradually diminishing and going off without any Crisis. A Fever had been supposed to wear itself out by producing an Alteration, as some of the Fluids occasioning them to be expelled. This Droctrine has been supported by this Appearance, that if a Crisis takes place in the first week of a continued Fever it is generally imperfect and the Fever relapses, but if it should take place in the 3d. Week, it is not so Subject to relapse, hence they assert, that the Matter was not concocted in the First week, but this is not sufficient Ground for such Matter being in the System. Fevers universally produce a peculiar Matter, as all Fevers are infectious, not by the Cause producing but by the Exertions carrying it on, but the Crisis is not an Expulsion of this Matter is evident from Fever being carried 27 any bitter will answer whether Century Gentian, wormwood or Broom, a decoction of the Broom with its Salt cur'd count six of a dropsy as Sydenham relates. Juniper Berrys sometimes prove Diuretic but you must change your Remedies till you find what will best suit the particular Circumstance of your Patient~ I have lately added the Tinct Flor Martial: with the above Diuretics for the Chalybeats strengthen the Habits- Mustard seed, Horse Radish, Garlic & are all Diuretic in their trom_ with regard to to [crossed out] to avoiding much water on Account of the great Quantity collected even when the patient 27 carried off immediately, while the Body seems to be loaded with Matter and why a Crisis should not be so often perfect at the beginning of Fever we do not know. ~ A Fever by no means necessarily tends to destroy a Patient being most commonly by some accident which if we can avoid, the Fever gone rally terminates in health; it therefore becomes necessary, that we should know there accidents in order to guard against them; in the first place a Fever may be so violent in itself as to proce Fatal. 2ndly General Inflamation arising at the beginning may be fatal; and in the next place Patient may be so weakened as to be destroyed and this Danger is encreased by Irregularity in the Disease; when a Fever destroyes simply it is total depression of strength generally happening at the Beginning of a Paroxsysm, but there is seldom such a severe Paroxsyssm in continued Fever except the First, in Intermittents it may happen in any of the Paroxsysms, though this is not 28 is pour'd with thirst & earnestly craves drink tis customary to deny the Indulgance but this practice I fear is carried too far there have been many Instances where patients have been turn'd out of Hospitals as Incurable of Dropsys, & they found a speedy cure at the Neighboring pump; I think we should attend to & indulge these Urgent Cravings of Nature has as well as in Acute Diseases. Much we all know is a good Diuretic & it should be try'd in these Cases as it is very agreeable, therefore if we cannot use by one measure should try another but water being collected out of the reach of Prins Visasin Dropsy [illegible] reason why we shold be afraid [ofallerof] it as drink for fear of 28 not very common in this Country, except in those parts that are fenny, and these are no Symptoms that preindicate the Death on the First Attack of Fever, or in the Cold Fit of an intermittent; except when the Former Paroxysm is violent; but the Mischief, which happens to the Head & Heart are preindicated by the Fever being violent, by Languor & weariness preceeding the Disease 4 or 5 Days before the Paroxysm takes place, which shows the Difficulty of pro ducing a hot Fit. It is attended by ga great prostration of Strength, strong Men capable of undergoing the severest Labour are rendered incapable of walking across the Room in one hour after the Fever has taken place. the Action of the Blood Vessels preventing the Blood from putrefying, till depression of Strength takes place, hence Symptoms of putrid Blood, the tongue is covered with a brown Fur; the Red particles of the Blood are broke down so as to pass out and produce dark purple Spots called pelectris, Breath fetid, and putrid Secretions 29 of increasing the Quantity a discharge from the skin in a desirable Object in these Disorders & for this purpose difft means have been employ'd as warm bathing flesh Brush & if this discharge could be procur'd it would be the best Remedy: after the water is Evacuated than Bark, Chaly =beats, Exercise chearfull compnay & proper Nourishment will be necessary. but when all other methods fail we too late have recourse to the Operation. but we should begin with the Operation & then Remedies would do the more good. it must be allow'd that many die after Operation, from what Cause it is hard to determine I would therefore use it only early in the Disease 29 Secretions, the Skin is dry, rough & unequal the Urine viscid & frothy owing to the seperating Mucilage being secreted; these Appearances, which are the violent Symptoms of the First Stage seldom take place in Intermittents for though there is great depression in the Paroxsysm, yet it is got rid of in the Intermission; but in continued Fever these Symptoms take place and may be said to be the Cause of its Continuance; there is likewise great Affection of the Mind, the patient feeling a Sense of Weight, he sighs frequently; Ulcer, if there was any come dry, these are Symptoms of Depression of Strength; the Pulse is obstructed, which is a Symptom of Contraction as also the Urine being pale, perfectly transparent and in small quantities,when the Nails & fingers remain Cold & pale, Ears cold, Nore sharp Eyes sunk, they indicate a great degree of Contraction and are dangerous Symptoms; the Face being of a dirty Colour, approaching to 30 & not when from the continuance of the Disorder the Viscera appear to be much diseas'd, as they always are from Consmauration in the collect'd water ___ 30 to a brown shews, the the Fever is violent and is one of the strongest Indications of the Strength of the Fever, that I have been able to tell, whether the Crisis had taken place by looking at the Ptients face. When the Breast is particularly affected, the pulse becomes frequent, irregular or intermitting generally from 100, to 106 or 108 but this does not show any great Affection of the Heart, but when it beats 120 in the first week of a Fever it is attended with Danger; if even sometimes in creases to 130 in a Minute and the patient falls into a Delirium and expires; at the same time there is this frequency of the Pulse Respiration is difficult and the particular Symptoms, showing the Heart affords violent tension and Oppression about the pracordia. Fevers are frequently fatal by Affections of the Heart but not so often as by Affections of the Head. While a patient is actually strong in the Beginning of a Fever the Accumulation of Blood in the large Vessels stimulates the Heart and Lecture upon Apoplexy This is a Disease accompanied with lots of domimution of sense & Voluntary motion has the action of the Heart, arteries & Respiration they continue~ in some there is the Apopletic Snoring_some are seiz'd with this Disorder suddenly, others are warn'd of its approach by a sense of weight, heavinys Giddiness noise in in the Ears, a gradual Diminution of the senses & particularly of the sight_ _ most kinds of sudden Death are said to be apopletic but this is wrong Detection shows it may be brot on by a great Number of difft Causes Apoplecys are of two kinds the serous & [sanguine??] 31 and Arteries to act more strongly, and produce General Inflammation at the same time Depression of Strength continues in other parts of the System but a particular part is [?etting] more strongly as the Blood Vessels; there are two ways by which it destroys; one is by the Affection of the Brain, and the other by the General Tension, it is known by the Pulse being full hard & strong; it is always necessary to attend to the difference between the hard and the obstructed pulse, there is universal Redness, Respiration quick; in General Inflammation happening simply or with Fever, the Mucus covering the Tongue is commonly white, this Colour appears to be connected in some degree with the Blood; so when the Blood is perfect as in an inflammatory State, it is white, and when it verges towards putrefaction, the mucous becomes brown, and when the Blood is putrid it is then black; and in general Inflammatin arising from the Affection of the Thoracic Viscera the 32 the sanguineous often from Exhaval Blood the other from an effusd serosaity & is most commonly in Elderly & Emaciated people some particular persons seems to be more predispos'd to the Apoplexy than other as those with large heads, short Necks, those eat & drink plentifully & are sedentary & Indolents_ & those who are subject to Hamorrhages when young- I think the apopletic period is between 40 & 60 year of Age-they may be Hereditary in the Disease of the word. they are most common after Eating when the Stomach is distended with food, Gravid Women are most subject to 32 the Mucous becomes brown, and when the Blood is putrid it is then black; and in General Inflammation arsing from an Affection of the Thoracic Viscera the Mucous is yellow; the Blood being propelled with greater force through the small Vessels hence considerable pain in the Head, and Delirium but this Delirium arising from General Inflammation differs from that arising from other Causes, the patient lies stupid, muttring something to himself, if you excite him, he becomes apparently sensible but presently returns into the same stupid State lying in this way for 2 or 3 Days, then falling into violent Convulsions, or Ravings, Eyes Bloodshot, flushing of the Face, but have a different Appearance in this State or appearing sensible, when the Patient is spoke to, whereas in the other Species of Delirium they appear stupid without much Affection of the Head or any particular Symptom, and he is cut off suddenly; this Danger is only in continued Fever; but when General Inflammation is great it always terminates in continued Fever, particularly in the Spring and in to them than other_ Tumor in the Neck whatever may occasion a stoppage of the Venous Blood may occasion apoplexy_ Electric Shock upon the head & sometimes occasions this Disorder. the serous kind_ may be easily distinguish'd , it depends upon a stagnation & Extravasation of water upon the Brain, in the old & Phlegmd & in those reduced by Evacuation -it comes on gradually & in this kind the Breathing is not so noisy as in the other. persons in this have sometimes been buried alive in this from their appearance & unless a polish'd surface, or Candle is held to try the Breath this mistake may 33 in the Country as not one out of a hundred died of General Inflammation in London but is very frequently fatal in the Country. ~ We come in the next place to consider the next and last danger, which is that of Patient being destroyed by merely worn out, but he may be so worn out as to be destroyed, before the Fever goes off; I have known one Circumstance of a Woman after ChildBirth, who in some Exertion affected her Head, fainted & died, after a perfect Crisis. The principal danger arising here is in the Fever continuing longer than its usual period, which is frequently owing to the irregularity, which Irregularities may be in a particular part and the whole Body not affected; this is shewn often by partial Evacuations without Relaxation of the other Glands, as partial Sweatings while the Tongue remains dry: Cold Colliguative Sweats are only a Symptom of Weakness and not Irregularity; the same happens where a purging takes place, or an increased Secretion from may often happen. this species may happen from a diminution of the watery secretions, a stoppage of accustom'd Evacuations Old Sores &c & it sometimes terminates in a Palsy. all Apoplexy from External Injuries may be refer'd to the Sanguineous Species _ there are some Symptoms which are common to both these species of Apoplexy, as head Ache, Giddiness loss of Memory, sleepiness torpor, occasionaly Tremors of the Lips, noise of the Ears &c as this Disease increases Respiration drawes the sanguineous seizes the patient suddenly, the Countenance appears florid the Eye half open & dim whenever this Symptom Appeams in 34 from the kidnies, on the Patients bursting into tears, if the Urine has a Mucous Sediment it is likewise only a Symptom of Weakness, and if there is any Affection of the Head, and the Skin now dry, and when there is difficulty of Breathing, Anxiety and no Affection of the Head, they are dangerous Symptoms; but the most dangerous Irregularity is with regard to the Exacerbations not taking place in the Evening, but at some other time of the Day and the Patient relieved in the Evening even if it is attended with Sleep it is dangerous; the Continued Fever observing Types and those Types varying being First a Tertian then a Quotidian, or one Paroxsysm being very severe, the next not so strong, and so on for two or three Paroxsysm doubles & tribles particularly if the true one becomes less severe, these Irregularities in Continued & intermittent Fevers run them out to a great length weakening and at last destroying the Patient; the simple Symptoms of Weakness are indicated by partial Secretions, Pulse small, and quick, which shews rather in fevers &c this a bad Symptom & denotes the Brain much affected, there is a snoring noisey Respiration, full strong slow pulse, immediately before or after the fit the patient sometimes finds a particular Palsy in some part of the Body particularly the arm. but sometimes this palsy does not come on till a Day or two after the Apoplectic attack. a concubine motion of the face is a bad Symptom _ in the Sanguineous Apoplexy & always the Symptoms are worse as the parts affected are nearer the head, -in atheserous Apoplexy the patient is remarkably drowsy with a pale sunk countenance, the Respiration is not 35 rather Irritability than simple Weakness and when the Pulse becomes tremulous the Patient is dying he lies to all Appearance Stupid, without much uneasiness, though sometime the depression is attended with great Uneasiness, and the patient is frequently moving; but when he is actually weak, he lies upon his back quiet, and will frequently tell you he is well (and whenever we find out Patient lying upon his Side with his Arms & knees folded, it is a very good Symptom, showing tht the Anxiety is removed while on the contrary if he lies upon his Back apparently easy, it is a very bad Symptom, he places himself in this posture to prevent Muscular Motion, and the Muscles of the Back which move is downwards are the only Muscles that are acting, hence his Feet are thrown out of Bed; and when in an Erect posture, he faints from every Evacuation in Consequence of the universal Weakness; Delirium & Subsultus Tendinum arise, and incoluntary Evacuations the Pulse in the Arm is lost & he is destroyed. These not so noisy as in the last species, there is a depress'd unequal & quicker pulse frequently it is Intermittant there is generally an effusion of saliva from the mouth sometimes in a considerable quantity_ sometime the serous & sanguineous Apoplexy's are combin'd, an [illegible] to the above Symptoms is the only way to distinh them. those in the Sanguineous have frequently an effusion of Blood from the Nose &c after Death the Brain appears loaded with blood, & the Lungs are very turgid. in the serous Apoplexy the Brain appears watery & callops'd & sometimes there are [?ysothd?sea?]- the Cause of this Disorder is Various, particular Forms 36 These are the Dangers to which the Patient is exposed during the progress of a Fever. ~ When depression is great according to the Contraction the Paroxsysms are long and vice versa. hense a strong indication of there being an Intermittent; another Indication of a Fever being an Intermittent is a strong Exacerbation taking place in the First week of a continued Fever, and when the Tertian or Quartan type are strongly marked on the first days it is frequently changed into an Intermittent The more perfect the Crisis the less danger of a Relapse and vice versa A Fever left to its own natural Cure has a greater tendency to terminate by Crisis. The Crisis of a Fever is sometimes fatal.~The more violent the Symptoms of the first Stage, whether indicating great Strength or weakness the less liables is the Fever to continue, and vice versa.~.~ forms of Body &c favour the Disorder._ too free feedt & sedentary life, powerfull sedatives, Opium posions &c will produce it Hemlock, nephilic Vapours from charcoal, Upls Liquor &c it sometimes goes off itself by Natural Evacuations. it generally terminates in a palsy of one side. if this does not happen before the 4th Day we need not much fear it. the palsy seems to be the proper Crisis of this Disease._the Danger of Apopletic disorder seems to be from the effect they have upon Respiration & from the state of this we form our Judgement. a fever follows both Apoplexy & 37 Indications of Cure in Fevers There are two ways by which a Fever may be cured, we may either employ Medicines to carry it off, or permit it to do through its natural Course and guard against the Accidents that are liable to occur; this last was supposed to be the best plan, and the only way to get rid off that supposed concocted Matter, otherwise we should produce a worse Disease; but I don't in reality know, what worse Disease we could produce therefore out best Direction will be to go by Observations, for I have frequently seen Fevers removed without producing any such Effect, but on the contrary have left the Patient free from any other Disease; but the principal Reason for our letting a Fever or any other Disease run throught its natual progress is because all our Arts and Remidies will not prevent it. We shall first consider the Remedies to be employed when a Fever is to go through its natural progress. When & palsy is good; if the patient lives a week from the stroke he often recovers. Conclusive appearances upon the face or on the sound side are very unfavourable Symptoms & do not a return of the Disorder. the 2nd fit is often fatal, profuse cold sweating in the serous Apoplexy is fatal; all Involuntary discharges either in or just after the fit are fatal_ Symptoms. the Speech to be much affested is bad ~ Cure 1st: of Sanguineous Apoplexy the first thing to be done is Bleed freely & here Arteriotomy is preferable to openg a Vein but as the quantiti we are able to procur in this 38 When a Fever is left to its natural Course the patient is not only subject to a painful but a dangerous Disease for a considerable length of time but happily for him, if he recovers the Body is in general soon restored to its perfect Vigour and is free from all Disease, so that many Practitioners have prefered this mode of treatment, but even those, who do not prefer it, must attend to it, because in many Cases nothing else can de done, all our Remedies not being sufficiently powerful to produce a Crisis, and Suppose as I have before told you, that this was the Reason why Practitioners preferred their mode of Cure in Fever._ All Fevers which are rendered by any means irregular are less apt to be affected by Types, and consequently less apt to terminate by Crisis, running out to a considerable length and at least prove fatal. one great point for our Consideration is then to prevent them being rendered irregular, as also to this way is but small we should open a large Vein at the same time, the patient lying supine with his head rais'd Bleedf should be repeated as often as the Symptoms require the Rule is not to Bleed after the Palsey appears but this is very wrong for I have seen some Palseys when Bleedf Remedy. Cupping many be us'd when V.f. may be improper from the patients weak [?y] & Stimulating clysters & Purges should be us'd at the same time for the Bowels being torpid & not affected properly with the usual purges, the Vapour of Tabacco & 39 the prevent them being increased by any accidental Cause; in the first place the digestion of Food produces a considerable Effect upon the whole System, it is therefore necessary to employ Food easy of Digestion; as the Patient cannot be sustained without we must choose such as is easy of Solution and Fermentation, otherwise it will remain undigested upon the Stomach, these acting as a Stimulus upon the whole System; the Solution of Food upon the Stomach depends upon the properties of it and not the Appearance only, as for instance Cuccumbers & Melons which though apparently soft, are difficult of fermentation and their Effects consequently violent as there has been instance of Cucumbers lying upon the Stomach 3 Days and not dissolved and when the Digestion goes on properly there is no Extrication of Air bubbles into the Intestines but food of difficult Digestion has that power of Extricating Air bubbles and producing flatulencies in the Intestines or Peas [?u] In the next place any Species of Food which & [?????] with common Salt & makes the best Clysters. the Sal: bath Amar diluted & given in large doses does great good & powerfully relieves the head in general more dependence & may be [illegible] our [??ng] than in the [mu??n?] or in Case [f??ery] commonly us'd who should then particularly Blister the [illegible] difft Respiration a Blister may be apply'd upon the sternum, the head should always be shav'd in apopletic Disorders Blisters should likewise by apply'd to the paralytic side but they should not be kept [discha?f] as they would weaken Internal [illegible] Stimulants are Volatile Alkali [illegible] are too freely imploy'd in the Sanguineous Apoplexy 40 which is of itself adhesive, or when dissolved in water tend to produce great disturbance in the System as Contraction of the Hearts and consequently increased Circulation, such as Shell Fish which have that degree of adhesiveness or glariness Food that is high flavoured is difficult of digestion particularly of Animals, though some Essential Oils of Vegetables are very agreeable to the Stomach when diseased; but Dutch Herrings are very improper.~ When a Man is in Health, his Stomach is capable of receiving a sufficient quantity of Food for the 24 hours, but Animals differ in this respect some requesting food constantly, while the Lyon will Satiate himself for 2 or 3 days, the Stomach of a Man is in a middle degree, but more acted upon by habit than any other Animal and in all cultivated Countries he eats four times as much as necessary, but to reduce the quantity of Food, which Man in general takes, would certainly be better.~ We must then in a Disease employ a little Food mustard iced & horse Radish seems to be the best as they keep the Body open & their Operation is mostly confind to the Stomach &c tis a good practice after recovering from the sanguineous Apoplexy to put a seton in the Neck, the drain after preventing a return of the Disorder. Cupf. takf. a few ounces of Blood from the arm, [Re?xpi??] the Body soluble with [??tic] Purges (as Hamorhoids would be of greatest use) the diet should be lightly cooling, boild preferable to Roast meat. using the Chalybeat water &c is the most likely way to preven a a return of the Complaint~the heat most of the 41 Food at a time and frequently, but not [crossed out] Animal as the former must be digested before we employ more, but fluids may be constantly employed. ~ We shall next Enumerate the Food proper to be employed in Fevers. In the first place, in Intermittents, where there is General Inflammation, very little Food is necessary and that of difficult digestion very hurtful; we must then only employ farinaceous seeds dissolved in water, bu which they loose their Adhesiveness as Rise, Barley & other of that Class; if a continued Fever be it not so violent and there is no General Inflammation, or when it has gone on for some little time we may employ farinaceous Seeds in Solid Form, requiring some little exertion to digest them, and consequently afford more Nourishment as fermented and baked into Bread, and to prevent its Fermenting it will be better to toast it by that means coagulating it more perfectly; we also Employ Puddings &c and of the sarous Apoplexy must be difft it requires more stimulants & we should be more sparing with the Lancet cupping being preferable to general Bleeds. here active Emets as the Tart Emets are the best to rouse the patients. Emetics are good in Palsey where the head is not much affected_ Blisters to the head and lower Extremitities, & the use of the [?dati??] [crossed out] Stimuli may be more freely us'd than in the Sanguineous Apoplexy if it proceeds from the obstruction of any accustom'd discharge_ The Bark Chalybeats & other tonic Remedies are 42 and if there is no disposition to flatulence we may use Potatoes, baked fruits &c; it is seldom that in continued Fevers we can employ any kind of Animal Food, except Milk, which is easy of Digestion, (but was rejected by Hippocrates) and on that account has been, and is still rejected by many Practitioners, but it may be very safely employed when it is pure and we want Nourishment, except when the coagulating fluid acts too strongly and then it is hurtful Practitioners are divided respecting the use of Animal Broths in Fevers, though they are not so noxious, as some have asserted yet they generally produce heat and had better not be used except in Intermittents. Solid Animal Food should never be employed in continued Fevers, and when the Febrile Symptoms are removed, particular Care should be taken not to take too much, but when there are perfect Intermissions, Solid Food may be used as Galli and Fowls of that Class which are easy of Digestion, we may employ Fish, but are good in the serous Apoplexy, preventing a determination upon the head by keeping the Body soluble is necessary as the disorder often terminates in a Palsey. I have lately Experienc'd the good effect of the Arum Goat in the Torpor &c After Apoplexy palsey & in its recent state it is a powerfull stimulus, but by drying it looses its power & becomes so mild as to make Bread food for the Inhabitants of many parts of sweden.~ tis best kept as a concerve, as Ginger.~ 43 not high flavoured or glary, and must observe always to employ Food in proper quantities and in such manner as that the Digestions may be compleated before the Accession of the next Paroxsysm.~ We have shown you that in Fever the Prima Via are disordered, the the different Secretions are not going m regular, that the powers of Digestion were lost, or greatly impaired, and that Spasmodic Constractions were frequently taking place; so that provided there was any Food in the Stomach at the Acccession of a Paroxsysm, it not only remains indigested, but becomes acid, and even putrefies, hence the whole System is violently agitated; Contraction of the external Vessels Nausea &c tending greatly to increase the Fever; it is therefore necessary to attend to the above Circumstances, as likewise to keep the prime via clear, which is best done by the early use of an Emetic, but it is seldom necessary to repeat it unless there is much uneasiness and foulness of the Tongue the pain in the forehead is greater than we might expect Lecture upon apoplexy Palsey Its Ginger & the dose 10 or 15 gry in that from 2 or 3 times a day. I would try to keep the Body soluble with mustard seed, as it does not loose its power of Operating by being us'd any length of time, most other Remedies do.- the Apoplexy often ends in a Palsey which & its other Causes we shall now consider. this is a disorder in which there is a diminution of the power of an Organ tis differently determind as difft parts are affected. a [??miphlp]: when one side is affected & this is the most common after Apoplexys, this generally accompanied with a [illegible] 44 expect from Fever simply, all of which indicates Matter upon the Stomach to be evacuated; we generally wish Emetic to have another Effect & employ them for that purpose, but we shall consider this hereafter; the Body is to be kept open by Laxatives, but it is to be observed, that we must not employ those, which are apt to affect the whole System as Jallop Teanmony &c but these tending to increase the peristaltic motion or increase the Secretion from the Intestines, in the beginning of Continued Fevers, when there is Strength in the Habit, we may employ Neutral Salts, so as to procure three Stools a Day, but not to act too violently in Intermittents as there is Relaxation during the time of Intermission there is seldom costiveness, but provided there should be there Remedies may be employed, but if the Patient is weak, we must only administer such Medicines as increase the peristaltic Motion as Rhem &c as all Mauna, Cassia, Tamarind &c but if of sensation when the Disorder is universal tis denominated Apoplexy, When Partial Palseys, a Palsey with stupor Drowsiness &c is like an Apoplexy. when the leg on one side & the arm on the other is affected then tis calldd a [???ip?] transversalis~ this Disorder is very frequent in this Country, & is peculiar to all Ages Sexes & Constitutions, tis to be met with in Infancy & Childhood but most commonly in advanc'd Life.~ the predisposition to this Disorder is the same as the Apoplexy._ tis more common in Winter than in Spring & is often preceeded by Apopletic Symptoms it it 45 if there is not this Affection we are to employ more certain Remedies, taking Care always to add Rhai as it prevents that purging, which we wish to avoid; but if the Patient is very weak indeed we dare not employ Purgatives upon the Stomach and in this Case we are to use Clysters, though it is much better, when we can throw Laxatives into the Stomach, for by this means the whole primae Via are cleansed~ Clysters seldom act any where but upon the Colon and Rectum; the next thing to be attended to is the Medium of the Circumambient Air, Heat applied externally occasions the Vessels to relax, if in a moderate degree, but it in a very violent degree, it then acts as a Stimulus by increasing the Circulation, or generating Cold on the other hand contracts the exterior parts and throws the Blood upon the interior parts, so that cold & Heat applied in an great degree produce Mischief, and this had been a Matter, which has been less attended to than any other Circumstance, when we consider the it of arises in Children from an affection of the Prima Via as from worms, [Insolubl???] great Irritation &c & in these Cases is best Curd by purging it often follows the [Col?a] Pictinum & other Colics, whither from the sedative poewr of bad upon the Bowels & thence by Symphathy I cannot say it often depends upon Gouty affections when the Stomach is much affected._ Violent fevers sometimes terminate in Palsys, there was an Instance in this house where this was the Case, she was cur'd by Barks Chalybeats & other [illegible] 46 the Importance of it in preventing Crisis in continued Fever and rendering Intermittends irregular; during the time of a Fever a Man should be kept in Bed, where it is in a moderate and equal degree of heat; there is another Reason, why a Man should be kept in Bed, and this in an horizontal position direction which is that it requires less Exertion of the Muscular power, when a Patient is left weak by the Effect of the Fever, and provided it is gone off, than lying Bed only increase the Weakness, but during the progress of the Fever it has a contrary Effect in producing universal Relaxation and keeping the Body of an equal temperature; it is necessary that the Bed Room be large; pure Air is always to be wished for, but it is not of such great Moment in Fever, as in other Diseases, for though the infectous Vapour in the large Hospitals produce Fever, yet the Fever goes on equally as well in the Hospital, as if he was removed into the Country, where they are equally as fatal Difficult Labour, pressures & other accidents upon the spine often preceed Palsys, high degrees of scurvy, Chronic Rheumatism & often Ends in Palseys; the parts are often in much pain even when the motion is lost, & this is not a bad Symptom; Venereal Complaints end F. in Palsey require the use of mercurials, fear Grief, anger, obstructed discharges, repelld Eruption; wounds of the head &c the application of sedatives to particular parts as Opium leads have all occasion'd Palseys; when a palsey has attack'd aside the pulse are slow & softer in that part than in the other: some degree of Fever often attends & is a good Symptom, clammy sweats 47 fatal as in large Torons, but in Abcesses, Gangrene & Mortification and Fractures it is of the utmost Importance, the last Circumstances with respect to the regulating of Fevers is Sleep. The Exacerbations of continued Fevers, generally take place at the time of Sleep in Consequence of which the Sleep is rendered unrefreshing, if not prevented; the Ordinary means of keeping a Patient quiet, and taking up his attention by pleasing Employment is attended with great Advantage. The Medicines which we employ for this purpose are first Opium, which is the most powerful one, but it can only be used, where there is great irritability, and when a Patient is much exhausted, as in all other Cases, it produces unrefreshing Sleep; Opium in general is not to be employed in Fever, unless the Restlessness is from Relaxation of the Glands, which depends up the Irritability sweats are bad, the sensation of pricking in the part is a good Symptom. the proximate Cause of Palseys, Various, a deficiency of the Brains secretion or of the Nerves of particular parts. if it originally depends upon the head then the general Symptoms preceed. Palsys are harder cur'd in those in advance'd Life than in the young, in Children often cur'd~ harder to cure in winter than summer if the mouth is distorded & the voice be cur'd, if the Respiration & deglution are impeded these are all bad Symptoms if preceeded by Apoplexy they are subject to a relapse, if cold or the Scurvy the Cause there is less danger, if the paralytic part is bad & Emaciated tis bad [?sis? this cont. on of convulsive motions a fever cont. on, with fever in the part, Spontanous disch. these are all good Symptoms._ 48 Irritability, sometimes Antispamodics as Liquor and: Hoffman &c have been used in procuring Sleep, sometimes with success as others not; and there is one common Circumstance of great Moment to be considered, which is that Anxiety from the Mind is to be removed. Cure of Palsy Nature sometimes tho seldom cures this Disorder by fever conf. on_ in Plethoric habits the Hamorhoids appearing affoard relief whatever especially excites the passion affoard relief as Joy, love &c we should endeavor to excite head by Exercise keeping warm & by stimulus_ the Indications in the Cure of the Palsey are 3_1st. under certain circumstances to promote Evacuations-2nd to Excite heat & the circulations & 3 by a Nutritive & Restorative Regimen to precent a Relapse under what circumstances are we to use Evacuations, while the head is affested with Vertigo, limbs Noise 49 The Manner of Avoiding Accidents We come now to show you the Means of avoiding these Accidents, which destroy a Patient during the progress of a Fever; the first of which is General Inflammation; in the first Stage of Fever all the small Vessels contract & [illegible] Blood upon the Heart the large Vessels, by this means stimulate it to a stronger Action, hence a hardness & fullness of the Pulse and other Symptoms of General Inflammation, which may arise to fuel a heigth in continued Fevers, as from its Effects upon the Brain to proce fatal, or it may do so much Mischief to the Brain to render the Patient afterwards liable to be destroyed by the Fever. General Inflammation arising in Intermittents render them irregular; it therefore becomes necessary to remove it by Evacuating; the most powerful one of which is Bleeding; as it weakens the Action of the Heart & Arteries but Noise in the Ears, the Eyes affected with blindness & the head affected with Stupor &c then leeches & Cupf. may be impoloy'd & are preferable to generous Bleedf an habitual drain or [?sue] in the Neck should be us'd_some say we are not to bleed after the Palsey has come on, but the Dr. says his Observations show it to be highly proper & servicable many times the Bowels should be kept open, the more drastic purges are requir'd as [decocotion?] of Jalap & when they are open'd then the Pil Rupi maybe imploy'd for a constancey to keep them so & these kind of purges are much better than the [Ven??al] Salts as they both derive from the head & promote thes 59 but if there is no General Inflammation, it will not be necessary to use any of these Evacuations because it is not a part of the Disease but an Accident, and when the General Inflammation is removed, the Fever is not cured; there has been a Method of practice in Fevers supposing that as they were violent Diseases, violent Remedies should be used; but so far should this Doctrine be from prevailing that the Body requires his utmost force to go through the natural progress of a Fever, and unless Evacuations are wanted they by no means should be employed; Bleeding in particular has no effect in Fever for weakening the System does not carryy off the Disease; a mere hardness of the pulse is not a strong indication of General Inflammation, but when the Pulse is full hard & strong and the Patient naturally robust add to which Stupor, Eyes Bloodshot and Delirium, in this Case there is the utmost danger from General Inflammation, and we must evacuate by Bleeding. We have shown you that the Piles at the same time_In the Paralytic Disease of Elderly people who are Phlegmatic Emets are very servicaable_Even the Tup: Min: & Vitall: have been employ'd with success, but I think the Tart Emets & other antimonials are sufficient._ For the Palsey there is often a diffiy in Vomits. for the torpid state of the stomach & therefore larger doses will be requir'd than in health. Vomits are particularly proper whence there is great drowsiness & when Bleedf is improper than Vomits will frequently rouse the patient_the sudoripic [?elan] I do not find to be attended with any advantage they only weaken the patient_In all apoplexys tend to 51 that this Evacuations produced a temporary, and permanent Weakness, in this Case it is evident that it is the temporary Weakness which we wish to produce, and therefore the more sudden the Evacuation the better the Effect; for if we take away a small quantity of Blood at once it will be found necessary to repeat it, at the same to take away double the quantity of Blood, and of consequence produce, what we wish to avoid a permanent weakness, it therefore becomes necessary to take away ℥16 or ℥xx and seldom less than ℥8 if may notwithstanding these copious Evacuations be found necessary to repeat the Operation if any of the dangerous Symptoms continue but it is to be observed, that it is not always necessary to bleed till the hardness of the pulse is gone, which will sometimes remain after the tension upon the Brain is removed when the Evacuation by V.L is no longer necessary.~ There is another Indication for taking away a quantity of Blood at the Begining of Fever which is Plethora, as for Palsey there is profuse sweating purging, setons typical Bleef &c answer much better - 2d Intention the topical powers are to be excited, by exciting heat Fevers & as by Electricity,- stimulating Rimeds motion &c the paralytic parts should be kept warm wrapt in flannel. the winter is unfavourable to Palsys, but the spring is good as we see in all dorment animals as the Bat_are really paralytic through the winter but the return of spring by putting their Juices in motion restore them to life & activity & hence the use of warm Baths 100 deg we see where there is a waisting &- privation of motion on pumping warm water as than of Bath [?9?] deg. has a most happy Effect [illegible] has 52 for instance when a stout young Man is attacked with Fever, his pulse is oppressed by the violent Contraction of the Vessels, if the Exaccerbation of a continued Fever shold take place at 10 o Clock in the morning instead of the Evening, or if the Fever should evidently observe the Tertian Type, that in the Paroxsysm taking place in the Evening and the Tertian Type strongly marked in all these Cases it is necessary to use Evacuation by Bleeding, for it is the General Inflammation that prevents the Intermission being so regular, and it is never so dangerous to weaken the System in Intermittents as in continued Fevers; Purgatives are Evacuations by which the System is weakened, but it is to be observed that in Fevers they occasion a Derivation of Blood to the Intestines and it is our Business in Fevers to keep the Action of the Vessels equal in all parts of the Body as we can therefore we must not use Purgatives which act with Violence so as to procure 9 or 10 Evacuations than general Baths, the weight of the water from the pump is much more serviceable that the simple baths without it,_ but we should be cautious how we use the warm bath in those who are of a full plethoric habit least we heat too much & for which reason local is safer than general Bathing [crossed out] ~ ~ ~ ~ in those palseys from colica Pictoneum more good is to be done than in those from Apoplexy, when from the Gout to be treated in the same manner _ _ & 2nd Caution the Body should be kept soluble with the Pil Rupi; fever comes in upon a palsey tend to cure it but we have to it 53 Evacuations in the 24 hours, but the more gentle Laxatives are very proper, as Neutral Salts, Senna &ue which remove the Faculent Matter in the Intestines. It is evident if we are using Evacuations by Bleeding that it is not necessary to employ Food to increase Nourishment; the Antients gave neither Food or Fluids to drink in Fevers, exhorting the Patient to bear the Thirst under a Supposition that their Paroxsysm would be rendered shorter but the modern Practitioners have differed greatly on another erroneous Suppositions that the Disease was caused by the Obstruction we allow diluting is very necessary, but not with the view of removing Ovstructions which I am certain never exist; but it appears to be very improper to follow the Patients method as being opposite to natural instrinct not giving the Patient drink when the Thirst is so great, for if we do not give diluents it but little in our power to excite a fever, as the Cold Chill &_ is necessary to the production this fever is much more serviceable than any Stimulants _& the best method to rouse in fever is by baths. in the sea which from the stimulants of the Salt answers better than cold bathing, hence we see weak & Emaciated patients bear sea baths when they will not bear the Cold bathing when the head is not much affacted & from- the sense of a hevy dullering pain Like seems to be about returns, to the part, then we should use the baths as above. but if the sensibility & motion are entirely gone then warm [??p?ny] is much better than cold baths-the Cold bathing .54 dilents, the Neutral Salts will stimulate and increase the Fever, and the best that we can employ are Decoctions of Farinaceous Substances, as Rice, Oats but particularly Barley. Sedatives if they were sufficiently powerful would be Medicine of very great Value in taking off General Inflammation on account of their taking off strong Action without weakening the System, but unluckily for us, we have no Sedatives, that we can trust; Acids may be employed as having some Effect but are not sufficiently powerful, when General Inflammation is dangerous, which puts us under the Necessity of evacuating by Bleeding. ~ The next danger which arises is that from Weakness; in the first place it is to be observed that we are to consider if a Fever is to go through its natural Course, that not withstanding a Man is sufficiently strong at the Beginning of the Disease; yet he will be gradually worn out by the Evacuations; we are therefore to the Cold bathing does not seem to me to act from its [illegible] [illegible] as many suppose but _ purely from its power of exciting fever, after the Patient come sout of the bath, friction &c should be us'd to bring heat into the diseas'd _ & torpid parts. the propriety of using the cold bath is Judge'd of from the succeeding heat upon coms. out, but if the patient continues a long time_ shaks with Cold & no fever follows then tis a proof the Bath is too Cold for the patient - strength ~ the following is directions respecting the use of Electricity there is setting upon a non Electric Body & communicating with the Machine this is the 55 to avoid this weakness as much as possible; in the first place we avoid it by preventing unnecessary Evacuations, and Exertions, and when Evacuations are found necessary they must be done in the manner I have before had occasion to direct you, always attending to the degree of General Inflammations & plethora, the primæ Viæ must be kept free from foeculent Matter but violent purging is to be avoided; for the same Reason Symptomatic Evacuations of any kind are to be checked, if it becomes necessary, as for instance if Purging takes place without Relief, having the Tongue dry &c in the same manner Sweating, if it afford no Relief, and all the other Symptoms of Fever continue, this may be done by Acids, or with gentle Astringents acidulated, the Patient is to be kept very quiet, and to avoid all Muscular Exercise, he must be supported by employing Food of such Nourishment as the Stomach is capable gentlest of drawing checks Sparks from the part, the other method is by throwing the shock through the part, but we should be careful that the strngeth of the shock be confind to the part; the Effect of Electricity is an Acceleration of the circulation, of the motion of the heart & moves powers & an increase of the Animal heat. if the Body is only kept in contact with the Machine the pulse & are quickend another effect of Electricity is an _ increase of all the secretions, of the particular part Electrifie'd in a particular manner for Example if the shock is general then a general sweating [illegible] the [illegible] Teams followd in 56 capable of digesting; but Solid Animal Food is never to be used in continued Fevers, and it is very rare that we should employ Animal Broths. but we may employ Solutions of Farrinaceous Substances, as Barley Water, Lago &c, which maybe used for common Drink, and are preferable to Mink Tea or Toast & Water, affording at the same time Nourishment, while they act as Diluents; by attending properly to these Directions, we shall seldom find at the termination of Fevers any very disagreeable Circumstances, arising inconsequences of weakness; the best Method of Stengththing the System after the Fever is gone off is by the Cortex Perucianus;- Preparations of [?on] &c. Stimulants may be employed, but as they have two Effects, that of increasing the Action and diminishing the Strength, they must be exhibited with Caution, and the best are Wines, which should be strong and well fermented as Mountain Sack, Madeira, Port, Lisbon, & Claret; these are frequently of use, and Sweet wines have is near the ear an increas'd Secretion of Wax, if near the Uterus then menses often follows, tis effect is that of Exciting groth in Emaciated Limbs, the the hair upon the hand, Beard upon the Chin we promoted in their groth by an Electric shock upon these parts, there prove its power of promoting heat & Groth in the part Electrified _ & the same effects are produc'd upon plants that _ Vegitation is an Electric air. ~~~ Cautions - you should be cautious of Electrifs.- those of a full habit of Body & where the head is much affected _ only drawing the sparks should be first us'd it being the mildest & eaisest method they should be taken from the paralytic 57 have one Advantage, which is that of their affording a little Nourishment, and the quantity we generally employ is from ℥vi to ℥8in 24 hours; many Practitioners have employed Spices, but undoubtedly with bad Effect, as they increase heat, rendering the pulse frequent &c but when there is flatulency they may be employed moderatly. Another Method of strengthening the System among Practitioners was by Blistering, which if small, produce very little Effect, but when large, the Cantherides are absorbed and Spasmodic Affections are the Consequence Irregularity & Irritiability on which Irregularity depends occasion Fever to run out a great length and a fatal weakness is produced; the Irritability on which this depends is to be taken off by employing Acids towards the End of the Fever, exhibiting them in such Manner as not to produce partial Secretions of any kind, but we have very few or more that afford as any very powerful Remedy; paralytic parts if the fingers of a paralytic limb_ are contracted they are immediately relax'd upon the sparks being taken ~ if a part has been Electrified it should be kept warm when the disorderd [crosses out] not depend upon an Original defect in the head then the disorder is easist cur'd by Electricity - After the patient is us'd to the spark then proceed to the shock, Electricity excites heat & increase motion, & is of great use in the Chronic Rheumatism, it has been recommended to draw the Shock, from a gouty foot to occasion a Regular fit & has been try'd with advantage the reason why a we do not often cure paralytic disorders by Electricity is our not continuing it not long enough we 58 Cortex Peruvianus is the best, and most powerful Medicine, but if there is any considerable degree of Fever, it will have no good Effect, but on the contrary even very small Doses will do Mischief; but if the Skin, Tongue &c are moist, and the other Symptoms of Fever going off, what few are left are generally the Conesquence of Irritiability, hence Cortex may be employed, and in Cases where the Evening Paroxsysms are very strong going off on the Morning; and when the Patient is restless, Eyes, Tongue &c moist, even some degree of Delirium Opium in small Doses may be employed and frequently repeated as gr 1/4 6th horis, and notwithstanding the first two Doses have no apparent Effect, yet it will gradually procure Sleep and is much preferable to large Doses. ~ ~ ~ ~ we should not dispair till we have try'd it 2 or 3 - months as sometimes as sometimes it has cur'd in v 3 months thos the patient did not appear better_ when two have been try'd_ the External Stimulants in the Palsey are the fol: Alkalis but the Ol: Succin is the best ~~ poultices of horse Radish & mustard seed are serviceable to stimulate but open Blisters are not proper as by their their discharge they weaken. Whips the part with Stinging Nettles has done service; - the Internal Stimulants are many & Various but infusions of the Horse Radish & Mustard seed made into syrup are the best. as the mustard keeps the Bowels open 59 The Remedies to be employed in the Cure of Fevers. We come now to consider the means of carrying off Fever not permitting it to do through its natural progress; it has been a question, whether we ought ever to attempt to prevent a Fever going through its regular progress; it having been supposed that there was some noxious Matter in the Body which was to be got ridd off and destroyed by the Fever, otherwise it would leave some Morbid Disease in the Constitution, this they accounted for by the Crisis, which happened in the first Week being imperfect, and the Fever is very liable to relapse; tho' frequently we have an imperfect Crisis in the early periods of Fever it is not a significant Ground for this Doctrine for I have seen a perfect Crisis in the First Week and had no Relapse, and when the Paroxsysm of an Ephermera is perfect there is no disposition to relapse; and I have frequently seen Sydenham recond Bals: Pem as a Specefic for palsey after Col: Pietonum, Gum Guacae with Volatiles are better proper. but the Neutral Salts & Saline Remedies should be avoided_ the A: Origine: is a very usefull stim: & is too much neglected_ an Ointment made with the Vitriolic acid sometimes done good & Vol: Alk: with Oyl:-the patient should use an Animal & Nutritious Diet, frequent friction should be employ'd & the fingers &c of the diseas'd Limb often madd_ Electricity has been found to be good_ in Ch. Rheu: Eruptions upon heals, in winter. Gut Ser:&: [crossed out] 60 seen the progress of a Fever put a Stop to, and the Patient quite relieved without any other Disease taking place, there may be a few febrile Symptoms but not sufficient to produce a Hot Fit.~A fever is so dangerous & painful in itself, that unless it was very clear that some other violent Disease was to take place; we would run the Risque of leaving some slight Disease. The first Method of putting a Stop to Fever, is by removing the present Paroxsysm, and preventing the next taking place; the first of these it does by Relaxants, which we have before enumerated as Ippecacs: Preparation of Antimony, Neutral Salts, and Cold Water, if we employ any Substance that should produce Vomiting, if there is violent Sickness before vomiting is excited, there is Contraction of the Exterior Vessels, but after the Vomiting has taken place, there has been a universal Relaxation, most of the Medicines producing Relaxation if given in large Doses, they produce Vomiting, hence it has been infered by a very valuable Author that Lecture upon Epilepsy.~ This may be defind a Disease in which every part is convuls'd, accompanied with a loss of Internal & External sensation. Children & Adults are more subject to this Disease than those advanc'd in Life, those of Lax & Irritable habit are particularly subject, Children that are Ingenious & Acute & are none liable to suffer this Disorder from fear & than other, Children have this disorder from the Irritation occasion'd by teethf., the head Eyes & upper Extrem: are particularly affected with the convulsive motion_it may be hereditary as a hereditary Irritability may be derived from the parents 61 that it was the Vomiting, which produced the Effect but it is the Relaxation afterwards; and there are instances of Fever being carried off without the least degree of Nausea being produced, and there is a Maxim, which is true in these Medicines, that is if the Body is irritable, they will act as simple Stimuli losing their relaxing power; therefore small Doses are best, for if it was the Vomiting, which produced the Effect, it would be of no consequence how large the Dose was, but it must be always held as a Rule that if we give large Doses we destroy the relaxing power, and he have 1000 instances, when Fevers have been carried off by them and produced perfect Crisis, when properly administered. Neutral Salts are not very powerful in removing Fever Cold Water was cured by the Antients, and even some modern Practitioners have used it, but is is not generally introduced. ~ Ippecacuanah has in many instances carried off Fever immediately, but has principally as well as a particular conformation & likeness is seizes both sexes Indifferently, in general women more than men, tis often brot on by a bad air as in large towns, using too freely an animal Diet-it seldom attacks after 20 Years of Age, the paroxysms peculiar to, Infants & Children are often cur'd at the period of Puberty _ when it comes on after 20 Yearsof Age tis but seldom & very difft. the predisposing Cause consists in in an Irrtable & lax fibre_ Symptoms, some are suddenly seiz'd & fall down with any warning, this Species is the most obstinate of all Diseases._a sense of weight in in the head Giddiness, & the appearance of Objects floating 62 principally been use of to vomit, as when purging took place; Preparations of Antimony are the best Medicines we can employ; this Medicine was first introduced by Van Helmont and since his time by a Number of Practitioners, and the Reputation of almost all those Empirics who have made any Figure in acute Disease has been raised by this Medicine, though it has not been long introduced into practice, a Neutral Salts have been employed as Laxatives, when other Stimulating Cathartics would be prejudicial when we wish to produce two or three Stools in the 24 hours; When Ippecacoanah is employed to produce Relaxation, we should not give more than gr 6tis horis; Cold Water Should be given in the quantity of Uy vel Div so as to produce Relaxation, which sometimes will vomit and even purge; of all the Preparations of Antimony we are possessed with Tartar Emetic is the best, but it is by no means so perfect as we could wish for it acts in such small Doses, that it becomes floating in the air, a temporary Blindness, hearing impaird, noise in the Ears, particulr sensation as particular taste in the the mouth, or smell a greater than ordinary flow of saliva, a Change of Colour in the Iris, particular passions as Joy, Anger, &c of proceed the paroxysm & which from use the patient knows to be the preludes to the Fit_ but in both the sudden & slow, species there is some defection in the Sensations & [illegible] proven. Epileptic patients are often troubld_ with the Incubus or Nightmare, owing to a distension of the stomach presing upon the aorta, & this is best relievd by changing the position of the Body & laying upong the side._ other 63 becomes difficult to divide, but the best Method I know is to dissolve a certain quantity of it in Water and by adding a little Mountain Wine it prevents the Decomposition (which always takes place in Solution of Metallic Salts) except a little brown lateritious Sediments, which is of no Consequence by employing Relaxants in Continued Fever we can in many instances shorten the paroxsysm and produce Crisis; in Intermittens we can frequently render the Crisis more perfect and prevent the Fever from recuring; or when the Fever is not entirely carried off we can diminish the Symptoms, so as to render the Patient capable of going through a continued Fever, which otherwise would have proved fatal, and we can in Intermittents, where the intermission are irregular render them perfect. ~ There are scarce any Medicines whatever which always produce the same Effect; hence is has been called a conjecturing Art. this is owning in some Measure to this Circumstance, when a Medicine is applied to any other have the fit preceded by yawning, Infected abdomen, Coldness in the Loins & lower Extremities & then they fall down with either sense or motion & are much convuls'd, the teeth strike together the Saliva foams from the mouth, the Tongue hangs out the countenence is at first pale then livid, there is a tremulous motion in the muscles of the face, the Jugular Veins are distended, the brethf is difft & laborious & the pulse very difft in difft people. there is an Involuntary discharge of difft secretions, & frequently a Vomitf_ after a short times these Symptoms begin to abate & the sense gradually return_ the Epiliepsy is to be distind easily 64 any irritable part, or when there is above a certain quantity administered on which account it must vary in the Effect it produced; as for instance Saccharum Saturni has naturally very powerful Effects as a Sedative in taking off the peristallic Motions of the Intestines but when given in large Doses it produces purging and if Acids are applied to the Skin they produce Contraction of the parts, and if the Skin is removed it produces Inflammation; hence it is to be observed that there is a Medium in the Doses of all Medicines, beyond which if we exhibit them, they lose this Effect instead of increasing it.~ We are now to consider whether these is any Mischief produced by Relaxants, when they do not remove Fever when there is a great quantity of General Inflammation at the Commencement of the Disease, if we employ Relaxants profuse Sweating arises and that often without Relief and is very prejudicial for in the first place if we cover the patient so as to heat him the easily from other diseases & tis of importance to know in what particular as many times people pretend to this Complaint only to impose upon the credulity of the good Naturd~ the true Epilepsy is ditn: from the false or pretended, by applying alight to the pupil of the Eye if the complaint is real is will not be affected, but if not true then it will contract in the true the Body will bear any kind of stimulus without shrinking but in the false they may be roud'd by pains but sometimes they have resolution to bear a great degree~ tis distinguish'd from an apoplexy, as in the last there is no convulsive motions 65 the General Inflammation is increases, and if we don't cover him the Contraction of the exterior vessels produces much Mischief, when the Pulse is hard, the Eyes red & Bloodshot or Stupor under these Circumstances Relaxants must not be employed; though there has been instances of their doing good in such Cases, yet upon the whole it is dangerous and frequently productive of bad Consequences; in the next place where there is considerable Weakness, Relaxants do not act regular, but act upon some particular Set of Vessels, and produce Sweating, or perhaps purging; and we must be always upon our Guard in preventing partial Evacuations in the State; it is lastly to be observed respecting Relaxants, that if a Fever fixes itself by Habit, in this Case they must be used very early, but it is a Custom among people in general always to think a Disease, when it attacks them will naturally go off, this is particularly the Case in Fever, which are at its beginning more easily removed we motions, the Breathf is noisy & laborious & the pulse are full hard and slow_ In the Epilepsy they are quick not full & hard tis difft. distinguish'd_ from an Hysterical Paroxysm except by the Convulsive motions originating in the abdomen of all Hysterical Patients with flatulencys rising in the throat & & after an Hysteric paroxysm the patient is able to recollect all that had pas'd during its continuance but this is not the Case in the Epilepsy_ When the Epilepsy seizes, the head Organ of the senses &c then it is to be distinguis'd from the Hysterics by layf. the hand upon the abdomen;_ the Catalepsy is distinguish'd by the Body & Limbs remaining in what for have you 66 we may employ Relaxants externally as warm Water; this was a Remedy particularly employed by the Greek Physicians, but is very little made use of by the Moderns, except when Delirium has taken place, which has sometimes be successful but not above once in five times.~ The next Remedy for removing Fever is by exciting Inflammations, which sometimes naturally takes place, otherwise it may be done by Art; the most convenient & best Method is to produce such Inflammation upon the Skin in order than it may not terminate in Suppuration. this is best done by the Application of Cantharides; though there are other modes of exciting Inflammation, as by Semina Sinapi; Allium &c; this Species of Inflammation has been employed to take off a continued Fever, and to prevent the Return, of the Exacerbattions in Intermittents, it does not act by producing a Crisis as Relaxants do but carries of the Fever you place [??ens], but this is not the Case in Epilepsy the occasional Causes of Epilepsy are Various as [crossed out] External Injuries &c they sometimes continue on for Life~ Women sometimes are subject to the epilepsey during their Pregnancy which are cur'd by delivery, some women are maniacal during Pregnancy & well in the Intervalls & the Reverse habits of drinkf. Spiritous Liquors have often produce'd the Epilepsey in fact all Violent impulses upon the Organs of Sense will produce Epilepsy as far &c & these are the most Obstinate especially in advancd'd Life in Children they proceed from slighter Causes 67 Fever; yet it diminishes the Action of the Symptoms, particularly if it is confined to any particular part, as for instance if the Head is princippaly affected, then Blisters behind the Ears may be applied with good Effect. Since Inflammation excited upon the Skin does not always carry off Fever, it becomes necessary to enquire, when it is to be employed. If there is considerable General Inflammation which is indicated by a hard & full pulse, Stupor &c it is then very improper to produce it, though the Mischief produced by them is not very great, particularly Cantarides, yet we had better avoid it. When a Patient is weak, the Irritability of the System considerably great, it is then very improper the Pulse being rendered weaker, and he is frequently cut off; it is to be observed, that as soon as the Inflammation is excited the Cantarides must be removed by which means Spasms will frequently be prevented from taking place, which is the general Action of slighter Causes & are therefore more easily cur'd, as the stimulus of the small pox, Teethf. Worms acrimony in the Groin &c & the Obstructions of accumstom'd discharges, [d?p??y] up of old Ulcers &c the more frequent the paroxysms the more diffiy cur'd, the more the upper parts about the head are affected so much the more, the Epilepsey sometimes terminates in Idiotism, the patients is often lone & melancholy in the Intervals of the Fits. in Plethoic Habits if Evacuations are not us'd the Epilepsy often terminates in an Apoplexy_ if the disease is original depending upon bad deformation of the head, with flat forehead as we often see in long contin'd Epilepseys, the they are [illegible] cur'd 66 of all Animal Poisons; - if the first blister has no effect, it is seldom that a Second Succeeds any better; but if the first produces a good Effect, the Second generally will; but always remember to heal the former before the Application of a Second, notwithstanding the Second has such a good Effect, it is the fist that tend to carry off the Fever. ~ When there is Delirium or a disposition to it with Redness of the Eyes, without hardness and fulness of the Pulse, it is a strong indication of the Vessels of the Brain being distended in this Case Evacuation from the System by Bleeding is of no use in removing it; But topical Bleeding is a very powerful Remedy, as opening the jugular Vein, or by applying Leeches to the Temple, which is most convenient the Cause of this Fullness of the Vessels of the Brain has not yet been ascertained; there is no Appearance of its being an increased Action of the Arteries nor other Symptoms of Inflammation in tis a disease that sometimes goes off about Puberty~ if it proceeds from worms & other stimulus upon the Bowels as in Children they are easily cur'd~if it comes on suddenly, then tis worse then when it gives notice_if heaviness of the head, Giddiness, a a defect of Memory &c remain after the fit tis had in Pregnant women Epilepsy endangers Abortion if Girls are subject to Epilepsey before their period of menstruation, they are apt to recur in Pregnancy. those which come on in the Night without notice are worse than those which appear in the Day. that kind of Epilepsy which terminates in the Apoplexy is the worst kind. the priximate Cause we know so little of from our Ignorance of the Nervous power that I shall not send your time in speaking upon 69 in the System, but a Distension of the small Vessels of the Brain producing Delirium; which continues after every other Symptom of Fever is removed; the Manner in which this Remedy produces this Effect is not known, but its being carried off by topical Evacuation gives some Idea of its being a Species of Inflammation; there is something similar to this, taking place naturally in Fevers, as pain in the Head and an Haemorrhage arising from the Nose carries it off, but why a Crisis should be produced is difficult to be ascertained, and accordingly the Remedy though a powerful one has been neglected; the degree of Weakness is the Criterion, bu which we are to judge respecting the quantity to be evacuated. Since the First Stage of Fever is apparently carried off by the Hot Fit; it has been supposed that increasing the Heat by Stimulants might price as affectual in producing that Crisis, hence they employed Conteayerva, Infus Saliva & and is but proceed to consider the Cure ~ first what is to be done during the fit never attempt to rouse by Stim: to Nose &c the patient is to be put to bed & carefully watched that he hurt not himself in the convulsive struggling, great Care should be taken to prevent his biting his Tongue by putting some soft thing between his teeth that he cannot swallow_the foam & froth should be remov'd from his mouth keep the teeth from bitf. by means of a towel &c to prevent it falling back & endangering inlocation & Choaking these are the principal things to be attended to in the paroxysm, everything about the patients Body should be [crossed out] made loose but as the patients friend you should do more, then the safest practice is using the 70 and other gentle Stimulants, which were called Diaphoretics; this practice has sometimes succeeded but much more frequently has prevented Intermissions, and thereby converted Intermittents into continued Fevers, and by preventing Crisis has lengthened Continued Fevers; this proves that there is some more peculiar Charge in the Hot Fit, than a mere increase of heat, which produces a Crisis. ~ the Volatile Alkali about the forehead &c but if you attempt to get the patients to swallow anything there is great danger of suffocation as many bad instances [c??nce]_ the Case is the same with respect to swallowing in both the Apoplexy& Palsey, - indeed I would never disturb an Active paroxysm of any kind without the most Urgent necessity_ Stimulating Clysters of Tabacco to derive from Lead, or a bitter decocn with much commonss pet'd Salt, if the patient is of a Plethoric habit, the Veins turgid & the countenance livid then 8.fo as in the Jugular_ or the Tempera artery many be open'd the patient should be kept in a cool Air, & these are the only things that should be done in the Fit~ In 71 The Means of preventing a Fever Recurring All that we have to do in Intermittents, when the Patient is free from Fever is to prevent the Accession of a fresh Exacerbation, and he will be cured; so in a Continued Fever, if we can prevent an Exacerbation, though we don't free the Patient entirely from Fever, yet we convert it into an Intermittent.~ In Intermittents the Return of the Paroxsysm are sometimes owing to the imperfection of the Crisis, when during the Intermission there shall remain a little Languor; pain in the Back, foulness of the Tongue, &c these tending to encrease the Action of the other Causes, which of themselves are sufficient to reproduce the Disease; these are to be taken off by the use of Relaxants, which stop the progress and are a preparation Method to employ other Remedies to put a Stop to In the Intervals the Remedys should be adopted to the patients particular circumstances. I think these are from Indications in the Removal of this disorder that should be attended to, 1st to render the Body less Irritable 2d. to avoid the occasional Causes, 3d. the habits of the Disorder returning should be [crossed out] remov'd, & these to prevent its accession the first is only to be answer'd by a Compleat change of Life from the present manner._ as a Change in air, Exercise Diet & the Diet should consist of milk & Vegitables, the Climate should be chang'd & in a word the whole way of living new moddeld- tis not to be expected that any 72 to the disease; in Continued Fevers when a Crisis has taken place, the same Remedies may be employed, under the same Circumstances; the next Method of preventing the Return of Parosysms, is by counteracting the Disease at the time of the Accession; which appears to consist of a Contraction of the small Vessels and Depression of Stength; so that by employing Remedies, which would appear to prevent this Contraction and Depression, we might expect to cure the Disease; but if we consider what little Connection there is between these two Symptoms, we shall find ourselves confused but happily for us that by Relaxants we can carry them off; this can only take place in an Intermittent on account of the Fever never being absent in a Continued; therefore we don't know when the Fever is to go off, or a Relapse to take place after a Crisis; the Relaxants that are to be used we have already pointed out, and the Stimulants, with which any particular Pill of Bolus, will entirely change a too Irritable constitution. this is to be affected only by a thorough change in the way of being _ another method is to use the cold Bathf. this helps to procur the change it has nearly the same affect are Intermittf. Fevers & & they have often cur'd Epilepsys the patients should go to bed & get up early, deep thinkf. & study should be avoided_ the medicines that are the best are the Veg & fossil Astringents. the Bark with Valerian in large does otherwise will do no good as 3 is in 34 hours is very usefull the [??lator] has had many things said in its favour & by some has been held a Specefic_ but the fossil astringents, are more powerfull and sudden in their effect 73 which we remove the Depression of Strength, should be such as act quickly and not Resinous Substances; these last have been applied externally, but external Applications leave little Effect; and those which we employ internally are Volatile Alkali, Spices, Wines &c as also Antispasmodics tending to remove irregularities as Opium, and Musk, which should be joined with Relaxants and will frequently prevent the Recurring of Fevers, bu producing Sweat, which continuing breaks into the Intermittent and renders the Paroxsysms shorter; by which means we have an Opportunity of introducing another Class of Medicines as Cortex Paruvianus and other Bitters as also Preparations of Iron, and other Astringents.~ We come now to shew you certain Remedies and particularly Cortex, which being exhibited before the Accession of a Paroxsysm will prevent its taking place; the Action of this Medicine particularly in producing this Effect, has been variously conceived by different Practitioners; some having considered it as effects & hence it is we use the preparations of Copper in this Disease as the Cuprum ammoniacum this I have known do the greatest service you must begin with 1/2 gr increase to 4 or 5 grs the Dr. says he thinks it the best remedy we have advises to persevere in its use where the stomach & digestive powers have much weakned the Bath waters have been recommend'd with advantage. I have seen some Cases where the VitAll: in small doses so as to excite Nauseas has done good & in those Cases where the Flor Line Remedy if the stomach is foul than Emet should be us'd so a Sickness & Change of Climate have sometimes wround too wonderfull Cures. sometimes the Epilepsey begins in a particular Extremety & then 74 as unaccountable and not to be investigated; other have considered it as a Stimulant, while another Practitioners has supposed it to act as a tonic Medicine increasing the powers of the Body; in the first place we can't believe that its Effects are unaccountable and not to be investigated, for I don't [crossed out] see, why we should say that respecting any of our Remedies; it is evident that it does not act as a Stimulant, for the Body does not grow hotter or the Pulse fuller &c from its Use; but it certainly acts as a tonic Medicine; this must be considered as increasing Contraction but how making the parts contract should prevent the Accession of Paroxsysm (for a Paroxsysm produces Contraction) we cannot conceive; in the Second place some have considered the increasing of the Tone was strengthening the System, but it is not merely Strength, that prevents Paroxsysms taking place; and if we consider it as altering the texture gradually advances to the head its progress is to be interupted by mcans of ligature apply'd which have often prevented the fit in these Cases~Blisters to the part first attack'd have done good but the ligature seton in the Neck more. Stork has recommended the Hyacymus much in Epileptic Disorders it being both soluable & sedative tis common in this Country in Sanguinous & Plethoeic habits who have warning of the approach of the fit to apply cupf. Glasses to the Neck & take on four ounces of blood by that means & it often prevents the Accession of both the Hysteria & Epileptic paroxysms when comf on.~ in Children subject to Epilepsy small doses of the Rhi & [Colom?] is the best Remedy - the [illegible] of antispasmodics at 75 texture of the ibres; it has not time for producing such Effect, it is therefore by some action that must take place upon the Stomach, and not an Alteration of the Juices, but an Alteration of the living powers, the Irritability of the Body is a power by which it is easily acted upon, and Cortex will take off this Irritability by which means it renders the Body less liable to be acted upon by any Applications; as in an Inflammation of the Urethra produced by Venereal Matter Cortex will take off the Irritability from the Mucous Membrane and remove the Inflammation; then curing Cortex are not so liable to be affected by contagious Diseases, instances of which we have in the Hospitals, as we seldom or ever see a Patient who is taking Bark that shall be attacked with Fever; Cortex not only prevents the Return of Paroxsysms in Fever, but likewise the return of all periodical as much Castor &c are only Temporary & palliative as strong Glyster of the Asfoetid will often bring the patient out of an Hysc & Epilep:Fit_ I have known the Ol: animale begin with g'iii- [crossed out] increase to gs xxx mix'd with sugar [pre??lase] produce a Radical Cure of the Epilepsey if the Disorder proceeds from a bad conformation of the head then Caustics to the head keeping up a constant drain as near the part as possible is proper_ the [pi?ney? Port have been recommended _ Opiums must have kept off the fit. 76 periodical Disease let the Causes of their Return be whatever they will for by diminishing the irritability of the System, it prevents the Cause from acting; and it may be employed to prevent a Fever taking place, provided there is contagien arising from any putrid Disease; - In Intermittent Fevers, where the Intermission are quite perfect it may be employed with great advantage; but although it has a power of producing a Crisis as it cannot take off the present Symptoms of Fever; so in Intermittents were the Intermissions are not perfect, but there are some Symptoms of teh First Stage remaining; Cortex will not remove them and consequently must not be employed with advantage but it shold be in small quantities. When we give give Bark to prevent the Accession of Paroxsysm, the Patient must take as much as he can bear for when given in smaller Doses it only acts as a strengthening Medicine simply; I have presented Chorea Sancti Viti St. Vitus Dance Frequent to be met in those who are young- Dr. Syndenham has describ'd this Disorder best of any writer & treated it the most. it generally [crossed out] appears between 10 years of Age and Puberty but sometimes in the advanc'd periods of Life particularly in women, there is a [lud?nc??y] convulsive motion of the Extremitys accompd with a tendency to Palsy, as we see by the patients drawing his Legs after him. the muscles about the face are often convuls'd with a deficiency of sense & memory _ Children who have liv'd freely on animal Food & us'd but little Exercise are the most subject to it_ In old Women there is a particular 77 prevented the Return of Intermittents by Chamomile, Absynthium and Salts of Copper but they are so uncertain, that they are scarce worth trying. Astringents have in some Measure this Effect as Alum &c. When we have procured a Crisis in continued Fevers if it shold be early, we must give large Doses of Bark, but if it happens in the third Week, we must give it in a Manner so as to strngethen the System (that is in small Doses). Remittent Fevers would be Intermittents provided the System was not so irritiable and on that account, we seldom make and Distrinction in Fevers, except by dividing them into Continued & Intermittents. Continued Fevers are all of one Species and seldom vary except in the Irregularity. Solubility of tongue in this Disorder, some as we observe in the arms of Children_ this disease arises from disorders in the [?rim] & [illegible] partiony in Children _ As I have seen & treated successfully a great number in this Disorder, I shall confine myself in the cure nearly to my own Inactive Cure. I have never found it necessary to follow Bleeding as Syndeham directs_ when Children are brot to me for a Cure I give them 2 or 3 Irish purges in the Course of a [crossed out] Week as Calomel: Jalap: Gum Gamboger then I use the Bark with Valerian & Cold Bathf. this method generally suceeds but sometimes it will fail_ 6 Weeks or 2 Months, generally compleat the Cure. 78 On the Plague This is undoubtedly a Fever, but so violent are its Effects as seldom to permit the Patient to go through its whole progress; it is most common to Countries that are warm and over flown with great Rivers, as in Aegypt where the Country is loaded with putrid matter from the Inundation. It has been an Idea that it was imputed but it certainly was not, as arising from some putrid Cause. ~ London was so confined and the Inhabitants very numerous, together with the want of Water and Ventilation, that it was no wonder why so fatal a Disease should attack the Inhabitants. The Symptoms and progress of this Disease we can only give you from Authors, but of all Fevers it attacks the Patient in general with the severest Symptoms; the Depression of Strength, which takes place frequently When the above faild I have often fear'd the greatest advantages from the Ol:animal&- this Disease seems to be between a paralytic & Violent Convulsive Disorder; I have often us'd the tin in large quantities in the Complaint & with great advantage where I suspected worms when all there means have faild I have recommended Electricity with great advantage_ Sometimes Chalybeat_ Water & in where pure Air & sea Bathing will Cure the Vitriol All the Dr. has [exp????] it to do great good in many Cases _ Butter, heavy food & whatever derives much frequently destroys immediately without any previous Symptom; sometimes there is only a pain in the Head, which has continued slightly and the Patient suddenly dies; or he is seized with violent Cold Fits attended with great Appression about the Pracordia; Sickness and Vomiting, the Cold Fit is succeeded by violent heat, with great Stupor and there is an Increase of all the Symptoms, generally destroying before the End of the second Week but not always, there having been Instances of its wearing itself out, it has been remarked that Inflammation of the Lymphatic Glands has arisen adding greatly to the Destruction of the Disease, and as this Disease arises from putrid Vapour or infectious Matter which being thrown into the different Cavities it is absorbed by the Lymphatics, and the Method of destroying the Disease must be by destroying the Matter, which is best done by Acids, and the Vapour arising Blood to the head should be avoided_ a Disorder of this kind prevailed in Scotland some time ago: in that there was a great tendency to runf & when the patient begun he would not stand till he had got to the End of his Course _ the above methord of treating then succeeded best; this disorder was propagated but looking upon a Diseas'd patient, therefore keepf those who were well from those who where diseas'd was all the was necessary to keep off the Disorder. _ Women render this Complaint where remarkable for their laying upon peoples Backs. _ Vitall. has done much good to 79 arising from Acids; and as it is attended with no difficulty to impregnate a large Town from the Volatility of this Vapour, it would certainly be adviseable to attempt it; and as the other common Causes of Fever act so strongly and the passions of the Mind [crossed out] which Anxiety renders the Body irritable, that it becomes necessary to employ the Cortex and Wine as being a preventative; and if the Disease had taken place, the Chance of his going through the whole progress is so uncertain, there we should employ the most powerful Remedies. In the first place the primæ viæ should be cleared by an Emetic, for which purpose a Misture of Ipecacoanah & Tart: Emet: are the best Ipecacoanah by itself not having such a Relaxing power, and Tartar Emetic being uncertain in vomiting; the Dose of an emetic is not of any great Consequence, for provided we give a larger Dose than is necessary, the superfluous quantity will be evacuated; warm Lecture upon Lock Jaw & other Species of tettany, Hysteria & Spasms of the muscles are diffif denomonated according to the part of the Body affected, when the patient is convuls'd backwards then the disorder is colld Opiethotones, when forwards Enpriothotones, when the [?a?eter] & other muscles about the face are affected so as to contract the Face the Dease is calld the Lock Jaw the only difference in all these is the seat of this Disease, tis frequent in hot Climates with any previous Injury of any part of the body; but among us it seldom occurs unless from a puncture or other Injury. 80 Warm Water, and Infus: of Chamomile will vomit, but they act from the disagreeable flavour, hence they do not clear the Stomach; nor like the Relaxants, do they tend to produce a Crisis; it is therefore necessary that the Patient be kept in Bed during the Action of an Emetic; in the first place he will be less liable to be Exhausted, and in the next he is by that means surrounded with a more equal degree of Warmth, which greatly assist the Relaxing powers of the Emetic, a Circumstance of the utmost Consequence; we are likewise to employ warm Water or Infus Chamomile to take off the violence of acting force; for if there shold be an Effort from the Stomach to vomit, and nothing to Evacuate, it will be very prejudicial to the Patient; we are not to give them in such quantities as to urge the Action of the Emetic about twice or three times, for this will have equal Effect in destroying the relaxing power Injury the Nerves &c the Causes are wounds puncture & laceration of Irritable parts, but in hot Climates the Body being heated & then suddenly expos'd to cold, in children it mostly proceeded from acrimony in the Prima Via. we should always endeavor to Investigate the Cause by Examf. - for hurts &c before we attempt the Cure. _ when it is produc'd by exposure to cold as above tis generally some Days before the attack, & the same when from other Injuries tis generally preceeded by a sense of stiffness about the muscles of the Neck & those suservenient to Respiratt there is a tremulous & convulsive motion of the muscles of the Jaw & then it become per [f???] clos'd 81 power; it has been observed that vomiting should not be [crossed out] excited during Inflammation but there is seldom General Inflammation sufficient to forbid their use in this Disease And when we wish to make a Patient sweat he must be covered with Cotton or Flannel not admitting any Linnen to lay over him; and as there is generally a slight Headach in consequence of the Emetic, he should have his Head Bound, which will afford much Relief, and provided there is any Sickness remains, it may easily be removed by Opium. ~ After the Operation of the Emetic we may employ Relaxants, as Small Doses of the Tart:Emet: which if it should vomit, must be joined with a little opium; this plan is to be continued 2 or 3 days; Inflaming the Skin does not appear to have any Effect in the Plague nor does there appear to be any Method (at least so advantageous) except Relaxants; if by this means we should be so fortunate there is no apparent External Inflamn fever & except what the pain produces, sometimes the Jaw may be ofen'd by mechanincal Violence the head in generally clear & the patient sensible with watchfullness & It often proves fatal in 3 or 4 Days tho sometimes it lasts till 4 or 5 nay even to the 15 Days & than kills _ Cure if sympf of fullness about head & [illegible] & consists in relaxing the spasms remef. the Irritating Cause if in finger amputate if tis accasion'd by the lodgment of any foreign Body in any part they should be speedily remov'd if from punctur'd Nerve it should be divided immediately for nothing will avail till that 82 fortunate as to procure a Crisis, we must immediately employ Cortex in very large Doses, without paying any Attention to those sligh Symptoms, which may appear. ~ that is done, then must Opium warm bathf. should be us'd. it's a frequent complaint in the West Indies, Dr. Chalmers & Ilillany are the best writers upon it _ Opium in very great quantities should be immediately us'd even take large quantity of ℥in of the Tinct Sheboir if it cannot be [???all'd] use it in Glyster to the quantity ʒ1 Opium every [crossed out] 10 Hours Tinct Thubaiu in an hour which has often been given with success in the West Indies, tis incredible what what quantitis of Opium the Body will [illegible] under these circumstances with advantages- Opium with musk is more servicable that Musk alone~ F of Opium should be dissolved in water & 83 Violent alias Putrid Fever That extreme Danger in Continued Fever when the danger depends upon the Fever itself we shall call the violent Fever: it has been generally called the putrid, malignant or pilectrial but we shall not employ any of these Names as they are accompanied with Ideas, that are erroneous; Putrid Fever giving us an Idea of there being always putrid Blood in the System; Malignant can only be applied to a Being, that has a Will; and petectria gives us an Idea of there being always Spots upon the Skin, which is not the Case; This Species of Fever arises from putrefaction or Contagion, but generally from the last and from every Cause that produces the Plague, except not being applied in the same degree; the Contagious Matter, which produces Fever is neither Sensible to the Smell of taste, nor & guide with musk Tulip every half hour till the spasm relaxes, using at the sometimes the warm Bath, Stimulating Glysters &c & this is the best way of beating it.~ best where these patient Remedies have been try'd & failed then others have been made use off. when the Jaw was originally affected a Blister to the part & to cover the whole head has been us'd to advantage, [???ing] the parts with anodine & Volatile linaments have been us'd & should be try'd the Body should be kept soluble a very Emminent Physician has us'd the [illegible] for Lock Jaw to the part & other tettanus with advantage he us'd it so freely as to bring on a spotting in 84 nor has it been sperated so as to investigate its properties; if it was putrid Matter it would be sensible, as the breaking down of the red particles &c and if any of the fluids are putrid, they acquire a foetid Smell and in what part of the body it is formed, whether in the Blood Vessels, or in any of the extravasated Fluids we do not know; It is sometimes produced by Fevers arising from other Causes the Patient is attacked with some slight Head Ach, Restlessness &c a few Days before the Fever actually takes place, but in general he appears to be in perfect health (after receiving the Contagian) for 10 or 12 Days, when he is suddenly seized with a Cold Fit, but what happens during this time, we can't tell, unless we were to reason from Analogy, we should then think that it had lain in some Cavity to be absorbed; sometimes it seizes the Patient immediately upon the Application of the in 24 hours he says he had try'd this method in 12 Cases they all recover'd & that he had before treated many in the other difft ways & they all died_ as no time is to be lost in this Disorder if one method fails try another_ the same method of treatment is proper for the other spasms_ Ol:Succin & other Volatile Liniments to [?hine], warm Bathf. Opiate &c will likewise [udiave] the Opistholones & _ _ Catalepsy This is a disorder but seldom met with it is a universal tettanus with an affection of the head - tis known by the limbs retaining whatever posture you place them in, the Disorder he 85 the Contagion; there is Coldness & Shivering in the first Attack, which goes off in an hour or less and then returns, so that in the First period there is apparently 20 Cold Fits; there is depression of Strengths, frequency of the pulse, loss of Appetite, Nausea, Oppression about the beginning of the second Day, the Coldness goes off, and seldom returns throughout the whole Disease; all the febrile Symptoms gradually increase, and those arise, which generally destroy in the second Week; there are Deliria of both kinds which arise in Fever, he is affected with great Stupor and staring of his Eyes, they are also Bloodshot, all increasing till the destroy our Patient in the Middle of the second Week; but if he constinues the second Week this Delirium is converted into a Stupor, which arising after Delirium, seldom detroys. Delirium with Stupor frequently takes place in the Second Week whish is more violent in the Night and relieved in the Morning, this he had seen only one Case, in which the patient was seiz'd on Horse Back which he contin'd till he came to town, when the fit went off the patient remaind a long time languid & lore. ~ Cause. Violent affection as Grief, Fear, surprise Violent Exposure to cold & produces it. Children have both this & Lock Jaw from worms which purging generally cures. ~ Cures if the habit is very full with florid countenance &c then cupf. Bledf. & open temporal arteris & may be us'd & every attempt should be made to procure stools as Acrid Glysters of Tobacco &c: assfoetid & the warm bath, musk & in Union with Opium should be us'd, if the stomach is foul & there is a tendency 86 this is frequently fatal; the Pulse at the Beginning of the Disease is very quick even 115 in a Habit not apparently irritable, it grdually becomes quicker Respiration is difficult, but no Cough. the pulse still continue to encrease till it arises at 130, or 140, when he is seized with Delirium and soon dies, or Symptoms of Putrefactions take place, the Pulse, which is sometimes hard, but generally soft dark purple Spots under the Skin putting on the Appearance of Marble, they afterwards become darker, the Tongue first brown and afterwards black. the Teeth are covered with Sordes, Foetid Breath, frothy Urine, Foeces foetid; it is seldom that Putrefaction is of itself fatal, but there arises an Hamorrhage from the Intestines, or Nose, which brings on great Weakness, and if the Symptoms of Putrefaction run to a great heigth the Pulse becomes amazingly quick and the Patient is destroyed. ~ If the Patient is not cut off by any of these Symptoms, the Fever continues increasing, till the latter End of the Second week when it begins to go off gradually by Critical appearances tendency to Vomits then use The Tart Emet: Musk has been much recommended in this Disorder, but the diffif of swallowing will prevent getting down this or any other medecine, however sinipisons may be apply'd to the feet. movf. the Body into a warm Air had done good _ the same practice may be us'd in other topical spasms _ _ Electricity has relax'd a Lock Jow _ but if one Remedy fails we should try another. ~ ~ ~ Hysterical Complaints - this is a disease that appears so Various that tis diff't to distinguish it,- but I shall mention its most genuine & leeding Symptoms. some Women are subject to a sensation resembling a Ball r oling about in the Intestines (- (which is nothf. but confind Air) this moves up into 87 Appearances; the Tongue becomes moist, Urine lets fall a lateritious Sediment, and every Exacerbation becomes less, or when the Fever is gone, the Patient may be destroyed by the consequent Weakness; ~ It is not very common for Inflammation to take place in this Fever nor for it to terminate by Crisis ~ It is a question whether Contagious Matter may be destroyed by Acids, which I am certain it may, and for the immediate prevention of such a Fever in large Towns, Hospitals & Jails there should be large Ventilations; and every Method employed to keep them clean, by removing putrid Matter &c If some slight Symptoms of the First Stage should arise, they by no means are to be neglected as a slight pain in the Head, of Sickness particularly if the person, who is affected has been exposed to Contagion; we must immediately employ an Emetic and afterwards small Doses of Relaxants, for by removing these Symptoms we frequently prevent the Disease and in this respect violent Fevers differ from Eruptive in the Stomach, Throat &c is then call'd the Globes Hystericus, this Spasm begins in the Colon & discharges at the top of the Osaphagus this often accompanied with considerable pain convulsive motion of the abdominal muscles the Umbilical Region is drawn in there is borborigma, frequent Hicoup, constriction of the Thorax Palpitation of the Heart, & a diffit Respiration, the Pulse are small quick & hard, these pateints are subject to a dry convulsive Irritatf. Cough, from the complaint in the Intestines, occasional flushing, & sometimes paleness a [pefrepetction] of the Hysterical Complaint & Symptoms chan yes the Voice & impair the senses _ sometimes then patients are subject to Involuntary Coughing [?e?jeny] &c 88 Eruptive, as the Small Pox &c in which Emetics will not prevent then Matter when introduced from acting; it is very rare that we find General Inflammation in such a degree as to render V.S. necessary, hence nothing is so prejudicial as that Operation, for all our Remedies are not sufficient to remove the Depression it produces and consequently the Disposition to putrefaction. ~ We are first to endeavor to take it off by the use of Relaxants, which should be exhibited in such Manner as not to produce profuse Sweating, for in this Case provided we should fail in our Attempts, we shall so weaken our Patient as to render him less able to go through the Disease; there has been two Methods of employing Relaxants either to make them act powerfully in the Evening, so as to act with the Evening Paroxsysm, or to give them every 6 hours so as to act constantly, which is certainly the best, but if the Stomach will not bear gr 1/4 of Tartar Emetic, or a Similar Dose of the Clavus Hysterious & other fix'd pains Rheums pains &c but they are distinguish'd from the true Rheumatism from their seat which is chiefly in the skin, they are subject to Violent convulsive_ paroxysms, by which the senses are much impair'd tis surprising what great degrees of strength even a weak patient will show under a fit of this Disease_ During the fit there is an unusual Motion of the abdomen, Borborigma & Globus Hystericus wn. Symptoms chiefly distinguish it from the Epilepsy _ languor lassitude torpor &c &c follow which the patient does not recover in 48 horus-those who are Gloomy & of an Irritable Habit are the most subject to it. - they are 89 of other Relaxants it is seldom that any great Advantage arises from their Action; the best Method of dividing Tart: Emetic; we have had occasion to mention; and it is to be observed that we should begin with a smaller Dose constantly increasing it but not so as to produce Nausea or Sickness. if there should be purging it is better to employ Ipecacoanah as Emetic Tartar will act upon the Intestines; if the Patient is thrown into a breathing Sweat, Tongue at the same time moist, about the Edges, Headach either diminishes or goes off we may then suppose the Disease to be going off. Relaxants act opon the Kidnies, hence a lateritious Sediment is produced; there is a Method of employing Relaxant by dividing Tar: Emet: into Doses and giving it every three or four hours till Sickness is produced this is employed by many Practitioners, but they frequently produce topical Evacuation and do not carry off the Disease; and if we employ Relaxants only at Night, we may employ other Medicines during the Day, as Acids &c ~ If they know when a fit is approaching from a sense of coldness in the loins & an Unusual flow of pale Urine. many are subject to Violent head-ach after the paroxysm is over-foaming at the mouth, shaking, frequent fainting,- trembling of the Extremities, Retching & tendency to Vomit, sometimes attend; the Hypocondriac Disease appears much like the Hysterics & yet the & yet they vary - Cause of the Hyst: a smooth soft skin, florid complexion, an Irritable habit, those whose minds are easily agitated are the most subject - it seldom happens before Puberty mostly in the advanc'd periods of Life when the Menses Ceases & they are more common in hot than cold Countries, [illegible] in 90 If by the above means we are able to produce a Crisis in the first Week, which is compleat under these Circumstances we may employ the Cortex Peruv: in large Doses.~as ℥i in 24 hours to prevent a Relaps; in the Beginning of this Fever, we may produce 2 or 3 Evacuations in the Course of 24 hours, by the Neutral Salts; it is worth while to employ Relaxants during the whole Course of the Disease; particularly if we have not been called in till the 2nd Week; if they produce Sweating on Purging without any Relief, we are to remember that we are doing Mischief, but if on the contrary the Tongue becomes moist &c we may continue to employ them; If there should be (which commonly happens) Delirium, continuing in the Day without hardness of the Pulse, but Redness of the Eyes, it is generally relieved by Bleeding from the Head by Leeches, which is better than opening the Jugular Vein; if the HeadAch should continue, the Delirium without Redness of the Eyes, than we may employ Blisters behind the Ears, as upon the Back and if Anxiety more common in Women than men, yet men have had it with all the Symptoms as Globus Husterious &c Widows & those who are Barren are the most subject to this Disorder_ love hatred & other passions of the mind may produce this Disease anger, sudden Joy, & strong impressions upon the Organ of the difft senses have been known to induce it - whatever produces sudden changes, a Plethor induc'd either by retention of the menses or a sedentary Life when this is the Cause there is a florid countenance, pain of the head &c in these Cases burping & takf a few ounces of Blood occasionally will prevent it. local Irritations, or Irritability inuc'd by profuse Evacuations as 91 Anxiety is great, Respiration is difficult, and oppression about the Praecordia, then Blisters upon the Breast are of great Use; and in the middle of the Disease we ought to employ Rhoeum & Senna to keep up a gentle Evacuations from the Intestines; if Symptoms of Putrefactions of the Fluids should take place, there is no Medicine we can employ in Fever, either to remove or carry it off; if there be Haemorrhage not depending upon putrefaction but upon a Laxity of the Vessels, we must employ Acids and Cortex in such a quantity as to give 3iv in 24 hours; Some have employed large Doses of Cortex in this Fever, to precent the Exacerbations, but it is improper, except in Haemorrhage of this kind. Acids may be employed when there are Symptoms of Putrescency, but if we consider what a Small quantity can be introduced into the Circulation, we shall think they can never act upon the Blood, hence there are no Medicines, notwithstanding all their Antiputrescents, that can remove putrescence of the Fluids; in the 3d Week, if we have employed Relaxants as purpose mensesf Hammhages & may bring on this Disorder _ In this Disease there is no immediate danger in the fit & the patient appears to be quite well In the Intervals _ tis often in the patients power to renew the fit by calling up Objects which formerly occasion'd it, & in these Cases it has been often prevented by threats of torturf. in the fit. Preg: if from a Plethora tis not easily cur'd, V.S. will palliate but it encreases the Plethora Ultimately. if the menses are obstructed this should be restor'd, if from other Causes proceed accordingly. if from profuse 92 Relaxants without Effect, it is not worth while to try them any longer, we are now to keep the Body open by Glysters only, the Patient not being able to bear purgatives; the Strength is to be supported and if the Weakness is very considerable by Wine, it was a Custom to employ Spices, and is now used by some Practitioners, but they have bad Effect. ~ This Disease terminates in two ways, sometimes there is a great degree of Stupor takes place instead of Delirium. In this Case Symptoms of Iritability seldom take place, and the Patients lies a fortnight and he dies suddenly; at another time no such Stupor takes place, but the Relaxation in the Day becomes more powerful, and the Exacerbations irregular, if the Tongue & Skin are moist, then Cortex may be employed so as to strengthen the System, as in Decoction it is much the Practice & particularly amongst Physicians to employ Camphor at the End of a Disease, which they imagine to take off the Malignancy, but I have never seen it of any use Evacuations, then the tonic & strengthf plan is the best;_ Cure in the fit little can be done the directions given for the Epileptic fit are applicable here, but I have known a strong Glyster of Assfoetid rec over from the fit immediately sprinkling with [c?t] [w??n], & other stimulating Body are servicable. if there is danger of the head being too much affected then take a little blood from the arm, those of a full plethoric habit should use a low bulk Regimen as Syndeham directs, but this is only proper in this Plethoric, when pain attends the opium joind with Assfaeind is the best Remedy as the pain is entirely spasmodic in these Cases 93 Use, as likewise Mosch; The Food in the Beginning of the Fever, if it is violent, which it generally is, consist of Farinaceous Substances dissolved in Water. ~ Fruits may be employed during the whole Course of the Diease, as likewise Milk & Water, or Barley Water, never using pure Water alone, and if towards the End, we find it necessary to employ Wine, it shold be diluted Some Practitioners have employed Animal Broths, but I have never seen them strengthen but on the contrary, they frequently render the Pulse quick, and upon the whole it is better not to employ them; these are the Remedies, which we employ during the progress of the Violent Fever, and provided the Disease was to be left to its natural Cure, four out of five would recover. ~ Cases conceal, our intention of giving an Opiate as these patients are in general prejudice'd against them. ~ Dr. Whytt who is the best writer upon Nervous Disease- Dr says Opium often does hurt given in too Small doses. to conceal this Remedy he began with T:Thebois gr in a Lady & by grdually increasing the dose he over came the consitutional aversion & she was able soon to take a full dose & with great advantage ~ the pain of an Hyst:paroxysm may be abated by a Volatile & Opiate Plaster to the Region of the abdomen_the menses should be promoted by Riding Exercise &c where there is no plethora Chalybeat & bath waters are 94 Inflammatory Fever The Fever which we are next to treat of is that which prevails in those who enjoy the pure Air of the Country and whose Food is sufficiently nourishing according to their Labour, although it may arise from all the common Causes of Fever, yet of the known Causes sudden Cold' it the most common and for the most part the Patient is attacked all at once in the same manner as Violent Fever; it is to be observed, that when Topical inflammation arises without any Fever, as it gradually increases, it produces Symptoms of Irritation and they keep constantly increasing; it sometimes happens that the Inflammation at the Beginning is not felt, as in an Inflammation of the Liver, in the meantime the Symptoms of irritation arise, and the Affection of the System comes to be violent in a Day or two; there is always a Suspicion of its being only General Inflammation, and are good, but not in a plethora, the body should be kept soluble & for this purpose the pil [illegible] answers best_ In Irritable habits sea bathf. should be us'd, in Case of great watchfulness & uneasiness the peldiluvium will prove Rest. in relax'd & weakened habit the Bark & Chalybeats are the best Remedy for the use of Borborigma, Globus Hys:&c the Assfoetid tis best given in solution of water in the form of a Lacc: as pill of it [ov?x] of difft solution in the stomach unless soup is added; I have seen Hoffmans Anodine Liquor abate the Spasm of the Prima Via & take off the uneasiness of the stomach : in Case of 95 and not Fever, but some Topical Inflammation on which it depends. Nervous Fevers come on gradually, and continue so, but this Fever though it is slightly at the beginning sometimes being no HeadAch Coldness or depression of Strength; but the Patient becomes hot, & dry, foulness of the Tongue, and the pulse becomes frequent, full, hard, and strong, pain in the Extremities, Nausea, less of Appetite; these are the Symptoms generally taking place and every indication of Strength in the System it very often happens that after the Disease has continued for an hour or two, some topical Inflammation arises and sometimes cures the Disease; it also happens that Hamorhages take place and carrys off the Fever; but supposing no topical Inflammation to arise the Symptoms of Fever go on attended by General Inflammation and there arises Universal pain, Pulse becomes fuller, harder & stronger, but not that kind of pain as in Violent Fever, there is Headach internally, the Patient describes it of fainting & lowness the Tinct Castor is one of the best Cordials tis bitter in Tincture then [crossed out] Substance_& is a better remedy than either the Tingt Tulig: Tatd many other Cordials we know. ~ I have often added Hoffmans anodine Liquor to it & given [???s] s powerfull occasionally while the use of Bark I restor'd the tone of the Habits, there patients are either Costive or have a Diarhal. I have known a sudden Noise bring on a Diarhal in these habits where the patient [crossed out] was Costive before. this is best reliev'd with Bark guarded with an Opiate. Dr. Whytt recomds the Complex Tapon: with the Bark in these Cases. I use a light 96 it, as if his Heads was bursting, Stupor, with a Redness of the Eyes, flushing of the Face, and he is sometimes immediately destroyed by the General Inflammation and this may happen in the second Week but if it does not proce fatal, the Brain is so much affected that the function of the Body cannot be performed, and the Patient is cutt off; if not the Delirium continues for want of Sleep and if the General Inflammation does not kill, the Exertions of the Body weaken, and we frequently have a Crisis in the Second Week about the 9th day of the Fever, but more frequently on the 11th if no Crisis is produced, the Disease gradually wears itself out, so that the principle danger is in the Injury done to the Brain bu the General Inflammation; in this Fever the treatment is very simple, we having only to remove the General Inflammation, before it has produced violent Effects it certainly will do; for this purpose Evacuations by Bleedings always attending to the proper quantity decotn of the Bark with the Elix Vitriol._ the [?ymont] water is the best Chalybeat P. S of this & Comn water makes a good substitute to the Bath waters & may be drank at home in the great advantage tis good in Acitities flatulency & after Eating.~ if the the paroxysm of an Hyst: as preceded with a Violent pain the Abdomen give an opiate & you prevent the fit if opiates are often wanted I join them with some warm aromatic by that means they are prevented weakening & fouling the Tongue &c the Phil is better than Opium by itself for an habitual Opiate _ a Change of Air Sea Voyage. Ol: animate- 97 quantity necessary to be evacuated and let the quantity if possible be taken away at once even 3xx for by this means we shall have a better Opportunity of diminishing the Inflammation and consequently prevents the injury that would necessarily follow, for we have no Remedy by which we can remove the Mischief done to the Brain, if once taken place; sometimes it is necessary to respect V. P. Relaxants at the beginning will sometimes carry it off, but on the other hand they are apt to produce profuse Sweating and heat, which increases the General Inflammation, therefore when we do employ them, they must not be very powerful; Neutral Salts may be employed so as to procure two, or three Stools in the 24 hours; it has been objected to be many Practitioners employing Emetics before V. P. for fear of rupturing some Blood Vessel, but I don't know one instance of it happening. When the General Inflammation is removed we may employ Relaxants; there arises a Ammon: & are all good. but above all a word whatever has a tendency to recall the fit. Hysterics sometimes terminate in madness but that is best obviated by an observance of the above method of treatment. In full habits I have seen brisk Purges of Alatics & Cal: do good,_ Retchf. &c which arises from too great Irritability of the Stomach & is best reliev'd with Naust Salin & Opiates if there is a local spasm the warm bath is good~& there is great advantage in going immediately from the warm to the Cold Bath ~ ~ the Anod: Liquor of Hoffmans will sometimes procure rest where Opium fouls then is a good Comunite Soap & Aloes best Remedy for Costiveness. 98 a Delirium for want of Sleep, coming on gradually with Eyes quick &e we may in this Case use Opium in small Doses, but if it increases it becomes very dangerous, and may sometimes be carried off by a large Dose of Opium, but then we run a Risque of destroying the Patient, and is never to be used but in the utmost Danger; we may employ small Doses, as gr. 6tis horis; by this means the 1st & 2nd Dose appear to have no Effect but the 3d generally has, & is preferable to larger Doses; it frequently happens, when the Crust exfoliates, which was formed upon the Tongue, leaves it inflamed and Ap than are produced but these are generally removed by Sedatives, as Acids mixed with Mucilaginous Substances; during the whole Course of the Fever the Patient must abstain from Animal Food, and if there should be a Crisis, we may give the Cortex though it is not of any great Consequence, there being very little danger of Relapse. ~ The Lecture on Hypochondriac Melancholy Madness The seat of Hypchondriac Disease is in the Aimentary Canal the Stomach Intestines & accompanying which the mind is affected with Melancholy & Gloomy apprehensions of [futu??g] those who are the most subject to this complaint are those who are employ'd in deep thinking in Comtemplation & hard study. tis often Hereditary but often induc'd by misfortunes a sedentary & studious Life tis frequent in advanced Life from high living and Indolence. sometimes suppresf Evacns. or Haemorrhages &c [Gi???inc] to it _ tis accompanied in the [Han??teny] Borborigma 99 The Irregular or Nervous Fever We come now to treat of the Irregular Fever, which arises more frequently in irritable Habits, and as Women are more of this Habit, they are consequently more affected with this Disease; amonst the lower Class of People it sometimes happens tht the Food, which they take is not of sufficient Nourishment, or in sufficient quantity in proportion to their Labour this happens more in the Country thatn in the large Towns, and in consequence of their irregularity are frequently fatal; this Disease is produced by a way Cause rendoring the Habit weak & irritable, as by the long use of Mercury &c it is likewise produced by the common Cause of Fevers, particularly from any Affection of the Mind, attended with Anxiety, which always renders Fevers irregular; they begin in so slight a Manner as scarce to be marked, not 100 & pain in Vomittf low Sprts& occasioned [crossed out] fainting, the patient secretes great quantities of thin pale Urine they are generally subject to a palpitation of the Heart, a slow irregular & - sometimes Intermitf Pulse, Vertigo, Watching,- frightfull Dreams, sadness & melancholy they seem to be afraid of Death, & yet not affraid of dying from these Gloomy thoughts they are fregF. tempted to destroy themselves. this Disease frequently ascends from the Intestines to the Esephagus,- & it has many Symptomsin common with the Hysteric Disease, but it is mostly confin'd to men, tis generally diffit. of cure & if of lonf continuance, or has been neglected of badly treated tis 100 not attacting the Attention of the Patient, perhaps a slight degree of Cold, sometimes more Languor, loss of Appetite, frequency of the pulse, heat & depression, but no so as to prevent his doing his ordinary Business; these gradually increase, but it is four or five Days, before he thinks himself afflicted, sometimes they attack his with strong Mark, a Depression, Nausea with every other Symptom of Fever; but in generally they are slight gradually increasing till the 2nd Week, during which time the Patient is apparently in no Danger, Appetite & Sleep a little impaired but none quite gone, hence Practitioners have supposed that there was no danger; the Patient Sweats profusely and that without Relief, or some slight Purging takes place, the Urine instead of being transparent, will have a Mucous Sediment, and the Appearance of a lateritious one without Relief; these are all Symptoms of great Irregularity; sometimes these shall be a 101 tis frequently incurable it often terminates in other Disorders, Piles &h give relief. Dissections show the Ven & Porta in these Disorders to be distended with Blood & the Intestines are generally immediately Inflated. the Liver [Chphorpo???] Viscera are mostly obstructed ~ ~ ~ Cure - tis of utmost importance in this Disorder to avoid Costiveness, tis best prevented by small doses of the Neutral Salts Crem Tart in why, Sol:Tart: &c in some who have much flatulency the warmer Alatic purges answer, better, but when there are Symptoms of obstructed Bile then the Neutral Salts are best. - but 101 a great Secretion of pale Urine, and the Patient worse in the Morning and better in the Evening, HeadAch, generally confined to the forehead; while the Skin & Tongue shall be moist; Delirium takes place generally at the End of the second Week and proves fatal, it happens with moisture in the Eyes universal Restlessness, but not attended with that Acuteness in the Eye even Delirium takes place for want of Sleep, no Redness of the Eyes the Delirium constant for 3 or 4 Days when it proves fatal; but if it does not destroy it continues for a considerable time and the great Mischief arising in this Fever is from its long Continuance, and its irregularity, the Patient becomes better for 2 or 3 Days, is succeeded by an universal Relaxation and the Patient to every Appearance is recovering but the frequency of the Pulse, the foulness of the Tongue, and the Colour of the Skin shew that this Appearance is fallacious. If 102 but in thin habits where there are torpid bowels, then the Alatic & antispasmodic Gums are the best laxatives. the Lancet should be avoided in this disorder as it increases every Symptom.- Exercise on horse Back is of great importance as in all these Exercise by which the abdominal Viscera are well shook, tis of consequence that the patient change his place of abode, He should mix with chearfull company, for whatever [crosses out] diverts the mind is serviceable. ~ If no fever attends, if there is not much headach & the Head does not seem to be much affected, then the Bath & Chalybeat Waters are good 102 If the Disease should be cured by a Crisis it is generally on the 14th day otherwise it may gradually wear itself out without destroying the Patient at the End of the 4th Week; and notwithstanding there is great Weakness remaining; Symptoms of Putrefactions of the fluids, and Hamorrhage seldom or never take place; If this fever should attack a Woman that has been rendered weak the attack then is more violent, and it sooner destroys, as for instance a Woman in ChildBed; the Heat this last Summer was so considerable, that it produced great Irregularities in Fevers as to prove fatal in many Cases. ~ No Evacuations by Bleeding is unnecessary it renders the Disease more irregular; - Relaxants employed at the Beginning, very frequently carry it off; but it had continued five or six dats, which is generally the Case, then Relaxants produce topical Evacuations without any Relief, as profuce Sweating, or purging; but notwithstanding the uncertainy of 103 as they help digestion, correct Acidity &c he said he had known the Hypocondriac Disease to be overcome by a Diet entirely consisting of Milk & Vegitables_ when us'd thus by themselves they do not occasion the flatulency & that we observe when weakly patients use them in conjunction with an animal Diet as in this last Case the fermentation &c is greater, all high season'd meat suppers Butter & should be carefully avoided Bark & Valerian has been much recommended but neither these nor the antispasmodic Gums are of the best service unless the greatest care is taken at the same time to keep the Body soluble on the contrary with constipated Bowels 103 of these Effects is the advanced Stages of this Fever, it would be worth while to try them; observing to omit them, provided such topical Evacuations should arise; when the Disease affects one part of the Body in particular; especially if at the beginning. Inflammation near the part is very useful not only in removing the Affection of that particular part, but the whole Diesease, but when the Disease has continued for 9 or 10 Days before our Assistance has been judged requisite, where therei is topical Affection or not exciting Inflammation is of no use; when the Irritability is rendered considerable from the Patients living in a warm Climate, or from any other Cause, we may employ Cortex in large quantities; it is very unfortunate for us that all our means of stopping the Fever are less powerful in this than almost any other, and the Disease will sometimes in Spite of all our Remedies go through its natural progress; which on every account 104 they increase the Disease ~ I have a Deobstucient laxative pill which I use with advantagein these Cases it consist of Rhei: Soap: Tar Vitriol: Alas. sea Bathf. is often us'd with advantage that with riding & an observance of the above plan I think the most likely to remove & relieve these Disorders the above Disorders often terminate in a Delirium accompanied with either Mania or Melancholy we shall first speak of Melancholy. __ great & long continued watchfullnessis often productive of Melancholy there is generally a pain in the head, a tinitus aur: great anciety & sighing Palin of the Heart, small unequal pulse, a constant fear of Dying, they [illegible] 104 account is very dangerous one, and ought if possible to be avoided. ~ In the Cure of this Fever we might avoid all unnecessary Evacuations as there is no General Inflammation we must keep the Intestines clear by Rhubarb and other Aperients, which will not act with violence and when the Disease has not considerable progress, this must be done by Enemas only; the Food at the Beginning may be of more Nourishment than that which we employ in either Inflammatory, or violent Fever. as Solid Farinaceous Matter, Fruits, either baked or roasted; for the Organs of Digestion are not so much impaird; towards the Middle, if Delirium arises from the Irritability, we may employ Opium as gr. 1/4 6tis horis which will remoce it; and when the Disease has gone on for 12 or 14 Dats, and the tongue & Skin should shun society, & false Images present to the mind & they Cry & laugh with out any provocation & eat but very little. long continued watchness & & abstinance from food are the distingf. Symptoms of Melancholy madness. tis accompanied with Violent Passions their passions are generally difficultf. rous'd but when rous'd they are very Violent. tis frequently produc'd by disappointd Love in Women & sometimes hereditary. ~ Obstructed Evacud. repell Eruptions may give rise to it. ~ upon dissection the Vessells generally appear turgid & the Brain is watery & colaps'd state. - Cure . - 105 should be moist without Delirium, we may employ Cortex to strengthen the System. but if any Oppression about the Praecordia or watchfulness, and at the same time the Tongue is dry, then the stengthening Effect of the Cortex will not be adequate to the Mischief it is doing; all kinds of simple Stimulants are to be avoided as Spices, for they render the pulse, smaller & quicker, and consequently increase the Irritability, a Circumstance which we are endeavoring to remove. ~ Cure when there are great watching [Ac?i??] Emets as of teh Tart Emet in a large dose proper. when from obstructed menses bathf. in bath waters is of service & relaxes that general stricture which the roughness of the skin of those people shows attend travels chearfull company diverting amusements &c change of Regimen is proper, whey, milk & Vegitables have sometimes cur'd - travelf from one place to another, Cold Bath keepf the Bowels Lax with soluble Tartar & the aforemention'd Laxative Dcot: Pil will sometimes procure the greatest reliefe - - - - - - Mania 106 Intermittent and Remittent Fevers We do not distinguish these, becuase the same kind of Remedies are to be employed in both. Intermittents arise almost in all Countries, whether they are warm or Cold; but Remittents Scarce ever happen in this Country, being peculiar to warm Climates, where they have seldom perfect Intermissions. they are freqeuntly produced by Moisture in the Air, which generates a great degree of Cold and especially upon the Body of Animals it is very seldom that they are produced by Contagions or putrid Vapour or by any passion of the Mind, and they are equally as seldom produced by any thing retained in the Primae Viae. Sometimes they attack the Patient as continued Fevers, and at others they Mania in this the Delirium is not constant the patient is reasonable for a time, till the particular subject which was the Cause of the Disorder is brot. up. they have a surprising degree of strength. & tis a fortunate circumstance they are call'd cowards for as they are very strong & very cruel they would otherwise do the greatest mischief,- Authority is easily kept up among them, & by threatning punishment you may in general make them comply with any directions hunger cold & fatigueare all [co?] by those unhappy people with remarkable 107 they are Intermittents from the beginning; when they begin as Continued Fevers, they sometimes come on suddenly, having the first Attack well marked by Coldness, Oppression &c and provided the Symptoms are gradual not exciting the Attention of the Patient at first they become very considerable in the first 24 hours. ~ When they begin as Intermittents the Attack is strongly marked by all the Symptoms of Fever in its 1st Stage; When the Continued Fever has taken place it grew on for 4 or 5 Days, but [crossed out] it is to be an Intermittent, is very evident from the Exacerbations not taking place in the Evening from the Sickness being considerable in proportion to the other Symptoms from the Tertian Type being strongly marked; and if one Paroxsysm is gone off, and the Skin returns to its natural Colour, the Tongue clear, no plain &c then we may consider it as an Ephema Simplex; but if the Skin remains of a dark Colour attended with pain &c we may be certain that the Disease will return when fortitude & perserverance. there is generally the appearance of a great determination of Blood to the head_the countenance florid and full the Pulse full strong hard and quick at times they are furious at others melancholy it often arises from over study, misfortunes, &c tis sometimes hereditary- Hysterical people are subject to become manial in the advanc'd period of Life, sometimes it is blended with a degree of Idiotism after fevers- but in these cases it comonly goes off with the return of strength. when a person has once be mad he is ever after subject to a relapse even 8 when the Intermissions have taken place they are less perfect at the Beginning, leaving a slight pain in the Legs, Forehead, Foulness of the Tongue, Languor, Loss of Appetite, sometimes a frequency of the Pulse &c. there remaining after a Crisis; though sometim a the Intermissions are quite perfect at first; it sometimes happens that the Patient is destroyed by the Violence of the Paroxsysm, and whenever it does do destroy it is at the Accession;- becoming Cold, pale, and the Strength is totally depressed and he dies; but this is a Circumstance which very rarely happens; nor do I know one instance of it happening, when the Hot Fit had taken place; towards the End the Disease becomes irregular, Tertians & Quartans not observing their Types and the true Paroxsysm being left violent; they are most commonly fatal by the Weakness, which they produce; the Attack of an Intermittent is more fevers than the Paroxsysm of a Continued Fever and of course there is a large quantity Blood thrown upon the after he has Appeard well for many years. this Disorder sooner yields to Evacuations, Agues & comf. on have remov'd it in dissection the Brain has been observ'd to be dryer & firmer than in health & grumous & Coagulated Blood is commonly found in it Vessels & sinews. _ _ Cure. If the patient is young & Plethoric with a full hard pulse & florid countenance we should then have recourse to the Lancet & use it freely. a few ounces of blood should be taken from the arm & repeated occasionally I have heard of washf. the head in Cold water very much being of service. we should endeavor to reduce the strength, by a temperate Regimen 109 the Lungs hence Cough, and the Abdominal Viscera become enlarged as the Liver, Spleen, &c and these Swellings not uncommonly continue after the Disease is removed, and from the Irregularity of teh perstatic Motion, there is an Accumulation of Bile hence it is thrown into the different parts and Jaundice produced from which Circumstance they have been called Billous Fevers, and it has one Effect in rendering the Disease more irregular; It has been a question whether we are to attempt a Cure of Intermittents; some having supposed it might Occasion the Matter to be concocted and they have therefore wished for its Continuance It is true, that if a Man has been afflicted with and habitual Disease, Fever will frequently carry it off; it is therefore adviseable provided such a person was to be attacked with an Intermittent, to let him suffer a few Paroxsysms; otherwise, they are by no means without danger, though it is not the Disease itself, yet its Conseqeunces are; as Deprresion and as a diet f milk & Vegitables & carefully avoiding Wine, Spiritous Liquor & Active purges should be given 2 or 3 times in a Week as an Infus. of San & a Tart Solub: a still situation & we should keep them from those who attended them in their Phrenzy. they should be placd under the Care of people skilled in their convern. & who are acquainted with the best methods of diverting their Ideas, Cold bathf. & should be us'd but we should first reduce the high Inflamy. [Symp?] by the above method of treatment. sometimes madness follows a blow on the Head & even many years after it was inflected, in this Case a Caustic apply'd, [consthuy] drain kept [upt?p??f.] the 110 and with regard to leaving Matter not concocted by causing Intermittents, we have had occasion to say that there was no Appearance of such Matter, and to pay any Attention to what we don't imagine exists, would be ridiculous; the first thing to be done after we have procured Intermissions is to render them perfect; for though we can prevent the Paroxsysms returning, yet there are Symptoms remaining during the Intermission that must be removed or the Disease will not be cured; we are therefore for this purpose to clear the primæ Viaæ first by an Emetic; it has been dispute at what time of the Intermission it should be administered but it is a Matter of little consequence provided we don't give it so as to oppress the Patient during the Paroxsysm; we shall by this means produce considerable Relaxation tending like to procure a prefect Intermission; when we wish it to produce this Effect (which should be always- it should be exhibited in a moderate quantity, so as to clear the Stomach. during the head & has cur'd, I have seen many Cases where Opium was serviceable by quieting & producing rest, & its effect have been the very reverse in other Cases wherin I have try'd; Opiate answers best but if there is no Plethora attendf requirif Bleeding & [puri???y] In those whose fibres are delicate & Irritable 50 or 100 drops of the Tinct [Shab??] often quiets & does much good. - Sacch Saturnia has been recomd. - 111 during its Action the Patient must be kept in Bed, as likewise afterwards, nor must the Vomiting be urged by drinking too much Δ and when one perfect Intermission is procured the Remainder onces are generally so; we ought to employ such a Purgative as will increase the peristaltic Motion; hence Seammony, and Coloeynth are to be rejected as stimulating the System and increasing the Secretion; and we are therefore to employ Rhubarb, which must be administered at the Beginning of the Intermission. sometimes there is General Inflammation and sometimes Plethora but very rarely as to prove fatal, notwithstanding they render the Intermission irregular and in these Cases we may employ Evacuations by V.S. and in order to procure perfect Intermission, we may employ Relaxants, and Neutral Salts in this Case are very active as Sal: Digest: Sylvii. Tarter Vitrialat. Neut: &c but Ipecacoanah and Antimony exhibited in such quantities as the Stomach Lecture on Mania &c contind._ Cure - Castration has been reccomf. possibly in some Cases it might be of service Nitri has been greatly recomd. in those Cases where Bleedf. was proper. Camphire with Vinegar has been us'd with advantage - Dr Mork thinks the [Tham] 2 or 3 3 Gr. apply'd specefic for Madness. but I have more faith in Evacuations, changing the Ideas, but a succession of new Entertainf- Objects proper Exercise & than in all the specefics yet us'd - In madness there is genf such a torpor as to require large doses of the difft. Medecines us'd as 10 Gr. of Tart Emetis but a small dose so of other, [T?ues] Setons & in 112 Stomach will bear are very powerful. in producing this Effect. ~ in the Neck have after some great service in Plethoric habits under these discorders. Cold Water thrown upon the head fromm a given height has done good by the throwf. the blood upon the Extremities & releving the head. - Cholics by which we mean a Disorder in the Intestines not confind to the colon, but is generally in the small Intestines. Cholics me be distinguish'd into 4 kinds, Vist the Billious, Spasmodic, flatulent or Colic Picton: & lead Cholics, sst of the Billious in which there is great thirst, a bitter taste in the mouth; & frequent Vomtf. hot of Billious Ms. 113 Prevention of Paroxsysms We have shewn you in what manner perfect Intermission are procured, provided the Fever is to go thought its natural progress We are first to endeavor to keep up the Strength of our Patient, for which purpose he should be brought into dry Air; we are likewise to employ Food of good Nourishment, but easy Digestion, if the Intervals are considerable, Solid Animal Food may be used, provided we give it in such a Manner, that it may be digested before the Accession of the next Paroxsysm; and in order to strengthen the System we may use Chomomile, Absynthium &c and Cortex in small quantities, we may for the same purpose employ Prepartations of Iron; this then is the Method, in which we must proceed, when the Disease is to go through its natural Course, but if we can procure perfect Intermissions, it is much preferable unless the Patient has had some habitual Disease. this accompanied with Obstinate Costiveness, but frequently with a Diarrhea there is a Violent pain in the Umbilical Region either fix'd or moveable there is mostly a a Violent pain in the Back in the Course of the Duodenum seat of Days in the Stomach. there is a constriction of the abdomen & a retaction of the umbilical the pain is Violent & sometimes gradually Abates. they are reliev'd by evact.. particularly by large Billious stools & if they are not speedily procur'd Gangrene Mortification &c comes on which seen kills the Urine is often deficient ~ As the Duodinum seems to be the seat of this Disorder we 114 this is best done by Cortex, which we have already shewn you, that it will prevent a future Paroxsysm, but not remove the present one; we are therefore to give it during the Intervals, or we shall convert the Disease into a Continued; it has been a question, whether it should be given the whole time of an Intermission, or a little before the Accession of teh Paroxsysm, but as this depends upon the length of time Cortex takes to act, and as it will continue it action a long time, it is therefore to be given immediately after the Paroxsysm has left the Patient and to be continued during teh whole Intermission. It was a Custom to give a large Dose at the Accession of a Paroxsysm; this will sometimes prevent it, but provided there should be any Symptoms of the former Paroxsysm remaining it will increase them and reproduce the Disease. yet there has been instances where this Method has been successful, when it giving it the whole Intermission has failed but these are Cases which seldom happen, with respect to the quantity it [crossed out] sometimes not easily distingd. from Vysh: Parox- we must not wonder Glysters which cannot reach should do so little good, purges given by the mouth are the most frequent in relieving sometimes terminate in [Paras??] of Limbs _ _ _ flatulent & spasmodic is that Disease in small which flatulent is of the large Intestines, the flatulent is distinguishable by berborgima, Euuctations & there is a sense of fullness & dispassion in the abdomen its seat mostly in the Colon the spamodic is mostly in the small Intestines more dangerous & painfull then when in the Large Eructations, Hiccup & obstinate Costiveness, the 115 it should be as much as the Stomach will bear and the greater the quantity the better our Chance of Succeeding; and the smallest quantity in ℥vi though sometimes ℥ij will be sufficient: We ought in a Quotidian to exhibit as large a quantity every hour as the Stomach will bear, beginning with ℥i for a Dose, we must exhibit Matter in quantities and frequently; if it is a Tertian or an Quartan that ℥i every two hour or ℥ij every 4 hours, and it is much better to give it at longer intervals, if the Patient can bear the proper it should be given in Substance for the Stomach has a power of dissolving the Medical properties of Substances when no other process will; but if the Stomach will not bear the Substance we must them employ the Decoction or Extract or by mixing a little of the Powder with the Decoction and adding a little Tincture the powder should be very fine; if notwithstanding the Exhibition of Cortex the Paroxsysm should return the pulse are slower than natural after Intermittent syncope yawning, Cold Extremeties, & often come the Spasmodic Cholic in women is often call'd the Hysteric Cholic tis mostly met with tis mostly met with in Irritable & relax'd habits - Vomitf. Costiveness & suppression of Urine are its common attendants. if the pain continues the pulse becomes small with partial sweating tis not easily distinguish'd from Inflamn. but by its being moveable In Hamn. find & in this there is not tendency to Delirium , by [ashy] Countenance & as in Inflamn. [crossed out] of Bowels. it returns at periods & is not constant the Setonf. Irritable & studious are the most subject to it _ 116 return, it must be omitted during the Fit, if it is a Tertian or Quartan, we should omit it during the time that Paroxsysm would have taken up, but in a Quatidian we may continue it, if there is no Paroxsysm; we are to continue it as along as there are any Symptoms recurring which when we have removed them, we must contiue giving ℥i every 24 hours for 2 or three days and then omit it for the same time, gradually decling its use observing longer intervals at each time; if we do not continue its use after the Omission of one Paroxsysm, they will gradually begin to return and the Disease entirely recur, which we shall find difficult to remove; Some have employed Cortex ~ constantly but it is much better to give it in the manner I have directed, or you will find it not near so sfficacious; if the Paroxsysm that returns after the Exhibition of Cortex should be violent, it must not be continued unless it should be in a Body that is irritable, then it will remove the Irritability and give strength Leader Cholea Pictonum: this are [trac???] in Demic in Devenshire & other Countries famous fammous for Cider, a retraction of Abdomin Billious Vomittf resembing solution Frq. Dys: & Obstructed Costiveness the Stricture at the return is frequently so great as to [crossed out] prevent a Clyster being thrown up, the pain remits at times & shifts about from the Groin back &c & shoots through the Extremities, the mysenteric Glands Peritoneum are often affected the Urine is often suppress'd Delerium &c comes on convulsions & then Death. this Disease frequently leaves a torpor in the Intestines they have a [??llow] count. & a paralysis of the Extremeties & particularly of 117 Strength to the Patient; if the Bark should purge it is easily checked by Opium, which should be given sperately and in small Doses but if on the other hand it produces Costiveness this must be removed by some Medicine increasing the peristaltic Motion, so as to procure one Evacuation in 24 hours; If by these means we do not procure perfect Intermissions Cortex is sometimes improper; if the Patient is strong we convert it into a Continued; or the Symptoms of the First Stage remain leaving the Patient diseased for some years and frequently prove fatal; if Bile should get into the Blood Vessels it does no other Mischief than by rendering the Intermissions imperfect; but if it is in warm Climates and the Patient naturally weak, and at the same time we have procured the most perfect Intermissions we can we must give Cortex, even in Remittents where there is no intermission; and the same place is to be pursued in temperate, and cold of the supper, as Estium:[rube??n] Tint. [u??u] & reversa - that hand & wrists being often affected. the Thorax is often much affected with asthma & from lead in some places the lead Asthma is a very common Disease - - the Consequences of this Cholic are difficultly remov'd, the torpid bowels require freq. & strong purges to keep them in order. Glaziers, Printers & miners are subject to this Disease - some have suppos'd new Rum, Strong acids & would produce a similar Complaint- Obstructed Perspiran. is often Cause of Cholics. if the Bowels are very Irritiable. there is a particular Sympathy - between the & Bowels so that the first being wet will often affect the last _ Obstructed many 116 cold Climates, under the same Circumstances; it frequently happens that Dropsy takes place and it have been supposed to produce it; we may in some Measure say so; because it is the Removal of the Paroxsysms, that produces it; for during the Paroxsysm the power of Absorption is so strong that there can be no Accumulation; but the longer the Paroxsysms are permitted to recure the more dangerous the Dropsical Symptoms, hence the use of Cortex, in all these Cases. ~ We may frequently prevent Fever recurring by counteracting the Cold Fit, for this purpose, we may use Opium and Tartar Emetic also Spices, and Volatile Alkali with Opium, but we must not employ Volatile Alkali with [crossed out] [crossed out] preparations of Antimony; and during the time we are administering such Medicines, the Patient must be kept in Bed covered warm with Flannel and his Hamorhoids & sometimes produce Cholic, the Gout upon the Bowels the Gouty Cholic: [?orumany] of difft kinds astrong Vomits, Purges, . &c have dispos'd to a return of Cholic. pain & spasm are the most alarmf. Symptoms in Cholic flatulent less dangerous than the spasmodic the more the pain is confind to a part the worse, it sometimes terminates in a jaundice. the danger from Cholic is its terminating in either Inflam: Illiac passion or Parolysis difn shows the Coats of the Intestines to be much thick'd in these Diseases& sometimes such contractions in the Colon that nothing can Pass particularly in dry Belly Ach: Accumulated foods 119 his Head must be bound at the same time; we must exhibit them before the accession of the Paroxsysm (about one hour) and provided the Sweat comes on very freqeuntly the Paroxsysm does not return and gives us an Opportunity of employing Cortex; this is also a very proper Method when Cortex has been very improperly employed. ~ faeces are often form'd Block deep In the Intestines even after a long continued Diarhea, pwrf. Clysters &c: whenever we have reason [?oappre?] Inflamn. from fix'd pain & we should always have recourse to the Lancet& I have observ' that after Bleedf. stools may be most readily procur'd. but Bleedf. is not proper in the Cholica Pictonum for from the beginf. of this Disorder there is a tendency to Palsy. there is one Invariable Indications in al Cholic s & that is to procure stools. Bleedf. is often proper always when pain is Violent & fix'd, the best means I know & which is proper in all Cholics is by the use of the Sal:bath Amas: Rhea 120 Inflammations WE have already treated of Inflammations in a general Way and though they have been considered as an Object of Surgery yet we shall give you the Cause, progress, and Termination; they have been divided into three: phlegmonous Erysipelatous, & Carbuncle, but the last is so rare that I have never seen an instance of it, and whether it be a seperate or a Species of Phlegmonous, we cannot certainly says; Erysipelatous is an Inflammation of the Skin, and Phlegmonous is an Inflammation of the Substance of a part, these are frequently mixed and have been called Phlegm- Erysipelatous but this Distinction is not necessary and it is to be observed that tho there is a mixture of both, yet they do not go on so, but Rhei is too null the Skin f baths improper dessolve'd in pepper mint water& if the stomach uret not chain it add the Tinct: Thebaux:- & give by soonsfull until it Operates we should remember that all bulky purges are proper. the above abates the Vomittf. & soon relieves all the Symptoms-External [fr???s] should always be attended to. warm bathfs, Clysters &c. will allasist the Operation of the purge, the Clysters should only consist of plain warm water without any addition for they do more good by their relaxing 121 but that which is superior takes its own progress, though sometimes at the beginning it goes on as on Erysipelatous and after it has continued sometime; Suppuration shall take place, which is the consequence of Phlegmonous Inflammation; thse two Species are exceedingly different; in the 1st. place either of them may happen in any Habit, but in Cold Climates, where there is a pure Air Phlegmonous more frequently take place, and if Erysipelatous should arise, it is generally mixed; whereas on the other hand; Erysipelatous arises more frequently in warm Climates, and in large Towns, as likewise in all irritable Habits; but is not near so common as Phlegmonous. There are certain Substances, which we call Stimuli; that are apt to produce Phlegm; as Spices and Resinous Substances; whereas Saline Substances, and Animal poisons, such as Cantharid: &e are apt to produce Erysipelatous Inflammation. Topical Inflammations often arise in Fever both externally and than purgin quality dont trust to Clysters [?t?n] without purges by the mouth often stools give an Opiate & thin dillute plentifully the steams of Tobacco from from theri being more penetrating are sometimes of great service a few days of the Tinct Tulaic maybe added to the warm waters with advantage a warm anodine or stimulating plaster with so small a proportion of Emp Epit as mos to Blister only raise a few primy is often serviceable in these Cases. purgatives act best in these Complaints where Torrid with Opiates, for they relax the spasm & promote the Operation first use Evact. then Opiates ~ 122 internnally; and that produced by Inflammatory Fevers is almost always Phlegmonous; but when Erysipelatous Inflammation is produced in consequence of Fever, it is by the violent; these are the Causes producing by any Application tending to destroy the part, as Wounds Fractures &e but these are generally [crossed out] phlegmonous, unless it is from a Wound, where there has been a large quantity of Blood lost, then it is Erysipelatous that arises; they are easy to be distinguished in phlegmonous Inflammation there is an Extravasation of fluids, hence a swelling, which is firm and tense, and to Appearance seems limited, it is attended with Redness, heat, pain, and great pulsation of the Arteries. In Erysipelatous there is some little or no Swelling, and if there should be it is a puffy one, giving way easily to pressure, owing to a quantity of watery fluid being thrown out into the Cellular Membrane; there is a Soreness and the part inflamed is irregular, sometimes it leaves the part it first affected; in phlegmon. & when the disorder is remov'd to prevent a Relapse use tonics as the Bark, Chalybeat, bitters &c if Violent Belchf should attend gently Incourge [illegible] to Empty their Stomach, but rember that Vomitf. counteracts purging. if it remainsafter the stoma is Empty tis then from Irritability & is best relax by Opiates. when Vomittf is first abated by [?ea??] then stools more easily be procur'd but not while Vomittf. continues. - to avoid the patients cough cold [spil?] Flennels with Brandy: or las of Flor:Cham build in Brandy which all holds its heat longer. [crossed out] 123 phlegmonous Inflammation there is generally Inflammation there is generally Inflammation sufficient to proceed to Suppuration, but very seldom to Gangrene; but in Erysipelatous Inflammation, Suppuration does not take place but the Vessels of the Skin propel a larger quantity of Blood through the Scar of Skin then it is able to contain, and in consequence of the Neutral Salts stimulating, Blisters arise, the Inflammation keep increasing the Blisters break, and Gangrene & Mortification take place; sometimes it appears to be gradually decreasing till it entirely leave the Patient and in this Case we generally find a little phlegmonous Inflammation upon some thing suppurating; they likewise produce different Effects upon the System; phlegmonous generally producing General Inflammation, which is known by the hardness of the Pulse, universal heat and tension, whereas the Affection of the System arising from Erisipelatous Inflammation is Irritation, attended with depression of the Strength I have long Experienc'd the good affects of the sal bath in pepper mint water as before recom'd in all Cholics_ Rhei is too insignificant to answer unless the Bowels are open. Steel Waters & bathf. in the Bath wates is the best Remedy for the paralysis which remains after the Col: Pic & other Cholics after the Cholic is remov'd Pills of soap:Rhei a little Aloes or Vitriol Tartar or Gum Guariac is serviceable to keep the Bowels lax & preventf a Relapse~ there is a good paper publish in the Medical Essays upon the Colical Pictonum wherein the recomd first to begin with Opium 125 Strength, small Pulse, loss of Appetite, Oppression about the praecordia &c As these differ in their Sise and progress they likewise differ in their Method of treatment; in phlegmonous Inflammation by Bleeding is a very powerful means of removing it, and if the Patient is strong with Symptoms of General Inflammation, we must employ. V.S. from the System, but on the other hand, if the System is not much affected we may use topical Bleeding. In Erysipelatous Inflammaation neither Bleeding from the System nor the part are of any Use, for altho by this means we diminish the Action of the Arteries yet the Irritability produced has a much worse Effect, than the Evacuation does good; In phlegmonous Inflammation we may give Purges every Day so as to procure several Evacuations but in Erysiphelatous Inflammation Purging not only tends to increase the Irritability but frequently produces Metastasis in the interior parts, we are therefore to avoid purging & to use it liberally even before we attempt purging _ Blisters in Cholics often relieve pain & procures stools as recomd by Dr. Pringle warm bathf. for paraly of Col. _ _ _ In the Colica Pictonum you cannot procure stools without using Opiates at the same time you use purges-this species never terminates in Inflamn. Dr advises to add Oyl to the purges _ after the bowels are open & keep them lax with Crem Tart & sal [Polychast?] Finis 125 purging, but at the same time the Intestines must be kept free from foeculent Matter by Rhaum &c; we may likewaise employ in a phlegmonous, Emollient Fomentatious & Cataplasms which are very powerful Remedies, but must not be used in Erysiphelatous Inflammation for by softening the fibres of the Scarf Skin more Blisters are raised, and the Disease consequently spreads; but we may employ internally Medicines dimimishing the Irritability particularly Cortex in large Doses as ℥i in 24 hours or it has but little Effect, but if we can employ ℥i every hour it is much more powerful; Cortex is likewise very powerful in promoting Suppuration in phlegmonous Inflammation and provided there should be a Mixture of these two Inflammation in phlegmonous Inflammation and [provided there should be] at the beginning the phlegmonous should be prevalent, we must use Evacuation by Bleeding, and if the Erysipelatous does not go off we must use Cortex Lecture upon Gonorhsu Virulen Those Symptoms which are induc'd by on introduction of Venereal Virus are called Venereal, those parts are the most subject to it which are most expos'd to the Infection, but they do not always suffer wither first or most, for it sometimes passes into the Habit without affecting the Genitals at all even tho the disease is receiv'd by these ways many suppose it can never affect the habit unless it first affects the Genitals but experience proves the contrary; it produces either Inflam or Ulcer, when only Inflamn. is produc'd then tis only topical, Absorption cannot take place from an Inflamd. Organ. a Gonorrhea [?caik] with 126 Cortex; but if the Erysopelatous is greater at the beginning, then we must employ Cortex to carry it off, and bring the phlegmonous to Suppuration, though in general it goes off without it, but it is of no Consequence. In the next place Erysipelatous Inflammation has something of a Sparmodic Affection mixed with it, and may sometimes be carried off by Stimulants, the Irregularities going on for want of sufficient force in the whole System, so that by increasing the Action we remove the Irritability as by Spices &c but it is not near so certain a Remedy, and sometimes does Mischief; it is therefore better to employ Cortex; they are likewise improper in phlegmonous Inflammation unless we wish to promote Suppuration; Inflaming the Skin in a different part is a very powerful Remedy in removing phlegmonous Inflammation as by Volatile Linement, Cantharides, &c but if the Inflammation is immediately under the Skin, it is better to employ Cataplasms and Ulceration & Increas'd secretion from Inflam but if chancre & appear they are from [Alsoy??] & Ulceration & they require Mercurials internally as much as any other Symptoms whatever the Symptoms the Symptoms are alway [pro??d] by the application of Infectious matter to the Body tis apply'd in a fluid form it unites readily with the mucus of the Urethra & by Irritating [pro??d] Inflamn. & that the Gonorrhea or dicharge it first appear'd in the Year 1494 at the Seige of Naples, & was but from thence in England by Columbus's Soldiers 1496, it was not known before that time & was much more Virulent a [??ml?e] at that time heat [poce????] the 127 and Fomentations. ~ In Erysipelatous Inflammation Astringent; Sedatives are very good as Alcohol diluted with Water and some Astringents Herbs employed in Decoction with the Addition of a little Alcohol, as Agrimony Hypericum &c but none of these are to be employed in phlegmonous Inflammation except Alcohol and not even that when there is much tension; but in all Inflammations arising from external Accidents and in all those which are incipient & and affecting lax parts as the Tonsils &c it may be employed; Acids are very powerful Sedatives and may be used in phlegmonous Inflammations but where teh Skin is affected, they cannot as in Erysipelatous Inflammation they would act as a Stimulus; Farinaccous Substances have been employed dry in Erysipelatous Inflammation but it is Subject to form hard masses & thereby do Mischief.~ the Symptoms of a true pox was the first that appear'd, but tis much milder now & seems to be growing spearly less severe so that in time [p???] it may disappear altogether. we are now [pop?p] of acertain Specefic Remedy for this disease which they were not formerly, the Venereal Virus is not communicable by simple contact, unless it be contact with an Infected Organ. for if it was lying in the same bed with or the breath of an Infected person would be sufficient to propagate the disease for the Veneral Virus cannot be converted into a subtle steam, but must be applied in its own 128 Inflammation of the Brain This has been called phrenetis and some Practitioners have given this Name to every Species of Delirium, but the Brain is by no means always inflamed in Delirium, for the Violence of pain in any part of the Body will frequently produce Delirium, which goes off when the pain is removed, this has been proved by Dissection; and as Delirium frequently happened in Fevers, which they called phrenitis hence it took the Name of Idiopathic and Symptomatic; but it is the Idiopathic of which we shall treat; - as the Brain is everywhere covered and defended from external Injuries this of Course becomes a very rare Disease, and it is to be observed that when any parts thus defended from external Stimuli are by any means hurt as by a Wound, or Fracture, and in consequence of which Inflammation is produced in the interior parts it own form another aircum stance without cndf. is that the mother cannot communicate the the Disease to the fotus in Utero, those who are born with this Disease receive is pasit. through the passage in the delivery. the Venereal Virus produces its effects in these parts where there is most musuc secreted as in the Nipples, Throat, Vagina &c mucus being the substances it can the most easy Assimilate - we should first [?m?d?] under its local form or Gonorrhea which it its most usual form, how it is introduced into the Urethra? through the Orifice of the urethra itself & not through the small Absorbing Vessels of the Glands, as they would as readily carry 129 it differs from any other Inflammation in its Symptoms; as in the Brain, Thorax &c; this Inflammation is frequently produced by an increased Action of the Vessels arising from drinking large quantities of Wine and other Spiritous Liquors, by sudden and violent Exertions of the Passions of the Mind Anger in particular; Indigested Food, particular Muscles when eat raw; Lobsters, & other Shellfish; it has been supposed that they were poisonous but they are not for their Effect is entirely owing to their being difficult of Digestion; Exposure of the Head to any violent heat, as a Man falling asleep in th heat of the Sun with his Head bare; it is also produced like other Inflammations from Fever - We have already treated of Delirium which sometimes is the Cause of this Disease. ~ When the Brain is affected it differs with respect to the tensions that is produced, from any other part of the Body; when the Meninges are affected a part which is very tense, there carry it into the habit as deposit it upon the Urethra. the Urethra may be considered as a Capillary tube free of air & that it receives the the Virus by capillary attraction the seat of this disorder is a few Inches from the termina of the Urethra at the Glans, & in the Lacuna it forms a lodgment there for some days till it Assimilates the Mucus to its own Nature & then it Stiml. occasions a greater flow of Blood into the Organ & in creasing the secretion of the Lacun & there is a Gonconhea or [??nf] produc'd of difft. Colour, according to the degree of Inflam. any other Cause that will Inflame the Urethra will produce a thin & 130 there is an acute pain; but if the Substance of the Brain only is affected, then these is an obtuse pain, situated more internal, the Patient describing it as though his Head was bursting; the Eyes which are commonly a Criterion have their Vessels full & distended, in consequences of their Communication with the Vessels serving the Brain; there is an increased Secretion from the Nose; there has been instances of of Inflammation of the Brain going on to Suppuration without much Affection of the system but this is very seldom the Case even in the Substance and when the Meninges are affected the Gen. Inflammatn. is too great to produce any other Effects but what are fatal. Delirium takes place beginning with Stupor, which continues for 2 or 3 Days, when on a Sudden he jumps up, falls into Convulsions and dies; at another time it comes on with Restlessness, Dreams, Loss of Memory, a great Insensibility to external Objects, the functions of the Body disturbed and & colourd dischange the same as the Venereal Virus the parts are often left so irritable after a bout by the least excess a thin colour'd discharge may be again brot. on by bringf. on Inflam. but this discharge is not in the least Infectious people under these circumstances are apt to think they [crossed out] were not thoroughly cur'd & to blame those who attended them when their own imprudence is the only cause, stimulus apply'd to the Nose will produce a discharge both thin & Various Colours, as those flowf. from the Urethra in Gonorrhei - the Infectious matter generally lodg'd from 3 to 10 Days before it makes its appearance the sooner a 131 and Discourse incoherent, he is constantly picking hairs, or catching at Flies, which he imagines are in the Air; these generally prove fatal. seldom proceeding to Suppuration, which if it should so happen the Pus cannot escape unless it is by destroying a Bone, when it has done so much Mischief, that the Patient dies. ~ In this Inflammation, there is no Natural Cure, and if any should take place it may be looked up as accidental; we are therefore if possible to produce Resolution by the most powerful Means we can employ or the Patient will be destroyed; and if he should be a robust young Man we must bleed very copiously from the System, bu taking away ℥xij, ℥xx or ℥xxx if he should not faint before that quantity is evacuated; we are also to Bleed, whether there is any General Inflammation or not. Topical Bleeding is likewise a powerful Remedy particularly if we can get to the Jugular Vein, it is a Gonorhea appears after infection the more violent is the disease & the reverse~tis first perceiv'd by an unusual Irritation about the then a clear colour'd pellucid fluid is dischargd which is Glutinous & there is a little Ardor thin & in a day or two more, the discharge is more copious if thin & colour'd from the increas'd Inflamn. & sometimes from the same cause even Blood is discharg'd with the [R???] there is a considerable degree of the ardor Urine & in a particular part which is the Original seat of the Disease but afterwards when the Disease is increas'd tis felt through the whole 132 is preferable to Bleeding from the Arm, we may likewise apply Leeaches to that part, which seems to be the Seat of the pain. Purging is particularly useful in all Affections of the Head, for which purpose we must employ Antiphlegistic purges tending to increase the Secretion, and to produce 10 or 12 Evacuation in 24 hours, and they must be repeated in such manner, as they may keep constantly acting; they are very useful even more so than V.S. when Inflamation arises in consequence of a Fissure, or Contusion of the Brain; after these Evacuations Blisters may be applied to the Head. and these are all the Remedies, which we can employ; we cannot employ Relaxant (which are useful in other Inflammation) with any good Effect; nor Sedatives of any kind. It would be better not to give any Food, during the whole progress of the Disease except Barley Water; for as Food of difficult Digestion will produce it; it will of course passage. ~ the Glans Penis are increas'd in size from more Blood than usualy flowing into them. & from the great distension in this Irritable part is produc'd the sensation is term Cordee, all the Symptoms may be explain'd upon the principle of Inflamn. & should be treated accordingly . if the Disorder is not interrupted by any medecine it often goes off of itself, or the patient has a natural Cure the Consequences of this Irritation & Inflamn. is a greater secretion of mucus which washes out the Infection _ we see that an [Irit???] Body in the Bladder occasions an increase of mucus, & the same obtains in all other the mucus 133 Course increase it. ~ If we employ these Remedies very early, we have some Chance of succeeding but if it is far advanced they will all probably fail. ~ musus Glands in every part of the Body upon being stimulated~if at this time whatever has a tendency to increase the Inflamn. is carefully avoided, the Infectious matter will by wash'd out & the patient cur'd _the discharge changes its Colour & consistance, & when there only remains a disposition the discharge from relaxation the disorder is calld a Gleet & is Independent of Infection ~ when the matter is thick & not colour'd than we may be assur'd that the Inflam:&Infection is gone, a Gonorhea is to be consider'd as an Inflam: of the Urethra, independent of Absorbtion or any other Symptoms the Venereal Virus seldom produces any effect upon the throat & other parts of teh Body without first producing a [???ncu] the Gonorhea are distinguish'd . ~ ~ ~ 134 Inflammation of the Eyes This is an Inflammation of an exterior part, which consists of a Number of Membranes containing certain Humors which can scarce been inflamed, and it is convered with a Mucous Membrane frequently affected by Catarrh, the Venereal Disease, Small Pox, Meazles and Serophulous Affection of every kind; it is a very irritable part and therefore liable to be affected by all Causes of Inflammation as every Application not acting upon other parts will here act as a stimulus; notwithstanding it is of necessity exposed, yet it is tolerably defended, nor is there any other Predisposition in it to Inflammation except Irritability. Inflammation may arise from any Mechanical Injury as a Cut, Blow &c but Inflammation arising from such Causes generally affects the Eyelids, more than the Lecture on Gonorrhea Vir: Gonorrheas are divided into External & Internal External when only the External parts are affected I knew a Gentlemen who never had any but External Gonorheas & upon inspecting him narrowly, as the parts were expos'd to View nothing more than an Inflamn. was to be seen & there was not the least appearance of Ulcers, & the many dissections that have lately been made of those persons who died while labouring under a Gonorhea proves that the Urethra is only Inflam'd & that there is not the least appearance of Ulceration Gonorrheas are again divided into benign & malign the last cannot be asoertaind from either the Colour 135 the Eye, any Solid Substance getting between the Eye and its covering, will produce Inflamation even of the softest kind; or if there is any sudden Application of a greater quantity of Light; this generally takes place at the beginning of Fever. The Membranes of the Eye are attached to each other by a very small quantity of Cellular Membrane as Scarce to admit of any Extravasation, and the Reason why it does not terminate in Suppuration is on account of this slight Connection; hence it varies considerably in its duration, sometimes going off in a few hours, and at other continuing for some Months; at first there is only a little Itching, and Redness in consequence of the small Vessels being a little distended with Red Blood, but as this distension increases the pain becomes exquisite, on account of the Membranes being very tense; the Retina becomes much more irritable than it is in its natural State and the least degree of Light gives pain the Colour or Consistance of the discharges for a will produce a Colour'd & thin discharge from the Urethra of the most healthy person by Exciting Inflamn: or [crossed out] ~ the Circumstance we must [Tyead se mosth] from the patients having been in the [illegible] of Infection & from the manner of its conf. on. if the Discharge is Rapy & of a white Colour we may resonably conclude that there is not Inflam: or Infecn: the Fluor Alb.- & Gonorhea are often diffif. distinguish'd in women, except that in the Fluor Alb. there is less Ardor Urine, the discharge abates under menstruation & other Evacs. In the Gonorrhea of women the discharge is more Copius & there is not 136 the Eyelids, which are Cellular become distended; sometimes it is only the bottom of the Eye that is affected, when there is exquisite pain attended with less of Sight; sometimes the Chrystalline Humour is inflamed but is not attended with so much pain, and there comes on a gradual Opacity, and in consequence of some slight Extravasation there is a small Tumour formed. The Inflammation of the Eye seldom affects the System, but when it does it is the General Inflammation, which seldom arises to such a degree as to prove dangerous; when the Inflammation is considerable, it occasions increased Secretion from the Lachrymal Glands which in a short time becomes yellow; this instead of being a Natural Cure only acts as a Stimulus and does much more Mischief than it does good; and in Consequence of this Stimulus there are more fluids secreted, than what can pass into Lacyrmal Sac, hence they run down the Face and Stimulate the Cheeks; it sometimes happens that not so much pain as in men & the disorder is more easily carried off. - Cure of Gonorhea or local compt. the Gonorhea is perfectly topical tis believed by many of the most ingenious to be a distinct disease from the Universal & that it can never be made to produce a pox by any bad treatment, there is certainly much reason in this Opinion & I think it cannot be readily confuted. tis certain that one under a Gonorrhea is no so easily pox'd as is generally imagin'd. a very small Chancre is a much worse [tes???] than a Violent Gonorrhea - a Gonorhea commonly produces a Gonorrhea, & a small Chancre is much more dangerous , no means that can be us'd to diminish a Gonorrhea can produce a pox 137 that the Coat, which covers the Conea becomes Opaque and thickens and when the Inflammation is removed, the Sight is lost. - This is the progress of this Disease and all the Remedies which we employ in other Inflammations are applicable in this. We may therefore employ Bleeding from the System, if there is any General Inflammation with hardness of the Pulse &c but as this seldom happens, topical [Inflammations] Evacuation becomes more necessary, as by the application of Leeches, and if the Inflammation has gone for a considerable time, having at the same time baffled other Evacuations, than we may open the Jugular Vein; sometimes opening the Vessels situated in the white of the Eye has been of Service but very seldom; sometimes there is a Running attended with a Tumour in the inner Angle of the Eye, which is opened, will be powerful Remedy, but unless it be considerably distended we cannot open it. Purging is a very useful Evacuation in swelld testicle, pain Inflamn. &c about the prostate & Neck of the bladder & other load inconveniencys may be occasion'd by the hasty use of astringents but they may be reliev'd by the antiphlogistic treatment if these matters were as of distinct they would appear together but the matter of Gonorrhea produces only a Gonorrhea & never a Chancre, & it appears to be a much milder Species of Infection it was 50 Years after the pox appear'd in Europe before a Gonarrhea was notic'd, now had they have the same diease they must most certainly have appear'd together in all that long period, method of treating the Gonorrhea is there any effectual means to check 138 in all Opthalmia, when the Inflammation is recent and proceeding with Violence; that must be administered in such Manner as to procure 8 or 10 Evacuations every other Day. When the Disease is not so violent and has gone on for sometime, and there is no General Inflammation, then Purging once or twice a Week, but not severely, is necessary; We may procure Relief from increased Secretion of the Glands of the Nose, and if we employ Errhines we produce two Effects, by increasing the Secretion and raising an Inflammation in a Neighboring part. In the next place we may apply Emollients externally as Fomentations & Cataplasms which are of great Use in Inflammation that have arisen, and in such as have arisen from external Injuries; we often prefer Sedatives, which have a degree of Astringency but if there is much tension, they must not be used; it is therefore better to employ a Decoction of Poppies, which acts as a Sedative & Emollient and check its progress, to obviate Infection &er the Cure consists in washf. out the Infected Matter, if we would wash it out by Introducing gentle Stimulants which would increase the discharge before that assimulated the humours within we might prevent it ~ Upon this principal has the Caustic Alkali Can recomd. highly dilud. for by its readily Uniting with the mucus of the Urethra & formf. a kind of soap. it promotes the discharge & thus expels the Virus before it has time to taint. _ If immediately after having communication with an Infected person we were to introduce a much diluted & weak [soh?t??] 139 and on this Account is preferable to pure Water, Relaxants employed internally are of very little use and it is the same with Sedatives; but Sedatives applied externally are very powerful, as Alum, Alcohol & Acids, and likewise Astringent Vegetables Substances, in Cataplasms, as Oatmeal, Conserv: Rosaesum &c but they cannot often be employed in Consequence of their adhering to the Eyelids and proving a Stimulus; there are some Metallic Salts and for this purpose as Vit. Alb: Zinc: & Tully &su it is to be observed, that when we use Acids, they must be greatly diluted. Alum is best adapted for this purpose by beating it with the white of an Eff, which must be inclosed ina linen Bag to prevent its adhering, and if we use any of the Metallic Salts, it should be in Collyrium as [?s] in [t??in] Exciting Inflammation is the neighbouring parts is of great use as by applying Blisters behind of the Corros: Sub: we might provent infectd. how are we to treat a Gonorha, we are to dimi. the Inflamn: by reducing the habit &c we are to apply our Remedies to the diseasd part & correct the Virus there, the difft: Opinions upon the Cert method of doing this [crossed out] convinces never have not yet aris'd at the greatest perfection in this particulr. - my plan is if the Sympts. of Inflam: [illegible] high, if the Organ is much enlarg'd, great tendency to Erection, to Homerhage & of from Urethra, to Fever &c I then Bleed & order 2 saline purges as in any other fever but we know how difft the Inflamn. of 140 behind the Ears, Setons, or [?sues]; if the Inflammation is recent Blisters are preferable but when it has run on for a considerable length of time, than we must prefer Setons or if we employ Blisters they must be prepetual ones if there should be any little Exulcerations in in the Eyelids keeping up the Inflammation than we must employ Mercury and Cortex particularly the first. I have seen instances where the Opacity of the Cornea was removed by blowing Glass into the eye, once or twice in 24 hours; but provided we wish to make use of it we must take great care that it be perfectly lavigated, and the Inflammation entirely removed. ~ of a particular Organ is releiv'd by general Beedf. the method I therefore recomd. is to [illegible] & local Applications Bleedf. &c immoderate Exercise &c should be avoided as it would [in??] Inflamn. & produce swell'd testicle &c the Urine should be freely diluated by large quantities of mucilaginous diluting drinking Nitri & Campho which are much recomd. by many I do not approve Barley water with Gum: Arab: is the best Remedy the Body should be rather kept soluble, than [dr?s??] purges us'd, Elect Lenet: with Crem Tart, & Sal: Polych: &c are best, avoidf. Irritations upon the Intestines, for we ever find that during the Operation of all the saline purges the [Ari?] Urine is increas'd at least for that Day. Under the 141 Angina Any difficulty of Breathing arising from an Affection of the Throat, was called Angina. but as such Circumstances may arise from any Tumour affecting the Throat whether it affects the Substances, or only the Skin and Mucous Membranes but this we shall not call Angina; and that of which we are going to treat is the phlegmonous; though there is a difference in Inflammations of the [crossed out] Throat; yet there is one Circumstance which renders them similar that is the Effect they produce, whether there is any praedisposition in the Habit, I do not know, but as it is frequently Epidermal, I am induced to think, there is. The common Causes of this Disease are the same as those producing other Inflammations; particularly Fever: ~ The Symptoms are the same as those in other the above Regimen I use Injections, the [arg??] that are brot. angainst Injections are not [satiff?f] they consider all Gonorha as drawf. Chancros in Urethra &c & that all Injections have a tendency to stop their discharges & occasion [Abs??.] but I think that Injections by contractf the small Vessells aboid rather tend to provent Absorptions abate Inflam: I know few purges [??hs] do not use Injections in the cure of this Disorder even the most Eminent & Rational Class cures all have recm. to them: ~ ~ are we to use & what are the disadvantages of Injections no one Injection is universally proper in the Case of all, & their being us'd in this [illegible] 142 other Inflammations; except those arising from the Distension affecting the Organs of Respiration, Phasynx & Asophages, and in consequence of the Jugular Vein & Lymphatics being compressed, the Blood meets with great difficulty in returning from the Head, hence Adematous [Fevers] Tumours are produced. It generally produces some Affection of the System, but seldom to such a degree as to destroy the Patient in the first Stage of the Disease; it becomes very necessary to consider the Effects of this Inflammation from the functions being so much disturbed, for if the Larynx be so inflamed that the Resera Glottidis Casmt. open and shut Respiration must be very difficult; and whenever Respiration is by any means interrupted, the Blood cannot pass easily through the Lungs, hence there is an Accumulation about the Right Side of the Heart, succeeded by great Oppression and Anxiety; the Head & Neck become swelled in manner has been the disgrace of Injections as difft. constitutions require difft. purges so difft: Gonorrhaas require difft. Injection no Symptoms not even Inflam: should [diso??] the Use of Injections. if it dies tis not with its Original Virus, in an Inviable Urethra upon Excess which Excites new Inflamn. & then the Injection & Surgeon has been llam'd, but this is observ'd for if it even went off of itself it might recur again under the above circumstances. ~ What kinds of Injections are we to use. metallic Saltsin Water, metals mercury, Copper, lead, &c link have all been us'd with advantage_ & Sal with regard to Copper Inje 143 in consequence of this Accumulation, attended with a lividness about the Eyes & Face, the Brain becomes compressed and Stupor is produced in consequence of this difficulty of Breathing there is great Depression of Strength, and the Heart acts more frequently, hence there is a frequent and irregular Pulse; the Depression constantly increasing till the Patient is destroyed. if the puseles serving for Deglutition are affected, or pressed upon by the adjacent parts in attempting to swallow there is pain with a Sense of Sivelling, the pain is produced by an Attempt to distend the Pharynx which is resisted by the Tumour; and if by any means we endeavor to brain an inflamed Muscle into Action pain must be the Consequence; Food and Drink pass with difficulty into the Stomach. and by lying upon the Pharynx produces Contraction and the Drink is thrown through the Nostrils, which cannot pass through the Mouth, on account of the form is a solution of the Orugo Oms in the Volatile Alkali there is a Tinct: in the [ne?v] Dispensatory, made with 3ij of [?riys] Orism 3i of the Volatile Alkali: as spt: Salt: Ammon. [illegible] Vol: F of Copper which is a clear transparent fluid when pour'd off from the foculent sediment 3 or 4 days of this Solution diluted with 3fs or 3ij of water so as to produce no pain upon using, us'd 2 or 3 times a day is a Speedy & safe method of curing _ it will cure 5 out of 7 in the space of a [crossed out] week as prov'd by the practice of most experienc'd - it was first us'd by a surgeon of the army who was remarked by all for his speedy & safe Cure of Gonorhaa _ the best Observations 144 the Velum Pendulatum being shut, and from its getting into the Larynx violent Fits of Coughing are produced, at last the passage is quite obstructed and he dies; the time in which Deglutition is affected is not very long, for when Suppuration has taken place the Swelling is considerably less and if our Patient is otherwise in tolerable Health, it very seldom destroys; but when the Body is diseased, the Depression produced is always increased and every other Symptom. It is to be observed that Swellings about the Head & Throast arise in consequence of some other Affection of the System, which if they shold, and Inflammation take place afterwards it generally proceeds from Serophula. If the Patient is not destroyed by any of these Affections it generally terminates in Suppuration in consequence of there being a large quantity of Cellular Membrane in the Throat; it many terminate in Gangrene, but I never Saw one instance of it; there Observation of the most able & Experienc'd [pract??] prove this method of proceeding to be effectual & Void of hazard or danger. for all metallic Salts thus diluted are sedative, the Nit: Carub: highly diluted [crossed out] is sedative, but when not diluted is corrosive & exchariotic - the mucilaginous & diluting & cooling plan should be us'd at the same time as the above, this will answer in many Cases & Constitutions but it sometimes fails. I known no better than a weak solution. of the corrosive sub: as gr in Water 3ii, the water should be distill'd & for the sake of the flavour its Rosewater is best. I know one Experience'd Surgeon who uses nothing else thrown into the Urethra _ it takes of the Inflam. & Calomel is much us'd but at more stimf. as it cannot be dissolv'd [Corros??] 145 there is seldom any natural Cure except it is accidental; but the Suppuration, which it commonly terminates in, is of no Consequence for the Pus is generally discharged by some Orifice about the Tonsils; though I have seen one instance of the Matter forming between the Asophagus, and Trachea, and insinuating itself itself down to the Sternum, which forming a Sinus upon the upper part of the Pleura, got to the Lungs and proved fatal. ~ There is nothing particular in the Cure of this Disease; we must endeavor to carry it off by Resolution and prevent Suppuration, not as the Suppuration is of any great Consequence but the Tumor, we must employ Bleeding from the System, if there are Symptoms of General Inflammation by taking away 3xx at once and repeating it if necessary but econtrario if there is no General Inflammation than Bleeding from the System is of no use. We may employ Purgatives in Cases where Evacuations by sublimate many in water a little mucilage of Gum Arab: may be added to the solution it should be retain'd their sometime in other Cases I have known the Ag: Saturnic of Golanda answer but the effects of this are not so permanent as the others, should be us'd in the proportion of 3ij of the Extract to a pint of water _ we should be carefull not to use any Vegitable mucilage with it at the same time as lead has a power of coagulating such substances as Gum: &c an other Injection us'd by others with great advantage but as Calomel cannot be dissolv'd in water tis too much concentratd & of course too stimulating is Calomel [crossed out] suspended by Bleeding is not necessary; but if the Vessels of the Head appear to be full, we open those lying under the Tongue which do not evacuate any great quantity and if not sufficient, we may open the Jugular Vein; we may produce topical Evacuation by increasing the Secretion from the Salivary Gland by which we might expect to procure Relief; but it is never a natural Cure, nor is it of much Service to increase it by Stimuli; we may also inflame the Skin near the part with great Advantage in slight Cases by Volatile Alkali, and in more violent ones by Cantharides, we may also employ both, when the Inflammation is deep seated we must use the former, and when it is more externally Cataplasms and fomentations. Sedatives may be used, as they will not hurt the parts about the Throat in consequence of their being lax, particularly when the Tonsil and interior parts are affected. Relaxants are useful, and after having diminished the General suspended by a mucilage this is a powerful sedative & nothf promotes the healing of Venereal Chancres more than the application of Calomel it both conects the Virus before it can be Absorbed & is sedative~ the vitriol All: highly diluted is sedative, - an Objection is that if they are left off too soon the discharge will soon return. - but from what I have observ'd I like the solution of Copper & Corrosive sub: much better. ~ ~ there is another a very unchampioned mixture which I had from an Experienc'd Surgeon who has us'd it with great advantage as [?s??S?ls] it consists of Pal: eberves Sanck Sat: Vil: All & Cal _ _ others use the blue [precc???] 147 General Inflammation if there was any by V.S. we must exhibit them in small Doses so as to act constantly. The Food should be farinaceous Substances dissolved in Water. and if the Tumor and Inflammation are very great, so as to threaten Suffocation; we must make an Opening into the Trochea below the inflamed part, which Operation is called the Bronchotomy, and if the Patient cannot Swallow he must be sustained by Enemas compounded of Mucilagenous Substances and Δ and it is to be observed that not above ℥vi of any fluid must be thrown up at once, for if there is more the Distension will stimulate; and whever we cannot avoid its terminating in Suppuration the Abscess must be oened of soon as there is any fluctuation. ~ prescripted powder of mercury as gr. 5 to 3 ij of water which is full strong enough ~ the Inconstancy of Injections is either from their being too acrid or improperly us'd _ but the Hernia [H??n:] is more commonly from a bad Regimen, Exercise &c than Injections when a Cure is affected by Injections they never leave a Gleet as the Natural Cure often does ~ a weak soution of Corr: Sub: when accomd. with the Irritation is very serviceable the Natural Cure is seldom perform'd in less than 6 Weeks or 2 months ~ the Injections should be always so diluted as not to stimulate the Glans ~ when the Inflam: is gone than 148 Peripheumony or Inflammation of the Lung. In this Country the constant Variations in the temperature of the Atmosphere arising from our Situation near a very large Continent and between us an immense Ocean render Diseases of the Thoracic Viscera more common, and much more fatal. they generally arise from sudden Exposure to Cold which contracting the External Vessels throw the Blood upon the Lungs hence they are much more commonly affected than any other part; it is the Inflammation of the Substance of the Lungs, we eve are now treating off and is called Peripneumony, it may be brought on by General Inflammation, or from Distension in consequences of a sudden and great Inspiration & Inflammation of the Mucous Membrane arising from Catarrh may some times then the Gleet is from relaxation & is cur'd best by Exciting Inflam: Olilanum Balsam Capini Blister to Sacnum. strong solutions of Galls in Brandy diluted is good _ inhodicef Bereger will often cure by exciting Inflam: local cold water better than Cold Bath. _ Brandy & water Injected has done much goodas has red Wine & water by exciting some degree of Inflam: they are better than the cold bath. Vin: Rub: injections are good _ Bark & other general methods alone. - you may ask perhaps would you use mercurials in a Gonorrhea, or trust to Injections alonef. - I answer I never trust to Injections alone but it will 149 times be communicated to the Substance but cold is the most common Cause whether applied partially to any part not accustomed to Exposure, or whether applied to the whole System. The pradisposing Causes are in the 1st place those of a Sanguineous habit living in a Cold Climate and pure Air have a disposition to Inflammation they are peculiarly liable to Peripheumony, who have narrow Chests for in consequence of any sudden & great Perspiration there must be a Contraction and of course the Distension be resisted. People whose Sternum is flat, or whose Shoulders come too near together, or where is approaches more to a Spherical figure, there it naturally is; when any part has been affected with Inflammation, it is more subject to be inflamed a second time; particularly the Lungs, for where there has been any Inflammation of the Lungs there is generally Adhesion remaining as in those who have had frequent Cat[h]arrhs; it very often happens that will do without any assistance from mercury internally us'd ~ ~ the Internal form of mercury should be Varied accordf. to circumstances, but of this we shall learn more to morrow, a Gonorhea is only a local Venereal complaint_ for when I see it in any other as the Inquinal Glands in Chancres I think it a general Complaint& not to be cur'd. without the use of Mercury. 150 that the Lungs achere to the Pleura, but these Adhesions sometimes remain this Life without producing any bad Effect, inconsequence of the Adhesion being in that part which the Lungs touch the Pleura, when in the act of Inspitation; but it frequently happens, that these Adhesions are formed in different parts and in this Case they will retard Inspiration and the natural Distension produce Inflammation; there is another pradisposing Cause for if there should be any cutaneous [Substance] Eruption or Exulcertaion should have taken place, whether natural or artificial as Seton, Gsue &c and should have continued for a year or two, if we employ Remedies to cure them Inflammation of the Thoracic Viscera takes place; it has been said by some Practitioners that there was a humour which being accustomed to pass outwards was carried inwards and attacked the interior parts; this we have been acquainted with since the Discovery of the Circulation, and is a very absurd Idea; but it is owing to some peculiar Law in the System, which we are not perfectly acquainted with.~ Inflam Lecture upon Lues Venereal We shall now speak of that Species of Venereal Disease which is produced by Absorbtion _ Absorbtion is seldom but from an Ulcerated part. if the Virus be apply'd to a denuded part it produces the disorder & a Chancre is always produc'd by the lues Venera _ we shall now [crossed out] trace the Infection in its path into the habit & mention the the Symptoms it produces we may trace it in its way through the Lymphatics as in the Groins where it produces pain Inflamn. & suppuration. the Irritability of 151 Inflammation of the Thoracic Viscera are generally complicated, hence some Practitioners have considered them all as the same Disease while other have divided them into a Number, Catarrh is frequently joined with Peripneumony and vice versa so that Inflammation of the Substance is often accompained with Inflammatn. of the Mucous Membrane (I mean the external Membrane) and as it is to be distinguished from other Inflammations of the Thorax it becomes necessary to describe each seperatly; Phlegmonous Inflammation generally occupies a small part of the Body, hencce it is that most commonly one part of either the right or left Lobe is affected, though the whole Substance may afterwards be equally affected; this Circumstance has been proved to us by Dissection. We have already told you that the Lungs have two Sets of Vessels, one through which the whole Blood passes to be acted upon the Ait; it is in this Set, that Inflammation is all probability never takes place; and this perhaps owing to these no Anastomosing Branches, which is Lymphl. is such that when the Virus is [crossed out] apply'd to its extremity it produces swelling [ten?i??] as is prov'd by the Experiments of the most celebrated Anatomists _ but this appears to me merely Theory. all swellings should be considered as from an Introduction of the Virus & should to treated accordf. another plentifull sourse is an Excoration after Erisipelalous Eruptions this is most likely to introduce the Visceral Absorbtion ~ we can most commonly trace the Lues Venereal from Chancre in the beginf. Cutaneous liable to Error in Judging of the Lues Venerea from its Symptoms ~ for the [Ab???] 152 is necessary for Inflammation; another strong indication of these Vessels not being affected with Inflammation is that there is no tension and consequently little pain; It is therefore very evident that it is the Bronchials that are affected which are they are a base part are seldom attended with much pain; hence the Patient complains of a pain on one Side, which is very obtuse seldom affecting both Sides; Respiration is difficult attended with a Cough, in consequence of the Capacity of the Lungs being diminished there is great Sense of heat in the Air coming from the Lungs; the Inflammation preventing the flow of Blood through the Lungs there arises a fullness in the Thorax, Oppression about the Pracordia, and the whole System is affected, but neither with Symptoms of General Inflammation, or of Irritation; sometimes General Inflammation is produced but this has been disputed by Authors, some having given us a Criterion that the Pulse was soft in Peripheumony; but then in Opposition to this, they have given us a Symptom of a hard of any acrid matter, of Inflam: of the Urethra will produce bubos &c so will many other causes independent of Absorbtion. any Irritan. of the Lymphatic system will produce a Bubo Inflam: & even suppurn. ~ in these dubious cases the general Character of the patient must be had recaurse to a watch forcibly press'd in has occasion'd a bubo. a bubo may be local & may arise from Sympathy & often without the Venereal Virus. but mercury is the sofest way of treating when we are in doubt. _ the Hernia Humoralis is Independent of Absorbtion & arises only from the Inflam chanf 153 hard Pulse by saying the Blood was vizy; there is Restlessness, loss of Appetite, Pulse sometime hard, but seldom full & strong; when the Difficulty of Breathing is very great a sufficient quantity of Blood does not pass thro the Lungs, and the Pulse becomes obstructed, and irregular, the Appearance of the Mucus upon the Tongue is very singular, being sometimes of a very bright yellow, the middle, and two edges clear, so that we have frequently two stripes of yellow, but why it should have this Appearance, we do not know; Urine frequently turbid; there is a Secretion of Mucus from the Lungs, which is thick and viscid; getting into the Branches of the Trachaea and produces that kind of Noise called a rattling in an horizontal posture he is apparently suffocated from the Abdominal Viscera pressing upon the Diaphragm, hence it is to be observed, that he should have his Head elevated; the Circulation being obstructed the Jugular Vein begin to Swell and it frequently happens that the Lymph is obstructed changing its place as from the Urethra Vas deferens &c & what is a proof of that is that in proportion as the pain swelling of the Testicle is greater, the Inf: fthar [illegible] & consequent Gonorhaa abates _ & as the Tip of the Urethra &c returns the swelling of the Testicle is less _ _ any other Inflam. as from a blow &c may produce the same Disorder of the Testicle _ the External parts very liable to Inflamn. tension &c [??themay] is swell'd & Inflam'd with a stricture behind the Glans so that the pressure cannot be drawn forwards then the Disorder is term'd Paraphymoses on the contrary if the 154 obstructed in its passage to the left Subclavian; in consequence of which Absorption is prevented and there is Adematous Swellings in the lower Extremities; the Pulse now becomes very irregular; there is an Accumulation of Blood in the Head; the Face swells, and the Countenance is livid, there arises Stupor succeeded by Delirium and the Patient may be killed in the first progress by the Depression of Strength. We have now shewn you its progress in the first Stage when it destroys, but it frequently does not, as terminating in Suppuration, which is Prepneumony, as in other phlegmonous Inflamations generally happens about the 4th Day but it may be retarded till even the 14th Day on account of the Natural Cure, which if it shold not carry it off always retards Suppuration. In treating of Suppuration we told you that one Appearance was Coldness attended with Shivering, and that every time [such Matter] fresh quantities of Matter were produced there Symptoms generally took place; and that the pressure is confind over the Glans with stricture so that they cannot be uncover'd with Chancres & underneath then the Disorder is calld a phimosis _ tis to be heated day Inflamf. & Venereal ~ but when the Disorder has got further into the habits is is hard to be disease'd _ for it produces no effect till it is secreted & deposited upon some particular part. in difft. habits tis parts are most liable to suffer as they oft are the lesat resistance if the patient is subject to weaks Inflam'd Eyes, then the Eyes will be soonest affected, there seems if [Im??] a 155 that the Swelling became greater till the Inflammation went off. This Disease seldom terminiates in Gangrene, notwithstanding it some times may, when the Patient is apparently relieved, Breath becomes datid, and he spits up a black Ichor, the pulse becomes weak, and every other Symptom of Irritation arises, and he is soon destroyed. Inflammation of the Thoracic Vescera have a natural cure called Expectoration. The Lungs having a Number of Glands secreting a Fluid called Mucus, and when there is any Inflammation, it stimulates these Glands to Secretion, and the Matter there collected is consequently evacuated; but as this Natural Cure carries off Disease, much more marked in their Appearances, and much more dangerous in their Consequences, this Expectoration has been more taken Notice off; supposing that that this Matter was the Cause of the Disase and it is difficult for the Air to lay hold of it at first, there arises an incessant Cough in 456 so term it a particular attraction between the Mucous of the Body & the Venereal Virus for those parts which abound with it are mostly affected with the Venereal Virus, and the Throat, Skin, Nipples, Nose, Lips. Eyes, & often the Cavity of the Bones, the Periosteum &c: it often lays hid a long time before it is secreted & produces its effects for some months & even sometimes Years. - as it cannot stimulate the Blood Vessells hence nature is not rous'd to throw it off, & cure as in the small pox & but a sure before observ'd when it is confind to the Urethra than by its shins it rouses the power of Nature that 156 in consequence of the Mucus adhering to the Trochea; hence arose that ridiculous Idea of the Matter not being fit for Evacuation; if the Inflammation is considerable, the Mucus becomes thinner, and is immediately thrown up without stimulating, and the Patient is much relieved; sometimes there is a quantity of Blood evacuated with the Mucus; this may arise in three different ways, 1st. there may be such a force of Circulation as to throw out Blood through the Exhalants, in which there is no danger; in the 2nd place a large Vessel may rupture the Lungs by a violent fit of Coughing and frequently proves fatal; lastly a small Vessel may rupture and the Blood ooze out; neither of thse last it is to be observed, that there is a Wound which may suppurate; but sometimes happens, that the Exhalants have lost their power of Contraction in Consequence of which there are repeated Hamorrhages; which is called by Authors Hamoptoe and not Inflammation; this takes the secretion is increas'd to such a degree often to carry off the Disease entirely, if once it get into the habit it cannot be thrown off by any means but must be corrected; with regard to its Appearance upon the throat - tis always [su???d] with an Erysipelatous Eruption, little or no Tumor, Ragged Ulcers with white Edges, a sloughy Appearance, there is no great pain or diffif. of swallowing. this Virus will sometimes even melt down bones, & these Ulcers sometimes often spread past; it is sometimes deposited upon the Eye in Obthalmia but these are remarkable in as much as there is not so much swellf. or are there much 157 takes place periodically till such times as it proves fatal; when the Matter spit up contains hard Masses, or is of a black, or dirty blue Colour there is always Suspician of there being Tubercles in the Lungs, which have been torn off the dirty blue Colour arises when there are no Tubercles but why it should, we do not know; but it is one of the worst Appearances and shews the patient to be in the greater danger; Two Inflammations subsist together with great difficulty, so Catarrh & Peripneumony carry off one another. If a copious Expectoration takes place in Peripneumony it generally removes it in 10 or 12 Days, but the Greeks said, that if it was not removed by the 4th day, it would prove fatal which might probably be the Case in that Country; but in colder Climates (for instance this) they may run on for 28 Days and yet be cured by Expectoration. There has been considerable despute amongst Practitioners, whether we ought to employ the ordinary Antiphlogistic plan and common menas of Revolution, or whether we should trust paind as other Opthalmia they are often accompand with Veneral Eruptions of a Coppery Colour with Crustaceous Seales throwing off when they are upon the forehead, they relieve pains of the head &c. in other parts they relive other complaints & the disorder is easilier cur'd when it thus come out. tis better when thus diffus'd than when collected in a part, as it does less mischief & is more readily ow'd _ the Periostum is often very much thicken'd & rises in such manner as reasonable an Enlargement of the affected ~ I have frequently seen a Gonorrhea from the Eyes Ears &c. & in this disorder the Organs 158 trust to Expectoration the natural Cure; The Greeks in particular trusted principally to Expectoration, whilst Boerhaave & Hoffman employed the ordinary means of Resolution; but the Consequence is this, that they who trust principally to Expectoration have it terminating in Suppuration, an instance of which we had of Van Helmont who himself died of such Suppuration. It therefore seems most eligible to employ the common Means of Resolution; it is to be observed that we have not any Criterion, by which we are to judge, what quantity of Blood must be taken away; We are therefore to judge of the Strength of our Patient before the Disease come on and provided he should be stout & young we take away ℥xr or ℥xvi, if we mean to trust to Expectoratio, and at the same time to diminish the Inflammation by Bleeding than ℥8 will be sufficient; we have in this (Case) Disease two advantages by the Evacuation, that of producing topical Evacuations, at the same time that we are Bleeding from the Organs of sense are often affected, in some the memory is destroy'd for a time & restor'd by mercury in others it is deposited upon the hands feet &c it appears about the anus in Waity Excrescences & tis deposited up on the lungs, & produces [crossed out] consumptions, as we often have probaby the good effects of mercury in these diseases ~ Cure: we have only one Remedy which will cure this Disease & besides that [Idants] believe there is an article in the materia medica that will answer _ tis true we may aid & direct its Operation to difft: parts as the skin & other Organs, antimonials determine it to be skin & tis best always to use mercury even in a 159 the System; Purging has been universally rejected by all Practitioners, as increasing the Circulation in the interior, and of course a greater quantity is thrown upon the Lungs at the same time, it must be observed that faculent Matter retained in the Intestnes is hurtful; we are therefore to use gentle Laxatives; Bleeding from the Breast by Leeches, or Cuppling Glasses is sometimes of Service. but we must take great Care that the Patient is not exposed to Cold, for that would produce the contrary Effect we wish the Evacuation to do; the Room should be moderately warm particularly if we employ the Air Pump; if we employ Leeches our principal Care must be to apply something warm; as soon as they are all seperated as Flannel dipt in a Decoction of Poppies; Relaxants as increasing the Circulation in the exterior parts are useful but when there is any considerable degree of Genl. Inflamatin they must not be used under which Circumstances Gonorhea to provide against Absoprtion & [crossed out] perchance it should happen _ I shall therefore [m?y] speak of our specefic mercury. & mention how it is best given, in what form &c. 1st. when you have Inflamn: from the Venereal Virus, treat it as from other Causes, if a Bubo you are to forget the Causes being Venereal while heating the Bubo use topical Bleedf. fomentation &c. _ but if you wish to supperate it then you may endeavor to increase the Inflamn: by all ouf the patient a freer diet & using more stimulating Application _ If the testes are swell'd and & Inflam'd treat them as if produc'd by accident by purging fomentation &c. only vomits [nh??] has 160 Circumstances, Nitre, and Neutral Salts have been employed; therefore in Case of General Inflammation we must first bleed and then employ Relaxants during the whole time the Patient must be kept in Bed the equal warmth of which keeps up the Circulation in a proper degree, he must not be exposed to any sudden Stream of Air, and that he lives in, should be very pure, nothing being more necessary in Inflammations of the Thoracic Viscera, particularly Perephneumony as which account we lose a great Number of Patients in the Hospitals, which provided they had been in the Country would have recovered; some have employed Stimulants particularly the Antients who used inflammatory ones as Spices &c but they should be avoided in all Inflammations, Volatile Alkali may be employed, when it is mixed with Peripneu[mony]monia Votha, or where there is an habitual Cough takes place in the Winter with some little degree of Inflammation, but where that is considerable it is very improper; but as has been much recomd. in these Cases. _ they seem to produce their good effects in two ways. 1st. in that Vasea &c that attends their seem to be a derivation of Blood from all the capillary Vessells upon the surface ^ 2d. there is more Blood deriv'd to the head which a must necessarily diminish the quantity in other parts: quick silver by itself is unactive from the great attraction between its own globules, hence a Chymical process becomes necessary to make it active enough to destroy the Virus, but the means best calculated to make it active is stricture, which produces in it a Chymical change the [crossed out] the difft. substances with which it 161 as the want of Circulation externally appeared to be almost fatal; they employed Stimulatnts to remove the present Symptoms without considering the future consequences; lastly we may inflame the Skin of the Breast, for which purpose Cantharides are used, and may be employed early, unless the General Inflammation is violent, and if the first Inflammation does not remove it, we had better heal it and raise another, which may be repeated as long as the Perphneumony continues and during the whole progress we must employ farenacious Substances dissolved in Water. We come now to shew you the Manner of treating Perpneumony & other Inflammations of the Thoracic Viscera, when we trust to Expectoration the Natural Cure. In the first place it is to be observed that if the Disease be advancing fast towards Suppuration, we must take away a small quantity of Blood. In the next place, Relaxants may be used with Advantage, and it is triturated are various as Honey Terebinth Com; Rosar. mucus Gum dralic &c or with brals Eyes or Sugar & many other Bodys so that we may use it either with a mucilage & or a powder triturate it by itself, but this last is a tedious process - a bare full analysis of Herseus pill shows it to be nothing more than mercury triturated with an acid - when trituration is properly us'd the particles are so divided that either attraction of each other is so destroy'd that it readily passes in to the skin & is soluble in the stomach & thus it is best prepar'd, there are two ways of preparing it firstly five as the mercurius Calcinal when tis rais'd into a Vapour by heat as in fumigef then 162 the only difference in the Modes of treatment is between copious and gentle Evacuations. We have likewise Medicine which act as Expectorants, and consequently must be useful, but how they produce that Effect we do not know; the most powerful of these are a Class of Plants called Lil of which are Scillæ, Colchium, Allium &c and the Essential Oil, on which this Stimulus is very volatile; - Allium is very apt to act upon the whole System, but the other only on the Glands, and it may be employed in habitual Coughs, where there is little Inflammation the other Class of Plants are those of the Unbelliferous kind as Assa Fatida, Gum Ammoniacum, Oppoponax & others of this Class; Sometimes Water drawn in as Vapour[s] has a very good Effect in Relaxing the Vessels of the Lungs and producing then tis only divided there is another set render'd active by acids & these are very difft. from difft. degrees of the same acids & difft. kinds of Acids - mercury prepar'd by Vitriolic acid as in the Tuep minn: by murcatic Acid as the Corros: sub: this render'd milder by the addition of more mercury becomes Calomel this is a milder preparation than the Corros: sub: with the same acid_ there are two preperations of mercury. with the Vitrous Acid 1st the merc: precip: Rub: 2 wards white drops ~ mercury with Vegitable Acid as ersers Pill _ there are two ways of owing the Veneual & Disease by mercury either by the after ative or purging, that is by 163 producing Experctorations; we may also add some slight Stimulus, as the Essential Oils of Pulegium, Melissa, Lavendula &c sometimes Acids may be used, but they must be of the Acetous kind; these are the Medicine, which we employ to increase the Secretion. We may defend at the same time the Mucous Membrane by employing Oily and Mucilagenous Substances; and if we trust to Expectoration, it is long before the Disease is removed, and of consequence becomes necessary to give Food of more Nourishment but it should be nothing except Farinaceous Seeds as Panada, Lago, Bread with dry Fruits, as Figs &c but no Animal Food. There is another Remedy that has been employed in cuffections of the Thorax, which is not an Antiphlogistic, nor does it by the Evacuf. or not Evacuating the injur'd & present fashionable method is the alteration the Old plan by salivation or Evacuation turns upon this principal, does mercury cure by Evacuating the Disease was a specific I think its power does not reside in Evacuating, but destroying a Netralizf. if its power depended upon Evacuf. then other medecines would produce the same good effect & the more they evacuated the better as by Vomitting, Purging, sweating, &c: Evacut. are so far from being necessary that they rather retard the Cure we are led into the eriar in favour of Evacuationsby the natural effect 164 it forward Expectoration, which is Opium; sometimes the Cough is very troublesome in these Inflammations giving great pain; this Medicine by taking off the cough, procures some immediate Relief, but it forwards Suppuration, therefore it tends to render the Disease fatal; it is also a powerful Restringent, and as such check the Secretion of Musuc, hence it is not to be used, unless when there is a Secretion of thin watery fluid as in Catarrh; the constant Stimulus of which produces Cough. In this Case it takes off the Irritability of the Trochea, and may be employed in small Doses, joined with Relaxants. ~ effect of mercury being that of salivation we might as well say tgr. of Ipecac is no medecine because a Scruple of it Vomits, would such an unreasonable position be admissable then mercury because its natural effect is to salivate many think it cannot cure without the 2nd. Curor is favour of salivation, from this that from the time the mercury begins to effect the mouth it begins to cure, but [and] it thus affecting the mouth is only a proof that it has enter'd the Blood. - another fact which has not been attended & that is that there is no one preperation of mercury that is infallable in every Venereal Disease difft. preperations according to their difft. degrees of solubility are Determin'd to difft. parts _ _ but 165 but in all the Ungt. seems to be determin'd tho the salivery system, Corrors: sub: to the skin, & other preparations upon other parts. therefore difft. prepars. are requir'd in difft. Cases, when we find one does not answer we should change to another. Surgeons in general I am certain confine themselves too much Ungt. for we often find that one preparation hurts while another cures. here the use of Chymistry comes in. for those who are unacquainted with these Chymical preparations of mercury, are unwilling to use them not knowf. their effects or being acquainted with their composition. therefore we see the reason why they confine themselves to Ungt. we are to doubt the [im] possibility of removing a Venereal 166 a Veneral Compt. when salivation has faild. but in most of the Cases if instead of despairing we should use the Corrors: Sub: or merc: Cal: we should succeed to the utmost of our wishes ~ Avoid salivation if you possibly can for it only proceeds from an Injudicous use of mercury. if a brackish taste is perceiv'd in the mouth tis enough is may not now be amiss to make an application of the Chyimical principal[e]s to cure the least fallable method is by inunction in this way it more readily enters the habit & you avoid the many inconveniencys it occasions upon the Purmf Vis when taken by the mouth Attention to Regimen I can affirm from much Experience, that there is no great advantage in rendering your patient too low I I have often known it do hurt. for some degree of Inflamn. coming on does good. I do not recomd. Excess upon these occasions only if the diet it the common kind it need not be alter'd. I would be equally attentive to a single Chancre as I would to the Disease appearing upon the Throat for Chancre being heald up is no proof of the Disorder being cur'd. hence I rather see a Chancre cur'd by unction that any particular application to the vitriol Cauct Calomel with Axung: [?] will seepdily curethem but to keep them only clean & not to heal them I think best by that means your patient will be induc'd to continue his medicines till the disorder is thoroughly remov'd from his habit when I cure by Inunction I use 167 I use 3ij every other Night omitf one Day to prevent the mercury rushing to suddenly to the mouth if it has no tendency to the mouth then we may use it 2 Days & omit i One. the patient should drink freely of Barley water &c at the same time The Dr. after recapitulating what he had spoke upon yesterday _ went on to show what preperation he thought best in particular Cases _ mercury when us'd either externally or Internally promotoes Inflam: & a full hard pulse it promotes the suppuration of a Bubo if in the Inflamf. stage, increases Hectic complaints for mercury as a stimulus increases the action of the Heart & promotoes [crossed out] Inflamf Complaints & I have often known the Cure not to succeed when when the habit has been so low that [?emercury] could not rouse enough to excite inflamn: you should stear the middle Course, between the two Extremes, if the Inflamn. is very high you should moderate it, but if only moderate it will be of service, this is Illustrated for it a habit is brought very lowly a too Abstemious Diet &c Anxiety of mind &c then the mercury will not cure unless a generous Regimen is us'd at the same time. I only attend to its sensible. Operationf not to enter into the Idle notions of its mechanical Action. ~ Another affect of mercury is its tendency to promote all the secretionsin generous all stmulants do the same, tis a fortunate 168 circumstance that they do otherwise theire effects would be very pernicious if you wish the mercurial to act upon the skin then the Corror: sub: is the best: if you add antimonials to mercury they will never salivate, but go off by skin ~ with Diuretics by the Kidneys &c. & there are many forms that only purge _ there is another fact that should be attended to Vizt. that when the mercury is once determined upon any Organ tis very diffif. [crossed out] diverted to another, in a Salivation Sulphuer Camphor, warm bath &c all will not do for the disorder must go if by its own proper secretory Organ in this particular we are often deceiv'd by Brcctis _ mercury maybe diverted from a part when its effects are just the ginf. but not late when it has settled ~ notwithstanding mercury is a Universal stimulus yet by itself it always determines to the mouth ~ the reason is difficulty explains so again why Cantharides always tend to Urines this fact must be admitted but are not so easy - Explain'd, Plenks Theory was now introduc'd &c but we must only trust to its effects leave the Cause. ~ As mercury may be suspended in water it does not appear to me that it acts by its weight breatf. dron the Blood &c. as many have suppod. Salivation is not necessary to the cure of this Disorder on the contrary tis retarded by it, as much as will prevent the continued use of mercury thereby prevent the sufficient quantity being thrown into the Blood ~ a Brass taste in the mouth with a full pulse is all that should be kept up, deluting peely at the same 169 time & by this means you will Cure. ~ Notwithstanding what we say here. the practice of salivating is so general that sometimes, you will be oblig'd to comply with the Inclination & Solicitation of your patient, I shall therefore show you here [you] it should be conducted. - 1st : you should attend to this circumstance that your patient be in good health Independent of the Venereal Disease; as a salivating greatly endangers the patient in a diseas'd System. avoid all Acute & Hectic Complaints. All tendency to dropsy, & those exhausted by preceeding diseases the tendency of an Ill conducted & even of a Judiciously conducted Salivation is to produce Hectic &c women [?can] delivery, or even under Pregnancy should be avoided as Salivation threatens absorption by exciting fullness & tendency to Hamorrhage, a tendency to Diarrhaa should be avoided or the mercury will run off by the Bowels _ for all stimulants have a tendency to exert their effects upon the weakest Organs, avoid all those Cases where the head is affected either by Epileptic or a tendency to Apoplectic Complaints & all other disorders of this kind. as it will occasion a fullness. Inflamn. & largness of the head passibly we should avoid it where there are scrofulous tumors in the Neck. I think it should be avoided in Infancy & in the advance'd stages of Life you should not discontinue the use of mercury upon the Symptt. firs disappearing. ~ ~ ~ ~ ~ ~ 174 Lecture on Lues Venerea conti. In one there is too much Irritability, & in the other too much debility, in short the subject should be healthy. for the Venereal Virus Does not act upon the Vessells like the small pox, but only shows it effects when deposited upon any parts part. hence there is no Acute Disease produc'd by this Virus. _ the reason should be likewise chose, I would wish to avoid the Extreems of heat & cold Spring & autumn are the most proper times. the warm bath is the best preparative to clear the skin & promote the Absorption & as it helps to divert the mercury from the mouth it will allow a sufficient quantity to be thrown in Une: in the best method; when you will salivate you are thus to conduct it the quicksilver should be rub'd with dsreny: neither Terebint LV Inlyh: properationsof any kind should be en play'd for all turpentine Stimulates & Inflam the skin, therefore the best Ointment consists of nothing but Axung: & Zuich fiber, the patient should wear flannel next his skin to keep up a free perspiration [pecousional] [illegible] bathf. & this will answer. but I do not mean to keep the Body too warm, avoid all Extreme colds, as a sudden ahach of a salivation by Cold has produc'd even the lock Jaw _ the diet should be fluid as broth, Barley Water & avoiding hard animal food &c. the patient should be cakon'd not to swallow any of his spittle, begin with ʒij of the Ungt. rub it into the legs & thighs 1700 before the five, the parts will often become red & Irritable more so in some constitutions than in others. often rubf: into the legs &c. the hands should be thoroughly cleans'd _ by carefully washf. them _ tis impossible to tell when the patient will feel mercury in his mouth, the signs of its approach are a Brackniss taste, foetid breath, white tender Gums, with heat &c & a copperish taste _ when these Symptoms appear then diminish the quantity of Ungt. or even omit it for a Night, for the longer you delay the spitting the more thorougly you will cure, if great pain swelling in its tensions Inflamn. &c come on about the Throat with fever &c then you may have recourse to V.S. & poef. with the Neutral Salts stopf. the use of the mercury, in these cases aboid all asstringent Gargles, if salivation is diffy. excited in one who will be salivated, then a then a few grains of the Irupeth min: upon the Ointment will always answer, when a salivation does come on it is not easy to moderate it [?determ?] its quantity from 3 to 6 pints in 24 hours is the usualy quantity & very great its & often of greater consequence than even the [?i] case for which it warn'd; only consider the consequences of a great a quantity of saliva being thrown off for 20 or 3 Days together ~ Costiveness & Diarrhea should oth be carefully avoided _ the first by a little Rhei or 3ij of the soluble [Sc???] & the lather by Rhei lidled & corrected with Opium _ or the Elect stand or the Philor drinkf. at the same time the decoct Alb: using the Jul: e Cretar if there is much [??] and a 171 a few days of the Tinct Thebaci, if there is a Diarrhaa & a Gribing mr w arner with Tinct of Bhulb with great advantage is Violent than Bleedf. to prevent Inflamn. diluting at the same time is proper ~ sometimes the head is suddenly with stupor Delirium & under a Salivation, here V.S. purging, Blisters &c should be imploy'd a Circumstances Indicate. sometimes there are Hamorrhages from the Gums Chancres &c appear in the mouth. hence you see that when a Salivation is conducted even upon the best and most prudent plan, that it is dangerous hence if possible I would endeavor to avoid salivations I shall now speak of of the Cure by the alternating plan _ (but of this tomorrow) we shall now speak of the best method on conducting the Alterative Plans _ & how to avoid salivation the Alterative Remedies, are mercury either by tincture, heat or combin'd with Acids ~ by tincture either for External or Internal use. the External by Unction is the best. In the Alterative method the use of mercury should be slow & weak to prevent salivation, therefore we should omit for one or two Days between the frictions, to prevent salivation comf. on before the mercury is thoroughly dispos'd through the habit. by introducing it slowly, & diluting freely at the same time, we shall prevent an Accumulation upon any particular Organ _ we should not be in to great an hurry to introduce too great a quantity into the habit, for as the Disease is slow in its progress therefore the slow method of giving mercury is the best when we consider 172 the Natural effects of mercury upon the constitution, that it Irritates & Excites Inflamn. & renders the habit more Irritable, I therefore prefer the alterative plan _ the patient under the alterative Course should not be wrapt in flannel or kept in a warm Room ~ for heat renders the Body more irritable & excites the [?pithf.] particularly when flannels are apply'd to the Throat, exposing to the Air when not too severe is the best method as it lessens the morbid Irritability & tendency of the mercury to the Throat Mercury cures sooner in some than in others. the [p??i?] time necessary is not to be asertain'd beforehand. for in some me Eavacn. is more readily promotedthen in others & in proportion the more readily mercury is discharg'd from the difft. outlets the long will be the cure I would begin with ʒi of the Ungt. merc: use it every other [Veg??] & this conducts for 5 or 6 Weeks, & if there is only Chancre I would continue this method 2 or 3 weeks after the Chancre is heald _ the action of mercury Internally administered is more uncertain ill its effects as it promotes a Number of stools Irritates the stomach & Bowels, thereby [pur???] its readily enerf. the Blood & therefore it is uncertain in in its effects _ upon this principal I always wish to se the mouth affected when I use mercury Internally it is a proof the mercury has enter'd the habit the Action of Mercury Internally us'd is not improper to the quantity but its solubility I mean its facility of mixing with the serum of the Blood which I think is the Vetricle of all medecines _ hense the Corros: Tinct: which is the most soluble produces its effects on the less mercury than any other preparation only consider it given in the dose of 1/2 gr. Nights mornf. f 1/2 a gr. is a large dose, this does not contain 1/3 part of a grain of quicksilber in a Day, if it is taken for 40 Days together which is the usual period for curing with the Corrosive sub: in this Case theres only 10 gr. of [illegible] 173 us'd for a confin'd pox ~ Calomel is not soluble in water only in serum of the Blood here every grain contains 2/3 of Quick Silver itself a very large proportion is us'd ~ hence we see it in the acrimony & solubility & not the quantity that if the thing ~ another remark worth attendf. to the acrimony of mercury seems to lead it the the skin & Kidneys more than to the mouth & that the milder preparations &c have the greatest tendency to the mouth &c this is generally allow'd but not yet Illustrated, Joarly sit out with this principle in the cure of the Venereal Disease Vizt. that every Sympe. of it has its own particular Remedy ~ the Corrosive sublimate is the most usefull for the skin, Venereal Opthalmia Chancres &c we have lately had two cases of the Venereal Opthalmia which has given way to the Corrosive sublimate in this house he then mentiond the followf. Case as being singular now in the house a woman with a sublimate was given to her, the Child by [s?id?f.] her milk was salivated this is the first instance I have seen of the corrs: sub: salivating best this leads the the Illustration of this principal Vizt that a mercury always runs off by the freest secretion for if she has not suckled it would not thus have run off by her Breast _ another conclusive is that if Children have Venereal Complaints best method of curf. them is to subject the [V???] who they such to a course of mercury. Harris [illegible] Children have been cur'd of this Disorder by suchf. a Verse who us'd the sarsaparilla [fe??] (a mistake) In the course of a Gonorhaa an [In??] Alterative is best, from the little danger there of Infection. here you have a great Choice, I [the?] the most manageable, & with which the patie may keep about, is small doses of Calomel when 174 does not purge & run off by the Bowels, to prevent this tis best to guard it by the use of an Opiate, for this it more readily enters the Blood, for we find that mercury combin'd with Opiates salivate more readily than withot them, as muown pinducs [Calomel] Irratibility hence they purge any kind of Regimen may be usd with Calomel as Vegitables, fruits, Cyder &c for the Calomel unites more strongly with its own Acid, that the Alterative power of Vegitable acids can have no effect upon it ~ another preparation which is any soluble which is the Mercurious Calcinatus, this is all mercury, with an Acid; but it has a very Active Operation upon the Bowels unless the Regimen is particularly attended to avoidf. acids _ Mercury triturated with Gum Arabic is an Excellent form. I was first led to this way of using by Plenk upon this subject; I translated his works & added Appendix I differ from him materially in some particulars - he says that mercury united with Gum Arabic is incapable of salivating but this is the most Absur'd, notion the that was ever entertaind, for there is not any other Body that can hinder the salivating power of [m??.] but Sulpher. as in the Athips &c & because the solubility of the mercury is wholly hindred by the Sulpher I myself with many other Practitioners have often experenc'd the great of this mixture in weak & Irritable habits, for the Gum has the same power to prevent a spitf. as a strong vanf. from Cnatharides &c I should have mention before that loadf. the habit with mucilage will [p???] a salivation 3ij of Quicksilver in a proper quantity of Gum Arab: & then diluted is the proper form with [???ted] with Cons: Rosar: Hips & will answer the same purpose _ the Inconveniencys of a fluid form 175 form of mercury is its precipitating to the bottom unless prevented by frequent agitation or suspended by a mucus. with regard to the Corros: sub: if the Disease is makf. any Rapid progress as upon the Throat & penis endangering the Bones, or appears in a Violent Opthalmia &c then you soonest overtake it & check its progress by the Corr: sub: but the Objection to this medecine is that it removes the Symps. but not the Disease _ this is true in great measure, therfor I do not trust to it alone, but only use is as a sudden check, whenever there is a great tendenctto mortificn., Inflamn. &c. you should always forget its being Venereal, & use the Bark, sarsaparil: good in & omitf. the mercury, & thus you restore the suppur; & when the strength is restored you may again use mercury. In high Venereal Inflan. you should stop the use of mercury & use V.S. &c After salivation or a Course of mercury when the habit is diseas'd without Infection Rhuematic pains , occasion'd bu cold fit the hbit being render'd too Irritable from the use of mercury. then a good Air, Bark &c will generally restore the patient from Theu: &c sarsaparilla Bark, Milk dict &c good Air &c are proper for the Hectic which proceeds from some of the mercury remaining in the habits. then the use of antimonials will often do great good. another Observation is that no Abcession the Venereal Disease is Critical as Budo &c no more than Bulos &c in Scrofulos complaints they are not like Abcess &c in the plague & other fevers ~ for only a small proportion of the Inf. can pass off this way, & a supurated Bubo all over a much greater quantity of matter to be absorb'd into the Blood, which requires more mercury to cure it, therefore they should be avoided, & resolved always be attempted unless they are far advanc'd 176 & a resolution impracticable, leeches upon the part. Avid, poultices, these of Golards of stale Beet &c should be us'd. with those that are sedative, if they suppurate then they should be opend, cleans'd & with the Assistance of mercury heal'd, unless they are phagedenic which mercury will sometimes occasion, then the Bark good Air, sarsaparilla are most proper omitf. mercury. when the Bones are diseas'd Exfoliation should be promoted & but above all things, avoid if possible the suppuration of Bulos. ~ ~ ~ ~ ~ ~ Lecture upon Disease of Women. ~ Those which arise from the peculiar Organization of their Bodys are thse I shall speack of. - sn: of Menstruation Women when arris'd at the age of puberty have a monthly discharge of Blood from the Uterus, the periods are difft. in difft. constitutions & Climates, in this country they usually appear between 14 between 14 & 15 years in the warmer by 10 & 12 years, they are calld menstrual from their period being usually a lunar month & the suppos'd Influence of the moon the final cause of this discharge seems to be that of the Nutriment of the Child, but with regard to the occasional or proximate Cuase there are Various Opinions I shall no consider the proximate Seause. to difft. Causes have been assigned. 1st the Influence of the moon 2d a formentation in the Uterus. 3 general Plethora or a typical or local Plethora. with regard to the of the moon had any Influence all Women would menstruate at the same time but this is not the case but a distention & accumulation is necessary , with regard to a ferment this is an absurd Opinion & only prevoild [illegible] when nothing but Chymical Reasoning was asmitted the menstrual Blood is the same with that remaining in the other parts of the body. how can this fermen [illegible] dormant for 14 or 15 Years, but some respectable [illegible] 177 have espous'd this Opinion as true has a difft. doctrine supposd that there was a parheidon oburcture in the Uterus which fitted it for accumulation. 3 the general plethora was suppos'd to arise in women from their using a more sendentary Life which occasion'd them to perspire less & hence they through proceeded the Plethora Abyecns. but this does not seem to be well founded for the menses appear before there are any Symptoms of Plethora was this true the menses ought to be in proportion as the person was more plethoric, but those who have a plethora have no more than others. as only about ℥ij is discharg'd in this Evacn. & that Grottation we cannot suppose that would remove a general plethora if one attended, & if this was the Cause V.S. at the arm would under the menses unnecessary. I would always answer when the Menses are obstructed, but it does not for a few ounces of Blood discharg'd from the Uterus afford more relief then 4 times the quantity from the arm &c & again V.S. from the arm often promotes promotes [thes] instead of discouraging where there are Symptoms of plethora &c they are rather the consequence than the cause of the menses _ what then is the Cause? In my Opinion it consists in a local Plethora. for a general Plethora rather hinders than promotes the Menses. what is the structure situation &c of the Uterus the Circulation in the Uterus is slower than in any other part, whence it is slower, this is a Law in Hydraulics & it obtains in the Uterus. if the Branches are smaller than the trunks the circulation will be quicker then supp the Blood sent to the Uterus by arteries & numerous Ramifications hence nature inttended an low Circulln. for if it was quick in these parts a fatal Haemorrhage would soon be the consequence hence we see the [Car???] of the slow circulation, this is another circumstance peculiar to the Uterus, the Uterine Arteres are [p???] 178 [?on??g] thin & weaker than many other parts of the body this again will occasion a slower circulation. the meatiness of the Uterine Arteries known from their sudden dilatetives under particular circumstances, hence it appears that the general structure of the Uterus favours a slow circulation. not only this is the affect but this Structure also invites a greater flow of blood into this part. from its lone porous structure & hence arises the accumulation & distension of the Uterine Vessells, another peculiar circumstance is the serpentine course of these Vessells which gives a greater resistance to the circulation. these arteries that are scarcely Visible before puberty become afterwards very large; another circumstance discouraging the return of the Blood is the largeness, of the Uterine Sinuses which are situated perpendicular & have no Valves. & hence they promote accumulation ~ I suppose a topical Plethora may exist in many parts of the Body & yet not be generally the same as an Inflam: maybe local without affecting the Heart how often do we see after a profuce floodf a free discharge of [Blood] Milk tho every other part of the Body is Empty'd - we shall now apply the cause of menstruation to practice & first of the Symptoms which attend an Approach, Girls in this country feal their approach between 14 & 15 1st. by a distended & tumid mamm & H sense of [?viy??] & uneasiness, & even a pain in the os pubis & Back there is frequent HeadAch genera Languor Lassituted, Worisomness, shooting pains in the abdomen Legs & thighs. these Symptomsmust be left to themselves & not Interrupted, there the first efforts & of an exceed allant can do, therfore we should only look on & observe what affect these effortswill produce I would observe that the arterial System becomes [pad??] dilated & open giving way to the distended Cause, at first there is only a pale serum from the small dialation , this 179 the periods at the beginf. of menstruation are very Irregular as 2 or 3 Months often go between but soon the Colour becomes more florid, the quantity increases & the periods become quite Regular but if the body is render'd very weak by Affections of the mind as Grief, fear &c then on have the disorder produc'd call'd a Chlororis, when the menses go on Regularly there are only stop'd by Pregnancy & an advanc'd period of Life, as 45 or 50 Years. the Uterus being less capable of dilation from Rigidity at this time, this period renders them susceptable of Disease & is the most critical period for Uterine Diseases as Schirrus Cancer &c I have observ'd that the menses seldom appear later in Life but they proceed from a diseas'd Uterus _ if one has had the proper Symps. for the menses & yet they do not appear when this is the Case there is general torpor lassitude loss of Appetite, flatulence in the stomach & Bowels, Costiveness a pale sunk dejected countenance; a greenish or yellowish colour of the skin when the disorder is call'd the Green sickness ~ There is a tendency to an asarcous swelling of the lower Extremities, a periodical Hectic, foul tongue, Acidity in the stomach, unusual being for Absorbing as Chalk Clay &c. Sydenham is the best describer of febri: Alb: Palpitation of the heart shortness of breath come one from the slightest motion, ~ Cure in this Disease we are to consider the system as not prepar'd for the Discharge, which is a very difft. Disorder from obstructed menses at this time they would only do hurt. for you must first Remedy the defcets of the System & then the Discharge will always appear. Women are too apt to believe that nothf. is wanted but the discharge, & that if that was procur'd all would do well, but theya re very wrong & from such mistaken notions as these it tis that they do so much damage to those whose credulity allows them to act for to Remedy the Diseas'd habit is our work, the appearance of the menses which will be the consequence is Natures 180 how are we to Remedy the habit 1st: as those subject to this disease are often troubled with Nausea, Sickness, & lead after eating, a seretion of a tough Phlegm upon the stomach hence a gentle Vomit of Ipecac given occasionally are serviceable Obstiante Costiveness is another Symptom, this should be remov'd with Rhei & Calein'd magnesium, the Caleind is much the best Remedy of the two magnes: tis a brisker medecine, it occasions no flatulency & is a better absorbent to a good laxative - & its relaxing power is concreted by the time action of the Rhei. After the Prima Via is taken care of then the fever demands our next attention, notwithstanding the quickness of the pulse or any other of it [Sym??] Chalybeats are by far the best medecine, Hence the use of the Bath, Sunbridge, Bymont, & [?paw] waters. _ of the Tinct Marle spt. sal: or Trow in substance, these with proper Exercise riding on horseback, Chearfull Company &c by these methods we shall mend the Lal [crossed out] thus [proo??] the menses, when the fever is gone the menses are not to be expected immediately, for the habit must be first wholy mended & they will find themselves much better before the menses appear ~ I likewise use the Bark with Chalybeats, but Chalybeats are the sovreign Remedies, the Regimen should be of the light nutritious kind _ when the menses have appear'd & Natures efforts are ineffectual, then the use of the Pediluvium & opium will be of the greatest service, & Opiates particular ulsa there [crossed out] is pain tis that alone sometimes will hinder the menses. the lower Region of the abdomen, legs & feet should be kept warm. it should be well remember'd that women under menses are more Irritable than at any other time, & then best bear the use of Opiates at this period great attention should be paid to avoid Costiveness for which the Pill Ruffics the best Remedy. but it is not good in thee early stages of a Chlornosis 3 rh at diseases flow from obstructions ofter the menses have appeard? Expirience shows that the menses 181 may be obstructed without any Inconveniency, which proves they do not depend upon a general plethora for if that was the Case many &. great disease would follow in case of obstruct'd menses there is a morbid Impetus upon either the head or stomach, hence Violent headAchs, Giddiness noise in the Ears flush'd countenance general Torpor&c great pain in the stomach distension after Eating, flatulence Nausea Vomitf. &c these are the Symptoms that arise from obstructed menses ~ we should carefully distinguish those Symptoms which arise from, & those which are the Cause of obstructed menses, wherever there is a weak Organ there the Impetus will be directed; I have seen the menses discharg'd from an Ulcer, the Eye, Extreme. when a person applys for assistance & has not been regular for some months you are to consider whither the Cause be independant of Pregnancy, for that will produce the same symptoms, but in Pregnancy there are particular Symy. which will sometimes distinguish it, but they are often the the same - the causes of Interupted menses are either affections of the mind as Grief, Fear despondy. &c Exposure to cold &c which has often occasion'd Inflamy. fever if the menses are not restor'd sometimes a Chlorosis will come on. as pale countenance flatulence, debility [Ca??a] what Assistance can we then affoard? the menses are often promoted by small & repeated Bleedings where there are Symptoms of a Plethora as 3iv once a weak for 2 or 3 months together, but if the head is particularly affected cupping, pediluvium &c if there is great pain in the System then Opiates. avoidf. Chalybeats, Cold Cold &c & regular Exercise, Uterine Purges, warm bathf. light &c. I have known Glysters of assfoetid do good in these Cases ~ musk & Opium I have us'd together in painfull & diffit Menstruation Calomel & Aloes have promoted the menses - Castor & other cordial Antispasmodics are serviceable in particular Symptoms as low Spirits & when the menses return, then Excercise, bath waters, Sea Bathf. [crossed out] will remove the Irritable habit those whose 182 whos menses are Irregular the Electric shock thrown through the Uterine System will bring down the menses, but great caution is requir'd in its use: - whenc Nature is makf. have efforts the Tinct of Black Helebore is good. - the Aperiot pil of soap: Aloes with a bitter of the Extract sabin: are good under some circumstances Uterine Hæmorrhages These may be either from too much Blood discharg'd at a time or the period returnf. too often, to determine upon the best method of treatf. this disorder we should consider the Cause as 1st. general relaxation of the Habit from a sedentary unactive Life _ Intemperance & too much of other discharges, indulgency of great quantities of hot relaxf. lops as Tea&c depression of spirits from misfortune & if at the time of Life when they oughto cease, if in the Cases they are acompanied with Pain &c a diseas'ed Uterus is too frequently the Cause as Schirrus Cancers &c from what I have seen when Women of 50 had the menses too freely the Uterus was generally so much diseas'd as not to allow the Hamorrhage to be check'd. some Women have the Uterus remarkably Irritable which occasions too great a discharge tis not often from a general Plethor, tho tis often in Corpulent women yet they are generally torpid pale & [crossed out] & relax'd. if the discharge is so great as to be alarming, then keep the patient in a proper posture. weaken the powers of the heart by Nitri Tinct: Rosar &c & contract the Uterus by Cold application as Vinegar & water, snow See water & which have been introduce'd into the Vagina [illegible] alarming Cases with advantage. bleedf at the arm does not seem to have any tendency to Check this Evacuation. ~