Class 2d Praternatural Evacuations Order 1st Hamorrhages The most Considerable are those from ye lungs more. Hamorrhoidal Veins, lirerus, Urinary passages, Sometimes tho verry Rarely Blood Issues from ye Eyes & gumes & there is Bloody sweat but those only happen in a verry disolvd state of ye Blood I shall Considers Uterine Hamorrhages under ye diseases of Women & those from ye Urinary Passages when it comes to speak of ye stones as they are Common sympe in this Disorder Hamorhages may be Consider'd again as proceeding from External or Internal Causes------------ Hamorrhage from Internall Causes, may Be Consider’d as either being Critical salutary or symptomatic they are Critical often in Fevers salutary Hamorrhages are ye Uterines & Hamorrhoids & the symptomatic Another which occurs in a Disolved state of ye Blood --- A fourth View of Hamorrhages is as being peculiars to particular periods of Life: Nasal ones are most Common before Puberty, after this to ye Age of 36 Spitting of Blood betisen 86 & 70% miting of Blood & Hamorrhoids after this Hamorrhages from ye Urinary Passage --- Proximate Cause, Hamorhages may proceed 1st from ye Rupture of ye Vessels 2d from Eudations, this may be produc'd by the following Causes 1st peculiar Constitution, there a peculiar tendency to Hamorrhages in some Constitutions & this is often Hereditary sanguine Temperaments. Delicate Habits and show of great sensibility of ye Nervous system are peculiarly liable to them, 2d Plethora This may be Either general or Topical, topical Plethora takes place in ye Menses, tho I do not deny there is general Plethora also, Plethra is generally ye Consequence of habit & when a pt. has been subject to Hamorrhages ye disposition to them grows stronger & If ye usual Hamorrhages be stopt ye same Disease arises as from Plethora in general 3d in Inflammotary disis Hamorhages often Depend on Inflammatory Diathesis of ye blood in Consequence of which they are attended with Fever 4th Putrid dissolution of ye Blood hence Hamorrhages in ye Seurvey 5th Dissolution of blood independent. of putresency is a cause of Hamorrhages as after large Evacuation &c, 6th Alseal Accumulations of blood from local Stimulous 7th As local Accumulation of blood from spasm in other parts of ye Body Hamorrhages from ye Nose Lungs, & Hamorrhoidall Veins may proceed from Spasmodic Contraction & Flatulency in ye Gurs 8th Erosions In Consequence of Acrimony, one of the strongest instance of this is a disentery Genus 1st Hamorrhagia Narium, This is in general preceeded by a Quickend Circulation Sympe of Determinations to ye Head, pulsations of Carotid & temporall Arteries, an oppressed pain in ye head flushing in ye face dryness heat & Itching of ye nostrils often a Redness & Swelling in ye Nostrils from which ye Blood is to flow as also of ye Cheek of ye same sides, dimmess of sight Involuntary tears Costiveness, Little & limpid urines Coldness of Extremeties & sometimes Vigor a shivering & suppression of usuall sweats when it happens in fevers then is a remarkable Tension in ye Hypochondria preceeding. Van Sweitens mentions several instances of ye approach of Periodical ones, being told by a painfull Feeling in ye spleen as bounding Pulse is spoke much of as a preceeding sympn. this was first observd by Solani & followed by Nicol For my hart I Coud never make any thing of this Sympn. & I am told by good Authority that Dr. Nicols Observations in Spain did not answer, when he practic'd it in Ireland The fever that prceeds Hamorrhges goes of at there Coming on ye quantity of blood in Now at Hamorrhages is sometimes Surprising there are many instances of 5 or 6 pound being lost & some of 20 Mentioned by Deautaud. ------------ The untimely supression of Hamorrhages when Criticall & often attended & with far all Consequences Vertigo Apoplexi, Gallaiman deafness Sinitus Ausum Convulsions & Lethargy & this is particularly ye Case in Suppressions of Periodicall Hamorhages Nasal Hamorrhages are Salutary in Vertigo Headach, all Fever, were thirci a determinnation to ye heads &c is often Criticall in Inflammation of ye Livers & spleens, they are this peculiar Crisis in Ardent Fever & are Sometimes Criticall in Anginas Rhumatism &c, Spontaneous Evacuations from ye Nose are mores Effectuall in ye Cure of disease & preservations of Health than any Artificiall ones Hamorrhages at ye Nose Are bad Sympe.. in all putrid Fevers In all Chronic complaints where any of ye Visera are Affected as in Jaundice or dropsy they are bad symps. also. Those who in youth are subject to Hamorrhages at ye Nose after Puberty are liable to spitting of Blood which induces Phthisis Pulmonalis or if this does not happen Nervous Disorders gout & Nophrisis. Great Hamorhages bring on great Debility. Dimness of Sight produceti Vertigo Pains in ye head & Eyes & frequently End in Dropsies Hypocrates observes that small Droppins from ye Nose of Blood on ye 4th Day of fever are a bad Sympe.. Causes Hamorrhages from ye Nose may happen at any time but spring & Autumn are ye most Common in ye Spring theres a peculiars [??gnom] on Lunges censy in ye Constitution Men are more Subject to this Hamorhages than Women. Climbing high Mountains when as person is subject to Hamorrhages brings them on all those who have lost a limb are Ever after subject to Hammorrhages Children that have great serous Discharges between ye Ears &e, are subject to Hamorrhages after 7 or 8 years Old, suppressed Evacuations Especially of Blood brings on Hamorrhages there is a predisposition Violent Passions Acid Stimulating diet either with a sedentary life or one of Violent Excercise will bring them on &o Lastly Eternal Violence regard to ye Cause as there is Commonly in Hamorrhages a febrile disposition & Inflammatory Diathesis V.S. seems to be indicated & is usefull in two Views 1st it has a tendency to stop Hamorrhages in generall & is more Effectuall when applied to a distant Part 2d to prevent too frequent Returns enable Repeated E[??] should not be left of suddenly but by degrees. Cathartics in ye time of Hamorrhage of no Use but afterwards may be usefull by taking ye plethora & are particularly serviceable when spasm a flatutencies in ye Bowels is ye Causes of Hamorrhages all Cooling Meds are proper both in and after ye Hamorrhages all Vegetable & Mineral Acids are made use of here Times Nosar Acidutated with Spt: Vitrol sat Prund Nitre, &c, these Meds act both as Coolens & sedatives and are Usefull whether the Disease arises from an Inflammotary Diathesis or an Putrid diathesis in the Patters R Nosar or Decoct: C. Peru Are ye best as Destroying ye specific Causes of the Disease Opiates these will sometimes stop an Hamorrhage when Venesection has faild but they should never be used till bleeding has been premised Cold Water large Draughts have been found Effectuall in stopping them it acts as a Cooler J. Antispasmodic & Derives greatly to ye skin Bark the use of this Can only take place when the Hamorrhage is not present & when it proceeds From Dissolution of ye Blood in ye most powerfull Remedy Pediluvium During Hamorrhages there no Coldness of Eputrom it is whatever therfore derives from ye head thither must be proper & putting ye hands or feet therfore into Warm Water will sometimes stop an Hamorrhage from ye nose The water should be of a moderate heat – just so As to Incite a Flux to the Feet & not heat the Body it shoud be of the same pemperature with the Body, Ligatures to the thighs should not be used but in Exstreem Cases as They make a Pt more subject to Topicall Inflammations Method of preventing the retu of Hamorrhages A free prespiration shoud be Constantly kept up which people subject to Hamorrhages want in generall they are apt too to have Cold Legs & feet these therefore shoud be kept warm In those who are subject to Hammorrhages from Inflammatory Diathesis a spare Diet is proper Milk & Vegetables Diet a total Abstience from fomented Liquors & moderate Excercise with an Easy Chearfull Mind & avoiding every thing that quickens ye Circulation or stimulate ye Nervous System will in generall Cure but when ye disease arises from a disolved state of the Blood this Method does not Answer here wines & Bark are Necessary External Applicans the intentions of these may be to derive from ye Head, this may be done by Pediluvium or friction of ye Extremities on Cold & repellens Applics to ye part Affected & this Method is most Commonly used every thing that, is snuffled up ye Nose is apt to Stimulate & Provoke Bleeding which will Encrease the Bleeding these repellent applicas however oft Stop the Hammorrhage but if they Fail Cotton plugs or Cotton dip'd in Vitriol. Allum or Ink will often answer, when we use these however we should be Carefull when ye Pt.. is stooping that none of ye blood Rundown his throat Repeated Mouthfulls of Cold Water will often stop a Nasal Hamorrhage any Cold application to ye Neck will often have this Effect as Iron and this is owing to its affecting ye Nervous system Cloaths dipped in Vinegar & Applied to ye Whole Body have Curd & when ye Hamorrhage is Violent Plunging in to Cold water has Cur’d but this Remedy I woud not Recommend sympathetic Remedies 1st dropping of ye Blood into Calcined Vitriol & water 2d dry Cupping to ye Belly this is Mentioned by Hildanue Authors Sltrat & his Followers, Caroll & Iunher particularly, but Only for the History not ye Treatment of Hamorrhages Hamoptisis By this I mean Blood Coming from ye Lungs Savage defines it to be a spitting of blood with out fever but there very few Cases were there is a Bloody Expectoration with Fever, its preceded by sense of Weight oppression & heat in ye Breast. a tickling Cough sometimes in ye fauces sometimes in ye Lungs Hoarseness a sense of dryness in ye Lungs with a greter or less degree of Dyspanae a Coldness of ye Exetremities with shivering often Costivness. Lasitudes of ye Limbs flatulency pain of ye Back with a kind of Andulatory motion in ye sides all these symps shew a spasmodic stricture, on ye Extremities & a determination to ye Lungs ye Blood spit up is sometimes Florid sometimes of a Darkish Colour & some pretend to say it Comes from ye Lungs when florid & when darkish Colour'd from ye fauces but the Colour depends on ye shorter or longer retention on ye Lungs we can form no Judment neither from ye floridness whether it Comes from The Arteries or Veins There is a Considerable Difference between ye Blood of Arteries & Veins but in ye Lungs ye Veinus Blood a rather more Florid a spitting of Blood is attended with a satinate Tafts in ye Mouth & a tickling in ye fauces if but little Blood is spit up ye Cough is sonorous but when ye Vomitting is large it is Obscure a more like a Vomitting of Blood & sometimes tho very Rarely the patient is suffocated he shoud be kept Erect in Bed to prevent this when there has been a large discharge ye Oppression & Dyspnaa wears of & the pain too if there be one when ye Hamorrhage is Violent it is then followed by Weakness paleness. Coldness, & a weak Smal Pulse but wt. Pulse cant be depended on in these Cases as the Fear is quickens it 30 or 40 in Minute it is followed also by pains in ye Stomach & all ye Dejestive powers & sometimes by Plshae Pulmon but this Seldom happens Hemoptoe is often Complicated with Phthoic Pulmonalis & is not ye Original of this disease When ye Blood has remained. a Longtime in ye Lungs it is spit up in ye forms of Phalypis from ye shape is often Mistaken for Branches of ye Pulmanory Artery Hemoptoe from External Violence is dangerous according to ye Effect is has upon ye Lungs if there be only a Rupture from a Vessel there is but little danger but if Inflamation is produced ye Consequence is often fatal Causes The Phthisical period of Life is between 16 & 36 Children, that have been subject to nasal Hamorrhages generally are troubled with Hemoptoe, this however is not always ye Case All Predispersing Causes of Phthsis maybe Reckon'd such of Hamoptae, those who have Remarkable feverishness at Night are remarkabley subject to it Hemoptoe like other Hamorhages is most frequent in spring & worst in Frost snow & Rains People that live in high Situations more subject to it Hemoptoic people then shoud Live in low vitiation & not go to ye tope of high hibs, the Cause of Cough may produce it, plethoria induced by high living & want of Excercise but particular that From Suppresd Usual Evacuations or amputation of a Limb whatever Quickens ye Circulation & determines a flux of blood to ye Lungs may produce it Crying, Running Quick & Violent Passions Streaking in & Externall Violence Strokes Wounds & Exteraneous Bodies in ye Lungs there has been Cough Hemoptic & a purulent spitting Yet when this has been spit up notwithstanding ye Loration & Ulcerations produced by it the patient has Recovered Hemoptoe is symptomatic in Putrid Fever Plaugue & ye last Stage of Scurvy Symptomatic also in Inflamatory Fever Affecting ye Lungs in Phthisis Pulmanatis, often when there are latent Tubercles & Vernica, but seldom were there in Ulserations it is Symptomatic at so in Dropsys So here a Mortall Symptom Also in Cateanious Concretions in ye Lungs The Event here depends on ye Size & situation of ye Calculi, it is Symptomatic too in Obstructions of ye Abdominal Viscera particularly Liver & Spleen & is here a Mortal Symptom Cure The Indications in general ye same as in Narval Hamorrhages Bleeding When Hamoptoe has a Tendency Phthisis as there is generally Fever Inflammatary diathesis a Buffy Coat upon ye Blood hence Repeated Bleedings is ye best Remedy People Subject be hemoptoe shoud les Blood in spring & Autumn Especially in ye Spring from the Peculiar Tergescensy & Orgasm in ye Symptom at that time Pediluvum Ligature friction &c When ye Hamorrhage is Violent those Remedies which insite a Flux of Blood to ye Extremities and takes of Tension from the System must be Used, 2 Astringents Cant be used so Freely as in Nasal Hamorrhages they promote Coughs increase ye Disease & when theres Inflammatory Diathesis then are very improper. Especially the Bark Cold Water has often Curd Violent Hemoptoes this is Mention'd by Hofman & Van Sweiten Balsams all of them Agravate the Disease for they stimulate, & I know no Case of Hemotoe from any Cause where Stimulants are proper Regimen the same as in Hamorrhagis Narium when ye hemotoe proceeds from External wounds & ye patient is plethoric too low a diet Cant be used Anodynes sometimes necessary not only to take of spasms in generall but when there is Cough. to Abate it likewise as it increases ye Hemorrhage Issues often of Service in habitual Hemoptoes in ye same way as Repend Bleedings but in a less degree Vomits it is lay'd anon as a Rule never to use Vomits in an Hemoptoe, now it Often happens in a threatened Phthisis there are Evident Indications for them & I never saw them of disservice but on ye Contrary of ye Greatess Advantages where ye Pt. has spit Blood Every Day however they shoud only be used while ye Hemoptoe is Moderate & never when the Blood is discharg'd Like Vomitting when ye Hemoptoe Proceeds from wounds we shoud be Carefull ye Wound dont heall too soon as this often proves Fatal Vomitus Cruentus Is attended with straitness & Anxiety about ye Precordia with great Tension, Vertigo & frequent Fainting is sometimes with delerium & sometimes Rigor Shivering & a degree of Fever This however not so Common as in other Hamorhages the Blood is thrown up with greater strains than in Common Vomittings ye Appearance of it Differs according to its Remora in ye Stomach it is generally Coagulated, this Hemorrhage is more attended with faintness than any other it is always attended with a Degree of Sickness and faintness & upon a great disharge ye 2d generally faints this is ye most Common Speceis of hamorrhage & ye most Fatal because it often happens in Consequence of Obstructed Abdominal Vicsera Especially Obstructed Livers & spleen but when but when this arises from suppression of Menses And is periodical it is attended with little dangers Infractions of ye Lungs Liver & spleen & they are more subject to it between ye Age of 60 & 70 & it then generally proves fatall another Cause of it in Women in pregnancy For by ye Violent Vomitting which occurs at this time a vessel is often sure in ye stomach or Osophagus to prevent this however they shoud be bled plentifully & Repeatedly it sometimes happens in Quartains & proves fatall healing of old Ulcer & Issues will sometimes produce it External Violence & Violent passions. Lieutaud Mentions its being Epidemic, Formerly on Dessection of Bodies that have died with this Disease, besides ye Accumulation of blood in ye Stomach the Veins there was found Distended & Varicose, & ye Spleen, Pancreas & Liver. Distended with Blood & ye Gall Bladder with Bile Cure Founded on ye Same principals with that of Other Hamorrhages however some Remedies used in Other Hemorrhages are Contradicted here Bleeding This is forbid by ye great faintishness & when ye Disease arises from Infraction of ye Abdominall Visera V.S. is of no Services it Can only be usefull when ye Disease Arises from Inflammatory Diathesis & this is Mostly Produced by pregnacy & suppressed Menses Astringents Can have but little place here they Stimulate & increase ye Hamorrhage Cold Water has Cur'd & seems to be one of ye best & safest Effectual Remedys Regimen, Shoud be mostly Cooling & Antiphlogistic Repd Glysters shoud be used to bring Away ye Blood in ye Intestines Chathartics are Are Recommended for this purpose but they are Dangerously Applied Especially ye Acrdonic Cathartics shoud never be used till the Hemorrhage has been stopt for 2 or 3 Days And then if there great Sickness & Signs of Accumulation in ye Stomach gentle Cathartics may be proper Hamorrhoidal flux It is to be consider'd either as Critical in Diseases or a salutary Evacuations in Health it is internal or External ye inturnal has been Mixtaken for ye Bloody but in ye Dysentary there are Gripes sickness as Affections of ye Stomach & in Hamorrhoids there is no pain after the discharge is begun ye Blood in ye Hamorrhoids comes first with ye stool in ye Dysentery generally last & is intimately fixed with ye Faces When ye Piles are External they swell & produce A good way From ye Anus & after they burst thers no danger from ye Evacuation ye Internal ones comes on sometimes without any Preceeding Symps sometimes with ye same that preceed other Hamorrhages sometimes they are Symps of Congestions in ye Vicera Pains in ye Back particularly in ye Os Sacrum Coldness of ye Extremities Shivering flatulency & often Nausea Urine in a small Quantity & of a pale Colour & with A slight Degree of fever often a sence of feeling a tension in ye Rectum are markable of Stiffness in ye Limbs & Vertigo. The Blood in Internal Hemorrhoid is passed only by Stool of a Black Colour & Congeald often & as been Imagin'd to be a Dispersion of ye Morbid part of ye Blood but this is without foundation Causes Men more subject to it then Women & generally in ye Decline of Life at least past 36 Sanguine plethoric Habits more subject to it & those Especially that incline to ye Melancolic Temperament & this may be there as on why the Spainiards are most subject to it people that have been subject to hamorrhages before are most liable to this it appears to be connected with ye gout & Stone hereditary dispositions in another Cause & when this is ye Case it makes an Appearance in Children about 7 or 8 yrs. Old Rich dense blood another Cause Riding verry hard for a long time or Violent Running Pregnancy is a very Common Cause and in ye last Month Women are verry often trobled with it that were never liable to it before Labor pains & strains bring it on Stimulating Cathartic & particularly Alloes promotes ye piles hence ye propriety of using aloes when you want them to Come down Costiveness Habit no Hemorrhage becomes so frequent by Custom or so salutary as this Venereal Dis these how or often produce the Blind Piles in fractions of ye Abdominal Viscera particularly ye Liver & spleen & inflatations of ye great gute ye Hamorrhoids are often Extremely salutary more so than any other hemorrhage because they happen in a time of life when people are liable to Obstructions in ye Viscera they are salutary too in hypocondriac Complains Madness Gout Ischious Cholics Automatic Divnder Catarrhs Suffocation, & Bloody Urine a supression of them when Periodical Produces these diseases they are however in general a preservator of health in ye Decline of Life it is however a dangerous disposition in A youn person as it is so difficult to be regulated this Evacuation of Blood in ye most easyest of all others to be born the quantity discharged is generally two or three Ounces at a stool but 4 or 6 Pounds how's been discharged in 24 Hours, The External Hemorrhoids are not so apt to bleed as ye internal & when they do not they are no more Vaucous swellings of ye Hemorrhidall Veins sometimes however with Violent pain & Inflamation & they sometimes ulcerate ye pain produces a Variety of anomalus Complaints & sometimes Convulsive fits sometimes theres no Inflamation nor Pains, Cure In general is to be Considered as salutary on Criticall & no Application shoud be mode to stop it unless it be verry Violent & here ye same same applies as in other hemorrhages however it is to be observ'd no hemorrhage is stop'd with greater danger than this I woud Recommend Repeated small Bleedins & low diet, with a total abstinence from fermented Liquors Hamorrhoid's Coci If they do not burst themselves they shou'd be open'd by Leeches or Lancets warm fermentations promote the Breaking, Where there are symps of Congestion in the Abdominal Viscera we shoud never endeavour to repel them as there is ye greatest pain in times of Stool we shoud Constantly keep an open belly and this with such Medicines as Stimulate ye last as Sulpher Glysters if ye Pt can bear it a Glyster of warm water or oil or Infux Lini guives Releif Reppellents In general Dangerous ye Juice of a Roasted Citron drops upon ye piles guives Great pain but if outward sometimes often Cures Limit Hamorrsho.) Phar Paup.) guives releif when they are hard & without pain nothing answers better than Rubbing them with Mercurial Oint. and some times when they have protruded a great way they have been Exterpated, Method of producing ye Hamorrhoid Youl find thers always more necessity for producing than Expelling ye piles for this purpose alone shoud be used just to keep ye Belly open but nor purge sitting over ye steam of hot water. Fomentations Acrid Glysters suppositiores of Honey a common Salt promote them when they appear they shoud be rubd with a hard Cloth or with Fig leaves Bloody Urine It is sometimes thought Difficuts to be distinguisd from high Colourd Urine but it is passed always opaque & high Colour'd Urine clear high Colour'd Urine when it has stood so long as to let fall a sediment by heat Recovers its Transparency but bloody Urine is always opaque & its Sediment has ye Appearance Grumous Blood Bloody Urine too tinges Cloth red when ye Blood Comes from ye kidneys it is in great quantities & with pain Except in Cases of Calculous Concretions it Coagulates often in ye Ureters & is passed in a Uniform appearance when ye Blood Comes from ye Bladder its in verry small quantites with great heat & pain faintness & Coldness of ye Extremeties it is disease when it Arises from an Internall Cause in ye Constitution peculiar to ye Decline of life after 70 the Blood [crossed out] sometimes Coagulates in ye Bladder & produce than Obstinate Ischuria In Case of Grumous Blood in ye Urethra & Bladder producing difficulty in passing water Injections of warm water in to ye Bladder are proper & if these do not answer a Catheter should be use'd Causes The same generall Causes as of other Hamorrhages as sanguine Plethoria & when this is ye Cause it comes from ye kidneys without pain it is sometimes as Critical in Ardent fever but is seldomer Critical than any other hemorrhages people that have been subject to hamorrhages are most liable to it suppressed sanguine Evacuations produce it also External Violence Vomitings Riding & in Children straight Clothes Bandages & stays sometimes it is bought on by Excess of Venery & sometimes by Calulous concresions in ye Urinary passages it is often symptomatic in fever where thence a putrid dissolution of ye Blood as in Scurvey smallpox &c, & is a fatal symptom in these Cases large doses of ye Bark with Mineral acid Red Wines & Rosar must be Used Blood is sometimes passed instead of Semen, it sometimes distills thro ye Urethra as in Gonnorrhea Hamorrhages from ye Bladder happen in old people & become periodical like ye piles Bloody Urine has been passed in Consequence of a Worm in ye Bladder Bury Mentions an Instance of a persons having Bloody Urine 5 Years from this Cause which Ceased upon ye worms Coming away Acrid Stimulating Diuretics particularly Cantharides will produce it when this is ye Case Dilulent Muscilaginous Drinks shoud be used Infractions of ye spleen & liver & other Abdominall Viscera will produce it Aloi Fluxus Gen 1st Vomiting This sometimes happens without any previous symps generally however ye Contrary the most Common are Nausera Cardialgia weight oppressions strictures ye Stomach frequent Spudderings & Sallivations this last in one of ye most Universall symps & happens in every Species of Vomitting there are also Vertigo dimmness of sight headach & Especially a Hammirania & a pain in ye Eyebrow & Eye bals Lassitude trembling of ye under lip this happens in every speices besides theres a bad taste furred Tongue thirst, & Dryness of ye Mouth very often a pain & food of Stomach And want of appetite some of these symps proceed every Vomitting Children Vomit more Easily than old People very full people Vomit with more strain than others Causes The Content of ye Stomach over Eating indigested food in ye Stomach putrid Bile or Viscid Colluires of any sort ye vomiting from these Causes are always preceeded by ye bad taste dryness of the Mouth & headach 2d too great as quanitiy of Milk in ye Stomach of sucking Children, this sometimes is not attended with sickness Children Cant judge how much is proper & nature provides for ye superfluous quantity when in by Diarrhea or vomiting which is verry casey anything too thick occations Violent Emotions in ye Mind in Nurses, affects ye Mind in such a manner as to produce vomiting in Children & sometimes Convulsions which prove Mortal 3d teething the Vomiting that occurs at this time is sometimes nervous, but often Varien to ye swallowing a great quantity of Saliva produced by ye Irritation 4th Worms 5th Artificiall Emetic's under this I include Poisons That produce Vomiting 6th Schiorhus Pylorus or watever present free Egress from ye Stomach to ye Duodenum in this Case ye pt Vomits 3 or 4 hours after Eating thus Cause Can only be guest at the when ye Pt. lies upon his Back there is often a hardness about ye part 7th Vomiting is symptomatic in hipocondriasis topical Affection of ye Liver, spleen Pancreas & Neighboring parts & Calculous Concretions in ye Bilary Ducts 8th Ulcers in ye stomach 9th it is symptomatic in pregnancy begins 10, 12, or 14 days after ye Menses is stop & Continues till ye Child Quickens in some Cases tho ye whole of Pregnancy it is most severe in ye Morning from being at that time little upon ye Stomach but as it seldom happens before they arise 2 or 3 Tea cups of Tea or anything else that is agreeable before they get up will Render it Easier 10th it is Symptomatic in Calculorous Consecretions if the Kidneys & Ureters 11th Obstructed Esophagus 12th Symptomatic in violent wounds & Contusions of ye head 13th Symptomatic in Abeacssassion 14th Certain Motions of ye Body will produce it as walking Sailing Riding Backwards &c 15th it is Critical & symptomatick in fevers 16th Morbid Acity in ye Stomach this is Distinct from what is Called a foul stomach it is Commonly in weak stomachs & those of great sensibility 17th Imagination answering another person Vomit smels on doity stones 18th Violent passion particularly Angers in this it is generally Bilious & Originous 19th pains & nervous Affections in different Parts there is no part Violently pained but what may Excite it in sensible habits, to this we may od ye Vomitting produced by Irritation of ye fauces & smoking tobacco 20th Metastatic repelled Gout Exanthematas 21st sometimes periodical in this Cases it is a salutary Evacuation 22d Vomitting is sometimes produced by pressing in of ye Cartilage Enisformis Proximate Cause A Convulsive Contraction & invented Peristaltic motion of ye stomach & Duodenum, which a Consultion of ye Diaphragm & Abdominal Muscles Cure The indication here is first to increase ye Vomitting if salutary 2d Remove ye Exciting Causes 3d Independent of any Exciting Cause We may try to take of The present spasm of ye Stomach for this Vomits are Employ'd & ye old aphorism applies here Vomitice Vomitus Curatic when Vomitting proceeds from a foulness in ye stomach warm water is proper but Camomile flower Tea much better if ye Pt can drink it Vomitting is very dangerously used when ye Vomitting arises from Violent passions. Vide Hoffmans, in this Case nothid Acid or Stimulating shoud be used when from poisons Especially from ye Saline kind large quantites of Warm water are proper & there may be mixed with Bil All Musilaginous Drinks are proper Purgatives Can have no Effect in ye time of Vomitting, yet purged is necessary to prevent ye Vomitting arising from foulness of Stomach Aloes & Elis Sacrum are best. Bleeding Sometimes necessary to prevent ye Bad Consequence of Violent Vomitting, & in pregnant Women [g] it seems Rather to stop it Testaceous Powders when the Vomitting arises from ye Morbid Acidity ye Testaceous Powders are proper & Especially them that are laxatives as Magnes alb, Stomachics When ye Vomiting Arises from ye weakness of ye digestives powers Stomachies must be used as Gentians & the Bark & there shoud be joined with Rhubarb & Aloes, Elix of Vitriol is also a very good Mede to strenghen ye Stomach but Constant use of bitters is very hurtfull as I have observed before during ye Vomitting Sal Tart with Vegetable acid maybe used & shoud be guiven in ye Act of Effervessense this is however often Vomitted up & then we must have Recourse to Antispasmodics & Opiates. Opiates however shouldn’t be used till ye Stomach is Cleansed ye best antispasmodic is Musk. Wine boild up with Spices & Mint Tea is proper External Applications Warm Cataplasms of ye Aromatic kind sometimes stop ye Vomitting when App,d to ye pit of ye Stomach Laudanum may be appld Externally & with good Effect. Aether also & ye best way of Applying this is to dip it upon Cottons & hold it upon ye part with ye hand when the Spasms is great Semicuptium to as been Used and Has remov'd ye Disorder & is ye best Antispasmodic, to this head we must refer Pediluvium, warm fomentations to ye Belly & Glysters, it is Necessary ye Belly should be kept open for Violent Vomitting with costiveness often produces Illiac Passion. Immersion of ye hands in cold water will sometimes stop the Vomitting All Convulsive Motions are stopped by sudden Emotion of ye Mind Astringents Earthy astringents are verry offensive & in most Cases Irritate & encrease ye Vomitting rather than diminish it ones of ye best things in common Causes is Cinamon Water. Regimen in people subject to Vomitting Shoud be of ye Evient Digestion & ye greater Degree of quiet both of Body & mind is necessary A good strengthener of weak stomachs is small quantities of Coldspring water this is often proper for pregnant Women of all Wines to strengthening the Stomach good old Claret is ye Best but this does not agree in some Stomachs & produces Costivness in this cases Maderia may be used which is next best of ye Mineral waters ye steel mei are ye best, Piermont Scarborough & Bristoll Sausages break of Nausea as different from Vomitting but as it proceeds from ye same Causes & it treated in the same manners this Distinction is Neeedless. Cholera Morbus This is a Violent Vomitting & purgin along with Gripes & Tenesmus it comes on generally with out any proceeding Symps sometimes however with sour Nidorus Belchings pain in ye stomach & guste Cardialgia & Anxiety about pracordia ye discharges are Billous & attended with Inflations of ye Stomach & Gutts Cardialghus Great thire with small Unequall pulse great Internall heat Anxiety & Nausea Cramps & Spasmodics Contractions of ye limbs hiccup & Sweatting, this last is merely symptomatic From ye Violence of ye pain, when Disease has Continued for some time there is a faintness Coldness of ye Extremeties a stoppane of Urine a Convulsions it Carries ye pt of sometimes in 24 hours & it seldom continues longer than 2 or 3 days but if well treated not Commonly Mortal, it is not Contagious ye Vomitting & stools are sometimes Eugineous & often so corrosive as to bring blood along with them sometimes when ye disease in going of or before it comes on other are symps of Cholera Sicea Causes This disease happens mostly in Billious Constitutions & in Autumn & then at that time more on life Epidemic in warm Countries it is often Epidemic it has been supposed to arise from Eating large quantities of fruit but this is a Mistake for fruit has been found to Cure it. It arises from first a Redunancy & putrid Acrimony of ye Bile 2d it is sometimes ye Effects of Violent Emetics & Catharics, & of Poisons that opperate in this way 3d it arises from surfeits, in this Case it is not attended with The same Violent Gripes & Billious discharges And very soon Cures itself 4th from passions of ye Mind particularly Angers ye discharge here is Constantly Billious in this way it is communicated from nurses to Children 5th from immoderate quantities of fruit this is not attended with Violent Gripes Tenesmus and Burning heat 6th it is symptomatic in tertians & sometimes quartans it goes of when ye fit Comes on & is Cur'd by ye Bark 7th from worm & 8th from Repelled Gout 9th Sauvages Moritions a species & quottes Bellonus attended with at ye symps of Cholera Morbus, that was Cur'd by ye Applycation of Red hot Iron to ye fat Disections of People who have Died of this discover, ye Stomach & Duodenum are found inflamed a Gangrened & all ye Marks of Redundancy of Bile with ye Biliary Ducts grately Dilated this pointed out ye proximate Cause Cure The indications are 1st to attempt to Discharge ye Morbid Matter producing ye disease 2d Imoderate ye Violence of ye symps to swift nature to Throw of ye Morbid Causes ye Vomitting & purgin must be encouraged plenty of warm water weak Broth or any Duluting Liquors not only dilute and discharges ye Morbid Cause but Mitigates ye Violence of Vomitting Cold water is recommended by Celeus Colius Aurelianous & Hoffman water with about & light of Milk may be used here & buttermilk is recommended by Tassett small Lemonade may be used with ye same intentions Emollient Injections of warm water & lineseed Tea greatly Releives ye Tenesmus which is ye most Troublesome symptom they shoud be guiven at least Every 2 hours a Pt seldom retains them above 2 Minutes yet notwithstanding this they afford Considerable Releif When ye Bile seems to be discharged & ye Strength much Exhausted ye Vomitting maybe stopd by ye salines Mixture taken in ye State of Effervescency Bleeding tho this has no place as a Remedy of ye Disease yet it is sometimes Necessary to prevent ye bad Consequences of Vomitting & Belching which might Induce Hemorrhages & Inflammation Vomits & Cathartics tho ye Vomitting & purging shoud be encouraged all Artificial Vomits shoud be avoided there are instances of many bad Effects being produc'd by them & they shoud not be used for 2 or 3 Days after the disease is removed Everything that is Acid or stimulating is improper the only Cathartic that Can be guiven here without danger is ye Decoct Tamrind Manna tho a gentle purgative is very improper it forments in ye Stomach & increases ye Gripes Semicupium This used for about a 1/4 of an Hour greatly releives all ye Complaints & a Pt at this time will often pass Stools Easily Opiates When ye Vomitting must be Stopped after ye Saline Draught has failed Opiates must be used & if with Judgment theres no danger from them & ye Pt. Recovers they Cant however be used till ye Bile is Evacuated. Bark The Cholera Morbus weakens ye Bowels greatly & there is no Better Corroborant at ye End of ye disease than Bark Dysentery & Diarrhea There is great Confusion in Authors on this subject. I shall Enumerate ye severall species of diarrhea as we have em from them 1st ye Caliaea when ye food passes indigested but mixed whith Chyle 2d when ye food passes perfectly indigested it is Licnteric 3d the Thius Hepaticus a discharge of ye Bloodsy water with pain or Tenesmus 4th ye Morbus Ingers when ye Stools are Black 5th Tenesmus this Consists in a Constant inclination to go to Stools with a Discharge only of Mucus Distinction The Common Notion of Dysentery is a bloody Flux attended with gripes of Diarrhea a flux with Blood a Diarrhea arises from Common secretional Causes is not Contagious or Epidemic & stools not often Bloody it is not dangerous & Easily Cur'd ye Dysentery is Epidemic & Contagious with Violent Gripes & Tenesmus in Consequence of which there's a discharge of Mucus & ye stools are generally Bloody I own however it is difficult to Distinguish them Accurately Diarrhea The stools here are sometimes Serous sometimes Billious & sometimes tho very Hardy Bloody in general not attended with fever & it is often Carried of by Diaphoresis Species 1st from ye repletion this is to be Considered as ye cause of a disease to this head we refer ye Diarrehea from altirfeit of fruit or drinking Fermented Liquors 2d that which happens in Fevers & other disease it is sometimes Symptomatic & sometimes Critical in Fevers it sometimes Carries of dropsy when Criticall it is presaged by a intermittent Pulse & Diarrhea inflammtun arises from their taking in a Greater Quantity of food than they are able to Digest ye younger they are ye more subject to it ye Diarrhea which occurs at ye time affecting arises from ye Nervous Irritation being communicated to ye Intestines or from ye swallowing Saliva, this prevents Children from being subject to Convulsions 4th periodical Diarrhea this happens mostly in plethoric People & is generally Salutary 5th that from passions particularly Anger this is Always Billious 6th from Violent purgatives & poisons 7th from suppressions of usual Evacuations particularly Menses or that which Happens in pregnant Women this is often Bloody & is a Salutary Discharge a Diarrhea arises too from Catching Cold this happens in people of weak stomachs and wet Feet is a frequent Cause 8 Abscesses Ulcers & Obstructions in the Guts & parts Contiguous to ye Gutts 9th it is sometimes brought on by this 10th a Diarrhea sometimes arises in Consequence of Cuttting for a Fistula in Etna I have seen 3 Instances of this & it always proved Mortull 11th an incontinence of Stools without there being liquid is mentioned as a species by Savauges 12th from gout Expelld or not Expelld 15th Colliquative Diarrheas. Common in ye last stage of [?] Pulmonatic & in all interall Ulcers it Comes on & has been Criticall from ye Matter being Absorbed & Carried of in this way 12th that which arises Worms 15th that which in ye Consequence of a long Continued Dysentery this seems to arise from Aloma ye Dysentery has Occationed, it is often ye Ticnture a very Obstinate 16th Diarrhea is often ye Epidemic in paris from drinking segan Water & peculiarly attacks strangers Proximate Cause Diarrhea seems to arise first from an Increas'd determination of fluid to ye Intestines which may be ye Consequence of Externall Spasm) which may be ye Consequence) as from Catching Cold or internal Stimulus, as Acrimony in ye Bowels 2d an Increase'd secretion of Mucus in ye Intestines which may be occationed by Acrid Stimulus Bilious Atonia 3d an Increasd Peristaltic Motion of ye Gutte 4th a Lessoned Absorption Cure The Indications are first if ye Diarrhea appears to be Salutory or Periodicall ye Consequence of a Surfeit Criticall in fevers or to Releive the Symps to Encourage it 2d to Expell ye Irritation & Matter that occations ye Increased Secresion of Mucus For this purpose Emetics & Cathartics are proper 3d to Correct the Acrid Matter or Sheath ye Intestines by Mucilaginous Med.s & Dict 4th So strengthen ye Intestines when ye disease arises from Antonia 5th to quiet symps or to moderate them a 6th to Determine ye Morbid Cause to another place hence ye Use of Diaphoretics 7th to remove ye Exciting Causes in whatever Part of ye Body it happens to be situated This depends upon ye particular nature of ye Exciting Cause The Observations I have to make on particular Remedies I shall refer till I speak of ye Dysentery I shall now proceed to ye general Method of Treatment of ye severall Speices of Diarrhea above Enumerated 1st when a diarrhea arises from a Repletion Crapula Eating immoderate quantities of Fruits or anything Effensive to ye Stomach This must be Expeld & for this purpose an Emitic with a dose of Rhubarb next day is very Effectual & must be sometimes repeated Several Times ye preference guiven to Rhubarb here is owing to its leaving ye greatest Astringency behind of any Cathartic a vomit too Determines to ye, Skin if ye Gripes be severe Opiates must be used at night to procure Rest be never till the Acrid matter is Evacuated 2d when symptomatic in Fevers 3d In of Diarrhea that attend theething there is always a Morbid Acidity, fences Testacea are ye most Effectuall Remedy & Magnesia when it does not purge much is ye Best for it not only Absords ye Acid but by being purgative Carries it off likewise Chel 6g & Chalk are used too but they seem to be too astringent & it is often necessary to interpose Rhubarb 4th when Periodicall it goes of it self & is salutary 6th when from passions Vomist are dangerously used or any thing that Irriates 6th when from poison Emetics or purges we must Expell or dilute them & sheath ye Guts with Oil & Diluting Liquors, If ye Poison be very Acrid & there be fever, with Violent, Gripe then V..S is Necessary as ye gutts Are of all parts ye most liable to Gangrene 7th when from Catching Cold or suppressed usual Evacuation V..S is often the only Cure sometimes however when from Cold lying in bed sweatting by Aphoretics will Cure without purges or Emetics 8th when from abscesses &c, it is generally Fatal here we can lay down no Indications from our Ignorance of ye part Affected 9th when from Violent Excercises after meals we shoud avoid such Excerises & Bark to strenghen ye tones of ye Stomach is very proper 10th when from Cutting For ye Fistula in Ans no Indication Can be Formed in Cases I saw Opiates lessen'd ye flux 11th Incontinency of Stool Depends on Atariea & is cured by Astringents. Especially ye Semi roubi & Bark 12th when from ye gout it must be heal'd with gentle doses of Rhubarb, Diaphoretics & a prudent use of Opiates 13th Colliguative Diarrheas Can only be Checked by Opiates 14th when from worms such Meds, shoud be used as Expels Worms, as Puls, Stammi & Mercurials 15th when from Atonia, Bark Semirauba good Old Port & Claret, Excercise, Cold Bath & what Ever tends to Invigorates ye habit of ye Body 16th When from drinking Seyner water an Abstinence from it is Necessary Dysentery Begins with Coldness shivering suceeded by heat and fever attended with dryness parchedness of ye Skin Violent Gripes slimy stools & more or less Blood, but there are instances of ye other Symptoms of Dysentery appearin without Blood there is great pain in goin to Stooll & a feeling as if alle ye gutts were Coming down great thirst. Tongue Cover'd with thick Mucous which is sometimes Black & dry Tenesmus & Procedentia Ani this is ye most Troublesome symptom & in Children the gut in often Obliged to be pushed up after Every stool there is great prostration of strenght & Spirits aptha sometimes appear & are a Mortal Symptom. Nausea & Vomiting Cardialgia with ye Stools that are passed often little Glandular & fatty substances hiccup Occurs in all ye stages, but when at ye End 2 is a fatal Sympn as it shews Gangrene towards ye End of ye disease ye Paient. is Affected with delerium convulsions & faintings Dysuira is a verry Common symptom & sometimes theres a total suppression of Urine, ye Urine is sometimes so Acrid as to give great pain in passing when ye patient has laboured for water under this Disease & has used nothing but liquids hard Sey Sola are passed which appears to have loged in ye Intestines from ye Beginning of ye disease worms are often passed both upwards & downwards ye stools are more or less fatid as ye disease is more or less of a putrid kind at ye End they are very fatid & Contagious Especially when theres a putrid fever & gangrene Ulceration are known by putrid stools Flatulency Borborygmi are frequent thro ye whole Course of ye disease but sometimes towards ye End to such a degree are to produce Tympany no disease is so subject to Relaps as ye Dysentery, Billious Autumnal fever of End in Dystentery, & dystentery in a low & Malignant fever when ye pain is in ye Umbilical Region & gripes preceed ye stools a considerable time we may suppose ye disease in ye small Gutts, But if ye pain be in ye Ipegastric or Hypocondriact Regions and ye stools immediately follow ye gripes there is Reason to think ye Colon is ye Seat of ye Tenesmus be Incessant & ye pain in ye Os Sacrum ye Rectum in generall is Affected. Cadaverous smell of ye stools Remission of pain small intermittent pulse delirium & Coldness of ye Exetremities are sympe of gangrene, after a Dysentery there is often great Diarrhea weakness of ye digestive organs Languor Leucophlematia swelling of ye Eye & often a Remarkable tenderness of ye Belly so great that ye Pt. Can hardly bare ye Bed Cloathes to be upon it Proximate Cause This seems to have a great Affinity with ye Billious Remitting Fever they are produced by near ye the same occational Causes & have Simular Sympe. & frequently pass into one another The Putrid Dysentery Corresponds with ye putrid fever in being highly Contagious & Infectious this is ye Distinguishing mark of all putrid disease attended with Fever Dysentery proceeds proceeds from putrid Acrimony which may be generated either first into ye Body 2d Communicated by Contagious Miasmata Atumnall Dysentery seems to Arise from ye putrefaction of ye animal Humours &c for it is induced by every thing that Induces putrefaction & is also highly Contagious The putrid Acrimony from which it proceeds may Be either generated in ye Body or be Caused by Putrid Effluvia from Corrupted substance Especially of Faces of dysenteric patients both Dysenterys & Billious Fevers are Epidemic in ye same season after great & long heats succeeded by Cold & Moisture towards ye End of ye Disease ye whole force of it seems to settle in ye Colon & Rectum Spring Dysentery has much more often an Inflammatory Diathesis, On dissection ye Gutts Especially ye great ones have been found eroded & Ulcerated, but mostly ye Coats are thicken'd much Indications of Cure these seems to be ye same as in ye Diarrhea only ye First there hast no place here the next to Expell ye Acrid matter Contagion does not seem to be universally ye Cause in these Climates Bleeding doth not properly belong to this Indication but I shall begin with it, it has only a place in ye spring Dysenteries unless ye Pt be verry plethoric or ye Fever Run high in some Epidemic Dysentery bleeding has been found of great Service Acorrding to Sydenham there again Remark it has been Attended with ye worst of Consequences Ratis Symptomatum ye Borborygmi a Seybala shew the Expulsive force of the intestines is weakened Bloody Stools arise from motions on a disolved state of ye Blood Vomits are of ye utmost Service both as a Necessary Evacuation & a powerfull Determiner to ye Skin they also increase ye peristaltic Motion of ye Alimentary Canal & there are innumerable Instances of Diarrhea being Cur'd by Vomit alone Ipeacuanha has long been look'd upon as a specific in Dysenteries, but lately several Eminent. Physicians have preferred Tartar Emetic for my own part I think there is no materiall Difference Emetic Mede. given in very small doses & repated, almost Entirely superceeds ye use of Cathartics experience has taught that Emetic Tartar is full as Efficatious a Ipecacuanha & is much less disagreeable ye latter produces an oppressive unsufferable Sickness or Nausea than that is well known to people that have taken them both & few or more will bear this Effect of Ipececuanha Cathartics Rhubarb is most used but when there is a putrid Colluises salts are less Stimulating & Occation a more Copious discharge All sweet purgatives are Reconed to increase ye Gripes & therefore are Condemned by Hoffman &c. in this Disease The Sal Catharticum Amarum disolved & given in small but frequent doses are ye most Efficatious remedies in ye Dysenterus. Aloes Scammony Colseynth & all Drastic purges are Universally & Justly Decryed by all Authors - Rhubarb and Calomel is of very singular Advantage Especially were there happens to Worms in ye intestinal Tube Calomel Joined with Rubarb oft Answers ye Intestion of Expelling Seybalas very well. The quantity of stools in a dysentery seldom bears any proportion to what is Evacuated in an ornary Diarrhea ye small Glabular fatty substances sometimes observd in ye facties of Dysenteric patients & supposed to be ye Glands of ye Intestines are nothing more than Coagulated Milk or Cheese in one Epedemic described by Sydenham purgatives were Prejudicall & Opiates only of Service Vitrum Antimonii Centarum Was formerly much used as an Emetic purgative & diaphoretic it was Esteem’d by many as a Specific but is now laid aside 3d Indication of Cure is answer'd by Diluents which are of very great service Especially if they be of ye Mucilaginous kinds as to ye next that of Correcting Acrid matter, I am not Certain of any Acrimony being here however there seems to be something of this sort of ye putrid kind & indeed I am apt to think Iuigeneric Testancous podders & Roles have been adminstred to Correct & Absorb this Acrimony but were there is a Tendency to putrefaction they do much Mischief Acids however are found of great service in these Cases Especially in ye warmer Climates Diet this shoud be of ye Mucilaginous kind as all farinaceas Jalep, all ye drinks out to be gratefully Acidulated ye decoctum All answers very well where there is no Symps of putrefaction Everything Acid & Stimulating is to be Cautiously avoided & great purity of ye Air is of ye utmost importance to ye Welfare of Dysenteric patients, where ye Disease is owing to ye Acrimony of ye Bile Dilution answers best; We come now to our fourth Indication nothing is Attended with worse Consequence then ye premature use for Astringent in Dysentery they occation Aptha & Inflamation & it Consequences & a Spasmodic Contraction affection of ye Intestines yet after ye Morbid matter is sufficiently Evacuated & ye flux still Remains Excessive Astringent Glysters in small quantities is Extremely Proper interposing now & then a proper Cathartic ye Astringent is used Cheifly in Dyet. are ye Decoction Album milk & water red wine & water boil'd with Spices Seminroutba & Cavearilla hath also been much Used with this intent and very successfully Comfort Fracash Plecke Seno: Confi: Japons: Tinct: Japon Ex: Ligne: Compact: are ye best kind of Astringents Lime water is only of use where there is an Acidity in ye Primae Viia Lapis Calamin, has also been much used so highly recommended but of these kinds of Medc. ye Bark with Bitter Aromatics is by much ye best as it Acts with a powerfull Antiseptic. & Tonic In ye 5th Indications Opiates are Chiefly used to releive ye pain Check ye Flux & promote a Diaphorisis they They shoud not be ventured upon till all the putrid Colluires in ye Gutts Causing ye Irritation be Expeld & suitable purgatives shoud be interpos'd every now & then during ye Use in ye Last stage where they are necessary for Checking ye flux &c, Dovers powders are most Effectualls Cataplasms of Therica are also of Service in Cases of a fixed pain in any part ye application of a Blister will answer very well strong Camomile Tea releives ye pain suprisingly Wax has beens Guiven in a Vast Variety of Ways Animal fat Disolved in Milk is more seviceable and agreeable than Expressed Oils which are arpt to becom Ancid & Acrid in ye Stomach & Bowels the Gripes are Migitated by frequent Injections of Any bum Infus. Liny with Liquid Laudanum to which we may add ye Tinct: Rhei: Oily Glysters are also Used & Releives ye Tenesmus which oft Continues Long after ye Flux is gone of intirely but at last it gets Spontaneously better when ye patient is very weak he is to be supported with wine & proper Nutritious Diet red wine is in generall is found too Irritating, where you have any Reason, to suspect an Erotion of the Gutts you may Inject Balsam Locattled for ye 6th Indication we Chuse Cheifly to Determine to ye Skin all warm Diaphretics are improper. Dovers powders is ye best Ins ye 7th Indication Bleeding is Necessary when ye Disease is Attended with Inflammation but I mean here those Cases where it is particularly Symptomatic & Can only be Cur'd by Cureing ye Causes or ye primary Disorder. Accidentall wounds have sometimes cured Obstinate Diarrheas this woud seem to point out ye propriety of Issues as Setons. ------------ With regard to ye best Prophylactics against this Infectious Disorder we must guive, ye preferences to avoiding ye place & all Communications with ye Diseas'd Patient ye Belly shou'd be gently kept open & Acidulated drinks & ripe fruits taken, but if there is any Symps of Infection already appearing it is right to take a Vomit immediately & go to bed & encourage a Diaphoresis by drinking proper Diluents & thus ye Disease has verry often been Necked in ye Buds – warm Cloathing, Acids are proper to prevent a Relapse, lime water with Milk may be used, or the Bark with proper Doses of Rhubard interpos'd now and then Excercise is often of ye utmost Importance here the new recover'd shoud Carefully Avoid all Fermented Liquors. ---------------------- Authors. Sydenham Huxham. Monro Wentringham. Cleghorn. & Deignerous Baker. Aikenside, Pringle, & Tifset Diabetes This is a præternatural Discharge of Urine ye Sympe. that attend it are Fever intenss thirst wasting of ye Body los of Appetite Viscid Saliva, internall heats, swelling of ye Loins. Testes, & feet, ye Urine has a sweetish taste & smell of Violets it is always thin Limpid & without any Sediment sometimes it has a wheyish appearance & sometimes oil is found floating upon the surface Especially were it is Accompanied with a great wasting. It is a Rare disease, yet in a less degree it is more Common then generally Imagined to be It is often found Symptomatic & only Continues For a short time, many have insisted upon ye Necessity of Inhalation from ye Atmosphere, the disease may proceed Either from too great a Laxiety of ye Vessels of ye Kidneys or from a Stimulous Residing there or from a disolved and watery state of ye Blood it also often proceeds from a spasm upon ye External surfaces of the Body ... The Indicasions of Cure are Various ... 1st To shun all Irritation ... 2d To Brace ye Urinary Passages ... 3d To Moderate ye Symps ... All ye food here shoud be of ye Mucilaginous kind ye Patient shoud lay much, however very gentle Excercise & frictions upon ye Skin are proper & girdles Round ye Body gentle Laxative shoud be used in order to divert from the Kidneys, and Also for ye same Reason whatever Determines towards ye Skin among the Astringent used here the Serum, Alluminum is ye best & Bristol waters together with gentle Excercise & proper Laxatives have oft Cured ye Complaint Lime water has been Found of great Service but these are only adviseable when there is no Obstruction in ye kidney Opiates Check all Evacuations, and have a place here particularly ye Disease is Symptomatic as in ye Hysteria ... Tinct: Canthared: is also warmly Recommended ... Strangury This is ye very opposite to ye for going diseases it Consits in passing ye Urine in Drops & generally these Involuntary it is not Easily Distinguis'd From ye Dyscuria where there is Constant pain so tormenting inclination to make water witht. being able to pas one Drop this is Calld Ischury ye Strangury may proceed from a relaxation or paralysis of ye Sphinctor Venice Urinaria, which is oft occationed in Consequence of Cutting For ye Stone it may also be induced by the Spincter becoming Callous or from Atonia of ye parts Cause whatever diminishes the sizes of ye Bladder may produce it hence often found in pregnancy in which Case a suppencery is of ye most service it often goes upon delivery but it often Continues long after & sometimes for Life this is owing to ye Bladders not recovering its tone or too Violent Strains Delivery ------------------------ Dysury The Symps of this is much ye same as ye foregoing only in this they are attended with greater pain Heat fever &c, --------------- The Causes of this may be 1st an Acrimony of ye Urine & then it is Cur'd by Mucilaginous Drinks Emulsion &c ------------------ 2d it may Arise from an Abrasin of ye Mucus lining ye Inner Surface of ye Bladder ---------- 3d its a Sympm Constanly Attending an Inflamation of ye Bladder & Urethra from what ever Cause 4th From an Erotion of ye parts ------------------------ 5 From Calculi or Carunculi in ye Bladder ---------- 6th It is sometimes intirely by Symptomatic, as in Cholics, Dysentery, Hemorhoids Hysteria &c, Method of Cure This must Vary According to the Cause, The Emulsia Aratica in Generall is ye Best Med. to which we may ad Emollient Glysters & Emollient injections into ye Bladder & Bleeding where ye Disease is Inflammatory, according to ye Urgency of ye Symps Ischury This is a total Supression of Urine & is of Three kinds ---------------- 1st Where ye Urine is properly Secreted into ye Bladder but there is an Obstruction to its Exit From thence 2d Where there is an Obstruction in ye Ureters 3d Where it proceeds from some Affections of ye kidneys, as Inflamation, Scirrhus, Calculus Concretions &c, Lulpis takes Notice of a periodicall Ischury, it is not Unfrequently Symptomatick Especially in ye Hysterias, and some other disorders as ye teething of Children &c, when it is Occasioned by spasm it is to be remov'd by taking away ye Original Cause of ye Spasm if this Cannot; Be done it may be Releiv'd by Emollient fomentations, it also arises from palsy those who Die by this disease Commonly Die Lethargic its verry often difficult to distinguish Ischuria Vecilralis from ye Nenalis but it is to be observ'd there is a Weight tention & Tumor to be left Just Above the Os pubis or lower part of ye Belly & a Cathether will draw of ye water in ye former but not in ye Isthuria Nenalis for there is none Containe'd in ye Bladder ------------------------ Occasional & Predisposing Causes 1st Inflammations ---------------------- 2d Stones in Neck of Bladder ------------- 3d Spasm -------------------------------- 4th Palsy --------------------------------- 5th Clotted Blood 6th Compression from ye Neigbouring Viscera as ye Uterus Rectum &c --- Method of Cure This must be regulated Entirely According to which of ye Causes Enumerated above occasions ye disorder, we shall proceed to our III Class of diseases or Morbi Paralytici The 3d Class of Disease or Morbi Paralytici et Debilitates These are divided into different Orders ----------- 1st of Which is ye Defect of Externall Senses ------- 2d the want of Sensitive appetites as hunger &c but omitting these we shall pass to what is properly Palsies singlmes else are seldom affected by this were ye Action of a Muscle is not Entirely but greatly impaired it is Call'd Laxa Immobilitas ... ye sence of the part sometimes Remains after ye power of Motion is lost sometimes they are lost both together there is an Extraordinary Instance in Sense of a person having lost Motion in one Arm & sence in another – The most Common speices of this disease is ye Hemiplege'd. – By paraplegia is usuly meant a palsy of all ye parts below ye Heads: her. Sasauges Confines it to ye lower Extremities. An Epilepsy is sometimes tho rarely Combind with palsy, ye palsy often attacks witht. any previous Notice or only a dull Pain in ye Head The pulse is usually soft & slow ye paralytic parts commonly remain Dry when other parts are in a sweat a these is generally ye part - a flaccid swelling tho in ye times it wastes & becomes smaller sometimes there is a Rigid Contraction in them but a Fornicated or thrilling in ye part is a favourable Symptom when it appears as to ye Antesedent - & procatartic Causes, it proceeds from all the Causes that produce Apoplexy & perhaps Apoplexy is only a more Universall Palsy, the principles of these Causes are as follows. Old age short & thick Necks, larges Veins, Lax Habits, thoses of a gross habit & who lives luxoriously, it is ye Consequence of Epilepsy & Convultions for these generally after they have Continued for some time have a part Paralytic All Violent straining & over Actions of ye Muscles are apt to produce it as is also Every great degree of pain that Continues long in one part - Hence it oft suceeds Chronic Rheumatisms, ye Colica. Pictonum & Gout, A Suppression of all Accustomed Evacuations are apt to bring it on Especially if succeeded by Vertigo. Further whatever Obstructs or Compresses the Nerves induces it as Ligature Strains &c & to this Head we may Refer that arising From Labor pains & a Blow upon the head ---------------------- The Sudden Application of Cold produces instaneously a partiall Palsy & may oft tend to induce it Hence palsys are most Frequent in spring and Winter if Application of very great heat hath ye same Effect, hence warm Bathing frequently brings it on Also a great Moisture many Occation it as well as ye use of large quantites of warm thin Diluting Liquors Especially Tea which if drank too strong & in too Large a quanitity particularly Affects ye Nervous System, it is also produced by severall Metallic Matters or Vapers & by ye Effluvia of fresh time Walls, it is also a Brat. in by Narcotics & among theses we may Rank Drunkenness it is also Symptomatic in Fevers & is also found to attend sometimes Disorders of ye Breast & arises sometimes in Consequence of a Putrid state if ye Blood as in Lues Venera & Scurvy &c, it has also been produced by Violent Passions of the Mind another Exciting Cause in Excessive Venery ------------------------- Proximate Cause we may in generall say that it is whatever Obstructs ye Nervous Influences & this Cause may either subsist in ye sensorium Commune or origins of ye Nerves or in their [Cau???e] there is sometimes here the same accumulations of in ye head as in ye Apoplexy we cannot admit of a Lentor in ye Nervous fluids as some will Call it & ye Experiences of such a fluid is by no means proved it arises then from ye Defects of a Nervous power or that what that power is we do not know the most generall Cause is the Mead & woud seem to be owing to accumulation of fluids Either Sanguine or Serious which may be Either in ye Vessels or Extravasted & the last more Frequently in ye Ventricles in generall ye proximate Cause of palsy is the same as that of apoplexy ------------------------------ Prognosis palsy is very apt to Recur after it has once Attached a person & in generall at lenght it proves Fatall it is most dangerous When it proceeds from Affection of ye sensorium Commune ye los of sence is a more unfavourable symptom than the loss of Motion and the loss of both is still worse a Fever Especially an Intermittent supervening often Carries it of it has also becured by Convulsions Violent pains & a Diarrhea it seldom happens to Children & oft does it goes of at puberty tho there are a few instances of its Continuing longest ---------------------------- Method of Cure here we must Regard The Variety of Causes - were it proceeds from an Affection of Sensorium Commune The Indication of Cure are in generall --- 1st to take of ye Determination to ye Accumulation in ye Encephalon ------- 2d To Stimulate & Rouse ye Nervous power Bleeding is Recommended in ye first of these but is very Dubious in it Effects, Were Palsy Comes on Suddenly, & in a full sanguine habit it ought to be used otherwise not ------ Emetics are oft very serviceable, sometimes merely perhaps as producing an Evacuation but generally much more from their Stimulus yet we ought to be Cautious in prescribing them Mustard Vomits are best when ye signs of Compression of ye Brain are Manifest Antimonial & Turperh Mineral hath been greatly Recommended --- Cathartics have only a place in Case of plethora inducing Compression on ye sensorium Commune on Encephalons the Belly shoud always be kept Moderately by warm Stomachic purgatives Jalap & Calomel in Considerable doses are good brisk purges in palsy Elixr .. searum Gum Guaiae are most proper --- Sudorifics are more universally used they Ought to be of ye warm Stimulating kind however all stimulants of ye Nervous System if Continued too long tend to Relax it & weaken it ----- Sternutatories are dangerous where ye Parolysis arise from a Compression in ye Brain Unless of ye Nervous kind when they may do great Good. --- Masticatories produce an usefull Evacuation Nigh ye part affected & prove a gentle Stimulus the Volatile Alkali are most used but ye Acrid Antiscorbutics answer best here are Mustard Hore Radish Garlick &c, There are Diaphoretics Discureric & sometimes Laxatives they particularly Stimulate ye Nervous System ------------ Aromatics are oft perscribed but they are less Efficatious than ye foregoing. Fatids are often used & of these fatids Assafatids is ye best Castor in its usuall dose is of no Service here ------------- Mercury has been much recommended but we have seen no good Effect from it & were ye parolysis is From an Affection of ye sensorium Commune it shoud seem to be verry improper --- And if Turbith Minorall is a good Mede. it is merely on ye Footting of an Evacuant Antimony promotes ye Secretions best and are ye best Metallic Stimulus, & powerful promotions of all ye Secretions ---------------------- The Regimen ought rather to be generous Solid Diet than Slops & such as is Restorative & Gently Stimulative Violent passions of ye Mind has often Remov'd ye Palsy but this Remedy is not in our Direction - besides it has also sometimes Reduced palsy Vides: Van Sweiten Dombroick and other Observations - External Applications Frictions are of much service & will of themselves often remove palsy that is only partiall - they must be often repeated & long Continued whipping the Part with Nettles is as Excellent & powerfull Stimulus Poultices that proves Rubesscientia particularly Mustard which answers very well, they stimulate sooner than Blisters & are more Easily Removed warm Stimulating Liniments do not seem to have so good an Effect these applications shou'd be made to ye Paralytic part or if as Convenient to the part were ye Cause of ye Disorder seems to Recide as upon ye spine when ye Lower Extremities are Affected and about ye Neck for ye superior Extremities thus in a palsy of ye Arms from a Colliea Pictonum Van Sweiten has found most service to Occur From these Applications to ye Belly Burning ye part has been much practised in several Nations but very little used in Europe ye application of heat invites ye Free flow of ye blood & promotes ye Nervous influence to ye parts yet its Effect are very Ambiguous & when long Continued it tends to Relax & weaken ye Nervous System as is found in long Continued warm Bathing steams of spts. of Wine have sometimes been of great service in partial palsies warm animals appl are found usefull, thus to have a sound health full Vigorus person to sleep Constantly with ye affected this is also of service to a person newly recovering from disease that has been severe particularly to Infants - Blisters are oft of great use they Act both as Stimulants & Evacuants of Serum which is of great service in serous habits - Issues & Setons too answers very well in these kinds of Serus Phlegmatic habits, I am not Fond of ye Application of ye strong Minerall Acids, for they Rather act as Sedatives in General upon ye whole Nervous power, tho they are local Stimuli, however if they are to be Used they are to be Mixed with a large proportion of Oil otherwise they woud prove highly corrosive but ye Vilatile Alkali is much better. Essential aromatic & lympyreumatic Oils are stimuli but but only local & are apt to produce gangrene. They are only Inflammatory Stimuli that is Chiefly Affect ye Sanguineous System --- Cold Bath this is one of ye most poweful Stimuli, & guises all ye Stadia of a Common Fever, Sn. J & Floyer particularly mentions its good Effect in Palsy - Electricity is one of ye most Effectual Remedies, its Effect are to promote & encrese ye heat & pulse, restore Emaciated limbs, promote Diaphoresis & all ye secretions, tho when it acts as a Dieuretic, it is apt to produce Costiveness, when applied to a particular part it guises some pain & produces & Involuntary Motion and oft heat & redness upon ye part, with a Formicratio & sweat. its want of success in some Cases may be owing verry probaly to its not being long Enough applied - Continued neither do we in this Island Guise such long & Violent Shocks as if foreingers do particularly Dehaem who relates its being Continued 6 Months and Affecting a Cure at last if there appears to be any Morbid Congestion in ye head it ought to be avoided till that is Removed otherwise it might induce aploplexy - Authors, De Haen, Sauvage, Carmichael &c, Especially Van Sweiting & a French Treatise on ye use of Elextricity in Mede. we now Come to ye forth division of Morbi Paralytici of this we shall First begin with - Syncope This is a less or Diminution of both motion & sence Sauvage distinguishes between The Syncope & Lypothymia but perhaps with any good Reasons, this last he says is attended with Consciousness & a Tinnitus Aurium, Vertigo &c. ye pulse at ye same time Remaining sufficiently full, this I have said shoud be looked upon as as a less degree of Syncope, But he makes ye Syncope Arise from ye Pericordia The Lypothymia from ye Brains, were as we have seen a totall syncope arise From ye Brain which entirely overthrows his distinction The Symps. of Syncope oft Occur in other Diseases but we only Call them syncope when they Come on suddenly & witht any Evident Cause Preceeding - Syncope or fainting oft Comes on with ye Cast previous Notice, tho often a great Anxiety & weight about if ye Pericordia preceed it, there are several species of this Genus 1st it arises from Inanitian as want of food From sudden & large Evacuations Especially of Blood Yet we are not always to look upon Syncope As an unfavourable Sympm, in Hæmorrhages as I have observed before, this speices only to be Cur'd by proper Cordials to a Restorative Diet. _ The Syncope happening from drawing ye water in an Ascites may properly be referd to this head _ Women Frequently faint upon delivery, this may partly be owing to ye Large discharge of Blood & partly to ye Diminution of ye Tension of ye System – & alteration in ye determination of ye Blood in Consequence of ye Contraction of ye Uterus not Admitting ye same quantity of bloods to flow thro its Vessels ----------- 2d Syncope arises from Violent pains which are to be releived by Emollient fotuis, Cataplasmes, Antispasmodics, particularly Opiates &c -------- 3d it is often symtomatic in Timers & a very Unfavourables sign it is here, it verry seldom happens in Inflammatory Fevers but very often in ye Nervous as also in some Epidemic Intermittents ---------- 4th it is often a Consequence of phlebotomy in which Case it is a Nervous affection for I have seen it Accompanied with Convulsions ye best Method of Avoiding this is to lay ye Patient, in a recumbent posture, & stopping ye flow of ye Blood from ye Vessell every now & then for a few Minutes by Clapping ye Finger over the Orifice --------------- 5th it arises from plethora & may be Distinguished by ye symps. of plethora accompanying it & ye pulse Rising upon Bleeding ----- 6th it is a Nervous affection Frequently Attendant upon ye Hysteria & to this head we may Refer these faintings that Arrive from Violent passions of ye Mind From sudden Fear certain smels both Aromatic & fatide, as also from Antipathics which delicate people have to different Matter here fatids antispasmodics and warm bathing are proper ye applications of stimulous & very general tho oft improper were there is a Plethora -------------------- 7th From an Anecrism of ye Aortas or great vessels this is distinguishable by a great oppression About ye precordia, palpitations irregular pulse Dyspnea great Debility &c ---------- 8th From poliypi in in ye Heart or large Vessels this is attended with ye same symps as ye fore going & like it incureable ------------------- 9th From putrid & Mephitic Air 10th From ye Breaking any internal Abscess Which had Compressed some large Vessels or it may be merely a Nervous Affection ----- 11th it accompanies a Hydropc pericardii with ye same symps innumerated in ye 7th & 8th above and Hydrops Pectoris -------------------------------- 12th it Frequently arises from Various affections of ye Stomach for those Causes which produce Sickness if carryed a little Further occasion Syncope, Cured by Vomits & Cathartics ----------- 13th of Symptomatic in gangrenes --------------- 14th as also from ye Scurvy & From Debility -------- 15th it is mention'd as a sympm of ye Gout ------- 16th it is frequent in pregnant women from too tight lacing ------------------------- 17th From too great heat ---------------------------- From ye innumeration of ye Causes of Syncope it is Evident that it arise sometimes from Error Loci or some other affection of ye Heart or Large vessels sometimes from an Effection of ye Brain at others for want of Blood being sent to ye head, Affections of ye Mind also produce Syncope whilst ye patient is in these fits recourse must be had to Everything thats Stimulating both to ye Nervous powers &c sanguineous System, 6 Tho when it is from plethora, acrid Stimulants or Sternutatories to ye Nose may prove very dangerous Acrid Glysters strong Frictions on ye Extremeties Vesicatories Velications, Cold water thrown upon ye Face are of Service bringing ye Paitient in to ye Cold air often Removes it. ye patient shoud have all his Cloathes loosened upon him as much as possible so as to be perfectly free & unconfined - Authors Senae in by much ye best on this subject Asphyxia. This Consists of a totall abolition of ye Senses both External and internall with an entire cessation of Motion & indeed it is hard to say when a Man is alive & when not & if only Certain & infallible sign of Death that I know is putrefaction of ye Body, all others as Cessation of Motion breathing pulsation of ye Heart &c are not sure symps. of Death ---------------------- This Disorder Arises From Various Causes. 1st From Drowning which is often a long time Consistent with Life, here we are to use strong Frictions, & applications of heat are also proper It is Common to open a Vein & if it does not bleed the patient is look'd upon as incuredbly Dead but this is by no means Certain for many have been recover'd by blowing into ye Lungs ... Life is not dependent on on Connected with Circulation for some Animals that sleep have no Circulation for a long time & therefore I think no person ought to be buried till symps of putrefaction Comes on this is more particularly adviseable in sudden Death & Especially of Hysterics & Hypocondriac People, For I am persuaded Thousands have been Buried alive. Bleeding, strongly Stimulating Agitation &c the Causes of ye death of Drowned people have been much Disputed, Lately it has been found that the water gets into ye Lungs, these people must Die Apoplectic. From ye want of respiration to Recover these people we may try if ye Water will Run out of ye Stomach & Lungs by hanging him up by his heels, but this posture is only to be Continued a verry short time otherwise it must prove Fatal by encreasing ye Congestion in ye heads - Excessive Bleeding is improper in those Cases were ye patient is Extremely Cold ...................... 2d From Mephitic smoakes & damps of which we have many Instances in Mines &c ----------- 3d From Mephatic Air, ye Gas Sylvestri, to which belong ye Air in ye Vaults, burial Grounds, Bogs and Confined place ------------------ 4th From hanging here we ought to treat ye Pt in ye same manner as in ye Sanguine Apoplexy 5th From Freezing this is a verry Easy sort of Death as they usually depart Comatose & witht. Convulsions. Animal heat or putting ye Pt Between too healthy people in beds is often of service, a sudden application of heat here being apt to induce a gangrene in ye Exstremities here there are many Instances of People being Recovered from ye Dead Torpid State by ye Actuall Cautery ---------------- 6th it Attends on Catalepsy ---------------- 7th It sometimes attends on Violent passions or Rather arises from them. Dr Chyne gives A Remarkable Case of Colonell Townshead, who had ye Power of dying when he pleased, or of Stopping all ye Vitall functions when and as long as he pleased ---------------- 8th From hysteria the pulse Commonly keeps up here but sometimes we have seen it so much gone that it Coud not be felt in ye Arm ----- 9th From Litening, we have no Instances of any recovering in this Case ------------------ Authors, Lansisi Dr. Morbis Substances & Winslow on ye Signs of death Malpigious The 5th Order Soporose Disorders These are Divided into severall Genera, but they sem only to differ in Degree -------- 1st is this Tythomania Sauvaugesii or Comatue where there is apparent sleep but ye Patient may be Easily awake it is mostly Attended with Delerium 2d Is Lethargy which is a Constant Sleepiness but no Delirium ----------------------------------------- 3d is ye Cataphona, or Comue som no lentum, is a Constant sleepiness out of which ye patient is ye patient is oft Recoverd, & answer sensibly, but immediately fals asleep again when ye Stimulus is Remov'd -------------------- 4th Is ye Carus a profound sleep & out of which ye patient Can scaresly be rous'd at all, this is attended with a soft Easy Breathing, a Fever and usually with a Flushid Face, it Differs from apoplex only in degrees & indeed in Cheifly distinguish'd from it by ye want of stricture &c in Respiration, ye Pulse in Commonly slower than natural & often soft & Irregular just before death ye Breathing is slow & deep & it often End in a Hemiplegia when only symptomatic in Fevers it is often of no great Consequence. Except in ye attack of ye intermittents, & then it is dangerous, Vido Werlhorlf, may it may often prove Criticall, in this situation, then, if other Symps. are Favourable it shoud not be Checked it is sometimes Symptomatic in ye Hysteria. Comes on too in Consequence of Ischuria of Externall Violence or the Brain, of ye Gout in ye head, of Worms Especially in Children, of Violent passions of the Mind, particularly Greif, from Narcotics Drunkenness, Mephitic Air, & all ye Causes of Syncope & Asphyxia in persons that seemed otherwise healthy, we have instances of ye sleep being protracted to an Astonishing length of time Velernus is a general Name applied to all Soporose Disorders, These disease always depend perhaps of ye Compression of ye Brain & therefore the Removeall of this guises own Indication of Cure which are answerd by Bleeding Purg in Pediluoria, after these ought to employ Stimulus of Various kinds ----------------- Method of Cure in person that are inclined to soporose affections. Evacuations are proper, particularly perpetuall Blisters & Setons, Sinapisms &c to ye Feet Issues shoud be dressed with Blister ointments in order to make them Discharge Copiously & keep up a Constant Stimulus & Determination tao them, or a Revulsion to ye head, And great Excercise of both Body and Mind are of Singular Service --------------- Calatepsy This Consist in a loss of senses & all Voluntary motiones ye Pulse of Breathing here is generally very Obscure, this disorder is Chiefly distinguish by ye Flexibility of ye Limbs, so there disposition to Remain in any situation into which they are put Catalepsy is generally preceeded by Torpor hed ach. Delerium and Convulusions, marks of increased Determination to ye head. it usually Continues only for a few Minutes, tho sometimes for a much longer time, it is sometimes periodicall as often accompanies other diseases Especially ye Hysteria it differs From ye Cataphora in not being attended with Spasm, It is oft produced by Violent passions of ye Mind as also by worms & in Quartan Intermittents ------------------------------ its Cure may be referd to Hysteria &c I shall only hear obsere that stimulants are improper A Very uncommon disease is ye Extasis, ..... In this the Patient Retains ye posture in which he was seized Fixed and immoveable like a statue A Temporary Extatis is often ye Consequence of verry great attention Especially to very abstract Studies - the patient is totally insensible to Every Externall Impression, tho by Sufficient Force they may be diverted ye Extatis will be Treated of among ye Shavams die diseases Of the Vertigo The Vertigo has no immediate Connection with soporose Disease, but is Nearly allied to ye apoplexy on which Acct I Chused to treat of It before ye Apoplexy, as it seems to be an Inferior degree of ye same disorder ----------- Definition, Vertigo is as particular sensation of all surrounding Objects being a Circulatory Motion, sometimes attended with a dimness of of Sight but not always & also a Tinitus Aurium flushing of ye Face & Vomitting sometimes ye Patient Falls down quite insensible these symptoms are not confind to ye Organs of sight. For ye same Circulatitory Motion is Imagined in ye Dark or with ye Eyes shut .... it is sometimes Idiopathic but oftner Sympathic. From Affections of ye Stomach - Causes, 1st From plethora, & is then often Idiopathic & attended with Symps. of determination to ye head & Accumulation there. to this head belongs ye Vertigo arising From a stoppage of usual Evacuations - 2d Arises from disorders of ye Stomach oftner than any other Cause - 3d From Narcotics, as Tobacco Drunkeness &c, 4th It is Symptomatic in ye Hysteria - 5th But it Arises Cheifly Originally, from Some affection of ye Mind. From looking Down an high frightfull Precipice a quick succession of Ideas produces it - 6th From Externall Violence as Compression of ye Brain - 7th its Symptomatic in fevers as all Disorders were ye head is Affected - 8th it is oft ye Consequence of great weakness Inanition & large Evacuations - 9th its sometimes periodic in Childrens it most Frequently preceeds & Epilepsy in old people an Elepsy likewise - Proximate Cause. May Either be Morbid Affection of ye Brain or ye Stomach or in some Cases perhaps a Morbid Topicall Affection - Method of Cure depends upon ye Nature of ye Causes which induced it. in ye First bleeding as other Evacuations are of ye greatest Use & Shoud never be neglected - In Old People tis a dangerous disorder Especially if Accompanied with Cachexy, however repeated small Bleedings at proper Intervals, & laxatives best prevent any bad Effect From it to prevent Vertigo terminating in Apoplexy in Old People & those predisposed to it we are to Employ every possible Means to prevent an Accumulation or Determination to ye head by proper Evacuation as by Blisters Setone, Issues, to keep ye Belly open & ye Feet Exetremely warm - Where it is a Diaphatic, Blisters & a Constant Drain are of ye greatest Advantage in Nervous people Antispasmodics, Bark Bitters & Exercise is proper, Content &c, for much Application to study hurte them much .. Frictions to ye Extremities, & Frequent Pediluvia are serviceable in Affections of ye Head, during Ye Fit. carious stimulating applications may be Usefull, Snuff is Usefull in Serous Cold Habite in ye Vigorous & Sanguines - Of the Incubus. This Consist in a great oppression of Breathing During sleep together with a sensation of Great Weight on ye Breast, all the symps go of upon ye patients Waking but leave a lassitude & dejection behind them, a palpitation of ye Heart & some times purple Eruptions on ye Lime one woud be apt to imagine People Frequently Die of it. For many who die in ye Night Unexpectedly are known to have struggled hard much however it is only dangerous when it seize such as are predispos'd to apoplexy - The most Common Cause of is Eating a full & heavy supper & sleeping on the Back Plethora is also a Cause of it &c, It is mostly a Disorder in ye Stomach that is sometimes Purely in ye Head It is Cured by proper Evacuations & Avoiding Occasionall Causes, Were Nervous it is to be treated as such turning ye pt. on his side or Waking immediately puts it of - Of the Apoplexy, This term is used in a Very Vague sense, all those who die suddenly of what ever Cause are said to Die of an Aploplexy - Definitions, It is an Entire loss of Senses both Externall & internall in a profound sleep into which People have often Fallen in monstrous Degrees of Drunkeness ye Breathing is oft Naturall ye pulse quik so this distinguishes it From ye Syncope in which there is a great distress & Diminution in ye Vital Functions but is Extremely difficult to Distinguish it from ye profound sleep in which a person falls in in an Excessive state of drunkeness tho it may perhaps be distinguished by ye Pulse in an Apoplexy, being soft Fuller & not more Frequent than Naturall when an Apoplexy goes of it generally Leaves some Functions or Faculties greatly Disturbed & most Commonly Terminates in palsy particularly an Hemiplegia all ye Limbs are Relaxed during ye fit in generall tho sometimes they are Rigid or Convulsed ... It comes on without ye least preceeding symptoms tho probably if we knew it & People were on there guard more, we shoud much more frequently discover preceeding symps. such as a heavy oppressive pains, Formication in ye Legs, Corpuscules &c Floating before ye Eyes Dimness of sight, swelling of the Eyelids, and Flushings of ye Cheek Tinitus Auriums. Coma. Failure of Memory Coldness of ye Extremities Paralytic Symps to which we may perhaps Refer the Change of Countenance. Trembling Tumors in ye Voice Deep Breathing Especially During Sleep The Danger of Apoplexy may be Estimated From the Violence of ye Symps. & antecedent Causes Visid Mucus in the throat is a verry bad symptom Often it is only preceeded for a few Minutes by a Violent head Ach Sickness & Cholic ye pulse being strong & Full is Rather an unfavourable sympm, Cold Sweat is a Mortall Sympm. as is also Convulsions on one Side, it is a bad sign if Glysters are Return'd immediately or not at all it is sometimes Carried of by a warm Universall Sweat ye sweat that immediately preeceds the Death of Apoplextics is very Different From this, it is Cold Viscid & Clammy it is also Oft Carried of by ye piles Diarrhea a large discharge of Turbid Urine by Bleeding at ye noses. Lancisi mentions a Man Aged 70 in this States that lost Hxij from his Nose Menses &c,- Remote Causes the Disposition to Apoplexy, Depend much upon a particular Conformation of ye Body, as a short Neck a large head a particular apperance of ye face & Eyes as if Strangld, Fatness too disposes people to Apoplexy as also Plethora Either Sanguine or Serous, it is Often hereditary, & peculiar to a Certain period of Life From 40 to 60 or more years of ages, seldom happening earlier Unless in Consequence of some strong occasionall Causes Luxurious Sedentary, & Studious person are verry Subject to it; - Among ye Occasionall Causes every thing that heats & rarafies ye Blood & quickness ye Circulation as Rich Plentifull Stimulating Diet hard drinking, warm Bathing, witht. previous Evacuations, Violent Excercise & Passions, Involation & every thing that Contributes to produce a Determination to ye Head, assists in bringing it on, as Coughing, Vomitting, Laughing &c, Intense Study too, Determines ye Blood to ye head, as does also Everything that Compresses ye Aorta Decendents, as a Full Stomach Fatness, pregnancy, Spasmodic Contrictions in ye guts & Abdomen whence it sometimes Attends Hysteria Hypocondriasis &c, Suppression of all Sanguine Evacuations healing up Issues &c, are found to Occasion it very warm or verry Cold applications in the Rhumatism &c are Found to occasion it Repulsion of any Exanthemata, ye Suffocating steams of Burning Charcoal & Vapers From Mines & other Confind places. Certain Narcotics have also Occasion'd it Epilepsy when it proves Mortall generally Ends in Apoplexy Obstinate Costiveness brings it on as does also severe Fits of ye Stone sometimes a Repultion of ye Gout does the same Externall Violence it sometimes also attend ye Cold fits of Agues it is also oft ye Consequence of Externall Violence, on Dissection a great Coagulation or Accumulation of ye Blood is found in ye vessels of ye head With sanguine or Some Effusions in ye Ventricles &c, - Tumors of Various kinds, Ossifications, Abscesses &c are Frequently found in ye Brain or its Membrances after death in many Cases there is no Visible Sign of any Topicall Affection of ye head at last not as hath yet been discovered Proximate Cause This is whatever disturbs ye Nervous Influence going from ye sensorium Commune to ye organs of sence & Voluntary Motions, by acting somehow upon the sensorium itself From wence this influence Flowns - This may be produced by various Causes 1st By Effusion, From a Rupture in ye Vessels of ye head. - 2d By Congestion, Either from too great a quantity of blood in ye head or by an Obstruction to its Return 3d By Compression From Tumors - 4th An Affection of ye sensorium Communes without Any Topicall Affection, it is Acertain'd what particular parts of ye Brain are Affected by ye Externall organs which are principally Disordered some also pretend to know what particular part of ye Brains are Connected with particular Faculties of ye Mind - There is one species of apoplexy were there is all ye symps of Inflam: Diathesis which is Calld the Sanguine - Another is ye Sense where there is Rather a Torpor of ye Nervous power: here the pulse is less full & ye Face has a very different appearance to that Formerly Mentioned - The Indications of Cure must have Reference to ye Remote Causes so that they are to be Calculated - 1st To take of ye Congestions From ye Head - 2d To Stimulate ye Nervous power &c, - 3d To prevent a Relapse - For ye Sanguine Apoplexy we must depend upon Verry large Bleedings ye Blood shoud be drawn From a very large Orifice & sometimes From too Veins at ye same time it is bests to Bleed Freely first in ye arm as ye lower Extremities are generally Cold & a Spasmodic Constrictions on ye Surface particularly on this part, - After this we are advised to bleed in ye Jugular Vein or Temporal Artery Morgagni Recomends Scarrifications on ye Occiput - In serus apoplexies it is improper to bleed so Lagerly, Cathartics are very Serviceable - immediately after Blood letting we shoud inject a Glyster, an Acrid Stimulating one such as is Commonly used may be most proper in ye serous Apoplexy but in ye Sanguine Emollient ones woud probably answer Better here warm Fomentations or Pediluvia are of singular Advantage if long Continued in ye serous apoplexy, where there is no Congestion all Stimulants are Serviceable Especially Blisters & warm Cathartics which shoud always be given here in a double dose on Acct, of ye sensibility of ye Alimentary Canal - Sturnutatories in ye Sanguine Apoplexy are to be avoided, as they have often Changed it into Epilepsy, & Destroy'd ye Pt. immediately The Actual Cautery shoud never be used before Copious Detraction of Blood has taken place & Even other Evacuations - Vomits in a sanguine apoplexy is very dangerous but where a serous Collesies or Torpor of ye Nervous power takes places they prove an Excellent Stimulus Especially if From a Surfeit- Vinegar in steams by being thrown upon a Red hot Iron afford a proper Stimulus, Sinapisms & Blisters are very Usefull after Bleeding in Cases of an apoplexy From Externall Violence, nothing but Trepanning Can be of any Service perhaps too this might have its use in other Cases of Apoplexy, When it Arises from Externall Violence it is Usually Accompanied with Vomiting - If there is any Necessity for Exciting a Vomiting it is best done by applying a Cataplasm of Tobacco over ye Stomach but sympm is merely Symptomatic & there wou'd seems to be little occasion to encourage it - of ye Prophylatic Method - If it be of ye Sanguine kind it is best prevented by Repeated Blood lettting Especially in Spring & Autum - It is always proper to keep ye Belly open Setons & Issues as near ye head as possible are of great Use - The strictest Regularity in Respect of Diet is required Especially in ye sanguine apoplectic - Abstinence, and much walkin are ye most powerful preservative from Sanguine Apoplexy ye Pt. shoud use as much Excercise as he is able to bear witht. much Fatigue going into warmer Climates is a good prophlaxis Antispasmodics should be Cautiously Administred, when there is a Tendency to Paralysis but they are proper in ye Inflammatory Diathesis in which those of ye warm strengthening kind are to be avoided such as Valerian Bark, Horse Radish steel &c, ye Feet must be kept warm - In Sanguine Disposition & apoplectics - Evacuations Bleedings Cold Regimen & Excercise answer best - In ye Serous we may Employ Stimulants as Wine, Mustard, Tonics & Excercise - Authors, Boerhave, Van Sweiten werefor Morgagni's Friend - The 4th Class of Spasmodics Diseases These are divided by Sauvages into 2 genera 1st Such as attendeded with Rigity: and ..... 2d Those attended with Motion & Agitation I shall only select a Few of ye most Remarkable and best diserving our Notice beginning with The Tetanus This Consists in a Rigidity of ye whole Body While ye senses remain Entire Savauges ads Difficulty of Breathing, but improperly it is Divided into three Speices - 1st Tetanus - 2d Emprosthetonos - 3d Opisthetanos you Find all these Fully & Accurately treated of by Dr. Chambers in ye Lond: Med, Obs, so by Dr. Hillary - The symps of ye Tetanus comes on gradually ye patient first Complains of a tention about ye Precordia, stiffness about ye Jaws which Encreases & induces a Dysphagia there is no Swelling, Either External nor Internall but sometimes a Creek in the neck as it is commonly Call'd, A pain now Extends all along ye spine with a Rigid Contraction of the Dorsal Muscles after these have been Continued for 2 or 3 Days, ye whole Body becomes Rigid & ye Joints immoveable a Constant Symptom is ye locked Jaw, & a great difficulty in Swallowing - The most pathogmonic sympm is a Violent Convulsive Spasm felt under ye Sternum The patients Can Usually speak & use there Fingers, & no other part & they seldom loose there senses Unless Just before Death - The spasm under ye Sternum soon Affects ye Diaphragm, Neck & spine with Excrutiating pain ye Legs are Commonly Extended The Spasm Usually recurs with Fresh Violence Every 15 or 20 Minutes & are always preeceeded by ye spasm under ye Sternum, when this Morbid affection is ye Consequence of a wound of some sensible part or Nerve it is witht, Fever heat or thirst ye Urine is high Coloured & small in quantity always attended with Costiveness, ye patient gets no sleep unless it is produced by Opiates & he is often skil'd in a strong Convulsion This Disease has no Regular Course or Crisis when a patient gets thro it - it is long before he Recovers ye proper use of The Several Muscles, when it preceded From Cold it is often attended with fever generally before a Pt. dies in this Disease all ye Muscles are Relaxled, & ye Spasms Remit- it sometimes attacks Infants of a Few days old & then advances with amazing Rapidity There is an instance in Schirrhius, of one Side being affected with a Tetanus and ye other paralytic - In these Emprosthotonos ye Chin is fixed Down upon ye Breast, attended with ye Risus Cynicus & a livid Faces, Hoarsness Dyspnæa, Difficulty of Deglutition & Dysuria - The Causes produceing this disease are - 1st Wounds which are ye Most Common - 2d Suppressed Prespiration, not so much from ye Retention of ye prespirable Matter as from of Exposures to Cold after being heated- 3d Retention of ye Meconrium or other Acrid Matter in ye Primæ Via of young Childn. Epileptic Fits in Children of end in Tetanus it is sometimes occasioned by worms 4th It is often Epidemic in warm Climates Especially After hot & then wet weather - Prognosis this disease almost Constantly Prove is Mortall - Indications of Cure are 1st To Remove ye Irritating cause when discoverable 2d To Relax ye Spasm - The whole of these turns upon the liberal use of Opiates ye does of which depends upon their Effects. With, any Regard to quantity Bleeding in generall does Mischief unless ye disease is attended with Fever or Plethoras ye same may be said of purgatives yet ye Belly ought to be kept open by frequent Emollient Glyster, ye same likewise Applies to Vomits - Opiates have been guiven in these to amazing & almost incredible Quantities Dr, Huch has guiven a dram in the space of 24 Hours & half an Ounce of Musk with success - Dr. Hillary guives a dram in 24 hours also, & found it answer better when Musk is joined with it - It is Observed that Opum never induces any stupor here & this is ye only limitation that Can be guiven with Regard to ye Use of Opium in ye Locked jaw a Dram of Opium with half an Ounce of Musk has been Guiven in a day, there are many Excellent Cures & papers on this Subject in ye Lon: Med: Obs: Musk without Opium has no Effect - Next to Opiates warm fomentations claim ye preference which Dr. Hillary prefers to Baths &c,- Warm oil has been used but not with any Peculiar advantages - Dr. Chambers advises ye Semicupium from 92 ad 100, when it arises from a small wound Dr. Hillary advises a free Enlargement of ye wound. Blisters always do harm Except in Partiall spasms, there a singular Method of Cure by a Mercurial Salivation Recommended by a Practitioner in Jamaica he says he Coud never save one Patient before he attempted in this & that sincere out of 12 he hath not loses one, But we must Remark that none of these Cases arose from wounds - The Patient should lie in an horisontall posture in ye Bath & afterwards put to bed withen ye Blankets so as to Encourage a gentle sweat but not too profuse - The Strenght must be Supported Especially by Urine, tho Opium is an Admirable Cordiall in short ye whole of ye Cure of these Diseases turns upon ye liberall use of Opium Warm Bath & keeping ye Belly open - Of the Epilepsy This Consists in an Entire loss of all ye Senses & a Convulsive Contraction of several parts of the Body - It is sometimes a Chronic Disease, tho it sometimes proves fatall on ye first attack It is oft Periodicall & sometimes tho but Rarely begins without any preceeding symptoms, the preceeding Symps, are Lassitude heavy pain in ye head all the senses more or less Disturbed, Broken sleeps & frighted Dreams Coma, Unusuall Fear, Dimness of Sight, Tinitus Aurium, palpitation of ye Heart Inflation of ye precordia interrupted Breathings, Bor borygami, large flow of Urine Coldness of ye Exstremeties, Tremors Spasm of ye limbs a fixed look and flashing of Light before ye Eyes, great Yawning Nausea, sometimes an immoderate Appetite a great discharge of Salliva a Nocturnall pollutions pale Countenance &c, Failure of Memory, some or other of These Usually Come on before ye fit a few Days, immediately before it other symps appear as Vertigo Flashings of Various Colours before the Eyes Dimness & then An Entire loss of Sight a sensation of the Disease arising From Extremity, as ye Foot this is call'd ye Aura A Epileptica, & ye fit may be prevented by making a light Ligature upon ye limb before it gets any height or above it, it is Compar'd to a Cold Vapor that Gradually proceeds up to ye Precordia when ye Pt. becomes insensible. Fals down & generally Cries at ye same time, there is a particular Fixed look in ye Eyes, & Contraction of ye Fingers, frequently preceeding an Epileptic Fit in Infants which may be Remov'd & the Fit presented by puting ye Child in warm water which Dr. Gregory has often known to Suceed - The first Attack of Epilepsy is in general in ye Night - The symps. during ye Fit are very various This Eyes generally are fixed ye palpetrce never entirely shut, & often only ye wt. of the Eye Appears tho somtimes they are in Constant Motion, the Face is variously Convulsed sometimes Alternate Contractions of ye Mouth & locked Jaw With gnashing of ye Teeth involuntary Discharge of ye Fœces & Urine & semen. Pulse at ye Beginning Small & quick afterwards more full & slow great Stricture in Breathing but this is very Different from ye Apoplectic stenter, amazing Muscular strengh so as to be Difficultly Confin'd & after ye fit goes of the Patient remains pale & Languid with all ye Senses impared, Very Few Ever Die in an Epileptic Fit such as are supposed to do so are generally Carried of in a Apoplexy in some few Cases ye Pt is Conscious he is going of - The Effect that ye Epileptic leaves upon ye Constitution are loss of Memory & Vivacity so that ye Patient becomes almost a Idiot . it is suceeded sometimes by a palsy or Tetanus - Of the Antecedent Causes - 1st. Is an Heriditary Disposition, tho it will Frequently pass one Generation and Appear in the Next, It is Singular Fact that those Children, that are Hereditary predisposed to Epilepsy Generally past this Period with Fewer Convulsive affections than such Children as are not hereditary predispos'd to Epilepsy this seldom appears before Pubity - 2d a particular time of life as Child hood . 3d a lax habit of Body & great sensibility of ye Nervous System - 4th a bad Conformation of ye Cranium some suppose this always to be the Case - 5th People of Remarkable acute parts - Occasionall Causes are 1st External Violence on ye head bruor loci in the Encephalon, & other Internall disorder of the Brain & its appendages - 2d whatever induces any proper natural state of the Brain as Inflammations Imers &c probably ye Repulsions of Cuticular Eruptions as ye Tinia Capitis, ye Serous Discharge behind ye Ears may produce Epilepsy From some Acrid Matter Repelled or some Alteration in The Determination of such Matters - 3d Fumes From quick silver & some other Mineral 4th Plethora arising From suppressed Evacuations 5th Exces of Venery - 6th intense Study - 8 Infections when Epilepsy has been brought in once by any occasionall Cause ye Repetition of the same, tho in a much weaker Degree will be apt to Renew it - 9th it is often symptomatic in Fevers small Pox gout &c, & particularly Dentition ye Epilepsy in Children is very different to that in Adults 10th Sordes in ye Prima Viæ to which we may refer Worms - 11th various impressions on ye Externall senses it has been produced by Tickling, sudden Noise loocken down a precipice and &c, - 12th Hysteria - 13th Violent pains - 14th Teething - Worms - 15th Carious Bones in different parts of ye Body 16th Great Evacuations - 17th Several kinds of poisons to which we refer Acrid Cathartics, Sallivations - 18th Repulsions of Tinea Capitis or any Natural Ouzing about ye Head - 19th From strong Vomits of this we have a case in Savauges, From one being administred in an ague - 20th From a particular Affection in some of the Limbs, as is ye Case in ye Aura Epileptica or that Cold Vapor arising from ye Extremity to ye Precordia - 21st it Often attends pregnancy - 22th It is Enfluenced by ye Full Moon or New - 23d it has been known to preceede thunder - 24th it is sometimes Epidemic - 25th it is Often a low of Habit - As to ye Effects of Epilepsy they are loss of Memory, impairing of all ye Faculties, Idiotism, Palsy, apoplexy - besides this Effect on ye Sensorium Commune there are others in different parts of ye System brot. on by the Violence of ye Convulsion - Epilesy often preceeds the Eruption of Exanthematas, particularly the small Pox generally Epilepsy is more difficulty to Cure ye longer ye Intervals between the Paroxysm. Especially when they are not Periodic .... It is most dangerous when it is Idiopathic proceeding from some predisposition or topicall Affection in the Brain It is Carried of by Puberty Tertians or quartans, Fevers, & Eruptions, of Various kinds - Causa Proxima Boeraaves Acct, of this only seems to be a Definition of ye disease There are two Desiderata to be attended to here - 1st The particular Construction of ye Brain which disposes to Epilepsy - 2d By what Exciting Causes this principle is Affected - I must Remark that one thing Seems to be proved here Namely that ye principles of Sensation & Motion are Different Modification of ye same Principles - The Distinction between Idiopathic & Sympathic is of great Consequence in practice but it doth not affect the proximate Cause in the least there has been no light thrown upon it by Disections there was either no Morbid appearances Discover'd in ye Brain or such as are Common in other Diseases - Dr Russell imagined that ye Epilepsy in Children depends on as Strumous state of the Brain but there seems to be little analogy between this & ye, Scrophula & by no means sufficient to acertain Dr. Russels supposition tho ye predisposition and Cure is pretty much ye same - Indications of Cure arises from our knowledge of ye predisposition & Exciting Causes - 1st to Cure ye Extreme Mobility of ye system with which ye predisposing Cause is Intimately Connected, in this & some other Obstinate Diseases it woud be adviseable to attempt to Change ye Habit of ye Pt. Entirely tho perhaps he has no Satisfactory Indication to answer in this attempt - 2d To Remove ye Exciting Causes - 3d To prevent ye Fit when it is known to be Approaching- 4th to Rouse a patient out of a Fit when it Comes on Under ye First of these we shall Mention - Regimen a Milk & Vegetables Diet has been known to Cure Elepsy Entirely Violent passion of ye Mind Excessive Study, sudden Applications of great heat or Cold are to be Carefully guarded against Change of Air is of great service Violent Contusions & Concussion of ye head have been known to Cure it these use of Cold Bath has been greatly Recommended but Require great Judgment to Employ it with advantages, which shoud always be done Gradually Vide Chyness English Malady it is of Much Importance to keep ye Belly open & Perspiration Free - Bark is very usefull here Especially in Pediodicall Elepe ....., which it often Cures its action we don't well understand - Valerians must be guiven in much larger Quantities than what it is Commonly done From ʒij to ℥i in a day if we Expect any advantages From it, it is much to be douted if Ever ye Valerian is of any service in ye Idiopathic Epilepsy but only in ye Sympathic, as From worm & in ye Intestimal Canall - Elexr. Vitriol Sal Martis & Cuprum, Ammoniacum come under the same Suspicion as do also ye Minerall Waters - A Great Variety of Specifics are Neumerated For this disease as Peonyroot, Ungula Calcri Puls Cranii Humani: Drinking the Blood of a Slain Gladiator & a number more Equally Stupid & Ridiculous Hoffman Recommended Cinnabar Decoctions of ye Woods &c, but they don't seem Likely to be of any great service to answer The second intention to Remove Exciting Causes Plethora is ye most Constant Abstinence & Exercise ye Best Remedy here bleeding is sometimes of the greatest Service Especially in Plethoric Constitutions - In some priodical Elepsis ye opening of the temporal Artery has been greatly recommended when Epilepsy attends pregnancy, Bleeding is almost without Exception adviseable however it does not always succeed tho Sydenham was of this Opinion - Vomits sometimes are guiven sometimes in Case of a Foull Stomachs, may if it is not so Yet they are often of very Considerable Service by guiven a shock to ye Nervous System. Emetics guiven in small Doses so as Just to Excite a Considerable Nausea: witht Vomitting a little before ye period of Regular. Epilepsy, will oft prevent the fit entirely And by doing this Frequently we shall be able to Cure ye Disease Altogether they are of ye greatest Service if guiven immediately before ye Fit is comes on provided they Can Certainly be worked off before the Attack, otherwise it is but a bold & Dangerous Practice they shoud be repeated Successively before severall Paroxyms Vide De Haen - Cathartics, are much used by ye Antients nor do they seem improper in plegmatic habits but when ye Disease is a pure nervous Affection beware for all Evacuations do Mischief at Present Cathartics seem to be entirely neglected Blisters are often usefull during ye fit but Setons & Issues are ye most Effectuall at all times the Actuall Cautery was applied by the Antients the ye Head & ye Practice is Still Retain'd among ye Asiatics. Vide Hem for Amonitales exotica: The Trepan is said to Cure ye Elepsy or at least to present it as long as the wound is kept Opens, De Haen guives ye History of two persons that were kill'd by the actuall Cautery - What shews the propriety of a Drain about the head is that Children are seldom Afflicted with Epilepsy while they have such a Discharge but if it is shou'd any how be Stop'd Epilepsy is very Frequently the Consequence hence Issues prevent Epilepsy During Dention when Epilepsy arises From worms it Cannot be Cured by Expelling them when from Hysteria ye Fatid gume & Much are ye most Efficatious Remedies - A Mercurial Salivation has been tried but it has been attended with bad Consequence In Children it often proceeds from Acidity in ye Prime Vie hence Absorbents so frequently cure it in them Especially Magnesia All - The use of Opiates are very ambiguious they are apt to induce Torpor Atonia &c, but they are of the greatest Service in Epilepsy's that arises From Irritations as in Teething after Evacuations, among the Antispasmodics ye Ole Animate is most Recommended but I doubt if it discovers what has been said it - Were ye Epilepsy arises By Aura a Epileptica from any particular part to ye head a strong Ligature above ye part will prevent ye Fit, as does any strong Stimulus when Applied to it as Blisters, ye Actuall Cautery & - There is a singular Case in this Medicall Essaye of an Epilepsy being Cur'd by divided the Nerve - when it arising from theething ye best remedy along with Opiates a Bleeding is an Issue in ye Arm the gum shoud be lanced after the tooth begins to Raise a painted Tumor - In order to answer the third Indication Various Antipasmodics are used much is one of the best, Other & Opium are Excellent, besides these when we have Evident Warning of the approach of ye Fit, Fomentation, Pediluvia, strong Frictions to ye Extremeties are proper & any thing that has a strong Effect; upon ye imagination, will often prvent it tho it sometimes a growths the Fit - I think ye Volatile Alk lies must be prejudicially, where there is so great a Mobility of ye Nervous System as there is in ye Epilepsy as people are very subject to bite there tongue in the fit it is proper to put something between there teeth to prevent this I have known these fits kept of by Keeping a peice of Flatten'd From in the Mouth in order to keep it moderately open, by this Method a Gentleman kept them of for two yrs. DeHaen Mentions a person who was always troubled with these fits When he went to sleep but his Sleep was of ye Apoplectic kind as appears From the Stenter which Accompanied it & it being Curd by inducing a Natural Sleep by means of Opium - For ye fourth Indication we shoud not use any strong Stimulus - but Emollient Fomentations perticularly ye semi cupium Emollient Glysters are also Proper - it is hurtfull to force open the Fingers when they are shut or any other Violently Contracted parts we shall not Enter at least not particularly on ye Species of Convulsives Disorders after we have treated so fully on ye Epilepsy - Authors The best writer on this subject is Van Sweiten - Of the Chore Sancti Viti It is hard to say wether this disease is more Aspasmodic or Paralytic one it is Chieftly distinguish'd by ye Pt. drawing one leg after him accompanied with Convulsive Motions of this arm of ye same Side this particularly appears in attempting to lift his hand to his head it sometimes happens to Children before Puberty it has been known to be periodicall with the Moon the Method recommended by Sydenham of Repeated Bleedings, interposing purges with a warm stomachic Electuary and Infusions is not followed at present, on ye Contrary ye use of Cold Bath, Stut preparations & ye Bark are found to answer much Better: - Electricity is warmly Recommended De Haen he also speaks only Singly of this Remedy in Cramps Vids likewise london Meds Obsers - of the Hiccup, This Consist of a quick sonorous Convulsive Respiration - Its duration is very uncertain from a Minute to a week may even Years - I may be produced by ye Will, but after it is produced it often Continues in spite of ye Will, and like other Convulsive disorders it often Continues when both ye occasion & Cause of it are Removed, it is Often Periodicalls - It Causes are - 1st A particular Stimulus appld to ye Stomach as ye swallowing down any dry mass: taking too large a draught of cold water. Foulness of ye Stomach, Sordes Acidity, Poisons strong Emetics or purgatives, Liquors in a state of Fermentation &c, 2d an Inflammatory Affection of ye Also pruge Stomach, Intestines Liver &c, it is Often a Symptom of some other Diseased Part as of Mortification - it particularly attends Apthæ, - 3d It is symptomatic in fevers where there is no appearance of sordes or any Topical Inflamation, it is generally then a mortall Symptom - it also particularly attends gangrene - 4th it is a Consequence of Repelled gout Rheumatism or any Exanthemata - 5 It Arises from Inanition or great Evacuations - 6th it is a pure Nervous Affection as in ye Hysteria & that Hiccupted which is so Frequent too in ye last stage of Fevers which Entirely goes of as the Pt. gets Strength Proximate Cause It is a Convulsive Contraction of ye Diaphragms & a long with this or immediately after it a Contraction of ye Larynx or Glottis. There is also probably a Contraction of ye upper Orifice of the Stomach - Indications of Cure are - 1st to engag'd powerfully ye Attention of ye mind 2d to remove ye Exciting Causes - 3d to affect ye Nervous System as by occasioning a Convulsions in some other part as sneezing. Under the head are Antispasmodic fomentations, anodyne Aromatic Cataplasms but above all Other Eternally applied, Mush, Castor, Opium is ye most Efficacious when it Comes on at ye End of long Continued & Violent Fevers. Bark is the Best Remedy, tho it will often Continue several days with: any bad Consequences - Hysteria it is very difficult to Define this Disorder but it may be said to be a Combination of Complaints Chefly Convulsive nor permanet particularly afecting ye Alimentary Canal it is attended with great sensibility and Irritability of the System - An Hysteric fit begins with the sensation of a ball as it was at ye lower part of ye Belly along with this a Manifest inflation of ye Bowels, with Nausea & not Frequently with a Vomiting this ball gradually Ascends till it gets into ye throat or top of ye Gullet where it Fixes & occasions a Degree of Strangulation Disphagia, Palpitations of ye Heart &c difficult Breathing, Vertigo, Coma, ye Pt. oft becomes insensible & falls into a Fitt resembling an Epileptic one & is preceedes by ye ordinary Sympe. of such. The duration & return of these fits are very Various, They are Easily induced by slight occasionly 9 occasionly Causes & acquires a great strenght by Habit, Besides these, there are Symps, Peculiar to ye Hysteria as Flatulences, Sour belchings. Nausea, Vomitting of Tough Viscid Phlegm sometimes an Immoderate at other times no Appetite a disordered digestion a Remarkable Debility, a Flow of Limpid Urine ye belly is for the most part Costive tho sometimes loose there is also Often a Dysury & pains greatly Resembling Nephritic ones alternate fits of heat & Cold transient pains all over the Body but particularly in ye Back - The pulse is very Variable tho usually quick & small when it seizes on the Lungs it has All ye appearance of a Spasmodic Asthma it is accompanied with a dry Cough which makes us Suspect a phthisis, Pulmonalis There are severall other symps as watchfullness disordered sleep. Incubus, Globus Hystericus or a sence of a Ball in ye throat Great sensibility & acuteness of Mind a Various State of ye Spirits either remarkably remarkably Exhilirated or much Depressed great Fearfullness & Capriciousness of temper & unnaturall Cravings - Prognosis The Disease of itself is seldom Mortall - Prodisposing Causes are 1st a Sanguine Temperament distinguish'd by a florid Complexion clear skin and Usually Small Vessells - 2d Great Sensibility of the system on which acount women about there Acme are most subject to ye Hysteria - 3d it is Hereditary - 4th A preternaturall Irritability & sensibility of ye Alimentary Canal - 5 an Hemorrhagious disposition - The Occasional Causes 1st Plethora which is sometimes Constitutionall Tho it usually depends of ye state of ye Menses being obstructed, tho a supression of ye menses is attended with a much Different Effect in different Women in one it produces Plethora of ye Sanguine kind in another which is most Frequent as Serous Colluires with great Laxity of ye whole system Flous Albus &c Anasacra - 2d Stertility in Women - ye lidinosa of Sausage uncommon - 3d Inanitions by Sudden Evacuations - 4th an Irregular Gout & ye Repulsion of Various Eruptions - 5th A Luxurious way of Life & want of Excercise 6th Sordis in ye Prime Via - 7 Whatever produces Flatulencies - 8 Violent Commotions of ye Mind - 9th infection from seeing others in the Fitts - 10th warm Climates - 11th Disagreeable smels those are peculiar to Each Person - Proximate Cause I am as much at a loss here as in Epilepsys in general theres a peculiar sensibility in ye whole system with an Irritability in ye Intestinal Canal most Hysteric people have a Laxity of ye Fibres tho these Fibres are not always ye Causes of Hysteria this laxity induces Venous plethora from ye Diminution of ye Secretions & tonic power in ye system whatever weakins ye tone of ye Alimentary Canal as drinking large quantities of tepid fluids Convulsive Motion &c may induce hysteria There is great similiarity between this Disease & hypocondriasis but ye last there is not that general encreased Sensibility of ye System & in prevails most in persons of Melancholic Temperaments - The great Irritability of ye system in Hysteria must occasion very Irregular determination of ye Nervous Influence & in Consequence of that of ye Fluids to particular parts, ye fits seem to take there Rise in ye great Guts most of the symps are owing to ye particular affection of ye Stomach in this Disease - It is so various that it personates at times Every disease to which the Body in subject, As it Commonly arises from a Constitution Natural of ye Nervous system, it is seldom to be Cur'd Radically, people of this Constitution are seldom affected with Inflamatory Disease it has a great Connection with ye gout which seldom proves Regular in people of this temperament - Method of Cure The 1st View is to Remove the Hysteria paroxysm when present or prevent there Return 2d To Remove ye Occasionall Causes - 3d To alter ye prodisposition Especially ye mobility of the system - It is of much Consequence to prevent ye Return of ye Fitts both on Account of ye danger that attends them & of there being encreas'd & Rendered more Obstinate by Repetition & Habit they also induce atonia - For this purpose Bleeding is oft Recommended & with sufficient propriety in sanguine Constitutions, but it is always more in ye Beginning For after ye disease has Continued Long, on when it is purely Nervous, this Practise woud be highly improper besides Repeated Bleedings are injurious as they Always tend to produce a plethora, the safest Remedy in ye paroxysm, is Emollient, Fomentation but they are not so proper in a Plethora, they are Chiefly serviceable where ye Disease arises from Inanition, here it is Attended with Coldness of ye Exstremities. Convulsive Twichings, ye Semicupium is of ye of ye Greatest service in those fits which proceed from an Eflux of ye Menses, along with anodyne & fœtid Glysters & if ye Pt be Plethoric gentle Bleeding which favours ye flow of ye Menses, ye Affects of Cold applications as a stimulus is very ambiguous, sometimes it produces Convulsions at other times very salutary Effects, ye same applies to every other Strong, Stimulus which are not proper unless where ye patient is in a state of Syncopes Glysters with Assafadia are very Effectuall with Opuim after Emollient ones - To answer ye other Indications, it is of ye utmost Consequence to Regulate ye Pte Mind and keep it Constantly Engag'd. Moderate & diverting Travelling, Sailing &c, have this Effect, It is in this way that great misfortunes On Afflictions have Removed this disease as Civill Warrs - The strickest attention is to be paid to ye Regimen & a low diet is often of ye greatest service but any great alteration in Diet Requires great Judgment, strong & warm Tea is peculiarly hurtfull independant of the quantity of water, ye Flushings & quickness of ye Pulse are Removed by a Glass of wine or a Dram, be Cautious ye most proper drink is water with a small portion of spirits Hysteric people shoud lie Cool in bed & in Large Rooms without Fire besides they shoud be as little in Bed as possible Riding in generall is ye best mode of Exercise but where ye patient cannot bear it, Sailing answers peculiarly Well, a dry cool Air is of Service, ye generall tendency to Costiveness is to be Obviated, Especially by Aloetics, a Milk diet is highly Recommended by Sydenham Exercise is unexceptionally proper, both for invigorating the System & Exhilirating the Spts, Regular Frictions may be added, Temperate Baths have been much used lately in France by Mons. Paume, and are ye most Effectuall means of Removeing an Hysteric, Paroxysm, but peam oxtols it most Rediculously, ye Cold Bath has good Effects in Obviating a dispositions to Hysteria - Cold Bathing From a supended Bath is Often preferable to going in to an Ordinary one, In these People ye Shock shoud be as Instantaneously as possible it shoud never be used but when ye patient feels Glowing warm after it, ye Following Meds are ye most Serviceable - 1st. The Different preparations of Steel Especially when ye disease arises from Obstructed Menses, or attended with Leucoplegmatia or Chlorosis, ye good Effects of Callybeate Waters, cannot be ascribed Particularly to ye small quantity of Iron they Contain, but to there openning ye Secretories, & promoting an Equall Tension & Circulation in he System - 2d Blisters. there seems of little Consequence Except were ye Stomach is Affectid it is best to Exhibit them in a Spiritous Tinctures, Gentian is ye best of these to - which orange Rid or some other agreeable Aromatics shoud be added. Elixr of Vitriol is an admirable Mede - The Bark is one of the best antispasmodics but it is generally quivens in two small Doses in this disease, it agrees better with Stomach, when some warm Aromatic is Joined too it Musk is ye best & safest Antispasmodic, Opium is of much importance in this disorder, but it is sometimes attended with bad Effects, thus if used too liberallily it induces Atonia, & Consequently increases the Disease. Stork, says that ye Exstract Hyocyami has all the good Effects of ye Opium & none of its bad ones, preventing Costiveness &c, in Doses from 1 Grain to four, if ye Stomach will not bear Opium it may applied Externally, or administred administred by way of Glyster, it generally induces Costiveness which must be guarded against by proper Cathartics, Opium is often found to Cured Nervous head Achs, it also Restrains too great a flow of Urine, which is so frequent in hysteria - Castor has in some Cases induced sleep were Opium occasioned Delerium, Dr Whytt. advises it to be Joined with opium Cold Applications on Vinegar & Water Cold in Glysters, oft Remove an Hysteria Paroxysm or Symps, When there is great Acidity in ye Stomach. Tetacea are ye best Remeds, A Roll of hard Sulphur held in ye hand oft Snaps which surprises ye patient - so as oft to Remove Convulsion - Hysteric Plaisters frequently answer well. These antispasmodies are often Found to act more particularly on Certain Idiosyncrasies, so the most powerfull Stimulants or sedatives act with less force on some Constitutions than others & therfore are more or less Insignificant, assafœtida in a large dose is a very Usefull Mede, it Dispells flakes procures Sleep & Stools Lime Water is of no Service except in Cases of Acidity, Viscid Plegm in ye Stomach - Authors, Whytt is very Excellent Sydenham Describes it well - Of the Asthma This differs from Dyspnea in degree only there is a particular difference between the Asthma Humidum, & Sicum, or that with & without a spitting of Matter it is a frequent symptom in various diseases, I shall here describe the Common Asthma, as it Commonly Occurs in Paroxyms - This Usually guives notice Of its Approach, by ye Spirits being much Affected before it, thus ye day before there is sence of fulnes at ye Stomach, heat stricture at ye Pracordia, Flatulence Coma, great discharge of Limpid pale Urine generally a Weariness of ye Limbs, a heavy oppressive pain, little Dyspnæas, a short dry Cough, if there be an Issue in any part of ye Body it generally inflames Now - The fit generally Comes on about two o Clock in ye Morning & begins with Stricture About ye precordia, Inspiration is made with difficultly, the Patient Cannot lie in bed & is not able to Cough, ye Stomach is Distended with flatu, & sometimes thers a Billious Vomittings, the Pt. has an Anxeious Desire For Cool Air & Cool Drink & when ye fit is Violent the windows are obliged to be open'd all warm drinks as warm Wine Encreases This Flatulency, when ye fit attacks upon a full Stomach, it is more Violent & of a longer duration, in ye paroxysms ye pulse is small quick and very Irregular with a great heat, ye patient generally gets a stool with flatulency upon getting out of bed which Releives ye pain at ye Precordia, when ye Fit is Reverse & Continues long ye Extremities are Cold, ye Countenance Livid, there are palpitations of ye Heart &c difficulty of swallowing, ye Lips are Contracted & there are all ye symps of Accumulation in the Fluid if Pt. sleeps a great deal & generally in an Erect posture, but ye head is always bent to one side or forwards seldom Backwards he Can bear no Cloaths about his heart, ye duration of ye fit is verry uncertain it sometimes Continues only a few hours & sometimes for 5 days when it goes off there is generally an Expectoration of Viscid Mucus with Black streaks summer fits are worse than winter once Dr. Jno. Hoyer observes ye longer ye duration ye longer ye Interval between them, ye Blood often has as Buffy a Coat as in Rheumatism & Pleurisy, after ye paroxysm ye Urine that had been pale Coloured is high & lets fall a large Sediment, Pts seldom die in Asthmatic fits asthma seldom Ends in peripneumony but often P. Pulmonatis, & in old people in Dropsy, either asites Hydrops pectoris, or Anasarcous swellings, sometimes tho seldom it ends in Lethargy or palsy, people often live long with it. It is sometimes Carried of by Diarrhea & sometimes by swelled legs, but this last Indicates only ye approach of Leucoplegmatia or Dropsy, - Predisposing Causes 1st Hereditary disposition, 2d Wrong Confirmation of ye Thorax, deformity &c 3d particular Irritatibility of ye Lungs, 4th some Diseases predispose to it Especially Measles, Catarrhal Fevers & sometimes Agues Exciting Causes It is often symptomatic particularly in Hysteria, Hypochondriasis & Gout, when ye Gout Attacks ye Lungs it is generally in ye form of an Asthmatic fit it is Often Symptomatic, in polypi about the Heart, in Sordes in ye Primæ Viæ in ye Rheumatism Exanthematous fever, and in Affections of ye Liver & Neighbouring parts. The Externall Exciting Causes are Metallic fumes, supression of usuall Evacuation, Violents Emotions of mind particularly fear & Catching Cold, this last may produce it by determining ye Blood From ye Surface to ye Lungs & partly by inducing a Spasmodic Stricture in ye Brochia, loss of Blood & Evacuations of any kind & Violent Exercise, it is often induced too hot air & damp weather whatever induces Plethora is apt to bring on a paroxysm & thunder has produced it - Proximate Cause 1st Obstructions of ye Lungs which hinder the Distention of them by ye Air, as Tubercles, infractions of ye Cels of ye Bronchia with a Viscid tenacious Mucus particularly in old People 2d Spasmodic Stricture of ye Bronchia there is always some degree of spasm on ye Bronchiæ where there is Accumulation in ye Cells 3d whatever straightens ye breast as ye Stomach being distended with flatus or hydrop pectori Disection ye Lungs are seldom found entirely sound 10 Cure The First Indication is to Remove the Paroxysm 2d to prevent Returns ~ in ye fit a particular attention must be had to ye Exciting Cause whaever takes of Plethora when present, as also whatever takes of spasm in proper, as V.S, Vomits gentle Cathartic, Blisters, Glysters, fomentations whatever promotes prespiration witht. heating, antispasmodics, Opiates, out of ye fits is to prevent Returns many of ye above Remeds are proper, as besides these any of Meds. that prevent Plethora, & take of Mobility of ye System are proper, Bark, stat Elixr Vitriol Excercise frictions & Cool air - Bleeding is often necessary when ye Diseases is purely spasmodics, if there be plethora it is Necessary to prevent bad Consequences from Accumulation in ye Head, & it is a good antispasmodic, but in Cases of humid Asthma, where there is serous Colluires in old People it generally weakens ye Systems, induces dropsy & Leucoplegmatia, in purely Spasmodic Asthma, I have often seen V, S Carried to a 101 Great Length Successfully, in Pts that have had Returns of asthmatic fits, daily for Months together nothing Coud answer, but Bleeding, & ye fit has often gone of before 3 Ounces has been taken, it has been necessary sometimes to Bleed 2 or 3 times in a Day, and ye Blood has always been Sizy, Large & Repeated Bleedings shoud if possible be Avoided as they induce a Habit - Cathartics, of great Service where there is a Serous Colluirie, & ye fit Continues severall Days, but they shoud be gentle & not Stimulating, if ye Exciting Cause be seated in ye Primæ Viæ, Cathartics Remove it, but in purely Spasmodic asthma they do Mischief, I have known a dose of salts takes of a fit of Humid Asthma in Hysteric People, entirely Saline purges are ye Best, as besides ye Evacuation they act as Sedatives - Vomits, dangerous in ye time of ye fit, but are often Effectual in preventing a fit when in Approach is percev'd, & these be marks of Disorder in ye Stomach, when a fit is remitting Vomits shorten it, ye Vomits Commonly used here is Ipecac, with Squills & Syr. of Squills is often Employ'd, but this Joined with Tart Emetic is more Certain in its operation & both Vomits & purges - Blisters, I have seen them of Service in both kinds of Asthma, & applied to ye back & legs are of particular Use in ye asthma Arising from the Gout - Glysters, Emollient Glysters shou'd be used in ye fit Especially when theres a flatus in ye P. Viæ, & there be an Obstruction of ye Faces in ye large Intestines, ye Glyster shoud be such as Remove a purge ye Flatus, & for this purpose Assifetida a ʒi or ʒis shoud be on them - Fomentations applied to ye legs & warm Bathing to ye Exstremities, in the fits which are often Cold, are of the greatest Service in Alleviating ye Violence of ye Spasm, Fomentations to ye Breast are also of great use Opiates ye Best antispasmodie in Asthma purely spasmodics after bleeding has been employs but they are very dangerously used before the Plethora is taken off when there is a defluxion in ye Lungs Opiates shoud be guiven with great Caution, they are Commonly Joined with Castor & Spt C.C. sometimes Volatile Alkali & Spt. Sallemmoniac but these additions dont seem to be of much Consequence the Best Correcter of Opium is Squills - Fetid Gums of Service in purely spasmodic Asthma, also Asifitida & Castor mostly Used, & are particularly Serviceable in hysteric Asthma: a Solution of asifedita is a good Medes, where paitents can bear it but it seldom agrees with ye Stomach in Hysteric people preferable to Gum Ammoniac Vol. Alki is of prescribed & will often Remove slights fitts, in large doses it is of particular Service in Asthma arising From Gout, - Refrigerants, in people of sanguine Constitutions answer very well, water with a 1/4 Vinegar Joined with honey, has answerd well but never in Hysteric or Hypochondriac People .... Regimen ye preventions of returns depends upon Regimen, but this must be various as the Cause, in People subject to Asthma from Plethora, a total Milk & Vegitable diet Joined with Excercises & Issues between ye Shoulders is ye Best, but in Hysteric & Hypochondriac People this does not answer, here light animal food shoud be used as a free glass of Wine, Milk & Vegitable Diet in Hypochondriac people always produces flatulencies, but in Hysteric if Brot. on gradually is of great Service Asthmatic people shou'd wear Flannell Shirts Especially about ye Breast, & keep an open Belly great Excercise is of most use & Country Air is necessary, tho Mead mentions Instancies of asthmatic People living best in ye smoak of a Town - Preservatives, Bark is ye best it takes of the Mobility of ye System, and Irritability of ye Lungs, it is particularly proper in ye Asthma attended with flatulency - Issues in ye Back & Setons in ye side is of great Service - Mercury Dr. Whytt observes that mercurial pills have Curd but not in spasmodic Asthma & Mercury is in generall bad in Weak Nerves - Pectorals in most of them do Mischief as they tend to foul ye Stomach & encreases Flatulencey - Authors Dr.John Floyer ye best on this Subject - Head Ach This I might have spoke of under Rheumatism As it is frequently Rheumatic, but as it is often Nervous I introduce it here, ye head Ach goes under different Names, Cephalgia & Cephalea it was formerly Called Cephalagia, when a Slight pain affected a particular part, & Cephalea when ye whole head was affected, ye pain more severe & of longer Duration But of late another Distinction has taken Place amongst them Cephalea is a sharp Accute pain in ye head Cephalagia a heavy Obstruce one, but these terms are used permsciously among authors, it is Calld hemicrane'd, when one half of ye head is afected & when there is a pain over ye Eyebrow it is Called Megrims, it is Called Calris when there is a sensation as if a Nail was driving in in any particular part, & this is often attended with a sense of Coldness, another Distinction of head Ash is into Idiopathic & Sympathic Hysteria Morbi, When Violent it affects in a greater or less degree all ye faculties of Body & mind it takes away sleep & appetite & Hinders digestion, is attended with Nausea Vertigo Dimmness of Sight, Tinitus Aurium, Bilious Vomiting Coldness of ye Exstremeties, often with scarcity of & pale Urine & with Costiveness with more or less of fever at particular times tho often ye pulse is slower than naturall & in particular Species ye greater ye pain ye slower ye pulse, when very severe it brings on Convulsions, Delirium & Coma & often leaves a Comatose comaatose disposition behind it, it is of importance to observe whether there be any appearance of Accumulation in ye head from Plethoia which is shewn by ye Flushed Face Pulsations of ye Carotide prominent in Inflammatory Eyes &c, or whether it be another kind of headAch were thers no flushings nor pulsations of ye Carotids, but when ye face is pale & ye pulse is Languid & Contracted attended with Torpor Coma & Marks of serous Accumlation in ye head there is sometimes a Violent pulsation in ye head witht pain, particularly in Hysteric & Hypochondriac people, & it arises from ye Stomach ye head Ach often comes on with a sensation as if ye hair stood an End, & the the skin of ye head is sore to ye Touch, head Ach is often Epidemic is Agues, pain in ye Head & Stomach often alternate, those people who in Youth are subject to head Ach, are Generally afterwards troubled with ye gout When head Ach Continues long it induces Epilepsy, Apoplexy, Paralytic Affections, lethargy & Amaurosis, without any Visible affection of Eyes; Predisposing Causes 1st it is Hereditary Disease - 2d Youth, old people are seldom subject to it Except From some violent occasionall Cause - 3d Female Sex, women more subject to it then Men, 4th Spring Season - 5th it is Connected with ye hemorrhagic disposition particularly ye hemorrhagia Narium - Occasional Causes, 1st it a symptom in all Fevers - 2d it arises from gout not fixed in ye Extremities From Rheumatism & repelled Cutaneous Eruptions 3d From Plethora, this may arise from too full Diet, hard drinking supression of Evacuations Especially Sanguine we Commonly find that all Sanguine Evacuations are preceeded by head Ach, Especially Nasal & Menstrual under this head we may include ye Head Ach From pregnancy - 4th, Venereall Head Ach, - 5 Stomachic Head Ach, this is as Common a Species as that From Plethora and is Commonly Either Hermicrania or Megrims 6th, it is a periodical disorder of ye intermittent kind, & appears to be a local intermittent Fever, what skews this is its being Epidemic with Intermittent Fevers, observing ye same Types & being Cured by ye Bark - 7th, Topical Affections of ye Brain Either From purulent Matter serous Effusion, Excrescence or External Violence, - 8th Catching Cold or ye application of any Cold Body to ye feet or Head - 9th it depends often on ye weather, in this Country Easterly winds produce it in some People 10th, it is Connected with Hysteria & is purely Nervous, comming on & going of suddenly like any other Nervous disorders - 11th, it arises from an Exposure to ye Suns heat, - 12th, From Violent Emotions of ye Mind nor Only Anger & Joy, but Fear, Grief, & hard Study, - 13th, Symptomatic in all External Disorders about ye heads, particularly ye tooth Ach and Disorders in ye frontal Sinusses, - 14th, it is sometimes periodic Observeing ye Course of ye Moon & Recurs every Eight day 15th From Violent Excercise & particularly what determines to the head as Coughing speaking loud &c, - 16th, too much or too little Sleep - 17th, Fasting & severe Evacuations produce it 18th, Various Smels & not always disagreeable 19th, Narcotics Opiates & drinking - 20th, Metallic Fumes - 21st, what ever makes a Violent impression on ye Senses, Violent Noise, strong light Odours &, - Proximate Cause Dissection throws no light upon this it seldom happen that a person Dies of ye Head Ach alone, & when this does happen, it is only in Consequence of other Disorders being induced, as Apoplexy. Palsy &c, it is an important distinction of Idiopathic head Achs into 1st, that From Accumulation of Blood in ye head. 2d that attended with paleness of Countenance & Torpor, which is sometimes from a Serous Accumulation & sometimes is purely Nervous, in this Case attended with a spasmodic Stricture on ye Extremeties, in ye one Case theres an Evident distention of the Vessels, in ye other a Contriction, ye Stahlaims Considerd of these head Achs, as Molamina Nature to bring on hæmorrhage, at ye Nose particularly, they Consider'd Rheumatic head Ach as of this kind, there is a great Connection between ye Externall & internall Parts of ye Head ye Skin is often pale, when ye Morbid Cause is within the Cranium - Method of Cure, the Indications are as follows, but I shall first Remark that I shall only speak of the - Method of Cure in the Idiopathic head Ach The 1st Indication then is to take of ye general plethora then were there is one, or when it is only Topicall Plethora to make a Deviation from ye head with Bleeding Cathartis, Fomentations Sinapism to ye Extremeties, Cold to ye head, Abstinences in Diet & Excercise - 2d To Remove ye spasm & tention which is affected by same mean as the first Indication with ye addition of Blisters Opiates & Issues 3d To Remove ye occasionall Causes whatever it may be as this will often Remove ye proximate 4th To take of the paticular Irritability of ye sensorium Commune or Brain & to invigorate the Nervous system, This is Effected by Cold Bathing, Bark Bitters &c, steel & Exercise - Bleeding, is absolutely Necessary where there are many Marks of generall Plethora, it shou'd be used With Caution, because as I have often had occasion to say that Repeated Bleedings is afterwards apt to occasion Plethora therefore it is to be Consider'd as Merely a palliative here & indeed in such other discourse as are apt to Return - In the Topical Plethora topicall Bleeding is preferable, this may be done by leeches Cupping & Scarifications at ye temple or the nose - Cathartics are particularly proper where there is a Serosa Colluires, & those answer ye Best that are ye least Stimulating, but ye head Achs of hypochondriacs warm purgatives are more proper, the Belly should be kept open - Valerian. In large quanties is said to be of Considerable Use, Dr. Whytt mentions that a person dran a pint of Elexor Sacrum, which gurged him seven times, & induced a Salivation for three days & Cur'd a Rheumatic head Ach, - Fomentations, Both derive from ye head, & diminish ye tension of ye whole System if applied to ye Exstemeties, hence ye Pediluvium so frequently alone Cure ye head Ach, Nothing Releives fatigue from a Journey more than warm Bathing - to this head we may refer Emollient Glysters & Sea it is perhaps Needless to observe that is warm Formentations to ye head are needless Dangerous where there is any Congestions of Blood tho they may do good in Nervous Cases - Cooling, Applications to ye part has been much recommended, but if they dont Remove the Plethora or Congestion they may do Irreparable Injury - Stimulants, have been applied with Effect to ye part Effected, where ye pain is Confind to ones place, - What is most to be depended on in presenting a Plethora is a proper Regimen That is by great Abstinence in point of Diet & much Excerise - Persons subject to head Achs, shoud sleep with there head Raised high, shou'd Eat no Suppers avoiding Everything that might Irritate, & Excessive Study, keep there belly Constantly open, & Frequently wash there heads in Cold water, & Constantly Shaved, they shoud always preserve there feet warm, Under ye second Indication comes ye mild Diaphoretics. The Volatile Alki, is of service both in this Respect, & as Antispasmodic it found to prevent ye paroxysm of a periodical Head Achs, when guiven in large doses, Gum Giac & Sal: C: C: are very powerfull in a Rheumatic head Ach. A dose of Opium before a periodic Head Ach will prevent it altogether, & they are ye only Meds, to be depended on, in Hysteric cases Opiates Combined with Emetics as Doson Powder, or Laudanum, with Vin: Ipecac and Spt. Minder are ye mos certain Mede, 11 For presenting Periodical head Ach, - Blisters, are verry Effectual in carrying of an head Ach, but they must be Cautiously avoided till ye Plethora is taken off, - Opiates, are of great service in some Cases, but are highly dangerous in those, which arise from Sanguine Congestion or Inflammatory Diathesis - Electricity, a very powerfull in Removing Nervous head Ache - Ather, too is a powerfull Med. or Antispasmodic- Essense of Lemons Joined to ye Vol. Alk, answer ye same purpose, these Constituted, Dr. Wards Celebrated Nostrums for this Complaint, Warm Plaisters removes fixed pain, Then third Indication Relates Chiefly to Symptomatic head Ache, in ye Hemicrania and most of ye other head Aches, that Arise from some disorder in ye Stomach, Vomits are of great Service, - Issues & Setons are very Usefull, 11 The Bark fails in afecting a Cure in those that are periodicall after a Vomit, - Errhines is of service where there is a dryness at ye Nose Spt.. C. C Hungary water Other oft Affords great Relief in Head Achs but perhaps only in those which are of ye Nervous kind - Absorbents, of Acidity are sometimes of Use, & Mercuriall Mede have at times Cured periodicall head Achs, or hemicrani as attended with a Swelling of ye part outwardly- For ye 4th Indication Valerian has been Chiefly Recommended, but to any service it shoud be guiven in substance, & to ye Quantity of two drams Every day - Bark, Cold, Bathing, Chalybeates &c, & other Regimen before advised Come under this Intention - Of the Cholic This term was greatly Extented & Variously Apply for Under this Tittle they Comprehend Every pain, that Afflicted of Alimentary Canall, - It is a Violent pain in ye Bowels, & principle Symptom in ye Enterisis, Dysentery & often in Jaundice, - Most Species of Gastrodynia are attended with Cholic pains, & I shall speak of them Under this head as ye Gastrodinia is properly a Cholic of ye Stomach ... the Billious Cholic is distinguish'd by having Billious Vomittings, & sometimes Costiveness a Bitter sour taste in ye Mouth, great thirst Urine Small & high Colourid, Vertigo Pulse small as Usually happens in all disease of ye Bowels, this then greatly Resembles ye Cholera Morbus - The Illiac passion too is placed by Sauvages under ye Alui fluxus, but improperly The Hysteric Cholic is attended with Violent pains at ye pit of ye Stomach, tho ye pain sometimes Fixes on ye Other, Parts of ye Abdomen, it is attended with Billious or porateous Vomittings, great Anxiety a Dejection of Spts. it is very liable to return Especially from slight Error in ye Non naturale, or violent passion of ye Mind it is often translated to other parts of ye Body, it always leaves Soreness behind it in ye part, it frequently shifts it, often terminates in Slight Jaundice - 3d ye Flatulent Cholic, is attended with an Unequal Distension of ye Belly, great Costiveness flatulencyes, Borborygmi, Umbilical, Hernia - 4th & last I shall Mention is ye Spasmodic Cholic, under which we also include ye, Cholica, Pictonum a Rachialgia or dry Belly Ach - In this peices ye pain mostly Affects ye Limbs & Spine, ye Spasmodic Constrictions here Affects ye whole Abdominall Viscera, ye Navel is drawn in with Violent Pains at ye Scorbiculus - There is great Anxiety, Violate Vomittings, Obstinate Costiveness, & often so great a Constrictions of ye Bowels that a Glyster Can not be thrown up it Alternates with ye pains of ye Limbs & sometimes too with those of ye head, its most Ordinary Metestasis, is upon the limbs which it Affects with palsy - All these species are apt to terminate in ye Illiac passion, there is a good deal of Difficulty to Distinguish this from Neptoritic pains, tho in these last they are more Confined to ye Region of ye Kidneys, ye Urine Also is Oft Bloody, Otherwise it is very Clear, the pain Often Extends along the whole Ureters, it is, not always attended with Costiveness, nor so much Releivd by Clysters, it is also attended with Sickness & Vomitting ye patient only Can lie on one side, pains & Mumness of ye Legs with a Retraction of ye Testicall Nausea & Vomitting attend a Stone in ye kidneys, And yet for all this a fore knowledge of the Peculiar predisposition Contributes most to distinguish Nephoritic Paroxysms - Cholic pains leave ye Body remarkably feeble & under a great prostration of Strengh, - They are often Curd by Diarrhea, by Copus sweat Hemorrhages from ye Noses, or hemorrhoids by a flow of ye Menses, a fit of ye Gout, Miliary Eruptions & Jaundice - It is a favourable Sign when ye pain shifts ye most dangerous Situation is in ye Region of ye Umbilicus - Occasional Causes are 1st, Costiveness which includes all ye articles of Diet that induces it, in this Case the pain is Usually Confined to ye Colon - 2d Flatulencies which is attended with Spasms 3d Worms - 4th Acidity in ye prima Via Especially in Childn, 5th Acrid Bile in ye Alimentary Canals, - 6th Hysteria & Hypochondriasis - 7th Repelled Gout, Rheumatism, & Various kinds of Eruptions - 8th Plethoras, - 9th Calculous Concretions or Jaundice - 10th, Exposure to Cold Especially ye Feet - 11th, Strong passions or any Violent Emotions of ye Mind Especially Anger - 12th, it almost always attends ye paroxysms of Auges - 13th, it is Often occasioned by Mettalic or other fumes 14th, From various Affections of ye Neighbouring Parts in which Case it is Symptomatic as from Dentition, Calculi in ye Kidneys - 15th, it is Epidemic in several Countries as in our Cyder Countries, Poieteire, Germany & the West Indies - 16th Various Extranious Bodies lodg'd in ye Bowels particularly fruit Stones - 17th Affections of ye Gulls themselves as Inflammation &c, - Proximate Causes, is a Violent Constriction of the Gutts in some parts, wilst Others are præternaturally Distended or Some Morbid Acrid Matter, Inflamation of ye Alimentary Canal is very apt to Gangrene, which generally prove fatall Especially in people from 40, or 50 to 60 or 70 Years of Age - Indication's of Cure are 1st to guard agints any Inflamation of ye Bowels 2d to Open ye Belly & procure a free passage through ye Intestines, - 4th to Remove pain & spasm - 5th after ye disease is Removed, to Strenghen is Alimentary Canall, to lessen its Irritability &c, - 6th we must have respect to ye primary disease as ye Cholic is often only Symptomatic Istial next Consided particular Remeds. that are best adapted to answer these Indications, it is a disputed point whether or not Bleeding is Serviceable, - When there has been such a Spasm of ye Spincter Ani that a Glyster Can not be guiven Bleeding has almost Instanly Releiv'd it, - When there is any degree of Plethora or Inflammatory Diathesis, Blood letting Cannot be Doubted, it is also a powerfull antispasmodic, it is of ye least service in Hysterical Cholic, & indeed in Spasmodic Cholic it does not seem to have any tendency to Remove ye Disease - Where there are marks of great Stricture on ye Intestines, Injections of 3 or 4 ounces of Oil at a time, & repeated every hour or Oftner have been of ye greatest service, & often brought large Quantities of Indurated fœces, if they shou'd not, A Stimulating Glyster ought to be thrown up after them, ye Smoke of Tobacco as a Glyster is very Efficatious, Warm water is a Usefull Injection, Glyster ought in general to be of ye Emollient kind, Especially in the Billious Cholic, For here all warm & stimulating ones are pernicious, - Carthartics, are Often absolutely Necessary but all Acrid warm ones are hurtfull in ye Billious Cholic, & in generall of discourse in Hysteric Cholic, in which even Glysters have bad Effects, Cathartics shoud be guiven in small doses & Repeated till they have ye Desir'd Effect, Cremor Tartar with a Verry few qts. of Jalap makes a very usefull Cathartic, & may be repeated, pills often sit upon ye Stomack when Fluids will not ... one of ye Best Cathicts in warm Climates for Billious Cholics, is Ripe fruit eaten ad Libitum - Two Ounces of Goubers Salt disolved in a H of Water will often sit well on stomach, in Small doses, as an Ounce every half hour. - Opiates, are Often prescribed with Glysters a Cathartics, in order that they may be Retaind a Sufficient time, by this means ye Spasm of ye Stomach is taken off, which before prevented anything, Even Opiates themselves to be Retain'd- In persons of plegmatic & weak lax habits ye Warmer Stomachic purgatives, a Tinct, sacra, are of ye greatest Service, In short, Cathartics are in generall Necessary, when there appears to be any sordes in ye Primæ Viæ, that Ought to be Evacuated - if the Spontaneous Vomitting so frequent in this Disorder be Carried too farr ye Saline Draughts in ye act of Effervescense may be Guiven with advantage, a warm Anodyne plaisters, as of Theriaca, may be Applied to ye Region of ye Stomach, Laudaum may be added to ye Saline Draughts - Vomits are seldom Requir'd for there is generally a Spontaneous Vomitting, small Draughts of Cold water oft ye most Efficatious, Remedy in Restraining Violent Vomitings Especially Billious ones witht. Inflammation - Diaphoretics, oft Afford great Releif, particularly in ye Spasmodic Cholic & such as Arise from taking Cold Saline draughts answers this purpose but & most Safely, they Also Check any Vomiting, yet we shoud be Cautious how we Meddle with ye warmer Diaphoretics - Blisters, over ye part are often of ye Greatest Service, where there is any topical Inflammation in ye Bowells or Even in ye flatulent or Spasmodic Cholic and wherever ye pain is fixed to one part of ye Belly They often procure Stools. - Semicupium, fomentations & pediluvia are Usefull, take of tension & Spasm, in Billious Cholics, Cold Applications or water are warmly Recommended by several Practicioners, in warm Climates where there is no Inflamation, the Application of Cupping Glasses is advised by Van Sweiten, - Punctures in ye Belly are Recommended by Ballonious & practised among ye Japoneze but ye Practice shoud seem too adventureous to be attempted upon Man. - The principle Remedy after proper Evacuations is Opium, Either by the Mouth or in Glysters, an Opiate along with a Cathartic is generally Succesfull in Alleviateing the Cholic, it does not prevent ye operation of ye Purgatives - In ye Hysterical Cholic it is of ye utmost Consequence & also in ye Cholica Pictonum & Rachialgia, - The practice of giving Aromatics & Spts is dangerous, & apt to Occasion an Enterisis, tho in flatulent Cholics & Leucophlegmatica Habits they answer Exstreemly well, in ye Gripes of Children Testacea or Vol Alkali are usefull but more Especially Rheubard, Bland & Expressed Oils are much Recommended by De Haun Either alone or with gentle Cathartics, in Considerable quantities, Upon these with Opium he rest the whole Cures of Cholica Pictorum The Actuall Cautery & burning with Moxa are much used in Asia - Swallowing Crude Mercury or Bullets is much Recommended by some, but ye practise is Hazardous & now pretty much laid aside, Affusions of Cold water have often Remov'd an Obstinate Costiveness, merely by pouring it on ye Extremeties or by wathing Upon a Cold stone flour, these act very Quickly (Vide Med Esays Vol VI) it is possible to open the Colon Especially about its beginning Without wounding ye Peritoneum, or Cavity of ye Obdomen, & Certainly always shoud be attempted when large Bolls are lodged there & Cant be removed by any other means, - The best Preservatives are a Vegitable Diet an open Belly keeping ye feet warm, ye use of ye Bark Steel & other Corroborants, Excercise, Particularly Riding, ye Cold Bath Mineral Waters, as those of Bath, Buxton, & Moffat, Hysteric plaisters prevent these Cholics, Authors, De Haen, - Huxham & Hillary are ye best on the Cholica Pictonum, to these we may ad Tronchin .... Cold Drinks & Injections are often Used, with very great success in Billious Cholics of ye warm Climates, but these Use in this Country is Doubtfull & Dangerous, in ye Hysteric Cholic or those attended with Fever & Topicall Affections - Of the Hypochondriasis - This disorder is Classed under ye Vesania by Savauages, but there is no Disease of ye Mind Except great Apprehentions - All ye Symps Arise from ye Alimentery Canal the most frequent of which are Borborygmi Nausea frequent Vomiting, pain in ye Stomach, Palpitations of ye Heart; Obstinate Costiveness frequent Spouting from the Stomach, A verry Irregular Appetite, Violent fitts of loosness, Alternate flushings of Heat & Cold, Vertigo & Disturbed Sleep, Frightfull Dreams Sallow Countenance, Heart burnings inexpressible Anxiety, and Apprehensions Flatulency lean Habit in Generall - All these Symptoms are much more durable than the Hysteria - Predisposing Causes are - 1st a Melancholic Disposition or Temperament which is distinguish'd by a Course thin tinse Fibres, Darke Complexion lean Habit, large Veins, a mind Capable of great Attention & not Easily Affected with passions, but when it is Stirred up it is incontroulable, - 2d, an Advanced period in life - 3d, an Hemorrhagic Disposition, - 4th, The Male Sex &c, - 5th, an Hereditary Disposition, - Occasional Causes 1st, a deep and Casting impression, on ye Mind as long Continued grief, intense Study &c, - 2d a Plethora of ye Venous System, this is ye Case when ye disorder arises from a Supression of some Usuall Evacutions that is Sanguine, particularly ye Hemorrhoidal Flux tho if the Check be sudden it is Rather apt to Produce Hysteria, - 3d Inanition or any great Evacuation. Especially of Blood, if Slowly Effected bringe on Hypochondriasis if it be sudden more Commonly it Occasions Hysteria, - I am not Certain wether ye Diabetes is to be Consider'd, as a Cause or Effect of this Disease 4th Excess of Venery this quives ye most Obstinate Speices - 5th The Gout; - 6th, The Repulsions of Cutaneous Eruptions, - 7th Obstructed Viscera, Especially of ye Liver & Spleen, tho I am not Certain, whether these are Causes or only the Effects of the Disease but ye last seems most probable, - 8th, it is often ye Consequence of Hysteria hence those who were liable to Hysteria in youth have generally ye Hypochondriasis in old Age, Often too these diseases are so Complicated or mingled together that it is impossible to Distinguish which is ye Disease Proximate Causes seems to be a Morbid Affection of ye Alimentary Canall which appears now to have a preternaturall, Irritability, but along with this no particular Mobility of ye System but rather an, Inertia, ye Alimentary Canal is less Contractile & tense than Naturall I have Knowns 17 grs of Tart Emet without Vomiting it evidently affects ye Secretory organs of ye Intestines, From the Costiveness & tenacious Matter which lines there Coats, hence ye strongest Vomits & Cathartics have hardly any Effect upon Hypochondriacs, hence also arise ye good Effects of Stimuli upon such people in this Affection - In Consequence of ye Torpor of ye System many of ye Secretions go on Slowly, hence ye great dryness of ye Skin - Indication's of Cure are 1st, To Clease ye Prima Viæ from any Morbid Matter or exiting Cause that may be loged there - 2d, to promote ye secretons, particularly those Of ye Alimentary Canal & by the Skin ..... Both of these are answerd by vomits Cathartics, frictions, Exercise, Diaphoretics &c, 3d, to strengthen the tone of ye Stomach, & system as by Bitters, bark Steel Exercise, &c 4th to Restore Chearfulness & Content of mind great attention must be paid to the Exciting Cause Vomits are often of great Service but in Common practice they generally too frequenly Repeated, for then they weaken the tone of ye Stomach & thereby agravate ye Disease I have known Small doses of Ipecac, or Tart Emetic given Successfully for several Mornings so as to produce a Considerable Degree of Nausea without actual Vomiting attended with Supprising good Effects they shoud be worked of with Camomile Tea, but ye [illegible] shoud never have above a H, of ye Infusion at a time, they Evacuate the Sordes and Restore ye Determination to ye System, - Purgatives, are Serviceable ye best are Alostics, the Milder & Cooler ones occasions Flatulencies, & Rheubarb binds ye Belly, afterwards severe purgins do Harm, - Diaphoretics, have but little Room here because plentifull Dilution relaxes ye Stomach so much, - Mineral Waters, are very servicable Especially, those that are impregnated with Caustic Alkai, & are of a Moderate heat such as Brexton, as to Bathing ye warm Bath may be proper in the true Melancholia Hypochondriasis, but in generall The Cold Bath is to be preferred, & is ye oft ye most Efficacious Remedy we can use Especially in ye Vinereall, Excercise is of ye Greatest Service Especially Riding on horse Back, ye best Succedaneum for Excercise is strong Frictions particularly of ye Superior Exstremeties - Sailing is found to be of the greatest service Warm Climates often Cures this for these people are always much Affected by Change of weather The Secretions too go on more briskly there as people in generall are more Chearfull & have a greater flow of Spts than in these cold Climates, but this Temperament is much Affected by many Causes, besides ye difference of ye Climates, ye Remedy most Commonly made use on are Bitters & aromatics, Steel is improper where there is Venous Plethora Yet these is found ye very long Continued to Relax the Stomach, - 3d The Bark & Steell answers the Indications much better than Aromatics, - Mineral Waters, have good Effects Which seems to be owing to there promoting Several Secretions, - as to Regimen solid animal food agrees better then Vegitable Acesents once are Hurtfull, the best drink is Cold Claret or Generous Maderia, if they agree with ye Stomach & do not Sour if this is the Case Spts & water shoud be used, sometimes Old London porter agrees well, ... Of the Mania The Mania & Melancholia are generally Treated of Seperately, but as they so frequently run into each other we shall Consider them together - Mania is a Delerium witht fever it is not however Easy to say what a Delerium is, most Understands by it, a Disorderd Imagination but this is too Generall All those of a lively Imagination are very Subject to have it Disturbed or Disorder'd, it is then to be distinguishd According to its Degree, Boehaave's first Description of Mania or 1st Stage as he Calst, is a Description of ye Melanchlic Temperament, His 2d Stage is the proper Hypochondriasis, in some Cases only ye Imagination is Affected, in others both Reason, & Judgment; this is ye highest degree & seldom Exists, I shall only here Describe ye Truest Speices of Mania, it seldom Continues Violent for a long time in general there is a preternatural Exertion of Muscular Strength, with a totall want of Sleep, sometimes for Severall weeks together, I shoud had Observ'd tis often known before it attacks, by a Redness of ye Eyes a quick Motion in ye palpetree to ant of sleep head Achs, Vertigo Unusual Actions & sayings, the appetite is Often very Immoderate... In the paroxysm it Effects Different People very Differently as you'l find Discribed by Sauvages The paitents are not at all Affected with ye most Intense Cold, & bear want of food & Drink for an amazing long time, from all ye Secretions being now Stopped, - Sometimes the Disease is Continued or permanent, tho in general, there is some lucid Intervals, ye paroxyms of return periodically During there Continuance there is often a wonderfull Degree of Acuteness of ye sense & in generall a Malicious Cunning, tho at ye same time there is in there Disposition a great degree of Cowardice, there appears to be an amasing tension in the System ye Blood Also is Dense oft Buffy - The pulse varies according to the nature of ye Passions, oft it is Naturall, - When ye Paroxysm goes of there is a great Languor & Lowness of Spts, left behind, it is a false Observation, that Maniacal persons, are oft long lived, they are generally Ere long Carried of by Apoplexy, Convulsions If not by these Atrophy will Effect it, - A Supervencing Fevers, Cutaneous Eruptions Hemorrhages Dropsy, Vomiting, purgin, & intermittent fever, have often removd Mania, when these intermittents are Cured ye Mania does not Return, Abscesses sometimes Carry it of, Again, a Mania has been Curd by a Dropsy, P. Pulmonalis &c, & Resists Epidemic & Cutaneous Diseases, Predisposing & Occasional Causes Mania seldoms Attacks infants or Children tho Women about ye appearance of ye Menses Especially if there be an Emansia Mensium are very liable to it, it Never Attacks Old People above 60, at least not from the most powerfull Occasional Causes, - 1st, an Hereditary Disposition, - 2d, A Melacholic Temperament - 3d, all ye occasionall Causes of Hysteria & Hypochondriasis may induce Mania 4th, Whatever, produces Plethora and Determine ye Blood at the same time to ye head, as high living, Violent Exercise. Excessive passions &c, - 5th Child Bearing this has been attempted to be Accounted for from a Supression of ye Menses, & Lochia, but in woud oftner seem to be owing to a supression of ye Milk, & thefore women who are strongly predisposed or in whom it is Hereditary, shoud be cautious in Repelling there Milk & suffer the Child to suck a little at least for a few weeks 6th, whatever keeps the mind long intent upon, anyone Subject; as love, Phlegion, Desire of Asarice & Honours, &c - 7th, Sudden terror Especially in Children 8th, want of Sleep from whatever Causes, 9th it is periodicall & follow Disorders that Attend ye Revolution, of the Moon hence that Species Call'd Lunacy - 10th, it often Comes on towards ye End of long Intermittent & Nervous fevers but this is Rather a Speices of Idiotism & wears of in three weeks or a months time, by proper Exercise & Diet, tho sometimes never goes entirely of, - 11th, Infection for it appears that it may be Received in this way from ye Camisands, this arises from a Communication of ye passion, tho is more particular in Religious Matters, ye Camisands were a set of pretended French prophets, that Came in to this Island About ye beginning of this Century, & preached Various New Doctrines, but always upon their holding furth, they were Seized with Various uncommon Convulsions which attracted numbers to Attend them & drew them into ye same state with themselves Even People of the best sense & greatest Learning - 12th, Externall Violence as Stroke & Compression on ye head, tho this is more apt to Induce Idiotism - 13th, the Melancholia Anglica or Sodium Vita - Proximate Cause, nothing can be said on this head with precision there has been found Various Morbid apperances in ye Cranium, on Dissection, but they are so different, they dont thro ye Cast light on this Subject, may woud Rather seem to be ye Consequence of the Disease than its Cause This Disease is Evidently on ye Nervous system & therefore beyond the Reach of our knowledge, it seldom proceeds from any materiall Cause, discoverable by our Senses - The Supposition of its being occasioned by ye Atra Billis does not in the least Explain ye Phenomona, the most importants fact, known in Regard to its Cure is that it is almost always accompanied with ye Inflamatory Diathesis, & at ye same times attended with a particular Determination to ye Head, ye appearance observ'd upon Dissections are more probably ye Consequence, than ye Cause of this Disease such as the, Dryness of Friability of ye Brain ye Viscosity of ye Mucus in ye Stomach &c, - Indications of Cure are, - 1st, to take of ye Plethora & Determination to ye Head, - 2d, To promote ye Secretions, - 3d, To Remedy ye State of mind & Various Arts, 4th To guard against & Remove all occasional Causes 5th, To induce a Sudden or Total Change in ye whole System, tho we dont know, what it is that Ought to be Changed, the Event then must be very Various, - Particular Remedies, - Evacuations of Every kind are of ye greatest Service, tho they do not touch the Proximate Cause of this Disease, - In most Maniacal persons there is a Plethora which Indicates Bleeding, Yet in the Melancholia, attended with depression of the Spirits, it is not proper nay Even in ye Mania, itself, this & Other Evacuations are to be Employ'd with Caution, less they shoud occasion The Disease to degenerate into an Incurable Idiotism, After ye Plethora is taken off Vomits are ye Principle Remedy, particularly in ye Melancholia, these besides dislodging any Sordes open ye Secretions, & give a Violent Concussion to ye whole System, these as well as all other Meds, are to be guiven in all Manicall Cases, in double doses or Even more to produce there Usuall Effect,- The use of Cathartics is not so Generall, however they seem to be more proper in a Mania then Melancholia, in ye last gentle saline Purges answer best, ye Antients used helebore, Diluents, woud be highly propers, but ye Pt, Can hardly be persuaded to take them, Tartm, Tartarizat, Caustic Alkali, they are Recommended & bid fair to be Serviceable, Decoct. of Dense Leonis or Teraxicums, or the Succi Scorbutics & soap in ye Spring and Mineral Waters in the succeeding Summer are of great Service, - In the Mania a low diet is absolutely Necessary, hence living upon fruit is known to Cure this Disease, the Head shoud be shavd and wash'd Every day, - Excercise is of great Service in the Melancholia less in Mania - a Voyage to the East Indies has Cur'd both Mania & Melancholia however Sailing Always keep a Constant Motion of Nausea, which no other Mede Can be Employ'd to do with Safety - Mercury has been sometimes found of Use but in ye Tryals we have made of it here in two Cases it did not succeed, - Warm Bathing, as Pediluvium or somicupium is of the utmost Service, tho Cold Bathing is much more practised, & Boerhaaves Strongly Recommends sudden Immersion this acts with great force both on ye Body & Mind, & yet the practice of keeping them Long in Water, is a bad one, I have known the pouring of Cold Water from an Height upon ye head of Manics procure strong, Sleep for many hours, when the paitent has not Slept, For many Days, it Causes a great Accumulation in ye Head, hence those who are drowned have generally ye apperance of those who die in Apoplexy pouring Cold water upon ye head is very propers but it shoud not be Continued too long at once, Especially were there is an Inflamatory, Diathesis as it may fix an immoveable Obstruction in ye Brains, Snow has also been applied to ye head with ye same intent Castration has been Recommended or became Melanchonics or Idiots, Celsus Recommends warm Pediluvia & fomentions to ye Exotic mentic whilst Cold water is pour'd upon ye Head - All antispasimodics seem to be of little use, the Van Sweiten Mentions good Effect from Musk, large doses of Camphor were sometimes in high Repute, There are great disputes about the Propriety of Guising Opiates, yet they have in many Cases been of ye greatest Services, & are Absolutely Necessary some to procure a little Sleep, & I never saw any bad Effects From ye Liberal use of them, after proper Evacuations - Blisters are sometimes of Service in ye low Kind of Mania, but never in the furious Constant drains from the head do much good, Issues & Seatons shoud be made, may even in bad Cases, tho trepan might be tried Great address in Requird in Regard of the Proper management of this in this disease, Fractures, or Trepanning of ye Skull has Often Cur'd Mania, & Merits Trial, - Music has great Effects in those that have an Ear to Music tho but temporary, Sometimes ye disease when it Arises from ye Passion, is Often Remov'd by Opposite Passions, Constant Employment in the Mind & Body is very useful in ye Melancholic madness, Class 5th Morti Cachectic This Class is not at all determinates, & the Severall Orders have no Common Vinculum, Ishall begin with - The Dropsy The 1st Spices of Dropsy is the - Anasarca which I shall next treat of It Consist in an Extravasation of water in ye Cellular Substances Membranes, it is a Soft white or Pale non Elastic Swelling of ye Whole Skin that pits upon pressure - It has been Called Leucoplegmatia & plegmatia - The Symptoms or Sign of this drop Are, the Skin pits on being pressed as with ye finger these Swellings are greatest in the Legs & feet Especially toward ye Evening, there is Usually a degree of Dyspnœa, - the Urine is pale & Watery & small in Quantity, - the pulse is very Various some quick small & irregular & at others very slow, there is generall Diminution of ye Contractile power of ye Muscular parts, & of the Sensibility of the Skin, the water in the Celluar Membrane, in some Cases Exudes thro the Skin but Often when it does this it Raises the Cuticle in the form of Blister, the Swelling is in Every portion of the Celular - Membrane & not Confind to that under the Skin, there is Often a Comatose Dispostion & general Inertia & torpor of the Whole Nervous System, the Sleep such as they get is not Refreshing, in Old People it often terminates in gangrene, it has been known to Alternate, with the Asthma, in Agues there has been Instances of the Hydropic swellings of the Legs Disappearing during the Cold fit, & of the Pt. being Suffocated by ye Metastasis The Remote Causes are - 1st. A Supresssion of Use all Evacuations - 2d Profuse Evacuations - 3d Pregnancy - this generally only Occasions a, Swelling of the Inferior Estremeties from the Compression of these Blood Vessels by the Impregnated Uterus - 4th Errors in diet Especially drinking large Quantities of thin fluids or Spirits, Liquors 5th Want of Exercise - 6th whatever weakens any particular part & weakens ye Determination to it, to this Cause we Refer the Adematious Swelling, happening Sometimes after Strains - 7th A Moist Fenny Country - 8th whatever Obstructs ye Return of the Blood toward the Heart, - Proximate Cause is an Extravasated Fluid in ye Celular Membranes, there are questions that woud Endeavour to make us believe there are Various kinds of this Membrane As ye Adipose which Contains ye fat or Oil & the Reticular which is supposed to be- Different From (& separate) this , & contams the water in an Anasarca the Air is an Emphysema &c - As I just before said Effusion of Serum into this Membrane that is not Resumed by ye Absorbents, seems to Constitue the dropsys proximate Cause, or Anasarca, - Tall People are Observd by Hofman to be most liable to ansarca, which is attended with great Laxaty of the Solids, & a torpor of the Nervous Systems, a Certain degree of tensions encreases the sensibility of ye Skin, but if it goes beyond that it diminishes it, ye Blood of these People has generally A Large Portion of Serum, tho frequently the Crasseamentum is Coverd with the buffy Coat - The Indications of Cure are - 1st to Carry of ye water by the severall secretions Scarifications &c. - 2d to prevent a relapse - 3d to promote Absorption - 4th to Remove Exciting Causes, 5th To palliate, - Bleeding is exstremly rarely Necessary Except there be great marks of Plethora & in Vigorus Habits - Vomiting, is an Evacuation that promotes all ye secretions, hence it is Extremely usefull by its Stimulus [crossed out] it seems to increase ye power of ye Absorbents, - Purgatives, Frequently Cures ye Dropsy, those mixd with mercurials are most Efficatious, if they do not produce sensible advantages, it is imprudent to Continue there Use, Vomits & Cathartics Joined in one perscripsion & quiven in very small Doses are found Excellent; & repeated - as Supr. De Spina Cervin, ℥ij & Tart Emetic is given in divided Doses - In Case of great weakness the safest Evacuation to encrease is ye Urine - but in this Case it must not be done by warm diluent drinks, but by warm diuretics; for which purpose the Alkline salts are powerfull Broom ashes have no Virtues but as an ordinary Fixt Vegitable Alkali, ye Squills particularly ye divided ones guives place to few where there is a great Torpor, &c, garlic Mustard Horse Radish &c, answer best, Oxymel Obeckfeum has had very good Effects here - at other times it has had no sensible once, however it is ye best I know it is Often Cathartic, Mercurials in Case of slight Congestions & in fractions of ye Viscera answer Extremely well but they are hurtfull were there are marks of a Relaxation of ye System No Diaphoretics, Can be administered with Profit as they Require so much diluents unless we may Reckon Exercise one which it surely is, & of ye greatest importance in this disease if it is not Carried too far Sweats are best & most Safely promoted by Emetics Joined with Opiates, as Dovers powder - the Decoct, Seneka, answers well For it acts both by stool Urine & prespiration .... The Diet shoud be of ye solid kind Abstaining from all fluids as much as possible Dropsical people should either take no Drink or very large quantities, for I have known Several who out of a kind of despair after been guiven up by theres physcians & with an intent to indulge themselves before death, have drank, immense quantities of fluids which open ye Obstructed kidneys, & Carried of ye water by ye most Elligble way, this practise however must be precarious & not to be recommended before further Experience has determined its Effects, with more Certainty, Compressions or bandages are Often applied to support ye parts, & prevent there being too much distended Especially on ye legs were it answers pretty well they shoud not however be too tight; least they shoud occasion an Inflamation & gangrene which is Easily done in Hydropic Persone - The most immediate Method of Eacuating ye water is by punctureing ye skin in a dependant part-,- Cabbage leaves & Blisters are much Used to answer. this intention. but Slight, Punctures or Scarifications are much preferable Even from these there is great danger of a Mortification coming on ye part - In generall this disease is not so dangerous as the Ascites, - After ye water is draind of, the most proper Meds, for preventing an Accumulation again, are warm Bitters, Bark, frictions, Excercise & Chalybeates, of the Acites, This is defind by sauvages to be a swelling of the Belly with an Evident fluctuation, but ye Common Definition is better than this namely, a Collection of water in ye Belly, tho ye fluctuation of it be not perceptible, - The Ascites generally begins with a swelling of the Legs, tho not always, it is attended with Great heaviness. Torpor Difficulty of Breathing & a dry Cough, the Belly is Costive Urine little & high Coloured, a slow fever for the pulse becomes more frequent, a dry Skin Often Anasarcus Swellings, Hydrocele &c, Hemorrhagies when the Disorder has Continued long the water Often becomes Extremely Acrid, & new Symps, appear, as Hemoptose, Diarrha Hamorrhagy, From ye Nose &c, & other signs of a putrid acrimony, abounding in ye System ye Ascites is sometimes Carried of Naturally by a Diarrhea, by increase of Turbid Urine by Evacuations from ye Lungs & Belly, & by a Spontaneous Vomiting people labouring under this disease has sometimes Died suddenly when they were Recovering & thought to be out of danger, - Occasional Causes, 1st, an Hereditary Disposition - 2d, Drinking large quantities of Cold liquids when hot, tho Exstremly Rarely, - 3d, profuse Evacuations long fever &c, - 4th, Obstructed Viscera Especially ye Liver in Fractions of ye Lungs also sometimes produce it & Obstructed Mensenteric glands, hence, - 5th, It Often happens in Scrophulous Children From Strumous Swellings in ye Mesentery 6th Repelled Itch, Gout, &c - 7th Whatever Causes an Obstructed Circulation, thro ye Heart, larger Vessels or lungs as, Polypi Asthma - all ye occasional Causes of Anasarca come in here for a place which I must desire you to Recollect as I gave them but lately, - Proximate Cause, Is a Collection of Water in ye Cavity of the Peritoneum, which may be owing to an encreas'd Exhalation or Diminished Absorption & perhaps sometimes to a Rupture of some Lymphatics, - On Disection we generally find some Obstruction in ye Abdominall Viscera particularly in the Liver - beside serum other matters are sometimes found in ye Abdomen, in Consequence of some erosion Ulceration &c, as puss Blood &c, Sometimes ye Water is Contained in ye Incysted Tumours Called Hydatids, we judge of this by ye Swelling of ye abdomen, being Confined and Circumscribed, by ye want of fluctuation & by ye pts. Enjoying a tolerable good state of Health; there are also often found, Smaller Hydatids floating loose in the generall Collection of waters .... if the Dropsy arises from Obstructed Viscera there is not Commonly any Tumefaction of ye Legs Otherwise there is, as ye first Symptom, ye Scarcity of Urine has been Ascribed to ye water, Compressing ye Kidneys, but this cannot be the Case as it is one ye first Symps,, before any Sensible quantity is accumulated, it woud Rather seem to be the Cause of this troublesome disease, - The Indication of Cure are here much ye Same as in Anasarca - but ye Use of Vomits are more Ambiguious here, ye Cure in general Chiefly depends on purgatives, Small & Reapeted doses of Emetics are very Efficacious in Removeing the Disease, but both these & purgatives are dangerous when ye Viscera are in a Morbid State, Oxymel Colchicum is ye most powerfull Diuretic, I know ye dose must be increased till its Efects are suficiently powerfull but I think when a Pt. Can take an Ounce of it, Witht. Effect it ought to be disused, - A Solution of Copper in a Volatile Alkali is much Recomended in this disease as being an Excellent Diuretic, it also operates by Stool & Urine half an ounce of Squils infused in a Bottle of Wine for sometime & there the Pt. take half Ounce of this Wine three or four times a day & he will Find great advantage from it a little Common Water added prevents Vomiting,.... Dry Bagnios are Recommended to promote a Diaphoresis with increasing ye Disease, By Diluents Necessary in ye other forms of Sweating,- The Regimen, shoud be ye same as in the Anasarca, there are some Instances of this dropsy, the more rare even than ye Anasarca, being Cur'd by ye Antiplogistic Regimen Vide Sasages,.... Frictions on the Belly with Olive Oil have been found servicable but ye Benefit probably depens on ye Friction ye Oil only preventing ye Skin from being Excoriated, & this allowing the frictions to be more powerfully & longer Used, - It has been Often Cur'd by Abstinence from drink Scarifications, Blisters & Issues are usefull but can not have ye Same Effect as they have in Anasarca - Mercury has been often perscribed but often without, Success, there is very Rarely any Occasion for Opiates, Except there happens to be great pain then they are usefull the same Medias answer ye Second Indications of anasarca are proper here also, the Operation of ye Paracentesis, is very very Antient; it is often Extremly usefull but it is Often, too long Delayed & tho it Seldoms Effects a Radical Cure yet it is an Excellent palliative it has been disputed wether ye water ought to be drawn of all at once or by How degree the, Former opinion is Universally Adopted Ever since ye time of Dr. Meade, ho has taught us that any bad Effect may be prevented by a proper Compression & bandage, Were ye Water is gelatinous, or in Case there be Hytadids, it is adviseable to make as large an Opening as Can be done with Safety, .. it has been purposed after all the Water is Evacuated to Inject Antiseptic & Corroborating Meds, in to ye Abdomens, as Red Wine, Decott, Cart, Peru; Lime water &c, but I Beleive it would prove highly dangerous & generally fatall (Vide Philos Transact.:) ye Belly sometimes fills again in a Short time sometimes there is a Nesicity to tapp, in two or more places from ye Peritoneum having ground to ye Bowels & divided ye Abdomens in Distinct Cavities that don't Communicate with Each other, - Hydrops. Pectoris, This is very Difficultly Distinguished it oft; Accompanies ye Spasmodic Asthma it is generally attended with anasarcus swellings, in ye Extremeties, & sometimes perhaps only on one side, but ye fluctuation of ye water in ye Cavity of ye Thorax is ye most Certains Sign, & this is very difficult to be distinguished, it is attended with great Torpor Palpitation of ye Heart & Irregular pulse Dyspnea & Dry Cough, it also is frequently attended with a paralytic Affection in one or both Arms, if ye Collection of fluid be only on one side of ye Thorax ye Pt. Cant lie upon ye other, but if it be in both he is Oblig'd to lie on his Back, it is Commonly attended with more or less Fever or thopnæa, ...... A peculiar Sympn. is ye Pt being Wakend out of his first Sleep, by a Violent asthmatic fit, which generally Continues for an hour or two, beginning About one O'Clock,, this fit takes Place tho ye Pt sit Erect; & be kept awake, - The Dyspnœa & its Violence seems to depend on ye quantity of water, which usually Floats at large tho it has been found in Cysts, it is to be distinguish'd from the Enpyema or a Collection of Matter, only by wanting any preceeding Signs of Inflamation & by its being Commonly attended with anasascous Symptoms of ye system in generall, sometimes ye Capacity of ye Thorax is enlarg'd, sometimes it points more particularly in one part, this disease may Arise from all ye Common Causes of dropsy particularly from Affection of ye Lungs There is no particular Method Requird in treating it, as it seems to be so intimately Connected with ye Spasmodic Asthma, so we find whatever Contributes to Remove this must be proper here, deep Setons in the sides are found to be of great Service, - Tapping is much less practised in this Species of dropsy, than in Ascites & perhaps more Seldom than it ought to be, it this case ye water shou'd be let out at different times, - 14 Hydrocephalus, This is Collection of water within ye Cranium or without it Sauvage has made an Enlargement of ye Head as an Esential Symptm. in this disease, but it is plain there may be water Accumulated in ye head witht. this to a Certain degree, it may be Consider'd as Either in ye Eranium or without it, - An Hydrocephalus according to Sauvages arrangement is not likely ever to happen Except in Children & perhaps even here very rare But this Disease is commonly without any such enlargement, Especially in ye beginning or were there is but a small quantity of water, it is best Described in a posthumous work of Dr. Whytts, - Childn. from 3 to 12 yrs of age are most Subject to it, tho it has been found in Fœtoses & Adults of at least twenty yrs of age, - The first Symptoms are a want of Appetite prostration of Strenght & Spts, paleness an Irregular intermittent fever, quick pulse flushings 14 of ye faces pain about the Eye Brows frequent, Vomiting, & yet not attended with much Sickness or straining ye belly is Usually so Costive as not to be easily moved with Cathartics an Impatience of sight with Degree of Squinting, Strider Dentium, this is ye apperance of the Disease in its first Stage, not that all those symps, Constantly attend every Hydrocephalous, nay many of them are generally wanting, - If these symps, dont go of with ye use of a Vomit a purge or two, a Blister will Commonly answer ye purpose those Symps, are Equally Signs of worms, - In ye Second stage ye pulse becomes slower than Natural & Irregular, ye other Symptoms Continue, ye Childs Complaint much but of no particular pain, sleeps but little & is not Refreshed or eas'd by this, ye Vision oft becomes double, when there Can be no doubt of this disease, ye breadth is sometimes fœtid, Expulsion of worms guives no Releif, Urine very various, in ye last stage The pulse becomes very Frequent & irregular, ye Child is Comatose, ye pupil is much and Often does not Contract in bringing it. Suddenly from a dark to a light place, Spasms arise in ye face & Exstremeties, & there is a Difficulty of swallowing, the Eyes become inflam'd & towards the lost a Diarrhea Frequently Comes on, this Diarrhea is said not to be Common in other Countries, the Internall Hydrocephalus is an Acute disease Seldom lasting more than 3 or 4 or 5 Weeks Wereas ye Externall Hydrocephalus may Continue for Months or Years, ye proper Hydrocephalus & an unborn Fætus will present its being Deliver'd till ye water is Evacuated - When the Cranium is much Enlargd it almost Certainly proves fatall, - Remote Causes, little can be said of these, it is found to Run in some particular Families, & is frequently Connected with A Scrophulous habits, & Confind to a Certain Age, from a year old to 14 mostly between 5 & ten, - Proximate Cause is a Collection of water within some part of ye Cranium this is sometimes very large, - In some descrybed by Dr. Whytt, ye quantity of water was Extremely Small, so that it woud seem these are a good deal owing to a Nervous Affection, - Method of Cure, I never saw it once Cur'd except in ye first stage, there seems plainly to be a Determination to the Head this shoud be taken of by Bleeding, Vomits Purgin Pediluvia Blisters Issues &c, thes last seem to be Efficatious, Prophlatics If ye water Can be Carried of by those means it is afterwards proper to Strenghen them a Brace & invigorate ye System, by the Bark, Cold Bath Excercise & proper Diet after ye Head is become Enlarged I imagine it has become incureatly, tho Priverious Mentions its having been Cur'd by Compression Letting out ye water by Puncture hastens Death of ye Patient, - Authors, Whytt, Monro, Van Sweiten, & De Haen, - The Spina Bifida is a Tumor that appears upon ye Os Sacrum & is a dropsy of ye Medulla Spinalis, opening it soon Destroys the Paitent, - Scrophula In this disease ye paitent has hard tumors in different part of ye Body. Especially in this Disease in ye Neck, but with! Discolouration of ye Skin, this disease is not so Modern as many may suppose it, for it appears to have been known by ye Antients & Describ'd by them under ye Term Struma These Swellings generally first begin in some of ye Maxillary Glands witht, Pair or Inflamation, many of them are Frequently Connected together, they are Commonly at first Moveable, but in time they become fixed, tho this Disease is Chiefly Confin'd to ye Conglobate Glands yet it appears in some Cases in every part of ye Body - & sometimes when ye glands themselves are not diseased to appearance as in ye small Bones of the hands & feet, in ye Joints ye bones are usually Affected, & are generaly found to be Cavious, particularly by the softes parts of them as ye Exetremities Before these Tumours suppurate they sometimes shift suddenly from one part to another, Scrophulous People have usually a peculiar Delicacy of Complexion, inflation, & fulness of ye lips & face, & often Acute parts & Sharp Wits, there is also an Enlargement of ye Tonissils large Nose &c, there is also a Scrophulus Opthalmia the Spina Ventosa also proceed from Spophula these Scrophulous Tumors often Remain indurated for Years without, Supperating which shoud alway be attempted to be, Prevented, as ye Ulcers are Extremely, Difficult, to be healed & leave very ugly Scarrs - When they have Supperated ye matter is Acrid & Corrodes ye Neighbouring parts the Discharges is thin & glutinous, with little White Masses Swimming in Curdled milk these Tumours rarely End in what is properly Col'd Schivis, & I Beleive hardly ever in Cancer, however they are frequently ye Cause of Dropsy & and Pulmonalis, - this Disease is almost always peculiar to Youth, tho it seldom appears in very young Children & generally disappears about, Puberty, in Women it has not appeard till ye time or after of Menstruation, & then it shows it self upon ye Menses being Obstructed - Again it sometimes leaves women that has been Afflicted with it upon ye appearance of the Coteminia ..... Remote Causes are, - 1st, it is peculiar to Childhood ......... 2d, is is Remarkably Hereditary ........ 3d, Scrophulus Nurses which are said to Communicate it to there Children, - 4th, A peculiar laxity of ye System with which it is Connected, & with great sensibility of ye parts with Acuteness, - 5th, Living much upon Farrinaceous Diet & fruit tho I Beleive this is rather a peice of mere theory than any fact, - 6th. Plethora from Rich Diet & want of Excercise, - 7th Drinking bad water especially disolved Snow, - 8 Leus Venerea in ye Parents,- 9 it is Epidemic in Spain the Alps & some part of Germany & other Countries tho it is to be doubted if these Tumors or Strumae, in ye Neck are properly Scrophulus 10th Contagion, ......... 11th, Externall Violence & Critical Metastasis tho it woud seem that there shoud be some predisposition in ye person to this disease, Scrophulus Tumors are Distinguis'd from Schirri by ye Difference of ye Glads, on which they fix ye former being in the Lymphatic ye other in ye Conglomerate & by ye Scirrhus being harder - from Steatome & other incysted Tumors, by these being Situated in ye Cellular Membrane & not any Gland, - the Scropulus appears to have a great Analogy with ye Leus Venerea, - White swellings are Commonly imputed to a Scrophulus habit, but they dont always seem to arise from it, - Proximate Cause, is some peculiar Nature in ye Conglobate or Lymphatic glands the Neighbouring parts become Effected by Communication - the Common theory is that it Consists in a Viscidity of ye Lymphatic Juice but we have no proof of this And ye great mobility attending ye Disease seems to Contradict it neither Can we ascribe it to Acrimony, as does not appear, till ye Disease has subsisted upon the habit a longtime. - In short neither ye Cause of this nor any other Disease is known that is Hereditary, the Morbid Acrimony supposed to Subsits in this disease is said to be of ye Acrid kind, & hence ye Frequency of this disorder in Children, & ye use of Absorbents in it but the specific Nature of this disease is not in ye least understood, - ye Reason of its being so Common to Children may be ye great determination there is in them to ye Surface, its frequent termination in Dropsy may be owing to ye laxity of ye System, Indications of Cure are 1st to prevent Suppuration taking place, - 2d, to invigorate ye System as it is always Connected with Debility - To answer these, most physycians administer Attenuants, Absorbents of Acidity &c, - Bleeding has no particular place here nor Emetics only occasionally, Cathartics are very generally employ'd but improperly tho ye belly ought to be kept open, hence ye proper Method of using sea water is by mixing it with an Equall quantity of Fresh water, for if guiven in such a quantity as to occasion great purgins it does harm, if ye sea Water disagrees with ye Stomach, the paitent shoud it a little while before he gets out of bed - Minereal Waters Moffat a Bath are ye best have often been of great service, Various Alka, Lescents have been used but with no good Effect Except by destroying Acidity in ye stomach, I never saw any good Effect acrue from antimonials, which are universally Recommended nay in many Cases I have known them do much harm by occasioning ye Tumors to Supperate, the Scrophular appears to me to be a specific Disorder & it is probable there may be in Nature a Certain antidote against, but this is not known, - all ye resolents so Call'd are of no advantage ye Expressed Juice of the Tussilage is warmly recommended by Dr. Collins, - the use of ye Bark has been lately introduced, & I have several times with great Employe'd it, Vide Med Inquiries & Obs, Mercury is ye worst Remedy we Can use Especially if Cairried to ye lenght of a Sallivation particularly in Children Scrophulus people shou'd be kept in Constant Exercise, both in body & mind, in a dry open air, Cold Bathing in ye Sea is perhaps ye most powerfull Remedy, a dry easy digestible digestible food not Animal is ye best; a glass of wine Daily is serviceable in some Cases Various External applications are Recommended, but all such as tend to promote Suppuration are to be avoided, it is a very dangerous Practice to attempt ye repulsion of these disorders, Tumors Especially if they Contain any Matter, as they are most apt to fix upon the Lungs when driven into ye System which are more Esentiall to Life than any External part, - Ol. Tartan with sea water has been used with success to repell them as has also ye steams of Vinegar, Spiritus Mindereri Cataplasms of hemlock; & of fresh Briony Root, & solutions of Sacct Saturni, & Alumstrong soap water, ye only internal Remedy of this kind is ye Cicuta or Hemlock, this generally Resolves these tumors or if they shoud happen to suppurate it makes them afford a Laudable Pus, - It has been propos'd to Extirpate ye Tumors & if it be so Situated That it Can be Easily & safely done it may be proper, but this is not always ye Case as generally more glands than one are Affected keeping ye belly open & an Issue in ye Arm have often good Effects,..... the Virtue of ye Royall Touch must depend on ye paitents Imaginations, - Authors Dr. Russell is the most Compleat on this Subject, - Of the Rickets This consists Chiefly in an Enlargement of ye Bones above ye Joint - Gibson who is ye first that has wrote any thing on this disease supposes that it never appeared before his time, but this is greatly to be Doubted, we must however trust to facts than Reasoning a Priori, - it seldom appears till two or three Months after birth & it is usually Confined from this to withing two or three years of age, - It begins with an Aversion to Excercise Languor want of appetite, bad digestion, wasting of the Musclar parts paleness & enlargement of ye Belly, and afterward also of ye Head - bones become Curved & there Exstremeties enlarged, ye Sternum is prominent, & ye Ribs flat, there is Commonly a Cough Asthma ye pulse is generally Slower than Usuall ye Skin flacid or anasarcus, the Voice Stridulus, & ye Child waddles when it walks from ye bones being incurvated & Shortened these Children is much more Acute & sensible than is Common at there age, in ye more advanced period an Hectic fever comes on or a Dropsy, & Often Convulsions & Coma or a profuse Diarrhea Urine generally pale & small in quantity, ye Belly Costive tho Often attended with fits of Diarrhea the food passes thro the Intestines witht. being Changed & towards ye End they have a most Voracious Appetite the teeth are apt to become Carious & fall out, - On Disection ye Liver, is found very much enlarged with many other Obstructions internally of ye Mesentery &c, as well as Liver, much water is Found in all ye Cavities, ye Muscles are Exstremely emaciated & flaccid the bones spungy & enlarged, - Antesedents & procatartic Causes 1st a singlar Constitution in parents particularly old Debauches - 2d, disease that wastes ye Streght much as severe teethings long Continued diarrheas 3d bad Diet or such as is difficult of Digestion to this head belong bad Nurses - 4th, bad Air & want of proper Exercise also a want of Cleanliness - Proximate Cause there appears in this disorder always to be a great laxity & want of proper tension in ye System, - it has a strong Analogy to ye Scrophula tho there is some unknown Specific Difference betwixt them, - Indication of Cure the only ones that Can take place here is - 1st, to take of ye Serosa Colluires if it be present 2d, to Brace & strengthen ye system, & - 3d, to guard against deformities or to Remedy them if they have already taken place, - Rheubarb, is Extremely usefull so are gentle Vomits in this disorder as well as in ye Scophula ye Regimen is of much more importance than any other Meds, - Exercise is particularly proper next to this is ye Cold Bath, a pure dry air & great Cleanlyness, Claret wine is one of ye kind of strengtheners for these Children, all kinds of Mineral waters are found to be of great Service which seem to shew that there Virtues here Depend Entirely upon ye water, & not on any Mineral particles they may be supposed to Contain, All warm Slope particularly Tea is very Pernicious, ye want of Exercise is best supplied by Frictions & ye Cold Bath, all Eacuations are improper Except perhaps Gentle laxatives particularly Rhubard, ye Bark when ye paitent will take it is ye best Mede, - Various Externall Applications Especially of Bark as in Waiscots have proved very usefull Issues are of great Service where there is a seros a Costives, - As to ye Cure - of Deformities it depends on ye proper application of Mechanical Means taking great Care that they dont do more harm than good. Authors Glison is ye Chief Petit; of The Tinea, This Consists in scales & ulcerations of ye hairy scalp & sometimes face these Scales are sometimes dry at others moist it first begins with small pustules that ooze out a matter spread & United as to form frequently on Scab that Covers the whole Head it is peculiar to Children Especially during there Sucking & teething particularly in those which are fed Coarse & Grosly, & also those subject to Scrophula or Rickets,- When ye scabs falls of ye Skin under appears quite Sound witht. ye least sign of Cicatrix, ye Repulsion of it has Occasioned dredfull Symptoms as Coma Convulsions & even Death, & often Epileptic fits, it seems to be an Affection of ye Sebacous Glands it is better in summer when ye prespiration is most Copious than in Winter, - tho it may be Considered as a Topical Ailment yet its repulsion is attended with ye greatest danger & hence nothing but Emollient Applications is adviseable, - The application of Pitch'd Cap or plaister Clove all over ye head as been often used & frequently proved successfull, but ye taken of this oft occasions intollerable pain & Inflamation, pulling most of ye hairs up by ye Roots, but then this is so soon taken of again by Emollient & easy application Leprosy, as to this it is so very rare in these Countries, that is scarcely worth Mentioning, it is divided into two kinds Viz Lepra Grecorum & Lepra Allaborum or Elephantiasis Sauvages Describe several kinds & Hillary, In great Brittain we sometimes meet with little Crust upon ye Skin attended with Universal Hardness which are Refer'd to this disease. In Case of furfuraceous Eurptions ye Warm Bath, Mercury, purgatives, Plumers Powder, Ethiops Pil &; are the most Effectuall, - Of the Sabies This disease Consists in small Pustles which Itch much, & when Scratched exudes a thin humor that becomes Crusty sometimes it appears Watery Viscicles, it is very Contagious tho some people receive ye Infection much sooner than others, it affects Chiefly ye Interstices between ye fingers ye Wrists ye sides of ye Belly & ye Hams - it is distinguish from Miliary Eruptions as these Cheifly Attacked ye neck and Breast, excite less Itching & generally go of in a few days, the Icth sometimes ulcerates very deeply, it woud seem to be Complaint not known by ye ancients Occasional Causes are 1st Infection, as it is an highly infectious diseas an in truth it does not seem to arise in any other way, tho we may perhaps add - 2d A want of Cleanliness, but I am Certain wether this alone is Capable of produceing it 3d, it is said to be Critical in fevers, but it seldom happen except in Hospitals were I am apt to think it is got by Infection, If a person has had ye itch for a very long time as 20 Years, he will never get quit of it Proximate Cause, is a Topicall, Affections of ye Skin probably depending on Unr Molcules - there are no signs of particular Acrimony here in ye System as it is perfectly & safely Curid by externals alone Sulphur is a Specific in this disease if Externally applied, as in ye form of an ointment with Lard, but its internal use is not to be depended on, .... Dr Pringle advises us not to Rub in ye Sulphurr too soon when ye Itch has succeeded a Fever, - The hands & feet is Enough to be rubbed as as it will Cure it in every part of ye body Mercurial Unctions will effectually Cure ye Ith, but there use is not entirely Safe nor are so Certain a Sulphur Dr. Pringle says it is Necessary to Rub Mercury over Every part of ye Body in order to Affect a Cure but this is a mistake as I have learnt From Experience, A Dram of Red precipitate with an Ounce of Axunger, answers very well an does not endanger Sallivation - Sulphur taken internally disagrees with some Stomachs producing great Anxiety and sickness & throws out Cutaneous Eruptions, the powder of Wt. Hellebore has been used in ointment but it is an Acrid Remedy Of the Scurvy. the proper nature of this disease was but lately ascertain'd. It was first described about ye beginning of ye sixteenth Century, but since that time it has been extended to almost every disease of ye Chronic kind especially those whose nature of was not well unsterstood but we have now Reduced it again in to its proper bounds, meaning by this term that Speices that was first described for it by ye first Writers on this subject; as Describd by Dr. Lind it is an Excessive Putrefaction of ye fluids witht. Fever, - The firs symps, are a bloated Countenance Lassitude Torpor Nausea, Fetid Breath, great prostration of Strength,. Dyspæa, great palpitation of ye heart, itching & swellings in ye gums with disposition in them to bleed much from ye Slitest Accidents ye gums are also Red & spungy ye teeth loose & apt to turn Carious spots Appears on various parts of ye Body particularly on ye Legs which generally swell ye pulse is weak & often irregular - In ye 2d Stage there's a Contraction of ye Legs a pain & swelling of ye Limbs which is of ye Adamatus kind Excessive great Languor & disposition a faint upon ye least motion wandering pains Especially in ye Breast a Disposition to sallivation & to Hæmorrhagy from every part of ye Body particularly from ye gums, Nose & Hæmorrhoidal Vessels the senses Continue Clear & Entire, - In ye 3d Stage all old peal'd ulcers breakout again, & bones that have been fractur'd become loose again, pain full Bleeding ulcers spread over ye Legs with large furgi A Dropsy or Jaundice frequently supersens ye Urine is Fetid & small in Quantity true Petechia break in various parts of ye Body it sometimes terminates in a putrid Fever tho in generall it has no tendency to Fever, - On dissection all ye Viscera is found enlarged ye Acrimony in ye Fluids in this disease must be very great, as they Often Corrode &c, ye finger of ye dissector, - The sores here Seldom Comes to Suppuration or Afford good pus, ye Paitent Dies witht. much Pain, & with a perfect Enjoyment of all his Senses, - In the 4th, & last Stage ye least Motion of air Often Carries them off tho it seldom occurs on ye Land, yet there are instances of it Mentioned were ye paitent that did not, seem Exstremly bad died suddenly upon being Exposed to ye air - It is very Remarkable that this altho so putrid a Disease is not Contagious, but indeed ye Same happens in other Putrid Disease that are not accompanied with Fever - Occasional Causes & Others 1st. Moisture & Cold together moisture Join'd with heat is more apt to induce putrid fever Dysenteries &c, - 2d Cold without Moisture; hence it prevails most in Cold Countries & more also in winter than Summer. - But Neither of these will be able to produce the disease without other Concurring Circumstances- 3d Living upon salt provisions, the reason of there Causing Scurvy seems to be because they are most difficult of digestion & because thee provisions have a great Tendency to purtrefaction ye Salt them does not seem to be in any fault, - 4th Want of fresh Vegitables, this is only an Occasional Cause for it self it most Capable of produceing this disease - 5th A Want of Fermenting Liquors, these seems to promote all ye Secrections which are much Obstructed in this disease, especially by ye Skin & Urine, this is Manifest from ye dryness of ye Skin Costiveness & small quantity of Urine Scorbutics make - 6th, Want of Exercise, hence the scurvy is Found to prevail most in such Ships as are over Manned as in ye kings Ships were Men do less duty than on board Merchant Men, 7th improper, diet as Salt Butter hard Cheese Bread not properly fermented &c, - 8th, Weakness in Consequence of any great Evacutation & long disorder preceeding this 9th all depressing passions as grief Melancholia &c, Sea salt is generally enumerated as a Cause but probably without any good Reason For sea water which often Contains much of it, is often Drank at Sea for other diseases & those who have been under a Course of it, were never Observed to be peculiarly liable to Scurvy, nay it has Even been Recommended as presenting or Curing this disease nor are those Employed in salt Work more liable to ye Scurvy than ye generallity of Mankind Proximate Cause seems to be, A putrid Diathesis of ye Blood & humors induc'd in Consequence of ye Retentions of Prespiration & other Exeretions - But we Cannot say in what this differs from ye Proximate Cause of Putrid fevers - There is an Excessive high degree of acrimony in ye Scurvy, but it is a peculiar one sui generis, & has to tendency to produce fever or Affect ye Head - Dr. Pringles, Opinion on this Subject is by no means Satisfactory - There is also an Uncommon degree of Relaxation in the Solids - Indications of Cure are, 1st, to Correct the Putresency, - 2d, to promote ye Obstructed Secretions - 3d, to Brace the Solids - Evacuations of any kind have very little Share here in Curing this disease nay they Rather tend to increase & aggravate this as well as other putrid diseases hence any purgatives guiven must be of ye gentlest kind & to open ye Belly with ye least Stimulus, if the Belly Can be kept open by fresh Vegitables which is Commonly ye Case, they are ye best Laxatives, but if they don't answer we must have Recourse to ye Decoct, Tamrindor, Cream, Tart, &c, - The only Proper & Adviseable Diaphoretis are ye Neutrall Salts, - Vomits are Rarely Required but were the Stomach is much Affected Squils Vomits answer ye best, it is of ye greatest Service to keep up a Constant Diaphoresis for wich purpose Thoraica Androm has been much Recommended, but Spts. Minder, Neutrall Salts are much prefereble, - Opiates, Find no place here as they Cause a great Dejection of Spts, with a lowness, this is another Objection against Theriaca besides its being a Healing & Stimulation Mede, A Moist fomentation to ye Limbs is a better of promoting prespiration, with Aromatic ingredients than ye use of dry Stoves, - Fresh Vegitables are incomparably the best of Remedies, & Seldom fails to Obtain a perfect Cure, these may be kept fresh along time by by Alternate Layers of Common Salt, different Vegitables have been at different times high by & peculiarly Extoll'd, as antiscorbutics but they all Cure it witht. Exception all kinds of Sallad & esculent vegitables are proper It has been thought that what has been Called Alkalescent Vegitables on plants were prejudicall, but Experience has now taught us that they are Equally servicable with ye Ascscent, nay ye Mixture of ye hot & Acrid with ye Cold Vegitables, seems to answer better than Either alone - Ripe Fruits are very good Especially manages a Lemons hence it has been propos'd to make Lemon Juice of such a Consistence as to make it keep long in order to be Carried t Sea but this does not answer so well as ye Fresh Juice the Next Vegitable Juice is Spruce Beer & Cyder Claims ye nex place to this all other Acids have been Recommended - Elexr. of Vitr. has no power of preventing this disease nor of Curing it Radically ye same may be said of Vinegar, tho it is more Efficatious than ye Acid of Vitrioll - Portable Soap is very usefull on bord Ships Sea water may be of Service as a gentle Laxative but in no other Respects, - The Succi Antiscorb, answer very well, - From ye good Obtain'd from Alkalescent, Vegitables, it was Conjectured that Spirits drawn from these woud answer ye purpose but they have been found verry pernicious Mr. Bride Recommends an Infus of Matt, which seems likely enough to be attended with success, but no trial has yet been of it. Fermented Liquors of Every kind are Servicable, except Virous Spts, which are hurfull & ought not to be employ'd, unless largely diluted & a large quantity of sugar added - Regimen, this is of the utmost Consequence, the Diet shoud Consist of Meat easily digested & well fermented, - What is next of great Consequence is fresh Air, hence ye great use of Ventilators in all Confind places as Ships Hospitals &c, - Not only in throwing fresh Vital Air but also that which is pure & dry, Expelling ye Damp Mephitic Air of such Crowded & Confined Place - Sleeping in wet Cloths are Carefully to be avoided as it tends Greatly to induce ye, Scurvy, hence it is found to prevail most in Ships after Severe stormis - When the sailor Can be brot. on Shore & 16 Have a Milk & vegitable Diet, they are almost to get well, taking care at ye same time to keep they Belly open, - There is no Tendency to Dysentery in this disease but Eating immoderately of fresh Vigitables has sometimes brought it on - If ye paitent is moved under this disorder he is Exstremly apt to faint nay many have died From this, hence it shoud be done Cautiously & the paitent be allow'd to take a glass of wine before it is attempted or some other Cordiall - The mind ought to be kept as easy & Chearfull as possible - Blisters, can seldom be requir'd & there is the greatess danger of them induceing Gangrene Bark is a good & usefull Meds but it is not of it Self Sufficient to Affect a Cure - Mercurials have ye worst Effects imaginable here, the gums are very troublesome in this disease, however they may Eased & Releiv'd by washing with diluted Tinct, Myrrhs Alum Elxr Vitriol &c, In Chiching Sallivation it is so troublesome in this disease, Gentle Laxatives are adviseable & hence Flr. Sulphur has been so highly Extolld as it answer extremely well, if ye Saliva be tough & Viscid Oxymel Scilliticum is propers - the Slightest & most insignificant Mercurials have Sallivated Scorbutics, even Ethiops Mineral, in Case of swelled logs worn Fomentation or ye steams of warm water answer very well as do also gentle Frictions - Pectoral Complaints often Continues after the Scurvy is Cur'd these are best Removed by a Milk & Vegitable Dict moderate Exercise Country Air Issues &c - Authors, the first or Original ones is ye best it is very Accurately describ'd in Lord Ansons Voyage, - Lynd, is the most Systematic writer on this Subject - Lues Venerea This is undoubtedly a Modern disease & First Made its appearance in Europe at ye Seige of Naples, but still there is Reason to beleive it was known in the west Indies before that: time no one Can tell how long - it was much more Violent when it made its appearance than at present, it is communicated by Contract with an Affected person, also from parents to there Children, but ye most freqent manner is by impure Coition its Communication &c is very different as some persons under the same Circumstances will Receive the Infection whilst others will not no internal Mede, is yet known that is an Effectual Safe guard against it after impure Coition, perhaps Anointing ye Glands Penis with Mercuriall ointment, or a diligent Ablution or washing might do it, - It generally appears first as a Topical disease in ye form of a Running &c from the Urethra which is called Gornorrhea this we shall first Consider Seperately - Gonorrhea This generally begins to make its appearance about ye fourth day after ye impure Coition with an Affected Person - the first Signs are an itching inflamation in some degree swelling & gaping of the Orifice of ye Urethra with a little Ozing of a Moisture there is also a little Ardor Urine which soon becomes exstremely painfull the whole Canal of ye Urethra is swell'd inflam'd & a Matters discharged from it of a Whitish Yellow, green & sometimes Bloody Colour, one of ye most troublesome & uneasy Symps. is an involuntary Erection of ye Penis at ye same time it is generally in curvated commonly downwards .... sometimes abscesses form in ye Perinium & ye testes become swel'd & painfull as do also ye Inguinal Glands there is now at least incommon pain in ye Back about ye Loins in ye Course of ye spermatic Vessels, after ten or twelve days, ye heat, Pain inflamation swelling &c Diminish & ye matter grows whiter & of a more Ropey Consistence, in some Cases theres no discharge from ye Urethra but from glance an inner surface of ye prepuse, this is what has been Called ye Gonorrhea Spuria - The Symps, are much ye Same in Women a Itching Inflamation, Swelling in ye Pudenda & Vulva ye matter flowing from ye Vagina is also ye same as in Men ye Symps are seldom so severe or painfull as in Men yet ye Cure is more difficult, it is often no Easy matter to distinguish a Virulent Gonorrhea in Women from ye Flour Albus, as ye matter in this last is sometimes Exstremely Acrid & Irritating - Proximate Cause there are great disputes about this & nothing certainly known, it as long thought that ye Discharges was Semin alone as its name Employe but this Notion is now Exstremly Rejected as being altogether Erroneous as also ye prostrate Glands being the seat of this disorder, it was next disputed wether there was any Ulcerations or not in ye Urethra this very Seldom ye Case tho no doubt but it is sometimes, in general this discharge is an encreasd secretion of ye Mucus of ye Urethra this Matter then must undergo Changes according to ye state of ye parts thus if highly inflam'd it may be bloody From a Rupture of some small Vessell green from Corruption &c, - It is also different in Consistence upon ye same Actt. in ye Gonorrhea Spuria there Evidently in most Cases is a discharge of purulent Matter Witht. the least Ulceration, & yet in verry Violent Cases on after ye imprudent use of strong Injections, there cannot be a doubt but that ye parts must frequently be Ulcerated Another question inquird after is, how is ye Virus or Infection got into ye Urethra it is said it Cannot enter ye orrifice of ye Canal nor Can it be brought there because ye Lymphatic Vessels of ye Penis dont terminate in ye Urethra this question is of no great importance suppose it never is Resolvd - there is greater force in an other argument in proving that it is Receiv'd by absorption the Violence of this disease may depend upon ye Virulence of ye matter or of the Constitution of the paitent. I mean from ye infection being so Often presented by Rubbing the parts of generation with Unctuous substances or Matters which Can have no Effect except it be in preventing Absoption - Indications of Cure are 1st, to Lessen ye Inflamation - 2d, to moderate ye Acrimony of ye Virus - 3d, to Restore ye tone & natural state of ye urethra & glands Bleeding is almost always proper, not a View to Cure ye disease but to moderate ye Inflamation & other urgent Symps, but this is to be Regulated According to ye state of ye Pt, When ye inflamation is entirely Topical or Local Topicall Bleedings by leeches are the most Effectual Method of guiven Releif - Formerly this disease was attacked by Drastic Purgatives but experience has Now taught us that they only tend to Exasperate ye Complaint in Common ordinary Cases there is no occasion for purgatives at all, for a strict aherence to ye antiphlogistic Regimen is in generall abundantly sufficient to Effect a Cure, - Repeated purges tho gentle as with Salts is hurtfull, as they generally weaken so much as to leave a Gleet, a troublesome if not dangerous Complaint, all Violent Exercise shou'd be Cautiously Avoided Especially on horse Back Plentifull dilution, particularly with Mucilliganeous liquours is very proper & usefull to lessen ye Acrimony of ye Urine, as linseed Tea but if this should disagree there are many others more palatable as ye Emule Commsoll arabica. - Ripe fruits are of great Service Nitre does not seem to produce any great Effects fomentation & Emollient Cataplasms to ye part Affected are very Proper yet whilst ye inflamation is very high warm Fomentations & Cataplasms are apt to encrease the Stimulus & determination upon ye parts & thus may prove very Pernicious they are generally more serviceable After ye inflamatory Diathesis is entirely taken of by proper Eacuations - Opiates, are very improper in this disease at ye beginning but afterwards they maybe used Nothwithstanding all this it is very usefull to guive a few grains, g, e, five or six of Calomel at Night & purge it of ye next morning, - Mercurial Injunctions upon ye glands &c, have been much Recommended tho in general I belive they are not Necessary, & if ye Pt, shoud Chance to Catch Cold to which he will be verry liable all his sympts. will be encreased injections of Oil &c have been much used to take of ye Ardor Urine but ye passages is now so greatly sweld that they Cannot be pushed any height into it, or if they Cou'd perhaps there might be some danger of there Carrying ye Virulent Matter higher up, & to parts which it woud never have Reached if any thing is to be Injected it is to be of ye Musilaginous or Oily kind & indeed nothing is better than pure oil all Mecurial injections are apt to Stimulate & inflame One of ye worst Consequences of a Gonorrhea is a gleet, or a ropy Pellucid, tho often a thing yellowish discharge, which resists all our art, Tho ye Vineral Virus be intirely Carried off, however we ought to be Cautious here & not too Venturous, which astringent Injections, - This Discharge may be owing to several Causes 1st. From Ulcers in ye Urethra - 2d, it may be ye Consequence of Excessive purgin which also induces a weakness of ye Visicula, Seminales which subjects ye paitent to Nocturnal Pollutions - The discharge is increas'd by Debauchery as great drinking & by Violent Exercise, - the Cure is Commonly attempted by Injections but these are bold practise & may prove very injurious, if ye Veneral Matter is not thoroughly Eradicated, as they are Commonly astringts, they may block it up & thus occasion swelled Testicles, Bubo, Pox &c, - Different Methods have been used to diffuse Mercury in fluids, for the purpose of injection of all these ye best is about one grain of Corrosive Sublimate, disolved in 4 ounces of Water,.... We shoud alternate these Injections with ye use of Mercurials internally, but total Abstinence & Cold Bath in Vinery are ye most Efficacious in gleets, - The Bark is very proper as a general Tonic assafœtida has been found successfull in ye Flour albus might prove so here, - Swelled Testicles often happen during a Veneral Gonorrhea at which time ye Running in generall Stops & an Induration is perceived in ye spermatic Chord, this Epididimis swells first & then ye Testicle as this goes of ye running Comes on again this Swelling of ye Testicles is not often Scirrhus at this time tho it some times becomes so afterwards - Whatever greatly Stimulated ye Urethra, may Occasion it, it is oft ye Consequence of strong Cathartics, & in short of everything that tends to stop ye Running before the Veneral Virus is Carried off, for the Cure of ye swell'd Testicle we must have recourse to the Antiphlogistic Method Regimen & Warm Fomentations - A Suspensory rest, & an Horizontall Posture are of ye greatest Service Strangury, is oft a Consequence of Gonorrhea this in general arises from A stricture in ye Urethra from Caruncles Constrictions Cicatrices &c, hence Escharotics have been used Mercurial Bougies or Candles are Recommended, may Le Draneson advices ye whole Urethra to be slipt up, from there practice we shou'd be apt to Conclude that they endeavoured to Cure a disease by making it worse, for they Employ'd those means that produced Exactly ye same Effect as ye Originall Cause did they not inflame irritate nay even destroy or Excoriate ye Urethra pray what more does ye Veneral Virus do, of late years it has been thought that all Obstructions in ye Urethra after a Gonorrhea are owing to Constriction or Contraction of this Canal, hence pliable suppurative Easy Bougies are Employ'd so as to dilate ye Urethra but not to irritate it, with very great Success, by those Easily distending & Relaxing ye urethra ye Constriction is Commonly Effectually Remov'd provided they be long enough Continued Darane Cases on this is not Creditable for a Candid & Accurate Acct, of ye use Bougies, you may Consult Sharpe Criticall Enquiry - the mucus appearing on ye Bougie is is no proof of all ye Existence of Ulcers in ye Urethra - Buboes, are very Common Accidents in ye Gonorrhea they usually appear in ye Inguinal glands, & have the same Termination as other Inflamations - these swellings are Rather symptomatic than Critical, it is often difficult to discuss them but ye most Effectual Means is by gentle Mercurial Inunctions taking Care that ye paitent is not Costive - If they Suppurate they are attended with many disagreeable Consequences, & they are exstreamly difficult to be heal'd ther fore it woud seem to be adviseable to Attempt to Discuss them - Chancres, usually being with a large Red spot or pimple which breaks & discharges Matter it spreads unequally & becomes an open it continued Ulcer, - Fomentations are exstremly proper & ye Rubbing in or dressing with a mild mercurial ointment answers very well, - other troublesome symps are ye Phymosis & Para Phymosis, - Exposing ye part wile heated to cold as after rubbing in ye Ointment often induces these inflamations - They are to be Removed by bleeding Especially gentle ones, a strict antiphlogistic Regimen gentle Laxatives Fomentations, There is a good deal of danger of a Gangrene Coming on here in Plethoric habits Especially in paraphymosis - if this Shoud happen large doses of ye Bark are to be administred suspending at ye same time ye use of all Mercurials these often Remain Cicatrices or Excescenses which it may be proper to destroy by Caustics, - General Pox, This is Often occasioned by an imature & imprudent Stopping of ye Running All ye symps formerly Mentioned may Remain or Come on here Except ye Running, ye disease in this stage is very apt to Affect ye Membrana Schreideriana & small bones in ye nose which soon becomes Carious & fall out hence hoarsness, a fetid Breath destruction of ye Nose Tonsils Uvula &c, - 17 In bed ye paitent has usually severe shooting pains in ye bones which generally become asier, towards Morning go of with a gentle breathing Sweat Broad spots of a yellowish purple or Copperish Colour appear on ye temples & spread all over ye hairy Scalp this Call'd Corona Veneris - Swellings & Excrescences often arise upon ye Bones Ligaments &c, which are Called Nodi Tophi, & when on ye softer parts Gummats there oft suppurate swellings of ye bones are Called Exostosis which are in this disease Chiefly Confined to ye most solid parts of bones as the Middle of Shin of the Tibia, - Ulcers or herpes break out in ye hands & feet & all over ye body - the bones are now Easily Broke by ye slightest Accidents, - ye Eyes are often particularly Affected with Ulcerations &c, of ye palpebsa, & frequently an amaurasis is brot, on all ye Vital & animal functions are much disturbed, hence fever Vertigo, palpitations of ye Heart Phthisis Pulmonalis, dropsy maius & God nows what - A true Hypochondriasis is often induced that Carries of all ye venereal Symps, - in the Cure two Method have been propos'd 1st, By Mercury - 2, by sweating with decoctions of ye Woods, as Guaiac Sasaf, China, Sarsaparil &c, - Mercury really seems to be a Specific in this disorder & ye only one we are acquainted with to raise a Sallivation by mercurials & Conduct it properly is a Certain Cure ye best Method is by unction which is not only most Certain but likewise life disposed to Run of by ye guts which is great inconvenience attending Mercurials. - A Sallivation shoud always be brought on gradually & slowly ye proper management & Conducting it depends much on the Constitution & Condition of the paitent Some Authors deem it Necessary that ye Paitent shou'd spit 5 or 6 pounds everyday but one pint or a little more is Sufficient during Sallivation it has been thought to keep ye paitent very hot, but this seems to be a bad & hurtfull Practice as it both purlongs ye Disease & is apt to induce inflamatory Affections, but Exposure to Cold is diligently to be Avoided for it often occasions very dreadfull Symps an yet ye Room shoud not be too hot so as to be disagreeable to persons Coming into it from ye open Air...besides too much warmth prevents Sallivation & Carries of fluids of Chiefly by prespiration, it seldom Require to be Continued more than three or four weeks, - If Fever or other disagreeable Symps. shoud come on, it must be treated as ye Peculiar Nature of the disease Requires if there be pain in inflamatory Affection &c Eacuation, Bleeding, &c, as as before advised are to be made use of & we are to endeavour to procure a determination upon some other part from ye Head ...... if Blood be drawn in an high Sallivation it will be found to be sizy which disproves ye general opion of Mercury, thinning and attenuating ye Blood, - A Diarrhea is to be Check'd by Opiates, the Scorbutic & Nervous bear Mercurials very Ill It has been Common to Renew ye Sallivation if any of ye Symps, Return but this is wrong For ye Mercurials are Required they ought to be Employ'd in a different Manner and a different preparation tried because they act different in different Constitutions, hence some will succeed whilst others fail but this we Cannot Acct. for, & only know it by Experience After having long Sallivated by mercuriall Ointments if any Mercurial shoud afterward be Necessary Swou'd prefer ye Solut Mer Sublim; Calomel has been much Recommended & Used, but is Actions is very uncertain & its Effects very Variable it is peculiarly apt to gripe & Run of by stool, - the Pilul Merc, answers very well in bringing on a Sallivation slowly but I prefer external inunctions - they are however a good alternative in small doses were Mercurials are indicated, ye use of ye Corrosive Sublimate disolved in proof Spts. was first introduced by Van Sweiten, & has been much used of late it is not so apt to Sallivate nor purge as most other powerfull Mercurials, yet it open & encreases all ye secretion thro ye whole System, accordingly proves a very Efficacious Remedy as it particularly goes of by ye Skin so it proves excellent in all Venereal Defadations & Ulcerations of it. - Externally applied has often Cur'd both Veneral & other Ulcers, when both it & all other Mercurials taken inwardly have fail'd in Regular & warm weather it scarsely obliges ye Pt. to be Confin'd water is as good a Solvent as Spirits - the Pilulæ Othiops have frequently answerd exstremly well in many Complaints of long standing & are oft more Effectual than Sallivation, after ye use of every Mercur, the disease is unwitting to quit its Ground in this Case Sarsaparil will seldom fail of Effecting a perfect Cure tho it does not seem to be of any great power before Mercurials have been Employ'd, if any Complaint Remain that dont seem to be veneral they are to be treated according as their own proper Nature requires, thus ulcers frequently Remain in ye throat which Mercurials wou'd never heal but astringent applications second it, as also Ulcers & Eruptions on ye Skin wich will either go of on there own accord, or are Easily Curd'd by a decoction of ye Woods, - Rheumatic pains & Effections often Remain after ye use of Mercury & are Cur'd by Excercise ye Cold Bath Bark &c, - the noted Decoct of Dr. Kenedy is a very good Meds, & I am Convinced does not Consist of Sarsaparilla Sarsaparilla Alone. - Mezereons has been much Recommended for Removeing Veneral, Nodes wich mercury had no power on ye quantity is an ounce boild in two gallons of water (Vid. Lond. Med. Obs:) - Dr. Gilchiust describes a particular speices of Leues Venerea here in Scotland in physical Essays - Authors the Chief are Astruc & Turner or ye History of ye disease at Gatakins, Jaundice this is defind by Savauge to be a Yellow suffusion of ye Skin with white Stools, but we take out ye Circumstances of Wt. fœces, - it begins with an Universal Torpor & listlessenss Itching in ye Skin & pricking as it were, ye Yellowness appears first, in ye Whitest parts as the Tunica Conjunctiva of ye Eyes, Costiveness & head Ach, Clay Colored Fœces & high Colored Urine that tinges linen Yellow, that is steeped in it. Bitter taste in ye mouth, Sickness Nausea, Loathing of Food &c, pain uneasiness of Stomach & Bowels &c, - Seeing Objects Yellow seldom happens there is often a stricture of pain in ye Region of ye Liver which is so Considerable as to Excite a Fever & Inflammation of ye Livers - there is sometimes a Jaundice witht. any Obstruction in Billiary Organs or Ducts but merely from an Acrimony & redundancy of the Bile - where ye Fœces are highly Vitiated ye Yellowness is sometimes Changed into a Blackish Colour - A Jaundice frequently attends ye Cold fit of intermittents & is Called ye Black Jaundice this disease frequently goes of of it self witht. any sensible Evacuation often by Diarrhea ye bad Terminations are into Schirrus Dropsy, Hæmorrhages from different parts Especially ye Nose, it is often Critical & Happens on the Criticall days of fever &c, when it does not appear too Early - Antecedent & Procatartic Causes 1st Sordes in ye Intestines obstructing ye Orifice of ye Ductus Communis Cholidochus, as ye Meconium is new born Infants this generally Goes of either Sponteaneously or by a diarrhea Either Accidental or procured Dr. Simpson thinks ye Jaundice in infants is not a true one but that ye disease Rather arises from Absorption of ye Meconium it self into the Habit - 2d, it is sometimes Critical sometimes symptomatic in Fever, - 3d, it generally attends Cholicks Violent Emetics purgatives & Hysteria, - 4th Violent passions of the Mind as also ye depressing ones as Anxiety Grief &c, - 5th Pregnancy - 6th, Suppression of Usuall Evacuations, 7th Bites of Several Animals particularly ye Viper, but this is a dubious Point whether, they Cause a Real Jaundice or not, yet they produce ye Signs of it According to our Definitions - 8th, it is periodical returning at stated times Dissection has taught us that ye proper Cause and almost ye only one is an Obstruction to ye passage of ye Bile, from ye gall Bladder into ye Duodenum this may be occasion'd by 1st, Calculous Concretions which is a very Common Cause - 2d Viscid Bile - 3d, Serosa Colluires - 4th Tumors of any kind Compressing ye Ducts as increased Pancreas distended Colon &c, 5th Inflamation of ye parts - 6th Coalescence of ye sides of ye Duct, - 7th Sometimes tho exstreemly rarely Scirrhus &c, of ye Liver when only partial, for if ye Liver does not Secrete any Bile there never Can be a Jaundice - there is a Jaundice in some Cases where there is an Obstruction but merely from a Redundancy of Bile - The Obstruction is generally in ye Ductus Communi sometimes tho Rarely in the, hence then ye, Proximate Cause is an Obstruction that prevents ye Bile flowing in ye Duodenum at least in those diseases we generally Call ye Jaundice for in some Billious Fevers &c, there may be no Obstruction, but a Jaundice may be induced by ye Redundancy of Bile in ye Prima Viæ wich is Absorbed by ye Lacteals & carried into ye Blood an Obstruction of ye Hepatic duct Cannot produce Jaundice, & it has been much disputed whether one of ye Lystic can but I think that it is Evident, provided ye Bile Can pass freely from ye Hepatic in ye duodenum, that it Cannot unles it happens from a Redundancy, being poured into ye intestines as is the Case in billious fevers &c, Doth the Bile get into ye blood by Regurgitating back upon ye Hepatic Ducts or by Absorption I think ye latter is much more propable, a partiall or particular Jaundice is Frequently produced by an imperfect Obstruction of ye ducts It is plain that ye want of Bile in ye first passage in Jaundice must greatly disturb digestion, - Method of Cure this must depend on ye Cause that produce it and as they are very Various so ye Event must also be various & Uncertain hence ye great Numbers of Meds. & seemingly directly opposite ones have so Often Cur'd ye Jaundice, However ye Indications of Cure are 1st to Remove ye Obstructing Cause, - 2d, to Supply ye Want of Bile - 3d, to Releive particular Symps - 4th to dilute & Correct ye Acrimony of ye Bile when it is super abundant & to Carry it off, Bleeding has no place here considering the disease as a Jaundice but its often very usefull where there is great pain and Symps. of Inflamation & Plethora, it also acts as an antispasmodic in cases of spasm hence it proves very useful in Jaundice attending pregnant women, Vomits, are of ye greater service in this disease particularly in ye Jaundice of Children sometimes tho they do harm by impacting or wedging, ye stones in the Ductes and thus rendering ye disease more Obstinate, & increasing ye Irritations tho I acknowledge much seldomer than we Shou'd expect Reasoning, a Priori they are improper in Jaundice arising from spasm Cathartics are Necessary both to supply the place of ye Bile in Stimulating ye gutts & also in Expelling ye obstructing Causes, & Cleansing ther Intestines, which probably together with their stimulus may be Often Sufficient to remove the Obstruction - the Stomachtic purgatives are Chiefly used As Rhubarb Aloes &c, - Sea water answers very well, - Attenuants, great variety of these have been recommended, soap and Neutral salts are ye most Efficacious, of ye neutral salts there has been much disputes some Recommend the Saline Mixturs of sal Diureticus others ye Spt Mindereri &c, tho various kinds of grasses are much Recommended when they Can be had fresh in Spring in ye way of decoction with ye addition of a little Sal polyorestum in order to keep ye Belly open this practice arose from an Obstruction of Glissons who says that Cattle are liable to this disease in winter but when they come to get grass in ye Spring they soon get well, & frequent pass many Calculous Concretions at this time Mercury has been sometimes used but I beleive with bad Success, - Millepides are of no Signification at all Minerals Waters are very serviceable as those of Tunbridge Bath, Spaw &c, &c, Hoffman is very averse to bitters but witht. any good Reason, - the Bile of Animals has been prescrib'd & it seems to keep ye Belly open - Emollient fomentations & Semipupia are of great service as are also Emollient Glysters, - in Cases of great pain & spasm Opiates are adviseable, - The Regimen shoud be of ye Ascescent kind as Butter, Milk whey, Honey &c, - Exercise & frequent frictions are of ye greatest service - in Case of Jaundice from a Redundancy of Bile, Acrids Cold, water &c, are ye most Efficacious, as in Cases of Billious Cholics Of the Stone, Calculous Concretions may happen in Every part of ye Body, they are however most frequent in ye Urinary Organs, they are very Common in ye kidneys & some times without giving ye least uneasyness for many people have died without ever having any Nephritic Complaints, & yet stones have been found in ye kidneys they seldom guive very much pain ye greatest pain is when they get into Ureters - ye signs of stones in ye kidneys are pains about that part often attended with Shiverings Coldness of ye Exstremeties Nausea Vomiting & Billious Matter & sometimes Aruginous Constant Belching of wind Spasmodic Constrictions of ye Bowels Dysuria or Total Ischury Costiveness Dyspnœa stupor & numbness in ye leg of that side & retraction of ye same Testicle When pain is very Violent it is attended oft with faintings Convulsions & Epilepsy where there is a Totall Ischury it is seldom long in destroying ye paitent, Ischury generally Affects ye head with Stupor &c, & often brings on fevers of ye worst kind ye Violence of ye pain will often Remit for different lenghts of time, - the Return of ye pain &c, is Called a Nephritic Paroxysm, ye paitent is easiest when he lays on the Affected Side - 18 the urine is generally thin during ye Paroxysm but after wards it becomes more Turbid more Copious & lets fall a Sediment, sometimes it is Bloody Especially after Exercise on Horseback ye stone seldom passes during ye Violence of ye Paroxysm but afterwards when ye Stricture is taken off, - I have before given you ye symps. that distinguish'd it from ye Colic when I was speaking of that,... When ye stone is in ye Bladder, it may be Detached with ye greatest Certainty by ye Sound it is also attended with dysuria &, strangury pain in passing ye Urine particularly about ye glands Penis White Turbid urine with a Mucus sediment tenemus Procedentia Ani universall tossings & tumblings about sometimes Convulsions Colics Obstinate Costiveness & sence of Opressive Weight about ye pubis with a Titillation there & in ye Perineum ye Urine is either Voided by drops or Sudden Jisks & when Floating in a full stream is often Suddenly stop'd ye last drops in particular Guiven much pain in Comming away ye internal hæmorrhoids have produced symps exactly similar to these - Morgagni Mentions a very particular Symps Viz.) A pain at ye pit of ye Stomach - Stone in ye Bladder oft produces an Inflamation & its Consequence Suppuration &c - Anticedent & Procatartic Causes, 1st, its particularly Hereditary - 2d, Old Age for it is Usually found in ye decline of life Children that have are seldom troubled with Nephritic Payoxysons, - 3d, a Luxurious Life & want of Excercise - 4th, an Hæmorrhagic disposition with which it is Connected & also with ye gout as we had occasion to Observe Formerly, - 5th, Whatever Obliges a person to lie long on the Back Especially in a warm bed, this is perhaps one of ye principles Reasons that Gouty People are so Generally troubled with it 6th it may be Really Consider'd as Epidemic For it is scarce found in some Countries whilst in others few Escape it ye Reason of this has been Commonly attributed to ye Water or Wine ye inhabitants drink peo that use smal Liquors are said to be less Subject to it than those that drink Wine as also those who have Naturally a lax Belly, - As to ye Cause inducing a paroxysm, it may be any thing that has a strong Commosion to ye System as Violent exercise Agitation, Passion of ye Mind Strong diuretics taking Cold &c, - Proximate Cause, Dissections discover Caculous Concretion of Various Sizes & Consistinces in ye Urinary passages, their is a Stricking Analogy between this disease & ye gout & they Often Alternate with each Other - From Experiments it is to be found that above one half of ye human Calculous Consist of fixed Air - From ye large quantities of these Concretions that are sometimes passed for a long time together it is plain'd that they are generated very quickly in these Cases, they are more frequent in ye left then in ye Rite kidney - Fat people are Cateris Paribus more subject to ye Stone than lean people from ye Compression of ye Fat which is of a harder Consistence than in other parts of ye Body. the Calculi is Evidently ye Cause of the Symps, but ye proximate that favour the generation of ye stone is not known some have supposed it to depend on Acidity in ye Primæ Viæ, be this as it will a Morbid Acidity is always Connected with it and we find those Meds, ye most powerfull Lithortriptics, that are Absorbent of Acidity. The Indication of Cure are 1st. to Releive the Present paroxysm 2d, To Disolve or disloge ye Calculus - 3d to prevent if possible ye future production of it - Bleeding is Often very Necessary to allay ye febrile heat & symps. of inflamation Especially in Stout full habits, it acts also as a powerfull Antispasmodic as Riserious hath long since observ'd - Emollient Glysters generally afford great Releif during ye paroxysm, ye Infusion Lini is inferior to none, if ye pain be Violent a few drops Tinct Theb, may be added to each Injection - In phlegmatic habits & were little - Urine is passed, turpentine Glysters answers Extremely well & prove Considerately diuretic Laxatives, oft Carry of a paroxysm when ye Belly has been Costive for some time, they shoud be of ye gentle kind as Manna Salts &c, - Diuretics Can seldom be administred with Safty, for if they don dislodge ye stone they are like to Exasperate the Symps. very much ye Common drink is Musilaginous - Opiates are our Sheet Anchor, they afford ye greatest Relief, & never fail of Migitating ye Symps, very much, but they Require some Caution in there use, as previous bleeding full Habits & laxatives if ye Pt. be inclin'd to be Costive ..... Various Externall Applications tend to Remove ye Paroxysm, ye semicupium is ye most Effectuall & will often do it when Opiates have Failed. - The second Indication, here various Diuretics have been used & Recommended - In strong & Vigorous habits where ye stone is exstremly Friable or not Compleatly Concreted, powerfull Diuretics may Often Carry it of ye Vulgar for this have Recours to hora romatics & Spts, but these nor ye Native Balsams Shoud not be used except in phlegmatic Torpil Habits for in ye delicate & sensible they will Exasperate ye Complaint very much the Safest diuretics are ye Saline draught Neutral Salts Squills, Garlic &c, Minerall waters are also powerfull in dislodging ye grain - The Diet shoud be light & of very easy digestion, ye Patient shoud eat no Suppers', ye belly shoud be kept open & Vomits occasionally Exhibited as often as there are symps of Morbid Acidity in ye Stomach Consequently Every kind of Aliment that tends to promote this prejudiciall - Exercise & strong Frictions & sleeping on a Mattrass are of very great Service. - a draught of warm water every day half an hour before dinner is very Usefull - Lime water has been much spoken of & undoubtedly has Considerable Effects but not nearly what has been said of it Steven's Meds, is A very Nauseous & Complicated perscription but; its Virtues are owing to lime & ye Caustic fixd Alkali which is Containd in Soap, - Dr Hartley has scientiffically & with Judgment reduced this into pure lime & soap - Dr. Whytt was ye first who brough lime water in Repute & his directions on this subject are ye Best, made public but there are no Remedies yet discover'd that Can be entirely depended on incurring ye Stone none at least that seems to have any power of disolving it in ye human Bladder - During ye use of these Meds, the Pt. must Abstain from Acid & fermented Liquors as they destroy ye Effects of lime water, acids Especially, diluted Spirits are more alowable if ye Paitent was Costive Aloetic pills or Rhubarb may be used, - Great Expections were hoped for, from injecting lime water into ye Bladder &, ye other Meds, but they did not answer, & several Pts were destroy'd by ye Experiment., Soap less occasion'd much pains, bloody urine use, Lime water indeed is not so severe but ye irritation it occasioned is as so great as to shew a very dangerous Experiment & this practice is now Entirely laid aside, All ye Medicines that deserve our attention may be Reduced to ye Caustic Alkali and Lime Water, - The difficulty with Regard to ye Caustic Alkali is how to guive it - When Combin'd with an Oil as in soap it is very diagreeable to ye Stomach but this is Obviated by Mixing it with a Mucilage either animal or Vegetable which answers as well as Oil, - However these kind of Meds, are only proper for ye phlegmatic, for they are exstreemly dangerous in ye Billious, - Chiturcks Meds, seems to be nothing but Caustic Alkali given in Veal Broth, - Mr. Bride has started an ingenious theory that those Meds which Contain no Fixed air but have a strong attraction for it prove Solvent to ye human Calculus, by extracting its fix'd air, he therefore Objected to its being mixt with Vegitables or milk &c, because these woud furnish them with Fixed air & Reduce ye lime water to an inert Catearious Earth & water ye Caustic Alkali to its Mild State in which Case they have no Effect upon ye Calculus Dr. DeHaens assumes that it Stevens promotes a disposition to generate Calculus & appeals for ye truth of this to ye large Quantities of Calculus Sediment the Urine of such People has have used it Contain - But this Catearious sediment is ye lime Reduc'd to its former inert State by having attracted fixed air He is Exstravagantly fond of ye Usa Urvi but it does not deserve ye Enconium he bestows upon it has perhaps no other virtues, but a gentle astringent, it may Generally be guiven to ye quantity of a dram For a dose tho this is to be regulated by its Effects on ye stomach sometimes then larger doses may be Exhibited than this, it has Frequently proved a very good palliative, but it is merely such & even very frequently Fails in this Respect, Authors, Dr. Whytt & Mr. Bride in his Essays are the Best of this subject, Of Worms, The Symps. of worms in ye Primæ Viæ are so Neumerous, that it is impossible to enumerate them beside many of them are Equally Common to other disorders, however in generall they are flushing of ye face a Itching of it & ye Nose a peculiar Complexion or Whiteness in ye Countenance with a swelling of ye upper Lip these last have been thought to be pathogmonic but they are attendants of a Scrophula Also, A particular fœtid Breath, Stridor dentium, a varacious Appetite, thirst frequent sallivation, sudden Startings and disturbed sleep, Epilepsy, & ye greatest Variety of Nervous Complaints frequent pains in ye sides dry Cough pulse very Various frequent feverish Paroxysms Hiccup, Nausea Vomiting alternate Costiveness & purgin Mucous Stools pains in ye Belly wich are more Violent in an Empty Stomach swelling of ye Abdomen, whilst other parts of ye Body are greatly Emaciated Urine exstremly different sometimes perfectly White the only symptom to be depended upon are a passing of worms Either downward or what is Frequently ye Case out at ye Mouth Worms have been found in every part of ye Body, in Children who are most liable to these ye irregularity of ye appetite waisting of ye Flesh & a greenish Cast in ye Countenance are what we Chiefly trust Antecedent & Procatartic Causes are 1st it is almost peculiar to Children tho it seldom appears before the Child is wean'd 2d. Worms are found to be attendants upon Various diseases Especially those of the putrid kind - 3d Moist seasons are said to produce them in Mashy Countries & amonghst ye Sedentary Leucoplegmatic Habits & whatever Weakens ye Vis Vitæ dispose to there generation but many of these Causes seem Rather to be derived from theory than Fact an Observation for many Leucoplegmatic & Weak Children are Never troubled with worms - 4th Legumens & Unripe fruit but these are as purely theoritical as ye Former, - The principall worm found in ye human Body are ye Tænia or tape worms or Lumbricitata ye Teres or Common Round worms & ye Asarides a very small Speices that infect ye Rectum - The Cause of worms being more frequent in Childn. than in Men. some have attributed to, the large quantity of Mucus found in their Intestines Others to ye want of Bile but Neither of these opinions seem to be well Founded - Indications of Cure are 1st, to kill ye worms- 2d, to Expell them out of ye Body - it has been Added as another indication to purge of ye Super abundant Mucus but as I before said this is only theoritical all ye Mede. used here may be Referred to such as act ie 1st by their Asperity 2d. poisonous quallities 3d. those that expell out of ye body Tin in powder or filed has been much Recommended it seems to act as a poison tho not from any Arsnick it Contains, according to Leuris Supposition but rather from its being soluble in ye Acid which it meets with in ye primæ Viæ, & forming a Compound Capable of destroying worms All the preparations of Steel are said to be usefull, - Solution of Copper have been much spoken of and the greatest expectations have been From Mercurials ye inert & & Unactive preparations, as Mercur. Alkalizat, Othiop Minerall have little Effect, tho with Jallop they woud seem to answer better than this purgative alone - ye best preparations of Mercury is Calomel whether it purges or not, but it Requires to but prudently administred - all ye Saline Substances as ye Neutral Salts, have been recommended but have very little Effect Harrowgate Water is much Celebrated - Expressed Oils are much used on a supposition that oils are poison to worms but this fact is by no means sufficiently well Establish - All kinds of Fœtid Meds are perscribed because they are supposed to be as disagreeable to them as they are to us - Most Bitter have been much spoken of as Excellent for destroying worms thus in particular the Indian Pink is Celebrated as in Anthelmintic .... The teres will live many hours in Oil or water yet a purgative brings away more worms after ye use of Oil then it wou'd have done without it - External Application Consisting Cheifly of Bitters are much used - The most powerfull remedies are Emetics & purgatives - the first are only usefull occasionally when worms are in ye stomach - Brisk Cathartics or those which Contain some Mercury are ye most Efficacious as Calomel with Jallop & Scammony &c, - the Root of ye Cabbage is very powerfull Remedy against ye Teres - Ardent Spirits will destroy all kind of worms but they Cant be guiven in ye human body in large enough Quantities to have any Effect, ye smoak of tobacco in Glysters Certainly destroys Ascarides, 19 Mineral waters act only as purgatives... Sulphur has been orderd in such a manner as to prove a very brik Purgative it undergoes some kind of decomposition in ye prima Viæ, as appears from ye peculiar smell a Person has that is Using it such as attends all Solutions and decompositions of sulphur - Milk Glysters have been used with a View to invite ye worms into the great Gutts, But at length there is no disease whose Cure is more Uncertain - Authors, the Chief are Rhedi Valisnori & Van Doverans, but none have taking proper pains to find out a Specific poison for ye several Speices of worms - Of Poisons this term is used in very Various Significations ye common meaning of it is any thing that in very small quantities destroys animal life ye Effects of different Poisons are very various therefore I cannot treat particularly of Each, I shall however Endeavours to be pretty full & Accurate on ye Hydrophobia - Hydrophobia, this is not Mentioned by Hypocrates or the Antients so that probably is was not known to them - this disease consists in various spasmodic affections, but ye distinguishing from whence ye disease has its Name is a dread of water & every other fluid & is almost all ways ye Consequence of a Bite of a Mad dog. - it is said that in South America the dogs never go Mad, - When a dog is going Mad he appears low Spirited & Solitary, doth not bark as usual & when he does theres a Remarable Change in his Voice Refuses his victuals flies at Strangers hangs his tail & Ears walks as if he was asleep his Eyes wander & appear inflam'd there Bite at this time is less dangerous than a afterwards when the Breathing becomes Short, they now roll, their tongue foam much at ye mouth never go in a strait line & when flying at any Object they frequently Miss it - their Eyes are now become exstreemly wild & furious, in this stage or Condition they Seldom live more than thirty hours - Some dogs are rather Comatose than furious, especially those of king Charles breed the nearer death ye more dangerous is their Bites, one Reason assign'd for dogs going Mad is their want of prespiration or sweat the symps. in Man in Consequence of a Bite of a Mad dog are very various & comes on at different times after the Accident sometimes in a few days at others Many Months - at first a pain is felt in ye part wounded tho perhaps it is now perfectly healed up, this is Extended to ye Neighbouring parts the paitent is low spirited listless has frightfull dreams &c, ye nervous system alone in here Affected, - The duration of it is very uncertain sometimes it last fourteen days - the Blood upon being Skewn does not skew any Morbid appearance in this stage of ye disease - In ye 2d Stage there is great Stricture about ye Præcordia great dyspnœa, difficulty of Swallowing any thing Fluid afterwards an Horror & dread at ye sight of water or anything that Breaths water into there imagination hence every Fluid or bright Object as a Mirror Affects thems: they Can swallow Solid Meat &c, their is also a Vomiting of Oruginous Matter & frequently a Priapism there is a great disposition to spit & sallivate & there are also all the distinguishing Marks of a Fever. - it is said they are inclin'd to bite people that Come scar them but I don't beleive this tho it does sometimes happen, - the patient of Continues sensible to ye last the pulse sinks gradually & ye paitent - Usually dies on about ye fourth day after this Stage Comes on with great dyspnœa & Convulsions, these symps cannot be accounted for, merely From ye difficulty of Swallowing they are Observ'd by Dr. Mea'd to follow ye Course of ye Moon, & this Obstruction is Confirm'd by Hillary, particularly ye Hydrophobia & Hydrophobia has Sometimes appear'd in fevers without any infection - it prevails most in hot weather & among dogs Feeding on Putrid food without any drink ye infection may be Communicated by bite tho no blood appears yet it does not seem to be of so Contagious a Nature as many have imagined many lies too are told about ye time this infection may Remain dormant in ye Blood for it Rarely happens that ye symps. dont appear within ye Space of three Months, - if Ever, the disorder is more Violent in Men than in Women - of those Bit by mad dogs, or such as are Supposed to be, not one in twelve go Mads, or perhaps in thirty that ever takes ye Infection, this has guiven Reputation to so many Meds, that have been tried - Dissection of dead Bodies dont throw any light upon this Subject except in skewing that it is not owing to a Topical Inflamation in ye head, ye blood is generally dissolved & soon putrefies - Proximate Cause is a poison that has a peculiar Specific action of the Nervous system, For ye disease is at first Manifestly Nervous tho afterwards it becomes inflamatory as to the - Prophylaxis, It is Recommended to prevent ye infection taking place Either to cut out ye part immediately or destroy it with a Red hot Iron but this practise is now entirely laid Aside, deep Scarrifications are however advised to be made into ye parts & to encourage ye Bleeding after this Suppuration is to be induced & Constantly kept up pretty largely for a long time nether is this by any means Sufficient to procure the patient from infection many specifics have been Recommended for this the princle of which is ye immersion in ye sevor Cold water. there has been some difference in Employing this - Boerhaave advises us to increase the Horror as much as possible, but probably this might have a bad Effect upon the Nervous System & thus prove more prejudiciall than Serviceable - the Regimen in generall shou'd be Cool with ye use of Acids exercise & agreeable amusement of ye mind, - the best Method of using ye Cold Bath is that directed by Hillary to as soon as his patient came out of ye water he puts him into Bed & endeavours to promote a Sweat by Musk Opiate & plenty of Diluent drinks, he mention that out of ten persons Bit with mad dogs seven were healed in this Manner & all Recoved ye other that did not make use of it Died ... another Mede. recommended as a powerful prophylactic is Mercury by way of Unction to ye part Injured or taken internally - Tiset and Dr. James have note particularly upon this. & ye Method of using so as to be Certain in promoting a sallivation or a Determination to ye Skin for when it promotes or increases no Secretions it woud seem to be of no Service - Turbith Mineral has Cur'd dogs by Inducing a Sallivation - The Lichen Cinercous terestres or Liver wort Recommended by Dr. Mead & ye principle ingredient in ye Pulv. Antilysus of ye Lond. Phars is now fallen into disrepute, - the patient shoud be kept upon a low Cool diet with an open Belly & proper Excercise there are few Instances of well attested Cures after ye Hydrophobia has Come on, if there are great symps of Inflamation, Bleeding ad Deliguium Animi have been practised but without Success, the Blood is found to be in rather a thin & disolved state - Diluent Cooling Remds, signifi nothing ye only usefull Meds are Dysphoretics ye Cold Bath is a powerful one Opiates are Sometimes given with ye same view joined with Emetics & there are instance of people being Curd by this means it has frequently Removed ye Hydrophobia so that ye paitient Coud drink water before he died - Effusion of Cold water on ye head while ye feet is kept warm is said to have Effected a Cure in one Case - Mercury has Cur'd it in this advanced Stage Turbith Mineral with ye addition of some Opium, is ye most to be depended on as it raises a Sallivation in ye bast time- Musk is ye only Antispasmodic of any Consequence, Cinnabar used to be aded to this but it is of no signification - the Volatile Alkali has lately been discoverd to be very Effectual in Cureing ye bite of a Viper, & from this it, is supposed might that of a Mad dog but this is not Confined by Facts & Experients - When ye Hydrophobia is Come on, the Meds, I shoud most depend on as antispasmodies are ye liberal use of Opium musk & ye Cold Bath,- Authors ye best Acct. of ye Sympts. is to be found in Caluis Aurelius Boerhaave Van Sweitens, Sauvages, Mead, & Hillary As to other poison they are very numerous, & Specifically Distinct, but I shall only mention a few of the most important I said in Common Language that a poison was defin'd to be such a matter as proves fatall to ye animal life in a small Quantity, but this is improper, as many of our most powerfull Remedies, Opium, Mercurials, Antimony &c are included in it, There are two very opposite Effects of poisons some act by Exciting Violent inflamation & Spasm in ye primæ Viæ, & in Consequence of this Affect ye Nervous System, such as Arsenic Corrosive Sublimate &c, others, again diminish Motion & act immediately on ye Nervus power, as Opium & all kinds of Narcotics, to which some wou'd have us Confine ye word poison - others act by disolving ye Blood - some of ye Narcotics act first as stimulants this is ye Case with Opium, Especially in small doses, tho even in large ones it is first Stimulant - & then its Narcotics Effect Comes on, which are much the most Permanent - Some poisons act immediately upon being applied to the Body as ye bite of a Viper, others remain long in ye system witht. Exerting their Effects, Poisons are also in some measure Relative thus one kind is poisonous to some Animals that is ye ordinary food of others, there is another distinction also in poisons some acting immediately on ye stomach &c, others not till they get into ye Blood, this last is ye Case with ye poison of ye Viper which is innocent if taken by ye mouth, & perhaps it is ye same with regard to that of a Mad dog, tho it is said to have been Communicated by ye Mouth, but without any good foundation, ye poison here does not seem to be diffused through ye Common for ye Liver of a mad dog has been eaten to prevent ye bad Effect of a Bite nor was it attended with any bad Consequences, - This is a strong instance of the power & Effects of ye imagination in this disease The Bite of ye Tarantula is a paticular kind of poison & attended with singular Effects, its Cure is said only to be affected by Music - as poisons are so very different in their Nature so ye method of Cure must be as Various, ye poisons most Frequently taken with us are arsenick & Corrose Sublimate ... ye indications in both these are to Evacuate ye offending Matter, hence if there is not a Copious Spontaneous Vomiting A proper dose of white Vitriol shoud be administred & great plenty of Bland diluents guiven as Milk, Oil, warm water &c, & frequent Glysters of ye same ingredients are serviceable, if ye Patient be plethoric, Bleeding shoud not be neglected when ye patient has been much Exhausted by these operations, opiates are proper but never before these Evacuations have been Copiously made - if ye poisons be of ye Narcotic kind very Strong Vomits are to be immediately given & large quantity of Oil & water is to be drank because there is Ever in these Casses some degree of inflamation excited, besides vomiting is easier by takin the Oils, after ye Evacuations diaphoretics are proper, Especially ye warm Bath, & after this musk & diluent Liquors when ye patient is stupid & Motionless the Strongest Stimuli to the Nervous system are proper - But still ye actions of poisons taking by the Mouth we are always to attend to what they do in the primæ Viæ, - with Regard to specific Antidotes we know every few, there is however undoubtedly one, with Regard to ye Bite of a viper which is said by some to be Common Oil others ye Grease of ye Viper itself, - Sucking ye wound as also prevented its bad Effects, - Diseases of Children I have already treated of the Scrophula Rickets, Worms. Epilepsys & several other Diseases to which Children are peculiarly incident - there is then but, Little to be said here, - I shall however give you short Acct. of ye Constitutions of Children or Infants - When they first Come into ye world they Seem to Stand in no need of Nourishment they are full of Blood & their bowels are likewise Full, besides they seem to require sometime to Recover ye fatigue they have under gone in ye strugles of Labour. & by ye natural sleep that they get for at least twelve hours after there Birth after they have been Cleand & wastid with luke warm water, - In ye Highlands they wash them with cold water without any bad Effect; - The practice of guiving a Child some thing soon after Birth to purge of the Meconium is entirely unnecessary & very often hurtfull, an infant increases Faster in Bulk than at any other period of life ye Vessels are more numerous, therefore ye younger a Child is the greater proportion of fluids it has to ye Solids, at ye laxer ye tone of ye solids the Heart is also proportionably larger - the Head also is Remarkably Large & the Glandular parts particularly the Lymphatic Glands & Vessels, ..... As the Body groes stronger the force of Action of ye heart; increases of resistance in ye solids consequently ye Heart that was in Infancy greater than the resistance of the Solids in after times will become Equal to them, at which time all further groth of ye Body must Cease because ye increase of an animal body depends on ye impetus of ye Blood propelled by the Heart with a greater Force into ye Minute Vessels than they can Resist, by which means they are Enlarged and Distended, - 20 During Infancy ye pulse is quicker, & the System much more Sensible & irritable ----- the Brain & Nerves are also much more Considerable in proportion to ye Rest of ye Body the Muscles are lax & feebles, ------------- Purgatives guiven to Nurses Seldom fails to opperate on a Child at ye Breast, --------- the Ostiffication of ye bones are very [crossed out] incompleat hence they are liable to Curvatur's &c, of the Bones from slight Accidents, -------- the superiority of ye hearts force to ye resistance of ye solids makes a quick waste of ye fluids, hence Children bear fasting worse than adults on ye loss of blood or any other Substance, Evacuation ------------------ Most of there secretions have an acid smell & there is oftener Morbid Acidity in ye Stomachs of Children than it adults --------------- In the first Month ye Child sleeps almost, entirely, & they always Require more sleep than a person that is past Puberty ---------- Children a fond of incessant Motion --------- they waste very Fast in every disease & their flesh Soon becomes Flaccid, but then they Recruit or Recover again as fast as they lost it & upon ye whole they bear diseases better than grown up persons, & frequently Recover under ye most unfavourable Circumstances they Bear particularly well all serious Evacuations, long Continued vomiting purgin &c, their fluids are all bland hence wounds heal so Readily - as they advance toward Manhood, all their Secretions become gradually more Acrid, there Blood is Little liable to either Inflammatory or Putrid diathesis ------------------------ Vomits and Blisters may be applied to them with more safty than to Adults, there last never produce any strangury ------------ Nature has provided Children with a Lax, Belly & facility in Vomiting, as they have not ye sence or faculty to regulate there appetites, their time of teething is naturally about ye Sixt or seventh Month ---------- the earlier or later appearance of the Teeth does not seem to point out ye degree of strength this period of life proves fatal to many Children many Causses are aduced for this mortality, but they are by no means sufficient to Acct. for it because other animals are Exposed to the same Cause without ye Effects or Fatality ------------------------- I before obser'd that Children when they are New Born Require little or no Nutrition, ther fore they shou'd be kept from ye Breast sometime they usually Sleep several hours After Birth, ----------------------- the Universal Analogy of Nature seems to point out the propriety of ye Childs sucking ye mothers Milk this has been denied by some Authors who have run into ye most Rediculous absurdities Concerning it, ------------------- the time of weaning seems to depend on Various Circumstances when a Woman has given suck for ten or twelve Months, the Menses Usually Come on at which time the Milk usually Gripes the Child, tho this is more particular a day or two before, they Actually appear, for after this the Child may Frequently suck a few weeks longer without ever having ye least Complaint of this kind these Circumstances seem to point out ye propriety of weaning the Child sometimes Children wean themselves of Refuse to suck any Longer ------------- there seems to be no bad Consequences from a Child sucking a pregnant Woman except that of impairing her strenght, -------------- it is better to bring up a Child by the spoon than at ye Breast of a strange woman seviry Alteration shoud be induced very gradually, beginning to Change their diet by little & little for three or four weeks before they are thoroughly weaned ------------------- I shall next speak of a Few particular Diseases, ------------------------- Gripes or Colic in Children This shews itself by the Child Crying incessantly drawing up its legs, want of sleep sometimes a swelling of ye Belly suppression of Urine, Obstinate Costiveness, at times others Diarhœa which is more Frequent with Billious stools & vomiting ... the alteration in ye smell of their Breath guives ye first sign of there being out of order Acid Eructations Borborygmi &c, are very Frequent & ye Violence of ye gripes very often induces Convulsion Occasional Causes, 1st, a Retention of are ye Meconium with wich ye gutts are stuffed at Birth & if it does not beging to be purged of in 24 hours it always induces Gripes, it shoud not however be purged of by Cathartics too suddenly, ye Meconium is never possesed of such a degree of Acrimony, as many has supposed it may Acquire when detaind too long in the Bowels since it is Containd in them long before birth ------------------------- 2d, another Cause of Gripes & which often Excites Vomiting is over feeding Children, As they are not, Capable of regulating their Appetites ------------------ 3d Bad diet whether Milk or any other Matter thus water sweetend with sugar is very apt to occasion these Colics. Diarrhœa Vomiting &c, puddings of all kinde & pastry are difficult digestion Milk diet and well fermermented Bread is ye best diet, --------------- 4th keeping a Child too hot, ----------- 5th want of Exercise & fresh air, -------- Proximate Cause, is a plethora & Viscid Colliores in ye Primæ Viæ The Cure varies according to ye Difference, in ye Causes, when it arises from ye first it is generally Cur'd by spontaneous purging, which goes of in eight or ten days Most Meds, are prejudicall, only these Can be addmitted that have little or no Stimulus. the nurse shoud be kept on a diet as nearly resembling ye former one as possible and ye nurses Milk should be Exactly of ye same age as ye mother ----------- Testacea are ye most proper Meds, for Cureing these Cholicks, when they arise from Acidity in the Primæ Viæ which is known by ye Stools being on a greenish Colour, of these Magnis. Alba is the best as it is generally laxative ------------- Vomits, are sometimes necessary & Children Bare them Extremly well --------- Oils have Frequently been guiven but they are improper ------------------------- in Case of Wind and flatus which is Common Aromatic or Carminatives in small doses are usefull. ---------------------- A Few drops of Spts. Corlew may sometimes Answer very well as an Antacid, but in general hot Meds. are pernicious ------------------ Aromatic fomentations to the Belly do good in Case of Costiveness, Emollient Glysters may serve as a Palliative ------------------- if all these Remeds, shoud prove unsuccessfull & ye gripes Still Continue there is no danger to be Apprehended from quieting ye Violence of ye symps, by a few drops of Ligi Laudanum but ye principle point to be attended to is Regimen which we defer till tomorrow ---------------------- As Children is Commonly Brought Up, the Cold Bath from ye time they aree three weeks old onwards is very proper -------- The Jaundice oft appears in Children two or three days after Birth but this soon disappears when ye Meconium is purged of ye Mother Milk &c, - When this has been Obstinate I have given a Vomit with great success tho the Child has been very weak, for they bear this Evacuation very easily --------------------- another most troublesome disease is the apthæ, but I spoke of this before, it is Epidemic in some Countries & also endemic it is known to be Coming by being preceeded by Torpor, & sleepiness sometimes ye pulse is low &c, as not to be perceptible & often is difficult to say whether ye Child is alive or not, however they never die in this Condition no Spot then appears on ye Corners of the Mouth & soon spreads all over it; ye Fauces & Intestinal Canal ------------ This Disease last about 12 days, nothing Shoud be guiven here but Sack Whey, it often Alternates with ye Red Gum & it is frequently attended with Hiccup Convulsions &c, Detergents are very improper here, --------------------- It appears to be a Critical Eruption or discharge tho from what Cause is uncertain perhaps it may be owing to the Child being kept too hot, it Commonly leave ye Child very thin, but they thrive & have very good health after ye Apthæ, sometimes Changes into a Brown Colour which is a very bad sign, When attended with Gripes Costiveness &c, Magnesia, Alba, & soap disolv'd in Milk may be given, when Apthæ are going of it is proper to wash them with a little honey disolved in warm water, ---- When a Child is brought very low by this or other diseases, it shou'd always sleep with ye mother or Nurse, as Human heat has something peculiar, & Specific in it, different from all other application Of heat, --------------------- The Tinea Capitis & Crusta Lactea where spoke of before, ----------------- This is Salutary & Criticall Discharge consequently its Repultion will always be attended with bad Consequence it is Owing to Errors in Diet, & Regimen &c, it Often goes of Spontaneously --------- Issues have frequently Cur'd it without any Detriment to ye Child -------- Excoriations, about ye Anus lars and in the flanks are oft, very troublesome they are owing to too tight bandages or Want of Cleanliness, dusting them with a little flour is safe in general & makes them Easier, but ye applications of White Lead is highly dangerous, & hath often occasioned Convulsions &c, & other, Effects of the Lead --------- No means shou'd be attempted to stop ye Discharge behind ye Ears of gross Children unless we substitue another for it, as Issues in the arms, nothing detergent is to be applied Frequent washing them, with Cold water & keeping them dry and is the best Method of treating them Theething Children suffer in common very much at this Period ------- The proximate Cause of all Disorders that arises from teething is Stimulus or Irritation from ye tooth Cutting thro sensible parts, when it proves fatall it is owing to something Morbid in the Constitution, Chiefly to Plethora Repletition & mismanagement, The Indications of Cure are, 1st, To take of ye Irritation, & its Consequence as fever Convulsions &c, --------- 2d to forward the Exit of ye teeth through the Gums ----------- Bleeding, is very proper when a Child is plethoric, & Local from the Gums by Leeches or Scarrifications, the Body shoud be kept Cool & ye Belly Open ----- The Prophylatics are to put issues in the Arms --- Vomits are very proper in Case of fever & Costiveness ------ Blisters are very Necessary & usefull ye Gripes Require the use of ye Testacea, amongst ye antispasmodic musk is the most Efficacious in Case of startings & Convulsions ---------- Opiates shoud only be used in cases of Extreem Necessity ------ the Coming out of ye teeth is best forwarded by letting ye Children Chew something that yields a little to ye pressures of ye gums but not too much nor must it be too hard hence a peice of Liqurice Root or a peice of wax is very proper for this purpose, it may Frequently be advisable to open ye gums freely by Incision over ye tooth but not before it is near bursting out or till you Can distinguish which it, is by swelling soreness &c, -------- All that I need Observe further is that Children ought never to be weaned whilst their teeth are troublesome, Authors I Recommend as the best on this subject Van Sweiten and Tissot ---- Diseases of Women, Women have less firmnes, tension, & Bodily Strenght than Men, they also have less Acrimony in there fluids & secretions & have a greater Sensibility & Mobility in ye Nervous system ------ the Circumstance of their Menses occasion, many peculiarities that influence our practice the Criticall Period of a Womans life, is at ye time ye Menses First appear or puberty, & when ye Menses Cease, in, these Countries ye menses usually appear between ye ages of Fourteen & seventeen there Frequency quantity &c is irregular in some they happen every three weeks in others once in Five or six yet both subjects are Equally health full ye Common period is about four weeks or perhaps a few days more, --- In case of a suppression of the Menses or their not Coming on at a proper time The first symps, are generally Torpor & heaviness pains in ye back & Loins & at ye bottom of ye Belly: disorder in all ye Animal functions, sometimes all ye Symps. of an inflamatory diathasis at others of a Serosa Colluires, pains in ye head & stomach particularly, when the Serosa Colluires abounds it is Called, Chlorosis, this induces a flour Albus & all ye Hysteric symps, as formerly Enumerated --- Sometimes hemorrhages break out in different parts of ye Body & flow very regularly at stated times these are most Frequent in such Girls as have never had ye Menstrual Flux, they often occasion glandular swellings particularly Cancerous Breast --- Some few Women Enjoy very Good health, tho they, have not ye Menses --- It is of Consequence to distinguish whether, ye Obstruction of ye Menses is Idiophatic or Sympathic, Among Particular --- Occasional Causes are 1st, Imperforated Vagina this is exstreemly rare --- 2d, Violent Emotions of ye Mind particularly Crying whilst ye Menses are a flowing --- 3d Catching Cold especially in ye feet --- 4th an improper Regimen & particularly Want of proper Excercise &c, --- 5th Celebacy --- From all this it appears that the proximate Cause may be referr'd to some of these heads, --- 1st to Want of Tone, --- 2d, to Spasm on the parts --- 3d, to a determination upon some other part The Effects of this Suppression, are so various & Extraordinary that they Can by no means be accounted for by ye want of ye Evacuation of so so small a quantity --- the Alterations in ye system Must rather depend upon ye want of tension & a Change in ye Determination --- Besides ye suppression in pregnancy is not attend with any such bad Consequences as that of ye natural ones from any other Cause --- The Indications of Cure are 1st. to Restore ye Evacuation --- 2d to Aleviate ye bad Consequences that may arise from ye suppression --- as ye Causes in producing ye Obstruction are very Various so must the Methodus Mendendi - in Chlorosis stimulating & Restoreative Meds. are proper --- The method of Treatment must be very Different & Totally opposite in different Cases, --- Bleeding, the best sign of Propriety of Bleeding is if ye pulse Rises after it, it is most proper to bleed in ye Feet, Excces of Bleeding from leeches must be guarded against and oft Bleeding is to be Repeated if ye inflamatory symps. run very high, or when ye small pox Lie under ye skin like an Erysipelass & do not Come forward Bleeding here from ye skin takes of ye tension & may be used in any perid of ye disease were there are marks of a topical inflamation this oft happen about the height; & the Lungs are apt to be affected then After ye inflamation of the Lungs has come on, I have scare ever seen bleeding Relieve Bleeding after is Recommended by sydenham but there is no Reason for it and it is now laid aside, --- Vomits, the Nausea at ye beginning of ye small Pox, seems to indicate the Propriety of Vomiting. But there is oft in this and other Diseases a Nausea where there is no foulness of ye Stomach, gentle Vomits however however promote ye Eruption. Bleeding is to be premis'd if ye patient is plethoric Vomits maybe repeated at any time and are of Espicially Necessary about ye Height large doses of Emetics are improper. small doses of Emetic Tartar best, there being danger of Strangulation from ye Viscitidy of ye Mucus & Saliva. Oxymell Scillitie best here So also from ye sensibility of the Stomach the thing appears to prevail in it, ... Purgatives are Necessary to keep ye Belly open, tart Emet may be quiven Oxymell Scillit is also Necessary as it promotes Sallivation & the flow of Urine gentle Laxatives are proper at ye beginning, but during the Eruptive Fever, ye patient is usually Costive & this seems Natural so unless ye Febrils Symps, Run high no thing is to be done but during ye Course of the Small Pox it is highly proper to keep, ye Belly open and the patient shoud have at least one Stool a day this is ye best affected by Glysters, but about the turn proper Exhibition of purgatives is of ye ulmost Consequence. this Caused a great dispute about 50 Years ago, between Dr. Frund & Dr... So if ye Face which was before Swelled sinks Suddently and Delirium Comes on with Other Mortal Symps. The secondary fever is not Mentioned from Rhasis to Ballinius nor from Ballinus to Sydenham yet it is more Fatall Sallivation too is not mentioned before Sydenham gentle Cathartics are Extremly proper in the lymphatic & Christalline kind, after the small pox are gone of, it is proper to guive 2 or 3 purges to Carry of those in the intestinal Canal, Manna which is oft quiven then is a bad Mede. itself ...... Regimen. This is to be particularly attended to before. Sydenham a very hot Regimen was used and is still too much Followed the drink shou'd be as gratefull as possible so that no Infusion of herbs is to be Given then small beer is prefered by Sydenham, but now much laid aside tho without Reason, in his first Editions he only allows it sparingly but afterward speaks more boldy of it this drink assidulated with Elixr. of Vitriol is particularly proper where ye disease is Petchia or other symps. of putrefactions. in most Cases Fruit of all kind may be allowed it serves to keep the Belly open and answers better than Glyster, ----- A Variety is guiven of drinks to promote ye Maturation of ye small pox as Infusion of Sheeps Dung &c, but without any Reason A Free pure air is to be allowed, & nothing is more fatal, than to Confine ye patient too much putting to bed in order to promote ye Eruption is absur'd for the longer that is delayed in general ye better Sydenham, advises the patient to be put to bed when the pox begin to turn, but if he can bear to Sit up their is no occasioned to put him to Bed ye Linnen shoud be Frequently changed otherwise ye Matter from ye heat acquires great putrefaction, which is offensive both to the by standers & to ye patient himself... Patients that have been stretchd out in ye Cold Air as dead by Reason of this hot Regimen have Recoverd from this Exposure, 150, People ill of ye small Pox were Remov'd from Blanford at ye time of ye Fire only 1 of Which Died an attenssion however is to be had in this Respect to ye Climate thus a free circulation of Air & keeping the Patient out of ye Bed is always proper. Cordials, as to these & diaphoretic Meds. they only serve to inflame the fever hinder ye Eruption & promote colliquative Sweats, & to Render ye small pox more Malignant, this is evident from ye Cases in Mortow, sometimes Cordials may be useful about ye Eruption where ye nervous Fever prevails, & ye patient labours under much, Fear or Langour or when the swelling of the Face suddenly fals, Wine is ye best Cordial, Myrrh is particularly recommended here but, is a very insignificant Mede. at least in the doses usually given Often grate quantities of wine are drank at this time without much Effect, which skews ye insensibility of ye stomach... External Applications in Eruptive fevers nothing promotes the Eruption more than warm fomentations warm Pediuvia are Reckoned particularly proper as Causing a derivation from ye head the practice of Bath an Vapor is as ancient as Rhazes, when ye small pox appears under ye Skin, & do not Rise from a Constitution that is in ye Skin, ye Semicupium of a gentle heat is of the greatest service it is Reconed particularly proper in Children Before accustomed to Cold Bath when an Epileptic Fit produces ye Eruption in Children Pediluvia and Semicupia promote ye Eruption better than Blisters which are generally made use of.  This is rather improper where there are Symps. of a slow Nervous fever or ye disorders of the head sometimes the patient towards the End of the disease Complains of pain in the Exstremities which are best Relieved by warm bathings & this too favours the swellings Cataplasm of Milk and bread may also be used the Care shoud be taken have them of proper temperature often changed about 6/52. of farenhiet is a proper temperature... Blisters are generally Mischieveous in Eruptive fevers unless of the Nervous kind or in the small pox accompanied with a Caterrhal fever Sydenham Recommends them after the Epileptic Fit in Children, but omitting them in ye semicupium is much more proper & Blistering is Commonly Safe after this, as their is great Difficulty of Breathing usually about the Height. Blisters are applied then, to the Back but wou'd be better on the Legs, this is the most proper reason for,  Lect. 26, Opiates Concerning these there has been great disputes I have often seen Syr Papas agree with the patient when Laudanum would not & vice versa, in many Cases they are highly serviceable not always, in Eruptive Fevers they are generally improper as increasing delerium when labours under great terror they are serviseable as a Cordiall Sydenham gave ʒi, Diaedman ct Vesper, after ye 6th Day, where painfullness keeps the patient Restless they ought to be used tho they may Check the Diarrhea which is so Necessary to Children tho this may be Remedied by gentle Glysters or laxatives Join'd to them, that kind of smal Pox accompanied with an Acrid defluxion on the Fauces peculiarly Requires opiates Sydenham even quives them during delirium & says they favour sallisation if the delerium is Consequence of  Restlessness & pain, Opiates may Relieve it as in Sallivation it depends Entirely upon ye Cause that Obstructs ye secretions for Opiates tho they Check Evacuations is general yet in some Cases they may promote them thus if Hæmorrhages proceed from great irritability they are checkd by opiates but if ye Menstrual Flux is Obstructed, by some violent Spasm Opium will take of the spasm & Renew the flow power I do not think Opium has any specific power of Maturating the Small pox; but only act by taking of Restlessness & pains, hence shoud not be used when the patient is pretty free from pain & sleeps well, thus too by taking of ye tension from the Skin, they oft produce sweats so that ye Cause obstructing ye secretions alone points out ye propriety or impropriety using opiates, they shoud not be indiscriminately guiven but as indicated. by ye above symps. particularly squils are ye bent Correctors of opium & particularly proper were there is any Cough,  Syrup of squils agrees better with most people than Oxymell, ye patient throat shoud be oft garlgled Especially about ye 6th or 8th day a decoction of Mustard with a little sugar answers very well for this. A little Caust Alk. has a very good Effect in attenuating ye Viscid phlegm ye steams of warm water act in some measure the Same, as this detergent Gargarisms and Especially if a little Vinegar be added to it, Acids we before mention'd ye use of this but we do not find that ye Mineral acids have any advantage over ye Vegetable, & these are most agreeable Acids are found sometimes to Effect Sallivation if so they favour'd ye diarrheas, a liberall use of Acids are particularly Serviceable in Small pox attended with Malignant fever, ye Vitriollic Acid has brought people through this disorder who have had ye worst kind even where bloody Urine In the Christalline. Acids are not to be  Liberally used, Dr. Morton says that Sydenhams practice was oft attended with bad Consequences to ye patients and particularly from this use of Acids, wich he says Dr. Sydenham was sensible of it before he died, but the latstest Editions skews he was still more addicted to cool Regimen ... Cort Peruv, the good Effects of Bark in promoting a laudable suppuration in Ulcers & in stopping Gangrene, naturally indicates ye use of it in that small pox where there is a great putrid dissolution of ye Blood & petechia appears, Accordingly is oft of service Bark in these Cases shou'd be begun upon as soon as ye Eruption is Completed & to ye quantity the patient stomach will bear tho it may be given in ye malignant kind ʒi in 5 or 6 hours, ye day after ye Eruption begins, many Cases of both petechia and Black Urine are Cur'd by ye Bark, the small pox then are oft succeded,  by swelling of the glands particularly the parotids, in ye lymphatic & Christalline kind too Bark is of Service as it is every were, were Matter doth not Come on properly, for it seems to have the same Effect here as in promoteing ye suppuration of Ulcers Dr. Morton gave it liberally but in the second fever, & were there evident Remissions, this sometimes happens and then ye Bark is very proper theres a practice Recommended by several authors which is to prevent ye Second fever by opening the Pustules when Ripe where small pox are fill'd with very acrid Matter this may prevent ye deep pitting of the face it is supposed too by this to prevent a Reabsorption of Matter into the blood which is Reckoned ye Cause of ye Secondary fever also to take of tension from the Skin, & to promote a more free and Equable Circulation over ye whole Body sometimes it is unavoidably necessary where the Pelicle does not allow ye Acrid Matter to get out, it seems  indeed in general a good practise nor are any bad Consequences to be apprehended from it ... Symptoms requiring Palpilation A Suppuration of urine Oft happens Especially in Children in consequence of too free use of Opiates here Children shou'd frequently be put in Mind of making water otherwise it may induces a paralysis of ye Neck of the Bladder, the opium rendering them insensible to ye Stimulus of ye Urine sometimes setting the patient on his knees will Remove this or Making move once or twice Round the Room, and the only Remedy of these fail is Emollient Glysters- If the Small pox sink Suddenly from a weakness of ye Vis Vitæ, the best Cordial is wine with Blisters and opiates, Coma and delirium is particularly Reliev'd by Bleeding & best by Topical ones the use of this is indicated from the good  Effects of a Bleeding from the Nose, sometimes but this delerium is oft in Consequence of a hot Regimen and is to be Remov'd by taking ye patient out of Bed warm fomentations and Cataplasms are oft of Service here, -    Prac. Book [illegible] An Hectic fever sometimes Remain after the small pox, this best Releivd by repeated small Bleeding by proper Milk & Vegetable diet saline draughts Bark with Rhubard Elxir Vitriol Bristol Water Riding if these fail to go to ye warm Climates. Violent hemorrhages are best Stop'd by the Bark, astringent and Opiates in a Variety of Liniments are prescrib'd here to prevent. - when ye pelicle is hard they may be of use otherwise Oily preparations & warm fomentations of warm Water may answer better, - preparation Both for Inoculation & when Epidemic, the Effects of Bleeding in preparing ye Body, are very inconsiderable, if ye patient is plethoric it is Necessary, but it has no Effect in, determining ye Quantity ye nature of the small pox gentle purgatives are agreed to make the Small pox Milder Mercury and antimony have been particularly Employ'd as preparitives small doses of Mercury purg'd of next day by cooling purgatives are oft used  Especially in North America, Sulph antimon with Calomell is now given & has been found of Service...Every one is Convinc'd of ye propriety of ye Antiphlogistic Regimen before ye Small pox. in generall Abstinence from Animal Food is proper one of ye best, drinks here is Certain preparations from Experience to be of great Consequence the this is denied in ye Medical Essay but every preparation shoud have Respect to particular Constitutions & to ye Manner of life before, Children that are strong lively and florid must be brought down in some measure but this is to be done with Caution, for too large Evacuations may weaken the Vis Vita too much ye antiphlogistic Method is proper in general, yet in weakly persons perhaps ye use of Bark may be a better preparatory, Bathing ye Legs in warm water towards Night is universally approved of to promote a determination to the parts, but ye water shoud not be too warm, the new Method lately introduced of...  Lect 27 Inoculation was Originally introduced in Circassia and Georgia & brought here by Lady Mary Wortley Mountague, ye above preparation in Receiving ye small pox in a naturall way is applicable here but there are Methods used in England with great sucees by severall persons none of whom belong to ye Faculty ye general plan of preparation is this for 14 days keep on Vegitable diet & allow fermented Liquors during this time allow'd as much Ripe fruit as they please if not on ye days of taking physic Tea Coffee & Chocolate, they then take 3 Boluses which Certainly are Mercurials, for they sometimes Affect ye mouth, The Day After ye Bolus a dose of Glaubers Salss if ye patient is not very young they Inoculate at all times but Chiefly in May & September, Autum is Reckon'd ye worst time they disregard ye Habit of Body particularly what is Call'd Scorbutic during the Eruptive Fever they dont Confine ye patient to his bed & all in Cold water but if this brings on Sweating they encourage it, after ye Eruption theres no Confinement at all. On the first Apperance of Maturation give gentle purgatives &, 3 days after Repeat this, between the,  the Inoculation & Eruption guives 13 pills which are also Mercurial, all this time the patient is allowed to go about at his pleasure by this treatment not above 4 or 6 Died out of 17000 according to Dr. Baker but in the Common way of Inaculation about 1 in 80, there manner of preparation agrees with what was said above, ye use of Mercurials is always used before inoculation in N America & ye patient is not Confined, thus we see how far the Regiment is to be Carried without danger, As to ye Choice of Matter take it from pustules after full Maturation, so from 11 or 12, to 16 days if before Maturation ye infection is supposed to proceed more Slowly, takin from another inoculated Pustle answer as well as from ye Natural, suppurated Matter in the arm in which ye infection did not take is founded to Communicate infection people in England generally take it before Maturation while the Matter is as yet water, in general we shou'd get from an healthy Subject & of a good kind but there great Reason to suppose that the Small pox Communicated do not partake of the Nature of ye Small pox which give the infection, thus there are instances of ye Confluent kind being Inoculated, which tho they  Proceed Mortal to ye person thad had them, yet where of a good kind in ye inoculated a person, the highlanders have long used Rubbing ye dry pustules into ye Skin which is a near approximation to Inoculation also to ty Cloathes dipt. in ye Matter Round the Arm but this does not always happen to Communicate infection - on ye Coast of Barbara if ye Breath is sweet skin Soft & Ulcers heal soon ye patient is thought fit for Inoculation at first in England they Inoculated in several part at once but this is now laid aside if the patient was Inoculated in the Leg it was found that after the small pox was gone ye wound did not heal well in ye arm too its disputed whether ye Skin shoud be cut through as these Ulcers are long a healing but its a question whether ye discharge from these Ulcers may not be Servicable wee now however make a very small incision and without penetrating to the Membr. Cellulasa if ye Skin is Scratched so as to fetch Blood & the Variolus Matter applied Infection Certainly is Communicated in paris they apply a Small Blister but an incision is better, it is of no Consequence how long it Remain, there are instances of ye dressing being taken  of immediately ye persons who inoculate in England are not apprehensive of any Accumulation of infection the Variolus Matter is not to be kept in a Liquid Form lest it shoud putrify but in Cotton the more the matter is the Better and more apt to Communicate Infection - the signs of Infection taking place are an Itching about ye Orifice in 24 hours, then as inflamation & afterwards a suppuration there sometimes ye wound heals up & does not break net again before the Eruptive fever Comes on, it is questioned whether any new Disease is Communicated even along with ye small pox it appears not in many places of ye Scrophula Leues Venerea. Chin Cough &c, we have only one Instance were According to Dr. Monro) Milliary Eruptions were Communicated but this is ambiguious we shoud not however Chuse to take Matter from an unhealthy person, ye person being in a bad state of health himself is Reconed an Objection to inoculation if the  Disease Can be Removed it ought but ye Hereditary he will Stand a better Chance of Escaping by Inoculation then if he took ye small pox in ye Natural Way, besides many diseases are oft Removd by ye small pox another - Question too is, whether there is not more Chance of a Return of this disease after Inoculation then when taking Naturally it is now confirm'd that there is, what gave Reason to this question was the mistaken other Eruptions for the Small pox, for if some few red pimples broke out they used to Conclude them to be ye small pox, but they are not so unless they fill with Matter properly the Use of Inoculation Appears from ye Calculation of the lives lost, it is computed that of those who take them Naturally 1/4 died at the small pox hospitall in London only one died out of 312, in America one out of 600 or 700, besides out of 2490, not one lost their, Sight of one Eye wich oft happens after ye small pox taken Naturally as to the time of life young Children have ye Small pox naturally more favourably. but in young infants ye infection does  not take besides they are more subject to Convulsions then which are oft fatall, if ye Child too is at breast, the apprehension of ye Matter will induce a Change in the Milk & this may bring on a Convulsions of which we have seen instances, in Authors of ye small pox in general Sydenham, Meds Huxam, & on Inoculation Bakers Glass, Holasell Dimsdall,... Lect 28 On the Measles, The History & the Symptoms this disease was first desribed by Rharzes, it was known as long since as ye small pox, it was Carried into Egypt by ye Arabians, & thence brought into Europe it is preceeded by Rigour alternate heat & Cold, Fever, Sickness, loss of appetite white but Moist Tongue, short Cough, heaviness of ye head & Eyes, Sleepiness Coryza, - Acrid Defluxions of ye Nose Eyes, Bronchiea &c, & this is a most distinguishing Symps, also a Sneezing, ye Eye lid is sometimes swoll so as to make ye patient Blind ther's oft a Slight Angina it is frequently preceed by vomiting and of toner by Diarrhea Especially in Children, were its preeceded by green Stools The Eruption is immediately preceeded by much Restlessnes, Timidity & Palpitation of the Heart by great Itching of ye faces by bleeding at ye Nose &c, then Symps continue 3, 4 or 5 days before ye Measles appears, or even 12 or 14 days for if ye Menses come on in them, there will be a great Dyspnea - a great Anxiety of ye and the Eruption, will be very much Retarded they generally appears first in the face like flea Bites they gradually grow larger & oft colesce ye face is oft swell'd much they sometimes appear first in the Breast, & Shoulders, those in ye face are a little raised above ye Skin, as can be perceived to ye Touchs on the Breast & Limbs they don't rise above the Skin, ye Feverish Symps, seldom abate an ye Eruption, coming out, ye only symps, that usually Remit is the Vomiting, ... On ye 6th day they turn Rough & on ye 8th, go off from ye Face & on ye 9th or 10th from ye whole Body, they leave Mealy Scale behind them oft ye fever & dystnea remain as doth ye diarrhea the last is one of ye most dangerous symps, hot Regimen too oft produce the petchia & turn the Measles livid Hæmorrhages oft happen & Relive ye patient much the heat and Anxiety is more than in the Small pox those who die usually die usually die on ye 9th day & of a Peripneumory they are attended with Severe Cholic pains if properly managed are seldom fatall but there Consequences are more dangerous than the small pox the most common Consequence are a waisting Diarrhea Swelling of ye Belly, hectic Fever & Phthsis Pulmonalis there are oft Tubereus which oft form Vomicea,... Prognostic Symptoms, A Remarkable Lavsitude & fixt pains before ye Eruptions is a bad sign, so is a pain of ye head & Eyes, after ye Eruption profuse Sweating are unfavourable Hæmorrhages are Rather servicable if not in Consequences of a putrid dissolution of the Blood - sometimes Billious Vomitting come on 2 or 3 days after ye Eruption which Releives all ye Symptoms, Remarkably more than ye Eruptions, the Fevers seldom goes off without a gentle sweat diarrhea or Copious flow of Urine, Proximate Cause It is Evidently Contagious & its S. is Sui Generis, it attacks only once in a persons Life & there are very few Exceptions to this Rule when Measles are Epidemic it is oft Easy to trace out the infection there are few Instances in which the Infection semed to be Converd by ye Air, without any Communication with Sick People, this Happened at Edinbh, after ye Measles had been Epidemic through ye greatest park of Scotland it is Remarked in these Epidemic Measles that some People, took ye Preceeding Fever without any Eruption but had ye Measles long afterwards Measles have been Communicated to Children in Ulcers the Measles and small pox are Analogues in several Respects but there is ye Remarkable difference that in ye small pox the Morbid Matter is more Complicately Carried of by ye Eruption tho ye Measles are not produced by any particular Constitution of the Air yet they are greatly influenc'd by it when they become Epidemic in the spring & go of about Summer but not always the Affect ye Mucous glands Remarkably, & Wholly Membrana,... on dissection too we find the internall Viscera cover'd with Measles, as is the Case also of ye small pox... Indications of Cure 1st to assist the Efforts of Nature in throwing out Morbid Matter & to moderate  them if too Violent... 2d. to aleviate particular Symps Especially the peripneumonious ones, ... the first indication is answer'd by Cool diluting diet, Bleeding Vomiting, Cathartics warm Bathing sometimes Cordials & Blisters the particular peripneumonious Symps. are Releiv'd by Bleeding Pectorats, Blisters &c, ... Bleeding is oft Necessary at the Beginning in Adults Especially as being more Subject to Topical inflammations, it Remarkably Releives Anxiety & Resstlessness it prevents Hæmorrhages & Peripneumony & oft Facilitates the Eruption when ye Febrile Symps Run, very high, this is oft very Necessary at ye other Periods of the disease if ye Dystnea & other Symps. Require it in short we must very often treat it as a Common Peripneumony ye practice  of Repeated Bleedings was introduc'd by Dr Mead, but has been much abusd since infants in particular are not to be bled without Exstreem Necessity, Bleeding is oft profus toward the End of the Disease if a hard Cough Remains Diarrhea will only yield to Bleeding ... Lect 29 Vomits, are frequently Necessary at ye beginning of ye Eruptive Fever & Especially in Children & oft too during ye Continuance of the Disease as Children swallow the Salive which loads the Stomach & likewise brings on a Diarrhea it also Endangers Strangulation unless discharged by a Vomit given now & then - the antimonial Vomits in small doses answer very well & they promote Diaphoretics particularly ... Cathartics these may be proper at first to Cleanse  the Prime Viæ but afterwards tis suficient to keep ye Belly open, by Emollient Glysters these are particularly Requisite at ye going of of ye disease ... Blisters these are oft Necessary where there is a great Acrimony of the Serum as in these defluxions mention'd above they oft being down ye pulse Remarkably here if the Measles fall in Suddently with a slow pulse Blisters are very proper when ye Expectoration is Very difficult they are also of Service as they are in all peripneumory Cases, Regimen this shoud be nearly ye same as in ye small pox it is observe'd however that Acids dont answer so well, as Exasperating ye Cough, so small Beer is less proper ye hot Regimen produces the same bad Effects, as in ye small pox increasing ye inflamatory Symps, and  oft producing Peripneumony or Delirium with inflamation of the Brain ... in Certain Cases were Cordials are Necessary wine is the best, warm Fomentation promotes ye Eruption, & restore it, wen ye Measles fall in suddenly, the hot Regimen also produces very profuse Sweats which are very unfavourable ye only Mede. to be given with propriety ye favour ye Eruption and promote diaphoresis, is a Saline Mixture, or Spirit Mendereri, Receiving the Steams of warm water takes of ye stricture & dryness which is sometimes produced by the Cough... Opiates these in general are Necessary to Alleviate the Cough, & are orderd by Sydenham every Nt. but this shoud depend on Circumstances, & its better if the patient Can Sleep without them sometimes theres a Constant Iactatis both in the Measles & small Pox ...  particulary Requiring opiates no Eruptions comes forwards then & Opiates by Removing this favours the Eruption and Maturation in low Cases they are the best Cordials (Re:) when ye Eruption is gone back by any Means Dr. Medd Objects that they Check Expectoration but we dont Observe this, I have sometimes thought them to asist it by taking of Stricture from ye Lungs... Symptoms requiring Palliation Cough is one of the most troublesome symps, Various pectorals are given for this such as Syrups & Expressed Oils, but we always find syrups prejudiciall as they have Scarcely any Effects, as pectorals Oils are more Efficacious, but Children will seldom take them, instead of these Infus Althea, Liquorice &c, load ye Stomachless & Assist Expectoration, if ye Stomach Can bear it Oil of sweet Almonds is a good Mede, one of ye best 5 pectorals when ye Expectoration is viscid is  the Squils, tho in a tickling Cough where there no Expectation or at least a very thin one they Rather do Mischief, the Oxymell is the best preparation for them, it is oft made up with Gum Ammon but many Stomachs nauseate this & its of little Effect in ye usual quantity given in Bleeding is particular Necessary to Relieve ye Cough & peripneumonic Symps if these Continue after ye measles go of it must be look upon as an incipient Phthysis Pulmonalis there is nothing more Effectual than Repeated Bleedings in small quantities, Gentle Vomits Country air, Riding, asses Milk Bristol Water, Vegetable diet & these failing, a warmer Climate a diahrre is best Check'd by gentle Vomits but that Succeeding ye Measles is Oft Carried of by Bleeding, when other Meds. fails, if it is during ye Measles it should not be stopped if Moderate Hysteric Women who are seaz'd with the Measles, & those just before ye Menses  have some particular Symps, as Stricture of ye throat &c, here Bleeding, Emollient Glysters, warm Bathings, & opiates at Nt. are proper but the Antispasmodics are Serviceable yet warm Nervous Meds, are improper here, ye itchings is best Removed by warm Fomentations of water a trouble Sympn. oft is a dryness & Stuffing of the Nose, & it sometimes produceth bad Consequences, for whatever Obstructs a free perspiration is dangerous, the steams of warm water & unctious applications to the Nose are serviceable here & their Effects seem to reach beyond ye part, to which they are - applied Authors, the best for they Hystory are Dr. Sydenham & Mead ... Of the Scarlet Fever, This Fever is oft treated of together with Milliary but as the Scarlet Fever is oft Epidemic, & the Milliary frequently only Symptomatic, I shall treat of these Seperately, Neither of these seem to,  have Subsisted among the antients, they are not describd till ye last Century, but were Mentiond by Prosper Marliatis... History of the Symptoms, It Commonly begins with Rigour Alternate heat & Cold but no great Sickness, & ye febrile Symps, dont Run high, it is distinguish from ye Measles by ye want of Coryza, and Defluxions of the Eyes it Resembles them in this, that ye Eruption is on ye fourth day, tho ye Eruption is in large Spots than in the Measles & less Uniform the Enlarge much & ye Inderstices between them Swell so that the whole requires a deep Scarlet Colour, so that if we dont Narrowly Examine, it appears a Uniform Scarlet Effusion, these spots too dont Rise above ye Skin or the Eruption is preceded by Head Ach and oft by Vertigo, Oppressed breathing fearfullness, Lowness Anxiety & Commonly a very Feeble Pulse. It is too oft too succeeded by Vomiting or Constant inclination to  Vomit this Vomiting generally Continues About 2 days After ye Eruption more rarely and only in Children by purgin, an Oppression of breathing is oft Mistaken Affections of ye Lungs and Bleeding is perscrib'd for it but this is merely a Nervous Symptom Bleeding is very prejudicial it Continues about ye Same time with ye Measles & then goes of in Scales & ye whole Cuticle Breaks & Comes off, it is attended with more or less Angina and it oft attends Angina, Maligna, it Seldom attacks more than once in a persons life & Observd at Edinbh, when Epidemic there they whose Faces are Affected, & there are oft Aphtha there, this Affection Seems to Exstend to ye Stomach, & occasions that inclination to Vomit, great tenderness of Mouth was Observd in this fever lately when Epidemic at Edinbh. ye Symps dont go of on ye Eruption but go away Gradually, & without any Sensible Crisis, it is in generall & Mild disease & it doth not accompany teething or visit Concomitant with tho Angina Maligna bleeding at the Nose sometimes  happen about ye Eruption & if not Copious is Serviceable this disease seems to be Contagious & all periods of life are Subject to it but Infancy most of all Sydenhan says it happens Ususally at ye Ends of Summer but we don't Observe this, it has a Regular progress as the Small pox, Measles & Erysipelass Girls are subject to it at ye time of the Coming on of the Menses... Methodus Medendi, When it is attended with Angina bleeding is proper at first but unless the Febrile Symps. Run too high, is not Necessary, Vomits are particularly useful at the beginning, ye Stomachs of Children are Usually full, so that Vomits are very Necessary for them at ye beginning of all Acute disorders but they are not to be Repeated tho ye inclination to Vomit Continues as this may depend on a topical Affection of if Stomachs, Cathartics are not Necessary till towards the decline. Opiates are oft Necessary tho there is no Cough in Order to Remove ye Anxiety & Restlessness, in  this fever they both favour the Eruption & Abate ye febrile Symps, accordingly by Sydenham Opiates are Recommended Every Nt, these also add a firmness to ye pulse which is oft very weak feeble & sunk Blisters are oft of Considerable Service here in very low Cases but I am not fond of them till towards ye decline warm Fomentation are better at ye beginning and answer ye End as well, but in Very low Cases a Succession of small Blisters are Serviceable, Bark oft is of Service here Cordials the only proper one is wine which is particulary Necessary when the Scarlet fever is Epidemic in Winter and after ye Eruption is gone it take away that feebleness of pulse Remaining, Children wont take ye Antimoniall Mixture to Alleviate ye inclination to Vomit nor will they even take proper food for Subsistence ye Mildest food is best & Milk, those that suck answers best,... Regimen a hot one is very improper in this disease & may bring petchiæ and bloody Urine...  Crisis, theres none unless you Can call Sleeping for 3 or 4 days a Crisis ... Lect 30} Of the Milliary Fever, this is preceeded by an Alternate heat and Chilness headA che Disturbed Sleep & frightfull dreams Clear Urine & sometimes by Delirium - Pathognomic Symps, are a Remarkable degree of Languor, Anxiety A fearfulness Sense of Stricture & Appression in ye Lungs Dystnea faintness when in an Erect posture frequent Sighing short dry Cough without Expectoration sometimes Sickness Gripes flakes pain in ye head sometimes in ye limbs always in the Back a stiffness of ye fingers & prickling over ye Body preceed an Eruption of ye white Milliary kind profuse sweats also Often preceed ye Eruption, As ye Eruption Comes on on the 3d, 4th, or 5th, day, but    26  It is a bad Symptom if it comes on too soon, If Epidemic, Convulsions preceeding is a Favourable Appearance it is divided into 2 Kinds the Purpura rubra & Alba, ye first is with us Called ye Rush the Eruption sometimes appears as if ye person was Stung with a Nettle but we have no occasion to Mention ye whole Variety of Pustules as they must all be treated in ye same way those first Appearing Rise above ye Skin & fill with a Clear Matter which afterwards turn Opaque those appearing afterwards dont fill at all they Continue to Come out sometimes 3 days in their fallen in Suddenly fits of sweating Faintness Subsultus Tendinum Convulsions &c, come on, both Species Appear together Sometimes, & are sometimes also intermix with ye Small pox & Measles the Eruption has a peculiar Smell particularly the purpura Alba, there is frequently a successive Sereis of these Eruptions in Fever Especially of the Nervous kind, these in those Cases are often Mistaken for Criticall, tho they are Generally Symptomatic, when ye Eruption  is very small they are said to Resemble Millet Lud, hence their Name, tho in general they are much larger, Sometimes they are attended with a Sallivation & Violent pain in ye Limbs & sometimes a swelling there this in general doth Abate ye Symps but they Commonly abate after the Eruption there is no Security against a Relapse, before we see a Copious Sediment in ye Urine Sleepiness if it doth not go to ye Length of Coma is a favourable appearance & oft Criticall, ye Purpura Rubra oft Changes in to ye purpura Alba, & always for ye worse, this last being always attended with a degree of fever, they oft Scale of like the Small Pox, if in the purpura Alba the Eruptions fill with a Clear Liquor, it is the worse & if in the purpura rubna, ye paler the worse, Causes, it is but a Modern disease, so that its Causa proxima is not ascertain'd, Hoffman Supposes it to be the introduction of Tea  & Coffee in to Use, tho he is very wrong, we have a proximate Cause assined for any of these Modern diseases, Except we Resemble some that Existed before, it was first describe'd by Valerius a Spanish physician but not Mention'd by any other Author before Riverious who only Mentions it as a Symptom it is not describ'd by Ballonius or Sennartus, it was first Attended to at Leipsic, were it was Epidemic & very Mortal, & from thence it spread Slowly over Germany, Sydenham Mention it only as a Symptom Ramarrani & Torti say Nothing of it, the first Express Treatise on it was Rote by Sn. at ye beginning of this Century, it seems to have prevail'd in Scotland before in England, for it is Mention'd by Sidwell in 1684 there are great dispute whether this is a proper disease or only Symptomatic. Dr Haen is of ye last Opinion, it is indeed of Symptomatic, & induced by hot Regimen, but in some Cases it is a primary Disease, tho in 9 Cases out of 10, it is  Symptomatic from hot Regimen, & is very Common in lying in Women - it has a great Affinity to Apthæ & ye Eruption oft goes through ye intestinal Canal Dr. Huxham says that it happens often in Nervous Fevers, this is inputed by De Haen to his hot Regimen which he perhaps is too much Adicted too, De Haen confounds this with ye petechial Fever which is Never Critical but ye Milliary is Sometimes those most Subject to ye purpura Alba are perhaps of a very weak habit of Body wanted by Evacuations & great passion of ye Mind it happens most frequently in Moist damp Weather, its evidently Contagious Especially ye Purpura rubra, it infects from Nurse to Child, & theres some Reason to suspect that its Communicated by Inoculation its frequently Attended with a disolved State of ye Blood Espeically when the Consequence of a hot Regimen... Methodus Medendi, The Purpura Alba is a primary disease, & Nature must be allow'd to have her Course,  Bleeding is oft Necessary at the beginning & if ye patient is plethoric it asist in favouring ye Eruption, it is particulably Necessary where the disease is attended with a local inflamation, it has been attended with bad Effects after ye Eruptions has come out, Cathartics may serve to Clear ye primæ Viæ, at first but afterwards they weaken the patient very much, when theres a great Determination to ye Skin Evolusion to ye Stomach & Bowels is oft attended with these bad Consequences, ... Cordials, the use of these depends upon Circumstance, if ye pulse is very low, & Nature wants Support, a little urine is very proper, but were ye purpura Alba is Symptomatic no attension is to be paid to it,... Opiates are of ye Same use here as in ye Scarlet Fever, when ye Belly is affected with severe Cholic pains & Tenesmus, warm Fomentations to the Belly are Most Efficacious along with Opiates, Blisters are sometimes Serviceable in  the Purpura Rubra, & a Sucession of small does are ye best, De Haen is too free in ye Use of Blisters, which when too much used produce all ye bad Effect of hot Regimen, when ye Vis Vitæ is weak and the patient 2 or 3. Blisters perhaps are not Sufficient but other wise if ye patient is sensible never were any good Effects found from more than two Blisters at once, ... Bark, It is often Necessary Especially where there a sensible Remission of ye Fever as oft happens in the Purpura rubra Bark instead of Checking Eruptions always Favours them, it may be given to ℥ij of Decoction by way of injection, after ye Bowels are Emptied by a laxative clyster, its in general of Service towards ye decline of the Eruptive Fevers, & which have great Affinity to ye Genious of Malignant fever in generall ... Authors - De Haen, Stork, Savauges & Fordyce,...  Lect, 31} Apththous Fever, Sauvages enumerates severall Speices of Milliary Fever, which are Chiefly of the Putrid Kind a particular Speices which is very Analogus to the Milliary Fever is ye Aphthous Fever, it is not Certain Wether this was known to ye Antients or Not; Our Aptha are different from the Description given by ye Antients, for they are Pustules Rather than Ulcers... This Fever is preceeded by great Anxiety Oppression, Great Dejection of Spirits Frequently it is ye Consequence of Fevers and sometimes these are Criticall - but theres a disease very Common in cold Countries 7 or 8 days after the Birth called ye Gum, but Called white Gum to distinguish it from ye Red Gum and Particularly Follows ye Autumnall Fevers & Especially Intermitt, is turned to Continued Fevers by hot Regimen it oft attends Dysenteries improperly  Stop'd by Astringents, it is Epidemic in Holland & especially in Zealand - Apthæ appear first at the tip of ye Tongue in a Little white Spot, which is a Favourable Sign, this gradually spreads over ye Tongue & then Affects ye Lips & in two days takes possession of ye Lips entirely, Sometimes they begin from ye Stomach and proceed upwards which is dangerous Sometimes, they fall of in 12 hours but, Generally Continue 3,4,5, or 6 Days, Prognosis, If very great Sleepiness with feeble pulse is Observ'd is if ye Chd. appears pale with blue Lips & this happens about 8, or 10 days after Birth you may generally Presage Apthæ, the Pulse here oft is not to be felt at all, if ye Skin appears dry after they go off Soon, they generally go through ye whole intestinall Canall, they hinder Deglutition so that the Child can Sometimes hardly Swallow at all for 2 or 3 Days, ...    hence the patient is wasted surprisingly perhaps to half the Bulk, they soon Recover again & enjoy very good health afterwds, but in Adults it induces a putrid diathesis of ye blood if they are very buid, the Causes Excoriation or Sallivation or even Bloody Dysentery, but this last only in adults they are oft Accompanied by Hiccup, Sometimes they walter so Acrid, so as to eat to ye Palate Bones: they oft attend Fevers, at ye beginning of which no Evacuation Can be Used, some times they attended Phthisis Pulmonalis & here they are Usually A Mortal Symptom Hiccup is not dangerous towards ye decline but it is bad if it preceeds Apthæ, for then the Apthæ begins from ye Stomach & proceeds upwards, they are usually Fatal to old People, ye while Color sometimes Changes to Brown or Black which is very dangerous, where ye Skin is very dry in Fevers they are often attended with 27 Apthæ, Hetler who Rites on this Subject  is a great Enemy to Critical days, but says there are ye 7th or 8th day of ye fever, it is Critical, if before that usually Mortall always have found them Critical When theres a quick pain & weight at ye Stomach about ye Eruption, it is a Sign that they proceed from ye Stomach upwards they prevail most in Cold Countries & in Cool seasons Especially, if they are warm some of its Symps, skew its Analogy with ye Milliary, Fever, & it is preceeded by ye same symps, Apthæ, in Coming out has the same acid Small both are Critical in ye fevers of ye same kind, both are Symptomatic if they are from hot Regimen, & from Stopping Diarrhea, they agree in having Severall Series, they have ye same bad symps, in Fallen in Suddenly, so their Course is Nearly ye same, its seat is in ye Ducts of ye Glands, seperating ye Mucus to lubricate the Fauces, & ye Apthæ appears of ye Nature of this Mucus, inspissated  Indication of Cure 1st. to promote ye Discharge by ye Mouth ... 2d, to Releive ye particular Symps, ... 3d, to Carry of ye Remains, by proper Cathartics Diluents Liquors, ye drink shoud be warm & diluent, everything Cold occassion pain & perhaps may make the apthæ fall in Nothing encourages Eruption more than warm Diluent Liquors & breathing in Steams of Boiling water Emollient Gargarisms & Linctisci are proper with ye same view, there should be Nothing Astringent in these nor any particular detergents, Nurses oft Clean ye Mouth by Red Wine & Sugar this occasions Excoriating pains & apthæ, appears again very Suddenly, ye least degree of Acrimony is improper ... Detergents, when ye Apthæ begin to fall of a little Castile Soap is ye best detergent & this ye swallowed occasions a  Little purgin which is of Service a little honey answer ye name purpose, ye Belly must be kept open, a little Cream with ye Yolk of an Egg is a very good Detergent, Glysters, when ye patient is not able to swallow a glyster of ℥o or ℥oj may be given 2 or 3 times a day and serve for Nutrition & also Asist Dilution, Freqt. Pediluvia and warm fomentations are good Diluents, After ye disease is passed, it will be Necessary to give gentle Cathartics, & ye the is ommited oft a putrid Diarrhea Super veneses ... Vomits are sometimes absolutely Necessary to prevent Strangulation, and are proper when ye Crusts are very loose Van Sweiten says that ye Sallivation be very great, its proper to swallow Salliva for Nourishment this seems a very bad practice ... Cordials towards ye End of this disease small proportion of Wine is proper, sometimes it is Necessary at,  ye Beginning also, Blisters at the Neck will Raise ye pulse & in generall their application is safer in Children than adults... Bark, there is no Mede. more proper nor of more Service than this in Adults Especially if ye Apthæ be brownish, this makes ye Crusts seperate much more readily too Of Erisypelas History of the Symptoms, they are called also Ignis Saur, St. Anthony Fire & ye Rose, this sometimes is very Slight & without preceeding the Fever, but usually is preceeded by ye Fever, it happens ye Joust in ye face and Legs, ye Skin appears a little swelled & of a particular red Color, ye Redness disappears on ye Slightest pressures, but Returns on Removeing your Finger, it is attended with burning Heat, but without any Pungency & pulsation, it encreases  generally for 2 or 3 days & Continues much at a Stand for a day or 2, & then scales of like ye Measles, ye preceeding Fever begins with all ye Symps, of ye Common inflamatory Fever & there no peculiar, Symptom from which we can Judge that Erysipelass comes on ye febrile Symps, abate & the Sickness goes of, tho ye fever remains in some degree Especially ye Erysipelas attack ye Face, in this Case theres always a Sleepiness & Head Ash ye Face is oft so swelled as to Close up the Eyes, it oft passes from one part of the Faces to another, but is mosly found in ye Cheeks & Nose, in ye Face it is oft attended with Delerium, & is then very dangerous to Old People, when it attacks ye Neck its always attended with angina when in ye Leg not only ye Limb is swell'd but ye Swelling extends much higher, when in ye face its oft Cover'd with watry Vesicles, & the Lymphs forms & a thick Crustaceous Membrane, sometimes it Continues for 7 or 8 days & then is oft  Carried of by Sweat, it has oft no Crisis Except perhaps a Copious Sediment in ye Urine, ye whole Skin & Mouth are very dry but without any great Thirst, it oft Recedes, & is then oft followed by Restlessness. Reacting to Vomit Anxiety about ye Precordia &c, on Coming on again all these symps. Vanish Sometimes thers a Recession in ye Legs & a Delerium comes on which Carries of the patient, sometimes it seizes of Lungs & then ye heat, Oppression & Anxiety are all inexpressible, it differs From a Phlegmone in generall that Superficiall it Spreads more, & is not Circumscribed, Phlegmone too goes deeper than Erysipelas & has its in ye Membrana Adiposa & Muscles, the Colour of ye Erysipelas is sometimes pale Especially in old People & it is usually fatall Natural Termination is Either by Resolution or Gangrene, this last seldom happens to Children or young Men  but oft to old people when it superats Ulcers are of a very bad kind & difficult to Cure it is oft Mistaken for phlegmone & Emollient Fomentations are Applied, this is a bad Method for it induces phlegmone & brings in Suppuration which is very difficult to put an End too, whatever tend to increas the Fever or diminish it too much is apt to Cause Recessions, which is always attended with bad Symptoms ... Lect 32} at goin of it leaves yellowness on ye Skin which is ye first Sign of its going of Gangrene is different from this for it begins with Watery Vesicles, this Disease is of Periodicall recurring oft at ye Equinox & sometimes at both if ye Blood be drawn it has a Buf Coat it is Carried of sometimes by Sweating & bleeding at ye Nose Especially when in the Face, sometimes theres a Sudden Metastatis from ye Face to ye Scrotum & - this swells so much as to give apprehensions of  Mortification, but this always yields to Emollient Fomentations, those who are Subject to it Usually die at last,... Causes, It is Frequently Epidemic Especially when joind to ye putrid Fever, as it Often happens in warmer Climates, here it has usually more of inflamatory diathesis, were its Constitutional any Error in Nonnaturals is apt to bring it on, tho its most Usually in ye prime of life, yet it happens in that species of Inflamatory Fever to which Old people are mostly Subject & in these its very dangerous. Women are more Subject to it than Men according to Astrues & other Observations, it is oft produc'd by Violent passions of ye Mind, those whose Health is most Broke by living in warmer Climates (& Commonly Called Scorbutic) are very Subject to it, it is Oft Symptomatic in Chronic disorders, as the Dropsy & Jaundice & it is Usually 28 Fatal there, whatever produces an  Inflamatory Fever is apt also to produce Erysipelas, & is Oft produced by Externall Wounds Contusions &c, ye immediate Effect of All Rubefacentia is to produce temporary Erisypelas Perhaps ye Stings of Bees & some other Animals are to be Repaired to this. Eating some kind of Fish is found to produce it, but ye Causes of this are impossible to be Investigated there are no distinguishing Marks by which we may Judge of Erisypelas producing internal Inflamation, as if ye Membranes, but if Erisypelas Strikes in & Marks of internal Inflamation then appear we may Judge so, Shingles in Childn are somewhat Analogus, to this Erisypelas most Resembles the Scarlet Fever it is distinguish'd from this by tension & pain, its Seat is in ye Skin affecting also ye Cellular Membrane, it never goes deep unless when Accompanied with phlegmone. Whether it Arises From ye Disposition of Matter in ye Skin or From a greater determination  to ye Skin is a question belonging to all Inflamatory Fevers Huxham gives it an Analogy to Eruptive Fevers Hoffman Endeavour'd to make it Analogus to ye plague but Unsuccessfully, it Resemble ye Gout in being Hereditary in Carrying of Certain diseases, particularly ye Spasmodic Asthma & ye Spasmodic Cough, on Recession it brings on Sudden Anxiety, it oft Affect ye Heart, inducing Delerium it sometimes Affect ye Lungs, inducing Peripneumony, sometimes ye Stomach too in ye same Manner as the Gout, this analogy ought to be Considerd, for it lead to Reflections which are not properly attended too, it Resembles the Gout in ye Exstreem Mobility of ye disease being very Easily drove in ... Methodus Medendi, This depends on ye View we take of it, if it be consider'd as a Critical disposition of Acrid Matter it is proper to Remove it;  if we Consider it as Analogous to ye gout it is to be Encouraged, it may oft be dangerous to remove it by Evacuations but when it attacks young people Especially in ye Face it is to be Removed immediately or it may Spread & Affect ye Brain. Our Views then are, ... 1st, to Encourage it if it appears Critical 2nd, to Abate ye Violence of ye Symps. ... 3rd, to procure Reduction of Swelling, ... 4th, to Attend to ye particular Consequences of it ending Either in Resolution or Gangrene, Attension here must be paid to ye Nature of ye Fever with which it is Continued, whether it be inflamatory or putrid - bleeding is Exstreemly Necessary when it attacks ye head & generally proper in young People, if the patients are Old & attended with a Putrid Fever it is very improper Bleeding too in persons of Nervous Constitutions is apt to cause a Recession, Opening ye jugular Vein or temporal  artery, when it attacks Face or head is most Efficacious, Scarrifiing on the part is found to be of Service, Regimen A Cool diet but in Old & Nervous People there must be something more Cordiall when it Attacks ye head warm Pediluvia is proper ye best diet to prevent a Relapse is Milk & Vegetable diet & drinking of Mineral water a little acidulated, along with these too much Exercise, & Tranquility of Mind prevent a Relapse purgatives are just Necessary in the Same Manner as Bleeding & ye same Causes that prevent ye one prevent ye other- tho no Inflamatory disease bears purgatives so well, they are very proper too at ye decline - Diaphoretics, of these all hot Cordial Meds. are very improper, & Especially when ye disease affect ye head. Saline Mixture & Spt. Mindereri are best - Absorbents, a great quantity of these Oft prescribed in this disease, as Cinnabar, Bezoar &c, but they are useless & very improper  proper, Nitre has been given, sometimes in Large quantities to ʒo or ʒoj in a day, there Few Stomachs who Can bear 1/6th of this quantity, where ye Stomach bear it, its a very good Cooling Mede. & proper in ye inflamatory kind of Erisypelas - External Applications many of these have been Order'd some Recommend Emollent & often Oily Applications, but it is best to apply Neither but keep ye Part warm by Flannel, Skins or soft Wool, whatever has a tendency to Repel Erisypelas is dangerous theres less danger of suppuration Coming on from Emollient applications to ye Face, but in other parts they are apt to bring on Phlegmone & then suppuration, if the pain be Violent ye steams of warm Water are best to be applied but ye Morbid Cause is of such Mobility, that Recession happens sometimes from the most Emollient applications Immediately, the most Common Applications are dry Matters, such as  absorbents, but even these often tend to hinder Resolution of whatever kind Oily applications produce ye same, one of the worst Applications is that Mentioned by Sydenham of warm Spirits, & is oft found of most fatall Consequences Even steams of warm water are not to be Repeated, Cabbage leaves are a most Cooling application here as it is in dressinng Blisters, the Pustules are not oft Found in the Face, if any gangrene appears there ye sooner open'd & dressed ye Better, Blisters to ye Legs along with Pediluvia has been found to transfer the Disease From ye head to ye Feet Sinapisms have sometimes ye Same Effects, if this disease Ends in a gangrene if ye Symps. of inflammation are very high Bleeding is still proper, but as this usually happens in old people, Bark alone is to be depended on, it is Necessary to Scarify ye part, to use warm Aromatic applications, & dres it with Basilicum, - Bark not only usefill if  Gangrine, but prevents ye Return of Erisypelas, if it be Periodical if it ends in Suppuration it is to be treated as Common Ulcers are, Bark is of Service here in promoting laudable Pus, Increase of Sudden Recession, & of its attacking the Head with Delerium, Immediate Recoure- must be had to Bleedings, purgatives, Fomentations. Blisters & Sinapisms to ye Feet, in Old People Recession Require much ye Same Treatment as ye Gout, ... Of the Plague This might have been treated with putrid Fevers, but as it Usually goes off by Buboes &c, we shall Rather Refer it to this Head the Term Pestilential has been Referred to every Malignant Fever that has been Epidemic, but we Mean that Fever which is Carried off by Buboes, & which is Usually attended with Petechia, & Milliary Eruptions, Such as that which happens at Merscilles, ...    29 Symptoms it begins with Coldness & is attended with Stupor, & with ye Same Sensation as that of drunknness, the Pulse is Very Freqt, but Remarkably tense & feeble Great internal heat but ye External heat is Moderate, an Unquenciable thirst with a White tongue, ye Speech is very Indistinct the Eyes Red Rolling & Sparkling, Face generally Flush'd, but sometimes Livid Cardialga with a laborius breathing, it is Sometimes quick & sometimes uncommonly Slow but without Cough & pains, Theres a Constant Reaching to Vomit & Nausea & what is thrown up is billious Stools too are of ye Same kind. theres a Constant Delerium, the Urine is turbid & towards ye Decline Black & Bloody, Lect 33} Violent Hæmorrhages which are usually, likewise profuse Sweats & thes are Sometimes Critical it is at tended with a Remarkable prostration  of Strenght & with a Continual trembling of ye hands which arises to subsultus Tendinum & oft Carries of in Convulsions petechia is a very Common Symptom but not Universal, .... Duration, it is uncertain sometimes to ye 14th Day but rarely & those who die mostly die on ye 7th, it is generally more Rapid in it progress at First, then after it has Continued sometime, sometimes people who have been Seizd with it have drop'd Down immediately .... Crisis the most Usual are Buboes & Anthraces, buboes are most Frequent in ye Inguinal Glands. Sometimes in ye others, these Usually Carry of the disease, but there are Instances in which they are discussed & yet the patient died, abuse are sometimes in other Fevers besides ye Plague & putrid Fevers, as in those which have lasted more than 20 Days, they Usually appear on ye 4th or 5th day & the  sooner ye better, Carbuncles appear at all parts of ye Body, it is a small Tumor, beginning in Form of a Red Fury Pustule with a livid spot in ye Middle that Spreads but Gangrene always stops it, & if Carbuncles are ever Fatall, it is in Consequence of the Fever being Excited, it is first known by great Itching on ye part & ye Pustules appears attended with great pain. on these or buboes Receeding ye patient generally dies, & Petechia usually Come on. theres a particular Analogy between the plague & a Malignant Fever, but here Petechia oft appears after the patient is dead, ye Tumor appears sometimes without ye preceeding & tho the plague is very Mortal it has very different degrees of Mildness sometimes on occasion of buboes the patient has been Sav'd by ye discharge of Perulent Urine, ye plague in different Variety of Shapes at different times & places & admits of ye Same degree of Mildness with ye Small pox when the Plague,  Continues long on a patient, it is a fever of if Remittent kind the paroxysms being Now very evident. In ye Levant it is oft Carried of by Sweat on the 3d Day but this Sweat tho it Removes ye febrile Symps, Doth not Carry of Buboes or Carbuncles so that the proper Crisis of the plague is by these Eruptions, Diarrhea in generall is an Unfavourable Symptom, the both this & ye Discharge by Urine have proved very favourable in Certain Cases, sometimes an Eruption is distinct From Buboes i.e, Pustules on ye Skin which Maturate & Much Resemble the small Pox, ... Causes. It Evidently depends on a Contagion Sui Generis, it Resembles ye putrid Fever in many Instances, in a great prostration of Strength & in all the Symps, of putrefaction, but it differs in that the Fever at ye beginning of the plague is much more Considerable & blood being then drawn has a Buf Coat, Sydenham looks on it Accordingly as of an Inflamatory kind & proposes Repeated Bleedings at first, But in 24 hours the  Inflamatory Diathesis is gone of, & a putrid Comes on. But in the Putrid Fever ye Patient Cannot bear to be Bled once weareas in ye plague His of Blood has been drawn of with Success. theres an Analogy between it & ye Small Pox, for both Arise from ye same Country, both are Carried of by Eruption & a Critical Deposition of ye Skin, in ye small pox there is always Suppuration, but this doth not happen to ye Plague, it has been said too that the plague never Seizes above once in a Persons life, but this is since denied Writers however have not Exactly Specified whether those in where ye plague went of by Buboes, Ever were seiz'd with it again, when ye Plague prevaild in Europe other Diseases were Remarkably Mild & those who Recover'd of it had their Constitutions improved, it is found that Cold Checks it in most places, but at Eleppo, hot Weather puts a Stop to it, it is Observd those who live very Soberly, Cleanly & of a thin Habit of Body, subject to ye Hemorrhoids, &  the Gout, Phthisical & comsumptive People & those who had any Ulcers on them, either Escaped it, or had it very Favourably the Same Extends to Resolute & Chearfull Persons, all those who live luxuriously, & those too who live on a very poor diet. & Filthily are more frequently Carried of by it, On Dissection much the same appearance are found after a Malignant Fever but these Dissections only Skew ye Consequence, not ye Proximate Cause of ye Fever, it is Observ'd that the Plague & all diseases of ye putrid kind are much less known in Europe within these 100 Years than Formerly, it was Mentiond before that Changes in ye way of life may Contribute to this, What is of the greatess Efficacy is, that now we guard more against ye Contagion, being brought from ye Levant & other Places, it is Observ'd that More People of Fashion die in the Plague than of ye Poorer People of whowm not so much Care are taken nor so many Meds. Administred ...  Methodus Medendi, There is a question whether is to be permitted to take its Course, or if ye Works is to be taken out of Natures hands Entirely, If the last Vigorous Measure are proper, Dr. Gregory Recommends to us, to begin at ye first attack of ye Disease, With Tartar Emetic, or James's Powder, in Such quantities as to produce Copious sweats & Continue it, or push ye other Call'd treat of Fevers to its utmost lenght ... Bleeding, this is Recommended by Sydenham at ye beginning & in a large quantity, but if it is not done at the beginning it is highly improper Afterwards one Circumstance Repugnant to Bleeding is, the great depression of Spts, which oft prevails, in ye Levant they Usually Bleed on ye First day but dont Repeat it, Sydenham Observes that there are Numbers of people killd by being shut up in Warm Rooms, & treated with warm Alexipharmic Meds. these were Observ'd to Aggravate all Febrile Symps. ...  Stop ye Sweat & other Secretions & present Buboes & other Suppurations instead of producing them & Forwarding the Maturation We know no Meds. that will produce Bubo & on the Contrary its better to let it Come on of itself, what Makes the Plague so Mortal amongst the Turks is, that they take no Care to Guard against Contagion & that by their particular way of life, they are More Exposed to take ye Contagion their Abstinence from Wine which is a great antiseptic, & their great use of Opium producing Atonia But Dr. Sydenham Was Oblig'd to give up this Practise & he next had Recourse to Sweating, he Bled ye Patient put him to bed well Cover'd with Cloathes, gave him posset to drink till he had made him Sick wich Favoured ye Determination to ye Skin & then gave him Sudorifics, he Observd that for ye last hour of Sweat it put on a different Appearance,  30  From what it did before, looking more like Natural Sweat & Relieving ye patient much More in Fevers too when you give hot Meds. to promote Sweat it is Necessary to push them Far Enough as otherwise it encreases all ye Symps. Dr. Russell at Aleppo Followed much the Same Method as Sydenham did & found it very Successfull ... Langrish seems to Reason very Absurdly in advising the Use of Alexipharmics before Bleeding, after Sweat Sydenham us'd a purgative but these in generall shoud only be give to Cool ye Body when open Russels Observes that a Purgative after Sweating Rather Favours Suppuration of Bubo than Check it ... Vomits are universally recommended at ye beginning & are oft Found to Carry of the Fever, if ye Vomiting be very Excessive, it is Check'd by a Saline Mixture in Act of Effervescence with a Few Drops of L. L. but What has the greatest Effect in Checking this Vomiting is ye promoting a determination  To the Skin Sydenham always gave a Vomit before his Artificial Sweat as otherwise his Meds woud not be on ye patient Stomach Lect 34} Bark this Mede. that shoud seem most Efficacious has never been tried this was not much useD till of Late this and the Spits. of Vitrol woud answer best, Probably after the putrid Diathesis Comes on. The Remission of this Fever too may Indicate ye Propriety of the Bark... Nitre this did not agree with ye Stomach & usually brough in a Diarrhea Which is a most Unfavourable Symptom Blisters, the are of no Service unless in Case of Coma, they are Supposed of Service Immediately below the part Where Bubo, had Appeard After Recession Emollient Cataplasms, These are prepar'd to bring on Suppuration of Buboes, Buboes either go back or  Twin Gangrenous & are thus to be treated as Common Gangrene ... Acids, those are usually Recommended As to Method of preserving from ye Plague the only Certain one is that of Cutting off All Communication with ye Affected Place All Foreingers ought to Stow themselves up in Houses at Aleppo & other places, then Provisions shoud be salted or Sprinkled with Vinegar, Meds. us'd as preservatives are Bark With Elexr. of Vitrioll, Smoaking Tobacco, is Said to be of Service, Authors, Sydenham Russell. Diembrock & Mead; much Exercises is perhaps one of the most Effectual Means of Preservation & ye Idleness of ye Common People at that time tends Much to propogate ye plague & make it More Fatall... Of Inflammatory Fevers With Topical Affections  These are divided by Savauges into two Classes as they Affect Membranes or as Substance of Viscera but this is a useless distinction & of no Application & in Fact these are usually Blended together, we shall therefore Consider these Fevers without attending to this distinction ... Of the Phrenitis this is a Constant Delirium attended with an Accute Fever it is divided into true & symptomatic. Either as arising From Topical Inflamation of the Brain or where only in Consequence of Some other Affection of the System,, they are Expressed by Various Terms in Mede. promiscously the Nature of these differs much in degree & Kind one Speices is were ye Imagination is so much Disturbd as to Conceive things Preasent that are not & yet the Patient Reasons very Justly supposing ye Existence  of these Things, Another Speices is where not only ye Imagination but all the Faculties are disorder'd, & no Coherence in Ideas it is occasiond by impression From Externall Objects not being in their usual State Either too Strong too Weak or too Confus'd - another Source where ye most Violent passions are Excited by Trifling Causes - another were the Faculty of Attension is lost, & yet the patient perceives things properly & Judges Righly of them - but Cannot attend to any impression song. this is an Enquiry which has never been persecuted to any Lenght how Far States of Body & Mind are Connected it is a great desideratum to find ye particular, Topicall Affection of ye Brain, that produces one or other of these Speices of Delerium, thus it is not known whether an Inflamation of ye Dura or Pia Mater will produce Delerium Lethargy Convulsions Apoplexy &c,...  Symptoms, The Symps. ye Phrenitis are intense Heat & pain of the head Redness and Inflammation in ye Eyes a Flushing in the Face disturbd Sleep great dryness & parching of ye Skin Costiveness & Relention of Urine or a sudden Change of it From high Colour'd to pale & Clear small droppings of Blood From ye Nose., Tinitus Aurium & an Exsteem Sensibility of the Nervous System when these symps, Comes on in a high Inflamatory Fever they Generally End in Phrenitis But Phrenitis oft Comes of in 2 or 3 Hours after the Beginning of the Fever. But Phrenitis is Either Primary or Symptomatic what is Said of it now will apply to both of these Speices, ye true Phrenitis is never Seen in these Countries tho it is in the Warmer Climates it has ye Usual Preceeding Symps, of a Common Inflammatory  Fever here there an Usually Debility of All ye Menta Faculties a Quick & hard Pulse Breathing deep & at large Intervals the Eyes are inflam'd, the Face generally Flushed but Sometimes pale & in a bad Case Silent Sullen delirium oft turn outragious, ye Pulse in the Cases is Seldom Full oft Trembling & irregular were the Substance of ye Brain is Affected, the Pulse is Usually Soft; as is Observ'd Parachymatous Inflamations in generall there is a Remarkable Strong throbbing & pulsation of ye Carotid Arteries, & oft of ye temporall too. From all these [cross out] Circumstances there are Marks of a great Determination to ye Head theres no Thirst, because ye patient is not Sensible of it ye disorder is oft of Short Continuance but Sometimes last till ye 7th Day, it then Usually Ends in a Lethargy, oft in a Palsy this most Commonly happens in that Phrenitis attending the Fever in Women,  After Pregnancy, Where it is a Serum oft Comes from ye Eyes Extreemly Acrid so as to Excoriate ye Cheecks there is a particular Species when ye Whole Ball of ye Eye is affected but this Seldom happens unless From Externall Violence this is Frequently Followed by Suppuration, & a Defluxion, of the whole Humours of ye Eye ... Opthalmia in one Eye oft Extends to ye other it oft leavers Specks in the Eye & sometimes a great Opacity this disorder is oft Periodical, & there are instances of its Returning Every Month & being Carried of by Sweat, theres an Instance of its being quotidian there partake much of the Gonus of the Common intermittent Fever ... Causes These may be first Externall Violence 2d. Stoppage of Usual Evacuation 3d Healing up of Ulcers & Issues Especially Scrophulus Patients 4th a Frequent Costiveness,    31  5th, Catching Cold during Menstruation, ... 6th Also Contagious, this is oft Caused in Childn. by Repelling Tinea Capitis or a Gutta Rosacea in ye face ye Common Causes are, Watchings I Know Nothing so hurtfull as Studying late or laying in Bed in ye Morning, Night Studies, Exposure to Sharp Winds to luminous Bodies, to Acrid Metallick Fumes & ye Remains of ye Measles & small Pox oft Occasion it too, - Temporary Opthalmia is oft Joined to Hæminania its oft Epidemic Especially after moist Season, Soldiers are much Exposed to it in Campaigns From ye Sun & dust, it has been Found owing to Irritation, From Hairs Growing withing ye Palpebræ or to insects there sometimes Conjoined with ye Vinerall Disease and oft to the Scrophula ... Proximate Causes, Is a Distention or Striction of the Tanica Albuginea & Termination Resolution, Suppuration, tho rarely, or Specks on ye Eye,  Methodus Medendi, Here are two things to be Observ'd 1st, General Habit of ye Body when from an internal Cause, ... 2d Local Affection of ye Eye when its Plethora Bleeding is very proper otherwises its of no Effect in ye Arm Bleeding in the Jugular Vein or the temporal Artery is oft of great Service but ye most Common Bleeding after Plethora is taken of is by Leeches as Scarrifying on ye temples, the Scarrifying the Veins of ye Externall Canthus of the Eye or Even the Globe of the Eye itself is Sometimes practis'd, the application of Leeches Sometimes brings on so great a fluction on ye Eye, as to Shut up ye light for sometime, whats said of bleeding applies to purging which is only Proper when its From an internal Cause & attended with Plethora...  Blisters, they are of Service here from whatever Cause they are usually applied behind ye Ears, but perhaps better on temples, Issues in the arm are of very great Service in Children, especially if they are of a gross Habit, [cross out] theres Something different in ye Effects of Issues & perpetuall Blisters & Issues or Setons are sometimes Found to answer Better than perpetuall Blisters, in what Case either is Proper, preferably to the Other is not Acertain'd Regimen. Shoud be Cooling, yet in some Cases of Chronic Opthalmia Every Cool Regimen is Found of Prejudice in particularly in Scrophulus People, its of ye greatest Service to them the light of ye Fire in Reading the best Preservative is to have the light transmitted thro Oil Papers its proper in Opthalmia to guard ye Eye.  From great glare but notto shut it up by Close bandages which keeps it hot & Makes it more tender Black or Green is the best for these Covers Frequent Pediluvia is of service to those who have Sore Eyes Shaving the Head & washing it: Cold water is very Proper in some Cases of Chronic Opthalmia Mercurial Sallivation has been known to Cure but very Oft Fails. Errhina has been Found of Service too, as Snuff to those not Acousstomed to it, When ye Opthalmia is Periodical, the Bark Seldom Fails to Cure effectually, its a good Mede. to an Opthalmia or Scrophulous People its Observ'd by Sydenham that in some Cases ye Exhibition of Opiates at Nt. has proved of Service but I Cant see how they shd. act; as to Externall Application they in general do Mischief and Require great Judgment they oft induce an Inflamation on the Other Eye, which before was Sound, Where the Inflamation, is great all Cold Astringent Applications oft. increase ye  Inflamation & are very apt to leave Specks on the Eye Powders are apt to have these Effects, warm Fomentations of Milk & Water & steams of warm water are best of the Inflamation be very great But even Emollient Fomentations shou'd not be too long continued ther's some Objections to Emollient Cataplasms the Pulph of a Boil'd & Rosted Apple & is one of the best, Emollient Application & ye weight of these upon ye Eye gives another Objection, but in Chronic Opthalmia Astringent Applications such as the Solution of White Vitriol or Saccarum Saturni &c, may be used with Success ye best & safest in these Cases of Laxity is Cold water Aq Aluminosa is 6 good Meds. here Ungt. Tutia is often used & oft found to Carry of Specks in the Eye these Unqts, shoud always be Used Fresh or Otherwise Very apt to irritate ye Eye the Best is Sr.. Hans Sloans, ...  Of Angina This is a Disease most Commonly attended with a Fever, but not always, we shall however Mention both its inflamatory & Chronic State, we shall not here Enter into a description of Cynanche or Cunanche & Parasunancha because its only a dispute about words Angina is a difficulty of breathing or a Deglution. the Causes above ye Lungs, there are many differnet Kinds of it, but we shall here treat Chiefly of Angina & Maligna Angina afterwards by it self, theres also Angina Aquosa an Angina From a Schirrhous & spasmodic Angina another division is from their Appearance into External & internall Angina. a third division is according to ye particular part of ye Fauces Affected as Tracheæ Phangngous when it Affects ye Tracheæ alone theres a great heat & pain in the part attended with an Accute Fever a Sharp shrill Voice which is a Diagnostic Sympm,  of the Larynx or Trachæ being Affected the Pulse frequently intermittent & irregular Difficulty of breathing which Usually happens in all disorders Affecting Respiration the nearer it is to ye Glottis the worse this appears to be one Cause of the C when it Continues any time in generally brings on Peripneumonia When it attacks ye Larynx, ye symps, are much ye Same, but theres also great pain, Elevating the Larynx in Deglutition & if this it not Speedily Remov'd it Carries Of the Patient; when ye disease is in the Muscles in Moveing ye Os Hyoides &c, Prespirations is free but Deglutition is difficult when it Attacks the Pharynx Deglution is very difficult Drink rehoming by the Nose oft going into ye Larynx & occasioning a very Violent Cough ye Fever Never Runs so high, here as prespiration is free when it happens in the Osophagus which is Seldom but From Extraneous Bodies, there are the Same Symps. as From ye Pharynx, but always much Greater, thirst than in  Proportion to ye Fever when ye swelling is Near to the Glottis, solids are more Easily Swallowed than Fluids a less Exertion of Muscles being Requir'd there, but ye most Common Species of it are when it Attacks the Tonsils & Usula & Velum Pendulum, Palati the Symps much ye Same as when the Pharynx is Affected & if ye swelling be Very Great but this not very Constantly the breathing is also Affected its attended with a Constant Defluxion of the Fauces with more or less pain in ye Externall Ear & sometimes Deafness & a sence of Crackling there it seldom attacks with Danger unless From ye Leus Venera the Swelling oft Supperates. & is very partial. Swelling sometimes Shuts up ye Tuba Eustachia & brings on incureable diseases, this Species is very Mobile & Seldom goes of without Affecting both Tonsils When all these Species happen together as sometimes Flushing of ye Face, Redness of the Face, Delirium,    32  Delirium & Coma are oft Fatal. Van Sweiten Guives a Full Account of Species. ... Angina Aquosa It Varies From a Serious Refluxion of the Fauces & happens successively on all parts of the Membrana beginning with Coryza going down to ye Tonsils & Uvula here is alongated & very Pale. The Inflamatory Angina ... It Carried of in 4 different ways by Resolution Suppuration Gangrene & Schirrhus X that particular Species of Angina a Quosa Called the Croup Mentioned by hume is Frequent in Scotland among Children, begining with mild Symps and Running to very Great Height, this admits of 4 Species again Inflammatory Malignant Spasmodic & Chronic of Angina Affecting the Organs of Deglutition these are oft From Hemiphlagia and here  Solids are more Easily Swallowed, perhaps it may Refer to this kind of Angina. Occuring oft at the end of Long Fevers and oft Supervening on Chronic Diseases which is Oft a Fatal Symptom. In these Cases ye Patient sometimes is not able to Swallow att all & food must be protruded down, theres an Instance of one by Willis who Lived Sixteen years in this Way Angina Arising From Spasms, a Sympton in Hysteric & Epileptic diseases but its only Temporary Clavus Hystericus and Catarrhus Suffocatus seems to belong to this but theres a most Exstraordinary Species of Angina which is Epidemic & arising From the Laxation of Vertebræ, this is Mentioned by Galen & Paulus Ogineteta which Scarselys Credible, theres a Species of Angina Mentioned by Van Sweiten, where theres a little Fever but Ulcerations Come on very soon its Particularly,  Describ'd by Aratous under the Name of Ulcer ofe Syrena, this is very different From the Angina Maligna & is Not attended with the same Symps. External Applications usually Succeed here ye Last Species of Angina is that Arising Schirrhous Tumors these are most Freqt, in the Tonsills & Gullet when in the Gullet they Occasion great difficulty of Swallowing & a sensible protrusion Above ye part where ye Obstruction is Formed Swellings of different Hinds Sometimes occasion this & ye I of different Glands particularly ye Theroid Something should be attempted here by Extirpating ye Tumor, we now speak in General of Angina Inflammatoria its Sometimes Carried of by a Copious Sweat & likewise by Diarrhea & in some Few Cases by Bleeding at the Nose or by Metastasis applied to the Extremities  and Precordia the most Common Metastasis applied Externally is to the Neck & Bronchia, this is oft Critical the Mumps are Frequently Carried of by the Translation to the Testes in these Metastasis before the Matter is settled in Another Part. the Patient is Extremely disordered ye Pulse Fluttering and Death seems Near at Hand, we hear an Angina only Affects Deglution its seldom Mortall but when it brings on Dystrea its always to be Lookd on as a Serious Affair their no Species of Inflamation so Mobile as Angina the worse Translation of it is to the Lungs producing peripneumony or a Corration of Purulent Matter independent of any Previous Inflammation in the Lungs, Sometimes it is Translated the same to the Head & generally Fatal there ...  Antecedent & procatartic Causes It Produced by all the general Causes of Inflamation mentioned above a Certain Construction of the Organs in some People detimines ye Inflamation to ye throat Keeping in new Plaister'd Rooms Often Occasion, Angina in which the Breathing is Affected which is always dangerous where the Angina Affecting ye Organs of Deglutition is Never Dangerous, the Use of White Hellebore Salanum, Mercury, & the Bite of a Mad Dog oft Produceth it, Schirrhus is is oft Produced by Astringent Cataplasms And by going abroad soon after Suppuration of Tonsills &, its sometimes Epidemic and Contagious ... Causa Proximata, Its the same with the Causa proximata of the Inflamation acting on the Organs of Respiration, and Deglutition. But,  besides the Inflamation Mentioned there are several Other Causes, as Spasms Palsys &c, Calculous Concretions in ye Extremities of the Salivary Ducts & in ye teeth which may produce Angina the Venereal Veins Next to ye Pudenda has a particular Connection with ye throat Angina is some Cases is to be Consider'd as the Cure of ye Disease, Being a Critical disposition, on the fauces Carrying off the Fever, Some N to the Salivary Glands the External Ear and Fauces which acct. For the Affections of these parts, Sometime a Rupture of ye Abcess in ye Lungs has been Mistaken for a Catarrhus Suffocacious... Methodus Medendi This depends on the Severall Causes. In general that of Angina Inflammatoria Where the Tonsills are only Affected and a Little Fever Bleeding is Scarsely Necessary, as the disease goes of of it Self in 2 or 3,  Days Where Fever & Plethora Bleeding is Proper where Respiration is at all Affected, large & Repeated Bleedings are Proper, the Common Direction is first to bleed in the Feet For the sake of Revulsion, but the same Quantity from a larger Vein in the Arm answers better than From a smaller one in the Leg, Bleeding in the Sublingual Vein, is apt to bring on defluxion of ye Fauces & is dangerous, it shou'd never be used till Plethora is taken off Previously the Jugular Vein, is best to Bleed from Especially Where its Affected. In Courses of this Disease Nothing Releives More than Cupping and Scarrifying. Especially in Cases of Externall Tumor but also where the Tonsills and Velum Pendulum are affected its very Safe to Scarrify these parts ... Purgatives are very proper in this Disease & shou'd be of a cooling kind as Creme of Tartar &c....  Glysters are very Proper & usefull for Revulsion. They are very proper too, with a view to dilution, & warm water may be jnjected every 3 or 4 hours -- The Patient When not Able to Swallow has been oft Nourishd by Injections Diet - shoud be diluent & Cool, the Patient should be kept as Erect as Possible, in Bed or out of Bed ... Ligatures on the Extremities These have been Recommended by Old Authors but the dont Answer at all Unless in Case of Sudden Hæmorrhage the may Serve here for Dilution, Frequent,    Pediluvia is very Serviceable... Blisters these are of use after Repeated Bleedings being Applied as near to the Part affected as Possible ... Gargles the use of these Require particular Judgment; in a slight Angina Without a Fever, any cool gargle Carries off the disease at the beginning as Black Currant Jelly when there's a Considerable Fever & great danger there's great danger in the use of Discutient Gargles, which, oft Repel ye Inflammation but Cause a Translation to some other Part wheres Theres more danger But Besides the Frequent use of these Repellent & Gargles has Oft produc'd Schirrus in Tonsils, when theres no Fever, & in ye Angina Aquosa Astringent Gargles are Serviceable, as Brandy or a little Allum & Sugar put on the Uvula, when Elongated, if there be No Inflamation there : Gargles in the Course of ye Fever & Inflammation shou'd be,  Perfectly Emollient... Acids these Rather tend to thicken ye Mucus & Contract the Orifices of the Excretions, the use of these tends Rather to Ptrotract the disease when the Mucus is very thick its best thin'd with a Mixture of Sal Ammon with Decoct Fici or Solut Caust Alkali greatly diluted, when Breathing is Affected Nothing Releives Breathing so much as Breathing over the Steams of warm Water The Patient Oft Cannot Use gargles when they are Necessary, here injections into ye throat may be Used... Emollient Fomentations &, Cataplasms, They help to take of ye Stricture from the throat but Care shou'd be taken that they Shou'd be Renewed & are Usefull particularly being applied when the Inflammation, is over and Suppuration begins...  Its oft Employd to produce External Metastasis to the throat by Sinapisms to the External Throat... Faces Canini this is only a Nasty Application of Volatile Alkalin Linimt. Volatil is much better & after the inflammation is Off it not only Produces a Redness on ye Neck, but a general sweat over ye whole Body Taken. the Suppuration seems to be Finished in ye Throat breaks of itself by Coughing Laughing &c, if the Sick Person be patient the abscess may be Open'd by a Lancet, some have ventur'd to guive a Vomit to Open ye Abscess but this is a dangerous Practice in Some Persons who are very Subject to Angina & the Tonsils being Scirruhus its proper to Extirpate them which may be done Safely. X an Angina affecting the Larynx ... when other Remedies Fail & a Suffocation is threatened, Bronchotomy is Advised. X Lect. XXX [illegible]  Many of ye Antients are very averse to it but it attended with Little danger & has Succeeded in in many Causes, on Several it has Faild because not us'd at a proper time, the Angina having before Produced Peripneumonia. wee Shou'd have Mention'd ye Angina Aquosa as very Common in Holland this does not Require ye Antiphlogistic Regimen, but its Cur'd by Repellent Gargles & Blisters the Angina Convulsiva is oft Remov'd by dry Cupping in ye Neck all kinds of Evacuations are hurtfull here & be Emollient Cataplasms & Fomentations in ye Neck. the Sepricupium is a safe an Gentle Antispasmodic & will be of Service here Other Applied Externally to ye Neck, & Balsamn, Anodynum Musk & Opium taken Internally may Resolve the spasm, Warm Acrids have been Found of bad Consequences here, and only Emollient Antispasms dies Applications are proper  Sometimes its only Symptomatic from ye Stomach & Remov'd by a Vomit, Angina at ye End of long Fevers & Chronic diseases is usually Fatall Where Schirrus is in ye throat that cannot be Reached it must be attempted with Mercury Bark &c, ... Of Angina Maligna Something like this was Mentione'd by Aræteous, but it is by no Means of the same Disease, this is a disease that did not appear in Europe before ye beginning of the last Century at which Period many New diseases First appeard in Europe, it appeard first in Spain it was Epidemic there, & very Fatal, it was only known in England within these 20 Years, & still Very Common in Scotland we Oft see Slight degrees of it but we shall describe it as of ye worst kin'd & when its Epidemic Symptoms. it generally begins with Alternate fitts of Shivering & heat, & other Symps, of Inflamatory Fever  is attended with a weak small Fluttering Pulse tho Generally Full & strong in ye beginning & ye weak Pulse usually Continue during ye whole disease its attended with a Remarkable Prostration of Strength, & Spirits Anxiety Sighing & oppression about ye Precordia Faintness heaving & Waterishness of Eyes pale thin Urine sometimes Turbid a white Moist Tongue which distinguishes it from an Inflamatory diathesis, but its Chiefly Distinguished by a very Florid Colour of ye Face Especially in ye Velum Pendulum theres interspersed with white specks or ash Coloured one which afterwards suppurate the Breath if Very Fœtid and Effervesence appearing on ye Skin going down to the Breast Arms & Fingers Sometimes Accompanies it & is Of Critical, ... It is attended with Vomiting & Purging Especially in Children, but this goes off on the Effervescence appearing, the Head is Generally affected & Commonly with an  Oppressive head Ach Sometimes with Silent Delerium & Coma the Countenance appears Bloated & Flushed all ye External throat Swells which is of an Odematus Kind & Pits & Pressure, Ulcers in the throat soon puts on a gangrenous Appearance and Marks of Putrefactions appear very soon Over the whole Body especially when the Disease is Fatall as Hæmorrhage from Various Parts these Marks sufficiently Distinguish it From an Inflamatory Angina it Found to be increased on Evacuations in Children who swallow Salliva it Oft brings on a Bloody Dysentery theres always a Remarkable Paroxysm at Nt. Which is Succeeded by a Sweat which some what Releives in some Epidemic ones a Sweat on ye 3d, or 4th, Day has been found Critical Deglutition is not injur'd in Proportion to the Externall Swelling ... Duration its Very Uncertain Usually is 4, or 5 Days,  Thirst in general is not great the sores Discharge a very Fetid Ichor both from the Fauces & sometimes From the Nose Occasioning a Constant Sneezing there always A great propensity to Hæmorrhage, & The Menses Oft Comes on then, theres like wise a heavyness of Voice When it goes of it leaves much Languor & Weakness, Frequently an Hectic Fever & its very Long before the Patient Receives his Voice And Deglutition the more plentiful ye discharge is by ye Morith its ye better in its Consequences it usually Seizes Childn and Particularly Girls these are also Weakend by Evacuations by Passions of the Mind &c, those of Strong Habits Usually Escape it or if Seiz'd they Get well over it, ...    34  it is Undoubtedly Infectious it Seizes at all time of the Year, but most Frequent at ye End of Autum & in warm damp Weather blood being drawn here is Oft of a loose Texture & Frequently doth not Coagulate at all but at First theres Oft a light Crust upon top but upon separating this the other appears disolved the Malignant Angina is always Accompanied with more or less of the Scarlet Fever ... Methodus Medendi, This the Common Malignant Fever accompanied with an Affliction of ye Throat So in ye Method of Cure we must attend to, 1st the general Fever, 2d, the Topical Affection, Bleeding woud seem from all ye Symps. Exstreemly proper but tis Found Very Prejudiciall, if Blood is taken in A Lage Quantity & Oft Repeated it heightons all ye Symps, Bleeding at First;  Seems to Relieve but in a Few hours all the Symps seem with more Violence Bleeding brings on difficulty of breathing. Cool Sweats Stupor. & stoppage of Sallivation, & a thickness of the Sloughs Cupping & Scarrifying are not attended with any good Effect; but when any Gangrene Comes on Scarifyin is Extreemly Necessary to give an opportunity For Applications & a discharge of Matter Purgatives also are found very Prejudicial and Even a slight Laxative has done Mischief but if ye Primæ Viæ be Foul tis to be Cleansed with a very gentle Laxative or Glyster Purgatives in the Course of ye Disease are found to thro in, the Effervescency which usually is Fatal but at the decline of the Disease a Hectic Fever Remains & here small doses of Rhubarb & Calomel are proper, these seems to discuss the Humors which Remain often in the,  Parotid & Milliary Glands, as Vomiting Very Frequently Occurs here in the beginning it may be encouraged by Drinking of Camamile Tea, but strong Vomits produce the same Effects as purgative Vomits however are oft Proper For the discharge of Salliva Swallowed by Children Blisters in this Disease then Blisterd part is apt to turn Gangrenous if this is guarded against they may be applied with advantage Cool Antiphlosistic Diet is improper, here ... Nitre is found Prejudicial & even Vegetable Acids are found to bring on Diarrhea diet Shoud be more warm & Cordial a Certain quantity of Red Wine is particularly Necessary to Support the Patients Strength & to support the Effervescence, it will be necessary to keep the Patient in Bed theres a Remarkable Cravin For Solid Food in Children, towards the decline of the Disease & there are no bad Consequences From it there are a variety of warm  Alexipharmic Meds. Prescrib'd Bark may be Joined with Myrrh Either in Exstract or Substance what is most used by ye Spanish & Italian Physicians was a decoction of Contrayerva, the Best is a Decoction of bark or Huxhams Tincture Acidulated with Spt of Vitriol. Bar in the substance is more to be depended upon but as the state of the Throat oft prevents this from being taken in Substance, the Decoction or tincture must be Substituted ... Volatile Alkali is an improper Cordial not as being Septic but on acct. of its Stimulating Nature it is proper to Gargarise very Frequently with something warm an Antiseptic. A decoction of Contrayerva Mixed with honey & Vinegar, or Elce a Tincture of Myrrh is most used this both Carries of the putrid Ichor & promotes Sallivation Injections go Further, down the Throat than Gargles, when ye Gangrene  has Come on, Decoctions of Bark with, Mil Ogyptiacum is the best Gargle, Vomiting this is best stop'd by Mint Tea with a little Red wine & perhaps a few drops of L. L. as the saline Julep is apt to purge and Cannot be quiven, with the Same advantages as in other Cases and is Likewise stop'd with an Anti Emetic Mixture taken in the state of Effervescence the same in purging, as also as tringents and Opiates (a Julep with Confect Japonic & L.L) Hemorrhages are never Critical & they are to be stop'd by a stringent External Applications, when From the Nose, Steams of Vinegar are best, if they Recur Frequently Bark is the best Mede, Strangury oft Comes on & is very troublesome, it is Removed, by Emollient Glysters & Emollient applications to ye part this disease oft leaves an, Hectic Fever Night Sweats & want of appetite & dejected spts. behind it. This is  best Remov'd by Bark & Elixr. of Vitriol, by Wine, Riding, Asses Milk &c, see Huxham Fothergill and and Wall. - Children in this Disease have a remarkable Craving for Solid Food which may be allowed,... Of the Catarrhal Fever, This is a Fever attended with Coryza, Hoarsness & a tickling Cough & a Distillation upon ye Fauces this is what is Commonly Call'd a Cold it begings with a Shivering. Coldness of the Exstremities Costiveness, & a Constant Stimulus to make Urine but this in a small quantity, head Ach languor increased appetite Thirst some Difficulty of Swallowing, something Stimulating about ye Larynx, & occasioning a frequent Spitting, much heat on the Nose & Faaces a frequent Sue sense of weight on the Breast the Fever worse towards Night, but remov'd at Morning as it goes on its attended with a dry Cough, Copious Discharge From the Nose & Fauces,  Disturbed sleep & head Ach in the Morning Heaviness of the head a Loss of appetite heat in ye Eyes Sniffing of ye Nose a stiffing & Redness of Fauces Hoarsness & Sense of dryness in the Trachæa a pain, oft under ye Sternum the Urine flame Coloured Blood with more or less a Beefd Coat, & with more Tenacity than in a sound State we mention this disorder here as Connecting Phthisis Pulmonalis & Peripneumony together in a Series when the Cough becomes loose & Expectoration thickens, tis a sign of its going off, when theres any degree of Fever it is Carried of by sweat Diarrhæ or a great Flow of Urine with a Sediment if it is improperly treated it oft ends in an Angina, sometimes in a Peripneunomony or Pleurisy especially if these disorder are Epidemic then it also sometimes Terminates in a Hemoptose, Tubercles are oft Found in the Lungs which may Remain there a long time witht. Inflamation,  A Suppuration, but on some future occasion, produce some Phthisis Pulmonalis, when once a determination, to the Mucus Membrana of the nose & Fauces & comes Habitual Slight Colds are apt to Affect that Part, on the Continent a Catarrhal & Petechial Fever a sometimes Combin'd but never here amongst ye Rest deformity may be Mentioned & all the depressing passions or any things that weakens the Vis Vitæ x. ... Predisposing Causes, Its oft Hereditary, those of a Narrow Chest long Neck of weak lax Habits and irritable Nervous Systems are very subject to it hence is oftnesst in Women & Children Occasional Causes, A Sudden Application of Cold, to the whole, Body not before Subject to it is apt to bring it on Ice it is very Common in this Island person who Change their winter Cloathes for lighter in Summer too soon are Liable to this disease a sudden Change of Cloaths & Exposure of ye Body when warm, to the Cold air, ...    35  and without motion is apt to Excite it Sitting on the Cold Ground wet Cloathes damp Exhalations From new wastid Rooms & new Plaisterd Walls any Northern Winds, act by a Sudden Absorption of the Moisture Exhaling from ye Body all these are Occasional Causes the more warm ye Body is in, Summer the more apt it is to take Cold, From some External Causes in ye Winter a particular stream of air applied to ye Body wen warm hence people are more apt to have this disease in Summer than in Winter for ye Body wilst warm is ye more sensible a sudden Stimulous from Cold occasions such a Muscular Exertion, as to produce a sence of heat & sweat as appears by the Cold Bath where ye Cold is applied to ye whole Body. & in Consequence of this Few People take Cold from the heat of it, all these weaken'd by Previous diseases, by Labour, by Evacuations, watching. Debauch Venery Passions of Grief, Fear &c are predisposed to take the disorder the strong & Vigorous & those that are in Constant Motion & under the Imple cense of agreeable Passions, seldom  taken Cold hence Neither Drunken or Mad People ever take Cold, it is more Common in spring and Autumn For 2 Reasons because when ye Greatest Vicisitudes of weather takes place & people are apt to Change from Summer in to Winter dress & has lately obtain'd the name of Influenza, its oft Epidemic & Contagious Spreading over all Europe, this skews that Contagion does not depend upon the state of the Air For during that time there must have been all possible Vicissitudes of weather when it attacks ye Nervous & Hypochondriac People its oft attended with Anxiety Dystrea & back all the Hypochondriac Complains it has a particular Connection with Eruptive Fevers & Especially ye Measles ... Proximate Cause This is an encreasd Secretion of Mucus in ye Mucus Membrane of the Nose Fauces & Bronchia together with more or less  Inflammation, of ye Membrane this is Commonly Ascrib'd to sudden stoppage of Perspiration, the dryness of ye Skin skews this actually takes place tho it may not be ye whole Cause of the Disease but may Contribute in some Measure to ye Plethora, so Evident yet it is not probable that such a sudden stoppage of perspiration which is only Temporary shoud produce this Especially as this usually made up by Urine tis Rather propable owing to a spasm on the Surface of ye Body determining ye Blood internally to those Parter hence those in when ye Circulation is most Languid are most subject to it, theres a dryness Commonly in ye Mucous Membrane before the secretion begins, a Cough arises from ye Irritation of this Secreted Mucus, which ever of these Causes we adopt tis Certainly Communicated by Sympathy from these parts over ye whole Body, the Mucous when first Secreted appears Saltish, but this Salt part is either absorbed or Exhaled for ye Mucus if allow'd to Remain sometimes looses this salt Taste & becomes insipid ... the theory of Frigorific Particles is not Necessary to be discussed, as being a very Frivolous Notion In time of Frosts, as ther's then a greater tension of ye Fibres people are  less apt to take Cold, & indeed Colds are most Frequent in damp Close weather which both Relaxes the Fibres & diminishes the Nervous Influence ... Method of Cure If the Person has good Lungs pehaps no application at all is Necessary & nursing a Cold is a very Pernicious Practice the Inflammation is to be Releiv'd by Bleeding. Evacuations, Diluent Drinks Cool Vegetable diet, Abstinence & Rest & topical Blister. 2d. Indication here is to promote the Secretion of Mucus, this is answer'd by pectoral Steams of warm water & Vinegar, a 3d Indication is to Correct the Acrimony of ye Secrete'd Mucus or to take of the Stimulus Encreas'd by ye Acrimony this is done by Oils, Mucilages, Honey, Sugar, and Opiates, a 4th Indication is to Restore an Equable Circulation to the Surface. this is to be Obtain'd From Repeated Gentle Vomits Diaphoretics, emollient Fomentations and Pediluvia. Let us now Remark particular  Remedies. As to diet when a Person has a Cold this is much to be attended to, all fermented Liquors are to be avoided a very great debauch Often Carries of Cold but it is a very dangerous, For if it fails in its Effect it may drive the Inflamation deeper and be apt to produce A Peripneumony. where there's no Febrile Spasm, Exercise & particularly on horseback is the Best Remedy People in Colds are apt to keep themselves very warms, which is a bad Practice for it Relaxes the Skin & makes it more Sensible to Cold & by Relaxation increases the Fever. Abstinence from all animal Food is Proper many People drink warm Gruell going to bed Sweeten'd with Honey or Sugar, if this is apt to produce a very great Sweat it is improper, & it induces as Temporary Fever it Relaxes the Stomach & whole Habit and hinders Digestion when long Continued it  may be proper to try it once or twice with Caution .... Bleeding oft is Necessary in this Disorder when it attacks the Lungs tis to be Considerd as an Incipient Peripneumony, here Bleeding is quite Proper & this Caution is very Proper to those who are Subject taken optoe but if then Fever is not high, shoud not be used unless the patient be of a very Plethoric habit as it has been found to protract ye Disease when there is any degree of Fever at the Beginning a gentle Cathartic may be used, but this is not to be Continued as they are oft found to Agravate a Cough, Oils & Syrup chiefly Pectorates are found Proper but both long Continued Foul the Stomach X undo The good Effects from them to Compensate for this Mucilages answer all their good Effects without any of the bad, Gum arabac is ye best, the Effects of all these seem to be to line the Membrane & to Secure it from ye Acrimony I may sheath these  these Acrid Particle too, as we find them do in, the Urinary Passages the most Effectual Pectorals are the Squills they are not to be used in the beginning as they Stimulate too much, & are to be used in small Quantities so as not to affect the Stomach too Much they are most Necessary when ye Cough is of long Standing & the Expectoration Viscid in a Recent Cold when the Secretion is thin they do Mischief this applies to Galbanum, and all Acrid Gums, Gum Ammonc, is most used. but this is more healing & stimulant than ye Rest and on that account improper in Case of Fever & when ye Mucus is thin (but may be weres a Torpor all these may be usefull as antispasmodics) what was said of Oils applies to Sperma Ceti there are a Variety of Pectorals used, as Pennyroyal. Elicapane &c, but I never Found ye good Effects usually ascrib'd to them one of the best is Juice of Liquorice, gentle Emetics at the beginning are  of Great Service as also in Chronic Catarrhs they are on of the most Effectual Meds, not only From their Cleasnsing the Stomach but From their Diaphoretcs Affects ... Blisters when ye deluxion is thin and Copious & ye Breast sore upon Coughing Blisters generally Releive all ye symps & seem to take of Spasm here & Evacuations do not appear to be their chief Use for Acrid Cataplasms without Evacuations produce ye same Effect, they are found here to bring down ye Pulse, Diaphoretics of every kind are much used on a supposition of their helping ye suppressed Perspiration, in generall they may answer but whilst ther's any degree of Fever they are bad, & apt to produce a Peripneumony.  36  Lect 40: But if ye Cough Continues after the Fever is gone warm diaphoretics may be us'd as dovers powders &c, in Recent Colds a draught of Cold water at going to bed is oft Prescrib'd, but is dangerous, when ther's any Suspicion of Inflamation, as in case of weak Lungs, the safest Diaphoretic is by Pediluvium or Semicupium but with water no more than Milk warm, small doses of Tartar Emetic is a safe & more Certain Diaphoretic than large warm Draughts, the Volatile Alkali is proper wheres theres no Fever those Meds. that are much Celebrated as Pectorats are Chiefly Antispasmodics, when a tickling Cough keeps the Patient from Sleeping. Opiates are the best Remedy and are perfectly Safe, when the Fever is not high & theres a tickling Cough it keeps of ye Irritations allows ye Mucus to thicken & the Excoriated Parts to heal & it promotes a Diaphoresis it is said to stop Expectoration, but this only for a short  Time tis improper where ye Fever is Considerable where there's a suspicion of local Inflammation & where ye Expectoration is Viscid, in this last Case Squills are best together with Gum Ammonc, if there is no Considerable Fever ye best Correcter of Opium is a gentle Laxative if the Belly happens to be Costive Aloes, if you are afraid of Checking Expectoration Squills is ye best Correcter & this and all asthmatic Disorders, it is best to guard against Cold by warm Cloaths. Rather than Sitting at home by ye Fire by ye use of Much Excercise by ye Cold Bath and Cold weather ... Cortex Peruviana is a good Meds, not a preservative, in those subject to Catarrhs & Defluxions at particular times as at Spring, it may then be proper to let Blood & to use abstinent and Spare diet. Tissot in his avis an people are to be consulted on this Head 1st. Let us consider some more general Kinds of Coughs as  arising From their different Causes, a Cough attends on ye Catarrhal. Fever on an Inflammations of the Lungs Pleura and other parts of ye Thorax.... 2d, a Cough too proceeds from another Cause & is purely Nervous, this is attended with no Expectoration & is usually Cur'd. Exercise antispasmodics &c, ... 3d, another Species of Cough arises From Calculous Concretion in the Lungs & Shirrhous Tubercles there 4th a fourth Species of Cough proceeds from Extraneous Bodies in the Lungs it seems absur'd in Savauges to Mention ye fictitious Cough of Impostors ... 5th is the Tussis Stomachia this is usually known by ye Symps. of a foull Stomach a Sence of Irritation here begins From the Pit of the Stomach and is attended with a Copious Expectoration tis not increasd by deep inspiration and is Frequent in Tertian Agues in Children & sometimes in Old People it has been Cur'd by vomits Alkalies Lime water, & Stomachic Laxatives as Elxr. Sacrum; & also those that Brace ye System all  Oily and Mucilaginous Remeds, are Prejudiciall here, Vander Linder First describ'd this Cough 6th, a Cough oft proceeds From a Defluxion on ye Larynx and Fauces the Matter Expectorated here has oft the appearance of purulent Matter I shall when on ye Peripneumony Mention the proper Marks of Pus, this Cough is Cur'd by Gentle Vomits Issues, Blisters & Exercise ... 7th another Species of Cough the Tuss is Convulsiva, but more particularly of this hereafter, ... 9th Species of Cough is that which attends on teeth and which probably be Referr'd to a Sordes in the Stomachs, gentle Momits are best here or Issues in the Arm which prevents the bad Consequences of Teething in every Respect Something to Chew in the Mouth is good then Which produces a great discharge of Saliva and makes them spit out ...  10th, a Cough sometimes attends Pregnancy Nothing Can be done here but Bleeding Opiates and a loose dress... 11th, a Cough also arises From Various other Affections as Polopy in ye Lungs and Heart & Tubercles in the Lungs... 12th, it sometimes happens in Case of an Hemoptoæ 13th. another Cough is ye Tussis Arthritica which is Relievd by nothing but Coming on of the fit,... Of the Tussis Convulsiva, This is usually a dry Cough especially at the beginning afterwards a little Viscid Mucus is thrown out, tis an incessant Cough till ye patient almost Entirely looses breath ye inspiration is fetched with a great deal of difficulty, so that if this Hooping or Chin Cough is ever heard, tis easily distinguished theres commonly a coloness in the Exstremities Costiveness pale Urine & always  More or less determination to ye head & Lungs Certain symps. arise Manifestly From this determination. the face is always Flushed but sometimes becomes livid & ye Eyes Red & prominent this Cough sometimes occasions a Rupture of the Lungs in adults & Epileptic Fits in Children it sometimes brings on an Apoplexy, Palsy, loss of Memory & Judgment, it Occasions an Hæmoptic & Peripneumony with all its Consequences, oft; during ye Cough theres an involuntary Emission of the Fœces & Urine... Prognosis, as now Managed tis seldom Fatal to Children who have got over teething and have good Lungs, it is dangerous when it accompanies the Measles tis not Oft attended by a Fever & the Fever is always short, one of ye best symps, & the Child vomiting at the end of the Fit, after this  Every fit of Coughing is terminated by vomiting ye Duration is very uncertain it always Continues some weeks & sometimes Months tis oft Carried of or relievd by Bleeding at ye Nose it goes of as summer advances tis oft Epidemic & Contagious, it attacks persons once in their lives, the theory of which is not known its of Epidemic with Agues tis oft Periodical coming on at Certain hours of ye Day this & the Vomiting shews that it approaches nearest to ye Tussis Stomachica than to proceeding From an Affliction of ye Lungs Indication of Cure 1st, to migitate the Violence of the Symptoms .... 2d, to shorten there duration the Remedy most us'd is Bleeding if ye Child is Plethoric if the Face is Red and turns Livid if an Epilepsy Comes on it is always proper, but if Vomiting Comes on theres no occasion for it, as the disease is usually  attended with Costiveness Laxatives Migitates the Violence of the Symps, and Carry of the Collection of Mucus in ye stomach, Sydenhams says that nothing but bleeding & Cathartics are of Service in this disease gentle vomits also carry of the Mucus in the stomach and have the Effect of bringing on that natural Vomiting which is so serviceable blisters oft Mitigate ye Violence of the Cough & also ye Pediluvia but the last is Constantly to be used as tending to Relax too much Pectorals are very insignificant & even do Mischeif one of ye best Remedies when the Chin Cough is run to any Length & without Fever is the Bark Fear has oft Curd the Chin Cough & any thing that acts powerfully upon the Nerves but whilst theirs a Buf Coat it does no good that is ye Bark must either has no Effect or acts in ye same way as Bark,  Dr. Morris in the last volume of the London Physic Essays Recommen'd Caster & Bark it is oft Necessary here to have recourse to opiates when thers a thin sharp acrid Defluxion on the Fauces if the Fever is gone it may be used but its less Effectual in this than any other Cough toward the end of the disease Mercurial Cathartics are proper a quantity of worms being oft found in ye Alimentary Canal when ye disease has run on for many months Cold Bathing is found of Service here if theres any suspicion of a Topical Inflammation many specifics are recommended for this disease but tis scarsely worth while to Mention them Cantharides taken internally were once in couge, & given alone with Camphire which is a good Corrector of Cantharides Millipedes are much Recommended by Dr Cheyne but they seem to have but little Effect, the Diet shoud be very Cool Especially at the beginning after it has Continued for some time & ye Inflammatory Diathesis is gone off Exercise & change of air  is of Great Service Authors, For a description of the disease Hoffman is the best tho his Meds, are not to be recommended & indeed this Mark upon him will hold in general Vide Flux: De: Morbis,... Lect 41st, Of Inflammatory Diseases of the Thorax the most common is ye pleurisy & peripneumony but besides these inflammations of the Diaphragm Mediastinum & Percardium the tis difficult to seperate these there are instances of peripneumony seperated from ye Pleurisy yet it appears from Morgane that a Pleurisy seldom happen without a Peripneumony, tho there Oft a Peripneumony with a Pleurisy some, Extend to one Inflammation of ye Diaphragm &c I shall therefore treat of them all together Definition of the whole, they beging with a Cold & shivering which is succeeded by a Fever 1st, the Pleurisy this is distinguish'd into 2 Kinds, 1st of true, 2d, ye Spurious,  In the true pleurisy theres always an accute Pungent pain in the side greatly increas'd by inspiration it shuts to ye Back & Clavicles and is attended with Cough sometimes a pain begins with ye Fever sometimes it doth not Come on till a day or two after & more Rarely preceeds the Fever, tis attended with a hard pulse ye pain is Releivd by a tight bandage Round the Breast it happens more Freqt in the Right side than in the lift but when in ye Left tis most dangerous in ye Peripneumony theres a true Dystnæa and not a Fear of Breathing From Pain the pain here extends to the Clavicles ... Diagnosis it is distinguish'd from a Peripneumony by a pain in ye side by ye hard pulse and Difficulty of Breathing arising rather from pain & Stricture ye Spurious Plurisy has the same quick hard Pulse & is only distinguish'd from the other by a great soreness to the Touch & sometimes by a Protuusion on ye  Part, by a pain in Inspiration but not oft a Cough Inflamation of ye Mediastinum is distinguishd by being attended with a sharp Pain in the Shoulder shouting down the spine and from ye Vertebræ to the Sternum attended with a Dystnea, dry Cough and a great anxiety this was first describd by Airsen, ... an Inflammation of ye Pericardium is known by the pain being very deep in ye Chest; attended with great oppression & anxiety & by a palpitation of the Heart & an irregular Pulse tho this last oft attends other Inflammation of the Thorax a very common Symptom too is freqt. Faintings the True Peripneumony is known by the breath being very hot in Expiration by a Cough by an oppression & sometimes with an Arthopnea or Inability to Breath but in an Erect Posture dull pain in Breathing with a sence of Stricture but when the  Externall Membrane of the Lungs is affected the pain is very Pungent there are great Flushings of ye Face a Prostrution of ye Eyes sometimes delerium or Cama in Consequence For an accumulation of blood in the Lungs the Pulse is generally full & soft but sometimes small soft and irregular all these symptoms are very Violent when both lungs are affected together and here theres a more Reasonable Prostration of Strenght and anxiety than in any other disease except a putrid fever the Cough at First is always dry but afterwards has a more Copious expectoration sometimes ye Expectoration is bloody, hot breath a desire of Cool air, a soft Pulse a particular Dystnea arising from Oppression Chiefly distinguish'd a peripneumony, where the substance of the Lungs is Affected but as the substance is seldom Affected without the Externall Membrane in some degree the symptom will be confused A Peripneumony Notha is no Distinguish'd  But by the Febrile symps, being much less, & attended rather with oppression than Pain and the marks of a Catarrhal Fever it is best distinguished by ye season of ye year Habit and Age of the Patient ... A Paraphrentis is distinguish'd by a a pain in ye Regim of ye Diaphragm, between the Cartilage Ensiformis, False Pibs, and Vertebræ of ye Back here theres a Convulsive Pain in Respiration attended with a Sneezing & hiccup very oft without delirium this is Reckoned the pathgnomonic Sign of this disease & thence it hath obtain'd its Name the patient Endeavours to Breath here by an Elevation of ye Thorax & has ye pain much increased in passing the Fœces & urine, its attended with an Affection of ye hypochondria & with a resius Sardonicus ... the Dyaphragm has been  Oft Found inflamed in who died of a Perpneumony without any of these symps, when attended with a delerium tis distinguish'd From a Phrenites by a quick and difficult Breathing there are other pains Resembling the Pleuratic Pains which arise from Flatus here there is no fever & ye pain is less Fixed ... In worms sometimes ye pains are attended with Fever without any affection Of ye Plura or Lungs nor can these be distinguish'd from Pleuratic Pains... these diseases are Carried of by different ways sometimes ye Inflammation is Resolv'd which is skewn by a free & Copius Expectoration, this begins about ye 3d day & in a Peripneumony is oft Bloody which is Rather a Favourable sign, they are also frequently carried of by different Evacuations as by a Flow From the Hæmorrhoidall Vessels, a flow of  Turbid Urine with purulent or bloody Sediment a diarrhea sometimes Carries of a Peripneumony but in general is rather unfavourable & symptomatic oft stopping the Expectoration tis sometimes carried of by a Copious sweat at others by a Critical Metastasis to ye Limbs either with or without abscesses, suppuration of ye Inquinat glands axillary & parotid glands sometimes terminates this Disorder, as to the shoulders this usually happens about ye sixt day... Bleeding at the Nose is oft Critical but if on ye 5th day, & is black & Viscid tis a Mortal signs, a flow of ye Menses has been known to carry it of an Eruption of hot red Pustules on the Breast has been oft Found Critical theres a greater or less degree of those diseases before they are Mortall,    36  Critical Days have seldom found even by Hoffman in these Diseases they also Terminate in Suppuration this is known by slite irregular Shiverrings, a Remission of Pain but ye difficulty of Breathing still Continuing by a hectic Fever attended with flushing of the face by ye Pulse being small and weak & a dry Cough which is Encreas'd by Motion when theres a Suppuration on one side a greater difficulty of Laying on the sound side then on ye Affected one takes place sometimes its attended with a Regular Quoditian one Tertian Paroxysms, the Consequences of Suppuration are Various on its bursting theirs an immediate Remission of all the Symps, but if it burst within the Lungs it may Suffocate the patient at once when it brakes without the Surface of the Lungs it forms an Empyema of wch. hereafter. Sometimes it is Contain'd in a Cyst; & then may be Expectorated along with its Cyst; sometimes it Corrodes the Neighbouring Parts & produces  A Phthysis Pulmonalis, sometimes the matter has not gone of in any Sensible way but is Reabsorbed into the Mass of Blood and Carried of by some Evacuation as purulent Urine & Purulent diarrhea another Termination is by Schirrus & Abrasions of the Lungs to the Pleura, a Schirrus is Commonly known by a dry Cough Remaining afterwards and increasing on Motion some dystnæ and ye Febrile Symptom going of without marks of Suppuration it oft leaves Tubercles in the Lungs which Continues for many Years without any other disturbance than a Slight dry Cough & perhaps dystnea thus you see a Peripneumony, a Foundation for the Phthsis Pulmonalis that doth not take place for some Years, this disorder sometimes Terminates in a Gangrene when it is attended with a weak Small irregular Pulse & Coldness of ye Exstremeties & cold Sweats. Delerium and Subsultus Tendinum with a Facies  Hypocratica. the sides sometimes becomes quite Livid, the Pleurisy and particularly the Spurious Pleurisy oft Terminates in external suppuration, there Can be no dependance upon the pulse in these diseases Women are less Subject to them than Men, but they are usually more Fatall to Women Especially during Pregnancy the same Observation also Extends to old Men & Children Lect. 42d, - Occasional Causes, It is more Common among ye lower sort of People & those who have had ye disease once before, are always more subject to it again in general whatever Produces an Inflammatory Fever, & particularly the Catarrhal is apt to produce a Pleurisy, its oft Caused by over heating with Exercise & then drinking cold & acrid Liquors. Sometimes in Consequence of Violent Passions, as also of external Violence & oft of suppressed Evacuations, it prevails most in Cold dry Countries, is sometimes Epidemic but not Contagious, even some particular speices of local Inflammation are Epidemic but I,  Never hear'd of an Inflammation of the lungs being so, it is sometimes produced by a Metastasis from an Angina &c, sometimes it is in Consequence of Worms by which there are Instances of a Pleurisy recurring Periodically their is a species of Peripneumony owing to the Gout being from the Exstremeties it is very Frequent in all Countries Subject to Vicissitudes of Weather, in dissection theres a Particular appearance mention'd by Morgagni of a Solid Membranus Crust Found sometimes in these parts, the Lungs sometimes appear Solid with all the parts fill'd up... Proximate Cause Boerrhave imagined that all Inflammations arose from Obstruction, by Red Globules getting into serous Vessels and the serious Fluid in to Vessels of a smaller size, &c, but Obstruction in general does not of it self produce Inflamation as appears From the tying the Naval String & other larger Vessels, Schirrhus  Oft Exists too without Inflammation we find an increas'd impetus & great accumulation of the fluids in the part Affected with inflammation what determines the fluids their is a Stimulus or Irritation wether from an external or internal Cause if this irritation is Considerable it stimulates the Heart itself and produces an increased Circulation over the System if it is very great it Causes an Effusion of Blood into ye Cellular Membrane, the Effect of Stimulus is always to encrease the Secretion of the Part Obstruction is not then the Proximate Cause of Inflammation there are many Hypotheses, Boerhave suppos'd Pus to Consist of the Solid Matter of the Part; but then there must be a greater Loss of Substance then we find to take Place De Haen supposes that purulent Matter previously in the Blood, & that there was no Occasion for previous Inflammation it never Exists in  the Blood but from Reabsorption & is always in Consequence of Inflammation Mediately or immediately, yet it appears that theres a Matter in the Blood like Pus, which seperates on Stagnation as shewn, by Dr. Pringle but I still suppose that Pus is secreted by the Vessels now Chang'd in Consequence of Inflammation, there shou'd be a large discharge of Sarum to Secrete this Purulent Matter of Dr. Pringles, but this doth not appear this Purulent matter seems to Consist much of the Nutritious Matter of the blood, since a discharge of it weakens the Patients strenght much, it was much disputed wether peripneumony arose from Inflammation of the Air or ye Blood Vessels but no facts Can be adduced on either side of the Question, tho I think more are of Opinion that it proceeds from an Inflammation of ye air Vessel themselves  Method of Cure In treating the Pleurisy we find on the Blood a Beef Coat, to a high degree but in some Epidemic Pleurisys the blood appears disolved & the Patient doth not bear bleeding but in general ye Indication of Cure in a Pleurisy are ... 1st to take of the Inflammatory diathesis ... 2d to Releive the Topical Affection ... 3d to assit the Critical Effects of Nature, the most Effectuall Remedy is Bleeding when the disease arises from an external Cause & it is always Necessary, Especially as the disease usually attacks strong Persons, Much depends here on the suddeness of the Evacuation. there have been great disputes among ye old Authors about the Propriety of Bleeding in a Inflammation of different Places it is now agreed that were ever the  Pain is Bleeding is proper it doth not stop any Crisis & nothing more promotes Expectoration in the pulmonary Fevers than, Bleeding let it be observ'd that on the 4th or 5th Day, if the Expectoration be free & bloody Bleeding is improper if the symps, are violent You may Bleed at anytime, otherwise not Neither the flow of Menses or Lochia shoud prevent Bleeding if the other symps. Require and it stops neither of these Evacuations the Rule in this Case Concerning the Repetiti of Bleeding is to be drawn from the appearance of the Blood Rising of the Pulse and Releif of the Symps, if the Pulse sinks after it, its a sure sign that Bleeding was improper  No Rule Can be guiven with Regard to the quantity of Blood, But such large Evacuations as were Formerly used seem unecessary in general, Lect 43d, its better to take away a large quantity at once than at different times, it is not proper here to bleed. Adanami Deliquiam, because theres a great accumulation of Blood in the Lungs the Pt. is oft more apt to Faint in the first bleeding than Afterwards the Buf Coat doth not always appear at the first bleeding but doth sometimes when Repeated, it is a Common Rule to bleed till this Buf Coat disappears, but very Erroneus For the blood will always have it, such large Bleeding as was formerly used are thrown a Side since Blisters were introduc'd, it was long disputed wether we shoud bleed in the Arm of the same side or the opposite Side to the Part Affected, When the Circulation was known it was Esteem'd a Matter of no Consequence in what part or vessel we bleed tho this last,  is now though Erroneous, and it is agreed now as the best Method to bleed on the same side the Pain is but in Epidemic Pleurisies the Pt. can not always bear bleeding Especially in damp Climates I never saw any Epidemic Fevers which were attended with local Inflammation that Required bleeding Silvius was a great Enemy to Bleeding from his notion of all inflammations Proceeding from Visicidity, A symptomatic diarrhea oft accompanies a Pleurisy & is of bad consequence Cupping & Scarrifiing between ye Shoulders & upon the side oft Releives much & Huxam applies Blisters to the Part where he had before Scarrified but I never saw this the use of Purgatives is denied by all Authors in those Topical Inflammations where Expectoration has Come on these Evacuations are indeed improper but before that I don't see Apriori the reason of this Practise the Belly how ever is to be kept open by Emollient,  Cooling Clysers, but in Epidemic Pleurisies of the Rheumatic Kind proceeding from Sorosa Colluvies wear the patient Cannot bear Bleeding. Purgatives have been Serviceable Sydenham in the Peripneumonia Notha Gave a Purgative the 2d. day after bleeding but this is not practised Blisters on the part tho Recommended by St, Theodore Mayerne &c as very usefull, have Only come into practise within these 20, or 30 Year. After bleeding they are the best Remedy Dr. Pringle Bleeds after the Blister is put on if the Cantharides have not yet began to Eat, Blisters are particularly serviceable in the Spurious Pleurisies were the Intercostall Muscles are Affected. Sinapisms were used very Antiently, as a Pleurisy is carried of by a Translation of the Morbid Cause, to the Limbs. & as a disease oft arises by means of A Repulsion From the Limbs, this points  out the Propriety of blisterings the Legs & this is of the most service next to Blistering on the Side there Can seldom be any Hesitation about the propriety of Blisters in these Diseases the pains often dont Remit till the Blisters are taken of the Diaphoretics of the Warmer kind are very improper the use of the Vol, Alk, is now abolish'd & the only Proper Diaphoretics are the Saline Mixture & the Spt Minder it oft answers well to encourage a sweat by Mustard Whey & Spt. Mindereri these Diaphoretics shoud be Joined with pectorals & the best Pectorals are those which will take of the Spasm from the Skin the Emulsio Oleosa answers very well to promote Expectoration, & a Diaphoresis. All Expressed Vegetable Pills, given in quantity can be of little use and Serve only to foul the Stomach, if they are to be given they are better mix'd with Mucilage than Yolk of an Egg. Vomits only takes place  in the Epidemic Pleurisies from a Serosa Colluires & in the Peripneumonia Notha it is Oft Necessary towards the End to discharge Viscid phlegm. Various Meds. have been Celebrated for Curing these disorders as Hermes, Minereal & Antimonials, Oxymell Scillit with Mustard whey is the best Pectoral No disorder Requires so plentifull a dilution the diet shou'd be Cool antiphlogestic The Drink Barley Water & when expectoration Comes on is of Service Mix'd with simple Oxymel, Acids Seem improper when the Cough is sharpe but after Expectoration Comes on are Very Serviceable Especially if it be Viscid it is Reckoned proper to keep the Pt. in bed and in a warm Room but this is entirely Theoretical.. on the Contrary the Pt. shoud get out of bed every day & theres no more Occasion for warmth here than in any other Inflammation Many Specifics (as the  Seneka Root has been much Recommended and used with much Success in America & Maybe of Service here) are Recommended by Serveral Authors but not worth Mentioning, as Goats Blood, Tarr Water Virginian Snake Root both in Powder & decoction but we Ought to trust to Bleeding Pletiful dilusion a Topical Blisters De Haen has introduced ye Practise of giving large Quantities of Oils which he ads takes of Nausea wereas they are most apt to induce it, as to external Applications, we oft find great Releif from Emollient Fomentations, as a Sollution of Soap in Milk & Water & Camphorated Oil used (to Relax and diminish the Morbid Cause) Externally but these if they fail to Releive at once commonly do Mischief. sometimes Violent pains of the Side Continue after the Fever is gone; An Opiate Clister is here  Recommended by Huxam Pediluvia are of great service in Releiving the Breathing and Promoting Expectoration and when the Pains are Violent. I shou'd think a semicupium shoud be of Service... Lect 44. many are great Enemys to unctuous applications to the part as Checking perspiration but theres no Reason to dread this tho these are of little Consequence it is of great Service to breath over the heat of warm water in a peripneumony, which both Releives the breathing & promotes Expectoration, where there Expectoration is very Viscid a Little Vinegar may be added. A Mixture of Sacch Saturni with Linseed applied to the side is Recommended by Boerhaave but likely to have Restringent & Repellent Effects, and is dangerous, as to Opiates they  they are much Comdemn'd in all inflammatory Fevers in general when the Fever tis Violent, tho some symps. Require opiates yet they have a bad Effect but if a Pt. has been Largely Blooded and these Evacuations dont Releive the Pain we shou'd then have Recourse to Opiates & I have never seen bad Effects From them when used in this manner, Opium takes of Irritation and Releives ye Cough & pain & takes of Spasm, as to it Stopping Expectoration when the Fever was Considerably Abated, I have thought it Rather promote Expectoration, this practise is most Us'd by Huxam and Carried to the greatest, Height; ~...  40  It has been propos'd to guve milder Opiates but these are not so determiate in their dose Squills is the best Corrector of Opiates, or in some cases Sat, Vol, C.C. De Haen has given opiates along with his Oil, Nature often attemps a cure by different Evacuations, & when she points this way she shou'd be asisted we may know wether a diarrhea is Critical or Symptomatic by the Releif it gives to the Symps; in a Spurious Pleurisy, Abscesses form Externally & these are to be encouraged when the matter is formed more Internally it may be proper to make a deep Incision that it may not break there these diseases also Terminate in Phthisis Pulmonalis Authors the best are on this Subject Boerhave Van Sweiten. Huxam Pringle, & a very ingenious Book wrote upon this Subject by Dr. Treller... 40  Of the Phthisis Pulmonalis This Springs from a Variety of Causes but usually from some preceeding Inflammation it is defind to be a Waisteing of the Body with a slow Fever, Cough & Dystnea and generally a purulent Spitting but not always when Streated on the Catarrhal Fever- is said that if the Lungs where then Affected it was to be Considered as a Incipial Phthisis Pulmonalis the symps are various in different Periods as dry Cough Shrill Voice a Particular Hoarsness, a greater Irritability of the system a sense of Oppression in the breast; a difficulty of breathing Especially upon walking up any Ascent; are usually the first symps, if these Continue & a Fever comes on, there is Reason to Suspect, that Affection of the  Lungs is tending to inflammation the Hectic Fever here has two Exacerbations in 24 Hours this is attended by Circumscribed Flushings in ye Cheeks whilst the rest of the face is pale Along with this theres oft. a flushing in the Palms of the hands & soles of ye Feet, in the Morning theres usually a Clammy Sweat on the head & Neck spreading over ye Body theres Reason to suspect Tubercles if there is a difficulty of lying of one Side, an Hæmoptoe sometimes attends it the surest proof of Matter in the Lungs is purulent spitting for other symps. only skew Tubercles, the common mark of Purulent Matter is its Fœtid smell when thrown upon Coals but thick Mucus has ye same fœtid smell another mark is its sinking in water but this depends entirely on ye Air Bubbles collected in it & Mucus  too may sink in water if depriv'd of these it is best known by the Smell & better to be Conceiv'd than Expressed Mucus in general but not always A Common attendant on an Ulceration of the Lungs is a remarkable Clearness of the Tongue a surprising transparency in the Tunica Conjunctiva with some degree of blue Colour ye spitting is very various. sometimes sweet sometimes exceeding Salt; so as to erode ye Trachea. Largnx & bring up some blood by this Means & sometimes it is very Fœtid. Towards ye end of ye Disease a Colliqutive Diarrhea Comes on Expectoration Stops and the hair falls of People in it seldom apprehend Danger, for they are in good spirits & theres but little sickness and pain those troubled with Hysteric Complaints Affecting the Stomach, are more apt to imagine themselves in a Phthisis Pulmonalis than those who Really are many persons may have endurated Tubercles in ye Lungs  Giving a dry Cough, Stricture on the Breast Dystnea without a Phthisis Pulmonalis, but in Case of Catching Cold they oft fall into one, it is surprizing that whilst people are Everyday Spitting up their Lungs they very seldom spit up their Blood some have an Hæmoptoe at the beginning & those troubled with always know when it is comeing on by a feverish Paroxysm but when once a purulent Expectoration Comes on it is seldom or never Observ'd a swelling of the hands & feet is one of the last symps. in a Phthisis Pulmonalis and it is said to be on ye Side opposite to the Lungs affected, sometimes this disease is Carried of by a discharge of Purulent Urine tho this happens Rarely it is also Carried of by a Metastasis to ye Lungs among bad signs are a universal Itching and Pustulary Eruptions on ye Skin it is said that this disorder is incurable always when there is an open Ulcer in the Lungs but this is  Erroneous as Evidently appears from dissection there are instance of its being Cur'd by a Mania a Woman in a Phthisis too is often sav'd by pregnancy & the Child Oft very Healthy the spring & autumn are the most unfavourable Seasons for Consumptive People ... Predisposing Causes, It is Certain that it is heridatary disorder but not from an Acrimony of ye Julles but a particular Conformation of the Parts, when Hereditary it most commonly appears frome ye Age of 16 to 36 tho disposed to it have a shrill Voice Hoarsness soft & white skin thin habit Elevated shoulders narrow Chest long Neck, deformity Redness of the Cheeks a peculiar delicacy of Complection, great sensibility a Quickness of parts those of Scrophulous habits are always Predispos'd to a Phthisis Pulmonalis so are those that are apt to have a gross spitting in ye morning  Occasional Causes, These are all that are Form'd in a Catarrhal Fever & Pleure Peripneumony also whatever induces an Hæmoptoe or Asthma Calculous Concretions in the Lungs gives Rise to it sometimes Venereal Complaints and drying up of ulcers a stoppage too of unusual Evacuations & Eruptive Fever Oft occasion it, one of the Most Occasional Causes among Women was the use of Stiff tight Stays along with the Predisposing Causes if a Person used a Rich Stimulating Diet with little Exercise it oft bring on a Phthisis ... Causa Proxima I have Mention'd Infarction & Tubercles of ye the Lungs as Oft laying a Foundation the Inflammation & suppuration of these occasion a great Variety in ye Nature of ye Disease,