t.t:.. -:*.: fe-7 Surgeon General's Office MteUWte r> - 1 n<>. 2,£, &JO...0. ^P PRESENTED BY ^■&r»ee,:, ZO'CQZ2"J^'0QZCCZjZCjZCZQ'C, »■ r * ■ •• .* \ N 2$:]3G2 ftr*i F«a *^'C? __^. ^f- » I >- TIM -~ Hf*7 <^i 72> / ^ A VIEW SCIENCE^ LIFE ; ON THE PRINCIPLES ESTAB LISHED'IN THE ELEMENTS of MEDICINE, OF THE LATE CELEBRATED JOHN BROWN, m. d*j WITH AN ATTEMPT TO CORRECT SOME IMPORTANT ERROR9 OF THAT WORK. And Cafes in illuftration, chiefly felefled from the Records of their Praftice, at the General HofpUai, at CaUutta. By PFILLIAM YATES fcr CHARLES MACLEAN. TO WHICH IS SUBJOINED A TREATISE On the Aflion of Mercury upon Living Bodies, and its Ap- plication for the Cure of Difeafes of Indirect Debility. AND A DISSERTATION ON THE SOURCE OF EPIDEMIC and PESTILENTIAL 1 DISEASES; - IN WHICH IS ATTEMPTED TO PROVE, BY A NUMEROUS IN- DUCTION OF 7ACTS, THAT THEY NEVER ARISE FROM CONTAGION, BUT ARE ALWAYS PRODUCED BY CERTAIN STATES, OR CERTAIN VIC ISSITUDES OF THE ATMOSPHERE, ———I By CHARLES MACLEAN, of Calcutta-.- c. DOVER, N. H. '•;;/£/ rc ^ Printed by SAMUEL BRAGG, jun. ^«'^:l:r.^,V 1801. MHmvt* A VIEW OF the SCIENCE 0F LIFE ; ON THE PRINCIPLES,ESTABLISHED IN THE ELEMENTS or MEDICINES. OF THE LATE CELEBRATED JOHN BROWN, M. D. ^PITH AN ATTEMPT TO CORRECT SOME IMPOR* TANT ERRORS OF THAT WORK ; AND,, CASES IN ILLUSTRATION, CHIEFLY SELECTED' FROM THE RECORDS OF TK1.IR PR ACTICE, AT THE. CtNKRAL HOS- PITAL, AT CALCUTTA. BY WILLIAM YATES fcf CHARLES MACLEAN. *' There are fome modern Pra&itioners, wno declaim *£■> fl " medical Theory, in general, not eonfidcring, that to tliak " is to theorife ; aBd that r^o one can direcVa Method of « Cure to a Perfon labouring under Duesfe, wiihout think- a ;ng,—that is wiihout theorifing ; and happy, therefore, " is the Patient, whofe Phyfician poffeffes the bell Theory." DARWIN'S ZOONOMIA.;--PRF.FACF, P. 2. D 0 V E R : 1801. f PREFACE. ■.■■s&z&atemaismt X XAVING applied to practice, in the General Hofpital, at Calcutta, thofe Medical Principles, vulgarly known by the name of Bru- nonian DoBrine ; and being convinced, from the Refult, of their Conformity to truth; we think. it may be ufeful to attempt to promulgate the Doctrine in India, where it feems to be almoft wholly unknown, and to call forth the attention of medical men, to a fubject, fo worthy of invef- tigation. Some Cafes are annexed, in illuftration of the mode, in which, according to our ideas, the prin- ciples of the doftrine fliould be applied to practice^ To thofe who cannot be acquainted with the Circumftances, it may be proper to explain, why two Names appear to this Publication. Having Carried on our practice together, in the General Hofpital at Calcutta, and having by chance dilcov- ered, that each of us entertained a defign of at- tempting to promulgate the doftrine of Brown, with fome modifications, in India ; we thought it might be more conducive to the end in view, to confider the fubjeft conjointly.—The refult is jiow fubmitted to the public. William Yates, Charles Maclean. , '\ ADVERTISEMENT. HE who abandons principles in deference to popular clamour, and he who perfeveres in error in fpight of conviction, may indeed obtain a momentary celebrity ; but they are equally unqualified for the promotion of Science. As truth, not an indijcriminate offerti'on of any doctrine, is the object of this publication, Members of the Profefjion, and others who may be fo inclined^ are invited to communicate facts, or obfervations, whether they may tend to confirm, ok refute the prin- ciples which it avows. The Communications thus received, will be pub- li/Jied, with comments, with or without the name of the Author, as may be mofi agreeable to himfelf. Papers on this fubjett, addreffed to Mr. Mag- lean, to Mefj'Crs Thompson & Ferris, PrintersY Calcutta, or to William Young, Bookfelkr3 Philadelphia, mil be attended to, INDEX. Pagr. .---- Anomalous, in its fymptoms, occuring in a patient of plethoric habit, with a peculiar. flownefs of pulfe, cuied by opium and mercury, - - - - 69 ---- Peripneumony, in an advanced ftage, treat- ed unfuccefsfully with mercury ; in which uncommon adheftons, &c. of the thoracic vifcera were found upon diflection, - 72 ---- Hepatitis, treated unfuccefsfully with ©pi- um, mercury, and other ftimulant powers, with a defcription of the appearances up- on difle&ion, - - .77 £. INDEX. Page J CASE, Dyfentery, treated unfuccefsfully, with a defcrrption of the appearances upon dif- feaion, . - - - 79 ,____ Dyfentery of high degree, treated fuccefs- fully, - - - 86 ____Fever &c. in which a great quantity of mercury was ufed, fhewing that falivation ariics from the fubdu&ion, or, irregular application of that medicine, - 9% ,----. Fever cured by mercury, &c. in farther il- luftration of the mode of applying that medicine, according to principle, - 96 'CONTAGION, not the caufe of peftilential difeafes, -. - " - 26 DEBILITY, direc*,—difeafes of, - 2629 -----------Cure of, - .-.->■ -. 29 ■---------- Indirect.,:—difeafes of, - 29 33 ,----------Proper.ion of, to difeafes of indi- rect debility, 29 33 —-------■— Difeates of warm climates, with- out exception, of this ftate, - 30 (----------Cure of - 30 32 .DISEASES, definition of, <" - 24 ..----------r- In what refpe&s they differ, - 24 ,----------Two cannot poflibly co-exift in the whole or anv part of a living body, 25 ,----------Principles of cure, - -. 25 ----------Suppofed to have arifen from excef- five excitement, depend upon a ftate of exhauftion, or indirect: debility, - - "33 EXCITABILITY, what, - - 23 -------------:----Accumulation of, - 24 ----------------- Middle or healthy ftate of, 24 -----------------Exhauftion of, ^ 24 EXCITEMENT, what, - - 25 -----------------Exceffive does not exift, - 37 EXHAUSTION, increufd by the abltradion offtimuli, ^^ INFLAMMATION, always depends on a ftate oi direct or indirect, - 39 INDEX. xL Page, ...... —Cure of7 depends upon the application of ftimulant powers, - - 41 LOCAL DISEASES, 39 Depend upon accumulation or exhauf- tion of the excitability, - 39 MEDICINES, called cathartics are ftimulant, 37 POISONS, efFeas of, - - - ' 26 PURGING, arifes from indirea debility, - 37 STIMULI, diviiion of, intoordinary and extra- ordinary, - - - 26 STIMULANT, or exciting powers, what, - 23 m-------.., ... Powers applied to a body in a ftate of accumulation will pro- duce exhauftion, '... ' - 35 to > 71 ■ INTRODUCTION. KJ PON examining trie records of medicine, from the earlieft periods, it appears that phyfi- cians have never confidered the living body as fubject, like all other parts of the univerfe, to regular and immutable laws ; but feem actually to have drawn anoppofite conclufion. It is front this clrcumftance principally, that the practice of medicine has hitherto acquired fo fmall a portion of certainty, as ftill to merit the appellation be- ftowed upon it, more than two thouiand years a- go, of a <; conjectural art." The various doctrines which have been pub- lished to the world, regarding the human body, are in general, nothing more than a mere afTem- blage of words, without the power of conveying any diftinct ideas. *Hypothefis has fucceeded hypothefis, in the fame regular manner, that phy- fician has fucceeded phyfician. Opinions have been adopted, according to the chances of educa- tion ; fupported by the authority of great names ; and religioufly adhered to as fundamental axioms, * As truth is but one, and the hypothefis, which may be formed upon any given fubjecr, infinite ; fo the chance of any hypothefis being irue, is as one is to an infinite number ; or the certainty of its being erroneous, abfolute. Every j«i(l de- duction of reafoning, is properly called theory. Bot the fo terms are, to the great detriment of faience, very generally confounded, c 14 INTRODUCTION. into the truth of which it would have been heref/ to enquire. - The mifchiefs arifing from' this.fource, " great- " ly extend their influence, and fpread in every 64 pofiible direction, when error-acquires the pat- " ronage of authority, and the protection of-dig- " nified names. It then1 takes its chair in the " fchools, and affumes the pompous titles of " profound, refined, or liberal-knowledge. Raif- " ed to this eminence, the ind'uftry of a fin- " gle teacher or author, may corrupt thoufands ; *; that of a few,whole nations; and the addition of- ^" a proportional number,-rain the education of: "a world. " This tiniverfal di'ffufion of'error, receives--, ': fanction and eftablifhrnent from the progrcfs of " time. It becomes venerable : and every at- cc tempt to detect it. is branded with the name of "profanity or madnefs.'* Such has, unhappily, been too long the ftate of kience. But, of late years, every department-of human knowledge has undergone a rapid improvement. The dawn of reafon has, in a particular degree, begun to en- lighten the medical world ; and the practice to af- fume a confiftency, which could only be found on the difcovery of the laws, by which all living bo- dies are governed.- This difcovery, one of the grandeft efforts of the human mind, that ever dignified the page of: fcience, the difcoveries of the immortal Newton himfelf not excepted, is contained in the Elements * Vid; Intrdduftion to the Outlines, &<;, by John Frown., P2f." »• % ..... » r"N trod Oct ion. 15* of Medicine, of the late celebrated John Brown., This difcovery, hitherto neglected from ignorance, oppofed from the (hame-of recantation, and ca- lumniated from -intercft, prejudice, and paffion, contains fo many-undeniable truths that, to an un- biased mfad, it only requires to be -known, in or- .der to be admired and adopted. The doctrine, although it has not yet been fanctioned by the medical fchools of Britain, has, however, been very generally received, in the other fchools of Europe, and ill America. "In the Univerfity of Pavia," fays Dr. Rafori, " undoubtedly one of *5 the firft in Europe, there is hardly a fludent en- " dowed with talents, who is not a Brunonian. " The doctrine begins equally -.to fpre.ad in Gfir- " many. Many of the periodical publications of " that country have noticed it, and the Elemen- "*ta have been lately publifhed there. A friend -" at Genoa affures mc, that lev eral furgcons to " French men of war have informed him, that " Brown is known and much admired in France. «' In the Univerfity of Pavia, Brown is in high " efteem, even with fome of the mod refpetiable " profeffors ; and in other parts of Italy, I can af- " fert, from my own knowledge, that old phyfi- " cians have not refu fed their fanction to many of ■*' the Brunonian principles.'* One of his Italian critics,-fupppfed to be Pro-. fcfTor Carminati, fays, " Ouaerenti mini 'caufas " incredibilis prope illius co'mmotionis animorum., 4i atque ingemis fere plattfus, qu/bus nuperime fin- i; gularis ilia hypothecs, cui novum Univerfo; <: Medicinae Synema c:'h?brifmus Anglisc -Scriptor *?. ct Medicus Brh.no fupcrftruxir, ah Us optnr.^: * ViJ: B:Ji >:?" la'- .C .i- i6 INTRODUCTION, " fpei adolefcentibus exceptaefTet,qui in florentiffi- " mo Ticinenfi Archigymnafio falutaris artis ftudiis " omnibus mecum incurobunt, peraduum fane, " non fuit eas **** invenire. Many tranflation^ and editions of this work, and various criticifms upon it, have appeared in different parts of Europe, which it is by no means neCeffary to enumerate here, ^hat the knowl- edge of it has alfo made a confiderable progrefs, among the medical philofophers of America, is evident from the frequent allufipns made to it, in, a late publication', by Dr. Rufh^ of Philadelphia. " The principle of the gradual application offtim- " uli to the body, in all the difeafes of indirect de- " bility on the o*ne hand, and of direct on the oth- " er, opens a wide field for the improvement of " medicine. Perhaps all the difcoveries of future " ages, will confift more in a new application of " eftablifhed principle, and in new modes of ex- " hibiting old medicine, than in the difcoveries of " new theories, or of new articles, of the Materia •« Medica."* Another proof of the excellence of the doc- trine, no lefs convincing, is deducible from the frequent plagiarifms of its fundamental principles^ by which fome men, defirous of palling them upon the world as their own difcoveries, have lately en- deavoured to eftabliftVa reputation for fuperior genius. Any attempt to detea thefe, in their various and moft infinite ramifications, would, as Dr. Beddoest very juflly remarks, be now un-' * Vide "' An account of the bilious remitting yci.'ov Few.'1 —page 2^4. T It would be inpRice, unon uV> occafion, to n3[s ove. INTRODUCTION. J7 neceffary. Among the mod confpicuous, however, in this lift, we may particularife Doctor Gritanner. —There is not a fingle idea in any of the papers, which he has publifhed upon that fubject, that is not borrowed from the Doctrine of Brown, or the different modification of it, difcuffed in the Medi- cal Society of Edinburgh, and recorded upon its books. Thefe he has freely ufed, without the fmalleft acknowledgment. His doctrine, of the! principle of irritability, is taken from-a paper, writ- ten by a reipcctable member of thai Society. Dr. O. was a ftudent at Edinburgh, long after the publication of the Elcmenta Medicines ; and at a pme, when the principles of the doctrine, were the fubject of inveftigation, in the literary focier ties of that Univerfity. His plagiarifrns mult therefore have been wilful; and no "acknowledg- ment, fubfequent to detection, can be confidercd as an atonement. There is fomcthing fo flagi- tious in the attempt to rob departed genu.is of v.% honours—honours too, in the acquifition of which friendfhips, emolument, and eafe, were all facn- ficcd,—that it cannot be too feverely reprobated. I r is a cor7;mqnan4 often a true obfervation, without a tribute of applaufe, the hud,ible exertions of Dr. Beddoes, in promulgating the knowledge of i .town's dochine. He is perhaps the only author in Britain, who has dan-d pnb- lickly to affi-rt the merits of it. This ingenious conduf), an'4, ihe liberal manner in which he flepped forward, to benclit ihs unfortunate family of our llluiirious philofopher,". equally e- vince bis fuperiur mind, and Bnir^rfal pbi!ant!:.-op>. * Vide a new edition of the I'lcmpnis of 7.iea;;ct:>e, of John Brown, M. T). v.-i-.h a b' /.phical ir'rrfice b^ Thom*i fied* d^s, M. 0. ** l8 INTRODUCTION. / that " no man is a prophet in his own country." Accordingly, it appears, that this doctrine was iotrger neglected, and is ftill more anxioufly op- pafedin Britain, than in other nations. Few men at an advanced period of life, have fufficient cou- rage to relinquifh errors to which they have been habituated, frqrruheir early years ; fewer ftill have candor enough to acknowledge the truth of what they have ftrenuoufly oppofed ; and young men, although generally open to conviction, feldom have fufficient confidence in themfelves, to ftem the torrent of general opinion. The rifing gener- ation, however, in order to adopt the new doc- trine, will not have many facrifices to make. It' will neither affect their intereft nor wound their vanity, -t ,. That the force of truth already begins to fi- lence the unmeaning clamour, which has hitherto been made againit this doctrine in Britain, is evin- ced, by the reception of a late voluminous publi- cation, of which the chief merit confifts in, an ac- cafional and imperfect coincidence with .the prin- ciples of "Brown. It will readily be perceived, that we allude to the Zoonomia of Dr. Darwin9 —a work which, from the excellent character and reputed talents of its author, had raifed confider- able expectation in the public mind. But difap- pointment, on the perufal, was in proportion to the previous expectation. Inftead of important and luminous corrections of the doctrine, which might- have been looked for, at this time of day, from a man of abilities, purfujng the fame tract of inveftigation, a want of argument and correct rea- fonifi:.',, isfound to pr-i v.ule the whole. It is fuch a ■rudis im1 igtjicq::: molts that, after v;:.d!:>^ through INTRODUCTION. 1C) ffearly fix hundred pages,* it Teems impoffible to comprehend the fcientific principles,upon which the author intended to build his doctrine. 'From thefe ftri6tures, it ought not to be infer- red, that we with to detract from the merits of the excellent poet, who has fo elegantly fungthe " Loves of the plants." But juftice forbids that,. out of refpea to charader or reputation, one man fhould be allowed to affume to himfelf, any por- tion of that honors which exclufively belongs to another. Science knows no perfonal diftinaion*. The author of a grand difcovery, is, at leaft, en- titled to poflhumous fame. .• *■*' The origin of this like every other difcove- ry of importance, has been attempted to be traced to hints thrown cut by preceding authors. Even rhe vifioriary fpeculadons of Cullen have been mentioned, as theTource, of fome of its fundamen- tal principles :—withjuft as much propriety might they be imputed to any ingenious fuggeftion in "The life and Opinions of Triftram Shandy." Upon the whole it may with confidence be afferted, that ibis doarine is, in all its parts, original, as it is un- doubtedly true, and important injts application. And thofe, who are difpofed to deny it this merit, fhould, in decency, adduce fomething like argu- ment, inftead of the ebullitions of vaniiv, detrac- tion, or jeal on fy. 3 After this eulogy, the reader may perhaps expea, that the following pages contain a mere?' verbal copy of Brown's Elements of Medicine ; but he will foon perceive, that this is not the cafe. For, although its fundamental principles are in- * At the time this wai written, the-firfl volume only, of .^jrnrin*: Zoonotnia. appeared in India. to fNTAODUCTlOS'. difputablv true, there are feveral errors in the de- tail arid fome of them o'f very confidefablc impor- tance. His opponents, however, if truth had been their objea, fhould have endeavoured to perfea the du&rine, by a correaion of its errors, inftead of illiberally affeaing, on account of partial blem- ifhes, to rejea the whole. To the candid,liberal and enlightened, it will appear much lefs Wonderful, that Brown fliould have fometimes erred, than that he ihould have been fo pre-eminently fuccefsful, in firft pointing out, to the world, the right path of medical inveftigation. The principal deviations, from the original doc- trine, to be found in the following " View of the Science of Life," are thefe : ift.—It is demonftrated, that difeafes of exccf- five excitement cannot exift ; and that all thofe. which have been fo called, are dileafes of indirect debility. 2dly.—Almost the whole of the difeafes, which were ranked, by Brown, and his followers among the difeafes of direa debility, are fhewn to be dif^ eafes of indirea debility. gdly.—In the mode of applying the exciting powers, for the cure of difeafes of indirea de- bility. From this ftatcment, it appears, that the alter- ations, here made in the doarine, as they affea the method of cure, in more than one half of the difeafes, to which living bodies are fubjea, are of the firft importance ; and therefore dcfervc a can- did examination, INTRODUCTION. 21 It may be proper to remark, that fome perfons have affeaed to rejea this doarine, upon the ve- ry grave and folemn ground, of its being favourable to intemperance. To thofe however, who will take the trouble of making themfelves acquainted with its principles, it will only be neceffary to ob- ferve, that fuch perfons do not underftand the fubjea. In climates and countries where the tranfition, from health to difeafe, and from difeafe to deaths is often alarmingly rapid, and health always pre- carious, the knowledge of a doarine, which re- duces the praaice of medicine to a degree of cer- tainty hitherto unknown, cannot but be attended with great and evident advantages. To diffufe that knowledge in India, where the doarine feems to have been but little cultivated, and to have ac- quired but a fmall degree of reputation fo juftly due to it, is the defign of this undertaking. The attempt is made with the greater confidence, from having experienced, in the application of the princi- ples to praaice, a degree of fuccefs, far beyond even the moft fanguine expeaations, that had pre- vioufly been formed in theory. If, however, this confidence fhould not, after a fair inveftigation, be juftified by the experience of others, the fub- jea remains open for free difcuffion, by which a- lone the doarine mud, finally, be either confirm- ed, or refuted. As it is, for obvious reafons, defirable, that a knowlege of medical fcience, fhould not be e*- clufively confined tq medical men, we have entire- ly divefted our obfervations of the myfterious garb, in which fuch knowledge is ufually convey- ed to the world. D VIEW OF THE SCIENCE oF LIFE. CHAPTER i. FUNBAMENTAL PROPOSITI©NS. I. JHLLL living bodies poffefs a certain prop- erty, capable of being aaed upon by external powers, fo as to produce the pheenomena of life. This property is denominated excitabil- ity.* II. The external powers are all fuch objeas as, applied to the whole, or a part of any living body, are capable of acting upon the excitability. They are denominated stimuli, or exci- ting powers. III. Upon the application of the exciting powers in a due, deficient, orexceffive degreerde- pend the different ftates of the excitability. * Some recent modifiers of tHis do8rin<», are of opinion, that the exciting powers aft upon themufcuhr fibre only ; and therefore ufc the term irritability. But as the powers which produce, as well as thofe wbith remove difeafe, evi- dently affeft the whole body, we.think it fafer to retain tie sore cotr.prehenftve term, adc.ucd by the origb.il author. »4 view of thb IV. Upon the different ftates of the excita- bility depend all the phenomena of health, and dif-; eafe. V. There are three ftates of the excitabilty, lft. The ftate of accumulation.—When a portion of the ufual ftimuli is withheld, the ex- citability accumulates ; and the body becomes fuf- ccptible of impreflion, in the direct ratio of the fubdu&ion. This ftate conftitutes difeafes of accumula^ tion, or of direct debility. 2dly. The middle ftate. When the exci- tability is fuch, that the application of the accufr tomed degree of exciting powers, produces tone^ or health.' 3dly. The ftate of exhaustion. When the application of ftimuli, has been greater than that which produces healthy aaion, the excitability isexhaufted ; and the body becomes lefs fufceptible of impreffion, in the direa ratio of the excefs. This ftate conftitutes difeafes of exhaus- tion or of indirect debility. VI. The ftates of accumulation, and exhauf- tion of the excitability, in their different degrees, conftitute all the difeafes, to which living bodies. are fubjea. VII. Diseases differ from each other, only in the degree of accumulation, or exhauftion of the excitability in the whole, or parts of the body, science of life. *5 VIII. Consequently, as two degrees of the fame ftate, or two different ftates of the ex- citability, cannot take place at the fame time, in the whole, or any particular part of the body, two difeafes cannot poffibly co-exift, in the whole, or a. particular part. IX. The cure of all difeafes depend upon an application of ftimuli, in a degree proportionate to the accumulation, or exhauftion of the excita- bility. X. The degree of power, with which the funaions of life are performed, is expreffed by the term excitement. Thus, there is a healthy ex- citement, when the funBions of life are juftly per- formed. But in proportion as a deviation from health takes place either in direa or indifea de- bility, fo the funaions of life are performed with lets power, or the excitement is diminifhed. CHAPTER II. QF STIMULI, OR THE EXCITING POWERS, XI. All objeas in nature, capable of pro- ducing an effea upon living bodies, are ftimu- lant, (n.) XII. Stimuli, rnay be divided into ordina- ry, and extraordinary. »6 View of the lft. Ordinary ftimuli, are all fuch powers as are ufually applied to living bodies, in a (late of health. 2dly. Extraordinary ftimuli, are fuch as are occafionally applied to living bodies, as nox- ious, or may be ufed, as curative powers. Of this defcription are all the aaive fubftances that are or may be employed as medicines, whether animal, Vegetable, or mineral. Substances ufually called pois©ns, as their deleterious operation depends wholly upon their fuperior degree of ftimulant power, ought not to be diftinaiy confidered. Any ftimulant, when exhibited in fufficient quantity to exhauft the ex- citability, aas as a poifon. Contagion has been enumerated as a caufe of peftilential difeafes. But as the exiftence of fuch a power is by no means proved, it ought not to be admitted in philofophical difquifitions. The grounds of diffent, from an opinion fo univerfally received, wii) be fully explained in another place. CHAPTER III. APPLICATION OF STIMULI, OR THE EXCITING POWERS, FOR THE CURE OF DISEASES. — ■ " "»jg^aagsiMi»w"» - ■ ■» i. Difafts of direct Debility, or of Accumulation, XIII. As the body becomes fnfceptible of im- prejTion, in the direa ratio of fubduaion of ftim- SCltNCrOF LIFE. 57 till (v. 1.) it follows that the force of ftimulus to' be applied, in the cure of difeafes, of this ftate, fhould be inverfely as the accumulation of the excitability. Thus in the cafe of perfons who have been expofed to great degrees of cold, heat fhould be appliedj firft in a degree not much great- er than the loweft temperature, to which the perfon has been expofed, and gradually increafed to the ufual ftandard.- To frozen limbs, the firft appli- cation fhould be fnow, then cold water, afterwards water lefs cold, and fa-on, through the various de- grees, until motion and fenfatibn are fully reftoredv Whereas, by the immediate application of the ac- cuftomed degree of heat, death would be produ- ced in the whole, or thofe parts of the body, which had been expofed.—To perfons who may have remained long without food, nourifhment fhould be exhibited in the fame gradual manner. The quantity ufually taken at a meal would, in fuch a cafe, in ft an tly extinguifh life,—a faa of which there are many inftances upon record. The eyes of perfons, who have been long kept in darknefs, become exceedingly fenfible to the frnalleft degree of light. Thofe unfortunate beings, whom the miftaken and perverfe policy of man has doomed to long confinement in dungeons, become, in the courfe of time, capable of diftinguifhing all the corners of their gloomy abode ; where, upon their firft entrance, they could diftinguifh nothing. The impreflion of the full glare of a meridian light, up- on organs in fuch a ftate of fufceptibility, would-" occafion inftant and irrecoverable blindnefs. A perfon, fuddenly awoke in the night, can fcarccly bear even the fmall degree of light, emitted from a common candle. It is only by the gradual ap- proach of day, that the eye is enabled to bear the full force of the raid-day fun. it VIEW OF THE Scurvy feems to be a difeafe of direa debili- ty, occafioned by the abfence of fome of the ufual exciting powers, particularly nutritive food, heat and the mental ftimuli. . Thefe powers muft be gradually applied, in order to re-produce health. Upon this principle it is, that vegetables and veg- etable acids, as being lefs ftimulant than frefh an- imal food, are found fo ufefui in the cure of fcur- vy. An immediate indulgence in the latter, after a long abftinence, would produce dangerous con- fequences. In advanced ftages of this difeafe, a very fmall quantity of ftimulus, fuch as a glafs of ardent fpirits, or a ftrong mental impulfe, has been frequently known to extinguifh life. That dimi- nution of heat has a fhare in the produaion of fcurvy, is evident from its more frequent occur- rence in cold, than in hot climates.- And that the abfence of the mental ftimuli, is often a fouree of this difeafe, is obvious from this,—that every cir- cumftance that can occur, during a long voyagej calculated to roufe the mind to moderate exer- tion, will produce an alleviation of the fymptons j —the fight of an enemy—the fight of land—ap- proaeff to the deftined port—the anticipation of the pleafures of the fhore, Sec. This is farther corroborated by the frequency of fcurvy among the enflaved Africans, in their paffage to the Weft-Indies, where all the mental ftimuli are as completely abftraaed, as can be fuppofed to hap- pen in almoft any poffible fituation. The difeafe in this cafe affeas the men, more than the women and children. The reafon is evident. With men, the tranfition from liberty to flavery, is greater than with women and children, accuftomed, in their moft free ftate, to look up to them as their fuperiors. The minds of the latter too, from be- ing lefs exercifed, are the lefs capable of reflec: SCIENCE OF LIFE. 29 tion, and become more eafily reconciled to their new fituation; which is alfo rendered lefs irkfome, by the indulgence ufually granted to them even on board of fhips, employed in the vile traffic of flaves. The abfence of thofe objeas, which were wont lo excite pleafurable fenfation in the mind, pro- duce difeafes of this ftate.—Such is the defpond- ence of a lover, in the abfence of the objea be- loved : and that melancholy, with which fome per- fons are affeaed, when abfent from their native country; XIV. As tne fituations, in which the ordina- ry ftimuli can be with-held, in any confiderable degree, are rare, the difeafes of this ftate are con- fequently few in number; and feldom become ob- jects of medical treatment* XV. In all of them, the cure confifts in a gradual re-application of thofe exciting powers, the abftraaion of which occafioned the difeafe ; Or, in fituations where that is impraaicable, by a fimilar application of other powers equivalent in force. a. Difeafes of indirect Debility, or of Exhauftion. XVI. As the body becomes lefs fufceptible of impreflion, in the direa ratio of the exceflive application of ftimuli (v. iii), it follows that the force of ftimulus to be applied, in the cure of dif- eafes of this ftate, fhould be direaiy as the exhauf- tion of the excitability. S© V-I-EW 0* THF. XVII. As all difeafes arife, either from accu- mulation or exhauftion of the excitability, (vi.) and as the difeafes of accumulation have been fhewn to be extremely few (xiv), difeafes of in- direa will probably be to thofe of direa debility, in fome fuch proportion, as nine /•hundred and ninety-nine to-one.- The difeafes. of warm cli- mates may be confidercd, without exception, as difeafes of exhauftion or of indirea debility. • j( ■ - XVIII. Asthehigheft-excuement is thegrcrt- eft degree of health, it is evident that, in difeafe, health is to be reproduced, by the application of fuch a degree of ftimulant power, as is calculated to fupport, thehigheft ftate of excitement, of which thebor^y, at the time, is capable. Let the mid- dle, ftate of the excitability for inft-ance, be repre- fented hy 20, and the appropriate degree of ftim- ulus, producing healthy excitement, by 20 alfo (vide Table) ; let the diminifhing or increafing ium of ftimulus, in proportion to the accumulation or exhauftion of the excitability, be rcprefented by numbers, as in the annexed table. If the ex- citability is exhaufted to 10, the furn of ftimulus to be applied, in order to produce the greateft ex- citement, which the ftate of the body will al- low, will be as 30. Every degree of ftim- ulus, beyond that, will exhauft the body ftill far- ther, and every degree, below it, will retard the cure. Thus 35 degrees of ftimuifos, will" be too- much, 25 too little. XIX. As the produaion of the healthy ftate is always gradual and progreffive, and is eflfeaed by the powers of life; it follows thatj in proportion to the degree, in which thefe powers can be main- tained, the cure will be accelerated, There is no SCIENCE OF LTFt. W «ther mode of fupporting them, but by an appli- cation of ftimuli, proportionate to the fuiceptibi ity of impreflion. v XX. As the fum of the powers, producing difeafe, cannot poffibly be afcertained, the degree of ftimulus to be applied, for the reproduaion of health, mult be entirely regulated by obfervation of the effeas, arifing from the application of med- icines, XXI. As the varieties of difeafes that occur, from the higheft degree of accumulation, to the loweft degree of exhauftion, of excitability ; fo is the variety, in the degree of ftimulus, neceffary to be applied, for the cure. XXII. This variety is of very great extent. The ufual mode, therefore, of prefcribing certain fixed dofes of medicines, in-every difeafe, what- ever may be the degree of it, k and mull be nu- gatory and inefficacious ; excepting when thefe dofes happen, by mere chance, to correfpond with the ftate of excitability.—In afcertaining thefe degrees, and proportioning the ftimuli, confift the judgment of the phyfician, XXIII. If, for example, opium, aether, vo- latile alkali, the preparations of mercury, wine, bark, &c. exhibited in the ufual dofes, do not pro- duce effeas, which indicate an approximation to health,—fuch as a diminution of frequency,* and an increafe of ftrength, in the pulle, a coolnefs of the ftin, moifturc of the tongue, refrefliing fleep, and * There is fomenmes a peculiar flown, fs, which is equally a figu of dcbilny, with a 4<»u.kn:f* of f oifc. Vide Cil'e 8,Ji. a* VIEW OF THE the other familiar figns of increafing excitement, ■—it is evident that the dofes are infufticient, and fhould be increaed, until thefe effeas are prpi duced. XXIV. The dofes fhould be repeated in fuch a manner, as to maintain the higheft degree of ex-» citement, of which the body, at the fame time is capable. But in proportion as the excitability accumulates, or the body approaches to the ftate of health, the dofes fhould be gradually and pro- portionally diminifhed, until at length, health be- ing eftablifiied, nothing more than the aaion of the ordinary exciting powers is required. XXV. All the difeafes enumerated by Brown, as difeafes of accumulation or direa de- bility, with perhaps the fingle exception of fcurvy* are difeafes of exhauftion. Typhus, Intermit- tents, Dyfentery, and fome other difeafes, as they appear to be occafioned by expofure to cold, and moifture, a deficiency of nutriment and of other ftimuli, have been ranked, by him, in the clafs of difeafes of accumulation. But as the fura of the powers, which are concerned in the produaion of any particular difeafe, cannot be afcertaincd, the nature of it can only be determined by the effeas of the ftimulantpowers, applied for the cure. And, as the cure of thefe difeafes depends upon the ap- plication of the moft powerful ftimuli, it neceffa- rily follows that, they are difeafes of indir.ea de- bility. This error feems to have arifen from an opin- ion, that upon the abftraaion of ftimuli from (or in the words of Brown, the application of direa debilitating power: to} a-bcdy in a ftate of <:\bauf- 6CI*NGE-OF LIF^B. w lion, the irritability wouldaccymulate ; or that 4v* rea would be fuperinduced on indirea del :i:y, J3ut this opinion is evidently.erroneous. If hoL\ a perfon labouring under plague, malignant fever, Or gangrenous fore throat, all the ufual remedies; ;are withheld, and only cold water given, no ac- cumulation of the excitability will take place; but on the contrary, the exhauftion will rapidly pro- peed, to the extinajon of life. If a perfon, prc- vioufly exhausted by expofqre to exceffive heat, drinks largely of, or plunges himfelf into cold wa- ter, the exhauftion wjlf not be removed ; but on the contrary, thofe greater degrees of it produced, conftituting Tetanus, Spafms of the ftomach, &c. And that thefe are all difeafes of indirea debility, the mode of cure, which confifts in the applica- tion of a very high degree of ftimulant power, is a fufficient proof. Gout is a familiar inftance in point. The ftate of body liable to this difeafe, is produced by a long continued application of food and diink, ftimulant in too high a degree. Let a . gouty perfon be expofed to cold and moilture, and a paroxifin will readily be produced. Let him fuddenly refrain from his ufual quantity of food and drink, his ftomach or head will be affec- ted ; and the molt powerful ftimuli, as vEther, Brandy, &c. will be requifite to relieve him. XXVI. Hence it follows that, in difeafes of exhauftion, the irritability does not accumulate upon the abftraaion of ftimuli ; but on the con- trary, the ftate of exhauftion is thereby, increafed. XXVII. It follows alfo that, in the produc- tion of Typhus, Intermittents, Dyfentery, and fuch other difeafes ?.s havj appeared to arifc from expofure to cold, moifture, &c. and have tkciu 34 VI'EW OF THE fore been ranked by Brown, among the difeafe* ©f direa debility, the body muft have previoufly been in a ftate exhauftion. By a fubduaion of exciting powers, from a body in fuch a ftate, the previous degree of exhauftion muft be increafed., and the difeafes of that ftate confequently in- duced. XXVIII. Most of the difeafes of exhauftion Appear to be produced in this manner. CHAPTER IV. &T DISEASES DENOMINATED BY BROWN, DIS^ EASES OE EXCESSIVE EXCITEMENT.* XXIX. As there are three ftates of the ex- citability, (v. 1, 2, 3,) fo there are three corref- ponding ftates of excitement. lft. The ftate of diminifhed excitement, from a deficient application of ftimuli, correfponding "with the ftate of accumulation, or direa debility. 2dly. The ftate of high excitement, from a due application of ftimuli, correfponding with the middle ftate of the excitability or health. * Vide Lynch's Table, prefixed to Beddoes' edition of Brown's Elements of Medicioc. SCIENCE OF LIFE. 3S 3cHy. The ftate of diminifhed excitement, from an excefijivz application of ftimuli, corefpond- i-ng with the ftate of exhauftion, or indirect de- bility. XXX. Although the ftimulant powers may be applied, in an exceflive degree, to the middle or healthy ftate of the excitability, it is evident that excitement never can be exceflive ; for eve- ry degree of ftimulant power, greater than is ne- ceffary to produce health, muft occafion a de- gree of exhauftion proportionate to the excefs, (v. $) ; and every degree of ftimulant power, lefs than is neceffary to produce "health, muft occafion a degree of accumulation, proportionte to the de- ficiency, (v. 1.) XXXI. There are, therefore, no difeafes 6f exceflive excitement. From whence it follows thofe, which have been fo denominated by Brown,: muft be difeafes, either of direa, or indirea de- bility, (vi.) XXXII. That they are all difeafes of indi- rea debility, feldom conftituting a very high de- gree of exhauftion, is proved, both by the powers that are known to induce them, and the remedies that are found moft fuccefsful in their cure. Catarrh, pneumonia, acute rheumatifm, and other difeafes of this clafs, are occafkmed by the application of a confiderable degree of heat, aftar the body has been previoufly expofed to cold ;— or vice verfa. The temperature of warm rooms is, in general, greater than is fufficient to fupport healthy excitement. If the body therefore has Veen previoufly expofed to a confiderable degree 46 be applied, to pro- duce the greateft pof- Gble excitement. _o or Dealh.J \W EXPLANATION of the TABLE. This Table is meant merely to convey a general f- dea of the manner, in which ftimuli fhould be increafed, or diminifhed, in proportion to the exhauftion, or ac- cumulation of the excitability. It is not fuppofed, that the degree of the excitability, or the proportion of ftim- ulus reprefented by the figures in the table, can be ascer- tained in any other manner, than by obfervation of the effects produced by their application. The range of figures, is by no means fufficient to exprefs the various degrees of accumulation and exhauftion of the excita- bility, that can take place, between the middle ftate and death. It will however, be fufficient to give a general idea of the mode of cure, deducible from the principles laid down in the preceding pages. CASES, By Dr. Y A T E S. ■lilfflHIB*" CASE I. JL RANCIS LOTE, aged 35, was admitted in- to the General Hofpital, at Calcutta, on the tft of May, 1796.—At that time, he complained of general pains over his body, with all thofe fymp- toms which indicate an exhaufted conftitution. On the 15th of May, he came under my care. At that time I found his mouth fore, from the ufe of Mercurv ; and he was much purged and griped. On the 3d of June, when I difcontinued at- tending him, his complaints were considerably relieved, by the ule of Opium. On the 21ft of Auguft, he again came under my care, in a flat* of extreme debility, with exceflive purging and bloody ftools. During the whole of this time, he had remained in the Hofpital ; but, from neceffa- ry arrangements, had fallen during intervals, un- der the care of other gentlemen. During the laft of thefe intervals he was fo extremely weak that, in the aa of vomiting, the right clavicle was fraaur- ed, which occafioned much pain/ On that and the two fucceflive days, I gave him eighty drops of Tinaure of Opium, morning, and evening. On the 24th, in the morning, as no effea feemed to Cases, Sec. 45 he produced by the medicine, it was ordered to be given three times a day. At one o'clock P. M. the fame day, I was called to him ; and found him complaining of violent pain in the bowels, with inceffant purging. He had taken the 2d draught about an hour before. The draught was order- ed to be immediately repeated. At 9 P. M. he was not relieved; upon which 150 drops of Tinc- ture of Opium was lkrefcribed immediately and or- dered to be repeated at 12 o'clock. A glyfter, with 200 drops of Tin6lureof Opium was alfo giv- en. On the 25th he was eafier. The glyfters^ with 200 drops of Tinaure of Opium, were con- tinued every three hours, and the draught, with 150 drops, was repeated in the evening. On the 26th, in the morning, he was nearly in the fame ftate ; the glyfters were continued, and the draughts ordered 3 times in the day. At 9 P. M. I found that the relief from the glyfters, •tvas merely temporary, that he had ftools every hour, and no inclination to fleep. Four hundred drops of Tinaure of Opium were ordered in glyf- ter, every two hours, and a fourth draught of 200 drops to be taken at 12 o'clock. On the 26th he was eafier ; he had fix or feven ftools in the night, with lefs griping. Slept better than he had done, fince he came to the Hofpital. ' His pulfe beat about 90 ftrokes in the minute ; previous to this his pulfe had been very quick and fmall, but the ftate of it was not particularly noted ; he had 15O drops of Tinaure of opium in the morn- ing, and 200 at 12 o'clock. Four hundred drops were ordered in glyfter, every three hours. One P. M. He had 5 ftools fince morning ; the glyf- ters were continued ; and a draught of 200 drops ordered to-be taken at 4 o'clock. At 8 P. M, G ^5 CA'SEi, &-. he had thirteen ftools fince the laft vifit with a gooct deal of p^tin in his bowels. He had not flept; vasordered a draught of four hundred dropsof Tinc- ture of opium at ten o'clock. Au^uft ihe 28th, he had flept a little the preceding night ; bowels were eafier; pulfe 80; bad'draughts of 200 drops every two hours, with the glyfters occafion- ally. At 2 P. M. his pulfe was 90 ; he was in other rcfpeQs as before : had taken three draughts. The draughts of 200 drops were repeated every hour. At 9-P. M. his pulfe was ftill 90 ; he had dofed much, but had no found fleep ;• he had tar- ken 4 draughts. A draught of 400 drops was or- dered to be giv-en at 12-'o'clock. On the 2 9th>, his pulfe was 80, and ftrong; he hid 3 ftools, with lefs pain; but flept Iktle; the draughts of 200 drops were continued-every hour.—2. P. M. had inceflant ftools fince morning, with violent pain of the bowels; glyfters of 400 drops were ordered every hour. 8- P. M. had four ftools fince 2 o'clock ; had taken only one draught ; his bow- els were eafier. after the glyfters; pulfe 112.— Eight draughts^ with 200 drops each, were order- ed to be placed athis bed-fide, of which he was direaed to take one every hour, during the night, with glyfters of 500 drops every hour, in the in- tervals between the draughts.—30th, had fix ftools during the night. He was free from pain, and his pulfe 80 and full ; the draughts were continued every two hours, and the glyfters occa- fronally. 9 o'clock P. M. he had eight or ten ftools- fince morning, with fome griping ; pulfe g-s. The draughts were increafed to 300 droops eve- ry two hours ; and the glyfters continued.:—31ft, had pafled a good night; his pulfe was 90 ; he had five ftools ; his medicines were continued a" the day before. In the evening, he was nearly- CASES, <£C7. ^ t'*j f "the fame ; no alteration was made in his medi- cines—-September the ill, he had fix ftools du- ring the night, with griping : did not fleep; had no blood in his ftools; for two days; the draughts of three hundred drops were given every hour, and the glyfters of five hundred drops were -con- tinued as before, and repeated according to his cwn difcretion, as the tenefmus and griping might indicate.—8 P. M. he was much woric ; had eight ftools during the day, and no fleep ; his pulfe was 120, and he was fo extremely wea.k, that I con- sidered him as approaching to dlffolution. Draught*] of 500 drops each, were ordered to be given eve- ry hour, and the glyfters of 5D0 drops, to be con- tinued as before.—2d, he had not flept, but felt himfelf better; pulfe 104; his medicines were continued, in the fame manner during the whole of that day. On the 3d, his pulfe was 100 ; he -bad flept well the preceding night ; his medicines were continued. On the 4th, he was muft better, had dofed much and had only .two-ftools ; the draughts were direacd to be taken occasionally, as circum- ftances might indicate--'—This plan was. continued until the 1 jth, at which time his mouth became fore, and the flow of falivia was increafed, as.if he had been tiling mercury. The draughts and glyf- ters were from that period, ordered to be repcatad occasionally, according to his own difcretion. On the 2.2d, the difcharge of faliva -continued in the fame ftate.—On the 26th, he was better; and lis bowels eafv.—29th, he continued without pain, with two or three ftools in the day, and his ftrength increafing. On the 30th, when I difcontinucd at- tending him, he had only two flow's :n the day. •without pain ; and felt a returning appetite. Be- ing a fenfiblc and ftcady man, he was, at that time, allowed to proportion the ftrength and frequency 4« CASES, &C. of the draughts and glyfters according to his own judgment.—During the whole of the time that he was under my care, he had an allowance of wine from one to two or three bottles in the 24 hours, according to exigency.—From his good fenfe and punauality, I have a perfea reliance upon his hav- ing conformed to my orders, in every particular, as far as it is poffible for patients, in an hofpital, to do. The treatment of this cafe may give fome idea of the manner in which ftimuli fhould be increaf- ed, in difeafes of great exhauftion, until the quan- tity is afcertained, which is capable of producing the higheft degree ofexcitement. It will fhcw the very great quantity of the moft powerful ftimuli that may be neeeflary, in fome difeafes of that ftate in order to effea a cure; and is alfo an examle of the mode in which the dofes ought to be repeated. The forenefs of the mouth, and the increafed flow of faliva, evince that there is a greater fimilitude between the aaion of opium & mercury, than has,y et been acknowledged. The forenefs of the mouth and fpitting commenc- ed, after the quantity of opium was diminifhed. Upon refuming the draughts, the mouth became lefs fore, and the flow of faliva decreafed ; and upon leaving them off, the forenefs and fpitting increafed. This was repeatedly remarked by the patient himfelf. It fhould be obferved, in order to prevent a rafh imitation, where the circumflan-. ces are not alike, that the tinaure of opium em- ployed ; upon this occafion, was much weaker than what is ufually made in Europe ; that a very great degree of exhauftion had taken place; and ihat the dofes were gradually increadd, frou: eight drops to five hundred. CASEE, <5cC. jq CASE II. De Haes, aged 40, was admitted into the General Hofpital, at Calcutta, on the evening of the 26th of Auguft, 1796, with dyfentery of ci!!ow the exhibition of opium, are, as I have uni- formly obferved, owing to the medicine not being repealed ac proper intervals. In every cafe, which requires fo hich a flirmilant power as that of opium, the exhibition of the dofei fhould be regulated by principle.__They ought to be repeated in the night as v.eli as in the day.—3ut the difficulty of doing this, which may arife from ibe ignorance or carelcffWfs of prac- titioners, the j rcjudices or obftlna-y if paiie't<, or the ner« ligrnce of aitendants, has often occafioned bad confrquen- eti, which bate been erroncoufl/ imputed to ibe opium. cases, Sec. , a? tgth. his pulfe was ftronger, an erruption appeared on his face, fuch as often happens after taking o- pium or mercury.—He complained that his mouth was very fore, and was ordered to have a gargle ; the pills, &c. were continued as before.—20th, he was better, the pills, fago, &c. were regularly ta- ken, and he drank plentifully of wine and water ; his thirft was diminifhed ; the pills and regimen were ordered to be continued as before.—21th, he was ftronger, and declared himlelf in every refpea better ; the only complaints that remained were a forenefs of the mouth and fauces, and fome fwelling of the face ; the pills, Sec. were continu- ed.— 22d, forenefs of the mouth and throat were troublefome ; he fpit more freely than ufual, the increafed flow of faliva fomewhat rcfembling that which takes place after the ufe of mercury.* He appeared in other refpeas fo much better, that the pills were difcontinued.t 23d, he had flept tol- erably ; but his fkin was hot, and he complained , of debility. No medicines were prefcribed.r— / 24th, flept ill, and was much harraffed with a cough and fpitting ; his pulfe was quick and ir- regular, and he was opprcfled with clammy fweats, — half a grain of opium was prefcribcd every half hour, and bark in wine wasgiven in the intervals'. Regimen as before. From that pciiod the 27th, his medicines were punaually adminiftered ; his cough, fpitting, and clammy fweats were diminifh- * I cannot fay, at ihis d'ftance of time, whether 7"».^ was any ulceration of the gums, having oun;:lcd to noinc it in the Journal. + This Is the ihird error that was commit!.".'.? in <'\e treat- ment of this enff. in fodden'y Wi'ib(Jrawi.--if> a flmulus, 'o «.«;< 1 the patient hid been C>r fome tir.n* aicuilvni.d, and before ileal ill ftii completed* .c-cOalli'li-d. 5« cases, Sec. ed; his pulfe, fkin, and tongue were nearly in a Wealthy ftate ; and the diarrhoea entirely flopped. —-28th, he was ftronger, had a good appetite, and Could fit up ; his medicines, &c. were continued. After this, it was thought unneceffary to make dai- ly reports in the Journal. His medicines were continued for fome days, and gradually left off as be approached the bealthy ftate. In the above cafe, the medicines were regular- ly given, either by a friend of the patient's, who took a particular intereft in his welfare, by Mr. Ridges, then furgeon's mate of the Northumber- land, or by myfelf.--The relapfes which always took place, upon fuddenly laying the medicines afide, or with-hclding them even for a night, fliew the neceflity of repeating the dofes, with the ut- tnoft regularity and care. The forenefs of the anouth, together with the increafed flow of faliva, af- ter the ufe of opium,was not apeculiarcircumftance, Upon that fubjea, the following remark appears. in my Journal ;—" In many cafes, in which opi- *£ urn was freely given, for a length of lime, a 4t confiderable increafe in the flow of faliva, was *s obferved to take place, and to continue long af- " ter the medicine was laid afide. But in cafes, " where a confiderable fpitting had before exifted, " opium as well as mercury had the effea of lef- " fening it." Thefe faas, with the explanation of them, will be confidered in another place. \ 3E CASE V. RXTRACTTD FROM THE JOURNAL OF THE ENGLISH EAST-INDIA COMPANY'S SHIP NORTHUM- BERLAND. Ensign G , 36thregiment, a flout healthy man, about 25 years of age, went up, in a fit of playful- nefs, to the main-top-maft-head, on the evening of the 10th of June, 170,1. After having remained there a fhort time, he fell afleep upon the crofs- trees, and about midnight fell down upon the quarter-deck. In the fall, he firft ftruck with his hip, as was fuppofed, again ft an iron ftauncheon inthe main-top, which bent; he then came upon the mizen-ftay, which took him, as far as could be colleaed from the confufed intelligence of fome people upon deck, about the middle of the abdomen, and from the flay he fell upon the quar- ter-deck. He was, as may well be fuppofed, en- tirely infenfible; much blood was difcharged from his mouth, nofe, ears, and even from his eyes ; in this ftate he was carried down to his cabin ; upon examination, no fraaure was found ; the whole confequences of the fall feemed to confift of contufions or concuflion, the marks of which were very general over his bo- dy. His pulfe was fmall, but regular. There happened to be in the fhip four profeflional gen- tlemen, befides m> felf. They all feemed of opin- ion, that Mr. G. fhould immediately lofe blood. Some of them infifted upon that with muchearneflr- nefs ; and the by-ftanders, knowing it to be a com- mon praaice, joined in urging a compliance. I replied, that however the common practice migh? f?o N cases, Sec. be, I was convinced of its being entirely wrong ; and that I would not, even with the fanfclion of a majority; do what I was certain muft endanger the lifeof my patient. But that if any of the gentlemen prefcnt chofe to take charge of Mr.G. they might have an opportunity of bleeding him, with propri- ety, if convinced in their confcience that it was right; and I would give them my opinion when afked. This offer was not accepted. Mr. G. v/as not bled. In the courfe of two hours from tne accident, he became fenfible ; was fick at ftomach, and vomited. This, as a fymptom of concuflion ufually enumerated, would farther in- i dicate, according to the hypothefes of the fchools, and the praaice of hofpitals, copious blood-letting. That, however, did not alter my plan. I was a- ware indeed that, if the patient died, his death would be attributed to the non-obfervance of cuf- tomary forms. But I was alfo perfuaded that, if he lived, after having been copioufly bled, it would be in fpite of the blood-letting. He was my friend, as well as my patient; and in defiance of obloquy, I determined to do what appeared to me beft, in order to fave his life. Externally the moft powerful ftimulating'fubftances were applied, in contourfe or fucceflion. For four days he could not move in bed, without excruciating pain. He had fmall opiates oceafionally, wine, and nonrifh- ing food; and onceh^lfan ounce of fal eatharti- cus amarus, fo as to produce one ftool. Nothing more was done. He had not an unfavorable fymp- tom. The pains gradually abated ; and on the eighth day, from the fall, he was carried upon deck in a chair. That there was abfolutely a confiderable de- gree of concuflion in this cafe appears, from his CASES, <&C?, 6l having wholly loft the fight of One eye, although, when the marks of contufion had difappeared from that fide of his face, the eye looked almoft as well as the other. He complained at times of head- ach, which was always relieved by wrapping up his head in warm cloths. Th e iffue of this, as well as of every other cafe of contufion or concuflion, which I have feen treated, either in orout of hoipitals, convinced me, that blood-letting is not only unneceflary but per- nicious. In private praaice, I fear, a mean and criminal Compliance with vulgar prejudice, in or- der to conciliate Vulgar favour, too often influences praaitionefs, whofe better judgments would lead them to rejea intirely fo deplorable a remedy—of which the ufe is not only contrary to all principle ; but which fo far as I kndW, cannot adduce a An- gle uncontrovertible faa, in proof of its utility. CASE VI. Willi Am Hoi low ay, aged 22, was ad- mitted into the General Hofpital, at Calcutta, on $e 3d of September, 1796, with fymptoms of ty- phus fever, of feVeral days ftanding. At bed time, he took two grains of opium; and fix grains of calomei.—4tb, he had flept a little ; his tongue ■was barched and black ; pulfe 96, he had two ftdofe on the 3d. Six grains of calomel, and fix grains of powder of jallap, were ordered to be Uii Gu\*ES',_.&C given every, four hours.—5th, w addition to- hir former fymptoms, he complained of cough and riain of breaft. He had only one ftool, fince he began to take the powders. The powders were ordered to be repeated, and a draught, with fixty drops of tinaure of opium to be given at. bed time. —9 o'clock, P. M. he had not yet taken the draught prefcribcd for him in the morning ; the pain of his brea ft was more lev ere ; he Had no- ftool for twenty four hours ; was ordered a glyfter with one ounce.of caftor oil, and one ounce of Glauber's falts; and afterwards to take the draught.—6th, he had no ftool from the glyfter. His' pulfe was 116"; his tongue furred and black, ai d his moutfi exceedingly parched,; he, was a little confufedi and had a flight degree of fubfultus- tendinunr. Two ounces of the common infufion of fenna was ordered" every hour, and a glyfter, double th'e ftrength1 of the former, every fecond hour-until'be fhould have a ftool'or two.—7 o'clock P. M. be bad one copious ftool, after having taken feveral dofes of the infufion, and two or three glyfters. Tour grains of opium and four grains of calomel; ' were ordered to be taken at 8 o'clock, and to be repeated at 12; On the ph, he conceived' bimfelf better ; pulfe 108; his tongue was ftill furred and flan hot. He was allowed twelve glaf- fes of wine in the day. Ten grains of .calomel, an,d fifteen grains of powder of jallap, were pre- fcribed every fouf-hours.—9o'clock, P. M.-lip fkin was very hot, pulfe only 100 ; he had taken three of the powders, and had 3 ftools; he com- plained *hat his tongue was fore*' It was ftill fur- red and black in the middle. He was ordered a draught, with a hundred drops of lin&u-re oJF-opi- umvat B. o'clockf^nd again at twelve. 8th, hi* pulfe was 100, and heat of fkin more moderate; CASES, &rc. «8 out bis tongue remained foul ; he expreffed a wifli for porter.* A bottle of porter was allowed him ; —and the wine was continued. The pow- ders and draughts were repeated.—9th, he re- mained nearly in the fame ftate; but complained of a fevere cough. He had two ftools. All his medicines were continued as the day before.—; 10th, he had no cough, and refted well ; his pulfe was 112 ; hehad no ftool ; two ounces ofjnfufion of fenna were ordered to be taken every hour through the day, and the draughts to be repeated at night.—11th, his pulfe was 116, tongue very foul, and mouth parched ; he had flept but little ; and had no ftool fince the 9th.—A glyfter, with two ounces of caftor oil, and two ounces of Glau ber's falts, was ordered to be given immediately, and to be repeated according to circumftanccs- The powders were given as before.---7 o'clock, P. M. his pulfe was only 1 co ; tongue cleaner, and moift.—He had one ftool after having taken' two glyfters. He remarked that he had, for the firft time, a diftina paroxifm of fever in the after- noon. The draughtsweregivenasufual.—12th, bis pulfe was 92, and his fkin nearly of a healthy temper- ature ; his tongue remained a little furred; he had no ftool. Theglyfters,pow ders&draughts, were direc- ted to be given in the fame manner as the day be- fore.— 13th, when I vifitcd him, he was found a- fleep, feemed eafy, and his fkin cool. The medicines were ordered to be continued.—7 o'clock P. M. his pulfe was 76; fkin moift and cool; he had two ftools, and was inclined to fleep. The draughts were continued.— 14th, he was not * The it fire for beer or porer, Is a fymptr^ tint fre- quently orctirs, when the mouth begins to be arTccled, after hivi.ng.uied mercury. 64 cases, Sea. fo well as the day before ; his pulfe was 96 in the morning, and 92 in the evening, and his tongue rather foul. The medicines were continued. On the 15th, his fkin, tongue, and pulfe, approached nearly to the healthy ftandard. He expreffed a defire to eat, and was ordered to have chicken ' broth. The powders and draughts were contih- ued. On the 16th, fie had no feverifh fymptom, his tongue was fore at the edges, and there was an increafed flow of faliva. The powders were omit- ted, and the draughts continued. From that pe- riod, he was convalefcent, and only took one draught occafionally at night. On the 23d, he was free from complaint, and difcharged from the Hofpital.—During the whole of the time, be wa$ allowed wine and porter, as at firft prefcribed, This cafe is not given as an uncommon one, either in refpea to the violence of the difeafe, or the quantity of medicines that were prefcribed. The hiftory of it fhews, that the fum of ftimulant power firft applied, was inadequate to effea a cure, even in a cafe of flight difeafe ; for the fymptoms by no means approach to the feverity of typhus gravior* In every fever, whatever be its no- sological defcription,tbe fame plan would have been purfued, increafing or diminifliing the force of the exciting powers, in proportion to the degree of in- direa debility. I ffuch a quantity, as was ufedheret be neceffary for the cure of mild typhus, what powerful ftimuli muft often be required in typhus gravior, dyfentery, or plague ? The intervals, I think, at which the medicines were repeated, are too long. The duration of the action of each dofe of mercury or jallap is not, perhaps near fo much a* four hours.—probably not 0A.5ES, Arc, 65 more than one. But whateyerit be, fuch is the period exaaiy, at which dofes ought to be repeat- ed. In tbis, as well as in many cafes, botb of dyf- entery and fever, I have given caftor oil, jallap, and other cathartics,, with a viewfimply to increafe the excitement. In fo far as they effea that, and thereby invigorate the funaions of life, they are proportionally as ufeful a^ opium, anher, mer- cury, brandy, wine, or bark, But the purging I conceive to be propprtionally as injurious a con- iequence, and as much a mark of indirea debili- ty, as the headach, ficknefs, and vomiting, which follow an eiccefCve or irregular ufe of thefe fub- ftances. This lubjea is considered at greater length el few here. C A $ £ VII, John Brown, aged 28, was admitted into the General Hofpital, at Calcutta, on the 10th of July, 1796, with typhus fever—He had befides a fore leg, and chancres. His fever, although ap- parently flight, was very obftinate. In the courfe of two months, he was feveral times almoft cured, by fmall and frequently repeated quantities ofo- pium, mercury, wine, and bark, varied according*' to circumdances. But, feeminglyin confequence of internal local affe6tion, he as often ro-lapled, without any apparent caufe. His fever, from con- tinued became remittent, and from remittent in- ^6 eAsts, Sec. termittent. .On the 24th of September, fufpeaing the exiftence of local difeafe, I reprefented to him ;the neceflity of undergoing fuch a courfe of mer- cury as to affea his mouth, to which he had hith- erto expreffed an infuperable averfion. He had, for fome days previoufly, taken calomel in fmall dofes ; and had latterly two emetics, at his own Tequeft.* On that day, he was ordered to take ten grains of calomel, and fifteen grains of jallap every four hours.—25th, he had taken three pow- ders in the courfe of the day, and was exceffively purged and griped through the night, t He had ilo fever. Two grains of opium, and four grains * That tartar emetic n a flimu'.ant of a very high power ij evident from the fmall quantity-of it, which producei the flare of indirefl debility, that occafioos vomiting.. It fliould .be given in fuch a manner, as to increafe and to lupport the ex- citement. But this will be found difficult, as the duration of its aftioo feems to be even {hotter than that of opium. If its aQion does not continue more than a quarter of an hour, might it not be repeated at fuch fliort intervals, and the dofes fo grad- ually reduced, as not to allow the eftablilbment of indircti de- bihty ? If, when given at fuch a random rate, as to produce vomiting, and the mod difagreeable fenfations (hat can be im- agined, medicines fometimes produce good effefls, bow much more ufeful muft they be, when given according to juft prin- ciples ? The predjudices of patients may fometimes be tufa. ed to their advantage, by judicioufly alternating (Umuli, "fo as to humour their whims. The medical prejudices ef the vulgar, are generally diclated by thofe of phyficians. At pre- sent ihey are as unreafonably in favour of tartar emetic, as they are againfl opium. + This is one of many fiflj that prove purging to be the effccl of a flatc of indirect debility, occafioiied by the impro- per fubdu£lion of flimulant powers. Had the powders been regularly repeated in th« night, the purging and griping would rot have taken place. This I have obferved fo repeatedly with refpefl to calomel, that T bars jqo hefitaiian in afftfling it to he aa undoubted f*d. oasej, Sec. 67 of calomel were direaed to be taken every three hours, through the day, and four grains of each at bedtime. 26th, the fame plan was continued; and he bad no return of fever.—27th, he had no fever and his mouth was very fore. The pills were ordered to be given every fix hours. 28th, his head, face, tongue and throat, were much fwelled ; he had a- confiderable dif- charge of blood from- the mouth and- fauces, and fome purging. In this cafe, the medicines were by no means correaively exhibited* But it i* probable alfo, that they were not regularly taken* Salivation, or, in cafes of local difeafe, where fair ivatkm cannot be produced, a difcharge of blood from the mouth and fauces, does not take place* while the mercury is regularly taken, but when it is either fudde.nly laid afide, ortgiven afe. improper intervals.*, The following mixture wasi pjrefcribed—tinaure of opium three hun* dred drops---water one pint—peppermint war- ter and fugar, as much as will make the mix- ture agreeable—an ounce, of it to be L;ken every hour. The pills were omitted. On the 29th and 30th, he continued the mixture ; his mouth was better; he had.no fever, an'd butlittle purging; and his pulfe was 86.—Oaober the 1ft, his pulfe was 76, and of good ftrength; his mouth was much better; and he had no return of fever. The tinaure of opium was diminifhed to two hundred drops.—From that period, he recoveredin ftrength and had no return of fever. The mixture was gradually decreafed in ftrength and discontinued. On the 16th of Oaober, he was difcharged appar=* ently well. * Vide the fubfequeot cafes,, a ad the " Treatife on Mer- cury." 6& CASES, &CC. There are feveral inferences to be drawn from this cafe. The obftinacy of the feVer con- vinced me, that it depended upon local difeafe, and determined me to give mercury in large dof- es. The difcharge of blood from the mouth and fauces, without a previous increafed flow of faliva, Was an additional proof of the exiftence of inter- nal local affeaion. And,- althdugh this patient left the Hofpital apparently welly 1 am convinced, from the circUmftances mentioned, as well as from an irregularity of his bowels, that his abdominal vifcera Were in a difeafed ftatej and that bis ex- emption from general difeafe was merely tempo- rary. From thefe obfervations, I would not be underftood to infer* that mercury aas as zfpecific in removing local difeafe ; but that, by fupporting the excitement of the whole body, it invigorates each particular part, and thus occafions, to a cer- tain extent, the regeneration of thofe organs, which may have been injured by difeafe. This is not the only inftawce, in which the good effeas of opium have been experienced, where an exceflive falivation, or a difcharge of blood from the fauces, after the ufe of mercury, had ta- k£n' pkce^ As; thefe- fymptoms happen from too fudden a fubduaion, or an1 irregular repetition of the mercury ; fo they may be either obviated or removed* by a proper application of the fame power. But as the prejudices of patients will fel- dom admit of a continuance of the medicine, in thefe cafes, it is abfolutely neceffary to fubftitute fome other ftimulant power, equivalent in force. Thofe which I have found to anfwer beft, are o» pium, blifters, and the warm bath. Other ftimuli, juftly proportioned might, no douht anfwer equal- CASES) Set. 69 \yt well. . But from the endlefs hypotbefes of the art, no, fuccefsful attempts have yet l?een made to afcertain their relative powers. This i»a difcovery, which, however diftant, tarn yet fanguine enough to expea. For,in the medical as in the moral world, attacnmen t, to principles inftead of perfons, may be expefted to increafe, with the progrefs of khow- ledge. CASE viii. Henry Dallawal, aged1 26, Was admitted into the General Hofpital, on the evening of the a.td of October, 1796. He had, for a fortnight before, complained of headach, pain of loins, hoarfenefs, and cough, Sec. pulfe 58.' He Was Or- dered to take two grains of opium and four grains of calomel, at 9 o'clock, P. M. arid again at twelve. On the 23d, he was fomewhat eafier. Pulfe as before.' He had no ftool. One grain of opium and three grains of calomel, wete given every three hours; and feyeral glyfters of caftor oil. -9 o'clock f. M. he had one ftool. The opium and calomel were defired to be repeated as the night before. Pulfe 64.—24th, he thought himfelf better ; but his cough continued fevere. Pulfe 56. He was defired to take four grains of calomel every three hours.—oVclock P. M. he was not fenfible that 7o" CASES, -&z. th e p i 115 prods c C-rl an t> e fife B." Fo or grai rts of op; - um and ten grriiirs of calomel wefe" brdcred to be falcon immediately, afid' repcated'a't 12 o'clock.— 55th, he was fciztd in the morning' with viol en 2 f^.afms\ Pulfe itfift' He w^'spu't into the warm bath" which Was 01 de-red to be repeated according to circumfiances." ; Afterwards, two grains of opi- um and-four grains of calomel were direaed to be taken; every two hours, day and night.—26th,, be was much better and had no cough. The pills were continued.—27th, he thought him- ftlfBiR'er. His]5TnMe'beat"only 4$ ftrokes in the minute. The pills were repeated every three hours. —2 8th,his mouth was gently affeaed. Two grains of opium and two vgrains of y calomel were given every three iroiirs!—29th, "he was in every refpea better, had fome flight fpitting, and felta re- turning appetite. Pulfe 68; One grain of opi-- um^and one grain of calomel were given every four hours.-—On the 30thy He Was difcharged well. ' Aw uncommonly flufTved; countenance, and what is called a plethoric habit, together with art. umifual flownefs of pulfe, hoarfehefs, cough, and bains, would-have indicated, ''according to the common praBice, blood-letting and other evacua- tions, In this cafe. The powers, however, by which a cure was effeaed, proved, that thefe fymptoms depended upon a ftate of indirea debility ; and that the "ufe of debilitating powers, would have neen improper. For the fame reafon, it may be inferred, that a peculiar flownefs, as well as a quick- hefs of/the pulfe, fometimes/ take's place in a ftate of indirea debility. : Every departure of the pulfe Trorn. the healthy ftandard, whether in quicknefs or JTbwnefs, depends upon debility ;'as well-as'every. deviation from health, in any of the other funaions*- c/>.ses, 'Sec* -Tl •Coftivenefs, as well as purging,'depends upon de- bility of theinteftinal canal. .This is {hewn from patients affected with die fame difeafe having, .jtn fome cafes a quicknefs, in others, a flownefs pf „pulfe; in fome cafes, purging, in others coftive- p-iiefs ; and aft of them being cured by the fame means. It is farther corroborated by the proof, ;that fuch a ftate as that of, exceflive excitement, cannot take place. A« blood-letting is the abftrac- tion of a high ftimulant power, it muft be fhewn that difeafes of exceflive excitement exift, before it can be admitted as a remedy. Or if it be con- tended that blood-letting is ufeful in difeafes of de- bility, it muft be fhewn that it a6ts as a ftimulant power. Mere affertions that it has been found ufeful. do. not amount to a fufficient refutation of ibis reafoning. ■■*!-' :nr There was an error of fome importance in the treatment of this cafe, which affords the moft con- vincing proof of the neceflity of repeating, the do- les of medicines,'at certain regular- intervals, and by a certain rule.—On the.morning of the 25th,— after having taken four grains of opium and ten • grains of calomel, at nine and at. twelve o'clock, ihe preceding night, the patient was feized with violent griping and fpafms.f This fyinptom, as*-I have had frequent opportunities of obfeving, was1 undoubtedly owing to the'dofes not having?been repeated at proper intervals. If a dofe of equal 'itrengtb, or one fomewhat fmaller, had been given at three, and another ft^ll fmaller, at fix o'clock in the morning, the ftate of indirea debility, confti- tuting fpafm, would not have taken place. A j thefe fymptoms may be occafioned, or prevented, r.t pleaftare^ tlie. fdflis incontrovertible. In tbh J2 CASES, &C* cafe, they immediately yielded to the ftimulant power of the warm bath,—another proof that they arofe from a ftate of indirea debility, occasioned by a deficient frequency or force, in the applica- tion of ftimulant powers. Opium, calomel, cam- phor, aether, or caftor oil, given in juft proportions, would have produced the fame effea with the warm bath. But external applications may often, with great advantage and conveniency, be alternated, or conjoined, with internal remedies. CA&E, IX, Robert Williamson, aged 25; was ad- mitted into the General Hofpital, at Calcutta, on the 28th of Oaober, with a quick and fmall pulfe, laborious breathing, pain of back, loins, &c. His face was tirged, and his eyes redandftarting. His tongue was foul and furred. He reported that he was attacked with fever, feven or eight days before, which had become more fevere and continued for the laft two days. Some medicines had been ta- ken before be came into the Hofpital.—At 3 o'clock P. M. when I firft faw. him, ten grains of calomel were ordered to be taken every three hours. At 10 P. M. his pulfe was 112., and his breathing exceedingly laborious. A fcruple of calomel was ordered to be given immediately, and to be repeated at one o'clock, A.M. A bliftcr was applied to his fternum. On the 29th of Oc- tober, his pulfe was 120, with burning heat of fkin. His tongue felt like a rough board. He had one fmall ftool in the morning.. Ten g.rain,s of culo* cases, Sec. 7$ mel were ordered to be repeated every three houte. At g o'clock P.M. his pulfe was 124. He had one ftool* ; his breathing was laborious, his eyes ftarting, and he feemed in all other refpeas worfe. Three grains of opium and twelve grains of calo- mel were defired to be given immediately, and re- peated at twelve o'7.ock." paober-the 30th, he died at 4 o'clock, A. M. ■ .-u rr?l -■ ' -Sli ' Upon diffeaion, the thoracic vifccra were found adhering to eacbottier, in fuch a manner as to form but one tnafs. The lungs adhered to the 'pleura?, mediaftinum arftfc diaphragm ; the heart to the pericardium • and the pericardium to ;all the furrounding parts. The Adhcfions were remarka- bly ftrong as well as general. The lungs were of a darker blue-than ufual. Upon a general view of the abdominal vifcera, they appeared to be found. The fcrotum was gangrenous. In one of the arms, there was a mark of a recent incjfion made by a lancet. This was undoubtedly a cafe of the moft vio- lent peripneumony. According to the common praaice, the patient would have been repeated- ly bled. 'Would the abftraaion of blood have produced a refolution of >the adhcfions, which were found in the thorax ? The greateft partizan of the praaice, I think, would fcarcely affirm ft. According to the confuted notions entertained of peripneumony being a difeafe of exceflive excitc- * In this cafe the medicine feemed to produce but a very fmall eff-ct. If 10 fuppljr ihe wafle of ibe etcitabiliiy be ihe proper fuocUon of (he lungs, it is evident that, aficr a certain degree of organic lefion has taken place, it cannot be recruited. hat ftimuli ave not therefore to be withheld. For, by %h % treatouwr, the excitability m„ft i,e Hill farther exhauflcd. y^ cases, etc *' «nent, it becomes neceffary, in order to preferve •fome appearance of confiftency, to divide the di£> cafe into different ftages ; and to ufe a different or eyen an oppofite plan of treatment, in each. Isitpoflible that any difeafe can vary in its prog. xefs, excepting in degree? And if not, ought the powers applied for the cure ♦:> be varied, in tfye progrefs of any difeafe, expepting in their, degree of force R Thefe would appear to be the conclu- sions of reason and common fenfe, $ut to over- turn fuch flimfy arguments, come in medRal by- pothefes and fay " inflammation wefuppofe arifes *Vfrom an increafed impetus of the blood in the ;j*fc part afte^ed, $nd is therefore to be oured by *' diminifliing-$he quantity of that blood, In pe- " ripneumony, there is an inflammation of the *l lungs; and in order to cure the difeafe, the im- " petus of the blood in the lungs, muft be leflen- " ed by blood-letting/' To this curious fabric of areafoning, 1 v.ilj juft oppofe a fingle faa.-—There is not an inflammation, with which we aTe.acquaint- ed, that is not to be cured (as far as it is curable) by the application of Simulant powers,—as warm fomentations, tinaure of opium, tincture of can* charides, camphorated fpjrits, aether, volatile alka- li, and mercury. If any perfon ferioufly doubts the faa, it will be an eafy matter to fubmit it to the teft of experiment-—And if there be any oth- er reafon, for perfevering in the praaice of blood- letting, than becaufe it is derived from the hy, pothefes of the fchools, and is conformable to.cuf- tom, let it be produced. That blood-letting had been ufed, in this cafe, previous to the patient's having been fent into the hofpital appears proba- ble from the incifion in the arm :—that he was purged is known. As catharticks, however, pro- duce an increafed . degree of esculent, befor/ ca-s£s,: <£e. fg the debilitating operation of purging fuc'ceeds, their ftimulant effeas will often more than coun- terbalance the indireaiy debilitating effeas, which afterwards arife. But as blood-letting is a direa> ty debilitating Operation,—the abftraalon of an' ordinary and powerful ftimulus,—itrmuft always^ be highly injurious In difeafes of direa debilk ry, as far as they can become fubjecis of medical' treatment, if muft add to the accumulation; in thofe of indirea; debility, it muft increafe the ex- hauftion* (*). It is upon the fuppofixion alone that fome difeafes depend' upon a ftate of exceflive excitement, that blood-letting can 'ever be thought aximiflible; And that fuch a ftate doe* not exift has, in my opinion" been fully proved. j* krtowit will be urged, by individuals, that they have found blood letting ufeful. But this like many oth- er medical faas, is mere aflerlion, not proof. Whatever has been ufeful in one cafe, muft be ufeful in every OmilarcaTe of difeafe. But it is not fo with blood letting.—It Has not invariably been found Ufeful in any One difeafe. We may there- fore,* I think, fairly conclude, that it has never been ufeful in any one cafe of difeafe. If it be fai'd that this is reafonihg, and that experience ; let me be permitted to afk whether juft reafoning and real experience can ever differ ? It is impoflible. -—Whatever is true in theory, muft be right in- praaice. To inculcate a contrary opinion is the grand fhield of empiricifm. CircUm fiances de- livered as fa as, from the prefumed experience of individuals, ought never to Weigh againft princi- ples which are deduced from numerous and un- doubted faas$ and which can be put to the left or experiment by all mankind. <-Vide " View: of ihe Suenceof-Life/1 Ptop. XXVI. 76 ca»es, Szc. The quantity of calomel given here was large*, £ut after taking two fcruples at two dofCs, and a!-. lowing time for the operation of purging from in- direa debility to. take place, only one fcanty ftool was produced. This fhews clearly, that, although' the quantity was large, in proportion to what is u- fually given, it was by rib means fufficiently large in proportion to the exhauftion of excitability thai; had taken place; or, in other words, to the vio- lence of the difeafe. Although it be extremely doubtful whether the excitability can ever be ac- cumulated to the healthy ftandard by any degree of ftimulant power, when fo many principal or- gans have become unable to perform their func- tions ; yet it is certain that, in order to give a pa- tient, in fuch circumftances, the only chance of cure, the ftimuli fhould be increafed in power, un-^ til they produce fome effea. In this cafe, there* fore, the medicines fhould have been both increaf- ed in quantity, and more frequently repeated. But as, in every kind of praaice, the prejudices of pa- tients, or carelefsnefs of attendants, Will frequently render it impofiible ftriclfy to adhere to the appli-| cation of principles, We can only make fuch ap- proach to them, as thefe, and other circumftances, will permit* Had it not been my wifb to bring the theory and praaice of this doarine to the fulleft and fair- eft proof of difcuflion and experiment, this is one of thofe cafes which I would have fuppreffed. It is to fie regretted that Writers.do .not oftener think it neceffary topublifh their unfuccefsful as well as their fuccefsful cafes. CASE X. Robert Woodside, aged 25, was admitted into the General Hofpital, at Calcutta, on the 24th of Oaober, with a dyfentery of a fortnights ftand- ing. He had io or 12 ftools in the day, with blood ; and complained much of headach, pain of loins, griping, and tenefmus. He lay eafieft on his right fide. His pulfe was 108 : and he had frequently a flufh in both cheek's. I began by giving him fmall dofes of calomel, frequently re- peated ; friaions of mercurial ointment; and draughts of 70 or 80 drops of tinaure of opium, repeated according to circumftances, through the night. In the courfe of a few days, the calomel was increafed to fix grains, with two grains of o- pium, every two hours ; an ounce and a half of ointment was rubbed in at four times, in the courfe of the day ; and draughts, with two hundred drops of tinaure of opium* in each, were given, every feCond hour, during"the night. The calomel was occafionally alternated with camphor, and the tinc- ture of opium with aether. Blifters were applied, and glyfters of caftor oil frequently given. Thefe applications were made in concourfe or fucceflion ; and increafed or diminifhed in ftrength, according to the judgment formed of the ftate of the excite- ment,atthe time. Forafortnighthefeemed to get better ; at one time the purging rather decreafed, * Some cafes of dyfentery will require much more than this quantity. It is to be recolle&ed however, that the laudanum teas weaker, perhaps one third, than what is commonly uicd in Europe. ;« cases, Sec. and he had no blood in his ftools. But from his mouth not being affc6ted, fo as to produce an in- creafed flowof faliva,-after having ufcdan uncom- mon quantity of mercury ; from frequent ficknefs and vomiting ; his always lying on the right fide; fome degree of fillinefs and anxiety ; an occafion- al flufh of the cheeks; and his having no appear- ance of getting better upon the whole; I con- cluded, although there was no apparent enlarge- ment, that his liver was difeafed.* The medi- cines, however, Were continued, with a view of fupporting the excitement, with as much equality as poflible. He continued nearly in the fame ftate as at firft dcfcribed, until the 14th of No- vember, when his pulfe (which had varied through- out from 6410 108,'with intcrmiffionsoccafionally) increafed in frequency to 120. His tongue be- came very dry and glofly. On-the 15th, togeth- er with his other fymptoms-, he had a fevere hic- cup, and intermiffion of the pulfe after every 7th or 8th beat. * On the i6tfi, the hiccup was fevere and inceffant; bis pulfe 116, and intermittent; he had no power in his extremities—and at ten o'clock* ?. M. he died. In tedious illnefs, patients naturally get dif- gufted with their medicines in the courfe of fome' weeks, or their attendants become negligent. Al- though both thefe circumftances happened, in fome degree, in this cafe, the direaions were up- on the whole obferved with much punaual* ity. From the beginning a cure was not expea- ed. For in every fimilar cafe, of between twen- * By difeafe of the liver is meant, that flate in which it i'j incapable of performing its funflions, whether it cor.fjft in in- flammation, fuppuratiop, induration, enlargement, oYc, ■ -cases, See.. -?<> ■ty and thirty that were opened by myfolf, and fome by Dr. Yates, the appearances of local difeafe were fo much alike, that I can nowalmoft venture to pronounce, from the fymptoms, in what ftate the vifcera will be found, upon diffeaion. In this cafe, I was fo certain the liver was difeafed, that it was mentioned in the daily report fome time beforehis death. Upon diffeaion, there were found feveral abfeeffes in both lobes of theliver, commu- nicating with each other, and containing, in all, a- bout one pound of matter, of a thick confidence and white colour. On the upper furface, there were five or fix ulcers, communicating with the abfeeffes. The edge of the right lobe, a part of the colon in contact with it, and part of the dia- phragm, at its origin from the cartilages of the ninth and tenth ribs, were all fphaceiated. The -interlines, omentum. Sec. were adhering through- put. Are fluffied cheeks a fympiom common t& perfons whofe vifcera are deceafed, whether of the thorax or abdomen ? I have frequently obferved it in both. CASE XL Thomas Kellan, aged 28, was admitted into the General Hofpital, at Calcutta, on the 2d of October, 1796, with dyfentery of five weeks (landing, accompanied by pain in the region of rh^ liver. He had the ufual fymptoms of griping, te- .icfnus, and a difcharge of blood ; generally lay e-- So cases, Sec, ther upon his right fide, or in a fitting pofition ; in the latter of which he found moft eafe. He was frequently fick, and vomited. His tongue was white and furred ; and his pulfe 1:04. Four grains of calomel, and one grain of opium were given every hour. One ounce of mercurial ointment, and half an ounce of calomel were rubbed in. On the 4th, he was eafier, and had flept well. His tongue and pulfe remained as before. The oint- ment was ordered to be rubbed in, morning and evening, and the pills to be continued*; he was allowed eight glaffes of wine in twenty four hourst. —Eight o'clock P. M. he had flept much during the day ; pulfe 120 ; he was in other refpeas much as before.—5th, his pulfe was 120, and he complained of weaknefs. He had fix or feven ftools, without blood ; and was much inclined to dofe. He complained of confiderable pain, and burning fenfations, in the region of the liver. A blifter was ordered to be applied ; and two grains of opium, with eight grains of calomel, to be giv- en every hour. He was allowed twenty glaffes of wine in the twenty four hours.—6th, he had taken ten dofes of the opium and calomel. Was much vomited and purged, and had. fome degree of fe- ver during the night* ; but was then better. Pulfe 108. The pain in the region of the liver * In the commencement, of this, ca^e, two miftakes were made : one in not giving draughts at night, ard the other in not rubbing the ointment at (h ort interval'. + This quantity was by far too little. In a cafe like tb'>, a wine giafsful every hour, would not have been too much. + In ronfequence of the irregular exhibition of ihe pillf. i This frequently happens, '*b-n pills aie j^ven in ihf Ciav. and d<.(rootinoer! a.t "ig'i* « or »ht»» dr*t'^i ;s j:c no- c:vcn at nieVi S» l\SV. OI li7S2I. CASES, SCC. 8l Was fomewhat relieved. A pill of one grain of opium and four of calomel was ordered to he ta- ken every hour ; a draught with one hundred and jfifty drops of tinaure of opium, to be given at eight o'clock P. M.; and to be repeated at twelve. The ointment was continued.—7th, he flept well, and had only two ftools. Had taken feven pills, and the draughts; pulfe 100. The pills, ointment, and draughts, were continued.—8th, he was con- siderably better ; had five or fix ftools. He had taken eleven pills, and the draughts, the pills, ointment and the draughts reduced to 100 drops, were continued.-9th, he had taken ten pills, and one draught; had fome ftools yef- terday,but none laft night. Pulfe 100; no fick- nefs. The medicines were continued..—10th, hav- ing begun to get indifferent about taking his med- icines, they were varied, in order to humour him. Inftead of the pills, a mixture confiding of half an ounce of tincture 0f opium, and one pint of water, was given in divided portions, in the day. This was again alternated with pills. Blifters were repeatedly applied, and the draughts were contin- ued ; but the pajn and burning fenfations over all bis abdomen fcknefs and vomiting ; frequency of ftools with blood ; fmallnefs of the pulfe, Sec. feemed to be rather increafing. On the 14th the tinaure of opium in the mixture was increafed to an ounce and a half, to. one pound of water, of which he was ordered to take an ounce every half hour ; the ointment was omitted, and the draughts continued. On the 15th, he faid that he had been eafier the day before ; but having be- come irregular in taking his draughts, he was fre- quently purged and griped at night. From that period till the 23d, the opium and calomel, from WO to four y.-'i;!* of -'"'• ^^? ir^ *"",TTl *"iX t0 te*' 82 casks, Sep, grains of the other, were alternated with the mix- ture ; the ointment was rubbed occafionally ; and the draughts, with from 60 to 100 drops of tinc- ture of opium were giyen at night, or 3 or 4 grains of opium, whichever he feemed inclined to prefer. From the 23d of Oaober, to the 18th of Novem- ber, he appeared to be fo much better, that, al- though confident of the exiftence of much inter- nal local difeafe, I was not without hopes, that it was of fuch a degree as to admit of a reproduc- tion of parts. His pulfe varied from 80 to 96. The dofes of medicines were confiderably diminifh- ed. Camphor, fourgrains every two hours, was al- ternated occafionally with the calomel and opium. Glyfters, with one ounce of caftor oil, were fome- times given every hour, or every two hours ; and two pounds of decoaion of bark, with an ounce of powder, was given in the day. The ointment, and calomel pills were gradually diminifhed, to two drachms of the former, four times in the day; and two grains of the latter, every two hours. His ficknefs and vomiting ftill recurred. The burning fenfations of the abdomen continued. And he was fenfiblc of a feverifh exacerbation every third day.—Nov. 17th, the pills were omitted, and the other medicines continued.— 18th, he had not taken any of his medicines the day before. Com- plained of tbcoffenfivefmell of his breath. This was evidently occafioned by leaving off the med- icines. Being tired of all thofe to which he had been accuftomed, I thought it might be of ufe to try the effeas of hepar fulphuris, to remove the offenfive fmcll of his breath, and prefcribed one drachm three times a day. The other medicines (viz. decoaion of bark, glyfters, and draughts) uere at the fame time, defired to be continued. -—-20; he had frequent ficknefs; and vomiting; cases, Sec. 83. much purging, and great thirft. No appetite; and a fenfe of burning heat in his ftomach and in- teftines. Common flowers of fulphur had been given inftead of hepar fulphuris. They were de- fired to be omitted. Two pounds of decoaion of bark, with half an ounce of aether, was given, in the courfe of the day ; and the draughts were repeated.—22d, his fymptoms continued as before. There was an evident enlargement of the right lobe of the liver; but no perceptible undulation. From that period, he had two pounds of decoaion of bark, with two hundred drops of tinaure of opi- um, in the day ; the draughts occafionally at night ; calomel, caftor oil, and:other medicines were alfo given, and alternated, fo as to prevent, as much as poflible, his beingdifgufted with a famenefs of treat- ment. But the fymptoms were rather increafing in violence. The purging became more fevere, with blood in the ftools ; ficknefs and vomiting more frequent; he complained much of heart- burn ; and had fometimes feverifh parox) fms, which feemed to be-of a quartan type. There was from the beginning, a flufh in both cheeks, like thofe of a confumptive perfon. He complained of infenfibility of the back, and weaknefs of the ex- tremities. From all thefe circumftances^ and from no increafed flow of faliva having been produced by the mercury, I concluded that there was fuch adegree of local difeafeas to render the cafe incura- ble, by any treatment that was poflible, in fuch a. fituation, to be purfued. It was, however, per- fifted in, with as much regularity as was praai- cable. He continued gradually finking, until the 2d of December, when he died. Upon diffeaion, the left lung was found adher- ing ftrcngly. to all the neighbouring parts. Its *4 CASES, oJC. fubftance was unufually dry, hard, and yellow; and appealed as if it had not, for fome time, trans- mitted blood, or performed its propeV funaions. The liver weighed about five pounds,* was con- siderably indurated, but had undergone no fup- puration. The other abdominal vifcera were ad- hering, in fuch a manner as to form but one mafs; with the exceptionof the fpleen, which had a found appearance.—The ccecum, colon, and reaum, were ulcerated throughout their whole extent. The ulcers were, in many places, an inch in diam- eter ; and had penetrated the two inner coats. It is fomewhat remarkable that, in between thirty and forty cafes of dyfentery which I have feen o- pened, there was not, in a fingle inftance, any of the fcybali mentioned by authors, as a fymptora of that difeafe. The uncommon quantity of mercury that was here ufed, without being followed by any affec- tion of the mouth, was a fufficient proof that there exifteda lefion of organs, which, if curable, requi- red the application of ftill higher powers than thofe that were employed. Even in external local af- feaions, it is now well known, that a cure depends more upon the fupport of the general excitement, than upon local applications. The cure then, of internal local difeafe, were it even poflible to ap- ply local remedies, muft ftill be performed by the application of powers, calculated to fupport the general excitement. We have yet, perhaps, no adequate idea of the degree of power, that may fometimes be required, i * The average weight of a found liver, I believe, may he abour three pounds and an half, or perhaps fomewhat more. cases. Sec. H to produce this effea. But it is very certain that while in fome cafes by far too little, in others by far too much of ftimulant power is applied. Mer- cury, for inftance, in cafes of dyfentery, is gener- ally ufed in too fmall proportions, while in venereal cales, it is by much too freely given. Haifa grain of caiomel, or lefs, given every two or three hours, will in a fhort time effea a cure in ordina- ry cafes of chancre, gonorrhoea, or even a certain degree of fyphilis. In thefe cafes, there is fel- dom any great degree of organic lefion, at leaft of thofe organs which are moft effential to life. It is only when fome of the primary organs are in a ftate of local difeafe, that a grefat and long contin- ued application, of high ftimulant powers, becomes neceffary,, in order to reproduce health. Of this ? dyfentery is one of the moft familiar and fatal ex- amples. The diminution of the medicines that was made at one period, upon the profpea of the patient be- ing better was injudicious. Although in fuch a cafe, no plan would probably have fucceeded, a perfeverance in the regular application of high exciting powers, would have given him one chance of recovery. The offenfive ftate of his breath, which he Com- plained on the 18th of November, was evidently occafioned by the fubduaion of the medicines. This is a fymptom of indirea debility, as well as falivation, purging, fweat or anv other effea of an irregular application, or fudden fubduaion, of mer- cury. Tlutt thefe tife&s are fo frequently pro- duced, by the ordinary mode of exhibiting that medicine, c friend, \v!im had with-held the medicines thro^b kindnefs, ihe danger of perfevering in fuch condua ; and en. treated that he would exhibit the dofes exaaiy a.; they were prefcribed, which he afterwards pun6lu- ally did. But in order to enfure a compliance, I thought it- beft occafionally to vry the remedies, BS caSj::, Sec* and to ufe fuch as fliould fall in with the preju- dices of the patient and his friend. Accordingly one drachm ofjallap was immediately given. The .warm bath was defired to be ufed three times a day ; and after the bath, two drachms of mercurial oint- ment to be rubbed in each time.—When the op- eration of purging fhould commence, after the ex- hit-! ion of thejall.ap, a pin confiding of four grains oi'opium, and fix of calon>e', was directed to be given every hour ; and to be continued through the nipht, in lieu oi the draughts.—23d, in the count of the pr.ceding day and night, he had taken nine pills, confifting of four grains of opium and fix of calomel each. He flept well; had lit- tle purging ; and w.-.s free fteen pain. He only complained of weaknefs and thirft. The pills were reduced to two grains of opium* and four grains of calomel, every two hours. The ointment was continued ; and the bath and. glyfters omitted— 24th, he was'better: He ftill paffed fome blood by ftool, and, and had a difficulty in making water. He complained that his mouth was fore. Thefe fymptoms I judged to have arifen, either from the fubduaion of flimulus the day before having been too great, or the patient having neg- lected to take the quantity that was prefcribed. The medicines were defired to be continued ; and the patient was particularly enjoined to take them regularly.—25-h, his mouth was lefs fore, he had fewer ftools,«and no blood in them ; his fkin was moift and his pulfe 80.—26th, pulfe 88, and fmal- ler, i'er'j'oT, and griping continued. By mif- t,ke, he had no pills during the niqht. This ful- ly accounted for the aheration lince :be chv/ be- fore. He was ordered to have a ee>a:t of decoc- tion of bark, with two hundred dvons of tindurc of opium, to be taken in divided c.oieii Through the S/CfES, &n not pre- f ribin.j dr.-.u^hi.s or pii'*, fuiTuictii to I'-jproit wis ceueme ;t in ihe nig?)'. % 9Q cases, Sec. ftitutes vomiting and purging, by exhibiting other -ftimuli, on the commencement of thefe operations., But this is generally very difficult to accomphfh, principally from the ideas, which patients tradi- tionally imbibe, of the utility of thefe operations. According to the hitherto uncertain ftate of the art, it is not furprizing that confutations, in which, to ufe the words of an elegant writer, " learned phyficians neutralize theirplans,*" fhould feldom be produttive of benefit to patients. They are too often fcenes of mutual complaifance, in which he, who has moft to gain, facrifices moft o£ his opinion. This has been a fubjea of much re-- gret to fenfible men of the.'profeflion ; and fuch icenes have confequently been avoided by many of them. It is no mean proof of the truth of the medical principles, afferted in thefe pages, that two perfons, who thoroughlv underftand them, will differ, but in a very fma\l degree, in their applica- tion to praaice. In this refpett, I have known a ■coincidence fo perfea, that it could, in no other manner, be accounted for. Their general adop- tion, then, would banifh that vulgar adage, which, at prefent, not undefcrvedly attaches a degree of ridicule to the cultivators of the healing art, " doc* tors differ." In the report of the £4th of November, it is obferved, that the patient had a difficulty in mak^ ing water, and a forenefs of the mouth, which werfc iudged to have arfen, either from the fubduBion of ftimulus, on the 23d, having been too great, or his having neglected to ufe the quantity prefcribed. This is not hypothefes; but a clear induction ci * A tin's Lettcrj to his Son. CASES, <&C. 3* C*as. It is certain, that a difficulty of making water, is a fymptom that arifes from a ftate of in- direa debility, whether that fucceeds the exhibi- tion of cantha rides, opium, or any other ftimulant power. It is alfo true, that it may be cured by opium, the warm bath, or cantharides. The gen- eral mode of applying blifters is fuch, as often to induce that ftate; and is therefore impro- per. Bidders of a fmall fize, frequently repeated, will produce a regular excitement, like fucceflive fiidions of mercurial ointment. But they ougnt not to lay on the flvin ten or twelve hours ; nor 10 long as to be fucceeded by vefication, which is a ftate of indirea debility. Neither is it neceffary that they fliould be applied, in preference, to any particular fpot. For although .hey make the firft, and a fomewhat greater impreflion, upon the part, with which they come immediately in contaa; yet, to whatever part of the body they are applied, their aaion will extend to every other. The ac- tion of ftimuli upon the excitability, may be com- pared to an electric fhock, which, fecrningly at the fa me inftant of time, affeas every perfon in compa- ny,—the neareft and moft, diftant from the phial. When the modus operandi of the one is afcertained, we may expea to afcertaln the modus operandi oi the other. In the preceding, as well as many other cafes^ medicines were often exhibited improperly ; fome- times from omiflions in prefcribing, fometimes from negligence or miftakes of attendants, and fometimes fVom the prejudices of the patients,. With any number of patients, there cannot be much difficulty in prefcribing, according to th<* fid plan of praaice, which confifts-ingiving certaiii 9* cases, Sec. fixed dofes of medicines, in every difeafe, what- ever'be its degree. Butjuftly to proportion the application of ftimulant powers,'to the exhauftion of the excitability of each patient, requires more exertion of judgment and conhdiivuion, on the part of the petitioner, and a ftriaer conformity with direaions, on the part of the patient, and of the attendants. It is evident then that, in an hofpital, it requires an unufual degree of exertion to apply thefe principles to praaice, in from thirty to forty bad cafes of difeafe, daily. But it is their intro- duaion only (hat is difficult. Once generally ad- mitted, their application would he attended with as milch facility, and certainly with more pleafure, becaufe with more fuccefs: than any routine of empiricifm. C A S £ XIII. Isaac Hudson"* aged 30, was admitted into the General Hofpital, at Calcutta, on the 31ft of Oaober,' 1796, with the following fymptoms ; Pulfe 132, and fmall. He had for fome time fe- verifh paroxyfms, at 11 o'clock, A. M. and at 11 P. M. which continued between two and three hours. Tongue foul ; fkin hot; his bowels were quite irregular, fometimes extremely loofe, at other times exceflively coftive. He had a cough, with hoarfenefs ; and pains of the bones and j >ints. Together with thefe complaints, he had chancre Cases, Sec. §3 bf a fortnights Handing.—One grain of opium and one grain of calomel were prefcribed every hour; and two drachms of mercurial ointment were or- dered to be rubbed in, three times in the dr-.y. November the ift, pulfe 96. The fever and purg- ing continued; His pains were rather lefs fevere. His tongue was very white. Ten grains of calo- mel were given every three nours. On the 2d, his pulfe was 92. He had taken four dofes of the calomel. His tongue was lefs foul. Eight grains of calomel Were ordered every three hours, day and night.—3d, pulfe 88; he had taken eight dofes of the calomel. He had a fore throat and hoarfenefs, wdth an incipient fpitting. The calo- mel was omitted, becaufe it was deemed highly probable that he would not have taken it, if pre- fcribed. Three grains of opium were given eve- ry hour. And three drachms of ointment were ordered to be rubbed in, three or four times in the day.—4th}his mouth and very throat were fore, and hefpit fome blood; from whenceit was conclud- ed, that he had omitted to take his medicines, or that he had ufed them in an irregular manner. A blifter was applied to one of his cheeks ; two grains of opium were given every two hours ; and a glyfter, with one ounce of caftor oil, was ordered every two hours. He was allowed four glaf- fes of wine in the day. On the 5th, his mouth became very fore, and there was fome increafed flow of faliva. A blifter was ap- plied to the other cheek ; the pills and glyfters were continued ; and he was allowed fix glaffes of wine.—6th, his mouth became exceedingly fore, and his face more fwelled. He had no ftool; a N & cases,-. Set. blifter* WES applied to his brwaft. The pills were* ordeied to be continued, and a glyfter, with two ounces of caftor oil, to be given every fecond hour.—7th, he was much in the fame ftate ; the medicines were ordered to be continued,—On the 8th, he had fome difficulty of breathing, his pulfe was exceedingly finally-^nd he bad fainting fits. Upon enquiry,- it was found that he had la|e^ ly negleaed to take the medicines,/which he him. felf confefled. In order to enfure a compliance in this refpea,'a change was made in the medir cines. He was put into the warm bath three times in the day. The glyfters were continued. And fie had three draughts, with one hundred drops of tinaure of opium in each, at regular intervals in, the night. 9th, he was better ;. his pulfe was 108 and ftronger. . Cough lefs fevere; and fwelling of the face abated. The bath, and glyfters were or- dered to be repeated';, .and a draught, with forty drops of tihaure of opium ,> to he given every hour. — 10th, he was much in the fame ftate ; the med- icines were continued.—11th his breath was very foetid, and tongue much" fwelled ; which evinced that he had been irregular in taking his medicines* Abb*Iter was applied to his neck, and the other medicines were continued.— 12th he was rather better ; the medicines were continued ; and two drachms of ointment were ordered to be rubbed in, twice a day.t—14th, his mouth continued very * Among patients, upon whofe veracity there is not much dependence, I prefer in thefe cafes, the ufe of blifters, upon this principle, that they cannot deceive". + Thh was too feldom. Wherever mercurial friftiom a*e neceffarv, they ru^'it to be u'ed a' leaft four t m » in the day : and it would alfo be attended with advantage to repeat thear at night. CASES, ifcc."' $5 :fore, and "he complained of Weaknefs; one drachm of ointment was rubbed in three times in the day, the other medicines continued.— 15th, he feemed better, but complained of weaknefs; fome blood was difcharged from his mouth and fauces ; he did not permit the ointment to be rubbed in, the day before. The ointment and glyfters were contin* ued ; and he was enjoined to ufe'his medicines regularly. The following mixture was given,— decoaion of bark two pounds, powder ofoark one ounce, tinaure of opium one hundred and fifty drops; the whole of it was ordered to be taken, in divided portions, -4^ the day. The draughts xvere continued as before. From that period, he .got gradually better. His mouth became more or lefs fore, in the exaa proportion of the regular- fry, with which he took his medicines. By that fymptom I could detea his irregularities. Hs: continued, for fome.ime, fubject to purging, and flight paroxyfms of fev jr occafionally. But, by a perfeverance in the fame plan of treatment, dim- inution of the medicines, he remained, on the 13th of December, free from complaint, excepting a flight forenefs of the mouth. And on the 14th, when I difcontinued attending him, he was in aij advanced ftate of convalefccnce. This is one of thofe cafes which fhews that fore* nefs of the mouth, and falivation, do not arife from the aaion of mercury, when regularly appli* «d, and gradually decreafed ; but -that thefe, ami other fymptoms of indirea debility aiife in con- fluence of -its irregular application, or hid- den fubduaion. Tl i. patient, like many others, was fo fenfible of the truth of the above obferya- iiiui that, after there, was a nccoffity for ufing the W2im bath, hejoek his n.cdici et with much regu- 96 bases, Sec. larity until he became convalefccnt. He was, from repeated experience, convinced that the forenefs of his mouth increafed, upon the fubduaion of the inercury, opium or warm bath. From the beginning I was doubtful of a ie- covery. For, a fmall and quick pulfe, hoarfenefs and difficulty of breathing, and the very irregu- lar ftate of his bowels, indicated, that fome degree of local affeaion, both of the thoracic and abdom- inal vifcera, had taken place. From the iffue, however, it appeared that they were of fuch a de- gree, as to admit of a regeneration of organs. CASE XIV. Abraham Jackson, aged 23, was admit- ted into the General Hofpital, at Calcutta, on the 15th of November, 1796, with dyfentery of a few days Handing.—16th, he had four dofes,confifting of ten grains of calomel each, through the night. Pulfe 100 ; tongue white ; fkin hot. There was a confiderable quantity of blood in bis ftools. Ten grains of calomel and four grains of opium, were ordered to be given every three hours ; and a glyfter, with two ounces of caftor oil, every two hours. On the 17th, he was rather eafier ; but had been much griped through the night.* The * Griping, purging and rrn!r{Tn'f% are fr-?i'T.i!v nrodu- eed ond( r aconite c;f oiunsn, or mercury, in conirq.jca e ot riie dofes not ben.^ properly repeated ihio^ti il.c :. An.. fZACSzSy SCC. W glyfters gave him eafe. The pills were intended %o have been continued through i.h? night ; but as it was not particularly expieifed in the report, they were not given.—-The pills v.ere omitted ; a glyf- ter was giyen every hour; and common in ufivm of fenna, with two grains of tartar emetic, in fmall. dofes, frequently repeated through the day. Draughts with 80 drops of tinaure of opium, were defired to be given at bed time ; and to be repeat- ed, according to circumftances, through the night. 18th, he was rather better. One grain of opium and four grains of calomel were giyen eycry fecondhour. Two drachms of mercurial ointment were ordered to be rubbed in, four times in the day. The glyf- ters and draughts were continued.— 19th, he had taken only one draught; and his head became confuted .towards morning.*' He was much gri- ped. Pulfe 80. The draughts were omitted, from a conviaion that he would not take them. The other medicines were continued ; and warm fomentations applied to the abdomen.—20th, he had not flept well, and was much purged and grip- ed- The pills were "omitted ; and a folution with ^endrachms,offalcathardcus amarus,andtwo grains of tartar emetic, was given, in fmall dofes, through the day.-—21ft, from this period, he had a quart of decoaion of bark, with one hundred drops o£ tinaure of opium, daily ; one drachm of mercu- rial ointment was rubbed in, four times in the day ; and three draughts, with fixty drops pf tinaure of opium ip each, were given at intervals during the night. He continued to get better. On the 28th, * It cannot *