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NATIONAL LIBRARY OF MEDICINE




        Bethesda, Maryland
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              1 J \
                 THE



  ELEMENTS OF MEDICINE;



                 OR



         «  A TRANSLATION


                OF THE



  ELEMENTA MEDICINE  BRUNONIS.


               WITH LARGE


•NOTES, ILLUSTRATIONS, AND COMMENTS.


    tfY THE AUTHOR OF THE ORIGINAL WORK.
TWO VOLUMES IN ONE.
VOL. I.
    PHILADELPHIA:
PUBLISHED BY JAMES WEBSTER,
1814. 
V
</ 
      PREFACE

                    TO  THE

ORIGINAL    WORK.
X>Y the  Author of this work more than twenty years
were  wafted in learning, teaching, and diligently fcruti-
nizing every part of medicine.  The firft five paffed away in
hearing others, fludying what he had  heard, implicitly be-
lieving it, and entering upon the poffeffion as a rich and va-
luable inheritance.   His mode of employment the next five
years, was to explain more clearly the feveral particulars,
to refine and give them a nicer polifh.  During the next
equal fpace of time, becaufe no part of it had fucceeded to
his mind, he became cold upon  the fubject, and with mr-
ny eminent men, even with the vulgar themfelves, to de-
plore the healing ?rt as altogether uncertain and incompre-
henfible.  All this time paffed anyay without the acciuifiition of
any advantage, and of that, which of all things is the molt
agreeable  to the mind, the light of truth ; and fo great, fo
precious, a portion of the fading and (hort-lived age of man
was loft.   It was only betwixt the fifteenth and twentieth
year of hisfiudies, that, like  a traveller in an unknown
country, wandering in the (hade of night, after lofing eve-
ry trace of his road, a very obfcure  gleam of light, like
that of the firft break of day, dawned upon him.
                         A 2                 Thirteen 
IV
PREFACE   TO  THE
   Thirteen years ago (a), when he was going in the thirty
fixth year of his age,  he fell into his firft fit of the gout.
For many years before he had lived well, with the excep-
tion of having confined himfelf to a diet more fparing than
ufual a few months before the arrival of the difeafe (b).   In
about fix weeks the  difeafe finifhed its courfe, and did not
return till fix years after, and not even  then, but in confe-
quence of unufual low living for feveral months (d).  He
wa6 in the vigour of  his age, and, excepting the taint of the
gout, and fome debility, brought on by his unufual abfti-
nence, his habit was good.   The difeafe, according to an
old theory among phyficians, wras faid to depend upon ple-
thora and exceffive vigour ; vegetable aliment was enjoin-
ed, wine was  forbidden, and the careful execution of that
plan of cure was promifed to be rewarded with no return of
the difeafe.   A whole year paft in a Uriel adherence to this
regimen.  In the courfe of that  fpace  of time, infiead of
never having a return of the difeafe, he experienced no lefs
than four fits,  moft violent, moft painful, and of  a very
great duration: In /hort, the whole year, except fourteen
days, was divided between limping and excruciating pain.
   If an over-proportion of blood and excefs of vigour was
the caufe of the difeafe, according to the general theory Juft
now mentioned, it became next with him a fubject of enquiry,
how fuch diftreffing fymptoms were to be explained; his
reflections were, why the difeafe  had not made its firft ap-
                                               pearance

  {a) Four years mufi be added now, it being that time fince the fecond
volume of the Elemcnta was publifhed, that is, feventeen years fince the
author's firft fit of the geut.  At  this very time Irom hard walking in
very hot weather, to infpeel the beauties and majtfty of Hampton-Court
he had a flight attack, which gave him no fort of trouble, never hinder-
ed him from bufinefs, and which he repelled in lefs than thirty-fix
hours.
  (b) It was about fix months.            (<1) Between five and fir- 
ORIGINAL  WORK.
V
pearance twelve or fifteen years before,at a time when there
was in reality more blood and vigour in the fyftem (e), and
why it only came on after an abatement of diet both confi-
derable in degree and duration; why fo great an interval
of time, during which he had returned to his ufual full di-
et, had intervened betwixt the firft fit and thefe recent ones;
and, why the difeafe had  twice,  almoft  inftantaneoufly,
come on after the change oifull nourifhing diet into a fpa-
ring one.  At laft the lolution of this queftion was made
out by the interpofition of one of greater magnitude, in the
following interrogatories: What is the effeft of food,drink,
and fimilar  fupports of life ?  They  produce  ftrength.
What is their effect afterwards ?  Always  lefs and lefs.
What is it  towards the end of life ?  They are fo far from
giving any more ftrength,  that they evidently prove weak-
ening.   Nay, the  very fame powers, by which life was at
firft fupported, at laft put an end to it, commonly through
the intervention of difeafe.
    As difeafes firft, and  death after, in general happen in
the way that has been jufi  now explained,  not from want,
but an over-abundance  of the fupports of life, he found,
 however,  that the caufe was debility, and faw that it was
 not debilitating (f) but ftrengthening powers that were
 to be thought upon as remedies.   To this fort of debility
 he thought  proper to give the name of indirect.  Such for
                                                    two

   (e) The blood is made  from the food, and is in proportion to th-i
 quantity, quality, and completenefs of its digeftion.  Now, before each
 of  his laft fits for the  time fpecified in the text, as  well as dur'ng the
whole courfe of the attacks of the fecoiid year, his food had been almoft
 folely vegetable, and, therefore, was not fuitcd to produce enough, much
 lefs an exceffive quantity, of blood, and the digeftiou was alfo more
 im perfect.
   (f) according to the common practice of evacuation and ftarving. 
VI         PREFACE   TO  THE
 two  years  was  the fuccefs  of his invigorating plan (g)i
 that at the  end of that fpace of time he only underwent a
 very flight  fit, which did not  amount to a fourth part of
 any of the former ones (h).  N-w, no phyfician will deny,
 that the recurrence of fuch a difeafe as the gouty which had
 made four attacks in one year,  would have been more fre-
 quent than in that proportion the next two years, had the
 fame method of  cure been  continued ; nor will any one
 think the addition of two fits every year too much.   The
 mild fit was four times lefs in degree than the more violent
 ones.   Multiply, therefore,  twelve by four, and, accord^
 ing to that  computation,  the proportion of alleviation of
 the difeafe will amount to a reduftion of eight and forty to
 one. As, during the firft year, he had made ule of vegetable
 food alone, fo, during thefe two years, his only food was
 of the land animal kind, and of the moft nutrient quality.
 Of the latter,  his choice was directed to the beft in kind,
 without any other precaution than being fparing in the quan-
 tity he ufed if).   A young gentleman, who lived with him
 and had laboured under a very fevere afthma, in confe-
 quence of fubmitting to the fame treatment, fuffered only
 one fit at the end of the fame  two years, inftead of experien-
 cing one every day, as he had done upon the common treatment.
   Afterwards to remove an opinion, that had been often
 infilled on, of the gout not  depending upon debility, be-
 caufe  inflammation accompanied it;  little doubting that
                                                    the

 (g) which he immediately after  the, laft mentioned reflections and
 queries carried into execution ;
  (A) the fit that happened at the thirty-fixth year of his age,  and the
 four fevere ones, th3t attacked him about fix years after, all within the
 courfe of the fame year.
  (i) He found moft kinds of fifh, whether from the fea or frefh-water,
nearly as debilitating  as vegetable matter, when folely or chiefly relied
rtyon for a meal, 
ORIGINAL   WORK.
vu
the inflammation itfelf depended on debility, he fubjected
the queftion to experiment.  He invited fome friends to
dinner, and by the ufe of certain ftimulants ufed in their
prefence (k), recovered the moft perfect ufe of that foot,
with which, before dinner, he could  not touch  the floor
for pain.   By thisy^r^7 he faw, that not only the gout itfelf,
but the inflammation accompanying  it, was afthenic (/).
And he found, afterwards, fuch inflammations affecting
the throat  in the putrid, in the gangrenous fore throat,
an i the joints in rheumatalgia, or that rheumatifin which
depends  upon  debility,  and is improperly denominated
chronic rheumatifin (m), and fuppofed, if there be any
truth in that fuppofition to attack the brain in the end of
typhus, to he> alfn afthenic.
   As the gout affects the alimentary canal, and efpecially
the ftomach, and proceeds in its courfe with diftrefling cir-
cumftances fimilar to thofe that happen in dyfpspfia («);
being defirous to know if there was any affinity betwixt it
and them,  he obferved that they, as well as it,  depended
on debility, and yielded to ftimulant remedies.  Nay, he
afterwards found  for certain,  that all  the fpafmodic, all
the convulfive, difeafes of the fame canal (e), and nearly
all the difeafes of children, were of the fame ftamp.
   Continuing his  inveftigation of the fame fpafmodic and
eonvul five difeafes, when they occupy the organs of vo-
luntary motion, he difcovered that their  nature was al-
                                                      io

  (jJYThefe are mentioned in Dr. Jones's Enquiry.
  (/) that is, depending on debility.
  (m) The word rheomatifm, as implying a fimilaricy of the difeafe to
the true acute rheumatifin, fhou Id be rejeded,and this term, taken from
Sauvrv^e, fubftituted in its place.
  («) or indigeftion ;
  (0) or, firft paffages, comprehending the paffage to the ftomach', tli**
organ itfelf, and the inteftines below it; 
 VIU        PREFACE   TO  THE

 fo the fame in  Tandy but only greater in degree; as they
 are  exemplified  in  the fpafms  and  pains, that  occur in
 various  parts of the  external furface of the body, and
 in epilepfy  'p), and in tetanus themfelves.   And  by
 that means he difcerned, that a vaft number of affections,
 in which, upon the fuppofition of their being inflammatory,
 no limits had been fet to the ufe of the lancet, infiead ofari-
fiingfrom an over-proportion of blood and excefftve vigour, or any
 other fuch cauje, depended upon an under-proportion of that
fluid, and other caufes of debility, and were to be cured,
 not by bleeding, nor any other evacuations (q), but by fill-
 ing the veffels, and reftoring the ftrength of the whole fyfiem.
   At firft, for the purpofe of removing fits of the gout, he
 went no farther than the  ufe of wine,  ami other ftrong
 drink of a  fimilar  operationy and  nouiifhing food, that is
 feafoned meat, and kept the ufe of the more powerful re-
 medies in referve.   But, of late (r), his  furprifing fuccefs
 in the ufe of the latter, has enabled  him to find in opium,
 and certain other ftimuli, the fecret of repelling the fits of
 the gout as often  as they returned, and at the fame time,
 re-eftablifhing the found healthy ftate, a  fecret that has hi-
 therto been fo much wanted and defpaired of.   This  he
 has  often effected both  in himfelf and in other perfons.
 It is now going the third year, and near  the end of it (/),
 fince he has always been able to prevent all return of the
 difeafe.
   Taught by fimilar inftances of actual practice, he found
 for certain that bleeding difcharges, which are called he-
 morrhages, do not depend  on plethora  and  vigour, but
 upon penury of blood and debility arifing from any other
   , v                                            fourse.
   (p) or the falling ficknefs,
   (q) fuch as vomiting, purging, fweating, bliftermg, glyftering, $tc,
   (r) that s, now, for many years paft.
   (/") now the feventh, 
ORIGINAL  WORK.
XI
   fource, and therefore did he reject them from the number
   of fthenic difeafes (t) among which they had been arran-
   ged in the firft edition of the text book, referving a place
   for them among the afthenic difeafes in the fecond volume
   of that work.   For he faw,  that bleeding, various other
   evacuations,  abftinence,  cold, and fedatives, as they are
   called, proved hurtful; and that the ftimuiant plan of cure
   alone, was falutary.  Even wine and  brandy, which had
   been thought fo hurtful in thofie difeafes, he found the moft
   powerful of all other remedies in removing them.   Upon
   finding that a certain fa£l; he learned, that in all the dif-
   eafes, in  which others had thought there was abundance
   of blood, there was a deficiency of it, and that from the
   defect of that and of other ftimulants  the real'caufe of the
   difeafes was debility; and  ftimulants,  given in proportion
   to the degree of the caufe, the proper remedies.
      In confequence of the light that thus beamed in from the
   practice, he found, that the caufe and cure of fevers, both
   intermittent and continued, was the fame as thofe already
   mentioned.
      Gradually led, as it were by the hand of nature, around
   the whole circle of  afthenic difeafes (u)  he thoroughly
   perceived, that they all depended upon the fame caufe, that
   is, debility, that rhey were all to be removed by the fame
   kind  of  remedies, to wit, ftimulants (#), and that neither
   their  caufe nor their cure differed but in degree.
                                                     With

     (/) Sthenic difeafes,  ars will be afterwards explained, are fuch as de-
   pend upon an exceffive application of the feveral powers that otherwife
   produce health.
     (u) difeafes of debility.
     (x)  Wherever the word ftimuiant is ufed without a particular quali-
   fication of itF degree, the degree is underftov.Hl to be greater than that
   required in the healthy ftatc, as will  afcervvards more  fully be e;;-
phii-i. 
X
PREFACE  TO  THE
   With refpect  to fthenic difeafes, the nature  of either
 the caufe or cure of which nobody had obferved; he had
 long ago underftood  that inflammation in them,  as well
 as the other fymptoms, were not, as had been univerfally
 believed by Syftematics, the caufe, but the effect: and that
 the inflammation arofe from the caufe, i. e. the diathefis
 fj), and not even from it, unlefs  very violent.   In fine,
 he experienced in his own perfon, that catarrh was not
 produced by cold according to the common opinion, but
 by heat, and the other known ftimuli,  and was removed
 by cold and other debilitating powers.   By which difcove-
 ry he was led to  form a proper judgment of the catarrhal
 fymptoms in the meafles : In which he found, that a very
 great  man who had improved the cure of fthenic difeafes,
but never attained to  any knowledge of the afthenic, had
been mifled, by the alexipharmic phyficians.  And, as thefe
 fymptoms are the moft  dangerous  part of the dikak, he
 was right in fuppofing, that the proper cure of them very
much interefted that  of the whole difeafe.  The confe-
 quence of which was that it came out a demonftrated fact,
 that the refrigerating antiphlogiftic  plan of cure was of e-
 qual fervice in the meafles and fmall-pox-
  In fthenic difeafes he illuftrated  the caufe, enlarged the
 plan of cure, enriched the knowledge of b< th, explained
 and reduced the whole to a certain principle •, he diftributed
all general dikafes into two forms, a fthenic and an afthenic
one (z).   He demonftrated that the former depended upon
excefs, the latter  upon deficiency of exciting power ; that
 the former were  to be removed by debilitating,  the latter
by ftimuiant, remedies;  that  the  hurtful powers  which
excited either were the remedies of the other, and the con-
                                              trary i

  (y) or habit.
  (t) Sthenic fignifies exce&j afthenic a defect, of invigorating power. 
            ORIGINAL  WORK.         xl

trary •, and that they acted by the fame operation with the
powe*s which produce the moft perfect  health, differing
from them only in degree.  He extended the fame doctrine
to plants. He laid down a principle which is illuftrated and
Confirmed by all the parts of the detail, and itfelf reflects
illuftration and confirmation upon every ene of them.
Lafilyy he put the queftion, whether the  medical art,  hi-
therto conjectural, incoherent, and in the great body of it
falfe, was not at laft, reduced to a demonftrated fcience,
which might be called the fcience of life [a\.

 (2.) That queftion has been anfwered in the affirmative by every enc
who had been at due pains to underftand the doctrine.
PRE- 
 
     PREFACE

                   TO

THE    TRANSLATION.
  A PRESSING, and very general, demand for an En-
glifh tranflation of the Elemcnta Medicinae, made feve-
ral  years before the publication of the fecond  edition of
that work, and fucceffively repeated with an encreafing
importunity ever fince;  a  defire  of fpreading the know-
ledge of a doctrine, which had exhibited fo many indubi-
table proofs of its importance and utility to mankind : an
ambition, not quite extinguifhed by advancing years, do-
meftic  cares, and a declining ftate  of health, to get the
better  of the keeneft,  and moft univerfal perfecution
that ever was raifed againft an  ufeful and extenfive difco-
very •, the neceffity for a^ranfiation in the prefent decaying
ftate of the knowledge of the  Latin language,  the dan-
ger of the doctrine coming before the public from adventu-
rers unequal  to the talk •,  and  fome other circumftances,
partly  of a  private, partly of a domeftic,  nuure, with
which  it  would be impertinent to trouble the reader; all
thefe at laft prevailed with the author to fubmit, for once,
to a tafk, otherwife not defirable, that of tranflating his
own work.  Such a tafk feemed more  naturally calcula-
ted  to lay the foundation of the commencing fame of an in-
genious pupil.  But, as no one of many, whofe literature
     4                                          and 
 XIV       PREFACE   TO  THE

 and knowledge of the fubject completely qualified  them
 for the undertaking, wifhed to fuperfede the occafion for
 his engaging in it himfelf;  and as  the courage of feveral
 perfons of a different  defcription keeped not peace with
 their affectation or intereftednefs ; it is  to be hoped the
 public will not be difpleafed to receive the work from the
 author himfelf.  This performance is intended for the ufe
 of three fets of readers ; thofe  who do not readily  enter
 into a thought conveyed in pure Latin,  and who, there-
 fore, might wifh to be poffeffed of a tranflation for the
 fake of comparing it with the original, and, thereby,  of
 acquiring,  renewing, or improving their  knowledge  of
 the latter;  thofe,  who  are  only  acquainted with  fuch
 Latin, as has prevailed in modern times ; and, laftly,
 thofe who either cannot, or will not be  fubjected to the
 trouble of  reading Latin at all, and  who,  furely,  may
 often be better employed.
  Both this and the  original work, are intended not for
 the exclufive ufe of medical readers, but alfb for that
 of the public at large, it  being evident, that  without
 even the exception of the profeffionai knowledge of each
 individual,  that of his  own health is preferable to all
Others.   And fuch an acquifition becomes valuable in pro-
 portion to its juftnefs and folidity.  The public  are pre-
fented with a work, that claims the merit of having redu-
 ced the doctrine and practice of medicine to fcientific cer-
tainty and exactnefs.   With refpect to the form in which
it is delivered, it is ftripped of that jargon of numerous,
unmeaning  or raifleading terms, and all that  myftery ei-
ther in ftyle or matter,  that has hitherto rendered the pre-
tended healing art impenetrable to the moft intelligent and
difcerning,  and locked it  faft  up in the fchools.   No
terms are admitted but the few that neceffity impofed, and
thefe  are every where defined.   The  ftyle is  fimple, and
                                                fuited 
             TRANSLATION.         XV
fuited to the fimplicity of the fubjedt.   In the language and
compofirion,  as  far  as the thoughts,  which  are  new
throughout, and that reftraint, which is infeparable from
exaflnefs of tranflation, permit, clearnefs is every where
preferred to elegance, and diffufionto brevity.
  The author, in prefixing his name to both forms of his
work, has thrown the gauntlet to its numerous, but anony-
mous, oppofers.  They are, therefore, called upon, now
pr never,  to difprove it, and the judicious and  candUl
part of mankind to judge between the parties.
THS 
 
   OBSERVATIONS



         ON THE




CHARACTER and WRITINGS




          OF




   JOHN BROWN, M. D.
Vol. I.
C 
 
        OBSERVATIONS

                 ON THE

CHARACTER  and  WRITINGS

                    OF

       JOHN  BROWN, M.  D,


   At the time I undertook to fuperintend this
 republication of the  Brunonian Syftem of Me-
 dicine, I was pleafed with the profpect  of re-
 cording the life of its extraordinary author.  Of
 the  viciffitudes he experienced I had former-
 ly heard enough to be perfuaded that they would
 furnifh a narrative fufficiently amufing.  I was,
 moreover, aware of circumftances in his hifto-
 ry, which it would be impoffible to relate with-
 out  adverting to  the condition of medicine—a
 fubject concerning which, unfortunately  for ma-
 ny who  have occafion  to feek afliftance from
 that art, grofs mifconceptions prevail through-
 out fociety.
   I find myfelf, however, obliged to relinquifh
 the office of biographer,  fuch as I had conceiv-
 ed it.  Of late I  have had few opportunities of
 perfonal inquiry , and very little  of the infor-
 mation, I had reafon to expect, has reached me.
                                   Never- 
XX
ON  THE  CHARACTER
Neverthelefs,  I may fucceed in delineating the
moral  portrait of my hero,  for  his  character
was exceedingly open to obfervation; and in his
productions the temper and understanding of the
man are moft faithfully exhibited.
  A perfon, who was his fchool-fellow,  and af-
terwards his pupil at fchool, informs me  that his
parents were mean,  but honeft.  What  was the
particular occupation of his  father I have not
heard.   Had his condition been fuperiof to that
of a petty village artificer, I fuppofe  the origi-
nal deltination of the fon would have been high-
er,  for this is  an  affair in which parents feldom
err by  excefs of  humility.
  Mr.  Wait,  the late refpcctable  rector of
Dumfries fchool,  fuppofes that John Brown was
born in 1735 or 1736.   He was a native of the
parifh of Buncle,  in the county of Berwick.  He
himfelf, in order to affociate his name with that
of John  Duns Scotus, commemorates the place
of his  education  rather  than of his birth.—
From  expreffions  he fometimes dropped in his
lectures,  I  conclude that he was  endowed with
that quicknefs of fympathy and that  fenfibility
to the  charms of  nature, which characterize the
infancy of genius.  This warmth of heart,  I
believe,  he never loft.
  . I  am  farry I cannot minutely trace the  fteps,
by which he advanced towards intellectual emi-
nence.  Mr.  Wait, without whofe communi-
                                      cations 
           OF JOHN BROWN,  M. D.         XXI

cations mine would have been a meagre narra-
tive,  flates that   u he early  difcovered un-
" common talents.  His aptitude for improve-
tc ment,"  continues this gentleman,  " induced
"his parents,   after  having fruitleffly bound
tc him apprentice to a weaver, to change his de-
" ftination.  He was, accordingly, fent to  the
Cf grammar-fchool  of Dunfe, where,  under Mr.
" Cruickftiank, an able teacher, he ftudied with
" great ardour and  fuccefs.  Indeed,  he was,  at
" that time, regarded as  a  prodigy.   I went
" the fame road to fchool with him ; and his ap-
" plication, I well remember,  was  fo intenfe
"that he was feldom withoutabookinhis hand."
It  is a fingular coincidence, that the two indivi-
duals, who in thefe times have been principally
celebrated   for their  attempts  to extend  the
knowledge of animal nature, mould  have been
both natives of Scotland,  and that each mould
have  been put  to  a coarfe mechanical  employ-
ment—John  Brown to  the trade of a weaver,
and  John  Hunter (according  to common fame
and  the  report of one of his biographers)  to
that  of a carpenter or wheelright.
   By an anonymous writer, who feems well-in-
formed, it is afferted that Brown " fubm.itted in
" his youth to be a reaper of corn to procure for
u himfelf the means  of improvement.  With
" the price of fuch labour he put  himfelf to
" fchool,  where his abilities and ardour attract-
                                          ed 
Xx'li         ON  THE  CHARACTER

 " ed the notice of his mafter,  and procured him
 " the place of affiftant to the fchool (a)." His
 revolt from the loom, according to this account,
 muft have been attended with highly honourable
 circumftances :  and the reader will  defire fuller
 information  concerning  both his motives and
 conduct than has been tranfmitted to me.—From
 the cuftomof the country, we may prefume that
 he had received much more inftruction, before
 he was put  apprentice, than commonly falls  to
 the  lot of boys of his condition  in England.—
 Confidering the energy of his mind, we cannot
 be furprifed that a little cultivation  fhould have
 rendered  the gloomy and uniform  labour of a
 weaver diftateful.   But this, though true,  is per-
 haps not the whole truth.   As he was repelled  on
 the  one hand,  fo he might, on the other, have
 had  fome peculiar attraction  towards literature.
 The fuppofition is, at leaft, conformable to analo-
 gy}  finceinthe hiflory of eminent men, when we
 are fully acquainted with  it, we never fail to dif-
 cover fome incident, which has determined each
 individual towards the purfuit in which he has
 excelled.   Now I imagine Brown may have ap-
 plied  himfelf  with fuch unufual  affiduity  to
 fchool,  learning from a perfuafion that it would
 qualify  him to propagate  more effectually the te-
 nets of his  feet.   My conjecture is  founded on

   (a) Analytical Review for Auguft, 1789. p. 450.
                                         the 
            OF JOHN  BROWN, M. D.       XXlii

 the following expreffions of Mr.  Wait : " he
 "had at this time"—the time of  his entrance at
 Dunfe fchool,—" fober habits : he was exceed-
 " ingly religious,  and fo attached to the feet of
 " Seceders or Whigs, as they  are called  in Scot-
 " land,  that, I  really believe he  would  have
 " thought his falvation hazarded, if he had heard
 " or read the profane difcourfes of the Scotch
 " eftablifhment.   He afpired to be the minifter
 " of  a purer church, of which it was  expected
 " he would prove a chofen veffel."  Nor is this
 force of religious  fentiment unufual in youthful
 minds.  Samuel Johnfon was early  ftruck  with
 fuperftitious terror :  Haller had  fcarcely emer-
 ged from his  infancy,  when he began to preach
 to his father's domeflics: and in families, where
 the hatred of feet againfl feet is cheriflied, one
 may generally perceive its moft virulent tokens
 in the  boys.   The moft humanized of my read-
 ers may remember the time when he  glowed with
 zeal againfl perfons who had been taught a differ-
 ent creed : and where reflection, foftening the
 heart  into univerfal charity,  has not introduced
 perfect indifference as to the religion or  irreligi-
 on of  others,  the pious flame muft be  ftill alive.
   The years of Brown's grammar education ap-
pear to have been,  in no common degree, well-
fpent and happy.   He had vigour of body with
vigour of mind, and exerted both.   He him-
felf, with much complacency, relates proofs of
                                         that 
XXIV          ON THE CHARACTER

 that ftrength, which his appearance indicated.
 When a boy, he fays he  valued himfelf on being
 a ftout walker.   At fifteen, on a fummer's day,
 he peformed a  march  of fifty  miles between
 Berwick upon Tweed and Morpeth in Northum-
 berland.   Some  years afterwards,  he  travelled
 on foot, refting  but one hour and making but
 one " hearty" meal, from  four o'clock  in  the
 evening of one day  till two in the evening of the
 day following—two-and-twenty hours—with fo
 ftiort  an intermiffion !   During  this txcurfion,
 he traverfed " all forts of ground,  in roads and
 " out, over fmooth and  plain,  mountain and
 ct heath."    We  have fee.n, however, that he
 could make a more rational ufe of his ftrength
 than merely to flake it againfl time and fpace.
   While he was thriving in  godlinefs and know-
 ledge, but at what precife  period I am not in-
 formed, there occurred an incident which finally
 diverted him from the path he had hitherto with
 fo much alacrity  purfued.   At a meeting of  the
 provincial  fynod of the  Merfe and Teviotdale,
 a party of his fchool-fellows urged him to ac-
 company them to the parifh church of Dunfe.—
 He manifefted reluctance,  but yielded to their
 importunity,  and remained to hear the fermon.
 The  fcandal did not pafs unnoticed.  He was
 fummoned before  the feffion of  the feeding
 congregation ; but not choofmg either to atone
 by an apology for his fin in  mixing with profane
                                  worfhippers 
           OF JOHN  BROWN, M. D.        XXV

worfhippers,  or to wait for a formal fentence of
excommunication, he  abdicated his  principles,
and profeffed himfelf a member of  the eftablifh-
ment.   Thus, bigotry is often  but the  mafque
of avarice, pride, or ambition; and here though
the nature of his prefent ^eal was a fecret to the
zealot himfelf, we fee  it fully  difclofed  by this
inftructive anecdote. Encouragementat firft, and
afterwards  flattery, from his brethren, feems \p
have formed a ftrong connection between the pe-
culiar articles of his faith and a fenfe of  his per-
ianal importance •, the moment this  connection
was diffolved, an  alteration of  fentiment fuc-
ceeded, not very much unlike that produced in
Luther's mind by the  offenfive meafure of the
pope :  the opinions he had fo warmly cherifhed
loft all their value in his eftimation ; or rather,
perhaps, became odious from the difgrace  with
which they threatened  him.  Religious enthufi-
afm, however,  furvived this facrifice to pride  ;
and his friends ftill recollect the vehement indig-
nation he expreffed on account of the dangerous
tendency of Mr. HuME's,fpeculative writings;
which,  fome time  after  this  event, he  found
much the fubject of converfation at Edinburgh.
   Thofe who regard the  Scottifh eftablifhment
as the tiue apoftolical church may have caufe to
rejoice,  that fo ardent a fecederdid not perfeverc v
in his original zeal.   For  complaints are fome-
times heard in Scotland,  as well  as in England,
                    D                    of 
XXvi         ON  THE CHARACTER

 of the incrcafe of fectaries -, and he might have
 become formidable as a propagator of fchifma-
 tic doctrines.  Among the divines of his nation
 he would have been unrivalled in claffical learn-
 ing -y  and I fee not what fhould have hindered a
 man endowed with fo acute and comprehensive a
 genius from attaining equal pre-eminence in po-
 lemical divinity.  He would have marched with al-
 acrity into the field of controverfy, and  confident^
 ly affailed the ftoutefl champion of the adverfe
 hoft.   His vehement eloquence mull have been
 deeply felt by  audiences, to  whom his dialect
 was  intelligible  and inoffenfive :  and, as  little
 regard  will be paid to ftyle, when the thoughts
 are intent on the high concerns of grace, faith,
 gcsd works, eleciion,  and reprobation,  he  might
 have  feconded,  with his  pen, the effect of his
 perfonal labours.  Had the  incredulity  of the
 age induced him to undertake  a general treatife
 on  chriftiamty,  he was  capable  of rendering
 Grotius obfolete by language of fuperior purity
 and  more fkilful management of his arguments.
 If he had borne  the crofs  as a feeding minifter,
 he mtift have led a  life  of the ftrictefl temper
 ranee ; fince in Scotland the clergy, even of
 the Gflablilhed church,  cannot fafely  indulge in
 open  diffipation. I need  not  therefore explain
 how  much leifure he  would have had for his
 claffical  and  theological  purfuits.  Nor would
 he have enjoyed fewer or  lefs lively fenfations of
                                      pleafure 
OF JOHN  BROWN. M. D.        XXVii
 pleafure  than a  different courfe procured him ;
 for to  a  perfon  of his  temperament, fame and
 fanaticifm may well fupply the place of wine.
    He  continued at the grammar fchool till he
 had nearly attained the  age of twenty.   In the
 fummer of 1755,  his reputation, as a fcholar,
 procured  him the appointment of tutor  in" a
 family of fome distinction in the neighbourhood
 of Dunfe.   But  here, it feems, he did not long
 continue to be an agreeable inmate.  It is likely
 enough that he had added the ftiffnefs of pedan-
 try to the fournefs of bigotry.  But I have no in-
 formation  concerning   his  deportment,  and
 fhould any of his difciples think a fuller  narra-
 tive due to their mafter's memory, fome notices
 may, I conceive, ftill be collected from the sur-
 viving members of the family.
   When  deprived of this employment, he  re*,
 paired to  the university  of Edinburgh.   In this
 bufy feat of fcience, aftervgoing through the ufa-
 al  courfe of philofophy, he regularly entered
 upon his theological fludies :  he  attended the
 lectures, diligently applied to the perufal of the
 authors recommended by the profcffbr,  and pro-
 ceeded fo far as to deliver  in the  public hall a
 difcourfe upon a prefcribed portion of fcri{>ture:
 which is an academical exercife previous to or-
dination as a clergyman of the Scotch eftablifh-
 ment.   At  this-  point he  flopped, and relin-
 quifhed the  pfofefiion of divinity  altogether.—
                                         The 
XXviii         ON  THE CHARACTER

 The fequel will fufficiently explain his  motives
 for this change.   Its immediate confequence was
 his retreat from Edinburgh to Dunfe.  Here, to
 gain time, as may be fuppofed, for arranging the
 plan of his future life, he engaged  himfelf as
 ufher to the fchool which he had lately quitted.
 In this  capacity  he officiated from Martinmas
 1758 to  Martinmas 1759.  Mr. Wait,  who
 profeffes  himfelf  to have benefited by  the new
 u frier's inftructions,  mentions,  as a proof of the
 accuracy of his memory,  that after once reading
 over, the lelfon, confiding of  two octavo pages
 in Latin,  he would lay afide the book and  pre-
 U5t the whole  over, without miftaking a fingle
 word.   In the courfe of this year, one  of  the
 claffes in the high fchool at Edinburgh  becom-
 ing vacant, Brown appeared as a candidate, but,
 " on a comparative trial,  proved unfuccefsful."
   While he remained at Dunfe, it was remark-
 ed  that the  ftrictnefs of his religious principles
 was  relaxed.   He even  began to be accounted
 licentious  both in  his principles and  conduct.—
 At a later period  he was open enough in his a-
 vowal  of irreligion.  Whatever  fcope  the fact
 may afford to the eloquence  of perfons, accu-
 ftomedto decry Edinburgh as a fchool where  the
 reafon  of  young men is  txercifed  more than
 their faith, it feems too evident to  be  denied,
 that this revolution of  opinion in our ftudent of
 theology took place  during his refidence there.
                                        The 
            OF JOHN  BROWN, M. D.       XXIX

 The  diftinguifhing  portion  of  his  heriditar.y
 creed he had  abjured from pique ; nor can he
 be fuppofed to have had any rational conviction
 of the remaining articles ;  if rational convicti-
 on can only originate in  sincere doubt and per-
 fect  carcleffnefs  in  regard to  the conclusion to
 whith examination may lead.   Under fuch cir-
 cumstances it is eafy to conceive by what a pre-
 carious tenure a  fpeculative ftudent, placed in  a
 situation where information is at hand and inqui-
 ry not only free but fafhionable, holds the bene-
 fit derived  from  the religious leffons of his pa-
 rents and preceptors.  Some unlucky fuggeftion
 may ftart a perplexing fcruple,  the ferious invef-
 tigation of  this fcruple may raife a hoft of diffi-
 culties, and deliberation terminate in unbelief.
   At the time he renounced divinity, the fcene
 before  him must have directed his thoughts to
 the ftudy of medicine.  The only difficulty lay
 in the expence: but his obfervatiorrs might have
 fuggefted the means of overcoming this difficul-
tly,  independently of the  encouraging circum-
 ftance which I  fhall immediately  relate.  He
 mufohave been aware that students of phyficare,
 in general,  by no means fuch proficients in claf-
 fical acquirements as to fpeak Latin with tolera-
 ble fluency.   Hence, before the examinations
 for  a  doctor's degree, which are carried  on in
 Latin, it is common to have recourfc to a pri-
 vate instructor, who converfes with the  candi-
                                          date 
XXX
ON THE  CHARACTER
 date in that language.  This preparation is fami-
 liarly called'grinding, as a fimilar procefs at Cam-
 bridge is, I think, called cramming.   The tranf-
 lation of inaugural differtations into Latin, which
 the  ftudents, in  moft instances,  compofe  for
 themfelves in Englifh-, is another occupation
 from which a good fcholar may derive emolu-
 ment at Edinburgh ; the ordinary gratuity for a
 tranflation being five, and for an  original com-
 position, where that is required, ten guineas.
   Of his qualifications for thefe employments,
 accident, fhortly after his unfuccefsful competi-
 tion for the vacancy  in the High fchool, furnifh-
 ed him with an agreeable proof.   Application
 being made to one of his friends to recommend
 a  perfon to turn a thefts into Latin,  Mr. Brown
 was mentioned.   He performed the tafk in a
 manner that exceeded the expectations both of
 the- friend and the candidate.   When it was ob-
 ferved how much  he had excelled  the  ordinary
 ftyle of fuch composition,  he faid he had now dif-
 wuered his ftrength, and was ambitious of riding iri
 his own:  carriage as  a phyftcian.—Towards the
 chofcof 1759, therefore, he fettled at Edinbi#rgh
 in  the double capacity of teacher and student.—-
At the opening of the feffion, he addrefTed a La-
tin letter to each of the medical profefibrs. They
were  perhaps already apprized of his merit as a
claffical fcholar ; and they were all induced by
his application to  prefent him with a  ticket  of
                                   admiffion 
            OF JOHN  BROWN, M. D        XXXI

 adrniflion to their lectures.   After fo aufpicious
 a beginning, he foon became famous as a teach-
 er of  Latin j and I believe he never afterwards
 refufed to  exercife  his  pen in the tranflation of
 thefis.  He was alfo at all times ready to furnifh
 an  original  differtation  according to the  fyftem
 his employer preferred.
   I have obtained no particular information con-
 cerning the firft four years of his medical  flu-
 dies.   His  circumstances  were  probably more
 flourifhing  than  at  any former period.  From
 the beginning of the masterly preface to his Ele-
 ments it  appears that he profecuted his ftudies
 with his characteristic  ardour.  In 1763,  an old
 acquaintance found him in as high repute among
 his  fellow-ftudents  as he had formerly  been
 among his  fchool-fellows—a distinction  which
 has never been obtained  without the conjunction
 of ability  with industry.  He feems, however,
 during the  intervals of his application, to have
 given into  the  moft dangerous of vices;  " for
 " the langour of his appearance feemed to  fhew
 " that he  had taken liberties with a constitution
 " originally firm and vigorous."
  In certain universities, destitute of foundati-
ons or yearly stipends  for fcholars,  the  students
live difperfed  in ordinary dwelling-houfes:  and
this difperfion,  according to  my obfervation,  is
not lefs  favourable  to diligence and regularity
 than refidence in colleges.   In mixed company
                                          the 
XXxii        ©N THE CHARACTER

 the vicious propenfities, peculiar to any clafs  of
 individuals, will  never be  countenanced ■,  or,
 in  the language  of Dr. Adam Smith,  a  whole
 company can never fympathize in thofe unbeco-
 ming practices, to which a few only feel  them-
 felves inclined.  By this mutual correction, the
 affociation of perfons of different ages and fexes
 becomes the great prefervative of good manners
 and good  morals.   Colleges, which, after the  _
 example of monasteries, feem instituted on pur-
 pofe to  prevent this falutary variety, doubtlefs
 give frequent occasions  to emulation in thofe ex-
 ceffcs,  to  which young men  are particularly
 prone:   A nice obferver, too, may perhaps dis-
 cover that their monadic difcipline irritates full
 as much  as it restrains. At Edinburgh the keepers
 of lodging and boarding houfes have generally
 fober habits; and the obfervance of early hours
 is enforced with as much effect, though with lefs
 form,  than by the porter's lift, the fine, and im-
 pofition.  As far as difcipline regards learning,
 every man mud estimate its value by his opinion
 of  the effect to be produced by fetting grown
 gentlemen  talks.   Where  there have existed
 none of  thofe restraints,  which always give more
 or  lefs difguft, I  have feen a large majority  of
 ftudents purfuing knowledge with as great eager-
 ness as any of their equals in age where elfc-
 where purfuing the pleafures of the chace ;  and
 from the fame motive—the immediate fatisfacti-
                                           on 
           OF JOHN  BROWN,  M. D.      XXX1U

on it affords.   Nor do I believe that the acquisi-
tion of knowledge can be otherwife than agreea-
ble,  except from the fault of the tutor or the in-
stitution.—If  examinations  are  considered  as
powerful incentives to diligence,  none can equal
in feverity  thofe which are carried on at the vo-
luntary  meetings, which it  has  long been the
custom to hold at the great fchool of medicine in
Scotland, and which have since been eftabliihed
among the  ftudents at  the inns  of court in Lon-
don, with the approbation of  the  moft  diftin-
guifhed profeffors of the law.
   Brown,  who now feems to have  fupported
himfelf in affluence  as a single man,  perceived
in the eftablifliment of a boarding-houfe for ftu-
dents,  a refource which  would  enable him to
maintain a  family. His reputation for  various at-
tainments was, he thought, likely to draw round
him  a  number  fufficient to fill a large  houfe.
With this profpect he married  in  1765 ;  and
his fuccefs anfweredhis expectations.  His houfe
was  foon filled with refpectable boarders.  But
he lived too fplendidly for his means,  and " ma-
"  naged foill that in two or three years he became
"  bankrupt.  Towards the end of 1770, though
Cf  reduced  in his circumstances,  he maintained
"  the  independence  of his character,  proving
"  himfelf  to be, in the  language of his favour-
"  ite Horace,
                      E 
XXxiv       ON.THE CHARACTER

               Satis inter vilia fortis.

"  He feems to be happy in his family, and, as
"  far as I could ever obferve, acquitted himfelf
cc  affectionately as an  hufband and a parent.—
"  He ftill frequented the medical claffes,"  (or
lectures) ; " and I heard him fay he had now
"  attended them ten or eleven years."
                               [Mr.  Wait].
   We have feen how liberally Brown was treat-
ed on his entrance upon the ftudy of medicine.
From the celebrated Cullen  he  early  received
the moft flattering marks  of attention.   This
fpecuiatifr,  like Boerhaave and other men of ge-
nius in  the fame station,  was  accuftomed to
watch the fluctuating body of  students with a
vigilant eye,  and to feek the acquaintance of the
moft promising.   There was a period when he
made the greateft exertions to gain profelytes to
his opinions j and his mind was  doubtlefs  alive
to that pleafure which the encouragement of me-
rit affords  to all who are capable of difcerning
it, when no dread of rivalfhip interferes with the
^ratification.   But Brown's power over the La-
tin language ferved him  as  a peculiar recom-
mendation ; and his circumstances might induce
Cullen to believe that he could render this talent
permanently ufeful to  himfelf.   Taking there-
fore its profeffor " under his  immediate patron-
"  age," he gave  him employment as  a private
                                   inftructor 
           OF JOHN BROWN,  M. D.      XXXV

 instructor in  his own family,  and fpared no pains
 in recommending him to others.  A very strict
 and confidential intimacy enfued.  The favour-
 ite pupil was at length permittad to give an e-
 vening lecture, in which he  repeated,  and per-
 haps illustrated, the morning lecture Of the pre-
 fcffor i  for which  purpofe he was intrufted with
 Cullen's own  notes.  Though Mr. Wait  had
 not recollected the profufe encomiums  of his old
 fchool-fellow, his warmth of attachment would
 be fully testified by fubfifting tokens j to his eld-
 eft  fon,   for instance  (William   Cullen
 brown)  were given  both  the chriftian-name
 and  firname  of his patron.   Other proofs of
 mutual confidence and esteem might be collected :
 but friendfhips originating in protection are very
 prone to terminate in enmity, unlefs difference
 of rank and purfuits totally preclude competiti-
 on ;  and it is  well known that  the friendfhip in
 queftion was far from permanent.  My materi-
 als do not furnifh distinct information  concern-
 ing the caufe or pretext of an alienation,  which
 was  certainly injurious to the dependant party,
 and perhaps detrimental to fociety.  In a com-
munication from Dr. S—, likewife an  old and
intimate acquaintance of Brown, it is faid, that
after the failure of  his boarding-houfe,  he  ccbe-
" came impatient,  and unfortunately quarrelled
" with  Dr. Cullen, from a fuppofition that the
" doctor had it in his power  to extricate him
                                        from 
 XXXV!       ON  THE CHARACTER

"  from embarrafTment by placing him in a more
"  liberal and  lucrative situation in the medical
<c  line."   A report I remember to have heard at
Edinburgh coincides with intimation ; but I re-
late it only on the authority of rumour.  When
the theoretical chair of medicine became vacant
either  on the death of Dr. Alexander Monro
Drummond, or  the refufal of this  promifing
young physician  to fill it,  Brown gave in his
name as a candidate.  On a former occafion of
a nature fomewhat fimilar,  he  had difdained  to
avail  himfelf  of recommendation,  which  he
might have obtained witheafe; and though,  ac-
cording to the friend whofe words I have juft
quoted, he acquitted himfelf in a manner far fu,
perior to the other candidates, private interest
then prevailed over the jufter pretentions of me-
rit.  At  the  prefent  competition  he was alfo
without recommendation; and, I iuppofe, could
have obtained none.  Such was his  simplicity,
that he feems  to have conceived nothing beyond
pre-eminent qualifications neceffary to fuccefs  ;
nor did he harbour any fufpicion of thatdebafing
fyftem of influence, which has infected the  land
fo thoroughly, that the pod  of a fcavenger, were
it held by appointment, would hardly be procu-
red without cabal, or retained without fervility.
The magidrates of Edinburgh appoints profeff-
ors to the college, as weM  as maders to the
fchool.   They  are  reported deridingly to have
                                    inquired 
          OF  JOHN BROWN,  M. D.      XXXVii

inquired who this unknown and unfriended candi-
date wasj  and Cullen, on being fhewn the name,
after  fome real or affectecl hesitation, is faid to
have exclaimed in the vulgar dialect of the coun-
try—Why, Jure, this can never be our Jock! With
this fneer  the application of a man was fet aside,
whofe equal the patrons  cf the Edinburgh pro-
fesTorfhips will probably not foon have  an op-
portunity  of rejeding.   Though this  account
mould come near the truth, it  does  not follow
that the municipal board deferves much cenfure.
In the execution  of their  truffc they are indeed
bound to  examine die pretentions of the  compe-
titors, or  rather to  cad their eyes round where -
ever the Englifh language  is fpoken,  and fekd
the perfon beft qualified for the office,  even if
he fhould not enter the lifts of competition.—
But they  had  not our means of deciding j and
although he,  who enjoyed fo high a  reputation
 among his fellows,  and to whom Cullen partly
committed the credit of his fyftem, could  not well
be deemed  a contemptible candidate, there  did
not perhap exists reafons to warrant them in raif-
ing him to the  vacant chair.  Public  fame feems
the fureft guide for fuch eledors ; and the repu-
tation, fo long enjoyed by the Univerfity  of
Edinburgh,  proves that it is a  guide  fufficiently
fure.  The  danger is,  left its patrons, relying
upon the edablifhed credit ofv the feminary,
fhould at any time fuffer intrigue to interfere
                                         with 
 xxxviii      ON THE CHARACTER

 with their choice.  In this cafe a fplendid col-
 lege may indeed  be ereded,  but dudents from
 different regions of the globe will foon ceafe to
 crowd its halls.
   Whether fuch  a  farcafm was uttered or not,
 Cullen (£) completely estranged the mind of his
 Latin fecretary on a fubfequent occafion.  As I
 am not diffidently acquainted  with the particu-
 lars, I cannot venture to appreciate his condud;
 but  the mortal  affront was given, when Brown
 attempted to gain admiffion into thatphilofophi-
 cal fociety whicK publifhed the Edinburgh Ef-
 fays.  After  this  tranfadion,  an open rupture
 took place j but, however it arofe, the account
 furnifhed, if not  written, by  Brown,  evinces
 that  both parties had before conceived a  fecret
jealoufy of each other: the account  is as fol-
 lows :  *r There is a junto of men in Edinburgh
 " who   at  all  times,  from  fear   of  his"
 (Brown's) ,c learning and abilities, have been
 " his determined enemies; and by all arts, but
 " good ones, have uniformly  fought  his ruin,
 " and that of a large and innocent family de-
 " pending upon him.  This  condud, firft  of
 " all,  was the return they made him  for great
 " fervices done  to them as a body, and to cer-

   (<5) Jones's Enquiry into the State of Medicine,
1781, p. 358.
tain 
           OF JOHN BROWN, M. D.     XXXIX

"  tain individuals  of them as friends.   Their
"  open condud to him was friendly j their fe-
"  cret a plot, a dark Catalinian confpiracy.—-
"  Accordingly, his fufpicion of it was late, the
"  full detedion later ....  He  chofe to tear
"  off the mafk of their pretended  friendfhip.
"  His firft ftep was to make application for be-
"  ing made a member of a certain literary foci-
"  cty, to which no man's petition had ever been
"  rejeded before,  or fince: forefeeing that he
"  would be rejeded.  This accordingly hap-
"  pened.   But he  was previoufly advifed by one
"  of themfclves, as a  friend, to withdraw his
(t  letter of application.   A frivolous and falfe
"  caufe was assigned for the opposition.  The
"  friendly monitor who  had perceived that our
"  author had a new dodrine of medicine in me-
"  ditation, began, as it would  appear, to fear
"  that it might terminate  in the extindion of
"  one which  he affumes as  his own.  He was
"  therefore the prime mover of  the plot.—The
c<  anfwer was, in a tone of firmnefs, that the ap-
"  plication would not be withdrawn . . and that
"  the applier" was refolvcd to  make the pre-
fent condud of the advifer  and his friends  "the
"  criterion of his  judgment of their intentions
"  towards him."   The  body muft mean the col-
lege   of phyficians ,  the fiervices I prefume to
have  been the tranflation  of their Pharmaco-
poeia into Latin,  and the plotter unqueftionably
                                         was 
xl
ON  THE  CHARACTER
 Cullen.  After the failure  of this bold  experi-
 ment upon  the ftrength of his credit, the pro-
 jedor had evidently no time to lofe in feeking
 fomefreih refource for the support of his family.
 The following notice from Dr. S-----applies to
 this part of  his hiftory.
   " Being  edranged from  Dr.  Cullen's family,
 " he gradually became  his greateft enemy, and
 " fhortly afterwards found out the new theory of
 " pbysk, which gave occafion to his publifhing
 " the Element a Medicine, in the preface to which
 " work he gives an account of the accident that
 " ledtothisdifcovery. The approbation his work
 " met with among friends encouraged him to give
 " ledures upon his fydem.   Though his ledures
 " were not very numeroufly attended by the ftu-
 " dents, on account of their dependence upon the
 " profeffors, dill it was always remarked that the
 " clevered  among them were all, as they were
 Cf now  called by way of nick-name, Bruno-
 " nians.  Hence arofe that  perfecution which
 rC was carried on  with  fuch rancour that it at
 " length obliged him to leave  Edinburgh.—"
 This account  of the origin of the Brunonian
 fydem,  as we may conclude from the preceding
 quotation, is not exad ■,  and in other particulars
 the ftatement, from evidence I fhall afterwards
produce, will appear overcharged.   Meanwhile,
 if it be undeniable that,  as the Cullenian hypo-
thefes were%finking into difrepute, many of the
                                      ableft 
             OF JOHN BROWN,  M.  D.        Hi

 students reforted  to  the dandard of Brown,  it
 ought not to be forgotten that it was joined alfo
 by the mod idle and diffoiute.  Their  mifcon-
 dud  and  their matter's imprudence in private
 life,  together  winh  the  offenfive manner in
 which he fpoke  of himfeif and  of  others,  kept
 the fydem  and the author in conftant difcredit.
   He was foon in a date of  open hoftility with
 all the medical teachers -at Edinburgh , and it
 required nicer  management than he could# ob-
 ferve to keep on fair terms with other pradition-
 ers of medicine.   To a difciple, who was  desi-
 rous that he fhould meet one of  the profcfTors in
 confultation, he remarked,  ic that he (the difci-
 ple)  "  was unacquainted with the intfereded arts
 "  of  thofe men;  that all their  ideas in medi-
 "  cine,  and  particularly in  its  pradical  part,
 "  were  {o diametrically oppofite to his, that they
 Cf  never could be brought to any fort of recon-
 "  ciliation."—Like other reformers, who have
had  to   wredle  with  powerful  opposition,  he
 committed and fuftained injuftice.  Like them
too, where  hisfydem was concerned, he gradual-
 ly lod his fenfe of equity. If we ju-Jge by his lan-
 guage the only way he  had to fhow his difpofirion,
his countryman Knox couldfcarcely have  exceed-
ed him in ferocity.  Thus, having remarked that
the dodrine of fpafm, fuggefted by Van Hel-
mot,  and clumfily wrought up into  a fyltem by
Hoffmann,  was banifhed by  Boerhaave from
                      F                  the 
1m          ON  THE  CHARACTER

 the country which gave it birth, " it found  at
 " laft," he adds,  " amidft  a new  perfecution
 " raifed agaift it by the pupils of Boerhaave—
 " then in poffcffion of the medical chairs atEdin-
 {C burgh—a friend and protedor in  Dr.  Cullen,
 " who had lately become one of  the number of
 " thofe profeffors.
   " This  brat,"  he  proceeds,  " the  feeble,
 " half-vital,  femkprodudion of phrenzy, the
 " darveling of drained fydematic dullnefs, the
 " forlorn  outcad of the fodering care to which
 " it owed its  infed  vitality, was  now  to  be
 " pampered by a  crude and indigedible nutri-
 " ture, colle&ed from all the materials  which
 " had compofed the feveral  fabrications of for-
 " mer erroneous fyftems, was to be  decorated
 " with every foreign  plumage,  and in this  its
 " totally  borrowed and heterogeneous  form,
 " inftead  of the  hideous  caricatura, which  it
 " was, contrived  to excite the derifion of man-
 " kind, it was to be odentatioufly obtruded up-
 " on the world as a new, and  refpedable doc-
 " trine, and held up, forfooth,  as the formida-
 " ble  rival of a fplendid fydem(c)."
   Such is the torrent of metaphors that rufhes
 upon his imagination when he thinks of the fyf-
 tcm of his ancient friend and mader.  Of the

   (c)  Obfervations on the old Syftems of Phyfic,
  1787, p. xxxi.
                                         pad 
           OF JOHN BROWN. M. D.        liv

pad and prefent condition of the healing art he
fpeaks  with  greater coolnefs,  but with equal
contempt :
   " The accomplifhments of the regulars have
" been learning and ingenuity in a few,  not di-
" reded to improvement in their own profeffi-
" on: a mere fliadow of learning, or the dudy
" of a bad kind of it,  as botany and the other
" branches of natural  hidory, in  the greated
" number ;  fly attention to reputation for fkill,
" intriguing with their brethren for countenance;
" opposition to improvement;  perfecution of
" difcovery;  narrowness  of mind  under the
" thin  veil of a falfe pretension to liberality ;
" affedation of decency; all for the purpofes
" of trade y  filence, from a confcioufnefs of in-
" ability to fpeak fo as to gain by it; formality,
" pomp,   ftatelinefs,   gravity,  all  making a
" motley group of abfurdities;  invincible  at-
" tachment to  the errors of  their education  ;
" avcrfion  to improvement; ready upon every
" flight occafion to break out into rage and
" tranfport;  invincible bigotry and prejudice  ;
" an over value of  what learning they have any
" pretensions  to;  and  under value of all they
" are confeious they want.
   "As every country, in proportion as it  is dif-
" tinguifhed  by riches, and opennefs of man-
ct ners, for that very reafon,  becomes the em-
" porium,  the fcene  of adion, for high-way-
                                       men, 
lv           ON THE CHARACTER

<e men, footpads, pickpockets, fwindlers, fharp-
" ers,  gipsies,  regular praditioners in law and
" phyfic, quacks in both profeflions, fo England
" has long held andftill holds the pre-eminence
" over all her  neighbour countries,  in  being,
" for the. reafon affigned, the place of common
" refort,  in  which a comfortable  fubfiflence  is
" afforded  to  all thofe different denominations
" of purfe-takers.

t{ Exilis  domus efly ubi non et multa fuperfunt Et
" fallunt dominos, et profunt furibus."(c)

   During the heat of the contention betwen the
 oppofers  and -defenders of  the new fyftem,  an
event happened which I wifh I could fairly pafs
 over in filence.  But as it  has already been the
 fubjed of more than one publication (d),  there
 can be no pretence for the omiffion.
   Mr. Ifaacfon, a dudent of medicine, had been
 feized with  a  fever,  which in its progrefs  exhi-
 bited the mod  alarming fymptoms.  Dr. Duncan
 was  fird  called in, and afterwards Dr. Monro.
 Dr.  Robert  Jones, a new graduate, and a  friend
 to Mr. Ifaacfon, tampered  with the nurfe  to in-

      (<:)  Obfervations, pp. bcxxi—111.
   (d) See Jones's Enquiry, p. p. 134—150.—Letter
 to Dr.  R. Jones, by Andrew Duncan, M. D. Cadell,
 1782.—Letter from Philalethes to Andrew Dr. Dun-
 can,  without date or title, announcing a reply to the
 former publication,  which, I believe, never appeared.
                                          duce 
           OF JOHN  BROWN, M. D.        lvi

duce her fecretly  to administer ftrong  ftimuiant
medicines: they were given, as he alfer;s,  for
about twenty-four hours, with fuch effed that, on
their next vifit, the phyficians " declared the pa-
"tient free of fever," though before he had  all
the fymptoms of approaching death.   In the af-
ternoon, however, of the fame day, he wasfeized
with a raging delirium.   Jones in his alarm ap-
plied to his preceptor; the  preceptor being told
that the nurfe defired  to fee him,  ordered  "her
"  to be  brought before him."   When fhe was
brought before him,  he complimented her by a
folemn  appeal to  her understanding concerning
the great principles of his  fyftem.   " He en-
"  deavoured to affure her that there was either
"  no inflamation in the cafe at all, or that it was
"  a very  different  affedion from the  inflamati-
"  on that phyficians were acquainted with j that
"  infiead of requiring bleeding and other eva-
"  cuant antiphlogiftic means,  it is required  the
"  very fame treatment which had been lad em-
"  ployed ■, and he afferted with confidence that
"  the  intermiffion  of  the dimulant  powers
"  through the day was the  caufe of all that had
"  happened ■, that, in fhort, the prefent affec-
"  tation was a difeafe of debility of the whole
"  fydem, predominant in the brain,  in confe-
"  quence of the great finking of ftrength which
"  conftantly follows a total ceffation of the  ufe
"  of fuch highly dimulant powers.  He beg-
                                         ged 
lvii
6N
THE  CHARACTER
 " ged therefore as the life  of a  fellow-creature
 " was at dake, and as fhe had been  fo late  a
 " witnefs of the good effeds refulting from the
 " method of cure,  the continuance of which
 " he dill recommended  that fhe would not ai-
 " low prejudice and impreffions from the falfe
 " theories of phyficians, among whom fhe had
 " been converfant,  to prevail  over the high
 " probability of fuccefs from this mode of cure.
 " He difmiffed her,   after obtaining  a promife
 " that fhe would continue the plan  of cure in
 " queftion (*)."
   Brown, for a comic figure, was not inferior
 to Sancho Panza;  nor indeed much unlike that
 entertaining  perfonage ; and this  clandestine
 conference,  if it had been delineated by  Cer-
 vantes, would have made a good  companion for
 the nodurnal interview between Don Quixote
 and the venerable duenna,  Donna Rodriguez.
   The patient,  thanks be to fortune, (kill, or
 virtue! recovered.   The Brunonians placed the
 cure to the credit of  their pradice,  which they
reported to have been fuccefsful after Dr. Dun-
 can and Dr. Monro had given the patient over j
 they publifhed the cafe ,  they afferted that the
 cure " gave great vexation to the attendant phy-
 "  ficians  and all their partizans;" and with the
policy ufual  among  agreffors, they  complain-

             (?) Jones, p.  136.
ed that 
OF JOHN BROWN, M. D
Iviii
ed that Dr.  Brown  was ill-treated,  becaufe he
was blamed in  " the numerous circles of phyfi-
" cians friends and his enemies, while no oppor-
" tunity  was offered him of  vindicating him-
" felf  from thefe charges."
  The nurfe had threatened, if the fecret pro-
ceedings  fhould  tranfpire, to deny the perform-
ance of her part  of what in the Enquiry is term-
ed  the paction.   Dr.  Duncan, roufed  by thefe
rumours,  applied for information to the  nurfe
and her affiftant, to Mr. Ifaacfon himfelf,  to the
miftrefs of the  houfe  where he lodged, to Mr.
Edmund  Goodwin,  and Dr.  Monro.  In his let-
ter he has publifhed their refpedive  atteftations
and  depositions upon oath i  it  appears that the
clandestine propofals were rejeded, and that only
one unfuccefsful attempt was made by the ne°-oci-
ator himfelf toadminider a dofe of his diffusible
ftimulants.  According to the nurfe's tedimony,
Mr. Jones on her  fird  refufal declared,  if fhe
"  would  do as  he defired her, Mr. Ifaacfon
"  would give her a handfome reward when he
"  recovered—that  the medicine he wifhed her
"  to adminider was a  bottle of double  rum,  of
"  which fhe was to  give him a glafsful, with
"  fifty drops of laudanum in it, the firft night j
"  and another glafsful,  with one hundred drops
"  of laudanum  in it,   the fecond night,  if the
u  firft dofe  fhould have a good effed.   To this
"  propofal fhe anfwered,  that if fuch medicines
                                        were 
llX          ON THE CHARACTER

fC were administered to Mr. Ifaacfon in the ftate
" in which he then was,  he would not recover
" to  reward either her  or Mr.  Jones.    To
" which he replied, that  fhe was a damned fool
" for refusing, and that he  would give  her  two
" guineas out of his own pocket if fhe would
" do it.   She faid,  that if  the bed graduate in
" Edinburgh would give her her apron full of
" sold, fhe would not."   This woman depo-
fed  moreover that  one evening, while fhe  was
employed  apart,  fhe heard Mr. Ifaacfon fuddenly
cry  out, " Good God,  what is this ?  It is laud-
" anum !  I am poifoned !" She then obferved
Mr. Jones by the bedfide with a tea-cup, con-
taining  fome liquor, in his hand, which he (tt
down on the  table,  requefting  the landlady to
give it to Mr. Ifaacfon  at  a  proper opportunity.
The  landlady afferts,  thac, late  one evening,
fhe  faw Mr. Jones drop one hundred  drops of
laudanum  into  a tea-cup,  and add fome wine,
which he immediately carried into Mr. Ifaacfon's
room  She  followed  him  : he endeavoured to
make Mr. Ifaacfon,  who was fo far delirious  that
he did not appear to know  Mr. Jones,  fwallow
the  contents j " on tading the medicine, he fpit
" it  out of  his mouth ; cried  out that it  was
" laudanum, and that  he was poifoned ; but to
" the bed of her obfervation,  he did not fwal-
" low any of the  medicine ;" which, foon af-
ter, was thrown into the  fire.
                                        The 
           OF JOHN BROWN,  M. D.         Jx

   Dr. Duncan's indignation urged him to  an
immediate  profecution,  which, as he was affu-
red by fome  eminent  advocates, would have
terminated  in the inflidion of  a fevere pumfh-
ment  on the negociator.   Dr.  Monro difcoura-
ged by this idea for rCafons which it would  be
injurious not to quote -3  they  are  thus  afllgned
in the letter to Dr. Jones :  " He was principal-
"  iy averfe to it on your  account,  becaufe  he
"  confidered you in the light of an imprudent
"  young man—he imagined that the mal-prac-
"  tices might be diffidently proved of you,  al-
"  though they could not be brought home to
"  Dr.  Brown, whom he confidered as  the ori-
"  ginal aggreffor.   He  was averfe to it on ac-
"  count of Dr. Brown's  wife and infant chil-
"  dren, who might have differed more feverely
"  by  it than we could eafily forefee.  And be-
"  fides this,  he thought  there was but  little
"  danger that  Dr. Brown fhould repeat fuch
"  pradices, and dill lefs chance that  he would
"  again find any dudentto be his affiftant in  the
*'  manner you had been."   In thefe reafons Dr.
Duncan acquiefced.
   By  this intrigue Dr. Brown's " charader was
"  very near ruined as a physician,  and as a man
"  {Enquiry, p. 139)-"   All chance of lucrative
employment in his profeffion,  if he ever  had
any,  was dedroyed.  His charader among  his
countrymen kklkred irretrievably, nor have Z
                     C              courage 
Ixi
ON  THE  CHARACTER
 courage without better documents  to undertake
 his vindication.  Dr.  Duncan affures me, that
 he  knows of no reply to his letter ; and little
 fatisfadion I apprehend will be found in the pleas
 offered by the  Enquirer and Philalethes.   If the
 means of erasing this blot remain,  I hope they
 will be employed without delay.  I fhali be glad
 to  have  folicited,  where I could not afcertain
 the truth.  But "the defire of refcuing a fellow-
 " creature,"  will never be admitted by the pub-
 lic  as  a  juftification of the clandestine interfe-
 rence  of  any  man, much lefs of a physician,
 in the treatment of the  fick.   Such motives may
 be chiefly  feigned ;  and,  when real,  they may
 occafion endlefs mifchief.
  Things and perfons  are generally estimated in
 the grofs; and this unwelcome portion of my
 narrative,  I fear, will  raife in many minds a
 prejudice  fatal to the credit of the following fyf-
 tem.   Juft and judicious readers will, however,
 difcriminate.   And  if,  in  the  cafe of Bacon,
 the bafenefs of the  magistrate detrads not from
 the wifdom of  the philofopher, why fhould the
 imprudent or  unjustifiable means which Brown
adopted to carry his principles into pradice, in-
 fluence our opinion concerning the juftnefs of
thofe  principles ?
  He  fbmetimes difcovered the propensity,  fo
common   among the framers of  fyftems,  in a
lefs offendve  way.
                                   A ftudent 
            OF JOHN B-ROWN,  M. D.         lxji

    A  ftudent of medkine died of a  low fever
 in fpitc of the full and avowed ufe of diffusible
 ftimulants.   The  body  was  opened  j  feveral
 perfons were prefent j  among others the gen-
 tleman  that informed me of the occurrence.—
 During the  examination of  the appearances,
 Brown with an air  of great fagacity  remarked
 that the body was unufuaily frefh.   The diffed-
 ing furgeon,  whom perhaps kindred devotion to
 Bacchus  had infpired  with  tendernefs for the
 Dodor, replied  that, confidering the circum-
 ftance, he had fcarce feen an instance where pu-
 trefadion had made  fuch littleprogrefs. "Then,
 " gentlemen,"  rejoined the dodor,  " I  appeal
 " to you if we may not consider this as  a clear
 " proof of the propriety of our pradice."
   Brown was eleded President o£ the Medical
 Society  in  1776 and again  in 1780.  In what
 years he became a ledurer and  graduate in me-
 dicine, I mud leave to fome  future biographer
 to fettle.  Though  he had attended the  medi-
 cal  claffes at  Edinburgh ten or eleven feffions
 [Mr.  Wait], he reforted  to  St. Andrews for
 a Dodor's degree.  His  pupils, I  believe, fol-
 lowing in his train,  strove to  give to his paffage
 the air of a triumphal progrefs s he was certain-
ly accustomed  to  relate with infinite fatisfadion
the circumstances  attending his graduation.   He
defcribed the  profeffors beyond  the Firth as
overawed by his fame and prefence -, it  is likely
                                     enough 
Ixiii
ON  THE  CHARACTER
enough that they wifhed  to exchange their di-
ploma for his  money with as much expedition
as poffible.
  For feverai  ^ears  after 1780, and  perhaps
before,  the profeffors, the phyficians to the in-
firmary,  and the focieties were unceafingly an-
noyed by the adherents of Brown ; the students'
debates were carried to the highest pitch of vi-
olence ;  by the Medical  Society a law was paf-
fed,  and, I think, put  in force,  that if any
member  fhould challenge another  for any  thing
faid  in  debate, he fhould incur  the  penalty of
expulfion.
  The  efforts   of the  Brunonians  to expofe
thofe praditioners,  who  followed  a  different
fydem,  are fully exemplified in a Letter on the
management of patients in  the Royal Infirmary (g).
This letter was occafioned by a reftridion an-
nexed to the allowance of a very thin beef-flake
to a patient in that hofpital.  It was ejipreffly
ordered that the dake fhould  not exceed one
inch  and five  sixteenths in  length,  nor  feven
eighths of an inch in  breadth.  This,  at  leaft,
is the meafure  of  the pattern (h).  The  tone,
affumed  in  the  commentary  upon  this text,  is
that of vehement invedive :  on the authority,

   (g). Edinburgh,  1782,  pp.  32  Signed  Vert
     Amiens
   (if). Letter, p. 9.
                                            as 
OF JOHN  BROWN, M. V.
Ixiv
as the writer fays,  "of one of  your own ftu-
" dents" he  gives  the  following  statement of
the hofpital  diet:

            <x The  Ccmr/icn Fare.
      " Soldiers pay is.  4^.  per week.
 " Breakfaft—One roll of bread and a measure of milk
   " or beer.
 " Dinner—One ditto, zv.'i a choppin of weak broth.
 u Supper—The fame  as breakfaft.
               Common Patients.
 " Breakfaft—Half a roll, and a meafure of miik or
   " beer.
 " Dinner—One roil,  and a choppin of weak broth.
 " Supper—The fame as breakfaft.

   " In a few  particular cafes,  a little meat is al-
" lowed and  other  neceffaries,  as may appear
" proper to the phyficians."
   He then notices the roaft beef and porter of
St. George's  hofpital in London,  and fubjoins
this  appeal:  " Let  me figure the cafe that you,
" Dodor,  were plunged at  once  into difeafe
" and beggary j I put this plain queftion, whether
fc would you choofe to be lodged and nurfed in
" St. George's hofpial, or to be deposited and
" starved  in  the  Royal Infirmary,  under fuch
" medical treatment as your own ? Your vidu-
" als,"  he  proceeds,  " are not only fcanty but
'f bad.   Your porridge  is  fometimes boiled
 " almoft into Water-gruel j   your  broth   is
                                   commonly 
 1XV         ON  THE  CHARACTER

 " commonly much better qualified to operate as
 " an emetic than to nourifh the fydem—of your
 " milk we need  only fay that it refembles  the
 " reft which is fold in the dreets of Edinburgh.
 " Your beer is not always tolerable even to the
 " palate of an alehoufe fcullion."
   None undoubtedly  but members of the  me-
 dical profeflion,  can have an adequate concep-
 tion  of the wide-wafting mifery that daily arifes
 from the want of food, fuel and cloathing.   Oc-
 casionally,  in  diftrefsful  feafons,  the gnawing
 pains of hunger are affuaged by private chari-
 ty ;  and impending death or madnefs is prevent-
 ed.  But no effort is made to improve the pre-
 dominant condition of the poor, though  it is
 alike destitute of comfort and of hope.  Expe-
 rience  teaches how little they have  to exped
 from thofe Political Swindlers,  who, un-
 der falfe pretences, acquire the power of fport-
 ing with the wealth and blood of nations.  The
 wretchednefs  of imprifoned criminals remained
 unredreffed only  becaufe it was  indiftindly
known 3  the wretchednefs of the indigent is not
more clearly understood; toexpofe it fully to the
eyes  of the community is a work of extenfive
beneficence referved for fome future Howard.
When  it is archieved we (hall be aftonifhed at
the proportion of human beings that languifh in
mifery  or perifh  prematurely ;  the  univerfal
feelings of mankind will rife in behalf of  thefe
                                     vidims 
           OF JOHN BROWN, M. D.       lxvi

vidims of penury ;  and their flefh will no long-
er be devoured by the luxurious creatures of cor-
ruption.  But our Brunonian  "friend of truth,"
feems  to work upon the passion of his reader,
merely for the purpofe of degrading a few pro-
feffors in  the opinion  of a fet of students.   If
his  letter  contains  material  exaggerations,  it
could only ferve to bring the caufe of humanity
into difrepute.
  In 1782,1 remember to have fpent an evening
in company with Dr. Brown.  He  affumed the
fovereignty of the circle, which confided prin-
cipally of his difciples;  and nobody thought of
difputing his title;  he difplayed uncommon vi-
gour  of imagination, but to  me the figures he
called up were fo little agreeable,  that I never
defired his converfation a fecond time.   Others
received entertainment j  and by thofe who knew
him well,  he is remembered as " the best com-
panion in the  world."  His Doric dialed had
nothing prepoffeffing to  an  Englifh  ear.   It
was fo broad as to leave me  often uncertain  of
what he faid  even in his ledures.   And yet be-
fore he undertook the charge  of a private tutor,
he had attended an Englifh mailer at Edinburgh,
" for the purpofe of acquiring a proper  pro-
" nunciation  and method of  teaching that  lan-
" guage, which he  had not  before had an og>-
" portunity  of being improved in'' £D.  S.].
But the veftigia ruris  were not to be effaced, or
elfe he had voluntarily refumed his original notes. 
 lxvii        on-  the  character   *

   Unprofitable adherence to the houfe of Sto-
 art, had been relinquifhed at Oxford before my
 entrance:  and Brown was the fird perfon I ever
 faw abfurd enough to profefs himfelf a Jacobite.
 He had feveral years fince embraced political fen-
 timents thus repugnant  to thofe he  once  held,
 and which had now become almoft univerfally
 extind.   In 1770, " I  was  furprifed,"  fays  a
 gentleman who had known  him long, " to find
 " the Dodor a  warm  admirer of the Scottifh
 " aridocracy : the lairds of Clanronald,  Kep-
 " poch,  and Gengary, were the theme of his
 " eulogy j and prints of fome of the chieftains
 " who had joined the late Pretender  were pla-
 " ced among the divinities of his houfehold."
 No  caufe for fuch a revolution of opinion is af-
 figned.  It did not  arife by  analogy from his
 hostility to the  profeffors, for it took place be-
 fore his rupture with Dr. Cullen.   This fpecies
 of fuperftition  eafily fadens upon the mind of
 the antiquary; and Brown had paid attention to
 the antiquities of  his country.  He was eleded
 affiftant Latin fecretary to the Antiquarian Soci-
 ety  of Edinburgh, without  his folicication  or
 knowledge, and  from  the fole confideration of
 his  literature,  according to  the  Enquiry;  but
 this affertion is contradided by Dr. Duncan.—
His contradidion  is founded on Mr. Cummyng's
declaration when he propofed Brov/n, that  <c he
 ff knew him to be very desirous of obtaining
 " the appointment." 
            OF  JOHN BROWN, M. D.       Ivii

   His  converfation  was full  of contempt for
the literature, talents, and dodrincfc of the me-
dical profeffors, one  great natural philofopher
excepted.   He  continually Criminated them as
his perfecutors,  and as unjud towards thofe ftu-
dents who  adopted  his principles.   This  inju-
stice is faid to have appeared in unufual feverity
on the examinations previous to graduation.  In
the Enquiry thefe complaints are repeated;  and
to fhew how much  the  right  of private judg-
ment was infringed in the  article  of inaugural
differtations,  the  following correfpondence  is
produced : the  candidate,  it  fhould be premi-
fed,  was defirous of  quoting  the  fixty-ninth,
feventieth,  and  feventy-firft paragraphs  from
the Elementa Medicine in a thefts on epilepfv.
      " Sir,
  "  A  former  experience of your civility pre-
" vents  my apologizing for troubling you on
" the following  occafion,  viz.
  "  From a  ftrid perufal and attention to my
" differtation, I find it neceffary  to folicit  your
" approbation of inferting the quotation I made
" from Dr. Brown's  printed-  book,  to which
" you formerly  objeded.
  "  Amongft many other reafons, I will fubmic
" the two following to your confideration.
  "  i.  That  without it I  am prevented from
" faying what  I really believe,  to the  manifest
t( injury of my  differtation.
                    H             « 2, That 
lviii         ON  THE  character

  <c  2.  That I am deprived of the liberty other
" candidates have  always  enjoyed in  making
" quotations from any author j  a  privilege too,
" which was promifed  me by Dr. Gregory.
  "  As  I  wifh to have my differtation printed
" immediately,  your anfwer as foon as eonveni-
" ent,  would oblige
                  " Your humble Servant,
                           "  J. Wainman."
         The anfwer was as follows :
      " Sir,
  " I objeded to your quotation, as I have of-
ef ten done to quotations made by other candi-
" dates, not that it contained  the opinion  of
" this doclpr, or  of that profeffor •> but  that  it
" contained  fuch jargon, as could not fail to
" difgrace the candidate,  and  of courfe the
" univerfity, which  gave fandion to its publi-
" cation.  As to the liberty you fay, 6 candidates
" always  enjoyed  of making quotations  from
" any author, right or wrong,'  I never heard
" of it before,  and am  determined to give it no
" quarter, neither now nor hereafter."
             (Signed.)  Alexander Monro.
  I  mud profefs  myfelf incapable  of entering
into thefe fentiments : and I fuppofe many rea-
ders will concur with me in regarding with con-
tempt the patch-work of education;  whether
it confift of a fpecimen of penmanfhip,  retouch-
                                       ed by 
             OF JOHN BROWN,  M. D        I'lX

  ed by the maftcr for the honour  of the fchool,
  or an inaugural fpecimen, garbled by the profcfT-
  ors for the honour of the  Univerfity.
    Obferving the  students of medicine frequently
  to feek  initiation  into the  mysteries of  free ma-
  fonry, the author of  the New Doftrine thought
  their  youthful curiofity afforded  him  a chance
  of profelytes.  In 1784 he indituted a meeting
  of that fraternity, and entitled it,  The Lodge of
  the Roman Eagle. The  bufinefs was conduded
  in the Latin  language,  "  which he fpoke with
  "  the fame  fluency and animation as he fpoke
 "  Scotch.   I was  much  diverted,"  adds Dr.
 Macdonald, " by his ingenuity in turning  into
 " Latin all the terms ufed in ma^Ary.''
   In unfolding his fyftem it wzs his pradice firft
to tranflate the text book,  fentence by fentence;
 and then  to expatiate upon the  paflage.   For
moft of  his pupils the tranflation was a prelimi-
nary highly neceffary j and he must have confik
dered  it  as politic to combine literary with fci-
entific inftrudion.   The profped of this dou-
ble advantage,  might perhaps, from time  to
time, bring him a few additional  hearers -,  but
whatever was the abfolute or comparative merit
of the theory he taught,  his feats,  I fear, were
ftldom crowded.
  The introdudory lecture, if my memory is
accurate,  was  intended to imprefs upon  his au-
dience  a fcnfe  of the importance  of the ledu-
                                        res's 
lx
ON  THE  CHARACTER
rer's difcoveries; its effed was rather to render
him ridiculous.   The dread of pain and  death
eafily perfuade us that improvements in medi-
cine are more beneficial than any other art;  but
when a  man  afferts  the fuperior utility of his
difcoveries  to  thofe of Newton,  he will with
difficulty avoid the appearance of afferting the
fupferiority of his talents.   The ledurer,  in his
cooler moments, would have been fenfible  that
lofty claims produce oniy laughter or resistance.
But his  imagination easily  kindled;   he  was
thrown  off his guard,  and  he  strongly   ex-
prefled what he  fervently believed.  He ufually
proceeded  to  open his fyftem with  animation;
but he  did not always perfevere with the fame
fpirit.   He was apt, as he advanced,  to fail in
punduality of attendance.   As the master's ar-
dour abated, flacknefs dole upon the pupils; fo
that his courfes not very unfrequently, I believe,
ihared the fate of Butler's ftory of the bear and
fiddle.   The numerous inaccuracies with which,
in fpite of the remonstrances of his well-wifli-
ers, he  fuffered  both  editions of his  Elements
to pafs through the  prefs, evince his negligence
in  thofe concerns  which might be fuppofed to
lie  neared his rysart.
  His voice  was in general  hoarfe and almoft
croaking,  but 6f when he became animated, he
" had fine cadences and pleasing tones,  which
« took off all the uncouthnefs of his accent and
k\ hjs manner," 
            OF JOHN  BROWN, M. D.       lxi

   One  of his pupils  informs me that when he
found himfelf languid, he fometimes  placed  a
bottle of  whifky in one hand, and  a phial of
laudanum on the other ; and that, before he be-
gan  his ledure,  he would  take forty or fifty
drops of  laudanum in a glafs of whifky;  re-
peating the dofe four or five times during the
ledure.   Between the effeds of thefe ftimulants
and voluntary exertion,  he  foon  waxed  warm,
and by degrees his imagination was exalted into
phrenzy.
   The fubjoined  quotation fhews that he fome-
times endeavoured to enforce his tenets in a man-
ner  not very  ufual; conceiving it  lay in his
power to  remove certain  objedions  deducible
"  from  the real or imagined inflammation of the
"  brain at the end  of  Typhus," and " from
"  the inflammatory part of the gout,"  he call-
ed together a party of his confidential pupils.
   " He had brought on a flight fit of the gout
"  by unufual exercife in walking.   This was an
".  opportunity for making an experiment which
"  was to decide the whole controverfy.  A per-
"  fon called for him before dinner, who was in
ft  a way of  bufinefs that led him to drink in the
"  morning; he expeded a glafs from him  and
"  was gratified.  The Dodor for a reafon that
"  the reader  must perceive, colleded  half  a
"  dozen of his principal pupils to dinne    and
'*  drank then  till he  only,  in confequence of
                                      " what 
  lxii         ON THE CHARACTER

  " what he had taken before, was considerably
  " affeded.   He told them he had planned fome
  " degree of intoxication in order to explain ma-
  " ny inflammations, which were univerfally  un-
  " derflood to be accompanied  with,  or to  de-
  " pend upon,  phlogidic diathefis.   Before  the
  " application of the stimulus we  fpeak of,  he
  " had not been able to put his  inflamed foot to
  " the ground,  but had fupported himfelf in any
  " little motion that he chofe  to make through
  " the  houfe,  by his found extremity,  assisted
 c<  by the  ufe of his ftaff;  but before he difmif-
 "  fed  his company,  he  recovered the perfect
 "  ufe 6f his  affeded leg(£)."
   A few words will defcribe the  tenor  of this
 unfortunate  man's life,  till his  removal from
 Scotland.  He  was fo reduced in his circum-
 flances as  to be committed to prifon for debt,
 where his  pupils attended his  ledures.   In  the
 abufe of intoxicating liquors he obferved no mo-
 deration.   In 1775 Mr. Wait  found him drink-
 ing water only.   His fituation, about that time,
 would have roufed almoft any man to a ftruooJe
 with  this  deftrudive habit.   His preface dif-
 clofes the  reafon of his  fobriety.  Finding the
 gout  return with  feverity, after fome perfeve-
 rance in this experiment of abdemioufnefs,  he
returned to the  bottle,  and  never  afterwards
 relinquifhed it.
             (>J) Enquiry, p. 134.
                                       - His 
           OF JOHN BROWN, M. D.       IxiU

  His profped of maintaining himfelf by teach-
ing medicine at Edinburgh becoming every year
worfe ;  he at length carried into execution a de-
fign which he had long meditated, and to which
he had received fome encouragement.   In 1786,
therefore, he embarked for London,  bearing in
mind  moft  probably,  if he did not utter, Sci-
pio's  exclamation againfl the ingratitude of his
country. Immediately on his arrival, an incident
befel him which I have heard Mr. Murray,  the
bookfeller of  Fleet-ftreet,  relate  in  proof  of
his simplicity.  The peculiarity of his appear-
ance,  as he moved along—a fhort fquare figure
with  an air of dignity,  in  a black  fuit which
heightened the fcarlet of his cheeks and npfe—
fixed  the attention of fome gentlemen in the street.
They addreffed him in  the dialed of his coun-
try ; his heart, heavy as it must have  been from
the precarioufnefs of his fituation,  and diftance
from  his accuftorncd haunts,  expanded at thefe
agreeable founds.  A conversation enfued, and
the parties, by common confent, adjourned to a
tavern.  Here the dranger was kindly  welcomed
to town ; and after the glafs had circulated for a
time,  fomething was propofed by way of fober
amufement--agameat cards or whatever the Doc*
torlmight prefer.  The Dodor had been too civil-
ly treated to demur, but his purfe was fcantily fur-
nifhed,  and  it was neceffary to quit his new-
friends in fearch  of a fupply.  Mr. Murray was
                                          the 
lxiv        ON THE CHARACTER

the perfon to whom he had recourfe ;  the read-
er will not wonder that his  interference  fhould
have fpoiled the adventure.
  A London fharper of another denomination
afterwards tried to make advantage by the Doc-
tor.  This was an ingenuous fpeculator in public
medicines.   He thought a  composition  of the
moft powerful ftimulants might have a run,  un-
der the title  of Dr. Brown's  exciting pill;  and
for  the privilege of his name offered him a fum
in hand by no means contemptible,  as well as a
fhare of the  contingent profits.  Poor Brown,
needy as he was,  fpurned at the propofal.
  It is eafy  to  anticipate the remainder of my
tale.  Change of  refidence wrought no  change
of condud.   Some of  his friends were difguft-
ed by thofe habits which repetition had unalter-
ably fixed.   In didating Brown's resolutions,
pride had always its  fhare:  Cullen,  who never
mentioned his  abilities without praife,  ufed to
add, that  his temper rendered  it difficult  to
deal with him.   At the prefent period  I have
been told, and I can eafily believe,  that he was
more impradicable than ever.  He fpoke  in
fanguine terms of  the probability that  his fydem
would become at length triumphant;  but what-
ever he faid or imagined, he effeded little.   He
attempted to open,  but never, I  underdand,
completed a courfe of ledures in London.   In
1787  he  publifhed, without  his'name,  thofe
                            " Obfervations," 
OF JOHN BROWN.  M. D.
Ixv
" Obfervations,"  from which I have  already
borrowed a paffage.   He could not  in  reafon
e"xpfcd to find a cordial welcome among his bre-
thren in England.   Public  opinion  can  alone
awe the body  of eflablifhed  phyficians in any
country into toleration of innovators; and know-
ledge on this fubjed was too  little  diffufed  for
public opinion to operate with effed in  his  fa-
vour.  Thefe  " Obfervations"  were  therefore
properly intended for general  perufal;  but the
author was  extremely defedive  in the talent of
rendering fcience popular.   Nor was he  patient
or rich enough to wait for the beneficial con-
fluences that might have refulted, if he could
have rendered his dodrine a fubjed of univer-
fal  curiosity.
   He perfided in his old irregularities for  fome
time, meditating  great defigns,  with expeda-
tions  not  lefs  ardent than if the fpring of life,
in all its bloom of hope, had been opening be-
fore him.   At length, on the feventh  of Odo-
ber,  1788,  when he was about fifty-two  years
of  age, he was feized with a fatal fit of apo-
plexy.  He died, if I  am not misinformed, in
the night, having  fwallowed as he went to bed
a very large dofe of laudanum ; a fpecies  of
dram to which he had, indeed, been long ad-
dided.   He was at this time  about to begin a
courfe of  ledures.  I  am  affured by one who
had feen him the evening preceding his  death,
                    I                    that 
1XV1          ON  THE  CHARACTER

that his appearance did not betray any tokens of
didrefs;  nor was it apparent that his conftituti-
on had run much into decay fince his departure
from Scotland.
  When Cullen,  two years afterwads, died in
embarraffed circumdances, his friends obtained
public aid for his  family.  Brown's deditute
widow and children were faved from  didrefs by
private benificence ;  but it cannot be expeded
that  the contributions, raifed for that purpofe,
fhould have proved  fufficient  for their perma-
nent fupport.
   Dr. Brown's family has been already mention-
ed  as numerous  :  he left two  fons and  four
daughters.  His elded fon is now dudying me-
dicine at Edinburgh, where he has experienced
great liberality from  the.profeffors and the foci-
etis of dudents.   His talents will, I hope,  meet
with  a more adequate compenfation than thofe
of his unfortunate father.
   In  the recital of this fcanty information, my
own fentiments have fluduated fo much  that  I
am doubtful whether I have preferved imparti-
ality,  or fhall appear confident in the diftributi-
on of pity, ridicule,  cenfure,  and applaufe,
among the incidents of Brown's life.  Yet the
peculiarities by which he was diftinguifhed, ap-
pear  obvious  enough.  He  was endowed with
uncommon fufceptibility  to  impressions.   By
whatever objed they were touched,  the fpringa
                                       of his 
           OF JOHN BROWN,  M. D.       lxvil

of his nature bent deeply inwards; but they im-
mediately rebounded with equal energy. .  This
quality is the foundation of all moral-and intel-
lectual fuperiority;  but,  unhappily,  the ftrong
feelings and bold refolutions of Brown  were not
improved into  steady principles.    He  never
feems  to have  taken pains to form a fydem' of
conduct advantageous  to  himfelf,  and jud to-
wards others.  As foon as  he lod the  controul of
fuperdition,  his high  fpirits hurried him into
the mod  intemperate exceffes;  and, at a later
period, his adions  can only be regarded as the
plunges of defpair.   The tendernefs  with which
his  cordiality  infpired thofe who  knew him
formerly,   I could demondrate by a varie-
ty of tedimonies.   By a writer already  quor
ted,  he  is dyled  "a man of infinite good-
<f nefs of  heart («)."  Dr.  5-------   con-
cludes his  communication with  thefe exprcf-
fions:  " He was poffeffed of a great mind that
" fupportedhim in  the midd of all his didreffes.
«' He defpifed riches ; deteded every thing bafe,
" and poffeffed  fuch openness of  heart as to be
" liable to be taken in by every  knave."   He
undoubtedly committed an error, which has  of-
ten been produdive  of fatal confequences to
perfons accudomed to fcientific fpeculation.—
He o-ave mankind credit for a more  fincere re-
(n) Analyt.  Rev.   See  above.
gard 
Ixviil        ON  THE  CHARACTER

gard for truth, and an higher fenfe of its impor-
tance,  than they  ,ave entertained in any age.—-
He imagined, perhaps, that  Plato's fally  con-
cerning Virtue was applicable to Science.   He
therefoi-e  utterly negleded thofe arts by which
the imagination is  captivated;  and truding to
their  intrinsic value, bluntly chalenged accep-
tance for his opinions.
   Cicero and Bacon were his favourite authors j
in  his  elaborate compofitions  he imitated, the
Roman orator with affedation ;  and it mud be
confeffed,  that by taking advantage of the pe-
nury  and  want  of precision, which Lucretius
and Cicero  fo loudly lament, he has fucceeded
to his utmod wifhes in  condruding a  dyle of
claffical obfcurity.   He could,  however, write
otherwife,  and  unite  at  will perfpicuity with
purity.  This may be afcertained by examining
the differcarions,  which he  furnifhed,  at lead,
with their  Latin garb.   Several are preferved in
a well-known colledion  (0) ; but for an obvi-
ous reafon I mud leave it to  the curious  reader
to difcover,  by  private  enquiry, which were
compofed by Brown,
    Bacon   he admired not only for his  maderly
furvey of  universal fcience,  butlikewife,  as Dr.
Macdonnel  acutely  conjedures,  becaufe  that
great author appeared to countenance him in the

   (0) See Thefaurus  Medicus, iii.  and iv.  Edin-
  burgh, 1785-
                                     difrefped 
OF JOHN BROWN, M. D.       IxiX
 difrefped with which he treated his predeceffors.
 He  had  Iktle medical eru  ition.  At firn he
 probably read more than ordinary dudents ;  but
 after he  had condruded  his theory,  he feldom
 perufed  or confulted any medical author.   He
 was  impatient when any difficulty was started
 which he did not fee clearly how to  folve  (p) :
 nor  would he ever  acknowledge any exception
 to his principles.   An argument againfl his fun-
 damental propofitions, which I  had mentioned
 in converfation  to a favourite pupil, was  com-
 municated  one evening,  to  the mafter in  my
 prefence, a little  before the  hour  of ledure.—
 He faid little in reply at the moment.   But it ap-
 peared that the objedion worked upon his mind;
 in the courfe of his  ledure he waxed unexped-
 edly warm ; and at lad, addreffed  himfelf parti*
 cularly to the pupil who had dated the objedion.
 He did not attempt to  expofe  its  futility,  as
 might  eafily have  been done;  but,  exhorting
 hirn  to differ no insinuations to divert his atten-
 tion  from the  do£lrine, he proceeded to deliver
 againd the exercife of the underftanding, a dif-
fuafive that  might have done  credit to the pul-
 pit.
  The Obfervations,  and the Elements of Me-
dicine, are all the produdions which he avow--
ed.   But there prevailed a fjfpicion, and it has

             (jj)  Dr. Macdonnel,
                                        b:en 
IxX         ON  THE CHARACTER
 been publicly  mentioned (q),  that he  was the
 author of the Enquiry,  publifhed  in the name
 of Dr. Jones.  By his moft confidential cfifciples
 I have been affured,  that they never heard him
 drop an hint of  having affifted in its compofiti-
 on.  In manner  it certainly bears  a drong re-
 femblance  to the  " Obfervations;" there  are,
 befides, as  the reader may obferve  in my quo-
 tations, forms  of expression peculiar to Scot-
 land ;  but the profeffed author may be  faid  to
 have derived the one from his preceptor, and
 the other from the country in which he  refided.
 This book,  we are told,  was compofed as fpee-
 dily as it could have been tranfcribed by an or-
 dinary hand.  It  is unqueftionably ill arranged,
 tedious, uncouth,  arrogant,  and illiberal; yet
 it  contains paffages prefenting juder views  of
 medicine than  I remember to have elfewhere
 feen, and conceived in the genuine fpirit of Ba-
 con,
   He defigned a  Latin  elementary  treaties  of
 morality on philofophical principles (r)—-Elemen-
ta  Morum ;  but he never, perhaps, committee!
any portion of fuch a work to paper.  We may
fairly prefume that it would have  been original,
luminous,  and profound..—And fince  no  man,
not deeply fkiiled in fuch knowledge, as  phy-

     {f) Dr. Duncan's  Letter, p. 25.
     (r) Dr. Macdonnel.
ever 
           OF JOHN BROWN, M. D.       Ixxl

ficians fliould poffefs, will ever trace back human
adions and paffions, along their winding courfe,
to the fountain head, the failure of Brown's de-
fign may be regretted as an heavy lofs to literature.

  Having received a little additional informati-
on,  too late for infertion in the proper place, I
annex it  here.   To Mr. Wait's account of his
quicknefs  in madering languages;  it may be
added, " that Brown difplayed a genius for li-
" terature  far fuperior  to any fcholar that had
" eves been under the care of Mr. Cruikfhanks.
" In the courfe of  two years, he could read-all
" the Latin daffies with the utmod facility; in
" the Greek language,  he made  the  fame re-
" markable'  proficiency."   This  intelligence
comes from Dr. S----:, who likewife mentions
the  adonifhing power of his memory,  and  adds,
that he fird went to Dunfe fchool in 1751,  when
he mud have been  above fourteen years of age.
The fad is remarkable,  as he  does  not appear
to have  been before indruded in the rudiments
of the learned languages.   The fame gentleman
confirms my account of the motives of his dre-
nuous application.  " The leading members of
" the feceding congregation at Dunfe, to which
" his parents belonged, were  druck with the
" proofs of capacity he manifeded at the cour-
" try-fchool,   where he  learned  reading and
" writing; they encouraged  him to  go to the
                                 " grammar- 
hxii        ON THE CHARACTER
" grammar-fchool, that he might be afterwards
" educated  as  one of  their miniders, exped-
cc ino- he would greatly contribute to the promo-
" tion of their particular intered,"-------
  I  have pleafure in recording that,  by advice
of the friend who brought  him the firft thefis to
tranflate,  he addreffed a Latin letter,  to the late
excellent  Alexander Monro,  then profeffor of
anatomy  at  Edinburgh,  requeding  gratuitous
admiffion to his ledures.   Having fucceeded in
this  instance, he  applied in the fame  manner to
tiie other medical profeffors.-------
  His intercourfe with  Cullen forms the  moft
curious part of Brown's history.   The following
memorandum  includes his reafons for diffatif-
fadion with his  patrcn, as they were affigned
foon after the  feparation to  a perfon  how ac-
knowledged his talents, without being a partizan
in his difpures, or  a  follower of his dodrines.
" They lived upon the ftrideft intimacy for ma-
*f ny  years ; and Brown could call for a bottle
" of  wine in Cullen's houfe, when he pleafed.
*' During all that time no  man in Brown's  com-
" pany could contradid any  of  Cullen's opini-
 " ons without danger  of offending him.   After
 " the quarrel, he faid Cullen had promifcd him
 «f his  interest  for the  first vacant chair in  the
 " college ;  but  when the late Dr. Gregory died,
 <c indead of  ufin<* his incered in  Brown's  fa-
 " vour,  he did the rcverfe—that,  to try him
                                       further 
          OF  JOHN  BROWN, M. D.      Ixxiil

"  further,  Brown petitioned for  admiffion in-
"  to  the  philofophical  fociety, but was re-
" jeded through Cullen's means."  Here only
one  fide of the quedion is fhewn: and the re-
prefentation comes  from a man  of impetuous
passions,  who,  to;obtain our full confidence,
fliould either  have been lefs violent in defend-
ing or in opposing Cullen.—Complaints of dif-
appointed expedations are dill more common
in the intercourfe of patronage, than  of  faith-
lefs vows in that  of  ^gallantry :  this happens,  I
fuppofe,  becaufe offers and promifes are extrad-
ed from harmlefs  expreffions, by which perfong
who  amufe  themfelves  with gallantry and pa-
tronage,  do not intend to -convey any particular
meaning.
K V,
OF 
(  ixxiv   )
  OF  Dr.  BROWN'S PRIVATE

              PRACTICE.


  TO fome  readers  it may appear strange that
I fhould have finiihed the life of a phyfician,
who caufed fo great an uproar  in the medical
world,  without more particular  notice of his
private pradice.   I enquired with fome folici-
cude, but in vain,  whether during the long pe-
riod of his studies he  was peculiarly obfervant
of  difeafes.   One  circumstance  I have  lately
learned ; and it will furprife thofe  who believe
him to have ineulcated contempt for the fciences
auxiliary to medicine :  my authority however is
unquestionable.  The feafon before he  became
an  independent ledurer, he v/as induftrious to
acquire more minute anatomical knowledge than
he had gained by attendance on the public lec-
tures ;  and for fome time attended a private in-
ftrudor at five o'clock in the morning, and con-
tinued with  him for two hours; botanical infor-
mation  was added, on thefe occasions, to the
anatomical.  He had formerly been advifed by
Cullen to qualify himfelf for giving demonftra-
tions in anotomy.  Nothing could be imagined
fo entirely  repugnant  to his turn of mind ;  no
wonder, therefore,  the advice was not followed. 
             PRIVATE PRACTICE.        lxXY

   Brown fomewhere  condefcends  to  fpeak of
his own  " very large pradice ;"  but  this  is a
compliment which every  medical  writer appa-
rently thinks that ufage justifies him in paying to
himfelf.
   I remember to have heard of an houfe at Edin-
burgh,  which  the Brunonians  opened for the
reception of poor patients;  probably they were
not able to procure funds for its permanent fup-
port.   The founder of the fed was, I believe,
feldom confulted but in  cafes given up as hope-
lefs ; .and he was then apt to fpeak with impru-
dent confidence.  According  to Dr.  S-----—,
" his wifh to ride in his carriage  would,  in all
" probability,  have been gratified,  had  it not
" been prevented by his fudden death afterwards
" in .London."  If this furmife is founded up-
on any  real tokens of  approaching profperity,
I could wills they had been afligned.  For Brown
went to London with no favourable omens; eve-
ry extraneous circumdance was againft him, and
whatelfe could avail him in a place,  where it is
well known to men of obfervation, that fuccefs
has  feldom been  in  proportion to merit ? Dr.
Johnson, who mud have witneffed .phyfician
after phyfician carrying away the.prize of public
favour from competitors, far  fuperior in parti-
cular fkill and general abilities,  declares that
" in a great city medical reputation is,  for  the
" jnoft  jparc,   totally .cafual."  " By  an acute
                                 " obferver," 
txxv'l         OF DR.  SROWNS,  &C

<c obferver,"  he fubjoins, " who  had  looked
" on the tranfadions  of the medical world for
" half a  century, a very curious book  might
" be written  on the  fortune of phyficians."—
The  idea  appears  to  me fo happy that I fliall
venture to profecute it through a kw pages.
   Such a book, with a  due extention of the
plan, would afford opportunities for difplaying
profeffional fcience,  to  wit, knowledge of the
world, and benevolence.  For if it be true that
many  have been received in the  name of the
goddefs of health,  who  were,  in reality; not
the  lead  adive among  the miniders of death,
the  midake  deferves to be cleared Up ;  and  a
proper explanation  would be better than  " cu-
tf rious ;"■ it  would not only teach how fome
members  of fhe faculty have  contrived to retain
a privilege which  the priedhood has lod,  but
furnifh I know not how much ufeful inftrudion
besides.

     OF  REPUTATION  IN  PHYSIC.
   On the mod fuperficial enquiry,  it would be
manifeft  that this man profpered becaufe he had
been of a certain univefity ; another,  merely be-
caufe he belonged to a particular fed;  a. third,
becaufe he happened to be in the way of procu-
ring a recommendation to fome leader iri poli-
tics or fafhion.  A great number would  be iecn
to have  fucceeded  in  life for  the fame  reafon
                                    precifely 
        OF REPUTATION IN  PHYSIC.   lxXVU

precifely that Faldaff  fucceeds upon the ftage.
Few  analyfe  their fenfations, and the firft im-
preffion made by thefe adventurers was pleasing.
As far as the dramatic perfonage is concerned,
'ihe reafon  is unqueflionable,  but it by no means
applies fo happily to the other cafe.  The qua-
lities producing  the happy impreflion,  have,  in
truth; frequently borne no nearer a relation  to
profeffional merit, than Faldaff's  pleafantry to
folid worth of charader ;  in a variety'of inftan-
ces,  they have been no other than  iymmetry of
•features or foftnefs of  addrefs.
   It is  calamitous  enough for  individuals, la-
bouring under difeafe,  to fall into  bad or indif-
ferent hands;''but when the  caprice  of  fortune
elevates her worthlefs  favourites to  the firft emi-
nence in fo important a profcfiion as medicine,
a more  extenfive injury is done  to fociety than
'we  fhould at" firft imagine.   To calculate its
amount  requires  a great deal of thought.   Be-
side the mifchief  they perpetrate with their own
hands, thefe  intruders occupy  the dation  due
(if the  general  welfare  is to fettle the prece-
dence),  to  phyficians of enlarged views, who
 would make a  beneficial ufe of its advantages,
 and  impel the defedive art on towards perfedi-
On.  Is  an example neceffary to enable  you to
 conceive what  might  be effeded by the power-
ful influence of medical men, enjoying the con-
 fidence of  the great ?  A number may be given,
                                          but 
IxSviii   OF REPUTATION  IN PHYSIC.

but one will fuffice :  and it is the better for its
fimplicity. x  We  have  no  obfervations  Jfrom
which we can certainly deduce the difference, in
point of efficacy, between certain warm medicinal
fprings and common water,  heated to the fame
temperature.  The problem, merely for its cu-
riosity,  defer yes to be folved ;  and  it happens
to be peculiarly intereJling to  that order, from
which dodors in  vogue receive  their  ampleit
gratukies.   They  have Ihewn little anxiety for
the  removal of this difficulty,  either for  their
own diredion in pradice, or by. way of return
to their benefadors.
   They will too often, I fear, be found  to have
been worfe than inattentive to the advancement
of their art;  and to have difoouraged ufeful in-
vestigations by insinuation,,  if not by dired op-
pofition.  Pride and avarice will always combine
to render a j>rofperous adventurer in medicine,
whofe views are,narrow,, jealous of improve-
ments and hostile to improvers.   The  internal
monitor  whifpers that it was  not by knowledge
he rofe, but by knowledge he  may fink.   It is
therefore  the  constant expedient of  dullnefs to
perfuade the world that men of  genius are defi-
cient in  judgement;  though it be certain that
the very perfons  who have been  moft remark-
able for devifing new means of relieving didrefs
and removing uncertainty,  have  alfo been  the
moft  acute  in difcerning the real relations  of
                                      things. 
         0*F REPUTATION Itf PHYSIC.    lxxi*

 things.   Still, however, the old way is judged
 the fafefi, and crafty mediocrity treafures up the
 fpoils of the credulous and the rich.
   It  is  possible  to meafure the number of de-
 grees by which medicine is  more imperfed than
 it would have been if the public was not fo Jiable
 to mifplace its confidence, and had not adually
 fo often  mifplaced  it.   For this purpofe,  our
 enquirer, I apprehend, will find in the progrefs
 of a kindred art,  a standard of eafy application.
 Let it  be fuppofed that a fucceflion  of  men of
 fpecious carriage  and mean talents had flourifhed
 for a  century paft, in the place of our great im-
provers  of furgery.  Then good part of their
difcoveries would have been loft,  for  we cannot
believe that,  under difcouragement, and  with
inferior opportunities,  Pott, Hunter, and their
predecefTors could  have rendered equal fervices
to humanity.   Of thefe fervices a concifc but
clear  account fhould be given ; the fame fcru-
tiny fhould then be  extended to the labours  of
the phyficians that have flourifhed during the
fame  period ;  it  may begin with  Radcliffe, and
be carried down to  our own times.  Thus ordi-
nary readers would be put in a condition to judge
how far it betrays a Fpirit of wanton difparage-
ment,  to affirm that a phyfician in a great city,
" is  the  mere plaything of fortune,   they  that
" employ him,  not knowing his excellencej
" nor 
IXXX    OP  REPUTATION IN  PHYSIC.

nor they  that rejed him, his deficience (j) ;"
thefe  affertions, if they be well-founded,  ine-
vitably  lead to a conclufion more  important
than fatlsfadory,  for however we may be Hart-
led, we mud infer that the greateft repute in medi-
cine affords fear ce the flight eft prefumption of fuperi-
or fkilfulnefs.
,  Of the  fortunate fons of Efculapius,  feveral
have been wary enough not to expofe themfelves
to criticifm  ; in mod cafes,  however, we have
memorials  fufficient  to  guide our  judgement ;
fome  have left written documents of their pow-
ers ; here the proportion between reputation  and
ability can be eftimated with great precision.
   Confidering that his enquiry can be ufeful  on-
ly by inculcating  falutary circumfpedion,  our
author mould not  be deterred by the fird fenti-
ments of repugnance which the attack would  ex-
cite in  many minds,  nor  by  the refped due to
his virtues, from examining the title of the cele-
brated Fothergill to prefent confidence, or post-
humous reputation.   He fliould infid the more
on this decifive example, becaufe Fothergill re-
ally appears to have done his bed towards  im-
proving the art that enriched him;  and becaufe
it would  be difficult to  prove that any among
his equals  in popularity,  have  performed,  or
could .have performed greater things.  How fas

          (i) Johnfon's Life Akenfide.
    -                            he excelled 
         OF REPUTATION  IN PHYSIC.   IXXXl

 he excelled in fagacity of difcrimination,  or fer-
 tility of refources,  would be eafily fhewn by an
 impartial furvey of his works; and little doubt
 would remain  whether his patients would have
 fuftained  much difadvantage,  or  our prefent
 flock of information  much diminution, if  any
 well-meaning man of plain fenfe had moved in
 his  fphere.   If  the fmalleft fcruple fhould be
 left, there exifts a  piece of evidence which it
 may be the more difficult  to refid,  as it comes
 from the mouth of the worthy Dodor himfelf.
 Fothergill  and others, have been heard by Dr.
 G.  Fordyce, " to  ftate in a ferious harrangue,
 " their infpiration,  not only in the knowledge of
 " difeafes without enquiring into their external
 " appearances, but in making prefcriptions to
 " flow  from their  pen,  without any previous
 " compofirion  in  their mind;  not in compli-
" ance with the prejudices of their patients,  but
 " from their own belief (/)."
  From fuch a comparative estimate,  the chief
 reafon why furgery'has fo far didanced medicine,
 would appear.  Should  it  be faid that furo-ery
 mud, from its nature, have outdripped  medi-
cine,  as mechanical philofophy  neceffarily at-
tained fome degree of perfedion before chemif-
try,  the judnefs of the obfervation may  be ac-
knowledged.  But  after a liberal allowance for

         (?) Fordyce on Fever, p. 160.
                      L                  this 
lxXXli   OF  REPUTATION  IN PHYSIC
this  caufe of inequality, the author of the Irr-
vedigation would find a far more powerful caufe
neceffary  to account for the whole effed.—He
might corroborate his inference by an enumera-
tion of  the  improvements adually made in me-
dicine ; from which it would  be evident that
they have been principally owing to perfons en-
joying moderate reputation in the country.
   Objedions will occur to hady reafoners ;  and
thefe the author mud take care to obviate.  " A
"  phyfician of great eminence may be too bufy
Cf  to write ; he  may,  alfo,  be highly ufeful in
"  his  generation  without leaving any traces of
"  his  fkill  behind."   He could  not, however,
well be  more bufy than feveral of the mod emi-
nent surgeons,  who have found time  to write
extenfive  treatifes; moreover, his pradice  and
converfation, without the aid of his pen, would
fo widely fpread the knowledge* of his difcove-
ries, that the patients of every village apothe-
cary would have caufe to blefs the London lumi-
nary of phyfic.
   The  anfwer, to thefe objedions affords  a cri-
terion,  by which we fhall be as little liable to be
deceived, as when we judge of  the value of a
fruit-tree  by its produce.  If a phyfician has  at-
tained to great eminence without having  made fome
affignable  improvement in  phyfic,  if he has  neither
executed nor promoted any defigns, tending to tbis
end, hi  mny Is'ffsly fet dovm as the narrow-minded
                                      creature 
         QF REPUTATION  IN PHYSIC.   IxXXM

creature of artifice, or thefpoiled child of chance.—
In an age where every incident is brought within
reach of every eye, we may with perfed fafety
apply to perfonages lb confpicuous the maxim of
the fchoolmen,  that  " what does not appear, is
" to be reputed not to exid."
  The work in quedion doubtlefs requires cou-
rage as well as other valuable qualities ;  yet  the
author,  if  I do  not  midake, would incur lefs
danger at prefent than at any preceding period.
The profeffors of furreptitious or accidental fame,
would infallibly join in crying  or hunting him
down, and by figns of alarm bear witnefs to the
merit of the produdion.   But I have reafon to
believe that the combination would fail in bring-
ing it into total difcredit.   Some progrefs has
been  made in  arranging the peculiar properties
of  animated nature,  and in recommending to
mankind the knowledge of themfelves.   A  fe-
ries of  propofitions,  expreffed in  intelligible
language,  and capable of  comparifon with  ap-
pearances, has been formed.  Thefe propofiti-
ons,  which occur principally in the writings of
Dr. Brown, Mr.  Hunter,  and  the  author of
Zoonomia,  may be regarded as the foundation
of a new fcience,  not lefs  generally intereding
than any of the preceding  : for it would be dif-
ficult to affign a reafon why the celedial motions,
the working of machines,  or chemical pheno-
mena,  fliould  be objed?  of liberal curiosity;
                                       to the 
lxxxiv  OF REPUTATION  IN PHYSIC
 to the exclusion of the effeds produced by the
 principle  of life.   One reafon, of which  the
 force will not be eafily eluded,  may be affigned
 in behalf  of the  latter dudy.  It diredly tends
 to promote the well-being,  and prolong the ex-
 idence, of the dudent.  The time  therefore
 cannot be far didant, when indrudion concern-
 ing  the caufes of health and difeafe will be ac-
 knowledged to  form a neceffary part of all rati-
 onal education; and the nearer we approach to
 this  period,  with lefs hazard may the analysis
 propofed by Johnfon,  with the plan fo enlarged,
 and the purpofe fo ennobled,  be  executed.
  There is,  dill, an addition  which,  in   my
 opinion,  would contribute fomewhat to precisi-
 on, and fomewhat to fecure the fick  againd the
 danger of medical flaughter.   This appendix I
 fhould call Jatrologia, a denomination from
 which the learned reader may infer, that I  have
 in view fome  fuch application of  the Linnasan
 method to phyficians, as Baron Born has exem-
 plified  in his claffification of Monks.
  If thofe affemblages of human animals,  that
 conditute political focieties,  were  arranged ac-
 cording to the nature of their occupations,  one
clafs would confid of individuals, depending for
 their fupport upon opinion.   This clafs,  being
 provided with the name of Greek origin, might
 be eafily fplit into orders; of thefe orders the me-
dical tribe  would make one.   We  have the or-
                                  der broken 
        OF  REPUTATION IN PHYSIC    lxXXV

der broken  into genera ready to our hands : of
the didribution into fpecies (which  is more dif-
ficult) a fpecimen is fubjoined.—Our writer's
prefent concern is only with the genus—Doffor
of Phyfic.   This genus  we may fubdivide  into
fedions, or groups ;  as Linnasusfometimes ma-
nages with genera, comprehending a number of
fpecies.
               SECT.   I.
Doctors as defirous, at leaft, of doing good and
  extending knowledge, as of amaJJing wealth.
   i.  The philanthropic Doctor, D.  equally fen-
fible of the  importance and imperfedion of me-
dicine ; compares the phenomena of health and
difeafe with  unwearied  affiduity, that he may
form  a jud arrangement  of the adions of life,
perfuaded that this is the only dire guide in me-
dical  pradice ;  cautioufly  tries new remedies,
and abides by the best;  beats the coverts of fci-
ence, that he may himfelf dart fomething ufe-
ful ;  is humane in  his  condud,  not fo much
from  fudden impulfes  of the  paflion  of  pity,
as from a  fettled convidion of the mifery pre-
vailing among mankind.
  Var.  a.. The  fhy philanth.  D. fick with dif-
guft at the manoeuvres of his intriguing brethren,
runs into the opposite extreme, and keeps too
clofcly retired from public notice.
   Var. &.  The renegado phil.  D. poffcffing ac-
                                       tivity
^ 
IXXXVI           JATROLOGIA.
 tivity of mind and integrity of principles;  re-
 linquifhes the pradice of phyfic, partly for the
 fame reafon as Var.  a. and partly from  diffatis-
 fadion with  its helplefs ftate;  applies his talents
 to literature or fcience.
   Obf. i. Several of the greateft acceffions to hu-
 man knowledge are  owing  to this  fecond  va-
 riety.
   Obf. i. A careful examination  and compari-
 fon  of  thefe  two varieties, with fome of the
 fucceeding fpecies,  will  elucidate the nature of
 thofe phyficians,  that have ufually had great  lo-
 cal vogue.
   More frequent than formerly—not apt to flou-
 rifh in great cities—otherwife not confined to any
 particular fituatioh.   As  felf-love grows more
 enlightened, the more common will  this fp.   of
 D. become,  till ir. fupplants all the others :  man
 being an animal lefs liable to be duped as his ig-
 norance decreafes.
               SECT.  II.
   D.  Mere colleclors  of fees,  regardlefs of medical
fcience, given to artifice and intrigue,  each fpecies
 after its own manner.
   3.  The bullying Doctor, D.
             -----Inexorabilis, acer
 looks big, struts,  fwaggers,  fwears.
   Obf. Surgeons, in our times, more frequent-
 ly bear  thefe marks.   According  to  a moft
 acute contemporary  author,  the famous Rad-
 cliffe was a compleat fpecimen of the bullying 
JATRCLOGIA.          IxXXVU
D.  " With fmall fkill in phyfic,  and hardly any
" learning, he got into pradice by vile arts.—
" He would negled a nobleman that gave exor-
<f bitant fees;" and to heighten the  infult by
contrast "  at the fame  time  carefully attend  a
" fervant or mean perfon  for nothing—he was
" furly and morofe;  treated his patients  like
" dogs—extended  his  infolence even  to the
" Royal Family—fcorned to consult with his bet-
" ters on what emergency foever; looked down
<f with  contempt on the moft deferving of his
" profeffion, and never would confer  with any
" phyfician who  would not pay homage to his
" fuperior  genius ; creep  to his humour,  and
" never approach him but with the flavifh obfe-
<f quioufnefs of a court flatterer."
  3. The bachanalian Doctor. D. given to fot-
tifhnefs,  if not drunkennefs—generally fome-
what of the Bully.
  4.  The folemn Doctor. D. with garb, voice,
gestures, and  equipage, contrived  to overawe
weak imaginations, and hide the futility of his
art.
  Obf.  1.  D.  of  this  remarkable fpecies  firft
pradifed phyfic with pomp:  they invented or
borrowed  from the other profeffions thofe  bar-
barous  habiliments, of which ridicule has but
lately stripped  phyficians.   In times,  when an
huge wig, or a flowing gown,  could  more effec-
tually 
lxXXVUi          JATROLOGIA.
 tually command  refped than  found morality,
 fubflantial judice, or ufeful  fkill,  the flratagem
 fucceeded to admiration.
   Obf. i.  D.  of this fpecies, when a pretext
 offers, fpeaks odentatioufly of their experience
 —never  fufpeding  any of  their  hearers  may
 know that there are underdandings which mul-
 tiplicity of appearances ferves but to confound.
   5.  The club-hunting Doctor.  D. frequenting
 the crowded haunts of  men;  pufhing himfelf
 forward, faluting all he knows, and all who will
 know him; talking much and loud.
   Obf. In England,  D.  of  this fpecies have of
 late been frequently feen  in paroxyfms of frantic
 loyalty, and of civifme in France.
   6.  The burr  Doctor. D. fastening himfelf
 upon you as tenacioufly as the heads of  the noi-
 fome weed  (centaurea calcitrapa),  from which
 the trivial name of the fp.  is taken, fix upon
your cloaths.
   Obf. Nothing  in  art, but the juggler's ad-
 dress in making you take what  card  he pleafes
 out of a pack, equals the dexterity with which
 D. of this fp. force themfelves on patients.
   7.  The wheedling Doctor. D. with an ever-
 lading fmirk upon his countenance—frequent at
 the polite end  of large cities, and at places of
 fafhionable refort.
   Var. «. The Adonis wheedling D. D.  with an
 handfome face,  joined to the wily addrefs, cha-
                                    raderiftic 
JATROLOGIA.           IXXxix
raderiftic  of  the  fp.—flourifhes  at  watering
places ; fometimes  joins to  his  profession  the
trade of a fortune-hunter ; and if he  fucceeds,
" gives phyfic to the dogs."
  Obf. i.  D.  of this fp. when moft moderate,
prefcribe for every  rich  patient two draughts a
day, and one  night draught, besides pills  and
powders.   Hence needlefily to fwallow naufeous
drenches may be numbered among the curfes of
wealth.
  Obf. 2.  The Adonis D. has fooner or later a
patient of  note,  ill of a fever or  fome difeafe,
that ufually  terminates  favourably;  in  cafe of
recovery the  female  bufy- bodies of the place,
exert their fpirit of cabal in behalf of the won-
der-working youth,  and his fortune is made.
  8.  The cafe-coining Doctor.  D.  publishing
forged or falfified cafes.
  Obf. " A very fertile fource of falfe fads has
" been opened for fome time past.   This is, in
" fome  young  phyficians, the vanity of being
" the authors of obfervations which are often too
" hastily made, and fometimes, perhaps', very en-
" tirely dreffedin the clofet.  We dare not at pre-
" fent be  more  particular ; but  the next  age
" will difcern many inftances of perhaps the di-
ef red falfhoods, and certainly the many  mif-
cc takes  in fad, produced in the  prefent age,
tf concerning the virtues and powers of medi-
" cines."   Cullen. Mater. Med. I.  153.
                     M                A-kin4 
xc
JATROLOGIA.
  A-kin to this flagitious abufe is the pradice of
purchasing falfe attedations, on oath,  for adver-
tifements;   and what  is dill  worfe in effed,
though not in intention ; a cudom beginning to
prevail among perfons of didindion—who cannot
be fuppofed  capable of  difcriminating  difeafes,
or deciding  on the efficacy of drugs—but  who,
neverthelefs, permit Quacks to ufe their names
in tedimony  of  cures, which they fuppofe them-
felves to have vvitneffed.
  9. The good-fort-of-man Doctor. D. a  good
fort of man,  armed, by fome midake with a di-
ploma.
  Var.  x.  The  goffiping  gcod-fort-of-man D.
fetches and carries fcandal.
  Obf.  Varieties numerous as the hues of the ca-
maeleon.
  10.   The  Sectarian  Doctor.  D.  dwelling
among his own  people at fird ;  and by them of-
ten pufhed  on to fpread devadation among the
red of mankind.
  Obf,  Varieties manifold ; each didinguifhable
by  the livery of its fed—one is too curious to
be omitted.
  Var.  ». The infpired Seel. Doctor. D. be-
lieving  himfelf  to  be  infpired with the know-
ledge of difeafes and remedies.
  In civilized countries not much more frequent
than witches.  Among rude tribes,  as amono-
the Tartar hordes,  a kindred variety is univer-
                                        fallv 
JATR0L0GIA.
xci
 fally  found.   See Gmelin's Travels.   But thefe
 feem rather to pretend to infpiration,  than really
 to believe that their deity ferves them in the ca-
 pacity of  Prompter :  and they conjoin the cha-
 raders of pried and conjurer with that of phy-
 fician.   I  have not been able  to afcertain whe-
 ther  our variety receives the afflatus,  except in
 its  medical capacity:  and  the miracles it  has
 wrought in this, are not fo perfedly authentica-
 ted, as to  filence cavillers.
   Obf.  People are now-a-days  delicate in giving
 recommendations on fome occafions;  but the
 best bred perfons make no  fcruple of preffing a
 favourite phyfician or apothecary upon their ac-
 quaintance.  Yet one would think that they are
 nearly as competent to fpeak to  the merit of  a
 footman, as of  a  prefcriber or compounder of
 drugs.  Seds fometimes improve this propensi-
 ty into a regular fyftem  of  cabal.  The deeper
 the hypocrify,   or  the wilder the enthufiafm of
 the Sed. Dodor, the more eagerly will his bro-
 ther-fanatics dafh through thick and thin to ferve
 him.   Now as belief or difbelief in certain points
 of theology, has  no apparent connedion with
 fkill in the adminidration of antimony, mercu-
 ry,  opium, and bark,  we may deduce from this
 fad a rule which is probably as little liable to ex-
 ception,  as any that be laid down on the whole
 fubjed.  Never  call in a phyfician,  because he is
recommended by a [perfon of the fame  feci:;  the more
                                         yo 
xcii              jatrologia.
you are urged, be the more on your guard againft the
fnare.   This rule extends to all dsemoniacs pof-
 feffed by the corporation-fpirit,  and to all fets  of
 perfons remarkably gregarious.

                  Observation.
   Concerning this decad of dodors,  there  re-
 mains a caution to be laid down ; and that it may
 make the greater impreffion, Iihall deliver it  in
 the  ftyle  of my models, the naturalists.   No-
 tandum in toto hoc genere naturam mirabiles edere lu-
fus.   It  is indeed applicable to all the fpecies ;
 individuals  being apt,  like  hybrid plants,   or
 mule  animals,  to exhibit fhe marks of two fpe-
 cies,  wholly or in part.
OF 
(  xciii  )
  OF THE BRUNONIAN DOCTRINE.
  A complete investigation of Dr. Brown's the-
ory of living nature, with its application to the
knowledge  and treatment of difeafes,  would,
at leaft, equal the original work in fize :  besides,
if I had any inclination to write fuch a commen-
tary, I  fhould  not confider this as the proper
place for  introducing it.  I have,  however, a
few words to fay on the outlines and  formation
of the  fyftem.  I fhall fubjoin fome refledions
to put medical students and readers, not profef-
fional, in the  way of profiting by the true prin-
ciples he promulgated  without being mifled  by
his doubtful or erroneous positions.
   Of Dr.  Brown's  Fundamental Propofitions.
  The varied ftrudure of organized  beings it is
the bufinefs  of  anatomy to explain.   Confciouf-
nefs,  aflifled by common  obfervation, will dif-
tinguifh animated from inanimate  bodies with
precifion more than fufficient for all the ends of
medicine.   The  caufe of gravitation has been
left unexplored by all prudent philofophers; and
Brown, avoiding all ufelefs difquifition concern-
ing the caufe of vitality, confines himfelf to the
phenomena, which this great moving principle
in nature may be obferved to produce.  His moft
general propofitions are eafy of  comprehenfion.
   I. To every animated being is allotted a cer-
tain portion only of the quality or principle, en
                                       which 
 xciv    OF the brunonian doctrine.

 which the phenomena of  life  depend.  This
 principle is denominated excitability.
   II.  The excitability varies indifferent animals,
 and in the fame animal at different times.  As it
 is more intenfe,  the animal is more vivacious or
 more fufceptible of the adion of txi.iting powers.
   III. Exciting powers  may be referred to two
 claffes.  i. External, as heat, food,  wine, poi-
 fons,   contagions,  the  blood,  fecreted fluids,
 and air. i. Internal,  as the fundions of the bo-
 dy itfelf, mafcular exertion, thinking,  emotion
 and passion.
   IV. Life  is a  forced ftate;  if the  exciting
 powers are withdrawn,  death enfues as certainly
 as when the excitability  is gone.
   V.  The excitement  may  be  too great,  too
 fmall,  or in just meafure.
   VI. By too great excitement weaknefs is indu-
 ced,  becaufe the excitability become defedive;
 this- is indirect debility:  when the  exciting powers
 or ftimulants are withheld, weaknefs is induced;
 and this is direft debility.  Here the excitability
is in excefs.                                 '
   VII. Every power that  ads on  the living
frame, is  ftimuiant, or produces excitement  by
expending excitability.  Thus,  although a per-
 fon, accuftomed to animal food,  may grow weak
 if he  livf s upon vegetables, dill  the vegetable
diet can only be confidered as producing an ef-
 fed,   the fame in kind with animals,  though in-
                                       ferior 
         OF THE BRUNONIAN  SYSTEM.     XCV

 ferior in degree.   Whatever powers therefore,
 we imagine, and however they vary from fuch
 as are habitually applied to produce  due excite-
 ment, they can only weaken the fydem  by ur-
 ging it into too much motion,  or differing it to
 fink into langour.
   VIII.  Excitability  is feated  in the medullary
 portion  of the nerves,  and in the mufcles.  As
 foon as it is any where affeded,  it is immediate-
 ly affeded every where;  nor is  the excitement
 ever  increafed in a  part, while it is generally di-
 minifhed in the fydem ;  in other words,  differ-
 ent parts can never be in  opposite dates  of ex-
 citement.
   I have already fpoken of an illudration, drawn
 up by Mr. Chridie  from a familiar operation, to
 facilitate the conception of Brown's fundament-
 al pofitions.  I introduce it here as more likely
 to anfwer its purpofe than if feparateiy placed at
 the end of my preliminary obfervations.  <f Sup-
 " pofe a fire to be  made  in a grate,  filled with
 " a  kind  of fuel  not  very combudible,  and
 " which could only be kept burning, by means
 " of a machine containing feveral tubes,  placed
 " before it,  and condantly pouring dreams of
 cc air into it.   Suppofe ahk» a pipe to be fixed in
 " the  back of the chimney,  through which a
 " condant fupply of  frefh fuel was gradually let
" down into the grate, to repair the wade occa-
 " fioned by the flame,  kept up by the air ma-
" chine." 
XCVl    ON THE  BRUNONIAN  SYSTEM.

  " The grate will reprefent the human frame ;
" fuel in it, the matter oflifey the excitability of the
" Dr. Brown and the fenforialpower of Dr. Dar-
" win ;  the tube behind fupplying frefh fuel, will
" denote  the power of all living  fydems con-
" dantly  to regenerate or reproduce excitabili-
" ty; while the  air machine,  of feveral  tubes,
" denotes the various ftimuli applied  to the ex-
" citability of the body ; and  the flame  drawn
" forth  in confequence of that application re-
<f prefents life,  the produd of   the  exciting
6t powers ading upon the excitability."
  " As  Dr. BrOwn has defined life to be f a for-
6( ced ftate,'  it is fitly reprefented by  a  flame,
" forcibly drawn forth, from fuel little difpofed
" to combudion, by  the condant application of
" dreams of air  poured  into it from the differ-
" ent tubes  of  a machine.  If fome  of thefe
*c tubes  are fuppofed  to convey pure or dephlo-
" gidicated  air,  they will denote the highest
" clafs of exciting powers, opium, mufk,  cam-
" phor, fpirits,   wine, tobacco, &c.—the dif-
" fusible  ftimuli of  Dr. Brown,  which  bring
<c forth  for a time a greater quantity of life than
" usual, as the blowing in of pure  air into a fire
" will temporarily  draw  forth an  uncommon
" quantity of flame.   If others of the tubes be
" fuppofed to convey common or atmofpheric
" air,  they will reprefent the ordinary  exciting
" powers, or  ftimuli, applied to the human
                                    " frame, 
            BRUNONIAN SYSTEM-         XCVU

 " frame, fuch as heat, light, air, food, drink, &c.
 " while fuch as convey impure and inflammable
 " air ma/ be ufed to denote what have formerly
 " been termed fedative powers* fuch as poifons,
 " contagious miafmata, foul air, &c."
   " The reader will now probably be at no lofs
 " to understand the feeming paradox of the
 " Brunonian fyftem;  that food,  drink, and all
 f< the  powers applied to the  body, though they
 " fupport life,  yet  confume it;  for he will fee,
 "that the application of thefe powers, though
 " it brings forth life,  yet  at the fame time  it
 " wastes the excitability or matter of life, juft  as
 " the air blown into the fire brings forth more
ct flame,  but wades the fuel or matter, of fire.'—'
"  This is conformable to  the common faying,
<f  c  the more a fpark is blown,  the  brighter  it
"  burns,  and the fooner it is fpent.'   A Roman
'*  poet  has given us, without intending it,  an
"  excellent illustration of the Brunonian fyftem,
"  when he fays,
   "  Balnea, Vina, Venus, confumunt corpora noftra,
   "  Sed Vitam faciunt Balnea Vina Venus."
   "  Wine, warmth, and love our vigour drain;   -
   "  Yet wine, warmth, love, our life fuftain."
   Or to tranflate it more literally,
   "  Baths, women, wine, exhauft our frame,
   "  But life itfelf is drawn from them." 
XCVlii          ILLUSTRATION OF THE

  " Equally eafy will it be to illustrate the two
cc kinds of debility,  termed direcl and indire5f9
" which, according to  Brown,  are the caufe of
" all difeafes.   If the quantity of stimulus, or
ce exciting power, is proportioned to the quanti-
tf ty of excitability, that is,  if no more excite-
" ment is drawn forth than is equal to the quan-
" tity of excitability produced, the human frame
" will be in a ftate of health, juft as the fire will
" be in a vigorous ftate, when no more air is
ec blown in,  than is fufficient to confume the
" frefh fupply of fuel conftantly poured down
e* by the tube  behind.   If a fufficient quantity
" of ftimulus is  not applied, or air not blown
« in, the excitability in the man, and the fuel in
" the fire will accumulate, producing direcl dibi-
" lity,  for the man will become weak, and the
" fire low.  Carried to a certain degree they will
« occafion death to the firft,  and extindion  to
"  the laft.  If again, an over proportion of ftimu-
" lus be applied,  or too much air blown in, the
" excitability will foon be wafted, and the  mat-
" ter of fuel almoft fpent.   Hence will arife in-
" direcl debility, producing the fame weaknefs in
"  the man* and lownefs  in  the  fire  as  before,
" and equally  terminating,  when carried to a
" certain degree,  in death and extinction,1'
  " As all the difeafes of the body, according  to
*c  Dr. Brown,  are occasioned by direct or indi-
"  red debility, in confequence of too much or
"  too little ftimuli,  fo all the defeds of the fire
                                       "muft 
            BRUNONIAN SYSTEM.          XC1X

 te  muft arifc from dired or indired loWnefs,  in
 "  confequence  of  too  much or too little air
 "  blown into it.  As BrOwn taught that one de-
 4( bility was never to be cured by another,  but
 w both by the more judicious application of fti-
 *' muli, fo will be found the cafe in treating the
 99 defeds of the fire.  If  the fire has  become
 " low,  or  the  man weak  by  the want of the
 f< needful  quantity  of ftimulus, more muft  be
 " applied,  but very gently  at firft, and increaf-
 u ed by degrees, left a ftrong ftimulus applied
 " to the accumulated excitability fhould produce
 " death, as in the cafe of a limb benumbed by
 cc cold  (that  is weakened  by the accumulation
 " of its excitability in confequence  of the  ab-
 " ftradion  of the  ufual ftimulus of  heat),  and
 " fuddenly held to the fire,  which we know from
 " experience is in danger of  mortification, or
 " as  in the cafe of  the fire become very low by
 " the accumulation of the matter of  fuel,  when
 " the feeble flame, affailed by  a fudden and
 cc ftrong blast of air, would be overpowered and
 Cf put out, infiead of being nourifhed and increaf-
 " cd.   Again,  if the man or the fire  have been
 " rendered  indirettly weak,  by  the application
" of too much  stimulus, we are not fuddenly to
" withdraw the  whole, or even a great quantity
,c of the exciting powers or  air, for  then the
" weakened life and  diminifhed  flame might
"  fink entirely,  but we are by little and little to
«< diminifh  the  overplus of  ftimulus, io as  to
                                    " enable 
e
REPUTATION OF THE
"  enable the excitability,  or matter of fuel, gra-
"  dually  to  recover its  proper  propbrtion.—
"  Thus a man  who has injured his constitution
"  by the abufe of fpirituous liquors,  is not fud-
"  denly to be reduced to water alone, as is the
"  pradice of fome phyficians,  but he is to be
"  treated, as the judicious Dr. Pitcairn of Edin-
"  burgh,   is faid to  have treated  a Highland
"  chieftain, who  applied to him for advice in
"  this situation.   The Dodor gave him no me-
"  dicines,  and  only exaded a promife of him,
"  that he would every day put in as much wax
"  into the wooden queich out of which he drank
"his  whifky,  as would receive  the  impression
"  of his  arms.   The  wax thus gradually accu-
"  mulating, diminifhed daily the  quantity  of
"  the whifky, till the whole queich was filled with
"  wax, and the chieftain was thus  gradually>
u  and without injury  to his constitution,  cured
"  of the  habit of drinking fpirits."
   " Thefe analogies might be purfued farther j
"  but my objed is folely to  furnifh fome general
"ideas,   to  prepare  the reader  for entering
"  more eafily into the Brunonian  theory,  which
"  I think he will be enabled to do after perufing
"  what I have  faid.  , The  great excellence of
ct  that theory, as applied not only  to the pradice
"  of phyfic, but to  the  general conducl  of the
*f  health is, that it imprefies on the mind a fenfe
lt  of the  impropriety and danger of going from
?f  one extreme  to another.   The human frame
t(is 
             BRUNONIAN SYSTEM.          CI

" is capable of enduring great varieties, if time'
" be given it, to accommodate itfelf to different
" states.   All the mifchief is done in the tranfi-
" tion  from one ftate to another.   In a ftate of
" low excitement we are not rafhly to induce a
" ftate of a high excitement, nor when elevated
" to the latter,  are  we fuddenly  to defcend to
" the former, but step  by ftep, and as one who
<c from the top of a.high tower defcends o the
" ground.  From hafty and violent changes the
" human frame always  differs, its particles are
" tornafunder,  its organs injured,  the vital prin-
" ciple impaired, and  difeafe, often death, is
  ' the inevitable confequence."

   "  I have only to add that though in this illu-
" ftration of the Brunonian  System (written fe-
" veral years ago),  I  have fpoken  of a tube
" condantly pouring in frefh fuel,  becaufe I
" could not otherwife convey to the reader a fa-
" miliar idea, of the power poffeffed by  all li-
" ving fydems,  to renew their excitability when
" exhauded, yet it may be proper to  inform the
" dudent,  that Dr. Brown fuppofed every livino-
" fydem  to have received  at the  beginning  its
" determinate portion of excitability,  andtiiere-
" fore,  although  he  fpoke of the  exhaudion,
" augmentation, and even renewal of excitabi-
" lity, I do not think it was his intention to in-
" duce  his pupils to think of it, as a  kind of
«f fluid fubftance, exifling in the animal and fub-
                        .   • :,           "jed 
Cli          REPUTATION OF THE

" ject to the law by which fucb fubftances art
" governed.   According to him excitability was
<c an  unknown  fomewhat, fubject  to  peculiar
«e laws of its own,  and whofe different ftates wc
" were obliged to defcribe (though inaccurately)
c< by terms borrowed from the qualities of mate*
" rial fubftances."
                                       T. C.

   IT was not unufual  for Brown's difciples to
difagree, when they were called upon for a ftrict
interpretation of his principal  tenets.  If they
be rigidly examined, they will be found, I think,
not quite consistent with his own important doc-
trine of  the  accumulation of excitability, du-
ring  different ftates of inadion.  It appears to
me,  that according to his firft chapters  (xviii),
living  beings ought to have proceeded through
langour to death in one unbroken tenourof wake-
fulnefs, and that all the images and lamentations
which fleep has  fuggefted to the poets,  would
have been loft.   He who affumes that a certain
portion of excitability is originally   affigned to
every living fyftem, by his very affumption, de-
nies its continual produdion, fubfequent diffufu
on, and expenditure at a rate equal to the fupply,
or greater or lefs.  That  the brain is an organ
destined to fecrete the matter of life, he could
never have fuppofed, other wife he  would not
have expreffed a doubt whether excitability be a
quality or a fubftance.
   If we admit a fucceffive fupply of this princi- 
             BRUNONIAN SYSTEM.         ciH

pie,  we may folve in a very eafy manner,  feve-
ral difficulties,  for the fake of which new epi-
cycles muft be added to Brown's fyftem.   In the
cold bath we may imagine the generation of fen-
forial power, to proceed with  fmall diminution,
while the  adions on the furface of the body are
considerably abated by local fubdudion of heat.
Thus the well-known glow will be the efFed of
undiminifhed produdion within,  while external
expenditure is diminifhed.  But weak  perfons
frequently do not experience  any  glow.   Here
the adion on the fkin affcds the fyftem univer-
fally; the produdion, therefore, is checked from
the torpor of the fecerning organ, and this ftate
of the brain explains the head-ache and chillinefs,
fubfequent to the mifufe of the cold bath.    Thefe
effeds are not, in my  apprehension, eafy  to be
reconciled to the hypothefis of a fixed original
flock of excitability j  the fame thing may be faid
of feeds and eggs long preferved, without fenfi-
ble change, in a ftate capable of germination and
growth.   Sleep fometimes produces  no refrefh-
ment, and yet  it feems  not  to be imperfed or
disturbed  in  proportion  to the langour felt on
awaking.  This I have attributed to a failure in
the fupply of excitability  (a,); and nervous fe-
ver is  imputed by another phyfiologift,  to this
caufe of debility, of which Brown had no fuf-

        («)  Obfervations on Calculus, &c.
fufpicions.- 
civ
REPUTATION OF THE
 picion.—If an illustrative analogy be defired, hfs
 excitability might be compared to a fluid lodged
 in the body as a  refervoir.  According to  the
 fiatement which I think more  confonant to the
 phsenomena,  excitability would be like a  fluid
 iffuing from the brain as water from a fpring.—
 Thefe referrtblances might be traced a little way,
 but they foon fail,  as always happens in  matters
 fo effentially diffimilar.
   The hypothefis  of Brown is happily  adapted
 to the limited term of life;   according to the
 other fuppofition,  we muft conceive old age and
 death to depend upon a limited power of fecreti-
 on in the brain.  The difference is; fcarcely  per-
 ceptible here, but in terms; it is, however, plea-
 fing to fuppofe thatwifer ages will be employed
• in the  culture of  the  human  fpecies to which
 prolongation of life is effential:  and we can more
 eafily reconcile out thoughts to augmentation of
 power in a fecerning organ, than of the original
 provision of excitability;  fo that the dodrine, in
 pther refpeds the  more  probable,  feems more
.conformable to the profped of improvement.

    Of Brown's  Application of his Principles.

   The mod negligent obferver might bring fpc-
 cious objedions againft that uniformity of opera-
 tion in ftimulus which is taught in the firft propo-
 fitions of thefollowingelements:( " heat and wine,
 <e it might be faid, can never ad in the fame
 " manner, for no perfon is intoxicated by heat."
 In the progrefs of his work we find  the author re- 
OF BROWN'S DOCTRINE.         CV
laxing,  in fome degree, the rigour of his princi-
ples.  When the excitability is wafted by one fti-
mulus,  excitement,  he fays, may  be  produced
by another ;  nor does it fcem neceffary, accord-
ing to the examples quoted in the latter part of
the thirty-first paragraph, and the fubjoined note,
that the fecond ftimulus fhould be more pow-
er ful than the firft.  The fucceffion in the note
is, food, thrught, wine, food, punch, opium, punch,
thought, and fipeech;  and this is not conformable
to the afcending fcale of ftimuli, according to his
estimate in other paffages.
  He alfo admits fome modification of dimulant
power, from the manner in which different dimu-
li are  applied.  Thus heat dimulates the furface
more than the fubjaccnt parts; and dimuli  re-
ceived  into the stomach exert more  adion there
than on any other part.
  It is  extraordinary that he fhould not have ex-
tended this inequality of operation to the consti-
tuent,  as well as the integrant parts  of the fyf-
tem.   It was his principal fault, naturam tanquam
e praaltd  turri defpicere; hence  his  explanation
of minute  appearances, will often  be found un-
fatisfactory.  The fourth and and  fixth chapter
of Part II. afford feveral examples; I fhall feled
one:  " Thirst and heat," he obferves, (CLIX.)
" depend upon fthenic diathesis  of the extreme
" veffels of the fauces and fkin.   Thefe veffels
" become fo much  constricted as to prevent the
" difcharge  of the  perfpirable  matter.   Mean- 
CVI
STRICTURES ON  SOME
" while the  b'ood,  flowing near the extremi-
" ties of the exhalant veffels, lodges under the
" cuticle, the heat which is  generated  in  the
" fyftem,  and which would be carried off, if the
" perfpiration were free."   He explains fthenic
thirst from a fimilar conftridion of the vefltls,
which fecrete faliva and mucus; and in the fmall-
pox the puftules are faid to be occafioned  by  a
fimilar conftridion, which detains the contagious
matter under the cuticle.  This permanent con-
ftridion, we are told, is not fpafm ; no diftindion,
however, is  attempted,  except by referring con-
ftridion to excefs, and fpafm to  defed,  of ex -
citement.
  Upon this reafoning,  it may be remarked, i.
That exceffive excitement of veffels confifts in
exceffive ofcillations—in  the increafe,  not in
the  fuppreffion of  their healthy  fundions ;  and
2.  That to account for  morbid alteration  in
the ordinary ftate of any difcharge,  we ought to
look for an alteration in the ad ion of thofe vef-
fels, by whofe counterading powers it is regula-
ted  in health.  The  balance in the perfpiration
depends on the cutaneous exhalants and abforb-
ents; but the properties of the lymphatic fydem
feem never  to have  ftruck the  imagination of
Brown, though  the investigation was carried on
with fo much ardour during the period of his flu-
dies ; attention to thefe anatomical  difcoveries
would have  aflifted  him in the full explanation of
many difeafes, which, though they  pafs  under
the fame denomination,  he h. s moft justly claffcd 
          OF  BROWN'S DOCTRINES.       CVU

as of a nature entirely oppofite;  the one, fthenic,
the other afthenic j but to make out this explana-
tion,  he muft have acknowledged in thefe differ-
ent  vafcular fyftcms, fome degree of inequality
in the way in which they are affeded by ftimu-
lants  that operate on both.  Thus if the power
of abforption be fooner increafed by the caufes
inducing the fthenic diathesis than that of exhala-
tion,  there is  no occafion to imagine any  con-
ftridion  to  account for  the  drynefs of  the
fkin and  fauces.  The  confequent  more fpeedy
exhaustion  of  excitability in  the  abforbents,
would likewife  have fuggefted  the  rationale  of
that difcharge that follows the ftate of drynefs or
hufkinefs of the fkin, fauces, or urethra, of the
trachea and its ramifications,  when  thefe parts
are affeded by inflammation.
  A great part  of the fymptoms of, Brown's aft-
henic  form of difeafe, depend upon imperfed ab-
forption  from  indired debility  of the veffels
destined  to  that office;  thus perfons whofe
lungs have been weakened by inflammation after
a meal expedorate mucus.  In this cafe the food
excites the  whole  fyftem;  the adivity of the
bronchial glands is increafed, more mucus is fe-
creted, and part becomes fuperfluous, on account
of the comparative inadivity of the abforbents.
^uibus poft inflammationem fupereft urethra debilitas
proftuit mucus limpidus,  poftquam t erf us fueritpenis.
The reafon is the  fame.
  Had it been once allowed by Brown that the
                                      different 
 CVlii             ORIGIN OF !

 different constituent parts  of the body,  bear  a
 different relation to  the fame agents,  he muft
 have admitted the operation of fpecific ftimulants
 to an unlimited extent.  This however,  would
 have destroyed the univerfality of his principles,
 which  he confidered as the great beauty of his
 fyftem ;  but his own opportunities of obfervati-
 on were probably too few, to force upon him a
convidion of their infufficiency;  it is eafy to ex-
 ceed equity and  prudence in refufing to hearken
 to tedimony, we may daily fee fpeculative  men
 forgetting that philofophy does not more confift
in petulent rejedion of information than in cre-
 dulity.

   Of the Formation of the Brunonian Syftem,

  It is believed that hints thrown out by Cullen,
 were the feed from which Brown raifcd his doc-
 trines.
   The   connexion between  the two  men,  is
 doubtlefs favourable to the fuppofition of a com-
munication of ideas,  and it is confirmed by  the
circumdantial evidence  of a common term, from
which  the other  terms,  employed by  Brown,
might be  condructed by  an  obvious  analogy.
The hints  fuggeded  by  Cullen occur  in  the
 CXXXth, and fome of  the  following paragraphs
of his Inftitutions of"Medicine.
  " It is," he fays, " probable that the " nervous
 if fluid in the brain,  is truly capable of different
                                      " ftates 
THE  BRUNONIAN SYSTEM.       CIX
w ftates or degrees of mobility,  which we fhall
" call its ftates of excitement and collapfie." In his
youth,  this author had  imagined a mechanical
hypothefis reflecting the  nervous fluid, which he
regarded with fondnefs through life,  and unfol-
ded with great prolixity in the decline of his pow-
ers (£).   When he wrote the paffage I have quo-
ted, his thoughts were  turned from the living
body to an eledrical machine ; and he evidently
does no more than defcribe the common experi-
ment, in which a congeries  of flexible fibres is
made to stand ered,  and to diverge by eledrici-
ty,  and then fhrinks together on the application
of a conduding fubftance.   His idea of excite-
ment has therefore nothing in common with that
of Brown;  and, on camparifon, I am perfuaded
it will appear that Brown was very little indebted
to the phyfiology of his mader.
  A  material  corredion of the Brunonian theory
may be more fafely afcribed to one of Mr. Hun-
ter's difcoveries,  than its origin to thefe obfcure
opinions of Dr.  Cullen.  An intelligent writer
whofe expreffions befpeak perfonal obfervation,
gives the following account of the extent and oc-
cafion of this  corredion. " In the firfl promul-
" gation of his dodrines, Dr. Brown did not fuf-
ec ficiently  didinguifh  between  the  adions of
" the living body and  its  powers.—Excitement
" and ftrength were  at  firft confidered  by  him

          (f).   See his Materia Medica
                                         " as 
ex
IMPERFECTIONS
" as fynonymous terms;  and on the ftate of ex-
" citement, his distinction  of diseafes were en-
" tirely founded.   To the laft he had but  two
" claffes;  difeafes of increafed and diminifhed
" excitement.
  " After many difcuffions of his dodrine,  in
" which the diftindion between the powers and
" adions  of the living  body.....was pref-
" fed upon by him,  he adopted the term excita-
" bility to express the difpofition  in aftion, and
cc to replace the terms irritability, fenfibility, and
" inability, which he had  difcarded from his fyf-
" tern (c)."
  An alteration of fome confequence refpeding
difcharges of blood, which was made in the inter-
val  between two Latin editions  of his elements,
is noticed by the author himfelf.  What correc-
tions  and enlargement are further  required, the
curious reader may determine by a careful com-
parifon of the following fyftem  with the kindred
fyftems of two contemporary  authors;  con-
stant  reference  being had to  nature at the fame
time.

          Of Predifpofition to Difeafe.

  Among a number of individuals equally expo-
fed to any caufe of  difeafe, we conftantly find
fome affeded,  and others  efcaping.   The cir-
cumstances on which exemption and aptitude de-
    (c). Englifh  Review for  Od. 1794, p. 282.
                                        pend 
                AND ERRORS.              cxj

pend have been anxioufly inveftigated;  and  if
we were well acquainted with the powers that fa-
vour and refift morbific influences,  we fhould be
able more effedually  to accomplifh one of the
two  grand  purpofes  of  the  medical art—the
prefervation of health.  But although fads have
been noted, the principle  lies involved in total
obfcurity.   Brown does not purpofely elude the
difficulty, but his principles lead him befide it;
and  we may doubt whether the term predifpoftti-
cn ought, in strict propriety, to have appeared in
his  Elements;  for predifpofition is with him  a
flight difeafe, differing only in degree from that
into which the perfon predifpofed falls.  (Chap-
ter VIII.  Parti.).
   Between thofe adions of our different organs,
and of the fame organ which frequently occur to-
gether or in fucceffion,  a bond of union is formed
by habit,  as in the cafe of our ideas.   Of any
two  movements, therefore, if the former tend to
introduce the fucceeding,  the fecond muft  take
place,  unlefsit be prevented by fome interpofino-
force.  Hence it is manifest that robudnefs  of
constitution,  principally consists  in the drength
of connexion between the feveral members of the
feries,  and  pronenefs  to  difeafe  in the facility
with which the feries may  be broken.  On this
principle  we  may  underftand why brutes  are
more robud than the human fpecies.   Their ac-
tions both of body and mind are lefs diversified1
than ours;  and being in confequence more fre-
                                     quently 
ex 11
IMPERFECTIONS
quently repeated in the fame order, they acquire
greater force of union, or,  as it has been lately
termed, ftrength of catenation.  It maydeferveto
be confidered whether the remarkable exemption
of negroes from the contagious fevers that have
lately raged in America and the Weft-Indies,
and  the comparatively  fmall mortality among
them depend on their uniform life. (d).
   Perfons  who  have enjoyed  uniformly  good
health,  are  faid to be in greater danger when they
become ill; and in  cafes where the  opinion  is
juft,  wre may deduce an  explanation of the ap-
parent paradox from the fame principle; for the
didurbance of the fundions betrays the interven-
tion of a powerful caufe.

  (d). "  Although the contagion feemed to vary much in
fC  different defcriptions of people,  it is highly probable  that
"  the virus of the contagion itfelf was uniformly the fame,
"  only varioufly modified by peculiar confHtutions, habits, or
"  modes of living.  Thus  among failors, perhaps a fcorbu-
"  tic taint,  joined to extreme irregularity and imprudence,
"  rendered  the difeafe infinitely  more fatal than among any
cf  other clafs  of men.   On the other hand, among field-ne-
;<  groes,  who certainly poflefs an idio-fyncracy peculiar ta
"  themfelves,  and whofe mode of living is generally tempe-
"  rate and regular in a remarkable degree, the virus of the
"  contagion was  fo blunted as to aft in the mildeft form.—
'« Why, however, it fhould operate with moft violence on
'*  Europeans juft arrived, and who had never entered the tor-
"  rid zone before,  is a angularity I do not pretend to ex-
"  plain."   Chifholm on the malignant peftilentia\ fever which
raged at  Grenada in 1793, P' I3°*I> one of the moft  fatal
difeafes on record.
                                               Are 
AND ERRORS.
cxiii
  Are not the embryons  of organized beings
placed in their  peculiar receptacles, that they
may be fecure againft violent impreflions, till
the movements  of their organs, by repetition,
come to proceed with a deady pace, and  the
animal machine is mounted ?
  Pregnant and  puerperal women are among
the perfons mod liable to be affeded by  the
flighter caufes of difeafe.  In the former, from
the great change of the fanguiferous and glan-
dular fydems, new irritative and fenfitive mo-
tions are perpetually  introducing  themfelves;
and at the time  of parturition, there is a  fud-
den  diffolution  of all the newly  formed  affo-
ciations ;  at this critical period they require to
be guarded with the nicest vigilance  from  all
sudden  changes  of temperature, irregularities
of diet, and exertions of body and mind.
  In the transition  from  climate to climate, it
is obvious that our habitual  movements, efpe-
cially thofe of the cutaneous veffels of all deno-
minations, muft be thrown into total confufion.
In this ftate of difordered adion, there can be
no power of affociation or  connedion to proted
the fyftem.  It  has  alfo  been  univerfally  ob-
ferved, that contagious fevers are liable to make
their attack after intoxication, when the whole
internal man is tumult.
  In the account of the Grenada fever, there is
a fcale to fhew the gradation in which the na-
                      P                tives 
cxiv
fM PERFECT IONS.
 tives of different countries, Africans, Ameri-
 cans, Creoles,  and Europeans,   affembled  in
 that ifland, were liable to be infeded and de-
 ftroyed.  This fcale will ferve as an illuftration
 of the two  laft mentioned caufes j  a thoufand
 otheas are at hand.
   " It is curious," fays the writer,  " and may
 " be ufeful to obferve the gradation of this fa-
 " tal  malady, with refped to the various de-
 " fcriptions of people expofed to its infedion.
 " Neither age nor fex  were exempted from its
 " attack, but fome were more obnoxious to it
 " than  others and the  colour  had evidently
 " much influence in determining its  violence.
 " The fcale of its violence, or the gradation it
 " obferved with refped to the different claffes
 " of the inhabitants, appeared to be  the follow-
 " ing:
   " I. Sailors, more efpecially the  robust and
 "young, thofe leaft accuftomed  to the climate,
 " and thofe moft given to drinking new rum.
   "II. Soldiers; more efpecially recruits,late-
 " ly from Europe, and the moft intemperate.
   " III. White males, in general,  lately arrived,
" more efpecially young men from Europe.
   " All other white males, more efpecially the
" lower claffes ; and of them, the mod intem-
" perate, thofe debilitated by recent ficknefs.
  " V. White  females, more efpecially  thofe
                                " conneded 
              AND.  ERRORS.               CXV

  " conneded with the (hipping, and thofe lateT
  " ly from Europe.
   " VI. People of colour, from Muftees to Ca-  .
 " bres," (that is, I think inverfely as the dark-
 " nefs of  complexion.)
   " VII. Negro men, more efpecially failors and
 " porters.
   " VIII.  Negro women, more efpecially houfe
 " wenches.
   " IX Children,  more efpecially thofe of co-
 lour.
   Infants,  whofe organic movements are not
 yet regulated by habit, feem  to afford an ex-
 ception to the rule of predifpofition.   They are,
 it is faid, lefs liable  to fome contagious fevers;
 and when  infeded,  their chance  of recovery is
 much greater ;  the  latter circumstance has been
 noticed by various  obfervers (e).  If children
 were only lefs liable to be infeded, the differ-
 ence might be fairly  fuppofod to depend on their
 not coming fo  often within the infeding  dif-
 tance ; but after infedion they  are proteded by
 fome unknown peculiarity.  Is  the contagion
 weakened, when firft (wallowed by a diarrhoea,
 as was the-cafe with  fome perfons who received
 the  dangerous infedion at the Black aflizes at
 Oxford ?  Or has the gaftric  liquor  of xhil-

   (e) See for inftance, Campbell's Olfenvations on Typhus,
1785,  p. 55.
                                        dren, 
cxvi
IMPERFECTIONS.
dren, fome power to render the poifon inert ?
This inferiority of power  in one or two parti-
cular contagions, to enfed and destroy children,
deferves further  enquiry.

           Of the Deprejfmg Pajftons.

  There are feveral other  opinions*,  whiclv in
a  complete revifal of the Brunoifan  fyftem,
would require particular examination ; fuch are
his dodrine concerning hereditary difeafes, the
peculiar feat of fthenic inflammation, and  the
nature of the paflions.  This iaft  fubjed is of
great importance, and if, in treating it, Brown
has failed,  he  has but fhared the fate of other
writers.  The mechanifm of the  pajjions,  or  the
ftate of our different  organs, while we are un-
der their influence, has never been explained. (
If any proof be required of the general want of
information on this fubjed, it may eafily be pro-
duced.  Writers, educated in different fyftems,
and who cannot be fuppofed to have been  mif-
led  by the  undiftinguifhing  ardour of youth-
ful  enthufiafm, have found no better refource
than to adopt Brown's theory (/).
  In fear, grief, and  anxiety, fome parts man-
ifedly betray, by their palenefs and coldnefs, di-

  (f). See Dr. Rum on the fever of Philadelphia, p. 31.
" Fear debilitates only becaufe it abftrafts its antagonift paf-
" fion of courage,"
                                     minifhed 
             AND ERRORS.             CXVU

minifhed exertion.  Now as no two parts, ac-
cording to our author, can be in opposite con-
ditions at the fame time, what could he in con-
fiftency do, but affert that the dodrine of heat
and  cold is exadly applicable to the pafHons
(Part I. Chap. iii. n. )?  In high fpirits, there-
fore, we are to fuppofe ourfelves animated by
fomething correfponding to the warmth  of
fummer ; in tranquillity we are  lowered by a
fubtradion of this  mental ftimulus  down  to
temperate, and in grief we fink to the freezing
point; how far the common opinion varies
from this of Brown, I cannot exadly fay, be-
caufe  I  do not  underdand what  particular
change the words deprejfing  or fedative paflions,
are designed to indicate.   When I try to affift
my apprehension by fome analogy, I  find no-
thing in nature to help me out, but am obliged
to think  of  certain paffages in books  of ro-
mance, where the enchanter is defcribed as in-
ducing a  date of permanent torpor by the mo-
tion of his wand.  To difcover whether any of
the paflions have a' benumbing operation, does
not appear  very difficult j  let us take a tran-
fient look into the mind of a mother forrow-
ing for the lofs of her fon,  I afk whether her
ideas are  more vivid than  fual ?  whether fhe
does not  exert herfelf t6 recoiled all he faid or
did between the cradle and the grave ? whether
                                      after 
 CXV1U           IMPERFECTIONS.

 after minutely considering what he has  been,
 fhe does not fet herfelf with equal earneftnefs to
 fancy what he would have been ? and whether
 every  pidure formerly  drawn by hope, does
 not pafs again before her imagination, with the
 figures more ftrongly illuminated, and  more
 diftindly imbodied ?
   " Grief fills the room up of my abfent child;
 '* Lies in hk bed;  walks up and  down  with
   '• me;
 " Puts on his pretty looks j repeats his words ;
 " Remembers me of all his gracious parts;
 " Stuffs out his vacant garments with his form ;
 " Thus have I reafon to be  fond of grief.5'
          Constance in the Play of king John,

  If this expreflion of forrow be not too ftrong,
 while an  happy meeting is dill believed  poflj-
 ble,  it may be doubted whether the faculties
 of Shakefpeare or Schiller,  strained to their  ut-
 most  pitch, are equal  to that  intenfity   of
 thought which takes  place when this  hope is
 finally destroyed.  Fear and anxiety excite ima-
ges of equal vivacity with  grief,  and on con-
fidering the fubjed, it  will  appear that  for
thefe ftates of mind, perturbation, which occurs
in the writings of the ancient philofophers, is a
far more apt term  than paffion.  Had it net
been for inaccurate language, which the au-
thor of the Enquiry into the State of medicine juft-
                                          h 
AND ERRORS.
cxix
 ly calls the greateft of all plagues in fcience, the
 opinions I am inviting the reader to compare
 with nature, would probably never have exist-
 ed.   Neither fhould  we  perhaps  have -been
 taught, that in grief the mind moves flowly—
 an affertion as diftant from the truth, as if it
 mould be faid that animals in full chace of their
 prey,  move more flowly than when they are
 not  aduated by  any appetite ; for  the eager-
 nefs, with which fome train of  ideas are pursu-
 ed in penfive forrow, admits of a comparifon
 with hunting.
   The excitability,  therefore,  is exhausted by
 any  paffion or perturbation, in the fame man-
 ner as by exceffive excitement  in other  cafes.
 Whether temporary wearinefs, or  irreparable
 debility fliall enfue, depends upon the intenfity
 and duration of the exertions, made by the or-
 gans in adion.   The explanation of the differ-
 ence between weeping  and  tearlefs grief, with
 the means of curing either and changing  the
 latter (which is a much more  dangerous  dif-
 eafe) into  the former, depends on principles,
 not to be found  in the following fydem.   In
the prefent fpecimen of criticifm, it is the  lefs
neceffary to enter upon thefe enquiries, as  the
public may foon exped better inftrudion on  the
pathological part of this fubjed than I am able
 to give.
                                   Conclufion. 
cxx
IMPERFECTIONS.
                 Conclufion.

  The Brunonian fyftem has  frequently been
charged with  promoting intemperance ;  the
objedion is ferious, but the view already given
of its  principles  fhews it  to be  groundlefs.
No writer had infilled  fo much  upon the  de-
pendence of life on external caufes, or fo ftrong-
ly ftated the inevitable confequences of excefs.
And there are  no means of promoting morality
upon which we can rely, except the knowledge
of the true relations between man  and other
beings or bodies.   For by this knowledge we
are diredly led to fhun what is hurtful, and pur-
fue what is falutary ; and in what elfe does mo-
ral condud, as far as it regards the individual,
confid ? It may be faid that the author's life  dif-
proves the judnefs of this reprefentation; his
life, however, only fhews the fuperior power of
other caufes, and of bad habits in  particular,
and I am ready to acknowledge the little  effi-
cacy of indrudion, when bad  habits are form-
ed.  Its great ufe  confifts in  preventing their
formation, for which reafon popular inftrudion
in medicine would contribute more to  the hap-
pinefs of the human fpecies, than the complete
knowledge of every thing which is attempted
to be taught in education, as it is conduded at
prefent.  But though the principles  of the fyf-
tem  in quedion did not corred the propenfi-
                                        ties 
             CONCLUSION.               CXX1

 ties of its inventor, it does not follow that they
 tend to produce the fame propenfities in others.
   The diflinguifhing merit of Brown is obvi-
 ous ;  he avoided all falfe analogies, and con-
 fined  himfelf within the proper fphere  of ob-
 fervation for a phyfician.   Hence  at  a time
 when  I could not be fufpeded of that  difpofik
 tion to diminifh the faults, and magnify the ex-
 cellencies of his fydem,  which my fhare in the
 prefent publication  may be  fuppofed to pro-
 duce ;  I was led to remark, that " if he has
 " not  always difcovered  the truth, he is feldom
 " forfaken by the fpirit of philofophy (g)." Be-
 fore him invedigations relative to medicine, had
 been carried on juft as rationally as if to dif-
 cover the qualities of the horfe, the  naturalist
 were to dired his attention to the movements
 of a windmill.   There exided no fyftem which
 was not either entirely, or in a great meafure,
 founded upon  the  obferved or fuppofed pro-
 perties of fubdances, deditute of life.  Thus
 Boerhaave taught that  difeafes  depend upon
changes of the  blood, fimilar to thofe  which
certain oily,  watery, or mucilaginous liquors
undergo ; and I have already had occafion to
ftiew that Cullen referred  the phenomena of
life to  an  imaginary fluid, endowed with the
fame properties as the eledric fluid j  though

 (g) Obfervations on Calculus, p. 159.
                  (^                    of 
.cxxii                 CONCLUSION.
of th's the very exidence isdillproblematical (h\
His predeceffors having in this manner left man
entirely out  of their fydems,  or assigned  him
an unimportant place, Brown atchieved the im-
portant fervice  of reftoring him to his proper

   (h). Mr. Hunter, who deferves fo much praife for Afcer-
tainingfafts, has been led aftray in fome of his Attempts to
eftablifti principles, by a different, but a very curious fpecies of
delufion.  In treating of that obfcure fubjeft, for inftance,  the
coagulation of the blood, he obferves' that it fometimes takes
place very quickly,  as in mortification ; but then " it is to an-
" fwer fome good purpofe and arifes from necessity, which
" appears to aft as a  ftimulus in difpofing the blood to coagu*
late." kk adds that by " aftions taking place from neceffity,
*' effefts are meant which arife from fome unufual or unnatural
" change going on in the parts, and become a ftimulus to aftion.
" The ftimuli from this caufe may vary exceedingly among
" themfelves:  but as we are unable to investigate them, I have
" included them under this general term, ftimulus of neceffity.'''
(0« the Hood, p. 24.).  It may be laid down as a rule in  logic,
that general terms ought never to be employed,  unlefs we can
kbftitute particular  terms expreffive of appearances in their
place.  Mr. Hunter confeffes his ignorance of thofe changes,
which he  comprehends under the phrafe, ftimulus of neceffity*
It  is manifeft, therefore, that it refers to nothing cognizable by
fenfe; and his pofition  amounts fimply to this, the blood coagu-
lates becaufe it muft coagulate.  This is not  the only occafion on
which this ingenious  anatomift has been betrayed into the my-
fiicifm of occult caufes; and it would  probably create fome fur-
prife in an ancient poet to find allegorical beings like necessi-
ty and death, figuring in  a modern work among the prin-
ciples of phyfiology. It is eafy to excufe Mr. Hunter fcr mif-
taking nominal for real ekences; but the example deferves no-
tice as it fo clearly fhews  the extenfive  utility of the  philofo-
phy of words. 
CONCLUSION.
cxxiii
station in the centre.  We have other obligati-
ons to him ; but as I have already had occafion,
to point out fome of them in the courfe of thefe
preliminary obfervations, and as the reft will be
difcovered by an attentive perufal cf the follow-
ing work,  I fhall leave the tafk of Angling them
out and appreciating them to the impartial rea-
der.  In forming this edimate he fhould have
before him, i.  The difficulty of emancipating
the mind from the  dominion of inveterate and
accredited  error.  2. The much greater difficul-
ty of giving  a new form to a  complicated and
obfcure fcience.
  Three years ago I had occafion to obferve that
the opinions of Brown had been fo widely diffu-
fed by oral communication,  as to  affed  the
whole pradice of medicine in Great Britan.  In
pamphlets recommending repeated dofes of opi-
um tofupport excitement, and in other publica-
tions, it would be eafy to deted attempts to pur-
loin his language and ideas ; but it is unneceffa-
ry, for though literature has always been infed-
ed by a race of pilferers, original genius has
feldom been injured by their difhoneft pradices.
Brown cannot now be defrauded of his juft re-
putation.   His writings have lately beenrepub-
lifhed (£),  and are gaining credit on the conti-
nent of Europe. In America his fuperiority to

 (k). See Brunonis Elem. Med. cum Prefatione Petri Mofchati.
preceding 
CXX1V             CONCLUSION.
 preceding fyftematic authors, appears to be ac-
 knowledged alike by students and profeffors (/).
   To  fpeak  of the dangerous influence  of his
 System on pradice, I think as ufelefs now as to
 deted plagiarifms.  His difciples have fometimes
 difgraced  themfelves by that  rafhnefs, which
 was too  much the charaderiftc of his fchool.
 But a cool perufal of his  work  will not pro-
 duce the effed of his  animated  and fometimes
 frantic preledions. What he has left can only in-
 form  or  exercife the underdanding : but he re-
 tains  no  power  to  inflame  the   imagination
 from  the grave.

 (/). See Rufh on theyallow  fever,  and fome inaugural dif-
fertations lately publifhed at Philaadelphi*
  Since the preceding pages were printed, I have received fur-
ther indubitable  proofs of the afcendancy which the truths,
promulgated by Brown, are gaining over men's minds in dif-
ferent parts of Europe.  A tranflation of his "Observati-
ons  under the title of Compendia della nuovadottrina medica di
G. Brovuti  was publifhed at Pavia in  1792.  It has been fince
republished at Venice, and fo has Mofcati's  Edition of the E-
lementa. The tranflation is' by Dr.  Rafori, who has prefixed a
fenfible introduftion, and added many judicious notes.  In a
letter accompanying a copy of his tranflation, Pr. Rafori fays,
*' In the Univerfity "of Pavia,  undoubtedly one ofthe firft
" in Europe, there is hardly a ftudent, endowed with talents,
" who is not a Brunonian.  The doftrine begins equally to
" fpread in Germany.  Many  of the periodical publications
" of that country have noticed it, and the Elementa have late-
" \y been publifhed there. A friend at Genoa affures me that
                                             feveral 
CONCLUSION.
cxxv
  " feveral furgeons 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 moft refpectable profeflbrs ; and in other parts
  ,c of Italy I can akert from my own knowledge that old phy-
  " Jicians have not refufed their fanftion to many of the Bruno-
  " nian principles."
    A late pamphlet intitled Jacobi Sacchi  inprincipia Theoriae
 Brunoniat animad'verfiones,  but fuppofed to be wtitten by pro-
 feftbr Carminati, affords ample confirmation of the  account,
 given by Dr.  Rafori.  The firft  fentence runs thus.  Quaeren-
 ti mihi caufas incredibilis prope  illius  commotionis  animorum, at-
 que ingentis fere plaufus,  quibus nuperrimefingularis ilia hypothe-
fis,  cui novum  univerfae Medicinae fysterna celebcreimus Angliai
fcriptor & medicus Bruno fuperftruxit, ab iis optimae fpei adolef-
 centibus except a efset, quid infiorentifsimo Ticinensi Arcbigymnafio
falutaris artis ftudiis omnibus  mecum incumbunt perarduum fane
nonfuit eas....  in-zienire. After fome pages of introduftory
matter,  the author objefts ftrongly  to  Brown's definition  of
life—quod id earn vitae non inproprietatefeu incitabilitate,^*/ in
aftione  collocarit.  He  adduces  various  inftances  in which
organic bodies lofe fenfe  and motion, without lofing their fus-
ceptibility of feeling and moving, when differently circumftan-
ced. profeflbr Carminati,  he fays, having killed a cat by me-
phitic air, took out the  ftomach with the inteftines, and expo*
fed  them to  the  influence of a frofty  air in his court yard.
They loft by degrees their periftaltic motion, and were frozen
flik. Next day, they were put into warm water; and when they
were thawed,  the periftaltic motion returned; and lafted for a
long time.  This feems to be  little  elfe than a  difpute about
terms. The objector next controverts Brown's grand difcovery
—omnia qu.ee  <vi<ventiumpartibus admo'venture, five interna Ji-vee
externafint, perpetuo incitantia esse. He produces the application
of cokl bodies blood-letting, as examples of effefts Produced
on the living body otherwife than  by ftimulating.  He forgets
that it is  the refiduary  heat  and the mlduary blood which
                                                    Brown 
cxxvi                 CONCLUSION.
Brown regards as ftimulants,  inferior indeed  in  efficacy but
ftill ftimulants. The effeft of  alkaline fubftances on acid  ge-
nerated in thejftomach,  and fome other fimilar cafes,  are after-
wards fpecified, as not comprehended under the general propo-
fition. The author however feems aware that no Brunonian can
want  the wit to repel thefe objections.  He mentions cauft^s
as exceptions to the rule; he however allows that they are part-
ly benificial  by ftimuladng,  and omits to mention that palt of
their  operation which is not ftimulating.  During this ikirmifh-
mg, in which  the adverfary of Brown takes cares to  retreat
nearly as much as he has advanced, he appears to gain cou-
rage, for he now attacks the new fyftem in its ftrongeft poft.
Opium,  he affirms, is a medicine which although it has fome
ftimulating power, removes irritation non eo, fed alio ftbi pro-
pria principio. So are all fedatives. Under this head the .power
of opium to allay excruciating pain and reftrain irregular moti-
ons is copioufly exemplified ;   the writer feems  to fuppofe that
pain always  implies excefs of aftion, and convulfions excefs of
general power. He ackowledges that volatile ftimulants  re-
move quasdam nervorum  aegritudines fed eas quae vera dibili-
tate procreantur.  At the clofe  of this article an argument  oc-
curs,  which 1 know not how the moft determined  Brunonian
will anfwer.  It is this ;  if there  were no difference but in energy
between opium and other drugs,  it might  be compenfated by
increafing the dofe of thefe, which is contrary to experience.—
An acute opponent would not, the reader may be fure,  fail to
bring forward the fyecific aftion of quick-filver,  cantharides
and other bodies ;  he even contends that univerfal ftimulants
by no means tend to evince that the excitability is one and
indivifible, fince they are  compounds, and their feveral con-
ftituent parts may aft  upon feveral portions  of  the fyftem.
Brown was  totally inattentive  to the affiliation  of motions ;
and our Italian critic does not  omit  to take advantage  of this
imperfeftion.  He quotes feveral  inftances of the  fympathy of
fimilar parts  (as the  decay  of  correfponding teeth),  and ar-
gues from them in the  following manner: juxta di-verfas  aut
                                                  Jimiles 
CONCLUSIONS.
cxxvii
fimiles partes, five fenfilitas five irritabilitas aut diverfa aut fi-
milis feu aequahs eft . . . llinc ubi caufa fraedifponens, aut idem
ftimulus feu eadem caufa  occafionalis,  quae in atique corporis fiede
morbum intulit, ad aliam quoque fimilem deferatur, nafcetur illico
caufa proxima ejusque effeclus,  nempe  morbus :  quod quidem fieri
non poffet in diverfa parte,  licet earn quoque idem ftimulus pertin-
gat.   Laftly, the author contends that  Brown has improperly
given the common name of excitability,  to irritability and fen-
fibility,  properties  eflentially  different.—The theory being
thus difmiffed, the praftice of the Brunonian fchool is brought
under examination. Frozen limbs, it is  faid, are to be wann-
ed gradually,  but only left the veffels fhould  be burft by the
fudden expanfion of their contents. So alfo a fmall quantity of
food is to be given to perfons  who  have been long fafting,
merelv beca ke ths  digeftive powers are weak, and  not to a-
void violent  excitement from  accumulation of excitability.
The writer protefts equally againft the ufe of fmall ftimulants
in direct debility, and of a  ftimulus nearly equal to that which
has  induced indirecl debility, in cafes of an  oppofite  nature.
On the latter principle,  he thinks, the  moft powerful  ftimu-
lants ought to be given  in the  moft  violent peripneumonies,
and  blood-letting to be avoided. Under the former head, he
afks ; £>uis ubifiphylisfaeirat atrociter ejus fanationem, validior-
ibus pift habit is mercurialibus, committet lenioribus ?—To prove
the  reality of contrary indications,  the complication of true
peripneumouy with malignant petechial fever and other difea-
fes,   requiring  the  ufe of debilitating and  ftrengthening
means at the  fame time are adduced. Several  pages are em-
ployed to fhew that  a low temperature  is  not debilitating
and  the converfe.   The Brunonians will eafily fhew by a few
obvious diftinftions, to how little purpofe  the  author has la-
boured here.  In conclufion, he points out what he deems ab-
furdities in  Brown's  opinions concerning  the itch, fcurvy,
epiiepfy, and fome other diforders.
   But whatever juftnefs there may be in fome of thefe remarks,
whatever errors Brown may have committed in the application
                                                        of 
cxxviii
CONCLUSION.
 of his principles, and however (hort his doftrine? may fill tf
 a perfeft fyftem of medicine, I will venture to predift that his
 credit on the continent will remain unfhaken. The introdufti-
 on of his opinions will have a moft beneficial  influence  upon
 thofe  by  whom they are adopted as  well as upon thofe by
 whom they are rejefteJ.  Brunonians will not imitate the ftu-
 pidity of the difciples of certain antient philofophers, but ex-
 ercife their reafon in expunging,   adding and correfting,  as
 experience fhall diftate.  With regard to Anti-Brunonians a
 recent example will  explain my meaning.   When Lavoifier
 firft announced his fyftem, the  chemifts who were moft fcan-
 dalized by it,  found themfelves obliged to revife  their whole
 ftock of fafts anddeduftions ; the immediate confequence was
 an entire change in their opinions.   Though  they would not
 go over to Lavoifier,  they could not adhere  to Stahl,  but re-
 luftantly  abandoned half their errors.   The diffemination  of
 the  Brunonian doftrine  will bring about the  fame thorough
 luftration  of opinions in medicine, and the moft pernicious a-
 mong the  prevailing prejudices will be relinquished without
 a conteft.
   The reader may eftimate what it is to have put fo many na-
 tions into the right path of medical inveftigation .  It is true,
 indeed, that we in Great Bfitain,  fuppofe ourfelves  to have
enjoyed the privilege of being purblind, while the eyes of fo-
 reigners were kaled to the agency of thofe caufes that aftuate
 animated nature; and would it not be a pity  if we fliould lofe
 our diftinftion ? But though we  fhould be outftripped in medi-
 cine by the awakened genius' of France,  or the  enlightened
 induftry  of Germany,  we fhall not be  without confolation :
 fince  in confequence of Brown's difcoveries,  our countrymen
 labouring  under diforders, fuch as we cannot  cure,   ftand a
 chance of profiting by the collective efforts of human ingenuity.

                      ERRATA.
  Page 32 line 3 from bottom for iclert read ivcre—p.  36 S 4 after i>.ith
 read^'i—p. 56 1. 20 dele is—p. 581. 2 after ofread the—p. 601. 6 dele
by—p.64 I. 10 for Hcfyial read Hofpital—p. 7C 1. 21 for Treaties read Trca-
tife__p. 72 \. 17 for iowread -who—p. 941. xi for M?f;dar read Mufi.hr. 
r +	>
t*	k*
N	►J
S	M
fc4	<!
H	H
TABLE  of  EXCITEMENT  and  EXCITABILITY,
DISEASES.
CAUSES.
     a
CURE.
^DEATH.jy
NOXIOUS
IMMEDIATE
Predifpofition to
Sthenic Difeafe.
Perfeft Health.
Predifpofition to
Afthenic Difeafe.
    Extreme 7 Indireft
75 f Sthenic, j Debility.



5c (High
   ^Sthenic!
Mild
Sthenic.
Sthenic
Diathefis. ><
Good Health.
I
    Mild
25 f Aftheniq.
EE lr tHigh
Dlreft
5 f Afthenuj. ' Debility


  • Extreme
5 | Afthenic
7 Afthenic
3 Diathefis.
Apoplexy.
Palfy.
Plague.      i
Malignant Fev£r,
Gangrenous Cynanche.
Confluent Small-pox,
Hydrothorax.
Phthifis.
Contagious Dyfentery,
   &c.
Synocha.
Phrenitis. ^
Inflammatory Cynanche.
Mild Small-pox.
Meafles.
Peripneumony.
Dyfentery.
Mania, &c.
Synochus.
Rheumatifm.
Catarrh.
Scarlet Pyrexia.
Miliary Fever.
Chicken-pox.
Ophthalmia, &c.
  Exceffive  aftion of powerful ftimuli; as heat,
exercife, food, abundance of blood, violent paf-
fions of the mind, contagion, and the like.
  The fame as above, but not to that excefs which
induce? indireft debility ;  yet afting with  greater
force than in the next range of difeafe.
  The  fame as  above, but not afting with that
force which  induces high fthenic  diathefis;  yet
greater than in the ftate of health.
Indireft debility.
Greatly increafed excitement.
Lefs increafed excitement.
  The indication of cure is to fupport the excitement.   The reme-
dies are powerful ftimuli, as eleftricity,  opium,  asther, fpirituous,
liquors, wine, mufk, cinchona bark, fnake root, camphor, rich foups,
and the like.
  The indication of cure is to diminifh the excitement; which is to
be effefted by fvoiding powerful ftimuli, and employing flight or
defeftive ftimuli, as lying cool in bed, tranquillity of mind, bleed-
ing, purging, fpare diet, and the like._____________________■

  The indication of cure is, as above, to diminifh the excitement,
but with more moderation.
  The range of good health is with propriety ranked from thirty to fifty degrees in the icale ; for perfeft health, which confifts in the
of the variation of the ftimuli to which man is continually expofed, as meat drink, and the paflions of the  mind; which fometimes aft
monly fluftuates between thirty and fifty degrees.
middle point folely, or forty degrees, rarely occurs ; in confequence
with more power, fometimes with lefs, fo that the excitement corn-
Intermittent Fevers
Mild Colic.
Dyfpepfy.
Hypochondriafis.
Hyfteria.
Epiftaxis.
Menorrhcea.
Amenorrhcea, &c.
Rheumatalgia.
Cholera.
Epilepfy.
St. Vitus's Dance.
Rickets.
H^moptyfis,
Scrofula, &c.
Typhus.
Colica Piftonum,
Gout.
Tetanus.
Scurvy,
Diabetes.
Dropfy.
Jaundice, &c.
  A  deficiency  of the  ftimuli  neceflary to  the
maintenance of good health ; and an improper ap
plication of powers, which, though ftimuiant, do
r>ot ftimulatein a fufiicient degree.
  Defeftive ftimuli alone ;  as cold,  diet -fparing
and not of good quality, fear, and the like.
Defeftive ftimuli alone.
Diminifhed. excitement,
Direft debility.
Lu
  The indication of cure is to increafe the excitement.   The reme-
dies are power/ul ftimuli, fuch as are exhibited for the cure" of indi-
reft debility, but with this difference, that here it is neceflary to be-
gin with a fmall degree of ftimulus, and increafe it gradually.

  The indication of cure is here the fame as above, but ftimuli muft
be applied fomewhat  more cautioufly.
  The indication of cure is the fame here alfo, but ftill greater cau-
tion is neceflary in the application of ftimuli.
Death.
                                       TO

             JOHN   BROW  N,    M.  D.

THIS TABLE IS  DEDICATED, AS A  TESTIMONY OF RESPECT,

                                                                     BY HIS  FRIEND AND PUPIL,

                                                                                              SAMUEL  LYNCH.
k
5435�9693371315574 
 
THE
ELEMENTS

                        O F

       MEDICINE.

THE  FIRST  AND REASONING  PART.
               CHAP    I.

I. "j^/TEDICINE is the  fcience of preferving the
   XVJL good and of preventing and  curing the bad,
health of animals.
  II. The application of the fame profeffion to  vegeta-
bles, fliould be named Agriculture.
  III.  Good health confifts in a pleafant,  eafy, and ex-
act ufe of all the functions.
  IV. Bad health confifts in an uneafy,  difficult, or di£
turbed exercife of all or any  of the functions.   The  latter
refpedts difeafes.
  V. Difeafes are either extended over the whole fyftem;
or confined to a part; the former merit the  appellation of
Univerfal, the latter that of Local.
  VI. The former are always univerfal fromtlieir firflcom-
mencement,  the  latter in their courfe, and that but fel-
dom.  The former are always, the latter never, preceded
by predifpofition.  The originality  of the  former  pro-
                         B                      ceeds 
2          THE   ELEMENTS
ceeds from an affection of the principle of life,  of the lat-
ter from local injury.   The cure of thofe is applied to the
whole body, of thefe to the  injured part.
  VII.  To the province of  the Phyfician belong all the
univerfal, and as many of the local, as firft affect a part,
and, in confequence of that,  at laft injure the  reft of the
body with fome refemblance xo the univerfal ones.
  VIII.  Predifpofition to difeafe is that ftate of the body,
that recedes from health, and approaches to difeafe in
fuch a manner, as to feem ftill within the boundaries  of
the former, of which, however, it is only an infidious and
deceiving refemblance.
  IX.  Thefe three ftates (a) conftitute the life (b) of ani-
mals ;   to which  that  of vegetables  is  not  diffimilar,
but more imperfect.

               CHAP.    II.

  X. IN all the ftates of life, man and other animals
differ from themfelves in their dead ftate, or from  any  o-
ther inanimate  matter in this property alone; that they
can be  affected by external  agents, as  well as by certain
functions peculiar to themfelves,  in fuch a manner, that
the  phenomena peculiar to their  living ftate, that  is,
their own functions,  can be  produced.   This  proportion
comprehends every thing that is vital in nature, and there-
fore, at leaftt applies to  vegetables.
  XI. The  external agents in general, are reducible to
heat, diet («), other matters taken into the ftomach,  the
blood, the fluids fecreted from the blood, and air.   How
                                                poifons
  [a) Of health, difeafe, and  predifpofition,
  (*) Or living ftate,
  («) Confuting of food, drink, and condiment. 
               OF   MEDICINE*           3

 poifons  and  contagions come under the fame view fhall
 afterwards be mentioned.
   XII. The functions of the fyftem itfelf, producing the
 fame effect,  are mufcular contraction, fenfe, and the ener-
 gy of  the brain in  thinking,  and exciting paflion and
 emotion.  While  thefe  affect the  fyftem in  the fame
 manner as the other agents ; fo, with refpect  to  their ori-
 gin,  they arife  both  from the  other aud from  them-
 felves.
   XIII. The refult  of withholding  either the  property
 diftinguifhing living from dead matter,  or the operation of
 either of the two fets of powers, is the  noiv-exiftenee of
 life.   Nothing elfe is neceffary to life.
   XIV. The property,  by which both fets of powers act,
 fhould be named Excitability;  and the powers themfelves,
 Exciting powers.   By the word  " body" is meant both
 the body fimply fo called, and alfo as endued with an in-
 tellectual part, a part appropriated to paflion and emotion,
 or to  the  foul;  the  appellation commonly given to it in
 medical writings is fyftem (b).
   XV. The  common effect,  produced  by the  exciting
 powers, is fenfe, motion, mental action,  and the paflions.
 Which effect being one and the fame,  it muft, therefore,
 be granted, that the operation of all  the powers is alfo
 one and the fame (c).
                           B 2                     XVI.

  (£) No difquifition is here meant to be entered into, as religion is no
where interftredwith,  but left to its proper guardians.
  (c) That is, fince fenfe, motion, mental functions, and the paflions
are the only, and a condant, effe.it of the exciting powers, acting upon
the excitability ; and fince that happens,  whether one,  or more, or aH
the powers, or which foever of them, act, the irrefiftible conclusion, that
arifes in the mind, is,  that the effect of the powers being the fame, the
mode of operation of them all muft be the fame.  This mode of reafon-
ing, which is certainly as juft as it is new in medicine, will often oc-
cur, and,  we truft, will itand the teft of the moft fcrupukm9 fcrutiny. 
4           THE  ELEMENTS
   XVI.  The effect of the exciting powers, acting upon
the excitability, is to be denominated Excitement.
   XVII.  Since,  of the  fame exciting powers, fome act
by evident impulfes, and the identity of the effect of others
infers  the fame  mode (h)  of operation ;  and fince they
have all a certain activity in them, they ought to be deno-
minated ftimuiant, or  ftimuli.
   *. Stimuli are either univerfal or local.
   G. The univerfal ftimuli  are the exciting powers,  \~6
acting  upon the excitability, as  always to produce fome
excitement over the whole fyftemr  And their appellation
of univerfal is convenient to diftinguifh  them from the
local.
   y. The local ftimuli act only on the part to which they
are applied; and  do  not, without  previoufly producing
an affection in it, affect the reft of the body.


             CHAP.     III.

   XVIII. WE know not  what excitability  is,  or  in
what manner it is affected by the exciting powers.   But,
whatever it be, either a certain quantity, or a certain ener-
gy of it,  is affigned to every being upon the commence-
ment of its living ftate.  The quantity, or energy, is dif-
ferent in different animals,  and in the fame animal at dif-
ferent times.   It is partly owing to the uncertain nature
of the fubject,  partly to the poverty of common language,
and likewife to the novelty of this doctrine, that the phra-
fes of the excitability being abundant, encreafed, accumu-
lated, fuperfluous ; or weak, not well enough fuftained,
not well  enough exercifed, or deficient in energy, when
                                              enough
(t) Or ratio, " 
O  F   M E D I C  I  N  E.            5
 enough of ftimulus has not been applied; fometimes ti-
 red, fatigued, worn out, languid, exhaufted or confumed,
 when the ftimulus has operated in a violent degree j or be-
 ing at other times in vigour, or reduced to one half, when
 the ftimulus has neither been applied in excefs nor defect,
 will be employed in different parts of this enfuing work.
 Both upon this, and every other fubject we muft abide by
 facts ;  and carefully avoid the flippery queftion about cau-
 fes, as being in general incomprehenfible, and as having
 ever proved a venemous fnake to  philofophy.
   XIX.  As there is always fome excitability,  however
 fmall,  while life  remains, and the action of the exciting
 powers in one degree or another is never wanting •,  the
 conclufion from  that fiacl is, that they are  all endowed
 with more or lefs  of ftimul&nt power,  and that this muft
 "be either exceffive, in due proportion, or deficient.   A
 great quantity of blood ftimulates in excefs, and there-
 fore, produces  the difeafes  that depend  upon too much
 .ftimulus ;  but an under proportion of blood,  though de-
 bilitating in its eJfieB, and inducing the difeafes that de-
 pend upon debility as their caufe, muft ftill be underftood
 to be ftimuiant; but only fo much more weakly ftimuiant,
 as the penury is more confiderable :  The  fame conclufion
 applies to all the other exciting powers,  unlefs that pok
 fons, contagions,  and fome few other powers,  mjght to
 fome feem exceptions.   But,
   XX   Poifbns either do  not  produce the univerfal  dif-
 eafes, which make our prefent fubject; or, if they do, by
 operating the fame effect as the ordinary exciting powers
 their mode of operation muft alfo be allowed to be  the
 fame (a).
                                                 X£L
  {a) ThU propofition of frequent  occurrence in this work, that iden-
 tity of known effect, always produces identity of caufe though un-
known, will be found to be a mode of reafoning  of equal fervice in
                                               guarding 
6         THE   ELEMENTS
   XXI. Some contagions accompany difeafes depending
 on too much ftimulus {b); others thofe that confift in de-
 bility (c).   If both thefe are the product,  not of contagi-
 on alone, but, by a conjoint operation, alfo of the hurtful
 powers that ufually  depend upon ftimulus, which is a
 fact afcertained: the effect, therefore, in this cafe being
 the fame,  the conclufion is unavoidable, that their caufe
 is alfo the fame,  and the mode of operation of both the
 fame.   It muft,  therefore, be admitted that the operation
 of contagions  is  ftimuiant (d).   It  makes for  the fame
 conclufion, that ho remedies, but thofe that cure difeafes,
 depending upon the operation of the ufual hurtful powers,
 remove thofe that have been fuppofed to  be induced  by
 contagions,  Finally, the great debilitating energy, ohfer-
 vabte in certain  contagions,  does not more prove a diver-
 fity of action in them, than it does'm the cafe of an equal or
 greater degree of debility, arifing from cold (<•).
   <r.  It might appear to fome, that  a certain matter  of
 food, not fufficiently nourifhing, and therefore, of hurtful
 tendency;  as alfo that emetics, and purgatives,  and fedative
 paflions, as they are called, might be thought  to belong to
 the  number of powers,  the operation of which might
 feem fo many exceptions  from the-ordinary ftimuiant ope-
 ration.
   ». In general all vegetable matter, when  depended upon
 alone for nourifhment, is hurtful,  at leaft, to thofe  who
                                                   have
guarding our reader from the deceitfulnefs of  abftract reafoning, and in
leading him into a proper  mode of inveftigating folid and ufeful truth,
 • ff) As the fmall pox and meafles.
  (c) As the petechial typhus fever, the plague.
  (</) This is all that is contended for at prefent 5 the degree of their ftj.
rnulus will be afterwards confidered.
  (e) At the freezing point, or below it, man, and fimilar animals of
warm bl»od, could not live a fecond in a dtnfe medium, fuch as that of
water ; but the animals of cold blood can. 
OF   MEDICINE.
7
have been accuftomed to better, and that by a debilitating
operation;  and yet even it, fince it fupports life, however
incommodioufly, longer than a total want of food, muft, of
courfe, be ftimuiant.  But,  if afthenic difeafes arife from
vegetable food, and not, to a certain degree, from want;
that circumftance muft be owing to a certain change pro-
duced in  the fyftem, by which the fum total of ftimuli  is
rendered  lefs fit to act upon the excitability.  That fuch is
the cafe,  is proved  by the moft ftimuiant matter of food
lofing part of its ftimulus by continued ufe, and requiring
the fubftitution of another in its place.
   £.  In the fame manner is the operation of emetics  and
purgatives to be explained, as diminifhing the fum total of
excitement; which depends partly on an agreeable relation
that the exciting power bears to the excitability, or on an
agreeable fenfation.  That it is fometimes  the relation,
fometimes the fenfation, that acts in this cafet  is evident
from the  hurtful effect of things moft grateful to the fenfe,
as in the  examples  of the legumina,  and other articles of
vegetable food i  and by the falutary effect of difagreeable
things, as the feveral forms and preparations of opium:
Both which produce their effect,  the former by a debilita-
ting, that is,  an  infufficiently ftimuiant,  the latter by a
confiderably ftimuiant, operation (g)
                                                     The

   (g)  Suppofe a certain power, as 40, to mark the degree, in which the
fum total of proper ftimuiant operation  confifts, and the  excitement,
produced to th3t  degree, to  arife from different exciting powers,  all of
them conducing to the fame effect, by the operation of each bearing an
agreeable relation to the excitability, or producing an agreeable fenfa-
tion on it;  the inference to be drawn from that fact is, that a certain
fuitablenefs in the mixture of the whole to  the excitability, as well as
the degree  of ftimulus,  produces the effect.   Again, fuppofe certain  in-
gredients, which cannot be denied to be ftimuiant, added to this given
mixture, the effect of the added article will be one of two : it will either
increafe the excitement firft produced,  without altering the agreeable
                                                      ftate 
8            THE   ELEMENTS
   ». The fedative affections, as they are called,  are only
"a leffer degree of the exciting ones.   Thus fear and grief
 are  only diminutions (h), or lower degrees, of confidence
 and joy.  The news of money gained produces joy, and
 grief arifes from the lofs of it.   Here then no operation of
 a nature contrary to ftimuiant takes place; it is nothing
 but a diminution, or inferior degree, of ftimuiant opera-
 tion.   The fubject of the paffions admits of the fame rea-
 foning in every refpect as  that of heat  (i);  and  in  the
 fame manner all the bodies in  nature,  that  feem  to  be
 fedative, are debilitating,  that is,  weakly ftimuiant -,  ow-
 ing  their debility to a degree of ftimulus greatly inferior to
 the  proper one.
   XXII. Since  the general powers produce all the phae-
 nomena of  life,  and  the pnly operation,  by which they
                                                           do

ftate which that had  induced; or it will, ftill without any reafon for
fuppofing it not ftimuiant, diminifh the excitement that had arifen from
the combination of the agreeable articles.  And this will happen merely
from the effect  of  a  difcordant combination of exciting powers, while
that, which diminifhes the exciting effect of the others, as well as thefe
others, that conftituted its given fum, are both ftimuiant; but the for-
mer in a higher, the latter in a lower degree, and therefore acting over
all as debilitating powers;   Muftard taken with meat, or onions with
heef-ilakes, are agreeable to moft taftes ; but they are, though ftill ftimu-
iant,  difagreeable to others, and debilitating, Peas-foup and peas-pud-
ding, though, independent of the animal  juice infufed into them,  they
are far from being falutary, will be borne by many ;  while in others, ef-
pecially  thofe who have been accuftomed to  more ftimuiant meals, and
in perfons who are gouty, and liable to complaints of the firft paflages,
they  will produce morbid affection.  The fame thing is to  be faid of
beef-ftakes with onions, which agree with the found  ftate, and difagree
with that of the  firft paflages juft now mentioned.   With regard to all
thefe enfeebling matters, there is no queftion about their being ftimu-
iant ; the whole effecl is to  be referred to their rendering a mixture^
ftimuiant in a certain degree,  lefs fo.
   (h) Not paffions different in  kind.
   (»'; The doctrine of cold as an active power, and, oppofite to heat, is
now  univerfally rejected, and confidered as only a diminution  of heat, 
OF   MEDICINE.
9
do Co, is ftimuiant; it, therefore, follows, that the whole
phenomena of life, every ftate and degree of health and
difeafe,  alfo confift in ftimulus,  and are owing to no
other caufe.
  XXIII. Excitement, the effect of the exciting powers,
the tiue caufe  of life,  is,  within certain  boundaries
produced in a degree proportioned to the degree of ftimu-
lus.   The degree of ftimulus, when moderate (*'), produ-
ces health j in a higher degree it gives occafion to difeafes
of exceffive ftimulus j In a lower degree, or  ultimately
low,  it  induces  thofe that depend upon a  deficiency
of ftimulus, or debility.  And,  as what has  been men-
tioned, is the caufe both of difeafes and perfect  health ; fo
that which reftores the morbid to the  healthy ftate, is a di-
minution of excitement in the. cafe of difeafes of exceffive
ftimulus, and an encreafe of the fame excitement for the re-
moval of difeafes of debility.   Both  which intentions are
called Indications of Cure.
   XXIV. This mutual relation obtains betwixt excitabi-
lity and  excitement,  that the  more weakly the powers
have acted, or the lefs the ftimulus has been, the more a-
bundant the excitability becomes ■, the more powerful the
ftimulus  of the agents has been, the  excitability becomes
the more exhaufted.
   XXV.  A mean ftimulus,  affecting alfo a mean or half
confumed  excitability, produces the higheft excitement.
And the excitement becomes lefs and lefs, in proportion
as either the ftimulus is appiied in a higher degree, or the
excitability more accumulated.  Hence the vigour of youth,
and the weaknefs of childhood and old age.  Hence with-
in a more moderate  fpace  of  time, a middle diet gives
vigour,  and debility is the effect of its being either too full
or too fparing.
                                              XXVI.
if) Of a middle kind.
2 
 lO         T H  E  EL E M E N T S

   XXVI. While that is the cafe, every age, every habit,
if the excitement be  properly directed, has its due degree of
vigour accommodated to it.  Childhood, and that weaknefs,
which  an  abundant excitability produces, admits of little
ftimulus, but, upon lefs than the" middle proportion becomes
languid, upon more is opprefied.  Old age, and that frail-
ty, which is occafioned by a deficiency  of excitability, re-
quires  a great deal of ftimulus, becomes enfeebled by kfs,
and overfet by  more.  The reafon for the latter is, that
the excitability, without which no vital action is produ-
ced, does not exift in that degree, by which vigour of the
functions is produced; while the former is to be explained
from the exciting or ftimuiant power, without which the
excitability is of no  effect, not being applied in that degree,
which  is requifite to the vigour that it fhould give.  The
impotency of ftimulus may rife to fuch a degree, as to pro-
duce death from its extreme under proportion.   On the
contrary,  the exhauftion of excitability may go fo far, as
to extinguifh life by the extreme excels of ftimulus.
   XXVII. The circumftances, under  which excitement
is produced, have two confining boundaries*
   XXVIII.  The  one  of thefe circumftances  is,  ex-
hauftion of the excitability  from violence  of  ftimulus.
For  all the ftimuiant powers  may carry their  ftimuiant
energy to that degree, zander which no  excitement will a-
rife.   The reafon for which is, that the body becomes no
longer  fit to receive the operation of ftimulus; another ex-
preffionfor which is, that the excitability is confumed.
   XXIX. The  termination (7) of excitement, from the
exhauftion of the excitability by ftimulus,  may be either
temporary or irreparable, and may arife either from a fhort
continuance of a high degree of ftimulus, or a long applica-
tion  of one the  excefs of which is more moderate.  Both
                                              cireum-
(4) Or eeffation, or extinction. 
OF   MEDICINE.          It
 circumftances cornetd the fame thing •, the high degree of
 ftimulus compenfating for the fhortnefs of its application,
 and the fhortnefs cf its application for its greater modera-
 tion  in degree (/).   The  effect of the former is fudden
 death 5 of the latter a  more gradual  death preceded  by
 difeafes.  And though a moft exact meafure of excitement
 wete kept up, yet death at laft, however late, fupervenes,
   XXX. Ebriety, debauch in eating and drinking, fweat5
 langour,  heift, either operating alone,  or overcoming the
 effect of cold, dulnefs in mental  exertion from exceffive
 thinking,  or finking of the fpirits in confequence of vio-
 lence of paflion,  Anally,  fleep;  all thefe  are the confe-
 qucrrces of a fhort application of a high degree of ftimulus^
 operating an exhattftion of excitability.   The  long conti-
 nuance of a more moderate excefs in the force of ftimulus,
 is followed by the frailty of  old age, predifpofition to dif-
 eafes of debility, as well as thofe difeafes themfelves.   The
 ultimate termination of both  is death.
   XXXI. When  the  excitability is wafted by any  one
 ftimulus, there is ftill a referve of it, capable of being abled
 upon  by any other.   Thus a perfon,  who has dined fully;
 or is  either fatigued in body, or tired  with intellectual exer-
 tion,  and therefore under a great difpofition to fleep, will
 be recruited by ftrong drink; and, when the laft has pro-
 duced the fame fleepinefs,  the more diffufible  ftimulus of
 opium will aroufe him (m).   Even after opium  fails, and
                                                  leaves
  (f) A force of ftimulus as fix, operating for a fpace of fime as one-
and a force cf ftimulus as one, operating for a fpace of time as fix, will
produce the fame effect in wearing out the excitability,
  («)  A gentleman, engaged in a  literary compofition, which required
an uninterrupted exertion of his mental faculties for more than forty
hours,  was enabled to go through it with alacrity, by fupporting him-
felf in  this manner.  After dining well and letting to bufinefs, he took
                                                        a 
*2        THE.  ELEMENTS
 leaves him heavy and oppreffed by the fame propenfity, a
 ftimulus ftill  higher and more diffufible,  if there be any
 fuch, will have the fame effect.   A, perfon fatigued with
 a journey will be roufed by mufic to dance and fkip ; and
 he will be enabled to run after a flying beauty, if her flight
 encourages him with the hope of overtaking her.
   XXXII. The wafte of excitabilility, firff exhaufted  by
 ftimuli,  and then recruited by new ones, is moft difficultly
 repaired; becaufe the more aft'mulant operation has  been
 employed, that is  the more the ftimuli have been applied;
 there remains the lefs accefs to frefh ftimuli, by the opera-
 tion of which the failure of excitement may be removed.
   XXXIII. The  reafon  of the  difficulty  is,  that  no
 means of reproducing the healthy ftate, that is, the proper
 decree of excitement, is left; but  the very  circumftance
 j hat  occafioned  the wafte, that  is, already an  excefs  of
 ftimuiant operation, not admitting of more ftimulus.
   XXXIV.  Such,  in  fine, is the  nature  of  the  fame
 jofs  of  excitement,  that it rufhes to inftant death, unlefs
 proper meafures be taken to preferve life by a great ftimu-
 lus,  but lefs  than that which  occafioned  it, and then by
 z full lefs, till by  means of the  moderate  ftimulus,  that
 is ikk.bie to  nature, or a  fomewhat greater, life  may at
                                                     Lift

 a glafs of wine e .-cry hour.  Ten hours after he ate fomething nourifh-
 ing, but faring in quantity, and for fome ho»rs kept himfelf  up with
 ■punch net too ftrong.  And, when he found himfelf at laft like to be
 overcome by an inclination to fieep, he changed all his ftimuli for an o-
 piatc ; and SniSied his bufinefs in forty hours.  What he had wrote was
 now to be put  to the prefs.  Ke had next to watch  and correct  the
proofs, which coft him between four or five hours further continuance of vi-
 gilance and activity. "To effect this he took a glafs with the Mafter Prin-
 ter, while his men  were going on with their part of the work. The
 fucceffion  of ftimuli in  this cafe was firft food, next the ftimulus of  the
 intellectual fundion, then wine, then the food varied, then punch, thea
 veiiem, then punch :wd cpnverfation. 
OF   MEDICINE.           IJ
laft he  prefervcd.  The difficult  cure of drunkards and
gluttons, already affected  with difeafes, fufficiently evin-
ces,  that the fame confideration applies to all the exciting
powers that ftimulate in excefs (a).
   XXXV.  The excitability, thus exhaufted by ftimulus
is debility,  which fhould be  denominated indirect, becaufe
it does not arife from defect,  but excefs of ftimulus {b).
   XXXVI. Through  the whole progrefs  to  Indirect
debility,  the fecond impreffion of every ftimulus has ld&
effect than  the firft, the third lefs  than the fecond, and fo
forth to the laft, which gives no more excitement ; and
the effect takes  place in proportion to the  degree or de-
ration of the feveral imprejfions, though every one always
adds fome excitement.   The inference from this propofi-
tion is, that,  before the eftablifiiment of indirect  debility,
and,  when it is now upon the eve  of being eftablifhed,
the ftimulus  which produces  it,  fliould be withdrawn;
a debilitating power fhould be applied, as in giving  ovec
drinking  wine at the end of an entertainment, and fuhfti-
tuting water in its place, and applying refrigeration  to a
perfon who has been expofed to an exceffive degree of heat

   XXXVII.  The  fame  progrefs  to  indirect  debility
                                                       is

  (a) This propofition applies to the moft difficult part  of the practice
for the cure of difeafes,  that is, thofe that depend upon a certain fpeciea
of debility, which  in the very  next paragraph will be denominated
indiretl.
  (l>) Lite another debility,  by and by to be  fpoken of.
  (e) A convalefcent, from  a difeafe of debility, was prefcribed wine,
but not to carry it to excefs_  A  hiccup was the fignal, by which he was
to underftand, that he had carried that ftimulus too ;far. He defifted,
and ended his jollity with two or  three tumbler glaffes of water ; which
prevented the eftablifhment of the  indirect debility into which  he was
about to fall, 
*4         THE   E L E M  E  N  TS
  is  retarded by diminifhing  the excitement  from  time to
  time, and proportionally encreafing the  excitability,  and
  thereby giving more force to the action  of  the  ftimuli.
 Take,  for  example,  cold  bathing  from time  to time,
 lowering the diet from time to time,  and a fimilar abate-
 ment of all the other ftimuiant powers.
    6.  If cold  fometimes feems to ftimulate,  it produces
 that effect, not as actual cold, but either by diminifhing
 exceffive  heat, and reducing it to its proper ftimuiant tem-
 perature (d), or by rendering the body acceffible to air, or
 by accumulating  the excitability diminifhed by exceffive
 ftimulus,  and  communicating energy to the ftimulus of
 the exciting powers,  now acting too languidly.   An in-
 ftance of this operation of cold occurs in the Torrid Zone,
 where actual cold is fcarcely to be procured, in the ufe of
 refrigerants, as they are called, in fevers, and in the con-
 traction,  by means of cold,  of a fcrotum previoufly re-
 laxed by  heat.   Nay, the effect goes fo far, that fthenic
                                                    difeafes

  (</) The principle upon which the operation  of the cold bath depends
has never been underftood,  and therefore all reafoning, as well as prac-
tice, with refpect to it, has been condacted in quite a vague and random
manner. Suppofe a range of excitement, the middle and healthy point of
which is 40 degrees of excitement, the ultimate degree of  its excefs
70.  It is, therefore,  the intermediate degrees between thefe extremes,
to which the practice  of cold bathing is applicable.   From 8® to 70, the
former of which is the head of the fcale, and conftitutes the range of in-
direct debility; and likewife through all the intermediate degrees from
40 down to O,  the cold bath,  which is a weakening power, as well as
every other, is improper-  It is a miftake prevalent among fyftematic
writers and lecturers,  that cold is of fervice in the fevers and other dif-
eafes of the Torrid Zone.  The truth is, that,  in that  country, there is
no accefs to the ufe of actual cald.  All, that can be done there, is, by
various means, to diminifh the excefs of heat, which is conftantly rufh-
ing from thofe degrees of it which ftimulate  and c«cite, to  thofe, in
which its ultimate  ftimuiant power deflroys excitement, and leave*no-
thing but indirect debility. 
OF   MEDICINE.            IC
difeafes  may arife more certainly from cold,  alternating
with heat, and either preceding or following it,  than from
pure heat.
   XXXVIII.  The other condition or circumfiance,  limi-
ting excitement, is, an energy of the exciting powers too
fmall, and therefore  infufficient to produce excitement.
As  this cafe arifes from a deficiency of ftimulus,  and an
abundant excitability, it ought to be diftinguifhed from the
other, which  fuppofes an abundance of the former,  and
deficiency of the latter.   The fame diftinction is required
alfo for  the purpofe of practice.  All the  exciting powers
may fall fo fhort of ftimuiant force,  as to produce that ef-
fect.  They all, therefore, equally ferve  to illuftrate and
confirm this propofiition.
   XXXIX.  In this cafe,  the excitability is  abundant, be-
caufe, in confequence of the  ftimuli being withheld,  it is
not exhaufted.   Thus, in the cold bath, the excitement is
diminifhed, becaufe the ftimulus of heat, and,  therefore,
the fum of all the ftimuli, is deficient;  and the excita-
bility, as being lefs exhaufted by ftimulus, is encreafed \fi).
                                                     The

  [e) This is altogether a negative circumftance.  The  accumulation,
encreafe,  or abundance of excitability, take any term youpleafe, is not
oceafioued by any action or operation, but by the want of action, the
want of operation.  To  form an adequate  idea of it, fuppofe a fcale of
 excitability  of 80 degrees, as in the line here drawn,
               Exciting  Power,
            o   10  ao  30  40 50  60  70  80
                 Excitability.
            80  70  60  50  40  30  ao  10  0
  At the commencement of life, the fum total affigncd is underftood to
be 80, becaufe no part, as yet, is wafted by the action of ftimnli.   Next
it is wafted in proportion as thefe are applied from the beginning to the
end of the fcale.  Its wafting is, therefore,  owing to adion and opera-
tion, but its accumulation to the reverfe, the want of the  action or ope-
ration of the exciting powers, as is exprefftd by the  numbers placed a-
                                                      bove 
  16         THE   ELEMENTS

 The fame conclufion applies to famifhed perfons, to water
 tlrinkers, to thofe who are in a ftate of refrigeration from
 other caufes, to thofe who have iuffered evacuations of any
 kind, to thofe who have neglecled the fiimulus of exercife,
 and given  themfelves up to indolence,  to thofe who have
 neglected  the ufe of that fiimulus,  which exercife of the
 mind affords, and to perfons in low fpirits.   The effect of
 withdrawing any ftimulus is the more liable to produce di-
 rect debility, the more any perfon has  been accuftomed to
 a higher operation of it (f).   Take, for an example, the
 gout, and  many other  difeafes, under  the fame  circum-
 ftances, affecting fome,  and fparing others (g).
                                                        XL.

 tove thofe firft mentioned.  Thus one degree of exciting power applied
 takes off  one degree  of  excitability,  and every fubfequeut  degree im-
 pairs the excitability in a proportion exactly equal to its degree of force.
 Thus a degree of ftimuiant or exciting power equal to 10, reduces the
 excitability to 70 ; ao to  60 ; 30 to 50 ; 40 to 40 ; 30 to 30 ;  60 to ao;
 70 to 10 ; 80 to o.  And,  on  the contrary, the fubtraction of ftimu-
 iant power allows the exciumlity to accumulate.  Thus, when the ex-
 citement is at 79, conftituting only one degree of life,  take off one de-
 gree of exciting power, and  a degrees of  excitability will 3rife. As 80
 degrees of exciting power leave no excitability, fo 70 degrees of exciting
 power leave 10; 60 »o ; 50 30 ; 40 40 ; 30 5© ; ao 60 ; 10 70; o 80.
 Hence death takes place from nothing pofitive, but from the negation of
 the only means by which life isfupported ; which  are the feveral exci-
 ting or ftimuiant powers, now fully explained.
  (/)  For inftance, perfons accuftomed to  drink wine, and eat well-
 feafoned nourifhing animal food, will be  more hurt by a water and ve-
 getable regimen, then thofe  who have not lived fo high in that refpect.
 The inhabitants of Britain could not live long upon the diet of the Gen-
toos,  Perfons in genteel life could never undergo the work of day la-
bourers upon their fare,
  (g) Vegetable aliment, and fruits and cold roots, as cucumbers, me-
lons, acid drinks, and many  other things  not fi'fficiently ftimuiant, will
 bring on a fit of the gout,  all or any one of them, at any time; while there
 ire other  perfons free from  the taint which diftinguifb.es that difeafe,
                                                         who 
OF   MEDICINE,           JJ
    XL.  As, during the encreafe of excitability,  the ex-
 citement decre-afes, and in proportion to the encreafe of
 the former ; fo that  that procefs may go all the way to
 death, is a fact from which nature exhibits no exception.
 It is confirmed by the effect of aH the debilitating powers
 mentioned above ,• every individual of which, as often as it
 proves urgent, has a rapid tendency to death.
    XLI. The  defect  of any one ftimulus,  and the  pro-
 portional abundance of excitability, is, for the time, com*
 penfated by any other, and often with great advantage to
 the fyftem*   So  a perfon, who has dined mfufficiently,
 and therefore not well enough fiimulated, is recruited by a
 piece of good  news.   Or, if during the courfe of the day,
 he has not been fufficiently invigorated by the ftimuiant
 operation of corporal or mental exercife, and confequently
 likely to pafs a fleeplefs night, he will be laid afkep by a
 dofe of  ftrong liquor.  When the latter is  not at hand,
 opium will fupply its place.  The want of the venereal
 gratification is  relieved by wine, and the want of the latter
 is made  amends for by the-ufe of the former,  each banifh-
 ing languor occafioned by the  want of the other.  The
 feme conclufion applies to the ufe of ftimuli,  for which we
 have an  artificial,  rather than a natural, craving.  The
 longing  for fnuff, when it cannot be got, is gratified by th£
 practice of chewing tobacco; and, when any one is lan-
 guid for want  of tobacco, fmoaking fupplies the place of
 it.   Nay, when the functions, as they often are, have un-
 dergone a temporary lefion, and oft account of that, there
 is no accefs to  the ufe of certain accuftomary arid natural
 ftimuli;  the fubftitution of others,  lefs accuftomary, and
 lefs natural, fuppof ts life, till the defire for the natural fti-
                          C                      Auli
who caA ufe them with impunity, or, at leaft, with much more freedom
and lefs harm. Something  fimilar to this obfervatioa applies t» m6$
difeafes, 
l8          THE    LEMENTS
muli is reftored,  and theie are now in a condition to fup-
port the natural vigour as ufual, and the health finally eft*-
blifhed («).
  XLII.  As,  in this manner, the fuperabundance of ex-
citability,  proportioned to the deficiency of ftimulus,  may
through  all the degrees  from its fmalleft  to its greateft
quantity, be worn out to a certain extent, by one ftimulus,
and then another, and the danger of its morbid accumulati-
on awarded,  till the fum of it be brought down to that,
which is fuitable to health; fo, the more abundant the fame
excitability is, that is the more ftimuli are withdrawn, or
the greater the penury of the moft powerful ftimuli Is, the
lefs recourfe can be  had to that mediocrity of excitability
on which the vigour of life depends ; and the weaknefs
may go.to that pitch, the excitability arrive at  that degree
of abundance,  that  the lofs of excitement may at laft be-
come irreparable.  This propofition is both illuftrated and
confirmed by the ufe of every debilitating power; as is ex-
emplified  by cold,  famine, thirft,  and the progrefs of fe-
vers.
   XLIII. This fuperabundant excitability proceeds with
fuch rapidity to  death,  that the only means of reftoring
health, is  firft to encounter it with a very fmall dofe of dif-
fufible ftimulus,a dofefcarcely exceeding the fcanty (w) pro-
portion of ftimulus,  that occafioned it; then, after wafting
a part of  the fuperabundance, to proceed to fomewhat a
ftronger dofe of the fiimulus; and in that manner to be con-
ftantly taking off whatever fuperfluity ftill remains, till at
                                                    laft

  («) This  propofition is of the utmoft importance, as holding eut the
true principle, upon which fo many actions and feelings of human \iitr
both in health and difeafe, are to he explained, and particularly as lay-
ing down an indication, which applies to V^thsof all the febrile difeafe*,
and include our artificial as well as our natural defire* and appetites.
  (w) Or under-proportioned. 
              OF   MEDICINE.            19

 laft the falutary mediocrity is regained.  This ftate is the
 converfe of that debility, which arifes from a worn out ex-
 citability (*),  and the danger of death  occafioned by it.
 To give examples ta famifhed perfon is not immediately to be
 gratified with a full meal; a perfon afflicted with a long du-
 ration or high degree of thirft,  is not immediately to be
 indulged with a large draught: but the former fhould be
 given bit by bit, the  latter drop  by  drop,  then both of
 them gradually more plentifully.  A perfon benumbed with
 cold fhould gradually receive the cherifhmentof heat. Every
 perfon, thoroughly penetrated with grief, forrow, or any
 high dejection of mind, fhould have good news gradually
 communicated to him.   The  news of the fafety of the Ro-
 man foldier, who furvived the difafter his countrymen
 at Cannae, fhould have been communicated to the mother
 in a round-about way, at firft as having no better founda-
 tion than doubtful report,  then as being fomewhat more
 to be depended on, afterwards as having ftill a greater ap-
 pearance of certainty, finally, as not admitting a fhadow
 of doubt:  and laft of all, before her fon was introduced
 to her, the woman fhould have been at the fame time  for-
 tified (y) both  by other ftimuli, and  a glafs of Falerni-
 an wine.

   XLIV.  Since  all life confifts in ftimulus,  and both the
 over-abundance and deficiency of it is productive of difeafes,
 and in exatl proportion to the over-abundance or deficiency;
 it follows,  that the remedies of both thefe deviations from
 the proper ft andard fhould be accommodated to their degree;
                        C 2                        and

  (x) An inftance of worn-out Excitability is that debility which ari-
fes from intoxication ;  one of an accumulated exci'tability is that which
dram-drinkers experience the day after a debauch, in confequence of
which their hands fhake till they are re-excited by their favorite cor-
dial.
  (y) Had a part of her tbundant excitability taken off, 
20          THE   ELEMENTS
 and that a high fum total of ftimulus,  through the courfe
 of the difeafe, fhould be applied to a high degree of debi-
 lity, or, what comes to the fame thing,  to a very abun-
 dant excitability ;  but,  that the quantity to be  applied at
 any particular time fliould be in the fame proportion fmall
 that the excitability is abundant.
   XLV.  The  debility  arifmg from  defect  of ftimulus,
 merits the appellation of direct , becaufe it happens in
 confequence of no pofrtive hurtful power, but from a fub-
 duction of the neceffary fupports of life.
   XLVI. Through the  whole courfe of direct  debility e-
 tery deficiency of ftimulus is encreafed by a fecond, the fe-
 cond by  a third, the third by a fourth,  till the effect at
 laft comes to  be a ceffation  of any further excitement.
 This laft, therefore, is never to be leffened, and the debility
 encreafed, with the view, forfooth, that  in  confequence
 of encreafing the excitability, the addition of a new  fti-
 mulus may act  more  ftrongly.  For,  as often as that  is
 put  in practice, the morbid ftate is encreafed ; and, if the
 debility fhould happen to be great, any further encreafe of
 it may induce death, but never encreafe  the ftrength.   For,
 while great debility,  and,  indeed,  at  pleafure, may, in
 that ivayy  be produced; any  excitement  to  be obtained
 from a ftimulus to come after, is confined within narrow
 boundaries (z).   Take for  an example,  cold bathing in
                                                  dropfy

  (2) Snppofc, that  in place of an  excitment of 40 degree*, the  ex-
citement is gone down to XXX, and the excitability mounted up to L,
and a debilitating power, fuch as  the cold- bath, or any of thofe that
are juft  now  to be mentioned in the text, has been fuperaddcd, reducing
the excitement to  XXV, and accumulating the excitability to  LV.
Suppofe alfo,  that any ftimulus is next employed, with a view to raife
the excitement, and fink or reduce the excitability,  what will be the re-
fok ? As an accumulated excitability admits of a very fmall degree of
                                                    ftim- 
OF    MEDICINE.            21
 dropfy, in the  gout,  in fevers  (a), in perfons who, pre-
 vious to this, have undergone refrigeration,  and in every
 fort of debility.   And who would treat the cafes o/Taminc,
 of deep forrow, of weaknefs of the mental function, of
 languor from inactivity, of penury of blood, which are all
 cafes of direcl debility ,• who would treat them by fuperin-
 ducing more direct debility, with a  view  to  his  gaining
 fome advantage from the very fcanty ftimulus, that can be
 admitted?  The accumulation  of excitability,  applies only
 to the predifpofition to indirect  debility,  or fthenic dia-
 thefis.
   XLVII. "With refpect  to every fort  of debility, it is to
 be obferved, from all that has been faid upon brth forms  of de-
 bility, that,  as  indirect debility  is never to be  cured by di-
 rect,  fo neither  the latter  by the former, nor either by
 the other,in the vain hope  of obtaining1 benefit from the af-
 ter employment of any ftimulus (b).
                                             CHAP.

ftimulus at any given time, while the accumulation of excitability, and
finking of excitement, even to death itfelf, can be  effected in the fhorc-
eft fpace  of time,  and by anyone  of the debilitating powers j confe-
quently, the  lofs of vigour by the firft practice,  and the reparation of
it by the laft, will hear no proportion to one another ; there will be no
poflibility of regaining the vigour thrown away, much lefs any hope of
procuring more than exifted before it was lowered.
   (a) r>y fevers here are meant thofe difeafes, fo named, which depend
on evident debility, and not any of thofe, which, though moft injudici-
nufly fo named, depend upon an oppofite caufe.  Inftances of the former
we have  in all the fevers of the interrnitent or remittent kind, in fyno-
chus,  typhus, and the plague itfelf, with others that  have never been
confidered as fevers,  Examples of  the latter occur in fynocha, or the
common  inflammatory fever in the feveral difeafes of  the fame ftamp
accompanied with inflammation in  a part, as in the throat,  lungs, and
various parts of the external furface.
   (J)  Indirect debility appears in the range of a fcale from 70 up to 80 ;
the direct, in all the degrees below 40 to o.  The only cafes, that ad-
 mit of debilitating operation, are thofe of exceffive excitement from 40
 ■jp to 70, For the cure of difeafes  within this latter range, all  the di-
                                                        re Aly 
22           THE   ELEMENTS
                 CHAP.     IV.

            Of the Seat and EffeEts of Excitability.

    XLVITI.  THE  feat  of excitability in the living body
 {a), is medullary nervous matter, and mufcular folid; to
 which the  application  of nervous fyftem may  be given.
 The excitability is inherent in it but not different in different
 parts of its feat. This fact  is proved by the production of
 fenfe,  motion,  the mental function,  and paflion (£),  im-
 mediately, inftantaneoufly, and not in a feries of fucceffive
 operation (c).
                                                       ,.  Dif-

 rectly debilitating powers are  proper, and, for the moft part, they only;
 becaufe there is no accefs to the ufe of the indirectly debilitating powers
 till they have run their full courfe of ftimuiant  operation from 40 to 70,
 at whieh hft only they become debilitating; and, though fometimes, and
 under ccrtai' circumftances, they may be employed, the fafeft general
 rule is to avoid them.
   (a) Called fyftem by medical writers.
   (£) That  is, all the functions which diftinguifk living animal fy-
 ftems.
   (c) If a fmall quantity of an opiate, or a large one of any ftrong fpirit
 taken into the ftomach,  can inftantiy alleviate an excruciating pain in a
 Tart the moft aiftant from that to which the remedy is applied, and, in
 a ftiort time after, remove it altogether, as is now well known, h >w  is
 that to be explained but by the above propofition :  it being impoffible to
 prctena  tnat it is earried in the veffels? Nor is any other of the many
 hypothefis, that have been thought of for the folution of this fact, more
 adnuffi.de.   tjhuuld it he imagined, that it moves along the nerves ac-
 cording  to the laft  opinion, we demand proof of that affertiou ; which
 has not  yet,  and will not eafily be produced ;  while the fact juft now
affigned  tarries its own de uonftrution in its bofom.  The quell ion re-
 folves. itfelf wholely into the following folution ; Why does opium at
 one* relieve  the gout in the ftomach, on the internal furface, and in the
rcmoteft extremity of that fu<Lce ? Becaufe tha property ih the living fy-
ftem, upon which and by which it a<SU, is one and the fame over all 
OF    MEDICINE.
   ,.  Different exciting powers are applied to different
 parts of the nervous fyftem, none at once to the them all; but
 the mode of their application is fuch, that, wherever they are
 applied, every one immediately affects the whole excitability.
   XLIX.  Every one  of the fame powers always affects
 fome part  more than any other, in which refpetl one pow-
 er off eels one part more  than any other, another another,
 nuith  the fame inequality.  The affected part is generally
 that to which any of the powers is directly applied.
   jc.  And  befides that, the more excitability has been
 affigned to any part from the beginning of the living fiate,
 that is, the more vivid and fenfible it is, the operation upon
 it of each exciting power, whether acting with due force,
 or in excefs, or in defect, and through all the intermediate
 degrees of its ablion,  becomes more powerful iff).   Thus
 the brain and alimentary canal  pofleffes more vivid exci-
 tability, that is, more propenfity to life, than other inter-
 nal parts ;  and the parts below the nails, than other exter-
 nal parts.   Again, while the fact juft now related is fuch,
 as it has been ftated, the affection of the part bears no pro-
 portion to that diffufed over the whole body.
   L.  An eftimate may be formed of the degree of affecti-
 on  in the  part more affected than any other, and of that
 which is diffufed over the whole body, by comparing the
 affection of the former with as  many  leffer affections, ta-
 ken together, as  equal the number of parts  in all the reft
 of the body.  Suppofe the  greater affection of a part (/)
                                                     to

  (</) That is to fay, if the exciting power acts with  that force which
 produces health, the degree of its action is greater upon the given than
any other part; as alfo when its action is eithei greater or lefs than that
 of the middle falHtary degree.
  (f) As the inflammation of the lungs in  peripneumony, the inflam-
mation of the foot in the gout, the effufion of water into a general or par-
 ticular cavity in dropfy. 
*4           T  H  E   E  L  E  M E  N T  S

tcTbe  as  f5, and the lefffer affection of every other part to
be 5, and the number of the parts lefs affe&ed to amount
to iooo (g); then it will follow, that  the ratio of affection,
confined to the part, to the  affection of all the reft of the
body, will be as 6 to 3000.   This eftirhate, or fomething
very like to  it, is proved by tfteeffeB of 'the exciting hurt-
ful powers, which ajways aft  upon the whole body (h);
and by that of the remedies,  which always  remove the
effect of the hurtful ppwersfrom the whole body (»')> in
every general difeafe (i)
                                                         LI.

  (ft) Which i* keeping greatly within the truth.
  (h) The hurtful powers, which produce pcripneumony* in common
Englifh, the inflammation of the lungs, are excefs in eating, drinking,
expofure to heat,  or to the alternation of heat with cold, an over pro-
portion of blood from inactivity, or an encreafed velocity of its motion
frotm violent labour, &c. the  effect of any or all which muft fall as much
upon every other part of the fyftem as upon a fmall portion of extreme
veffels, <n the lungs, and therefore the  morbid affection produced cannot
be confined to the latter, but  muft be  extended to, the former.  The
whole body muft partake of the morbid change ; it muft be one common
affection prevading .the whole.   If this is not  probation, let any thing
left  on  record by authors, or any living phyfician, produce a Angle hurt-
ful power, that, without affecting the fyftem over all, can p«netrate in-
to the  inmoft  receffes of the lungs,  and there produce an inflamma-
tion.   I fhall be content with one fuch hurtful power, and in exchange
for it, when produced, give up my whole doctrine.
  (/) Here too I throw the gauntlet.   Find  a fingfe remedy which re-
moves the difeafe by an operation confined to the lungs. There is not oBe.
  (1)  A wpund in the lungs, among other  effects, of it,  may produce
an inflammation.   But that is not a pcripneumony, or a general difeafe
at all.  It is, on the contrary, a local one, arifing from a local caufe, and
to be removed by local remedies, if accefs could be had to them.  And
though nothing has been more common than blending fuch cafes of local
and general difeafe, at the fame time n« error that has hitherto crept
into the art, needs more to be corrected.   Such an accident is as much a,
pcripneumony, as an inflammation from a contufion in the foot is a gout,
or the fwelled legs of women heavy with child is dropfy.  But of all this
more hereafter. 
OF  MEDICINE,          2^
  LI. In this way temperature affects the furface of the
body; diet the ftomach, and the reft of the fame canal;
the blood and other fluids their rcfpcctive veffels;  labour
and  reft the veffels  again, and fibres of the mufcles:
paflion and exertion in thinking,  the brain ; all thefe af-
fect the parts mentioned, each that upon which its' action
is exerted, more than any other equal part.
  LII. Inftances of a greater excitement of a part than of
the reft of the body, are found in fweat in a perfon in health,
flowing firft from the brow  under exercife, in checked
perfpiration, in inflammation or  an affection analagous to
it  in   difeafes^  in  head-aeh   and  delirium.  Proofs
of a leffer excitement in a part, are exceffive perfpira-
tion  and  fweat not occafioned by  labour or heat, ef-
peeialfly when  it is cold and  clammy,  profufion of the
other excretions* fpafm, convulfion, partial palfy, weak-
nefs or confufion of intellect, and again delirium.
   LIII. As  the operation of the  general powers, whether
exciting in  excefs-,  in due proportion, or  in defect, is di-
rected to  fome one part a little more  than to any other
equal  partj it  is next to  be obfervcd, that it  muft be
of the fame kind in that  part as  in the reft, and as well
as the general operation, be either in excefs, or in juft pro-
portion or  deficient, but never of an oppofite nature.
For as the exciting powers are the fame, and the excitabi-
lity  every where the fame, it is impoffible that the effect
fhould not be  the  fame.   The excitement, therefore, is
never encreafed in a part, while it is diminifhed in the gene-
 ral  fyftem—nor diminifhed, while the general excitement
is encreafed.   There is no difference here, but one of de-
gree ; nor can different effects flow from one and the fame
 caufe.
   * For though, on account  of the  great fenfibility of
                    %                           certain 
20         THE   ELEMENTS
certain parts, (for inftancc, the ftomach (/), and the for-
cible energy of the exciting powers, either in ftimulating
or debilitating, exerted on them, thefe parts run fooner
than moft others either into direct or indirect debility, or
into a great encreafe of excitement;  that however is only
a matter of fhort duration, and  it is not long before the
reft of the functions are hurried into the fame ftate.  Thus,
naufea, vomiting, diarrhoea, and other fimilar fymptoms,
produced by ftrong drink and opiates;  as well as the fame
affections apparently, and the gout, colic, gripes, and other
fimilar fymptoms, occafioned by abftinence and water drin-
king ; likewife good appetite, and the removal of the tur-
bulent fymptoms of the ftomach and inteftines, which we
have  mentioned, taking place in the  convalefcent ftate,
in confequence  of a proper adminiftration of food, drink,
and diffufible ftimulants : all thefe are fhortly followed by
a fimilar ftate of the reft of the body,  and the eftablifhment
of indirect  debility is  the confequence of the firft cafe;
that  of  direcl debility fucceeds to the fecond, and health
over all is the termination of the laft.
   LIV. A  part, therefore, is the feat of no general affecti-
on ; the whole body is the feat of them all; becaufe, with
the inequality above related, the whole excitability is affect-
ed in them all.
   LV. Neither is the affection of the more fuffering part
the firft, and afterwards propagated over the fyftem ; for
this good reafon, that, as foon as the excitability is affected
any where, it is alfo and immediately affected every where.
Both facts are confirmed by the operation of every exci-
ting power, affecting the whole body as quickly as any one
part; by general morbid affections appearing equally foon
                                                  over

  (l) For the fame reafon, i. e. the fenfibility of the genital fyftem,
wine and other ftrong liquors, as well  as opium, operate indirect debi*
Kty fooner upon thefe parts  than other*, 
                OF   MEDICINE.          27

 over all the fyftem as in any part, and for the  moft  part
 fooner (m).   Therefore,
   LVI.  Evsry affection of a  part,  however formidable,
 occurring in general dife-afes, is to be confidered as only a
 part of the  affection inherent in  the  whole body,  and the
 remedies are not to be directed  to a part, as if the whole
 difeafe lurked there, and was thence to be taken off only,
 but to the whole body, to all which it belongs («).


                CHAP.     V.


                Of Contraction and its  Effecls.

   LVII.  THE entire  and  vigorous contraction with
 which mufcular fibres are  endowed, is  in  proportion to
 the degreeof excitement on which it depends (a).  This
 is proved by all the phaenomena of health and difeafe, and
 by the  operations of all the exciting powers and of all the re-
 medies.   Force  and propenfity  to  motion are the fame.
 We muft judge from facts, not from appearances.   Con-
                                                  fequently

  (m) The pain  of the thorax in peripneumony, which is the fign of
 the inflammation within, never appears fo foon as the  general affection,
 and in more than in one-half of many  hundred cafes, where  this fact
 has been painfully feminized, it did not appear till one, two, or three
 days after the commencement of the general affection,  Likewife the
 pain of the gout is not the firft of the phenomena of that difeafe.  But
 all thefe, and many more particulars,  will be brought  in with more ad-
 vantage  in their proper places afterwards.
  (») When the affection  of  a part is external, and, therefore, acceffi-
 ble, the application of a remedy over it, in conjunction with the ufe of
 the internal remedies, is of fervice,  in confequence of their mutually
afiifting each other.  A rag drenched in a liquid opiate, helps the opera-
tion of that remedy taken internally ; but that is ftill by operating upon
 the excitability ever all.
  {a) It has  already been proved, that all  the functions depend upofl
 excitement and therefore contraction among  the reft. 
28
THE   ELEMENTS
 fequently, tremor, convulfion, and every affection com-
 prehended under it, are to be imputed to debility as their
 caufe.  The hurtful exciting power is a ftimulus uncom-
 monly irritating to the part.
   LVIII.  The degree  of  contraction, that conftitutes
 fpafm, is not an exception from this propofition.   It is a
 continued and deficient function, rather than  a  great and
 exact  one; and in  fo far as it is  a great contraction, it
 depends upon the  local ftimulus of  diftention,  or of fome-
 thing  refembling  diftention, it confifts  in diminifhed ex-
 citement,  is devoid of force, and removed by  ftimuiant
 remedies.  The appearance of fymptoms, which is ever
 mifleadlng,  is never to be trufted  in forming any  judge-
 ment.  Take now both the  fact and the  explanation of
 it.
   LIX. As the degree of contraction,  in fo far as it is a
 found function,  is connected with force;  from that  we
 are to hold it as a certain and demonftrated fact, that the
denfity of mufcuiar fibres confidered as fimple  folids,  is
 proportioned to the degree of their  contraction.
   LX. It muft therefore be admitted, that  excitement  is
 the caufe of denfity.  And the denfity is rendered  great-
 er and greater by the excitement in proportion to the de-
 gree -of the latter :  Which it is eafy to perceive through
 all the intermediate degrees offirengthy from the highefi, or
 that which takes  place in madnefs, and the denfity cor-
 refponding to it, to the lowefiy or  that debility which is
 difcerned in the article of death, in death itfelf,  and after
 death, with  a  laxity correfponding to  it.  That  this  is
 the fact, is proved by the weaknefs of  the fame fibres in
their dead, and  their ftrength in  the  living ftate ; the
 only caufe of which difference, we know for certain, is
 excitement (b).
                                                  LXI.
 (b) Experiments have been made  by Baron Haller and others, to af-
certain the comparative ftrength of mufcuiar fibres, and tbc criterion 
OF   MEDICINE.          29
   LXI.  Hence the cavities of the veffels,  through their
whole tracts, over the whole body, are diminifhed in afiate
cf ftrength, and encreafed in  weaknefs.  This is the true
caufe of diminifhed prefpiration  (c).


               CHAP     VL


          The forms of Difeafes and Predifpofition.

   LXII. EXCITEMENT,  the effect  of  the  exciting
powers, when o/"a proper degree, conftitutes health ; when
either exceffive or deficient, it proves the occafion of difeafe,
and, of predifpofition  previous to  the  arrival of difeafe.
The ftate both of the fimple folids and fluids follows that
of health as  conftituted by  the excitement,  and a given
ftate (a).
   I*. The firft caufe of the formation of fimple folids,
and the fole one of their prefervation after,  is the excite-
ment.   Under the direction of the  excitement, the living
folids produce the blood from an external matter taken in-
to the fyftem, keep it in motion, form its mixture, fecrete
from it various fluids, excrete them; abforb others, and
circulate and expel them from the body.   It is the excite-
ment alone, thro' its varying degrees, that produces either
health,  difeafes, or the return of the found ftate.   It alone
governs  both  univerfal and local  difeafes.  Neither of
                                                   which

of judgment was their greater or leffer difpofition to break by appendci
weights;  but the power by which any body refifts ftretching, is the
denfity of that body.  Thofe experiments fhow that the fibre* in the li-
ving body are prodigioufly ftronger than the dead.
   (c) and not any of the hypothetical ones, as conflriction from cold,
•r fpafm, which are to be confidered afterwards,
   (*) This propofition overture* the principal fyftems that have ever,
appeared in the prof cifion of medicine.   But more of it after, 
3°        THE   ELEMENTS
  which ever arife from faults of the folids or fluids, but al-
  ways  either from encreafed  or diminifhed excitement.
  The cure of neither is to be directed  to the ftate of the
  folids  or  fluids,  and  only to the diminution or the en-
  creafe of excitement.  But.
    LXIII.  Affections peculiar to parts, or organic mala-
  dies, being foreign from this place of the work, in which
  the treatment of the general ftate of the body is only confi-
  dered, muft be paffed over at prefent.
    LXIV. That the excitement governs all life is proved
  by the exciting powers, acting always by ftimulating, and
  thereby producing excitement; it is proved by  the great-
  er or fmaller activity of the functions  being proportion-
  ed to the force of the exciting powers ; it is proved by the
  effect of the remedies, which always oppofe deficient,  to
 exceffive, and  exceffive, to  deficient  excitement,  in ef-
fetling the cure of difeafes.
    LXV. The notion of health and difeafe being different
 ftates,  is difproved by  the operation of the powers which
 produce them, and thofe that remove them, being one and
 the fame.
   LXVI.  The general difeafes,  arifing from  exceffive
 excitement,  are  called  fthenic  (b);   thofe  that origi-
 nate from  a   deficient  excitement,  afthenic.   Hence
 there are two forms of difeafes, and both are always  pre-
 ceded by predifpofition.
   LXVII. That the origin of difeafes, and predifpofition
Juft now mentioned, is the only one and  true,  is  pro-
ved by the fame  powers which  produce any difeafe, or
                                                   pre-
  (£) Their old name is phlogiftic ; but as that word is afcfurdly meta-
phorical from an old notion of that fort of difeafes depending upon fire
or flame ; and becaufe it was not a proper contraft to the term here to
be oppofcd to it; as alfo becaufe it is ftill more ridiculous when applied
to plants, which are comprehended in this doctrine;  for thefe reafons
it has been thought proper to reject  it, and fubftltute the  other in ki
place. 
OF   MEDICINE.          31
 predifpofitiou, alfo producing the whole form of difeafes
 to  which it belongs;  and  by  the fame  remedies, which
 eure any difeafe,  or predifpofition, alfo curing all the dif-
 eafes and predifpofitions  of its refpective form (c).   Be-
 twixt thefe oppofite fets of difeafe and predifpofition,  per-
 fect health is the mean, leaning to neither extreme.
   LXVIII. The exciting  powers, which  produce  pre-
 difpofition to difeafes,  or thofe difeafes themfelves,  fhould
 be  denominated fthenic, or ftrictly ftimuiant.  Thofe that
 pave the way to afthenic  difeafes, or produce the latter,
 fhould be called afthenic, or'debilitating.   The ftate of the
 body producing the former or the predifpofition  to them,
 is to be called Sthenic  Diathefis ; that  which occafions the
 latter, with the predifpofition peculiar to it, receives the
 new term of Afthenic Diathefis.   Each of thefe  diathefes
 are a ftate of the body, the fame with predifpofition and
 difeafe,  varying only in degree.   Diftinguifh the powers
 that raifeboth the diathefis to the degree (d) of difeafe, by
 the term exciting hurtful powers.  The fthenic difeafes, in
 which the pulfe is turbulently  affected, fhould not be de-
                                 i              nominate

  (c) The fame hurtful powers produce,  and the fame remedies re-
 move, both Catarrh and Peripneurnony, only differing in degree-   The
 powers  producing them are excefs in the ufe of ftimulants,  and the re-
 medies whatever moderates that excefs.  Evacuation, cold, and ftarving,
 are  the means.   All the difference is, that more of the means are em-
 ployed for the eure of Peripneumony than for that of Catarrh,  The
 hurtful  powers producing indigeftion and fevers, are alfo the fame, to
 wit, debilitating ; and the remedies the fame, to wit ftimuiant. Only a
 fmall degree of the remedies, proportioned to the flightnefs of the de-
gree of the caufe, is  fufficient  for the  cure of indigeftion; while  the
moft diffufible ftimuli are required to effect the cure of fevors. Stimu-
lants, in one degree  or other, make  the cure of all afthenic difeafes ■
 evacuants  and other weakening means in  different degrees, form  the
 whole cure of the fthenic form of difeafes.  Might net this have been
 known long fince ?
  (<f) or full meafure. 
 32         THE   ELEMENTS

 nominated fevers or febrile difeafes, but, for the fake of
 diftinguifhing them from the afthenic difeafes that difturb
 the pulfe, to which fever is a proper name, they fhould be
 coldPyrexies.

              CHAP     VII.

 The Effetl of both the Diathefis, and ofithe mojlperfieB Health
                         itfelf.

   LXIX.  THE common  effect of the  fthenic  hurtful
 ipowers upon the functions, is, firft to encreafe the func-
 tions, then partly to impair them, but never by a debilita-
 ting operation (a).  The effect, in common to the  afthenic
 hurtful powers, upon the  fame fiunclions, is to diminifh
 them, in fuch a manner, as fometimes to exhibit an appea-
 rance, but a falfe one (b), of encreafing them.
   LXX.  If the juft  degree of excitement could  be con-
 ftantly  kept up, mankind would enjoy  eternal  health.
 But  two circumftances prevent that.  Such is the nature of
 the fthenic diathefis,  that it waftes the fum total of exci-
 tability  affigned to every being upon the  commencement
 of its living ftate, and, thereby fhortening life  often by the
 interpofition of difeafes, fooner or later  induces death.
 Which is one caufe of mortality.
   LXXI. the afthenic diathefis is hurtful by not fupply-*
 mg that degree of excitement, which is neceffary to life,
                                                   and
  (a) The inability to perform  motion in peripneumony,  arifes  not
from  debility, for two good reafons;  firft, no powers but thofe that pro-
duce all the other fymptoms produce it; and the faime remedies, that re-
move the other fymptoms, are equally effectual for the removal of it,
  (t>) Spafm and convulfion, fuppofed to arife from encreafed influx of
the nervous power, are both occafioned, and cured, by the fame pow-
ers, as all the other fymptomsj 
                e F    MEDICINE.          22-

 and thereby allowing the ftate of life to approach  more
 nearly to that  in which death confiffcs. Which opens ano-
 ther.gate of death to mankind.
   v.  Further difeafes and  death are  the confequences  of
 the change of either diathefis into the other.   Either dia-
 thefis, by means of the hurtful powers producing the other,
 when  thefe are employed as remediesk"), may, either from
 accident, inadvertence, or defign, be completely converted
 into the other ;  and when that has been done, and oppo-
 fite remedies  to thofe,  that in  this manner proved  hurt-
 ful, are employed ; it may, by  a contrary excefs, be turned
 back  to the fame ftate from which it fet out iff).  This
                             D                   obfervation

   (c) Stimulants  are the proper remedies for curing the gout; but they
 may be carried fo far as to produce fo much fthenic diathefis as to bordtr
 upon indirect debility.   A confequence of which is vomiting, purging,
 a feeling of burning in the inteftines, intermillion of the pulfe, and ftran-
gury ; which are only to be cured by fubftituting watery drink and low
diet in place of thofe oppofite remedies:  Nay, the ftimulants may be
carried fo far, as to effect the eftablifhment of indirect debility.  Hence,
Will arife paralytic affection, anafarca,  dropfy, &c* The evacuants and
other debilitating remedies, by which the difeafes of fthenic deathefis
are removed, may, by being pufhed to excefs, produce the laft mention-
ed difeafes, as depending on direct debility.
   (</.)  Pufhing the remedies of fthenic difeafes too far, may reduce the
patient  to an incipient dropfy ; and the remedies of  the latter may be
 urged to fuch excefs, as  to pafs the range of fthenic diathefis, and ter-
 minate in indirect  debility.   A  is affected with a difeafe of debility,
where  the excitement has gone down to 10, the excitability mounted
 up to 70, degrees in the fcale.  What is to be done?  By a proper
ufe of high ftimulants the 30 degrees of loft excitement may be reftored
and as many of fupsrfiuous excitability difcharged, ami the excitement
 and excitability made to meet again at the middle point of 40.  If the
 remedies are carried up to any degree betwixt 40 and jj, they  have
gone too far, and produced predifpofition to fthenic difeafes ; if ftiii far-
 ther, but not exceeding 70, they  will have produced  one or other of
 thefe difeafes,  But carried beyond 70, the difeafes, which their opera-
                                                           tion 
34           THi   ELEMENTS
  obfervation  will be found of the greateft confequence in
  the cure of  both predifpofitions and difeafes  (*).  What
  is wanting to a further illuftration of it fhall be given af-
  terwards.   An illuftration of the change of fthenic diathe-
  fis into afthenic is found'in hydrothorax fucceeding pcrip-
  neumony*    Again,   the immoderate   ufe  of ftimulants
  may convert any afthenic  affecTSoo into a fthenic one;
  as when a  violent cough,  a catarrh, or an inflammatory
  fore throat, are induced in confequence of the cure of the
  gout, though proper in kind,  being carried to excefs  in
  degree.
    f.  Though excitement governs all the phenomena of
  life ; yet the fymptoms of difeafes, which either its excefs
  or deficiency produces,  do not of themfelves lead to any
  proper judgment  refpecting it ;  on the  contrary,  their
  deceiving appearance has proved a fburce of infinite error.
   LXXII.  From  all that has hitherto  been faid, it is  a
 certain and demonftrated fact,  that, life is  a (f) forced
 ftate, that the tendency of animals every moment is to dif-
 folution ; that they are kept from it (g), by foreign pow-
                                                       ers,

 tion produces,  are thofe of indirect debility.  Any difeafe of this fort,
 when treated according to a rule lately delivered, will be cured.  But
 if the ftimulants adapted to this purpofe be urged further ; the fthenic
 diathefis will again be produced ; and the debilitating power, fuited to
 the removal of it, may carry down the excitement below 40 into the
 range of predifpofition betwixt 40 and 25 ; and then, by a further abufe
 of remedies, which fhould only be ufed in the range betwixt 40 and 70,
the excitement may return to  the fame  point from which it fet out, to
wit, the point of 10, and the  excitability rife to its original point, that
of 70.
  (e)'It muft never be forgot, that we are nothing in ourfelves, but,
while we have any excitability remaining in proper capacity to be acted
npon,  we entirely depend on the exciting powers  ailing on it,
  (/) not a natural, but,
  fg) not by any powers in themfelves,  but 
               0 E  Tvl  E DIC  I  N  E.          35

 ers,  and even by thefe with difficulty and  only for a little ;
 and then,from the neceffity of their fate, give way to death,


             G   H   A   P.     VIIL

                     Of Predifpofition.

   LXXIH.  Predifpofition is a  middle ftate betwixt pet-
 feet  health and difeafe.   The powers, producing it, are
 the fame with thofe which produce difeafe.
   LXXIV.   The period of predifpofition will be fhorter
 or longer, according to  the greater or leffer force of the
 hurtful powers that have induced it>• and the interval be-
 tween health  and actual difeafe will be more quickly or
 flowly got over.
   LXXV. That predifpofition neceffarily precedes difea-
 fes,  is evident from  the fact of its arifing  from the fame
 exciting  powers, acting upon the fame excitability, from
 which both health and  difeafe arife, and of its being an in-
 termediate ftate betwixt them both.   And, as the excite-
 ment of  health differs much from that of difeafe; it is not,
 therefore,  to be fuppofed, that the former immediately
 mounts up to the latter, and fldps over the boundaries  of
 predifpofition :  nay,  the  contrary  is certain and  beyond
 a  doubt.
   LXXVI.  Contagious difeafes are not an exception from
 this obfervation ; becaufe, whether the matter of contagion
 act by a  ftimuiant or a debilitating operation, its operation
 is the fame with that of the ordinary powers, that is to fay,
 its caufe  is the fame (a).  If, as it fometimes happens, no
                            D  2                general

  («) The  fmall-pox and meafles are cured by the fame means as pcrip-
neumony or any other fthenic  difeafe ;  and, excepting the contagious
matter, arife from the fame ftimuiant hurtful powers; they muft, there-.
                                                    fore 
 36           THE   ELEMIN T  S

 general affection follows the application of contagion,  if?
 no  undue excefs or  defect  of excitement is  the confe-
                                                        quence ;

fore,  with the fame exception, be the fame.  The  only difference is,
that they are  accompanied with a contagious  matter,  and the other
fthenic  difeafes are not.  The amount of which is altogether unimport-
 ant.  For, if the ordinary powers have not operated, the affection does
not come under the definition of general difeafe j- none of the functions
receding  from their  natural ftate,  and  the eruption amounting to no
more than a flight local complaint.  It is, therefore, only  of ufe to re-
gard the general circumftances of  thefe difeafes, making no more ac-
count of the local part, than to confidcr,  arrange, and treat it as fuch.
 It is well known, that,  when by the means ufed for the cure of fthenic
difeafe  without  contagion and their fequel, eruption,  the fthenic dia-
thefis is prevented or  removed, the local part  gives no trouble; and
that the difeafe is never dangerous hut from the neglect  of that manage-
ment.  But the management is nothing elfe but the ordinary one in any
fthenic cafe.   If it fhould be  contended, th3t, all  that being granted,
ftill  the eruption may contribute a  little : Be that fo, and it can  be but
very little ;  what is the  effect ? The cure fhows it; which is exactly the
fame  as in fthenic difeafes  without eruption.  The difeafe, therefore,
being the fame (for its mere local part is out of the queftion, as only re-
quiring  a peculiar expofure  to  cold,  which is equally proper in every
fthenic difeafe) ; every part  of reafoning refpecting it, and, confequently
that affecting the queftion about predifpofition, muft alfo be the fame.
If, therefore, other general difeafes have their predifpofition, fo  muft
the fmall-pox, the meafles,  and the plague  itfelf.   If it fhould  ftill  be
faid, that the  eruptive difeafes, though in other refpects the  fame with
the non-eruptive, differ, in fo far as predifpofition is required as a com-
mon  circumfiance between them ;. the anfwer is, that that difference
only refpects their local part,  which, without the powers producing the
difeafe,   is infignificant  and a mere local complaint.  As general fthe-
nic difeafes,  the fmall-pox and meafles, and as general afthenic ones, con-
tagious fever and the plague, to the full extent of their generality, have
their period of predifpofition ; we may have occafion afterward  to efta-
blifhthe queftion about preelfpofition to them even as local difeafes, but
this is not the place for  it; all that was required here being to fettle the
queftion about predifpofition to  them as general difeafes.  In the fame
point of view all that has been faid of contagious difeafes, will apply to
 difeafes in which perfons may have been concerned, 
               OF   MEDICINE,            37

 quence;  in that cafe,  the affection is altogether local and
 foreign from this place.
   LXXVII.  If poifons communicate any fort of morbid
 affection  without predifpofition, fuch an affection, for that
 very reafon, is not to be confidered. as a general difeafe, as
 alfo for this additional reafon,  that  the afeBion is neither
 removed nor relieved by the ufual cure of general difeafes;
 and the diverfity of the effect proves, that both the caufe
 and exciting hurtful power are different from the general
 ones.   In one word,  fince predifpofition and difeafe are
 the  fame, varying  only in  degree,  the unavoidable  con-
 clufion is, that whatever, with a given force, produces the
 latter,  the fame, with a leffer force,  will produce the for-
 mer.  The  only cure of moft poifons  is their early dis-
 charge from thefyfiem.   And if, as often happens, others,
 by wounding an organ neceffary  to life, are not curable,
 but  fatal; the effect of  both is foreign from our prefent
 fubject, and to be referred to local difeafes.
   LXXVIII.  The  only thing to  be  regarded in  the
 powers producing either predifpofition to general difeafeSj
 or thofe difeafes in their full force, is the degree of the for-
 mer (c) compared with that of the -latter (d), or of the in-
 dividual powers compared with one another; for the pur-
 pofe of difcerning the degree of hurtful power that each
 poffeffes, and the degree of curative  means to be employ-
 ed in order to remove the hurtful effect (e).
                                                 ,LXXI&
  (c) thofe that produce the predifpofition,
  (</) thofe that produce the difeafe,
  (e) The diftinctions of the powers producing predifpofition, and of
thofe that excite difeafe, under the general appellation of prcdifponent
or occafional caufes have been multiplied and refined upon without end.
But the whole  fyftem of remote caufes, as  they have been called, is
falfe in its firft id§a.  The hurtful powers, wl atever they be called, that
produce difeafes, alfo produce the predifpofition to them. Which be-
ing once admitted, as it henceforth muft, the whole fabric of aitiology 
 3&          THE    ELEMENTS

   LXXIX. The  knowledge of predifpofition is of great
importance; as enabling  the  phyfician to prevent difea-
fes (f), comprehend the true caufe of them founded in pre-
difpofition,  and to diftinguifli them from local affections,
which are widely different from them  (g).
   LXXX.  As the predifpofition,  to difeafes, and the dif-
eafes themfelves,  are  tha  fame  ftate; a  great  criterion,
by which general difeafes may be diftinguifh^d from local
ones, will be found in this Jingle circumfiance, that general
difeafes are always,  local never,  preceded by predifpofi-
tion (h).
                                                    LXXXI.

or of the doctrine of remote caufes muft fall to the ground : Consequent-
ly, fimply remote caufes, not divifible into predifponent and occafional;
relative remote caufes, or fuch as are fo divifible; internal and external
predifpoTient,  internal and external occafional caufes ; approaching cau-
fes, or caufte propricres proximate caufes, of which, not only one, but
often feveral, arc affigned to every difeafe, muft ccafe in medical language,
and the ftudent's attention  be turned away from the endlefs purfuit of
diftinctions without a difference, to the ftudy of the folid and ufeful facts
that nature holds up to his contemplation in great abundance, when once
his eyes are fairly opened to behold them,
   (_/) from his acquaintance with the powers that lead to them,
   (g)  Such  is the fimpliciry to which medicine is now reduced, that
when a phyfician comes to the bed-fide of a patient,  he has only three
things to fettle in his mind,   Firft, whether the difeafe be general or lo-
c?i ; fecondly, if general, whether it be flhenic or afthenic; thirdly,what
is its degree ?  When once  he  has fatisfied himfelf  in thefe point?;  all
that remains for him to do, is to form his indicatisn or general view of
the plan of cure, and carry that into execution by the adminiftration of
proper remedies.
  (£) An inflammation in fome part  of the ftomach,  or  as it has been
commonly called, " the  Inflammation of the Stomach," as if  it were
always of the fame kind, produces many fymptoms, that bear fo great
a refemblance to general fthenic difeafes, fuch as peripneumony, that by
fyftematics and nofolotifts,  it,  as well as many other inflammations  of
internal cavities, have been united into an order of difeafes, fuppofed all
to partake of one common  nature.  The Gaftritis, however, which is
                                                            its 
                OF   MEDICINE.            ^Q

    LXXXI.  As the affection  of a part is always the ori-
 ginal fource of local difeafes,  and as the diftinctions,  we
 have related are eftabli.hed upon the folid bafis of truth ;
 it follows, that the following diforders  muft be  rejected
 from the number of general difeafes, how great foever
 their refemblance to them  may be, and however  much
 they may conceal their own nature.   Whatever  affec-
 tions,  then, arife, from any ftate of a part,  from ftimuli,
 from debilitating circumftances (neither of which laft pro-
 duce any commotion in  the whole body,  or only  do fo in
 confequence of the force of  the local caufe),  from com-
 preffion of a part,  from obftruction,  from other difeafes
 (;'),  and not from the exciting powers which produce  ge-
                                                       neral

 its  nofologkal  name, is effentially different, both from Peripncufnony
 and all the other general difeafes of the order with  which it is affociated,
 both in other refpe&s, and in that of which we are fpeaking.  As ari-
 fing from certain local hurtful powers, it is not preceded by predifpofi-
 tion.  So when I come to the bed-fide of a patient under thefe circum-
 ftances, though I had no previous knowledge of the nature of his difor-
 dcr; whenever I hear that he has fwallowed ground glafs,  fmall fiffi-
 bones, or, perhaps, a great quantity of Caien pepper, I  can be at no
 lofs to difcern the nature of the difeafe, and to find, that it is altogether
 local; and that for two of the beftof all reafons;  firft, the perfon ha-
 ving been in perfect health Immediately before that accident;  and fe-
 condly, that the fubftances which he had fwallowed were fuch as would
 naturally divide a found part, or, in the language of our profeffion,  pro-
 duce a folution of continuity in it.  From this, again, inflammation is
 an infeparable confequence,   And it  is equally an  univerfal fact in the
animal economy,  that, when any part, whether internal or external,
which pofleiTes  great fenfibility, is wounded or othcrwife injured in its
fubftauce, the pain  arifing from the inflammation fupcrinduced,  fpreads
fymptoms of diforder over the whole fyftem, which are liable to mlf-
lead thofe, who are not in poffeffion  of the criterion we here  point  out.
As fuch a cafe,  then, is not preceded by  predifpofition, fo peripneumo*
ny as well as every other fthenic,  every afthenic, difeafe muft, from thp
proofs of the univerfality of the fact, be allowed t» be, it muft be local.
 Aad here again we throw the  gauntlet.
  £') whether general or local, 
  4°          THE    ELEMENTS

  neral difeafes (k); all thefe muft be rejected from the num-
  ber of general difeafes :  and that for the mofi folid reafons ;
  to wit,  their differing from them  in the  hurtful powers
  that produce them in their true caufe (/), in their cure (m),
  and in every effintial refpect, agreeing with  them in no-
 thing,  but in a deceitful and deceiving fuperficial appear-
  ance.
                                                  CHAP.

   (i)  Let it here be added, that the powers producing general difeafe?,
 are thofe that act upon the excitability, and are, thereby, quickly commu-
 nicated over the whole fyftem ;  while thofe, that act upon the folid tex-
 ture of a part, fo as to cut, prick, bruife, or contufe it, &c, are the pow-
 ers productive of local difeafe.
   (/)  The caufe of the inflammation of the ftomach has been mention-
 ed.   To concentrate it into a definition ;  it is a folution of the continui-
 ty of a folid part in the ftomach, by mechanical or acrid means, follow-
 ed by inflammation and pain, and in confeqnence of the great fenfibility
 of the part, propagating fymptoms of diforder over all the fyftem.  The
 caufe of the general difeafes here alluded to is an encreafe of excitement,
 and the inflammation accompanying thofe difeafes arifes from that en-
 creafe.
   (/») The cure  of Gaftritis, or the inflammation of the ftomach, is to
 contrive means to keep the hurtful, and all rude matters, from  coming
 into contact with the inflamed part, and leave that part to heal;  taking
 C3re, neither to encreafe the local affection by too fthenic a diet, nor  to
 produce a  tendency in the  inflammation to run into gangrene,  by the
 abufe of evacuations and other debilitating powers;  3nd if, than which
 nothing is more likely, the acutenefs or continuance of pain fhould  at laft
 bring  on a ftate of general debility, then to ufe the  palliative means  of
 preventing that bad confequence.  The cure of Penpneumony is to wea-
 ken the fyftem, from the very commencement of the difeafe, by diminifh-
 ing the energy of all the exciting powers ;  that of the abundance of the,
, blood by bleeding, that of the over-proportion of the other fluids by pur-
 ging, ftarving ; that arifing  from the ftimulus of heat and other exceffiyj
 ftjmuli by cold,  &c, 
OF   MEDICINE.           4I
                CHAP.     IX.

                    The general diagnofis.

    LXXXII.  THE violence and danger of univerfal difea-
 fes is in proportion to the degree of exceffive excitement {a)
 or its  indirect or direct deficiency  (Jb);  as is proved by
 all that has been faid above : confequently, their principal
 variety turns  upon this variation of the degree of excite-
 ment.
    LXXXIII.  The  only diagnofis (c) of any importance
 is  that, by which general  difeafes are diftingui fh-d from
 local,  or  fymptomatic  affections, throwing the whole
 fyftem into diforder,  with a certain refemblance to univer-
 fal difeafes.   To execute  which,  the following  maris are
 to  be underftood to fiuff.ee for the detection of every gene-
 ral difeafe; firft,  its being preceded by a diathefis, and
 this followed by one fimilar to it, and removed by an ope-
                                                      ration

  [a)  The excefs is  contained between  4©,  the point of health in the
table, and 70.
  [V)  The cafes of indirect  deficiency or debility are comprehended
betwixt 70 and 80.   The direct are all the degrees below 40,  Betwixt
40 and 55 confifts predifpofition to fthenic ; betwixt 40 and 2j the pre-
difpofition to afthenic difeafes.
  (c)  Diagnofis is the doctrine of diftinguifhing difeafes from one ano*
ther.  It was naturally thought to be of the grejfceft importance, when
difeafes were fuppofed very numerous, and as different from each other
as their names and the various appearances of their fymptoms.  That,
however, has been  found to be altogether a miftake in this work,  in
which the endlefs variety of general difeafes is reduced to two forms, a
fthenic and afthenic  one, without any other difference but what  con-
fifts merely in degree.  The huge volumes of diagnoftics are then in this
chapter fuperfeded ;  and much labour, not only irkfome to the artift, but
worfe  than  ufclefs,  often pernicious to patients, is proved to be fuper.
fluous,
                                               2 
43         THE  ELEMENTS
  ration of the remedies of an oppofite nature to that which
  occafioned the difeafe : while  on the contrary, local af-
  fection  is  diftinguifhed,  firft,  by  the  affection of  a
 part,  and  the  diforder  of the  fyftem  (d)  being  fuch
  as may be traced back to that affection ; and by the
 abfence of the diathefis of the difeafe which the local affeBi-
 cns refembles, or only its accidental prefence.
    LXXXIV. In order to attain to this ufeful knowledge
 learn  what is neceffary from  anatomy, wafte no time in
 fuperfluous ftudy in it; perufe the works of the illuftrious
 Morgagni; diffect  fubjects ; diftinguifh remaining effects
 from caufes that have paffed away; examine diligently very
 many bodies  of perfons who have been hanged, or have
 died  of wounds,  and  are otherwife found:  compare
 thefe diligently with the bodies of thofe who have died by
 lingering and  often repeated difeafe;  compare every par-
 ticular with every other, the whole with the whole j guard
 againft the rafhnefs of forming opinions, and, if you can,
 you will be among a very few, who have ever been able
 to do fo; never expect to  difcover the caufe of difeafe in
 dead bodies; be circumfpect in forming a judgment.
    LXXXV. As  internal local affections are  often a cer-
 tain taint that remains after general difeafes have paffed
 away, it is therefore a matter of found judgment to under-
Jland, that there is lefs or more reafon to fufpedt the for-
 mer, in proportion as the latter have feldomer or oftener
 preceded them.

              CHAP.     X.
   The general Prognofis, or general Judgment of the Event.
   LXXXVI.  SINCE the powers producing fthenic and
 ?.fthenic diathefis, always act upon a part with more force
 than any other equal part; it follows, therefore, that the
 danger of difeafe  during the predifpofition, and  of death
                                               during
  (</) not ar'Sflg  from any change in the excitement, but 
           OF    MEDICINE.            43

 during the difeafe, arifes in proportion to  the degree of
 diathefis, or  to the importance of the part efpecially af-
 fected.  But, its  degree being given, the more equal the
 diathefis is, the more fafe it is.  Nor does it ever fall hea-
 vy upon an orgakneceffary to life, without infb.nt danger.
 And hence it is, that peripneumony, apoplexy, phrenitis,
 eryfipelas, and the gout, when the two latter affect the head
 with violence, are  chiefly formidable.
   LXXXVII.  Local and  fymptomatic affections  ought
 to be diftinguifhed from general difeafes, and the remarks
 made  in the LXXXIII. LXXXV.  transferred  to this
 place.

              CHAP.    XL

   LXXXVIII.  THE indication for the  cure of  fthenic
 diathefis  is to diminifh, that for the cure of the afthenic
 diathefis, is to encreafe  the excitement, and to continue to
 encreafe it, till that degree  of it, which conftitutes  the
 mean betwixt its extremes, and which is  fuited to good
 health, be replaced.  This  is the only indication of cure
 that univerfal difeafes admit of.
   LXXXIX. As  both diathefes arife from an operation
 of the exciting  powers, the fame  in kind but varying in
 degree; fo they are both prevented and removed by an ac-
 tion of the remedies,  alfo the fame in kind, but oppofite in
 degree, to that which produced them.  As their cauie, fo
 is alfo  their  plan  of cure,  confirmed by an induction of
 proof  (a), drawn from the whole courfe of facts and phx-,
 nomena (b).   The fame debilitating  remedies, which re-
                                                 move
  (a) not one or two, but
  (£) Suppofe the fthenic diathefis mountad up to  60 in the fcale ; to
reduce it te 40 it it evident,  that the 20 degrees of fuperfluous excite-
                                                  ment 
44           the    Elements
  move any one fthenic difeafe, remove  that whole fornnf
 'difeafes:  and the  fame ftimuiant  means, which  cure any
  one afthenic difeafe,  remove all the reft (c).   Are not pal-
  fy, in fo far as it is  curable (d), and  dropfy,  in  fo far as
  it is a general affection (e), as well as the gout, and fevers,
 "both relieved and removed by the fame remedies ? And are
 not peripneumony,  the  fmall-pox, the  meafles,  rheuma-
                                                          tifm,

 ment muft he taken off, and therefore, that remedies operating with
 a ftimuhis, ■ weak  enough to produce that effect, muft be  employed:
 they are ftill,  however, ftimuiant, and of confequence, though they re-
 move it, ftill the fame in kind, as the powers that produced the  diathe-
 fis ; it having been proved, that they are not  to be fuppofed fedative,
 both for the reafons already given, and for this additional one, that proof
 has not been'/et brought of a fingle  fedative in nature.   As their ftimu-
 lus, however, is lefs than that which is required to fupport the ordinary
 ftate ef health, they are underftood to be  debilitating,  and, therefore,
 proper remedies of fthenic diathefis.
   (e) Snppofe the afthenic diathefis to have funk down to %o ; to raife it
*up to the ftandard of health, it is  plain, from all the propofitions hither-
 to laid down,  that the ao degrees of deficient ftimulus muft  be reftorcd,
 and, therefore, that remedies operating with a degree of ftimulus ade-
 quate to the production of that effect, muft  be ufed.  All the difference
 betwixt this force of ftimulus and that of the other, is only a  difference
 of 40 degrees.   As, therefore, the debilitating powers, though ftimu-
iant, employed in the firft, removed the morbid fupcrfluity ; fo the fti-
muiant  powers ufed in this cafe, called ftimuiant by way of eminence,
remove the morbid deficiency,  and thereby, reftore ths degree of ex-
ciement, that conftitutes the ftandard of  health.
   (d) When the prevalence of debility, and that to fuch a degree as to
deftroy the connect^n that fubfifts betwixt the fibres of mufcles, and that
function of the brain which we call will, takes place in parts of the fy-
ftem, net only remote from the center of activity,,but  beyond the cir-
culation, it muft be of difficult cure ;  becaufe tha moft poweiful means
 of effecting that operation, act moft  powerfully when taken internally,
and much more feebly when applied  to the fkin.
  (0 What is called dropfy confifts of a cafe which is a general difeafe,
■and a number of others, which are  only fymptoms of local internal dif-
eafes, and to be treated  in the laft part of this work:  Thefe arife from
                                                          offifi- 
             OF   MEDICINE.            £J

 tifm and catarrh, removed by the fame remedies (/) ? But
 all thefe remedies in the afthenic cafe encreafe, in the fthenic
 diminifh, the energy of life.   In both cafes the operation
 is a common one ever all, nor is there any diverfity but in
 degree.
   XC. The remedies, therefore of fthenic diathefis are
 powers, exciting by a  weaker ftimulus, than that which
 is fuited  to  health ; and are in this work  to be  denomi-
 nated, for the fake of brevity, Debilitating or Antif;henic
 Remedies.
   XCI. The remedies of afthenic diathefis are powers, ex-
 citing with more force, than fuits the beft  health; to be
 named here in  the  practice ftimulants or fthenic, for the
 more  convenient diftinction  of them from the other re-
 medies.
   XCII.  Thefe are to be employed with more or lefs free-
 dom in proportion to the higher or lower degree of each di-
 athefis, and of the local affection depending upon it.   And
 fuch a choice of each fhould be  made in fuch  a way as
 that the moft powerful may be adapted to the moft violent
 cafe.   But the cure of any difeafe of confiderable violence,
 and fcarce of any  at all,  is never to be entrufted to any
 one remedy.  The ufe of feveral remedies is preferable to
 that of one ; becaufe, thereby,  their direct energy is ap-
 plied to the fyftem to a greater extent, and the excitability
                                                       is
offifications in the large veffels  next the heart, from tumors, whether
fchirrous or fteatomatous, impeding  by their preffure the return of the
blood by the veins to the heart.  It is the general cafe that is here allu-
ded to, and  the public may depend upon it, that it is to be cured, hut not
by evacuant means, and, on the contrary, by the high diffuQble  ftimuli,
neceflary to the cure of difeafes of high debility, fuch 3s the  extremity
of typhus fever, and an  expiring gout.  All thefe are cured by high fti-,
mutants.
  (/) to wit, evacuants, told, and ftarving, 
 4*>         THE   ELEMENTS

 is more ccnpkrdy red more equa.Iy aikcted.  The per-
 fon, who  means th.:: his remed es fliould go to  a puik-
 cellar part  (,?), is equally wife,  as any one would be, who,
 by cropping a twig, expects to eradicate a tree.  What re-
 medies are  of general, what of local operation, fhall next be
 mentioned.
   XCIII.  General  remedies  are thofe,  which,  acting
 upon the excitability, by an operation diffufed  over the
 whole body, reproduce the ftate of health.
   XCIV. Local remedies are thofe, which  act by a fimi-
 Jar operation  on a part, and by an operation confined to
 that, reftore the found ftate.
   XCV. Since every univerfal difeafe, every predifpofi-
 tion, depends  upon  encreafed  or  diminifhed excitement,
 and is removed by the converfion of that into  the degree
 which conftitutes the mean betwixt both ;  for that reafon
 in order both to prevent and cure difeafes we muft always
 ufe the indication propofed,  and  ftimulate  or  debilitate;
 never lay by, nor truft to the fuppofed powers of nature,
 which have no real exiftence.
   XCVI. In the indication of cure, the only regard to be
 had to morbific matteY, is to  allow time for  its paffing out
 of the body.  For whether it acts, like all other  exciting
 powers, fometimes by a ftimulating  (*'), fometimes by  a
 debilitating operation  (k), or  whether itraBion  confifi in
 only giving the peculiar form of its refpective difeafe, and,
 thereby, adding a local affection to a general one; in ei-
 ther cafe there is no room for a new indication.
   XCVII.  For if the difeafe, as  a general  one,  be pro-
 perly managed, every  eruption,  aud its  confequences,
                                                 every
  (A) and there, from a  local operation, and not by an affection of the
excitability, ferve  the purpofe,
 (:') as in the frnajl pox and meafles,
 {k} as in contagious fevers and the plajjuc, 
                 OF   MEDICINE.           Ay

  every fpecies of inflammation, every fpecies of ulceration,
  give way to the happy effect of the general plan of cure.
  And, when a contrary event takes place in confequence
  of a bad method of cure, the local fymptoms are propor-
  tionally aggravated.  This is proved in the fmall-pox long
  ago, and in the meafles lately (/), but, with equal certain-
  ty ; it is proved by the  plague, at leaf, as often as it has
  been treated with any judgment, and by remedies proper
  in kind and adminiftered in due proportion ; it is proved by
  the malignant, or  gangrenous  fore  throat (m), and by
                                                        other

   (/)  After the difcovery of the nature of  the catarrh, the catarrhal
 fymptonas in the meafles came naturally to be enquired into. A full trial
 was given to the refrigerant debilitating plan, in the author's own fa-
 mily,  as well as among feveral patients, and laftly among near an hun-
 dred patients in England,  treated by the father of one of the anther's
 pupil's ; who all did well,  while others, who were kept warm, according
 to a practice that Dr Sydenham had left  as he found it among his
 Alexipharmac cotemporaries, many died, and all had a bad recovery.
 The Author's own fon and name-fon, a boy about fix years of age, was
 ftript half naked and allowed to go out and play as he pleafed. The only
 check upon him was, his being allowed nothing but fluid vegetable mat-
 ter, when he returned home with a keen  appetite. This matter will be
 further explained, and in a more proper place afterward.  But, what
 has been faid, was in illuftration of the hint in the text.
  (»»)  This cafe of difeafe  has been confidered, as wholly and folely feat-
 ed in the throat, and therefore conjoined with  other difeafes, where
 that local affection was underftood to be  the effential fymptom, and a
 fymptom that connected all the  cafes. But the other cafes are fthenic or
to be cured in the  ordinary way  of bleeding and evacuation ; while fuch
a practice is  certain death  in it,  a? being not only an afthenic cafe, that
 is a cafe of debility, but one of  the  higheft; and, inftead of depending
 upon the affection of the throat, the affection of the throat depends on it.
Give ftimulants to the patients labouring under the  inflammatory fore
 throat, and you kill theih ; bleed,  purge,  vomit, and ftarve, in the
gangrenous cafe, and  you  enfure the fame fate.  Such, however, are
the difeafes, that fyftematics, nofologifts, and  other ftraugers in the
eity of nature, have, from  thecr ignorance of the place, in fpite of their
                                                       natural 
4&*         THE   ELEMENTS
 other cafes of typhus, with a fimilar affection of a part.
 In the two laft, the danger to life depends upon the degree
 of the general affection, without which there is no occafion
 for any apprehenfion from the local.   And the fame pro-
 pofition is fo true, with refpedt to the three former, that,
 though the contagious matter has been applied, yet without
 the general  hurtful  powers preceding,  no true general
 difeafe arifes, the danger  encreafes in proportion to their
 violence, and  the whole cure depends upon the general
 remedies.   Thefe are fo many facts, that fhow,  that no
 matter,  whether  of a contagious nature or not, contri-
 butes towards the caufe of the general difeafe, which it
 accompanies or diftinguifh.es, or, if it contributes any thing,
 that in that  it differs not from the ufual hurtful powers.
   XCVIII.  As,  both in overabundant and deficient ex-
 citement, the found perfpiration is diminifhed during the
 predifpofition, and fuppreffed in the courfe of the  difeafe
 (which has been already hinted, and  will more fully be
 demonftrated afterwards);  it is, therefore, proper  that it
 fhould be carefully fupported and kept up, for the purpofe
 of difcharging every hurtful matter from the body.  But
 neither does that fuggeft a new indication of cure ; fince
 the only means of effecting it are.thofe,  which otherwife
 remove both the diathefis  in proportion to their force, and
 which are not ferviceable as local, but  as  general reme-
 dies \ri).
                                                  XCIX.

natural diftance, brought all together.  (See Dr Cullen's Genera  Mor-
borum, all the three editions, genus VII.)  As foon will Mile end and
Knightforidge meet; as foon will London place itfelf on the Calton-hill,
und become an elevEtaed fuburb of Edinburgh.
  (n) The difcovery of thefupport of perfpiration upon a principle, which
extends to all the phenomena of the fubject, was referved for this work.
The heating remediesof the Alexipharmic phyficians were intented to fup-
port the perfpiration, andthereby,throwouta morbific matter; Which was
> very  unlucky thought in the fthenic difeafes,the piincipal of which were 
               OF   MEDICINE.          49

   XCIX.   When  any one, who, during the former part
of his life  has lived luxurioufly, has now, at an advanced
age, either from intention or compulfion, abated a good
deal of his ufual indulgence, nnd yet preferves fome appear-
ance of  an abundance of fluids and of  vigour;  he muft
not, therefore, as is commonly done, be fuppofed to labour
under plethora (o) and exceffive vigour; but, on  the con-
trary, unlefs  there  be  arecent and evident caufe for  itj
which is poiTible, he muft be held for one  who labours
under  indirect  debility ; and  fo  much  the  more, if to
hurtful powers already too kkgorating, in the number of
which are all thofe which fill the  veffels,  directly  debili-
tating powers have fucceeded :  and it is not a debilitating
or afthenic plan of cure, which would increafe the  direct
debility, nor one too ftenic (p), which would increafe the
                            E                     indirect

peripueumony, of which we have already fo often fpoken ; phrenitis, in
which the brain was fuppofed to be inflamed ;  and the fmall-pox and
meafles ; becaufe the nature of thofe difeafes, and the tendency of all the
powers producing them, was to check  the perfpiration, (fee N°. LXI.)
From the excefs of their ftimulus;  confequently,  the addition of more
ftimuli, by way of cure, was to check it ftill more.  But thofe difeafes are
only three out of the hundred of general difeafes: whereas the followers
of a great man  who corrected that abufe through a fiery perfecution,
6-c  J1 * Tfpoc, againft himfelf, went  all  into  a much worfe extreme,
Their imitation of their mafter tranfported them into a rage to carry the
plan of promoting perfpiration, by the fame means, through the remain-
ing 97 of the hundred.  And they fucceeded with a vengeance.   For, a9
it is here the nature of thofe dileafes to tranfmit too great a quantity of
fluids through the perfpiratory pores, in confequence of  the debility
 which conftitutes  their caufe ;  certainly the encreafe of that debility,
that is to fay,the encreafe of the caufe, fhould encreafe the effect. Which
it  moft certainly did,  through all the fyftems that have appeared for
more than  a century pad.  This is intended  only as a hint,  to enable
our intelligent readers to underftand the fuller explanation of perfpira-
 txn, which wil! foon follow.
  . (o) or an over proportion of W"od,
    (p) or ftinviiant. 
   SO         THE   ELEMENTS

   indirect debility, the principal part of the caufe, and, con-
   fequently, increafe the  force of the  difeafe:  But it is a
   middle  method,  which is commonly  called tonic, that
   fhould be purfued (q).
     C.  Since to the degree of difeafes (under  which, to
   make  few words,  let predifpofition, alfo be comprehend-
   ed, the degree of curative force fhould be accommodated ;
   in the indication, therefore, of cure, regard fhould be had
   to age, fex, habit, conftitution, climate, foil, in fine, to the
   operations of all the exciting  powers in general, of all the
  hurtful  ones  in particular, of all the remedies, whether
  they have previoufly been  adminiftered properly,  or im-
  properly.
     CI.   The  fubjeits of  direct debility are women, under
                                                     inanition

    (q) The blood if made from the food, and elaborated by the powers of
 digeftion ; that is, the  more nourifhing food is taken in, and the  more
 ftrength there is in the fyiiem to convert it into real blood, the more,
 and aifo  better, blood will b* produced   The quantity of blood, fo pro-
 duced, may go  to excefs, as well as every other exciting  power, the
 principal of which is.  Dut the queftion is, when, in whom, and under
 wh;it circumftances,  is *n over-proportion of blood generated ?  Com-
 mon fenfe would fay,  not at the beginning  or  the  end of life,  when
 the degree of nutriment ufed is far from being fo confidcrable, as at the
 middle and vigorous  period of life.   Again, which of the two fexes are
 fuppofed moft liable to generate this morbid  redundancy of the vital
 fluid?  A fimple creature aLI-.d by nothing but natural fagacity, would
 be apt t* ff-y, the rrv.r ; both becaufe they eat  more,  and, from the
 greater variety of the modes  of promoting digeftion to which  they ^rc
 addided, di :rft better.   How medical fyftcmatics would laugh at i'uch
 Cmplicity ?  How contrary that would feem to meyftery, their JLydian
ftonc under which they  think all wifdom fo fafely lodged, as to fear it
would be dangerous  to turn  it up,  and examine what  was under it!
What fort of habits are  mod liable to it?  Not thofe,  who have the
o-reatcft bulk of fimple folids, whether they eat or not, much lefs thofe,
who are liable to  bleed ng difcharges, who can neither eat nor digeft,
but all thofe who eat and c'keft well. 
              OF   MEDICINE.         ^L

inanition (f),  thofe who have had an infufficient fhare of
ftimulus; thofe who have a delicate fet of folids ;  thofe
who  have  been accuftomed to  moifture, whether from
the climate or foil; finally,  all perfons in a languid ftate,
without a preceding vigorous one, either from the powers
that produced their, difeafes,  or from the mode of cure
employed to remove thefe.
   CII.  Oa the contrary, the perfons in whom indirect
debility is prevalent are adult  males ; thofe who are full
and over ftimulated, and fo much the more,  the longer
the latter  has been the cafe; thofe who have formerly
had vigorous habits ; thofe  who have been overheated,
whether with moifture, without  it,  or from whatever
fource;  in  one word,  all whofe former vigour, either
from the ordinary hurtful powers,  or improper methods
of cure,  is now converted into afiate of languor.
   CIII.  In the cure of indirect debility, whatever  be its
degree, from  whatever  fort of exceffive ftimulus  it has
arifen ; of the ftimv.ias, which is to be employed as the
chief remedy,  not much lefs than that, which produced
the difeafe, fhould at  firft be ufed ; and then lefs and lefs,
till the difeafe is cured.
   CIV.  When the firft part of the cure is completed, and
the convalefcent now can  ufe the  more permanent and
natural ftimuli, he fhoulff gradually be confined to  them,
and drop the ufe of the more diffufible ;  with this dif-
tinction, that if he has been in the habit of ufing a confi-
derable deal of ftimulus, he  may be  indulged in  fome-
thing extraordinary in that way  for fome time  (t).
                        V. 2                      cv.

  (f) or an empty f-atc of the veffels,
  (t) This indulgence is chiefly intended for thofe, who have gone  to fome
excefs in the ufe ■ f the ftimulus of mink, and who ftill, without it al-
together, are not capable  of  taking  enough of food and other  durable
                                                 ftimnli 
 52         THE   ELEMENTS

   CV.  The cure of the  hurtful  effect  of any ftimulus
 fhould firft be fet  about by changing it for a leffer one,
 this for  a ftill lefkr;  and  the intention of cure fhould be
 always to pafs from the ufe of the  more violent and dif-
 fufible-, which  nature in her found ftate rejects, to that of
 the more durable,  and  more fuitable to nature when un-
 oppreffed, till  the  healthy ftate can at  laft be upheld by
 the ufual fupports (u).
   CVI. In the cafe of indirect debility,  when  the view
 Is to reftore vigour, a  debilitating plan of cure  fhould be
 avoided ; becaufe no fort of debility is to be cured by an-
 other, nor any degree of it by any degree of another.   It
                                                            is

 ftimuli for their fupport.  The aim, however, of all fuch perfons (with
 the exception only  of thofe who are of an advanced age, or of thofe whofe
 debility threatens to run a certain courfe), fliould be to lay afide the daily
 ufe of drink  altogether, and to  indulge in occafional approaches to
 excefs as feldom as poffible.  Some perfons, even beyond  the  fiftieth
 year of  their  age, when they found they could eat  and  perform all
 their other functions with vigour, have had the refolut;on  to  abftain
 from all fort of ftrong drink, not only with impunity, but with a moft
 wond.rful improvement of their health ana vigour. Another advantage,
 arifing from this management, is, that, whenever any difeafe, to which
 a perfon may be liable, fuch as the gout, various affections of debility,
 chiefly prevalent in the alimentary canal; in a word, the dileafes of either
 form  of  dtbility), cither returns, or threatens to return ;  a return to
 the ufe of wine and other ftrong drink will then  become  an excellent
remedy, and even fupercede the  ufe of the high diffufible  ones.  That
 practice would  be attended  with this  further  advantage,  that, whin
 the occafion  that called for it was over, and the difeafe prevented or
 removed, the perfon might again lay afide the ufu of drink, with all the
good cotifequenccs he had formerly experienced  from the practice, and
thereby both prolong his iifc, improve  his health,  and enjoy the pn.per
 and vigorous ufe of all his functions.
  (u) 'n many difeafes of debilty arifing from a former  exeefs,  the fti-
 muiant effecls of which have paffed away, the ufe of cold water,  though
in grat ficatioa of the patients craving, and of other th  r potions, as well
as of vegetable aliment in a fluid form, and of evacuation of every kind,
 is moft hurtful. 
               OF   MEDICINE.           $$
is only in the progrefs to indirect debility (x), that direct-
ly debilitating powers are fuitable for the purpofe of fup-
porting the vigour, in that cafe,  in danger of being worn
out (y); fuch as cold bathing, lowering the  diet, weak
drink,  and a  fimilar  abatement in  the ufe of the other
ftimuli.
   CVII. For the cure of direct  debility, we fhould begin
with the fmalleft degree of ftimulus, and then  rife to the
ufe of a greater and greater, till  the  morbid abundance  of
cxciteability be gradually worn off, and the health at laft
reftored.
   CVIII. When the difeafe arifes from the want of any
one ftimulus,  the return to  its ufe fliould be gradual, and
facilitated by other ftimulants more powerful than itjelf.
   CIX.  Alfo in this  part of the general method of cure,
debilitating, cither directly or indirectly fhould  be abftain-
ed from; both  for the re.ifon formerly given, and alfo,
becaufe the ftimuiant plan of cure, which is the only pro-
per one, when carried to excels, converts the fthenic dia-
                                                     thefis

  (x) Betwixt 40 and 70,
  (y) At 65 there are only 5 degrees of vigour left, which, either by
a continuance of  the fame exceffive ftimuli that produced them, or, by
the addition of a degree proportioned to that effect, would be worn  out.
Remove fome of the ftimuiant powers, the excels of excitement  will be
diminilhcd,  fuppofe to 60; remove mure of the former, and the excefs
of the later will be further diminifhed, till the excitement is reduced to
ics natural healthy ftandard of 40.  The ftate  of excitement, then, within
this range,  that is,  between  40 and 70, efpecially in proportion to the
approach of the exce-fs to 70, is tha:, to  which only directly debilitating
powers fliould be  applied.  In all cafes above 70 where the excitement is
gone,  and below 40 where it conftantly decreufes all the way,  till it is
loft at o, directly debilitating powers are  pernicious. How bad  then
muft the only practice be, that we find in books and  lectures, a practice
tranfmitted from the firft accounts of our profe:Tion,  and which deals in
the ufe of no other means  but directly debilitating ones?   Bad, indeed,
muft it be! 
 54        THE  ELEMENTS
 thefis (x) into the afthenic (a), and the latter into death (b).
 For which reafon,  while on  the one hand, the debilitat-
 ing powers, mentioned before, are to be avoided ; it muft
 on the other,  not  be forgot,  that  the  force employed in
 the cure fhould be accommodated to the degree of morbid
 ftate.  The thirft,  which is occafioned by debility, is in-
 creafed by draughts of cold water, is hurried on to (c)
 naufea, and vomiting; is quenched by pure wine or fpirit,
 which prevent  the troublefome  fymptoms  that would
 otherwife follow. Pure wine (d) encreafes the thirft which
 proceeds from a fthenic caufe, and excites the  fitme trou-
 blefome fymptoms, which cold water  does  in the other
 cafe; cold water fates it, and  prevents the future tumult.
   CX. Since, therefore, the  fame powers excite all the
 phenomena of life, and  produce fometimes  an excefs,
 fometimes  a  juft proportion, fometimes a deficiency, of
 life, according to  the various degrees  in which  they are
 applied ; and fince the fame obfervation extends to the
 fame powers, when they are  applied as remedies of dif-
eafes ;  let it,  therefore,  be an univerfal ruk,  never  un-
 guardedly to convert either diathefis into the  other.  And
as every difeafe, that debilitating powers remove, is fthe-
nic, every  one, that is cured by ftimuiant means, afthenic,
the knowledge  of  that  may  furnifh the proper means of
caution againft miftake,
                                               THE
  (x) that between 40 and 70,
  (a) between 70 and 8o,
  (b) at 80.
  (c) the higher fymptoms of
  (d) which is one of its principal czvle-. 
i  ss  1
                 THE

SECOND     PART.
                  CHAP.     I.

   Ofithe hurtfiul Powers, which produce either Diathefis,
                  Sthenic, and Afihenic.

   CXI.  THE powers producing the ftate  of the body,
 upon which the predifpofitions, to fthenic or afthenic dif-
 eafes. or thofe difeafes themfelves, depend,  that is,  that
 produce  the fthenic or afthenic diathefis,  are thofe which
 were mentioned before (a).

        The hurtful powers producing both Diathefis.
   CXII.  Heat, which is neceflary to the production, the
 growth,  and the vigour of animals  and vegetables, as
 alfo to the  form of the elements (a) from its aBion upon
 the  furface  of the animal  body, directly ftimulates the
 whole; an effect which it  alfo exerts upon vegetables.
 From this action of  heat there is no exception when It
 keeps within a certain  range of fcale ; but when it is ei-
 ther deficient, where  it takes the name of cold, or excef-
                                                   five,

  (a) XI. xn.
  (a) In a certain degree of diminifhed heat water freezes; but if fuch
a diminution of it could be found as to freeze air, the whole fabric of
the univerfe would rufh into diffolution. 
 56         THE   ELEMENTS
 five, its effect varies(b).  This ftimulus,  in  a moderate
 degree, produces its effect in due proportion, in a degree
 above that the excefis of its action is  fuch as to produce
 more or lefs of fthenic diathefis.
   CXIII. Becaufe the action of heat k increafed fome-
 what more upon the furface than  in the internal parts,
 where  the temperature is nearly ftationary,  it, therefore
 ftimulates more in the former than in the latter.   Hence,
 in the phlegmafiae (c), the inflammation is always external.
 The fame agent encreafes  the tone of the mufcuiar fibres
 every where, and confequently their denfity (d).  Hence,
 as the diameters of all the veffels are  diminifhed,  fo thofe
 of the extreme veffels every where, and efpecially in the
 fkin, where a greater force of the caufe is exerted, are of-
 ten  entirely effaced.   But actual fuppreffion of the per-
 fpiration is incompatible with predifpofition, and arifes
 only from the diathefis, when it arifes  to  the juft mea-
 fure of difeafe (e).
   CXIV. Hence in  the  meafles and fmall-pox, the irra-
 tating  matter,  together  with the perfpirable, is detained.
 And not only in thefe, but all  other fthenic difeafes,  the
 perfpiration is fuppreffed, the  excitement both upon  the
 furface and in  the reft of the  body is encreafed,  and ca-
 tarrh particularly induced (f).
                                                   cxv,

  (b) as mail he fhown by and by,
  (c) difeafes with inflammation of a part.
  (d) oee Chap. V. Which produces a fuppreflion of perfpiration by fome
imputed to conftriction from cold, by ethers to conftriction from fpafms;
both erronoufly.
  (e) The perfpiratitn is diminiflied during the predifpofition ; but the
condenfing power is not fufficient to fupprefs it, till it attains the degtte
of producing the difeafe.
  (f) Calefacients, or heating thing?, were  one of the means that the
Alexipharmic phyficians employed to free perfpiration ;  but the princi-
ple is now laid down, that  fhows they produce the oppoiite effect.
                                                    Hcr.c- 
                OF   MEDICINE.           f-7
     CXV. Heat, in extreme excefs, whether  it acts hurt-
  fully by its duration or intenfity, conftantly debilitates by
  diminifhing  the tone,  and  producing laxity  inftead of
  denfity.   Which effect is fomewhat  greater upon  the
  kin,  to which the direct energy of heat is applied, than
  in  the interior part, in  which there is little change of tem-
  perature.  ILnce  arifes  fweating as in the torrid zone;
  hence the diameters  of ail the  veffels, and  particularly of
  of the perforatory veffels are  enlarged.  Hence  proceed
  the colliquative fweats in fevers, and a fimilar  ftate of
  the belly.   Hence, alfo corruption of the fluids,  and  not
  from  a  ftate  of them  directly  produced by corrupting
  powers(g).
    CXVI. The fame power  in the violent meafies, in  the
  confluent fmall-pox,  in  fevers, and in every kind of afthe-
  nic (h) difeafe, in which the  perfpiration is deficient, does
  not leflen the deficiency (i), though  it expands  and  en-
 larges the veffels, but  on the contrary, encreafes it(k).
                                                   CXVik

 Hence the merit of Dr. Sydenham in recommending cold both in the
 fmall-pox and in peripneumony, in which difeafe he took his patients out
 of bed, and  placed them in an eafy chair.  Happy had it been for the
 profeffion, and happier for the fick, had he extended his improvement to
 the meafles  end catarrh, and all the reft  of the few fthenic difeafes, and
 ftopt there ; but by extending his antiphlogiftic and refrigerant doctrine
 to the whole form of afthenic difeafes, the  harm and good he did were
 in the proportion of 97 of the former to  three of the latter.
   (g) The idea of certain powers  of a tendency to corrupt our fluids,
 and of certain others to correct that effect,  and take off the degeneracy
 long prevailed in  the minds of  fyftematics, and is not among many of
 their followers yet l.i J afide.   Heat was <ne of the number; but that it
 acts fo, is difproved not only by the explanation here given, but by the:
 certainty of the fact, that the fame effect is produced by cold, as wc'l
as e very other debilitating pow.
  (h) or difeafe of debility,
  (I) that is, does not encreafe the perfpiration,
  (k) i. e. diminifhed perfpiration. 
   5&        THE   ELEMENTS
     CXVII.  Cold, inimical to animals,  vegetables, and
  the elements, weakens the reft  of the fyftem,  and ftill
  more the furface, the  temperature of which it almoft
  only diminifhes, and it produces that effeB always by a di-
  rect operation, always in proportion to its degree.  Cold
  equally as  exceffive  heat,  produces atony and laxity  of
  the veffels, grangrene, and the other  effects  of exceffive
  heat (1).
    CXVIII. That thefe effects of the extremes of tempe-
  rature  arife from  debilitating not  generating putrefaction,
  from an affection of the  excitement,  nor of the fluids,
  plainly appears  from this ; that  other exciting hurtful
  powers,  fuch  as  famine, an overbundance of blood,  as
  in the cafe  of thofe who die of peripneumony, and fimilar
  hurtful powers, which neither have been, nor  can be, be-
  lieved  to affect  the fluids  by  any direct  operation  upon
  them(m), produce both the fymptom of corruption, and
  all the  reft of the fymptoms,  and  the fame  ftimulants,
 which remove the latter, remove the former.   Nay, the
 fuppofed antifceptics, fuch as wine, Peruvian bark, acids,
                                                      and
   (1) In Siberia the phenomena of cold on the human body very much
 refemble thofe of heat.
   (m) Famine, acids, and cold, have all the fame effects upon the fluids
 that the putrefying fubftances were fuppofed  to have ; but furely acids
 produce no putrefactive procefs; neither can want act as pofitive matter;
 nor cold be fuppofed to produce any fuch effect.  In a word, any cor-
 ruption that is  produced, arifes only from the weaknefs by the heart and
 arteries, predominant in their extremities.  They ceafe to act; the fluids
 within ftagnate, and, under the heat of the body, degenerate.  This is
 the true caufe of the corruption.   And the remedies are not correctors
 of the corrupted mafs; but whatever invigorates the whole body, and
 confequently the heart and arteries.  Nothing can be more abfurd than
 to fuppofe that a glafs or two of wine and water, a little bark, and fo on,
 after being blended in the whole mafs oi fluids, fhould go to a portion of
 fluids in the extreme veffels, even without  the circulation, and, by mix-
ing with it, change its qualities, 
              OF   MEDICINE.           $g
 and other things of that kind, are either entirely deftitute
 of that operation,  or  they neither  are  given, nor can be
 given, in that quantity, by which they can have any ten-
 dency to effect the mixture of the  fluids : In fine, the ef-
 fects  of inanimate matters upon one another are never,
 with  any propriety, transferred to  living fyftems.  Tho,'
 then,  the fluids are frequently  corrupted, the corruption
 is the effect of weak veffels not giving a fufficient mixture
 or diffufion to  them, but is never the caufe.
   CXIX.  The difagreeable  fenfation both of  cold and
 of heat in extreme,  '13  alfo hurtful,  by diminifhing the
 fum total of ftimuiant operation, which, in fo far as it is
 agreeable, is ferviceable  by ftimulating (n).
   CXX. As cold is naturally fo debilitating, and all de-
 bilitating powers diminifh excitement, it is therefore, ne-
 ver of fervice but in fthenic difeafes, that is, in thofe which
 are in their progrefs towards indirect debility (o): becaufe
 the excitability, already  too abundant, can never be ren-
 dered more abundant,  nor, when too much wafted, ren-
 dered more  accumulated, without  an aggravation of the
 difeafe(p);  excitability admitting of lefs ftimulus in pro-
 portion  as it  is either  more abundant, or more ultimately
 wafted.   When the  debility is moderate,  a miftake of
 this kind is lefs evident: but in' a high degree of debility
 of either fort, a violent difeafe, or even death itfelf, may
 be the confequence of  the fmalleft encreafe of debility (q).
                                              . CXXI.

  (n) See note (r in par. XXI.
  (o) See (JVI.
  (p) XLVI. XLVII.
  (q) When the debility of the direct kind is very moderate, that Is, the
excitement has not funk much  below XL. in the fcale, the ftiort fufpen-
fiou of a few degrees more would not do much mifchief.  Suppofe the ex-
citement at 30 inftead of 40, and a dip in cold water has brought it down
to 25, the effect even of that is not of a trifling nature ;  the debility by
                                                     this 
60         THE   ELEMENTS
    CXXI. As cold, as well as exceffive heat relaxes, a faft
 that is  feen in the cure  of the fmall-pox, and of every
 fthenic difeafe, from  that we are to underftand, that  the
 property of cold in conftricting(r) inanimate  matter does
 not extend to living  matter (f).   The diminution of the
 bulk of the furface (t) arifes from debility of the  veffels,
 not fuffkiently propelling the  fluids, and fkling the vef-
 fels.   In this  way does cold produce afthenic diathefis.
    CXXII. But, as always lefs and lefs excitement arifes in
 proportion as  ftimuiant operation has been applied, till at
 laft no  more.at  all is  added; cold  (u), as  well  as  any
 other directly debilitating power may, according to  va-
 rious degrees  of it,  produce health, and all the degrees
 of fthenic  diathefis (x);  in  the following way,  however,
 only.   It flops the wafte of  excitability, makes  the  body
 more fufceptible  of ftimuiant operation,  checks the  pro-
 grefs to indirect debility, and ftems the latter.  But it on-
                                                          iy
 this means has paffed the  whole range of predifpofition, and arrived at
 the degree where difeafe commences.  It is true the excitement will rife
 the moment the perfon is taken out of the bath ;  but ftill fomething is
 loft.  The very accumulation implies a  reduced difpofition in it to be
 acted upon by ftimuli.  A perfon, who has abftaincd from any one fti-
 mulus for a given time, when it  is again applied, will not bear near fo
 much of It as he did formerly.   If he abftain longer, he will  bear ftill
 lefs, till, at laft, he will be fit to bear none at all.  If, on the other
 hand, the excitement fhould have fallen to 10,  an addition of debilita-
 ting power would, be attended with the utmoft danger, not only of en-
 creafing the difeafe, but of inducing death.
   (r) or condenfing,
   (f; It has been alledged, that the diminution of the bulk of the body
 by cold, furnifhed an argument iu favour of its being an aftringent  to
 it, as it certainly is a condenfor of dead matter.
   (t) or fhrivelling of the fkin,
   (u) on that footiug of adion,
   (x) from the higheft to the loweft, from that degree of It, which,
 under the circumftances here mentioned, produces a moderate catarrh,
to that, where the modification of its adtion rifes to the degree of being
 adequate to the effect of producing a pcripneumony. 
             OF  MEDICINE.         6l
ly effects that by checking the career of heat and other fti-
 muli, which accelerate indirect debility, and by keeping
 the excitement within the boundaries of vigour.   And
 hence vigour in cold countries, when the body is defended
 by clothes, the fhelter of a houfe, the warmth of a fire, as
 well as by its own proper motion.  Hence alfo the brace-
 ing, by cold, of parts that have been relaxed by exceffive
 heat.  Laftly, hence ,a remedy for the corruption  of the
 fluids, which  confifts in invigorating the veffels, not cor-
 recting the degeneracy of their contents.   This effect of
 cold upon the furface, which is nearly the only part of the
 fyftem  fubject  to  refrigeration,  is  fomewhat greater
 than in the internal parts.
   CXXIII.  The debilitating  effect of temperature, and
 therefore alfo its hurtful tendency, is encreafed by moif-
 ture.
   CXXIV.  Of the articles of diet, the only food  in dan-
 ger of being too ftimuiant, is  flefh and land-animal food,
 ufed  in great quantity.  Meat too fait, and  hardened, efpe-
 cially when it has now begun to fpoil, is an exception.
   CXXV.  The fame thing is  to be faid of condiment; of
 which a very fmall portion, upon account of its high de-
 gree  of ftimulus, is fufficient.
   CXXVL  Spirituous or vinous drink, in which the al-
 kahol is always diluted,  ftimulates, more quickly, and
 more readily, than feafoned food, and  its ftimulus is  in
 proportion to the quantity of alkahol that it contains.
    c. But there  are ftimuli, which poffefs an operation as
 much quicker, and more powerful (y), than thefe juft now
 mentioned, and which  ar*the agreeable and proper ones
 in health, as  their operation is  of fhorter duration.   To
 thefe  the  name  of diffufible is  to be given.  They rank
 kowve ftrong drink in the following order:
                                               -rt Next
(y) than that of the articles of diet. 
62         THE   ELEMENTS
    *  Next  to ftrong drink, and  immediately above it,
 fiands mufk;  above  it  volatile alkali;  higher than  this
  a?ther ;  and the higheft of all,  as far as  experiments  have
  yet reflected light on the fubject, is opium (z).
    P  Thefe  according to their degree,  poffefs the property
  of converting  the afthenic diathefis into a ceffation of all
  diathefis in health ; this into fthenic diathefis, the fthenic
  diathefis into  indirect  debility, and the laft into death :
  all  which they accomplifh with  as much more eafe  and
  prompitude, as they are more powerful than  all the reft of
  the ftimuli (a).
   CXXVII.  The ftimilus of the articles of diet,  not ex-
  clufive of  the diffufible ftimuli, fhould be  denominated
  c'.rect, becaufe it acts directly  and  immediately upon the
  excitability of the part to which it is applied.  The direct
 ftimulus, at leaft in fo far as it regards  the  food,  is alfift-
  ed by another, depending upon a  diftenfion of mufcuiar
 fibres, on which account, for  the fake of diftinction, the
 latter  fliould be  called indirect.  As the latter is  afford-
 ed by the bulk of animal and vegetable food, fo the  for-
 mer is produced by  a  relation of the  fiimulus to exci-
                                                   tability.

   (z) Wc  are prety certain of the exactnefs of that plaee in  the fcale
 which  we have, aff.gned to opium.  Nor is our arrangement of the
 others  uncountenanced by the fame kind of criterion ;  but having not
 yet made all the trial neceflary to eftablifh the propofition, we  defer any
 final decifionof this point to an after oportunity.
   (a) In the ufe of the diffufible  ftinuili great care fhould be taken to
 apply them only to the cafes that require them: which  are only the dif-
 eafes of the higheft  debility,  or of which th-? intolerable pain, befides
 tormenting the patient, threatens the jvorft cn:,i'. quenccs.  All from the
 end of  CXXVI. is an addition  in the MS.  his moft valuable part  of
 the exciting powers,  whether confidered as  a p.^t of diet, as  the chief
 of them are among the Turks, or as ufed for the prevention of difeafes,
 to which there may be a ftrong bias in  the habit, or as rcmedi cs of thefe
 difeafes when they have come on, or as hurtful powers when improperly
employed, having been left out in both the  editions of the Latin  V" >rk
 that have yet been prefented to the public. 
              OF    MEDICINE.            6$

 tability.  The  indirect acts upon the living folids in fo
 far as they  are  to be confidered as fimple;  the direct acts
 upon them  as  living only.   From  a long and habitual
 excefs in food  and  drink,  at  laft indirect  debility arifes
 and the group  of  difeafes depending upon  it (b).
    c. All  thefe ftimuli have alfo a  tendency  to produce
 afthenic diathefis.
    CXXVIII.  All the vegetable food (c), and too fparing
 an ufe of animal, as alfo meat  too fait, and  deprived of its
 native juices by keeping, when better nourifhing matter is
 withheld,   conftantly  weaken,   and  thereby  produce
 afthenic diathefis through  all  its  degrees.   Hence arifes
 that remarkable imbecility both of body and mind, which
 diftinguifhes  the  Gentoos,  who follow the  Brahminan
 ceremonial  of religion.   Hence the difeafes  of  the  poor(d)
                                                       every

   (b) When I make a meal of animal food, much lefs bulk isrequifite to
 give the fame nourifhment,than when the vegetable matter is the only one
 made ufe of.  Wnat makes the difference is, that there is fomething in
 the animal matter which  affords a nourifhing ftimulus independent of its
 bulk ; and though the vegetable matter is not altogether  devoid of that
 kind of ftimulus, it, however, poffeffes it  in a much fmaller degree.
 Both ftimuli are neceflary, but chiefly the direcl:, by which animal food
 chiefly acts; and  therefore is the vegetable the worft and weakeft fort
 of aliment, becaufe it chiefly acts by its bulk of in utcr.   A fmall p «■-
 tion of the indirect ftimulas is neceflary ;  hence the very general ufe of
 bread.   But our vigour of mind and body depends upon the direft.
   (c) take in any quantity-
   (d) The nourifhment of animal  feod needs only a little fupport of ten-
 fion  from a modera:e quantity of bread  but the vegetable food, even
 when fupported by ftrong condiments, in  no quantity whatever, ever
gives due fupport, appears plainly  from the inftancc brought in the text.
 Of the poor labouring people in Scotia,id, who chiefly Hve on vege-
table  rn?:tcr,  it would take three to go through the work that one
Yorkfhire m ;n nourifhedby  boltin.; fat pork, can eafily  execute.  And
among the Gentoo fsrvants a dozen is not able to perform us much work
as a fingle hnglifh fcrvant.   A year's experience of vegetable  food, and
it* pernicious confequenccs (vide the Pref.ice) has row put th'  r-.jef1 ion, 
 04         THE   ELEMENTS

 every  where;   hence  fcrofula(e),  fevers(f),  epilepfy,
 cough, with profufe expectoration and hemorrhage,  and
 the whole band  of afthenic difeafes.   The direct debility
fiowing from  this  hurtful power, affects  the ftomach
 fomewhat more than any other equal p.in {-f ;  the confie-
 qucnces  of 'which cjfeclion  are kk of appetite, ftomach
 fickntk,  vomiting,  very  loofe  belly,  and fimilar  dif-
 r.urbanccs of the firft paffages. •
    r But  while improper aliment produces fuch effeBs, thefe
 will alfo  be induced  by an ultimate excefs  in the ufe of
 food, confifiing o'i the proper material; which muft be in-
 ferred from the  univerfal effect of all the other ftimuiant
 power?,  when their operation  has  been pulled to the fame
 excefs{h).   The  mean betwixt the extremes of the hurt-
 ful powers, in fo far as diet is concerned, is  abftinence (i).

                                                   CXXIX.

 about the fuppofed falutary effects of low living, and the pretended vir-
 tue of a rigid obfervance of it, beyond all doubt, and brought  irrefraga-
 ble proof of its weakening effect.
   {<-.) Scrofula, though fuppofed hereditary, produces its worft effects,
 r.ot from that circumftance, but the method of management, both for
 the prevention and  cure.
   (f) Various particular, and  fometimes fpecific caufes, have been af-
 C^n-ed for th; production of fevers ;  but it flnll be proved, that, what-
 ever debilitates in a hij?h degree, is  adequate to that effect.
   (g) Chap. IV.
   (h) It will now appear how fur an  affertion of the oppofers of this doc-
 trine is juft or calumnious: low living and ftarving are condemned for
 the facts and reafons afiigned ;  but can it now be faid, that the doctrine
 is friendly to intemperance ?  On the contrary, it has reduced the fact to
 its prrp^r ftandard,  reprobating the  extremes, and tftablifhing the mean
 under which virtue  takes her poll-   It is certainly as immoral or irre-
 ligious, if you will, to hurt health,  and haften death  by abftinence, as
 by a luxurious excefs.  There is a gloomy luxury in fuperftition, a chear-
 ful one in fenfuality; both bad.
   (I) At leaft I* fb.vds at the  fee of  the fcale of directly debilitating
                                                       powers, 
               of   Medicine.         $>§

   CXXIX.  The witholding alfo of the ufe of  condi-
 ments, which, without animal food (k), ate not  fuffici*
 ent to give ftrength, gives an additional weaknefs.
   CXXX. Strong drink,  arid the  diffufible  ftimuli, are
 never neceflary to young and ftrortg people, upon account
 of their rapid tendency to  indirect debility, from their
 high ftimuiant power; nor are they even fafe.  But, in
 perfons who  have been accuftomed to  them, in the cafe
 of thofe who are advanced in age, and of thofe who are weak
 from  that or any other circumftance, cold, watery, acid,
 or fermenting drink,  has a great influence directly,  and
 excefs in the ufe  of ftrong drink indirectly ^ in producing
 afthenic diathefis.
   v. If the diffufible ftimuli j after they have been employ-
 fed, are too quickly withdrawn, they, in the fame manner
 as the more durable, allow the excitability to  accumulate,
 and indirect debility to come on,  and  confequently may
 be faid to produce afthenic diathefis.  But afthenic dia-
 thefis is never the confequence of withdrawing their ope-
 ration At leaft worth fpeaking of, but when that has been
 habitual.  And all the hurtful effects which they have moft
 untruly, to the great detriment of mankind, been faid ra-
 ther, than are now faid, to occafion, arife not from  them-
 felves, but from the want of knowledge  how to  manage
 them.  And as this operation of diffufible ftimulus  ought
 to be fupported by that of a durable;  at the fame time,
 it muft not be confounded with debilitating powers.  What
 difturbances, during the operation of opium, will not *
 breath of cold air, affecting the body, create ?  And how
                            F                   eafily,

powers, if they are to have the  rank of ftandiiig  uppermost, as being
moft hurtful and  to be followed by the enumeration of  the  indirectly
debilitating powers, as being next fo, which' by ihe way, is the rank
that nature feems to point out for both.
  (I) as in the cafe of the Gentoos, who makt uf« of a gr«at deal #f
condiment with their vegetable aliaient, 
 66         THE   ELEMENTS'

eafily, as well as quickly,- are they all removed, by care-
fully covering up the body ? (/).
   <?. Both the other diffufible ftimuli, as  well  as opium,
and the more durable one of ftrong drink, by an indirectly
debilitating operation,  produce afthenic diathefis.
   CXXXI.  A further ftimulus is an  abundance of chyle
and blood; by this the excitement is encreafed every whefe,
and particularly in  the blood-veffels, and encreafed in de-
grees proportioned to its degree of abundance.   The quali-
ty  of the blood,- at  leaft, as a caufe,  is of no effect, it is
the quantify only that is.  The quantity,  by its aBion of
diftending the mufcuiar  fibres of the  veffels,  acts  with  a
conftant impulfe (m).    The  doctrine  of plethora, fo  no-
                                                          ted

  (/) As there  are  cafes of indirect debility from an habitual abufe  of
ftrong drink, there are alfo others from a miftaken or  intemperate ufe
of the diffufible ftimulus,  particularly  opium.  Both  of them require
nicety and /kill in the management of them for their cure ;  for which
confult Chap. XI. from par. Clll.'to CX.  The management is out of
our prefent queftion ; but what affects that is,  that, from this  obfer-
Vation, we can clearly find, as it was to be expected from-the analogous
operation of the other exciting powers, that the diffufible  ftimuli, when
their operation is carried to excefs, will alfo produce an afthenic diathefis
 of the indirect kind,
 •  (m) The blood by its quantity diftends the mofcular fibres of the vef-
 fcl*; that diftention ftimulates the-excitability in the fibres, and pro-
 duces excitement, commonly called their irritability ; thus excited, the
 §bres contract j the contraction of each portion fends the wave onward
 to another portion : when  the wave has paffed any given portion of vef-
 fel, its fibres  again relax,  and make Way for  the next, which is pufhed
 along 1ft *fte fame manner.  In this way the circulation goes on in all ca-
 fes while life remains;  contraction and relaxation conftantly alternate ;
 the former propelling the wave before the latter opens to reccivcthe next.
 But the veffel may be in different ftates with refpect  to its power of ei-
 ther contracting or relaxing.  When it is weak, which every part of the
 vafcular fyftem is as often as all the reft of the fyftem is weak, both the
 contraction and relaxation of each portion of veffel is imperfect.  The
 contraction from its fmallncfs, and the relaxation from its being more
                                                         owing 
                OF   MEDICINE,           £7

  ted in the  medical fchools, is only  applicable  to fthenic
  diathefis, and takes place in proportion to its degree (n).
    CXXXII.  The effect of diftention (0) is encreafed by
  the velocity of the blood, both as arifing from other four-
  ces,  and efpeciaily from that  motion of the body which
  its own mufcles perform, amotion, which,by compreffing
  the veins, carries  the blood  more quickly back to  the
  heart.
    CXXXIlI. Nothing is  more  effectual than  thefe two
 lafi mentioned fiimuli, in producing fthenic  diathefis,  and
  the difeafes depending upon it.   Thofe difeafes are violent
  in proportion to the over proportion of the blood,  and the
  rapidity of the force with which it flows;  a fact,  that is
  proved by all the exciting  powers,  all the  fymptoms of
  thofe difeafes, and, efpecially,  the pulfe of the arteries;
                             F 2                           it

 owing  to the pafilve ftate of the fimple, the active ftate of the fivftig,
 fibres,  leave betwixt them a large diameter upon the whole.  But, in a
 vigorous, or fthenic, ftate of the whole fyftem in general, and  of that of
 the veffels in  particular,  the contractions are ftrong and forcible, and
 the relaxations active and in confent with the contractions.  Hence the
 diameter of each portion of veffel is diminifhed upon  the whole, and while
 the quantity ol the blood Is at the fame time encreafed, the action and
 re-acYion are great; the blood diftends with mechanical, the veffels re-
 fill with vital energy ; the mutual effect of both upon the excitability is
 confidcrable ; all is activity, all is force, and thefe are in exact proportion
 to their caufe over all  the fthenic diathefis.  This ftate of the veffel, in
 fo far as it  refpects the mufcuiar  fibres,  is its tone; in fo far as it re-
 fpects them ds fimple folids, its denfity.  It is a fthenic ftate of the vef-
 fel, oppofed to the afthenic firft defcribed, which is  diftinguifhed by the
 epithets of atony and laxity ; which, however, oppofed to'tone and den-
 fity are only relative  terms, emplo) ed for convenience, not abfolute i
 like the term cold, ufed for diminifhed heat, they  only fignify a dimi-
 nution  of tone and denfity.
  (n) It is a curious fact, that, while the truth of this propofition is
demonftrated, the plethora of the fchools is only underftood oif a ftate
6f the veffels diametrically oppofite to a juft idea of  plethora,'
  («) that we have been defWribing, 
6S
THE   ELEMENTS
 it is alfo proved by the great efficacy of bleeding, purging",
 abftinence from food, and reft, in the cure of the difeafe (/>)•
   CXXXIV. While an over-proportion and velocity of
 blood is a chief caufe of fthenic diathefis ; there is nothing
 more powerful in producing the afthenic, than that penury
 of blood which the greateft celerity of motion accompanies.
 Hence,  the  fmallnefs,  weaknefs, and quicknefs  of the
 pulfe:  Hence the  excitement  is diminifhed every where,
 and in preference to other equal parts, in the whole fan-
 guiferous fyftem, and that in  exact proportion to the pe-
 nury.
   £. From thisfiate of the  veffels arifes  the  difcharge of
 blood from the  lungs, from  the uterus,  from the anus,
 or around the anus, from the urinary paffages, and through
 the perfpiratory  pores.   Hence arife difturbances  of the
 ftomach, want of appetite, loathing of food, and,  there-
 fore, upon account of want of nourifhment,  and the lan-
 gour of the digeftive organs, always  lefs and lefs blood
 arifes in the fyftem.  So great a penury of blood  is the
 principal origin of bleeding difeafes; which never happen
 but iri. the afthenic ftate.   The {"ame penury of blood acts in
 fuch a manner, and chiefly affects its own veffels, becaufe,
 according to a law  fo  often  mentioned, its debilitating
 energy chiefly falls upon  them.  In  fthenic difeafes, that
 have advanced to their height, or a little beyond it, a few
 drops of blood from the nofe,  or a dropping of blood from
 the  fame  or any other  part,  demonftrate only a  predif-
 pofition  to indirect debility, but not  an eftablifhment of


  if) Relief from bleeding and other avacuations is certainly a good ar-
gument for the caufe of the difeafe being fo far owing to an over-pro-
portion of blood ; and reft is as good for the proof of agitation of the vef-
fels being concerned in the caufe : befides, exercife is otherwife a noted
caufe of quicknefs of  the pulfe :  and  the hurtful powers and fymptom;
are equally decifive,  " 
OF   MEDICINE.
ty
it, and that the matter ftill remains within the operation of
exceffive ftimulus  (q).
                                                       4.  Thus

  if) Who ever heard of a flood of bloed comin'g'from the lungs in a pe-
ripneumony ? Or, who has not heard of it in confumptive cafes; which
are the difeafes depending  upon the  laxity of veffels of which we are
(peaking.  What  vigorous woman, found in all her functions, as a wo-
man, ever fell into perpetual floodings ? What had been the ftate of thefe
women before  the difeafe ?  Did they eat and  digeft fo completely, as
that there was any reafon for fuppofing  their  veffels were filled with
blood ? No;  long before the arrival of the difeafe their eating was puny,
and confidering the kind of matter they  made ufe of, to wit, vegetable,
it was not to be fuppofed more beneficial from its quality than its quan-
tity.   What was the idea to be gathered from their fymptoms, and par-
ticularly the piilfe?  The pulfe had all  the marks of an afthenic one ; be-
ing weak, fmall, and quick,  like that of a new born infant.   What was
the ftate of  their habit ?  Was it vigorous  and robuft ? It was  the re-
verfe ; foft, delicate ; the habit lax ;  a falling off in flefh, with weak-
nefs over the whole fyftem,  and total  lofs of appetite.  What were the
remedies emrdoyed to remove this fuppofed offspring of plethora ? Bleed-
ings,  repeated without end ;  other evacuations with the fame freedom,
and vegetable food in a fluid form, and a horizontal pofture,  with their
head lower  than their body and under-extremities.   Miferable are the
refources  of ignorance, and contemptible  their execution ?  Fill a rigid
tube full of water, open at both ends, and the fluid,  no doubt,  will run
out at the end which is moft below an exact horizontal pofition.   But
that is not the cafe  with the fluids in living veffels.   The excitement,
diftinguifhing them from all rigid inanimate tubes,  counteracts the ef-
fect of gravity, while its living ftate remains:  In proportion to the de-
gree of which, the fides of the veffel will embrace their column of flu-
ids,  and prevent  the flowing out of the fluids,  in proportion to the de-
gree of excitement; and before the gravity can act,  the  excitement muft
be extinguifhed,  and the living fyftem reduced to a  lumpilh mafs of
dead matter.  It  is the latter, that enables them to produce that effect.
And  therefore, bleeding difcharges can never happen, either in health
or fthenic diathefis, unlefs in that very high degree of it that approach-
es to indirect debility, and even then, only in the  forced, fcanty, man-
ner  described in  the text; whereas,  after  the eftablifhment of indirect
debility, or in  the cafe of direct, the great  difcharges only can happen,
and that without force, in great plenty, but  ftill fhort of what would
happen if no excitement reftrained it. 
 JQ          THE   ELEMENTS

   4. Thus it is not  an excefs in the quantity of bloody
 but laxity and atony  from its deficiency, that upholds the
 affair of bleeding difcharges ; which proceed in their courfe
 not with any effort f>), but  adimunition of tone: They
 are  ali afthenic,  and the afthenic diathefis, as far as it de-
 pends upon them,  confifts  in direct debility.
   a. But, as every other exciting hurtful power may be
 converted into  indireft debility, fo,  alfo may  an over-
proportion of blood.  For the  veffels, ultimately diftended,
 and beyond all bounds, may (/), by the excefs of that fti-
 mulus,  exhauft their own excitability, and, thereby, put
 an end to their excitement.' Upon which the forcible con-
 traftions are converted into languid ones, ox fuch as could;
 fcarce be called contractions  at  all;  the diameters for-
 merly effaced, are converted into an  extremely  patulous
 ftate. ' The finer parts of the fluids flow through the patu-
 lous extremeties of the artefies,whereverthey find an outlet,
 and carry with them,fometimes ferum, fometimes red blood.
   In the  afthenic, diathefis as  well as  the fihenlc, it  is
 not the quality of the blood, but its quantity, which  is
to be found fault with, and the fault in quality here is de-
ficiency.  The deficient quantity produces  the fymptoms
of the pulfe, that have been mentioned above, by not fuf-
 ficiently diftending the veffels, and giving them fufficient
excitement.   Plethora,  which has  been thought to be-
long to  this form of difeafes only,  has abfolutely no exift-
ence in  it.  The  ftate of the  veffels,  with  refpect to the
quantity of blood in them,  that is pleafant and fuitable to
health,  is  the mean betwixt the extremes that have been
fpoken of.
   CXXXV.  This ftate («) is the chief origin of afthenic
                                                difeafes,
  (r) or active impulfe,        (/) under the high fthenic diathefis,
  (k) of the blood and Veffels, that we have been defcribing, that is, pe-
nury of blood, and atony and laxity *>f the veffels, chiefly from direct^
fometimes from indirect debility; though the latter cafe is exceedingly.
rare. 
               OF  MEDICINE,            fl

  difeafes, of which the fo very hurtful effects of evacuation,
  efpecially bleeding, as well as vomiting, purging the belly,
  and every other mode of diminifhing ihe bulk and quantity of
 fluids, give full proof.  This proof  has of late received a
 further confirmation,  in the fiwgular fuccefs of the cure by
  other ftimulants firft, and then by every mode of filling the
  fyftem (k).
    CXXXVI. The different fluids fecreted from the blood
  in different ways,  are, by the diftention which they give to
  their refpective veffels,  alfo underftood to ftimulate.   In
  that refpect the milk and feed, by  the abundance of each
  in its refpective veffels,  and likewife. the perfpirable fluid,
  have the chief effect, the commotion of the fecretory organ
  (y), by means of excitability, which is one and the fame.
  undivided property over  all, is eafily diffufed over the
  whole  body,  and,  when  it rifes  to excefs,  is capable,-
  with other powers that  communicate an excefs of excite-
 ment, to produce fthenic diathefis.
    CXXXVII.  The fame fecreted fluids,  when they  do
 not fiifficiently diftend their refpective veffels, when they
 do not communicate enough of excitement,make noinconfi--
                                                    derable
   (x)  Syftematics  allow that  there are  many difeafes, which are a re-
 proach to  their art, from their never yielding to their method of cure,
 but, on the contrary,  becoming worfe  and worfe in proportion to the
 time and pains taken about it.  Of thefe opprobria medietas  (it would
 be better, I believe, to call them opprobria medicorum) few  are more
•fo than the bleeding difeafes j  which feem uniformly to have proceeded
 from evil to worfe under the  evacuant  debilitating plan ; while it has
 now been found, that the high ftimuiant plan removes them  ,vyith the
 greateft fuccefs.
  (y) It has been faid above, in chap. IV. that the excitability is one uni-
 form undivided property over the whole  living fyftem ; and that, where-
 ever it is acted upon in any part of its feat, it is affeded over all.  This
 fact, which is ftrictly true and univerfal over every part  of living mat-
 ter in nature, with  the utmoft eafe explains many things, that were con-
 feffedly inexplicable upon  every other medical doctrine; and,  among
 the reft, the feveral affections of the fecretory fyftem. 
7?         THB   ELEMENTS

derable part of the hurtful powers,  that conftitute afthenic
diathefis.
   A. For which reafon vomiting, purging, and every o-
ther evacuation, are powerful inducers of afthenic diathe-
fis, which they effect in proportion to the debility that at-
tends  their operation.  The fame  thing  is to be  faid  of
excefs in  venery,  which is partly an indirect, partly  a
direct, always a great, debilitating power (a).
   b, Sometimes the  fecretory  veffels feem fo crammed
with a colluvies of fluids, that indirect debility  may pof-
fibly arife from thatfource,  as is exemplified in that over-
flowing of bile, which  diftinguifhes  the yellow fever (b).
Here too the debilitating effect, by means of the excitabi-
lity, tends to diffufe the diathefis over all.
   From this fource, arife, a languid action of the extreme
veffels (d), a flow, then no, motion of the fluids,  a ftag-
                                                      nation

   (a) Nothing  is more effectual in haftening of death than a love mar-
riage betwixt an old man of worn out excitability,  and a young beauti-
ful virgin : I need not explain  to any reader on which fide, that of the
man or the wife, either the love or the danger lies.
   (J) of the Torrid zone.  I have been fo often, and by perfons of good
enough fenfe to make juft obfervations, informed of the neceffity of pur-
ging off the redundancy of that fluid, which1 not only fills the inteftines,
hut diffufes itfelf over the whole  alimentary canal;  and, then, of fol-
lowing out the cure of the difeafe by the ufe of wine, fpirits, and the
diffufible ftimuli, that I have,  though at firft  with fome reluctance, ad-
mitted the fact.  The reafon of the flownefs of my affent to it was, that,
upon every other occafion of any  accumulation of matter in the firft paf-
fages, even in the colic itfelf, 1 had always found the pactice of invigo-
rating the perilialtic motion, by ftimulants,  fufficient to clear away all
fuch extraneous matter ; while vomiting and purging, by their relaxing
effect upon the veffels, ferved  to generate more, and increafe the caufe
 of the difeafe, which is a.ways debility.  This I found not an exception
 to that general principle,  but an  inftance of a fort of local difeafe, from
an over-repletion of the exhalant mucous and biliary veffels.
   (rf) Thefe are the exbalants that pour out the faline,  watery part of
                                                          the 
               OF   MEDICINE,           73

 nation and corruption of them.  A diminution, or tempora-
 ry deft ruction of excitement, over this large fpace in the fyf-
 tem  (e),  by means  of the  fame excitability, communi-
 cates debility to the  reft  of the body ;  and,  in conjunc-
 tion with other hurtful powers that give not enough of ex-
 citement,  produces  afthenic diathefis.
   r. The  various forts of geftation if), and of exercife and
 labour,  by roufing the  mufcles into contraction,  and
 thereby accelerating the  motion  of  the blood  in the
 veins towards the heart, while the valves prevent its taking
 a contrary direction, greatly promote excitement in all the
 veffels,  and,  therefore,  over  the whole fyftem;  and  the
 effeB may go  fo far as  to produce fthenic diathefis.
  a. As nothing contributes more to health than moderate
 and frequently repeated exercife, and its excefs acts in the
 manner that has jufi now been defcribed ; at the fame time a
                                                     degree
the blood unchanged; the mucous glands that change, by their fecretory
operation, the fluid they receive from the blood ; the pori biliarii that
change the fluid that they receive from the extremities of the veins of
the  gate, and of the hepatic artery, or artery of the liver ;  the little
ducts which thefe form by the union of numbers  into fmgle veffels ; the
 hepatic duct or great biliary veffel of the liver, which receives the bile
 from all the ducts;  and, laftly, the  ductus  communis choledochus,  or
 the  duct that may be denominated in Englifh,  the general receiver of
 all the bile,  whether from the  great duel of the liver,  or that  which
fends to. the ^all-bladder a part of the bile that returns in the fame veffel
to the general receiver.   Thefe, and befides them,  the inhalants or ab-
forbents as they are called,  to wit, the fmall veffels that take up from
the exhalants aud other arterial terminations of veffels, the fluid, called
lymph, which is once more to be returned into the circulation j  are the
veffels that fuffer the concourfe of fymptoms defcribed in the text.
  (e)  How great the fpace in  the whole fyftem is that thefe veffels oc-
cupy,  may be  eafily imagined,  when it is confidered,  that every evane-
fcent artery, over  the whole body, terminates in one or more of thefe
 colourlefs veffels that have been defcribed,
  (/) as riding on horfeback, going in a carriage, ufing an  hobby,
kihng. 
 74          THE   ELEMENTS

 degree of it, either greater or lefs, than the falutary degree,
 by its weakening effect, the former in wafting the excitabi-
 lity, the latter in with-holding a neceffary ftimulus ; th at
 is the one by debilitating  indirectly, the other  directly,
 produces afthenic diathefis.
   CXXXVIII.  Thinking,  which  acts  more upon the
 brain,  to  which it is  immediately applied than upon any
 other equal part of the fyftem (h), encreafes excitement  o-
 ver the whole body (/').   Straining and thinking, whether
 in a high degree for  once, or often repeated in a leffer
 degree, or habitual may alone prove hurtful; but, in con-
junction with other powers alfo hurtful from their excefs
 of ftimulus, may become more fo, and amount to a degree
 equivalent to the production of fthenic diathefis.
   CXXXIX.  An evident  caufe of afthenic diathefis  is
 that  ftate  of the  intellectual function,  in  which excefs
                                                          in
  ffi) Vide Chap. IV.  Parti.
  (J) None of the exciting powers have more influence upon our activity
than the two which are juft going to be mentioned, the exercife of our
mrellettlual function, and  that of paflion or emotion.   With refpect to
the farmer,  Homer obferves of the  hero,  whom he gives for a pattern
of eloquence, that upon his firft  addrefs,  that is while he  was under
 fome agitation,  and had not  ;et got into his train of thought, he was
 awkward in every motion, and in his whole attitude; he looked down
 to the ground,  his hands hung ftrait along his fides as if powerlefs ;  his
whole appearance was torpid.  But  when he once entered upon his fub-
ject, his eyes were all fire, his limbs all motion, with force, grace and
 energy.  Upon commencing a lecture, the  pupils have often obferved
 the fame torpor in the lecturer, and a fimilar vivacity and life in a few
 minutes, when he had now got fairly into his fubject: the report which
 a. lecturers daughter, upon looking through the hole  of a door, while
 the ledure was going on, made to  the family and foirie company then
 prefent, was, that her father looked, in his lecture, as if he would look
 through his hearers.  A Mr. Donaldfon is one of the few great matters,
 in the  art of painting, who never fail, with a moft exact likenefs, to
 difplay the whole influence of the mind upon the features.   A minfa-
 \nre of me, done by him,  as a prefent, is reckoned the greateft mafter-
 piece iu thefe refjoccts, that ever came from the hands of a painter. 
              GF   MEDICINE.           y£

 in thinking, by  wafting the excitability, ends in indirect
 debility;  or  that deficient, weak, vacant  ftate of mind,
 uncapable of'keeping up a  train, which  produces the
 fame hurtful effect by direct debility.  This faulty ftate of
 the mind contributes greatly to weaken thefyfiem [k).
   CXL. Violent  paffions  of mind, as great anger,  keen
 grief,  unbridled joy,  going to fuch a pitch as to  deftroy
 excitability,  have the fame effect as exceffive  thinking,
 and admit of all the fame reafoning.
   CXLI.  A force of paflion  rifing to the height of ex-
 haufting the excitability, induces that afthenic  diathefis,
 which is occafioned by indirect debility, and difeafes of
 that ftamp.  Hence epilepfy (/), hence apoplexy, and that,
 when the  mind has been fcrewed up to the height of paf-
 lion, often fatal.
   CXLII. On  the contrary,  when there  is a deficiency
 of paffion, as in melancholy, grief,  fear, terror, defpair,
 which are only lower degrees of joy, affurance, and hope,
 and imply no more than a diminution of exciting paffions,
 not emotions of a  nature oppofite to thofe,  and pofitive;
 their tendency is to produce the afthenic diathefis, which
 depends upon direct debility.   The immediate production
 of this is  lofs of appetite, loathing of food, ficknefs at fto-
 mach, vomiting, pain of the ftomach (?«), loofe belly with-
 out pain, the fame with pain, indigeftion in), cholic, the
 gout, and fevers,
   CXLIII. The exercife of the fenfes, when it is  agreea-
 ble, has a very great effect in exciting the whole body, and
                                                     in

  {l) It may often be remarked by phyficians, that their patients, after
 every other proper part of cure has been executed, art never completely
reftored to their healthy ftate, till they are again -n,;:  ;;■; in their ufual
occupations both of mind and body,
  (/) or the failing ficknefs,
  (m) calle d cardialgia by fyftematics        .' •-•,  ' ■'••.,  'i < pepfia, 
 j6        THE   ELEMENTS

 in prdducing emotions, which, together with the hurtful
 powers mentioned above, may eafily contribute to the pro-
 duction of fthenic diathefis.   Thofe  emotions are exem-
 plified in drinking,  dancing, in agreeable  entertainments
 where the eye is dazzled with the fplendour of the difhes,
 of the company, and of all the objects around.
  CXLIV. The energy of the  fame exercife of the fenfes,
 when it is  exceffive, and carries the effects, juft how men-
 tioned, too far, produces indirect debility.  On the con-
 trary, when the fenfes are either in part deftroyed, or in
 part dulled,  or difagreeably affected if), the mind is  de-
jected, and the whole body thrown into afiate of languor
 and direct debility.  And, in both cafes, efpecklly when
 there is a concurrence of other debilitating hurtful powers
 the afthenic  diathefis arifes.
  CXLV.  The effect 6f the air (p),  independent of its
 qualities,  as they are called,  or  its properties, and its  ufe
 in fupporting refpiration, is lefs obvious to obfervation (§-) -y
 at the fame time it cannot be doubted, that its application
 to the whole furface of the body is  a ftimulus  riot to be
 difpenfed with.  The air is feldom applied in a pure ftate : it
 is commonly blended with foreign matters that diminifh
 Its force of ftimulus; and, while itsfalutary ftimulus depends
 upon its purity, at the fame time it is uncertain whether e-
 ver its purity goes fo far as to ftimulate in excefs, and there-
 by produce fthenic diathefis. Theballoons, lately invented, by
 which men get  above the clouds, would ferve excellently to
 throw light upon that matter, if it were not for the cold that
                                           accompanies
  (») Nothing is  more deafly difagreeable th m an obfcure light, as
when one reads with a fmall or unfnuffed candle, Hence, the luxury of
more candles than one,  or of wax or fpermact candles.  This is often
experienced  at  Ranelagh,   aud may be feen in children cxquifitely
amufed.
  (p) upon the human body,
  (j) than the other powers that have been fpoken of,
I 
           OF   MEDICINE-            JJ

accompanies this progrefs.  Be that as it may ;  fince we
never live in the pureft air, and yet live commodioufly e-
nough, it is, therefore, credible, that too pure an air has a
tendency to ftimulate in excefs,  and therefore,  produce
fthenic diathefis.
   CXLVI.  But, as  nothing is more ufual  than impurity
of air, and every impurity diminifhes its  ftimulus, a very
impure air, or air blended with  impure matters, without
doubt debilitates, and produces afthenic diathefis.   Ac-
cordingly,  impure air is a frequent caufe of typhus, as is
evident from the fate of thofe who died in the black hole of
Calcutta.   Whether ever  the  air, from an excefs of pu-
rity, produces afthenic diathefis,  is the  more  doubtful,
that, as has been faid, it is as yet  undecided whether it
produces fthenic diathefis or not.
   e. Contagious  matter, in fo far as it may have any  ten-
dency to produce general difeafes,  in one form produces
fthenic,  in another afthenic difeafes, and, therefore, acts
like the ordinary hurtful powers of either fort, and admits
of all the fame reafoning.   But, in fo far as it only occa-
fions the eruption, without making any change in the ex-
citement, it is to be referred to the local difeafes.
   z. To poifons, if they  act as  general ftimulants,  all
the reafoning that has been employed with refpect to the
other hurtful powers, will apply.   It is not,  however,
likely that they are general ftimulants.
   CXLVIT. It is feldom  from the feparate, almoft  al-
ways  from the united operation of all the powers, that
both the  diathefis, whether as  remaining  within the range
of predifpofition,  or rifing to the degree of actual morbid
ftate are produced,  and from no inherent power in the
fyftem.-
                                           CHAP. 
  7$         THE  ELEMENT  Si



               CHAP.     II.

                 The  Caufe of each Diathefis.

   CXLVIII?\  The caufe of fthenic  diathefis, produced
 in the way that  has now been explained, is,  in confe-
 quence of the operation of the powers that have been men-
 tioned, too great an  excitement of the living fyftem every
 where, with the ejfeB of firft encreafing all the functions,
 then of  producing a difturbance in fome,  arid impairing
 others, but never by a debilitating operation.
   CXLIX. The caufe  of, the  afthenic diathefis arifing
 from the fame fource, is, in confequence of the  debilita-
 ting hurtful powers, too little excitement of the living fyf-
 tem every where, with the effeB of impairing all the func-
 tions,  difturbing fome,  giving  a falfe appearance of en-
 creafing  others, but always  debilitating (a).
                                                 CHAP.

   {a) It muft now appear ro the reader, to what fimplicity the hitherto
conjectural, incoherent, erroneous, myfterious, and enigmatical art of
phyfic, is now reduced.  It has been demonftrated',  that there are only
two forms  of difeafes, that the deviation from the  ftate of health,  in
which the  morbid ftate confifts, is not either repletion or inanition, of
changes  in  the qualities of the fluids, whether of an acid  or alkaline
nature, or  the introduction  of foreign  matters into the fyftem, or a
change of figure of the extreme particles, or a  difprop'vrtion  in the dif-
tribution of the blood, or an encreafe or decreafc of the power of the
heart and veffels as regulating the circulation, or a rational principle-
governing the actions of  the body,  or an alteration in the* extreme par-
ticles as beinjr of too large or too fmall a fize, or an alteration of the
pores, as being too narrow or too capacious, or a conftriction of the
fuperficial veffels from cold, or a fpafm of them producing a reaction,
as it  is called, of the heart and interior veffels, or any thing that any
perfon has yet thought of refpecling the caufe and nature or morbid ftate.
On the tontrary, it has been proved that health and difeafe are the fame
ftate  depending upen the fame caufe, that is, excitement, varying only
                                                           in 
OF   MEDICINE.
79
                CHAR      III.


                    The fihenic Diathefis.

   CLI. P R E V I O U S to the difturbance  (a) which
never happens  till after the arrival of the difeafe (b),  and
even then only in a violent attack of it,  all the fenfes are
acute : the motions both  voluntary and involuntary if), are
                                                     vigorous,

in degree ; and that the powers producing both are the fame, fome-
times acting with a proper degree of force, at  other times cither with
too much or too little;  that the whole and fole  province of a phyfician,
is not to look for  morbid ftates and remedies which have no exiftencc,
but toconfider the deviation of excitement fron\the healthy ftandard, in
order to remove it by the proper means.  The reafoning part of this doc-
trine, it Is expected, the reader will find irreprehenfible and unanfwer-
able ; and the practical part,  from the aftonifhing cures that have upon
innumerable occafions been effected, will ever  ftand in fupport of the
truth and utility, as well as fimplicity of the whole,
   (a) uf the functions, which, it has juft now been faid, the hurtful ef-
fects of both fets of powers produce,
   (I) During the predifpofition to peripneumony, as well as to every
other difeafe, neither the fymptoms of difturbance,  or any other fymp-
toms at all  appear.  And in mild cafes,  fuch as catarrh, the fymptoms
of difturbance occur not through the whole courfe of the  difeafe :  But,
when a difeafe is, like the peripneumony or the gout, of a vaolent na-
ture, then  the fyftem is commonly difturbed, and in a moft confpicuous
degree.   The affection  of the lungs in the former, from the inflamma-
tion  within, and of one of the feet, or fome other  part  in the latter,
from an external inflammation, give extreme difturbancc to  the affected
parts, while there is a difeafe of the fame nature as the gout, that is dy~
fpepfia, or indigeftion, in which the inflammation never appears.
   (f) The voluntary motions  are thofe that are  performed under the in-
fluence of the will, fuch as the motion of the limbs in walking, or in any
fort of exercife.  The organs, by which they are moved, confift of bun-
dles of moving fibres called mufcles.  The involuntary motions are thofa
tff the interior parts of the fyftem, fuch  as thofe of the heart and vef-
                                                             fel? 
So        THE   ELEMENTS
 vigorous, there is an acutenefs of genius, and a great force
 of fenfibility as well as of paflion and emotion.   Thefis
 veral parts of the body are perceived to be in afiate of vigour'
from the following marks ofit; the heart and arteries from
 the pulfe ; the extreme veffels on the furface of the body
 from the complexion;  all the mufcles from the ftrength
 that they exert; the internal fecretions from  the great
 quantity of milk and femen ; the digeftive organs from the
 appetite,  the digeftion, the vigour of the body, and the
 manifeft abundance of blood.
   CLII. How  far the intellectual faculty, and  the force
 of paffion, are encreafed, will be learned from a comparifon
 of them in this diathefis, in  good  health, in the fecond
 form of difeafes and predifpofition  to it.  In this way it
 is that the functions are firft encreafed.


              CHAP     IV.

 The Sthenic Diathefis illufiratedby an explanation of its Symp-
                         toms.

   CLIII. The encreafe of the force of the fenfes, of the
 motions, of the intellectual faculty, and of the paffions,
depends upon the encreafe of excitement in every one of
their organs,  among other actions, quickening the moti-
on of the blood through them.
   CLIV.  The coming  on of every fthenic  difeafe is
announced by a fhivering.  It depends upon a diminifhed
perfpiration,  by means  of the diathefis being exqnijitely
ftrong in the extreme veffels of the fkin.  The fame is the
                                               explana-
fels connected with it; the periftaltic motion in the firft paffages, which
are the paffagc to the ftomach, the ftomach itfelf, and the whole convo-
lution of the inteftincs; as alfo thofe of the womb, of the  bladder, of
orine, and fo forth; None of the latter are under the influence of the will.
                          3 
OF   MEDICINE.           8l
 explanation to be given of  the fenfe of cold, which com-
 monly accompanies the fhivering; and the fame is the ex-
 planation of the drynefs of the fkin.
   CLV.  In the fame difeafesthe pulfe is ftronger, harder,
 and fuller, and fomewhat more frequent, than in its found
 ftate.  Its fulnefs and hardnefs is owing to taking animal
 food plentifully  during the predifpofition.  The force
 and frequency is occafioned by the fame  and any other
 ftimulus,  as that of ftrong drink; that of the diffufible
 kind, and that of exercife, whether corporeal or  mental:
 Nay all the ftimuiant  hurtful powers  are participant of
 the fame effect.
   CLVI. If, in the progrefs of the difeafe, the pulfe fome-
 times becomes weaker, fofter, emptier,  and quicker, that
 is a bad fign, and occafioned either by the debilitating plan
 of cure being pufhed beyond the proper bounds ; or, in
 confequence of a neglect of  that fort of cure, it may be
 owing to  fome debility induced  by the  excefs of excite-
 ment.  The former of thefe is  direct, the latter indirect
 debility ; both to  be avoided.
   CLVII. The complexion in the veffels,  which is often
 a confequence of a previous appearance of palenefs, and
 great quantity of fecreted fluids, is occafioned by an over-
 proportion of blood,  in confequence of an exceffive fthenic
 diathefis  obftructing the perfpii ation.   The fame is  the
 caufe of the head-ach and pains in different parts.   For
 as the head-ach fo quickly and eafily yields to bleeding, it
is, therefore, feldom to  be fufpedted of being owing to in-
 flammation within the head. And the reafon for fo think-
ing is ftrengthened by this  further circumftance,  that the
inflammation arifing in  general difeafes always  affects  an
external part,  as  fir as that fact has been enquired in-
to'(a\'
                         G                  CLVIIL
              ,n)  Vide above, CXIII. 
$2        THE   ELEMENTS
  CLVIII. The delirium alfo, that fometimes arifes in a
violent ftate of  difeafe, is not to be imputed to inflamma-
tion, and for the fame reafon; for it yields fo  much  to
bleeding and other evacuations, that there is no reafon for
fufpecting inflammation within the head.  That abun-
dance of blood  in the  veffels, diftending thefe to excefs,
is the caufe of the whole affair, is proved on the  one hand
by the rednefs of the face, implying fuch abundance, and
on the other by  bleeding, removing the difeafe  at once.
  CLIX.  Thirft and  heat, which are alfo  remarkable
fymptoms in fthenic difeafes, depend upon the fthenic dia-
thefis in the extreme veffels of the fauces and fkin; the
diathefis  fo obftructing the veffels as not to  allow  a re-
turn of perfpiration, but to fuffer, however, the blood to
pais into the very neighbourhood of the ends of the vef-
fels, and by means of the fuppreffion of the perfpiration,
to accumulate,  under the cuticle, the  heat generated in
the fyftem.  Thus, in the throat, from an affection of the
ends of the veffels, the faliva and other fluids, by the free
flow of which  the throat is lubricated, and  freed from
that fenfe  of drynefs, which is called thirft, are now con-
fined  (b),  and thereby produce thirft.
   CLX.  Hoarfenefs, cough, and expectoration, which
are fometimes obferved in fthenic difeafes, commonly pro-
ceed, and fucceed to each other in the following order.
There is firft often a hoarfenefs, then a  dry cough, then a
cough with expectoration.   The caufe of the hoarfenefs
and dry cough  is an obftrudtion of the exhalants and mu-
cous  veffels, which terminate in the bronchia, ftill occa-
fioned by a violent fthenic diathefis, and prevented  from
tranfinitting their contents to lubricate the air-veffels (c),
                                                   fo
 (b) and prevented to flow out,
  (c) The bronchia are the divifions of the wind-pipe running through
the fubftantc of the lungs, and blended with the blood-veffels.  In the
                                               fubftance 
OF   MEDICINE.
83
fo as that hoarfenefs may be removed, and the expectora-
tion proceed with freedom.   Again, the expectoration is
next freely made, becaufe the diathefis,  being now dimi-
nifhed, and allowing the ends of the veffels to be relaxed,
and  the  fluids to be pouned out in abundance upon the
air-veffels, is the occafion of the fluids producing a com-
motion of the excitability over this whole organ, and by
the convulfive motion, which is called cough,  of being
themfelves thrown out.
   CLXI. As the greater freedom  of expectoration now
implies an abatement of the  diathefis :  fo too great a flow,
and too long a continuance  of it, fhows, that the diathefis
is now rufhing into the afthenic ftate,  either from indirect
debility, or when the difeafe, in its  progrefs,  has much
exhaufted the excitability; or  from direct debility,  as
when the plan of cure, proper in kind, has been pufhed be-
yond the  bounds.
  CLXII.  Thofe fame fymptoms (d), while they flop fhort
of the range of direct debility, or are not yet changed into
the indirect, are occafioned by heat, and whatever ftimu-
lates in excefs, and removed by cold and whatever acts as
a weakening power.
   CLXIII. Palenefs, fhrivelling of the fkin, clearnefs of
 the   urine,  and  bound]  belly,   which  chiefly  happen
 about the beginning of  the difeafe,  arife from a de-
 gree of  the  diathefis,   fhutting up  the ends  of the
 veffels in fuch a  manner,  that either nothing is excreted,
                          G 2                        or

inblance of the lungs, befides thefe two fets of veffels, the air-veffels and
blood-veffels, there are likewife  exhalants, fmall arteries,  and mucous
glands, coming off from the extremities of the red arteries.  The wind-
pipe is covered with the latter; and the great quantity of mucus thrown
up from the lungs, often in perfect health, and  in  innumerable cafes,
  both of fthenic and afthenic general difeafe, fufficiently proves the exift-
 encc of the fource from which they flow.
   (d) mentioned juft now, 
$4        THE   ELEMENTS

or the thinner part,  as  in the urine, only efcapes.  The
cure of the affection of the urine, of  the obftructed per-
fpiration and coftivenefs, fhows that the diathefis is now
gradually abating, the difeafe becoming mild, and now up-
on the eve of being thoroughly removed by emetics, pur-
gatives, and fudorifics, and the ufe of other debilitating
remedies.
  CLXIV.  In fthenic difeafes, when they are gentle,  the
appetite is often not  much diminifhed,  and oftener more
food can be taken than is ferviceable.   But,  unlefs  the
lighteft vegetable matter only, and that in the form of wa-
tery potion, or in a fluid form, be given, every morfel of
it will do harm.
 ULXV. But, when either from indulgence in food of a
rich nature, or from employing a ftimuiant plan of cure,
or from the difeafe having, from the beginning, arifen from
very violent, hurtful powers, and now attained its higheft
degree of violence; in any, or all thefe circumftances, both
the other  bad fymptoms, mentioned  above,  break out
directly, and the violent diforders of the ftomach, or an
acute pain of the thorax, fhow themfelves indirectly.
  CLXVI.  In a violent diathefis, therefore, where there
is little appetite for food, but a very great defire for drink;
with the  latter the patient is by all means to be gratified;
but the former fhould be avoided, as producing  loathing,
ficknefs at ftomach, and vomiting.  Thofe fymptoms  are
not ufually  of long duration, Unlefs when the diathefis is
now going, or actually gone, into the afthenic ftate by  the
means that have been mentioned above (f), and, by remo-
moving the other fymptoms by the proper debilitating plan
of cure, they go off;  but when the ftomach ficknefs and
vomiting are urgent, and begin now to be a little more ob-
ftinate, and of a little more  duration,  one may know that
                                                they
(f) Vide laft paragragh and a few immediately preceding it. 
OF    MEDICINE.
85
 they ftill remain fhort of the change  into  indirect debi-
 lity, by the following  mark : if the pulfe  ftill maintains
 moderation in its frequency,  and does not abate much of
 its  fulnefs and force;  if artificial vomiting and purging
 diminifh the  morbid vomiting, and, in one word, if the
 debilitating plan of cure ftill fucceeds.   But, it will then
 at  laft  be  underftood that  the difeafe  is altogether
 changed, and its caufe  converted  into  the oppofite, when
 thofe fymptoms every day  increafe;  when the pulfe be-
 comes weaker and weaker  ; when gripes in the inteftines,
 and liquid ftools,  are  fuperadded  to  the fymptoms that
 difturb  the ftomach, and when the antifthenic or debili-
 litating  plan of cure is  now of evident detriment (g).
   CLXVII.  While the fame fymptoms (h)  ftill flop fhort
 of indirect debility, the exceffive  excitement in the fto-
 mach being of quicker  tendency to indirect debility there
 than any where elfe, upon  account of  the ftomach's great
 fenfibility, and the force of the moft powerful ftimuli be-
 ing  chiefly exerted upon it, produces fymptoms of difturb-
 ance (i); for the moft powerful ftimuli, and thofe that are
 fignally  powerful in producing fthenic diathefis  (k)  are
                                                     firft
  (g) See above, CIX.
  (h) of the ftomach and inteftines,
  (i) See above, LIV.
  (k) as high-feafooed animal food, wine, fpirituous drink,  cordials,
and the whole train of high diffufible ftimuli, fome of thefe,  «.s meat
Bnd wine,  have no effect upon the external furface, or any other part;
others, as  fome of the condiments," fuch as muftard and ftrong fpirits,
and above all the  diffufible ftimulants) as aether, camphor, and opium in
a liquid form, do act upon  the fecond,  and by their application to it
fupport their own intern .1 afe.  Thus to prevent or remove  the gout,
• nafarca, fprains, and fo forth, the application of ary of thofe Ugh dif-
fufible remedies, juft now mentioned, will|greatly contribute, along with
 their ufe as taken into the ftomach, to fupport the general operation,
Thefe, and innumerable others, are fo many facts that have been fug.
geftcd by  obfervations and tria*s made in the profecution of this doc-
trin:, 
 86       THE    ELEMENTS
 firft applied there, and exert a greater force upon the ex-
 citability in that than any other part.  Thofe ftimuli are
 the feveral preparations of animal food, the feveral con-
 centrated ftrong drinks, the feveral condiments with which
 they are feafoned,  the various diffufible ftimuli,  as the
 different preparations of opium, volatile alkali, camphor,
 mufk, and aether:  and they all act upon the ftomach with
 that force which they exert not upon any other part; they
 do not upon the inteftines below, becaufe they undergo a
 change from the firft digeftion before they pafs over into
 the firft portion of the inteftinal canal; not upon the lac-
 teal veffels, becaufe they are riot  received into them till
 they are further diluted, and undergo another change from
 the digeftive operation, and when fo changed,  they are
 next carried to be mixed with the blood;  not  upon the
 heart and arteries, upon account of the fame dilution meet-
 ing them alfo in thofe veffels, and ©f a conftant change of
 mixture occurring through the whole courfe of the circu-
 lation ; not upon the terminations of the arteries, whether
 exhalant or glandular, and whether thefe excrete from the
 body a matter already corrupted,  or carry back by the
 lymphatic veffels, an ufeful matter to  the blood ; and that
 both for the reafons that have been  given, and particu-
larly becaufe fome great change is made in the exhalants
 and glands ; not upon the lymphatic veffels, where a new
fluid is conftantly flowing in upon the old in thefe parts
by means  of anaftpmofing branches,  and chiefly  in  the
 thoracic duct; not upon the other blood-veffels, upon ac-
count of the great change that a repetition of the circular
tion produces  ; nor upon the mufcuiar  fibres,  whether
 voluntary or involuntary, becaufe the ftimuli by no means
come in contact with thefe;  nor upon the brain or  me-
dullary fubftance for the fame reafon  (1),  as well  as for
                                                 the
 (1) to wit, that they do not come into contact with them, 
              OF   MEDICINE.           87

 thegreat diftance of thefe parts from the part that receiv-
 ed the firft contact of the ftimuli.   In one word,  as all
 exciting powers, whether falutary or hurtful, or curative,
 act fomewhat more powerfully upon certain parts  than
 upon others, as thefe parts are generally thofe which they
 firft affect, and with which they come into direct contact;
 thofe, therefore, in preference to others,  are moft liable
 to pafs either from fthenic diathefis into afthenic, or from
 the latter to the former ; which, however, happens in
 fuch a manner,  that, becaufe the excitability is one uni-
 form, undivided property over the whole body ; whether
 the excitement has been increafed in a peculiar  part, or
 diminifhed;  and, whether its diminution has been owing
 to direct or indirect debility, and  in either way the afthe-
 nic diathefis produced; all the reft of  the body foon fol-
 lows the kind of change that has taken place; and, fince
 the powers that have acted, have been, and are the fame,
 that is, either exceffively (m)  or infufficiently ftimuiant (n),
 or fo to an ultimate excefs;  and as the excitability upon
 which they have acted, and  ftill act, is the fame,  that is,
 the whole confideration of the caufe is the fame, the effect
 muft alfo be  the fame, that is,  the fame fort of actions,
 whether  in excefs or defect (o), muft be eftablilhed over
 the whole body.
   CLXVIII. The inflammation which accompanies the
 phlegmafiae (p),  occupies  an external part,  as far as its
 nature has been yet afcertained.   And the reafon of that
                                                     is,

  (m) in fo far as they produced fthenic diathefis,
  fn)  that is, debilitating, in fo far as they produce the afthenic diathe-
fis, that depends on direct debility, or in fo far at they produce the aft-
henic diathefis that depem s upon indirect debility.
  (o)  whether fthenic or afthenic,
  (p) difeafes that arc fthenic and accompanied with an inflammation
of a part, as a portion of the lungs, the throat, fome of the joints, and
in which, as has been formerly faid, the inflammation is like asy other
eVmptom, an cftVct cf the caufe of the difcaft, not itfelf the cauf;, 
 88       THE   ELEMENTS.

is, that heat, which is the moft powerful hurtful agent in
thofe difeafes,  either alone, or alternating with cold,  o»
fucceeding to it, has much more power externally, where
it is directly applied, than internally, where the tempera-
ture is  nearly  ftationary, in ftimulating,  and, therefore,
raifing  the  general diathefis, to the degree of actual in-
flammation in a part.   Hence the throat, hence the dif-
ferent joints, hence the face, where the form of inflam-
mation is different (q), hence the lungs, which are to be
confidered  as  an external part, becaufe the air has direct
accefs to them, all thefe are affected with inflammation in
preference  to other  parts.   And, befides the  energy  of
the exciting hurtful power, juft now mentioned, there is
in the part, that is to undergo the inflammation, a greater
fenfibility (r) than in others, or a more accumulated  ex-
citability ; by  which it happens,  that,  of the parts that
have been mentioned, fometimes one, fometimes  another
is affected, more than  the reft (f).  To this confidera-
                                                      tion

  (q)  as when the inflammation of eryfipelas appears there;
  (r)  §ee above, LIII. \.
  (f)  In the  inflammatory fore  throat the inflammation affects the
throat, which is alfo fometimes the feat of an eryfipelatous inflamma-
tion. In eryfipelas, fometimes the face, fometimes one of the legs, fome-
times the ear, fometimes the temples, are inflamed. I have frequently
been affeded with an eryfipelas, that begins with an acute inflammation
and pain in one ear, which is thickened to four times its ufual dimen-
fion; from that it fpreads over the  whole hairy-fcalp till it reaches the"
neighbourhood of the ear in the oppofite fide, never, however, affecting
that ear ; this progrefs has been fometimes from the right to the left,
fometimes from the latter to the former, in proportion as either had been
more expofed than the other to heat, or the alternation of  heat with
cold, or the fucceffion to each other.  This difeafe is fthenic, but in a
 mild degree, and  to be removed by coolnefs, cold water, low vegetable
 fluid diet, and a flight purge. It was once greatly aggravated by wine,
fpirituous drir.k,  and the high diffufible ftimuli.  In rhematifm, the in.
flammation attacks a large joint, fometimes fhifting from tine to another^
                                                   fomctir.ie3 
                OF    MEDICINE.           89

 tion of the caufe, it is to be added, that which ever of the
 parts we  have mentioned has been injured,  in  whatever
 manner it may have undergone the inflammation peculiar
 to the phlegmafife, that part, in every after attack of a
. new phlegmafia, is in more danger of being inflamed than
 the reft.   This is the true caufe of the recurrence-of fome
 of the phlegmafi?e, as  the inflammatory  fore throat, and
 rheumatifm. (t).  Peripneumony is a difeafe lefs frequent
 than any of the reft of this form, becaufe " the feat of its
 inflammation"  is exempted from many   ftimuli,  liable
 to produce fthenic  diathefis with its   accompanying in-
 flammation.
                                                       H.  A;

 fometimes feveral at a time, and, in contrad'fiincriontothc eryfipeLitns,
 is  deep featcd, extending fo the interior part of the true fkin, which is
 the cafe with every fuch inflammation, called, therefore, phlegmonic ;
 while its feat in eryfipe'atus is betwixt the fcaif-flcin and the outer nai t
 of the true fkin  upon the corpus mucofum.  To  thefe plileo-mdfise  ac-
 companied with an inflammation of a part, depending upon the general
 caufe of the difkfe, and efpeeialiy up<n the effect of temperature, reuiy
 be added that which an  inflammation in one of the ears accompanies,
 though this cafe  Is  feldom admkted into the number of the phlet-nu.fi;>;.
'It  is, indeed,  fometimes loml, arifing frou local i.jijries,  hut is as cer-
 tainly st  others,  a general difcafu, and to all inir.ijj and  purpefes a
 phlegmafia.
  £t) Thofe two  difeafes, in young vigorous perfons, are very liable to he
 exceeding troublcfcmc by the frequency of their  occurrence.  In  the
 younger part of my life the violer.ee in degree, and frequency of recur-
  rence, of the fthenic inflammatory fore throat, was very dillrtfi;::g, 1:5
 the leaft variation of the  external temperature, fuperaddcd to a  f-e'.l
 nourifhing diet,  not without the ftimulus of a chcirfnl r.hf-, '■' as ready
 to renew it, not only the  inflammation, but the whole p'utnm-na vi
 the difeafe.  The fame thing I have often obfervcd in the frequent re •
 currcr.ee of the rheumatifm in perfons <if the fame age and h.ibit, pcr-
 hi.ps with  fome difference of temperament.  But  it is to be obfrrve-'l,
 thnt, in proportion to the advance cf life, and diminution cf vigour, both
 thefe dift.'ifi sbecon.c m'jch lefs frequent,  and much lefs violcr.t.  I'.-.j
 is at y thing ii'(.rc C( n.rr.in than :h::r giving way ct t!.r t:~c *.r a very
                                                        cri-cfi- 
9°         THE    ELEMENTS
   H. As the inflammatory fever, catarrh, the gentle fmall-
  pox,  are unattended  by inflammation (unlefs that in the
  laft a local inflammation from a local caufe, quite  differ-
  ent from that which makes our prefent fubject, takes place)
  and as  the inflammation in peripneumony,  violent eryfi-
  pelas, and fimilar other cafes of great violence, is found
  the higheft  in degree; for that reafon the conclufion  is,
  that the degree of inflammation, which is a fymptom of
  general fthenic difeafes, is proportioned to the degree of
  the fthenic diathefis (y).
    CLXIX. The inflammation, in this cafe, is nothing elfe,
 but a ftate of the inflamed part of a common  nature with
  that in the reft of the body.   And as the  inflammation is
 produced by a greater degree of excitement in the inflam-
 ed, than in any other equal part;  fo before the difeafe
 comes on, of which the inflammation is  only  a part or
 fymptom,  the excitement of that part is underftood to be
 proportionally greater than in any other part (z).
                                                  CLXX.
 oppofite difeafe, the gout, which depends upon a fuperaddition of direct
 debility to  the indirect, that laid the foundation of it. I am pretty cer-
 tain my inflammatory fore throat, or eryfipelas, never happened fponta-
 neoufly, nor without an addition of ftimuiant power, to thofe that pro-
 duce that difeafe, in  confequence of carrying to fome excefs the plan of
 care fuited to the removal or prevention ©f the gout.
  (yj It fhall by and by be fhewed, that this fort of inflammation is only
 a part of the general diathefis, fomewhat higher  in degree than any o-
 thcr part, but far ftiort of the degree conftituted by  the whole general
 affection.
  ' (z) See above, par. L. and Lf. Suppofe the excitement in every part
 of the fyftem to be 45 at fome point in the period of the predifpofition,
 »nd 54 in the part to be inflamed; after the coming on of the difeafe
 the fame proportion will hold ; when the excitement  has now mounted
 up to 60, the excitement of apart will be underftood to have gone to
 60 • keeping up ftill the fame proportion. But this 9 degrees of greater
excitement in a part, comes far fliort of the fum total of exritement in all
the  parts affected with the general fthenic diathefis ;  that you may fup-
                                                      1*0 fc 
              OF    MEDICINE.          91

   CLXX. This inflammation, which for the fake of dis-
tinction is to be called general fthenic inflammation, fhould
be diftinguifhed from another, which is a  local affection,
arifing from local hurtful powers, and depending upon a
fault in the organ, or a folution of continuity (a).
   CLXXI. To this  the term of fthenic local inflamma-
tion applies.  The general always  depends  upon fthenic
diathefis, is a fymptom or part  of it, never precedes it,
always  fucceeds to it fooner or later, arifes from the fame
hurtful powers (b), and is reduced  by the fame remedies.
In contradiftinction to which, the local affection, as it a-
rifes from local injury, producing a folution of continuity,
or deranging the texture of the part; fo, if the  labouring
part is not very fenfible, the affection extends no further.
In the cafe of a part being endued with  a high  degree of
fenfibility, fuppofe the ftomach,  the inteftines, among the
internal parts ;  among the external, the tender fubftance
under the nails  -, in thefe cafes,  the effect  of the inflam-
mation is propagated over the whole fyftem, and, in con-
fequence of an affection of all the veffels, excites a tumult
every where.   The fame local fthenic inflammation, whe-
ther it be fixed  in the part, or from its propagation, gives
more general difturbance, yields to no remedies, but thofe
that act upon the affected part firft, and heal the folution
of continuity (c). Let itfuffice to have faid fo much at prefent
                                                  upon
pofe 3000 : and then the conclufion will  be, that the general fihenic
diathefis  confifts in  a fum total of morbid affection, as 3600; while the
inflammation of the part is only an affection of 3 degrees of excitement.
  (a) Solution of continuity in all its forms, whether a* being the effect
of puncturing, cutting, bruifing, conipreflion, erofiou from acrid matter
or from heat, or cold, is always followed by an inflammation, which
when It goes on brifkly, and needs to have its violence reftraincd, ihould
be ealled as is expreffed u. the next paragraph.
  (b) which produce the other fymptoms,
  (c) or reparation »t  united fubftance^ 
9*2        THE   ELEMENTS
 upon thefe inflammations, for the fake of eftablifhing ne-
 ceflary diftindtions, as more is afterwards to be faid upon
 the local, in its proper place.   There are as many inflam-
 mations ftill remaining, univerfal  and  local, to be more
 fully explained in that part of our work where the proper
 order requires it.
   CLXXII. Inflammation,  alfo, as  often as it affects a
 vital part, produces fymptoms of difturbance.   Whether
 ever the general fthenic inflammation affects the brain and
 its membranes, is hitherto not afcertained (d).   And  it is
 more probable, that the  commotion of the head,  and
 other difturbing fymptoms of phrenitis, do not depend up-
 on inflammation, as the following phasnomena feem to
-fhow :  The firft of thofe is,  the eafe by which the cure
 is effected, the whole tumult of fymptoms  readily yield-
 ing to bleeding, purging and  other  afthenic (e) remedies;
 and, it not being very credible, that  the effect of actual in-
 flammation in  a part fo  delicate, and fo neceflary to life,
 could be  fo eafily effaced. .  Then  another argument a-
 gainft the fame opinion  is,  that there is no certain proof,
 after recovery, of the exiftence of inflammation during
 the difeafe.  Next, analogy  makes for the fame conclu-
 fion which wc are difpofed to draw j for, it has been faid
 above,  general inflammation does not arife internally in
 any fthenic difeafes (f);  on the contrary, as often as it oc-
 curs,  it is always in  an external part (g).   Nay, all the
                                              fymptoms
  (d) Phrenitis has been thought, and commonly even defined, an in-
 flammation of the brain ;  an opinion that, however Hniverfal, feeni9 to
 be liable to much doubt :  nay, there art m«iny reafons for adopting an
 oppbfite one, as will appear from the reafoning in this paragraph of the
 text.
   (e) What are commonly called antiphlogiftic.  we  call debilitating.
   (f) See above, par. CXIII.
   (g) It was long an opinion,  that the inflammation in rheumatifm
 might be transferred to an  internal part, as the ftomach ; but that, alfo,
                                                      it 
              OF   MEDICINE,          93

fymptoms are fuch as arif* from the general fthenic hurt-
ful powers,  and that, alfo yield to the general antifthenic
remedies, and in  proportion to their degree.
   CLXXIII. The fame (h) is the caufe of head-ach, red-
nefs of the eye, as well as of delirium.
   CLXXIV. There is, however, no reafon to doubt, but
that inflammation is the caufe of that difturbance,  which
happens to the lungs in peripneumony. To the part where
the pain is felt externally,  whatever part of 4the thorax it
is, an  actual inflammation is oppofed internally.  And,  as
the inflammation  is proportioned to the degree of general
fthenic diathefis,  and never happens but in a high degree
of  that diathefis  •, fo that the  pain is proportioned to the
degree of inflammation (i); and the  ftate of the  pulfe
muft  be cftimated  by paying a due regard to its caufe.
In  the cafe of an high diathefis, and high d-cgree of in-
flammation, its effects, the pain, feated  in fome part of the
thorax, fometimes about the fternum, fometimes nigh the
nipples, fometimes farther  back on either fide, fometimes
in the back between cr above the fhoulders, is acute and
                                                 pungent,
is now laid afide, and all the cafes where there could be the leaft appear-
ance of any fuch transference, have been found  to be cafes of  the gout,
or fome analogous difeafe of debility.
  (h) that we have afligned as the caufe of phrcnitic affection alfo.
  (i) The infla nmation was fuppofed a chief dnd primary circumltance
and its  caufe and ft-at, the caufe and feat of the whole difeafe; wh.h- the
general fthenic diathefis, and all the fymptoms depending on it, was fup-
pofed to be the offspring of the inflammation. I-ut the truth is, in every
rtfpect, the reverfe of this account. The general fthenic diathefis is  ths
effect of the general exciting hurtful powers.  As the effe& of thefe, i:i
a leffer  degree.it exits during the predifpofition, and before the arrived
of the difeafe; and, after the difeafe  is come on, it fubfifts as certui.ily
as fuch, for one, two, or three days, as afterwards, when the fign of the
inflammation, the pain, makes its appearance.   It is only an increafe  of
it, that induces the latter; and  i: is n >t to bs cared by a.sy concrlv '.ncc
                                                        of 
   94        kH  E    ELEMENTS

  pungent, and the pulfe very hard and ftrong.   When the
. diathefis, and the part of it we call inflammation is lefs, the
  pain is lefs acute, more dull, and eafier to be botne •,  the
  pulfe is (k)  ftill hard and ftrong, though lefs fo  than in
  the other cafe.  Afterwards, in the progrefs of the  dif-
  eafe, the pain abates, becomes dull, the refpiration, which
  had been much difturbed by it,  becomes more eafy  and
  free.   The pulfe, now, which  formerly was only hard,
  becomes truly and  pofitively foft, and that in proportion
  to the degree of indirect debility, occafioned by a neglect
  of the proper plan of cure ; or in proportion to the pro-
  duction of direct debility, from the antifthenic or debili-
  tating plan of cure having been pufhed too far.   But the
  hardnefs of the pulfe, and increafe of the pain, is never to
  be  imputed  to the inflammation being feated in the mem-
  brane ; nor  is the foftnefs of the former, and dullnefs of
  the latter to be attributed to its occupying the foft paren-
  chymatous fubftance (1), it being impoffible that an in-
  flammation, if it occupied either of thofe parts, fhould not
  affect the next  points of the veffels in the other.   The
  caufe, therefore, of thofe fymptoms that has here been af-
   figned,  muft be admitted.
    CLXXV. The puftules, which accompany certain fthenic
                                                   difeafes,
  of throwing any thing into the infhmmed part, there being no fuch thing
  to be found in nature, but  by the feveral means of removing the com-
  mon caufe, that is, evacuant and other debilitating remedies. Thofe,
  while, at the fame time, they remove the other fymptoms, by alfo re-
  moving the difeafe,prove that the common caufe of the whole is the ge-
  neFul diathefis.  The inflammation, therefore, inftead of being the caufe
  of the general diforder, is a confequence, like every other fymptom.
    (k) not foft and yielding, according to the common notion,  but
    (1) Such, however, and many other diftiuctions, equally falfe,  frivo-
   lous and mifleading in  the practice, have been at all times univetfilly
   received T>y fyftematic, and lately by nofologieal writers. 
 95         OF   MEDICINE.
 difeafes arife from a contagion, taken  into the body, dif-
 fufed over the whole, and, in pafling out of it, detained
 along with the perfpirable  fluid,  under the  fcarf-fltin.
 The caufe of the diftenfion, and,  therefore, of the great
 number of puftules, is the fthenic diathefis, taking place in
 a high degree over the whole body, but in a ftill higher
 in the veffels of the fkin, for  the reafons formerly  (m)
 affigned. In  which operation  the  mufcuiar fibres  of the
 veiTels,  becaufe they are as much increafed in denfity, in
 fo far as they are confidered as fimple folids, as they re-
 receive an increafe of tone, in fo far as they are confidered
 as  living (n), are, on  that  account fo  fhortened,  as not
 fufficiently to tranfmit the imperceptible vapour of the
 perfpirable fluid.  All the fthenic hurful powers have a
 tendency to produce this effect,  but heat, in a degree
 within its ftimuiant range, and fhort of indirect debility,
 more than any of them.  The fame is the caufe of coftive-
 nefs.
    0 Sthenic difeafes are often followed by debility, fome-
' times direct, at other times indirect,  as is exemplified in
 the change of peripneumony into hydrothorax, the expla-
 nation of which is evident from what has formerlv bee.n
 faid.


                C    H   A    P.    V.

                 The AJlhcnic  Diathefis.

     CLXXVI. Before the fymptoms of difturbance appear,
 which  only fupervene upon  a violent degree of mor-
          2                                         bid
    (m) See abo\e, par. CXIII. and CXIV,
    (n) See Chap. V. 
 <)6         THE   ELEMENTS

 bid ftate, all the fenfes  are dull; the motions, both vo-
 luntary and involuntary, are torpid ;  the  acutenefs of ge-
 nius h impaired •, the fenfibility and  paffions become lan-
 guid.  The following functions are all in a ftate of lan-
 guor, which is dikoverable  by the annexed marks :  The
 languor of the heart and arteries is difcernible in the pulfe;
 as is alfo that of the extreme veffels on the furface, which
 is evident from the palenefs, the drynefs of the fkin, and
 the fhrinking of tumors, and drying up of ulcers (a), and
 the manifeft abfence  of  the  fthenic diathefis,  to produce
 any refemblance to thofe fymptoms.   That the mufcles are
 in a ftate of torpor is  demonftrable by their weakened ac-
 tion ; and that the internal fecretions are defficient,  is  e-
 qually certain  from the penury of femen and milk,  and
 the redundance of fluids in a ftate of degeneracy.   The
 languor of the digeftive organs is.manifefted by want  of
 appetite, loathing of food,  fometimes  thirft,  ficknefs  of
 ftomach, vomiting, weaknefs of  the  fyftem, and evident
 penury of blood.
   CLXX^II. In the fame dkthefis, whether as net having
 attained to the height of difeafe, and only remaining with-
 in the latitude of predifpofition,  or as raifed  to the mea-
 ikre of actual difeafe, the  intellectual faculties and the
 paffions are impaired.   In this way are the functions im-
 paired.

               CHAP.   VI.

 The Afthenic Diathefis  illttftrated by  an explanation of  its
                     Symptoms.

   CLXXVTII. SHIVERING is not unufual at the com-
 mencement of afthenic difeafes of any confiderable fere-
                                                 rity;
  (a) Thefe fymptoms have  lately been conftrued into fo many mar'.ti
amounting to a proof of the cxiftence of fpafm upon the extreme veffel j
but we fhall, by and by, find a much better explanation of them, 
             OF   MEDICINE.          97

 rity ; and that, as often as its caufe, a very deficient per-
 fpiration takes place.   In this cafe the caufe of the defi-
 ciency is, from the weaknefs of the whole fyftem,  that
 weaknefs of the heart and arteries,  in  confequence of
 which they propel their fluids every where with difficulty,
 and in  their  extremities with ftill more difficulty, or
 fcarce at all.   Hence the perfpiration ceafes.   The fame
 is the explanation to be given of the fenfe of cold, when
 it accompanies  the fhivering.
   CLXXIX. In afthenic  affections the  pulfe is weak,
 foft, fmall, and very quick.   The foftnefs, when it can be
 perceived for the fmallnefs, as  well as the fniallnefs, is
 occafioned by an under-proportion of blood,  arifing, dur-
 ing the period of predifpofition, from a fcantinefs  of ani-
 mal food, and an excefs in the ufe of vegetable •, or from
 a deficiency of aliment upon the whole, whether from the
 one or the other fource.   The caufe of the weaknefs and
 very great quicknefs of the pulfe is the fame deficiency of
 nourifhment,  as well as of all the ftimuli, fuch as that of
 ftrong drink, that of mental or corporeal exercife, and an
 under-proportion of blood.
   CLXXX. Since the excitability can only be gradually
 worn down (a) and the ftrength,  thereby, repaired; if,
 at any time, therefore, the pulfe becomes full and hard
 too foon, and without a proportional relief of the fymp-
 toms, that is a bad fign, and happens becaufe the ftimuiant
 plan of cure (b) has been pufhed beyond the proper rule
(c) ; and it is a  cafe of indirect debility fuperadded to the
direct (d).
   CLXXXI. The fame is  the caufe of the  palenefs and
 drynefs of the flan, as that of a checked perfpiration; that
is,  the  weaknefs of the heart and arteries.   Hence the
blood is not fufficiently propelled  to the furface of the
body.l
                         H                CLXXXII.
  (a) See above, par. XXVI. XI.HI. (b) otherwife the proper one,
 (c) See aW-\ par. Xi.JX.    (d) See above, par. CLVI. 
 98         THE    ELEMENTS

   CLXXXII.  Head-ach, which is a moft frequent fymp^-
tom of afthenic affections,  and pains in the joints, which
are more rare, are occafioned by a fcantinefs of blood :
for fuch is the effect of the blood in diftending the veffels,
that a moderate diftention,  fuch as takes place in health,
excites  an agreeable fenfation ; and every thing, either
above or below that ftandard, occafions an ungrateful one,
and, therefore, (e), pain.   But, we are much lefs in this
cafe, than  in that of fthenic pain (f), to fufpect inflamma-
tion for the caufe of the pain ; becaufe, not only the pain
here, but  even delirium, yields  fo eafily to the ftimuiant
method of cure; which would not readily happen, if fb
delicate and fenfible an organ, and one fo neceflary to life,
laboured under  an affection  fo liable  to deftroy the tex-
ture of the affected part.
   CLXXXIII. Neither in general,  is  delirium,  and for
the fame reafon  (g) to be imputed to inflammation.   It
is, on the contrary to be attributed to a fcantinefs of blood,
and a deficiency  of other  ftimuli.  Nor is that by any
means to  be doubted; fince ftimuiant remedies, which
have no effect in  filling the veffels, fuccefsfully and quickly
cure every delirium depending on debility (h).
   And, when, in confequence of the removal of the dif-
                                                    eafe,
  (e) when it rife9 to a certain degree,
  (f) See above, par, CLVII.
  (g) that has been juft now mentioned,
  (h) This  is a fact as new, and of as much importance as any in this
whole work.  Phyficians hitherto,  had no diftinct notion of a variety
of inflammations, and had fcarce any idea of any inflammation, but
fuch a one as was  to  be treated with bleeding and evacuation ; nay, of-
ten, when they had no reafon to fufpect inflammation at all, the mere
circumftance of pain was, in their eftimation of it, fufficient to warrant
a profufion of bleeding without end.  But, the  truth is, that pain may
net only  arife from an inflammation, which they had no idea of, and
which was to be cured by ftimulants, but it arifes from fpafms, convul-
fions, and even from emptinefs. 
              OF   MEDICINE.          99

cafe,  and of  the  re-production and eftablifhment of the
healthy ftate,  enough of nourifhment is taken in and di-
gested, then it is that, at laft the mental function receives
a complete and folid re-eftablifhment.
  CLXXXIV. Thirft and heat, which do hot lefs diftin-
guifh afthenic, than fthenic difeafes, and are not lefs fre-
quent fymptoms, arife from the afthenic diathefis in the
throat, and on the furface of the body, checking, in the
latter cafe, the perfpiration ; in the former, the excretion
of the faliva, the exhalable fluid, and the mucus, and that
from the atony and relaxation of the extreme veffels.  In
confequence of the former, the throat being not fufficient-
ly lubricated  with a due quantity of its refpective fluids,
is fcorched with thirft.   The effect of the latter is, that,
the perfpirable fluid being detained under the cuticle, to-
gether with it the  heat, which in  a free perfpiration ufu-
ally goes off in wafte into the air, and remains nearly of
the fame degree, is accumulated and increafes.  But  the
increafe of heat depends not on the  ftate of excitement,
or, as it is commonly called, the principle of life,  fince it
happens both in the fthenic diathefis, and, likewife, in in-
direct,  as well as  direct debility.   But the  weaknefs of
the veffels on  the furface  of the body,  under which the
throat and whatever part is acceffible to air, is comprehend-
ed, is a part of the debility of the heart and arteries;  the
latter a part of that of the whole fyftem.
  CLXXXV. This afthenic thirft, which is a much more
frequent and more violent affection  than the  fthenic, is
preceded by lofs of appetite;  the lofs of appetite by loath-
ing of food ; it is fucceeded by ficknefs at ftomach, vomit-
ing, often an acute pain of the ftomach, and other trouble-
fome fymptoms ;  the explanation of which we next pro-
ceed to.
                       II  2                CLXXXV J. 
  I0O        THE    ELEMENTS

    CLXXXVI. Want of appetite, loathing of food (i), de-
 pend upon a debility of the whole body; as is proved by all
 the debilitating antecedent powers that produce them, al-
 ways acting by debilitating;  and by all the remedies, which
 both prevent and cure them, always acting by a ftimuiant
 and ftrengthening operation. The  caufe of the appetite is
 a ftrong and found contraction of the fibres of the ftomach,
 by which digeftion is fupported (k), and the excretion of a
                                                         fluid
   (i) Thefe fymptoms of want of appetite, loathing of food, thirft, fick-
 nefs at ftomach, vomiting, and acute pair of the ftomach, as well as thofe
 that follow to the CXCV. and from that to the CXCVIII. form a chain
 of fymptoms depending upon incrcafing debility, which, inftead of being
 different in kind, are all connected by an uniform operation of nature.
 And they furnifh  an iuftructive  inftance of the  erroneous  mode of
 judging of the nature of fymptoms, and morbid affections, which hasbeen
 fo prevalent in all fyftems of phyfic, that we are yet acquainted with.
 However different in appearance they are not only  fimilar, but all unite
 in forming one and the fame kind of difeafe, one and the fame morbid
 affection : which is proved by their arifing all from one and the fame
 fet of hurtful powers, to wit, debilitating;  and by  their being cured by
 one and the fame fet of remedies, to wit, ftimuiant.  The former powers
 may vary in degree,but they are all debilitating; and the latter may alfo
 act with different degrees of force, hut they are all  ftimuiant.  And the
 ftate of the fyftem, from which the former conftitute a deviation, as well
 as that, to which the latter produce a return, is health, which is always
 the fame.
  (k) The fibres of the ftomach are mufcuiar,  and partly longitudinal,
 partly oblique, or approaching to circular.  When the food is taken in,
 the former are contracted and fhortened, by which  theyraife the under
 part of the ftomach, which is unfixt upwards.   Thefe gradually relax
 as the food, after its firft digeftion in this organ,.and its converfion into a
 more fluid form, in the fame gradual manner, paffes out of the pylorus,
 or under orifice of the ftomach. This operation takes off the difteading
 weight in the direction from above downward j and, as the food,  in
 proportion to its converfion from a more folid to a more fluid form, i»
 more and more collected into the under part of the cavity of the ftomach,
 this gives a preffure in the lateral way, and, therefore, throws the other
fibres into contraction, by which the fides of the ftomach are fqueezed
 together, and, thereby,perform the office, of throwingout.bythc pyloruj,
                                                          the 
OF   MEDICINE.           IQI
  fluid, fuch as the gaftric (1) liquor, fuch as the faliva (m):
  and to the effect of both a certain emptinefs of the ftomach
  is neceflary.   But none of thefe circumftances  can take
  place in a ftate of debility. The fibres do not contract with
  fofce ; the extreme veffels do not pour out their fluids; the
  matter of food,  formerly taken  in,  is  not diffolved and
  properly mixed,  and in that ftate thrown  out of the fto-
  mach ; but continues  in a great meafure unchanged and
  indiffolved.  Hence it is, that there is no appetite for food,
  and in a higher degree of it, that a loathing takes place.
    CLXXXVII.  In the fame manner has thirft been ex-
 plained (n); and  in the fame manner is the ficknefs at fto-
  mach, which is a higher degree of affection from the fame
  caufe ; for when  there is ftrength and vigour, fenfation is
 moft agreeable in every part of the  fyftem,, as well as in
 the ftomach and neighbouring parts.
    CLXXXVIII.  With refpect to vomiting;  it is the  chief
 of all thefe affections, that we have been fpeaking of; for
 to fuch a  height has the atony and laxity of the fibres in
 the ftomach gone, when it comes on; to fuch a degree has
                                                      the
 the remaining part of the alimentary matter. Befides thefe fucceffive ac-
 tions, the mufcuiar fubftance of the ftomach isfo conftructed as to be pro-
 vided withfibres, the motion of which,when the ftomach is ftill, isupward
 and downward; when empty downward only.  All thefe motions give the
 alimentary matter the mechanical agitation  neceflary to promote its
 mixture.
  (1) or fluid peculiarly fecretcd and excreted in the ftomach.
  (m) The gaftric fluid, poured into the cavity of the ftomach, as well
 as the faliva that  follows it from the palate, and the watery or other
 drink taken in by  the mouth, contrihute to change the food more and
 more Into a fluid confiftence, which is a change only of its form; but by
 certain means, a change alfo of its nature, called in chemiftry proper mix-
ture, takes place. This change is chiefly effected by the gaftric fluid, to
which, perhaps, a certain relation that the other fluidsbea'r to the alimen-
tary matter in this living organ, contributes. Another means of promot-
 ing the folution that goes on in this procefs  is the heat  of the ftomach.
  (n) See par. CLXXXIV. 
  102      THE   ELEMENTS

 the collection  of crude nafty matters proceeded, and the
 diftention of the ftomach from thefe laft, and air let loofe
 is become fo exquifite, that  the fibres are oppreffed, and
 cannot perform their motion from the  upper to the lower
 part, which is commonly called the periftaltic motion. And
 as in  every cafe, both of health and difeafe, the tendency
 of that motion is always  from the ftimulus in an oppofite
 direction ; downward when the ftimulus proceeds  from
 the mouth, and upwards when it comes from the ftomach,
 in that  way it is that the crudities, and air let loofe, of
 which mention has been made, acting  as a local ftimulus,
 direct all the motion, that they excite,  towards the upper
 parts of the canal. This  inverted motion, being contrary
 to  nature, can never be agreeable;  and  hence, before
 the  arrival  of the  vomiting, ftomach-ficknefs, arifes;
 which when it continues for  any time,  muft be violent,
 becaufe the local ftimulus roufes the mufcuiar fibres into
 violent aud irregular motions.
   CLXXXIX. The  caufe of pain in the ftomach and in-
 teftines, and other parts, both Internal and external, under
 a fthenic diathefis, is fpafm.  Spafm in any internal cavity,
 that is, in the organs of involuntary motion, is, by means
 of the debility  in common to its feat with the whole body,
 a relaxation and atony of the fibres, and together with that
 a diftending matter ; what conftitutes that matter in the
 ftomach  is the fordes or foul crudities,  in the inteftines;
 hardened excrement: in both air let loofe.   The effect of
 this matter in the diftention that it gives, does not fo much
 depend upon itfelf as upon the lax ftate  of the fibres dif-
 tended by it;  for the fibres, when ftrong and vigorous,
 eafily repel the diftending power, which overpowers them
 In this ftate: but the relaxed fibres, of which we are fpeak-
 ing, yield more and  more, and that in proportion to the
urgent force exerted on them, till looting  all  power of re-
                                              filition, 
©F   MEDICINE.          103
 filition or contraction, all power of relaxation,  they con-
 tinue immoveably contracted.   All which happens accor-
 ding to the nature of that property in mufcuiar  fibres, by
 which, when they are ftretched, they do not, like  com-
 mon elaftic matter, only contract when  the diftending
 power is removed, but even while it remains.   During
 fuch action and fuffering the fenfible fibres undergo a cer-
 tain violence; and hence the pain.  But, that more is to
 be attributed to their own laxity, than the diftending mat-
 ter, is proved by ftimulants reftoring the tone and  denfity,
 which  are exactly in proportion to each other, as depend-
 ing upon the fame  caufe; by which means contracting
 in the  manner  of found fibres, and powerfully reacting,
 they, without any affiftance, as has lately been afcertained,
 reftore the periftaltic motion, and drive downward before
 them the matter ftill  remaining,  and ftill  continuing to
 diftend (o).   In this way wine, aromatics, and volatile al-
 kali, and, above all the reft, the various forms of  opium,
 diflodgefrom its feat all fuch hurtful matter without either
 vomiting  or purging, and that without any difficulty, and
 in a very fhort fpace of time.
   CXC.  The pain, which is fo  often  troublefome in the
 external parts of the body, alfo depends upon fpafm, but
 not with  the conjunction of a diftending matter.  And a
 power  takes the place of it, which is not to be referred to
 any matter, but to a certain effort of the will in moving a
 limb (p). By means of that the fpafm is excited in the fame
                                                manner
  (o)  The  prevailing notion with refpect to this kind of affection has
been, and ftill is, that its caufe is the matter here fpoken of, which is
only an effect of the caufe, and that its cure, when the affection is in the
ftomach,  is vomiting to carry off the fuppofed caufe.   Hut its true caufe
is the laxity of the fibres, and their atony from the  general debility,
yielding to the diftending force of the matter, and thereby lofing their
tone and  denfity more and more ;  while vomiting therefore  increafes,
ftimulating  removes the difeafe,
  (P)  Sea LVIJI. 
104
THE   ELEMENTS
 manner as in the other cafe, by diftention, and often with
 the moft exquifite pain, where, as the effect is the fame,
 that is, a fpafm, arifing from debility, and to be removed
 by reftoring the ftrength ; for that reafon the caufe alfo
 muft be the fame, and be reducible to debility, together
 with fomething that altogether refembles debility, and pof-
 fefs a power equal to it.   In this way of reafoning  (q) we
 may often fafely rife from the contemplation of known ef-
 fect to that of unknown caufe.  The pain we  fpeak of at
 prefent is that which refpects the  fpafms of the mufcles.
   CXCIII. There is another pain,  lefs confined to the fame
 part, more diffufed, and equally troublefome, which is not
 fupported by diftention, but  by  another local  ftimulus,
 equally arifing from debility, of equal tendency to increafe
 the debility, and, by  its  debilitating operation, together
 with the other fymptoms  of debility, haftening on death.
 This pain arifes from a concentrated acid, which is fome-
 times predominant in the alimentary canal, when under
 the influence of great debility, of which cholera chiefly is
 a clear example; but, befides that, all the affections of
 the alimentary canal, that are accompanied with vomiting
 and a loofe belly, are more or lefs examples of it.
   CXCII.  This acid is not the primary caufe,  but only
 a fymptom fupervening upon the difeafe, already  formed
 in confequence of the debility, its proper caufe, and now
                                                   fully
   (q) a way of reafoning never made ufe of in medicine befo/e, butwhich
 runs through, and influences moft of the propofitions in this work. It is
 further to be obferved, that, upon no occcafion, can we ever arrive at an
 adequate knowledge of abftract caufes ; that the cagernefs of mankind
 to rufli into wild and fanciful explanations of them, without any regard
 to real phenomena of nature, has been the caufe of all the falfe phseno-
 mena that ever appeared in the world, and  that the only fure snd faithful
 guide to the ftudy of caufes is a cautious and painful inveftigation of the
 effects and phenomena of nature that proceed from them. See  more up-
 on this important fubject, and, indeed, a complete difcuffion of  it, in my
book, entitled, " Obfervations on the old Syftems of Phyfic." 
OF   M £  D  I -€ I N E»          10$
fully eftablifhedi arifing from the fame fource as the other
fymptoms,  and to be removed by  the  fame remedies.
When the  fame acid has arifen, it continues  to  increafe
all debility  that happens to be  predominant, either in the
firft paffages, or in the reft of the body: And,  while it
exerts the operation over the whole body, its influence is
in the part where it exifts, and where  the diminution or
the force of the difeafe is moft wanted.
   CXCIII. But, though it be itfelf  in that way the off-
fpring of debilityi and of a tendency  to create further de-
bility j ifi the fame manner as fpafm has been ftid to be ;
ftill there is not, either for the fake of changing, or thfow-
ing it out of the body, occafion for any Other indication Of
cure: For, as it has its rife at firft from a general caufe,
foupon that it all along depends; whatever has the effect
of overcoming the other fymptoms, has alfo that of over-
coming this.  For that  purpofe it is, that, as in the cafe
of fpafm,  ftimulants,  not emetics^  nor purgatives, nor
any other debilitating powers, are required.
   CXCIV. As the acid, which has been mentioned, pro-
duces the  pain in the internal parts, or in the organs of in-
voluntary  motion; fo in the external parts, or organs of
voluntary  motion, it is occafioned by fomething  that pro-
 duces the  fame effect as the acid,  that depends  upon the
 will, and acts in conjunction with the convulfive ftate; and,
 as in the cafe of fpafm,  there is no matter that correfponds
 with the diftending, fo in this there is  none to correfpond
 with that which produces the pain. Nay, as the fpafmodic
 cafe is reprefented by any cramp of the mufcles,  fo is the
 convulfive by any convulfion, but, above all, by epilepfy.
 Finally, as in the former,the fame reafoningfrom known ef-
 fect  to unknown caufe proves the farhenefs of the external
 and  internal cafe, it equally proves  their famenefs in the
 latter (r).                                     CXCV.
   (r)  All this reafoning with  rcfpect to fpafm and Convulfion, fho\y»
                                                    ing 
  106        THE   ELEMENTS

    CXCV. The fimple courfe of morbid affection from its
 filghteft to it moft violent degree (to take a review of the
 fubjects from the place where we fet out), is, that it begins
 with lofs of  appetite, and is brought on by want of the fup-
 ports of food and of other ftimuli, or by an over-proportion
 of ftimuli, and proceeds through all the intermediate de-
 grees to  fpafmodic  or convulfive pain.  For the reafons
 lately  affigned, there is firft no appetite for food, and if
 the patient perfeveres in the debilitating procefs of cure, and
 food is not adminiftered, fuch, fuppofe, as can betaken in
 the form of foups, a loathing of it follows. By-and-by,if
 ftill nothing  is ufed to produce ftimuiant effect, thirft will
 come on; there will be the moft keen defire for  the  moft
 debilitating power, cold water, which will be  preferred
 to the greateft dainties, and will be greedily fwallowed (f).
 To this ftomach  ficknefs  immediately fucceeds, which,
 unlefs prevented by a diffufible ftimulus, fuch as a glafs of
 the moft pure and ftrong fpirit,  or,  failing that,  another
                                                  perhaps,
ing them to be the fame, and only a part of the whole, a link in the chain
of the other afthenic affections, which have been mentioned, as well as
the facts and arguments next to be brought, which will ferve to prove all
that follow to be alfo the fame, is, of itfelf, of the higheft importance to
mankind. In a particular manner, the whole tribe of difeafes of the ali-
mentary canal, and almoft all thofe of children, all. indeed, but the con-
tagious eruptive ones, arc  both explained, and their principle  of cure af-
certained, with geometrical exactnefs. Here, then, atonCe is a difcovery,
noon fcientific principles, of the true nature, and certain cure, of more
than one-half of the difeafes of the human race; the method of cure arif-
ing from this doctrine having never failed in any of them, and never fuc-
ceeded upon a contraryplan, the debilitating and evacuant, fo univerfally
recommendedbythe authority of the fchools. The fpafms and convulfions
 of the external  parts,  unlefs when  immoderate in degree, are equally
certainly removed by the  new  method,  and even epilepfy and tetanus
yield to it.
 (f) When this  afthenic thirft conies on, it is the higheft luxury in na
 tnre to be allowed a free indulgence  in the ufe of cold water, which is
 always hurtful in proportion to the degree of its coldnefs. 
O F  M  E  D  I C I N  E.          I ©7
perhaps, in fomecafes a third, rufhesinftantly on to vomiting.
When the affection rifes a little higher, during the vomiting
a violent pain arifes in the ftomach, giving a fenfation as if
there were a bar of iron in it, forcibly ftretching and tear-
ing it acrofs (t).   When the affection becomes ftill more
fevere, and the caufe of the difeafe ftill higher in degree,
every kind of torture is undergone ; an head-ach comes on
with a feeling  of ftrokes  like thofe given by an hammer.
Thefe fymptoms  of difturbance are communicated to  the
alimentary canal,  for the moft part not immediately,  but
in confequence of the difeafe remaining, and lurking, with
an  intervention of  intervals of deceitful  refpite.   The
belly is often affected with gripes  and great pains, and ex-
ceedingly  loofe; but,  which will not be wondered at in
an inverted ftate of the periftaltic motion, it is oftenercon-
ftipated, and,  from time to time, undergoes all the vicif-
fitudes of alternate vomiting and purging.   Among the
troublefome fymptoms, that  hare  been mentioned,  are
comprehended  dyfpepfia, called in common Englifh Indi-
                                                  geftion,

  (t) A lady, after nurfing  her twelfth child for feven months,  was
found by her hufband, a phyfician well acquainted with the new doctrine,
very low fpirited one evening.   She was of a delicate, thin, exhaufted
habit, and had been fubject  often before, towards the end of her peri-
ods of nurfing, to lofs of appetite, colic,  dejection of fpirit, and as often
cured by removing fhe child from her breaft,  and putting her  upon a
rich ftimuiant regimen.  Her friend and phyfician perceiving the caufe
of her dejection, ordered two of their daughters, who happened to be
grown up. to fit up and rock the child in the  cradle all night, and alfo
watch their mother to adminifter to  her the things he  had ordered.
They themfelves went to bed.  The reader fhould have been informed,
that fuch was thi» lady's lowncfs of fpirlts, that tears burfted from her
eyes upon hearing the fudden order for  the weaning of the infant. He
fell afleep;  but in an hour's time was wakened by the noife of  a moft
violent vomiting fhe had fallen into. She had a  pain in her ftomach at the
fame time, from her account of which the defo-iption above was taken.
All  this had been  occafioned by her applying the child's mouth to her
nipple 
  IoS         THE   ELEMENTS

 geftion,  the  gout,  diarrhoea, loofe-belly, dyfentery,   or
 the bloody-flux,cholera (u), the colic (x), the iliac (y) paf-
                                                            fion,

   (u) or that difeafe, the urgent fymptom of which is alternate vomiting
 and purging, the effect  of which, while their caufe is a  -eneral weak-
 nefs over all, but prevalent in the I'-vH paffSges, is to ilicr-rsfe the weak-
 nefs, from which they proceed to fitch a degree,  as to In><^<  {>•■ thepa-
 tient's death, with every fyrflptom of expiring debility,   in  the fhort
 fpace of fixteen hours.  This happens ia the warm countries, as the fou-
 thern parts of Europe, and efpecially In the torrid zone, whether *u Afia,
 Africa, or America.
  (x) The colic  has teen commonly treated by purging  and bleeding,
 and low diet ; but in no inftance has that treatment of it been fncc«fsful.
 Opiates were particularly forbidden upon the fuppofiticn of thei- .onfti-
 pating the belly; but the truth is, that the colic, as wli as ^.iarrhcea
 (Which has been fuppofed a difeafe of an oppafitt nature, fro en the feem-
 ing contrarietyof loofenefsof the belly,and coftive-ueft tb each other), are
 the fame kind of affection, only differing in degree,  .rd  the colic is to
 be remostd by no other means than thofe that re   vt the fimple loofe-
 nefs; that is by durable and diffufible ftimulants
  (y) which is that higher  degree of colic where vomiting comes  on,
 and the periftaltic motion is fo inverted  as to Occafion the rejection of
 ftercoraeeous matter by the mouth.   Sometimes in the progrefs of  the
 fame difeafe, efpecially when treated only by evacuation and bleeding,
a portion of gut is infinUated into the cavity of the n*xt portion. This is
called in the art Volvulus, or Ihtns Sufceptio.   The quick and effectual
 cure of colic before the fymptoms of volvulus make their appearance, is
 i good proof that the latter is induced by the purgative medicines, em-
 ployed to deaT away the obftructing caufe, acting with fuch relaxing ef-
 fect, and ttrgerit  vioknce,rs to turn back the inverted motion in one part,
 while it continues inverted in  all the reft, and particularly in the portion
 next to it. The ordinary cvacuant plan therefore, is a caufe of the violence
of the difeafe in all its ftages; and laftly, of the laft, which becomes a lo-
 cal and immoveable affection.  Nothing could be  more abfurd than the
reafofling that has dire&ed the practice of phyficians.  In which, befides
the general rules  of bleeding to cure bleeding, vomiting to cure vomiting,
and purging to Cure purging, and befides the eontradictio h of employing
 purging in colic, Which by the laft rule only applies to diarrhcea ; they
have taken it into their head, that a good means of remeving the ob-
                                                         ftructing 
                  OF    MEDICINE.            109

  fion, the green purging of infants,, the worms, that wafting
  of the body calledTabes, or Confurnp tion, and atrophia (z),
                                                             both

 ftructing matter in colic, was to throw in a large quantity of heavy fub-
 ftance with the intention of forcibly difplacing it; reaforing in that way
 not fo well as a foldier would do in clearing away any foul matter from
 his firelock ;  for it fliould have been remembered, that whatever effect
 fuch fubftances, as quickfilver, might have by their weight in pufhing
 downward any obftructing matter,  they  muft  operate with a contrary
 effect,  as often  as in the  convoluted  ftate of the inteftinal canal, the
 courfe  of any portion was upward*  Neither did it ever ftrike them,
 upon any one occafion, what they never fhould have left out of view
 upon every occafion,  that the idea of  the action ot dead matter upon
 dead matter, whether mehanical or chemical,  that is, perceptibly or im-
 perceptibly mechanical, is never to be transferred, in found reafoning,
 to the mode of action  of the fame dead  matter on living matter ; the
 excitement in no cafe whatever admitting of any fuch analogy.
   (z) Thefe two  difeafes, according to a theory that has at  all times
 prevailed in the fchools, and has pervaded all medical fyftems, are fup-
 pofed to originate from an obftruction in the mefentric glands, through
 which the chyle, or alimentary matter, after undergoing a doable prepa-
 ration, one in the ftomach, and another in the firft convolutions of the
 inteftines, has to pafs  before  it arrives at its  common  receptacle, the
 thoracic duct, in order to be thrown into the venous mafs of blood; and
 to remove it, ftill upon the fame idea, as if all  the cavities of the animal
 economy, whether great or fmall, were to  be cleanfed, like the fol-
 dier's firelock, no limits were fet to the ufe of gentle aperients, and par-
 ticularly the ufe  of mineral waters.  And they  ufed gravely to tell us^
 that with the help of a courfe of  time, fuppofe the arrival of the in-
 fant, or child, at the feventh  year of his  age, that would carry off the
 difeafe by its detergent operation, provided the obftruction  were not f»
 great as to i;ui ice death before the lapfe of that period.   That all this is
 idly theory devoid of all foundation in truth, is  proved by the completion
 of hundreds of cures in the fhorteft fpsces  of time, by means of durable
 ftimuli, which act upon their delicate frames with fuch efficacy as t© fi>
 percede,  unlefs in the moft violent cafes, all ufe  of the diffufible.   This
remark applies likewife to worms, for the  cure of which no bounds were
 fet to the ufe of  purgatives, npon the idea of clearing away the fluff in
 which this vermin  neftled ; a practice not fo judicious as that of fome
 foolifh boys, who place their fuccefs in bird-catching upon the chance of
                                                         bringing 
HO       THE   ELEMENTS
both of them difeafes chiefly  of children, and by far the
greateft part of the difeafes of that age.
   CXCVI.  As the caufe of the difeafe proceeds, and the
exciting hurtful powers prove more urgent; the external
parts are drawn into confent,  and now the organs of vo-
luntary motion are  affected.   Sometimes the legs,  fome-
times the arms, and other parts, differently  upon different
occafions, are tortured with cramps; fometimes the thorax
varioufly all round ; fometimes  the fhoulders, fometimes
the fides,  fometimes the back,  fometimes  the neck, are
affected with pain, from which pains no part of the hu-
mon body is exempted, and  the region of  the lungs, of
the liver, and of the ftomach,  are efpecially liable to them.
The fmart pains that affect thofe parts, and are fuppofed to
                                                   proceed

bringing*down the nefts from the top of high trees, by throwing flicks
and ftones at them ; while other boys, both more fenfible and alert, climb
up and feize every one of them.  The caufe of worms is the fame as that
of all the other difeafes we have fpoken  of, differing  in nothing but in
what they all differ from each other, mere degree.  Debility over all,
but prevalent in the alimentary canal, occafions a weaknefs both in all
the other functions, and particularly in that of the periftaltic  motion.
This ftate implies  a fimilar weaknefs in the veffels that pour their fluid?
into that cavity ; their weaknefs implies an enlargement of their diame-
ters, and that enlargement an Increafe of the quantity of fluids thrown
in, without any increafed impulfe behind.   Hence arifes  a colluvies of
matter, which the increafed periftaltic motion is not able to throw off.
The colluvies is increafed by the ufe  of vegetable matter and fruit taken
into the ftomach, and depofiting their feculent parts upon the inteftines.
The indication of cure is not to increafe cither the general, or particu-
lar part of the  caufe, by purging, and the ufe of other debilitating pow-
ers, but to ftrengthen the whole living fyftem ; arid efpecially the  intef-
tinal canal, by the whole round of ftimuiant remedies diffufible or dur-
able.  To this treatment the tabes and atrophia will yield in a few days,
or even hours; the worms in as many weeks. And they are all increafed
by the common ptan of cure, as univerfal experience has proved to a dc-
monfl ration. 
OF   MEDICINE.
Ill
 proceed from internal inflammation, are, in reality, owing
 to  fpafmodic or  convulfive affection (a).   That  this  is
 their true origin is proved by the renewal of ftimuli, remo-
 ving the affections, often immediately,  always in a fhort
 time, and reproducing the healthy ftate.   It is proved by
                                                            the

   (a) Endlefs have been the bleedings and other evacuations employed
 to remove thofe painful affections, and as difmal has been the effe.»©f
 that method of cure.  The univerfal rule fuggefted by the principles,
 and confirmed by the practice of this new doctrine, is to invigorate the
 whole fyftem, and apply any diffufible ftimulus, particularly laudanum,
 to the pained parts.  By that practice I know not one cure, of fonie
 hundreds, that  either I or  my  pupils have performed, that has failed.
 The gout will fometimes make its attack in this way.   Eut whatever be
 the particular force of difeafe, with which they may feem te have any
 connection, the only diagnofis here neceflary is to be fare that the  true
 pcripneumony, is not the morbid ftate.  When that is out of the quef-
 tion, and  whether the painful complaint be denominated baftard peri-
 pneumony or not, the only indication of cure is what has been juft now
 mentioned.  A young lady,  with whom I am nearly and tenderly con-
 nected, has been often affected with an acute pain in her right fide, moft -
 ly fixed and folitary, fometimes accompanied with a certain numhnefs
 and fenfeleffnefs in her extremities, commonly with lofs of appetite, and
 fome degree of head ach.  The effectual method  of cure  is to apply
 rags dipped in laudanum, volatile alkali, or aether, and renew them as
 often as they become dry,  and to  fupport her internally with durable
 and diffufible ftimuli, proportioned in kind and quantity to the exigence
 of the cafe.  This method of cure of a morbid affection,  that upon  the
 contrary debilitating evacuant plan would  be readily and quickly con-
 verted into an incurable afthenic difeafe, has always proved infallible in
 removing  the attacks, which never after return but when fhe has enfee-
 bled herfelf by keeping the houfe too much, and neglecting air, exercife,
 and the ufe of the other diffufible ftimuli.  Friction ufed over all the af-
 fected parts, is alfo found ufeful in fupporting the ftimuiant operation
 of all the other remedies.  There  is in the fens of Lincoln, where an e-
minent phyfician, and follower of this doctrine, practifes,  a difeafe call-
ed a baftard peripneumony ; in which, though it had always baffled aH
the efforts  of the common evacuant practice, he never loft  a patient,  by
•icrcifing the contrary one. 
  112       THE   ELEMENTS

 the tmfuccefsfulnefs of the contrary method of cure, which
 proceeeds upon bleeding, the various modes of purgation
 and abftinence.  Nay, what even makes more for the fame
 conclufion, is, that, while abftinence almoft alone is often
 fufficient to produce the  pains,  rich diet  alfo  alone  has
 been fufficient to remove them (b).
   CXCVII. The fame pains,  fometimes combined with
 enormous motion (c) fometimes  without it (d), are abfo-
 lutely free from inflammation. To diftinguifh them, then,
 from the pains that flow from inflammation or a fimilar o-
 rigin, the concourfe of accompanying fymptoms muft be at-
 tended to. Sthenic diathefis points out that whatever pains
 occur are fthenic; and  the information received from the
 afthenic diathefis is, that the pains appearing in it are parti-
 cipant of its nature and as certainly afthenic. This remark
 is of deep application to difeafes of daily occurrence,  and
 overturns the common practice.   Even head-ach, which
 is fo frequent an affection,  is ten times to  be removed by
 the ftimuiant plan, for once that the contrary anfwers (e).
            2                                  CXCVIII.
  (b)  This I have often experienced in the cafe of  the gout.  Eefore
 dinner, when my ftomach was empty, I have limped in going abroad to
dine.  But after having made that meal heartily, and taken a  glafs or
two of wine, have returned with a perfect firm ftep, and  free from all
feeling of pain and uneafinefs.
  (c)  as in the convulfive kind fo lately fpoken of, where the enormity
of motion is fometimes external and in the organs of voluntary  motion,
fometimes internal, as in cholera and fo forth,
  (d) as in the fpafmodic pains, head-ach, pains in the legs and foles,
where there is an inability to perform the due  motion.
  (e)  The true reafon for all this, and innumerable errors in the prac-
tice, is that the leaders in the profeffion never underftood any diathefis
but a fthenic one, or any indication of cure but an  afthenic, to which
they gave the name of an antiphlogiftic, as they didthatof phlogiflic to
the diathefis.  By his reformation of the erroneous plan of cure, that hia
cotemporaries, the Alexipharmacs, had introduced, in the fn'.all-pox and
the few other fthenic difeafes that ever occur,  in all  the reft cf the ge-
                                                    neral 
OF    MEDICINE.          t I j
    CXCVIII.  Symptoms  of  difturbance occur alfo in at
 thenic difeafes as well as the fthenic.' Such a ftate of dif-
 turbance takes place in the alimentary canal in the cafes
 of hyfteria, colic, dyfpepfy, and the gout.   Thus in the
 alimentary canal, befides the pains, mentioned above, a cer-
 tain fenfe of burning, anguifh, contortion and direful tor-
 ture, exhibit a fet of appearances, formidable in the high-
 eft degree, both to the patient and  by-ftanders, and which
 beget a fufpicion of their proceeding from inflammation as
 their caufe.   But that thofe affections have nothing to da
 with  inflammation as  their caufe,  and that they  depend
 upon a ftate of the part quite the reverfe, has been proved
 by the ftimuiant method of curing them turning out fuc-
 cefsful  in every inftance in  which  it has been tried (i).
                             I                          The

 neral difeafes, Br Sydenham's authority confirmed the error.  He left
 alfo the meafles as he had found that difeafe,  and  all other general dif-
 eafes, which are much more in frequency than 97 out of the 100, or 97
 to 3 of the fthenia.  Great men had need to be cautious, as the leaft in-
 advertency in them, not to fay effential miftakes, never fails to lead their
 followers,  who are commonly fervile imitators, and implicit believers^
 into capital error.  If ever they attempt  any thing of  themfelves it is
 commonly to raife a craZy fuperftrUcture upon  a falfe  foundation, it is
 commonly to refine upon error ad infirritum.
 (i)  Till this doctrine appeared, it was impoffible to  erafe from the
 minds of phyficians animpreflionthat had been deeply made there, that,
 nothing but  the only inflammation, that they were acquainted with,
 could be the caufe of fuch pain and torture, as is defcribed in  the text.
 1 have more than once experienced the whole concourfe,here mentioned,
 and have always found them to yield to  the moft  ftimuiant method of
 cure, that I could contrive,  T once laboured under this modification of
 afthenic difeafe for no lefs than  ten days, and was always able to over.*
 come it in  two hours, and procure an interval of complete cafe and re-
lief for the reft of the day.   The remedies employed were the whole
round of diffufible ftimuli, as opiates in all their forms,  camphor, rnufk,
volatile alkali, and aether, &c.  By thefe the  functions for the time were
completely reftored.   But their ftimuiant effect was no  fooner perfectly
gone off, that is, after the interpofition of along fleep, through the night,
                                                        than 
 114        THE   ELEMENTS.

 The fame fact is confirmed by the ufe of wine,  opium,
 and other diffufible ftimuli.   After that, and  ftill in con-
 junction with  their  ufe, animal  foups,  and next  folid
 meat,  and the ufual way of living,  and guarding againft
 debility, effectually  re-eftablifh  ths  ealthy  ftate (k.)
                                                           This

 than the fymptoms returned with a violence little ftiort of what it had
 been the day before.  This was proof pofitive, that their nature  was
 afthenic, or confifti ng in debility;  fince they yielded to ftimuiant reme-
 dies; and that the debility was cxquifitely great, fince it required fo
 high a degree of ftimuiant  operation to  remove it.  While that is the
 undoubted fact, there is a nicety with refpect to proportion to be attend-
 ed to in this cafe. It is  a rule, that the degree of curative means, whe-
 ther in the curs of fthenic or afthenic difeafes, fliould be accommodated
 to the degree of the difeafed ftate or degree of the  caufe.   If too little
 of the curative means is employed,  a proportional part of the difeafe
 will remain ;  if too much, the difeafe will be  more  than removed, that
 is, another ftate which may be  morbid in another extreme, may take
 place.   Too much was once employed in this affection, and the effect
 was, that the difeafe was not eradicated till the tenth day of its courfe
 from the beginning.
  (k) The rule here is, if indirect debility be  the caufe, to begin with a
 high degree of ftimuiant cure, and gradually reduce it to the ordinary de-
 gree that is fufficient for the healthy ftate. And the caution is to be fure
 of this gradual reduction, otherwife the indirect debility will be liable ta
 return the moment the effect of the ftimuli is gone off.  By an attention
 of this kind a difeafe depending upon indirect debility may be cured in
 the  fixth part of the time, that would be taken up by the cure, when
 the remedies are every day carried beyond the due bounds.  For exam-
 ple,  if the indirect debility be in the table the effect of an application of
 71 degrees of exciting power inftead of 40, that is to fay, the excitement
 is worn  down to 9 inftead of being up at 40; it is evident, that an appli-
 cation of 71 degrees byway of remedies, will  leave the difeafe where it
 was. Suppofe only 65 degrees of ftimuiant power adminiftered; the ex-
citement will  fall to 66, and the wafted excitability rife to 15.  Next
day let only a degree of exciting power as 60 be applied; then the degree
of excitement  will be that number, and that  of excitability 20. Five
 degrees of exciting power ftill lefs will reduce  the morbid excitement to
 55,  and raife the excitability to 25.  And fo on may  the matter go,
 till the  excitability israifed to 40 and the excitement reduced to the fame"
                                                         number. 
              OF   MEDICINE*           I f j

  This plan of cure proves to a demonftration,  that thofe
  affections are moft foreign both from fthenic inflammation
  and every degree of fthenic diathefis ; and,  befides the
  general fthenic inflammation, not appearing to affect inter-
  nal parts, it  affords another argument againft inflamma*
  tion in this cafe being the caufe (1).
     CXCIX.  The afthenic pulmonary difturbance diftrefles
  the patient with fo intolerable a fixed pain, that no bounds-
  have been fet to bleedings for the cure of it.  But all fuch
  bleedings have not only been ufelefs, but detrimental, and
  often fatal;  whereas, on the contrary, the ftimuiant plan
  of cure has always fucceeded (m). By it the refpiration is
  interrupted, and nearly all the fymptoms that accompany
  an actual peripneumony, diftrefs the patient, and to fuch a
  degree, that it has been fufpected, there was an inflamma-
  tion in the cafe, or rather it has confidently been believed
  that there was. Or, if any difference was difcerned betwixt
 this affection and that phlegmafia, or fthenic general affec-
 tion with inflammation; that was only a fhadow of diftinc-
 tion, and led not to the rejection of the notion of inflamma-
                            I 2                       tion

 number.  But, if the reduction be much lefs by the day, the cure will
 be proportionally flower.  Nay, fuch an error may be committed as to
 increafe the difeafe inftead of reducing it, which will happen, as often
 as a degree of ftimuiant power is applied, which is more than equivalent
 to that which produced the difeafe. All this attention and caution is ne-
 ceflary in the cure of afthenic difeafes of indirect debility; while that of
 thofe of direct debility is eafy and fimple, to wit, to give the ftimulants
 in fmall proportion and often repeated, till the difeafe is removed, un-
 lefs, which may happen, you can guefs the proportion, which may fuf-
 fice  to remove the difeafe at once, or, at leaft,  twice.
  (1) See CLXXXII. and CLXXXIH. par;  above.
  (m) A young lady afflicted with thefe fymptoms was in the courfe of
 a month bleeded thirty times, always with a temporary relief, but with
a return of the difeafe more violent than ever.   She was then put upon
 m ftimuiant plan, and in lefs than a month reftored to her perfect health*
 That was among the moft early cures taken from this doctrine. 
 Il6       THE    ELEMENTS

 tion being the caufe, but only gave occafion to a queftion.
 about its feat.   But  truly,  that there is no inflammation
 4t all here, at leaft as a caufe, and that the difeafe depends
 upon pure debility, is fufficiently proved by the arguments
 that have been brought before.   The difeafe is increafed
 by the antipWogiftic, and diminifhed and removed by the
 ftimuiant plan of cure.
   CC.  The formidable fymptoms  of  difturbance, that
 accompany epilepfy,  apoplexy, and fevers, fuch as ftu-
 por, a  difpofition to fleep,  in  them all ; in fevers often
 that falfe watching,  that is called  typhomania, and fome-
 times coma (n); in the latter,  (or fevers), ftarting of the
 tendons, in the former, (or epilepfy and apoplexy), con-
 vulfion or a diminution of the voluntary motions ; which
 by moft phyficians have been partly imputed to irritation(o),
                                                         as

  (n) or an infuperable pronenefs to fleep,
  (o) No difeafes are more oppofite to each other than high fthenic diC
 cafes, fuch as the common inflammatory fever, or peripneumony,  and
proper fevers; the  former, in the table,  Handing at  the head of tha
fcale of increafed excitement, and the latter at the bottom of the fcale
 of diminifhed excitement.  And the fame method for the cure of both
has  been purfued, to wit, the evacuaut, debilitating.   If, in peripneu-
 mony, large quantities of blood were taken at a time, the difference has
been made up in the cure of fevers by repeating it the oitencr; while
all the ether evacuations were carried on with the  fame profufion in
both.  When they talked of the refpective caufes of thofe difeafes, phlor
 giftic diathefis was the  word for the hjgh fthenic difeafes, and irritation
for the high afthenic.   But thefe were words only, while in fact the me-
thod of treatment of both was the fame at leaft in kind; and fcarcely
different in degree.  To  whatever part of any fyftem of phyfic we turn
our  attention, we conftantly fee one mode of practice running through
the whole.'e'and that too, notwithftanding of the fuppofed great number
of difeafes very limited.  It turns all upon bleeding, other evacuations,
ftarving, and fome other trifling directions under the  title of regimen.
It was all antiphlogiftic to ufe their own language; and whatever other
language they held, the nature of the  difeafe, if we arc to judge froai
their treatment, was phlogiflic. 
                OF   MEDICINE.         \%*j

  as typhomania and the ftarting of the tendons ;  partly to
  plethora, either alone and pure, or together with its mobi-
  lity : All thefe without diftinctioft are evidently owing to
  the fame caufe, upon which all afthenic difeafes  depend,
  that is,  debility.   Which is proved by the  debilitating
  hurtful powers, whether acting directly or • indirectly, a-
  lone  producing thofe difeafes;  and by the remedies, the
  whole action of which depends on ftimulus,alone relieving
  or removing them.   But it is in vain to impute apoplexy
  to plethora (p); as if at that  time of life,  when the  body
  is  nearly worn out and almoft bloodlefs, that is,  when
  the ufual degree of aliment is neither defired, nor taken in,
  nor digefted, more blood  could be  produced than in the
  flower and vigour of human life. On the contrary, at the
  time when apoplexy comes on, in confequence of indireft
  debility, induced by old age and exceffive excitement in
  the mode of living, the folids are languid, the quantity of
 fluids deficient, as alfo their fountain, the blood. Epilepfy
 depends  upon  the  fame debility, and the  fame fcantinefs
 of fluids, only that its debility is oftener ot the direct kind.
 Fevers may depend upon indirect debility,  as in the  con-
 fluent fmall-pox (q), or where drunkennefs has been the
 principal hurtful power  producing them, but at the  fame
 time their moft frequent caufe is direct  debility.   And in
                                                      all
   fp) or an over proportion of blood, fee above, CXXXI.
   (q) The confluent fmall-pox, as depending upoe a very high degree
of debility, is ranked among the high fevers in the after part of this
work, becaufe the fcale is  not regulated by the appellations givsn by
phyficians, or by any of  their erroneous diftinctions,  but by ftrict re-
gard to the degree of excitement.  And for the fame reafon is the vio-
lent cholera marked nearly in the fame place ; becaufe the debility, ta-
king place in it, is nearly equal in degree to the moft finking febrile de-
bility ;  in a word, becaufe the fame degree of debilitating power pro-
duces, and the fame degree cf ftimuiant operation, removes the difeafei
fo affartcd. 
 I j8      THE   ELEMENTS

all the cafes, that have been juft now mentioned, debility
is the primary caufe and final termination both of all the
reft of the fymptoms and of thofe of difturbance.
  CCI. To the fymptoms of difturbance fometimes alfo
belong the following that affect the head ; great head-ach
in fevers,  imbecility of the intellectual function, confufion
of thought, and delirium, the laft often fufficiently fierce,
though occuring in the higheft degrees  of debility, and
leading to efforts beyond the ftrength.  This ftate often
happens towards the end of a nervous fever,  even when
violent.  Inflammation is apprehended, blood is  let, but
directly from the head ; blifters, which are extreme unc-
tion in  the art,  are clapped on, filence and darknefs are
prefcribed, even the moft gentle ftimulants areforbid.  In
confequence of the emptinefs of the ftomach,  as well  as
of the veffels of the whole body, and of the  higheft de-
gree of languor from the want of many ftimuli, vertigo is
fuperadded to delirium,  and  the  patient, deprived  of
ftrength, fenfe and intellect, breaths out his laft.
  CCII. But in this cafe there is either no inflammation,
or, if there be, it is altogether of a different nature from
the general fthenic one.   That it is  not the  latter, the
unfuccefsfulnefs of the debilitating plan of cure, and the
incredible  fuccefs of  that which firfl ftimulates, and after
fills the veffels,  afford  certain proof: and that it is not
any other  inflammation is evinced by the fo fudden refti-
tution of health.  Now, as an impaired ufe, or confufion
of the intellectual faculty is, in a certain degree, always
the  confequence  of  debility, whether arifing  from any
other fource, or from emptinefs, or a general inanition of
the veffels, and that too even in thofe, who nre otherwife
found; where is the wonder, if, in the higheft degree of
inanition, compatible with life, in the  higheft degree of
diminution of excitement,  fcarcely leaving a  fhadow  of
                                                 life 
OF   MEDICINE.
119
life, alfo the higheft degree of failure  in the intellectual
function, that is, delirium, among other inftances of im-
paired function, fhould take place.  Nay this  very fact
is certain, and proved to a demonftration.  Thus famine,
thus drinking water contrary to cuftom, after a courfe of
drinking to excefs,  of both eating and drinking with in-
temperance,  a gloomy ftate of the animal fpirits,  grief,
terror, defpair, not only  induce a temporary  delirium,
but frequently bring on downright madnefs.  The  fame
conclufion applies to any confiderable lofs of blood.  For
how many perfons, after being wounded either  in line of
battle or on the highway, have never after, and  often du-
ring a long life time, come to the right ufe of their fenfes.
To fay nothing of contufions, wounds and other  inju-
ries, by which the  texture of  the brain is injured, as be-
longing to  local  difeafes, of which we  are to treat after-
wards ; how does cold induce death ?  Is it  not, amidft
a diminution of all the other functions, by a delirium pre-
ceding death ? From thefe facts,  of fuch weight,  both
from their  number  and validity, and that bring forward
all the powers in fupport of the argument, it muft be ad-
mitted,  that  both head-ach,  and every failure of the in-
tellectual function,  in every degree, and that higheft de-
gree of fuch failure, delirium, depend not  at  all  upon
general fthenic inflammation, the only inflammation hi-
therto known; but  arife from the higheft defficiency,  both
of other ftimuli, and of that which depends upon a  pro-
per fulnefs in the veffels, that is, debility.  Debility  then
is the moft frequent caufe  of the fymptoms, that  have
been mentioned, as  is proved by the reftoration  of health
fo quickly  upon  the new plan of cure.
   CCIII.  But if ever the  afthenic inflammation, menti-
oned (r) before, excited the tumult of  fymptoms, which
                                                 are
  (r) See above, paragraph CLXXI.  and CCII. It is to be defined in
the next paragraph, 
ISO      .THE   ELEMENTS
are our prefent fubject; it produces that effect in the fame
manner precifely, that debility produces it, by means of a
penury of blood  and deficiency of other ftimuli.   For,
   CCIV.  The general afthenic inflammation is nothing
elfe but  afthenic  diathefis,  fomewhat more  violent  in  a
 part than in any other equal part (f); and upon this foot-.
ing, that the degree of afthenic  diathefis conftituting the
inflammation is by no means to be compared with the de-
gree  of diathefis in all the reft of the fyftem;  becaufe the
affection diffufed- over  the whole body is far greater than
that confined to  a part (t).
   CCV.  Inflammation, in  this  cafe, is nothing elfe  but
a ftate of thelnflamed part, of the fame kind with that of
all the reft of the body.   And, as the  inflammation is con-
stituted by a leffer excitement in  a part, than in any other
.e.qual part; fo, before the arrival of the difeafe (u), of
which the inflammation is a part,  a  fymptom, or fequel,
the excitement of that part is underftood to be proportion-
ally lefs, than  that  of  any other part.
   CCVI.  This inflammation  (x) fhould be diftinguifhed
from another, which is local: It is general,  and depends
                                                    upon

   (f)  See above, paragraph XL1X.
  (t) See above, XLVIIl. XLIX.  L. LI.
   (u) See above, par. CLXTX. and compare it with this. The meaning
in  both is, that as certain parts of the fyftem have more excitability than
others (LI.), fo thofe parts, which in the difeafed ftate are more affected
than any other, that is, arc cither more excited, as in fthenic inflamma-
tion, or lefs, as in afthenic, than in any other, keep up the fame proportion
of  difparity before the arrival of the difeafe,  before the appearance of
any of theTymptoms, and while, as yet,  nothing but mere predifpofition
has taken place.  The truth of this propofition is eftablifhed by that of
another fo comprehenfive as to extend to the whole fubject of life; which
is, that over the whole living creation, throughout the univerfe, health,
predifpofkioa to difeafe, and difeafe itfelf, are  the fame ftate, only dif-
fering in degree,  (vid. par. XXHI. and LXV.). Health, therefore,
pis alfo comprehended under this fame propofitioB.
   (x) mentioned  in the two laft paragraphs, CC1Y. and CCV. 
            OF   MEDICINE.          121

upon a general diathefis and only happens when the diathe-
fis has attained to a certain degree; while the local arifes
from fome hurtful^ower, that produces a folution or viti-
ation of the texture of the part, without  regard either to
diathefis or degree: The general inflammation is brought
on by  the fame hurtful exciting powers,  which  produce
the general diathefis, only applied in a  higher  degree;
and  the fame remedies remove both the diathefis and the
inflammation: The local inflammation depends upon hurt-
ful powers, that only harm a part, and is  removed by re-
medies that change the ftate of the part; but is not affected
either by general hurtful powers, or general remedies. Ex-
amples of the univerfal are thefe inflammations, which ac-
company the gout,  the putrid fore throat, the gangrenous
fore throat, and  that inflammation  which produces fore
eye*, :  The local inflammation will be illuftrated by exam-
ples, to be produced in their proper places (y): The gene-
ral inflammation is  attended by debility over the whole
fyftem;  which debility  is only a fequel of the local, and
not always. To remove the former the general method of
cure (z) is  adapted; but the  cure of the latter turns  upon
healing up the part.   In this way, then, there  are four
fets  of inflammation, two univerfal, a fthenic, and an af-
thenic, and two local; one of which is  fthenic,  and the
other afthenic. The former often ends infuppuration, often
in folution; the latter in gangrene,  and fometimes fphace-
lus,  fometimes  at  the laft in death.  If, in the end of a
                                                typhus
  (y)  as in the inflammation, that is produced by a wounding inftrument
when a perfon, previous to fuch an accident, is in health, and continues
to be fo after the accident.  Or it may ftill be local, though a perfon is
in bad health when it happens, but fo, however,as that the general :tate
of the health is underftood to have no concern in it.  A wound in a very
tender part may induce  diforder  over the general fyftem ; but  ftill all
the fymptoms can be traced to the wound, and not to the ordinary caufe
of general difeafe.
  (7) See par. LXXXVIII. 
12*
THE    ELEMENTS
  typhus fever (a) inflammation affects the brain or its mem-
  branes, which (b) is neither yet proved, nor a very likely
  fact, it will ferve for an inftance of an afthenic general in-
  flammation.
    CCVII. As the general  fthenic  inflammation is occa-
  fioned by a quantity of blood, exceffively diftending the
 veffels, which are its  feat,  by that diftention ftimulating
 them, by ftimulating increafing their excitement,  by the
 laft  producing more forcible and more frequent contrac-
 tions, by thefe increafing the tone of the  fibres as  living,
 and thtir denfity as fimple folids, and thereby diminifhing
                                                         their

   (a)  or a low nervous fever, which is a difeafe of the higheft debility,
 next to the plague,  and often not inferior to that  difeafe in malignity,
 and, therefore, to be arranged in the fcale, as next to that difeafe, which
 ftands at the bottom of diminifhed excitement.  Phyficians have  con-
 ftantly confounded the different degrees of this difeafe with fthenic ones,
 affecting the pulfe. But they are diametrically oppofite as fliall  be point-
 ed oat when we come to  the proper place for fuch diftinctions,
   (b) though ftrongly afferted.  A profeffor in his lectures gives a cfe
 of a typhus fever, where, upon account  of delirium and fome other fymp-
 toms, thought to announce an  inflammation in or near the brain, the
 patient was fo freely  Weeded, that the ftate of  the pulfe (which is faid
 to have been, in his words, *• a palfus vacivus, if ever there was fuch a
 "pulfe",) forbid any further bleeding.  The patient was given up, and
 the extraordinary phyficians withdrew, leaving the ordinary one of the
 family, only, about him.  This gentleman, from fome impreffion on
 hisrrind,  began  to  think, that another bleeding  might be tried with
 advantage.   He bleeded him, aud the patient recovered. This is an ac-
 count of a cafe that I pretend not to underftand, and I believe it will be
 no lefs puzzling to my readers, and the more puzzling  the more fenfe
 they have.  It is, however, brought as an example, that in  a  feeming
 expiring debility, the higheft degree of afthenic diathefis, there may be
 an univtrfal fthenic debility,  that requires bleeding. I have mentioned
 it, not for the fake of information, but of caution  to the reader.   /\ny
 perfon may fee the frivolity and lightnefs of the theories of our proftffion,
but it reqaires knowledge and difcernment to  guard againft the fedux*
 tion of fi-fts. 
OF   MEDICINE.
J23
their diameters (c); and, confequently, making the blood
flow with great effort through the contracted veffels, and,
during its flow, produce pain from the high force of the
contractions,  and the narrownefs  of the  fpace through
which it has to pafs ; and as the fame, though in a leffer
degree, is the caufe of fthenic diathefis  over the whole
vafcular fyftem, whether red or colourlefs : So,
   CCVIII. The caufe of general afthenic inflammation
is alfo abundance of blood  in the inflamed veffels,  pro-
ducing the fame effects in the inflamed portion as in the
fthenic inflammation; and, notwithftanding of the penury
of blood in every part of the vafcular fyftem befides, flow-
ing abundantly into the inflamed veffels,  upon account of
a greater atony and laxity in them, than in the others, di-
ftending them and producing the phenomena peculiar to
any inflammation (d).
   CCIX. As the indication of cure for the former is, to
diminifh the quantity of blood, which is the firft caufe of
the ftruggle, and, thereby, to reduce the exceffive excite-
ment to the degree that fuits the healthy ftate, and the ex-
ceffive contractions, which  conftitute the ftruggle, to the
moderate ones,   which  are pleafant and agreeable to
health (f): So
   CCX. The indication of cure for the  latter  is,  firft,
                                                    by
  (c)  Sec LXI. above, and CXXXI.
  (d) Thefe definitions, apply to all the four inflammations (par. CC VI.)
with refpect to the ftate of the inflamed veffels; their differences only
depending upon the general ftate of all the reft of the veffels, which in
the local, may be quite the healthy ftate of thefe, while, in fthenic gene-
ral inflammation, it is the fthenic, and in this the afthtnic diathefis, that
are conjoined with the inflammatory ftate.  Further, as their caufe is
influenced by thefe general circumftances, fo alfo is their cure ; the fthe-
nic and afthenic general inflammations requiring the remedies of the
diathefis to which they refpcctively belong, and the local only therenjct
dies fuited to heal up the part,
  Jf)  See above, CXXXIV. 
  J24      THE   ELEMENT  ST.

 by powerful ftimuli, to drive on  the quantity of blood
 which there is in every part of the fyftem, that the portion
 which loiters in the languid veffels  of the inflamed part,
 may be thereby propelled, and the veffels relieved of their
 burthen; and then by the gradual  adminiftration of fea-
 £>ned animal food, in the form of foups, and, foon after,
 and when now the ftrength Is recruited, in a folid form, to
 fill the whole fyftem of veficls.
   CCXL   The two other inflammations, both local, will
 be treated of afterwards, each in its proper place.
   CCXII. That inflammation of the throat, which ends
 in what they call a putrid (g), fore throat, is Angularly in-
 fidious.   During the  firft days it differs  little in its ap-
 pearance from the fthenic fore throat. The general fymp-
 toms are alfo fimilar.  The pulfe fcarce exceeds  the mea-
 firre of the fthenic pulfe in its frequency and other charac-
 terifHcs.  For fome time the wh»le difeafe proceeds with
 gentlenefs and tranquillity, excepting that  a conftant re-
 jection by fpitting  of  a  tough mucous matter is trouble-
 some. At laft, when head is not made againft it by means
 of th« moft powerful ftimuli, a period arives, when all the
 fymptoms are fuddenly precipitated into a bad ftate; when
 the pulfe becomes very quick, very weak, and remarkably
 finall;  when the ftrength, over the whole fyftem, finks ;
 and now it is not a moderate portion of diffufible ftimulusjt
 not before  adminiftered, that will flop the much to be
 lamented death of the greateft  ornament  of human  na-
 ture (h).  The beft plan of curing this difeafe, is to pre-
                                                  vent

  (g)  The difeafe, here mentioned, is neither defcribed nor, feemingly*
 underftood,  in medical books and lectures.  In this work it  is taken, as
 every thing elfe is, from nature at the bed-fide of the fick, and deferves
 fo much the more attention, that, though it is a difeafe of the utmoft ma*
h'gnity, it feems to  have been altogether overlooked.  Its appearances
 axe mild at firft, but, without both fkill and attention, will end fatally.
  (h)  All this refers to a lady in Scotland, of lingular worth and amiabi,-
                                                    lit. 
OF   MEDICINE.
1*5
"rent the mortal period by employing the moft powerful
ftimuli.
   CCXIII.  The diffufible ftimuli  are  fo powerful in re-
moving the  inflammation of the gout,  that, fometimes,
ftrong ftrink, undiluted, as wine, and fpirits, or the latter
diluted with water, as warm as  can be borne,  have in a
few hours removed the moft violent fit, and reftored the
ufe of the affected foot.   And the fame remedies, as have
been mentioned before, are of equal efficacy in removing
the general fymptoms  (i).
   CCXIV.  The inflammation of the  throat, in  the gan-
grenous fore throat,  is  not, according to  the common
opinion, a primary affection ; but, like every other general
afthenic inflammation, depends upon the  general diathefis,
which, in this cafe is manifeftly afthenic, being a part  or
fymptom of the diathefis,  when that has attained a cer-
tain high degree.
   This inflammation  has nothing in common with the
                                                   fthenic

!ity, who died, but not in  confequence of the plan of cure, which this
doctrine enjoins, having been followed ;  efpecially at the period of the
difeafe when it was moft wanted.
   (i) Treated in the way, here and formerly (vid. the pref.) mentioned,
the moft violent degree of the difeafe always gave way in a few days,
and milder cafes in as many hours. I never found a fingle cafe baffle me
but one, where the patient, who, with his valet, had quacked himfelf
into the gout as well as other complaints, and particularly an habitual
coftivenefs, by  forcing every paffage by the belly, for the fpace of feven-
teen years.  I was difmiffed  without having my directions  complied
with ; and without being  allowed to accommodate the remedies to his
practice  of purging and throwing up injections, fo as to endeavour, at
leaft, to prevent ox mitigate their hurtful effect. For, it muft be obferv^.
ed here, that, as every directly debilitating power is an exciting hurtful;
means of bringing on any afthenic difeafe, fo the effect of every evacu-
ation, and particularly that by the belly, is well known to be a certain.
means of bringing on a fit of the gout.   Among many other means of
inducing that difeafe, a fingle dofe of Glauber's fait, though that be but
 a mild cathartic,, will bring a fit of the gout ou me at any time. 
  126       THE   ELEMENTS

 fthenic  general  inflammation,  which  diftinguifhes  the
 fthenic inflammatory fore throat, (k) or with the two local
 inflammations.
    CCXV.  The crowded puftules, in the fmall-pox, when
 it is now converted into the confluent difeafe of that name,
 that is, into an afthenic general difeafe,  become partakers
 of the new diathefis, and,  inftead of fthenic, which was
 their firft ftate, become aftfthenic ; and, as by their local
 ftimulus before, they quickly changed the fthenic into the
 afthenic diathefis, by means of indirect debility ; fo they,
 now,  by the debilitating influence of their afthenic nature,
 confirm afthenia,  or  a ftate of debility, over the whole fy-
 ftem ; they increafe it, and carry it quickly on to death (1).
   CCXVL    To throw   light   and  illuftration  upon
 them,  by comparing their  refpective methods of cure ;
 it is  to be  obferved that the cure;  in  the  one eafe
                                                         is

  (k) Yet in their fyftems of nofology, which are laboured volumes of
 diftinctions without differences, begun, within this half century, to be
 fupcradded to the former  modes of fyftematizing, which, without this
 new ore, had fufficiently difgraced the art, and needed no more than the
 moft abfurd of the whole, or that the milled fancy of men could invent,
 to complete, in all its copartments, thevaft fabric of error, and particu-
 larly in the laft of thefe, that publifhed in Edinburgh, the  putrid fore
 throat, as defcribed (above CCX1I.) was left out, and the gangrenons,
 which is that juft now alluded  to in the text,  conjoined with the com-
 mon fthenic fore throat, though diametrically in its nature oppofite to it.
  (1) There cannot be a more exquifite ftimulus in living nature, than
that univerfal cake of  inflamed puftules, which covers the whole furface
 in a crowded fmall-pox.   It is no wonder then, that, when it is fuper-
addcd to the ordinary ftimuiant hurtful powers, to which this difeafe
firft owes its violence,  and afterwards, that very eruption, the united
effect of both fliould foon  pafs the whole range of exceffive ftimulus, and
 quickly run into the ftate of indirect debility (fee par. CC ).   Such is
the nature and progrefs of the fmall pox, in pafling from the fthenic in-
 to the afthenic ftate, that is, from one difeafe into another of a moft op-
pofite nature. 
            OF   MEDICINE.          12J

is quite different from that of the  other (m).   The
remedies  of the diftinct  fmall-pox,  and of  its accom-
panying eruption, are cold, and whatever,  by evacuation
or otherwife, debilitates.   The remedies of the confluent
difeafe, as well as of its accompanying eruption, are heat,
remaining within the indirectly debilitating degree, and all
the powers, which ftimulate  as quickly, and as power-
fully as poffible, and confequently, the moft diffufible.
   CCXVII. They differ befides in this, that all the hurt-
ful powers in the diftinct  cafe are fthenic;  all in the con-
fluent afthenic.   And this difference  equally  applies to
both difeafes, and both eruptions.
   CCXVIII. And as the fthenic or diftinct  puftules have
a direct tendency to produce afthenic inflammation,  and
fthenic eruption; fo the tendency of the  afthenic or con-
fluent, is as directly to gangrene, fphacelus, and death.
   CCXIX. The boils, carbuncles, and buboes, which of-
ten accompany the  plague, and fometimes the typhus fe-
ver (n) arife from a contagious matter, taken into the body,
and then detained with the perfpiratory fluid,under the cu-
ticle, and in the glands.   The cafe of the detention, and,
therefore, of this eruption, is a total ceffation of motion in
the extreme arteries, efpecially the glands and perfpiratory
 terminations, upon account of the univerfal debility, and
 the very great languor of the heart and arteries. That this
 is the cafe, is proved by their being no eruption during the
 period of predifpofition, when fome  vigour ftill remains ;
                                                   and,
   (m) The cure of the diftinct  fmall-pox is the debilitating ; that of the
confluent, the ftimuiant plan   The caufe of  the former is  fthenic dia-
thefis, that of the latter the afthenic, occafioned  by indirect debility;
which is a diftinction unattended to in general, and with very bad effect
upon the practice.  For, when the confluent fmall-pox is eftabliflied, the
puftules flat, and figns of mortification coming on, the covering the pati-
ent with a fingle fhcet is as common as in the diftinct fmall-pox.
   (n) Sec above,the note (c), under par. CCVH. 
t2&        THE  ELEMENTS
 and, therefore, the perfpiration goes on in a certain  de-
 gree ; none in the cafes of fudden death from the violence
 of the difeafe; neither eruption  nor difeafe  in all  the
 cafes, whether thefe are early prevented by the ufe of the
 more powerful ftimulants ; by the  difeafe being always
 gentle,  and the eruption  always  fparing, in  proportion
 to the proper management of the ftimuiant plan of cure.
 For, whether  the fuppreffion of perfpiration  be the con-
 fequence of a  very great degree of fthenic  diathefis, or
 of an equal degree of fthenic as in the prefent cafe ; all the
 foreign  mat ter,  that fhould be thrown out of the fyftem
 along with the perfpirable is,  together with it, detained,
 and fo detained below  the cuticle, by ftagnating, and ac-
 quiring a more acrid nature, it produces local inflammation,
 either of afthenic or afthenic nature, in proportion to the
 different nature of each, or rather of the habit of the body.
   CCXX.  In the fame manner  is that  eruption which
 diverfifies  the fkin in the gangrenous fore throat to be  ex-
 plained ; as well as another, which fupervenes upon that
 ftate of the fmall-pox, which by reafon of the debility of the
 fyftem, would otherwife turn out well; but if the new e-
 ruption be not oppofed  by the moft powerful ftimuli, is
 fare to end in death.  Both thefe eruptions (o) are fpotted
 both of them red; but the  former (p) is marked by fmaller,
 the latter by larger fpots ;  in the latter the colour is a fine
 fcarlet,  far exceeding all art, and almoft the power of na-
 ture herfelf in other refpects (q).  Both of them are owing
    4                                   %              to
  (o)  A young child  of mine, who had been long weakly, and often, in
 confequence of that, fnatched from the jaws of death b) being properly
fupported, according to the principles of the new doctrine, Lad been pre-
 pared to receive the fmall- pox, and inoculated.  After the eruption was
completed, and it  was now certain it would be exceedingly moderate,
one morning he was brought before  me covered over with the appear-
ance of the eruption defcribed in the text.                   v
  (p) or that in the gangrenous fore-throat.
  (q) The beautiful colours fometimes painted in the clouds are often
not to be copied by art. 
OF    MEDICINE,
129
to a fuppreffion of the perfpiration by the debility that has
been mentioned : the former is removed, in practice,  by
the ftimuiant  plan of cure,  which removes all the other
fymptoms; in the latter or uncommon eruption, the debility
produced of purpofe in the preparatory plan of manage-
ment, to render the  fmall-pox miil, muft be oppofed, as
foon as the eruption  appears, and the ftrength muft be re-
ftored by the ufe of the moft diffufible ftimuli: the puftules
which  are  both  few,  and  of no confequence,  and  do
not even  attain to the  meafure of actual general difeafe,
and are, therefore, free from all danger, are not to be re-
garded.  If this practice be executed, the recovery is both
certain and quick ; but, if it be neglected, or if a contrary
plan of cure be fet on foot,  death is inevitable (r).
V                             K                    CCXXI.

  (r) It is certain, that the fafe conduct of the fmall-po* depends upon
debilitating the habit which  is to receive the infection;  and it is as lit-
tie doubtful that we may  carry that operation a great way, by lowering
the diet,  purging the belly,  and  applying intenfe eold to the furface,
and,  by all means.'guarding  againft all alternation with heat.  By this
means the phlogiflic diathefis,  chiefly arifing from the ordinary powers
and in part, as it would feem, from the contagious matter, is prevented
or removed ; the great flow of the fluids to the furface checked ; and
the diameters of the perfpiratory, as well as of all the other veffels, kept
open and patulous.  But  it had been long a queftion with me, whether
this debilitating operation might not be carried too far.   If it be certain,
as it is, that extreme debility fupprcffes perfpiration, furelythe procefs
pufhed near to that degree muft endanger that event.  This  phenome-
non happening to my child, folved the doubt that I had not yet decided,
and it feemed to be in perfect conformity to the principles of this doctrine
to underftand, that, as this child had been formerly weak, and, perhaps,
ftill retained fome degree  of that ftate, the further weakening him by the
preparatory management, for the better regulating this difeafe, had been
carried too far.  A furgeon  happened to be by when the child was un-
der examination ;  I afked him  if he had ever feen fuch a cafe, for  I had"
neither feen, nor heard, nor read, of any thing like it.  His anfwer was,
that  he had feen three, and all of them fatal.  I knew how that would
happen, that is, that they would continue the debilitating pradice they
                                                          had 
 I30       THE   ELEMENTS

   CCXXI. Heat is not  peculiar to fthenic pyrexiae (f),
but  belongs  alfo to other  difeafes of  the fame ftamp.
Nor is it fo confined to thofe, as not alfo to arife in all the
degrees of predifpofition to thofe difeafes, and in proportion
to each degree (t).  But the matter does not end here. The
fame  heat diftinguifNfes all afthenic difeafes,  whether fe->
brile,  which is  a diftinction without any  good  meaning,
or not febrile,  and alfo  the  predifpofitions  to them all
and that in proportion to the degree of debility .There is not
a  more certain mark of a departing difeafe, whether fthe-
nic or afthenic,  than a return of that temperature,  which
is commonly  called cool, to diftinguifh it from morbid
heat.
   CCXXII.  The heat is then only natural, when neither
 diathefis is prefent. From that  point it  encreafes, through
 all the degrees of encreafed excitement, till indirect debi-
 lity, from excefs  of ftimulus,  is  eftablifhed;  and it en-
 creafes in proportion to the degree of excitement, rendering
 the perfpiratory veffels always lefs  and lefs patulous.   It
 alfo encreafes through all the  degrees  of diminifhed ex-
                                                   citement

had been following. On the contrary, I ordered the  child fpirit and wa«
 ter,  and a little of an opiate, then reftored the  meals that had been ta-
 ken from him, and brought him about to his perfect health (for the fmall-
 pox gave no trouble) in twelve or fixteen hours.
   (f) Pyrexia is the word for fthenic difeafes affecting the pulfe, called
 febrile, or fevers, very improperly,, while the term fever isreferved for
 the high afthenic difesfes that have been confounded with the pyrexix.
   (t) That heat takes place in predifpofition, is  a matter of daily obfer-
 vation. Thus, when a perfon has no other fymptom of difeafe, it is of-
 ten remarked, fometimes  by himfelf,  fometimes by another,, who may
 have happened to feel his hancVr that he is certainly not quite well as
 his hands are hot.   When this heat happens, either  in the hands or feet,
 without any caufe to account for it confiftently  with health, it is a fure
 prelude of difeafe, that  is  a fure mark of a confidcrable predifpofition to»
 difeafe 1 and the kind of  difeafe; of which it is the harbinger, is  ofi-
 tener afthenic than fthenic 
OF   MEDICINE.          IJI
  crteftient to certain boundaries, which are fixed by a caufe
  by-and-by to be explained, and encreafes in proportion to
  the degree of decreafing excitement, though the latter all
  along renders the perfpiratory veffels more patulous ; and,
  thereby, among other effects, diminifhes the motion, both
  of all the veffels, and particularly of the perfpiratory.
    CCXXIII. When  the heat has now been the greateft
  it can be, and the debility encreafed in proportion,  at laft
  in the exremities, and afterwards gradually in the reft of
  the body, cold, which is always a bad fign, fucceeds to it.
  In the progrefs of the  debility motion  begins to be very
  languid, firft in the extreme veffels of the extremities of
  the limbs, and then to be deftroyed altogether.   Hence,
  as heat, whether in due proportion, or in excefs, depends
  upon the motion of the blood and other fluids, being per-
  formed in due proportion, in excefs, or to a certain extent,
  in a deficient degree;  if, therefore, the heat is either no*
 thing, or next to nothing, as in the prefent cafe, the effect,
 together with the caufe, by an univerfal  law in nature,
 ceafes.   The fame thing happens  in both extremes of ex-
 citability, that is, of exceffive abundance in direct, and of
 nearly a ceffation of it,  in indirect debility;  and fo much
 more readily  will this happen, becaufe,  whatever  be its
 fource, debility is always the fame.
   CCXXIV. Becaufe the excitement  in fthenic difeafes
 is for  the moft part much and equally  encreafed over the
 whole body; the heat,  on   that account, is  alfo equally
 diffufed over  the  whole.  From which fact no cafes are
 excepted, but thofe, in which, in certain parts,  as the
 ftomach, under a ftrong difpofition to vomiting,  and,
 therefore in danger of falling into indirect debility, indi-
 rect debility  either actually  takes place, from the  difeafe
 proceeding with an exceffive force of ftimulus ; or direct
 debility comes on, when the debilitating plan of cure has
been pufhed beyond the rule.  But, fo long as the fthenic
                         K 2                 diathefis 
*32       THE   ELEMENTS
 diathefis is vigorous, and fupports a high force of excite-
 ment the heat will almoft always be equal.
   CCXXV. The fame thing happpens in moderate de-
 bility.  Accordingly, through the whole courfe of predif-
 pofition, and in thofe difeafes, where the matter has not
 gone fo fV as almoft a total ceffation of motion,  the  heat
 is pretty  equal..  The effect of ceffation  of  motion has
 been explained (u).  But, before that happens, if any ine-
 quality of  heat occurs in difeafes of moderate  debility, as
 is frequently the cafe in the hands and feet;  the reafon
 of that is, that a greater degree of debility as  in cold, la-
 bour, and  fweat from thefe, or any other fource, and that
 fweat cold and clammy, has been  applied to  thofe parts,
 than to others.  Not only in the  gout, but alfo in other
 affections both of direct and indirect  debility, a  burning
 heat, chiefly diftreffing to  the foles of the feet, torments
 the patient, efpecially in walking.   That that arifes from
 debility, checking perfpiration, is proved by fatigue, cold,
 and other debilitating powers proving hurtful to  it ;  and
 heat, reft,  and other ftimuiant powers,  giving it eafe.
  CCXXVI. It  remains now, that it be explained, how
 too  great  excitement, in high  fthenic  difeafes,  impairs
fome functions, but never, by a debilitating operation;  and
how too fmall  an  excitement in violent afthenic  difeafes,
gives an appearance of encreafing fome functions,  but
always a falfe one.
   CCXXVII.  If, in  peripneumony, fynocha (x), and,
violent rheumatifm, the voluntary  motions are impaired,
and to fuch a degree, that a perfon can neither ufe his hands
nor his feet, more than a paralytic  perfon ; that that is  not
owing to debility,  that is,  diminifhed excitement whether
directly or indirectly (y),is evident from this double proof;
                                                 that,

  (u) See above, CCXXIII.      (x) or the inflammatory fever.
  (y)  When the excitement is at 40 all the functions arc performed in
                                                   the 
OF    MEDICINE.            I33
 that, if the apparent debility were real, ftimulants would
 be of fervice, and debilitating remedies  of differvice (z),
 But the reverfe is the truth.  For the fame debilitating pow-
 ers, which cure  the other fymptoms of confeffed exceffive
 excitement, alfo remove this indifpofition to the perform-
 ance of motion ; and the contrary encreafe the affection.
    CCXXVIII.  Again, in fpafms  and convulfions, either
 of the  involuntary motions,  in the internal  parts,  as in
                                                     dyfpepfia

 the beft and compltteft manner. Above that there is more force through
 all the fteps of predifpofition, but  with  lefs durability and fteadinefs;
 which is exemplified by the comparifon of hard labourers, who  at the
 fame time are well  fupported,  and gentlemen, who live well, without
 ufing a proportional degree of  labour or exercife to prevent a luxuriant
 ftate of vigour.  When two fuch perfons are fubjected to a comparative
 trial  of  their vigour in any exertion, the former will be found to go
 through the exertion with more fteadinefs, and to hold out longerand bet-
 tsr than the other; even though his firft efforts may have been inferior irj
 force to thofe of  his antagonift. And the reafon is evident; a moderate
 and proper degree of vigour,will bear an addition  of ftimuiant operation
 longer than  a higher degree of it approaching to morbid ftate; becaufe
 the diftance of the excitement from indirect debility, which puts  an end
 to excitement, is greater in the former than in the  latter cafe. The dif-
 ference in the well-fupported labourer is 30 before he can  reach an en-
 creafe that leads up to 70 ; whereas that of the gentleman is perhaps not
 more than 20.   The exertion in the ftruggle adds ftimulus; which will
 be better borne by him who has leaft and yet enough, than by him who
 has more, but of  a fuperfluous degree, and more liable to ran into the
 extreme of a ceffation of excitement.  The effect  of exertion in  the la-
 bourer will be to carry him foon up, by its ftimuiant operation, to the
 degree of excitement where the gentleman began, fuppofe that to be 50,
 and perhaps by and by to  60.  But the fame ftimulus of exertion in the
 gentleman will have the effect of firft mounting up to 60. and by  and by
 to 70, where the  excitement begins to ceafe.
  (z) Who would adminifler wine, opium and the other  high ftimuli,
 whether durable or diffufible, to cure the inability to perform motion in
 either peripneumony or that rheumatifm which is highly fthenic ?  Or
 rather, who would think of any other means of removing that fymptom,
 than the debilitating  powers, fo effectual in removing all the reft, and
pot  lefs fo in remsvinj them ? 
134       THE    ELEMENT9
 dyfpepfia (a), in  colic, in dyfentery (b), in cholera (c), in
 hyfteria, in  any violent attack either of vomiting or loofe-
 nefs of belly, (great numbers of which affections happen
 every  day, without being diftinguifhed by names); or in
 the burning affection of the alimentary canal (d), which is
 confidered by phyficians as an inflammatory affection; or
 in affections of the voluntary motions externally, as in the
 lock-jaw, in tetanus (e), and in many fpafms of other parts j
                                                           or

   (a) in Englilh indigeftion;     (b)  in Englifh the bloody-flux.
   (c) or that difeafe the urgent fymptom of which  is vomiting and
purging i
   (d) See above* CXCVIII. and the annexed notes.
   (e) Tetanus is a vi.ojent fpafmodic motion of the mufcles of  the head,
neck, and upper part of the thorax, whereby the head is  kept immove-
able  in the fame pofitiop, ip which it had been found upon the coming
on of the fpafm.  The teeth alfo, from the affection occupying the muf-
cles of the under jaw, are kept immoveably locked, and hence the name
of Jock-jaw.  Befides the affection of the mufcles,that has been mention-
ed, there is fcarce one  mufcle in the whole body, free from one degree
or other of the affection.   Further,  there is a moft painful feeling over
all, but  efpecially in the parts moft affected.  This difeafe fometimes
happens in cold countries,  fuch as this, in confequence of a wound in
any fenfible part, or when fmall bones, as. the offa fpongiofa. are bruifed,
crufhed and dafhed into the fofter parts.   The part  of it called lock-
jaw is frequently a fymptom in fevers.   But the difeafe is more frequent
in warmer countries than this, as in the fouth of Europe,  where the ex-
cefs of heat is liable to run into indirect debility.   It is moft frequent of
all in the Torrid Zone, where indirect debility is ihe moft conftant at-
tendant  on heat. As a violent and permanent contraction of the mufcles
was the  moft ftriking fymptom of it, and fyftematic phyficiaps fuppofed
every fuch contraction  the effect of an encreafe of excitement,  or, to ufe
»htir own words,  an increafed  flux of the nervous fluid or  nervous
power into the parts affected ; confequeptly their indication of cure was
to relax the rigid Contracted parts.   Hence no bounds were fet to their
emalient relaxing meafures.  Such  were bleeding,  other evacuations,
and warm-bajhing. But experience foon taught, that  all thefe increafed,
inftead of removing the difeafe.  Of late opium, becaufe it was thought
8 fedative, was tried,  The trial fucceeded,  13*t immenfe quantities of 
OP   MEDICINE.         IJJ
  or in convuklon, epilepfy (f), and many other convulfive
  affections; if thefe  functions feem very much encreafed ;
  that that is not  owing to encreafe  of ftrength,  that is,
  encreafe of excitement, fhall alfo be proved to any unpre-
 judiced judge by  the  following two-fold fact; that, If
  this were a cafe  of really encreafed ftrength, debilitating
  powers, or the remedies of fthenic diathefis, would remove
  it, and ftimulants (g) not proceeding to their ultimate effect
  of inducing indirect debility, but remaining within  that
  range, in which they remove afthenia (h) would increafe it.
  But to fuch a fact alfo is the  truth in diametrical oppofi-
  fion (i).  For ftimulants alone, which remov* the other
  figns of acknowledged debility, alfo remove  thofe fpafms
  and convulfions ; and debilitating powers encreafe them,
  or change the tiifeafe into a worfe (k).
                                                 CCXXIX.

 that medicine were found neceflary to effect the complete cure. Lauda-
\ num ufed to be thrown in without meafure, or any other rule,but to give
 it on till the difeafe ceafed.
   (f) or the falling-ficknefs in Englifh,
   (g) keeping within their ftimuiant range, and
   (h) or  affections of debility,
   (i)  Who does not now know, that bleeding, evacuations of  other
 kinds are hurtful, and that ftimnlants proportioned to the degree of the
 caufe, are the only fuccefsful remedies ?
   (k) A certain gentleman in his defk, fpeaking of the method of cur-
 ing epilepfy or .the falling ficknefs, and recommending among other eva-
 cuant and other debilitating means, fmall but frequently repeated bleed-
 ings, unguardedly contradicts himfelf  in his very next fentence.----
 " However," fays he, " we regular practitioners are liable to be too cau.
 " tious and even timid fometimes.   For I have known  a bold practiti-
 " oner in  the country, who cured an epilepfy by very profufe bleeding,
 " In a few months after the patient died of an univerfal dropfy,but the
 " epilepfy never returned."  I would afk this gentleman, what fort of a
 cure that wa«, that converted a difeafe, which may come and go for ma-
 ny years,  nay even for a long life time, into one that, in a very fhort
 time, proved fatal ?  What reafon would a podagric have to thank any
 one, who fhould convert the gout in him  upon any violent attack, into
                                                           a 
 l$6        X «vE   ELEMENTS

   CCXXIX. Becaufe  we know not what contraction is,
or almoft any function of living fyftems (1);  we fhall not,
therefore,  wrangle- about  whether it be  an increafed or
diminifhed function (m); but we will by no means give up
the point of thofe fpafmodic and convulfive motions being
an impaired function (n);,  for, if, within certain bounda-
ries,
 a fatal dropfy ? That fort of treatment  is not  curing a difeafe but en-
 creafing it, and even that to death.  The convulfive fymptoms of aB
 aflhenia may pafs away ,  but the afthenia remains.  You may ceafc to
 call it epilepfy; but dropfy  ftill  fhews that the caufe of the difeafe re-
 mains, nay is prodigioufly increafed.  This fatal miftake of an encreafe
 of the difeafe upon  the whole, for the cure of an inferior degree of it,
 proceeds |from an improper ufe of directly debilitating powers in place
 of the proper ftimuiant ones.   But there are cafes, where the laft, by be-
 ing carried too far, produce the fame fatal miftake.  Thus in peripneu-
 mony, to get rid of the hard pulfe, and the acute pungent pain (lee a-
 bove,CLXXlV. and the notes), the bleedings are carried  fo far as to
 produce a  fatal hydrothorax, or dropfy of the cheft.
   (1)  This' is, perhaps, the firft philofophicalperformance in which care
 has been taken to keep clear of abftract caufes. The profecution of then,
 has contaminated almoft every department of knowledge that had beeu
 treated fcientifically.  See the introduftion tt, my Obfervations on the
 feveral erroneous Syftems of Phyfic, &c. where it will appear, that even
 the great Sir Ifaac Newton did not altogether avoid this error, efpeciaUy
 in the queftions he put,  however modeftly, with refpect to an all  per
 vading aether;  the wanton and aerial theoretical fabrics that have been
 raffed upon which, have, in fpite of Lord Bacon's better directions, dif.
 graced the philofophy of the middle of the eighteenth century  Com-

 xvnl^r.  WiU find ^  thcb0°kwith the UI-Cha>- f-W*
   (m) See above, Chap. V. throughout.
   (n) I know not what  the abftract ftate of mufcuiar  fibres is, either
wncn  they contra*  and  relax with rapid, violent, and morbid force or
when  they remain immoveably fixed in one forcible permanent contrac-
tion:  But I know, that nothing but debilitating „        k

-.who M toprove myfeIt. fo„ a!id cauti« - «*£


                                                          the 
              OF   MEDICINE-         137

ries, (o), excitement,  when  increafed, produces  more
ftrength, and lefs when it is either diminifhed without limi-
tation, or ultimately encreafed ;  and if every function fo
arifing is properly defined to be either a function encreafed
in proportion  to the  encreafe of excitement as contained
within its boundaries,  or as a function diminifhed in pro-
portion to the deficiency of the fame excitement,  without
any boundary,or to the ultimate encreafe of exciting power
beyond  the ftimuiant range ;  confequently, jn the laft of
thefe cafes  it  is a moft proper definition to fay,  that  the
function is  diminifhed ; and in the 'firft, that it is increa-
fed (p).
                                                   CCXXX,

the example of many others, groping in the dark under the guidance of
abftract reafoning, but to view every fubject of obfervation, by nature's
ckareft light.
  (o) See  above, par. XXIV.
  (p) In  the fpafmodic  and convulfive ftate of the function  of motion,
When compared with the vigour of the fame function in its healthy ftate,
who  would fay that  the former is greater than the latter >  The healthy
and vigorous ftate of motion confifts not in the degree  of contraction,
but,  with  a certain degree of that, in the well proportioned alternation
between contraction and relaxation ; of which we have proof indifputa-
ble in this mode of  motion being beft performed in that middle  ftate of
vigour, that intervenes betwixt the extreme of the healthy,  or moderate-
ly encreafed  vigour, and the other extreme of direct  and indirect debi-
lity.  The encreafe of vigour and excitement keep pace to a  certain ex-
tent,  even through  fome degrees of morbid excefs of the latter: but a,
period, and that fliort of indirect debility, arrives, as  in peripneumony
where1 the excitement is increafed beyond the healthy ftate,  and muft be"
reduced in order to reftore the due healthy vigour.  There are other ca-
fes, as that of mania, or fthenic Infanity, where the conjoined  encreafe of
vigour and excitement will ftill g0 further.  ]5ut in every cafe the en-
creafe of vigour,  ftill judging of it from its effects i„  the healthy ftate,
ceafes before that of excitement; and, perhaps, we may make a  ftep to-
wards finding the boundary, by obferving, that the greater  the fum  total
of excefs of exciting power is,  the fooner does the point arrive,  beyond
which the vigour does not proceed.  I„ peripneumony it ccafes at a cer-
                                                          taiu 
138
THE   ELEMENTS
     CCXXX. The notion, therefore, hitherto received with
  refpect to thefe motions  is fajfe.   It proceeds upon a fup-
  pofition  (q), as if the motions  proceeded  from  an ex-
  cefftve  influx  of the nervous fluid, according to a mode
  of ftyle  which they firft held (r),  or of the nervous pow-
                                                               er

 tain period of the difeafe, where the falutary effect of bleeding and other
 debilitating means fhows that the encreafe of excitement is ftill going on.
 But here the fum total of excitement, confidering the ftate of all the other
 functions,  is greater than in mania, where the function chiefly encreafed
 in vigour is only that of voluntary motion, while all the functi»ns of in-
 voluntary  motion  are very little affected.   From this  inveftigation we
 can clearly difcern, that every increafe of excitement leads to a morbid
 encreafe of vigour, and that there is, fomewhere or other,  a point in the
 fcale of encreafing excitement, ami below the point of indirect debility,
 where the  vigour is no further encreafed ; and this inference  arifes with
 refpect to the  practice, that we fhould be very obfervant  of both facts,
 as pointing out a very material diftinction in the indications of cure; that
 in indirect  debility being to ftimulate, while that at the ceffation of vigour
 is to continue to debilitate till the fum total of exceffive  vigour be redu-
 ced  to the proper and healthy.  The inability to the performance of
 motion in peripneumony is an inftance of (he latter : that of the conver-
 fion of the fame difeafe  from excefs of debilitating cure is an inftance of
 the former.
   (q) Indeed they have talked fo confidently of it, that they may more
 juftly be arraigned of going upon a petitio principii, or  that error in lo-
 gic where a point,  chiefly required  to be ptoved, is taken for granted,
 and made a ground work of other reafoning.
  (r) From  a microfcopical wbfervatiou  of Leuenhoeck, where he once
 thought he faw a hollow cavity in the nerves (but could never fee it a-
 gain, nor any  body after him, though that inftrument has been infinite-
 ly improved fince his time),  the celebrated Dr Boerhave took his noted
 intertexture of veffels, making the  whole mafs of living bodies confift of
 fuch.   The  functions  were, at that time, fuppofed to depend upon an
inelaftic fluid fecreted in the brain,  and diftributed in the cavities of the
nerves, to every part  of the  fyftem.  Much reafoning has been em-
ployed in refutation of that beautiful, though fanciful, fyftem.  But the
only reafon, that  fhould have been employed againft it, was to deny the
truth of the hypothefis  upon which it was built j  and that negative argu-
ment  might have been  fupported by this pofitive one, that it is now
                                                          known, 
OF    MEDICINE.          139
   er (f), which is now the common language, that is,if it has
   any meaning, from an exceffive excitement in the fibres that
   havebeenmentioned(t); and,asaccording to the phrafeology
   of the logicians," error draws on error;" fo this notion of
   the abftract caufe led to another (u) with refpect to the ope-
   ration of opium.   And as they fenfelefly enough fuppofed
   exceffive motions to be occafioned by an excefs in the prin-
   ciple of life,  at leaft  in the labouring parts, fo they either
   thought, or taught, that opium poffeffed the virtue of check-
   ing or allaying, as a fedative, thofe motions, and  that con-
   trary to the whole analogy of nature, and the certain  proof
                                                        afforded

   known, that the nerves are  folid fubflances,  and not hollow tubes.
   The  next theory that was taken up was, that though the nerves werefo-
   lid fubflances; yet they were  porous, and, therefore,  fitted to  receive
   into their pores an elaftic  fluid, like the electrical, the magnetical, and,
   like,  or rather a modification of, the fuppofed ftther of Newton ;  that
   this inelaftic fluid alfo floated Hpon the furface of tha nerves, and formed
   an atmofphere around them, and by It all the functions of living  fyftems
   even  thofe of the moft perfect,  the human,  were explained.  For a full
   account of it foe the Preface  to the Obfervations on the Principles of the
   old Syftems of Phyfic,from page 19 to page 58.   Among other applica-
   tions of the sther, under the denomination now of nervous power, 011*
   v/as to make its influx into the  mufcuiar fibres affected with fpafm,  or
   convulfion, the caufe of thefe morbid motions; as its influx, as an inelaf-
   tic fluid,  into the hollow  cavities of the nerves had been before fuppofed
   to afford  the fame explanation,
      (f) That was their word, after an ingenious philofopher in Edinburgh,
   whofe differtation upon this fubject is given at full length in the place of
   the Obfervation  referred  to, had ridiculed  them out of their asther-
     (t) It is here  to be obferved, that the change of  the theory here has
   led into a vaguenefs of terms. It might have been proper, had the notion
   of either  an inelaftic, or elaftic, fluid been retained, to have called the
   fuppofed caufe of the function a fluid, and to have talked of its influx as.
   fuch ; but now  that we know nothing  about it, or whether it has any
.  exiftence  at all, to call it  a  power, and yet to talk of its influx or efflux,
   its flowing in or out, is furely vague and incoherent.
      (u) that is, they fuppofed the moft powerful  ftimulus, opium a feda*
   |i>c. 
 143         -OF  MEDICINE.

afforded by all the exciting powers/every one of which has
been proved to be ftimuiant,  not one fedative (x) but if it
were in any refpect doubtful,  that nothing in nature, at
leaft in thofe powers, that are commonlytapplied to animal
bodies  is fedative, how can there  be any uncertainty of
that point as to opium,  much lefs, that the contrary con-
clufion  fliould be held for the truth ? Has not it the fame
effect upon the  Turks, that wine has upon us ?  Or, are
we to fuppofe,  that  the troops of that people,  on  their
march to the onfet of battle, chew opium, with the in-
tention of checking their natural alacrity and propenfity to
action,  and  of blunting and depreffing their high fpirits
and courage ? If fevers, if the gout, if indigeftion, if the
colic, if afthma, and the whole train of fpafmodic and con-
vulfive difeafes,  in fine all afthenic difeafes, have lately,
to the conviction of every perfon who gave the fubject a due
confideration, and, contrary to the expectation and opinion
of all men hitherto,  been proved to yield to the various
forms of opium without difficulty ; and if all thefe difeafes,
in which it is ferviceable, have been demonftrated to be af-
fections depending on debility, are we to agree, that opium
proves  of fervice, by an operation that is further debilk
tating, or rather that extinguifhes the miferable remains of
nature's motions ?  If the various forms of wine, and other
ftrong drinks, have a very great effect in removing the fame
difeafes, which has likewife been difcovered by late expe-
riments, and are, therefore, underftood to be beneficial by
the fame mode of operation as opium, are we to agree, that
that fimilitude of operation argues a diverfity, nay  a di-
ametrical oppofition in the nature of the powers that unite,
with fuch harmony, in producing the fame effect ? Laftly,
if it cures difeafes, that depend upon a confeffed deficiency
                                                    of

   fx) See above, par.  XIX.  to XXII, with the additions and notes, 
            OF    MEDICINE.          I4I

 of motion (w), equally as thofe, the motions  in which,
 though  feemingly increafed, are  in  reality diminifhed;
 what can any perfon fay in objection to fo ftrong an  argu-
 ment, added to  fo many and fo powerful ones already ad-
 vanced ?  In faith opium is not a  fedative ; on the con-
 trary, as it is the moft powerful of all the agents that fup-
 port life, and that reftore health,  and a  truly bleffed re-
 medy,  to the  divine virtue of which the  lives of fo  many
 mortals has been owing,  and,  in future,  will be owing;
 fo it muft be acknowledged, that fpafms and convulfions,
 over which it has fo great power, do not confift in increaf-
 ed, but diminifhed excitement, and that opium cures them
 by the fame operation by which it cures any of the difeafes
 depending upon debility.
   CCXXXI. Sometimes  in difeafes there is a preternatu-
 ral flow of blood.   Thus in fthenic difeafes blood  drops
 from the nofe: it  is  fparingly expectorated  from  the
 lungs, and tinges the  urine.   The firft and laft of thefe
 three are confidered as  critical figns ; but  they have no
 other meaning  than an abatement of fthenic  diathefis,
 and a  difpofition to indirect debility.  This is an  ef-
 fect, that, for the moft part foon goes off, leaving behind
 it a ftate of convalefcence(z), and foon after a reftoration
 of health, feldom pafling  into an eftablifhment of indirect
 debility.
                                             CCXXXII.
  (w) In one fit of the gout, when its paroxyfms were allowed to return-,
 in cenfequence of a difrelifh  that I had taken for a  certain  ftimulus  of
the drink kind, and, therefore, all at once abftaining from ftimultis, I
fell into a ftate of perfect inaction, and, though without feeling ef twin
 or uneafinefs, fo devoid of mufcuiar force, or capability of producing
any motion or exertioD, that even the flight degree of mufcuiar contrac-
tion neceffary to fupport my pofture in bed failed.  In that ftate, when
my  eyes  were glazed,  the whole dangerous paroxyfm was removed by
changing my drink into a more agreeable one } any ftrong  drink would
have anfwercd,  and opium beftof all.
 (z) or of recovery. 
   142       THE    ELEMENTS

    CCXXXII. Great  and continued bleeding difcharges,
  whether from the womb, from the anus, or from around
  the latter,  or by the nofe,  depend  upon  pure  debi-
  lity (b).  An over-proportion of blood, diftending the vef-
  fels beyond bounds,  and eftablifhing indirect debility, may
  fometimes be the primary caufe-   But, in this cafe,  if no
  other debilitating power, and particularly directly debili-
  tating, has acceded to the caufe; if the difcharge be ftopt
  by a ftimuiant plan of cure;  if the body be ftrengthened,
  and the laxity of the veffels taken off, the whole affection
  will foon  difappear, and  the  health be reftored.   On the
  contrary,  when  indirect debility has  not  preceded, and
  other directly debilitating powers have been applied;  fuch
  as thofe are which have been fpoken of;  and more  efpe-
  cially,  if the difeafes are treated  by bleedings  and other
  evacuations, by abftinence, or  by vegetable food and watery
  drink ; in fuch a  cafe the  difeafes become chronic (c),
 troublefome, at laft direful and fatal.   That they depend
                                                      upon

   (b) Thefe  are the fcverat hemorrhages of fyftematic and nofblogical
 authors.  They  have hitherto been fuppofed to depend upon fthenic,
 what  they call phlogiftic diathefis, and the particular difcharge to be fup-
 ported by an activity, an effort, what they call a molimen haemorihagi-
 cum, in the veffels pouring out the blood and the parts of the veffels im-
 mediately behind.  Their continuance was accounted for upon the fup-
 pofition of there being an over-proportion of blood in the fyftem, or what
 is commonly called a  plethora j  but they are all afthenic difeafes, de-
pending  upon relaxation and atony both  of  all the reft of the vaf-
 cular  fyftem, and particularly of the  bleeding veffels.  (See  above
 CXXXIV. x) ana\ inftead of a plethora, there is a penury of blood ;
all which is proved by the phenomena during the predifpofition,  when
little food is taken in, and lefs, upon  account of the weaknefs of the di-
 geftive organs, is digefted; thefe circumftances are increafed after the
arrival of the difeafe.  The pulfe withil is weak,  fmall and frequent ;
and the patient puny and emaciated.  The difeafe is encreafed by bleed-
ing and other evacuations, and both relieved and removed by wine, fpi-
,-its and diffuble ftimuli; a method of cure which, till within thefe fif-
teen years, would have ftartlcd all the phyficians upon earth.
  (c)  of long duration, 
OF    MEDICINE.           143
upon debility, is proved by the failure of the cure juft now
mentioned, and by the great fuccefs of the ftimuiant plan.
The  true caufe  of bleeding difcharge  is  not plethora,
which cannot happen in the cafe of perfons ill nourifhed,
in water drinking, and under the application of other hurt-
ful powers, that equally deftroy the tone and denfity of the
veffels  (d).  For as food is  nearly the only material, from
which  blood is formed; how, when it is withheld in the
abfence of the caufe, can the effect remain ? and, if, upon
account of the debilitating effect of other hurtful powers,
any food that is taken is not digefted, how can there be an
over-proportion,  and  not a manifeft fcantinefs of blood ?
But it  may be alleged, that lofs of blood, and every fort of
 debilitating power, diminifh perfpiration, and that from that
circumftance the  quantity of blood is increafed. How can
that "happen? The matter, from which the blood is  made,
it may  be added,  is taken into the ftomach, and a fmaller
quantity of fluid paffes off by perfpiration. But, to that it
is to  be anfwered, that in the firft place it is not taken in;
 and next the little that is,   is not digefted (e);  then after
the ferous  part has been  feparated from the red,  will it,
                                                        if
  (d)  Sec above, CXXIV. and x-
  (e)  Na idea in medical writings feems ever  to have been formed of
the body as a whole.  On the contrary, nothing has been more common,
than to talk of the functions as operating in a great meafure, each from
a caufe cxifting within  itfelf, or  but flightly and arbitrarily connected
with fome  other.  This falfe notion was carried to its moft ridiculous
pitch in  the doctrine of fympathy, and not rendered much more decent,
after the word confentpf parts came to befnbftitutcd in its place. Thus,
the common expreffions were the fympathy and confent  of the ftomach
with the head, of the ftomach with the face, of the ftomach with the
external  furface, of the latter with the internal,,  and particularly with
 the inteftines, of the  excretions  with each other, of the  feet with the
kidneys, and fo forth.  It was never dreamed, that there was one over-
ruling principle throughout upon which all  the functions depended.
The ftomach, for inftance, cannot be ftrong while the  perfpiratory or-
gans are weak, and therefore take in and digeft too much while they can-
not throw out their fluid. 
  144       THE    ELEMENTS

 if detained and thrown back into the blood, again become
 blood ? If thefe queftions, to which there is no poffibility
 of returning any anfwer, fhould feem in any  degree ambi-
 guous ; are we to believe that one part of the body is in
 fuch a ftate of vigour, as to produce an over-proportion of
 blood, and another in  fo languid a ftate, as not to be able
 to carry off by the due outlets its corrupted  matter ? And
 muft we, giving up our fundamental principle after fo com-
 plete an eftablifhment of it, allow, that the excitability over
 the whole body is not the fame uniform, undivided property
 over all the fyftem ; that the powers acting upon it are not
 the  fame, finally that  matter can be  created  out of  no-
 thing (f) ? It is ia vain  to talk of the fattening of chickens
                                                         and

   (f) It has been proved in the IVth chapter, Part  I. that the excita-
 bility  is one uniform, undivided property over all, and  that,  in Whate-
 ver part of its feat it is acted upon, that action extends inftantaneoufly
 over  all ;  that  though fome parts, differently  upon different occafions,
 may be more acted upon than any other, equal in fize and nervous im-
 portance, thit that is only in fo  infignificant a proportion as to have
 no effect in conftituting an inequality of action in the fyftem.  Again
 the force of the powers that ait is a given  force, being either weak, in
 due proportion, or exceffive, or weak again from ultimate excefs. Their
 effect  then upon the fyftem, which receives their action in eveiy degree in
 which it is communicated, and that with the utmoft exactnefs, muft al-
 ways be the fame, that is, either direct debility,  health, fthenic diathefi9,
 or indirect debility. To apply this to the prefent cafe, the ftomach can-
 not be healthy,  or under a predifpofition to fthenic.  ftate, and thereliy
 take in and digeft, with the help of the other digeftive organs, too much
 of the  matter, from which blood is made; while the perfpiratory vef-
 fels are too weak to perform their function of throwing  off their excre-
 mentitious matter.  On the contrary, the ftate  of the ftomach muft run
 through the whole living fyftem.  If it can perform its functions pro-
 perly,  or in whatever degree it performs it, all the other organs of di-
geftion, the upper part of the inteftines, biliary veffels, the lacteals, the
 veins betwixt their common trunk and the heart, the heart through ail
 its cavities, the whole arterial fyftem, and the colourlefs terminations of
that fyftem, whether exhalant or glandular, and the excretory orifices of
                                                        thefe, 
OF   MEDICINE.         I45
 and cattle by keeping them from exercife and in a ftate of
 reft.   The condition of health and difeafe is very different.
 In the former there is a certain latitude of the ftrength of
 the ftomach ; in the latter, and efpecially when debility is
 the caufe, there is a proftrationof ftrength.   In fine, it is
 an univerfal and conftant effect of all debility, to produce
 a deficiency of the fluids in the internal parts  of the fyftem
 with a relaxation  of the veffels over all, efpecially about
 their excretory terminations, and a difcharge of the fluids
 by fome out-lets.   The death, that happens, during the
 time of an entertainment, is not to be imputed to an  over
 proportion of blood, which cannot happen in fo fhort a
 fpace of time.   The drink has no effect in filling the veffel?.
 Nor do  any  perfons,  but thofe who are under direct or
-indirect  debility,  meet  with fuch  an  end,  never  thofe
 who have an over-proportion of blood; which as the ap-
 petite is gone, and the digeftive powers deftroyed, cannot
 be produced.   In  what difeafes was it that plethora was
 fuppofed to take place ?  Not in thofe, in which the digef-
 tive organs, and thofe that produce blood, in fine, in which
 the whole fyftem, are in a ftate of vigour, where the appe-
 tite is very keen,  and the digeftion moft perfectly perfor-
 med, and the digefted matter moft completely converted in-
                             L                        to
 thefe, the inhalents, and all the venous blood returned by the  arteries;
 laftly, sll the excretories upon the external and internal furface, all thefe
 will perform their functions in the fame degree as the ftomach whether
 properly or  imperfectly.  To promote the moft perfect health all the
 exciting powers muft be applied, each in its due proportion.   And the
 want of any one or more may make fome odds,  which is infignificant to
 this point.  If a perfon has not had his ufual exercife a chearful glafs will
 prepare him for fleep.  For want of the fame exercife the appetite will
 be impaired, but fo is the function of perfpiration.  Too much exercife
 under heat will impair the appetite, but it alfo impairs the perfpiration
 after a perfon gets into a ftate of reft.  In fhort, any flight inequality
 from want of any one or more ftimuli can be made  up by others.  Sec
 above, par. XL1. 
 I46      THE   ELEMENTS

 to blood ; but in thofe, in which upon account of the dew
 bility propagated over the whole body, all the functions
 are in a ftate of languor, and in which the only matter,
 fuited to make blood, is either not applied, or not affimi-
 lated.  In this way,  the gout,  apoplexy, epilepfy, palfy,
 afthma and hyfteria,  the indigeftions of perfons, who have
 been formerly addicted to luxury, in fine, thofe very difea-
 fes,  which make our prefent fubject, the hemorrhages, as
 they are called and falfely defined by that term, laftly; the
 far greateft part of afthenic difeafes, have been thought, at
 all times and by all phyficians to depend either upon plethora
 with vigour,or plethora with mobility. But in fact and truth,
 that both all the reft of thofe difeafes, and thofe accompani-
 ed with bleeding difcharge, depend upon a penury of blood
 and  other debilitating powers is proved, by the conftant
 failure of the antifthenic plan  of cure to  the great difgrace
 of the profeffion, and by the incredible fuccefs of the new
 ftimuiant plan.   And with refpect to the bleeding difchar-
 ges,  confider the perfons affected with them in the hurt-
 ful powers, that precede them,  and in the fymptoms that
 attend them.   During the whole period  of predifpofition,
 quite delicate and weakly, they have very little appetite for
 food, and take very little, and what they take, is not di-
 gefted, and  often  rejected by vomitting.  In their weak
 ftate they are not fupported by the ftimuiant operation of
 corporeal, or mental exercife,  nor by that of the animal
 fpirits, which are quite puny and dejected, nor by that of
 pure air, which they are not able to go out to take, nor  by
 that cf agreeable fenfationmorby that of ftrong drink, which
 from the mifleading  advice of their phyficians, they look
upon as poifon,  nor by that of the diftention of the veffels,
which are not fufficiently filled with blood, nor by that of
the fecretory  fmall veffels, upon account of their fluggifh.
motion, and the ftagnation of their degenerated fluids every
 where, and the  direct debility conftantly arifingfrom that.
                                                What 
             OF    MEDICINE.           I47

 What fort of pulfe have they ? Such, as it is in all difeafes of
 manifeft debility, for inftance, fevers, (in which laft, which
 is furprifing their favourite plethora, was feldom fufpected
 by them), fmall, weak and very quick and  almoft empty.
 Upon the whole, what like are their intellectual functions,
 thofe of paflion and emotion, and their  corporeal functi-
 ons,  either in fenfe, or motion whether of the voluntary
 or involuntary kind? All  weak, all frail,  all fuch,  as fhow
 Jthat they have not a third part of  life to  fupport them.
 What, on  the contrary, is the ftate of thofe, who abound
 in blood, and yet never experience difcharges of it ? They
 are ftrong and full of vigour in all their functions, with
 rednefs  of countenance, fparkling eyes,  ftrong, hard and
 moderately frequent pulfe.  Their appetite for food is keen,
 the quantity they take is great and well digefted.  As thofe
 perfons, may experience droppings of blood of  no con-
 fequence, and  yet  not often,  fo they  fall into  no dif-
 charges of blood.  And  it is  in perfect confiftency
 with  all that has  been  faid, to  add,  that the  various
 forms of ftrong drink, and thefe particularly, which are
 the  ftrongeft, fuch as are called fpirits, are  furprifingly
 fuccefsful remedies of  bleeding  difcharges, in fpite  of
 every thing  that has  hitherto been thought to the con-
 trary, in  fpite of  rooted  prjudices: But the  preparati-
 ons of opium (h) and  of the other diffufible ftimuli are
                            L 2                     ftill
  (h) Opium, though much ufed in the cure of certain fymptoms of dif-
eafes was never underftood by thofe phyficians, who, in books and lec-
tures affumed to themfelves the province of directing the profeflion of
phyfic. Every property they affigned to it was the reverfe of the truth.
Inftead of allowing it to  be the ftrongeft ftimuiant in nature, they made
it a fedative ;  and, though they found great difficulty in finding a fingle
fedative more, to help to make out their catalogue of a clafs of fuch bo-
dies in nature, they were confident that it was one (fee above, CCXXX.
cud the notes).  Another property they afcribed to it was that of bring-
ing on fleep; whereas, it is the moft powerful body of all others in pro-
ducing and keeping up the watching ftate (fee abovc,XXX. XXXI.
                                                     note 
r4$
THE    ELEMENTS
 ftill .more fuccefsful.   This is a faft, that proves to a de-
 monftration, that in the bleeding difcharges there is no
 exceffive activity, no hemorrhagic effort as it is called, and
 on  the contrary,that there is only a falling off* of the natu-
 ral moving energy.   The hemorrhages,  then, that have
 been the fubject of fo much falfe explanation, and falfe de-
 nomination,  muft  be rejected from the number of fthenic
 difeafes,  and transferred to the afthenic difeafes,  under
 the title of Haemorrhaeae.
   CCXXXIII.   If any perfon be feized with a cough at
 firft rather dry  and bound, then more moift and free, and
                                                         after

 note (b).   They alfo affigned it the virtue of allaying pain, but there is
a kind of pain, that it encreafes, and befides that, aggravates every other
fymptom of the difeafe.  They never could deny, that opium, was ex-
 ceedingly improper in inflammatory difeafes, that is, the feveral fthenic
difeafes with affection of a part whether inflammatory or cattarhal. And
wherever they found it of fervice in pain,  they might have perceived,
 that fuch pain was different from what they called inflammatory, or our
general fthenic pain.  The truth is; it is not a palliater of pain, but a
remover of its caufe, as often as that depends upon debility, while it as
certainly aggravates every other.  The  pains, that opium Is  calculated
to remove, are  all thefe, that depend upon general afthenic affection, as
thofe of the gout,  of chronic rheumatifm,  that of the gangrenous, as
well as the  putrid, fore throat, all fpafmodic  and convulfive pains,  all
 pains from pure debility,  as in the legs, ankles and foles, or in any purt
of the fkin, nineteen  head-ach 3 out of twenty, which are in that pro-
portion afthenic ; the pain of any deep-feated fore orgun-fhot wound af-
ter every degree of fthenic diathefis is removed from the habit;   It is an
equal remedy agal'nft the  afthenic inflammation whether local or  gene-
ral, as preventing their tendency to mortification and fphacclus.  Nay,
when thefe latter ftates have come on, it is a moft powerful means  of re-
moving them, and  of correcting the degeneracy ; fur the effecting of
which the bark had fo often failed.  All this is the difcovery of the au-
thor  of the Elementa, though the credit of the laft and fmalleft part of it,
from their ignorance of the high merit of the whole, they have fhewn
difpofition to give another, a gentleman and eminent author in  London.
Tut a treatifeon the gout, with a full, account of ail the virtues opium
xvill foon be prefented to the public, in which all this will be cleared up.
Sleffcd 3S opium in all thefe cafes is, it is equally bad itl all fthenic ones. 
             OF   MEDICINE.          149

 after that accompanied with  a large expectoration, if the
 hoarfenefs at  firft is  deep,  and  afterwards flighter and
 freer, in proportion as the cough becomes more and more
 moift ; if the cheft all round, over the whole region of the
 lungs, is diftreffed with  a degree of diffufive pain; if there
 i3 either no vomiting, or what of k there is, feems forced
 up by the convulfive motion of the cough ending in expec-
 toration, and in fuch a manner, as either not to return, or
 to  have  no fpontaneous tendency to a  return; if the
 ftrength is otherwife good, and the pulfe  ftrong, full, and
 more or lefs hard,  and not much  exceeding the frequency
 of a healthy pulfe: Such a cafe will be found to be fthenic,
 and to depend upon heat and every other ftimulus (I), to
 be cured by cold and every other debilitating remedy (k).
 The caufe of thefe fymptoms is a high degree of fthenic
 diathefis (1) over the whole body, higher on the external
 furface of the body, and efpecially in  the throat,  which
 is a part of that furface (m). The  fame fymptoms in what-
 ever morbid cafe they occur,  are to  be explained in the
 fame  manner.  Confequently, the catarrhal  fymptoms,
 which are an infeparable part  from the meafles, admit pre-
 cifely of the fame conclufion; and, as well as the whole
 difeafe, are to be underftood to arife from  exceffive excite-
 ment, and to be cured by the debilitating plan.   The fame
 is the  judgment to be formed of the influenza.   In all
 which cafes it is eafy to make trial of the truth.  Give a
                                                  glafs
  (i) See  above the following paragraph*  CXIH. CXIV,  CXXU.
CXXIV.
  (k) and alfo CXVH, CXXVIII. CXXXIV. and all the debilitating
powers throughout the whole chapter; while all the ftimuiant ones in
it will be found to be fuch as contribute according to their degree of fti-
mulus towards the' production of the morbid  effect, which makes our
prefent fubject.
  (1) or ftimuiant operation or exceffive excitement, or wafted excita*
 kility.
  (m)  See above, par.  CXIII. 
 150       THE   ELEMENTS

glafs of wine or brandy, give a little opium;  the hoarfe-
nefs will encreafe, the cough will be more hard and bound,
the  expectoration  will  fuffer a  temporary fuppreffion.
Give a large draught of cold water, and all the fymptoms
will be relieved.  Often does it happen that a perfon trou-
bled with a cough when he fits down to  drink  wine, is
freed from it in the courfe of the circulation of the glafs (n).
The reafon  of which is, that afthenic diathefis was  the
caufe, which was converted by the  drink  into a ceffation
of all diathefis, or into a temporary fthenic diathefis. Of-
ten at the end  of a debauch in drinking,  the cough, and
that very violent, returns for this reafon, that the fthenic
diathefis has made confiderable advances.  It will be cur-
ed by drinking a tumbler or two of cold water, and drink-
ing  no more wine ; which precautions operate by flop-
ping the excefs of excitement.
   CCXXXIV. From the defcription  juft now  given (o)
it appears, that fymptoms,  commonly fuppofed to be  the
fame, are however of a diametrically oppofite'nature (p);
                                                   which
   (n) Whenever his cough  is cured he fliould flop; as the carrying
the ftimulus too far will endanger the return of  the  cough from a
very oppofite caufe.  The cough at firft, fuppofe, to be from an excite-
ment as 26 ; its cure to be brought about by an excitement at or above
40 ; it, return to an excitement at or above 60, will bring on a fthenic
cough.
   (o) of the nature and cure of the fymptoms we have been fpeaking of,
compared with that  which is next to be given.
  (p) This miftake of fymptoms in confequence of judging of their inte-
rior nature from the fimilarity or diffimilavity of their appearance is the
falfe idea, upon which the whole fabric of a department, lately introdu-
ced into the art of medicine, has been reared.  It is to be obferved,  that
fymptoms the moft fimilar to each other in their appearance are, in rea-
lity, the moft different, and  thofe, that have  the leaft refemblance in
their  appearance, have the neareft affinity in their interior  nature, and
indeed are one and the  fame,  with no other difference, but  a difference
of degree, and even that often  very flight, fometimes next to none at all.
                                                      The 
                OF   MEDICINE,            15 I

  which will be evinced by a fuller explanation.   If, there-
  fore any one has a very great cough, a  very great ex-
  pectoration, either at firft with hoarfenefs, and afterwards,
                                                        through

 The great variety of fymptoms that diftinguifh the whole form of afthe*
 nic difeafes affords as many proofs of the truth of this propofition, as the
 inftances of diflimilarity or difference in opinion are numerous.  What
 is feemingly more oppofite than diarrhoea and colic, than typhomania
 and coma, than epilepfy and general dropfy, than the cold and hot fit of
 agues, than fpafmodic and convulfive affections compared  with thofe in
 which there is no fault in the motions either as to excefs or regulurityj
 than the feveral degrees of morbid diminution of menftruation down to
 the actual fuppreffion, and the feveral degrees of the morbid encreafe of
 that natural difcharge till their flow, at laft, attains its ultimate excef3
 both in degree and dui ation ? And,  with refpect to  febrile and  non-fe-
 brile difeafes, what is more fimilar than a flight fynocha or inflammatory
 fever and a typhus in the fame degree, which, yet, are diametrically op*
 pofite both in their caufe and cure? What is more diffimilar than the va-
 rious phasnomena of fevers of the intermittent kind through all their
 degrees of  intermitting and remitting and thofe of the more continued
 kind ? And yet they all  arife from caufes highly debilitating, and  are
 effectually removed by remedies equal in their degree of  ftimulus.  In
 one word, to fliow the infignificancy of the diftinction of difeafes into
 febrile-and non-febrile, and,  when the degree of debility conftituting
 the caufe in both, is confidered  and compared;  is there any reafon for
 feparating the high dropfy, the  high dyfentery, and finking cholera from
 their place betwixt intermittent and remittent fevers and the moft con-
 tinued kind ? Laftly  what two things can be liker one another, than a
 crowded diftinct and confluent  fmall-pox, or than the common inflam-
 matory fore throat and that which was lately defcribed (fee above, par.
 CCXIl.)  Such have been the ideas, that have guided the directors of
 the art of medicine in their inquiries into the natures, caufes and cures
 of difeafes.   If botanifts and natural hiftorians, by all their artificial me-
 thods of arrangement, have made little progrefs in exploring the true
 nature of their fubject, and on the contrary, with fcarce a fingle excep-
 tion, have confounded it;  if it was ridiculous to unite into one genus a
 man, a monkey, and a bat, how much more abfurd was the attempt to
 arrange the mere qualities cf  matter in the fame way.  Yet upon this
hopeful employment has John Bull expended vaft fums of money, while
 he left the moft folid and important departments of fcience  neglected
                                                             and 
f52      THE   ELEMENTS
 through the whole courfe of the difeafe, without the hoarfe-
 nefs ; if he is of a very advanced age,  or arrived at  the
 laft ftage of life; if he is of a Weak habit;  if his pulfe is
 neither ftrong, nor full, and withal very quick; if this con-
 eourfe of fymptoms has been preceded by either direct
 or indirect debility, as ufually happens in the cafe of famine,
 of water drinking, of a long courfe of ebriety, and of
 having led a life of luxury : one may be certain,  that all
 thefe fymptoms are afthenic (q),  and to  be removed  by
 ftimuiant remedies.
   CCXXXV.  The explanation of the dry cough is eafy,
 and fuch as was formerly given (r). The origin of the cough
 and expectoration is quite the reverfe (s).   For, whether
 the fyftem has been weakened  directly or indirectly, as
 the excitement over the whole body is  diminifhed in the
 higheft degree, as  the debility in every part is exquifite j
 the confequence is,  that in the vafcular fyftem the tone, and
 in proportion the denfity, is every where diminifhed; and
 the diminution chiefly takes place in the extreme termina-
 tions of the arteries, that are moft remote from the center
 of activity, and above all other parts of  the vafcular fyf-
 tem, in the perfpiratory veffels (t). When all this has taken
 place; the quantity of fluid that is thrown  up by expec-
 toration is incredible.   Indeed (u) it is great enough, not
 to be inferior in its degree to the greateft profufion that
 ever takes place in confumption, and even to exceed it.
                                          ccxxxvr.
 and covered  by the dirt among his feet.  We have too little ufeful fci-
ence yet, it is time to improve our fcanty ftore (fee the Introduction to
Obfervations, &c.)
  (q) or depend upon debility.       (r) See above, par. CLX.
  (s) CXXV1H.  in the  M.  S. addition  CLXI. and particularly
GXXXIV.
  (t)LlX. LX.LXl.
  (u) though it has never been attended to. 
OF    MEDICINE.
lS3
   CCXXXVI.  The cure of it,  however, in all the cafes
 that depend upon direct debility, is by no means difficult (x).
 unlefs the difeafe has proceeded beyond the  boundary of
 admitting a cure, and life is now approaching to its  end.
 The cure, however, is a good  deal more difficult in the
 cafe of indirect debility,  and  for this  good reafon,  that
 there is no other plan of cure, but ftimulating, to remove a
 difeafe occafioned by an excefs of ftimuiant operation (y).
 Nay,  the fame debility,  as fhall afterwards be  obferved,
 produces the fame relaxation both of the bronchia  and of
 the reft of the body, but it does not always produce con-
 fumption.   With this  profufion of expectoration  appear-
 ing fometimes in the form of fever (z), fometimes in that
 of the gout, the phyfician has often along ftruggle, while
 he employs his diffufible ftimulants, the event of which ia
                                                      fuch,

   (x) I have experienced fuch a cafe more than once, and have feen ancf
 treated it in great numbers. It is fometimes a part of the concourfe of
 fymptoms,  that form that  afthenic cafe of difeafe, which is commonly
 called fever, A  gentleman,  under or about the thirtieth year of his age,
 had been teu days in a typhus fever, occafioned by extreme cold, fuc-
 ceeding to  the debilitating effects left upon his habit by too great  mode-
 ration in his diet, and, certainly, not a good choice of the different arti-
 cles of it.  To aid the debilitating effects arifing from thefe, he had ex-
 perienced all the extremes of the heat and fatigue,that fall to a foldler's
 lot, in very warm countries. He was, over and above, of a fmall fize
 flender and emaciated.   He had alfo, from his infancy, been affected;
 with a fliort cough,"fometimes dry, and fometimes with a little expecto-
 ration.   During the  courfe of his cure, he had been more than once
 bleeded, though his difeafe  had ufhered itfelf in by a great profufion of
 bleeding, which fuddenly took him as he was on a journey in a cold day
 of about 44 miles in a carriage.  He was vomited, purged, bliftered pro-
digioufly, and glyftered.   The whole force of the old plan of  cure was
exhaufted upon him, and he fo exhaufted by it, as to be given up  for an
incurable of two difeafes, a bad fever, and rotten lungs.  His face was
 hippocratic, he had the dead rattle, and his cough and  expectoration
were afliduous.   liy the ftimuiant new plan of cure he was put  out of
 danger in ten days, and fet upon his feet in as many more.
     (y) See above, Cill.       (z) Sec th? laft note (x). 
   154        THE   ELEMENTS

  fuch as to produce'a complete rcftoration of health, and
  thereby to leave not the leaft fufpicion, of there being any
  local affection in  the lungs, which is  fo much the  object
  both of the faith and fear of phyficians (a).
                                                      I.  When

   (a) A defcription of this difeafe, in which the lungs are fuppofed to
 be affecled with  ulcers or tubercles, has been given in the note under
 this paragraph at (x),  But, as the fubject is both as new and intereft-
 >ng as any in this work, it may be proper t» give a  further illuftration
 of it by the expofition of another fet of facts.  Both ia> perfons liable to
 the gout, and other afthenic difeafes, fometimes of direct and at other
 timesof indirect debility, and efpecially in thofe who have been much
 expofed to cold, without the debilitating effect of the cold being over-
 come  (vide par.   CXXIIe), by  an alternation with, or fucceffion  of,
 heat, and in very many old people, efpecially among the poorer fort,
 who have been, and naturally are, much expofed to  various debilitating
 powers,  there is often, efpecially in winter, a very great cough and ex-
 pectoration.  This fometimes goes to fuch a height as to give fufpicion
 of the affection of the lungs juft now fpoken of.   But the completenefs
 of its cure, which when it arifes from indirect debility,  is effected by
 the ufe of animal  food, avoiding vegetable,  and fifh, and by good wine
 ?nd diluted fpirits in moderate proportion at a time,  but frequently re-
 peated, avoiding  claret and other French wines, and  all four  and all
 beer-drink, unlefs perhaps a little warm porter in cold weather, and a
 very moderate ufe of diffufible  ftimuli, keeping the  feet 3nd the body
 in general moderately warm; fhowsfufficiently, that there had been no
 local affection in the lungs. When the debility of the difeafe is of the in-
 direct kind, in which  the cure  is more difficult, there is, ftill, as little
 reafon to be apprehtnfive of the pulmonary or any other local affection.
 For the cure of it  alfo proves the contrary.   In it the means of cure are
 to change the forms of ftimulus, and to proceed from the ufe  of the
 ftronger to that of the weaker, till at length the patient can do without
 much of the very ftrong ones.  (See above, par.  XClX.  and thofe
 that follow).  When the difeafe cannot be overcome in that way, the
 excitability muft be underftood to be worn out, and life come to its end;
bat ftill from general debility, not  local difeafe.  For, if ever any lo-
 cal affection does  appear, it is  always the laft effect, not the primary
 cuufe.  In this way I loft two gentlemen, after having been able to fup-
port them for many weeks, when the prognofis upon the common prac-
                                                             tice 
             OF   MEDICINE.          I C$

    I. When, in all the veflels, the fluids are not agitated
 by a fufficient action, they are proportionally more imper-
 fectly mixed, and therefore in a vitiated ftate.   But in the
 extreme terminations of the  veffels, as being at a greater
 diftance from the center of motion,  they often, from a
 total ceffation of motion,  ftagnate, and degenerate into a
 foreign nature.   This is  an effect  not produced by heat
 alone (b) but by cold (c), not only by this, but by all the
 powers that debilitate in an equal degree (d).


               CHAP      VII.

      OJ Sleep and Watching, ivhether fialutary or morbid.

    CCXXXVTI. AS death finifhes the operations of all
 life, fo ffeep finifhes thofe of every day ; and as the former
 is  the confequence of a perfect extinction  of the excite-
 ment,  from, either  a complete exhauftion or  ultimate
 abundance of excitability;  fo the latter (a) fucceeds  to a
 diminifhed excitement, while  the excitability is either di-
 minifhed, but in fuch fort that it can be accumulated again,
 or abundant, in fuch  fort that  the  abundance  can be
 wafted, and the excitement, in both cafes, renewed.
    CCX'XXVIII. Such is  the  nature of  the excitability
 of animals,  that it can neither be deficient nor over-abun-
                                                    dant,
 tice did not allow them asmany hours.  The caufe of their indirect de-
 bility had been hard drinking.   But  even in thofe who die of a  con-
firmed confumption, there is not often reafon for the fufpicion of tuber-
cles in the lungs.  Their bodies have been opened after death and the
lungs found quite found;  And in the diffections,  where the tubercles
have been found, ftill they were only an effect.
  (b) See above, paragraph CXV.    (c)  See alfo paragraph XVII.
  (d) See alfo CXIX. which compare with par. XXVIII.   Nay, all the
power mentioned in par. XI. and Xll. and fully explained in Part Second,
Chapter I. throughout.
  (a) or  fleep, 
Ij6         THE  ELEMENTS
 Jant, without detriment;  a deficiency producing indirect
 and a fuperabundance,  direct  debility.   And, as any ex-
 citing power, carried beyond  its boundary (b),  can pro-
 duce the former,  and the  with-holding of any, give oc-
 cafion to the latter (c); fo the fame propofition holds good
 of the exceffive or too fparing ufe of feveral of them, or of
 them all (d). Sleep,  then, is the effect of the actions of the
 day, at  firft giving always more and more excitement, but
 lefs  and lefs in proportion to.the continuance of their opera-
 tion (e), but in fuch fort as always to add fome excitement,
 till the matter at laft comes to a point, where the degree of
 excitement, neceffary to conftitute the  waking  ftate, no
 longer exifts.  Of this we have the  moft certain proof
 in every day's experience,  and in the confirmation of it,
 which  the complete induction of the effects of all the ex-
 citing powers afford (f).
                                                    Thus,

  (b) See par. XXVIII,         (c) See par. XXXVUI.
  (d) This is completely illuftrated through the whole firft chapter of
the fecond part, from par. CXI. to par. CXLVII. incluiivc.  Nay, the
propofition is conftantly alluded to through the whole that has yet been
laid, and will be in what remains to be faid.
  .(c) See par. XXXVE.
  (f) To illaftrate this, let us take the exciting powers one by one, and
be«in with wine.  When a perfon is infufficiently excited with  refpect
to that ftimulus, and rifes not, fuppofe above 300 in his excitement,  a
glafs carries him up 2°, another 2° more, and fo forth,till after five glaffes,
and their effect in carrying him up to 400, he finds himfelf well and vi-
gorous in all his functions.  But, ftill, we are not fo flimfily made, as
 not to bear a little of what  is either too much or too little.   Suppofe
him then to take five  glaffes  more, and, confequently,  to  be raifed to
5c0, or io° above the  ftandard.  As his fpirits, his intellectual,  and all
 his other  functions, were low, while his excitement remained  below
 43°,  fo they are all proportionally exalted by the time  that his excite-
 ment is elevated to 500.  Let him ftill go on, and his intellectual func-
 tion will rift  ftill higher; he will now difplay the full extent of his ge-
 r.ius  ; his paffions and emotions, of whatever kind, will rife in the fame
                                                  proportion; 
              OF    MEDICINE.            157

   Thus, heat not ultimately exceffive, or reduced, by cold,
 from that excefs to its ftimuiant degree (g), and food, and
 drink, and labour, either of body or mind,and the exercife
 of paflion and emotion,  when their ftimulus neither ftops
 fhort of the proper  point, nor goes beyond it, all give a
 difpofition to fleep.  This is the moft falutary ftate of fleep.
                                                        k, Pre-

 proportion ; he will, in one word, be an example of the effects of Alex-
 ander's feaft.  Suppofe,  to bring him to ail this he has fwallowed, be-
 fides thofe he had before, other five glaffes.  Let him go on, till he has
 taken  five glaffes more, and we fliall  fee the effect: In the  courfe of
 time, employed  in taking thefe, he gradually falls off in his fpirits, in
 his intellectual, and in his corporeal, functions ; his tongue, his feet, his
 eyes, his memory, his judgment, all, fail him ; he, at laft, becomes drow-
 fy, and then falls faft a-fleep.  The  fame is the progrefs of excitement
 as it arifes from labour or exercife through the day, whether of mind or
 body.   The fame is the effect of the ftimulus of eating, efpecially nou-
 rifhing ftimuiant things,  and in great plenty.  Before dinner,  the occu-
 pations of the former part of the day, are not yet fufficient to prepare
 one for fleep ; which, however after a heavy dinner, v/i.l, uniefs the in-
 terference of fome  other ftimulus  prevent it, very readily happen  to
 mod people, efpecially to thofe, whofe frailty, from age or any other
 caufe,  renders them more liable to  be  Ltigued by the paft operations of
 the day than others.  The younger and  more v:gorous will be able to
 hold out to the end of the day ; when they too, after  having undergone
 the degree of ftimulus neceffary to give that wafte of excitability that
 difpofes to fleep, will be overcome by it.  The v:ry flow of the blood in
 the veffels, and the exercife of the involuntary motions, that keep it up,
 tend atlcaft to the  fame effect.   The fame thing applies to the motion
 conftantly,going on in the ftomach and inteftines, as well as the motions
 that occur in all the fecretory and excretory fmall veffels.  Light, ftimu-
 lating  the eyes, and found, the cars, and the feveral fubflances that ail
 upon  the organs of the other  three  fenfes, all, tend, by wafting the ex-
 citability, to wear down the excitement to that point  in the fcale where
fleep commences.  And the procefs, in every cafe, is, firft a  low,  then a
higher and higher,  then the higheft, vigour of all the functions; which,
 again,  gradually falls till its termination in fleep.  Ve have,  therefore,
 after viewing their  effects fingly, to fuppofe them, in one degree or hi
 another,united, and fleep the finifhi.ng effeft of their united operation.
   (g) See above, par. CXXII. 
158       THE    ELEMENTS
   k. Premature, unfeafonable,  or morbid fleep, is produ-
ced by either indireft or direct debility.
   a. With refpect to the effect of the former, an excef-
five energy of any one or more of the ftimuli (i) produces
it; accordingly, any  one or more of thofe that have been
mentioned, by acting in  excefs, and wafting the excitabi-
lity, fuch as hurried drinking, produce that effect.
   m. Of the directly debilitating  powers, which produce
the fame effect, the want, or fparing  application,  of the
powers,  which, by  a due degree of ftimulus,  produce
fleep, will furprife into a bad  kind of  it; accordingly,
when a perfon is in that ftate,  that he wants  excitement
in order to be in health, the defect of light, of found, and
of the various contacts of the bodies that excite the other
fenfes, the defect of both fets of motions, the voluntary and
involuntary,  as well as of the exercife of the mind, of the
exercife of paflion, of heat,  acting in its  ftimuiant degree,
and too long continued fleep itfelf, all thefe  produce hurt-
ful fleep (k).
   CCXXXIX.  On the  contrary, found watching is the
effect of the fufpence of the fame diurnal actions during the
period of  fleep, taking off more and more  excitement,
moft at firft, and lefs and lefs after, but always adding  to
the fum of diminution of excitement, and accumulation  of
excitability;  that is, always continuing to take  off fti-
mulus, till the matter comes  to the  degree  of diminifhed
                                             excitement,
  (i) Of  indirect  debility in producing  premature fleep, fee par.
CXXXVI1I.
  (k) Coma, or an infuperable  difpofition to fleep, is moft commonly
owing to the want of moft of the ftimuli  mentioned in the text, as that
of food, of wine, at leaft in the ordinary practice of cure,  of good animal
fpirits, of  the power of thinking in a  pleafant  exciting train, of a due
quantity of blood in the veffels, of pure  open air, of corporeal exercife,
and of the abftnee of certain ftimuli, that otherwife irritate in the wea-
Vencd ftate, and produce watchfulnefs. 
             O?   MEDICINE.         I59

excitement, and encreafing excitability  neceffary to the
watching ftate. In this way does fleep prepare the fyftem
for the watching ftate; which is afterwards kept up, for,
the due length of time,  by the feveral exciting powers,
acting through the day, till  at kft,  by a  certain failure of
their action,  fleep is produced again (1).
   n.  Too long or morbid watching is alfo brought on in
a two-fold way,  by indirect and direct debility.   Thus,
intenfe thinking (m), violence of paflion in extreme (n),uk
timate excefs in corporeal labour (o), unufual and high
relaxing heat, debauch in eating and drinking, a great ex-
cefs  in the ufe of the diffufible ftimuli (p), a great abun-
dance and velocity of blood ; all, or  any of thefe, riling
to indirect debility by an ultimate excefs in their operation,
are notorious for their  effect of repelling fleep.   Again,
cold,  not in that extreme degree which immediately pre-
cedes death ; abftinence from food, or that ibrt of it that
is  not fufficiently nourifhing, or of fufficient indirect fti-
mulus to produce the requifite diftention; weak drink, as
tea, coffee, or watery drink, efpecially when a perfon has
been accuftomed to more generous; intermiffion of ufual
labour or exercife,  whether of body  or mind; a fenfe of
fhame from difgrace, and fear,  and  grief; all thefe,  by
their  operation not  fufficiently approaching to indirect de-
bility, produce an undue or morbid ftate of watchfulnefs.
   CCXL.  As debility,  therefore, whether indirect or di-
rect,  or in part a mixture of both (q), is the caufe of fleep,
the firft of found fleep, the two latter of an improper or
morbid ftate of that function ;fo  an  excefs of  the fame de-
bility, whether indirect  or  direct,  is alfo a caufe of im-
                                                proper
  (1) See laft par. CCXXXVIII.     (m) See above, CXXXVIII,
 (n)SceCXL.                  (o)  SeeCXXXVII. r,
 (p) See CXXIV. CXXV. CXXVI. 0. p.
 (q) Sec par. XLVII. and the note belonging to it. 
l6o       THE    ELEMENTS.
 proper or morbid vigilance.   The only falutary  fleep is
 that which is produced by a proper degree of excitement,
 occafioned by a proper action of the exciting powers upon
 the excitability; all the extremes of either exceffive fleep,
 or exceffive vigilance,  are either  fb many  tendencies  to
 difeafe, or actual  difeafe (r).
   A  perfon,  fatigued with his ufual exercife,  is imme-
 diately  compofed  to  fleep ; which,  equally,  flies from
 him who has had either lefs,  or more,  than that middle
 degree (f).
             4                                       CCXLI.

  (r) Too much, or too long continued, fleep, is hurtful, becaufe it im-
plies a fufpenfion of that excitement, to which proper health and due vi-
gour is owing, it is, confequently,  a ftate of direct debility.   Too little
fleep, or of too fhort duration, is of equal detriment, as implying  a de-
gree of excitability, not fufficiently accumulated to receive  a fufficient
impreffion from a renewal of the  exciting powers.   From  the former
arife moft of the complaints of the rich and indolent;  from  the latter,
many of the difeafes of the poor and laborious.  As the action of the ei-
citing powers fliould be adapted  to the ftrength, a little indulgence in
fleep is the fdfeft  extreme to the weak, as in the cafe of children,  and
perfons labouring under debility.
  (f) When a  boy, I valued myfelf much for enduring the fatigue of
walking :  About the fifceerth year of my age I walked, in  a fummcr
day.from, Tcrwick on Tweed to Morpeth,  which, with two miles wan-
dering out of the high road, I found to be a journey of fifty miles.   But
I got not a wink of fleep the whole night, from the excefs of the exerti-
tion ; and the next day, fo pained and enfeebled were all my joints, that
it was with  the utmoft difficulty I made out the fingle ftage from  Mor-
peth to  Ncwcaftle, which was  only a walk of  fourteen miles.   Some
years after that,  when I was now  arrived  at my full ftrength, and my
joints perfectly  knit, I walked and wandered in  all  forts of ground, in
reads and out cf them, over fmooth ^nd plain, and heathy and moun-
 tainous tracts, from  four o'clock P. M. to two o'clock, P. M. next day,
with only an hour's reft, and one hearty meal at  betwixt ten and eleven
o'clock in the forenoon, when I was now within fix miles of n»y deflina-
tion.  The hills over which I wandered in the courfe  of the  night  arc
thofe called Lammer-muir, fituated betwixt Eaft Lothian and the Mers:
                                                            the 
                 OF   MEDICINE.          l6l

    CCXLI. As the effect of both indirect and  direct de-
 bility is fometimes fleep, fometimes watching, both of them
[ unfound, both hurtful;  fo the caufe of bad fleep is either
 fort of debility; without  a ftimulus acting upon the fyftem
 in a weakened ftate, and, thereby, throwing the fyftem in-
 to a  ftate  of difturbance.  The  fune debility of  either
 kind, with fuch  a  ftimulus, produces the morbid watch-
 ing ; in  which cafe it  is a fmall  ftimulus that acts as an
 irritating power (t).
                            M                      n.  Inftan-

 the places T travelled  between  in this rout  were Edinburgh and Duns,
 the place of the nativity of the celebrated fchoolman and metaphyfician,
 John Duns Scotus, and that of my grammar education.  In  this great
 exertion I was futained by  a  great  ftimulus,  high animal fpirits, and
 love.  At  the end of my journey, and finding myfelf among my friends,
 and the object  my affection,   I had vigour enough  to  dance with the
 latter.  Thu time I flept well, and was perfectly recruited next day,
   (t)  Volumes have been filled with the doctrine of irritation as a caufe
 of morbid ftate. and  the indications of cure and remedies to remove it
 have been equally tedious and  laboured.  In fthenic difeafes, phlogiflic
 diathefis inftead of plethora and vigour (for  the belief  in which two laft
 there might have  been  fome  foundation in that  form  of difeafes,  fee
 above from CXXXI. to CXXXlV ) has been  the univerfal pathology;
 andbleeding, other evacuations, and celd, the  univerfal idea, or, as it is
 called, indication of  cure ;  and while they thought of no other method
 or means of cure for the afthenic form of difeafes, the  pathology, applied
 to them, was plethora with  vigour or with mobility in other cafes, and,
 in the febrile, irritation.  By irritation they  explained  the ftartings of
 the tendons, the reftleffnefs, the frequency of  the pulfe, the typhoma-
 nia or conftant working, of fo frequent occurrence and fo noted a fymp-
 tom in thofe difeafes.  But as we have  proved, that the reverfe of ple-
 thora and vigour is the fue ftate of the fyftem in every difeafe of debi ■
 lity;  fo  we  affert  with the  fame folidity  of  argument, and the fame
 weight of proof, that  irritation, as bein^ confidered, either as the caufe
 of morbid watchfulnefs or of any other fymptom, is nothing that re-
 quires either  eve.cuant, or any other debilitating remedies,  to renove
 it.  It is merely a weakened ftate of the fyftem, thrown  into fluttering
 from the flighteft exertion of  thr. ordinary functions,  as when a perfon
 falls into tremors from noife, or into a fweat from walking a ftep or two; 
 iGz         THE   ELEMENT*

   N.Inftances of morbid fleep occur in the predif pofitions
to difeafes, and the actual difeafes, that depend upon fthe-
nic  diathefis, and in  the ordinary ftate  of intoxication
from drinking.  But all the exciting  powers,  when con-
verted into  hurtful ones of  exceffive ftimulus, each in
proportion to its degree of excefs, have the fame tenden-
cy (u).   Bat, when the exciting power proceeds beyond
the fleep-inviting point; or when any ftimulus, ftill find-
ing unwafted excitability to act upon, continues to  act;
in that cafe, the  watching will  be   continued with  bad
effect (x).
   CCXLII. Inftances  of morbid fleep  occur  in  all  the
difeafes of indirect debility, and in pains that have advanc-
ed to thefamedegree of exhauftedexcitabilityinthefcale(y);
as  in the  feveral cafes  of the  phlegmafia?, that arife from
the violent progrefs of  the morbid ftate, or the improper
adminiftration of ftimulants for the  cure; which is  par-
                                                  ticularly
  (u) A heavy dinner, exceffive fatigue from either  corporeal or menta}
labour, a high fit of paflion, and heat, are, each of them, noted for giv-
ing a difpofition to fleep ; which is an effect, arifing from their high
degree of ftimulus,  hurrying the excitement to that degree of wafte in
which the fleep-inviting point confifts; and it will the more readily take
place, that  no  exciting power, by ftill finding  excitability  to act  upon,
continues, therefore, to act,  and prevent the fleep.
  (x) as in the harrowing watchfulnefs, which is liable to accompany
the phlegmafia;, or the feveral fthenic difeafes with inflammation of a
parr.
  (y) That happens in the phlegmafiz, where the effects, not only, of
the inflammatory pain, but of the whole diathefis, and of every  other
fymptom, as well as  that  of pain,  is to run up into indirect debility.
The laft part of debility,  that ufhers in a fit of  the gout, is commonly of
the direct kind;  but the effect of the continuance of the pain is often
fleep, the origin of which is indirect debility, its confequence an encreafe
of the difeafe, and its remedy an interruption of the morbid fleep for the
purpofe of adminiftering fuch. diffufible, and other ftimuli, as have the
effect of removing the  debility which occafions  both the fleep, and  other
fymptoms of the difeafs, 
OF   MEDICINE.
163
 tlcularly exemplified in the dropfy  of the breaft,  that of-
 ten arifes from  peripneumony  under fuch management!
 With refpect to fleep  from direct  debility, women, who
 have had many deliveries, who have often fuckled, as well
 as all lazy perfons, and thofe of both fexes, who are ad-
 dicted to luxury, and whofe cuftom it is to fleep too much,
 are all liable to fall into this fort of morbid fleep.
    CCXLIII.   When  either  direct  or indirect  debility,
 fometimes produces fleep that gives   no refrefhment (z),
 fometimes an ungentle, turbulent waking ftate,  neither
 of them  accommodated  to health;  as the debility pro-
 ductive of either effect, exceeds that in which found fleep
 confifts; the ufe of that degree of ftimulus which may re-
 pel the former, and convert the latter into fleep, will re-
 move  the complaints,  and ferve for an illuftration of the
 nature of both (a).   In afthenic difeafes the watching ftate
                             M  2                      for

   (a) which often  happen in  fevers and many other cafes of debility^
befides thofe mentioned in the text (CCXLII.) and ought never  to be
encouraged, but repelled by every means of exciting the patient.
   (a) Let the point of indirect debility, in which fleep confifts, be as 15
degrees in a particular fcale, and the greater  debility, than that which
either conftitutes morbid fleep or morbid watching, be 20 degreesor up-
wards in the cafe of  its being indirect, or 10 or downward in the cafe of
its being direct debility.  It is evident, that, tobringon falutary watch*
ing on the one hand, or falutary fleep on the other, or to convert both
into falutary fleep, if that be required by the circumftances, the deficient
degree of ftimulus muft be  adminiftered ; that is five degrees to bring
up the excitement from io to 15 degrees, and as many for the purpofe
©f renewing the worn-out excitement by means of a new exciting power
which may ftill find a  portion of excitability to act upon, or to remove
certain ftimuli, which,  however flight and mild, are fatiguing and dif-
turbing to the fyftem  in its weakened  ftate.   Accordingly in  fever,
when the patient, amidft every fort  of directly debilitating powers, had
befides  wanted  fleep for ten days, a fmall  portion  of an opiate given
him every quarter of an hour,in three hours time laid him afleep, which
in  fpite of an urgent cough and profufe expectoration, lafted for fixteen,
                                                       hours, 
   164       THE    ELEMENTS

  for  the  moft  part is the  confequence of direct  debility^
  with fome power acting with flight ftimuiant effect ;  the
  reafon of which is, that  the difeafe depends upon more
  debility than that which conftitutes fleep.  Hence it comes
                                                          about,

  hours, and Was followed by the moft furprifing relief.  The continuance
  of this practice with only an encreafe  of the dofcs in  proportion  as the
  abundant excitability was gradually worn off, and alternating them with
  wine and beef foup, in  ten days  removed all danger,   A child of  three
  months had had no found fleep for ten days, but had cried night and day
  from a complaint in his belly; which the ordinary practitioners would
  have called an obftrudlion in the mefenteric glands.  A large dofe of
  the tiuctura thebaica, for the patient's age, was adminiftered, which laid
  him  in a profouud fleep, that continued near 36 hours, and  at once re-
  moved the difeafe.  Numberlefs are the cafes of a  kind fimilar to this
 where the morbid watchfulnefs was  partly from direct, partly from in-
 direct debility, that have been conftantly removed by the fame practice.
 A child of 7 years of age, in a  fever of great direct debility, in confe-
 quence of a moft rapid growth happening during the difeafe, which was
 not completely removed till  near the end of 7 weeks, after having  beeH
 under the difeafe near a  fortnight, was affected with the moft conftant
 difpofition to fleep, fo found that no noife or fhaking of his body could
 waken  him.   The adminiftration of the opiate repeated in  fmall dofes
 till the  effect took place, kept him awake,   Some  time after, in the
 courfe of the fame lingering difeafe, when he had not yet acquired any
 permanent ftrength, but  was only better fupported by the diffufible and
 other ftimuli, than he had been  till I  was called in, his predominant
 fymptom came to be great watchfulnefs, which was partly the effect  of
 a certain, though not a great degree of excitement that the tincture
 and other cordial powers had given him.  It,  however, induced too
 great a  degree of  indirectly debilitating exertion for his  ftill very weak
 ftate, and it, therefore, became neceffary to give him an addition of ex-
 citement to bring him to the ftate of falutary and recruiting fleep, and
 thereby to fufpend the aclion of  a number of exciting powers, however
 flight their  operation was,  which were too much  for the enfeebled
 flate of his fyftem.  In  the cafes of children whofe difeafes are almofl
 all afthenic, and in other  difeafes of high debility,the inftances of fuch ef-
 fects of the diffufible ftimuli, (for  more than one  was employed upon this
is well as  many other occafions) are  equally numerous  and furprifing.
In a very large practice  I am fure I never, in the very worft cafe?, loft
three patients* 
               OF   MEDICINE.          165

 about,  that every thing that ftimulates,  every thino- that
 raifes the excitement as it were to that point, which com*
 pofes the fyftem to fleep, produces that effect by a ftimu-
 iant,  not a fedative, virtue.  In a fmall degree of debility,
 where the excitement has fallen  only a  little below the
 point of fleep, a very fmall degree of ftimulus,  fuch as a
 little  animal food, if the weaknefs had been owing  to
 vegetable food, fuch as wine,  or any drink of equal  pow-
 er,  after a water regimen; fuch as confolation in affliction
 of mind; heat, when cold has been the debilitating  pow-
 er ; gentle exercife or geftation ; or the ftimulus  of a plea-
 fant train of thought, when one has been  deprived of the
 ftimulus  of corporeal  or  mental exercife, is  fufficient,
 In a higher degre of debility (for the curative force fhould
 always  be adapted to the degree of the difeafe (b); either
 a proportional higher degree of the  ftimuli which  have
 been  mentioned,  or fome more powerful  one, fucn as
 thofe, which are called diffufible, fhould  be employed.
   CCXLIV.  In both which cafes, the virtue, of opium
 is great;  its virtue,  however, is not  peculiar  to it,  or a-
 ny other than what  it poffcffes in common with  all the o-
 ther ftimuiant powers,  differing only from the reft in the
 higher degree of its  (c) virtue.   Thus in great debility, as
                                                       in
   (b)See  above, par. XLIV. and  XCII.
   (c) The notion of fome powerful remedies, as opium, mercury,  the
Jefuits' bark, &c. ailing by an operation peculiar to each, and different
from every other power  in nature, was long prevalent in the fchools of
medicine.  Thofe they called fpecifics; an idea, which, like many other
of their vague conceptions, was altogether contrary to found philofophy ;
fince the  mare careful our inquiries  into nature's  operations  are,l th«
more and more reafon have we to be convinced, that fimplicity and uni-
formity pervade the  whole phenomena of the univerfe.  Accordingly,
in the exciting powers that act upon the excitability of our bodies, we find
only  one action, that of ftimulating,  varying only in its degree, to take
place in all animal as well as vegetable bodies, nay in every thing that
                                                       VfC 
  l66       THE   ELEMENTS

 in fevers, as in a violent fit of the gout, difturbing with tu-
 multuary diforder the internal parts,andin other fimilar dif-
 eafes of debility, in which the violence of the difeafe keeps
 off fleep; opium often, after the watchful ftate has remained
 many days, brings on profound and found fleep; in which
 cafe, becaufe the excitability is very abundant, and, there-
 fore, can bear but a very fmall force of ftimulus, we fhould,
 on that account, begin with the fmalleft degree of ftimulus,
 and proceed gradually to more and more (d); till at  laft wc
 arrive at the point of fleep, which will foon happen, as it
 is  placed much within the range of direct debility:  And
 with refpect to coma, or that fleep  which is not recruit-
 ing : fuch is the effect both of other diffufible ftimuli and
 of opium, that it converts  morbid fleep into  vigilance;
 vigilance, after a certain fpace of  time, into  refrefhing
 fleep, and, in that way, conducts the patient fafely, gently,
 and pleafantly, to health.   But as the influence  of  the fti-
 muiant  operation,  that fupports excitement,  is   of fo
 great importance, and as  fleep of longer duration than to
 prove refrefhing may arife even from good remedies,  the
 rule to be obferved when that happens is, whenever any at-
                                                      tack

 we know to poffefs life in the univerfe.  We alfo find,  to the fame ex-
 tent, only one property in living fyftems upon which it acts, that is, the
 excitability; and one effect produced by the mutual relation betwixt
 them in that refpect, to wit, the excitement.   Inftead .>f the diftracted
 notion of vortices, or  atmofpheres in rapid motion, governing the mo-
 tion of the planets,  Sir Ifaac Newton found the whole planetary fyfteni9
of the univerfe governed in their motions by one finale principle.  In-
ftead of the infinite difference of habits and temperaments,  I have found
every individual precifely the fame as every other.  Whatever produce*
the gout in one; will produce it in another,prepared to receive its influ-
ence.  And whatever cures it in any one, cures it alfo in every other;
 and fo forth with refpect to every other difeafe. The deeper we explore
 the works of nature, the more will we be convinced of this wonderful
 Simplicity, fo that, to a philofopher, all nature would appear the effect
of one fingle inftruntent in the hand of the all-wife all powerful creator,
  (dj See above, pan  CVU» 
OF   MEDICINE.
167
tack of fleep, upon account of too long a fufpenfion of fti-
muiant aftion,  has been of lefs fervice than was expected,
to fhorten its next attack, and renew the operation of the
ftimulus.
   CCXLV. In afthenic difeafes, and  thofe arifing from
indireft debility, in which fleep is alfo kept off; in order
both to reftore it, and remove the other  fymptoms, and
bring about the healthy ftate, both other ftimuli fhould be
employed according to the degree of debility requiring their
ufe, and, when the degree of debility is very confiderable,
the diffufibla  ftimuli, and among the reft opium, fhould
not be omitted.
   CCXLVI. Thefe  are  the times and circumftances of
the body in which opium produces fleep.  In all the other
ftates either of health or difeafe, it  excites the functions
both of body and mind, as well as of paflion and emotion;
among others  it banifhes fleep and produces great activity
and vigilance.   Thus if any one is  under the preffure of
fleep without an evident caufe, he will by opium be ren-
dered furprifingly fp rightly, lively, and vigilant; it banifh-
es melancholy, begets confidence, converts fear into bold-
nefs, makes the filent eloquent, and daftards brave-   No-
body, in defperate circumftances, and finking under a dik
relifh for life,  ever laid violent hands on himfelf after ta-
king a dofe of opium, or ever will.  In one word, through
all the intermediate degrees of excitement from direct to
indireft debility, opium is by far the moft powerful of all
the agents, and as fuch muft be moft hurtful in fthenic di-
athefis; becaufe,  when added to the other ftimuiant pow-
ers, it not only banifhes fleep, but  is liable to precipitate
thofe difeafes from the fthenic ftate to indireft debility, and
from this laft  to death.
   CCXLVII.  That  the debility,  upon which coma de-
pends,  is lefs than that which fupports morbid vigilance,
                                                   is 
168       THE    ELEMENTS
  is proved, from the former being lefs dangerous, and more
  eafily removed;  yet,  when its duration is in  any degree
  confiderable, or when it rcfembles profound fleep,  care
  fhould be taken to prevent the hurtful effect it may produce
  from direct debility (e);  in which cafe recourfe fhould be
  had to the different forms of wine and opium, with the in-
  tention of raifing the excitement to that degree, which re-?
  pels the fkcpy ftate, produces more ftrength, and facili-
  tates the return of health (f).
    CCXLVIII.  In  the  gout,  in indigeftion, of  which
  examples have already been adduced, in diarrhoea and the
 colic,  and many other afthenic difeafes, particularly dif-
 turbing  the alimentary canal,  and chiefly affecting thofe
 women who are exhaufted with frequent child bearing,and
 long and repeated nurfing;  it often happens, that there is
 a ftrong propenfity to fleep, contrary to what happens to
 the fame  perfons in health, and the period of fleeping at-
 tack is prolonged,  without  the indulgence in it bringing
 any alleviation of the difeafe.   The fame thing happens to,
 thofe who have fallen into indirect debility from drunken-
 nefs  or any other caufe.  That this defire for fleep depends
 upon direct or indirect debility is evident from every thing
 that  gives further debility encreafing the difeafe, and every
 thing that ftrengthens,  removing it.  Among thofe all
 ftrong drink, and the preparations of opium, are peculi-
                                                     arly
  (e)  See above,  par, CCXLI. and the note under it, as well at this
whole chapter,
  (f)  Phyficians have had a more favourable idea of coma, or the fleep-
ing ftate in fevers, than it merited.  Inftead of deferving to be looked
upon as a pofitively good fign,  enfuring a fafe return of the  difeafe, as
they did ; it was at heft but a  negative mark, implying that the flight
ftimuli acting upon the fyftem in a ftate of high debility, and, therefore,
by their operation, flight as it was, encreafing the direct debility by the
addition of the indirect to it, were kept off and hindered from producing
that hurtful effect. Their authority in giving that judgement of it is over-
thrown by their extreme ignorance of its naturs, 
              OF   MEDICINE,         169

 arly  effectual, -and that  in proportion to their  greater
 and  more diffufible  ftimuiant  power, than that which
 others poffefs.
   CCXLIX. Nor is it unconnected with this explanation
 of the nature of fleep and watching, and of both of them
 being fometimes repelled, fometimes induced, by a certain
 degree of ftimulus (g): that exceffive motions, as the fpaf-
 modic and convulfive,which have been mentioned (h), fuch
 as the quick pulfe in fevers (i) and other motions, are remo-
 ved by an equal force of ftimuli,  to that which is required
 to remove morbid affection without any motions.  Hence
 it is plain, that irregular motions are not only encreafed
 functions (k), independent upon  debility, but that they are
 impaired functions, and confift nearly in the fame degree
 of debility.
   CCL. From what  has been faid, the analogy between
 watching and life,  and fleep and death, and their depen-
 dence upon  the fame laws of  nature, that govern  all the
 other functions, clearly appears ; and the moft  folid pro-.
 bation has been adduced, that the moft vigorous vigilance
 confifts in the higheft degree of falutary excitement; that
 the middle and deep period of fleep depends on the high-
 eft debility that is confiftent with the  healthy ftate ; that
 true fleep depends on a middle degree of indirect debility,
 and that both morbid fleep and morbid  watching  are the
 offspring of great debility, whether of the indireft or di-
 rect kind.
                                           CHAP.
  (g) See above, par.  CCXLI. where this propofition is reduced t»
its exact principle.
  (h) See above, par. CCXX.             (i) See par. CLXXIX.
  (k) Sec above, CCXXIX, 
 I JO       THE   ELEMENTS


             CHAP.   VIII.

             The Cure of both the Diathefis.

   CCLI. AS the caufe of both the diathefes is that which
has been formerly  (a)  related *, the indication of cure,
therefore, to be taken from that is, in the fthenic diathefis
to diminifh exceffive excitement  over the whole fyftem;
in the afthenic to encreafe deficient excitement  likewife
over all the fyftem, till it be brought to that degree, which
proves the caufe of health.
   CCLII.  The remedies that produce that effect  in the
eure  of fthenic diathefis, are the powers, which,  when
their ftimuiant operation is exceffive, produce that very
diathefis, in this cafe,  afting with that flight and reduced
force of ftimulus, by which they produce lefs excitement
than  health requires, or by which they  prove debilita-
ting.
   CCLIII. The  powers which produce the  fame effect
in the afthenic diathefis,  are thofe that, when their ftimu-
lus is fmall,  produce that diathefis, in this cafe, exciting,
with  that high dagree of ftimulus, by means of  which
they give more excitement, than fuits the healthy ftate, or
by means of which they ftimulate.
   CCLIV. In the fthenic diathefis that  temperature  (c)
                                                  which
  (a) See above, par. CXLVIU.
  (c) The fame order is followed here,  that has all along been obfer-
ved, to wit, that of the enumeration of the powers in par.  XL and XII.
and that of the explanation of them, when viewed as the hurtful powers
producing either  diathefis in Chap.  I. Part IF. and it will be kept to
throughout the whole work.  Nothing can be more fimple and natural,
and better fuit the fimplicity oi the fubject, while nothing is more artifi-
cial and arbitrary  than the arrangements either of Syflematics or Nofo-
logift*.  Juft order could never be expected from an erroneous and confu-
                                                      ted 
OF    MEDICINE.          171
which  is  called heat, muft by all  means be avoided;
and for this very good  reafon, that the only degree of it
which proves debilitating, that is the exceffive to an ex-
treme,  cannot  be carried to that  height, in which it de-
bilitates,  without the rifk of hurtful  or pernicious confe-
quence from the excefs of ftimulus (d).
   CCLV.  But,  when the diathefis,  and its caufe the en-
creafed  ftimulus, is gentle in the aftual  difeafed ftate,
there is no  occafion for forbidding that degree of  heat,
which accompanies the operation of fweating and pediluvi-
um (e); becaufe the wafte of fluids   in the former,  and
the agreeable  fenfation in the latter, promife fomewhat
more advantage than the moderate degree of heat employ-
ed in this cafe threatens difadvantage.
   CCLVI.  In a particular manner, after the applica-
tion of cold in an intenfe degree, muft the  application of
heat be avoided,  becaufe its operation,  from the encreafe
of the excitability of  cold,  becomes more effective (f).
And the confequence is the more to be dreaded, that,  at
the fame time,  other ftimuli  are ufually urgent.
                                                 CCLVII.
fed view of the fubject to he treated of; while a clear conception of the
fubjedl as a whole, infallibly leads to a diftinct diilribution of the feveral
parts that compofe it ; fo that what Horace fays of language, equally ap-
plies to order, and the fame thing applies here  as to his Verba & lucidus
ordo. Rite paratam rem verba haud in vita fequentur.
   (d) See above, par. CXV.  Though  very intenfe heat relaxes the
fimple and induces atony on the living folids, who in a peripneumony,
would think of ufing it with that view?  That difeafe from its own vio-
lence, often  mounts up fo high in the fcale  of increafed  ftimulus,  as
nearly to approach the point of indirect debility, and it fometimes actu-
ally gains that  point.  The addition, therefore, of more ftimulus, from
the application of heat, would enfure that effect, and thereby occafion
the converfion of the difeafe into a much worfe one, fuch as hydrotho-
rax, or the dropfy of the brcaft.
   (e) Pediluvium  is the warm bath of the legs ar.d feet.
  (f) See above, par, XXXVII.  9 and note (d), 
  172       THE   ELEMENTS

    CCLVII.  Cold is the  beneficial  degree of tempera*
 tnre in the cure of this  diathefis, but it muft be cold not
 fallowed by any confiderable degree of  heat.  That mi-
 ftake,  therefore,  in medical praftice,  of  thinking cold
 Irartful in  fthenic  diathefis by  a  ftimuiant operation,
 fhould be corrected; and its benefit in the fmall-pox is not
 to be underftood to arife fo much from its mere debilita-
 ting degree, as from avoiding  the  ftimulus of heat after
 its  operation.   When the fame precaution  is employed,
 the  fame cold  either  alone,  or in conjunction with other
 debilitating powers, has  lately been found the moft effeft-
 al remedy of catarrh (g ).
   CCLVIII.   From  which circumftance,  and  becaufe
 a cap of frefh dug up earth put upon  the head, has been of
 fervice in phrenitis; and that degree of cold, which produ-
 ces  froft and fnow, when applied to the naked body, has
 removed a  fynocha accompanied with delirium (h); and
                                                   becaufe

  (g) or the common cold in Englifh, ^ name ftampt upon it by the ve-
ry blunder we have been fpeaking of.
   (b) It is called the common  inflammatory fever,  very improperly, as
being no fever, but a general pyrexia, or affection of the whole fyftem,
without  inflammation or local affection, and producing heat over all
and tumultuous effect upon the pulfe.  Its proper generic name is pyrex-
ia.  See  above par. LXVIII. where that appellation  is affigned to it;
an appellation to avoid miftaking its. nature, that fhould be accurately
attended to.  Great mifchief has been occafioned by this vague term.
Thus when a perfon is faid to be affected with a difeafe; when it is afked
what difeafe it is, and the anfw.-r given, that  it is a fever, immediately
bleeding is thought of, though that, and every, evacuation is as hurt-
ful in proper fever as it may be ferviceablc in the pyrexia.  To give  an;
example of this pyrexia, the particular appellation for which is fynocha,
or fthenic pyrexial difeafe ; many years ago, a perfon in the old town of
Edinburgh, labouring under it, efcaped the vigilance of his nurfe ; flew
naked out of the houfe in a very keen froft with fnow upon the ground,
acrofs the ftreets,  pafftd over into the new town,  and from that to the
fields beyond it. lit foon became fenfible of his ftate, ftole iflto a houfe
                                                       next 
OF    MEDICINE.
*73
 becaufe cold is fo efficacious a remedy in the fmall-pox 5
 it clearly follows, that the ufe of cold fhould be extended
 to the whole range of  predifpofition, the whole circle of
 difeafes, depending upon fthenic diathefis.
   CCLIX. That no  hurtful effect arifes from the fup-
 pofed aftringent power of cold in the  fthenic diathefis (I),
 Is proved by its very high Influence, when  applied to the
 furface of the body in the fmall-pox, in keeping up a free-
 dom of perfpiration  in proportion to the degree of its ap-
 plication.   And its  influence in  producing atony with
 proportional laxity of the fibres of the veffels, is in con-
 formity to the fame obfervation (k).
   CCLX.  For the removal of afthenic diathefis the ftimu-
                                                         lus

 next to him, got fome clothes thrown about him, and  was carried home
 in a chair, perfectly cured of his difeafe.   From which, and a prodigi-
 ous number of facts to the fame purpofe, all concurring in the proof of
the debilitating operation of cold, there can hardly arife a doubt in the
 mind, that in a certain high  degree, if it could be conveniently ufed, or
 if there were occafion to have recourfe to it for want of efficacious reme-
 dies, it would at once remove the higheft  degree of  fthenic ftate that
 ever occurs in difeafe, and reduce the excitement from the neareft ap-
 proach to 70 down to 40.   Nay it might run into the oppofite extrem*
 and go all the way to death.   But we fhall, by and by, have occafion to
 obferve, that we are fo well provided with effectual remedies as not to
 be under any temptation of  ftraining this  to its height.  And we fliall
 alfo find that a number cf remedies in a moderate, degree are preferable
 to any one,  or to a fmaller number in a higher degree. The difcovery
 i<f the principle upon which the cure of fthenic difeafes turns, has ena-
 bled us to render the cure both more complete and exact,  than it  could
have been without principle.
   (i)  I remember, when I was a young ftudent, of hearing the old phy-
 ficians in Edinburgh very gravely forbid a draught of cold water in  an
inflammatory pyrexia and even in a common catarrh,  for fear it fhould
 produce  an inflammation  in  the ftomach.
   (k) The fibres being relaxed defcribe a greater cavity, and  hence the
 check given to the perfpiration by the contrary effect of the fthenic dia-
 thefis in encreafing their denfity in diminifhing their diameters, is taken
 off. 
'74
THE    ELEMENTS
 lus of heat is fignally  ufeful, and chiefly for the follow-
 ing reafon; that it  muft  be as ufeful in this  diathefis,
 ■where the excitement is too low, as it is hurtful in the fthe-
 nic, by giving a  further  encreafe of the excitement,  too
 much increafed  already.   Hence in  fevers,  in the gout,
 in dyfpepfia,  in  the colic, in rheumatalgia (1), and in all
 afthenic difeafes,  the fyftem is very much cherifhed by
 heat, and debilitated by cold: Which, by its debilitating
 effect, is ranked among the powers that produce the dif-
 eafe (m), and is deftruftive in fevers.
    CCLXI. As cold is  hurtful in afthenic diathefis in the
 proportion in which it  is ferviceable in the fthenic (n); it
 is accordingly, for this further  reafon, to be avoided in
 difeafes of  the higheft debility, that, like intenfe heat, it
 relaxes the extreme veffels, and produces a putrefaction
 in the fluids (o).
    CCLXII. The more certainly to moderate the fthenic
 diathefis while as yet it remains within the range of pre-
 difpofition, a  fparing ufe fhould be made of flefh and the
 preparations from it, and  vegetable difhes ufed with grea-
 ter freedom. But, when the fame diathefis is encreafed to
 the degree, that conftitutes  difeafe, abftinence  from animal
 food, efpecially in a folid form, and  a free,  but ftill not
 exceffive, ufe of vegetable matter,  efpecially  in a fluid
 form, are the beft means of removing it, as far as the ma-
 nagement of diet goes.
                                               CCLXIII.
   (1) or what is improperly, as it has been faid before, called the chro-
 nic rheumatifm.
   (m) No gouty perfon can  bear the operation of much cold, and every
 one can endure more heat, than moft other perfons.  And the reafon is
 evident : So debilitating a power muft, in propoition to its degree, be
f peculiarly hurtful in all difeafes, in which the debility conftituting their
 caufe, runs high, as  it naturally does in the gout,  where it is encreafei
 by the advance of age, and other caufes, and much more fo in fevers.
   (n) Sec par. CCLVI1I.        (o) See above, CXVII. 
            OF   MEDICINE.         17 J

  CCLXIII.  In that degree of this diathefis, which does
not exceed predifpofition, it is proper to avoid feafoning,
which is deftruftive in difeafes.
  CCLXIV. Watery drink is  very fuitable to it, and all
pure and ftrong drink hurtful, and that in proportion to
the quantity of alkahol  that it contains.   The latter fort
of drink, unlefs taken very weak, is deftruftive in difeafes.
In the number of which pure water, efpecially with an ad-
dition of fomething to acidulate it, is preferable to fmall-
beer, which a great authority admitted.  B ut  the diffufible
ftimuli in this diathefis are above all others hurtful.
  CCLXV. Since the indireft ftimulus  of food affifts the
direct, that is, propagates itfelf over the whole body; for
that reafon bounds fhould be fet to the bulk even of the
fuitable matter (q).
   CCLXVI. In every degree of afthenic diathefis, vege-
table food fhould be avoided, and recourfe had as foon as
poffible to that, which confifts of meat and animal matter.
And,  as that can feldom be executed  immediately upon
account of the weaknefs of the ftomach; the diffufible fti-
muli fhould, therefore, be ufed; fuch as  the different forms
of wine when the debility is moderate, and opiates when
it is greater.   And at the fame time, from the very begin-
ning rich foups fhould be given in great quantity upon the
whole,  and a gradual tranfition made to the ufe of more
folid matter.
   CCLXVII.  As it is animal matter  in this cafe,  that
is of fervice,  fo the degree of ftimulus,  that feafoning adds
to it, improves its effect (r).
   CCLXVIII. During the predifpofition to  afthenic dif-
eafes, watery, cold, acid, fermenting drink is  hurtful, and
that proportion  of  pure ftrong  liquor, that the degree
of debility requires,  is beneficial.   But, after the difeafes
                                                 have
  (q) Sec above, par. CXXVII,     (r) Sec above, par. CXXV, 
  176      THE  ELEMENTS.

 have actually taken place, and have now attained  a high
 degree of vehemence,  the fame ftrong drink becomes fo
 indifpenfibly neceffary, that excepting the foups, and the
 ftill more diffufible ftimuli, it is the only fupport required
 for a long time. There is no occafion for any dread of the
 indireft ftimulus of food, when the matter,  which chiefly
 affords it, that is, vegetable matter, is guarded againft (t).
   CCLXIX. For the purpofe  of diminifhing the ftimulus,
 which an over proportion of chyle and blood(u), directly
 applied to a great extent of the body, produces ; the over
 proportion, when it is very great, fhould be removed by
 abftinence, bleeding, and purging : when it is more mo-
 derate, but yet adequate to the effect of producing difeafes,
 the directions lately given (x), refpecting a moderate dia-
 thefis, ought to be obferved; that is, we fhould adhere to
 the practice of  vomiting and  purging from time to time,
 and to a fparingnefs in diet.   But blood fhould not be let.
 And, if upon any occafion, the patient fhould give way to a
 little fulnefs in  his  ufe of food,  he fhould  ufe  vegetable
 matter, abftinence, gentle and frequent exercife, and fweat-
 ing, and, thereby, keep up a full perfpiration.
   CCLXX.  The fame are the means of cure for an  ex-
 cefs in the velocity of the blood (z), in fo far as it depends
 upon an over proportion : when the velocity depends upon
 violent motion of the body, the means of leffening it, when
                                                     the

  (t) Compare this with what was lately faid in paragraph CCLXV.
  (u) The chyle is the alimentary matter, that has undergone a prepa-
ration in the ftomach, and an after one in the upper part of the intefti-
nal canal, and, which,  fo prepared, or in part digefted, is taken up by
 the mouths of a nnmber of fmall veffels that open into the inteftines;
thefe carry it to a great trunk,  in which all thefe veffels, called lacteal,
unite, and through that trunk, to be afterwards mixed, firft with the
venous, and then with all the other blood in fucceffion.  Such is the nou-
rifhing matter of animals.
  (x) See above, par. CCLV,
  (2) See above, par. CXXXI. to CXXXTV. 
              OF   MEDICINE.          177

the diathefis is fo moderate,  as only to produce predifpo-
fition,  or a gentle degree of actual  difeafe,  are an abate-
ment of exercife, more indulgence in reft, and a reduction
of other ftimuli.  In the very great diathefis,  that which
occafions fevere difeafes, in order to retard the motion of
the blood, a point muft be made to avoid the  ftimulus of
all the exciting powers, and blood muft be taken profufe-
ly.   Here  it is fuperfluous to lay down a rule for the ob-
fervance of keeping the body in a ftate of reft, as reft, even
in fpite of the patients, is unavoidable  (a).
   CCLXXI. Withdrawing the powers that occafion an
over-proportion of the fecreted fluids in the excretory
dufts, is the beft method of removing the ftimulus, which
that  over-proportion,  by its diftending energy, produ-
ces  (b .   The cure, therefore, confifts in more frequent
coition,  drawing off the milk,  taking in food  of  a lefs
nourifhing nature, and in reftoring the perfpiration by re-
moving the fthenic  diathefis upon the external furface.
   CCLXXII.  To  remove the  debility, or  atony  and
laxity, of the veffels, which is occafioned by a penury of
chyle and blood over a very great extent of the  fyftem(c),
                              N                      firft
  (a)  It would be ridiculous to require of a patient in the rage of peri-
pneumony not to run a race, when his real ftate is, that he cannot move
or turn himfelf in the bed without pain.
  (b) In par.  CXXXVI. you will find, that the fecreted fluids, here al-
luded to, are the milk, the femen, and the perfpirable fluid.  As the
diftention occafioned by the over-abundance produces the morbid ftimil-
lus, fo the fubduction of the fluids rauft, of courfe, take it off, and give
the defired relief.
  (c)  How great the fpace or extent of the fyftem  that, in the flhe-
jiic diathefis,  receives the ftimulus of an over abundance of blood ; and,
in the afthenic diathefis  is fubjected to the debilitating  power of an un-
der-proportion of the  fame fluid,  may eafily he conceived from the
well known fact, tliat there is not a foft part in the whole fyftem,  into
which the infertion of the point of the fmalleft needle will not draw blood;
confequently, the ftimulus arifing from an over-abundance of blood, as
                                                       w«R 
I*fi       THE    ELEMENTS.

firft, the ftrength muft be gradually brought back by dif-
fufible ftimuli  (d) and foups ;  next, we fhould gradually
ufe the latter more fparingly, and folid matter more plenti-
fully: laftly,  to give the whole fyftem ftill more ftrength,.
it fhould be fortified by exercife,  and the reft of the du-
rable ftimuli;  but no further ufe  fhould be  made of the
 diffufible, than to employ them fo long as confiderable de-
 bility remains (e).
                                                  CCLXXIII.

well as the debility arifirg from too fmall a quantity, muft be the moft
confiderable of all others.  Every circumftance here concurs to render
the one  the greateft fthenic, and the other an equal afthenic,  hurtful
 power.  If the force  of every  ftimulus, of every exciting power, be in
proportion, firft, to the degree of it applied ; fecondly, to the fenfibility
 of the part on which it acts ; and, thirdly, to the extent of that part,  it
 will be no wonder, that thefe two powers fliould prove  the  moft formi-
dable of all others.  Hence il is, that, in  the curative part,  bleeding is
 tiie moft powerful remedy of fthenic, and filling the veffels an equal one,
 of afthenic-diathefis.
   (d) which act by giving  vigour to the whole fyftem,  and more efpc-
Gially to the ftomach, with which they come into actual contact.  Hence
 digeftion, and the converfion of the matter taken in into  good chyle, and
 blood ; and hence, at laft, the fulncfs of the veffels firft indicated.  The
 procefs of emptying the veffels in the cure of fthenic diathefis  has the
 advantagebf being the firft in order;  and hence  is it that  the cure of
 fthenic difeafes is more quickly effected than that  of the afthenic ; it be-
 ing,  over all nature,  much more eafy to take away than replace.  See
 and compare par. CXXVI. andCXXX.  and fubjoined notes, and a lit-
 tle above, par. CCLXVI.
   (e) The fole ufe, and a great one, of the diffufible ftimuli is, in great
 weaknefs,  where they are only required, to fupport the fyftem,  while it
 cannot be fupported by the ordinary durable ftimuli;  and, after the ex-
 citement is fo far reftored, that the ordinary fupports are now fufficient,
 to lay afide the extraordinary ; the continuance of which would now be
 hurtful, and to manage the convalefcent, and reftored, ftate of health  by
 the  powers employed in health.  When the diffufible are continued  lon-
 ger, they are equally hurtful,  and a caufe  of difeafe, as they are ferviee-
 able when difeafe requires their fupport; analogous to wine, they bring
 about the fyftem in a weakened ftate to be fuftained by its natural  and
                                                       ordinary 
                OF    MEDICINE.         I^g

     CCLXXIII.  In  a weak ftate both  of the veffels and
  of the reft of the body, every motion  of the body, any
  way confiderable,  and all other ftimuli,  which quicken
  the motion of the blood,  and bring on an indireft  tern-
  porary debility, fhould be with-held.   But  in a  cafe of
  flighter debility, fuch motion as does not prove fatiguing,
  but  afts  as  an agreeable ftimulus,  and gives  recruit,
  fhould not be avoided.   When a perfon  is recovering from
  a difeafe, he fhould be gradually brought back to his ufual
  plan  of life;  nor fhould it  be  forgot,  that, till that is
  done, the health is never completely reftored.
    CCLXXIV.  The debility which  an under-propor-
  tion of fecreted  fluids, or a degenerate,  though plentiful
  ftate of them, produces in the excretory  dufts, is removed
  by the ftimuiant plan of cur^ which has juft now beenfpo-
  ken of (f), not by an antifeptic one (g).
    CCLXXV. The fuitable remedy of that fort of ftimu-*
  Ins, which arifes from either violence or affiduity of think-
 ing,  is an abatement in the degree  of thinking,  or  that
 high ftretch of the intellectual function, whether its  de-
                           N  2                      gree
 ordinary fupports; but,  analogous to it in another refpect,  when the
 ftrength of the fyftem requires not their additional ftimulus, they  carry
 it up into indirect debility, and prove the caufe  of difeafes and death.
 In one word, whatever has been faid againft the propriety of the  ufe of
 exceffive, and ultimately exceffive  ftimuiant powers, the former prod u-
 cing fthenic diathefis, and the latter indirect debility, all that applies,
 with propriety,  for the difcontinuance  of the ufe of  diffufible ftimuli,
 when the durable arc now fufficient for the purpofes of the fyftem. And
 another argument that ftill remains againft the fuperfluous ufe  of both
 the diffufibles and ftrong  drink, when debility requires not their ufe ;
 which is, that,independent of death.or even difeafes,being their immediate
confequence, predifpofition to difeafes muft; confequently, as the fyftem
muft at laft be wornby ftimuli, all the unneceffary, that is, all that do
not contribute to that middle  vigour, in which  found health  confifts,
 fliould be avoided.
   (f) See above,  CGI XXII.      (g) Sec above,  GXVII. and CXVhh 
f So        THE   ELEMENTS
gree or frequent repetition be regarded,  that, by wafting
the excitability,  proves, at laft, indirectly  debilitating :
Which is a rule,  however it may fuit the ftate of predif-
pofition, that is by no means  fafe, after the difeafe has
once made its appearance, and efpecially if it is a violent
one ; becaufe there is no accefs to any benefit from it, but
through the intermediate degrees of that ftimuiant range,
which by  encreafing the excitement,  already too great,
would do  mifchief (h).
   CCLXXVI.  In order to cure a  flight fthenic diathefis,
fuch as occurs in predifpofition,  and to prevent difeafe,
habitual paflion fhould be  avoided ;  but  the removal  of
actual difeafe requires,that every fiift guff, of paflion fhould
be prevented. The ultimate excefs of paffion,upon account
of the  intermediate danger of ftimulating  too much,  is
by no means to be thought of.
   CCLXXVII.  In fo far as  debility  depends upon ex-
cefs in mental  exertion, or upon a languid  ftate of that
faculty, the excefs fhould be diminifhed, and the languor
removed,  and an agreeable train  of thinking fet on foot;
without which latter, however much  all  the other fti-
muiant powers may have been employed, it may be de-
pended upon,  that perfect health, in every  refpeft, will
not be brought about (i).
                                           CCLXXVIII.
   (h)  S^c above,  CCL1V.
  (i) The ftate of the intellectual function has a great  influence upoa
that of excitement ; and, often,  when all other ftimuli  have been ap.
plied iu due proportion, the  deficiency of that fingle ftimulus will point
out a want in the proper meafnre of excitement.   There is not a finer
ftimulus than the pleafurable feeling arifing from a happy train or flow
of thinking;  hence the high delight, that arifes from a flight of wit,
or from a pleafant vein of humour; hence all the fine feelings of the bel-
ler letters; hence, in youth, the  ardent keennefs to be acquainted with
the learning, wifdom,  and elegant produdlons of the ancients, as well
as of th»fc, who lvive made a diftingvifhed figure in lattr times; hence
                                                     the 
OF    MEDICINE.            iSl
    CCLXXVIII. In every degree  of debility  that high
 force of the paffions, that produces  indireft debility, muft
 be avoided ;  and it muft not be forgot, that a very, fmall
 degree of them is fufficient for that effect: we are not to
 give loofe reins to  agreeable paffions (k).
                                                  CCLXXIX.

 the enthufiafm  fo natural to the human feelings, to outfirip  others in
 every mental excellency : The arts,  the fciences,  every department of
 human  knowledge,  are all the effects of that intellectual propenfity.
 How happy would it he for mankind were this noble ftimulus duly che-
 r'rfhed! What benefits,  which fociety is deprived of, would not accrue
 from a  proper cultivation of  it! How fine was that feeling  in Julius
 Cxfar Scaliger, when he declared he would rathej be the author of Ho-
 race's few ftanzas of Lydia and Telephus, than accept of the  crown of
 Arragon ! What muft  have  been the delight of  Pythagoras,  when he
►found out the  XLVIIth propofition of the  firft book of the mathema-
 tical elements, commonly called Euclid's? He jumped about in an ccftacy,
 crying out Ei/p»x«,  and was fo much more fubftantial than fome of his
 few brother difcoverers, as to poffefs the means of offering a facrifice of
 an hundred fat bullocks to the gods.  See Obfervations on the principles
 of the old Syftems of Phyfic, from page ix. to xv. of the introduction.
 How delightful muft the feelings of Horace  have been, in whofe works
 every Ode is an effort of the moft beautiful,  and frequently, of the moft
 fublimc, conceptions of  human genius ! What muft have been the fire
 and force of Milton's foul, in the description  that he gives of the appear-
 ance of the Son of God in his coeleftial panoply, " his countenance too
 fevere to he beheld!" How towering that foul, how exalted that  intellect,
 which the great Marquis of Montrofe difplaycd in a  ftratagem, which
 converted into  a glorious victory a blunder in one of his officers, that
 might have proved fatal to both his caufe and his glory. When it was
 whifpered to him, Handing in the center of his army, that one of  his
 wings was overpowered, he fhouts out to the commander in the other :
 " My Lord Aboyn,  fhall you  and I fland here doing nothing, and
 M'Donald carry off all the honour of the day I"
  (k) See  above par. XLIII. and CXLI.  Recollect the method pre-
 fcribed in the XL HI. paragraph of this work for preventing the fatal ca-
 taftrophe of the Roman woman, when her fon, whom fhe had counted
 upon, for certain, in the nunber of the dead, was contrary to every
 expectation, prefented.to her in perfect health. The danges and fatality 
 182       THE   ELEMENTS

   CCLXXIX. When there is a deficiency in the force of
any of the paffions, as in fadnefs, grief, fear, terrof and
defpair, which are only leffer degrees of gladnefs, confi-
dence, and hope, and imply only a diminution of exciting
paffions ; fuch deficiency or diminution muft be expelled,
and the exciting degree of paflion recalled;  hop eand af-
furance muft be infufed, and the patient gradually carried
up to feelings of joy.
   n.  For there is only a fum total of the paflions, which
aft in the fame manner  as all the other ftimuli, that Is, by
ftimulating, either in excefs,,  or in due,  or in deficient,
proportion; nay, like the  reft,'as often as any one is defi-
cient,  it,  by  accumulating the  excitability, has the  ef-
fect of making the other ftimuli aft more powerfully (1).
Take, for inftance,  the terror  of an army  before the
found of trumpet for the onfet of battle,  and the courage
with which they are afterwards infpired, from the con-
fcioufnefs of their bravery,  the  General's fpeech to ani-
mate them, or  perhaps, his commemoration of their for-
mer brave deeds.
   p.  An ultimately exceffive voluptuoufnefs in the exer-
cife of the fenfes, as well as the effect of difagreeable ob-
jects,  prefented to them, in  afthenic diathefis,  fhould
                                                 equally
of her ftate was, that her excitability was too accumulated, with refpeft
to the ftimulus of exciting paflion, to bear fuch a ftrong impreflion as
that which the prefence of her fon,  in life and health, had made.  She
was in the ftate of a famifhed perfon, whofe accumulated excitability is
 overpowered by a fingle morfel of food,  or of a perfon, who had been
long affeded with thirft, where  the fmalleft indulgence in drink may
prove fata!;  or of a perfon,  near ftarved  to death by cold, in whom a
rafh approach to heat, might induce the fame fatal effect;  all which are
precifely upon the fame footing, and  equal inftanccs of an excitability
too accumulated to bear any  degree of ftimulus.
   (1) See  above, par. XXXVII, and the note annexed to it. 
            OF    MEDICINE.         igj

 equally be avoided; and in the fthenic diathefis, their tur-
 bulent force fhould be guarded againft (m).
  2.  Nothing is better accommodated to the afthenic ftate
 than purity of air;  which, either alone, or conjoined with
 exercife, muft, confequently be of the greateft benefit to
 convalefcents.
   T. Since the matter of contagion, in fo far as it has any
 tendency to produce general difeafe, produces either fthe-
 nic (n) or afthenic diathefis (o), and afts by an operation
 fimilar to that of the general hurtful powers;  the  infer-
 ence to be drawn from that is, that in the cure, general
 remedies fhould be employed; and debilitating ones op-
 pofed to fthenic, ftimuiant  ones to afthenic, diathefis (p).
   CCLXXX. Thefe powers, the fame in kind with thofe
 that produce the diathefes, differing  only  in degree, and
 in that refpect diametrically oppofite, remove the diathefis
 feldomer, and lefs fuccefsfuly, one by one ; oftener, and
 more effectually,  when feveral co-operate, but, beft of
 all,  if all of them be taken  together, efpecially  when
 there is occafion for great afjiftance.


              CHAP     IX.

 A Comparifon ofithe different Parts of the Sthenic  Plan of
                 Cures with each other.

   CCLXXXI. AS, in the fthenic diathefis,  bleeding is
the moft powerful remedy of all others, being that, which
completely carries off a ftimulus, as much more powerful
than any other, as it is directly applied to a greater extent
over the fyftem;  confequently, as often as the diathefis
                                                    is
  (m) See par. CXLIII, and CXLIV.
  (n) as in the fmall-pox and meafles.
  (o) as the contagious typhus, the gangrenous fore-throat, dyfentery,
 and the plague,
  (p) Par, CXLVII, and CLXXV. 
 184       THE   ELEMENTS

is very high, it  fhould  be freely ufed ; but never rifked
during predifpofition, and fparingly, or not at all, ventured
upon in difeafes of a gentle nature; in which other reme-
dies fhould be preferred (a).
   CCLXXXII. The next place of importance to bleeding,
when heat and other ftimuli are guarded againft, is claim-
ed by cold.  Heat is always hurtful, and ftill more fo af-
ter a previous application of cold; but it is moft hurtful,
when it is alfo  combined With other exceffive ftimuiant
powers.  Cold is always of fervice, and in  proportion to
its degree; provided foreign ftimuli, blended with it, and
overcoming its  debilitating effect, be cautioufly fhunned.
   CCLXXXIII. The third place  in rank after thefe re-
 medies is claimed by vomiting and purging and fweating.
Thefe  evacuations  have a  powerful  effect in removing
fthenic diathefis, and therefore do they, with great advan*
 tage, fuperfede the oftener  imaginary than  real, neceffity
of profufe bleeding.  They are often alone fufficient to
 reftore the healthy ftate,
   CCLXXXIV. Together  with all  thefe, the articles of
diet, the ftimuiant operation of which prevents the bene-
fits  to  be received from them,  fhould be fparingly ufed,
and that in  exact preportion fo the degree of the diathefis.
This precaution alone is adequate to the removal of pre-
difpofition,  and often to that  of difeafes, efpecially thofe
£hat depend upon a fmall and  gentle  diathefis.
                                           CCLXXXV.
   (a) Sec above, par. GCLXIX.  With the exception of peripneumony,
phrenitis, and violent and mifmanaged cafes  of the fmall-pox and mea-
fles, and rheumatifm; in the laft in their mild ftate, as well as the other
fthenic cafes, the lancet fliould never  be unfheathed,   Tim is to fay, in
feven cafes out of ten even of the fthenic difeafes,  which are the only
 ones that either require or bear any degree of it, the practice muft be
laid afide, and never thought of  in  any afthenic affe&ions whatever.
Confequently, the cafes, where it is in any degree allowable, are exceed-
ingly few. 
OF   MEDICINE.          1 8j
   CCLXXXV. Alfo with all the remedies yet mentioned
we muft conjoin reft,  when the difeafed ftate has taken
place, and moderation in motion during the period of pre-
difpofition (b).
   CCLXXXYI. The  praftice  of the common run  of
phyficians is very bad, in going too much upon any one of
the remedies that have been mentioned,  and overlooking
all the reft,  or enjoining them carelefsly.   We are not to
depend upon bleeding alone, not even in peripneumony it-
felf ; but employ all the  reft either in concourfe or fuc-
ceffion.
   CCLXXXVII. The dlfturbed functions, or thofe that
are impaired (c) not from a debilitating caufe, admit of the
general plan of cure, and no other.
   CCLXXXVIII. The fymptoms of debility, which are
the confequence of the violence of the fthenic diathefis, in
the progrefs of the difeafe, and that threaten death by in-
direct debility, ought  to be prevented by an early interpo-
fition of the remedies.
   CCLXXXIX. The  fame early cure ferves to prevent'*
fuppuration, effufion,  and gangrene, which arife from ul-
timately exceffive excitement, pafling into indireft debility.
   «.  If fthenic  diathefis  fhould happen to be conjoined
with a local difeafe, the former, to prevent it from aggra-
vating the  latter, fhould be removed by its own refpec-
tive remedies,
                                             CHAP.
   (b) So confiderable a ftimulus is exercife, that, if in fuch a degree of
fthenic diathefis.,  as that, which forms only predifpofition to the difeafes
depending on  it, exercife may of itfelf be fufficient to effect the conver-
fion of the  predifpofition into the actual difeafed  ftate.   Often has tha
higheft of thefe difeafes, and even peripneumony itfelf, been brought on
by violent exertion in exercife.
   £c) See above,  par. CXLVIL CLI. CLXXII, 
l86       THE   EL E M  E N T  S
              CHAP.     X

   The fame Comparifon of the different p art t of the Afthenic
             Plan of Cure with one another.

   CCXC. IN afthenic diathefis,  and the difeafes depen-
ding upon it,  reproducing the loft quantity of blood, is
the moft powerful remedy, when we, at laft,  find accefs
to it, as being the only means of reftoring a ftimulus of fo
much more power and efficacy, that its direct application
is made to fo great an extent of the  fyftem (a).  For
which reafon, as, in every degree of debility, the quan-
tity of food, from which only blood is made, that is taken
and digefted, is always in an inverfe proportion to the de-
gree of debility, (b);  fo much, and of fuch a form, as can
foe  taken and digefted, fhould immediately, and without
lofs of time, be adminiftered ;  on which account, if the
debility be moderate, giving folid animal food fparingly
^ach time, but  often  repeated, is proper and  fuitable.
When the debility is greater, and folid animal food can
neither be taken, nor if taken, digefted, broth made from
it, as rich as poffible, and as free of fatty matter, fhould
be carefully adminiftered (c). With this view to excite the
ftomach, and render it more fit for  receiving and digeft-
Sng the food juft now mentioned; the  diffufible ftimuli,
fuch as different kinds of  wine,  and more  particularly
ftill opiates and other remedies of  fimilar powerfulnefs,
ought  to  be conftantly employed; fparingly at firft, and
afterwards more  fully,  if the debility  be direct; after
which, the ufe of the diffufible Jhould be gradually laid
                                                 afide
  (a) Compare this with par. CCLX^XI. above, and with all the pa-
ragraphs from CXXXI. to CXXXVI.
  (b) or in a direct  proportion to the degree of excitement,
  (c) Compare this with par. CCLXXII, 
              OP   MEDICINE.          187

 afide,  and, in the fame gradual way, recourfe be had to a
 larger and larger ufe of the more durable and natural fti-
 muli (d.)   In the cafe of indireft debility,  we fhould al-
 fo gradually proceed from the higheft to the loweft force
 of  ftimulus, as has been mentioned formerly (e), and, in
 an inverfe manner, go on  from the fmalleft  force of dura-
 ble ftimulus to the greateft.  Laftly, in that moderate de-
 bility,  which conftitutes  the  predifpofition  to afthenic
 difeafes, it muft always be kept in mind,  that  an abun-
 dance of blood is the greateft fupport of health (f ), and
 that we are not to give way to a weakened appetite (g).
    CCXCI.  To the  vital fluid,  and  the  feveral means
 of encreafing its quantity,  which have juft now been men-
 tioned, the next remedy in the cure of afthenic diathefis is
 heat;  as being the power by which animals  (i), in their
 firft formation,  in  their growth, and moft efpecially  in
 their decay, are brought forth into exiftence,  arenourifh-
 ed, and acquire vigour, and afterwards, through the feve-
 ral  degrees of their  declining ftate, are to fome extent up-
 held, till their excitement is all extingulfhed  (k).  By heat,
 uriderftand that point of external temperature, which in-
 tervenes as a mean betwixt cold,  as it is called, and high
 heat (I); under which our fenfe of temperature is agree-
                                                    able
   (d) See laft note (e), and compare it with this.      (e) Par. CI1I.
   (f) How widely different is that maxim from any that have hitherto
 evnsr been received in the profeflion of phyfic; in which flying to the ufe
 of the lancet, was the firft thought that arofe in the mind, with refpect
 to the idea of cure  of every difeafe ; and  bleeding and  evacuation
 through the courfe of each difeafe, the only remedies.
   (g) This is equally the reverfe of the general practice  of inanition if
 almoft every difeafe, without a fingle  exception.
  (i) And we may add vegetables.
  (k) Compare this with par. CXI I. and CCLIV. and CCLX.
  (1) The Latins have a fingle word for this which we want;  the wor<J
it ar^or. 
188       THE    ELEMENTS
  able and pleafant; under which the body is neither weaken-
  ed by that relaxation which produces fweat, nor  by that
  torpor (m) which cold begets, where the debility is, in this
  cafe,  direct,  and in the former indirect;  under which
  the functions of the whole body are excited, called forth,
  and,  as it were, eherifhed  in the fun beams;  without
  ■which all  other ftimuli are of no effect (n).
    CCXCII. Such a temperature as that is fuited to eve-
  ry  ftate of the body, but ftill more to its different ftates of
  debility ;  becaufe in the latter  cafe, as the excitement is
  deficient from other fources, there is fo much more occafi-
 on  for this  ftimulus, which  is much eafier  come at than
 many others, to fupply  fuch deficiency.   Hence both in
 other difeafes of great and direct debility, and particularly
 in fevers,  heat is found to be of  the greateft benefit, and a-
 bove all others in all fuch complaints of that kind  as cold
 has had any fhare in producing  (o).    In the fame  difeafes
 cold muft be moft carefully avoided,  as it is always of a di-
 rectly  debilitating operation,  and never  of fervice but in
 fthenic difeafes, and thofe that are in a progrefs  to indirect
 debility (p).  We muft be equally on guard, in every de-
 gree of afthenic diathefis, againft exceffive heat; which is
                                                  equally
   (m)Or benumbed ftate.
   (n) It  is plain, that though all the other powers fliould be in full acti-
 on upon  our bodies, and that with the effect of keeping up in them  a
 due degree of excitement over all ;yet plunging any perfon naked into a
 denfe medium, fuppofe that of water, in a degree of cold at or under the
 freezing point, will moft certainly, in an inftant, put an end to  life.
   (o) See again, par, CCLX.
   (p) The operation of cold has been fo widely miftaken by all phyfici-
 ans, that it enmes to be of the greateft confequence to underftand the fe-
 veral propofitions flated in this work with regard to it.  For that pur-
 pofe confult par. XXXVII. and the note upon it marked 8, as well as
 par. CCLX.  and all that has been faid upon the fubjects of either heat
or cold  in Ch3p. I. of the  fecond Tart from CXII. to CXXIII. a;
 alfo par. CXX. 
           OF    MEDICINE.          I 89

equally debilitating as cold, and equally productive of a-
tony, laxity and gangrene of the veffels, as well as ftag-
nation and corruption of the fluids, in confequence of the
inactive ftate of the veffels (q).
  CCXCIII. As refilling the veffels is the greateft reme-
dy, becaufe its direct ftimulus is applied  over fuch an ex-
tent  of the fyftem;  for  that reafon heat, which is imme-
diately applied to the whole furface of the body, and di-
rectly affefts the body  to that extent, fhould be next in
virtue to it.
  CCXCIV. Since vomiting, purging (r) and fweating (s)
are fo powerful in debilitating, as to claim the third place
of rank  in the fthenic cure; they muft, for that reafon,
by the fame debilitating operation, be  equally hurtful m
afthenic diathefis, and the ftimuli that flop their operation,
and, confequently, both the other ftimuli, and particularly
the  diffufible ones, equally ferviceable.
   CCXCV.  To run over the lift  of ftimuli, that  anfwer
this  purpofe, we muft begin with the cure of that flighter
lofs  of fluids that occur  in thofe difeafes, and proceed to
the  more violent kinds of them.
   In a flight loofenefs of belly, fuch as happens in predif-
pofition to afthenic difeafes, or in the {lighter degrees of the
latter ; it will be  commonly fufficient to abftain from ve-
getable food, and from weak, watery drink, or that kind
of it that ferments in the firft paffages, fuch as the feveral
drinks make from barley, called beers ; to ufe animal food„
as well  feafoned  and as  rich as poffible, and free of all
fatty matter; to drink pure wine,  orfpirit, in different de-
grees of ftrength ; and  to  take fuch exercife as is gentle
in degree, and often rcpaated (t).
                                             CCXCVI.

  (q) With this propofition compare par. CXV. CXVII. and CXVIII.
  (r) See par. CLLXXXIII.             (s) See par. CCLV.
  (t) See and compare, for the more clear underftanding  of this para**1
graph,  the CCLXVI. CCLXVIIi. CCLXXlIf. 
19°      THE   ELEMENTS
    CCXCVI. When the belly is ftill, loofer and with that
 affected with gripes and pains, as happens in the violent
 diarrhoea, and in the dyfentery, in which the loofe ftools
 are accompanied with vomiting ; or when, without thefe
 troublefome fymptoms affecting the belly,  diftreffing vo-
 miting is an urgent fymptom;  or, when the vomiting is
 conjoined with a moifture upon the furface, or macerating
 fweat; or when fweat is the only urgent fymptom, and as
 fuch waftes the ftrength, exhaufts the body, and diffipates
 the fluids : in all thefe cafes, we muft have immediate re-
 courfe to the moft diffufible  ftimuli, and check fuch an
 impoverifhment of the fluids of the fyftem.
   CCXCVII. In which cafe, the ufe of ftimuli will be
 fo much the more neceffary, that other fymptoms ufually
 accompany thofe encreafed excretions.  Their great effi-
 cacy, and ftimuiant power, is proved by their fingular vir-
 tue in removing thofe and other fymptoms,  in fevers and
 other moft violent  fthenic difeafes, nay, in the article of
 death itfelf, from ultimate debility.
   CCXCVIII.  Accordingly,  in fpafms  and convulfions
 in the internal, in the external, parts  (u) in bleeding dif-
 charges (x) in the direful delirium of fevers, and  other
 very violent difeafes (y),in afthenic inflammation (z); when
 thofe ftimuli which have a more permanent influence fail,
 or aft to no good purpofe ; the virtue of  the diffufible
 ftimulants, the principal of which is opium, is eminent.
   CCXCIX. As, therefore,  the energy of that ftimuiant
 virtue ferves to check loofenefs of the belly, and vomiting,
 or even fweating,  when thefe fymptoms are gentle, and
 depend upon a lefs violent degree of the caufe; fo that de-
                                                gree

  (u) See par. CXCV, and CXCVI.
  (x) See par, CXXX1V. x- t- and  CCXXXII. and the fubjoincd
rictes,
  (y) See par. CXCVIII. CC. CCI.  (z) Sec par, CClV. to CCX1I. 
            OF   MEDICI  NE.         iqi

 gree of its power, which is fitted to check thefe affections
 in the greateft height of their violence, and to re-eftablifh
 the ftate of health, is by far the greateft of all the powers,
 which are ever applied tathe human body ; which may
 be known from this proof, that when the aftion of all the
 other powers by which life is fupported is  of no effect,
 they turn afide the inftant ftroke of death.
   CCC. The moft weak degree of the diffufible ftimuli (a)
 are the white wines, except madeira, canary, good fherry
 and the red wines, except port  and fpirits procured by
 diftillation,  fo  diluted, as to equal the ftrength of  the
 wines, or exceed it a little.  Still higher  than thefe  are
 the latter taken pure,  and higher ftill, thofe that have
 undergone many rectifications.   The ftrength of  which
 is in proportion to the quantity of water expelled, and of
 the alkahol retained.
   CCCI. A higher place in the fcale is  claimed by mufk,
 volatile alkali,  camphor ;  our trials of which  are not yet
 fo complete, as to afcertain its force exactly; next comes
 aether, and, laft of all, opium.  Of all which,  however,
 unlefs, when, as they fometimes do, they have loft their ef-
 fect by a continuance of their application,  and  are, there-
 fore fubftituted in place of each other for the fake of a re-
 newal of the operation of each;  and when, in that way
 we make the complete round of them, for the fake of re-
 pelling extreme debility; in every  refpect, the preparations
 of opium are fufficient for  moft purpofes  of high ftimu-
 lating.                    4
   CCCII. Together  with  all thefe  (d), regard muft be
 had to the articles  of diet (e).
                                                 And,
  (a) See above, par CXXVl.  o. *. ». ?.
  (d) They are animal foups, and folid meat (CCXC.) heat, (CCXCI.)
ftimalants (CCXCV,)  diffulMc ftimulants (CCXC1X.)
  (c) See par. CC'-.-I.CXIV. 
 192       THE  ELEMENTS

   And, as in great debility, and the difeafes depending
upon it, of the only fuitable matter,  that is meat, nothing
folid can be taken ; for that reafon, the matter to be ufed
muft be fluid, but ftrong.  Animal foups fhould be given
fparingly at  a time, but repeatedly, in  proportion to the
degree of debility, and jellies both along with the diffufible
ftimuli.  After that, when,  chiefly by means of the dif-
fufive ftimuli, the ftrength is in part reftored ; at firft folid
meat,  likewife in fparing quantities, but often repeated ;
then given more plentifully, and at greater intervals, fhould
betaken.  In which progrefs the patient fhould gradually
reced* from the ufe of the diffufible ftimuli.
   CCCIII. When now the diffufible ftimuli are altoge-
ther laid afide, and the convalefcent is given up to his ufu-
al diet and manner of living, and that management, which
perfons in health commonly obferve,.(only  that more care
is taken than in perfeft health,to avoid any thing thatmight
prove hurtful) ;then it is,thatevery attempt of the phyfician
fhould be directed to the confideration of the ftrength of
his patient, as returning, but not yet quite eftabliflied (f).
In his movements  he fhould firft ufe geftation, and then
gentle but frequent exercife, and the latter fhould always
end in fome, but not an high, degree of fatigue. His fleep
fhould neither be too long, nor too fhort,  left the former
produce direct, the latter indirect debility  (g) : the moft
nourifhing food fhould be taken, but not in  too great  a
quantity, left the excitability of the ftomach be worn off,
without the attainment of a due degree of vigour;, but it
fliould be often taken, in order to  reduce the excitability
gradually, which onlyferves to produce proper vigour, and
reduce it to its half wafted ftate (h); that degree of heat,
which ftimulates, fhould be employed (i), and both excefs
of it, as well as cold, as they are equally debilitating, fliould
                                                   be
 (f) See above, par.CV. and CIX.   (g) See par.CCXLII. andfcqucnt.
 (h) Sec above the XXIV. XXV and XXIV.     (i) See par. CXI I. 
              OF   MEDICINE.          %g£

  be avoided;  the patient fhould breathe pure air, and avoid
  impure; he fhould keep his mind in gentle action, obferve
  moderation in his paffions, and court agreeable obj.efts of
  fenfe ; he fhould have no companions, around him,  but at
  greeable ones, and be in frequent gay entertainments; he
  fliould travel through a pleafant country, and be moderate
  in love. Neither is the management of the fenfes, and any
  return of contagious matter to be neglected.


               CHAP.     xr.

             Hew the Remedies fhould be varied*

    CCCIV.  AS  the hurtful powers, that produce predifr
  pofition to difeafes,  or difeafes themfelves,  aft fome ott
  one part, fome on another, with fomewhat more force than
  on any other equal part;  and as fuch a part is commonly
 that  which they  directly affect (a); fo the powers,  which
  are employed as remedies, in order that their general effect
 may reach the whole body with the more certainty, fhould
  be in the fame  manner,  differently  applied  to different
 parts.
    CCCV. The  cure of  any fthenic  difeafe whatever, is
 Improperly entrufted to bleeding alone, though that  is one
 of the moft powerful of the debilitating remedies.  And
 the reafon is, that,  though the excitability  is fufficiently
 reduced by that  remedy in the greater blood-veffels, per-
 haps  too  much, yet  in the extremities of thefe, as well as
 in  the reft of the body, it is not fufficiently reduced (b).
                             O                   Nor
  (a)'Par,  XLIX.
  (b)'The action of every exciting power, whether falutary dt hurtful*
*r curative, always extends over the whole body, the whole feat of ex-
citability, but ftill with the inequality mentioned in the fourth Chapter
»f part firft.  This is the bafis of the diftinotion with refpect to the pre
                                                    fent 
 194       THE   ELEMENTS

 Nor is the alternation of bleeding with purging a perfect
 fort of cure ; becaufe, though the exceffive excitement be
 fufficiently, and more than fufficiently,  removed in  the
 greater blood-veffels, and  in the innumerable  fmall  ar-
 teries whether exhalent or mucous, which difcharge their
 fluids into the inteftines; yet, neither on the perfpiratoy ter-
 minations of the arteries, nor on the reft of the body, is
 an equal debilitating energy  exerted : for inftance,  the
 fmall veffels which open into  the ftomach, are not fuffici-
 ently relieved of their diftending (c)load. And although vo-
 miting (d), which  has been improperly left out of the cure
 of fthenic difeafes, and ftill more improperly employed in
 every one of the afthenic, fliould be conjoined with the tw■-;
 remedies juft  now mentioned, even that would not be e-
 nough to produce an equality of diminifhed excitement;
 as there would ftill remain in the perfpiratory veffels,  the
 fame  ftate  of the excitement,  which has been mentioned,
 as in the reft of the body,  that is not vafcular.   In  vio-
 lent fthenic difeafes, therefore, after diminifhing the  dia-
 thefis, and in the flighter from the beginning of the dif-
 eafe, the addition of the operation of fweat to the evacuati-
 ons that have been fpoken of, will produce a more equal di-
 minution of excitement,  a  more perfeft  folution  of the
 difeafe.   For by means of this evacuation, not only from
 the larger blood-veffels, in the interior parts of the body,
 but from an infinity of outlets both of the external,  and
                                                 internal
 fent fubject: which i>, that' asevery power acts moft effectually on the
 part where its action  is immediately exerted, it is better to truft to a
 number, every one of which poffeffes that advantage,  than rely on any
 one, however powerful otherwife ;  as  by that means, whatever be the
 indication, whether it  be to encreafe or diminifh excitement, the effect
 will be more equally produced over all in confequence of there being a
 number of parts that have had a ftrong action exerted upon  them.
  (c) And therefore ftimulating load, the  ftimulus in any veffel being
the quantity of its fluid,
   (d) See par. CCLX1X. 
              OF  MEDICINE.         \gf

internal furface of the body, an immenfe quantity of flu**
ids, every where diftending, and, thereby, producing a ve-
ry great fum of excitement, is withdrawn.  But the mat-
ter flops not even here. For, fince in flight fthenic affecti-
ons much nourifhing food, and in them all, too much, can
be taken; the confequence of that muft be, that, however
much the quantity of the blood artd other fluids has been
diminifhed,  if the food, which  is the only power that can
produce blood, continues to be taken, all the veffels, in
proportion to the  quantity that has been  taken, will  a-
gain go on to be filled', and! to be fired  with the fuel of
exceffive  excitement.   To prevent which inconvenience,
and to diminifh excitement, ftill with greater equality over
the fyftem;  abftinence, or an allowance of vegetable mat-
ter in a fluid form, and watery drink, will have a very
great effect.  But neither does the matter end here*  For,
if, after taking all the precautions and fecurities that have
been recommended, the degree of heat, that proves hurt-
ful from its ftimulus, be allowed to approach the external
furface of the body; it will produce another inequality of
excitement,  however  much that may have been properly
and equally diminifhed by the other means of cure. Where-
fore, as the fthenic diathefis depends fo much upon the fti-
mulus of heat, directly affecting the fkin (e), and is,  on
that account, prevalent in the fkin in preference to Other
parts ; to make fure of rendering the diminution of ex kre-
ment as equal as poffible,the debilitating effect of cold fhould
be oppofed to the high degree of excitement,which the heat
has produced. When, at laft, all the directions, which have
been fo fully  pointed out, have  been executed, ftill to re-
produce the equality of excitement, fuited to good health;
it remains,  that we be 0:1 our guard againft the  ftimuli
that arife from the intellectual functions and paffions.  For,
                         O 2                      as
(e) See par. CXTfl. 
X$6      THE   ELEMENTS.

as they have a great effect in producing fthenic diathefis (f)
fo the guarding againft them, or prevention of them, muft
be equally effectual in removing that diathefis, and in re-
producing that equality of excitement, upon which health
depends (g).
   CCCVI. If the  cure of fthenic  difeafes  hitherto has
confifted  in bleeding,  purging of  the belly,  and in the
ufe of refrigeration in a few cafes ; and, if the other ob-
jefts of attention, which have now been fo fully treated of,
have either been totally neglected, or mentioned in a flight
way, by the by, and as if they had been of no confequence,
and, in the cures which were prefcribed in that way, not
reduced to any principle;  it will eafily now appear,  from
what has been faid above, and in other parts of this work,
how much the knowledge of thofe  difeafes  has been im-
proved,  both in the practical  and  reafoning part: and
it  will now,  at laft, be found a certain and eftablifhed
faft, that both the nature  and true  theory of fthenic dif-
eafes,  as  well as the praftice of the cure of them, confi-
dered either as an art  and imitative, or  as rational and
fcientific, has been difcovered and demonftrated.
   CCCVII. As the debilitating or antifthenic (h) reme-
dies are the fame with the  afthenic  hurtful powers (i); fo
the fthenic remedies (k) are alfo the fame as the fthenic
hurtful powers.
    <p. And as the remedies  of afthenic diathefis, to what-
ever part they are applied,alfo ftimulate that part more than
                                                   any

  (f) See par. CXXXVIIT. CXL.
  (g) As the moft healthy ftate of man is occafioned not by the opera-
tion of any one, or of a few exciting powers, but by the united operation
of them all; fo neither is its re-eftablifhment to be effected, but by the
fame united operation of all the  remedies, the laft of which come to be
the ordinary means of the fupport of the healthy ftate.
  (h) See par. XC/  (i) See par. CCCIV. to CCCVIf. the prefent one.
  (k) See par. XCI, 
             OF   MEDICINE.        \yf

 any other; fome Of them one, others another part, and
 encreafe the excitement;
   CCCVIII. So, in  afthenic difeafes, if we want to roufe
 the excitement with  more equality, and reftore the loft
 ftrength, we muft not depend upon the moft diffufible fti-
 muli alone (m).   For, while they indeed encreafe the ex-
 citement over the whole body,   at the fame time,  they
 produce that effect in  the ftomach with  greater  force
 than any where elfe.   Hence, even from the beginning Of
 the cure, when  almoft no food can be taken, and other
 durable and more natural ftimuli (n) are moft imperfectly
 applied;  yet, together with the  diffufibles, foups (6)
 fhould be given,  and as much hafte as poflibre fhould be
 made to bring the patient to take folid meat,  while care,
 at the fame time, fhould be taken  to apply a proper degree
 of heat.  For, by this method,  we moft properly fecure
 both the internal and external furface.  Nay,  in the  fame
 Way,  we  move that  inanition of the veffels which takes
 place in afthenic difeafes in an exact proportion to their
 degree. For, as in that abundance of blood, which is the
 moft powerful means  of bringing  on fthenic difeafes, there
 is an opportunity of making  a  quick cure by immediate
 taking of blood ;  fo it is only by  infenfible,  gradual, im-
 perceptible,  and  ob'fcure fucceffive fteps,  that  we  open
 the accef6 to the removal of that penury of blood,  which
 proves the moft hurtful power  in afthenic difeafes, and
 effect the filling of the veffels again.
   CCCIX. After this management of both  furfaces  Of
 the body,  and  this partial filling of the veffels ; ftill the
 excitement is not, equally enough encreafed.  To effect
 this further  in part; at the fame time forrie moft diffufi-
                                                 ble

  (m) See pari CCCI.
  (n) as that of pure air, exercife, the ftimulus  ot the motion of the
food and other fluids in their refpective veffch.
  (o) Sec par. CCCIi. 
  I9&      THE.  ELEMENTS

  ble  ftimulus, fuppofe any preparation of  opium, fhould
  be adminiftered, and the little animal food, or meat, thc.t
  there is any  appetite  for, and that can be taken and di-
  gefted,  fhould be added.  The idea of giving food is evi-
  dent from the  late explanation given about  foups (q).
  But, the ufe of the more durable, and lefs diffufible, fti-
  mulus depends on this, " that when the excitability  is'
  worn out by any one ftimulus, any new ftimulus finds ex-
  citability, and draws it forth,  and thereby  produces  a
  further variation,of the effect.
    CCCX. Hitherto the ftimulus of the motion, by which
  all  the mufcles, which, from their fituation on  the fur-
  face of the body,  by their contractions propel the.blood
  along the veins to the heart, are thrown into  aftion, has
  not been fupplied (r); and, therefore, both upon account
  of the emptinefs of the veffels, and the flow circulation
  from  the want of that impulfe,  the  excitement is not
  fufficiently aroufed over all that tract.  After the  ftrength
 has, then,  been fo recruited,  that rich food can new be
 taken, the body can now be roufed,  firft by foreign, then
 hy its own organs, of which the former is called geftation,
 the latter exercife, and alfo refrefhed by air ; when all that
 has happened, then it is, that the excitement is further rai-
 fed  in  feveral points,  and becomes more equal upon the
 whole.
   CCCXI.   The  laft ftimuli to be mentioned,  which,
 along with thofe already mentioned, have a natural tenden-
  cy to produce an equalization of excitement over the whole
 fyftem,  arife from the action of the mind, the energy of
 paffion or emotion,  and a ftill greater purity of air,  than
 is attainable by perfons fhut up in a room (s).   In this
                                                  ftate
  (q)Seepar.CCCVIII.
   (r) See par. CXXXVII. *..£. y. A CCLXXIII. CCCI1I.
   (s) See and compare with thefe laft mentioned ftimuli the following
paragraphsCCLXXV. CCCLXXVIU. CCLXXIX- t, 
               OF    MEDICINE.          199

  ftate of convalefcence,  the fame management, which was
  formerly mentioned upon the going off of fthenic difeafts,
  perfectly applies (t).
    CCCXII.  The ftimuiant plan of cure, in  all its parts,
  is new,  whether the reafoning part, or the merely practi-
  cal be  regarded;  and,  whether the caufe and  the exci-
  ting  hurtful powers,  or  the indication  of cure and the
  remedies,  be confidered.   May it,  therefore,  be put as
  a queftion, whether the whole doctrine, which has hitherto
  been delivered, has, at  laft, brought forward clear proof,
  that the  art of medicine,  hitherto conjectural (u), incon-
                                                       fiftent

   (t) The  convalefcent ftate from either of the two general forms of
 difeafes, or from local ones, the effect of which had drawn the whole fyf-
 tem into confent, is much the fame ; being a ftate of fome remaining de-
 bility in all; in the fthenic from the excitement either  going too low,
 by the remedies being  pufhed to fome  excels,  or not equally diffufed
 over all the parts in confequence of the natural fupports  only beginning
 to be brought fully into play ; in the afthenic from the perfect point of
 health  being not quite gained,  cither from the ftimuiant remedies not
 having been carried exactly up to 40, or from fome of them having
 been carried further than the wafted excitability could receive them with
 invigorating effect, and thereby an inequality left upon the whole.   The
 convalefcence,  from the general effects upon the conftitutlon fometimes
 arifing from local difeafes, is to be explained upon the principles laid
 down, with refpect to the two other cafes of convalefcence.
   (u) Celfus fays, ars noftra conjecturalis eft.  And every man of fenfe,
 whether of the profeffion, or out of it, has held the fame fentiments of
it.  Nothing is more glaring than the contradictions in medical writings
 and reafoning of every kind, nothing ever could be more incoherent.  If
 a piece of knowledge, that fets out with a fixed principle, which applies
to all the parts of die detail,  while they reflect  on it, both illuftration
and confirmation, be entitled  to be confidered as a fcience, the reader is
 defired to confider, how far that criterion will  apply to this doctrine.
The pedantry cf mathematicians has contributed  as much to  brine their
fcience into difgrace, as any other circumftance, particularly in allowing
 no fort of probation, but that which is made out by lines and diagrams ;
 while, except  the elements of thit fcience, every application of that'de-
                                                      partment 
 200       THE   ELEMENTS

 fiftent with itfelf,  altogether incoherent, is now reduced
 to an exact fcience,proved not by mathematical principles,
 which is only one kind of probation, but.by phyfical ones,
 and eftabliflied by the certain teftimony of our fenfes, nay,
 and by the very axioms of the mathematical elements ?

              CHAP.    XII.

 As tbi Atliati of all the other Powers, that ail upon living Boditsj,
     is thefat?ie, that that ofithe Remedies is alfo the fame.

   CCCXII. As it is found certain, and proved, that th«
 common effect of all the exciting powers  is precifely the
 fame, to wit, the production of the phenomena peculiar to
 life,  that is, that fenfe, motion, intellectual operation, and
 paffion and emotion, are the fame;for what elfe is the ef-
 fect of hear, of food, of feafoned food, of drink,  of the
 blood, of the colourlefs fluids fecreted from it, and of the
 air, among external bodies;  what elfe in the functions of
 the living body itfelf, is the effect of mufcuiar contraction,
 of thought, of the paffions, and of fenfation, but to excite,
 preferve, and continue  as  the fuftaining caufe of  thofe
 functions in common to animals ?   And,  as  it is from
 that evident,  that the operation of all the fame powers is
 alfo the fame; (for it muft be granted, that the fame caufe
 by an univerfal law in nature, tends to the fame effect (a):
and further, as the operation betwixt caufe and effect depends
                                                   upon
partment of knowledge has led to as many falfe eonclufions as any other.
If they will not allow the proof, that arifes from our feelings, compared
with  thofe of all men, whofe organs of fenfe are not deranged, what
Will they make of their own axioms ? They muft admit of other proba-
tion ) while human reafon holds its reign, truth and falfhood will be
diferiminated, without regard to fuch empty and ufelcfs prepoffefficms.
  (a) Sec par. XX, with the annexed note 
            OF   MEDICINE.          201

upon ftimulating (b), and that ftimulus produces  all the
phenomena of life, health,  difeafe, and thofe intermedi-
ate degrees  between both,  which are called predifpofi-
tions (c); from thefe certain and demonftrated fafts it fol-
lows,  and muft be admitted, that the operation of the re-
medies, both in fthenic and  afthenic difeafes is the fame*
For, if there is no difference betwixt health and fthenic
difeafes, except an excefs of excitement in the hitter,  and
none betwixt the  former and afthenic difeafes,  but defi-
cient excitement in thefe laft,  what elfe, can the operation
of the  remedies, to remove fthenic difeafes  be, but to di-
minifh, and of thofe that remove the afthenic, but to en-
creafe  the excitement (d).
   CCCXIII. Whatever thing  produces the  fame effect
as another,  or  feveral things, it muft be the  fame thing as
each of them, each of them the fame thing as it, and every
individual of them the fame thing as every other individual.
   & In fthenic difeafes, bleeding (e), vomiting, and pur-
ging (f),fweating, abftinence (g), reft of body and mind (h)
tranquility with refpeft to paffion, all thofe  reftore health
by nothing eHe but a diminution of excitement.'
   CCCXIV.  In  afthenic difeafes,  the   adminiftration
firft of diffufible ftimulants, for the purpofes of gradually
bringing back the appetite for the greateft remedy,food jas
well as keeping the food upon the ftomach, and of affiftlng
in the  digeftion of it (i), then the application of heat (k),
then the ufe of the left  diffufible and more durable ftimu-
lants  as animal food,  without  and with feafoning) winej
gcftation,  gentle exercife (1), moderate fleep, pure air, ex-
ertion  of mind, exertion in paffion and emotion, an agree-
                                                 abte
  (b) See XIX- and XXII           (c) See XXIII.
  (d) See LXXXVIII.             (e) See CCLXXXL
  (f) See CCL XXXIII.            (g) See CCLXXXIV.
  (h) See CCLXXXV.             (i) See CCXCIV. to CCCII.
  (k) See CCCII,                  (1) See CCCII. CCCJII. 
202'
THE   ELEMENTS
able exercife of the fenfes, all thofe reproduce health, by no
other operation, but that of only  encreafing excitement,


             C    H    A   P.    XIII.

That all the Poivers, which fupport any Sort of Life, or the
     fundamental Principal of Agriculture, are the feme.

   CCCXV. AGAIN, are not the powers, wiiich produce
perfeft health, the  fame as thofe, which, by  an excefs of
force, produce, fthenic difeafes;  by a deficiency of force,
afthenic, as well  as the  predifpofitions to both, are they
not the'fame, with no  other variation  but  that  of de-
gree (a)?
   CCCXVI.  Further,  as  we learn from the whole doc-
trine delivered above, the hurtful exciting powers, which
produce fthenic difeafes, are the remedies of afthenic; and
thofe which produce the latter,  are the remedies of the
former (b).
   CCCXVII. All  the  powers,  therefore,  that  fupport
any ftate of life, are the fame in kind, only varying in de-
gree;  and  the propofition is true, of every fort of life, to
its full extent  over the animal creation.
   Such is the life of animals (c).   Concerning which,  all
that has been  faid applies to the life of vegetables.
   CCCXVIII. Accordingly,  as  animals,  in every ftate
of life, have their  exciting powers (d) in predifpofitions
and difeafes, their hurtful exciting powers (e) in the cure
of both thofe, their indications, and remedies adapted to
each  (f); all that,  in every refpeft,  is precifely the cafe
in plants.
                                            CCCXIX.
 (a) See XXIII. LXXIII. (b)SeeLXXXIX.XC: XCI. XCIII. XCIV.
 (c) See from X. to XIII. inclufive.        (d) See LXII. LXVII.
LXVIII. LXIX. LXXIII. CXII. to an CXLVII.
 (e) See the fame.      (f) See LXXXVIII, LXXXIX. XC, XCI, 
            OF   MEDICINE.          203

   CCCX1X. The powers that fupport plants,  in  every
ftate of life, are heat,  air, moifture, light, fome motion,
and their internal juices.
   CCCXX.  The aftion of plants  alfo confifts in  ftimu-
lus (g);  by means of which, the phoenomena peculiar to
that fort of life, fenfe, fome motion, and verdure, are ex-
cited : and the caufe of this ftate is excitement, an effect in.
common to all exciting powers (h).
   CCCXXI. Nay, in this cafe too the exciting powers,
when applied in due proportion, produce health; but their
too great or too fparing aftion occafions difeafes,  or pre-
difpofition to difeafes ; of which the former depend on an
exceffive,  the latter upon a deficiency of ftimulus.   Ac-
cordingly, excefs or fcantinefs of moifture, exceffive heat
or cold, by an equality  of hurtful operation, lead  to dif-
eafe and death, indirectly or directly.  And, as the rays of
the fun or darknefs,  when their operation is either too
great, or too long continued, prove debilitating, the for-
mer indirectly, the latter direftly ; fo the alternate fuc-
ceffion of night to day, of darknefs to night, feems to be
the effect of an intention in nature, to prevent too great an
effulgence of the light of  day, or too long a continuance of
it, from  ftimulating either in  excefs or in ultimate excefs,
and thereby inducing fthenic difeafes, or thofe of indirect
debility ; or to prevent an excefs, or long continuance of
darknefs from producing direct debility,  and the difeafes
peculiar to it (i).
   CCCXXII.   Nor   do  plants  want their  excitability,
which, equally as in animals, " is not different in diffe-
" rent parts of its leaf; nor is it made up of parts, but one,
                                             " uniform,
  (g) See XVII. XIX, and notes.         (h) See Part J. Chap. II,
  (i) Chap. IV. We have no lefs proof, than that of the univerfal feel-
ing of mankind, of the truth of what has been advanced, with refpect to
the ftimulus of light and the debilitating effect of darknefs; 
204
THE   ELEMENTS
  " uniform,undivided,property over the whole fyftem (k)."
  The effect of which is,  that, to whatever part of a plant
  any exciting power is  applied,  its operation,  whether in
  eXcefs, in due proportion, or in under-proportion,  Im-
  mediately afreets the excitability over the whole.
    CCCXXIII. This effeel is alfo produced with the fame
 inequality as hi animals, being, for inftance, greater in any
 part to which its exciting power is direftly applied, thai!
 in  any other equal part.   And,  as there are two reafons
 for tnat faft in animals,  the direct impreffion of the pow-
 er  upon the part more  affected,  and a greater energy of
 the excitability of a part or relation to which it is fo applied,
 than on that of any other  equal part (1);  the very fame
 is  the fact with refpeft to plants.  Further, as the exci-
 tability bears a greater relation to the impreffion of the
 exciting powers,  on the brain,  the ftomach,  and inte-
 ftines, than on any of moft of the other parts ; fo the part
 in  plants,  that  correfponds to thefe parts, is the root,
 which  is affected in the  higheft  degree by  the exciting
 powers.  It  is fhe  root of plants, in preference to any
 of their other parts, to which the conflux of moifture is
 made.   The heat  there is the beft, which is neither ex-
 ceffive, and therefore liable to produce fthenic affection,
 nor ultimately exceffive, and therefore ready to induce in-
 direft debility (both which dlfadvantages are prevented by
 the depth of the ground); nor deficient, or what is called
 cold, which would bring on direct debility (m).
   CCCXXlV.   kut the only ufe of the foil, through the
 pores of which the powers that have been mentioned pe-
                                                netrate,
  (k) See Part  I. Chap,  IV.    (1) See XLlX. and addition L. LI.
  (m) Hence it would appear, that it fltauld be a general rule in plough-
ing and harrowing to adapt the depth, where the feed is to be laid, to
the ftate of the  furrounding temperature.  It would feem, when other
circumftances are equal, that the feeds of plants may more fafely lie fu-
perfiually in warm than in cold countries.  The fame fact  feems to be
favoured by the difference of perfection that planted and natural woods
                                                  attain 
              OF   MEDICINE.          20$

  netrate, is to furnifh that fort of a ftrainer, by which the
  powers may neither, from the pores being too patulous,
  go down in too great quantity, and produce firft a fthenic,
  or too luxuriant a ftate of the plant, and then indireft de-
  bility; nor,  from thecontraftednefs of the pores, be in-
  fufficiently  admitted to the root,  and occafion  indirect
  debility, or the decaying ftate of  a  plant.  But that  the
  foil is not otherwife neceffary to the production of fome de-
  gree of vegetable life, is proved by plants often living, to
  a certain  degree, in  pure  water.   That however, it is
  ufeful as a filter, is proved by the good effect of ploughing,
  of breaking the clods, of dividing the tough  clay by lime
  and other abforbent earths,  and by thefe means relaxing
  the pores : On the other hand, we have proof of the fame
  thing in  the fuccefs of  contracting the pores by  making
  ground,  naturally too friable, more tenacious with dung,
  and covering light ground with rags and ftones, and there-
  by keeping in both heat and  moifture.
   CCCXXV. From this view of the facts, the reafon is
  evident,  why every fandy as well as clay foil, when the
  former has not received, and the  latter parted  with its
 toughnefs, is barren and unfruitful.   Hence it is that very
 hot fummers and countries are hurtful to clay grounds, by
 fhutting up the pores ; and ferviceable to friable and lean
 grounds, by  diminifhing their porofity.   Hence, dry fea-
 fons are fuitable to low-lying rich grounds, which, from
 all quarters,  conduct a quantity of moifture  around the
 roots of the plants ; while rainy feafons  are thofe that an-
 fwer in grounds that are high and of a thin foil.  Decli-
 vities facing the north, which are commonly of a thin and
 poor foil,are cberifhed and protected by hedges and clumps
                                                     of
attain in cold countries;  the former, the feeds of which are lodged in a
certain depth, turning to better account than the latter, which rife from
feeds that have randomly been fcattercd upon the furface.  Might not
the hills in the weft of Scotland, upon fome fuch principle, be mate ufe
 ful oak forefts ? 
206       THE   ELEMENTS
 of trees, and a  great number  of bare ftones,  covering
 every thing, which fome  perfons, of more  induftry than
 fenfe, often remove with hurtful effect ; their good effect
 being to give heat and  keep in moifture.   But in ihofe
 places, the declivity of which looks towards  the fouth,
 there is not equal occafion for  fuch protection  from cold
 and drynefs, as they, from their more happy fituation, are
 cherifhed by the fun, defended from the cold winds, and
 expofed to thofe which blow  from the  fouthern points
 that are feldom too dry (n).
   CCCXXVI. To return from this digreffion on agricul-
 ture to our proper fubjeft; from what has been faid upon
 the cultivation and nature of plants, we learn, that their life
 is fimilar to that of animals ; that every thing vital in na-
 ture is governed by excitement, which the exciting pow-
 ers only afford ;  that there is in no living,  fyftem, whe-
 ther of the animal or vegetable  kind,, any  inherent power
 neceffary to the prefervr.tion of life; that the fame powers
 which form life at firft, and afterwards fupport it, have
 at laft a tendency to produce its  diffolution ;  that life,
 the prolongation of life, its decay and death, are all ftates
 equally natural; that every living fyftem lives in that which
 it procreates; that the  generations of  animals and  ve-
 getables are in that way renewed, that the fyftem  of nature
 remains, and maintains an eternal vigour  ;  in one word,
 that  all the phcenomena of nature are fabricated by one
 fingle organ (o).
                                                 There
  (n) While the northern winds, that is, the wind due north, and all the
intermediate ones in every point of the compafs from due  eaft to due
weft, are cold and dry, and commonly of a tendency to bring fnow ; the
fouthern, or the winds that blow from any point of the  compafs toward*
the fouth, from the fame points of due eaft to due weft, are as common-
ly warm and moift, and often productive of mild fertilizing rains.
  (o)  No difcovery, of any importance or extent over nature, has yet
been made, that does not warrant, as far as the fmallnefs of the  number
of fuch difcoveries go, the truth of this affcrtion.  See the Introduction
to my Obftrvations. 
              OF  MEDICINE.        207

   There are many  circumftances  that  give  reafon to
 believe, that this  globe  has undergone  great  changes,
 and that whatever is now fea, has  been  land;  whatever
 is land at  prefent,  has  been  fea;  and  that  the foffil
 kingdom of  nature  has  not been more  retentive of the
 refpective form of each of its individuals.   But whether
 the laft, like animals and plants, have a fort of life, fo as,
 after their manner, to be produced into  living  exiftence,
 to grow, to run through a period equally without growth
 and diminution of bulk,  to  decay,  to die, and, in death
 lofe their  proper  form;  the great duration  of  their age,
 and the fhortnefs of  ours, deprive us of any poffibiiity of
 learning.
   CCCXXVII.  As  all the motions of the planets, which
 latter were formed to remain and continue their  courfes
 for ever, depend upon this one principle, to proceed ftraight
 onward, according to the manner in which all projectiles
 move, and then by the influence of gravity, which affefts
 them all, to be pulled downward, and thereby,  upon the
 whole, thrown all into circular motions ;  fo, in  the leffer
 and living bodies with which  thofe greater bodies  are filled,
 that is, animals and plants, of which the whole fpecies re-
 main though the individuals of each fpecies die;  whatever
 Is the caufe of their functions, whatever gives commence-
 ment and  perfection  to thefe, the  fame weakens,  and, at
 laft extinguifhes  them.  It  is not,  therefore, true,  that
fome powers are contrived by nature for the  prefervaticn
of life and health,  others to  bring on  difeafes and death.
The tendency  of  them all is   indeed to  fupport life,
but  in a forced way, and then to bring on death, but by
a fpontaneous operation.
PART 
  2C8      THE   ELEMENTS


PART     THE    THIRD.

       OF  GENERAL   DISEASES.

THE  FIRST  FORM,  OR  STHENIC DISEASES.
             CHAP.     XV.

   CCCXXVIII.  IN every fthenia,  in all fthenic dif-
 eafes, in the whole firft form of difeafes (a) an univerfal
 criterion is  encreafed excitement over the whole fyftem,
 evidenced, during the predifpofition, by an  encreafe of
 the functions of body and mind (b), and demonftrable,
 after the arrival of difeafe,  by an encreafe of fome of the
 functions, a difturbance of others^ and a diminution  of
 others; in fuch  fort, that the  two latter are eafily per-
 ceived to arife from the hurtful powers, that produce the
 former, and to depend upon their caufe.  As by that com-
 mon band of union the difeafes of this form are connected
 together ; fo
   CCCXXIX. There are certain circumftances, by which
 they are diftinguifhed by a difference of their degree : for,
 there are  fome fthenic  difeafes, accompanied with  py-
 rexia (c) and the inflammation of fome external part; there
 are others without the latter of thefe,  and others without
 both.
                          2               ccexxx.
  (a) See above par. LXIX.LXXXVJII. CXLVIII.CLI. CCLI. Chap.
IX,              (b) See par. CLI. throughout;
  (c) See par. LXVIII. and the fubjoined note, for the meaning of py-
rexia, which will be juft now repeated. 
OF    MEDICINE*
209
   CCCXXX.  The  general  fthenic  difeafes, with py*
 rexia and inflammation, are fome of them called phlegm*
 afia?, others exanthemata.   But they will all, without dif-
 tinftion, be treated here according to  their rank in excite-
 ment, from the higheft to the loweft degree of excitement.
   CCCXXXI. The  phlemafiae and  exanthematic difea-
 fes  have  the  following  fymptoms in common  to them.
 The firft of thefe is that degree of fthenic diathefis, that
 diftinguifh.es predifpofition (d). This diathefis upon the for-
 mation of the difeafe, is fucceeded by  fhivering, a fenfe of
 cold, languor, and a certain feeling like that which we have
 in fatigue from labour, called by phyficians, laffitude. The
 pulfe at firft, in every cafe, and in mild ones^through their
 whole courfe is moderately frequent, and, at the fame time,
 ftrong and hard; the fkin is dry, and .there is a retention
 of other excretions (e): The urine is  red; there is  great
 heat and often thirft.
   CCCXXXII.  The fymptoms peculiar to the  phlegma-
 fiaz  (f),  are an inflammation of an external part, or an
 affection nearly allied to it ;  while the general  affection,
 for  the moft part, precedes this local one, and never fuc-
 ceeds to it (g).   This  general affection, for the  greater
                             P                convenience

  (d) From the firft deviation  from perfect health to the cornmence-
 reient of actual fthenic difeafe, the  fthenic diathefis takes place in an en-
 creafing fcale from 400 to 550.
  (e) Such as that by the belly, and that which pours out the faliva and
 mucui, and forms the matter of expectoration.
  (f) The phlegmafiae are fthenic difeafes, accompanied with inflamma-
tion in an external part, as has been faid fomewhere before, according to
the definition of nofologifls.  But, as there is no difference betwixt them
and fynocha or the  catarrh, which latter  are unaccompanied with in-
flammation, wc therefore  pay  no regard to  the diftinctlon ; and fhall
regard nothing either in thefe or any other difeafes, but what is conflic-
ted by a real difference of excitement. It  is the excitement  by which
we are to be guided through our whole diflribution of difeafes.
  (:) Long before .my part of thisdoctrine was difcovcred,  when I was
                                                        in 
 210        THE   ELEMENTS

 convenience of diftinguifhing it from fevers, is to be de-
 nominated pyrexia (h).   In the exanthematic fthenic dif-
 eafes, an eruption of fpots or puftules, more or lefs crowd-
 ed, according to  the degree of the diathefis, covers and di-
 verfifies the fkin.  The eruption appears upon the occafion
 of a foreign, contagious  matter, having been taken into the
 body,  and  detained below the cuticle.
    CCCXXXIII.  The explanation of all thofe fymptoms
 eafily  flows from the doftrine delivered above.   The fthe-
 nic diathefis in the  manner that has been fo fully explain-
                                                           ed

 in fearch of certain facts refpecting peripneumony and pleuritfs, I difco-
 vered one which»I was not  looking for,  of more importance than 3ll the
 reft put together.  It had been afferted, by moft fyftematics and all the
 nofologifls, that the primary fymptom in the phlegmafia was the inflam-
 mation  of a part. I  faw that  was not- true with refpect to rheumatifm,
 in which the general affection or pyrexia often rages one, two, or three
 days before  the fign of inflammation, pain, is perceived in any of the
 joints.  I could alfo difcern, that from the moment the pain and inflam-
 mation  appeared in eryfipelas,  or the rofe,, there was alfo the general af-
 fection  equally confpicuous.  In fhort, in no one of that fet of difeafes,
 did the fact appear that the inflammation was primary, and the pyrexia,
 or affection of the whole fyllem dependent upon it.  Put  as peripneu-
 mony was faid in Edinburgh to be an exception, the detection I made
 equally  difproved that.  In all the works of Morgagni, where peripneu-
 mony and eryfipelas are treated, and in all thoft of Trillerus, a profeffed
 writer on that fubject, and  in a thefis  in Sand-fort's  Thefaurtfs, taken
 from no lefs than 400 cafes  of that difeafe (for they  arc now by others,
 as well as me,  confidered as one), I found that in  fomewhat more than
 one-half of the given number, which was very  refpectable, the general
 affection appeared from one to three days before the pain  came on, and
 in all the rell of the cafes that, though for any thing thefe authors faid to
 the contrary, they might fometimes have come on together, yet, there
 was not one, in which it could be fairly alledged, that the pain was the
 firft and primary appearance.  Hence I found,  that all fhe theories raif-
 ed upon that hypothefis-of courfe  fell to the ground.  Indeed the  fact
 is quite  confident wish every one here.
  (h) Ofthisdefignation warning  has been given more than once.  See
note at CCCXXIX. 
OF   MEDICINE.          211
ed (i)  precedes.   The charafteriftics of the  pulfe are ne-
ver to be referred to the affection of a part,  having been
demonftrated to arife from the'diathefis (k).
   CCCXXXIV.  The frequency of the pulfe in fthenic
dileafes is moderate, becaufe, while the ftimulus in the fyf-
tem cannot fail to produce  fome frequency,  the quantity
of blood,  to be thrown into quick motion,  fets bounds to
it and prevents its rifing to quicknefs.   But,  at the fame
time, it is evident, that a quantity fo great cannot be tranf-
mitted with the fame celerity,  as an under proportion (1).
The ftrength of the pulfe is occafioned  by the degree of ex-
citement in the moving fibres of the veffels, which is com-
monly called their tone,  and by that of their denfity con-
fidered as fimple folids (m).  Thehardnefs of the fthenic
pulfe is nothing  elfe, than the continuance for fome time
of each ftrong contraction,  clofely embracing a great co-
lumn of blood, and, thereby,  as  it were, refembling  a
ftretched rope (n).
                         P 2                 ccexxxv.

  (i) See above all the paragraphs, where the operation of the powers
producing fthenic diathefis, are accounted for.
  (k) See alfo par. CLV, andCLVI. and particularly CLXXIV.
   (1)  In fevers and  other afthenic difeafes of great debility, frcm the
weaknefs of the ftomach and other digeftive organs, and the fmall quan-
tity of nutrient matter taken in, the quantity of blood which is diminifh-
ed in every one of thofe difeafes, cannot be more than one-third lefs than
that which overfills the veffels in llhenic difeafes.  Confequently, by a
given power, it may be propelled in the fame proportion,  that is, one-
third fuller than in the fthenic difeafes, which alfo appears in fact; for
while ioo beats in a minute is a frequent pulfe in fthenic difeafes, till
their approach  or actual converfion  to indirect debility,  the common
frequency in fevers and the  other high afthenic difeafes, is 150 beats in
the fame time.
   (m) See above LIX. LX. and LXI.
   (11) See par.  CLV.  If it fhould be alledged, that, though in fevers
and the other cafes mentioned juft now  in the note (a), the deficient
 quantity of blood to be put in motion will account for the greater cele-
                                                        rity 
  212       THE   ELEMENTS

    CCCXXXV. That this  is  the exact ftate of the arte-
  ries is proved  by the great quantity of food taken with a
  good appetite, before the  arrival of the difeafe, and  du-
  ring the period of predifpofition; it is proved by the fame
  and other powers,  giving  an unufualiy great excitement
  Over the whole fyftem (o), and,  therefore,  among their
  other effects encreafing the digeftive energy; and it is pro-
  ved by evacuant, with other debilitating  remedies, both
  preventing, and removing the difeafes.   The confounding,
  therefore,  this ftate with one diametrically  oppofite  (p),
  which has hitherto been  an univerfal praftice, was a very
  capital blunder, and could not mifs of producing the worft
  confequences, by equally perverting the theories  aild ac-
  tual praftice of the  art.
                                               CCCXXXVL

 rity of motion, than in the difeafes whkh make the prefent fubject; ftill
 the great weaknefs of the heart, for want of the fiimulus of a due quan-
 tity of blood, as well as of many others, fhould overbalance the effect
 arifing from the fmall quantity to be moved.  But  the anfwer to  that
 objection i9 eafy.   It arifes from the explanation of the ftrength and
 haidnefs of the pulfe juft now mentioned in the text.  The febrile pulfe
 is indeed one-third quicker than the fthenic pyrexial,  hut it is weak, and
 frnall, and foft, while the other is ftrong, and full, and hard,  An equal
 force then of the heart to that  in the fthenic cafe is not required to ac-
 count for the difference of the effect.   A third lefs of blood, with an
 equal force behind, will be driven  not only one-third fafler,  but with
 ftrength and hardnefs.  The want of thefe two laft then is to be fet t»
 the account of the  heart's greater weaknefs.  Though the blood then be
 driven one-third quicker, yet the impulfe communicated upon the whole
 is one third lefs, as the characteriftics of both kinds  of pulfe readily ex-
 plain to us.
  (o) See the whole of the firft Chapter of Part II. upon the powers'
 producing fthenic diathefis.
  (p) Which authors and too many practitioners have univerfally done,
in jumbling proper fevers with the  prefent difeafes, under the vague and
falfe denominations of febrile or feverifh difeafes.  In nofology the fy-
nochtis is conjoined with  typhus, the gangrenous fore-throat, which if
a typhus fever, with the -i/mmon fthenic inflammatory pyrexia. 
OF   MEDICINE.           213
  CCCXXXVI. The fhivering and fenfe of cold depend
for their caufe upon the drynefs of the fkin. The languor
and feeling of laffitude point out a higher degree of excite-
ment in the brain and fibres of the mufcles, than can be
conveniently borne by the excitability, confined within
certain boundaries (q). They are therefore functions im-
paired from a ftimuiant, not from a debilitating caufe (r).
  CCCXXXVII. The drynefs of the fkin  is occafioned
by the great excitement and denfity of the fibres that en-
circle the extreme veffels, diminifhing their  diameters to
fuch a degree,  that the imperceptible vapour of perfpira-
tion cannot be taken  into them, or,  if  taken in,  cannot
be tranfmitted  (s).   This ftate is  not fpafm, is not con-
ftriction from cold, but a fthenic diathefis, fomewhat grea-
ter on the furface, than in any other part.  The ftimuiant
energy ,of heat, efpecially  after the application of cold,
which is otherwife a powerful exciting  caufe  of  fthenic
difeafes, is applied to this part with more force than to any
of the interior  parts, and encreafes the fum total of ftimu-
iant operation (t).
   CCCXXXVIII.  The fame,  in general, is the caufe of
the temporary  retention of the other excretions (u)  ; only
that the operation  of heat, juft now mentioned (x),  is
foreign from the prefent explanation ; and on that ac-
count, the diathefis  that  affefts  the interior veffels  is
more gentle.   Thefe  veffels, for that  reafon, and becaufe
                                                   they

  (q) See above CLIV.              (r) See above par. CLXVI.
  (s)  See LX1X. and CXIU.
  ^t) See XXXVII. 0. and CXIII. juft now quoted.
  (u) See CCCXXXL and note (d) ;  and alfo the par. CLIX. CLX,
 CLXIIL
   (x) in the CCCXXXVIII. and the reafon is, that heat being flatio-
Piry in the interior parts, has not that force which it has upon the extcr-
 ftti furface.  See above par, CXIII. 
 214      THE   ELEMENTS

 they are naturally of a large diameter, are fooner relaxed
 in thefe difeafes, than the pores upon the fkin  (y).
   CCCXXXIX. The rednefs of the  urine  is owing to
 the general diathefis affecting the veffels that fecrete it, and
 proving an obftacle to the fecretion (z).  Hence arifes the
 ftraining of the fluid to be fecreted to diftend the fmall vef-
 fels (a), and the  counterftraining of the  moving fibres,
 by their contractions, to diminifh the cavities which the
 diftention encreafes; and, in fo far as they perform the
 function of fimple fibres, to refift  the diftention.   But,
 as, in this forcible aftion of the veffels, the cohefive force
 of all the fimple folids yields fomewhat, the effect comes
 to be the  tranfmiffion of fome  particles of blood.  This
 tranfmiffion happens not at firft, becaufe the diftenfion does
 not fuddenly, but after fome time, overpower the cohefion
 of the mafs of fimple folids.
   CCCXL. The  caufe of the great heat is the interrup-
 tion of the perfpiration,  preventing  the heat generated in
 the inner parts of the fyftem to pafs  off by the fkin.
   CCCXLI. The thirft is occafioned by the  fthenic dia-
 thefis, clofing up the excretory veffels of  the  throat, and
 there oppofing the excretion of the peculiar fluid (c).  And
 the heat, by diffipating what fluid is excreted, contributes
 to the effect.
   CCCXLII.  The inflammation and affection nearly al-
 lied to it (d), whether of a catarrhal or of any other nature,
 is a part of the fthenic diathefis, greater in the affected,than
 any other equal, part of the fyftem (e): Which is mani-
   i,                                            fefted
  (y) It is reafonable to think, that veffels, which pour out a watery flu-
id, have a larger diameter than thofe, which, like the perfpiratory, even
in their healthy ftate, only tranfmit an imperceptible vapour.
  (z) See par. CLXIII.                   (a) Or tubuli uriniferi.
  (c) See par. CLIX.
 (d) mentioned above in par.  CCCXXXIJ.
 (e) CLXVIII. CLXIX- CLXX.CLXXI, 
OF   MEDICINE,          21^
 fefted by the exciting powers, alfo in this cafe afting upon
 the whole fyftem, by the fymptoms of the difeafes fhowing
 an affection in common to the whole, and by  the reme-
 dies driving that affection, not from the inflamed part on-
 ly,  but from the whole fyftem (f).
   CCCXLIII.  The general affection, for the  moft part,
 precedes that confined to one part, or is funchronous with
 it, never comes after  it, becaufe its caufe, the exceffive
 excitement (g),  producing the diathefis, exifts before the
 difeafe itfelf (h); and, though it  forms the rudiments of
 the affection of the part during the predifpofition (i),  yet
 it does not, at that time, form that affection itfelf, and not
 always  even during the difeafe, but only in a certain high
 degree both of the difeafe and of the particular affection
 itfelf (k).   Hence, when the diathefis is great, the affec-
 tion of  the part is in proportion (1) and flight under a leffer
 degree of the diathefis (m); while in a moderate and gentle
 diathefis it does not happen at all (n) and for this  reafoe,
 that a high degree of diathefis is neceffary to the formation
 of it.   Thus hi peripneumony, where the diathefis is  the
 g;reateft, and in rheumatifm, where it is next in greatnefs,
 the inflammation is found proportionably great (o). And
                                                   jsvcn
   (f) LXXXIX.   See alfo part firft, Chap. IV.
 [(g) SeeLXII.LXIX-             (h) See CLXXIV.
   (i) See above CLXIX.            (k) See above CLXVIII.».
  (I) as in peripneumony and rheumatifm, inflammatory fore thrpat,
 and mild eryfipelas,  fore throat.
   (m) as in the fthenic.
  (n) As in fynocha, or the common inflammatory fever  and  catarrh.
  (o) This propefition does not gofo far as to affert, that there may not
 be a fthenic difeafe, without any adlual inflammation, but with an affec-
tion of a part nearly allied to it, which depends upon an equally high
diathefis  as either peripneumony or rheuma'tifm, and even higher than
 the latter. Such we find, as I have formerly faid (CLVII and CLVIII.)
 in phrenitis.  But the meaning is, that the inflammation,  when it does
 happen, is always in proportion to the degree of diathefis. 
2l6      THE    ELEMENTS

even in the meafles, the danger of which  turns  entirely
upon the degree of fthenic diathefis, the danger of inflam-
mation is equal, by which,  and often in  a high  degree,
the lungs themfelves are affected.   Synocha is never phre-
nitic, but when a great diathefis occurs,  threatening the
brain  with inflammation, or the danger  of u\   Nor  is
there any danger  to be  apprehended in  eryfipelas (p),
even when its inflammation  affefts the face, but v/hen the
pyrexia is violent.  And the mildnefs of the diathefis enfures
a good termination.  Simple fynocha  is nothing elfe but a
phlegmafia, confuting of a  pyrexia and diathefis, inade-
quate, upon account of their  fmall degree, to the produc-
tion of inflammation.  Yet, as all the hurtful powers pro-
ducing it, and all its remedies are precifely the fame, with
thofe of any phlegmafia; the feparating it from them, and
uniting it with fevers, which are difeafes of extreme debi-
lity, was an unpardonable blunder (q) ; and fo much the
more fo,  that  inflammation, which was falfely fuppofed
effential to the nature of the  phlegmafias, does take place
in it, as often as  the diathefis, neceflary to produce it, is
prefent (r).  Yet this faft, upon account of another blun-
der, neither of a  flighter nature, nor of lefs hurtful con-
fequence, that of  fuppofing  inflammation the caufe of the
phlegmafia?, could not be difcerned.   In fine, to remove
all doubt of inflammation being compatible with the na-
ture of catarrh, but commonly not taking place in it, upon
                                                account

   (p) or the rofe, or  St. Anthony's fire.
  (q)  This has been more than once hinted at, and once a little above.
The Nofologifls have excluded fynocha from their order of phlegmafia:,
becaufe forfooth, though it was in every other refpect the fame, it want-
ed the inflammation of a part, and they united it  with proper fevers»
though in the powers producing it, in its proper caufe, and in the reme-
dies that remove it, it was in every refpect diametrically oppofite to thofe,
difeafes.  But their rule of judging was different from ours.
  (r) What  is a peripneumony, a rluiimatifm, or any phlegmafia,  hut
S fynocha, with a dijtbefis fufficient to preduce irflEmmation I 
OF   MEDICINE.          2l"J
account of the moderate general diathefis, upon which it
ufually  depends ;  even in it, as often as the diathefis rifes
high, which fometimes happens, when  the proper plan
of cure for it has been neglected, and the effect of the ex-
citing hurtful powers has been carried to excefs, an inflam-
mation, and a formidable one indeed,  arifes, often affec-
ting the throat (s), and fometimes the lungs, and producing
there an affection riling to all the rage of peripneumony.
  CCCXLIV. It is in vain to talk of a thorn thruft un-f
der  the nail, wounding it, fuperinducing inflammation
upon the wound, andfpreading a fimilar affeftion along the
arm to the fhoulder, and a pyrexia over the whole body.
As  an illuftration and proof  of the manner, in which the
phlegmafios arife from inflammation.  For nothing like
a phlegmafia follows  this,  or any fimilar affeftion of a
part, unlefs the fthenic  diathefis  previoufly  happens to
have taken place, and is now upon the eve of fpontaneoufly
breaking out into fome one or other of its  refpective dif-
eafes.   But,  without that  diathefis, no general affection
takes place, and if an oppofite diathefis be prefent when
fuch an accident happens, an oppofite general affeftion will
be the confequence, to wit,  a typhus fever,  arifing as a
fymptom of gangrene (t), and dangerous to life.
  CCCXLV.  That  the affeftion of  the part  depends
upon the  general affection is proved by the frequent oc-
currence of inflammation, without being followed by any
                                            phlegmafia.
  (s) When that happens it is ftill commonly a mild difeafe, as will be
Jhewn by and by.
  (t).It is with much regret, that I fhould have had occafion to obferve
the bad, and too often fatal, confequence of treating fuch local affections,
without difcrimination of the habit with which they may coincide. The
difeafe. is treated by evacuation and flarving,  even in habits the moft
weakened, and drink is withheld from perfons even the moft accuftome4
to it. The difeafe increafcs, and, as if that were for want of more fuch
treatment, the inuc iKatir.ent is perfevcred hi till death ckfes ^hs fcciij. 
 2l8       THE   ELEMENTS

phlegmafia.  "Which happens, as  in  the cafe  juft  now
mentioned, as  often as the general diathefis is abfent,  or
the inflamed part is not an internal one and of  high fen-
fibility (u). Accordingly, all the examples of phlegmone,
all thofe of erythema or  eryfipelas, without  general dia-
thefis (x), are foreign from the phlegmaficE, abfurdly con-
joined with them, and more abfurdly ftill  confidered  as
their prototypes;  being in faft all only local affections,
or fymptoms of other  difeafes.    This conclufion is not
weakened by a certain refemblance of difeafes with inflam-
mation in an internal part to the phlegmafias; thefe dif-
eafes being neither  preceded by the ufual hurtful powers,
that produce either the phlegmafias, or any general difeafe
whatever, nor  cured by the ufual  remedies  of the latter.
It was, therefore, a very bad miftake,  and of moft  hurt-
fol confequence to  the  praftice of  cure,  to enumerate
                                                   among

  (a) Set above CLXXI.
  (x) See alfo par. LXXXI.  The Nofologifls, under their genus of
phlegmone  which  in one of them  is divided into two fpecies, proper
phlegmone,  and erythema, have raked together a number of local, and
moft of them infignificant affections, which they have confidered as lay-
ing the foundation of their phlegmafia, or general fthenic difeafes with
an inflammation in a part.  13ut will any man in his fenfes fee any con-
nection betwixt chill-blanes, which is one of them, or anthrax, which is
a local fymptom of the plague, or the flight inflammation upon the eye,
called a flic , or the inflammation in the groins of children from their
being fcalded by their urine, or the bites of infects, the effects of which
are confined to the bit part; will he fee any connection betwixt thefe
and a peripneumony ; which arifes from hurtful powers affecting the
whole fyftem, and no part in particular;  and  is cured by remedies that
affect the whole fyftem, and the  inflamed part not more, nor even fo
much as many others ?  All thefe, however, have been made the proto-
types  of inflammation, by which they  meant their phlegmafia;; as if
there were nothing to be regarded in them but the inflammation, which3
in fact, is their moft infignificant part, bearing do higher proportion to
the fum of morbid flate over the fyftem than that of 6 to 3000, or even
htjb.   See above Part firft, Chap. IV. and particularly par.  L. 
             OF   MEDICINE.         219.

 among the phlegmafia; thofe difeafes, that arife from fti-
 mulants,  acrids, and compreffion, and are only curable
 by removing  their  local caufe, which is  feldom effected
 by art (y).
   CCCXLVI.  It is not without good reafon, that the ap-
 pellation of pyrexia has been given to the general affeftion,
 which appears in the phlegmatic and exanthemata ; they
 being by it moft advantageoufly diftinguifhed on the one
 hand from fevers, which are difeafes of debility in extreme,
 and  on the other from a fimilar, but altogether different,
 affection, which is a fymptom of local difeafes (z) and may
 be called a  fymptomatic pyrexia.
                                               CCCXLV1I.

   (y) See above par. LXXXI.  Take for an example gaftriti?, which
 the Nofologifls have made one  of their phlegmafia, and put upon die
 fame footing with the peripneumony and the other difeafes that may be
 admitted as phle^mafias. That affection is an inflammation in a portion
 of the ftomach, in confequence of a folution of continuity from the pre-
vious fvvallowing of  ground glafs, fmall fifh bones, a quantity of Cayen
 pepper;  or fymptomatic of a fchirrous obftruction and tumor.  Thefe,
 not the ordinary hurtful ones that operate upon the whole fyftem, as in
 the true  phlcgmafiae, are the powers that induce that affection.  It has
 no connection with the excitement, the affection of which is only an eF-
 fect  of  the local ftimulating power,  and of the fenfibility of the fto-
 mach ; its true caufe being the folution of continuity or obftruclion,
keeping up the Inflammation ; and its remedies fuch, as are adapted to
 the removal of that local ftate.  It may happen to a found habit, where
 there  is  no diathefis in  any degree, in which cafe it is purely local; or
it may accidentally coincide with  either diathefis; in which cafe it is a
 combination.  When the combination is with fthenic diathefis, debili-
 tating evacuant remedies can only palliate, but they  bring life into din-
ger when the afthenic diathefis is prefent, which  is 17 times out of 20
for the other.
  (z)  The general affection arifing in the fyftem from the effect of z.
thorn  pufhed under  the nail (fee par. CCCXLIV. and note), and that
occurring in  the gaflritis, mentioned in the laft paragraph of the text
(fee the note on that garagraph) are good examples  of cafes to whkh
 fhe term fymptomatic pyrexia fhould be applied* 
220       THE   ELEMENTS
    CCCXLVII.  The true  fthenic difeafes (a)  accompa-
 nied, except one, with pyrexia  (b) and external inflam-
 mation (c), are peripneumony,  phrenitis, the fmall-pox,
 the meafles, as often as thefe two laft are violent, the fe-
 vere eryfipelas, rheumatifm, the mild eryfipelas, and the
 cynanche tonfillaris.   Thofe free  of inflammation  are
 catarrh,  fimple fynocha, the fcarlet fever, the fmall-pox,
 the meafles;  when in the two  latter cafes,  the eruption
 confifts only in a few puftules.

            The Deficription of Peripneumony.

    CCCXLVIII.  The fymptoms  peculiar  to  peripneu-
 mony (d) (under which pleurify, and, as far as it is a gene-
 ral difeafe, carditis, are comprehended), are pain  fome-
 where in the region of the cheft, often changing its feat;
 difficult breathing; cough, for the moft part bringing up
 an expectoration,  and fometimes a  mixture of blood in
 the matter of expectoration.
   CCCXLIX. The feat of the difeafe is the whole body,
 the whole nervous fyftem (e); which is proved by the dif-
 eafe being produced by an increafe of the diathefis, which
 took place in the predifpofition, and by no new circum-
 ftance (f); by the inflammation within the cheft, for the
 moft part following the  pyrexia at a confiderable interval
 of time, and never preceding it (g), and  by bleeding and
                                                  other

   (a)  See above CCCXXIX.
  (b)  See par. CCCXXXII.                   (c) See CLXVIII.
  (d)  The fymptoms in common to it and the other difeafes of the fame
form, enumerated in the laft paragraph, have been defcribed in par.
CCCXXXI.  Thefe peculiarly diftinguiftiing the phlegmafia; and exan-
themata, that is the difeafes either accompanied with inflammation, or
an approach to it, are defcribed in par. CCCXXXII,
  (e) See par. XLVII. XLVIII. XLIX. LIV. LV. and not the in-
flamed portion of the lungs, accordiHg to the common opinion.
  (f) See above LXXV. LXXVII.
  (g) See ahove CCCXXXII. and the note (b), 
OF   MEDICINE.          1%\
 ther remedies of fimilar operation,  which affeft not the
 inflamed part, more than any other equally diftant from the
 centey of activity, removing the difeafe.  The proper feat
 of the inflammation,  which is only a part of the general
 diathefis,  is the fubftance of the lungs, and a production
 of the pleura,  covering their furface, or any part of that
 membrane, whether the part lining the ribs, or that con-
 taining,  within the external furface of it, the thoracic vi-
 fcera, different in different cafes,  and in the fame cafe at
 different times.
   CCCL. Pain, in fome part of the cheft, depends upon
 an inflammation of the  correfponding internal parts juft
 now mentioned (h), which is proved by diffeftion ; only
 that  it is  oftener occafioned by an adhefion of the lungs
 to the pleura coftalis,  feldom to an  inflammation  of that
 membrane, as we learn from the fame evidence.
   CCCLL When the inflammation takes place on the fur-
 face of the lungs, it is impoffible it can be confined either to
 the fubftance of the lungs, or the membrane covering their
 furface.  For how can any perfon fuppofe,that the points of
 the fame veffels, either as diftributed upon the membrane,
 or plunging into the fubftance of the lungs,  or emerging
 from it,  can alone be inflamed without a communication of
 She affection to the next points (i).   The diftinftion, there-
                                                  fore,
  (h) See  above, par. CLXXIV.
  (i) Yet one Nofologift, upon that Very fuppofition, makes two orders
 of phlegmafia:, one fe3ted on the membrane, the other in the interior
 furface of each vifcus.  Into this error,  he had been led,  by obfefving,
 that, after death,  the interior fubftance of  the liver exhibited figns of
 previous inflammation.  And, as other diffections fhowed the membrane
 upon other occafions to have been in a ftate of inflammation, he thence
 drew his rafh conclufion.  But it is to be obferved, that the firft menti-
 oned ftate ef the  liver was not a phlegmafix at all, as it had not during
life exhibited any of the fymptoms of that difeafe, or even given any fign
 of the prefence of Inflammation.  Its is a cafe,  then, we have nothing to
                                                      do 
%%%      THE   ELEMENTS
 fore, of the inflammation accompanying the phlegmafioc In-
 to perenchymatofe,or that affecting the fubftance of the vif-
 cus, and into membranous :  as well as the notion which
 mikes the latter cafe univerfal, is equally remote from the
 truth.  The  reafon of neither the membrane contiguous
 to the lungs, nor the fubftance of the latter, being always
 inflamed,  but  of the inflammation being fometimes com-
 municated to fome part of the neighbouring membrane, is
 explained by the vicinity of the part inflamed in the laft cafe
 to that which receives  the air, and, therefore, varies in its
 temperature (k).
   CCCLII. The pain often fhifts its feat (1) in the courfe
 of the difeafe, becaufe its  immediate caufe,  the inflamma-
 tion,  is equally liable to change, being difpofed  to leave
 its firft feat, or  in part to remain in it, while in its great-
 eft part it ruflies into another.  Which is a  fact proved by
 the  companion of the known  change of  the pain with
                                                       the

 do with upon this  fubject, even fo far as it applies to the liver.  But the
extending the  application to all the vifcera, which  he was pleafed to
make the feats of fome  phlegmafia: or other, was  loofnefs of reafoning,
and careleffnefs of iv.ntter of fad,  in extreme.  A  gentleman, whofe
works have lately been buried, without any ftruggle or figns of life, but
that of a feeble unintelligible  found from within the tomb,  which  no
living reafon could make any fenfe of in their life time, took it into his
head to maintain (for the fake of feeming to differ with men of name
and reputation, his hijjieft ambition), that the inflammation in the phleg-
mafia was always fcated in the membrane: The anfwer to which is
given in the text.
   (k) So far is it from being true, that this fort of inflammation  can
be confined to  a few points of the affeded veffels (fee the note here at
(i), that in, fact we find it, though not fo often as has been fuppofed,
fometimes in the mediaftinum, fometimes in the external membrane of
the pericardium, fometimes in the fuperior membrane of the diaphragm,
lloerhaye's notion  of the tranflation of inflammation from one viftVi»
to another, was an error in the oppofite extreme.
   (1) See above CCCXLVIH. 
             OF   MEDICINE.          223

 the traces of inflammation in the correfponding parts, dis-
 covered after death (m).
   CCCLIII. This faft, added to thofe already produced,
 brings another folid argument (n) in refutation of the opi-
 nion of the difeafe being produced or kept up by inflamma-
 tion, or in  any fhape depending  upon it;  confirms that
 here advanced, and proves that the inflammation is regula-
 ted by a ftrong general diathefis, and directed by it fom»-
 times to one part, fometimes to another ; that, as depend-
 ing on that caufe, it increafes and is in a manner multipli-
 ed.   And the fame conclufion is confirmed by the inflam-
 mation abating,  becoming more fimple, and at laft rece-
 ding from every part it had occupied, in proportion to the
 progrefs of the cure in relieving or removing the diathefis.
 The fame faft is confirmed by the nature of rheumatifm,
 the pains of which are feverer and greater in number, in
 proportion as the diathefis  runs higher; and milder and
 fewer in proportion to its gentlenefs.   Thefe pains, that
 have their dependance upon the general diathefis, and are
 a part  of the general  difeafe,  ought to be diftinguiflied
 from local ones, which often occur, and may accidentally
 precede this difeafe (o).
   CCCLIV.  The difficult breathing is owing to no fault
 in the lungs,  as an organ, to no defect  of excitement in
 them, but  to the air  alone  in infpiration,  by filling and
 diftending its own, compreffing the inflamed, veffels.
   CCCLV. The caufe of the cough  is  a large fecretion
 and excretion of the exhalable fluid, and mucus, irritating
                                                   the
   (m) Many fuch are to be found in Morgagni, Bonnetus, and Leiuaud,
   (n) See all that has been faid.
   (o) Stitches, as they are called, frequently happen from flight acci-
dents, and may appear before the arrival of rheumatifm, but thty fhould
be diftinguiflied from the pains that arife from the diathefis, conftitu-
ting that difeafe ; a diftinction. that has feldom been attended t j, f^r
want of a right principle to lead to luch attention. 
224       THE   ELEMENTS
  the air veffels, encreafing their excitement, as well as that
  of all the powers, that enlarge  the cavity of the thorax j
  then fuddenly fufpending it, and thus  performing a full in-
  fpiration, and a full expiration, partly in conjunction with
  the operation of the will (p).
    CCCLVI. The cough is lefs or none at all at firft; be-
  caufe,  on account of a ftrong diathefis occupying the ex-
  tremities of the veffels, the fame fluids flow on in the form
  of an infenfible vapour, are lefs irritating in that form, and
  difmiffed with lefs effort.
    CCCLVII.  Again,  the  cough is afterwards  followed
 by expectoration  ; becaufe the accumulated  fluids,  with
 their effect, the effort of coughing, are carried forward in
 the rapid aftion of the air rufhing out, as it were, in a tor-
 rent (q).   And the mixture of blood with  them point out
 the force of fecretion formerly explained.
    CCCLVIII. The  foftnefs of ihe pulfe,  commonly ta-
 ken into the  definition of the difeafe (r), has been  here
 rejected, becaufe the charafteriftics of the pulfe do not fol-
 low the inflammation, but the general diathefis (s). With
 refpect to the diathtfis,  the proper language is,  that the
 pulfe, inftead of foft, is  lefs hard ; and when the effect,
 that the cure has produced upon the pulfe, is confidered, it
 may then be faid to be foft (t).
   CCCLIX. Nor is the varying feeling of pain,  which is
 defcribed as fometimes acute, and pungent, fometimes ob-
 tufe, gravitative, and rather to be confidered ao an uneafi-
 nefs than pain, though immediaiely dependent upon the
       2                                  inflammation,
  (p) See above CLX. and CLXI.    (q) See  above par. CCXXXIX.
  (r) at leaft, when they called it pen'pr.euniony,
  (s) See above CLV. CLXX1V.
  (t) It is an univerfal effect of fthenic diathefis to render the pulfe hard
In one degree or another.  And peripneumoRy  js not an exception from
that fait.  Cut the diftin&ion arofe frcm the miftake of inflammation
being the all, inftead of an unimportant part of,  the difeafe, 
              OF   MEDICINE.         225

  inflammation, to be confidered as of any confequence in
  pointing out the ftate or feat of the inflammation : becaufe,
  however great the inflammation is, wherever it is feated,
  whatever danger it denounces, the only means of remov-
  ing it, and of averting the danger, is to remove the gene-
  ral  diathefis.  The notion,  therefore, of the membrane
  being inflamed,  when the pain is acute,  and the interior
  fubftance, when  it is obtufe, muft be rejected as good for
  nothing, muft be guarded againft as  deftruftive (u).  For
  often, when the difeafe has arrived at an advanced ftage, a
  fudden abatement of the pain taking place, without a pro-
  portional relief of the breathing, to an  unflcilful perfon
  gives an appearance of a return of health.   But the caufe
  of that, while it has nothing to do with the feat or fort of
  inflammation, is  that degree of excitement, which fhows,
  that the excitability is exhaufted,  the excitement come to
  an end, and that the vigour, before exceffive, is now con-
  verted into direct or indirect  debility (x).  Hence arifes in
  the veffels, efpecially the labouring veffels, in place of the
 exceffive excitement, with which  they were before affect-
 ed,  no excitement at all; and extreme laxity takes place of
 their former denfity.  Hence, inftead of an  excretion en-
 creafed .by  violence, an immenfe difcharge takes place
 without force, without effort, and merely by the watery
  part of the fluid, from the inert ftate of the veffels, leav-
 ing  the more con fiftent; and  a fudden fuffocation takes
 place, in confequence of an effufion of fluids from all quar-
 ters into  the air veffels.
   CCCLX. The  carditis, or  inflammation of the  heart,
 is a difeafe of rare occurrence, is  ill underftood, and for
                          Q^                      the

  (u) See par CCCLI. and the note under it at (i).
  (x) The  direct debility  may be owirg to  the proper cure, which 15
directly debilitating, having been carried too far, or to  the indirect de-
bility arifing in the courfe  of the difeafe,  feldom now  to alexipharmic
treatment.  Se above par. XLVH.  and the fubjoined notes, 
il6       THE   ELEMENTS

the moft part a local affeftion.   When the latter is the
cafe, there is no ufe for the interference  of a phyfician.
And, if ever it be a general difeafe, it admits of no other
definition or cure but thofe of peripneumony.  From pe-
ripneumony then,  as  it arifes from the fame antecedent
hurtful powers, and is removed by the fame remedies, it
is not to be feparated.

              The Defcription of Phrenitis.

   CCCLXI. Phrenitis is one of the phlegmafiae (y), with
 A flight inflammatory or catarrhal affeftion of fome one, or
 more joints, or of the fauces, with head-ach, rednefs of
 the face and eyes, impatience of light and found, watch-
 fulnefs, and delirium.
   CCCLXII. Inflammation, in its proper form, appears
 not in this cafe.   And yet there is  an approach to inflam-
 matory ftate in the joints, in the  mufcles,  and efpecially
 over the fpine, or about the cheft, or in the bottom of the
 throat; or there is a catarrhal ftate, which is an affeftion
 depending, however, upon the fame caufe, as inflammation,
 and only differing from it in being lefs.
   CCCLXIII. The head-ach, and rednefs of the face
 and eyes, arife from an exceffive quantity of blood in the
 veffels of the brain and its membranes, diftending, ftimu-
 lating in excefs, exciting in  excefs, and contracting the
 veffels, to a degree that gives pain  (z).  To the production
 of which laft inflammation is not  neceffary; independent
 of which, this exceffive  action is painful, becaufe it ex-
 ceeds that mediocrity in which  agreeable fenfation takes
 place (a).   The rednefs  both points out  and explains the
 over-proportion of blood.   And that the over-proportion
 gives pain by its diftending operation, is fhewn by the re-
                                                  lief
  (y) See above par. CCCXLVII. (z) Sec aboveCLVH. and CLVIII.
  (a) See pas, CLXXXII- CLXXXIII, 
              OF   MEDICINE.         £27

 Ikf that bleeding and every thing that diminifhes the quan-
 tity,  and moderates the impetus of the blood, adminifters.
   CCCLX1V. It is the  overabundance alfo that  produ-
 ces the impatience of light and found.  For, as a certain
 impulfe of the blood is neceffary to the exercife of every
 fenfe, by wheting the organ of fenfation (b);  fb,  when
 the caufe rifes to excefs,  an  equal encreafe of the effect
 muft be the confequence.   But thefe very fymptoms, with
 pain, arife in an oppofite ftate of excitement, to wit, the
 afthenic.
   CCCLXV. The vigilance  and  delirium are occafioned
 by the fame excefs of excitement, produced by the exceffive
 ftimulus of the abundance of blood and of the other pow-
 ers. Other hurtful powers,  contributing  their  effect, are
 intenfe thinking, and a high commotion of paffion. Excited
 by thofe, no body, even in health, fleeps ; and, therefore,
 the wonder is the lefs, that a high degree  of them, and
 under the  influence* of a violent difeafe, fhould repel fleep.
 Both encreafed watching  and delirium are fymptoms of
 difturbance.

        An Explanation of the Sthenic Exanthemata.

   CCCLXVI. The fthenic  exanthemata, after the ap-
 plication  of  a contagious  matter, and of the ufual hurt-
 ful powers which produce fthenic diathefis, appear  firft in
 the form of  a fthenic pyrexia, or fynocha, and  then after
 a fpace of time, not certain to a nicety, are followed with
 fmall or larger fpots.
   CCCLXVII.  That  the exanthematic fthenic difeafes
 differ not from the other fthenic difeafes not exanthematic,
                        Qja                       iu
  (b) There is commonly in the organ where any nicety of fenfe is to
be exercifed an extraordinary apparatus of blood veffels.  Blood flov.ing
into thefe, encreafes,by i^s heat ar:d  the ftinvviib of Its motion, the f>->fe.
to which it U fubfervient. 
22 6*       THE   ELEMENTS
 in any circumftance of confequence, is proved by this ftrong
 argument; that, except the eruption and the phaenomena
 peculiar to it, there is nothing in the fymptoms, and  ex-
 cept the contagion, there is  nothing in  the hurtful excit-
 ing powers,  but what  happens in  any  fthenic difeafe;
 and the preventatives, as well as the remedies, are the fame
 in  all.   While  that is the ftate  of the faft, it was the
 height  of  abfurdity, merely for the fake of the eruption and
 its peculiar phenomena, to feparate the exanthematic from
 their kindred difeafes, and to unite them with  the moft
 oppofite difeafes both to them and to one another (c). For
                                                        how,

   (c) The nofologifls have feparated the exanthematic difeafes, real or
 imaginary, into a clafs  or order by themfelves, which they have  filled
 »p with difeafes, of which there is not two, but the fmall-pox and mea-
 fles, that have any  other connection, than their mere eruptive appear-
 ance, while they are feparated from others, with which, in every refpect,
 they have the moft effential connection.  Thus-the fmall-pox and mea-
 fles are taken from the  natural place to  which they are here reftored.
 And  it is unaccountable, that  we fliould have it to fay, that even ery-
 fipelas, which has furely no right even to the Aim diftinction of eruptive,
 has alfo been placed among them.  Again, the plague, which is to all
 intents and purpofes a typhus fever, its eruptive part not always disjoin-
 ing it from that, is feparated from it,  though it  is fo nearly the fame,
 fcarcely excepting degree, and conjoined with fthenic  difeafes of a dia-
 metrically oppofite  nature.  And the gangrenous fore throat, which is
 alfo a typhus, h3s neither been placed among fevers, in its proper place,
 nor  among the exanthemata ; to which the efflorcfccnce, that it produ-
 ces on the external furface, according to their own rules of arrangement,
 feemed better to entitle  it than fome  others, efpecially the eryfipelas.
 And it again (for there  is no end  of the confufion of this pretended order
 of fome phyficians), is  conjoined not only as  a genus with fthenic dif-
 eafes, but even as a fpecies of one of thofe genera.  The truth is, that
 fyftematics, who were  otherwife no nofologifls,  have made too much
 work about eruptive and contagious difeafes, and have never dived into
 the interior nature  either of them or almoft 0f any other.   They have
 all followed each other from their firft leader,  and never once deigned
totunxagbaceof  their eye upon- the phenomena of nature 3S thefe
                                                          arofs 
            OF   MEDICINE.          229

how, when the ufual plan of cure removes the effect 6i
the eruption, whatever that be, and thereby fhews it to be
the fame, can any ©ne imagine, that the caufe fhould be
different and not precifely the fame ? unlefs we muft again
have to do with thofe who maintain, that the fame effect
may flow from different caufes.   Truly, the operation of
contagion, in  fo far as it affefts general difeafe, is not of
an oppofite nature to the general fthenic operation, but
precifely the fame.
  CCCLXVIII.  Contagion is a certain  matter,  imper-
ceptible,  of an unknown nature, and  like moft of the
phenomena of nature,   only in any  meafure  open to
our enquiry in its evident effects.   Taken from the body
of one affefted with it, or from any grofs matter (fuch as
clothes or furniture, where it happens to have been lurk-
ing), and received into a found body, it ferments without
any change of the folids  or fluids,  it fills all the veffels,
and then is gradually ejected by the pores.
  CCCLXIX. And, as  no effect, except fthenic diathefis*
follows  it, and the hurtful powers, that otherwife ufu-
ally produce the diathefis, always precede it, and  an aft-
henic or debilitating plan of cure always, and only, fuc-
ceeds in removing it, and confequently its effect no ways
differs from the difeafes hitherto mentioned; it is, therefore,
withjuftice, that the difeafes arifing from it, are conjoined
with thofe others, as belonging to the fame form.
  CCCLXX.  Betwixt them there is only this difference,
that in the exanthematic  cafes of fthenic difeafe, the matter
requires fome  time to pafs out of  the body, which time is
different in different cafes: and it  paffes out more copiouf-
                                                    iy
arofe before them. Hippocrates mifled his followers, they mifled theirs
from age to age, and they all mifled the poor nofologifls.   Who have.
laid on the cap-ftone of the abfurdlty of the art, and, having finifhed
the fabric of folly, left mankind, if they are not pleafed with it, to leck
out  it their leifure for a better and more folid. 
2,$0       THE   ELEMENTS

ly or fcantily, the more free or impeded the perfpiration
is (d).   But it is impeded by no fpafm, by no conftriction
from cold, and only by the prevalence of fthenic diathefis
upon the furface of the body;  as is evident from this faft
that cold, by its debilitating operation, procuring a free
iffue for the matter,  clearly promotes the perfpiration (e).
And that it produces this effect, by diminifhing the diathe-
fis, not by removing a fpafm,  has been demonftrated for-
merly.  As the iffue of the matter is in this way promoted
by inducing a free perfpiration ; fo
   CCCLXXI.  Whatever  part of it is detained below the
cuticle,  by that delay, it acquires a certain acrimony, pro-
duces little inflammations, and conducts them, when pro-
 duced, to fuppuration.  Thefe, by irritating the affected
part, create a  fymptomatic pyrexia fymptomatic fthenic
diathefis, which fhould be diftinguifhed from the general
pyrexia and general fthenic diathefis (f).
   CCCLXXII. The period of eruption is more or lefs
 certain, becaufe the operation  of fermentation,  being in
fome meafure certain and  uniform, to that extent requires
 a certain uniform fpace of time, for being finifhed, diffufed
 over the fyftem, and reaching the furface of it, as is at-
 tefted by  the  effect.  Again, it is not exactly  certain,
 becaufe the perfpiration, in the  varying ftate of vigour,
 that muft occur, muft, at different times, and under dif-
 ferent circumftances, be more vigorous or more languid.
    CCCLXXIII. The pyrexia, fymptomatic of the erup-
 tion,  fometimes takes  on the form of an  aftual fever :
 The reafon of  which is, that the high degree of ftimulus,
  which the eruption throws upon the whole furface, produces
                                            ultimately
   (d) See above par. XXT. and LXXVI.
   (c) See par. CXVH.CXVIII. CXX. CXXl.
   (f)  See above par. CLXXV. and CCCXLV1. 
OF   MEDICINE.       23I
altimately exceffive excitement, and therefore puts an end
toitiu the eftablifhmeut of indireft debility (g).

         The Defcription ofithe violent Small-pox.

  CCCLXXIV. The violent fmall-pox is a fthenic exan-
thema, on the third or fourth day of which, fometimes
later, fmall fpots or points, inflamed, and by and by to
be transformed into exact puftules, break out; containing
a liquor which, generally on the eighth day after the erup-
tion,  often later, is changed into pus, and dwindles away
in the form of crufts. The eruption, the degree of which
is always in proportion to that of the fthenic diathefis, in
this cafe is the greateft that ever occurs.
   CCCLXXV.  All  thefe phenomena are governed by
the laws of fermentation, lately mentioned (h). The num-
ber of puftules, being proportioned to the degree of diathe-
fis, fhows that, without the  hurtful powers,  that other-
wife, and without any co-operation of contagious matter,
produce that  diathefis, the contagion has not much effect
in producing the real morbid ftate, and that it chiefly re-
gulates the exterior form of the difeafe (i).
  CCCLXXVI. But  a  violent fmall-pox is diftinguifhed
by  the following fymptoms; Before the  eruption there
is a very fevere pyrexia; this is fucceeded by an univerfal
cruft of puftules over the whole body. Antecedent to which
the hurtful powers are very  violent fthenic ones, and par-
ticularly heat;  the remedies that remove it are very afthe-
nic, and in preference to any of them cold.

          The Defcription ofithe violent Meafies.

   CCCLXXVII. The  violent meafles is a fthenic exan-
thematic difeafe (k), beginning with fneezing, watery eyes,
                                                  dry

  (g) See par. CCXV.CCXV1.    (b) See above par. CCCLXViH.
  (i)  Which,  without diathefis, it of no confequence, and do?$ not
anwmnt to general morbid ftate.      (k) See above par. CCCLXVI? 
232       THE    ELEMENTS

dry cough, and hoarfenefs; on the fourth day of which,
or later, there appears an eruption of fmall numerous pa-
pulse, or  little points ;  that on the third day, or later,
terminate  in  an appearance of branny fcales.   This dif-
eafe, when preceded with a high degree of fthenic diathe-
fis, is proportionally violent.
  CCCLXXVIII. The fneezing, watery eyes, dry cough,
and hoarfenefs, are catarrhal fymptoms, and, therefore,
depend upon fthenic diathefis (1).  And, fince  they ap-
pear, four days or more, before the eruption, that is, be-
fore the matter might feem to have  reached the affefted
parts, and are conftant and univerfal; hence  are we to
fuppofe, that  the  fthenic diathefis  follows the  hurtful
powers, that ufually produce it, and not entirely the pecu-
liar matter is this cafe,  and that it  is indifpenfably necef-
fary to the meafles. But  though that fuppofition fhould be
rejected, and it fhould be contended, that thofe fymptoms
arife from the contagious matter;  it ftill muft be granted,
that this  difeafe  differs,  however, in nothing from the
other fthenic difeafes, but equally depends upon fthenic
diathefis, and yields to anrifthenic or  debilitating remedies.
And it muft be allowed, that, fince the  matter produces
the fame effect as the  ufual hurtful  powers,  its operation
muft be abfolutely the  fame, and the caufe of the difeafe
the fame.   Confequently, we find  nothing in  the  indica-
tion of cure, but what is in common to this difeafe with
other fthenic exanthematic ones, which is, that time muft
be given to the matter to pafs out of  the body, and the
perfpiration be conducted in the fame manner, as the
fthenic diathefis is ufually treated upon other occafions (m).
  CCCLXXIX. The  eruption admits of the fame rea-
foning that has been delivered (n).  The  circumftance
                                                  of
  (1) See above par CLXXV.         (m)  Sec above par, XCVI,
  (n) See above par. CCCLXXV. 
             OF    MEDICINE.           233

of its being a violent difeafe when preceded by a violent
fthenic diathefis, and mild in a mild degree of that diathe-
fis, is a further inftance  of the little difference that there
is betwixt the operation of  contagion, and that of the or-
dinary powers producing fthenic diathefis.
   CCCLXXX.  When  the diathefis runs fo high  as to
fupprefs the  perfpiration,  the eruption often difappears
for a time, as if it went into the interior parts of the body:
Which is a danger, that  is chiefly  threatened  at the end
of  the difeafe ; and fhows, that this matter,  in the fame
manner  as  the  variolous,  kindles up  a fymptomatic in-
flammation over the furface of the body, and then,  by  a
fnrther  increafe of  the diathefis, fuppreffes the perfpira-
tion.   Hence, with other vifcera,  the lungs (p)  are often
inflamed.
                                              CCCLXXXI.
          •
   (p) That the lungs fbould be inflamed in a violent ftate of the diathe-
fis in the meafles is not to  be  wondered at; as  the  common catarrh,
when its diathefis runs high, is liable to produce the fame effect.  (See
par. CCCXLUI. towards the end).   Eut, countering how many facls
in medical writings I  have found falfe, the effect of that on my mind, is
to render the weight of teftimouy in favour of the various internal vifce-
ra being fo liable to be  inflamed, from this fuppofed ftriking in of the
meafly eruption, very light, and to difpofe me to  doubt of the fact aito»
gether; Which I am the more  inclined to do, from  the analogy of a
broad fact in direct contradiction to it: Which is, that the inflamma-
tion, depending upon the general diathefis in fthenic difeafes,  never, as
I have yet found, affects an interior part.  (See par.CXIlI. CLXVIII.)
Neither is inflammation, from  any other fource,  nearfo frequent in in-
ternal parts as vulgar opinion has taught us Diffccticn has fhown inflyu-
mation in the inteftinal canal in dyfentery, or what Is called in Fnglifh
the bloody flux.   But that  only happened under the evacuant, debilitat.
ing vegetable, plan of cure : and, even in that cafe, feems to have been
an ultimate, not an early, effect, much lefs a caufe.  And it has hee:i
fhown, that what has been  confidered as a burning inflammation in the
firft paffages, is not an infhrarration at ail. (See above par. CXCVTII).
 Nay, even ■when inflammation does hspp-. n ir.terr.aily, it is never of 
 234       THE   ELEMENTS

   CCCLXXXI. The violent ftate  of the fmall-pox,  of-
ten from the great ftimulus of the eruption, converts both
the fthenic diathefis and eruption into  the afthenic ones,
and thereby produces the confluent fmall-pox, of which
we are afterwards to treat.   Whether  any thing like that
is  the  confequence of the meafles, is not yet afcertained :
But, as every excefs of exitement, as in the converfion of
peripneumony into a dropfy of the cheft, is liable to run
into indireft debility, it is, therefore, fcarce to be doubted,
but that the fame thing  happens to this difeafe, which is
inferior to none in violence.

          The Defcription of the violent Eryfipelas.

   CCCLXXXII. The violent eryfipelas  is  a phlegmafia,
always beginning with  pyrexia,  and followed by inflam-
 mation.   The inflammation is feated in fome external part
 of the body, ofteneft in the face, fometimes in the throat,
with rednefs, of an unequal edge, fomewhat raifed, creep-
ing from one place to another, and attended with a fenfe
 of burning.
                                          CCCLXXXIII.

the fthenic, hut always of the general, or local afthenic kind, and, when
 quickly cured, cannot be inflammation.  If there be any truth in the
frequency of inflammation towards the end of  the meafles, it muft be
of the afthenic kind. Which is the more likely from its late appearance,
and from a cireumftauce that, though  no  where taken notice of, has
great weight with me ; which is,  that the diftinct fmall-pox paffes into
the confluent, peripneumony into dropfy of the cheft, and any fthenic
difeafe with its diathefis, into any afthenic difeafe,  and the diathefis on
which it depends;  there is nothing in the nature of the animal cecoiio-
 my and of the powers acting on it, to prevent the fame converfion of
 fthenic  into afthenic ftate in the meafles.  And if, which is moft pro-
 bable from the alexipharmac practice, that was then ufed in this difeafe,
 indirect debility can induce fuch a cnangc.no difeafe has a fuller chance
 for it than the meafles.  But I am fure, were the debilitating plan ufed
 from the beginning, no fuch  confequence would happen. 
            OF    MEDICINE.        23$

   CCCLXXXIII.  It  is peculiar  to this inflammation,
and foreign from the other general  ones, to invade the
corpus mucofum.   To affign a reafon for which is of no
confequence; fince this inflammation does not differ from
the others either in the operation of  the exciting powers
producing it, or in that of the remedies which remove it.
   CCCLXXXIV.  The  caufe of  the rednefs of the in-
flammation, in this as well as in  every cafe, is an exceffive
quantity of blood in the inflamed veffels ; for the queftion
about the degree of rednefs is of no  importance.  There
is lefs fwelling in the inflamed part, than in other fthenic
inflammations,  becaufe there is here a free fpace betwixt
the fcarf-fkin and true fkin, allowing the effufed humour
room to  fpread and diffufe itfelf.  The fame is the caufe
of the flow motion of the inflammation, and of the inequa-
lity of its edges.   The fenfe of burning is owing to an
acrimony of the contained fluid,  acquired by ftagnation.
  CCCLXXXV. The attack of the inflammation upon the
face is not more  dangerous than upon any other place,
except when the diathefis, upon which it depends, is great,
rendering the inflammation proportionally great (q). In
which latter cafe, whatever part is  inflamed, the difeafe
muft  be  held for a  fevere one;  but ftill feverer, if the in-
flammation feizes the face; in which cafe a great tumult
of affection internally accompanies the difeafe.
   CCCLXXXVI. When  fuch  a fthenic diathefis, and af-
fection of the head depending en  it, happens, no difeafe
is more dangerous, none more rapid in its race to death ;
while in  a mild diathefis no difeafe is milder.

            A Defcription of the Rheumatifm,
   CCCLXXXVII.  Rheumatifm  is a phlegmafia,  efpe-
cially in  that  temperament,  which inclines to the fan-
                                              guinc.
  (q) Sec par. LXXXV, CCCXLUI- 
 236      THE   ELEMENTS

guine.  It is a confequence of heat fucceeding to cold, or
fo alternating with it as to prove the  more ftimuiant: It
is accompanied with pain nigh, or between, the joints,
chiefly the greater ones, and proportioned to the degree
of the diathefis (r): And the inflammation always comes
after the pyrexia.
   CCCLXXXVIII.  External  temperature  is hurtful in
this difeafe in the fame way,  as it has  been often now ex-
plained (s).
   CCCLXXXIX. The rage of the pain is in the parts
that have been mentioned (t), becaufe it is in thefe parts
that the inflammation, or more encreafed part of the gene-
ral diathefis (u), chiefly afts.  Which again happens, for
this reafon, that the nearly moft powerful of the exciting
hurtful caufes, the temperature, that has been mention-
ed (x), is only directed thither. There is no  tranflation of
the inflammation to the internal parts, for this reafon, that
thefe parts,  which preferve  nearly an equal temperature
amidft  every change of it externally, are not afted upon
by the fame hurtful power which annoys the external parts.
   CCCXC.  Cold, according  to the common opinion,
is not hurtful  in this difeafe; becaufe the rage of the dif-
eafe is greateft under the operation of heat, which has an
effect quite oppofite to that of conftriction (y).  This faft
is confirmed by ftimuiant diet,  in all its articles, proving
always hurtful, and  by abftinence being always fervicc-
able, and often alone making out the  cure. And it brings
a fufficient refutation of that miftaken notion, according to
which,  temperature  is alleged to be more  hurtful, and
fweating more ferviceable,  than is  confiftent with  the
truth; as if there were no other hurtful powers but the for-
mer, no other remedies but the latter.  In this, as well as
in all other general fthenic difeafes, it is the general fthenic
                                             diathefis
  (r)CCCXLUI.     («) CXIII. et paSim.      (t) CLXVIII.
  („)  Ibid.           (x) CXIII.              (y) Ibid. 
OF   MEDICINE.           237
diathefis alone that produces, and the folution of it alone,
that removes the difeafe.  Which is a clear faft, and fup-
ported  by the evidence of every part of this  doctrine that
has yet been delivered.   The pains of parts, which fome-
times  precede this difeafe, oftener happen without being
followed by it, and that, in both cafes, have nothing to do
with fthenic  diathefis,  upon which this  difeafe entirely
hinges,  are a local affection, or belong to a very different
general difeafe, rheumatalgia,of which more afterwards (z).
   CCCXCI.   The  reafon of  the greater  joints  being
affefted in this difeafe,  and the leffer ones in the gout,  is
the following: In  rheumatifm,  becaufe both the reft of
the difeafe and the pains  depend upon a violent  fthenic
diathefis; therefore it is,  that the greater joints,  which,
for the reafons affigned, undergo more of  the  diathefis,
have alfo a greater fhare of the difeafe.  But as the gout
confifts  in debility, its influence  will be greateft, where
there is naturally the greateft debility, and therefore in the
extreme parts, and thofe  moft remote from the centre of
 activity (a).

            A Defcription of the mild Erfipelas.

    CCCXCII. Both the definition and explanation of the
 violent eryfipelas (b),  delivered before, fuffice for thofe
                                                       of
    (z)  CCCLIII.
   (a) To make this fubject fimple to any apprchenfion,  A perfon has
teen expofed to intenfe cold a whole day. He comes home at night, is
 fet by a warm fire, receives hot rreat aid Warm cordial drink.  He is
 next covered up in his bed  with an  addition of clothes, receives  more
 warm ftrong drinh.  He falls afleep,  and next morning feels a pain in
fome part or other of his upper extremities, nigh, or between, the  great
joints;  and, previous to that, a high ftate of heat and bouncing pulfe,
 with a certain feeling of uneafinefs in different parts of his trunk.   The
 pains encreafe in the bed next night in proportion to the encreafe  of the
 general affection; and cold, evacuation, and abftinence from food, from
 alternation of temperature,  cure hin:.
    (b)  From CCCLXXXH. to CCCLXXXVII. 
138       THE   ELEMENTS
  of the mild; but in fuch fort, that the latter,  both in its
  antecedent hurtful powers and fymptoms,snd in the whole
  nature of its caufe, muft be underftood to be much mil-
  der than  the former, and not only fo, but a remarkably
  mild difeafe.
    CCCXCIII. It is often not fo much a fequel  of the
  fthenic cynanche, which is commonly called tonfillar, or
  the common inflammatory  fore-throat,' as a fupervention
  upon it before it has finifhed its courfe.  It often appears
  alone and unaccompanied with the cynanche, arifing from
  a fimilar lenity of the hurtful powers,  and manifefting a
  fimilar mildnefs of fymptoms through its  whole courfe.
    CCCXCIV. Nay,  in  the fame  perfons, in the fame
  ftate of the hurtful powers, fometimes the eryfipelas, fome-
  times cynanche, fometimes  catarrh, promifcuoufly  arife,
 and are all removed by the fame gentlenefs in the method
 of cure (c).

           A DeficrlpUor. of the Cynanche Sthenlca.

    CCCXCV. The fthenic cynanche is a phlegmafia, with
 an inflammation taking place in the throat,  and efpecially
 the tonfik, never preceding the pyrexia. It is accompanied
 with fweiling and iednefs,  and an aggravation  of pain in
 fvvallowing, efpecially any thing fluid.
   CCCXCVI. The reafon for the  inflammation occupy-
 ing the place mentioned  here, has been given before (d).
                                                  And,
  (c) I have often experienced them all, fometimes fingly, fometin.es
all three, in the courfe of the fame difeafe, oftencr a combination of in-
flammatory  fore-throat,  and the mild eryfipelas, and, as far as I could
obferve, could difcern, that the degree of phlogiflic  ftate that produced
them, and of remedies that removed them, were both gentle,  the for-
mer as ftimuiant?, and the latter as debilitating powers ;  and both fo
nearly of the fame degree, that in airangirg them, I was at a lofs which
to pkee over the other in the fcale,
  (d)Fcv. CXIII. CCCXIII 
OF    MEDICINE.         I39
And, when it has  once taken place, it is  afterwards li-
liable to frequent recurrence,  becaufe its feat being in the
way of the moft hurtful power (e), and lefs covered than
other parts (f), is expofed : And the veffels firft diftended
by the inflammation, and then afterwards relaxed, take in
an over-proportion of blood upon every increafe of its im-
petus fg).
   CCCXCVII.  As the  inflammation,  like that of the
other phlegmafia never precedes the pyrexia (h), for the
reafon affigned  (i); fo, if an unfkilful perfon fhould  think
it did, the reafon of that is the gradual degeneracy of the
general fthenic inflammation into a local difeafe, from its
frequent recurrence,  and always leaving a  taint behind it
in the affefted part. This latter inflammation may happen,
without a general  fthenic diathefis, and therefore, without
being followed by a fthenic cynanche; and it may acci-
dentally coincide with the former, or fthenic diathefis, and,
therefore, precede the latter or fthenic cynanche : But, in
both cafes, it ought to be diftinguifhed from the pure ge-
neral  cafe, for the fake of guarding againft  the commiffion
of a hurtful miftake in the cure (k).  In an afthenic habit,
 whether fucceeding to the former or not, there is again an-
                                                    other

   (e) Heat and alternation of temperature. See XXXVI. with addition,
   (f)See par. CLXVf II.   lone is  walking in the evening,  when a
fudden fog  comes on, with cold and chillincfs, he may cover his throat
 externally,  but it is impoflible to defend it internally.
   (g) This  isfo liable to happen, when any perfon has once experienced
 this  difeafe, that the encreafed motion of the blood in walking in a warm
day, and then fitting down in a cool place, has fometimes produced oph-
thalmia, fometimes this fore-throat.
   (h) Sec the definitions of them all, &c.
   (i) See par. CLXVII1. CCCXLUI.
   (k)  This might happen to a perfon under an afthenic diathefis, which
 would be encreafed by the debilitating plan of cure, and would he uveitis
 in the abfe<ic« of diathefisJ 
240
THE    ELEMENTS
 other general inflammation, to be referred to afthenic dif-
 eafes.
   CCCXCVI1I.  If  any perfon  can explain why  the
 pain is aggravated in fwailowing, he may communicate his
 knowledge; if he cannot, it is no matter.
   CCCkCIX. The cynanche  oefophagaea has been here
 omitted, becaufe it is  a rare affection, and  admits of
 the  fame reafoning  and  cure as the tonfillar, from which
 it differs not but in  the inflammation being farther down,
 and in fome rednefs  only coming within view.  But, as a fu-
 fpicion that it may be local, as when the aefophagus hap-
 pens to be eroded or burnt, by a ftimulus, or fome acrid
 matter;  the distinctions,  therefore,  fliould be attended
 to (l),and made ufe of for the fake of praftice.
   CCCC. There is  likewife  a  rare difeafe,  fometimes
 happening in certain countries, never in others, called  the
 croup (m).  Jn it the refpiration is laborious,  theinfpira-
 ticn fonorous, with hoarfenefs, a ringing cough, and  a
 fwelling fcarce to be difcerned (n).  It is a difeafe that in-
 fefts very young ch'ldren almoft  only.   And in ail other
 particulars it k of a doubtful nature  (o).;
   CCCCL  Concerning  which, when  it happens to  oc-
 cur  in practice, ufe the following marks  of judgment.  As
 the fthenic diathefis, in the degree requifitefor the forma-
 tion of actual difeafe,which depends upon a high degree of
                          2                    diathefis

  (I) See above LXXXI. LXXXIU. CLXX.
  (m) by  r.ofclogifts cynanche ftridula.
  (n) It is cercelved upon diffection  of tlu dead fubject.
  (o) I  never faw this difeafe, hut when I was fo young a ftudent, that
any obfervations I could make, can be of no ufe  to me now.  There
have b:cn many battles of words about, whether it be inflammatory or
fpafmodic,  without any adequate  meaning of the difference betwixt
thefe two word*, at leaft fo far as to  influence the practice ;  which re-
mained much the fame betwixt the parties, and probably the right one
miffed by both. 
              OF  MEDICINE.         24.I

diathefis, happens lefs, either in the beginning,  or to-
wards the end of life; becaufe the high degree of excitabi-
lity in the former, and the low degree of it in the latter,
admit a fmaller degree of the effect of the exciting power,
that is, a fmaller force of excitement (p), than the long pe-
riod of human  age betwixt thefe two extremes; yet it is
not  altogether foreign from either (q). In childhood, the
 high degree of excitability compenfates for the flightnefs
of the ftimulus ;  while, in old age, the high degree and
force  of the latter may compenfate for  the deficiency of
the  former, and fuflice to induce fome fthenic diathefis,
even to  that degree which conftitutes difeafe. In this way
infants undergo wonderful viciffitudes of excitement, and
 within the  fhorteft fpaces of time.  This day they will
 fhow every fign of extreme debility, next day every one
of reftored vigour; becaufe the operation of any ftimulus
given them foon rifes to its higheft, upon account of their
 high degree of excitability, and finks as foon to its loweft,
 upon account of its own fmall degree (r .  Hence every
fthenic  diathefis, that happens  to  them, is fhort, acute,
and foon removed (s); nor is their afthenic ftate of long
continuance,  or difficult to be removed; provided there Is
no  local affeftion (t),  and a proper method of cure is em-
 ployed (u).
     2                       R                 CCCCIL
  (p) See par. XXV. and XXVI,
  (q) Though it is feldom that either a child, or very old man, will be
fo fthenic as to need bleeding and much evacuation, yet they will fome-
times.
  (r) A child of mine was given over for death by his nurfe : His mo-
ther gave him fome of the diffufible ftimulus. He flept two hours, and
waked he waked made figns; for he could not yet fpeak, to have a little
 pic, moft of which he ate,
  (s) A fingle gentle purge will do it.
  (t) which very feldom, indeed, happens,
  (u) Which, till of late, has been very rare : The antiphlogiftic cure
has made  away with three-fourths of mankind, before thsy arrived at
the lVv.-nth year of their age, 

THE  ELEMENTS
  CCCCII. The marks of  fthenic diathefis  at  this ag6
are, great frequency of pulfe, when compared with that
of adults,  more frequent than their own in  health, dif-
tinftly meeting the finger upon feeling it; a boundifhnefs
of belly at firft, which becomes more free in  the progrefs
of the difeafe; drynefs of the fkin ;. burning  heat, thirft,
Watching, ftrong crying.
   CCCCIII.  The  figns of the afthenic diathefis at the
fame age are,  a pulfe not to  be reckoned from its  frequen-
cy, fmall, falling foftly like fnow upon the finger of him
who reckons  it, fo that he is uncertain if he touch it at-
all; a very loofe fcouring belly, with green matter ; fre-
quent vomiting;   drynefs of the fkin, heat greater than
natural, and greater in fome parts than others; interrupted
fleep, never refrefhing ; a  feeble  voice  in crying, fit to
excite compaffion.
   CCCCIV.  The  former diathefk, befides other hurtful
powers, is preceded by the  ufe of found milk, animal food,
an abufe of opium or ftrong drink; exceffive heat after cold
and moifture, which latter encreafes the debilitating  effect
of the former ; a ftrong fet of fimple folids.
   CCCCV.  The latter, together  with the known  hurt-
 ful powers, is preceded from the ufe of milk by  a  weak,
 fickly nurfe; that of vegetable food, with fugar in it; wa-
tery diet; watery  drink ; habitual vomiting,  habitual pur-
 ging, both by other means ufed for the latter, and particu-
 larly by magnefia, given with  the intention of abforbing
 an  acid ; cold not followed by  heat; a  weak  mafs  of
 fimple folids.
   CCCCVI.  Confider which of thefe fets of figns pre-
 cede or accompany the croup,  and whether its pyrexia be
 fthenic or afthenic.   Weigh the different fentiments of
 authors upon the fubject.  Sufpeft their theories, but their
fafts ftill more.  Be on guard not to be  mifled by the va-
nity, emptinefs, and rafhnefs of young phyficians ; as well
                                                   as 
               OF   MEDICINE.          243

 as by the obftinacy and bigotry of the older fort,  that en-
 creafes with their age and practice, to be bent by no force
 of reafoning, no weight of truth, fcarce by the power of
 Cod : Regard their minds as bound in the fetters of preju-
 dice : Remember, that a  whole age of phyficians were in
 the wrong, except one man (x),and perfilled obftinately in-
 their  error,  in the cafe   of the Alexipharmac phyficians :
 And, reflect within yourfelf, good reader! whether the pre-
 fent phyficians, who follow the doctrines delivered  in the
 fchools, judge better than their predeceffors,and do not run
 into the contrary extreme  cf madnefs, doing as much mik
 chief in fevers, and difeafes of pure debility, as they  did in
 fthenic difeafes, and in faft take a wide range of fpreading
 deftruftion among mankind.   Thus  fecured  againft mif-
 take, confider the  cures of this difeafe that have appeared.
 If in  thofe,  or in any trial that you may make, you fhall
                            R  2                       find

   (x) The  improvement  that I)r Sydenham  made was good  for the
 length it went, which was, to ufe cool and gentle evacuants for the cure
 of the fmall-pox, peripneumony, and one or two more of the fthenic dif-
 eafes.  The bias,  in favour  of the alexipharmac practice,  for the cure
 of catarrh and meafles,  he  never got over.  His theories were vague,
 but  with refpect to the practice in the difeafes among which his refor-
 mation lay, they were innocent. He attained not any  idea of  the na-
 ture of difeafes depending on debility :  And his practice was hurtful in
 them :  He fell a victim to his gout, which could not have happened had
 he been a«quainted but with  one difeafe of the debility.  His practice,
even when light, was deftitute of principle : he had no fort of compre-
henfion of the doctrine of life as  a whole, and as a  department of know-
ledge diftinct from all others.   It would have been lucky, however, for
poflerity, had his fucceffors done  as much in afthenic, as he did in fthenic
difeafes.  From that beginning,  the ingenuity of fome,  at laft under a
right direction,  might have brought out more iHformation, and  by gra-
dual and fure fteps, at  laft attained a comprehenfion of their whole fub-
ject. Uut profcffors of univerlities ruin every thing :  For while they
find out nothing themfelves, they throw into falfe lights the ufeful hints
of other;. This was the effeel firft of the Boerhaavian, then of the Hoff-
mauian and Stah.lian d**lrini:».   Sec our  Obfervatio:is3  Outline:,
 p. lxxxiv. to cxli- . 
244      THE   ELEMENTS
find that either bleeding and purging, or antifpafmodic3,as
they are called, that is, ftimulants fucceed;  then  be al-
fured, that in the former  cafe,  the difeafe is fthenic, in
the latter afthenic ; of which you will be ftill more certain,'
if you fhall find that the exciting hurtful powers and fymp-
toms, which have been  enumerated,  at the fame  time
agree with the other marks of judgment.

                A Defcription of Catarrh.
   CCCCVII.  Catarrh is a phlegmafia, in which,  to the
general fymptoms mentioned before (y), are added cough;
hoarfnefs ; and firft  a fuppreffion, or flight encreafe of
the excretion  from the  nofe, fauces,  and bronchia, fol-
lowed afterwards by a further  encreafe; arifing from fti-
muiant powers, often heat alone, but chiefly after a pre-
vious application of cold ; and to be removed by debilitating
 powers, often by cold alone,  guarding againft heat (z).
    CCCCVIII. The explanation of the cough is the fame
as that given before.  But it is freer, than in peripneumonv,
and not avoided, becaufe there is no inflammation in the
neighbourhood to aggravate it, and raife pain (a).
   CCCCIX. That the hoarfenefs is owing to a fuppref-
fion of the vapour that  fhould  be exhaled into the bron-
chia, may be known from this;  that, when the hoarfenefs
has remained  long, almoft  without  expectoration and
cough, or with  a moderate  degree of  them, while the
fthenic diathefis continued in full force, and  did not abate
in the bronchia ;  upon the diathefis giving way,  and the
expectoration and cough becoming more free, the hoarfe-
nefs abates, or goes off.  That this can be effected  by a
                                             ftimulus
  (y) CCCXXXK
  (z)See par. CXlI.CXIV.CXVII.CXXII. and all the ftimuiant pw-
eVs> from CXII. to CXLVII.
  (a) See p;ir. CLX. CCCLV. 
            OF   MEDICINE.          245

ftimulus of that kind and degree, that conftitutes fthenic
diathefis, is fhown by the effect of ftrained fpeaking pro-
ducing temporary hoarfenefs,  by filence removing the
hoarfenefs, and cold drink relieving it.
  CCCCX. The fuppreffion of excretion is that of the
mucu.; and exhalable fluid, related before (b), and it ad-
mits of the fame explanation that was formerly given.
  CCCCXI. That ftimulants produce catarrh is evident
from this, that heat alone, fulnefs in food, ftrong drink,
and moderate exercife, for certain produce it; cold, cold
drink, fpare diet, and reft, as certainly and effectually re-
move it.  It was,  therefore a very unlucky miftake, to
think it arofe from cold alone,  and was to be cured by
heat. On the contrary, cold is never hurtful in it, but when
its aftion is fucceeded by that of heat, to be explained as
before (c).  The occurrence of catarrh fo often in fummerj
where its  aftion can be a thoufand times traced back to
heat, but not to cold ; the influenza never needing the
affiftance of cold, which catarrh often does, in the  man-
ner juft now faid ;  its  never fucceeding to pure cold, but
immediately to heat, fafts known to old women, to fhoe-
makers and taylors, to fore-eyed perfons and barbers, un-
known to medical authors and profeffors, all confirm the
fame faft.
           A Defcription of the fimple Synocha.
  CCCCXII.  The definition  of fimple fynocha is the
fame with that  of phrenitis (d), excepting the fymptoms
affecting the head.   It is a flight difeafe, ending in health,
often in one, always in a few days, unlefs when new hurt-
ful  powers, cither accidentally, or from the ufe of a ftimu-
iant plan of cure, have been fuperaddcd.
     v                                        A De-

  (W) See par. CCCCVHI.               (0 Sec CXXl'l.
  (d) See par; CCOLXJ. 
246      THE   ELEMENTS
           A Defcription of the Scarlet Pyrexia.
   CCCCXIII.  The fcarlet pyrexia  is an exanthema (e);
about the fourth day of which, or later, the  face fwells
fomewhat, and  at the fame time the  fkin is here and there
affefted with a  red efflorefcence, and then chequered with
large fpots ;  which are  afterwards to unite, and in three
days to end in little feales, as if branny ones.   This  erup-
 tion does not arife, but in confequence of fthenic diathefis
 produced from another fource.   And there is another fi-
milar to this, which accompanies an oppofite  difeafe, af-
terwards to be  mentioned.
   CCCCXIV.  The  eruption, appearing at a certain time,
and  remaining  for fome  time,  muft be imputed to  the
fermentation, requiring a certain time, different in differ-
ent difeafes, and is to be explained in a fimilar manner as
before (f).
   CCCCXV. The fwelling of the  face depends upon a
greater degree of fthenic diathefis there, than any other
equal part. And we are to imagine, that, befides the hurt-
ful powers that ufually produce it, it is encreafed by the
contagious matter, now approaching the furface.
   CCCCXVI.  This matter of itfelf produces no morbid
ftate, only giving the exterior and exanthematic form (g),
and following the nature of the fthenic or afthenic diathe-
fis.  Hence, after its application, the difeafe that arifes is
fometimes fthenic, as this  is, of which we have  given a
definition, fometimes afthenic, as that difeafe which we
are afterwards to mention  in its proper place.  This view
Of it ferves to reconcile  the jarring and contradictory ex-
planations, and methods of cure of authors, who have
gone into fuch controverfies to fettle its nature.
                                              A Da-
  (e) See CCCXXX.  (f) See par. CCCLXVII. and CCCLXXVI1!.
 (g) See par. CCCLXXV. 
Or   MEDICINE,
247
           A Defcription of the mild Small-Pox.

   CCCCXVII.  The  definition  of the mild and violent
fmall-pox is the fame; excepting that there are often very
few puftules, never exceeding one or two hundred in num-
ber : Sometimes the place only, which was inoculated, is
befet with  puftules,  without any other  in the reft of the
body; and  befides thefe, there may be only one.
   CCCCXVIII. The number of  puftules  and crowded
eruption is occafioned not by the nature ""of the contagious
matter, nor by its quantity, but by the fthenic diathefis,
in fo far as  it is induced by  the fthenic hurtful powers, in
which the  matter has  very little participation (h).   If,
therefore, that diathefis  be  prevented, and efpecially  upon
the lurface, the eruption will never be crowded ;. and, af-
ter it has appeared, if it be immediately removed, the erup-
tion will never be  dangerous.
   CCCCXIX.  As  the  contagious matter does not con-
tribute much towards fthenic diathefis, for the reafons al-
ledged (i);   fo,  that it does contribute fomething, is prov-
ed by a crowded eruption both appearing and encreafing,
when the diathefis, after the reception of the contagion,
was-not encreafed by the ordinary hurtful powers (k).
   CCCCXX. And, therefore,while the excitement fhould
be reduced below that degree which fuits perfeft health ;
there  are,  however,  certain boundaries, beyond which
we fliould not proceed in the debilitating-procefs.
   CCCCXXI.  For, when  the  fthenic diathefis  is  very
much reduced, and the excitement immoderately diminifh-
                                                   ed,
  (h)  Sec par. CCCLXX. CCCLXX1I. CCCLXXV.
  (1) From CCCCXVII. to CCCCXIX.
  (k) This indeed is a clear  proof, that the matter contributes fome-
thing, and th.t there may be a degree of diathefis,  compatible with
health, unless when it is encreafed, and the perfpiration diminifhed, by
ia;h co: ;ajious ro tfr. 
24°*      THE  ELEMENTS
 ed, there appears over the whole body, an eruption quite
unlike the variolous, of a  high fcarlet colour, and in its
progrefs proceeding conftantly from a fpetted appearance
into a continued fheet of  efflorefcence (1); which, unlefs
treated upon a ftimuiant plan, would prove fatal.

             A Defcription ofithe Mild Meafies.

   CCCCXXII.  The  definition of the mild meafles is the
fame  with that of  the violent.  To which all the reafon-
ing that has been employed about the fmall-pox will ap-
ply.   If, immediately upon the arrival of the catarrhal
fymptoms, the afthenic diathefis contrary to every  mode
of curing this difeafe  hitherto thought of, be removed ;
often no difeafe of that kind which affefts the whole body,
follows.  And the difeafe always proceeds with the fame
gentlenefs as the fmall-pox treated in the fame way (m).
  CCCCXXIII.  The catarrhal fymptoms  are of the fame
nature as in the catarrh, and admit of the feme cure, that
is, afthenic (m).
   CCCCXXIV. Catarrh, and fimple fynocha, are free
from all inflammation, whether general or  local.   The
 fcarlet fever, and the mild fmall-pox and meafles, are free
from the general, and exhibit upon the furface a local in-
 flammation of no confequence (n).

           A Defcription of the Sthenic Apyrexia.

   CCCCXXV. The fthenic apyrexise which are equally
 free of pyrexia (o) and every degree of inflammation, arife
                                                from
  (1)  from the top of  the head to the ancles.  See above par. CCXX.
and two notes.
  (m) All this has been well proved by every  one of my children, and
by an hundred patients at once.
  (n) See par. CLXX- and CCXI.       (o) Sec par. CCCXXIX. 
            OF  MEDICINE.         249

from a fthenic diathefis, that has lefs effect upon the vaf-
cular fyftem, than the other fthenic difeafes (p).

                 A Defcription of Mania.
  CCCCXXVI. Mania is a fthenic apyrexia; in which the
mind is difordered, and forms falfe ideas of every thing.
  CCCCXXVII. In fo far as mania does not arife from
a fault of the fubftance of the brain, which is  a local
cafe that fometimes happens: the powers that have the
chief fhare in producing it,  are exceffive exercife of the
mental function, and a high exuberance of paffion. Thefe,
however, while they aft  more upon  the brain  than  any
other part, at the fame time do aft more or lefs alfo upon
the whole body, though not to the degree of drawing py-
rexia after them (q).  Which is proved by the difeafe be-
ing  cured by a debilitating  plan,  and by other ftimuli,
as well as thofe juft  now  mentioned, not  immediately
applied to the brain, but to a diftant  part of the fyftem
from it.
  CCCCXXVIII. The moft powerful of thofe ftimuli
are,  fpirituous or vinous drink, and opium, and,  perhaps,
 fome other things, taken into the ftomach, and firft afting
there.  Of the other afthenic hurtful powers, fome of them-
felves, and operating alone, have lefs effeft in inducing ma-
nia, and yet, even they,  by their ftimuiant operation en-
creafe the force of thofe, that have that hurtful effect;
as is proved by the effeft of removing them in relieving
the difeafe.
                                        CCCCXXIX.
  (p) "b much fo, as never to have been thought in any fort connected
With  that affection we call pyrexia-
  (q) Compare this with par,XLIX. L. LI- LIL L1II. and indeed with
that whole chapter, as the fevertft trial of the truth of it; nothing being
more natural, than  than the fuppofition that a mad man is only affected
in his he ad, but we fhall find that cot true. 
250      THE   ELEMENTS

   CCCCXXIX.  If  poifons  fometimes  produce  mania,
without hurting the fubftance of any folid part, their ope-
ration muft be fuppofed the fame, as that of the general
ftimulants, their effeft the fame, and the difeafe a genera
one, and the fame (r).  But if thefe very poifons aft by de-
ftroying the texture of a  part, they muft be confidered as
the origin of a local difeafe (f).
   CCCCXXX. The heart and  arteries are lefs affefted
in mania, than in any of the pyrexial difeafes ; becaufe, the
hurtful  power, which chiefly affefts the veffels, too much
food, has lefs concern in the number of the hurtful pow-
ers here.  And yet that the food, fuperadded to the other
hurtful  powers, does prove hurtful even in this difeafe, is
evident  from a contrary power, abftinence, being, among
other remedies, found of very great efficacy in reftoring the
healthy  ftate.  Which, with what has been faid  above,
proves  that mania is not a difeafe confined to a part,  but
extended to the whole fyftem.
   CCCCXXXI. Although, in the difeafes that have juft
now been mentioned (t),  the pulfe is commonly faid, and
believed, to be not at all affefted, that, however is not
exactly  the truth ; for in mania,  fo long as it continues to
be a fthenic difeafe (u), more or lefs of fthenic  ftate can be
perceived (x).

          The Defcription  of Morbid Watchfulnefs.

   CCCCXXXII.  Pervigilium,  or   morbid  watchful-
nefs, is a fthenic apyrexia (y); in which there is no fleep,
                                                   or

  (1) See par. XX.                (f) See par. V. VI. XX.
  (t) from CCCCXXV.  to CCCCXXXII.
  (u) that is, fo long as it is rcaly mania,
  (x) The characteriftic of hardnefs of the pulfe is never wanting, and
therefore alfo fulnefs.   See CCCXXXI V,
  (y) See  par. CCCCXXV. 
             ©F   MEDICINE.        25I

or no found fleep, and the mind, in a ftartled ftate, is agi-
tated with vivid, ftrong, or uneafy impreffions.
  CCCCXXXIII.  The  hurtful  powers,  that  produce
perviligium,  are the fame with thofe that produce mania,
but inferior in force.   It is evidently produced  by  hard
thinking,  commotion,  or difturbance of mind, in prefer-
ence to other hurtful powers. The degree of thought, that
has that effeft,  is not ultimately exceffive; for, if if were,
by effecting a temporary wafte of the excitability, it would
produce found  fleep ; or if it repelled fleep, it could only
aft  fo, by means of indirect debility, the confideration of
which is foreign from this place (a). And the  fame is the
degree of difturbance of feeling, that proves hurtful, info
far as it  produces this difeafe: Every ultimate excefs of
which (b), either ends in fleep, or induces that vigilance,
of which indirect debility is the caufe.  But it is not a fin-
gle operation of the intelleftual faculty, or of the ftate of
any paffion,  or one that happens but. rarely, that proves
adequate to the effeft.   For the effect, in that cafe, wcjuld
be either too flight, or of too fliort continuance ; to merit
the title of difeafe.  It is an often returning, or deeply af-
fecting, irritation upon the brain, and, therefore, one that
leaves a lafting impreffion,  which  has any confiderable
force in producing this difeafe. In this laft way, an eager,
inordinate, and vaft defire for the attainment of high ob-
jefts of purfuit, the impulfe that hurries on to the revenge
of a great injury,  and the horror that arifes upon the per-
petration  of it, the fear of future punifhment for crimes,
are held up to us as productive of high commotion of mind,
in the examples of Cataline,  Oreftes, and Francis Spira.
 As often, therefore, as  the mind is fo excited in its ideas
and paffions, as not to be capable of being compofed to reft
and found fleep, after  a certain fhort continuance of thofe,
                                                   or
(a) See CXLL
(b) See CXW, 
2J2       THE   ELEMENTS
  or other ftimuli;  fo often are we to conclude,  that this
  difeafe takes place.
     CCCCXXXIV. As the hurtful powers juft now  men-
  tioned (c), produce this difeafe; fo there are others,  which
  belong not to this place, but are to be mentioned, that al-
  fo repel fleep.
     CCCCXXXV.  To pervigilium belong all the  hurtful
  powers that have been already  mentioned in  mania  (e),
  whether acting within or  without the brain,  but afting
  with lefs force, and which  yield to the afthenic plan of
  cure.
     CCCCXXXVI.  As  the  powers   ftimulating  vigour-
  fly in  this way  (f), and without  any dimunition of their
  fum of ftimulating,produce pervigilium; from that we learn
  that the caufe of this difeafe  is the fame with that of the
  reft of the fthenic form of difeafes (g), and that the fame is
  the ftate of the body in which every one of thofe difeafes
 confift: Nor is it underftood, that different hurtful powers,
 but precifely the fame, with only a variation in the propor-
 tion of their force, which often  happens to other fthenic
 difeafes precede this difeafe.
     CCCCXXXVII. The fame faft is alfo difcovered from
 the. functions, of which,  though thefe difeafes are called
 apyrexise, or without pyrexial ftate,  the pulfe, however,
 is not altogether free of difeafe (h). On the contrary, it is
 as  much ftronger than in health,  or in the  predifpofition
 afthenic to difeafes, or in thofe difeafes themfelves, as there
 is more vigour, and more excitement upholding that vi-
 gour, in the fyftem (i).   And the ftate of the other func-
                                                tions,

  (c) See the par. CCCCXXX.and CJCCXXXIU.
  (e) See from CCCCXXVI. to CCCCXXXII.
  (f) Sec CCCCXXCIII.            (g) from CXLI to CXLVIIL
  (h) See CCCCXXX. and CCCCXXXl. and the note to the latter.
  (1) For a proof of their vigour maniacs have often four  times the
ftrength, they ufed to have in health. 
           OF   MEDICINE.         253

tions, except fhofe of the brain, that are chiefly affected,
is truly the fame as in the milder fthenic  affections, or in
the predifpofition to thefe.  But, if the brain in this dif-
eafe, and in mania, is much more affefted than the reft
of  the body ;  there is nothing unufual  in that circum-
ftance ; it being an univerfal faft with refpeft to both dif-
eafes and the predifpofition to them, that fome part is
more affefted than any other part (k).

                 A Dfieriplion of Obefity.
   CCCCXXXVIII.  Obefity is a fthenic apyrexia (1); in
which  in confequence of an exceffive'health, rich living,
efpecially in the article of food, and an eafy fedentary way
of life, the  fat rifes  to  the degree of incommoding  the
functions.
   CCCCXXXIX. That obefity, fo defined, is a difeafe,
is underftood from the definition of difeafe (m); and that
it is a  fthenic  difeafe,  appears from the certain figns of
fthenic diathefis in it.   Of which,  the  ftrong action of
the ftomach, whether the appetite  or  the digeftion  be
confidered (n), and the ftrength  of the other digeftive or-
gans, are a glaring proof.
   CCCCXL. And as in this difeafe, the ftimulus of the
exciting powers, raifes the excitement above that  degree
of it which fuits good health, to that in which  fthenic
diathefis confifts, without  which laft there could not be
fuch force in the aftion of the ftomach, and of the organs
that form chyle and blood ;  fo it  is in  common to  this
with the other difeafes called fthenic apyrexiae that the
fum of all the  ftimuli is  much  lefs  than in the other
difeafes of the fame form, that is, thofe with pyrexia and
inflammation ;  that  it never rifes  to the extreme height
 ■.it which indirect debility is produced, and is never indeed
                                                   lb
   (k) See part firfl, Chap. IV. and in it XLIX- and LII, CI.TX. Cv V,
  (I) See CJCCXXV.    (m)  Sci IV.     (n) See pai. O.TX1I.
                          ( 
254      THE   ELEMENTS
fo great as to be fufficient to have any confiderable effect oil
die heart and veffels.
  CCCCXLT. But it happens  to all thofe difeafes,  that
both thefe laft and all the other functions, get fomewhat
above the ftandard of  the found functions, and  a great
deal above afthenic diathefis.   And the fthenic apyrexia;
differ from the other fthenic difeafes chiefly in this, that the
exiting powers keep much within that degree of force, that
waftes the excitability much ; as is  perceived from the
proof of the effeft ; for they are difeafes of much longer
ftanding than any other afthenic difeafes.
  CCCCXLII. From  which  fact, however  much the
brain maybe affefted by its own proper ftimuli; however,
great the quantity of blood in its veffels may be; unlefs to
the excitement arifing from thefe, that excitement, which
the other ftimuiant powers produce, be added, it is cer-
tain, that the general effeft will be  much lefs, and that
the united energy of all the powers has more effect, than
the feparate force of any.
  CCCCXLIII.  The diathefis, then,  in thefe difeafes,
is upon the whole, lefs than in the reft of the fthenic dif-
eafes ;  that of a part, as of the brain in mania and pervi-
gilium, and of the blood veffels in obefity, is pretty confi-
derable.   The whole is in general as great as that in the
predifpofition to the other difeafes, and exceeding its force.
in the labouring  part.   Hence it comes out,  that, con-
trary to the nature of thofe other difeafes, and fimilar to the
predifpofition to  them, they are ufually of long Handing
and duration, and for this reafon,  that the mediocrity of
the fum of ftimuiant operation never confumes the excita-
bility, and always produces too much excitement.  The
great tumult of fymptoms in the brain and blood-veffels in
thefe difeafes does not imply a great fum of excitement,
for  this reafon, that the affection of a part, however for-
midable, compared with the affection of all the5 reft of the
                                              My? 
             OF  MEDICINE.         255

body,  is infinitely inferior  in its degree (o).  However
much then,  any ftimulus prefles  upon a part, and from
thatfpreadsat large over the reft of the body; unlefs, how-
ever, other ftimuli, applied to other parts, fuftain its ope-
ration, fo as that  the  fum of the operation of them all
may deeply affeft  the whole body; the effeft of the foli-
tary ftimulus, making  a figure in a part, will be lefs confi-
derable in the reft of  the body :  In fine, it muft be kept
in mind, that every violent difeafe always arifes from the
excitement which the  united force of feveral ftimuli has
produced.
  CCCCXLIV. In thefe fthenic apyrexise, as a  certain
part,  the brain in the two  firft,  and the blood veffels in
the laft (p), is much more affefted, and in greater propor-
tion, than in the other fthenic difeafes, becaufe the affec-
tion of the  part is much lefs fupported by ftimuli acting
upon the other parts ; fo  the ftimuli, afting in that way
spon the labouring parts,  are,  however,  underftood to
affeft the reft of the body, though lefs confiderably. That
this is the faft, is proved by there being in this cafe, no
afthenic diathefis, and evidently fuch a fthenic one, as up-
holds  the predifpofition to other difeafes  of the fthenic
form; by the remedies, which affect other parts, as it will
by  and by  appear, being aiding  in the cure here, and by
powers of  a contrary nature,  always  proving hurtful.
Whence, it is an evident  and  certain truth, even  here,
where it might have been leaft expected, that every ftimulus
that afftfts  a part, affefts the whole  body, upon account
of the excitability being one uniform, undivided, property
over the whole.
    CCCCXLV. With refpect to  obefity  in particular;
that the other hurtful powers, as well as food have more
or  lefs effect, one may know from the certain fact of t'n-
                                            digeflivj

  (o)  Seepar. XLlK.tc LIH.          (p) S;e P:r CCCC'XUII. 
2$6       THE   ELEMENTS
 digeftive powers, which  depend upon the influence of
 thefe powers, being of fuch force andvigour, as to perform
 their  functions  more perfectly in  fat  perfons, than in
 others, who  are, neverthelefs, not  by any means  weak.
 Yet thefe hurtful  powers  are applied in a  degree fliort of
 that,  which  being  ultimately  exceffive, or approaching
 nearly to that, puts an end to  excitement  by wafting the
 excitability, or which tends, by a high degree of difturb-
 ance, to exhauft the body.
   CCCCXLVI.  Thus paffions are  not with fuch  per-
 fons too ftimuiant; a circumftance known to the generality
 of mankind, among  whom it is an adage, that fat perfons
 are  commonly  good natured (p), while morofe perfons
 are for the moft part lean.   Thus it is obfervable,  that
 fat perfons are averfe to thinking, which is a great ftimu-
 lus (q).   They are  averfe to bodily motion, by  which all
 the functions, and particularly that of the veffels, are much
 excited, and the  perfpiration  proportionally  promoted;
 and they have fo far reafon for it, that all motion is more
 fatiguing to them than to others.   Hence, that quantity
                                                       of

  (p) This mull he taken with more than grains of allowance; fince
 fuch is the effect of the different motives to human action received from
example and  education, that the paflions themfelves are drawn into a
fubferviency to every perfons  predominant purfuit.  I have known a
perfon in Edinburgh get great credit for his integrity, though that was
not extraordinary, from roughnefs  of manners and an affectation of paf-
fionatenefs, while the diflimulation of that real difpofition is the more
general engine among men of promoting their intereft.  At any rate, fo
much more than mere appearance of temper, which may  be fo much
ever-ruled, is neceffary to the  eftablifhment of maxims; that Illiould
think my life or property upon en inlecurc footing, if it depended on the
goodnature of a perfon, for which the only fecurity was his fatnefs.
  (q) The moft poring perfons  are the atrabilarians, who, though they
are not calculated for the elevation  of mind that difcovery requires, have
 by their affiduity, contributed much to the improvement of many of the
arts.  They are commonly very meagre indeed, and iudifeatlgable in
any purfuit, to which they give themfelves up. ~ 
             OF    MEDICINE.        257

 ©f fluids,  which under motion is ufually thrown off by
 the pores on the furface, and turned out of the courfe to
 the adipofe cells, has a great opportunity of quitting the
 direftion to the former, and of turning afide, in a ftate of
 reft, to the latter.
 .  CCCCXLVH.  After  explaining the  peculiarities  of
 thefe difeafes ; it is now to be obferved, that, fince the af-
 feftion of a part in general difeafe, depends upon the gene-
 ral affection, is of the fame kind, arifes from the fame ex-
 citing powers, and is removed by the fame remedies (r );
 it is from that reafonable to believe, that the affeftion of a
 part, whether it be inflammation, or a greater affection of
 the brain or veffels, than of any other part, is not different
 in different cafes,  but altogether  the fame in all; that it
 only  differs in fome trifling circumftances of no fignifica-
 tion,  and by no means requires a different plan of cure, or
 affords fundamental  diftinctions;   and that a miftake,
 which has had the  moft ruinous effeft upon the art, muft
 be done away.  It is with propriety, then, that all the dif-
 eafes that have been treated of have been reduced not firft
 to two genera,  and after to fpecies, but without regard
 either to genera or fpecies, only to two forms.
   CCCCXLVIII.  Further, as in  all  thofe difeafes the
 whole morbid ftate, either in fo far as it is univerfal in the
 fyftem, or confined to a part, proves hurtful by giving too
 much excitement;  and as the remedies, that remove the
 general morbid ftate, alfo remove  the portion  of it con-
 fined  to a part, and are never to be  directed to a part (t),
 with  the view of removing, by their aftion  upon it, the
 difeafe, as if all locked up in it ; the meaning of all that
is, to  lay a fure foundation  for the eftablifhment of a cer-
tain feries,  or fcale, of encreafing ftrength  from perfect
                        S                    health

 (r) See Part firft, Chap. IV. and particularly par. LIU
 (t) See par. LVf. and XCI I. 
258       THE   ELEMENTS
 health to the moft fthenic difeafes.   In that fcale  perip-
 neumony holds about the higheft, and obefity the loweft,
 degree.
   CCCCXLIX. Peripneumony and phrenitis in the up-
 per end are followed by two difeafes, that fometimes equal
 them  ; the violent  fmall-pox and meafles.   Thefe  two
 are fucceeded  by  a difeafe,  that  fometimes vies with
 them, the eryfipelas, when accompanied with a moft fe-
 vere affection of the head.  Equal to this,  not in danger,
 but for the moft part in the degree of diathefis;  rheuma-
 tifm comes next.  Next to rheumatifm is marked the mild
 and gentle eryfipelas, far fhort cf thofe above it  in vio-
 lence, and claiming nearly an equal  place  to the fthenic
 cynanche, being much more nearly allowed to the latter
 than any of the former.  Thofe are the difeafes accompa-
 nied with pyrexia and inflammation.
   CCCCL.  Of thefe two which  ftand loweft,  the mild
 eryfipelas and the ftnenic cynanche, or common inflam-
 matory fore throat, are of fo doubtful a rank with refpeft
 to each other and catarrh (u), a difeafe without the accom-
 paniment  of inflammation ; that it is doubtful which of
 them  all fhould be fet above the others.   Below them,
 however, the fimple  fynocha and fcarlet fever, in fo far as
 the latter is an afthenic difeafe, and in fo far as the ufual
 ftate of them both is  confidered, are to be placed without
 any hefitation (x). The loweft part of the fcale of fthenic
                                               difeafes

  (u) See CCCXCIV. and the note to it.
   (x) The fimple fynocha is fo fimilar to a gentle typhus, that it requires
 great judgment to diflinguifh them at firft.  The fcfeft way, when the
 doubt cannot be determined, is to keep the patient in a moderate tempe-
rature,  and in a ftate of reft ; as any debilitating power, in cafe the dif-
 eafe fhould turn out a typhus, would be  dangerous ;  and, though it
fhould afterwards manifeft itfelf a fynocha, ftill its mildnefs renders the
omifiion of any thing that might have been done, innocent; and it is
always eafy to take down fthenic diathefis. 
               OF   MEDICINE.        2^9

 difeafes with  pyrexia,  is affigned  to  the  fmall-pox  and
 meafles, in their mild ftate.
   CCCCLI. Through  this whole fade it is not fo much
 the titles and names, that have been made ufe of, but mor-
 bid energy, that is regarded ; it being the certainty derived
 from the caufe, not  the uncertain and perfectly deceitful
 confideration of fymptoms, that was to be confidered (y).
 The inveftigation of fymptoms, which has hitherto been
 devoid of all benefit, has been of the higheft detriment to
 the art; and  as much  in medicine the moft  productive
 fource of fundamental blunders, as the queftion about ab-
 ftract caufes had been in the other  departments of philo-
 fophy (z), muft be laid  afide, and Nofology damned.
   CCCCLII.  Below the laft mentioned difeafes, mania,
 pervigilium, and obefity are fet.   Betwixt which, and the
 difeafes mentioned above, is the point of perfeft health to
 be fixed (a).

         The Cure of the  Sthenic  Form of Difeafes.

   CCCCLIII.  To  apply the  indication  of the cure of
 the fthenic form of difeafes to  praftice ;  that  mentioned
 before (b) will be accommodated firft to a violent degree
 of the diathefis  and danger of parts, in  fuch a manner, as
 that regard only will be had to the degree of force in the
 remedies (c).
   CCCCLIV.  When, therefore,  a violent diathefis is difk
 Gerned, as in peripneumony, phrenitis, the fmall-pox, the
 meafles, and eryfipelas,  in the higheft degree of thefe three
 laft, immediate recourfe  muft be had to  the moft powerful
                         S 2                      and
  (y) See par. LVIII.
  (z) See par. XVIII. and look into Obfervations on the different fyf-
tems of phyfic, and in it the introduction throughout.
  (a) It will be eafy for the reader with the direction above to make
 cut the table for himfelf.
  (b) See par. LXXXVIII.             (c)  See alfo par. XCIL 
a6o       THE   ELEMENTS
and quickly effectual remedy; and fo much blood fliould
not be taken, as many who entruft nearly the whole cure
of the difeafe to it, think (d), but more, however,  than
others are of opinion, fhould be taken away (e).
   CCCCLV.  No  meafure fuits all cafes ; the quantity
to be taken being different in different cafes, as thofe differ
in age, fex, ftrength, and in the degree of force applied by
 the exciting hurtful powers.  In childhood, which, ex-
cepting the meafles,  and fmall-pox (f), is feldom affefted
with the difeafes we have mentioned, and in a very advan-
ced age, which is alfo in lefs danger than that at the flower
of human life ;  fparing bleeding fucceeds for this reafon,
that, at both thofe ages, it is a leffer degree of excitement
that upholds the difeafe as a caufe ; while in the former,
the high degree of excitablility, in the latter the neceffity
for more ftimulus or exciting power,  than  formerly, fet
bounds to the meafure of the  remedy.
   CCCCLVI.  A better rule for limiting the degree of
bleeding is the relief, or temporary folution, of the urgent
fymptoms. If, therefore, after blood has be been taken, the
 great heat, the  hardnefs of the pulfe, the affeftion  of the
 head or the lungs,  and drynefs of the  furface, fhall have
 gone off, or been much abated ; and now the temperature
 is difcerned  to be much  more moderate, the pulfe more
 foft and lefs frequent, and  the furface of the body more
 moift, at leaft lefs dry; if the pain is every where quieted,
                                                   the
  (d) which is the common practice;
   (e) The moft early among the Alexipharmac practitioners, after once
 making his efcape from pcripneumony without bleeding, fell a victim t»
 the folly of his theory in the next attack. The Alexipharmacsin gene-
 ral were too moderate in thair bleedings in the true, though few fthe-
 nic difeafes that require it, and all in the wrong in their ufe of heating
 ftimuiant prefcriptions in them,
   (f> Seepar.CCCCL, 
Of   MEDICINE.         26l
the breathing relieved, and the delirium removed (g); then
it may be looked upon as certain, that enough of the vital
fluid has been fhed for the time.
   CCCCLVII.  To obtain thr.t benefit,  in  the moft  vi-
gorous adult ftate  10 or 12 ounces, and  much  lefs either
before or after that period of Ufe, will for the moft part be
found fufficient.  As this ririe will not anfwer in every cafe,
when it fails, recourfe muft be had to that, which recom-
mends the abatement of the fymptoms as a direction more
to be depended upon (h).
   CCCCLVIII. Since the local affection  depends upon
the  degree of the general (i)  diathefis, remember, there-
fore that there is no occafion for any particular direction
with regard to it, any  farther,  than to take advantage of
its being  acceffibie to  help the general remedy by an  ap-
plication of it to the part (k).
   CCCCLIX. When that has been dofte, and the firft vi-
olence of the difeafe is now broken ;  we muft ne)tt have
recourfe to  purging the belly, as a great remedy in point
of efficacy (1).   To effeft which,  we fhould not employ
violent means, fuch as many formerly employed (m);  the
ftimulus accompanying the fiift operation of which being
liable to be hurtful;  but it  is the gentle  cathartics that
fhould be depended upon, filch as  Glauber's falts, which
are  highly debilitating,aiid carry a great quantity of fluids
out  of the veffels.  Though a man  of good fenfe in the
laft  century  ufed thefe day  about  with  bleeding; yet, if
                                                   the

   (p) The references for fads arc CLIX. CLV. CCCXXXIV. CLVII.
CLXXIV. CCCXLIX.  to  CCCLV.  CL1V. CLIX.  CLXXXIV.
CCcXxXlII.toCCCXXXVl.CLV.CCCXLin.CCCLlV. CLVIII.
   (h) SeeCCCCVl. (i) SeeaboveLVI.andCCCXLlLtoCC'CXLVI.
   (k) Ibid, an inftance of fuch affiflance may  be the local bleedings
over  the pained part in rheumatifin and the gout, and fome other afthe-
nic remedies are aided by local ftimuli.
   (1) Sec CCLXMXUI.    (m) the Akxlplurraacs particularly. 
262      THE   ELEMENTS
  the violence of the difeafe fhould be urgent, there is no-
  thing to hinder the ufe of them the fame day that the blood
  has been taken.
    CCCCLX. Purging, after a fparing bleeding, has more
  effeft in overcoming fthenic diathefis,  than any bleed-
  ing without it; becaufe, as it has been mentioned above,
  in that way the debilitating power (which has always more
  debilitating effeft in  the place  to which  it is firft applied
  than in any other), is applied to more parts ; and not only
  to the greater blood-veffels, but alfo to a prodigious num-
  ber of their terminations ; and the excitability is more ex-
  tenfive, and therefore, with more equality diminifhed (n).
    a, Vomiting,  which, in afthenic  difeafes, where it is
 pernicious,has hitherto never been admitted in the common
 praftice, and in fthenic ones, where it is of the  greateft
 benefit, ever neglected, comes in here as a proper part of
 cure; being of the fame evacuant nature, and in another
 part of the fame canal, and admitting of all the  reafoning
 that has been applied  to purging.
   CCCCLXI. At the fame time that  the  exceffive, and
 therefore hurtful,  ufe of the lancet is fuperfeded by thofe
 two laft mentioned evacuations ; its ufe, however, is not
 altogether to be laid afide in  the difeafes of exceffive ex-
 citement : and for this reafon,  that the excitement,  by
 its  ftimulating operation often  rifes to that high  degree,
 that,  from the confumption  of excitability  which  puts
 an end to its exiftence,  threatens inftant death (p).
  CCCCLXII. Befides, thofe remedies  (q), the  patient
fhould ilways be required to abftain from every fort of food
but vegetable, and in a  fluid form, as well as from all ftrong
drink, and indeed all but watery drink, accidulated (r)
                                                This

  (n) See par. CCCCLXXXIII. CCCCLXXXVl. alfoCCCV.
  (p) See par.CCLXXXl.  and CCLXXXIII. CCLXXXIV.
  (q) From CCCCL1V to CCCCLXU.      (r) Sec CCLXXXIY, 
            OF    M.E D  I C  I  N E.          26$

Thk direction does not feem to have been fo much  ne-
glected in words by former writers and authors, as in faft
and actual application to the praftice ;  it having been  de-
livered flightly, by the by, and as if it had been thought
of no confequence, with fuch effeft, that its force made no
imprefhon upon the mind of the reader or hearer. No fti-
mulus is more powerful, and, therefore,  in this part of
the practice, more hurtful, than that of the articles of di-
et : Confequently,  whatever quantity of blood is taken
from its veffels, whatever quantity of ferous fluid is carri-
ed off by the mouth and anus, if that ftimulus is not round-
ly guarded againft, all this evacuation may eafily be fruftra-
ted.  While that is the cafe, ftill fluid vegitable  matter
is not to be difcharged, and for this good reafon, that  wa-
tery matter  is  not kept in the veffels ;  but, eafily enterina
the fmalleft  of them, flows out in all directions by their va-
rious outlets ;  and, at the fame time, fupports the efficacy
of another remedy  (s), by and by to be mentioned.
   CCCCLXIII. Conjointly with the ufe of the firft bleed-
ing, of the firft vomiting and purging, and that of abfti-
nence and watery drink, it muft not be forgot, that parti-
cular regard muft be paid to temperature (t); For,  if cold
always debilitates,  and if that is its proper operation (u),
if it only feemingly afts otherwife, becaufe heat  fucceed-
ing to its action, or alternating with it (x), converts it into
a ftimuiant  one, if it alone is adequate to the cure of the
fmall-pox (y), and prevents the violence of that difeafe, if
it is the beft remedy for catarrh (z),  and, when  heat is
avoided, of  the greateft afliftance in every fthenic difeafe; it
is not to be  doubted, but that it is of the greateft benefit in
the difeafes  of the higheft fthenic  diathefis.
   CCCCLXIV.  Its  operation in the fmall-pox,  and  in
the reft of the fthenic difeafes, is not different, but altoge-
                                                  ther
  (s) fweat.    (t) See par. CCLXXXU.    (u) See par. CXVII.
  i>) See XXXVI',   (y) See par. CXXI.      (z) See CCC'-VU, 
264       THE   ELEMENTS
 ther the fame. Nay, in all the difeafes of this form, as cold
 alone is fufficient to effeft the cure ; fo whenever the dia-
 thefis, which is the cafe in the difeafes that make our pre-
 fent fubjeft, rifing to its greateft rage, demands inftant re-
 lief; becaufe, in that cafe, every moment's delay brings in-
 ftant danger; becaufe the remedies, which we have  men-
 tioned, are fufficient for the folution of the difeafe, of which
 we have the direct proof in the practice ; becaufe that  de-
 gree of cold, which could produce that effect, is neither al-
 ways within our reach, nor can be managed by every per-
 fon ; and many perfons might not be difpofed to believe its
 effeftsfo beneficial: For thofe reafons we fhould not  defift
 from the plan of cure here laid down (a), and do our beft
 for our patient, by taking off the blankets, and other clothes;
 by cooling the room, and, inftead of laying him on a couch
 or bed, putting him into a chair.
   CCCCLXV. This plan of cure fhould,  for the moft
 part, be preferred to that of the moft intenfe cold, for this
 further reafon, that the fhortnefs of the time in which any
 one could poffibly remain in it, would oblige him immedi-
 ately to return to higher temperature, which would produce
 a greater ftimulus of excitement, than that he had been un-
 der before his expofure, at leaft too great a ftimulus (b).
   CCCCLXVI. Since fuch is the operation of cold (c),
 the power falfely imputed to it of occafioning the ftriking
 in of the meafles, is to be imputed not to cold alone, but
 to heat and other ftimuli;  giving, as has been explained,
 more excitement (d), than if it had not preceded   And
why not ? If cold does' not interrupt the eruption in the
fmall-pox; but, on the contrary,  by an enlargement  of
the diameters of the perfpiratory veffels,  which are  fhut
up by  fthenic diathefis, highly promotes the difcharge of
                                                that
 (a) From CCCCLIV. to CCCCLXV.     (b) See XXVI.
 (c) Look back from CCCCLXIII t» CCCCLXVI.
 (d) SeeXXVU.^nd the addition,and CCCLXXX, 
           OF   MEDICINE.          265

 tltot matter (e): Why, in a moft particular cafe, fhould its
 operation be fuppofed different,  not  to fay, diametrical I v
 oppofite ? Muft we again have the trouble to refute thee falfe
 notion of thinking a caufe precifely the fame fhould pro-
 duce contrary effects ? Cold diminifhes the eruption in the
 fmall-pox : It makes it difappear in  the meafles.   What
 then ? Take a nearer view of the faft : Is its effect in botft
 thefe cafes to be fuppofed the  fame, or different ? How
 comes any perfon to know, tfiat the  matter, which  has
 difappeared, is driven into the interior parts? What proof
 will you bring of that? Confefs the truth : And be candid
 enough >to acknowledge, that this is  another relic of the
 alexipharmac doftrine,handed down to us,which fuppofed,
 that the ftimulus of heat as well 33 other ftimuli promot-
 ed, and that cold impeded, perfpiration. And after a great
 man had fhown  the error of that doftrinc, both  in the
 fmall-pox and other difeafes (f), becaufe he did not carry
 the application fo far as the meafles, neither has any one
 of his followers, who never could ftep a nail's breadth be-
 yond his words.  But it might have been obferved, if ob-
 fervation had been any part of their employment, that the
 meafles was a  fthenic difeafe as well as the fmall-pox. Are
 not all the fuccefsful remedies in both of the debilitating
 kind ? And as was manifeft, that in the fmall-pox  alfo
 cold debilitated, or in the common language, afted as a
 fedative ; might not fome fufpicion have, from that very
 circumftance,  occurred to their mind, that cold,  in the
 meafles, did not ftimulate, or act as  an aftringent;  and
 in that way,  repel the eruption, but perform the fams
 operation as in  the fmall-pox ?  Is it,  to fuch a degree,
 difficult and up-hill work,  to think  and ufe one's own
                                                good
  (e) See CCCLXXVI.
  (f) In peripneumony he took his patients out of bed, and fet them in
51 chair, for the fake  of cooling tlwnij and avoiding the hurtful effect cf
 fceat. 
 255      THE    ELEMENTS

good fenfe, that, a great part of mankind, even thofe who
take upon them the bufinefs of teaching and taking the lead
of others, in no cafe ever think of exercifing a moment's
reflection of their own ? Eut,  in this  cafe, it may be con-
tended,  that the action of cold is peculiar, becaufe,  after
the eruption which is fuppofed to check, has difappeared,
all  the fymptoms encreafe  in  rage and violence.   Con-
sider what that circumfiance makes for the argument, or
whether it makes any thing, and not abfolutely againft it ?
Was the  action of cold,  that is fuppofed, followed  by
that of ftimuiant or debilitating powers ? If it was by the
former, the caufe of the mifchief muft  be imputed to
them ; which, as has been faid juft now (g), produce ex-
ceffive excitement after a previous application of cold, and
more than without it;  if the latter, or debilitating powers
were ufed, then there would not  be wanting a  fufpicion,
that cold, had a concern in  the effect.  But it  is not fo:
And, in ,every cafe,  in which the action of cold has been
followed by fthenic diathefis,  the true caufe of that effect
is not fufficiently guarding againft the  ftimulus of heat, as
 well as that of other noxious powers.  And this is moft
 clearly proved by the ufe of heat being pofitively ordered,
iuftead of being forbid, in the common practice.  Nor is
that to be wondered at:  For if the caufe of catarrh (h)
 deceived phyficians fo much, the catarrhal fymptoms in the
 meafles could not fail to deceive them.   And, if doc-
 trines, difcarded in words, are often kept up in faft: what
 was there to hinder this part of the alexipharmac doctrine
 from meeting with a fimilar fate ?
   CCCCLXVII.  If cold, therefore, can  fcarce  be fo
 managed, as that the effect occafioned by  the accompani-
 ment, the fucceffion, or  the alternation, of  ftimulants
                                                with
  (g) in the laft paragraph but one.
  (h) See from CCCCVII. to CCCCXU. 
             OF  MEDICINE.         2Gf

with it, may be prevented,  whether that be the fault of
the phyfician, or owing to the difficulty of the nature of
the thing (i);  it  is,  notwithftanding, a rule in common
to the meafles and other exanthemata of the fame ftamn,
to avoid  heat,  and  compenfate for the  degree  by the
greater duration of  cold, and to guard with all poffibk
care againft every ftimuiant power.  It is now then moft
evident, that the opinion of cold being peculiarly hurtfr!
in the meafles, both in that and every other difeafe of tht
feme  form, falls to the ground.

               A Repetition  of the Cure,

   CCCCLXVIII. After ufing the Remedies which have
been mentioned  (k), when the fymptoms are renewed, the
fame train of medicines muft be again gone through: Blood
muft  be again taken, emetics and purgatives again admi-
niftered ;  nor muft we defift from the ufe of the refrige-
rant and  attenuant plan : And all thefe particulars mufir
be executed, till the tumult of the fymptoms be allayed,
and the healthy ftate, at leaft for the time, be reftored;
and perhaps the repetition may be required a third time
or oftener: After doing which ;
   CCCCLXIX. If the diathefis feems now nearly remov-
ed, if the  affeftion of the head,  of the lungs, or any in-
ternal one, feems alleviated or repelled; and yet there-is
fome  apprehenfion of a likelihood of the return of the dif-
eafe :  in that cafe, recourfe muft be had to  more gentle
debilitating powers.   Sweating, the ftimulus accompany-
ing the firft operation of which, the body, as the diathefk
is now rendered mild or ended, will be able to bear, muft
be preferred to  bleeding, vomiting,  and purging.  But
before proceeding to fpeak of it, it feems proper to fay a
                                                few

  (i) Turn back to CCCCLXV. and CCCCLXVI,
  (k)  fromCCCCLlV. to CCCCLXVIII, 
 l6%      THE   ELEMENTS

few things upon the fum total of blood that fhould be ta-
ken during the courfe of the whole difeafe.
  CCCCLXX. As  in  fingle bleedings, fo alfo  in the
whole quantity of blood to be taken, the fum fliould be a
mean betwixt thofe, which the common run of phyficians
approve, while fome think too much, fome  too  little,
fliould be taken.  The reafon for this recommendation is
ftrengthened, by the confideration of their being now lefs
occafion for fheddinga great deal of the vital fluid, fince
fhe cure is now more divided among the other remedies
that have been fpoken of.   The age muft be regarded, as
wasformerly recommended (1), theformer mode of life muft
be looked to, the quantity of ftimulus, that may lately have
preceded the morbid ftate, muft be  confidered, and the
ftate of the body  compared with the degree of the fymp-
toms and the effect of the cure. From thofe circumftances
a judgment fhould be formed of bleeding and other eva-
cuations ; and it fhould be eftimated, what further of the
fame fort may feem proper to be put in praftice, or what
difference of management  may  be required.  Upon the
whok, it will be found, that there will be the left occafion
for any one medicine,  the  more freely  others have been
brought into ufe;  and it will be underftood, that the dan-
ger of too great evacuation will be thereby avoided, and
the health better fecured (m).
   CCCCLXXI. With refpeft to the kind of bleeding, it
 fliould always be made from & very  large vein; becaufe
 the cutting a leffer one, or opening an artery, does not
afford a fufficient  quantity for the relief of the veffels, and
arteriotomy is further attended with certain inconvenien-
 ces (n). As far as any certain rule,  in an affair of fetch
                                              variety,
  (1) Sec CCCCLV.          („) See CCLXXXVI. and CCCV.
  (n) The blood is ready to break out again after the tying up ; and if,
»s feme advifc, the arterial twig fhould be cut through, it  diminifhes the
                                               number 
           OF   MEDICINE.         269

variety, can be eftabliflied, two pounds of blood in three
or four days, with  the  afliftance of  the other remedies,
will  for the moft part, be fufficient  at the middle age of
life, and lefs at a more early or later period.
   CCCCLXXII.  All bleeding fhould  be followed by
vomiting and purging, fo long as any confiderable part of
the fthenic diathefis  remains ; nor fhould the other parts
of cure, that have been pointed out, be neglected.  But
purging, a fingle dofe of which can at any time,  bring
back a fit  of the gout; which cures the fthenic cynanche
or common inflammatory fore throat, and the mild eryfi-
pelas, when even the face or head is affefted ; which is of
manifeft detriment in fevers, which, in dyfpepfia, in afth-
ma, and every  fort  of difeafes depending upon  debility,
whether direct or indirect, does very great  and confpicu-
ous mifchief; and is a great part of the very bad, common
method of cure over the whole form of afthenic difeafes;
in proportion as it ought to be avoided in all thofe difeafes,
fliould be as certainly laid hold of in fthenic difeafes, and
not omitted in any confiderable one, fuch  as thofe are that
require bleeding, but be managed according to the direc-
tions given (o) lately, and as it was directed to be managed
before (p).  And we muft, abpve  all things, be on our
guard againft that diffidence in the ufe of this remedy, as
well as in that of vomiting, where they are ferviceable, and
that confidence in  them when of differvice, both intro-
duced by the fpafmodic doftrine;  and know that they
were both admitted upon a falfe and abfurd principle (q\
                                       cccclxxiu.
number of the few acceffes to this mode of bleeding; neither does there
feem to be any ufe in dcftroyinjr fuch veffels, efpecially as no good puo
pofe can be fhewn for doing Co.
     (0) See CCCCUXI.            (p) Sse CCLXXXIII.
   (q) The principle, at leaft with refpeil to purging, was, that it dimi-
nilhed perfpiration, and, therefore,, was understood not to acll as an an-
                                             tifpaftnodi.;. 
 270      THE    ELEMENTS

 .  CCCCLXXIII. As  nothing in afthenic  difeafei  has
 been more ufed than thefe two modes of evacuation, no-
 thing with  more hurt, and often with inftantaneous de-
 finition ;  fo, for that very reafon, nothing is more happy
 and fuccefsful than their ufe in the  cure  of fthenic dif-
 eafes.
   CCCCLXXIV. It is fcarce  credible  to fay, how  far
 the averfion  to the alexipharmac method of cure has had
 the effeft of branding the very befl medicines, what a de-
 praved ufe of them it has fuggefted, and to what a degree
 it has perverted their proper ufe. Not to repeat what has
 been formerly faid of that kind in other inftances ; fweat-
 ing, which is of the higheft fervice, and a moft efficacious
 means of cure, in every moderate fthenic diathefis, in every
 degree of it,  that is not the higheft, or where it prefles not
 upon any organ  of importance to life ; that is, in all the
 difeafes of this form, except in the beginning  of thofe of
 which we are here treating, has, however, of late been
 completely banifhed from the cure of every one of them,
 but one, not  only, as ufelefs, but  as hurtful;  which has
 chiefly happened  fince the fpafmodic  doftrine began to be
 received into this  country, and, for a few years only, gra-
 dually to gain ground (r).
   CCCCLXXV. But, in truth and faft, except rheuma-
 tifm (which,  at leaft as produced by one form or a medi-
 cine,  it is allowed to cure), if it moft certainly either re-
 lieves or removes  the fthenic cynanche, eryfipelas itfelf, and
 catarrh, and  the fimple fynocha, in proportion to the more
 free or fp:kng ufe of it ; if that be known to the very vul-
                                                  gar,

tifpafmodic.   A balance betwixt  the excretion by the belly, and that
on the furface was talked of, and they were held for oppofite operations.
In fuch theoretical nonfenfe they deferted their only good leader, at
leaft in thofe difeafe?, who alternated his bleedings  and purging*, and,
as I have found upon the bed foundation,
  (r) Turn back to CCCCLXIX. 
              OF    MEDICINE.          271

 gar, and moft certainly to phyficians, of any other than the
 fpafmodic  practice;  what reafon, what certain and well
 proved  fact,  will  any one bring,  to fhew why fweating
 fliould not be ufed, after the moft violent diathefis as much
 diminifhed by the other medicines, and is now reduced to
 that fmall degree, to which that remedy is adapted ; what
 eloquence  would be requifite to bring any man of fenfe
 into fuch  a- perfuafion ?
   CCCCLXXVI.  They will fay,  that the heat,  which
 accompanies  the firft part of the operation of fweating,
 may be hurtful;  for as he  never made trial of it, he ha;
 it not in his  power to fay, that for certain it will be hurt-
 ful  (s). As that effeft will readily be admitted in  an high
 rage of diathefis, threatening indirect debility (t) ; it will
 not alfo be granted, that in a moderate degree of the dia-
 thefis, either from the beginning, or effected by the other
 remedies,  and, confequently, after the plan of cure, that
 we have laid  down, has been  executed,  that fuch heat will
 not be compenfated by the great profufion of fluids taken
 away over the whole body; and that, when this part of the
                                                 vafcular
  (s) It is laughable to hear fuch perfons talk of their profiles, from
 which they never can receive information ; it being not the effect of any
 thing they know themfelves, but  what they have been told by others.
 In that way, without any exercife of judgment;  without  a fingle obfer-
 vation, that they can call their own in the courfe of a long life, do they
jog on, like the blind beggar led by  his more faithful dog, or,  llko chil-
 dren  in the play of blind Harry, groping about with thtir eyes tiki up,
through the whole courfe of a practice boallcd of, God knows, by no
body who knows it but themfelves.
  (t) If the diathefis fhould rife within two or three degrees of indireft
debility, in that cafe the heat of the fir/t part of a fweat, by exhauiling
the little excitement that remains, may have a moft hurtful effect.  But
if the diathefis be any where below that high point, the addition of fti-
mulus can be borne for the fhort time of its continuance ; and be after-
 wards much re ore than compenfated by the large and continued-flow
ever ;M. 
 2-+J2       THE   ELEMENTS

vafcular fyftem has been freed from a violent ftimulus, th*
diminution of excitement will not be more equal in all the
veffels, and over the whole nervous fyftem.  If the nume*
rous veffels, that open into the inteftines and into the fto-
mach, are fo powerful in diminifhing fthenic diathefis, how
fhould a fimilar evacuation in the fimilar perfpiratory vef-
fels have no tendency to produce the  fame effect ? With
which reafoning, if the fafts juft nowrelatedbefurther con-
joined, what will any perfon have to fay againft the ufe of
fweating, when a degree of heat, not greater thanwhatcan-
not be avoided, attendingthe operation of the fweat, can no
longerbehurtful,and the fweat itfelf certain to be of great
fervice u)   Let the fpafmodic caviller againft the ufe of
that remedy, in the cafes of fthenic affeftion where it is ad-
miffible mufler up all his fafts and all his theories, let him
 turn himfelf into all fhapes, he will never  produce a folid
argument againfl this  remedy. But what,  again, is all this
about ? Will there never be an end of running from one
extreme of error into the oppofite? Shall no mean be found
betwixt the Alexipharmac plan of cure,  and an equally
bad or worfe one ?  If that doctrine hefitated not to pre-
fcribe fweating in the rage of a peripneumony, and that too
by means of the molt heating ftimuiant powers;  does it
therefore follow that a plan of cure muft beadmitted,which
rejects the certain  and fafe ufe that remedy,  when con-
ducted by the moft gentle means? If it was the opinion of
                             2                      Dr.
  (u) 111 an excitement of fixty-fcven, within three  degrees of indirect
debility, the heat in the firft part of the fweat, by  adding thefe, might
kill the patient, if you will, without leaving any chance of relief from it£
evacuant effect,  jJut if the excitement be no higher than 6o°, the ad-
dition of the three degrees will keep greatly within the point of indirefi
debility, and therefore, be fafe ; while the fucceeding evacuation may
reduce the excitement perhaps io°, and bring it within the range ofpre-
4ifpofition ; and a new courfe,  or a little  prolongation of this, carry  it
down to the point of health, and finifh the cure, 
              OP  MEDICINE.        27^

 Dr Sydenham, that heat fhould be avoided in the cure of
 fthenic difeafes, which was quite right, as heat certainly en-
 creafes the excitement;  are we, for that reafon, to avoid
 that tolerable degree of heat which accompanies a remedy
 the moft powerful in reftoring the healthy ftate, and,there-
 by, deprive ourfelves of great benefit upon the whole ? If
 fuch  perfons did not know, that feveral  remedies  dimi-
 nifhed excitement more powerfully than any one ; and, if
 they  were to be forgiven for that; were they alfo to be ex-
 cufed for not feeing, what any empiric might have feen, that
 is, that fome things were of fervice, and others of differ-
 vice; was that want not of genius, which is not required
 of them,  but of common fenfe, alfo to be pardoned ?  If
 thinking without a leader,  and making any fort of difco-
 very, was too much, and not to be expected from them ;
 is it not fomewhat feirprifing, that out of a  thoufand per-
 fons, who had treated of every part of medicine, and enter-
 tained different fentiments from one another, in fome mea-
 fure right, and, no doubt, wrong too, they could fqueeze
 no information,  but always trod in the footfteps of one
 fingle man ?
   CCCCLXXV1I.  Sweat, therefore,  after the manage-
 ment that has been mentioned,  is to be excited,  and fo
 much the more determinedly,  if there fhould feem fome-
 thing ftill wanting to the complete return of health, fome
 degree of fthenic diathefis ftill remaining, and a fpontane-
 ous tendency to it fhould appear.
   CCCCLXXVIII.  When the  figns  of a fpontaneous
 fweat arifing are perceived, nothing more is to be done, but
 firft to lay the clothes about the patient, remove the fheets,
 put the blankets next to his body, guard againfl the ap-
 proach of air, and keep up the difcharge for a fufficient
length of time,  at leaft ten or twelve hours.  If,  by this
management, there  fhall enfue  a copious and univerfal
flow of fweat, there will be no occaffon for giving a me-
                         T                   dicine. 
 274      THE   ELEMENTS

 dicine.   After it has fucceeded,  and encreafed the relief
 formerly procured ; if it fhould fink in toward the end, it
 fhould at laft be fupported by Dover's powder, or by laud-
 anum alone, covering  the body, fo as that it may get as
 quickly as poffible to the furface,  till the expected bene-
 fit be  obtained. And to this management it muft be ad-
 ded, that, if a draught of cold water be fometimes given,
 and then the body well covered up and properly managed,
 the bufinefs often fuccecds  to our wifh.   But, as in the
 other cafes, that belong to this part of our indication,  the
 fweating muft then only be  fet on foot, when the medio-
 crity of the diathefis, procured by the other remedies, will
 permit; fo in the fmall-pox and meafles,  becaufe there is
 occafion for a certain time to allow the matter to pafs away,
 we muft alfo keep that in our eye, and never be too early
 in making trial of this remedy.  Laftly, if the heat fhould
 happen to  prove hurtful, if at any  time the flow of the
 fweat fhould be attended  with lefs relief, or with fome in-
 convenience, it  fhould be immediately flopped :  For it
 was not for no purpofe, but  for that of making the reme-
 dies fupply the defects of one another, and of reducing the
 excitement more equally over the whole body, that a num-
 ber was recommended.
   CCCCLXXIX.  In all  the cafes of a violent diathefis,
 all the remedies that have been mentioned, are  more or
 lefs, and differently on different occafions, in proportion
 as the remaining part of diathefis may require, each in a
 higher or lower degree, or in a larger or fmaller quantity,
 to be brought into play, and the  curative circle enlarged :
 And befides them,
   CCCCLXXX.  Some of ilighter confequence, fuch as
 acids and nitre ; fome of uncertain ufe, fuch  as leeching,
 cupping, and bliflering, are mentioned, as of the firft con-
fequence.   Of  thefe, the acids, in fo far as  they render
the drink more agreeable,  and, in an affection of the lungs
do not produce  cough,  and prove, in a certain  meafure,
                                          refrigerant, 
            OF    MEDICINE.         2~] $

refrigerant,  are to be permitted ; and more certainly, if
there fhould be a defire for them.  Every body fhould
know, that  the refrigerant power of nitre is lefs than is
commonly thought.  In rheumatifm, and the fthenic cy-
nanche if the latter fhould be unufually fevere,  blifters,
leeches, and  cupping-glaffes, applied in the neighbourhood
of the inflamed parts, may,  in fome meafure, be of fer-
vice.  Nor does there feem to be any reafonable objection
to the clapping a cap of recently dug-up earth upon the
head in  the cafe of phrenitis.

          The other Part of the Indication of Cure.

   CCCCLXXXI. To pafs  over to the  other  part of the
Indication of cure (y): When there is # gentler diathefis
in the habit, as in the other phlegmafiae, and fthenic affec-
tions, that have not  been yet named in the cure ; as in the
mildeft ftate  of eryfipelas, of the  fthenic cynanche,  catarrh,
fimple fynocha, the fcarlet fever, and the mild fmall-pox
and  meafles; a fmaller force  of debilitating power  is re-
quired ; and, therefore, neither all the remedies that have
been  mentioned,  nor in general fo much of each, as in
the other part are demanded.
   CCCCLXXXII. In all thefe  cafes,  not even wit h the
exception of rheumatifm, which  depends upon a very great
diathefis, bleeding is not neceffary; and with the exception
of that difeafe, bleeding, with any degree of freedom, is
hurtful: For, v/hen the excitement is not the greateft,
and, on  the contrary,is moderate, fcarce exceeding that de-
gree  that produces  the predifpofition to other difeafes ;
in that cafe  it is abfurd to make ufe of a moft debilitating
power,  by way of a remedy, as if we had to combat a ve-
ry violent difeafe.  And,   fince the intention in bleeding
is to  prevent an  ultimate excefs of  exciting power from
                         T  2               producing
                     (y) CCCCLL 
Z~j6       THE  ELEMENTS

producing a ceffation of excitement in death, an event of
which there is not the leaft danger, in a moderate diathefis,
fuch as that, which is the caufe of the difeafes here in quef-
tion ; for that reafon, the cure muft be adapted to the caufe,
and bleeding muft be either abftained from altogether,  or
very fparingly ufed.
   CCCCLXXXIII. It is not,  therefore, only  in difeafes
of debility, which belong to  the  other form (in moft of
which it has, neverthelefs, been, and ftill is, the cuftom,
to fpill more or lefs of the vital fluid), but alfo  in all the
difeafes  of  this form, except the very violent ones,  that
the lancet is to be reftrained.
   CCCCLXXXIV.  Though in rheumatifm the diathe-
fis often runs considerably high, the ufual profufe bleeding,
is not, however, required. For, as every diaihefis is always
greater in fome parts than in any other equal one, fo it is
with the fthenic diathefis in this cafe; which is found much
greater upon the furface of the body, than in any other equal
fpace  within.  And the reafon is, that the moft powerful
npxious agent, hsat, fucceeding to cold,  or fo alternating
with it, that its own ftimulus is encreafed by its effect  (z),
directs its  principal  energy  to the furface  of  the body.
Hence, after exceffive bleeding, the difeafe, notwithftand-
ing, often obflinately recurs.   The   caufe of which  fact,
if the principles of this doctrine be well underftood, can-
not be obfcure.  Bleeding diminifhes the fthenic diathefis
chiefly in the red veffels, lefs in any of the extremities,
leaft of all  in the perfpiratory veffels, and thofe difpofed of
in the traft-of the mufcles; and flill lefs in the laft, becaufe
the operation  of the bleeding  is counteracted  by that of
heat: Which is an  explanation confirmed by  the certain
teftimony of phyficians ; who often  complain  that  their
favorite remedy fails them.
                                      CCCCLXXXV.
(a) Sec XXXVII. and addition. 
OF  MEDICINE.         277
   CCCCLXXXV.   Upon  which  account,  fweating,
 which we fpoke of fo  lately,  is remarkably adapted to
 the cure of this difeafe: To it, therefore, after a previous
 bleeding to twelve ounces, and obferving the rule of tem-
 perature and diet before directed, muft we have immediate
 recourfe, if the diathefis  happens to be confiderably vio-
 lent, and is fignalized by heat of the body, by pains raging
 moft in the night time, and by a tlrongand hard pulfe.
 In order to render  the fweat  univerfal, and of fufficient
 duration, it fhould be brought out by Dover's powder, or
 laudanum, as before hinted, and kept up for twelve hours
 in full flow, and then fome hours longer, or till the abate-
 ment of the fymptoms, in the form  of a moifture or free
 perfpiration, and repeated when the fymptoms return. The
 reft of the cure muft be entrufted to low diet and an exact
 temperature.
   CCCCLXXXVI.  In  this  cafe,  after  the fweating
 courfe, and alfo in that of a fimple fynocha, of the fcarlet
 fever, of the fthenic fore-throat, of catarrh, eryfipelas, and
 the gentle fmall-pox and  meafles,  when the  diathefis is
 fomewhat  confiderable, but far fhort of that rage  which
 conftitutes the cafe of cure firft taken notice of; we fhould
 ufe either a very fmall bleeding, and then chiefly the eva-
 cuations before  mentioned (a) ; then a flight and fliort
 fweat ought to be kept up not longer than eight or ten
 hours; and, during the whole time of the cure, we fhould
 go on with abftinence, weak drink, reft of body and mind,
 and cold,  unlefs in the time of fweating,  and even then
 with as little heat as poffible ;  and, finally, with tranquil-
 lity of mind, as thefe were formerly enjoined:  The united
 ufe of which is perfeftly equal to the removal of  any of
thefe difeafes ; but there will not always be occafion for
 them all.
                                   CCCCLXXXVII.

                  (a)  SeeCCCV, 
278       THE    ELEMENTS

  CCCCLXXXVII.  Often fo gentle a diathefis occurs,
that one or two of them, once or twice employed, is fuf-
ficient for the cure : So flight a diathefis that is, in which,
unlefs for a little at firft, the fhivering, languor, and then
heat, is very moderate, pointing out a proportional flight-
nefs of diathefis upon the furface; in which there is fcarce
any laflitude, fhowing the fame moderation of diathefis in
the organs of voluntary motion ; in which the vigour of
the ftomach remains, manifefting a moderate excefs of ex-
citement in it; in which, in fine,  the other functions, over
the whole body are fufficiently calm, and only fuffer con-
fpicuoufly in the labouring part: In thefe cafes often a
fingle purge with Glauber's fait,  often, without that, cold,
reft, and abftinence, have conducted the morbid excite-
ment to its falutary degree.   A  thoufand times has the
fthenic  cynanche, a thoufand times  has catarrh and. the
fimple fynocha, nay eryfipelas itfelf with affeftion of the
face, been in that way removed.  And the fcarlet fever is
often fo gentle as to yield  to the  fame management.
   CCCCLXXXVIII.   In this  way muft a conftant re-
gard be had to the degree of excitement and diathefis in
the method of cure, and often terms muft be difregarded.
 For, as  it was with  this  view, that the fimple fynocha
 was before diftinguiflied from the phrenitic, and the gentle
 eryfipelas from  the  violent; fo,  it often happens, that
 catarrh  rifes to that magnitude that threatens or brings on
 a peripneumony, and that the latter proceeds with much
 more gentlenefs than ufual.  In which  circumftances, it
 is the degree of excitement alone, that ought to govern the
 phyfician, without refpect to names.
    CCCCLXXXIX,  Another ufeful  caution here is, to
judge of the ftate of the pulfe, of the temperature  upon
 the fkin,  and the fkin in  other refpefts, with good fenfe,
and due reflection upon thefe principles.  The frequency
 of the pulfe in all fthenic difeafes is moderate :  With that
                                                 there 
            OF   MEDICINE.          279

 there is conjoined fome hardnefs and fulnefs. Whenever,
 therefore,  the pulfe  is  very quick, it is to be fufpcfted,
 that the fthenic diathefis has paffed into the afthenic, the
 exceffive excitement into a ceffation of excitement, or that
 the difeafe has been fthenic from the beginning.   To re-
 move which doubt and afcertain the truth, the habit of
 body, the age, muft be confidered, and an enquiry be made
 to know whether the difeafe has been preceded, or not,
 by contagion.   Heat of the fkin is in common  to  thefe
 difeafes and fevers, which are difeafes of an oppofite flamp
 and therefore a doubtful mark. Which, as it depends up-
 on  an interruption of perfpiration, from whatever fource,
 is never  to be ftrained into a proof of the ftate of excite-
 ment.   And, fince drynefs of the fkin,  which is in com-
 mon to  the fame  difeafes however different from each
 other,  in the afthenic difeafes depends upon debility; in
 order to know the amount of what that fymptom means,
 the other fymptoms and  the  exciting hurtful  powers,
 fhould be confidered. In fine, the only enquiry fhould be,
 whether the excitement is  abundant or deficient, and all
 the figns  fhould be  confulted with that view ; nor are we
 to judge rafhly of any peculiar form.
  CCCCXC. When, therefore, the figns, than have been
 related,'are compared with all the reft and with the diathe-
 fis, we are then to fet about the  antifthenic or ftimuiant
 plan of cure.   The violent fthenic difeafes, which we firft
 confidered  can fcarce be confounded with  the contrary
ones; the more gentle are daily confounded. But, while
 it is eafy to diftinguifh them from the afthenic difeafes re-
fembling them ; if, however, any perfon fhould think the
 marks of diftinftion ambiguous, let him know, that, upon
 account of that gentlenefs, though the difeafe under exa-
 mination fhould be afthenic, blood  is not even to be let,
 much lefs under the apprehenfion that they may turn out aft-
 henic to which laft fo debilitating a power is deftruftive, as
                                                  it 
280      THE   ELEMENTS

it has fo often already been faid upon  former occafions ;
and, with that  information, let him underftand, that his
method of cure conducted in that way, will be fenced and
fecured from all miftake.   For, if the diathefis, though
fthenic, be  flight,  bleeding will  often precipitate it into
the oppofite, and will at the beft  be  ufelefs (b).  If, on
the contrary, the difeafe that paffes  for a fthenic one,
fhould, in its progrefs, fhow itfelf an evident afthenic one;
in that cafe every drop of blood that may have been taken
will go to the encreafe of the difeafe (c).  Yet this perni-
cious and daily praftigs fends more men out of this world,
than all the curfes of human life (d).
   CCCCXCI. As  abftinence, cold, and the management
of the belly are  fufficient to prevent a gentle ftate of the
fmall-pox; fo when that proper preparatory plan has been
neglected, and now  a  crowded eruption appears; be-
fides  thofe, trial muft be made alfo of  the  other reme-
dies (e),   except  fweat.   But fweat muft be avoided, be-
caufe  the tendency of the  ftimulus accompanying it, by
encreafing the fthenic diathefis on the furface, would be to
check the perfpirable fluid, and detain  the contagious mat-
ter under the fcarf-fkin, and produce that pyrexia, fymp-
tomatic of the inflammation, which is called the fecondary
fever. This particularity of cure is taken from the parti-
cularity of the fymptom  juft now mentioned, and forms
                                                     no
  (b) Suppofe the diathefis be two degrees above the higheft of the points
ef predifpofition. at 570; and bleeding to the degree of producing 25°
of debilitating influence be employed ; it is evident, the excitement will
go down not only the 170 neceffary to bring it to the ps>int of health,
but fink to z%°, that  is, 30 below  the range of  predifpofition to afthenic
difeafe, and therefore complete the converfion of the fthenic into an aft-
henic difeafe.
  (c) See CCXLIX. CCLXXXI.CCXC.
  (d) Ste par CCC<-VI. towards the end.
  (e) CCCCLlII.to CCCCLXVHL 
             OF   MEDICINE.        28l

no objection to  the principles of this work.   In perfeft
confiflency with which, though there is all the proof that
can be derived from fure practice, that the remedies we
have mentioned are fufficient;  yet,  before the eruption
comes on, there is nothing can be objected either to fweat-
ing or bleeding, as remedies in common to this with every
other fthenic difeafe (f).  In fine, as the fuccefs of low di-
et, cold and purging,  in this manner, is certain;  at the
fame time, the other remedies that remove fthenic diathe-
fis, in  this cafe likewife operate to the fame effect (g).  It;
was proper to fay  fo much for the fake of fhowing the un-
exceptional fteadinefs and univerfality of  the principles of
this work.   Nor  are we to  think, that the fmall-pox and
meafles, differ from other fthenic difeafes attended  with
pyrexia, but in the particularity  of their eruption in run-
ning a certain courfe, and not admitting  of an accelerated
cure.
   CCCCXCII.  We are not to wait the arrival  of the
fymptoms  of debility, that follow a violence of diathefis,
and threaten certain death by indirect debilhry,  with the
view, fo.rfo.oth,  that, when they  have happened, we may
cure them:  On the contrary, they ought to be prevented
by the early adminiftration of the remedies,  now fo  fully
commented upon.   If that fhould  be omitted,  the confi-
deration of the difeafes that will be the  confequence, and
which is altogether an afthenic confideration, muft be re-
ferred to the afthenic form.
                                          CCCCXCIIL
  (f) The fmall-pox is, in one word, to be treated as any fthenic difeafe,
according to its degree of morbid ftate, and the eruption is only to be
regarded during the period of its exiftence, either with refpeel to the
exception of fweating then, or of any thing elfe.
  (g) It is not, that low diet, cold, and purging, operate by any peculi-
arity, but becaufe they debilitate to the degree, and in the manner re
quired of the other remedies. 
 2$2       THE    ELEMENTS

   CCCCXCIII. As often as fthenic diathefis happens to
be conjoined with  the pyrexia, which is induced by the
operation of ftimulants, of acrid fubflances, of compreffion,
of obftruftion, and fimilar hurtful  powers acting upon a
fenfible part, of which we have examples in gaftritis, ente-
ritis, nephritis, cyftitis, hyfteritis, hepatitis, or the inflam-
mations of the ftomach, of the inteftines, of the kidneys,
of the bladder of urine, of the womb, of the liver (h); the
diathefis, becaufe it aggravates the pyrexia, fhould be re-
moved by its refpective remedies, to wit, the debilitating
ones.   And, when neither it nor the afthenic diathefis is
prefent, nothing fhould be attempted : But, if the afthenic
diathefis  fhould  be prefent, which  very readily may hap-
pen ; the ftimuiant plan fhould be proceeded upon, to pre-
vent a very bad  difeafe (i). Nor, when that is as much as
pofjible attended to, are we to forget, that, in fo doing, the
principal affeftion  is not touched ;  that, on the  contrary,
it is its effeft, not its caufe, that is tampered with;  and
that the full confideration of fuch cafes belongs to the lo-
cal difeafes  afterwards to be taken notice of.
                                           CCCCXCIV.
  (h) See LXXX1. LXXXIII. LXXXV. LXXXVII.
  (i) As afthenic difeafes to fthenic ones are in the proportion of ninety-
feven to three of the hundred ; fuch  alfo muft be the frequency of pre-
difpofition to them : The  inference from which is, that as we are fel-
dom in the moft perfect ftate of health, and confequently, for the moft
part, under the fame degree of predifpofition, all the chances are greatly
in favour of that predifpofition being the afthenic one. Hence the impro-
priety of treating all local difeafes in the fame way, and as if they were
general fthenic ones.   Death has been too often the confequence of that
practice, when the local fault, for which it was intended, was no more,
perhaps than  a thorn pufhed under a nail, a  cut, or contufion of a finger.
In fuch circumftances, however fully the perfon may have lived, wine
is withheld, fluid vegetable matter prefcribed, and the  rotine of every
fpecies  of  evacuation gone through.   Difmal are the confequcnces of
gun-fhot wounds on  this plan of cure.  Turn bach to the paragraph*
LXXX. and LXXXI. and the notes fubjoincd to them. 
            OF   MEDICINE.         283

   CCCCXCIV. Befides all the remedies now  mentioned,
it is of advantage in every degree of diathefis  to keep the
mind eafy and unruffled  with paffion or emotion ; a prac-
tice that in the very high degrees of the diathefis is indif-
penfably neceffary.   Our  attention will efpecially be di-
rected to this particular, when we obferve, that the ftimu-
lus of thinking and of any paffion, carried  to a great
height, has had a fhare  in the production cf the difeafe.
   CCCCXCV.  In mania, therefore, and pervigilium, this
direftion muft be particularly, and as much as  poifible, at-
tended to.  In the latter of which difeafes, thinking, and
every ftate of commotion, and more certainly an habitual
practice in  them, muft be fhunned, efpecially before going
to bed. When the patient is refting there, he fhould have
ftupid" books read to him, all inordinate defires, the pro-
penfity to revenge, the remembrance of any degree of cri-
minality, of which  he may have been  guilty, fhould be
diverted from his recollection  (k).
   CCCCXCVI. That faft of great confequence, to give
corroboration to this whole doctrine, is  confirmed by this
other,  that the fame things, which are ferviceable in pervi-
gilium, or the morbid watchful ftate, are alfo ferviceable
in mania, or madnefs, only adminiftered in a higher degree,
as that is a difeafe of a higher degree of excitement. Thus
it is not eafe and tranquillity of mind that  are to be pre-
ferred here, both of which are quite gone, but a ftate  op-
pofite to that high commotion of fpirits and irregular vk
gour in the exercife of the intelleftual function : And, as
an exceffive energy of the intelleftual powers, or of the
animal fpirits,  or both,  are the moft noxious powers in
this cafe ; for that reafon, the patient fhould be ftruck with
fear and terror,  and driven, in his ftate of infanity, to def-
pair : As a remedy againft the great excitement of the or-
                                                gans
           (k) See above par. CCCCXXXIII. 
284       THE   ELEMENTS
gans of voluntary motion, the labour of draft-cattle fhould
be impofed  on him, and affiduoufly continued ;  his diet
fhould be the pooreft poflible, and his drink only water(l):
In water as cold as poflible, the patient fhould be immer-
fed, and kept  under it, covered all over, for a long time,
till he is near  killed.
   CCCCXCVII.  If, in phrenitis  the brain, in peripneu-
mony the lungs, in rheumatifm the external joints, poffefs
more diathefis than any  other part; why may not ma-
nia and pervigilium confift more in an affeftion  of  the
brain, upon which the  principal noxious powers aft, than
of the other parts, over which the influence of thofe pow-
ers is lefs confiderable ?  Laftly, fince remedies, the firft
aftion  of which falls upon other parts, are of fervice in
thofe difeafes  (m), that  proves, that not  even in them,
where you might moft  be difpofed to believe it, the whole
morbid affeftion depends upon the part confpicuoufly af-
fefted ; but that the whole body is concerned in it, that
the excitability is one uniform undivided property over all;
that the force  both of the exciting hurtful powers  and of
the remedies is directed to the whole, with the inequality
fo often mentioned (n);  and that the foundations of this
doctrine are fure and ftable.
   CCCCXCVIII.  As thefe are  the principal hurtful
powers in mania and pervigilium, and the brain principally
affefted ; fo in obefity, the hurtful  powers moft confider-
able are animal  food (o) and reft, or fedentary life; in
confequence of which laft, the ftimulus of exercife, which,
                                                   by
  (1) See CCCXXVHI. CCCCXXX.CCCCXXXV. CCCGXXXVI.
  (m) Part I. Chap. II.                    (u) Part I. Chap. IV.
  (o) Becaufe  no effect, can  arife without a caufe, the exciting powers,
therefore muft here have operated with more force, than in the other
cafe; and if it fhould be objected, that the circumftances  in both cafes
were equal, the difference then niuft be fet to the account of the greater
vigour of the excitability in the cafe of obefity. 
            ©F   MEDICINE.          28j

by wearying and fatiguing the body, tends to indireft de-
bility,  is underftood to be wanting.  Bnt,  fince, in con-
fequence  of  ufing tjie fame  food,  both in  quality and
quantity, and the fame indulgence in reft and eafe,fome per-
fons become fat, others continue lean ;  from thence it is
afcertained, that all the digeftive powers have more force
in the former, than in the latter,  and confequently, that
the other exciting hurtful  powers have contributed to the
effeft,  and  that a proportional  excitement  follows. Of
the hurtful powers, that belong to this place, an eafy ex-
ercife of the intelleftual faculty,  and tranquillity of mind,
which are moderate ftimuli, favour obefity ; over ftrained
thinking,  and habitual indulgence in any paffion, fuch as
that of anger, the repetition of which conftitutes ill nature,
oppofe it.   Corporeal  motion,  which  diminifhes the
quantity of fluids  in the fyftem, and as often as it  is con-
fiderable,  proves  fatiguing and  debilitating, oppofes it.
Equally unfavourable to it is hard drinking; which, in a
fimilar manner, wears out the excitement, by conftantly
wafting the excitability from the high degree or long conti-
nuance of its ftimulus.  On the contrary, the powers that
favour it, are thofe that aft gently, and with fome excefs :
but never attain that high  degree of activity, that inclines
to indireft debility : They are powers that go on foftly and
pleafantly,  that particularly keep up moderation  in the
perfpiration, and  thereby fill the veffels with blood ; but,
becaufe motion is  avoided, they do not very much encreafe
the excitement of the  veffels, and by  means of the  tran-
quillity of motion kept up  in the latter, allow a fluid, that
would  otherwife pafs off by the external pores of the fur-
face, to turn afide into the cells of fat.  Hence, though
as it has been faid before, an abundance of blood is indeed
a very  great ftimulus; yet, witiiout other ftimuli, and that
moft powerful one, which mufcuiar motion affords ; it is
evident, that a confiderable degree of ftimulus can be borne
                                            witho.it 
 286      THE   ELEMENTS

 without any confiderable difeafe, and that  it always pro-
 duces a predifpofition  to fthenic difeafes,  but does  not
 immediately  bring them on.   Hence, it  is  underftood
 what place in the fcale of exceffive excitement, or of fthe-
 nic diathefis, obefity holds ; what the degree of ftimuiant
 power is, and what the ftimuli in particular, are that pro-
 duce it.
   CCCCXCIX. As the degree  of curative force muft be
 accommodated to the degree of force in the caufe (p);  hence
 it muft be obferved, that for the  cure alfo of this difeafe the
 common indication is fufficient (q);that is,  that theexcefe
 of excitement muft be reduced to the falutary degree, and a
 remedy oppofed  to every hurtful power, equal to the re-
 moval of it.
  D. In this cafe, therefore, as food  is the principal hurt-
 ful  power, lefs of it fhould be given, and more exercife en-
 gaged In.  Thefe are fufficient for the cure (r).
  Ik. But, for the fake of bringing  both further confir-
 mation,  as well as illuftration of this doctrine ;  it is to be
 obferved, that all  the powers,  which very much affect  the
excitement, and in a greater degree, than the hurtful power
of this difeafe mentioned above, and that have a tendency,
by their ftimuiant operation, to indirect debility, have the
fame effect; that they either prevent or cure obefity, and
continue productive of that effect, till they induce that de-
gree of meagernefs which is connected with debility.
  DII.  The beft  method of lowering the diet, is to com-
bine a quantity of vegetable matter with a moderate por-
tion of animal.  The next rule to thatyis to refrain from  the
latter, and ufe  the former  in greater abundance.  The
firft of thefe is fuitable to all fuch perfons. as.are Hable to
difeafes of debility, fuch  as the gout, the indigeftion that
after a long time fucceeds to luxury, afthma, epilepfy and
                                              fimilar

  (p) See CIX.   (0 XLVIII.CCCCLIII. (r) CCCCXCVIH. 
            OF   MEDICINE.          287

fimilar others.  The latter  management is more accom-
modated to thofe, who otherwife enjoy great vigour, are
under predifpofition to fthenic pyrexia,and in the flower of
their  age.   But,  it is not,  even in the latter ftate of the
body, to be profecuted, unlefs for a time; becaufe, fuch is
the debilitating influence of that praftice, that, while it is
fufficient to remove any degree of obefity, efpecially with
the additions of exercife, it is found to have fignal efficacy
in producing afthenic diathefis, and all the difeafes depen-
ding on that.
PART 
iB8
THE   ELEMENTS
PART    THE    FOURTH.

   THE   SECOND  FORM   OF

      GENERAL  DISEASES.

                      O  R

     THE  ASTHENIC  DISEASES.
               CHAP.    I.

 Dill. HP HE form of afthenic difeafes, and which is to be
       -S-  called afthenia, for the fake of diftinguiftiing it
 from the form of fthenic difeafes, which is called fthenia,
 is a ftate of the living body, in which all the functions are
 more or lefs weakened, often diflurbcd,  almoft always with
 a more confpicuous affection of fome function.  In  the
 treatment of which, that order will be  obferved, in which
 the progrefs from  the fmalleft degree  of his kind to  the
 greateft through all the intermediate degrees, is to be fol-
 lowed out.
   DIV. In this part of our fubject, there occurs a great va-
 riety of fymptoms ; of which, becaufe it is without mean-
 ing, and even mifleading, no ufe is to be made in marking
 the icale of difeafes.  But, for the fake of placing what is
 about to be delivered in a clearer, if not more fpecious,
point of view, we  fhall begin with a fimple enumeration
of the principal difeafes to  be afterwards fully treated of.
  DV. The afthenic difeafes are macies, inquietude, or
reftleffnefs without fleep, the afthenic amentia, the fcably
                       2                    eruption, 
             Of   MEDICINE.        289

eruption, the flight diabetes, the afthenic fcarlet fever, the
rickets ; the ha?morrha:ae,  or  general bleeding difchar-
yes, fuch as  menorrhxa, or a morbid excefs ©f the men-
fes, epiftaxis, or bleeding from the nofe, hasmorrhois, or
ihe piles;  and alfo three morbid ftates feemingly in  ap-
pearance  oppofite to thefe,  the loitering, impaired, or
fiippreffed menflruation ; next come  thirft, vomiting, in-
digeftion, diarrhoea,  or  loofe belly, and colic  without
pain ; after thefe the affections of children, as the worms,
the general confumption, called tabes, dyfentery and cho-
lera in the gentle ftate of thefe  two; angina,  the fcurvy,
the gentle hyfteria, rheumatalgia, nfthenic cough, cyftirhae-
a, or mucous difcharge  from the  bladder ; the gout of
ftrongifh perfons, afthma, cramp, anafarca, dyfpepfia with
pain, the violent hyfteria, the gout of weakened perfons,
the hypochondriafis, dropfy, chin-cough, epilepfy, or the
falling  ficknefs,  palfy,  the lock-jaw, apoplexy, tetanus;
laftly fevers, as  the quartan, tertian, and quotidian, inter-
mittents or remittents, dyfentery,and cholera, both in their
violent degree, fynoclius, fimple typhus, the gangrenous
fore throat, the confluent fmall-pox, the peftilential typhus,
and the plague.
   DVI. This fcale of afthenic difeafes is to be underftood
in this way, that  thofe difeafes, which in their moft ufual
ftate are flight,  and claim a higher place in the  fcale, are
fometimes  more, fometimes moft, violent; and thofe
that in their  moft common  ftate are fevere, fuch as the
gout of weakened perfons, the peftilential fevers, and frhe
plague itfelf,  fometimes proceed with the greateft gentle-
nefe (a).
   DVII. The affections  of parts, which often  accompany
thofe difeafes, fuch as ulcer, tumor, encreafed excretion,
bleeding difcharge, inflammation, fpafm, convulfion, point
out indeed fome degree  of debility as their cav.fe, but in
                         U                      fuch
(1) See par. CCCCL, 
 29O      THE   ELEMENTS

 fuch fort that the fame degree may happen without them.
 Hence, becaufe it is the influence of debility that is funda-
 mentally  ragarded in this fcale ;  with the  difeafes, that
 are often conjoined with thefe affections, others, without
 them, as  hyfteria and the cramp are blended ;  and, with
 the cafes  that are accompanied with fpafm and convulfion,
 dropfy is conjoined, by keeping to the idea of an equal de-
 gree of debility; and all this without any regard to remar-
 kable fymptoms, but keeping the degree of debility only in
 view.  Neither is the violent cholera kept back from its
 place among fevers, which laft are diftinguifhed by failure
 in the intelkft and affections of the head, becaufe it fhews
 a degree  of debility equal to the febrile.  The idea in
 proportioning  this dmfion is  to fhow,  that true morbid
 energy  does not confift in an affeftion of any parts, but of
 the  whole body; and that the refloration of health is not
 to be attempted by a change of the ftate of parts only, but,
 without excluding that,  by a  change  of the ftate of the
 whole fyftem.

                      OfLeannefs.

   DVIII. Leannefs  is an afthenia, lefs difcernable in the
 other functions, but evident from the weaknefs of the di-
 geftive  function ; in confequence of which, the fyftem,
 though receiving proper aliment, does not become plump.
  DIX. Since the caufe of this difeafe is debility, both
 in the reft of the fyftem, and in the ftomach and other or-
 gans'of digeftion ; it thence follows, that the general indi-
 cation for the cure of it, fhould be chiefly direfted  to the
moft languid part, that is, the organs of digeftion and the
perfpiratory veffels.  More nourifhing food, therefore,
fhould be ufed, lefs labpur undertaken, and moifture on the
furface,  or too free perfpiration, fhould be checked by more
reft of body, by  proper geftation, and  rubefaftion, and a
                                                plan 
           OF    MEDICINE,          tgi

plan, quite contrary to that which is fuited to the cure of
obefity fliould be purfued.

                  OfRefilefs Watching.

   DX. In the afthenia called inquietudo, or rtftlefe watch-
ing, the other funftions are under fome degree of lan-
guor, and the patient is affefted with a conftant neceffity
to change his pofture, and tofs about his limbs without be-
ing able  to fall afleep.
   DXI.  As  the caufe in this cafe, in the fame manner
as in every other general difeafe, is univerfal over the fyf-
tem ; fo it affefts the organs of voluntary motion, and the
brain in particular, with the inequality  fo often formerly
mentioned (b): Confequently, to remove the difeafe, ulti-
mate excefs in either mental labour, or exertion in any paf-
fion, as well as the oppofite extreme of deficiency in either,
fhould be  avoided; and  that ftimulus of both, which is
agreeable,  ultimately exceffive  corporeal labour  when
it has proved hurtful, as well as deficient when it has had
a concern in  the caufe,  fhould be guarded againft ; and
the proper medium betwixt the extremes of exceffive acti-
vity and indolence reftored : Or the difeafe fhould be re-
pelled by wine, and the other ftimuli have, each  its propor-
tion, in the cure.

                 Ofithe Scabby Eruption.

   DXII. In the feabby  eruption, the face is pale,  the
fkin difeoloured, dry, lank, and varioufly disfigured  with
puftules ; there is a lownefs of fpirits, and the funftions of
the body weak and fluggifh.
   DXIII.  In  this  cafe,  while the debility  is univerfal,
there is a prevalence of it in the perfpiratory veffels.  And,
therefore, the chief parts of cure are, together with the re-
                       ll 2                   medies,
(b) See par, XLIX, 
 292      THE   ELEMENTS

medico, the operation of which is direfted to the whole fy-
ftem, fuch as nourifliing food,  ftrong drink, to fupport
the  perfpiration by its refpective remedies; to bathe the
furface of the body in tepid water, to reader it acceffible
to air, to order clean linen for  the patient, and every thing
clean about his cloathes.

                 Ofithe Gentle DiabeUs.

  DXIV.  In that afthenia,  which is named  the gentle
diabetes,  there is an excefs in the quantity of urine dif-
charged, but the profufion is not immoderate as in the moft
violent cafe of the fame name.  The organ of reipiration
labours under the feme weaknefs and fluggifhnefs,  as in
the feabby eruption.
  DX\k  To remove this affection much more frequent
than it has been hitherto believed, the fyftem fhould be fti-
mulated by food (c), by ftrong drink  (d), and  by proper
exercife (e , fuch as is neither immoderately exceffive, and
therefore debilitating nor deficient in degree,and therefore,
not fupplying enough of ftimulus : And, above all things,
the  perfpiration  fhould be fuftained.  The contrivances
for checking  the flow of urine, which have no exiftence,
are to be paffed from.

                    Ofithe Rickets.

  DXVI.  The  rickets is  an afthenia;  to  the general
fymptoms  of which are added an unufual bulk of the head,
efpecially the  fore part of it,  and likewife of  the knees
and abdomen, a flatnefs of fhe ribs and meagernefs.
  DXVII. The rickets is a  difeafe of children, chiefly
arifing from uncleanlinefs,  want of dandling or exercife,
cold,either without moifture or with it,food not giving fuf-
ficient nourifhment, and bad air.
                                            DXVIII.
fo) Sec par. CCLXVI.
(d) See par. CCLXVIII,  (e) CCLXX. 
OF   MEDICINE.          293
   DXVIII.  For its cure the common afthenic indication
 muft be employed ; remedies, of an oppofite nature to the
 hurtful powers that excite the difeafe, muft be looked out
 for ; the furface of the body fhould be kept clean (f), the
 perfpiration fhould be carefully reftored by the ftimulus of
 pure air and  of heat; the child  fhould be more carefully
 dandled,  and  kept much  in  the open air, animal food
 fhould be adminiftered,  vegetable withheld, and ftrong
 drink allowed (g).

                 Of Retarded  Menfirualion.

   DXIX.  Retarded menftruation is alfo an afthenia :  In
 which, befides the difcharge not  making its appearance at
 that time of life, when it fhould, other evidences of debi-
 lity, fuch as a flender make of body,  weaknefs,  laxity of
 habit, want of appetite, or a craving for things not aliment-
 ary, palenefs of the fkin, and fimifer fymptoms, appear.

               Of Impaired Menftruation.

   DXX. Impaired Menftruation is that ftate of afthenia,
 in which after it has appeared,  and the flow continued for
 fome time, the difcharge is  made in too fparing quantity,
 or after too long intervals of time, with other  figns of
 weaknefs accompasying it.

            Of the Supprejfion of Menftruation.

   J)XXI. Suppreflion of menftruation  is that degree of
afthenia, in which the difcharge is totally ftopt at any pe-
 riod  betwixt  their natural  commencement and the time
when, in the  courfe of nature, they oeafe altogether.
   DXXII. An enquiry muft be made into the caufe of na-
tural menftruation, before it fliould be proper to enter upon
                                                that
(f)SceDXIII.
(g) See CCXCV. CCCIII. 
 294      THE   ELEMENTS

that of the retardation, or deficiency, of the difcharge in
any of its degrees.

              Of the Caufe of Menftruation.

   DXXIII.  The caufe of menftruation is a conformation
of the veffels that pour out the blood in this difcharge,
taking place at a certain time of life, that is, about the age
of puberty, and a ftimuiant energy in women, more power-
ful than in the females of the other fpecies of animals.
   DXXIV.  Of other animals there are very few, the fe-
males of which undergo any fort of menftruation out of
the venereal orgafm.
   DXXV. As all the veffels are gradually unfolded in the
courfe of the growth of the body,  fo the fame thing hap-
pens to the  genital and uterine veffels, but laft of all to
thefe. The ends of the latter, terminating, on the fides of
the womb about the age of puberty, are at laft fo very
much expanded, as now to tranfmit firft theferous part of
the blood, and then, after an effort kept up for fome time,
pafs to formal blood.
   DXXVI.  At this  time of life a great  change over the
whole fyftem takes place.   Now the defire for coition, a
ftimulus, never experienced before, produces a commotion
over the whole body; and, in preference to other parts, in
the genitals  of both fexes, in the female, over the whole
region of the ovaria, womb and vagina: By this ftimu-
lus, the  uterus, its feat, being nearly inceffantly folicited,
is the  more powerfully affefted,the more there is of exci-
 tability,  hitherto afted upon by no fuch ftimulus, exifting
in the  fyftem.  Hence, among other organs, the mufcuiar
fibres of the next veffels, as well as the nerves interwoven
 with them, undergo the higheft degree of excitement: This
 excitement encreafing over  the whole fyftem, again en-
 creafes that in the uterus: The mutual contact of the fexes,
                                             whether 
OF   MEDICINE.         295
whether in kiffing, in  fliaking hands,  or otherwife, fires
both fets of genitals, and the uterus in a remarkable man-
ner ; but the aftual embrace produces the higheft degree
of that effect. The remembrance of each embrace remains,
renews the dear idea of the delightful fcene, and continues
more or lefs to excite the uterus.
   DXXVII.  This new affeftion is further cherifhed and
nourifhed by every ftimulus that is ufually applied to  the
fyftem  : Hence,  in the abfence, in the prefence, of  the
beloved object, at all times generally, fcarce with the  ex-
ception of  that which paffes in dreaming, a ftimulus fo
fteady, and the  more powerful, that its novelty implies,
that the excitability in this cafe  is entire, roufes the fibres
of the veffels, already fufficiently unfolded, to violent con-
tractions.  The blood is carried into the region of the ute-
rus with the greateft rapidity, a rapidity momentarily en-
creafed, in proportion as the blood, by powerfully diften-
ding the veffels, and agitating them by its impetuous flow,
ftimulates the fibres more and more, and therebv encrea-
fes the activity by which it is driven on.  This is the firft
caufe of menftruation: In that way the two circumftances,
a fufficient enlargement of the diameters of the veffels,
and the ftimulus afting more powerfully, from its novel-
ty, upon the  unwafted excitability (h), are fufficient  for
the whole  bufinefs.
   DXXVIII. This ftate  is not inconfiflent with other
ftates of the body, but bears an analogy to fome well known
ones :  Accordingly, different veffels, from the  mere  dif-
ence of their diameters, are fubfervient  to different pur-
pofes : The perfpiratory veffels are deflined to the tranf-
miffion of a vapour, the excretory veffels of the alimentary
 c^inal to that of a thin fluid, the renal veffels to that  of a
 groffer one; fo as  to take off our furprife at finding veffels
                                                fitted
                    (h) SecDXXII.L 
296       THE    ELEMENTS
fitted by their degree of diameter, for the purpofe of tranf-
mitting red blood.
   DXXIX. The reafon that the females of other animals
do not menftruate  but  in their orgafm, and not at other
times, is, that it is only at certain times that they are ex-
pofed to that energy of ftimulus which  produces men-
ftruation.
   DXXX. How much is owing  to the ftimulus juft now
mentioned (i), in the production of menftruation, is fur-
ther evident from the following chain of fafts: Which are,
that, the  lefs  addicted  to love women are, the lefs they
menftruate; the more they give  way to that paffion, the
freer do they  experience  this difcharge  within certain
boundaries; that, before puberty, and after the time of life
when menftruation ceafes (which are the two periods, at
which the fitnefs for effective love has not yet commenced,
or is now paffed), the menftrual difcharge isconflantly
wanting ;  that  the privation of enjoyment, which, by its
debilitating effeft, produces chlorofis (k) and other fimilar
difeafes, is remarkable for bringing on a menorrhcea,  or
a retention of menftruation ; and, finally,  that girls, who
are of a forward growth, of great ftrentgh,and large limbs,
and  confequently fooner ripe for love, are alfo more early
in menftruation; while  thofe, who are  weakly,  puny,
and  of  a fmall  fize,  and, confequently, later in attaining
to the period of puberty, are proportionally late in attain-
ing the firft  menftrual difcharge.   Laftly, if, like all the
other functions, that of love is limited at the fame time by
its duration and degree; and if,  as the commencement of
the love embraces it more or lefs early, it is proportionally
more early or late  in coming to its final termination,  and
if the duration  of menftruation  does not ufually exceed
that  period ; that faft alfo, which it certainly is, added to
                                               thofe
(i)SeeDXXIH-l>XXVI.
(k) or the green fkknofs, 
           OP  MEDICINE.         297

thofe above,  gives weight to our conclufion, and fhows,
in a clearer point of view, how much menftruation de-
pends upon the venereal emotion.  It is to be  afferted,
therefore, again (k), that, befides the conformation of the
veffels, fuited to the function of menftruation, and the ftimu-
lus which has been mentioned (k), there is occafion for no
other circumftance to explain either commencement, efta-
blifhment, or continuation, of the menftrual difcharge.
   DXXXI.  The caufe of full menftruation, and that of
a moderate degree of it, happening within the boundaries
of health, is the fame; only differing in degree; the degree
of the latter being fmaller, and that of the former greater.
   DXXXII. And, as the ftimuli, mentioned above, ex-
plain, why women menftruate more than the females of
other animals ;  fo their immoderate  operation upon wo-
men ferves to  fhow,  why their effeft, the menftrual dif-
charge, becomes greater than natural (1).
   DXXXIII. The ftimuli  that produce  abundant  men-
ftruation,  fhort of morbid ftate, are unchafte ideas,  and a
high energy of paffion.  In  this way,  the influence of
reading to ones' feif, or to others,  of converfation, of
pictures, contrived to kindle  up luftful appetite,  and the
uncovering of parts that modefly conceals, which all pro-
duce a lively impreffion on the imagination of the thing fo
much defired,  can be indiftinftly felt by none perhaps but
eunuchs.   The fame is the effeft of nourifhing food, and
generous drink, and high feafoning;  and hence the pro-
verb, without meat and drink love ftarves : Likewife, that
degree of exercife, or even labour, that does not prove fa-
tiguing, but that keeps within the boundary of ftimuiant
                                            operation;
   (k) DXXIII. DXXVI.
   (1) Women menftruate more than other females,becaufe  they arc fub-
j2<Sed to  a higher degree  the ftimulus, which is its  caufe ; and fuch
women as are expofed to more of the fame ftimulus than others, will al-
fo experience more of the cfkit; preiifely upen that fame principle. 
298      THE   ELEMENTS

operation ; as alfo an abundance of blood, both from that
circumftance and from rich diet;  laftly, frequent and ar-
dent dalliance, or inconcefla hujus imitatio; all thefe, en-
creafe the menftrual difcharge, in proportion  to the high
degree of their ftimulus, but ftill do not carry their effeft
to morbid excefs.
   DXXXIV.  The fame conclufion applies to the effeft
of thefe ftimuli,  which was formerly applied  to an over-
proportion of blood producing fthenic diathefis : For the
ultimate end of all the ftimuli,  that produc« exceffive
menftruation,  is  fuch, that, if exceffive menftruation  and
an encreafe of love be the confequence of the excefs of the
ftimuli, one or other of the following muft be the effeft :
that is, it will either be fuch as  remains within the  lati-
tude of health, or fuch, as firft produces fthenic diathefis,
and then,  in a higher degree of it, runs rapidly into indi-
rect debility.
   DXXXV.  That that is the  faft, is proved by the hurt-
ful powers that produce exceffive and morbid menftrua-
tion ; and by remedies, that are ftimuiant and  fuited to fill
the veffels, removing the difeafe according to  our late dif-
covery ; and alfo by the unfortunate effeft of  the debilita-
ting evacuant plan of cure in the fame difeafes.
   DXXXVI. As it is ftimuiant operation  that produces
both proper menftruation  and that which goes to a little
excefs; fo when once menftruation is eftabliflied, the con-
formation and ftimulus, that  have been mentioned, re-
maining, are fufficient to fupport it.   The fame opera-
tion is renewed during every interval of menftruation :  The
ftimulus afts and quickens the motion of the blood in  eve-
ry part, but chiefly in that where it is moft powerful and
moft required, that is,  in the region of the womb :  The
blood thrown into quick motion, and ruffling with a
 more rapid flow, encreafes its caufe, the ftimulus : And,
 as this mutual ftimulus continues inceffantly to affeft the
                                             w) n 11 
          _0F   MEDICINE.           299

women through the whole interval, when they are allowed
fcope of love; the  uterine veffels  gradually  wvfolded,
till at laft,  within three weeks, or a lunar month, they
are  opened to their ultimate extremities :  And, when the
fluid, firft ferous for a little, and afterwards fanguine, and
afterwards  ferous again for a little, has flowed one, two, or
three days,in healthy perfons,the veffels are at laft fhut up.
  DXXXVII. During the whole time of this procefs, the
more excitability there is,  and confequently at the begin-
ning of each menftrual effort, the more violently the fti-
mulus afts, and produces proportionally more excitement:
And it has, from this time, always lefs and lefs effect to the
end, in proportion  as  the excitability is  more wafted;
though, till the excitability, in fo far as it has a relation  to
the ftimulus,  is altogether exhaufted, the ftimulus always
adds fomething to the fum of excitement (m), though con-
ftantly lefs  and lefs.  The Jame is the explanation of the
operation of food, of drink, and of all the exciting pow*
ers.
  DXXXVIII. As  what has  been  faid of the ftimulus,
productive  of menftruation, is conformable  to the effects
of all the other ftimuli;  the fame is its conformity to the
whole fum of menftrual effeft  from the beginning to the
end of the  procefs.   Thus, ;n  the beginning of that long
period,the force of the ftimulus is far the greateft, upon ac-
count of its novelty, and theunwafted ftate of excitability
that relates to it.  At this period, above all others, love in
perfons in health  is exquifite; and, in confequence of the
ftimulus which excites it, menftruation, when  once efta-
blifhed,  is moft exactly performed;  that is, it does not,
either from deficiency or excefs, deviate into morbid ftate.
   DXXXIX. But after the beginning of this function, ,
and when now the office of menftruation is eftabiifhed j
                                              becaufe
(w) sce XXXVI. 
3°°
THE   ELEMENTS
becaufe in this, as well as every other function,  the exci-
tability is gradually diminifhed in the progrefs of life,  the
ftimuiant power alfo has gradually lefs, and, at laft,  no
effeft: Confequently, in the fame gradual way, the power
of love in women, and, in proportion, that of menftrua-
tion, is diminifhed, and at laft altogether extinguifhed.
  DXL. While both the faculties, that of love as well as
that of menftruation, in this way decreafe from the begin-
ning to the end ; fo,  menftruation is often interrupted, in
pregnancy, in fuckling, in the diminution or fuppreffion of
of menftruation.  This interruption in the two  former is
natural,  and fuitable to health ; but in the diminution or
fuppreffion of the menftrual evacuation, it becomes mor-
bid.
  DXLI. Since the ftimulus with the conformation of the
veffels is the caufe of menftruation, and the latter depends
upon the former ; fo again the defect of the ftimulus, and,
therefore, of the conformation, produces both the retar-
dation, diminution, and, at laft, the complete fuppreffion of
the difcharge.
  DXLII.  Whether ever the defect of menftruation, like
that of perfpiration, or of any internal  excretions, as that
in the fauces  and alimentary canal,  is fometimes to be im-
puted to fthenic diathefis, is uncertain, for this reafon; that,
while the diameters of the fmall veffels on  the fkin and in
the inteftines are more nearly allied to fuch a contraction
for a reafon formerly affigned (n);fo great a force of excite-
ment, fo high a degree of fthenic diathefis, as would be fuf-
ficient to fliut up veffels deftined  to the tranfmiffion  of
blood, is not eafy to be  conceived.   And the doubt is
further encreafed by a certain faft;  which is, that both in
the retardation of  the menftrua,  and aU the degrees of
their diminution  to their total fuppreffion, when local af-
                                              feftion

              (n) LVII. LXII. CXII. CXIII. 
            OF   MEDICINE.         30I

 feftion is out of the queftion, there are evident proofs of
 a debilitating caufe.
   DXLIII. To afcertain that faft, which is of the greateft
 confequence for this reafon, that it direftly interefts the
 method of cure, and, if not explained, would leave a gap
 in our principles ; we have to obferve, that, as fome men,
 in confequence of the ftimulus of exceffive love, in the cafe
 of a moft beautiful woman being the fubject of it, have,
 by means of fthenic diathefis, been fo inflamed as to fall
 into a temporary fit of impotence, and been cured by bleed-
 ing; fo, befides that that is a rare faft (o), it is not very pro-
 babl^that the patulous uterine veffels can be fo contracted
 in their diameters, as to be incapable of tranfmitting their
 fluid. Nay fafts contradict it:  The retardation or defici-
 ency of menftruation receives a temporary alleviation from
 the debilitating plan of cure; but the difcharge is  not ulu-
 allv brought back, on the contrary it is more kept off:
 But allowing an over-proportion of blood and an excefs  of
 ftimulus to be the caufe of the firft deficiency of menftru-
 ation, after it has been removed by bleeding and  the reft
 of the debilitating plan  of cure,  can it again  be the caufe
 of a difeafe, which refifts a degree of evacuant and debili-
 tating plan of cure, that would  cure ten peripnenmonies ?
 And fince any ftimulus, as well as that of an over-propor-
 tion of blood, may, from its exceffive force  go into indi-
 reft debility ; why may not the fame thing happen in a
 difappointment in love, and firft  deficiency of menftruation;
 and, in both cafes, atony, ufhering in manifeft  debility,
 and not excefs of tone, be the caufe ?  As peripneumony,
 where the over-proportion of blood and fthenic diathefis
 is by far the greateft that ever  happens,  in confequence
 of indireft debility paffes into hydrothorax ; why may not
 a fimilar caufe in this cafe produce a fimilar effeft ?
                                            DXLIV.
  (o) I remember one inftance in Dr.  Vv'hyte, and I think I have onlj-
heard of another. 
302      THE   ELEMENTS

  DXLIV. The caufe, then, of deficient menftruation,
whether partial or complete, is a languid excitement over
the whole body, efpecially in the uteius, from a deficien-
cy of the ftimulus of love (p),  and of  all thofe ftimuli
that fupport it (q), and from a penury, or under-propor-
tion of blood.
  DXLV. That that is the fact, is proved by the hurtful
powers mentioned in the retardation of menftruation, and
other debilitating ones in every deficiency of that difcharge,
producing each difeafe ; it is proved by the ftimuiant and
filling plan of cure removing it, and alfo by the hurtful
effect of the debilitating plan of cure (r).          .
  DXLVI.  The remedies for the cure of retardea men-
ftruation are,  rich food, generous drink, geftation, exer-
cife accommodated to the  ftrength, pediluvium and femi-
cupium, or the warm bath of the under-extremities, and
gratification in love (s).
  DXLVII.  The  feme remedies are  required  for the
fuppreffion, and the fame, but inferior in  their degree of
force, for the diminution of menftruation : When there is
an unufual force of the difeafe, either in degree or dura-
tion, we muft have recourfe to the affiftance of the diffuf-
ible ftimuli.

    Of Menorrhcea, or the excefftve Difcharge of Menftruation,

   DXLVIII.  Menorrhcea is  an effufion of  blood from
the uterus, or an over-copious menftruation, or too long a
continuance of it in a more moderate degree  of  the ex-
cefs, accompanied by all the fymptoms  of afthenia.
   DXLIX. This difeafe is occafioned not by an over-pro-
portion of blood, not by a vigorous ftate of body, but by
                                                   an
  (p) DXXIII.  DXXVI. DXXIX.
  (q) DXXVI. DXXVII. DXXXIl. DXXXVII,
  (r) DXXXV,           (s) DXXVI. 
             OF   MEDICINE.        303

 an under-proportion of the former, and an exhauftion of
 the latter.   The hurtful powers, therefore, that produce
 it, are food not nourifhing enough, or too  fmall a propor-
 tion of what is fo, watery drink, or that over-proportion
 of pure ftrong drink that produces indireft debility, ex-
 ceffive heat, or cold not prevented from  its  debilitating
 operation by any ftimulus, and falacity.
   DL. Its remedies are  the reverfe of the hurtful powers;
 rich food,  generous ftrong drink,  heat acting within its
 ftimuiant range, cold kept from direct debility  by the
 ftimulus of heat and other ftimuli, and  gratification in
 love.
   DLL The effect of  the hurtful  powers and remedies
 of which we have fpoken, that of the former in produc-
 ing, and that of the latter in removing, the difeafe, and
 the failure in fuccefs of the debilitating plan of cure, all
 confirm the faft.

          Of Epiftaxis,  or bleeding from the Nofe.

  DLII. Epiftaxis is an afthenia ; which, befides the ge-
 neral  fymptoms of the latter, is diftinguifhed by bleeding
 from  the  nofe,  without any force behind, an affeftion
 troublefome at any age,  but particularly to young perfons
 under a rapid growth, and to enfeebled old age.

                   Of Hamorrhois.
  DLIII.  The charafteriftic of hasmorrhois, or the piles,
 added to other figns of  afthenia, is a flow of blood from
 the anus, or the parts around it.
  DLIV.  The  fame thing, nearly, that has been  faid of
menorrhcea, is to be faid of the hurtful powers and reme-
dies of this difeafe.
  DLV. The caufe of the piles is manifeft,  from the hurt-
ful powers producing it, the remedies removing it, and the
unhappy effect of the common afthenic plan of cure; that
                                                  is 
304        THE  ELEMENTS
is to fay, it is debility of the whole body, from the defied
ency of other ftimuli, and chiefly that of  the  blood  (t):
Which debility, while it relaxes all the veffels, and impairs
their tone, produces that effeft, in a fpecial manner, upon
the labouringVeffels. The reafon of which is, that, in con-
fequence  of the inequality fo often mentioned, the chief
prevalence of the caufe operates in the feat of the urgent
fymptom (u).  Nor  is it to  be thought  wonderful,  that
the blood fhould flow through the veffels of the uterus that
are patulous, and in the habit of pouring out blood, through
the pendulous hemorrhoidal veffels, and thofe of the nofe,
which are delicate, and weakly fupported,  in preference
to others. In this cafe plethora, which has noexiftence(x).
is equally unneceffary to our reafoning (y).

Of Thirfi, Vomiting,  and Indigeftion, as well as the Kindred Difi
              eafes of the Alimentary Canal.

   DLVI. There is a very frequently occurring affeftion,
beginning with thirft and  proceeding to vomiting (z).  It
often proceeds no farther than thofe fymptoms ; it oftencr
ufhers in the moft fevere affections, fuch as fometimes dyf-
pepfia, or indigeftion, fometimes colic, fometimes the gout,
fometimes proper fevers, and many other afthenic difeafes.
Its moft frequent fource by far is weaknefs, being the at-
tendant fometimes  of too long fuckling, fometimes in the
diarrhoea  incident  to women, wafted with  a long courfe
both of that and repeated pregnancies.
  DLVII. There  are two caufes  of as  many affections
which have  got only one name between them,  that of
thirft: The one is  fthenic, the other afthenic (a).   The
former arifes from the ftimulus of felt, of rich and plenti-
                         2                        ful
 (t)  See par. DXLIX.              (u) See XLIX. L. LI.
 (x)  See par. CXXXI. CXXXIV.    (y) CCXXXH.
 (z)  CLIX. CLXXXV. CLXXXVI. and CLXXXVII.   (a) Ibid. 
             OF    MEDICINE.         30^

 •ul meals, of heat and labour, and fome others;  never
endingrin vomiting till the fthenic ftate is over, which is
feldom.  Its cure, with which we have here no concern,
is cold water and the feveral debilitating powers.
  DLVIII.  The afthenic  thirft, which  is our prefent
fubject, depends always  on pure debility,  fometimes in-
direct, fometimes direft (b).   Its tendency is  always  to
ftomach ficknefs, and, as that  encreafes, to  vomiting (c);
and when the vomiting  becomes any way confiderable,
the confequence is that moft acute pain, which a cramp in
the ftomach produces (d), and the other affeftion formerly
explained (e).   This progrefs  is fpontaneous, direft, and
for the moft part rapid.
  DLIX. The hurtful powers here are  all debilitating.
The indirectly debilitating  hurtful powers  are, debauch
in eating and drinking (f),  drunkennefs, extreme fatigue,
ultimately exceffive heat (g), violent paffions  (h), exceffive
exercife of the intelleftual faculty (i), debilitating food (k),
an over-proportion of blood now converted into an under-
proportion,  together with the converfion of the fthenic
diathefis  that attended the former, into the afthenic, the
infeparable attendant on the latter.  The  following pow-
ers aft by a direftly debilitating operation; cold corrected
by no ftimulus (1), cold drink, vegetable food (m), penury
of blood (n), of other fluids(o), want of pure air (p), anxie-
ty, grief, fear (q), and in fine, that weaknefs  of the fyftem,
which arifes from all thofe.  The affeftion  is often of a
mixt origin, from a mixture of  both  thefe forts of hurtful
powers: For, as direft debility always increafes thg indirect,
fo does the latter the former, both in  this and all cafes (r).
                         X                    DLX.
  (b) CLXXXV.           (c) Se« CLXXXVII. CLXXXVIIIi
  (d) See par. CLXXXIX.
 (e) CXC. to CXCV. and from that to CXCVIII.
 (f) CXXVIII. CXXX.  (g) CXV.  (h) CLXl.  (i) CXXXIX.
 (k)CXXVIII.    (l)CXXII-  (m) CXXVIII.   (n) CXXXIV.
 (o) CX-XXVII. (p) CXLVI.  («j) CXLII. (r) XLVIh XXJCf. 
          306       THE   ELEMENTS

             DLX.  A corruption of  the common mafs  of fluids,
          whether it be called acrimony, or putrefaction, has no con-
/         cern in the caufe ; becaufe, while life remains, and the ac-
          tion of the veffels upon their  refpective  fluids continues,
          fuch  a faulty ftate of the  fluids cannot make its havock
          over  fuch an extent of the fyftem,  that being only the ef-
          fect of a  ceffation of motion of the fluids under heat; nor
          can it happen, but in  the extreme veffels and excretory
          dufts, which, by their atony, do occafion fuch a  ceffation
          of motion, and likewife in the alimentary canal.
             DLXL The caufe of this thirft is the common one of
          every afthenia, but predominant in the throat and ftomach,
          upon account of the atony  of the falivary,  and other ex-
          cretory dufts (s).
             DLXII.  The remedies  are alfo the common ones of
          every afthenia, to be accommodated to the degree of debi-
          lity in the caufe.  In a flighter degree of thirft a glafs or
          two of brandy, or of anyfimilar fpirit,or, which is a better
          rule, given till the complaint is removed, is fufficient. It
          fhould be either pure, or diluted with a very little hot wa-
          ter (t).   That fhould be followed by eating fome animal
          food (u); and it fhould afterwards be fupported  by other
          ftimulants taken moderately, and in the degree that fuits
          good health.   After which the proper practice is, to pro-
          ceed  to the ufe of the permanent ftimuli.
             DLXIII. When the thirft, not quenched by thefe means,
          proceeds  direftly to vomiting, and when, by and by, an
          excruciating pain fupervenes upon the vomiting ; which,
                  •                                   excepting
            (s) CLXXXVI. CLXXXVIT.
            (t) The addition  of cold water counteracts, that of hot co-operates
          with, the effect, which has been afcertained in a thoufand triali.
            (u) When th thirft was but juft coming on, and not yet  eftablifhed,
          I. have found a hearty breakfaft carry it off.  But when  it is come to a
          head, the mixture of ftomach ficknefs,  that now begins to take place
          with it, renders eating impracticable. 
            OF  MEDICINE.        307

excepting the pain, is an affeftion, that together with the
fymptoms that have  been mentioned (x), fhould receive
the appellation.

     ■Of Dyfpepfanodyne, or Indigefiion without Pain :

   And when, befides the pain of the ftomach, now induc-
ed, the affection  going downward to the inteftines, fome-
times produces a loofe, fometimes a bound, belly; at other
times only a loofe belly, and at others only a bound one;
which  is an affeftion, when unaccompanied by coftivenefs
that is  diftinguifhed by the title

                    Of Diarrhoea.

   DLXIV. And, when accompanied with coftivenefs, is
entitled to the denomination

          Of Colicanodyne, or Colic without Pain :

   DLXV. In all thofe cafes  recourfe muft be had to  a
larger dofe of the drink: And, when that does not fucceed
to our wifh, we  muft next fly to opium, and other more
diffufible ftimuli, if they are  to be  found :  When, by
thefe, relief is procured, rich and pure foups, without
greafe, fhould, from time to time, be •poured in, and the
canal carefully bathed all over with them.   After which,
the  other  ftimulants  fhould be  added;  in  the  ufe of
which, a ftraight direftion between direft and indireft de-
bility fhould be field, without the leaft deviation towards
cither ; And our efforts muft always be continued till the
difeafe  is radically removed.
   DLXVI. The  neceffity for this  direction in the cure is
fo much the greater ; that, by neglecting it, or depending
upon the common purgative debilitating plan, the confe-
                         X 2                 quence
(s) From DLVI. toDLXIL 
308      THE   ELEMENTS

quence is, that often a proper general difeafe degenerated
into  a local affection.  To proceed to the confideration

       Of the Kindred Difeafes of the Alimentary Canal.

   DLXVTI. Among them, befides thofe that have been
mentioned above (y), there are not wanting, others, which,
when compared with them  in the fimilitude and nature of
the cure, abfolutely claim this place in the fcale.

                Of the Difeafes of Children.

   DLXVIII. The difeafes of children  are, drynefs of
the flan, fudden flaver, or falivation of fhort continuance ;
a fimilar  rejection of milk, without effort (z); a green
fcouring; at other times coftivenefs; both commonly with
gripes; the ufual mark  of  which is., a pulling up of their
knees towards their ftomach,  with very  fevere crying;
unequal heat.   A little  more fevere.than thofe are the two
following cafes, the one of which has the name

                       Of  Worms.

   DLXIX. Which are diftinguifhed by a thickening of the
 columna nafi (a);  by a cuftom of picking the noftrils; by
 lofs of complexion; by  palenefs of the face and of the reft
 of the fkin; by a fwelling of the belly; and, laftly, by the
 difcharge of worms by ftool.   The moft diftinct fymp-
 toms of the other  affeftion, or

        Of Tabes,  or the general Wafiing of the Body,

   DLXX.  Are meagernefs all over the body, an unufual
 bulk of the abdomen,  almoft conftant watching,  fuch a
                                                weak,

     (y) From DLVL to DLXVf.             (z) See CCCCIII.
   (*) It is that longitudinal  depreflion which runs down from the par-
tition of the noftrils perpendicular to the upper-lip. 
OF   MEDICINE.        3O9
weak, diftreffed,  affiduous, and hoarfe manner of crying,
as excites tendernefs and compaffion.
   DLXXI. The hurtful powers,  producing all thofe af*
feftions, are in common to  them with  every afthenia;
that is,  they are every thing that has an effect of debilita-
ting the  whole fyftem, and efpecially the alimentary canal:
Such as, at this age, are, milk not nourifhing enough, and
at the fame time acefeent  and flatulent;  want of food, or
made of watery matter and bread ; cold, and moifture-,
the latter encreafing the effeft of the former; habitual vo-
miting and purging ; too little dandling ;  miftiming fleepj
and meals; and every part of management; naftinefs ;  im-
pure air ; a negleft of natural likings and diflikings.
   DLXXII. The  remedies are the coliverfe of all thofe,
nourifhing exciting milk; three or font meals a day, con-
fifting chiefly of warm milk, pure animal  foups, not weak,
with  a mixture of flower or bread of the fame kind;  heat
without being carried fo far  as to produce fweat, or too
much rednefs, and free from moifture; laying afide eveff
fort of evacuation; a great deal of dandling and geftation;
a proper timing of fleep, of food j and of every part of ma-
nagement of thefe delicate fyftems; cleanlinefs ; tepid ba-
thing in cold  weather,  and cold  bathing in warm;  and
pure air, being out in the fields as often as poflible in all
but moift weather ; fuch a judicious  attention to defires
and propenfities as not to negleft fcratching any part that
itches (b).
   DLXXIII.  Thefe  directions  fiiit  the gentler  cafes
under confideration.   To remove the more violent, while
they alfo are not by any means to be neglefted; at the fame
time  others  to be fubjoined.  When the green feour-
ings, great lobfenefs,and boundnefs of belly,are vexatious;
recourfe muft be had to pure wine, fpirits,  more or  lefs
                                              diluted
(b) See above DXVIII, 
 310      THE  ELEMENTS

diluted as the occafion may require, or if there fhould be
negd, not diluted at all: More of the foup that has been
 mentioned and of a richer kind.
   DLXXIV. If thofe fhould notfucceed to the phyficians
 mind, which will  feldom be the cafe; in the fame affec-
 tions and more certainly in worms, and ftill more certainly
 in the tabes, or general confumption,  with the remedies
 that have  been fpoken of,  the more diffufible  ftimuli  of
 opium and mufk fhould be alternated.   Both forts of re-
 medies (c), fhould befo accommodated to the violence of
 the fymptoms, as not to be dropped till the whole morbid
 tumult is allayed, and the healthy ftate replaced ;  which
 will, upon trial,  be found more practicable, than  has yet
 been imagined from the employment  hitherto of the con-
 trary plan of cure, to the great comfort of mankind  in their
 fufferings.
   DLXXV. From  what has  been faid  it  will appear,
 that thefe affections of children, all  flow from the fame
 caufe, are removed all upon the  fame indication of cure,
 as any other afthenia, or difeafe of debility, that has either
 yet been, or is to  be, mentioned in this  work.   The un-
 happy termination of them hitherto, is to be imputed not
 to their caufe, but to the depravity of the common method
 employed for  their cure (d): Nay, though they do dege-
 nerate into local affections, as  in the inftance of the tabes,
 or  general comfumption,  ending in an obftruction of the
                                             mefentery;
  (c) The durable and diffufible.
  (d)  I cannot help repeating again, becanfe the importance of the fub-
ject calls upon  me to do fo ;  that the practice of the new plan of cure,
in all the difeafes of children,  as well as in the others  lately fpoken of,
has ever fucceeded in my hands, as well as in thofe of my pupils, to a
miracle.  I cannot fay that I ever met with an inftance where it could
be faid to have/ailed.   Let then who will  compare that account with
the known mortality that is every day the refult of any other praclic*
yet thought of in the profeffion. 
             OF   MEDICINE.        311

 mefentery; in that of cholic at every age, terminating in an
 inflammation, tumor,  or complication of  the inteftines ;
 and in thofe of both cholic and long-neglefted diarrhoea,
 running  into a gangrene in the fame part;  that is a mif-
 fortune that never happens, when a proper method of cure
 is early enough ufed to remove primary difeafe :  And, on
 the contrary, it moft commonly arifes from the perverfity
 of that plan of cure, or the neglect of this,  which is the
 proper one.   To the fame kindred difeafes of the alimen-
 tary canal (e), further belong the two followingones, un-
 der the title

           Of the gentle Dyfentery and Cholera.

   DLXXVI.  To which,  every thing that has been faid
 of thofe kindred ones, will apply: Or, if there be occafion
 for any particular obfervation upon them,  it will be taken
 up, after we come to treat of them in their more fevere and
 violent ftate: Of a fimilar nature  to all thefe, but of a
 degree fo much higher as to merit the next place in rank
 below them, and, at the fame time, not unconnected with
them, as  having the feat of its  predominant fymptom in
the fame canal, is the difeafe to which  I  have given the
 name

                      Of Angina.

   For the fymptoms and method of cure of which  turn
 back to number  CCXXII.  where it  is  introduced, in
the explanation of afthenic fymptoms.

                     Of Scurvy.

   DLXXVII. Scurvy is an evident afthenia : The prin-
cipal fymptoms of which are, want of appetite, loathing
                                                  of

          (e) From DLXVI, to the prefent paragraph. 
312      THE    ELEMENTS
 of food, laxity of the living folids confidered as  fimple fo-
 lids ; an oozing of blood, both from other parts, and par-
 ticularly from the gums ; averfion to labour; low fpirits,
 and a langour in all the functions.
   DLXXVIII. The hurtful powers producing this  dif-
 eafe, are the common afthenic ones, appearing in the fol-
 lowing form;  It is cold in this cafe, but conjoined with
 moifture in the northern feas, and, as wc may well fuppofe,
 in the parts of the fouthern ocean of the fame temperature,
 that generally produces  the peculiar form of the difeafe.
 But with it all the other debilitating powers contribute their
 fhare :  Such are, grief for the lofs of liberty, relations,
 kindred, and friends ; a horrid diflike to their prefent ftate
 of life; a longing defire for that which they have parted
 with; the awe which the feverity of difcipline keeps them
 in; the effect of a calm, where there is nothing to do, pro-
 ducing  direct debility on them ; a ftorm, where they have
 to labour above their powers, as certain a caufe of indirect
 debility; there not having been allowed, till of late, frefh
 meat, which is the only nourifhing and envigorating  (f)
 form of it;  their being kept upon falted and fpoiled meat,
 and not even corrected by recent vegetable aliment, fuch as
 that is (g); watery  or fmall drink; the terror which  the
 expectation of a battle at  fea infpires.
   DLXXIX.  All thofe particulars prove, that fcurvy is
 fo far from being the effeft of one or two hurtful powers,
 and from  refting upon fo narrow a bafis of the caufe pro-
 dacing it,  as has hitherto been imagined ; that it is rooted
 in a multiplicity of debilitating powers,  and is a real aft-
 henia, or univerfal difeafe of debility.
   DLXXX.  And this faft is confirmed by both the true
 and falfe; method employed for its cure: For, though nearly
 a\} the common powers concur in the production of fcur-
vy; if,however,it be confidered, how eafily, upon the remo-
moval of the hurtful powers, and the patient getting afhore,
                                                  the
        (f)SCXXlV«         <g) See CXXV HI. 
            OF    MEDICINE.         313

 the difeafe is got under, by frefhmeat, either with or with*
 out greens, by wine, geftation, and exercife, in fine, by the
 recovery of his ufual manner of living; it will be impof-
 fible to entertain a doubt of its being both an afthenia, and
 by no means a violent one.  The pretence of its cure being
 effected by greens, roots, four crout, and fimilar things, fo
 much boafted of lately, which, without the remedies juft
 now enumerated, could not fail, by their debilitating ope-
 ration, to aggravate the difeafe, is derived from a  noted
 blunder among phyficians, by which they are led to over-
 look  the moft certain, fimple, and evident fafts, and take
 up in place of them, the greateft falfehoods, or fuch fafts
 as have a very narrow foundation in truth.

                 Of the gentle Hyfleria.

   DLXXXI.  The gentle hyfteria is a form of  sfthenla,
 of frequent occurrence among women,  but  very rarely
 happenning to men; in which a noife is heard in the belly,
 and the patient has a fenfetion of a ball rolling within the
 bowels, rifing up  to the throat, and there threatening the
 patient with fuffocation.
  DLXXXIII.  The ftriking fymptom in this difeafe is a
fpafm, not fixed in a part, but running the courfe juft now
 defcribed.  The difeafe attacks in fits, for the moft part
 leaving long intervals betwixt them, and often never re-
 curring more than once or twice.
   DLXXXIII. The fits are foon removed by fmall  doles
of opium, repeated at fhort intervals: The intervals fnould
be fecured from danger by full diet, and a moderate and
 naturally ftimuiant management,

        Of Rheumatalgia, 6r the Chronic Rheumatifm.

  DLXXXIV. Rheumatalgia is an affhenia, not fo much
a fequel of rheumatifm when left to proceed  in its own
                                         fpontaneoug 
 3*4      THE   E L E M  EN  T  S

fpontaneous courfe, as of the profufion of blood and of
other fluids employed for the cure of it, and of too debi-
litating a cure ; with a change of the fthenic  diathefis and
the inflammation, which is  a part of that, into the afthenic
diathefis and inflammation. Palenefs of the fkin takes the
place of complexion : The appetite is diminifhed, the in-
voluntary motions are impaired, debility and torpor pre-
vail over all. So far the difeafe is underftood to be chronic.
As in rhematifm, the joints are pained and inflamed : As
that, which has been affigned, is the moft frequent caufe
of rheumatifm, fo it fometimes arifes  not from a fthenic
origin, and  an excefs in the means of reducing that.
   DLXXXV. The caufe of the difeafe is the ufual one
of any afthenia,  predominant in the moving fibres of the
mufcles, fituated below the flan over the whole furface of
the body.
   DLXXX VI. Its worft morbific powers are, penury of
blood, cold, efpecially with the  addition of moifture, im-
pure air, and befides thefe, as many of the other powers
that aft bya debilitating operation as happen to be applied,
contribute, in proportion to the degree in which they are
applied to the  morbid  effeft.   Of thefe exceffive indo-
lence and the reverfe are particularly hurtful.
   DLXXXVII.  As all ftimulants contribute to the refto-
ration of the healthy ftate ; fo the moft powerful of them
in this cafe  is nourifhing food,  friction, geftation, wine,
taken in moderation, exercife, rather frequent than violent,
and being as much as poflible in the open air.   If it is an
acknowledged faft, that rheumatalgia is one of the reproa-
ches of phyficians, it is more fo than has been hitherto un-
derftood ; it being an afthenic  difeafe, while  they at all
times made  ufe of the fame kind  of cure, as if it had  been
                                                 the 
             OF   MEDICINE.          315

the moft fthenic, or even  upon the whole more debilita-
ting (h).

                  Of  the Afthenic Cough.

   DLXXXVIII. The afthenic cough is an afthenia, which
with the conftant fymptoms cf the latter, depends upon
a frequent expectoration, that the cough excites ; affecting
every age which has been  under the influence of either
direct, or  indirect debility, and therefore old age, which
is unavoidably the prey of indireft debility.
   DLXXXIX.  As confifting in  direft debility, it is the*
effect of an  exceffive  violence of all ftimuli that  have been
applied either for a fhort time, or  for a great part of life,
their operation coming to the fame amount, that of the for-
mer from  its degree,  and  that of the latter from its long
continuance (i).  In fo far as its caufe is direct  debility, a
deficiency of all the  ftimuli,  leaving the excitability to be
accumulated, allows this form of afthenia to happen  from
the fpontaneous tendency of nature, of which life is  only
a forced ftate (k).
   DXC.  The cough, which depends upon indireft  debi-
lity,  is cured by reducing the ftimulus which occafioned
it, gradually and cautioufly to the proper and natural degree.
                                                     And
  (h) If they fhould pretend to fay that their bleeding and  other  evacu-
ations were more moderate than in rheumatifm ; the anfwer is, that :!iey
were not fo  profufe at any given time .•  Hut, confidering the length of
time, that rheumatalgy draws out into, the frequent, and almoft conftant
evacuations, conjoined with every fpecies of inanition, made the  debili-
tating practice  upon the whole far exceed that ufed in the fthenic cafe.
No wonder, then, that much mifchief was done.
  (i) See above XXIX.XXX . and CCCCL
  (k) So great is nature's tendency to that particular encreafe of exer-
tion, which forms the matter of cxpceSloration in this difeafe, that every
cafe of death from  difeafe is an inftance of it.  Kencc the dead rattle in
the throat is  nniverfally  the  expiri:^  fympt cm.  See  Z-XXl'. aud
CCCXXVL 
 316      THE   ELEMENTS

 And when it originates from indireft debility, the encreafe
 of the ftimulus, the want of which occafioned the difeafej
 till the degree of excitement, which conftitutes health is
 replaced, effects the cure.
   DXCI. Such is the nature of direft and indireft debi-
 lity ; that if the remedies of the former be pufhed beyond
 the boundary, the cough appears again ; and the fame is
 the event of the fame excefs in  the ufe of the remedies of
 the latter (1).
   DXCII. Frequent and violent cough with copious ex-
pectoration has been always held for  a fure mark of a vi-
 tiation or faulty ftate in the lungs.  That faulty ftate  was
 cfteemed to be of a fthenic nature, and to give affurance of
 the prefence fometimes of phthifipneumony, or confump-
 tion from an ulcer in the lungs, fometimes baftard perip-
 neumony, fometimes of a burning inflammation in the ali-
 mentary canal.  In the former cafe an ulcer, or, in their
 way of fpeaking, and what amounts to  the fame  thing,
 tubercles were believed the caufe of the difeafe ; in the fe-
 cond cafe inflammation either in the  intercoftal  mufcles,
 or a different one from that, which in true peripneumony
 was, in their opinion, its  primary caufe, was confidered
 as the caufe; and in  the laft cafe, no  one of them would
 have hefitated a moment to have afcribed the ftate of the
 bowels to the only inflammation they were acquainted with,
 that which requires bleeding and evacuation for its cure.
 And no other enquiry was  made, but  whether the matter
 that was  fpit up,  was mucus or pus. To afcertain that
 premiums were propofed.
   DXCIII. But, in faft, befides that no phthifipneumony,
 no baftard peripueumony,  as they call it, no inflammation
 in  the  alimentary canal, was.  ever cured by antifthenic
                                                  or
  (1) See par. XXXIII. XXXIV. and XLIIL XXX. CXXXIV.w*
 ffpecially CCXXXIII. to CCXXKYl. 
             OF   MEDICINE.         317

or debilitating remedies; and that, in the feveral trials that
have yet been made,  the firft of thele cafes has been evi-
dently affifted, nay frequently completely removed, and the
$wo latter, thoroughly cured in numberlefs inftances, and
in all in which it has been ufed by the fthenic, or ftimu-
iant plan of  cure ; I fay, befides thefe large and compre-
henfive  fafts,  fb little  fignification is there, either in the
quantity or appearance of the expectoration,  that in cer-
tain fevers, in other difeafes of debility,  quite free of all
local affeftion, and finally in this very cough of which we
are fpeaking, there is  often a more violent cough, and a
greater expectoration of matter putting on every form and
every appearance, than ufually happens in a confirmed
confumption, and where every hour is expected to be the
laft.   And yet the whole  tumult, hitherto fo alarming,
could be ftopt in a few hours, and quite cured in as many
days.
   DXCIV.  And, who does not know,  that there are
many perfons,  who have an  immoderate cough, and pro-
portional expectoration for a whole  and long life time,
whofe lungs, however, are found, and free from any or-
ganic  taint ?  How often in phthifipneumony  itfelf after
finifhing its courfe, and at laft  terminating in death, has
the whole fabric of the lungs been found upon diffeftion
as found as ever happens in death from any caufe (m) ?
                                               DXCV.
   (m)Thcre are feveral cafes upon record, of the lungs after death from
a confirmed confumption, having been found perfectly found,  A molt
refpeftable pupil of mine went to Lifbon with  a young gentlemen rf
confiderable  rank in Scotland,  under a confirmed confumption, whom
he brought back perfectly freed from his difeafe.  He alio faved either
two or three  ladies, I am not juft now fure which; equally given upup-
en the common practice.  He happened to affert before the phyfician of
the factory, that a perfon juft dead of the fame difeafe had no local af-
fection in the lungs, and upon diffeftion it was found to be  as he had
faid. I have rsftored many phthifipBeumonbcs.bist am obliged to own, 
3f8       THE   ELEMENTS
   DXCV. The  caufe of cough has hitherto been  un-
known.  To pafs over the fthenic cough, with which we
have nothing to do in  this part  of  our fubject (n);  the
caufe of the afthenic, is the  fame as  that of any afthenia,
but more vehement in the fountain of expectoration, to wit,
the exhalant  and  mucus  arteries, the fecreted  fluids of
which, infpiffated by flagnation in the bronchia, compofe
the matter to be expectorated.
   *. <*. The moft  powerful of the afthenic hurtful agents
in exciting afthenic cough, is cold,  juft as heat has been
demonftrated the moft hurtful agent in catarrh (o). Nay,
in the  afthenic cough, fuch is the rage of cold, that the
fiightefl breath of air  reaching the body, excites  a  moft
prodigious tumult of coughing, and brings out the whole
feries of fubfequent fymptoms; and heating the body in the
bed,  as foon allays the cough, prevents the  threatening,
and cures the urgent difturbances.
   DXCVI.  In this as well as the fthenic  cough,  it is-the
ferous and mucous fluids that chiefly flow to the bronchia.
Which b^ar their preffure for a little, till, diftended by the
load, they can bear  it  no longer. The  difagreeablefs of
the ftimulus excites  a commotion in  the excitability of the
labouring part, and, therefore, over its whole feat,  and
roufes the excitement.   A  cough arifes  and throws off
its caufe, the collected humours.
   DXCVII. This difeafe is always  to be treated for its
cure, firft with ftimuiant remedies, and then with  fuch as
                                                   alfo
that I have loft three, to whom I was called too late. Their lofs, how-
ever mortified me, bccr.ufe there were many reafons for my fetting my
heart upon the cure.  I  alfo loft in Edinburgh the moft amiable young
man of that kingdom, ufter curing a prodigious hemorrhagy from his
lun^s.  This was he whom my pupil two years before brought home
fafe from Lifbon.  But  I was prematurely difmiffed in this,  and coun-
teracted, in the other cafes.
   (n) See CLX. CCXXXIII.  (o) See par. CCCCVII. to CCCCXII. 
             OF    MEDICINE.         3IQ

alfo fill the veffels. If indireft debility has been the mor-
bific power,  ftill we  muft ftimulate, but at firft with a
force of ftimulus little lefs than  that, which  occafioned
the difeafe, and then with flill lefs; and, after changing,
from time to time, the form of the ftimulus, with lefs ftill;
till we come down to the ftimuli that are agreeable to na-
ture, thofe that fuit the moft perfect health (q).    In that
way is ebriety, in that way is every form of intemperance,
to be treated.   If direft debility has been the caufe,  the
cure will be a good deal more eafy : That is we  muft go
on to ftimulate more and more, till we get up to that point
of excitement, to which we came  down in the cafe of in-
direft debility.   In  this way is the firfl flage of phthifip-
neumony, as well as its  middle courfe, and alfo baftard
peripneumony,  nay, moft cafes  of the debility  affecting
young people, and the difeafe to which the name

                      Of Chincough

   DXCVIII. Is given,  to be  encountered in practice.
Chincough is attended by a contagious matter ; which va-
ries  in its degree, but in fuch fort, however, that a fthenic
plan of cure, adapted to the degree of the difeafe, for cer-
tain cures it.  The change of climate or place is a tale, the
praftice of vomiting is death (r). And, fince the  difeafe is
                                                      an
   (q) See par. CIII.
   (r) Still to the old tune" cantilenam eandem canunt " They corSei-
fed they knew nothing about  this difeafe, yet they prefcribe change of
air and place : If they knew nothing about the difeafe, how  could they
know what would  be of fervice ?—Others told them fo.   Kut why c'o
they  prefcribe  vomiting ?—They heard that from their mafter's dtfk
at  fchool, and found, that the fame authority, was th<; reafon of others
for doing the fame thing. Why vomiting ? For the fame ree.fon, and
becaufe a reL'que of the doftrine cf morbific matter has run through ail
their fyftems. Hence in bleeding difeafes, the univerfal rule has been to
bleed j in vomiting to give ernetics,  in diarrhoea to give cathartics, in
                                                 imitation, 
$20       THE    ELEMENTS
 an afthenia, vomiting, which is  fo very  debilitating an
 agent, cannot fail to be of the higheft detriment (s).

 Of the Cyfierrhaa,  or the mucous Difcharge from the Bladder of
                          Urine.
   DXCIX. Cyfterrhcea  is  that mode  of afthenia;  in
 which, to the general fymptoms of afthenia, and the par*
 ticular ones of afthenic cough, there is an addition of mu-
 cus, rendering the urine turbid, without any previous pain
 or fymptom of internal local  affeftion.
   DC. In fo far as this is a general affeftion, the laxity
 proportioned to the atony muft  be removed equally in it,
 as in other cafes of encreafed excretion; and particularly
 ihe ftimuli of health muft be accurately adminiftered.

              Of  the Gout of fironger Perfons.

   DCI.  The gout of fironger perfons is a form of afthe-
 nia ; in which, after a long habit of luxury and  indolence,
 and efpecially,  when to thofe hurtful powers direftly de-
 bilitating, ones have been recently fuperadded, indigeftion,
 or diarrhcea, or rather both conjoined, with  manifeft figns
 of a diminifhed perfpiration, precede; then the lower extre-
 mities are affefted with languor.  Of the leffer joints, al-
 moft always the one or other foot is feizedwith an inflam-
 mation, which,  if not refilled by  a piece of art quite new,
 will prove moft fevere, moft  painful, and of a fliort dura-
 tion, comparatively  to its ftate in that  refpeft in the after
 part of the difeafe.
             2                                  DCCII.
 imitation, forfooth, of nature. The fymptoms of difeafe have been mif-
 taken for efforts of the conftitution  to remove the difeale.  It is now;
 however, proved that  there arc  no fuch efforts.  Every fymptom, and
 particularly every morbid evacuation, is to be ftopt. The contrary prac-
tice is as good fenfe, as it wouidbe to propofe bringing on a dead rattle
 to cure  he morbid one.
  (s) See par. CXXXVH. and CCXClV. 
                 OF   MEDICINE.        33!

     DCII. This  difeafe may be called the  indigeftion or
  dyfpepfia of the luxurious, that is, depending upon indirect
  debility; while dyfpepfia may be denominated  the feme
  difeafe, that is the gout of perfons under direft debility,
  as having every fymptom of the gout, except the inflam-
  mation (t).   For, in difeafes,  fo little is there in names,
  that not only  thofe difeafes, of which we have been juft
  now treating,  but likewife aflhma,  hyfteria, the cholic,
  and moft of the difeafes, which have taken their appella-
  tions from any remarkable chtlurbance of the alimentary
  canal, are equally  prevented and cured by the feme me-
  thod of cure precifely.  Which is indeed the reafon why
  the gout has been ranked in the number of the difeafes of
  the fame canal.
    DCIII. A taint tranfmitted from parents  to their off-
  fprini7, and celebrated under the appellation of hereditary,
  is a tale, or there is nothing in the fundamental part of this
  doctrine.  The fons of the rich, who fucceed to their fa-
  thers eftate, fucceed alfo to his gout: thofe who are exclu-
  ded from the former,  are alfo from the latter, unlefs they
  bring it on by their own merit.   Nay, if there be but on-
  ly two difeafes in the ftrict fenfe of the word, they muft be
  either all, or none of them,heredhary. The former fuppofi-
  tion makes the hurtful powers  fuperfluous,  which have
                            Y                      been

  (t) There; are very few perfons, who at one time or another in their
 life have  not experienced painful twiches in fome part or other of one
 of their feet, efpecially when they happened to be in a ftate more languid
 and fluggifti  than ordinary.  Every which cafe, may be confidered as a
 gout in miniature,   i'ut when the whole phenomena, except the inflam-
 mation, happen to any perfon, call it dyfpepfia,  or what you will;  it 19
 to all intents a^id purpofes a gout.  Indeed,  from all that has been faid
 through this work, general morbid ftate appears to be a very fimple af-
fair, being nothing but  an encreafe or diminution of the caufe of the
funftions or powers of life, without any other difference, but that of the
mere appearance of the fymotoms to our fenfes, an appearance by which,
 whcei v,'c lpck no further for information, weare sdfo conftantly deceived, 
 3^2      THE   ELEMENTS

 been proved to be every thing refpefting difeafe; and, as it
 is, therefore abfurd,  fo the truth of the latter muft be ad-
 mitted.  The flamina,  or bulk of our fimple folids, are
 fo given  in our firft  confirmation, that fome perfons are
 diftinguifhed by a grofs, others by  a flender ftate of the
 whole mafs.   That variety of the flamina, if the exciting
 powers, upon which the whole phcenomena of the life de-
 pend, be properly direfted, admits each its refpective ftate
 of health, fuited toits refpective nature, and fufficiently com-
 modious, if the excitement fuited to each, from a proper di-
 rection of the ftimuli producing it, be properly  applied.
 Though  Peter's  father may have been affefted with the
 gout,it does not follow that Peter muft be affefted; becaufe,
 by a proper way of life, that is by adapting his excitement
 fo his flamina, he may have learned to evade his father's
 difeafe.
   /3. j8. If  the fame perfon,  who from his own fault and
 improper management has fallen into the difeafes; after-
 wards by a  contrary management, and taking good care of
 himfelf, both prevents and removes the  difeafe, as it haa
 been lately difcovered; what then is become of hereditary
 taint ?
   Laftly, if the gout is the fame difeafe as dyfpepfy,  ari-
 fes from the fame hurtful powers, is removed  by the fame
 remedies;  and the only  fymptom,  in which it can pof-
 fibly be thought to differ, the inflammation, is only a flight
 part of the difeafe, depending upon the fame original caufe,
 and  ready to yield to  the fame remedies; what fignify di-
 ftinftions about either, that do not appply to both (x)? No-k
                                                 thing
  (x) If I have kept off my gout for feven year* paft, after having been
fubjefted  to the moft fevere rage of the difeafe, might not I, much more
eafily, have prevented it before ? Put, it may be faid perhaps, that ex-
cruciating pain makes a great  difference in the fcale of  comparifon o£
any two difeafes:  The anfwer to that is, that fince the pain is as eafily
removed  cs the other fymptoms, the difference is removed, and the
weights in the fcale equalised, 
              O F    M  E  D  I  C  I  N E.           $23

 thing by them further is fet forth, than, that a certain tex-
 ture of flamina  is favourable to certain forms of difeafes,
 which (forms) are of no  confequence, in fuch fort, that,
 when the excitement is adapted  to  the flamina, even thofe
 forms can be prevented or cured.
    DCIV.  The hurtful  powers  producing the  gout are,
 firft, indirectly debilitating, not effectual all cf a fudden,
 nor commonly before the meridian of life, that h,  before
 the thirty-fifth year of one's age.   Rich food, too much
 eafe, have a very great effekt,  drink has kfs.   To that kJ
 that have a tendency, to wear out life, to confume the ex-
 citability, contribute.  But the firfl fit fcarce comes en till
 direftly  debilitating hurtful powers have been fuperadded
 to the indirect (y).  The following are.particularly hurtful,
 abftinence,  vegetable food, the hurtful effeft of which is in
 proportion to the -imbecility of the matter  that compofes
 it.   The farinaceous fubflances,  which are by no means
 fafe  (z),  and kfs hurtful than roots, and thefe kfs fo thar.
 greens (a); but fruits are the moil hurtful of all (b). Cold
                            Y 2                     water,

   (y)  My gout came on at the thhty-fixth year of my age, after five or
 fix month's low living: It returned net  again tiil betwixt five or fix
 years after, becaufe all the intermediate time I had been well  fupported :
 And this fecond fit \t.ts ufhered in with low living, immediately previ-
 ous to it,  for  near the fame length of time, as before the coming on of
 the firft fit;  Nay, r.i gout ever came on but in confequecce of direft
 debility; the  indireft has not  fo quick an effeft in that refptft ;  at the
 fame  time it  has a tendency to be  hurtful, and therefore fnould be
 .avoided.
   (z) A mefs  of porridge, a difh ufed in  Scotland, with fmall beer pour-
 ed upon it, and taken over night, would bring on a fit of the gout next
 day.
   (a) The juice of turnips,»f cabba?c,and even peafe-puddrn? and peife-
 foup,  which are commonly reckoned fubft antial difiief,  have the faj.ee
 effeft :  When thofe fubftances, after being boiled, are ufed with a good
 folid meal of meat, I have always found them innocent.  Green pteife
 ate, with lamb or fowl,are both harmlefs and gratdul.
   (b) Apples and pears are fuch :  but the cold fruit-% as melons, cu-
cumbers, are almoft infiantaexoajs mi  their hurtful e£>ft. 
3^4       THE   ELEMENTS

water, in the height of the diathefis, given to quench thirft,
immediately produces naufea, vomiting, and other diftrel-
fing fymptoms of the ftomach and of the reft of that canal,
and hurries on a formal fit (c).   The mixture of an acid
with pure cold water encreafes the hurtful effeft.   Of the
flrong drinks ;  thofe prepared from barley by fermenta-
tion, that is, the different ales and beers, all the white wines
in common ufe, except  Madeira and Canary;  and among
the ted wines claret, indeed all the French wines,and punch
with acid, all thefe are remarkably hurtful.   And as indo-
lence helps on  with the firft fit, fo fatigue, efpecially that
of walking,  hurry on  all future  ones.   Want  of a fuf-
ficient quantity of blood is  fo  hurtful at all times, that,
though the theory of phyficians led them to  the notion
that the  difeafes depended on plethora and vigour, yet no
body ever thought of taking blood (d).   Vomiting is bad,
and indeed one of the natural fymptoms of a very  bad ftate
of the difeafe ; but purging the belly is worfe (e).  Every
evacuation has a fimilar bad  effect, with this  diftinftion,
that the artificial are  much more hurtful than  the fponta-
neous.
   DCV. One is to be excepted, that is, exercife in venery,
to which, though it be a fpontaneous and natural, not an
artificial, evacuation, gouty perfons are fo addicted, and
fo exceed others in power,that in the very middle  of a very
bad fit,  they are not fparing of it.  That effort  at firft is
not perceived ;, but in the advance of age, and after many
returns of the difeafe, it is felt at laft with a vengeance (f).
                                                 Great

   (:) See CLXXXIV. to CXC. to CCXXXVII.
   (d)  This is one  of their many contradictions bctwceu  theory and
practice.
   (e)  At any time I can bring on a fit by  a fingle  dofe of Glauber's fait,
unlefs I happen to be very ftrong and quite free of all diathefis,
   ff ) At an advanced period of age, in perfons who had been vigorous,
                                                     an 
             OF   MEDICINE.         325

 Great  heat, by its indirectly debilitating operation,  does
 fome hurt (g), but great cold, by its direft debility, much
 more (h).   Impurity of air is inimical (i), as. well as an
 interruption in the train of thinking (k); but hard thinking
 is more hurtful. A deficiency in the ftimulus of paffion is
 a pretty confiderable hurtful power (1): but a high inten-
 fity of it will convert this immoderate degree of the gout in-
 to that higheft degree of it, that attacks the head ; lays a
 fnare to life, and brings on certain death (m).
   DCVI. Long fleep is  bad  (n), as producing direft debi-
 lity, by deferring the re-application of the ftimuli, which
 the watching ftate afford; but fhort fleep  is much more
 hurtful, leaving behind it a degree of fatigue ftill remaining
 from the-effect of the ftimuli of the former day (o). Often
 after the upper parts  of  the body have been recruited with
 enough of fleep, after getting  up, the podagric feeling a
 ftate of languor  in his  lower extremities, and a demand
 for  more fleep to them,  is obliged to go to bed again, and
 give the unrecruited limbs their  refpective  fhare of fleep.
 When a perfon is torpid  from fliort fleep, how great is the
 luxury to cherifh again  by the heat of the bed-clothes all
 the parts that have been  expofed to cold, that is, the whole
 furface of the body and  thighs, but efpecially the legs and
 feet, which laft,  during  the prefence of the fit, is the feat
 of the inflammation ; and, how delightful in that way, to
 make up  the  neceffary  complement of the fleep that is
 wanted.
                                               DCVII.

 an unnatural power of execution fometimes, even an aftual morbid ft ate,
 will take place, fo as that the perfon will be able to outdo all his former
 doings in that way.  Dut it is a falfe power, it is a fymptom of difeflrie :
 It is like unnatural appetite for food amidft a weaknefs of the powers of
digeftion.
  (g) CXV.           (h) CXVII.         (i) CXLVI.
  (k) CXXXIX.        (1) CXLI.            (m) Ibid;
  (n) CCXI.V.        (o) See Part II. Chap. VII. CCXXXVH. 
 32(5       THE  ELEMENTS

   DCVII.  To prolong the intervals of health,  and  pre-
 vent a fit,the remedies are all the reverfe of the hurtful pow-
 ers: They  are, rich food taken in plenty (p), but remain-
 ing within its ftimuiant range, confequently of the animal
 kind, with a rejection of all forts of vegetable matter, or a
 very fparing ufe  of it;  ftrong drink, not taken cold, unlefs
 when there is no danger of the  difeafe (q) (at which time
 cold water is fafe after a geed meal), not  mixed wiih acid
 not acefcent, not under a tuibid fermentation while it is ta-
 ken (r); geftation(s) exercife fhort of bringing out fweat,or
 giving fatigue (t), a fmall quantity of blood,  which is pro-
 cured by food, and the motion juft now mentioned (u), no
 evacuation (x), fparing venery, if that be made good in fuch
 perfons (y), a moderate temperature (%), kept equally be-
 tween the extremes of direct and indireft  debility, and in-
 clining to neither; pure air (a), confequently ckanlinefs, and
 being much  in the open fields, a happy train of thinking (b);
                                                     fuch

  (p) See par.  CCLXVI.
  (q) I know well when I may take cold drink and ufe fome vegetable
matter ; it is, when, for fome time paft, I have been well fupported, and
feel ftrong and  vigorous. I alfo know, if I have, cither in food or drink,
taken any thing improper in kind, how to correft it; which is, by hav-
ing recourfe to  a proper ftimulus.  By eating an exotic fruit, which had
a mixture of the qualities of the water melon the orange and lime, in
a quarter of an hour I had an attack in my ftomach, in the middle of
my lefture laft fummer, at the Devil Tavern.  By fome of the diffufible
ftimulus I repelled it, and went well on with my lefture. At other times
I have prevented fuch an effeft, by anticipating the  remedy. Thii doc-
trine puts much more in our  power : But we fhould not, therefore, piay
tricks with it. On the contrary, we have great reafon  to be  thank-
ful &r the  command  it gives us over our health,  and that alfo. by the
ufe of means not inelegant, naufeous and clumfy,but quite the contrary.
The old motto of Afcleiades, tuto, celeriter, et jucunde, is verified and
improved by the important addition ef falubriter.
  (r) CCLXVIII.        (s) CGLXIX.         (t) Ibid.
  (u) CCXC.  CCXCV.   (x)CCXC.          (y)DCXIX.
  (z)CXII.           (a)CCCIII,       (b)DXHl.DXVIir. 
           OF    MEDICINE.         327

fuch a ftate of excitement as to paffion, as keeps between
fiery excefs and ftupid apathy, with as great tranquillity of
mind as poflible (c); moderate fleep, rather inclining to be
long than fhort, a rule which fhould be fo much the more
obferved, as  the difeafe is of longer ftanding and greater
feverity: In fine, fleep fhould be  allowed to continue till
the moft vigorous watching ftate is procured (d).
  DCVIII.  From what has been faid it muft appear cer-
tain, that the gout of fironger perfons is not alfo itfelf a
difeafe of ftrength, or a fthenic one ;  and that it does not
depend upon vigour of the conftitution and plethora, as it
has been commonly hitherto imagined; but that it is ma-
nifeftly afthenic, like all the reft of the cafes belonging to
afthenia, and proved to be fo by the ftrongeft evidence;
and  that it is not to be treated by an afthenic, as it has
hitherto been the notion, but by a fthenic plan of cure .;
and that there is every encouragement for treating it in
that point of view.
  DCIII. What had hitherto  deceived  phyficians,  and
paffed for a caufe of the gout, was the appearance of vigour
and an over-proportion of blood, in  moft podagrics, from
the bulk of fimple folids in confequence  of their  way of
life, and often from  great ftrength. But, good men !  they
never recollected, that vigour and a great quantity of blood
was  not a property inherent in animals, but that it depend-
ed upon foreign circumftances every day and every hour (e).
If any one, according to that idea, who has happened to
get a great bulk of fimple folids, and who has had abun-
dance of proper diet,  and lived in that way to the thirty-
fifth or  fortieth year of his age, fhould all at once be depri-
ved of all the articles of diet; and if a dwarf two feet high,
who has lived poorly, and is, therefore meagre, and flender
fhould equally fuddenly be put upon a rich living ;  will
                                                there

  (c) CXL. CCCIII.      (d)DC,     (e) X. XI. XII.  XIII 
328       THE   ELEMENTS
there be the leaft probability,  that the former will, not-
withftanding his prefent abfolute want, continue plethoric
and vigorous;  and that the latter, from being now cram-
med with unufual plenty,  will continue empty,  as he
had been before ? Is the fundamental propofition of this
doctrine, in which it has  been demonftrated, that we are
nothing of ourfelves, and that we are altogether governed
by foreign powers, to  be forgot ?  Is a perfon liable to the
gout, who has for twenty years undergone an excefs of fti-
muiant operation, about the fortieth  years of  his age, or e-
ven afterwards, to be  reckoned fuller of blood and more
vigorous, either' than another perfon who has lived lower,
or than himfelf twenty years before?  Where, pray, was
the neceffity of comparing gouty perfons with others free
from all bias to that  difeafe, and not  comparing them with
themfelves (f)  ?

   (f)  Such is the effeft of  the powers operating upon us, that a certain
degree of that operation produces an effeft  that would not  arife under
another.  If the accuftomary operation has  been moderate, habit will
render the excitement arifing from it, in fome meafure, fufficient for the
demands of the fyftem: Hence, day-labourers, are fupported upon lefs fti-
mulus than gentlemen. Again, which is a circumftance liable to happen
to the.latter, if the accuftoenary operation has been exceffive, there willbe
a  neceffity for a continuation of fome degree of the excefs. A  podagric
may be ftronger than a labourer, and yet fallinto the gout. For, though
compared with the other perfon, he is ftrong; compared with himfelfat
another time he is weak : And the reafon is, that though he is ftill bet-
ter fupported than the labourer, he is worfe fupported, than the ufual
ftate of his fyftem requires.  Further, the labourer, though he falls not
iato the gout, may, by carrying his moderation too far, fall into indigef-
tion, or fome other difeafe, in every effential  refpeft the fame as the gout.
A double inference arifes here ; Which is, that, though both excefs and
deficiency pan be borne to a certain  degree, fo as to require a continu-
ance of tlum, or a gradual corredion, yet they fhould both be avoided
as entailing that fort of neceffity for their continuance while their effeft
makes no fort of compenfation, being, at heft, not the beft ftate, that of
perfect health, but a ftate of predifpofition to difeafe; the one to fthenic 
OF    MEDICINE.
3^9
                    Of the gentle Afthma.

   DCIV. Afthma is  an afthenia ; in which, to the fymp-
toms in common to all aftheniae, there is fuperadded a diffi-
cult refpiration, returning at uncertain fpaces of time, of-
ten unequal,  without any  unufual expectoration accom-
panying the fits.
   DCXI. The fame  are the hurtful and curative powers
here, as in the gout:  In the fame manner are the fits both
prevented and removed (g).

                        Of Crainp.

   DCV.  Cramp  is alfo one  of the cafes of afthenia ;  in
which, often from pain, often from  drunkennefs, and not.
feldom  from fweat,  and difagreeable foaking heat, fome-
times the wrifts, fometimes one of the calves of the leg, in
fine, any external part, are affefted : Of the internal parts,
it is fometimes the  ftomach,  fometimes feme part in the.
inteftinal canal, fometimes the bladder of urine,  that fuf-
                                                     fers:

and at laft indireft debility ;  the other to afthenic,  as depending on di-
reft debility. The perfeft rule for enfuring the healthy ftate, is to keep
within the extremes of excefs and defeft, and thereby produce the due
degree  of excitement; and to  apply all the exciting powers equally,
each in its due proportion.  The  due degree may be fecured by one or
a few, but the equality of it over the fyftem can only be fecured by their
equal application.  This propofition goes to the bottom of two extenfive
doctrines, that of life,  and that of morals ;  the laft of which has as yet
not attained to any thing  like a fundamental principle.   I intend to pio-
fecute the idea upon fome future occafion.   I know a book filled with
valuable ethic fafts, but have not yet had time to confider, whether they
all point to a general one, in which they all agree, and which reflcfts
proof and confirmation upon them ; without which it would fall fliort of
fcientific exaftnefs.
   (e) This has been proved, both upon other occafions, and particularly
in the cafe  of a young gentleman, who lived with me during my firft m~.
nagement of my gout, See Preface to the Irlement?. 
3JO       THE   ELEMENTS
 fers : The difeafe is not confined to indirectly debilitating
 powers, as producing it; it alfo arifes from direftly de-
 bilitating ones, fuch as abftinence, vomiting, loofe belly,
 and drinking water contrary to cuftom.
   DCXIV. To remove  this difeafe; when it  does  not
 exceed the gentlenefs that is here underftood, the whole bo-
 dy muft be invigorated by moderate ftimuli, every moft ur-
 gent exciting power  fhould be taken out of the  way, ge-
 ftation,  and  that  exercife, which does not exceed the
 ftrength, fhould be put in praftice.   A more fevere degree
 of the difeafe will by and by be treated under tetanus.

                     Of Anafarca.

   DCVI. Anafarca is a form of afthenia,  diftinguifhed by
 water betwixt the fell and the flefh, occafioning an ex-
 ternal fwelling of the body, without the figns of any fuffu>
 lion of the fame fluid into the interior parts.
   DCIX. In the cure,  the body muft be invigorated, and
 in that part of it chiefly, where the greateft laxity and ato-
 ny prevails, that is the fkin.   This indication is  anfwered
 by ftimulating heat,  by friction, by pure and dry air, by
 nourifhing ftimuiant  diet,  and  the  Peruvian bark: No
 internal local affeftion gives occafion to it, which may be
 known from the fymptoms yielding to this plan of cure.

                 Of Cholic with Pain.

   DCX. Cholic with pain is a form of  afthenia,  and a
 higher degree of the cholic without pain; in which, to
 the  figns of debility in common to all the afthenic cafes,
 are fuperadded a greater violence of the fame fymptoms,
 and twifting pain about the navel, with pain in forae part
 of the belly,  often enormous, and fometimes with a tu-
 mour, that can be felt externally (h).
                                                   Of
  (h) Immediately above the hrim of the pelvis, on the right-fide, at
the place of the blind-head of the colon, 
O ¥  MEDICINE.         331
       Of tha Dyfpepfodynia, or Indigeflion with Pain.

  DCXI. Indigeftion  with pain  is an afthenia,  which
adds to the  fymptoms of indigeftion without pain, a pain
and  gnawing feeling in the region  of the  ftomach, and
is highly expreffive of a very fevere difeafe.

                  Qfthe vivlent Hyfteria.

  DCXII.   The  violent  hyfteria is  a higher degree  of
the gentle hyfteria: in which, befides the fymptoms there
defcribed, mobility and changeability of mind, difpofition to
fleep, convulfive ftate,  and a great refemblance to epilepfy,
are confpicuous.   The temperament, that favours hypo-
chondriafis,  is of an oppofite nature to this, which is com-
monly called the  fanguine.  Both the temperament and
predifpofition  in this  cafe are produced by a moift., lax,
fet of fimple folids.

             Ofithe Gout of weakened Perfons.

  DCXIII.  The gout of weakened perfons, which is  an
encreafed degree of the gout of ftrong perfons, is that aftr
henia,in which the inflammation runs out to greater length,
and at laft, does not form at all; and the general affeftion
encreafes in violence, in  obftinacy,  and,  at laft,  attains
its higheft degree; exhibiting, towards the end of the dif-
eafe,  almoft all the fymptoms of debility, every  form of
afthenia, and  fometimes by  a falfe refemblance, counter-
feiting fynocha.
  DCXIV.  As the difeafes affecting  the alimentary canal,
formerly mentioned (i), have, in a great meafure, a com-
mon nature; fo, thefe alfo, that is, the colicodynia (k), the
dyfpepfodynia (I), the violent hyfteria (m),and the gout (n),
                                                  are

 (i) From DLVI. to DLXXVI.                  (k) DCX.
  (J) DCXI.             (m) DCXII.           (n)DCXiII. 
 3$2      THE   ELEMENTS

 are equally participant of the fame, differing only from the
 former In their higher degree of violence.   Their moft di-
 ftinguifhed fymptoms are either fpafm, which takes place
 In the cholic, and indigeftion, both with pain, or a fpaf-
 modic convulfive affection, diftinguiftiing the reft.  But
 neither, in that refpect, do thefe differ from each other in
 z.-.y thing effential; fince they all, without diftinftion, de-
 pend not only on debility, but alfo nearly upon an equality
 in the degree of it, as the fimilarity of their morbific powers
 and  remedies proves.   For a  very full explanation  of
 fpafm and convulfion go back to the following numbers,
 CLXXXVIII. to CXCV. and from the latter to CCI.
   DCXV. For  the cure of them all (o), abftinence, fa-
 tigue, evacuations, acids,  and acefeents, cold, direftly and
 indirectly debilitating  paffions, the  debility  arifing from
 exertion of the intelleftual function, and impurity of air,
 snuit be avoided.  The cure of every one of them muft be
 ftimuiant. When each of them is but flight, beef foup
 and fimilar rich ones, which aft partly by dilution, partly
 by a nourifliing and ftimuiant operation, in the weak ftate
 of the ftomach, and by fupporting theffyftem, and after-
 %'ixds, when the ftrength is fo far  recovered,  folid animal
 food, and moderately diluted drink, which,  at laft, con-
 firm the ftrength, are  fufficient.  In  a  Higher degree  of
 violence of any of them,  while the foups fhould ftill be
 continued, at the fame time pure  ftrong drink fhould be
 iJminiflered.  And when the violence of any cafe baffles
this whole form of ftimulus, recourfe muft be had to mufk,
 volatile alkali, camphor, sether, and opium.   Thefe muft
be adminiftered in large dofes ; and all acid and fermen-
 ting things, every thing cold,  though accompanied with
ftimulus, muft be guarded againft.
                                           DXXCII.

 (o) rerufe the whale of Chap. IX. Part II. from numb. CCLXXXI. 
            OF  MEDICINE.        333

  DCXVI.  For the patient's management in the inter-
vals, all debilitating powers muft be avoided, fuch as fa-
tigue, abftinence, cold, and exceffive heat (p); and take it
for  a certain and demonftrated faft, that the fits of recur-
rent difeafes, do not return from any inherent power of na-
ture, but from human folly.   Accept of that as a joyous
piece of news, and fuch as nobody ever expected.  The
recurrence of fits of the gout itfelf is not unavoidable (q);
but,by guarding againft the hurtful powers mentioned,may
be  repelled for any length of time; and, when it happens
at any time to come on from the fault of the patient, it
can often be removed in two hours,  and almoft always in
as many days, and the ftate  of health fecured in every re-
fpect.    In  all the fame difeafes of fimilar  vehemence,
whenever any ftimulus, from a long continuation of its
ufe, has begun to have lefs effeft, we fliould lay it afide,
and proceed to the ufe of another,from that flill to another,
and in that way go over the whole circle (r).

                   Of Hypochondriafis.

   DCXVII. The hypochondriafis is an afthenb,in which,
with the fymptoms of dyfpepfy, there is a noife in the bel-
ly, flatulency, and uneafinefs, and a rooted opinion in the
patient, of the difeafe being always worfe than it is.  The
way is paved  to the difeafe  by  a dry fet of fimple  folids,
and that temperament, in which there is a natural flow-
nefs to paffion ; which, however, once excited rifes to the
 higheft violence, and continues long with obfrinacy.   It
 is further diftinguifhed by a fixed attention of mind, where-
 by the patient is liable to dwell to excefs upon any purfuit
 or ftudy, and not to be eafily diverted to another, as  alfo by
                                                a dry

   (p) See again the fame Chapter, which compare with the prtccdinj,
the VHIthof the lid Part.
   (q) See par. DXCVII.               (r) XLI. 
334      THE    ELEMENTS
a dry ftate of the furface of the body, a rough fkin, with
black hair, and black eyes, and always a dark complexion
and ferious afpeft.
   DCXVIII. From the definition  given of it  by hypo-
chondriacs,  it is beyond doubt an  afthenia,  as being ac-
companied with a noife in the  belly and flatulency;  and
the courfe of the difeafe  diftinguifhed by flownefs to paf-
fion, keennefs in thinking, and that ftate of the fimple fo-
lids, which requires a high force of ftimuiant operation to
procure, and keep up a fufficient degree of excitement.
   DCXIX.  Since the ftate  of the fimple folids is  a ftate
given by nature,  and not to be changed by art, and the
only indication of cure left in the  phyficians power, is to
fit a certain degree of excitement to that given ftate, which
is exactly  the cafe in this difeafe ;  it follows, therefore,
that  the fiimulus of food, drink, and others,  fhould be
employed  in the  cure of hypoehondriafis.  The patient
fliould be kept cheerful, by being placed in agreeable com-
pany, and gay entertainments, by entering upon a journey,
and amufing himfelf with the various feenes of nature and
art through which he paffes. He fhould ride, that in guid-
ing the horfe, his  mind may be more occupied.  His ftu-
dies and every fubjeft of his ordinary contemplation fhould
be often changed and varied.   He fhould have generous
wine given him to refieve the fymptoms of his ftomach
and inteftines, and to raife his animal fpirits.  And if thefe
fhould fail of fuccefs,  the diffufible ftimuli,  as opiates,
fhould have their turn for a time,  for the purpofe of ftrik-
ing a flroke at once.   And their ufe again gradually  laid
afide in proportion as the ftrength can now be fupported
by the more natural and accuftomary ftimulants.   Dark-
nefs and bad air fhould be fhunned; pure light,  and all
lively objefts, fhould be fought after.  No hypochodriac,
                                                 even
r 
OF    MEDICINE.
335
 even in a fit of delirium, fliould be provoked, but by every
 contrivance foothed (f).

                        Of Dropfy.

   DCXX. Dropfy is an afthenia, commonly in the form
 of an anafarca, with a fwelling in fome vifcus, which, for
 the moft part,  at leaft in the beginning, attacks fome place
 in preferrence to others, and more than any other.
   DCXXI. The caufe of dropfy, in fo far as it refpefts
 the collection of water, is eafily explicable upon this doc-
 trine, but  altogether inexplicable upon any other.   For
 the univerfal debility,  that is laxity and atony,  is chiefly
 predominant in the extreme red arteries,  and the exha-
 lants immediately continued from thefe, as well as in the
 commencements of the ablorbent veins ; and, of the fame
 kind of veffels, it is often urgent in a   particular part  in
 preference to others.
   DCXXII. As all the debilitating hurtful powers con-
 cur in producing this,  as well as any other afthenia;  fo
 thofe powers have the greateft influence in this cafe, that
 prefs moft  urgently upon the vafcular fyftem.   Hence,  as
 we fee  in the converfioft of peripneumony into the dropfy
 of the cheft, profufe bleeding, and a  large draught of cold
                                                   water,

  (f) I  hare heard of an hypochondriac fo  pro voked'at his phyficians)
who maintained that nothing ailed him, that  he, on the contrary, to car-
ry his opinion of his difeafe to the Utmoft ; at laft took it into his head,
that it had attained its utmoft height, by depriving him of his life.   Ke
continued obftinately in the notion  of his being dead, till a more fenfible
practitioner was called in to fee him.  This gentleman agreed that  he
was dead, tut as-he could not difcern the particular caufe of his death ;
he, therefore,  propofed to open the body : In fetting about which,  he
made luch a clafhing with a great apparatus of inftruments, provided for
the purpofe he intended, that the patient was roufed from his obftinate
fullennefs, and allowed, that this gentleman had come nearer to his cafe
than any of the reft ; but acknowledged, that he now found he had fome
remains of life. 
  33&      THE    ELEMENTS

 water, when the body is fatigued, over-heated, and burn-
 ed up with thirft,  are the moft powerful agents in bring-
 ing on  this  difeafe.   The hurtful effect of  the latter of
 which, in every cafe of debility, when its operation is fol-
 lowed by no ftimulus, has been more than fufficiently ex-
 plained above (t).   Befides, in this cafe, when all the vef-
 fels are open,  the water flowing to their moft weak termi-
 nations, pafling out by thefe, and being not at all tranfmit-
 ted from the exhalants into the abforbents, is collected in-
 to e^very neighbouring cavity (u).  And hence the com-
 mencement of the urgent fymptom in this difeafe.
   DCXX1II.  To this afthenia belong all the watery ef-
 fufions, which do not arife from a local affection, but de-
 pend on pure  debility.   And,  therefore, if at any  time
 any other form of afthenia, whether from wrong treatment,
 cr ether hurtful powers, in its progrefs terminates in this
 effufion; every fuch cafe fliould be held as a proper drop-
 fy (x); and it fliould be ever prefent to our recollection,
 that there are  only two general difeafes, and that the dis-
 tinctions hitherto received,  are devoid of all folid founda-
 tion.   Accordingly, both from other improprieties, and
 particularly from bleeding, epilepfy, palfy, the gout, ter-
 minate in real  dropfy.  Nay, the  fame  is the termination
 of peripneumony itfelf, when it is either  converted into in-
 direct debility, from the debilitating plan of cure having
 been puined to excefs, or into direft  debility, from having
 been left to itfelf, and the body not fufficiently debilitated.
 The affections, confined to parts, which are confidered as
 the remote caufes of dropfy, will be treated among the lo-
 cal  difeafes, to which they belong.
  DCXXIV. After this explanation of the nature of drop-
fy, the cure of it,provided that it be a proper one,and early
                          2                   enough

  (t) See par. (XVII. to CXXIV.         (u) LTX. LX. LXI.
  (x) See LXXXI, 
              O  F  M E D„ I C  I  N  E.         ^37
 enough fet about, ought  by  no means to be fo much def-
 puired of,  as it fliould be when local affection, with a fimi-
 lar effufion,  and the general difeafe are blended together
 without diftinftion, and confidered as one and the fame (y).
 If long before the effufion  there was no internal complaint,
 if the difeafe rather came on fuddenly, and in confequence
 of evident hurtful powers, and yields to the firft part of
 the curative means, there  is reafon to doubt of a cure.
   DCXXV.  Befides  the general indication of cure for
 afthenia, that faked to this cafe muft be particularly directed
 to the whole vafcular fyftem, and efpecially about their ter-
 minations,and the commencements of the abforbent veins.
 The remedies are alfo the ufual ones ;  that  is  diet, as
 nourifhing and ftimuiant as poflible; firfl in a fluid form,
 when the folid cannot  be  admitted upon  account  of the
 debility of the ftomach; then, alfo  in a folid; and toge-
 ther with both, ftrong drink, fuch as the beft wine that can
 be got,fermented fpirit,fometimes pure,fometimes diluted.
 If the difeafe does not  yield to thefe, after their  ufe has
 been continued for a  proper length  of  time; recourfe
 muft be ha.I to the diffufible forms: By this means, when
 the effufion has not yet attained to that high degree that
 conftitutes a local affection, not to be altered by any  ftate
 of the excitement, this afthenia can be as eafily cured as
 any other.
   DCXXVI.  But, when a great quantity of water has
 now got into fome large cavity, it fhould immediately be
 removed by the catheter ;  when that has been done, and
 the emptied cavity fecured with as much care as poffibie,
 and the ftrength fupported by wine, ftrong drink, and any
 ftimulus more  diffufible, we muft return  to the manage-
                          Z                     ment

  (y) Sometime? the predominant fymptom rifes to the degree of being
above the pot:er of the excitement, as in the tumor of fchirrus, and the
tffuiion here. 
538       THE    ELEMENTS

ment mentioned a little above.   And if it fliould likewife
fail now, our judgment muft be,  that either the general
aifeafe, has degenerated into a local, or that the affection
has been local from the beginning.

                     Of Epilepfy.

   DCXXVII.  Epilepfy is an afthenia; the diftioguifhing*
 fymptoms  of which are, fome heavinefs of intellect, dul-
 nefs in the exercife of the fenfes; and then a very impaired
 fiate, or temporary extinction of  the latter, accompanied
 with various convulfions over the  body: Fits, confifting of
 fuch a concourfe of fymptoms  ufually return afterwards
 at uncertain fpaces of time, and  each of them terminates in
 i foaming at the mouth.
   DCXXVIII.  As  all the debilitating hurtful agents arc
 productive of this difeafe; fothe lofs of the blood and other
 Maids, excefs in venery, paffions, fuch  as fear, terror, afli-
 duous and intenfe thinking in great geniufes ; a deficiency
 of that kind  of ftimulus in flupid  perfons, are particularly
 fo (z).  Thefe powers that produce the firft fit, more ea-
 fily bring  on after ones: And befides them, certain unu-
 fual impreffions upon the fenfes,  fome of them difagree-
 able, fome highly agreeable ; fuch as  the flavour of fome
 foods, the fmell of a rofe, have  the fame tendency ; and
 certain poifons (a) are faid to have the fame effect.
    DCXXIX. But the appearance of  fymptoms is  a thing
 full of fallacy, and unlefs the nature of the hurtful powers
 producing them, and of the remedies removing them, be
 thoroughly underftood, it is incomprehenfible.   To folve
  the preefent difficulty about poifons, and to fettle the quef-
  tion, whether the fymptoms belong to univerfal, or local
  difeak; we muft confider, whether the latter one produced
                         2                         by
   (z) See above par. CXXXlV, CXXXVII. CXLII  and CXXXIX.
   (a) See XX. 
             OF   MEDICINE.         339

 by a vitiated ftate of a part,  fuppofe that  part either the
 ftomach or  brain, fuch a vitiated  ftate, as in fome point
 oi the lower extremities proves the caufe of the aura epi-
 leptic!; and whether this vitiated ftate refifts the virtue of
 the remedies, that perform their cure by changing the ex-
 citement; or whether all the fymptoms are either relieved
 or removed by the change of excitement. If the former is
 the caufe, the affection muft  be confidered as local (b); if
 the latter be the truth, the difeafe muft be held for a ge-
 neral one, and a true, but a great afthenia.   Nor muft we
 forget, that a great many fymptoms  of general  difeafes
 from the feme origin, are diffimilar; and many from differ-
 ent,  nay, oppofite caufes  are  fimilar ; that many local
 fymptoms  have a great refemblance  to thofe  of general
 difeafes, and that they fometimes, by a moft falfe appear-
 ance, counterfeit epilepfy, fometimes apoplexy, fometimes
 certain other general difeafes befides.
   DCXXX.  For the purpofe of preventing this difeafe,
 wTe muft both avoid other debilitating powers,  and thofe
 that have the greateft power in producing it.  The veffels
 fliould be filled, by giving food as nourifhing, and as effec-
 tual in producing blood as poflible ; the indulgence in ve-
 nery muft be moderated, chearfulnefs and tranquillity cf
 mind muft be favoured,  an  agreeable train of thinking
 muff be found, and all the objefts of the fenfes,  which
 give them difturbance, guarded againft^ the ftrength muft
 be fortified by recruiting exercife, by the Peruvian bark,
 if the approach of the fits can be perceived, and by wine
 and the more diffufible ftimuli.   A length of fleep, that
 is a medium betwixt too long and too fhort a continuance
 of it, fliould be kept up. Stimulant heat fliould be applied ;
 and all excefs of it as v/ell  as cold avoided (c).  The
                       Z 2                    pureft
  (b) See above CCXVIV.
  (c) SeeCXXIV. CXXVI. CCXXVIII. CCLXXVII CXXXVII,
CXXX. CCXXXVIII. Cc XXXIX. CCLX. 
34-Q       THE    ELEMENTS

pureft air, fuch as that in the fields, which is free from
moifture fliould be fought after.  The furface of the body
fliould be excited by friction, and cleanlinefs, for the pur-
pofe of cherifhing the organs of voluntary motion, that are
m.ofl clofely  connected  with  the  animal  power in the
brain.
  DCXXXI.  The fame remedies,  which  radically  cure
the gout, alfo cure  epilepfy,  and  precifely in the fame
manner  (d).

                        Of Palfy.

   DCXXXI. Palfy  is an afthenia,  in  which,  with  the
ether proofs of the ufual debility, often with fome degree
of apoplectic fit, commonly all on a fudden, the motion of
feme part of the body, and fometimes the fenfe of feeling
is impaired.  When the  fit is flight, and of fliort continu-
ance it terminates in health ;  but  the  confequence  of a
higher degree and greater duration of it is death.
   DCXXXIII. The  hurtful  powers, that ufually  pro-
duce epilepfy and apoplexy, alfo  tend to produce palfy.
                                                      And

  (d) This paragraph is the  anfwer to the jueftion propofed in that
which ftands  in the Elements, anfwering  to the fame number.  That
paragraph therefore is erafed, and this  put in its place.   I had hoard
from forre of  my pupils, that  they had been able by their diffufible fti-
muli, to remove epileptic fits.   But in cafe  of  any miftake I would not
venture to mark the fad for certain, which I have now done from my
own perfect conviction.  A young man lately married had the moft a-
l-.'.rming fit of  epilepfy that ever was : His cafe was thought beyond re-
medy : as an extreme one, however, he  got from fome p'-rfon the full of
a te:t-cup of tinitura thebaica up to a blue  ring a little below the brim.
He got out of his fit fome how or other.   But was perfectly ftupid and
lenfelefs for a fortnight.   Upon his falling into another I was  fent for,
;>nd brought him about in twenty minutes, as  I am told,  (for I did not
wait), fo conipktcly, that he got  out of bed, and ate a hearty meal of
beef ftaker. JVIasy weeks after, by mifmun aging himfelf,  and neglecting
<iirec~lio:is given him, he ftII into  a  flightcr one, and was cured in the
 fame way. 
              OF   MEDICINE.       34I

 And befides thefe, all the common debilitating powers that
 produce any afthenia direftly  or indirectly; great com-
 motion of the nervous  fyftem by means of too diffufible
 ftimuli; more affecting the circumference of the body,
 where the organs of voluntary motion are chiefly feated,
 and the internal parts and the brain lefs ; as is evident in
 ebriety, gluttony, and every fort of intemperance ; likewife
 an indolent v/ay of  life, which  is  commonly connected
 with thefe hurtful powers, have all the fame tendency.
   DCXXXIV. When the difeafe has once taken place, as
 it is kept up equally  by  directly or indirectly debilitating
 powers ; fo
   DCXXXV. For the indication of cure,which is precifely
 the fame as in epilepfy as.the energy of the caufe operates
 more immediately upon the  furface  of the  body, confe-
 quently  according  to what  was faid upon the fubject
 of epilepfy, the principal remedies are thofe, that have the
 greateft power in invigorating the  furface of the body ;
 Such are friction, geftation, that degree of exercife which
 the ftrength can bear, for the purpofe of roufing by their
 powerful operation, the languid excitement in  the fibres
 of the mufcles ; likewife a proper degree  of  heat of pure
 air, and therefore, as much as poflible, the open air; laftly,
 as none of the powers endued with ftimuiant virtue, by any
 means fhould be omitted, in order that  the excitement,
 which is of great confequence in every cure, be more equal
 and vigorous all over ; fo in that extreme debility which
 produces fuch an  impotency  of voluntary  motion, as it  is
 of the greateft confequence  to  make an impreffion upon
 the principal fymptom ;  we fhould, therefore,  employ a
great deal of an opiate,  (CXXX. and CCXXX.) the in-
fluence of which,  upon the furface, is  the moft confider-
able of all other powers, and prefs the cure, till fome com-
mencement of returning motion be procured ; and then,
 ,k;hovtt neglecting  the  afliftance  of any of the other fti-
                                               muli, 
34-       THE   ELEMENTS

mull, but ufingthem all in concourfe or fucceffion, for the
fake of rendering their common effect more powerful and
more equal, to eradicate the difeafe.
   DCXXXVI.  Debilitating and evacuant powers are  to
be avoided  for this reafon, that it is not vigour, it is not an
over-proportion of blood, but a fcantinefs of the latter, and
a deficiency of the former, that is the caufe.

                     Of Apoplexy.

   DCXXXVII. Apoplexy is an afthenia, refembling the
two juft now mentioned,  in its caufe and cure, differing in
the appearance  of  the fymptoms, which makes no differ-
ence in the truth (e): In  which, befides the  fymptoms in
common to it with them  and the other afthenije, all of a
fudden, fenfe, intelleftual energy, and  the voluntary mo-
tions, are impaired, the refpiration remains, but with fnor-
ing, the pulfe is weak, and the whole fit is finifhed  with
appearance of a profound fleep (f).
   DCXXXVII'I. The heads of the patients are large and
not well formed, their necks fhort and thick:  The  dif-
eafe arifes from both direct and indirect debility, but chiefly
from the latter.   Of the  indireft debilitating powers, the
moft powerful is the luxury of food, drink, and (loth,
which, after its courfe of ftimulating and filling the veffels
is run, is truly debilitating and productive of a penury of
fluids : And, as each fort of  debility  is encreafed by the
other, and confequently the indireft by the direct,  fo that
is remarkably the cafe in this difeafe.   Hence the effeft of
the debilitating  plan of cure is fo pernicious in apoplexy,
that it is received as a rule, that the third fit is not often,
the fourth  never, got the better of.
   DCXXXIX.  The caufe  of epilepfy,  palfy,  and apo-
plexy, is the fame with that of every afthenia ; affecting
                                                  the
(e)LXXXI.DXXIX.            (f) CLIII, CC. 
             OF   MEDICINE.          343

 the head kefs in palfy, excepting in the beginning and end,
 but greatly in the two others ; and in all the three produ-
 cing a difturbance in the organs of voluntary motion. This
 difturbance,  whether the motion  be deftroyed or  dimi-
 nifhed, in convulfion feemingly increafed, amounts  to the
 fame thing, and as was formerly explained, depends upoa
 debility (g).
   DCXL. The fame here too is the indication of  cure;
 with that, which runs through this whole form of difeafes,
 and the force of the remedies is efpecially, and as much as
 poflible, to be direfted to the parts moft  affefted. To pre-
 vent,  therefore, the fits, in every refpect alarming and full
 of danger, we ought to recollect, how far indirect debility-
 has a fhare in producing this  difeafe, and how far the di-
 reft concurs  with it; and alfo eonfider .the operation of a
 greatly advanced age.   All exceffive ftimulus,  therefore,
 muft  be avoided in fetch a manner, that the body may be
 invigorated and direct debility guarded againft, the ftimu-
 iant .plan  of  cure fhould be fet on foot with moderation
and accuracy; and in the place of the forms of ftimuli, that
 have,  either from long or exceffive ufe, loft their ftimuiant
 operation, according to the rule of nature,  others, which
the excitability, yet not worn out with refpect to them, can
 receive,  fliould be fuhftituted, tha: is, the .lands of food4
 of drink,, and of  diffufible ftimuli,, fhould be changed aU
 round, and upon the failure of .each lately ufed one., to re-
turn to thofe that have been long ago laid afide (h).
   DCXLI.  The  three  difeafes we are treating  of,  are
commonly fuppofed to arife from a  jpiethora,  attacking
 the head, and  proving hurtful by  compreffioa upon the
brain.   But,  befides that, .plethora has no exiftcnce in any
cafe where it has been fuppofed (i),  at that extreme age at
                                              which

  (g) LVI1I. CCXXX.             (h) ccci.
  (i)CXXXJ. CXXX1V. DXLIX. DLV. 
344      THE   ELEMENTS
 which thofe  difeafes happen ; or fometimes in epilepfy,
 when it  affefts weak and ftarved children,  how can the
 blood be in over proportion ? Can penury of food, which
 alone is the matter that forms blood in the latter, and in the
 former a vigour long gone,  create an over-proportion of
 blood, and not, on the contrary, a penury of it ?
   DCXLII.  As plethora has then no fnare in inducing
 thofe difeafes,  fo neither is  an effufion of blood or of fe-
 rum (k) upon the brain, to be accufed of it. Nay, a fimilar
 effufion happens in every cafe of the veffels, from great de-
 bility as well as in this cafe.

                    Ofithe Lock-faw.

   DCXLIII. The lock-jaw  is  a lefs degree of tetanus,
 its fpafm being confined to the lower jaw and  the neigh-
 bouring  parts.  This is a rare affection, without others
 equally confpicuous ; as being a formidable fymptom of fe-
 vers and wounds.   When the former of thefe happens, it
 will be treated of in fevers ;  when  the latter, it will give
 occafion  to an enquiry, whether it belongs to local or ge-
 neral difeafe.
 DCXLIV. Since it never arifes immediately after a wound
 is inflicted, but ufually  happens, either when the latter is
 healed up, or after a confiderable interval of time ; the in-
 ference from that is, that it either  arifes from  the violence
 and duration of the pain, which is always a caufe of very
 much debility, or from that debility, which the ufual an-
tifthenic plan of cure produces, or from an unknown taint
 in the fubftance of the nervous fyftem.
  DCXLV. That it depends upon debility we  have rea-
fon to believe, from every fort of fpafm always depending
 on debility  (1); from tetanus, which is precifely the fame
                                             affection,
  (k) CXXXV1II. and the addition.   (1) CLXXXIX. CXf. 
           OF   MEDICINE.          345

affeftion, only differing in degree (m), having no other ori-
gin ; and, in fine, from the faccefs of the ftimuiant plan
of cure in this  as well as all other fpafms;  and the want
of fuccefs of the antifthenic, or debilitating evacuant  one.
All the other particulars regarding this fubjeft will be ta-
ken notice of under the next head of difeafe, tetanus.

                      Of Tetanus.

   DCXLVI. Tetanus is an afthenia, and, therefore,always
affecting perfons under debility,whether direft or indireft;
in which, fometimes with concioufnefs,  fometimes  not,
fometimes with difficulty, fometimes with freedom of ref-
piration, the whole body, or the neck and its neighbour-
hood only, are bent fometimes forward, fometimes back-
ward, and held faft by a rigid fpafm.
   DCXLVII. Tetanus is the offspring of cold countries,
as the northern parts  of Europe,  but rarely ; more fre-
quently of the warm fouthern regions of that divifion of
the world ; but moft frequently of the torrid zone.   The
rare cafe, fuch as that among us, is the fequel of a debili-
ty fcarce ufual in other general difeafes :  On the contrary,
it almoft always arifes from that unufual debility, which is
occafioned by a lacerating wound, through which fractu-
red bones are dafhed, increafing the fum of  that debility
that exifted before, or that happened to be induced in tha
courfe of the cure.  To produce the more frequent cafe, or
that moft frequent one of all,  which is quite common in
the  torrid zone.  The moft powerful of the debilitating
powers, and a  very  great many, if not all of them,  con-
 cur.   The moft powerful of thefe is, that degree of heat,
which is intolerable, to  perfons engaged in exercife or la-
bour (n), to whom almoft only,and therefore to the flaves,
it is hoftile. Hence, even under the flightefl corporeal mo-
                                                 tion

     (m) CCXXVIII.      (n) CXXVU. and '-he addition 
346      THE   ELEMENTS
 tion, fatigue, and fweat,  are produced (0),  and from the
 fweat a fcantinefs of blood and other fluids.   From  all
 thofe arifes a languor over the whole body, and, therefore,
 in the ftomach.(p): From the languor of the ftomach there
 is  a puny appetite,  and food, which is another caufe  of
 penury of the fluids, is either not taken in, or thrown  up
 again.   All thefe affections, as well as that indolence both
 in mind and body, which is infeparable from fuch a  ftate
 of circumftances, are followed by the higheft degree of de-
 bility over the whole body: And,  as the  moft noxious
 power, the intenfe heat diftreffes the head more than any
 other part, as v/ell as the organs of voluntary motion, whe-
 ther in the neighbourhood of the head, or more diftant
 from it;  that is the  caufe  of the urgent  fymptom,  the
 fpafm, occupying the parts that have been mentioned.
   DCXLV1II. As tetanus is occafioned by aft the debili-
 tating powers, according to the different degrees in which
 they poffefs that effect, and, confequently, like every other
 afthenia,  depends upon  debility  as its -caufe;  and, as  all
 the aftheniae, are removed by remedies, exciting the whole
 fyftem in fuch a manner,  as to exert the greateft influence
 poflible upon the labouring part;  the fame, accordingly,
 is the nature  of tetanus, however little that difeafe has
 been underftood, the fame fimplicity of nature is found in
 jt: And if there  is occafion in it for the very higheft reme-
 dies, that circumftance fhows, that the whole difeafe  does
 not depend upon the fpafm, and that the labouring mufcles
 are not its whole feat, but that there is vaft debility in every
 part, only greater in the mufcles, than in any other equal
 part, according to the lav/ we have mentioned (q).
   DCXLIX. From what has been  faid, after tetanus has
 taken place, and upon accomut cf the teeth  being fhut by
                                                 the
  (o) CXV. CXXV1I. and the addition.   (p) CLXXXVl. CXCIV,
foCXCVIlI.   (<j)XLIX.
* 
             OF    MEDICINE.          347

 the lock-jaw, there  is  neither accefs to the weaker and
 lefs powerful ftimuli of food, drink, and fuch like, which
 are often fufficient for the cure of difeafes of leffer debility,
 nor any fenfe in nfing them; we muft, therefore, immedi-
 ately have recourfe to the moft powerful and moft diffu-
 fible ftimuli poflible,  and continue  their ufe without  re-
 gard to quantity,  not even   that of  opium itfelf, till the
 whole tumult of the difeafe is allayed (r).

                   Of Intermittent Fevers.

   DCL.  Paroxyfms, confifting of a cold, hot, and fweat-
 ing fit, are a fort of phenomena that occur in every inter-
 mittent;  and, in  a certain proportion, in every remittent
 fever.  They  often come on in confequence of  a certain
 taint received from neighbouring morafles, or from a fimi-
 lar ftate of a neighbouring foil; but they alfo happen andof-
 ten too, after an application of cold only (s); at other times
 after that of heat only (t), when the common afthenic hurt-
 ful  power accompanies either:  And they return  with ^
                                              remarkable
  (r)CCXCV. to CCCII.
  (s) as in the vernal interniittents in Scotland.  In the Mers, or coun-
ty of Berwick, where I laboured three montlw under a tertian, that is,
from the beginning of March to the beginning of Jun;, and in the Carfe
 of Cowrie, and fome other places in that country,  nothing is more com-
 mon than the tertian ague happ-etting at the time at which I was affect-
ed ; and nothing is more certain, than that the cold and moifture are th§
chief powers inducing it.   It is fomewhat ftrange, that a man born in
that country, if he would patch ui  a fyftem of fevers,  fhould have over-
looked a form of them, that occurred to his eye- fight every day, and bor-
rowed his hypothetical courfe from a marfh miafma, fuppofed to be  the
produce  of great heat and moifture, though he had only heard or read
of the intermittents of warm countries.
  (t) In the warm countries agues often occur, when it is eafy t<> difcern
heat to be an hurtful power; but when moifture is much lefs prevalent,
for that very reafon that the  hot is  prevalent,  than at other feafenj
 vvhen the dfeafe docs net occur. 
 34§       THE   ELEMENTS

remarkable exacerbation, after a temporary folution of the
difeafe, or an abatement of it;  in the cold fit, exhibiting
manifeft  debility;  in .the  hot, counterfeiting a deceitful
appearance of vigour; and fcarce ever obferving any ftrift
exaftnefs in the time of  their return (x); but returning
fooner in a higher, and later in a lower degree of the dif-
eafe ; and not unfrequently, befides the remittent, alfo gra-
dually afluming a continued form ; and, on the contrary,
fometimes without interference, oftener  in  confequence
of an improper  method of cure, before the difeafe is ended,
changing into quintans (y), feptans (z), nonans(a) or into
fextans, oftons, and decans (b).
  DCLI. The fever of this kind, which returns every
fourth day,  and is therefore called a quartan, is milder that
that which receives the name of tertian, from its recurrence
being on the third day, and the latter is milder than that
which, from its return everyday, is denominated quotidian.
The difeafe, that degenerates into a remittent or continued
form, is of a worfe nature than that which is regular in its
returns, or that which puts off fits, and protracts the inter-
vals betwixt them: And,  the form and type of each cafe
being given, the whole fet is both of more frequent recur-
rence, and of a more fevere kind in hot, than cold, climates.
  DCLII. That this  fort of  fever depends upon  debi-
lity throughout the cold fit, is proved  by the fymptoms,
by  the exciting hurtful powers, and by the method of
cure, whether fuccefsful, or the contrary.
                                              DCLIII.
  (x) Dr, Sydenham was content  to co,unt the periods by the day, which
was even too particular, but Nofology has refined the  matter into the
wonder of exactnefs to an hour.
  (y) Where the fit does not return till the fifth.
  (z) Where its return is not till the feventh day.
  (a) Where the intermiffion continues till the ninth day,
  (b) That i*, prolonged  their intermiffion  till the fixth, eighth, or
teoth day. 
            Of   MEDICINE.          349

   DCLIII. The whole difeafe, as well as every paroxyfm,
begins with a fenfe of cold, the greateft defire for a warm
fituation (c), with  trembling, and that fhaking motion in
which the whole body is lifted up from the bed (d), with
palenefs, drynefs, and fliriveliing of the fkin, with the di-
minution of tumors and drying up of ulcers, that the pati-
ent may happen to have had before the arrival of the dif-
eafe, with an impaired ftate of the intelleftual faculty, a
want of fteadinefs in its exertions, and fometimes delirium,
with a dulnefs of fenfation,  languor of fpirits,  torpor of
the voluntary motions, a liltkfnefs of mind and body in all
the functions, in fine, a manifeft debility.
   DCLIV. If terror,  horror, cucumbers, cold melons, fa-
mine, debauch in eating and drinking, food of difficult di-
geftion, have been found for certain, to have  a great effect
in bringing back paroxyfms, after a long intermifiion of
them;  if in cold fituations, where  cold is  the principal
hurtful power, it  is the poor people, who are ill clothed,
ftarved in their diet, and enfeebled by labour, who in gene-
ral are only affefted with difeafe; if in warm regions of the
globe, thofe who have been moft expofed to debilitating
hurtful powers of all kinds, who, in preference to others
are feized with it (f ) ;  if in moft places,  thofe who live
well in their diet, and cheer themfelves with their bottle,
efcape the difeafe (g), and water drinkers and perfons in a
                                                   ftate
  (c) I remember yet, that it was the higheft luxury for me, when the
cold fit came on, to be put in bed, and covered under fuch a load of blan-
kets (for the cold of fheets wa6 intolerable) as would, at any other time,
have oporeffed me. I was  then  about eleven years of age-
  (d) Ey authors and lecturers in Latin abfurdly called rigor.
  (f) See DOXLVII.
  (g) as in Holland ;  where the  Dutch ftudents who live not  near fc*
well as the Englifh, are very liable to the difeafe, while the jolly living
c.nglLfh, who do not like the wenk llhcnifh wines, and the weak ill ma-
                                                   na?e4 
  35°        THE    ELEMENTS

 ftate of inanition from low living peculiarly experience it;
 all thefe fafts fhew, how far this difeafe is from depending
 upon heat and moifture alone; and prove, that it alfo arifes
 from cold, and not from either alone, but alio from aU the
 ufual hurtful powers,  like every other afthenk.
   DCLV.  Further, if every kind  of evacuation, as of-
 ten as it has  been tried, is found without the poffibility of
 a doubt, to be hurtful; if no perfon in his fenfes has fcarce-
 ly ever attempted bleeding(h); if, before the Peruvian and
 fome other barks of fimilar operation were found out to act
 as remedies, a variety of ftrong drinks (I) were  ufed with
 fufficient fuccefs ; and if it now alfo is found and demon-
 ftrated in faft,  that the diffuble ftimuli are by fir more ef-
 fectual then any bark;  nay, that the bark often falls, while
 theyare perfeftly effectual in the re-eftablifhmcnt of health;
                                                       from

 naged vjn de Bourdeaux, which is a cheap dirty dare*, almoft never fall
 into the difeafe at Leyden. while the Dutch are perpetual  victims to  it
 as often as it is epidemic.
  (h) They have talked of  taking a little blood in the fpring  intermit-
 tents, but that was a theory  of Dr. Sydenham's, who divided the difeafes
 nf the whole yeai;, into inflammatory and putrid, and 1  do not find, that
 that idea has ever been fo lowed in pradice.  For though they follow
 him moft fervilely in  moft refpects, efpecially where he is  wrong, their
 vanity, that they may sow and then feem to ftrike out fuir.cthir.g frora
 themfelves, difpofes them to differ from  him in others, efpecially where
he is  riyht, as in the objection of purging in  fome  fthenic  difeafes
 (CXXXVII).
  (i)  as ale, wort, win?, fpirits, ftrong punch.  Riverius followed this
 plan ;  and I remember it was euflomary among the common people to
 cure themfelves  by getting  tipfy.   But  I  was allowed neither the one
 method of cure,  nor  the ether. The authority of Dr. Stahl and Uoer-
 haavc, had thrown the bark into difrepute in Britain. And my mother,
 " who truflxd in God, and  net in phyficians," left me to the courfe of
 defires and  averfions, which were chiefly to avoid cold, and anxioufly
 feek for keat.  She kept re\c upon a vegetable diet in the i:itermifl3ensa
 which I even then did not much like.  It was the kindly warmth of fum-
mer, which then fet in early, that had the chicfeft effect in  gradually fi-
 nifhing the.t cure. 
            OF   MEDICINE.          35I

from this fort of argument and certainty in point of faft,
we derive the moft folid conviction, that there is nothing in
this difeafe different from  other afthenioe, but that it per-
fectly agrees with them in the exciting hurtful powers, in
the caufe, and in the cure.  And, if it differs in the appea-
rance of the fymptoms, that fhows no difference of nature,
and  not even  any thing unufual; as all the afthenia; that
have been mentioned, however much they  have been pro-
ved  to be the fame (k), differ notwithflanding, in a fimilar
manner, from each other, and fymptoms lead not to truth,
give  no real information.   For, though precifely the fame
found functions flow from the fame ftate of perfect health;
yet when the latter is fo changed, as that the excitement is
either encreafed or diminifhed, the functions are changed
from the ftandard into every  fort-of appearance,  in fuch
fort, however, that they point out no difference in the caufe
as has  been commonly  believed, and not always even a
difference of degree (1).
   DCLVI. Accordingly, the following demonftrated faft;>
of fpafm, convulfion, tremor, inflammation from weaknefs,
deficiency of menftruation(m), bleeding difcharges (n), lofs
of appetite, thirft, naufea, vomiting, diarrhaea with paia,
diarrhaea  without pain,  and all  the other afthenic affec-
tions (o), arifing from one and the fame caufe, and beinc
removed by one and the feme operation of the remedies (pk
and  not even in their morbid ftate, expreffing degrees of
debility in fuch a manner,  as that it can  be thought
proper  to take any order of arrangement from that mark;
all thefe ferve to confirm the obfervation juft now made,
and  by  their analogy, to dernonftrate, that the fevers alfo
                                                   are

  (k) See par. LXXI. and the addition. LXXXI. DCXXlX.
  (1)  DlV. DV1I.     (i-.) DXLV. and the following paragraph.
  (n) DXLVIII.      (o) CLXXVI. to CXCV.  and to CXCVU.
  (p)CXXII. DLVI. DLXI DLXXI.  DLXXII.  DLXXlV. to
DCXCV. and from that to DCXCVUI. Look alfo carefully over the
whole iVth Chapter of the fecond part. 
  yj2       THE   ELEMENTS

  are diftinguifhed by intervals of freedom from febrile ftate,
  fometimes greater, fometimes fearcely perceived in  com-
  mon with what happens to many other difeafes, not from
  any peculiarity in the caufe,but from a variation in its force.
  If fevers fometimes intermit their febrile impulfe, fometimes
  exert it more remikly, and fometimes, by performing the
  Inter imperceptibly, go on almoft in a continual career (q);
  do they, in that refpeft, differ from  the  gout (r), which
  never goes on with an equal force, but abates from time to
  time ; and even, when it has interpofed an interval of health
  returns  with more feverity than  ever ? Or do they differ
  from afthma, as well as  many other difeafes, in all which
  the feme  thing precifely happens ?  And  what is  more
  ufual, in indigeftion, and often violent vomiting (s), ac-
                                                  companied

   (q)  DCL.
   (r) When the gout in the  eld way, is left to patience and ff an.iel and
 low  diet and watery drink, it fhews both remiffionsand confiderable in-
 termifiions.   I  have been often mortified,  at finding, in confequence of
 walking.a little too freely, when I thought the fit was gone, a more vio-
 lent return than the firft part had been ;  when I had not yet attained to
 the full knowledge of the nature and management of that difeafe. Which
 is a circumftance, that every podagric, who is ftill treated in the old way,
 tan bear wit:icfs to,  Dr Sydenham fell a  victim to his ignorace of its
 nature.
  (s) A gentleman in Scotland, came to dine with his brother, who lived
 with me and  my  family, in a houfe in the neighbourhood of Edinburgh,
 He ate  and drank fo fparingly,  that I predicted, from a knowledge I had
 of his manner of living, which was an excefs of temperance and abftemi-
 oufnefs to a faulty degree, tlret  if he did not indulge a little more in thefe
 refpects, he would foon fall  into a difeafe  of debility. The prediction
 was verified  in a few days ;  when  his brother having occafion to go  to
 town, found him, in the intervals of a violence  of vomiting, making hi*
 tcftameiit.  By a good dofe  of the  diffufible ftimulus, he removed the
 whole difeafe at once, and enabled him, with the additional help of fome
good found port and genuine  Madeira, in a few minutes to' eat heartily
of beef flakes. Before his brother's arrival  he-  had been treated in the
 ufual evacuant, and, fas they call it,  the antiphlogiftic way. Upon the
 return of his  medical friends a  glifkr was prtferibed, which threw him
                                                        hack 
               OF   MEDICINE.         ^53

companied with a rage of other fymptoms,  than the inter-
vention  of the intervals of the greateft relief ?  The fame
is the nature of the chin-cough (t) the  fame as that of
the afthenic cough (v).   In fine, where is there  one of all
the fthenic, or all the afthenic difeafes, the morbid career
of  which  continues the  fame   from beginning to end ?
There is none (u).   For,  as  life in  all its ftates  (x) is
always in proportion to the aftion  of the exciting pow-
ers,  upon the  excitability, and  both  predifpofition  to
difeafes, and difeafes themfelves fupervene in proportion to
its being greater or lefs  than  the proper degree;  fo the
courfe of difeafes follows the fame rule; and, according to
                            A a                          the

back into his difeafj, from which, with the fame eafe and in  the fame
fhort fpace of time,  he  was extricated upon his brother's  return to his
poft.   This young gentleman from that beginning,  like many other of
my pupils, is now a moft refpectable man in his  profeffion.  ISome time
after that, he performed  the greateft cure, that ever happened fince the
firfl annals of medicine.  In a very dirty fhip, the  Dutton, which was
going to the Eaft Indies,  he ftemmed,  in the latitude of Rio Janeiro, a
fever that was carrying off numbers every day,  lofing not one ; as can
be attcfted by the Ihip's books, for no lefs than five weeks—his name is
Dr Campbell.
  (t) See 579.             (v) And from DLXXXVI1. to DXCViT.
   (u)  All this confirms, and not  only the point at prefent meant to be
fettled, which is that the diftinctions, thatjphyficians have made about
 the differences of fevers, are without all foundation,  and that they are all
the fame with no other difference but in degree, and that, unlefs in that
refped, they do not differ from other  difeafes of the fame form ; but it
likewife adds additional weight to our fundamental propofition, that we
 are nothing in ourfelves, but according to the powers acting on us.  Ma-
 ny circumftances in the  courfe of difeafes,  that efcape the obfervation
 both of patients and phyficians, are of hourly'and momentary occurrence,
 and fufficient, when their importance is weighed according to the prin-
ciples of this doctrine, to accoun t for the variations in the progrefs of dif-
 eafes.  We fhall, by and by, fee that thi circumftance ef heat, from the
 "ratification of indulging in which the patient is not to be turned afide,
 by any advice, is with its conferences upon the whole fyftem, fufficient
 to  account for the gradual  converfion  vf the cold into the hot, aud the
I hot, into the fweating, ftagss.             (x) Sec par.  IX, 
  554       THE   ELEMENTS

  the variation of the degree of that aftion, is one while en-
  creafed, another while diminifhed, another while exhibits
  a temporary eruption ; juft like what happens in this fort
  of fevers.
    DCLVII. The  caufe  of them is the common one of
  all aflhenise,  whether  febrile or not;  but under fuch di-
  rection and application to the fyftem, that,  after an interval
  of fome hours, all their morbid energy departs entirely,
  or in feme degree.  And the reafon of that is, that  the
  exciting hurtful powers in the fame proportion are either
  removed, or more gentle in their operation ; in one word,
  the excitement is encreafed for  the time.  -The variation
  of types is not owing to a matter, fubjeft  to the fame va-
  riation : For, if that were the cafe, how  could the fame
  cafe run through all the forms, fometimes  of intermiffion,
 iometimes of remiffion, and at other times of nearly going
 on with a continued movement and the contrary ?  Is the
 matter, which is fuppofed to produce each  form, in order
■ to produce another form, changed into that matter, which
 is fuppofed neceffary to the latter (y) ? Is the vapour, or,
 as they call it,  the effluvium,  proceeding  from animals,
 which is fuppofed to produce any typhus, or continued fe-
 ver, and, therefore, the ^Egyptian one, when this is chan-
 ged into an intermittent, or remittent nature, alfa, together
 with  the change of type,  changed into a  marfh miafma,
 or defilement arifing from moraffes, which is  fuppofed
to produce that form of fever ? Or rather does the matter,
which at firft produced each type, ftill continue the fame,
and become the caufe of  another form ?  If any  perfon
fliould fix upon the latter as being the truth, how fliould the
                                                 fame
  (y) The ancients fuppofed, that every  type arofe from a matter fuited
to produce it.  Now, fuppofe a quotidian type to depend upon any giv
en matter, and a tertian upon^any other, different from that; when ei
ther type is changed into the other, are we to fuppofe  that the nutter i&
alfo changed, and fo forth of the reft I 
            OF  MEDICINE.          355

 fame caufe produce different effects ? But, if he inclines
 to adopt the former fuppofition, what proof is there, that
 can be admitted upon any principle of reafoning, that, as
 often as the form of the fever changes, fo often its  caufe,
 the matter, is alfo changed ? It has been already proved,
 that marfh miafmata, or defilements, are not the caufe (z).
.And it fhall be by and by evinced, that the  animal effluvi-
 um, or vapour, arifing from the body, when affefted with
 a continued fever, is not: Nay, it has been  proved by the
 moft folid argument,  that neither is any other matter tak-
 en into the body, either in this or any cafe, that which pro-
 duces the difeafe, and that the change of excitement alone
 is the univerfal fource of all  general difeafes (a).
   DCLXI. To enquire into the  return  of fits  ; it is
 not peculiar to this form of fevers, to have a return of the
 general affection after  its temporary folution ; the fame
 thing happens  to the gout, as often as a return of the dif-
 eafe again fucceeds to a return of health (b), and for the
 fame reafon (c): For, as thofe difeafes are repelled by in-
 vigorating means, fo they are brought back by the debi-
 litating powers, which were their firft caufe. Accordingly,
 v/hen the difeafe is left to itfelf, when it is treated by a de-
 bilitating plan of cure, it perfeveres in returning; when it
 is treated with Peruvian bark, and ftill more certainly by
 the forms of wine  and  diffufible ftimuli, and when that
mode of cure is perfifted in,  till the ftrength is quite con-
 firmed, it never returns.
  DCLX.  The tertian vernal fevers of Scotland  go off
 without medicines, in procefs of time, firft in confequence
of the heat of the bed, and then, as the fummer fets in, by
balking in the rays of the fun, and by a moderate ufe of food
 ,                        A a 2                  and

  (z) DCLIII. DCLIV.  DCLV.
  (a) Sec the paragraphs XXII. XXIII. LXII. LXIX. LXX  LXXIT.
LXXIII. and LXXXV1II.
 (h) DCLVl.               (c) D7LVII. 
 35&        THE   ELEMENTS

 and ftrong drink, their duration commonly not exceeding
 the fpace of three months.  In all the fouthern regions, and
 even in England, the Peruvian bark, when the whole cure
 is entrufted to it, often fails,  and they are not removed
 but by very diffufible ftimuli (d).
   DCLXI. The debility  during   the  cold ftage  is the
 greateft, that of the hot lefs, and that of the fweating ftage,
 which ends in health for the time, is the leaft of all. Hence,
 in a gentle degree of the difeafe, as cold is the moft hurtful
 power, the confequence is, that its effeft is gradually ta-
 ken off by the agreeable heat of the bed or of the fun, and the
                                                   ftrength,

  (d) Dr. Wairiman, as it was faid before, found that to be the cafe in
the fens of Lincolnfhire.  From which we may learn how little depend-
ence is to be had on the  facts  in medicine, as they are delivered from
defks or in books;  from both which we have always been taught to be-
lieve,  that the Peruvian bark  was a catholicon  in intermittent fevers.
But, if it fails in the cure of the mild ftate of that  difeafe in this country,
what muft we think of its efficacy in the malignant intermittents and re-
mittents of the tvarm countries? And, if that medkine, with its univer-
fjl high character, fliall turn oat next to an impofition, what are we to
think of teftimonies in favour of any thing? One  of the ways of admini-
ftering the bark is in ftrong wine or fpirit, and it can hardly be  doubt-
ed, but in that compound form it may have been of fervice.  But where
fhall we find a panegyrift on the bark,  who will make any allowance
for the powerful medicine conjoined with k ?  They talk of it as a ve-
hicle, without allowing it any other credit.  In the fame manner, at all
times, have many powers of great operation been overlooked in the ac-
counts given  us of remedies, and the merit of the cure imputed to the
moft inert.   J have moft generally found an analagy  betwiit the tenie-
dics, that are, in reality, powerful, and our ordinary fupports of health.
The wines and ftrong drinks are certainly a part of  diet with moft people,
and fo is opium an umg the Turks.  But what analogy can be found be-
twixt the fame ordinary fupports oflifc, thefame durable and natural fti-
muli, and the bark of a tree, whether brought from South America, or
growing among ourfelves ?  I will not pretend to fay, that the bark is de-
void of all virtue; but I muft have greater proofs  of its power  over dif-
eafe than I have yet met with,  before I can retract much of what I have.
&id. 
            OF   MEDICINE.          357

 ftrength, thereby gradually drawn forth.  The heart and
 arteries, gradually excited by the fame heat, acquire vi-
 gour, and at laft, excited in their perfpiratory terminations
 by  the fame ftimulus the moft  hurtful fymptom being
 thereby removed, they reftore the hot fit, and afterwards
 carry on the fame procefs to the breaking out of fweat.
   DCLXII. When  the  force of the  difeafe is greater,
 thefe powers are ineffectual;  and, unlefs the moft power-
 ful remedies are applied, the  difeafe, inftead of producing
 intermiffions, rufhes head-long  into the remittent ftate
 only,  or even into thofe very obfcure remiffions,  which
 give the  appearance of a continued difeafe.
   DCLXIII. And,  fince in every cafe of difeafe of any
 energy, the difeafe returns, for this reafon, that either the
 leffer force, by which it is kept up, is not flopt by a leffer
 force of remedies, or the greater force  of the former  by a
 greater force of the latter (e);  the  remedies, therefore,
 fliould be given both before the cold  fit, and during it, as
 alfo through the whole courfe of the intermiffion to the
 next paroxyfm, and they fliould becontinued even through
 this, and after it is over.   Laftly, like the praftice in every
 other  cure of afthenic difeafes,  we  fhould gradually re-
 cede from the ufe of the higheft  ftimuli, in proportion as
 the  body can  now  be fupported  by the leffer and more
 natural (f).

                 Of the fevere Dyfentery.

   DCLXIV.  The  fevere dyfentery, or bloody flux, is
 an afthenia ;  in which,  befides the fymptoms  in common
 to that whole form of difeafes, fo often now repeated, there
 are pains in the inteftines, gripes,  innumerable dejections,
                                               chiefly
  (e) For the curative force muft always be accommodated to  the mor-
bific, or caufe of the difeafe.   See above XClI. CIX.
  (f) CV.andCVII. 
358      THE   ELEMENTS

 chiefly mucous, fometimes bloody, for the moft part with-
 out the natural matter that paffes that way, all which hap-
 pen often after contagion has been applied.

                 Of the fevere Cholera.

    DCLXV.  The  fevere cholera  adds to  the common
 fymptoms of every afthenia, thofe of vomiting and purg-
 ing, alternating with great violence, and for the moft part
 confifting of bilious matter.

                      Of Synochus.

    DCLXVI.  Synochus is a very mild typhus, and fuch
 as chiefly happens in cold countries and cold feafons ; in
 the beginning deceiving phyficians by a certain refemblance
 to fynocha, but a couterfeit one.

           Of thefimplc Typhus,  or Nervous Fever,

    DCLXVII. The fimple  typhus, or  nervous fever, is
 fuch a fynochus, as appears in warm countries or feafons,
 but fomewhat more fevere, and yet fufficiently fimple.

               Of the Cynanche Gangrenofa.

    DCLXVIII. The gangrenous cynanche is a typhus,  a
 little more fevere than the fimple typhus, or nervous fever,
 with  an eruption upon the fkin, and a red tumid inflamma-
 tion of the  throat, and with mucous crufts of a whitifh
 colour,  and concealing ulcers below them.  The end of
 the angina,  formerly mentioned(g), equals or exceeds the
 \ iolence of this difeafe.

                 Of the confluent Small-pcx.

    DCLXIX.  The confluent fmall-pox is a typhus chiefly
 depending  upon indireft debility.  It  is  preceded by
                                                a great
               (g) CCXXll, ccxxiv. 
OF   MEDICINE.         359
a great eruption of the diftinct kind, and an univerfal cruft
of local inflammation over  the whole body ;  which,  by
their local and violent  ftimulus, convert the fthenic into
the afthenic diathefis, and the inflammatory affeftion into
a gangrenous one.  Its cure is  to be conducted upon the
ftimuiant or antifthenic plan, but in fuch a way, however,
as is fuitable to indireft debility.

Ofi the pfiilential Typhus, the jail, putrid, or the petechial Fever,
                    and the Plague.

  DCLXX. The peftilential  typhus, or the jail,  putrid,
and petechial Fever, is an afthenic difeafe of the higheft de-
bility, fcarce excepting the plague itfelf; in which the fur-
face of the body is firft dry,  pale, hot, fhrivelled ; then,
chiefly towards the end,  moift,  drivelled with fpots, and
colliquative fweats, diverfified with vibices, or long ftrokes
like thofe laid on by a whip, and wafted with colliquative
diarrhoea ;  in which the ftomach is affefted with the want
of appetite, loathing of food, naufea, often with vomiting;
in which the belly is firft boundifh, and then, as it has been
faid fubject to colliquative  evacuation; in which  the  in-
telleftual function is firft impaired, then becomes incohe-
rent, afterwards delirious,and that often in the higheft de-
gree ;  in which the fpirits are  dejected and wafted with
fadnefs smd melancholy; in which the voluntary motions
are early impaired, and then fo deftroyed, that the patient
cannot be fupported in his pofture in bed by hisownmufe
cles, or prevented from flipping down, from time to time,
from the upper to  the lower part, and the fenfes are either
blunted or preternaturally  acute.  In fine, the urine,  the
fceces, the breath, and all the excrementitious difcharges,
have a lingular foetid fmell.
   DCLXXI. Thejplague  begins,  holds  on in its courfe,
and ends  with fimilar fymptoms: To which,  however,
                                           carbuncles, 
360       THE   ELEMENTS
 carbuncles, buboes, and anthraces, or fiery fores, are added*
 Thefe are moft frequent in the plague, but not fo confined
 to it, as to be excluded from the peftilential fever (g).
   DCLXXII. Contagious  matter fometimes accompa-
 nies typhus, always the plague : The former is of a com-
 mon nature,  or fuch as is liable to happen in any part of
 the globe; the latter is thought peculiar to the eaftern part
 of Europe, and the weftern of Afia, poffeffed by the Turks,
 called the Levant.
    DCLXXIII.  With refpeft to  the contagious matter
 of typhus ; the corruption of the fluids is by no means to
 be  imputed to it (h), nor is  heat fo much to be blamed ;
 for cold has an equal power in producing that effeft  as
 heat (i), as has alfo every thing, as well as heat, that either
 directly,  like cold,  or indirectly like  it,  debilitates  (k).
 Nay, the emptinefs  of the veffels, from want of food, or
 from the incapability of the digeftive organs to take it in
 and affimilate it, as  alfo that debility which is  induced by
 melancholy and grief, though, in thefe cafes, no matter at
 all is prefent, admit of the fame application. By means of
 that debility in the  extreme veffels, internally, as well as
 externally, and,  therefore, efpecially in thofe of the ali-
 mentary canal and in the perfpiratory veffels, the  fluids
 ftagnate ;  and by ftagnating under the heat of the body,
 degenerate into that foreign quality, which, in a more ex-
 tenfive fenfe, is called corruption, but  in a more uncertain
 one, putrefaction (m).
                                           DCLXXIV.

  (g) CCX1X.         (h) See above CXV. CXXII. CCXXXVI.
  (i) Ibid, and CCLXI,    (k) See again CCXXXVI.
  (m) There are three ftates or qualities produced in fluids by as many
different fermentations, the faccharine, acid, or putrefactive.  To one or
other of thofe we are  apt to refer every ftate of  corruption in our fluids;
but they are liable to  degeneracies, which do not exactly correfpond to
any of thofe : And, as we are not yet acquainted with any of thofe de-
                                                viations 
              OF   MEDICINE.           361

   DCLXXIV. As the caufe  of  all thefe difeafes is the
 fame with that of the  difeafes not febrile, to wit, debility;
 differing only in this,  that it is the greateft debility compa-
 tible with life,  and not  long compatible with it; fo,
   DCLXXV.  The indication alfo of cure is the  fame as
 that of the  other afthenia, but muft be conducted with a
 good  deal of more attention than is neceffary in them, up-
 on account of their much greater mildnefs (n). It is, then,
 debility alone, that is  to be regarded in the cure;  and fti-
 muiant or antifthenic  remedies alone, that are to be ad-
 ministered.   Nor is there occafion for any diftinftion in
 the method of  cure,  but  what direft or indireft debility
 requires  (o).
   DCLXXVI. The  indirectly  debilitating powers, are
 the violent and local  ftimulus  of the eruption in the  con-
 fluent fmall-pox (p),  fo  often  inducing proftration  of
 ftrength, and drunkennefs(q), heat (r), or long continued
                                                    luxury

viations from the natural ftate, it is fafer to ufe the general term corrup-
tion.   Even the word acrimony is too general as we can by no means
pretend to  fay, that perfect blandncfs is the natural and healthy ftate of
our fluids :  Nay the different ufes and fubferviency to the functions feem
to require a confiderable deviation from  blandnefs; the urine, the per-
fpirable fluid, the bile, and other*, being intended, by a certain poignan-
cy, to  anfwer  certain purpofes.  Thefe, compared to certain blander
fluids, may  be fiid to be acrid;  while compared to their ftate  in morbid
degeneracy, they, may be called bland, and the latter acrid.
   (11) Fevers will require many more vifits from the phyfician than are
commonly  either bellowed or required, and often a good deal of watch-
in-T.  While this is more  generally the  cafe in fevers, at leaft in the
high decree in which thefe fevers exift, at the fame time they are not the
only otus that require fuch  ftrict attention ; as every difeafe, when it has
attained to  the fame degree of debility, endangering life, will claim the
fame circumfpetftiou and vigilance from the judicious and confcientious
phyfician,
   (o) See  par. CHI. CVII.
   (p) See  CLXXV. CCXV. CCXVI. CCXVH. CCXVIIT,
   (q)CXXX.                  (r)SeeCXV. 
  362       THE    ELEMENTS

 luxury (s).   To thefe hurtful powers, thus indirectly de-
 bilitating, all the others may more or lefs be added  (t).
    DCLXXVII. And as it never happens,  that either di-
 reft or.indireft debility  alone proves hurtful, hence we
 have a third  cafe given, where we have to combat both
 forts of debility (u).
                                                 DCLXXVIII.

   (s) See above  par. CXXV1I.   (t) Look for them in Part. I.  Chap. I.
   (u)  Suppofe any direct' debility has occafioned a difeafe, when that is
 eftabliflied, the excitability is fa morbidly accumulated,  that the flighted
 exertion of any exciting  power becomes too much for it; which  immedi-
 ately conftitutes an  admixture of indirect debility.   The ftimulus of cor-
 poreal  motion, which is a great and rough indirectly debilitating power,
 is often too long continued, after  a typhus fever has begun  its  infidious
 attack upon the habit ;  and  hence the after-part of the difeafe  becomes
 more fevere and dangerous.  It is alfo to the fame  caufe that we owe the
 propriety of excluding light and found, when they prove caufes of irri-
 tation,  their ftimulus, though flight, being too ftrong  for  their accu-
 mulated excitability. The guarding againft gufts of paffion and emotion,
 as well as mental exertion, is all upon the fame principle.  When a per-
 fon falls into a fever from exceffive labour and low  diet at the fame time,
 that is an inftance of a mixture of debility from the beginning.  Again,
 when any  difeafe, chiefly  of indirect debility, is treated by bleeding,
 pther evacuations and ftarving,that is an  inftance of a fuperinducement of
 direct upon indirect debility.  A judicious practitioner, and who pre-
 fcribesaccording to the rules that arife from a near acquaintance  with the
 operations of the inanimate part of matter upou living fyftems, will find
 plenty  of fcope for the exercife of  his judgment in  thefe and  many other
 niceties ; And he will find that the Brunonian doctrine, as it is now nick-
 named by thofe who know it not, is not a doctrine to be practifed without
 knowledge, without judgement, and without fenfe ; but that it require*
 eyerypart of knowledge requifite to  throw light upon fo extenfive a fub-
ject, as that of the fcience of life over all nature, and all the  judgement
 and good fenfe of the foundeft underflanding to carry  it into application
 upon many occafions of nicety and difficulty,  The  trafh that has hitherto
 too often paffed for knowledge,is to be acknowledged not  only ufelefs.but
hurtful.  But the true knowledge of  nature muft be always elegant,  al-
ways fatisfactory, always ufeful.   It is to be hoped the day is not far
tilftant,  when this doctrine will change its prefent  appellation, into that.
                                                                of 
             OF    MEDICINE.        ^3

   DCLXXVIII. The  direftly debilitating  powers  are
known, to wit, cold (x), low diet, (y), bleeding, and other
evacuations  (z), reft of body and mind, and want of paffion
and emotion (a), and  impure air (b).
   DCLXXIX.  As both thofe fets of powers aft by de-
bilitating ;  be, at the fame time, on your guard from be-
lieving, that fome of them arefeptic, and prove hurtful by
fermentation,  and are to be cured by antifeptks, or pow-
ers that refift  putrefaction ;  and that, among the former,
heat is to be reckoned ;  among the latter, cold, wine, the
Peruvian bark, and acids (c).
   DCLXXX. In  the gentle  cafes, as  in the  agues  of
cold places, and efpecially the vernal agues (d),  and like-
wife in fynochus, in the fimple typhus, and in the plague
itfelf, when mild ; fcarce any fironger ftimulus than wine
is required; and the  reft of the cure is to be condufted
according to the directions fo  often now laid down in the
mild afthenic difeafes.
   DCLXXXI.  In  the  moft fevere fevers, fuch  as  the
remittent (e), in the  warmer regions of the earth, and in
the torrid zone, and in  the  fevere typhus,  when it is  pe-
ftilential, in the very violent dyfentery and  cholera of the
fame places, and in the  moft violent plague itfelf (e), the
caufe of all which affections,  is in general direft debility ;
or in gentler cafes of the fame  difeafe at firft, and that hava
now  acquired a great deal of virulence in  their  progrefs
                                                  from
ef the doctrine of Nature,  over the living part of her  productions ; com-
prehending not only the morbid but healthy phoenomena, and the  dis-
tinctions between the living  and the dead ftate.
   (x) See par. CXVII.  (y) CXXVIII.  (z) CXXXIV. CXXXVII.
   (a) CXXXVII. and CXXXIX. andCXLH.
   (b) CXLVI. Compare the whole with Part II.  Chap. X. all from
CCXG.  toCCCXH. and from that to par, CCCXV.
   (c) See par. DCLXXIIl.       (d) See DCL. DCLIV- DCLX,
  <e) DCL. DCI.X, DCLXIV, DCLXV, 
 364       THE    ELEMENTS

 from the negleft of the proper, or tfJe ufe of an improper
 plan of cure ; we ought  immediately to begin with  the
 higheft diffufible ftimuli,  fuch as  opium, volatile alkali,
 mufk, and aether, in fmall dofes but often repeated (f);
 and afterwards, when the  ftrength is reftored, and the force
 of the ftomach confirmed by their ufe,  to proceed to the
 trfe of food, drink, geftation, pure air, cheerfulnefs,  and,
 laft of all, to the ufual offices and occupations of life.
    DCLXXXII.   When  indirect debility has  had more
 concern in the cure, as in  agues, or more continued fevers,
 occafioned by drunkennefs, and in the confluent  fmall-
 pox; the fame remedies  are to be employed,  but in an
 inverted proportion of dofe.  We fhould,  confequently,
 fet out here in the cure with the largeft dofes, and which,
 are next in quantity to that degree of ftimulus, which pro-
 duced the difeafe (g); then recourfe fhould be had to leffer
                                                   ftimuli,

  (f) XLI. XLIU, CXIII. DCLX. to DCLXIV.
  (g) This may be exemplified by the treatment of a perfon the next
and fecond day after he has been hurt by drinking.  His excitability has
been worn out by an unufually ftreng ftimulus,  the effect of the firft
night's fleep is to allow it to accumulate again : In this ftate much exer-
cife fatigues, for want of excitement to enable it to be  born:  Fluid nou-
rifhment is commonly ufed, but it is not ftrong enough to wafte  the re-
dundance of excitability, and bring the patient back ta his healthy ex-
citement.  The dram drinkers know the remedy,  but they know not its
bounds. They have recourfe to a glafs of ftrong fpirit, and they would
he right if they ftopt at one, two, or a very few, according to the quan-
tity, that their former habit may render neceffary, and take no more
than what gave them an  appetite for folid nourifhing animal  food ;
which, whatever the quantity that is required to produce it be, is thebeft
general rule : Hut they go on,  and every day till that of their death,
which foon arrives, renew the difeafe.  The rule is to take a  little  of
what proved hurtful,  till a return of appetite comes on : After eating a
little  a walk or a ride will add more ftimulus :  The  air, in which the
exercife or geftation is performed, will furnifh another.  In that way,
pr^art ftrength will be acquired  in proportion as a greater number of fti-
                                                        n.uli 
OF   MEDICINE.           36$
ftimuli, and a greater number of them, till, as was faid juft
now (h), the ftrength can be fupported by the accuftomary
and natural ftimuli (i).
   DCLXXXIII.  To give  fome eftimate of  the dofe  in
both cafes (k); in direct debility, where the redundancy of
excitability does not, for  the time, admit of much ftimu-
lus (1), ten or twelve drops of laudanum given every quar-
                                                           ter

muli have wafted more excitability, and with more equality.  A fecond
day's management by applying the ftimuli in ftill  a leffer degree, will
commonly remove all  the complaints.  When a habit of hard drink-
ing has brought on,  as it always will  fooner or later, a very bad and
confirmed difeafe ;  if the excitability is nearly worn out, and what re-
mains is very unequal, as having been  produced chiefly by an  alteration
betwixt one ftimulus acting with partial excefs and fleep, either imper-
fectly removing the  excefs, or by its length fuperadding direct  to the in-
direct  debility, which  the  drink occafions;  the  patient fhould  have
fomewhat  a leffer quantity, than that which at any time  hurts him j
then the next day ftill lefs;  and fo on, till very little will ferve hioi, and
he fhould add all the other ftimuli in proportion as he diminifhes the
morbid one.
   (h)DCLXXXl.                  (i) CCCVIII. to CCCXII.
   (k) DCLXXXI.  and DCLXXXIII.
   (1) The abundant excitability of aH infant cannot be reduced at once
to that wafted degree, in which the ftrength  of an adult confifts; it mult
be by the gradual application, of what it can bear always for the prefent-
time that that can be brought about; and, therefore, not fooner than a
fpace of time equal to half the individual's given period of exiftence.  In
a fimilar manner, an excitability that has been accumulated from defici-
 ency of ftimuli for a number of weeks or months, will require a fpace of
time, fomewhat proportioned to that, to wear it out in the manner moft
fuitable to reftore the loft vigour.  Some health will be fooner brought
about, but the effectuating of perfect  health muft be a work of time. A-
gain, the direct debility of a few days will be eafily removed in  a few
 days.   In fevers, and every cafe of high debility, the accumulation ot ex-
 citability for want  ol  ftimuiant power to produce excitement,  muft bs
eftimated by the number of ftimuli that have been with-held, as well as
the degree of force of each of them.  In a fever, then, the ftimulus of
 •xercife,of the open air, of converfation, »f diverfion of every kind, o£ 
   366        THE    ELEMENTS

  ter of an hour, till the  patient, if,  as is  ufually the cafe,
  in fuch a high degree of debility,  he has  wanted  fleep
                                                              long

 an agreeable flow of fpirits, of a pleafant  train of thinking, 0f light and
 found in a great meafure, as v/ell as of the exercife of all the other fenfes,
 and particularly the ftimulus of a due quantity of blood, and other fluids,
 a-nd moft efpecially that of nourifhing food, and, at  leaft upon  the com-
 mon plan of practice,  that of wine and exhilarating drink, all thefe, are
 with-htld, and, therefore,  for want of them, the diminution of excite-
 ment muft both be great and unequal.   What then is required as to the
 idea of the cure ? Since moft  of thofe, which are the ordinary ftimuli, by
 which the ordinary health is fupported, cannot be applied ; the proper
 idea is to look out for  a power in nature, that can,  as nearly as poflible,
 fupply,  both the degree andcquality of ftimuiant operation that is want-
 ed.  Such apower we find in the few diffufible ftimuli, and particularly
 in opium (See par. CXXX.) Any of thofe act powerfully on the fto-
 mach, and diffufe  proportional excitement over the fyftem.   So foon
 and effectually do they pervade if,  and act with the moft powerful ef-
 feft upon the furface, that it is often an object of attention in the prac-
 tice to think of means to prevent it from going too far.  1-y the bleiT: 1
 ufe of thofe remedies, the excitement of the ftomach is reftored,  fo that
 with a  return  of appetite,  food can be taken in, and digefted,  in fo far
 as the powers  of that organ go  ; which are confined chiefly  to the firft
 part of  digeftion,  or what is called the firft concoction.   Next the ex-
 citement is reftored in the other digeftive organs,  in  theduodtnum,  in
 the biliary veffeh, the pancreatic duct, in the lacteal veffels, through their
 whole courfe from the inteftines to their common receptacle, as all the
 veffels that return lymph from every part of the body,  in  the veins be-
 tv.-ixtthe thoracic duct and the heart, in all the cavities of the  latter, in
 all the  red arteries,  in the colourlefs terminations of all thefe, whether
 exhalant  or glandular,  and whether only fimply feparating, or alfo chan-
ging the  property of the fluid they fetrete,* in all the internal cavities of
the body, in the commencing  extremities of the abforbent veffels, and
 in their progrefs through their lymphatic trunks to the receptacle in com-
 mon  to them with the lacteals, which are  a part of their aumher, in
the thoracic duct again; as alfo from that  to the heart, and  from the
heart  to  the extremities of the arteries : Laftly the  influence of excite-
ment is extended to thefe  terminations ef the arterial fyftem, whether
exhalant  or glandular, which perform the feveral functions of excremen-
 titious fecrction andexcrction,,by which every portion of fluids, now he-
                                                             corn© 
                OF   MEDICINE.     -    367

   long (m) falls into it: After fleep,when now fome vigour is
   acquired both by that and the medicine, and now fome of
   the exceffive excitability is worn off, a double quantity of
   the diffufible ftimulus fhould be added, and, in that way,
   gradually encreafed, till the healthy  ftate can now be fup-
   ported by ftimuli leffer in degree, greater in number, and
   more natural (n).
     DCLXXXIV. In indireft  debility  an hundred  and
   fifty drops  fhould forthwith be thrown in;  and then  the
   fuperaddition to be made, fhould be lefs and lefs, till we ar-
   rive at the boundary juft now mentioned(o).  Boththemea-
   fures recommended (p),  are in general applicable to adults;
   but lefs will fuffice at an early or late age.  Nay, the rule
   further varies according to the habit, the way of life,  the
   nature of the place, and the peculiarities of the patient (q).
                                                DCLXXXV.

  come ufelefs, or, if they were retained, hurtful to the fyftem, are thrown
  out by their feveral emunctories.  When, by^the ufe of the diffufible fti-
  muli, the ftomarh, and all the organs can perform';their refpective func-
  tions, the natural ftimuli begin to be reftored ; the  ftomach the intef-
  tines, the lacteal j and blood veffels, and all the other veffels, are gradu-
  ally filled with their refpective  fluids ; the mufcles on the furface, and
  the mufcuiar fibres  recover their tone and denfity;  the brain recovers
  its vigour ; heat and air can be now reftored to the furface ; exercife tan
  now add its ufeful ftimulus ; and all the functions return  to their ufual
  capability of being acted upon by the ufual and ordinary exciting powers,
    (m) Want of lleep is an  indirectly debilitating power ; and, in this
  weakened ftate of the fyftem, in this redundancy of excitability, where
  every exciting  power is liable to be too much for the excitability, the
  want of fleep, by not allowing this partial wafte of excitability to be re-
  paired, is the occafion of fo much more indirect debility being  added to
  the direct ; and hence the fum total of debility is encreafed,  Theeffect
  of fleep in removing this partial indirect debility becomes fo far au  invi-
  gorating power.
    (n) See above par. CHI. and CVII.      (0) DCLXXXHT.
    (p) in par.DCLXXXII. and this.
    (q) When the habit is delicate,  the patient's way of life moderate a
•  to the ufe of the ftimuli, the  p'ace cold, cr both  cold and rnoift, and 
 368        THE   ELEMENTS

   DCLXXXV. And fince  the ufe of the diffufible ftimuli
only fucceeds,  when life cannot be preferred by the ufual
and more congruous tonature,and a due quantity of blood
and other ftimuli foon become fufficient to finifh the heal-
thy ftate ; we fliould on that account, even from the be-
ginning immediately give animal food, if not in a folid form
in which it can neither be taken nor digefted, at leaft in
a fluid form, in  that of foups ; which fhould be alternated
with all the  dofes of the  diffufible ftimulus: Then, in a
gradual way, proportioned to the return of  vigour, firft a
very little of fomething folid, and afterwards more and more
fliould be thrown in, and the other ftimuli, each at its pro-
per time, brought  into play; till the  whole cure termi-
nate  in the  management  commonly  obferved  In good
health, where there is lefs occafion for medical injunc-
tions.
   DCLXXXVI. When the affeftion is more a mixture of
both forts of debility, thefe proportions of the dofes muft
be blended together.
   DCLXXXVII. Contagion, which either adds nothing to
the effeft of the ufual hurtful powers, or proves hurtful
by the fame operation by which they are fo, is not otherwife
                              4                         to

the patient eafily affected with ftimuli of all kinds ; in all thefe cafes the
rule, which common fenfe prefcribes, is to diminifh the dofe of the dif-
fufible. A lady in  Edinburgh, who had born and nurfed many children,
had lived exceedingly moderately, had been and ftill was very affiduous
in the management of her family affairs, and ufually ftimulated with lit-
tle air out of her  own  houfe, fell into a cholic, and, by the evacuant
and flarving plan,  had been kept in it for a full month, till the urgent
fymptom of vomiting required further afliftance : When I came, I firft
retarded the vomiting by a glafs of whifky : And,  by two more,  with
no other help  but  that of a mixture containing 30 drops of the Thebaic
tincture,  which the furgeon had been adminiftering in miferable fmall
portions, in three  hours removed the whole difeafe.  As I have faid
fomewhere before,  the difeafe,  from her neglect in fulfilling direction*
had very nigh returned next day ; but another glal'3 repelled it. 
OF   MEDICINE.         369
to be regarded, than that time be allowed for its paffing
out by the pores, together with the perfpiratory fluid, and,
therefore,the perfpiration be properly fupported; which,as
it is effefted by ftimulating, is no  addition to the general
indication (r).
   DCLXXXVIII. Laftly, the corruption of the fluids in
the extreme veffels muft be obviated (s), not by means,
that by a direft operation remove it,but by the powers that
aft upon the excitement of the folids,  and that encreafe
excitement over the whole body, and  therefore, among
other parts upon the labouring veffels.
   DCLXXIX.  Having now run over the whole fcale of
decreafing exciting power from  peripneumony to the
plague, and from death by indireft, to death by direft de-
bility; and having fo executed the work, as to prefent the
public with a new fcience, if not finifhed off in an elaborate,
elegant, and highly poliflied manner, at leaft marked in
outlines, and,like a rough ftatue,to be poliflied afterwards,
in fome meafure fafhioned in all its limbs, and embracing
an entire plan of a work, connected in all its parts ;  we
muft  next pafs over to the confideration of local  difeafes.

  (r) See'LXXXVIII. XCVIII.
  (s) CCXXXVI. andCCLXXlV.
Bb
The 
370       THE   ELEMENTS
The    FIFTH    and   LAST    PART,

          LOCAL   DISEASES.
                CHAP.     I.

                     Of Local Difeafes.

DCXC. T  OCAL  difeafes  (a)  are  divided, according
         -*—^ to an order  of nature, into five parts ;  the
firft of which confifts of organic affections, where no dif-
feafe over the whole fyftem arifes, none but in the hurt part.
This is a fort of affeftion, that happens in parts lefs fenfi-
ble, according to common language,  or more devoid of
excitability.
   DCXCI.  The fecond  part,  likewife  made  up of or-
ganic affections, occurs in parts of the fyftem, whether inter-
nal, or external, that are very fenfible, endued with a great
deal of excitability (b); where the effect of the local affec-
                                                       tion

  (a) V. VI. Vil.
  (b) The excitability is here not talked of  in its comparative ftates of
abundance or deficiency,  but in the degree in  which any part poffeffcs
it in preference to other parts.   It is ufed in the fenfe of the grratcror
leffer vitality of parts:  Accordingly we can fay, that fome parts poffefs
an exquifite fenfibility, as the ftomach, the brain, and inteftines, and, I
believe, moft of the interior, foft, ffefliy parts,  and the fhut cavities;
and externally, the parts immediately under the nails; that others pof-
fefs ltfs, as the bones, ligaments, and cartilages and ligaments;  and  ex-
ternally, the cuticle, or fcarf-fkin,   It it,  with  refpect to the difference
                                                          of 
O  F   MEDICINE.         37I
 on is propagated over the whole body, over the whole ner-
 vous fyftem, and where a very great many fymptoms arife,
 fimilar to thofe which are peculiar to univerfal difeafes.
    DCXCIL The  third part of local difeafes, takes place
 When a fymptom of general difeafe, that at firft arofe from
 encreafed or  diminifhed excitement (c), arrives at that
 height of degree, at which,  being no longer, under the in-
 fluence  of excitement, it cannot be affefted  by remedies
 that correct the  excitement.
    DCXCIII.  The fourth part, or divifion of local difea-
 fes, confifts of thofe, in which a contagion, externally ap-
 plied to the body, is diffufed over all, without affefting the
 excitement (d).
    DCXCIV.  The fifth part of local difeafes, arifes  from
 poifons  that  have  been  applied  to the body, and  flow
 through all the veffels in fuch a manner, that they are un-
 derftood not immediately, nor at firft, to have any tenden-
 cy either to encreafe or diminifh the excitement,  but fal-
 ling upon parts, fome on one, fome on another,  hurt the
 texture of thefe in different manners ; and, after occafion-
 ing that local hurt, by means of it produce difturbance over
 the reft of the body.

of fenfibility, or excitability, or Capability, to be acted upon by exciting
powers, that we ufe the expreffion of more or lefs excitability.  See
above par. XL1X. and  the addition, and LIII. and addition,
  (c) like all the other fymptoms, of which it was one,
  (d)Ifit affected the excitement its effect wouidbe general difeafe,
which fometimes happens, as in the fmall-pox, meafles, contagious ty-
phus, and the plague.
Bb  2
CHAP. 
372       THE    ELEMENTS
               CHAP     II.

The firfl Part  of Organic Local Difeafes,  where no  Effecl, but
                  in the hurt Part,  arifes.

   DCXCV. WITH regard to the firft part of local, organic
difeafes ; the hurting powers, that produce them, are fuch
as produce a folution of the continuity of a part, by wound-
ing, eroding, or poifoning; or that derange a part by con-
tufion, compreffion, or fpraining.
   DCXCVI. The hurting powers, producing folution of
continuity,  are all cutting, pricking, or miffive, weapons:
Acrid bodies  and poifons produce folution of  continuity
in another manner.
   DCXCVII. When any  of thefe hurting powers flightly
divide the furface,  and fearcely, or not at all, get to the
bottom of the fkin ;  for the cure of fo trifling an affeftion,
there is occafion for nothing but fhutting out the air, and
cold, and exceffive heat, and avoiding every irritating fub-
ftance.   For the only ufe of the cuticle is, by means of its
infenfibility (a), (it being a fimple (b) folid, and devoid of
all excitability), to keep off the air, and all excefs of tem-
perature, and every rough or rude matter,  which are all
inimical to living folids (c), whether external or internal.
   DCXCVUI. When the furface, therefore, is hurt  in its
texture, either by  being cut, or bit, or  flung by  venemous
                                                animals

  (a)See DCXCl. and the note.                  (b) not a living,
  (c) So hurtful is  the air and  temperature to parts below the cuticle,
that notking is a more certain  caufe of gangrene  than their  expofure,
even for a very fhort  fpace  of time:  Nor is  there any other way of ac-
counting for the fatal  effect of flight, fuperficial, but extenfive burning.
Death has been the confequence of a burn, that extended no farther than
the fore-part of the thorax, or the breaft, and was not of longer contin-
uance, than the time taken to tear off the burning clothes that occafioned
it. 
             OF   MEDICINE          373

animals, or by being burned, or by a very high degree of
cold ; in that cafe a thin, mild,  oily plafteris fufficient for
the cure.
   DCXCIX. The divifion, therefore, of phlegmafias, into
phlegmone, or erythema, is without foundation,  and mif-
leading, both as  to the caufe, and as to the cure, from the
knowledge of the truth (d):  For, however much they dif-
fer in their remote  caufe, as they call it, and in  their feat,
and in their appearance; fince the exclufion of the air and
of other ftimuli  is  their effectual cure ; it,  confequently,
follows, that their caufe is the fame, that is,-that the na-
ture of all  thefe affections is the fame.
   DOC.  In  the cure of contufion,   compreffion,  and
fprains"(e), the fame, in general are the remedies ; and be-
fides them, there is occafion for reft of body, andbland te-
pid fomentation.
   DCCI.  Through  this whole divifion of  local  affec-
tions, there is a certain energy of nature, that tends to the
reftoration of  the healthy ftate; but it  is not the celebra-
ted vis medicatrix naturae of phyficians ; For in this cafe
nothing elfe happens, but what equally happens in the cure
of general difeafes.   If proper   remedies are applied, the
found  ftate in both forts of difeafes follows :  If the  reme-
dies be neglefted,  the folution of continuity  degenerates
Into a  worfe and worfe nature, and then into gangrene, or
the death  of the part (f).  It is the excitability, or that
                                                property

   (d) See the feventh Genus in Genera Morborum Culleni, where you
will find Lianaeus's prototype of inflammation, that is, of inflammatory
difeafes, or what is in this work called  phlegmafias, or  fthenic  difeafes
with inflammation or an approach to it- alfo adopted by this author.  It
isjiothing elfe but a  collection of local affections,or, in a few cafes, fymp-
toms of difeafe, and that they almoft all come under this head  /if local
difeafes, and every one of thcni under one of thefe heads,
   (c) See par. DCXCV,
   (f) Of this we are prefented with cxai>ip'es  in every  day's experi.
                                                     ence ; 
374       THE   ELEMENTS
  property of life, by which the functions are produced (g),
  that, wherever life,  whether in a part, or over the whole
  body, is hurt,.procures the return of the healthy ftate by
  means of the external powers afting upon it.   It is, then,
  the excitability, affefted by the aftion of thofe powers, that
  is to fay, the excitement, that governs the ftate of the fo-
  lids, both in  parts, and over the whole body (g).


                CHAP.     Ill,

             The fecond Divifion of Local Difeafes.

    DCCII.  THE  local  organic  difeafes  of  the  fecond
 divifion are the inflammation of the ftomach (a), and that
 in the inteftines  (b) ; as alfo bleeding difcharge, with  an
 inflammation fubfequent to it;  and in fine, an inflamma-
 tion  in any very fenfible part in confequence of a wound,
 producing commotion over the whole body.
                                                         Of
 enfce;  where we find the flighteft fores, from the neglect of the fimple
 rule of cure laid down here, degenerate into very troublcfome affection*,^
   (g) See above  par. X. to XIV.  If I  cure a peripneumony by bleed-
 ing, other evacuations, and other debilitating powers, that are not eva-
 cuant, it is by diminifhing the force of exciting powers; if I cure a fever
 by opiates and other ftimuiant powers, whether ftimulating by filling the
 veffels, or without that, it is by encreafing the fame force ; and if 1 cure
 a fore on the furface, by the method juft now mentioned, I thereby pre-
 vent the force of exciting power from rifing too high, from an excefs of
 ftimuli, or from running either into direct or indireft debility, from too
 little ftimulus, or an ultimate excefs.  If either thefe  general or local
cures are neglefted,  or mifmanaged, the eure will  net be fupplied by
any effort  of the fyftem ;  and if the cure is made out by regulating the
excitement, fuch effort  is fuperfluous.   The vis medicatrix then is as
little real in local as general difeafes.   See  above par. LXII. and  the;
addition.
   (a) or gaftritjs.            (h) or enteritis, 
OF   MEDICINE.
315
            Of the Inflammation in the Stomach.

  DCCIII.  The principal fymptoms  in gaftritis   are,
pain in the region of the ftomach,  a burning heat,  deep
fea ted, encreafed by every thing that is either ate Or drank,
or in any fhape taken into the ftomach ;  hiccup, an incli-
nation to  vomiting, and the fudden throwing up what is
taken in ; and the pulfe foon  getting into a ftate of debi-
lity, quicknefs, fwiftnefs,  and hardifhnefs.
  DCQIV. The exciting hurtful powers, and which pro-
duce the folution of continuity in this cafe, are fuch  as aft
by cutting, pricking or erofion.  Such are the fmall bones
of fifties, ground glafs, or Cayenne  pepper and fuch like
things.
  DCCX. Inflammation is a confequence of the wound
or erofion, that are the effeft of the operation of thofe ex-
citing powers: The effeft of which, in the very fenfible
organ of the ftomach, is to diffufe the difturbance before-
mentioned (c) over the whole fyftem.  The burning heat
and pain, infeparable from every inflammation,  and the
anxiety (d), are the offspring of the inflammation (e) : And,
of them, the  anxiety is more peculiar to the ftomach, the
latter being its accuftomary feat (f), and the pulfe becomes
fuch as  has  been  related, becaufe it is peculiar  to every
rude, fixed, and permanent local ftimulus (g); to weaken
and to be fo much the more liable to that effeft, the greater
the excitability of the part is. Hence, in the external parts
of the body, that are lefs endued with excitability, a  pretty
confiderable inflammation by ho means affefts the pulfe or
the body any way generally ; though even there, when a
part is fenfible, as in the cafe of a burn fpread  to any ex-
tent, or of a  thorn having been thurft below the nails, an
                                                equal

    (c) DCXCVI.     (d) CLXXI. CCCXLV.     (e)  CLXXI.
    (f) CCCXLV,     (g) XVII. 
 376       THE   ELEMENTS

 equal difturbance arifes over the whole body (h), which con-
 firms a former propofition, in which it is afferted, that the
 more abundant the excitability is (i), the lefs ftimulus can
 be born.
   DCCVI. The difeafe is eafily  known, both from the
 fymptoms above defcribed, and, with not a little more cer-
 tainty, from the known taking in of the hurtful powers ;
 and over and above, by this particular fign, that, as it has
 been faid before, without fuch marks, inflammation fcarce
 feizes upon an internal and fhut part (1).
   PCCVII,  As this is a local difeafe,  and does not, like
 the general ones, depend upon the encreafe or diminution
 of excitement; confequently, the indication fuited to the
 latter, to  wit, to diminifh encreafed, or encreafe diminifhed,
 excitement, over all, will not apply.  On the contrary un-
 lefs a general difeafe happen to be combined with it, no*
 thing elfe is to be done, but, by throwing in bland, demul-
 cent liquors, to defend the tender part from the rude contact
 of the ftomach's contents, and give the inflammation time to
 finifh its courfe; and, if the phyfician is called foon enough,
 to wafh off the hurtful matter with a diluent drink.

             Of the  Inflammation in the Inlefiines,

   DCCVIII.  The  inflammation in the inteftines is a lo-
 cal affeftion ; in which there is  an acute pain in the belly,
                                                     and
  (h) CCCXLIV. CCCXLV.       (I) XXXVI.
  (I) CXIII. and CLXVI1I.  The ftomach is fometimes inflamed from
a fchirrous tumor occupying the pylorus ; and that cafe alfo is taken in
by the fyftematic and nofological writers, as belonging to their gaftritis ;
But the confideration of it does not belong to this head of local difeafes,
but to the third divifion  of them. At the fame time, both it and the pre-
fent cafe are local difeafes, and not phlegmafias, differing from the phlegm-
afiz, fo fully treated of in the third part of this work.  It, as well as en-
teritis, of which  we are next to fpeak, have every mark of difference
from the general  difeafes mentioned in the Vfth paragraph.   £ee alfo
 Chap, I. of the fifth Part. 
             OF   MEDICINE.        377

and diftention, and fometimes a fort of twifting of the pain
around the navel, with vomiting,  and an  obftinate cof-
tivenefs, and fuch a pulfe as in the inflammation of the in-
teftines.
  DCCIX. The hurtful powers, exciting this difeafe, are
precifely the fame, as thofe that have been faid to excite the
inflammation of the ftomach, that is :
  DCCX. The inflammation arifes in a fimilar  manner,
as in the inflammation of the ftomach, and the more rea-
dily, that the  inteftines are more  fenfible than the fto-
mach (m).  And hence alfo, in a fimilar manner, is a ftate
of difturbance diffufed over the whole body.
   DCCXI. The acute pain of the belly depends upon
the inflammation : Its  diftenfion and the coftivenefs is the
offspring of the detained feces.  The fame is  the caufe of
vomiting; for the periftaltic motion  being prevented, upon
account of the obftruction, to proceed downward in its ufu-
al way, from its reftlefs nature recoils in the direftion up-
ward ; as affecting neither direftion, unlefs in  fo far as the
ftimulus, by  the  impulfe of which  it is regulated, either
commences from above, as health requires, or from below,
as happens in other difeafes, and in this in particular (n).
The pain twifting about the navel, is produced by  the in-
 flammation, for this reafon that the principal, and by fer
the greateft part of the inteftines, is thrown in a convoluted
ftate about the navel.
   DCCXII.  The diagnofis  is the  fame as In the  gaftrl-
 tis ; excepting, that the feeds of fruits, hairs, and fimilar
foreign bodies, fometimes upon account of the torpor of
the periftaltic motion, adhering to the fides of the inteflmal
canal, gradually, by their irritation,  kindle up an inflamma-
                                                  tion

  (m)  13aron de  Haller, from fome experiments that he made, found
the inteftines more fenfible than moft parts of the body, more the.u t!c
ftomach, and equal in fenfibility to the brain.
  (n)  See par. CLXXXVllI. CLXXXlX. 
 378      THE   ELEMENTS

tion :  Which  is a  faft, that if  examined  attentively,
and once rightly  confidered will not difturb our diagno-
fis.
   DCCXIII. The cure is precifely the  fame as in the
inflammation of the ftomach.
   DCCXIV. All the reft of the pretended phlegmafix,
diftinguifhed by the appellation of " itides," as thefpleni-
tis (o), hepatitis (p), the true nephritis (q),  the cyffitis (r),
without a ftone, or the hyfteritis, not arifing from fehirrus
(s), and the peritonitis (t), do not belong to this place ; as,
befides the doubt of their ever being inflamed, not arifing
from ftimulants and acids, neither of which  have accefs
to the fliut vifcera (for thefe fubflances are not carried in
the veffels, or can be carried), but from the relics of other
difeafes, of which we are to fpeak afterwards, with the fol-
lowing exception :
   DCCXV. The exception is, that if any one falls from
 a heipht, if he is run through  any part of his  bowels with
 a fword, if a poifoned arrow, thrown by any favage,  has
 pierced any of his inward parts, he will in
   DCCXVI. The cafe of the inflammation  affefting the
 liver,  be affefted with a pain in his right hypochondrium,
 with vomiting  and hiccup:  If
   DCCXVII.  The  inflammation  affeft his fpleen,  the
 pain will be in his left  hypochondrium; in
   DCCXVIII. The cafe of the tiue nephritis, or inflam-
 mation of one of the kidnies, he will be pained in the re-
 gion of the kidney, and feized with vomiting, and a flu-
 por of his leg; in
                                            DCCXIX.
   (o)  or inflammation of the fpleen
   (p)  or the inflammation of the liver
   (q)  or inflammation of the kidnies,
   (r)  or infla-nmatien of the bladder of urine;
   (s)  or inflammation of the womb.
   (t)  or inflammation of the peritonieumn 
              OF    MEDICINE.         379

    DCCXIX.   The  cafe of  the  inflammation happen-
 ing in his bladder,  he will have a tumour and pain in the
 under belly.
    DCCXX. Bleeding difcharge,  followed  by inflamma-
 tion (u), fuch as happens in the inflammation  of the womb,
 or of any neighbouring part, and in abortion, and in the
 wound of any internal part, is eafily diftinguifhed by the
 pain of the  affefted part; and  by the preceding accident.
   DCCXXI.  In the inflammation of  the womb,  or
 any neighbouring part, the lower belly  is  affefted with
 heat, tenfion, tumor, pain,  and thefe fymptoms accompa-
 nied with vomiting (x).
   DCCXXII.  The hurtful powers, that excite the hy-
 fteritis, or inflammation of the womb and parts in its neigh-
 bourhood, all amount to violence done to the womb. Thus
 ufing violence during the labour, hurrying the birth, often
 produce a folution of continuity, and  wound the womb
 with a tearing rudenefs.
   DCCXXIII.  And, fince  a  great deal of blood is often
 loft in that way, and the local affeftion followed by debili-
 ty of the whole fyftem (y); for  that reafon bleeding, ac-
 cording to the common praftice, any mode of evacuation,
 are not to be praftifed, nor is the patient to be forbid to
 eat; but, in  the firft place, regard is to be had to the affect-
 ed  part, the body muft be laid in an horizontal pofture,
 fhe muft be kept from motion, and be allowed rich foups
 and wine : By and by more folid animal food fhould be ufed
 morfel by morfel frequently  repeated,  and  fhe fliould
                                                 have

  (u) DCCH.
  (x) The inflammation is frequently not in the womb, but in a neigh-
bouring portion of (he inteftines, or mefocolon, or in the peritoneum it-
felf, as diffection has frequently fhown.  This is a difeafe, than which
 rone has been  more enquired into, and none yet lefs underftood.
  (y) Pain and lofs of blood are in one degree or another inevitable
caufes of debility. 
380       THE   ELEMENTS
have her belly bathed : And, if  the debility fhould get
a-head,  recourfe  muft be had to more wine, drink  ftill
fironger, and opiates :  The ufe of which laft fhould not
be neglefted, even at firfl.

                     Of Abortion.

  DCCXXIV. In  abortion, the back, the loins,  the
belly, are pained, like what happens in child-labour;  and
there is either an unufual flow of the menfes, or an extra-
ordinary difcharge from the vagina.
  DCCXXV. The  hurtful powers,  that force  abortion,
are falling from a height, flipping a foot, a rafh ftep, in-
tenfe walking, running, going up and down hill.  This
difeafe feldom, however, happens but to perfons previoufly
weak ; and the moft powerful agent in bringing it on, is
fome taint left fince a former abortion, which encreafes in
proportion to the  number of abortions.   When the  dif-
eafe happens in confequence of the local hurting powers
mft now  mentioned, in that cafe it is perfeftly local:  But
when debility is blended with the effeft of thofe powers
it is a cafe of combination of general with local affeftion,
  DCCXXVI. The indication for  preventing the  dif-
eafe is, to guard againft all the hurting powers that induce
the difeafe ; to ride out, when the patient has any degree of
ftrength ; but, in cafe of any apprehenfion of danger from
weaknefs, to go in a caniage, which will be more fafe ; to
be upon guard from the third month of pregnancy till the
feventh is paffed; to invigorate the fyftem,  and keep up
the patient's fpirits,  and intelleftual amufements.
  DCCXXVII.  The indication of cure is, to keep the
body in a horizontal pofition, with  the buttocks higher
than the head ; to be ftudious to keep the patient eafy in
body and mind; to repair the lofs of blood with foups,
to fecure the veffels, for  the purpofe of contrafting their
                                            enlarged 
■  OF   MEDICINE.       381
 enlarged  diameters, with wine and opiates,  and, in that
 way, take off, at the fame time, the atony and laxity, which
 are the principal caufe of the difcharge.

                 Of Difficult Child-Labour.

   DCCXXVHI.   In  difficult   child-labour,  the   moft
 common caufe of which by far  is weaknefs,  and which
 always produces weaknefs when it proves lingering; the
 lying-in woman fhould be fupported with wine, and when
 the labour proves more difficult,  and is now like to be te-
 dious, opium fhould be adminiftered.
   DCCXXIX.  When  now fome  part of the uterus is
 hurt by the hurting powers that have been mentioned (a),
 and  the child  and placenta are now both delivered, the
 woman fhould be kept in an horizontal pofture, as was
 recommended in abortion ;  fhe  fhould be invigorated by
 foups, chicken, wine and the ftill higher ftimuli;  every
 thing contrary fhould be avoided ; and the healing up of
 the wound waited for.

                 Of deepfeated Wounds.

   DCCXXX. In deep feated, or gun-fhot, wounds  when
 the ball, if a ball occafioned the wound, is now extracted,
or though it ftill  remains in the body, in a place not neceffa-
 ry to life; firft of all the whole fyftem is very much irrita-
 ted, heated, pained, chafed, and  diftrefled with reftleffnefs
and tolling,  the pulfe  is ftrong, full and  more frequent
than in health.   The caufe of all thofe fymptoms  is the
commotion,  which, as we have faid, the local ftimulus,
either of the bailor of the inflammation fupervening upo:i
the wound, by its conftant irritation of a fenfible part, gives
to the whole fyftem.
                                        dccxxxl
(a) See par. DCCXXV. 
 382      THE   ELEMENTS

   DCCXXXI. Becaufe, In this  cafe  afthenic diathefis
is commonly fuppofed to arife over the whole body, upon
account of the irritation from the wound; the antifthenic
plan of cure is, therefore, always employed through the
whole courfe of the difeafe;  and the ufe of opium, which,
in this cafe is conjoined with the antifthenic, or ftimuiant
remedies, is admitted only for the purpofe of acting as a fe-
dative and duller of pain, is admitted : Confequently, upon
account of the fear of a fever being to fupervene, though
often a great quantity of blood is loft  by the wound ; ftill
large bleeding is praftifed,  the belly is purged, nourifh-
ment is with-held, abftinence enjoined : The moft frequent
confequence of which treatment is death, and  never a re-
covery that is not owing to  accident.
   DCCXXXII. But all this is a method of cure  con-
dufted upon an erroneous theory, which is proved by all
the principles of this doctrine, and by the very unfortunate
iffue of that practice.  In a perfon, who has loft a great
deal of blood, an  over-proportion of  blood, can  ne-
ver  be  the caufe  of  fthenic diathefis:  Neither  can
any tolerable reafon  be  affigned for  the profufe evacu-
ation of the ferous fluid, or for not rather fupplying new
fluids by the  ufe of food.   It is in  vain to accufe  fre-
quency of the  pulfe, as a fign of an excefs in the quantity
of blood, and of too much vigour, or of any irritation that
wants an antifthenic plan of cure : For,  befides its hard-
nefs, if the pulfe is not, at the fame time, ftrong and full;
it has been now often above  demonftrated, that all its cele-
rity depends upon debility and penury of blood (c).   Fi-
nally,  as  the afthenic diathefis depends upon  the general
fthenic hurtful powers, as the  energy of pain, from local
affeftion, and particularly inflammation, has no tendency to
inducethatdiathefis,butthecontrary one of debilitating (d);
that is another reafon for the fuppofition of the habit, either
                                            remaining
   (c) See par. CLXXIX. to CLXXXI.               (a) DCCV. 
            OF    MEDICINE.           383

remaining fuch as it was before the wound was received (e),
or, which is more probable, of degenerating into the afthe-
nic diathefis.  Laftly, the true explanation of the diftinftion
betwixt irritation and fthenic diathefis is in confirmation of
the fame conclufion ;  the fthenic diathefis being that ftate
of the fyftem, which is produced by all the powers, the ope-
ration in common to which is ftimuiant, over the  whole
fyftem,  and,  by fullnefs in the veffels producing the fame
effeft, and to be removed by debilitating powers  weakens
alfo the whole fyftem, and by evacuant remedies afting by
the fame general operation; whereas,on the contrary,itisir-
ritation or that ftate,in which the whole body is often, with-
out any  ftimulus, debilitated (f); and often a local ftimulus,
fuch as diftention exciting fpafm, or a concentrated acid, in-
ducing  convulfion, or the pain of a wound that producing
the general commotion here (g), and effeft enormous moti-
                                                        ons

   (e)  Which can hardly happen if blood has been loft, which muft di-
minifh the excitement,  and in proportion to its degree,
   (f ) When the body  is  debilitated, the ordinary ftimuli,  that  in its
healthy ftate invigorate it, and even a much lefs degree of ftimulus, will
produce the irregular motions, which are fuppofed owing to irritation;
not that any thing irritating is applied, but that the exceffive abundance,
or defect of excitability, admits not, without fuch effecls, the degree of
ftimulus,  which, applied to it in its healthy half-wafted ftate, would
produce  healthy vigorous motions.   (See XXV. and XXVI)   The
tremors that are occafioned by the turning of a door upon its hinge, the
fweat  occafioned by flight exertions in walking, are fo many inftances
of that, and the irregularities of the pulfe are owing to the fame caufe.
As the weaknefs upon which fevers depend encreafes, fo alfo do the
fuppofed fymptoms of irritation,  fuch as colliquative fweats, colliquative
diarrhoea, fubfultus tendinum, &c.  13ut they are all the effect of the
general weakened ftate being flutterred by every flight ftimuli. At other
times irritating powers, in the fame weakened ftate, do occur; fuch as
thofe mentioned in the text.
   (g) But even in that cafe, the real ftate is  debility, and the indication
of cure is to remove it, as well as the irritating powers : Which,  while
they encreafe it, are at the fame  time  its offspring, and require ftimu-
lants to enable the fyftem to refift its effect.  (D'JLXXXVIII.) 
 384      THE   ELEMENTS

 ons in a weakened fyftem.  But, whether the debility be
 without ftimulus, or excited by it, there is never occafion
 for debilitating evacuant remedies, but always for mode-
 rately  ftimuiant ones : And we have only to take care,
 that the fthenic diathefis be not produced by the method
 employed for the cure, and thereby a general difeafe, at
 leaft, a predifpofition to general difeafe be fuperadded to the
 local,which could not fail to aggravate the latter.
   DCCXXXIIL  As,  therefore, the antifthenic plan of
 cure is not to be praftifed, from an apprehenfion of a fever
 being about to come on, with a view to allay  the diftur-
 bance arifing from it; which has the contrary tendency,
 that of inducing the fever, and of exciting the difturbance
 apprehended ;  fo,  neither is the ftimuiant plan to be at-
 tempted, till the wound is healed, or the difeafe has arrived
 at an advanced ftage, and a great deal of debility is now
 induced by the continuance of the pain, left,  if that me-
 thod fhould be fooner employed, the blood fhould be car-
 ried with more rapidity than the cafe would admit of,  and
 with an encreafed momentum, into the ftill open termina-
 tions of the veffels: For it is underftood, that neither dia-
 thefis takes place in this cafe, and that the only affeftion
 prefent is a commotion over the fyftem, depending upon
local affeftion; and that, confequently, there is no occafion
for the remedies of either ; excepting this fingle confidera-
tion, that, as the lofs of blood, in proportion to its degree
has a tendency to produce more or lefs of afthenic diathe-
 fis ; there will, therefore, in that proportion, be occafion
for fome fthenic remedies.
  DCCXXXIV. During  the firft days  of the difeafe, be-
caufe the patient, all at once, does not any longer engage
in geftation, exercife, and the other funftions both of body
and mind, and of pafifon or emotion, according to cuftom,
and of courfe, lefs nourifhment and recruit is now requi-
red ; therefore,  there fhould be fuch an abatement in his
                           2               allowance 
              OF   MEDICINE.       38^

 allowance of the ufual ftimuli, as to accommodate what is
 ufed to the prefent condition of the fyftem and the ftate of
 the wound juft now defcribed (h).  Therefore, to prevent
 too great an impetus in the  veffels, filence fhould be kept
 around the patient, he fhould not fpeak himfelf, he fhould
 lie quiet and without motion,  his pofture fhould not be
 changed, but to avoid the difagreeable feeling of too long
 continuance of it, and even then it fhould be done as warily
 as  poflible.  He fhould make his water lying, and in an
 urinal; he  fhould rather ufe foups, than folid meat; his
 wound fhould be examined every day, for the fake of keep-
 ing it clean ; its progrefs fhould be obferved; it fhould be
 dreffed with frefli, foft, and  bland matter ; and if even at
 this early period, any faintifhnefs appears, a glafs of wine
 fhould not be with-held.
   DCCXXXV. After fome days, which may be more, or
 fewer, according to the ftrength of the patient, when now
 the habit is rufhing into debility, upon account of the great-
 nefs or long continuance of the pain; in that cafe, befides
 the foups formerly allowed,  meat as rich and delicate as
 poflible fliould be given; wine fhould be adminiftered
 fparingly at a time, but often, and upon the whole in large
 quantity; and then at laft, recourfe fhould be had to opium,-
 which,  in the common praftice, is ufually given from the
 beginning of the difeafe, and to the other diffufible ftimuli;
 and the difeafe fhould be treated precifely in the fame way
 as a typhus.
  DCCXXXVI.When very tender external parts are viola--
 ted by any rude matter, fuch as happens m that cafe, where
 a thorn  is puflied below any  of the nails,  and  an inflam-
 mation fpreads from the affefted part to a confiderable ex-
 tent, and then, upon account  of the great fenfibility of the
part, the whole body is  drawn into confent; the injured
                       C c                     part'*
(h) See laft paragraph. 
   386      THE   ELEMENTS

   part fliould be fomented with warm water, and dreffed with
   lint, and foft and bland ointment: And as long as the di-
   fturbance of the fyftem remains, the patient fhould be kept
   quiet, and free from motion, and nothing more attempted.

               CHAP.    IV.

   Of a Part of a  General Dtfeafe,  degenerating  into a Local.

    DCCXXXVII. To fet about the treatment of that divU
  fion of local, organic, difeafes ; in which a part, or fymp-
  tom, of  general difeafe degenerates into a local one; we
  next proceed to

                      Suppuration.

    DCCXXXVIII. Suppuration, with which we begin,  is
  for the moft part a confequence of any general inflamma-
  tion, whether fthenic, or afthenic, or that inflammation,
 which is a fymptom of general difeafes, or it is a confe-
 quence of local inflammation, whether fthenic, or afthenic,
 as a fymptom of  local affeftion.  In it the pulfe is  fofter,
 fuller, and a little flower,  than  in fthenic difeafe when
 that precedes it; but a great deal  flower, than in afthenic
 difeafe, if it happen to fupervene upon  it, and it is accom-
 panied with an undulatory,  and as it  were, a pulfatory,
 motion of the labouring part;  thefe fymptoms are com-
 monly preceded by a fhivering: If  the affeftion is internal,
 the patient fhould be kept quiet, and free from motion, and
 be ftimulated ; if it be external, the affefted part fhould,
 over and above, be fomented, dreffed,  and covered, and
 the pus, when ripe, let out.

                     Of Pufiule.

   DCCXXXIX.  A puftle is a purulent veficle,  turgid,
and at laft of  its  own accord opening in  confequence  of
having become tender,  and full  of pus.
                                           DCCXL. 
             OF   MEDICINE.         387

   DCCXL. It follows  the fmall-pox, arifing from the
contagion peculiar to that difeafe:  In the  fmall-pox the
number of the puftules is greater or lefs in proportion, as
more or lefs fthenic diathefis,occafioned by improper treat-
ment, or a negleft of the proper, has preceded (a).
   CCCXLI.  The indication  of cure for them is, firft to
remove fthenic diathefis, and then, if that has paffed  into
the afthenic, to remove it, each by its refpective remedies ;
and to befprinkle  the puftules with a ftrong fpirit, or with
laudanum, and in the former, cafe to guard againft cold, in
the latter againft heat, and to open the puftules and foment
them.

                     Of Anthrax.

   DCCXLII.  Anthrax  is a glandular tumor under the
fkin, gangrenous in the top, and inflamed in its edges all
round.

                      Of Bubo.

   DCCXLIII.  Bubo is a glandular tumour, efpecially
affefting the one or the other groin, and of a tendency to
fuppuration.
   DCCXLIV.  Thefe two affections  the  anthrax  and
bubo as well as carbuncle, are almoft always combined with
a general difeafe, to wit, fometimes with typhus, much of-
tener with the plague.  They depend upon a contagious
matter, and in fo far as they do not fufficiently yield to the
general remedies,  they muft be treated with a very ftrong
fpirit poured upon them, and with laudanum, and opening
them.
                       Cc 2                      Of
        (a) XXf. LXXVI.XCVI. XCVII. XCVIIL 
  388      THE  E  LEMENTS

                       Of Gangrene.

    DCCXLV. Gangrene is an imperfect inflammation of a
  part, not terminating in fuppuration,  difeoloured, fcarce
  painful, confifting of puftules of a bad matter, and at laft
  inducing the death of the part.
    DCCXLVI. The hurtful power,that precedes gangrene,
  is always inflammation, often ultimately violent in a fen-
  fible part, oftener languid and  occupying a part lefs fen-
  fible, lefs fupported by the powers of life (b); it is fome-
  times a fymptom of the phlegmafia, fometimes of fevers,
  fometimes of local phlegmone (c).
    DCCXLVII. The method of cure, when the gangrene
  is feated in the alimentary canal, is to pour in fpirit and lau-
  danum ;  when the fhut vifcera are affefted, to place fome
  hope in the fame and other  ftimuli, but much lefs.   And,
  as the fame remedies alfo fuit gangrene, when it is exter-
  nal, confequently liquid opium fhould be  rubbed in upon
  the  dying part, fpirit  fhould be poured upon it, the parts
  already dead fhould be cut out, the edge of the living part
  all round fliould be ftimulated,  and an inflammation made
  in it.

                       Of Sphacelus.

    DCCXLVIII. Sphacelus is a more perfeft and more ex-
  tended  gangrene, with an  extinction of fenfe, motion,
  and  heat;  in which the part becomes foft, blackifh, com-
  pletely black, putrid, and at laft thoroughly  putrid to the
                                                   very
   (b) The inflammation, out of which gangrene arifes, is always ud-
 fnpported,  and the gangrene always a ftate of cither direct or indirect
[ debility : the high excitement in the phlegmafiae, and the low in fijvsrs,
 caufing that.
   (e) CCCXLVIL DCL. to DCLXXIX. 
              OF  MEDICINE.         389

 very bones, thoroughly cadaverous, and fhifts rapidly to
 the neighbouring parts, and quickly extinguifhes life.
   DCCXLIX. The remedies are in general the fame as in
 gangrene, but they fhould be ftronger, and adminiftered in
 greater quantity, and with greater nicety, and in lefs  ex-
 pectation of a cure.   When any limb is greatly affefted,
 it fhould be immediately cut off,to prevent the found parts
 from being infefted.

              Of Scrofulus Tumor and Ulcer.

   DCCL.  When a ferofulous tumor and ulcer has been
 of  long ftanding, has  disfigured the parotid gland and
 neighbouring parts,  and all the remedies, that have any
 effeft in removing fcrofula, have been employed; after that
 no  more is to be done, but to keep the ailing  part clean,
 bathe it often, and defend it from the injury of the air; un-
 lefs that, as local debility alfo takes place here, fpirit and
 laudanum, applied to the part, may be of fervice.

                  Of Schirrous Tumor.

  DCCLI.  When  the tumor,  which while it was mo-
 derate,  was a part or fymptom of the general difeafe, calU
 ed fehirrhus, has now attained a certain bulk; if it be ex-
 ternal,  or fituated in the exterior or convex part of the li-
 ver, it fhould be cut off,  and the fyftem invigorated : If it
 be internal, nothing can be attempted, but to prevent  its
 enc -eafe by ftimuiant remedies, and in that way keep the
 patient as long alive as poflible, and in as good health as
 the prefent circumftances will admit of.
  DCCLII. The two heads of divifion that remain (e),
are  of fo obfcure and abftraft a nature, that if ever they
                                                  are
(c) DCXCIII. and DCXCXIV. 
390       THE  ELEMENTS
are to be attempted, they muft be paffed over at prefent.
The third head (f) is here only imperfeftly fketched and
fcarce begun: But  becaufe it both admits of a complete
execution, and when fo executed, will make an  important
addition to the work; fhall be prepared for the  public pe-
rufal, as foon as I fhall be happy enough to find as much
leifure and feope for thinking as  are requifite to  refcue the
fubjeft from its prefent intricacy, diforder and obfeurity.

          (f) DCXCII. DCCXXXVII. to DCCLJI.
FINIS. 
      I       N       D

              A.
      ABORTION,  page 380.
      Abftinence, not lefs im-
   moral  and irreligious than
   excefs,  64.
Abftract reafoning, cautions a-
   gainft,  136.
Acid in the alimentary canal
   fymptom, not caufe of dif-
   eafe,  104.
Acrimony, in what fenfe may
   be admitted, 361.
Agents, external, what, 2.
Agriculture, hints refpedting,
   204.
          what fhould be fo
   termed, 1.
Air, atmofpheric, if too pure
   would be perhaps injurious,
   77-
     impure, produces afthenic
   diathefis, ibid.
      inimical to living folids.
   372-
Air, ftimulus of,  neceffary to
   convalefcents, 198.
Aitiolgy,  abfurdity of, 37.
Anafarca, 330.
Angina,putrid, defcribed, 124.
Anthrax,  387.
Antifeptics, notion of,  to  be
   guarded againft, 363.
Apoplexy, 342.
       not owing to plethora,
   XI7-
Appetite,  caufe of, 100.
Apyrexiae, fthenic, 248.
Afthenia,  meaning of, 30.
Afthenic diathefis, caufe of, 7 8.
                cure of, 17c.
                 may be con-
   verted into fthenic, 33.
               fymptoms  of,
   96.
               predifpofition
  to, 95.
           difeafes, 288.
              cure of $6$,
      E       X.

 Afthenic plan of cure, different
   parts of,  compared, 4.
 Afthma, advantages of a full
   diet in, IV.
            gentle, 329.
 Author's inducements to tranf-
   late his own work, XL
             B.
 Bark,  Peruvian, not to be de-
   pended on in  intermittents,
   355'-
 Bathing, cold, remarks on, 14.
 Bladder, inflammation of.  See
   cyftitis.
 Bleeding, cautions againft, 98,
   279» 379-
       remarks on, 259,  268.
       fhould always  be  fol-
   lowed by other evacuations,
   269.
         lingular  inftance  of
   benefit from, in typhus, 120.
         when neceffary, 176,
   177,183.
 Blifters, in what cafes ufeful,
   274.
 Blood, great extent of the ftU
   mulus of, 177.
     irritates by its quantity,
   not quality, 66.
         flight difcharges  of
   from indirect debility  ap-
   proaching, 142.
         veffels, ufually more
   numerous in moft fenfible or-
   gans, 227.
 Breathing, difficulty of, to what
   owing, 223.
 Bubo,  387.
             C.
 Calcutta,  death  in the black-
  . hole  at,  occafioned by ty-
   phus, 77.
Canal,alimentary,afthenic dif-
   eafes of, 304.
Carditis, 220, 225.
Catarrh defcribed,  244.
      method of cure of, 275. 
                 I   N   D
       produced by heat, and
  removed by cold, VIII. 172.
Caufes, inquiry into,  to  be  a-
  voided, 5.
Changes to be brought  about
  gradually, 18.
Children, difeafes of, 38.
                   generally
  owing to debility, V.  241.
        figns  of afthenic dia-
  thefis in, 242.
              fthenic ditto, ib.
Chincough, 319.
Cholera, gentle, 311.
  fevere, 358.
Circulation, howcarried on, 6o*
Cold, effects of, 14,58,60,170.
     how diminution of bulk in
  animals produced by,  60.
     remarks on, as a remedy,
  184, 264.
     fucceeding to heat, bad
  fymptom, 131.
Colic, obfervations on, 109.
     with pain, 330.
                cure of, 332.
Colicanodyne, 307.
Colliquative fweets, &c. caufe
  of, 57.
Coma, caufes  of, 158.
     remarks on, 167.
Conftitutions ofindividuals not
  fundamentally different, 16^.
Contagions aft by ftimulus, 6.
          produce  a fermenta-
  tion, 229, 231.
          remarks  on, 35,  77,
   127, 182, 267,368.
Contraction and its effects con-
  fidered, 27.
Contufions, cure of, 373.
Convalefcent ftate,remarks on,
   199.
Convulfions, obfervations on,
   fo5.
Corruption of the fluids, 57.
   58, 360.
Cough, afthenic,  151,315.
        in peripneumony, how
   occafioned, 223.
        fthenic, 82, 148, 244.
Cramp. 329
  E    X.
Croup, remarks on, 240.
Cupping-glaffes when may be
  ferviceable. 275.
Cure,generalindicationsof 43.
     means of, cautions repect -
  ting, 45, 50, 267.
Cuticle, not a living fubftance
  373*
Cynanche,  gangrenofa,  124, •
  358.
           fthenic, 238.
                cure of, 275.
Cyftirrhasa 320.
Cyftitis, remarks on, 282, 378
            D.
Darknefs debilitates, 203.
Day,alternation of,with night,
  end of, ib.
Death,howbroughtabout, III.

       effected  by the powers
  which produce life, 207.
Debilitating powers, in what
  cafes to be ufed, 52.
Debility, direct. 15.
               cure of, 53.
              leffening ftimu-
  lus in cafes of, carefully to be
  avoided, 20.
             who fubjects of,
  50,
           indirect, III.  13.
                cure of 51.
                how progrefs
  to be retarded, 13.
                 who  fubject
  to, 50.
Debility, one kind of, never to
  becured by the other,50,52.
Deliriumproducedby deficient
  ftimulus, 98. 118.
                     fupera-
  bundant ftimulus, 172.
Diabetes, gentle, 292.
Diagnofis, general, 41.
Diarrhoea, 307.
Diet.  See food.
Difeafes, afthenic enumeration
  of, 288.
Difeafes, afthenic, general  re-
   marks on, 30, 288. 
                 INDEX.
                method of                  cure of, 254,
curing 363.                 Eruptions, caufe of, in difeafes,
      caufe  of, III. 30, 78,     127.
        general  and local,                fcabby, 291.
mark of diftinftion between,  Exanthemata, fthenic difeafes,
1, 39.                        210.
             how to diftin-                    explained,
guifh, 42.                     227.
             how  produ-  Excitability; 3.
ced, 40.                               boundaries of, 10.
     general principles and               effects  of the ex-
method of cure of, VIII. 9.     hauftion of, n.
  29> 43-
                  local, 370
               caufes of, 40.
                 in what way
  cured, 373. _
         fthenic, enumeration
  of, 220.
             method of cure
  of, 229.
                 remarks on,
  30, 208, 254.
Drink, abftinence from,recom-
mended, 52.
      cautions reflecting, 51.
  65. 364.
       may be  given freely in
       fthenic difeafes, 84.
Dropfy, 335.
Dyfentery, gentle, 311.
             fevere,  357.
Dyfpepfanodyne, 307.
Dyfpepfia, effect of debility,  V.
Dyfpepfodynia,  331.
               cure  of, 332.
             E.
Earth, frefh, cap of ufeful in
  phrenitis, 275.
Enteritis,  cure of, 378.
       defcription of, 376.
       remarks, on, 281.
Epilepfy, cafe of, converted  in-
  to dropfy by  bleeding, 13CJ.
          defcription of, 338.
       owing to debility, 117,
Epiftaxis, 303.
Eryfipelas,  mild,   defcribed,
  237
               method  of cu-
  ring, 275.
              violent, 234,
           general, not par-
  tial, 22, 144.
           how increafed or
  diminifhed, 9.
             feat of, 22.
           fuperabundant, to
  be taken off gradually, 18.
             what or how af-
  fefted, unknown, 4.
             when wafted by
  one ftimulus  may be acted
  upon  by another, 11, 197.
Excitement defined, 4.
           effefts of, 29.
           higheft degree of,
  how produced, 9.
           lofs of, from over
  aftion,howto be repaired, 12.
Excitement,  lofs  of, may  be-
  come irreparable, 18.
         proportioned to  de-
  gree of ftimulus, 8.
Exciting powers aft more on
  fome parts than others,  23,
  25> 37°-
               univerfilly 23,
               effefts of, 4.
         what  implied by, 3.
Excretions, caufe of temporary
  retention of, 213.
Exercife, obfervations on, 73,
   179,  192, 198.
Expeftoration, natural tenden-
  cy to, great, 315.
               of pus, not al-
  ways  owing to organic leu-;
  on 316.
              F.
Fermentations, effefts of, 229.
  231. 
                 I    N    D
            remarks on, 360.
 Fever, intermittent, 347.
       jail, putrid, or petechial,
   359-
       nervous, 358.
       requires more attention
   from phyficians than ufually
   beftowed, 361.
     yellow,  purging   necef-
   fary in, 72.
 Fifh, not a nourifhing food,I V.
 Fluids how produced,  29.
 Food, remarks  on, III. IV.
   61,  62.
                as a remedy,
   184, 186,191, 282.
     fhould be ftimuiant to  a
   certain degree, 246.
       vegetable, debilitating,
   ibid.
 Force, what,  27.
 Foflils, perhaps, not without
   life, 207.
 Funftions afting on the living
   animal, 2.
       may  be  impaired by
   fthenic diathefis, 132.
                increafed by
   afthenia, ibid.
             G.
 Gangrene defcribed, 388.
        to prevent, 148, 185,
 Gaftritis, 348.
         cure of, 40, 376.
        remarks on, 40, 219,
   281.
Gentoos, imbecility of, owing
   to diet, 63.
Globe, great change of, 207.
Gout brought on by low living,
   II.
     cured by ftimuli, III. VI
   125.
     not hereditary, 321.
     of ftronger  perfons, 120,
     of weak  perfons, 331.
             H.
Habits, effefts of, to be confi-
   dered,  328.
Hemorrhages always owing to
  E    X.
   debility, 68,  142.
               blood deficient
   in cafes of, VII. 142.
              ftimuli falutary
   in, VI. 142.
 Haemorrhois, 303.
 Health and difeafe not differ-
   ent ftates, 30.
     good  and bad, defined,
   1,  29.
 Heart, inflammation of.   See
   carditis.
 Heat, a remedy of afthenic di-
   athefis, 187.
     afts more externally than
   internally, 253.
     exceffive, cautions againft
   application of, 188.
     unufual, caufe of, 214.
             fymptom of dif-
   eafe or predifpofition, 130.
 Hepatitis, remarks on, 281,
   378.
 Hereditary difeafes do not ex-
  ift, 321.
Hypochondriafis, 333.
                 curious cafe
  of. 335-
Hyfteria, gentle, 313.
         violent, 331.
                cure of, 332.
Hyfteritis,  remarks on,  282,
   379-
              I.
Identity of effeft proceedsfrom
  identity of caufe, 5.
Imbecility, mental and  corpo-
  real, induced by food infuf-
  ficiently ftimulating, 63.
Inflammation, afthenic, caufes
  of, 119,123.
                    cure of
   123.
                attacking the
  brain at the  end of typhus
  doubted, IV.

   in phrentis,  not probable,
   92.
         Boerhaave's opinion 
                 I    N    D
  of the tranflation  of, from
  one vifcus to  another, erro-
  neous, 222.
            changes its feat
  fometimes, ib.
           diftinftion of, into
  parenchymatofe and mem-
  branous in phlegmafise,  ex-
  ploded, 221.
           erifypelatorus, feat
  of, 88.
           four kinds of, 12 i.
           in general difeafes
  always external, 82, 89.
           local, 91,123.
            not the caufe, but
  effeft of difeafe, VIII.  90.
  215.
           produced by debi-
  lity in various difeafes, V.
           rheumatic, feat  of
  88.
            fthenic, caufes of,
  122.
                     cure of,
  123.
Influenza, a fthenic difeafe, 149.
Intelleftual  funftions, failure
  of, owing to debility, 119.
Intermifllons, not peculiar  to
  fever, 355.
Inteftines, inflammation of. See
  Enteritis.
Irritation, not owing to extra-
  neous matter, 161.

Joints fmaller, affefted in gout,
  greater in rheumatifm,  and
  why, 237.
             K.
Kidney, inflammation of.  See
  Nephritis.
             L.
Labour, difficult, 381.
LafTitude, caufe of, 213.
Leannefs, 290.
Leaches, in what cafes may  be
  applied, 275.
Life, defined, 2.
     different periods of, diffe-
   rent excitability in, requiring
   different degrees cf ftimuli, 9.
  E   X.
    not a natural but a forced
  ftate, 34.
    powers fupporting, differ
  not from thofe which bring
  death,  207.
                        have
  not various qualities, 302.
Light, a ftimulus, 203.
Liver, inflammation  of.   See
  Hepatitis.
Lock-jaw, 344.
Lungs, not always affefted in
  confirmedconfumption, 155,
  3J7-
Lungs, tubercles in, fymptoms
  not caufe of difeafe, 155.
              M.
Mania, 249.
       cure of, 283.
       fometimes arifes  from
  fault of the fubftance of the
  brain, 249.
Mathematicians, pedantry ©f,
  200.
Matter morbific,remarkson,4c'.
Meafles,  antiphlogiftic  plan
  ufeful in, VIII. 148.
       mild, defcribed, 248.
       no danger of ftriking
  in by cold, 264.
       violent, 231.
            cure of,  259.
Medicine, fcience of, what, 1.
Menorrhsea, 302.
Menftruation, caufe of 294.
             impaired, 293.
             retarded, ib.
              fupprefled, ib.
Mind, exercife of, to a certain
  degree, neceffary to health,
  75-
Moifture increafes  hurtful ef-
  feft of temperature, 61.
Mortality, caufes of, 32.
Motion,  inability to  perform,
   may not proceed from debi-
  lity, 32. 138.
Motions, involuntary, 80.
       voluntary, 79.
              N.
 Nature, healing powers of, non-
    exiftent, 46, 374. 
                   I   N   I
 Nephritis,  remarks on,  281.
   .378.
 Night, alternation of with day,
   how ufeful, 203.
 Nitre,not fo refrigerant as com-
   monly fuppofed, 275.
 Nofologifls, common,errors of,
   229.
 Nourifhment, folids not always
   neceffary to, 176.
                 See food.
              O.
 Oaks perhaps might beplanted
   in parts of Scotland with ad-
   vantage,  204.
 Obefity, 253.
          cure of, 284.
 Opium, an excellent ftimulus,
   VI. 62.
        cold to be avoided du-
   ring the operation of, 59.
     in what dofes to be given
   in different cafes, 365.
       large dofe of given in
   epilepfy, 340.
       prevents mortification,
   I47-
     fedative qualityattributed
   to, falfe notion, 141.  148
   167.
         under what circum.
   ftancesfleep produced by,; 7,
   76.
              P.
   Pain, caufes of, 108. 104.
     occafioned by emptinefs
   as well as fullnefs, 98.
Palfy, 340.
Part moft affefted, in general
   difeafe, not  afted on before
   the reft, 26.  214.
Paffions, cautions on exciting,
   19. 75. i8r. 192.
       or emotions, ftrongly
   influence our activity, 72.
   fometimes   neceffary  to
   be excited, 180. 182. 198.
      termed  oppofite,  differ
   not in nature but degree, 8,
   75-
       violent,  produce  dif-
   eafe and death, 75.
)    E   X.
  Peripneumony, 220.
              cure of, 40, 259.
                difference   in
    fymptoms of, not owing to
    feat of the difeafe but degree,
    94.
               not a merely lo-
  cal difeafe, 24.
              fpurious, cure of,
    no.
  Peritonitus, remarks on, 378.
  Perfpiration, diminifhed, caufe
    of, 28, jj6^.
              more difficultly
    brought on  in fthenia than
    the  other  excretions^  213.
             produced by cold,
    J73-
                       by ex-
    treme heat 57.
            to be kept  up in
    difeafes, and by what means
    48.
 Phlegmafise, local, cure of, 373.
            fymtoms of, 227.
 Phrenitis, 226.
          cure of, 256.
           inflammation of
   brain, in, not probable,  92.
 Phyfician does notbeftow fuffi-
   cient attention to patients in
   fever, 361.
       province of, 2.
 Plague, 359
Plethora, error  of the fchools
   refpefting, 67.
Pleurify, the fame  with perip-
   neumony, 220.
Poifon  produce local difeafe,
   37> 77-
       remarks on, 5, 77.
Poor,difeafes of, owing to want
   of ftimulating food. 63.
Predifpofition, a criterion  be»
   twixt local and general dif-
   eafe, 39.
          differs from difeafe
   only in d egree, 37.
         knowledge  of,  im-
   portant, 38.
           neceffarily precedes
   general difeafe, 35. 
                   I    N   D
Predifpofition  to difeafe defin-
  ed 2, 35.
Prognofis, general, 42.
Pulfe,  celerity of, owing to de-
  bility, 97,382.
     Obfervations on,  211.
Purging remedies confidered,
  184, 262, 269.
Puftules produced by  contagi-
  on, 94.
       remarks on, 386.
Pyrexia, 31. 210.
         fcarlet, 246.
               cure of, 275.
       fymptomatic, 220, 280.
             R.
Remedies,  a fingle one never
  to be  trufted to in violent
  difeafes, 46.
           general  and local,
  what, ibid.
        remarks on  the vari-
  ation of, 242.
        feveral in a moderate
  degree to be preferred to few
  in excefs, 173, 175, 184.
         Uniform  in their ac-
  tion, 2C0.
Reft neceffary in fthenic  dia-
  thefis, 184.
Rheumatalgia, 363.
Rheumatic-inflammation can-
notbe transferredtoftomach ,9 2.
                     feat of,
  88.
Rheumatifm defcribed,  235.
           method of curing,
  276.
Rickets, 292.
              S.
Scarlet fever.    See  Pyrexia,
  fcarlet.
Schirrous tumor, 389.
Scrofulous  tumor  and  ulcer,
  389-
Scurvy, 311.
     not cured by  vegetables,
  3*3;
Sedative powers are but leffer
   degrees of ftimuli,  8.
              do not, as fuch,
  exift in nature, 139.
        X.
Senfation, not different in dif-
  ferent parts of its feat, 22.
Senfes,  exercife of, remarks on
  the, 75.
Shivering and  fenfe of cold,
  caufe of, 213.
Skin, drynefs of,  how  occa-
  fioned, 213.
Sleep confidered,  155, 240.
     morbid, how produced,
  158.
       of convalefcents  to  be
  attended to, 312.
       owing to a  ftimuiant,
  not fedative power, 163.
      remarks  on, producing,
   166.
Small-pox, 358.
       confluent, a difeafe  of
  debility,  126.            #
         diftinft,  fthenic dif-
  eafe, 35, 127.
         mild,  247.
         cure of, 275, 280.
         rare cafe cf, 312.
  241.
         remarks on the debi-
  litating plan in,  129.
         violent,  230.
                cure of, 259,
Solids, formation and  prefer-
  vationof, 29.
Spafmodic difeafes, cautions a-
  gatnft evacuants in, VI. 290.
                   owing to
  debility. VI.  210. 289.
Specincs,ideaof,an error, 165.
Sphacelus, 388.
Splenitis, remarks  on, 373.
Sprains, cure of, 377.
Stenia, meaning of, 215.
Stenic  diathefis, caufe cf, 78.
                cure of, 170.
                may be con-
  verted into afthenic, 32.
          fymptomatic, 230.
               fymptoms  of,
  80. 209.
                          of
  predifpofition to, 79.
       plan of cure, different
parts of compared. 183. 
                  I    N   D
 Stimuli, cautions On the appli-
   cation of, 18, 51, 18 6.
          deficiencies  of fome
   may be fupplied by others,

        diffufible, cautions on
   the ufe of, 62, 179.
                properties of,
   62.
                 fcale of, 62,
   190.
          durable, 197, 201.
          effefts of may be lef-
   fened by mixture, 7.
        general, affeft moft the
   part  to v/hich applied, 23.
      hurtful  effeft   of,  how
   to cure, 52.
        indireft, 62.
t,       local and univerfal de-
   fined, 4.
        proper  in a  ftate of
   health,6i.
          fum of the aftion of,
   compofed of power multipli-
   ed by continuance,  11.
      what degree of, neceffary
   in various cafes, 161. 365.
 Stomach,  moft affefted by inter-
   nal remedies, 23.  85.
        inflammation  of.  See
   gaftritis.
 Studies, the author's,  progrefs
   of, I.
 Suppuration, 386.
 Sweating, utility of, as a reme-
   dy, 178. 268. 278.
 Symptoms,  apparently  very
   different, arife from  the fame
   difeafe, and vice verfa, 150.
        deceitful,  34.
 Synocha,  fimple, 245.
                cure  of, 295.
 Synochus, 358.
 Syftem, no power inherent in,
   productive of difeafe, 77.
 Syftems, old, exploded, and a
   new one eilablilhed, 78.
            T.
 Tabes,  308.
        X.
Temperaments of every indi-
vidual the fame, 160.
Temperature, due return ofy
   beft fign of returning health,
   130.
Tetanus,  defcription of,  133,
   344-
Thinking  has  great influence
   on our aftivity, 74.
          ftraining in,  may
   prove hurtful* 74.
Thirft, afthenic 304.
       caufes of, 81, 99,  214.
       not always to be allay-
   ed by the  fame means,  53.
Typhus, occafioned by impure
   air, remarkable inftance of,
   77-
       peftilential, 334.
       fimple, 358.
             U.
Urine, rednefs of, how produ-
   ced, 213.
              V.
Vegetables fubjeft to the fame
   laws as animals, 2,202, 204.
Veffels, contracted in ftate of
   ftrength, enlarged in ftate of
   weaknefs, 29.
Vigour, abatement of, not al-
   ways owing to debility,  138.
Vomiting, caufe of, 84, 101.
      confidered as a remedy,
   184. 262,  269.
              W.
Watching caufes of, 158,
          morbid, 159, 250.
                cure of, 283.
           owing to over-fa-
   tigue, inftance of, 160.
         reftlefs, or afthenic,
   291.
Womb inflammation of.   See
   Hyfteritis.
   Worms, 308.
Wounds, deep-feated, or gun-
   fhot, 381.
         irritating fufceptible
parts, 385.
          neceffity of keeping
   air from, 372. 
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