i,V< / : *• ■ , A*' as '^si :t-V $ ft &i:-'H #1 ^•ufi ?! ;^-"■ *■ '»** 2^3? i m* 'c&dUf/fei^ Surgeon General's Office k___ K».Z/tOa& 'J._clC- ^V -^rlOO.QO.-.C^Sl . / V jj? THE Elements of Medicine, Of. ✓ / JOHN BROWN, M.D. Tranflatcd from the Latin, with Comments and Illuftrations; BY THE AUTHOR, ^•> A NEW EDITION, REVISED AND CORRECTED. WITH A Biographical Preface. BY THOMAS BEDDOES, M. D. / • > The coincidence of some parts of this work with* correspondent "deductions in the •• Bnmonian Ekmenta Medicine—a. work (with some exceptions) of great genius—must " be considered as a confirmation of the truth of the theory, as thty were probably " ?H*YC4 at hy different train* ef rcasvning." Dr. Darwin, zotmtmia, p. 7 j. VOLUME I. 'tROM THE LATEST LONDON EDITION. PORTSMOUTH, N. H. Printed hy William & Daniel Tread* el?. 1804. * f :. a \ V TO The Ingenious^ THE Candid & Humane, The following Production O* Unfortunate Genius^ IS INSCRIBED BY The Editor. ( fl ) Account of the Origm and OhjeB of this Edition, and of the tir* cumjlances in which it differs from the preceding. JL CAN fcarcely imagine an undertaking in which, a little while ago, 1 was lefs likely to engage than an edition of Dr. Brown's Elements of Medicine ; and I think it proper to ftate, that it was not either the hope of fame, or of profit, or enthufiaftic attach- ment to the ingenious author's fyftero, that induced me to fub> mit to a tafk fo extremely unpleafant. The penury in which Dr. Brown lived, and the diftrefs in which he left his family, are fo well known, that to mention them can be no indelicacy. Soon after his death, a fubfcription in their behalf was fet on foot, and produced considerable temporary advantage. But as the cir- cumftances which gave rife to that fubfcription (till, in a great meafure, fubfift, it was conceived by fome benevolent perfons, that a republication of his fyftem, of which few copies remain on fale, might contribute to the fame defirable endt This refolution being finally adopted, it became highly neceflary to find a perfon willing to. fuperintend the edition. For this purpofe application was made to me ; and who could refufe his afliftance to fo good a defign ? I fear, indeed, the author's family will not derive any great benefit from the adventure. The very attempt, however, to ferve them may afford this coniolation to men of genius, pin- ing under poverty and neglect ; that, although they themfelves may receive no reward for their ufeful labors, a fenfe of their merit may at lafl: procure fome regard to thofe who are neareft and deareft to them ;- an idea, in my opinion, full as foothing as the profpect of poflhumous fame. In his translation, Dr. Brown feems to have exceeded his ufual negligence. His Englifh, it is true, when he is unfettered by the Latin idiom, fhows that he was poorly qualified to do his own work juflice, had he exerted his utmoft care.—Thele two caufes Qonfpired with the labored perplexity of his Latin ftyls to (r iv ), to render the tranflation difguftingly uncouth throughout, and in many paflages almofl impenetrably obfcure. Imagine the words of a fchoolboy, raw in Englifh, taken down, as he is in the ufual manner rendering a Lntin author to his matter, and you will have a juft notion of the ftyle of the work, which I had to refit for publication. Befides, fhange as it may appear, he fometimes miftakes either his own meaning, or the import of the Englilh terms in which he tries to convey it. Here is an inftance.— CLIX. Sitis et calor, quae injignes quoque in morbis fihenicis notae funty ajihenicd infflucium et cutis extremis vafcutis diathefi pendent, ita ea obturante, ut nondum peifpiratio reddatur, fed fangutnem tamen ad penultimos vafculorum fines pertranfire Jinat, et corporis genitum caloremy ob retentam adhuc perfpirationem, fubter cuticulam cumulet. This paflage is thus tranflated : — Thirji and heat, which are a Ifo remarkable fymptoms in fihenic dijeafes, depend upon the fihenic diathejis in the extreme vefjels of the fauces and fkin ; the diathefis fo obftructing the veffefe as not to allow a return of perfpirafion, but to fuffer however the blood to pafs into the very neighborhood of the ends of the vejjelsy and, by means of the fuppreffwn of the perfptratiotiy to accumulate under the cuticle the heat generated inthefyfiem. Again: Calor frigor i fuccedens, he tranflates, Heat overcoming the effecl of cold. An entirely,new tranflation was what I could by no means undertake. The next thing was to endeavor to render the author's meaning plainer by correcting his language throughout. Hitherto, few, I imagine, except thole who attended the lectures in which it was delivered, have had any precife knowledge of a fyftem, which appears to me, in fpite of many difadvantages, to have wrought a memorable change in medical opinions and practice. This knowledge will, I hope, henceforward be found far lefs difficult to acquire.—In the typography of the firft edition there was a remarkable peculiarity. The fupplementary words inferted in the text were printed in italic characters, and very frequently fhort explanatory phrafes were placed at the foot of the page. This feems to have been done in imitation of the Englifh bible ; nor do I doubt but the author confidered his Latin text as facred, both on account of the purity of the ftyle and the excellence of the doctrine. But as few reader:, I con- ceive '( v )1 ceive, will regard it with the fame reverence, and as the effect is difagreeable, the printer has been directed to change the italic for ioman characters, and to take the fhort phrafes into the text. There were alfo certain corrections, as well as additions to the original work, given in Englifh in the text, and in Latin at the bottom of the page. Thefe I have caufed to be omitted. They can be of no ufe, except in cafe of another edition of the Latin work, for which they may be eafily procured from the former edition of the tranflation. To complete tnis account of the alterations I have made, it is necefTary to add, that a few of the author's longer notes, for the reader's convenience, are received into the text. With this ftatement let the reader compare my inftrudlions, which were " to give a corrected tranflation of the elements, " fuch as the author, had he taken more time, would have made " or wiflied to make; for it fhould ftill remain his book; fome " freedoms indeed, if that be thought necefTary, may be taken, " as the original Latin will ftill remain." I have only to fay further, that I have placed a table of contents at the head of each chapter ; and inftead of difperfing the prin- cipal obfervations I had to make on the fyftem in notes, I thought it would be more advantageous to give them in connexion.— An illuftration by Mr. Chriftie, which has been found to aflifl fome perfons in conceiving the Brunonian doctrines, and a table, compofed many years ago, by Dr. Lynch, are alfo added to this Edition, PREFACE ( vii } PREFACE TO THE ORIGINAL WORK. THE Author of this work has fpent above twenty years in learning, teaching, and diligently fcrutinizing every part of medicine. The firft five paft away in hearing others, in ftudying what he had heard, implicitly believing it, and entering upon the pofleflion as a rich and valuable inheritance. His employment, the next five years, was to explain more clearly the feveral par- ticulars, to refine and give them a nicer polifh. During the five following years nothing having fucceeded to his fatisfaction, he grew indifferent to the Subject ; an^^with many eminent men, with the very vulgar, began to deplore the healing art as alto- gether uncertain and incomprehensible., All this time pafled away without the acquifition of any advantage ; without that which of all things is the moft agreeable to the mind, the light of truth ; and fo great and precious a portion of the fhort and per- ifhable lifeofraan, was totally loft. He was, at this period, in the fituation of a traveller in an unknown country, who, after lofing every trace of his way, wanders in the fhades of night; nor was it till between the 15th and 20th year of his ftudies that a faint gleam of light, like the firft break of day, dawned upon him. Seventeen years ago, in the thirty-fixth year of his age, he had his firft fit of the gout. For many years before, he had lived generoufly, except for the half year previous to this attack, dur- ing which he had obferved a more fparing diet. In a.bo#f fix weeks the difeafe finifhed its courfe ; it did not return till fix years after, and not even then, but in confequence of unufual low living for between five and fix months. • He was now in the vigor of his age, and, excepting the gouty taint, and fome debility, brought on by his late unufual abftemioufnefs, his conftitution was good. The gout, according to theory, long prevalent among phyficians, was faid to depend upon plethora and exceflive vigor; vegetable Vlll PREFACE. vegetable aliment was enjoined, wine was forbidden, and the careful execution of that plan of cure was promifed fo be reward- ed with exemption from the difeafe. A whole year paft in ftrict adherence to this regimen. During this year, inftead of exemption from the difeale, he had no lefs than four fits, exceed- ingly violent and painful, and of very long duration : In fhort, thi whole year, except fourteen days, was divided between limping and excruciating pain. i If, according to the theory, over-proportion of blood ancj excefs of vigor were the caufe of the difeafe, how, he confidered, were fuch diftrefling fymptoms to be explained ? Why had not the difeafe made its firft appearance twelve or fifteen years before, at a time when there was in reality more blood and vigor in the fyftem (a) ? Why did it only come on after a reduction of diet confiderable both in degree and duration ? Why had fo great an interval of time, during which he had returned to nis ufual full diet, intervened between the firft fit, and thefe recent ones ? and, why had the difeafe twice, almoft inftantaneoufly, come on after the change of a full nourifhing diet to a fparing one ? The folu- tion of this queftion was, at length, afforded by the ftatement of one more comprehenfive.—What is the effect of food, drink, and the things that fupport life ? They produce ftrength. What is their effect afterwards'? Always lefs and lefs. What is it towards the end of life ? So far from giving ftrength, they evident- ly^ prove weakening. Nay, the very fame powers, by whi.h life - was at firft fupported, at laftputan end to it, commonly through the intervention of difeafe. Notwithstanding difeafe firft and afterwards death are produc- ed, not by the privation, but by the abundance of thofe things, by which life is fuftained, he perceived that debility was the caufe of his diforder ; and that the remedy was to be fought, not in debilitating but Strengthening meafures. To this fort of difficulty (a) The blood is made from the food, ^nd is in proportion to its quantity, quality, and the completenefs of its digeflion. Now, before each of his lalt fits for the time fpecified in the text, as well as during the whole courfe i the attacks of the fecond jear, his food had b.-en almofl: folely vegetable, and, therefore, was i:ck fuited to produce enough, much lef^an excJIive quantity) of blood, and the d'gsitioa was alfo more impei/cft. PREFACE TO THE IX debility he thought proper to give the name ofindireSl. Such for two years was the fuccefsof the invigorating plarj, which he immediately after his reflections and queries carried into execu- tion, that at the end of this time he had only a flight fit, not equal to the fourth part of any of the former fits. Now no phy- fician will deny, that the recurrence of fuch a difeafe as the gout, which had made four attacks in one year, would have been more frequent ftill during each of the next two years, had the fame treatment been continued ; nor will any one think the addition of two fits every year too much. The mild fit was four times lefs fevere than either of the more violent ones. Multiply, therefore, twelve by four, and according to this computation, the proportion, in which the difeafe was alleviated will be as eight and forty to one. During the firft year, he had made ufe of vegetable food alone. During thefe two years, his only food was of the land animal kind, and of the moft nutricious quality.— His choice was directed to the beft in kind ; and he obferved no other precaution except being moderate in the quantity he ufed. Moft kinds of fifh, whether from the fea or frefh water, he found nearly as debilitating as vegetable matter, when folely or chiefly relied upon for a meal. A young gentleman, who lived with him, and had labored under a very fevere afthma, in confequence of the fame treatment, had only one fit at the end of the fame two years, inftead of a fit every day, as he had durii.g the common treatment. Afterwards, to refute a prevailing opinion, that the gout cannot depend upon debility, becaufe inflammation accompanies it ; little doubting that the inflammation itfelf depends on debility, he fubjected the queftion to experiment. He invited fome friends to dinner and by taking certain ftimulants in their prefence (b), recovered the moft perfect ufe of that foot, with which, before dinner, he could not touch the floor for pain. By this he faw, that not only the gout itfelf, but the inflammation accompanying it, was afthenic, that is, depending on debility. And he found, afterwards, the inflammations affecting the throat in the putrid and gangrenous fore throat, and the joints in B rheumata/gia, (£) Thefe asc mentioned in Dr. Jones's Enquiry. ORIGINAL WORK,' rheumatalgia, or that rheumatifm which depends upon debility, and is improperly denominated chronic rheumatifm to beafthenic: as alfo the inflammation, which is imagined, with whatever juft- nefs, fometimes to attach the brain at the end of typhus. As the, gout affects the alimentrary canal, and efpecially the ftomach, and in its courfe is attended with fymptoms fimilar to thofe that occur in dyfpeplia ; he was defirous to know if there was any affinity betwixt thefe difeafes, and he found that dyfpepfia, equally with gout depended on debility, and yielded to ftimulant remedies. Nay, he afterwards afcertained, that all fpafmodic convulfive difeafes of the alimentary canal, and nearly all the difeafes of children, (c) were of the fame ftamp. Continuing his inveftigation of fpafmodic and convulfive dif- eafes, when they occupy the organs of voluntary motion j he dis- covered that their nature was alfo the fame in kind, but only greater in degree ; as they are exemplified in the fpafms and pains, that occur in yarious parts of the external furface of the body, and in epilepfy, and in tetanus themfelves. Hence 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 th-j lancet, inftead of arifingfrom an over-proportion of blood and cxceflivc v igor, or any other fuch caufe, depended upon an under- proportion of that fluid, and other caufes of debility, and were ; to be cured, not by bleeding, or any Other evacuations, but by j filling the veffcls and reftoring the ftrength of the whole fyftem. i At firft, for the purpofe of removing fits of the gout, he went 1 no farther than the ufe "of wine, and other ftrong liquors, with nourilhing food, that is, feafoned meat, and kept the more pow- erful (c) A grofs and dangerous error ! Children are very fubjedl to inflamma- ! tovy difeafes of the thorax, which require bleeding ; fometimes when the hooping cough is prevalent, peripneumony fupervenes : in which cafe bleed- ing is almoft efTentially neceuary to the prefcrvation of life.—Children are fubj-icr ro other inflammatory difeafes as well partial as general. The croup and hydrocephalus hit.jrr.ui, if the latter be fthenic at firft, are forms of inflam- ' rnitory rtfledtion, almoft, peculiar to children. It is true^thoufands are cut off at an early petio.l of life, and tens of thoufands are^kept languiftiing during childhood in u. ft ate of miiery, by afthenic difeafes. But their chief cau.re :s ihe wan: of the r..reffa:i<.s of life. Editor. I > PREFACE TO THE XI erful remedies in referve. But, for many years paft, his furprifing fuccefs in the ufe of the latter,has enabled him to find in opium and fome other ftimuli, the fecret of repelling the fits of the gout as often as they returned, and, at the fame time, of re-ef- tablilhing the healthy ftate, a fecret that has hitherto been fo much wanted and defpaired of. This he has often effected, both in himfelf and in other perfons. It is now feven years fince he has been able entirely to prevent the return of the difeafe. By fimilar inftances in actual practice, he found that bleeding difcharges, which are called haemorrhages, do not depend oa plethora and vigor, but upon penury of blood, or debility arifing from fome other fource, and therefore he rejected them from th~ number of fthenic difeafes, (d) among which they had been ar- ranged in the firft edition of his text book, referving a place for them among the afthenic difeafes in the fecond volume of that work. For he faw, that bleeding, other evacuations, abftinence, vt?old, and fedatives, as they are called, proved hurtful; and that the ftimulant plan of cure alone was fuccefsful. Even wine and brandy, which had been thought fo hurtful in thofe difeafes, he found the moft powerful of all remedies in removing them. Hence he learned, that in all the difeafes, in which others had fuppofed there was abundance of blood, there was a deficiency, that the real caufe of thefe difeafes was debility, arifing from de- fect of blood and other ftimuli; and that ftimulants, given in proportion to the degree of the caufe, were the proper remedies. By the light that thus beamed in from practice, he faw, that the caufe and cure of fevers, both intermittent and continued, were the fame. Gradually l$d, as it were, by the hand of nature, around the whole circle of afthenic difeafes, he became convinced that they all depended upon the fame caufe, that is, debility: that thry were all to be removed by the fame kind of remedies, to wif, ftimulants fej ; and that neither their caufe nor their cur* differed but in degree. With (d) Sthenic difeafes, as will be afterwards explained,are fv-ch as ^ep?nd.i?pon an excefllve application of the feveral powers that otherwife nroduce health. (?) Wherever the word ftimulant is ufed without a particular qualification of its degree, the degree is underftpod to be greater than that required in tb» healthy itate, as will afterwards more folly be explained. xii ORIGINAL WORK. With refpect to fthenic difeafes, the caufe or cure of which nobody had underftood ; he wajWong ago aware that neither the inflammation, nor the other Symptoms attending them, as had been univerfally believed by fyftematics, were the caufe, but the effect : that the inflammation arofe from the caufe, i. e/the diathefis, or habit, and that it did no.t occur at all, except in cafes where the diathefis was very ftrong. In fine, he experienced in his own perfon, that catarrh was not produced by cold, according to the common opinion, but by heat, and other ftimuli, and was removed by cold and other debilitating powers. By this difr covery he was led to form a proper judgment of the catarrhal fymptoms in the meafles : Concerning which the great man who fo much improved the cure of fthenic difeafes, but who never attained to any knowledge of the afthenic, was muled by the alexipharmic phyficians. And, as thefe fymptoms are the moft dangerous part of the difeafe, he was right in fuppofing, that the proper treatment of them was of great importance to the cure of the whole difeafe. In confequence it came out that the refrige- rating antiphlogiftic plan was of as much fervice in the meafles as in the fmall-pox. In fthenic difeafes he illuftrated the caufe, enlarged the plan of cure, accounted for the fymptoms, and reduced the whole to a certain principle ; he distributed all general or univerfal difeafes into two forms a fthenic and an afthenic. He demonftrated that the former depended upon excefs, the latter upon deficiency, of exciting power ; that the former were to be removed by debili- tating, the latter by ftimulant, remedies ; that the noxious pow- ers, which excited either, were the remedies of the other, and the contrary ; and that they acted in the fame manner as the powers which produce the moft perfect health, with only a difference in degree. He extended the fame doctrine to plants. He laid down a principle which is illuftrated and confirmed by every particular ap- pearance, and by which every particular appearance is connected and illuftrated. Finally, he demanded whether the medical art, hitherto conjectural, incoherent, and in the great body of its doctrines falfe, was not at laft reduced to a fcience of demonftra- iion, which might be called thefcienceof life—aqueftion which has been anfwered in the affirmative by every one who has been ,t due pains to understand the doctrine. tuu fHE AUTHOR'S PREFACE TO THE TRANSLATION. A PRESSING, and very general, demand for an Engliflj tranfjation of the Elementa Midicinre, made feveral years before the publication of the fecond edition of that work, and fucceffive- ly repeated with an increafing importunity.ever flnce , a defirs of fpreading the knowledge of a doctrine, which had exhibited fo many indubitable proofs of its importance and utility to man- kind 5 ah ambition not quite extinguifhed by advancing yearst domeftic 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 difcovery; the neceffky for a tranflation in the prefent decaying ftate of the knowledge of the Latin language j the danger of the doctrine coming before the public from adventurers unequal to the tafk j and fome other circumftances, partly of a private, partly of a domeftic, nature^ with which it would he impertinent to trouble the reader ; all thefe, at laft prevailed with the author to fubmit, for once, to * talk, otherwise not defirable, that of tranflating his own work. Such a tafk feemed more naturally calculated to lay the foundation of the commencing fame of an ingenious pupih But, as no one of many, whofe literature and knowledge of the fubject complete- ly 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 pace with their affectation or intereftednefs'j 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 lets of readers; thofe xiv The author's preface, &c. thofe who db not readily enter into a thought conveyed in pure Latin, and, who, therefore, might with to be poffeffed of a tranf- lation 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 ex- clusive ufe of medical readers, but alfo for that of the public at large, it being evident, that, without even the exception of the profeflional knowledge of each individual, that of his own health is preferable to all other. And fuch an acquisition becomes valuable in proportion to its juftneis and folidity. The public are prefented with a work, that claims the merit of having reduc- ed the doctrine and practice of medicine to fcientific certairty and exactnefs. With refpect to the form, in which it is deliver- ed, it is stripped of that jargon of numerous, unmeaning or mif- leading terms, and all that mystery either in ftyle or matter, that has hitherto rendered the pretended healing art impenetra- ble to the moft intelligent and difcerning, and locked it faft up in the fchools. No terms are admitted but the few that necef- fity impofed, and thefe are every where defined. The ftyle is fimple, and fuited to the simplicity of the fubject. In the lan- guage and composition, ds far as the thoughts, which are new throughout, and that restraint, which is inieparable from exact- nefs of tranflation, permit, clearnefs is every where preferred to elegance, and diffusion to brevity. The author, in prefixing his name to both forms of his work, has thrown the gauntlet to its numerous, but anonymous, 6p- pofers. They are, therefore, called upon, now or never, to dis- prove it, and the judicious and candid part of mankind to judge between the parties. OBSERVATIONS OBSERVATIONS ON THE CHARACTER and WRITINGS OF JOHN brown; m. d. AT the time I undertook to fuperintend this republication of the Brunonian System of Medicine, I was pleafed with.the profpect of recording the life of its extraordinary author. Of the viciflitudes he experienced I had formerly heard enough to be perfuaded that they would furnifh a narrative fufficiently amufing. I was, moreover, aware of circumstances in his history, which it would be impoffible to relate without adverting to the- condition of medicine—a fubject- concerning which, unfortu- nately for many wfio have occafion to feek afliftance from that art, grofs mifconceptions prevail throughout fociety. I find myfelf, however, obliged to relinquifh the office of bi- ographer, fuch as I had conceived it. Of late I have had few opportunities of perfonal enquiry ; and very little of the infor- mation, I had reafon to expect, has reached me. Neverthelefs, I may fucceed in delineating the mortal portrait of my hero, for his character was exceedingly open to obfervation -y and in his productions the temper and underftanding of the man are moft faithfully exhibited. A perfon, who was his fehool-fellow, and afterwards 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 fuperior to that of a petty village artifi- cer,'I fuppofe the original deftination of the fon would have been higher, for this is an affair in which parents feldom err by excefs of humility. Mr. in ON THE CHARACTER Mr. Wait, the late refpectablc rector of Dumfries fchool, fiippofes 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 expreflions 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 cf heart, I believe, he never loft. I am forry I cannot minutely trace the fteps by which he ad- vanced towards intellectual eminence. Mr. Wait, without whole communications mine would have been a meagre narrative, ftates that " he early difcovered uncommon talents. His apti- •' tude for improvement," continues this gentleman, " induced •' his parents, after having fruitlefsly bound him apprentice to a •' weaver, to change his deftination. He was, accordingly, lent •c to thegrammar-fchool of Dunfe, where, under Mr.Cruickfhank, *«an able teacher, he studied with great ardor and succefs. In- **deed, he was, at that time, regarded as a prodigy. I went the '* fame road to fchool with him ; and his application, I well re- "member, was fointenfe that he was feldom without a book in 44 his hand." It is a lingular coincidence, that the two individuals, who in these times have been principally celebrated for their at" tempts to extend the knowledge ot animal nature, fhould have been both natives of Scotland, and that each fhould have beeri put to a coarfe mechanical employment ; 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 wheelwright. By an anonymous writer, who feems well-informed, it is affert- ed that Brown " fubmitted in his youth to be a reaper of corn, " to procure for himfelf the means of improvement. With the " price of fuch labor he put himfelf to fchool, where his abilities " and ardor attracted the notice of his master, and procured him " the place of afiiftant to the fchool (a)" His revolt from the loom, (a) Acaiytical Review for Auguft, 1789, p. 450. OF JOHN BROWN, M. D. XVil loom, according to this account, muft have been attended with highly honorable circumstances : and the reader will defire fuller information concerning both his motives and conduct than has been tranfmitted to me. From the cuf- tom of the country, we may prefume that he had received much more instruction, before he was put apprentice, than commonly falls to the lot of boys of his condition in Eng- land. Confidering the energy of his mind, we cannot be fur- prized that a little cultivation fhou'.d have rendered the gloomy uniform labor of a weaver distasteful. But this, though true, is perhaps 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 fup- pofition is, at least, conformable to analogy; fince in the history of eminent men, when we are fully acquainted with it, we never fail to difcover fome incident, which has deter- mined each individual towards the pursuit in which he has excelled. Now I imagine Brown mav have applied himfelf with fuch unufual afliduity to fchool learning from a per- fuafion that it would qualify him to propagate more effec- tually the tenets of his feet. My conjecture is founded on the following expreffions of Mr. Wait : l( He had at this "time"—the time of reentering at Dunfe fchool—"fober " habits: he was exceedingly religious, and fo attached to " the feet of Seceders or Whigs\ as they are called in Scotland, " 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 minister. " 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 struck with fuperflitious terror: Haller had fcarce- ly emerged from his infancy, when he began to preach to his father's domeftics : and in families, where the hatred of fed againft feet is cherifhed, one may generally perceive its moft virulent tokens in the boys. The moft humanized of my readers may remember the time when he glowed with zeal againft perfons who had been taught a different creed : C and xvui ON THE CHARACTER and where reflection, fofteninp- the heart into univerfal cbari*" ty, has not introduced perfect indifference as to the religion or irreligion of others, the pious flame muft he ftill alive The years of Brown's grammar education appear to have been, in no common degree, v.ell-fpent and happy. He had cigor of body with vigor of mind, and exerted both. He himfelf, with much complacency, relates proofs of that ftrength, which his appearance indicated. When a boy, he fays he valued hirnielf on being a stout walker. At fif- teen, on a hammer's day, he performed a march of fifty miles, between Berwick upon Tweed, and Morpeth in Northumberland. Some years afterwards, he travelled on foot, resting 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 fhort an intermiflion 1 During this excurfion, he traverfed " all forts of ground, in roads and out, over fmooth '? and plain, mountain and heath." We have feen, how- ever, that he could make a more rational ufe of his ftrength than merely to ftake it againft time and fpace. While he was thriving in godlinefs and knowledge, but at what precife period I am not informed, there occurred an incident which finally diverted him from the path he had hitherto with fo much alacrity purfued. At a meet- ing of the provincial fynod of the Merfe and Teviotdale, a party of his fchool-fellows urged him to accompany them to the parifh church of Dunfe. He manifested reluctance, but yielded to their importunity, and remained to hear the fermon. The fcandal did not pafs unnoticed. He was fummoned before the feflion of the feceding congregation j but not choofing either to atone by an apology for his fin in mixing with profane worihippers, or to wait for a formal fentence of excommunication, he abdicated his principles, and profeffed himfelf a member of the eftablifhment.— Thus, bigotry is often but the mafque of avarice, pride or ambition ; and here, though the nature of his prefent zeal was a fecret to the zealot himfelf, we fee it fully difclofed by this inftrudive anecdote. Encouragement at firft, and. afterwards OF JOHN BROWN, M. -D. XIX afterwards flattery, from his brethren, feern to have formed a strong connexion between the peculiar articles of his faith and a fenfe of his perlonal importance ; the moment thi$ connexion wasdiflblved, an alteration of fentiment fucceed* ed, not very much unlike that produced in Luther's minq hy the offenfive meafuje of the pope : the opinions he ha<4 fo warmly cherifhed loft all their value in his estimation ; or Tather, perhaps, became odious from the difgrace with which they threatened him. Religious enthufiafm, however, fur- Vived this facrifice to pride ; and his friends ftill recollect the vehement indignation he exprefled on account of the dangerous tendency of Mr. Hume's fpeculative writings ; which, fome time after this event, he found much the fub- .jed of converfation at Edinburgh. Thofe who regard the Scottifh eftablifhment as the true apostolical church may have caufe to rejoice, that fo ardent a feceder did not perfevere in his original zeal. For com- plaints are fometimes heard in Scotland, as well as in Eng- land, of the increafe of fedaries ; and he might have be- come formidable as a propagator of fchifmatic jdodrines. Among the divines of his nation he would have been unri- valled in claflical learning ; and I fee not what fhould have hindered a man endowed with fo acute and comprehenfive a genius from attaining equal pre-eminence in polemical divinity. He would have marched with alacrity into the field of controverfy, and confidently affailed the flouteft champion of the adverfe hoft. His vehement eloquence must have been deeply felt by audiences, to whom his dialed was intelligible and inoffensive : and, as little regard will be paid to ftyle, when the thoughts are intent on the high con- cerns of grace, faith, good works\ cleclion, and reprobation, he might have feconded, with his pen, the effed of his per- lonal labors. Had the incredulity of the age induced hirh to undertake a general treatife on Christianity, he was capa- ble of rendering Grotius obfolete by language of fuperior purity and more fkilful management of his arguments.—If he 1,ad borne the crofs as a feceding minister, he muft have fed a life of the ftrideft temperance ; fince in Scotland the clergy, XX ON THE CHARACTER clergy, even of the eftablifhed church, cannot fafely indulge in open diflipation. I need not therefore explain how much leifure he would have had for his clafiical and theological pursuits. Nor would he have enjoyed fewer or lefs lively fenfations of pleafure than a different courfe procured him ; for to a perfon of his temperament, fame and fanaticism 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 diftindion in the neighborhood 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 fliffnefs of pedantry to the fournefs of bigotry. But I have no information concerning his deportment ; and fhould any of his difciples think a fuller narrative due to their master's memory, fome notices may, I conceive, {till be colleded from the furviving members of the family. When deprived of this employment, he repaired to the univerfity of Edinburgh. In this«bufy feat of fcience, after going through the usual courfe of philofophy, he regularly entered upon his theological studies : he attended the lec- tures, diligently applied to the perufal of the authors re- commended by the profeffor, and proceeded fofar as to de- liver in the public hall a difcourfe upon a prefcribed portion of fcripturc : which is an academical exercife previous to ordination as a clergyman of the Scotch eftablifhment. At this point he stopped, and relinquifhed the profeflion of di- vinity altogether. The fequel will sufficiently 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 17 ;8 to Martinmas 1759. Mr. Wait, who profeffes him- felf to have benefited by the new ufher's inftrudions, men- tions, as a proof of the accuracy of his memory, that *fter once reading over the leflbn, coufifting of two octavo pages in OF JOHN BROWN, M. T>; XXl in Latin, he would lay afide the book and prelecl the whole over, without miftaking a fingle word. In the courfe of this year, one of the clafles in the high fchool at Edinburgh becoming vacant, Brown appeared as a candidate, but, *< on a comparative trial, proved unsuccessful." While he remained at Dunfe, it was remarked that the ftridnefs of his religious principles was relaxed. He even began to be accounted licentious both in his principles and condud. At a later period he was open enough in his avowal of irreligion. Whatever fcope the fad may afford to the eloquence ofperfons, accustomed to decry Edin- burgh as a fchool where the reafon of young men is exet- cifed more than their faith, it feems too evident to be de- nied, that this revolution of opinion in our ftudent of theology took place during his refidence there. The dif- tinginfhing portion of his hereditary creed he had abjured fropi pique ; nor can he be fuppofed to have had any rational corfvidion of the remaining articles; if rational convidion can only originate in sincere doubt and peried careleflhefs in regard to the conclusion to which examination may lead. Under fuch circumstances it is eafy to conceive by what a precarious tenure a fpeculative ftudent, placed iaafituation where information is at handj and enquiry not only free but fafhionahle, holds the benefit derived from the religious Jeifons of his parents and preceptors. Some unlucky sug- gestion may ftart a perplexing fcruple, the ferious investi- gation of this fcruple may raife an hoft of difficulties, and deliberation terminate in unbelief. At the time he renounced divinity, the fcene before him muft have direded his thoughts to the study of medicine. The only difficulty lay in the expence : but his obferva- tions might have fuggefted the means of overcoming this difficulty, independently of the encouraging circumstance which 1 (hall immediately relate. He muft have been aware that ftudents of phyfic are, in general, by no means fuch proficients in claffical acquirements as to fpeak Latin with tolerable fluency. Hence, before the examinations foradodor's degree, which are carried on in Latin, it is com- mon XXii -ON THE CHARACTER^ mon to have recourfe to a private inftrudor, whoconverfe^ with the candidate in that language. This preparation is familiarly called grinding, as a similar procefs at Cambridge is, I think, called cramming, The tranflation of inaugural dissertations into Latin, which the students, in moft in* ftances, compofe for themfelves in Englifh, is another occu^ pation from which a good fcholar may derive emolument at Edinburgh ; the ordinary gratuity for a tranflation being five, and for an original compofition, where that is required, ten guineas. Of his qualifications for thefe employments, accident, fliortly after his unfuccefsful competition for the vacancy in the high fchool, furnifhed him with an agreeable proof. Application being made to one of his friends to recom- mend a perfon to turn a thefis into Latin, Mr. Brown was mentioned. He performed the tafk in a manner that ex- ceeded th&expedations both of the friend and the candi^te. When it was obferved how much he had excelled the ordi- nary ftyle of fuch compositions, he faid he had now difcovered his firength, and was ambitious of. riding in his own carriage as a phyfician. Towards the clofe of 1750, therefore, he fettled at Edinburgh in the double capacity of teacher and ftudent. At the opening of the feffion, he addreffed a Latin letter to each of the medical profeffors. They weri perhaps already apprized of his merit as a claflical fcholar ; and they were all induced by his application to prefent him with a ticket of admiffion to their lectures. After fo auf- picious a beginning, he foon became famous as a teacher of Latin ; arid I believe he never afterwards refufed to exercife his pen in the tranflation of thefes. He was alfo at all times ready to furnifh an original deffertation according to the fiyftem his employer preferred. I have obtained no particular information concerning the firft four years of his medical ftudies. His circumftances were probably more flourifhing than at any former period. From the beginning of the masterly preface to his Elements it appears that he profecuted his ftudies with his charac- teristic ardor. In 1763, an old acquaintance found him in as OF JOHN BROWN, M. D. Xxiii as high repute among his fellow-ftudents as he had formerly been among his fchool-fellows—a diftindion which has never been obtained without the conjundion of ability with industry. He feems, however, during the intervals of his application, to have given into the moft dangerous of vices; '^ for the languor of his appearance feemed to fhow that he u had taken liberties with a constitution originally firm and " vigorous," In certain universities, destitute of foundations, or yearly ftipends for fcholars, the students live difperfed in ordinary dwelling-houfes : and this difperfion, according to my ob- fervation, is not lefs favorable to diligence and regularity than refidence in colleges. In mixed company the vicious propensities, 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 unbecom- ing pradices, to which a few only feel themfelves inclined. By this mutual corredion, the affociation of perfons of dif- ferent ages and fexes becomes the great prefervative of good manners and good morals. Colleges, which, after the ex- ample of monasteries, feem instituted on purpofe to prevent this falutary variety, doubtlefs give frequent occafions to emulation in thofe exceffes, to which young men are par- ticularly prone. A nice obferver, too, may perhaps difcover that their monastic difcipline irritates full as much as it re- strains. At Edinburgh the keepers of lodging and boarding houfes have generally fober habits ; and the obfervance of early hours is enforced with as much effed, though with lefs form, than by the porter's lift, the fine, and impofition. As far as difcipline regards learning, every man muft eftimate its value by his opinion of the effed to be produced by fet- ting grown gentlemen tafks. Where there have existed none of thofe reftraints, which always give more or lefs dif- guft, I have feen a large majority of ftudents purfuing knewledge with as great eagernefs as any of their equals in age were elfewhere purfuing thepleafuresof the chace ; and from the fame motive—the immediate fatisfadion it affords. Nor do Lbelieve that the acquisition of knowledge can be otherwife XXtV ON THE CHARACTER etherwife than agreeable, except from the fault of the tutor or the institution. If examinations are confidered as pow- erful incentives to diligence, none can equal in feverity thofe which are carried on at the voluntary meetings, which it has long been the cuftom to hold at the great fchool of medicine in Scotland,and which have fince been eftablifhed' among the ftudents at the inns of court in London, with the approbation of the moft distinguished profeffors o^thc law. , Brown, who now feems to have fupported himfelf in afflu- ence as a fingle man, perceived in the eftablifhment of a hoarding-houie for students* 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 profped he. married in 1765 ; and his fuccefs anfwered his expeda- tions. His houfe was foon filled with refpedable boarders. But he lived too fplendidly for his means, and " managed " fo ill that in two or three years he became bankrupt. w Towards the end of 1770, though reduced in his circum- " stances, he maintained the independence of his charader, " proving himielf to be, in the language of his favourite " Horace, -----Satis inter viliafortis, ** He feemed to be happy in his family, and, as far as I " could ever obferve, acquitted himfelf affedionately as an " hufband and a parent. He ftill frequented the medical "claffes," (or iedures ;) " and I heard him fay he had now " attended them ten or eleven years." [Mr. Wait.] We have feen how liberally Brown was treated on his entrance upon the ftudy of medicine. From the celebrat- ed Cullen he early received the moft flattering marks of at- tention. This fpeculatift, like Boerhaave and other men of genius in the fame station, was accuftomed to watch the fluctuating body of ftudents with a vigilent eye, and to feek the acquaintance of the moft promifing. There was a period when he made the greatest exertions to gain prof- elytes OF JOHN BROWN, M. D. XXV clytes to his opinions 5 and his mind was doubtlefs alive to that pleafure which the encouragement of merit affords to all who are capable of difcerning it, when no dread of rival- fhip interferes with the gratification. But Brown's power over the Latin language ferved him as a peculiar recom- mendation j and his circumftances might induce Cullen to believe that he could render this talent permanently ufeful to himfelf. Taking therefore its poffeffor " under his im- •" mediate patronage," he gave him employment as a private inftrudor in his own family, and' fpared no pains in re- commending him to others. A very ftrid and confiden- tial intimacy enfued. The favoured pupil was at length permitted to give an evening ledure, in which he repeated, and perhaps illustrated, the morning ledure of the profeffor ? for which purpofe he was intrufted with Cullen's own notes. Though Mr. Wait had not recolleded the profufe encomiums of his old fchool-fellow, his warmth of attach- .ment would be fully testified by fubfifting tokens ; to his eldest fon, for instance (William Cullen Brown) were given both the christian name and firname of his patron. Other proofs of mutual confidence and esteem might be colled- ed : but friendfhips originating in protedion are very prone to terminate in enmity, unlefs difference of rank and pur- suits totally preclude competition : and it is well known that the friendfhip in question was far from permanent. My materials do not furnifh information concerning the caufe or pretext of alienation, which was certainly injurious to the dependant party, and perhaps detrimental to fociety. In a communication from Dr. 5----, likewife an old and intimate acquaintance of Brown, it is faid, that after the fail- ure of his boarding-houfe, he " became impatient, and " unfortunately quarrelled with Dr. Cullen, from a fupjbofi- " tion that the dodor had it in his power to extricate him " from embarraffment by placing him in a more liberal and " lucrative fituation in the medical line." A report I re- member to have heard at Edinburgh coincides with this intimation ; but I relate it only on the authority of rumour. When the theoretical chair of medicine became vacant, D either XXVI ON THE CHARACTER either on the death of Dr. Alexander Monro Drummond, or the refufal of this promising young physician to fill it, Brown gave in his name as a candidate. On a former oc- cafion of a nature fomewhat fimilar, he had difdained to avail himfelf of recommendation, which he might have ob- tained with eafe ; and though, according to the friend whole words I have juft quoted, he acquitted himfelf in a manner far superior to the other candidaies, private intereft then prevailed over the jufter* pretentions of merit. At the pref- ent competition he was alfo without recommendation ; and, I fuppofe, could have obtained none. Such was his Sim- plicity, that he feems to have conceived nothing beyond pre-eminent qualifications necefTary to fuccefs ; nor did he harbor any fuipicion of that debating fyftem of influence, which has infeded the land fo thoroughly, that the poft of a fcavenger, were it held by appointment, would hardly be procured without cabal, or retained without ferviiity. The magistrates of Edinburgh appoint profeffors to the college, as well as masters to the fchool. They are reported derid- ingly to have enquired who this unknown and unfriended candidate was ; and Cullen, on being fhown the name, after fome real or affeded hefrtation, is faid to have exclaimed in the vulgar dialed of the country—Why,fure9 this can never be our Jock / With this fneer the application of a man was fet afide, whofe equal the patrons of the Edinburgh pn> fefforfhips will probably not foon have an opportunity of rejedjng. Though this account fhould come near the truth, it does not follow that the municipal board deferves much cenfure. In the execution of their trust they are indeed bound to examine the pretentions of the competitors, or rather to caft their eyes round wherever the Englifh lan- guage is fpoken, and feled 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 ; 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 perhaps exift reafons to warrant them in raifing him to OF JOHN BROWN, M. D. XXVil to the vacant chair. Public fame feems the fureft guide for luch eledors : and the reputation, fo long enjoyed by the Univerfity of Edinburgh, proves that it is a guide fuffi- ciently fure. The danger is, left its patrons, relying upon the eftablifhed credit of the feminary, fhould at any time fuffer intrigue to interfere with their choice. In this cafe a, fplendid college may indeed be ereded, but ftudents from different regions of the globe will foon ceafe to crowd its halls. Whether fuch a farcafm was uttered or not, Cullen (b) completely estranged the mind of his Latin fecretary on a fubfequent occafion. As I am not fuffkiently acquainted with the particulars, I cannot venture to appreciate his con-! dud j but the mortal affront was given, when Brown at- tempted to gain admiffion into that philofophical fociety which publifhed the Edinburgh Effsys. After this tranf- adion, an open rupture took place ; 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 follows:—" There is a junto «« of men in Edinburgh who at all times, from fear of his" {Brown s) " 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 " depending upon him. This condud, firft of all, was the " return they made him for great fervices done to them as " a body, and to certain individuals of them as friends, " Their open condud to him was friendly ; their fecret a " plot, a dark Catalinian confpiracy. Accordingly, his fuf- " picion of it was late, the full detedion later.....He chofe " to tear off the mafk of thei? pretended friendfhip.....His 11 firft ftep was to make application for being made a mem- " ber of a certain literary fociety, to which no man's petition *' had ever been rejeded before, or fince : forefeeing that he 4i would be rejeded. This accordingly happened. But he M-D. XXXV paffage, relative to this tranfadion, is evidently apologeti- cal ; but neither in that publication, nor in the letter of Philalethes, have I been able to find any plaufible excufe for fuch a violation of good manners, and good morals. 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 fyftem. Juft and judicious readers will, how- ever; difcriminate. And if, in the cafe of Bacon, the bafe- nefs 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, influence our opinion concerning the juftnefs of thofe principles ? He fometimes difcovered the propensity, Co common among the framers of fyitems, in a lefs offenfive way, A ftudent of medicine died of a low fever in fpite of the full and avowed ufe of diffufible stimulants. The body was opened ; feveral perfons were prefent ; among others the gentleman that informed me of the occurrence. Dur- ing the examination of the appearances, Brown with an air of great fagacity remarked that the body was unusually frefh. The difleding furgeon, whom perhaps kindred devotion to Bacchus had infpired with, tendernefs for the Dodor, re- plied that, confidering the circumftances, he had fcarce feen an instance where putrefadion had made fuch little pro- grefs. "Then, gentlemen," rejoinedthe dodor, "I appeal " to you if we may net confider this as a clear proof of the " propriety of our pradice." Brown was eleded prefident of the Medical-Society in 1776 and again in 1780. In what years he became a lec- turer and graduate in medicine, I muft leave to fome fu- ture biographer to fettle. Though he had attended the medical claries at Edinburgh ten or eleven feflions [Mr. Wait,] he reforted to St. Andrews for a Doctor's degree. His pupils, I believe, following in his train, strove to give to his paffage the air of a triumphal progrefs ; he was cer- tainly accustomed to relate with infinite fatisfadion the cir- circumftances XXXVI ON THE CHARACTER cumftances attending his graduation. He defcribed the pro? feifors beyond the Firth as overawed by his fame and pre- sence j it is likely enough that they wifhed to exchange their diploma for his money with as much expedition as . poffible. For feveral years after 1780, and perhaps before, the profeflbrs, the phyficians to the infirmary, and the focieties were unceasingly annoyed by the adherents of Brown ; the ftudents' debates were carried to the highest pitch of vio- lence , by the Medical Society a law Was paffed, 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 expulsion. The efforts of the Brunonians to expofe the praditioners, who followed a different fyftem, are fully exemplified in a Letter on the management of patients in the Royal Infirmary (g). This letter was occafioned by a reftridion annexed to the allowance of a very thin beef-stake to a patient in that holpital. It was exprefsly ordered that the stake fhould not exceed one incli and five fixteenths in length, or feven eights of an inch in breadth. This, at lcaft, is the meafure of the pattern (h). The tone, assumed in the commentary upon this text, is that of vehement invedive : on the au- thority, as the writer fays, " of one of your own ftudents*1' he gives the follow ftatement of the hofpital diet; " The Common Fare. " Soldiers pay zs. ^d. per week. «* Breakfaft—One roll of bread and a meafure of milk or beer. *' Dinner—One ditto, and a choppin of we^k broth* w Supper—The fame as breakfaft. Common Patients. '! Breakfaft—JJalf a roll, and a meafure of milk or beer. " Dinner—One roll, and a choppin of weak broth. « Supper—The fame as breakfaft. "In, lg). Edinburgh, 1782, pp. 32. Signed Veri dmievs. (A}. Letter, p. 9. OP JOHN BROWN, M, D. -vXXVll " In a few particular cafes, a little meat is allowed and " other neceffaries, as may appear proper to the physician," He then notices the roaft beef and porter of St. George's hofpital in London, and subjoins this appeal : " Let me .*.' figure the c'afe that you, Dodor, were plunged at once " into difeafe and beggary ; I put this plain question, whe* " ther would you choofe to be lodged and nurfed in.St. " George's hofpital, or to be deposited and ftarved in the " Royal Infirmary, under fuch medical treatment as your " own ? Your victuals," he proceeds " are not only fcanty " but bad. Your porridge is fometimes boiled almoft into " water-gruel ; your broth is commonly much better qua- " lifted to operate as an emetic than to nourilh the fyftem; " of your milk- we need only fay that it refembles the reft " which is fo}d \n the ftreets of Edinburgh. Your beer is " not always tolerable even t:; the palate- of an alehoufe t( fcullion." None undoubtedly but members of the medica!. profeffion, can have an adequate conception of the wide- wafting mifery that daily arifes from want of food, fuel and cloathing. Qccafjonally, in distressful feafons, the gnawing pains of hunger are affuaged by private charity ; and im- pending death or madnefs is prevented. But no effort is made to improve the predominant condition of the poor, though it is alike destitute of comfort and of hope. Ex- perience teaches how little they have to exped from thofe Political Swindlers, who, under falle pretences, ac- quire the power of fporting with the wealth and blood of nations. The wretchednefs of imprifoned criminals remain- ed unredressed only becaufe it was indiftindly known ; the wretchednefs of the indigent is not more clearly underftood; to expofe it fully to the eyes of the community is a work of extenfive beneficence referved for fome future Howard. When it is atchieyed we fhall be aftonifhed at the propor- tion of human beings that languifh in mifery or perifli prematurely ; the universal feelings of mankind will raife in behalf pf thefe victims of penury ; and their flefh will no longer be devoured by theluxurious creatures of corruption. #ut our Brunonian " friend to truth," feems to work upon the XXXV11I ON THE CHARACTER the companion of his reader, merely for the purpofe of de- grading a few profeffors in the opinion of a fet of ftudents. Jf his letter contain material exaggerations, it could only ferve to bring the caufe of humanity into difrepute. In 1782 I remember to have fpent an evening in com- pany with Dr. Brown. He aflumed the fovereignty of the circle, which consisted principally of his difciples ; and no- body thought of difputing his title ; he difplayed uncom- mon vigour of imagination, but to me the figures he call- ed up were fo little agreeable, that I never desired his con- verfationa fecond time. Others received entertainment; and by thofe who knew him well, he is remembered as " the beft companion in the word." His Doric dialed had nothing prepoffefling to an Englifh ear. It was fo broad as to leave me often uncertain of what he faid even in his ledures. And yet before he lindiertook the charge of a private tutor, he had attended an Englifh mafter at Ed- inburgh, " for the purpofe of acquiring a proper pronuncia- " tion and method of teaching that language, which he " had not before had an opportunity of being improved in." [D. S.] But rhe vefiigia ruris were riot to be effaced, or elfe he had voluntarily refumed his original notes. Unprofitable adherence to the houfe of Stuart, had been relinquifhed at Oxford before my entrance : and Brown Was the firft perfon I ever faw absurd enough to profefs himfelf a Jacobite. He had feveral years fince em- braced political fehtimerits thus repugnant to thofe he once held, and which had now become almoft univerfalty ex- tind. In 1770, " I was furprized," fays a gentleman who had known him long, " to find the Dodor a warm ad- *c mirer of the Scottiffi aristocracy : the lairds of Clanronald, " Keppoch, and Gengary, were the theme of his eulogy ; " and prints of fome of the chieftains who had joined the " late Pretender were placed among the divinities of his " household." No caufe for fuch a revolution in opinion, is afligned. It did not anfe by analogy frorri his hof- tility to the profeffors, for it took place before his rupture with Dr. Cullen. This fpecies of fuperftitution easily faf- tens upon the mind of the antiquary -3 and Brown had paid attention OP JOHN BROWN, M. D; XXX1X attention to the antiquities of his country. He was eleded aftiftant Latin fecretary to the Antiquarian Society of Ed- inburgh, without his folicitation or knowledge, and from the fole confederation of his literature, according to the Enquiry ; but this affertion is contradided by Dr. Duncan. His' contradidion is founded on Mr. Cummyng's declara- tion when he propofed Brown, that " he knew him to be " very desirous of obtaining the appointment." His converfation was full of contempt for the literature, talents, and dodrines of the medical profeffors, one great natural philofopher excepted. He continually criminated them as his perfecutors, and unjuft towards thofe ftudents who adopted his principles. This injustice is faid to have appeared in unufual feverity on the examinations pre- vious to graduation. In the Enquiry thefe complaints are repeated°; and to fhew how much the right of private judgment was infringed in the article of inaugural diflerta- tions, the following correfpondence is produced : the can- didate, it fhould be premifed, was desirous of quoting the fixty-ninth, feventieth, and feventy-firft paragraphs from the Ekmenta Median* in a thefis on epilepfy. "Sir, " A former experience of your civility prevents my apol- " ogizing for troubling you on the following occafion, viz. *' From a ftrid perufal and attention to my deffertation, " I find it necefTary 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 fubmit the two " following to your consideration : " i. That without it I am prevented from faying what " I really believe, to the manifest: injury of my deffertation. " 2. That I am deprived of the liberty other candidates " have always enjoyed in making quotations from any au- " thor j a privilege too, which wzspromifed me by Dr. Gregory. " As I wifh to have my deffertation printed immediately, " your anfwer as foon as convenient, will oblige " Your humble fervant "J. Wainman." Thr xl ftN THE CHARACTER The anfwer was as follows t "Sir, " I objected to your quotation, as I have often done t<5 " quotations made by other candidates, not that it con- " tained the opinion of this doclor, or of that profejfor ; but " that it contained fuch jargon, as could not fail to dif- " grace the candidate, and of courfe the ttniverfity, which "gave fandion to its publication. As to the liberty you " fay, * candidates always enjoyed of making quotations " from any author, right or wrong,' I never heard of it be- " fore, and am determined to give it no quarter > neither now ** nor hereafter." /P. » . A • •** (Signed.) Alexander Monro* I muft profefs myfelf incapable of entering into thefe fentiments : and 1 fuppofe many readers will concur with me in regarding with contempt the patch-work of educa- tion ; whetheSft confift of a fpecimen of penmanfhip, re- touched by the mafter for the honour of the' fchool, or an inaugural fpecimeni garbled by the profeffors for the honour of the University. Obferving the ftudents of medicine frequently 10 feefc initiation into the myfteries of free-mafonry, the author of - the New Doclrine thought their youthful curiosity afforded him a chfence of profelytes. In 1784 he instituted a meet- ing 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 ani- ' "mation as he fpoke Scotch. I was much diverted," add9 Dr. Macdonald, "by his ingenuity in turning into "Latin all the terms ufed in mafonry." In unfolding his fyftem it was his pradice firft to tranf* late the text book, fentence by sentence ; and then to ex* patiate upon the paffage. For moft of his pupils the tranf- lation was a preliminary highly necefTary ; and he muft have confidered it as politic to combine literary with fcien- ' tific inftrudion. The profped of this double advantage, might perhaps, from time to time, bring him a few addi- tional hearers j but whatever was the ablolute or compara- tive OF JOHN BROWN, M, D. xK ttve merit of the theory he taught, his feats, I fear, were feldom crowded. The introdudory ledure, if my memory is accurate, was intended to itnprefs upon his audience a fenfe of the importance of the ledurer's difcoveries ; its effed was rather to render him ridiculous. The dread of pain and death easily perfuade us that improvements in medicine are more beneficial than in any other art ; but when a man afferts the fuperior utility of his difcoveries to thofe of New- ton, he will with difficulty avoid the appearance of affert- ing the fuperiority of his talents. The ledurer, in his cooler moments, would have been fenfible that lofty claims produce only laughter or refiftance. But his imagination eafily kindled j he was thrown off his guard, and he strongly expreffed what he fervently believed. He usually pro- ceeded 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 matter's ardour abated, flacknefs ftole upon the pupils ; {o that his courfes not very unfrequently, I believe, flured the fate of Butler's ftory of the bear and fiddle. The nume- rous inaccuracies with which, in fpite of the remonstrances of his well-wifhers, he fuffered both editions of his Elements to pafs through the^prefs evince his negligence in thofe con- cerns which might be fuppofed to lie nearest his heart. His voice was in general hoarfe and almoft croaking, but "when he became animated, he had fine cadences "and pleafing tones, which took off all the uncouthnefs of "his accent and his manner." One of his pupils informs me that when he found him- felf languid, he fometimes placed a bottle of whifkey in one hand, and a phial of laudanum on the other; and that, .before he began his ledure, he would take forty or fifty drops of laudanum in* a glafs of whifky ; repeating 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. F The xlit * ON THE CHARACTER The fubjoined quotation fhews that he fometimes en- deavoured to enforce his tenets in a manner not very ufual » conceiving it lay in hi^ power to remove certain objedions■ m deducible "from the real or imagined inflammation of theJ*^ "brain at the end of Typhus," and "from the inflamma- tory part of the gout," he called 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 mak- "ing an experiment which was to decide the whole contro- -^ "verfy. A perfon called for him before dinner, who was* "in a way of bufinefs that led him to drink in the morn- \ "ing; he expeded a glafs from him and was gratified, $ "The Dodor for a reafon that the reader muft perceive, "colleded half a dozen of his principal pupils to dinner, "and drank with them till he only, inconsequence of what "he had taken before, was considerably affeded. He' told " them he had planned fome degree of intoxication in or- " der to explain many inflammations, which were univer- sally understood to be accompanied with, or to depend^ "upon, phlogiftic diathefis. Before the application of the " ftimulus we fpeak of, he had not been able to put his in- " flamed foot to the ground,, but had fupported himfelf V "in any little motion that hechofe to make through the" "houfe, by his found extremity, aflifted by the ufe of his " staff; but before he difmifled his company,, he recovered^ "the perfed ufe of his affeded leg (k).*' ™ A few words will defcribe the tenor of this unfortunate j man's life, 'till his removal from Scotland. He was fo re* duced in his circumftances as to be committed to prifon' for debt, where his pupils attended his ledures. In the; abufe of intoxicating liquors he obferved no moderation.. In 1775 Mr. Wait found him drinking water only. His fituation, about that time, would have roufed almoft any man to a struggle with this deftrudive habit. His preface difclofes the reafon of his fobriety. Finding the gout re- turn with feverity, after fome perfeverance in this experi- ment (k) Enquiry, p. 134. 0? JOHN BROWN,* M. D. ziiii ment of abftemioufnefs, he returned to the bottle, and never afterwards relinquifhed it. His profped of maintaining himfelf by teaching medi- cine at Edinburgh becoming every year worfe j he at length carried into execution a defign which he had long medi- tated, 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, Scipio's exclama- tion againft 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 appearance, as he moved along—a fhort fquare figure with an air of dignity, in a black suit which heightened the fcarkt of his cheeks and nofe—fixed the attention of fome gentlemen in the ftreet. They addreffed him in the dialed of his country; his heart, heavy as it muft have been from the precarioufnefs of his situation, and distance from his accustomed haunts, ex- panded at thefe agreeable founds. A conVerfation enfued, and the parties, by common confent, adjourned to a tav- ern. Here the ftranger was kindly welcomed to town 1 and after the glafs had circulated for a time, fomething was propofed by way of fober amufement—a game at cards, or whatever the Dodor might prefer. The Dodor had been- too civilly treated to demur, but his purfe was fcantily fur- nifhed, and it was necefTary to quit his new friends in fearch of a fupply. Mr. Murray was the perfon to whom he had recourfe ; the reader will not wonder that his interference fhould have fpoiled the adventure. A London fharper of another denomination afterwards tried to make advantage by the Dodor. This was an in- genious fpeculator in public medicines. He thought a com- position of the moft powerful stimulants might have a run, under the title of Dr. Brown's exciting pill; and for the privilege of his name offered him a ium in hand by no means contemptible, as well as a fhare of the contingent profits. Poor Brown, needy as he was, fpurned at the pro- pofal. L Xliv ON THE CHARACTER It is eafy to anticipate the remainder of my tale. Change of residence wrought no change of condud. Some of his friends were difgufted by thofe habits which repetition had unalterably fixed. In didating Brown's refolutions, pride had always its fhare: Cullen, who never mentioned his abilities without praife, ufed to add, that his temper ren- dered it difficult to deal with him. At the prefent period- m 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 fyftem woald become at length triumphant j but whatever he faid or imagined, he effeded little. He attempted to open, but never, I underftand,;* completed a courfe of ledures in London. In 1787 he publiflied, without his name, thofe " Obfer vat ions," from which I have already borrowed a paffage. . He could not in reafon exped to find a cordial welcome among his breth- ren in England. Public opinion can alone awe the body of eftablifhed phyficians in any country into toleration of innovators; and knowledge on this fubjed was too little diffufed for public opinion to operate with effed in his fa-^ vor. Thefe " Obfervations" were therefore properly in- tended 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- fequences that might have refulted, if he could have ren- dered his dodrine a fubjed of univerfal curiosity. He perfifted in his old irregularities for fome time, med*» *( itating great designs, with expedations not lefs ardent than if the fpring of life, in ail its hloom of hope, had been. opening before him. At length on the feventh of Odober, 1788, when he was about fifty-two years of age, he was feized with a fatal fit of apoplexy. He died, if I am not mifinformed, in the night, having fwallowed as he went to bed a very large dofe of laudanum j a fpecies of dram to which he had, indeed, been long addided. He was at this time about to begin a courfe of ledures. I am afiured by one who had feen him the evening preceding his death, that his appearance did not betray any tokens of diftrefs; nor was OP JOHN BROWN, M. Jp. xlv was tt apparent that his conftitution had run much into decay fince his departure from Scotland, When Cullen, two years afterwards, died in embarraSed circumftances, his friends obtained public aid for his family* Brown's dcftitute widow and children were faved from dif- trcfs by private beneficence; but it cannot be expeded that the contributions, raifcd for that purpofe, fhould hav* proved fufncient for their permanent support, Dr. Brown's family has been already mentioned as nu> merous: he left two fans and four daughters. His eldeft fon is now studying medicine at Edinburgh, where he has experienced great liberality from thtf profeffbrc and the fa- cieties of ftudents. His talents will, I hope, meet with a more adequate compenfation than thofe of his unfortunate father. Jn the recital of this fcanty information, my own fenti* ments have fluduated fo much that J am doubtful wheth* er I have preferved impartiality, or fhall appear confiftent in the distribution of pity, ridicule, cenfure, and applaufe, among the incidents of Brown's life. Yet the peculiarities by which he was diftinguifhed, appear obvious enough. He was endowed with uncommon fijfceptibility to impref- fions. By whatever ofcyect they were touched, the fpnngs of his nature bent deeply inwards; hut they immediately rebounded with equal energy, This quality is the founda- tion of all moral and intellectual fyperiority ; but, unhap- pily, the ftrong feelings and bold refolutions of Brown were not improved into fteady principles, $$e never feems to have taken pains to form a fyftem of condud advantageous to himfelf, and juft towards others. As foon as he loft the controul of fuperftition, his high ipirits hurried him into the moft intemperate exctifes; and, at a later period, his actions can only be regarded as the plunges of defpair. The ten- dernefs with which his cordiality infpired thofe who knew him formerly, I could demonstrate by a variety of teftimo- nies. By a writer already quoted, he is ftyled " a man of infinite goodnefs of heart (9)." Dr. S — concludes his communication (*) Analyt. Rev. See above. Xlvi ON THE CHAR ACT EK communication with thefe expreflions : " He was poffeffed " of a great mind that fupported him inthemidft of all his " diftrefles. He defpifed riches ; detefted every thing % " bafe, and poffeffed fuch opennefs of heart as to be liable ^ " to be taken in by every knave."—He undoubtedly com- mitted an error, which has often been produdive of fatal cdnfequencesto perfonsaccuftomedtofcientific fpeculation. .'J He gave mankind credit for a more fincere regard for truth, j^ and an higher fenfe of its importance, than they have en- tertained in any age. He imagined, perhaps, that Plato's 1M fally concerning Virtue was applicable to Science. He | therefore utterly negleded thofe arts by which the imagin- ation is captivated; and trusting to their intriniic value, •' 1 bluntly challenged acceptance for his opinions. * j Cicero and Bacon were his favourite authors; in his ela- j borate compofitions he imitated the Roman orator with« J affedation ; and it muft be confeffed, that by taking ad- vantage of the penury and want of precision, which Lucre- '•■ J tius and Cicero fo loudly lament, he has fucceeded to his 1\ utmost wifhes in conftruding a ftyle of claffical obfcurity. J He could, however, write otherwife, and unite at will perf- tm picuity with purity. This may be afcertained by examin-, Jl ing the differtations, which he furnifhed, at least, with their *| Latin garb. Several are preferved in a well-known collec- * tion {o); but for an obvious reafon I muft leave it to the j 'curious- reader to difcover, by private enquiry, which were compofed by Brown. ^| Bacon he admired not only for his mafterly furvey of ^ univerfal fcience, but likewife, as Dr. Macdonnel acutely V corrjedures, becaufe that great author appeared to counte- nance him in the difrefped with which he treated his pre- J 'deceffors:—He had little medical erudition. At firft he J probably read more than ordinary ftudents; but after he *• had conftruded his theory, he feldom peruled or confulted ^ any medical author. He was impatient when any difficul- i ty was ftarted which he did not fee clearly how to folve (p): nor ^ (a) See Thefaurus Medicos, iii. and iv. Edinburgh, 1785. (/>) Dr. Macdonnel. OP JOHN BROWN, Mr D,' Xlvii iior would he ever acknowledge any exception to his prin- ciples. An argument againft his fundamental propofitions, which I had mentioned in converfation to a favourite pu- pil, was communicated 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 appeared that the objec- tion worked upon his mind ; in the courfe of his ledure he waxed unexpededly warm ; and at laft, addreffed himfelf particularly, to the pupil who had ftated the objedion. He did not attempt to expofe its futility, as might eafily have been done; but, exhorting him to fuffer no infinuations to divert his attention from the doflrine, he proceeded to deliver againft the exercife of the underftanding, a diflua- five that might have done credit to the pulpit. The Obfervations, and the Elements of Medicine, are all the produdions which he avowed. But there prevailed a fufpicion, and it has. been publicly mentioned (q)> that he was the author of the Enquiry, publifhed in the name of Dr. Jones. By his moft confidential difciples I have been affured, that they never heard him drop an hint of having affifted in its competition. In manner it certainly bears a ftrong refemblance to the " Obfervations ;" there are, be- iides, as the reader may obVerve in my- quotations, forms of expreflion peculiar to Scotland ; but the profeffed authof 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 compoied as fpeedily as it could have been tranferibed by an ordinary hand. It is unquestiona- bly ill arranged, tedious, uncouth, arrogant, and illiberal; yet it contains paffages prefenting jufter views of medicine than I remember to have elfewhere fcen, and conceived in the genuine fpirit of Bacon. He designed a Latin elementary treatife of morality on philofophical principles (r)—Elements Morum ; but he ne- ver, perhaps, committed any portion of fuch a work to pa- per. We may fairly prefume that it would have been original, I {t) Dr. Duncan's Letter, p. 25. (r) Dr, Macdonnel, Jtlvirt ON THE CHARACTER original, luminous, and profound. And fince no man* not deeply fkilled in fuch knowledge, as phyficians fhould pof- &fs, will ever trace back human actions and paflions, along v their winding courfe, to the fountain head, the failure of J Brown's defign may be regretted as an heavy lofs to litera- ture. Having received a little additional information, too late for infertion in the proper place, I annex it here. To Mr. Wait's account of his quicknefs in mattering languages, it may be added, " that Brown difplayed a genius for litera- ture far superior to any fcholar that had ever been- under "the care of Mr. Cruikftianks. In the courfe of two years, x ^he could read all the Latin daffies with the utmoft ,J "facility ; in the Greek language, he made the fame re- "markable proficiency.*' This intelligence comes from Dr. S----■, who likewife mentions the aftonifhing power of his memory, and adds, that he firft went to Dunfe fchool in 1751, when he muft have been above fourteen years of age. The fad is remarkable, as he does not appear to have been before inftruded in the rudiments of the learned languages. The fame gentleman confirms my account of the motives of his ftrenuous application. "The leading " members of the feceding congregation at Duns, to which "his parents belonged, were ftruck with the proofs of ca- pacity he manifested at the country-fchool, where he "learned reading and writing; they encouraged him to go> "to the grammar-fchool, that he might be afterwards edu- cated as one of their ministers, expeding he would greatly "contribute to the promotion of their particular inter- «eft."----- I have pleasure in recording that, by advice of the friend who brought him the firft thesis to tranflate, he addreffed a Latin letter, to the late excellent Alexander Monro, then profeflor of Anatomy at Edinburgh, requesting gratui- tous admiflion to his ledures. Having fucceeded in this • instance, he applied in the fame manner to the other med- ical profeffors. His OP JOHN BROWN, M. D. XllX His intercourfe with Cullen forms the moft curious part of Brown's hiftory. The following memorandum includes his reafons for diffatisfadion with his patron, as they were affigned foon after the feparation to a perfon who acknow- ledged his talents, without being a partizan in his difputes, or a follower of his dodrines.—"They lived upon the ', "ftrideft intimacy for many 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 company could '/contradid any of Cullen's opinions without danger of "offending him. After the quarrel, he faid Cullen had "promifed him his interest for the firft vacant chair in the "college ; but when the late Dr. Gregory died, inftead of "using his interest: in Brown's favour, he did the reverfe— "that, to try him further, Brown petitioned for admifiion "into the philofophical fociety, but was rejeded through "Cullen's means." Here only on one fide of the queftion is fhewn: and the reprefentation comes from a man of im- petuous passions, who, to obtain our full confidence, fhould either have been lefs violent in defending or oppofing Cul- len.—Complaints of difappointed expedations are ftill more common in the intercourfe of patronage, than of faith- lefs vows in that of gallantry ; this happens, I fuppofe, be- caufe offers and promifes are extraded from harmlefs ex- preflions, by which perfoiis who amufe themfelves with gallantry and patronage, do not intend to convey any par- ticular meaning. G OF 1 OF Dr. BROWN's PRIVATE PRACTICE. TO fome readers it may appear strange that I fhould have finiflied the life of a physician, who caufed fo great an uproar in the medical world, without more particular notice of his private pradice. 1 enquired with fome foli- citude, but in vain, whether during the long period of his ftudies he was peculiarly obfervant of difeafes. One cir- cumstance I have lately learned ; and it will furprize thofe who believe him to have inculcated contempt for the fcien- ces auxiliary to medicine : my authority however is un- questionable. The feafon before he became an indepen- dent ledurer, he was industrious to acquire more minute anatomical knowledge than he had gained by attendance i on the public ledures; and for fome time attended a pri- vate inftrudor at five o'clock in the morning, and contin- * i ued with him for two hours ; botanical information was added, on thefe occasions, to the anatomical. He had for- merly been advifed by Cullen to qualify himfelf for giving « demonstrations in anatomy. Nothing could be imagined fo entirely repugnant to his turn of mind ; no wonder, therefore, the advice was not followed. Brown fomewhere condefcehds to fpeak of his own " ve- ry large pradice ;" but this is a compliment which every medical writer apparently thinks that ufagejuftifies him in j^ paying to himfelf. I remember to have heard of an houfe at Edinburgh,' which the Brunonians opened for the reception of poor pa- tients ; probably they were not able to procure funds for % its permanent fupport. The founder of the fed was, I" believe, feldom confulted but in cafes.given up as hopelefs ; and he was then apt to fpeak with imprudent confidence. / According to-Dr. S----, " his wifli fo ride in his carriage " would, in all probability, have been gratified, had it not " been prevented by his hidden death afterwards in Lon-, " don." If this furmife is founded upon any real tokens of approaching profperity, I could wifh they had been affigned. For Brown went to LondQn with no favourable ; omens. - OF REPUTATION IN PHYSIC II omens ; every extraneous circumftance was againft him, and what elfe 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 muft have witneffed phyfician after phyfician carrying away the prize of public favour from competitors, far fuperior in particu- lar fkill and general abilities, declares that " in a great city " medical reputation is, for the moft part, totally casual." " By an acute 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 phy- ficians:* The idea appears to me fo happy that I (hall ven- ture to profecute it through a few pages. Such a book, with a due extension of the plan, would afford opportunities for difplaying profeffional fcience, 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 leaft adive among the minifters of death, the mistake deferves to be cleared up ; and a proper explanation would be better than " cu^ _ " rious ;" it would not only teach how fome members of ' the faculty have contrived to retain a privilege which the priesthood has loft, but furnifh I know not how much ufe- ful instruction befides.. OF REPUTATION IN PHYSIC. On the moft superficial enquiry, it would be manifest that this man profpered becaufe he had been of & certain university ; another, merely becaufe he belonged to a par- ticular fed ; a third, becaufe he happened to be in the way of procuring a. recommendation to fome leader in politics or falhion. A great number would be feen to have fuc- ceeded' in life for the fame reafon precifely that Falftaff fucceeds upon the ftage,. Few analyfe their fenfations, and the firft impreflion made by thefe adventurers was pleafing. As far as the dramatic perfonage is concerned, the reafon is unquestionable, but it^by-no means applies fo happily.to the other cafe. The qualities producing the happy im- Hi OF REPUTATION IN PHYSIC. predion, have, in truth, frequently borne no nearer a rela- tion to profeffional merit, than Falftaff's pleafantry to folid worth of charader; in a variety of instances, they have been no other than fymrnetry of features or foftnefs of addrefs. It is calamitous enough for individuals, labouring under difeafe, to fall into bad or indifferent hands; but when the caprice of'fortune elevates her worthlefs favourites to the firft eminence in fo important a profeffion as medicjne, a more extensive injury is done to fociety than we fhould at firft imagine. To calculate its amount requires a great deal of thought. Befide the mifchief they perpetrate with their own hands, thefe intruders occupy the station due (if the general welfare is -to fettle the precedence), to physi- cians of enlarged views, who would make a beneficial ufe of its advantages, and impel the defedive art on towards perfedion. Is an example necefTary to enable you to con- >■ ceive what might be effeded by the powerful influence of medical men, enjoying the confidence of the great ? A number may be given, but one will suffice ; and it is the better for its fimplicity. We have not obfervations from which we can certainly deduce the difference, in point of efficacy, between certain warm medicinal fprings and com- mon water, heated to the fame temperature. The pro- blem, merely for its curiofity, deferves to be folved ; and it happens to be peculiarly interesting to that order, from which dodors in vogue receive their amplest gratuities* -j*' They have fliewn little anxiety for the removal of this dif- ficulty, 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 j have difcouraged ufeful investigations by insinuation, if not ; by dired opposition. Pride and avarice will always com- bine to render a profperous adventurer in medicine, whofe * views are narrow, jealous of improvements and hostile to improvers. The internal monitor whifpers that it was not by knowledge he rofe, but by knpwledge he may fink. It is therefore the constant expedient' of dullnefs to perfuade A the OF REPUTATION IN PHYSIC liii the world that men of genius are deficient in judgment; though it be certain that the very perfons who have been moft remarkable for devising new means of relieving dif- trefs and removing uncertainty, have alfo been the moft acute in difccrning the real relations of things. Still,how- < ever, the old way is judged the Jafefi, and crafty mediocrity treasures up the fpoils of the credklous and the rich. It is poffible to meafure the number of degrees by which medicine is more imperfed than it would have been if the public was not fo liable 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 kin- dred art, a standard of eafy application. Let it be fuppo- fed that a fucceflion of men of fpecious carriage and mean talents had flourifhed for a century paft, in the place of our great improvers 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 predeceffors could have rendered equal fervices to humanity. Of thefe ferviccs a concife but clear account fhould be given ; the fame fcrutiny 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 ordinary readers would be put in a condition to judge how far it betrays a fpirit of wanton difparagement, to affirm that a phyfician'in a great city, "is the mere plaything of " fortune, they that employ him, not knowing his excel- lence, nor they that reject him, his deficience (j);" thefe affertions, if they be well-founded, inevitably lead to a con- clusion more important than fatisfadory, for however We may be startled, we muft infer that the great eft repute in medicine affords fearce the flight efi prefumption offuperior JkiU •* fulnefs. Of the fortunate fons of Efculapius, feveral have been wary enough not to expofe themfelves to criticifm; in moft cafes, however, we have memorials sufficient to guide our (/) Johnfen's Life of Akenfide. judgment; IlV OP REPUTATION IN PHYSIC.' judgment; fome have left written documents of their pow- ers ; here the proportion between reputation and ability can be estimated with great precision. Confidering that his enquiry can be ufeful only by incul- cating falutary circumfpedion, our author fhould not-be deterred by the firft fentiments of repugnance which the attack would excite in many minds, nor by the refped due to his virtues, from examining the title of the celebrated Fothergill to prefent confidence, or posthumous reputa- tion. He fhould infift the more on this decifive example, becaufe Fothergill really appears to have done his beft to- wards improving 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 far he excelled in fagacity of difcrim- ination, or fertility of refources, would be eafily fhewn by an impartial furvey of his works ; and little doubt would remain whether his patients would have sustained much difadvantage, or our prefent ftock of information much \ diminition, if any well-meaning man of plain fenfe had moved in his fphere. If the fmalleft fcruple fhould be left, there exists a piece of evidence which it may be the more difficult to refiftj as it comes from the mouth of the worthy J Dodor himfelf. Fothergill and others, have been heard J by Dr.. G. Fordyce, ".to ftate in a ferious harangue, their "infpiration, not only in the knowledge of difeafes with- * "out enquiring into their external appearances, but in mak- " ing prefcriptions to flow from their pen, without any pre- " vious composition in their mind ; not in compliance *c with the prejudices of their patients, but from their own " belief (/)." * From fuch a comparative eftimate, the chief reafon why furgery has fo far distanced medicine, would appear. Should it be faid that furgery muft,from its nature, have outstrip-* ped medicine, as mechanical phylofophy neceflarily attain- ed fome degree of perfedion before chemistry, the juftnefs ■' of the obfervation may be acknowledged. But after a lib- eral (/) Fordyce on Fever, p. 160. OF REPUTATION IN PHYSIC Iv eral allowance for this caufe of inequality the author of the Investigation would find a far more powerful caufe necefTa- ry to account for the whole effed.—He might corroborate bis inference by an enumeration of the improvements ac- tually made in medicine ; from which it would be evident that they have been principally owing to perfons enjoying moderate reputation in the country. Objedions will occur to hafty reafoners ; and thefe the author muft take care to obviate. " A phyfician of "great eminence may be too bufy 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 moft eminent furgeons, who have found time to write extensive treatifes ; moreo- ver, 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 apothecary would have caufe to blefs the London luminary of phyfic. The anfwer to thefe objedions affords a criterion, 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 attained to great eminence without having made fome a(fignable improvement in phyfic, if he has neither execu- ted nor promoted any defigns, tending to this end, he may be fafely fet down as the narrow-minded creature of artifice, or the [polled child of chance. In an age where every incident is brought within reach of every eye, we may with perfed fafety apply to perfonages fo confpicuous the maxim of the fchoolmen, that "what does not appear, is to be reputed "not to exist." The. work in question doubtlefs requires courage as well as other valuable qualities ; yet the author, it I do not mistake, would incur lefs danger at prefent than at any preceding period. The posTefTors of furreptitious or acci- dental 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 com- bination would fail in bringing it into total difcredit. Some, Ivi OF REPUTATION IN PHYSIC. progrefs has been made in arranging the peculiar properties * of animated nature, and in recommending to mankind the: knowledge of themfelves. A feries of propofitions, ex- preffed in intelligiblejanguage, and capable of comparifou with appearances,'has been formed. Thefe propofitions, 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 interest- ing than any of the preceding : for it would be difficulty toaffign a reafon why the celestial motions, the working of machines, or chymical phsenomena,fhould be objeds of libe- ral curiofity; to the exclufion of the effeds produced by the principle of life. One reafon, of which the force will not be easily eluded, may be affigned in behalf of the latter ftudy. It diredly tends to promote the well-being, and prolong the existence, of the ftudent. The time therefore cannot be far distant, when inftrudion concerning the cau- fes of health and difeafe will be acknowledged to form a necefTary part of all rational education ; and the nearer we v approach to this period, with lefs hazard may the analyfis propofed by Johnfon, with the plan fo enlarged, and the purpofe fo ennobled, be executed. There is, still, an addition which, in my opinion, would contribute fomewhat to precision, and fomewhat to fecure . * the fick againft the danger of medical flaughter. This appendix I fhould call J at ro logi a, a denomination from which the learned reader may infer, that I have in view fome fuch application of the Linnaean method to Phyfi- cians, as Baron Born has exemplified in his claflification of Monks. If thofe asTemblages of human animals, that constitute { political focieties, were arranged according to the nature of their occupations, one clafs would consist of individuals, depending for their fupport upon opinion. This clafs, be- ' ing provided with a name of Greek origin, might be easily fpht into orders ; of thefe orders the medical tribe would make one. We have the order broken into genera ready to our hands : of the distribution into fpecies (which is more JARTROLOGIA. lvii more difficult) a fpecimen is subjoined.—Our writer's pre- fent concern is only with the genus—Doctor of Phyfic* '•This genus we may fubdivide into fedions, or groups ; as Linnaeus fometimes manages with genera, comprehending a number of fpecies. SECT., I. Doctors as defirous, at jeaft, of doing good and extending knowledge, as of amafifmg wealth. i. The philanthropic Doctor, D. equally fenfible of the importance and imperfedion of medicine ; compares the phenomena of health and difeafe with unwearied affiduity that he may form a juft arrangement of the adions of life, perfuaded that this is the only lure guide in medical pradice; cautioufly tries new remedies, and abides by the beft; beats the coverts of fcience, that he may himfelf start fomcthing ufeful ; is humane in his condud, not fo much from hid- den impulfes of the passion of pity, as from a fettled con- y vidion of the mifery prevailing among mankind. Var. a. The fhy philanth. D. fick with difguft at the manoeuvres of his intriguing brethren, runs into the oppo- fite extreme, and keeps too clofely retired from public no- tice. Var. b. The renegado phil. D. poflefling adivity of mind and integrity of principles ; relinquilhcs the pradice of phyfic, partly for the fame reafon as Var. a. and partly from diflatisfadion with its helplefs ftate ; applies his tal- ents to literature or fcience. Obf. i. Several of the greatest acceflions to human knowledge are owing to this fecond variety. » Obf. 2. A careful examination and comparifon of thefe two varieties, with fome of the fucceeding fpecies, will elu- cidate the nature of thofe phyficians^ that have ufually had great local vogue. More frequent than formerly—-not apt to flourifh in great cities—otherwife not confined to any particular fitu- ation. As felf-love grows more enlightened, the more com- mon will this fp. of D. become, till it fupplants all the H others j Iviii JARTR0L0«rA. ethers ; man being an animal lefs liable to be" du#cd as his ignorance decreafes. SECT. IL . ., D. Mere collectors of fees, tegardkfs of medical* .fiieuie\ given to artifice and intrigue, each fpecies after its own man- ner. 3, The bullying Doctor D. ... ■ Inexorabilitf, aeer looks big, struts, fWaggers, fwears. Obf. Surgeons, in our times, more frequently bear thefe marks. According to a moft acute contemporary author, the famous Radcliffe was a complete fpecimen of the fcullying D. "With fmall ik.il! in phyfic, and hardly any " learning, lie got into pradice by vile arts.—He would* ne- ^gled a nobleman that gave exorbitant fees;" and to height- en the infult by contrast "at the fame time carefully at- " tend a fervant or mean perfon for nothing—he was furly f'and morofe ; treated his patients like dogs—extended his "infolence even to the Royal Family—fcorned- to confrilt "with his betters on what emergency foever;, looked down "with contempt on the moft deferVing of his profeffion, ?ahd never would confer with any phyfician who would not " pay homage to his fuperior genius; creep to his humour, "and never approach hsm but with the flavifh obfequiouf- < "nefs of a court flatterer." 3* The bacchanalian Doctor. D. given to fottifhnefs, if jlot to drunkennefs—generally fomewhat of the Btilly. 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 phy- fic with pomp: they invented or borrowed from*the other profefiions thofe barbarious habiliments, of which ridicule has but lately ftripped phyficians. In times, when an huge wig, or a flowing gown, Could more effedually command refped than found morality, fubftantial juftice, or ufeful fkilly the stratagem fucceeded to admiration. Obf. 2. D. of this fpecies, when a pretext offers, fpeak oftentacioufly JATROtOGIA. ' lix dftentaqknifly of their experience—never fufpeding any of their hearers may -know that there are understandings which multiplicity of appearances ferves but to confound. 5. Tfiedub-htinting 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 paroxysms of frantic loyalty, and of a- vjfme in France. 6. The burr Doctor. D. fattening himfelf upon you as tenaoioufly as the heads of the noifome weed fcentaurea calcitrapa), from which the trivial name of the fp. is taken, fix upon your cloaths. Obf. Nothing in art, but the juggler's addrefs in mak- ing you take what card he pleafes put of a pack, equals the dexterity with which D. of this fp. force themfelves on pa- tients. 7. The wheedling Doctor. D. with an everlasting fmirk upon his countenance—frequent at the polite end of large cities, and at places of fafhionable refort. Var. a. The Adonis wheedling D. D. with an handfbme. face, joined to the wily addrefs, charaderiftic of the fp.— flouri,fhes as watering places ; fometimes joins to his pro- feflion the trade of a fortune-hunter; and if he fucceeds, "gives phyfic to the dogs." Obf. 1. D. of this fp. when moft moderate, prefcribe for every rich patient two draughts a day, and one night draught, befide pills and powders. Hence needlefsly to fwalfow 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 Doc tor. D. publilhing forged or fal- sified cafes. Obf "A very fertile fource of falfe fads has been opened "for Ix JARTR0L0GIA. "for fome time paft. This is, in fome young phyficians, "the vanity of being the authors of obfervations which "are often too hastily made, and fometimes, perhaps, very "entirely dreffed in the do fet. We dare not at prefent be " more particular ; but the next age willjdifcern many in- " stances of perhaps the dired falfehoods, and certainly the "many mistakes in fad, produced in the prefent age, con- "cerning the virtues and powers of medicines." Cullen. Mater. Med. I. 153. A-kin to this flagitious abufe is the pradice of purchaf- ing falfe attestations, on oath, for advertifements; and what is ftill worfe in effed, though not in intention ; a cuftom beginning to prevail among perfons of diftindion—- who cannot be fuppofed capable of difcriminating difeafes, or deciding on the efficacy of drugs—but who, neverthe- lefs, permit Quacks to ufe their names in testimony of cures, which they Juppofe themfelves to have witneffed. 9. The good-fort-of-man Doctor. D. a good fort of] man, armed, by fome mistake, with a diploma. Var. a. The goffiping good-foi t-of-man D. fetches and carries fcandal. Obf. Varieties numerous as the hues of the chamaeleon. 10. The Sectarian Doctor. D. dwelling among his own. people at firft ; and by them often pufhed on to fpread devastation among the reft of mankind. . Obf. Varieties manifold ; each diftinguifhable by the Jivery of its icd—one is too curious to be omitted. Var. #. The infpired Seel. Doctor. D. believing him- felf to be infpired with the knowledge of difeafes and rem- edies". In civilized countries not much more frequent than witches. Among rude tribes, as among the Tartar hordes, a kindred variety is univerfally found. See Gmelin's Trav- els. But thefe feem rather to pretend to infpiration, than really to believe that their deity ferves them in the capac- ity of Prompter : and they conjoin the charaders of prieft and conjurer with that of phyfician. I have not been able to afcertain whether our variety receives the afflatus, ex- cept JARTROLOGIA. lxt cept in its medical capacity: and the miracles it has wrought in this, are not fo perfedly authenticated, as to filence cav- illers. Obf. People are now-a-days delicate in giving recom> meadations on fome occafions ; but the beft bred perfona make no fcruple of prefling a favourite phyfician or apoth* ecary upon their acquaintance. 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 propensity into a regular.fyftem of Cabal. The deeper the hypocrisy, or the wilder the enthu* iiafm of the Sed. Dodor, the more eagerly will his brother- 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 administration of an- timony, mercury, opium, and bark, we may deduce from this fad a rule which is probably as little liable'to excep- tion, 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 Seel; the more you are urged, be the more on your guard againfi the fnafe. This rule extends to all demo- niacs poffefTed by the corporafion-fpirit, and to all fets of perfons remarkably gregarious. Obfervatioq. Concerning this decad of dodors, there remains a cau- tion to be laid down ; and that it may make the greater impreffion, I fhall deliver it in the/ftyle' of my models, the naturalifts. Notandum in toto hoc genere naturam mirahles edere htfus. It is indeed applicable to all the fpecies ; in- dividuals being apt, like hybrid plants, or mule animals, to exhibit the marks of two fpecies, wholly or in part. > . ■ " ">0 1 7" ,»§§?*«.■- n . ...;: no.l or ( Ixii ) OF THE BRUNONIAN IX>CTRiN£. A complete inyeftigation of Dc Brown*s theory of liv- ing nature, with its application to the knowledge and treat- ment of difeafes, would, at least, equal the original worfc in fize; befides, if I had any inclination to write fuch a com- mentary,! fhould not consider this- as the proper place fof ia-troducing it. I have, however, a f;ew words to fay on the outlines and formation of the fyftem. •! mall fabjoi^ fome refledions to put medicad ftwdents and readers, not jprofeffional, in the way of profiting by the true principl«p> he promulgated without being mifleif by his doubtfal eil erroneous positions. • . - ■'!* L,' Of Dr. Browns Ftindamc'tttal Propofitions. .The varied structure of organized beings it {s the buii» nefs of anatomy to explain. Confcipumcfs., affifted hy, common obfervations will diftinguifh animated from inan») imate bodies with precision more tfian fuificient for all the. ends of medicine. The caufe of gravitation has heen left» unexplored by all prudent philofophers; and Brown, avoidjf ing all ufelefs difquifition concerning the caufe of vitality^ confines himfelf to the phenomena, which this great mov-. ing principle in nature may be. ojrferyed £o produce. Hili moft general propofitions are easy of comprehenfion. I. To every animated, being isallotted a certain portioi, only of the quality or principle, on^wJIpjch the. phenomena of life depend.- Tlus principle isde^Qminated^ExciTABiL*-1 ?TT- . . ■a\'-\-:: . '. .,:""■! '";.' '.'.; ;.-«■-,> II. The., excitability varies in different animals, audi,in the fame aninja^ at different times^ .As; it is more intense, the animal is more vivacious^or r^ore fuff eptible of the,ao-; tion of exching powers. , ;i ,,,,... , ' III. Exciting powers may be referred to two claffes. i. - External, as heat, food, wine, poifons, contagions, the; blood, fecreted fluids, and air. 2. Internal, as the func-< tions of the body itfelf, mufcular exertion, thinking, emo- tion and paffion. \ IV. Life is a forced Jiate ; if the exciting powers arc withdrawn, death ensues as certainly as when the excita- bility is gone. ; V. < OF THE * RUN ON* AN DOCTRINE. Ixiil < V. The excitement may be too- great, too fmall, or in juft meafure. VI. By too g^eat excitement weaknefs is induced, be- caufe- the excitability become* defedive ; this is indireB dt&tlity : when the exciting powers or ftimulants are with- held, weaknefs is induced ; and this is direct debility* Here the excitability is in excefs. VII, Every power that ads on the living frame, is ftim- ulant, of produces excitement by expending excitability. Thus, although a perfon; accustomed to animal food, may gjtow weak if he live upon vegetables, ftill the vegetable diet can only be confidered as producing an effed, the fame in kind with animals, though inferior in degree. What- ever powers therefore, we imagine, and however they vary from fuch as are habitually applied to produce due excite- ment,., they can only weaken the fyftem by urging it into too much motion, or fuffering it to fink into languor. VIII. Excitability is feated in the medullary portion of the nerves, and in the mufcles. As foon as it is anywhere affeded, it is immediately affeded every where ; nor is the excitement ever increafed in a part, while it is generally diminifhed in the fyftem ; in other words, different parts can never be in opposite states of excitement. ^ I have already fpoken of an illustration, drawn up by Mr. Chriftie from a familiar operation, to facilitate the con- ception of Brown's fundamental pofitions. I introduce it here as more likely to anfwer its purpofe than if fcparately placed at the end of my preliminary obfervations. "Sup-^v "pofe a fire to be made in a grate, rilled with a kind of "fuel not very combustible, and which could only be kept V burning, by means of a machine containing feveral tubes, " placed before it and constantly pouring streams of air "into it. Suppofe alfo a pipe to be fixed in the back of "the chimney, through which a constant fupply of frefh "fuel was gradually let down into the grate, to repair the "watte occasioned by the flame, kept up by the air ma- chine." "Tht grate will reprefent the human frame ; the fuel in "it ^1 IxiV OF THE BRUNONtAN POCTRlNE. " it, the matter of life, the excitability of Dr. Brown and the "fenforial power of Dr. Darwin ; the tube behind fupply- "ing frefli fuel, will denote the power of all living fy stems " conftantly to regenerate or reproduce excitability ; while " the air machine, of feveral tubes, denotes the various film* " uli applied to the excitability of the body; and the fame "drawn forth in confequence of that application reprefents "life, the produd of the exciting powers ading upon the "excitability." "As Dr. Brown has defined life to be "a forced fiate" "it is fitly reprefented by a flame, forcibly drawn forth, " from fuel little difpofed to combustion, by the constant "application of streams of air poured into it from the dif- ferent tubes of a machine. If fome of thefe tubes are " iuppoied to convey pure or dephlogifticated air, they will "denote the highest clafs of exciting powers, opium, mufk, "camphor, fpirits, wine, tobacco, &c. the diffusible ftim- " uli of Dr. Brown, which bring forth for a time a greater " quantity of life than ufual, 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 stimuli, applied to the •' human frame, fuch as heat, light, air, food, drink, &c. " while fuch as convey impure and inflammable air may 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 under- "stand the feeming paradox of the Brunonian fyftem; that "%food, drink, and all the powers applied to the body, »k though they fupport life, yet consume it; for he will fee, "that the application of thefe powers, though it brings forth "life, yet at the fame time it wattes the excitability or "m<:::^r of life, juft as the air blown into the fire brings "forth more fame, but wattes the fuel or matter of fire* "This is conformable to the common faying, "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, ILLUSTRATION OF THE lXY "^'Balnea, Vina, Venus, confumunt corpora noflxa, "Sed Vicam 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, wiae, exhauft our frame, "But life itfelf is drawn from them." "Equally eafy will it be to illustrate the two kinds of "debility, termed direct and indirect, which, according to "Brown, are the caufe of all difeafes. If the quantity of " stimulus, or exciting power, is proportioned to the quan- tity of excitability, that is, if no more excitement is "drawn forth than is equal to the quantity of excitability "produced, the human frame w,ill be in a ftate of health, "juft as the fire will be in a vigorous ftate, when no more "air is blown in, than is sufficient to consume the frefh "fupply of fuel constantly poured down by the tube be- "hind. If a fufficient quantity of stimulus is not applied, "or air not blown in, the excitability in the man, and the "fuel in the fire will accumulate, producing direct debility, "for the man will become weak, and the fire low. Car- " ried to a certain degree they will occasion death to the "firft, and extindion to the laft. If again, an over pro- portion of stimulus be applied, or too much air blown in, "the excitabilitywill foon be wafted, and the matter of "fuel almoft fpent. Hence will arife indirect debility, pro- ducing the fame weaknefs in the man, and lownefs in the "fire as before, equally terminating, when carried to a "certain degree, in death and extindion." "As all the difeafes of the body, according to Dr. Brown, "are occasioned by dired or indired debility, in confo- "quence of too much or too little stimuli, fo all the de- "feds of the fire muft arife from dired or indired low- " pets, in confequence of too much or too little air blown "into it. As Brown taught that one debility was never to "be cured by another, but both by the more judicious ap- plication of stimuli, fo will be found the cafe in treating "the defeds of the fire. If the fire has berome low, or I • "the iXVl BRUNONIAN SYSTEM. "the man weak by the want of the needful quantity of "ftimulus, more muftbe applied, but very gently at firft, "and increael by degrees, left a strong ftimulus applied to "the accumulated excitability fhould produce death, as in " the cafe of a limb benumbed by cold (that is weakened ''by the accumulation of its excitability in confequence of "the abftradion of the ufiial ftimulus of heat), and fud- ■* denly 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, afiailed by a fudden and "strong blast of air, would be overpowered and put out, "inftead of being nourifhed and increafed. Again, if the " man or the fire have been rendered indirectly weak, by "the application of too much ftimulus, we are not fudden- " ly to withdraw the whole, oreven a great quantity of thei "exciting powers or air, for then the weakened life and^ "diminifhed flame might fink entirely, but we are by lit- "tle and little to d'iminifh the overplus,of ftimulus fo as to enable the "excitability, or matter of fuel, gradually to reco- ver its'" proper proportion. 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 J "fome phyficians, but he is to be treated, as the judicious " Dr. Pitcairn of Edinburgh,is faid to have treated a high- "land chieftain, who applied to him for advice in this fit- "uation. The Dodor gave him no medicines, 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 impreflion of his "arms. The wax thus gradually accumulating,diminiflfiB " ed daily the quantity of the whifky, till the whole qmcn^K "was filled with wax, and'the chieftain was thus gradual-j "ly, and without injury to his constitution, cured of theS "habit of drinking fpirits." 1 " Thefe analogies might be purfued farther ; but my " objed is folely to furnifh fome general ideas, to prepare " the reader for entering more easily into the Brunonian " theory, ILLUSTRATION OF THE Ixvii *{ theory, which I think he will be enabled to do after pe- "rufing what I have faid. The great excellence of that " theory, as applied not only to the pradice of phyfic, but " to t\\tgeneral conduct of health is, that it impreffes on the "mind a fenfe of the impropriety and danger of going from "oneextreme to another. The human frame is capable "of enduring great varieties, if time be given it, toaccom* "modate itfelf to different states. All mifchief is done in "transition from one ftate to another. In a ftate of low " excitement we are not rafhly to induce a ftate of high " excitement, nor when elevated to the latter, are we fud- "denly to defcend to the former, but step by ftep, and as "one who from the top of a high tower defcerids to the "ground. From hafty and violent changes the human "frame always fuffers, its particles are torn asunder, its or- "gans injured, the vital principle impaired, and difeafe,of- *ten death, is the inevitable confequence." "I have only to add that though in this illustration of " the Brunonian System (written feveral years ago), I have "fpoken of a tube constantly pouring in freih fuel, becaufe "I could not otherwife convey to the reader a familiar idea, "of the power poffefTed by all living fyftems, to renew their "excitability when exhausted, yet it miy be proper to in- "form the ftudent, that Dr. Brown fuppofed every living " fyftem to have received at the beginning its determinate "portion of excitability, and therefore, although he fpoke "of the exhaustion, augmentation, and even renewal of ex- citability, I do not think it was his intention to induce "his pupils to think of it, as a kind of fluid fubftance, exist- "ing in the animal and fubjed to the law by which fuch "fubftances are governed. According to him excitability "was an unknown fomewhat, fubjed to peculiar laws of its "own, and whofe different states we were obliged to de- scribe (though inaccurately) by terms borrowed from the "qualities of material fubftances." ?. C IX Ixvill BRUNONIAN SYSTEM. IT was not unusual for Brown's difciples to difagree,when they were called upon for a ftrid interpretation of his prin*. cipal tenets. If they be rigidly examined, they will be found, I think, not quite confiftent. with his own impor* tant dodrine of the accumulation of excitability, during different ftates of inadion. It appears to me, that accord* ing to his firft chapters (xviii), living beings ought to have proceeded through languor to death in one unbroken ten- our of wakefulness, and that all the images and lamenta- tions which fleep has fuggefted to the poets, would have been loft. He who alTumes that a certain portion of ex- citability is originally afligned to every living fyftem, by his very affumption, denies its continual produdion; fubfe-c quent diffusion, and expenditure at a rate equal to the fup* ply, or greater or lefs. That the brain is an organ destined to fecrete the matter of life, he could never have fuppofed, otherwife he would not have exprefled a doubt whether ex* citability be a quality or a substance. If we admit a fucceffive fupply of this principle, we may folve in a very eafy manner, feveral difficulties, for the fake of which new epicycles muft be added to Brown's fyftem. In the cold bath we may imagine the generation of fenfo- rial power, to proceed with fmall diminution, while the ac- tions 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 ex- ternal expenditure is diminifhed. But weak perfons fre- quently do not experience any glow. Here the adion on the fkin affeds the fyftem univerfally ; the produdion, therefore, is checked from the torpor of the fecerning organ, and this ftate of the brain explains the head-ach and chil- linefs, fubfequent to the mifufe of the cold bath. Thefe effeds are not, in my apprehension, eafy to be reconciled to the hypothesis of a fixed original ftock of excitability ; the fame thing may be faid of feeds and eggs long preferved, without feDfible change, in a ftate capable of germination and growth. Sleep fometimes produces no refrefhment, and yet it feems not to be imperfed or disturbed in pro- portion STICTURES, &c lxix portion to the languor felt on awaking. This I have attrib- uted to a failure in the fupply of excitability (a.) ; and nervous fever is imputed by another physiologist, to this caufe of debility, of which Brown had no fufpicion.—If an illustrative analogy be desired, his excitability might be compared to a fluid lodged in the body as a refcrvoir. According to the ftatement which I think more confonant to the phenomena, excitability would be like a fluid issu- ing from the brain as water from a fpring. Thefe refem* blances might be traced a little way, but they foon fail, as always happens in matters fo effentially diflimilar. The hypothefis of Brown is happily adapted to the limi- ted term of life ; according to the other fuppofition, we muft conceive old age and death to depend upon a limited power of fecretion in the brain. The difference is fcarcely perceptible here, but in terms; it is, however, pleafing to fuppofe that wifer ages will be employed in the culture of the human fpecies to which prolongation of life is effen- tial: and we can more eafily reconcile our thoughts to aug- mentation of power in a fecerning organ, than of the orig- inal provision of excitabilily; fo that the dodrine, in other refpeds the more probable, feems more conformable to the profped of improvement. Of Browns Application of his Principles. The moft negligent obferver might bring fpecious ob- jedions againft that uniformity of operation in stimulants, which is taught in the firft propofitions of the following elements: "heat and wine, 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 relaxed, in fome degree, the rigour of his principles. When the ex- citability is wafted by one ftimulus, excitement, he fays, may be produced by another ; nor does it feem necefTary, according to the examples quoted in the latter part of the thirty-firft paragraph, and the fubjoined note, that the fecond ftimulus fhould be more powerful than the firft. The («). Obfervations on Calculus, &c. IXX 8TICTURES ON SOME The fuccefllon in the note is, food, thought, wine, food, punch, opium, punch, thought* and fpeech •. and this is not conformable to the afcending fcale of ftimuli, according to his estimate in other paffages. He alfo admits fome modification of ftimulant power, from the manner in which different stimuli are applied, Thus heat stimulates the furface more than the fubjacent parts ; and stimuli received into the stomach exert more adion there than on any other part. It is extraordinary that he fhould not have extended this inequality of operation to the constituent, as well as the integrant parts of the fyftem. It was his principal fault, naturam tanquam e prtcaltd turn defpictr Diathefis. "1 - t Extreme b f Afthenic1 Death.. >J Intermittent Fevers Hyfteria. Mild Colic. Epiftaxis. Dyfpepfy. Menorrhcea. Hypochondriafis. Amenorrhcea, &c* A deficiency of the ftimuli necefTary to the maintenance of good health ; and an improper ap-plication of powers, which, though ftimulant, do riot ftimulate in a fufficient degree. Diminiflied. excitement, or Direct debility. The indication of cure is to increafe the excitement. The reme-dies are powerful ftimuli, fuch as are exhibited for the cure of indi-rect debility, but with this difference, that here it is necefTary to be-gin with a fmall degree of ftimulus, and increafe it gradually. Rheumatalgia. Rickets. Cholera, Hsemoptyfis, Epilepfy. Scrofula, Sec. St. Vitus's Dance. Defective ftimuli alone ; as cold, diet -fparing and not of good quality, fear, and the like. The indication of cure is here the fame as above, but ftimuli muft be applied fomewhat more cautioufly. Typhus. Scurvy, Colica Pietonum. Diabetes. Gout. Dropfy. Tetanus. Jaundice, &c. Infective ftimuli alone^ The indication of cure is the fame here alfo, but ftill greater cau-tion is neceflary in the application of ftimuli. lw 7 TO JOHN B R O W N, M. D; THIS TABLE IS DEDICATED, AS A TESTIMONY OF RESPECT, * BY HIS FRIEND AND PUPIL, SAMUEL. LYNCK THE Elements of Medicine.1 THE FIRST AND REASONING PART, CHAP. L EXPLANATIONS. Of medicine—"Of health, good and ill—Of difeafes local and univerfal—Of predifpofition. I. *% yTEDICINE is the fcience of preferving the good, J\d. and of preventing and curing the ill, health of animals. II. The application of this fcience to vegetables, may be named Agriculture. III. Good health confifts in a pleafant, eafy? and exact ufe of all the functions. IV. HI health confifts in an uneafy, difficult, or difturb- ed exercife of all or any of the functions. Difeafes come under this head. V. Difeafes either extend over the whole fyftem, or are confined to a part ; the former may not improperly be called univerfal or general, the latter local. VI. The former are always univerfal from their very commencement, the latter only in their progrefs, and that but feldom. The former are always, the latter never, pre- ceded by predifpofition. The former proceed from an affection of the principle of life, the latter 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 univer- fal difeafes, and as many of the local, as being at firft limit- ed to a part, afterwards affect the whole body, and afTume, in fome meafure, the appearance of univerfal difeafes. VIII. Predifpofition to difeafe is that ftate of the bod}% which S3 i THE ELEMENTS Parti which recedes from health, and approaches to difeafe, in fuch a manner, as to feem ftill within the boundaries of the former,-towhich!however, ft bears.only deceitful refem- blance. IX. Th#fe;tee ftates of health, difeafe, and predifpo- fition, conftitute the life or living ftate of animals ; to which that of vegetables is not diffimilar, though more imperfect. CHAP. II. Of life—Of the exciting powers, external and internal—Of excitability—Of excitement—Of filimuli* X. IN all the ftates of life, man and other animals differ from themfelves in their dead ftate, or from any other in- animate matter, in this property alone j they can be affeded^ by external agents, as well as by certain functions peculiar to themfelves, in fuch a manner, that the phanomena peculiar 'to the living fiate can be produced. This propofition extends to every thing that is vital in nature, and therefore applies' to vegetables. XI. The external agents are reducible to heat, diet, and other fubftances taken into the ftomacn, the blood, the fluids fecreted from the blood, and air. How poifons and contagions come under the fame view fhall afterwards be explained. ■XII. The functions of the fyftem itfelf, producing the fame effect, are mufcular contraction, fenfe or perception, and the energy of the brain in thinking, and in exciting paffion and emotion. Thefe affect the fyftem in the fame manner as the other agents ; and they arife both from the other and from themfelves. XIIL If the property which diftinguifhes living from dead matter, or the operation of either of the two lets of powers be withdrawn, life ceafes. Nothing elfe than the prcfence of thefe is necefTary to life. • * XIV. ■* Chap. II. OF MEDICINE. 8g XIV. The property, on which both fets of powers act, may be named Excitability; and the powers themfelves, Exciting Powers. By the word Body, is meant both the body limply fo called, and alfo as endued with an intellec- tual part, a part appropriated to paffion and emotion, or a foul.' the ufual appellation in medical writings\sfyftefo(a)m XV. The effects, common to all the exciting powers, are fenfe, motion, mental exertion, and paffion. . Now their effects being the fame, it muft be granted, that' the operation of all the powers is the fame (b). XVI. The effect of the exciting powers actjng upon the excitability, may be denominated Excitement. '*" .."-* XVII. Since fome of the exciting powers evidently atjfc by impulfe, and the identity of the effe<5t of others imp}t& the fame mode of operation ; and fince they' all ponefs-^i certain activity ; they may be denominated ftimulant, xft ftimuli. •• '• -: o i. Stimuli are either univerfal or local. '.','"* 2. The univerfal ftimuli are exciting powers, fo acting upon the excitability, as always to produce fomeexcitenierit over the whole fyftem. The -appe#ation of univerfal, ii convenient to diftinguifh them from the local. , 3. The local ftimuli act only on the part to which-they* 'are applied ; and do not, without prevjoufty producing an affection in it, affect the reft of the body. ■ji; '- cl M :^'' t ' ..••>': CiW. (a) No difquifition is here meant to be entered into, as religion it no where interfered with, but left to its proper guardians. (b) That is, fince fenfe, motion, mental functions, and the paffion* are the on'y, and conftant, effects of the exciting powers, acting upon Xhe excitability ; and fince thefe happen, whether one, or more, or all the powers, or whichever of them, act, the irrefiftible conclufion, 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 reafori- ing, which is certainly as juft as it is new in medicine, will ofcen occur, and, we truft^will ftand the teft of the moft fcrupulous fcrutiny. #0 THE ELEMENTS ?Wt I. C H A P. HI. Of the najure of excitability—-and'exciting powers—df . pojfonsr—contagions—debilitating food—Of the fedative or s depi effing paffions— Of the nature and limits of excitement-^ .: 0£m production—$Ufceffj'on and fubftitution of fiimuli-^ ,:- Txtfitment of exhaiified—and accumulated excitability. ."XVIII. WE know not what excitability is, or in what manner it is affected by the exciting powers. Bflt, what- ever it be, whether a quality or a fubftance, a certain portion is affigned to every being upon the commencement ^its living ftate. The quantity, or energy, is different in different anirpals, and in the fame animal at different times. Jt is partly owing to the uncertain nature of the fubject, mrtLy to the poverty of la^guage? and partly to the novelty of this doctrine, that the phfafes of the excitability being abundant, increafed, accumulated* fuperfluous, weak, not jBfell enpugh fuftained, not well enough exercifed, or defied ent in energy, when enpugh of ftimulus has not been ap- plied—-tired, fatigued,' worn out, languid, exhaufted of confumed, when the ftimulus has operated in a violent flegree—at other times in vigour, or reduced to one half. When the ftimulus has neither Been applied in excefs no; defect, will fee employed in different parts of this work* Both upon this, and every other fubject, we muft abide by facts j and carefully avoid the flippery queftion concerning caufes, as being in general incomrirehenfible, and as having ever proved the bane of philofophy. ^ XIX. As there is always fome excitability, however final], while life remains, and as the action of the exciting powers always takes place in fome degree, I conclude that *hey have all more or lefs of ftimulant effe&, and that this muft be either exceffive, in due proportion, or too fmall. 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 effect, and inducing the difeafes that depend upon Chap. HI. OF MEDICINE. eration of both the fame.. It muft, therefore, be admitted that th6 operation of contagions is ftimulant (&)„. Moreover, no remedies, but thofe that cure difeafes, produced by the* ufual noxious powers, remove thole fuppofed to be induced by contagions. Finally,, the great debilitating energy, ob* iervable in certain contagions, no more proves that they acts differently from the ordinary noxious powers, than an equal or greater degree of debility arifing. from, cold proves thai it acts differently (c). 4. It might appear to forne, that certain kinds of foodi. not fufficiently nourifhing, and, thercfore,.of hurtful tenden* cy •* as alfo that emetics, and purgatives, and fedative- , pafiidns. '(a) This propoGtion of frequent occurrence in this work; that identity of known effect always implies identity of caufe though un- known, will be found to be a mode of reafoning of equal ferricehv guarding our reader from the deceitfulnefs of abftract reafontng, and; mleading him into a proper mode of inveftigating folid and ufeful truth, (b) This is all that is contended for at prefent j the degree of their ftimulus will be afterwards confidered. (c) At the freezing point, or below it, man, and fimilar animals of warm blood, could not live a fecond in a denfe medium, fuch as thai. #£ water ; but the animals of cold blood can. $2 THE ELEMENNtS Part I, paffions, as they are called, belong to the number of powers^ the operation of which forms fo many exceptions to the ordinary, ftimulant operation. .5. Vegetable matter in general, when ufed alone for nourifhment, is hurtful j it is Co, at leaft, to. thofe who have been accuftomed to better fare, and that by a debili- tating operation ; yet even vegetable food, fince it fupports life, however poorly, longer than a total want of food, muft% of courfe, be ftimulant. But, if afthenic difeafes, in fome inftances, arife from vegetable food, and not always from fafting ; this muft be owing to a certain change produced in the fyftem, by which the fum total of ftimuli is rendered • lefs fit to act upon the excitability. That this is the cafe, is proved by the moft ftimulant foodlofing part of its effect Dy continued ufe, and requiring the fubftitution of another, ftjmulus in its place, to produce equal excitement. 6. The-operation of emetics and purgatives is alfo to be explained, as diminifhing the fum total of excitement x W^JGh is fupported, either by fome affinity between the exciting power and the excitability, or by agreeable fenfa-r, tion. That it is fometimes the amnity, fometimes the fenfation, is evident from the occasionally hurt;ful effect of things moft grateful to the fenfe, as the legumina.and other articles of vegetable food ; and from the falutary effect of .' difagreeable things,, as the feveral forms and preparations o£ opium : Both which produce their effect, the former by a^ debilitating, that is, an infufEciently ftimulant, the latter fcy^a confiderably ftimulant, operation (d). - , - ■ 7. The {d) Suppofe a certain power, as 40, fo mark the degree, in which the fum total of proper ftimulant operation confifts, and the excitement, produced to that degree, to arife from different exciting powers, all of them conducing to the fame effect, by the operation of each having a proper affinity to the excitability, or producing an agreeable fenfation ; the inference to be drawn is, that a certain fuitablenefs in the mixture of the whole to the excitability, a- well as the degree of ftimulus, pro* duce< the effect. Again, fuppofe certain ingredients, which cannot be denied to be ftimulant, added to this 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 which that had induced; or Chap. III. OF MEDICINE. 93 7. The fedative affections, as they are called, are only a lefs degree of the exciting ones. Thus fear and grief arc only diminutions, or lower degrees, of confidence and joy, not paffions different in kind. The news of gain produces joy, and grief arifes from the Jofs of money. Here then no operation of a nature contrary to ftimulant takes place ; it is nothing but a diminution, or inferior degree, of ftimu- lant operation. The lpbject of the paffions admits of the fame reafoning in every refpect as that of heat (^ ; and in the fame manner all the bodies in nature, that feem to be fedative, are debilitating, that is, weakly ftimulant ; in- ducing debility by a degree of ftimulus greatly inferior to fhe proper one. XXIf. Siqce the general powers produce all the pheno- mena of life? and the only operation, by which they do fo, is a ftimulant ; it follows, tnat the whole phenomena of life, every ftate and degree of health and difeafe, are alio owing to ftimulus, and to no other caufe. XXIII. Excitement, the effect of the exciting powers, the or it will, ftill without any reafpn for fuppofing it not ftimulant, di- minifli 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 ftimulant ; but the former in a higher, the latter in a lower degree, and therefore acting over all as debilitating powers. Muftard taken with, meat^ or onions with beef-fteaks, are agreeable to moft taftes ; but they are, though ftill ftimulant, difa- greeable to others, and debilitating. Peas-foup and peas-pudding, though, independent of the animal juice infufed into them, they are far from being falutary, will be well borne by many ; while in others, efpecially thofe who haye been accuftomed to more ftimulant meals, and in perfons who are gouty, and liable to complaints of the firft paffages, they will produce morbid affection. The fame thing is to be faid of beef-fteaks with onions, which agree with the healthy ftate, and difagree with the unhealthy ftate of the firft paffages. With regard tp all thefe enfeebling matters, there is no queftion about their being ftimulant; the whole effect is to be referred to their rendering a mixture, ftimulant in a certain degree, lefs fo. (e) The doctrine of cold as an active power, and oppofite to heat, is r.ow univerfally rejected, and it is confidered as ©oly a diminution of heat. ;54 i'HE ELEMENTS Parth\. , the true caufe of life, is, within certain boundaries, propor. tionai to the degree of ftimulus. The degree of ftimuluX when moderate, produces health ; in a higher degree it gives occafion to difeafes of exceffive ftimulus ; in a lower degree, or exceffively weak, it induces thofe that depend upon a deficiency of ftimulus, or debility. And, as excite- ment is fhe caufe both of difeafes and perfect health ; fo. that which reftores the morbid to the healthy ftate, is a diminution of excitement in difeafes of exceffive ftimulus, and an increafe of excitement in difeafes of debility. Thefe intentions are called Indications of Cure. XXIV. This mutual relation obtains betwixt exritabilH ty and excitement, that the more weakly the powers have acted, or the lefs the ftimulus has been, the more abundant ihe excitability becomes ; the more powerful the ftimulus, the excitability becomes the more exhaufted. XXV, A mean ftimulus, acting on a mean or half con- fumed excitability, produces the higheft excitement, And the excitement becomes lefs and lefs, in proportion either as the ftimulus is applied in a higher degree^ or as the ex-i citability is more accumulated. Hence the vigour of youth, and the weaknefs of childhood and old age. Hence, within a (hortcr period, a middle diet will produce vigour, and excefs, or abftemioufnefs* debility. XXVI. Every age, therefore, and every conftitution, if the excitement be properly directed, has its appropriate degree of vigour. Childhood, and that weaknefs, which, depends on abundant excitability, admit of little ftimulus i. by lefs than the due proportion it is rendered languid, by more it is opprefled. Old age, and that weaknefs, which is occafioned by a deficiency of excitability, require a great deal of ftimulus, become enfeebled by lefs, and are overfet by more. The reafon of the latter phenomenon is, that the excitability, without which no vital action is produced,. loes not exift in the degree necefTary to vigour of the functions ; while the former is to be explained from the exciting or ftimulant power, without which the excitability lies dormant, not being applied in the degree requiiite to vigour. Chap. III. OF MEDICOS. a' vigour. The failure of ftimulus may be fuch, as to pro- duce deafh. On the contrary, the exhauftion of excita- bility may go fo far, as tp extinguilh life by the 'extreme excefs of ftimulus* XXVII. The circumftances, under which excitement is produced, have two boundaries. XXVIII. One of thefe is, exhauftion of the excitability from violence of ftimulus. For all the ftimulant powers may carry their energy to the degree, under which no ex- citement wijl arife. The reafon is, that the body becomes no longer fufceptible to the operation of ftimulus; another expreffion for which is, that the excitability is confirmed. v XXIX. The ceffation of excitement, from the exhauf- tion of the excitability by ftimulus, may be either tempo- rary or irreparable: it may arife either from the (h'ort continuance of a ftrong ftimulus, or the long application of one more moderate. Both cafes come to the fame ; the ftrength.of the ftimulus compenfating for the fhortnefs of its application, and the length of its application for its greater moderation in degree. A force of ftimulus as fix operating for a fpace of time as one j and a force of ftimu- lus as one operating for a fpace of time as fix, will produce the fame effect in wearing out the excitability. The effect of the former is fudden death ; of the latter a more gradual death preceded by difeafes. And though a moft exact meafure of excitement be kept up, yet death at laft, how- ever late, will fupervene. XXX. Ebriety, debauch in eating, fweat, languor, heat, either alone or fucceeding to cold, dulnefs of mental exer- tion from exceffive thinking, depreffion of mind from violence of paffion, finally, fleep ; are all confequences of the fhort application of a high degree of ftimulus, operat- ing an exhauftion of excitability. The long continuance of lefs exceffive ftimuli is followed by the feeblenefs of old age, by predifpofition to difeafes of debility, as well as thofe difeafes themielves. The termination of both is in Heath. XXXI. When the excitability is wafted by any cr.s- ftimulus, there is ftill a referve capable of being acted upon bv 96 THE ELEMENTS Pdft U by any other. Thus a perfon, who has dined fully,or is either fatigued in body, or tired with inte ettualL^ion, and therefore has a difpofition to fleep, will be refrefhed by ftrong liquors ; and, when thefe have produced the iarne fleepinds, the more diffufible ftimulus of opium will aroufe him (/). Even after opium fails, and leaves him^heav? and oppreffed, a ftimulus ftill higher and more diffufible, it there be any fuch, will have the fame effect. A perlort fatiaued with a journey will be roufed by mufic to dance ancffoip ; and he will be enabled to run after a flying beautv. if ffie fly fo as to leave him hopes of overtaking her. XXXII. The exhauftion of excitability, by fucceffive ftimuli, is moft difficultly repaired ; becaufe the more ftimulant operation has been employed, that is, the more ftimuli have been applied, there remains the lefs fufcepti- bility to frefh ftimuli, by which the failure of excitement; might be removed. XXXIII. The reafon of the difficulty is, that no means of reproducing the healthy ftate, or the proper degree of excitement, are left; except thofe that occafioned ' the wafte, that is, an excefs of ftimulant operation, rendering the body lefs and lefs fufceptible of ftimulus. XXXIV. After this wafte of excitement, there is danger of fpeedy death, unlefs proper meafures be taken to pre:- fervfe! ,t* (/) A gentleman, engaged In a literary compofkion, which requt?* edan uninterrupted tuition of his mental faculties for more than rorty hours, was enabled to go thiough it with alacrity, by lupporting him- felf in this manner. After dining weil and fe- ting to bufinef, he took a glafb of wine every hour. Ten hours after he ate fomething nourifiV ing, but fpuving in quantity, and for fome hours kept himfelf up with puruh not too ftrong. And, uhen he found himfelf at laft like to be oveicome by an inclination to fleep, he changed all his ftimuli for. an opiate ; and finifhed his bufinefs in forty hours. What he had wrote was now to be put to the prefs. He had next to watch and coireft fhe proofs, which coft him between four >t five hours further continu- ance of vigilance and activity. To effedt this he took a glafs with the mafter printer, while his men were going on with their part of the work. The fucceflion of ftimuli in this cafe was firft fofid, next the ftimulus of the intellectual function, then wine, chen the food varied, then punch, then opium, then punch and converfation. Chap. III. * OF MEDICINE. 97 ferve life by a powerful ftimulus, but lefs than that which occafioned it, and then by one ftill lefs, till by means of the moderate ftimulus, that is fuitable to nature, or one fomewhat greater, life may at laft be fecured. The difficult cure of drunkards and gluttons, affeded with difeafe, fuf- ficiently evinces, that this confideration applies to all the exciting powers that ftimulate in excefs. This propofition applies to the moft difficult part of the practice of medicine. XXXV. The excitability thus exhaufted by ftimulus cpnftitutes debility, which may be denominated indired, becaufe it does not arife from defect, but excefs of ftimulus. XXXVI. Through the whole progrefs to indirect de- bility, the fecond application of every ftimulus has lefs effect than the firft, the third lefs than the fecond, and fo forth to the laft, which produces no more excitement; this effect takes place in proportion to the degree or duration of the feveral applications, though each gives fome excitement. Hence, before the eftablifhment of indirect debility, and juft as it is upon the eve or being eftablifhed, the ftimulus which is producing it, fhould be withdrawn ; a debilitating power fhould be applied ; as in giving over drinking wine at the end of an entertainment, and fubftituting water in its place, or applying cold to a perfon who has been expofed to an exceffive degree of heat (g). XXXVII* The progrefs to indirect debility is alfo retard- ed by diminifhing the excitement from time to time, and proportionally increafing the excitability, and thereby giving more effect to the adion of ftimuli. Take for example, cold bathing, or lowering the diet from time to time, or a limilar abatement of other ftimulant powers. 8. If cold fometimes feems to ftimulate, it produces this effed, not as adual cold, but either by diminifhing exceffive heat, (g) 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 carded 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. N 98 THE ELLMENTS Part I. heat, and reitorino the proper ftimulant temperature {h),ox by rendering the body acceffible to air, or by accumulating the excitability diminiihed by exceffive ftimulus, and heightening the effect of the exciting powers, before ading too languidly. An inftance of this operation of cold oc- curs in the torrid zone, where adual cold is fcarcely to be procured j in the ufe of refrigerants, as they are called, in fevers ; and in the contradion, by means of cold, of the fcrotum previoufly relaxed by heat. Nay, fuch is the efficacy of this caufe, that fthenic difeafes may be more certainly produced by cold, alternating with heat, and either preceding or following it, than by pure heat. XXXVIII. The other condition or circumftance, limit- ing excitement, is, a ftate of the exciting powers infufficient to produce excitement. As this cafe arifes from deficiency of ftimulus, and abundant excitability, it ought to be diftinguilhed fiom the other, which fuppofes abundance of ftimulus, and deficiency of excitability. This diftindion is required alfo for the purpofe of practice. All the excit- ing powers may fall fo far fliort in ftimulant force, as to produce this effed. They all, therefore, equally ferve to illuftrate and confirm this proportion. XXXIX. In (h) The principle upon which the operation of the cold bath depends has never been underftood, and therefore all reafoning, as well as practice, with refpect to it, has been conduced 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 80 to 70, the former of which is the head of the fcale, arid conftitutes the range of indirect debility ; and likewife through all the intermedi- ate 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 ledums, that cold is of fervice in the Fevers and other difeafes of the torrid zone. The truth is, that, in that country, there is no accefs to the ufe of actual cold. All that can be done there is, by various means, to diminifh the excefs of heat, which is constantly ruftung from thofe degrees of it which ftimulate and ex- cite, to thofe, in which its ultimate ftimulant power deftrojs excitement, and leaves nothing but indirect debility. ' wwrcmcm, (Hhap. III. OF MEDICINE. 99 XXXIX In this cafe, the excitability becomes abundant, becaufe, in confequence of the ftimuli being withheld, it is not exhaufted. Thus, in the cold bath, the excitement is diminiihed, becaufe the ftimulus of heat is reduced, and, therefore, the fum of all the ftimuli falls fliort; fo that the excitability, being lefs exhaufted by ftimulus, is increafed (/'). The fame conclufion applies to famiftied perfons, to water drinkers, to thofe who are in a ftate of refrigeration from other caufes, to thofe who have fuffered evacuations of any kind, to thofe who have negleded the ftimulus of exercife, to thofe who have negleded the ufe of that ftimulus, which exercife of the mind affords, and to perfons in low fpirits. The {i) This is altogether a negative circumftance. The accumulation, increafe, or abundance of excitability, take any term you pleafe, is not occafioned 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 to 20 30 40 50 60 70 80 Excitability. 80 70 60 50/ 40 30 20 10 o At the commencement of life, the fum total afligned is underftood to- be 80, becaufe no part, as yet, is wafted by the aclion of ftimuli. 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 action and operation* but its accumulation to the reverfe, the want of the action or operation of the exciting powers, as is expreffed by the numbers, placed above thofe firft mentioned. Thus one degree of exciting power applied takes off one degree of excitability, and every fubfequent degree impairs the excitability in a proportion exactly equal to its degree of force. Thus a degree of ftimulant or exciting power equal to 10, reduces the excitability to 70 ; 20 to 60 ; 30 to 50 ; 40 to 40; 50 to 30 ; 60 to 20 ; 70 to 10 ; 80 to p. And on the contrary, the (ubtraclion of ftimulant power allows the excitability to accumulate. Thus, when the excitement is at 79, conftituting only one degree of life, take off one degree of exciting power, and two degrees of excita- bility will arife. As 80 degrees of exciting power leave no excitability*. Co 70 degrees of exciting power leave 10 ; 70 20 ; 50 30 ; 40 40 ; 3050; 2060; 1070; 08c. Hence death takes place from nothing pofttive, but from the negation of the only means by which life is fup. ported ; which are the feveral exciting or ftimulant powers, now fully, explained. 100 THE ELEMENTS Part I The withdrawing of any ftimulus is the more likely to produce dired debility, as the perfon has been accuftomedo to a higher degree of it (k). Take, for an example, the gout, and many other difeafes, which, under the fame circumftances, affed fome, and fpare others (/). XL. During the increafe of excitability, the excitement proportionally decreafes, nor is there any cafe, in which this procefs, carried far enough, will not produce death. This is confirmed by the effed of all the debilitating powers, mentioned above ; every individual of which, as often as it proves urgent, has a rapid tendency to produce death. XLI. The defed of any one ftimulus, and the propor- tional abundance of excitability, are for the time, compen- ; '; fated by any other ftimulus, and often with great advantage to the fyftem. So a perfon, who has dined infufficiently, and therefore has not been well enough ftimulated, is re- refreflied by a piece of good news. Or, if during the courfe of the day, he has not been fufficiently invigorated by the ftimulant operation of corporeal or mental exercife, and is confequently likely to pafs a fleeplefs night, he will be laid afleep by a dofe of ftrong liquor. When the latter is not at hand, opium will fupply its place. The want of 1 the venereal gratification is relieved by wine, and the want .- j of the latter is made amends for by the ufe of the former, each banifhing the languor occafioned by the want of the. »rj other. The fame conclufion applies to the ufe of thofe 11 ftimuli, for which we have an artificial, rather than a natu- ral, {i) For inftance, perfons accuftomed to drink wine, and eat well- feafoned nouriftiing animal food, will be more hurt by a water and vegetable regimen, than thofe who have not lived fo high in that re- fpect. The inhabitants of Britain could not live long upon the diet of the Gentoos. Perfons in genteel life could never undergo the work of day labourers upon their fare, (/) Vegetable aliment, and fruits and cold roots, as cucumbers, melons, acid drinks, and many other things not fufficiently ftimulant, will bring on a fit of the gout, all or any one of them, at any time ; while there are other perfons free from the taint which diftinguifties that difeafe, who can ufe them with impunity, or, at leift, with much more freedom and lefs harm. Something fimUar to this obfervation applies to moft difeafes. Chap. III. OF MEDICINE. IOT ral, craving. The longing for fnulF, when if cannot be gotten, is gratified by the pradice of chewing tobacco ; and, when any one is languid for want of tobacco to chew, fmoaking fupplies the place of it. Nay, when the fundions, as they often do, have undergone a temporary leifon, and on this account there is no accefs to the ufe of certain cuftomary and natural ftimuli ; the fubftitution of others, lefs habitual, and lefs natural, will fupport life, till the defire for the natural ftimuli is reftored, and thefe can be employed to fupport the natural vigour as ufual, and health is finally eftablifhed (m). XLII. As, in this manner, the fuperabundance of excita- bility, 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 accumula- tion be warded off, till the fum be brought down to that, which is fuhable to health ; fo, the more abundant the excitability is, that is, the more ftimuli are withdrawn, or the greater the failure cf the moft powerful ftimuli, is ; the lefs it is in our power to maintain that mediocrity of ex- citability on which the vigour of life" depends. So much debility may be induced and excitability fo.far accumulat- ed, that the reftoration of excitement fhall become imprac- ticable. This propofition is both illuftrated and confirmed by the adion of every debilitating power, as cold, famine, thirft ; and it is exemplified in fevers. XLIII. This fuperabundant excitability fo fpeedily brings on death,, that the only means of reftoring health is firft to encountftrl'it with a very fmall dofe of diffufible fti- mulus, a dofe fcarcely exceeding the fcanty portion of ftimu- lus, that occafioned it : after wafting a part of the fupera- bundance, we may proceed to a fomewhat ftronger dofe ; and (m) This propofition is of the utmoft importance, as holding out the true priociple, upon which fo many actions and feelings of human life, both in health and difeafe, are to be explained, and particularly as laying down an indication, which applies to f&hs of all febrile difeafes, and includes our artificial as well as our natural defires and appetites. 102 THE ELEMENTS Part I. and thus be conftantly taking off whatever fuperfluity ftill remains, till at laft the falutary mediocrity is regained. This ftate is the converfe of that debility, which arifes from a worn-out excitability («), and the danger accruing from it. To give examples, a famifhed perfon is not immediate- ly to be gratified with a full meal ; a perfon afflided with long continued or exceffive thirft is not immediately to be indulged with a large draught ; but food fhould be given bit by bit, and drink drop by drop, then both of them by degrees more plentifully. A perfon benumbed with cold fhould be gradually warmed. A perfon in deep forrow fhould have good news gradually communicated to him. { The news of the fafety of the Roman foidier, who furvived the difafter of his countrymen at Cannae, fhould have been communicated to his mother in a round-about way ; at firft as having no better foundation than doubtful report; then as being fomewhat more to be depended on ; after-. wards as being ftill more probable ; then as not admitting a fhadow of doubt : and laft of all, before he was intro- duced, the mother fhould have been at the fame time fortified, or had a part of her very abundant excitability taken off, by other ftimuli, and a glafs of Falernian wine. -\ XL1V. Since life is folely the effed of ftimulus ; which alfo produces difeafe in proportion to its excefs or defect, the remedies of both thefe deviations from the proper ftandi -4 ard fhould be accommodated to their degree j and a large fum total of ftimulus, through the courfe of the difeafe, muft be applied to a great degree of debility, or, what : comes to the fame thing, to a very abundant excitability i but the quantity to be applied at any one time fhould be • fmall, in the fame proportion as the excitability is abundant. XLV. The debility arifing from defed of ftimulus may be called direct •* becaufe it is not produced by any pofitive > (») An inftance of a worn-out excitability is that debility which arifes from intoxication ; one of an accumulated excitability is that which dram-drinkers experience the day after a debauch, in confe- quence of which their hands fhake till they are re-excited by their favorite cordial. Chap. III. OF MEDICINE. r°3 pofitive noxious power, but by a fubdudion of the things necefTary to fupport life. XLVI. Through the whole courfe of dired debility, every deficiency of ftimulus is incieafed by a fecond, the fecond by a third, the third by a fourth, till the effed at laft comes to be a ceflation of any further excitement. Excitement therefore, is never to be leflened, and debility increafed, with the view of giving greater effed to a new ftimulus by accumulating excitability. For, as often as this is put in pradice, the morbid ftate is increafed ; and, if the debility fhould happen to be great, any further in- creafe may induce death, but will never increafe the ftrength. For, though debility may be induced in this way at pleafure, the excitement to be obtained from a ftimulus to be applied after is confined within narrow boundaries {o). Take for an example, cold bathing in dropfy ; in the gout ; in fevers (p); in perfons who, previous to this, have been much expofed to cold -* or in any fort of debility. Who would (o) Suppofe,that in place of an excitement of 40 degrees, the excite- ment is gone down to 30, and the excitability mounted up to 50, 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 fuperadded, reducing the excitement to 25, and accumulating the excitability to $$. Suppofe alfo, that any ftimulus is next employed, with a view to raife the ex- citement, and fink or reduce the excitability ; what will be.the refult ? As an accumulated excitability admits of a very fmall degree of ftimu- lus at any. given time, while the accumulation of excitability, and finking of excitement, even to death itfelf, can be effe&ed in the fhorteft" fpace of time, and by any one of the debilitating powers ; confequent- ly, the lofs of vigour by the firft practice, and the reparation of it by the laft, will bear 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 befqre it was lowered. (p) By fevers here are meant thofe difeafes, fo named, which de- pend on evident debility, and not any of thofe which, though moft injudicioufly fo named, depend upon an oppofite caufe. Inftances of the former we have in all the fevers of the intermittent or remittent kind, in fynochus, 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 particular part, as in the throat, lungs, and various parts of the external furface. f04 THE ELEMENTS Part I* would treat fafting, deep forrow, weaknefs of the mertal functions, languor from inadivity, penury of blood, which are ail cafo of dired debility ; who would treat fuch cafes, I lav, by 'fuperinducing more dired debility, with a view to advantage from the very fcanty ftimulus, that can be admitted \ Tive accumulation of excitability is only proper where there is a predifpofition to indirect debility, OT afthenic dmhefis. XLVII. With refped to the two kinds of debility, we muft never attempt the cure of the indired by the direcV or of the direct by the indired, in the vain hope of obtain- ing benefit from the fubfequent employment of any ftimu- lus. Indired debility appears in the range of fcale from 70 up to 80 , the dired, in all the degrees below 40 to o. The only cales, that admit of debilitating operation, are thofe of exceffive excitement from 40 up to 70. For the' cure of difeafes within this latter range, all the diredly debilitating powers are proper, and, for the moft part, they only y becaufe there is no accefs to the ufe of the indirectly j debilitating powers, till they have run their full courfevof ftimulant operation from 40 to 70, at which laft only they become debilitating ; and, though fometimes, and under certain circumftances, they may be employed, the fafeft general rule is to avoid them. CHAP. Chap.1V. OF MEDICINE, lO^ CHAP. IV. Of the feat and effecls of excitability—Of the inequality with which different powers affetl the fyfiem—Which parts mofi affeded—Proportion of the partial to the general affeclion— What parts the ordinary powers mofi affefi—Partial and local dffeclions fimilar and fynchronous—Remedies do not acl partially. XLVIII. .THE feat of excitability in the living body is the medullary nervous matter, and mufcular folid ; to which the appellation of nervous fyfiem may be given. In this the excitability is inherent, but is not different in dif- ferent parts of its feat. This is evident, becaufe the exciting powers will immediately roufe into exertion any of the fundions that diftinguifh living animal fyftems ; or, in other words, produce fenfe, motion, thought or paffion (a) 9. Different exciting powers are applied to different parts of the nervous fyftem, none to them all at once j but the mode of their action is fuch, that, wherever they are applied, every one immediately affeds the whole excitability. XLIX. Every one of thefe powers always affeds fome one part more than any other, and different powers affed different (a) If a fmall quantity of an opiate, or a large one of any ftrong fpirit, taken into the ftomach, can inftantly alleviate an excruciating pain in a part the moft diftant from that to which the remedy is appli- ed, and, in a fliort time after, remove it altogether, as is now well known, how is that to be explained but by the above propofition ; it being impoffible to pretend that it is carried in the veflels ? Nor is any other of the many hypothefes, that have been thought of for the folu- tion of this fact, more admiffible. Should it be imagined, that it moves along the nerves according to the laft opinion, we demand proof of that aflertion ; which has not yet, and will not eafily be produced ; while the fact juft now affigned carries its own demonftration in its bofom. The queftion refolves itfelf wholly into the following folution 2 Why does opium at once relieve the gout in the ftomach, on the ex- ternal furface, and in the remoteft extremity of that furface ? Becaufe the property in the living fyftem, Upon which and by which it acts, is one and the fame over all. Q io6 TH£ ELEMENTS Part I. different parti in this unequal manner. The affeded part is generally that to which the power is diiedly applied. . 10. Moreover, the more excitability was affigned to any part originally, that is the more vivid and fenfible it is, the operation of each exciting power, whether ading with due force, or in excefs, or in defed, is, the more confiderable (b). Thus the bain and alimentary canal poffefs more vivid excitability, that is, more propenfity to life, than other in- ternal parts ; and the parts below the nails, than other external parts.—Neverthelefs, the affedion of the part bears no proportion fo that diffufed over the whole bod)'. L. An eftimate may be formed of the degree of affedion in the part moft affeded, and of that which is diffufed ovef the whole body, by comparing the affedion of the former with as many lefs affedions, taken together, as there are equal parts in all the reft of the body. Suppofe the greater affedion of a part (c) to be as 6, and the lefs affedion of every other part to be 3, and the number of the parts lefs affected to amount to 1000 , which is keeping greatly within the truth. The ratio of affedion confined to the part, to the affedion of all the reft of the body, will be as 6 to 3000. That this eftimate is accurate, or nearly fo, appears by the effed of the exciting noxious powers, whip]} always act upon the whole body (d) -9 and from that of the remedies^ (b) That is to fay, if t^e exciting power acts with that force which produces health, the degree of its adion is greater upon the given than any other pa.rt; as alfo when its action is either greater or lefs than that of the middle falutary degree. (c) 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 particular cavity in dropfy. x? ^ift hurtful powers, which produce peripneumony, in common Engliih, 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 inadivity, or an increafed velocity of its motion from violent labour, &c. the effect of any or aU which muft fall as much upon every other part of the fyftem as upon a fmall portion^ extreme veffels in the lungs, and therefore the morbid affection produ- ced cannot bte confined to the latter, but muft be extended to the former. The Chap. IV. OF MEDICINE. IO7 remedies, which always remove the effed of the noxious powers from the whole body (e), in every general alifeafe (f). LI. Temperature particularly affeds the furface of the body j diet, the ftomach and bowels; the blood And other fluids their refpedive veffels ; labour and reft both the veffels and mufcular fibres ; paffion and mediation, the brain ; all thefe affcd the parts mentioned (each that upon which its adion is exerted) more than any other equal part. LII. Inftances of the greater excitement of a part than of the reft of the body, are afforded by the earlier fweating of the brow of an healthy perfon, when he is ufing exercife ; Jpy checked perspiration j by inflammation, or fome analo- gous affedion in general difeafes , by hcad-ach and deliri- um. Proofs of a lefs excitement in a part are exceffive perfpiration not occafioned by labour or heat, efpecially when cold and clammy, profufion of the other excretions^ fpafms, convulfion, partial palfy, weaknefs or confufion of intelled, and again delirium. LIII. As the operation of the general powers, whether exciting in excefs, in due proportion, or in defed, is dired- ed to fome one part a little more, than to any other equal part j. The whole body muft partake of the morbid change ; it muft be one common affection pervading the whole. If this is not probation, let any thing left on record by authors, or any living phyfician, produce a fingle hurtful power, that, without affecting the fyftem over all, can penetrate into the innermoft recedes of the lungs, and there produce an inflammation. I (hall 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 fingle remedy which removes the difeafe by an operation confined to the lungs. There is not one. (/) A wound in the lungs, among other effects, may produce an inflammation. But that is not a peripneumony, 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 no error, that has hitherto ereeped into the art, needs more to be corrected. Such an accident is as much a peripneumony, as an inflammation from a coritufion in the foot is a gout, or the fwelled legs of women heavy with child h dropfy* But of all this, more hereafter. X08 THE ELEMENNTS ran I. part j the effed 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 proportion, or deficient, but never of an oppofite nature. For, as the exciting powers are the fame, and the excitability every where the fame, it is im- poffible that the effed fhould not be the fame. The ex- citement, therefore, is never increafed in a part, while it is diminiihed in the general fyftem—nor diminifhed, while the general excitement is increafed. There is no difference here, but in degree ; nor can different effects flow from one and the fame caufe. n. For though, on account of the great fenfibility of certain parts, for inftance, of the ftomach (g), and the adion, cither ftimulating or debilitating, exerted by the, exciting powers on them, thefe parts run fooneft either into. dired or indired debility, or into high excitement ; this effed is but of fhort duration, and the reft of the fundions are foon hurried into the fame ftate. Thus, naufea, vomit- ing, diarrhoea, and other fimilar fymptoms, produced by ftrong liquors and opiates : as well as the fame affedions apparently, and the gout, colic, gripes, and other fimilar fymptoms, occafioned by abftinence and water drinking : , like wife good appetite, and the removal of thefe turbulent fymptoms of the ftomach and inteftines, in the convalefcenfr [ ftate, in confequence of a proper adminiftration of food, drink, and diffufible ftimulants; all thefe are fhortly follow- ed by a fimilar ftate of the reft of the body, and the eftab- lifhment of indired debility is the confequence of the firft cafe ; that of dired debility fuceeeds the fecond ; and health over all is the termination of the laft. UV. No part, therefore, is the feat of general affedion; they extend over the whole body ; becaufe, with the in- equality above ftated, the whole excitability is affeded in every general difeafe. LV. Neither does the affedion of the moft fuffering part (g) For lhc feme reafon, i. e. the fenfibility of the general fyftem, wine and other ftrong liquors, as well as opium, induce indirect debility fooner upon thefe parts than others. Chap.lV. OF MEDICINE. 109 part take place firft, and afterwards fpread over the fyftem ; for as foon as the excitability is affeded any where, it is alfo and immediately affeded every where. Both fads are confirmed by the operation of every exciting power, affed- ing the whole body as quickly as any one part ; by general morbid affedions appearing equally foon over all the lyftem, and commonly fooner, than in the part moft affeded in the courfe of the difeafe (h). Therefore LVI. Every affedion of a part, that occurs in general difeafes, howevei formidable, is to be confidered as only a part of the affedion inherent in the whole body ; and the remedies are not to be direded to a part, as if the whole difeafe lurked there, and was only to be removed thence, but to the whole body, all which it^affeds (*). (b) 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 one-half, of many hundred cafes, where this fact has been painfully fcrutinized, 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 affedion of a part is external, and, therefore, acceflible, the application of a remedy over it, in conjunction with the ufe of the internal remedies, is of fervice, in confequence of their mutually affifting each other. A rag drenched in a liquid opiate helps the operation of that remedy taken internally ; but that is ftill by operating upon the excitability over all. CHAP. no THE ELEMENTS Peril. CHAP. V. Of Contradion and its efeds—Excitement the caufe of denfi- ty—Difference- of firength in the mvfcles m health—in ficknefs—and after death. LVII. MUSCULAR contradion depends upon excite- ment, and is proportional to the degree of excitement (k). This is proved by all the phenomena of health and difeafe, and by the operations of all the exciting powers and of all the remedies. Force and propenfity to motion are the fame. We muft judge from fads* not from appearances. Confequcntly, tremor, convulfion, and every affection com- prehended under it, are to be imputed to debility. The noxious exciting power in thefe cafes is a ftimulus uncom- monly irritating applied to the part. LVIII. The degree of contradion, that conftitutes fpafm, is not an exception from this propofition. This is a continued and deficient, rather than a great and due adion ; and in fo far as it is a ftrong contradion, it de- pends upon the local ftimulus of diftenfion, or of fomething equivalent to diftenfion. It confifts in diminiihed excite- ment, is devoid of force, and removed by ftimulant remedies*. The appearance of fymptoms, being ever fallacious, ought not to be relied on as the foundation of any judgment. Take now both the fad and the explanation.. LIX. As the degree of contradion, in fo far as it is a healthy fundion, depends upon ftrength, we are to hold it as certain, that the denfity of mufcular fibres,.confidered as fimple folids, is proportioned to the degree of their con- traction. LX. It muft therefore be admitted, that excitement is the caufe of denfity. And the denfity is rendered greater and greater by the excitement in proportion to its degree*. It is eafy to perceive this through all the intermediate de- grees (k) It has already been proved, that all the functions depend upon excitement, and therefore contraction among the reft. Chap. VI. OF MEDICINE. Ill grees of ftrength ; from the higheft, or that which takes place in madnefs, and the denfity correfponding to it, to the loweft, or that debility which is obferved in the article of death, in death itfelf, and after death, with a laxity cor- refponding to it. This is proved by the weaknefs of the fibres in their dead, and their ftrength in their living, ftate ; the only caufe of which difference, we know for certain, to be excitement (/). LXI. Hence the cavities of the veffels, through their whole trad, over the whole body, are diminiihed in a ftate of ftrength, and increafed in weaknefs. This is the true caufe of dimiijiifhed peifpiration, not conftridion from cold or fpafm. CHAP. VI. The forms of difeafes and predifpofitions—Relation between health, predifpofition, and difeafe—All from varied excite- ment—Life regulated by excitement—Sthenic and afthenic difeafes—and diathefes. LXII. EXCITEMENT, the effed of the exciting powers, when of a proper degree, conftitutes health : when either exceffive or deficient, it proves the occafion of difeafe, or of predifpofition, previous to the formation of difeafe. The ftate both of the fimple fohds and fluids depends upon the ftate of health, which is regulated by the excitement {a). 12. The firft caufe of the formation of fimple folids, and the fole caufe of their prefervation, is excitement. Under the direction of the excitement, the living folids produce the (/) Experiments have been made by baron Haller and others, to *fce«tain the comparative ftrength of mufcular fibres, and the criterion of judgment was their greater or left; difpofition to break by appended weights ; but the power by which any body refifls ftretching, is the idenfuy of that body. Thofe experiments fhow, that the fibres in the living body are prodigioufty ftranger than in the dead. (a) This propofition overturns the principal fynems that have ever appeared in the profeffion of medicine. But more of it hereafter. 112 THE ELEMENTS ***** I" the blood from an external matter taken into 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 excitement alone, through us varying degrees, that produces either health, diieale, or recovery. It alone governs both univerfal and local dilealcs; neither of which ever arife from faults of the folids or fluids, but always either from increafed or diminifhed excitement. Hence the cure is never to be direded to the ftate of the folids or fluids, but only to the diminution or the increafe of excitement. LXII1. Affedions peculiar to parts, or organic maladies, being foreign to this part of the work, in which the treat- ment of the general ftate of the body only is confidered, they are palled over at prefent* LXIV. That life is entirely regulated by excitement appears, i. becaufe the exciting powers have a ftimulating effed only : 2. becaufe the adivity of the fundions is proportional to the ftrength of the exciting powers : and ;. becaufe efficacious remedies are fuch as oppofe deficient ftimulus to exceffive excitement, and exceffive ftimulus to deficient excitement. LXV. The notion of health and difeafe being different ftates is difproved by the identity of the operation of the powers producing or removing each ftate* LXVI. The general difeafes, arifing from exceffive ex- citement, are called fihenic (b) ; thofe that originate from a deficient excitement, afthenic. Hence there are two forms of difeafes, and both are always preceded by predif- pofition. LXVII. That this is the only real origin of difeafes and predifpofitions is proved by the fame powers, which pro- duce (!) Their old name is phlogiftic : but as that word is abfurdly metaphorical from an old notion of that fort of difeafes depending upon fire or flame ; and becaufe it was not a proper contrail to the term here to be oppofed to it; as alfo becaufe it is ftill more ridiculous when applied to plants, which are comprehended in this doctrine ; it has been thought proper to reject it, and fubftitute the other in its place. Chap* VI. OF MEDICINE. 112 duce any difeafe 6t predifpofition, alfo producing the whole fet of difeafes to which it belongs ; and by the fame reme- dies, which cure any difeafe, or predifpofition, alfo curing all the difeafes and predifpofitions of its refpedive form (c). Betwixt thefe oppofite fets of difeafe and predifpofition, perfed health is the mean, leaning to neither extreme. LXVIII. The exciting powers, which produce fthenic predifpofition, or fthenic difeafes, fhould be denominated fthenic, or ftimulant, in a ftrid fenfe. Thofe that pave the way to afthenic difeafes, or produce them, fhould be called afthenic, or debilitating. The ftate producing the former or the predifpofition to them, may be called fihenic diathefis ; that which occafions the latter, with the predif- pofition peculiar to them, afthenic diathefis. Each of thefe diathefes is a ftate of the body common both to predifpo* fition and difeafe, which differ only in degree. I diftinguifh the powers, that raife both the diathefes to the meafure of difeafe, by the term exciting, noxious powers. The fthenic difeafes, in which the pulfe is much affeded, fhould not be denominated fevers or febrile difeafes, but pyrexies, for the fake of diftinguithing them from the afthenic difeafes, that difturb the pulfe, for which fever is the proper name. * CHAP. (c) The fame noxious powers produce, and the fame remedies re- move, both catarrh and peripneumony, difeafes only differing in degree. The powers producing them are excefs in the ufe of ftimulants, and the remedies whatever moderates that excefs. Evacuation, cold, and ^•fhmriffg, are the means. All the difference i<, that more of the means are employed for the cure of peripneumony than for that of catarrh. The noxious powers producing indigeftion and fevers are alfo tjw fame, to wit, debilitating ; and the remedies the fame, to wit, ftimulant. Only a fmall degree of the remedies, proportioned to the flightnefs of the degree of the caufe, is fufficient for the cure of indigeftion ; while the moft diffufible ftimuli are required to effect the cure of fevers.—• Stimulants, in one degree or other, make the cure of all afthenic di& eafes ; evacuants, and other weakening means, in different degrees, form the whole cure of the fthenic form of difeafes. Might not thw have been known long fince ? H4 THE ELEMENTS Part I CHAP. VII. The effvd of both the diathefes, and cf the moft perfed health itfelf—Sthenic powei sr.nfe—cfihenic lower the fundions-r-' Why man is not immortal—Convtrfion of the diathefes into each other—Fallacy , firft, to increafe them, then to impair them in part, but never by a debilitating opera- tion {aS. The effed common to the afthenic noxious powers, upon the fundions, is to diminifh them, in fuch a manner, as fometimes to feem, though the appearance is fallacious (b), to increafe 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 excitability affigned to every being upon the commencement of its living ftate, and thereby fooner or later induces difeafe, and afterwards death. This is one caufe of mortality. LXXI. The afthenic diathefis is hurtful by not fupply- ing the degree of excitement necefTary to health, and thereby allowing the ftate of life to approach more nearly \ to that, in which death confifts. This opens another gate of deftrudion to mankind. 13. Further, difeafes and death are confequences of the change of either diathefis into the other. Either diathefis, by means of the noxious powers producing the other, when thefe {a). Xhe inability to perform motion in peripneumony arifes not from debility, for two good reafons ; firft, no powers, but thofe that produce all the other fymptoms, produce it ; and the fame remedies that remove the other fymptoms, are equally effectual for the removal of it. (b) Spafm and convulfion, fuppofed to arife from increafed influx af tho nervous power, are both occafioned, and cured, by the fame powers, as all the other fymptoms. Chap.Yll. OF MEDICINE. II£ thefe are employed as remedies (c), may, by accident, in- advertence, or defign, be completely converted into the other ; and by oppofite meafures, carried to a certa:n extent, it may be changed back to the fame ftate from which it fet out (d). This obfervation will be fou d it the ^reateft confequence in the cure both of predifpofi ons and dif- eafes (f). What is wanting to further illuftration (hall be given (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 bWrder upon indirect debility. A confequence of which is vomiting purging, a feeling of burning in the inteftines, intermiflion of the pulfe, and ftrangnry ; which are only to be cured by fubftituting watrry drink and low diet in place of thofe oppo -te remedies. Nay, the ftimulants may be carried fo far, as to effect the eftablifhment of indi- rect debility. Hence will arife paralytic affe&i n, anafarca, dropfy, &t. The evacuants and other debilitating remedies, by which the difeafes of fthenic diathefis are removed, may, by being pufhed to excefs, produce the laft mentioned difeafes, as depending on direct debility. (d) 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 jo, the excitability mounted up to 70, degrees in the fcale. What is to be done ? By a proper ufe of high, ftimulanis the 30 degrees of loft excitement may be reftored, and as many of fuperfluous excitability difcharged, and 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 55, they have gone too far, and produced predifpofition to fthenic difeafes; if ftill l.irther, but not exceeding 70, they will have produced one or other of thefe difeafes. Buc carried beyond 70, the difeafes, which their opera- 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 10 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 forgotten, that we are nothing in ourfelves,.but while we have any excitability remaining in proper capacity to be acted upon, we entirely depend on the exciting powers acting on ir. llfc THE ELEMENTS Part I, given hereafter. Hydrothorax fucceeding peripneumony is an inftanceof the change of fthenic diathefis into afthenic. Again, the immoderate ufe of ftimulants may convert any'- afthenic affedion into a fthenic one ; as when a violent cough, a catarrh, or an inflammatory fore throat, is induced in confequence of the treatment of the gout, though proper in kind, being carried to excefs in degree, 14. Though excitement regulates all the phenomena of Jife ; yet the fymptoms of difeafes, which either its exjflfs or deficiency produces, do not of themfelves lead tojpfy » proper judgment refpeding it ; on the contrary, tneir fallacious appearance has proved the fource of infinite ' errour. LXXII. From all that has hitherto been faid, it is cer- tain, that life is not a natural, but a forced ftate ; that the "tendency of animals every moment is to diffolution ; that they are kept from it, not by any powers in themfelves, but by foreign powers, and even by thefe with difficulty, and only for a time ; and then> from the necefnty of their fate,, they yield to death. CHAP. VIII. Of predifpofition—Definition—Predifpofition neceffari'v pre- cedes difeafe—even in cafe of contagions and poifom—• Criterion of general difeafes—tVhat difeafes are not general. "J LXXIII. PREDISPOSITION isa ftate intermediate betwixt perfed 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 lefs force of the noxious powers that have induced it j and the interval between health and adual difeafe will be more quickly or flowly"* paffed over. * LXXV. That predifpofition neceffarily precedes difeafes, is Chap. VIII. OP MEDICIKE. JfL is evident, as it arifes from the fame exciting powers, ading upon the fame excitability, from which both health and difeafe arife, and is an intermediate ftate betwixt both. And, as the excitement of health differs much from that of difeafe ; it cannot be fuppofed, that the former immediate- ly mounts up to the latter, and lkips over the boundaries of predifpofition : nay, the contrary is certain and beyond a doubt. ^ LXXVI. Contagious difeafes do not furnifh an excep- tion to this obfervation ; becaufe, whether the matter of contagion ad by a ftimulant or a debilitating operation, its operation is the fame with that of the ordinary powers, that is to fay, the caufe of difeafe is the fa^e (a). If, as fometimes (a) The fmall-pox and meafles are cured by the fame means as peripneumony or afly other fthenic difeafe; and, excepting the con- tagious matter, arife from the fame ftimulant hurtful powers ; they muft, therefore, with the fame exception, be the fame. The only dif- ference is, that they are accompanied with a contagious matter, and • the other fthenic difeafes are not. The amount of wjjich is altogether - unimportant. For, if the ordinary powers have not operated, the affection does not come under the definition of general difeafe ; none or 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 regard the general circumftances of thefe difeafes^ making no more account of the local part, than to confider, arrange, and treat it as fuch. It is well known, that, when by the means ufed for the cure of fthenic difeafes without contagion, and their fequel, eruption, the fthenic diathefis is prevented or removed, the local part gives no trouble ; and that the difeafe is never dangerous but from the neglect of that management. But the management is nothing elfe but the ordinary one in any fthenic cafe. If it fhould be contended, that, • all that being granted, ftill the eruption may contribute a little: Be it fo, and it can be but very little ; what is the effect ? The cure (hows it; which is exactly the feme as in fthenic difeafes without eruption. The difeafe, therefore, being the fame (for its mere local part is out of the queftion, as only requiring a peculiar expofure to cold, which is equally proper in every fthenic difeafe) ; every part of reafontng 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 predifpofi. tion i i.S the elements Part k, fometimes happens, no general affection follows the applies tion of contagion, if no undue excefs or defed of excitement is the confequence, the affection is altogether local and foreign to this place. LXXVII. Any morbid affedion that poifons may pro- duce without pred^ofition is not to be confidered as a general difeafe, both for thijgery reafrn, and becaufe it can neither be removed nor reli|Hd by the ufual treatment of general difeafes ; and tjje diverfity of the effed proves, that both the caufe and exciting noxious power are different from the general ones.; In one word, fince predifpofition and difeafe differ only in degree, the unavoidable conclu- fion is, that whatever, with a given force, produces the latter when ading with a lefs force, will produce the former. The only cure.for moft poifons is their early difcharge from the fyftem. And if, as often happens, others, by woundlap an organ necefjary to life, are fatal ; the effed of both is foreign from our prefent fubjed, and to be referred to local difeafes. . LXXVIII. In the powers producing either predifpofition or completely formed general difeafe* the only thing worth inveftigating is the proportion which thofe producing the predilpofition bear to thofe producing the difeafe ; in order to learn the degree of noxious force pofleffed by each, and. the degree of curative means necefTary to remove the effect. Diftindions between the powers producing predifpofition and thofe that excite difeafe, under the general appellation of predifponent or occafional caufes, have been multiplied and tion is required as a common.circumftance 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 com- plaint. As general fthenic difeafes, the fmall-pox and meafles, and as general afthenic ones, contagious fever and the plague, to the fall ex- tent of their generality, have their period of predifpofition ; we may have occafion afterward to eftablifh the queftion about predifpofition 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 poifons may have been concerned. Chap. VlII. of mEdici&E. 119 and refined upon without end. But the whole fyftem of remote caufes, as they have been called, is falfe in its firft idea. The noxious powers, whatever they be called, that produce difeafes, alfo produce the predifpofition to them. Which being once admitted, as it henceforth muft, the whole fajpric of aitiology, or of the dodrine of remote caufes, muft fall to the ground : Confequently, fimply re- mote caufes, not divifible into predifponent and ocafional ; relative remote caufes, or Inch as are fo divifible ; internal and external predifponent, internal and external occafionul, caufes -* approaching caufis, or caufa propriores, proximate caufes, of which, not only one, but often feveral, are afiign- ed to every difeafe, muft ceafe in medical language, and attention will be turned away from the endlefs purfuit of diftindions without a difference, to the ftudy of the folid and ufeful fads that nature holds up to contemplation in great abundance, when once our eyes are fairly opened to them. LXXIX. The knowledge of predifpofition is of great importance ; as enabling the phyfician to prevent difeafes, from his acquaintance with the powers that lead to them ; to comprehend the true caufe of them founded in predif- pofition ; and to diftinguifli them from local aftl-dions, which are widely different. Such is the fimplicity to which medicine is thus 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 local; fecondly, if general, whether it be fthenic or afthenic ; thirdly, what is its degree ? When once he has fatisfied himfelf in thefe points, all that remains for him to do, is to form his indication or general view of the plan of cure, and carry that into execution by the adminiftration of proper remedies. LXXX. As predifpofition and difeafes themfelves are the fame ftate ; a criterion, by which general good may be diftinguilhed from local difeafes will be found in this fingle circumftance, that general difeafes are always, local never, preceded by predifpofiuo 1 An inflammatien in fome part 120 THE ELEMENTS Part I. part of the ftomach j or as it has been commonly called, " the inflammation of the ftomach," as if it were always of the fame kind, produces many fymptoms, that bear fo great a refemblance to general fthenic difeafes, fuch as peripneu- mony, that by fyftematics and nofologifts, this and 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 nosological name, is eflentially different, both from perip- neumony and all the other general difeafes of the order with which it is affociated, both in other refpeds, and in that of which we are fpeaking. As arifing from certain local noxious powers, it is not preceded by predifpofition. So when I come to the bed-fide of a patient under thefe cir- cumftances, though I had no previous knowledge of the nature of his diforder, whenever I hear that he has fwallow- ed ground glafs, fmall fifh bones, or, perhaps, a great quantity of cayenne pepper, I can be at no iofs to diicern the nature of the difeafe, and to find, that it is altogether local ; and that for two of the beft of all reafons; firft, the perfon having been in perfed health immediately before that accident ; and, fecondly, becaufe the fubftances he had fwallowed were fuch as would naturally divide a found part* or, in the language of our profeffion, produce a folution o£ continuity. From this, again, inflammation is an infepara- ble confequence. And it is equally an univerfal fad in the animal economy, that, when any part, whether internal or external, which poffeffes great fenfibility, is wounded or otherwife injured in its fubftance, the pain arifing from'the inflammation iuperinduced fpreads fymptoms of diforder over the whole fyftem, which are liable to miflead thofe, who are not in pofleffion of the criterion we here point out. As fuch a cafe then, is not preceded by predifpofition, which peripneumony as well as every. other fthenic, and every afthenic difeafe muft, from, the proofs of the univer- fality of the fad, be allowed to be, it muft be local. LXXXI. As the affedion of a part is always the original fource of local difeafes, and as the diftindions, we have ftated, Chap. VIII. OF MEDICINE. 121 ftated, are eftablifhed upon the folid bafis of truth ; the following diforders muft be rejeded from the number of general difeafes, however great their refemblance to them may be. Whatever affections, then, arife from any ftate of a part ; from ftimuli or from debilitating circumftances not producing any commotion in the whole body, or only in confequence of the violence of the local caufe 3 from comprefiion of a part -, from obftrudion ; from other difeafes whether general or local, and not from the exciting powers which produce general difeafes (b) ; all thefe muft be rejeded from the number of general difeafes, and that for the moft folid reafons; to wit, their differing from them in the noxious powers that produce them, in their true caufe (r), in their cure (d), and in every effential refped, agreeing with them in nothing, but in a deceitful and de- ceiving fuperficial appearance. CHAP. IX'. [b) Let it here be added, that the powers producing general difeafes, are thofe that ait upon the excitability, and are, thereby, quickly com- municated over the whole fyftem ; while thofe, that act upon the folid texture of a part, fo as to cut, prick, bruife, or contufe it, &c. arc the powers productive of local difeafe. (c) The canfe of the inflammation of the ftomach has been mention- ed. To concentrate it into a definition ; it is a folution of the con- tinuity of a folid part in the ftomach, by mechanical or acrid means, followed by inflammation and pain, and, in confequence of the great fenfibility of the part, propagating fymptoms of diforder over all the fyftem. The caufe of the generafdifeafes here alluded to is an increafe of excitement, and the inflammation accompanying thofe difeafes arifes from that increafe. (d) 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 p?urt, and leave that part to heal; taking care, neither to increafe the local atfcflion by too fthenic a diet, nor to produce a tendency in the inflammation to run into gangrene, by the abufe of evacuations and other debilitatiug.powers ; and if, than which uothing 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 core of pei ipneumeny is co weaken the fyftem, from the very commencement of the difeafe, by diminithing the energy of all the exciting powers ; that of the abun. dance of the blood by bleeding ; that of the over-proportion of the Other fluids by purging, ftt^vwtgff that ar.i.ng from tSc ftimulus of heat and other exceflive ftimuli by cold, &c. I2~ THE ELEMENTS Part I. CHAP. IX. The general db.gnofis—Vaiiety of difeafes from variation in the excitement—Marks of general difeafe—How to attain ufeful medical knowledge—Origin of certain internal local affedions. LXXXIl. THE violence and danger of univerfal difeafes is in proportion to the excefs of excitement (a), or its indi- red or dired deficiency (b) ; as appears from all that has been faid above : confequently, their principal variety de- pends upon this variation of the degree of excitement. LXXXIII. The only diagnofis (c) of any importance is that, by which general difeafes are diftinguilhed from thofe local or fymptomatic affedions, which, by throwing the whole fyftem into diforder, affume a certain refemblance to univerfal difeafes. The following marks are fufficient for the difcrimination of every general difeafe ; firft, its being preceded by a diathefis, and this followed by a difeafe fimilar to it, and removed by an operation of the remedies of an oppofite nature to that which occafioned the difeafe ; while, (a) The excefs is contained between 40, the point of health in the table, and 70. (b) 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 25 the predifpofition to afthenic difeafes. (c) Diagnofis is the doctrine of diftinguifhing difeafes from one another. It was naturally, thought to be of the greateft importance, when difeafes were fuppofed very numerous, and as different from each other as their names and the various appearances of their fymp- toms. 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 an afthenic one, without any other differ- ence but what confifts merely in degree. The huge volumes of diag- noftics are then in this chapter fuperceded ; and much labour, not only irkfome to the artift, but worfe than ufelefs, often pernicious to patients, is proved to be fuperfluous. Chap, IX. OF MEDICINE. 123 while, on the contrary, local affedion is diftinguifhed by the affedion of a part, and the diforder of the fyftem not arifing from any change in the excitement, but being fuch as may be traced back to that affedion ; and by the ab- fence of the diathefis of the difeafe which the local affedion refembles, or only its accidental pretence. LXXX1V. In order to attain to this ufeful knowledge, learn what is necefTary from anatomy ; wafte no time in fuperfluous ftudy of it ; perufe the works of the illuftrious Morgagni ; diffed fubjeds ; diftinguiih refiduary effeds from caufes that have paffed away ; examine diligently many bodies of perfons who have been hanged, or have died of wounds, but were otherwife healthy; compare thefe diligently with the bodies of thofe who have died of linger- ing or often repeated difeafes; compare every particular with every other, the whole with the whole ; guard againft rafh hypothefes, which if you. can, you will be among a very few, who have ever been able to do it ; never exped to difcover the caufe of general difeafe in dead bodies ; be circumfped in forming a judgment. LXXX V. Internal local affedions often confift in a taint that remains after general difeafes have paffed away :. it may therefore aflift in forming a right opinion to remark, that there will be lefs reafon for fufpeding fuch a local affedion, the lefs'the patient has been fubjed to general difeafes, and the contrary. CHAP. 124 THE EX.EMENNTS Part I. CHAP. X. The general prognofis, or general judgment of the event*-? ^ Danger according to the degree of the diathefis and impor- tance of the mofi affeded part. LXXXVI. SINCE the powers producing fthenic and afthenic diathefis always ad upon fome one part with more force than upon any other equal part ; it follows, that the danger of difeafe during the predifpofition, and of death during the difeafe, increafes in proportion to the degreeof diathefis, or to the importance of the part principally af- feded. But, its degree being given, the more equal or general the diathefis is, the more lafe it is. Nor does it ever fall heavy upon an organ necefTary to life, without inftant danger. Hence it is, that peripneumony, apoplexy, phrenitis, eryfipelas, and the gout* when the two latter much afled the head, are chiefly formidable. LXXXVII. Local and fymptomatic aftedions ought to be diftinguifhed from general difeafes, and the remarks in LXXXIII. LXXXV. transferred to this place. CHAP. XI. The generate at ment—Indications of cure—Mode of adion of remedies—Sthenic and antifihenic remedies—how to be employed—Local and general remedies—What regard is to be paid to contagious matter—IVhen the middle or tonic treatment is proper—Peculiar circumftances mv.fi regulate the indication—Perfons fubjed to indired, and dired de- bility—Cure of indired, and dired debility—Danger of weakening the body* LXXXVIII. THE indication for the cure of fthenic diathefis is to diminifh, that for the cure of the afthenic diathefis j Chap. XI. of MED-rcirr. ir.; diathefis is to increafe, the excitement, till that degree, which conftitutes the mean betwixt its extremes, and which is fuited to good health, be reftored. This is the only indication of cure that univerfal difeafes admit. 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 adion of the remedies, alfo the fame in kincj, but oppofite in degree, to that which produced them. As the caufe, fo is alfo the plan of treatment, confirmed by an indudion from the whole feries of fads and phenomena (a). The fame debilitating remedies, which remove any one fthenic difeafe, remove that whole fet of difeafes : and the fame ftimulant means, which cure any one afthenic difeafe, remove all the reft (b). Are not palfy, in fo far as it is curable and (a) Suppofe the fthenic diathefis mounted up to 60 in the fcale ; to reduce it to 40 it is evident, trial the 20 degrees of fupeTfluous excitement muft be taken off, and, therefore, that remedies operat- ing with a ftimulus, weak enough to produce that effect, muft be employed : they are ftill, however, ftimulant, and of confequence, though they remove it, ftill the fame in kind, as the powers that produced the diathefis ; it having been proved, that they are not to be foppofed fedative, both for the reafons already given, and for this additional one, that proof has not been yet brought of a f ngle fedative in nature. As their ftimulus, however, is lefs than that which is required to fupport the ordinary ftate of health, they are under flood to be debilitating, and, therefore, proper re- medies of fthenic diathefis. (b) Suppofe the afthenic diathefis to have funk down to 2c *, to raife it up to the ftandard of health, it is plain, from all the propofitions hitherto laid down, that the 20 degrees of deficient ftimulus muft be reftore'd, an J, therefore, that remedies operating vith a degree of ftimulus adequate to the production pf fhat effect, moft be ufed. All the difference betwixt the force of this ftimulus and that of the other, is only a difference of 4,0 degrees. As, therefore, the debilitating powers, though ftimulant, employ- ed in the firft, removed the morbid fuperfluity ; fo the ftimulant powers ufed in this cafe, called, ftimulant by way of eminence, re- move the morbid deficiency, and, thereby, reftore the degree of excitement, that conftitutes the ftandard of health. 126 THE ELEMENTS Parti. {c), and dropfy, in fo far as it is a general affedion (d), as well as the gout, and fevers, both relieved and removed by the fame remedies ? Andare not peripneumony, the ImaJl-pox, the meafles,, rheumatifm, and catarrh, re- moved by the fame remedies, to wit, evacuants, cold, and&aw«g^ But alt thefe remedies in the afthenic cafe increafe, in the fthenic diminifh, the energy of life. • In both cafes the operation is the. fame,, 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 fuired to health ■* which in this work are denominate. ed, for the fake of brevity, debilitating or antifthem$ remedies. XCI. The remedies of afthenic diathefis are powers exciting with more force, than fuits the beft health ; they may be called fiimulants or fihenic* for the fake of diftindion. XCII. Thefe remedies are to be employed with more or lefs freedom in. proportion to the higher, or lower degree (c) When the prevalence of debility, and that to fuch a degree,. as to deftroy the connexion that fubfifts betwixt the fibres of mufcles, and that function of the brain which we call will, takes place in parts of the fyftem, not. only remote from the centre of activity, but beyond the circulation, it muft be of difficult cure ;. becaufe the moft powerful means of effecting that operation a&, moft powerfully when taken internally, and much more feebly when applied to the fkin. (d) 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 difeafes, and to be treated in the laft part of this work. Thefe arife from ©ffifications in the large veffels next the heart, from tumours, whether fcirrhous or fteatomar,ousr impeding by their preffure the return of the blood by the veins to the heart. It is the general cafe that is here alluded to, and the public may depend upon it, that it is to be cured, though not by evacuant means, but, on the contrary, by the high diffufible ftimuli, necef- fary to the cure of the difeafes of .faigferdebiJity, fuch as the ex- tremity of typhus fever, and aa expiring gout*. Ail thefe are cured by high ftimulants. QlUp. XI. 0> MEDICINE. r27 degree of each diathefis, and of the local affedion de- pending upon it. And fuch a choice fhould be made, that the moft powerful may be adapted to the moft violent "cafe. But the cure of no difeafe of confiderabfc violence, and fcarcely of any difeafe at all, ought to be intrufted to any one remedy. The ufe of feveral remedies is preferable to th'at of one ; becaufe their energy is applied to the fyftem to a greater extent, and the excitability is more completely and more equally affeded. The perfon, who means that his remedies fhould go to a particular part, and there, from a local operation, and not by an affedion of the excitability, ferve his purpofe, is equally wife with him, who, by cropping a twig, expeds to eradicate a tree. What remedies are of general, what of local operation, fhall next be defcribed. XCI1I. General remedies are thofe, which, ading upon the excitability, by an operation diffufed over the whole body, reproduce the ftate of health. XGIV. Local remedies are thofe, which ad by a fimilar operation on a part, and, by an operation con- fined to that, reftore the found ftate. XCV. Since every univerfal difeafe, every predifpo- fition, depends upon increafed or diminifhed excite- ment, and is removed by the converfion of that into the degree which conftitutes the mean betwixt both ; in order both to prevent and cure difeafes, we muft always ufe the indication propofed, ant! ftimulate or debilitate ; never wait, or truft to the fuppofed powers of nature, which have no real exiftence. XCVI. In the indication of cure, the only res'1 1 to be had to morbific matter, is to allow time for irs, pafling out of the body. For whether it ads like other exciting powers, fometimes by ftimulating, as in the fmall-pox and meafles, at other times by debilitating, as in contagious fevers and the plague, or its udion confifts in only giving the peculiar form of its refpcC. ;v« difeafe, and, thereby, adding a local affedion m a general 128 THE ELEMENTS Pa7t i. general one •* in either cafe there is no room for a new indication. XCV1I. For if the difeafe, as a general one, be properly treated, every eruption and its confequences, every fpecies of inflammation, every fpecies of ulcera- tion, give way to the happy effed of the general plan of cure. And when the event, in confequence of a bad method of cure, threatens to be unfavourable, the local fymptoms are proportionally aggravated. This was proved in the fmall-pox long ago, and in the meafles lately (*) with equal certainty ; it is proved in the plague, at leaft as often as this difeafe is treated by remedies proper in kind and adminiftered in due pro- portion ; it is proved in the malignant or gangrenous fjiC throat (/), and in other forms of typhus, with a1 fimilar (e) After the difcovery of the nature of the catarrh, the ca- t.tnhal fymptoms in the meafles came naturally to be inquired into. A full tiiil w*s given to the refrigerant debilitating plan, in rhc author's ov\n family, as well as among feveral patients, and Ulily among near an hundred patients in England, treated by the father of one of the author's pupils ; who all did well, while of chers, who were kept warm, according to a practice that Dr. uvdtuhan; had left as he found ic among his idexipharmic con- ttnipnraiies, 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 njked and allowed to go out and play as he pleafed. The only check upon him was, his being allowed nothing but fluid vegetable matter, when he returned home with a keen appetite. This maiier will be further explained, and in a more proper place, hereafter. Bui what h^s been faid was in illuftration of the hint in the text. (/) This cafe of difeafe has been confidered, as wholly and folcly feated in the throat, and therefore conjoined with other difeafes, where that local affection was underftood to be the effea- tiai 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 pradice is certain death in it, as being not only an afthenic cafe, that is a cafe of debility, but one of the higheft ; and, inftead of depending upon the affec- tion of the throat, the affection of the throat depends on it. Give ftimulants to ihe patients labouring under the inflammatory fore * throat, Chap. XI. op medicine. 129 fimilar local affedion. In the two laft inftances, the danger of life depends upon the degree of general af- fedion, without which there is no occafion for any apprehenfion from the local. And the fame propofition is 10 true, with refped to the three former, that, though the contagious matter has been applied, yet, without the general noxious powers preceding, no real general difeafe arifes, the danger is in proportion to their vio- lence, and the whole cure depends upon the general remedies. Thefe fads all concur to fhow, that no kind of matter, whether contagious or not, contributes any thing towards the general difeafe it accompanies and difcriminates ; or, if it does contribute, that it ads exadly as the ordinary powers do. XCVIII. During both overabundant and deficient excitement, the healthy perfpiration is diminiihed during the predifpofition, and fupprefled in the courfe of the difeafe (which has been already hinted, and will more fully be demonftrated hereafter). It is, therefore, proper that it fhould be carefully kept up, for the purpofe of difcharging any hurtful matter from the body. But this fuggefts no new indication of cure ; lince the only means of effeding this purpofe are thofe, whiph tend to remove both the diathefes in proportion to their force,.and which are not ferviceable as lrcal, but as general remedies (g). XCIX. Should throat, and you kill them ; 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 ftrangers in the city of nature, have, from their ignorance of the place, in fpite of their natural diftance, brought all together. (See Dr. Cullen's Genera Morborum, all the three editions, genus VII). As foon will Mile-end and Knightibridge meet j as foon will London place itfelf on the Calton-hill, and become an elevated fuburb of Edinburgh. (g) The difcovery of the fupport of perfpiration upon a princi- ple, which extends to all the phenomena of the fuljeft, was referved for this work. The heating remedies of the alexiphar- mic R i3° THE ELEMENTS Psrt I. XC1X. Should a perfon, who during the former part of his life has lived luxurioufly, at an advanced age, either from intention or necetfity, abate a good deal of his ufual indulgence, and yet preferve fome appearance of an abundance of fluids and of vigour ; he muft not, as is commonly done, be fuppofed to labour under plethora and exceffive vigour ; but, on the contrary, unlefs there be a repent and evident caufe for it, which is poffible, he muft be held for one who labours under indired debility ; and fo much the rather, if, to noxi- ous powers already too invigorating, among which all thofe that fill the veffels are to be numbered, directly debilitating powers have fueceeded. In this cafe it is neither a debilitating or afthenic plan of cure, for that would increafe the dired debility ; nor a plan too fthenic, for that would increafe the indirect debility, the mic phyficians were intended to fupport the perfpiration, and, thereby, throw out a morbific matter ; which was a very unlucky thought in the fthenic difeafes, the principal of which were peripneumony, of which we have already fo often fpoken ; phreni- tis, 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 No. LXI.) from the excefs of their ftimulus ; confequently, the addition of more ftimuli, by way of cure, would check it ftill more. But thefe difeafes are only three out pf an hundred general difeafes; whereas the followers of the great man, who correded that abufe through a fiery perfection {as through fire) 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 remaining 97 of the hundred. And they fueceeded with a vengeance. For, as it is the nature of thefe difeafes to tranfitnit too great a quantity of fluids through the perfpiratory pores, in confequence of the debility, which conftitutes {heir caufe j certain- ly the increafe of that debility, that is to fay, the increafe of tke caufe, fhould increafe the effect. Which it moft certainly did, < through all the fyftems that have appeared for more than a cen- tury paft. " Stulti dum fugiunt vitia, in contraria currunt." This is intended only as a hint, to enable our intelligent readers to underftand the fuller explanation of perfpiration, which will foon follow. Chap. XI. er medicine. *3' the principal caufe, and, confequently, the difeafe ; but it is a middle method, which is commonly called tonic, that fhould be purfucd (h). ^ C. Since we ought to adapt the efficacy of the cura- tive means to the degree "of difeafe (under which, for the fake of brevity, let predifpofition alfo be compre- hended), regard fhould be had, in the indication of cure, to age, fex, habir, conftitution, climate, foil, in fine, to the operations of all the exciting powers in general, of all the noxious ones in particular, of all the remedies, whether they have been proper or improper. CI. The fubjeds of dired debility are women ; perfons in a ftate of inanition ; thofe who have been mfufficiently ftimulated ; 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,. which has not been preceded by hi-'h excitement, (h) The blood is 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 fyftem to convert it into real blood, the more, and alfo better, blood will be produced. The quantity of blood, fo produced, may go to excefs, as well as every, other exciting power, the principal of which it is. But the queftion is, when, in whom, and under what circumftances, is an overproportion of blood generated ? Common fenfe would fay, not at the beginning or the end of life, when the degree of nutriment ufed is far from being fo confiderable, as at the middle and vigorous period of life. Again, which of the two fexes is fuppof- ed moft liable to generate this morbid redundancy of the vital fluid ? A fimple creature, aided by nothing but natural fagacity,. would be apt to fay, the men ; both becaufe they eat more, and, from the greater variety of the modes of promoting digeftion to which they are addicted, digeft better. How medical fyftematics would laugh at fuch fimplicity ! How contrary that would feem to myftery, their lydian ftone, 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 moft liable to it ?' Not thofe, who have the greateft bulk of fimple folids, whether they eat or not, much lefs thofe, who are liable to bleeding difcharges, who can neither eat nor digeft ; but all thofe who eat and digeft well. 132, THE ELEMENTS ran x* excitement, arifing either from noxious powers, or the mode in which they may have been treated. ^ # CII. On the contrary, the perfons in whom indired debility is prevalent are adult males ; perfons of too full an habit ; perfons who are over ftimulated, and the diathefis is the ftronger, the longer they have been over, ftimulated ; thofe who have been overheated, whether they have been wet at the time or not ; all thofe, in fliort, who, having been once vigorous, have been rendered languid either by the ordinary noxious powers, or by improper treatment, when difeafed. CIII. In the cure of indired debility ; whatever be its degree, from whatever fort of exceffive ftimulus it has arifen ; little lefs of the ftimulus, which is to be employed as the chief remedy, than that, Vvhich pro- duced the difeafe, fhould, at firft, be ufed j and then lefs and lefs, till the difoafe is cured. CIV. When the firft part of the cure is completed* and the convalefcent can ufe the more permanent and natural ftimuli, he fhould gradually be confined to them, and drop the ufe of the more diffufible ; though if he has been in the habit of uling much ftimulus, he may be indulged in fomething extraordinary in that ^ way for fome time (/*). CV. The'' (/') This- indulgence is chiefly intended for thofe, who have gone to fome excefs in the ufe of the ftimulus of drink, and who ftill, without it altogether, are not capable of taking enough of food and other durable ftimuli for their fupport.' The aim, how- ever, of all fuch perfons (with the exception only of thofe who are of an advanced age, or of thofe whofe debility threatens to run to a certain courfe), fhould 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 refolution to abftain from all forts of ftronk drink, not only with impunity, but with a moft wonderful improvement of their health and 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 Chap. XI. ©F MEDICINE. m CV. The cure of the hurtful effed of any ftimulus mould firft be fet about by changing it for a lefs; this for a ftill lefs; and the intention of cure fhould be always to pafs from the ufe of the more violent and . diffufible, which nature in her healthy ftate rejeds, to that of the more durable, and more fuitable to nature when unoppreffed, till the healthy ftate can at laft be maintained by the ufual means [k). C VI. In the cafe of indired debility, where the view is to reftore vigour, a debilitating plan of cure fhould be avoided ; becaufe no fort of debility is to be cured by another, or any degree of it by any degree of another kind. It is only in the progrefs to indired debility (/), that diredly debilitating powers are fuitable for the purpofe of fupporting the vigour, which is, in that cafe, in danger of being worn out (m): fuch as cold bathing, alimentary canal; in a word, the difeafes of either form of de- bility), either returns, or threatens to return ; a return to the ufe of wine and other ftrong drink will become an excellent remedy, and even fupercede the ufe of high diffufible ones. That practice would be attended with this further advantage, that, when t'he occafion that called for it was over, and the difeafe prevented or removed, the perfon might again lay afide the ufe of drink, with all the good confequences he had formerly experienced from the praftice, and thereby both prolong his life, improve his health, and enjoy the proper and vigorous ufe of all his functions. (k) In many difeafes of debility arifing from a former excefs* the ftimulant effects of which have paffed away, the ufe of cold water, though in gratification of the patient's craving, and of other thin potions, as well as of vegetable aliment in a fluid form, and of evacuation of every kind, is moft hurtful. (/) Betwixt 40 and 70. (»/) At 6$ there are only 5 degrees of vigour left, which, either by a continuance of the fame exceflTve ftimuli that produced them, or, by the addition of a degree proportioned to that effect, would be worn out. Remove fome of the ftimulant powers, the excefs of excitement will be diminiihed, fuppofe to 60 ; remove more of the former, and the excefs of the latter will be further diminiftied, till the excitement is reduced to its natural healthy ftandard of 40. The ftate of excitement, then, within this range, that *34 THE ELEMENTS POTt I, bathing, lowering the diet, weak drink, and a fimilar abatement in the ufe of the other ftirftuli. CVIL For the cure Of dired debility, we fhould begin with the fmalleft degree of ftirflUltfs, artd then life to the ufe of a greater and greater, till the morbid abundance of excitability be gradually worn off, and health at laft reftored. CVIII. When the difeafe arifes from the want of any one ftimulus, the return to its ufe fhould be gradu- al, and facilitated by other ftimulants more powerful than itfelf. CJX. Alfo in this part of the general method of cure, debilitating, either diredly or indiredly, fhould be avoided ; both for the reafon formerly given, and alfo, becaufe the ftimulant plan of cure, which is the only proper one, when carried to excefs, converts the fthenic diathefis, that between 40 and 70 into the afthenic, (between 70 and 80), and the latter into death (at 80). For which reafon, while, on the one hand, debilitating powers are to be avoided ; it muft, on the other, not be forgotten, that the power employ- ed in the cure fhould be accommodated to the dggret of morbid ftate. The thirft, which is occafioned bf debility, is increafed by cold water, and hurried on to the higher fymptoms of naufea and vomiting j it is quenched by pure wine, or fpirit, which prevent the troublefome fymptoms that would otherwife follow. Pure wine increafes the thirft, that proceeds from a fthenic caufe, and excites the fame troublefome fymp- toms, that is, between 40 and 70, efpecially in proportion to the ap- proach of the excefs to 70, is that, to which only directly debili- tating powers fhould be applied. In all cafes above 70 where the excitement is gone, and below 40 where it conftantly decreafes all the way, till it is loft at o, directly debilitating powers arc pernicious. How bad then muft the only practice be, that we find in books and lectnres, a pradice tranfmitted from the firft accounts of our profeffion, and which deals in the ufe of no other means but. directly debilitating ones ? Bad, indeed, muft it be ! Chap.Xl. OF MEDICIKE. I*£ toms, which cold water does in the other cafe ; cold water fates it, and prevents the future diforder. CX. Since, therefore, the fame powers excite all the phenomena of life, and produce fometimes an exGefs, fometimes a juft proportion, fometimes a deficiency, of vigour, 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 difeafes ; let it be a general rule, never unguardedly to convert either diathefis into the other. And, as every difeafe, that debilitating powers remove, is fthenic, every one, that is cured by ftimulant means, afthenic ; the knowledge of this may furnifh the proper means of caution againft miftake. THE !"** THE SECOND PART. CHAP. I. Of the noxious powers, which produce either diathefis, fihenic, or afthenic. CXI. THE powers producing the ftate of the body, upon which the predifpofitions to fthenic or afthenic difeafes, as well as thofe difeafes themfelves, depend— in other words, the powers producing both the fthen- ic and afthenic diathefis—were enumerated before (XL XII.) The noxious powers producing both diathefes. Heat fiimulates the whole fyfiem—particularly the furface__ Hence the inflammation in phlegmafia is always exter- nal—and perfpiration from thefirong contradion of the fmall vefjels of the fkin is checked or fupprefed—Hence contagious matter is detained—Excessive Heat debilitates—particularly the cutaneous vefels—How it checks perfpiration in afthenic difeafes—CoLD debili- tates—Identity of operation of other debilitating powers —exceffive heat, and cold, debilitate by producing pain- ful fenfation—Cold never ufeful but in fihenic difeafes— Does not condenfe the living fo/Usr-^Phenomena it pro- duces by flopping the wafte of excitability—Cold affeds the furface moft—Mqi$.tv re—No food can be too ftimulating* except flefh of land-animals—.$eafoning__ •3 ' ...... ■. ^Spirituous 138 THE ELEMENTS Part 17, Spirituous liquors—Diffufible film uli—Scale—DireEi a:-id indired ftimulus of food—Of vegetable food-*- How diffufible ftimuli produce debility—Of plethora-^- Mufcular exertion—Of penury of blood—Of dijchar get of blood, falfely called hemorrhages—Secreted fluids in too great quantity ftimulate—In too fmall debilitate-— exertion and ineitnefs of intelled—Effed of the paffions—Of air*?-Powers applied fingly feldom produce diathefis. CXII. HEAT, which is necefTary to the produdion, the growth, and the vigour of animals and vegetables, as alfo to the form of the elements (a), from its adion upon the furface of the animal body, diredly ftimulatcs the whole ; an effed which it alfo exerts upon vege- tables. To this adion of heat there is no exception while it keeps within a certain range ; but when it is either deficient, where it takes the name of cold, or exceffive, its effed varies. This ftimulus, when mode- rate, produces its due effed ; in an higher degree it produces more or lefs of fthenic diathefis. CXIII. But as the adion of heat is fomewhat more exerted upon the furface than in the internal parts, where the temperature is nearly ftationary, it ftimulafcflS" the former more than the latter. Hence, in the phlegm mafise (difeafes with inflammation of a part) the in- flammation is always external.—This agent increafes the tone of all the mufcular fibres, and confequently their denfity (fee Chap. V.) : which produces a fup- 1 preflion of perfpiration, by fome imputed to confine- j tion from cold, by others to conftridion from fpafms; both erroneoufly. Hence, as the diameters of all i%c Veffels are diminiihed, fo thofe of the extreme veffcls every where, and eipecially of the fkin, where the caufe is more powerfully exerted, are often entirely effaced. But (a) In a certain degree «f dimmi/hed beat water freezes; but if fuch a diminution of it could be found as to freeze air, the whole fabric of the unwwie would rvflx into difiblution. Chap. I. OF MEEMCINE. »39 But this entire fuppreflion of the perfpiration is incom- patible with predifpofition, and arifes only from the diathefis, when it extends to the juft meafure of difeafe. The perfpiration is diminiihed during the predifpofi- tion y but the condenfing power is not fufficient to fupprefs it, till it attains the degree of producing the difeafe. CXlV. Hence in the meafles and fmall-pox, the irritating matter, together with the perfpiration, is detained. And not only in thefe, but all other fthenic dileafes, is the perfpiration fuppreffed, the excitement both upon the furface and in the. reft of the body in- creafed, and catarrh in particular induced (b\. CXV. Heat in excefs, whether the excefs arife from long application or intenfity, conftantly debilitates, by diminifhing the tone, and producing laxity inftead of denfity. This effed is fomewhat greater upon the fkin, to which the dired energy of, heat is- applied, than in the interior parts, in which, there is little change of temperature. Hence arifes fweating as in the torrid zone ; hence the diameters of all the veffels, and par- ticularly of the perfpiratory veflels, are enlarged. Hence proceed the colliquative fwcats in fevers, and a fimilar ftate of the bowels. Hence,, alfo, corruption of the fluids, and not from iny change immediately produced by corrupting or putrefadive powers. The idea of certain powers having a tendency to corrupt our fluids, andi (b) Calefacients, or heating thing*, were one of the means that * the alexiphai mic phyficians employed to force perfpiration ; but the principle is now laid down, that fhows they produce the oppo- fite effect. Hence the merit of Dr. Sydenham in recommending . cold, both :n the fraall-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 profeffipn, and happier for the fick, bad he extended his improvement to the meafles and 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 laUer. .140 THE elements Pari ll and of certain.others to corred that effed, and take off the degeneracy, long prevailed in the minds of fyftematics, and is not among many of their followers yet laid afide. Heat was one of the number ; but that it ads fo, is difproved^not only by the explanation here given, but by the certainty of the fad, that the fame effed is produced by cold, as well as every other debilitating power. CXVI. Exceffive heat in the violent meafles, in the confluent fmall pox, in fevers, and in every kind of afthenic difeafe, in which the perfpiration is checked,; does not leflfen the deficiency, though it expands and enlarges the veffels, but, on the contrary, increafes it j i. e. dirninifh.es perfpiration. , CXVII. Cold, a power unfriendly to animals,' vegetables, and the elements, weakens the whole fyftem, but the furface moft, of which almoft alone it diminifhes the temperature. It produces this effed by a dired operation, always in proportion to its degree. Cold, equally with exceffive heat, produces atony and, laxity of the veffels, gangrene, and. the other effeds of exceffive heat. In Siberia the phenomena of cold on the human body very much refemble thofe of heat. CXVIII. That thefe effeds of the extremes of tern-., perature arife from their debilitating, not from their generating putrefadion—from an affedion of the ex-.' citement, not of the fluids—plainly appears from this;, that other exciting noxious powers, fuch as fafting,. over-abundance of blood (as in the cafe of thofe who ■ die of peripneumony), and fimilar noxious powers, which neither have been, nor can be, fuppofed to affedfc the fluids by any dired operation (c), produce corrup- tion (c) Fading, acids, and cold, have all the fame effects upon the fluids that the putrefying fubftances were fuppofed to have ; but furely acids produce no putrefadive procefs ; neither can want act as pofitive matter ; nor cold be fuppofed to produce any fuch effect. In a word, any corruption rhat is produced, arifes only from the weaknefs of the heart and arteries, predominant in their extremities. Chap. I. of medicine. 141 tion of the fluids, and all the other fymptoms ; and the fame ftimulants, which remove the latter, remove the former. Nay, the fuppofed antifeptics, fuch as wine, peruvian bark, acids, and other things of that kind, either have no fuch property under any circum- ftances ; or they neither are given, nor can be given, in fuch quantity, as to affed the compofition of the fluids : In fine, the effeds of inanimate matters upon one another can never, with any propriety, be transfer- red to living fyftems. Though, then, the fluids are frequently corrupted, the corruption is fhe effed of weaknefs of the veffels, which prevents them from being fufficiently mixed and diffufed, but it is never the original caufe of difeafe. CXIX. The difagreeable fenfation both from cold and heat in extreme, is alfo hurtful, by diminifhing the fum total of ftimulant operation, which, in fo far as it is agreeable, is ferviceable by ftimulating. (See note (d) in par. XXI.) CXX. As cold is naturally fo debilitating, and as all debilitating powers dimjnifh excitement, it can never be of fervice but in fthenic difeafes, that is, in thofe which are in their progrefs towards indirect debility (feeCVI.) ; becaufe the excitability, already too abun- dant, can never be rendered more abundant, or, when too much wafted, be more accumulated, without an aggravation of the difeafe (XLVI. XLVH.); excitability admitting of lefs ftimulus in proportion as it is either more abundant, or more ultimately wafted (d). When the extremities. They ceafe to act ; the fluids wit'hin 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 abfard 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 of fluids, jfiiould go to a portion of fluids in the extreme vefTels, even with- out the circulation, and, by mixing with it, change its qualities. (d) This obfeure phrafe, more ultimately wafted, has nothing anfwering to it in the original latin. It feems quite inconfiftent with XXVI. and the other paffages referred to. Eoitor. 142 the elements Part II. 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 increafe of debility (e). CXXI. As cold as well as exceffive heat relaxes, as is feen in the cure of the fmall pox, and of every fthenic difeafe, we learn, that the property of cold to condenfe inanimate matter does not extend to living matter (/). The diminution of the bulk of the furface, or the fhrivelling of the fkin, arifes from debility of the arte- ries, which do not propel the fluids with fuflicient force to diftend the fmall veffels of the fkin. In this way cold produces afthenic diathefis. CXXI I. But, as always lefs and lefs excitement arifes in proportion as ftimulant operation has been applied, till at laft it ceafes altogether ; cold, as well as any other diredly debilitating power, may, at fome degree produce health and all the degrees of fthenic diathefis (e) When the debility of the indirect kind is very moderate, that is, the excitement has not funk much below 40 in the fcale, the fhort fufpenfion of a few degrees more would not do much mifchief. Suppofe the excitement it 30 inftead of 40, and a dip in cold water has brought it down to 25, the effect even of thai is not of a trifling nature ; the debility by 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, r ho has abftained from any one ftimulus for a given time, when it is again applied, will not bear near fo much of ic 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 debilitating power would be attended with the utmoft danger, not only of increafing the difeafe, but of inducing death. (/) It has been alleged, that the diminution of the bulk of the body by celd, furnifhed an argument in favour of its being aa aftringent to it, as it certainly is a cendenfer of dead matter. Chap. I. OF MEDICINE. *4S diathefis (g); in the following way, however, only. It flops the wafte of excitability, makes the body more fulceptible of ftimulant operation, checks the progrefs to indired debiiity, and licms the latter. But it only affeds this by checking the effed of heat and other ftimuli, which accelerate indired debility, and by keeping the excitement within the bounds of vigour. Hence vigour in cold countries, when the body is de- fended by clothes, the (belter of a houfe, the warmth of a fire, as well as by its own proper motion. Hence alfo the bracing, by cold, of parts that have been relax- ed by exceffive heat. Laftly, hence a remedy for the corruption of the fluids, which confifts in invigorating the veffels, not in correding the degeneracy of their contents. This effed of cold upon the furface, which is nearly the only part of the fyftem fubjed to refrige- ration, is fomewhat greater than on the internal parts (h). CXXIII. The "debilitating effed of temperature, and therefore alfo its hurtful tendency, is increafed by moifture. CXXIV. Of the articles of diet, the only food in danger of being too ftimulant, is the flefh of land- animals, ufed in great quantity. Meat too fait,- and hardened, efpecially when it has now begun to fpoil, is an exception. CXXV. The (g) 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 action rifes to the degree of being adequate to the effect of producing a peripneumony. (b) This account of the falutary operation of cold is not com- plete, even according to the author's own principles. For as difagreeable fenfation, in his opinion, debilitates, cold may very often be fo applied as by removing the very difeagreeable fenfe of heat, that attends fome difeafes, to produce an effect equivalent to ftimulation. It is, I believe, exactly in this way that bathing the body with cold water proves ferviceable in low fev be confounded . with the debilitating \ powers. What difturbances, during the operation of opium, will not a breath of cold air upon the body create ? And how eafily, as well as quickly, are they all, (p) At lead it Hands at the foot of the fcale of directly debili- tating powers, if they are to have the rank of (landing uppermoft, as being moft hurtful, and to be followed by the enumeration of the indirectly debilitating powers, as being next fo, which, by the way, is the rank that nature feems to point out for both. (?) As in the cafe of the Gentoos, who make ufe of a great dcalof condiment with their vegetable aliment. 148 THE ELEMENTS Pert It; all removed, by carefully covering up the patient ! As there are cafes of itidired debility from an habitual; abufe of ftrong drink, there are alfo others from a rhiftaken or intemperate ufe of the diffufible ftimuli^ particularly opium. Both of them require nicety and ikill in the management of them for their cure ; for which confult Chap. XI. from par. CHI. to CX. The management is out of our prefent queftion ;. but from this obfervation, we can clearly find, as it was to be exp'eded 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 indired kind. 21. Other diffufible ftimuli,, as well as opium, and the more durable one of ftrong liquor, by an indiredly debilitating operation, produce afthenic diathefis. CXXXI. An abundance of chyle and blood is another ftimulus : by this the excitement is every where increafed, and particularly in the blood-veffels, in a degree proportioned to the abundance. The quality of the blood, at leaft, as a caufe, is of no effed, it is the quantity only that is. The quantity, by diftending" the mufcular fibres of the veffels, ads with a conftant impulfe (r). The dodrine of plethora, fo noted in the. medical} \ i i (r) The blood by its quantity diftends the mufcular fibres of the veffels ; that diftenfion ftimulates the excitability in the fibres, and produces excitement, commonly called their irritability ; thus excited, the fibres contract ; the contraction of each portion fends the wave onward to another portion : when the wave has paffed any given portion of veffels, its fibres again relax, and make way for the next, which is pufhed along in the fame manner. In this way the circulation goes on in all cafes while life remains; contraction and relaxation conftantly alternate ; the former pro- pelling the wave before the latter opens to receive the next. But the veffel may be in different ftates with refpect to its power of either 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 fraallnefs, and the relaxation Chap. T, OE MEDICINE. HS> medical fchools, is only applicable to fthenic diathefis, and takes place in proportion to its degree (j). CXXXII. The effed of diftention is increafed by the velocity of the blood, both as arifing from other fources, and efpecially from mufcular motion, a motion, which, by compreffing the veins, carries the blood more quickly back to the heart. CXXXII I. Nothing is more effedual than thefe two laft mentioned ftimuli, in producing fthenic dia- thefis, and the difeafes depending upon it. Thefe difeafes are violent in proportion to the over proportion of the blood, and the rapidity of the force with which it flows ; a fad, that is proved by all the exciting powers, all the fymptoms of thofe difeafes, and, efpeci* ally, the pulfe ; it is alfo proved by the great efficacy of relaxation from its being more owing to the paffive ftate of the fimple, than the active ftate of the living, 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 flrong and forcible, and the relaxations active and in confent with the contractions. Hence the diameter of each portion of veffel is diminiftied upon the whole, and while the quantity of the blood is at the fame time increafed, the action and re-action are great ; the blood diftcnds with mechanical, the veffels refift with vital energy ; the mutual effect of both upon the excitability is confiderable ; all is activity, all is force, and thefe are in exact proportion to their caufe over all the fihenic diathefis. This fiate of the veffel, in fo far as it refpects the mufcular fibres, is its tone ; in fo far as it refpects them as fimple folids, its denfity. It is a fthenic ftate of the veffel, oppofed to the afthenic firft defcribed, which is diftinguifhed bv the epithets of atony and laxity ; which, however, oppofed to tone and denfity are only relative terms, employed for convenience, not abfolute ; like the term cold, ufed for diminiihed heat, they only fignify a diminution of tone and denfity. (/) It is a curious fact, that, while the truth of this propofition is demonftrated, the plethora of the fchools is only underftood of a ftate of the veffels diametrically oppofite to a juft idea of plethora* i^a t^e elements PartHs 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 \% 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 fanguiferious fyftem, and that in exad proportion to the penury. 2 2. F rom this ftate of the vefiels, 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 difi turbances of the ftomach,. want of appetite, loatbingi of food, and, therefore, upon account of want of nourifhment, and the languor of the digeftive organs, always lefs and lefs blood arifes m the fyftem. So great] a penury of blood is the principal origin of bleeding, difeafes ; which never happen but in the afthenic ftate. The fame penury of blood ads in this manner, chieflji ! affeding its own veffels, becaufe, according to a Jaw ff>. often mentioned, its debilitating energy chiefly falM. upon them. In fthenic difeafes,, that have advance*^ 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 predifpopl fition to indired debility, but not an eftablifhment of it, and that the matter ftill remains within the opera- tion of exceffive ftimulus (u). zp Thus,- (rj Relief from bleeding and other evacuations is certainly a good argument for the caufe of the difeafe being fo far owing to an over-proportion of blood ; and reft is as good for the proof of agitation of the veffels being concerned in the caufe : befidcs, exercife is otherwife a noted caufe of quicknefs of the pulfe : aaA the hurtful powers and fymptoms are equally decifive. (a) Who ever heard of a flood of blood coming from the lung* in a peripneumony ? Or, who has not heard of it in confnjnptiflF cafes} Chap. I. OF MEDICINE. 1£ I 23. Thus it is not an excefs in the quantity of blood, but laxity and atony of veffels from its deficiency, that upholds the bleeding difcharges ; which proceed in their courfe, not with any effort or adive impulfe, but a cafes; which are the difeafes depending upon the laxity of veffels of which we are fpeaking. Whit vigorous woman, found in all her functions as a woman, ever fell into perpetual floodings * What had been the ftate of thefe women > efore the difeafe ? Did they eat and digeft fo completely, as that there was any reafon for fuppofing their veffels were filled with blood r No ; long before the arrival of the difeafe their appetite 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 quantity. What was the idea to be gathered from their fymptoms, and particularly the pulfe ? The pulfe had all the marks of an afthenic one ; being weak, fmall, and qilick, like that of a new- bora infant. What was the ftate of their habit ? Was it vigor- ous and rcbuft ? It was the reverfe ; foft, delicate ; the habit lax ; a falling off in flefh, with weaknefs over the whole fyftem, and total Icifs of appetite. What were the remedies employed to re- move this fuppofed offspring of plethora ? Bleedings, repeated without end ; other evacuations with the fame freedom ; vegeta- ble 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, open at both ends, full of water, 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 ia living veffels. The excitement, diftinguifhing them from all rigid inanimate tubes, counteracts the effed of gravity, while its living ftate remains : In proportion to the degree oi which, the fides of the veffel will embrace their column of fluids, and prevent the flowing out of the fluids, in proportion to the degree of excite- ment ; and before the gravity can act, the excitement muft be extinguiftied, and the living fyftem reduced to a lumpifh mafs of dead matter. It is the latter that enables them to produce that effect. And, therefore, bleeding difcharges can never happen, cither in health or fthenic diathefis, unlefs in that very high degree of it that approaches to indirect debility, and even then, only ia the forced, fcanty, manner defcribed" in the text ; whereas, after the eftablifhment of indirect debility, or in the cafe of direct, the great difcharges oqly can happen, and that without force, in great plenty, but ftill fhort of what would happen if no excitement re,- ftraioed ic. t5l THE ELEMENTS Patttt* a diminution of tone : They arc all afthenic, and the afthenic diathefis, as far as it depends upon them, con* fifts in dired debility. 24. But, as every other exciting noxious power may induce indired debility, fo alfo, may an over-proportion of blood. For the veffels, diftended beyond all bounds, may, by the excefs of that ftimulus, exhauft their own excitability, and, thereby, put an end to their excite- ment. Upon which the forcible contradions are con- verted into languid ones, or fuch as can fcarce be called contradions at all ; and the area formerly effaced becomes extremely patulous. The finer parts of the fluids flow through the patulous extremities of the arteries, wherever they find an out-let, and carry with them, fometimes ferum, fometimes red blood. In the. afthenic diathefis, as well £$ the fthenic, it is not the.quality of the blood, but its quantity, which is prejudicial, and the fault in quantity here is deficien- cy. The deficient quantity produces the fymptoms 01 the pulfe defcribed above, by not fufficiently diftending the veffels, and giving them fufficient excitement. Plethora, which has been thought to belong to this form of difeafes only, has abfolutely no exiftence in it. The ftate of the velfeis, with refped to the quantity of blood in them, that is pleafant and fuitable to health, is the mean betwixt the extremes that have been def- cribed. CXXXV. This ftate of the blood and veffels, that is, penury of blood, and atony and laxity of the veffels, chiefly from dired, fometimes from indired debility ; though the latter cafe is exceedingly rare, is the chief origin of afthenic difeafes j of this the very hurtful effects of evacuation, efpecially bleeding, as well as vomiting, purging, and every other mode of diminifh- ing the bulk and quantity of fluids give full proof. This proof has of late received a further confirmation, in Chap. I. Of MEDICINE. I53 . in the lingular fuccefs of the cure by other ftimulants firft, and then by every mode of filling the fyftem (x). CXXXVI. The different fluids, fecreted 'from the blood, are, by the diftention which they give to their refpedive veffels, alfo underftood to ftimulate. In this refped the milk and femen, by the abundance of each in its refpedive veffels, and likewife the perfpirable fluid, are the moft remarkable. The commotion of the fecretory organ (y) is eafily diffufed by means of the excitability, which is one undivided property, over the whole body, and, when it rifes to excefs, is capable, with other powers that communicate an excefs of ex- citement, of producing fthenic diathefis. CXXXVII. The fame fecreted fluids, when they do not fufficiently diftend their refpedive veffels, when they do not communicate enough of excitement, make no inconfiderable part of the hurtful powers^jhat con- ftitute afthenic diathefis. ■£■• 25. For which reafon vomiting, purging,jfnd every other evacuation, arc powerful inducers of afthenic diathefis, which they effed in proportion to the debili- ty that attends their operation. The fame thing is to be (x) Syftematics allow that there are many difeafes, which are a reproach to their art, from their never yielding to their method of cure, but on the contrary, becoming worfe and worfe in pro- portion to the time and pains taken about it. Of thefe opprobria medicine (it would be better, I believe, to caff them opprobria medicorum) few are more fo than the bleeding difeafes ; which feem uniformly to have proceeded from evil to worfe under the evacuant debilitating plan ; while it has now been found, that the high ftimulant plan removes them with the greateft fuccefs. (y) It has been faid above, in chap. 4, that the excitability is one uniform undivided property over the whole living fyftem ; and that, wherever it is acted upOn in any part of its feat, it is affected over all: This fact, which is ftiictly true and univerfal over every part of living matter in nature, with the utmoft eafe explains many things, that were confeffedly inexplicable upon every other medical doctrine ; and, among the reft, the feveral aftecttons of the fecretory fyftem. U JT4 THE ELEMENTS { Part U. be faid of excefs in venery, which is partly art indired, partly a dired, always a great, debilitating power (z). 26. Sometimes the fecretory veffels feem crammed with a colluvies of fluids, capable of producing indirect debility, as in that overflowing of bile, which diftin- guifhes the yellow fever of the torrid zone (a). Here too the debilitating effed tends, by means of the ex- citability, to diffufe the diathefis over the whole fyftem, From this fource arife, a languid adion of the extreme veffels (b), a flow motion of the fluids, laftly a ftagnation (2) Nothing is more effectual in haftening death than a love . marriage betwixt an old man of worn out excitability, and a young beautiful virgin : I nsed not explain to any reader on which fide, that of the man or the wife, either the love or the danger lies. (a) I have been fo often, and by perfons of good fenfe enough to make juft obfervations, informed of the neceflity of purging off the redundancy of that fluid, which not only fills the inteftines, ► -but diffufes itfelf over the whole alimentary /canal ; and, then, tjf following 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, admitted the fact.* The reafon of the flownefs of my •aflent to it was, that, upon every other occafion of any accumu- lation of matter in the firft paffages, even in the colic itfelf, I had always found the pradice of invigorating the periftalic motioni 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 always debility. This I found not an exceptioa to that general principle, but an inftance of a fort of local difeate* from an over-repletion of the exhalant mucous and biliary veffels. (b) Thefe are the exhalants that pour out the faline, watery part of 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 fingle veffels ; the hepatic duct or great biliary veffel of the liver, which receives the bile from all the ducts; and, laftly, the ductus communis chole-dochus, or the duct that may be denominated in Englifh, the general receiver of all the bile,' whether from the great duct of the liver, or that which fends to the * This has not been found true in the billms fever* that lately pre vailed in the United States* L. S. Chap. I. OF MEDICINE. *$$ ftagnation and corruption of them. The diminution, or temporary deftrudion of excitement, over fo con- fiderable a part of the fyftem (c), communicates debility, by means alfo of excitability, to the reft of the body , and, in conjundion with other noxious powers that produce too little excitement, gives rife to the afthenic diathefis. 27. The various forts of geftation, as riding on horfeback, going in a carriage, ufing an hobby, and failing, as alfo of exercife and labour, by roufing the mufcles into contradion, and thereby accelerating the motion of the blood in the veins toward the heart, while the valves prevent its taking a contrary diredion, greatly promote excitement in all the veffels, and, therefore, over the whole fyftem ; and the effed may go fo far as to produce fthenic diathefis (d). 28. As nothing contributes more to health than moderate and frequent exercife, and as its excefs ads in the manner juft defcribed, a degree, either greater or lefs than the falutary degree,.will produce the afthenic diathefis , the former by wafting the excitability, the latter by with-holding a necefTary ftimulus ; that is, the one by debilitating indiredlv, the other diredly. CXXXVIIL Thinking, the gall-bladder a part of the bile that returns in the fame veffel to the general receiver. Thefe,. and befides them, the inhalants or abforbents as they are called, to wit, the fmall veffels that take up from che exhalants and other arterial terminations of veffels, the fluid, called .'ymph, which is once more to be returned into; thecirculation ; are the veffels that fuffer the concourfe of fymp- toms defcribed in the text. (c) How great the fpace in the whole fyftem is that thefe veffels occupy, may be eafily imagined, when it is confidered, that every evanefcent artery, over the whole body, terminates in one or more of thefe colourlefs veffels that have been defcribed. (d) Too undiftinguifHmg again ! Thefe kinds of geftation are well known often to produce general languor j and even the fymptoms of debility. So does fwinging, efpecially circular twinging, or twirling. So, I believe, does walking at a certain flow rate, or faunterinq ; by which I have found the force, of the, circulation to be much diminiftied. Editor. 1J« THE ELEMENTS Part II. CXXXVIII. Thinking, which more immediately \ affects the brain, than any other equal part of the fyftem, encreafes excitement over the whole body (e)% Intenfe thinking, whether for once in a great degree,-* or often repeated in a lefs degree, or habitual, may alone prove hurtful ; but, in conjundion with other powers alfo hurtful from their excefs of ftimulus, be-. comes more fo, and may produce fthenic diathefis. CXXXfX. An evident caufe of afthenic diathefis i*>* that ftate of the intelledual fundion, in which excefj in thinking, by wafting the excitability, ends in indired debility ; or that deficient, weak, vacant ftate of mind, incapable of keeping up a train of thought, which produces the fame hurtful effed by direct debility. This faulty ftate of the mind contributes greatly to weaken the fyftem (/). CXL.. Violent (e) 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 intellectual function, and that of paffion or emotion. With refpect to the former, Homer obferves of the hero, whom he gives for a pattern of eloquence, that upon his.firft addrefs, j that is while he was under fome agitation, and had not yet gotten into his train of thought, he was awkward in every motion, aruQ{ in his whole attitude ; he looked down to the ground, his handfjj hung ftraight along his fides as if powerlefs ; his whole appear^ ance was torpid. But when he once entered upon his fubject, his! eyes were all fire, his limbs all motion, with force, grace, and energy. Upon commencing a lecture, the pupils have often ob^ ferved the fame torpor in the lecturer, and a fimilar vivacity and life in a few minutes, when he had gotten fairly into his fubject: the report which a lecturer's daughter, upon looking through the hole'of a door, while the lecture was going on, made to the family and fome company then prefent, was, that her fath«r looked, |n his lecture, as if he would look through his hearers. Mr. Donald* fon is one of the few great mafter?, in the art of painting, who never fail, with a moft exact likerrefs, to difplay the whole influ« er.ee of the mind upon the features. A miniature of the author, clone by him, as a prefent, is reckoned the greateft mafter-piecein thefe refpects, that ever came from the hands of a painter. (f) It may often be remarked by phyficians, that their patients, after every other proper part of cure has been executed, are never completely reftored to their healthy ftate, till they are again en« gaged in their ufual occupations both of mind and body.. Chap. I. OF MEDICINE. I57 CXL. Violent paffions, as great anger, keen grief, unbridled joy, rifing to fuch a pitch as to deftroy ex- citability, have the fame effed as exceffive thinking, anrfiadmit exadly of the fame reafoning. CXLI. Paffion fo ftrong as to exhauft the excita- bility induces that afthenic diathefis, which is occafioned by indired debility, and difeafes of that ftamp. Hence epilepfy, hence apoplexy, which, when the mind has been fcrewed up to the higheft pitch of paffion, often proves fatal. CXLII. On the contrary, deficiency of paffion, (as in melancholy, grief, fear, terror, defpair, which are only lower degrees of joy, affurance, and hope, and imply only a privation of the exciting paffions, and are by no means pofitive emotions of a contrary nature) tend to produce that afthenic diathefis, which depends upon dired debility. The immediate confequence is lofs of appetite, loathing of food, ficknefs, vomiting, pain of the ftomach, diarrhoea without pain, or with pain, indigeftion, colic, the gout, and fever. CXLIII. The exercife of the fenfes, when it is agreeable, has great effed in exciting the whole body, and in producing emotions, which, together with the noxious powers mentioned above, may eafily produce fthenic diathefis. Thefe emotions are felt in drinking, dancing, in agreeable entertainments, where the eye is dazzled with the fplendour of the difhes, of the com- pany, and of all the objeds around. CXLIV. The exercife of the fenfes, when exceffive, produces indired debility. On the contrary, when the fenfes are either in part deftroyed, or impaired, or difagreeably affeded (g), the mind is dejeded, and the whole body thrown into a ftate of languor and dired debility. (g) Nothing is more clearly difagreeable than 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 fpermaceti candles. This is often experienced at Ranelagh, and may be feen in children exquifitely amufed. V I58 THE ELEMENTS Part II, debility. In both cafes, efpecially when there is a concurrence of other debilitating powers, the afthenic diathefis arifes. CXLV. The effed of the air, independently of its fenfible qualities, and its ufe in fupporting refpiration, is lefs obvious, than that of the other powers that have been fpoken of; at the fame time it cannot be doubt- ed, that its application to the whole furface of the body is a necefTary ftimulus. The air is feldom appliedina pure ftate : it is commonly blended with foreign. matters that diminifh its ftimulating power ; and, though its falutary ftimulus depends upon its purity, it is uncertain whether ever its purity goes fo far as to ftimu- late in excefs, and thereby produce fthenic diathefis. The lately invented balloons, by which men afcend above the clouds, would throw much light upon this matter, if it were not for the cold of the upper regions of the atmofphere. Be that as it may ; fince we live commodioufly enough, without air of the greateft purity, too pure an air has probably a tendency to produce fthenic diathefis, by ftimulating in excefs. CXLVI. But, as nothing is more common than impure air, and as every impurity diminifhes its ftimu- lus, a very impure air without doubt debilitates, and produces afthenic diathefis. Accordingly, impure air is a frequent caufe of typhus, as is evident from the fate of thofe who died in the black hole of Calcutta [h\ Whether ever the air, from an excefs of purity, produces afthenic (b) Is it fo certain that thefe people died of typhus 11 hope to elucidate this queftion foon by experiment. In the mean time I may refer the reader to a cafe, in which the infpiration of oxygene air produced exactly the fame violent effects as opium had done. The circumftances of the patient rendered it abfolutely certait that he had taken very little wine or other ftimulants, indeed left than ufual. This cafe would have been the occafion of great triumph to Dr. Brown, had he lived to read it. See a cafe of epileptic affection in Letters from different phyficians t9 Dr. Beddot:- The cafe is Angular in degree, but not in kind* Editor. Chap. I. OF MEDICINE. I 'g afthenic diathefis, is the more doubtful, becaufe, as has been faid, it is as yet undecided whether it produces fthenic diathefis or not. 29. Contagious matter, in fo far as it may have any tendency to produce general difeafes, in one form pro- duces fthenic, in another afthenic difeafes, and, there- fore, ads like the ordinary noxious powers, and admits of exadly the fame reafoning. But, in fo far as it only occafions eruption, without making any change in the excitement, it is to be referred to the local difeafes. 30. To poifons, if they ad as general ftimulants, all the reafoning that has been employed with refped to the other noxious powers, will apply. It is not, how- ever, likely that they are general ftimulants. CXLVII. It is feldom by the feparate, almoft always by the united, operation of all the powers, that both the diathefes, whether they remain within the range of predifpofition, or rife to the degree of adual morbid ftate, are produced, and by no inherent power in the fyftem. CHAP. 0 iCQ THE ELEMENTS Part l{ CHAP. II. The catfe of each diathefis—Sthenic from too great-i afthenic from too little excitement. CXLVIII. THE caufe of fthenic diathefis is too great an excitement of the whole living fyftem by the powers abovementioned. All the fundions are firft increafed, a difturbance or irregularity then takes place in fome, others are impaired ; but not, as long as this diathefis lafts, by a debilitating operation. CXLIX. The caufe of the afthenic diathefis, arifing from the debilitating noxious powers, is too little ex- ciment of the whole living fyftem, impairing all the fundions, difturbing fome, giving a falfe appearance of increafing others, but always debilitating. It muft now appear to the reader, to what fimplicity the hitherto conjedural, incoherent, erroneous, myfterious, and enigmatical art of phyfic is reduced. It has been de- monftrated, 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 in- anition ; or changes in the qualities of the flui4§9 whether of an acid or alkaline nature; or the intre£l dudion of foreign matters into the fyftem ; or a change of figure of the extreme particles, or a difproportien in the diftribution of the blood ; or an increafe or decreafc of the power of the heart and veffels as regulating the circulation ; or a rational principle governing the adions of the bocy ; or an alteration in the extreme particles, as being of too large or too fmall a fize ; or an alteration of the pores, as being too narrow or too capacious ; or a conftridion of the fuperficial veffels from cold ; or a fpafm of thefe veffels, producing a readion, as it is called, of the heart and interiour vef- fels ; or any thing that any perfon has yet thought of refpedidg Chap. III. OF MEDICINE. 161 refpeding the caufe and nature of morbid ftate. On the contrary it has been proved that health and difeafe are the fame ftate depending on the fame caufe, that is,, excitement, varying only in degree; and that the powers producing both are the fame, fometimes ading with a proper degree of force, at other times either with too much or too little ; that the whole and folc province of a phyfician is not to look for morbid ftates and remedies which have no exiftence, but to confider the deviation of exeitement from the healthy ftandard, in order to remove it by the proper means. The reafoning part of this dodrine, it is expeded, the reader will find irreprehenfible and unanfwerable ; and the pradical part, from the aftonifhing cures that have upon innumerable occafions been effeded, will ever ftand in fupport of the truth and utility, as well as fimplicity oi the whole. CHAP. III. The fihenic diathefis—Increafe of ail the fundions previous to the difiurbance of the fundions. CL. PREVIOUS to the difturbance of the fundions, which the hurtful effeds of both fets of powers produce, and which never happens till after the formation of difeafe (a), and even then only when the attack is vio- lent, (a) During the predifpofition to peripneumony, as well as to every other difeafe, neither the fymptoms of difturbance, or any other fymptoms 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 violent nature, then the fyftem is commonly difturb- ed, and in a moft confpicuous degree. The affection of the lungs in the former, from the inflammation within, and of one of the feet, or fome other part in the latter, from an external inflamma- tion, give extreme difturbance to the affected parts, while there is a difeafe of the fame nature as. the gout, that is dyfpepfia, cr indigeftion, in which the inflammation never appears. W i6z THE ELEMENTS Part II. knt, all the fenfes are acute, the motions both volun- tary and involuntary (b) are vigorous, there is an acute- nefs of genious, great fenfibility, and tendency to paffion and emotion. The feveral parts of the body are perceived to be in a ftate of vigour from the follow- ing marks; the heart and arteries from the pulfe ; tjie extreme veffels on the furface of the body from the colour ; all the mufcles from the ftrength they exert j the internal fecfetions from the great quantity of milk and femen ; the digeftive organs from the ftrong ap- petite, the power of digeftion, the vigour of body, and the manifeft abundance of blood. CLI. A comparifon of the ftate of the intellec- tual faculties, and of the difpofition to paffion and emotion, in this diathefis, in good health, in the fecond. form of difeafes and the predifpofition to it, will fhow how much they are heightened in the fthenic diathefis. So much for the increafe of the fundions. CHAP. (£) The voluntary motions are thofe that are performed under the influence of the will, fuch as the motion of the limbs in walk- ing, or in any fort of exercife. The organs, by which they are moved, confift of bundles of moving fibres called mufcles. The involuntary motions are thofe of the interiour part of the fyftem, fuch as thofe of the heart and veffels connected with it; the perif- taltic -notion in the firft paffages, which are the paffage to the ftomach, the ftomach itfelf, and the whole convolutions of the inteftines ; as alfo thofe of the womb, of the bladder of urine, and fo forth. None of the latter are under the influence of the will. Chap. IV. OF MEDICINE. l63 CHAP. IV. The fthenic diathefis illuftrated by an explanation of its fymptoms—Fundions increafed from excitement— Shivering from lefened perfpiration—Increafed circula- tion—High colour of the fkin—Delirium—Thirft and heat—Affedion of the thorax—Palenefs and corrugation of the fkin — Pale urine—Coftivenefs—Appetite— Proper diet—Symptoms affeding the ftomach explained —Why inflammation in phlegmafia is external—Local fthenic inflammation—Phrenitis—Peripneumony—Pufi tules. CLII. THE increafe of the force of the fenfes, of the motions, of the intelledual faculty, and of the paffions, depends upon the increafe of excitement in every one of their organs, by which, befide other effeds, the motion of the blood through them is quickened. CLIII. The onfet of every fthenic difeafe is an- nounced by fhivering. This depends upon a diminiih- ed perfpiration, by means of the diathefis being ex- quifitely ftrong in the extreme veffels of the fkin. The fame explanation is to be given of the fenfe of cold, which commonly accompanies the fhivering ; and of the drynefs of the fkin, CLIV. In thefe difeafes the purfe is ftronger, harder, fuller, and fomewhat more frequent, than in the healthy ftate. Its fulnefs and hardnefs are owing to the plenti- ful ufe of animal-food during the predifpofition. The force and frequency are occafioned by this or any other ftimulus, as ftrong liquor or exercife, whether corporeal or mental : Nay all the ftimulant noxious powers are adequate to this effed. CLV. If, in the progrefs of the difeafe, the pulfe fometimes becomes weaker, fofter, emptier, and quicker that is a bad fign. This circumftance is occafioned- . either 164 THE ELEMENTS Part 11. either by the debilitating plan of cure being pufhed beyond the proper bounds ; or where this method of treatment has been negleded, it may be owing to debility induced by the excefs of excitement The former of thefe is dired, the latter indired debility ; both to be avoided. CLVI. The rednefs of the furface of the body, which is often preceded by palenefs, and by a great in- creafe of fecretion, is occafioned by an over-proportion of blood, in confequence of an exceffive fthenic diathefis obftruding the perfpiration. 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 feldom to be fufpeded of being owing to inflammation within the head. And the reafon for fo thinking is ftrengthened by this further circumftance, that the in- flammation arifing in general difeafes affeds external parts only, as far as we knovy at prefent. CLVI1. The delirium alfo, that fometimes arifes in a violent ftate of difeafe, is not to be imputed to inflam- mation, and for the fame reafon ; for it yields fo readily "' to bleeding and other evacuations, that there is no reafon for fufpeding inflammation within the head.- ' That abundance of blood, by diftending the veflels todf excefs, is the fole caufe, is proved on the one hand by*H the rednefs of the face (c), which indicates this abun- dance, 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 diathefis in the extreme veffels of the fauces and fkin ; in confequence of which thefe veffels become fo con- ftrided that the perfpirable matter cannot be difchargc&*a At the fame time as the blood finds its way very near to - (c) This rednefs is no pmof of abundance of blood ; temporary • excefs of exertion in the Veffels of the part will produce it. In many difeafes it comes and goes, where no plethora can be fuf- ; petted. Editor. Chap. IV. OF MEDICINE. '«5 to the extremities of the veffel?, it accumulates under the cuticle the heat generated in the fyftem, which would be continually carried off, if the perfpiration were free. So alfo from the affedion of the ends of the veflels in the throat, 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 fuppreffed, and prevented from flowing out, and thirft is the confequence. CLX. Hoarfenefs, cough, and expedoration, which are fometimes obferved in fthenic difeafes, commonly fueceeded each other in the following order :—hoarfe- nefs, then a dry cough, then a cough with expedoration. The caufe of the hoarfenefs and dry cough is an ob- ftrudion of the exhalants and mucous veffels, which terminate in the bronchia, and are prevented from tranfmitting their contents to lubicrate the air-veffels (d), fo that the hoarfenefs may be removed, and the expedoration take place with freedom. Again, the expedoration is afterwards free, becaufe the&diathefis being now diminiihed, and allowing the ends of the veffels to be relaxed, and the fluids to be poured out in abundance upon the air-veffels, this whole organ is ftimulated, and the fluids are thrown out with a couffh or convulfive motion. CLXI. As the greater freedom of expedoration now implies an abatement of the diathefis ; fo too great a flow, and too long a continuance of it, fhows, that the diathefis is declining faft into the afthenic ftate ; either from (d) The bronchia are the divifions of the wind-pipe runnin* through the fubftance of the lungs, and blended with the blood- veffes. In the fubftance of the lungs, befides thefe two fets of veffels, the air-veffels and blood-veffels, there are likewife exhalants ImaU arteries, and mucous glands, coming off from the extremi- ties of the red arteries. The wind-pipe is covered with the latter • ?« r!rKa\Tanli? °fmucus ^rown up from the lungs, often m per.cct health, and in innumerable cafes, both of fthenic and afthenic general difeafe, fufficiently proves the exiftenceTf the fource from which it flows. l66 TH2 ELEMENTS Part 11. from indired debility, as when the difeafe, in its pro^ grefs, has much exhaufted the excitability ; or from direct debility, as when the plan of cure, proper in kind, has been pufbed beyond due bounds. CLXII. Thefe fymptoms, while they^ftop fhort of dired debility, or are not yet changed into the indirect, are occafioned by heat, and whatever ftimulates in ex- cefs, and removed by cold, and whatever ads as a weakening power. CLXIII. Palenefs and fhriveling of the fkin, clearnefs of the urine, and bound belly, which chiefly happen about the beginning of the difeafe, arife from a degree | of the diathefis, fhutting up the ends of the veffels in fuch a manner, that either nothing is excreted, or the thinner part, as in the cafe of pale urine, only efcapes,,; The ceffation of the affedion of the urine, of the obr . ftruded perfpiration, and of the coftivenefs, fhows thaf- i the diathefis is now gradually abating, the difeafe be- coming mild, and that it may entirely be removed by emetics, purgatives, fudoriflcs, and other debilitating remedies. CLXIV. In fthenic difeafes, when they are mild^ the appetite is often not much diminiihed ; and ftill oftener more food is defirable than is ferviceable. But every thing, except the lighteft vegetable matter, in; the form of watery potion (?), will do harm. • CLXV. When either from indulgence in rich fooc| or from a ftimulant pian of cure, or from the difeafe having arifen from very adive, noxious powers, and, attained its higheft degree of violence ; in any, or all thefe circumftances, the other bad fymptoms, mention-., ed above, break out diredly, and the violent difordeii^J of the ftomach, or an acute pain of the thorax, fhow themfelves indiredly. CLXVI. In a violent diathefis, therefore, wher£ ' there is little appetite for food, but a very great defire for (e) It fhould be cold too, according to this fyftem. Editor J Chap. IV. OF MEDICINE. 167 for.drink ; the patient is by all means to be gratified with the latter; but food fhould be avoided, as pro- ducing loathing, ficknefs at .ftomach, and vomiting. Thefe fymptoms are not ufually of long duration, unlefs when the diathefis is now changing or adually changed into the afthenic ftate by the means mentioned above : but on removing the other fymptoms by the proper debilitating plan of cure, they go off. When the fick- nefs and vomiting are urgent, and begin now to be a little more obftinate, and have lafted fome time, one may know that the diathefis ftill remains fliort of the change into indired debility, by the following marks : if the pulfe ftill maintain moderation in its frequenq, and has not much abated of its fulnefs and force ; it artificial vomiting and purging diminifh the morbid vomiting—in a word, if the debilitating plan of cure ftill fucceeds. But, it will then at laft be underftood that the difeafe is converted into the oppofite, when thefe fymptoms every day increafe ; when the pulfe becomes weaker and weaker j when griping and liquid ftools are fuperadded to the fymptoms that difturb the ftomach, and when the antifthenic or debilitating plan of cure is now of evident detriment. CLXVII. While thefe affedions of the ftomach and inteftines, ftill flop fhort of indired debility, exceffive excitement will produce great difturbance in the ftomach ; this origin having on account of its great fenfibility more pronenefs to indired debility than any other (LIV): the moft powerful ftimuli too, and thofe that are fignally efficacious in producing fthenic diathe- fis (/) are firft applied to it, and exert a greater force upoa (/") As high feafoned animal food, wine, fpirituous drink, cordials, and the whole train of high diffufibb'ftimuli. Some of thefe, as meat and wine, have no effect upon the external furface, or any other part : others, as fome of the condiments, fuch as muttard and ftrong fpirits, and above all the diffufible ftimulants, as fcther, camphor, and opium in a liquid form, do act upon the external furfaee, and by their application to it fupport their own internal 168 THE ELEMENTS PartU. upon the excitability in that than any other part. Thefe ftimuli are the feveral preparations of animal food, the feveral kinds of ftrong liquor, the fevetal condiments with which they are feafoncd, the various diffufible ftimuli, as the different preparations of opium, volatile alkali, camphor, mufk, and aether. Thefe all ad upon the ftomach with more force than upon ahy other part ; than upon the inteftines below, becadtc they undergo a change from the firft digeftion before they pafs into the upper portion of the inteftinal canal; than upon the ladeaL veffels, becaufe they are not re- ceived into them till they are further diluted, and have undergone another change from the digeftive operation, and when fo changed, they are next carried to be mix- ed with the blood ; than upon the heart and arteries, upon account of further dilution in thofe veffels, and a conftant change taking place through the whole courfe of the circulation ; than upon the terminations o'f the arteries, whether exhalant or glandular, and whethet thefe excrete from the body a matter already corrupted, or carry back by the lymphatic veffels an ufeful matte* to the blood—and that both for the reafons that have1 been given, and particularly becaufe fome great change is made in the exhalants and glands ; than upon the lymphatic veffels, where a new fluid is conftantly flor- in upon the old in thefe parts by means of anaftomofing branches, and chiefly in the thoracic dud ; than upfln the other blood-veffels, upon account of the greaf change that a repetition of the circulation produces t than upon the mufcular fibres, whether voluntary Qf< involuntary, becaufe the ftimuli never come in contact with internal ufe. Thus, tof prevent or remove the gout, anafarca.i fprains, and fo forth, the application of any of thofe high diffufijj ble remedies, juft now. mentioned, will greatly contribute, alont with their ufe as taken into the ftomach, to fupport the general operation. Thefe, and innumerable others, are lb many fafl*. that have been fuggefted by obfervations and trials made in tbej profecution of this doctrine. " •' Chap. IV* OF MEDICIN.E*. 169 with thefe ; than upon the brain or medullary fub- ftance, for the fame reafon, as well as from the great diftance of thefe parts from the part that received the firft contad of the ftimuli. In one word, as all the exciting powers, whether falutary or hurtful or curative, ad fomewhat more powerfully upon certain parts than upon others, which parts are generally thofe firft affed- ed, and with which they come into dired contad ; thefe,, therefore, in preference to others, are moft liable to pafs either from fthenic diathefis into afthenic, or from the latter into the former. Whether however the excitement has been increafed or diminiihed in a peculiar part ; and whether its diminution has been owing to dired or indired debility, and in either way the afthenic diatrjefis has been produced ; all the reft of the body* foon follows the kind of change that has taken place, becaufe trtrexcitability- is an uniform, un- divided; univerfal property of the fyftem. Since the agents have been, anoWe the fame, that is, either ex- ceffively or infufficietitly ftimularlt or fo to an ultimate excels ; and fince the excitability ujton which they have aded, and ftill ad, is the fame, that is, fince the whole confideration of the caufe is the fame, the effed muft alfo be the fame, that is, the fame fort of adions, whether in excefs or defed, muft be eftablifhed over the whole body. CLXVIII. The inflammation, which accompanies the phlegmafii-e, or fthenic difeafes, accompanied by local inflammation, occupies an external part, as far as its nature has been yet afc'ertained. The,reafon is, that heat, which is the moft powerful noxious agent in thofe difeafes, either alone, or alternating with cold, of fucceeding to it, has much more power to ftimulate externally, where it is diredly applied, than- internally, where the temperature is nearly ftatioriary, and there- fore raifes the general'diathefis to the degree of adual inflammation in fome one part. Hence the throat, the different joints, the facej where the form of inflam- X' motion j^o THE ELEMENTS Part It, mation is different, as when the inflammation of ery fipelas appears there ; hence the lungs, which are to be confidered as an external part, becaufe the air has direct accefs to them, are all more liable to inflammation than other parts. And, befides the peculiarity in the mode of adion of heat, there is in the part, that is to under- go the inflammation, a greater fenfibility (fee above LIII. 11.) than in others, or a more accumulated ex- citability ; by means of which it happens, that of the parts that have been mentioned, fometimes one, fome- times another is affeded, more than the reft (g). To this confideration of the caufe it may be added, that whichever of the parts we have mentioned has been injured, (g) In the inflammatory fore-throat the inflammation affefts the throat, which is alfo fometimes Uje feat of an eryfipelatoui inflammation. In eryfipelas, fometimes the face, fometimes eat of the legs, fometimes the ear, fometimes the temples, are inflam« ed. I have frequently been affected with an eryfipelas, that begin! with an acute inflammation and pain in orte ear, which is thickened to four times its ufual dimenfion ; from that it fpreads over tht whole hairy-fcalp till it reaches the neighbourhood of the ear ia 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 et* pofed than the other to heat, or the alternation of heat with cold, or their fuccetfion 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 drink, and the diffufible ftimuli. In rheumatifm, the inflammation attacks a large joint, fometimes fhifting from one to another, fometimes feveral at a time, and, ia contradiction to the eryfipelatous, is deep feated, extending to the interior part of the true fkin, which is the cafe with every fuch inflammation, called therefore, phlegmonic ; while its feat in eryfipelatous is betwixt the fcarf-flcin and outer part of the true fkin upon the corpus mucofum. To thefe phlegmafise, depending upon the general caufe of the difeafe, and efpecially upon the effect of temperature, may be added that which an inflammatioo in one of the ears accompanies, though this cafe is feldom admit- ted into the number of the phlegmafise. It is, indeed, fometimei local, arifing from local injuries, but is as certainly at others, % general difeafe, and to all intents and purpofes a phlegma&u Chap. IV. OF MEDICINE. IJ1 injured, in whatever manner it may have undergone the inflammation peculiar to the phlegmafia?, that part, in every fubfequent attack of phlegmafia, is in more danger of being inflamed than the reft. This is the true caufe of the frequent recurrence of fome of the phlegmafia^ as the inflammatory fore-throat, and rheumatifm (h). 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* flam mat ion. 31. As inflammatory fever, catarrh, the mild fmall- pox, are unattended by inflammation (unlefs that in the laft a local inflammation from a local caufe, quite different from that which makes our prefent fubjecti takes place), and as the inflammation in peripneumony, violent eryfipelas, and fimilar violent affections, is found the higheft in degree ; I conclude, that, the degree of inflammation, when.it is a fymptom. of general fthenic difeafes,, (b) Thefe two difeafes, in young vigorous perfons, are very liable to be exceedingly troublefome by the frequency of their occurrence. In the younger part of my life the violence in de- gree, and frequency of recurrence, of the fthenic inflammatory fore threat, was very diftreffmg, as the leaft variation of the ex- ternal temperature, fuperadded to a full nourifhing diet, not without the ftimulus of a chearful glafs, was ready to renew, not only the inflammation, but the whole phsenomena of the difeafe. The fame thing I have often obferved in the frequent recurrence of rheumatifm in perfons of the fame age and habit, perhaps, with fome difference of temperament. But it is to be obferved, that, in proportion to the advance of life, and diminution of vigour, both thefe difeafes become much lefs frequent, and much lefs violent. Nor is any thing more common than their giving way at this time to a very oppofite difeafe, the gout, which depends upon a fuperaddition of direct debility to the indirect, that laid the foundation of it. I am pretty certain my inflammatory fore throat, or eryfipelas, never happened fpontaneoufly, nor without an addition of ftimulant power, to thofe that produce that difeafe, in confequence of carrying to fome excefs the plan of cure fuitrd to the removal or prevention of the gout. j^2 THE ELEMENTS Pari 11. difeafes, is proportioned to the degree of the fthenic. diathefis (*"). CLXIX. The inflammation in this c&fe, is only a ftate of the inflamed part analogous to that of the reft, of the body. And as the inflammation is produced by. a greater degree of excitement in the inflamed, 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 pro- portionally greater than in any other part {k). CLXX. This inflammation, which for the fake of diftindion may be called general fthenic inflammation* fhould be diftinguifhed from another, which is a locals affedion, arifing from local noxious powers, or depend^ ing upon a fault in the organ, or a folution of con- tinuity (/). CLXXI. To this laft the term of fthenic local in- flammation applies. General inflammation always depends, ;* (/) It fhall by and by be fhowed, that this fort of inflammation^ is only a part of the general diathefis, fomewhat higher in degree , than in any other part, but far fhort of the degree conftituted by " the whole general affection. {k) See above par. L. and LI. Suppofe the excitement in everyf* part of the fyftem to be 45 at fpme point in the period of thgtf predifpofition, and 54 In the part to be inflamed ; after the coming** on of the difeafe the fame proportion will hold : when the excite- ment has now mounted up to 60, the excitement of the part will be underftood to have gone to 69 ; keeping up ftill the fame proportion. But thefe 9 degrees of greater excitement in a par; come far fhort of the fum total of excitement in all the parts af- fected with the general fthenic diathefis ; that you may fuppofe. 3000 : and then the conclufion will be, that the general fthenic diathefis confifts in a fum total of morbid affection, as 3000; while the inflammation of the part is only an affection o£ 3 de- grees of excitement. (/) Solution of continuity in all its forms, whether as being the effed of puncturing, cutting, bruifing, compreffion, erofion from acrid matter, or from heat, or cold, is always followed by an in- flammation, which, when it goes on brifkly, and needs to have its violence reftrained, fhould be called as is expreffed in the next paragraph. Chap. IV. OF MEDICINE. 173 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 noxious powers which pro- duce the other fymptoms, and is reduced by the fame remedies. In contradiftindion to which, the local affedion arifes from fome local injury, producing a folution of continuity, or deranging the texture of the part ; and if the injured part is hot very fenfible, the affedion extends no further. But when the injured part is 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 effed of the inflammation is propagated over the whole fyftem, and, in confequence of an affedion of all the veffels, excites a tumult every where. The fame local fthenic inflammation, whether it be fixed in the part, or from its propagation gives more general difturbance, yields to no remedies, but thofe that ad upon the affeded part firft, and heal the folution of continuity. Let it fuffice to have faid fo much at prelent.upon thefe inflammations, for the fake of eftablifhing necefTary diftindions. More is after- wards to be faid upon the local, in its -proper place. There are two inflammations ftill rernaining, one uni- verfal and one 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 affeds a vital part, produces fymptoms of difturbance. Whether ever the general fthenic inflammation affeds the brain and its membranes, is hitherto not afcertained (m). It is more provable, that the commotion in the head, and other violent fymptoms in phrenitis, do not depend upon inflammation, as the following phenomena feem to (m) Phrenitis has been thought, and commonly even defined* an inflammation of the brain ; an opinion that, however univerfal* feems to be liable to much doubt : nay, there are many reafons for adopting an oppofite one, as will appear from the reafoning in this paragraph of the text. 174 THE elements PartlW to fhow : i. the eafe by which the cure is effeded, all the fymptoms readily yielding to bleeding, purging, and other afthenic remedies ; and, it not being very credible, that the effed of adual inflammation in a part fo delicate, and fo neceffary to life, could be fo eafily effaced : 2. There is no certain proof, after re» covery, of the exiftence of inflammation during the difeafe : 3. Analogy makes for the fame conclufion y for, as has been faid above, general inflammation does not arife internally in any general fthenic difeafes j on the contrary, as often as it occurs, it is always in an external part («).. Nay all the fymptoms are fuch as arife from the general fthenic hurtful powers, and, alfo, yield to the general antifthenic remedies, and in pro- portion to their degree. CLXXIII. The fame that we have afligned as the caufe of phrenitic affedion alfo is the caufe of headb ach, rednefs of the eye, as well as of delirium in phren- itis. 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 iff . the thorax it is, ar> adual inflammation is oppofed in- ternally. And, as the inflammation is proportional to " the degree of general fthenic diathefis, and never happens but in a high degree of that diathefis ; fo the pain is proportional to the degree of inflammation (0) ; and th* ^ (n) It was long an opinion, that the inflammation in rheuma» tifm might be transferred to an internal part, as the ftomach; but that, alfo, is now laid afide, and all the cafes where there could be the leaft appearance of any fuch transference, have been found to be cafes of the gout, or fome analagous difeafe or debility. (o) The inflammation was fuppofed a chief and primary cir- cumftance, and its caufe and feat, the caufe and feat of the whole difeafe ; while the general fthenic diathefis, and all the fymptoms depending on it, was fuppofed the offspring of the inflammation. But Chap.lV. ^ MEDICINE. 175 the ftate of the pulfe muft be eftimated by paying a due regard to its caufe. In the cafe of an high diathe- fis, and high degree of inflammation, its effed, the pain, feated in fome part of the thorax, fometimes about the fternum, fometimes nigh the nipples, fome- times further back on either fide, fometimes in the back between or above the fhoulders, is acute and pungent, and the pulfe very hard and ftrong. When the diathefis, and the part of it we call inflammation, -wJjthe pain is lefs acute, more dull, and eafier to be borne 5 the pulfe is not foft and yielding, according to the common notion, but ftill hard and ftrong, though lefs fo than in the other cafe. Afterwards, in the pro- grefs of the difeafe, the pain abates, becomes dull, the refpiration, which had been much difturbed by it, be- comes more eafy and free. The pulfe which before was only lefs hard, now becomes truly and pofitively foft, and that in proportion to the degree of indirect debility, occafioned by a negled of the proper plan of cure ; or in proportion to the produdion of dired de- bility, from the antifthenic or debilitating plan of cure having been pufhed too far. But the hardnefs of the pulfe, and violence of pain, are never to be imputed to the inflammation being feated in the membrane ; nor is But the truth is, in every refpect, the reverfe of this account. The general fthenic diathefis is the effect of the general exciting hurtful powers. As the effect of thefe, in a lefs degree, it exifts during the predifpofition, and before the arrival of the difeafe ; and; after the difeafe is come on, it fubfifts, as certainly, as fuch, for one, two, or three days, as afterwards, when the fign of the inflamma- tion, the pain, makes its appearance. It is only an increafe of it, that induces the latter ; and it is net to be cured by any contri- vance of throwing any thing into the inflamed part, there being no fuch thing to be found in nature, but by the feveral means of removing the common caufe, that is, evacuant and other debili- tating remedies. Thefe, while, at the fame time, they remove the other fymptoms, by alfo removing the difeafe, prove that the common caufe of the whole is the general diathefis. The in- flammation, therefore, inftead of being the caufe of the general diforder, is a confequence, like every other fymptom. ■£--€e45i* 176 the elements Part i[t is the foftnefs of the former, and dulnefs of the latter, . to be attributed to its occupying the foft parenchyma- tous fubftance (p), it being impoffvble that an inflam- mation, if it occupied either of thofe parts, fhould not reach the contiguous points of the veffels in the other. The caufe, therefore, of thofe fymptoms that has here been afligned, muft be admitted. CLXXV. The puftules, which accompany certain 9 fthenic difeafes, arife from a contagion, taken into the body, diffufed over the whole, arid, in pairing out, de-' tained along with the perfpirable fluid, under the fcarf- fkin. The caufe of the diftention, 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 affigned, (fee above, par. CXIII. and CXIV.) In which operation the mufcular fibres of the veflelsj becaufe they are as much increafed in denfity, in fo far as they are confidered as fimple folids, as they re* ceive an increafe of tone, in fo far as they are confidered as living (fee chap. V.), are on that account fo fhorfen- ed, as not fufficiently to tranfmit the imperceptible vapour of the perfpirable fluid. All the fthenic hurtful powers have a tendency to produce this effed, but heati in a degree within its ftimulant range, and fhort of indired debility, more than any other. The fame is the caufe of coftivenefs. 32. Sthenic difeafes are often followed by debility, fometimes dired, at other times indired, as is- exem- plified in the change of peripneumony into hydrotho- rax, the explanation of which is evident from what'has already been faid. CHAP. ( p) Such, however, and many other diftinctions, equally falfe, frivolous, and mifleading in the practice, have been at all times univerfally received by fyftematic, and lately by nosological writers. Chap*V. OF MEDICINE, I77 CHAP. V. The afthenic diathefis~lts charaders. CLXXVI. BEFORE the difturbance, which only fypervenes in a violent degree of morbid ftate, all the fenfes are dull ; the motions, both voluntary and in- voluntary, are flow ; the acutenefs of genius is impair- ed ; the fenfibility and paffions become languid. The following fundions are all in a ftate of languor, as is difcoverable from the annexed marks : The languor of the heart and arteries is difcernable in the pulfe ; as is alfo that of the extreme veffels on the furface, from the palenefs, the drynefs of the fkin, the fhrinking of tumours, the drying up of ulcers (a), and the manifeft abfenceof fthenic diathefis, to produce any fymptoms like thefe. That the mufcles are in a ftate of torpor is demonftrated by their weakened action ; and that the internal fecretions are deficient, is equally certain from the penury of femenand milk, and the redundance of fluids in a ftate of degeneracy. The languor of the digeftive organs is manifested by want of appetite, loathing of food, fometimes thirft, ficknefs, vomiting, weaknefs of the fyftem, and evident penury of blood. CLXXVII. In the fame diathefis, whether remain- ing within the latitude of predifpofition, or raifed to the meafure of adual difeafe, .the intellediial faculties and the paffions are impaired. In this way are the func* tions impaired. CHAP. (#) Thefe fymptoms have lately been conftrued into fo many marks amounting to a proof of the exiftence of fpafm upon the extreme veffels ; but we fhall, by and J»y, find a much better e* ponation ,of them. T 178 the elements Parti], CHAP. VI. The afihenic diathefis illufirated by an explanation of its fymptoms—Shivering and fenfe of cold from checked perfpiration—Weak circulation from defied of ftimuli—. Eadfign when the circulation becomes fuddenly firong— Pale and dry fkin—Head-ach—Delirium—Thirft and heal whence—Appetite—Affedion of the ftomach— Cramps—No internal inflammation—Symptoms atiend- * *nS Zont—Nature of the afthenic pulmonary affedion— Head-ach and delirium, not from inflammation—Nature of afthenic inflammation—Of putrid fore-throat—Dif- fufible fiimuli cure gouty inflammation—Confluent fmall- ■ pox—Puftules, and other eruptions*—Curious eruption in fome cafes of fmall-pox—Heat whence—and coldnefsh one fiage of afihenic difeafe—How in violent fihenic difeafes fome fundions are impaired, but not from de- bility—and in afihenic difeafes augmented in appear- ance—Of fpafm and convulfion—Adion of opium—Of difcharges of blood—Sthenic and afthenic affedions of the lungs compared—Similarity of fymptoms—Cured by oppofite means. CLXXVIII. SHIVERING is not unufual at the commencement of afthenic difeafes of any confiderable ' feverity ; it depends upon the perfpiration being greatly checked. The caufe of the great check is weaknefs of the whole fyftem, but particularly of the heart and ar- teries, in confequence of which they propel the fluids every where with difficulty, and in the extreme veflels with ftill more difficulty, or fcarce at all. Hence the perfpiration ceafes. The fame explanation is to be given of the fenfe of cold, when it accompanies the fhivering. CLXXIX. In afthenic affedions the pulfe is weak, foft, fmall, and very quick. The foftncfs (when it can be Chap.Vl. of medicine. 179 be perceived for the fmallnefs), as well as the fmallnefs, is occafioned by an under-proportion of blood, arifing, during the period of predifpofition, from a fcantinefs of animal food, and an excefs in the ufe of vegetables; orfrom a deficiency of aliment upon the whole, whether from one or other of thefe" fources. 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, as ftrong liquors, mental or corporeal exercife, and an under-proportion of blood. CLXXX. Since the excitability can only be gradu- ally worn down (fee above, par. XXVI. XLIII.), and the ftrength, thereby, repaired ; if, at any time, the pulfe becomes full and hard too foon; and without a proportional relief of the fymptoms, it is a bad fign, and happens becaufe the ftimulant plan of cure has been pufhed beyond the proper rule (fee above, par. XLIX.); this is a cafe of indired debility fuperadded to the dired (fee above, par. CLVI.) CLXXXI. The caufe of the palenefs and drynefs of. the ikin is the fame as that of a checked perfpirarfon ; viz. the weaknefs of the heart and arteries. Hence the blood is not fufficiently propelled to the furface of the body. CLXXXII. Head-ach (which is a moft frequent fymptom in afthonic affedions) and pains in the joints (which are more rare) are occafioned by a fcantinefs, of blood : for fuch is the effed 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, oc- cafions an ungrateful one, and, therefore, when it rifes to a certain degree, pain. But in this cafe, we can much lefs fufped inflammation to be the caufe of the pain than in fthenic difeafes ; becaufe, not only the pain here, but even delirium, yields fo eafily to the ftimulant method of cure ; which would not readily happen, if fo delicate and fenfible an organ, and one fo neceffaty %io the elements Part IX, necefTary to life, laboured under an affedion fo likely to deftroy the texture of the affeded part. CLXXXIII. Neither, in general, is delirium to be imputed to inflammation. It is, on the contrary, to be attributed to a fcarttinefs of blood, and a deficiency of other ftimuli. Nor can this be doubted ; fince ftimulant remedies, which have no effed in filling the veffels, fuccefsfully and quickly cure every delirium depending on debility (b). And, when, in confequence of the removal of the difeafe, arid of the re-produdion and eftablifhment-of the healthy ftate, enough of nourifhment is taken in and digefted, then it is that, at laft, the mental func- tions are completely and folidly re-eftabli-fhed. CLXXXIV, Thirft and heat, which are not left remarkable in afthenic, than fthenic difeafes, arife from the afthenic diathefis in the throat, and on the furface of the body. In the latter cafe, the perfpiration ; in the former, the excretion of the faliva, the exhalabte fluid, and the mucus, are checked by the atony and relaxation of the extreme veffels. In confequence of the former, the throat, not being fufficiently lubricaterj^ \ with a due quantity of its refpedive fluids, is fcorchecf with thirft. The effed of the latter is, that, the per* 1 ; fpirable fluid being detained under the cuticle, the heat, which in a free perfpiration ufually goes off into the air, and remains nearly of the fame degree, is ac-i cumulated and increafes. ^ But the increafe bf heat does not (b) This is an obfervation as new, and of as much importance as any in this whole work. Phyficians, hitherto, had no diftinet notion of a variety of inflammations ; and had fcarce any idea of any inflammation, but fuch a one as was to be treated with bleed- ing and evacuation ; nay, often, when they had no reafon to fufpett inflammation at all, the mete circumftance of pain was, in their cftimation of it, fufficient to warrant a profufion of bleeding without end. Bur, the truth is, that pain may not only ante from an inflammation, which they had no idea of, and which was to be cured by ftimulahts, but it arifts from fpafms, convulfion^ and even from emptinefs. Chap. VI.- OF MEDICINE. lBi. not depend on the ftate of excitement, or, as it is c6m- monly called, on the principle of life, fince it happens both in the fthenic diathefis, and, likewife, in indired, as well as dired, debility. But the weaknefs of the veflels on the furface of the body (under which the throat, and whatever part is acceflible to air, arc com- prehended) is a part of the debility of the heart and arteries ; the latter a part of that of the whole fyftem. CLXXXV. This aftheniG thirft, which is a much more frequent and more violent fymptom than the fthenic, is preceded by lofs of appetite ; the lofs of ap- petite is fueceeded by loathing of food, by ficknefs, vomiting, often by an acute pain of the ftomach, and other troublefome fymptoms; to the explanation of which we next proceed. CLXXXVI. Want of appetite, and loathing of food (c), depend upon debility of the whole body ; as is prqyed by the powers that produce them, always ading by debilitating; and by the remedies, which both prevent and cure them, always ading by a ftimu- lant and ftrengthening operation. Tire caufe of appetite: is (c) Thefe fymptoms of want of appetite, loathing of food, thirft, ficknefs at ftomach, vomiting, and acute pain of the ftomach, as well as thofe that follow to CXCV. and from that to CXCVIIL form a chain of fymptoms depending upon increafing debility, which, inftead of being different in kind, are all connected by an uniform operation of nature. And they furnifh an ihftructive in- ftance of the erroneous mode of judging of the nature of fymptoms, and morbid affections, which has been fo prevalent in all fyftems of phytic, 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 affec- tion : 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, ftimulant. The former powers may vaty in degree, but tbey are all debilitating ; and the latter may alfo act with different degrees of force, but they are all ftimulant. And the ftate of the fyftem, from which tbe former constitute a deviation, as well as that, to which the latter produce a return, is health, which is always the fame. l82 THE ELEMENTS Partll is a ftrong and found contradion of the fibres of the ftomach, by which digeftion is fupported (d), and the excretion of a fluid, as the gaftric liquor, and the faliva (e) : and to both effeds a certain emptinefs of the ftomach is neceffary. But none of thefe circumducts can take place in a ftate of debility. The fibres do not contrad with force ; the extreme veffels do not pour out their fluids ; the food, before taken in, is not dif- folved or digefted, and in that ftate thrown out of the ftomach ; but continues in a great meafure unchanged and undiffolved. Hence there is no appetite for food,' and (d) The fibres of the ftomach are mufcular, and partly long!- tudinal, partly oblique, or approaching to circular. When the food is taken in, the former are contracted and fhortened, by which they raife the under part of the ftomach, which is unfixt, upwards. Thefe gradually relax as the food, after its' firft digef- tion 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 diftending weight in the direction from above downward ; and, as the food in proportion to its converfion from a more folid to a more fluid form, is more and more collected into the under part of the cavi« ] ty of the ftomach, this gives a preffure in the lateral way, audi therefore, throws the other fibres into contraction, by which the J fides of the ftomach are fqueezed together, and, thereby, perfori j the office of throwing out, by the pylorus, the remaining part of the alimentary matter. Befides thefe fucceflive actions, the muf- I cular fubftance of the ftomach is fo conftructed as to be provided with fibres, the motion of which, when the ftomach is full, is up* ward and downward ; when empty, downward only. All thefe motions give the alimentary matter the mechanical agitation neceffary to promote its mixture. • (e) The gaftric fluid, poured into the cavity ef the ftomach, as well as the faliva that follows it from the palate, and the watery or other drink taken in by the mouth, contribute 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 mixture, takes place. This change is chiefly effected by the gaftric fluid, to which, perhaps, a certain relation that the other fluids bear to the alimentary matter in this living organ, contributes. Another means of promoting the folution that goes on in this procefs is the heat of the ftomach. Chap. VI. OF MEDICINE. 183 and in a higher degree of this affedion loathing takes place. •CLXXXVII. In the fame manner thirft has been explained (fee par. CLXXXIV.); and in the fame manner is ficknefs, which is a higher degree of affedion from the fame caufe, to be explained ; for when there is ftrength and vigour, fenfation is moft agreeable in every part of the fyftem, as wejl as in the ftomach and neighbouring parts. - CLXXXVIII. With refped to vomiting; it is the * moft confiderable of all thefe affedions : 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 collection of crude matters proceeded, and the dif- tenfion of the ftomach from thefe laft, and from extri- cated air, 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 in an oppofite diredion from the ftimulus. ; downward when the ftimulus proceeds from the mouth, and upwards when it comes from the ftomach ; hence the crudities and air ading as a local ftimulus, diced 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, ficknefs arifes; which when it continues foF any time, muft be violent, becaufe the local ftimulus roufes the mufcular fibres into violent and irregular motions. CLXXXIX. The caufe of pain in the ftomach and. inteftines, and other parts, both internal and external, under afthenic diathefis, is fpafm. Spafm in any internal cavity, that is, in the organs of involuntary motion, arifes from a relaxation and atony of the fibres, (in confequence of the debility common to the feat of the fpafm with the whole body) accompanied by a diftend- ing :34 THE ELEMENTS i art II. ing matter : this diftending matter in the ftomacfcis the fordes or foul crudities; in the inteftine?, hardened excrement; in both, air let loofe. The effed: here does not fo much depend upon the diftention as upqn the lax ftate of the diftended fibres ; 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 fpeaking, yield more and more, in proportion to the urgent force exerted on •hem,"till lofing all power of alternate motion, they continue immovably contraded. All which arifes from that property in mufcular fibres, by which, when they are ftretched1, they do not, like common elaftic matter, contrad only after the diftending power is removed, but even while it remains. In this ftate the fenfifctlt fibres undergo a certain violence ; and hence the pain (/). But, that more is to be attributed to their, own laxity, than the diftending matter, is proved by ftimur lants reftoring the tone and denfity, which are exadly in proportion to each other, as depending upon the fame caufe. After the application of ftimulants, thejj contrad ; and, re-ading like healthy fibres, without anv other afliftance, as has lately been afcertained, the* reftore the periftaltic motion, and drive downward be? rore them the matter, ftill remaining, and ftill continut ing to diftend them [g)„ In this way wine, aromatic^ and volatile alkali, and, above all the reft* the various forms (f) Pain arifes here from dimlnrflied action. Senfation, either agreeable or difagreeable, always follows any confiderable increafe or diminution of the irritative motions. Editor. (g) The prevailing notion with refpect fo this kind of affection has been, and ftill is, that its caufe is the matter here fpokenvofv 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 4 caufe. But 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. Chap* VI. OF MEDICINE. is* forms of opium, diflodge all fuch hurtful matter with- out either vomiting or purging, and without any difficulty, in a very fhort fpace of time. CXC. The pain, which is fo often felt in the exter- nal parts of the body, alfo depends upon fpafm, but without any diftending matter : for an effed of volition on the voluntary mufcles produces the fame effed ; fo that the fpafm is excited in the fame manner as by djftention, and often with the moft exquifite pain. Now as the effed is the fame, that is, fpafm arifing 'from debility, and as it may be removed by reftoring the ftrength ; the caufe alfo muft be the fame, and be reducible to debility, together with fomething that ads like diftention, and poffeffes a power equal to it. By . this way of reafoning (h) we may often fafely afcend from the contemplation of known effed to fhe unknown caufe. The pain we fpeak of at prefent, is that pro- duced by fpafm of the mufcles. CXCI. There is another pain, more diffufed, and equally troublefome, which is not fupported by dif- tention, but by another local ftimulus : this pain squally arifes from debility, has equal tendency to increafe the debility, and, by its debilitating operation, after having induced other fymptoms 'of debility, foon occafions death. This pain arifes from a ftrong acid, which is fometimes {b) A way of reafoning never made ufe of in medicine before, but which runs through, and influences moft of the propofitions in this wonc. It is further to be obferved, that, upon no occafion can we ever arrive at an adequate knowledge of abftract caufes; that the eagernefs of mankind to rufh into wild and fanciful ex' pianations of them, without any regard to real phenomena of na- ture.hasbeenthecaufeofall the falfe phenomena that ever appeared in the world, and that the only fure and faithful guide to the ftudy ot caufes is a cautious and painful inveftigation of the effects and phenomena of nature that proceed from them. See more upon this important fubject, and, indeed, a complete difcuffion of it, in jny book, entitled, "Obfervations on the old Syftemsof Phy- z 186 THE elements Part II. fometimes predominant in the alimentary canal, when under the influence of great debility, of which cholera is the chief inftance ; but all the affedions of the ali- mentary canal befides, that are accompanied with vomiting and a loofe belly, are more or lefs examples of it. CXCII. This acid is not the primary caufe of the dif- eafe ; it is only a fymptom arifing, after the complete eftablifhment of the difeafe, from the fame fource as the other fymptoms, viz. debility ; and it may be removed by the fame remedies. This acid increafes the debility both of the firft paffages and the reft of the body : but while it exerts that operation over the whole body, its chief influence is in the part where it exifts, and where it is moft urgent to leffen the violence of the difeafe. CXCIII. But, though it be itfelf, like fpafm, the offspring of debility, and tends to create further debili- ty ; ftill there is not, either for the fake of changing, or throwing it out of the body, occafion for any other indication of cure : For, as it has its rife from a general caufe, fo it all along depends upon that; and whatever lias the effed of overcoming the other fymptoms^ has alfo that of overcoming this. For this, as in the cafe of fpafm, ftimulants,—not emetics, not purgatives, or any other debilitating powers,—are required. CXCIV. As this acid produces pain in the internal parts, or in the organs of involuntary motion ; fo in the external parts, or organs of voluntary motion, pain is occafioned by fomething that produces the fame effed as the acid, and depends upon the will, and a&s in conjundion with the convulfive ftate; and, as in the fpafm of the voluntary mufcles, there is no matter that correfponds with the diftending matter fometimes lodged in the ftomach, fo in this there is none to cor- refpond 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 Chap.Sl. OR MEDICINE, 187. above all, by epilepfy. Finally, as in the former, the fame reafoning from known effed to unknown caufe proves the famenefs of the external and internal cafe,.it equally proves their famenefs in the latter (/). CXCV. The fimple courfe of the morbid affedion, from its flighted to its moft violent degree (to take a review of the fubjed from the place where we fet out), is this : it begins with lofs of appetite, and is brought on by want of food and of other ftimuli, or by an over proportion of ftimuli, and proceeds through all the in- termediate degrees to the 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 adrnjniftered, (fuch, fuppofe, as can be taken in the form of foup), a loath- ing of it follows. By-and-by, if nothing, is ufed to produce ftimulant effed, thirft will come on ; there will be the kecneft defire for that moft debilitating power, cold water, which will be preferred to the greateft dainties,, and will be greedily fwallowed (£), To this, ficknefs (/') All this reafoning with refpect to fpafm and convulfion* fhowing them to be the fame, and only a part in 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 alimentary canal, and almoft all thofe of children, all, indeed, but the contagious eruptive ones, are both explained) and their principle of cure afcertained, with geometrical exactnefs. Here, then, at once is a difcovery, upon fcientific principles, of the true nature, and certain cure, of more than one-half of the difeafes of the human race ; themethod of cure arifing from this doctrine having never*failed in any of them, and never fueceeded upon a contrary plan, the debilitating and evacuant, fo univerfally recommended by the 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. (i) When this afthenic thirft comes on, it is the higheft luxury in nature to be allowed a free indulgence in the ufe of cold water, which is always hurtful in proportion to the degree of its coldnefs. x8S THE ELEMENTS Part II. ficknefs immediately fucceeds, and very foon, vomiting, unlefs prevented by a diffufible ftimulus, fuch as a glafs of pure fpirit, or if one fails, a fecond, and perhaps, in fome cafes, a third. When the affedion nfes a little higher, during the vomiting a violent pain is felt in the ftomach, giving a fenfation as if there were a bar of iron in it, forcibly ftretching and tearing it acrofs (/). When the affedion becomes ftill more fevere, every fpecies of torture is undergone ; an head-ach comes on with a fenfe of ftrokes like thofe given by an hammer. Thefe violent fymptoms are communicated to the ali- mentary canal, for the moft part not immediately, but in confequence of the difeafe remaining, with the inter- vention of intervals of deceitful refpite. The belly is often affeded with very painful gripes, and is exceed- ingly loofe ; but, what will not be wondered at in an inverted ftate of the periftaltic motion, it is oftener conftipated, and, from time to time, undergoes all the viciffitudes of alternate vomiting and purging. Among' \ the troublefome fymptoms, that have been mentioned/ " are comprehended dyfpepfia, the gout, diarrhoea, dy- fentery, ; ,? (/) A lady, after nurfing her twelfth child for feven months-,^H was found by her hufband, a phyfician well acquainted with the -i new doctrine, very low fpirited one evening. She was of a deli- cate, thin, exhaufted habit, and had been fubject often before, to- wards the end of her periods of nurfing, to lofs of appetite, colic, dejection of fpirit, and as often cured by removing the child from her breaft, and putting her upon a rich ftimulant 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 this lady's lownefs of fpirits, that tears burft from her eyes upon hearing the fudden order for the weaning of the infant. The hufband 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 defcription above was taken. All this had been occafioned by her applying the child's mouth to her nipple. Ckdp.Xl. OF MEDICINE. 1S9 fentery, cholera (m), the colic («), the iliac paffion {0), the green purging of infants, the worms, that waft- ing (/») Or that difeafe, the urgent fymptoms of which are alternate vomiting and purging, the effect of which, while their caufe is a general weaknefs over all, but prevalent in the firft paffuges, is to increafe the weaknefs, from which they proceed to fuch a degree, as to hurry on the patient's death, viiih every fymptom of expiring debility, in the fhort fpace of fixteen hours. This happened in the warm countries, as the fouthern parts of Europe, and efpecially in the torrid zone, whether in Afia, Africa, or America. («) The colic has been commonly treated by purging and blteding, and low diet ; but in no inftance has that treatment of it been fuccefsfnl. Opiates were particularly forbidden upon the iuppofuion of their conftipating the"beily ; but the truth is, that the colic, as well as diarrhoea (which has been fuppofed a difeafe of an oppofite nature, from the feeming contrariety of loofenefs of the belly and cofti- enefs to each other), are the fame kind of af- fection, only differing in degree. And the colic is to be removed by no other means than thofe that remove the fimple loofenefs i that is by durable and diffufible ftimulants. (0) Which is that higher degreeof colic where vomiting comes on, and the perifialtic motion is fo inverted as to occafion the re- jection of ftercoraceous matter by the mouth. Sometimes in the progrefs of the fame difeafe,efpecially when treated only by evacua- tion and bleeding, a portion of gut isinfinuated into the cavity of the next portion. This is called in the art Volvulus, or Intus Sufceptio. The quick and effectual cure of colic before the fymp- toms of volvulus make their appearance, is a good proof that the latter is induced by the purgative medicines, employed to clear away the obftructing caufe, acting with fuch relaxing effect, and urgent violence, as 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 evacuant plan, therefore, is a. caufe of the violence of the difeafe in all its ftages ; and laftly, of the laft, which becomes a local and immoveable affection. Nothing could be more abfurd than the reafoning that has directed 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 contradiction of employing purg- ing in colic, which by the laft rule only applies to diarrhoea ; they have taken it into their head, that a good means of removing the obftructing matter in colic, was to throw in a large quantity of heavy fubltance with the intention of forcibly difplacing it; reafon- ing in that way not fo well as a foldier would do in clearing away any iq° THE elements Part II ing of the body called tabes, or atrophy (p)* both of them difeafes chiefly of children, and their moft frequent difeafes. CXCVI. As the caufe of the difeafe increafes ia violence, and the exciting noxious powers prove more urgent ; the external parts are drawn into confent, and now any foul matter from his fire-lock ; for it fhould have been remem, bered, that whatever effect fuch fubftances, as quick-filver, might have by their weight in pofhing downward any obftructing matter, they muft operate with a contrary effect, as often as in the convo- luted ftate of the inteftinal canal, the courfe of any portion was Bpward.. Neither did it ever ftrike them, upon any one occafion, what they fhould never have left out of view upon every occafion, that the idea of the action of dead matter upon dead matter, whether mechanical or-chemical, that is, perceptibly or impercerj. tibly mechanical, is never to be transferred, in found reafoning, to the mode of action of tbe fame dead matter on living matter j the excitement in no cafe whatever admitting of any fuch analogyAi (/>) Thefe two difeafes, according to a theory that has at all times prevailed in the fchools, and has pervaded all medical fyf- tems, are fuppofed to originate from an obftruction in the mefe^ teric glands, through, which the chyle, or alimentary matter, after undergoing a double preparation, 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 blocd ; and to remove it, ft^l upon the fame idea, as if all the cavities of the animal economy,, whether great or fmall, were to be cleanfed like the foldier's fire- lock, no limits were fet to the ufe of gentle aperients, and parti- cularly the ufe of mineral waters. And they ufed, gravely (" rifum teneatis amici!") to tell us, that with the help, of i courfe of time, fuppofe the arrival of the infant or child, at the feventh year of his age, that would carry off the difeafe by its detergent operation, provided the obftruction were not fo great as to induce death before the lapfe of that period. That all this is filly theory devoid of all foundation in truth, is proved by the completion of hundreds of cures in the fhorteft fpaces of time, by means of durable ftimuli, which act upon their delicate frame* with fuch efficacy as to fupercede, unlefs in the moft violent cafes, all ufe of the diffufible. This remark applies likewife to worm*, for the cure of which no bounds were fet to the ufe.of purgatives, upon the idea of clearing away the fluff in which thefe vermin reftled ; a practice not fo judicious as that of fome foolifh boys, who Chap. VI. 6F MEDICINE. I9I now the organs of voluntary motion are affeded. Some- times the legs, fometimes the arms, and other parts, differently upon different occafions, are tortured with cramps 1 fometimes the thorax all round ; fometimes the fhoulders, fometimes the fides, fometimes the back, fometimes the neck are affeded with pain, from which no part of the human body is exempted ; the region of the lungs, of the liver, and of the ftomach, are efpecially liable to them. The ftnart pains that affed thefe parts, and are fuppofed to proceed from internal inflammation, are, in reality, owing to fpafmodic or convulfive affedion \q). That this is their true origin is who place their fuccefs in bird-catching upon the chance of bring- ing 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, differ- ing 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 particu- larly in that of the periftaltic motion. This ftate implies a fimilar weaknefs in the veffels that pour their fluids into that cavity ; their weaknefs implies an enlargement of their diameters, and that enlargement an increafe of the quantity of fluids thrown in, with- out 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 faculent parts on the inteftines. The indication of cure is not to increafe either the general, or particular part of the caufe, by purging, and the ufe of other debilitating powers, but to ftrengthen the whole living fyftem ; and efpecially the inteftinal canal, by the whole round of ftimulant remedies diffufible or durable. To this treatment the tabes and atrophy will yield in a few days, or even hours ; the worms in as many weeks. And they are all increafed by the common plan of cure, as univerfal experience has proved to a demonftration. (y) Endlefs have been the bleedings and other evacuations em- ployed to remove thofe painful affections, and as difmal has been the effect of 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 diffufi- 192 THE ELEMENTS Part II. is proved by the application of ftimpli, which remove the affedions, often immediately, always in a fhort time, and reproduce the healthy ftate. It is proved by the unfuccefsfulnefs of the contrary method of cure, which confifts in bleeding, purging and abftinencc. Nay, what even makes more for the fame conclufion, is, that, while abftinence almoft alone is often fufficientto produce the pains, rich food alfo alone has proved fufficicnt to remove them (r). CXCVII The He ftimulus, particularly laudanum, to the pained parts. By that practice I know not one cure, of fome hundreds, that either I or my pupils have performed, that has failed. The gout will fome- times make its attack in this wrty. But whatever be the particular' force of difeafe, with which tjiey may feem to have any connection, the only diagnofis here neceffary is to be fure that the true- peripneumony is not the morbid ftate. When that is out of the quelfion, and whether the painful complaint be denominated baftard peripneumony or not, the only indication of cure is what has been ju'.t now mentioned. A young lady, with whom I am nearly and tenderly connected, has been often affected with an acute pain in her right fide, moftly fixed and folitary, fometimes accompanied with a certain numbnefs and fcnfelcffnefs in her ex- tremities commonly with lofs of appetite, and fome degree «f head-ach. The effectual method of cure is to apply rags dipped in laudanum, volatile alkali, or xthcr, 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 converted into an incurable afthenic difeafe, has alwaj^ proved infallible in removing the attacks, which never after return but when fhe has enfeebled herfelf by keeping the houfe too much, and neglecting air, exercife, and the ufe of the other diffufible ftimuli. Friction ufed over all the affected parts, is alfo found uftfdl in fupporting the ftimulant operation of all the other reme- dies. _ There is in the fens of Lincoln, where an eminent phyfician, and follower of this doctrine, practifes, a difeafe called a hatted peripneumony ; in which, though it had always baffled all the efforts of the common evacuant practice, he never loft a patient, by exercifing the contrary one. 4 (r) This I have often experienced in the cafe of the gou^i Before dinner, when my ftomach was empty, I have limped it. ■ going abroad to dinner. But after having made that meal hsartiiy. and taken a glafs or two of wine, I have returned with a perfectly firm ftep, and free from all feeling of pain and uneafinefs. Chap. VI. OF MEDICINE. l9Z CXCVII. The fame pains, fometimes combined with inordinate motion (s) fometimes without it (/), are abfolutely free from inflammation. To diftino-uifh them from the pains that flow from inflammation or a fimilar origin, the accompanying fymptoms muft be attended to. A fthenic diathefis indicates that what- ever pains occur are fthenic ; and we may gather from the afthenic diathefis that the pains appearing in it participate of its nature and are as certainly afthenic. This remark is of general application to difeafes of daily occurrence, and overturns the common pradice. Even head-ach, which is fo frequent an affedion, may ten times be removed by the ftimulant plan, for once that the contrary anfwers (»). CXCVIII. Symptoms of difturbance occur alfo in afthenic difeafes as well as in fthenic. Such a ftate of difturbance (x) takes place in the alimentary canal in the » (s) As in the convulfive kind fo lately fpoke of, where the enormity of motion is fometimes external, and in the organs of voluntary motion, fometimes internal, as in cholera and fo forth. (/) As in the fpafmodic pains, head-ach, pains in the legs and foles, where there is an inability to perform the due motion. (a) The true reafen for all this, and innumerable errors in the practice, 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 antiphlogiftic, as they did that of phlogiftic to the diathefis. By his reformation of the erroneous plan of cure that his contemporaries, the alexipharmics, had intro- duced, in the fmall-pox and the few other fthenic difeafes that ever occur, in all the reft of the general difeafes Dr. Sydenham's authority confirmed the error. He left alfo the meafles as he had found that difeafe, and all other general difeafes, which are much more in frequency than 97 out of the 100, or 97 to 3 of the fthenic. Great men had need to be cautious, as the leaft inad- vertency 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 fuperftrudure upon a falfe foundation, it is commonly to refine upon error ad infinitum. (x) All in the original from "Talem" in the laft line to "febri- bus" in the firft of the next page inclufive is erafed, as being an anticipation of a fubjact, that is to follow in the CC paragraph. 194 THE ELEMENTS Part II, the cafes of hyftcria, colic, dyfpepfy, and the gout. Tims in the alimentary canal, befides the pains, men- tioned above, a certain fenfe of burning, anguifh, con- tortion and direful torture, exhibit a fet of appearances, formidable in the higheft degree, both to the patient and byftanders, and which beget a fufpicion of their proceeding from inflammation. But that thefe affec- tions have nothing to do with inflammation, and that they depend upon a ftate of the part quite the reverfe, has been proved by the fuccefs of the ftimulant method of treatment in every inftance in which it has been tried (y). This is confirmed by the ufe of wine, opium, and (y) Till this doctrine appeared, it was impoflible to erafe from the minds of phyficians an impreffion that 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. I have more than once experienced the whole concourfe, here mentioned, and have always found them to yeld to the mod ftimulant method of cure, that I could contrive.- I once laboured under this modification of afthenic difeafe for do lefs than ten days, and was always able to overcome it in two hours, and procure an interval of complete eafe and relief for the reft of the day. The remedies employed were the whole round of diffufible ftimuli, as opiates in all their forms, camphor, mufk, volatile alkali, and aether, &c. By thefe the functions for the time were completely reftored. But their ftimulant effect was no fooner perfectly gone off, that is, after the interpolation of a long fleep, through the night, than the fymptoms returned with a violence little fliort of what it had been the day before. This wis proof pofitive, that their nature was afthenic, or confifting in de- bility ; fince they yielded to ftimulant remedies ; and that the debility was exquifitely great, fince it required fo high a degreeof ftimulant operation to remove it. While that is the undoubted fact, there is a nicety with refpect to proportion to be attended to in this cafe. It is a rule, that the degree of curative meant) whether in the cure of fthenic or afthenic difeafes, fhould be ac- commodated to the degree of the difeafed ftate or degree of the caufe. If too little of the curative means is employed a proper* tional part of the difeafe will remain : if too much, the difeafe will be more than removed, that is, another ftate which may be tnorbid 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' Chap. VI. OF MEDICINE. l95 and other diffufible ftimuli. Afterwards and along with them animal foups, then folid meat, the ufual way of living, and precautions againft debility, effedually rc- eftablifh the healthy ftate (2). This plan of cure provds to a demonftration, that thefe affedions are very foreign both to fthenic inflammation and every degree of fthenic diathefis ; and, as general fthenic inflammation o>es not appear to affed internal parts, this affords another argument againft inflammation being here the caufe (fee CLXXXII. and CLjKXXIII). . ♦ CXCIX. The afthenic pulmonary affediofr is ac- companied with fo intolerable a fixed pain, that no bounds (z) The rule here is, if indirect debility be the caufe, to begin with a high degree of ftimulant cure, and gradually reduce it to the ordinary degree that is fufiicient for the healthy ftate. And the caution is to be fure of this gradual reduction, otherwife the indirect debility will be liable to return the moment the effect of the ftimuli is gone off. By an attention of this kind a difeafe de- pending 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. Ijor example, if the indirect debility be in the table the effect of an application of 71 degrees of exciting power inftead of40, that is to fay, the excite- ment is worn down to 9 inftead of being up at 40 ; it is evident, that an application of 71 degrees bv^way of Remedies, will leave the difeafe where it was. Suppofe only 6f degrees of ftimulant power adminiftered ; the excitement will fall to 65, 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 flill lefs will reduce the morbid excitement to 55, and raife the excitability to 25! And fo on may the matter go, till the ex- citability is raifed to 40 and the excitement reduced to the fame number. But» if the reduction be much lefs by the day, the cure will be proportionally flower. Nay, fuch an error may be com- mitted as to increafe the difeafe inftead of reducing it, which will happen, as often as a degr/e of ftimulant power is applied, which is more than equivalent to that which produced the difeafe. All this attention and caution is neceffary 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 propor- tion and often repeated, till the difeafe is removed, unlefs, which may happen, you can guefs the proportion, which may fufficc t« remove the difeafe at once, or at Leaft, twice. 196 THE ELEMENTS PartII. Iiounds have been fet to bleedings for the cure of it. But they have not only been ufelefs, but detrimental, and often fatal; whereas, on the contrary, the ftimulant plan of cure has always fueceeded (a). In this affedion the refpiration is interrupted, and nearly all the fymp- toms that accompany an adual peripneumony, diftrefs the patient to fuch a degree as to give rife to the fuf- picion, or rather to eftablifh a firm perfuafion, of the . prefence of inflammation. Or if any difference was obferved betwixt this affedion and that fpecies of phlegrriafia. the obfervation only fuggefted a futile dif- tindion,-and a queftion concerning the feat of the inflammation. The opinion that inflammation is the caufe of thefe fymptoms ftill fubfifted. But that the difeafe depends on pure debility, is abundantly evident from the arguments already adduced. It is increafed by the antiphlogiftic, and removed by the ftimulant plan of cure. < CC. The following formidable fymptom?, which moft medical writers have imputed either 1, to irrita- tion, as typhomania and the ftarting of the tendons; or 2, to plethora alone ; or 3, to plethora joined to mobility ; are manifeftly owing to debility (b), the common (a) A young lady afflicted with thefe fymptoms was in the courfe of a month bled thirty times, always with a temporary relief, but with a return of the difeafe more violent than ever. bhe was then put upon a ftimulant plan, and in lefs than a month reftored to her perfect health. This was among the moft early cures taken from this doctrine. (b) No difeafes are more oppofite to each other than high fthenic difeafes, fuch as the common inflammatory fever, or peripneumony, and proper fevers ; the former, in the^table, Hand- ing at the head of the fcale of increafed excitement, and the latter at the bottom of the fcale of diminiftied excitement. And the fame method for the cure of both has been purfued, to wit, the evacuant, debilitating. If, in peripneumony, large quantities of blood were taken at a time, the difference has been made up in the cure of fevers by repeating it the oftener j while all the other evacuations Chap. VI. OF MEDICINE. 197 common caufe of afthenic affedions : theier are ftupor in apoplexy, in epilepfy and in fever ; the falfe wake- fulnefs, called typhomania, ftarting of the tendons, and coma, in .fever ; convulfion and diminution of the voluntary motions in epilepfy and apoplexy. This appears from the debilitating noxious powers, whether ading diredly or indiredly, alone producing thefe dif- eafes ; and from the ftimulant remedies alone, relieving or removing them. It is in vain to impute apoplexy to plethora ; as if at a period, when the body is nearly worn out and almoft bloodlel's, when the ufual degree of aliment is neither defiretl, 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 from indirect debility, induced by old age or exceffive incitement, the folids are languid, the quantity of fluids deficient, as is alfo their fountain, the blood. Epilepfy depends likewife upon debility, and the fame fcantinefs of fluids, only here the debility is commonly of the dired kind. Fevers may arife from indired debility, as in the confluent fmall-pox (c), or evacuations were carried on with the fame profufirn in both. When they talked of the refpeaive caufes of thofe difeafes, phlo- giftic diathefis was the word for the high fthenic difeafes, and irritation for the high afihenic. But thefe were words only, while in fact the method 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, and that too, notwithGand- ing 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 regimen. It was all anti- phlogiftic to ufe their own language ; and, whatever other language they held, the nature of the difeafe, if we are to judge from their treatment, was phlogiftic. (c) The confluent fmall-pox, as depending upon 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 appel- lations given by phyficians, or by any of their erroneous diftinaions, but by drift regard to the degree of excitement. And for the fame I98 THE ELEMENTS ran Li. or where drunknefs has been the principal exciting noxious power applied ; but at the fame time, the moft frequent caufe of fever is dired debility. And in all thefe cafes, debility is the primary caufe and final ter- mination both of the violent fymptoms and the others. CCI. Among the fymptoms of difturbance fome- times alfo appear thofe affedions of the head ; great head-ach in fevers, imbecility of intelled, confufion of thought, and delirium often fufficiently furious, though occurring in the higheft degree of debility, and leading to efforts beyond the ftrength. This ftate often hap- pens towards the end of typhus even when malignant. Inflammation is apprehended, blood is let diredly from the head, blifters, which feive for extreme undion in the art of medicine, are clapped on, filence and darknefs are prefcribed, even the moft gentle ftimulants are for- bidden. In confequence of the emptinefs of the ftomach, as well as of the veffels of the whole body, and of the great degree of languor from the want of many ftimuli, vertigo is fuperadded to delirium, and the patient, deprived of ftrength, {cixCq and intelled, breathes out his laft. CCII. But in this cafe there is either no inflarama-< tion, 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 firft ftimulates, and afterwards fills the veffels, afford certain proof: And that it is not any other fpecies of inflammation is evin- ced by the fudden reftitution of health. Now, as an impaired ufe, or confufion of the intelledual faculty is, in a certain degree, always the confequence of debility, whether arifing from any other fource, or from empti- nefs fame reafon is the violent cholera marked nearly in the fame place ; becaufe the debility, taking place in it, is nearly equal in degree to the moft finking febrile debility ; in a word, becaufe the fame degree of debilitating power produces, and the fame degree of ftimulant operation removes, the difeafes fo afforted. VJtap* VI. OP MEDICINE, I99 nefs of the veffels, and that too even in perfons, who are otherwife healthy ; where is the wonder, if, in the higheft degree of inanition, compatible with life, in the greateft diminution of excitement, where fcarcely a fhadow of life is left, the higheft degree of failure in the intelledual fundion, that is, delirium, among other inftances of impaired fundion, fhould alfo take place ? Nay this very tad is indubitably certain. For faffing, drinking water contrary to cuftom, after a courle of hard drinking, or both eating and drinking to intem- perance, a gloomy ftate of mind, grief, terror, defpair, not only induce temporary delirium, but frequently bring on downright madnefs. The fame conclufion applies to any confiderable lofs of blood. For how many wounded perfons, have not at all, or not till a long time afterwards, recovered the ufe of their fenfes. To fay nothing of contufions and other injuries, by which the texture of the brain is injured, as belonging to local difeafes, of which we are to treat afterwards ; how does cold prove fatal ? Does not a delirium, in this cafe accompanied with a diminution of all the fundions, precede death r From thefe weighty, numer- ous and authentic fads, which include all the powers, it follows that head-ach, every degree of failure of the intelled, and that higheft degree of delirium, by no means depend upon general fthenic inflammation, the only inflammation hitherto diftinguifhed ; but that they arife from the higheft deficiency, both of other ftimuli, and of a proper fulnefs in the veffels, that is from debility. Debility then is the moft frequent caufe of thefe fymptoms, as is proved by the quick re- ftoration of health upon the new plan of cure. CCIII. But if ever the afthenic inflammation, men- tioned (fee CLXXI. and CCII.) before, excites the tumult of fymptoms, which are our prefent fubjed ; it produces that effed in the fame manner precifely, that debility produces it, by means' of a penury of blood and deficiency of other ftimuli. For, CCIV. The 200 THE ELEMENTS Part II. CCIV. The general afthenic inflammation is but afthenic diathefis, more violent in fome one part than in any other equal part (fee XLIX). The degree of afthenic diathefis conftituting the inflammation is however by no means to be compared with the degree of diacheiis in all the reft of the fyftem ; becaufe the whole affedion diffufed over the whole body is far more coiifideiable than that confined to a part (fee XLVIII. XLIX. L. LI). CCV. Inflammation, in this cafe, is only a ftate of the inflamed part, of the fame kind with that of all the reft of the body. And, as the inflammation is confti- tuicd by a lels excitement in fome one part, than in any other, equal part ; fo, before the eftablifhment of the difeafe (d), of which the inflammation is a part, a fymptom, or fequel, the excitement of that part is underftood to be proportionally lower, than that of any < ther part. CCVI. This fhould be diftinsruifhed from local in- flatmuation : it is general, and depends upon a general diathefis, and only takes place when the diathefis has attained to a certain degree Awhile local inflammation arifes from fome noxious power, that produces a folution or vitiation of the texture of the part, without regard either to diathefis or degree : The general inflammation is (d) See above, par. CLXIX. 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 affeded than any other, that is, are either more excited, as in (thenic inflammation, or lefs, as in afthenic, than any other, keep up the fame proportion of difparity before the arrival of the difeafe, before the appearance of any of the fymp- toms, and while, as yet, nothing but mere predifpofition has taken place. The truth of this propofition is eftablifhed by that of another fo eomprehenfive as to extend to the whole fubject of life; which is, that over the whole living creation, throughout the univerfe, health, predifpofition to difeafe, and difeafe itfelf, are the fame ftate,only differing in degree, (vide par. XXIII. and LXV.) Health, therefore, is alfo comprehended under this fame pronoft- tion. * k Chap. VI. OF MEDICINE. 201 is brought on by the fame noxious 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 inflam- mation depends upon noxious powers, that only injure a part, and it is removed by remedies that change the ftate of the part ; but is not affeded either by general noxious powers, or general remedies. Thofe inflam- mations, which accompany the gout, the putrid fore throat, the gangrenous fore throat, and fore eyes are examples of univerfal inflammation : Local inflamma- tion will be illuftrated by examples in its proper place (e) : General inflammation is attended by debility over the whole fyftem ; which debility is only a fequel of the local, and that not always. To remove the former the general method of cure (fee LXXXVII1.) is adapt- ed ; but the cure of the latter turns upon healing up the part. Thus there are four forts of inflammation ; two univerfal, a fthenic, and an afthenic ; and two local, one of which is fthenic, and the other afthenic. The former often ends in fuppuration, but is often difperfed without fuppuration ; the latter in gan- grene, fometimes in fphacelus, fometimes in death. If, at the end of typhus (/) inflammation affeds the brain (?) As in the inflammation, that is produced by a wounding inftrument, when a perfon, previous toj fuch an accident, is in health, and continues to be fo after the accident. Or it may ftill be local, thougli a perfon is in bad heahh when it happens, but fo, however, as that the general ftate 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. {f) 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 diminiftied excite- ment. Phyfcians have conftantly confounded the different de- grees of this difeafe with fthenic ones, affeaing the pulfe. Bttt^J* they are diametrically oppofite, as fhall be pointed out when we come to the proper place for fuch diftiactions. 202 THE ELEMENTS Part II. brain or its membranes, which (g) is, however, not proved, or very likely, this will ferve for an inftance of an afthenic general inflammation. CCVII. As general fthenic inflammation is occafion- ed by a quantity of blood, ftimulating the veffels by diftention; by ftimulating, increafing their excitement; by increafe of excitement, producing more forcible and more frequent contradions ; by thefe, increafing the tone of the fibres as living, and their denfity as fimple folids, and thereby diminifhing their diameters ; and, confequently, caufing the blood to flow with great effort through the contraded veffels, and to produce pain from the force of the contradions and the narrownefs of the fpace through which it has to pafs ; and as the fame, though in a lefs 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 effeds in the inflamed portion as in the fthenic inflammation ; and, notwithstanding the penury (g) Though ftrongly afferted. A profeffor in his lectures gives a cafe of a typhus fever, where, upon account of delirium and fothe ether fymptoms, thought to announce an inflammation ii> or near the brain, the patient was fo freely bleeded, that the ftate of the pulfe (which is faid to have been, in his words, " a pulfus vacivus "if ever there was fuch a pulfe/') forbid any further bleeding. The patient was given up, and the extraordinary phyficians with- drew, leaving the ordinary one of the family, only, about him. This gentleman, from fome impreffion on his mind, began ta think, that another bleeding might be tried with advantage. He bled him, and the patient recovered. This is an account 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 2 feeming expiring debility, the higheft. degree of afthenic diathefis, there may be an univerfal fthenic debility, that requires bleeding. I have mentioned it, not for the fake of information, but of caution to the reader. Any perfon may fee the frivolity and lighmefs of the theories of our profeffion, but it requires knowledge ana difcernraeat to guard againft the feductioit of fo#s. Chap.Vl. OF MEDICINE. 20i penury of blood in every part of the vafcular fyftem befides, flowing abundantly, into the inflamed veffels, upon account of a greater atony and laxity in them, diftending them and producing the phenomena peculiar to all inflammations (h). CCIX. As the indication of cure for the former is, to diminifh the quantity of blood, which is tjhe firft caufe of the violent exertion, and, thereby, to reduce the exceffive excitement to the healthy degree, and the exceffive contradions, which conftitute the exertion, to fuch moderate contradions, as are pleafant and agreea- ble to health : So CCX. The indication of cure for the latter is, firft, by powerful ftimuli to propel the blood in every part of the fyftem, that the portion which loiters in the languid veffels of the inflamed part, may be alfo pro- pelled, and the veffels relieved of their burthen ; and then by the gradual adminiftration of feafoned animal food, in the form of foups, and, when the ftrength is recruited, in a folid form, to replenifh the whole fyftem of veffels. CCXI. The local inflammation*will be treated of afterwards, each in its proper place. k CCXII. That inflammation of the throat, which ends in what they call a putrid (/") fore throat, is Angu- larly (k) Thefe definitions apply to all the four inflammations (par. CCVI.) with refpea 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 general inflammation, it is the fthenic, and in this, the afthenic diathefis, that are conjoined with the inflam- . matory ftate. Further, as their caufe is influenced by thefe , general circumftances, fo alfo 4s their cure ; the fthenic and afthenic general inflammations requiring the remedies of the dia- thefis to which they refpeaively belong, and the local only the remedies fuited to heal up the part. (i) The difeafe, here mentioned, is neither defcribed, nor, feem- ingly, underftood, in medical books and leflures. In this work it m taken, as every thine elfe is, from nature, at the bed-fide of the fick, 204 THE. ELEMENTS Part II. larly infidious. During the firft days it differs little in its appearance from the fthenic fore throat. The general fymptoms are alfo fimilar. The pulfe fcarce exceeds the meafure of the fthenic pulfe in its frequency and other charaderiftics. For fome time the whole difeafe proceeds with gentlenefs and tranquillity, except- ing that a conftant rejedion by fpitting of a tough mucous matter is troublefome. At laft, it it is not counteraded by the moft powerful ftimuli, a period arrives, when all the fymptoms fuddenly become alarm- ing 5 when the pulfe becomes very quick, very weak, and remarkably fmall ; when the ftrength, over the whole fyftem, finks ; and now it is not a moderate portion of diffufible ftimulus that will prevent the lamentable fate of the greateft ornament of human nature (k). The beft plan of cure is to prevent the mortal period by employing the moft powerful ftimuli. CCXIII. The diffufible ftimuli are fo powerful in removing the inflammation of the gout, that, fometimes, ftrong liquors, as wine, and fpirits, or fpirits 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 affeded foot. The fame remedies are of equal efficacy in removing the general fymptoms (/). CCXIV. The, fick, and deferves fo much the more attention, that, though it is a difeafe of the utmoft malignity, it feems to have been altogether overlooked. Its appearances are mild at firft, but, without both fkill and attention, it will end fatally. (k) All this refers to a lady in Scotland, of Angular worth and amiability, who died, but not in confequence of the plan of cure, which this doarine enjoins, having been followed ; efpecially at the period of the difeafe when it was moft wanted- (/) 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. From. hard walking in very hot weather to infpea the beauties and' majefty Qf Hampton Court, I have myfelf very lately had a flight fit of the gout ; but it gave me no fort of trouble, never hindered; me from bufinefs, and I repelled it in lefs than thirty-fix hours. I never Chap. VI. OF MEDICINE. 205 CCXIV. The inflammation in the gangrenous fore throat is not, according to the common opinion, a primary affedion ; 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 an high degree. This inflammation has nothing in common with the fthenic general inflammation, which diftinguifhes the fthenic inflammatory fore throat (m), or with the two local inflammations. CCXV. The crowded puftules, in the fmall-pox, when it is converted into the confluent kind, that is, into an afthenic general difeafe, become partakers of the new diathefis, and, inftead of fthenic, which was their firft 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 feventeen years. I was difmiffed, without having my direaions complied with ; and without being allowed to accommodate the remedies to his praaice of purging and throwing up injeaions, fo as to endeavour, at leaft, to prevent or mitigate their hurtful effea. For, it muft be obferved here, that, as every direaly debilitating power is an exciting hurtful means of bringing on any afthenic difeafe, fo the effea of every evacuation, 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 cathart- ic, will bring a fit of the gout on me at any time. {m) Yec in their fyftems of nofology, which are laboured volumes of diftinaions without differences, begun, within this half century, to be fuperadded to the former modes of fyftematiz- ing ; which, without this new one, 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, the vaft fabric of error, and particularly in the laft of thefe, that publiflied in Edinburgh, the putrid (ore throat, as defcribed above (CCXII.) was left out, and the gangrenous, which is that juft now alluded to in the text, conjoined with the common fthenic fore throat, though diametrically in its nature oppofite to it. io 6 THE ELEMENTS Par.t II. firft ftate, become afthenic ; and, as by their local ftimulus, they before quickly changed the fthenic into the afthenic diathefis, by inducing indired debility;' fo now, by the debilitating influence of their afthenic nature, they eftablifh afthenia, or a ftate of debility over the whole fyftem, which they afterwards aggravate, till death often enfues (»). CCXVI. To throw light upon thefe two fpecies of fmall-pox, by comparing their refpedive methods of cure, it may be'obferved, that the treatment in the one cafe fhould be quite different from that in the other (0). The remedies'of the diftind fmall-pox, and of its ac- companying eruption, are cold and whatever, by evacuation or otherwife, debilitates. The remedies of the confluent kind, as well as of its accompanying erup- tion, are heat, fliort of the indiredly debilitating degree; and all the powers, which ftimulate as quickly, and as powerfully as poffible, and, confequently, the moft dif- fufible. CCXVII. They differ befides in this, that all the hurtful powers in the diftind kind are fthenic > all in the («) There cannot be a more exquifite ftimulus in livmg nature, than that univerfal cake of inflamed puftules, which covers the whole furface in the confluent fmall-pox. It is no wonder then", that, when it is fuperadded to the ordinary ftimulant hurtful powers, to which this difeafe firft owes its violence, and afterwards that very eruption ; the united effea of both fhould foon pafs the whole range of exceffive ftimulus, and quickly run into the ftate of indirea debility (fee par. CC.) Such is the nature and pro- grefs of the fmall-pox, in pafling from the fthenic into the afthenic ftate, that is, from one difeafe into another of a moft oppofite nature. («) The cure of the diftba fmall-pox is the debilitating ; |hat of the confluent, the ftimulant plan. The caufe of the former'is fthenic diathefis, that of the latter the afthznic, occafioned by in- direa debility ; which is a diftinaion unattended to in general, and with very bad effea upon the pradice. For, when the con- fluent fmall-pox is eflablifhed, the puftules flat, and figns of mortification coming on, the covering the patient with a fingl* flieet is as common as in the diftina fmall-pox. Chap. VI. 0? MEDICINE. 207 the confluent afthenic. • And this diftindion equally applies.to both difeafes, and"both eruptions.- CCXVIII. And as the fthenic or diftind puftules have a direct tendency to produce a fthenic inflamma- tion, and kindly fuppuration ; fo the tendency of the afthenic or confluent, is as diredly to gangrene, fpha- celus, and death. CCXIX. The boils, carbuncles, and buboes, which often accompany the plague, and fometimes typhus, arife from a contagious matter, taken into the body, and detained with the perfpiratory fluid, ui der the cuticle, and in the glands. The caufe 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. ^ This appears from feveral circumftances : 1. there is no eruption during the period of predifpo- fition, when fome vigour ftill remains, and, therefore, the perfpiration goes on in a certain degree ; 2. there is none in cafes of fudden death from the violence of the difeafe ; 3. no eruption or difeafe in all the cafes, where thefe are early prevented by* the ufe of the more powerful ftimulants ; 4. the difeafe is always mild, and the eruption always fparing, in proportion to the proper management of the ftimulant plan of cure. For, whether the fuppreffion of perfpiration be the confe- quence of a very great degree of the fthenic diathefis, or of an equal degree of the afthenic as in the prefent cafe ; all the foreign matter, that fhould be thrown out of the fyften\ along with the perfpirable matter, is, together with it, detained ; and when fo detained below fhe cuticle, by ftagnating, and acquiring a more acrid nature, it produces local inflammation, either of a fthenic or afthenic nature, in proportion to the different nature of each, or rather of the habit. ^ CCXX. In the fame manner is that eruption which diverfifics the fkin in the gangrenous fore throat to be explained ; 208 THE ELEMENTS Part 11, explained ; as well as another, which fupervenes in that ftate of tU fmall-pox, which by reafon of the .debility of the fyftem, would otherwife turn out well ; but which, if the new eruption be not oppofed by the moft powerful ftimuli, is fure to end in death. Both thefe eruptions (p) are fpotted, both red ; one is marked by imaller, the other by larger fpots ; in this the colour is a fine fcarlet, far exceeding all art, and almoft the power of nature herfelf to produce in any other circum- ftances. Both are owing to afuppreffion of the perfpi- ration by debility : the former is removed by the ftimulant plan of cure, which removes all the other fymptoms ; in the uncommon eruption, the debility produced in the preparation, to render the fmall-pox mild, muft be oppofed, as foon as the eruption appears, and the ftrength muft be reftored by the ufe of the moft diffufible ftimuli : The puftules, which are few, do not even attain to the meafure of adual genera! difeafe, and are, therefore, unattended with danger, and not to be regarded. If this pradice is followed, the recovery is both certain and quick ; but, if it bejieg- leded, or if a contrary plan of cure be adopted, death '. is inevitable [q). CCXXI. Heat' ■; (/>) A young child of mine, who had been long weakly, and often, in confequence of that, fnatched from the jaws of death by being properly fupported, according to the principles of the new doarine, had been prepared to receive the*fmall-pox, and inocu- lated. 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 appearance of the eruption de£~ ( cribed in the text. (?) It is certain, that the fafe condua of the fmall-poi depend* upon debilitating the habit which is to receive the infeaion ; and it is as little doubtful that we may carry that operation a great" way, by lowering the diet, purging the belly, and applying intenfe cold to the furface, and, by all means, guarding againft all alter- nation with heat. By thfe means the phlogiftic diathefis, chiefly arifing from the ordinary powers, and in part, as it would feem, from the contagious master, is prevented or removed ; the great Chap, VI. OF MEDICINE.' 209 CCXXI. Heat is not peculiar to fthenic pyrexiae (r), but belongs alfo to other fthenic difeafes. Nor is it fo confined to the difeafes, as not alfo to arife in all the degrees of predifpofition in proportion to the degree (j). Nor is this all. Heat alfo attends.all afthenic difeafes* whether febrile, which is a diftindion without any good meaning, or not febrile, and alfo the predifpofitions to them 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 fuppreffes perfpiration, fure- ly the procefs pufhed near to that degree muft endanger that event. This phenomenon happening to my child, folved the doubt that I had not yet decided, and it teemed to be in perfea con- formity to the principles of this doarine, 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 pre- paratory management, for the better regulating this difeafe, had been carried too far. A furgeon happened to be by when the child wa*s under examination ; I afked him if he had ever feen fuch a cafe, for I had neither feen, nor heard, nor read, 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 praaice they had been following. On the contrary, I ordered the child fpirit and water, and a little of an opiate, then reftored the meals that had been taken from him, and brought him about to his perfea health (for the fmall-pox gave no trouble) in twelve or fixteen hours. (r) Pyrexia is the word fpr fthenic difeafes affeaing the pulfe, called febrile, or fevers, very improperly, while the term fever is referved for the high afthenic difeafes that have been confounded with the pyrexiae. - (/) That heat tak#s place in predifpofition, is a matter of daily obfervation. Thus, when a perfon has no other fymptom of dif- eafe, it is often remarked, fometimes by himfelf, fometimes by•' .another, who may have happened to feel his hands, 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 confidently with health, it is a fure prelude of difeafe, that is, a fure mark of a confiderable predifpofition to difeafe : and the kind of difeafe, of which it is the harbinger, is pftenerafthenic than fthenic. C2 2IO THE-ELEMENTS Pa} t\l them all, in proportion to the degree of debility. There , is not a more certain mark of the decline of a difeafe, whether fthenic or afthenic, than a return of that temperature, which is commonly called cool, to dif- tinguifh it from morbid heat. CCXXII. The heat is then only natural, when neither diathefis is prefent. From that point it in- creafes, through all the degrees of increafed excitement, till rndired debility, from excefs of ftimulus, is eftab- lifhed ; and it increafes in proportion to the degree of excitement, rendering the perfpiratory veffels always lefs and lefs patulous. It alfo increafes through all the degrees of diminiihed excitement to a certain boundary, which is.fixed by a caufe by-and-by to be explained ; it increafes in proportion to the degree of decreasing excitement, though the latter all along renders the perfpiratory veflels more petulous; and, thereby,among other effects, diminifhes the motion of all the veffels, and particularly of the perfpiratory. CCXXIII. When the heat has attained its higheft dagree, and the debility has increafed in proportion, it is at length in the extremities, and then gradually in the reft of the hody, fueceeded by cold. This is a bad fign. In the progrefs of debility motion begins to be very languid, firft in the fmall veffels at the extremities of the limbs, and then in cafes altogether. Hence, as animal heat, whether in due proportion, or in excefs, depends upon the due, or to a certain degree deficient or exceffive, motion of the blood and other fluids, the heat of the body, in the prefent cafe, almoft entirely difappears ; that is, the effed, according to an univerfal law of nature, fubfides along with the caufe. The fame thing happens in both extremes of excitability, that is, of exceffive abundance in dired, and of great exhauftion in indired debility ; for, whatever be its lource, debili- ty is always the fame. CCXXIV. As in fthenic difeafes the excitement is for the moft part much and equally increafed over the whole Chap.yi. 0? MEDICINE. Zlt whole body ;. the heat is alfo equally diffufed. To this, the only exceptions are, i. where the violence of the difeafe produces indired debility in certain parts, as in the ftomach^ in which ficknefs indicates the near approach of that ftate ; or 2. where dired debility comes on from the debilitating plan of cure having been pulhed too far. But, fo long as-the fthenic dia- thefis prevails, and fupports a high excitement, that heat will almoft always be equal. P^^V. The fame thing happens in moderate de- bility. Accordingly, through the whole courfe of predifpofition, and in all cafes fhort of almoft a total ceffation of motion< the heat is pretty equal. The effed of ceffation of motion has been explained. But, before that happens, if any inequality of heat occurs in difeafes of moderate debility,, as is frequently the cafe in" the hands and feet;. the reafon is,.that a greater degree of debility has been induced upon thofe parts, than upon .others ; by cold, for inftance, labour, or fweating, any way excited, efpecially when the fweat has been cold and clammy. Not only in the gout* but alfo in other affedions both of dired and indired debility, a burning heat, chiefly diftreffing to the foles of the feet, torments the patient, efpecially in walking.. That. this arifes from debility, checking perfpiration,.. is. proved by fatigue, cold, and other debilitating powers proving hurtful to it ; and heat, reft, and other ftimulant powers, giving eafe. CCXXVI, It remains now to explain, how too great - excitement, in high fthenic difeafes, impairs fome funcr tions without a debilitating operation ; and how too fmall an excitement, in violent afthenic difeafes, feems to increafe fome fundions, though the appearance is always fallacious. CCXXVJJ^ If, in peripneumony, fynocha, and vio- lent rheumatifm, the voluntary motions are impaired to fuch a degree, that a perfon can ufe neither his hands nor his feet, any more than a paralytic perfon ; this 212 THE ELEMENTS ^ Part 11. this is not owing to debility, or diminiihed excitement, whether diredly or indiredly (/), as is evident from this double proof; i. if the apparent debility were real, ftimulants would be of fervice, and 2. debilitating remedies of differvice (»). But the reverfe is# the truth. For the fame debilitating powers, which cure the other fymptoms of confeffed exceffive excitement, alfo re- move this indifpofition to the performance of motion ; and the contrary powers increafe the affedion. CCXXVIII. Again, (if) When the excitement is at 40 all the funaions are perform- ed in the beft and completeft manner. Above that there is more force through all the fteps of predifpofition, but with lefs durabili- ty and fteadinefs; which is exemplified by the comparifon of hard labourers, who at the fame jime are well fupported, and gentle- men, who live well, without ufing a proportional degree of labour or exercife to prevent a luxuriant ftate of vigour. When two fuch perfons are fubjeaed to a comparative trial of their vigour in any exertion, the former will be found to go through the exer- tion with more fteadinefs, and to hold out longer and better than the other ; even though his ft/ft efforts may have been inferior in force to thofe of his antagonift. And the reafon is evident ; a moderate and proper degree of vigour, will bear an addition of ftimulant operation longer than a-higher degree of it approaching to morbid ftate ; becaufe the diftance of the excitement from in- direa debility, which puts an end to excitement, is greater in the former than in the latter cafe. The difference in the well-fupport- ed labourer is 30 before he can reach an increafe 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 run into the extreme of a ceffation of excitement. The effea of the exer- tion in the labourer will be to carry him foon up, by its ftimulant 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 effea of firil mounting up to 60, and by and by to 70, where the excite- ment begins to teafe. (a) Who would adminifter, 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 ? Ox rather who would think of any other means of removing that fymptom, than the debilitating powers, fo effec- tual in removing all the reft, and net lefs fo in removing it ? Chap.VL OF MEDICINE. 213 CCXXVIII. Again, in fpafms and ccnvulfions, either of the involuntary motions in the internal parts, as-in dyfpepfia, in colic, in dyfeptery, in cholera, in hyfteria, in violent vomiting or diarrhoea, (great num- bers of which affedions happen every day, without being diftinguifhed by names) ; or in the burning affedion of the alimentary canal, which is confidered by phyfi- cians as an inflammatory affedion ; or in affections of the voluntary motions externally, as in the lock-jaw, in tetanus (x), and in many fpafms of other parts ; or in convulfion, epilepfy, and many other fimilar affec- tions ; (.v) Tetanus is a violent fpafmodic motion of the mufcles of the, head, neck, and upper part of the thorax, whereby the head is kept immoveably in the fame pofition, in which it had been found upon the coming on of the fpafm. The teeth alfo, from the af- feaion occupying the mufcles of the under jaw, are kept immove- ably locked, and hence the name of lockjaw. Befides the ^affeaion of the mufcles, that has been mentioned, there is fcarce one mufcle in the whole body, free from one degree or other of .the affeaioh. Further, there is a moft painful feeling over all, but efpecially in the parts moft affeaed. This difeafe fometimes .happens in cold countries, fuch,as this, in confequerce of a wound in any fenfible part, or when fmall bones, as the offa fpongiofa, are bruifed, crafiied and dafhed into the fofter parts. The part of it called lock-jaw is frequently a fymptom in fevers. But the difeaie is more frequent in warmer countries than this, as in the fouth of Europe, where the excefs of heat is liable to run into in- direa debility. It is moft frequent of all in the torrid zone, where indirea debility is the moft conftant attendant on heat. As a violent««nd permanent contraaion of the mufcles was the moft ftriking fymptom of it, and fyftematic phyficians fuppofed every fuch contraaion the effea of an increafe of excitement, or, to ufe their own words, an increafed influx of the nervous fluid or nervous power into the parts affeaed ; confequently their indication of cure was to relax the rigid contraaed parts. Hence no bounds were fet to their emollient relaxing meafures. Such were bleed- ing, other evacuations, and warm bathing. But experience foon taught, that all thefe increafed, inftead of removing the difeafe. Of late opium, becaufe it was thought a fedative, was tried. The trial fueceeded. But immenfe quantities cf~ that medicine were found neceffary to effea the complete cure. Laudanum ufed to be thrown in without meafure, or any other rule, but to give it on till the difeafe ceafed. 214 THE ELEMENTS Part IL tions; if the fundions feem very much increafed, this is not. owing to increafe of ftrength, that is, to increafe of excitement, as will appear to any unprejudiced judge from the following two-fold confederation ; i. if this were a cafe of really increafed ftrength, debilitating powers, or the7remedies of fthenic diathefis, would re- move it ; and 2. ftimulants not proceeding to their ultimate effed of inducing indired debility, but con- fined within that limit, in which they remove afthenia, would increafe it. But the truth is juft the reverfe (y). ' For ftimulants aLone, which remove the other figns of acknowledged debility, alfo remove thefe fpafms and convulfions ; and debilitating powers increafe them or change the difeafe into a worfe (z). CCXXIX. As (y) Who does not now know, that bleeding, and evacuations of other kinds are hurtful, and that ftimulants proportioned to the degree of the caufe, are the only fuccefsful remedies ? (z) A certain gentleman in his defk, fpeaking of the method of- curing epilepfy or the falling ficknefs, and recommending, among. other evacuant and otherwife debilitating means, fmall but fre- quently repeated bleedings, unguardedly contradias himfelf in his very next fentence. " However," fays he, " we regular praw " titioners are liable to be too cautious and even timid fometimes., " For I have known a bold praaitioner 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 afkthis gentleman, what fort of a cure that was, that converted a difeafe, which may come and go for many years, nay even for a long life-time, into one that, in a very fliort 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 fatal dropfy ? That fort of treatment is not euring a difeafe but increafing it, and that even to death. The convulfive fymptoms of an afthenia may pafs away ; but the afthenia remains. You may ceafe to call it epilepfy ; but dropfy ftill fhows that the caufe of the difeafe remains, nay is prodigioufly increafed. This fatal miftake of an increafe of the difeafe upon the whole, for the cure of an inferior degree of it, proceeds from an improper ufe of direaly debilitating powers in place of the proper ftimulant ones. But there are cafes, where the laft, by being carried too far, produce the fame fatal miftake. Thus in peripneumony, to get rid of the hard pulfe, and the acute pungent pain (fee above, CLXXIV. and the notes), the bleedings are carried fo far as to produce a fatal hydrothorax, or dropfy of the cheft. Chap. VI. OF MEDICINE. 215 CCXXIX. As we know not what contradion is (and we are indeed ignorant of the manner in which every fundion of the living fyftem (a) is performed} we fhall not difpute whether it be an increafed or di- miniihed fundion : we fhall however by no means allow thefe fpafmodic and convulfive motions to be any other than an impaired fundion (b) ; for, if, within * certain boundaries, excitement, when increafed, pro- duces more ftrength, and lefs when it is either dimin- iihed without limitation, or exceffively increafed ; and if every fundion fo arifing is properly defined to be either a fundion increafed in proportion to the increafe of excitement as contained within its boundaries, or as a fundion diminiihed in proportion to the deficiency of the fame excitement, without limit, or to the ulti- mate increafe of exciting power beyond the ftimulant range ; in the laft of thefe cafes it is a moft proper definition (a) This is, perhaps, the firft philofophical performance in which care has been taken to keep clear of abftraa caufes. The profecution of them has contaminated almoft every department of knowledge that had been treated fcientifically. See the intro- duaion to my Obfervations on the principles of the old Syftems of Phyfic, &c. where it will appear, that even the great fir Ifaac Newton did not altogether avoid this error, efpecially in the queftion he put, however modeftly, with refpea to an all-pervad- ing aether ; the wanton aerial theoretical fabrics that have been raifed upon which, have, in fpite of lord Bacon's better direaions, difgraced the philofophy of the middle of the eighteenth century. Compare what you will find in that book with the III. Chap. paragraph XVIII. in this. (b) I know not what the abftraa ftate of mufcular fibres is, either when they contraa and relax with rapid, violent, and mor- bid force, or when they remain immoveably fixed in one forcible permanent contraaion : But I know, that nothing but debilitating powers produce thefe effeas, and nothing but invigorating ones remove them, which is enough for me, who mean to prove myfelf a fure and cautious obferver of the phasnomena of nature ; and in my praaice as a phyfician, to avoid, after the example of many others, groping in the dark under the guidance of abftraa reafon- ing, but to view every fubjea of obfcrvation by nature's cleareft light. 2l6 THE ELEMENT5 Partll definition to fay, that the fundion is diminiftied j and in the firft, that it is increafed (c). CCXXX. The (c) In the fpafmodic and -convulfive ftate of the funaion of motion, when compared with the vigour of the fame funaion 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 the contraaion, but, with a certain degree of that, in the well proportioned alternation between contraaion and re- laxation ; of which we have proof indifputable in this mode of motion being beft performed in that middle ftate of vigour, that intervenes betwixt the extreme of the healthy, or moderately in- creafed vigour, and the other extreme of direa or indhea debility. The increafe of vigour and excitement keep pace to a certain extent, even through fome degrees of morbid excefs of the latter i buc a period, and that fhort of indirea debility, arrives, as ia peripneumony, where the excitement is increafed beyond the healthy ftate, and muft be reduced in order to reftore the due healthy vigour* There are other cafes, as that of mania, or ithenic infaniiy, where the conjoined increafe ef vigour and ex- citement will dill go further. Bu/in every cafe the increafe of vigour, ftill judging of it from its effeas in the healthy ftate, ceafes before that of excitement ; and, perhaps, we may make a fieri towards finding the boundary, by obferving, that the greater fum total of excefs of exciting power is, the fooner does the point ar- rive, beyond which the vigour does not proceed. In peripneu. mony if ceafes at a certain period of the difeafe where the falutary effea of bleeding and other debilitating means fliows that the in- creafe of excitement is ftill going on. But here the fum total of excitement, confidering the ftate of all the other funaions,is great* *han in mania, where, the funaion chiefly increafed in vigour is only that of voluntary motion, while all the funaion? of involun- tary motion are vtry little affeaed. From this inveftigation we can clearly difcern, that every increafe of excitement leads to a morbid increafe of vigour, and that there is, fomewhere or other, a point in the fcale of increafing excitement, and below the point of indirea debility, where the vigour is no further increafed ; and this inference arifes with refpea to the praaice, that we fhould be very obfervant of both fads, as pointing out a very material,dif- tinaion in the indications of cure ; that in indirea debility being to ftimulate, while that at the ceffation of vigour is to continue to debilitate till the fum total of exceffive vigour be reduced to the proper and healthy. The inability to the performance of motion in peripneumony is an inftance of the latter ; that of the conver- fion of the fame difeafe from excsfs of debilitating cure is an ia- ftance of the former. 'Chap. VI. OF MEDICINE. 217 CCXXX. The notion, therefore^ hitherto received with refped to thefe motions, is falfe. It goes upon the fuppofition (d), that the motions proceed from an exceffive influx of the nervous fluid, according to the firft manner of ex^preffion '( a little warm porter ?n cold weather, and a very moderate nle of diffufible ftimuli, keeping the feet and the body in general moderately warm ; fliows fufficiently, that there had been no local affeaion in the lungs. When the debility of the difeafe is of the indirect kind, in winch the cure is more difficult, there is, ftill, as little reafon to be apprehenfive of the pulmonary or any orher local affedion. For the cure of it alfo proves the contrary. In ic the means of cure are to change the forms of ftimulus, and to proceed fiom the ufe of the flronger to that of the weaker, till at length the patient can do without much of the very ftrong ones. (See above, par. XCIX. and thofe that follow.) When the dif- eafe cannot be overcome in that way, the excitability muft'be underftood to be worn out, and life come to its end ; but ftill from general debility, not local difeafe. For, if ever any local affeaion does appear, it is always the laft effea, not the primary caufe. In this way I loft two gentlemen, after having been able to fupport them for many weeks, when the prognofis upon tho common praaice did not allow them as many hours. The caufe of their indirea debility had been hard drinking. But even in thofe, who die of a confirmed confumption, there is not often reafon for the fufpicion of the tubercles in the lungs. Their bodies have been opened after death, and the lungs fonnd quite found. And in the diffeaions, where the tubercles have been found, ftill they were only an effea. Chap*Vl\. «F MEDICINE. C HA P. VII. Of fleep and wakefulnefs, falutary and morbid—Sleep from leffened excitement—Ordinary fiimuli produce fleep by gradually exhaufting the excitability-—Morbid, fleep from dired and indired debility—Healthy wakefulnefs how the effed of fiimuli—Inftances of morbid fleep— How ftimulants cure both morbid fleep and watchful- nefs—No fpecific foporific virtue in opium—In what circumftances it induces fleep—Sleepinefs attending af- fedions of the alimentary canal—Good fleep, what. CCXXX VII. AS death clofes all the labours of life, • fo fleep clofes thofe of every day : and, as the former is the confequence of a perfed extindion of the excite- ment, either from a complete exhauftion or extreme abundance of excitability ; fo the latter fucceeds a di- minution of excitement, during which the excitability is either, i. only fo far diminifhed that it can be ac- cumulated again ; or, 2. fo abundant, that the excefs can be wafted ; and, in each cafe, the excitement re- ftored. CCXXXVIII. Such is the nature of the excitability of animals, that it can neither be deficient nor over- abundant, without detriment : a deficiency producing indired, and a fuper-abundance, dired debility. And, as any exciting power, carried beyond its boundary, (XXVIII.) produces the former, and the with-holding of any gives occafion to the latter ; the fame propofi- tion holds good of the exceffive or too fparing ufe of any of them, or of all (a). Sleep, then, is the effed of our (a) This is completely illuftrated through the whole firft chap- ter of the fecond part, from par. CXI. to par. CXLVII. inclufive. Nay, the propofition is conftantly alluded to through the whole that has yet been faid, and will be in what remains to be faid. Fa 2-34 THE ELEMENTS Part IX our adions during the day, at firft giving always more and more excitement, afterwards lefs and lefs, in pro- portion to the continuance of their operation, but fo as always to afford fome excitement, till the perfon arrives at that ftate, where the degree of excitement, neceffary to the waking ftate, no longer exifts. Of this we have the moft certain proof in every day's experience, and in the common effed of all the exciting powers to produce fleep {b). Thus, [b) To illuftrate this, let us take the exciting powers oneby one, and begin with wine. When a perfon is infufficiently excited with refpea to that ftimulus, and rifes not, fuppofe above 300 in his excitement, a glafs carries him up 20, another 20 more, and fo forth, till after five glaffes, and their effea in carrying him up to 400, he finds himfelf well and vigorous in all his funaions. But, ftill, we are not fo flimfily made, as not to bear a little of what is cither too much or too little. Suppofe him then to take five glafles more, and, confequently, to be raifed to 500, or io° above the ftandard. As his fpirits, his intelleaual, and all his other, funaions, were low, while his excitement remained below 400, fo they are all proportionally exalted by the time that his excitement is elevated to 500. Let him ftill gO on, and his intel- leaual funaion will rife ftill higher ; he will now difplay the full extent of his genius ; his paffions and emotions, of whatever kind, will rife in the fame proportion ; he will, in one word, be an ex- ample of the effeas of Alexander's feaft. Suppofe, to bring him to all this, he has fwallowed, befides thofe he had before, other five glaffes. Let him go on, till he has taken five glaffes, more, and we fhall fee the effea : In the courfe of time, employed in taking thefe, he gradually falls off in his fpirits, in his intelleaual, and in his corporeal, funaions ; his tongue, his feet, his eyes, his memory, his judgment, all fail him ; he, at laft, becomes drowfy, and then falls faft afleep. 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 effea of the ftimulus of eatingi efpecially nourifhing ftimulant things, and in great plenty. Before dinner, the occupations of the former part of the day are not yet fufEcient to prepare one for fleep ; which, however, after a heavy dinner, will, unlefs the interference of fome other ftimulus prevent it, very readily happen to moft people, efpecially to thofe, whofe frailty, from age or any other caufe, renders them more liable to be fatigued by the fall operations of the day than others. The younger Chap. Vll*. OF MEDICINE. 2J5 Thus, a certain degree of heat, food, drink, labour, either of body or mind, and paffion and emotion, when their ftimulus neither flops fhort of the proper point, nor goes beyond it, all give a difpofition to fleep. This is the moft falutary fleep. 33. Premature, unfeafonable, or morbid fleep, is produced by either indired or dired debility. 34. With refped to the former, an exceffive opera- tion of any one or more of the ftimuli produces it ; accordingly, any one or more of thofe above mention- ed, by ading in excefs, and wafting the excitability, fuch as hurried drinking, produce that effed. 35. Of the diredly debilitating powers, which pro- duce the fame effed, the want, or fparing application, of the powers, which, by a due degree of ftimulus, in- duce fleep* will induce a bad kind of it ; accordingly, when a perfon wants excitement in order to be in health, the defed of light, of found, and of the bodies that excite the other fenfes, the defed of both fets of motions, the voluntary and involuntary, as well as of the exercife of the mind, of paffion, of heat, ading in its younger and more vigorous 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 very flow of the blood in the veffels, and the exercife of the involuntary motions, that keep it up, tend at laft to the fame effea. 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, ftimulating the eyes, and found, the ears, and the feveral fubftances that acl upon the organs of the other three fenfes,. all tend, by wafting the excitability, 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 fuaions ; which, again, gradually falls till its termination in fleep. We have, therefore, after viewing their effeas fingly, to fuppofe them, in one degree or another, united, and fleep the fioifhing effea of their united •peratie-ni 236 THE ELEMENTS Part II. its ftimulant degree, and too long continued fleep itfelf, all thefe produce hurtful fleep (c). CCXXXIX. On the contrary, healthy wakefulnefs is the effed of the fufpenfion of the diurnal adions during the period of fleep, which takes off more and more excitement, moft at firft, and lefs and lefs after.; but always adds to the fum of diminution of excite- ment, and accumulation of excitability i that is, al- ways continues to take off ftimulus, till we have the degree of diminiftied excitement, and increafed excita- bility neceffary to the watching ftate. In this way does fleep prepare the fyftem for the waking ftate ; which is afterwards kept up, for the due length of time, by the feveral exciting powers, ading through; ' ] the day, till at laft, by a certain failure of their effect^ 1 fleep is produced again. 36. Too long or morbid watching is alfo brought ., on in two ways; by indired and dired debility. Thus, intenfe thinking, violence of paffion, exceffive labour, unufual and highly relaxing heat, debauch in eating'. ^B and drinking, great excefs in the ufe of the diffufible*.™ ftimuli, great abundance and velocity of blood ; all, or . any of thefe, bringing on indired debility by an excefsv+P% in their operation, are notorious for their effed in re- pelling fleep. Again, cold, not in that extreme degree which immediately- precedes death ; abftinence from ■,_ food, or the ufe of food not fufficiently nourifhing, or not fufficient to produce the requifite indired ftimulus; weak liquids, as tea or coffee, efpecially when a perfon has been accuftomed to ftronger ; intermiflion of the ufual exercife, whether of body pr mind ; fhame, fear, w.. and (c) Coma, or an infuperable difpofition to fleep, is moft com- monly owing to the want of moft of the ftimuli mentioned in the text, as thofe of food, of wine, at leaft m the ordinary praaice 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 abfence of certain ftimuli, that otherwife iiritate in the weakened ftate, and produce watcfcfulnefs. Chap. VII. OF MEDICINE. . ^** and grief; all thefe, by their operation not fufficiently approaching to indired debility, produce an undue or morbid ftate of watchfulnefs. CCXL. As debility, therefore, whether indired or dired, or both conjoined, produce fleep, the firft found fleep, the two latter an improper or morbid kind ; fo an excefs of debility, whether indired or dired, is alfo a caufe of improper or morbid vigilance/' The only healthy fleep is that which is produced by a proper degree of excitement, occafioned by a proper adion of the exciting powers upon the excitability j all the ex- tremes of exceffive fleep, or exceffive vigilance, are either fb many tendencies to difeafe, or adual difeafe (d). A perfon, fatigued with his ufual exercife, is imme- diately compofed to fleep ; which, equally, flies from htm who has had either lefs or more, than that middle degree (e). CCLI. As , ^ {d) Too much, or too long continued, fleep, is hurtful, becaufe it implies a fufpenfion of that excitement, to which proper health and due vigour is owing : it is, confequently, a ftate of d-'reA debility. Too little fleep, or of too fhort duration, is of equal detriment, as implying a degree of excitability, not fufficiently ac- cumulated to receive a fufficient impreffion from a renewal of the excitisg 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 aaion of the exciting powers fliould be adapted to the ftrength, a little indulgence in fleep is Ue fafeft extreme to the weak, as in the cafe of children, and perfons labouring under debility. (e) When a boy, I valued myfelf much for enduring the fatigue ©f walking: About the fifteenth year of my age I walked, in a fummer day, from Berwick on Tweed to Morpeth, which, with two miles wandering out of the high road, I found to be a josrney of fifty miles. But I got not a wink of fleep the whole night, from the excefs of the exertion ; 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 Morpeth to Newcaftle, which was only a walk of fourteen miles. Some years after that, when I was now arrived at my full ftrength, and my joints perfealy knit, I walked and wandered in all forts of ground, in roads and out 2o§ THE ELEMENTS PorilL CCXLI. As the effed of both indired and dired debility is fometimes fleep, fometimes watching, both of them unhealthy,, both hurtful : fo the caufe of morbid fleep is either fort of debility, when no ftimulus ads upon the weakened fyftem-fo as to throw it into a ftate of agitation : and debility of either kind, accom- panied by fuch a ftimulus, produces morbid watching; in which cafe fome fmall ftimulus ads as an irritating power (/). 37. Inftance* out of them, over fmooth and plain, and heathy and mountainous- traas, 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 my deftination. The hills over which I wandered in the courfe of the night are thofe called Lammer-muir, fitnated be* twixt Eaft Lothian and the Mers: the places I 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 fuftained by a great ftimulus, high animal fpirits, and lova. At the end of my journey, and finding myfelf among my friendsi and with the objea of my affeaion, I had vigour enough to dancr with the latter. This time I flept well, and was perfectly recruit? ed next day. * (/) Volumes have been filled with the doarine of irritatidwas a caufe of morbid ftate, and the indications of cure and remetM to remove it have been equally tedious and laboured. In fthenii difeafes, pheogiftic diathefis, inftead of plethora and vigour (for the belief in which two laft there might have been fome foundatioi in that form of difeafes, (fee above from CXXXI. to CXXXIV.) has been the univerfal pathology; and bleeding, other evacuationftgl and cold, 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 then, 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, typhoma? nia or conftant working, of fo frequent occurrence and fo noted a fymptom in thofe difeafes. But as we have proved, that the reverfe of plethora and vigour is the true ftate of the fyftem io every difeafe of debility ; fo we affert with the fame folidity of argument, and the fame weight of proof, that irritation, confider- ed, Chap.VU. OF MEDICINE. 37. Inftances of morbid fleep occur in the predifpo- fitions to difeafes, and in the adual difeafes, that depend upon fthenic diathefis, and in the ordinary ftate of in- toxication from drinking. But all the exciting powers, when noxious from exceffive ftimulus, each m propor- tion to its degree of excefs, have the fame tendency (g). But, when the exciting power proceeds beyond the fleep-inviting point; or when any ftimulus, ftill finding unwafted excitability to ad upon, continues to ad ; in that cafe the watching will be continued with bad effed, as in the harrowing watchfulnefs, which is liable to accompany the phlegmafise. CCXLII. Inftances of morbid fleep occur in all the difeafes of indired debility, and in pains that have ad- vanced to the fame degree of exhaufted excitability in the fcale (h) ; as in the feveral cafes of phlegmafia, that arife from the violent progrefs of the morbid ftate, or the ed, either as the caufe of morbid watchfulnefs or of any other fymptom, is nothing that requires either evacuant, or any other debilitating remedies, to remove it. It is merely a weakened ftate of the fyftem, thrown into flutterings from the flighteft ex- ertion of the ordinary funaions, as when a perfon falls into tremors from noife, or into a fweat from walking a ftep or two. (g) A heavy dinner, exceffive fatigue from either corporeal or mental labour, a high fit of paffion, and heat, are, each of tbem, noted for giving a difpofition to fleep : which is an effea, arifing from their high degree of ftimulus, hurrying the excite- ment 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 aa upon, continues, there- tore, to aa, and prevent the fleep. (b) This happens in the phlegmafia:, where the effea, 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 ufliers in a fit of the gout, is commonly of the direa kind ; but the effea of the continuance of the pain is often fleep, the origin of which is indirea debility, its confequence an increafe of the difeafe, and its remedy an inter- ruption of the morbid fleep for the purpofe of adminiftering fuch diffufible, and other, ftimuli, as have the effea of removing the debility which occafions both the fleep, and other fymptoms of the difeafe. *19 24O THE ELEMENTS Part 11, the improper adminiftration of ftimulants for the cure; which is particularly exemplified in the dropfy of the breaft, that often arifes from peripneumony under fuch management. With refped to fleep from dired de- bility, women, who have had many children, who have often fuckled, as well as all lazy perfons, and thofe, of both fexes, who are addided to luxury, and whofe cuftom it is to fleep too.much, are all liable to this fort of morbid fleep. CCXLI1I. When either .dired or indired debility produces fleep without refrefhment (/'), or a turbulent waking ftate, as the debility exceeds that in which found fleep confifts ; the ufe in both thefe cafes of a ftimtuus capable of repelling the former, and converting |ke latter into fleep, will remove the complaints, and ferve for an illuftration of the nature of both (k). In afthenic difeafes (/) Which often happens 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. (i) Let the point of indirea debility, in which fleep confifts,be as 15 degrees in a particular fcale, and the greater debilityTT that which either conftitutes morbid fleep or morbid watchinj 20 degrees or upwards in the cafe of its being indirea, or f downward in the cafe of its being direa debility. It is evident, that, to bring on falutary watching 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 excite- ment from 10 to 15 degrees, and as many for the purpofe of re* newing the worn out excitement by means of a new exciting power which may ftill find a portion of excitability to aa upon, or to remove certain ftimuli, which, however flight and mild, are fatiguing and difturbing to the fyftem in its weakened ftate. Accordingly in fever, when the patient, amidft every fort of \ direaly 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 expeaoration, lafted for fixteen hoursi and was followed by the moft furprifing relief. The continuance of this praaice, with only an increafe of the dofes in proportion as Chap. VII. ©F MEDICINE. 241 difeafes the watching ftate for the moft part is the con- fequence of dired debility, with fome power ading by a flight ftimulant effed ; the reafon that the difeafe depends upon more debility than that which confti- tutes fleep.—Hence every thing that ftimulates, every thing that raifes the excitement as it were to that point, which as the abundant excitability was gradually worn off, and altern- ating 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 praaitioners would have called an obftruaion • in the mefenteric glands. A large dofe of the tinaura thebaica, for the patient's age, was adminiltered, which laid him in a pro- found fleep, that continued near 36 hours, and at once removed Hhe difeafe. Numberlefs are the cafes of a kind fimilar to this, ^where the morbid watchfulnefs was partly from direa, partly . from indirea debility, that have been conftantly removed by the ! fame practice. A child of 7 years bf age, in a fever of great direa debility in confequence of a moft rapid growth happening during the difeafe, which was not completely removed till near the end of feven weeks, after having been under the difeafe near a fortnight, was effeaed 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 effea took place, kept him awake. Some time after, in the courfe of the fame lingering difeafe, when he had not yet ac- ^ quired 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, \*L which was partly the effea of a certain, though not a great de- * gree of excitement that the tinaure and other cordial powers had given him. It, however, induced too great a degree of indirealy ^, debilitating exertion for his ftill very weak ftate, and it, therefore became neceffary to give him an addition of excitement to bring him to the ftate of falutary and recruiting fleep, and thereby to fufpend the aaion of a number of exciting powers, however flight their operation was, which were too much for the enfeebled ftate of his fyftem. In the cafes of children, whofe difeafes are almoft all fthenic, and in other difeafes of high debility, the inftances of fuch effeasof the diffufible ftimuli, (for more than one was em- ployed upon this as well as many other occafions) are equally numerous and furprifing. In a very large praaice I am fure V never, in the very worft cafes, loft three patients. Gz 242 THE ELEMENTS Part 11. which compofes the fyftem, to fleep, produces that effed by a ftirftulant, not a fedative, virtue. In a fmall de- gree of debility, where the excitement has fallen only a little below the point of fleep, a very fmall degree of ftimulus is fufficient; fuch as a little animal food where the weaknefs is owing to vegetable food ; wine, or any liquor of equal power, after a water regimen; confolation under afflidion of mind ; heat, when cold has been the debilitating power ; gentle exercife or geftation, or the ftimulus of a pleafant train of thought, when the patient has been deprived of the ftimulus of corporeal or mental exercife. In a higher degreei of debility (for the curative power fhould always be adapt- ed to the degree of the difeafe) either a proportionally higher degree of the ftimuli which have been mention' ed, or fome more powerful one, fuch as thofe, which arc called diffufible, fhould be employed. CCXLIV. In both thefe cafes, the virtue of opium is great ; its virtue, however, is not peculiar, or any other than what it poffeffes in common with all the other ftimulant powers, from which it differs only in the higher degree of its (/) virtue. Thus in great de- bility (/) The notion of fome powerful remedies, as opium, mercuryt the Jefuit's bark, &c. aaing 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 fpecifis \ an idea, ' which, like many other of their vague conceptions, was altogether contrary to found philofophy j fince .'.the more careful our in- quiries into nature's operations are, the"' more and more reafon have we to be convinced, that fimplicity and uniformity pervade the whole phenomena of the univerfe. Accordingly, in the ex- citing powers that aa upon the excitability of our bodies, we find only one aaion, that of ftimulating, varying only in its degrcef to take place in all animal as well as vegetable bodies, nay in - every thing that wevknow to poffefs life in the univerfe. We alfo find, to the fame extent, only one property in living fyftems upon which it aas, that isfthe excitability ; and one effea produced by ; the mutual relation betwixt them in that refpea, to wit, the ex- citement. Inftead of the diftraaed notion of vortices, or atmof* pheres in rapid motion, governing the motion of the planets* »•" Ifaac Chap. VII. OF MEDICINE. 243 bility as in fevers, or a violent fit of the gout, where there is much internal commotion, and in other fimilar difeafes of debility, in which the violence of the difeafe keeps off fleep ; opium, after the watchful ftate has remained many days, will often bring on profound and found fleep : Here, as the excitability is much accu- mulated, and as very weak ftimulants only are admjffi- ble, we fhould begin with the weakeft and gradually increafe them, till we arrive at the point of fleep, which will foon happen, as it is placed much within the range of dired debility. With refped to coma, or that fleep which is not refrefhing ; fuch is the effed 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 thus reftores the patient lately, gently, and pleafantly, to health. But as the influence of the ftimulant operation, that fupports excitement, is of fuch great importance, and as fleep of longer duration than proves refrefhing, may arife even from proper remedies, the rule to be obferved is, whenever fleep, upon account of too long a fufpcn- fion of ftimulant adion, has been of lefs fervice than was expeded, to fhorten its next period, and renew the operation of ftimulants. CCXLV. In afthenic difeafes, from indired 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, other ftimuli fhould be employed according Ifaac Newton found the whole planetary fyftems of the univerfe 'governed in their motions by one fingle principle. Inftead of the infinite diffeience of habits and temperaments, I have found every individual precifely the fame as every other. Whatever produces the gout in one, will produce it in another, prepared to receive its influence. And whatever cures it in any one, cures it alfo in every other j and fo forth with refped to every other dif- eafe. The deeper we explore the works of nature, the more (hall we be convinced of this wonderful fimplicity, fo that, to a philo- fopher, all nature would appear the effea of one fingle inftrument in the hand of the all-wife all-powerful creator. 244 ™E ELEMENTS PartlT. according to the degree of debility, and, when the de- gree of debility is very confiderable, the diffufible ftimuli, and among the reft opium. CCXLVI. Thefe are the times and circumftances in which opium produces fleep. In all the other ftates either of health or difeafe, it excites the fundions both of body and mind, as well as of paffion and emotion ; fo as to banifh fleep, and produce great adivity and vigilance. Thus if any one is fleepy without an evident caufe, he will by opium be rendered furprifingly fprightly, lively, and vigilant; it banifhes melancholy, begets confidence, converts fear into boldnefs, makes the filent eloquent, and daftards brave. Nobody, in defperate circumftances, and finking under a difrelifh for life, ever laid violent hands on himfelf after taking a dofe of opium, or evei will. In one word, through! all the intermediate degrees of excitement from dired to indired debility, opium is by far the moft powerful of all the agents, and as fuch muft be the moft hurtful in fthenic diathefis, becaufe, when added to the other ftimulant powers, it not only banifhes fleep, but may fuddenly induce indired debility, and even death by exhaufting excitability. CCXLV1I. That the debility, upon which com^ depends, is lefs than that which fupports morbid vigi- lance, appears from the former being lefs dangerous, and more eafily removed ; yet, when its duration is in any degree confiderable, or when it refembles profound fleep, care fhould be taken to prevent dired debility ; in which cafe recourfe fhould be had to the different forms of wine and opium, in order, to raife the excite- ment to that degree, which repels the fleepy ftate, produces more ftrength, and facilitates the return of health M- CCXLVIII. In («) Phyficians have had a more favourable idea of coma, or the fleeping ftate in fevers, than it merited. Inftead of deferving to be looked upon as a pofitively good fign, infuring a fafe return of the difeafe, as it was by them, it was at beft but a negative mark, Chap.VH. OF medicine. 24c; CCXLVIII. In the gout, in indigeftion, of which examples have already been adduced, in diarrhoea and the colic, and many other afthenic difeafes, particularly thofe that difturb the alimentary canal, and chiefly af- fect women exhaufted with frequenr 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 fleep is prolonged, without any alleviation of the difeafe. The fame thing happens to thofe who have fallen into indired debility from drunkennefs or any other caufe. That this propenfity to fleep depends either upon dired or indirect debility is evident, for whatever produces further debility increafes the difeafe, and. every thing that ftrengthens, removes it. Strong liquors,.and the preparations of opium, are peculiarly eftedual, and that in proportion to their greater and more diffufible ftimulant power. CCXL1X. Thus fleep and wakefulnefs may be either induced or obviated by certain degrees of ftimulation. The removal of morbid affedion without inordinate motion by a ftimulant power equal to that which is required to cure fpafms and convullions or to reduce the quick pulfe in fevers, is an analogous circumftance. Upon the whole, it is plain, not only that irregular /,.: motions are not increafed fundions, depending upon fek increafed excitement, but' that they are impaired func- II tions, and depend nearly on an equal degree of debility. ^ CCL. From what has been faid, the analogy be- tween wakefulnefs and life, fleep and death, and their [v. dependence upon the fame laws that govern all the other fundions, clearly appears; and folid proof has I been mark, implying that the flight ftimuli aaing upon the fyftem in a ftate of high debility, and, therefore, by their operation, flight as it was, increafing the direa debility by the addition of the indi- rea to it, were kept off and hindered from producing that hurtful effea. Their authority in giving that judgment of it is over- thrown by their extreme ignorance of its nature. £46 THE ELEMENTS PartIL been adduced, that the moft vigorous wakefulnefs con- fifts in the higheft degree of healthy excitement j that p-ood profound fleep depends on the higheft debility that is confiftent with the healthy ftate ; that true fleep depends on a mean degree of indired debility, and that both morbid fleep and morbid watching are the offspring of great debility, whether «of the indirect or direct kind. CHAP. VIII. The cure of both the diathefis—Indication either to dimin* iflh or increafe excitement—Powers that cure, differ only in the degree of their adion from thofe that induce, either diathefis—In the fthenic, when ftrong, heat to ber avoid- ed—When and how admiffible—Cold the great remedy,* in this diathefis—Never injurious from afiringeney-*- Heat ufeful in afthenia—Cold baneful—Produces putre- fadion of the fluids—Diet in fihenic—and afihenic dia- thefis—Bleeding, purging, vomiting to diminifh fulnifi. \ of veffels—How to treat inanition—Of bodily and' mental exertion—Of the paffions—Of air—Of cont(h~.< gious difeafes—Single lefs effedual than united powersi i CCLI. THE caufes of both the diathefes have been | formerly (CXLVIII.) affigned : whence it appears that the indication of cure, iiv the fthenic diathefis, is to h diminifh exceffive excitement over the whole fyftem ; in the afthenic, to increafe deficient excitement like- wife over all the fyftem, till it be brought to the healthy degree. CCLI I. The remedies that effed the cure of fthenic diathefis, are the powers, which, when their ftimulant operation is exceffive, produce that very diathefis ; but which, in effeding a cure, ad with fuch diminiihed force. Chap. VIII. OF MEDICINE. 2,~ force, as to produce lefs excitement than health re- quires, or to prove debilitating. x , CCLIII. The powers which produce the fame effed in the afthenic diathefis, are thofe that, when their ftimulus is too weak, produce that diathefis. In effeding a cure, they muft be applied fo as to produce higher excitement than is confiftent with the ftate of health, or fo as to ftimulate. CCLIV. In the fthenic diathefis that temperature (a) which is called heat, muft by all means be avoided ; becaufe that degree alone of what we from our feelings name heat, which proves debilitating, viz. an exceed- ingly high temperature, cannot be applied without the rifk of pernicious confequences from the previous ex- •cefs of ftimulus (b). v CCLV. But, when the diathefis, and its caufe the ■ increafed excitement, are moderate, though the difeafe is (a) The fame order is followed here, that has all along been 'obferved ; to wit, that of the enumeration of the powers in par. XI. and XII. and that of the explanation of them, when viewed as the hurtful powers producing either diathefis in Chap. I. Part II. and it will be kept to throughout the whole work. Nothing can be more fimple and natural, and better fuit the fimplicity of the fubjea, while nothing is more artificial and arbitrary than the arrangements either of fyftematics or nofologifts. Juft order „•■ could never be expeaed from an erroneous and confufed view of '>, the fubjea to be treated of; while a clear conception of the fub- '<-'. jea as a whole, infallibly leads to a diftina diftribution of the V feveral parts that compofe it; fo that, what Horace fays of > language, equally applies to order, and the fame thing applies here as to his Verba £jf lucidus or do. Verbaque ptovifam rem non invito, fequentur. lb) 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 violence, often mounts up fo high in the fcale of increafed ftimulus, as nearly to approach the point of in- direa debility, and it fometimes aaually gains that point. The addition, therefore, of more ftimulus from the application of heat, would infure that effea, and thereby occafion the converfion of the difeafe into a much worfe one, fuch as bydrothorax, or the dropfy of the breaft. 248 . THE ELEMENTS Part XL is fully formed, there is no occafion for forbidding that degree of heat, which accompanies the operation of iweating and the pediluvium ; becaufe the wafte of fluids in the former, and the agreeable fenfation in the latter, promile fomewhat more advantage than fuch a moderate degree of heat threatens difadvantage. CCLVI. After the application of intenfe cold, the application of heat muft be ftudioufly avoided, becaufe its operation, from the increafe of the excitability by cold, becomes more effedive. And the confequence is the moie to be dreaded, becaufe, at the fame time, other ftimuli are ufually applied. CCLVil. Cold is the beneficial temperature in the cure of the fthenic diathefis, but it muft not be follow- ed by any confiderable degree of heat. The miftake, therefore, in medical pradice, of thinking cold hurtful in fthenic diathefis by a ftimulant operation, fhould be correded : its ufe in the fmall-pox is not to be under- ftood to arife fo much from its mere debilitating degree, as from avoiding the ftimulus of heat after its operation. When the lame precaution is employed, cold either alone, or in conjundion with other debilitating powers, has lately been found the moft effedual remedy for catarrh, or for a cold, as it is vulgarly called. CCLVIII. From which circumftance, and becaufe* a cap of frefh earth put upon the head, has been of fervice in phrenitis ; and becaufe that degree of cold, which attends froft and fnow, when applied to the naked body, has removed a fynocha accompanied with delirium (c); and becaufe cold is fo efficacious a remedy (c) It is called the common inflammatory fever, very improper- ly, as being no fever, but a general pyrexia, or affeaion of the whole fyftem, without inflammation or local affeaion, and pro- ducing heat over all and tumultuous effea upon the pulfe. Its proper generic name is pyrexia. See above, par. LXVIII. where that appellation is affigned to it ; an appellation to avoid miftak- ing its nature, that fhould be accurately attended to. Great mif- chief has been occafioned by this vague term. Thus when a perfon Chap.Vlll. OF MEDICINE. £.g remedy in the fmall-pox ; it clearly follows, that the ufe of cold fhould be extended to the whole ranee of predifpofition and the whole circle of difeafes, depend- ing upon fthenic diathefis. CCLIX. That no hurtful effed arifes from the fuppofed aftnngent power of cold in the fthenic diathe- fis {d), appears from its remarkable effed, when applied to the furface of the body in the fmall-pox, in keeping up perfon is faid to be affeaed with a difeafe; when it is afked what difeafe it is, and the anfwer given, that it is a fever, immediately bleeding is thought of, though that, and every, evacuation is as hurtful in proper fever as it may be fervieeable 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 jperfon 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, paffed over into the new town, and from that to the fields beyond it. He foon became fenfible of his ftate, ftole into a houfe next to him, got fome clothes thrown about him, and was carried home in a chair, perfealy cured of his difeafe. From which, and a prodigious number of faas 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 re- courfe to it for want of efficacious remedites, it would at once remove the higheft degree of fthenic ftate that ever occurs in difeafe, and reduce the excitement from the neareft approach to 70 down to 40. Nay it might run into the oppofite extreme and go all the way to death. But we fhall, by and by, have occafion • to obferve, that we are fo well provided with effeaual remedies as not to be under any temptation of ftraining this to its height. And we fhall alfo find that a number of remedies in a moderate degree are preferable to any one, or to a fmaller number in a higher degree. The difcovery of the principle upon which the cure of fthenic difeafes turns, has enabled us to render the cure both more complete and exaa, than it could have been without principle. (d) I remember, when I was a young ftudent, of hearing the old phyficians 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. H2 Z$Q THE ELEMENTS Part II. up freedom o'f perfpiration in proportion to the degree of its application. Its effed in producing atony with proportional laxity of the fibres of the veffels, depends upon the fame principle (e). CCLX. For the removal of afthenic diathefis the ftimulus of heat is fignally ufeful, artd chiefly for the following reafon ; that it muft be as ufeful in this diathefis, where the excitement is too low, as it is hurt* ful in the fthenic, by increafing the excitement, already too high. Hence in fevers, in the gout, in dyfpepfia, in the colic, in rheumatalgia, and in all afthenic difeafe^ the fyftem is very much invigorated by heat, and de- bilitated by cold : which, by its debilitating effed, is ranked among the powers that produce thefe difeafes (/) ; and in fevers is fatal. CCLXI. As cold is hurtful in afthenic diathefis in the proportion in which it is ferviceable in the fthenic; it is accordipgly, for a further reafon, to be avoided in difeafes of the higheft debility, for,.like intenfe heat, it relaxes the extreme veffels, and produces a putrefac- tion in the fluids. (See CXVII.) CCLX1I. The more certainly to moderate the fthenic diathefis while it remains as yet within the limits of predifpofition, a fparing ufe fhould be made of fleflj and the preparations from it, and vegetabk diet be ufed with greater freedom. But, when this diathefis is increafed to the degree, that conftitutes difeafe, ab- ftinence from animal food, efpecially in a folid form, | and (e) The fibres being relaxed defcribe a greater cavity, and hence the check given to the perfpiration by the contrary effccVef the fthenic diathefis in increafing their denfity and diminifhing their diameters, is taken off. (/) 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, ia proportion to its degree, be peculiarly hurtful in all difeafes, in which the debility conftituting their caufe, runs high, as it natural- ly does in the gout, where it is increafed by the advance of age and other caufes, and much more fo in fevers. Chap. VIII. OF MEDICINE. 251 and a free, but ftill not exceffive, ufe of vegetable mat- ter, efpecially in a fluid form, are the beft means of removing it, as far as the effed of diet reaches. CCLXIII. In the degree of this diathefis, which does not exceed predifpofition, it is proper to avoid feafonings^ which are deftrudive in fthenic difeafes fully . formed. CCLXIV. Weak liquids are very ufeful ; and all fpirits and ftrong liquors hurtful in proportion to the quantity of alkahol they contain. Such liquors, unlefs extremely diluted, are fatal in fully formed fthenic dif- eafes. In thefe difeafes pure water, efpecially with the addition of fomcthing to acidulate it, is preferable to ' fmall-beer, which a great authority admitted. But the diffufible ftimuli in this diathefis are above all others hurtful. CCLXV. Since the indired ftimulus of food affifts the dired, that is, propagates itfelf over the whole body, bounds fhould be fet to the quantity even of fuitable food. CCLXVI. In every degree of afthenic diathefis, Vegetable food fhould be avoided, and recourfe be had as foon as poffible to animal matter. But as this can feldom be executed immediately upon account of the weaknefs of the ftomach ; the diffufible ftimuli fhould . be ufed ; fuch as the different forms of wine when the debility is moderate, and opiates when it is greater. At the fame time, from the very firft, rich foups fhould be given in great quantity upon the whole, though not too much at once, and a gradual tranfition made to the ufe of more folid matter. CCLXVII. As animal matter in this cafe is of fer- yice, fo the degree of ftimulus, that feafoning adds to it, improves its effed. CCLXVIII. During the predifpofition to afthenic difeafes, watery, cold, acid, fermenting liquors are hurt- ful, and that proportion of ftrong liquor, that the degree of debility requires, is beneficial. But, after the 2^2, THE ELEMENTS Part II. the difeafes have adually taken place, and have attained a greater degree bf vehemence, ftrong liquors become fo indifpenfably neceffary, that excepting foups, and the ftill more diffufible ftimuli, they are the only fupport required for a long time. There is no occafion to feai the indired ftimulus of food, when the matter, which chiefly afford* this indired ftimulus, viz. Vegetable matter, is guarded againft. Compare this with para- graph CCLXV. CCLXIX. For the purpofe of diminifhing the ftimu- lus, which an over proportion of chyle and blood (g), diredly applied to a great extent of the body, gives; the over proportion, when it is very great, fhould be removed by abftinence, bleeding, and purging ; when it is more moderate, but yet adequate to the effed of producing difeafes, the diredions lately given (CCLV.) refpeding a moderate diathefis, ought to he obferved $ that is, we fhould adhere to the pradice of vomiting, and purging from time to time, and to fparingnefs in diet. But blood fhould not be let. And, if upon any occafion, the patient fhall give way to a little freedom in his ufe of food, it fhould confift of vegetables ; and he fhould afterwards obferve abftinence, and take gentle. and frequent exercife, fo as to keep up a full perfpira- tion. CCLXX. The means of cure for an excefs in the velocity of the blood (paragraph CXXXI. toCXXXIV.) in fo far as it depends upon an over proportion, are the fame : when the velocity depends upon violent motion of the body, the means of leffening it, as long as the diathefis (g) The chyle is the .alimentary matter, that has underg6nea preparation in the ftomach, and an after-one in the upper part of the inteftinal canal, and which, fo prepared, or in part digefted, is taken up by the mouths of a number of fmall veffels that open into the inteftines ; thefe carry it to a great trunk, in which all thefe veffels called laaeal, unite, and through that trunk it is afterwards mixed, firft with the venous, and then with all the other blood in fucceflion. Suc-h is the nourifhing matter of animals. Cl.tf.VIII. OF MEDICINE. 253 diathefis is confined to predifpofition, or to a flight de- gree of adual difeafe, are an abatement of exercife, more indulgence in reft, and a redudion of other fti- muli. In that high diathefis, which occafions'fevere difeafes, in order to retard the motion of the blood, the ftimulus of all the exciting powers muft be ftudioufly avoided, and blood muft be drawn profufely. Here it is fuperfluous to lay down any rule for the obfervance of reft, as reft, even in fpite of the patients, is unavoidar ble (h). CCLXXI. Withdrawing the powers that occafion an over proportion of the fecreted fluids in the excre- tory duds, is the beft method of removing the ftimulus, which that over proportion, by its diftending effed, produces (i). The cure, therefore, confifts in more .frequent coition, drawing off the milk, taking in food of a lefs nourifhing nature, and in reftoring the perfpi- ration by removing the fthenic diathefis upon the ex- ternal 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 {k)} firft, the ftrength muft be gradually reftored by tb) It would be ridiculous to require of a patient in the rage of peripneumony not to run a race, when his real ftate is, that he cannot move or turn himfelf in bed without pain. (/) In par. CXXXVI. you will find, that the fecreted fluids, here alluded to, are the milk, the femen, and the perfpirable fluid. As the diftention occafioned by the over-abundance produces the morbid ftimulus, fo the fubduaion of the fluids muft, of courfe, take it off, and give the defired relief. (k) How great the fpace or extent of the fyftem is, that, in the fthenic diathefis, receives the ftimulus of an over- abundance of blood ; and which, in the afthenic diathefis, is fubjeaed to the debilitating power of an under-proportion of the fame fluid ; may eafily be conceived from the well known faa, that there is not a foft part in the whole fyftem, into which the infertion of the point of the fineft needle will not draw blood ; confequently, the ftimu- lus arifing from an over-abundance of blood, as well as the debility arifing 254 THE ELEMENTS Part II. by diffufible ftimuli (/) and foups ; next, we fhould gradually fubftitute folid food for foups ; and laftly, to give the whole fyftem ftill more ftrength, it fhould be fortified by exercife, and the reft of the durable tumu- li ; but the ufe of diffufible ftimuli fhould not be ex- tended beyond the period of confiderable debility (m). CCLXXHi.In arifing 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, noxiom power. If the force of every ftimulus, of every exciting power, be in proportion, firft, to the degree of it applied ; fecondly, te the fenfibility of the part on which it aas ; and, thirdly, to the extent of that part ; it will be no woneTer, that thefe two powers fhould prove the moft formidable of all others. Hence it is, that, in the curative part, bleeding is the moft powerful remedy of fthenic, and filling the veffels an equal one, of afthenic diathefis. (/). Which aa by giving vigour to the whole fyftem, and more efpecially to the flomach, with which they come into aaual coa- taa. Hence digeftion, and the converfion of the matter taken in into good chyle and blood ; and hence, at laft, the fulnefs of the veffels firft indicated. The procefs of emptying the veffels in the cure of fthenic diathefis has the advantage of being the firft in order ; and hence it is that the cure of fthenic difeafes is more quickly effeaed than that of the afthenic, it being, over all naturei much more eafy to take away than replace. See and compare paragraph CXXVI. and CXXX. and fubjoined notes, and a little , above, par. CCLXVI. ! (z») 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, «fter the excitement is fo far reftored, that the or- dinary fupports are now fufficient, to lay afide the extraordinary, the continuance of which would now be hurtful, and to manage the eonvalefcent, and reftored, ftate of health by the powers em- ployed in health. When the diffufible are continued longer, they are equally hurtful, and a caufe of difeafe, as they are ferviceable 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 fupports ; but, analogous to it in another refpea, when the ftrength of the fyftem requires not their addi- tional ftimulus, they carry it up into indirea debility, and prove the caufe of difeafes and death. In one word, whatever has been feid againft the propriety of the ufe of exceffive, and ultimately exceffive Chap. VIII. OF MEDICINE. *ss CCLXXIII. In a weak ftate both of the veffels and of the reft of the body, every confiderable motion of the body, and all other ftimuli, which quicken the motion of the blood, and bring, on temporary indired debility, fhould be avoided. But in (lighter debility, fuch motion as does not prove fatiguing, but ads as an agreeable ftimulus, and refrefhes, fhould be enjoined. During convalefcence, the patient fhould be gradually brought back to his ufual plan of life ; nor fhould it be forgotten, that, till this is done, health is not com- pletely reftored. CCLXXIV. The debility, which an under-propor- tion of fecreted fluids, or a degenerate, though plentiful . ftate of them, produces in the excretory duds, is re- moveable by the ftimulant plan of cure (CCLXXII.) not by antifeptics. CCLXXV. The remedy for that fort of ftimulus, which arifes from either intenfe or conftant thinking, is either an abatement in the degree of thinking, or elfe fuch an exertion of the intelled, as by exhauitlng the excitability, fhall prove indirectly debilitating. This laft expedient, however, though it may be adapted to the ftate of predifpofition, is by no means fafe, after the difeafe has once made its appearance, and efpecially if it be violent ; becaufe no benefit can refult from it, till a degree of excitement, that would probably prove • injurious, has been raifed by the ftimulus. CCLXXVI. In exceffive ftimulant powers, the former producing fthenic diathefis, and the latter indirea debility, all that applies, with propriety, for the difcontinuance of the ufe of diffufible ftimuli, when the dura- ble are now fufiicient for the purpofes of the fyftem. And another argument, that ftill remains againft the fuperfluous ufe of both the diffulibles and ftrong drink, when debility requires not their ufe, ' is, that, independent of death, or even difeafes, being their imme- diate confequence, predifpofition to difeafes muft ; confequently, as the fyftem muft at laft be worn by ftimuli, all the unneceffary, that is, all that do not contribute to that middle vigour, in which found health confifts, fhould be avoided. k^O THE ELEMENTS Part II. CCLXXVI. In order to cure a flight fthenic dia- thefis, fuch as occurs in predifpofition, and to prevent dileale, habitual paffion fhould be avoided ; but the removal of adual difeafe requires the firft guft of paffion to be prevented. Excefs of paffion, upon ac- count of the intermediate danger of ftimulating too much, is by no means to be thought of, as the means of inducing indired debility. CCLXXVII. Where debility depends upon excefs' of mental exertion, or upon a languid ftate of the in- telled, the excefs fhould be diminiihed, the languor removed, and an agreeable train of thinking promoted; without which latter, however much all the other ftimulant powers may have been employed, it may be depended upon, that perfed health, in every refpcct,1 will not be reftored•(«]. CCLXXVIII. In j. ■ («) The ftate of the intelleaual funaion has a great influence^'1, upon that of excitement ; and, often, when all other fiimuli have' been applied in due proportion, the deficiency of that fingle flimu^ Ius will point out a want in the proper meafure 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 j; hence all the fine feelings of the belles lettres; hence, in youths the ardent keennefs to be acquainted with the learning, wifdodfl and elegant produaions of the ancients, as well as of thofe, who have made a diftinguifhed figure in later times; hence the enthu.f fiafm, fo natural to the human feelings, to out-ftrip others in every j mental excellency : The arts, the fciences, every department of human knowledge, are all the effeas of that intelleaual pro- ) penfity. How happy would it be for mankind were this noble ftimulus duly cherifhed ! What benefits, which fociety is deprived \ of, would not accrue from a proper cultivation of it ! How fine was that feeling in Julius Caefar Scaliger, when he declared he would rather be the author of Horace's ftw 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 mathematical ele- ments, commonly called Euclid's? He jumped about in an ecftacy, crying out / have found it, and was fo much more fubftantial than fome of his few brother difcoverers, as to poffefs the means of offering Chap. VIII. OF MEDICINE. 257 CCLXXVIII. In every degree of debility, fuch force of paffion, as produces indirect debility, muft be avoid- ed ; nor muft it be forgotten, that a very fmall degree of it is fufficient for this effed : we are not even to in- dulge agreeable paffions too freely (o). CCLXXIX. When there is a deficiency of paffion, as in fadnefs, grief, fear, terror, and defpair, which are onty inferior degrees of gladnefs, confidence, and hope, and imply only a diminution of exciting paffions ; the deficiency 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 Introduaion. 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 fublime, conceptions of human genius ! What muft have been the fire and force of Milton's foul, in the defcription that he gives of the ap- pearance of the Son of God in his celeftial panoply, " his counte- nance too fevere to be beheld !" How towering that foul, how exalted that intelka, which the great marquis of Montrofe dis- played in a ftratagem, which converted into a glorious viaory 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, finding in the centre of his army, that one of his wings was over- powered, he fhouts out to the commander in the other : " My Xord Aboyn, fhall you and I ftand here doing nothing, and M'Donald carry off all the honour of the day !" .9 (o) See above, par. XLIII. and CXLI. Recollea the method , prefcribed in the XLIII. paragraph of this work for preventing '. the fatal cataftrophe of the Roman woman, when her fon, whom | fhe had counted upon, for certain, in the number of the dead, was, contiary to every expeaation, prefented to her in perfea health. The danger and fatality of her ftate was, that her excitability was too accumulated, with refpea to the ftimulus of exciting paffion, to bear fuch a ftrong impreffion as that which the prefence of hsr 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 affeaed with thirft, where the fmalleft indulgence in drink may prove fatal ; or of a perfon, nearly-flaivecffio death by cold, in whom a rafh approach to heat might induce the fame fatal effea; all which are precifely upon the fame footing, and equal inftances of an excitability too accumulated to bear any degree of ftimulus. I 2 25§ THE ELEMENTS Part\\- deficiency muft be fupplied, and the exciting degree'of paffion recalled ; hope and affurance muft be infufed, and the patient gradually carried up to the feelings of joy. 38. For there is a fum total of paffion, which ads in the fame manner as other ftimuli, that is, by ftimulat- \ ing either in excefs, or in due, or in deficient, propor- tion ; nay, like the reft, as often as any one is deficient:/ 1 by accumulating the excitability, it makes the other ftimuli ad more powerfully (XXXVII. and the note). Take, for inftances, the terror of an army before the trumpet founds for battle, and the courage with which they are afterwards infpired, by the confcioufnefs of their \ own bravery, the general's fpeech to animate themj or, perhaps, his commemoration of their former brave iJ deeds. n 39. Exceffive voluptuoufnefs in the exercife of the fenfes, as well as difagreeable objeds, fhould equally be avoided in afthenic diathefis y in fthenic diathefis, they ' fhould be guarded againft on account of the agitatiofiM they produce. ™ 40. Nothing is better accommodated to the afthenic ftate, than a pure air ; which, either alone, or joined with exercife, muft, confequently, be of the greateft benefit to convalefcents. j 41. Since the matter of contagion, in fo far as it has j any tendency to produce general difeafe, produces either^! fthenic (p), or afthenic, diathefis (q). and ads by an \ operation fimilar to that of the general noxious powers^ general remedies fhould be employed in the cure ; and debilitating ones oppofed to fthenic, ftimulant ones to afthenic diathefis. CCLXXX. Thefe powers, the fame in kind with 5 thofe that produce the diathefes, but differing in de- j gree (p) As in the fmall-pox and meafles. (?) As the contagious typhus, the gangrenous fore throat,: dyfentery, and the plague. Chap. VIII. OF MEDICINE. 2*g gree and in that refped diametrically oppofite, remove the diathefes feldomer, and lefs fuccefsfully, when fingle • oftener, and more effedually, when feveral co-operate' but, beft of all, when taken together, efpecially if there is occafion for a great curative effed. end of Vol. i. THE Elements of Medicine OF JOHN BROWN, M. D. Translated from the Latin, with Comments and Illustrations, BY THE AUTHOR. ■——■——» A NEW EDITION, REVISED AND CORRECTED. WITH A BIOGRAPHICAL PREFACE, BY THOMAS BEDDOES, M. D. « The coincidence of some parts of this work with correspondent |* deduaions in the Brunonian Elementa Medicinae—a " work -(with fome exceptions) of great genius—muft be con- " fidered as a confirmation of the truth of the theory, as they " were probably arrived at by different trains of reafoning." D&. Darwin, Zqonomia, p. 71J. VOLUME II. FROM THE LATEST LONDON EDITION. PORTSMOUTH, N. H. PRINTED BY WILLIAM cjf DANIEL TREADWELL, AT THE ORACLE PRESS. MDCCCIII. «%* THE Elements of Medicine. PART IL CHAP. IX. Comparifon of the different parts of the fihenic plan of cure with each other—Comparative efficacy of antifihenic remedies—Of bleeding—Of cold—Of vomiting, purg- ing, and fweating—Spare diet—Reft—Conjundion of remedies—No remedies adapted to fymptoms—Indired debility to be obviated. CCLXXXI T"^ ^e ftnen'c diathefis, bleeding is J[ the moft powerful of all remedies; becaufe it completely carries off a ftimulus, fo much more powerful than any other, as it is directly applied to a greater extent of the fyftem : confequently, as often as the diathefis is very high, bleeding fhould be freely ufed ; but never rifked during predifpofition ; and fparingly, or not at all ventured upon in difeafes of a mild nature ; in thefe other remedies fhould be pre- ferred (a). CCLXXXII. The (a) See above, par. CCLXIX. With the exception of perip- neumony, phrenitis, and violent and mifmanaged cafes- of the fmall-pox and meafles, and rheumatifm ; in the laft in their mild ftate, as well as all the other fthenic cafes, the lancet fhould never be unfheathed. That is to fay, in feven cafes out of ten even of the fthenic difeafe*, which are the only ones that either require or bear any degree of it, the praaice muft be laid afide, and never thought of in any afthenic affeaions whatever. Confequently, the cafes, where it is in any degree allowable, are exceedingly few. £64 the Elements Part 11. CCLXXXII. The next place to bleeding, when heat and other ftimuli are guarded againft, is claimed by cold. Heat is always hurtful, but ftill more after the application of cold ; it is moft hurtful, when it is com- bined with other exceffively ftimulant powers. Cold is always offervice, in proportion to its degree ; pro- vided foreign ftimuli, blended with it, and overcoming its debilitating effed, be cautioufly fhunned. CCLXXXIII. The third place in rank belongs to vomiting, purging, and fweating. Thefe evacuations have a powerful effed in removing fthenic diathefis, and therefore they, with great advantage, fupercede the oftener imaginary than real neceffity for profufe bleed- ing. They are frequently alone fufficient to reftore the healthy ftate. CCLXXXIV. When thefe remedies are employed, thofe articles of diet, the ftimulant operation of which prevents the benefits to be received from them, fhould' be fparingly ufed, in exad proportion to the degree of the diathefis. This precaution alone is adequate to the removal of predifpofition, and often to that of difeafes, efpecially thofe that depend upon a fmall diathefis. CCLXXXy. With all thefe remedies we.muft con- join reft, when the difeafed ftate has taken place, and moderation in motion muft be obferved during the period of predifpofition [b). CCLXXXVI. The pradice of the common run of phyficians is very bad, in trufting too much to any one of the remedies that have been mentioned, and over- looking all the reft, or enjoining them carelefsly. We are not to depend upon bleeding alone, even in perip- neumony itfelf ; but employ all the reft either in con- couife or fucceflion. CCLXXXVII. The (3) So confiderable a ftimulus is exercife, that, 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 effeft the converfion of the predifpofition into the aaual difeafed ftate. Often has the higheft of thefe difeafes, and even peripneu- mony itfelf, been brought on by violent exertion in exercife. i Chap. X. of medicine. 26c CCLXXXVII. The difturbed fundions, or thofe ?raVtrfr ^paired (fee abovc' Par' CXLVII. CLI. CLAXII.) but not by a debilitating caufe, admit of the general plan of cure, and no other. • CCLXXXVIIL The fymptoms of debility, which arife in the progrefs o£the difeafe from the "Violence of the fthenic diathefis, and threaten death from indirect ; debility, ought to be prevented by an early application of the remedies* CCLXXXIX. The fame early attention ferves to \ prevent fuppuration, effufion, and gangrene, which arife from ultimately exceffive excitement, palling into f indired debility. t 42. If fthenic diathefis fhould happen to be conjoin- ' ed with a local difeafe, the former, to prevent it from | aggravating the latter, fhould be removed by its own refpedive remedies. CHAP., X. Comparifon of the different parts of the afthenic plan of Ecure with one another—Reprodadion of a due quantity of blood—Management of ftimuli—Heat—Diffufible ftimuli—Diet—Opium — Wine— Spirits—Exercife— Management of the mind. CCXC. IN afthenic diathefis, and the difeafes de- pending upon it, to reproduce the proper quantity of blood is the moft powerful remedy, when we, at laft,, [ have accefs to it, as it is the only means of reftoring a ftimulus of fo much the more power and efficacy as its dired application is made to fo great an extent of the *" fyftem (a). For which reafon, as* in every degree of! debility, (a) Compare this with par. CCLXXXI. above, and with all the paragraphs from CXXXI. to C&CXVI. K z 266 THE ELEMENTS PartU. debility, the quantity of food (from which alone blood is made, that is taken and digefted, is always in an in- verfe proportion to the degree of debility, or in a direct proportion to the degree of excitement, as much, in fuch a fcrm, as can be taken and digefted, fhould im- mediately, and without lofs of time, be admmiftered ; on which account, if the debility be moderate, folid animal food, fparingly at a 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, flefh broth, as rich as poffible, and as free from fatty matter, fhould be carefully adminiftered. With a view to excite the ftomach, and render it more fit for receiving and digefting this kind of food ; the diffufible ftimuli, fuch as different kinds of wine, and, more particularly, ftill, opiates and other remedies of fimilar efficacy, ought to be conftantly employed^ fparingly at firft, and afterwards more fully, if the de- bility be dired : after which, the ufe of the diffufible fhould be gradually laid afide,and,in the fame gradual way, recourfe be had to a larger and larger ufe of the more durable and natural ftimuli. In cafe of indirect debility, we fhould alfo gradually d'efcend from the higheft to the loweft ftimulus, as has been mentioned formerly, and, in an inverfe manner, go on from the fmalleft force of durable ftimulus to the greatefk Laftly, in that moderate debility, which conftitutes the predifpofition to afthenic difeafes, it muft always be kept in mind, that abundance of blood is the greateft fupport of health (b), and that we are not to give way to a weakened appetite (c). CCXCI. To (b) How widely different is this maxim from any that have hitherto ever been received in the profeffion of phyfic ; in which flying to the ufe of the lancet, was the firft thought that arofe in the miad, with refpea to the idea of cure of every difeafe ; and bleeding and evacuations, through the courfe of each difeafe, the only remedies! (c) This is equally the reverfe of the general praaice of inani- tion ia almoft every difeafe, without a Angle exception. Chap. X. oe medicine. 167 OCXCI. To the vital fluid, and thefe feveral means of increafing its quantity, the next remedy in the cure of afthenic diathefis is heat ; as being the power by which animals and vegetables are brought forth into exiftence, are nourifhed, and acquire vigour, and after- wards, through the feveral ftages of their decline, are upheld, till their excitement is all extinguifhed (d). By heat, underftand that point of external temperature, which intervenes as a mean betwixt cold, as it is called, and high heat, ardor ; under which our fenfe of tem- perature is agreeable and pleafant ; under which the body is neither indiredly weakened by that relaxation which produces fweat, nor diredly by that torpor or t>enumbed ftate which cold begets ; under which the 4undions of the whole body are excited, called forth, and, as it were, cherifhed in the fun beams; without which all other ftimuli are of no effed (e).. CCXCII. Such a temperature as this is fuited to every ftate of the body, but ftill more to different ftates of debility ; hecaufe, in the latter cafe, as the excite- ment is deficient from other fources, there is fo much more occafion for this ftimulus, which is much eafier come at than many others, to fupply the deficiency. Hence, both in other difeafes of great and dired de- bility, and particularly in fevers, heat is found to be of the greateft fervice, and above all in fuch febrile com- EjJ plaints as cold has had any fhare in producing (/). In it-* thefe difeafes cold muft be moft carefully avoided, as it is always of a diredly debilitating (Operation, and never of fervice but in fthenic difeafes, and thofe that Id) Compare this with par. CXII. and CCLIV. and CCLX. \e) It is plain, that though all the other powers fhould be in full aaion upon our bodies, and that with the effea of keeping iip 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 certain* ly, in an in ft ant, put an end to life. (/) Sec again par. CCLX. 268 THE ELEMENTS Part H. are in progrefs to indired debility {g)% We muft be equally on our guard, in every degree of afthenic dr^ thefis, againft exceffive heat, which is equally debilitat- ing with cold, and equally produdive of atony, laxity, and gangrene of the veffels, as well as ftagnation and corruption of the fluids in confequence of the madive ftate of the veffels (h). CCXCIII. As refilling the veffels is the beft remedy, becaufe its dired ftimulus is applied over fuch an extent of the fyftem ; heat, which is immediately applied to the whole furface of the body, arid diredly affeds the body to that extent, muft be next in virtue to it. CCXCIV. Since vomiting, purging (/), and fweat*-' ing (k)y 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 in afthenic diathefis, and the ftimuli^ that ftop their operation ; and, confequently, both the t other ftimuli, and particularly the diffufible ones, equal- ly ferviceable. CCXCV. In reviewing the lift of ftimuli, that anfwer this purpofe, we muft begin with the treatment of the fighter lofs of fluids that occurs in this fet of y, in tthkh the loofe ftools arc accompanied with vomiting ; or when, without thefe troublelome fymptoms affrding the belly, diftreffing vomiting is an urgent fymptom ; or, when the vomit- ing is conjoined with a moifture upon the furface, or jnacerating fweat ; or when lweat'is the only urgent fymptom, and as fuch waftes the ftrength, exhaufts the body, and d'ffipates the fluids : in all thefe cales, we muft have immediate recourfe to the moft diffufible ftimuli, and check fuch an impoveniijnient of the fyftem. CCXCVII. In this cafe, the ufe of ftimuli will be fo much the more neceffary, as other fymptoms ufually I accompany thefe increafed excretions. Their great ^efficacy, and ftimulant power, are proved by their Angu- lar virtue in removing thefe and other fymptoms in fevers and the other moft violent afthenic difeafes, nay, in the article of death itfelf, from ultimate debility. CCXCVIII. Accordingly, in fpafms and convulfions in the internal or external parts (m), in difcharges of blood («), in the raging delirium of fevers and other fyery violent difeafes (o), in afthenic inflammation (p) 5 when (I) See and compare, for the more clear underftanding of this pawgraph, the CCLXVI. CCLXVIII. CCLXXIII. (») See par. CXCV. and CXCVI. ;# j«) See par. CXXXIV. 22. 23. and CCXXXII. and the-fiuV Joined notes. fo) See par. CXCVIII. CC. CCI. >) See par. CCIV. to CCX.II. I S&70 THE ELEMENTS PartU. when thofe ftimuli, which have a more permanent-in- fluence, fail, the virtue of the diffufible ftimulants, the - principal of which is opium, is eminent. CCXC1X. As therefore, the energy of its ftimulant virtue ferves to check diarrhoea, and vomiting, or even fweating, when thefe fymptoms are gentle, and depend upon a lefs violent caufe ; fo that degree of its power, which is fitted to check thefe affedions in the greateft height of their violence, and to re-eftablifh the ftate of health, is by far the moft confiderable of all the powers, which are ever applied to the human body ; as may be deduced from this, that when the adion of all the other powers by which life is fupported, is of no effeft, it turns afide the inftant ftroke of death, CCC. The weakeft of the diffufible ftimuli (er) are the white wines, except madeira, canary, good fherry ; and the red wines, except port ; and fpirits procured by diftiflation, fo diluted, as to equal the ftrength of the wines, or exceed it a little. Still higher than thefe are fpirits taken pure, and higher ftill, thofe that have undergone many redifications. The ftrength is in proportion to the quantity of water expelled, and of alcohol retained. CCCI. A higher place in the fcale is claimed by mufk, volatile alkali, camphor (though with the laf? our experiments are not yet fo complete, as to afcertain its force exadly ) : next comes sether, andr laft of all*, opium. Unlefs, however* as they fometimes do, they have loft their effed by a continuance of application and are, therefore, fubftituted in place of each other; for the fake of a renewal of the operation of each ; and hence we take them all round, for the fake of repelling extreme debility. The preparations of opium, in every refped, are fufficient for moft purpofes of high ftimu- lation. • CCCII. Together with thefe remedies, regard muft be had to the articles of diet. And, as in great debili- ty, {q) See above, par. CXXVI. 15. 16. 17. 18. Chap. X. OF MEDICINE. IP ty, and the difeafes depending upon if, of the only fuitable matter, that is, meat, nothing folid can be taken ; the matter to be ufed muft be fluid, but ftrong. Along with the diftufible ftimuli, jellies and animal foups fhould be given, fparingly at a time, but repeat- edly, in proportion to the degree of debility. After that, when, chiefly by means of the diffufive ftimuli, the ftrength is in part reftored ; at firft folid meat fhould be likewife taken in fparing quantities, but often repeated ; then more plentifully, and at longer intervals. In which progrefs the patient fhould gradu- ally recede from the ufe of the diffufible ftimuli. CCCIII. When the diffufible ftimuli are altogether laid afide, and the convalefceflt is given up to his ufuai diet, and his ufual courfe of life, and to that manage- ment, which perfons in health commonly obferve, (only that more care is taken, than in perfed health, to avoid any thing that might prove hurtful) ; then it is, that every attempt of the phyfician fhould be direded to the confideration of the ftrength of his patient, as re- turning, but not yet quite eftablilhed (r). In his movements he fhould firft ufe geftatiorr, and then gentle but frequent exercife, and the latter fhould always end in fome, but not an high, degree of fatigue. Hts fleep ftiould neither be too long, nor too fhort, left the former1 produce dired, the latter indired debility (s): the mofi: nourifhing food fhould be taken, but not in too large a quantityr left the excitability of the ftomach be worn off, without the attainment of a due degree of \Tgour; but food fhould be frequently taken, rn order to reduce the excitability gradually to its half wafted ftate (/), in which alone it is capable of giving due vigour ; that degree of heat, which ftimulates, fhould be employed [u), and both excefs of heat, as well as cold, as they are (r) See above, par. CV. and CIX. (/) See par. CCXLIf. and the following. (f) See par. XXIV. XXV. XXVI. («) See par. CXJI. Ifl THE ELEMENTS Pari 11 are equally debilitating, fhould be avoided ; the patient fhould breathe pure air, and avoid impure ; he fhould keep his mind in gentle adion, obferve moderation in his paffionsj and court agreeable objeds of-fenfe ; he fhould have no companions around him, but agreeabld ones, and be frequently at gay entertainments ; he fhould travel through a pleafant country, and be moderate in the indulgence of love. Neither is the management of the fenfes, and the prevention of the return of contagious matter," to be negleded* CHAP. XI. How the remedies fliould be varied—Principle on which they fhould be combined—Bleeding debilitates the veffels chiefly—Purging, the bowels—Vomiting, the ftomach-* Cold, not alternating with heat, the fkin—How all thefe powers are to be direded to the equable redudion of ex- citement—and the oppofite powers to an equable increafi of excitement, in afihenic difeafes. CCCIV. AS the noxious powers, that produce pre-* dilpofition to difeafes or difeafes themfelves, ad fomU on one part, fome on another, with fomewhat more force than on any other equal part ; and as this part is commonly that to which they are diredly applied (a); fo the powers, which are employed as remedies, in order that their general effed may reach the whole body with the more certainty, fhould be, in the fame manner, differently applied to different parts. CCC V. 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. The reafon is, that, though the e*ertabrrrt}Ss fufficient- ly reduced by that remedy in the greater blood-veffeb, • perhaps (a) Tar. XLIX. Chap. XI. of medicine. 273 perhaps too much,.yet in the extremities of■ thefe, as well as in the reft of the body, it is not fufficiently re- duced (b). Nor is the alternation of bleeding with purging a perfed mode of cure ; becaufe, though the exceffive excitement be fufficiently, and more than fuf- ficiently, removed in the greater blood-veffels, and in the innumerable fmall arteries, whether exhalant or mucous, which difeharge their fluid into the inteftines; yet, neither on the perfpiratory terminations of the arteries, nor on the reft of the body, is an equal debili- tating energy exerted : the fmall veffels, for inftance, which open into the ftomach, are not fufiiciently reliev- ed of their diftending load , and therefore ftimulating load, the ftimulus in any veffel being the quantity of its fluid. And although vomiting (c), which has been ^improperly negleded in the treatment of fthenic dif- eafes, and ftill more improperly employed in every one of the afthenic, fhould be conjoined with the two remedies juft mentioned, even this would not be enough to produce an equally diminiihed excitement; as there would ftill remain in the perfpiratory veffels, the fame ftate of excitement, as alfo in the reft of the body, that is not vafcular. In violent fthenic difeafes, therefore, after diminifhing the diathefis, and in the flighter from the beginning of the difeafe, the addition of the opera- tion ; (b) The aaion of every exciting power, whether falutary or hurtful, or curative, always extends over the whole body, the whole feat of excitability, but ftill with the inequality mentioned in the fourth chapter of part the firft. This is the bafis of the diftinaion with refpea to the prefent fubjea : which is, that, as every power aas moft effbaually on the part where its aaion is immediately exerted, it is better to truft to a number, every one of which pofTeffes that advantage, than rely on any one, however powerful otherwife ; as by that means, whatever be the indica- tion, whether it be to increafe or diminifh excitement, the effea will be more equally produced over all in confequence of there being a numfler of parts that have had a ftrong aaion exerted upon them. (c) See par. CCLXIX. La 274 THE ELEMENTS /ty1/IT. fion of fweating to the evacuations that have been fpoken of, will produce a more equal diminution of excitement, and a more perfed 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 furface of the body, an immenfe quantity of fluids, every where diftending, and, thereby, producing a very great fum of excitement, is withdrawn. Nor is this all. For, fince in flight fthenic affedions, the patient can take much nourifhing food, and in them all, too much ; the confequence muft be, that, how- ever the quantity of blood and other fluids has been cjiminifhed, if food, which is the only power that can produce blood, continues to be taken, all the veflels, in proportion to the quantity that has been taken, wilt again go on to be filled, and to be fired with the fjStel of exceffive excitement. To prevent this inconveni- ence, and to diminifh excitement, with fttfl greater equality over the fyftem ; abftinence, or a certain al- lowance of vegetable matter in a fluid form, and watery clrink, will have a very great effed. Nor is this fuf- ficient. For, if, after taking all the precautions and fecurities that have been recommended, the degree of heat, that proves hurtful from its ftimulus, be allowed ;f to approach the external furface of the body ; it will *j produce another inequality of excitement, however f much it may have been properly and equally diminiih- ed by the other means of cure. Wherefore, as the . fthenic diathefis depends fo much upon the ftimulus of heat, diredly affeding the flyn (d)', and is, on that ac- count, prevalent in the fkin in preference to other parts> to. make fure of rendering the diminution of excitement* as equal as poffible, the debilitating effed of cold fhould be oppofed to the high degree of excitement, which the heat has produced. When, at laft, all the diredions, which have been thus fully pointed out, have been executed „ (<0 See par. CXIII. Chap. XI. OF MEDICINE. 275 executed, ftill, to re-produce the equality of excitement, futted to good health ; it remains, that we be ori our guard againft the ftimuli that arife from the intelledual fundions and paffions. For, as they have great effed in producing fthenic diathefis (e), fo the prevention of them, muft be equally effedual in removing that dia- thefis, and in re-producing that equality of excitement, upon which health depends (/). CCCVI. If the cure of fthenic difeafes hitherto has confifted in bleeding, purging, and in the ufe of refrige- ration in a few cafes ; and, if the other objeds, which have now been fo fully explained, have either been totally negleded, or mentioned in a flight way, by the by, and as if of no confequence, and, in the treatment prefcribed in thefe cafes, not reduced to any principle ; it will eafily appear, from what has been faid above and in other parts of this work, how much the knowledge of thefe difeafes has been improved, both in the pradi- cal and reafoning part : and it will now, at laft, be found a certain and eftablifhed fad, that both the nature and true theory of fthenic difeafes, as well as the method of treatment, confidered either as an art and imitative, or as rational and fcientific, has been dif- covered and demonftrated. CCCVII. As the debilitating or antifthenic (g) remedies are the fame with the afthenic noxious powers (^t); fo the afthenic remedies (i) are alfo the fame as the fthenic noxious powers. 43. And () See par. CCCIV. to CCCVII. the prefent one, (/) See par. XCI. tj6 THE ELEMENTS Part II. 43. And as the remedies of afthenic diathefis, to whatever part they are applied, alfo ftimulate that part more than any other; fome of them one, others another part, and increafe 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 ftimuli a>ne (k). For, while they indeed in- creafe excitement over the whole body, at the fame time, they produce this effed in the ftomach with , greater force than anywhere elfe. Hence, even from the beginning of the cure, when ha'cily any food can be taken, and other durable and more natural ftimuli (/) are moft imperfedly applied ; yet, together with the diffufible ftimuli, foups (m) fhould be given, and as much hafte as poffible fhould' be made to bring the " patient to take folid meat, while care, at the fame time, ihould be taken to apply a proper degree of heat. For, by this method, we moft effectually fecure both the internal and external furface. Nay, in the fame way, we remove that inanition of the veffels which takes place in afthenic difeafes in an exad proportion to their degree. For, though in cafe of that abundance of blood, which is the moft powerful means of bringing «s on fthenic difeafes, there is an opportunity of making a quick cure by the immediate taking away of blood ; it is only by infenfible, gradual, imperceptible, and un- perceived fucceffive fteps, that we can obviate that penury of blood, which is the moft noxious power in afthenic difeafes, and replenifh the veffels. CCCIX. After this management of both futfaces of the body, and this partial filling of the veffels ; ftill the excitement is not equally enough increafed. To promote this effed, fome very diffufible ftimulus, fup- pofe (k) See par. CCCI. (/) As that of pure air, exercife, the ftimulus of the motion of the blood and other fluids in their refpeftive veffels. {m) See par. CCCII. Chap. XI. OF MEDICINE. 277 , pofe any preparation of opium, fhould at the fame time be adminiftered, and the little animal food, or meat, that there is any appetite for, and that can be digefted, fhould be added. The method of giving food is evi- dent from the late explanation about foups (fee par. CCCVIII.) But, the ufe of the more durable, and lefs diffufible, ftimulus depends on this, " that when the excitability is worn out by any one ftimulus, any new ftimulus finds excitability, and draws it forth," and , thereby produces a further variation of the effed. CCCX. Hitherto, for want of the adion of thofe mufcles, which, from their firuation on the furface of the body, propel the blood along the veins towards the heart, as well as from the inanition of the veffels, the !/; excitement has remained too languid over that whole trad. Therefore, after the ftrength has been fo far re- organs, of which the former is cilled geftation, the latter exercife, and alfo refrefhed by air ; when all this has been accomplifhed, the excitement will rife in feveral jr points, and become more equal upon the whole. CCCXI. The laft ftimuli, which, along with thofe already mentioned, have a natural tendency to produce an equalization of excitement over the whole fyftem, !,- arife from the adion of the mind, the energy of paffion I or emotion, and a ftill greater purity of air, than is ? attainable by perfons fhut up in a room (»). To this ftate of convalefcence, the fame management, which was formerly direded during the decline of fthenic difeafes, perfedly applies {0). CCCXII. This 1 («) See and compare with thefe laft mentioned ftimuli the following paragraphs CCLXXV. CCLXXVIII. CCLXXIX. 38. (0) The convalescent ftate from either of the two general forms of difeafes, or from local ones the effea of which had drawn the whole fyftem into confent, is much the fame ; being a ftate of fome remaining debility in all ; in the fthenic from the excitement a7« THE ELEMENTS PartU. CCCXII. This ftimulant plan of cure, in all its parts, is new, whether the reafoning part, or the merely pradical, be regarded ; and, whether the caufe and the exciting noxious powers, or the indication of cure and the remedies, be confidered. May it not, there- fore, be put as a queftion, whether the whole dodrine, which has here been delivered, has not, at laft, brought forward clear proof, that the art of medicine, hitherto conjedural {p}, inconfiftent with itfelf, and altogether incoherent, is now reduced to an exad fcience, proved 'not excitement either going too low, by the remedies being puftied to fome excefs, or not equally diffufed over all the parts in confe- quence of the natural fupports only beginning to be brought fully into play ; in the afthenic from the perfea point of health being not quiie gained, either from the ftimulant remedies not having' been carried exaaly up to 40, or from fome of them having been carried further than the wafted excitability could receive them with invigorating effea, and thereby an inequality left upon the whole. The convalefcence, from the general effeas upon the conftitution fometimes arifing from local difeafes, is to be ex- plained upon the principles laid down, with refpea to the two other cafes of convalefcence. (p) Celfas fays, ars noftra conjeauralis eft. And every man of fenfe, whether of the profeffion, or out of it, has held the farrfe "ieniiments of it. Nothing is more glaring than the contradiftioos 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 the detail, while they refl«a on it, both illuftration and confirmation, be entitled to be confidered as a fcience, the reader is defired to con- fider, how far that criterion will apply to this doarine. The pedantry of mathematicians has contributed as much to bring that fcience into difgrace, as any other circumftance, particularly in allowiug no fort of probation, but that which is made out by lines and diagrams ; while, except the elements of that fcience, every application of that department of knowledge has led to as many falfe conclufions as any other. If they will not allow the proof, that arifes from our feelings, compared with thofe of all men, whofe organs of fenie are not deranged, what will they make of their own axioms 1 They muft admit of other probation ; while human reafon holds its reign, truth and falfhood will be dif- criminated, without regard to fuch empty and ufelefs prepoflefEons. Chap. XII. OF MEDICINE. 2"'9 not by mathematical principles, which is only one kind of evidence, but by phyfical ones, and eftablilhed by the certain teftimony of our fenfes, nay, and by the very axioms of the mathematical elements ? CHAP. XII. As the adion of all the other powers, that ad upon livin* bodies, is the fame, that of the remedies is alfo the ■ fame. < CCCXIII. IT is certain and indubitable that the exciting powers have one common efted. They pro- duce the phenomena peculiar to life—perception, motion, intelledual operation, and thinking. For what elfe, I afk, but to excite and fuftain thefe com- mon animal fundions, is the effed of heat, of food, feafoned or unfeafoned, of the blood, of the colourlefs fluids fecreted from the blood, and of the air, among '? external bodies ?—Among the fundions themfelves, f Ijave not mufcular contradion, thought, the pafTicns., and fenfation, the fame effed ?—Now fince it is an univerfal law of nature that the fame cs.ufe produces the fame efted, it is evident that the mode of operation of the feveral powers above enumerated muft be the fame (a). Moreover, as their operation confifts fold7 in ftimulating (b), and as ftimuli, therefore, produce ail ;■■ the phenomena of life—health, difeafe, and the in'ir.- J. .mediate degrees of predifpofition (c) ; it muft be ad- mitted, that the operation of the remedies, both in fthenic and afthenic difeafes, is the fame. For, if there is no difference betwixt health and fthenic difeafe, ex- cept an excefs of excitement in the latter, and nope betwixt (a) See par- XX. with the annexed note. . (b) See XIX. and XXII. . (0 See XXIII. 280 THE ELEMENTS Part it. betwixt health and afthenic difeafes, but deficient ex- citement in thefe laft, what elfe can the operation of the remedies, in removing fthenic difeafes, be, but to diminifh, and of thofe that remove the afthenic, but to increafe the excitement id) ? CCCXIII. Whatever thing produces the fame effed as another, or feveral other things, muft be the fame thing as each of them, each of them the fame thing as it, and every individual of the whole fet the fame thing as every other individual. 44. In fthenic difeafes, bleeding (e), vomiting, and purging (/), fwcccting, abftinence (g), reft of body and mind (//), tranquility with refped to paffion,all reftorfc- health by nuthing elfe but a diminution of excitement. CCCXIV. In afthenic difeafes, the adminiftration firfr of diiibfible ftimulants, for the purpofes of gradual- ly bringing back the appetite for the greateft remedy, food, as well as of keeping the food upon the ftomach, and of affifting in the digeftion of it (/'), then the appli- cation of heat (k), then the ufe of the lefs diffufible and more durable ftimulants, as animal food without and with feafoning, wine, geftation, gentle exercife (/), 1 j moderate fle.-p, pure air, exertion of mind, exertion in paffion and emotion, an agreeable exercife of the fenfes, *I all thefe reproduce health, by no other operation, but 1 tfut only of increafing excitement. CHAP* (d) SeeLXXXVIII. (e) See CCLXXX1. (/) See CCLXXXIII. (g) SeeCCLXXXIV. \h) See CCLXXXV. (0 See CCXCIV. to CCCII. \k) See CCCII. (/) See CCCII. to CCCIII. Chap. XIIL OF MEDICINE. 28l CHAP. XIII. That all the powers, which fupport any fort of life, are the fame, or the fundamental principle of agriculture. CCCXV. AGAIN", are not the powers, which pro- duce perfed health, the fame as thofe, which, by excefs of operation, produce fthenic difeafes ; by deficiency of operation, afthenic ; as well as the predifpofitions to both ; are they not the fame, I fay, without any varia- tion but of degree (a) ? CCCXVI. Further, as we learn from the whole dodrine delivered above, the noxious exciting powers, which produce fthenic difeafes, are the remedies,of afthenic ; and thofe which produce afthenic, are the remedies of the fthenic (b). CCCXVIL All the powers, therefore, that fupport any ftate of life, are the fame in kind, only varying in degree ; 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 noxious exciting powers (e) ; in the cure of both their indications, and remedies adapted to each (/); all this, in every refped, is precifely the fame in plants. CCCXIX. The powers that fupport plants in every ftate of life, are heat, air, moifture, light, fome motion, and their internal juices. CCCXX The (a) See XXIII. LXXIII. \b) See LXXXIX. XC. XCI. XCIII. XCIV. (c) See from X. to XIII. inclufive. (4 See LXII. LXV1I. LXVIIi. LXIX. LXXIIL CXI I. to an CXLVII. (e) See the fame. (/) See LXXXVIIL LXXXIX. XC. XCI. M 2 282 fflE ELEMENTS Partll. CCCXX. The adions of plants alfo are produced by ftimulus (g) ; by means of which, the phenomena peculiar to this foit of life, perception, fome motion^ and verdure, are excited : and the caufe of this ftate is excitement, an effed 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 adion occafions difeafes, «r predifpofition to difeafes ; of which one fet depends on ah excefs, another upon a deficiency of ftimulus* Accordingly, excefs or fcantinefs of moifture, exceffive heat or cold, equally lead to difeafe and death, indi- redly or diredly. And, as the rays of the fun or dark- nefs, when their operation is either too great, or too long continued, prove debilitating, the former indired- ly, the latter diredly ; fo the alternate fucceflion of night to day, of darknefs to night, feems to be the ef- fed 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 indired debility ; and an excefs, or long continuance of darknefs from producing dired debility, and the difeafes peculiar to it. We have no lefs proof, than that of the univerfal feeling bf mankind, of the truth- of what has been advanced, with refped to the ftimulus of light and the debilitating effed of darknefs. CCCXXII. Nor are plants without their excitabili- ty, which, equally as in animals, " is not different in '* different parts of its feat ; nor is it made up of parts* " but one uniform, undivided, property over the whole " fyftem (*).*' Confequently, to whatever part of a plant any exciting power is applied, its operation* whether in excefs, in due proportion* or in under-pro- portion, g) See XVII. XIX. and notes. b) See Part I. Chap. II. i) See Part I. Chap. IV. Chap. XIII. OF MEDICINE. 283 portion, immediately affeds the excitability over the whole. CCCXXIIl. This effed is alfo produced with the lame inequality as in animals ; being, for inftance, greater in that part to which its exciting power is di- redly applied, than in any other equal part. And, as there are two reafons for this effed in animals, the dired impreflion of the power upon the part more affeded, and a greater energy of the excitability of the part to which it is fo applied, than of that of any other equal part (k) ; the very fame is the fad with refped to plants. Further, as the excitability bears a greater re-i lation or affinity to the exciting powers, in the brain, the ftomach, and inteftines, than in moft cf the other- parts ; fo the part in plants, that correfponds to thefe moft excitable parts in animals, is the root, which is affeded in the higheft degree by the exciting powers. It is the root of plants, in preference to any other part, to which the conflux of moifture tends. The heat there is the moft congenial, being neither exceffive, and therefore liable to produce fthenic affedion, or ultimate- ly exceffive, and therefore ready to induce indired de- bility (both which difadvantages are prevented by a proper depth of foil) ; nor deficient, or what is called Cold, which would bring on dired debility (/), CCCXXIV. The only ufe of the foil, through the pores of which the powers that have been mentioned penetrate, it) See XLIX. and addition L. LI. {I) Hence it would appear, that it fhould be a general rule ill ploughing 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 fufely lie fuperficially in warm than in cold countries. The fame faa feems to be favoured by the difference of perfec- tion that planted and natural woods attain in cold countries ; the former, the feeds of which are lodged in a certain depth, turning to better account than the latter, which life fr#m feeds that have randomly been fcattered upon the furface. Might not the hills in the weft of Scotland, upon fome fuch principle; be made ufeful, eak forcfts ? 284 THE ELEMENTS Part 11. penetrate, is to furnifh a proper ftrainer ; fo that the powers may not, 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 indired debility; or, from the too great contradednefs of the pores, be inefficiently admitted to the root, and oc- cafion indired debility, or the decaying ftate of a plant. But that foil is not otherwife neceffary to the produc- tion of any degree 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 goodtj effed of ploughing, of breaking the clods, of dividing! the tough clay by lime and other abforbent earths, and by thefe means opening the icil : On the other-, hand, we have proof of this dodrine in the fuccefs of- condenfing the foil by making ground, naturally too friable, more tenacious with dung, and covering light ground with rags and ftones, and thereby keeping in both heat and moifture. CCCXXV. From this view of the fads, it is evident, why every fandy as well as clayey foil, when the former has not been made more tenacious, or the latter loofev ' muft be barren and unfruitful. Hence very hot fum- mers and countries are unfavourable to clayey grounds, by thutting up their pores ; and ferviceable to friable and lean grounds, by diminifhing their porofity. Hence," dry feafons are fuitable to low-lying rich grounds, to ,which, from all, quarters, a quantity of moifture is brought, and applied around the roots of the plants ; while rainy feafons are thofe that anfwer beft in grounds lying high and having a thin foil. Declivities facing the north, which have commonly a thin and poor foil, are cherifhed and proteded by hedges and clumps of trees, and by a great number of bare ftones, covering the whole furface, which fome perfons, of more induftry than fenfe, often remove with hurtful effed ; for they • are of fervice in preferving warmth and retaining moif- ture. But in thofe grounds, the declivity of which loo Is Chap. XIII, OF MEDICINE. 285 looks toward the fouth, there is not equal occafion for fuch protedion 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 winds which blow from the fouthern points and are feldom too dry [m). QCCXXVI. To* return, from this digreffion on agriculture, to our propea fubjed ; 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 nature is regulated by excitement, which the exciting powers alone produce ; that there is in no ft' living l)ftem, whether of the animal or vegetable kind, any inherent power neceilary to the prefervation of life ; that the fame powers which form life at firft, and after- wards^ 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 t generations of animals and vegetables are in this way v renewed ; that the fyftem of nature remains, and main- tains an eternal vigour ; in one word, that all nature has been fabricated by one fingle organ (»). There are many circumftances rendering it probable, that this globe has undergone great changes ; 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 than the organic V of (w) While the northern winds, that is, the wind due north, and all 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 towards the fouth, from the fame points of due eaft to due weft, are as commonly warm and moift, and often . produaive of mild fertilizing rains. (») 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 afferfion. See the Introduaion to my Obfervations. 286 THE ELEMENTS OF MEDICINE. Partll, of the refpedive form of each of its individuals. But whether minerals, like animals and plants, have a fort of life, fo as, after their manner, to be produced into living exiftence, to grow, equally with plants and arii- mals, to pafs a certain period without growth or dimi- nution of bulk, to decay, to die, and, in death, lofe their proper form ; the long duration of their age, and the fhortnefs of ours, deprive us of any poffibility of learning. CCCXXVII. All the motions of the planets, .which were formed to remain and continue their courfes for ever, depend upon this principle ; to proceed ftraight onward, according to the manner in which all projec- tiles move, and then by the influence of gravity, which affeds them all, to be drawn downwards, and, upon the whole, to perform circular motions. In the fmaller living bodies, with which thofe greater bodies are peopled, that is, in animals and plants, of which the fpecies remain, though the individuals of each fpecies die ; whatever is the caufe of their fundions, whatever gives commencement and perfedion to thefe, the fame weakens, and, at laft, extinguifh.es them. It is not, therefore, true, that fome powers are contrived by natuitf for the prefervation 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 PART THE THIRD OF GENERAL DISEASES. The first Form, or Sthenic Diseases. CHAP. I. Ciratmfiance common to all fihenic difeafes—Peculiarities —Phlegmafia and exanthemata—Circumftances they have in common—Their peculiarities—Rationale of the pulfe—Shivering— L affitude— Dry fkin— Excretions— Heat—Thirfi—Nature of the inflammation in phlegma- fia—General affedion precedes that of a part, and regulates the latter—Oppofite general affedions arife from the fame local accident, as a wound, Taken the diathefes, previous to the accident, are of an oppofite hind—Enumeration of the fihenic phlegmafia. CCCXXVIII T"^ ^very ftnenia> t0 *H fthenic dif- J eafes, to the whole firft form of difeafes (a), increafed excitement over the whole fyftem is a common circumftance : it appears, during the pre- difpofition, in an increafe of the fundions of body and mind {b) ; and, after the arrival of difeafe, in an in- creafe of fome of the fundions, a difturbance of others, { and a diminution of others; in fuch fort, that the two latter phenomena are eafily perceived to arife from the \A noxious powers that produce the former, and to depend upon their caufe. As by this common bond of union the difeafes of this form are conneded together; fo CCCXXIX. There are certain circumftances, by which they are diftinguifhed by a difference of their degree; (a) See above par. LXIX. LXXXVIII. CXLVIII. CLL CCLI. Chap. IX. (b) See par. CLI. throughout. 288 THE ELEMENTS Part III. degree : for, there are fome fthenic difeafes accompani- ed with pyrexia (c); fome with inflammation of an external part ; there are others without the latter of thefe, and others without both. CCCXXX. The general fthenic difeafes with pyrexia and inflammation, are fome of them called phlegmafia;, others exanthemata. But they will all, withdut any other diftindion* be treated here according to their rank in excitement, from the higheft to the lowefl: degree. CCCXXXI. The phlegmafise and exanthematie difeafes have the following fymptoms in common. That deg'ee of fthenic diathefis, that diftinguifhes pre- difpofition (d). This diathefis upon the formation of the difeafe, is fueceeded 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 tneir whole courfe, is moderately frequent, and, at the fame time, ftrong and hard : The fkin is dry, and there is a retention of the other excretions, as well as of per- fpiration (e) : The urine is red ; there is great heat, and often thirft. CCCXXXII. The fymptoms peculiar to the phlegm mafiae if), are an inflammation of an external part, or an (c) See par. LXVIII. and the fubjoined note, for the meaning *of pyrexia, which will be juft now repeated. id) From the rirft deviation from perfea health to the com- mencement of adual fthenic difeafe, the fthenic diathefis takes place in an increafing fcale from 400 to 55°. (e) Such as that by the belly, and that which pours out the faliva and mucus, and forms the matter of expeaoration. (f) The phlegmafise are fthenic difeafes accompanied with in- flammation in an external part, as has been faid fomewhere before, according to the definition of nofologifts. But, as there is no difference betwixt them and fynocha or the catarrh, which latter are unaccompanied with inflammation, we therefore pay no regard to the diftinaion ; and fhall regard nothing either in thefe or any other difeafes, but what is conftituted by a real difference of ex- citement. It is the excitement by which we are to be guided (through our whole diftribution of difeafes. Chap. I. OF MEDICINE* . 289 an affedion nearly allied to it ; while the general af- fedion, for the moft part, precedes this local one, but never fucceeds to it (g). This general affedion, for the greater convenience of diftinguifhing it from fevers, is to be denominated pyrexia (k). In the exanthematic fthenic difeafes, an eruption of fpbts or puftules, more or lefs crowded, according to the degree of thelfrathefis, covers and diverfifies the fkin. The eruption appears in confequence of a foreign, contagious, matter having been taken into the body, and detained below the CUtlde' CCCXXXIII. The {g) Long before any part of this doarine was difcovered, when I was in fearch of certain faas refpeaing peripneumony and pleu- ritis, I difcovered one which I was not looking forj of more im- portance than all the reft put together. It had been afferted, by moft fyHematics and all the nofologifts, that the primary fymptom in the phlegmafise was the inflammation of a part, I faw that was not true with refpea to rheumatifm, in which the general affec- tion 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 inflammation ap- peared in eryfipelas, or the rofe, there was alfo the general affec- tion equally confpicuous. In fhort, in no one of that fet of dif- eafes, did the faa appear, that the inflammation was primary, and the pyrexia, or affeaion of the whole "fyftem dipfendent upon it. But as peripneumony was faid i§ Edinburgh to be an exception, the deteaion I made equally difproved that. In ail the works of Morgagni, where peripneumony and eryfipelas are treated, and in all thofe of Trillerus, a profeffed writer on that fubjea, and in a thefis in Sandiforth's Thefaurus, taken from no lefs than 400 cafes of that difeafe (for they are now by others, as well as me, confidered as one), I found that in fomewhat more than one-half 1 of the given : amber, which was very refpeaable, the general af- feaion appeared from one to three days before the pain came on, and in all the reft 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 't could be fairly alleged, ihat the pain was the firft and primary appearance. Hence? I found, that all the theories raifed upon rhat hypothefis of courfe fell to the ground. ||hdeed the faa is quite confiftent with every one here. x (h) Of this deflation warning has been given more than •nee. See note at CCCXXIX. N - 29° THE ELEMENTS Part IIL CCCXXXIII. The explanation of all thefe fymp- toms eafily flows from the dodrine delivered above. The fthenic diathefis, in the manner that has been fo fully explained (/), precedes. The charaderiftics of the pulfe are never to be referred to the affedion of a part, having been demonftrated to arife from the diathefis (k). CCCXXXIV. The frequency of the pulfe in fthenic difeafes is moderate, becaufe, while the ftimulus' in the fyftem cannot fail to produce fome additional 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 tranfmitted with the fame celerity, as an under proportion (m). The ftrength of the pulfe is occafioned by the degree of excitement in the moving fibres of the veffels, which is commonly called their tone, and by that of their denfity confidered as fimple folids (LIX. LX. and LXI). The hardnefs of the fthenic pulfe is nothing elfe than the continuance for fome time of each ftrong contradion, clof^ly embracing a great (/) See above all the paragraphs, where the operation of the powers producing fthenic diathefis are accounted for. (k) See alfo par. CLV. and CLVI. and particularly CLXXIV. (/) If this caufe ever operate^it is probably not the principal caufe. As both the fyftole and diaftole of the veffels are more confiderable in fthenic diathefis than in health, we cannot expea them to be performed with fuch celerity as in fome afthenic dif- eafes, though the fibres may contraa with more velocity than even in health. Editor. («?) In fevers and other afthenic difeafes of great debility, from the weaknefs of the ftomach and other digeftive organs, and the fmall quantity of nutrient matter taken in, the quantity of\ blood which is diminiftied in every one of thefe difeafes, cannot be more than one third lefs than that which overfills the veffels ip\fthenjc difeafes. Confequently, by a given power, it may be tpropelled in the fame proportion, that is, one-third fafter than in the. fthenic difeafes, which alfo appears in faa ; for while ioo beats in a minute is a frequent pulfe in fthenic difeafes, till their appr$acl|^>i aaual converfion to indirea debility, the common frequenly in fevers and the other high afthenic difeafes, is 150 beats in the fame time. Chap. I. OF MEDICINE. 291, a great column of blood, and, thereby, as it were, re- fembling a ftretched rope («). CCCXXXV. That this k the exad ftate of the arteries is proved by the great quantity of food taken with a good appetite, before the arrival of the difeafe, during the period of predifpofition ; it is proved by this plentiful diet and other powers giving an unufual- ly great excitement over the whole fyftem (0), and, therefore, among their other effeds, increafing the di- geftive energy ; and by evacuant with other debilitating remedies, both preventing and removing the difeafes. To confound, therefore, this ftate with one diametrical- ly oppofitite (p), which has hitherto been an univerfal pradice* was a very capital blunder, and could not fail to («) See par. CLV. If it fhould be alleged, that, though in fevers and the other cafes mentioned juft now in the note (*»), the deficient quantity of blood to be put in motion will account for the greater celerity of motion, than in the difeafes which make the prefent fubjea ; ftill the great weaknefs of the heart, for want of the ftimulus of a due quantity of blood, as well as of many others, fhould overbalance the effea arifing from the fmall quantity to be moved. But the anfwer to that objeaion is eafy. It arifes from the explanation of the ftrength and hardnefs of the pulfe juft now mentioned in the text. The febrile pulfe is indeed one-third quicker than the fthenic pyrexial, but it is weak, and fmall, 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 effea. A third lefs of blood, with an equal force behind, will be driven not only one-third fafter, but with ftrength and hardnefs. The want of thefe two laft then is to be fet to the account of the heart's greater weaknefs. Though the blood then be driven one-third quicker, yet the impulfe com- municated upon the whole is one-third lefs, as the charaaeriftics of both kinds of pulfe readily explain to us. (0) See the whole of the firft chapter of Part II. upon the powers producing fthenic diathefis. (p) Which authors and too many praaitioners have univerfal- ly done, in jumbling proper fevers with the prefent difeafes, under the vague and falfe denomination of febrile or feverifh difeafes. In nofology the fynoehusis conjoined with typhus, the gangrenous fore-throat, which is a typhus fever, with the common fthenic inflammatory pyrexia. 2$Z THE ELEMENTS Part III. to produce the worft confequences, by equally pervert- & ing the theories and adual pradice of medicine. * CCCXXXVI. The fhivering and fenfe of cold de- pend upon the drynefs of the fkin. The langouf and reeling of laffitude point out a higher degree of excite- ment in the brain and fibres of the mufcels, than can be conveniently borne by the excitability which is con- fined within certain boundaries (q)» They are there-? fore fundions impaired from a ftimulant, not from a debilitating caufe (r). CCCXXXVU. The drynefs of the ecaufe (q) See above CLIV. (r) See above par. CLXVI. ). Accordingly, all the examples of ■ phlegmone, and of erythema or eryfipelas, without V ^general diathefis (q), are quite different in their nature from the phlegmafise, though they have been abfurdly claffed with them, and more abfurdly ftill confidered as their prototypes ; fince they are/in fad,all,only local affedions, or fymptoms of other difeafes. This opinion is not weakened by a certain refemblance of difeafes with inflammation in an internal part to the phlegma- fise ; for thefe difeafes are neither preceded by the ufual noxious powers, that produce either the phleg- mafiae, or any general difeafe whatever, nor cured by the ufual remedies of the latter. It was, therefore, a miftake of moft pernicious cdrffequence to the pradice, to enumerate among the phlegmafise thofe difeafes, that arife from ftimulants, acrids, and compreffion, and which (/») See above CLXXI. (?) See alfo par. LXXXI. The nofologifts, 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 affeaions, which they have confidered as laying the foundation of their phlegmafiae, or general fthenic difeafes with an inflammation in a part. But will any man in his fenfes fee any connexion 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 ftie, or the inflam- mation in the groins of children from their being fcalded by their urine, or the bites of infeas, the effeas of which are confined to the bitten part ; will he fee any connexion betwixt thefe and a ( peripneumony ; which arifes from hurtful powers affeaing the whole fyftem, and no part in particular ; and is cured by reme- dies that aftec! the whole fyftem, and the inflamed part not more, or even fo much as many others ? All thefe, however, have been madeahe prototypes of inflammation, by which they meant their phlegmafiae; as if there were nothing to be regarded in them but the inflammation, which, in faa, is their moft infignificant part, bearing no higher proportion to the fum of morbid ftate over the fyftem than that of 6 • «• 3000, or even lefs. See above Part I. chap. IV. and particularly par. L. 02 298 THE ELEMENTS /Will. which are only curable by removing their local caufe, which is feldom effeded by art (r). C'CCXLVI. It is not without good reafon, that the *; appellation of pyrexia has been given to the general affedion, which appears in the phlegmafise and exan- themata ; for thus they are moft advantageoufly diftin- guifhed on the one hand from fevers, which are difeafes of debility in extreme, and on the other from a fimilar, bat altogether different, affedion, which is a fymptom of local difeafes (s), and may be called a fymptomatic pyrexia. CCCXLVII. The true fthenic difeafes (/), which, except one, are accompanied with pyrexia [u) and ex- ternal « (r) See above par. LXXXI. Take for an example gaftritis, which the nofologifts have made one of their phlegmafise, and put upon the fame footing with peripneumony and the other difeafes that may be admitted as phlegmafia?. That affeaion is an in- flammation in a portion of the ftomach, in confequence of a folu- tion of continuity from the previous fwallowing of ground glafs, fmall fifh bones, a quantity of Cayenne pepper ; or fymptomatic of a fcirrhous obftruaion and tumour. Thefe, not the ordinary hurtful ones that operate upon the whole fyftem, as in the true phlegmafia?, are the powers that induce that affeaion. It has no conneaion with the excitement, the affeaion of which is only an affea of the locally ftimulating power, and of the fenfibility of the ftomach ; its true caufe being the folution of continuity or obftruaion, 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, debilitating evacuant reme- dies can only palliate ; but they bring life into danger when the afthenic diathefis is prefent, which is 17 times out of 20 for the other. (s) The general affeaion arifing in the fyftem from the effea of a thern pufhed under the nail (fee par. CCCXLIV. and note), and that occurring in the gaftritis, mentioned in the laft paragraph of the text (fee the note on that paragraph) are good examples of cafes, to which the term fymptomatic pyrexia fhould be applied. CO See above CCCXXIX. («) See par. CCCXXXH. Qkap.l. OF MEDICINE. 299 rnal inflammation (x), are peripneumony, phrenitis, the fmall pox, the meafles, as often as thefe two laft are violent, the fevere eryfipelas, rheumatifm, the mild eryfipelas, and the cynanche tonsillaris. Thofe free from inflammation are catarrh, fimple fynocha, the fcarlet fever, the fmall pox, the meafles ; when, in the two latter inftances, the eruption confifts only in a few puftules. The Defcription of Peripneumony. CCCXLVIII. The fymptoms peculiar to peripneu- mony (y) (under which term pleurify, and carditis, as far as it is a general difeafe, are comprehended), are pain fomewhere in the region of the cheft, often chang- ing its feat ; difficult breathing ; cough, for the moft part attended with expedoration, and fometimes with a mixture of blood in the matter expedorated. CCCXLIX. The feat of the difeafe is the whole ^body, the whole nervous fyftem (z); as appears from the (difeafe being produced by an increafe of the diathefis, (Which took place in the predifpofition, and by no new circumftance (a) ; from the inflammation within the cheft, for the moft part following the pyrexia at a con- fiderable interval of time, and never preceding it {&) ; and from bleeding and other remedies of fimilar opera- tion, which do not affed the inflamed part, more than any other equally diftant from the centre of adivity, removing (*) See CLXVIII. (y) The fymptoms in common to it and the other difeafes of the fame form, enumerated in the laft paragraph, have been def- cribed in par. CCCXXXI. Thefe peculiarly diftinguifliing the \phlegmafia? and exanthemata, that is the difeafes either accom- panied with inflammation, or an approach to it, are defcribed in par. CCGXXXII. (z) See par. XLVII. XLVIII. XLIX. LIV. LV. and not the inflamed portion in the lungs, according to the common opinion- fa) See above LXXV. LXXVI. h) See above CCCXXXIL and the note (g). 30© THE ELEMENTS Part III. removing the difeafe. The proper feat of the inflartMj mation, which is only a part of the general diathefis,'! is either the fubftance of the lungs and the produdion of the pleura, that covers their lurface ; or fome part of that membrane, whether the part lining the ribs, or that containing, within the external furface of it, the thoracic vifcera ; it r> different in different cafes, and in the fame cafe at different times. ^ CCCL. The pain in the cheft depends upon an in- flammation of the conefponding internal parts juft mentioned {c), as is proved by diffedion ; though in- deed it is ftill oftener occafioned by an adhefion of the lungs to the pleura coftalis, feldom to an inflamnv.hon of that membrane, as we learn from the fame evidence. CCCLI. When the inflammation takes place on the furface 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 fup-' pofe, that the points of the fame Veflels, whether dif- tributed upon the membrane, or plunging" into the fubftance of the lungs, or emerging from it, can be in- flamed without a communication of the affedion to the contiguous points (d). The diftindion, therefore/11 of; {c) See above par. CLXXIV. (d) Yet one nofologift, upon that very fuppofition, makes two orders of phlegmafia?, one feated on the membrane, the other in the interior furface of each vifcus. Into this error, he had . been led, by obferving, that, after death, the interior fubftance of the liver exhibited figns of previous inflammation. And, as other diffeaions ftiowed the membrane upon other occafions to have been in a ftate of inflammation, he thence drew his rafh conclu^ fion. But it is to be obferved, that the firft mentioned ftate of the liver was not a phlegmafia 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. It is a cafe, then, we have nothing to do with upon this fubjea, even fo far as it applies to the liver. But the extending the application to all the viicera( which he was pleafed to make the feats of fome phlegmafiae or other, was loofenefs of reafoning, and careleffnefs of matter of fad, Chap. I. OF MEDICINE. 3OI of the inflammation accompanying tbe phlegmafize into rparenchymatofe, or that afteding the fubftance of the vifcus, and into membranous, and the notion which makes the latter cafe univerfal, are equally remote from the truth.. The reafon why neither the membrane con- tiguous to the lungs, nor the fubftance of the latter, is always inflamed, and why the inflammation is fome- times communicated to fome part of the neighbouring membrane, appears from the vicinity of the part in- flamed in the laft cafe to that which receives the air, } and, therefore, varies in its temperature ( CCCLXXVII. The violent meafles ^ is a fthernfc . exanthematic difeafe (c), beginning with fneezing,, * watery eyes, dry cough, and hoarfenefs ; on the fourth day, or latere there appears an eruption of fmall nu- merous papSae or little points ; thefe on the third dayL or later, terminate in an appearance of branny fcales«>. This difeafe, when preceded with a high degreeof fthenic diathefis, is proportionally violent. ... CCCLXXVIII. The fneezing,watery eyes, dry cough | and hoarfenefs, are catarrhal fymptoms, and, therefore, depend (*) See above par. CCGLXVIII. («) See above par. CCCLXVL ** CkapA. OF MEDICINE. * j. r depend upon fthenic diathefis (d). And, fince they ^appear, four days or more before the eruption, that is, f before the matter might feem to have reached' the af- feded parts, and are conftant and univerfal; here we arc to fuppofe, that the fthenic diathefis is the effed of the noxious powers, that ufually produce it, and not entirely of the peculiar contagious matter, and that this diathefis is indifpenfably neceffary to the meafles. But though this fuppofition fhould be rejeded, and it fliould be contended, that thefe fymptoms arife from the con- tagious matter ; it ftill muft be granted, that this dif- eafe differs in nothing from other fthenic difeafes, but equally depends upon fthenic diathefis, and yields to antifthenic or debilitating remedies. And it muft be allowed, that, fince the contagious matter produces the fame efted as the ufual noxious powers, its operation, muft be abfolutely the fame, and fo the caufe of the difeafe the fame. Confequently, we find nothing in the indication of cure, but what is common to this difeafe with other fthenic exanthemata ; viz. that time muft be given to the matter to pafs out of the body, and the perfpiration be conduded in the fame manner, as when we have any other form of fthenic diathefis to treat (e). CCCLXXIX. The eruption admits of the fame reafoning that has been employed above (/j. The circumftance of its being a violent difeafe when preced- ed by a violent fthenic diathefis, and mild in a mild . degree of that diathefis, is a further inftance of the little difference that there is betwixt the operation of con- tagion, and that of the ordinary 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 receded into the interior parts of the body. \d) See above par. CLXXV. (0 See above par. XCVI. (/) See above par. CCCLXXV. %l% THE ELEMENTS Part IIJ» .. body. ,This dangerous appearance occurs chiefly to- wards the end of the difeafe. The fad is, that thitL^ matter, in the fame manner as the variolous, kindles a j| fymptomatic inflammation o< er the furface of the body, ^ and then, by a further increafe of the diathefis, fup- * preftes the perfpiration.. Hence the lungs (g). and other vifcera are often inflamed* « CCCLXXXI. The (g) That the lungs fhould be inflamed in a violent ftate of the diathefis in the meafles is not to be wondered at; as the common catarrh, when its diathefis runs high, is liable to produce the fame effea. (See par. CCCXLIII. towards the end j But, con* tidering how many faas in medical writings I have found falfe, the effea of that on my mind, is to render the weight of teftimony in favour of the various internal vifcera being fo liable to be in- flamed, from this fuppofed ftriking in of the meafly eruption, very light, and to difpofe me to doubt of the faa altogether : Which I am the more inclined to do, from the analogy of a broad faa in direa contradiaion to it : Which is, that the inflamma- tion, depending upon the general diathefis in fthenic difeafes, never, as I have yet found, affeas an interior part. (See par. CXIII. CLXVIII.) Neither is inflammation, from any other fource, near fo frequent in internal parts as vulgar opinion has taught us. JDilTeaion has fhown inflammation in the inteftinal canal in dyfentery, or what is called in Englifh the bloody fluxf j But that only happened under the evacuant, debilitating, vegeta- ble plan of cure ; and, even in that cafe, feems to have been ai * ultimate, noc an early, effea, much lefs a caufe. And it has been ihown, that what has been confidered as a burning inflammation' ■ in tbe firft paffages, is not an inflammation at all. (See above par. CXCVIII. Nay, even when inflammation does happen ij*- — ternally, it is never of the fthenic, but always of the general, or local, afthenic kind, and, when quickly cured, cannot be inflam- mation. 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 x circumftance that, though no where taken notice of, has great? weight with "me ; which is, that, as the diftina fmall-pox partes 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 ceconomy and of the powers aaing on it, to prevent the fame converfion of fthenic into afthenic ftate in the meafles. And if, which is moft probable from the alexipharmic praaice, Chap. I. OF MEDICINE.' 313 * CCCLXXXI. The violent ftate of the fmall-pox, _ from the great ftimulus of the eruption, often converts : - both the fthenic diathefis and eruption into afthenic, and thereby produces the confluent fmall-pox, of which we are afterwards to treat. Whether any thing like this occurl in meafles, is not yet afcertained : But, as every excefs of excitement, as in the converfion of peripneumony into a dropfy of the cheft, is liable to induce indired debility, it is, therefore, fcarce to be tfoubted, but that the fame thing happens in this dif- eafe, which is inferior to none in violence. The Defcription of the violent Eryfipelas. CCCLXXXII. The violent eryfipelas is a phlegma- sia, always beginning with pyrexia, and followed by inflammation. The inflammation is feated in fome external part of the body, and ofteneft in the face, fometimes in the throat; lfjs of a red colour, has an un- equal edge, is fomewhat raifed, creeps from one place to another, and is attended with a fenfe of burning. CCCLXXXIII. It is peculiar to this inflammation to invade the corpus mucofum, which the other general rnflammations never do. To affign a reafon for this peculiarity is of no confequence ; fince this inflamma- tjon docs not differ from the others either in the opera- : tion of the exciting powers producing it, or in that of the remedies which remove it. CCCLXXXI V. The caufe of the rednefs of the in- flammation, in this as well as in every cafe, is an excef- five quantity of blood in the inflamed veffels; for the wgeftion about the degree of rednefs is of no importance. There is lefs fwelling in the inflamed part than in other <> fthenic that was thea ufed in this difeafe, in direct, debility can induce fuch a change, no difeafe has % fuller chance for it than the ineafles. But I am fure, were the debilitating plan ufed from the beginning, no fuch confequence would happen. Q,2 314 THE ELEMENTS Part III. 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. This is alfo the caufe of the flow creeping motion of the inflamma- tion, and of the inequality of its edges. The fenfe of burning is owing to an acrimony of the contained fluid, acquired by ftagnation (h). CCCLXXX V. The attack of the inflammation ur>. on the face is not more dangerous than upon any othef place, except when the diathefis, upon which it depends, is great, and renders the inflammation proportionally great (/'). In which cafe, whatever part is inflamed, the difeafe muft be held for a fevere one ; but ftill feverer, if the inflammation feizes the face ; for then the difeafe is always accompanied by great commotion in the fyftem. CCCLXXXVI. When fuch a fthenic diathefis and affedion of the head depending on it, occur, 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 Rheumatifm. CCCLXXXVII. Rheunjatifm is a phlegmafia, mqft frequent in that temperament, which inclines to the fanguine. It is a confequence of heat fucceeding'to cold, or fo alternating with it as t© prove on this ac- count the more ftimulant : It is accompanied with pain nigh, or between, the joints, chiefly the large joints, and proportioned to the degree of the diathefis (k): And the inflammation always fucceeds the pyrexia. CCCLXXXVIII. External temperature is hurtful in this difeafe in the fame way, as has been often ex- plained (/). CCCLXXXIX.The (h) This may fafely be queftioned, fince, if the veffels are ex- ceflively full of blood and exceflively excited, there is no oceafie* to fuppofe any other caufe of the heat: and this latter hypothefis is much more agreeable to analogy. En 1 tor. (1) See par. LXXXV. CCCXLIII. (*) CCCXLIII. (/) CXIII. ct paflira. Ghap. I. OF MEDICINE. 3*5 CCCLXXXIX. The rage of pain is in the parts that have been mentioned (m), becaufe it is thefe parts that ^ the inflammation, or more increafed part of the general diathefis («), chiefly affeds. The reafon of this is, that nearly the moft powerful of the exciting noxious caufes, the temperature that has been mentioned (0), only af- feds them. There can be no tranflation of the in- flammation to the internal parts, fince thefe parts, which prcferve nearly an equal temperature amidft every change of it externally, are not affeded by the fame hurtful power which annoys the external parts. CCCXC. Cold is not, according to the common opinion, hurtful in this difeafe by producing conftric- tion ; becaufe the violence of the difeafe is greateft ). This fad is confirmed by ftimulant chet, in all its articles, proving always hurtful, and by abltinence being always fervicea- ble, and often alone effeding the cure. This affords a fufficient refutation of the 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 noxious powers but the former, no other remedies but the latter. In this, as well as in all other general fthenic difeafes, it is ' .the general fthenic diathefis alone that produces, and the folution of it alone that removes, the difeafe. The ' fad is not only well afcertained,. but countenanced by the analogy of every part of this dodrirm that has yet been delivered. Such pains of parts, as fometimes precede this difeafe, oftener happen without being fol- lowed by it : whether followed by rheumatifm or not, "*they have nothing to do with fthenic diathefis, upon which this difeafe entirely hinges ; they proceed from a local affedion, or belong to a very different general difeafe, rheumatalgia, of which more hereafter. CCCXCI. The ' (»/) CLXVIII. («) Ibid. (o) CXIIL (/) Ibii. 316 THE ELEMENTS Part III. CCCXCI. The reafon why the larger joints are af- feded in this difeafe, and the fmaller in the gout, is the d following : In rheumatifm, becaufe the other circum- * fiances of the difeafe, as well as the pains, depend upon < a violent fthenic diathefis ; the greater joints, which, for the reafons affigned, are more fubjed to the diathe- fis, have alfo a greater fhare of the difeafe. But, as the gout confifts in debility, its violence will be greateft, where there is naturally the greateft debility, and there- fore in the extreme parts, and thofe mpft remote from the centre of adivity (q)* A Defcription of the mild Eryfipelas. CCCXCII. Both the definition and explanation of the violent eryfipelas (r), delivered before, are applica- ble to the mild ; the latter, however, both in the antecedent noxious powers, in the fymptoms, and in the whole nature of its caufe, muft be underftood to be much milder 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 fuperven- tion upon it before it has finifhed its courfe. It oftea 1 appears alone and unaccompanied with the cynanche, arifing (q) To make this fubjea fimple to any apprehenfion. A perfon • has been expofed to intenfe cold a whole day. He comes horse at night, is fet by a warm fire, receives hot meat and warm cor- dial drink. He is next covered up in his bed with an addition of clothes, receives more warm ftrong drink. He falls aflcep, and; next morning feels a pain in fome part or other of his upper ex- tremities, nigh, or between, the great joints ; and, previous to - that, a high ftate of heat and bouncing pulfe, with a certain feel- ing of uneafinefs in different parts of his trunk. The pains in- creafe in the bed next night in proportion to the increafe of the general affeaion ; and cold, evacuation, and abftinence fiom food, from alternation of temperature, cure him. (r) From CCCLXXXII. to CCCLXXXVII. Chap.I. ©F MEDICINE. 317 arifing from a fimilar lenity of the noxious powers, and manifefting a fimilar mildnefs of fymptoms through its whole courfe. " CCCXCIV. Nay, in the fame perfons, in the fame ftate.of the noxious powers, fometimes this eryfipelas, fometimes cynanche, fometimes catarrh, arife promif- cuoufly, and are all removed by the fame mild method of cure (j). A Defcription of the Cynanche Sthenica. CCCXCV. The fthenic cynanche is a phlegmafia, with an infhmmation of the throat, and efpecially of the tonfils, but never preceding the pyrexia : It is ac- companied ■* ith fwelling and rednefs, and an aggrava- tion of pain in fwallowing, efpecially any thing fluid. CCCXCV I. The reafon for the inflammation occu- pying the place mentioned here,hasbeen given before(r). And, when it has once taken place, it is afterwards liable to frequent recurrence, becaufe its feat is expofed to the operation of the moft noxious power, heat and alternation of temperature (fee XXXVI. with addition), and is lefs covered than other parts (u): And the veflels firft diftended by the inflammation, and then afterwards relaxed, (s) I have often experienced them all, fometimes fingly, fome- times all three, in the courfe of the fame difeafe, oftener a com- bination of inflammatory fore-throat, and the mild eryfipelas, and, as far as I could obferve, could difcern, that the degrees of phlogiftic ftate that produced them, and of remedies that removed them, were both gentle, the former as ftimulants, and the latter as debilitating powers ; and both fo nearly of the fame degree, that, in arranging them, I was at a lofs which to place over the other in the fcale. (/) See CXIII. CCCXLII. (a) See par. CLXVIII. If one is walking in the evening, when a fudden fog comes on, with cold and chillinefs, he may cover his throat externally, but it is impoffible to defend it in- ternally. 3x8 THE ELEMENTS Part III. relaxed, take in an overproportion of blood upon every increafe of its impetus (.v). CCCXCVI1, The inflammation here, as in the other phlegmafiae (y), never precedes the pyrexia, for the reafon affigned (z) f but if an unfkilful perfon fhould think it does, the reafon he will have been mifled is, the gradual degeneracy of the general fthenic inflam- mation into a local difeafe, from its frequent recurrence, and from its leaving behind, after each attack, a taint in the affeded part. This latter inflammation may happen, without a general fthenic diathefis, and, there- fore, without being followed by a fthenic cynanche ; and it may accidentally 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 general cafe, for the fake of guarding againft the commiflion of a hurtful miftake in the treatment (a). In an afthenic habit, whether fucceeding to the former or not, there is again another general inflammation, to be referred to afthenic difeafes. CCCXCVIII. If any perfon can explain why the pain is aggravated in fwallowing liquids, he may com- municate his knowledge ; if he cannot, it is no matter, CCCXCIX. The cynanche cefophagaea has been here omitted, becaufe it is a rare affedion, and admits of the fame reafoning and cure as the tcnfillar, from which it differs only in the inflammation being lower down, and a little rednefs only coming within view. But, as there is always a fufpicion that it may be local, from {x) This is fo liable to happen, when any perfon has once ex- perienced this difeafe, that the increafed motion of the bleod in walking in a warm day, and then fitting down in a cool place, has fometimes produced ophthalmia, fometimes this fore-throat. (y) See the definitions of them all, &c. (z) See par. CLXVIII. CCCXLIII. (af This might happen to a perfon under an afthenic diathefis, which would be increafed by the debilitating plan of cure, and would be ufelefs in the abfence of diathefis. Chap. I. OF MEDICINE. 319 from erofion or a burn of the cefophagus, from the ap- plication of an hard, corrofive or hot fubftance ; the above diftindions fhould be attended to, and made ufe of for the fake of pradice. See above LXXXI. LXXXIII. CLXX. CCCC. There is likewife a rare difeafe, fometimes oecurring in certain countries, never in others, called the croup (b). In'this difeafe the refpiration is labori- ous, the infpiration fonorous, with hoarfenefs, a ringing cough, and a fwelling fcarce to be difcerned (c). It is a difeafe that infefts very young children almoft only. And in all other particulars it is of a doubtful nature (d). CCCCI. In forming your judgment concerning this difeafe, when it happens to occur in pradice, attend to the following circumftances. As the fthenic diathefis, in the degree requifite to the formation of adual difeafe* which depends upon a high degree of diathefis, occurs lefs frequently, either in the beginning, or towards the end of life ; becaufe the high degree of excitability in the former, and its low degree in the latter, admit a fmaller degree of the effed of the exciting power, that is, a fmaller force of excitement (e), than the long period of human life betwixt thefe two extremes ; yet it is not altogether foreign^from cither (f). In child-^ hood, the high degree of excitability compenfates for the flightnefs of the ftimulus; while, in old age, the high degree and foroe of the latter may comper.iate for the (b) By nofologifts cynanche ftridula. (c) It is perceived upon diffeaion of the dead fubjea. \d) I never faw this difeafe, but when I was fo young a ftudent, that any obfervations I could make, can be of no ufe to me now. There have been many battles of words about it, whether it be; inflammatory or fpafmodic, without any adequate meaning of the differences betwixt thefe two words, at leaft fo far as to influ- ence the praftice ; which remaiaed much the fame betwixt the parties, and probably the right one was miffed by both. (e) See par. XXV. and XXVI. (f) 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 fometimes. \ 320 THE ELEMENTS Part Hi. j i the deficiency of the former, and fufHce to induce fome fthenic diathefis, even to tnat degree which conftitutes difeafe. Thus infants undergo wonderful viciffitudes of < excitement, and within the fhorteft fpaces of time. To-day they will fhow every fign of extreme debility, td-morrow every one of reftored vigour ; becaufe in them the operation of any ftimulus foon iifes to its higheft pitch, upon account ot their high excitability, and finks as foon to its loweft, upon account of its own fmall degree (g). Hence every fthenic diathefis, that happens to them, is fhort, acute, and foon removed [h); nor is their afthenic ftate of long continuance, or diffi- cult to be removed ; provided there is no local affection, which very feldom, indeed, happens ; and a proper method of cure is employed ; which, till of late, has been very rare : the antiphlogiftic cure having made away with three-fourths of mankind, before they arriv- ed at the feventh year of their age. CCCCII. The marks of fthenic diathefis at this age are, great frequency of pulfe, when compared with that cf adults, more frequent than their own in health, dif- tindly meeting the finger upon feeling it ; a ftate of bowels rather coftive at firft, which goes off in the pro-* j grefs of the difeafe ; drynefs of the fkin ; burning heatJJ *m thirft, watching, ftrong crying. * ™ CCCCIII. The figns of the afthenic diathefis at the fame age are, a pulle not to be numbered from its frequency, fmall, falling foftly like fnow upon the finger, fo that you are uncertain if you touch it at all; a very loofe fcouring belly, with green difeharge ; frequent vomiting ; drynefs of the fkin, heat greater than natu- ral, and greater in fome parts than others ; interrupted fleep, never refrefhing ; a feeble cry, calculated to ex- cite companion. CCCCIV. The (g) A child of mine was given over for death by his nurfe : His mother gave him fome of the diffufible ftimulus. He flept two hours, and when he waked made figns, for he could not yet fpeak, to have a little pie, moft of which he ate. (h) A fingle gentle purge will do it. Chap. I. OF MEDICINE. / 3H CCCCIV. The former diathefis, befides other noxious powers, is preceded by the ufe of good milk, animal food, an abufe of opium or ftrong liquors ; exceffive heat after cold and moifture, which latter increafes the debilitating effed cf the former ; a ftrong fet of fimpie folids. CCCCV. The latter diafhefis, together with the common noxious powers, is preceded by the ufe of milk from a weak, fickly nurfe ; that of vegetable food, with fugar in it ; watery diet ; watery drink ; habitual vomiting, habitual purging, both from other means ufed for the purpofe, and particularly magnefia, given with the intention of abforbing an acid ; cold not fol- lowed by heat ; a weak mafs of fimple folids. CCCC VI. 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 fubjed. Sufped their theories, and their fads ftill more. Be on your guard, that you may not be mifled by the vanity, emptinefs, and rafh- nefs, of young phyficians ; as well as by the obftinacy and bigotry of the older fort, which increafe with their age and pradice, and are not to be bent by any force ef reafoning, any weight of truth, fcarcely by the power of God himfelf : Regard their minds as bound in the tetters of prejudice : Remember,'that a whole opera- tion of phyficians were in the wrong, except one man (/), and (/) The improvement that Dr. Sydenham made was good for "the length it went, which was, to ufe cool and gentle evacuarrts for th* cure of the fmall pox, pe. ipneumony, and one or two more of the fthenic difeafes. The bias., in favour of the alexipharmic praaice, for the cure of catarrh and meaflesyhe never got over. His theories were vague, but whh refpea to the praaice in the difeafes among which his reformation lay, they were innocent. He attained not any ioea of the nature of difeafes depending on debility and his praaice was hurtful in them : He fell a viaim ro lis gout, which could not have happened had he been acquainted with 322 THE ELEMENTS . Part III* and that they petfifted obftinately in their error, in the cafe of the aleixipharmic phyficians : Refled within yourfelf, good reader ! whether the prefent phyficians, who follow the dodrines delivered in the fchools, are more judicious than their predeceflbrs, and whether they do net run into the contrary extreme of madnefs* doing as much mifchief in fevers, and difeafes of pure debility, as the former did in fthenic difeafes, and fpreading deftriidion wide among mankind. Thus fecured againft miftake, confider the methods for treat-. ing this difeafe that have been propofed. If in thefe, or in any trial that you may make, you fhall find that either bleeding and purging, or antifpafmodics, as they are called, that is, ftimulants, fucceed ; then be affured, that, in the former cafe, the difeafe is fthenic, in the latter afthenic ; of which you may be ftill more certain, if you fhall find that the exciting noxious powers and fymptoms, which have been enumerated, at the fame time agree with the other marks. A Defcription of Catarrh* CCCCVII. Catarrh is a phlegmafia, in which, to the general fymptoms mentioned before (k), are added cough ; hoarfenefs ; and at firft a fuppreffion, or flight increafe 'h with but one difeafe of the debility. His praaice, even when right, was deftitute of principle : He had no fort of comprehen- fion of the doarine of life as a whole, and as a department of knowledge diftina from all others. It would have been lucky, however, for pofterity, had his fucceffors done as much in afthen- ic, as he did in fthenic difeafes. From that beginning, the in- genuity of fome, at laft under a right direaion, might have brought out more information, and, by gradual and fure fteps, at laft at- tained a comprehenfion of their whole fubjea. But profeffors of univerfities ruin every thing : For, while they find out nothing themfelves, they throw into falfe lights the ufeful hints of others. This was the effea firft of the Boerhaavian, then of the Hoffman- nian and Stahlian doarines. dee our Obfervations, Outlines, p. lxxxv. to cxlix. (*) CCCXXXI. Chap. 1. OF MEDICINE. 3^3 •increafe of the excretion from the nofe, fauces, and bronchia, followed afterwards by a further increafe ; arifing from ftimulant powers,, often from heat alone, but chiefly after a previous application of cold ; and to be removed by debilitating powers, often, by cold alone, when the accefs of heat is- prevented (/). CCCCVIII. The explanation of the cough is the fame as that given before. But it is more free, than in • peripneumony, and not fuppreffed, becaufe there is no inflammation in the neighbourhood, to aggravate it, and occafion pain (w). CCCCIX. The hoarfenefs is owing to a fuppreffion of the vapour, that fliould be exhaled into the bronchia j. for when it. has remained long, almoft without expec- toration and cough, or with a moderate degree of them, as long as the fthenic diathefis continued in full force in the bronchia ; upon this diathefis giving way, and the expedoration and cough becoming more free, the hparfenefs abates, or goes off.. That this can be effed- ed by a ftimulus of the kind and degree, that conftitutes fthenic diathefis, is fhown by the effed of long and loud fpeaking producing temporary hoarfenefs, by filence removing the hoarfenefs, and cold water reliev- ing it. CCCCX, The excretion fuppreffed is that of the mucus and exhalable fluid, and it admits of the fame explanation that was formerly piven. CCCCXI. That ftimulants produce catarrh is evi- dent from, this, that heat alone, fulnefs of diet, ftrong drink, and moderate exercife, for certain produce it ;; cold, cold water,.fpare diet, and reft, as certainly and effectually remove it.. Jk 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 hurt- ful in catarrh, but when its adion is fueceeded by that of (/) See par. CXIL CXIV, CXVII. CXXII. and all the ftimu- lant powers, from CXIL to CXLVII. (m) See par, CLX, CCCLV. 32) Compare this with par. XLIX. L. LI. LII. LIII. and in- deed with that whole chapter, as the fevereft trial of the truth of j it; nothing being more natural, than the fuppofition that a mad man is only affeaed in his head, but we fhall find that not true. (*) See par. XX. (d) See par. V. VI. XX Qhap* I, ©f medicine. 3*9 CCCCXXXI. Although, in the difeafes that have juft been mentioned (e), the pulfe is commonly faid, and believed, to be not at all affeded, this, however, is not exadly the truth ; for in mania, fo long as it con- tinues to be a fthenic difeafe, that is, fo long as it is really mania, more or lefs of fthenic ftate can be per- ceived. The charaderiftic of hardnefs of the pulfb is never wanting, and therefore alfo fulnefs, (See CCCXXXIV.) The defcription of morbid Watchfulnefs* CCCCXXXII. Pervigilium, or morbid watchfulnefs, h a fthenic apyrexia (f) ; in which there is no fleep, or no healthy fleep, and the mind is agitated with vivid, ftrong, or uneafy impreffions. CCCCXXXIII. The noxious powers, that produce pervigilium, are the fame with thofe, that produce mania, but inferior in force> It is evidently produced by hard thinking, commotion, or difturbance of mind, more frequently than by other noxious powers. The degree of thought, that has this effed, is not ultimately exceffive; for, if it were, by effeding a temporary wafte of the excitability, it would produce found fleep ; or if it repelled fleep, it would only ad fo by inducing indired debility, the confideration of which is foreign to this place (g). The fame degree of agitation of mind proves hurtful, in fo far as it produces this difeafe : For every ultimate excefs either ends in fleep, or induces that vigilance, of which indired debility is the caufe. But it is not a Angle operation of the intelledual faculty, or of the ftate of any paffion, or of one that happens but rarely, that proves adequate to the effed. For the effed, in that cafe, would be either too flight, or of too fhort continuance, to merit the title of difeafe. It is (<) From CCCCXXV. to CCCCXXXII. (fj See par. CCCXXV. {:) See CXLL S z 33© the element^ Part 111, is only an often returning, or deeply affeding* irritation upon the brain, and, therefore, one that leaves a lafting impreffion, which has any confiderable power in pro* ducing this difeafe. In this laft way* an eager, inordi^ nate, and vaft defire for the attainment of the objeds of ambition, the impulfe that hurries on to the revenge of a great injury, the horror that arifes upon the perpe* tration of it, and the fear of future punifhment for crimes, are exhibited as produdive of ftrong commo- tion 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 cbmpofed to reft and found fleep; after a cer- tain fhort continuance of thefe, or other ftimuli; fo often are we to conclude, that this difeafe takes place. CCCCXXXIV; As the noxious powers juft men- tioned (&) produce this difeafe ; fo there' are other powers* which belong not to this place, but are to be mentioned j that alfo repel fleep; CCCCXXXV. To pervigilium belong all the nox- ious powers that have been mentioned under mania (£), whether ading within or without the brain, but here they Sd with lefs force, and yield to the afthenic plan of cure, GCCCXXXVI. As in this way pervigiluni is pro- duced by certain ftrong ftimulant powers (/), while the fum of other ftimuli remains undiminifhed, it muft be inferred, that the caufe of this difeafe is the fame with that of the reft of the fthenic form of difeafes (hi), and • that the ftate of body in which every one of thofe dif- eafes confift is the fame : Nor do different noxious powers, but precifely the fame, with only a variation in the proportion of their force, as often happens in other fthenic difeafes, precede this difeafe.- CCCCXXXVII. The fame fad is alfo manifeft from the fundions; of which, though thefe difeafes are lb) See par. CCCCXXX. and CCCCXXXIII. Ik) See from CCCCXXVI. to CCCCXXXII. (/) Sc* CCCCXXXIII. (ra) from CXLI. to CXLVJIfc Chap* I. 0* MEDICINE. 33* are called apyrexise or without pyrexial ftate, the pulfe is not altogether free from difeafe («). On the con- trary, it is as much ftronger than in health, or in the predifpofition to afthenic difeafes or in thofe difeafes themfelves, as there is more vigour, and more excite- ment upholding that vigour, in the fyftem (o). And. the ftate of the other fundions, except x thofe of the brain, which is the part chiefly affeded, is truly the fame as in the milder fthenic affedions, or in the pre- difpofition to thefe. But, if the brain in this difeafe, and iri mania, is. much more affeded than the reft of the body ; there is nothing unufual in that circum- stance ; it being an univerfal fad, with refped both to ^ifeafes and the predifpofition to them, that fome part is more affeded than any other part (p)* A Defcription of Qbefity* CCCCXXXVIII. Obefity is a fthenic apyrexia ($5> in which, in confequence of an excefs of health, rich living, efpecially in the article of foot], and an eafy iedentary way of life, the fat increafes fb much as to; incommode the fundions. CCCCXXXIX. That obefity, fo de%cd, is a difeafe, is underftood from the definition of difeafe (r) j and. that it is a fthenic difeafe, appears from the certain figns of fthenic diathefis attending it. Of which, the ftrong adion of the ftomach, whether the appetite or the di- geftion be confidered {s), and the ftrength of the other digeftive organs, are a glaring proof. CCCCXL. And as in this difeafe, the ftimulus of the exciting powers raifes the excitement from the de- gree (») Sec.CCCCXXX. and CCCCXXXL and the note to the latter. (o) For a proof of their vigour maniacs have often four times the ftrength they ufed to have in health. (/>) See part firft, chap. IV. and in it XLIX. and LII. CLIX* **°{q) Sec CCCCXXV. (r) See IV. (/) See par. CCLXIL ??* the elements Part III. gree confiftent with good health, to that which conftir tutes fthenic diathefis. without which there could not be fuch force in the action 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, in thofe with pyrexia and inflammation -*. that it never rifes to the extreme height at which indired debility is produced* - and that it is never indeed fo great as to be fufficient io have any confiderable effed on the heart and veffels. CCCCXLI, But it happens in all thofe difeafes, that both thefe and all the other fundions get fomewhat above the ftandard of health, and a great deal above afthenic diathefis. And the fthenic apyrexiae differ from the other fthenic difeafes chiefly in this, that the exciting powers keep far below that degree of force, that waftes the excitability much ; as is perceived from, the effed ; for they are difeafes of much longer con- tinuance than any Other fthenic difeafes. CCCCXLII. From which circumftance, however. 3 much the brain may be affeded by its own proper ftimuli ; however great the quantity of blood in its veffeis mayjDe ; unlefs to the excitement arifing frorr^* thefe, there be added that excitement which the other1; ftimulant powers produce, it is certain, that the general * effed will be much lefs, and that the united energy of all the powers has far more effed, 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 difeafes; though that of a part, as of the brain in mania and pervigilium, and of the blood-veffels in obe- flty, is pretty confiderable. The whole is in general as great as in predifpofition to the other difeafes, and ex- ceeds this degree in the moft affeded part. Hence it appears, that the fthenic apyrexise, compared with the predifpofition to fthenic pyrexiae, but differ from thefe ffafr *• of medicine; 333 laft difeafes, when they are fully formed, in being lifually of l©ng duration. This happens becaufe the fum of ftimulant operation is moderate, and never con- fumes the excitability, though it continually produces too much excitement. The great tumult of fymptoms in the brain and blood-veffels does not imply a great fum of excitement, becaufe the affedion of a part, however formidable, compared with the affedion of all the reft of the body, is infinitely inferior in its degree (/), However much, then, any ftimulus urges a part, and from that fpreads at large over the reft of the body ; unlefs other ftimuli, applied to other parts* fuftain its pperation, fo that the furra of their operation may deeply affed the whole body ; the effed of the folitary ftimu- lus, though it makes a figure in a part, will be lefs con* fiderable in the reft of the body : In fine, it muft be kept in mind, that every violent difeafe arifes from the - excitement which the united force of feveral ftimuli has produced. CCCCXLIV. In thefe fthenic apyrexize, as a certain part, viz. the brain in the two firft, and the blood- veffels in the laft (a), is affeded in much greater pro.- portion, than in other fthenic difeafes, becaufe the ^ffedion of the part is much lefs fupported by ftimuli ading upon the other parts ; fo the ftimuli, ading with fuch effed upon the moft affeded parts, are, how- ever, underftood to affed the reft of the body, though lefs confiderably. That this is the cafe, is proved by the abfence of afthenic diathefis, in thefe inftances, and by the evident prefence of fo much fthenic diathefis, as upholds the predifpofition to other difeafes of the fihenic form ; by the remedies, which affed other parts, as it will by and by appear, aiding in the cure here, and by powers of a contrary nature, always proving hurtful. Whence it is an indifputable confequence, that even here, where it might have been leaft expeded, every ftimulus (r) See par. XLIX. to HI. (a) Sec par. CCCCXLIIL 334 the elements PartUU ftimulus that affeds a part, affeds the whole bodyy upon account of the excitability being one uniform unV divided property, diffufed over the whole. CCCCXLV. With*refped; to obefity in particular. It appears, that the other'noxious powers, as well as food, have more or lefs effed, from the certain fad o£ the digeftive powers, which depend upon the influence of thefe powers, being here of inch force and vigour, as to perform their fundions more perfedly in fat perfons, than in others, who are, neverthelefs, not by any means' weak. Yet thefe noxious powers are applied in a de- gree fhort of that, which being ultimately exceffive, or very nearly fo, puts an end to excitement by wafting the excitability, or which tends, by a high degree or difturbance, to exhauft the body. * CCCCXLVI. Thus the paffions are not in fuch perfons too ftimulant ; a circumftance known to the generality of mankind, among whom it is an adage^ that fat perfons are commonly good-natured (x), while' xnorofe perfons are for the moft part lean. Thus it is obfervable, that fat perfons are averfe to thinking, which is a great ftimulus (y). They are averfe to bodih motioif ,(*) This muft be taken with more than grains of allowance ^ Unce fuch is the effecT: of the different motives to human actiefc' received from example and education, that the paffions themfelves are drawn into a fubfervieucy to every perfon's predominant pur* s fint. I have known a ptrfon in Edinburgh get great credit ftf" J!ris integrity, though that was not extraordinary, from roughnejt j «f manner, and an affectation of pafiionatencfs, while the diffimrila. n firm of that real difpofition is the more general engine among men of promoting their ifltereft. At any rate, fo much moie than mere appearance of temper, which may be fo much over- ruled, is neceffary to the eftablifhment of maxims ; that I fhould, S&ink my life or property upon an infecure footing, if it dependent cm the good-nature of a perfon, for which the only fecurity was ids fatnefs. (?) The moft poring perfons are the atrabilarians, who, though, tbey are not calculated for the elevation of mind that difcoyery acquires, have, by their affiduity, contributed much to the im- provement of many of the arts. They are commonly very meagTe, indeed, and indefatigable in any purfnit to which they give themfelves up. ' Vlkap.l. he MEDICINE. 32 C motion, by which all the fundions, and particularly the adion o£ the veffels, are much excited, and the perfpiration proportionally promoted ; and they have this motive for their indolence, that all motion is more fatiguing to them than to others. Hence, the quanti- ty of fluids, which during exercife is ufually thrown off by the pores on the furface, and thus diverted from the adipofe ceils, is allowed, during a ftate of bodily quief- cence, to take its courf» to thefe*cells rather than to the furface of the body. - CCGCXLVII. Having explained the peculiarities bf thefe difeafes ; I may obferve, that, as the affedion of a part, in every general difeafe, depends upon the general affedion, as it is of the fame kind, arifes from "the fame exciting powers, and is removed by the fame remedies (^); it is reafonable to believe, that the af- fedion of a part, whether it be inflammation, or more Confiderable adion of the brain and blood-veffels than of any other part, is not different in different cafes, but altogether the fame in all; that it only differs in fome circumftances of no fignification, and by no- means re- quires a different plan of cure, or affords fundamental diftindions ; and that this miftake, which has had the moft pernicious effed upon the art of medicine, muft: be done away. It is with propriety, then, that I have avoided reducing all the difeafes of which I have treat- ed, firft to two genera, and after to fpecies ; and that without regard either to genera or fpecies, I have refer- ' -ted them to two forms only. ' CCCCXLVIII. Further, as in all thefe laft 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 confined to a part, and arc never to be direded to a part (a), with the view ef removing, by their (z) See part firft, chap. IV. and particularly par. LIII. (*) See par. LVI. and XCII. 3& The Elements Ari IB; their adion upon it, the difeafe, as if all locked up there ; by means of this theory we may lay a fure foun- dation for the eftablifhment of a certain feries, or fcale, of increafing ftrength^ from perfed health to the moft fthenic difeafe. In that fcale peripneumony holds about the higheft, and obefity the loweft, degree. CCCCXLiX. Peripneumony and phrenitis are foh. lowed by two difeafes, that fometimes equal them ; the violent fmall-pox and meafles. Thefe two are fueceed- ed by a diieale, that fometimes vies with them, the eryfipelas, when accompanied with a Very fevere affec- tion of the head. As equal to this* not in danger, but for the moft part in the degree of diathefis, rheumatifm comes next. Next to rheumatifm is marked the mild eryfipelas : this is far fhort of thofe above it in violence, and claims nearly an equal place with the fthenic cynanche, with which it is much more nearly allied than with any of the former. Thefe are the difeafes accompanied with pyrexia and inflammation. CCCCL. The two which ftand loweft, the mild eryfipelas, and the fthenic cynanche or common inflam- matory lore throat, are of fo doubtful a rank with refped to each other and to catarrh (b), a difeafe which is not accompanied by inflammation ; that it is doubt- ful which ot the three fhould be fet higheft. Below them, however, the fimple fynocha and fcarlet fever, in fo far as the latter is a fthenic difeafe, and in fo far as the ufual ftate of both is confidered, are to be placed ; without any hefitation (c). The loweft part of the fcale of (b) See CCCXCIV. and the note to it. (c) The fimple fynocha is fo fimilar to a gentle typhus, that it requires great judgment to diftinguifh them at firft. The fafeft way, when the doubt cannot be determined, is to keep the patient in a moderate temperature, and in a ftate of reft ; as any debili- tating power, in cafe the difeafe fhould turn out a typhus, would be dangerous ; and, though it fhould afterwards manifeft itfelf a fynocha, ftill its mildnefs renders the omiffion of any thing that might have been done, innocent ; and it is always eafy to take down fthenic diathefis. Chap. I. OP MEDICINE, 337 of fthenic difeafes with pyrexia, is affigned to the fmall- pox and meafles, in their mild ftate. CCCCLI. Through this whole fcale it is not fo much the titles and names, but morbid energy, that is regarded ; it being the certainty derived from the caufe, not the uncertain and perfedly deceitful con- fideration of fymptoms, that was to be confidered (d). ■ The inveftigation of fymptoms has hitherto been un- attended with any advantage ; on the contrary, it has been of the higheft detriment to the art ; and fince it has proved in medicine as produdive a fource of funda- mental errors, as the queftion about abftrad caufes " proved in the other "departments of philofophy (e), it muft be laid afide, and nofology damned. CCCCL1I. Below the laft mentioned difeafes are fet -mania, pervigilium, and obefity. Betwixt which, and the difeafes to be mentioned hereafter, the point of perfed-health is to be fixed ffj. The Cure of the Sthenic Form of Difeafes. CCCCLIII. As to the indication of cure in the fthenic form of difeafes, I fhall apply that already laid down (g), viz. to lower excitement, firft to a violent degree of the diathefis, then to a (lighter, and to the danger of parts, in fuch a manner, that regard fhall only be had to the degree of force in the remedies (h). CCCCLIV. When, therefore, we have a violent diathefis, as in peripneumony, phrenitis, the violent fmall-pox, meafles, and eryfipelas, immediate recourfe muft be had to the moft powerful and quickly effedual remedy $ (d) See par. LVIII. *- (e) See par. XVIII. and look into Obfervations on the different fyftems of phyfic, and in it the introduction throughout. (f) It will be eafy for the reader, with the directions above, to make out the table for himfelf. (g) See par. LXXXVIII. {b) See alfo par, XCII. T 2 V* THE ELEMENTS PartUL remedy ;• but fo much blood fhould not be taken, as many who entruft nearly the whole cure of the difeafe to it, think, and commonly pradife ; but more, how- ever, than others fuppofe fliould be taken (i). CCCCLV. No meafure fuits all cafes > the quanti- ty to be taken being different in different cales, ac- cording to the difference of age, fex and ftrength, and to the degree of the exciting noxious powers. In child- hood, which, excepting the meafles and fmall-pox (k)r is feldom affeded with the difeafe we have mentioned, and in a very advanced age, where there is alfo lefs danger than at the flower of human life, fmall bleed- ings fucceed ; becaufe, at both thofe ages, a lefs degree of excitement upholds the difeafe ; while in the former the high degree of excitability, in the latter the necefli- %y for moreftimulus, or exciting power, than formerly, fet pounds 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 been taken, the great heat, the hardnefs of the pulfe, the affedion of the head or of the lungs, and drynefs of the forface, fhall have gone off, or be much abated ; and if the temperature be much lowered, 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 breathing relieved, and the delirium re- moved (/); then it may be looked upon as certain, that enough of the vital fluid has been fhed for the time. CCCCLVH. To- (/)• The moft early among the alexipharmic practitioners, after once making his efcape from peripneumony without bleeding, felt a victim to the folly of his theory in the next attack. The alexi- pharmics in general were too moderate m their bleedings in the true, though few, fthenic difeafes that require it, and all in the wrong in their ufe of heating ftimulant prefcriptions in them* (k) See par. CCCCI. (/) The references for facts are CLIX. CLV. CCCXXXIV. CLVII. CLXXIV. CCCXLIX. to CCCLV. CLIV. CLIX. CLXXXIV. CCCXXXIILtQCCCXXXVI. CLV. CCCXLIII* CCCLIV. CLVIII. Chap, h OF MEDIOINE, *$} CCCCLVII. To obtain this benefit, in the moft vigorous adult ftate 10 or 12 ounces, and much lefs either before or after that period of life, will for the moft part be found fufficient. As this rule will not anfwer in every cafe, when it fails, recourfe muft be had to that, which recommends the abatement of the fymptoms as a diredion more to be depended upon (m). CCCCLVIH. Since the local affedion depends upon the degree of the general («) diathefis, there is no occa- fion for any particular diredion with regard to it, any farther, than to take advantage of its being acceffible, in order to help the general remedy by an application of it to the part (0). CCCCLIX. When that has been done, and the firft Violence bf the difeafe is now broken ; we muft have recourfe to purging, as a great remedy in point of effi- cacy (j>). For this purpofe, we fboujd not employ violent means, fuch as many formerly employed (q) j becaufe the ftimulus accompanying this firft operation ■may be hurtful ; but it is the gentle cathartics that fhould be depended upon, fuch as Glauber's fait, which is highly debilitating, and carries a great quantity of fluids out of the veflels. Though a man of good fenfe in the laft century ufed cathartics and bleeding on alternate days ; yet, if the violence of the difeafe fhould be urgent, there is nothing to hinder the ufe of •cathartics the fame day that the blood has been taken. CCCCLX. Purging, after a fmall bleeding, has more effed in overcoming fthenic diathefis, than any bleed- ing without it; becaufe, as has been mentioned above* in this way the debilitating power (which has always more debilitating effed in the place to which it is firft applied, (m) See.CCCVI. \n) See above LVL and CCCXLII. to CCCXLVI. (?) Ibid. An inftance of fuch afliftance may be the local "Weedings over the pained part in rheumatifm and the gout, and: fome other afthenic remedies are aided by local ftimnU. (p) See CCLXXXIII. (g) The alexipharmics particularly.. 34© the elements Part Hi applied, than in any other,) is applied to more parts ; and not only to the greater blood-veffels, but alfo to a prodigious number of their terminations ; and the ex- citability is more extenfively, and therefore more equal- ly, diminiihed (r). 44. Vomiting, which has hitherto been fo freely employed in afthenic difeafes,, where it is pernicious, and in the common pradice conftantly negleded in fthenic difeafes, where it is of the greateft fervice, comes ia • here as a proper part of the treatment : it is of the fams evacuant nature, ads upon another part of the fame -canal, and admits of juft the reafoning that has been applied to purging. CCCCLXI. At the fame time that the exceffive, and therefore hurtful, ufe of the lancet is fuperceded by thefe two evacuants; its ufe is not altogether to be laid afide in the difeafes of exceffive excitement ; becaufe the excitement is often raifed by the operation of ftimur lants fo high, as, from the conlumption of excitability, which puts an end to its exiftence, to threaten inftant death (s). CCCCLX1I. Befides thefe remedies (/), the patient Ihould always be required to abftain from every fort of , food but vegetable, which Ihould be taken in a fluid form, as well as from all ftrong liquors, and indeed * from all but watery liquors acidulated (».). This direc- tion does not feem to have been fo much negleded in words by former writers and authors, as adual applica- tion to pradice ; it having been delivered flightly, by the by, and as if it had been thought of no confequence, fo that it made no impreffion upon the mind of the reader or hearer. No ftimulus is more powerful, and, therefore, in this part of the pradice, more hurtful, than that of the articles of diet : Confequently, whatever quantity (r) See par. CCCCLXXXIII. CCCCLXXXVI. alfo CCCY. (/) See par. CCLXXXI. and CCLXXXIII. CCLXXXIV. (/) From CCCCLIV. to CCCCLXII. (u) See CCLXXXIV. Chap, I. OP medicine. 34* quantity of blood is taken from the veffels, whatever |' quantity of ferous fluid is carried off by the mouth and " anus, if this ftimulus is not effedually guarded againft, the effed of all this evacuation may eafily be counterad- ed. Still, however, fluid vegetable matter is not to be forbidden, becaufe fuch watery matter is not retained in the veflels ; but, eafily entering the fmalleft of them, it flows out in all diredions by their various outlets ; and, at the fame time, fupports the efficacy of fweating remedies (x). ^ CCCCLXIII. Conjointly with the firft bleeding, the firft; vomiting and purging, with abftinence and watery fluids, it muft not be torgotten, that particular regard is to be paid to temperature (y) : For, if cold always debilitates, and if that is its proper operation (z), if it only feemingly ads otherwife, becaufe heat fucceeding to its adion, or alternating with it (a), renders its effed ' ftimulant, if cold alone is adequate to the cure of the fmall-pox (b), or prevents the violence of that difeafe, if it is the beft remedy for catarrh (c), and, when heat is ayoided, of the greateft efficacy in every fthenic dif- eafe ; it is not to be doubted, but that it is of the greateft benefit in difeafes of the higheft fthenic dia- thefis. CCCCLXIV. Its operation in the fmall-pox, and in other fthenic difeafes, is not different, but altogether the fame. Nay, in all the difeafes of this form, as cold alone is fufficient to effed the cure ; fo, whenever the ' diathefis, as is the cafe in the difeafes that are our prefent fubjed, rifes to its greateft height, and demands inftant relief; (x) This obfervation feems to me of that fort which fuits an hydraulic machine better than the animated fyftem. Thefe weak ' liquors, in being abforbed, and in being exhaled, muft produce much animal action, which, according to the general tenor of I>r. Brown's reafoning, muft do mifchief. Editor. (j) See par. CCLXXXI1. (z) See par. CXVII. (a) See XXXVII. and the addition. (b) See par. CXXL (c) SeeCCCCVII. 34= THE ELEMENTS Part lit. relief; becaufe, in that cafe, every moments dela? brings inftant danger; though the remedies, which we have mentioned, are fufficient for the folution of the n difeafe, of which we have dired proof in pradice; though that degree of cold, which would produce the effed, is neither always within our reach, nor can be properly applied by every perfon ; and many perfons might not be difpofed to believe its effeds fo beneficial: We fhould not defift from.the plan of cure here laid down (d), but do our beft for the 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 indeed fhould, for the moft part;, be preferred to the application of very intenfe cold, on another account; for the fhortnefs of the time in which any one could poffibly remain in intenfe cold, woul^ oblige him immediately to return to higher tempera- ture, which would produce a greater excitement than he had been under before his expofure, at leaft too, great an excitement (e). CCCCLXVI. The effed, therefore, fahely impute% to cold, of occafioning the ftriking in of the meaflesyfe not to be imputed to cold alone, but to heat and other ftimuli ; giving, as has been explained, more excite- ment (f), than if cold had not preceded. And how can it be otherwife ? If cold does not interrupt tht eruption in the fmall-pox ; but, on the contrary* by an enlargement of the diameters of the perfpha*iii|r ■ veflels, which are fhut up by fthenic diathefis, mutn promotes the difeharge of the matter (g): Why, in a perfedly fimilar cafe, fhould its operation be fuppofed different, not to fay, diametrically oppofite ? Muft we again have the trouble to refute the falfe notion that a caufc? (d) From CCCCLIV. to CCCCLXV. (e) See XXVI. (f) See XXVII. and the addition, and CCCLXXX. (g) Sec CCCLXXVL Chap. 1. Of MEDICIN3. 343 a caufe precifely the. fame may produce contrary effeds ? Cold diminifhes the eruption in the fmall-pox : It \ Snakes the eruption difappear in the meafles. What *then ? Take a nearer view of the fad : Is its effed in both thefe cafes to be fuppofed the fame, or different ? How do you know, that the matter, which has difap- peared, is driven into the interior parts ? What proof will you bring ? Confefs the truth ; and be candid enough to acknowledge, that this is another relic of the alexipharmic dodrine, according to which, the ftimulus of heat as weft as other ftimuli promotes, and cold im- ' pedes, perfpiration. After a great man had fhown the error of that dodrine, both in the fmall-pox and other difeafes (/;), 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 beyond his Vords. But it might have been obferved, if obferva- tion 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 de- jbilitating kind ? And as it was manifeft, that in the fmall-pox alfo cold debilitated, or, in the com moft language, aded as a fedative ; might not fome fuf- picion, from that very circumftance, have arifen irt jtheir minds, that cold, in the meafles, does not ftimu- late, or ad as an aftringent,and repel the eruption, but produces the fame effed as in the fmall-pox ? Is it, to fuch a degree, up-hill work, to ufe one's own under- ftanding, 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 refledion ?-----But, it may be contended, that the adion of cold is in this cafe peculiar, becaufe, after the eruption, which it is fuppofed to check, has difappeared,. (B) In peripneumony he took his patients out of bed, and fet them in a chair, for the fake of cooling them, and avoiding the hurtful effect of heat. 344 THE ELEMENTS Part III; difappeared, all the fymptoms increafe in violence. Confider what that circumftance makes for your argiafl ment, or whether it makes any thing for you, and not! abfolutely againft you ? Was the adion of cold follow- ed by that of ftimulant or debilitating powers ? If it was by the former, the caufe of the mifchief muft be imputed to them ; which, as has been juft fa'id, pro- duce exceffive excitement after a previous application ot cold, and more than without it ; if debilitating powers had been applied,- then there would be room lor fufpicion, that cold had a concern in the effed. But it is not io : And, in every cafe, in which the action of cold has been followed by fthenic diathefis, the true caufe was not fufficiently guarding againft the ftimulus ot heat, as well as that of other noxious powers. This is clearly proved by the application of heat being pofuively ordered, inftead of being forbidden, in the common pradice. Nor is that to be wondered at :, l*or it the caufe of catarrh (/') deceived phyficians fo much, the catarrhal fymptoms in the meafles could not tail to deceive them. And, if dodrines, difcarded in words, are often obferved in pradice ; what was there to hinder this part of the alexipharmic dodrine from meeting with this fate ? CCCCLXVIL If cold, therefore, can fcarce be fo managed, that the effed occafioned by the accompani- ment, the fucceflion, or the alternation, of ftimulants, -can be prevented, whether that be the fault of the phyfician, or owing to the nature of the thing (k) ; it is, notwithstanding, a rule in common to the meafles and other exanthemata of the fame ftamp, to avoid hear, and compenfate for the degree by the greater duration of cold, and to guard with all poffible care againft every ftimulant power. It is now then moft evident, that the opinion of cold being peculiarly hurt- ful in the meafles, both in that and every other difeafe of the fame form, falls to the ground. . Refition (i) See from CCCCVII. to CCCCXII. (i) Turn back to CCCCLXV. and CCCCLXVI, Gkap* L of medicine. 345 A Repetition of the Cure, \ CCCCLXVIII. After ufing the remedies which have been direded (/), if the fymptoms recur, the fame train of medicines muft be again gone through : Blood muft be again taken, emetics and purgatives again adminis- tered ; nor muft we defift from the ufe of the refrige- rant and attenuant plan : And all thefe means muft be employed, 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 which, CCCCLXIX. If the diathefis feems now nearly re- moved, if the affedion of the head, of the lungs, or any internal one that may be prefent, feems alleviated or * repelled; and yet there is fome apprehenfion of the return of the difeafe ; recourfe muft be had to more ' moderately debilitating powers. Sweating, the ftimu- lus accompanying the firft operation of which, as the diathefis is now rendered mild or removed, the body will be able to bear, fhould be preferred to bleeding, vomiting, and purging. But before I proceed to fpeak of it, it feems proper to fay a few things concerning the fum total of blood that fhould be taken 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 fhould be a mean betwixt the quantities, which the common run of phyficians approve, while fome. think it too much, fome too little. The reafon for this recommendation is ftrengthened, by the confideration of there being now lefs occafion for (bedding a great deal of the vital fluid, fince the cure is more divided among the other reme- dies that have been inculcated. The age muft be regarded, as was formerly recommended (m)* the former mode 11) From CCCCLIV. to CCCCLXVIII. \m) Set CCCCLV. 346" THE ELEMENTS Part III. mode of living muft be attended to, the quantity of ftimulus, that may have immediately preceded the Jj morbid ftate, muft be confidered, and the habit of the * body compared with the degree of the fymptoms and * the effed of the treatment. From thefe circumftances a judgment fhould be formed of bleeding and other evacuations ; and it fhould be eftimated, what further treatment of the fame fort may feem proper, and what difference of management may be required. Upon the whole, it will be found, that there will be the lefs oc- cafion for any one medicine, the more freely others have been brought into ufe ; and it will be underftood, that the danger of too great evacuation will be thereby a- voided, and health better fecured (»). CCCCLXXI. With refped to the manner of bleed- ing, blood fhould always be taken from a very large vein ; becaufe the cutting a fmaller one, or opening an artery, does not afford a fufficient quantity for the relief^■'} of the veflels, and arteriotomy is further attended with inconveniencies (o). As far as any certain rule, in an affair admitting of fuch variety, can be eftablifhed, two pounds of blood in three or four days, with the aflift- ance of the other remedies, will, for the moft part, be fufficient at the middle of life, and lefs at a more early or later period. CCCCLXXII. Bleeding fliould be always followed by vomiting and purging, fo long as any confiderable part of the fthenic diathefis remains ; nor fliould the other parts of the treatment, that have been pointed out, be negleded. But cathartics, of which a Angle dofe can at any time bring back a fit of the gout; which cure the fthenic cynanche or common inflamma- tory (*) See CCLXXXVI. and CCCV. (o) The blood is ready to break out again after the tying up r and if, as fome advife, the arterial twig Ihould be cut through, it diminifhes the number of the few accents to this mode of bleed- ing ; neither does there feem to be any ufe in deftroying fuch yeiels, efpecially as no good retf?g caji be frown for doing fo* Chap. I. , of medicine; M7 tory fore-throat, and the mild eryfipelas, when even the face or head is affeded ; which are of manifeft detri- ment in fevers ; which, in dyfpepfia, in afthma, and every fort of difeafes depending upon debility, whether dired or indired, do great and palpable mifchief; and form a great part .of the vecy bad common method of treatment in the whole form of afthenic difeafes -r in proportion as they ought to be avoided in all fuch difeafes, fhould be as certainly employed in fthenic difeafes •» they fliould never be omitted in any con- fiderable one, fuch as thofe that require bleeding, but be managed according to the directions lately given. We ihould, above all things, be on our guard againft that diffidence in the ufe of this remedy, as well as of vomiting, where they are ferviceable,. and that confi- dencatin them when of differvice—both errors introdu- ced By the fpafmodic dodrine„ and both therefore ad- mitted upon a falfe and abfurd principle (p). CCCCLXXIII. As nothing in afthenic difeafes has been more ufed than thefe two modes of evacuation, nothing with more hurt, and often with inftantaneous deftrudion ; fo, for this very reafon, nothing is more fuccefsful in the cure of fthenic difeafes. CCCCLXXIV. It is fcarce credible,, how far the averfion to the alexipharmic method of cure has had the effed of branding the very beft medicines, what a mis- application of them it has fuggefted, and to what a degree it has perverted their proper ufe. Not to repeat what has been formerly faid ; fweating, which is of the higheft fervice in every moderate fthenic diathefis, and in every degree except the higheft, or where it preffes upon {p) The principle, at leaft with refpecTi to purging, was, that it diminiftied perfpiration, and, therefore, was underftood not to act as an antifpafmodic. 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 defert- ed their only good leader, at leaft. in thofe difeafes, who alternated his bleedings and purgings, and, as I have found, upon the befl authority. 343 THE elements Psrt III. 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 them all except one, not only as ufelefs, but as hurtful ; which has chiefly happened fince the fpafmodic dodrine be- gan to be received into this country, and during the few years it continued to gain ground (q). CCCCLXXV. But, in truth, befides rheumatifm (which fweating, at leaft as produced by one medicine, is allowed to cure), if it moft certainly either relieves or removes the fthenic cynanche, eryfipelas itfelf, and ca« tarrh, and the fimple fynocha, in proportion to the more free or fparing ufe of it ; if that be known to the very vulgar, and moft certainly to phyficians of every other (except the fpafmodic) fchool; what reafon, what well-afcertained fad, will any one bring to%iow, why fweating fhould not be univerfally ufed, after the very violent fthenic diathefis is much diminiihed by other medicines, and is now reduced to the degree, to which this remedy is adapted ; what eloquence would be requifite to bring any man of fenfe to fuch a per-: fuafion ? *. CCCCLXXVI. He 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 has it not in his power to fay, that for certain it will be hurtful (r). This is readily admitted in an high, diathefis, (q) Turn back to CCCCLXIX. (r) It is laughable to hear fuch perfons talk of their pradice, from which they never can receive information ; it being not the effect ef any thing they know themfelves, but what they have been told by others. In thf: way, without any exercife ofjudg- ment, without a fingle obfervation, 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, like children in the play of blind Harry, groping about with their eyes tied up, through the whole courfe of a practice boafted of, God knows, by nobody who knowt it but themfelves. Chop. I. ©F MEDICINE. • 34f diathefis, threatening indired debility (s); but it can- not alfo be granted, that in a moderate degree of the pf diathefis, either original, or effeded by other remedies, and, confequently, after the plan of treatment, that we have laid down, has been executed, fuch heat will not be compenfated by the great profufion of fluids taken away from the whole furface of the body -y or that, when this part of the vafcular fyftem has been freed from a violent ftimulus, the diminution of excitement will not be more equal in all the veffels, and over the whole nervous fyftem. If the numerous velfeis, that open into the inteftines and into the ftomach, afford fuch an opportunity to diminifh fthenic diathefis, how is it poffible that a fimilar evacuation in the fimilar perfpiratory veffels fhould have no tendency to produce the fame effed ? To which reafoning if the fads juft related be added, what can any perfon have to fay againft the ufe of fweating, if a degree of heat, not greater than what cannot be avoided in the operation, can no longer be hurtful, and if the fweating itfelf is certain to be of great fervice (/) ? Let the fpafmodic caviller againft the ufe of that remedy in the cafes of fthenic affedion wher# it is admiffible, mutter up all his (x) If the diathefis fliould rife within two or three degrees of indireft debility, in that cafe the heat of the firft part of a fweat, by exhaufling the little excitement that remains, may have a moft hurtful effect. But if the diathefis be any where below that higk point, the addition of ftimulus can be borne for the fliort time of its continuance ; and be afterwards much more than compenfated by the large and continued flow over all. (t) In aa excitement of fixty-feven, within three degrees of in- direct 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 its evacuant effect. But, if the excitement be no higher than 6o°, the addition of the three degrees will keep greatly within the point of indirect debility, and, therefore, be r fafe ; while the fucceeding evacuation may reduce the excitement perhaps 10*, and bring, it within the range of predifpofition ; and a new courfe, or a little prolongation of this, carry it down tm the point of health, and finifb tbe cure> 35© THE ELEMENTS Part III. j his fads and all his theories, let him turn himfelf into^jl all fhapes, he will never produce a folid argument TM againft this remedy.—But what, agavn, is the tendency lB of all this difputation ? Will there never be an end of f 1 running from one extreme of error into the oppofite ? Shall no mean be found betwixt the alexipharmic plan of cure, and one equally bad or worfe ? If that dodrine J hefitated not to prefcribe fweating in the rage of a '] peripneumony, and that too procured by means of the j moft heating ftimulant powers ; does it therefore fol- j low, that a plan of treatment muft be admitted, which rejeds the certain and fafe ufe of this remedy, when excited by the moft gentle means ? If it was the I opinion of Dr. Sydenham," that heat fhould be avoided ] in the cure of fthenic difeafes, which was quite right, as heat certainly increafes the excitement ; are we, for that reafon, to avoid that tolerable degree of heat, !,-*j which accompanies a remedy the moft powerful in re- ftoring the healthy ftate, and, thereby, deprive our- felves of great benefit upon the whole ? If fuch perfons do not know, that feveral remedies diminifh excitement more powerfully than one ; and, if they are to be ex- cufed for their ignorance ; are they alfo to be excufed 1 for not feeing, what any empiric might have feen, that fome things are of fervice, and others of differvice ; is » fuch want—not of genius, for genius is not required of them—but of common fenfe alfo, to be pardoned ? . If to think for themfelves, and to make any fort of difcovery, was too much to be expeded from them ; is it not fomewhat furprifing, that out of a thoufand writers, who have treated of every part of medicine, "J and entertained different fentiments from one another, they could fqueeze no information, but always trod in the footfteps of one fingle man ? • CCCCLXXVII. Sweat, therefore, after the manage- ment that has been defcribed, is to be excited; efpecial- ly if there fhould feem fomething ftill wanting to the complete return of health, fome degree of fthenic dia- thefis ' Chap. J. OF MEDICINE* 4£.% thefis fftill remaining, and a fpontaneous tendency to t iTvveating fhould appear. f CCCCLXXVIII. When the figns of a fpontaneous * fweat are perceived, nothing more is to be done, butt firft to lay the clothes about the patient;, remove.the flieets, put the blankets next to his body, guard againft the approach of air, and keep up the difeharge for a fufficient length of time, at leaft ten or twelve hours. If from this management there fhall enfue a copious and univerfal flow of fweat, there will be no occafion for giving medicine for the purpofe.-—After fweating has increafed the relief formerly procured ; if it fliould difappear towards the end, it fhould at laft be fupport- ed by Dover's powder, or by laudanum alone ; at the fame time the body fhould be covered, fo that it may .get as quickly as poffible to the furface, till the exped- ed benefit be obtained. If a draught of cold water be fometimes given, and then the body be well covered up and properly managed, the effed often fucceeds 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 mediocrity 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 off, we muft keep this circumftance 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 fweat fhould be attended with lefs relief, or with inconvenience, it fhould be immediately flopped r For it was not for no purpofe, but for that of making the remedies fupply the defeds of one another, and of reducing the excitement more equally over the whole body, that a number was recommended. CCCCLXXIX. In all the cafes of a violent diathefis, all the remedies that have been mentioned, are, more or lefs, differently on different occafions, in proportion as the remaining diathefis may require, each in a higher or 35* THE ELEMENTS PartllU { or lower degree, or in a larger or fmaller quantity, to be brought into play, and the curative circle enlarged. CCCCLXXX. Some flight medicines, fuch as acids "Sj and nitre ; fome of uncertain ufe, fuch as leeching, ^| cupping, ai*l bliftering, are mentioned in writers, as of the firft confequence. Of thefe, the acids, in fo far as they render the drink more agreeable, and, in an affec- tion of the lungs, do not produce cough, but prove, in a certain meafure, refrigerant, are to be permitted ; efpecially if there fhould be a defire for them. Every body ought to know, that the refrigerant power of nitre is lefs than is commonly thought. In rheumatifm, and the fthenic cynanche if this fhould be unufually fevere, blifters, leeches, and cupping-glaffes, applied in the neighbouihood of the inflamed parts, may, in fome \ meafure, b- of fervice. Nor does there feem to be any reafonable objedion to the application of a cap of recent earth to the head in phrenitis. The other Part of the Indication of Cure. CCCCLXXXI. To pafs on to the other part of the indication of cure(»): When there is a gentler diathefis, as in the other phlegmafise, and in thofe fthenic affec- tions, of which the treatment has not yet been confider- ed ; as in the mildeft ftate of eryfipelas, of the fthenic cynanche, in catarrh, fimple fynocha, the fcarlet fever, and the mild fmall-pox and meafles; a fmaller debili- \ tating power is required ; and, therefore, neither all the remedies that have been mentioned, nor in general fo much of each, as in the other difeafes of this form, are lequifite. CCCCLXXXII. In all thefe cafes, not even with the exception of rheumatifm, which depends upon an high diathefis, bleeding is unneccffary ; and in all, with the exception of rheumatifm, bleeding to any ex- tent is hurtful : For, when the excitement is not very great, («) CCCCLL •€&ap. I0 of medicine 35* ^reat, but, on the contrary, is moderate, fcarce exceed- |;ing that degree that prices the predifpofition to other ^ difeafes, it is abfurd to make ufe of a very debilitating power, by way of a remedy, as if We had to combat a very violent difeafe. And, fince the intention in bleed- ing is to prevent an ultimate excefs of exciting power from producing a ceffation of excitement, an event of which there is not the leaft danger in a moderate dia- thefis, fuch as that which is the caufe of the difeafes in queftion, the treatment ihould be adapted to the caufe, and bleeding fhould be either abftained from altogqther, or very fparingly ufed. CCCCLXXXIIL It is not, therefore, only in dif- eafes 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 profcribed. CCCCLXXXIV. Though in rheumatifm the dia- thefis often runs confiderably high, the ufual profufe bleeding is not, however, required. For, as every diathefis is always greater in fome parts than in any Other equal part, fo it is with the fthenic diathefis in this cafe ; which is found much greater upon the fur- face of the body, than in any other equal fpace within. The reafon is, that the moft powerful noxious agent, heat, fucceeding to cold, or fo alternating with it, that its own ftimulus is increafed by the cold (x), exerts its principal energy on the furface of the body. Hence, after exceffive bleeding, the difeafe often obftinately recurs. The reafon of the recurrence, if the principles j of this dodrine be wrell underftood, cannot be obfeure. Bleeding diminifhes the fthenic diathefis chiefly in the red veflels, lefs in any of their extremities, leaft of all in the perfpiratory veffels, and in thofe difpofed in the trad of the mufcles, becaufe the operation of bleeding; (*) See XXXVIL and addition. Wa 354 THE elements Part UlJ is counteraded by that qf heat : This explanation is ... confirmed by the certain teft'gflbny of phyficians ; whoJ often complain that their favorite remedy fails them. ^B CCCCLXXXV. Hence fweating is remarkably ™ adapted t$ the cure of this difeafe : To fweating, therefore, after a previous bleeding to twelve ounces, and with attention to the rule of temperature and diet before given, we muft have immediate recourfe, if the diathefis happens to be confiderably violent, which appears from the heat of the body, the pains raging moft in the night time, and from a ftrong and hard pulfe. In order to render the fweat univerfal and of fufficient duration, it ihould be excited 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 abatement of the fymptoms, in the form of moifture or free perfpiration, and repeated when the fymptoms return. The reft of the cure muft be en- trufted to low diet and an exad temperature. CCCCLXXXVI. In this difeafe, after the fweating, and alfo in the cafe 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 diathe^ lis is fomewhat confiderable, but far fhort of the cafe ) firft confidered ; we fhould ufe either a very fmall ' bleeding, and then chiefly the evacuations before men- tioned (y) , next a flight fweat ought to be kept up, not longer than for eight or ten hours ; and, during ihe whole time of the cure, we fhould enjoin abftinence^ weak liquors, reft of body and mind, and cold/except at the time of fweating, and even then the heat fhould be as low as poffible, as fermerly direded : The united ufe of thefe means is perfedly equal to the removal of any of thefe difeafes; but there will not always be occafion for them all. CCCCLXXXVII. Often fo mild a diathefis occurs, that one or two of them, once or twice employed, is fufficient (j)gwcscvr Chap. I. OF MEDICINE? %$$ fiifficient for the cure :,*—In a flight diathefis, that is, - one in which,, unlefs for a little at firft, the fhivering, languor, and, heat, are fo inconfiderable as to indicate a proportional flightnefs of diathefis upon the furface -, in which there is fcarce any laffitude, whicrAidicates a fimilar moderation of diathefis in the organs of volun- tary motion ; in which the vigour of the ftomach re- mains fo as to manifeft a moderate excefs of excitement in it ;. in which, in fine, the other fundions are fuffici- ently regular, and only fuffer CQnfpicuoufly in the af- feded part—In fuch a cafe, a fingle purge of Glauber's fait, and, without that, cold, reft, and abftinence, have often reduced the morbid excitement to its falutary degree. A thoufand times has the fthenic cynanche, a thoufand times catarrh and the fimple fynocha, nay, eryfipelas itfelf with affedion of the face, been fo re- moved. And the fcarlet fever, is often fo mird as to yield to the fame management. CCCCLXXXVI1I. In this way muft a conftant re- gard be had to the degree of excitement and diathefis in the method of cure,, and terms muft be often difre- garded. It was with a view to the treatment, that the fimple fynocha was before diftinguifhed from the phrenitic, and the gentle eryfipelas from the violent. For the fame purpofe it may be remarked, that catarrh often rifes to.fuch violence as threatens or brings on a peripneumony ; and that peripneumony itfelf is fome- times much flighter than ufual.. Under thefe circum- ftances, it is the degree of excitement alone, that ought to govern the phyfician, without regard 'to names. CCCCLXXXIX. Another ufeful caution here is, to judge of the ftate of the pulfe, of the temperature upon the fkin, and of the ikin in other refpeds, with due attention to thefe principles. The frequency of the puife in all fthenic difeafes is moderate : With that .there is conjoined fome hardnefs and fulnefs. When- ever, therefore, the pulfe is very quick, it is to be fuf- peded, that the fthenic diathefis has paffed into the afthenic, $$& THE ELEMENTS. Part 111 afthenic, the exceffive excitement into a ceffation of excitement, or that the difeafe has been asthenic from«'.| the beginning. To remove all doubt, the habit of * body, and the age, muft be confidered, and an inquiry be made, vfhether the difeafe has been preceded, or not, by contagion. Heat of the fkin is common to thefe difeafes and to fevers, which are difeafes of an oppofite ftamp, and therefore is a doubtful mark. As it depends upon an interruption of perfpiration, from whatever fource, it is never to be ftrained into a proof of the ftate of excitement. And, fince drynefs of the fkin, which. is common to difeafes fo different from each other, in the afthenic difeafes depends upon debility ; in order. ^ to judge of this fymptom, the other fymptoms, and the exciting noxious powers, fhould be confidered. In fine, the only inquiry fhould be, whether the excite- ment is abundant or deficient, and all the figns ffiould be confulted with that view ; nor are we to judge rafh* . ly from any peculiar form the affedion may have af-, fumed. CCCCXC. When, therefore, the figns, that have been enumerated, are compared with all the others and with the diathefis, we are to fet about either the anti- fthenic or the ftimulant plan of cure. The violent , fthenic difeafes, which we firft confidered, can fcarce be confounded with the afthenic ; the more mild are daily confounded with them.. But, though it is eafy to diftinguifh thefe from afthenic difeafes refembling them ; Ihould any perfon think the marks of diftinc- tion ambiguous* let him be informed, that, upon ac- count of their mildnefs*, though the difeafe under ex- amination fhould be fthenic, blood is not to be let, for fear they Ihould turn out afthenic ; in which fo de- bilitating a power is deftrudive, as has often already been faid upon former occafions ; let him alfo under- ftand, that his method of cure, conduded in this way, will be fecured from all dangerous miftakes. For, if the diathefis, though fthenic, be flight, bleeding will often s Qhap. I. OF MEDICINE. 3S7 often precipitate it into the oppofite ; it will at the beft: —^£>e ufelefs (z). If, on the contrary, the difeafe that Kpaffes for fthenic, fhould, in its progrefs, (how itfelf r_ evidently afthenic ; in this cafe, every drop of blood that may have been taken will go to the increafe of the difeafe (a). Yet this pernicious pradice daily fends more men out of this world, than all the plagues of human life (b). CCCCXCI. As abftinence, cold, and the manage- ment of the bowels, are fufficient in a gentle ftate of the fmall-pox ; fo when the proper preparatory plan has been negleded, and the eruption is thick, trial muft: be made alio of the other remedies (c), except fweating. This muft be avoided, becaufe the ftimulation accom-. Epanying it, by increafing the fthenic diathefis on the ;•■' furface, would tend to check the perfpirable fluid, and detain the contagious matter under the fcarf fkin, and •produce that pyrexia, which is fymptomatic of the inn flammation, and is called the fecondary fever. This peculiarity of treatment is taken from the ^peculiarity of the fymptom juft mentioned, ancJ forms no objec- tion to the principles of this work. In confirmation of which, it may be remarked, that, though there is all the proof that can be derived from fure pradice, the remedies wc have mentioned are fufficient; yet, before the eruption comes on, nothing can be objeded either to fweating or bleeding, as remedies applicable to this in (z) Suppofe the diatKefis be two degrees above the higheft of the points of predifpofition, at 570 ; and bleeding to the degree of producing 350 of debilitating influence be employed j it is evident, the excitement will go down not only the 17° necefTary to bring it to the point of health, but fink to 220, that is, 30 beiow the range of predifpofition to afthenic difeafe, and therefore com- plete the converfion of the fthenic into an afthenic difeafe, (a) See CCLXIX. CCLXXXI. CCXC. (b) See par. CCCCVI. towards the end. (0 CCCCLIIL to CCCCLXVIII, # 358 the elemerits ParlllU imcommon with every other fthenic difeafe (d). In fine, the fuccefs of low diet, cold, and purging, is certain ; but at the fame time, the other remedies, that remove fthenic diathefis, likewife operate to the fame effed (e). It was proper to fay fo much for the fake of ihowing the unexceptional fteadinefs and univerfality of the principles of this work.. IS or are we to imagine, that the fmall-pox and meafles differ from other fthenic difeafes attended with pyrexia, except in the particu- larity of their eruption, in running a certain courfe, and not admitting of a fpeedy cure. CCCCXCIL. We are not to wait for the arrival of the fymptoms of debility, that follow violence of dia- thefis, and threaten certain death by inducing indired debility, with the view, forfooth^when they have taken place, to cure them. On the contrary, they ought to be prevented by the early admirftftration of the reme- dies fo fully confidered. Should that be omitted, the confederation of the difeafes that will be the confe- quence muft be referred to the afthenic form, to which it altogether belongs. CCCCXCI1I. As often as fthenic diathefis happens to be conjoined with, the pyrexia, which is induced by the operation of ftimulants, of acrid fubftances, oi compreffion, of obftrudion, and fimilar noxious powers ading upon a fenfible part, of which we have examples in gaftritis, enteritis, nephritis,, cyititis, hyfteritis,.he- patitis, or the inflammations of the ftomach, of the. inteftines, of the kidnies, of the urinary bladder, of the uterus, of the liver (f). ; the diathefis, as it aggravates the pyrexia, fhould be removed by its refpedive de- bilitating _ (d) The fmalhpox is, in one word, to be treated as any fthenio difeafe, according to its degree of morbid ftate, and the eruption is only to be regarded during the period of its exiftence, eithes with refpecT: to the exception of fweating then, or of any thing elfe. (e) It is not, that low diet, cold, and purging, operate by any peculiarity, but becaufe they debilitate to the degree, and in.the manner required, of the other remedies. (f) See LXXXI. LXXXUI. LXXXVS, LXXXVIL Chap.l, ©f medicine; 3^ bilitating remedies. When neither the fthenic nor the afthenic diathefis is prefent, nothing fhould be attempt- Wed. But, if the afthenic diathefis fhould be prefent which may very readily happen ; the ftimulant plan Ihould be proceeded upon, to prevent a very dangerous difeafe (g). Nor, when this is as much as poffibly at- tended to, are we to forget, that, in fo doing, the principal affedion is not touched ; that, on the con- trary, it is its effed, not its caufe, that is tampered with ; and that the full confideration of fuch cafes be- ( longs to the local difeafes, afterwards to be taken notice of. r CCCCXCIV. Befides all the remedies now mention- ed, it is of advantage in every degree of diathefis to keep the mind eafy and unruffled ; a pradice that in the very high degrees of the diathefis is indifpenfably neceffary. Our attention fhould efpecially be direded to this particular, when we obfetve, that the ftimulus of thinking and of paflion, carried to a great height, has had a fhare in the produdion of the difeafe. CCCCXCV. In mania, therefore, and pervigilium, this diredion muft be particularly, and as much as poffible, attended to. In the latter of which difeafes, thinking, {g) As afthenic difeafes are to fthenic ones in the proportion •f ninety-feven to three of the hundred ; fuch alfo muft be the frequency of predifpofition to them : The inference from which is, that as we are feldom in the moft perfect Hate of health, and confequently, for the moft part, under fome degree of predifpo- fition, all file chances are greatly in favour of that predifpofition being the afthenic one. Hence, the impropriety of 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 contuf:on of a finger. In fuch circumftances, however fully the perfon may have lived, wine is withheld, fluid vegetable matter prefcribed, and the routine of every fpecies of evacuation gone through. Difmal are the confequences of gun-fhot wounds on this plan of cure. Turn back to the paragraphs LXXX. and LXXXI, and the notes fubjoined to them. * $Co TiiE elements Part III. . . . 1 thinking, and every ftate of com.motionj and more j certainly an habitual pradice in them, muft be fhun^Jj hed, efpecially before going to bed. When the patient^! is refting there, he fliould have ftupid books read to 1 him ; ail inordinate defire, the propenfity to revenge* the remembrance of every degree of criminality, of which he may have been guilty, fhould be diverted from his recolledion (h). CCCCXCVI. This fad is of great confequence to give corroboration to this whole dodrine i it is con- firmed by this other, that the fame things* which are ferviceable in pervigilium, or the morbid watchful Itate, are alfo ferviceable in mania, or madnefs, only they j muft be adminiftered in a higher degree, as that is a difl?afe of a higher degree of excitement. Thus, it is not eafe and tranquility of mind that are to be pre- fcribed here, both of which are quite gone, but a ftate oppofite to that high commotion of fpirits and irregu- lar vigpur in the exercife of the intelledual fundion. And, as an exceffive energy of the inteljedual powers, or of the animal fpirits, or both, are the moft noxious powers in this cafe ; the patient fhould be ftruck with fear and terror, and driven, in his ftate of infanity, to defpair : As a remedy againft the great excitement of the organs of voluntary motion, the labour of draught- i cattle Ihould be impofed on him, and affiduoufly con- tinued ; his diet fhould be the pooreft poffible, and his drink only water (i). The patient fhould be immerfed in water as cold as poffible, and kept under it for a long time, till he is nearly killed. * m CCCCXCVII. If, in phrenitis the brain, in perip- neumony the lungs, in rheumatifm the external joints, poffefs more diathefis, than any other part ; why may not mania and pervigilium confift in a ftronger affec- tion of the brain, upon which the principal noxiou3 powers (b) See above CCCCXXXIII. (i) See par, CCCXXVIII. CCCCXXX. CCCCXXXV. CCCCXXXVI. Chap,U OF medicine." 361 powers ad, than of the other parts, over which the influence of thofe powers is lefs confiderable ? Laftly, fince remedies, the firft adion of which falls upon other parts, arc of fervice in thofe difeafes (k), it is certain, that not even in them, where you might be moft dif- pofed to believe it, the whole morbid affedion depends upon the part confpicuoufly affeded ; but that the whole body is concerned ; that the excitability is one uniform undivided property over all ; that the force both of the exciting noxious powers, and of the reme- dies, is exerted on the whole fyftem, with the inequality fo often mentioned (/) ; and that the foundations o£ this dodrine are fure and ftable. CCCCXCVIII. As thefe are the principal noxious powers in mania and pervigilium, and as the brain is principally affeded ; fo, in obefity, the moft confidera- ble noxious powers are animal food {m) and reft, or fedentary life $ in confequence of which laft, the ftimu- lus of exercife, which, by wearying and fatiguing the body, tends to indired debility, is obvioufly wanting. But, fince, in confequence of ufing the fame food, both in quality and quantity, and the fame indulgence in reft and eafe, fome perfons become fat, others continue lean ; it appears, that all the digeftive powers have more force in the former, than in the latter, and, con- fequently, that the other exciting noxious powers have contributed to the effed, and that a proportional ex- citement follows. Of the noxious powers, that belong to this place, moderate exercife of the intelledual facul- ty, and tranquility of mind, which are gentle ftimuli, favour obefity $ over-ftrained thinking, and habitual indulgence (i) Part I. Chap. II. (/) Part I. Chap. IV. (w) Becaufe no efFeft can arife without a caufe, the exciting powers, therefore, muft here have operated with more force, than in the other cafe ; and if it fliould be objected, that tbe circum- ftances ia both cafes were equal, the difference then muft be fet to the account of tbe greater vigour of the excitability in the cafe of obefity. , v * / 362 THE ELEMENTS Part III indulgence in any paffion, fuch as that of anger, the repetition of which conftitutes ill-nature, ojbpofe it. Corporeal motion, which diminishes the quantity of fluids in the fyftem, and, as often as it is confiderable, 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 by the high degree or long continuance of its ftimulus. On the contrary, the powers that fa- vour obefity, are thofe that ad gently, and with fome excefs ; but never attain the high degree of adivity, that inclines to indired debility: They are powers that go on foftly and pleafantly, particularly thflt keep up moderation in the perfpiration, and thereby fill the veflels with blood ; but, becaufe motion is avoided, they do not very much increafe the exritemenfTof the veffels, and by means of the tranquility of their adion, allow a fluid, that would otherwife pafs off by the ex- ternal pores, to turn afide into the cells of fat. Hence, though, as has been faid before, abundance of blood is indeed a very great ftimulus; yet, without other ftimu- li, and that moft powerful one7 which mufcular motion affords ; it is evident, that a confiderable degree of ftimulus can be borne, without any confiderable difeafe, and that it always produces a predifpofition to fthenic difeafes, but does not immediately bring them on. Hence we perceive what place in the fcale of exceffive excitement, or of fthenic diathefis, obefity holds ; what the degree of ftimulant power is, and what the ftimuli In particular are, that produce it. CCCCXCIX. As the degree of curative force muft be accommodated to the degree of force in the morbific caufe (n) j it may be obferved, that for the cure alfo of ^ .this difeafe the commonindication is fufficient (0) •* that is, that the excefs of excitement muft be reduced to the falutary degree, and a remedy oppofed to every noxious power, equaj to the removal of it. D. In [^ See CIX. (0 XJL,YIII. CCCCLIIL Chap. I. of medicine. 363 D. In this cafe, therefore, as food is the principal noxious power, the quantity Ihould be reduced, and more exercife taken. Thefe means are fufficient for the cure (p). DI. But, for the fake of the further confirmation, as well as iljuftration of this dodrine ;'- it is to be obferv- ed, that all the powers, which affed the excitement in a greater degree than the noxious "powers inducing this: difeafe, and that have a tendency, by their ftimulant operation, to indired debility, have the fame effed ; that they either prevent or cure obefity, and continue to produce this effed, till they induce that degree of meagrenefs which is conneded with debility. DII. The beft method of lowering the diet, is to •combine a quantity of vegetable matter with a moder- ate portion of animal food. The next rule is, to refrain from the latter, and ufe the former in greater abundance. The firft rule is fuitable to all fuch perfons as are liable to difeafes of debility, as the gout, the indigeftion that after a long time fucceeds to luxury, to afthma, epilep- fy, and other fuch difeafes. The latter is more accom- modated to thofe, who otherwife enjoy great vigour, have predifpofition to fthenic pyrexia, and are in the flower of their age. But, it is not, even in the latter ftate of the body, to be followed for a long time to- gether ; becaufe, fo great is the debilitating influence of fuch a diet, that, while it is fufficient to remove any degree of obefity, efpecially with the addition of exer- cife, it is found to have fignal efficacy in producing afthenic diathefis, and all the difeafes depending on it. PART if) CCCCXCVIIL » -; PART THE FOURTH. The Second Form of General Diseases $ 035. THE ASTHENIC DISEASES^ CHAP, h r>TTT T^HE form of afthenic difeafe, which rnay J^ be called afthenia, for the fake of diftin-. guifhing it from the form of fthenic difeafe, which may. be cv\\z& fthenia, is a ftate of the living body, in which 3,11 the fundions are more or lefs weakened and often difturbed : it is almoft always attended with a con- i fpicuous affedion of fome one fundion. In treating j of afthenia, I fhall proceed from the flighteft difeafe of , ; this kind to the moft violent, through all the inter- mediate-degrees. •^ DIV. In this part of our fubjed, there occurs a great variety of fymptoms. Of this variety, however, as it affords no certain information, and is even fallacious, no life will be made in marking the fcale of difeafes. But, for the fake of placing what is about to be delivered in a clearer, if not a more plaufible, point of view, we fhall begin with a fimple enumeration of the principaLdifeafes that are afterwards fully treated of. a DV. The fthenic difeafes are emaciation, inquie- tude or reftleffnefs without fleep, afthenic amentia, the fcabby Chap*l. THE ELEMENTS OF MEDICINE* fcabby eruption, flight diabetes, afthenic fcarlet fever, the rickets ; the hsemorrhceae or general bleeding dif- charges, fuch as menorrhcea or a morbid excefs of the rnenfes, epiftaxis or bfeeding from the nofe, hsemorrhois or the piles y and alfo three morbid ftates feemingly in appearance oppofite to thefe^the loitering, impaired, or fuppreffed menftruation ; next come, thirft, vomiting, indigeftion, diarrhoea, and colic without pain ; after thefe, the affedions of children, as the worms, the general coafumption called tabes, dyfentery and cholera in their mild ftate y angina, the fcurvy, the mild hy- fteria, rheumatalgia, afthenic cough, cyftirhcea or mu- cous difeharge from the bladder; the gout of ftrongifh perfons, afthma, cramp, anafarca, dyfpepfia with pain, the violent hyfteria, the >gout of weak perfons, hypo- chondriafis, dropfy, chin-cough, epilepfy, pally, the lock-jaw, apoplexy, tetanus ; laftly, fevers, as the quar- tan, tertian, and quotidian, intermittents or remittents, dyfentery and cholera in their violent degree, fynochus^ fimple typhus,the gangrenous fore-throat, the confluent fmall-pox, the peftilential typhus, and the plague. DVI. Of this fcale of afthenic difeafes it is to be underftood, that thpfe difeafes, which in. their ufual ftate are flight, and claim a higher place in the fcale, are fometimes more fevere and fometimes extremely violent ; and thofe, that in their moft common ftate are fevere, fuch as the gout of weakened perfons, pefti- lential fevers, and the plague itfelf, fometimes proceed With the utmoft mjldnefs (a). DVI I. The affedions of parts, which often accom- pany thefe difeafes, fuch as ulceration, tumour, increafed excretioh^ bleeding, difeharge, inflammation, fpafm, convulfion, indicate indeed fome degree of debility, but the fame degree may exift without them- Hence, be- caufe it is the influence of debility that is fundamentally regarded in this fcale ; the difeafes, that are often ac- companied with local affedions, as hyfteria and the cramp, («) See par. CCCCL. 366 THE ELEMENTS Part IV. cramp, are intermixed with difeafes unaccompanied by local affedion ; and, with the cafes of afthenia that are accompanied with fpafm and convulfion, dropfy is affo- ciated, on the fuppofition of an equal degree of debility ; fo that throughout no regard is paid to remarkable fymptoms, but the degree of debility only is kept in view. Neither is the violent cholera excluded from its place among fevers, which are diftinguifhed by failure' of intelled and by affedions of the head, becaufe this kind of cholera fhows a degree of debility equal to the febrile difeafes. The idea in this diftribution is to fhow that true morbid energy does not confift in an affedion of parts, but of the whole body ; and that the reftoration of health is not to be attempted by a change of the ftate of parts only, but, without negleding that* by a change in the ftate of the whole fyftem.. Of Emaciation. DVIII. Emaciation is an afthenia, lefs difcernible in the other fundions, but evident in the weaknefs of the/ digeftive fundion ; whence, the fyftem, though receiv- ing proper aliment, does not become plump. DI.X. As the caufe of this difeafe is debility, both in the reft of the fyftem, and in the ftomach and other organs of digeftion ; it follows, that the general indica- tion of cure fhould be chiefly direded to the moft lan- guid part, that is, to the organs of digeftion and the perfpiratory veffels. More nourifhing food,, therefore* fhould be ufed, lefs labour undertaken, and too free perfpiration fhould be prevented by more reft of body, by proper geftation, and fridion : and a plan, exadly the reverfe of that which is fuited to the cure of obefi.- ty, fhould be purfued. Of reftlefs Watching. DX. In the afthenia, called inquietudo or reftlef* watching* the other fundions are under fome degree of Chap.lo OF MEDICINE. $$j of languor, and the patient is affeded with a conftant propenfity to change his pofture and tofs about his limbs, without being able to fall afleep. DXI. As the caufe in this cafe, juft as in other general difeafes, is univerfal over the fyftem ; fo it af- feds the organs of voluntary motion, and the brain in particular, with the inequality fo often mentioned al- ready (b): Confequentlyyto remove the difeafe, ultimate excefs in either mental labour, or exertion in any paffion, as well as the oppofite extreme of deficiency in either, fhould be avoided ; exceffive corporeal labour when it has proved hurtful, as well as indolence when it has had any concern in producing the difeafe, fhould be guard- ed againft ; and the proper medium betwixt the ex- tremes of exceffive adivity and indolence reftored : Or the difeafe ihould be repelled by wine ; and other ftimuli fliould have each its proportion in the treat- ment. Of the fcabby Eruption* DXII. In the fcabby eruption, the face is pale, the fkin difcoloured,dry, lank, and varioufly disfigured with puftules,; there is alfo a lownefs of fpirits, and the fundions of the body are weak and fluggifh. DXIII. In this cafe, though the debility is univerfal, it is moft confiderable in the perfpiratory veffels. And, therefore, the chief circumftances in the treatment are,—together with the remedies direded to the whole fyftem, fuch as nourifhing food and ftrong drink,—to fupport the perfpiration by its refpedive remedies ; to bathe the furface of the body in tepid water, to render it acceflible to air, to order clean linen for the patient, and to have every thing clean about his clothes. Of [b) See par. XLIX. 36$ TME ELEMENT^ part IV- , ^ Of the mild Diabetes. , DX1V. In that afthenia, which is named the mild \ diabetes, there is an excefs in the quantity of urine dif- charged, but the profufion is not immoderate as it is ' in the violent cafe of the fame name. The\ organ of \ perfpiration labours under the fame weaknefs and flug- gifhnefs, as in the fcabby eruption. DXV. To remove this affedion, which is much more trequent than it has been hitherto fuppofed, the fyftem ihould be ftimulated by food (c), by ftrong drink (d), and by ptoper.exercife (e), fuch as is neither immoderately exceffive, and therefore debilitating, nor deficient in degree, and therefore not affording ftimulus enough : Above all things, the perfpiration fhould be fuftained. The contrivances for checking the flow of urine, which have no exiftence, are to be omitted. Of the Rickets. DXVI. The rickets is an afthenia ; in which to the general fymptoms arc added an unufual bulk of the head, efpecially the fore part, and likewife of the knees J and abdomen, a flatnefs of the ribs, and meagrenefs. DXVII. The rickets is a difeafe of children ; it .j chiefly arifes from uncleanlinefs, want of dandling or exercife, cold either without moifture or with it, food not giving fufficient nourifhment, or bad air. DXVIII. For its cure the common afthenic indica- tion muft be employed ; remedies, of an oppofite nature to the noxious powers that excite the difeafe, muft be looked oufrfor ; 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 fliould be adminiftered, vegetable withheld, and ftrong liquors allowed {g). '.Of (c) See.par. CCLXVI. (d) See CCLXVIII. {*) CCLXX, (f) See DXIII. (*) CCXCV. CCCIIL €hap. L • F MEDICINE. 360 Of retarded Menftruation. DXIX. Retarded menftruation is alfo an afthenia ; in which, befides this difeharge not making its appear- ance at that time of life when it fhould, other evidences of debility, fuch as a flender make of body, weaknefs, laxity of habit, want of appetite, or a craving for things not alimentary, palenefs of the fkin, and fimilar fymp- toms, appear. Of impaired Menftruation. DXX. Impaired menftruation is that ftate of afthe- rna j in which, after it has appeared, and the flow con- tinued for fome time, the difeharge is made in too fparing quantity, or at too long intervals, with other iigns of weaknefs accompanying it. Of the Suppreffion of Menftruation. DXXI. Suppreffion of menftruation is that degree ; "of afthenia, in which the difeharge is totally ftopped at any period betwixt its-natural commencement and the natural time for its total ceffation. DX^ftl. An inquiry muft be made concerning the I caufe of natural menftruation, before it would be proper t to enter upon an inveftigation of the retardation, or deficiency, of the difeharge in any of its degrees. Of the Caufe of Menftruation. DXXIII. The caufe of menftruation is a certain conformation of the veffcls that pour out the blood in this difeharge, which takes place at a certain time of life, that is, about the age ef puberty, and a ftimulant energy in women, more powerful than in the females •f other fpecies of animals. DXXIV. Of Yj 3/j the ELEranrra Partffl; DXXIV. Of'other animals there are very few, the females of which undergo any fort of menftruation ex- cept at the time of the venereal orgafm. * DXXV. As all the veflels are gradually unfolded in the courfe of the growth of the body, fo the fame thing happens to the genital and uterine vefieft, but laft of all to thefe. The ends of the latter, terminating on the fides of the uterus, are fo very much expanded about the age of puberty, as to tranfmit firft the ferous part of the blood, and then, after, an effort kept up fos fome time, to pafs complete 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 the genitals of both fexes more than in other parts : In the female this commotion is felt over the whole region of the ovaria, uterus, and vagina. The uterus (its feat) being almoft incefiantly folicited by this ftimulus, is the more powerfully affeded ; as there is more excitability, hitherto aded upon by no fuch ftimulus, exifting in the fyftem. Hence, not to mention other organs, the mufcular fibres of the contiguous veflels, as well as the nerves interwoven with them, are thrown into the higheft degree of excitement. This exciteltaent, in- creafing over the whole fyftem, again increafes that in the uterus. The mutual contad of the fexes, whether in killing, in fhaking hands, or otherwife, fires both fets of genitals, and the uterus in a remarkable manner ; but the adual embrace produces that effsft in the higheft degree. The remembrance of each embrace remains, renews the idea of the pleafure, and continues more or lefs to excite the uterus. DXXVI I. This new affedion is cherifhed by every ftimulus that is ufually applied to the fyftem : Hence, in the abfence and in the prefence of the beloved ob- jed, and at all times fcarce with the exception of that -which paffes in dreaming, a ftimulus fo fteady, and fo much* C/lOp. I. OF MEDfCINE." 3»/£ much the more powerful, as its novelty implies, that the excitability in this cafe is entire, roufes the fibres of the veflels, already fufficiently unfolded, to violent con- tradions. The blood is carried into the region of the uterus with great rapidity, increafing in proportion as the blood, by powerfully diftending the veffels, and agitating them by its impetuous flow, ftimulatcs the fibres more and more, and thereby increafes the adion by which it is impelled. This is the firft caufe of menftruation : In this way, two circumftances—a fuffi- , cient enlargement of the diameters of the veflels, and the ftimulus ading more powerfully from its novelty upon the unwafted excitability (/;)—are adequate to- the whole effed. , DXXVIIL This ftate is not of a different nature from other ftates of the body, but bears ah analogy to fome well-known cafes : Thus, different veffels, from the mere difference of their diameters, are fubfervient to different purpofes : The perfpiratory veffels are deftined to the tranfmiflion of a yapour, the excretory veffels of the alimentary canal to that of a thin fluid, the renal veflels to that of a groffer one ; thefe inftan- ces, therefore, ihould take off our furprife at finding veffels fitted, by their wider diameter, for the purpofe of tranfmitting red blood. DXX1X. The reafon why the females of other ani- mals do not menftruate but in their orgafm, is, they are only at certain times expofed to that energy of ftimulus which produces menftruation. DXXX. How much is owing to this ftimulus in the produdion of menftruation, is further evident from the following chain of fads : i. The lefs addided to love women are, the lefs they menftruate; 2. The more they give way to that paffion, the more freely do tney experience this difeharge within certain boun- daries > 3. Before puberty, and after the period when menftruation ceafes (when the fitnefs for effedive love has th) See DXXIIL 37^ THE ELEMENTS x PartlV. has either not yet commenced, or is now paffed), the menftrual difeharge is conftantly wanting ; 4. The privation of enjoyment, which, by its debilitating ef- fed, produces chlorofis and other fimilar difeafes, is remarkable for bringing on either a menorrhcea, or a retention of menftruation ; 5. Girls who are of a for- ivard growth, have great ftrength, and large limbs, and confequently are 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 attaining the firft menftrual difeharge ; Laftly, af, like all the other fundions, that of love is limited at the fame time in its duration and degree ; and if, as the commencement of the love embraces is 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 j, thefe fads alfo, added to the others, give weight to our conclufion, and fhow, in a clearer point of view, how much menftruation depends upon the venereal emotion* It may, therefore, be repeated, that, befides the confir- mation of the veffels, fuited to the fundion of men- ftruation, and the*ftimulus which has been mentioned, there is occafion for no other circumftance to explain either the commencement, eftablifhment, or continua- tion, of the menftrual difeharge, DXXXI. The caufe of full menftruation, and that of a moderate degree, 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 circumftances, mentioned above, explain, why women menftruate more than the females of other animals ; fo their immoderate opera- tion upon fome women ferves to fhow, why their effed, the Chap. I. OP MEDICINE 373 the menftrual difeharge, then becomes greater than natural (/). DXXXIII. The ftimuli that produce abundant menftruation, fhort of morbid ftate, are unchafte ideas, and a high energy of paffion. In this way, the influ- ence of books, converfation, or pidures, calculated to kindle up luftful appetite, and the uncovering of parts that modefty conceals, which all 'produce a lively imagination of the thing fo much defired, can be in- diftindly felt by none perhaps but eunuchs. Nourifh- ing food, and generous drink, and high-feafoning, pro- duce the fame effed ; hence the proverb, without meat and drink love ftarves: Likewife, that degree of exer- >•' cife, or even labour, that does not prove fatiguing, but keeps within the boundary of ftimulant operation ; as alfo an abundance of blood, both from due exercife and from rich diet,; laftly, frequent and ardent enjoyment, or inconceffa hujus imitatio ; all thefe increafe the men- ftrual difeharge, in proportion to, the high degree of their ftimulus, but ftill do not carry their effed to morbid excefs. .DXXXIV. The fame conclufion applies to the ef- fed ot thefe ftimulij which was'formerly applied to an over-proportion of blood producing fthenic diathefis : For, if exceffive menftruation and an increafe of love ' be the confequence of the excefs of the ftimuli, one or | other of the following muft be the effed ; it will either be fuch as remains within the latitude of health, or fuch as firft produces fthenic diathefis, and then, in a higher degree, rapidly brings on indired debility. DXXXV. That this is the fad, is proved by the noxious powers that produce exceffive and morbid menftruation ; and by remedies, that are ftimulant and fuited (/) Women menftruate more than other females, becaufe they are fubjedted to a higher degree of the ftimulus, which is its caufe; and fuch women as are expofed to more of the fame ftimulus than others; will alfo experience more of the effect, precifely upon that fame principle. 374 'fflE ELEMENTS 'PartlV; fuited to fill the veffels, removing the difeafe, according to our late difcovery ; and alfo by the unfortunate iffue of the debilitating evacuant plan of cure in the fame difeafes. DXXX VI. As it is ftimulant operation that produces both proper menftruation and that which goes to a little excels ; fo, when once menftruation is eftablifhed, the conformation and ftimulus remaining are fufficient to fupport it. The fame operation is renewed during every interval of menftruation : The ftimulus ads and quickens the motion of the blood in every part, but chiefly in that where it is moft powerful and moft re- hired for the effed, that is, in the region of the uterus: The blood thrown into quick motion, and rufhing with a more rapid flow, increafes the ftimulus which is the caufe of this acceleration : And, as this mutual ftimu- lus continues inceffantly to affed women through the 'whole interval, when they are allowed fcope of love ; the uterine veffels are gradually dilated, till at laft, within three weeks, or a lunar month, they arc opened at their extremities :. And, when the fluid, which is firft ferous for a little, and afterwards fanguine, and afterwards ferous again for a little, has flowed one, two^ or three days, the veffels at laft clofc DXXX VII. During the whole time of this procefs* 'the more excitability there is—confequently at the be- ginning of each menftrual effort—the more violently the ftimulus ads, and produces proportionally more excitement : And it has, from this time, always lefs and lefs effed to the end, in proportion as the excita- bility is more wafted ; though, till the excitability, in fo far as it has a relation to this ftimulus, is altogether exhaufted, the ftimulus always adds fomething to the fum of excitement (k), though conftantly lefs and lefs. The fame explanation applies to the operation of food, of drink, and of all the exciting powers. DXXXV1II. What (k) See XXXVI. Chap. I. OF NfEDICINEv $?$ DXXXVIII. What has been faid of the ftipulus, produdive of menftruation, is conformable to the effeds of all the other ftimuli. It is alfo conformable to tl>e whole fum of menftrual effed from the time it begins till it entirely ceafes. Thus, at the beginning of this , long period, the force of ^ftimulus is far the greateft, upon account of its novelty, and the unwafted ftate of the 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, men- ftruation, when once eftablifhed, is moft exadly per- formed ; that is, it does not, either from deficiency or excefs, deviate into morbid ftate. DXXXIX. But when now the office of menftruation is fully eftablifhed ; becaufe in this, as well as every \ ether fundion, the excitability is gradually diminifhed in the progrefs of life, the ftimulant power alfo has gradually lefs, and, at laft, no effed : Confequently, in the fame gradual way, the power of love in women, and, in proportion, that of menftruation, is diminiihed, and at laft, altogether extinguiftied. DXL. While both the faculties, that of love as well as that of menftruation, in this manner decreafe from their beginning to their abolition, menftruation is often interrupted, as in pregnancy, in fuckling, in the dimi- nution or fuppreffion of menftruation. This interrup tion in the two former cafes is natural, and confiftent with health ; but in the diminution or fuppreffion of the menftrual evacuation, it becomes morbid. DXLI. Since the ftimulus, together with the con- formation of the veffels, is the caufe of menftruation, and the latter depends upon the former -*, fo again the defed of the ftimulus, and, therefore, of the conforma- tion, produces both the retardation, diminution, and, at laft, the complete fuppreffion of the difeharge. DXLII. Whether ever the defed of menftruation,, like that of perfpiration, or of an internal excretion, as that in the fauces and alimentary canal, is to be imputed 376 THE ELEMENTS PartIV* 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 capable of fuch a contradion for a reafon formerly affigned (/) ; fo great a force of " ' excitement or fo high a degree of fthenic diathefis, as would be fuffident to fhut up veffels deftined to the tranfmiflion of blood, is not eafy to be conceived. And . * the doubt is further increafed by a certain fad ; which is, that both in the retardation of the mcnftrua, and in all the degrees of their diminution to their total fup- preffion-, when local affedion-is out of the queftion, there are evident figns of a debilitating caufe. DXL1I1. In order to eftablifh this point, which is of the greateft confequence, as it diredly affeds the method of cure, and, if not explained, would leave a gap in our principles; we have to obferve, that, though «. iome men, in confequence of the ftimulus of exceffive g love, excited by a moft beautiful woman, have, by means of fthenic diathefis, been fo inflamed as to fall into a temporary fit of impotence, and been cured by bleeding ; befides the infrequency of the occurrence (m), jj is not very probable, that the large uterine veffels can be fo contraded in theij diameters, as to become in- < capable of tranfmitting their fluid. Nay, fads contra- did the fuppofition : The fymptoms arifing from the. ij retardation or deficiency of menftruation receive a tern- \ porary alleviation from the debilitating plan of cure ; ■ but the difeharge is not ufually brought back ; on the contrary, it is more retarded. But, allowing an over- proportion of blood and an excefs of ftimulus to be the caufe of the firft deficiency of menftruation, after it has been removed by bleeding and the reft of the de- bilitating plan of cure, can this over-proportion and excefs be the caufe of a difeafe, which refifls a degree of evacuant and debilitating operation, that would cure ten i (I) LVII. LXII. CXIL CXIII. (w) I remember one inftance in Dr. Whrte, and I think I have only haard of another. Chap. I. OF MEDICINE. 377 ten peripneumonies ? And fince any ftimulus, as well as that of an over-proportion of blood, may, from its exceffive force, induce indired debility ; why may not the fame thing happen in a difappointment in love, and on occafion of the firft deficiency of menftruation ; and, in both cafes, atony, ufheringin manifeft debility, and not excefs of tone, be the caufe ? As peripneumony, where the over-proportion of blood and fthenic diathe- fis is by far the greateft that ever happens, in confe- quence of indired debility paffes into hydrothorax ; why may not a fimilar caufe in this cafe produce a fimilar effed ? DXLIV. The Caufe, then, of deficient menftruation, whether partial or complete, is a languid excitement over the whole body, efpecially in the uterus, from a deficiency of the ftimulus of love («), and of all thofe ftimuli that fupport it (o), and from a penury or under- proportion of blood. DXLV. This appears, becaufe the noxious powers mentioned in the retardation of menftruation, and other debilitating powers in every deficiency of that difeharge, produce each difeafe ; it further appears, from the re- ftoration of the juft quantity, in confequence of tne ftimulant and replenifhing plan of cure, and alfo from the hurtful effed of the debilitating plan of cure (p). DXLV I. The remedies for the cure of retarded menftruation are, rich food, generous drink, geftation, exercife accomodated fo the ftrength, pediluvium and femicupium, or the warm bath of the lower extremi- ties, and gratification in love (q). DXLVI1. The fame remedies are required in cafes of fuppreffion, and the fame, but inferior in their de- gree of force, for the diminution of menftruation : When U) DXXIII. DXXVI. DXXIX. (0 DXXVI. DXXVII. DXXXIL DXXXVIL it) DXXXV. (0 EXXVL Z2 57S TH]E ELEMENTS /V/IV. When there is an unufual violence of the difeafe, cither in degree or duration,'we muft have recourfe to the afliftance of the diffufible ftimuli. Of Menorrhcea, or the exceffive Difeharge of Menfirmtion. DXLVIII. Menorrhcea is an effufion of blood from the uterus, or too 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- proportion of blood, not by a vigorous ftate of body, but by an under-proportion of the former, and an ex- hauftion of the latter. The noxious powers, therefore, that produce it, are food not nourifhing enough, or in too fmall proportion, watery liquids, or that over-pro- portion of pure ftrong liquors that produces indired debility, exceffive heat, or cold when its debilitating( operation is not counteraded by any ftimulus, and falacity. DL. Its remedies are the reverfe of the noxious powers ; rich food, generous liquors, heat ading with - in its ftimulant range, cold kept from inducing dired' debility by the ftimulus df heat and other ftimuli, and gratification in love. DLL The effed of the noxious powers* and remedies. of which we have fpoken, that of the former in pro-" ducitig, and of the latter in removing, the difeafe, and the failure in fuccefs of the debilitating plan of cure, all confirm the dodrine. Of Epiftaxis* or Bleeding from the Nofe. DLII. Epiftaxis is an afthenia; which, befides having the* general fymptoms, is diftinguifhed by bleeding from the nofe without any force behind—an affedion trou- blefome at any age, but particularly to young perfons in a ftate of rapid growth* and to enfeebled old age. Ghap.% of medicine; 37$ Of Hamorrhois. ^ DLIII. The charaderiftic of hsemorrhois, or the piles, is a flow of blood from the anus, or the parts around it, added to other figns of afthenia. DLIV. The fame nearly, that has been faid of menorrhcea, is to be faid of the noxious powers and remedies of this difeafe. DLV, The caufe of the piles is manifeft, from the noxious powers that produce it, the remedies that re- move it, and the unhappy effed of the common afthen- ic plan of cure ; that is to fay, it is debility of the whole body, from the deficiency of other ftimuli, and chiefly that ot the blood (r). This debility, while it relaxes all the veflels, and impairs their tone, produces that effed, in a fpecial manner,! upon the affeded veffels. The reafon is, that, in confequence of the inequality fo often mentioned, the caufe chiefly operates in the feat of the urgent fymptoms (s). Nor is it to be thought wonderful, that the blood fhould flow through the veflels of the uterus that are. patulous and in the habit of pouring out blood, through the pendulous hemorrhoidal veffels, and through thofe of the nofe, which are delicate, arid weakly fupported, in preference to others. In this cafe plethora, which has no exift- ence (/•), is equally unneceffary to our reafoning (»). Of Thirft, Vomiting, and Indigeftion, as well as the- kindred Difeafes of the alimentary Canal.. DLVI. There is a very frequent affedion, beginning with thirft and proceeding to vomiting {x). It often proceeds no farther than thefe fymptoms ; it oftener ufhers in the moft fevere affedions, fuch as fometimes dyfpepfia,. (r) See par. DXLIX; (/) See XLIX. L. LI. (0 See par. CXXXL CXXXIV. and the addition. («) CCXXXII. (0 CLIX. CLXXXV. CLXXXVI. and CLXXXVIL 380 THE ELEMENTS Part lY*i dyfpepfia, or indigeftion, fometimes colic, fometimes the gout, fometimes proper fevers, and many other afthenic difeafes. Its moft frequent fouroe by far is weaknefs, from too long fuckling and fometimes from; the diarrhoea incident to women wafted both with a long courfe of fuckling and by repeated pregnancies. DLVII. There are two affedions which have only one name between them, viz. thirft : The one is fthenic,, the other afthenic (y). The former arifes from the ftimulus of fait, of rich and plentiful meals, of heat and labour, and fome others; never ending in vomiting till the fthenic ftate is over, and this happen? but 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 fubjed, depends always on pure debility, fometimes in- dired, fometimes dired (z). Its tendency is always to ficknefs, and, as that increafes, to vomiting (a) ; and when the vomiting becomes any way confiderable, the confequence is that, moft acute pain, which a cramp in the ftomach produces (b), and the other affedion for* merly explained U). This progrefs is fpontaneous, dired, and for the moft part rapid, DLIX. The noxious powers here are all debilitating. The indiredly debilitating powers are, debauch in eat- ing and drinking (d), drunkennefs, extreme fatigue, ultimately exceffive heat(0, violent paffions (f), excef- five exercife of the intellectual faculty (g), debilitating food (h), an over-proportion of blood converted into an under-proportion, together with the converfion of the fthenic diathefis that attended the excefs into the af- thenic, the infeparable attendant on the diminution. The > CLIX. CLXXXV. CLXXXVI. and CLXXXVIL ) CLXXXV. (a) See CLXXXVIL CLXXXVIIL lb) See par. CLXXXIX. (e) CXC. to CXCV. and from that to CXCVIII. (d) CXXVIII. CXXX. (g) CXXXIX. (0 cxv. (0 cxxviii. (f) CXLL fc Chap. I. OF MEDICINE. 3^1 The following powers ad by a diredly debilitating operation ; cold not counteraded by any ftimulus (1), cold water, vegetable food{k), penurv of blood (/), of other fluids (m), want of pure air («), anxiety, grief, fear (0), .and, in fine, that weaknefs of the fyftem, which arifes from all thefe. The affedion is often of a mixed origin, from a combination of both thefe forts of noxious powers : For, as dired debility always increafes the in- dired, fo does the latter the former, both in this and all cafes (p). DLX. The corruption of the common mafs of fluids, whether it be called acrimony, or putrefadion, has no concern here ; becaufe, while life remains, and the adion of the veffels upon their refpedive fluids con- tinues, fuch a ftate of the fluids cannot become general; it being only the effed of the ceffation of motion of the fluids and of heat; nor can it happen, but in the extreme veffels and excretory duds, which, by their atony, do allow fuch a ceffation of motion, and like- ,wife in the alimenta^r canal. DLXI. The common caufe of every afthenia, pre- dominant in the throat and ftomach, upon account of the atony of the falivary, and other excretbry duds, is the caufe of this thirft. DLXII. Its remedies are alfo the common remedies of every afthenia ; they fhould be accommodated to the degree of debility. In a flighter degree of this thirft, a glafs or two of brandy, or of any fimilar 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 water (q). It fhould be followed (/) CXXIL M CXXXVII. (9) CXLII. (k) CXXVIII. (*) CXLVI. (p) XLVII. LXXL (/) CXXXIV. (q) The addition of cold water counteracts, that of hot eo*. operates with, the effect, which has been afcertained in a thoufand trials. 3*2 THE ELEMENTS ParilV* followed by eating fome animal food (r); and the effed fhould afterwards be fupported by other ftimulants taken moderately, and in the degree that fuits good health. After which the proper pradice is, to proceed to the ufe of the permanent ftimuli. DLXIII. %Vhen the thirft is not quenched by thefo means, and vomiting, as it foon will, comes on ; and when excruciating pain fupervenes upon the vomiting ; which, when the pain is not prefent, is an affedion, ; ' that, together with the fymptoms that have been, mentioned (s), fhould receive- the appellation Of Dyfpepfanodyne, or Indigefiion without Pain : And when, befides the pain of the ftomach, now in- duced, the affedion going downward to the inteftines, fometimes produces a loofe, fometimes a bound, belly °% at other times only, a loofe belly, and at others only a bound one ; which is an affedion, when unaccompani* ed by coftivenefs, that is diftinguithed by the title Of Diarrhoea : DLXIV. And, when accompanied with coftivenefs, is entitled to the denomination Of Colicunodyne, or Colic without Pain : DLXV. In all thefe cafes recourfe muft be had to,' a larger dofe of the ftrong liquors : And, when that '. does not fucceed to our wifh, we muft next fly to opi- um, and other more diffufible ftitnuli, if they are to be found : When, by thefe, relief is procured, rich and pure foups, without fat, fhould, from time to time, be adminiftered, (r) When the 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 ficknefs, that now be- gins to take place with it, renders eating impracticable. (0 From DLV1. to DLXII. Chap. 1. qf medicine; 3S3 adminiftered, and the canal carefully bathed all over with them. Afterwards, the other ftimulants fhouhj be added ; in the ufe of which, a ftraight courfe be- tween dired and indired debility fhould be held without, the leaft deviation towards either : And our efforts muft always be continued till the difeafe is radically removed. DLXVI. The neceflity for this diredion in the cure is fo rrmch the greater ; as, by negleding it, or depending upon the common purgative debilitating plan, the confequence is, that a proper general difeafe often degenerates into a local affedion. To proceed to the confideration Of the Kindred Difeafes cf the Alimentary Canal. DLXVII. Among which, befides thofe that have been mentioned above (/), there remain others, which, when compared with them, both as to the nature of the affedion and of the treatment, abfolutely claim this place in the fcale. Of the Difeafes bf Children. DLXVIII. The difeafes of children are, drynefs of fkin ; fudden flaver, or falivation bf fhort continuance ; a fimilar rejedion of milk without effort («); green . fcouring ; at other times coftivenefs ; both commonly attended with gripes ; of which the ufual fign is, a pulling up of the kctees towards the ftomach, with very fevere crying '; unequal heat : A little more fevete than thefe are the two following cafes, the^ane of which has the name v,"^»-'. Of Worms. DLXIX. Which are diftinguifhed by a thickening 7* of the columna nafi ; by a cuftom of picking the nof- trils; (0 Fre™ DLVI. to DLXVI. («> SeeCCCCIII. 384 ttiE Ei-EMENfs Pan IV* trils ; by a 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 difeharge of worms by ftool. The moft diftind fymptoms of the other affection, or Of Tabes, or the general Wafting of the Body^ DLXX. Are meagernefs all over the body, an un- ufual bulk of the abdomen, almoft conftant watching, fuch a weak, diftreffed, affiduous, and hoarfe manner of crying, as is peculiarly calculated to excite tender* nefs and compaffion. DLXX J. The noxious powers, producing all thefe affedions, are common to them with every afthenia ; that is, they are every thing that has an effed of de- bilitating the whole fyftem, and efpecially the alimen- tary canal : Such as, at this age, milk not nouriihing enough, and at the fame time acefcent and flatulent , want of food, or diet of watery matter and bread ; cold, and moifture, the latter increafing the effed of the former ; habitual vomiting and purging ; too little dandling ; unfeafonable fleep, and meals, and every part of management; naftinefs; impure air; a negled of natural likings and diflikings. DLXX 11. The remedies are the converfe of all thefe; nourifhing, exciting milk ; three or four meals a day, 4 confiding 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 without moifture ; laying afide every fort of evacuation ; a great deal of dandling and geftation ; a proper timing of fleep, of food, and of every part of management of thefe delicate fyftems ; cleanlinefs ; tepid bathing in moderately cold weather, and cold bathing in warm ; pure air; being out in the fields as often as poffible in all but moift weather ■* and fuch a judicious attention to defires and propenfirics Ghap. I. of medicine? 385 propenfities as not even to negled gently fcratching any part that itches (x). DLXXIII. Thefe diredions fuit the milder cafes, under confideration. They ought not by any means .to be negleded ; at the fame time others are neceffary for the more violent cafes. In the green fcourings, great loofenefs, or coftivenefs, recourfe muft be had to pure wine, to fpirits, more or lefs diluted as the occa- fion may require, or, if there fhould be need, not dilut- ed at all : More of the foups abone mentioned, and alfo of a richer kind. DLXX1V. If thefe means fhould not fucceed to the phyfician's mind, which will feldom be the cafe ; in thefe affedions, more certainly in worms, and ftill more certainly in thfe tabes, or general confumption, with the remedies that have been fpoken of, the more diffu- fible ftimuli of opium and mufk fhould be alternated. Both forts of remedies, the durable and diffufible, fhould be fo accommodated to the violence of the fymptoms,. as not to be dropped till the whole morbid tumult is allayed, and the healthy ftate reftored ; which will, ' upon trial, be found more pradicable, than has yet I been imagined from the employment of the contrary * plan of cure, to the great comfort of mankind in their f fufferings. • t. DLXXV. From what has been faid it will appeaiy f that thefe affedions of children, all flow from the fame i 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 unhappy termination of them, heretofore, is to be y imputed not to their caufe, but to the ill-advifed methods commonly employed for their cure (y): Nay, when (x) See above DXVIII. {/) I cannot help repeating again, becaufe the importance of the fubject calls upon me to do fo ; that the practice of the new plan of cure, in all the difeafes of childieu, as well as in the others $$6 THE ELEMENTS PartlY. when they degenerate into local affedions, as in the inftance of tabes or general confumption, ending in an obftrudion of the mefem?ry ; in that of colic at any age, terminating rn an inflammation, tumour, or twift- ing of the inteftfnes ; and in thofe of both colic and long-negledcd diarrhoea, running into a gangrene#in the fame part; this is a misfortune that never happens, when a proper method of cure is early enough ufed to remove phe primary difeafe : And, on the contrary, it moft commonly arifes from injudicious treatment, or from the negled of this, which is the proper one. To the kindred difeafes of the alimentary canal (z) further belong the two following ones, under the title Of the gentle Dyfentery and Cholera. DLXXVI. To thefe, every thing that has been faid of the former, will apply : Or, if there be occafion for any particular obfervation upon them, it will be given 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 more violent, as to merit the next place in rank below them, and, at the fame time, not unconneded with them, as having the feat of its pre- dominant fymptom in the alimentary canal, is the dif- eafe to which I have given the name Of Angina. For the fymptoms and method of cure of which turn back to number CCXXIL where it is introduced, in the explanation of afthenic fymptoms. Of lately fpoken of, has ever fueceeded in my hands, as well as in thofe of my pupils, to a miracle. I cannot fay that ever I meli with an inftance where it could be faid to have failed. Let tbea who will compare that account with the known mortality (hat is every day the rcfult of any other practice yet thought of in the profeffion. 0) From DLXVL to the prefent paragraph. Chap. I. OF MEDICINE. 3^2 Of Scurvy. DLXX VII. Scurvy is an evident afthenia : The principal fymptoms are, want of appetite, loathing of food, laxity oi the living folids confidered as fimple iblids ; an oozing of blood, both from other parts, and particularly from the gums ; averfion to labour ; low fpirits, and a languor in all the fundions. DLXXVIIL The noxious powers producing this difeafe, are the common afthenic ones, appearing in the following form. It is cold, but conjoined with moifture in the northern feas, and, as we may well fup- pofe, in the parts of the fouthern ocean of the fame temperature, that generally produces the peculiar form of the difeafe. But all the other debilitating powers contribute their fhare : Such are, grief for the lofs of liberty, relations, kindred, and friends; a horrid dif- like to the prefent ftate of life y a longing defire for that which they have parted with ; the awe which the feverity of difcipline keeps them in ; the effed of a calm, where there is nothing to do, producing dired debility on them ; a ftorm, where they have to labour above their powers, as certain a caufe of indired de- bility ; their not having been allowed, till of late,frefh t meat, which is the only nourifhing and invigorating [a) form of it ;. their being kept upon falted and fpoiled meat, not even correded by recent vegetable aliment, fuch as that is (b); watery or fmall drink ; the terror which the expedation of a battle at fea infpires. DLXXIX. All thefe particulars prove, that fcurvy is fo far from being the effed of one or two noxious powers, and from retting upon fo narrow a bafis, as has hitherto been imagined ; that it is rooted in a multi- plicity of debilitating powers, and is a real afthenia, or univerfal difeafe of debility. DLXXX. This inference is confirmed by both the true and falfe method employed for its cure : For,, though (0 See CXXIV. (0 See CXXVIIL 383 THE ELEMENTS Part IV; though nearly all the common powers concur in the produdion of fcurvy ; if, however, it be confidered, how eafily, upon the removal of the noxious powers, and upon the patient's getting a-fhore, the difeafe is fubducd, by frefh meat, either with or without greens, by wine, geftation, and exercife ; in fine, by the return of his ufual manner of living ; it will be impoffible to entertain a doubt of its being an afthenia, but by no means a violent one. The pretence of its cure being effeded by greens, roots, four crout, and fimilar things, which have been fo much commended lately, though, without the remedies juft now enumerated, they could not fail, by their .debilitating operation, to aggravate the difeafe, is derived from a noted blunder among phyficians, by which they are led to overlook the moid certain, fimple, and evident fads, and take up, in place of them, the greateft falfehoods, or fuch fads as have a very narrow foundation in truths Of the mild Hyfteria. DLXXXI. The mild hyfteria is a form of afthenia,: of frequnt occurrence among women, but very rarely happening to men ; in which a noife is heard in the belly, and the patient has a fenfation of a ball rolling within the bowels, rifing up to the throat, and'there threatening fuffocation. DLXXXII. The ftriking fymptom in this difeafe is a fpafm, not fixed in a part, but moving along the; courfe juft defcribed. The difeafe attacks in fits, for the moft part leaving long intervajs between them, and often not recurring more than once or twice. DLXXXIII. The fits are foon removed by fmall dofes of opium, repeated at fhort intervals : The in- tervals fhould be fecured from danger by full diet., and a moderate and naturally ftimulant management. Of CJ:ap. L Of medicine. Of Rheumatalgia, or the Chronic Rheumatifm. DLXXXIV. Rheumatalgia is an afthenia, not fo much a fequel of rheumatifm when this difeafe is left to proceed in its own fpontaneous courfe, as of the profufion of blood and of the other fluids during tho treatment, or of too debilitating a f)lan of cure ; by which the fthenic diathefis and the inflammation pe- culiar to it, are changed into the afthenic diathefis and inflammation. Palenefs of the fkin takes the place of ruddinefs : The appetite is diminiihed, the involuntary motions are impaired, debility and torpor prevail ovtr all. So far the difeafe is underftood to be chronic. As in rheumatifm, the joints are pained and inflamed. But though this is the moft frequent caufe of rheuma- talgia, fo it fometimes arifes—not from a fthenic origin, and an excefs in the means of reducing that—but from pure debility. DLXXXV. The caufe of the difeafe is the ufual one of any afthenia, predominant in the moving fibres of the mufcles, fituated below the fkin over the vvho;o furface of the body. DLXXXVI. Its1 worft morbific powers are, penury of blood, cold, efpecially with the addition of moifture, impure air ; and, befides thefe, as many of the other debilitating powers as happen to be applied, contribute, in proportion to the degree in which they are applied, to the morbid effed. Of thefe, exceffive indolence and the reverfe are particularly hurtful. DLXXXVII. As all ftimulants contribute to the reftoration of the healthy ftate ; fo the moft powerful of them in this cafe are nourifhing food, fridion, gefta- tion, wine, taken in moderation, exercife, rather frequent than violent, and being as much as poffible in the open air. Though it is an acknowledged fad, that rheuma- talgia is one of the reproaches of phyficians ; it is more fo than has been hitherto yet underftood ; it being an afthenic difeafe ; while they at'all times made ufe of 3*9 390 THE ELEMENTS P&t IV. *he fame kind of treatment, as if it had been the moft fthenic, or, even upon the whole, a more debilitating V treatment \c). '^ Of the Afthenic Cough* DLXXXVIIL The afthenic cough is an afthenia, which, with the conftant common fymptoms, depends £ upon a frequent expedoration, which the cough excites; affedir.g every age, which has been under the influence of either dired, or indired debility, and therefore old age, which is unavoidably the prey of indired debility. DLXXXIX. As confifting in indired; debility, it is the effed of an exceffive operation of all the ftimuli that have been applied either for' a fliort time, or for a great part of life ; the effeds amounting to the fame ; that" of the former from its degree, and that of the latter from its long continuance (d). In fo far as its caufe is dired debility, a deficiency of all the ftimuli,, leaving the excitability to be accumulated, induces this form of afthenia, from the fpontaneous tendency of nature, life being only a forced ftate (e)* DXC. The cough, which depends upon indired debility, is cured by reducing the ftimulus which oc- ^ cafioned it, gradually and cautioufly to the proper and ..■ natural degree. And when it originates froin indired debility, (r) If they fliould pretend to fay that their bleeding and other evacuations were more moderate than in rheumatifm ; the anfwer is, that they were not fo profufe at any given time : But, cefn- fidering the length of time, that rheur .atalgy draws out into, tjie frequent, and almoft conftant evacuations, conjoined with every fpecies of inanition, made the debilitating practice upon the whole far exceed that ufed in the fthenic cafe. No wonder, then, that much mifchief was done. {d) See above XXIX. XXX. and CCCCI. (e) So great is nature's tendency to that particular increafe o£ excretion, which forms the matter of expectoration in this difeafe,. that every cafe of death from difeafe is an inftance of it. Hence the dead rattle in the throat is univerfally the expiring fymptom* See LXXIL and CCCXXVI. Chap.1, OF MEDICINE, £n;I debility, the increafe of the ftimulus, the want of whicii f occafioned the difeafe, till the degree of excitement, ^ which conftitutes health, is reftored, effeds the cure. DXCI. Such is the nature of dired and indired de- bility ; that if the remedies of the former be puftied beyond the proper boundary, the cough appears again 5 and the fame is the event of the fame excefs in the ufe £• of the remedies of the latter '(f). DXCII. Frequent and violent cough with copious expedoration has been always held for a fure mark of a vitiation or faulty ftate of the lungs. That faulty ftate was efteerned to be of a fihenic nature, and to give aflurance of the prefence fometimes of phthifipneu- mony, or confumption from an ulcer in the lungs', fometimes of baftard peripneumony, fometimes of a burning inflammation in the alimentary canal. In the former cafe an ulcer, or, in their way of fpeaking and what amounts to the fame thing, tubercles were believ- ed the caufe of the difeafe ; in the fecond cafe, inflam- mation, either in the intercoftal mufcles, or a different one from fhat, which occurs in true peripneumony, was, in their opinion, its primary caufe; and,, in the laft •cafe, not one of them would have hefitated a moment to have afcribed the ftate of the bowels to the only in- flammation they were acquainted with, that which re- quires bleeding and evacuation for its cure. And no other inquiry was made, but whether the matter that was fpit up, was mucus or pus. To afcertain this, premiums were propofed. DXCIII. But, in fad, befides that no phthifipneu- mony, no baftard peripneumony, as they call it, nor any inflammation in the alimentary canal, was ever cured by antifthenic or debilitating reinec.es ; and, in the feveral trials that have yet been made, the firft of •thefe cafes has been*evidently relieved, nay, frequently completely removed, and the two latter ihorcu:.»;nly cured (f) See par. XXXIII. XXXIV. and XLIII. XXX. CXXX1V. ith the addition, and efpecially CCXXXIII. to CCXXXVI. 39^ "THE ELEMENTS PartTVl ♦|| cured in numberlefs inftances, and'in all in which the l fthenic or ftimulant plan of cure has been ufed ; I fay, ? ^ befides thefe largef and comprehenfivc fads, fo little in- c lormation can be derived either from the quantity or * appearance of the expedoration, that in certain fevers, ■] m fome other difeafes of debility, quite free from local affedion, and finally in this very cough of which we are fpeaking, there is often a more violent cough, and a greater expedoration of matter putting on every form and eveiy appearance, than ufually happens in a con- firmed confumption, and where every hour is expeded to be the laft. And yet this whole tumult, heretofore fo alarming, can be ftopped 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 proportional expedoration, for ailong lue, while their lungs, however, are found, and free from any organic taint ? How often in phthifipneumony itfelf, after finiihing its courfe, and terminating in death; has the whole fabric of the lungs been found upon diffedion as found as ever happens in death from any caufe (g) ? DXCV. the (g) There are feveral cafes upon record, of the lungs, "after death from a confirmed confumption, having been found perfectly feund. A moft refpe&able pupil of mine went to Lifbon with a young aentleman or confiderable rank in Scotland, under a con- firmed confumption, whom-he brought back perfectly freed from his difeafe. He alfo faved either two or three ladies, I am not jult now fure which, equally given up upon the common practice. Jrle happened to affert before the phyfician of the factory, that a perfon juft dead of the fame difeafe had no local affection in the lungs, ;tnd upon diffeftion it was found to be as he had faid. I have reftored many phthifipneumoniacs, but am obliged to own,' that I have loft three, to whom I was called too late. Their lofs, however, mortified me, becaufe there were many reafons for my letting my heart upon their cure. I alfo loft in Edinburgh the moft amiable young man of that kingdom, after curing a prodi- gious hemorrhagy from his lungs. This was he whom my pupil two years before brought home fafe from Lifbon. But I was pre- maturely difmiOed in this, and counseled in the other cafes. * Chap. I. of medicine." 393 DXCV. The caufe of coughing has hitherto been unknown. To pafs over the fthenic cough, with & which we have nothing to do in this part of our fub- jed (h) ; the caufe of the afthenic is the fame as that of any afthenia, but more vehement in the foun- tain of expedoration, viz. the exhalant and mucous 9 arteries, the fecreted fluids of which, infpiffated by ftag- f nation in the bronchia, conftitute the matter to be expedorated. 45. The moft powerful of the noxious agents in ex- citing afthenic cough, is cold, juft as heat has been demonftrated to be the moft noxious agent in catarrh (i). Nay, in the afthenic cough, fuch is the power of cold, that the flighteft breath of air reaching the body, excites exceedingly violent coughing, and brings on the whole feries of fubfequent fymptoms; the warmth of 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. The bronchia bear their preffure for a little, till, diftended by the load, they can bear it no longer. Thendifagreeable fenfation exsites a commotion in the excitability of the affeded part, and, therefore, over its whole feat, and roufes the excitement. A cough fol- lows, and throws off the colleded humours by which it is provoked. DXCV 11. This difeafe is always to be treated, firft with ftin^ilant remedies, and then with fuch as alfo fill the veffels. If indired debility has been the morbific power, ftill we muft ftimulate,—at firft to a degree little lefs than that which occafioned the difeafe,jind then ftill lefs ; and, after changing, from time to time, the form of the ftimulus, lefs ftill; till we come down to the ftimuli that are agreeable to nature or1 thofe that fuit ih) See CLX. CCXXXIII. t, (i) Sec par. CCCCVII. to CCCCXII. B3 394 THE elements part IV. fuit the moft perfed health (k). In this way are ebriety. * and every form of intemperance to be treated. If ? MEDICINE* 39? wines, claret, indeed all the French wines, and punch with acid, are remarkably hurtful. And as indolence helps on with the firft fit, fo fatigue, efpecially that of walking, hurries on all future ones. Want of a fufii- cient quantity of blood is fo hurtful at all times, that, though the theory of phyficians led them to the notion that the difeafe depended on plethora and vigour, yet nobody ever thought of taking blood («). Vomiting is hurtful, and indeed one of the natural fymptoms of a very bad ftate of the difeafe ; but purging is worfe {x\ Every evacuation has a flmilar bad effed, with this dif- tindion, that the artificial are much more hurtful than the fpontaneous. , DCV. One is to be excepted,—excefs in venery,— to which, though it be a fpontaneous and natural, not an artificial, evacuation, gouty perfons are fo addided, and fo exceed others in power, that in the very middle of a very bad fit, they are not fparing of it (y). The exertion at firft is not felt; but in the advance of life, and after many returns of the difeafe, it is felt at laft with a vengeance (z). Great heat, by its indircdly debilitating operation, does fome hurt (a); but <*reat cold, by its dirodly debilitating, much more(£). Im- purity of air is injurious (c), as well as an interruption in the train of thinking (d), but hard thinking is more fo. (a) This is \)ne of their many contradictions between theory and theory, and theory and practice. (x) At any time I can bring"on a fit by a fingle dofe of Glau- ber's fait, unlefs I happen to be very ftrong, and quite free of all diathefis. (y) It is not quite correct to fay that the mere evacuation is the mifchievous circumftance here. It is the high degree of pleafurable fenfation that principally enervates. Editor. (z) At an advanced period of age, in perfons who had been vigorous, an unnatural power of execution fometimes, evefi in actual morbid ftate, will take place, fo as that the perfon will be able to outdo all his former doings in that way. But it isafalfe power, it is a fymptom of difeafe : It is like unnatural appetite for food amidft a weaknefs of the powers of digeftion. 0) CXV. (*) CXVIL (*) CXLVL {J) CXXXIX 'tOO THE ELEMENTS Pari IV. fo. A deficiency in the ftimulus of paffion is a pretty confiderable noxious power (e); but violence of paflionijj v ill convert this moderate degree of the gout into that™ higheft degree of it, that attacks the head, lays a fhare ^ for life, and brings on certain death (f). DCVI. Indulgence in fbep is bad (g), as producing dired debility, by deferring the re-application of the j ftimuli, which takes place in the waking ftate ; but top little fleep is much more hurtful, as it leaves behind it a degree of fatigue from the efted of the ftimuli of the fo:r-ner day (h). Often, when the upper parts of the body have been recruited by fleep enough, the podagric, after getting up, feels a ftate of languor in his lower ex- -1 tremities, and a demand for more fleep on their account, and is obliged to go to bed again, and give the unre- quited limbs their refpedive fhare of fleep. When a perfon is heavy from fhort fleep, how great is the luxury to cherifh again by the heat of the bed-clothes all tbe 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 compliment of fleep ? j DCVII. To prolong the intervals of health, and . j prevent a fit, the remedies are all fhe reverfe of the noxious powers: They are, rich food taken in plenty (/), but remaining within its ftimulant range, confequently of the animal kind, with a rejedion 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 thcdifeale (k), (at which time cold water after a good (e) CXLI. (f) Ibid. (g) CCXLV. (h) See Part II. Chap. VII. CCXXXVIL (/) See par. CCLXVI. \k) I know well when I may take cold drink and ufe fome vegetable matter ; it is when, for fpme time paft, I have been well fupported, and feel ftrong and vigorous. I alfo know, if I have, Cnap. X. Ot MEDICINE. 401 ■>jgood meal is fafe,) not mixed with acid, not acefcent, not turbid from fermentation when it is taken (/) ; geftation {m), exercife not fo ftrong as to occafion fweat, or give fatigue («), a full quantity of blood, which is procured by food and the exercife juft direded (o), no evacuation (/>), fparing venery, if gouty perfons can ob- ferve the rule (q), a moderate temperature (r), equally between the'extremes of dired and indired debility j pure air (s), confequently cleanlinefs, and being much in the open fields ; a chearful train of thinking (/) j fuch a ftate of excitement, as to paffion, as keeps be- tween fiery excefs and ftupid apathy, with as great tran- quility of mind as poffible (u); moderate fleep, rather inclining to be long than fliort, a rule which Ihould be fo much the more carefully obferved, as the difeafe is of longer ftanding and greater feverity : In fine, fleep* fhould be allowed to continue till the moft vigorous waking ftate is procured (x). DC VIII. From what has been faid it muft appear certain, that the gout of ftronger perfons is not alfo it- felf a difeafe of ftrength, or a fthenic one ; and that it does nave, either in food or drink, taken any thing improper in kind* how to correct it; which is, by having recourfe to a proper ftimu- lus. By eating an exotic fruit, which had a mixture of the quali- ties of the water melon, the orange and lime, in a quarter of ant hour I had an attack in my ftomach, in the middle of my lecture* laft fumraer, at the Devil tavern. By fome of the diffufible ftimulus I repelled it, and went well on with my lecture. At? other times I have prevented fuch an effect, by anticipating the: remedy. This doctrine puts much more in our power : But wa Ihould not, therefore, play tricks with it. On the contrary, we have great reafon to be thankful for the command it gives us over our health, and that alfo, by the ufe of means not inelegant, nau- leous, and clumfy, but quite the contrary. The old motto of Afclepiades, tuto, cekriter, et jucunde, is verified and improved by the important addition offalubriter. {I) CCLXVIII. (p) CCX'C. (i) DXIII. DXVIII. t» CCLXIX. iq) DCXIX. («) CXL, CCCIIL («) Ibid. (/) CXIL (x) DC. (0 CCXC. CCXCV. (r) CCCIIL C * 40i THE ELEMENTS PartlV, * does not depend upon vigour of the conftitution and plethora, as has been commonly hitherto imagined ; but that it is manifeftly 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 antifthenic, as it has hitherto been the notion, but by a fthenic plan of cure ; and that there is every en- couragement for treating it in that point of view. DCIX. What has hitherto deceived phyficians, and paffed for the caufe of the gout, is 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 their great ftrength. But, good men ; they never recolleded, that vigour and a great quantity of blood are not properties inhe- rent in animals, but that they depend every day and every hour upon foreign circumftances (y). If any one, according to that idea, who has happened to acquire a great bulk of fimple folids, and who has enjoyed abun- dance of proper diet, to the thirty-fifth or fortieth year of his age, ihould all at once be deprived of alfthe articles of diet for ten days •* and if a dwarf two foot high, who has lived poorly, and is, therefore, meager and flender, fhould equally fuddenly be put upon rich living ; will there be the leaft probability, that the former fhall, notwithftanding his prefent abfolute priva-. tion, continue plethoric and vigorous ; and that the latter, from being crammed with unufual plenty, fhall continue empty, as before ? Is the fundamental propo- fition of this dodrine, in which it has been demonftrat- ed, that we are nothing of ourfelves, and that we are altogether regulated by external powers, to be forgot- ten ? Is a gouty perfon, who has for twenty years undergone an excefs of ftimulant operation, about the fortieth year of his age, or even afterwards to be reckon- eed fuller of blood and more vigorous, than another perfon who has lived lower, or than he himfelf was twenty U) X.XI.XILXIIL Chap.h OF MEDICINE.1 403 twenty years before ? Where, pray, was the nccefiity of comparing gouty perfons with others free from all bias to that dileafe, and why not compare them with themfelves (z) ? Of (z) Such is the effect of the powers operating upon u«, that a certain degree of that operation produces an effect 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 ihe demands of the fyftem : Hence? day-labourers are fupported upon lefs ftimulus than gentlemen. Again, which is a circumftance liable to happen to the latter, if the accuftomary operation has been exceffive, there will be a necef- fity for a continuation of fome degree of the excefs. A podagric may be itronger than a labourer, and yet fall into the gout. For though compared with the other perfon, he is ftrong ; compared with himfelf at another time, he is weak : And the reafon is, that, though he is ftill better fupported than the labourer, he is worfe fupported than the ufual ftate of his. fyftem requires. Further, the labourer, though he falls not into the gout, may, by carrying his moderation too far, fall into indigeftion, or fome other difeafe, in every effential refpect; the fame as the gout. A double infer- ence arifes here ; which is, that, though both excefs and deficiency can be borne to a certain degree, £0 as to require a continuance of them, or a gradual correction, yet they fhould both be avoided as entailing that fort of neceflity for their continuance while their effect makes no fort of compenfation, being,, at beft, not the beft ftate, that of perfeft health, but a ftate of predifpofition to difeafe ; the one to. fthenic, and at laft indirect debility ; the other to af- thenic, as depending on direct debility.. The perfect rule for in- furing the healthy ftate, is to keep within the extremes of excefs and defect, and thereby produce the due degree of excitement; and to apply all the exciting powers equally, each in its due pro- portion. 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 exienlive 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 profecute the idea upon fome future occa- fion. I know a book filled with the valuable ethic facts, but have not yet had time to confider, whether they all point to a general one, in which they all a^:te, and which reflects proof and confir* mation upon them -, without which it would fall fhort of fcientific. isactnefc. 404 THE ELEMENTS ' Part IV, Of the gentle Afihma. DCX. Afthma is an afthenia ; in which, to the fymptoms common to all aftheniae, there is fuperadded * a difficult refpiration, returning at uncertain and often unequal intervals, without any unufual expedoration accompanying the fits. DCX1. The noxious and curative powers here are the fame as in the gout : In the fame manner the fits. are both prevented and removed [a). Of Cramp. DCXIIi 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, fometimes the wiifts, fometirz>es one of the calves of the leg, in fine, any external part, are affeded : Of the internal parts, it is fometimes the ftomach, fometimes fome pait in the inteftinal canal, fometimes the urinary bladder, that fuffers : The difeafe is not produced only by indircdly debilitating powers ; it alfo arifes from diredly debilitating ones, fuch as abftinence, vomiting, diarrhoea, and drinking water contrary to cuftom. DCXIII. To remove this difeafe, when it does not exceed the degree that is here underftood, the whole body muft be invigorated by moderate ftimuli, every violent exciting power fhould be taken out of the way ; geftation, and fuch exercife as does not exceed the ftrength, fhould be ufed. A more fevere degree of this difeafe will by and by be treated under the title of tetanus. Qf {a) This has been proved, both upon other occafions, and par- ticularly in the cafe of a young gentleman, who lived with me during my firft management of my gout. See Preface to ttp Elementa, Chap. I. OF MEDICINE, 4°5 Of Anofarca. DCXIV. Anafarca is a form of afthenia, diftinguifh- ed by water betwixt the fkin and the flefh, occafioninc an external fwelling of the body, without the figns of any fuffufion of the fame fluid into the interior parts. DCXV. In the treatment, the body muft be in- vigorated, and in that part of it chiefly, where the greateft laxity and atony prevail, that is, the fkin. This indication is anfwered by ftimulating heat, by fridion, by pure and. dry air, by nourifhing ftimulant diet, and the peruvian bark. No internal local affec- tion gives occafion to it, which may be known from the fymptoms yielding to this plati of cure. Of Colic with Pain. DCXVI. Colic with pain is a form, of afthenia, and a higher degree of the colic 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, twilling pain about the navel, with pain in fome part of the belly, often enormous, and fometimes with a tumor, that can be felt externally, immediately above the brim of the pelvis, on the right fide, at the place of fhe blind head of the colon. Of the Dyfpepfodynia, or Indigeftion with Pain, DCXVII. 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 a very fevere difeafe. Of the violent Hyfteria. DCXVIII. The violent hyfteria is a higher degree of the mild hyfteria ; in which, befides the fymptoms defcrihed 4^6 THE ELEMENTS PartlV." j defcribed under that head, mobility and changeablenefs , J of mind, difpofition, to fleep, convulfive ftate, and a 8 great refemblance to epilepfy, are confpicuous.. The ^ temperament, that favours hypochondriafis, is of an oppofite nature to this, which is commonly called the i fanguine. Both the temperament and predifpofition in this cafe are produced by a moift, lax, fet of fimple, ] folids. Of the Gout of weakened Perfons^ DCXIX. The gout of weakened perfons, which is an increafed degree of the gout of ftrong perfons, is that afthenia, in which the inflammation runs to greater length, and, at laft, does not form at all; while the general affedion increafes in violence and obftrhacy, and, at laft, attains its higheft degree ; exhibiting, to- wards the end of the difeafe, almoft all the fymptoms, of debility, every form of afthenia^ and fometimes counterfeiting fynocha, DCXX.. As the difeafes affeding the alimentary- canal, formerly mentioned (b), have, in great meafure^ a common nature ; fo thefe alfo, that is, the colicody-. J nia {c), the dyfpepfodynia {d), the violent hyfteria (e)9% jj and the gout (f), equally participate of the fame, dif-' fering only from the former in their higher degree of violence, Their moft: diftinguifhing fymptoms arc either fpafm, which takes place in colic and indigeftion with pain, or a fpafmodic convulfive affedion, which, accompanies the others. But they do. not differ from each other in any thing effential ; fince they all, with- out diftindion, depend not only on debility, but alio nearly upon an equal degree, as the fimilarity of their morbific powers and remedies proves. For a very fulf explanation* \ 'i (b) From DLVI. to DLXXVI. (e) DCXVIII, (c) DCXVI. (f) DCXIX, (d) DCXVIL Chap. 1. OF MEDICINE." 407 explanation of fpafm and convulfion go back to the following numbers, CLXXXV1II. to CXCV. and from the latter to CCI. DCXXI. In the treatment of them all(^), abftinence, fatigue, evacuations, acids and acefcents, cold, diredly and indiredly debilitating paffions, the debility arifing from exertion of the intelledual fundion, and impurity of air, muft be avoided. The mode of cure of every one of them muft be ftimulant. When each is but flight, beef foup and other rich foups, which ad partly by dilution, partly by a nourifhing and ftimulant opera- tion in the weak ftate of the ftomach when folid food cannot be taken, and by fupporting the fyftem ; after- wards, when the ftrength is in fome meafure reftored, folid animal food, and moderately diluted drink, which, at laft, eftablifh the health, are fufficient. In a higher degree of difeafe, while the foups fhould ftill be con- tinued, at the fame time pure ftrong liquors fhould be adminiftered. And when the violence of any cafe baffles this whole fet of ftimuli, recourfe muft be had to mufk, volatile alkali, camphor, sether, and opium. Thefe muft be adminiftered in large dofes ; and all acid and fermenting things, every thing cold, though accompanied with ftimulus, muft be guarded againft. DCXXII. As to the management of the patient in the intervals, all debilitating powers muft be avoided, fuch as fatigue, abftinence, cold, and exceffive heat (h); it is a certain and demonstrated fad, that the fits of recurrent difeafes do not return from any inherent power of nature, but from human folly. You may accept of this as a joyous and unexpeded piece of news. The recurrence of fits of the gout itfelf is not unavoida- ble (?) ; but, by guarding againft the noxious powers, may (g) Perufe the whole of Chap. IX. Part II. from number CCLXXXI. {b) See again the fame Chapter, which eompire with the pre- ceding, the VIIIth of the lid Part, (/} See par. DXCVIL 4£>8 TilE' ELEMENTS PariiW may be repelled for any length of time ; and, when it happens at any time to come on frorh the fault of the patient, it can often be removed in two hours, and al- moft always in as many days, and the ftate of health fecured in 'very refped. In all difeafes of fimilar vehe- mence, wiic never any ftimulus, from a long continuation of lfs'ulc, has begun to have lefs efted, we fhould lay it alide, and proceed to the ufe of another, from that ftill pais to another, and in that way go over the whole circle (k). Of Eypochondriafis. DCXXIIf. The hypochondriafis is an afthenia, in which, with the fymptoms of dyfpepfy, there is a noife in the belly, flatulency, and uneafinefs, and a rooted o\ mioi in the patient, of the dileafe being always worfe tii:.m it is. The way to the difeafe is paved by a dry lot of fimple folds, and that temperament, in which Lure is a natural flownefs to paffion ; which,however, once excited, riles to extreme violence, and continues long with obftinacy. It is further diftinguifhed by a fixed attention of mind, whereby the patient is liable to dwell to excefs upon any puriuit or ftudy, and is not to be eafily diverted to another, as alfo by a diy ftate of the furface of the body, a rough fkin, with black hair, and black, eyes, and always a dark complexion and ferious afped. DCXX1V. From this definition, hypochondriafis is beyond doubt an afthenia. as it is accompanied with a noife in the bcllv and flatulency, and as the courfe of the difeafe is diftinguilhed by flownefs to paffion, earn- eftnefs in, thinking, and by that ftate of the fimple folids, which requires a high force of ftimulant opera- tion to procure and keep up a fufficient degree of ex- citement. DCXXV. Since the ftate of the fimple folids is a ftate given by nature, and not to be changed by art. and H) XLL <6hep. I; of medicine: 409 and the only indication of cure left in the phyfician's power, is to fit a certain degree of excitement to that given ftate, which is exadly the cafe in this difeafe 5 the ftimulus of food, drink, and others, fhould be em- ployed in the cure of hypochondriafis. The patient ihould be kept cheerful, by agreeable company and gay entertainments, by a journey, and by the various fcenes of nature and art through which he paffes. During his journey he fhould ride, that, in guiding the horfe,, his mind may be more occupied. His ftudies and every fubjed of his Ordinary contemplation ihould be often changed and varied. He fhould have generous wine given him, to relieve the fymptoms of his ftomach and inteftines, and to raife his animal fpirits. And if thefe Ihould fail of fuccefs, the diffufible ftimuli, as opiates, fhould have their turn for a time, for the purpofe of ftriking a ftroke at once. And their ufe again fhould be gradually laid afide in proportion as the ftrength cart be fupported by the more natural and accuftomary ftimulants. Darknefs and bad air fhould be fhunned ; bright light, and all lively objeds, ihould be fought after. No hypochondriac, even iu a fit of delirium, ihould be provoked, but by every contrivance footh- ed(/). Of (l) I have heard of an hypochondriac fo provoked at his phy- ficians, who maintained that nothing ailed him, that he, on the contrary, to carry 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. He 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 ; but, as he could not difcern the particular caufe of his death, he, therefore, propofed to open the body : In letting about which, he made fuch 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. D3 wjUU* TJI« ELEMENTS PattlVi Of Dropfy. DCXXVI. Dropfy is an afthenia, commonly in the? form of an anafarca, with a fwclling of fome vifcus, which, for the moft part, at leaft in the beginning, at- tacks fome part in preference to others. DCXXVII. The caufe of dropfy, in fo far as it re- fpeds the colledion of water, is eafily explicable upon this dodrine, but altogether inexplicable upon any other. For the univerfal debility, that is, laxity and atony, is chiefly predominant in the extreme red arte- ries, and the exhalants immediately continued from thefe, as well as in the commencements of the abforbent veins ; and it is often urgent in a particular fet of thefe veffels only. DCXXVIII. As all the debilitating noxious powers concur in producing this, as well as every other afthenia y fo thofe powers have the greateft influence in this cafe, that prefs moft upon the vafcular fyftem. Hence, as we fee in the converfion of peripneumony into the dropfy of the cheftr profufe bleeding, and a large draught of cold water, when the body is fatigued, over- heated, and burned up with thirft, are the moft powerful agents in bringing on this difeafe. The hurtful effed of the latter, in every cafe of debility,, when its opera- tion is not followed by fome ftimulus, has been more than fufficiently explained above (/»). Befides, in this Cafe, when all the veffels are dilated, the water flows to their terminations, which arc their weakeft part, paffes out at thefe, and, as it cannot all be taken up by the abforbents, it colleds in every neighbouring cavity (»). Hence the urgent fymptom in this difeafe. DCXXIX. To this afthenia belong all the watery effufions, which do not arife from local affedion, but depend on pure debility. And, therefore, if at any time (m) See par CXVII. to CXXIV, fa) LIX. L£. UI. Chap.h OF MEDICINE, 411 time any other form of afthenia, whether from wrong treatment, or other4 noxious powers, terminates in this effufion y every fuch cafe fliould be held as a proper dropfy (0); arid it fhould be ever prefent to our recol- ledion, that there are only two general difeafes, and that the diftindions hitherto received are devoid of all folid foundation. Accordingly, both from other im- proprieties in the treatment, and particularly from bleeding, epilepfy, palfy, and gout, terminate in real dropfy. Nay, fuch is the termination of peripneumony itfelf, when it is either converted into dired debility, from the debilitating plan of cure having been pufhed to excefs, or into indired debility, from having been left to itfelf, and the body not fufficiently debilitated. The affedions, confined to parts, which are confidered as the remote caufes of dropfy, will be treated among the local difeafes, to which they belong, DCXXX. After this explanation of the nature of tlropfy, its cure, provided the treatment be proper, and 'early enough fet about,, ought by no means to be fo much defpaired of, as it fliould be when local affedion with a fimilar effufion, and the general difeafe arc blend- ed together without diftindion, and confidered as one and the fame (p). If long before the effufion there was no internal complaint, if the difeafe rather came on fuddenly, and in confequence of evident noxious powers, and yields to the firft part of the curative means, there is no reafon to doubt of a cure. DCXXXI. Befides the general indication of cure for afthenia, that fuited to this cafe muft be particular- ly direded to the whole vafcular fyftem, and efpecially to the termination of the arteries, and the commence- ment of the abforbent veins. The remedies are alfo the ufual ones ; that is, diet as nourifhing and ftimu- lant » (*) See LXXXI. (/>) Sometimes the predominant fymptom rifes to the degree of being above the power of the excitement) as in the tumour of fcirrhus, and the effufion here. \iz THE ELEMENTS I tmWA lant as poffible ; firft in a fluid form, when the folid cannot be admitted upon account of the debility of the ftomach ; then, alfo in a folid form y and together with both, ftrong drink, fuch as the beft wine that can be gotten, 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 had to the diffufible forms : By this means, when the effufion has n6t yet attained to that high degree that conftitutes a local affedion, and is not to be altered by any ftate of the excitement, this afthenia can be as eafily cured as any other*. •DCXXXIL But, when a great quantity of water has now gotten into fome large cavity, it fhould im- mediately be removed by the catheter ; when that has been done and the emptied cavity fecured with as much care as poffible, the ftrength fhould be fupported by ivine, ftrong drink, and any ftimulus more diffufible, as direded a little above. And if this fhowild likewife fail, we muft conclude, either that the general difeafe has degenerated into a local, or that the affedion has been local from the beginning. Of Epilepfy. DCXXXIIL Epilepfy is an afthenia; its diftinguifli- ing fymptoms are, fome heavinefs of intelled, dulnefs in the exercife of the fenfes; afterwards a very impair- ed ftate or temporary extindion of the latter, accom- panied with various convulsions over the body : Fits, confifting of fuch a concourfe of fymptoms ufually, at length return at uncertain fpaces of time, and each of them terminates in a foaming at the mouth. D.CXXXIV. As all the debilitating noxious agents are produdive of this difeafe ; fo the lofs of the blood and other fluids, excefs in venery, fuch paffions as Tear, terror, afliduous and intenfe thinking in perfons of great genius, a deficiency of intelledual exertion in ftupid Chap. L ©y MEDICINE. 4*3 ftupid perfons, are particularly fo {q)> The powers that produce the firft fit, more eafily bring on fubfequent fits : Befides, certain unufual impreffions upon the fenfes, fome of them difagreeable, fome highly agreea- ble ; fuch as the flavour of fome foods, the fmell of a rofe, have the fame tendency ; and certain poifons (r) are faid to have the fame effed. DCXXXV. But the appearance of fymptoms is full of fallacy, and, unlefs the nature of the noxious powers producing and of the remedies removing them,, be thoroughly underftood, it is incomprehenfible. To % folve the prefent difficulty about poifons, and to fettle ; the queftion, whether the fymptoms belong to univer- fal, or local difeafe ; we muft confider, whether the \ .latter, confifting in the vitiated ftate of a part, fuppofe either of the ftomach or brain, or in fome point of the I lower extremities, proves the caufe of the aura cpilep- tica ; and whether this vitiated ftate refifls the virtues of the remedies, that ad by changing the excitement; or whether all the fymptoms are either relieved or re- moved by the change of excitement. If the former is i the caufe, the affedion muft be confidered as local (s); v if the latter, the difeafe muft be held for a general one, [ ««nd a true, but a great afthenia. Nor muft we forget, \ that a great many fymptoms of general dileafes, though • from the fame origin, are diflimilar ; and many from different, nay, oppofite caufes, are fimilar ; that many local fymptoms have a great refemblance to thofe of general difeafes, and that they fometimes, by a fallacious i appearance,, counterfeit epilepfy, fometimes apoplexy, y fometimes certain other general difeafes. DCXXXVI. For the purpofe of preventing this difeafe, we muft avoid other debilitating powers, and efpecially thofe that have the greateft power in pro- ducing it. Tnc veffels fjiould be filled, by giving food as tq) See above par. CXXXIV. CXXXVII. and the addition ; CXLII. and CXXXIX. \r) See XX. (/) See above CCXXIV. 4^4 THE elements Part iVi as nourifhing and as effedual in producing blood as poffible ; indulgence in venery muft be moderated, chearfulnefs and tranquility of mind muft be promoted, an agreeable train of thinking muft be induced, and all objeds difagreeable to the fenfes, which give them dif- turbance, guarded againft ; the ftrength muft be fortified by proper exercife, by the Peruvian bark, if the approach of the fits can be perceived, and by wine and the more diffufible ftimuli. A medium betwixt too long and too fliort a continuance of fleep ihould be obferved. Stimulant heat fhould be applied ; but all excefs of heat, as well as cold, avoided (/). The purcft air, fuch as that in the fields, when it is free from moifture, fhould be fought after. The furface of the body fliould be excited by fridion, and cleanli- nefs, for the purpofe of cherifhing the organs of volun- tary motion, which are very clofely conneded with the animal power in the brain. DCXXXV1I. The fame remedies, which radically cure the gout, alfo cure epilepfy, and precifely in the feme manner («}. (;) See CXXIV. CXXVII. CCXXVIII. CCLXXVII. CXXXVII. CXXX. CCXXXVIII. CCXXXIX. CCLX. (a) This paragraph is the anfwer to the queftion propofed ia that which ftands in the Elementa, anfwering to the fame number. That paragraph therefore is erafed, and this put in its place. I had beard from fome of my pupils, that they had been able, by their diffufible ftimuli, to remove epileptic fits. But in cafe of any miftake I would not venture to mark the fact for certain, vhich I have now done from my own perfect conviction. A young man lately married had the moft alarming fit of epilepfy that ever was : His cafe was thought beyond remedy ; as an extreme one, however, he got from fome perfon the full of a tea- cup of tinctura Thebaica up to a blue ring a little below the brim. He got out of his fit lome how or ether : But was perfectly flupid and fenfelefs for a fortnight. Upon his falling into another, I was lent for, and brought him about in twenty minutes, as I am told, (for I did not wait,) £o completely, that he got out of bed, and ate a hearty meal of beef fteaks. Many weeks after, by xnifmanaging himfelf, and neglecting directions given him, he fell into a fiighter one, and was cured in the fame way. map. t Qt MEDICINE. 4*5 Of Palfy. DCXXXVIil. Palfy is an afthenia, in which, with the other ufual marks of debility, often with fome de- gree of apopledic attack, commonly on a fudden, the motion of fome part of the body, and fometimes the fenfe of feeling, is impaired. When the fit is flight and of fhort continuance, it terminates in health ; but the confequence of a higher degree and longer dura- tion is death. DCXXXIX. The noxious powers, that ufually pro- duce epilepfy and apoplexy, alfo tend to produce palfy : Befides thefe, all the common debilitating powers that produce any afthenia, diredly or indiredly ; great commotion of the nervous fyftem by means of too dif- fufible ftimuli ; which affed the circumference of the body, where the organs of voluntary motion are chiefly feated, more than the internal parts and the brain ; fas is evident in ebriety, gluttony, and every fort of in- temperance ;, likewife an indolent way of life, which is commonly conneded with thefe noxious powers y have all the fame tendency. DCXL. When the difeafe has once taken place, it is kept up equally by diredly and indiredly debilitat- ing powers ; DCXLI. For the indication of cure, which is pre- cifely the fame as in epilepfy, as the energy of the caufe operates more immediately upon the furface of the body -* confequently, according to what was faid upon the fubjed of epilepfy, the principal remedies are thofe, that have the greateft power in invigorating the furface of the body : Such are fridion, geftation, that degree of exercife which the ftrength admits, for the purpofe of routing by their powerful operation the languid ex- citement 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 41& THE ELEMENT* >Jrr IV.' endued with ftimulant virtue fhould be by any means omitted, in order that the excitement, which is of great confequence in the treatment of all difeafes* be more equal and vigorous ; fo in that extrerhe debility which produces fuch an impotency of voluntary motion, as it is of the greateft confequence to make an impref- lion upon the principal fymptom ; we fhould employ a great deal of opium (CXXX. and CCXXX.) ; the influence of opium upon the furface is more confidera- ble than that of all the other powers. We fhould con- tinue this plan of treatment with vigour till fome com- mencement (\f returning motion be procured ; and then, without negledi'ng the afliftance of any of the other ftimuli, but ufing them all in conCourfe or fucceflion, for the fake of rendering their common effed more powerful and more equal, we fhould try to eradicate the difeafe. DCXLII. Debilitating and evacuant powers are to be avoided for this reafon, that it is not vigour, it \% not an over-proportion but a fcantinefs of biocd, and a deficiency of vigour, that is the caufe. Of Apoplexy. DCXLII I. Apoplexy is an afthenia, refembling the two juft mentioned in its caufe and cure, diftering in the appearance of the fymptoms, which makes no dif- ference in the nature of the thing (x) : In this difeafe, befides the fymptoms in common to it with palfy, epi- lepfy, and other afthenia?, fenfe, intelledual energy, and the voluntary motions, are fuddenly impaired, the re- fpiration remains, but with fnoring, the pulfe is weak, and the whole fit is finifhed with the appearance of a profound fleep (y). DCXLIV. The heads of perfons, fubjed to this difeafe, arc large and not welt formed, their necks fhort and thick. It is produced by both dired and indired debility, (*) LXXXI. DXXIX. (;) CLIII. CC. Gfiap.I. qF medicine: 417 debility, but chiefly by the latter. Of the indiredly debilitating powers, the i*oft powerful is the luxury of food, drink, and floth, which, after its courfe of ftimu- lating and filling the veffels is run, proves truly debili- tating and produdive of a penury of fluids : And, as each fort of debility is increafed by the other, and con- fequently the indired by the dired, it is remarkably the cafe in this difeafe. Hence the effed of the de- bilitating 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, gotten the better of. DCXLV. The caufe of epilepfy, palfy, and apoplexy, is the fame with that of every afthenia ; affeding the head lefs in palfy, excepting in the beginning and end, but greatly ia the two others ; and in all the three producing a difturbance in the organs of voluntary motion. This difturbance, whether the motion be deftroyed or diminiihed, or as in convulfion feemingly increafed, amounts to the fame thing, and, as was for- merly explained, depends upon debility (z). DCXLVL The indication of cure is the fame here, j|. too, as that which runs through this whole form of difeafes ; and the force of the remedies is efpecially, and as much as poffible, to be direded to the part* ; moft affeded. To prevent, therefore, the fits, which are in every refped alarming and full of danger, we ought to bear in mind, how far indired debility has a fhare in producing this difeafe, and how far the dired concurs with it ; alfo we ought to confider the opera- tion of a greatly advanced age. All exceffive ftimulus, therefore, muft be avoided in fuch a manner, that the body may be invigorated and dired debility guarded againft ; the ftimulant 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 ftimulant operation, others, ac- cording (*) LVIII. CCXXX. * * e3 4i 3 i^e elements r.t?/lV. cording to the rule of nature, which the excitability, yet not worn out with refped to them, admits, fhould be fubftituted ; that is to fay, tne kinds of food, of drink, and of diffufible ftimuli, fhould be changed all round, and upon the failure of each lately ufed, we fhould return to th6fe that have been long ago laid afide (a). DCXLVII. The three difeafes we are treating of, are commonly fuppofed to arife from a plethora, at- tacking the head, and proving hurtful by compreffion upon the brain. But, befides that plethora has no exiftence in any cafe where it has been fuppofed (£), how can the blood be in over-proportion either at that extreme age at which thefe difeafes happen ; or in epilepfy, when it affeds weak and ftarved children ? Can penury of food (which alone is the matter that forms blood) in the latter, and in the former the lofs of vigour, create an over-proportion, and not, on the contrary, occafion a penury of blood ? DCXLVllI. As plethora then has no fhare in in- ducing thefe difeafes, fo neither are they to be imputed to an effufion of blood or of ferum (c) upon the brain. Nay, a fimilar effufion happens in every cafe of great debility of the veffels. Of the Lock-Jaw. DCXLIX. The lock-jaw is a lefs degree of tetanus, the fpafm being confined to the lower jaw and the neighbouring parts. This by itfelf is a rare affedion; it is a formidable fymptom in fevers and wounds. When it is the former, it will be treated of under fever j when the latter, it will give occafion to an inquiry, whether it belongs to local or.general difeafe. DCL. Since it never arifes immediately after a wound is inflided, but ufually happens, either when ,. vthe ta) CCCI. lb) CXXXI. CXXXIV. DXLIX. DLV. (0 CXXXVIL and the addiuca. £ Chap. L OF MEDICINE. 4*9 the wound is healed up, or after a confiderable interval of time ; we muft infer, that it either arifes from the violence and duration of the pain, which is always the Caufe of much debility, or from the debility which the ufual antifthenic plan of cure produces*, or from an unknown taint in the fubftance of the nervous fyftem. DCLI. That it depends upon debility we have reafon to believe, from every fort of fpafm always depending on debility (d) ; from tetanus, which is precifely the fame affedion, only differing in degree (e), having no other origin ; and, in fine, from the fuccefs of the ftimulant plan of cure in this as well as all other fpafms ; and the want of fuccefs of the antifthenic, or debilitating evacuant plan. All the other particulars refpeding this fubjed will be taken notice of under the next head. Of Tetanus. DCLII. Tetanus is an afthenia, and, thefore, always affeds perfons in a ftate of debility, whether dired or indirect; in which, fometimes with confeioufnefs, fome- times without, fometimes with difficulty, fometimes with freedom, of refpiration, the whole body, or the neck and its neighbourhood only, are bent fometimes forward^ fometimes backward, and. held faft by a rigid fpafm. DCLTII, Tetanus is rarely feen in cold countries, as the northern parts of Europe ; more frequently in the warm fouthern regions of that divifion of the globe ; but moft frequently in the torrid zone. When it ap- pears among us, it is the fequel of a debility uncommon in general difeafes : On the contrary, it almoft always arifes from that unufual debility,.which is occafioned by a lacerating wound, through which fradured bones are forced, increafing the fum of that debility that ex- ifted before, or that happened to be induced in the courfe {d) clxxxix. CXI. CO ccxxvni. 42,0 THE ELEMENTS Part W. courfe of the treatment. To produce the more fre* quent cafe, or that moft frequent one of ail, which is quite common in the torrid zone, the moft powerful of the debilitating powers, and a great many, if not all of them, concur-. The moft powerful of thefe is, that intolerable degree of heat, to which perfons engaged m labour, or exercife are there expofed ; fuch perfons, and confequently flaves, are almoft the only victims of tetanus. Hence, even under the flighteft motion, fatigue, and fweat, are produced (g), and from the fweat arifes a fcantinefs of blood and other fluids. From all thefe arifes a languor over the whole body, and, there- fore, in the ftomach (h) : From the languor of the ftomach there is a puny appetite, and food—which is another caufe of penury of the fluids—is either uot taken in, or thrown up again. All thefe affedions, as well as that indolence both in mind and body, which , is infeparable from fuch circumftances, are followed by the higheft degree of debility over the whole body r 'And, as the moft noxious power, intenfe heat, diftreffes the head more than any other part, as well as the organs ©f voluntary motion, whether 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. DCLlV. As tetanus is occafioned by all the debili- tating powers, according to the different degrees in which they poffefs that property, and, confequently, like every other afthenia, depends upon debility ; and, as all the afthenae are removed by remedies, exciting the whole fyftem in fuch a manner, as to exert the greateft poffible influence upon the affeded part ; the fame, accordingly, is the nature of tetanus, however little that difeafe; has been underftood, and the fame " fimplicity of nature is found in it. If it requires the very higheft remedies, this fhows, that the whole dif- eafe (g) CXV. CXXXVII. and addition. (-6) CLXXXVI. CXCIV. to CXCVIII. Chap. I. OF MEDICINE. 411 eafe does not confift in fpafm, and that the affeded mufcles are not its whole feat, but that there is extreme debility in every part, but greater in the mufcles than in any other equal part, according to the law we have mentioned (/). DCLV. After tetanus has taken place, as the teeth are clofed by the lock-jaw, there is neither accefs to the weaker and lefs powerful ftimuli of food and drink, which are often fufficient for the cure of difeafes of lefs debility, nor any fenfe in ufing them ; we muft, there- fore, immediately have recourfe to the moft powerful and the moft diffufible ftimuli poffible, and continue their ufe without regard to quantity, not even to that of opium itfelf, till the whole tumult of the difeafe is allayed (k). Of intermittent Fevers,. DCLVI. Paroxyfms, confifting of a cold, hot, and fweating fit, are phenomena that occur in every inter- mittent y and, in a certain degree, in every remittent fever. They often come on in confequence of a certain taint received from contiguous moraffes, or from the marfhy ftate of the contiguous foil ; but they alfo fre- quently occur after an application of cold only (/) ; at other # if) XLIX. [k) CCXCV. to CCCFL (/) As in the vernal intermittents in Scotland. In the Mere, •r county of Berwick, where I laboured three months under a tertian, that is, from the beginning of March to the beginning of June, in the Carfe of Gowrie, and fome other places in that country, nothing is more common than the tertian ague happen- ing at the time at which I was affected ; and nothing is more certain, than that cold and moifture are the chief powers inducing it. It is fomewhat ftrange, that a man born in that country, if he would patch up a fyftem of fevers, fhould have overlooked a form of them, that occurred to his eye-fight every day, and bor- sowtd his hypothetical caufe from a marfh miafma, fuppofed to be the produce of great heat and moifture, though he had only beard or read of the intermittents of warm countries. 42Z THE ELEMENTS PartlV. other times after that of heat only (m), when the com- mon afthenic noxious powers accompany either : They return with a remarkable exacerbation, after a tempo- rary folution or an abatement of the difeafe ; in the \ cold fit, exhibiting manifeft debility ; in the hot, coun~ terfeiting vigour ; and fcarce ever obferving any ftrtd j exadnefs in the time of their return (»); but returning fooner in a higher, and later in a lower, degree of the difeafe ; and not unfrequently, befides the remittent,. ' alfo gradually affuming a continued form ; and, on the contrary, fometimes - without interference, oftener in confequence of an improper method of cure, before the difeafe is ended, changed into quintans (o), feptans, ,t ip), nonans (q), or into fextans, odans, and decans (r). I DCLVIL The intermittent fever, which returns every fourth day, and is therefore called a quartan, is milder than 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 every N day, is denominated quotidian. The difeafe-that de- generates into a remittent or continued form, is of a worfe nature than thajt which is regular in its returns* or that which the intervals betwixt fits are protraded :. and, the form and type of each cafe being given, the* .' whole fet is both of more frequent recurrence, and of a. more fevere kind in hot, than cold, climates. DCLVIII. That this fort of fever depends upon de-, bility throughout the cold fit, is proved by the fymp-. • toms* (w) In the warm countries agues often occur, when it is eafy to difcern heat to be an hurtful power ; but when moifture is much lefs prevalent, for that very reafon that the heat is prevalent,. than at other feafons when the difeafe does not occur. («) Dr. Sydenham was content to count the periods by the i day, which was even too particular, but Nofology has refined the matter into the wonder of e^actnefs to an hour. (0) Where the fit does not return till the fifth. Ip) Where its return is not till the feventh day. iq) Where the intermiflion continues till the ninth day.' (r) That ii, prolonging their intermiftlon till the fixth, eighth, or tenth day. Chap. I* OF MEDICINE. 423 toms, by the exciting noxious powers, and by the method of cure, whether fuceefsful, or the contrary. DCLIX. The whole difeafe, as well as every paroxyfm, begins with a fenfe of cold, the greateft de- fire for a warm fituation (s), with trembling, and a fhaking motion in which the whole body is lifted up from the bed (/), with palenefs, drynefs, and fhriveling of the fkin, with the diminution of tumours, and dry- ing up of ulcers, which the patient may happen to have had before the arrival of the difeafe, with an impaired ftate of the intelledual 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 liftleffnefs of mind and body in all the fundions, in fine, with manifeft debility. DCLX. If terror, horror, cucumbers, cold melons, famine, debauch in eating and drinking, food of difficult digeftion, have been found for certain, to have a great effed in bringing back paroxyfms, after a long inter- miffion ; if in fituations, where cold is the prindpal noxious power, it is the poor people who are ill clothed, ftarved in their diet, and enfeebled by labour, who in general are affeded with this difeafe ; if in warm regions of the globe, it is thofe who have been moft expofed to debilitating noxious powers of all kinds, who, in prefer- ence to others, are feized with it (u); if in moift places, thofe who ufe a plentiful diet, and cheer themfelves with their bottle, efCape the difeafe (x), and water drinkers (/) I yet remember, that it was the higheft luxury for mc, when the cold fit came on, to be put in bed, and covered under fuch a load of blankets (for the cold of fheets was intolerable) as would, at any other time, have oppreffed me. I was then about eleven years of age. (/) By authors and lecturers in Latin abfurdly called rigor. (u) SeeDCLIII. (x) As in Holland ; where the Dutch ftudents who live not near fo well as the Englifh, are very liable to the difeafe, while the jolly living Englifh, who do r,c; Ukc tbe weak rhenifh wines, and 424 the elements Part XV. drinkers and perfons in a ftate of inanition from low living, are peculiarly fubjed to it; all thefe fads fhow, how far this difeafe is from depending upon heat and moifture alone ; and that it alfo arifes from cold, and not from thefe alone, but aHb from all the ufual noxious powers, like every other afthenia; DCLXI. Further, if every kind of evacuation, as often as it has been tried, is found, without the poffi- bility of a doubt, to be hurtful; if no perfon in his fenfes has fcarcely ever attempted bleeding (y); if, be- % fore the Peruvian and fome other barks of fimilar operation were found to ad as remedies, a variety of ftrong drinks (2 were ufed with fufficient fuccefs; and if it now alfo is found and demonftrated in fad, that the diffufible ftimuli are by far more effedual than any bark ; nay, that the bark often fails, while they zxp perfedly effedual in the re-eftablifhment of health ; from thefe considerations, we derive the moft folid con- % vidion, and the weak ill managed vin de Bourdeaux, which is a cheap dirty claret, almoft never fall into the difeafe at Leyden, while the Dutch are perpetual victims to it as often as it is epidemic. fy) They have talked of taking a little blood in the fpring ia- termitients,.but that was a theory of Dr. Sydenham's, who divid- ed the difeafes of the whole year, into inflammatory and putrid ; and I do not find, that that idea has ever been followed in practice. Yor though they follow him moft fervilely in moft refpects, efpecially where he is wrong, their vanity, that they may now and then feem to ftrike out fomething from themfelves, difpofes .them to differ from him in others, efpecially where he is right, as in the rejection of purging in fome fthenic difeafes (CXXXVII). (z) As ale, wort, wine, fpirits, ftrong punch, Riverius followed this plan ; and I remember it was a cuftom among the common people to cure themfelves by getting tipfy. But I was allowed neither the one method of cure, nor the other. The authority of Dr. Siha.. and Boerhaave, had thrown the bark into difrepute in Britain : And my mother, " who trufted in God, and not ia phyficians," left me to the courfe of defires a ad averGons, which were chiefly to avpid M, and anxioufly feek for heat. She kept me upon a vegetab ' t in the intermiffions, which I evea then did not much like. was the kindly warmth of fumraer, which then fet in r .rly r had the chief eff"** ia gradu&Ap fi&ihing (hat cure. Viap. L of medicine; 4*5 Vidion, that there is nothing in this difeafe different from other afthenise, but that it perfedly agrees with them in the exciting noxious powers, in the caufe, and in the cure. And, if it differs in the appearance of the fymptoms, this indicates no difference of nature, arid not even any thing unufual ; for all the afthenize that have been mentioned, clearly as they have been proved to be the fame (a), differ notwithftanding, in a fimilar manner, from each other; and fymptoms neither «lead to truth, nor do they give any real information. For, though precifely the fame fundions flow from the fame^ftate of perfed health ; yet when the latter is changed, the excitement is either increafed or diminiih- ed, the fundions are changed from the healthy ftandard into every fort of appearance ; in fuch fort, however, that thefe changes argue no difference in the caufe, as has been commonly believed, and not always even a difference of degree in its operation (b). - DCLXIL Accordingly, the following certain fads—- that fpafm, convulfion, tremor, inflammation from weaknefs, deficiency of menftruation (c); bleeding dif- charges (d), lofs of appetite, thirft, naufea, vomiting> diarrhoea with pain, diarrhoea without pain, and all the other afthenic affedions (e), arife from one and the fame caufe, that they are removed by one and the fame operation of the remedies (f), and they do not even in the fucceflion of morbid ftates, indicate degrees of de- bility in fuch a manner, that it can be proper to eftab- lifh any arrangement upon that mark—they all ferve to confirm the obfervation juft made, and, by their analogy, (a) See par. LXXI. and the addition. LXXXI. DCXXX. (b) DIV. DVII. (c) DXLV. and the following paragraph. (d) DXLVIII. (?) CLXXVI. to CXCV. and to CXCVH. (f) CCXXII. DLVI. DLXI. DLXX I. DLXXIII. DLXXIV. to DCCL and from that to DCCIV. Look alfo carefully over the whole IVth. Chapter of the fecond part, ca 4^6 THE ELEMENtS Part IV. analogy, to de nonftrate, that fevers alfo are diftinguifh- ed by intervals of freedom from febrile ftate fometimes greater, fometimes fcarcely perceivable, in common 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 in violence, fome- times exert it more remiffly, and fometimes impercepti- bly go on almoft in a continued career (g); do they, in that refped, differ from the gout (i), which never goes on with an equal force,'but abates from time to time ; and even, when an interval of health is interpoled, re- turns with more feverity than ever? Or do they differ from afthma, or from feveral other difeafes, in all which the fame thing precifely happens ? And what is more ufual, in indigeftion, and violent vomiting (i), accom- panied fe) DCLVI. (b) When the gout in the old way, is left to patience and lannel and low diet and watery drink, it fhows both remiflions and confiderable intermiflions. I have been often mortified, at finding, in confequence of walking a little too freely, when I thought the fit was gone, a more violent return than the firft part had been ; when I had not yet attained to the full knowledge of the nature and management of chat difeafe. Which is a circum- ftance, that every podagric, who is ftill treated in the old way, can bear witnefs to. Dr. Sydenham fell a victim to bis ignorance of its nature. (/') A gentleman in Scotland came to dine with his brother, who lived with me and my family, in a houfe in the neighbour- hood of Edinburgh. He ate and drank fo fparingly, that I pre- dicted, from a knowledge I had of his manner of living, which was an excefs of temperance and abftemioufnefs to a faulty de- gree, that 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 his teftament. By a good dofe of the diffufible ftimulus, he re- moved the whole difeafe at once, and enabled him, with the ad- ditional help of fome good found port and genuine Madeira, in a few minutes to eat heartily of beef fteaks. Before his brother's arrival he had been treated in tbe ufual evacuant, and, as they call it, the antiphlogiftic way. Up»a the return of his medical friends Chap. I. « OF MEDICINE. panied with other violent fymptoms, than the interven- tion of intervals of the greateft relief ? The fame is the nature of the chin cough (k), and that of the afthenic cough (/), In fine, where is there one of all the fthenic, or all the afthenic difeafes, of which the morbid career ■continues the fame from beginning to end ? There is not one (m\ For, as life in all its ftates (n) is always in proportion to the adion of the exciting powers upon the excitability, and as both predifpofition to difeafes, and difeafes themfelves fupervene in proportion as the excitement is greater or lefs than the proper degree ; fo the friends aglifter was prefcribed, which threw him back into his: difeafe, 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. Some time after that, he performed the greateft cure, that ever happen- ed fince the firft 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 attefted by the fhip's books, for no lefs than five weeks—his name is Dr. Campbell. (/{) SeeDLXXIX. (/) And from DLXXXVIL to DXCVIL \m) All this confirms, not only the point at prefent meant to be fettled, which is that the diftinctions, that phyficians 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 refpect, they do not differ from other difeafes of the fame forn\; but it likewife adds additional weight to our fundamental propofition, that we are nothing in ourlelves, but according to the powers acting on us. Many circumftances in the courfe of difeafes, that efcape the obfervation both of patients and phyficians, are of hourly and momentary occurrence, and fufficient, when thejr importance is weighed according to the prin- ciples of this doctrine, to account for the variations in the progrefs of difeafes. We fhall, by and by, fee that the circumftance of heat, from the gratification of indulging in which the patient is not to be turned afide by any advice, is, with its confequences upon the whole fyftem, fufficient to account for the gradual con- verfion of the cold into the hot, and the hot, into the fweating, ftages. («) See par. IX, 42$ THE ELEMENT? Part IV J the courfe of difeafes follows the fame rule ; and, ac- cording to the variation of the degree of that adion, is one while increafed,. another while diminiihed, another while exhibits a ten»porary exacerbation ; juft like what happens in this fort of fevers. DCLXIII. The caufe of intermittent fevers, then, is the fame as in all aftheniae, whether febrile or not ;. but it is under fuch diredion and application to the fyfiem, that, after an interval of fome hours, all their morbid energy departs entirely, or in fome degree. The reafon is, that the exciting noxious powers are either removed in the fame proportion, or more gentle in their operation ; in on,e word, the excitement is in- creafed for the time. The variation of types is not owing to any matter, fubjed to the fame variation : For how, upon this fuppofition, could the fame cafe run through all the forms, fometimes of intermiflion, fometimes' of remiflion, and at other times nearly go on with a continued movement,'and the contrary ? Is the matter, which is fuppofed to produce any form, in order to produce another form, changed into that mat- ter, which is fuppofed neceffary to the latter (o) ? h the vapour, or, as they call it, the effluvium-,, proceed- ing from animals which is fuppofed to produce any typhus or continued fever, and, therefore, the ^Egyptian typhus, when this is changed into an intermittent or remittent nature, alfo, together with the change qf type-, changed into a marfh miafma^or impurity arifing from moraffes, which is fuppofed'to produce that form of fever ? Or rather does the matter, which at firft pro- duced each type, ftill continue the fame, and become the caufe of another form ? If any perfon fhould fix upon the latter as the true fuppofition, how fhould the fame {o) Xhe ancients fuppofed, that every type arofe from a matter fuited to prodnce jt. Now, fuppofe a quotidian type to depend upon any given matter, and a tertian upon any other, different from that ; when either type is changed into the other, are we to fuppofe that the matter is alfo changed, and fo forth of the reft ? Chapa\l - OP MEDICINE." 429 fame caufe produce different effeds ? But, if lie 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 tho$§ever changes, fo often its caufe, the matter, is alfo changed ?. It has been already proved, that rnarfh miafmata are not the caufe \p). And it fhall be by and by evinced, that the animal effluvium, or vapour arifing from the body, when affeded with a continued fever, is not : Nay, it has been proved by the moft folid arguments, that it is not any matter taken into the body, which produce* difeafe, either in this or any cafe, and that the change of excitement alone is the univerfal fource of all general difeafes (q). DCLXIV. As to the return of fits; it is not pecu- liar to to this form of fevers, to have a return of the general affedion after its temporary folution ; the fame • thing happens in the gout, as often as a return, of the difeafe fucceeds a return of health (r), and for the fame > reafon (s) :. For, as thefe difeafes are repelled by in- vigorating means, fo they are brought back by the debilitating powers, which were their firft caufe. Ac- cordingly, when the difeafe is left to itfelf, or when it is treated by a debilitattng plan of cure, it perfeveres in returning ; when it is treated with Peruvian bark, and ftill more certainly by wine and diffufible ftimuli, and when that mode of cure is perfifted in, till the ftrength is quite confirmed, it never returns. DCLXV. The tertian vernal fevers of Scotland go off, in procefs of time, without medicines,- firft in con- fequence of the heat of the bed, and then, as the fummer fets in, from bafking in the rays of the fun, and by a moderate ufe of food and ftrong drink, their duration " commonly not exceeding the fpace of three months. In {p) DCLIX. DCLX. DCLXI. (a) See the paragraphs XXII. XXHL LXIL and addition LXIX. LXX. LXXIL LXXIII. and LXXXVIII, (r) DCLVL (i) DCLVII. 43° THE ELEMENTS PartIV. 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 dif- fufible ftimuli (t). * DCLXVI. 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 mild degree of the difeafe, as cold is the moft hurtful power, its effed is gradually taken off by the agreeable heat of the bed or of the fun, and the ftrength thereby gradually drawn forth.. The heart and arteries, gradually excited by the heat, acquire vigour,, and at laft, having their perfpiratory terminations ex- cited) (t) Dr. Wainman,as it was faid before, found that to be the cafe in the fens of Lincolnfhire. From which we may learn how little dependence is to be had on the facts in medicine, as they are de- livered from defks or in books; from both which we have always, been taught to believe, that the Peruvian bark was a catholicoa 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 arid remittents of the warm countries ? And, if that medicine, with its univerfal high character,, fliall turn out next to an impofition, what are we to think of tefti- anonies in favour of any thing ? One of the ways of adminiftering. the bark is in ftrong wine or fpirit, and it can hardly be doubted,, but in that compound form it may have been of fervice.. But where fhall we find a panegyiift qn the bark, who will make any allowaace for the powerful medicine conjoined with it ? They talk of it as a vehicle, without allowing it any other credit. In, the fame manner, at all times, have many powers of great opera- tion been overlooked in the Accounts given us of remedies, and; the merit of the cure imputed to the moft inert.. I have mofi generally found an analogy betwixt the remedies, 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 among the Turks. But what analogy can be found betwixt the fame ordinary fupports of life, the fame dura- ble and natural ftimuli, 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 devoid of all virtue ; but I muft have greater proofs of its power over difeafe than I have yet met. with, before I can retract much of what I have faid* Chap.t. dfc msdictne; 4-1 cited by the fame ftimulus, the moft hurtful fymptom is thereby removed, the hot fit produced, and after- wards the fame procefs carried on to the breaking out of fweat.' DCLXVII. When the:force of the difeafe is greater, thefe powers are ineffedual ; and, unlefs. the moft effi- cacious remedies are applied, the difeafe, inftead of having inter millions, appears in the remittent ftate only, or even in thofe very obfcur^remiffions, which give the appearance, of a continued difeafe. DCLXVIII. And, fince in every cafe of confiderable violence, the difeafe returns, becaufe either the lefs force, by which it is kept up, is not ftopt by a propor- tionate force of remedies, or a greater force of difeafe by a greater force of remedies (u) ; the remedies fhould 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 fhould be continued even through this, and after it is over. Laftly, like the pradice in every other cure of afthenic difeafes, we Ihould gradually recede from the ufe of the higheft ftimuli, in proportion as the body can be fupported by the lefs and more natural (#).. Of the fevere Dyfentery. DCLXIX. The fevere dyfentery, or bloody-flux, is an afthenia; in which, befides the fymptoms in com- « mon to that whole form of difeafes, fo often repeated, there are griping pains in thcs inteftines, innumerable dejedions, chiefly mucous, fometimes bloody, for the moft part without the matter that naturally paffesthat way ; all which fymptoms often occur after contagion has been applied. Of («) For the curative force muft be always accommodated to th-5 morbific, or caufe of the difeafe. See above XCII. CIX, (x) CV. and CVII. 42Z "^'E ELEMENTS PaftW. Of the fevere Cholera. DCLXX. The fevere cholera adds to the common fymptoms of every afthenia, thofe of vomiting and purging alternately with great violence ; which dif- charges for the moft part confift of bilious matter. Of Synochus. DCLXXI. Synochus is a very mild typhus, fuch as chiefly .occurs in cold countries and cold feafons ; in the beginning deceiving phyficians by a certain but a falfe refemblance to fynocha. Of the fimple Typhus or Nervous Fevers. DCLXXII. 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. DCLXXIII. The gangrenous cynanche is a typhus, fc a little more fevere than the fimple typhus or nervous fever, with an eruption upon tbe fkin, and a red turbid inflammation of the throat, and with mucous crufts of a whitifh colour, concealing, ulcers below them. The angina, formerly mentioned (y), in its termination equals or exceeds the violence of this difeafe. Of the confluent Small-pox. DCLXXIV. The confluent fmall-pox is a typhus chiefly depending upon indired debility; It is preced- ed by a great eruption of the diftind' kind, and an , univerfal cruft: of local inflammation over the whole body ;, thefe, by their local and violent ftimulus, con- vert 0) CCXII. CCXIV. %'hMp. 1. #F MEDICINE. 43$ Vert the fthenic into the afihenic diathefis, and the in- flammatory affedion into a gangrenous one. Its cure is to be conduded upon the ftimulant or antifthenic plan, but in fuch a way, however/as is fuitable to in- dired debility. Of the peftileutial Typhus, the jail, putrid, or petechial Fever, and the Plague. DCLXXV. The peftilential typhus, or the jail, putrid, and petechial fever, is an afthenic difeafe of the higheft debility, fcarce excepting the plague itfelf; the furface of the body is firft dry, pale, hot, fhrivelled ; then, chiefly towards the end, moift, diverfified with fpots and vibices or long ftrokes like thofe laid on by a whip, and the body itfelf is wafted with Colliquative diarrhoea ; the ftomach is affeded with want of appe- tite, loathing of food, naufea, often with vomiting ; the belly is firft rather bound, and then, as it has been faid, fubjed to colliquative evacuation ; the intelledual fundion is firft impaired, then becomes incoherent, afterwards delirious, and that often in the higheft de- gree ; the fpirits are dejeded and wafted with fadnefs and melancholy ; the voluntary motions are early im- paired, and then fo deftroyed, that the patient cannot fupport himfelf in pofture in bed by his own mufcles, or prevent himfelf from flipping down, from time to time, from the upper to the lower part, while the fenfes arc either blunted, or preternaturally acute. In fine, the urine, the fasces, the breath, and all the excremen- titious difcharges, have a lingular foetid fmell. DCLXXVI. The plague begins, holds on in its courfe, and sends with fimilar fymptoms : To which, however, carbuncles, buboes, and anthraces, or fiery fores, are added. Thefe are moft frequent in the plague, but not fo confined to ir, as to be excluded from the peftilential f£ver(z). DCLXXVII. Contagious {%) CCXIX. 4° .3 434 THE ELEMENTS PartlV; DCLXXVII. Contagious matter fometimes accom- panies typhus, always the plague : The* former is of a common nature, or fuch as is liable to happen in any part of the globe; the latter is thought peculiar to the eaftern parf "of Europe, and the weftern of Afia, poffeffed by the Turks, called the Levant. DCLXXVIII. With refped to the contagious matter of typhus; the corruption of the fluids is by no means to be imputed to it (a), nor is heat fo much to be blamed ; for cold has an equal power in producing this effed as heat (b), as has alfo every thing, as well as heat, that either diredly, like cold, or indiredly like heat, debilitates (c). Nay, the emptinefs of the veffels, from want of food, or from the incapability of the di- geftive 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, ad- mit of the fame application. On account of the de- bility in the extreme veffels, internally, as well as externally, and, therefore, in thofe of the alimentary canal efpecially, and in the perfpiratory veffels, the fluids ftagnate ; and by ftagnating in the heat of the body, degenerate into that quality, which, in a more extenfive fenfe, is called corruption, bpt in a more un- certain one, putrefadion (d). DCLXXIX. The (a) See above CXV. CXXII. CCXXXVI. and the addition L \b) Ibid, and CCLX I. ;■£ \c) See again CCXXXVI. and the Iddition at I. \d) There are three ftates or qualities produced in fluids by as many different fermentations, the faccharine, acid and putrefac- tive. To one or other of thefe 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 them : And, as we are not yet acquainted with any of thefe deviations from the natural ftate, it is fafer to ufe the general term corruption. Even the word acrimony is too general, as we can by no means pretend to fay, that perfect blandnefs is tbe natural and healthy ftate of oar fluids : Nay, the different ufes and fubferviency to the functions feera to require a confiderable deviation from blandnefs; the urine, Chap. L «F MEDICINE. 435 DCLXXIX. The caufe of all thefe difeafes is the fame with that of difeafes not febrile, to wit, debility ; differing only in this, that it is the greateft debility compatible with life, and not long compatible with it. DCLXXX. The indication alfo of cure is the fame as in the other afthenia?, but it muft be conduded with a good deal more attention than is neceffary in them, upon account of their much greater mildnefs (e). It is, then, debility alone, that is to be regarded in the cure ; and ftimulant or antifthenic remedies alone, that are to be adminiftered. Nor is there occafion for any diftindion in the method of cure, but what dired or indired debility requires (f). DCLXXXI: The indiredly debilitating powers, are the violent and local ftimulus of the eruption in the confluent fmall-pox (g) fo often inducing proftration of ftrength, drunkennefs (h), heat(*), or long continued luxury (k). To thefe noxious powers, thus indiredly debilitating, all the others may more or lefs be added (/). DCLXXXII. And as it never happens, that either dired or indired debility alone proves hurtful, hence we urine, tbe perfpirable fluid, the bile, and others, being intended, by a certain poignancy, to anfwer certain purpofes. Thefe, compared to certain blander fluids, may be faid to be acrid ; while compared to themfelves in a ftate of morbid degeneracy, they may be called bland in the natural ftate, and in the latter acrid. ie) Fevers will require many more vrfits from the phyfician than are commonly either beftowed or required, and often a good deal of watching. While this is more generally the cafe in fevers, stt leaft in the high degree in which thefe fevers exift, at the fame time they are not the only ones that require fuch ftrict attention ; as every difeafe, when it has attained to the fame degree of de- bility, endangering life, will claim the fame circumfpection and vigilance from the judicious and confcientious phyfician. (f) See par. CHI. CVII. \g) See CLXXV. CCXV. CCXVL CCXVII. CCXVIII. h) CXXX. and addition. /) SeeCXV. k) See above par. CXXVII. and addition. /) Look for them in Part I. Chap. I. 43^ , **E elemekts Part IV, we have a third cafe given, where we have to combat both forts of debility (m). DCLXXXIII. The diredly debilitating powers are known y to wit, cold (*»), low diet (».), bleeding, and other (w) Suppofe any direct debility has occafioned a difeafe, whca that is eftablifhed, the excitability is fo morbidly accumulated, that the flighteft exertion of any exciting power becomes too much for it ; which immediately conftitutes an admixture of indirect debility. The ftimulus of corporeal motion, which is a great and ^ough 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 ), and impure air (q). DCLXXXIV. As both thofe fets of powers ad by debilitating ; be, a£ the fame time, on your guard againft believing, that fome of them are feptic, and prove hurtful by fermentation, and are to be cu*ed bv antifgptics, or powers that refift putrefadion ; and . that, among the former, heat is to be reckoned ; among the latter, cold, wine, the Peruvian bark, and acids (r). DCLXXXV. In the mild cafes, as in the agues of cold places, and efpecially the vernal agues (s), and likewife in fynochus* in the fimple typhus, and in the plague itfelf, when mild ; fcarce any ftronger ftimulus than, wine is required ; and the reft of the treatment is to be conduded according to the direc- tions fo often laid down for the mild afthenic difeafed DCLXXXVI. In the moft fevere fevers, fuch as the remittent, which is frequent in the warmer regions of the earth and in the torrid zone, in the fevere typhus, whea it is peftilential, in the very violent dyfentery and cholera of the fame places, and in the moft violent plague itfelf (/), the caufe of all which affedions is in general dired debility ;. or- in milder cafes of the fame difeafe at firft, and that have acquired a great deal of virulence in their progrefs from the negled of the proper, or tbe ufe- of an improper plan of cure ; we ought immediately to begin with the higheft diffufible ftimuli, fuch as opium, volatile alkali, mufk, and sether, in fmall dofes, but often repeated (u) j and afterwards, when the ftrength is reftored, and the force of the ftomach (o) CXXXIV. CXXXVIL and the addition. (/») CXXXVIL and addition, and CXXXIX. and CXLII. (q) CXLVI. Compare the whole with Part II. Chap. X. all from CCXC. to CCCXII. and from that to par. CCCXV. (r) See par. DCLXXVIII. (,) See UCLVI. DCLX. DCLXV. (0 DCLVI. DCLXVI. DCLXIX. DCLXX. (a) XLI. XLIII. CXIII. DCLXVI. to DCLXIX 43** THE ELEMENTS Part IV. ftomach confirmed by their ufe, to proceed to food, drink, geftation, pure air, cheerfulnefs, and, laft of all, to the ufual offices and occupations of life. DCL,XXXVII. When indired debility has had more concern in the cafe, as in agues, or more continu- ed fevers, occafioned by drunkennefs, and in the con- fluent fmall-pox ; the fame remedies are to be ern^loy- ed, but in an inverted proportion of dofe. We fhould, confequently, fet out here in the cure with the largeft dofes, fuch as are next in effed to that degree of ftimu- lus, which produced the difeafe (x) ; then recourfe fhould (x) 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 ftrong ftimulus, the effect of the firft night's fleep is to allow it to accumulate again : In this ftate much exercife fatigues, for want of excite- ment to enable it to be borne : Fluid nourifhment is commonly ufed, but it is not ftrong enough to wafte the redundance of exr citability, and bring the patient back to his healthy excitement, The dram drinkers know the remedy, but they know not its bounds," They have recourfe to a glafs of ftrong fpiril, and they would be right if they ftopped at one, two, or a very few, accordt ing to the quantity that their former habit may render necefTary* and take no more than what gave them an appetite for foli4 nourifhing animal food ; which, whatever the quantity that is required to produce it be, is the beft general rule : But they go on, and every day till that of their death, which foon arrives, re- new 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, more ftrength will,be acquired in proportion as a greater number of ftimuli have wafted more excitability, and with more equality. A fecond day's management, by applying the ftimuli in a ftill lefs degree, will commonly remove all the complaints. When an habit of hard drinking has brought on, as it always will fooner or later, a very bad and confirmed difeafe ; if the excita- bility is nearly worn out,, and what remains is very unequal, as having been produced chiefly by an alternation betwixt one ftimu- lus acting with partial excefs and fleep, either imperfectly remov- ing the excefs, or by its length fuperadding direct to the indirect debility, which the drink occafions ; the patient fhould have a fomewhat Caap. i. OF MEDICINE; 439 fhould be had to lefs ftimuli, and a greater number of them, till, as was faid juft now (y), the ftrength can be fupported by the accuftomary and natural ftimuli (z i. DCLXXXVIII. To give fome eftimate of the dofe in both cafes (a) ; in dired debility, where the redun- dancy of excitability does not admit of much ffimulus at a time (a), ten or twelve drops of laudanum every quarter fomewhat lefs quantity, than that which at any time hurts him j then the next day ftill lefs j and fo on, till very little will ferve him ; and he fhould add all the other ftimuli in proportion as he diminifhes the morbid one. * iy) DCLXXXVI. (z) CCCVIII. to CCCXII. (*) DCLXXXI. and DCLXXXII. (y very flight ftimuli. At other times ir- ritating powers, in the fame weakened ftate, dc? jeeur ; {;»'• as thofe mentioned in the text. %hap. HI. OF MEDICINE.' 457 as diftention exciting fpafm, or a concentrated aeid in- ducing convurfion, or the pain of a wound, produces general commotion (#), and effeds enormous motions in the weakened fyftem. But, whether the debility be independent of ftimulus, or excited by it, there is never occafion for debilitating evacuant remedies, but always for moderately ftimulant 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. DCCXXXVIII. As, therefore, the antifthenic plan of cure is not to be pradifed, from an apprehenfion of a fever being about to come on, and with a view to allay the difturbance arifing from it; for it has the contrary tendency, that of inducing fever, and of ex- citing the difturbance apprehended ; fo, neither is the ftimulant plan to be attempted, till the wound is heal- ed, or the difeafe has arrived at an advanced ftage, and a great deal of debility is induced by the continuance of the pain, left, if that method fhould be fooner em- ployed, the blood fhould be carried with more rapidity than the cafe would admit of, and with an increafed momentum, into the ftill open terminations of the veffcls : For it is underftood, that neither diathefis takes place in this cafe, and that the only affedion prefent is a commotion over the fyftem, depending upon local affedion ; and that, confequently, there is no occafion for the remedies of either; excepting upon this fingle confideration, that, as the lofs of blood, in proportion to its degree, has a tendency to produce more (x) But even in that cafe, the real ftate is debility, and the in- dication of cure is to remove it, as well as the irritating powers: Which, while they increafe it, are at the fame time its offspring, and require ftimulants to enable the fyftem \» refift the effect. (DCXCIIL) K3 45$ TftE elements Part V. more or lefs of afthenic diathefis; there will, therefore; in that proportion-, be occafion for fome fthenic reme- dies. DCCXXXDC. Curing the firft days of the difeafe, becaufe the patient, all at once, ceafes from geftation, exercife, and the other fundions both of body and mind, and of pafliOn or emotion^ to which he has been accuftbmedj and, of courfe, lefs nourifhment and re- cruit is now required ; there fhould be fuch an abate- ment in his allowance of the ufual ftimuli, as to ac- commodate what is ufed to the prefent condition of the fyftem and the ftate of tbe wound juft defcribed^). Therefore, to prevent too great an impetus in the veflels', filence mould be kept around the patient, he fhould not fpeak himfelf, he fhould lie quiet» and his pofture fhould not be changed but to avoid the difa- greeable feeling of too long continuance in it, and even then it fhould be done as warily as poffible. He ihould make his.water lying, in an urinal; he fhould rather life foups, than folid meat ; his wound fhould be ex- amined every day, for the fake of keeping it clean ; its progrefs fhould be obferved ; it fhould be drefled with frefh, foft, and bland matter ;-and if, even at this early period, any faintifhnefs appears, a glafs of wine fhould not be withheld. •DCCXL. After fome days, which may be more, of fewer, according to the ftrength of the patient, when the habit is falling into debility, from the feverity or long continuance of the pain ; befides the foups for- merly allowed, meat as rich and delicate as poffible mould be given ; wine fhould be adminiftered a little at a time, but often, and upon the whole in large quantity j and then, at laft, recourfe fhould be had to opium, which, in the common pradice, is ufually given from the beginning of the difeafe, ancj to the other diffufible ftimuli; and the difeafe fhould be treated precifely in the fame way as a typhus. DCCXLI. When (j) See laft paragraph. i CMap. IV. ' OF MEpICINE. 459 DCCXLI. When very tender external parts are violated by any rude, matter, as where a them is pufhed under any of the nails,, and an inflammation fpreads from the affeded part to a confiderable extent, and then, upon account of the great fenfibility of the part, the whole body is drawn, into, confent ; the injured part fliould be fomented with warm water, and drefled with lint, and foft and bland ointment : And as long as the difturbance of the fyftem remains, the patient fhould be kept quiet, and free from motion, and nothing more attempted. J-.....- ' -,',i ,■'.'" " •■ ■ ■■ .■",<::• 2 ";.'^.'..^ii>'- CHAP. IV., Of a Part of a general Difeafe degenerating into a Local. DCCXLII. TO fet about the treatment of that divifion of local, organic difeafes ; in which a part, or fymptom, of general difeafe degenerates into a local one •* we next proceed to, Suppuration. DCCXLIII. Suppuration, with which we begin, is for the moft part a confequence of general inflamma- tion, whether fthenic, or afthenic, or of that inflam- mation, which is a.fymptom of general difeafes, or it is a confequence of local inflammation, whether fthenic, or afthenic. During fuppuration, the pulfe is fofter, fuller, and a little flower, than in fthenic difeafe, when that precedes it; but a greatdeal flower than in afthenic difeafe, if this happen to,, intervene ;.and it is accom- panied with an undulatory, and, as it were, a pulfatory, motion of the affeded part.; thefe fymptoms are com- monly preceded by a fhivering : Jf the affedion is in- ternal, the patient fhould be kept quiet, and free from motion, 460 THE ELEMENTS Part Y. motion, and be ftimulated ■* if it be external, the af- feded part fhould, over and above, be fomented, dreflfed, and covered, and the pus, when ripe, let out. Of Puftule. DCCXLIV. A puftule is a purulent veficle, gradu- ally growing turgid, and at laft of its own accord opening in confequence of having become foft and full of pus. DCCXLV. It follows the fmalLpox, arifing from the contagion peculiar to that difeafe : In the fmall- pox the number of the puftules is greater or lefs, as more or lefs fthenic diathefis, occafioned by improper treatment, or a negled of the proper, has preceded (a). DCCXLVI. The indication of cure is, firft to re- move fthenic diathefis, and then, if that has paflfed into the afthenic, to remove it, each by its refpedive reme- dies ; and to befprinkle the puftules with 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.. DCC2JLVH. Anthrax is a glandular tumour under the fkin, gangrenous at the top, and inflamed at its edges all round. Of Bubo, DCCXLVHI. Bubp is a glandular tumour, efpecial- ly affeding the groin y it has a tendency to fuppura- tion. DCCXLIX. Thefe two affedions, the anthrax and bubo, as well as carbuncle, are almoft always combined with a general difeafe, to wit, fometimes with typhus, much (c) XXL LXXVI. XCVI. XCVII. XCVIII. Chap* IV. ©y medictn*. 461 much oftener with the plague. They depend upon a contagious matter, and, in fo far as they do not fuf- ficiently yield to the general remedies, they muft be treated with a very ftrong fpirit poured upon them, with laudanum, and the lancet. Of Gangrene. DCCL. Gangrene is an imperfed inflammation of a part, not terminating in fuppuration, difcoloured, fcarce painful, confifting of puftules of a bad matter, and at laft inducing the death of the part. DCCLL The noxious power, that precedes gan- grene, is often inflammation, often ultimately violent in a fenfible part, oftener languid, and occupying a part lefs fenfible or lefs fupported by the powers of life (b) ; it is fometimes a fymptom of the phlegmafise, fome- times of fevers, fometimes of local phlegmone (c). DCCLII. The method of cure, when the gangrene is feated in the alimentary canal, is to pour in fpirit and laudanum ; when the vifcera fecluded from the air are affeded, to place fome, but much lefs hope, in thefe and other ftimuli. And, as the fame remedies alfo fuit gangrene, when it is external, confequently liquid opium fhould be rubbed in upon the dying part, fpirits fhould be poured upon it, the parts already dead mould be cut out, the edge of the living part all round Ihould be ftimulated, and an inflammation excited in it. Of Sphacelus. DCCLI1I. Sphacelus is a more perfed and more extended gangrene, with an extindion of fenfe, motion, ajid heat ; in which the part becomes foft, blackifh, completely (b) The inflammation, out of which gangrene arifes, is always unfupported, and the gangrene always a ftate of either direct or indirect debility ; the hightxeitement in the phlegmafise, and the low in fevers, caufing that. (t) CCCXLVII. DCLVIL to DCXCIV, 462 THE ELEMENTS BartV* completely black, and at laft thoroughly putrid to the very bone, thoroughly cadaverous, and ftufta rapidly ta the neighbouring parts, and quickly extinguifhes life. DCCLIV. The remedies are in general the fame as in gangrene, but they fhould be ftronger, and adminik tered in greater quantity, and with'greater nicety, and in lefs expedation of a cure. When any limb is greatly affeded, it fhould be immediately cut off, to prevent the found parts from being infeded.. Of Scrofulous Tumour and Ulcer. DCG^V. When a fcrofulous tumour and ulcer-basr been of long Handing, has disfigured the parotid gland and neighbouring parts, and all the remedies, that have any effed in removing fcrofula, have been employed ; no more is to be done, but to. keep the ailing part clean, foment it often, and defend it from the injury of, the air ; unlefs, as local, debility alfo. takes place here, fpirit and laudanum, applied to the part, may be of, fervice. Of Scirrhous Tumour. DCCLVI. When the tumour, which, while it waf»; moderate, was a part or fymptom of the general difeafe, called fcirrhus, has now attained a certain bulk ; if it be external, or fituatcd in the exterior or convex part of the liver, it fhould be cut off, and the fyftem.. invigorated: If it be internal, nothing can be attempt- ed, but to prevent its increafe by ftimulant remedies, and in that way keep the patient as long alive as pofli-. ? ble, and in as good health as his circumftances will. . admit. DCCLVII. The two heads of divifion that remain. [d) are of fo obfeure and abftrad a nature, that, if ever they are to be attempted, they muft be paffed over at prefent id) DCXCVIII. and DCXCIX. Chap. IV. *£ MEDICINE. 463 prefent. The third head [e) is here only imperfedly fetched and fcarce begun : But, becaufe it both ad- mits of a complete execution, and, when fo executed, will make an important addition to the work ; it fhall be prepared for the public perufal, as foon as I fhall be ■happy enough to find as much leifure and fcope for thinking as are requifite to refcue the fubjed from its prefent intricacy, diforder, and obfcurity. ■//'"', (0 DCXCVII. DCCXLII. to DCCLVIL INDEX, XfThe figures refer to the paragraphs, except when contained in a parenthefis, then they refer to a §ec7ion of the paragraph preceding the parenthefis ; 'when roman numerals are employed, they refer to the pages of the author's preface."} A A. Appetite, caufe of, 186. BORTION, 729—732. Apyrexiae, fthenic, 425—446. Abftinence, not lefs immoral Afthenia, meaning of, 66. and irreligious than excefs, 128 Aftheiiic diathefis, caufe of, 149. iig)noteo. .....cureof,25i— AbftracT: caufes, cautions againft 280. reafoning on, 229 notes a,b. ----- may be con* Acid in the alimentary canal Verted into fthenic, 71 (13)' fymptom, not caufe of difeafe,.....predifpofition 192. to, 176, 177. Acrimony, in what fenfe may.....fymptoms ot, be admitted, 678 note d. 178—236. Agents, external, what, 11. Afthenic difeafes, 503—694. Agriculture, hints respecting, - - - - - cure, 680 323, and note. 693. ... - what fliould be fo - - - plan of cure, different termed, 2. parts of, compared, 290—303. Air, atmofpheric, if too pure Afthma, advantages of a full would be perhaps injurious,^. diet in, ix. - - impure, produces afthenic - - - gentle, 6io, 611. diathefis, 146. Author's inducements to tranf- b - inimical to living folids, late his own work, xiii. »02. - - - ftudies, progrefs of the, - - ftimulus of, necefTary to vii. convalefcents, 310, 311. B. Aitiology, abfurdity of, 78. Bark, Peruvian, not to be de- Anafarca, 614, 615. pended on in intermittents, 665 Angina, putrid, defcribed, 212. note t. Anthrax, 747. Bathing, cold, remarks on, 37, Antifeptics, notion of, to be ib. n«te h, 39, 122. guarded againft, 684. Bladder, inflammation of. See Apoplexy, 643, 648. Cyftitis. - - - not owing to plethora, Bleeding, cautions againft, 183 641,642. ^£,490,728. L 3 Bleeding, INDEX. Bleemrrg, remSrfcs on, 454,470 —472. - - fhould always be fol- lowed by other evacuations, 472. - - - lingular inftance of benefit from in typhus, 206 mte g. - - - when neceffary, 269, ■278, 281. Bmters, in what cafes ufeful, "480. Blood, great and continued dif- charges of, depend on debility, 232. - - - extent of the ftimulus of, 272 note i. - - - irritates by its quantity, not quality, 13^ - - - flight difcharges of, from indirect debility approaching, 231. - - - veffeh, ufually more nu- merous in moft fenfible organs, 364 note s. Brain, not inflamed in phrenitis, or at the end of typhus, r. 172. Breathing, difficulty of, to what owing, 354. Bubo, 748,749; C. Calcutta, death in the black hole at, occafioned by typhus, 146. Canal, alimentary, afthenic dif- eafes of, 556—567. Carditis, 348—36*. Catarrh defcribed, 407—411. - - - method of cure of, 481 —483, 486-490. - - - produced by heat, and removed by cold, xii. 257. Caufes, inquiry into, to be avoid- ed, 18. Changes to be brought about gradually in certain cafes, 43. Children, difeafei«f,568—57 J. .....generally ow- ing to debility, x. 401. This a dangerous miftake, x,note c. • - - figns of afthenic diathe- fis in, 403. .....fthenic diathefis, 402. Chincough, 598. Cholera, gentle, 576. - - - fevere, 670. Circulation, how carried on, 131 note r. Cold, effects of, 37, (8) 117, 121, 122, 257—9. - - how diminution of fculk in animals produced by, 121. * - remarks on, as a remedy, 282, 463—467. * - - fucceeding to heat, bad fymptom, 223. Colic, obfervations on, 195 notes n. 0. - - with pain, 616. - - - - cure of 621,622. Colicanodyne, 565, 566. Colliquative fweats, &c. caufe of, r 15. Coma, caufes 258 (M) note c - - - remarks otl, 24*7. Conftitutions of individuals not fundamentally, different, 244 note I. Contagions act by ftimulus, 21. -. - - produce a fermenta- tion, 368,375. This a miftake, 368 note u. t - - - remarks on, 76, 146, (29) 219, 279, (38) 368— 373,692. Contraction and its effects con** fidered, 57—61. Contufions, cure of, 705. Convalefcent ftate, remarks on, 3I1, Convulfions, obfervations on, Corruption I N D Corruption of the fluids, 115, 118, 678. Cough, afthenic, 234,588—597. - - - in peripneumony, how occafioned, 355. - fthenic, 160—163, 233, 407—411. Cramp, 612, 613. "Croup, remarks on, 400,401, 406. Cupping-glaffes, whea may be ferviceable, 480. Cure, general indication of, 88 — no. - - means of, cautions refpect- iog, 92, 100. Cuticle, not a living fubftance, 702. Cynanche, gangrenofa, 212, 214,673. - - - fthenic, 395—398. cure of, 481, 482, 486, 487. Cyftirrhcea, 599. Cyftitis, remarks on, 493, 719. D. Darknefs debilitates, 321. Day, alternation of with night, end of, ibid. Death, how brought about, via. i3> 29» 3°»4°' - - effected by the powers which produce life, 327. Debilitating powers, in what cafes to be ufed, 106. Debility, direct, 38, 45. . - - - cure of, 107 — 109. - - leffening ftimu- lus in cafes of, carefully to be avoided, 46. - who fubjects of, 101. - . indirect, ix. 23. . . - cure of, 103— io6. E X. Debility, indirect, how ptogrefs to, to be retarded, 36, 37. - - * • who fubject to, 102. Debility, one kind of, never to be cured by the other, 47,106. Delirium produced by deficient ftimulus, 183, 201. - - fuperabundant ftimulus, 158. Diabetes gentle, 514, 515. Diagnofis, general, 82—85. Diarrhoea, 564. Diet. See Food. Difeafes, afthenic, enumeration of, 505. general re- marks OR, 62—72, 503—507. - - - method of cur- ing, 680—693. ^ - - caufe of, ix, 66, 149. - - - general and local mark of diftinction between, 6, 80. - - - • how to diftin- guifh, 82—85. - - how produced, 81 note b. general principles and method of cure of, xii, 23, 62 — 68, 88—110. . - - local, 695—756. - - - - caufes of, 8r. - - - - in what way cur. ed, 702—706. - - - fthenic, enumeration of, 347- - - - - method of cure of, 453-5<>2. - - - - remarks on, 66, 328—347. Drink, abftinence from, recom- mended, 104 note i. - - cautions refpecting, 130, 687 note x. - - may be given freely in fthenic difeafes, 166. Dropfy, 626—632. Dyfentery, INDEX. Pyfentery, gentle, 576. - s- - fevere, 669* Pyfpepfanodyne, 563. Dyfpepfia, effect, of debility, x. Pyfpepfodynia, 617, 620. - - - - cure of, 621,622. E. be taken off gradually, 43,44; Excitability, wafte of, how r;- paired, 32—34. - . . . what, or how af- fected, unknown, 18. - -. - - when wafted by one^ ftimulus, may be" acted upon by another, 31, 309. Earth, frefh, cap of, ufeful in Excitement defined, 16. phrenitis, 480. Enteritis, cure of, 718. - - - defcription of, 713 — 716. - - - remarks on, 493. Epilepfy, cafe of,converted into dropfy by bleeding, 228 nete%. - - - defcription of, 633— 635» effects of, 60,62—67. - higheft degree of, how produced, 25. - - lofs of, from over ac- tion, how to be repaired, 34. may become, irreparable, 42. -. - proportioned to der gree of ftimulus, 23. - owing to debility, 200. Exciting powers adt more on, - treatment 0^636,637. fome parts than others, 49 — 53,(11)696. # *' - - univerfally^ 481. - - . - effects of, 15. - - - what implied, by, 11 —14. Excretions, caufe of temporary retention of, 338. Exercife, obfervations on, 137, (25) and note d, 285 note b, 303j 310. Epiftaxis, 552 Eruptions, caufe of^ in difeafest .219, 220. - " - - fcabby, 512, 513; Eryfipelas, mild, defcribed, 392, 323.- - - - - - method of cur- ing, 481.. - - - violent, 38^—386, - - - - cure of, 454— 480. Exanthemata, fthenic, 332,374 Expeaoration .natural tendency -386. - explained, 366—373, Excitability, 14. . .-- boundaries of, 27, 28. - -effects of the ex- hauftion of, 29, 30, ^$. . . . . general, not partial, 48, 232 note /. - - - - how* increafed or diminiftied, 24. - - - feat and effects of, 48—56; - - - . fuperabundant, to to, great, 589 note e. of pus, not always' owing to organic lefion, 592—- 594- F. Fermentations, remarks on, 368, 375* 678 note d. Fever, bathing the body with cold water ferviceable in cer- tain ftates of, 122 note h. - - intermittent, 656—668. - - jail, putrid, or petechial, 675—693. - - nervous, 672. Fever, INDEX. Fever, requires more attenion from phyficians than uftially beftowed, 680 note e. - - yellow, purging neceffary in, 137 (26) note a. Fifti, not a nourifhing food, ix. Fluids, how produced, 62 (12), Food, remarks on, yiii, ix, 124, 127 — 128 (19). .....as a remedy, 284, 290, 302, 303,462. - - fliould be ftimulant to a certain degree, 127—129. - - vegetable, debilitating, 128. Force, what, 57. Foffi)s, perhaps not without life? 326. Fundions acting on the living animal, 12. . - - may be impaired by fthenic diathefis, 227. „ . - - - increafed by af- thenia, 228. a Gangrene defcribed, 750 — 752. - - - to prevent, 23 2 notem, 289. Gaftritis, 708 —711. . - - cure of, 81 note d, 712. . - - remarks on, 80, 345, note r, 493. Gentoos, imbecility of, owing to diet, 128. Geftation,remarks on, 137 (27) and note d, 303, 310 Globe, great changes of the, 326. Gout brought on by low liv- ing, vii. . -.cured by ftimuli,ix, x, 213. . . >not hereditary, 603. - - of ftronger perfons, 601— 609. .. ofweakperfons,6i6—622. H. Habits, effects of, to be con- fidered, 609 note z. Haemorrhages always owing to debility, 134, (22) (24) 232. - - - - blood deficient in cafes of, xi, 132 note i. - - - - ftimuli falutary in, xi, 232 and note i. Haemorrhois, SS3~55S- Health and difeafe not different ftates, 65. - - good and ill, defined, 3, "4, 6a: Heart, inflammation of. See Carditis. Heat, a remedy of afthenic dia- thefis, 291. - - acts more externally than internally, 337, 338 note x- - - exceffive, cautions againft application of, 292. - - unufual, caufe of, 340. . - - - fymptoms of dif- eafe or predifpofition, 221. Hepatitis,remarks 011,493, 719. Hereditary difeafes do not ex- ift, 603, 603 (46). Hypochondriafis, 623—625. - . . - - curious cafe of, 625 note I. Hyfteria, gentle, 581—583. - - - violent, 618. ----- cure of, 621, 62a. Hyfteritis, remarks on, 493, 726—729. T. Identity of effect proceeds from identity of caufe, 20. Imbecility,^mental and corpo- real, induced by food in fuffici- ently ftimulating, 128. Inflammation, afthenic, 202— •208. .......cure of, 209, 210. - - - - attacking the braia at the end of typhus doubted, Inflammation i n r Inflammation attacking the brain in phrenitis, not proba- ble, 172. - - - - Boerhaave's opini- on of the tranflation of, from one vifcus to another, errone- ous, 351 note e. - - - - changes its feat fometimes, 352. - - - - diftinction of, into parenchymatofe and membra- nous In phlegmafise, exploded, 351. - - - - eryfipelatous, feat of, 168 note g. - - - - four kinds of, 206. - - - . in general difeafes always external, 157,168,172J - local, 171, 206, 707, &c. not the caufe, but effeit of difeafe, xi, 169, 343. - of the throat, 212 —214. produced by debili- ty in various difeafes, ix. rheumatic, feat of, 168 note g. fthenic, caufes of, £07. cure of, 209, Influenza, a fthenic difeafe, 233. Intellectual functions,failure of, owing to debility, 202. Intermiflions, not peculiar to fever, 664. Inteftines, inflammation of. See Enteritis. Irritation, not owing to extra- neous matter, 241. Joints, fmaller, affected ia gout, greater in rheumatifm, & why, 391. K. Kidney, inflammation of. See Nephritis. E X. L. Labour, difficult, 733, 734. Laflkude, caufe of, 336. Leannefs, 508, 509. Leeches, in what cafes may be applied, 480. Life defined, 10. - - different periods of, differ- ent excitability in, requiring different degrees of ftimuli,25, 26. - • not a natural but a forced ftate, 72. - - powers fupporting, differ • nor. from thofe which bring. death, 327. have not. various qualities, 315—327. Light, a ftimulus, 321. Liver, inflammation of. See Hepatitis. Lockjaw, 649—65x. Lungs, not always affected in confirmed confumptions, 236 note r, 594. - - tubercles in, fymptoms not caufe of difeafe, 236 note r. M. Mania, 426—431. - - cure of, 496. - - fometimes arifes from fault of the fubftance of the brain, 427. •Mathematicians, pedantry of, 312 note p. Matter, morbific, remarks on, 96, 97. Meafles, antiphlogiftic plan ufe- ful in, xii, 233. - - mild,defcribed, 422,424. - • no danger of linking in by cold, 466. - - violent, 377—381. cure of, 45 3 - 480. Medicine, fcience of, what, 1. Menorrhcea, 548—551. Menftruation, caufe of, 523— Menftruation- I N D Menftruation impaired, 520, k 5M—S47- I ' retarded, 519, 54s — 54?. - - fuppreffed, 521,^41 -547- . r Mind, exercife of, to a certain degree,neceffary to health, 139. Moifture increafes the hurtful effect of temperature, 123. Mortality, caufes of, 70—71 (S3). -i Motion, inability to perform, may riot proceed from debili- t ty, 69 note a, 229. Motions, involuntary, 151 note b. voluntary, ibid. N. Nature, healing powers of, non- ^ exiftent, 95, 706. Nephritis, remarks on, 493, 719, 723. Night, alternation of with day, ;. how ufeful, 321. §. . Nitre, not fo refrigerant as com- » monly fuppofed, 480. f\t Nofologifts, common errors of, £• 367 note t. I' Nouriftiment, folids not always fe'. neceffary to, 268. Wt - - See Food. * O. i Oaks perhaps might be planted in parts of Scotland with ad- * vantage, 323 note i & Obefity, 438-446. - - cure of, 498—502. Opium, an excellent ftimulus, xi, 126 (16). - - cold to be avoided during the operation of, 130 (20). - ■- in what dofes to be given in different cafes,683,689,691. - - large dofe of given >n epi- lepfy, 637 note u. E X. Opium prevents mortification, 232 note m. - - fedative quality attribut- ed to, falfe notion, 230, 232 note m, 246. - - under what cirqumftances fleep produced by, 30,^41, 343 — 246. P. Pain, caufes of, 189—194. - - occafioned by emptinefs as well as fulnefs, 182. Palfy, 638—642, 645—648. Part moft affected, in general difeafe, n 343- Paffions, cautions on exciting, 43, 140, 141, 2;8, 303. or emotions, ftrongly influence our activity, 138note e. fometimes neceffary to be excited, 277,279, 311. termed oppofite, differ not in nature but degree, 21 (7) i4»-. violent, produce difeafe and death, 140, 141. Peripneumony, 348—360. cure of, 81 note d. 453, 480. difference in fymp- toms of, not owing to the feat, but degree of the difeafe, 174. not a merely local difeafe, co note d. fpurious, cure of, 196. Peritonitis, remarks on, 719. Perfpiration diminiftied, caufe of, 59-61, 113, 114, 337. more difficulty brought on in fthenia than the other excretions, 338. produced by cold, 259; by extreme heat, i N D E X. heat, in fome cafes, but not in all, 115, 116. Perfpiration to be kept up in dif- eafes, and by what means, 98. Phlegmafia:, local, cure of, 704 —706. -~ - fymptoms of, 33a —347* Phrenitis, 361 — 365. cure of; 453—480. inflammation of brain in, not probable, 172. Phyfician does not beftow fuffi- cient attention to patients in fever, 680 note e. - - province of the, 7. Plague, 676—693; Plethora, error of the fchobls refpecting, 131 note s. — - what, 131 and note r. Pleurify, the fame with perip- neumony, 348. Poifons produce local difeafe, 77- - - remarks on, 19, 20,146 (29). ' Poor* difeafes of,owing to want of ftimulating food, 128. Predifpofition, a criterion be- twixt local and general difeafe, 80. *• - - differs from difeafe only in degree, 78. - - knowledge of, im- portant, 79. - - neceffarily precedes general difeafe, 75—77. remarkson, 73—81. - . to difeafe defined, 8, 73- „ Prognofis, general, 86, 87. Pulfe, celerity of, owing to de- bility, 179—181, 738. - - obfervations on the, 333 Purging remedies confidered, 283, 459, 460. Puftules produced by contagion, *7S- Puftules, remarks oh, 744— 74^« Pyrexia, 68, 332, 347. - - fcarlet, 413—416. - - cure of, 481—502. - - fymptomatic, 346, 371. R. Remedies, a fingle one never to be trufted to in violent difeafes, 92. general 8c local, what j 93>94- ■* *"- remarks on the varia- tion of 304—31 r. - - feveral in a moderate degree to be preferred to few in excefs, 258 notcc, 280, 286; uniform in their action, 312—314- Reft neceffary in fthenic diathe- fis, 285. Rheumatalgia, 584—587. Rheumatic inflammation can- riot be transferred to the ftom- ach, 172 note n. - - - feat of; 168 noteg. Rheumatifm defcribed, 38;— 391. method of curing* 484—487. Rickets,'516—518. S. Sauntering produces languor, \tf i%l) note d. Scarlet fever. See Pyrexia, fcarlet. Scirrhous tumour, 756. Scrofulous tumour and ulcer, 7Sv Ssurvy, 577—580. - - not cured by vegetables, &c. 580. Sedative powers are but lefirde- grees of ftimuli, 21(7) - do not, as fuch, exift in nature, 230. Cenfatioa, JL> J-* «/»w Senfation, not different in dif- ferent parts of its feat, 48. - - - painful and pleafura- ble, remarks on, 122 note h, 489 notef. Senfes, exercife of, remarks on the, 143, 144. , Shivering and fenfe of cold, caufe of, 336. Skin, drynefs of, how occafion- ed, 337. Sleep confidered, 237—250. - - morbid, how produced, 238 (33)—(34)- - - of convajefcents to be at- tended to, 303. - - owing to a ftimulant, not fedative power, 243. - - remarks on producing, 244. Small-pox, confluent, 215—213, 674. - - ... a difeafe of debility, 215. - - - diftinct, fthenic difeafe, 76 note a, 215. - - - mild, 417—421. - - - - cureof,48i—502. - - - rare cafe of, 220. - - - remarks on the debili- tating plan in, ibid. - - - violent, 374—376. . _ - - cure of, 453— 467. Solids, formation and preferva- tion of, 62 (12). Spafmodic difeafes, cautions a- gainft evacuants in, x. 195. ... owing to de- bility, x. 57, 58» 189-194 Specifics, idea of, an error,.244 note /. . - - pointed at, 631. Sphacelus, 753, 754- Splenitis, remarks 0^719,722. Sprains, cure of, 7°5- Sthenia, meaning of, 66. M3 Sthenic diathefis, caufe of, 148. - cure of, 251— 280. - - - - effect of, 69. - may be convert- ed into fthenic, 71 (14). fymptomatic, 371- * r - fymptoms of, *53—«7S (2<5)»33l- - fymptoms of predifpofition to, 151. plan of cure, different parts of, compared, 281—289 (42). - . Stimuli, cautions on the appli- cation of, 43, 44, 103—105, 290. - - deficiencies'of fome may be fupplied by others, 41. - diffufible cautions on the ufe of, 126 (17), 272 note m. properties of, 127 (18). fcale of, 127(10), 300, 301. - - durable, 302, 308, 314. - effects of may be leffened by mixture* 21 (6) note d. - - general, affect moft the part co which applied, 49. - hurtful effect of, how to cure, 105. - - indirect, 127: - local and univerfal, de- fined, 17 (2), (3).* - - proper in a ftate of health, 124—126. - - fum of the action of, ' compofed of power multiplied by continuance, 29. - what degreeof neceffary in various cafes, 295—299, 688-691. Stomach, moft affected by in- ternal remedies, *i 67. Stomach, INI S'tomaeh, inflammation of. See Gaftritis. Studies, the author's, progrefs of, vii. Suppuration, 743. Sweating, utility of, as a reme- dy, 283, 469, 474—478. Swinging, remarks on, 137 (27) note d. Symptoms, apparently very^dif- ferent, arife from the fame difeafe, and vice verfa, 234. - - deceitful, 71 (14). Synocha, fimple, 412. cure of, 481 —502. Synochus, 671. Syftem, no power inherent in, productive of difeafe, 147. Syftems, old, exploded, and a new one eftablifhed, 149. T. Tabes, 570—575. Temperaments of every indi- vidual the fame, 244 note I. Temperature, due return of, beft fign of returning health, 221. Tetanus, defcription of, 288 note x, 652—6£^. Thinking has great influence on our activity, 138. - - - ftraining in, may prove hurtful, 138, 139. Thirft, afthenic,- 556—563. - - caufes of, 159, 184, 185, 34»- - - not always to be allayed by the fame means, 109. Typhus, occafioned by impure air,remarkable inftance 01,146. E X. Typhus, peftilential,675—693". fimple, 672. U. Urine, rednefs of, how produ- ced, 339. V, Vegetables fuoject to the fame laws as animals, io, 317, 322 —326. Veflels, contracted in ftate of ftrength, enlarged in ftate of weaknefs, 61. Vigour, abatement of, not al- ways owing to debility, 2291 note c. Vomiting, caufe of, 166, 188.: - - - confidered as a reme- dy, 283, 460 (44), 472, 473. W. Watehing, caufes of, 239—240; - - - morbid, 239 (36), 240, 432—437, cure of, 494. -498. - - - owing to over-fatigue, inftance of, 240 note e. • - - reftlefs, or afthenic^ 510,511. . Womb, inflammation of. . Sec Hyfteritis. Worms, 569, 571—575. Wounds, deep-feated, or gun- fhot, 735—740. - - - irritating fufceptibla parts, 741. - - - neceffity of keeping air from, 702. j FINIS. tiSft W':$p*f*YS' t-"^.; «/-:^. ?.VLV;<&:». w.&M *-:*? 1 4 r1 *«J!. ' ^ f. *■„■•* '-■ I 1-- ■•»'■'■ »•' ■■#.'*..!■•