UNITED STATES OF AMERICA
^    --^—•—_.  ^-
FOUNDED  1836
WAS  HINGTON, D.C. 
 
 
                 THE

   ELEMENTS OF MEDICINE;

                  on,
          A TRANSLATION
                OF THE

ELEMENTA MEDICINE BRUNONIS.
              WITH LARGE
  NOTES, ILLUSTRATIONS, AND  COMMENTS.
    BY THE AUTHOR OF THE ORIGINAL WORK.
        with OBSERVATIONS on the
 CHARACTER AND WRITINGS OF THE AUTHOR,
       BY THOMAS BEDDOES, M. D.
A NEW EDITION.
           PHILADELPHIA:
          PRINTED BT A. BARTRAM,
FOR THOMAS D0BS0N, AT THE STONE HOUSE, NO. 41 SOUTH
             SECOND STREET.
1806. 
y/  j       *    *
^\ 
      PREFACE

                    TO tHE

ORIGINAL     WORK.
X>Y the Author of this work more than twenty  years
were  wafted in learning, teaching, and  diligently fcruti-
nizing every part of medicine. The firft five pafled away in
hearing others, ftudying what he had heard, implicitly be-
lieving it, and entering upon the pofTeflion as a rich and va-
luable inheritance.  His  mode of employment the next five
years, was to explain more clearly the' feyeral particulars,
to refine  and give them a nicer polifli.   During the next
equal fpace of time, becaufe no part of it  had fucceeded to
his mind, he became cold upon  the fubjecl,  and with ma-
ny eminent men, even with the vulgar themfelves, to de-
plore  the healing art as altogether uncertain and incompre-
heniible.   AH this timepajfed away without the acquifttion of
any advantage, and of that, which of all things is the moil:
agreeable to the mind, the light of truth ; and fo great, fo
precious, a portion of the fading and fhort-lived age of man
was loft.   It was only betwixt the fifteenth and twentieth
year of hisfiudies, that, like a traveller in  an unknown
country,  wandering in the (hade of night, after lofing eve-
ry trace of his road, a very obfcure gleam of light,  like
that of the firft break of day, dawned upon him.
                         A 2                 Thirteen
V2-&/?y 
 IV         PREFACE   TO   THE
   Thirteen years ago (a), when he was going in the thirty
 fixth year of his age, he fell into his firft fit of the gout.
 For many years before he had lived well, with the excep-
 tion of having confined himfelf to a diet more fparing than
 ufual a few months before the arrival of the difeafe (b).   In
 about fix weeks the difeafe finifhed its courfe, and did not
 return till fix years after, and not even then, but in confe-
 quence of unufual low living for feveral months (d).  He
 was in the vigour of his age, and, excepting the taint of the
 gout,  and fome debility, brought on by his unufual abfti-
 nence, his habit was good.  The difeafe, according to an
 old theory among phyficians, was faid to depend upon ple-
 thora  and exceflive vigour ; vegetable aliment  was enjoin-
 ed, wine was forbidden, and the careful execution of that
plan of cure was promifed to be rewarded with no return of
 the difeafe.  A whole year paft in a ftric~r. adherence to this
 regimen.  In the courfe of that  fpace of time, infiead of
 never having a return of the difeafe', he experienced no lefs
 than four fits, moft violent,  moft painful, and of a very
 great duration: In /hort, the whole year, except fourteen
 days, was divided between limping and excruciating pain.
   If an over-proportion of blood and excefs of vigour was
 the caufe of the difeafe, according to  the general theory juji
 now mentioned, it became next with him a fubjecl of enquiry,
 how fuch diftre fling fymptoms were  to be explained ; his
 reflections were, why the difeafe  had not made its fir/} ap-
                                               pearance

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

  (e) The blood is made from  the food, and is in proportion to ths
quantity, quality,  and rompleteiefs of its digeftion.  Now. before each
of his lafl fits for the time fpecified in the text, as well as dur'ng the
whole courfe of the attacks of the fecond year, his fo:id ha.i  been almoft
folely vegetable, and, tl.erefore, was not ftiitcd to produce enough, much
lefs an exceflive quantity, of blood, and the digeition was a!fo mora
impcrfucl.
  (f) according to the common  pra&ice of evacuation and ftarving. 
  VI         PREFACE   TO  THE
  two  years  was the fuccefs of his invigorating plan (g),
  that at the  end of  that /pace of time he 6nly underwent a
  very flight  fit, which did not amount to a fourth part of
  any of the former ones (h).  Now, no phyfician will deny,
  that the recurrence of fuch a difeafe as the gout, which had
  made  four attacks in one year, would have been more fre-
  quent than  in that proportion the next two years, had the
  fame method of cure been continued ;  nor will any one
  think  the addition of two fits every year too much.   The
  mild fit was four times lefs in degree than the more violent
  ones.   Multiply, therefore, twelve by four,  and, accord-
  ing to that computation, the proportion  of alleviation  of
  the difeafe will amount to a reduftion of eight and forty to
  one. As, during the firft year, he had made ufe of vegetable
  food alone,  fo, during thefe two years, his only food was
  of the land  animal kind, and of the moft nutrient quality.
  Of the latter, his choice was  directed to the  beft in  kind,
  without any other precaution than being fparing in the quan-
  tity he ufed (i). - A  young gentleman, who lived with him
  and  had laboured  under a very fevere afthma, in confe-
 quence of fubmitting to the fame treatment, fuffered only
 one fit at the end of the fame two years, inftead of experien-
 cing one every day, as he had done upon the common treatment.
   Afterwards to remove an opinion,  that had been often
 infifted on,,  of  the gout not depending upon debility, be-
 caufe inflammation  accompanied it;  little doubting that
                                                    the

 (£) which he  immediately after  the  laft mentioned reflections and
 queries carried  into execution ;
  (b)  the fit that happened at the thirty-fixth  year of his age, and the
 four fevere ones, that attacked him about fix years after, all within the
 ceurfe of the fame year.
  [i) He found moft kinds of fifh, whether from the fca or frefh-water,
 nearly as debilitating as vegetable matter, when folcly or chiefly relied
*pon for a meal. 
            ORIGINAL  WORK.          VH

 the inflammation itfelf depended on debility, he fubjected
 the queftion to experiment.   He invited fome  friends to
 dinner, and by the ufe of certain ftimulants ufed in their
 prefence (k), recovered the moft perfect ufe of that foot,
 with which, before dinner, he could not tonch the floor
 for pain.   By \\AsfatJ he {aw, that not only the gout itfelf
 but the inflammation accompanying it, was afthenic (/).
 And he found, afterwards, fuch inflammations  affecting
 the throat in  the putrid, in the gangrenous  fore throat,
 and the joints in rheumatalgia,  or that rhetimatifm which
 depends upon debility, and is  improperly denominated
 chronic rheumatifm (m),  and fuppofed, if there be any
 truth in that fuppofition to attack the brain in the end of
 typhus, to be alfo afthenic.
   As the gout affects the alimentary canal, and efpecially
 the ftomach, and proceeds in its courfe with diftreffing cir-
 cumftances fimilar  to thofe that happen in dyfpepfia («);
 being defirous to know if there was any affinity betwixt it
 and them, he obferved that they, as well as it, depended
 ©n debility, and yielded to ftimulant remedies.  Nay,  he
 afterwards found for certain, that all  the fpafmodic,  all
 the convulfive, difeafes of the fame canal (0), and nearly
 all the difeafes of children, were of  the fame ftamp.
   Continuing his inveftigation of the fame fpafmodic and
 convulfive difeafes,  when they occupy the organs of vo-
 luntary motion;  he difcovered  that their  nature was  al-
                                                      fo

  (k) Thefe are  mentioned in Dr. Jones's Enquiry.
  (/) that is, depending on debility.
  (m) The word rheumatifm, as implying a fimilarity of the difeafe ttt
the true acute rheumatifm, mould be rejected, and this term, taken from
Sauvage, fubftituted in its place.
  (») or indigeftion;
  (0) or, firft paffages, comprehending the paffagc to the fteroaeh, thai
organ itfelf, and the inteftinc« below it; 
Vlll       PREFACE   TO  THE
 fo the fame in kind, but  only greater in degree;  as  they
 are  exemplified in  the fpafms  and  pains,  that  occur in
 various  parts of the  external furface of the body,  and
 in epilepfy  (/>), and in  tetanus themfelves.   And  by
 that means he difcerned, that a vaft number of affections,
 in which, upon the fuppofition of their being inflammatory,
 no limits had been fet to the ufe of the lancet, infiead ofari-
fingfrom an over-proportion of blood and excejjive vigour, 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, nor any other evacuations (q), but by fill-
 ing the veffels, and reftoring the ftrength of the whole fyjlem.
   At firft, for the purpofe of removing fits of the gout, he
 went no farther than the  ufe of wine,  and other ftrong
 drink of a  fimilar operation, and nourifhing food,  that is
 feafoned meat, and kept the ufe of the more powerful re-
 medies in referve.   But, of late (r), his  furprifing fuccefs
 in the ufe of the latter, has enabled  him to find in opium,
 and certain other ftimuli, the fecret of repelling the fits of
 the gout as often as they returned,  and  at the fame time,
 re-eftablilhing the found healthy ftate, a fecret that has hi-
 therto been fo much  wanted and defpaired of.   This he
 has often effeaed both in himfelf and in other  perfons.
 It is now going the third year, and near the end of it  (/),
 fince he has always been able to prevent all return of the
 difeafe.
   Taught by fimilar inftances of actual praftice, he found
 for certain that bleeding difcharges,  which are called he-
 morrhages',  do not depena  on plethora  and vigour,  but
 upon penury of blood and debility arifing fromlny other
   (P) or the falling fickneft,                           fburse,
   (q) fuch as vomiting, purging, fweating, bliftermg, glyftering, &c,
   (r) that s, now, for many years paft.
   (/)nowthefevepth, 
ORIGINAL   WORK.
Xi
  Iburce, and therefore did he rejeft them from the number
  of fthenic difeafes (t) among which they had been arran-
  ged in the firft edition of the text book, referving a place
  for them among the afthenic difeafes in the fecond volume
  of  that work.  For  he faw, that bleeding,  various other
  evacuations, abftinence,  cold, and fedatives, as  they are
  called, proved hurtful •, and that the ftimulant plan of cure
  alone, was falutary.   Even wine and brandy, which had
** been thought fo hurtful in thofe difeafes, he found the moft
   powerful of all other remedies in removing them.  Upon
   finding that a certain faft ; he learned, that in all the dif-
   eafes, in which o hers had thought  there was abundance
   of blood, there was  a deficiency of it, and that  from the
   defect of that and of othei ftimulants the rar/caufe of the
 ** difeafes was debility -,  and ftimulants, given in proportion
   to the  degree of the  caufe, the proper remedies.
      In confequence of the light that thus beamed in from the
   practice, he found, that the caufe and cure of fevers, both
   intermittent and continued, was the fame as thofe already
   mentioned.
      Gradually led, as  it were by the hand of nature, around
   the whole circle  of  afthenic difeafes (u) he thoroughly
   perceived, that they all depended upon the fame caufe, that
   is, debility, that they were all to be removed by the fame
   kind of remedies, to wit, ftimulants (#), and that neither
   their caufe nor their cure differed but in  degree.
                                                     With

     (/) Sthenic difeafes, as will he afterwards explained, are fuch as de-
   pend upon an exceffive application of the fevetal powers that otherwiij
   produce health.
     (u) difeafes of debility.
     (xj Wherever the word ftimulant is ufed without a pa-ticuiar quali-
   fication of its degree, the degree is underllood to be greater than that
   required in  the healthy  ftate, as wi.l afterwards more  fully be ci- 
  ±         PREFACE  TO  fHE

   With refpea to fthenic difeafes, the nature of either
 the caufe or cure of which nobody had obferved ; he had
 long ago underftood that inflammation in them, as well
 as the other fymptoms, were not, as had been univerfally
 believed by Syftematics, the caufe, but the effea : and that
 the inflammation arofe from the  caufe,  i. e. the diathefis
 (y), and not even from it, unlefs very  violent.  In  fine,
 he experienced in his own perfon, that catarrh was not
 produced by cold according  to the common opinion, but
 by heat, and the other known  ftimuli,  and was removed
 by cold and other debilitating powers.   By which difcove-
 ry he was led to form a proper judgment of the catarrhal
 fymptoms in the meafles : In which he found, that a very
 great man who had improved the cure of fthenic difeafes,
 but never attained to any  knowledge of the afthenic, had
 been milled, by the alexipharmic phyficians.  And, as thefe
 fymptoms are the moft dangerous part  of the difeafe, he
 was right in fuppofing, that the proper cure of them very
 much interefted that of the  whole difeafe.   The confe-
 quence of which was that it came out a demonftrated faa,
 that the refrigerating antiphlogiftic plan  of cure was of e-
 qual fervice in  the meafles and  fmali-pox.
   In fthenic difeafes he illuftrated the caufe, enlarged the
 plan of cure, enriched the knowledge of both, explained
 and reduced the whole to a certain principle; he diftributed
all general difeafes into two forms, a fthenic and an afthenic
one (z).  He demonftrated that  the former depended upon
excefs, the latter upon deficiency of exciting power; that
the former were to be  removed by debilitating, the latter
by ftimulant, remedies ; that the hurtful powers which
excited either were the remedies of the other, and the con-
                                              trary ;

  (y) or habit.
  (x) Sthenic fignlfles excefs, afthenic a defect, of  invigorating power. 
ORIGINAL   WORK.         XI
trary j and that they aaed by the fame operation with the
powers which produce the moft perfea health, differing
from them only in degree.  He extended the fame doarine
to plants.  He laid down a principle which is illuftrated and
confirmed by all the parts of the detail, and itfelf refteas
illuftration and confirmation upon  every one of them.
Lafily, he put the queftion, whether the medical  art, hi-
therto conjeaural, incoherent, and in the great body of it
falfe, was not at laft,  reduced to a demonftrated fcience,
which might be called the fcience of life (a).

 (z.) That queftion has been anfwered in the affirmative by  every one
who had been at due pains t* snderftand the doctrine.
PRE- 
 
PREFACE
                   TO


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

  and knowledge of the fubjea completely qualified them
  for the undertaking, wifhed to fuperfede the occafion for
  his engaging  in it himfelf;  and as the courage of feveral
  perfbns of a  different defcription keeped not peace with
  their affeaation or intereftednefs ; it is to be hoped  the
  public will not be difpleafed to receive the work from the
  author himfelf.   This performance is intended for the ufe
  of three fets of readers ;  thofe who do not readily enter
 into  a thought conveyed in pure Latin, and who, there-
 fore, might wifh to be poffeffed of a tranflation for the
 fake  of comparing it with the original, and,  thereby, of
 acquiring, renewing, or improving  their knowledge of
 the latter; thofe,  who are only acquainted with fuch
 Latin,  as  has prevailed  in  modern times ;  and, laftly,
 thofe who either cannot, or will not be fubjeaed  to the
 trouble of reading Latin  at  all, and who,  furely, may
 often be better employed.
   Both this and the original work,  are intended  not for
 the exclufive  ufe  of medical readers, but alfo for that
 of  the public at large, it being evident, that  without
 even  the exception of the profeffional knowledge of each
 individual, that  of his  own health  is preferable to  all
 others.  And  fuch an acquifition becomes  valuable in pro--
 portion to its juftnefs and folidity.   The  public are pre-^
 fented with a work, that claims the merit of having redu-
 ced the doarine and praaice of medicine to fcientific cer-
 tainty and exaanefs.   With refpea to the form in which
 it is delivered, it is ftripped of that jargon of numerous,
 unmeaning or  miileading terms, and all that  myftery  ei-
 ther in ftyle or matter, that has hitherto rendered the pre-
tended healing art impenetrable to the moft intelligent and
 difcerning,  and  locked  it faft up in the fchools.  No
terms are admitted but the few that neceffity impofed, and
thefe  are every where defined.  The ftyle is fimple, and
                                                fuited 
             TRANSLATION.          XV

fuited to the fimplicity of the fubjea.   In the language and
compofition,  as  far  as the thoughts,  which  are new
throughout, and that reftraint, which is infeparable from
exaanefs of tranflation, permit, clearnefs is every where
preferred to elegance, and  diffufion to brevity.
  The author, in prefixing his name to both forms of his
work, has thrown the gauntlet to its numerous, but anony-
mous, oppofers.  They are, therefore, called upon, now
or never,  to difprove it, and the judicious and candid
part of mankind to judge between the parties.
THE 
 
   OBSERVATIONS




         ON THE




CHARACTER and WRITINGS




          OF




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

                  ON THE

CHARACTER  and  WRITINGS

                    OF

       JOHN  BROWN, M.  D,


   At the time I undertook to fuperintend this
 republication of  the Brunonian Syftem of Me-
 dicine,  I was pleafed  with the profpect of re-
 cording the life of its extraordinary author.   Of
 the  vicifiitudes  he experienced  I  had former-
 ly heard enough to be  perfuaded that they would
 furnifh a narrative fufHciently amufing.  I was,
 moreover, aware of circumftances in his hifto-
 ry,  which it would be impofiible to relate with-
 out  adverting to the condition of medicine—a
 fubject  concerning which,  unfortunately for ma-
 ny  who have occafion to feek afliftance from
 that art, grofs mifconceptions prevail through-
 out  fociety.
   I  find myfelf,  however, obliged to relinquifh
 the  office of biographer, fuch as I had conceiv-
 ed it.   Of late I have had few opportunities of
 perfonal inquiry ; and very little of the infor-
 mation,  I had reafon to expect,  has reached me.
                                    Never- 
XX
ON  THE  CHARACTER
 Nevertheless, I may fucceed in delineating  the
 moral portrait  of my  hero, for his character
 was exceedingly open to obfervation -,  and in his
 productions the temper  and underftanding of the
 man are moft faithfully  exhibited.
   A perfon, who was his fchool-fellow,  and af-
 terwards his pupil at fchool, informs me  that his
 parents were mean, but honeft.  What  was  the
 particular occupation of his  father I have  not
 heard.  Had his condition been fuperior to that
 of a petty village  artificer, I fupppfe  the origi-
 nal deftination of the fon would have been hi^h-
 er, for this is an affair in which parents fcldom
 err by excefs of humility.
   Mr.  Wait,  the  late refpectable  rector of
 Dumfries fchool, fuppofcs 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 ailbciate 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
 leftures,  I  conclude  that he was endowed with
 that quicknefs of  fympathy and that fenfibility
 to the charms of nature, which Characterize the
 infancy  of genius.   This warmth of heart, I
 believe, he never loft.
  I  am forry I cannot minutely trace the fteps,
 by which he advanced towards intellectual emi-
nence.  Mr. Wait, without whofe communi-
                                      cations 
           OF JOHN BROWN,  M. D.         XXI

cations mine would have been a meagre narra-.
rive,  ftates that   " he early  difcovered un-
<c common talents.  His aptitude for improveV
Cf ment,"  continues this gentleman,  " induced
" his parents,   after  having fruitleflly bound
ff him apprentice to a weaver, to change his de-
" ftination.  He was, accordingly, fent to  the
" grammar-fchobl  of Dunfe, where,  under Mr.
" Cruickfhank, an able teacher, he ftudied with
" great ardour and  fuccefs.  Indeed,  he was,  at
,c that time, regarded as  a  prodigy.  I went
" the fame road to fchool with him ; and his ap-
tf plication, I  well remember,  was  fo intenfe
"that he was feldom without a book in his hand."
It  is a fingular coincidence, that the two indivi-
duals, who in thefe times have been principally
celebrated  for their attempts  to extend  the
knowledge of  animal nature,  fhould have been
both natives of Scotland,  and that each fhould
have been put  to  a coarfe mechanical employ-
ment—John Brown to the trade  of a weaver,
and John Hunter  (according to common fame
and the  report of one of his biographers) to
that of  a carpenter or wheclright.
   By an anonymous writer, who feems well-in-
formed,  it is afTerted 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 labour  he put  himfelf to
 cr fchool, where his abilities and ardour attract-
                                          ed 
XXH         ON  THE  CHARACTER

 ff ed the notice of his mafler,  and procured him
 <( the place of affiftant to the fchool (a)." His
 revolt from the loom, according to this account,
 mult have been attended with highly honourable
 circumftances : and the reader will  defire fuller
 information  concerning  both  his  motives and
 conduft than has been transmitted to me.—From
 the cuftomof the country, we may prefume that
 he had received much more inftruction, before
 he was put apprentice, than commonly falls  to
 the  lot of boys of his condition in  England.—
 Confidering the energy of his  mind, we cannot
 be furprifed that a little cultivation fhould have
 rendered  the gloomy and uniform  labour of a
 weaver diftateful.   But this,  though true, is per-
 haps not the whole truth.  As he was repelled on
 the  one hand, fo he might,  on the other,  have
 had  fome  peculiar  attraction towards literature.
 The fuppofition is, at leaft, conformable to analo-
 gy;  finceinthe hiftory of eminent men, when we
 are fully acquainted with it, we never fail to dis-
 cover fome incident,  which has determined each
 individual  towards  the purfuit in which he has
 excelled.   Now I imagine Brown may have ap-
 plied himfelf  with  fuch unufual afliduity to
 fchool, learning from a perfuafion that it would  ,
 qualify him to propagate more effectually the te-
 nets of his fc6t.  My conjecture is  founded on

   {a) Analytical Review for Auguft, 1789. p. 450,
                                         the 
OF JOHN  BROWN, M. D.       XXUl
the following  expreffions  of Mr.  Wait: "he
"had at this time"—the time of his entrance at
Dunfe fchool,—" fober habits : he was exceed-
" ingly religious, and fo attached to the feet of
" Seceders or Whigs, as they  are called  in Scot-
" land,  that I really  believe  he  would  have
<c thought his falvation hazarded, if he had heard
" or read the  profane  difcourfes  of the Scotch
" eftablifhment.  He afpired to be the minifter
" of  a purer church,  of which it was expected
" he would prove a chofen vefTel."  Nor is this
force of  religious fentiment  unufual in  youthful
minds.   Samuel Johnfon was early (truck with
fuperftitious terror : Haller had  fcarcely emer-
ged from his infancy,  when he began to preach
to his father's domeftics: and in families, where
the  hatred  of feet againfl feet is cherifhed, one
may generally perceive its moft virulent tokens
in the boys.   The moft humanized of my  read-
ers may remember the  time when he glowed with
zeal againft perfons who had  been taught a differ-
ent creed : and where reflection, foftening the
heart into  univerfal charity,  has not  introduced
perfed indifference as to the religion or irreligi-
on of others,  the pious flame muft be ftill alive.
   The years of Brown's grammar education ap-
pear to have been, in no common degree, well-
fpent and happy.  He had vigour of body with
vigour of  mind, and exerted both.   He him-
 felf,  with  much complacency, relates proofs of
                                         that 
XX1V          ON THE CHARACTER

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

worfhippers,  or to wait for a formal fentence of
excommunication, he abdicated his  principles,
and profefTed himfelf a member of the eftablifh-
ment.   Thus, bigotry is often  but the  mafquc
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
inftructive anecdote. Encouragement at firft, and
afterwards  flattery, from his brethren, feems to
have formed a ftrong connection between the pe-
culiar articles of his faith and a fenfe of his per-
fonal importance ; the moment this  connection
was diffolved, an  alteration of  fentiment Suc-
ceeded, not very much unlike that produced in
Luther's mind by the offenfive meafure of the
pope :  the opinions he had fo warmly cherifhed
loft all their value in his eftimation ; or rather,
perhaps, became odious from the difgrace  with
which they threatened-him.   Religious enthufi-
afm, however,  furvived this Sacrifice to pride ;
and his friends ftill recoiled the vehement indig-
nation he exprefTcd on account of the dangerous
tendency of Mr.  Hume's Speculative writings;
which,  fome time  after  this  event, he found
much the fubjea of conversation at Edinburgh.
   Thofe who regard the  Scottifh eftablifhment
as the true apoftolical church may have caufe to
rejoice,  that fo  ardent a fecederdid not perSevere
in his original zeal.   For  complaints are fome-
times heard in Scotland,  as well  as in England,
                    D                     of 
XXVI         ON  THE  CHARACTER
or the increafe of Sedaries ;  and he might have
become formidable as a propagator of fchifma-
tie doarines.  Among the divines of his nation
he would have been unrivalled in craflical learn-
ing ■,  and I fee not what fhould have hindered a
man endowed with fo acute and comprehenfive a
genius from attaining equal pre-eminence in po-
lemical divinity.  He would have marched with al-
acrity into the field of controverfy, and confident-
ly affailed the ftouteft champion of the  adverfe
hoft.   His vehement eloquence  muft have been
deeply  felt  by audiences, to  whom his dialea
was intelligible  and inoffenfive  : and, as little
regard  will be paid to ftyle,  when the thoughts
are intent on the high concerns  of grace, faith,
good works, eledfion, and  reprobation*  he  might
have  ftconded, with his pen, the efFed of  his
perfonal labours.   Had the  incredulity  of the
age induced him to undertake a general treatife
on  chriftianity,  he  was  capable  of renderino-
Crotius obfolece by language of  Superior purity
and more fkilful management of his arguments.
If he  had borne the crofs as  a Seceding minifter,
he muft have led a life of the ftrideft  tempe-
rance  ; fince in  Scotland the clergy,  even of
the eftablifhcd church, cannot Safely indulge in
open  diffipation. I  need  not therefore  explain
how  much  leifure  he would have had for his
eia&cal  and  theological  purfuics.   Nor would
he have enjoyed  fewer or lefs lively fenfations of
                                     pleaSure 
          OF  JOHN  BROWN. M„ D.        XXVII

pleafure  than  a  different courfe procured him ,
for to a  perfon  of his temperament, fame and
fanaticifm may well fupply the place of wine.
   He continued at  the grammar  fchool till he
had nearly attained the age  of twenty.   In the
Summer  of  1755,  his reputation,  as  a fcholar,
procured  him  the appointment of tutor in a
family of fome diftindion in  the neighbourhood
of Dunfe.   But here, it Seems, he did not long
continue to be an agreeable inmate.   It is likely
enough that he had added the ftiffnefs of pedan-
try to the fournefs of bigotry.  But I have no in-
formation  concerning his  deportment;  and
fhould any of his difciples think a  fuller narra-
tive due  to their matter's memory,  fome notices
may,  I conceive, ftill be colleded from the fur-
viving members of the family.
   When  deprived of this employment,  he re-
paired to the univerfity of Edinburgh.   In this
bufy feat of fcience, after going through the ufu-
al courfe of  philofophy,  he regularly  entered
upon  his theological  ftudies  :  he  attended the
ledures, diligently applied to the perufal of the
authors recommended by the profeflor, and pro-
ceeded fo far as to deliver in the public  hall a
difcourfe upon a prefcribed portion of fcripture:
which is an academical exercife previous  to or-
dination as a clergyman of the Scotch cftabliih-
ment.   At  this point he  flopped,  and relin-
quifhed the profeflion of  divinity  altogether.—
                                        The 
/
XXviii         ON  THE  CHARACTER

 The fequcl will fufficiently explain his  motives
 for this change.   Its immediate confequence was
 his retreat from Edinburgh to Dunfe.  Here, to
 gain time, as may be fuppofed,  for arranging the
 plan of his future life,  he engaged  himfelf as
 ufher to the fchool which he had lately quitted.
 In this  capacity  he^ officiated  from Martinmas
 1758 to  Martinmas  1759.  Mr. Wait,  who
 profefTes  himfelf  to have benefited by  the new
 ufher's inftrudions, mentions, as a proof of the
 accuracy of his memory,  that after once reading
 over the leifon, confifting of two octavo pages
 in Latin,  he would lay afi.dc the book and  pre-
 left the whole  over, without miftaking a fingle
 word.  In the courfe  of this year, one  of the
 clafTes in the high fchool at Edinburgh  becom-
 ing vacant, Brown appeared as a candidate,  but,
 " on a comparative trial, proved unfuccefsful."
   While he  remained at Dunfe, it was remark-
 ed  that the  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 a-
 vowal of irreligion.  Whatever  fCOpe  the fad
 may  afford to  the eloquence of perfons, accu-
 ftomed to decry Edinburgh as a School where the
 reafon of young  men  is exercifed  more  than
 their faith, it feems too evident to  be  denied
 that this revolution of opinion in our ftudent of
 theology took place during his refidence there.
                                         The 
OF JOHN  BROWN, M. D.
XXIX
The  diftinguifhing  portion  of his heriditar,y
creed he had  abjured  from pique j nor can he
be fuppofed to have had any rational convidion
of the remaining articles j  if rational  convidi-
on can only originate in  fmcere doubt and per-
fea  carekfTnefs in regard to  the conclufion to
which examination may lead.   Under fuch cir-
cumftances it is eafy to conceive by what a pre-
carious tenure a fpeculative ftudent, placed in a
Situation where information is at hand and inqui-
ry not only free but fafhionable, holds the bene-
fit derived from the religious leffons of  his pa-
rents and preceptors.   Some unlucky fuggeftion
may ftart a perplexing fcruple,  the ferious inves-
tigation of this fc-ruple may raife a hoft of diffi-
culties, and deliberation terminate in unbelief.
   At the time  he renounced divinity, the fcene
before  him muft have direaed his thoughts to
the ftudy of medicine.   The only difficulty lay
in the expence: but his obfervatiorrs might have
fuggefted the means of overcoming this difficul-
ty, independently of the encouraging circum-
ftance which  I fhall immediately  relate.   He
muft have been aware that ftudents of phyfic are,
in general,  by no means fuch proficients in claf-
fical acquirements as to Speak Latin with tolera-
ble  fluency.   Hence, before the examinations
for  a doaor's degree,  which are  carried on in
Latin, it is common to have recourfe to  a pri-
 vate inftruaor, who conyerfcs with the candi-
                                         date 
XXX          ON THE  CHARACTER
 date in that language.  This preparation is fami-
 liarly called grinding, as a fimilar procefs at Cam-
 bridge is, I think, called cramming.  The tranf-
 lation of inaugural difTertations into Latin,  which
 the  ftudents, in moft inftances,  compofe  for
 themfelves  in  Englifh,  is  another  occupation
 from which  a  good fcholar  may derive emolu-
 ment at Edinburgh ; the ordinary gratuity for a
 tranflation being five, and for an original com-
 pofition, where that is required, ten guineas.
   Of his qualifications for  thefe employments,
 accident,  fhortly after his unSuccefsful competi-
 tion for the vacancy in the High fchool, furnifh-
 cd him with  an agreeable proof.  Application
 being made to one of his friends to recommend
 a  perfon to turn a thefis into Latin, Mr. Brown
 was  mentioned.  He performed the tafk in  a
 manner that  exceeded the exbedations both of
 the friend and the candidate.   When  it was ob-
ferved  how much he had excelled the  ordinary
 ftyle of fuch composition, he faid be bad now dif-
covered bis ftrength, and was ambitious of riding in
bis own carriage as a phyfician.—Towards the
clofeofi759, therefore, he fettled at Edinburgh
in the double  capacity of  teacher and ftudent.—.
At the  opening  of the feffion, he addreflfed a La-
tin letter to each of the medical profeflbrs.  They
were perhaps already apprized of his merit as a
claffical fcholar; and they were all  induced  by
his application  to prefent him with a ticket  of
                                   admifiion 
           OF JOHN  BROWN, M. D        XXXI

admiffion to their ledures.  After fo aufpicious
a beginning,  he  foon became famous as a teach-
er of Latin ; and I believe he never afterwards
refufed  to cxercife  his pen in the tranflation of
thefis.  * He was  alfo at all times ready to furnifh
an  original diflertation according to the  fyftem
his employer  preferred.
   I have obtained no particular information con-
cerning the firft  four years of his  medical  Stu-
dies.   His circumftances were  probably more
flourifhing than at any former period.  From
the beginning of the mafterly preface to his Ele-
ments  it  appears that he profecuted his  Studies
with his charaderiftic ardour.  In 1763,  an old
acquaintance  found him in as high repute  among
his  fellow-Students as he had  formerly been
among  his fchool-fellows—a diftindion which
has never been obtained without the conjundion
of ability  with  induftry.  He feems,  however,
during the intervals of his application, to have
given into the moft dangerous of vices;   " for
 " the langour of his appearance feemed to fhew
" that he had taken liberties with a constitution
" originally firrrjand vigorous."
   In certain  univerfities, deftitute of  foundati-
ons or yearly ftipends for fcholars, the ftudents
live difperfed in ordinary dwelling-houfes:  and
this difperfion,  according to  my obfervation,  is
not  lefs  favourable  to diligence and regularity
 than residence in colleges.   In mixed company
                                          the 
XXX11        CN THE CHARACTER

 the vicious propenfities, peculiar to any clafs of
 individuals,  will  never be  countenanced ;  or,
 in  the language of Dr. Adam Smith, a  whole
 company can never Sympathize in thofe unbeco-
 ming pradices, to which a few only feel  them-
 felves inclined.  By this mutual corredion, the
 aflociation of perfons of different ages and fexes
 becomes the great  prefervative of good manners
 and good  morals.    Colleges, which, after  the
 example of monafteries, feem instituted on pur-
 pofe to  prevent this falutary variety, doubtlefs
 give frequent occafions to emulation in thofe ex-
 ceflcs,  to which  young men  are particularly
 prone.  A nice obServer, too, may perhaps dis-
 cover that their monaftic difcipline  irritates full
 as much as itreftrains. At Edinburgh the keepers
 of  lodging and boarding houfes have generally
 fober habits ; and the observance of early  hours
 is enforced with as  much efFed,  though with lefs
 form, than by the porter's lift, the fine, and im-
pofttion.   As  far as difcipline regards learning,
 every man muft eftimate its value by his opinion
 of  the efFed to be produced by fetting grown
 gentlemen  tafks.  Where  there have  exifted
 none of thofe restraints,  which always »ive more
 or  lefs  difguft, I  have  feen a large majority of
 ftudentspurfuing knowledge with as great ea^er-
 nefs as  any of their  equals in age  where elfe-
 where purfuing  the pleaSures  of the chace  ; and
 from the fame motive—the immediate fatisfadi-
                                          on 
           OF JOHN BROWN,  M. D.     XXXHl

on it afFords.   Nor do I believe that the acquisi-
tion of knowledge can be otherwife than agreea-
ble,  except from the fault of the tutor or the in-
ftitution.—If  examinations  are  confidered  as
powerful incentives to diligence,  none can equal
in feverity thofe which are carried on at the vo-
luntary  meetings, which it  has  long been the
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 Lon-
don, with the approbation of  the  moft diftin-
guifhed profefTors of the law'.
   Brown, who now feems to have  Supported
himfelf in affluence  as  a fingle man,  perceived
in the eftablifhment  of  a boarding-houfe for ftu-
dents,  a refource which  would  enable him to
maintain a family. His reputation for  various at-
tainments was, he thought, likely to draw round
him  a  number  fufficient to fill a large houfe.
With this profpea he  married  in  1765 ;  and
his fuccefs anfweredhis expeaations.  His houfc
was  foon filled with refpeaable boarders.   But
he lived too Splendidly for his means,  and " ma-
" naged fo ill that in two or three years he became
" bankrupt.  Towards the end of 1770, though
" reduced in his circumftances, he maintained
" the  independence of his charaaer, proving
" himfelf to be, in the language of his favour-
" ite Horace,
                      E 
 XXx'lV       ON  THE CHARACTER

         ■   ■   ■ Satis inter villa fort is.

 " He feems to be happy in his family, and, as
 " far as I could ever obferve,  acquitted himfelf
 " affeaionately as an hufband and a parent.—
 " He Still frequented  the medical claSFes," (or
 ledures.) ;  " and  I  heard him  Say he had now
 " attended them  ten or eleven years."
                               [Mr. Wait],
  . We have Seen how liberally Brown  was treat-
 ed on his entrance upon the Study of  medicine.
 From the celebrated  Cullen he  early received
 the moft flattering marks of attention.   This
 SpeculatiSt, like Boerhaave and other men of. ge-
 nius  in  the  fame Station,  was  accuftomed to
 watch the fluauating  body of ftudents with a
 vigilanteye, and to feck the acquaintance of the
 moft  promifing.   There was a period when he
 made r,he greateft exertions to  gain profelytes to
 his opinions ; and his mind was  doubtlefs  alive
 to that pleafure which the encouragement of me-
 rit  affords  to all  who are capable of difcerning
 it, when no dread of rivalfhip interferes with the
 gratification.   But Brown's power over the  La-
 tin  language  Served  him as a peculiar recom-
 mendation ; and his circumftances mi^ht induce
Cullen to believe that he could render this talent
permanently ufeful to himSelf.   Taking there-
fore its profeffor " under his immediate patron-
 " age,"  he  gave him employment as a private
                                   inftrudor 
          OF  JOHN  BROWN,  M. D.      XXXV

inftruaor in  his own family, and fpared no pains
in recommending him to  others.  A very ftrid
and confidential intimacy enfued.  The favour-
ite pupil was at length permitted to give an e-
vening leaure, in which he repeated, and per-
haps illuftrated, the morning leaure of the prc-
feffor; for which purpofe he was intruded with
Cullen's own  notes.  Though Mr. Wait had
not recolleaed the profufe encomiums of his old
School-fellow,  his warmth of attachment would
be fully teftified by fubfifting tokens; to his eld-
eft  fon,   for  inftance  (William   Cullen
brown)  were given  both the chriftian-name
and firname of his  patron.  Other  proofs  of
mutual confidence and efteem might be  colkaed :
but friendfhips originating in proteaion are very
prone to terminate in enmity, unlefs  difFerence
of rank and  purfuits totally preclude competiti-
on ; and it is well known that the friendfhip in
queftion was far  from  permanent,   My materi-
als do not furnifh diftind infprmation concern-
ing the caufe or pretext of an alienation, which
was certainly  injurious to the dependant party,
and perhaps  detrimental to fociety.  In  a com-
munication from Dr. S—,  like wile an  old and
intimate acquaintance  of  Brown, it is faid, that
aSter the failure of his boarding-houfe,  he "be-
" came impatient, and unfortunately  quarrelled
" with Dr.  Cullen, from a fuppofition that the
" dodor had it in his power  u  extricate him
                                       from 
XXXvi       ON  THE  CHARACTER
" from embarrafFment by placing him in a more
" liberal and  lucrative Situation in the medical
" line."   A report I remember to have heard at
Edinburgh coincides with intimation ;  but I re-
late it only on the authority of rumour.  When
the  theoretical chair of medicine became vacant
either  on the  death of Dr. Alexander Monro
Drummond, or  the refufal of this promifing
young  phyfician to fill it,  Brown  gave in his
name as a  candidate.  On a former occafion of
a nature fomewhat fimilar, he  had diSdained  to
avail himfelf  of recommendation,  which  he
might have obtained with eafe; and though,  ac-
cording to the friend whofe words I  have juft
quoted, he acquitted himfelf in a manner far Su-
perior  to the  other candidates, private intereft
then prevailed over the jufter pretentions of me-
rit.  At  the prefent  competition  he was alfo
without recommendation;  and, I fuppofe, could
have obtained none.  Such was his Simplicity,
that he feems to have conceived nothing beyond
pre-eminent qualifications neceffary to fucceSs j
nor did he harbour any SuSpicion of thatdebafing
Syftem of influence, which has infeded the land
fo thoroughly, that the poft of a Scavenger, were
it held  by appointment, would hardly  be procu-
red without cabal, or retained without Servility.
The magiftrates  of Edinburgh appoints profeff-
ors  to the college, as  well as  mafters  to the
fchool.  They are reported deridingly to have
                                     inquired 
          OF  JOHN BROWN,  M. D.      XXXVii

inquired who this unknown and unfriended candi-
date was;  and Cullen, on being fhewn the name,
after  fome real or afFeded hefitation, is faid to
have exclaimed in the vulgar dialed of the coun-
try—Why, Jure, this can never be our Jock! With
this fnee*  the application of a man was fet afide,
whoSe equal the patrons  cf the Edinburgh pro-
fefForfhips will probably not foon have  an op-
portunity  of rejeding.   Though  this  account
Should come near the truth, it  does  not follow
that the. municipal board deferves much cenfure.
In the execution  of their  truft they are indeed
bound to  examine the pretentions of the  compe-
titors, or  rather to  call their eyes round where -
ever the Englifh language is Spoken,  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 fy Stem, could not well
 be deemed  a contemptible candidate, there  did
not perhap exifts reafons to warrant them in raif-
ing him to the vacant chair.   Public fame feems
the fureft  guide for  fuch eleaors ; and the repu-
tation, fo long enjoyed by  the Univerfity  .of
Edinburgh,  proves that it is a  guide  Sufficiently
Sure.  The  danger is,  left its patrons,  relying
upon the eftablifhed credit of  the feminary,
fhould at any time Suffer  intrigue to interfere
                                        with 
 XXXviii      ON THE CHARACTER

 with  their choice.  In this cafe a  fplendid col-
 lege  may indeed  be  ereaed,  but ftudents from
 different regions of the globe will foon ceafe to
 crowd its halls.
   Whether fuch  a farcaSm was uttered or not,
 Cullen (b~) completely eftranged the mind of his
 Latin fecretary on a fubSequent occafion.   As I
 am not Sufficiently acquainted  with the particu-
 lars, I cannot venture  to appreciate  his condua;
 but the mortal  afFront was given, when Brown
 attempted to gain admifFion into that philofophi-
 cal Society  which publifhed the Edinburgh  Ef-
 fays.   After this  tranfaaion,  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 fol-
 lows :  " 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 de-
 " pending upon him.  This condua,  firft of
 " all,  was the  return they made him for great
 " fervices done  to them as a body, and to cer-

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

" tain individuals  of them  as friends.   Their
" open  condua to him was  friendly; their fe-
" cret a plot, a dark Catalinian confpiracy.—«
" Accordingly, his fufpicion  of  it was late, the
" full deteaion later ....  He chofe to tear
" ofF the mafk of their pretended  friendfhip.
" His firft Step was to make application for be-
" ing made a member of a certain literary foci-
" ety, to which no man's petition had ever been
" rejeaed before,  or fince:  forefeeing that he
" would be rejeaed.  This  accordingly hap-
" pened.   But he  was previously advifed by one
" of  themfelves, as a friend, to withdraw his
" letter  of application.  A frivolous and falfe
" caufe was afligned for  the oppofition.  The
" friendly monitor who  had perceived that our
" author had a new doarine of medicine in me-
" ditation, began, as it would  appear, to fear
" that it might terminate  in the extinaion of
" one which  he aSFumes as  his own.  He was
" therefore the prime mover of  the plot.—The
" anfwer was, in a tone of firmnefs, that the ap-
" plication would not be withdrawn . . and that
" the applier" was refolved to  make the pre-
fent condua of the advifer and his friends  "the
" criterion of his  judgment of their intentions
" towards him."   The body muft mean the col-
lege  of phyficians ; the fervices I  prefume to
have  been the tranflation  of their Pharmaco-
poeia  into Latin,  and the plotter unqueftionably
                                         was 
Xl          ON  THE CHARACTER

Cullen.  After the failure of this bold experi-
ment upon  the ftrength of his credit,  the  pro-
jeaor  had  evidently no time to lofe in feeking
fome frefh refource for the Support of his family.
The following notice from Dr. S-----applies to
this part of his hiftory.
  " Being eftranged from Dr. Cullen's family,
" he gradually became his greateft enemy,  and
« fhortly afterwards found outthe new  theory of
" phyfic, which  gave occafion to his publifhing
" the Elementa Median*, in the preface to which
" work he gives  an account of the accident that
" ledtothisdifcovery.  The approbation his work
f( met with among friends encouraged him to give
" kaures upon his Syftem.  Though his kaures
tc were not very numeroufly attended by the ftu-
" dents, on account of their dependence upon the
" profeflbrs, Still it was always remarked that the
" ckvereft among them  were all, as they  were
" now called by way of nick-name,  Bruno-
" nians.  Hence aroSe that perfecution which
" was carried on  with  fuch  rancour that it at
" length obliged him  to leave Edinburgh.—"
This account  of the origin  of the Brunonian
fyftem, as we  may conclude from the preceding
quotation, is not exaa ; and; in other particulars
the Statement, from evidence  I fhall afterwards
produce, will appear overcharged.   Meanwhile,
if it be undeniable that, as the Cullenian hypo-
thefes  were finking into dUrepute, many of the
                                      ableft 
OF JOHN BROWN/M. D.
Hi
 ftudents  reforted to the  Standard of Brown, it
 ought not to be  forgotten that it was joined aifo
 by  the moft idle and difFolute.  Their  mifcon-
 dua and  their matter's  imprudence in private
 life, together  with  the ofFenfive manner in
 which he fpoke  of himfelf and  of others, kept
 the  fyftem and the author in conftant difcredit.
   He was foon in a ftate of open hostility with
 all  the medical teachers  at Edinburgh ;  and it
 required  nicer  management than he could  ob-
 ferve to keep on fair terms with other praaition-
 ers of medicine.   To a difciple, who was defi-
 rous that he fhould meet one of  the profefFors in
 confultation, he remarked, "that he (the difci-
 ple)  " was unacquainted with the interested arts
 " of thofe men; that all their ideas in mcdi-
 " cine, and  particularly  in  its praaical part,
 " were fo diametrically oppofite to his, that they
 " never could be brought to any fort of recon-
 " ciliation."—Like other reformers, who have
 had  to  wreftle  with powerful  oppofition,  he
 committed and fuftained  injustice.  Like them
 too,  where his fyftem was concerned, he gradual-
 ly loft his fenfe of equity.  If we judge by his lan-
 guage the only way he had to fhow his difpofition,
 his countryman Knox could fcarcely have  exceed-
 ed him in ferocity.   Thus, having remarked that
 the  doarine  of fpafm, fuggefted by Van Hel-
mot,  and clumfily wrought up into a fyftem  by
Hoffmann, was  banifhed by  Boerhaave  from
                      F                 -the 
lift          ON THE CHARACTER
the country  which gave  it birth, " it found at
"  laft," he  adds, " amidft a  new perfecution
"  raifed agaift it  by the pupils of Boerhaave—
"  then in poSFefFion of the medical chairs atEdin-
c<  burgh—a friend and proteaor in Dr. Cullen,
"  who had lately become one of the number of
"  thofe profefTors.
   "  This  brat," he  proceeds,   " the  feeble,
"  half-vital,  femi-produaion of phrenzy, the
"  Starveling of Strained fyftematic dullnefs, the
"  forlorn  outcaft of  the  foftering care to which
"  it  owed its infea  vitality, was now  to  be
"  pampered by a  crude  and indigestible  nutri-
"  ture, colle&ed from all the materials  which
"  had compofed the feveral fabrications  of for-
"  mer erroneous fyftems,  was to be decorated
"  with every foreign  plumage, and in this  its
"  totally  borrowed  and heterogeneous  form,
"  inftead  of the  hideous caricatura,  which it
"  was, contrived to excite the derifion of man-
"  kind, it was to  be oftentatioufly obtruded up-
"  on the world as a new, and reSpeaable doc-
"  trine, and held up,  forfooth, as the formida-
"  ble rival of a fplendid  fyftem(<;)."
   Such is the torrent of metaphors that rufhes
upon his imagination when he thinks of the fyf-
tem  of his  ancient friend and mailer.   Of  the

   (c) Obfervations on the old  Syflems of Phyfic,
 1787, p. xxxi.
paft 
OF JOHN BROWN. M. D.
liv
 paft and prefent condition of the healing art he
 fpeaks  with  greater  coolnefs, but  with equal
 contempt:
   ,f The accomplishments of the regulars have
 " been learning and ingenuity in a few,  not di-
 " reaed to improvement in their own profeffi-
 " on: a mere fliadow of learning, or the Study
 " of a bad kind of it,  as botany and the other
 " branches of natural  hiftory,  in  the greateft
 " number ;  fly attention to reputation for fkill;
 " intriguing with their brethren for countenance;
 " oppofition to improvement j  perfecution  of
 " difcovery;   narrownefs  of mind  under the
 " thin  veil of a falfe pretenfion to liberality;
 " afFeaation of decency; all for  the purpofes
 " of trade;  filence,  from a confcioufnefs of in-
 " ability to fpeak fo as to gain by it; formality,
 " pomp,   ftatelinefs,   gravity,  all  making a
 " motley group of abfurdities; invincible  at-
 " tachment to  the errors of their education ;
 " averfion  to improvement; ready upon every
 " flight occafion to  break out into rage and
 " tranfport;  invincible bigotry  and prejudice ;
 " an over value of  what learning they have any
 " pretentions  to;  and under value of all they
 " are confcious they want.
   " As every country, in proportion as it  is dif-
 ,e tinguifhed  by riches, and openneSs of man-
" ners, for that very reafon,  becomes the em-
" porium,  the  fcene  of aaion, for high-way-
                                        men, 
u
ON  THE  CHARACTER
"  men, footpads, pickpockets, Swindlers, fharp-
"  ers, gipfits, regular praaitioners in law and
"  phyfic, quacks in both profeffions, fo England
"  has long held and ftill holds the pre-eminence
"  over all her neighbour  countries,  in being,
c<  for the reafon affigned, the place of common
"  refort,  in which a comfortable fubfiftence  is
,f  afforded to  all thofe different denominations
"  of purfe-takers.

"  Exilis  domus eft>  ubi non  et multa fuperfunt Et
" fallunt dominos,  etprcfunt furibus."(c)

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

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

duce her fecretly to adminifter ftrong  ftimulant
medicines: they were  given, as he afFerts, for
about twenty-four hours, with fuch efFea that, on
their next vifit, the phyficians " declared the pa-
" tient free of fever," though before he had all
the fymptoms of approaching death.   In the af-
ternoon, however, of the fame day, he was feized
with a raging delirium.   Jones in his alarm ap-
plied  to his preceptor;  the  preceptor being told
that the nurfe defired to fee him,  ordered  "her
"  to  be  brought before him."   When fhe was
brought before him, he complimented her by a
folemn appeal to her understanding concerning
the great principles of his  fyftem.   " He en-
"  deavoured to aflure  her that there  was either
"  no inflamation in the cafe at all, or that it was
"  a very  different  affeaion from the inflamati-
"  on that phyficians were acquainted with; that
"  inftead of requiring bleeding and other eva-
"  cuant antiphlogiftic  means,  it is required the
<f very fame treatment which had been laft em-
" ployed;  and he afFerted with confidence that
" the  intermiffion  of  the ftimulant  powers
 " through the day was the  caufe of  all that had
" happened; that,  in  fhort,  the prefent affec-
 " tation was a difeafe  of debility of  the  whole
 " fyftem, predominant in the  brain, in confe-
 " quence of the great finking of ftrength which
 " constantly follows a total cefFation  of  the ufe
 " of fuch  highly ftimulant powers.   Pie beg-
                                         ged 
lvii
ON  THE  CHARACTER
" ged therefore as the life of a fellow-creature
« was at Stake, and as Ihe had been fo late a
" witnefs of the good effeas refulting from the
" method  of cure, the  continuance  of which
" he ftill recommended that fhe would  not al-
" low prejudice and impreffions from the falfe
" theories of phyficians,  among whom fhe had
" been converfant, to prevail over  the high
" probability of fuccefs from this mode of cure.
« He difmifFed her,  after obtaining a promife
" that fhe would continue the plan of  cure in
" queftion  (<?)•"
   Brown, for a comic figure, was not inferior
to Sancho Panza;  nor indeed much unlike that
entertaining perfonage;  and this  clandeftine
conference, if it had  been delineated by Cer-
vantes, would have made  a good companion for
the noaurnal interview between Don Quixote
and the venerable duenna,  Donna Rodriguez.
   The patient, thanks be to fortune, Jkill,  or
virtue!  recovered.  The Brunonians placed the
cure to the  credit of their praaice,  which they
reported  to have been  fuccefsful after Dr. Dun-
can and Dr. Monro had given the patient over ;
they publifhed the  cafe ;  they aiFerted that the
cure  " gave great vexation to the attendant phy-
" ficians and all their partizans ;" and with the
policy ufual among agrefFors, they  complain-
              (e)  Jones, p.  136.
ed that 
           OF JOHN BROWN,  M. D        lvift

ed that Dr. Brown  was ill-treated,  becaufe he
was blamed in  " the numerous circles of phyfi-
" cians friends and his enemies, while no oppor-
" tunity  was offered him  of  vindicating him-
" felf  from thefe charges."
  The nurfe had threatened,  if the fecret pro-
ceedings  fhould tranfpire,  to deny the perform-
ance of her part of what in the Enquiry is term-
ed  the pattion.   Dr.  Duncan, roufed  by thefe
rumours,  applied for information  to the nurfe
and her affiftant, to Mr. Ifaacfon himfelf,  to the
miftrefs of the  houfe  where he lodged, to Mr.
Edmund  Goodwin,  and Dr. Monro.   In his let-
ter he has publifhed their refpeaive  atteftations
and  depofitions upon oath; it appears that the
clandeftine propofals were rejeded, and that only
one unfuccefsful attempt was made by the ne°x)d-
ator himfelf to adminifter a dofe of his diffufible
ftimulants.  According to  the nurfe's testimony,
Mr. Jones on her  firft refufal declared, if fhe
<f would  do as  he defired her,  Mr. Ifaacfon
" would give her a handfome reward when he
<f recovered—that  the  medicine he wifhed her
" to adminifter was a  bottle of double rum, of
" which  fhe was to  give him a glafsful, with
■«' fifty drops of laudanum in it, the firft night;
" and another glafsful,  with one hundred drops
" of laudanum  in it,  the  fecond night,  if the
," firft dofe fhould have a  good effea.   To this
" propofal fhe anfwered,  that if fuch medicines
                                        were 
]ix         ON THE CHARACTER

«  were administered to Mr. Ifaacfon in the ftate
"  in which he then was, he would  not recover
"  to  reward either her or  Mr. Jones.    To
"  which he replied, that fhe was a damned fool
"  for refufing, and that he would give  her two
"  guineas out of  his own  pocket  if fhe would
"  do it.   She faid, that if the beft graduate in
"  Edinburgh would  give  her her  apron full of
"  gold, fhe would not."   This woman depo-
fed moreover that  one evening, while fhe was
employed  apart, fhe heard Mr. ISaacSon Suddenly
cry out, " Good God,  what is this ?  It is laud-
"  anum!  I  am poifoned !"  She then obferved
Mr. Jones by the bedfide with a tea-cup, con-
taining fome liquor,  in his hand,  which he fet
down on the table, requefting  the  landlady  to
give it to Mr. Ifaacfon at a proper opportunity.
The  landlady afFerts,  that,  late one evening,
fhe faw Mr. Jones drop one  hundred drops  of
laudanum  into a  tea-cup,  and add fome wine,
which he immediately carried into Mr. Ifaacfon's
room  She  followed  him :  he endeavoured to
make Mr. Ifaacfon, who was fo far delirious that
he did not appear  to know Mr. Jones,  Swallow
the contents; " on tailing  the medicine, he  Spit
<c  it out of his mouth ;  cried out that it was
"  laudanum, and  that  he was poifoned ; but to
"  the beft of her  obfervation,  he did not fwal-
"  low any of the  medicine ;" which, foon af-
ter,  was thrown into the fire.
                                        The 
OF JOHN BROWN, -M. D.         1»
  Dr. Duncan's indignation  urged him to an
immediate profecution,  which, as he was aflu-
red  by  fome  eminent advocates, would have
terminated in the  infliaion of  a fevere punifh-
ment on  the negociator.   Dr.  Monro difcoura-
ged by  this idea for reafons which it would be
injurious not to quote ;  they are  thus  afligned
in the letter to Dr. Jones :  " He was principal-
" ly averfe to it on your  account,  becaufe he
" confidered you  in  the light of an imprudent
" young man—he imagined that the mal-prac-
" tices might be Sufficiently proved of you,  al-
" though they could not be brought home to
" Dr.  Brown, whom he confidered as  the ori-
" ginal  aggreflbr.  He was averfe to it  on ac-
" count  of Dr. Brown's  wife and infant chil-
" dren, who might have fufFered more fevercly
" by it than we could eafily forefee.  And be-
" fides  this, he thought  there was but little
" danger that  Dr. Brown fhould repeat fuch
kk pradices, and ftill lefs chance that he would
" again find any ftudent to be his affiftant in the
«' manner you  had been."  In thefe reafons Dr.
Duncan acquiefced.
  By this intrigue Dr. Brown's " charaaer was
" very near ruined as  a phyfician,  and as a man
" (Enquiry,  p.  139)."  All chance of lucrative
employment  in his profeflion,  if  he ever  had
any, was deftroyed.   His  charaaer among  his
country me a  fufFered  irretrievably ; nor have  I
                     G              courage 
Ixi           ON  THE CHARACTER

courage without better documents to undertake
his  vindication.   Dr. Duncan affures me,  that
he  knows of no reply  to  his letter ;  and little
fatisfaaion I apprehend will be found in the pleas
offered by the Enquirer and Philalethes.  If  the
means of erafing  this blot remain, I hope  they
will be employed without delay.   I Shall be glad
to have  Solicited, where  I could not afcertain
the  truth.  But " the defire of refcuing a fellow-
" creature,"  will  never be admitted by.the pub-
lic  as a  juftification of the clandeftine  interfe-
rence of any  man,  much  lefs of a phyfician,
in the treatment of the fick.   Such motives may
be chiefly feigned ; and, when real, they  may
occafion endlefs mifchief.
  Things and perfons are generally estimated in
the grofs; and this unwelcome portion of my
narrative,  I fear, will  raife in  many minds a
prejudice fatal to the credit of the following fyf-
 tem.  Juft and judicious readers will, however,
discriminate.  And if,  in  the  cafe  of Bacon,
the bafenefs of the magistrate detracts not from
the wifdomof the philofopher,  why fhould the
imprudent or unjustifiable  means which Brown
adopted to carry his principles into praaice, in-
 fluence our opinion concerning  the juftnefs of
thofe principles ?
  He fometimes  difcovered the propenfity,  fo
common  among  the framers of  fyftems, in a
lefs ofFenfive way.
                                   A ftudent 
           OF JOHN BROWN, M. D.        lxil

   A ftudent of medicine died of  a  low fever
 in fpite of the full and avowed ufe of diffufible
 ftimulants.   The  body  was  opened;  feveral
 perfons  were prefent;  among others the gen-
 tleman that informed me of the occurrence.—
 During  the  examination of  the  appearances,
 Brown with an  air of great fagacity remarked
 that the  body was unufually frelh.   The diffea-
 ing furgeon,  whom perhaps kindred devotion to
 Bacchus had infpired  with  tendernefs for the
 Dodor,  replied that, confidering  the circum-
 stance, he had fcarce feen an inftance where pu-
 trefadion had made fuch little progrefs. "Then,
 " gentlemen,"   rejoined the  doaor, " I appeal
 " to you if we may not confider this  as a clear
 " proof of the propriety of our praaice."
   Brown was ekaed  Prefident of the Medical
 Society in 1776 and again  in 1780.   In  what
 years he  became a lecturer and graduate in me-
 dicine,  I muft leave to  fome future biographer
 to fettle.   Though he had attended the medi-
 cal claSFes  at Edinburgh ten  or eleven  feflions
 [Mr.  Wait],  he reforted to St. Andrews for
 a Doaor's degree.   His pupils, I believe, fol-
lowing in his train,  Strove to give to his pafFage
 the air of a triumphal progrefs; he was certain-
ly accuftomed to relate with  infinite fatisfaaion
the circumftances attending his graduation.   He
defcribed  the profeSFors  beyond the  Firth  as
overawed by his fame and prefence; it is likely
                                     enough 
Ixiii          ON THE  CHARACTER

enough that they wifhed to exchange  their di-
ploma Sor  his  money  with as much expedition
as poffible.
  For Several  years after 1780,  and perhaps
before,  the  profeflbrs,  the phyficians  to fhe in-
firmary,  and the focieties were unceafingly an-
noyed by the adherents of Brown ;  the ftudents'
debates were carried to the higheft pitch of vi-
olence j  by the Medical Society a  law was paf-
fed,  and,  I think,  put in force,   that if any
member fhould challenge another  for  any thing
faid  in  debate,  he  fhould incur the penalty of
expulfion.
  The  efforts  of  the Brunonians to expofe
thofe praaitioners,   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 reftriaion an-
nexed to the allowance of a very thin  beef-Stake
to a patient in that hoSpital.  It  was expreflly
ordered that the flake  fhould  not exceed one
inch and five  fixteenths  in  length,  nor  Seven
eighths of an inch  in breadth.  This,  at leaft,
is the meafure of the  pattern (h).  The tone,
afFumed  in  the commentary  upon this text,  is
that  of vehement inveaive :  on the  authority,

   (g).  Edinburgh,  1782,  pp.  32  Signed  Veri
      Amicus
   (¥), Letter,  p. 9.
                                            as 
OF JOHN  BROWN, M. D.
Ixiv
as the writer fays,  " of one of your own ftu-
" dents" he  gives  the  following ftatcment of
the hofpital diet:

            " The  Common Fare.
      " Soldiers pay is.  ^d.  per week.
 u Breakfaft—One roll of bread and a meafure of milk
   " or beer.
 " Dinner—One ditto, and a choppin of weak brotb.
 " Supper—The fame as breakfaft.
               Common Patients.
  " Breakfaft—Half  a roll,  and a meafure of milk or
   " beer.
  " Dinner—One roll,  and a choppin of weak broth.
  " Supper—The fame as breakfaft.

   " In a few  particular cafes, a little meat is al-
 " lowed and  other  necefFaries,  as  may appear
 " proper to the phyficians."
   He then notices the roaft  beef and porter of
 St. George's  hofpital in  London, and fubjoins
 this appeal:  " Let me figure the cafe that you,
 " Dodor,  were  plunged at once  into difeafe
 " and beggary; I put this plain queftion, whether
 "  would you choofe to be lodged and nurfed in
 " St. George's hofpial,  or to be depofited and
 " ftarved in the  Royal Infirmary,  under  fuch
 "  medical treatment as your  own ?  Your vidu-
 " als," he proceeds, " are not only fcanty but
 "  bad.   Your porridge is fometimes  boiled
  " almoft into  water-gruel;  your broth  is
                                    commonly 
Ixv
ON  THE  CHARACTER
 " commonly much better qualified to operate as
 " an emetic than to nourifh the fyftem—of your
 " milk we  need only fay that it refembles the
 " reft which is fold in the Streets of Edinburgh.
 " Your beer is not always tolerable even to the
 " palate of an alehoufe fcullion."
   None undoubtedly but  members of the me-
 dical profeflion,  can have an adequate concep-
 tion of the wide-wafting mifery that daily arifes
 from the want of food, fuel and cloathing.  Oc-
 cafionally,  in  diftrefsfui  feafons, the  gnawing
 pains of hunger are afluaged by private chari-
 ty ;  and impending death or madnefs is prevent-
 ed.  But no effort is made to improve the pre-
 dominant condition of the poor, though it is
 alike deftitute of comfort and of hope.   Expe-
 rience  teaches  how little  they have to  exped
 from thofe Political  Swindlers, who, un-
 der falfe pretences, acquire the power of fport-
 ing with the wealth and blood of  nations.  The
 wretchednefs of imprifoned criminals remained
 unredrefFed only  becaufe  it  was   indiftindly
 known;  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  atchieved we  (hall be aftonifhed at
 the proportion of human beings that languifh in
mifery  or perifh  prematurely ;  the univerfal
feelings of mankind will rife in behalf  of thefe
                                    vidims 
OF JOHN BROWN, M. D.      lxVl
vidims of penury ;  and their flefh will no long-
er be devoured by the luxurious creatures of cor-
ruption.  But our Brunonian  "friend of truth,"
feems  to work upon the paflion  of his reader,
merely for the purpofe of degrading a few pro-
feflbrs in the opinion  of a fet of ftudents.  If
his  letter contains  material  exaggerations,  it
Could only ferve to bring the caufe of humanity
into difrepute.
  In 17821  remember to have fpent an evening
in company with Dr. Brown.   He affumed the
fovereignty  of the circle,  which confided prin-
cipally of his difciples ;  and nobody thought of
difputing his title; he difplayed uncommon vi-
gour  of imagination, but to me  the figures he
called up were fo little  agreeable, that I never
defired his  converfation a fecond time.   Others
received entertainment; and by thofe who knew
him well, he is remembered as " the beft cora-
" panion in  the world."   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 kaures.  And yet be-
 fore he undertook the charge of a private tutor,
 he had attended an Englifh mafter at Edinburgh,
 " for the purpofe of acquiring a proper pro-
 " nunciation and method of  teaching that ian-
 " guage, which  he had not  before had an op-
 " portunity of being improved in'' [D. S.].
 But the  veftigia ruris were  not to be effaced,  or
 elfe he had voluntarily refumed his original notes. 
 Ixvii        ON THE CHARACTER

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

   His converfation was full of contempt for
the literature, talents,  and dodrincs of the me-
dical  profefFors,  one great natural philofopher
excepted.   He continually criminated them as
his perfecutors, and as unjuft towards thofe ftu-
dents who  adopted his  principles.   This inju-
stice is faid to have appeared in unufual  feverity
on the examinations previous to graduation.   In
the Enquiry thefe complaints are repeated;  and
to fhew how much  the  right of private judg-
ment  was infringed in the article  of inaugural
differtations,  the  following correspondence  is
produced :  the candidate,  it fhould be premi-
fed,  was defirous  of quoting the  Sixty-ninth,
Seventieth,  and  feventy-firft paragraphs  from
the Elementa Medkin<e in a thefis on epilepfy.
      " Sir,
  " A former experience of your civility pre-
" vents  my apologizing for troubling you on
" the following occafion,  viz.
  "  From  a  ftrid perufal and attention to my
" differtation, I find it neceffary  to folicit your
" approbation of inferting the quotation I made
" from Dr. Brown's printed  book,  to which
" you formerly objeded.
  " Amongft many other reafons, I will fubmit
" the two following to your confideration.
  " i. That  without it I am prevented from
" faying what I really believe,  to the  manifeft
tc injury of my differtation.
                    II              "  2. That 
Iviii         ON  THE  CHARACTER

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

 ed  by the matter for the honour of the  fchool,
 or an inaugural fpecimen,  garbled by the profefF-
 ors for the honour of  the Univerfity.
   Obferving the ftudents of medicine frequently
 to fcek initiation  into the myfteries of free-ma-
 fonry,  the author of the New Doftrine thought
 their youthful curiofity afforded him a chance
 of profelytes.   In 1784 he  instituted a meeting
 of that fraternity, and entitled it,  The Ledge of
 the  Roman Eagle. The  bufinefs was conduded
 in the Latin language, " which he fpoke  with
 " the fame  fluency and animation as he fpoke
 " Scotch.  I was much diverted,"  adds Dr.
 Macdonald,  " by his  ingenuity in turning into
 " Latin all the terms ufed in mafonry."
   In unfolding his fyftem it was his pradice firft
 to tranfiate the text book,  fentence by fentence;
 and  then  to expatiate  upon the paffage.  For
 moft of his pupils the tranflation was a prelimi-
 nary highly neceffary; and lie muft have confi-
 dered it as politic to combine literary with fci-
 entific inftrudion.   The profped of this dou-
 ble advantage,  might  perhaps, from  time to
 time, bring him a few additional hearers;  but
 whatever was the abfolute or comparative merit
 of the theory he taught, his feats,  I fear, were
 fcldom crowded.
   The introdudory  ledure, if my memory is
accurate, was intended  to imprefs  upon his au-
dience a fenfe  of  the importance of  the  ledu-
                                        rer's 
 IX           ON  THE  CHARACTER

 rer's difcoveries;  its effed was rather to render
' him ridiculous.   The dread of pain and death
 eafily perfuade us that improvements in medi-
 cine are more beneficial than any other art;  but
 when a man  afferts the fuperior  utility of his
 difcoveries to thofe of. Newton,  he will  with
 difficulty avoid the appearance of afferting the
 fupfcriority 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;  he  was
 thrown  off his  guard, and he  ftrongly   ex-
 preffed what he fervently believed. He ufually
 proceeded  to open his fyftem with animation;
 but he did not always perfevere with the fame
 fpirit.   He was apt, as he advanced, to fail in
 punduality of attendance.   As the mailer's  ar-
 dour abated,  SlackneSs  Stole upon the pupils ;  (o
 that his courfes not very unfrequently, I believe,
 fhared the fate of Butler's Story of the bear and
 fiddle.  The numerous inaccuracies with which,
 in Spite of the remonftrances of his well-wifh-
 ers, he  Suffered both  editions of his  Elements
 to pafs through the prefs, evince his negligence
 in thoSe  concerns which might be SuppoSed  to
 lie  neareft his heart.
   His voice was in general hoarSe 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
 (f his manner." 
OF JOHN BROWN,  M. D.
lxi
  One of his pupils informs me  thai when he
found himfelf languid,  he  fometimes placed a
bottle of whifky in  one hand, and  a  phial of
laudanum on the other;  and that,  before he be-
gan  his  ledure, he  would take  forty or fifty
drops of laudanum  in  a glafs of whifky;  re-
peating  the dofe four  or  five times during the
ledure.   Between the effeds of thefe ftimulants
and voluntary exertion,  he  foon  waxed  warm,
and by degrees  his imagination was exalted into
phrenzy.
  The Subjoined quotation fhews  that he fome-
times endeavoured to enforce his tenets in a man-
ner  not  very  ufual; conceiving it lay in his
power to remove certain  objedions deducible
" from the real or imagined inflammation of the
" brain  at the end  of Typhus," and " from
" the inflammatory part of the gout,"  he call-
ed together a party of his confidential pupils.
  " He had brought on a flight fit  of the gout
"  by unufual exercife in walking.   This was an
"  opportunity for making an experiment which
"  was to decide the whole controversy.  A per-
"  fon called for him before dinner,  who was in
"  a way of bufinefs that led him to drink in the
"  morning; he expeded a glafs from  him and
"  was gratified.  The Dodor for a reafon that
"  the reader muft perceive, colkded  half a
"  dozen of  his principal  pupils to  dinner,  and
" drank then till he only, in confequence of
                                      " what 
lxii
OK THE CHARACTER
 " what he had taken before, was  confiderably
 " affeded.   He told them he had planned fome
 " degree of intoxication in order to explain ma-
 " ny inflammations, which were univerfally un-
 " derftood to be accompanied  with, or  to de-
 " pend upon,  phlogiftic diathefis.   Before the
 " application of the ftimulus we  fpeak of, he
 " had not been able to put his  inflamed foot to
 " the ground,  but had fupported himfelf in any
 " little motion that he chofe to make  through
 " the  houfe,  by his found extremity,  aflifted
 " by the ufe of his Staff;  but before he difmif-
 " fed  his  company, he  recovered the perfed
 " ufe of his affeded leg(£>."
   A few words will  defcribe the tenor  of this
 unfortunate  man's  life, till his removal  from
 Scotland.  He was  fo  reduced in his  circum-
 ftances  as to be committed  to  prifon for debt,
 where  his pupils attended his ledures.   In the
 abufe of intoxicating liquors he obferved no mo-
 deration.  In 1775 Mr. Wait found him drink-
 ing water Only.  His fituation,  about that time,
 would have roufed almoft any man to a ftruggle
 with this deftrudive habit.  His  preface dif-
elofes the reafon  of  his fobriety.  Finding the
gout return with feverity, after fome perfeve-
rance in this experiment of abftemioufnefsj he
returned  to  the  bottle,   and never afterwards
 relinquifhed it.
             (k)  Enquiry,  p, 134.
                                        Bis 
           OF JOHN BROWN, M. ■.       lxift

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

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

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

 of his nature bent deeply inwards;  but they im-
 mediately  rebounded with equal energy.  This
 quality is the foundation of all moral and intel-
 ledual Superiority; but, unhappily, the ftrong
 feelings and bold refolutions of Brown  were not
 improved  into  fteady principles.   He  never
 feems to have  taken pains to form a  fyftem  of
 condud advantageous to  himfelf,  and juft to-
 wards others.  As foon as  he loft the controul  of
 fuperftition,  his high Spirits hurried him into
 the  moft intemperate exceffes;  and,  at a later
 period, his adions can only be regarded as the
 plunges of defpair.   The tenderneSs with which
 his  cordiality   inSpired thole who knew him
 formerly,  I could demonftrate by  a  varie-
 ty of teftimonies.   By a writer already quo-
 ted,   he is Styled  " a man  of  infinite  good-
 " nefs  oS  heart (»)."  Dr.  S—»----  con-
 cludes  his  communication with thefe expref-
 fions : " He was poffeffed of a great mind that
 " Supported him in the midft of all his diftreffes.
 <f He defpiSed riches ; detefted every thing baSe,
 " and poffeffed  Such openneSs oS heart as to be
 " liable to be taken in by  every knave."   He
undoubtedly committed  an error, which has of-
 ten been produdive  of fatal confequences  to
 perfons accuftomed to fcientific  Speculation.—
 He gave man kind credit for a more firicere re-
(n) Analyt.  Rev.   See  above.
gard 
lxvift        ON THE CHARACTER

gard for truth, and an higher fenfeof its impor-
tance,  than they ave entertained irt any age.—
He imagined, perhaps,  that  Plato's Sally con-»
Cerning Virtue was applicable to Science.   He
therefore  utterly negleded thofe arts by which
the imagination is  captivated;  and trufting to
their  intrinfic value, bluntly chalenged accep-
tance for his opinions.
   Cicero and Bacon were his favourite authors ;
in  his elaborate compofitions he  imitated the
Roman orator with  affedation ;  and it muft be
confeffed,  that by taking advantage of the pe-
nury  and  want  of precifion, which Lucretius
and Cicero  fo loudly lament, he has Succeeded
to his utmoft wifhes in  conftruding a ftyle  of
claffical obfcurity.   He could, however,  write
otherwife, and  unite at  will perfpicuity  with
purity.  This may be afcertained by examining
the differtations, which he  furnifhed,  at  lefcft,
with their Latin garb.   Several are prefcrved in
a well-known colkdion  (o) ; but  for an obvi-
ous reafon I muft leave it to the curious reader
to  difcover,  by private  enquiry,  which  were
compofed  by Brown.
   Bacon  he admired not only  for his mafterljf
furvey of univerfal fcience,  but  likewife,  as Dr.
Macdonnel  acutely  conjedures,   becaufe  that
great author appeared to countenance him in the

   (6) See Thefaurus Medicus, iii. and iv.   Edin-
  burgh, 1785-
                                     difrefpcd 
OF JOHN BROWN, M. D.       Ixix
 difrefped with which he treated his predeceffors.
 He  had  J ttle medical cru  tion.   At nr  he
 probably read more than ordinary ftudents;  but
 after he  had conftruded his theory, he feldom
 perufed  or confuted any medical author.   He
 was impatient when  any difficulty was ftartcd
 which he did not See cka-iy how to Solve  (p) :
 nor  would he ever acknowledge any exception
 to his principles.   An argument againfl his fun-
 damental propofitions, which I  had mentioned
 in converfation  to a favourite pupil, was com-
 municated one evening, to  the mafter in  my
 prefence, a little before the  hour of ledure.—-
 He faid little in reply at the moment.  But it ap-
 peared that the objedion worked upon his mind;
 in the courfe of his ledure he waxed unexped-
 edly warm ; and  at laft, addreffed himfelfparti-
 cularly to the pupil who had dated the objedion.
 He did not attempt  to  expofe  its  futility, as
 might  eafily have  been done;  but, exhorting
 him to fuffer no insinuations to divert his atten-
 tion  from the doftrine,  he  proceeded to deliver
 againfl the exercife of the understanding, a dif-
fuafive that  might have done credit  to  the pul-
 pit.
  The Obfervations, and the  Elements of Me-
dicine, arc all the produdions which he avbw-
ed.   But  there prevaileu a fufpicion, and it has

             (f)  Dr. Macdonnel.
                                        been 
lXX         ON*  THE  CHARACTER
 been publicly  mentioned (q), that he  was the
 author of the. Enquiry,  publifhed  in the name
 of  Dr. Jones.  By his moft confidential difcipks
 I have been affured, that they never heard him
 drop an hint of having affifted in its compositi-
 on.  In manner it  certainly bears a ftrong re-
 femblance  to the "Observations;"  there  are,
 befides, as the reader may obServe in my quo-
 tations, forms  of expreffion peculiar to Sept-
 land ;  but the profeffed author may be  faid  to
 have derived  the  one from his preceptor,  and
 the other from the country in which he  refided.
 7 his book,  we are told,  was compoSed  as Spee-
 dily as it could have been tranferibed by an or-
 dinary hand.   It is unqueftionably ill arranged,
 tedious, uncouth,  arrogant,  and illiberal;  yet
 it contains paffages prefenting  jufter views  of
 medicine than  I  remember to  have  elfewhere
 fcen, and concrived in the genuine fpirit of Ba-
 con.
  He defigned a Latin  elementary  treaties  of
 morality on philosophical principles (r)—Elemen-
ts Morum ;  but he never, perhaps, committed
any portion of fuch a work to paper.   We  may
fairly prefume that  it would have  been orio-ihal,
 luminous,  and profound.—And fince  no man,
not deeply fkilled  in fuch knowledge, as phy-
(q)  Dr.  Duncan's Letter, p. 25.
(r)  Dr.  Macdonnel.
ever 
           OF JOHN BROWN, M. D.       lxxl

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

   Having received a little additional informati-
on, too late  for infertion  in the proper place,  I
annex  it here.   To Mr. Wait's account  of his
quicknefs  in maftering languages; it  may be
added,  " that  Brown difplayed a genius for li-
" terature far fuperior  to any fcholar that had
" ever been  under the care of Mr. Cruikfhanks.
" In the courfe of two years,  he could read all
" the Latin  claffics with the utmoft facility;  in
" the Greek language,  he made  the  fame  re-
" markable   proficiency."   This intelligence
comes from  Dr. S—, who likewife mentions
the adonifhing power of his memory,  and adds,
that he fird went to Dunfe fchool in  1751, when
he 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 ftre-
 nuous application.   " The leading members of
" the feceding congregation at Dunfe, to which
 " his parents belonged,  were ftruck with the
 " proofs of  capacity he manifested at the coun-
 " try-fchool,  where he  learned  reading and
 " writing ;  they encouraged him to  go to the
                                  " grammar-
 
lxxii
ON  THE  CHARACTER
" grammar-fchool,  that he might be afterwards
" educated as  one  of  their ministers,  exped-
•' ing he would greatly contribute to the promo-
" tion of their particular intereft,"-------
   I  have pleafure in recording that, by advice
of the friend who brought him the firft thefis to
tranffate,  he addreffed a Latin letter, to the late
excellent  Alexander Monro,  then  profeffor of
anatomy  at  Edinburgh,  requefting gratuitous
admiflion to his ledures.  Having Succeeded in
this  inftance, he  applied in the fame manner to
the other medical profefFors.-------
   His intercourfe with  Cullen forms the moft
curious part of Brown's hiftory.  The following
memorandum includes  his reafons  for  diffatif-
fadion  with his  patron, as  they were afligned
foon  after  the feparation to a perfon  how ac-
knowledged his talents, without being a partizan
in his difputes,  or a follower of his dodrines.
" They lived upon the ftrideft intimacy for ma-
" ny years ; and Brown could call for a bottle
" of wine in Cullen's houfe,  when he pleafed.
" During all that time no man in Brown's com-
" pany could contradid any  of Cullen's opini-
" ons without danger of offending him.   After
" the quarrel, he faid Cullen had promifed him
" his  intereft for the  firft vacant chair in the
'« college ;  but when the late Dr. Gregory died,
" inftead  of ufing his intereft in  Brown's  fa-
" vour,  he did  the reverfe—that, to try him
                                       further 
OF JOHN BROWN, M. D.      Ixxiit
"  further,  Brown petitioned  for  admiffion in-
"  to  the  philofophical  fociety, but was re-
" jeded through Cullen's means."  Here only
one  fide of the queftion  is fhewn :  and the re-
prefentation comes from a man  of impetuous
paffions,  who,  to  obtain our full  confidence,
fhould either  have  been lefs violent in defend-
ing or in oppofing Cullen.—Complaints of dis-
appointed expedations are Still more common
in the intercourSe of patronage,  than  of faith-
leSs vows in that of gallantry:  this happens,  I
fuppofe,  becauSe offers and promifes are extrad-
ed from harmlefs expreffions, by which perfons
who  amufe themfelves with  gallantry and pa-
tronage,  do not intend to convey any particular
meaning.
                 i
A-
OF 
{  Ixxiv   )
  OF  Dr.  BROWN'S PRIVATE

              PRACTICE.


  TO fome  readers  it may appear ftrange that
I fhoulcj  have finifhed the life of a phyfician,
who caufed fo great an uproar in the  medical
world, without more particular  notice of his
private practice,   I enquired with fome folici-
tude, but in vain,  whether during the Jong pe<-
fio4 of his ftudies he  was peculiarly obfervant
of  difeafes.   One  circumstance  I have  lately
learned ;  and it will furprife thofe  who believe
him to have inculcated contempt for the fciences
auxiliary to medicine :  my authority however is
unquestionable.  The feafon before he  became
an  independent ledurer, he was induftrious to
acquire more minute anatomical knowledge than
he had gained by attendance on the public lec-
tures ;  and for fome time attended a private in-
ftrudor at five o'clock in the morning, and con-
tinued with  him for two hours; botanical infor-
mation was added, on  thefe occafions, to the
anatomical.   He had formerly been advifed by
Culkn to qualify himfelf  for giving demonstra-
tions in anotomy.  Nothing could be imagined
fo entirely  repugnant  to ihis turn of mind;  no
wonder, therefore,  the advice was not followed. 
3
             PRIVATE PRACTICE.         kxV

   Brown  fomewhere condefcends to  fpeak of
his own " very large pradice ;" but  this is a
compliment which every medical writer appa-
rently thinks that ufage juftifies him in  paying to
himfelf.
   I remember to have heard of an houfe at Edin-
burghj which the Brunohians opened for the
reception of poor patients ; probably they were
not able to procure funds for its permanent fup*
port.  The founder of the  fed was, I believe,
feldom confulted but in cafes given up as  hope-*
lefs;  and  he was then apt to fpeak with impru*
dent confidence.  According to Dr.  S—=-----,
"  his wifh to ride in his carriage would, in ail
"  probability,  have been gratified, had it not
*'  been prevented by his fudden death afterwards
"  in London."  If this furmife is  founded up*
on any real tokens of approaching profperky,
I could wifh they had been affigned.   For Brown
went to London with no favourable omens; eve*
ry extraneous circumftance was againfl him, and
what elfe could avail him in a  place,  where it is
Well known to men of fcbfervation,  that fuccefs
has  fcldom 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 parti-
cular (kill and general abilities, declares that
"  in a great city medical reputation  is, for the
"  moft part,  totally cafual,"   " By an acute
                                " obferver," 
lxXVi         OF DR. BROWNS,  &C.

"  obferver,"  he fubjoins, Cf who had  looked
et  on the tranfadions of  the medical world for
"  half a century, a very curious  book  might
"  be written  on the  fortune of phyficians"—
The idea appears to me fo happy  that I fhall
venture to profecute  it through a few pages.
   Such a book, with a  due extention of  the
plan, would afford opportunities for difplaying
profeffional  Science,  to  wit, knowledge of  the
world,  and benevolence.   For if it be true that
many have  been received in  the  name of  the
goddefs of  health,  who  were,  in reality,  not
the  leaft adive among the ministers of death,
the  miftake 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 priefthood has loft,   but
furnifh I know not how much ufeful.  inftrudion
befides.

     OF REPUTATION IN  PHYSIC.
   On the moft Superficial  enquiry,  it would be
manifeft  that this man proSpered  becaufe he had
been of a certain univefity ; another, merely be-
caufe he belonged  to a particular fed;  a third,
becauSe he happened to be in the way of procu-
ring a recommendation to Some  leader in poli-
tics or fafhion.   A great number would be feen
to have  Succeeded in life for the fame.reaSon
                                    precisely 
OF REPUTATION  IN PHYSIC.    lxXVU
precifely that FalftafF fucceeds upon the ftage.
Few  analyfe their fenSations,  and the  firft im-
preflion made by thefe adventurers was  pieafing.
As far  as  the dramatic perfonage is concerned,
the reafon is unqueftionaule, but it by no means
-applies fo happiy to the other cafe*  The qua-
lities producing tne happy imprefiion,  have,  in
truth, frequently borne  no nearer a relation  to
profeflional merit,  than FalftafPs pleafantry to
folid worth of charader ;  in a variety of inftan-
ces,  they have been no  other than fymmetry of
features or foftnefs of addrefs.
   It is  calamitous  enough-for individuals,  la-
bouring under difeafe„tto fall  into bad or indif-
ferent hands; but when the caprice of  fortune
elevates her worthlefs favourites to the  firft emi-
nence in So  important  a profeflion as medicine,
a  more  extenfive injury is done to Society than
twe  fhould at  firft  imagine.  . To calculate its
amount  requires a great deal  of thought.   Be-
fide the miSchief they perpetrate with their own
hands,  thefe intruders  occupy the Station  due
(if the  general  welfare  is to fettle the prece-
dence),  to phyficians  of enlarged views, who
would  make a beneficial  ufe of its advantages,
and  impel the  defedive art on towards perfeai-
on.   Is an example  neceffary  to enable  you to
conceive what  might be effbaed by the power-
ful influence of  medical men,  enjoying the con-
fidence of the great ?  A  number may  be given,
                                          but 
ixxvili   OF REPUTATION IN  PffYSlC.

but one will fuffice :  and it is the bettef for its
fimplicity.   We  have  no obfervations  frorh
which we can certainly deduce  the difference, in
point of efficacy, between certain warm medicinal
Springs and common water,  heated to the fante
temperature.  The problem, merely for its cu-
rioflty,  deferves to be folved; and it happens
to be  peculiarly interefting  to that order, from
which dodors  in  vogue receive their ampleft
gratuities.   They  have  fhewn  little anxiety  for
the removal of this difficulty, either for  their
own diredion in pradice, or by way of returft
to their benefadors.
  They will too often, I fear,  be found to have
been worfe than inattentive to the advancement
of their art j  and to have difcouraged ufeSul  in*
veftigations by infinuation,  if not by dired op*
pofition.  Pride and avarice will always combine
to render a profperous adventurer in medicines,
whofe views are narrow, jealous of improve-
ments and hoftile to improvers.  The  internal
monitor  whifpers that it was not by knowledge
he rofe, but by knowledge he may fink.  It is
therefore  the conftant expedient of dullnefs to
perfuade the world that men of  genius are defi-
cient  in  judgement;  though it be certain that
the  very perfons who have been moft remark*
able for deviling new means of  relieving diftrefs
and removing uncertainty,  have alfb  been the
moft  acute  in  difcerning the real relations of
                                     things. 
         ©P  REPUTATION IN PHYSIC.    lxxtX

 things.   Still,  however,  the old way is judged
 the fafeft, and crafty mediocrity treafures up the
 ipoils of the credulous and the rich.
    It is poflible to meafure the number of de-
 grees by which medicine is more imperfed than
 it would have been if the public  was not fo  liable
 to mifr)1ace its confidence,  and  had not adually
 fo often mifplaced  it.   For  this purpofe, our
 enquirer, I apprehend, will find in the progrefs
 of a kindred art, a Standard of cafy application.
 Let  it be fuppofed that a  fiiccefnon  of men of
 fpecious carriage and mean talents had flourifhed
 for a century paft, in the place of our great im-
 provers  of furgery.  Then good part  of  their
 difcoveries would have been loft, for  we cannot
 believe that, under difcouragement, and  with
 inferior opportunities,  Pott, Hunter, and their
 predeceflbrs  could  have rendered equal fervicea
 to  humanity.  Of thefe fervices a concifc but
 clear account fhould be given; the fame Scru-
 tiny fhould then be extended to  the labours  of
 the  phyficians that have flourifhed during the
 fame period ; it may begin with Radcliffe, and
 be carried down to our own times.  Thus ordi-
 nary readers would be put in a condition to judge
how far it betrays a fpirit of wanton difparage-
ment,  to affirm that a phyfician  in  a great  city,
 H  is the- mere plaything of fortune, they  that
" employ him,  not  knowing his excellence,
" nor 
 IXXX    OF REPUTATION  IN PHYSIC.

 nor they that  rejed him,  his deficience 0)i"
 thefe affertions,  if  they be well-founded,  ine-
 vitably lead to  a  conclufion more  important
 than fatisfadory, for however we may be dart-
 led, we muft infer that the greateft repute in medi-
 cine affords fear ce the flight eft prefumption of fuperi-
or Jkilfulnefs.
  Of the fortunate fons of Efculapius,  feveral
 have been wary enough not to expofe themfelves
 to cnticifm ; in mod: cafes, however, we have
 memorials Sufficient to  guide our judgement;
 fome have left written documents of their.pow-
 ers ; here the proportion between reputation and
 ability can be edimated with great precision.
  Considering that his enquiry can be uSeful on-
 ly  by inculcating falutary  circumfpedion, our
 author fhould not be deterred by the fird Senti-
ments of repugnance which the attack would ex-
cite in many minds, nOr  by the refped due to
his  virtues, from examining the title of the cele-
brated Fothergill to prefent confidence, or poft-
humous reputation.  He fhould infift the more
on this decisive example,  becauSe Fothergill re-
ally appears to have done his bed: towards  im-
proving the art that enriched him ; and  becaufe
it  would  be  difficult to prove that  any among
his  equals  in popularity, have performed,  or
could have performed greater things.   How far

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

         (t) Fordyce on  Fever, p. 160.
                     L                  this 
lxXXli   OF  REPUTATION  IN PHYSIC.

this caufe of inequality, the author of the In-
vestigation would find  a far more powerful caufe
neceffary  to account for the whole efFed.—He
might corroborate his inference by an enumera-
tion of  the  improvements adually made in me-
dicine ; from which it would  be evident that
they have been principally owing to perfons en-
joying moderate reputation in the country.
   Objeaions 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 emi-
nent furgeons, who have  found time  to write
cxtenfive  treatifes; moreover,  his praaice  and
converfation, without  the aid of his pen, would
fo  widely Spread the knowledge of his difcove-
ries, that the patients of every village  apothe-
cary would have caufe  to blefs the London lumi-
nary of phyfic.
   The anSwer to thefe objeaions affords  a cri-
terion,  by which we Shall be  as little liable to be
deceived, as when we judge of  the value of a
fruit-tree  by its produce.  If a  phyfician has  at-
tained to great eminence  without having  made f&mt
affignable  improvement in phyfic,  if be has neither
executed nor promoted any deflg:^, tending to tbis
r,:dt he may befafelyfet dawn as the narrow-minded
                                      creature 
         OF REPUTATION  IN PHYSIC.   IXXXIU

creature of artifice, or thefpoiled child of chance.—
In an age where every incident is brought within
reach of every eye, we may with perfea fafety
apply to perfonages fo confpicuous the maxim of
the fchoolmen,  that  " what does not appear, is
" to be reputed not to exift."
  The work in queftion doubtlefs requires cou-
rage as well as other valuable qualities ;  yet  the
author,  if  I do  not  miftake, would  incur lefs
danger at prefent than at any  preceding period.
The profefFors of Surreptitious or accidental fame,
would infallibly join in crying  or hunting him
down, and by Signs of alarm bear witnefs to  the
merit of the produaion.  But I have reafon to
believe that the combination would fail in bring-
ing it into  total difcredit.  Some progrefs  has
been  made in arranging the peculiar properties
of animated nature,  and in  recommending to
mankind the knowledge of themfelves.   A  fe-
ries  of propofitions, expreffed in intelligible
language,  and capable of comparifon with ap-
pearances,  has been formed.   Thefe propofiti-
ons, which occur principally in the writings of
Dr.  Brown, Mr. Plunter,  and  the  author  of
Zoonomia,  may be regarded as the  foundation
of a new fcience,  not lefs generally  interefting
than any of the preceding : for it would be dif-
ficult to affign a reafon why the celeftial motions,
the working of machines,  or chemical pheno-
mena,  fhould be objeas of liberal  curiofity;
                                       to  the 
1XXXIV  OF  REPUTATION  IN PHYSIC.

to the exclufion  of the effeas produced by the
principle  of life.   One reafon,  of which  the
force will not be eafily eluded,  may be affigned
in behalf  of the latter Study.  It direaiy tends
to promote the well-being,  and prolong the ex-
idence, of  the  dudent.   The time  therefore
cannot be far didant,  when inftruaion concern-
ing  the caufes of  health and difeafe will be ac-
knowledged to form a neceffary part of  all  rati-
onal education;  and the nearer we approach to
this  period,  with  lefs hazard may the 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 Somewhat to precisi-
on, and fomewhat to fecurc the fick againfl the
danger of medical  flaughter.   This appendix I
fhould call Jatroi.ogia, a denomination from
which the learned reader may infer, that  I have
in view fome fuch application of the Linnsean
method to phyficians, as Baron Born has exem-
plified in his claffification of Monks.
  If thofe affemblages of human animals,  that
constitute political  Societies,  were  arranged ac-
cording to the nature -of their occupations,  one
clafs would confift of individuals,  depending for
their fupport upon  opinion.   This clafs,  being
provided with the name of Greek origin, might
be eafily fplit into orders;  of thefe orders the me-
dical  tribe would make one.   We have the or-
                                  der broken 
        OF REPUTATION  IN PHYSIC    1XXXV

der broken into genera ready to our hands:  of
the diftribution into Species (which is more dif-
ficult) a Specimen is Subjoined.—Our writer's
prefent concern  is only with the genus—Doclor
of Phyfic.  This genus  we may  Subdivide into
feaions, or groups ; as Linnseus fometimes ma-
nages with genera, comprehending a number of
fpecies.
              SECT.  I.
Doctors as deftrous, at leaft,  of doing good and
  extending knowledge, as of amaffmg wealth.
   i.  The philanthropic "Doctor,  D.  equally fen-
fible of the importance and imperfeaion of me-
dicine ;  compares the phenomena of health and
difeaSe with  unwearied afliduity,  that he may
form  a juft arrangement of the  aaions of life,
perfuaded that this is the only fiire guide in me-
dical  praaice ;  cautioufly tries  new remedies,
and abides by the  beft ;  beats the coverts of fci-
ence, that he may himfelf Start Something uSe-
ful ;  is humane  in  his  condua,  not  fo much
from  Sudden impulfes  of  the paflion  of pity,
as from a fettled  conviaion of the mifery pre-
vailing among mankind.
  Var.  «. The Shy philanth.  D.  fick  with dif-
guft at the manoeuvres of his intriguing brethren,
runs into the oppofite extreme,  and keeps too
clofcly retired from public notice.
   Var. £.  The renegado phi!. ID. poffefling ac-
                            -           tivity 
IxXXV'i           JATROLOGIA.
  tivity of mind and integrity of  principles ; re-
  linquishes  the praaice of phyfic,  partly for the
  fame reafon as Var. a.  and partly from diffatis-
  faaion with its helplefs ftate;  applies his talents
  to literature or fcience.
   Obf. i. Several of the greateft acceflions to hu-
 man knowledge are  owing to this fecond  va-
 riety.
   Obf. i.  A careful examination and compari-
 fon  of  thefe  two  varieties, with  fome  of the
 Succeeding  fpecies, will  elucidate the  nature of
 thofe phyficians, that have ufually had  great lo-
 cal  vogue.
   More frequent than formerly—not apt toflou-
 rifh in great cities—otherwife not confined to any
 particular  Situation.   As  felf-love  grows more
 enlightened, the more common will this fp. of
 D. become, till it fupplants all the others :  man
 being an animal lefs liable to be duped as his ig-
 norance dccreafes.
               SECT.  II.
   D. Mere colleclors of fees, regardlefs of medical
fcience, given to artifice and intrigue,  each fpecies
 after its own manner.
   3. The bullying Doctor, D.
             ----Inexorabilis, acer
 looks big,   Struts,  Swaggers,  Swears.
   Obf.  Surgeons,  in our times, more frequent-
 ly  bear  thefe marks.   According to a  moft
 acute contemporary author,  the famous Rad-
 cliffe was a compleat fpecimen of the bullying 
JATROLOGIA.          lxXXVU
D.  " With fmall fkill in phyfic, and hardly any
" learning,  he got into praaice by vile arts.—
" He would negka a nobleman that gave exor-
" bitant fees;" and to heighten the  infult by
contrail " at the fame time carefully attend  a
" fervant or mean perfon  for  nothing—he was
" fiirly and  morofe;  treated  his patients like
" dogs—extended  his infolence  even  to the
" Royal Family—fcorned to confult with his bet-
" ters on what emergency foever; looked down
" with contempt on the moft deferving of his
" profeffion,  and never would confer with any
" phyfician who would not pay homage to his
" fuperior genius ; creep  to  his  humour,  and
" never approach him but with the flavifh obfe-
" quioufnefs of a court flatterer."
  3.  The bachanalian Doctor. D. given to fot-
tifhneSs, if not  drunkennefs—generally fome-
what of the Bully.
   4.  The folemn Doctor. D. with garb, voice,
geftures, and equipage, contrived to overawe
weak  imaginations,  and hide  the futility of  his
art.
   Obf 1.  D.  of this remarkable fpecies firft
praaifed phyfic with  pomp:  they invented or
borrowed  from the other profeffions thofe bar-
barous habiliments, of which ridicule has but
lately  ftripped phyficians.  In times, when an
huge wig, or a flowing gown,  could more effec-
tually 
IxXXviU          JATROLOGIA.
tually  command refpea than found morality,
fubftantial juftice, or ufeful  fkill, the Stratagem
fucceedcd to admiration.
   Obf.  i.  D. of this  fpecies,  when a pretext
offers, fpeaks oftentatioufly of their experience
—never fufpeaing  any of  their hearers  may
know that there  are  understandings which mul-
tiplicity of appearances ferves but to confound.
   5.  The club-hunting Doctor. D.  frequenting
the crowded haunts of men;  pufhing himfelf
forward, faluting all he knows, and all who will
know him; talking much and loud.
   Obf. In England,  D.  of  this fpecies have of
late been frequently feen in paroxyfms of frantic
loyalty, and of civifme  in France.
   6. The burr Doctor. D. faftening himfetf
upon you as tenacioufly as the heads  of  the noi-
fome weed (centaurea  calcitrapa), from which
the trivial name  of the fp.  is taken, fix. upon
your cloaths.
   Obf  Nothing in  art, but the juggler's ad-
drefs in making you take what card he pleaSes
out of  a pack, equals  the dexterity with which
D. of this fp. force  themfelves on patients.
   7.  The wheedling Doctor. D. with an  ever-
lafting fmirk upon his countenance—frequent at
the polite end of large cities,  and  at places of
fafhionable  refort.
   Var.  «.  The Adonis  wheedling D.  D.  with an
handfome face, joined  to the wily addrefs,  cha-
                                    raaeriftic 
JATROLOGIA.           Ixxxix
raderiftic  of  the  fp.—flourifhes at  watering
places ; fometimes  joins  to his  profeffion  the
trade of a fortune-hunter ; and if he fuccecds,
"  gives phyfic to the dogs."
   Obf. i.  D.  of this fp. when moft moderate,
preScribe for every  rich patient  two draughts a
day, and one  night draught,  befides pills and
powders.   Hence needkflly to Swallow  nauSeous
drenches may be numbered among the curSes 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 Spirit of cabal in behalf of  the won-
der-working youth, and his fortune is made.
   8.  The cafe-coining  Doctor.  D.  publifhing
forged or falfified cafes.
   Obf " A very fertile fource of falfe  fads has
"  been opened for fome time paft.  This is,  in
"  fome young phyficians, the vanity of being
"  the authors of obfervations which are often too
"  haftily made,  and fometimes, perhaps,  veryen-
eC  tirely dreffedin the clofet.   We dare not at prc-
"  fent be more  particular ;  but the next age
"  will difcern many indances of perhaps the  di-
"  red falfhoods, and certainly the many mif-
"  takes in  fad, produced in the prefent age,
"  concerning the virtues and powers of medi-
"  cines."   Cullen.  Mater. Med. I. 153.
                     M                A-kin 
XC             JATROLOGIA.

  A-kin to this flagitious abufe is the pradice of
purchafing falfe attestations, on oath,  for adver-
tifements;   and what  is Still  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,
neverthelefs, permit Quacks to ufe their names
in testimony of cures,  which they fuppofe them-
felves to have witneffed.
   9.  The good-fort-of man Doctor. D. a good
fort of man, armed, by fome miftake with a di-
ploma.
   Var. a.  The goffiping  good-fort-of man  D.
fetches and carries fcandal.
   Obf.  Varieties numerous as the hues of the ca-
 maekon.
   10.  The  Sectarian  Doctor. D.  dwelling
 among his own people at firft ;  and by them of-
 ten pufhed on to Spread devastation  among the
 reft of mankind.
   Obf. Varieties manifold ; each diftinguifhable
 by  the livery  of its fed—one is too curious to
 be omitted.
   Var.  a. The infpired Seel. Doctor.  D. be-
 lieving  himfelf to  be infpired with the know-
 ledge of difeafes and remedies.
    In civilized countries not much more frequent
 than  witches.  Among rude tribes, as among
 ihc Tartar hordes,  a  kindred variety is univer-
                                         fally 
JATROLOGIA.             XC1
fally found.  See Gmelin's Travels.  But thefe
feem rather to pretend to infpiration, than really
to believe that their deity ferves them in the ca-
pacity of Prompter ; and they conjoin the cha-
raders of prieft and conjurer with that of phy-
fician.  I  have not been able to afcertain whe-
ther our variety receives the afflatus,  except in
its  medical capacity: and  the miracles  it   has
wrought in this, are not fo perfedly authentica-
ted, as to fiknce cavillers.
  Obf People are now-a-days delicate in giving
recommendations on  fome  occafions; but  the
beft bred perfons make no fcruple  of preffing a
favourite phyfician or apothecary upon their  ac-
quaintance.  Yet one would think that they are
nearly as competent to fpeak to the merit of a
footman, as of  a prefcriber or compounder of
drugs.  Seds fometimes improve this propenfi-
ty into a regular fyftem of  cabal.   The deeper
the hypocrify,' or the wilder the enthufiafm of
the Sed. Dodor, the more  eagerly will his bro-
ther-fanatics dafh through thick and thin to ferve
him.   Now as belief or difbelief in certain points
of theology, has no  apparent connedion with
fkill in the administration of antimony,  mercu-
ry, opium, and bark,  we may deduce from this
fad a rule which is probably as little liable to ex-
ception,  as any that be laid down on the whole
fubjed.  Never call in a phyfician, because  he is
recommended by a perfon of the  fame feci / the  more
                                          yo 
 XCli              JATROLOGIA.

you are urged, be the more on your guard againft the
fnare.   This rule extends to  all demoniacs pof-
 feffed by the corporation-fpirit,  and to all fets  of
 perfons remarkably gregarious.

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

which the phenomena of  life  depend.  This
principle is denominated excitability.
   II.  The excitability varies indifferent animals,
and in the fame animal  at different times.  As it
is *nore intenfe,  the animal is more vivacious or
more  fufceptible of the adion of exciting powers,
   III. Exciting powers may be referred to two
claffes. i. External, as heat, food,  wine, poi-
fons,   contagions,  the blood,  fecreted fluids,
and air. 2. Internal,  as the fundions of the bo-
dy itfelf,   mafcular exertion, thinking,  emotion
and paffion.
  IV. Life  is a  forced ftate;  if  the  exciting
powers are withdrawn, death enfues as certainly  "^
as  when the excitability is gone.
  V.  The excitement may be  too great,  too
fmall, or  in juft meafure.
  VI. By  too great excitement weaknefs is indu*
eed,  becaufe the excitability become defedive;
this is tndiretl debility: when the exciting powers
or ftimulants are withheld, weaknefs is induced;
and this is direft debility.  Here the excitability
is in excefs.
  VII. Every power  that ads  on  the living
frame, is  ftimulant, or  produces  excitement  by
expending excitability.   Thus,  although a per-
fon, accuftomed to animal food, may grow weak
if  he  lives upon  vegetables, ftill  the vegetable
diet can only be confidered as producing an ef-
fed,  the fame in kind with animals,  though in-
                                       ferior 
        OF THE BRUNONIAN SYSTEM,    XCT

ferior in degree.  Whatever powers therefore,
we imagine,  and however they vary from fuch
as are habitually applied to produce due excite-
ment, they can only weaken the fyftem by ur-
ging it into too much motion, or fuffering it to
fink into langour.
   VIII.  Excitability is feated in the medullary
portion  of the nerves, and in the mufcles.  Aj
foon as it is any where affeded,  it is immediate-
ly affeded every where ;  nor is  the excitement
ever increafed in a part, while it is generally di-
minifhed in the fyftem ;  in other words, differ-
ent parts can never be in  oppofite dates of ex-
citement.
   I have already fpoken of an illustration, drawn
up by Mr. Chriftie from a familiar operation, to
facilitate the conception of Brown's fundament-
al positions.   I introduce  it here  as more likely
to anfwer its purpofe than if feparately placed at
the end of my preliminary obfervations.   " Sup-
" pofe a fire  to be made  in a grate, filled With
" a  kind of fuel not very combuftible,  and
" which could only be kept burning, by means
" of a machine containing feveral tubes, placed
" before it,  and conftantly pouring ftreams of
" air into it.   Suppofe alfo a pipe to be fixed in
" the back  of the chimney, through which a
" conftant fupply of frefh fuel was gradually lee
" down into the grate,  to repair  the wafteocca-
" fioned by the flame, kept up by the air ma-
"  chine." 
XCVi    ON  THE  BRUNONIAN SYSTEM.

  " The grate will reprefent the human frame ;
" fuel in it, the matter of life, the excitability of the
" Dr. Brown and  the fenforialpower of Dr. Dar-
« win ;  the tube behind fupplying frcfh fuel,  will
« denote the power of all living fyftems con-
" flantly to regenerate or reproduce excitabili-
" ty; while the  air machine, of feveral tubes,
" denotes the various ftimuli applied  to the ex-
" citability of the body; and the flame drawn
" forth  in confequence of that application re-
6C prefents life, the produd of  the exciting
*c powers ading upon the excitability."
  " As  Dr. Brown has defined life to  be  c a for-
<c ced ftate,'  it is fitly reprefented by a flame,
" forcibly drawn forth,  from fuel  little difpofed
" to combuftion,  by the conftant application of
" Streams of air  poured  into it from the differ-
" ent tubes  of a machine.  If fome of thefe
" tubes are fuppofed to convey pure  or dephlo-
" gifticated  air,  they  will denote  the higheft
" clafs  of exciting powers, opium, mufk, cam-
" phor, Spirits, wine,  tobacco,  &c.—the dif-
" fufible ftimuli  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  ftimuli, applied to   the human
                                    " frame, 
BRUNONIAN SYSTEM.
XCVll
 " 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 fedarive powers, fuch as poifons,
 " contagious miafmata,  foul air, &c."
   " The reader will now probably be at no lofs
 " to understand the feeming paradox of the
 " Brunonian fyftem ; that food,  drink, and all
 Cf the  powers applied to the  body, though they
 " fupport life,  yet confume it;  for he will fee,
 " that the application of thefe powers, though
 ct it brings forth life, yet at the fame  time  it
 " waftes the  excitability ox matter of life, juft as
 " the air blown into the fire brings forth more
Cf flame,  but  waftes 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 Sooner it is Spent.'   A Roman
" poet  has given  us, without intending it,  an
" excellent illustration of the Brunonian fyftem,
" when he fays,
   "  Balnea, Vina, Venus, confumunt corpora noftra,
   "  Sed Vitamfaciunt Balnea Vina Venus."
   "  Wine, warmth, and love our vigour drain;
   *'  Yet wine, warmth, love, our life fuftain."
  Or to tranflate it more literally,
   "  Baths, women, wine,  exhauft our frame,
   "  But life itfelf is drawn from them."
                                   " Equally
                     N 
XCviii         ILLUSTRATION OF THE

  ." Equally eafy will it he to Uluftrate thejwo
" kinds of debility, termed diretl  and indiretl,
" which, according to  Brown, are the caufe of
" all difeafes.   If  the quantity of  Stimulus, ox
" exciting power, is proportioned to the quanti-
" ty of excitability, that is,  if no more excjte-
" ment is drawn  forth than is equal to the quan-
," tity of excitability produced, the human frame
<c will be in a ftate of health, juft as the fire wiij
7 be in a vigorous Slate, when no mOTe  air &
c5 })lown in,  than is  Sufficient to confume the
f;f frefh funply of fuel constantly poured  dowjj
" by the tube behind.   If a fufficient quantity
" of ilimulus is  not applied,  or  air not blown
" in, the excitability in the man, and the fuel in
" the fire vyili accumulate,  producing direel fyb\-
X\ Hty» % the man will become weafa and fhe
" fire hw.  Carried to a certain degree they will
" occafion death to the firft,  and extindipn t#
" the laft. If again, an over proportion qffti.mu-
" lus be applied,  or too much air blown in, the.
" excitability will foon be wafted, and the  mat-
" ter of fuel almoft Spent.   Hence will arife in-
" direcl debility,  producing the fame weaknefs in
" the man,  and lownefs in the fire as before,
" and equally terminating,  when  carried  to a
" certain degree,  in death and extindion."
   " As all the difeafes of the body, according to
" Dr. Brown,  are occafioned by  dired or indj-
" red debility,  in confequence of too much or
" too little ftimuli, fo all the defeds of the fire
                                      "muft 
BRUNONIAN SYSTEM.
xcix
 ce miiffarife frotfi'difed or indired lownefs,  in
 " corifequerice  of too  much,™' too little  air
 " blown into it.   As Browh taught that one de-
 " bility1 was never to be cured by another,  but
 " both by the more judicious application of fti-
 " rfiull, fo will be found the cafe in treating the
 ,f defeds of the  fire.  If the fire has become
 "low, or  the  man weak  by  the" want of the
 "'needful  quantity of Stimulus, more riiuft  be
 " applied,  but very gently at firft, and increaf-
 " ed by degrees, .left a* ftrong Stimulus applied
 " to the accumulated excitability'fhould produce
 " death,  as in the caSe of a'limb benumbed by
 " cold (that  is  weakened by the accumulation
 " of its excitability in confequence  of the ab-
 " ftradion  of the ufual  ftlmulu^ of  heat)^ and
 " Suddenly held to the fife',  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', affaikd  by  a fiidden and
 " ftrbng blaft of air, would b6 overpo we reel and
 *e put out, ihftead of being nourifhed and increaf-
 " cd.   Again,  if the man or the fire  have been
 " rendered  indiretliy' weak,  by  the  application
 "of to6 much Stimulus,  we are not Suddenly to
 " withdraw the Whole, or even a great quantity
" of the" exciting powers or  air, for  then the
" weakened; life  and diminifhed  flame  might
"  finksenrirely, but we are by little and little to
" drminifh'' the overplus of ftimulus, fo as to
                                    " enable 
c
REPUTATION OF THE
"  enable the excitability,  or matter of fuel, gra-
"  dually  to  recover its  proper proportion.—
"  Thus a man  who has injured his constitution
tf  by the abuSe of  Spirituous liquors, is not fud-
"  denly to be reduced to water alone,  as is the
"  pradice of fome phyficians, but he is to be
"  treated, as the judicious Dr. Pitcairn ofEdin-
"  burgh,   is faid  to have treated a Highland
"  chieftain, who  applied to him for advice in
"  this Situation.   The Dodor gave him no me-
"  dicines,  and only exaded a  promife of him,
"  that he would every day put  in as much wax
"  into the wooden queich out of which he drank
"  his  whifky,  as  would receive the  imprefiion
"  of his  arms.  The  wax thus gradually accu-
"  mulating, diminifhed daily  the  quantity  of
"  the whifky, till the whole queich was filled with
"  wax, and the chieftain was thus gradually,
"  and without injury to his constitution,  cured
"  of the  habit of  drinking Spirits."
   " Thefe analogies might be purfued farther j
"  but my objed is folely to furnifh fome general
<?  ideas,   to  prepare  the reader  for   entering
"  more eafily into the Brunonian theory, which
"  I think he will be enabled to do after perufing
"  what I have  faid.  The  great excellence of
"  that theory, as applied not only to the pradice
"  of phyfic, but  to the  general conducl  of the
Cf  health is,  that it impreffeson the mind a fenfe
*'  of the  impropriety and danger of going from
"  one extreme  to another.   The human frame
<{h 
BRUNONIAN SYSTEM.
CI
" is capable of enduring great varieties, if time
u be given it, to accommodate itfelf to different
" ftates.  All the mifehief is done in the tranfi-
<* tion  from one ftate to another.   In a ftate of
ff low excitement we are not rafhly to induce  a
" ftate of a high excitement,  nor when elevated
"  to  the  latter, are we Suddenly to defcend to
"  the former, but ftep by Step,  and as one who
"  from the  top of a high tower defcends to the
" ground.  From hafty and violent changes the
"  human frame always  differs,  its particles  are
"  tornafunder,  its organs injured, the vital prin-
"  ciple' impaired,  and  difeafe, often death, is
"  the inevitable confequence."
  " I have only to add that though in this illu-
" ftration of the Brunonian Syftem  (written fe-
" veral years ago), I have fpoken  of a  tube
" constantly pouring in frefh  fuel,   becaufe  I
" could not otherwife convey to the reader a fa-
" miliar idea, of the power poffeffed by all li-
" ving SyStems,  to renew their excitability when
" exhaufted, yet it may be proper to inform the
" dudent,  that Dr. Brown fuppofed every living
" fydem  to have received at the beginning its
" determinate portion of excitability,  andthere-
" fore, although he  fpoke of  the exhaudion,
" augmentation, and even renewal of  excitabi-
" lity, I do not think it was  his intention to in-
" duce his pupils to think of it, as a kind of
*f fluid'fubftance, exiding in the animal and fub-
                                        "jed 
 Cli          REPUTATION Of THE

 " jeer* to* the law by which fucb fubftanCeY are
 " governed.   According to him excitability wa^
 " an  unknown Jomewbaf, fubjed  to peculiaP
 " laws of its own,  and whofe different dates'we?
 " were obliged"to defcribe  (though inaccurately)1
 " by terms-borrowed from-the qualities of ritatc-*
 " rial  fubilances."
                                       T.  C.

   IT  was not  unufual  for Brown?S difciplcs to
 difagrce, when they were called upon for a ftrifb
 interpretation  of his principal- tenets.   If they*
 be rigidly examined; they will be found, I think,"
 not quite confiftent with his own important doc-
 trine of  the  accumulation of excitability,  du-
 ring  different  Slates  of inadion.  It appears to
 me,  that according to his firft chapters (xviii),
 living  beings ought to have proceeded through
 langour to death in one unbroken tenour of wake-'
 fulnefs, and that all the images and lamentations
 which  fleep has' Suggefted to  the poets,  would
 have been loft.  He who affumes that  a certain
 portion of excitability is originally  afligned  to
 every living Syftem,  byr his very^affurhption,' de-
 nies its continual produdion, fubfequent difirrnV
 on,- and expenditure at a rate equalto-the fuppiy,
or greater or lefs.  That the brain is an organ'
 deftined  to fecrete the matter of life,*het:ourdJ
 never have fuppofed, otherwife he" would -not*
 have expreffed  a doubt whetherextrtabiKty.be" a'
 quality or a Subftance.
   If we admit a fucceffive Jupply of this princi- 
             JBRUHONIAN  SYSTEM.         ClU

pie,  we may folye in a very .eafy manner,  fever
ral difficulties, for the fake of which new epi-
cycles muft be added to Brown's fyftem.   In the
co\d ;hat& WC jrnay imagine the generation of fen-
forial pow.er3 to proceed with  (mail diminution,
while the a&ions  on the furface of the body are
considerably abated by local fuhdudion of heat.
Thus /the well-known glow will be the effed of
undiminished produdion within,  while external
expenditure  is  .diminiflied.  But weak  perfons
frequently do not  experience any  glow.   Here
the  action on the (kin affieds the fyfte^a univer-
fally; the produdion, therefore, is checked from
the torpor of the  fecerning organ, and this ftate
of the brain explains  the head-ache and chiliinefs,
fubfequent to the mifufe of the cold bath.   Thefe
effeds are not, in my apprehenfion, 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 fenfi-
ble change, in a ftate capable of germination and
growth." Sleep fometimes produces no refrefh-
ment, and yet it feems not to be imperfed or
difturbed in  proportion  to  the langour felt  on
awaking.  This t have attributed to a failure in
the fwftpty of excitability (a,) j and nervous fe-
ver  is  imputed by another phyfiologjft,  to this
caufe qf debility, of which Brown had no fuf-

        (d) Obfervations on Calculus, &c.

                                 fufpicions.—* 
civ
REPUTATION OF THE
picion.—If an illustrative analogy be defired, his
excitability might be compared to a fluid lodged
in the body as a  refervoir.  According  to  the
ftatement which I think more  confonant to  the
phenomena,  excitability would be like  a fluid
iffuing from the brain as water from a fpring.—
Thefe refemblances 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 limited term of life;  according to  the
other fuppofition,  we muft conceive old age and
death to depend upon a limited power of fecreti-
on in the brain.  The difference is Scarcely per-
ceptible here, but in terms; it is, however, plea-
fing to fuppofe that wifer ages will be employed
in the  culture of  the  human  fpecies to which
prolongation of life is effential:  and we can more
eafily reconcile our thoughts to augmentation of
power  in a fecerning organ, than of the  original.
provifion of excitability; fo that the dodrine,  in
other refpeds  the  more probable, feems more
conformable to the profped of improvement,  .

    Of Brown's Application of bis  Principles,

   The moft negligent obfcrver might bring fpe-
cious objedions againft  that uniformity of opera-
tion in Stimulus which is  taught in the firft propo-
fitions 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 re- 
OF BROWN'S DOCTRINE.
CV
laxing, in fome degree,  the rigour of his princi-
ples.  When the excitability is wafted by one Sti-
mulus, excitement, he  fays, msy be produced
by another ; nor does it feem neceffary, accord-
ing to the examples quoted in the latter part of
the thirty-firft paragraph, and the fubjoined note,
that the fecond ftimulus  fhould be  more pow-
erful than the fird.  The fucceflion  in the note
is, food, thrught, wine, food, punch, opium,  punch,
thought, and fpeech ; and this is not conformabk
to the afcending fcak of dimuli, according to his
edimate in other paffages.
   He alfo admits fome  modification  of dimulant
power, from the manner in which different ftimu-
li are applied.  Thus heat Stimulates the  furface
more than the fubjacent parts; and ftimuli re-
ceived into the ftomach exert more  adion there
than on any other part.
   It is extraordinary that he fhould not have ex-
tended this inequality of operation to the consti-
tuent, as well as the integrant parts of the fyf-
tem.   It was his principal fault, naturam tanquam
epraalta turri defpicere; hence  his  explanation
of minute appearances, will  often be found un-
satisfactory.  The fourth and and fixth  chapter
of Part II. afford feveral examples ;  I fhall feled
one : " Thirft and heat,"  he obferves, (CLIX.)
" depend upon fthenic  diathefis of the extreme
" veffels of the fauces and fkin.  Thefe veffels
" become fo much conflicted as to  prevent  the
" difcharge of the perfpirable matter.   Mean-
                       O 
cvi
STRICTURES  ON  SOME
" while the  frood,  flowing  near  the  extremi-
" ties of the exhalant  veffels, lodges under the
" cuticle, the heat which is generated in the
" Sydem,  and which would be carried off,  if the
" perfpiration were free."  He explains fthenic
third from a  fimilar condridion of the veffels,
which fecrete faliva and mucus; and in the Small-
pox the puduks are faid to be  occafioned  by   a
fimilar condridion, which detains the contagious
matter under the cuticle.   This permanent con-
dridion, we are told, is not fpafm ; no diftindipn,
however, is attempted, except by referring con-
ftridion to excels, and fpafm to defed, of ex -
citement.
  Upon this reafoning, it may be remarked,  i.
That exceffive excitement of veffels confifts  in
exceffive oScillations—in  the  increafe, not  in
the  fuppreffion of  their healthy fundions  ; and
2.  That  to  account  for morbid alteration   in
the ordinary ftate of any difcharge,  we ought to
look for an alteration in the ad ion of  thofe vef-
fels, by whofe counterading powers it is regula-
ted in health.  The balance in the  perfpiration
depends on the cutaneous exhalants and abforb-
ents; but the properties of the lymphatic fyftem
feem never to have  ftruck the imagination  of
Brown, though the investigation was carried  on
with  fo much ardour during the period  of his flu-
dies ;  attention to thefe  anatomical difcoveries
would have affided  him in the full explanation of
many difeafes,  which, though  they pafs  under
 the fame denomination, he has moft juftly claffed 
          OF  BROWN'S DOCTRINES.       CVli

as of a nature entirely oppofite;  the one, fthenic,
the other afthenic ; but to make out this explana-
tion,  he muft have acknowledged in thefe differ-
ent  vafcular fyftems, fome  degree  of inequality
in the way in which they are affeded by  ftimu-
lants  that operate on both.   Thus  if the  power
of abforption be fooner increafed by the  caufes
inducing the fthenic diathefis than that of exhala-
tion,  there is  no occafion  to imagine any con-
ftridion  to   account for  the   drynefs  of  the
fkin  and  fauces.  The  confequent more  fpeedy
exhauftion  of  excitability in  the  abforbents,
would likewife  have fuggeded the  rationale  of
that difcharge that follows the date of drynefs or
hufkinefs of  the fkin, fauces, or urethra,  of  the
trachea and its ramifications, when  thefe parts
are affeded  by inflammation.
  A great part of the fymptoms of Brown's aft-
henic  form of difeafe, depend upon imperfed  ab-
forption  from  indired debility of  the  veffels
dedined  to  that office;  thus  perfons  whofe
lungs have been weakened by inflammation after
a meal expedorate mucus.  In this cafe the food
excites  the  whole  fyftem; the  adivity  of  the
bronchial glands is increafed,  more mucus is fe-
creted, and part becomes Superfluous, on account
of the comparative inadivity of the  abforbents.
Quibus poft inflammationem fupereft urethra debilitas
profluit mucus limpidus,  poflquam  ten)us fuerit penis.
The reafon is the  fame.
  Had  it been once allowed by Brown that the
                                     different 
cviu
ORIGIN OF
 different condituent parts of the body,  bear a
 different relation to  the  fame agents,  he muft
 have admitted the operation of fpecific ftimulants
 to an unlimited extent.  This however,  would
 have destroyed the univerfality of his principles,
 which  he confidered as the great beauty of his
 fyftem ;  but his own opportunities of obfervati-
 on were probably too few, to force upon him a
 convidion of their infufficiency;  it is eafy to ex-
 ceed equity and  prudence in refufing to hearken
 to testimony,  we may  daily fee fpeculative  men
 forgetting that philofophy does not more confift
 in petulent rejedion of information than in cre-
 dulity.

   Of the Formation of the Brunonian Syftem.

   It is believed that hints thrown out by Cullen,
 were the feed from which Brown raifed his doc-
 trines.
   The   connexion  between  the two  men,  is
 doubtlefs favourable to  the fuppofition of a com-
 munication of ideas,  and  it  is confirmed by the
circumstantial evidence  of a  common term, from
which the other terms,  employed by  Brown,
might be  constructed  by an obvious  analogy.
The  hints  fuggefied  by Cullen occur  in the
 CXXXth, and fome of  the following  paragraphs
of his Inflitutions of Medicine.
 " It is," he fays, " probable that the "nervous
 " fluid in the  brain, is  truly capable of different
                                     " ftates 
         THE BRUNONIAN SYSTEM.       CIX

" ftates or degrees of mobility,  which we fhall
" call its ftates of excitement and  collapfe." In his
youth,  this  author had  imagined a mechanical
hypothefis refpecting the  nervous fluid, which he
regarded with fondnefs through life,  and unfol-
ded with great prolixity in the decline of his pow-
ers (b).  When he wrote the paffage I have quo-
ted, his thoughts were  turned from the living
body to an eledrical machine ; and he evidently
does no more thanvleferibe the common experi-
ment,  in which a congeries of flexible fibres is
made to Stand ered,  and to diverge by eledrici-
ty,  and then lhrinks together on the application
of a conduding fubftance.   His idea of excite-
ment has therefore nothing in common with that
of Brown ;  and, on camparifon, I am perfuaded
it will appear that Brown was very little indebted
to the phyfiology of his mafter.
  A  material corredion of the Brunonian theory
may be more fafely afcribed to one of Mr. Hun-
ter's difcoveries,  than its origin to thefe obfcure
opinions of  Dr.  Cullen.  An intelligent writer
whofe expreffions befpeak perfonal obfervation,
gives the following account of the extent and oc-
casion of this corredion.  " In the firft promul-
" gation of his dodrines, Dr. Brown did not fuf-
" ficiently diftinguifh  between the actions of
" the living body and  its powers.—Excitement
" and ftrength were  at  firft confidered  by  him

          (b).  See his Materia Medica
" as 
ex
IMPERFECTIONS
" as Synonymous terms ;  and on the ftate of ex-
" citement, his distinction  of diseafes were en-
" tirely  founded.   To the laft he had but  two
" claffes;  diSeaSes of increafed and diminifhed
" excitement.
   " After many difcuflions of his dodrine, in
" which the diftindion between the powers and
" adions of the living body.....was pref-
" fed upon by him,  he adopted the term excita-
" bility to exprefs the difpofition in adion,  and
" to replace the terms irritibility, fenftbility,  and
" inability, which he had discarded from his fyf-
" tern (0-"
   An alteration of fome confequence refpeding
difcharges of blood, which was made in the inter-
val between two Latin editions of his elements,
is noticed by the author himfelf.  What correc-
tions and enlargement are further required,  the
curious reader may determine by a careful com-
parifon of the following fyftem with the kindred
fyftems of two  contemporary  authors j  con-
ftant reference  being had to nature at the fame
time.

          Of Predifpofttion  to  Difeafe.

   Among a number of individuals equally expo-
sed to any caufe  of  difeafe, we conftantly  find
fome affeded, and  others efcaping.  The  cir-
cumftances on which exemption  and aptitude de-
    (c). Englifh  Review for Od.  1794, p. 282.
                                       pend 
AND ERRORS.
CXI
pend  have been anxiouffy  inveftigated;  and if
we were well acquainted with the powers that fa-
vour and refift morbific influences, we fhould be
able  more effedually to accomplifh  one of the
two  grand  purpofes of the  medical art—the
prefervation of health.  But although fads have
been noted, the principle  lies  involved in total
obfcurity.  Brown does not purpofely elude the
difficulty, but his principles lead him befide it;
and we may doubt whether the term  predifpofiti-
on ought, in ftrid propriety, to have appeared in
his Elements;  for predifpofition is  with him  a
flight difeafe, differing only in degree from that
into which the perfon predifpofed falls.  (Chap-
ter VIII. Part I.).
   Between  thofe adions of our different organs,
and of the fame organ vvhich frequently occur to-
gether or  in fucccffion, a bond of union is formed
by habit,  as in the cafe of our  ideas.  Of  any
two movements, therefore, if the former tend to
introduce the Succeeding,  the  Second muft  take
place, unlefs it be prevented by fome  interpofing
force.   Plence it  is manifeft that robuftnefs of
conftitution, principally confifts in the drength
of connexion between the feveral members of the
feries, and  pronenefs to  difeafe in  the facility
with which  the feries may  be broken.  On this
principle we may underdand why  brutes  are
more robuft than the human fpecies.   Their ac-
tions  both of body and mind are lefs diverfified
than ours;  and  being in confequence more  fre-
                                      quently 
CX11
IMPERFECTIONS
quently repeated in the fame order,  they acquire
greater force of union,  or,  as it has been lately
termed, ftrength of catenation.   It may deferve to
be confidered whether the remarkable exemption
of negroes from the  contagious fevers that  have
lately  raged in  America and  the  Weft-Indies,
and  the  comparatively  fmall  mortality  among
them depend on their uniform life (d).
   Perfons  who  have enjoyed uniformly  good
health, are faid to be in greater danger when they
become ill;  and in  -cafes where the  opinion is
juft,  we  may deduce  an explanation of  the  ap-
parent paradox from the  fame principle;  for the
disturbance of the fundions betrays  the  interven-
tion of a  powerful caufe.

  (d). " Although the  contagion feemed  to vary much in
" different defcriptions of  people, it is highly probable that
" the virus of the contagion itfelf was uniformly  the fame,
" only varioufly modified by peculiar conftitutions,  habits, or
" modes of living.  Thus among failors, perhaps a fcorbu-
" tic taint, joined  to extreme irregularity  and  imprudence,
" rendered the  difeafe infinitely  more fatal than among any
" other clafs of men.   On the other hand, among field-ne-
" groes, who certainly  poffefs an idio-fyncracy peculiar to
" themfelves, and whofe mode of living is  generally tempe-
" rate and regular in a  remarkable degree, the virus of the
" contagion was fo blunted as to aft in the mildeft form,__
*e Why, however, it mould operate with moft  violence on
" Europeans juft arrived,  and who had never entered the tor-
" rid zone before, is a Angularity I do not pretend to ex-
'« plain."  Chifholm on the malignant peftilential fever which
raged at Grenada in 1793, p. 130-1, one of the  moft fatal
difeafes on  record.
Are 
AND ERRORS.
CX111
  Are not the embryons of  organized beings
placed in their peculiar receptacles,  that they
may be fecure againft  violent impreflions, till
the movements of their organs, by repetition,
come  to proceed with a fteady pace, and  the
animal machine is mounted ?
  Pregnant and  puerperal  women are among
the perfons moft liable to  be affeded by  the
flighter caufes of diSeafe.   In the former, from
the great change of the fanguiferous and glan-
dular  fyftems, new irritative  and fenfitive mo-
tions are perpetually introducing themfelves;
and at the time of parturition, there is a fud-
den diffolution of all the newly formed affo-
ciations ;  at this critical period they require to
be  guarded with the niceft vigilance  from all
fudden changes  of temperature, irregularities
of diet, and exertions of body and mind.
  In fhe tranfition  from climate to climate, it
is obvious that our habitual  movements, efpe-
cially thofe of the cutaneous veffels of all  deno-
minations, muft be thrown into total confufion.
In  this ftate of difordered adion,  there can be
no  power of aflbciation or connedion to proted
the fyftem.  It has  alfo  been univerfally  ob-
ferved, that contagious fevers are liable to make
their attack after intoxication, when the whole
internal man is tumult.
  In the account of the Grenada fever, there is
a fcale to  fhew the gradation in which the na-
                      P                 tives 
cxiv             IMPERFECTIONS.

tives  of different countries, Africans, Ameri-
cans,  Creoles, and  Europeans,  affernbled  in
that ifland, were liable to  be infeded and  de-
ftroyed.  This fcale will ferve as an illuftration
of the two  laft mentioned caufes j a thoufand
otheas are at hand.
  " It is curious,'* fays the writer, " and  may
" be ufeful to obferve the gradation of this fa*
" tai malady, with  refped to the  various  de-
"  fcriptions of people expofed to its  infedion.
" Neither age nor fex were exempted from its
" attack, but fome were more obnoxious to it
" than others, and the colour had  evidently
" much influence in determining its violence.
" The Scale of its violence, or the gradation it
" obferved  with refped to the  different  clafles
" of the inhabitants, appeared to be the follow-
" ing  :
  " I. Sailors, more  efpecially  the robuft and
" young, thofe leaft accuftomed to the climate,
" and thofe moft given to  drinking new rum.
  " II. Soldiers ; more efpecially recruits, late-
" ly from Europe, and the moft intemperate.
  " III. White males, in general, lately arrived,
" more efpecially young men from Europe.
  " All other white males, more efpecially the
" lower clafles ; and of them, the moft intem-
" perate, thofe debilitated by recent ficknefs.
  " V.  White  females, more eSpecially  thofe
                                 " connected 
AND ERRORS.
CAV
  i: connected with the Shipping, and thofe  lateT"
  " ly from Europe.
    " VI. People of colour, from Muftees to Ca-
  " bres," (that is, I think inverfely as the dark:
  " nefs of complexion.)
    " VII. Negro men, more efpecially failors and
  " porters.
    " VIII. Negro women, more efpecially houfe
  " wenches.
    " IX. Children, more efpecially thofe of co-
  lour.
    Infants, whofe organic  movements are not
  yet  regulated by habit, feem to afford an ex-
  ception to the rule of predifpofition.  They are,
  it is faid, lefs liable to fome contagious fevers 5
  and when infeded, their chance of recovery  is
  much greater ; the latter circumftance has been
  noticed by various obfervers (e).  If children
  were only lefs liable to be  infeded,  the differ-
  ence might be fairly fuppoSed to depend on their
  not  coming fo often within the infeding  dif-
  tance j but after infection they are proteded by
 fome unknown  peculiarity.  Is the  contagion
 weakened, when  firft Swallowed by a diarrhoea,
 as was the cafe with fome perfons who received
 the dangerous infection at the Black  affizes at
 Oxford ?  Or has the gaftric liquor of chil-
   (e) See for inftance, Campbell's Obfer-vatiom on Typhus,
1785, p. 55.
                                        dren, 
cxvi
IMPERFECTIONS.
 dren, fome power to render the poifon inert ?
 This inferiority of power in one or two parti-
 cular contagions, to enfed and deftroy children,
 deServes further  enquiry.

           Of the Depreffing Pajfions.

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

  (J).  See  Dr. Rum on the fever of Philadelphia, p.  31.
" Fear debilitates only becaufe it abftracts its antagonift paf-
 " fio.i of courage."
                                     minifhed 
AND J.RR0RS.
cxvu
minifhed exertion.  Now as no two parts, ac-
cording to our author, can be in oppofite con-
ditions at the fame time, what could he in cori-
fiftency do, but affert that the dodrine of heat
and cold is exactly applicable to the paflions
(Part I. Chap. iii. n. )?  In high Spirits, there-
fore, we are to SuppoSe ourSelves animated by
Something corresponding to the warmth  of
fummer ; in tranquillity we are lowered by a
fubtradion of this  mental ftimulus down  to
temperate, and in grief we fink to the freezing
point; how far the common opinion varies
from this of Brown, I cannot exadly fay, be-
caufe  I  do not  underftand  what  particular
change the words depreffing or fedative paflions,
are defigned to indicate.   When I  try  to aflift
my apprehenfion by fome analogy, I find no-
thing in nature to help me out, but am obliged
to  think  of  certain paffages in books  of ro-
mance, where the enchanter is deScribed as in-
ducing a  ftate of permanent torpor by the mo-
tion of his wand.  To difcover whether any of
the paflions have a benumbing operation, does
not appear  very difficult  ; let us take a tran-
sient look into the mind of  a mother forrow-
ing for the lofs of her fon, I afk whether her
ideas are  more vivid than   fual ? whether fhe
does not  exert herfelf to  recoiled all  he faid or
did between the cradle and the grave ? whether
                                      after 
cxviii            IMPERFECTIONS.

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

  If this expreffion of forrow be not too ftrong,
while an  happy meeting is ftill believed poffi-
ble, it may be doubted whether the faculties
of Shakefpeare or Schiller, ftrainedto their ut-
moft pitch,  are  equal to  that  intenfity  of
thought which takes  place when this  hope is
finally deftroyed.  Fear and anxiety excite ima-
ges of equal vivacity with  grief, and on con-
fidering the  fubjed, it will appear  that for
thefe ftates  of mind, perturbation, which occurs
in the writings of the ancient philofophers, is a
far more apt term  than pajfion.  Had  it  not
been for inaccurate language, which  the au-
thor of the  Enquiry into the State of medicine juft- 
AND ERRORS.
CX1X
ly calls the greateft of all plagues in fcience, the
opinions I am inviting the  reader to compare
with nature, would probably never have exift-
ed.   Neither  Should we perhaps  have  been
taught, that in grief the mind moves flowly—
an affertion as distant from the truth, as if it
fhould be faid that animals in full chace of their
prey, move more flowly than when they are
not  aduated by any appetite ; for the eager-
nefs, with which fome train of ideas are purfu-
ed in penfive Sorrow, admits of a comparifon
with hunting.
  The excitability, therefore, is exhaufted by  "/■
any  paffion or perturbation, in the fame man-
ner as by exceffive excitement in other  cafes.
Whether temporary wearinefs, or irreparable
debility fhall enSue, depends upon the intenfity
and  duration of the exertions, made by the  or-
gans in adion.  The explanation  of the differ-
ence between weeping and  tearlefs  grief,  with
the means of curing either and  changing the
latter (which is a  much  more dangerous dif-
eafe) into  the former, depends  on principles,
not  to be found in the following  fyftem.  In
the prefent fpecimen of criticifm, it is the lefs
neceffary to enter upon thefe enquiries, as the
public may foon exped better inftrudion on the
pathological part of  this fubjed than I am able
to give.
                                   Conclufion. 
ex*
IMPERFECTIONS.
                 Conclufion.

  The Brunonian fyftem has frequently been
charged with  promoting  intemperance ;  the
objedion is Serious, but the view already given
cf its  principles  fhews it to  be groundlefs.
No writer had infilled  fo much  upon the  de-
pendence of life on external caufes, or fo ftrong-
ly dated the inevitable conSequences  of excefs.
And there are no means of promoting morality
upon which we can rely, except the knowledge
of the true relations between man and other
beings or bodies.  For  by  this knowledge we
are diredly led to ftvun what is hurtful, and pur-
Sue what is Salutary ;  and in what elSe does mo-
ral  condud, as far as it regards the individual,
confift ? It may be faid that the author's life dis-
proves the juftnefs of  this reprefentation; his
life, however, only fliews the fuperior power of
other caufes, and of bad habits  in particular,
and I am ready  to acknowledge the  little effi-
cacy of inftrudion, when bad habits are form-
ed.  Its great ufe confifts in preventing their
formation, for which reafon popular inftrudion
in medicine  would contribute more to  the hap-
pinefs of the human fpecies, than the complete
knowledge of every  thing which is attempted
to be taught in education, as it is conduded at
prefent.  But though the principles of the fyf-
tem in queftion did not  correct the propenfi-
                                        ties 
CONCLUSION*
cxxi
 tiesof its inventor,  it does not follow that they
 tend to produce the fame propenfities in others.
   The diftinguifhing merit of Brown  is obvi-
 ous  ;  he avoided all falfe analogies, and con-
 fined himfelf within the proper fphere of ob-
 fervation for a phyfician.   Hence  at  a  time
 when I could not be fufpeded of that  difpofi-
 tion to diminifh the faults, and magnify the ex-
 cellencies of his fyftem, which my fhare in the
 prefent publication  may be  fuppofed  to  pro-
 duce ; I was led to remark, that " if he has
 " not always difcovered the truth, he is feldom
 " forfaken by the Spirit of philofophy (g)." Be-
 fore him investigations relative to medicine, had
 b: en  carried on juft as rationally  as if to dif-
 cover the qualities of the horfe, the naturalift
 were to  dired his attention  to  the movements
 of a windmill.  There exifted no fyftem which
 was not either entirely, or in a great meafure,
 founded  upon  the  obferved  or fuppofed pro-
 perties  of fubftances, deftitute  of life.  Thus
 Boerhaave taught that difeafes depend upon
changes of the blood, fimilar to thofe  which
certain oily, watery,  or mucilaginous liquors
undergo ; and I  have already had occafion to
fliew that Cullen referred the phenomena of
life to an  imaginary fluid, endowed with the
fame  properties as the eledric  fluid j  though

  (g)  Obfervations on Calculus, p.  159, 
txxii                  CONCLUSION*
 of this the very cxiftence is ft ill problematical (h\
 His predeceffors having  in this manner left man
 entirely out of their fyftems,  or afiigned  him
 an unimportant place, Brown atchieved the im-
 portant Service of reftoring  him to his proper

   (£).Mr. Hunter, who deferves fo much praife for Afcer-
 taining fafts,  has been led aftray  in fome of his  Attempts to
 eftablifh principles, by a different, but a very curious fpecies of
 delufion. In treating of that obfcure fubjeft, for inftance,  the
 coagulation of the blood, he obferves  that it fometimes takes
 place very quickly,  as in mortification ; but then " it is to an-
 '■ fwer fome good purpofe and  arifes from necessity, which
 *'- appears to aft as a ftimulus in difpofing the blood to coagu-
 late." He adds that by  " aftions taking place from neceflity.,
 *' effefts are meant which arife  from fome unufual or unnatural
 ** change going on in the parts, and become a ftimulus to action.
 " The ftimuli from this  caufe may vary exceedingly among
 " themfelves: but as we are unable to invefligate them, 1 have
 " included them under this  general term, ftimulus of neceffity."
 (0* the blood,  p. 24). It may be laid down as a rule in logic,
 that general terms ought never to be employed, unlefs we can
 fubftitute particular terms expreffive of appearances in their
 place.   Mr. Hunter confefles his ignorance of thofe changes,
 which he comprehends under the phrafe, ftimulus of neceffity.
 It is manifeft, therefore,  that it  refers to nothing cognizable by
 fenfe; and his pofition amounts  fimply to this, the blood coagu-
 lates becaufe it muft coagulate.  This is  not the only occafion on
 which this ingenious anatomift has been betrayed into the my-
 fticifm of occult caufes; and it would probably create fome fur-
 prife in an ancient poet to find allegorical beings-like necessi-
 ty and death, figuring in a modern work among the prin-
ciples of phyfiology. It is eafy to excufe Mr. Hunter for mif
taking nominal for real effences j but the example deferves no-
tice as it fa c early <h;ws the extenfive  utility of the philofo-
phyofwjrds. 
  '            CONCLUSION.              CXXU1

ftation in the centre.  We have other obligati-
ons to him ; but as I have already had occafion
to point out Some of them in the courfe of thefe
preliminary obfervations, and as the reft will be
difcovered by an attentive perufal of the follow-
ing work, I fhall leave the tafk of fingling them
out and appreciating them to the impartial rea-
der.   In forming this eftimate he  Ihould have
before him, i.  The difficulty of emancipating
the mind from the dominion of inveterate and
accredited error.  2. The much greater difficul-
ty of giving a new form to a complicated  and
obfcure fcience.
   Three years ago I had occafion to obferve that
the opinions of Brown had been fo widely diftu-
fed by  oral communication, as to affed the
\yhole pradice of medicine in Great Britan. In
pamphlets recommending repeated dofes of opi-
um to fupport excitement, and in other publica-
tions, it would be eafy to deted attempts to pur-
loin his language and ideas ;  but it is unneceffa-
ry, for though literature has always been infeft-
ed by a race  of pilferers, original genius has
feldom been injured by their difhoneft pradices.
Brown cannot now be defrauded of his juft re-
putation.  His writings have lately been repub-
lifhed (k),  and are gaining credit on the conti-
nent  of Europe.  In America his Superiority to

'  (£). See Brunonis Elem. Med. cum Prefatione Petri Mofcbati..
preceding 
cxxiv
CONCLUSION.
preceding fyftematic authors, appears to be ac-
knowledged alike by ftudents and profefFors (/).
   To fpeak of the  dangerous  influence of his
Syftem or. practice, I think as ufelefs now as to
Jeted plagiarifms. His difciples have fometimes
difgraced  themfelves  by that rafhnefs, which
was too  much  the charaderiftc  of his  fchool.
But a cool  perufal of his work  will not  pro-  <
duce the effed of his animated and  fometimes
frantic preledions. What he has left can only in-
form or exercife the underftanding: but he re-
tains no power to  inflame   the  imagination
from the  grave,
 (/). See Ruih  on theyallow fever, and fome inaugural dif-
fertations lately  publifhed at Philaadelphi*
  Since the preceding pages were printed, I have received fur-
ther indubitable proofs of the afcendancy  which the truths,
promulgated by Brown, are gaining over men's  minds in dif-
ferent parts of Europe. A tranflation of his "Observati-
ons  under the title of Compendia delta nuovadottrina medica di
G. Brown was publifhed at Pavia in 1792.  It has been fince
republifhed at Venice, and fo has Mofcati's Edition of the E-
lementa. The tranflation is by Dr. Rafori, who has prefixed a
fenfible i itroduftion, and added many judicious notes.  In a
letter a companying a copy of his tranflation, Dr. Rafori fays,
" In the Univeruty "of Pavia,  undoubtedly one of the firft
" in Europe, there is hardly a ftudent, endowed with talents,
" who is not a Brunonian.  The doctrine  begins  equally to
" fpread in Germany.  Many of the periodical publications
" of that country have noticed it, and the Elementa have late-
" ly been publifhed there. A friend at Genoa affures me that
                                           ^  feveral 
                    CONCLUSION.                CXXV

 " feveral Surgeons to French men of war have informed him,
 " that Brown is  known and much admired in France.   In
 " the Univerfity of Pavia, Brown is in high efteem even with
 " fome of the moft refpectable profeffors;  and in other parts
 " of Italy 1 can affert from my own knowledge that old phy-
 " ficians have not refufed their fanction to many of the Bruno-
 " nian principles."
   A late pamphlet intitled Jacobi Sacchi inprincipia Tbeoriac
 Brunoniat animadverfiones, but fuppofed to be wtitten by pro-
 feffor Carminati,  affords  ample confirmation of the account,
 given by Dr, Rafori.  The  firft fentence runs thus. Quaeren-
 ti mihi caufas incredibilis prope illius commotionis  animorum, at-
 que ingentis fere plaufus, qmbus nuperrimtfingularis ilia hypothe-
Jis,  cui novum univerfae Medicinac fy sterna celeberrimus Angliae
fcriptor l£ medicus Bruno fuperftruxit,  ab iis optimae fpei adolef-
 centibus excepta efset, quid inftgrentifsimo Ticinensi Arcbigymnafio
falutaris artis ftudiis omnibus  tnecum incumbunt perarduum fane
 nonfuit eas.. ..  invenire.  After  fome  pages of introduftory
 matter, the author objects ftrongly to  Brown's definition of
 life—quod  ideam vitae non inproprietatefeu incitabilit-te,y£*/ in
 aftione  collocarit.  He  adduces  various inftances in  which
 organic bodies Iofe fenfe and motion, without lofing their fus-
 ceptibility  of feeling and moving, when differently circumftan-
 ced. profeffor Carminati,  he fays, having killed a cat by me-
 phitic air, took out the ftomach with  the inteftines, and expo-
 fed  them to  the influence of a frofty air in  his court  yard.
They loft by degrees their periftaltic motion, and were frozen
[ftiff. Next day, they were put into warm water ; and when they
were thawed,  the periftaltic motion returned ; and lafted for a
long time.  This feems to be little elfe than a  difpute about
terms. The objector next controverts Brown's grand difcovery
—omnia qua  viventium partibus admoventure, five interna fvvte
externa Jint, perpetuo incitantia esse. He produces the application
of cold bodies blood-letting, as  examples of effects Produced
on the living body otherwife than by ftimulating.  He forget,
that  it is  the refiduary  heat and the refiduary blood  which
                                                    Brown 
cxxvi
CONCLUSION.
Brown regards as ftimulants, inferior indeed in efficacy but
ftili ftimulants.  The effeft of alkaline fubftances on  acid ge-
nerated in the|ftomach, and fome other fimilar cafes, are after-
wards fpecified, as not comprehended under the general propo-
fition. The author however feems aware that no Brunonian can
want the wit to repel thefe objeftions.  He mentions cauftics
as exceptions to the rule ; he however allows that they are part-
ly benificial  by ftimulating,  and omits to mention that part of
their operation which is not ftimulating. During this  fkirmifh-
ing, in which the adverfary of Brown takes cares to  retreat
nearly as much as he has advanced, he appears  to gain  cou-
rage, for he now attacks the new fyftem in its ftrongeft poft.
Opium,  he affirms,  is a medicine which although  it has fome
ftimulating power, removes irritation  non eo, fed alio fa pro-
prio principio. So are all fedatives. Under this head  the power
of opium to allay excruciating pain and reftrain irregular moti-
ons is copioufly exemplified ;  the writer feems to fuppofe that
pain always implies  excefs of aftion,  and convulfions  excefs of
general power.  He ackowledges that  volatile ftimulants re-
move quasdam nervorum  aegritudinesfed eas quae vera debili-
tate procreantur.   At the clofe of this  article an argument oc-
curs, which I know not how the moft determined Brunonian
will anfwer. It is this ; if there were no difference but  in energy
between opium and other drugs, it might be compenfated  by
increafing the dofe of thefe,  which is contrary to experience.__
An acute opponent  would not, the reader may be fure, fail to
bring forward the fpecific  aftion of quick-filver, cantharides
and other bodies; he even contends that univerfal ftimulants
by no  means tend to evince that the  excitability is  one and
indivifible,  fince they are compounds,  and their feveral con-
ftituent parts may  aft  upon  feveral  portions of" the  fyftem
Brown was  totally  inattentive to the  affociation of  motions ;
and our Italian critic does not omit to take advantage of this
imperfeftion.  He quotes feveral inftances of the fympathy of
fimilar parts (as the decay  of correfponding  teeth), and  ar-
gues from them  in the following manner: juxta diverfas aut
                                                   fimiles 
CONCLUSIONS.
cxxvii
fmiles partes, five fenfilitas five irritabilitas dut diverfa aut ft-
milisfeu aequahr eft . . . Hinc ubi caufa praedifponens, aut idem
ftimulus feu eadtm caufa occafionalis, quae in alique corporis fede
morbum intulit, ad aliam quoque fimilem deferatur, nafcetur illico
caufa proxima ejus que effeSlus,  nempe morbus :  quod quidem fieri
non poffet in diverfa parte,  licet earn quoque idem ftimulus pertin-
gat.   Laftly,  the author contends that Brown has improperly
given the common name of excitability, to irritability and fen-
fibility, properties  effentially  different,—The  theory  being
thus difmiffed, the praftice  of the Brunonian fchool is brought
under examination.  Frozen limbs, it is faid,  are to be warm-
ed gradually,   but only left the veffels fhould be burft by the
fudden expanfion of their  contents. So alfo a  fmall quantity of
food  is to be given  to perfons who  have been  long failing,
merely becaufe the digeftive powers are  weak, and  not  to a-
void  violent  excitement  from accumulation of excitability.
The writer protefts equally  againft the ufe of fmall ftimulants
in dire3 debility, and of a ftimulus nearly equal to that which
has induced indired debility,  in cafes of an^oppofite nature.
On the latter principle, he  thinks, the moft  powerful ftimu-
lants ought to be given in the moft  violent peripneumonies,
and  blood-letting to be avoided. Under the former head, he
afks; Quis ubifipbylis faeirat atrociter ejus fanationem, validior-
ibus pofthabitis mercurialibus, committet lenioribus ?—To prove
the reality of contrary indications,  the  complication of true
peripneumony with malignant petechial fever and other difea-
fes,   requiring  the  ufe  of debilitating and  ftrengthening
means at the fame time are  adduced.  Several pages are em-
ployed to fhew  that  a low temperature  is not debilitating
and the converfe.   The Brunonians will eafily fliew by a few
obvious diftinftions, to how little purpofe the  author has la-
boured here.  In conclufion, he points out what he deems ab-
furdities in  Brown's opinions concerning  the itch, fcurvy,
epilepfy, and fome other diforders.
   But whatever juftnefs there may be in fome  of thefe remarks,
whatever errors Brown may  have committed in the application
                                                        of 
cxxviii
CONCLUSION.
 of his principles, and however (hort his doftrines may fall of
 a perfea fyftem of medicine, I will  venture to predift that his
 Credit on the continent will remain unfhaken. The introducti-
 on of his opinions will have a moft  beneficial influence  upon
 thofe by  whom they are adopted as well as upon thofe by
 whom they are rejected.  Brunonians will not imitate the flu-
 pidity of the difciples of certain antient philofophers, but ex-
 ercife their reafon in expunging,  adding  and correcting,  as
 experience-fhall diftate. With regard to Anti-BrlM*!mians a
 recent example will  explain my  meaning.   When Lavoifier
 firft announced his fyftem, the chemitts who were moft fcan-
 dalized by it, found themfelves obliged to revife  their whole
 ftock of fafts anddeduftions ; the immediate confequence was
 an entire change in their opinions. v  Though they would not
 go over to Lavoifier, they could not adhere to Stahl, but re-
 luftantly  abandoned half their errors.  The diffemination of
 the Brunonian doctrine will bring about the fame thorough
 luftration  of opinions in medicine, and  the moft pernicious a-
 mong the  prevailing prejudices will be relinquished without
 a conteft.
   The reader may eftimate what it is to have put fo many na-
 tions into the right path of medical inveftigation .   It is true,
 indeed, that we in Great Britain,  fuppofe ourfelves to have
enjoyed the privilege of being  purblind, while the eyes of fo-
 reigners were fealed to  the agency of thofe caufes that actuate
 animated nature ;  and would it  not be a pity if we fhould lofe
 our diftinftion ? But though we fhould be outftripped in medi-
 cine by the awakened genius of France,  or the enlightened
 induftry of Germany, we  fhall not be without confolation:
 fince in confequence of Brown's difcoveries,  our  countrymen
 labouring  under diforders, fuch as we  cannot cure,  ftand  a
 chance of profiting by the collective efforts of human ingenuity.
                         —i—■ ■
                      ERRATA.
  Page 32 line 3 from bottom for -where read were—p. 36 1. 4 after -with
 read tbh—p. 56 1. 20 de'e h—p. 58 1. 2 after 0/read the—p. 60 1. 6 dele
ty—V- 64 I- 19 f»r Hofpialr^d. Hofpital-?. 70 I. 2I for Treaties read Trca.
fife-?. 7z 1.17 for Wread tvbo-p. 94\, n for Macular read Macular. 
 
j^DEATH.y
Predifpofition to
Sthenic Difeafe.
Perfeft Health.
Predifpofition to
Afthenic Difeafe.
TABLE  of  EXCITEMENT  and  EXCITABILITY,
DISEASES.
           t
8oY

   [ Extreme" 1 Indirect
75 j Sthenic.) j Debility.

70J
65 (.High
    Mild
55 ("Sthenic.
NOXlGlJS
 CAUSES.
_____A.____
CURE.
IMMEDIATE
Sthenic
Diathefis.y
Good Health.

Mild
Death..
5 r Afthenic.
   High
5 * Afthenic.
  ^ Extreme
5 f Afthenic;
qJ
.Direct
h Debility
7 Afthenic
yDiathefis.^
Apoplexy.
Palfy.
Plague.      |
Malignant Fever,
Gangrenous Cynanche.
Confluent Small-pox,
Hydrothorax.
Phthifis.
Contagious Dyfentery,
   &c.
Synocha.
Phrenitis. ,;iV
Inflammatory Cynanche.
Mild Small-pox.
Meafles.
Peripneumony.
Dyfentery.
Mania, &c.
Synochus.
Rheumatifm.
Catarrh.
Scarlet Pyrexia.
Miliary Fever.
Chicken-pox.
Ophthalmia, &c.
  Exceffive action of powerfuf ftimuli;  as  heat,
exercife.food, abundance of  blood, violent paf-
fions of the mind, contagion, and the like.
  The fame as above,  but not to that excefs which
induces indireft debility; yet acting with greater
force than in the next range of difeafe.
  The  fame as  above, but not acting with that
force which induces high fthenic diathefisj  yet
greater than in the ftate of health.
Indirect debility.
Greatly increafed excitement.
Lefs increafed excitement.
—r
  The indication of cure is to fupport the excitement.  The reme-
dies are powerful ftimuli, as electricity, opium, asther, fpirituous,
liquors, wine, mufk, cinchona bark, fnake root, camphor, rich foups,
and the like.
  The indication of cure is to diminifh the excitement; which is to
be effected by avoiding  powerful ftimuli, and employing flight or
defective ftimuli, as lying cool in bed, tranquillity of mind, bleed-
ing, purging, fpare diet, and the like.__________________■
  The indication of cure is, as above, to diminifh the excitement,
but with more moderation.
  The range of good health is with propriety ranked from thirty to fifty degrees in the fcale ; for perfect health, which confifts in the
of the variation of the ftimuli to  which man is continually expofed, as meat drink, and the paflions of the mind;  which fometimes act
monly fluctuates between thirty and fifty degrees.
middle point folely, or forty degrees, rarety occurs ; in confequence
with more power, fometimes with lefs, fo that the excitement corn-
Intermittent Fevers
Mild Colic,
Dyfpepfy.
Hypochondriafis.
Hyfteria.
Epiftaxis.
Menorrhcea.
Amenorrhoea, &c»
Rheumatalgia.
Cholera.
Epilepfy.
St. Vitus's Dance.
Rickets.
Hsemoptyfis,
Scrofula, &c.
Typhus.
Colica Piftonum.
Gout.
Tetanus.
u
Scurvy,
Diabetes.
Dropfy.
Jaundice, &c.
  A  deficiency  of the ftimuli neceffary to the
maintenance of good health ; and an improper ap-
plication of powers, which, though ftimulant,  do
not ftimulate in a fufficient degree.
  Defeftive ftimuli  alone ;  as cold,  diet Tparing
md not of good quality, fear, and the like.
Defective ftimuli alone.
Diminifhed- excitement,
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-
reft debility, but with this difference, that here it is neceffary to be-
gin with a fmall degree of ftimulus, and increafe it gradually.

  The indication of cure is here the fame as above, but ftimuli muft
be applied fomewhat more cautioufly.
  The indication of cure is the fame here alfo, but ftill greater cau-
tion is neceffary in the application of ftimuli.
TO
             JOHN    BROW  N,    M.  D,

THIS TABLE IS DEDICATED,  AS  A TESTIMONY  OF RESPECT,
A
BY HIS FRIEND AND  PUPIL,

                          SAMUEL LYNCK,
7768�4545476670574 
THE
ELEMENTS


                        O F

       MEDICINE.


THE  FIRST  AND REASONING  PART.
               CHAP     I.

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

              CHAP.    II.

  X. IN all the ftates of  life, man  and  other  animals
differ from themfelves in their dead ftate,  or from any  o-
ther inanimate matter in this property alone 5  that they
can be  affected by external agents, as well as by certain
functions peculiar to themfelves,  in fuch a manner,  that
the  phenomena peculiar  to their living   ftate,  that  is,
their own functions, can be produced.  This propofitien
comprehends every thing that is  vital in nature, and there-
fore, at leaf, applies to vegetables.
  XI.  The external agents in  general, are  reducible to
heat, diet (a), other matters taken into the ftomach, the
blood, the fluids fecreted from the blood,  and air.  Hoiv
                                                poifons
  (a) Of health, difeafe, and predifpofition,
  (*) Or living ftate.
  (•) Confuting of food, drink, and condiment. 
OF   MEDICINE.            3
 poifons  and  contagions come under the fame view fhall
 afterwards be mentioned.
   XII. The functions  of the fyftem itfelf, producing the
 fame effect, are mufcular contraction, fenfe, and the ener-
 gy of  the brain in thinking, and exciting paffion and
 emotion.  While  thefe affect  the  fyftem in  the  fame
 manner as the other agents ; fo, with refpect to their ori-
 gin,  they arife both  from the other  and  from them-
 felves.                                 ,
   XIII. The refult of withholding  either the property
 diftinguifhing living from dead matter, or the operation of
 either of the two fets of powers, is the non»-exiftence of
 life.  Nothing elfe is neceffary to life.
   XIV. The property, by  which both fets of powers act,
 fhould be named Excitability;  and the powers themfelves,
 Exciting powers.   By the word " body" is meant  both
 the body fimply fo called, and alfo as endued with an in-
 tellectual part, a part appropriated to paffion and emotion,
 or to the foul -,  the appellation commonly given to it in
 medicalwr itmgs is fyftem (b).
   XV. The  common  effect,  produced  by  the exciting
 powers, is fenfe, motion, mental action,  and the paffions.
 Which effett being one and the fame, it muft, therefore,
 be granted, that the operation  of all the  powers is alfo
 one and the fame {c).
                          B 2                      XVI.

  (L) No difquifition is here meant to be entered into, as religion is no
where interfered with, but left to its proper guardians.
  (c) That is, fince fenfe, motion, mental functions, and the paffions
arc the only, and a conftant, etfeit of the exciting power;, acting upon
the excitability ; and fince that happens, whether one, or more, or all
the powers, or which foever of them, act, the irrefiftible conclufion, tha:
ariLs in the mind,  is, that the effect of the powers being the fame, the
moile of ojer-.tion of them all muft be the fame.  This mode of reafon-
ing, which is certainly as juft as it is new in medicine, will often oc-
cur, and,  wc truft, will ftand the  teft of the moft fcrupulous fcrutiny. 
4           THE  ELEMENTS
      XVI.  The effect of the exciting powers, acting upon
   • the excitability, is to be denominated Excitement.
      XVII.  Since,  of  the  fame exciting powers,  fome act
   by evident impulfes, and the identity of the effect of others
   infers  the fame  mode (/>) of operation ;  and fince they
   have all a certain  activity in them, they ought to be deno-
   minated ftimulant, or ftimuli.
      «. Stimuli are either univerfal or local.
      C. The univerfal ftimuli  are the exciting  powers, fo
   acting upon the excitability, as always to produce fome
   excitement over the whole fyftem.   And their appellation
   of univerfal is convenient to diftinguifh.  them from  the
   local.
      y. The local ftimuli act only on the part to which they
   are applied j and do not, without  previoufly producing
   an affection in it,  affect the reft of the body.


                CHAP.     III.

      XVIII. WE  know not  what excitability   is,  or in
   What manner it is affefted by the exciting  powers.  But,
*   whatever it be, either a certain quantity, or a certain ener-
   gy of it,  is affigned to every being upon the commence-
   ment of its living ftate.  The quantity, or energy, is dif-
   ferent in different animals, and in the fame animal at dif-
   ferent times.   It is partly owing to the uncertain nature
   of the fubject, partly to the poverty of common language,
   and likewife to the novelty of this doctrine, that the phra-
   fes of the excitability being abundant, encreafed, accumu-
   lated, fuperfluous •,  or weak, not well enough fuftained,
   not well  enough exercifed, or deficient in energy, when,
                                                  enough
(/j) Or ratio, 
O  F   M E D I CI N  E.            J
   enough  of ftimulus has not been applied; fometimes ti-
   red,  fatigued, worn out, languid, exhaufted or confumed,
   when the  ftimulus has operated in a violent degree; or be-
   ing at other times in vigour, or reduced to one half, when
   the ftimulus has neither been applied in excefs nor defect:,
   will  be  employed in different parts of this enfuing work.
   Both upon this, and every other fubject we muft abide by
   facts ; and carefully avoid the flippery queftion about cau-
   fes, as being in general incomprehenfible, and as having
   ever proved a venemous fnake to  philofophy.
      XIX. As there is always fome excitability, however
a  fmall, while life  remains, and the action of the exciting
   powers  in one degree or another is never wanting; the
   conclufion from that fail is, that they  are  all endowed
   with more or lefs  of ftimulant power, and that this muft
   be cither exceffive,  in  due  proportion,  or  deficient.  A
   great  quantity of blood ftimulates in  excefs, and  there-
   fore,  produces  the difeafes  that depend upon too much
   ftimulus ;  but an  under proportion of blood,  though de-
   bilitating in  its  ejfecl,  and inducing the difeafes  that de.-
   pend upon debility as their caufe, muft ftill be underftood
   to be ftimulant; but only fo much more weakly ftimulant,
   as the penury is more considerable : The fame conclufion
   applies to  all the other exciting powers, unlefs that poi-
   fons,  contagions,  and fome few  other powers, might to
   fome feem  exceptions.   But,
      XX  Poifons either  do  not  produce  the univerfal dif-
   eafes, which make our prefent fubject;  or, if they do,  by
   operating  the fame effect as the ordinary exciting powers
   their mode of operation muft alfo be allowed to be the
   fame (a).
                                                    XXI.
     (a) This propofition of frequent occurrence in this work, that iden-
   tity of known  efTect, always produces identity  of caufe though un-
   known, will be found to be a mode of rcafoning of equal fervice in
                                                  guarding 
6
THE   ELEMENTS
   XXI. Some contagions accompany difeafes depending
 on too much ftimulus (b); others thofe that confift in de-
 bility (r).   If  both thefe are the product, not of contagi*
 on alone, but,  by a conjoint operation, alfo of the hurtful
 powers  that ufually depend upon  ftimulus,  which is a
 fact  afcertained: the effect, therefore, in this cafe being
 the fame,  the  conclufion  is unavoidable,  that their caufe
 is alfo the fame,  and the mode  of  operation of both the
 fame.  It  muft, therefore,  be admitted that the operation
 of contagions  is  ftimulant  (d).   It  makes for the fame
 conclufion,  that no remedies, but thofe that cure  difeafes,
 depending upon the operation of the ufual hurtful powers,
 remove  thofe  that have been fuppofed to be  induced by
 contagions.  Finally, the great  debilitating energy, obfer-
 vable in  certain contagions,  does not more prove a diver-
 fity of action in them, than it does in the cafe of 'an equal or
 greater degree of debility, arifing from cold (e).
   ef.  It  might appear to fome,  that a certain matter  of
 food, not  fufficiently nouriftiing, and therefore, of hurtful
 tendency: as alfo that emetics, and purgatives, and fedative
 paffions, as they are called, might be thought to belong to
 the number of powers, the operation of which  might
 feem fo many exceptions from the ordinary ftimulant ope-
 ration.
   ». In general all vegetable matter,  when depended upon
 alone for nourifhment, is  hurtful, at leaft, to thofe who
                                                    have
guarding onr reader from the deceitfulnefs of abftract reafoning, and in
leading him into a proper mode of inveft.'gating folid and ufeful truth.
  (&) As the  fmall pox and meafles.
  [e) As the petechial typhus fever, the plague.
  (/Q This is all that is contended for at prefent; the degree of their fti-
mulus will be afterwards confidered.
  (<f)  At  the freezing point, or below it, man, and fimilar animals of
warm bleod, could not live a fecond in a dtnfe medium, fuch as that of
water { but the animals of cold blood can. 
OF   MEDICINE.
7
 have been accuftomed to better, and that by a debilitating
 operation; and yet even it, fince it fupports life, however
 incommodioufly, longer than a total want of food,  muft, of
 courfe, be  ftimulant.  But,  if afthenic difeafes arife from
 vegetable  food,  and not, to a certain degree, from want;
 that circumftance muft be owing to a certain change pro-
 duced in the fyftem, by which the fum total of ftimuli is
 rendered lefs fit to act upon the excitability.   That fuch is
 the cafe, is proved  by the moft ftimulant matter of food
 lofing part of its ftimulus by continued ufe, and requiring
 the fubftitution of another in  its place.
   r.  In the fame manner is the operation of emetics and
 purgatives to be explained, as diminifhing the fum total of
 excitement; which  depends partly  on an agreeable relation
 that the exciting power bears to the excitability, or on an
 agreeable  fenfation.  That it is fometimes  the relation,
 fometimes the fenfation,  that  acts  in this cafe, is  evident
 from the hurtful effect of things moft grateful to the fenfe,
 as in the examples of the legumina, and other articles of
 vegetable food; and by the falutary effect of difagreeable
 things,  as  the  feveral forms  and preparations of opium:
 Both which produce their effect, the former by a debilita-
 ting, that is, an infufficien'ly ftimulant, the latter  by a
 confiderably ftimulant, operation (g)
                                                     Thf

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

ftate which that had induced; or it will, ftill without any reafon for
fuppofing it not ftimulant, diminifh the excitement that had arifen from
the combiuatisn 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 for-
mer in a higher, the latter in a lower degree, and therefore acting over
all as debilitating powers.   Muftard taken with meat, or onions with
ncef-ftakes, are agreeable to moft taftes; hut they are, though ftill ftimu-
lant, difagreeable to others, and  debilitating,  Peas-foup and peas-pud-
ding,  though, independent of the animal juice infufed into them,  they
are far from being falutary, will be borne by many ; while in others, ef-
pecially thofe who have been accuftomed to  more 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-ftakes with onions, which agree with the found ftate, and difagree
with that of the firft pafTages juft now mentioned.  With regard to all
thefe enfeebling matters, there is no quellion about their being ftimu-
lant j the whole effect is to  be referred  to their rendering a mixture,
ftimulant in a certain degree, lefs fo.
   (b)  Not paflions different in kind,
   (jj The doctrine of cold as an  active power, and, oppofite to heat, is
now uniyerfally rejected, and coEfidcred as only a diminution of heat. 
OF   MEDICINE.            Cj
io fo, is ftimulant; it, therefore, follows, that the whole
phenomena of life, every ftate and degree of health and
difeafe, alfo confift in ftimulus,  and are owing to no
other caufe.
  XXIII. Excitement, the effect of the exciting powers,
the tiue Caufe  of  life,  is,  within certain  boundaries
produced in a degree proportioned to the degree of ftimu-
lus.   The degree of ftimulus, when moderate (/), produ-
ces health ; in a higher degree it gives occafion to difeafes
of exceffive ftimulus; in a lower degree, or ultimately
low,  it  induces thofe that depend upon a deficiency
of ftimulus, or debility.  And,  as what has been men-
tioned, is the caufe both of difeafes and perfect health ; fo
that which reftores the morbid to the  healthy ftate, is a di-
minution of excitement in the cafe of difeafes  of exceffive
ftimulus, and an encreafe of the fame excitement for the re-
moval of difeafes of debility.   Both  which intentions are
called Indications of Cure.
   XXIV.  This mutual relation obtains betwixt excitabi-
lity and  excitement,  that the  more weakly the powers
have acted, or the lefs the ftimulus has been, the more a-
bundant the excitability becomes ; the more powerful the
ftimulus  of the agents has been, the  excitability becomes
the more exhaufted.
   XXV.  A mean ftimulus,  affecting alfo a mean or half
confumed  excitability, produces the higheft  excitement.
And the excitement becomes lefs and lefs, in proportion
as either the ftimulus is applied  in a higher degree, or the
excitability more accumulated. Hence the vigour of youth,
and the weaknefs of childhood and old age.  Hence with-
in a  more  moderate fpace of time,  a  middle  diet gives
vigour, and debility is the effect of its being either too full
or too fparing.
                                              XXVI.
(0 Off middle kind. 
    IO         THE  ELEMENTS

      XXVI. While that is the cafe,  every age, every habit,
   if the excitement be properly directed, has its due degree of
   vigour accommodated to it.  Childhood, and that weaknefs,
   which an  abundant excitability produces, admits of little
   ftimulus, but, upon lefs than the middle proportion becomes
   languid, upon more is oppreffed.  Old age, and that frail-
   ty, which is occafioned by a deficiency of excitability, re- V
   quires a great deal of ftimulus, becomes enfeebled by lef,t>,
   and overfet by  more.  The reafon for the latter is, that
   the excitability, without which no vital action is produ-
   ced, does not exift in that degree,  by which vigour  of the
   f un&ions is produced •, while the former is to be explained
   from the exciting or ftimulant power, without which the
   excitability is of no effect, not being applied in that degree,
   which is r.?quifite to the vigour that it fhould give.   The
   impotency of ftimulus may rife to fuch a degree, as to pro-
   duce death from its  extreme under proportion.   On the
   contrary,  the exhauftion of excitability may go fo far,  as
   to extinguifh. life by the extreme excefs of ftimulus.
      XXVII. The circumftances, under which excitement
   is produced, have two confining boundaries.
      XXVIII.  The one  of thefe  circumftances  is, ex-
   hauftion of the  excitability  from violence  of ftimulus. X
   For  all the ftimulant powers  may carry their ftimulant
   energy to that degree, under which no excitement will a-
v  rife.   The reafon for which is, that the body becomes no
   longer fit to receive the operation of ftimulus ; another ex-
   preffion for which is, that the excitability is confumed.
     XXIX.  The  termination  (t)  of excitement, from the
   exhauftion of the excitability by ftimulus, may be either
   temporary or irreparable, and may arife either from a fhort
   continuance of a high degree of ftimulus, or a long applica-
   tion of one the excefs of which is more moderate.   Both
                                                 circum-
(l) Or ecfiation, or extinction, 
              OF   MEDICINE.          I£

circumftances come to the fame thing;  the high degree of
ftimulus compenfating for  the fhortnefs of its application,
and the fhortnefs of its application for its greater modera-
tion in  degree (/).   The effect of the former is fudden
death ;  of the latter a mere gradual death  preceded by
difeafes.  And though a moft exact meafure of excitement
were kept up, yet death at laft, however late, fupervenes.
   XXX.  Ebriety, debauch in eating and drinking, fweat,
langour,  heat, either operating alone, or  overcoming the
effect of cold, dulnefs in mental  exertion from  exceffive
thinking, or finking of the fpirit.s  in confequence of vio-
lence of  paffion,  finally, fiecp;  all thefe-are the confe-
quences of a fhort application of a high degree of ftimulus,
operating an exhauftion of excitability.  The long conti-
nuance of a more moderate excefs in the force of ftimulus,
is followed by the frailty of old age, predifpofition to dif-
eafes of debility, as well as thofe difeafes themfelves.   The
ultimate termination of both is death.
   XXXI. When the  excitability is wafted by  any  one
ftimulus, there is ftill a refervc of it, capable of being aclcd
upon by any other.  Thus a perfon,  who has dined fully;
or is either fatigued in body, or tired with intellectual exer-
tion, and therefore under a great difpofition  to fleeo, will
be recruited by ftrong drink; and, when the laft has pro-
duced the fame fleepinefs,  the more diiiufible ftimulus of
opium  will aroufe him {m).  Even after opium fails, and
                                                  leaves
  (/) A force of ftimulus as fix, operating for a fpace  of time as one;
and a force  of ftimulus as one, operating for a fpacc of time as fix, will
produce the fame effect in wearing out the excitability,
  (ot)  A gentleman,  engaged in a literary conapafition, which r^u'red
an uninterrupted exertion  of his mental faculties for more th-.n fcrrv
hours, was  enabled to go through it with alacrity, by fupportiug him-
felf ip this manner.  After dining well and fating tobufinefs, he try.-1: 
12        THE   ELEMENTS
leaves him heavy and oppreffed by the fame propenfity, a
ftimulus ftill higher  and more diffufible, if there be any
fuch,  will have the fame effect.  A perfon fatigued with
a journey will be roufed by mufic to dance and fkip •, and
he will be enabled to run after a flying beauty, if her flight
encourages him with the hope of overtaking her.
   XXXII. The wafte of excitabilility, firft exhaufted by
ftimuli, and then recruited by new ones, is moft difficultly
repaired ; becaufe the more a ftimulant operation has been
 employed, that is the more the ftimuli have been applied ;
there remains the lefs accefs to frefh ftimuli, by the opera-
tion of which the failure of excitement may be removed.
   XXXIII. The reafon  of  the  difficulty  is,  that  no
means of reproducing the healthy ftate, that is, the proper
degree of excitement, is left \  but  the very  circumftance
that  occafioned the wade,  that is, already  an  excefs  of
ftimulant operation, not admitting of more ftimulus.
   XXXIV.  Such, in  fine,  is  the nature  of  the  fame
lofs  of excitement, that it rufhes  to inftant  death, unlefs
proper meafures be taken to prefervelife by a great ftimu-
lus,  but lefs than that which occafioned it, and then by
a ftill lefs,  till by means of the moderate ftimulus,  that
is fuitable to nature,  or a  fomewhat  greater, life may at
                                                      laft

a glafs of wine every hour.  Ten hours after he ate fomething nourifh-
ing, but fparing in quantity, and for fome hours kept himfelf up with
punch not too  ftrong.  And,  when he found  himfelf at laft like to be
overcome by an inclination to fleep, he changed all his ftimuli for an o-
piate \ and finiflied his bufinefs in  forty hours.  What he had wrote was
now to be put to the prefi.  Ke had next to watch and correct  the
proofs, which coft him between four or five hours further continuance of vi-
gilance and activity. To efteti this he took a glafs with the Mafter Prin-
ter, while his  men were going on with their part of  the work.  The
fucceflion of ftimuli in this cafe was firft food, next the ftimulus of the
intellectual function, then wice, then the food  viridl, then punch, then,
opium, then punch and converfation. 
OF   MEDICINE.           13
laft he  preferved.  The difficult  cure of drunkards and
gluttons, already affected  with difeafes, fufficiently evin-
ces, that the fame confideration applies to all the exciting
powers that ftimulate in excefs (a).
   XXXV.  The excitability, thus  exhaufted by ftimulus
is debility,  which fhould be denominated indirect, becauie
it does not arife from defect, but excefs of ftimulus (b).
   XXXVI. Through  the whole  progrefs  to indirect
debility,  the fecond imprelTion of every  ftimulus has lefs
effect than  the firft, the third lefs than the fecond,  and fo
forth to the laft, which gives no more excitement ; and
the effect takes  place in proportion to the  degree or du-
ration of the feveral impreflions,  though every one always
adds fome excitement.   The inference from this propofi-
tion is, that, before the eftablifhment of indirect debility,
and,  when it is now upon the eve of being eftablifhed,
the ftimulus  which produces it,  fhould be withdrawn;
a debilitating power fhould be applied,  as in giving over
drinking wine at the end of an entertainment,  and fubfti-
tuting water in its  place, and applying refrigeration  to a
perfon who has been expofed to an exceffive degree of heat
(4    .
   XXXVII.  The  fame  progrefs  to   indirect debility
                                                       is

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

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

  (?) This is altogether a negative circumflance.  The  accumulation,
encreafe,  or abundance of excitability, take any term youpleafe, is not
oceafioned by any action or  operation, but by the want of action, the
want of operation.  To form an adequate  idea of it, fuppofe a fcale of
 excitability of 80 degrees, as in the line here drawn.
               Exciting  Power,
             o  10  so  30  40  50  60  70   80
                 Excitability.
            80  70  60  50  40  30  20  10  o
  At the commencement of life, the fum total affigned is underftood to
be 80, becaufe no part, as yet, is wafted by the action of ftimnli.   Next
it is wafted in proportion as thefe are applied from the beginning to the
end of the fcale.  Its wafting is, therefore,  owing to action and opera-
tion,  but its accumulation to the reverfe, the want of the  action or ope-
ration of the exciting powers, as is expreffed  by the  numbers placed a-
                                                      bove 
  I 6         THE   ELEMENTS

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

fcove thofe firft mentioned.  Thus one degree of exciting power applied
takes off  one degree  of  excitability,  and every fubfequent degree im-
pairs the excitability in a proportion exactly equal to its degree of force.
Thus a degree of ftimulant or exciting power equaj to 10, reduces the
excitability to  70 ; 20 to  60; 30 to 50 ; 40 to 40 ; 30 to 30 ; 60 to 20;
70 to 10 ; 80 to o.  And,  on  the contrary, the fubtraction of ftimu-
lant  power allows the excitability to accumulate.  Thus,  when the ex-
citement is at  79, conftituting only one degree of life, take off one de-
gree  of exciting power, and a degrees of excitability will  arife.  As 80
degrees of exciting power leave no excitability, fo 70 degrees of exciting
power leave IO; 60 ao ; 50 30 ; 40 40 ; 30 50 ; 20 60 ; IO 70 ; O 80.
Hence death takes place from nothing pofitive, but from the negation of
the only means by which life isfupported ;  which are the feveral exci-
ting or ftimulant powers, now fully explained.
  (y) For  inftance, perfons accuftomed to drink wine,  and eat well-
feifoned nourifhing animal food, will be more hurt by a water and ve-
getable regimen, then thofe who have not lived fo high in that refpect.
The inhabitants of Britain o.uid not live long upon the diet of the  Gen-
roos.   Perfons in genteel life eould never undergo the work uf day la-
bourers upon their fare,
  (g) Vegetable aliment, and fruits and cold roots, as cucumbers, me-
lons, acid drinks, and many other things not fnfficiently ftimulant, will
[>rbg 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 diftinguifhes that difeafe,
                                                         who 
             OF   MEDICINE.           IJ

   XL.  As,  during the  encreafe of excitability, the ex-
citement decreases, and in proportion to the encreafe of
the former •, fo that that proccfs may go all the way to
death, is a fact from which nature exhibits no exception.
It is confirmed by the effect of all  the debilitating powers
mentioned above; every individual of which,  as often as it
proves urgent, has  a rapid tendency to death.
   XLI. 'fhe  defect of any one ftimulus, and  the pro-
portional abundance of excitability, is, for the time, com-
penfatcd by any other, and often with  great advantage to
the fyftem*   So a perfon,  who has dined  infufficiently,
and therefore not well enough ftimulated, is recruited 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 corporal or mental exercife, and 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 the venereal
gratification is relieved by wine, and the want of the latter
is made amends for by the ufe of the former,  each banifh-
ing languor occafioned by the want of the other.   The
fame  conclufion applies to the ufe of ftimuli, for which we
ruive  an artificial,  rather than a natural, craving.   The
longing for fnuff, when it cannot be got, is gratified  by the
practice of chewing tobacco; and, when any one is lan-
guid  for want of tobacco, fmoaking fupplies the place of
it.  Nay, when the functions, as they  often are, have un*
dergone a temporary lefion, and on account of that, there
is no  accefs to the ufe of certain accuftomary and natural
ftimulj;  the fubftitution of others, lefs accuftomary, and
lefs natural, fupports life, till the defire for the natural fti-
                          C                       muli

who can ufe them with  impunity, or, at leaft, with much more freedom
and lefs harm.  Something fimilar to this obfcrvatiou applies  to moft
^.l/eyfes, 
iS
THE    LEMENTS
 muli is reftored,  and thefe are now in a condition to fup-
 port the natural vigour as ufual, and the ht*\xhfinally efta-
 blifhed («).
   XLII.  As,  in  thi-s manner,  the fuperabundance of ex-
 citability, proportioned to the deficiency of ftimulus, may
 through  all the  degrees  from  its fmalleft to its greateft
 quantity, be worn out to a certain extent, by one ftimulus,
 and then another, and the danger of its morbid accumulati-
 on awarded,  till the fum of it be brought down to that,
 which is fuitable to health; fo, the more abundant the fame
 excitability is, that is the more ftimuli are withdrawn, or
 the greater the penury of the moft powerful ftimuli Is, the
 lefs recourfe can  be  had to that mediocrity of excitability
 on which  the vigour of life depends ;  and the weaknefs
 may go to  that pitch, the excitability arrive at that degree
 of abundance,  that the lofs of excitement may at laft be-
 come irreparable. This propofition is both illuftrated and
 confirmed  by the ufe of every debilitating power; as is ex-
 emplified by cold, famine, thirft, and the progrefs of fe-
 vers.
   XLIII.  This fuperabundant excitability proceeds  with
 fuch rapidity  to  death,  that the only means of reftoring
 health, is firft to  encounter it with a very fmall dofe ofcM-
 fufibleftimulus,« Jo/^fcarcely exceeding the fcanty {w) pro-
 portion of ftimulus, that occafioned it; then, after wafting
 a part of the fuperabundance,  to proceed to fomewhat a
 ftronger dofe of the ftimulus ,• and in that manner to be con-
 ftantly taking off whatever fuperfiuity ftill remains, till at
                                                     laft

   (a)  This propofition is of the urmeft imp«rtance, as holding out the
true principle, upon which fo many actions and feelings ef human life,
both in health and difeafe, are to be explained, and particularly as lay-
ing down an indication, which applies to y&ihs of all the febrile difeafes,
and include our artificial as well as our natural defire* ajid appetites.
  (w) Or uader-proportiened. 
                OF   MEDICINE,            lg

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

     XLIV.  Since  all life confifts in ftimulus,  and both the
   over-abundance and deficiency^ it is productive of difeafes,
   and in exacl proportion to the over-abundance or deficiency,
   it follows,  that the remedies of both thefe deviations from
   the/ro/rrftandardfhould be accommodated to their degree;
                          C 2                        and

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

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

ftimulus at any  given time, while the accumulation of excitability, and
ficking of excitement, even to death itfelf, can be effected  in the fhort-
eft fpace of time,  and by any  one  of the  debilitating powers; conse-
quently, 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
poffibility of regaining the vigour thrown away,  much lefs  any hope of
procuring more than exifted before it was lowered.
   (a) Dy fevers here are meant  thofe difeafe?, fo named, which depend
on evident debility, and not any of  thofe, which, though moft injudici-
oufly fo named, depend upon an  oppofite caufe.  Inftancesof the former
we have in all  the fevers of the intermitent or remittent kind, in fyno^.
chus,  typhus, and the plague itfelf, with others  that have never been
confidered as fevers,  Examples of the latter occur in fynocha, or the
common inflammatory fever in the feveral difeafes of the fame ftamp
accompanied  with inflammation in a part,  as in the throat, lungs, and
various parts  of the external furface.
  (f)  Indirect debility appears in the range of a fcale from 70 up to 80 ;
the direct, in all the degrees below  40 too.  The only cafes,  that ad-
mit of debilitating operation, are thofe of exceffive excitement from  40
 wp.ro  70,  For the cure of difeafes  within this latter range, all  the di-
                                                        rectly 
22           THl   ELEMENTS
                CHAP.      IV.

            Of the Seat and Ejfetls of Excitability.

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

rectly debilitating powers are proper, and, for the moft part, they only;
becaufe there is no accefs to  the ufij of the indirectly debilitating  powers
till they have run their full courfe of ftimulant operation from 40 to 70,
at whieh laft only they become debilitating; and, though fometimes, and
under certain circumftances, they may be employed, the fafeft general
rule is to avoid them.
  (a) Called fyftem by medical writers.
  (A) That is, all the  functions which  diftinguifh  living animal 4y-
ftems.
  (*) 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 applied, and, io
a fhort  time after, remove it altogether, as is now well known, h >w  is
that  to be explained but by the above propofition :  it being impoffible to
pretend tnat it is carried in the veffels?  Nor is any other of the many
hypothefis, that have been thought of for the folution of this fact, more
adnuffible.  Should it he imagined,  that it moves along the nerves ac-
cording to the laft opinion, we demand proof of that affertion ; which
has not yet, and will not eafily be produced ; while the fact juft now
affigned carries its own dciionltraton in its bofom.   The queftion re-
folvc* itfelf wi.olely  into the following fohition ;  Why does opium at
ence rel.cve the gout in the ftomach, on the internal furface, and in the
rcmotcft extremity of that fuiface ? Becaufe the property in the living fy-
ftem, upon which and by which it acts, is one and the fame over all 
          OF   MEDICINE.         23

   j. Different exciting powers are applied to different
parts of the nervous fyftem, none at once to the them all; but
the mode of their application is fuch, that, wherever they are
applied, every one immediately affects the whole excitability.
   XLIX. Every one  of the fame powers always affects
fome part more than any other, in which refpecl one pow-
er ajfecls one part more  than any other, another another,
with the fame inequality.  The affected part is generally
that to which any of the powers is directly applied.
   *. And  befides that, the more excitability has  been
affigned to any part from the beginning of the living ftate,
that is, the more vivid and fenfible it is, the operation upon
it of each exciting power, whether acting  with due force,
or in excefs, or in defect, and through all the intermediate
degrees of its aclion,  becomes more powerful (af).   Thus
the brain and alimentary canal  pofleffes more vivid exci-
tability, that is, more propenfity to life, than other inter-
nal parts •, andthe parts below the nails, than other exter-
nal parts.   Again, while the fact juft now related is fuch,
as it has been ftated, the affe&ion of the part bears no pro-
portion to that diffufed over the whole body.
   L. An eftimate may be formed of the degree of affecti-
on in the part more affected than  any other, and of that
which is diffufed over the whole body, by comparing the
affection of the former with as many leffer  affections, ta-
ken together, as  equal the number  of parts in all the reft
©f the body.   Suppofe the greater affection of a part (f)
                                                     to

  (J) That is to fay, if the exciting power acts with that force which
produces health, the degree of its action is greater upon the given than
any other part; as alfo when its action is cither greater or lefs than that
of the middle falutary degree.
  (/) 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 p;.r-
ikular cavity in dropfy, 
24           THE   ELEMENTS

to be  as 6, and the lefTer affection of every other part to
be 3, and the number of the parts lefs affected to  amount
to iooo (g); then it will fallow, that the ratio of affection,
confined to the part,  to the affection of all the reft of the
body, will be as 6 to  3000.  This eftimate, or fomething
very like to it, is proved by the effcft ofxhz exciting hurt-
ful powers, which always act upon the whole body (h) •
and by  that of the remedies,  which  always  remove  the
effect of the hurtful  powers from the whole body  (i),  in
every general difeafe (k)
                                                          LT.

  (f) Which is keeping greatly within the truth.
  (b) The hurtful powers, which produce peripticumony, in common
Englifh,  the inflammation »f the lungs, are excefs in eating, drinking,
expofare to heat, or to the alternation of heat with cold, an over  pro-
portion of blood from inactivity, or an encreafed  velocity of its motion
from violent labour, &c. the effect of any or all which muft fall  as much
upon every other part of the fyftem as upon a fmall- portion of extreme
veffels in the lungs, and therefore the morbid affection produced cannot
be confined  to the latter, but muft be extended  to the former.  The
whole body muft partake of the morbid change ; it muft be one common
 affection  prevading the whole.  If this is not probation, let any  thing
left on record by authors, or any living phyfician, produce a Angle hurt-
ful power, that, without affecting the fyftem over all, can penetrate in-
to the inmaft receffes of the lungs, and there produce an  inflamma-
tion.   I fhall be content with one fuch hurtful power, and in exchange
for it, when produced, give up my whole doctrine.
  (i) Here too I throw the gauntlet.  Find a fingle remedy which re-
moves the difeafe by an operation confined to the lungs. There is not one.
   (i)  A wound in the lungs,  among other effects of it, may  produce
 an inflammation.   Eut that is not a pcripneumony, or a general difeafe
at all.   It is, on the contrary, a local one, arifing from a local caufe, and
to be removed by local remedies, if accefs could be had to them.  And
though nothing has been more common than blending fuch cafes of local
 and general difeafe, at the fame time no error that has hitherto crept
 into the art, needs more to be corrected.  Such an accident is as much a
 peripneumony, as an inflammation from a contufion in the foot is a gout,
or the fwelled legs of women heavy with child is dropfy.  But of all this,
more hereafter. 
OFMEDICINE.          2$
  LI. In this  way temperature affects the furface  of the
body; diet the ftomach,  and the reft of the fame canal;
the blood and other fluids their refpective veffels ; labour
and  reft the  veffels  again, and fibres of the mufcles:
paffion and exertion in thinking,  the brain ;  all  thefe af-
fect the parts mentioned, each that upon which its action
is exerted, more than any other equal part.
   LII. Inftances of a greater excitement of a  part than of
the reft of the body, are found in fweat in a perfon in health,
flowing firft from the  brow  under exercife, in checked
perfpiration, in inflammation or  an affection analagous to-
it  in   difeafes,  in  head-ach   and  delirium.  Proofs
of a leffer excitement in a part, are exceffive  perfpira-
tion and  fweat  not  occafioned   by  labour  or  heat, ef-
pecially when it is cold and clammy,  profufion of the
other excretions, fpafm,  convulfion,  partial  palfy,  weak-
nefs or confufion of intellect, and again delirium.
   UII. As the operation of the  general powers, whether
exciting in excefs,  in due proportion, or in defect, is di-
rected to  fume one part a little more than to any other
equal  part; it  is next  to  be obfrved, that it  muft  be
of the-fame kind in that part as  in the reft,  and as  well
as the general operation, be either in excefs, or in juft pro-
portion or deficient,  but  never of  an oppofite  nature.
For as the exciting powers are the fame, and the excitabi-
lity  every where the fame, it is impoffible that  the effect
fhould not be the fame.   The  excitement,  therefore, is
never encreafed in a part, while it is diminifhed in the gene-
 ral fyftem—nor diminifhed, while the general excitement
is encreafed.  There is no difference here, but one of de-
gree ; nor can different effects  flow from one and the fame
caufe.
   k For though, on account  of the  great  fenfibility of
                   2                            ceiuun 
7,6         THE  ELEMENTS
eertain parts, (for inftance,  the ftomach (/),  and the for-
cible energy of the exciting powers, either in ftimulating
or debilitating,  exerted on  them, thefe  parts run fooner
than moft others either into direct or indirect debility, or
into a great encreafe of excitement;  that however is only
a matter of fhort duration,  and it is not long before the
reft of the functions are hurried into the fame ftate.  Thus,
naufea, vomiting, diarrhoea, and other fimilar fymptoms,
produced by ftrong drink and opiates j as well as the fame
affections apparently, and the gout, colic, gripes, and  other
fimilar fymptoms, occafioned by abftinence and water drin-
king ; likewife good appetite,  and the removal of the tur-
bulent fymptoms of  the ftomach  and inteftines, which we
have  mentioned,  taking  place in the convalefcent  ftate,
in confequence of a proper  adminiftration  of food, drink,
and diffufible ftimulants : all thefe are fhortly followed by
a fimilar ftate of the reft of the body, and the eftablifhment
of indirect debility is the confequence of the firft  cafe;
that of direct debility fucceeds to the fecond, and health
over all is the termination of the laft.
   LIV. A part, therefore, is the feat of no general affecti-
on ; the whole body is the feat of them all; becaufe, with
the inequality above related,  the whole excitability is affect-
ed in them all.
   LV. Neither is the affection of the more fuffering part
the firft, and afterwards  propagated over  the fyftem ;  for
this good reafon, that, as foon as the excitability is affected
any where, it is alfo and immediately affected every where.
Both facts are confirmed by the operation of every exci-
ting power, affecting the whole body as quickly as any one
part; by general morbid affections appearing equally foon
                                                  over

  (/) For  the fame reafon, i. e. the fcnfibility of the genital  fyftem,
wine and other ftrong liquors, as well  as opium, operate indirect debi»
ttty fooner upon thefe parts thaa ethers, 
               OF   MEDICINE.          27

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


               CHAP.     V.


               Of Contraction and its Ejfeels.

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

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

               CHAP     VL


          The forms of Difeafes jrnd Predifpofition.

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

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

  (»)  Th« fame hurtful powers produce, and the feme remedies re-
 move, both Catarrh and Peripneunsony, only differing in degree-  The
 powers producing them are excefs in the ufe of ftimulants, and the re-
 medics whatever moderates that excefs.  Evacuation, cold, and  ftarving,
 are the means.  All the difference is, that more of the means are em-
 ployed for the cure of Peripueumony than for that of Catarrh,  The
 hurtful powers producing indigeftian and fevers,  are alfo the  feme, to
 wit, debilitating ; and the remedies the fame, to wit ftimulant.   Only a
 fmall degree of the remedies, proportioned to the flightneis of the de-
 gree of the caufe, is  fufficient  for the cure of indigeftion; while  the
 moft diffufible ftimuli arc required to effect the cure of fevers.   Stimu-
 lants, in  one degree or other,  make the cure of  all afthenic difeafes j
 evacuants and other weakening means in different degrees, form the
whole cure of the fthenic form of difeafes. Might not this have been
 known long fince i
  (d) «r full meafwe. 
 32         THE   ELEMENTS

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

              CHAP     VII.

The Efecl of both the Diaihefes, and of the moft perf eel Health
                          itfelf.

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

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

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

 !ion produces,  are thofe of indirect debility.   Any  difeafe of this fort,
 when treated according to a rule lately delivered, will be cured.  But
 if the ftimulants adapted to this purpofe be urged further ; the fthenic
 diathefis will again be produced ;  and the debilitating  power, fuited to
 the removal of it, may  carry down the excitement below 40 into the
 range  of predifpofition betwixt 40 and 25 ;  and then, by a further abufe
 of remedies, which fhould only be ufed in the range betwixt 40 and 70,
the excitement  may return to  the fame point  from which it fet out,  to
wit, the point of 10, and the  excitability rife  to its original point, that
of 70.
  (*)Itmuft  never be forgot, that we arc 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 it,
  (/) not a natural, but,
  (f) not by aay powers in theaifehcs, but 
OF   MEDICINE.
35
 ers, and even by thefe with difficulty and only, for a  little ;
 pnd then,from the neceffity of their fate, girc way to  death.


             C    H    A   P.     VIII.

                    Of Predifpofition.

   LXXIII. Predifpofition is a  middle ftate betwixt per-
 fect health and difeafe.   The powers, producing it, are
 the fame with thofe which produce difeafe.
   LXXIV.  The per.od of predifpofition will be fhorter
 or longer, according to  the greater or leffer force  of the
 hurtful powers  that have induced it; and the interval be-
 tween health and  actual difeafe will be more quickly or
 flowly got over.
   LXXV. That predifpofition neceffarily precedes difea-
 fe?, is evident from the fact of its arifing  from the fame
 exciting powers, acting upon the fame excitability, from
 which both health and difeafe arife, and of its being an in-
 termediate ftate betwixt them both.   And, as the excite-
 ment of health differs much from that of difeafe; it is not,
 therefore, to be fuppofed, that the former  immediately
 mounts up to the latter, and fkips over the boundaries  of
 predifpofition :  nay,  the contrary  is certain and beyond
 a doubt.
   LXXVI. Contagious difeafes are not an exception from
 this obfervation  ; becaufe, whether the matter of contagion
 act by a ftimulant or a debilitating operation, its operation
 is the fame with  that of the ordinary powers, that is to fay,
 its caufe is the fame (a).   If,  as it fometimes happens, rip,
                            D a                general

  (a) The fmall-pox and meafles arc cured hy the fame means as perip-
neumony or any other fthenic  difeafe ; and, excepting  the contagious
matter, arife from the fame ftimulant hurtful powers; they muft, there-
                                                    fere 
3«
THE   ELEMENTS
 general  affection follows the application of contagion,  if
 So  undue  excefs or  defect  of excitement  is  the  confe-
                                                        quence -,

fore,  with the fame exception, be the fame.  The only difference  is,.
that they are  accompanied  with a contagious  matter,  and the other
fthenic  difeafes are not.  The amount of which is altogether unimport-
 ant.  For, if the ordinary powers have not operated, the affection does
not come  under the definition of general difeafe  j none of the functions.
receding  from their  natural ftate,  and the eruption  amounting to  no
more than a flight local  complaint.  It is, therefore, only  of ufe to re-
gard the  general circumftances of  thefe difeafes, making no more ac-
count of the local part, than to confider,  arrange,  and treat it  as fuch.
 It is well known, that,  when by the means ufed for the cure of fthenic
difeafe  without  contagion and their fequel, eruption, the fthenic dia-
thefis is prevented or removed, the local part  gives no  trouble; and
that the difeafe is never dangerous but from the  neglect of that manage-
ment.  But the management is nothing elfe but the ordinary one in any
fthenic cafe.   If it  fhould be contended, that,  all  that being granted,
ftill  the eruption may contribute a  little : Be that fo, and it can be  but
very little ;  what is the  effect ? The cure  fhows it;  which is exactly the
fame  as in fthenic difeafes without eruption.   The  difeafe, therefore,
Seing the  fame (for its mere local part is out of the queftion, as only re-
quiring a peculiar  expofure to  cold, which is  equally proper in every
fthenic difeafe) ; every part of reafoning rtfpecting it, and, confequentry
that affecting the queftion  about predifpofition,  muft alfo be the fame.
If, therefore, other general  difeafes have  their  predifpofition,  fa muft
the fmall-pox, the  meafles,  and the plague itfelf.  If it  fhould ftill be
faid, that  the  eruptive difeafes,  though in other refpects the fame with
the non-eruptive, differ,  in fo far as predifpofition is required as a com-
jnon  circumftance  between them ;  the anfwer is, that that difference
enly refpects their local part, which, without the powers producing the
difeafe,  is iafignificant and a mere local complaint.  As general fthe-
nic difeafes, the fmall pox and meafles, and as general afthenic ones, con-
tagions fever and the plague, to the full extent of their generality, have
their peiiod of predifpofition ; we  may have occafion afterward  to cfta-
blifh 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, vill apply to.
difeafes  in which perfons may have been concerned, 
OF   MEDICINE.
37
quence; in that cafe, the affection is altogether local and
foreign from this  place.
  LXXVII. If poifons communicate any fort of morbid
affection without  predifpofition, fuch an affection, for that
very reafon, is not to be confidered as a general difeafe, as
alfo for this additional reafon, that the afeelwn is neither
removed nor relieved by the ufual cure of general difeafes.;
and the diverfity of the effect proves, that both  the caufe
and exciting hurtful power are different from the general
oRes.   In one word, fince predifpofition  and difeafe are
the fame,  varying only  in degree, the unavoidable  con-
clufion is, that whatever, with a given force, produces the
latter,  the fame, with a leffer force, will produce the for-
mer.   The  only  cure of  moft poifons is their early dis-
charge from the fyftem.   And if, as often happens, others.,
by  wounding an  organ neceffary to life, are not curable,
but fatal; the effect of  both is foreign from our prefent
fubject, and to be referred to local difeafes.
   LXXVIII.   The  only  thing to  be regarded  in  the
powers producing either predifpofition to general difeafes,
or thofe difeafes in their full force, is the degree of the for-
mer (c) compared with that of the latter (d), or of the in-
dividual powers compared with one another; for the pur-
 pofe of difcerning the degree of hurtful power  that each
poffeffes,  and the degree of curative means to be employ-
ed in order to remove the hurtful effect (e).
                                                  LXXDR
  •(c)  thofe that produce the predifpofition,
  (</) thofe that  produce the difeafe,
  (e)  The diftinctions of the  powers producing predifpofition, and 6i
thofe that excite difeafe, under the general appellation of predifponent
or occafional caufes have been multiplied and refined upon without end.
But the whole fyftem of remote caufes, as they have been called,  is
falfe in its firft idsa.  The hurtful powers, wl atever they be called, that
produce difeafes, alfo produce the predifpofition to them.  Which be-
ing once admitted, as it henceforth muft, the whole fabric of aitiology 
3§
THE   ELEMENTS
   LXXIX. The knowledge of  predifpofition is of great
importance; as  enabling the phyfician to prevent difea-
fes (f), comprehend the true caufe of them founded in pre-
difpofition, and  to diftinguifft them  from lo:r.! affections,
which  are widely different from  them  (g).
   LXXX.  As the predifpofition,  to difeafes, and  the dif-
eafes themfelves, are  the fame  ftate;  a great  criterion,
by which general difeafes may be diftinguifhed from local
ones, will be found in this fngle circumftance, that  general
difeafes are  always,  local never,  preceded by predifpofi-
tion {h).
                                                    LXXXI.

or of the doctrine of remote caufes muft fall to the ground : Confcquent-
ly, fimply remote caufes, not divifible into predifponent and occafional j
relative  remote caufes, or fuch as are fo  divifible; internal and external
predifponent, internal and external occafional caufes ;• approaching cau-
fes, or caufae propriores proximate caufes,  of which, not only one,  but
often feveral, are affigned to everydifeafe, muft ceafe in medical  language,
and the ftudent's attention  be turned away from the endlefs  purfuit of
diftinctions without a difference, to the ftudy of the folid and ufeful facts
that nature holds up to his contemplation in great abundance, when one*
his eyes are fairly opened to behold  them,
   (/) from his acquaintance with the powers that lead to them,
   (g)  Such is the  fimplicity  to which medicine is now reduced, that
when a  phyfician comes to the bed-fide  of a patient, he has only three
things to fettle in his miud,  Firft, whether the difeafe be general or lo-
cal ; 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.
  (h)  An inflammation in fome part of the ftom3ch, or as it has been
commonly called, " the Inflammation of the  Stomach," as  if it were
always  of the fame  kind, produces many fymptoms, that bear fo great
a refemblance to general fthenic difeafes, fuch as peripneumony, that by
fyftcmatics and nofologifts,  it, as well as many other inflammations of
internal  cavities, have been united into an  order of difeafes, fuppofed all
to partake of one common nature,  The  (jaftritis, however, which is
                                                            its 
OF   MEDICINE.            39
   LXXXI.  As the affection  of a part is always the ori-
 ginal fource of local difeafes, and as the diftinctions,  we
 have related are eftablitied upon the folid bafis of truth;
 it follows, that the following  diforders  muft be rejected
 from the number of general difeafes, how great foever
 their refemblance to them  may be, and however much
 they may conceal their own nature.   Whatever affec-
 tions,  then, arife, from any ftate of a part, from ftimuli,
 from debilitating circumftances  (neither of which laft pro-
 duce any commotion in  the whole body,  or only do fo in
 confequence of the force of the local caufe),  from  com-
 preffion of a part,  from obftructbn,  from other difeafes
 (/),  and not from the exciting powers which produce  ge-
                                                        neral

 its nofological  name, is effentially different, both from Peripneumony
 and all the other general difeafes of the order with which it is affociated,
 both in other refpects, and in that of which we are fpeaking.  As ari-
 fing from certain local hurtful powers, it is not preceded by predifpofi-
 tion,  So when I come to the bed-fide of a patient under thefe circum-
 ftances, though I had  no previous knowledge of the nature of his difor-
 dcr;  whenever I hear that he has fwallowed ground glafs, fihall fifh-
 bones, or, perhaps, a great quantity of Caien  pepper, I can be at no
 lofs to difcern the nature of the difeafe, and to find, that it is altogether
 local; and that for two of the beft of all reafons;  firft, the perfon ha-
 ving been in perfect health immediately before that accident; and fc-
 condly, that the fubftances which he had fwallowed were fuch as would
 naturally divide a found part,  or, in the language of our profeffion,  pro-
 duce a folution of continuity in it.  From this,  again, inflammation is
 an infeparable confequence.   And it is equally an  univerfal Tact in the
 animal economy, that, when any part, whether internal or external,
 which poffeffes  great fenfibility, is wounded or otherwife injured in its
 fiibftancc, the pain  arifing from the inflammation fuperinduced, fpreada
 fymptoms of diforder over the whole fyftem, which are liable to  mif*
lead thofe, who are not in poffeffion  of the criterion we here point  out.
As fuch a cafe, then, is not preceded by predifpofition, fo peripneumo-
 ny as well as every other fthenic, every afthenic, difeafe muft, from the
proof; of the univerfality of the fact, be allowed te be, it muft be local.
 And here again we  throw the  gauntlet.
  (J) whether general or local, 
4-0          THE    ELEMENTS
 neral difeafes (k); all thefe muft be rejected from the num-
 ber of general difeafes :  and that for the moft folid reafons j
 to  wit, their differing from them in the hurtful  powers
 that produce them  in their true caufe (/), in their cure (m),
 and in every effential refpect,  agreeing with  them  in no-
 thing, but in a deceitful and deceiving fuperficial appear-
 ance.
                                                 CHAP.

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

                     The general diagnofts.

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

   (0) The excefs is contained between 4$,  the point of health in  the
 table, and 70.
   (6) The cafes of indirect deficiency or  debility are  comprehended
 betwixt  70 and 80. The direct are all the degrees below 40,  Betwixt
 40 and SS confifts predifpofition to fthenic; betwixt 40 and 25 the pre-
 difpofition to afthenic difeafes.
   (c)  Diagnofis is  the doctrine  of diftinguifhing difeafes from one ano-
 ther.  It was naturally thought to be of the greateft importance, when
 difeafes were fuppofed very numerous,  and as different from each other
 as  their names and the various appearances of their fymptoms.  That,
 however, has been found to be altogether a miftake in this work, ia
 which the endlcfs variety of general difeafes is reduced to two forms, a
fthenic and afthenic one, without any  other difference but what con-
fifts merely in degree.  The huge volumes of diagnoftics are then in this
chapter fuperfeded ; and much labour, not only irkfome to the artift, but
worfe  than ufelefs,  often pernicious to patients, is proved to be fuper-
fluous,
                                               3 
   42         THE  ELEMENTS

   ration of the remedies of an oppofite nature to that which
   occafioned the difeafe :  while on the contrary,  local af-
   fection  is  diftinguifhed,  firft,  by  the  affection  of a
   part, and  the diforder of  the  fyftem  [d) being fuch
   as may be traced back  to  that affection ;  and  by the
   abfence of the diathefis of the difeafe which the local affetli-
   gns refembles, or only its accidental prefence.
     LXXXIV. In order to attain to this ufeful knowledge
   learn what is neceffary  from anatomy, wafte no time in
   fuperfluous ftudy in it; perufe the works of the illuftrious
-  Morgagni; diffect fubjects;  diftinguifh remaining effects
   from caufes that have paffed away •, examine diligently very
   many bodies of perfons who have been hanged, or have
   died  of wounds,  and  are  otherwife found: compare
   thefe diligently with the bodies of thofe who have died by
   lingering and often repeated difeafe;  compare every par-
   ticular with every other, the whole with the whole; guard
   againft the raftmefs of forming opinions, and, if you can,
   you will be among a very few, who have  ever been able
   to do fo;  never expect to difcover the caufe of difeafe in '
„  dead bodies,- be circumfpect  in forming a judgment.
     LXXXV. As  internal local affections are often a cer-
   tain taint that remains after general difeafes have paffed
   away, it is therefore a matter of found judgment to under-
 ftand, that there is lefs or more reafon  to fufpect the for-
   mer, in  proportion as the latter have feldomer  or oftener
   preceded them.

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

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

              CHAP.     XI.

   LXXXVIII.  THE indication for the cure  of fthenic
 diathefis  is  to diminifh,  that  for the cure of the afthenic
 diathefis, is to encreafe the excitement, and  to continue to
 encreafe it, till that degree  of it,  which conftitutes  the
 mean betwixt its extremes, and which is fuite.d  to good
 health, be replaced.   This  is the only indication of  cure
 that univerfal difeafes admit of.
   LXXXIX. As  both diathefes arife from an operation
 of the exciting  powers,  the  fame  ;'// hind but varying in
 degree ; fo they are both prevented and removed by an ac-
 tion of the remedies, alfo the fame i:i kind, but  oppofite in
 degree, to that which produced them.  As their caufe, fo
 is alfo  their plan  of cure, confirmed by an induction cf
 proof (a), drawn from the whole courfe of facts and phe-
 nomena (b).   The fame debilitating  remedies, which re-
                                                  move

  (a)  not one or two, but
  (&) Suppofe the fthenic diathefis mountad up to 60 in the wale ; to
reduce it te 40  it i» evident, that the 30 degrees of fuperfluous excite-
                                                   ment 
44           the    Elements
 move any one fthenic  difeafe, remove that  whole form
 difeafes:  and the  fame  ftimulant means, which cure any
 one afthenic difeafe, remove all the reft (c).    Are not pal-
 fy, in fo far as it is  curable (d), and dropfy, in fo far as
 it is a general affection (e), as well as the gout,  and fevers,
 both relieved and removed by the fame remedies ? And are
 not  peripneumony,  the finall-pox,  the meafles,  rheuma-
                                                          tifm,

 ment muft  be taken off, and  therefore, that remedies operating with
 a ftimulus, weak enough to produce  that effect, muft be employed :
 they are  ftill, however, ftimulant, and of confequence, though they re-
 move it, ftill the fame in kind, as the powers that produced the diathe-
 fis ;  it having been proved, that they are not to be  fuppofed fedative,
 both for the reafons already given, and for this additional one, that proof
 has not been yet brought of a Angle fedative in nature.  As their ftimu.
 las, however, is lefs than  that which is required to fnpport the ordinary
 ftate of health, they are underftood to  be debilitating, and, therefore,
 proper remedies of fthenic diathefis.
  (c) Suppofe the afthenic diathefis to have funk down to ao ; to raife it
 up to the ftandard of health, it is plain,  from all the propofitions hither-
 to laid down, that the ao degrees of deficient ftimulus muft be reftorcd,
 and, therefore, that remedies operating with a degree of ftimulus  ade-
 quate to  the production of that effect, muft be ufed.   All the difference
 betwixt this force of ftimulus and that of the other, is only a difference
 of 40 degrees.  As,  therefore, the debilitating  powers,  though ftimu-
 lant, employed in the firft,  removed the morbid fupcrfluity ;  fo the fti-
 mulant powers ufed in this cafe, called ftimulant by way of eminence,
 remove  the morbid deficiency, and thereby, reftore the degree of ex-
 ciem ent, that conftitutes the ftandard of  heakh.
  (</) When the prevalence of debility, and that  to fuch a degree as to
 deftroy the  connection that fubfifts betwixt the fibres ofmufcles, and that
 function  of the brain which we call will, takes place  in parts of the fy-
 ftem, not only remote from the center of activity, but beyond the cir-
 culation, it muft be of difficult  cure ; becaufe th« moft powerful means
 of effecting that operation,  act moft powerfully when taken internally,
 and much more feebly when applied to the fkin.
  (0 What is called dropfy confifts of a  cafe which is a general  difeafe,
and a number of others,  which  are only fymptoms of local internal dif-
 trJcs, and to be treated in the laft par* uf this work:   Thefe arife from
                                                           offifi- 
OF   MEDICINE.           45
tifm and catarrh, removed by the fame remedies (/} ? But
all thefe remedies in the afthenic cafe encreafe, in the fthenic
diminifh, the energy of life.  In both cafes the operation
is a common one ever all, nor is there any diverfity but in
degree.
   XC. The remedies,  therefore of fthenic diathefis  are
powers, exciting by a weaker ftimulus, than that  which
is  fuited to health ; and are in  this work  to be denomi-
nated, for the fake of brevity,  Debilitating or Antifihenic
Remedies.
   XCI.  The femedies of afthenic diathefis are  powers, ex-
citing with  more force, than fuits  the beft  health ; to be
named here in  the practice ftimulants  or fthenic,  for the
more  convenient diftinction of them from the other re-
medies.
   XCII. Thefe are to be employed with more  or lefs free-
dom in proportion to the higher or lower degree of each di-
athefis, and of the local affection depending upon it.  And
fuch a choice of each fhould be made  in fuch  a way as
that the moft powerful may be adapted to the moft  violent
cafe.  But the cure of any difeafe of confiderable violence,
and fcarce of any at all, is never to be entrufted  to any
one remedy.  The ufe of feveral remedies is preferable to
that of one ; becaufe, thereby, their direct energy is ap-
plied to  the fyftem to a greater extent, and the excitability
                                                      is

offifications in the large  yeffels next  the heart, from tumors, whether
fchirrous or fteatomatous, impeding by  their preffure the return of the
blood by the veins to the heart.  It is the general cafe that is here  allu-
ded to, and the public may depend upon it, that it is to be cured, but not
by evacuant means, and, on the contrary, by the high diffufible  ftimuli,
neceffary to the cure of difeafes of high debility, futh as the extremity
of typhus fever, and an expiring gout.  All thefc are  cured by high fti-
mulants.
  (/) to wit, evacnants, cold, and ftarvin». 
   46         THE   ELEMENTS

   is rr.O'.-'. completely and more equally affected.   Fhe f ix-
   fon, who  means tha? hid remedies, mould go  to a parti-
   cular part  (h), is equally  wife, ai. fl,7y one would be,, who,
   bT- cro-r.vm - t.vy, expects tj eradicate r. tree.   What re-
   medies are gf general, what of local operation, liiuii next be
   mentioned.
     XCIII.  General  remedies are  thofe,  which,  acting
   upon  the  excitability, by an operation diffufed over the
   whole body, reproduce the ftate of health.
     XCIV.  Local remedies are thofe, which act by a fimi-
   lar  operation on  a part,  and by an operation  confined to
   that, reftore the found ftate.
     XCV. Since every univerfal  difeafe,  every predifpofi-
   tion, depends upon  encreafed or diminifhed  excitement,  -
   and is removed by the conversion of that into the degree
   which conftituies the mean betwixt both ; for  that reafon
   in order both to prevent and cure difeafes we muft always
   ufe the indication propofed,  and ftimulate or debilitate;
   never lay  by, nor truft to the fuppofed powers of nature,  X
   which have no real exiitirnc?.
      XCVI. In  the indicaticn of cure, the only regard to be
   had to morbific matter, is to allow  time for its paffiug out
"^  of the body.   For whether it acts, like all other  exciting
   powers, fometimes  by a fi:iniulating  (i),  fometimes by  a
   debilitating operation  (£), or whether  its aelion  cotftft in
   only giving the peculiar form of its  refpective  difeafe, and,
   thereby, adding a local  affection to a general one; in ei-
   ther cafe there is no room for a new indication.
      XCVII. Fcr if the diieaie, as a general one, be pro-
   perly managed,  every  eruption,  aud  its confequences,
                                                     every

     (b) and there, from a local operhf.ion, and not by an affection  of-{he
   excitability,  ferve the purpofe,
     (i) as in the faiall pox and meaflep,
     [i) as in contagious fevers and the plague, 
                OF   MEDICINE.           47

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


   (/) After the  difcovery of the nature of the catarrh, the catarrhal
 fymptoms in the meafles came naturally to be enquired into. A full trial
 was given to the refrigerant debilitating plan, in the author's own fa-
 mily, as well as among feveral patients, and hftly among near an  hun-
 dred patients in England,  treated by the father of one of the auther's
 pupil's ; who all did well, while others, who were kept warm, according
 to a practice  that Dr Sydenham had left as he found it among his
 Alexipharmac  cotemporaries, many died,  and all had a bad recovery.
 The Author's own foil and name-fon, a boy about fix years of tage, was
 ftnpt half naked and allowed to go out and play as he pleafed.  The only
 check upon him was, his being allowed nothing but fluid vegetable  nm-
 ter, when he returned home with a keen appetite. This matter will be
 further  explained,  and  in a more proper place afterward.  Eut,  wl.ut
 has been faid, was in illuftration of the hint in the text.
  (w) This cafe of difeafe has been confidered,  as wholly and folely fca:-
 ed in the throat, and therefore conjoined  with  other difeafes, where
 that local affection was underftood to be the effential fymptom, and a
 fymptom that connected all the cafes.  But the  othtr.cafes are fthenic or
to be cured in the ordinary way of bleeding and evacuation ; while fuch
a practice is certain death in it, a* being not only an afthenic cafe, that
 is a cafe of debility,  but one of the higheft; and, inftead of depending
 upon the affection of the throat, the affection of the throat depends on it.
 Give ftimulants to the patients labouring under the  inflammatory fore-
 throat, and you kill them ;  bleed, purge,  vomit, and  ftarvc, i:i the
gangrenous cafe, aud  you  cnfure the fame fate.  Such,  however, arc
the difeafes,  that fyftcmatics, nofologifts, and  other ftrangers in the
city of nature, have, from th*r ignorance of the place, in fpite cf their
                                                        natural 
4 8
THE   ELEMENTS
 other cafes of typhus,  with a fimilar affection of a part.
 In the two laft, the danger to life depends upon the degree
 of the general affection, without which there is no occafion
 for any apprehenfion from the local.  And the fame pro-
 pofition is fo true, with refpect to the three former, that,
 though the contagious matter has been applied, yet without
 the general  hurtful powers preceding,  no  true general
 difeafe arifes, the danger encreafes  in proportion to their
 violence, and the whole  cure depends upon the general
 remedies.   Thefe are fo many facts, that fhow, that no
 matter,  whether of a contagious nature or not, contri-
 butes towards the caufe of the general difeafe, which it
 accompanies or diftinguifhes, or, if it contributes any thing,
 that in that it differs not from the ufual hurtful powers.
   XCVIII.   As, both  in overabundant and  deficient ex-
 citement, the found perfpiration is diminifhed during the
 predifpofition, and  fuppreffed in the courfe of the difeafe
 (which has been already hinted, and will more  fully be
 demonftrated afterwards); it is, therefore, proper that it
 fhould be carefully fupported and kept up, for the purpofe
 of difcharging every hurtful matter from the body.   But
 neither does that fuggeft a new indication of cure ;  fince
 the only means of effecting it are thofe,  which otherwife
 remove both the diathefis in proportion to their force, and
 which are not ferviceable as local, but as  general reme-
 dliS («).
                                                  XCIX.

 natural diftance, brought all together.  (See Dr Cullen's Genera Mor-
 borum, all the three editions, genus  VII.)  As foon will Mile end and
 Knightfbridge meet; as foon will London place itfelf on the Calton-hill,
 und become an elevstaed fnburb of Edinburgh.
  («) The difcovery of thefupport of perfpiration upon a principle, which
 extends to all the phenomena of the fubject, was rcferved for this work.
The heating reniediesof the Alexipharmic phyficians wereititented tofup-
 pi>rt the perfpiration, and thereby,throw out a morbific matter; Which was
 a very unlucky thought in the fthenic difeafes, the principal of which were
                                                      pc- 
               OF   MEDICINE.           49
   XCIX.  When  any one, who, during the former part
of his life has lived luxuriously, has now, at an advanced
age, either from intention or compulfion,  abated a good
deal of his ufual indulgence, and yet preferves fome appear-
ance of  an abundance of fluids and of vigour; he muft
not, therefore, as is commonly done, be fuppo;ed to labour
under plethora (o) and exceffive vigour;  but, on the con-
trary, unlefs  there  be  arecent and evident caufe for it,
which is poffible, he muft be held for one who  labours
under  indirect  debility;  and  {o  much  the more,  if to
hurtful powers already too invigorating, in the number of
which are all thofe which fill the  veffels, directly debili-
tating powers have fucceeded :  and it  is not a debilitating
or afthenic plan of cure, which would increafe the direct
debility,  nor one too ftenic (p), which would increafe the
                            E                      indirect
peripneumony, Of which we have already fo often fpoken ; phrenitis, in
which the  brain was fuppofed to be inflamed ; and  the fmall-pox and
meafles; becauf.- the nature of  thofe dileafes, and the tendency of all the
powers pro facing them, was to check  the perfpiration, (fee N°. LXI.)
from the excefs  of their ftimulus;  confequently, the addition of  moee
ftimuli, by way of cure, was to cheek it ftill more.  Hut thofe JKeafes are
only three out of the hundred of general dtfeafes: whereas the followers
of a great  man who corrected that abufe  through a fiery perfecution,
&{ J1 a. Ti'f.e, againft  himfelf,  went  all into  a much worfe extreme.
Their imitation of their mafter tranfported them into a rage to carry the
plan of promoting perfpiration, by the  fame means, through the remain-
ing 97 of the lundred.   And they fucceeded with a vengeance.  For, as
it is here the neture of thofe dileafes to tranfmit too great a quantity of
fluids  through the  perfpiratory  pores,  in confequence of the debility
which conftitutes  their caufe ;  certainly the  encreafe of that debility,
that is to fay, the encreafe of the caufe,  fhould encreafe the effect. Which
it  moft certainly did, through  all the fyftems that have appeared for
more than a century paft.  This is intended only as a hint, to enable
eur intelligent readers to underfland the fuller explanation of perfpira-
tion, which will foon follow.
(o) or ati over proportion of blood,
(p) or ftimulant.
 
   £0          THE   ELEMENTS

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

     (q) The blood \> made from the food, aud 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 pro-   ,\-
'% duced, may go  to excefs,  as well as every other exciting power, the
  principal of which is.  But the queftion is, when, in whom, and under
  what circumftances,  is an over-proportion of blood generated ?  C oni-
  mon fttife would fay, not at the beginning or  the end of life,  whea
  the degree of nutriment ufed is far from being fo confiderable,  as at the
  middle and vigorous  period of life.  Agan, which of the two fexes are
  fuppofed  moft liable to generate this morbid  redundancy of the vital
  fluid ?  A fimple creature  aided by nothing but natural fagacity, would   • '.i
  he  apt to fay,  the men;  both becaufe they  eat  more,  and, from the
  greater variety of the modes of promoting digeftion to which  they <sre
  addidltd,  digeft better.  Kow medical fyftcmatics would laugh at fuch     j
  fimplicity ?  How contrary that wou'd feem to myftery, their Lydian
 ftone under which they think all wifdom fo fufely 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 arc liable  to  bleeding difcharges, who can  neither eat nor digeft j
 hut  ;?! thofe who eat and digeft well. 
              OF  MEDICINE.         ^ i

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

  (f) or an empty ft-te or the veffels,
  (t) This indulgence is chiefly intended for th-.C.?,who have gone to fome
rxcefs in the  ufe < f the ftimi'lus cf drink, and who ftill,  without it al-
•.♦■  :!if, r.n  .••''  '■■.:}■'■• of raking enough of food and other durable
                                                 ftimuH 
 52          THE   ELEMENTS

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

 ftimuli for their fupport.  The aim, however, of all fuch perfons (with
 the exception only of thofe who are of an advanced age, or of thofe whofe
 debility threatens to run a certain courfe), 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 fort of ftrong drink,  not  only with impunity, but with a moft
 wond.rful 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 canal; in a word, the difeafes of either
 form  cf debility),  either returns, or threatens to return ;   a return to
 the ufe of wine and other ftrong  drink will then become  an excellent
remedy, and even fupercede the ufe of the high  diffufible ones.  That
practice would be  attended with  this  further advantage,  that, when
the occafion that called for it was over, and  the difeafe  prevented  or
ren.oved, the perfon might again lay afide  the ufe of drink,  with all the
good confequences he had formerly experienced from the practice, and
thereby both prolong his life,  improve his health, and enjoy the proper
and vigorous ufe of all his functions.
  (u) In many difeafes of debihty arifing from a former excefs, the fti-
mulant effects of which have paffed away, the ufe of cold water, though
in grat.'ficatioa of the patients  craving, and of other th<n potions, as well
as of vegetable aliment in a fluid form, and of evacuation of every kind,.
is moft hurtful. 
               0 F   M E  D I C I  N  E.           $$

is only in the progrefs to indirect debility (x), that direct-
ly debilitating powers are fuitable for the purpofe of fup-
porting the vigour, in that cafe, in danger of being worn
out (y); fuch as cold  bathing, lowering the  diet, weak
drink,  and a fimilar abatement in  the ufe of the other
ftimuli.
   CVII. For the cure of direct debility, we fhould begin
with the fmalleft  degree of ftimulus, and then  rife to  the
ufe of a greater and greater, till the morbid abundance of
exciteability be gradually worn off, and  the health at laft
reftored.
   CVIII. When  the difeafe arifes from the want of any
one ftimulus, the  return to  its ufe fhould be gradual, and
facilitated by other ftimulants more powerful than itfelf.
   CIX.  Alfo in this part of the general method of cure,
debilitating, either direfrly or indirectly fhould be abftr.in-
cd from;  both  for  the reafon formerly given, and alfo,
becaufe the ftimulant plan of cure, which is the only pro-
per one, when carried  to excefs, converts the fthenic dia-
                                                     thefis

  (x) Betwixt 40 and  70,
  (y) At 65 there are only 5 degrees of vigour left, which, either by
a continuance of the fame excefhve ftimuli that produced them, or, by
the addition of a degree proportioned to that effect, would he worn out.
Remove fome of the ftimulant powers, the excefs  of excitement will be
iiiiiiinifiied, fuppofe to 60; remove mure of the former, and the excefs
of the later will be further diminifhed, till the excitement is reduced to
its natural healthy ftandard of 40.  The ftate of »xcitcment, then, within
this range, that is,  between 40 and 70, efpecially in proportion to the
approach of the  excefs to 70/is that, to which only directly debilitating
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 are pernicious. How bad  then
muft the only practice be, that we find in books and lectures, a pradlice
tranfmitted from the firft accounts of our profeffion, and whkh deals in
the ufe of no other  means but directly debilitating ones ?   Bad, indeed,
iv 11 ft  it be ! 
54        THE   ELEMENTS
thefis (x) into the afthenic (a), and the latter into death (b).
For which reafon, while on the one hand, the  debilitat-
ing powers, mentioned before, are to be avoided ; it muft
on the other, not be forgot,  that the  force employed in
the cure fhould be accommodated  to the degree of morbid
ftate.  The thirft, which is occafioned by debility, is in-
creafed by draughts  of cold water, is hurried  on to (c)
naufea, and vomiting; is quenched by pure wine or fpirit,
which prevent the troublefome  fymptoms that would
otherwife follow.  Pure wine (d) encreafes the thirft which
proceeds from a fthenic caufe, and excites the fame trou-
blefome fymptoms,  which  cold water  does  in the other
cafe; cold water fates it, and prevents the future tumult.
   CX. Since, therefore,  the  fame powers excite all the
phenomena of life,  and produce fometimes an excefs,
fometimes a juft proportion,  fometimes a deficiency, of
life, according to the  various degrees  in which  they are
applied ;  and fince the fame obfervaticn extends to the
fame powers, when they are applied as  remedies of dif-
eafes •, let it, therefore, be an univerfal rule, never un-
guardedly to convert either diathefis into the other. . And
as every difeafe, that debilitating powers remove, is fthe-
nic, every one, that is cured by ftimulant means, afthenic,
the knowledge of that may furnifh the proper  means of
caution againft miftake.
                                               THE
  (x) that between 40 and 70,
  (a) between 70 and 80,
  (b) at 80.
  (c) the higher fymptoms of
  (d) which is one of its principal caufes. 
f  55  1
                 THE

SECOND     PART.
                 CHAP.    I.

  Of the hurtful Powers, which produce either Diathefis,
                 Sthenic, and Afthenic.

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

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

  (a) XI. XII.
  (a) In a certain degree of diminifhed heat water freezes; but if fuch
a diminution of it could be found as to freeze air,  the whole fabric ©f
the univei-fe would rufh into diffolution. 
  $6         THE   ELEMENTS
  five, its effect variesfb).   This ftimulus, in a moderate
  degree, produces its effect in due proportion, in a degree
  above that the excefs of its  action  is fuch as to  produce
  more or lefs of fthenic diathefis.
    CXIII. Becaufe the  action  of heat  is  increafed fomc-
  what more upon the furface than  in the internal parts,
  where  the temperature is nearly ftationary,  it, therefore
  ftimulates more in the former than  in the  latter.   Hence,
  in the phlegmafiae (c), the inflammation is always external.
  The  fame agent encreafes the tone  of the  mufcular fibres
  every where, and confequently their denfity (d).  Hence,
  as the diameters of all the veffels are diminifhed,  fo thofe
  of the extreme veffels every where, and efpecially in the
  fkin,  where a greater force of the  caufe is exerted, are of-
  ten entirely effaced.  But actual fupprefiion of the  per-
  fpiration is incompatible with predifpofition, and  arifes
  only  from the  diathefis,  when it arifes  to the juft mea-
  fure of difeafe (e),
    CXIV.  Hence in the meafles and fmall-pox, the irra-
  tating matter, together with the perfpirable, is detained.
  And not only in thefe,  but all other fthenic  difeafes,  the
 perfpiration is  fuppreffed, the excitement  both  upon  the
 furface and in the reft of the  body is encreafed,  and ca-
 tarrh  particularly induced (f).
                                                    CXV.
  (b) as fhall be fhown by and by.
  (c) difeafes with inflammation of a part.
  (d) oee Chap, V. Which produces a fupprefiion of perfpiration by fome
imputed to conftridlion from cold, by others to conftruStion from fpafras;
both crronoufly.
  (e)  I'he  perfpiratk n is diminifhed during the predifpofition  ; but the
condenfing power is not fufficient to fupprefs it, till it attains the degree
pf producing the difeafe.
  (f; Caiefacicnts, or  heat^g things, were one of the means that the
Alexiph rn.i  phyficia; s employed to free perfpirjcum J  but the princi-
ple  is 'now laid down,  that  fhows they produce the oppofite effect.
                                                     Hence 
                OF   MEDICINE.           $J
    CXV. Heat, in extreme excefs, whether it  acts hurt-
  fully by its duration or intenfity, conftantly debilitates by
.  diminifhing the  tone, and  producing laxity  inftead  of
  denfity.  Which  effect  is  fomewhat greater  upon the
  fk<n, to which the direct energy of  heat is applied, than
  in the interior part, in which there is  little change of tem-
  perature.   Hence arifes  fweating  as in  the torrid zone;
  hence the diameters of all the veffels,  and particularly  of
  of the  perfpiratory veffels are enlarged.   Hence  proceed
  the  colliquative fweats in fevers,  and a fimilar  ftate  of
  the  belly.  Hence, alfo corruption of the fluids, and not
  from a ftate of them directly produced by  corrupting
  powers (g).
    CXVI. The fame power in the violent meafles, in the
  confluent fmall-pox, in fevers, and in every kind of afthe-
  nic (h)  difeafe, in  which the perfpiration  is deficient, does
  not  leflen the  deficiency (i),  though  it  expands  and en-
  larges  the vefiels,  but  on the contrary,  encreafes  it(k).
                                                   CXV1I.

 Hence the merit of Dr. Sydenham in recommending cold both in the
 fmall-pox and in peripneumony, in which difeafe he took his patients out
 of bed, and placed  them in an  eafy chair.  Happy had it  been for the
profeffion, and happier for the fick,  had he extended his improvement to
the meafles  end catarrh, and all the reft of the few fthenic difeafes, nnd
ftopt there ; but by extending his antiphlogiftic and refrigerant doctrine
to the whole form of afthenic difeafes, the harm and good  he did were
in the proportion of 97 of the former to three of the latter.
  (g;  The iJea of certain powers of a tendency  to corrupt our fluids,
and of certain others to correct  that effect, and take off the degeneracy
long prevailed in the minds of fyftematics, and is not among many of
their followers yet ltid afide.  Heat was < ne of the  number  ; but that it
ads fo, is difproved not only by the explanation here given, but by the
certainty of  the fact, that the fame efLct is produced by  cold, as well
as every other debilitating pow.
  (h)  or difeafe of debility,
  (i) that i>, does not encreafe the perfpiration,
  (k) i. e. diminifhes perfpiration, 
 58         THE   ELEMENTS
    CXVII.  Cold, inimical to  animals, vegetables,  and
 the elements,  weakens the reft of  the fyftem, and  ftill
 more the furface, the  temperature  of which  it  almolt
 only diminifhes, and it produces that  effebl always by a di-
 rect  operation, always in proportion to its  degree. Cold
 equally as exceffive  heat, produces  atony  and  laxity of
 the veffels, grangrene, and the other effects of exceffive
 heat  (1).
    CXVIII. That thefe effects of the extremes  of tempe-
 rature arife trom debilitating not generating putrefaction,
 from  an affection  of the excitement, not  of the fluids,
 plainly appears from this ; that other exciting  hurtful
 powers,  fuch as  famine, an overbundance  of blood, as
 in  the cafe of thofe who die of peripneumony, and  fimilar
 hurtful powers, which neither have been, nor can be, be-
 lieved  to affect the  fluids by  any diredt operation upon
 them(m), produce both the fymptom of corruption,  and
 all the reft  of the fymptoms,  and the fame ftimulants,
 which  remove the  latter,  remove the former.  Nay, the
 fuppofed antifceptics, fuch as wine, Peruvian bark, acids,
                                                       and

  (1) In Siberia the phxnomena of cold on the human  body very much
refemble thofe of heat.
  (m) Famine, acids, aud cold, have all the fame effects upon the fluids
that the  putrefying fubllances were fuppofed to have ; but furely  acids
produce no putrefactive procefs; neither can want act as pofitive matter;
nor cold be fuppofed to produce any fuch effect.  In  a word,  any cor-
ruption that is produced, arifes only from the weaknefs by the heart and
arteries, predominant in their extremities.  They ceafe to act; the fluids
within ftagnate, and, under the heat of  the body, degenerate.  This is
the  true caufe of the corruption. And the remedies are not correctors
of the  corrupted  mafs; but whatever invigorates the whole body, and
confequently the heart and arteries   Nothing can be  more abfurd than
to fuppofe that a glafs or two of wine and water, a little bark, and fo on,
after being blended in the  whole mafs of fluids, fhould go to a portion of
fluids in  the extreme veffels, even without the circulation, and, by mix-
in"1  with it, change its qualities, 
              OF   MEDICINE.          59

 and other things of that kind, are either entirely deftitute
 of that operation,  or  they neither are given, nor can be
 given, in that quantity, by which they can have any ten-
 dency to effect the mixture of the fluids:  In fine, the ef-
 fects of inanimate matters upon one another are never,
 with any propriety, transferred to living fyftems.   Tho,'
 then, the  fluids are frequently corrupted, the corruption
 is the effect of weak veffels not giving a.fufficient mixture
 or diffufion to them, but is never the caufe.
   CXIX.  The  difagreeable fenfation both of cold and
 of heat in extreme,  is alfo  hurtful, by diminifhing the
 fum  total  of ftimulant operation, which, in fo far as it is
 agreeable, is ferviceable by ftimulating (n).
   CXX. As cold  is naturally fo debilitating, and all de-
 bilitating powers diminifh excitement,  it is therefore, ne-
 ver of fervice but in fthenic difeafes, that is, in thofe which
 are in their progrefs towards  indirect debility (o): becaufe
 the excitability, already too abundant,  can never be ren-
 dered more abundant, nor, when too much wafted, ren-
 dered more  accumulated,  without an aggravation of the
 difeafe(p); excitability admitting of lefs ftimulus in pro-
 portion as it is  either more abundant, or more ultimately
 wafted.  When the  debility is  moderate, a miftake of
 this kind is lefs evident:  but  in* a high  degree of debility
 of either fort, a violent difeafe, or even death itfelf, may
 be the  confequence of the fmalleft encreafe of debility (q).
                                                 CXXI.

  (n) See note (r in par. XXI.
  (o)See CVI.
  (p) XLVI. XLVII.
  (q) When the debility of the direct kind is very moderate, that is, the
excitement has not funk much below XL. in the fcale, the fhort fufpen-
fipn of a few degrees more would not  do much mifchief.  Suppofe the ex-
citement  at 30 inftead of 40, and a dip in  cold water has brought it down
tv 15, -be effed! even of that is not of a trifling nature ;  the debility by
                                                      this 
60         THE   ELEMENTS
    CXXI. As cold, as well as exceffive heat relaxes, a fact
 that is feen in  the cure of  the fmall-pox,  and  of every
 fthenic difeafe, from that  we are to underftand, that the
 property of cold in conftricting(r) inanimate matter does
 not extend to living  matter (f).  The diminution of the
 balk of the  furface (t) arifes from debility of the veffels,
 not  fuffiuently  propelling  the  fluids,  and  filling the vef-
 fels.   In this  way does cold produce  afthenic diathefis.
    CXXII.  But, as always  lefs and lefs  excitement arifes in
 proportion as  ftimulant operation has been applied, till at
 laft no more  at  all is added;  cold  (u),  as well as any
 other directly  debilitating  power may, according  to  va-
 rious degrees  of it,  produce health, and all the degrees
 of fthenic diathefis (x);  in  the following way,   however,
 only.   It flops the wafte of  excitability,  makes  the body
 more fufceptible of ftimulant operation,  checks  the pro-
 grefs to indirect debility, and ftems the latter.  But it on-
                                                          iy
 this means has paffed the whole range of predifpofition, and arrived at
 the degree where  difeafe commences.  It is true the excitement will rife
 the moment the perfon is taken out of the bath ;  but ftill fomcthing is
 loft.   The very accumulation implies a reduced difpofition in it to be
 acted  upon by ftimuli.  A perfon, who has abftaincd from any one fli-
 ir.nlus for a gives  time, when it  is again applied, will not bear near fo
 much of it as he did formerly.   If he abftain longer, he will bear ftill
 lefs, till, at laft,  he w:il be fit to  bear none at all.  If, on the other
 hand, the excitement fhould have fallen to IO,  an  addition  of  debilita-
 ting power would be attended with the utmoft danger, not  only of en-
 creafmg the difeafe, but of inducing death.
  (r) or condenfing,
  (f;  It has been alledged, that the diminution of the bulk  of the body
 by cold, furnifhed  an argument in favour of its being an aftringent to
 it, as it certainly is a condenfor of dead matter.
  (t) or fhriveiling of the fkin,
  (u) on that footiug of action,
  (x)  from the higheft to the Ioweft, from that degree of it, which,
 under the circumftances here mentioned, produces  a moderate  catarrh,
othat, where the  modification of its action rifes to  the decree  of being
adequate to the effect of producing a peripneumony. 
OF   MEDICINE.          6l
ly effects that by checking the career of heat and other fti-
muli, which accelerate indirect debility, and  by keeping
the excitement  within the  boundaries of vigour.   And
hence vigour in cold countries, when the body is defended
by clothes, the fhelter of a houfe, the warmth of a fire, as
well as by its own proper motion.  Hence alfo the brace-
ing, by cold, of parts that have been relaxed by exceffive
heat.   Laftly, hence a remedy for the corruption  of the
fluids, which confifts in invigorating the veffels, not cor-
recting the degeneracy of their contents.   This effect of
cold upon the furface, which is nearly the only part of the
fyftem  fubjeft  to refrigeration,  is  fomewhat  greater
than in the internal parts.
   CXXIII.  The debilitating  effect of temperature, and
therefore alfo its hurtful tendency, is encreafed by moif-
ture.
   CXXIV.  Of the  articles of diet, the only food in dan-
ger of being too ftimulant, is  flefh and land-animal food,
ufed in great quantity.  Meat too fait, and hardened, efpe-
cially when it has now begun to fpoil, is an exception.
   CXXV.  The fame thing is  to be faid of condiment; of
which a very fmall portion, upon account of its high de-
gree of ftimulus, is  fufficient.
   CXXVL  Spirituous  or vinous drink, in which the al-
kahol is  always  diluted, ftimulates, more quickly, and
more readily, than feafoned food, and its ftimulus is  in
proportion  to the quantity of alkahol that it contains.
   o.  But there are ftimuli, which poffefs  an operation as
much quicker, and more powerful (y), than thefe juft now
mentioned, and which are the agreeable and prefer ones
in health, as their operation is  of fhorter duration.  To
thefe the name of difTafiblc is  to be given.   They rank
ab.^ve ftrong drink in the following order:
                                               *• Next
(y) than that of the articles of diet. 
$2         THE   ELEMENTS
      * Next  to ftrong  drink, and immediately  above it,
v ftands muflc;  above it volatile alkali •,  higher  than  this
   aether ; and the higheft of rdl,  as far as  experiments have
   yet reflected light on the fubject, is  opium (z).
      />  Theie  according to their degree,  poffefs the property
   of converting the afthenic diathefis  into a  ceffation of all
   diathefis  in health ; this  into fthenic diathefis, the fthenic
   diathefis  into indirect debility, and the laft into death:
   all which they accomplifh with  as  much more eafe  and
   prompitude, as they a:e more powerful than all the reft of
   the ftimuli (a).
      CXXVII.   The ftimilus of the articles of diet, not  ex-
   clufive  of  the diffufible  ftimuli, fhould  be  denominated
   direct,  becaufe it acts  directly and  immediately upon  the
   excitability of the part to  which it is applied.  The direct
   ftimulus,  at leaft in fo far as it regards the food, is  affift-
   ed by another, depending upon a diftenfion of  mufcular
   fibres,  on which account, for the fake of diftinction,  the
   latter fhould be  called indirect.  As the latter is  afford-
   ed by ths bulk of animal and vegetable food, fo the for-
   mer is  produced by a relation of  the  ftimulus to exci-
                                                     tability.

     (z) We are  prety certain of the exactnefs of that plaee  in the  fcale
  which we have affigned to opium.   Nor  is our arrangement  of the
  others uncountenanced by the fame kind of  criterion ;  but having nut
  yet made all the trial neceffary to eftablifh the propofition, we defer any
  final decifionof this point to an  after oportunity.
     (a) In the uf:  ef the diffufible flireuli great care fhould be taken to
  apply them only to the cafes that require them: which are only the dif-
  eafes of the  higheft  debility, or of which the intolerable pain, befides
  tormenting the patient, threatens the worft confequences.  All from the
  end of CXXVI, is an addition  in the MS. this moft valuable part of
  the exciting powers, whether confidered as a part of diet,  as the  ch:ef
  of them are among the Turks, or as ufed for  the prevention of diftakt,
  to  which there may be a ftrong bias in  the habit, or as remedies of thefe
  difeafes when they have come on, or as hurtful powers when improperly
  emoloyed, having been left  out  in both the editions of the Latin Wink
  that have  yet been prefented to  the public. 
              OF    MEDICINE.            6$

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

   (b) When I make a meal of animal food, much lefs bulk isrequifite to
 give the fame noun'fliment, than when the vegetable matter is the only one
 made ufe of.  Wnat makes the difference is, that there is fomething in
 the animal matter which affords a nourifhing ftimulus independent of its
 bulk ;  and though the vegetable matter is not altogether devoid of  that
 kind of  ftimulus, it, however, poffeffes  it  in a much  fmalier degree.
 3oth ftimuli are neceffary, but chiefly the direct, by which animal food
 chiefly acts;  and therefore  is the vegetable the worft and weakeft  fort
 of aliment, becaufe it chiefly acts  by its bulk of matter.   A fmall por-
 tion of the indirect ftimulus is neceffary ;  hence the  very general ufe of
 bread,  "ut our vigour of mind and body depend*  upon the direct.
   (c) take in any quantity.
   (d) The nourifiiment of animal food needs only a iittle fupiort of ten-
 fion from a moderate quantity of bread but die vegetable food, even
 when  fupported  by ftrong  condiments, in no quantity whntiver,  ever
 gives due fupuort, appears plainly from the inftance brought in thetext.
 Of the  poor  labouring people in Scotland, who chiefly live on vege-
 table  mstter,  it  would take  three to go through the  work that one
 Vorkfliire man nourifhed by bolting fat pork, can  eafily  e::ccute.   And
1 among the iJentoo fervants a dozen is not able to perform as much work
 as a finale linglifh fervant.   A year's experience of vegetable food, and
 its pernicious confequ.wees (vide the Preface) has now put the queftion, 
 64          THE   ELEMENTS

 every  where;   hence   fcrofula(e),  fevers(f),  epilepfy,
 cough, with profufe expectoration and hemorrhage,  and
 the whole band of afthenic difeafes.   The direct debility
ftowing from  this hurtful power,  affects  the  ftomach
 fomewhat more than any other equal part (g);  the confe-
 quences  of which  ajfeclion  are lofs of  appetite,  ftomach
 fickntfs,.   vomiting,  very  loofe  belly,  and fimilar  dis-
 turbances of the firft paffages.
    t  But  wattle improper aliment produces fuch eft els, thefe
 will alfo  be induced  by an ultimate excefs  in the ufe of
 food, conffting of the proper material 5  which muft be in-
 ferred from the univerfal effect of all.the other ftimulant
 powers,  when their operation  has  been  pufl:ed to  the fame
 excefs(h).  The mean betwixt the extremes of  the hurt-
 ful powers, in fo far as diet is concerned, is  abftinence (i).

                                                    CXXIX.

 about the fuppofed falutary effects of low living, and the pretended vir-
 tue of a rigid obfervance of it, beyond all doubt, and brought irrefraga-
 ble proof of its weakening effed.
   (e.) 3 rofula, though fuppofed hereditary, produces its worft effeds,
 not from that circumftance,  but the method  of management, both for
 the prevention and cure.
   (f) Various particular, and fometimes fpecific caufes, have been sf-
 figned for the produdion of fevers ;  but it fhall be proved,  that, what-
 ever debilitates in a high degree, is  adequate to that effed.
   (g) Chap. IV.
   ^h) It will how appear how far an  affertion of the oppofcrs of this doc-
 trine 13 juft or calumnious: low  living and ftarving are condemned for
 the fads and reafons afligned ; but can it now be faid, that the dodrine
 is friendly to intemperance ?  On the contrary, it has reduced the fad to
 its proper ftandard, reprobating the  extremes, and cftablifhing the mean
 under which virtue takes her poft.  It is  certainly as immoral or irre-
 ligious, if  you will, to hurt  health, and haften death  by abftinence,  as
 by a luxurious excefs.  There is a gloomy luxury in fuperftition, a chear-
 ful one in fenfuality ; hoth bad.
   (i) At leaft it ftatds at the foot of the fcale of diredly debilitating
            1                                          powers, 
              OF   MEDICINE.          6$

   CXXIX. The withholding  alfo of the  ufe  of condi-
ments, which,  without animal food (k),  are  not fuffici-
ent to give ftrength, gives an additional  weaknefs.
   CXXX. Strong  drink, and the  diffufible ftimuli, are
never neceffary to young and ftrong people, upon account
of their  rapid tendency to indirect debility, from  their
high ftimulant power; nor are they even fafe.  But, in
perfons who have  been accuftomed to <them,  in the cafe
of thofe who are advanced in age, and of thofe who are weak
from that or  any other circumftance, cold, watery, acid,
or fermenting drink, has a great  influence directly,  and
excefs in the ufe of ftrong drink indirectly ? in producing
afthenic diathefis.
   v. If the diffufible ftimuli, after they have been employ-
ed, are too quickly withdrawn, they, in the fame manner
as the more durable, allow the excitability to accumulate,
and indirect debility to come  on, and  confequently. may
be faid to  produce afthenic diathefis.   But afthenic  dia-
thefis is never the confequence of withdrawing their ope-
ration at leaft worth fpeaking of, but when that has been
habitual.  And all the hurtful effects which they have moft
untruly,  to the great detriment of mankind, been faid ra-
ther, than  are now faid, to occafion, arife not from them-
felves, but from the want of knowledge how  to manage
them.   And as this operation  of diffufible ftimulus ought
to be fupported by  that of a  durable;  at the fame time,
it muft not be confounded with debilitating powers. What
difturbances, during the operation  of opium,  will not a
breath of cold air, affecting the body, create ?  And how
                           F                   eafily,
powers,  if they are to have the rank of ftanding uppermoft, as being
moft hurtful and to be followed by the enumeration of the indiredly
debilitating powers, as being next fo, which by the way, is the  rank
that nature feems  to point out for both.
  (i) as in the cafe of che Gentcos, who make  »fe of a great deal df
condiment with their vegetable aliment, 
66
THE   ELEMENTS
eafily, as well as quickly, afe they all removed, by care-
fully covering up the body ? (/).
   <p. Both the other diffufible ftimuli, as well as opium,
•nd the more durable one of ftrong drink, by an indirectly
debilitating operation, produce afthenic diathefis.
   CXXXI. A further ftimulus is an  abundance  of chyle
and blood; by this the excitement is encreafed every where,
and particularly m the blood-veffels,  and encreafed in de-
grees proportioned to its degree of abundance.  The quali-
ty  of the  blood, at leaft,  as a caufe, is  of  no effect, it is
the quantity only that is.   The  quantity,  by its aclion of
diftending the mufcular fibres of the  veffels,  acts with  a
conftant impulfe (m).   The  doctrine of plethora, fo  no-
                                                          ted

  (/) As there  are  cafes of indired debility from an  habitual abufe  of
ftrong drink, there are alfo others from a miftaken or  intemperate ufe
of the diffufible ftimulus, particularly opium.   Both  of them require
nicety and fkill 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 what affeds  that is, that, from this  obfer-
vation,  we can clearly find, as it was to be expeded from the analogous
operation of the other exciting powers, that the diffufible ftimuli, when
their operation is carried to excefs, will alfo produce an afthenic diathefis
 of the indirect kind.
   («) The blood by its quantity diftends the mufcular fibres of the vef-
 fels ; that diftention ftimulates the excitability in the fibres, and pro-
 duces excitement, commonly called their irritability ; thus excited, the
 fibres contrad } the contradion of each portion fends the wave onward
 to another portion : when the wave has paffed any given portion of vef-
 fel, its  fibres again  relax, and make way for the next, which is pufhed
 along in the fame manner.   In this way the circulation goes on in all ca-
 fes while life remains; contradion  and relaxation conftantly alternate ;
 the former  propelling the wave before the latter opens to reccivethe next.
 Uut the veffel may be in different ftates with refped to its power of ei-
 ther contrading or relaxing.   When it is weak, which every part of the
 vafcular fyftem is  as often as ill the reft of the fyftem is weak, both the
 contradion and relaxation of each portion of veffel  is imperfed.  The
 contradion from its fmallnefs, and the relaxation from its being more
                                                          owing 
OF    MEDICI  M E.
67
 tfcd in the medical  fchools, is only applicable to fthenic
 diathefis, and takes place in proportion to its degree (n).
   CXXXII.  The effect  of diftention (0) is encreafed by
 the velocity of the blood, both as arifing from other four-
 ces,  and efpecially  from  that motion of the body which
 its ownmuicles perform, amotion, which,bycompreffing
 the veins,  carries  the blood more quickly back to the
 heart.
   CXXXIII.  Nothing is  more effectual than thefe two
 laft mentioned ftimuli,  in producing fthenic  diathefis, and
 the difeafes depending upon it.    Thofe difeafes  are violent
 in proportion to the over proportion of the blood, arfd the
 rapidity of  the force with which it flows ;  a fact,  that  is
 proved  by  all the exciting powers,  all the fymptoms of
 thofe difeafes,  and, efpecially,  the pulfe of the  arteries;
                             F 2                           it

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


  (/>) Relief from bleeding and  other avacuations is certainly a good ar-
gument for the caufe of the difeafe being fo far owing to an over-pro-
portion of blood ; and reft is as good for  the proof of agitation of the vef-
fels being concerned in the caufe : befides,  exercife is otherwife a noted
caufe of quicknefs  of the pulfe :  and the hurtful powers and fymptom*
are equally decifivc. 
               OF    MEDICINE.             (>Q

it, and that the matter ftill remains within the operation of
exceffive ftimulus (g).
                                                      4.  Thus

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

    4. Thus it is not an excefs in the quantity of blood,
 .but  laxity and atony from its deficiency, that upholds the
  affair of bleeding difcharges } which proceed in their courfe
  not with  any effort (r), but a dimunition  of tone: They
  are all afthenic, and the afthenic diathefis, as far as it de-
  pends upon them,  confifts in direct debility.
    a.  But, as every other exciting hurtful power may  be
  converted  into indirect debility,  fo, alfo  may an  over-
 proportion of blood. For the veffels, ultimately diftended,
 and beyond all bounds, may (/), by the excefs of that fti-
 mulus,  exhauft their own excitability,  and, thereby, put
 an end to their excitement.   Upon which the forcible con-
 tractions are converted into languid ones, or fuch as could
 fcarce be!called contractions at all; the diameters  for-
 merly effaced, are converted into an  extremely  patulous
 ftate.  The finer parts of the fluids flow through the patu-
 lous extremeties of the arteries,wherever they find an outlet,
 and carry with them,fometimes ferum, fometimes red blood.
   In  the  afthenic,  diathefis as well as the fthenic, it  is
 not the quality  of the blood,  but its "quantity, which  is
 to be found fault with,  and the fault in quality  here is de-
 ficiency.   The deficient quantity produces the fymptoms
 of the pulfe, that have been mentioned above, by not fuf-
 ficiently diftending  the  veffels, and giving them fufficient
 excitement.   Plethora,  which has been thought to be-
 long  to this form of  difeafes only, has abfolutely no exift-
 ence in it.   The  ftate of the  veffels, with refpedt to the
 quantity of blood in them,  that is pleafant  and fuitable  to
 health, is  the mean betwixt the extremes that  have been
 fpoken of.
   CXXXV. This ftate (u) is  the  chief origin of afthenic
                                                difeafes,
  (r) or adive impulfe,        (/) under the high fthenic diathefis,
  (k) of the blood and Veffels, that we have been defcribing, that is, pe-
nury of blood, and atony and laxity »f the veffels, chiefly from dired,
fometimes from iudired  debility; though the latter cafe is exceedingly
rare. 
OFMEDICINE.           71
 difeafes, of which the fo very hurtful effects of evacuation,
 efpecially bleeding, as well as vomiting, purging the belly,
 and every other mode of dimini/hing the bulk and quantity of
fluids, give full  proof.  This proof has of late received a
ftrtlxr confirmation,  in the fngular fuccefs of the cure by
 other ftimulants firft, and then by every mode of filling the
 fyftem (x).
   CXXXVI. The different fiuids fecreted from the blood
 in different ways, are, by the diftention which they give to
 their refpective veffels,  alfo underftood  to ftimulate.   In
 that refpedf the milk and feed,  by the abundance of each
 in its refpective veffels, and likewife the perfpirable fluid,
 have the chief effect, the commotion of the fecretory organ
 (v), by means of excitability,  which is one and the fame
 undivided property over  all,  is eafily  diffufed over  the
 whole  body,  and, when   it  rifes  to excefs, is  capable,
 with other powers that communicate an excefs of excite-
 ment, to produce fthenic diathefis.
   CXXXVII.  The fame fecreted  fluids, when  they  do
 not fufficiently diftend their refpective veffels, when they
 do not communicate enough of excitement,make noinconfi-
                                                   derable
   (x) Syftematics allow that there are many difeafes,  which are a re-
 proach to their art, from their  never yielding to their method of cure,
 but, on the contrary,  becoming worfe and worfe in proportion to the
 time and pains taken about it.  Of thefe opprobria inedicinre (it would
 be better, I believe, to call them opprobvia 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.
  (jr) It has been faid above, in chap. IV. that the excitability is one uni-
 form undivided property over the whole living fyftem ; and that, where-
 ever it is aded upon in any part  of its feat, it is affeded over all.   This
 fad, which is ftridly true and univerfal over every part of living mat-
 ter in nature, with the utmoft eafe explains many things, that were con-
 feffedly  inexplicable upon every other  medical dodrin e; and,  among
 the reft, the feveral affections of the fecretory fyftem. 
72         THE   ELEMENTS

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

   (a) Nothing  is more effedual in haftening of death than a love mar-
riage betwixt an old man of worn out excitability,  and a young beauti-
ful virgin : I need not explain  to any reader on which fide, that of the
man or the wife, either the love or the danger lies.
   (i) of the Torrid zone  I have been fo often, and by perfons of good
enough  fenfe to make juft obfervations, informed of the neceffity of pur-
ging off the redundancy of that fluid, which not only fids the inteftines,
but diffufes itfelf over  the whole alimentary canal;  and, then, of fol-
lowing  out the cure of the difeafe by the ufe  of wine, fpirits, and the
diffufible ftimuli, that I have,  though at firft with fome reludance, ad-
mitted the fad.  The reafon of the flownefsof my affent to it was, that,
upon every other occafion of any accumulation of matter in the firft paf-
fages, even in the colic itfelf,  I had always found the padice of invigo-
rating the pentlaltic motion, by ftimulaiits,  fufficient to clear away all
fuch extraneous matter ; while vomiting and purging, by their relaxing
effed upon the vtffels, ferved  to generate more, and increafe the caufe
of the difeafe, which is always debility.   This I found not an exception
to that general principle,  but an inftance of a fort of local difeafe, from
an over repletion of the exhalant mucous and biliary veffels.
   (rf) Thefe are the exhalants that pour out the faline, watery part of
                                                          the 
OF   MEDICINE.
73
nation and corruption of them.  A diminution, or tempora-
ry deftruction of excitement, over this large fpace in the fyf-
tem (e), by means  of the fame  excitability,  communi-
cates debility to the  reft  of the body •,  and, in conjunc-
tion with other hurtful powers that give not enough of ex-
citement, produces afthenic diathefis.
   r. The various forts of geftation (/), and of exercife and
labour,  by  roufing  the  mufcles  into  contraction,  and
thereby accelerating the  motion  of the  blood in  the
veins towards the heart, while the valves prevent its taking
a contrary direction, greatly promote excitement in all the
, effels,  and, therefore,  over the whole fyftem;  and  the
effect may go fo far as to produce fthenic diathefis.
  a. As nothing contributes more to health than moderate
and frequently repeated exercife, and its excefs acts in the
manner that has juft now been defcribed; at the fame time a
                                                     degree

the blood unchanged; the mucous glands that change, by their fecretory
operation, the fluid they  receive from the blood ; the pori biliarii that
change the fluid that they  receive from the extremities of the  veins of
the gate, and  of the hepatic artery,  or artery of the liver ; the little
duds which thefe form by the union of numbers into firigle vefftls ; the
hepatic dud or j^rcat biliary veffel of the liver, which receives the bile
from all the  duds; and, laftly, the dudtus communis choledochus, or
the dud that may be denominated in Engiifh,  the general  receiver of
all the bile, whether from the  great dud of the liver, or that which
fends to 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 ab-
lorbents as they 3re called, to  wit,  the fmall veffels  that take up from
the exhalants aud other arterial terminations of veffels, the fluid,  called
lymph, which is once more to be returned into the circulation ; are the
veffels that fuller the concourfe of fymptoms defcribed in the text.
   [e) How great the fpace in  the whole fyftem is that thefe veffels oc-
cupy, may be eafily imagined, when it is confidered, that every evane-.
(cent artery, over the whole body, terminates in one or more of thefe
colourlefs veffels that have been defcribed.
   (/)  as riding on horfeback, going in a carriage, ufing  an hobby,
foiling. 
 74         THE   ELEMENTS

 degree of it, either greater or lefs, than the falutary degree,
 by its weakening effect, the former in wafting the excitabi-
 lity, the latter in  with-holding a neceffary  ftimulus; that
 is the one by  debilitating  indirectly, the  other directly,
 produces afthenic diathefis.
   CXXXVIII. Thinking, which acts  more  upon the
 brain,  to which it is immediately applied  than upon any
 other equal part of the fyftem (h), encreafes excitement o-
 ver  the whole body (i).   Straining and thinking, whether
 in a high degree  for once,  or often repeated in a leffer
 degree, or habitual may alone prove hurtful; but, in con-
 junction with other powers alfo hurtful from their excefs
 of ftimulus, may become more ib, and amount to a degree
'equivalent to the production of fthenic diathefis.
   CXXXIX.  An evident caufe  of afthenic diathefis  is
 that ftate  of the  intellectual function,  in v/hich excefs
                                                         in
  (£) Vide Chap. IV.  Part I.
  (i) None of the exciting powers have more influence upon our adivity
than  the two which are juft going to be mentioned,  the exercife of our
intelledual fundlion,  and that of paffion or emotion.  With refped to
the former, Homer obferves of the hero, whom he  gives for a pattern
of eloquence, that upon his  firft addrefs, that is while  he was under
 fome agitation, and had  not jet got into his train of thought, he was
awkward in every motion, and in his whole attitude ; he looked down
to the ground,  his hands hung ftrait along his fides as if powerlefs ; his
whole appearance was torpid.  But when he once entered upon his fub-
jed,  his eyes were all fire, his limbs all motion,  with force, gricc and
 energy.   Upon commencing a  ledure,  the pupils have often obferved
 the fame torpor in the Iedurer, and a fimilar vivacity and life in a few
 minutes, when  he had now got fairly into his fubjed : the report which
 a Iedlurcrs daught.-r,  upon locking through the  hole of a door, while
 the ledure was going on, made to  the family and fome company then
 prefent, was, that her father looked, inhisltdure, as if he would look
 through his hearers.  A Mr. Donaldfon is one of the few great matters,
 in the art of painting, who never fail, with a moft exad likenefs, to
 difplay the whole influence of the mind upon the features.  A minia-
 ture of me, done by him, as z prefent, is reckoned the greateft mafter-
 piece iu thefe refpects, that ever came from the hands of a painter. 
OF   MEDICINE.           75
    in thinking, by  wafting the excitability, ends in indirect
    debility;  or  that deficient, weak, vacant  ftate of mind,
    uncapable of keeping  up a  train, which produces the
    fame hurtful effect by dirett debility.  This faulty ftate of
    the mind contributes greatly to weaken the fyftem (k).
       CXL. Violent  paffions  of mind, as great  anger,  keen
\s  grief,  unbridled joy, going to fuch a pitch as to deftroy
    excitability,  have the  fame  effect as exceffive thinking,
    and admit of all the fame reafoning.
       CXLI.  A force of paffion rifing to the height of ex-
    haufting the excitability, induces that afthenic diathefis,
    which is occafioned by indirect debility, and difeafes of
    that ftamp.  Hence epilepfy (/), hence apoplexy, and that,
    when the  mind has been fcrewed up to the height of pat
    fion, often fatal.
       CXLII. On  the contrary, when there  is  a deficiency
    of paffion, as in  melancholy, grief, fear, terror,  defpair,
    which are only lower degrees of joy, affurance, and hope,
    and imply no more than a diminution of exciting paffions,
    not emotions of a nature oppofite to thofe, and pofitive;
    their tendency is to produce  the afthenic diathefis, which
    depends upon direct debility.   The immediate production
    of this is lofs of appetite, loathing of food, ficknefs at fto-
    mach, vomiting, pain of the ftomach (/»), loofe belly with-
    out  pain,  the fame with pain, indigeftion («), cholic, the
    gout, and fevers.
       CXLIII. The exercife of the fenfes, when  it is agreea-
    ble, has a  very great effcdt in exciting the whole body, and
                                                         in

      (i) 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 engaged in their ufual
    occupations both of mind and body,
      (/) or the falling ficknefs,
      (w) called cardialgia by fyftematics        (») called dyfpepfia,
      \ ■ / ■ ■■ ■                                    ... 
76
THE   ELEMENTS
 in producing emotions,  which, together with the hurtful
 powers mentioned above, may eafily contribute to the pro-
 duction of fthenic diathefis.  Thofe emotions are exem-
 plified in drinking,  dancing, in agreeable entertainments
 where the eye is dazzled with the fplendaur of the difhes,
 of the company, and of all the objects around.
   CXLIV. The energy of the  fame  exercife of the fenfes,
 when it is exceffive, and carries the effects, juft now men-
 tioned, too far, produces indiredl debility.   On the con-
 trary, when the fenfes are either in part defhoy&l, or in
 part dulled, or difagreeably affected (o), the  mind is de-
 jected, and the whole body thrown into a fate of languor
 and direct debility.   And, in both  cafes, efpecially when
 there is a concurrence of other debilitating hurtful powers
 the afthenic diathefis arifes.
   CXLV,   The effect of the air (p),  independent of its
 qualities,  as they are called, or  its properties, and its ufe
 in fupporting refpiration, is lefs obvious to obfervation (q);
 at the fame time it cannot be doubted, that its application
 to the whole furface of the body is  a ftimulus not to be
 difpenfed with.  The air is feldom applied in a pore ftate: it
 is commonly blended with foreign matters that diminifh
 its force of ftimulus; and, while itsialutary ftimulus depends
 upon its purity, at the fame time it is uncertain whether e-
 ver its purity goes fo far as to ftimulate in excefs, and there-
 by produce fthenic diathefis.Theballoons, lately invented, by
 which men get above the clouds, would ferve excellently to
 throw light upon that matter, if it were not for the cold that
                                           accompanies
  (t) Nothing is more clearly difagreeable th m an obfcure light, ac
when cue reads with a fmall or unfnuffed candle. Hence the luxury of
more candles than one, or of  wax or fpermact candles.   This is often
experienced at Ranelagb, and may be feen in children exquifitely
amufed.
  (p) upon the human body,
  (f) than the other powers that have been fpoken of, 
OF    MEDICINE.            77
accompanies this progrefs.  Be that as it may ;  fince we
never live in the pureft air, and yet live commodioufly e-
nough, it is, therefore, credible, that too pure an air has a
tendency to ftimulate-in excefs,  and  therefore,  produce
fthsnic diathefis.
   CX:LVi.  But," as nothing is mOre ufual  than  impurity
ofair'i and every impurify dimihiTffes its  ftimulus, a very
impute air, or air blended'with  impure matters, without
doubt debilitates,  and produces afthenic diathefis.  Ac-
cordingly,  impure air is a frequent caufe of typhus, as is
evident from the fate of thofe who died in  the black hole of
Calcutta.   Whether ever the  air, from an excefs of pu-
rity, produces idMienic diathefis,  is the  more doubtful,
that, as has  been faid, it is as yet  undecided whether it
produces fthenic diathefis or not.
   f. Contagious matter, in fo far as it may have any ten-
dency to produce general  difeafes,  in one form produces
fthenic, in another afthenic difeafes,  and, therefore, acts
like the ordinary hurtful powers of either fort, and admits
of all the fame reafoning.   But, in fo far as it only occa-
fions the eruption, without making any change in the ex-
citement, it is to be referred to the local difeafes.
   z. To poifons, if they  act as  general ftimulants,  all
the reafoning that has been employed with refpedt to the
other hurtful powers, will apply.   It is not, however,
likely that they are general ftimulants.
   CXLVII.  It is feldom from the feparate, almoft  al-
ways  from the united  operation of all the powers, that
both the diathefis, whether as  remaining  within the range
of predifpofition, or rifing to the degree of actual morbid
ftate are produced, and from no inherent power in the
fyftem.
                                            CHAP. 
7§
THE   ELEMEN  T*S
               CHAP.     II.

                 The Caufe of each Diathefis.

   CXLVIIL   The caufe of fthenic  diathefis, produced
 in the way that  has now  been explained,  is,  in confe-
 quence of the operation of the powers that have been men-
 tioned, too great an excitement of the living fyftem every
 where, with the effect of firft encreafing all the functions,
 then of  producing a difturbance in fome, and impairing
 others, but never  by a debilitating operation.
   CXLIX. The  caufe of the  afthenic  diathefis arifing
 from the fame fource, is, in confequence of the  debilita-
 ting hurtful  powers, too  little excitement of the living fyf-
 tem every where,  with the ejfecl  of impairing all the func-
 tions,  difturbing  fome, giving a falfe appearance of en-
 creafing  others, but always debilitating (a).
                                                 CHAP.
  fa) ft muft now appear ro the reader, to what fimplicity the hitherto
conjedural, incoherent, erroneous, myfterious, and enigmatical art of
phyfic, is now reduced.  It has been demonftrated,  that there are only
two forms of difeafes, that the deviation-from the  ftate of health, in
which the  morbid ftate confifts, is not either repletion or inanition, or
changes in the  qualities of the fluids, whether of an acid  or alkaline
nature, or  the introdudion  of foreign matters into the fyftem, or 3
change of figure of the extreme particles, or a difprop rtion  in the  dif-
tribution of the blood, or an encreafe or decreafe  of the power of  the
heart and veffels as regulating  the circulation, or a rational principle
governing the adions of the body, or an alteration in the extreme par-
ticles  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 them producing a readion,
as it is called, of the heart and interior veffels, or any thing that  any
perfon has yet thought of refpeding the caufe and nature or msrbid ftate.
On the contrary, it has been proved that health and difeafe are the fame
ftate depending upon the fame caufe, that is, excitement, varying only
                                                           in 
OF    MEDICINE.
79
               CHAP.      III.


                    The fthenic Diathefis.

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

in degree ; and that the powers producing both are the fame,  fome-
times ading with a  proper degree of force, at other times either with
too much or too little; that the whole and fole province of a phyfician,
is not to look for morbid ftates and remedies which have no exiftence,
but to confider the deviation of excitement from the healthy ftandard, in
order to remove it by the proper means. The reafoning part of this doc-
trine, it is expeded,  the reader will find irreprehenfible and nnanfwer-
able ; and the pradical  part, from the aftonifhing cures that have upon
innumerable occafions been effedled,  will ever ftand in fupport of the
truth and utility, as well as fimplicity  of the whole,
   («) «f the fundions, which,  it has juft  now been faid, the hurtful ef-
fedsof both fets of powers produce,
   {&)  During the predifpofition to peripr.tumony,  as well as to every
other difeafe, neither the fymptoms of difturbance,  or any other fymp-
toms at all appear.   And in mild cafes, fuch as catarrh, the fymptoms
of difturbance occur not through the  whole courfe of the difeafe :  But,
 when a difeafe is, like the peripneumony or the gout,  of a uiolent na-
ture, then the fyfttm is commonly difturbed,  and in a meft confpicuous
degree.  The affedion  of the lungs in the former, from the inflamma-
 tion within,  and of one of the feet,  or fome other part in  the latter,
from an external inflammation, give extreme difturbance to the affeded
parts, while there is a difeafe of the fame nature as the gout, that is dy-
fpepfia, or indigeftion, in which the inflammation never appears.
   {c) The voluntary motions are thofe that are performed under the in-
fluence of the will, fuch as the motion of the limbs in walking, or in any
 fort of cxercife.  The organs, by which they are moved, confift of bun-
 dles of moving fibres celled mufcles.   The involuntary motions are thofe
 rf the ulterior parts of the fyftem, fuch as  thofe of the heart and vef-
                                                             fck 
80        THE  ELEMENTS
 vigorous, there is an acutenefs of genius, and a great force
 of fenfibility as well as of paffion and emotion.   The fe-
 veral parts of the body are perceived to be in a ftate of vigour
from the following marks of it; the heart and arteries from
 the pulfe ; the extreme veffels on the furface of the body
 from the complexion; all the mufcles from the ftrength
 that they exert; the internal fecretions  from  the great
 quantity of milk and femen ; the digeftive organs from the
 appetite,  the digeftion, the vigour of the body, and the
 manifeft abundance of blood.
   CLII. How  far the intellectual faculty, and  the force
 of paffion, are encreafed, will be learned from a comparifon
 of them in this diathefis,  in  good health, in the  fecond
 form of difeafes and predifpofition  to it.  In this way it
 is that the functions are firft encreafed.


              CHAP    IV.

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

   GLUT. The encreafe of the force cf the fenfes,  of the
 motions, of the intellectual faculty, and of the paffions,
 depends upon the encreafe of excitement in every one of
 their organs, among other actions, quickening  the moti-
 on of the blood tlrrcugh them.
   CLTV.  The coming on of every  fthenic   difeafe  is
 announced by a fhivering.   It depends upon a diminifhed
 perfpiration,  by means of the diathefis being  exqnifitely
 ftrong in the extreme veffels of the fkin.  The fame is the
                                               explana-
 fels connected with it; the periftaltlc motion in the firft paffages, which
 are the paffage to the ftomach, the ftomach itfelf, and the whole convo-
 lution of the inteftines;  as alfo thofe of the womb, of the  bladder, of
 »rine, and fo forth,  None of the latter are under the influence of the will.
                          3 
OF*  MEDICINE.           8l
explanation to be given of the fenfe of cold, which com-
monly accompanies the fhivering;  and the fame is the ex-
planation of the drynefs of the fkin.
  CLV.  In the fame difeafes the pulfe isitronger, harder,
and fuller, and fomewliat more frequent, than in its found
ftate.   Its  fuln«fs and hardnefs is owing to taking animal
food plentifully during  the. predifpofition.   The force
and frequency  Is occafioned by the fame and any other
ftimuius, as  that of ftrong drink; that of the diffufible
kind, and that of exercife, whether corporeal or mental:
Nay all the ftimulant hurtful-powers are participant  of
the fame effect.
   CLVI. If, in the progrefs of the difeafe, the pulfe fome-
times  becomes, weaker, fbfter, emptier, and quicker, that
is a bad fign, and occafioned either by the debilitating plan
of cure being pufhed beyond  the proper bounds ; or, in
confequence  of a neglect of that fort of cure, it  may be
owing to fome debility induced by the excefs of excite-
ment.   The former of thefe is direct, the latter indirect
debility ; both to be avoided.
   CLVII.  The complexion in the veffels, which is  often
a confequence of a previous  appearance of palenefs, and
great quantity of fecreted fluids, is occafioned by an over-
proportion of blood, in confequence of an exceffive fthenic
diathefis obftructing the perfpii ation.   The fame is the
caufe of the head-ach and pains in different  parts.  For,
as the  head-ach {o  quickly and eafily yields to bleeding, it
is, therefore, feldom to be fufpected of being owing to  in-
flammation within  the head. And the reafon for fo think-
ing is ftrengthened by this further circumftance, that the
inflammation arifing in general difeafes always affects  an
external  part, as far as  that  fact has been enquired  in-
to (a\
                         G                  -CLVIII.
(a) Viik above, CXIII. 
82        THE   ELEMENTS
   CLVIII.  The delirium alfo, that fometimes arifes m a
violent ftate of difeafe, is not to be imputed to inflamma-
tion, and for  the fame reafon; for it yields lo much  tr>
bleeding and other evacuations, that there is no reafon for
fufpecting inflammation within the head.   That abun-
dance of blood in the veffels, diftending thefe to excefs,
is the caufe of the whole affair, ia proved on the one hand1
by the rednefs of rile face, implying ftich abundance, and
on the other by bleeding, removing the difeafe at once.
   CLIX. Thirft and  heat,  whic|ji are  alfo remarkable
fymptoms in fthenic difeafes, depend upon the fthenic dia-
thefis in the extreme veffels of the fauces and fkin; the
diathefis (6 obftructing  the veffels as not to allow a re-
turn of perfpiration, but to fuffer, however, the blood  to
pafs into the very neighbourhood of the ends of the vef-
fels, and by means of the fuppreffion of the perfpiration,,
to accumulate,  under the eoticle, the  heat generated ia
the fyftem*  Thus, in the throat, from an affection of the
ends of the veffels, the faliva and other fluids, by the free
flow of  which the throat is lubricated, and freed from'
that fenfe of drynefs, which is called thirft, are now con-
fined (b), and thereby produce thirft,
   CLX.  Hoarfenefs, cough, and expectoration, which
are fometimes obferved in fthenic difeafes, commonly pro-
ceed, and fucceed to each other i» the following order.
There is firft often a hoarfenefs, then a dry cough, then a
cough with expectoration.   The caufe of the hoarfenefs
and dry  cough is an obftruction of the exhalants and mu-
cous veffels, which terminate in the bronchia, ftill occa-
fioned by a violent fthenic diathefis, and prevented from
tFanfmitting their contents to  lubricate the air-veffels {c\
                                                    fo
  (b) and prevented to flow out,
  (c) The bronchia arc the divifions of the wind-pips running through
the fubftantt of the lungs, and blended with the blood-vcflels.  In the
                                                fubftancc 
            OF   MEDICINE.            8j

fo as that hoarfenefs may be removed, and the expectora-
tion proceed with freedom.   Again, the expectoration is
next freely made, becaufe the diathefis,  being now  dimi-
nifhed, and allowing the ends of the veffels to be relaxed,
and  the  fluids to be potired out in abundance upon the
air-veffels, is the occafion of the fluids producing a com-
motion of the excitability over this whole organ, and by
the convulfive motion, which is called  cough, of  being
themfelves thrown out.
   CLXI.  As the greater freedom  of expectoration now
implies an abatement of the diathefis : fo too great a flow,
and too long a continuance of it, fhows, that the diathefis
is now rufhing into the afthenic ftate, either from indirect
debility, or when the dife&fe, in its  progrefs,  has much
exhaufted the excitability;  or from direct  debility,  as
when the plan of cure, proper in kind, has been pufhed be-
yond the bounds.
  CLXII.  Thofe fame fymptoms (d), while they flop fhort
of the range of direct debility, or are not yet changed into
the indirect, are occafioned by heat,  and whatever ftimu-
lates in excefs, and removed by cold and whatever acts as
a weakening power.
   CLXIII. Palenefs,  fhrivelling of the fkin,  clearnefs of
the  urine,  and  bound  belly,  which chiefly  happen
about the beginning  of the difeafe,  arife  from  a  de-
gree  of  the  diathefis,   fhutting up  the ends of  the
veffels in fuch a manner, that either nothing is excreted,
                         G2                        or

fubtance of the lungs, befides thefe two fets of veffels, the air-vefle!s and
blood-veffels, there are likewifc exhalants, fmall arteries, and mucous
glands, coming off from the extremities of the red arteries.  The wind-
pipe is covered with the latter; and the great quantity of mucus thrown
up from the lungs, often in perfed health, aud  in innumerable  cafes,
both  of fthenic and afthenic general difeafe, fufficiently proves the etift-
joce of the fource from which they flow.
  (d) mentioned juft now, 
u
THE- ELEMENTS
or the thinner part,  as in the urine, only efcapes.   The
cure of the affection of the urine, of the obftructed per-
fpiration and coftivenefs,  fhows that the diathefis is now
gradually abating, the difeafe becoming mild, and now up-
on the eve of being thoroughly removed by emetics, pur-
gatives,  and fudorifics, and the ufe of other debilitating
remedies.
   CLXIV.  In fthenic difeafes, when they are gentle, the
appetite is often  not  much diminifhed,  and oftener more
food  can be taken than is ferviceable.   But, unlefs  the
lighteft vegetable matter  only, and that in*the form of wa-
tery potion, or in a fluid form, be given, every morfel of
it will do harm.
  CLXV. But, when either from indulgence in food of a
rich nature, or from employing a ftimulant plan of cure,
or from the difeafe having, from the beginning, arifen from
very,violent, hurtful powers, and now attained its higheft
degree of violence; in any, or all thefe circumftances, both
the other bad fymptoms, mentioned above,  break  out
directly, and the violent diforders of the ftomach,  or an
acute pain of the thorax,  fhow themfelves indiredtly.
  CLXVI.  In a violent diathefis, therefore, where there
is little appetite for food, but a very great defire for drink';
with the latter the patient is by all means to be gratified;
but the former fhould be avoided, as producing loathing,
ficknefs at ftomach, and vomiting.   Thofe fymptoms are
not ufually of long duration, unlefs  when the diathefis is
now going, or a6f ually gone, into the afthenic ftate by the
means that have been mentioned above (f), and,  by remo-
moving the other fymptotrrs by the proper debilitating plan
of cure, they go  off;  but when the  ftomach ficknefs  and
vomiting are urgent, and begin now to be a little more ob-
ftinate, and of a little more duration, one may know that
                                                 they
  (f) Vide laft paragngh and a few immediately preceding it. 
OF    MEDICINE.
85
 thay ftill remain fhort of the change into indirect debi-
 lity, by the following mark : if the pulfe ftill maintains
 moderation in its frequency, and does  not abate much of
 its- fulnefs  and force; if artificial vomiting and purging
 diminifh the  morbid vomiting, and, in  one word, if the
 debilitating plan of cure ftill fucceeds.   But, it will then
 at  laft  be  underftood  that  the difeafe  is altogether
 changed, and its caufe converted  into the oppofite, when
 thofe fymptoms every day  increafe;  when the pulfe be-
 comes  weaker and weaker ; when gripes in the inteftines,
 and liquid  ftools,  are fuperadded  to the  fymptoms that
 difturb the ftomach,  and when the antifthenic or  debili-
 litating plan of cure is now of evident detriment (g).
   CLXVII.  While the fame fymptoms  (h) ftill flop fhort
 of indirect debility, the exceffive excitement in the fto-
 mach being of quicker tendency to indirect debility there
 than any where elfe,  upon  account of the ftomach's great
 fenfibility,  and the force of the moft powerful ftimuli be-
 ing chiefly  exerted upon it, produces fymptoms of difturb-
 ance (i); for the moft powerful ftimuli, and thofe that are
 fignally powerful in producing fthenic diathefis  (k)  are
                                                     firft
   (g) See above, CIX.
   (h) of the  ftomach and inteftines,
   (i) See above, LIV.
   (k) as high-fcafoned animal  food, wine, fpirituous drink, cordials,
and the whole train of high diffufible ftimuli, fome of  thefe,  as meat
and wine, have no effed upon the external furface, or any other part;
others, as fome of the condiments,* fuch as muftard and  ftrong fpirits,
and above all  the  diffufible ftimulants, as aether, camphor, and opium in
a liquid  form, do ad upon the fecond,  and by their application to it
fupport their own interm.l ufe.  Thus to prevent or remove the gout,
anafarca, fpriins,  and fo forth, the application of  any of  thefe high dif-
fufible remedies, juft now mentioned, wilf.greatly  contribute, along with
their ufe as taken into the ftomach, to fupport the general operation.
Thefe, and innumerable others, are fo many fads that  have been fug.
fvflcd by obfervations and trials made  in the profccution of this doc-
trine, 
 86        THE    ELEMENTS
 firft applied there, and exert a greater force upon the ex-
 citability in that than any other part.  Thofe ftimuli are
 the feveral preparations of animal food, the feveral con-
 centrated ftrong drinks, the feveral condiments with which
 they are feafoned,  the various diffufible ftimuli,  as  the
 different preparations of opium, volatile alkali, camphor,
 mufk, and aether: and they all act upon the ftomach with
 that force which they exert not upon any other part; they
 do not upon the inteftines below, becaufe they undergo a
 change from the  firft digeftion before they pafs over into
 the firft portion of the inteftinal canal; not upon the lac-
 teal veffels, becaufe they are not received into  them till
 they are further diluted, and undergo another change from
 the digeftive operation, and when fo changed,  they  are
 next carried to be mixed with the blood ;  not  upon  the
 heart and arteries, upon account of the fame dilution meet-
 ing them alfo in thofe veffels, and of a conftant change of
 mixture occurring through the whole courfe of the circu-
 lation ; not upon the terminations of the arteries, whether
 exhalant or glandular, and whether thefe excrete from the
 body a matter already corrupted, or carry back by  the
 lymphatic veffels, an ufeful matter to the blood ; and that
 both for the reafons that have  been given,  and particu-
larly becaufe  fome great change is made in the exhalants
and glands; not upon the lymphatic veffels, where a new
fluid is conftantly flowing in upon the old in thefe parts
by means  of  anaftomofing branches, and chiefly in  the
 thoracic duct; not upon the other blood-veffels, upon ac-
count of the great change that a repetition of the circula-
tion  produces; nor upon the mufcular  fibres,  whether
voluntary or involuntary, becaufe the ftimuli by no means
come in contact with tbefe;  nor upon the brain or me-
dullary fubftance for the fame reafon (1),  as  well as  for

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

  *(m) in To faT as they-produced fthenic diatfhelk,
  (n) that is, debilitating, in fo far as they produce the-afthenic diathe-
fis,  that depends on dircd debility,  or in fo far as they produce the att-
fcenic diathefis that depem's upon indired -debility.
  (o) whether fthenic or aftheak,
  (p)  difeafes that arc fthenic and accompanied  with an Joflanimatian
 of a part,  as a portion of the lungs, the throat, fome of the joints, and
 in which, as has hf en formerly faid, the inflammation is like any other
fymptom, an effed of the caufe of the difeafe, not itfelf the caufe. 
 88        THE   ELEMENTS.

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

  (q)  as when the inflammation of eryfipelas appears there;
  (r) See above,  LUI. \.
  (f) Tn the inflammatory fore throat  the  inflammation affects the
 throat, which is alfo fometimes the feat of an erysipelatous inflamma-
 tion. In eryfipelas, fometimes the face, fometimes one of the legs, fome-
 times the ear, fometimes the temples, are inflamed.  1 have frequently
 been affeded with  an eryfipelas; that begins with an acute, inflammation
 and pain in one ear, which is thickened to four times its ufual dimen-
 sion; from that it  fpreads over the whole  hairy-fcalp till it reaches the
 neighbourhood of  the ear <n the oppofite fide, never, however, affeding
 that ear ; this progrefs has been fometimes from the right to the left,
fometimes from the latter to the former, in proportion as either had been
 more expofed than the other to heat, or  the alternation of heat with
cold, or the fucceffion to each other.  This difeafe is fthenic, but in a
 mild degree, and to be removed by coolnefs, cold water,  low vegetable
 fluid dier, and a flight purge.   It was once greatly aggravated by wine,
fpirituous drir.k, and the high diffufible ftimuli.  In rhematifm, the in-
flammation attacks a large joint, fometimes {hitting from one to another,
    .                                              fometunes 
OF    MEDICINE.           89
tion of the caufe, it is to be added, that which ever of the
parrs we have mentioned has been injured,  in  whatever
manner  it may have undergone the inflammation peculiar
to the phlegmafiae,  that part, in every  after attack of  a
new phiegrr.afia, is in more danger of being inflamed lhap
the reft.   This is the true caufe of the recurrence of fome
of the phlegraa'fias, as  the inflammatory fore throat, and
rheumatifm (t).   Peripncumony is a difeafe lefs frequent
than any of the reft of this form, becaufe " the feat of its
inflammation"  is  exempted from many  ftimuli,  liable
to produce fthenic diathefis  with its  accompanying in-
flammation.
              .: *•»»                                  H.  As

fometimes feveral at a time, and, in contradiflindion to the eryfipelatus,
is deep feated, extending to the interior part of the true fkin, which is
the cafe with every fuch inflammation,  called, therefore, phlegmonie;
whil< its fsat in eryfipelatus is betwixt the fcarf-fkin and the outer part
of the true fkin upon the corpus mucofum.   To thefe phlegmafiaj, ac-
companied with an inflammation of a part, depending upon the general
cauf- of the difeafe, and tfpceially upon the effed of temperature, may
be added that which an inflammation in one of the ears accompanies,
though this cafe is (eldom admitted into the number of the phle^mafia;.
It is,  indeed,  fometimes local, arifing from local  injuries, but is as cer-
tainly at  others,  a general difeafe, and to all intents ai:d purpofes a
phlcgmafiat
  (t) Thofe  two difeafes, in young vigorous perfons, are very liable to be
exceeding troublefome  by the frequency of  their occurrence.  In the
younger part of my life the violence in degree, and frequency of recur-
 rence, of the flheui: inflammatory fare throat, was very diftreffing, as
the leaft variation of the external temperature, fuperaddcd to a full
nourifliing diet, not without  the ftimulus of  a chexrfnl glafs, was  ready
to renew it, not only the  inflammation, but the whole pha:nomena ft
the difeafe.  The fame thing I  haveuftcn obferved in the frequent re-
currence  of the rheumatifm in perfons of the  fame age and habit, per-
haps  with fome  difference of temperament.  But  it is to be obferved,
thot, in proportion to the advance of life, and diminution of vigour, b<uh
thefe  difeafes become much lefs frequent, and much lefs violent.   Nor
is «ry thing mere ccrr.ir.cn tl.2n their giving way Et '.his tlir.e to a very
                                                       oppofitc 
90
THE    ELEMENTS
   H.  As the inflammatory fever, catarrh, the gentle fmall-
  pox,  are  unattended by inflammation (unlefs that in the
  laft a local inflammation from a local caufe, quite differ-
  ent from that which makes our prefent fubjeft, takes place)
  and as the inflammation in peripneumony, violent eryfi-
  pelas, and fimilar other cafes  of great violence,  is found
 the higheft in degree;  for  that reafon the conclufion is,
 that the degree of inflammation, which is a fymptom of
 general fthenic difeafes, is proportioned to the degree of
 the fthenic diathefis (y).
    CLXIX. The  inflammation, in this cafe, is nothing elfe,
 but a ftate of the inflamed part of a common nature with
 that in the reft of the body.  And as the inflammation  is
 produced by a greater degree of excitement in the inflam-
 ed, than in any  other equal part; fo before  the difeafe
 comes on,  of which the inflammation is only a part or
 ■fymptom,  the excitement of that part is underftood to be
 proportionally greater than in any other part (z).
                                                  CLXX.
«ppofite difeafe, the gout, which depends npon a fuperaddition of dired
debility to the indired, that laid the foundation of it.  I am pretty cer-
tain my inflammatory fore throat, or eryfipelas, never happened fponta-
 neoufly, nor without  an addition of ftimulant power, to thefe that pro-
 duce that difeafe, in  confequence of earrying to fome excefs the plan of
cere fuited to the removal or  prevention »f the gout.
  (y) It fhall by and  by befhewed, that this fort of inflammation is only
a part of the general  diathefis, foxnewhat higher in degree than any o-
thcr part, but far fhort of the degree conftituted by the whole general
affedion.
  (z) See above, par. L. and LI. Suppofe the excitement in every part
of the fyftem to be 45 at fome point in the period of the predifpofition,
and 54 in the part to be inflamed; after the comicg on of the difeafe
the fame proportion will bold ; when the excitement has now mounted
up to 60, the excitement of  a  part will be underftood to have gone to
69 •  keeping up ftill  the fame proportion. But this 9 degrees of greater
excitement in a part,  comes far fliort of the fum total of excitement in all
*hc  parts affeded wifh thf general fthenic diathefis}  that you may fup-
                                                       pofe 
              OF    MEDICINE.          OJ

   CLXX. This inflammation,  which  for the fake of dif-
 finction is to be called general fthenic inflammation, fhould
 be diftinguifhed from another,  which  is a local affection,
 arifing from local hurtful powers, and depending upon-a
 fault in the  organ, or  a folution of continuity ^a).
   CLXXI.  To this the term of fthenic local inflamma-
 tion applies.   The  general always depends  upon fthenic
 diathefis,  is a fymptom or part of it, never precedes it,
 always fucceeds to it fooner or  later, arifes from  the fame
 hurtful powers (b), and is reduced by the fame remedies.
 In contradiftinction to  which,  the local affection, as it a-
 rifes from local injury, producing a folution of continuity,
 or deranging the texture of the part;  fo,  if the labouring
 part is not very fenfible, the affection  extends no further.
 In the cafe of a part being endued with a high degree of
 fenfibility, fuppofe the ftomach, the inteftines, among the
 internal parts ; among the external, the tender fiibftancc
 under the nails ; in thefe cafes, the effect  of the inflam-
 mation is propagated over the  whole fyftem, and, in con-
 fequence of an affection of all the veffels, excites a tumult
 every where.   The fame local  fthenic  inflammation, whe-
 ther it be fixed in the part, or from its propagation, gives
 more general difturbance, yields to no  remedies, but thofe
 that act upon the affected part firft, and heal the folution
 of continuity (c). Let itfuffice to havefaid fo much at prefent
                                                   upon
pofc 3000 : and then the conclufion will be, that the general fthenic
 diathefis confifts in a fum total of morbid affedion, as 3000- while the
inflammation of the part is only an affedion of 3 degrees of excitement.
  (a) Solution of continuity  in all its forms, whether as being the effed
of punduring, cutting, bruifing, comprcflion, crofion from acrid matter
or from heat, er cold, is  always followed by an inflammation, which
when it goes on  brifkly, and  needs to have its violence rcftraincd, fto«I4-
be failed as isexpreffed u the next paragraph.
  (b) which produce the other fymptoms,
  (c) or reparation «t united fiibftancc, 
92
THE    ELEMENTS
upon thefe inflammations, for the fake of eftablifhing ne-
ceffary diftinctions, as more is afterwards to be faid upon
the local,  in its proper place.  There are as many inflam-
mations ftill  remaining,  univerfal and local, to be more
fully explained in that part of bur work where the proper
order requires it.
   CLXXH. Inflammation, alfo,  as often as it affects a
vital part, produces fymptoms of difturbance.   Whether
ever the general fthenic inflammation affects the brain and
its membranes, is hitherto not afcertained (d).   And it is
more probable, that the commotion  of the  head, and
other difturbing fymptoms of phrenitis, do not depend up-
on inflammation, as the  following phenomena feem to
fhow : The firft of thofe is, the cafe  by which the cure
is effected, the whole tumult of fymptoms readily yield-
ing to bleeding, purging and other  afthenic (e) remedies j
and, it not being very credible, that the effect of actual in-
flammation in a part fo delicate, and fo  neceffary to life,
could be  fo eafily effaced.   Then another argument a-
gamft the fame opinion is,  that there is  no certain proof,
after recovery,  of the exiftence of inflammation during
the difeafe.  Next, analogy makes for the fame conclu-
fion which we are difpofed to draw ; for, it has been faid
above,  general inflammation does not arife internally in
any fthenic difeafes (f);  on the contrary,  as often as it oc-
curs, it is always  in  an external part (g).  Nay, all the
                                             fymptoms
  (d) Phrenitis has been thought, and commonly  even defined, an in-
flammation of the brain ; an opinion that,  however aniverfil, feems to
be liable ta much doubt:  nay, there are many reafons for adopting an
oppofite one, as will appear from the reafoning in this paragraph of the
text.
  (e) What are commonly called antiphlogiftic. we call debilitating.
  (f) See above, par. CXIII.
  (g) It was long an opinio*, that the inflammation in rheumatifm
might be transferred to an internal part, as the ftomach ; but that, alfo,
                                                      is 
OF    MEDICINE.           93
fymptoms are fuch as arife from the general fthenic hurt-
ful powers,  and that, alfo yield to the general antifthenic
remedies, and in proportion to their degree.
   CLXXIII. The fame (h) is the caufe of head-ach, red-
nefs of the eye, as well as of delirium.
   CLXXIV. There is, however, no reafon  to doubt, but
that inflammation is the caufe of that difturbance,  which
happens to the lungs in peripneumony. To the part where
the pain is felt externally, whatever part of ,the thorax it
is, an  actual inflammation is oppofed internally. And,  as
the inflammation is proportioned to the degree of general
fthenic diathefis, and never happens but in a high degree
of that diathefis ; fo that the  pain is proportioned to the
degree of inflammation (i); and the  ftate of  the pulfe
muft  be eftimated  by paying a due regard  to  its caufe.
In the cafe of an high diathefis, and  high degree of in-
flammation,  its effects, the pain, feated in fome part of the
thorax, fometimes about the fternum, fometimes nigh the
nipples, fometimes farther back on either fide, fometimes
in the back  between or  above the fhoiilders, is acute and
                                                pungent,
is now laid afida, and all the cafes where there could be the leaft appear-
ance of  any fuch transference, have been found to be cafes  of the gout
or fome analogous difeafe of debility.
   (h) that we have afligned as the caufe of phrcnitic affedion alfo.
  (i) The infla nmation was fuppofed a chief and primary circumftance.
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 fup.
pofed to be the offspring of the inflammation. Hut the truth is, in every
refped, the reverfe of this account. The general fthenic diathefis is  the
effed of the general exciting hurtful powers.  As tht effed of. tlufc, \:t
a leffer degree, it cxifts during the predifpofition, and before tlie arrival
of the difeafe,-  and, after the difeafe is come on, it fubfifts as certainly
as fuch, for ore, two, or three days, as afterwards, when the fi^n of  the
inflammation, the pain, makes its appearav.ee.  It is only an incre ife of
it, that  induces the latter-, and it is nit to bs cured b/ a:iy coiKrivauc-
                                                       of 
 94        THE    ELEMENTS

pungent, and the pulfe very hard and ftrong.  "When the
diathefis, and the part of it we call inflammation is lefs, the
pain is lefs acute, more dull, and eafier to be borne ;  the
pulfe is  (k)  ftill hard and ftrong, though lefs fo than in
the other cafe.  Afterv/ards, in the progrefs of the dif-
eafe, the pain abates, becomes dull, the refpiration, which
had been much difturbed by it, becomes more eafy and
free.   The pulfe, now, which formerly was only hard,
becomes truly and pofitively foft, and that in proportion
to the degree of indirect, debility, occafioned  by a neglect
of the proper plan of cure ; or in proportion to the pro-
duction of direct  debility, from the antifthenic or  debili-
tating plan of cure having been pufhed too far.  But the
hardnefs of the pulfe, and increafe of the  pain, is never to
be  imputed to the inflammation being feated in the mem-
brane ;  nor is  the foftnefs of the former, and dullnefs of
the latter to be attributed to its occupying the foft paren-
chymatous fubftance (1),  it being  impoffible that an in-
flammation,  if it occupied either of thofe parts, fhould not
affect the  next points of the veffels in the  other.   The
caufe, therefore, of thofe fymptoms that has  here been af-
figned, muft be admitted.
  CLXXV.  The puftules, which accompany certain fthenic
                                                difeafes,
«f throwing any thing into the- inffimmcd part, there being no fuch thing
to be found in nature, but by the feveral means of removing the com-
mon C3ufe, that is, evacuant and other debilitating remedies.  Thofe,
while, at the fame time, they remove the other fymptoms,  by alfo re-
moving the difeafe,prove that the common caufe of the whole is the ge-
ne raldiathefis.  The inflammation, therefore, inftead of being the caufe
oj the general diforder, is a confequence, like every other fymptom.
  (k) not foft and yielding, according to the common notion, but
  (1)  Such, however, and many other diftindions, equally falfe, frivo-
lous and mifleading in the pradice, have been at  all times univetfally
tfre'ved l»y fyflematic, and lately by nofolngical writer.;, 
05         OF   MEDICINE.

difeafes arife from a contagion, taken into the body, dif-
fufed over the whole, and, in paffing out of it,  detained
along with the perfpirable fluid, under the fcarf-fkhx.
The caufe of the diftenfion, and, therefore, of the great
number of puftules, is the fthenic diathefis, taking place in
a high degree over the whole body, but in a ftill higher
in the veffels of the fkin, for the Feafons  formerly  (m)
afligned. In  which operation the mufcular fibres of the
veffels, becaufe they are as much increafed in denfity, in
fo far as they are confidered as fimple folids, as they re-
receive an increafe of tone, in fo far as they are confidered
as  living (n), are, on that account  fb fhortened, as not
fufficiently to tranfmit the imperceptible vapour of the
perfpirable fluid.  All the fthenic hurful  powers have a
tendency to produce  this effect, but heat,  in a degree
 within its ftimulant range, and fhort of indirect debility,
 more than any of them.  The fame is the caufe of eoftive-
 nefs.
    © Sthenic difeafes are often followed by debility, fome-
 times direct, at other times indirect, as 'is exemplified in
 the change of peripneumony into hydrothorax, the expla-
 nation of which is  evident from what has formerly been.
 faid.


               C   H   A    P.    V.

                 The Afthenic Diathefis.

    CLXXVL Before the fymptoms of difturbance appear,
 which only fupervene  upon a violent degree of  mor-
          2                                         bid
   (m) See above, par CXIII, and C XIV,
   (n) Sec Chap. V. 
96         THE  ELEMENTS

bid ftate, all the fenfes are dull;  the motions, both  vo-
luntary and involuntary, are torpid ; the acutenels of ge-
nius is impaired ; the fenfibility and paffions become lan-
guid.  The following functions are all  in a ftate of lan-
guor, which is difcoverable by the annexed marks :  The
languor of the heart and arteries is difcernible in the pulfe;
as is alfo that of the extreme veffels on the furface, which
is evident from the palenefs, the drynefs of the fkin, and
the fhrinking of tumors, and drying up of ulcers  (a), and
the manifeft abfence of the fthenic diathefis, to produce
any refemblance to thofe fymptoms.   That the mufcles are
in a ftate of torpor is  demonftrable by their weakened ac-
tion ; and that the internal fecretions are defficient,  is e-
qually certain  from the penury of femen  and milk,  and
the redundance of  fluids in a ftate of degeneracy.   The
languor of the digeftive organs is manifefted by want of
appetite, loathing of food, fometimes  thirft,  ficknefs of
ftomach, vomiting,  weaknefs of the fyftem, and evident
penury of blood.
   CLXXVII. In the fiime diathefis, whether as not having
attained to the height,of difeafe, and only remaiping with-
in the latitude of predifpofition, or as  raifed to the mea-
fure of actual difeafe, the intellectual  faculties and the
paffions are impaired.   In this way are  the functions im-
paired.

               CHAP.   VI.

The Afthenic Diathefis  illuf rated by an explanation of its
                      Symptoms.
   CLXXVIII. SHIVERING is not unufual at the com-
mencement of afthenic difeafes of any confiderable feve-
                                                 rity 5
  (a) Thefe fymptoms have lately been conftrued into fo many marks
amounting to a proof of the cxiftence of fpafm upon the extreme veffel- >
but we fhall, by and by, find a much better explanation of them, 
OF   MEDICINE.          97
rity ; and that, as often as its caufe, a very deficient per-
fpiration takes place.  In this cafe the caufe of  the  defi-
ciency is,  from the weaknefs of  the whole fyftem, that
weaknefs  of the  heart  and arteries, in confequence of
which they propel their fluids every where with difficulty,
and  in  their extremities with ftill  more difficulty,  or
fcarce at all.   Hence the perfpiration ceafes.  The  fame
is the explanation to be given of the fenfe of cold, when
it accompanies the fhivering.
  CLXXIX.  In  afthenic affections  the pulfe  is weak,
foft, fmall, and very quick.  The foftnefs, when it can be
perceived  for  the fmallnefs, as well  as the fmallnefs, is
occafioned by an under-proportion of blood, arifing, dur-
ing the  period of predifpofition, from a fcantinefs of ani-
mal  food, and an excefs in the ufe of vegetable; or from
a deficiency  of aliment upon the whole, whether from the
one or the other fource.   The caufe of the weaknefs and
very great quicknefs of the pulfe is the fame deficiency of
nourifhment, as well as of all the ftimuli, fuch as that of
ftrong drink, that of mental or corporeal exercife, and an
under-proportion of blood.
  CLXXX.  Since the excitability can only be  gradually
worn down  (a) and the ftrength, thereby, repaired;  if,
at any time, therefore,  the pulfe  becomes full  and hard
roo foon,  and without a proportional relief of the fymp-
toms, that is a bad fign, and happens becaufe the ftimulant
plan of  cure  (b) has been  pufhed  beyond the proper rule
(c); and it is a cafe of indirect debility fuperadded to the
direct (d).
  CLXXXI.  The fame is the caufe of the palenefs and
drynefs of the fkin, as that of a checked perfpiration; that
is,  the  weaknefs of  the  heart and arteries.   Hence the
blood is not  fufficiently propelled to the furface of the
bodv.l
                         H                CLXXXII.
  (a) Sec above, par. XXVI. XLUI.  (b) otheiwifc the proper one,
 (c)  .lee a'i >ve, par. XUX.   (t») ^ce  above, par. CLVf. 
 98        THE    ELEMENTS

   CLXXXII. Head-ach, which is a moft frequent fymp-
 tom of afthenic affections,  and pains in the joints, which
 are more rare, are occafioned by a fcantinefs of  blood :
 for fuch is the effect of the blood in diftending the veffels,
 that a moderate diftention,  fuch as takes place in  health,
 excites  an  agreeable  fenfation; and every thing, either
 above or below that ftandard, occafions an ungrateful one,
 and, therefore, (e), pain.   But,  we are much lefs in this
 cafe, than in that of fthenic pain (f), to fufpect inflamma-
 tion for the caufe of the pain ; becaufe, not only the pain
 here, but even delirium, yields  fo eafily to the ftimulant
 method of cure; which would not  readily happen, if fb
 delicate and fenfible an organ, and one fo  neceffary to life,
 laboured under  an affection fo liable to  deftroy the tex-
 ture of the affefted part.
   CLXXXIII. Neither in  general, is delirium,  and for
 the fame reafon (g)  to  be imputed to inflammation.   It
 is, on the contrary to be attributed to a fcantinefs of blood,
 and a deficiency of other  ftimuli.  Nor  is that by any
 means to be  doubted ;  fince ftimulant remedies, which
 have no effect in  filling the veffels, fuccefsfully and quickly
 cure every  delirium depending on debility (h).
   And, when, in confequence of the removal of the dif-
                                                    eafe,
  (e) when it rifes to a certain degree,
  (f) See above, par. CLVII.
  (g) that has been juft now mentioned,
  (h) This is a fad as new, and  of as nauch importance as any in thi9
 whole work.  Phyficians hitherto, had no diftiiid notion of a variety
 of inflammations, and had fcarce any idea of any inflammation, but
fuch a one as was to be treated with bleeding and evacuation ; nay, of-
ten, when they had  no reafon to fufped inflammation at all,  the mere
 circumftance of pain was, in their eftimation of it, fufficient to warrant
 a profufion of bleeding without end. But, the truth is, that pain may
 not only  arife f»om an inflammation, which they had no idea of, and
 which was to be cured by ftimulants, but it arifes from fpafms, convul-
 sions, and even from emptinefs. 
             OF   MEDICINE.          99

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

    CLXXXVI. Want of appetite, loathing of food (i), de-
 pend upon a debility of the whole body; as is proved by all
 the debilitating antecedent powers that produce them, al-
 ways acting by debilitating; and by all the remedies, which
 both prevent and cure them, always acting by a ftimulant
 and ftrengthening operation.  The caufe of the  appetite is
 a ftrong and found contraction of the fibres of the ftomach,
 by which digeftion is fupported (k), and the excretion of a
                                                        fluid
   (i) Thefe fymptoms of want of appetite, loathing of food, thirft, fick-
 nefs at ftomach,vomiting, and acute pain of the ftomach, as well as thofe
 that follow to the CXCV. and from that to the  CXCVIII. form a chain
 of fymptoms depending upon incrcafiug debility, which, inftead of being
 different in kind, are all connededhyan uniform operation of nature.
 And they furnifh an iuftrudive inftance of the erroneous  mode  of
 judging of the nature of fymptoms, and morbid affedions, which hasbecn
 fo prevalent in  all fyftems of phyfic, that we are yet acquainted with.
 However different in appearance they  are not only fimilar, but all unite
 informing one and the fame kind of difeafe, one and the  fame morbid
 affedion : 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 vary in degree, but they are all debilitating; and the latter may alfo
 ad with different degrees of force, but they are all ftimulant.  And the
 ftate of the fyftem, from which the former conftitute a deviation,  as well
 as that, to which the latter produce  a return, is health, which is always
 the fame.
  (k) The fibres of the ftomach are mufcular, and partly longitudinal,
 partly oblique, or approaching to circular.  When the food is taken in,
 the former are contraded and fhortened, by which theyraife the under
 part of  the ftomach, which is unfixt upwards.  Thefe  gradually relax
 as the food, after its firft digeftion in this organ, and its converfion into a
 more fluid form, in the  fame gradual manner, paffes out of the pylorus,
 or under orifice of the ftomach. This operation takes off the diftending
 weight in the diredion 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  colleded into the under part of the cavity of the ftomach,
 this gives a preffure in the lateral way, and, therefore, throws the other
fibres into contradion, by which the  fides of the ftomach  are fqueezed
 together, and, thercby,perform the office of throwingout, by the pylorus,
                                                          the 
               OF   MEDICINE.          101

 fluid, fuch as the gaftric (1) liquor, fuch as the faliva (m):
 and to the effect of both a certain emptinefs of the ftomach
 is neceffary.   But none of thefe circumftances  can take
 place in a ftate of debility. The fibres do not contract with
 force ; the extreme veffels do not pour out their fluids; the
 matter of food,  formerly taken  in,  is not diffolved and
 properly mixed, and in that ftate thrown out of the fto-
 mach ;  but continues in a great meafure  unchanged and
 indiffolved.   Hence it is, that there is no appetite for food,
 and in a higher degree  of it, that a loathing takes  place.
    CLXXXVII.  In the  fame manner has thirft  been ex-
 plained (n); and in the fame manner is the ficknefs at fto-
 mach, which  is a higher degree of affection from the fame
 caufe ; for when there is ftrength and vigour, fenfation is
 moft agreeable in every  part of the fyftem,  as well as in
 the ftomach and neighbouring parts.
   CLXXXVIII.  With refpect to vomiting; it is the chief
 of all thefe affections, that we  have been fpeaking of; for
 to fuch a height  has the atony and laxity of  the fibres in
 the ftomach gone, when it comes on j to fuch a degree has
                                                      the
 the remaining part of the alimentary matter. Befides thefe fucceffive ac-
 tions, the mufcular fubftance of the ftomach isfo conftruded as to be pro-
 vided with fibres, the motion of which,when the ftomach is full, isupward
 and downward; when empty downward only. All thefemotions give the
 alimentary matter the mechanical agitation neceffary to promote its
 mixture:
  (1) or fluid peculiarly fecreted and excreted in the ftomach.
  (m) The gaftric fluid, poured into the cavity of the ftomach, as well
 as the faliva  that follows it from the palate, and  the watery or other
 drink taken in by the mouth, contribute to change the food more and
 more into a fluid confiftencc, which is a change only of its form; but by
 certain means, a change alfo of its nature, called in chemiftry proper mix-
ture, takes place.  This change is chiefly effeded by the gaftric fluid, to
which,perhaps,a certain relation that the other fluidsbear to the aim.en.
tary matter in this living organ, contributes. Another means of promot-
 ing the folution that goes on in this procefs is the heat of the  ftomach-
  (n) S;c par. CLXXXIV. 
t02
THE  ELEMENTS
 the collection of crude nafty matters proceeded, and the
 diftention of the ftomach from thefe laft, and air let loofe
 is become fo exquifite, that the fibres are oppreffed, and
 cannot perform their motion from the upper to the lower
 part, which is commonly called the periftaltic motion.  And
 as in every cafe, both of health and difeafe, the tendency
 of that motion is always  from the ftimulus in an oppofite
 direction; downward when the ftimulus proceeds from
 the mouth, and upwards when it comes from the ftomach,
 in  that way it is that the crudities, and air let loofe,  of
 which mention has been  made, acting as a local ftimulus,
 direct all the motion, that they excite, towards the upper
 parts of  the canal.  This  inverted motion, being contrary
 to nature, can never be agreeable; and  hence,  before
 the arrival  of  the  vomiting,  ftomach-ficknefs,  arifes;
 which when it continues for  any time,  muft be violent,
.becaufe the local ftimulus roufes the mufcular fibres  into
 violent aud irregular motions.
   CLXXXIX. The caufe of pain in the ftomach and in-
 teftines, and other parts, both internal and external, under
 a fthenic diathefis, is fpafm. Spafm in any internal cavity,
 that is, in the organs of involuntary motion, is, by means
 of the debility in common to its feat with the whole body,
 a relaxation and atony of the fibres, and together with that
a diftending matter ; what conftitutes that matter in the
 ftomach  is the fordes or foul crudities,  in the inteftines;
hardened excrement: in both air let loofe.   The effect of
this matter in the diftention that it gives, does not fo much
 depend upon itfelf as upon the lax ftate  of the fibres dis-
tended by it;  for the fibres, when ftrong and vigorous,
eafily repel the diftending power, which overpowers them
in this ftate: but the relaxed fibres, of which we are fpeak-
ing,  yield more and more, and that in proportion to the
urgent force exerted on them, till loofing  all power of re-
                                              /ilition 
9  F   MEDICINE.          IO3
 filition or contraction,  all power of relaxation, they con-
 tinue immoveably contracted.  All which happens accor-
 ding to the nature of that property in mufcular fibres, by
 which, when they  are ftretched, they do not, like com-
 mon elaftic  matter, only contraft when the diftending
 power is  removed, but even while it remains.  During
 fuch action and fuffering the fenfible fibres undergo a cer-
 tain violence; and hence the pain.   But, that more is to
 be attributed to their own laxity, than the diftending mat-
 ter, is proved by ftimulants reftoring the tone and denfity,
 which  are exactly in proportion to each other, as depend-
 ing upon  the fame caufe;  by which means contracting
 in the  manner  of  found fibres, and powerfully reacting,
 they, without any affiftance, as has lately been afcertained,
 reftore the periftaltic motion, and drive downward before
 them  the matter ftill  remaining,  and ftill continuing to
 diftend (o).   In this way wine, aromatics, and volatile al-
 kali, and, above all  the reft, the various forms of opium,
 diflodge from its feat all fuch hurtful matter without either
 vomiting  or purging, and that without any difficulty, and
 in a very fhort fpace of time.
   CXC.  The pain,  which is fo often troublefome in the
 external parts of the body, alfo depends upon fpafm, but
 not with the conjunction of  a diftending matter.   And a
 power  takes the place of it, which is not to be referred to
 any matter, b.ut to  a certain effort of the will in moving a
 limb (p).  By means of that the fpafm is excited in the fame
                                                manner
  (0) The prevailing notion with refped to this kind of affedion has
been, and ftill is, that its caufe is the matter here fpoken of, which is
only an effed of the caufe, and that its cure, when the affedion is in the
ftomach,  is vomiting to carry off the fuppofed caufe.  l>ut 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
twne and denfity more and more ; while vomiting  therefore increafes,
ftimulating removes the  difeafe.
  (p) See LVIH. 
104
THE   ELEMENTS
 manner as in the other cafe, by diftention, and often with
 the moft exquifite pain, where, as the effect is the fame,
 that is, a fpafm, arifing from debility, and to be removed
 by reftoring the ftrength ; for that reafon the caufe alfo
 muft be the fame, and be reducible to debility, together
 with fomething that altogether refembles debility, and pof-
 fefs a power equal to it.  In this way of reafoning (q) we
 may often fafely rife from the contemplation of known ef-
 fect to that of unknown caufe.  The pain we fpeak of at
 prefent is that which refpects the  fpafms of the mufcles.
   CXCIII. There is another pain,  lefs confined to the fame
 part, more diffufed, and equally troublefome, which is not
 fupported by diftention,  but  by  another local ftimulus,
 equally arifing from debility, of equal tendency to increafe
 the debility, and, by its debilitating operation, together
 with the other fymptoms of debility, haftening on death.
 This pain arifes  from a concentrated acid, which is  fome-
 times predominant in the alimentary canal, when under
 the influence of great debility, of which cholera chiefly is
 a clear example; but,  befides that, all the affections of
 the alimentary canal, that are accompanied with vomiting
 and a loofe belly, are more or lefs examples of it,
   CXCII.  This acid is not the primary caufe,  but only
 a fymptom fupervening upon the  difeafe, already formed
 in confequence of the debility, its proper caufe, and now
                                                   fully
   (q) awayofreafoningnevermadeufeof in medicine before, but which
 runs through, and influences moft of the propofitions in this work. It is
 further to be obferved, that, upon no occcafion, can we ever arrive at an
 adequate knowledge of abftrad caufes ; that  the cagernefs of mankind
 to rufh into wild and fanciful explanations of them, withput any regard
 to real phenomena of nature, has been the caufe of all the falfe pheno-
 mena that ever appeared in the world, and  that the only fure r.nd faithful
 guide to the ftudy of caufes is a cautious and painful inveftigation of the
 effeds and phenomena of nature that proceed from them. See more up-
 on this important fubjed, and, indeed, a complete difcuffion of it, in my
book, entitled, " Obfervations on the old Syftems of Phyfic." 
OF   MEDICINE.          IC5
fully eftablifhed, arifing from the fame fource as the other
fymptoms,  and to  be removed by  the  fame remedies.
When the  fame acid  has arifen, it continues  to  increafe
all debility  that happens to be predominant, either in the
firft paffages, or in the reft of the body: And,  while it
exerts the operation over the whole body, its influence is
in the part where it exifts, and where  the diminution of
the force of the difeafe is moft wanted.
   CXCIII. But, though it be itfelf  in that way the off-
fpring of debility, and of a tendency  to create further de-
bility, in the fame manner as fpafm has  been faid to be;
ftill there is not, either for the fake of changing, or throw-
ing it out of the body, occafion for any other indication of
cure: For, as it has its  rife at firft from a general caufe,
fo upon that it all along depends; whatever has the effect
of overcoming the other fymptoms, has alfo that of over-
coming this.  For that  purpofe  it is, that, as in the  cafe
of fpafm,  ftimulants, not emetics,  nor  purgatives,  nor
any other debilitating powers, are required.
   CXCIV. As the acid, which has been mentioned, pro-
duces the  pain in the internal parts, or in  the organs of in-
voluntary  motion;  fo in the external parts, or organs of
voluntary  motion, it  is occafioned  by fomething  that pro-
 duces the  fame effect as the acid,  that depends upon the
 will, and acts in conjunction with the  convulfive ftate; and,
 as in the cafe of fpafm, there is no matter that correfponds
 with the diftending, fo  in this there is none to correfpond
 with that which produces the pain. Nay, as the fpafmodic
 cafe is reprefented by any cramp of the mufcles,  fo is the
 convulfive by any convulfion, but, above all, by epilepfy.
 Finally, as in the former, the fame reafoning from known ef-
 fect  to unknown caufe proves the famenefs of the external
 and internal cafe, it  equally proves  their famenefs in the
 latter (r).                                     CXCV.
   (r) All this reafoning  with refped  to  fpafm and convulfion,  fhow^ 
  106        THE   ELEMENTS

    CXCV. rI he fimple courfe of morbid affection from its
 flighteft to it moft violent degree (to take  a review of the
 fubjects from the place where we fet out),  is, that it begins
 with lofs of appetite, and is brought on by want of the fup-
 ports of food and of other ftimuli, or by an  over-proportion
 of ftimuli, and proceeds through all the intermediate de-
 grees to  fpafmodic  or convulfive pain.   For the reafons
 lately  afligned, there  is firft no appetite  for food, and if
 the patient pcrfeveres in the debilitating procefs of cure, and
 food is not adminiftered, fuch, fuppofe, as can be taken in
 the form offoups, a loathing of it follows. By-and-by, if
 ftill nothing is ufed to produce ftimulant effect, thirft will
 come on; there will be the moft keen defire for the moft
 debilitating power, cold  water, which will be  preferred
 to the greateft dainties, and will be greedily fwallowed (f).
 To this ftomach  ficknefs  immediately fucceeds,  which,
 unlefs prevented by a diffufible ftimulus, fuch as a glafs  of
 the moft pure and ftrong fpirit,  or, failing that, another
                                                  perhaps,
ing them to be the fame, and only a part of the whole, a link in the chain
of the other afthenic affections, which have been mentioned, as well as
the fads and arguments next to be brought, which will ferve to prove all
that follow to be alfo the fame, is, of itfelf, of the higheft  importance to
mankind. In a particular manner, the whole tribe of difeafes of the ali-
mentary canal, and almoft all thofe of children, all indeed, but the con-
tagious eruptive ones, are both  explained, and their principle of cure af-
certair.ed, with geometrical exadnefs. Here, thtn, 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; the method of cure arif-
ing from this dodrine having never failed in any of them, and never fuc-
ceeded upon a contrary plan, the debilitating and evacuant, fo univcrfally
recommended byihe authority of the fchools. The fpafms and convulfions
of the external parts,  unlefs when immoderate in degree, are equally
certainly removed by the new  method, and even epilepfy and tetanus
yield to it.
 (f) When this afthenic thirft comes on, it is the higheft luxury in na
tnre to be allowed a free indulgence  in the ufe of cold water, which ia
always hurtful in proportion to the degree of its coldnefs. 
             OFMEDICINE.           I07

perhaps, in fome cafes a third, rufhesinftantly on to vomiting.
When the affection rifes a little higher, during the vomiting
a violent pain arifes in the ftomach, giving a fenfation as if
there were a bar of iron in it, forcibly ftretching and tear-
ing it acrofs (t).   When the affection becomes ftill more
fevere, and the caufe of the difeafe ftill higher in degree,
every kind of torture is undergone; an head-ach comes on
with a feeling of  ftrokes like thofe given  by an hammer.
Thefe fymptoms of difturbance are communicated to  the
alimentary canal,  for the moft part not immediately, but
in confequence of the difeafe remaining, and lurking, with
an  intervention of  intervals of deceitful  refpite.   The
belly is often affected with gripes and great pains, and ex-
ceedingly  loofe; but, which will not be wondered at in
an inverted ftate of the periftaltic motion, it is oftener con-
ftipated, and,  from time to  time,  undergoes all the vicif-
fitudes of  alternate vomiting and purging.   Among the
troublefome fymptoms, that have  been mentioned,  are
comprehended dyfpepfia, called in common Englifh Indi-
                                                  geftion,

  (t) A lady, after nurfing her twelfth child  for feven months,  was
found by her hufband, a phyfician well acquainted with the new dodrine,
very low fpirited one evening.  She was of a delicate, thin, exhaufted
habit, and had been fubjed often before,  towards the end of her peri-
ods of nurfing, to lofs of appetite, colic,  dejedion 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 dejedion, ordered two of their daughters, who happened to ba
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 burfted from her
eyes upon hearing the fudden order for the weaning of the infant. He
fell afleep;  but in an hour's time was wakened by the noife of a moft
violent vomiting fhe had fallen into. She had a pain in her ftomach at the
fame time, from her account of which the defcription above was taken.
All this had been occafioned by her applying the child's mouth to hcr
nipple- 
  108          THE   ELEMENTS

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

   (u) or that difeafe, the urgent fymptom of which is alternate vomiting
and purging, the effed of which, while their caufe is a general weak-
nefs over all, but prevalent in the firft paffages, is to increafe the weak-
nefs, from which they proceed to fuch a degree,  as to hurry on the pa-
tient's death, with every fymptom  of expiring  debility,  in the fhort
fpace of fixteen hours. This happens in the warm countries, as the fou-
thern parts of Europe, and efpecully in the  torrid zone, whether in Afia,
Africa, or America,
  (x) The colic has been commonly treated by purging and bleeding,
 and low diet ; but in no inftance  has that treatment of it been fuccefsful.
Opiates were particularly forbidden upon the fuppofition of their confti-
pating the belly; but  the truth is,  that the  colic, as well as diarrhoea
 (which has been fuppofed a difeafe of an oppofite nature, from the feem-
ing contrarietyof loofenefsof the belly.and coftivenefs to each other), are
the fame kind of affedion, only differing in degree.  And the colic is to
be removed  by no other means than thofe that remove the fimple loofc-
nefs; that is by durable and diffufible ftimulants.
   (y) which is that higher  degree of colic where vomiting comet on,
and the periftaltic motion is fo  inverted as  to occafion  the rejedion of
ftercoraceous matter by the  mouth.  Sometimes in the progrefs of the
fame difeafe,  efpecially when treated only  by evacuation 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 effedual
cure of colic before the fymptoms  of volvulus make their appearance, is
a good proof that the latter is induced by the purgative medicines, em-
ployed to clear away  the obftruding caufe,  ading with fuch  relaxing ef-
fed, and urgent violence, ss 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 lo-
cal and immoveable affedion. Nothing could be more abfurd than the
reafoning that has direded the pradice 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 eontradidio n of employing
purging  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 ob-
                                                        ftruding 
                 OF   MEDICINE.            109

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

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

bringing^down the neftsfrom the top of high trees, by throwing flicks
and ftones at them ; while other boys, both more fenfible and alert, climb
up and feize every one of them.  The caufe of worms is the fame as that
of all the other difeafes we have fpoken of, differing in nothing but in
what they all differ from each other, mere degree.  Debility over  all,
but prevalent in the alimenrary canal, occafions a weaknefs both in all
the other fundions, and particularly 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 diame-
ters, and that enlargement an increafe of the quantity of fluids thrown
in, without any increafed impulfe behind.   Hence arifes a colluvies of
matter, which the increafed periftaltic motion is not able to throw off.
The colluvies is increafed by the ufe of vegetable matter and fruit taken
into the ftomach, and depofiting their feculent parts upon the inteftines.
The indication of cure is not to increafe either the general, or particu-
lar part of the caufe, by purging, and the ufe of other debilitating pow-
er?, but to ftrengthen the whole living fyftem ; and efpecially the intef-
tinal canal, by the whole round of ftimulant remedies diffufible or dur-
:,l>le.  To this treatment the tabes and atrophia will yield in a few days,
or even hours; the worms in as many weeks. And they are  all increafed
by the common plan of cure, as univerfal experience has proved to ade-
monftration. 
               OF   MEDICINE.           Ill

 proceed from internal inflammation, are, in reality, owing
 to fpafmodic or  convulfive affection  (a).   That this  is
 their true origin is proved by the renewal of ftimuli, remo-
 ving the affections, often immediately,  always  in a fhort
 time, and reproducing the healthy ftate.   It is proved by
                                                           the

   (a) Endlefs have been  the bleedings and other evacuations employed
 to remove thofe painful affedions, and as  difmal has been  the effed of
 that method of cure. The univerfal  rule fuggefted by the principles,
 and confirmed by the pradice of this new dodrine, is to invigorate the
 whole fyftem, and apply any diffufible ftimulus,  particularly laudanum,
 to the pained parts.  By that pradice I  know not one cure, «f fome
 hundreds, that either  I or my pupils have performed, that has failed.
 The gout will fometimes make its attack in this way.  But whatever be
 the particular force of difeafe, with which they may feem  ta have any
 connedion, the only diagnofis here neceffary is to be fure that the true
 peripneumony, is not the morbid ftate. When that is out of the quef-
 tion, and whether the painful complaint be  denominated baftard peri-
 pneumony or not, the only indication of cure is what has been juft now
 mentioned.  A young lady,  with whom  I am nearly and tenderly con-
 neded, has been often affeded with an acute pain in her right fide, mo li-
 ly fixed and folitary, fometimes accompanied with a certain numbnefs
 and fenfeleffnefs in her extremities, commonly with lofs of appetite, and
 fome  degree of head ach.  The effedual method  of  cure is to apply
 rags dipped in  laudanum,  volatile alkali,  or rether,  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 mcthv-i of cure of a morbid affedion, that upon the
 contrary debilitating evacuant plan would be readily and quickly con-
 verted into an incurable afthenic difeafe, has always proved infallible in
 removing  the attacks, which never after return but when fhe has enfee-
 bled herfelf by keeping the houfe too much, and negleding  air, exercife,
 and the ufe of the other diffufible ftimuli.  Fridion ufed over all the af-
 feded parts, is alfo found ufeful in fupporting the ftimulant operation
 of all the other remedies.  There is in the fens of Lincoln, where an t-
minent phyfician, and follower of this dodrine, pradife*, a difeafe call-
cd.a baftard peripneumony ; in which, though  it had always baffled all
the efforts of the common evacuant pradice, lie never loft a patient, by
 exircifing the contrary one. 
I 12
THE   ELEMENTS
 the unfuccefsfulnefs of the contrary method of cure, which
 proceceds upon bleeding, the various modes of purgation
 and abftinence.  Nay, what even makes more for the fame
 conclufion, is, that, while abftinence almoft alone is often
 fufficient to  produce the  pains,  rich diet  alfo  alone has
 been fufficient to remove them (b).
   CXCVII. The fame pains,  fometimes  combined  with
 enormous motion (c) fometimes  without it (d), are abfo-
 lutely free from inflammation.  To diftinguifh them, then,
 from the pains that flow from inflammation or a fimilar o-
 rigin, the concourfe of accompanying fymptoms muft be at-
 tended to. Sthenic diathefis points out that whatever pains
 occur are fthenic; and the information received from the
 afthenic diathefis is, that the pains appearing in it are parti-
 cipant of its  nature and as certainly afthenic.  This remark
 is of deep application to  difeafes of daily occurrence, and
 overturns the common practice.   Even  head-ach, which    v-
 is fo frequent an affection,  is ten times to  be  removed by
 the ftimulant plan, for once that the contrary anfwers (e).
           2                                  CXCVIII.

  (b) This I have often experienced in the cafe of  the gout. Before
 dinner, when my ftomach was empty, I have limped  in going abroad to
dine.  But after having made that meal heartily,  and taken a glafs or
two of wine, have returned with a perfed firm ftep, and free from all
feeling of pain and uneafinefs.
  (c) as in the convulfive kind fo lately fpoken of, where the enormity
of motion  is fometimes external and in the organs of voluntary motion,
fometimes internal, as in cholera and fo forth,  ■
  (d) as in the fpafmodic pains, head-ach, pains  in the legs and folcs,
 where there is an inability to perform the due motion.
  (e)  The true reafon for all this, and innumerable errors in the prac-
tice, is that the leaders in the profeffion never underftood any diathefis
but a fthenic one, or any indication of cure but an  afthenic, to which
they gave  the name of an antiphlogiftic, asthey didthatof phlogiUic to
the diathefis.  By his reformation of the erroneous plan of cure, that his
cotcmpcrarits, the Alexipharmacs, had introduced, in the fmall-pox 3rd
 the  few other fthenic difeafes that ever occur, in all  the reft of the ge-
                                                     neral 
               OF   MEDICINE.           iij

    CXCVIII.  Sy nptoms  of  difturbance occur alfo in af-
 thenic difeafes as well as the fthenic. Such a ftate of dif-
 turbance takes place  in the alimentary canal in the cafes
 of hyfteria, colic, dyfpepfy, and the gout.   Thus in the
 alimentary canal, befides the pains, mentioned above, a cer-
 tain fenfe of burning,  anguifh,  contortion and direful tor-
 ture, exhibit a fet of appearances, formidable in the high-
 eft degree, both to the patient and  by-ftanders,  and which
 beget a fufpicion of their proceeding from inflammation as
 their caufe.  But that thofe affections have nothing to  do
 with  inflammation as their caufe,  and that they depend
 Upon  a ftate of the part quite the reverfe, has been proved
 by the ftimulant method of curing them turning out fuc-
 cefsful  in  every inftance in  which  it has been tried (i);
                           ' I                           The

 Heral difeafes, Dr Sydenham's authority confirmed the'error.  He left
 alfo the meafles as he had found that difeafe,  and  all other general dif-
 eafes, which are much more in frequency than 97 out of the loo, or 97
 to 3 of the fthenia.  Great men had need to be cautious, as the leaft in-
 advertency in them, not to fay effential miftakes, never fails to lead their
 followers,  who are commonly fervile  imitators, and implicit believers,
 into capital error.  If ever they attempt  any  thing of  themfelves it is
 commonly to wife a crazy fuperftrudure upon a falfe foundation, it is
 commonly to refine upon error ad infinitum.
 (i) Till this  dodrine appeared, it was  impoffible to  erafe from the
 minds of phyficians animpreffionthat 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 yield to the moft ftimulant method of
 cure, that I could contrive,  T once laboured under this modification of
 afthenic difeafe for no lefs than ten days, and was always able to over-
 come it in two hours, and procure  an  interval of complete eafe and re-
 lief for  the reft of the day.  The remedies employed were the whole
round of diffufible ftimuli, as opiates in all their forms, camphor, mufk,
volatile alkali, and rether, &c.  By thefe the  fundions for the time were
completely reftored.  But their ftimulant effed was no fooner perfcdly
gone off, that is, after the interpofition cf along flecp, through the night,
                                                        than 
 114        THE  ELEMENTS.

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

 than the fymptoms returned with a violence little fhort of  what it had
 been the day before.  This was proof pofitive, that their  nature  wars
 afthenic, or confiftirg in debility ;  fince they yielded to ftimulant reme-
 dies j  and that the debility was cxquifitely  great, fince it required fo
 high a degree of ftimulant operation  to remove it.  While that is the
 undoubted fad, there is a nicety with refped to proportion to be attend-
 ed to in this cafe. It is a rule, that the degree of curative means, whe-
 ther in the curs of fthenic or  afthenic difeafes, fhould be accommodated
 to the degree of the  difeafed ftate or degree of the caufe.   If too little
 of the curative means is employed, a proportional  part of the difeafe
 will remain ; if too much, the difeafe will be more than removed, that
 is, another ftate which may be  morbid in another  extreme, may take
 place.   Too much was once employed in this affedion, and the effed
 was, that the difeafe was not eradicated till  the tenth day of its courfe
 from the beginning.
  (k)  The rule here is, if indired debility be the caufe, to begin with a
 high degree of ftimulant cure, and gradually reduce it to the ordinary de-
 gree that is fufficient for the healthy ftate. And the caution is to be fure
 of this gradual  redudion, otherwife the indired debility will be liable to
 return the moment the effed of the ftimuli is gone off.  Ky an attention
 of this kind a  difeafe depending upon indired debility may be  cured in
 the  fixth part of the time,  that would be taken up by the cure, when
 the remedies are every day carried beyond the due bounds.   For exam-
 ple,  if the indired debility be in the table the effed of an application of
 71 degrees of exciting power inftead of 40, that is to fay, the excitement
 is worn  down to 9 inftead of being up at 40; it is evident, that an appli-
 cation of 71 degrees by way of remedies, will leave the  difeafe where it
 was. Suppofc only 6j degrees of ftimulantpower adminiftered; the ex-
citement will fall to 66, and the wafted  excitability rife to  15.  Next
day let only a degree of exciting power as 60 be applied; then the degree
of excitement will be that number, and that of excitability 20.  Five
 degrees of exciting power ftill lefs will reduce the morbid excitement to
 55, and raife  the excitability to 25.   And fo on may the matter go,
 till the  excitability israifed to 40 and the excitement reduced to the fame
                                                         number. 
              OF   MEDICINE.           I f 5

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

 number.  But,  if  the redudion be much lefs by the day, the cure will
 be proportionally flower.  Nay, fuch an error may be committed as to
 increafe the difeafe inftead  of reducing it, which will happen, as often
 as a degree of ftimulant power is applied, which is more than equivalent
 to that which produced the difeafe. All this attention and caution is ne-
 ceffary in the cure of afthenic difeafes of indired debility ; while that of
 thofe of dired debility is eafy and fimple, to wit, to give the ftimulants
 in fmall proportion and often repeated, till the difeafe is removed, un-
 lefs, which may happen, you can  guefs the proportion, which may fuf-
 fice to remove the difeafe at once, or, at leaft, twice*
  (1) See CLXXXII. and CLXXXIII. par. above.
  (m) A young lady afHidcd with thefe fymptoms was in the courfe of
 a month bleeded thirty  times, always with a temporary relief, but with
a return of the difeafe more violent than ever.   She was then put upon
 a ftimulant plan, and in lefs than a month rcftored to her perfed health*
 That Was among the moft early cures taken from this dodrine < 
Il6      THE    ELEMENTS
 tion  being the caufe, but only gavt occafion to a queftion
 about its feat.   But truly, that there  is no inflammation
 at all here, at leaft as a caufe,  and that the difeafe depends
 upon pure debility, is fuffieiently proved by the arguments
 that  have been brought before.   The  difeafe is increafed
 by the antiphlogiftic, and diminifhed and removed by the
 ftimulant plan of cure.
    CC.  The formidable  fymptoms  of difturbance, that
 accompany epilepfy,  apoplexy, and fevers, fuch  as ftu-
 por,  a  difpofition to fleep,  in them all ;  in fevers often
 that  falfe watching, that is called typhomania, and fome-
 times coma (n);  in the latter, (or fevers), ftarting of the
 tendons, in the former, (or epilepfy and apoplexy), con*-
 vulfion or a diminution of the voluntary motions ; which
 by moft phyficians have been partly imputed to irritation (o),
                                                          as

   (n) or an infuperable proncnefs to fleep,
   (o)  No difeafes are more oppofite to each other than high fthenic dif-
 eafes,  fuch as the common inflammatory fever, or peripneumony,  and
 proper fevers; the former,  in the table,  ftanding at the head of the
 fcale of increafed excitement, and the latter at the bottom of  the fcale
 cf diminifhed excitement.  And the fame method for the cure of both
 has been purfued, • to wit, the evacuant, debilitating.  If, in peripneu-
 mony, large quantities of blood w«re taken at a time, the difference has
 been made up in the cure of fevers by repeating it the ottener ; whil$
 all the other evacuations were  carried on with the fame profufion ia
 both.  When they talked of  the refpedive caufes of thofe difeafes, phlo-
 giftic diathefis was the word for the high fthenic difeafes,  and irritation
 for the high afthenic.  But thefe were words only, while in fad the  me,
 thod of treatment of both was the  fame at leaft in kind; and fcarcely/
 different in degree.  To whatever part of any fyftem of phyfic we turn
 our attention, we conftantly fee one mode of pradice running through
 the whole, and that too, notwithftanding of the fuppofed  great number
 of difeafes very limited.   It turns all  upon bleeding,  other evacuations,
 ftarving, and fome other trifling diredions under the title of regimen.
 It was all antiphlogiftic to ufe their own language; and whatever other
 language they held, the nature  of the difeafe,  if we arc to judge from
their treatment, was phlogiftic. 
               OF   MEDICINE.        JtJ

 as typhorriania and the flatting of the tendons;  partly to
 plethora, either alone arid pure, or together with its mobi-
 lity : All thefe without drftinctiort are evidently owing to
 the fame caufe, upon which all afthenic difeafes depend,
 that is, debility.   Which  is proved by the  debilitating
 hurtfufl powers, whether  acting directly'or indirectly, a-
 lone producing thofe difeafes; and by the remedies,  the"
 whole action of which depends- on' ftimulus, alone relieving
 or removing them.   But  it is  in vain to impufe apoplexy
 to plethora (p) ; as if at  that  time of life, when the body
 is  nea'rly Worn out  and almoft bloodlefs, that is,  when
 the ufual degree of aliment  is neither defired, nor taken in,
 nor digefted,  more blood could be produced than in the'
 flower and vigour of human life.  On the contrary,  at the
 time when apoplexy comes on, in confequence  of indirect
 debility,  induced by  old age and exceffive  excitement in
 the mode of living,, the folids are languid, the quantity of
 fluids' deficient, as- alfo their fountain, the blood.  Eptlepfy
 depends upon the  fame debility,  and  the  fame fcantinefV
 of fluids, ortly that its debility is oftener of the direct kind.
 Fevers may depend upon indirect .debility, as in the con-
 fluent fmall-pox (q),  or where drnnkennefs has been  the
 principal hurtful power producing them,  but at the fiimc
 time their moft frequent caufe is direct debility.  And in
                                                      all

  (p) or an ovr proportion of blood, fee above, CXXXI,
  (q) 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 appellations givbn by1
phyficians, or by any of their erroneous diftindions, but  by ftrid re-
gard to  the degree of excitement.  And for the fame reafon is the vio-
lent cholera marked nearly in the fame place ;  becaufe the debility, ta-
king place in it, is nearly equal in degree to the moft finking feliriie de-
bility ;  in a \vord,  becaufe the fame degree of debilitating power pro.
duces, and tbefame degree cf ftimulant operation; removes the difeafe*
fo afforted, 
1X3      THE   ELEMENTS
all the cafes, that have  been juft now mentioned, debility
is the primary caufe and final termination both of all the
reft of the fymptoms and of thofe of difturbance.
  CCI.  To the fymptoms  of difturbance fometimes alfo
belong the following that affect the head ; great head-ach
in fevers, imbecility of the intellectual function, confufion
of thought, and delirium, the laft often fufficiently fierce,
though occuring in the higheft degrees of debility, and
leading to efforts beyond the ftrength.  This  ftate often
happens towards the end of a nervous fever, even when
violent.   Inflammation is apprehended, blood is  let,  but
dire&ly from the head ; blifters, which are extreme unc-
tion m the art, are clapped on, filence and  darknefs are
prefcribed, even the moft gentle ftimulants are forbid.  In
confequence of the emptinefs of the ftomach,  as well as
of the veffels  of the whole body, and of the higheft de-
gree of languor from the want of many ftimuli, vertigo is
fuperadded  to delirium,  and the patient,  deprived  of
ftrength, fenfe and intellect, breaths out his laft.,
   CCII. But in this cafe there is either no inflammation,
or, if there be, it  is altogether of a different nature from
the general fthenic one.  That it is not the  latter,  the
unfuccefsfulnefs of the debilitating plan of cure, and the
incredible fuccefs of that which firft ftimulates, and after
fills the veffels, afford certain proof: and  that it is not
any other inflammation is evinced by the fo fudden refti-
tution of health.  Now,  as an impaired  ufe, or confufion
of the intellectual faculty is, in  a certain degree, always
the  confequence  of debility, whether arifipg from  any
other fource, or from emptinefs, or a general inanition of
the veffels, and that too even in thofe, who are otherwife
found;  where is the wonder, if, in  the higheft degree of
inanition, compatible with life,  in the higheft degree of
diminution of  excitement, fcarcely leaving  a  fhadow of
                                                   fife 
              OF   MEDICINE.          11 Cj

 life, alio the higheft degree of failure in the  intellectual
 function, that is, delirium, among other inftances of im-
 paired function,  fhould  take  place.   Nay this very fact
 is certain, and proved to a demonftration.  Thus famine,
 thus drinking water contrary  to cuftom,  after  a courfe of
 drinking to excefs,  of both eating and drinking with in-
 temperance,  a gloomy ftate of the animal  fpirits, grief,
 terror, defpair,  not only induce a temporary delirium,
 but frequently bring on downright madnefs.   The fame
 conclufion applies to any confiderable lofs of blood.   For
 how many perfons, after being wounded either in line of
 battle or  on the highway, have never after, and often du-
 ring a long life time, come to the right ufe of their fenfes.
 To fay nothing of contufions, wounds  and other inju-
 ries, by  which the texture of  the brain is injured, as be-
 longing to local  difeafes,  of which we are to treat after-
 wards ; how does cold induce death ? Is  it not, amidft
 a diminution of all the other functions, by  a  delirium pre-
 ceding death ? From thefe facts, of fuch  weight,  both
 from their number and validity, and that bring forward
 all the powers in fupport of the argument, it muft be ad-
 mitted, that both head-ach, and every failure  of the in-
 tellectual function, in every  degree, and that higheft de-
 gree of  fuch failure, delirium, depend  not at all  upon
 general fthenic inflammation, the only inflammation hi-
 therto known ; but arife from the higheft defficiency, both
 of other  ftimuli, and of that which depends upon a pro-
 per fulnefs in the veffels, that is, debility.   Debility then
 is the moft frequent caufe of  the fymptoms,  that have
 been mentioned, as is proved by the reftoration of health
 fo quickly upon the new  plan of cure.
  CCI1I.  But if ever the afthenic  inflammation,  menti-
oned (r)  before,  excited the tumult of fymptoms, which
                                                  are
  (r) See above, paragraph CLXXI.  and CCH.  It is to be defined ia
 the next paragraph. 
  IZQ       THE    ELEMENTS

 are our prefent fubje/f; it produces that effect in the fame
 manner precifely, that debility produces it, by means of a
 penury of blood and deficiency of other ftimuli.  For,
    CCIV. The general  afthenic  inflammation is nothing
 elfe but afthenic diathefis, fomewhat more violent  in  a
  part than in any other equal part (f); and upon this foot-
 ing, that the degree of afthenic  diathefis  conftituting the
 inflammation is by no  means to be compared with the de-
 gree of diathefis in all the reft of the fyftem; becaufe the
 affeftion diffufed over the whole body is far greater  than
 that confined to a part (t).
    CCV. Inflammation, in this  cafe,  is nothing elfe  but
 a ftate  of the inflamed part, of the fame kind with that of
 all the reft of the body.  And, as the inflammation is  con-
 ftituted by a leffer excitement in  a part, than in any other
 equal part;  fo, before  the arrival of the difeafe  (u), of
 which the inflammation is a part, a  fymptom, or fequel,
 the excitement of that part is underftood to be proportion-
 ally lefs, than that  of any other part.
   CCVI. This inflammation (x) fhould  be diftinguifhed
 from another, which is  local: It is general,  and depends
                                                    upon
  (f) See above, paragraph XJL.IX,
  (t)  See above, XJLVIIl. XLIX. L. L*-
  (u) 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 exjeittd, as in fthenic inflamma-
 tien, or lefs, as in afthenic, than in any other, keep up the fame proportion
.of difparity before the arrival of the difeafe,  before the  appearance of
any of the fymptoms, and while, as yet,  nothing but mere predifpofition
 has taken place. The truth of this propofition is eftablifhed by that of
 another fo comprehenfive as to extend to  the whole fubjed of life; which
 is, that over the whole living  creation, throughout the uniyerfe, health,
 predifpofition to difeafe, and difeafe itfelf, are  the fame ftate,  only dif-
fering in degree,-(vid. par. XXIII.  and LXV.).   Health, thcrefore?
,is alfo comprehended under this fame propofiiion.
  4[x) mentioned in the two laft paragraphs, CGIV. and CCV. 
OF   MEDICINE.          121
upon a general diathefis and only happenswhen the diathe-
fis has attained to a certain degree;  while the local arifes
from fome hurtful power, that produces a folution or viti-
ation of the texture of the part, without regard either to
diathefis or degree: The general inflammation is brought
on by the fame hurtful exciting powers,  which  produce
the general diathefis,  only applied  in  a  higher degree;
and  the fame remedies remove both the diathefis and the
inflammation: The local inflammation depends upon hurt-
ful powers, that only harm a part, and is removed by re-
medies that change the ftate of the part; but is not affected
either by general hurtful powers, or general remedies. Ex-
amples of the univerfal are thefe inflammations, which ac-
company the gout, the putrid fore throat, the gangrenous
fore throat, and  that  inflammation  which produces  fore
eyes : The local inflammation will be illuftrated by exam-
ples, to be produced in their proper places  (y).: The gene-
ral inflammation is attended by debility over the  whole
fyftem;  which debility is only a fequel of the local, and
not always. To remove the former the general method of
cure if) is. adapted;, but the cure of the latter turns upon
healing up the part.   In this way, then,  there  are  four
fets of inflammation, two univerfal, a fthenic,. and. an af-
thenic,  and two local; one of which is fthenic,  and the
other afthenic. The former often ends infuppuration, often
in folution;  the latter in gangrene, and fometimes fphacc-
lus,. fbmetimea  at the laft in death.  If,  in the end  of a
                                                typhus
  (y) as in the inflammation, that is produced by a. wounding inftrument
when a perfon, previous to fuch an accident, is in health, and continues
to be fo after the accident.  Or it may ftill be local,  though a perfon is
in bad health.when.it happens, but fo, however, as that the general ftate
of the health is underftood to hive no concern iw it.   A w< und 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.
  ((z) See par. LXXXVH.I. 
   12%       THE    ELEMENTS

  typhus fever (a) inflammation affects the brain or its mem-
  branes, which (b) is neither yet proved, nor a  very likely
  fact, it will ferve for an inftance of an afthenic general in-
  flammation.
    CCVII. As the general  fthenic inflammation is  occa-
  fioned by a quantity of blood, exceffively diftending the
  veffels, which are its  feat,  by that diftention ftimulating
  them, by ftimulating increafing their excitement,  by the
  laft producing more forcible and more frequent contrac-
 tions, by thefe increafing the tone of  the fibres as  living,
  and their denfity as fimple folids, and thereby diminifhing
                                                         their

   (a) or a low nervous fever, which is a difeafe of the higheft debility,
 next to the  plague, and often not inferior to that difeafe in malignity,
 and, therefore, to be arranged in the fcale, as next to that dife-fe, which
 ftands at the bottom of diminifhed excitement.   Phyficians have con-
 ftantly confounded the different degrees of this difeafe-with fthenic ones,
 affeding the pulfe. But they are diametrically  oppofite as fhall be point-
 ed out when we come to the proper place for  fuch diftindions.
   (b) though ftrongly afferted.   A profeffor in his ledures gives a c.fe
 ef a typhus fever, where, upon account of delirium and fome other fymp-
 toms, thought to announce  an  inflan mation  in 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 palfus vacivus, if  ever there was fuch a
 ** pnlfe",) forbid any further bleeding.  The patient was given up, and
 the extraordinary phyficians withdrew, leaving the ordinary one of the
 family, only, about him.  This gentleman, from fome impreflion on
 hisnr.ind, began  to think,  that another bleeding might be tried with
 advantage.   He bleeded him, and the patient recovered. This is an ac-
 count of a cafe that I pretend not to underftand, and I believe it will be
 no lefs puzzling to my readers,  and the more puzzling  the  more fenfe
 they have.  It is, however, brought as an example,  that in a  feeming
 expiring debility, the higheft degree of afthenic diathefi*, 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 lightncfs of the theories of our proftffion,
but it requires knowledge and difccrnment to  guard againft the feduci
 tion of fads. 
OF    MEDICINE.          123
their diameters (c); and, confequently, making the blood
flow with great effort through the contracted veffels, and,
during irt flow, produce pain from the high force of the-
contractions,  and the narrownefs of  the  fpace through
which it has  to pafs ■; and as the fame, though in a leffer
degree, is the caufe of fthenic diathefis  over the whole
vafcular fyftem, whether red or colourlefs : So,
   CCVIII. The  caufe  of general afthenic inflammation
is alfo abundance  of blood  in the inflamed veffels, pro-
ducing the fame effects in the inflamed portion as in the
fthenic inflammation; and; notwithftanding of the penury
pf blood in every  part of the vafcular fyftem befides, flow-
ing abundantly into  the inflamed veffels,  upon account of
a greater atony and  laxity in them, than in the others, di-
ftending them and producing the  phenomena peculiar to
any inflammation  (d).
   CCIX. As the  indication of  cure for the former is, to
diminifh the quantity of blood, which is  the firft caufe of
the ftruggle, and,  thereby, to reduce the exceffive excite-
ment to the degree thatfuits the healthy ftate, and the ex-
ceffive contractions, which conftitute the ftruggle, to the
moderate ones,   which  are pleafant  and agreeable to
health (f): So
   CCX. The indication of  cure for the latter is, firft,
                                                    by
  (c) See LXI. above, and CXXXI.
  (d) Thefe definitions, apply to all the four inflammations (par. CCVI.)
with refped to the ftate of the inflamed  veffels; their differences only
depending upon the general ftate of  all the reft of the veffels, which in
the local, may be quite the healthy ftate of thefe, while,in fthenic gene-
ral inflammation, it is the fthenic, and in  this the afthenic diathefis, that
are conjoined with the inflammatory ftate.   Further, as their caufe is
influenced by thefe general circumftances, fo alfo is their cure ; the fthe-
nic and afthenic general inflammations requiring the remedies of the
djathefis to which they refpedivcly belong, and the local only the rente--
dies fuited to heal up  the part,
   (f) Sec above, CXXXIV. 
124       THE    E L E M  E N T S"<
 by powerful ftimuli, to drive on  the quantity of  blood
 which there is in every part of the fyftem, that the portion
 which loiters  in the languid veffels  of the inflamed  part,
 may be thereby propelled, and the veffels  relieved of their
 burthen; and then by the gradual  adminiftratioft of fea-
 foned animal food,  in the form of foups,  and, foon after,
 and when now the ftrength is recruited, in a folid form, to
 fill the whole fyftem of veffels.
   CCXI.   The two other inflammations, both local, will
 be treated of afterwards, each in its proper place.
   CCXII. That inflammation of the throat, which end*
 in what they call a putrid (g), fore throat, is Angularly in-
 fidious.   During the  firft days it differs little in its ap-
 pearance from the fthenic fore throat. The general fymp-
 toms are alfo fimilar.  The pulfe fearce exceeds the mea-
 fure of the fthenic pulfe in its frequency and other  chtirac-
 teriftics.  For fome time the whole difeafe proceeds with
 gentlenefs and tranquillity, excepting that a conftant re-
 jection by fpitting  of  a  tough mucous matter is troublc-
 fome. At laft, when head is not made againft it by means
 of the moft powerful ftimuli, a period arives, when- all the"
 fymptoms are  fuddenly precipitated intoa bad ftate; when
 the pulfe becomes very quick, very weak, and remarkably
 fmall; when  the ftrength, over the whole fyftem, fink's ;
,and now it is not a moderate portion of diffufible ftimulus,
 not before  adminiftered, that will flop  the' much to be
 famented death of the greateft  ornament of human na-
 ture (h).   The beft plan of curing this difeafe, is to pre-
                                                   vent

  (g') The difeafe, here mentioned, is neither defcribed nor, feeming'y,
nnderftood,  in medical books  and ledures.  In this work it is taken, as
every thing elfe is, from nature at the bed-fide of the fick, and deferves
fo much the more attention, that, though it is a difeafe of"the utmoft ma-
lignity, it feems to  have been altogether overlooked.  Its appe3rancer
are mild at firft,but, without both fkill and attention, will end fatally:
  (h) All this refers to a lady in Scotland, of Angular worth and amiabi.
                                                    lit 
OF   MEDICINE.
**5
    vent the mortal period by employing the moft powerful
*   ftimuli.
      CCXIII. The diffufible ftimuli are fo powerful in re-
    moving the  inflammation of the  gout,  that, fometimes,
    ftrong ftrink, undiluted, as wine, and fpirits, or the latter
    diluted with water, as warm as can be  borne, have in a
    few hours removed the moft violent fit, and reftored the
    ufe of the affected foot.   And the fame  remedies, as have
    been mentioned before, are  of equal efficacy in removing
    the general fymptoms  (i).
       CCXIV. The inflammation of  the  throat, in the gan-
    grenous fore throat,  is not,  according to  the common
    opinion, a primary affection ; but, like every other general
    afthenic inflammation, depends upon the general diathefis,
    which, in this cafe is manifeftly afthenic, being a part or
    fymptom  of the diathefis,  when that has attained a cer-
    tain high degree.
       This  inflammation  has  nothing  in  common with the
                                                       fthenid

    !ity, who died, but not in  confequence of the plan of cure,  which this
    dodiine enjoins,  having been followed ; efpecially at the period  of the
    difeafe when it was moft wanted.
       (i) Treated in the way, here and formerly (vid. the pref.) mentioned,
    the moft violent degree of the difeafe always gave way in  a few days,
    and milder cafes in as many hours. I never found a fingle cufe baffle me
    but one, where the patient, who, with his valet, had quacked himfelf
     into the gout as well as  other complaints, and particularly an  habitual
    coftivenefs, by forcing every paffage by the belly,  for the fpace of feven-
    teen years.  I was difmiffed without having my diredions complied'
    with ;  and without bting  allowed to accommodate the remedies to his
    pradice of purging and throwing up injedions,  fo as to endeavour, at
    leaft, to prevent or mitigate their hurtful effed.  For, it muft be obferv-
    ed here, that, as every diredly debilitating power is an exciting hurtful
    means of bringing on any afthenic difeafe, fo the effed of every evacu-
    ation, and  particularly  that by the belly, is well known to be a certairs
    means of bringing on a fit of the gout.  Among many other means of
    inducing that difeafe, a finglc dofe of Glauber's fait, though that be but
     a mild cathartic, will bring a fit of the gout on me at any time. 
is6
THE   ELEMENTS
 fthenic  general  inflammation,  which diftinguifh.es  the
 fthenic inflammatory fore throat, (k) or with the two local
 inflammations.
    CCXV*.  The crowded puftules, in the fmall-pox, when
 it is  now converted into the confluent difeafe of that name,
 that is, into an afthenic general difeafe,  become partakers
 of the new diathefis, and, inftead of fthenic, which was
 their fii ft ftate, become aftfthenic ;  and, as by their local
 ftimulus before, they quickly changed the  fthenic into the
 afthenic diathefis, by means  of indirect debility ; fo they,
 now, by the debilitating influence of their afthenic nature,
 confirm afthenia,  or  a ftate of debility, over the whole fy-
 ftem ; they increafe it, and carry it quickly on to death (1).
   CCXVI.    To throw  light  and  illuftration  upon
 them,  by comparing their  refpective methods of cure ;
 it is to be  obferved that the  cure;  in the  one eafe
                                                         is

  (k) Yet in their fyftems of nofology, which are laboured volumes of
 diftindions without differences, begun, within this half century, to be
 fuperadded to the former  modes of  fyftematizing, which, without this
 new one, had fufficiently difgraced the art, and needed no more than the
 moft abfurd of the whole, or that the mifled fancy of men could invent,
 to complete, in all its copartments, the vaft fabric of error, and particu-
 larly in the laft of thefe, that puhlifhed in Ediuburgh, the  putrid fore
 throat, as defcribed (above CCXII.) was left out, and the gangrenons,
 which is that juft now alluded to in the text, conjoined with the com-
 mon fthenic fore throat, though diametrically in its nature oppofite to it.
  (1) There cannot be a more exquifitc ftiinulus in living nature, than
that univerfal cake of inflamed puftules, which covers the whole furface
in a crowded fmall-pox.   It is no wonder then, that, when it is fuper-
addcd to the ordinary ftimulant hurtful powers, to  which this difeafe
firft owes its violence,  and afterwards, that very eruption, the united
effed of both fhould foon pafs the whole range of exceffive ftimulus, and
quickly run into the ftate of indired debility (fee par. CC ).   Such i->
the nature and progrefs of the fmall pox, in paffing from the fthenic in-
 to the afthenic ftate, that is, from one difeafe into another of a moft op-
pofite nature. 
            OF   MEDICINE.          127

Is quite different  from  that  of the  other  (m).   The
remedies  of the  diftinct fmall-pox,  and of its accom-
panying eruption, are cold, and whatever, by evacuation
or otherwife, debilitates.   The remedies of the confluent
difeafe, as well as of its accompanying eruption, are heat,
remaining within the indirectly debilitating degree, and all
the powers, which ftimulate  as quickly, and as power-
fully as poffible, and  confequently, the moft diffufible.
   CCXVII. They differ befides in this, that all the hurt-
ful powers  in the diftinct cafe are fthenic; all in the con-
fluent afthenic.   And this difference  equally  applies to
both difeafes, and both eruptions.
   CCXVIII. And as the fthenic or diftinft puftules have
a direct tendency to produce afthenic inflammation,  and
fthenic eruption; fo the  tendency of the  afthenic or con-
fluent, is as directly to gangrene, fphacelus, and death.
   CCXIX. The boils, carbuncles, and buboes, which of-
ten accompany the plague, and fometimes the typhus fe-
ver (n) arife from a contagious matter, taken into the body,
 and then detained with the perfpiratory fluid,under the cu-
 ticle, and in the glands.   The cafe of the detention, and,
 therefore, of this eruption, is a total ceffation of motion in
 the extreme arteries, efpecially the glands and perfpiratory
 terminations, upon account of the univerfal  debility, and
 the very great languor of the heart and arteries. That this
 is the cafe, is proved by their being no eruption during the
 period of predifpofition, when fome vigour ftill remains ;
                                                    and,
   (m) The cure of the diftind fmall-pox is the debilitating ; that of the
confluent, the ftimulant plan  The caufe of  the former  is fthenic dia-
thefis,  that of the  latter the afthenic, occafioned  by indired debility;
which is a diftindion unattended to in general, and with very bad effed
upon the pradice.  For, when the confluent fmall-pox is eftablifhed.thc
puftulesflat, and figns of mortification coming on, the covering the pati-
ent with ,1 fingle fhcet is as common as in the diftind fmall-pox.
   (n) See above, the note (c), under par. CCVII. 
128
THE   ELEMENTS
 and, therefore, the perfpiration  goes on in a certain  d6*
 gree; none in the cafes of fudden death from the violence
 of the difeafe; neither eruption nor difeafe  in all  the
 cafes, whether thefe  are early prevented by the ufe of the
 more powerful ftimulants ;  by the  difeafe being always
 gentle, and the eruption  always fparing, in proportion
 to the proper management of the ftimulant plan of cure.
 For, whether the fupprcffion of perfpiration be the con-
 fequence  of a very  great degree of fthenic d iathefis, or
 of an equal degree of fthenic as in the prefent cafe ; all the
 foreign  matter, that fhould be thrown out of the fyftem
 along with the  perfpirable is, together with it, detained,
 and fo detained below  the cuticle, by ltagnating, and  ac-
 quiring a more acrid nature, it produces local inflammation,
 cither of afthenic or afthenic nature, in proportion to the
 different nature of each, or rather of the habit of the body.
   CCXX. In the fame manner is  that  eruption which
 diverfifies  the fkin in  the gangrenous fore throat to be ex-
 plained ; as well as another,  which fupervenes upon that
 ftate of the fmall-pox, which by reafon of the debility of the
 fyftem, would otherwife turn out well; but if the new e-
 ruption be not oppofed  by the moft powerful ftimuli, is
 fure to end in death.   Both thefe eruptions (o) are fpotted
 both of them red; but the former (p) is marked byfmaller,
 the latter by larger fpots; in the latter the colour is a fine
 fcarlet, far exceeding all art,  and almoft the power of na-
 ture herfelf in other refpects (q).   Both of them are owing
    4                                                to
  (o) A young child of mine, who had been long weakly, and often, in
 confequence of that, fnatched from the jaws of death bj being properly
lupported, according to the principles of the new dodrine, Lad been pre-
pared to receive the fmall- pox, and inoculated.  After the eruption was
completed, and it was now certain it would be exceedingly moderate,
one  morning he was brought before me covered over with the appear-
ance of the erupticn defcribed in the text.
  (p) or that in the gangrenous fore-throat.
  (q) The beautiful colours fometimes  painted in the clouds are often
not to be copied by art. 
                  OF    MEDICINE.          120

    to a fuppreffionof the perfpiration by the debility that has
    been mentioned :  the former is removed,  in practice,  by
    the ftimulant plan of cure,  which removes all the other
    fymptoms; in the latter or Uncommon eruption,the debility
    produced  of purpofe in the  preparatory plan of manage-
    ment,  to render the fmall-pox mild, muft be oppofed, as
    foon as the eruption appears, and the ftrength muft be re-
    ftored by the ufe of the moft diffufible ftimuli: the puftules
    which  are both few,  and  of no confequence, and  do
    not even  attain to the  meafure of actual  general difeafe,
    and  are, therefore, free from all danger,  are not to be re-
    garded.  If this practice be executed, the recovery is both
    Certain and quick ; but, if it be neglected,  or if a contrary
    plan of cure be fet on foot, death is inevitable (r).
                                  K                   CCXXL

     (r) It is certain, that the fafe condud of the fmall-pox depends upon
   debilitating the habit which is to receive the infedion; and if is as lit-
   tle doubtful that we may carry that operation a great way, by lowering
   the diet, purging the belly, and  applying intenfe eold to the furface^
   and, by all means.'guarding  againft all alternation  with heat.  By this
   means the phlogiftic diathefis, chiefly arifing from the ordinary powers
   and in part, as it would feem, from the contagious matter,  is prevented
   or removed ;  the great flow of the fluids to the furface checked ;  and
   the diameters of the perfpiratory, as well as of all the other veffels, kept
   open ahd patulous.  But it had been long  a queftion with me,  whether
   this debilitating operation might not be carried too far.  If it be certain,
   as it is, that extreme  debility fupprcffes perfpiration, furely the procefs
   pufhed near to that degree muft endanger that event.   This phenome-
   non happening to my child, folved the doubt that I had not  yet decided,
'   and it feemed to be in perfed conformity to the principles of this dodrine
   to undcrftand, that, as this child had been formerly weak, and,  perhaps,
   ftill retained fome degree of that ftate, the further weakening him by the
   preparatory management, for the better regulating this difeafe, had been
   carried too far.  A furgeon happened to be by when the child was un-
   der examination ;  I afked him if he had ever feen fuch a cafe, for I had
   neither feen, nor heard, nor read, of any thing like it.   His anfwer was,
   that he had feen three, and  all of them fatal,  I knew how that would
   happen, that is, that they would continue the debilitating pradice they
                                                             had 
 t$0       THE    ELEMENTS

   CCXXI.  Heat is not  peculiar to fthenic  pyrexia?  (f),
but  belongs  alfo to other  difeafes  of the  fame  ftamp.
Nor is it fo confined to thofe, as not alfo to arife in all the
degrees of predifpofition to thofe difeafes, and  in proportion
to each degree (t).  But the matter does not end here. The
fame heat  diftinguifhes all afthenic difeafes, whether fe-
brile, which is  a diftindion without any good meaning,
or  not febrile,  and alfo  the  predifpofitions to them all
and that in proportion to the degree of debility.There is not
a more certain mark of a departing difeafe, whether fthe-
nic or afthenic,  than' a return  of that temperature, which
is commonly  called cool, to diftinguifh it from  morbid
heat,
   CCXXII.  The heat is then  only natural, when neither
diathefis is prefent.  From that point it encreafes, through
all the  degrees of encreafed excitement, till indirect debi-
lity,  from  excefs of ftimulus,  is eftablifhed;  and it en-
creafes in proportion to the degree of excitement, rendering
the  perfpiratory veffels always lefs and lefs patulous.   It
alfo encreafes through  all the degrees of diminifhed ex-
                                                  citement
had bae» following. On the contrary, I  ordered  the child fpirit and wa-
ter, and a little of an opiate, then reftored the  meals that had been  ta-
ken from him, and brought him about to his perfed health (for the fmall-
pox gave no trouble), in twelve or fixteen hours.
  (f; Pyrexia is the word for fthenic difeafes affeding  the pulfe, called
febrile, or fevers, very improperly,, while the term, fever is referved  for
the high afthenic dif«festhat have been confounded with the pyrexiae.
  (t) That heat takes place in predifbofition,. is a matter of daily obfer-
vation.  Thus, when  a perfon has no other fymptom of difeafe, it is of-
ten remarked, fometimes  by himfelf, fometimes by another, who may
have happened to feel his hands, that he is certainly not quite well as>
his hands are hot.  When this heat happens, cither  in the hands or feet,
without any caufe to account for it confiftently  with health, it  is a fure
prelude of difeafe, that is a fure mark of a confiderable predifpofition u>
difeafe :  and the kind of  difeafe, of which it it the harbinger, is  o£-
;cner afthenic than fthenic. 
OF   MEDICINE.          13I
  element to certain boundaries, which are fixed by a caufe
  by-and-by to be explained, and encreafes in proportion to
  the degree of decreafing excitement, though the latter all
  along renders the perfpiratory veffels more patulous ; and,
  thereby, among other effects,  diminifhes the motion, both
  of all the veffels, and particularly of the perfpiratory.
    CCXXIII. When  the heat has now been the greateft
  it can be, and the debility encreafed in proportion, at laft
  in the exremities,  and afterwards gradually in the reft of
  the body, cold, which is always a bad fign, fucceeds to it.
  In the progrefs of the  debility motion begins to be very
  languid, firft in the extreme veffels of the  extremities of
  the limbs,  and then to  be deftroyed altogether.   Hence,
  as heat, whether in due proportion, or in excefs, depends
  upon  the motion of the blood and other fluids,  being per-
 formed in due proportion, in excefs, or to a certain extent,
 in a deficient degree;  if, therefore, the heat is either no-
 thing, or next to nothing, as in the prefent cafe, the effect,
 together with the  caufe, by an  univerfal  law in nature,
 ceafes.  The fame thing happens in both extremes of ex-
 citability, that is, of exceffive abundance in direct* and of
 nearly a ceffation of it,  in indirect debility;  and fo much
 more readily will this happen, becaufe, whatever  be its
 fource, debility  is always the fame.
   CCXXIV. Becaufe the excitement  in  fthenic difeafes
 is for  the moft part much and equally encreafed over the
 whole body; the heat,  on  that  account, is  alfo equally
 diffufed over the whole.  From  which faft no cafes are
 excepted, but thofe,  in  which, in  certain parts, as the
 ftomach, under  a ftrong difpofition  to  vomiting,  and,
 therefore in danger of falling into indirect debility, indi-
 rect debility  either  actually  takes place, from the difeafe
proceeding with an  exceffive force of ftimulus ;  or direct
debility comes on, when the debilitating plan of cure ha3
been pufhed beyond the rule.  But, fo long as the fthenic
                         K 2                 diathefis 
*3*
THE   ELEMENTS
 diathefis is vigorous,  and fupports a high force of excite-
 ment the heat will almoft always be equal.
    CCXXV.  The  fame thing  happpens  in  moderate de-
 bility.   Accordingly, through the whole courfe of predif-
 pofition, and in thofe difeafes, where  the matter has not
 gone fofar as almoft a total ceffation of motion,  the heat
 is pretty equal.  The effect of ceffation of motion  has
 been explained (u).   But, before that happens, if any ine-
 quality of heat occurs in difeafes of moderate debility,  as
 is  frequently the cafe in  the hands and feet;  the reafon
 of that is,  that a greater degree of debility as in cold, la-
 bour, and fweat from thefe, or any other  fource, and that
 fweat cold and clammy,  has been applied to thofe parts,
 than to others.   Not ortly in the gout, but alfo in other
 affections both of direct and indirect debility,  a burning
 heat, chiefly diftreffing to the  foles of  the feet, torments
 the patient, efpecially in walking.  That that arifes from
 debility, checking perfpiration,  is proved by fatigue, cold,
 and other debilitating powers proving hurtful to it ;  and
 heat, reft, and other ftimulant powers, giving it eafe.
 CCXXVI. It remains  now, that it be explained, how
 too  great excitement, in high fthenic difeafes, impairs
 fome functions, but never, by a  debilitating operation; and
 how too fmall an excitement in  violent afthenic difeafes,
 gives an appearance of  encreafing fome functions, but
 always a falfe one.
  CCXXVII. If, in  peripneumony, fynocha (x), and,
 violent rheumatifm, the  voluntary motions are impaired,
 and to fuch a degree, that a perfon can neither ufe his hands
 nor his feet, more than a paralytic perfon ; that that is. not
owing to debility, that is, dirnhiifhed excitement whether
 directly or indirectly (y),is evident from  this double proof;
                                                 that,
 (u) See above,  CCXXHI.     (x) or the inflammatory fever.
 (y) When the excitement is at 40 all the fundions-are peiformed in
                                                   the 
                   OF    MEDICINE.           1%%

     that, if the apparent debility were real, ftimulants would
     be of fervice, and debilitating remedies  of differvice (z).
     But the reverfe is the truth. For the fame debilitating pow-
     ers, which cure the other fymptoms of confeffed exceffive
\    excitement, alfo remove this  indifpofition to the perform-
     ance of motion ; and the  contrary encreafe the affection.
        CCXXVIII.  Again, in fpafms  and  convulfions, either
     of the involuntary motions, in  the internal  parts,  as in
                                                        dyfpepfia

     the beft and compl-teft manner. Above that there is more force through
     all the fteps of predifpofition, but with lefs  durability and fteadinefs;
     which is exemplified by the comparifon of hard labourers, who  at  the
     fame time  are well fupported, and gentlemen, who live well, without
     ufing a proportional degree  of labour or exercife to prevent a luxuriant
     ftate of vigour.  When two fuch perfons are fubjeded to a comparative
     trial of  their vigour in any exertion, the former will be found to go
     through the exertion with more fteadinefs, and t® hold out longer and bet-
     ter than the other; even though his firft 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 indired debility,  which puts an end
    to excitement, is greater in the former than in the latter cafe.  The dif-
    ference in the well-fupported labourer is 30 before he can reach an en-
    creafe that leads up to 70; whereas that of the gentleman is perhaps not
    more than SO.   The exertion in the ftruggle adds ftimulus; which will
    be better borne by him who has leaft and yet enough, than by him who
    has more, but of a fuperfluous degree,  and more liable to ran into the
    extreme  of a  ceffation of excitement.  The effed of exertion in the la-
    bourer will be to carry him foo« up, by its ftimulant operation, to the
    degree of exclteiiwnt 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 effed of firft mounting up to 60. and by and by
    to 70, where  the excitement begins to ceafe.
     (z) Who would adminifter wine, ©piuin and the other high ftimuli,
    whether durable or diffufible, to cure  the inability to perform motion in
    either peripneumony or that rheumatifm which  is highly fthenic ?  Or
    rather, who would think of any other means of removing that fymptom,
    thm the  debilitating powers, fo sffedual in removing all the reft, ai>u
   not lefs ^o in removing t'.itra i 
 134       THE   ELEMENT9

dyfpepfia (a), in colic, in dyfentery (b), in cholera (c), in
hyfteria, in any violent attack either of vomiting or loofe-
nefs of belly, (great numbers of which affections happen
every day,  without being diftinguifhed by names); or in
the burning affection of the alimentary canal (d), which is
confidered by phyficians  as an inflammatory affection; or
in affections of the voluntary  motions externally, as in the
lock-jaw, in tetanus (e), and in many fpafins of other parts;
                                                           or

  (a) in Englifh indigeftion;     (b) in Englifh the bloody-flux.
  (c) or that difeafe  the urgent  fymptom of which is vomiting and
purging.
  (d) See above, CXCVIII. and the annexed notes.
  (e) Tetanus is a violent fpafmodic motion of the mufcles of the hcacf^
neck, and upper part of the thorax, whereby the head is kept immove-
able in the fame ppfition, in which it had been  found upon the coming
op of the fpafm  The teeth alfo., from the affedion occupying the muf-
cles of the under jaw, are kept immoveably locked, and hence the name
of Joek-jaw.   Befides the affedion of the mufcles ,that has been mention-
ed, there is fcarce one  mufcle in the whole  body, free from one degree
or other of the affedion.   Further, there is a moft painful feeling over
all, but efpecially in the parts moft affeded.  This difeafe fometimes
happens in cold countries,  fuch as this, in CQnfequence of a wound  ia
any fenfible part, or when fmajl bones, as the offa fpongipfa are biuifed,
cruihed and dafhed into the fofter parts.  The part of it called lock-
jaw is frequently a fymptom in fevers.  But the difeafe is more frequent
in warmer countries thap this, as in the fputh of Europe,  where the ex-
cefs of heat is liable to run, into indired debility.  It is moft frequent of
all in the Torrid Zone, where indired debility is ihe moft conftant at-?
tendant on heat. As a violent and permanent contradion of the mufclei
was the moft ftrikiug fymptom of it,  and fyftematic phyficians fuppofed
every fuch contradion the effed of an encreafe of excitement, or, to ufe
their own words,  an  increafed flux of the nervous fluid pr  nervous
 power into the parts affeded ; confequently their indication of cure was
 to relax the rigid  contraded parts.  Hence no, bounds were fet to their
 emolienf  relaxing  meafures.   Such were bleeding, 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
 ; f.-dativc, was tried.  The trial fucceeded,  B»t immenfe quantities of
                                                           that 
                OF   MEDICINE.         I $$

 or in convulfion, epilepfy (f), and many other convulfive
 affections; if thefe  functions feem very much encreafed;
 that  that is not owing to encreafe  of ftrength, that is,
 encreafe  of excitement, fhall alfo be proved to any unpre-
 judiced  judge  by   the following two-fold  fact;  that, if
 this were a cafe of really encreafed  ftrength, debilitating
 powers, or the  remedies of fthenic diathefis, would remove
 it, and ftimulants (g) not proceeding to their ultimate effect
 of  inducing  indirect debility, but remaining within that
 range, in which they remove afthenia (h) would increafe it.
 But to fuch a fact alfo is  the  truth in diametrical oppofi-
 tion (i).   For ftimulants alone, which removs the other
 figns  of acknowledged debility, alfo  remove thofe fpafms
 and convulfions ; and debilitating powers  encreafe them,
 or change the difeafe into a worfe (k).
                                                CCXXIX.

 that medicine were found neceffary to effect the complete cure. Lauda-
 num ufed to be thrown in without meafure, or any other rule,but to give
 it  on till the difeafe ceafed.
   (f) or the falling-ficknefs in Englifh,
   (g) keeping within their ftimulant range, and
   (h) or affedions of debility,
   (i) Who  does not now know, that bleeding, evacuations of other
 kinds are hurtful, and that ftimnlants proportioned to the degree of the
 caufe, are the only fuccefsful remedies ?
   (k) A certain  gentleman inhisdefk, fpeaking of the method of cur-
 ing epilepfj or the falling ficknefs, and recommending among other eva-
 cuant and other debilitating means, fmall but frequently repeated bleed-
 ings, unguardedly  contradids  himfelf in his very next fentence.——
 " However," fays he, " we regular praditioners are liable to be too cau •
 " tious and even timid fometimes.   For I have known  a bold praditi-
 " oner in the  country, who cured an epilepfy by very profufe bleeding.
 " In a few months after the patient died of an uniyerfal dropfy, feut the
 " epilepfy never returned."   I would afk this gentleman, what fort of a
cure that was, that converted a difeafe, which may come and go for ma-
ny  years, nay even for a long life time, into one that, in a very fliort
 time, proved fatal ?  What reafon would a podagric  havi to thank any
enc, wli© fhould convert the gout in him upon any violent attack, into
                                                           a 
 1^6        THE   ELEMENTS

   CCXXIX. Becaufe  we know not what contraction is,
or almoft any function of living fyftems (1);  we fhall not,
therefore,  wrangle about  whether it be  an increafed or
diminifhed funftion (m);  but we will by no means give up
the  point of thofe fpafmodic and convulfive motions being
an impaired function (n);  for,  if, within certain bounda^
                                                          ties,

a fatal dropfy  ?  That fort of treatment is not curing a difeafe but en-
creafing  it, and even that to  death.  The  convulfive fymptoms  of an
afthenia  may pafs away , but the afthenia remains.  You may ceafe to
call it epilepfy ; but dropfy ftill  fliews that the caufe of the difeafe re-
mains, nay is prodigioufly increafed.  This fatal miftake of an encreafe
of the difeafe upon the whole,  for the cure  of an inferior degTee of it,
proceeds |from an improper ufe of diredly debilitating  powers in place
of the proper ftimulant ones.  But there arc cafes, where the laft, by be-
ing carried too far, produce the fame fatal miftake.  Thus in peripneu-
mony, to get, rid of the hard pulfe, and the acute pungent pain (fee a-
bovc, CLXXIV, and the notes), the  bleedings are carried fo far as to
produce a fatal hydrothorax,  or  dropfy of the cheft.
   (1) This is,  perhaps, the firft philofophical performance in which care
has been taken to keep clear of abftrad caufes. The profecution of them
has contaminated  almoft every department  of knowledge that had been
.treated fcientifically.  See  the introdudion to my Obfervations on the
feveral erroneous Syftems of Phyfic, &c. where it will appear, that even
 the  great Sir Ifaac Newton did not altogether avoid this error, efpecially
 in the queftions he put, however modeftly, with refped to an all-per-
 vading rether ; the wanton and aerial  theoretical fabrics that have been
 raifed upon which, have, in fpite of Lord Bacon's better diredions, dif-
  graced the philofophy of the middle of the eighteenth century.  Com-
 pare what yen will find in the book with the III. Chap, paragraph
 XVIII. in this.
   (m)  Sec above, Chap. V. throughout.
   (n) I knew not what the abftrad  ftate of mufcular fibres is, either
 when theycontrad and relax with rapid, violent, and morbid force,  or
 -when they remain immoveably fixed in one forcible permanent contrac-
 tion: But 1 know, that nothing but debilitating powers produce them
 and nothing but invigorating ones remove them, which is enough for
  me, who mean to prove myfelf a fure  and cautious obferver of the ph*
 *;WW of nature;  and in my  pradice as a phyfician, to avoid, after
                                                            the 
              OF   MEDICINE.           I37

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

the example of many others, groping in the dark under the guidance  of
abftrad reafoning, but to view every fubjed of obfervation, by nature's
cleared light,
   (o) See above, par. XXIV.
   (p)  In  the fpafmodic and convulfive ftate of the fundion of motion,
 when compared with the vigour of the fame fundion 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 contradion,
 but, with a certain degree of that, in the well proportioned alternation
 between contradion and relaxation ; of which  we haye proof indifputa-
 ble in this mode of motion being beft performed in that middle ftate of
 vigour, that intervenes betwixt the extreme of the healthy, or moderate-
 ly encreafed  vigour, and the other extreme of dired and indired debi-
 lity.  The encreafe of vigour and excitement keep pace to a certain ex-
 tent, even through  fome degrees cf morbid excefi. of the latter: but a
 period, and that fhort of indired  debility, arrives, as in peripneumony,
 where the excitement is increafed beyond the healthy ftate,  and muft he
 reduced in order to reftore the due healthy vigour.   There are other ca-
 fes, as  that of mania, or fthenic infanity, where the conjoined encreafe of
 vigour and excitement will ftill go further.  But in every cafe the  en-
 xreale  of vigour, ftill judging of  it from its effeds in .the healthy ftate,
 leafes before that of excitement; and,  perhaps, wc may make a fteo to-
  wards finding the boundary, by obferving, that the greater the fum totid
 of excefs of exciting power i«, the fooner does the point arrive, beyond
 which the vigour docs not proceed.  In peripneumony it ccafes at a  cer-
                                                            tain 
  l$8       THE   ELEMENTS

    CCXXX. The notion, therefore, hitherto received with
 refpect to thefe motions  is falfe.  It proceeds upon  a fup-
 pofition  (q), as if the motions proceeded  from  an ex-
 ceffive influx  of  the nervous fluid, according to a  mode
 of ftyle which they firft held (r),  or of the  nervous pow-
                                                              er

 tain period of the difeafe, where the falutary effed of bleeding and other
 debilitating means fhows that the encreafe of excitement is ftill going on.
 But here the fum total of excitement, confidering the ftate of all the other
 fundions, is greater than in mania, where the fundion chiefly encreafed
 in vigour is only that of voluntary motion, while all the fundians of in-
 voluntary motion are very little affeded.  From this inveftigation we
 can-clearly  difcern, that every  increafe  of excitement leads to a morbid
 encreafe of vigour, and that there is, fomfiwhere or other,  a point in the
 fcala of encreafing excitement,ami below the point of indired debility,
 where the vigour is no further encreafed ; and this inference  arifes with
 refped to the pradice, that we fhould be very obfervant  of both fads,
 as pointing out a very material diftindion in the indications of cure; that
 in. indired debility being to ftimulate, while that at the ceffation of vigour
 is to continue to debilitate till the fum total of exceffive vigour be redu-
 ced  to the  proper and healthy.  The  inability to the performance of
 motion in peripneumony is an inftance of the latter ; that of the  conver-
 fion of the fame difeafe from excefs of debilitating cure is an inftance of
 the former.
   (q) Indeed they have talked fo confidently of it, that they may more
 jnftly be arraigned of going upon a petitio principii, or that error in lo-
 gic where a point, chiefly required to  be proved, is taken for granted,
 and made a ground work of other reafoning.
  (r) From  a microfcopical observation  of Leuenhoeck, where he once
 thought he faw a hollow cavity in the nerves (but could never  fee it a-
 gain, nor any body after him, though that inftrument has been infinite-
 ly  improved fince his time), the celebrated Dr Boerhave took his noted
iirtertexttire of veffels, making the whole mafs of living bodies confift of
 fuch.  The fundions  were,  at that time, fuppofed to depend upon an
itie'aftic fluid fecreted in the brain, anddillributed in the cavities of the
 nerves, to every part  of the fyftem.  Much  reafoning has  been em-
ployed in refutation of that beautiful, though fanciful, fyftem.   But the
only reafon, that fhonld have been employed againft it,  was to deny the
truth of the hypothefis  upon which it was built; and that negative argu-
 ment might have been fupported by this pofitive one, that it is now
                                                          known,, 
OF    MEDICINE.          139
er (f), which is now the common language, that is,if it has
 any, meaning, from an exceffive excitement in the fibres that
 havebeenmentioned(t); and, as according to the phrafeology
 of the logicians,"  error draws on error;" fo this notion of
 the  abftract caufe led to another (u) with refpect to the ope-
 ration of opium.    And as they fenfelefly enough fuppofed
 exceffive motions to be occafioned by an excefs in the prin-
 ciple of life,  at leaft  in the labouring parts, fo they either
 thought, or taught, that opium poffeffed  the virtue of check-
 ing or allaying, as  a fedative,  thofe motions, and  that  con-
 trary to the whole analogy of nature, and the certain proof
                                                     afforded

 known, that  the nerves  are folid fubftances,  and not hollow  tubes.
 The next theory that was taken up was, that though the nerves were fo-
 lid fubftances; yet th:y were porous, and, therefore, fitted to receive
 into their pores an elaftic fluid, like the  eledrical, the magnetical, and,
 like, or rather a modification of, the fuppofed ather of  Newton  ; that
 this  inelaftic fluid alfo floated upon the furface of th« nerves, and formed
 an atmofphere around them, and by it all the fundions of living fyftems
 even thofe of the moft perfed, the human,  were explained.  For a full
 account of it fee the Preface to the Obfervations on the Principles of tho
 old  Syftems of phyfic,from page 19 to page 58.  Among other applica.
 tions of the aether, upder the denomination now of nervous power, one
 was to make its influx into the mufcular fibres affeded with fpafm, or
 convulfion, the caufe of thefe morbid motions; as its influx, as an inelaf-
 tic fluid,  into the hollow cavities cf the nerves had been before fuppofed
 to afford the fame explanation.
   (f) That was their word, after an ingenious philofopher in Edinburgh,
 whofe differtation upon this fubjed is given at full length in the place of
 the  Obfervation referred to, had ridiculed  them out of their jether.
   (t) It is here to be obferved, that  the change of the theory here has
 led  into a vaguenefs of terms.  It might have been proper, had the notion
 of either an inelaftic, or  elaftic, fluid been retained,  to have called the
 fuppofed caufe of the fundion a fluid, apd to have talked of its influx a?
 fuch ;  but now that we  know  nothing about  it, or whether it has any
 tKiftenceatall.to call it  a power, and yet to talk of its influx or efflux,
 its flowing in or out,  is furely vague and incoherent
   (u) that, is, they fuppofed the moft powerful  ftimulus, opium a f-da,
 |i>c. 
 140         OF  MEDICINE.

afforded by all the exciting powers, every one of which has
been proved to be ftimulant, not one fedative (x) but if it
were  in any refpect doubtful, that nothing in nature,  at
leaft in thofe powers, that are commonly,applied to animal
bodies is fedative, how can there  be any  uncertainty of
that point as to opium,  much lefs,  that the contrary con-
clufion fhould be held for the truth? Has not it the fame
effect upon the Turks,  that wine has upon us ? Or,  are
we to  fuppofe, that  the troops of that people, on  their
march to the onfet of  battle, chew opium, with the in-
tention of checking their natural alacrity and propenfity to
action, and of blunting and depreffing their  high fpirits
and courage ?  If fevers, if the gout, if indigeftion, if the
colic, if afthma, and the whole train of fpafmodic and con-
vulfive difeafes, in fine all  afthenic difeafes, have lately,
to the conviction of every perfon who gave the fubject a due
confideration, and, contrary to the expectation and opinion
of all men hitherto, been proved to yield to the  various
forms of opium without difficulty ; and if all thefe difeafes,
in which it is ferviceable, have been demonftrated to be af-
fections depending on debility, are we to agree, that opium
 proves of fervice, by an operation that is further debili-
tating, or rather that extinguifhes the miferable remains of
nature's motions ? If the various forms of wine, and other
ftrong drinks,have a very great effect in removing the fame
difeafes, which has likewife been difcovered by late expe-
riments, and are, therefore, underftood to be beneficial by
the fame mode of operation as opium, are we to agree, that
that fimilitude of operation argues a diverfity, nay a di-
ametrical oppofition in the nature of the powers that unite,
with fuch harmony, in  producing the fame effect ? Laftly,
if it cures difeafes, that depend upon a confeffed deficiency
                                                    of
  {\) See abo7e. par. XIX. to XXII. with the additions and note** 
OF    MEDICINE.
I4I
of motion (w), equally as thofe, the motions in  which,
though feemingly increafed, are in reality  diminifhed |
what can any perfon fay in objection to fo ftrong an argu--
mcnt, added to fo many and fo powerful ones already ad-
vanced ?  In faith opium is not  a fedative ; on the con-
trary, as it is the moft powerful of all the agents that fup-
port life,  and that  reftore health, and a truly bleffed re-
medy, to the divine virtue of which the lives of fo many
mortals has been owing,  and, in future,  will be owing;
fo it muft be acknowledged, that fpafms and convulfions,
over which it has fo great power, do not confift in increaf-
ed, but diminifhed excitement, and that opium cures them
by the fame operation by which it cures any of the  difeafes
depending upon debility.
   CCXXXI. Sometimes in difeafes there is a preternatu-
ral flow of blood.   Thus in fthenic difeafes blood drops
from  the nofe: it  is  fparingly  expectorated from the
lungs, and  tinges the urine.  The  firft and laft  of thefe
three are confidered as critical figns ;  but  they have no
other meaning than  an  abatement of fthenic  diathefis,
and  a difpofition  to indirect debility.   This is  an ef-
 fect, that, for the moft part foon goes off, leaving behind
 it a ftate of convalefcence(z), and  foon after a reftoration
 of health, feldom paffing into an eftablifhment of indirect
 debility.
                                             CCXXXII.
  (w) In one fit of the gout, when its paroxyfms were allowed to return,
in confequence of a difrclifh that I had taken for a certain ftimulus of
the drink kind, and, therefore,  all at once abftaining from ftimulus, I
fell into a ftate of perfed inadion, and, though without feeling ef pain
or uneafinefs, fo devoid of mufcular force, or capability of  producing
any motion or exertion, that even the flight degree of mufcular contrac-
tion neceffary to fupport my pofture in  bed failed.  In that ftate, when
my eyes were glazed,  the whole dangerous paroxyfm was removed by
changing my drink into a more agreeable one ; any ftrong drink would
have anfwered, and opium beft of all.
,  (z)  or of recovery. 
   14-       THE    ELEMENTS

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

   (b) Thefe are the feveral hamorrhages  of fyftematic and nofological
 authors  They  have hitherto been fuppofed to depend  upon fthenic,
 what they call phlogiftic diathefis, and the particular difcharge to be fup-
 j«jrted by an  adivity, an effort, what they call a molimen  hsemorrhagt-
 enm, in the veffels pouring out the blood and the parts of the veffels im-
 mediately behind.  Their continuance was accounted for upon the fup-
 pofition of there being an over proportion of blood in the fyftem, or what
 is commonly  called a plethora; but they are all afthenic  difeafes, de-
pending upon relaxation and atony both of  all  the reft of  the vaf-
 cular  fyftem, and  particularly of the bleeding veffels.   (Sec above
 CXXX1V. X-) ;inJ> inftead of a plethora, there is a penury of blood ;
ail which is proved by the phenomena during the  predifpofition, when
little food is taken in, and lefs, upon account of the weaknefs of the di-
geftive organs, is digefted; thefe circumftances are increafed after the
arrival of the  difeafe.  The pulfe withal is weak,  fmall and frequent  ;
mid the patient puny and emaciated. ' The difeafe is encreafed by bleed-
ing and other evacuations,  and both relieved and removed  by wine, fpi-
rits and diffuble ftimuli; a method of cure which, till within thefe fif«
teen years, would have ftartlcd all the phyficians upon earth.
  ^c) of Ions duration, 
OF    MEDICINE.
143
 upon debility, is proved by the failure of the cure juft now
 mentioned, and by the great fuccefs of the ftimulant plan.
 The true  caufe of  bleeding difcharge is not plethora,
 which cannot happen in the cafe of perfons ill nourifhed,
 in water drinking, and under the application of other hurt-
 ful powers, that equally deftroy the tone and denfity of the
 veffels (d). For as food is nearly the  only material, from
 which blood is formed; how, when it is  withheld in the
 abfence of the caufe,  can the effect remain ? and, if, upon
 account of the debilitating effect of other hurtful powers,
 any food that is taken is not digested,  how can there be an
 over-proportion, and not a manifeft fcantinefs of blood ?
 But it  may be  alleged, that lofs of blood, and  every  fort of
 debilitating power, diminifh perfpiration, and that from that
 circumftance the quantity  of blood is increafed.  How can
 that happen? The  matter, from which the blood is  made,
 it may  be added, is taken  into the ftomach, and a fmalfer
 quantity of fluid palTes off by perfpiration.  But, to  that it
 is to be anfwered, that in the firft place it is not taken in;
 and next the little  that is,  is not digefted  (e);  then after
 the ferous  part lias  been  feparated from the red, will it,
                                                        if
  (d) See above, CXXIV. and >
  (e)  N<* idea in medical writings feems ever  to have been formed of
 the body as a whole. Ou the contrary, nothing has been more common,
 than to talk of the fundions as operating in a great meafure, each from
 a caufe cxifting within  itfelf, or  but flightly and arbitrarily conneded
 With fome other.  This falfe notioH was carried to its moft ridiculous
 pitch in  the dodrine of fympathy, and not rendered much more decent,
 after the word confentof parts came to befubftituted in its place. Thus,
 the common expreffions were the fympathy and confcnt  of the ftomach
 with the head, of the ftomach with the face, of the ftomach  with the
 external  furface, of the latter with the internal, and particularly with
 the inteftines, of the excretions  with each  other, of the  feet with the
 kidneys, and fo forth.   It was never dreamed,  that there was one over-
 ruling principle throughout upon which all  the fundions depended*
 The ftomach, for inftance, cannot be ftrong while the  perfpiratory or-
 gans are  weak, and therefore take in and digeft too much while they c*:\-
fiot throw out their fluid.
                              2 
  144       T  ft E    ELEMENTS

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

   (f) It  has been proved in the IVth chapter, Part I. that fhe excita*
 bility is one uniform, undivided property over all, and that,  in whate-
 wrpartof its feat it is aded upon, that adion extends inftantaueoufly
 over all ; that  though fome parts, differently upon different occafions,
 may be more acted upon  than  any other, equal in fizc and nervous im-
 portance, that that is only in fo infignificant  a proportion as to have
no effed in conftituting  an inequality of adion irt the fyftem.  Again
 the force of the powers that ad is a given force, being either weak, in
 due proportion, or exceffive, or weak again from ultimate excefs.  Their
 tffed then upon the fyftem, which receives their  adion in cveiy degree in
which it is communicated, aud that with the utmoft exadnefs, muft al-
 ways be the fame, that is, either dired debility, health, fthenic diathefis,
 or indired debility. To apply this to  the prefent cafe, the ftomach can-
not be healthy,  or under  a predifpofition to fthenic ftate, and thereby
take in and digeft, with the help of the other digeftive organs, too much
of the matter, from which blood  is made ; while the perfpiratory vtf-
fcta are too weak to perform their fundion of throwing off their excre-
mentitious matter.   On the contrary, the ftate of the ftomach muft run
through the whole living  fyftem.  If it can perform its fundions pro-
perly, or in whatever degree it performs it, all the other organs of di-
geftion, the upper part of  the inteftines, biliary veffels, the ladeals, the
veins betwixt their common trunk and the heart,  the heart through a'l
its cavities, the whole arterial fyftem, and the colourlcfs terminations of
that fyftem, whether cxhalant or glandular, aud the excretory orifices of
                                                        thefe, 
              OF    MEDICINE.         I45

and cattle by keeping them from exercife and in a ftate of
reft.  The condition of health and difeafe is very different.
In the former there is a certain latitude of the ftrength of
the ftomach ; in the  latter, and efpecially when debility is
the caufe, there is a proftration of ftrength.   In fine, it is
an univerfal and conftant effect of all debility, to produce
a deficiency of the fluids in the internal  parts of the fyftem
with  a relaxation of the veffels over all, efpecially about
their  excretory  terminations, and a difcharge of the fluids
by  fome out-lets.   The death, that happens, during the
time of an entertainment, is not to be imputed to an over
proportion of blood, which  cannot happen in fo fhort  a
fpace of time.   The drink has no effect in filling the veffels.
Nor do  any perfons,  but  thofe who are under  direct or
indirect debility, meet with fuch  an end, never  thofe
who have an over-proportion of blood;  which as the ap-
petite is gone, and the digeftive powers deftroyed, cannot
be  produced.   In what difeafes was it that plethora was
fuppofed to take place ?  Not in thofe,  in which the  digef-
tive organs, and thofe that  produce blood, in fine, in which
the whole fyftem, are in a  ftate of vigour, where the  appe-
 tite is very keen, and the digeftion moft  perfectly perfor-
med, and the digefted matter moft completely converted in-
                              L                        to

thefe, the inhalents, and all the  venous blood returned by the arteries;
laflly, all the excrctories upon the external and internal furface, all thefe
will perform their fundions in the fame degree as the ftomach whether
properly or  imperfcdly.  To promote the  moft perfed health all the
exciting; powers muft be applied, each in its due proportion-  And the
want of aiiy one or more may make fome odds,  which is infignificant to
this point.  If a perfon has not had his ufual exercife a chearful glafs will
prepare him for fleep.   For want of the fame exercife the appetite will
be  impaired, but fo is the fundion of perfpiration.  Too much  exercife
under heat will  impair the appetite,  but it alfojrapairs the perfpiration
after a perfon gets into a ftate of reft. In  fhort, any flight inequality
from want of any  one or more ftimuli can  be made  up by others.   Sec
 above, par. XLL          « 
I46       THE   ELEMENTS

to blood ; but in thofe, in which upon account of the de*
bility propagated over the whole body, all the functions
are in a ftate of languor,  and in which the only matter,
fuited to make blood,  is either not applied, or not affimi-
lated.  In this way,  the gout, apoplexy, epilepfy, palfy,
afthma and hyfteria, the indigeftions of perfons, who have
been formerly addicted to luxury, in fine, thofe very difea-
fes, which make our prefent fubject, the hemorrhages, as
they are called and falfely  defined by that term, laftly; the
far greateft part of afthenic difeafes, have been thought, at
all times and by all phyficians to depend either upon plethora
with vigour,or plethora with mobility. But in fact and truth,
that both all the reft of thofe difeafes, and thofe accompani-
ed with bleeding difcharge, depend upon a penury of blood
and other debilitating powers is proved,  by the conftant
failure of the antifthenic plan  of cure to the great difgracc
of the profeffion, and by the incredible fuccefs of the new
ftimulant plan.   And with refpect? to the bleeding difchar-
ges, confider  the perfons  affected with them in the hurt-
ful powers, that precede them, and in the fymptoms that
attend them.   During the whole period of predifpofition,
quite  delicate and weakly, they have very little appetite for
food, and take .very little,  and what they take,  is not di-
gefted, and often rejected by vomitting.   In their weak
ftate they are not fupported by the ftimulapt operation of
corporeal,  or mental exercife,  nor by that of the animal
fpirits, which are quite puny and dejected, nor by that of
pure air, which they are not able to go out to take, nor by
that of agreeable fenfation,nor by that of ftrong drink,which
from the miflea.ding advice of their phyficians, they look
upon as poifon, nor by that of the diftention of the veffels,
which are not fufficiently filled with blood, nor by that of
the fecretory fmall veffels, upon account of their fluggifh
motion, and the ftagnation of their degenerated fluids every
where, and the direct debility conftantly arif;ng from that.
                                                What 
            OF    MEDICINE.          147

 What fort of pulfe have they ? Such, as it is in all difeafes of
 manifeft debility, for inftance, fevers, (in which laft, which
 is furprifing their favourite plethora, was feldom fufpected
 by them),  fmall, weak and very quick and almoft empty.
 Upon the whole, what like are their intellectual functions,
 thofe of paffion and emotion, and their corporeal functi-
 ons,  either in fenfe, or motion whether of the voluntary
 or involuntary kind? All weak, all frail, all fuch, as  fhow
 that they have not a third part  of life to fupport them.
 What, on the contrary, is the ftate of thofe, who abound
 in blood, and yet  never experience difcharges of it ? They
 are ftrong and full of vigour in all their functions, with
 rednefs of countenance, fparkling eyes,  ftrong, hard and
 moderately frequent pulfe. Their appetite for food is keen,
 the quantity they take is great and well digefted.  As thofe
 perfons, may  experience droppings of  blood of no con-
 fequence,  and yet  not often, fo  they  fall into no dif-
 charges of  blood.   And it is  in   perfect  confiftency
 with all that  has  been   faid, to  add,  that the various
 forms of ftrong drink, and thefe particularly,  which are
 the  ftrongeft, fuch as are called fpirits,  are  furprifingly
 fuccefsful  remedies of bleeding difcharges,  in fpite  of
 every  thing that has  hitherto been  thought to the con-
 trary,  in fpite of rooted  prjudices:  But the  preparati-
 ons of  opium (h) and of the other  diffufible ftimuli are
                           L 2                     ftill
  (h) Opium, though muchufed in the cure of certain fymptoms of dif-
eafes was never underftood by thofe phyficians, who, in books and lec-
tures affumed to themfelves the province of direding the profeffion of
phyfic.  Every property they afligned to it  was the reverfe of the truth.
Inftead of allowing it to  be the ftrongeft ftimulant in nature, they mi.de
it a fedative ; and, though they found great difficulty in finding a fingle
fedative more, to help to make out their catalogue of a clafs of fuch bo-
dies in nature, they were confident that it was one (fee above. CCXXX.
and the notes).  Another property they afcribed to it was that of bring-
ing on fleep; whereas, it is the moft powerful body of all others in pro-
(ducing and keeping up the watching  ftate (fee abovc,XXX. XXXI.
                                                     note 
 I4*>       THE    ELEMENTS

 ftill more fuccefsful.   This is a fact, that proves to a de-
 monftration, that in the bleeding difcharges there  is no
 exceffive activity, no hemorrhagic effort as it is called, and
 on the contrary,that there is only a falling off of the natu-
 ral moving energy.   The hemorrhages,  then, that have
 been the fubject of fo much falfe explanation, and falfe de-
 nomination, muft  be rejected from  the number of fthenic
 difeafes,  and  transferred to  the afthenic difeafes,  under
 the title of Haemorrhaeae.
   CCXXXIII.   If any perfon be feized with a cough at
 firft rather  dry  and bound, then more moift and free, and
                                                         after

 note (b).   They alfo afligned it the virtue of allaying pain,  but there ii
a kind of pain, that it encreafes, and befideathat, aggravates every other
fymptom of the dTeafe.  They never could deny, that opium, was ex-
 ceedingly improper in inflammatory difeafes, that is, the feveral fthenic
difeafes with affedion of a part whether inflammatory or cattarhal.  And
wherever they found it of fervice in pain, they might have perceived,
 that fuch pain was different from what they  called inflammatory, or our
 general fthenic pain.   The truth is; it is not a palliater of pain, but a
remover of its caufe, as often  as that depends upon debility, while it as
 certainly aggravates  every other.   The pains, that opium is calculated
 to remove, are all thefe, that depend upon general afthenic affedion, as
 thofe  of the gout, of chronic rheumatifm,  that of the gangrenous, as
 well as the putrid, fore throat, all fpafmodic  and convulfive pains, all
 pains from pure debility,  as in the legs, ankles and foles, or in any part
 «f the fkin, nineteen head-achs out of twenty,  which arc  in that pro-
 portion afthenic ; the pain of any deep-fcatcd fore or gun-fhot wound af-
 ter every degree of fthenic diathefis is removed from the habit;  It is an
 equal remedy aga>nft the afthenic inflammation whether local or gene-
 ral, as preventing their tendency to mortification and fphacelus.  Nay,
 when thefe latter ftates have come on, it is a  moft powerful means of re-
 moving them, and  of corredingthe degeneracy; for the  effeding of
 which the bark had fo eften failed.  All this is the difcovery of the au-
 thor of the Elementa, though the credit of the laft and fmalleft part of it,
 from their ignorance of the high merit of the whole, they have fhewn
 difpofition to give another, a gentleman and eminent author in London.
 iUit a trcatife on the gout, with a full, account of all the virtues opium
will foon be prcfented to the public, in which all this  will be cleared up.
 gjeffed as opium in all thefe cafes is, it is squally bad in all fthenic ones. 
             OF   MEDICINE.         iq.$

 after that accompanied with  a large expectoration, if the
 hoarfenefs  at  firft is  deep,  and  afterwards flighter and
 freer, in proportion as the cough becomes more and more
 moift; if the cheft all round, over the whole region of the
 lungs, is diftreffed with a degree of diffufive pain; if there
 is either no vomiting, or  what of it there is, feems forced
 up by the convulfive motion of the cough ending in expec-
 toration, and in fuch a manner, as either not to  return, or
 to  have  no fpontaneous tendency to a  return; if  the
 ftrength is  otherwife good, and the pulfe  ftrong, full, and
 more or lefs hard,  and not much exceeding the frequency
 of a healthy pulfe: Such a cafe will be found to be fthenic,
 and to depend upon heat and every other ftimulus (i), to
 be cured by cold and every other debilitating remedy (k).
 The caufe of thefe fymptoms is a high degree of fthenic
 diathefis (1) over the whole body, higher  on the external
 furface of the body,  and  efpecially in  the throat,  which
 is a part of that furface (m).  The fame fymptoms in what-
 ever morbid cafe they occur, are to  be explained in the
 fame manner.   Confequently,  the catarrhal fymptoms,
 which are an infeparable part from the meafles, admit pre-
 cifely of the fame conclufion; and, as well as the whole
 difeafe, are to be underftood to arife from exceffive excite-
 ment, and  to be cured by the debilitating plan.   The fame
 is the  judgment to be formed  of the influenza.   In all
 which cafes it  is eafy to make trial of the truth*  Give a
                                                  glafs
  (i) See  above  the following paragraphs  CXIU. CXIV.  CXXII.
 GXXIV.
  (k) and alfo CXVII. CXXVIII. CXXXIV. and all the debilitating
 powers throughout the whole chapter ; while all the ftimulant ones in
 it will be found to be fuch as contribute according to their degree of fti-
 mulus towards the prodtidiofi of the morbid effed, which makes  our
 prefent fubjed.
  (1) or ftimulant operation or exceffive excitement, or wafted excita-
bility.
  (m) See above, par. CXHT. 
 I50       THE   ELEMENTS

glafs of wine or brandy, give a little opium; the hoarfe-
nefs will encreafe, the cough will be more hard and bound,
the  expectoratidn will  fuffer a  temporary fuppreflion.
Give a large draught of cold water, and all the fymptoms
will be relieved. Often does it happen that a perfon trou-
bled with a cough when he  fits  down to  drink wine, is
freed from it in the courfe of the circulation of the glafs (n).
The reafon of which is,  that  afthenic diathefis was the
caufe, which was converted by the drink  into a ceffation
of all diathefis, or into a temporary fthenic diathefis. Of-
ten at the end of a debauch in  drinking, the cough, and
that very violent, returns for this  reafon,  that the fthenic
diathefis has made confiderable advances.   It will  be cur-
ed by drinking a tumbler or two of cold water, and drink-
ing  no more wine ;  which precautions operate by flop-
ping the excefs of excitement.
   CCXXXIV.  From the defcription  juft now given (o)
it appears, that fymptoms, commonly  fuppofed to be the
fame, are however of a diametrically oppofite 'nature (p);
                                                   which
  (n) WTienever his cough is cured he fhould flop ;  as the carrying
the ftimulus too far will  endanger the return of the cough  from a
very oppofite caufe. The cough at firft, fuppofe, to be from  an excite-
ment as a6 ; its cure to be brought about by an excitement at or above
40 ; its return to an excitement at or above 60, will bring on a fthenic
cough.
  (0) of the nature and cur« of the fymptoms we have been fpeaking of,
 ompared with that which is next to be given.
  (p) This miftake of fymptoms in confequence of judging of their inte-
rior nature from the fimilarity or difiimilarity of their appearance is the
falfe idea, upon which the whole fabric of a department, lately introdu-
ced into the art of medicine, has been reared.   It is to be obferved, that
fymptoms the moft fimilar to each other in their appearance are, in rea-
lity, the moft different,  and thofe, that have the  leaft refemblance in
their  appearance,  have the neareft affinity in their interior nature, and
indeed are one and the fame, with no other difference, but a difference
of (kjjree, and even that often  very flight, fometimes next to none at all.
                                                      Tfce 
                OF   MEDICINE.            151

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

 The great variety of fymptoms that diftinguifh the whole form of afthe-
 nic difeafes affords as many proofs of the truth of this propofition, as th£
 inftances of diffimilarity or difference in opinion are numerous.  What
 is fecmingly more oppofite than diarrhoea and colic, than typhomania
 and coma, than epilepfy and general dropfy, than the cold and hot fit of
 agues, than fpafmodic and convulfive affedions compared  with thofe in
 which there is no fault in the motions either as to excefs or regularity,
 than the feveral degrees of morbid diminution of menftruation down to
 the adual fuppraffion, and the feveral degrees of the morbid encreafe of
 that natural difcharge till their  flow, at laft, attains its ultimate excefs
 both in degree and dm ation ? And,  with refped to febrile and toon-fe-
 brile difeafes, what is more fimilar than a flight fynocha or inflammatory
 fever and a typhus in the fame degree, which, yet, are diametrically op-
 pofite both in their caufe and cure? What is more diffimilar than the va-
 rious phenomena of fevers of the intermittent kind  through all their
 degrees of  intermitting and remitting and thofe of the mora continued
 kind ?  And yet they all arife from caufes highly debilitating, and are
 effedually  removed  by remedies equal in their degree  of  ftimulus.  In
 one word,  to fliow  the infignificancy of the diftindion of difeafes into
 febrile and non-febrile, and, when the  degree of debility couftituting
 the caufe in both, is  confidered and compared;  is there any reafon for
 fcparating the high dropfy, the high dyfentery, and finking cholera from
 their place  betwixt intermittent and remittent fevers and the moft con-
 tinued kind ? Laftly  what'two things can be likcr  one another, than a
 crowded diftind and confluent fmall-pox,  or than  the common inflam-
 matory fore throat and that which was lately defcribed (fee above, par.
 CCXII.)   Such have been  the  ideas, that have guided the diredors of
 the art of medicine in their inquiries into the natures,  caufes and cures
 ef difeafes.   If botanifts and natural hiftorians, by all their artificial me-
 thods of arrangement, have made little progrefs  in exploring the true
 nature of their fubjed, and on the contrary,  with fcarce a finglc excep-
 tion, have confounded it; if it was ridiculous to unite into one genus a
 man, a  monkey, aud a bat, how much more abfurd was the attempt to
 arrange the mere qualities of matter in the fame way.  Yet  upon this
hopeful employment  has John Bull expended vaft funis of money, while
 he left the  moft folid and important departments of fcience negleded 
 1^2      THE   ELEMENTS

through the whole courfe of the difeafe, without the hoarfe-
nefs ; if he is of a very advanced  age,  or  arrived at the
laft ftage of life ; it  he is of a wejak habit;  if his pulfe is
neither ftrong, nor full, and withal very quick;  if this con-
courfe of fymptoms  has been preceded  by  either direct
or indirect debility, as ufually happens in the cafe of famine,
of water  drinking, of a long courfe of ebriety, and of
having led a life of  luxury :  one may be certain, that all
thefe fymptoms are afthenic (q), and to  be removed by
ftimulant  remedies.
   CCXXXV. The explanation of the dry cough is eafy,
and fuch as was formerly given (r). The origin of the cough
and expectoration is quite the rcVerfe (s).   For, whether
the fyftem has been weakened  directly or indirectly, as-
the  excitement over the whole  body is  diminifhed in the
higheft  degree,  as the debility in  every part is exquifite;
the confequence is, that in the vafcular fyftem the tone, and
in proportion the denfity, is every where diminifhed; and
the diminution chiefly takes place in the extreme termina-
tions of the arteries, that are moft remote from the center
of activity, and  above all other parts of the vafcular fyf-
tem-, in the perfpiratory veffels (t). When all this has taken
place;  the quantity of fluid that is thrown up by expec-
toration is incredible.   Indeed (u) it is  great enough, not
to be inferior in its degree to the greateft  profufion that
ever takes place in confumption, and even to exceed it.
                                           CCXXXVL
and covered by the dirt among his feet.  We have too little ufeful fci-
ence yet, it is time to improve our fcanty ftore (fee the Introdudion to
Obfervations, &c.)
   (q) or depend upon debility.        (r) Sec above, par. CLX.
   (s)  CXXVIII, in the  M. S.  addition CLXI.  and particularly
 LXXXIV.
   (t) LIX. LX. LXI.
   {u) though it h?.*. never been attended to, 
              OF   MEDICINE.           153

   CCXXXVI.  The cure of it, however, in all the  cafes
that depend upon direct debility, is by no means difficult (x).
unlefs the difeafe has proceeded beyond  the boundary of
admitting a cure, and life is now approaching to its  end.
The cure, however, is a good deal more difficult in the
cafe of indirect debility, and for this good reafon,  that
there is no other plan of cure, but ftimulating, to remove a
difeafe occafioned by an excefs of ftimulant operation (y).
Nay, the fame debility,  as fhall afterwards be obferved,
produces the fame relaxation both of the bronchia and of
the reft of the body, but it does not always produce con-
fumption.  With this profufion of  expectoration appear-
ing fometimes in the form of fever (z),  fometimes in that
of the gout, the phyfician has often a long ftruggle, while
he employs his diffufible ftimulants, the event of which is
                                                      fuch,

   (x)  Ihave experienced fuch a cafe more than once, and have feen and
treated it iri great numbers.  It is fometimes a part of the concourfe of
fymptoms, that form that afthenic cafe of  difeafe, which is cdmmonly
called  fever, A gentleman, under or about the thirtieth year of  his age,
had been  ten days in a typhus fever, occafiwncd  by extreme cold, fuc-
cceding to the debilitating effeds left upon his habit by too <:reat mode-
ration in his diet, and, certainly, not a good choice of the different arti-
cles of it.   To aid the debilitating effeds arifing from thefe, he had ex-
perienced all the extremes of the heat and fatigue,that fall to a foldier's
lot, in very warm countries.  He was, ov«r and above,  of a fmall fize,
flender and emaciated.  He had alfo, from his infancy, been affeded
with a fhort cough,"fometimcs dry, and fometimes with  a little expedo-
ration. During the courfe  of his cure, he had  been more than once
bleeded, though his difeafe had ufhered itfelf in by a great profufion of
bleeding, which fuJdenly took him as he was on a journey in a cold day
of about 44 miles in a carriage.  He was vomited, purged, bliftered pro-
digloufly, and glyftered.   The whole force of the old plan of cure was
exhaufted upon him, and he fo exhaufted by it, as to be given up for an
incurable of two difeafes, 3 bad fever, and rotten lungs.  His face was-
hippocratic, he had the dead rattle,  and his cough  and expedoration
were affiduous.   liy the ftiniulant new plan of cure he was pnt out of
danger in ten days, and fet upon his feet in as rnsny more.
      (y)  See above, Cill.       (z) See the laft note (*). 
  IJ4        THE   ELEMENTS

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

   fa)  A defcription of this difeafe, in which the lungs are fuppofed to
 be affeded with ulcers or tubercles, has been given in the note under
 tF.is paragraph at (x),  But, as the fubjed is both as new and intereft-
 ing as any in this Work, it may be proper to give a further illuftration
 ef it by the expofition of another fet of fads.  Both in perfons liable to
 the gout, and other  afthenic difeafesj fometimes of dired and at other
 time» of indired debility,  aud efpecially in  thofe who have been much
 expofed to cold, without the debilitating effed of the cold being over-
 come (vide par.  C'XXII}, by  an alternation  withj or fucceffion  of,
 heat, and in very many old people, efpecially among the  poorer fort,
 who have been, and naturally are, much expofed to various debilitating
 powers, there is often, efpecially in winter, a very great cough and ex-
 pedoration. This fometimes goes to fuch a height as to give fufpicion
 of the affedion of the lungs juft now fpoken of.   But the completeness
 •f its cure, which.when  it arifes from indired debility,  is effeded by
 the ufe of animal food,  avoiding vegetable, and fifh, and by good wine
 and diluted fpirits in moderate proportion at a time,, but frequently re-
 peated, avoiding claret and ether French wines, and all four  and all
 heer-drink, unlefs perhaps a little warm porter in cold weather, and a
 very moderate ufe of diffufible ftimuli, keeping the feet and the  body
 in general moderately warm; fhows fufficiently, that there had been n»
 local affedion in the lungs. When the debility of the difeafe is of the in-
 dired kind, in which the cure  is more difficult,  there is,  ftill, as little
 reafon to be apprehtnfive of the pulmonary or any other local affedion.
 For the cure of it alfo proves the contrary.   In  it the means of cure are
 to change the forms  of ftimulus, and to proceed from the ufe of the
 ftronger to that of the weaker, till at length the patient can do without
 much of the very ftrong ones.  (See above, par. XClX. and thofe
 that follow).  When the  difeafe cannot be overcome in that way, the
 excitability muft be underftood to be worn out,  and life come to its end;
but ftill from general debility,  not local difeafe.   For, if ever any lo-
 cal  affedion does appear, it is always the laft  effed,  not the primary
 caufe.  In this way I loft two gentlemen, after having been able to fup-
pt.rt them for many weeks, when the prognofisupon the common prac-
                                                             tice 
OF    MEDICINE.          155
   I. When, in all the  veffels, the fluids are not agitated
by a fufficient action, they are proportionally more imper-
fectly mixed, and therefore in a vitiated ftate.   But in the
extreme terminations of the veffels, as being  at a greater
diftance from the center of motion, they often, from a
total cefiation  of motion, ftagnate,  and degenerate into a
foreign nature.  This is an  effect not  produced by heat
alone (b)  but by cold (c), not only by this, but by all the
powers that debilitate in an equal degree (d).


               CHAP     VII.

     0/ Sleep and Watching,  whether falutary or morhld.

   CCXXXVII. AS death  finifhes the operations of  all
life,fo fleep finifhes thofe of every day ; and as the former
is the confequence of a perfect  extinction of the excite-
ment, from,  either  a  complete exhauftion  or  ultimate
abundance of excitability;  fo the latter (a) fucceeds to a
diminifhed excitement,  while the excitability  is either di-
minifhed, but in fuch fort that it can be accumulated again,
or abundant,  in  fuch  fort  that  the  abundance can  be
wafted, and the excitement, in both cafes, renewed.
   CCXXXVIII. Such  is the nature  of the excitability
of animals, that it can neither be deficient nor over-abun-
                                                    dant,
tice did not allow them as many hours.  The caufe of their indired de-
bility had been hard drinking.  But even in thofe  who die of a con-
firmed confumption, there is not often reafon for the fufpicion of tuber-
cles in the lungs.  Their bodies have been opened after death and the
lungs found quite found;  And in the diffections, where the tubercles
have been found, ftill they were only an effed.
  (b) See above, paragraph CXV.    (c) See alfo paragraph XVII.
  (d) See alfo CXIX. which compare with par. XXVIII.  Nay, all the
power mentioned in par. XI. and Xll. and fully explained  in Part Second,
Chapter I. throughout.
  (a)  or  fleep, 
  I56         THE   ELEMENTS

 dant, without detriment;  a deficiency producing indirect
 and a fuperabundance,  direct:  debility.   And, as any ex-
 citing power, carried beyond  its boundary (b),  can pro-
 duce the former,  and the  with-holding of any,  give oc-
 cafion to the latter (c); fo the fame propofition holds good
 of the exceffive or too fparing  ufe of feveral of them, or of
 them all (d). Sleep, then, is the effect of the attions of the
 day, at firft giving always more and more excitement, but
 lefs and lefs in proportion to the continuance of their opera-
 tion (e), but in fuch fort as always to add fome excitement,
 till the matter at laft  comes to a point, where the degree of
 excitement,  neceffary to conftitute the waking ftate, no
 longer exifts.  Of this  we have the  moft certain proof
 in every day's experience,  and in the  confirmation of it,
 which  the  complete induction  of the effects of all the ex-
 citing powers afford (f).
                                                     Thus,

  (b) See par. XXVIII.         (c) See par. XXXVUI.
  (d) This is completely illuftrated through the whole firft chapter of
the fecond part, from par. CXI. to par. CXLVII. iuclufive.   Nay, the
;"-r.pofition is conftantly alluded to through the whole that has yet becH
laid, and will be in what remains  to be faid.
  (c) Sec par. XXXVI.
  (f) To illaftratc this, let us take the exciting powers one by one, and
begin with wine.  When a perfon is  infufficiently excited with refped
to that ftimulus, and rifes not, fuppofe above  300 in his excitement, a
j;!afs carries him up z°, another a° more, and fo forth, till after five glaffes,
 and their effed  in carrying him up to 400, he finds himfelf well and vi-
gorous in all  his fundions.   But, ftill, we are not fo flimfily made, as
 not to bear a little of what is either too much or too little.  Suppofc
him then to take five  glaffes more, and, confequently,  to  be railed to
5'c°, or io° above the ftandard.  As his fpirits, his intellednal, and ail
 his other fundions, were low, while his excitement remained  below
 <>oe,"fo they are all proportionally exalted by the time  that his excite-
 ment is elevated to jo°.  Let him ftill go on, and his intelledual func-
 tion will rife  ftill higher; he will now difplay the full extent of his ge-
 nius ;  his paffions and emotions,  of whatever kind, will rife in the fame
                                                  proportion; 
OF    MEDICINE.
*57
   Thus, heat not ultimately exceffive, or reduced, by cold,
from that excefs to its ftimulant degree (g), and food, and
drink, and labour, either of body or mind,and the exercife
of paffion and  emotion, when their ftimulus neither ftopi
fhort of the proper point,  nor goes beyond it, all give a
difpofition to fleep. This is the moft falutary ftate of fleep.
                                                       k. Pre-

proportion ; he will, in one word, be an example of the effeds of Alex-
ander's feaft.   Suppofe, to bring him to all this he has fwallowed, be-
fides thofe he had before, other five glaffes.  Let  him go on, till he has
taken five glaffe"s more, and we fhall  fee the effed : In the  courfe of
time, employed in taking thefe,  he gradually  falls off in his  fpirits, in
his iiitelledual, and in his corporeal, fundions; his tongue, his feet, his
eyes, his memory, his judgment, all, fail him ; he, at laft, becomes drow-
fy, and then falls faft a-fleep.  The fame is the progrefs of excitement
as it arifes from labour or exercife through the day, whether of mind or
body.  The fame is the effed of the ftimulus of eating, efpecially nou-
rifliing ftimulant  things,  and in great plenty.  Before dinner, the occu-
pations of the former part of  the day, are not yet fufficient to prepare
one  for fleep ;  which, however after a heavy dinner, will, unlefs the in-
terference 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 paft operations of
the  day  than  others.  The 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 cf the blood in
the  veffels, and the exercife of the involuntary motions, that keep it up,
tend at leaft to the fame effed.   The fame thing applies to the motion
conftantly going  on in the ftomach and inteftines, as well as the motions
that occur in all  the fecretory and excretory fmall veffels.  Light, ftimu-
lating  the eyes,  and found, the ears, and the  feveral fubftances that ad
upon the organs of the other three fenfes, all, tend, by wafting the ex-
citability, to wear down the excitement to that point in the fcale where
fleep commences.  And the priccfs, in every  cafe, is, firft a low,  then a
higher and higher, then the higheft., vigour of all the fundions ; vlr'ch,
again, gradually falls till its termination in fleep.  We have,  therefore,
after viewing their effeds fingly, to fuppofe them, in  one degree or ia
another, united, and fleep the fir.ifhing effed of their united operailci.
   (g) Sec above, par. CXXil. 
 158       THE    ELEMENTS

   k. Premature, unfeafonable,  or morbid fleep, is produ-
ced by either indirect or direct debility.
   a. With refpect to the effect of the former, an excef-
five energy of any one or more of the ftimuli (i) produces
it; accordingly, any one or more of thofe that have been
mentioned, by acting in excefs, and wafting the excitabi-
lity, fuch as hurried drinking, produce that effect.
   m. Of the directly debilitating powers, which produce
the fame effect, the want, or fparing  application, of the
powers,  which, by a  due degree of ftimulus,  produce
fleep, will furprife into a bad  kind of  it ;* accordingly,
when a perfon is in that ftate,  that  he wants excitement
in order to be in health, the defect of light, of found, and
of the various contacts of the bodies that excite the other
fenfes, the defect of both fets of motions, the  voluntary and
involuntary, as well as of the exercife of the mind, of the
exercife of paffion, of heat,  acting in its ftimulant degree,
and too long continued fleep itfelf, all thefe  produce hurt-
ful fleep (k).
   CCXXXIX.  On the contrary, found watching is the
effect of the fufpence of the fame diurnal actions during the
period of  fleep, taking off more and more excitement,
moft at firft, and lefs and lefs after, bnt always adding to
the fum of diminution of excitement, and accumulation of
excitability;  that is, always continuing to take  off fti-
mulus, till the matter comes  to the  degree  of diminifhed
                                             excitement,
   (i) Qf  indired debility in producing  premature fleep, fee par.
CXXXVI1I.
   (k) Coma, or an infuperable difpofition to fleep, is moft  commonly
owing to the want of moft of the ftimuli mentioned in the text, as that
of foo.d, of wine, at leaft in the ordinary pradice ot cure, of good animal
fpirits, of the  power of thinking in a pleafant exciting train, of a  due
 quantity of blood in ihc veffels, of pure open air, of  corporeal exercife,
«nd of the abftnee of certain ftimuli, that otherwife irritate in the we*-
 k'.ned ftate, and produce watchfulntfs. 
OF   MEDICINE.        159
excitement, and encfeafing excitability  neceffary to the
watching ftate. In this way does fleep prepare the fyftem
for the watching ftate ; which is afterwards kept up, for,
the due length of time,  by the feveral exciting powers,
acting through the day, till  at laft, by a certain failure of
their action,  fleep is produced again (1).
   N.  Too long or morbid watching is alfo brought on in
a  two-fold way, by indirect and direct debility.  Thus,
intenfe thinking (m), violence of paffion in extreme(n),ul-
timate excefs  in corporeal labour (o), unufual  and high
relaxing heat, debauch in eating and drinking, a great ex-
cefs in the ufe of the diffufible ftimuli (p),  a great abun-
dance and velocity of blood; all, or  any of thefe, rifing
to indirect debility by an ultimate excefs in their operation,
are notorious for their effect of repelling fleep.  Again,
cold, not in  that extreme degree which immediately pre-
cedes death ; abftinence  from food,  or that fort of it that
is not fufficiently  nourifhing, or of fufficient indirect fti-
mulus to produce the requifite diftention; v/eak drink, as
tea, coffee, or watery drink, efpecially when a perfon has
been accuftomed to more generous; intermiffion of ufual
lahour or exercife, whether of body or mind;  a fenfe of
fhame from  difgrace, and fear,  and grief; all thefe, by
their operation uot fufficiently approaching  to indirect de-
bility, produce an undue or morbid ftate of watchfulnefs.
   CCXL. As debility, therefore, whether  indirect or di-
rect, or in part a mixture of both (q), is the caufe of fleep,
the firft of found fleep,  the two latter of an improper or
morbid ftate of that function; fo an excefs of the fame de-
bility, whether indirect or direct, is  alfo  a caufe  of im-
                                                proper

   (1) See laft par. CCXXXVIII.      (m) See above, CXXXVIH.
   (n) See CXL.                  (o) See CXXXVII. r,
   (p) See CXXIV. CXXV. CXXVI. 0. p.
   (q) Sec par. XLVII. and the note belonging to it. 
l6o       THE   ELEMENTS.
 proper  or morbid  vigilance.   The only falutary fleep is
 that which is produced by a proper degree of excitement,
 occafioned by a proper action of the exciting powers upon
 the excitability; all the extremes of either exceffive fleep,
 or exceffive vigilance,  are either  fo many tendencies  to
 difeafe,  or actual  difeafe (r).
    A  perfon,  fatigued with his ufual exercife,  is imme-
 diately   compofed  to fleep ; which,  equally, flies  from
 him who has had either lefs,  or more,  than  that middle
 degree (f).
             4                                       CCXLI.

   (r) Too much, or too long continued, fleep, is hurtful, becaufe it im.
plies a fufpenfion of that excitement, to which proper health and due vi-
gour is owing, it is,  confequently, a ftate of dired debility.   Too little
fleep, or of too fhort duration, is of equal detriment, as implying a de-
gree of excitability, not fufficiently accumulated to receive  a fufficient
 impreffion from a renewal of the  exciting powers.  From  the former
arife moft of the complaints of the rich and indolent; from  the latter,
many of the difeafes of the poor arul laborious.  As the adion of  the ex-
citing powers fhould be adapted  to the ftrength,  a little indulgence in
fleep is the fiifeft extreme to the weak, as in the  cafe of children,  and
perfons labouring under debility.
   (f) When a boy, I valued myfelf much for enduring the fatigue of
walking :  About the fifteenth year of my age I walked, in a fnmmer
day,from Berwick on Tweed to Morpeth, which, with two miles wan-
dering out of the high road, I found to be a journey of fifty miles.   But
I got not a wink of fleep the whole night, from the excefs of the exerti-
tion ; and the next day, fo pained and enfeebled were all my joints, that
it was with the utmoft difficulty I made out the fingle ftage from Mor-
peth to 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 perfcdly knit, I walked and wandered in all forts of ground, in
roads and out cf them, over fmooth and plain, and heathy and moun-
tainous trads, 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 eleveu
o'clock in the forenoon, when I was now within fix miles of my defini-
tion.  The hills over which I wandered in the courfe of the night arc
thofe called Lammer-muir,fituated betwixt Eaft Lothian and the Mers:
                                                           the 
OF   MEDICINE.
161
    CCXLI.  As  the effect of both indirect and  direct de-
 bility is fometimes fleep, fometimes watching, both of them
[ unfound, both hurtful;  fo  the caufe of bad fleep is either
 fort of debility; without a ftimulus afting upon the fyftem
 in a weakened ftate, and, thereby, throwing the fyftem in-
 to a  ftate  of  difturbance.   The  feme debility of  either
 kind, with fuch  a  ftimulus, produces the morbid watch-
 ing ;  in  which c:\fe it  is a fmall ftimulus that  acts as an
 irritating power (t).
                            M                      n.  Inftan-

 the places I travelled between in this rout were Edinburgh and Duns,
 the place of the nativity of the celebrated  fchoolrcan and nietaphyfician,
 John Duns Scotus, and that  of my grammar education.  In this  great
 exertion I was fuftained by a great ftimulus,  high animal fpirits, and
 love.   At the end of my journey, and finding myfelf among my friends,
 and the objed  my  affedion, I had vigour enough to dance with the
 latter.  This time I flept well, and was perfedly recruited next day,
   (t)  Volumes have been filled with the dodrine of irritation as a caufe
 of morbid ftate, and the indications of cure and remedies to remove it
 have been equally tedious and laboured.   In fthenic difeafes, phlogiftic
 diathefis inftead of plethora and vigour (for  the belief in which two laft
 there might have been fome foundation in that  form of difeafes, fee
 above from CXXXI. to CXXXIV ) has been  the univerfal pathology;
 and bleeding, other evacuations, 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 them, was plethora with  vigour or with mobility in other cafes, and,
 in the  febrile, irritation.  By irritation they explained the ftartings of
 the tendons,  the  reftleffnefs, the frequency of  the pulfe, the typhoma-
 nia or conftant working, of fo frequent occurrence and  fo noted a fymp-
 tom in  thofe difeafes.  But  as we have proved, that the rcverfe of ple-
 thora and vigour  is the true  ftate of the fyftem in every difeafe of  debi -
 lity;  fo we affert with the fame folidity of argument, and the  fame
 weight of proof, that irritation, as being confidered, either as the  caufe
 of morbid watchfulnefs or of any other fymptom, is nothing that re-
 quire* cither  ev.icuant,  or any other debilitating remedies, to renove
 it.  It is merely a weakened ftate of the fyftem, thrown into fluttering*
 from the flighteft exertion of the ordinary fundions, as when a perfon
 Mis into tremors  from noife, or into a fweat from walking a ftep or two. 
 162        THE   ELEMENTS

   n. In ftances of morbid fleep occur in the predifpofitions
to difeafes, and the actual difeafes, that depend upon fthe-
nic diathefis, and  in  the  ordinary ftate  of intoxication
from drinking.   But all the exciting powers,  when con-
verted into  hurtful ones  of exceffive  ftimulus,  each  in
proportion to its degree of excek, have the fame tenden-
cy (u).  But, when the exciting power proceeds beyond
the fleep-inviting point; or when any ftimulus, ftill find-
ing  unwafted excitability to act upon, continues to act;
in that cafe, the watching will be  continued with bad
effect (x).
   CCXLII. Inftances of morbid fleep occur in all the
difeafes of indirect debility, and in pains that have advanc-
ed to the fame degree of exhaufted excitability in the fcale (y);
as in the feveral cafes of the  phlegmafiae, that arife from
the violent  progrefs of  the  morbid flate, or the  improper
 admmiftration of ftimulants for the cure;  which is par-
                                                  ticularly
   (u) A heavy dinner, exeeffivc fatigue from either corporeal or mental
labour, a high fit of paffion, and heat,  are, each of  them, noted fcr  giv-
ing a difpofition to fleep ; which is an effed, arifing from their high
degree of ftimulus,  hurrying the excitement to that degree of wafte in
which the fleep-inviting point confifts; and it will the more readily take
place, that  no exciting power, by ftill finding excitability to ad upon,
continues, therefore, to ad,  and prevent the fleep.
   (x) as in the harrowing watchfulnefs, which is  liable to accompany
the phic^mafix, or  the feveral fthenic difeafes with inflammation  of a
 par*.
   (y;That happens in the phlegmafiae, where the  effeds,  not only, of
the inflammatory pain,  but of the whole diithefis, and of  every other
 fymptom,  as well  as that of pain, is to run up into indired debility.
 The laft part of dtbility, that ufhers in a fit of the  gout, is commonly of
 the dired kind;  but the effed  of the continuance of the  pain is often
 fleep, the origin of which is indired debility, its confequence an encreafe
 of the difeafe, and its remedy an  interruption of the morbid fleep for the
 purpop.: of adminiftcring fuch  diffufible, and other  ftimuli, as have the
 effed of removing the debility which occafions both the fleep, and other
 fymptoms of the difeafe. 
OF   MEDICINE.
l6l
ticularly exemplified in the dropfy of the breaft, that of*
ten arifes  from peripneumony under fuch management.
With refpect to fleep from direct debility,  women, who
have had many deliveries, who have often fucklcd, as well
as all lazy perfons, and thofe of both fexes,  who are  ad-
dicted to luxury, and whofe cuftom it is to fleep too much,
are all liable to fall into this fort of morbid fleep.
   CCXLIII.   When either direct  or indirect  debility,
fometimes produces fleep that gives  no  refrefhment (z),
fometimes an ungentle, turbulent waking  ftate, neither
of them accommodated to health; as  the debility pro-
ductive  of either effect, exceeds that in which found fleep
confifts; the ufe of that degree of ftimulus  which may re-
 pel the former,  and convert the latter into fleep, will re-
move the complaints, and  ferve for an illuftration of the
nature of both (a).   In afthenic difeafes the watching ftate
                            M   2                       for

  (a)  which often happen in fevers  and many other cafes of debility,
befides thofe mentioned in the text (CCXLII.) and ought never to be
encouraged, but repelled by every means of exciting the patient.
  (a) Let the point of indired debility, in which fleep confifts, be ss 15
degrees in a particular fcale, and the  greater debility, than that which
either conftitutes morbid fleep or morbid watching, be ao degrees or up-
wards in the cafe of its being indired, or IO or downward in the cafe of
its being dired debility.  It is evident, that, tobringon falutary watch-
in" ou the one hand, or falutary fleep on the other, or to convert both
into fal»tary fleep, if that be required by the circumftances, the deficient
degree of  ftimulus muft be adminiftered ; that is  five degrees to bring
up the excitement from 10 to 15 degrees,  and  as many for the purpofe
•f renewing the worn-out excitement  by means of a new exciting power
which may ftill find a  portion of excitability to ad upon, or to remove
certain ftimuli, which, however flight and mild, are fatiguing and dif-
turbing to the fyllem  in its weakened ftate.  Accordingly in fever,
when the patient, amidft every fort of diredly  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  profufc opedoration, laftsd for fixtcen,
                                                      hours, 
  tGdr       THE   ELEMENTS

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

 hours, and  was followed by the moft furprifing relief.  The continuance
 of  this pradice  with only an encreafe  of the dofcs in proportion as the
 abundant excitability was gradually worn off, and alternating them with
 wine and beef foup, in  ten days removed all danger,  A child of three
 months had had no found fleep for ten days, but had cried night and day
 from a complaint in his belly,  which the ordinary praditioners would
 have  called an obftrudion in the  mefenteric glands.  A large dofe of
 the tiudura thebaica, for the patient's age, was adminiftered, which laid
 him in a profouud fleep, that continued near 36 hours, and at once re-
 moved the difeafe.   Numberlefs are the cafes of a kind fimilar to this
 where the morbid watchfulnefs was partly from dired, partly from in.
 dired debility, that have been conftantly removed by the fame pradice.
 A child of  7 years of age, in a fever of great dired debility, in confe-
 quence cf a  moft rapid growth happening during the difeafe, which was
 not completely removed till near the end of 7 weeks, after having been
 under the difeafe near a fortnight, was affeded  with the moft conftant
 difpofition to fleep, lo found that no noife or fhaking of his body could
 waken him.  The adminiftration of the opiate repeated in  fmall  dofe*
 fill  the effed took place,  kept him awake.  Some time aftsr, in the
 courfe of the fame lingering difeafe, when  he had not yet acquired any
 permanent ftrength, but was only better fupported by the diffufible and
 other ftimuli, than he had been till I  was called in,  his predominant
 fymptom came to be great watchfulnefs, which was  partly the effed of
 a certain, though not a great  degree of  excitement that the tindure
 and other cordial powers  had given him.  It,  however, induced too
 great  a degree of indiredly  debilitating exertion for his ftill very weak
 ftate,  and it, therefore, became neceffary to give  him an addition of ex-
 citement to britig him to the ftate  of falutary and recruiting fleep, and
 thereby to fufpend the adion of a number of exciting powers, however
 flight their  operation was,  which  were too much for the enfeebled
 ftate of hU fyftem.   In  the cafes of children whofe  difeafes are almoft
 a'l afthenic, and in other difeafes of high debility,theinftances of fuch ef-
 fed* of the  diffufible ftimuli, (for more than one was employed upon this
:s well as many other occafions)  are equally numerous and furprifing.
 In  a very large pradice I am fure I never, in the very worft cafes loft
three patients. 
©E   MEDICINE.          165
 about, that every thing that ftimulates, every thing that
 raifes the excitement as it were to that point, which com-
 pofes the fyftem to fleep, produces that cffeft by a ftimu-
 lant,  not a fedative, virtue.  In a fmall degree of debility,
 where the excitement  has fallen  only a little below the
 point of fleep, a very fmall degree of ftimulus,  fuch as a
 little  animal food,  if the  weaknefs had been owing  to
 vegetable food,  fuch as wine, or any drink of equal pow-
 er,  after a water regimen ; fuch as confolation in affliction
 of mind; heat,  when cold has been the debilitating pow-
 er ;  gentle exercife or geftation ; or the ftimulus of a plea-
 fant train of thought, when one has been deprived of the
 ftimulus  of  corporeal  or  mental exercife,  is fufficient.
 In a higher degre of debility (for the curative force fhould
 always be adapted  to the degree of the difeafe (b);  either
 a proportional higher degree of the  ftimuli which  have
 been  mentioned, or fome more  powerful  one, fuch  as
 thofe, which are called diffufible,  fhould be employed.
   CCXLIV. In both which cafes, the virtue, of opium
 is great; its virtue,  however,  is not  peculiar to it,  or a-
 ny other than what it poffeffes in common with all the o-
 ther ftimulant powers,  differing only from  the reft in the
 higher degree of its (c)  virtue.   Thus in great debility, as
                                                       in
   (b)Sse above, par. XUV. and  XCIL
   (c) The notion of fome powerful remedies, as opium, mercury,  the
Jefuits' bark, &c. ading by an operation peculiar to each, and different
from every other power in nature, was long prevalent in the fchools of
medicine.  Thofe they called fpecifics; an idea, which, like many other
of their vague conceptions, was altogether contrary to found philofophy ;
fince  the more careful our inquiries into nature's operations are,J the
more  and more reafon have we to be convinced, that fimplicity and uni-
formity pervade the whole phenomena of the univerfe.  Accordingly,
in the excitiug powers that ad upon the excitability of our bodies, we find
only one adion, that of ftimulating, varying only in  its degree, to  take
place in all  animal as well as vegetable bodies, nay in every thing that
                                                        VVi 
166       THE   ELEMENTS
  in  fevers, as in a violent fit of the gout, difturbing with ttr-
  multuary diforder the internal parts,and in other fimilar dif-
  eafes of debiiitv, in which the violence of the difeafe keeps
  off fleep; opium often,after the watchful ftate has remained
  many days, brings on profound and found fleep; in which
  cafe, becaufe the excitability is very abundant,  and, there-
  fore, can bear but a very fmall force of ftimulus, we fhould,
  on  that account, begin with the fmalleft degree of ftimulus,
  and proceed gradually to more and more (d); till at laft we
  arrive at the point of fleep, which will foon happen, as it
  is  placed much within  the range of direct debility: And
  with refpect  to coma,  or that fleep which is not  recruit-
  ing : fuch is the effect both of other diffufible ftimuli and
  of  opium,  that  it  converts morbid fleep into  vigilance;
  \igi!ance,  after a  certain fpace  of  time, into  refreshing
  fleep, and, in that way,  conducts the patient fafely,  gently,
  and pleafantly,  to health.   But as the influence of the fti-
  mulant  operation, that  fupports  excitement,   is  of  fo
  great importance,  and as fleep of longer duration than to
  prove  refrefhing may  arife even from good remedies,  the
  rule to be obferved when that happens is, whenever  any at-
                                                      tack

 we knew to peffefs lift in  the univerfe.  We alfo find, to the fame ex-
 tent, only one property in living fyftems upon which it ads, that is, the
 excitab-lity; and  one  effed  produced by the mutual relation betwixt
 them i;. that refped, to  wit, the excitement. Inftead of the diftraded
 rot.0:1 of vortices, or atniofpheres in rapid motion, governing the mo-
 f;rn  of the planets,  Sir Ifiac Newton  found the whole planetary fyftems
of the univ-rl- gov.-rued in their motions by one fingle principle.   In-
ftead  of the infinite difference of habits and temperaments,  I have found
cvn; individual precifely the fame as every other.  Whatever produce*
the gout in one; wdl produce it in another, prepared to receive its influ,
ence.  And  whatever cures it in any one, aires it alfo in every other ;
and fo forth  with refped to every other difeafe. The deeper we explore
the works of nature, the more will we be convinced of this wonderful
fimplicity, f, that, to a  philofophcr,  all nature would appear the effed
of one fingle  inftrument in the hand of the all-wife all powerful creator,
  (d} See above, jar. CVII, 
OF   MEDICINE.
r67
tick of fleep, upon account of too long a fufpenfion of fti-
mulant aftion,  has been of lefs fervice than was expected,
to fhorten its next attack,  and renew the operation of the
ftimulus.
   CCXLV. In afthenic difeafes, and  thofe  arifing from
indirect debility, in which fleep is alfo kept off; in order
both to reftore it, and remove  the other fymptoms, and
bring about the healthy ftate, both other ftimuli fhould be
employed according to the degree of debility requiring their
ufe, and, when the degree of debility i3  very confiderable,
the diffufible  ftimuli, and among the reft opium, fhould
not be omitted.
   CCXLVI. Thefe  are  the  times and circumftances of
the body in which opium produces fleep.  In all the other
ftates either of health or difeafe, it excites the  functions
both of body and mind, as well  as of paffion and emotion;
among others  it banifhes fleep and produces great activity
and vigilance.   Thus if  any one is  under the preffure of
fleep without  an evident caufe,  he will by opium be ren-
dered furprifingly fprightly, lively, and  vigilant; it banilii-
es melancholy, begets confidence, converts fear into bold-
nefs, makes the filent eloquent,  and daftards brave.   No-
body, in defperate circumftances, and finking under a dil-
relifli for life,  ever laid violent hands on himfelf after ta-
king a dofe of opium, or ever will.  In one word, through
all the intermediate degrees of excitement from direct to
indirect debility,  opium is by  far the moft powerful of all
the agents, and as fuch muft be moft hurtful in fthenic di-
athefis; becaufe,  when added to the other ftimulant pow-
ers, it not only banifhes fleep,  but is liable to precipitate
thofe difeafes from the fthenic ftate to indirect debility, arJ
from this laft  to death.
   CCXLVII.   That the debility,  upon which coma de-
pends,  is lefs  than that which fupports morbid vigilance,
                                                   is 
i6i
THE    ELEMENTS
  is proved, from the former being lefs dangerous, and more
  eafily removed;  yet,  when its duration  is in any degree
  confiderable, or when it  refembles profound fleep,  care
  fhould be taken to prevent the hurtful effect it may produce
  from direct debility (e); in which cafe recourfe fhould be
  had to the different forms  of wine and opium, with the in-
  tention of raifing the excitement  to  that degree, which re-
  pels the fleepy ftate, produces more ftrength, and facili-
  tates the return of health (f).
    CCXLVIII.  In  the gout,  in  indigeftion, of which
  examples have already been adduced, in diarrhoea and the
  colic,  and many other  afthenic difeafes, particularly  dis-
  turbing  the alimentary canal,  and chiefly affecting thofe
  women who are exhaufted with frequent child bearing,and
  long and repeated nurfing; it often happens,  that there is
  a ftrong propenfity  to fleep,  contrary to what happens to
  the fame  perfons in health, and the period of fleeping at-
  tack  is prolonged,  without  the indulgence in it bringing
 any alleviation of the difeafe.  The fame thing happens to
 thofe who have fallen into indirect debility from drunken-
 nefs  or any  other caufe. That this defire for fleep depends
 upon direct or indirect debility is evident from every thing
 that  givesfurther debility encreafing the difeafe, and every
 thing that ftrengthens, removing it.   Among thofe all
 ftrong drink, and  the preparations of  opium, are peculi-
                                                     arly
  (e)  See above,  par, CCXLI. and the note under it,  as well as this
whole chapter,
  (f)  Phyficians have had a more  favourable idea of coma, or the fleep-
ing ftate in fevers, than it merited.  Inftead of deferving to be looked
upon as a pofitively good fign, enfuring a fafe return of the difeafe, at
they did ; it was at beft but a negative mark, implying that  the flight
ftimuli ading upon the fyftem in a ftate of high debility, and, therefore,
by their operation, flight as it was, encreafing the dired debility by the
addition of the indired to it, were kept off and hindered from producing
that hurtful effed. Their authority  in giving that judgement of it is over-
thrown by their extreme ignorance of its nature, 
OF   MEDICINE.
169
arly effectual,  and  that  in proportion to their greater
and  more diffufible  ftimulant power, than that which
others poffefs.
   CCXLIX. Nor is it unconnected wid^ this explanation
of the  nature of fleep and watching, and of both of them
being fometimes repelled,  fometimes induced-, by a certain
degree of ftimulus (g): that exceffive motions, as the fpaf-
modic and convulfive,which have been mentioned (h), fuch
as the quick pulfe in fevers  (i) and other motions, are remo-
ved by an equal force of ftimuli, to that which is required
to remove morbid affection without any motions. Hence
it is  plain, that irregular motions  are not only encreafed
functions (k), independent upon debitity, but that they are
impaired functions,  and confift nearly in the fame degree
of debility.
   CCL.  From  what has been faid, the analogy between
watching and life,  and fleep and death, and their depen-
dence upon the fame laws of nature, that govern all the
other functions, clearly appears ;  and the  moft  folid pro-
bation has been adduced, that the  moft vigorous vigilance
confifts in the higheft degree of falutary excitement; that
the middle and  deep period of fleep depends on the high-
eft debility that is confiftent with  the healthy  ftate ; that
true fleep depends on a middle degree of indirect debiiitj',
and that both morbid fleep and morbid  watching are the
offspring of great debility,  whether of the indirect or di-
rect land.
                                            CHAP.
 (g) See  above, par.  CCXLI. where this propofition is reduced ta
itsexad principle.
 (h) See above, par. CCXX.             (i) See par. CLXXIX,
 (k) Tec above, CCXXIX, 
170
THE   ELEMENTS
              CHAP.   VIII.

              TWCure of both the Diathefis.

    CCLI. AS4he caufe of both the diathefes is that which
 has been  formerly  (a) related ; the indication of cur,,
 therefore, to be taken from that is, in the fthenic diathefis
 to dirniniih  exceffive excitement  over the whole fyftem ;
 in. the afthenic to encreafe deficient excitement  likewife
 over all the fyftem, till it be brought to that degree, which
 proves the caufe of health.
    CCLII. The remedies that produce that effect in the
 cure of fthenic diathefis, are the powers,  which,  when
 their ftimulant operation is exceffive, produce that very
 diathefis, in  this cafe, acting with that flight and  reduced
 force of ftimulus, by which they  produce lefs excitement
 than health requires, or by which  they prove debilita-
 ting.
    CCLIII.  The  powers which produce the  fame effect
 in the afthenic diathefis, are thofe that, when their ftimu-
 lus is fmall,  produce that diathefis,  in this  cafe, exciting,
 with that high dagree of ftimulus, by means of which
 they give more excitement,  than fuits the healthy ftate, or
 by means of which they ftimulate.
   CCLIV.  In the fthenic  diathefis that temperature (c)
                                                  which
  (a) See above, par.  CXLVHT.
  (c) The fame order is followed here, that has all along been obfer-
xedyto wit, that of the enumeration of the powers in par.  XL and XII.
and that of the  explanation of them, when viewed as the hurtful powers
producing either diathefis in Chap.  I. Part 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 fubjed, while nothing is more artifi-
cial and arbitrary than the arrangements  either of Syllematics or Nof>-
iogifls.  Juft order co'-ild never be expeded from an erroneous and confu-
                                                      ted 
OF    MEDICINE.
X7*
which  is  called  heat, muft by all  means be avoided;
and for this very good  reafon, that the only degree of it
which proves debilitating, that is the exceffive to an ex-
tremc,  cannot  be carried to that height, jp which it de-
bilitates,  without the rifle  of hurtful  or pernicious confe-
quence from the excefs of ftimulus (d).
   CCLV. But, when the  diathefis,  and its caufe the en-
creafed  ftimulus,  is gentle  in the  actual difeafed ftate,
there is no occafion for forbidding that  degree of heat,
which accompanies the operation of fweating and pediluvi-
um (e); becaufe  the  wafte of fluids  in the former,  and
the  agreeable fenfation  in the  latter, promife fomewhat
more advantage than the moderate degree of heat employ-
ed in  this cafe threatens difadvantage.
   CCLVI.  In a  particular manner,  after the  applica-
tion of cold in  an intenfe degree, muft the  application of
heat be avoided,  becaufe its operation, from the encreafe
of the  excitability of cold, becomes more effective (f).
And the confequence is the more to be dreaded, that, at
the fame time,  other" ftimuli are ufually urgent.
              *                                CCLVII.
fed view of the fubjed to be treated of;  while a clear conception of the
fubjed as a whole, infallibly leads to a diftind diftribution of the feveral
parts that compofe it ; fo that what Horace fays of language, equally ap-
plies to order,and '.he fame thing applies here as to his Verba & lucidu*
orio.  Rite para tarn rem verba haud in vita fequentur.
  (d)  See above, par.  CXV.  Though very intenfe heat relaxes the
fimple and induces  atony on the living folids, who in a peripneumony,
would think of ufftjg it with that view ?  That difeafe from its own vio-
lence,  often  mounts up fo high in the fcale  of increafed ftimulus, as
nearly to  approach the point of indired debility, and it fometimes adu-
ally gains that point.  The addition, therefore, of more  ftimulus, from
the application of heat, would enfure that effed, and thereby occafion
the converfion of the difeafe into a much worfe one,  fuch as hydrotho-
rax, or the dropfy of the brcaft.
  (e) Pediluvium is the warm bath of the legs and feet.
  (f) See  above,  par,  XXXVII. 6 and note (d), 
 1J2       THE   ELEMENTS

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

  (g) or the common cold in Englifh, a name fUmpt upnn it by the ve-
ry blunder we have been fpeaking of.
  (h) It is called the common inflammatory  fever, very improperly,  ai
being no fever, but a general pyrexia, or affedion of the whole fyftem,
without  inflammation or local affedion, and producing heat over all
and tumultuous effed upon the pulfe.   Its proper generic name is pyreic-
ia.  See  above par. LXVIII.  where that appellation Is afligned to it;
an appellation to avoid miftaking its nature, that fhould be accurately
attended to.  Great mifchiefjhas been occafioned by this vague term.
Thus wncn a perfon is faid to be affeded with.a difeafe, when it is afked
what difeafe it is, and the anfvv-r given, that it is a fever, immediately
bleeding is thought of, though that, and every, evacuation is as hurt-
ful in proper fever as it may be ferviceablc in the  pyrexia.  To give  an
example of this pyrexia, the particular appellation for which  is fynocha,
or fthenic pyrexial difeafe ; many years ago, a perfon  in the old town of
Edinburgh, labouring under it, efcaped the vigilance  of his nurfe ; flew
naked out of the houfe in a very keen  froft with fnow upon the ground,
acrofs the ftreets,  paffed over into the  new  town, and from that to the
fields beyond it,  He foon became fcnfiblc of his ftate, ftole into ahoufe
                                                        next 
            OF   MEDICINE.            173

becaufe cold is fo efficacious a remedy in the fmall-pox;
it clearly  follows, that the ufe*of cold fhould be extended
to the whole range of predifpofition, the whole circle of
difeafes, depending upon fthenic diathefis*
   CCLIX. That no hurtful  effect  arifes from  the fup-
pofed aftringent power of cold in the fthenic diathefis (i),
is proved by its very high influence, when applied to the
furface of the body in the fmall-pox, in keeping up a free-
dom of perfpiration in proportion to the degree of its ap-
plication.   And its influence in  producing  atony with
proportional laxity  of the fibres of the  veffels, is in con-
formity to the fame obfervation (k).
   CCLX.  For the removal of afthenic diathefis the ftimu-
                                                        lus

next to him, got fome clothes thrown about him, and was carried home
in a chair, perfedly cured of his difeafe.  From which, and a prodigi-
ous number of fads to the fame purpofe, all concurring in the proof of
the debilitating operation of cold,  there can hardly arife a doubt in the
mind,  that in  a certain high degree, if it could be conveniently ufed, or
if there were occafion to have recourfe to it for want of efficacious reme-
dies,  it would at once remove the higheft  degree of fthenic ftate that
ever occurs in difeafe, and reduce the excitement from the neareft ap-
proach to 70 down to 40.  Nay it might run into the oppofite 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 effedual 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
cf the principle upon which the cure  of fthenic difeafes turns, has ena-
bled us to render the cure both more complete and exad, than it could
have beeu without principle;
  (i) I remember, when I was a young ftudent, of hearing the old phy-
ficians in Edinburgh very gravely forbid a draught of cold water in an
inflammatory pyrexia and even in  a common catarrh, for fear it fhould
produce an  inflammation in the ftomach.
  (k) The  fibres being  relaxed defcribe a greater cavity, and hence  the
check given to the perfpiration by the contrary effed of the  fthenic dia-
thefis in encrcV.ini; their de:ifity in dimicifhing their diameter^ is ta!*a 
*74
THE    ELEMENTS
  lus of heat is fignally ufeful, and chiefly for the follow-
  ing reafon;  that  it  muft £>e  as ufeful in this  diathefis,
  where the excitement is too low, as it is hurtful in the fthe-
  nic, by giving a further encreafe of the  excitement, too
  much increafed  already.   Hence  in fevers, in the gout,
  in dyfpepfia, in the colic, in rheumatalgia  (1),  and in all
  afthenic difeafes,  the fyftem is  v.ery much  cherifhed  by
  heat, and debilitated  by cold :  Which, by its debilitating
  effect,  is ranked among the  powers that produce the dif-
  eafe (m), and is deftructive in fevers.
    CCLXI. As cold is hurtful in afthenic diathefis in the
  proportion in which it is ferviceable in the fthenic  (n); it
  is accordingly,  for this further  reafon,  to be avoided in
  difeafes of the  higheft debility, that, like intenfe heat, it
  relaxes the extreme veffels,  and produces a putrefaction
  in the fluids (o).
    CCLXII. The  more certainly to moderate the fthenic
  diathefis while as  yet it remains within the  range of pre-
  difpofition, a fparing ufe  fhould be made of flelh and the
  preparations from  it, and vegetable difhes ufed with grea-
  ter freedom.  But,  when the  fame diathefis is encreafed to
  the degree, that conftitutes difeafe,  abftinence from animal
  food,  efpecially  in a folid form, and a free,  but  ftill not
  exceffive,  ufe of  vegetable  matter, efpecially in a fluid
  form, are the beft means of removing it, as far as  the ma-
  nagement of diet goes.
                                               CCLXIII.
   (1) or what is improperly, as  it has been faid before, called the chro-
 nic rheumatifm.
   (m) No gouty perfon can bear the operation of much cold, and every
 one can endure more heat, than moft other perfons. And the reafon is
  evident : So debilitating a power muft,  in proportion to its degree, be
[peculiarly hurtful in all difeafes,  in which the debility conftituting their
 caufe,  runs high, as it  naturally does in the gout, where it is encreafel
 by the advance of age, and other caufes, and much more fo in fevers.
   (n) Sec par. CCLVIII.       (o) See above, CXVII. 
OF   MEDICINE.          175
  CCLXIII.  In that degree of this diathefis, which doe*
not exceed predifpofition,  it is proper to avoid feafoning,
which is deftruftive in difeafes.
  CCLXIV.  Watery drink is  very fuitable to it, and all
pure and ftrong drink hurtful, and that in proportion to
the quantity of alkahol that it contains.  The latter fort
of drink, unlefs taken very weak, is deftructive in difeafes-
In the number of which pure water, efpecially with an ad-
dition of fomething to acidulate it, is preferable to fmall-
bcer, which a great authority admitted.  B ut the diffufible
ftimuli in this diathefis are above all others hurtful.
  CCLXV. Since the indirect ftimulus of food affifts the
direct, that is, propagates  itfelf over the whole body; for
that reafon bounds fhould be fet to the bulk even of the
fuitable matter  (q).
  CCLXVI. In every degree of afthenic diathefis, vege-
table food fhould be avoided, and recourfe had as foon as
poffible to that, which confifts of meat and animal matter.
And, as that can fcldom  be executed immediately upon
account of the weaknefs of the ftomach; the diffufible fti-
muli fhould, therefore, be ufed; fuch as the different forms
of wine when the debility is moderate, and opiates  when
it is greater.  And at the fame time, from the very begin-
ning rich foups  fhould be given in great quantity upon the
whole, and a gradual tranfition made to the ufe of more
folid matter.
   CCLXVIL As  it is animal ,matter in this  cafe, that
is of fervice, fo  the degree  of ftimulus, that feafoning adds
to it, improves its effect (r).
   CCLXVIII. During the predifpofition to afthenic dif-
eafes, watery, cold, acid, fermenting drink is hurtful, and
that proportion of pure  ftrong liquor, that the degree
of debility requires, is beneficial.  But, after the difeafes
                                                 have
  (q) Sec above, par. CXXVIf.    (r) Sec above, par. CXXV. 
 I76       THE  ELEMENTS.

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

   (t) Compare this with what was lately faid in paragraph CCLXV.
  (u) The chyle is the alimentary matter, that has undergone a prepa-
ration in the ftomach, and an after one  in the upper part of the intefli-
nal canal, and, which,  fo prepared, or  in part digefted, is taken up by
the mouths cf a nnmber of fmall veffels that open into the inteftines;
thefe ca:ry it to a great trunk, in which all thefe veffels, called  ladeal,
unite, and through that trunk, to be aftcrwirds  mixed, firft with the
venous, and then with all the other blood in fucceffion.   Such is thenou-
r.fhing matter of animals.
  (x) See above, par. CCLV,
  (z) See above, par. CXXXI. to CXXSIV. 
OF   MEDICINE.          tjf
the diathefis is fo moderate, as only to produce predifpo-
fition, or a gentle degree of actual difeafe> are an abate-
ment of exercife, more indulgence in reft, and a reduction
of other ftimuli.  In  the very great diathefis, that which
occafions fevere difeafes, in order to retard the motion of
the blood, a point  muft be made to avoid the ftimulus of
all the exciting  powers, and blood muft be taken  profufe-
ly.   Here it is fuperfluous to lay down a rule for the ob-
fervance of keeping the body in a ftate of reft, as reft, even
in fpite of the patients, is unavoidable (a).
   CCLXXI. Withdrawing the powers that occafion an
over-proportion of the  fecreted fluids  in the excretory
ducts, is the beft method of removing the ftimulus, which
that  over-proportion, by its  diftending energy,  produ-
ces  (b .  The cure,  therefore, confifts in more frequent
coition,   drawing  off the milk,  taking in food of a lefs
nourifliing nature, and in reftoring the perfpiration by re-
moving the fthenic diathefis upon the external furface.
   CCLXXII. To remove  the  debility, or  atony  and
laxity, of the veffels,  which is occafioned by a penury of
chyle and blood over a very great extent of the  fyftem (c),
                             N                      firft
  (a) It would be ridiculous to require of a patient in the rage of peri-
pneumony not to run a race, when his real ftate is, that he cannot move
•r turn himfelf in the bed without pain.
  (b) In par. CXXXVI. you will find, that the fecreted fluids, here al-
luded to, are the milk, the femen, and the perfpirablc fluid.  As the
diftention occafioned by the over-abundance produces the morbid ftinm-
lus, fo the fubdudion of the fluids muft, of courfe, take it off, and give
the defired relief.
  (c) How great the fpacc or extent of the fyftem that, in the fthe-
nic diathefis, receives the ftimulus of an oter abundance of blood ; and,
iniheafthenie diathefis is fubjeded to the debilitating power of an un-
der-proportion of  the fame fluid, may eafily be conceived  from the
well known fad, that there is not a foft part in the whole fyftem, into
ti-hich the infertion of the point of the fmalkft needle will not draw blood;
confequently,  the ftimulus arifing from an ever-abundance of blood,  as
                                                      wcR 
 lyS       THE    ELEMENTS.

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

 well as the debility anting from too fmall a quantity,  muft be the moft
 confiderable of all others.  Every circumftance here concurs  to render
 the one the greateft fthenic, and the other an equal  afthenic, hurtful
 power. If the force of every  ftimulus, of every exciting power, be in
 proportion, firft, to the degree of it applied ; fecondly, to the fenfibility
 of the part on which it ads ; and, thirdly, to the extent of that part, it
 will be no wonder, that thefe two powers fhould prove the moft formi-
 dable 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.
   (d) which ad by giving vigour to the whole fyftem, and more efpe-
 cially to the ftomach, with which they come into adual contad.  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 is it that  the cure of
 fthenic difeafes is more quickly effeded than that of the afthenic; it be-
 ing, over all nature, much nr ore eafy to take away than  replace.  See
 and compare par. CXXVI. andCXXX.  and fubjoined notes, and a lit-
 tle above, par. CCLXVI.
   (e)  The fole ufe, and a great one, of the diffufible ftimuli is, in great
 weaknefs,  where they are only required, to fupport the fyftem, while it
 cannot be fupported by the ordinary durable ftimuli;  and, after the ex-
 citement is fo far reftored, that the ordinary fupports are now fufficient,
 to lay afide the extraordinary ; the continuance of which would now be
 hurtful, and to manage the convalefcent, and reftored, ftate of health by
 the powers employed in health.  When the diffufible are continued lon-
 ger, they are equally hurtful,  and a caufe of difeafe, as they arc fervice-
 able when difeafe requires their fupport; analogous to wine,  they bring
 about  the fyftem ia a weakened ftate to be fuftained by its natural and
                                                        ordinary 
©F    MEDICINE.
I7J
    CCLXXIII.  In a  weak ftate both of the vefTels and
 ©f the reft of the body, every motion of  the body, any
 way confiderable,  and all other  ftimuli, which quicken
 the motion of the blood, and bring on  an indirect  tem-
 porary debility, fhould be  with-held.   But  in a cafe of '
 {lighter debility,  fuch motion as does not prove fatiguing,
 but  acts  as an  agreeable ftimulus,  and gives  recruit,
 fhould not be avoided.   When a perfon is recovering from
 a difeafe, he fhould be gradually brought back to his ufual
 plan  of life ; nor fhould it be forgot, that, till that is
 done, the health is never completely reftored.
   CCLXXIV.  The debility which  an under-propor-
 tion of fecreted fluids, or a degenerate,   though plentiful
 ftate of them, produces in the excretory ducts, is removed
 by the ftimulant plan of cure which hasjuflnow beenfpo-
 ken of (f), not by an antifeptic one (g).
   CCLXXV. The  fuitable remedy of that  fort of ftimu-
 lus, which arifes from either violence or affiduity of think-
 ing, is an  abatement  in the  degree of thinking, or that
 high ftretch of the intellectual function, whether its  de-
                           N  2                       gree
•rdinary fupports; But,  analogous to it in another refped, when the
ftrength of the fyftem requires not their additional ftimulus,  they carry
it up into indired debility, and prove the  caufe of difeafes and death.
In one word,  whatever has been faid againft the propriety of the ufe of
exceffive, and ultimately  exceffive ftimulant powers, the former prod la-
cing fthenic diathefis,  and  the latter indired debility, all that  applies,
with propriety, for the difcontinuance  of the ufe  of diffufible  ftimuli,
when the durable are now fufficient for the purpofes of the fyftem. And
another argument that ftill remains againft the fuperfluous ufe  of both
the diffufibles and ftron g drink, when debility requires  not their ufe ;
which is, that,independent of death,or even difeafes,being their immediate
confequence,  predifpofition to difeafes muft; confequently, as the fyftem
muft at laft be 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.
  (f) See above, CC1.XXII.      (g) See above, CXVI I. and  CXVIII. 
Lcto       THE   ELEMENTS
 grec or frequent repetition be regarded,  that, by wafting
 the excitability,  proves,  at laft, indire&ly  debilitating:
 Which is a rule, however it may fuit the ftate of predif-
 pofition, that is by  no means fafe,  after the difeafe has
 once made its appearance, and efpecially if it is a violent
 one ; becaufe there is no accefs to any benefit from it, but
 through the intermediate degrees of that ftimulant range,
 which by  encreafing the excitement,  already too  great,
 would do mifchief (h).
    CCLXXVI. In order to cure  a flight fthenic diathefis,
 fuch as occurs in predifpofition,  and to prevent difeafe,
 habitual paffion fhould be avoided ; but  the removal of
 actual difeafe requires,that every firft guft of paffion fhould
 be prevented. The ultimate excefs of paffion,upon account
 of the intermediate danger of ftimulating too much, is
 by no means  to be thought of.
    CCLXXVII. In  fo  far as  debility depends upon ex-
 cels in mental exertion, or upon a  languid  ftate of that
 faculty,  the  excefs fhould  be diminifhed, and the languor
 removed,  and an agreeable train of thinking fet on foot;
 without  which  latter, however much all  the other fti-
 mulant powers may have  been employed,  it may be  de-
 pended, upon,  that perfect health, in  every  refpect, will
 not be brought about (i).
                                           CCLXXVIII.
   (h) See above, CCLIV.
   (i) The ftate  of the intellednal fundion has a great influence upo«
 that of excitement; and, often, when  all other ftimuli have been ap-
 plied in due proportion, the deficiency of that fingle ftimulus 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;  hence all the fine feelings of the bel-
 les letters;  hence, in youth, the ardent keennefs to be acquainted with
 the learning, wifdom, and elegant produdions of the ancients, as well
 as of thefe, who have made a diftinguifhed figure in  later times ; hence
                                                       the 
OF    MEDICINE.
181
     CCLXXVIII. In  every  degree of debility that  high
  force of the paffions, that produces indirect debility,  muft
  be avoided ; and it muft not be forgot, that a very fmall
  degree of them is fufficient  for that effect: we are not to
  .give loofe reins to agreeable paffions  (k).
                                                   cclxxix.

 the enthufiafm fo  natural to the human feelings, to outftrip others in
  every mental excellency : The arts, the fciences,- every department of
 human knowledge,  are all the effeds of  that intelledual propenfity.
 How happy would it be for mankind were this noble ftimulus duly che-
 rifhed .'  What  benefits,  which fociety is deprived of, would not accrue
 from a proper  cultivation  of  it!  How fine was that feeling in Julius
 Cxfar Scaliger, when he declared he would rathej be the author of Ho.
 race's few ftanzas of Lydia and Telephus,  than accept  of  the crown of
 Arragon ! What muft  have  been  the delight of Pythagoras, when he
[found out the  XLVIIth propofition of the firft book of the  mathema-
 tical elements, commonly called Euclid's? He jumped about in  an ecftacy,
 crying out E &/>»*«, and was fo much more fubftantial than fome of his
 few brother difcoverers, as  to poffefs the means of offering a facrifice of
 an hundred fat bullocks to thegods.  See Obfervations on the principles
 of the old Syftems of Phyfic, from page ix. to xv. of the introduction.
 How delightful muft the feelings of Horace have been, in whofe works
 every Ode is an effort of the moft beautiful, aud frequently, of the moft
 fublimc, conceptions  of  human genius 1 What muft have  been the fire
 and force of Milton's  foul, in the defcription that he gives of the appear-
 ance of the Son of God in his cceleftial panoply, " his countenance too
 fevere to be beheld!" How towering that foul, how exalted that intelled,
 which the great Marquis of Montrofe difplaycd in  a ftratagem, which
 converted into a glorious vidory  a blunder in one of his officers, that
 might have proved fatal to both his caufe and his glory. When it was
 whifpered to hiti, ftanding in the center ef his army, that one of his
wings was overpowered, he fhouts out to the commander in the other:
M My Lord Aboyn,  fhall  you and  I ftand here doing nothing,  aud
M'Donald carry off all the honour of the dayl"
  (k) See  above par. XLIII. and  CXLI.   Recoiled the method pre-
fcribed in the XLIII. paragraph of this work for preventing the fatal ca-
taftrophc of the Roman woman, when her fon, whom fhe had counted
upon, for certain, in  the nunber of the dead,  was contrary  to every
rxpedation, prefented, to her in perfed health. The danger and fatality
                                                             o? 
i82
THE   ELEMENTS
   CCLX'XIX. When there is a deficiency in the force of
 any of the paffions, as in fadnefs, grief, fear, terror  and
 defpair, which are only leffer degrees of gladnefs, confi-
 dence, and hope, and imply only a diminution of exciting
 paffions ; fuch deficiency or diminution muft be expelled,
 and the exciting degree of paffion recalled; hop eand af-
 furance muft be infufed,  and the patient gradually carried
 up to feelings of joy.
   n.  For there is only a fum  total of the paffions, which
 act in the fame manner as all  the other fthnuli, that is, by
 ftimulating, either in  excefs, or in  due,  or. in deficient,
 proportion; nay, like the reft,'as often as  any one is defi-
 cient, it,  by  accumulating the excitability, has  the ef-
 fect of making the other  ftimuli aft more powerfully (1).
 Take, for  inftance,  the  terror  of an army before the
 found of trumpet for the  onfet of battle, and the courage
 with  which they are afterwards infpired, from the con^
 fcioufnefs of  their bravery,  the General's fpcech to ani-
 mate them, or perhaps, his commemoration of their for-
 mer brave deeds.
   p. An ultimately exceffive  voluptuoufnefs in the exer-.
 cife  of the fenfes, as well as the effect  of difagreeable ob-
 jects, prefented to  them, in  afthenic  diathefis,  fhould
                                                 equally
 of her ftate was, that her excitability  was too accumulated, with refpedt
 to the ftimulus of exciting paffion, to bear fuch a  ftrong imprcflion as
 that which the prefence of her fon, in life and health, had made.  She
 was in the ftate of a famifhed perfon, whofe accumulated excitability is
 everpowered by a fingle morfel of food, or of a perfon, who had been
long affeded with thirft, where  the fmallcft indulgence in drink may
prove fatal; or of a perfon,  near ftacvcd to death  by cold, in whom a
rafh approach to heat, might induce the fame fatal effed ; all which are
precifely upon the fame footing, and  equal inftances of an excitability
too accumulated to bear any degree of ftimulus.
  (1) See  above, par. XXXVII. and the note annexed to it. 
           OF    MEDICINE.         183

equally be avoided; and in the fth«nic diathefis, their tur-
bulent force fhould be guarded againft (m).
 2. Nothing is better accommodated to the afthenic ftate
than purity of air; which, either alone, or conjoined with
exercife, muft, confequently be of the greateft  benefit to
convalefcents.
   t. Since the matter of contagion, in fofar as it has any
tendency to produce general difeafe, produces either fthe-
nic (n) or afthenic diathefis (o), and acts by an operation
fimilar to that of the general hurtful powers ; the infer-
ence to be drawn from that i6, that in the cure, general
remedies fhould be employed;  and debilitating ones op-
pofed to fthenic, ftimulant ones to afthenic, diathefis (p).
   CCLXXX. Thefe powers, the fame in kind with thofe
that produce the diathefes, differing only in degree, and
in that refpect diametrically oppofite, remove the diathefis
feldomer, and lefs fuccefsfuly, one by one ; oftener, and
more effectually, when  feveral co-operate, but,  beft of
all, if  all of them  be taken together,  efpecially  when
there is occafion for great afliftance,


              CHAP    IX.

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

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

is- very high, it  fhould be freely ufed ;  but never rillccd
during predifpofition, and fparingly, or not at all, ventured
upon in difeafes of a gentle nature; in which other reme-
dies fhould be preferred (a).
   CCLXXXII. The next place of importance to bleeding,
when  heat and other ftimuli are guarded againft, is claim-
ed by cold.  Heat is always hurtful, and ftill more fo af-
ter a previous application of cold; but it is moft hurtful,
when  it is alfo  combined  with other exceffive ftimulant
powers.  Cold is always of fervice, and in proportion to
its degree; provided foreign ftimuli, blended with it, and
overcoming its debilitating effect, be cautioufly fhunned.
   CCLXXXIII. The  third place  in rank after thefe re,
medies is claimed by vomiting and purging and fweating.
Thefe evacuations  have a powerful effect  in removing
fthenic diathefis, and therefore do they, with great advan-.
tage,  fuperfede the oftener imaginary than real, neccffity
pi profufe bleeding.  They are often alone fufficient to
reftore the healthy ftate.
   CCLXXXIV. Together with all thefe, the articles of
diet, the ftimulant operation of which prevents the bene-
fits  to be received from them,  fhould be fparingly ufed,
and that in  exact preportion to the degree of the diathefis.
This  precaution alone is adequate to the removal of pre-
difpofition, and  often to that of difeafes, efpecially thofe
that depend upon a fmall and gentle diathefis.
                                           CCLXXXV.
   (a) See above, par. CCLXIX.  With the exception of peripneumony,
phrenitis, and violent and mifmanaged cafes  of the fmall-pox and mea-
fles, and rheumatifm; in the laft in their mild ftate, as well as the other
fthenic  cafes, the lancet fhould never be unfheathed. That is to fay, in
feven cafes out of ten even of the fthenic difeafes, which are the oaly
ones that either require or bear any degree of it, the pradice muft be
laid afide, and never thought of  in any afthenic affedions whatever.
Confequently, the cafes, where it is in any degree allowable, are exceed-
ingly few. 
           OF   MEDICINE.          185

  CCLXXXV. Alfo with all the remedies yet mentioned
we  muft conjoin reft,  when the difeafed ftate has taken
place, and moderation in motion during the period of pre-
difpofition (b).
  CCLXXXVI. The  practice  of the common run  of
phyficians is very bad, in going too much upon any one of
the remedies that have been mentioned,  and overlooking
all the reft, or enjoining themcarelefsly.   We are not to
depend upon bleeding alone, not even in  peripneumony it-
felf ;  but employ all the  reft either in concourfe or fuc-
ceffion.
   CCLXXXVIL The difturbed functions,  or thofe that
are impaired (c) not from a debilitating caufe, admit of the
general plan of cure, and no other.
   CCLXXXVIII. The fymptoms of debility, which  are
the confequence of the violence  of the fthenic diathefis, in
the progrefs of the  difeafe, and that threaten death  by in-
direct debility,  ought to be prevented by an early interpon
fition of the remedies.
   CCLXXXIX. The fame  early cure ferves to prevent
fuppuration, effufion, and gangrene, which arife from ul-
 timately exceffive excitement, paffing into indirect debility.
   u.  If fthenic diathefis  fhould  happen  to be conjoined
 with a local difeafe, the former, to prevent it from aggra-
 vating the latter,  fhould be removed by its own refpec-
 tive remedies.
                                              CHAP.
  (b) So confiderable a  ftimulus is exercife, that, if in fuch a degree of
 fthenic diathefis, as that, which forms only predifpofition to the difeafti
 depending on it, exercife may of itfelf be fufficient to effed the conver-
 fion of the predifpofition into the  adual difeafed ftate. Often has th<:
 higheft of thefe difeafes, and even peripneumony itfelf, been brought oj»
 by violent exertion in exercife.
  fc) See above, par. CXLVII. CLI.  CLXXII, 
l56       THE   ELEMENTS
              CHAP.     X

   The fame Comparifon of the different  Parts of the Afthenic
             Plan of Cure with one another.

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

afide, and, in the fame gradual way,  recourfe he had to a
larger and larger ufe of the more durable and natural fti-
muli  (d.)   In  the cafe of indirect  debility, we fhould al-
fo gradually proceed from the higheft to the loweft force
of  ftimulus, as has been mentioned  formerly (e), and, in
an inverfe manner, go on from the fmalleft force of dura-
ble ftimulus to the greateft.   Laftly, in that moderate de-
bility, which conftitutes the  predifpofition to afthenic
difeafes, it muft always be kept in mind, that  an abun-
dance of blood is the greateft fupport of health (f), and
that we are not to give way to a  weakened appetite  (g).
   CCXCI.  To the vital fluid, and  the feveral  means
of encreafing its quantity, which have juft now been men-
tioned, the next remedy in the cure of afthenic diathefis is
heat; as being the power by which animals (i), in their
firft  formation, in  their growth,  and moft efpecially  in
their decay, are brought forth into exiftence, arenourifh-
ed, and acquire vigour, and afterwards, through the feve-
ral degrees of  their declining ftate, are to fome extent up-
held, till their excitement is all extinguifhed (k).  By heat,
underftand that point of external temperature,  which in-
tervenes as a mean betwixt cold, as  it is called, and high
heat (1); under which our fenfe of temperature is  agree-
                                                    able
  (d) See laft note (e),and compare it with this.      (e) Par. CIH.
  (f) How widely different is that maxim from any that have hitherto
tver been received in the profeffion of phyfic j  in which flying to the uf:
of the lancet,  was the firft thought that arofe in the mind,  with refped
to the idea of cure of every difeafe ;  and  bleeding  and evacuations
through the courfe of each difeafe,  the  only remedies.
  (g) This is  equally the reverfe of the general pradice of inanition ia
almoft every difeafe, without a finglc  exception.
  (i) An.d we may add vegetables.
  (k). Compare this with par. CXI I. and CCLIV. and CCLX.
  (1) The Latins have a finglc word for  this which we waut; the wor^L
u ardor. 
l88       THE   ELEMENTS
  able and pleafint; under which the body is neither'weaken-
  ed by that relaxation which produces fweat, nor by that
  torpor (m) which cold begets, where the debility is, in this
  cafe, direct, and  in the former indirect; under  which
  the funftions 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 effect (n).
    CCXCII. Such  a temperature  as that is fuited to eve-
  ry ftate of the body, but ftill more to its different ftates of
  debility ;  becaufe in the latter  cafe, as  the excitement is
  deficient from other fources, there is fo much more occafi-
  on for this  ftimulus, which is much eafier come at than
  many others, to fupply  fuch deficiency.    Hence both in
 other difeafes of great and direct debility, and particularly
 in fevers, heat is found to be of the greateft benefit, and a-
 bove all others in all fuch complaints of that kind as cold
 has had any fhare in  producing (o).   In the fame difeafes
 cold muft be moft carefully avoided, as it is always of a di-
 rectly debilitating  operation, and never of fervice but in
 fthenic difeafes, and thofe that are in a progrefs to indirect
 debility(p).  We muft be equally on guard, in every de-
 gree of afthenic diathefis, againft exceffive heat ; which is
                                                  equally

   (m)Orbenumbcd ftate.
   (n) It is plain, that though all the other powers fhould be in full adi-
 on upon our  bodies, and that  with the effed of keeping  up in them a
 due degree of excitement over all ;yet plunging any perfon naked into a
 denfe medium, fuppofe that of water, in a degree of cold at or under the
 freezing point, will moft certainly, in an inftant, put an end to life.
   J.o) See again, par. CCLX.
   (p) The operation of  cold has been fo widely miftaken by all phyfici-
 ans, that it comes to be of the greateft confequence to undcrftand the fe-
 veral propofitions dated in this work with regard to it.   For that pur-
pofe confult par. XXXVll. and the note upon it marked fl, as well as
par. CCLX. and all that has  been faid upon the fubjeds of either heat
or cold in Chap. I. of the fecond Part  from CXII. to  CXXIIL as
 alfo par. CXX. 
           OF   MEDICINE.          r§9

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

  (q) With this propofition compare par, CXV. CXVII. and CXVHI.
  (r) See par. CtLXXXIII.           (s) See par.CCLV.
  (t) See and compare, for the more clear underftandir!~ of this para-
traph, the CCLXVI. CCLXVIII, CCLXX1IP, 
l$0      THE   ELEMENTS
   CCXCVI. When the belly is ftill, loofer and with that
*ffe£bed with gripes and pains, as happens in the violent
diarrhoea, and in the dyfentery, in which the loofe ftools
are accompanied with vomiting ; or when, without thefe
troublefome fymptoms affecting the belly,  diftreffing vo-
miting is an urgent fymptom;  or, when the vomiting is
conjoined with a moifture upon the furface, or macerating
fweat; or when fweat is the only urgent fymptom, and as
fuch waftes the ftrength, exhaufts the body, and diffipates
the fluids : in all thefe cafes, we muft have immediate re-
courfe to the moft diffufible  ftimuli,  and  check fuch an
impoverifhment of the fluids of the fyftem.
   CCXCVII.  In which cafe, the ufe of  ftimuli  will be
fo much the more neceffary, that other fymptoms ufually
accompany thofe encreafed excretions.  Their great effi-
cacy, and ftimulant power, is proved by their Angular vir-
tue in removing thofe and other fymptoms, in fevers and
other moft violent fthenic  difeafes, nay, in the article of
death itfelf, from ultimate debility.
   CCXCVIII. Accordingly, in fpafms and convulfions
in the internal, in the external,  parts (u) in bleeding dif-
charges (x) in the direful delirium of fevers,  and other
very violent difeafes (y),in afthenic inflammation (z); when
thofe ftimuli which have a more permanent influence fail,
or act  to no good  purpofe ; the virtue of the diffufible
ftimulants, the principal of which is opium, is eminent.
   CCXCIX. As, therefore, the energy of that ftimulant
virtue ferves to check loofenefs of the belly, and vomiting,
or even fweating,  when thefe fymptoms are gentle, and
depend upon a lefs violent degree of the caufe ; fo that de-
                                                gree

  (u) See par. CXCV, and CXCVI.
  (x) See par.  CXXX1V. x> t- and CCXXXII.  and the fubjoined
lit-tes.
  (y) See par. CXCVIII. CC. CCI.  (z) See par. CCIV. to CCXII. 
           OF   M E D  I C  I NE  .          I£I

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

  (a) See above, par. CXXVI. o. ir. p. c.
  (d) They are animal foups, and folid meat (CCXC.) heat, (CCXCI.J
ftimulants (CCXCV.) diffufible ftimulants (CCXCIX.)
  (e) See par.  CCLXXXIV. 
tgi       THE  ELEMENTS
   And, as in great debility,  and the  difeafes depending
Upon it, of the only fuitable matter, that is meat, nothing
folid can be taken ; for that reafon, the matter to be ufed
muft be fluid, but ftrong.  Animal foups  fhould be given
fparingly at  a time, but repeatedly, in proportion to the
degree of debility, and jellies both along with the diffufible
ftimuli.  After that, when,  chiefly by means of the dif-
fufive ftimuli, the ftrength is in part reftored ; at firft  folid
meat, likewife in fparing quantities, but often repeated ;
then given more plentifully, and at greater intervals, fhould
be taken.   In which progrefs the patient fhould gradually
recede from the ufe of the diffufible ftimuli.
   CCCIII. When now the diffufible ftimuli are  altoge-
ther laid afide, and the convalefcent is given up to his ufu-
al diet and manner of living, and that management, which
perfons in health commonly obferve, (only  that more  care
is taken than in perfect health,to avoid any thing that might
prove hurtful) ;then it is,thatevery attempt of the phyfician
fliould be directed to the confideration  of the ftrength of
his patient, as returning, but not yet quite  eftablifhed (f).
In his movements  he fhould firft ufe geftation, and then
gentle  but  frequent exercife, and the latter fhould always
end in fome, but not an high, degree of fatigue. His  fleep
fliould neither be too long, nor too fhort,  left the former
produce direct, the latter indirect debility  (g) : the moft
nourishing  food fhould be taken, but not  in too great  a
quantity, left the excitability  of the ftomach be worn off,
without the attainment of a due degree of vigour; but it
fnould be o ften taken, in order to reduce  the excitability
gradually, which only ferves to produce propervigour, and
reduce it to its half wafted ftate (h) ; that  degree of heat,
which ftimulates, fliould be employed (i), and both excefs
of it, as well as cold, as they are equally debilitating, fhould
                                                   be
 (!) Seeab.ve.par.CV. and CIX.  (g) See par.CCXLII. andfcqucnt.
 (h) Sec above the XXIV. XXV and XXIV.     (i) Sec par. CXII. 
OF   MEDICINE.
*93
 be avoided;  the patient fhould breathe pure air, and avoid
 impure; he fhould keep his mind in gentle action, obferve*
 moderation in his paffions, and court agreeable objects of
 fenfe ; he fhould have no companions, around him, but a-
 greeable ones, and be in frequent gay entertainments; he
 fhould travel through a pleafant country, and be moderate
 in love. Neither is the management of the fenfes, and any
 return of contagious  matter to be neglected.


              c   ii   a   p.     xr.

            How the  RemediesJhould be varied^

   CCCIV. AS the hurtful powers, that  produce predif-
 pofition to difeafes, or difeafes  themfelves,  afl fome on
 one  part, fome on another, with fomewhat more force than
 on any other equal part; and as fuch a part is commonly
 that which they directly affect (a);  fo the powers,  which
 are employed as remedies, in order that their general effect
 may reach the whole  body with the more certainty, fliould
 be in the fame manner,  differently  applied to  different
 parts.
   CCCV. The cure  of  any fthenic difeafe  whatever, is
 improperly entrufted  to bleeding alone, though that is one
 of the moft powerful of the debilitating remedies.  And
 the reafon is,  that, though the excitability is  fufficiently
 reduced by that remedy in the greater blood-veffels, per-
 haps too much, yet in the extremities of thefe, as well as
 in the reft of the body,  it is not fufficiently reduced (b)»
                            O                    Nor

  (a) Par.  XLIX.
  (b) The adion of every  exciting power,  whether falutary or hurtful,
or curative, always extends over the whole body, the whole feat of ex-
citability, but ftill with the inequality mentioned in the fourth Chapter
*>:' pirt firft.  This is the bafi6 of the diftindion with refped to the pre
                                                    fent 
 1^4       THE   ELEMENTS

 Nor is the alternation of bleeding with purging a  perfect
 fort of cure ; becaufe, though the exceffive excitement be
 fufficiently, and more than  fufficiently,  removed in the
 greater bhood-veffels, and in the innumerable fmall ar-
 teries whether exhalent or mucous,  which difcharge their
 fluids into the inteftines; yet, neither on the perfpiratoy ter-
 minations of the arteries,  nor on the reft of the body,  is
 an  equal debilitating energy exerted : for inftance, the
 fmall veffels which open into the ftomach, are not fuffici-
 ently relieved of their diftending(c)load. And although vo-
 miting (d), which has been improperly left out of the cure
 of fthenic difeafes, and ftill more improperly employed  in
 every one of the afthenic, fliould be conjoined with the two
 remedies juft  now mentioned, even  that would not be  e-
 nough to produce an equality of diminifhed excitement;
 as there would  ftill  remain in the perfpiratory veffels, the
 fame  ftate of the excitement, which has been mentioned,
 as in  the  reft of the body, that is not vafcular.   In vio-
 lent fthenic difeafes,  therefore, after diminifhing the dia-
 thefis, and in  the flighter  from  the beginning of  the dif-
 eafe, the addition of the operation of fweat to the evacuati-
 ons that have been fpoken of, will produce a more equal di-
 minution  of excitement,  a more perfect folution of the
 difeafe.  For by means of this evacuation,  not only from
 the larger blood-veffels, in the interior parts of the body,
 but from an infinity of outlets  both of the external, and
                                                  internal

 fent fubjed : which is, that/ as every power ads moft effedually on  the
 part where its  adion  is  immediately exerted, it is better to trufl to a
 number, every one of which poffeffes that advantage, than rely on any
 one, however powerful  otherwife ; as by that means, whatever be  the
 indication, whether it be to encreafe or diminifh excitement, the effed
 will be more equally produced over all in confequence of there being a
 number of parts that have had a ftrong adion exerted upon them.
  (c) And therefore ftimulating load, the  ftimulus in any veffel being
the  quantity of its fluid.
   (d) See par. CCLXJX. 
              OF   MEDICINE.         19 j

 Internal furface of the body, an immenfe quantity of flu-
 ids, every where diftending, and, thereby, producing a ve-
 ry great fum of excitement, is withdrawn.  But the mat-
 ter ftops not even here. For, fince in flight fthenic affecti-
 ons much nourifliing food, and in them all, too much, can
 be taken; the confequence of that muft be, that, however
 much the quantity of the blood and other fluids has been
 diminifhed,  if the food, which is the only power that  can
 produce blood, continues to be taken, all the veffels, in
 proportion to the  quantity that  has been taken, will  a-
 gain go on  to be filled,  and! to-be fired  with the fuel of
 exceffive  excitement.  To prevent which inconvenience,
 and to diHiinilh excitement, ftill with greater equality over
 the fyftem;  abftinence, or an allowance of vegetable mat-
 ter in a fluid form,  and watery drink, will have a very
 great effect.  But neither does the matter end here*  For,-
 if, after taking all the precautions  and fecurities that have
 been recommended,  the degree of heat, that proves  hurt-
 ful from its  ftimulus, be allowed to approach the external
 furface of the body;  it will produce another inequality of
 excitement,  however much that may have been properly
 and equally diminifhed by the other means  of cure. Where-
 fore, as the fthenic diathefi.i depends fo much upon the  fti-
 mulus of heat,  directly affecting the fkin (e),  and is,  on
 that account, prevalent in  the ikin  in preference to  other
 parts; to make fure of rendering the diminution of excite-
ment as equal as poifible,the debilitating effect of cold fliould
 be oppofed to the high degree of excitement,which the heat
 has produced. When, at laft, all the directions, which have
 been fo fully pointed out, have been executed, ftill to  re-
 produce the equality of excitement, fuited to good health;
 it  remains,  that we  be on our guard againft the ftimuli
 that arife from the intellectual functions and paffions. For,
                         O  2                       as
(e) See par. CXU1. 
 196      THE   ELEMENTS.

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

  (f) See  par.  CXXXVIII.  CXL.
  (g) As  the moft healthy ftate of man is occafioned not by the  opera-
tion of any one, or of a few exciting powers, but by the united operation
 of them all; fo neither is its re-eftablifhment to be effeded,  but by the
fame united operation of all the remedies,  the laft of which come to be
 the ordinary means of the fupport of the healthy ftate.
  (h) See  par. XC.  (i) See  par. CCCIV. to CCCVII. the prefent one.
  (k) See par/XCI. 
              OF    MEDICINE.        197

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

  (m) See par. CCCI.
  (n) as that of pure air, exercife, the ftimulus of the motion of the
food and other fluids in their refpedive veffels.
  (o) See par, CCCJi". 
 I98      THE   ELEMENTS

 ble  ftimulus, fuppofe any preparation of opium, fhould
 be adminiftered, and the little animal food, or meat,  that
 there is any  appetite  for, and that can be taken and di-
 gefted,  fhould be added.  The idea of giving food is evi-
 dent from the  late explanation given about  foups  (q).
 But, the ufe of the more durable, and lefs diffufible, fti-
 mulus  depends on this, " that when the  excitability  is
 worn out by any one ftimulus, any new ftimulus finds ex-
 citability, and draws it forth,  and thereby produces a
 further variation of the effect.
   CCCX.  Hitherto the ftimulus of the motion, by which
 all the  mufcles, which, from their fituation on  the  fur-
 face of  the body,  by their contractions propel the blood
 along the veins to the heart, are thrown  into aftion, has
 not been fupplied (r); and, therefore, both upon account
 of the  emptinefs of the veffels, and the flow  circulation
 from the want of  that impulfe,  the  excitement  is not
 fufficiently aroufed over all that tract.  After the ftrength
 has,  then, been fo recruited, that  rich food can now be
 taken, the body can now be roufed,  firft  by foreign,  then
 by its own organs, of which the former is called geltation,
 the latter exercife, and alfo refrefhed by air; when all that
 has  happened, then it is, that the excitement is further rai-
 fed  in  feveral points, and becomes  more equal  upon the
 whole,
   CCCXI.   The laft ftimuli to be mentioned, which,
 along with thofe already mentioned, have a natural tenden-
 cy to produce an equalization of excitement over the whole
 fyftem,  arife from the action of the mind, the energy of
 paffion  or emotion,  and a ftill greater purity of  air,  than
 is attainable by perfons fhut up in  a room (s).  In this
                                                  ftate
   (q) Seepar.CCCVIII.
   (r) See par. CXXXVIi. *.£. y. *. CCLXXIII. CCC1II.
   (s) See and compare with thefe laft mentioned ftimuli the following
paragraphsCCLXXV,  CCCLXXVUI, CCLXXlX. Tf 
              OF   MEDICINE.           199

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

  (t) The convalefcent ftate from either of the two general forms of
 difeafes, or from local ones, the effed of which had drawn the whole fyf-
 tem into confent, is much the fame ; being a ftate of fome remaining de-
 bility in all; in the fthenic from the excitement either going too low,
 by the  remedies being pufhed  to fome  excefs, or not equally  diffufed
 over all the parts in confequence of the natural fupports only beginning
 to be brought fully into play ;  in the afthenic from the perfed point of
 health  being not quite  gained, either from the ftimulant remedies not
 having been carried exadly up to 40, or from fome of them having
 been carried further than the wafted excitability could receive them with
 invigorating efFed, and thereby an inequality left upon the whole.  The
 convalefcence, from the general effeds upon the conftitution fometimes
 arifing from local difeafes,  is to be explained  upon the principles laid
 down, with refped to the two  other cafes of convalefcence.
  (11) Celfus fays, ars noftra conjeduralis eft.  And every man of fenfe,
 whether of the profeffion, or out of it, has held the fame fentiments of
it.  Nothing 'u more glaring than the contradidions in medical writing*
 aud 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 nil the parts of the detail,  while they refled on it, both illuftration
 and confirmation, be entitled to be confidered as a fcience, the reader is
 defired to confider, how far that criterion wiil apply to this dodrine.
The pedantry rf mathematicians has contributed as much tr> bring their
fcience into difgracc, as any other circumtlance, particularl/ in allowing
 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 de-
                                                      partKi;!!,i 
200      THE   ELEMENTS

fiftent with itfelf,  altogether incoherent, is  now reduced
to an exact fcience,proved not by mathematical principles,
which is only one kind of probation, but by phyfical ones,
and 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 ail upon living Bodies,
     is the fame, that that of the Remedies is alfo the fame.

   CCCXII.  As it is found certain, and proved,  that the
common effect of all the exciting powers  is precifely the
fame, to wit, the production of the phenomena peculiar to
life,  that is, that fenfe, motion, intellectual operation, and
paffion and emotion, are the fame;for what elfe is the ef-
fect of heat,  of food, of feafoned food, of drink,  of the
blood, of the colourlefs fluids fecreted from it, and  of the
air, among external bodies ; what elfe in the functions of
the living body itfelf, is the effect of mufcular contraction,
of thought, of the paffions, and of fenfation, but to excite,
preferve, and continue as the fuftaining caufe of thofe
functions in  common to animals ?   And, as it is from
that  evident, that the operation  of all  the fame powers is
alfo the fame; (for it muft be granted, that the fame caufe
by an univerfal law in nature, tends to the fame effect (a);
and further, as the operation betwixt caufe andeffect depends
                                                   upon
partment 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 fenfe are not deranged,  what
will they make of their own axioms ? They muft admit of other proba-
tion ;  while human reafon holds its reign, truth and falfhood will  be
difcriminated, without regard to fuch empty and ufelefs prepoffeflioiw,
  (a) See par. XX, with the annexed note 
OF   MEDICINE.          201
upon ftimulating (b), and that ftimulus produces  all the
phcenomena of life, health,  difeafe, and thofe intermedi-
ate  degrees  between both,  which are called predifpofi-
tions (c);from thefe certain and demonftrated facts it fol-
lows,  and muft be admitted, that the operation of the re-
medies, both in fthenic and afthenic difeafes is the fame.
For,  if there is no difference betwixt health and fthenic
difeafes, except an excefs of excitement in the fetter, and
none  betwixt the  former and afthenic difeafes,  but defi-
cient excitement in thefe laft, what elfe, can the operation
of the remedies, to remove fthenic difeafes  be, but to di-
minifh, and of thofe that remove the afthenic,  but to en-
creafe the excitement (d).
   CCCXIII. Whatever thing  produces the fame effect
as another, or feveral things, it muft be the  feme thinor aj
each of them, each of them the fame thing as it, and every
individual of them the fame thing as every other individual.
   £.  In fthenic difeafes,  bleeding (e), vomiting, and pur-
ging (f), fweating, abftinence (g), reft of body and mind (h)
tranquility with refpect to paffion, all thofe reflore health
by nothing elfe but a diminution of excitement.
   CCCXIV.  In  afthenic  difeafes,  the   adminiflration
firft of diffufible ftimulants,  for the purpofes of gradually
bringing back the appetite for the greateft remedy,food,as
well as keeping the food upon the ftomach, and of affifting
in the digeftion of it (i), then the application of heat (k),
then  the ufe of thelefy diffufible and more durable ftimu-
lants  as animal food,  without  and with feafoning, wine*.
geftation, gentle exercife (1), moderate fleep, pure air, ex-
ertion of mind, exertion in p.iffion and emotion, an agree-
                                                 able

  (S) Sec XIX and XXII           (c) See XXITI.
  (d) See LXXXVIII.              (<0 See LCLXXXI.
  (f) : tl- CC XXXIII.             (c) Sce CCLXXXIV.
  (h) See CCLXXXV.              (0 *cc CCXC1V. to CCCII.
  (k) See CCCII,                  O See CCCII. CCCIII. 
 202       THE  ELEMENTS

able exercife of the fenfes, all thofe reproduce health, by no
other operation, but that of only  encreafing excitement,


             CHAP.    XIII.

That all the Powers, which fupport any Sort of Life, or ths
     fundamental Principal of Agriculture, are the fame.

   CCCXV. AGAIN, are not the powers, which produce
perfect health, the  fame as thofe, which, by  an excefs of
force, produce, fthenic difeafes; by a deficiency of force,
afthenic, as well as the predifpofitions to both, are they
not the fame, with  no other variation  but  that  of de-
gree (a)?
   CCCXVI.  Further,  as  we learn from the whole doc-
trine delivered above, the hurtful exciting powers, which
produce fthenic difeafes, are the remedies of afthenic; and
thofe which  produce the latter,  are the  remedies of the
former (b).
   CCCXVII. All  the  powers,  therefore,  that fupport
any ftate of life, are the feme in kind, only varying in de-
gree;  and the propofition is true, of every fort of life, to
its full extent over the animal creation.
   Such is the life of animals (c).   Concerning which, all
that has been  faid applies to the life of vegetables.
   CCCXVIII.  Accordingly,  as animals, in every ftate
of life, have their  exciting powers (d) in predifpofitions
and  difeafes, their hurtful exciting powers (e) in the cure
of both thofe, their indications, and remedies adapted to
each (f); all that,  in every refpect,  is precifely the cafe
in plants.
                                             CCCXIX.
 (a) Sec XXIII. LXXIII. (b)See LXXXIX. XC. XCI. XCIII. XC1V.
 j(c) See from X. to XIII. iuclufive.         (d) See LXII. LXVII.
LXVIII. LXIX. LXXIII. CXII. to an CXLVII.
 (e)  See the  fame.      (f)  Sec LXXXVIII, LXXXIX. XC, XCI, 
              OF   MEDICINE.          20J

     CCCXIX. The powers that fupport plants,  in  every
  ftate of life, are heat,  air, moifture, light, fome motion,
  and their internal juices.
     CCCXX.  The action of plants alfo confifts in  ftimu-
  lus (g);  by means of which, the phcenomena peculiar to
  that fort of life, fenfe, fome motion, and verdure, are ex-
  cited : and the caufe of this ftate is excitement, an effect in
  common to all exciting powers (h).
     CCCXXI. Nay, in this cafe too the exciting powers,
  when applied in due proportion, produce health; but their
* too great or too fparing action occafions difeafes,  or pre-
  difpofition to difeafes; of which the former depend on an
  exceffive,  the latter upon a deficiency of ftimulus.   Ac-
  cordingly, excefs or fcantinefs of moifture, exceffive heat
  or cold, by an equality of hurtful operation, lead  to dif-
  eafe and death, indirectly or directly.  And, as the rays of
  the fun or  darknefs,  when  their operation is either too   v
  great, or too long continued,  prove debilitating, the for-
  mer  indirectly, the latter directly ; fo  the^ alternate fuc-
  ceffion of night to day,  of darknefs to night, feems to be
  the effect of an intention in nature, to prevent too great an
  effulgence of the light of day, or too long a continuance of
  it, from ftimulating either in excefs or in ultimate excefs,
  and thereby inducing fthenic difeafes, or thofe of indirect
  debility ; or to  prevent an excefs, or long continuance of
  darknefs from producing direct debility, and the difeafes
  peculiar to it (i).
     CCCXXII.  Nor  do plants   want their excitability,
  which, equally as in animals,  "  is not different in diffe-
  " rent parts of its leaf; nor is it made up of parts, but one,
                                               " uniform,

     (g)  See XVII. XIX. and notes.         (h) See Part I. Chap. II.
     (i) Chap. IV. We have no lefs proof,  than that of the univerfal feel-
  in"- of mankind, of the truth of what has been advanced, with refped to
  the ftinvulUB of light and the debilita::;^ effed of darknefs. 
 204         THE  ELEMENTS

" uniform,undivided,property over the whole fyftem (k)."
The effect of which is, that, to  whatever part of a plant
any exciting power is  applied,  its operation,  whether in
excefs, in due proportion,  or in under-proportion,  im-
mediately affects the excitability over the whole.
   CCCXXIII. This effect is alfo produced with the fame
inequality as in animals, being, for  inftance, greater in any
part to which its exciting power is directly applied, than
in  any other equal part.  And,  as there are two reafons
for that fact in animals, the direct impreffion of the pow-
er  upon the  part more affected, and a greater energy of
the excitability of a part or relation to which it is fo applied,
than on that of any other  equal part (1);  the very fame
is the  faft with refpect to plants.  Further, as the exci-
tability bears a greater relation to  the impreffion of the
exciting  powers,  on the  brain,  the ftomach, and inte-
ftines,  than on any of moft of the other parts ;  fo the part
in plants,  that  correfponds  to thefe parts, is  the root,
which is affected  in the higheft  degree by the exciting
powers.   It is the root of plants,  in  preference to  any
of their other parts, to which the conflux of  moifture is
made.   The heat there is the beft, which is neither  ex-
ceffive, and therefore  liable to produce  fthenic affection,
nor ultimately exceffive, and therefore ready to induce in-
direct  debility (both which difadvantages are prevented by
the depth of the ground); nor deficient, or what is called
cold, which would bring on  direct debility (m).
   CCCXXIV.  But the only ufe of the  foil, through the
pores of which the powers that  have been mentioned pe-
                                                netrate,

  (k) See Part I. Chap, IV.    (1) See XLIX. and addition L. LI.
  (m) Hence it would appear, that it ihould be a general rule in plough-
ing and harrowing to adapt the depth,  where the feed is to be laid, to
the ftate of the furrounding temperature.  It would feem, when other
circumflances are equal, that the feeds of plants may more fafely lie fu-
perficially in warm than in cold countries.  The fame fad feems to be
favoured by the difference of perfedion that planted and natural woods
                                                  artain, 
             OF  MEDICINE.         205

 netrate, is to furnifh that fort of a ftrainer, by which the
 powers may neither, from  the pores  being too patulous,
 go down in too great quantity, and produce firft a fthenic,
 or too luxuriant a ftate of the plant, and then indirect de-
 bility; nor, from the contractednefs of the pores, be in-
 fufficiently admitted  to the  root, and occafion indirect-
 debility, or the decaying ftate cf a plant.   But that the
 foil is not otherwife neceffary to the produdf ion of fome de-
 gree  of vegetable life, is proved  by plants often living, to
 a certain degree, in pure  water.  That however, it is
 ufeful as a filter, is proved by the good effect of ploughing,
 of breaking the clods, of dividing the tough clay by lime
 and  other abforbent earths, and by  thefe means relaxing
 the pores : On the other hand, we have proof of the fame
 thing in the fuccefs of  contracting the pores by  making
 ground, naturally too friable, more tenacious with dung,
 and covering light ground with rags and ftones, and there-
 by keeping in  both  heat and moifture.
   CCCXXV.  From this view of the facts, the reafon is
 evident, why  every fandy as well as clay foil, when the
 former has not  received, and the latter parted with its
 toughnefs, is barren and unfruitful.  Hence it is that very
 hot fummers and countries  are hurtful to clay grounds, by
 fhutting up the pores ; and ferviceable to friable and lean
 grounds, by diminifhing their porofity.  Hence, dry fea-
 fons  are fuitable to low-lying rich grounds, which, from
 all quarters, condu6t a quantity of moifture around the
 roots of the plants ; while rainy  fer.fons are thofe that an-
 fwer  in grounds that are high and of a thin foil. Decli-
 vities facing the north,  which are commonly of a thin and
 poor  foil, are cherifhed and protected by hedges and clumps
                                                    of
attain in cold countries; the former, the feed- of which are lodged in a
certain depth, turning to better account than the latter, which rife from
feeds that have randomly been  frattere.l upon the furface.  Might not
the hills in the weft of Scotland, upon foaic fu.h principle, be made ufc
 fid oak for efts ? 
206
THE   ELEMENTS
 of trees, and a great number  of bare ftones, covering
 every thing, which fome perfons, of more  induftry than
 fenfe, often remove with hurtful effect ; their good effect
 being to give he.tt and keep  in moifture.   But in thofe
 places, the declivity  of which  looks towards the fouth,
 there is not equal occafion for fuch protection from cold
 and drynefs, as they, from their more happy fituation, .ire
 cherifhed by the fun, defended  from the cold winds,  and
 expofed to thofe which blow from the  fouthern poiata
 that are feldom too dry (n).
   CCCXXVL To return from this digreffion on agricul-
 ture to our proper fubiect; from what has been faid upon
 the cultivation and nature of plants, we learn, that their life
 is fimilar to that of animals ; that every thing vital in na-
 ture is governed by excitement, which the exciting pow-
 ers only afford; that there is in no living,  fyftem, whe-
 ther of the animal  or vegetable kind, any  inherent power
 neceffary to the prefervation of life ; that the fame powers
 which form life at firft, and afterwards fupport it, have
 at laft a tendency  to produce its  c'llfolution ; that life,
 the prolongation of life, its decay and death, are all ftates
 equallynatural; that every living fyftem lives in that which
 it procreates ; that the generations of animals and  ve-
 getables are in that way renewed, that the fyftem of nature
 remains,  and maintains an eternal vigour;  in one word,
 that all the phcenomena of nature are fabricated  by  one
 fingle organ (o).
                                                 There
  (n) While the northern winds, that i<, the wind due  north, and all the
intermediate ones in every point of  the compafs from due eaft to due
weft, are cold and dry, and commonly of a tendency to bring fnow ; the
fouthern, or the winds that blow frnni any point of the compafs toward*
the fouth, from the fame points of due eaft to due weft, are as common-
ly warm and moift, and often produdive of mild fertilizing rains.
  (o)  No difcovery, of any importance cr extent over nature, has yet
been made, that does not warrant, as far 38 the fmallnefs of the number
of fuch difcovefies go, the truth of this affertion. See the Introdudion
to rsiy ObfeivatUras, 
             OF   MEDICINE.        207

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

       OF   GENERAL  DISEASES.

THE  FIRST  FORM,  OR  STHENIC  DISEASES.
             C   H   A    P.     XV.

   CCCXXVIII.   IN every fthenia,  in all fthenic dif-
eafes, in the whole firft form of difeafes (a) an univerfal
criterion is encreafed excitement over the whole fyftem,
evidenced, during the predifpofition, by an encreafe of
the functions of body and mind (b), and  demonftrable,
after the arrival of difeafe,  by an encreafe of fome of the
function;., a difturbance of others, and  a  diminution of
ethers; in fuch fort, that the two latter are eafily per-
ceived to arife from the hurtful powers that produce the
former, and to depend upon their caufe.  As by that com-
mon band of union the difeafes of this form  are connected
together ; fo
   CCCXXIX. There are certain circumftances, by which
they are diftinguifhed by a difference cf their degree : for,
there  are fome fthenic  difeafes,  accompanied with py-
rexia (c) and the inflammation of fome external part; there
are others without the latter of thefe,  and others without
both.
                          2                CCCXXX.
  (a) See above par. LXlX. LXXXVIII. CXLVill. CLI. CCLI. Chap.
IX.               (b) See par. CLI. throughout.
  (c) See par. LXVIII. and the fubjoincd note, for the meaning of py-
rexia, which will be juft now repeated, 
                OF   MEDICINE.        $09

    CCCXXX.  The general  fthenic difeafes,  with  py-
 rexia and inflammation,  are fome of them called phlegm*
 afras, others exanthemata.  But they will all, without dif-
 tinction, be treated here according to their rank in excite-
 ment, from the higheft to the loweft degree of excitement.
    CCCXXXl. The phlemafix and exanthematic, difea-
 fes have the  following   fymptoms  ia common to them.
 The firft of thefe is that degree of fthenic diathefis,  that
 diftinguifhes predifpofition (d). This diathefis upon the for-
 mation of, the diicaie, is fucceeded by fhivering,  a fenfe of
 cold, languor, and a certain feeling like that which we have
 in fatigue from labour, called by phyficians, laffitude.  The
 pulfe at firft, in every cafe, and in  mild ones  through their
 whole courfe is moderately frequent,  and, at  the fame time,
 ftrong and  hard ; the fkin is dry,  and there is a retention
 of other excretions .(e): The urine is red;  there is great
 heat and often thirft.
    CCCXXXII. The fymptoms peculiar to the phlegma-
 fiae (f),  are an inflammation of  .-m  external part, or an
 affection nearly allied to it ; while the general  affection,
 for the moft part, precedes  this  local one, and never  fuc-
 ceeds to it (g).   This general  affeftion, for the  greater
                             P                convenience

   (d) From the firft  deviation from perfed  health to the commence-
 ment of adual fthenic difeafe, the  fthenic  diathefis takes place in an en-
 creafing fcale from 400 to 550.
   (e.) Such as that by the belly, and that which pours out the faliva and
 mucus,, and forms the matter of expectoration.
   (f) The phlegmafix are fthenic difeafes, accompanied with inflamma-
 tion 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 in-
flammation, wc therefore  pay  no regard to  the diftindion ; and fhall
regard nothing either in thefe or any other difeafes, but what is conftitu-
ted by a real dirTerence of excitement.  It is  the excitement by which
•Te are to be guided through our whole diftribution of difeafes.
  (g) Long bei'ore any part of thisclodrine was difcovered,  when  I was
                                                        in 
2J0
THE   ELEMENTS
convenience of diftinguifhing it from fevers, is to be de-
nominated  pyrexia (h).   In  the exanthematic  fthenic dif-
eafes, an eruption of fpots or  puftules, more or lefs crowd-
ed,, according to the degree of the diathefis, covers and di-
verfifies the fkin.  The eruption appears upon the occafion
c3f a foreign, contagious matter, having been taken into the
body,  and detained below the cuticle.
   CCCXXXIII.  The explanation of  all thofe fymptoms
eafily flows from the doff rine delivered above.   The fthe-
nic diathefis in the manner, that has been fb fully explain-
                                                           el

in fearch of certain fads refpcding peripneumony and pleuritis, I difco-
vered  one which I was not looking for,  of more importance than all the
reft put together.  It had been afferted, by  moft fyftematics and all the
nofologifts, that the primary fymptom in the phiegmafi* was the inflam-
mation of a part. I faw that was not true with refped to rheumatifm,
in which the general affedion or pyrexia often rages one,  two, or three
days before the fign of inflammation, pain, is perceived in any  of the
joints.  I could alfo difcern, that from the moment the pain and inflam-
mation appeared hr eryfipela*,  or the rofr,  there was alfo the general af-
fedion equally confpicuous,'  In fhort, in no one of that fet of difeafes,
did the fad appear that the inflammation was primary, and the pyrexia,
or affedion of the whole fyftem dependent  upon it.  .But  as peripneu-
mony was faid in Edinburgh to be an exception, the  detedion I made
equally difproved that.   In all the works of Morgagni, where peripneu-
mony and eryfipelas are treated,  and in all thofe of Trillerus, a profeffed
writer on tint fubjed, and in a thefis  in  Sandifort's  Thefaurus, taken
from no lefs than 4O0 cafes of that  difeafe (for they arc now by others,
as well as me, confidered as one),  I found that in fomewhaf more than
one-half of the given number, which was very  refpedable, the  general
affedion appeared from one to three days before the pain came on, and
in all  the reft of the cafes that, though for anything thtfe authors faid to
the contraiy, they might fometimes have come on together, yet, there
was not one, in which it could be fairly allcdged, that the pain was the
firft and primary appearance.   Hence I  found, that all the theories raif-
ed upon that hyporheGs of courfe fell to the ground.  Indeed the  f'd
is quite confiftcnt with every one here.
  (h)  Ofthisdefignition warning has been given more than oncc^  See
nitcatCCCXXIX. 
Or   MEDICINE.          211
cd (i) precedes.   The characteriitics of the  pulfe are ne-
ver to be referred to the affection of a part,  having been
demonftrated to arife from the diathefis (k).
   CCCXXX1V.  The frequency of the pulfe in  fthenic
difeafes is moderate, becaufe, while the ftimulus in the fyf-  .
tern cannot fail to produce fome frequency,  the quantity
of blood,  to be thrown into quick motion, fets bounds to
it and prevents its riling to quicknefs.   But,  at the fame
time, it is evident, that a quantity fo great cannot be tranf-
mitted  with the fame celerity, as an under proportion (1).
'fhe ftrength of the pulfe is occafioned by the degree of ex-
citement in the moving fibres of the veffels, which is com-
monly  called their tone,  and by that of their denfity con-
fidered as fimple folids (m).  The hardnefs of the fthenic
pulfe is nothing  elfe, than the continuance for fome time
of each ftrong contraction, clofely embracing a great co-
lumn of blood, and,  thereby,  as it were,  refembling a
ftretched rope (n).
                         p 2                cccxxxv.

   (i) 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.
   (1)  In fevers and other afthenic difeafes of great debility, from the
weaknefs of the ftomach and other digeftive organs, and the fmall quan-
tity of nutrient matter taken iu, the quantity of blood which is diminifh-
ed in every one of thofe difeafes, cannot be more than one third lefs than
that which overfills the veffels in  fthenic difeafes.  Confequently, by a
given power, it may be propelled in the fame proportion,  that is, one-
third fuller than in the fthenic difeafes, which alfo appears in fad ; for
vhile ioo beats in a minute is a frequent pulfe in fthenic difeafes, till
their approach or actual converfion to indired debility, the common
frequency in fevers and the other hi*h afthenic difeafes, is ijo beats in
the fame time.
   (m) Sea above LlX. LX and LXI.
   (n) See par. CLV.  If it fhould he alledged, that, though in fevers
jnd the other cafes mentioned juft now  in the note (a),  the deficient
qiMtitity cf blood to be pnt in motion will account for  the greater cele-
                                                         rity 
212       THE    ELEMENTS
   CCCXXXV. That this is  the exact  ftate of the  arte-
 ries is proved by the great  quantity of food taken with a
 good appetite, before the arrival of the difeafe, and du-
 ring the period of predifpofition; it is proved by the fame
 and other powers,  giving an unufualiy great excitement
 over the  whole fyftem (o), and, therefore,  among their
 other effects encreafing the digeftive energy; and it is pro-
 ved by evacuant,  with other debilitating  remedies,  both
 preventing and removing the difeafes.   The confounding,
 therefore, this ftate with one diametrically  oppofite (p),
 which has hitherto been  an univerfal  practice, was a very
 capital blunder, and  could not mifs of producing the worft
 confequences,  by equally perverting  the theories and ac-
 tual practice of the art.
                                              CCCXXXVI.

 rity cf motion, than in the difeafes which make the prefent fubjed;  ftill
 the great weaknefs of the heart, for want of the ftimulus of a due quan-
 tity of blood, as well as  of many others, fhould  overbalance the effect
 arifing from the fmall quantity to be moved.  But  the anfwer to that
 objedion 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 effed.  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, yrt the impulfe communicated upon the whole
 is one third lefs,  as the charaderiftics of both kinds  of pulfe readily ex-
 plain to us.
  (o) See the whole of the firft Chapter of Part II.  upon the powers
 producing fthenic diathefis.
  (p) Which authors and too many praditioners have univerfally done,
in jumbling proper fevers with the prefent difeafes, under the vague and
falfe denominations of febrile  or feverifh difeafes.  In nofology the fy-
nochrs  is conjoined with  typhus,  the gangrenous fore-throat, which i«
a typhus fever, with the common fthenic inflammatory pyrexia. 
OF   MEDICINE.           213
  CCCXXXVI.  The fhivertng and fenfe of cold depend
for  their caufe upon the drynefs of the fkin. The languor
and feeling of laffitude point out a higher degree of excite-
ment in the brain and fibres of the  mufcles, than can be
conveniently borne by the excitability, confined within
certain boundaries (q). They are therefore functions im-
paired from a ftimulant, not from a debilitating caufe (r).
  CCCXXXVII. The drynefs of the fkin  is occafioned
by the great excitement and denfity of the fibres that en-
circle the extreme veffels,  diminifhing their  diameters to
fuch a degree,  that the imperceptible vapour of perfpira-
tion cannot be taken into them,  or, if  taken in,  cannot
be tranfmitted  (s).   This  ftate is not fpafm, is not con-
ftriction from cold, but a fthenic diathefis, fomewhat grea-
ter  on the furface, than in any other part.  The ftimulant
energy oi  heat,  efpecially after  the application of cold,
which is otherwife a powerful exciting  caufe  of fthenic
difeafes, is applied to this part with more force than to any
of the interior  parts, and encreafes the fum total of ftimu-
lant operation  (t).
   CCCXXXVIII.  The fame, in general, is the caufe of
the temporary  retention of the other excretions (u)  ; only
that the operation  of  heat, juft now mentioned (x), is
foreign from the prefent explanation ; and on that ac-
count,  the diathefis that affects the interior veffels is
more gentle.   Thefe veffels, for that  reafon, and becaufe
                                                   they

  (q) See above CLIV.             (r) See above par. CLXVI.
  (s) See LXIX. and CXIIl.
  ^t) See XXXVll. 8. and CXIII. juft now quoted.
  (u) See CCCXXXI. and note (d) ; and alfo the par. CLIX. CLX,
 CLXIIL
  (x) in the CCCXXXVIII. and the reafon is, that heat being ftatio-
nary in the interior parts, has not that force which it has upon the exter-
nal furface.   See  above par, CXIII. 
214      THE   ELEMENTS
 they are naturally of a large diameter, are fooner relaxed
 in thefe difeafes, than the pores upon the fkin (y).
   CCCXXXIX. The rednefs  of the urine is owing to
 the general diathefis affecting the veffels that fecrete it, and
 proving an obftacle to the fecretion (z).  Hence arifes the
 ftraining of the fluid to be fecreted to diftend the fmall vef-
 fels (a), and the counterftraining of the moving fibres,
 by their contractions, to diminifh the cavities  which  the
 diftention encreafes ; and, in fo  far as they perform the
 function  of fimple fibres, to refift the diftention.   Bur,
 as,  in this forcible action of the veffels, the cohefive force
 of all the fimple folids yields fomewhat, the effect comes
 to be the tranfmiflion of fome particles  of blood. This
 tranfmiffion happens not at firft, becaufe the diftenfion does
 not fuddenly, but after fome time, overpower the cohefion
 of the mafs of fimple folids.
   CCCXL. The caufe of the  great heat is  the interrup-
 tion of the perfpiration, preventing the heat generated in
 the  inner parts of the fyftem to  pafs off by the fkin.
   CCCXLI. The thirft is occafioned by the fthenic dia-
 thefis, clofing up the excretory veffels  of the throat, and
 thereoppofing the excretion of the peculiar fluid (c).  And
 the  heat, by diffipating what fluid is excreted, contributes
 to the effect.
   CCCXLII.  The inflammation and  affection nearly al-
 lied to it (d), whether of a catarrhal or of any other nature,
 is a part of the fthenic diathefis, greater in the affected,than
 any other equal, part of the fyftem (e):  Which is mani-
                                                 fefted
  (y) It is reafonable to think, that veffels, which pour out a watery fin-
id, have a larger diameter than thofe, which, like the perfpiratory, even
in their healthy ftate, only  tranfmit an imperceptible vapour.
  (z) See par. CLXIII.                   (a) Or tubuli urinifi-ri.
  (c) See par. CLIX.
 (d) mentioned above in par. CCCXXXII.
 (e) CLXVUI.CLXIX. C1.XX. CLXXJ, 
OF    MEDICINE.          21 5
fefted by the exciting powers, alfo in this cafe acting upon
the whole fyftem, by the fymptoms of the difeafes fhowing
an affection  in common to the Whole, and  by fhe reme-
dies driving that affection, not from the  inflamed part on-
ly, but from the whole fyftemi(f).
   CCCX-LIIL  The  general affection, for the moft part,
precedes that confined to one part, or is funchronous with
 it, never comes after it,  becaufe its caufe, the exceffive
excitement (g), producing fhe diathefis, exifts before the
difeafe itfelf (h);  and, though it forms the rudiments of
the affection of the part during the  predifpofition (f), yet
it does not,  at that time, form that affection itfelf, and-not
always even during the difeafe, 'but  cmiy in  a certain high
degree both of fhe difeafe and of the particular affection
itfelf (k).   Hence, when the diathefis is great, the affec-
 tion of the part is in proportion (1) and flight under a leffer
 degree of the diathefis (m); while in  a moderate and gentle
diathefis it does not happen at all -(n) and for this reafoa,
that a high degree of diathefis is neceffary to the formation
of it.   Thus in peripneumony, where the diathefis is the
greateft, and in rheumatifm, where  it is next in greatnefs,
fhe inflammation is found proportionably great (o).  And
                                                   <evc>2

   (0  LXXXIX. See alfo part firft, Chap. IT.
 Kg)  Sec LXII. LXIX-              (h) See CLXXIV.
   (i) See abov* CLXIX.             (k) See above CLXVIH. *.
   (1) as in peripneumony and  rheumatifm, inflammatory fore throat,
and mild eryfipelas, fore throat.
   (m)  as in the fthenic
  .(11) As in fynocha, or the common inflammatory fever and catarrh.
   (o) This propofition does not gofo far as to affert, that there may not
be a fthenic difeafe, without any adual inflammation, but with an affec-
tion of  a part  nearly allied to it, which depends irnon  an equally high
diathefis as either  peripneumony or rheumatifm, and even hightr than
tJie latter.  Suchwc find, as I have formerly  faid (CLVII and CLVIH.)
in phrenitis.   But the meaning if, that the  inflammation, when it drves
tappen, is always in proportion to the d<^ree of diathefis. 
 2l6      THE   EL  E M  E N  T  S

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

   (p) or the rofe, er St. Anthony's fire.
   (q) This has been more than once hinted at, and once a little above.
 The Nofologifts have excluded fynocha from their order of phlrgmafix,
becaufe forfooth, though it was in every other "refped the fame, it want-
ed the inflammation of a part, and  they united it  with, proper fevers*
 though in the powers producing it, in its proper caufe, and in the reme-
 dies that remove it, it was in every refped diametrically oppofite to thofe
difeafes.  But their rule of judging was  different from ours.
  (r)  What is  a peripneumony, a rluumatifm, or any phlegmafia, but
 & fynocha, with a diathefis fufficient to produce inflammation \ 
OF   MEDICINE.
217
account of the moderate general diathefis, upon which it
ufually depends ; even in it, as often as the diathefis rifes
high, which fometimes happens,  when the  proper plan
or cure for it has been neglected,  and the effect of the ex-
citing hurtful powers has been carried to excefs, an inflam-
mation, and a formidable one indeed, arifes, often  affec-
ting the throat (s), and fometimes the lungs, and producing
there an affection rifing to all the rage of peripneumony.
   CCCXLIV". It is in vain  to talk of a thorn thruft un-
der  the nail,  wounding  it, fuperinducing  inflammation
upon the wound, andfprcading a fimilar affection along the
arm to the flioulder, and a pyrexia over the whole  body,
As an illuftration and proof of  the manner, in which the
phlegmafiae arife from inflammation.  For nothing like
a phlegmafia follows  this, or any fimilar affection of .9.
part, unlefs  the fthenic  diathefis   previoufly happens to
have taken place, and is now upon the eve of fpontaneoufly
breaking out into fome one or other of its  refpective dif-
eafes.   But, without that diathefis, no general affe&ion
takes place,  and if an oppofite diathefis be prefent  when
fuch an accident happens, an oppofite general affection will
be the confequence, to wit, a typhus fever,  arifing as a
fymptom of gangrene (t), and dangerous to life.
   CCCXLV.  That  the  affection of the  part depends
upon the general affection is proved by the  frequent  oc-
currence ,pf inflammation, without being followed by any
                                            phlegmafia.
  (s) When that happens it is ilill commonly a mild difeafe, .as will bs
fhewn by and by.
  (t) It is. with much regret, that I fhould have had occafion to obferve
the bad, and too often fatal, confequence of treating fuch local affedions,
without difcximiuation of the habit with which they may coincide. The
difeafe is treated by evacuation  and ftarving, even in habits the molt
weakened, and drink is withheld from perfons even the moft accuflonud
to  it.  The difeafe increafes, and, as if that w.re for want of more fuch
Uutmcr.t, the fame treatment is perfc\ertd iu till death dofcs tlw fccie 
2l3
THE   ELEMENTS
phlegmafia.  Which happens, as  in  the  cafe  juft now
mentioned, as  often as the general diathefis is abfent, or
the inflamed part is not an internal one and of  high fen-
fibility (u). Accordingly, all the examples  of phlegmone,
all thofe of erythema or  eryfipelas, without  general dia-
thefis (x), are foreign from the phlegmafia?, abfurdly con-
joined with them,  and more abfurdly ftill  confidered as
their prototypes; being in faft all only local affections,
or fymptoms of other  difeafes.    This conclufion is not
weakened by a certain refemblance of difeafes with inflam-
mation in an internal  part to the phlegmafiae; thefe dif-
eafes being neither  preceded by the ufual hurtful powers,
that produce either the phlegmafiae, or any general difeafe
whatever, nor  cured by the ufual remedies of the latter.
It was, therefore, a very bad miftake,  and of moft hurt-
ful confequence to the  practice  of cure,  to  enumerate
                                                   among

  (u) See aDove CLXXI.
  (x) 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 infigniflcant affedions, which they have confidered as lay-
ing the foundation  of their phlegmafiae, or general fthenic difeafes with
an inflammation in a part.  But will any man in his fenfes  fee anycon-
nedion 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 inflammation in the-groins of children from their
being fcalded by their urine, or the bites of infeds, the effeds of which
are confined to the bit part;  will he fee any  connedion betwixt thefe
and a peripneumony *, wliich arifes from hurtful powers affeding the
whole fyftem, and no part in particular;  and is cured by remedies that
affed th« whole fyftem, and the inflamed part not  more, nor even fo
much as many others ?  All  thefe, however, have been made the proto-
types of inflammation, "by which they  meant their phlegmafix; as if
there were nothing to be regarded in them but the inflammation, which,
in fad, is their moft infigniflcant part, bearing no  higher proportion to
the fum of morbid  ftate over the fyftem than that of 6 to 3000, or even
Idk  See abovr Part firft, Chap. IV. and particularly par.  h. 
             OF    MEDICINE.         219

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

   (y) S;e above par. LXXXT.  Take for an example gaftritis, which
 the Nofologifts have made one of their phlegniafije, and put upon the
 fame footing with the peripneumony  and the other difeafes that may be
 admitted as phlegmafia:. That affedion is an inflammation in a portion
 of the ftomach, in confequence of a folution of continuity from the pre-
 vious fvvallowing of ground glafs,  fmall fifh hones, a quantity of Cayen
 pepper;  or fymptomatic of a fchirrous obftrudion and tumor.  Thefe,
 not the ordinary hurtful ones that operate upon the whole fyftem, as in
 the true phlegmafirc,  are the powers that induce that affedion.  It hzs
 no cofinedion with the excitement, the affedion of which is only an ef-
 fed  of  the  local ftimulating power, and of the fenfibility of the ftc»
 mach ; its true caufe being the folution of continuity or  obftrudion,
 keeping up the inflammation ; and its remedies fuch, as are adapted to
 the removal of that local ftate.  It may happen to a found habit, where
 there is no diathefis in any degree, in which cafe it is purely local; or
 it may accidentally coincide with  either diathefis; in which cafe it is a
 combination.  When the combination is with fthenic diathefis, debili-
 tating evacuant remedies can only palliate, but they  bring life ir.to din-
 ger whew the afthenic diathefis is prefent, which is  17 times cut  of ;o
for the other.
  (2)  The general affedion arifing in the fyftem from the effed of a
thorn  pufhed under the  nail  (fee par. CCCXLIV. and note), and that
occurring in  the gaflritis,  mentioned in the laft paragraph of  the test
(fee the note on that garagraph) are good examples  of cafes to which
the term fymptomatic pyrexia fhculd be apj-lied. 
2 20       THE   ELEMENTS
    CCCXLVII.  The true fthenic difeafes (a)  accompa-
  nied, except one, with pyrexia (b) and external inflam-
  mation (c), are peripneumony, phrenitis,  the fmall-pox,
  the meafles, as often as thefe  two laft are violent, the fe-
  vere eryfipelas, rheumatifm,  the mild eryfipelas, and the
  cynanche torifillaris.   Thofe  free of  inflammation are
  catarrh, fimple fynocha, the fcarlet fever,  the fmall-pox,
  the meafles; when  in the two latter cafes, the eruption
  confifts only in a few puftules.

             The Defcription of Peripneumony.

    CCCXLVIII. The fymptoms  peculiar to peripneu-
  mony (d) (under which pleurify, and, as far as it is a gene-
  ral difeafe,  carditis, are comprehended),  are pain  fome-
  where in the region  of the cheft, often changing its  feat;
  difficult breathing; cough, for the moft part bringing up
  an expectoration, and fometimes  a mixture of blood in
  the matter of expectoration.
   CCCXLIX.  The feat of the difeafe is the whole body,
  the whole nervous fyftem (e); which is  proved by the dif-
 eafe being produced by an increafe of the diathefis, which
 took place in the predifpofition, and by no new circum-
 ftance (f);  by the inflammation within  the cheft, for the
 moft part following the  pyrexia at a confiderable interval
 of time, and never preceding it (g), and by bleeding and
                                                  other
  (a) See above CCCXXIX.
  (b) See par.  CCCXXXII.                    (c) See CLXVIII.
  (d) The fymptoms in common to it and the other difeafes of the fame
form, enumerated in the laft paragraph,  have been defcribed in par.
CCCXXXI.  Thefe peculiarly diftinguifhing the  phlegmafiae and exan"
themata, that is the difeafes either accompanied with inflammation,  or
an approach to it, are defcribed in par. CCCXXXII'
  (e) See par. XLVII. XLVIII, XLIX.  LIV. LV. and  not  the in-
flamed portion of the lungs, according to the common  opinion.
  (f) See above LXXV. LXXVIl.
  {-) See above CCCXXXII. and the note (b). 
OF   MEDICINE.          221
 thcr  remedies of fimilar operation, which affect not the
 inflamed part, more than any other equally diftant from the
 center of activity, removing the difeafe.  The proper feat
 of the inflammation, which is only a part of the general
 diathefis, is the fubftance of the lungs, and a production
 of the pleura, covering their furface,  or any part of that
 membrane,  whether the part lining the ribs, or that con-
 taining,  within the external furface of it,  the thoracic vi-
 feera, different in different cafes, and in the fame cafe at
 different times.
   CCCL. Pain,  in fome part of the cheft, depends upon
 an inflammation of the  correfponding internal parts juft
 now mentioned (h), which is  proved by diffection ; only
 that   it is oftener occafioned by an adhefion of the lungs
 to the pleura  coftalis,  fcldom to an inflammation, of  that
 membrane,  as we learn from the fame evidence.
   CCCLI. When the inflammation takes place on the fur-
 face of the lungs, it is impoffible it can be confined either to
 the fubftance of the lungs, or the membrane covering their
 furface.  For how cart any perfon fuppofe,that the points of
 the fame veffels,  either as diftributed upon the membrane,
 or plunging into the fubftance of the lungs,  or emerging
 from it, can alone be inflamed without a communication of
 the affection to the next points (i).  The diftinction, there-
                                                   fore,
  (h) See above, par. CLXXIV.
  (i) 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 diffedions fhowed the membrane
 upon other occafions to have been in a ftate of inflammation, he thence
 drew his rafh conclufion.  But it is to be obferved, that  the firft menti-
 oned ftate of the liver was not a phlegmafix at all, as it had not during
life exhibited any of the fymptoms of that difeafe, or even given any fi^n
 of the prefence of  inflammation.  It is a cafe, the:i, we have nothing to
                                                      do 
 222       THE   ELEMENTS

fore,of the inflammation accompanying the phlegmafix in-
to perenchymatofe,or that affecting the fubftance of the vif-
cus, and into membranous: as well as the notion which
makes the latter cafe univerfal, is equally remote from the
 truth.   The reafon of neither the membrane contiguous
to the lungs, nor the fubftance of the latter, being always
inflamed,  but of the inflammation being fometimes  com-
municated to fome  part of the neighbouring membrane, is
explained by the vicinity of the part inflamed in the laft cafe
to that which receives the air, and, therefore, varies in its
temperature (k).
   CCCLII. The pain often fliifts its feat (1) in the courfe
of the difeafe, becaufe its immediate caufe,  the inflamma-
tion, is equally  liable to change, being  difpofed to leave
its firii feat, or in part to  remain in it,  while in its great-
eft part it rufhes into another.  Which is a  fact proved by
 the comparifon   of the known  change  of  the pain  with
                                                       the

 do with upon this fubjed, even fo far as it applies to the liver.  Ent the
extending the application to all the vifcera, which  he was pleafed to
make the feats of fome  phlegmafix or other, was loofnefs of reafoning,
and careleffncfs of ir*tter of fadt,  in extreme.   A  gentleman, whofe
works have lately been buried, without any ftruggle or figns of life, hut
th?t of a feeble unintelligible  found from within the tomb, which  no
living reafon could make any fenfe of in their life time, took it into hii
head to maintain (for the fake of feeminjr to differ with men of name
and reputation, his hitheft ambition), that the inflammation in the phleg-
mafix was always feated in the membrane: The anfwer to which is
 given in the text.
   (k) So far is  it from being true, that this fort of inflammation can
 be confined to a few points of the affeded veffels (fee the note here at
 (i), that inj fad we find it, though not fo often as has been fuppofed,
 fometimes in the mediaftinum, fometimes in the external membrane of
 the pericardium, fometimes in the fuperior membrane of the diaphragm.
 Koerhare's notion  of the  tranflation  of  inflammation from one viftus
 to another, was an error in the oppofite extreme.
   (I) See above CCCXLVIII. 
OF   MEDICINE.          223
the traces of inflammation in the correfponding parts, dif-
covered after death (m).
   CCCLIII.  This fact, added to thofe already produced,
brings another folid argument (n) in refutation of the opi-
nion of the difeafe being produced or kept up by inflamma-
tion,  or in any fhape depending upon it,  confirms that
here advanced, and proves that the inflammation is regula-
ted by a ftrong, general diathefis, and directed by it foma-
times to one part,, fometimes to another ; that, as depend-
ing on that caufe, it increafes and is in a manner multipli-
ed.   And the fame conclufion is confirmed by the inflam-
mation abating, becoming more fimple, and at laft rece-
ding from every part it had occupied, in proportion to the
progrefs of the cure in relieving or removing the diathefis.
The fame  fact is confirmed by the nature of rheumatifm,
the pains of which are feverer and greater in number,  in
proportion as the diathefis  runs higher; and milder and
fewer In proportion to its gentlenefs.  Thefe pains,  that
have their dependance upon the general diathefis, and are
a part of the general  difeafe,  ought to be diftinguifhed
from local ones, which often occur, and may accidentally
precede this difeafe (o).
   CCCLIV. The difficult breathing is owing to  no fault
 in the lungs, as an organ,  to no  defect of excitement in
 them, but to the air  alone in infpiration,  by filling and
 diftending its own, compreffing the inflamed,  veffels.
    CCCLV.  The caufe of the cough is a  large fecretion
 and excretion of the exhalable fluid, and mucus, irritating
                                                    the

   (no) Many fuch are to be found in Morgagni, Bonneius, and Leutaud.
   (11) See all that has been faid.
   (o) Stitches, as they are called, frequently happen from flight acci-
dents, aud may appear before the arrival of rheumatifm, but they fliould
V diftinguifhed from the pains  that arife from the diathefis, configu-
ring that  difeafe; a diftindion. that has feldom been attended ■-», fvv
Want of a right  principle to lead to fuch attention. 
 224       THE   ELEMENTS

the air veffels, encreafing their excitement, as well as that
of all the .powers, that enlarge  the  cavity of the thorax;
then fuddenly fufpending it, and thus performing a full in-
fpiration, and  a full expiration, partly in conjunction with
the operation of the will (p).
  CCCLVI. The cough is lefs or none at all at firft; be-
caufe, on account of a ftrong diathefis occupying the ex-
tremities of the veffels, the fame fluids flow on in the form
of an infenlible vapour, are lefs  irritating in that form, and
difmiffed with lefs effort.
  CCCLVII.  Again, the cough is afterwards followed
by expectoration ; becaufe the accumulated  fluids, with
their effect, the effort of coughing, are carried forward in
the rapid action of the air rufliing out, as it were, in a tor-
rent (q).   And the mixture of blood with them point out
the force of fecretion formerly explained.
  CCCLVIII. The  foftnefs of the pulfe, commonly ta-
ken  into the  definition  of the difeafe (r), has been here
rejected, becaufe the characteriftics of the  pulfe do not fol-
low the inflammation, but the general diathefis (s). With
refpeit ic the diathefis,  the proper language is,  that the
pulfe, inftead of foft, is lefs hard ;  and when the effect,
that the cure has produced upon the  pulfe, is confidered, it
may then be faid to be foft (t).
  CCCLIX. Nor is the varying feeling of pain, which is
defcribed as fometimes acute, and pungent, fometimes ob-
tufe, gravitative, and rather to be confidered  as an uneafi-
nefs than pain, though  immediately  dependent upon the
      2                                   inflammation,

  (p) See above CLX. and CLXl.    (q) See above par. CCXXXIX.
  (r) at leaft, when they called it peripneumony,
  (s) See above CLV. CLXXIV.
  (t) It is an univerfal efftd of fthenic diathefis to render the pulfe hard
in one degree or another.  And peripneumony is not an exception from
that fad.  Eut the diftindion arofe from the miftake  of inflammation
being the all, inftead of an unimportant part of, the difeafe, 
              OF   MEDICINE.         22£

  inflammation, to be confidered as of any confequence in
  pointing out the ftate or feat of the inflammation : becaufe,
  however great the inflammation is, wherever it is feated,
  whatever danger it denounces, the only means of remov-
  ing it, and of averting the danger, is to remove the gene-
  ral  diathefis.  The notion,  therefore, of the membrane
  being inflamed, -when the pain is acute, and the interior
  fubftance, when  it is obtufe, muft be rejected as good for
  nothing, muft be guarded againft as  deftructive (u).   For
  often, when the difeafe has arrived at an  advanced ftage, a
  fudd<:n abatement of the pain taking place, without  a pro-
  portional relief of the breathing, to  an unfkilful perfon
  gives an appearance of a return of health.  But the caufe
  of that, while it has nothing to do with the feat or fort of
  inflammation, is  that degree of excitement, which fhows,
  that the excitability is exhaufted, the excitement come to
  an end, and that the vigour, before exceffive, is now con-
  verted into direct or indirect debility (x). Hence arifes in
  the veffels, efpecially the labouring veffels, in place of the
  exceffive excitement, with which they were before affect-
  ed, no excitement at  all; and extreme laxity takes place of
  their former denfity.   Hence, inftead of an excretion en-
  creafed by  violence,  an  immenfe difcharge t.:kcs place
  without force, without effort, and merely by the watery
  part of the fluid, from the inert ftate of the veffels, leav-
 ing the more c0:1 fiftent; and a fudden fuffocation takes
 place, in confequence of an effufion of fluids from all quar-
 ters into the air veffels.
   CCCLX.  The carditis, or  inflammation of the heart,
 is a difeafe of rare occurrence, is ill underftood, and  for
                          C^                       the

  (u) Sec par CCCLI. and the note unkrit at (i).
  (x) The dired debility may be owirg to the prober cure, which it-
diredly debilitating, having i^en carried too far, or to the indired de-
bility arifing in tlu c.uirfj  of the diL-ift-, feldom now to aletiph inn i<
tr-.it ncnt.  So abavc p*r. \LVII. and the fubjoined notes, 
226       THE   ELEMENTS
the moft part a local affection.  When the latter  is the
cafe, there is no  ufe for the interference of a phyfician.
And, if ever it be a general difeafe, it admits of no other
definition or cure  but thofe of peripneumony.  From pe-
ripneumony then, as  it arifes from the feme antecedent
hurtful powers, and is  removed by the fame remedies, it
is not to be feparated.

              The Dcfcription of Phrenitis.

   CCCLXI. Phrenitis is one of the phlegmafia: (y), with
 a flight inflammatory or catarrhal affection of fome one, or
 more joints, or of the fauces, with head-ach, rednefs of
 the face and eyes, impatience of light and  found, watch-
 fulnefs, and delirium.
   CCCLXII. Inflammation,  in its proper form, appears
 not in this cafe.   And yet there is an approach to inflam-
 matory ftate in the joints, in the mufcles,  and efpecially
 over the fpine, or about the cheft, or in the bottom of the
 throat; or there is a catarrhal ftate, which is an  affection
 depending, however, upon the fame caufe, as inflammation,
 and only differing from it in being lefs.
    CCCLXIII. The  head-ach, and  rednefs  of  the  face
 and eyes, arife from an  exceffive quantity of blood in the
 veffels of the brain and its membranes, diftending, ftimu-
 lating in excefs,  exciting in  excefs, and' contracting the
 veffels, to a degree that  gives pain (z). To the production
 of which laft inflammation is  not neceffary; independent
 of  which, this exceffive  action is painful, becaufe it ex-
 ceeds that mediocrity in  which agreeable  fenfation takes
 place (a).  The  rednefs both points out and explains the
 over-proportion  of blood.  And that the over-proportion
 gives  pain by its diftending operation, is fliewn by the  re-
                                                   lief
  (y) See above par. CCCXLVII.  (z) See aboveCLVll, and CLVIH.
  (a) See par, CLXXXII- CLXXXIII, 
              OF   MEDICINE.        227

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

   CCCLXV I. The  fthenic exanthemata, after the  ap-
 plication of  a  contagious matter, and of the ufual  hurt-
 ful powers which produce fthenic diathefis, appear firft in
 the form of  a fthenic pyrexia, or fynocha, and then after
 a fpace of time, not certain to a nicety, are followed with
 fmall or larger fpots.
   CCCLXV1I. That the  exanthematic fthenic difeafes
 differ not from the other fthenic difeafes not exanthematic,

  (b) There is commonly  in the organ where any nicety of fenfe  is to
be exercifed an extraordinary apparatus of blood veffels. Blood flowing
into thefe, encreafes, by its heat and the ftimulus of its motion, the fenfe,
to which it is fubfervient. 
228       THE   ELEMENTS
in anycircumftance of confequence, is proved by this ftrong
argument; that,  except the eruption and the pha:nomena
peculiar to it,  there is nothing in the  fymptoms, and ex-
cept the contagion,  there is  nothing in the hurtful excit-
ing powers,  but  what  happens  in any  fthenic difeafe;
and the preventatives, as well as the remedies, are the fame
in all.   While that is  the ftate of the  fact,  it  was the
height of abfurdity, merely for the fake of the eruption and
its peculiar phcenomena, to feparate the exanthematic from
their kindred difeafes,  and to unite  them with  the  moft
oppofite difeafes both to them and to one another (c). For
                                                        how,

   (c) The nofologifts have fepaiated the exanthematic difeafes, real or
imaginary, into a clafs or order by themfelves, which they have filled
«p with difeafes, of which there is not two,  but the fmall-pox and mea-
fles, that have  any other connedion, than their mere eruptive appear-
ance, while they arc feparated from others, with which, in every refpect,
they  have the moft effential connedion.  Thus the fmall-pox and mea-
fles are taken from the  natural place to  which they are  here reftored.
And it is unaccountable, that we fliould have it to fay,  that even ery-
fipelas, which has finely no right even to the Aim diftindion of eruptive,
has alfo been placed among them.  Again, the plague, which is to all
intents and purpofe* a typhus fever, its eruptive part not always disjoin-
ing it from that, is feparated from it,  though  it is  fo nearly the fame,
fcarcely excepting degree, and conjoined with  fthenic difeafes of a dia-
 metrically oppofite nature.   And the gangrenous fore throat, which is
alfo a typhus, has neither been placed among fevers, in its proper place,
 nor  among the exanthemata ; to which the efflorefcence, that it produ-
 ces on the external furface, according to their own rules of arrangement,
 feemed better to entitle it  than, fome others, efpecially the ejjfipelas.
 And it again (for there is no end of the confufion of this pretended order
 of fome phyficians), is conjoined not only as a genus with fthenic  dif-
 eafes, but ^ven as a fpecies of one of thofe genera.  The truth is, that
 fyftcmatics, who were otherwife no nofologifts,  have  made too much
 work about eruptive and contagious difeafes,  and have never dived  into
 the  interior nature  either of them or almoft  of any other. They have
 all followed each other from their firft leader, and never once deigned
to turn a glance of  their eye upon  the phenomena of  nature as thefe
                                                           arofe 
OF   MEDICINE.
229
how, when the ufual plan of cure removes the effect of
the eruption, whatever that be, and thereby fhews it to be
the fame, can any one imagine, that the caufe fhould be
different and not precifely the fame ?  unlefs we muft again
have to do with thofe who maintain, that the fame effect
may flow from different caufes.   Truly, the operation of
contagion,  in fo far as it affects general difeafe, is  not of
an oppofite nature to the general fthenic operation, but
precifely the fame.
   CCCLXVIII.  Contagion is a certain matter,  imper-
ceptible, of an unknown nature, and like moft  of the
phcenomena of nature,  only in any  meafure  open  to
our enquiry in its evident effects.   Taken from the body
of one affected with it,  or from any grofs  matter (fuch as
clothes or furniture, where it  happens to have been lurk-
ing), and received into a found body, it  ferments without
any change of the folids or fluids,  it fills  all the veffels,
and then is gradually ejected by the pores.
   CCCLXIX. And, as no effect, except fthenic diathefis,
follows it, and the hurtful powers,  that otherwife ufu-
ally produce the diathefis, always precede it, and an aft-
henic or debilitating plan of cure always, and only, fuc-
ceeds  in removing it, and confequently its effect no ways
differs from the difeafes  hitherto mentioned; it is, therefore,
withjuftice, that the difeafes arifing from it, are conjoined
with thofe others, as belonging to  the fame form.
   CCCLXX.  Betwixt  them there  is only this difference,
that in the exanthematic cafes of fthenic difeafe, the matter
 requires fome time to pafs out of the body, which time is
different in different cafes: and it paffes out more copiouf-
                                                     iy
arofe before them. Hippocrates mifled his followers, they  mifled theirs
from age to age,  and they all mifled the poor nofologifts.   Who have
laid on the cap-ftone of  the abfurdity of the art, and, having finiftied
the fabric of folly, left mankind, if they are not pleafed with it, to lock
i.'."t at their leifcre for a  better and more folid. 
23O       THE   ELEMENTS

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

         The Defcription of the violent  Small-pox.

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

          The Defcription of the violent Meafles.

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

  (g)  See par. CCXV.CCXVf.     (h) See above par. CCCLXVIII.
  (ij Which, without diathefis, is of no confequence, an.I  doss no;
amount to general morbid ftate.      (k) See above par. CJl'LXVI. 
23^       THE    ELEMENTS
dry cough, and hoarfenefs; on the fourth day of which,
or later, there appears an eruption of fmall numerous pa-
pulae,  or  little points ; that  on the third day, or later,
terminate  in an  appearance of branny feales.   This dif-
eafe, when preceded with a high degree of fthenic diathe-
fis, is proportionally \iolent.
   CCCLXXVIII. The fneezing, watery eyes, dry cough,
and hoarfenefs, are catarrhal  fymptoms, and, therefore,
depend upon fthenic diathefis  (1).   And,  fince they ap-
pear, four days or more, before the eruption, that is, be-
fore the matter might feem to have reached  the affected
parts, and are conftant and univerfal; hence  are we to
fuppofe, that the fthenic diathefis  follows  the hurtful
powers, that ufually produce it, and not entirely the pecu-
liar matter ia this cafe, and that it is indifpenfably necef-
fary to the meafles. But though that fuppofition fliould be
rejected, and it fhould be contended, that thofe fymptoms
arife from the contagious matter; it ftill muft be granted,
that  this  difeafe  differs,  however, in nothing from the
other fthenic difeafes,  but equally depends upon  fthenic
diathefis, and yields to antifthenic or debilitating remedies.
And it muft  be allowed, that, fince the matter produces
the fame effect as the ufual hurtful powers,  its operation
muft  be abfolutely the  fame,  and the caufe of the difeafe
the fame.   Confequently, we  find nothing in the indica-
tion of cure,  but what is in common to  this difeafe with
other fthenic  exanthematic ones, which is, that time  muft
be given to the matter to pafs  out of  the bodv, and the
perfpiration   be conducted in  the fame manner,  as  the
fthenic diathefis is ufually treated upon other occafions (m).
  CCCLXXIX. The eruption admits of the  fame rea-
foning that  has been delivered  (n).  The  circumftance
                                                   of
  (1) ?eeabove jar CLXXV.         (m) Sec above par. X'.VI.
  (11) Sec above par* CCCLXXVt 
OF    MEDICINE.
*33
of its being a violent difeafe when preceded  by a violent
fthenic  diatlufn, and mild in a mild degree of that diathe-
fis, is a further inftance of the little difference that there
is betwixt the operation of  contagion, and that of the or-
dinary  powers producing fthenic diathefis.
   CCCI.XXX.  When the  diathefis runs fo high as to
fupprefs the  perlpiration,  the eruption  often difappears
for a time, as  if it went into the interior parts of the body:
Which is a danger, that is chiefly threatened  at the end
of  the dife.de ; and  fliows, that this matter,  in the fame
manner as  the  variolous,  kindles  up a fymptomatic in-
flammation over the furface of the body, and then, by a
fnrther increafe of the diathefis, fuppreffes the perfpira-
tion.   Hence, with other vifcera, the lungs  (p)  are often
inflamed.
                                             CCCLXXXI.

   (p) That the lungs fhould he inflamed in a violent flate ef the diathe-
fis in the meafles is not to be wondered at; as the common catarrh,
when its diathefis runs high, is liable to  produce the (ame effed.  (See
par. CCCXLUI. towards the end).  But, confidering how many fads
in medical writings I have found falfe, the effed of that on my mind, is
to render the weight of teftimony in favour of the various internal vifce-
ra being fo liable to be inflamed,  from this fuppofed ftriking in of the
meafly eruption, very light, and to difpofe me to doubt of the fad alto-
gether;  Which I am the more inclined to do, from the analogy of a
broad fad in dired contradiction to it:  Which in, that the Inflamma-
tion, depending upon the general diathefis in fthenic difeafes, never, as
I have yet found, affedsan interior part. (See par.CXIII. CLX VIII.)
Neither is inflammation, from any other  fource, near fo frequent in in-
ternal parts as vulgar opinion has taught us Diffedion has fhown infl.iju-
mation in the inteftinal canal in dyfentery, or what is called in Knglifh
the bloody flux.   But that only happened under the evacuant, debilitat-
ing v< getable, plan of cure :  and, even in that cafe, feems to have been
an ultimate, not  an early, effed, much lefs a  caufe.   And it has been
fhown, that what has been confidered as  a burning inflammation in the
firft paflages, is not an iuiiamn ation at all. (See ubove par. CXL'VUI).
 Nay, even when iiif.uii.n.atitn  does hr.pp.n ii'.urr.ally, it is  n.virtf
                                                          the 
 234      THE    ELEMENTS

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

          The Defcription of the violent Eryfipelas.

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

the fthenic, but always of the general, or local afthenic kind, and, when
quickly cured, cannot  be inflammation.  If there be any truth  in the
frequency ef inflammation towards the end of the meafles, it muft be
of the afthenic kind.  Which is the more likely from its late appearance,
and from a circumftance that, though no  where taken notice of, has
great weight with me ; which is,  that the diftind fmall-pox paffes into
the confluent, peripneumony into dropfy of the cheft, and  any fthenic
difeafe with its diathefis, into any afthenic difeafe,  and the diathefis on
which it depends; there is nothing in the nature of the animal cecono-
my and  of the powers ading on it, to prevent the fame  converfion of
fthenic into afthenic ftate in the wierifles.  And if,  which is moft pro-
bable from the alexipharmac pradice, that was then ufed in this difeafe,
indired debility can induce fuch a change, no difeafe has a fuller  chance
for it than the meafles. But I am fure, were the debilitating plan ufed
from the beginning, no fuch confluence would happen. 
OF    MEDICINE.         23$
  CCCLXXXIII.  It  is peculiar  to this inflammation,
and foreign from the other general ones, to invade the
corpus mucofum.  To affign a reafon for which is of no
confequence; fince this inflammation does not differ from
the others either in the operation of the exciting powers
producing it, or in that of the remedies which remove it.
   CCCLXXXIV.  The  caufe of  the rednefs  of the in-
flammation, in this as  well as in every cafe, is an exceffive
quantity of blood in the inflamed veffels ; for the queftion
about the degree of rednefs is of no importance.  There
is lefs fwelling in the inflamed part, than in other fthenic
inflammations,  becaufe there is  here a free fpace betwixt
the fearf-fkin and true fkin, allowing the cffufed humour
room to fpread and diffufe itfelf.   The fame is the caufe
of the flow motion of the inflammation, and of the inequa-
lity of  its ed;>cs.  The fenfe of burning is owing  to an
acrimony of the contained fluid, acquired by ftagnation.
  CCCLXXXV. The attack of  the inflammation upon the
 Lice is  not more  dangerous  than upon any other place,
 except when the diathefis, upon which it depends, is great,
 rendering the inflammation proportionally great (q).  In
 which  latter cafe,  whatever part  is inflamed, the difeafe
 muft be held for a fevere one; but ftillfeverer, if the in-
 flammation felies the face; in which cafe a great tumult
 of affection internally accompanies the difeafe.
    CCCLXXXVI. When  fuch a  fthenic diathefis, and af-
 fection of the head depending on it, happens, no difeafe
 is  more dangerous, none more rapid in its race to death ;
 while in a mild diathefis no difeafe is milder.

            A Dfcripiicn cf the Rhc;tm:t!;f;i.
    CCCLXXXVII.   Rheumatifm is  a phlegmafia, efre-
 tially in "that  temperament, which  incl'.r.es to the  iru>
                                                j, nine.
   (q: Sec par. I.XXXV. CCCXUIl. 
 236      THE   ELEMENTS

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

            A Defcription of the mild Eryfipelas.

    CCCXCII. Both the definition and explanation of the
 violent eryfipelas  (b),  delivered before,  faffice for thofe
                                                       or
   (z) cccLifr.
   (a) To make this fubjed fimple to any apprclunfion,   A  perfon ha*
been expofed to intenfe cold a whole day.  He comes home at night, is
fet by a warm fire, receives hot meat and warm cordial drink.  He is
next covered up in his bed with an addition of clothes receives more
warm ftrong drink.   He falls afleep,  and next morning feels a pain in
fome part or other of  his upper extremitie?, r.i^h, or between,  the great
joints; and, previous to that, a high ftate of heat and bouncing pulfe,
 with a certain feeling of uneafinefs in different parts of his trunk.  The
 pains encreafe in the bed next night in proportion to the encreafe of the"
 general affedion; and cold, evacuation, and abftinenc'." from food, fro*<
 alternation of temperature, cure him.
    (b) From CCCLXXXII. to CCLXX \\\\. 
   Xj3       THE   ELEMENTS

  of the  mild; but in fuch fort, that the latter, both in its
  antecedent hurtful powers and fymptoms,and in thewhole
  nature  of its  caufe, muft be underftood to be much mil-
  der than the former, and not only fo, but a remarkably
  mild difeafe.
    CCCXCIIL It is often not fo much a fequel of the
  fthenic  cynanche, which is commonly called tonfillar,  or
  the common  inflammatory fore-throat, as a fupervention
  upon it  before it has finiftied its courfe.  It often appears
  alone and unaccompanied with the cynanche, arifing from
  a fimilar lenity of the hurtful powers,  and manifeftinga
  fimilar mildnefs of fymptoms through its whole courfe.
    CCCXCIV. Nay, in  the fame  perfons,  in  the  fame
  ftate of the hurtful powers, fometimes the eryfipelas, fome-
  times cynanche,  fometimes  catarrh, promifcuoufly arife,
  and are  all removed by the fame gentlenefs in the method
  of cure  (c).

          A Dfcription of the Cy.iar.che Sthenic a.

    CCCXCY. The fthenic cynanche is a phlegmafia, with
 an inflammation taking place in the throat,  and efpecially
 the tonfils, never preceding the pyrexia. It is accompanied
 with fweliing and 1 ednefs, and an aggravation of pain in
 fwallowing, efpecially any thing fluid.
   CCCXCVI. The reafon  for the  inflammation occupy-
 ing the  place mentioned  here, has been given,before (d).
                                                  And,

  (c) I have often experienced them all, fumetimes fingly,  fometimes
;dl three, in the courfe of the fame difeafe, oftener a combination of in-
flammatory fore-throat, and the nild eryfipelas, and, as far as I could
obferve, could difcern, that the degree ofphlogiftic ftate that produced
them,  and of remedies that removed them, were both gentle, the for-
mer as ftimulants, and the latter as debilitating powers; and both  fo
nearly of the fame degree, that in airargirg them, I was at a kit which
to place over the other in the fcale.
  (d)FecCMIII.CCCXLlI 
OF    MEDICINE.         139
And, when it has once  taken place,  it is afterwards Ti-
llable to frequent recurrence, becaufe its feat being in the
way of the moft hurtfnl power (e), and lefs covered than
other parts (f), is expofed :  And the veffels firft diftended
by the inflammation, and then afterwards  relaxed, take in
an over-proportion of blood upon  every increafe of its im-
petus (g).
  CCCXCVII.  As the  inflammation,  like  that  of the
other phlegmafia never precedes the pyrexia (h),  for the
reafon afligned  (i); fo, if an unfkilful  perfon fhould think
it did, the reafon of that is  the gradual degeneracy of the
general fthenic  inflammation into a local difeafe, from  its
frequent recurrence,  and always leaving a taint behind it
in the affected part. This latter inflammation may happen,
without a  general fthenic diathefis, and therefore, without
being followed  by a fthenic cynanche; and it may acci-
dentally coincide with the former,  or fthenic diathefis, and,
therefore, precede the latter or fthenic cynanche :  But, in
both cafes, it ought to be diftinguifhed from the pure ge-
neral cafe, for the fake of guarding againft the commiffion
of a hurtful miftake in the cure (k).   In an afthenic habit,
whether fucceeding to the former or not, there is again an-
                                                    other

  (e) Heat and alternation of temperature. See XXXVI. with addition,
  (f)See par. CLXVIII.    lone 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 internally.
  (g) This isfo liable to happen, when any perfon has once experienced
this difeafe,  that the encreafed motion of the blood in wa'king  in a warm
day, and then fitting down in a cool place, has fometimes prod :>^1 oph-
thalmia, fometimes this fore-throat.
  (h) Seethe definitions of them all, <kc,
  (i) See par. CLXVIII. CCCXLIII.
  (k) This  might happen to a perfon under an afthenic diatht lis, which
would be encreafed by the debilitating plan  of cure, and would he uleitis
»u the abfencc of  diathefis* 
24O       THE    ELEMENTS
 other general inflammation, to be referred to afthenic dif.
 eafes.
    CCCXCVIII.  If  any  perfon can  expfehi  why  the
 pain is aggravated in fvvallowing, he may communicate his
 knowledge; if he cannot,  it is no matter.
    CCCMCIX.  The cynanche oefophagaea has been  here
 omitted, becaufe it is  a  rare affection, and  admits  of
 the feme reafoning  and  cure as the tonfillar, from which
 it differs not but in  the inflammation being farther down,
 and in fome rednefs  only coming within view. But, as a fu-
 fpicion that it may be local, as when the aefophagus hap-
 pens to be eroded or burnt, by a ftimulus,  or fome acrid
 matter; the diftinctions, therefore,  fliould be  attended
 to  (l),and made ufe of for  the fake of practice.
    CCCC. There is  likewife a  rare  difeafe,  fometimes
 happening in certain countries, never in others, called  the
 croup (m).  In it the refpiration is laborious,  theinfpira-
 tion fonorous, with hoarfenefs, a ringing cough, and a
 fwelling fearce to be c'ifcerned  (n).  It is a difeafe that in-
 fefts very young children almoft only.   And in all other
 particulars it is of a doubtful nature  (o). 4
   CCCCI.  Concerning  which,  when  it happens to   oc-
 cur in practice, ufe the following marks of judgment.  As
 the fthenic diathefis, in the degree requifite for the forma-
 tion of actual difeafe,which depends upon a high degree of
                           2                    diathefis

  (1) See above LXXXl. LXXX1H. CI.XX.
  (in) by nofclogifts cynanche ftridula.
  (11) It is perceived upon diffedion  of ths dead  fubjed.
  (o) I never faw this difeafe, but when I was fo young a ftudent, that
?r.y obfervations I could make, can  be of no ufe  to me now. There
have been many battles of words  about, whether it be inflammatory or
fpafmodic,  without any adequate meaning of the difference betwixt
th. fe two words, at leaft fo far as to  influence the pradice ; which re-
mained much the fame betwixt the partus, and probably the right one
iniiT.d by both. 
             OP  MEDICINE.          24£

diathefis, happens lefs,  either in the beginning,  or to-
wards the end of life; becaufe the high degree of excitabi-.
lity in the former, and the low degree of it  in the latter,
admit a fiaaller degree of the effect of the exciting power,
that is, a finaller force of excitement (p), than the long pe-
riod of human  age betwixt thefe two extremes; yet it is
not altogether foreign from either (q). In childhood, the
high degree of  excitability compenfates for the flightnefs
of the ftimulus  ;  while,  in old age, the high degree and
force  of the latter may compenfate for the deficiency of
the former, and fuffice to induce fome fthenic diathefis,
even  to that degree w^aich conftitutes difeafe. In this way
infants undergo wonderful  viciffitudes of excitement, and
within the  fhorteft fpaces of time.    This day they will
fhow every fign of extreme debility, next day every one
of reftored  vigour; becaufe the operation of any ftimulus
given them  foon rifes to its higheft, upon  account of their
high  degree of excitability, and finks as foon  to its loweft,
upon account of its own fmall degree (r .  Hence every
fthenic diathefis, that  happens to  them, is  fhort, acute,
and foon removed (s); nor is their afthenic ftate of long
continuance, or difficult to be removed; provided there is
no local affection (t), and a proper  method of  cure is em-
ployed (u).
    2                       R                 CCCCII.
  (p) See par. XXV, and XXVI,
  (q) Though it is  feldom that either a child, or very old man, will be
fo fthenic as to need bleeding and much evacuation, yet they will fome-
times,
  (r) A child  of mine was given over for death by his nurfe : His mo-
ther gave him fome of the diffufible ftimuks.  He flcpt two hours, and
waked he waked made figns; for he could not yet fpcak,  to have a little
pic, moft of which  he ate,
  (s) A fitigle gentle purge will do it.
  (t) which very feldom, indeed, happens,
  (u)  Which, till of late, has been very rare : The antiphlogiftic ctrre
has made  away with threj-fcuit!v of >  unkind, before they arrived at
the fev^nth year of their age, 
THE  ELEMENTS
  CCCCII. The marks of fthenic diathefis at thia age
aTe, great- frequency of pulfe, when compared with that
of adults, more frequent  than their  own in health, dif-
tinctly meeting the finger  upon feeling it; a boundifhneis
t/f belly at firft, which becomes more free in the progrefs
of the difeafe;  drynefs of the fkin ; burning heat, thirft,
watching, ftrong crying.
   CCCCIII.  The  figns of the afthenic diathefis  at the
fame age are, a  puife not to be reckoned from its frequen-
cy, fmall, falling foftly like fnow upon the finger of him
who reckons  it, fo that he is uncertain if he touch it at-
all;  a very loofe fcouring belly, with green matter ; fre-
quent vomiting;  drynefs of the fkin,  heat greater  than
natural, and greater in fome parts than others; interrupted
fleep, never  refrefhing; a feeble  voice in  crying, fit to
excite compaffion.
   CCCCIV. The former  diathefn, befides  other hurtful
powers, is preceded by the ufe of found milk, animal food,
 an abufe of opium  or ftrong drink; exceffive heat after cold
and moifture, which latter encreafes the debilitating effect
 of the former ; a ftrong fet of fimple folids.
   CCCCV.  The  latter, together  with the known hurt-
 ful powers, is  preceded from the ufe of milk by a weak,
 fickly nurfe; that  of vegetable food, with fugar in it; wa-
 tery diet; watery drink ; habitual vomiting, habitual pur-
 ging, both by other means ufed for the latter, and particu-
 larly by magnefia, given with the intention of abforbing
 an  acid ; cold not followed by  heat; a weak mafs  of
 fimple folids.
    CCCCVI. Confider which of thefe fets  of figns  pre-
 cede or accompany the croup,  and whether its pyrexia  be
 fthenic or afthenic.  Weigh  the different  fentinients  of
 authors upon the  fubject.   Sufpedt their theories, but their
 facts ftill more.   Be on guard not to be mifled by the va-
 nity,  emptinefs, and rafhnefe of young phyficians ; as well
                                                    as 
OF    MEDICINE.         243
a.s by the obftinacy and bigotry of the older fott,  that en-
creafes with their age and practice, to be bent by no force
of reafoning, no weight of truth,  fearce by the power of
God : Regard their minds as bound in the fetters of preju-
dice:  Remember,  that a  whole age of phyficians were in
the wrong,except one man (x),and perfifted obftinately in-
their error, in the cafe  of the Alexipharmac phyficians :
And, reflect within yourfelf, good reader! whether the pre-
fent phyficians, who follow the doctrines delivered in the
fchools, judge better than their predecefibrs,and do not run
into the contrary extreme of madnefs, doing as much mif-
chief in fevers, and difeafes of pure debility, as they did in
fthenic difeafes, and in fact take a wide range of fpreading
deftruction among  mankind.   Thus fecured againft mif-
take, confider the cures of this difeafe that have appeared.
If in thofe,  or in any trial that you may make,  you fhali
                           R 2                        find

  (x) The  improvement that  Dr Sydenham made was good for the
length it went, which was,  to ufe cool and gentle evacuants for the cure
of the fmall-pox, peripneumany, and one or two more ol the flhenic dif-
eafes.  The bias,  in favour of the alexipharmac pradice, for the cure
of catarrh and meafles,  he never got over.  His theories were vague,
but with refped to the pradice in the difeafes among which his refor-
mation lay, they were innocent.   He attained not any idea of  the na-
ture of difeafes depending on debility : And his pradice was hurtful in
them :  He fell a vidim to his gout, which could not have happened had
he been acquainted but with one difeafe of the debility.  His pradice,
even when right, was deftitute of principle : he had no fort of compre-
henfion of the dodrine of life as a whole, and as a department of know-
ledge diftind from all others.  It would have been lucky, however, for
poflerity,had his fucceffors done as much in afthenic, as he did in flhenic
difeafes.  From that beginning, the ingenuity of fome,  at laft under a
riirhtdircdion, might have brought out more information, and by gra-
dual aud fure fteps, at laft attained a camprehenfion of their whole fub-
jed.  Uut prof-.fforj of univerfities ruin everything:   For while they
find uut nothing themfelves they throw into falfe lights the ufeful hints
of others.  This was the effed firft of the Boerhaavian, then of the Hoff-
manian and  Stahiiar- dedrines.  S<.r  c r Obfeivations, Outlines,
 p. ixx>:iv. to c\\ir- . 
244      THE   ELEMENTS
find that either bleeding and purging, or antifpafmodics,a8
they are called, that is, ftimulants  fucceed;  then be af-
fured, that in the former  cafe, the difeafe  is fthenic,  in
the latter afthenic ; of which you will be ftill more certain,
if you fhall find that the exciting hurtful powers and fymp-
toms, which have been enumerated,  at the fame  time
agree with the other marks of judgment.

               A Defcription of Catarrh.
   CCCCVII.  Catarrh is a phlegmafia, in which, to the
general fymptoms mentioned before (y), are added cough;
hoarfnefs ; and firft  a  fuppreffion,  or flight encreafe of
the excretion  from the nofe,  fauces,  and bronchia, fol-
lowed afterwards by a further encreafe; arifing from fti-
mulant  powers, often heat alone, but chiefly after a pre-
vious application of cold; and to be removed by debilitating
powers, often by cold alone, guarding againft heat (z).
    CCCCVIII. The explanation of the cough is the  fame
as that given before.  But it is freer, than in peripneumonv,
and not avoided, becaufe  there is no inflammation in the
neighbourhood to aggravate it, and raife pain (a).
   CCCCIX. That  the hoarfenefs is owing to a fuppref-
fion of  the vapour that fhould be exhaled into the bron-
chia, may be known from this; that, when the hoarfenefs
has  remained long, almoft without  expectoration and
cough,  or with a moderate  degree of them, while the
fthenic  diathefis continued in full force, and  did not abate
in the bronchia ; upon the diathefis giving way, and the
expectoration and cough becoming more free, the hoarfe-
nefs abates, or goes off.   That this can  be  effected by a
                                              ftimulus
   (y) CCCXXXI.
   (z)See par.CXII.CXlV.CXVILCXXII.andailthe ftimulant pow-
ers, from CXII. to CXLVII.
  (a) See par. CLX. CCCLV. 
              OF   MEDICINE.         243

 ftimulus  of that kind and degree, that conftitutes fthenic
 diathefis, is fhown  by the effect of ftrained fpeaking pro-
 ducing temporary  hoarfenefs,  by  filence  removing  the
 hoarfenefs, and cold drink relieving it.
   CCCCX. The fuppreffion of excretion is that of  the
 mucui and exhalable fluid, related before (b), and it ad-
 mits of the fame explanation that was formerly given.
   CCCCXI. That  ftimulants produce catarrh is evident
 from this, that heat alone, fulnefs in food, ftrong drink,
 and moderate exercife, for certain produce it; cold, cold
 drink, fpare diet, and reft, as certainly and effectually re-
 move  it.   It was,  therefore a very unlucky miftake, to
 think  it arofe from cold alone, and was to be cured by
 heat. On the contrary, cold is never hurtful in it, but when
 its action  is fucceeded by that of heat, to be explained as
 before (c). The occurrence of catarrh fo often in fummer,
 where its action can be a thoufand times traced  back to
 heat, but not to  cold ;  the  influenza never needing the
 affiftance of cold, which catarrh often does, in the man-
 ner juft now faid ; its never fucceeding to pure cold, but
 immediately to heat, facts known to old women,  to fhoe-
 makers and taylors, to fore-eyed perfons and barbers, un-
 known to medical authors and profeffors, all confirm the
 fame fact.

           A Defcription of the fimple Synocha.
   CCCCXII.  The definition  of fimple fynocha is the
fame with that of phrenitis (d), excepting the fymptoms
affecting the head.  It is a flight difeafe, ending in health,
often in one, always in a few days, unlefs when new hurt-
ful powers, either accidentally, or from the ufe of a ftimu-
lant plan of cure, have been  fuperadded.
                                              A De-
(b) See par. CCCCVIN.
(d) See par; CCCLX'.
(c) See CXXIf. 
246      THE  ELEMENTS


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

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

            A Defcription of the Mild Meafles.

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

           A  Defcription of the Sthenic Apyrexia.

   CCCCXXV. The fthenic apyrexiae which are equally
 free of pyrexia (o) and every degree of inflammation, arife
                                                from
  (I) from the top of the head to the ancles.  See  above par. CCXX,
and two notes.
  (m) All this has been well proved by every  one of my children, and
by an hundred patients at once.
  (n) See par. CLXX- and CCXL       (o) See par. CCCXXIX- 
OF   MEDICINE.
249
" ~»m a fthenic diathefis, that has lefs effect upon the vaf-
cular fyftem, than the other fthenic difeafes (p).

                 A Defcription of Mania.
  CCCCXXVI. Mania is a fthenic apyrexia; in which the
mind is difordered, and forms falfe ideas of every thing.
  CCCCXXVII. In fo far as mania does not arife from
a fault  of the fubftance of the brain,  which is  a local
cafe that fometimes happens: the powers that have the
chief fhare in producing it,  are exceffive exercife of the
mental function, and a high exuberance of paffion. Thefe,
however, while they act more upon the brain  than any
other part,  at the fame time do act more or lefs alfo upon
the whole body, though not to the  degree of drawing py-
rexia after them (q). Which is proved by the difeafe be-
 ing cured by a debilitating plan,  and by other ftimuli,
 as  well as  thofe juft now mentioned,  not  immediately
 applied to the brain, but to a diftaut part of  the fyftem
 from it.
   CCCCXXVIII. The  moft powerful of thofe ftimuli
 are, fpirituous or vinous drink,  and opium, and, perhaps,
 fome other things, taken into the ftomach, and firft acting
 there.  Of the other afthenic hurtful powers, fome of them-
 felves, and operating  alone, have lefs effect in inducing ma-
 nia, and  yet, even they, by their  ftimulant operation en-
 creafe the  force of thofe,  that have that hurtful effect;
 as  is  proved by the effect of removing them in relieving
 the difeafe.
                                         CCCCXXIX.

  (p) So much fo, as riever to have been thought in any fort conneclcd
 with that affedion we call pyrexia.
   (q) Compare this with par,XLIX.L. LI- LIL LIII. andindeedwith
 that whole chapter, as the fevereft trial of the truth of it; nothing beirg
 more natural, than than the fuppofition that a mad man is only affeded
 in his head, but wc fhall find that not true. 
250
THE   ELEMENTS
   CCCCXXIX.  If poifons fometimes  produce mania,
without hurting the fubftance of any folid part, their ope-
ration mult be  fuppofed the  fame,  as that of the general
ftimulants, their  effect the fame, and the difeafe a genera
one, and the fame (r).  But if thefe very  poifons act by de-
ftroying the texture of a part,  they muft be confidered as
the origin of a local difeafe (f).
   CCCCXXX. The heart and arteries are lefs affected
in mania, than in any of the pyrexial difeafes ; becaufe, the
hurtful  power, which chiefly affects the  veffels, too much
food, has lefs concern in the number of the hurtful pow-
ers here.   And yet that the food, fuperadded to the other
hurtful powers, does prove hurtful even in this difeafe, is
evident from a  contrary power, abftinence, being, among
other remedies, found of very great efficacy in reftoring the
healthy ftate.   Which, with  what has been faid above,
proves  that mania is not a difeafe confined to a part,  but
extended to the whole fyftem.
   CCCCXXXI. Although, in the difeafes that have juft
now been mentioned (t),  the  pulfe is commonly faid, and
believed, to be not  at all  affected, that, however is not
exactly  the truth ; for in mania,  fo long as it continues to
be a fthenic difeafe (u), more or lefs of fthenic ftate can be
perceived (x).

          The Defcription of Morbid Watchfulnefs.

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

  (r) See par. XX.               (f) See par. V. VI. XX.
  (t) from CCCCXXV. to CCCCXXXII.
  (u) that is, fo long as it is realy mania,
  (x) The charaderiftic of hardnefs  of the pulfe is never wanting, and.
therefore alfo fulnefs.   See CCCXXXIV,
  (y) Sec par. CCCCXXV. 
OF   MEDICINE.
251
tsf no found fleep, and the mind, in a ftartled ftate, is agi-
tated with vivid, ftrong, or uneafy impreffions.
   CCCCXXXIII.  The  hurtful powers, that produce
perviligium,  are  the fame with thofe that produce mania,
but inferior in force.   It is evidently  produced by hard
thinking, commotion, or difturbance of mind, in prefer-
ence to other hurtful powers.  The degree of thought, that
has that effect, is not ultimately exceffive; for, if it were,
by effecting a temporary wafte of the excitability, it would
produce found fleep ; or if it repelled  fleep, it could only
act fo, by means  of indirect debility, the confideration of
 which is foreign from this place (a).  And the fame is the
 degree of difturbance of feeling, that proves hurtful, info
 far as it produces  this difeafe: Every ultimate excefs of
 which (b), either ends in fleep, or induces that vigilance,
 of which indirect debility is the caufe.   But it is not a finT
 gle  operation of the intellectual faculty, or of the ftate of
 any paffion, or one that happens but  rarely,  that proves
 adequate to the effect.   For the effect, in that cafe, would
 be either too flight, or of too fliort continuance ; to merit
 the title of difeafe.   It is an often returning,  or deeply af-
 fecting, irritation upon the brain, and, therefore, one that
 leaves a lafting  impreffion,  which has any confiderable
 force in producing this difeafe.  In this laft way, an eager,
 inordinate,  and vaft defire for the attainment of high ob-
 jects of purfuit,  the impulfe that hurries on to the revenge
 of a freat injury,  and the horror that arifes upon the per-
 petration of it, the fear of future punifliment for crimes,
 are held up to us as productive of high commotion of mind,
 in the examples of Cataline,  Oreftes,  and Francis Spira.
  As often, therefore, as the mind is fo excited in its ideas
 and paffions, as not to be capable of being compofed to reft
 and found fleep, after a certain fliort continuance of thofe*
                                                     or
(a) See tXLI.
(b) See CXLI, 
2,52
THE   ELEMENTS
  or other ftimuli; fo often are we to conclude, that this
  difeafe takes place.
    CCCCXXXIV.  As the hurtful powers juft  now  men-
  tioned (c), produce this difeafe; fo there are others,  which
  belong not to this place, but are to be  mentioned, that al-
  fo repel fleep.
    CCCCXXXV. To pervigilium  belong all the  hurtful
  powers that have been already mentioned in  mania (e),
  whether acting within or  without  the brain,  but acting
  with lefs force, and which  yield  to the afthenic plan of
  cure.
    CCCCXXXVI.  As  the powers  ftimulating  vigour-
  fly in  this way  (f), and without any dimunition of their
  fum of ftimulating,produce pervigilium; from that we learn
  that the caufe of this difeafe  is the fame with that of the
 reft of the fthenic form of difeafes (g), and that the fame is
 the  ftate of the body in which every one of thofe difeafes
 confiit: Nor is it underftood, that different hurtful powers,
 but precifely the fame, with only a variation in the propor-
 tion  of their force,  which  often happens to  other fthenic
 difeafes precede this difeafe.
    CCCCXXXVII. The fame fact is alfo difeovered from
 the fun&ions, of which,  though thefe difeafes are called
 apyrexiae, or without pyrexial ftate,  the pulfe,  however,
 is not altogether  free of difeafe (h). On the contrary, it is
 as much ftronger than in health, or in the  predifpofition
 afthenic to difeafes, or in thofe difeafes themfelves, as there
 is more vigour, and more excitement upholding that vi-
 gour, in the fyftem (i).   And the ftate  of the other func-
                                                tions,

  (c) Seethe par. CCCCXXX.and CcCCXXXIII.
  (e) See from CCCC.XXVI. to CCCCXXXII.
  (f) See CCCCXXCIIL           (g) from CXLl to CXLVIII.
  (h)  See CCCCXXX.  and CCCCXXXi. and the note to the latter.
  (\)  For a proof of their vigour maniacs have often four times the
ftrength, they ufed to have in health, 
           OF   MEDICINE.         253

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

                 A Dfcription of Obefty.
   CCCCXXXVIII.  Obefity is a fthenic apyrexia (I); in
which  in confequence of an exceffive health, rich living,
efpecially in the article of food, and an eafy fedentary way
of life, the fat rifes to  the degree of  incommoding  the
functions.
   CCCCXXXIX. That obefity,  fo defined, is a difeafe,
is underftood from the definition of difeafe (m); and that
it is a  fthenic  difeafe, appears from the certain figns of
fthenic diathefis in it.   Of which,  the ftrong action of
the ftomach, whether the  appetite or the digeftion be
confidered (n), and the ftrength of the other digeftive or-
gans, are a glaring proof.
   CCCCXL. And as in this difeafe, the ftimulus of the
exciting powers, raifes the excitement  above that  degree
of it which fuits good health,  to  that in which fthenic
diathefis confifts, without  which laft there  could not be
fuch force in the 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  apytexiae. that the
fum of all the  ftimuli  is  much  lefs  than in the other
difeafes of the  fame form, that is, thofe with pyrexia and
inflammation;  that it never rifes to the extreme height
 at which indirect debility is produced,  and is never indeed
                                                   fb
   (k) See part firft, Chap. IV. and in it XI.IX- and I  Il.CLIX.  CfV.
  (1) S.c CCCCX.W,    (m) See IV.     (n) See par. CCLXH. 
 254      THE    ELEMENTS

fo great as to be fufficient to have any confiderable cfleet on
the heart and veffels.
  CCCCXLI. But it happens  to all thofe difeafe >,  that
both thefe laft and ail the other functions,  get fomewhat
above the ftandard of  the found function.';, and a  great
deal above afthenic diathefis.  And the fthenic apyrexiae.
differ from the other fthenic difeafes chiefly in this, that the
exiting powers keep much within that degree of force, that
waftes the excitability  much ; as is  perceived  from the
proof of the effect; for they are difeafes of much longer
ftanding than any other afthenic difeafes.
  CCCCXLII. Fro.u  which  fact, however much  the
brain may be affected by its own proper ftimuli; however,
great the quantity of blood in its veffels may be; unlefs to
the excitement arifing from thefe, that excitement, which
the other ftimulant powers produce, be added, it is cer-
tain, that the general effect will be  much lefs, and that
the united energy of all the powers has more effect, than
the feparate force of any.
  CCCCXLIII.   The diathefis, then,  in  thefe difeafes,
is upon the whole, lefs than in the reft of the fthenic dif-
eafes ;  that of a part, as of the brain in mania ?.nd pervi-
gilium, and of the blood  veffels in obefity, is pretty confi-
derable.   The whole is in general as great as that in the
predifpofition to the other difeafes, and exceeding its force
in the labouring  part.    Hence it comes out, that,  con-
trary to the nature of thofe other difeafes, and fimilar to the
predifpofition to  them, they are ufually of  long ftanding
and duration,  and for this reafon,  that the mediocrity of
the fum of ftimulant operatijn never confumes the excita-
bility, and always produces too much  excitement.   The
great tumult of fymptoms in the brain and blood-veffels in
thefe difeafes does not imply a great fum of excitement,
for this reafon, that the affection of a part, however for-
midable,  compared with the affection of allthc reft of the
                                              body, 
             OF   MEDICINE.         255

body,  is infinitely inferior in its degree (o).  However
much then,  any ftimulus prefles upon a  part, and from
thatfpreadsat large over the reft of the body; unlefs, how-
ever, other ftimuli, applied to other parts, fuftain its ope-
ration, fo as that the fum of the operation of them all
may deeply affect the whole body; the effect of the foli-
tary ftimulus, making a figure in a part, will  be lefs confi-
derable in the reft of the body :  In fine, it muft be kept
in mind, that every violent difeafe always arifes from the
excitement which the united force of feveral ftimuli has
produced.
   CCCCXLIV. In thefe fthenic apyrexiae,  as a  certain
part,  the brain in the  two firft, and the blood veffels in
the laft (p), is much more affected, and in greater propor-
tion, than in the other fthenic difeafes, becaufe the affec-
tion of the part is much lefs fupported by ftimuli acting
upon the other parts ; fo the ftimuli, acting in that way
upon the labouring  parts, are,  however, underftood to
affect the reft of the body, though lefs eoafiderably. That
this is the fuct, is proved by there being in  this cafe,  no
afthenic diathefis, and  evidently fuch a fthenic  one, as up-
holds  the  predifpofition  to other difeafes of  the fthenic
form; by the remedies, which affect other parts, as it will
by and by  appear,  being aiding in the cure here, and  by
powers  of a contrary nature,  always proving hurtful.
Whence, it is an  evident and certain truth,  even here,
where it might have been leaft expected,that eve; -yftimulus
that affects a part, affects the whole body, upon account
of the excitability being one uniform, undivided, property
over the whole.
   CCCCXLV. With  refpect to obefity in  particular;
that the other hurtful  powers, as well as food have more
or lefs effect,  one may ku:;w from the cert;.i:i  fact of the
                                             digeftive

   (o) ?ce par. XLIX. to LLI.         (p) Sei pir. CC.VXLIU. 
 2$6       THE    ELEMENTS

digeftive powers, which  depend upon the influence of
thefe powers, being of fuch force and vigour, as to perforin
their functions  more perfectly in fat perfons, than in
others, who are,  neverthelefs, not by any means weak.
Yet thefe hurtful powers are applied in a degree fliort of
that, which being ultimately  exceffive, or  approaching
nearly to that, puts an  end  to  excitement by wafting the
excitability, or which tends, by a high degree of difturb-
ance, to exhauft the body.
   CCCCXLVI.  Thus paffions are not  with fuch per-
fons too ftimulant; a circumftance known to the generality
of mankind, among whom it is an adage, that fat perfons
are  commonly  good natured (p), while morofe perfons
are for the moft part lean.  Thus  it  is obfervable, that
fat perfons are averfe to thinking, which is a great ftimu-
lus (q).    They are averfe to bodily motion, by which all
jhe functions, and particularly that of the veffels, are much
excited,  and the  perfpiration  proportionally promoted;
and they have fo far reafon for it, that all motion is more
fatiguing  to them than to others.  Hence, that quantity
                                                       of
  (p) This muft be taken with more than grains of allowance;  fince
fuch is the effed of the different motives to human adion received from
example and education, that the paffions themfelves are drawn into a
fubferviency to every  perfons predominant purfuit.  I have known a
perfon in Edinburgh get great credit  for his integrity, though that was
not extraordinary, from roughnefs of  manners and an affedation of paf-
fionatenefs, while the  diffimulation of that real difpofition is the  more
general engine among men of promoting their intereft.  At any rate, fo
much more than mere appearance  of temper,  which may be  fo  much
overruled, is neceffary to the eftablifhment of maxims; that I fhould
think my life or property upon an infecure footing, if it depended on the
good nature of a perfon, for which the only fecui ity was his fatnefs.
  (q) The moft poring perfons arc the atrabilarians, who, though they
are not calculated for the elevation  of mind that difcovery requires, have
by their afliduity, contributed much to the improvement of many  of the
arts.  They are commonly very meagre indeed, and indefatigable in
any purfuit, to which they givfe themfelves up. 
              OF   MEDICINE.        1^1

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

 (r) See Part firft, Chap. IV. and particularly par. LIII
 <t) See par. L VI. and XCI I. 
  258       THE   ELEMENTS

 health to the moft fthenic difeafes.   In that fcale perip-
 neumony holds about the higheft, and obefity the loweft,
 degree.
    CCCCXLIX. Peripneumony and  phrenitis  in  the up-
 per end are followed by two difeafes, that fometimes equal
 them ; the  violent fmall-pox  and meafles.  Thefe two
 are  fucceeded  by a difeafe, that fometimes  vies  with
 them, the eryfipelas, when accompanied  with a  moft fe-
 vere affection of the head. Equal to this,  not  in danger,
 but for the moft part in the degree of diathefis; rheuma-
 tifm comes next.   Next to rheumatifm is marked the mild
 and gentle eryfipelas, far fhort cf thofe abovev it in vio-
 lence, and claiming nearly an equal  place to the fthenic
 cynanche,  being much more nearly allowed to the latter
 than any of the former.   Thofe are the difeafes accompa-
 nied with  pyrexia and inflammation.
    CCCCL. Of thefe  two which ftand loweft, the  mild
 eryfipelas  and the ftnenic cynanche, or common  inflam-
 matory fore throat, are of fo doubtful a rank with refpect
 to each other and catarrh (u), a difeafe without the accom-
 paniment  of inflammation ; that it is doubtful which of
 them all fhould be fet above  the others.  Below them,
 however, the fimple fynocha and fcarlet fever, in fo far as
 the latter is an afthenic  difeafe, and in fo far as the ufual
 ftate of them both is confidered, are  to be placed without
 any hefitation (x). The loweft part of the fcale of fthenic
                                                difeafes
  (u) See CCCXClV.andthe note to it.
   (x) The fimple fynocha is fo fimilar to a gentle typhus, that it requires
 great judgment to diftinguifh them at firft. The fifeft way, when the
 doubt cannot be determined, is to keep the patient in a moderate tempe-
rature,  and in a ftate of reft; as any debilitating power, in cafe the dif-
 eafe fhould turn out a typhus, woidd be dangerous ; and, though  it
fliould 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,* 
               OF   MEDICINE.        259

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

         The Cure of the Sthenic Form  of Difeafes.

    CCCCLIII. To  apply the  indication of  the cure of
 the fthenic form of difeafes to practice ; that mentioned
 before (b) will be accommodated firft to a violent degree
 of the diathefis and danger of parts, in fuch a manner, as
 that regard only will be had to the degree  of force in the
 remedies (c).
   CCCCLIV. When, therefore, a violent diathefis is dif-
 cerned, as in peripneumony, phrenitis, the fmall-pox, the
 meafles, and  eryfipelas, in the higheft degree of thefe three
 Jaft, immediate recourfe muft be had to the moft powerful
                         S 2                      and
  (y) See par.  LVIII.
  (z) See par. XVIII. and look into Obfervations on the different fyf-
tems of phyfic, and in it the introdudion throughout.
  (a)  It will be eafy for the reader with the dircdion above to make
 out the table for himfelf.
  (b)  See par. LXXXVlIi.             (c) See alfo par. XCIL 
26o       THE   ELEMENTS
and quickly effectual remedy; and  fo much blood fhould
not be taken, as many who entruft nearly the whole cure
of the difeafe to it, think (d), but more, however, than
others are of opinion, fhould be taken away (e).
   CCCCLV.  No  meafure  fuits  all cafes ; the quantity
to be taken being different in different cafes, as thofe differ
in age, fex, ftrength, and in the degree of force applied by
the exciting hurtful  powers.  In childhood, which, ex-
cepting the meafles, and fmall-pox (f), is feldom affected
with the difeafes we have mentioned, and in a very advan-
ced age, which is alfo in lefs danger than that at the flower
of human life; fparing bleeding fucceeds for this reafon,
that, at both thofe ages, it is a leffer degree of excitement
that upholds the difeafe as a caufe ; while in the former,
the high degree of excitablility, in  the latter the neceffity
for more ftimulus or exciting power,  than formerly,  fet
bounds to the meafure of the remedy.
   CCCCLVI.  A better rule for limiting the degree of
bleeding is the relief, or temporary folution, of the urgent
fymptoms. If, therefore, after blood has be been taken, the
great heat, the hardnefs of the pulfe, the affection of the
head or the lungs, and drynefs of  the  furface, fhall have
gone off, or been much abated ; and now the temperature
is difcerned to be much more moderate, the pulfe more
foft and  lefs frequent, and  the furface of the body more
moift, at leaft lefs dry; if the pain is every where quieted,
                                                    the
  (d) which is the common pradice;
  (e) The moft early among the Alexipharmac praditioners, after once
making his cfcape from peripneumony without bleeding, fell a vidim to
the folly of his theory in the next attack.  The Alexipharmacs in gene-
ral were too moderate in their bleedings in the true, though few fthe-
nic difeafes that require it,  and all in the wrong in their ufe of heating
ftimulant prefcriptions in them,.
   (f)  See par.CCCCI. 
OF   MEDICINE.         261
 the breathing relieved, and the delirium removed (g); then
 it may be looked upon as certain, that enough of the vital
 fluid has been fhed for the time.
   CCCCLVII.  To obtain that benefit,  in  the moft vi-
 gorous 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 recom-
 mends the abatement of the fymptoms as a direction more
 to be depended upon (h).
    CCCCLVIII. Since the local affection depends upon
 the degree of the general (i)  diathefis, remember, there-
 fore that there  is no occafion for any particular direction
 with regard to it, any farther, than to take advantage of
 its being acceffibie to help the general remedy by an ap-
 plication of it to the part (k).
   CCCCLIX. When that has been done, and the firft vi-
 olence of  the difeafe is now broken; we muft next have
 recourfe to purging the belly, as  a great remedy in point
 of efficacy (1).   To effect which,  we fhould not employ
 violent means, fuch as many formerly employed (m); the
 ftimulus accompanying the fiift operation of which being
 liable to be hurtful; but it is the gentle cathartics that
 fliould be depended upon, fuch as  Glauber's falts,  which
 are highly debilitating,and carry a great  quantity of fluids
 out of the veffels.   Though a man of good fenfe in the
 laft century ufed thefe day  about  with bleeding;  yet, if
                                                   the

   (g)The references for fads are CLIX. CLV CCCXXXIV. CLVII.
 GLXXIV. CCCXLIX. to CCCLV. CL1V.  CLIX.  CLXXXIV.
 CCCXXXlII.toCCCXXXVl.CLV.CCCXLin.CCCLIV. CLVIH.
   (h) SeeCCCCVI. (i) SeeabovcLVI.andCCCXLH.to CCCXLVI.
   (k) Ibid, an inftance of fuch afliftance may be the local bleedings
 over the pained part in rheumatifm and the gout, and fome other afthe-
 nic remedies are aided by local ftimuli.
•  (1) See CCLXXXIII,    (m) the Alexipharmac. particularly. 
262      THE   ELEMENTS
 the violence of the difeafe fhould be urgent, there is no-
 thing to hinder the ufe of them the  fame day that the b.'ood
 has been taken.
    CCCCLX. Purging, after a fparing bleeding, has more
 effect in overcoming fthenic diathefis, than any  bleed-
 ing without it; becaufe, as it has been  mentioned above,
 in that way the debilitating power (which has always more
 debilitating effect in the place to which it is firft applied
 than in any other), is applied to more parts ; and not only
 to the greater blood-velfels, but alfo to a prodigious num-
 ber of their terminations ; and the excitability is more ex-
 tenfive, and therefore, with more equality diminifhed (n).
    w, Vomiting,  which, in afthenic difeafes, where it is
 pernicious, has hitherto never been admitted in the common
 practice, and in fthenic ones, where it is  of the greateft
 benefit, ever neglected, comes in here as a proper part of
xure; being of the fame evacuant nature, and in another
 part of the fame canal, and admitting of all the  reafoning
 that has been applied to purging.
   CCCCLXI. At the fame time that the  exceffive, and
 therefore hurtful,  ufe of the lancet  is fuperfeded by thofe
 two laft mentioned evacuations ; its ufe, however, is not
 altogether to be laid afide in  the difeafes of exceffive ex-
 citement : and  for this reafon,  that the excitement,  by
 its  ftimulating operation  often rifes to that high degree,
 that,  from the confumption  of  excitability  which  puts
 an end to its exiftence,  threatens inftant  death (p).
   CCCCLXII. Befides,  thofe remedies  (q), the patient
fliould ilways be required to abftain from every fort of food
but vegetable, and in a fluid form, as well as from all ftrong
drink,  and indeed all but watery drink,  accidulated (r)
                                                This
 (n) See par. CCCCLXXXIH.CCCCLXXXVl. alfoCCCV.
 (p) See par.CCLXXXI. and CCLXXXIII. CCLXXXIV.
 (q) From CCCCL1V to CCCCLXII.      (r) See CCLXXXIV, 
OF   MEDICINE.           263
This direction does not feem to have been  fo much ne-
glected in words by former writers and authors, as in fact
and affual application to the practice ; it having been de-
livered flightly,  by the by, and  as if it had been thought
of no confequence, with fuch effect, that its force made no
impreffion upon the mind of the reader or hearer.  No fti-
mulus is more powerful, and, therefore,  in this  part of
the practice, more hurtful, than that of the articles of di-
et : Confequently,  whatever  quantity of blood is taken
from its veffels, whatever quantity of ferous fluid  is carri-
ed off by the mouth and anus,if that ftimulus is not round-
ly guarded againft,all this evacuation may eafily be fruftra-
ted.   While that is the cafe, ftill fluid vegitable matter
is not  to be difcharged, and for this good reafon, that wa-
tery matter is not kept in the veffels  ; but, eafily  entering
the fmalleft of them, flows out in all directions by  their va-
 rious outlets ; and, at the fame  time, fupports the efficacy
 of another  remedy (s),  by and  by to be mentioned.
   CCCCLXIII. Conjointly with the ufe of the firft bleed-
 ing,  of the firft vomiting  and purging, and that of abfti-
 nence and watery drink, it muft not be forgot, that parti-
 cular regard muft be paid to temperature (t); For, if cold
 always debilitates, and if  that is its proper operation (u),
 if it only feemingly acts otherwife, becaufe heat  fucceed-
 ing to its action, or alternating with it(x),  converts it into
 a ftimulant one, if it alone is adequate to the cure of the
 fmall-pox (y), and prevents the violence of that  difeafe, if
 it is the beft remedy for catarrh (z), and,  when heat is
 avoided, of the greateft afliftance in every fthenic difeafe; it
 is not to be doubted, but that it is of the greateft  benefit in
 the difeafes of the higheft  fthenic  diathefis.
    CCCCLXIV.  Its  operation in the fmall-pox, and  in
 the reft of the fthenic difeafes, is not different, but altoge-
                                                   ther

   (s) fweat.   (t) See par. CCLXXXU.    (u) See par. CXVII.
   (x)  SeeXXXVi!,    (y) Sec par. CXXI.     (z) See CCCCVII, 
264      THE   ELEMENTS

 ther the fame. Nay, in all the difeafes of this form, as cold
 alone is fufficient to effect the cure ; fo whenever the dia-
 thefis, which is the cafe in the difeafes that make our pre-
 fent fubject, rifing to its greateft rage, demands inftant re-
 lief; becaufe, in that cafe, every moment's delay brings in-
 ftant danger; becaufe the remedies, which we have men-
 tioned, are fufficient for the folution of the difeafe, of which
 we have the  direct proof in the practice ; becaufe that de-
 gree of cold, which could produce that effect, is neither al-
 ways within our reach, nor can be managed by every per-
 fon ; and many perfons might not be difpofed to believe its
 effects fo beneficial: For thofe reafons we fliould not defift
 from the plan of cure here laid down (a), and do our beft
 forourpatient,by taking off the blankets, and other clothes,
 by cooling the room, and, inftead of laying him on a couch
 Or bed, putting him into a chair.
   CCCCLXV.  This plan of cure fhould, for the moft
part, be preferred to that of the moft intenfe cold, for this
further reafon, that the fhortnefs of the  time in which any
one could poffibly remain in it, would oblige him immedi-
ately to return to higher temperature, which would produce
a greater ftimulus of excitement, than that he had been un-
der before his expofure, at leaft too great a ftimulus (b).
   CCCCLXVI. Since fuch is the operation of cold  (c),
the power falfely imputed to it of occafioning the ftriking
in of the meafles, is to be imputed not  to cold alone, but
to heat and other ftimuli; giving, as has been explained,
more excitement (d),  than if it had not  preceded   And
why not ? If cold does not interrupt the eruption in the
fmall-pox; but,  on the  contrary, by an enlargement of
the diameters of the perfpiratory veffels, which are fhut
up by  fthenic diathefis,  highly promotes the difcharge of
                                                 that
 (a) From CCCCLIV. to CCCCLXV.     (b) See XXVI.
 (c) Look back from CCCCLXII I to CCCCLXVI.
 (d) See XXVII. jrnd the addition,and CCCLXXX. 
           OF   MEDICINE.          265

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

good fenfe, that, a great part of mankind, even thofe who
take upon them the bufinefs of teaching and taking the lead
of others, in no cafe ever think of exercifing a moment'6
reflection of their own ?  But,  in  this cafe, it may be con-
tended, that the action of cold is peculiar, becaufe, after
the eruption which is fuppofed to check, has difappeared,
all  the fymptoms encreafe  in  rage and violence.   Con-
fider what that circumftance makes for the argument, or
whether it makes any thing, and not abfolutely againft it ?
Was the  action of cold, that is fuppofed, followed by
that of ftimulant or debilitating powers ? If it was by the
former, the caufe of the  mifchief muft  be imputed to
them ;  which, as has been faid juft now (g), produce ex-
ceffive excitement after a previous application of cold, and
more than without it;  if the latter, or debilitating powers
were ufed, then there would not  be  wanting a fufpicion,
that cold had a concern in  the effect.  But it is not fo:
And, in every cafe,  in which the action of cold  has been
followed by fthenic diathefis,  the true caufe of that effect
is not fufficiently guarding againft the ftimulus of heat, as
well as that of other noxious  powers.  And this is moft
clearly proved by the ufe of heat being pofitively  ordered,
iriftead of being forbid, in the common practice.   Nor is
that to be wondered at: For if the caufe of catarrh (h)
deceived phyficians fo much, the catarrhal fymptoms in the
meafles could not fail to deceive them.   And, if doc-
trines, difcarded in words, are often kept up in fact: what
 was there to hinder this part of the alexipharmac doctrine
from meeting with a fimilar fate ?
   CCCCLXVII.  If cold, therefore, can  fearce  be fo
 managed, as that the effect occafioned by the accompani-
 ment,  the fucceffion, or  the alternation,  of ftimulants
                                                with
  (g) in the laft paragraph but one.
  (I.) Sec from CCCCVII. to CCCCXU. 
             OF   MEDICINE.         267

with it,  may be prevented, whether that be the fault of
the phyfician, or owing  to the difficulty of the nature of
the thing (i); it is,  notwithftanding,  a rule in common
to the meafles and other  exanthemata of the fame ftamp,
to avoid heat,  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 moil
evident, that the opinion of cold being peculiarly hurtful
in the meafles, both in that and every other difeafe of the
fame form, falls to the ground.

               A Repetition of the Cure.

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

  (i)  Turn back to CCCCLXV. and CCCCLXVI,
  (k) fromtCCCLIV. to CCCCLXVIU. 
268      TH E   ELEMENTS
few things upon the fum total of blood that fhould be ta-
ken during the courfe of the whole difeafe.
  CCCCLXX. As in fingle bleedings,  fo  alfo  in the
whole quantity of blood to be taken, the fum fhould be a
mean betwixt thofe, which the common run of phyficians
approve, while fome  think too much, fome too little,
fhould be taken.  The reafon  for this recommendation is
ftrengthened, by the confideration of their being now lefs
occafion for fheddinga great deal of the vital fluid, fince
the cure is now more  divided among the  other remedies
that have been fpoken  of.  The  age muft be regarded, as
wasformerly recommended(l), theformer mode of lifemuft
be looked to, the quantity of ftimulus, that may lately have
preceded the morbid ftate, muft be  confidered, and the
ftate of the body compared with the degree of the fymp-
toms and the effect of the cure.  From thofe circumftances
a judgment fliould be  formed of bleeding and other eva-
cuations ; and it fhould be eftimated, what further  of the
fame fort may feem proper to be put in practice,  or what
difference of management may  be required.  Upon the
whole, it will be found,  that there will be the lefs occafion
for any one medicine, the  more freely others have been
brought into ufe ; and it will be underftood, that the dan-
ger of too great evacuation will be thereby avoided, and
the health better fecured (m).
   CCCCLXXI. With refpect to the kind of bleeding, it
fhould always be made from a very  large vein ; becaufe
the cutting a leffer one, or opening an artery, does  not
afford a fufficient quantity for the relief of the veffels, and
arteriotomy is further attended with  certain inconvenien-
ces (n).  As far as any  certain  rule,  in an affair of fuch
                                              variety,
  (1) Sec CCCCLV.          (m)  See CCLXXXVI. and CtCV.
  (n) The blood is ready to break out again after the tying up ; and if,
ss feme advife, the arterial  twig fhould  be cut through, it diminilhesthe
                                                number 
OF   MEDICINE.         269
variety, can be eftablifhed, two pounds of blood in three
or four days,  with the affiftance of the other  remedies,
will for the moft part, be fufficient at the middle age of
life, and lefs at a more early or later period.
   CCCCLXXII.  All bleeding fhould  be followed by
vomiting and  purging, fo long as any confiderable part of
the fthenic diathefis  remains ; nor fhould the other parts
of cure, that  have been  pointed out, be neglected.  But
purging, a finglc dofe of  which can at any time,  bring
back a fit of the gout; which cures the fthenic cynanche
or common inflammatory fore throat,  and the mild eryfi-
pelas, when even the face or head is affected ; which is of
manifeft detriment in fevers, which, in dyfpepfia, in afth-
ma, and every fort of difeafes depending upon debility,
whether direct or indirect, does very great and confpicu-
ous mifchief; and is a great part of the very bad, common
method of cure over the whole form of afthenic difeafes;
in proportion as it ought to be avoided in all thofe difeafes,
fliould be as certainly laid  hold of in fthenic difeafes, and
not omitted in any confiderable one, fuch as thofe are that
 require bleeding, but be managed according to the direc-
 tions given  (o) lately, and as it was dire&ed to be managed
 before (p).   And we muft, above all things,  be on our
 guard againft that diffidence in the ufe of this remedy, as
 well as in that of vomiting, where they are ferviceable, and
 that confidence in  them when of differvice, both intro-
 duced by the fpafmodic doctrine; and know that they
 were both admitted upon a falfe and abfurd principle (q).
                                        CCCCLXXIII.
 number of the few acceffes to this mode of bleeding; neither does there
 feem to be any ufe in deftroyingfuch veffels, efpecially as no good pur-
 pofe can be fhewn for doing fo.
      (o) See CCCCl.XI.            (p) See CCLXXXIII.
   (q) The principle, at leaft  with refped to purging, was, that it dimi-
 nifhed perfpiration, and, therefore, was underftood not to ad as an an-
                                              tifpafjiodic. 
 270      THE   ELEMENTS

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

tifpafmodic.  A balance betwixt the excretion by the belly, and that
on the furface was talked of, and they were held for oppofite operations.
In luch theoretical nonfenfc  they deferted their only good leader, at
lead in  thofe difeafes, who alternated his bleedings and purgings, and,
as I have found upon the beft foundation,
  (r) Turn back to CCCCLXIX. 
              OF   MEDICINE.          27I

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

 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 nume-
 rous veffels, that open into the inteftines and into the fto-
 mach, are fo powerful in diminifhing fthenic diathefis, how
 fhould a fimilar evacuation in the fimilar perfpiratory vef-
 fels have no tendency to produce the fame effect ?  With
 which reafoning,if the facts juft nowrelated be further con-
joined, what will any perfon have to fay againft the ufe of
fweating, when a degree of heat, not greater thanwhat can-
 not be avoided, attending the operation of the fweat, can no
 longer be hurtful, and the fweat itfelf certain to  be of great
 fervice u)   Let the fpafmodic caviller againft the ufe of
 that remedy, in the cafes of fthenic affection where it is ad-
 miflible rnufter up all his facts and all his theories, let him
 turn himfelf into all fhapes, he will never produce a folid
 argument againft this  remedy. But what,  again, is all this
 about ?  Will there never be an end of running  from one
 extreme of error into the oppofite? Shall no mean be found
 betwixt the Alexipharmac plan of cure,  and an equally
 bad or worfe one ? If that doctrine hefitated aot to pre-
 feribe fweating in the rage of a peripneumony, and that too
 by means of the moft heating ftimulant powers,;  does it
 therefore follow that a plan of cure muft be admitted,which
 rejects the certain  and fafe ufe that remedy,  when con-
 ducted by  the moft gentle means? If it was the opinion of
                             2                      Dr.
   (u) In an excitement of fixty-feven, within three degrees of iadired
 debility, the heat in the Srft part of the fweat, by adding thefe, might
 kill the patient, if you will, without leaving any chance of relief from its
 evacuant effed.  But if the excitement be no higher than 6o°, the ad-
 dition of the three decrees will keep greatly within the point of indired
 debility, and therefore, be fafe; while the fuccceding evacuation may
 reduce the excitement perhaps io°, and bring it within the range of pre-
 difpofition ; and a new courfe,  or a little prolongation of this, carry it
 down  to the point of health, and finifh the cure. 
              OF   MEDICINE.        2?3

 Dr Sydenham, that heat fliould be avoided in the cure of
 fthenic difeafes, which was quite right, as heat certainly en-
 creafes the excitement;  are we, for that reafon, to avoid
 that tolerable degree of heat which accompanies a remedy
 the moft powerful in reftoring the healthy ftate, and,there-
 by, deprive ourfelves of great benefit upon the whole ? If
 fuch perfons did not know,  that feveral  remedi-y  dimi-
 nifhed excitement more powerfully than any  one ; and, if
 they were>to be forgiven for  that; w.are they alfo to be ex-
 eufed for not feeing, what any empiric might have feen, that
 is, that fome things were of fervice, and others of differ-
 vice; was that want  not of genius, which is not required
 of them,  but of common fenfe, alfo to be pardoned ? If
 think'vng without a leader, and making any fort of difco-
 very, was too much, and not to be expected  from them ;
 is it not fomewhat furprifing, that out of a  thoufand per-
 fons, who had treated of every part of medicine, and enter-
 tained different fentiments from one another, in fome mea-
 fure right, and,.no doubt, wrong too., they could fqueeze
 no  information, but always  trod in the footfteps of one
 fingle man ?
  CCCCLXXV1L Sweat, therefore,  after the manage-
 ment that has been mentioned, is to be excited,  and fq
 much  the more determinedly,  if there fhould feem feme-
 thing ftill wanting to the complete return of health, fome
 degree of fthenic diathefis ftill  remaining, and a fpontano
 ous tendency to it fhould appear.
  CCCCLXXVTII.  When the  figns  of a fpontaneous
 fweat arifing are perceived, nothing more is to be done, but
 firft to lay the clothes about the patient, remove the fheets,
 put the blankets next to his  body,  guard againft the ap-
proach of air, and keep up the difcharge for  a fufficient
length  of time,  at leafi ten or twelve hours.   If,  by this
management, there  fhall  enfue  a copious and univerfal
flow c>v fweat, there will be no occaffm for giving a me-
                         T                   dicine. 
274      THE   ELEMENTS

dicine.  After it has fucceeded, and encreafed the relief
formerly procured ; if it fhould fink in toward the end, it
fhould at laft be fupported by Dover's powder,  or by laud-
anum alone, covering the body, fo as that it may get as
quickly as poflible to-the furface,  till the expected bene-
fit be  obtained. And to this management it muft be ad-
ded, that, if a draught of cold water be fometimes given,
and then the body well covered up and properly managed,
the bufinefs often 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 medio-
crity of the diathefis, procured by the other remedies, will
permit; fo in the  fmall-pox and meafles,  becaufe there is
occafion for a certain time to allow the matter to pafs away,
we muft alfo keep that in our eye, and never be too early
in making trial of this remedy.   Laftly, if the heat fhould
happen to prove hurtful,  if at any time the flow of the
fweat fhould be attended with lefs relief, or with fome in-
convenience, it fliould  be  immediately flopped: For it
was  not for no purpofe,  but for that of making the reme-
dies fupply the defects of one another, and of reducing the
excitement more equally over the whole body, that a num-
ber was recommended.
   CCCCLXXIX. In all the cafes of a violent diathefis,
all the remedies that have been mentioned, are more or
lefs,  and differently on different occafions,  in proportion
as the remaining part of diathefis may require, each in a
higher or lower degree, or in a larger or fmaller quantity,
to be brought into play,  and the curative circle enlarged:
And befides them,
   CCCCLXXX.  Some  of flighter confequence,  fuch  as
acids and nitre ; fome of uncertain ufe, fuch as leeching,
cupping, and bliftering, are mentioned, as of the firft con-
fequence.   Of thefe,  the  acids, in fo  far as they render
the drink more agreeable, and, in an affection of the lungs
do not produce cough, and prove, in  a certain meafure,
                                          refrigerant, 
            OP    MEDICINE.          275

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

          The other Part of the Indication of Cure.

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

 producing  a ceffation of excitement in death, an event of
 which there is not the leaft danger, in a mode.--.ve diathefis,
 fuch as that, which is the caufe of the difeafes here in quef-
 tion ; for that reafon, the cure rr.uft be adapted to the caufe,
 and bleeding muft be either abftained from altogether, or
 very fparingly ufed.
   CCCCLXXXIII.  It is not,  therefore, only  in difeafes
 of debility, which belong to the other form (in moft of
 which it has, neverthelefs, been, and ftill is, the cuftom,
 to fpill more or lefs of the vital fluid), but alfo in all  the
 difeafes of  this form,  except the very violent ones, that
 the lancet is to be reft rained.
   CCvJCLXXXIV.  Though in rheumatifm the diathe-
 fis often runs confiderably high, the ufual profufe bleeding,
 is not, however, required. For, as every diaihefis is always
 greater in fome parts than in any other equal one, fo it is
 with the  fthenic diathefis in this eafe; which is found much
 greater upon the furface of the body, than in any other equal
 fpace within.  And the reafon is, that the moft powerful
 noxious agent, heat,  fucceeding to cold, or fo alternating
 with it, that its own ftimulus is  encreafed by its effect (2),
 directs its  principal  energy to the furface of the  body.
 Hence, after exceffive bleeding, the difeafe, notwithftand-
 ing, often obftinately recurs.  The caufe of which fact,
 if the principles of this doctrine be well underftood, can-
 not be obfcure.  Bleeding diminifhes the fthenic diathefis
 chiefly in the  red  veffels, lefs  in any of the extremities,
 leaft of all  in the perfpiratory vefTels, and thofe difpofed of
 in the tract of the mufcles; and ftill lefs in the laft, becaufe
 the operation  of the  bleeding  is counteracted  by that of
 heat:  Which  is an explanation confirmed by  the certain
teftimony of phyficians ; who  often complain  that their
 favorite remedy fails them.
                                     CCCCLXXXV.
(z) See XXXVll. and addition. 
            OF   MEDICINE.         277

  CCCCLXXXV.   Upon  which  account,  fweating,
which we fpoke of fo  lately, is remarkably adapted to
the cure of this difeafe : To it, therefore, after a previous
bleeding to twelve ounces, and obferving the rule of tem-
perature and diet before directed, muft we have immediate
recourfe, if the diathefis happens to be confiderably vio-
lent, and is fignalized by heat of the body, by pains raging
moft in the night time, and by a iftrongand hard pulfe.
In order to render the fweat univerfal, and of fufficient
duration, it fliould be brought out by Dover's powder, or
laudanum, as before hinted, and kept up for twelve hours
in full flow, and then fome hours longer, Or till the abate-
ment of the fymptoms, in the form  of a moifture or free
perfpiration, and repeated when the fymptoms return. The
reft of the cure muft be entrufted to low diet and an exact
temperature.
  CCCCLXXXVI.  In  this cafe,  after  the fweating
courfe, and alfo in that of a fimple fynocha, of the fcarlet
fever, of the fthenic fore-throat, of catarrh, eryfipelas, and
the gentle fmall-pox and  meafles, when the diathefis is
fomewhat confiderable, but far fhort of that rage which
conftitutes the cafe of cure firft taken notice of; we fliould
ufe either a very fmall bleeding, and  then chiefly the eva-
cuations before mentioned  (a)  ; then a flight and fhort
fweat ought to be  kept up not  longer than eight or  ten
hours ; and, during the whole time of the cure, we fhould
go on with abftinence, weak drink, reft of body and mind,
and cold,  unlefs in the time of fweating,  and even then
with as little heat  as poffible ; and, finally, with tranquil-
lity of mind, as thefe were formerly enjoined : The united
ufe of  which is perfectly equal to the removal of any of
thefe difeafes ; but there will not always be occafion for
them all.
                                   CCCCLXXXVH.
(i) SeeCCCV, 
2J$       THE    ELEMENTS

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

there is conjoined fome hardnefs and fulnefs. Whenever,
therefore, the pulfe  is very quick,  it is to be fufpccted,
that the fthenic diathefis has paffed into the afthenic, the
exceffive excitement into a ceffation of excitement, or that
the difeafe has been fthenic from the beginning.   To re-
move which doubt  and afcertain the truth, the habit of
body, the age, muft be confidered, and an enquiry be made
to know whether the difeafe has  been preceded, or not,
by contagion.  Heat of the fkin is in common to  thefe
difeafes and fevers, which are difeafes of an oppofite ftamp
and therefore a doubtful mark. Which, as it depends up-
on  an interruption of perfpiration, from whatever fource,
is never to be ftrained into a proof of the ftate of excite-
ment.   And, fince drynefs of the fkin,  which is in com-
mon to the fame difeafes however different  from each
other,  in the afthenic difeafes depends upon debility; in
order to know the amount of what that fymptom means,
the other fymptoms  and  the exciting hurtful  powers,
fhould  be confidered.  In fine, the only enquiry fhould be,
whether the excitement is  abundant or deficient, and all
the figns fhould be confulted with that view ; nor are we
to judge rafhly of any peculiar form.
  CCCCXC. When, therefore, the figns, than have been
related, are compared with all the reft and with the diathe-
fis, we are then to fet about the  antifthenic or ftimulant
plan of cure.   The violent fthenic difeafes, which we firft
confidered  can fearce be confounded with  the contrary
ones; the more gentle are daily confounded.  But, while
it is eafy to diftinguifh them from the afthenic difeafes re-
fembling them ; if, however, any perfon fliould think the
marks of diftinction ambiguous, let him know, that, upon
account of that gentlenefs, though the difeafe under exa-
mination fhould be afthenic, blood is not even to be let,
much lefs under the apprehenfion that they iriay turn out aft-
henic to which laft fo debilitating a power is deftructive, as
                                                  ir 
28o       THE    ELEMENTS
 it has fo often already been faid upon former occafion*;
 and, with that information, let turn understand, that hi-t
 method of cure conducted in that way, will be fenced and
 fecured from all miftake.  For, if the diathefis,  though
 fthenic,  be flight, bleeding will often -precipitate it into
 the oppofite, and will at the beft be ufelefs  (b).  If, on
 the contrary, the difeafe that paffes for a  fthenic one,
 fhould, in its progrefs, fhow itfelf an evident afthenic one;
 in that cafe every drop of blood that may have been taken
 will go to the encreafe of the difeafe (c).  Yet this perni-
 cious and daily  practice  fends more  men out of this world,
 than all  the curfes of human life {d).
   CCCCXCI.  As abftinence, cold, and the  management
 of the belly are fufficient to prevent a gentle ftate of the
 fmall-pox; lo when that proper preparatory plan has been
 neglected, and now  a  crowded eruption appears; be-
 fides  thofe, trial muft be made alfo of  the   other reme-
 dies (e), except fweat.   But fweat muft be  avoided, be-
 caufe  the  tendency of the ftimulus accompanying it, by
 encreafing the fthenic diathefis on the furface, would be to
 check the perfpirable fluid, and detain the contagious  mat-
 ter under the fcarf-fkua,  and produce that pyrexia, fymp-
 tomgtic of the inflammation, which is called the,feconcUrry
 fever. This particularity of cure is taken from the parti-
 cularity of the fymptom  juft now  mentioned, and forms
                                                     no
  (t>) Suppofe the diathefis be two degrees above the higheft of the points
ef predifpofition. at 570; and bleeding to the degree of producing 35°
of debilitating influence be employed ;  it is evident, tire  excitement will
go down not only the 170 neceffary to bring it to the point of health,
but fink to za°, that is, 30 below the range  of predifpofition to afthenic
difeafe, and therefore complete the converfion of the fthenic into an aft-
henic difeafe.
  (c) See CCXLIX. CCLXXXI. OCXC.
  (d) S.c par CCC - VI. towards the end.
  (e) CCCCLlII.to CCCCLXVUl. 
             OF   MEDICINE.        281

no objection to  the principles of this work.   In perfect
confiftcncy with which, though there is all the proof that:
can be derived from fure practice, that the remedies  we
have mentioned  are fufficient; yet, before the eruption
comes on, there is nothing can be objected either to fweat-
ing Or bleeding, as remedies in common to this with every
Other fthenic difeafe (f).  In fine, as the fuccefs of low di-
et, cold and purging,  in this manner, is certain;  at  the
feme time, the other remedies that remove fthenic diathe-
fis, in this cafe likewife operate to the fame effect (g).   It
was proper to fay fo much for the fake of fhowing the un-
exceptional fteadinefs and univerfallty of the principles of
this work.   Nor are we to think, that the fmall-pox  and
meafles, differ from other  fthenic  difeafes attended with
pyrexia, but in the particularity of their eruption  in run-
ning a certain courfe, and not admitting of an accelerated
cure.
   CCCCXCII.   We are not to wait the arrival  of  the
fymptoms of debility, that follow a violence of diathefis,
and threaten certain death by indirect debility,  with  the
view, forfooth, that, when they have happened, we may
cure them:  On the contrary, they ought to be prevented
by the early adminiftration of the remedies,  now fo fully
commented upon.   If that fhould be omitted,  the confi-
deration of the difeafes  that will be the confequence,  and
which is altogether an afthenic confideration, muft be re-
ferred to the afthenic form.
                                          CCCCXCIII.

  (if) The fmall-pox is, in one word, to be treated as any fthenic difeafe,
according to its degree of morbid ftate, and the eruption is only  to be
regarded during the period of its exiftence, either with refped to the
exception of fweating then, or of any thing elfe.
  (g) It is not, that low diet, cold, and purging, operate by any pecnli--
arity, but becaufe they debilitate to the degree, and in the manner re
quired of the other remedies. 
 2$2      T-H-E' ELEMENTS

   CCCCXCIII.  As  often as fthenic diathefis happens td
 be conjoined with the pyrexia,  which is induced by the
 operation of ftimulants, of acrid fubftances, of compreffion,
 of obftruction, and fimilar hurtful powers acting upon a
 fenfible part, of which we have examples in  gaftritis, ente-
 ritis, nephritis, cyftitis, hyfteritis, hepatitis,  or the inflam-
 mations of the ftomach, of the inteftines,  of the kidneys,
 of the bladder of urine, of the womb, of the liver (h); the
 diathefis, becaufe it aggravates the pyrexia, fhould be re-
 moved by its refpective remedies, to wit, the debilitating
 ones.  And, when neither it nor the afthenic diathefis is
 prefent, nothing fhould be attempted : But,  if the afthenic
 diathefis fhould be prefent,  which very readily may hap-
 pen ; the ftimulant plan fhould be proceeded upon, to pre-
 vent a  very bad difeafe (i).   Nor, when that is as much as
 poffible attended  to, are we to forget, that, in fo doing, the
 principal affection is not touched ; that, on  the contrary,
 it is its effect,  not its caufe, that is tampered with; and
 that the full  confideration of fuch cafes belongs to the lo-
 cal difeafes afterwards to be taken notice of.
                                            CCCCXCIV.
   (h) See LXXXf. LXXXIII. LXXXV. LXXXVII.
   (i) As afthenic difeafes to fthenic ones are in the proportion of ninety-
 fcveu to three of the hundred ;  fuch alfo muft be the  frequency of pre-
 difpofition to them :  The  inference from which is, that as we are  fcl-
 dom  in the moft perfect ftate of health, and confequently, for the moft
part,  under the fame degree of predifpofition, all the chances are greatly
 in favour of that predifpofition being the afthenic one.  Hence the impro-
 priety of treating all local difeafes in the fame way, and as if  they were
 general fthenic ones.  Death has been too often the confequence of that
 practice, when the local hult, for which it was intended, was ho more,
 perhaps  than a thorn pufhed under a nail, a cut, or contufion of a finger.
 In fuch  circumftances, however fully the perfon may have lived, wine
 is  withheld, fluid vegetable mutter prefcribed, and the rotine of every
 fpecies of evacuation gone through.  Difmal are the confequences of
gun-fhot wounds on this plan of cure,  Turn back  to the paragraph!
 LXXX.  and LXXXI. ?nd the notes fubjoined to them. 
            OF   MEDICINE.         283

  CCCCXCIV. Befides all the remedies now mentioned,
it is of advantage in every degree of diathefis to keep the
mind eafy and unruffled with paffion or emotion ; a prac-
tice that in the very high degrees of the diathefis is indif-
penfably neceffary.   Our attention  will efpecially be di-
rected to this particular, when we obferve, that the ftimu-
lus of  thinking and  of any paffion,  carried to a great
height, has had a fhare in the production cf the difeafe.
   CCCCXCV.  In mania, therefore, and pervigilium, this
direction muft be particularly, and as much as poffible, at-
tended  to.   In the latter of which difeafes, thinking, and
every ftate of commotion, and more certainly an habitual
practice in  them, muft be ihunned, efpecially  before going
to bed. When the patient is refting there, he fhould have /
ftupid books read to him, all inordinate defires, the pro-
penfity to revenge, the remembrance of any degree  of cri-
minality, of which  he may have been  guilty, fhould be
 diverted from his recollection (k).
   CCCCXCVI. That faft of great confequence, to give
Corroboration to this whole doctrine, is confirmed by this
other, that the fame things, which are ferviceablein pervi-
 gilium, or  the morbid watchful ftate,  are alfo ferviceable
in mania, or madnefs, only adminiftered in a higher degree,
as that is a difeafe of a higher degree of excitement. Thus,
it is not eafe and tranquillity of mind  that are to be pre-
ferred here, both of which are quite gone, but a ftate op-
pofite to that high commotion of fpirits and irregular vi-
gour in the exercife of the intellectual function : And,  as
an exceffive energy of the intellectual powers, or of the
animal fpirits, or both, are the  moft noxious powers  in
 this cafe ;  for that reafon, the patient fliould be ftruck with
 fear and terror, and driven, in his ftate of infanity, to de{-
 pair :-As a remedy againft the great excitement of the or-
                                                 gans
(k) See above par. CCCCXXXIIJ. 
 284      THE   ELEMENT'S

 pans of voluntary motion, the labour of draft-cattle fhould
 be impofed on him,  r.nd affiduoufly continued ;  his diet
 fnould be the pooreft poflible, and his drink only water(l):
 In water as'cold as poflible, the patient fhould be immer-
 fed, and kept under it, covered all over, for a long time,
 till he is near killed.
   CCCCXCVII.  If, in phrenitis  the brain, in peripneu-
 mony the lungs, in rheumatifm the external joints, poffefs
 more  diathefis than any  other  part; why may not ma-
 nia and pervigilium confift  more in an affection of the
 brain, upon which the principal noxious  powers act, than
 of the other parts, over which the influence of thofe pow-
 ers is lefs confiderable ? Laftly, fince remedies,  the firft
 aftion of which falls upon other parts,  arc of fervice in
 thofe difeafes (m), that proves, that not even in them,
 where you might moft be difpofed to believe it, the whole
 morbid affection depends upon the part confpicuoufly af-
 fefted; but that the whole body is concerned  in it, that
 the excitabilityis one uniform undivided property over all;
 that the force both of the exciting hurtful powers and of
 the remedies is directed to the whole, with the inequality
 fo often mentioned (n);  and that the foundations of this
 doctrine.are fure and ftable.
   CCCCXCVIII.  As thefe are  the principal  hurtful
 powers in mania and pervigilium, and th.e brain principally
 affected ; fo in obefity, the hurtful  powers moft confider-
 able are animal  food (o) and reft, or fedentary life ; in
 confequence of which laft, the ftimulus of exercife, which,
                                                   by
  (1) Sec CCCXXVHI. CCCCXXX.CCCCXXXV. ccccxxxvr.
  (m) Part I. Chap. II.                   (11) Part I. Chap. IV.
  (o) Eecaufe no effect can arife without a caufe, the exciting powers,
therefore muft here have operated with more force, than in the other
cafe; and if it fhould be objected, that the  circumftances in both cafes
vrere equal, the difference then niuft be fet to the account of the greater
vigour ef the excitability in the cafe of obefity. 
            0 F   MEDICINE.          285

 by wearying and fatiguing the body, tends to indirect de-
 bility, is  underftood to be wanting.  But,  fince,  in con-
 fequence  of  ufing the fame  food,  both in quality and
 quantity,and the fame indulgence in reft and eafe,fome per-
 fons become fat, others continue lean ;  from thence it is
 afcertained, that all the digeftive powers have mors force
 in the former, than in  the latter,  and confequently, that
 che other exciting hurtful powers have contributed to the
 effect, and  that  a proportional excitement follows. Of
 the hurtful  powers, that belong to this place, an eafy ex-
 ercife of the intellectual faculty, and tranquillity of  mind,
 which are moderate ftimuli, favour obefity ; over ftrained
 thinking, and habitual  indulgence in any paffion,  fuch as
 that of anger, the repetition of which conftitutes ill nature,
 oppofe it.   Corporeal  motion,  which  diminifhes the
 quantity of fluids  in the fyftem,  and as often as it is con-
 fiderable, proves fatiguing and  debilitating, oppofes it.
 Equally unfavourable to his hard drinking; which, in a
 fimilar manner, wears  out the excitement, by  conftantly
 wafting the excitability from the high degree or long  conti-
 auance of its ftimulus.  On the contrary, the powers that
 favour it, are thofe that aft gently, and with fome  excefe :
 but never attain that high  degree of aftivity, that  inclines
 to indirect debility : They are powers that go on  foftlv and
 pleafantly, that particularly keep up  moderation  in the
 perfpiration,  and thereby fill the veffels with blood ; but,
 becaufe motion is avoided, they do  not very much encreafe
 the excitement of the veffels, and by  means of the  tran-
 quillity of motion kept up in the latter, dlow a fluid, that
 would otherwife pafs off by the external pores of thefeir-
 face,  to turn afide into the cells of  fat.   Hence,  though
 as it has been faid  before, an abundance of blood is indeed
 a very great ftimulus; yet, without other flirr.oli, and that
moft powerful one, which mufcular motion affords; it is-
evident, that a confiderable degree 0; ftimulus can be borne
                                            with o:n 
286      THE   .ELEMENTS
without any confiderable difeafe, and that it always pro*
duces a  predifpofition to fthenic difeafes, but does not
immediately bring them on.  Hence,  it  is underftood
what place in the fcale of exceffive excitement, or of fthe-
nic diathefis, obefity holds; what the degree of ftimulant
power is, and what the ftimuli in particular, are that pro-
duce it.
   CCCCXCIX. As the  degree of curative force muft be
accommodated to the degree of force in the caufe (p); hence
it muft be obferved, that for the cure alfo of this  difeafe the
common  indication is fufficient (q); that  is, that the excefs
of excitement muft be reduced to the falutary degree, and a
remedy oppofed  to every hurtful power, equal to the re-
moval of it.
   D. In  this cafe, therefore, as food is the principal hurt-
ful power, lefs of it fhould be given, and more exercife en-
gaged in.  Thefe are fufficient for the cure (r).
   DI. But, for the fake  of bringing both further confir-
mation, as well as illuftration of this doftrine ;  it is to be
obferved, that all the powers, which very much affect the
excitement, and in a greater degree, than the hurtful power
of this difeafe mentioned above, and that have a tendency,
by their ftimulant operation, to indirect debility, have the
fame effeft ; that they either prevent or cure obefity, and
continue  productive of that effeft, till they induce that de-
gree of meagernefs which is connected with debility.
   DII. The beft method of lowering the diet,  is to com-
bine a quantity of vegetable matter with a moderate por-
tion of animal. The next rule to that,'is to refrain from the
latter, and ufe the former in greater abundance.   The
firft of thefe is fuitable to all fuch perfons as are liable to
difeafes of debility, fuch as the gout, the indigeftion that
after a long time fucceeds to luxury, afthma, epilepfy and
                                               fimilar

  (p) See  CIX.   (*) XLVI1I.CCCCLIII.  (r) CCCCXCVIII. 
OF  MEDICINE.          2-87
fimilar others.  The latter  management is more accom-
modated to thofe, who otherwife enjoy great vigour,  are
under predifpofition to fthenic pyrexia,and in the flower of
their  age.   But,  it is not, even in the latter ftate of the
body, to be profecuted, unlefs for a time; becaufe, fiich is
the debilitating influence of that practice, that, while it is
fufficient to remove any degree of obefity, efpecially with
the additions of exercife, it is  found to have fignal efficacy
in pr during afthenic diathefis, and all the difeafes depen-
ding on that.
PART 
2c?8      THE   ELEMENTS
PART    THE    FOURTH.

   THE   SECOND   FORM   OF

      GENERAL   DISEASES.

                      o  R

      THE  ASTHENIC  DISEASES.
               CHAP.    I.

 Dili. rTP HE form of afthenic difeafes, and which is to be
       -»-  called afthenia, for the fake of diftinguifhing it
 from the form of fthenic difeafes, which is called fthenia,
 is a ftate of the living body, in which all the funftions are
 more or lefs weakened, often difturbed, almoft always with
 a more confpicuous affeftion of fome funftion.  In the
 treatment of which, that order will be obferved, in which
 the progrefs from the fmallelt degree of his kind to the
 greateft through all the intermediate degrees, is to be fol-
 lowed out.
  DIV. In this part of our fubjeft, there occurs a great va-
 riety of fymptoms ; of which, becaufe  it is without mean-
 ing, and even mifleading, no ufe  is to be made in marking
 the fcale of difeafes.  But, for the fake of placing what is
 about to be  delivered  in a clearer,  if not more fpecious,
point of view, wc fhall b:-g:.n with a fimple  enumeration
of the principal difeafes to be afterwards fully treated of.
  DV.  The afthenic difeafes are macies, inquietude, or
reftleflhefs without fleep, the afthenic  amentia, the fcabby
                       2                    eruption, 
              OF   MEDICINE.        289

 eruption, the flight diabetes, the afthenic fcarlet fever, the
 rickets ; the haemorrhaeae,  or  general bleeding difchar-
 ges, fuch as menorrhaea, or a  morbid excefs of the men-
 fes, epiftaxis, or bleeding from the nofe, haemorrhois, or
 the piles ;  and alfo three morbid ftates feemingly in  ap-
 pearance oppofite to  thefe, the loitering,  impaired, or
 fipprefled  menftruation; next come thirft,  vomiting, in-
 digeftion, diarrhaea, or  loofe  belly,  and colic  without
 pain ;  after thefe the affeftions of children, as the worms,
 the general confumption, called tabes, dyfentery and cho-
 lera in the gentle ftate of thefe two; angina, the feurvy,
 die gentle hyfteria, rheumatalgia, afthenic cough,cyftirhac-
 », or mucous  difcharge  from the bladder ; the gout of
 ftrongifh perfons, afthma, cramp, anafarca, dyfpepfia with
 pain, the violent hyfteria, the gout of weakened perfons,
 the hypochondriafis, dropfy, chin-cough, epilepfy, or the
 falling ficknefs,  palfy, the lock-jaw, apoplexy, tetanus;
 laftly fevers, as the quartan, tertian, and quotidian, inter-
 mittents or remittents, dyfentery, and cholera, both in their
 violent degree, fynochus, fimple typhus, the gangrenous
 fore throat, the confluent fmall-pox, the peftilential typhus,
 and the plague.
   DVI.  This fcale of afthenic difeafes is to be underftood
 in this way, that thofe difeafes, which  in their moft ufual
ftate are flight,  and claim a higher place in  the fcale, are
 fometimes  more,  fometimes   moft,  violent; and thofe
that in their molt  common  ftate are fevere,  fuch  as the
gout of weakened perfons, the peftilential fevers, and the
plague  itfelf, fometimes  proceed with the greateft gentle-
 nefe (a).
   DVIL The affeftions of parts, which often accompany
thofe difeafes, fuch as ulcer, tumor,  encreafed excretion,
bleeding  difcharge, inflammation, fpafm, convulfion, point
out indeed fome degree  of  debility as their caufe, but in
                         U                      Uu;b
(a) See par. CCC 
290
THE   ELEMENTS
 fuch fort that the fame degree may happen without them.
 Hence, becaufe it is the influence of debility that is funda-
 mentally regarded in this fcale ;  'with the  difeafes, that
 are often conjoined with thefe affeftions, others, without
 them, as hyfteria and the cramp are blended ; and, with
 the cafes that are accompanied with fpafm and convulfion,
 dropfy is conjoined, by keeping to the idea of an equal de-
 gree of debility; and all this without any regard to remar-
 kable fymptoms, but keeping the degree of debility only in
 view.   Neither is the violent cholera  kept back from its
 place among fevers, which laft are diftinguifhed by failure
 in the intelleft and affeftions of the head, becaufe it fliews
 a degree of debility equal  to the febrile.  The  idea  in
 proportioning this divifion  is to fhow,  that  true morbid
 energy does not confift in an affeftion of any  parts, but of
 the whole bod)'; and that the reftoration of health is not
 to be attempted by a change of the ftate  of parts only, but,
 without excluding that,  by a change of  the ftate of the
 whole fyftem.

                     OfLeannefs.

   DVIII.  Leannefs  is an afthenia, lefs difcernable in the
 other funftions, but evident from the weaknefs of the di-
 geftive funftion ; in confequence of which, the fyftem,
 though receiving proper aliment, does not become plump.
  DLX.  Since the caufe  of this difeafe is debility, both
 in the reft of the fyftem, and in the ftomach and other or-
 gans of digeftion ; it thence follows, that the general indi-
 cation for the cure of it, fhould be chiefly  directed to the
 moft languid part, that is, the organs of digeftion and the
 perfpiratory veffels.   More nourifliing  food, therefore,
 fhould be ufed, lefs labour undertaken, and moifture on the
furface, or too free perfpiration, fhould be checked by more
reft of body, by  proper geftation, and rubefaftion, and a
                                                plan 
OF   MEDICINE.          291
plan, quite contrary to that which is fuited to the cure of
obefity fhould be purfued.

                  OfRefilcfs Watching.

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

                 Of the Scabby Eruption*

   DXII. In the icabby eruption,  the face  is pale,  the
 fkin difeoloured, dry, lank, and varioufly disfigured  with
 puftules ; there is a lownefs of fpirits, and the funftions of
 the body weak and fluggifli.
   DXIII. In this   cafe,  while the debility  is  univerfal,
 there is a prevalence of it in the perfpiratory veffels.  And,
 therefore, the chief parts of cure are,togeth&r with the re-
                        U 1                  medies,
(b) S«(;'.r. XLIX, 
   2gi      THE   ELEMENTS

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

                   Of the Gentle Diabetes.

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

                      Of the Rickets.

    DXVI. The  rickets is  an  afthenia  ; to  the general
   fymptoms of which are added an unufual bulk of the head,
   efpecially the  fore part of it,  and  likewife of the knees
   and abdomen, a flatnefs of the ribs and meagernefs.
    DXVII. The rickets is  a difeafe of  children, chiefly
   arifing from uncleanlinefs, want of dandling  or exercife,
.   cold,either without moifture or with it,food not giving fuf-
   ficient nourifhment, and bad air.
                                               DXVIII.

    (c) See par. CCLXVI.  (d) See par. CCLXVIII,   (e) CCLXX. 
            OF   MEDICINE.          293

   DXVIII.  For its cure the common afthenic indication
 muft be employed ; remedies, of an oppofite nature to the
 hurtful powers that excite the difeafe, muft be looked out
 for; the furface of the body fhould be kept clean (f), the
 perfpiration fhould be carefully reftored by the ftimulus of
 pure air and  of heat; the child  fhould be more  carefully
 dandled,  and  kept much  in  the open air,  animal food
 fhould be  adminiftered,  vegetable  withheld, and  ftrong
 drink allowed  (g).

                 Of Retarded  Menfilruation.

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

                Of Impaired Menftruation.

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

            Of the Suppreffion of Menftruation.

   DXXI. Suppreffion of menftruation is that degree of
 afthenia, in which the difcharge is totally ftopt at any pe-
 riod  betwixt  their natural  commencement  and the time
when, in the  courfe of nature, they ceafe altogether.
  DXXI1.  An enquiry muft be made into the caufe of na-
tural menftruation, before it fliould be proper to enter upon
                                                 that
(f) See DXIIf.
(g) Sec CCXCV, CCCIII. 
 294      THE   ELEMENTS

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

              Of the Caufe of Menftruation.

   DXXIII.  The caufe of menftruation is a conformation
of the veffels that pour out the blood in this difcharge,
taking place at a certain time of life, that is, about the age
of puberty, and a ftimulant energy in women, more power-
ful than in the females of the other fpecies of animals.
   DXXIV.  Of other animals there are very few, the fe-
males of which undergo any fort of menftruation out of
the venereal orgafm.
   DXXV. As all the veffels are gradually unfolded in the
 courfe of the growth of the body,  fo the fame thing hap-
 pens to the  genital and uterine veffels, but laft of all to
 thefe. The ends of the latter, terminating, on the fides of
 the womb about the age of puberty, are at laft  fo very
 much expanded, as now to tranfmit firft the ferous part of
 the blood, and then, after an effort kept up for fome time,
 pafs to formal blood.
   DXXVI. At this  time of life a great change over the
 whole fyftem takes place.   Now the defire for coition, a
 ftimulus, never experienced before, produces a commotion
 over the whole body; and, in preference to other parts, in
 the genitals  of both fexes, in the female, over  the whole
 region of the ovaria, womb and vagina: By this ftimu-
 lus, the uterus, its feat, being nearly inceffantly folicited,
 is the more powerfully affefted,the more there is of exci-
 tability, hitherto afted upon by no fuch ftimulus, exifting
 in the fyftem.  Hence, among other organs, the mufcular
 fibres of the next veffels, as well as the nerves interwoven
 with them, undergo the higheft degree of excitement: This
 excitement encreafing over the  whole fyftem, again en-
 creafes that in the uterus: The mutual contaft of the fexes,
                                              whether 
           OF   MEDICINE.          1$$

whether in kiffing, in fhaking hands,  or otherwife, fires
both fets of genitals, and the uterus in  a remarkable man-
ner ; but the aftual embrace produces the  higheft degree
of that effeft. The remembrance of each embrace remains,
renews the dear idea of the delightful fcene, and continues
more or lefs to excite the  uterus.
   DXXVII.  This new affeftion is further cherifhed and
nourifhed by  every ftimulus that is ufually applied to the
fyftem : Hence,  in the abfence, in  the prefence,  of the
beloved objeft, at all times generally,  fearce with the ex-
ception of that which paffes in dreaming, a  ftimulus fo
fteady, and the  more powerful,  that its novelty implies,
that the excitability in this cafe is entire, roufes the fibres
of the veffels, already fufficiently unfolded, to violent con-
traftions.  The blood is carried into the region of the ute-
rus with the greateft rapidity, a. rapidity momentarily en-
creafed, in proportion as ihe  blood, by powerfully diften-
ding the veffels,and agitating them by  its impetuous flow,
ftimulates the fibres  more and more, and thereby encrea-
fes the aftivity by which it is driven on. This is the firft
caufe of menftruation: In that way the two circumftances,
a fufficient enlargement of the diameters  of the  veffels,
and the ftimulus afting more powerfully,  from its novel-
ty, upon the  unwafted excitability (h),  are  fufficient for
the whole bufinefs.
   DXXVIII. This  ftate  is  not inconfiftent with other
 ftates of the body, but bears an analogy to feme well known
 ones : Accordingly, different veffels, from  the mere dif-
 ence of their diameters, are fubfervient to different pur-
 pofes : The  perfpiratory veffels are deftined to the  tranf-
 miffion of a vapour,  the excretory veffels of the alimentary
 canal  to that of a thin fluid, the  renal vdfels to that of a
 groffer one; fo as to take off our furprife at finding veffels
                                                 firi'd
                     (h) SccDXXIH. 
296      THE   ELEMENTS

fitted by their degree of diameter, for the purpofe of trans-
mitting red blood.
   DXXIX. The reafon that the females of other animals
do not menftruate but in their  orgafm, and not at other
times, is, that it is only at certain times  that they are ex-
pofed to that energy of ftimulus which produces men-
ftruation.
  • DXXX. How much is owing to the ftimulus juft now
mentioned  (i). in the  produftion of menftruation, is fur-
ther evident from the following chain of fafts: Which are,
that, the lefs addicted to love women are, the lefs they
menftruate;  the more they give way to that paffion, the
freer do they experience  this  difcharge within  certain
boundaries; that, before puberty, and after the time of life
when menftruation ceafes (which are the two periods,  at
which the fitnefs for effective love has not yet commenced,
or is now paffed), the menftrual difcharge isconftantly
wanting ; that  the privation of enjoyment, which, by its
debilitating effeft, produces chlorofis (k) and other fimilar
difeafes, is  remarkable for bringing on a menorrhcea, or
a retention of menftruation ; and, finally, that girls, who
are of a forward growth/of great ftrentgh,and large limbs,
and confequently fooner ripe for love, are alfo more early
in menftruation;  while thofe,  who are weakly, puny,
and of  a fmall  fize,  and, confequently,  later in attaining
to the period of puberty, are proportionally late in attain-
ing the firft menftrual difcharge.  Laftly, if, like all the
other funftions, that of love is limited at the fame time by
its duration and degree; and if,  as the commencement of
the love embraces it more or lefs early, it is proportiona^y
more early  or late  in coming to its final  termination, and
if the duration  of menftruation does not ufually exceed
that period; that faft alfo, which it certainly is, added to
                                                thofe
(i)SecDXXIII.DXXVL
(k) or the green ficknefs, 
          OF   MEDICINE.         297

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

   (k) DXXIII. DXXVI.
   (1) Women menftruate more than other  fcTules.bccaufe they arc fub-
  jrcledto a higher degree  the ftimulus, which is its caufe ;  a::J fuch
 womeu as arc expofed t > more of the fame ftimulus than others, will A
 fo experience more of the effeftj precifely rp^i  that fame principle. 
 590       THE   ELEMENTS

 operation ; as alfo an abundance of blood, both from timt
 circumftance and from rich diet;  laftly, frequent and ar-
 dent dalliance, or inconcefla hujus imitatio;  all thefe, en-
 creafe the menftrual difcharge, in proportion to the high
 degree of their ftimulus, but ftill do not carry their effeft
 to morbid excefs.
   DXXXIV. The fame conclufion applies to the  effect
 of  thefe ftimuli, which was formerly applied to an  over-
 proportion of blosd producing fthenic diathefis :  For the
 ultimate end of all the  ftimuli,  that producs  exceffive
 menftruation, is fuch, that, if exceffive menftruation  and
 an encreafe of love be the confequence of the excefs of the
 ftimuli, one or other of the following muft be the effect:
 that is,  it will either be fuch as  remains within  the lati-
 tude of health, or fuch, as firft produces fthenic diathefis,
 and then, in a higher degree of it, runs rapidly into indi-
 rect debility.
   DXXXV. That  that is the faft, is proved by the hurt-
ful powers that produce exceffive and  morbid menftrua-
 tion ; and by remedies, that are ftimulant and fuited to fill
 the vcifels, removing the  difeafe according to our late dif-
 covery ;  and alfo by the unfortunate effeft of the  debilita-
 ting evacuant plan of cure in the fame difeafes.
   DXXXVI. As it is ftimulant operation that produces
 both proper menftruation and that which goes to a little
 excefs ; fo when once menftruation is eftablifhed, the con-
 formation  and ftimulus,  that  have  been mentioned, re-
 maining, are fufficient to fupport it.  The  fame opera-
 tion is renewed during every interval of menftruation : The
 ftimulus afts and quickens  the motion of the blood in eve-
 ry  part, but chiefly in that where it is moft powerful and
 moft required, that is,  in  the region of the  womb : The
 blood thrown into quick  motion,  and rufhing with a
 more rapid flow, encreafes its caufe, the ftimulus : And,
 as  this mutual  ftimulus continues inceffantly to affect the 
OF   MEDICINE.          299
women through the whole interval, when they are allowed
fcope of love ;  the  uterine veffels gradually unfolded,
till at laft, within three weeks, or a lunar  month, they
are opened to their  ultimate extremities :  And, when the
fluid, firft ferous for a little, and afterwards fanguine, and
afterwards ferous again for a little, has flowed one,two, or
three days,in healthy perfons,the veffels are at laft fhut up.
   DXXXVII. During the whole time of this pfocefs, the
more excitability there is,  and confequently at the begin-
ning of each menftrual effort, the  more violently the fti-
mulus afts, and produces proportionally more excitement:
And it has, from this time, always lefs and lefs effeft to the
end, in proportion  as the excitability is more wafted ;
though, till the excitibility, in fo far as it has a relation to
the ftimulus, is altogether  exhaufted, the ftimulus always
adds fomething to the fum of excitement (m), though con-
ftantly lefs and lefs.   The  fame is  the  explanation  of the
operation of food, of drink, and of all the exciting pow-
ers.                                        ,
   DXXXVIII.  As what has been faid of the ftimulus,
produftive of menftruation, is conformable to the effects
of all the other ftimuli; the fame is its conformity  to the
whole fum of menftrual effeft from the beginning  to the
end of the procefs.   Thus, in the  beginning of that long
period,the force of the ftimulus is far the greateft,upon ac-
count of its novelty, and theunwafted ftate of excitability
that relates to it.   At this period, above all others, love in
perfons in health is exquifite; and, in confequence  of the
ftimulus which excites it, menftruation, when once efta-
blifhed,  is moft exaftly performed;  that is, it does nat,
either from deficiency or excefs, deviate into morbid ftate.
   DXXXIX. But  after the  beginning of this  funftion,
 and when now  the office  of menftruation is cftablifhed ;
                                              becaufe
(in) See XXXVL 
 3CO      THE   ELEMENTS

becaufe in this, as well as every other funftion, the exci-
tability i;, gradually diminifhed in the progrefs of life,  the
ftimulant power alfo has gradually lefs,  and,  at laft, no
effeft: Confequently, in the fame gradual way,  the power
of love in women, and, in proportion, that of menftrua-
tion, is diminifhed, and at laft altogether extinguifhed.
  DXL. While both the faculties, that of love as well as
that of menftruation, in this way decreafe from  the begin-
ning to the end ; fo, menftruation is often interrupted, in
pregnancy, in fuckling, in the diminution or fuppreflion of
of menftruation.   This interruption in the two former is
natural,  and fuitable to health ;  but in the diminution or
fuppreflion of the menftrual evacuation, it becomes  mor-
bid.
  DXLI. Since the ftimulus with the conformation of the
veffels is the caufe of menftruation, and the latter depends
upon the former; fo again the defeft of the ftimulus, and,
therefore, of the conformation,  produces both the retar-
dation, diminution, and, at laft, the complete fuppreflion of
the difcharge.
  DXLIL  Whether ever the defeft of menflruation, like
that of perfpiration, or of any internal excretions, as that
in the fauces and alimentary canal, is fometimes to be im-
puted to fthenic diathefis, is uncertain, for this reafon; that,
while the diameters of  the fmall veffels on the fkin and in
the infeftines are more  nearly allied to fuch a contraction
for a reafon formerly afligned (n);fo great a force of excite-
rrtentjfo high a degree of fthenic diathefis, as would be fuf-
ficient to fhut  up veffels deftined to the tranfmiffion of
blood, is not eafy to be  conceived.   And  the doubt is
further encreafed by a certain faft; which is, that both in
the retardation of  the  menftrua, and nil the degrees of
their diminution to their total fuppreflion, when local af-
                                              feftion

              (n) LVII. LXII CXII. CXIII. 
             OF   MEDICINE.         301

 fcftion is out of the queftion, there are evident proofs of
 a debilitating caufe.
   DXLIII. To afcertain that faft, which is of the greateft
 confequence for thh reafon, that  it directly interefts the
 method of cure, and, if not explained, would leave a gnp
 in our principles; we have to obferve, that,  as fome men,
 in confequence of the ftimulus of exceffive love, in the cafe
 of a moft  beautiful  woman being the fubjeft of it, have,
 by means  of fthenic diathefis, been fo inflamed as to fail
 into a temporary fit of impotence, and been cured by bleed-
 ing; fo, befides that that is a rare faft (o), it is not very pro-
 bable, that the patulous uterine veffels can be fo contracted
 in their diameters, as to be incapable of tranfmitting their
 fluid.  Nay facts contradict it: The retardation or defici-
 ency of menftruation receives a temporary  alleviation from
 the  debilitating plan of cure; but the difcharge is not ufu-
 ally brought back, on  the  contrary it is  more kept off:
 But allowing an over-proportion of blood and an excefs of
 ftimulus to be the caufe of the firft deficiency of menftru-
 ation,  after it has been  removed by bleeding and the reft
 of the debilitating plan of cure, can it again be the caufe
 of a difeafe, which refifts  a degree of evacuant and debili-
 tating  plan of cure, that would cure ten peripneumonies?
 And fince  any ftimulus, as well as that of an over-propor-
 tion of blood, may, from  its exceffive force go into indi-
 rect debility ;  why may not the fame thing happen in a
 difap p ointment in love, and firft deficiency of menftruation;
 and, in both cafes,  atony, ufhering in  manifeft debility,
 and  not excefs of tone,  be the caufe ? As  peripneumony,
 where the  over-proportion of blood aud fthenic diathefis
 is by far the greateft that ever happens,  in confequence
 of indireft  debility paffes into hydrothorax  ; why may not
 a fimilar caufe in this cafe produce a fimilar effect ?
                                            DXLIV.
  (o) I  remember one inftance  in  Dr. Whyte, and I think 1 have Only-
heard of another. 
$02      THE    ELEMENTS
  DXLIV. The caufe,  then, of  deficient menftruatio.i,
whether partial or complete, is a languid excitement over
the whole body, efpecially in the uterus, from a deficien-
cy of the ftimulus of love (p), and of all thofe ftimuli
that fupport it (q), and from a penury, or undet-propor-
tion of blood.
  DXLV. That that is the faft, is proved by the hurtful
powers mentioned in the retardation of menftruation, and
o.hcr debilitating ones in every deficiency of that difcharge,
producing each difeafe ;  it is proved by the ftimulant and
filling plan of cure removing it,  and alfo by the hurtful
erfeft of the debilitating plan of cure (r).
  DXLVI. The remedies for the cure of retarded men-
ftruation are,   rich  food, generous drink, geftatior, exer-
cife accommodated  to  the ftrength, pediluvium and femi-
cupium, or the warm bath of the under-extremities,  and
gratification in  love (s).
  DXLVI1.  The  fame remedies  are  required for the
fupprelTion, and the fame, but inferior in their degree of
force, for the  diminution of menftruation : When there is
an unufual force of the difeafe, either in degree or dura-
tion, we muft have recourfe to the  affiftance of the  diffuf-
ible ftimuli.

    Of Menorrhcea, or the exceffive Difcharge of Menftruation.

  DXI.VIII.  Menorrhcea is  an effufion of blood from
the uterus, or an over-copious menftruation, or too long a
continuance of it in a more moderate degree of the ex-
cefs, accompanied by all the fymptoms  of afthenia.
  DXLIX.  This difeafe "u occafioned not byan over-pro-
portion of blood, not by a vigorous ftate of body, but by
                                                   an
  fP) DXXIII. DXXVI. DXXIX.
  (q) DXXVJ.  OXXVli. DXXXll. DXXXVH.
  (r) DXXXV,           (6) DXXVI,
.. A 
             OF   MEDICINE.        303

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

           Of Epiftaxis, or bleeding from the Nofi.

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

                   Of Hamorrhois.
   DLIII.  The charafteriftic of haemorrhois, or  the piles,
 added  to other figns of afthenia, is a flow of blood from
 the anus, or the parts around it.
   DLIV. The fame thing, nearly, that has  been faid of
menorrhcea, is to be faid of the hurtful powers and reme-
dies of this difeafe.
   DLV. The caufe of the piles is manifeft, from  the hurt-
ful powers producing it, the remedies removing it, and the
unhappy effect of the common afthenic plan of care; that 
 30.|        THE   ELEMENTS

is to fay, it is debility of the whole body, from the defici-
ency of other ftimuli, and chiefly that of the  blood (t) :
Which debility, while it relaxes all the veffels, and impairs
their tone, produces that effeft, in a fpecial manner, upon
the labouring veffels. The reafon of which is, that, in con-
fequence of the inequality fo often mentioned, the chief
prevalence of the caufe operates in the feat of the urgent
fymptom (u).  Nor is it to be thought  wonderful, that
the blood fhould flow through the veffels of the uterus that
are patulous, and in the habit of pouring out blood, through
the pendulous hemorrhoidal veffels, and thofe of the nofe,
which are delicate, and weakly fupported,  in preference
to others.  In this cafe plethora, which has noexiftence(x).
is equally  unneceffary to our reafoning (y).

Of Thift, Vomiting, and Indigftion,  as <well as the Kindred Dif-
              eafes of the Alimentary Canal.

   DLV1. There is a very frequently occurring affeftion,
beginning with thirft and proceeding to vomiting (z). It
often proceeds no farther than thofe fymptoms ; it oftentr
ufhers in the moft fevere affeftions, fuch as fometimes dyf-
pepfia, or indigeftion, fometimes colic, fometimes the gout,
fometimes proper fevers, and many other afthenic difeafes.
Its moft frequent fource by far is weaknefs, being the at-
tendant fometimes of too long fuckling,  fometimes in the
diarrhoea  incident to women, wafted with a long courfe
both of that and repeated pregnancies.
  DLVII. There are two caufes of as  many affections
which  have  got only  one  name between them,  that of
thirft :  The one is fthenic,  the other afthenic (a).   The
former arifes from the  ftimulus of fait, of rich and plenti-
                          z                        ful
  (t)  See par. DXLIX.              (u) Sec XLIX. L, LI.
  (x) See par. CXXXI. CXXXIV.    (y) CCXXXH.
  (z) CLIX.CLXXXV. CLXXXVI.  and CLXXXVII.   (a) Ibid 
OF   MEDICINE.         30J
fail meals, of heat and labour,  and fome others;  never
ending in vomiting till the fthenic ftate is over, which is
feidom.  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
fubieft, depends always  on pure debility,  fometimes in-
direct, fometimes direct (b).  Its tendency is  always  to
ftomach ficknefs, and, as that encreafes, to vomiting (c);
and when the vomiting  becomes any way confiderable,
the confequence is that moft acute pain, which a cramp in
the ftomach produces (d), and the other affeftion formerly
explained (e).   This progrefs is fpontaaeous, direct, and
for the moft part rapid.
   DLIX. The hurtful powers  here are  all debilitating.
The indireftly debilitating hurtful powers are, debauch
in eating and  drinking (f), drunkennefs, extreme fatigue,
ultimately exceffive heat (g), violent pafiions (h), exceffive
exercife of the intellectual faculty (i), debilitating food (k),
an over-proportion of blood now converted into an under-
proportion, together with the converfion of  the  fthenic
diathefis that  attended the  former, into the afthenic, the
infeparable  attendant on  the latter.   The following pow-
ers aft by a direftly debilitating operation; cold corrected
by no ftimulus (1), cold drink, vegetable food (m), penury
of blood (n), of other fluids (o), want of pure air(p), anxie-
ty, grief, fear (q), and in fine, that weaknefs of the fyftem,
which arifes from all thofe.  The affeftion is  often of a
inixt origin, from a mixture of both thefe forts of hurtful
powers: For, as direct debility always increafes theindireft,
fo does the latter the former, both in this and all cafes (r).
                          X                    DLX.
  (b) CLXXXV.            (c) See CLXXXVII. CLXXXVIIh
  (d) See par. CLXXXIX.
  (e) CXC to CXCV. and from that to CXCVIII.
  (f) CXXVIII. CXXX. (g)CXV.  (h)CLXl. (i)CXXXIX.
  (k)CXXVIII.    (l)CXXII  (m) CXXVIII.  (n)CXXXIV.
  (o)CXXXVU.  (p)CXLVI. (,)CXLIL (r) XLVII.  LXXl. 
306       THE   ELEMENTS
   DLX.  A corruption of the common mafs of  fluids,
 whether it be called acrimony, or putrefaction, has no con-
 cern in the caufe;  becaufe, while life remains, and the ac-
 tion of the veffels upon their refpective fluids continues,
 fuch a  faulty ftate of the fluids cannot make its havock
 over fuch an extent of the fyftem, that being only  the ef-
 fect of a ceffation of motion of the fluids under heat; nor
 can it happen, but in the extreme veffels and  excretory
 ducts, which, by their atony, do occafion fuch a ceffation
 of motion, and likewife in the alimentary canal.
   DLXI. The caufe of this thirft is the common  one of
 every afthenia, but predominant in the throat and ftomach,
 upon account of the atony of the falivary,  and other ex-
 cretory dufts (s).
   DLXII. The remedies are alfo the common ones of
 every afthenia, to be accommodated to the degree of debi-
 lity in the caufe.  In a flighter degree of thirft  a glafs or
 two of brandy, or of 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 wa-
 ter (t).   That ihould be followed by eating fome animal
 food (u); and it ihould afterwards be fupported by other
 ftimulants taken moderately, and in the degree  that fuits
 good health.   After  which the proper practice is, to pro-
 ceed to the ufe of the permanent ftimuli.
   DLXIII. When the thirft, not quenched by thefe means,
 proceeds directly to vomiting, and when, by  and by, an
 excruciating pain fupervenes upon the vomiting ; which,
                                              excepting
  (s) CLXXXVI. CLXXXVlr*
  (t) The addition of cold water counteracts, that of hot co-operatei
 with, the effeft, which has been afcertained in a thoufand trials.
  (u) 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 ftomach ficknefs, that now begins to take place
with it, renders eating impracticable. 
OF   MEDICINE*         307
excepting the pain, is an affection, that together with the
fymptoms that have  been mentioned (x),  fhould receive
the appellation.

     Of Dyjpepfiinodyne, or Indigeftion without Pain :

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

                    Of Diarrhvea.

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

          Of CoUcanodyne, or Colic without Pain :

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

       Of the Kindred Difeafes of the Alimentary Canal.

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

              • Of the Difeafes of Children.

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

                      Of Worms.

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

        Of Tabes, or the general Wafting of the Body,

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

     (y) From DLVL to DLXVI.             (z) See CCCCIIL
   (a) It is that longitudinal depreffion which runs down from the par-
tition of the noftrils perpendicular to the upper-lip. 
OF  MEDICINE.        309
weak, diftreffed,  afliduous, and hoarfe manner of crying,
as excites tendernefs and compaffion.
  DLXXI. The hurtful powers,  producing all thofe af-
feftions, are in common to  them with  every afthenia;
that is,  they are every thing that has an effect of debilita-
ting the  whole fyftem, and efpecially the alimentary canal:
Such as, at this age, are, milk not nourifliing enough, and
at the fame time acefcent  and flatulent;  want of food, or
made of watery matter and bread ; cold, and moifture,
the latter encreafing the effect of the former; habitual vo-
miting and purging; too little dandling;  miftiming fleep,
and meals, and every part of management; naftinefs;  im-
pure air ; a negleft of natural likings and diflikings.
  DLXXII. The remedies are the converfe of all thofe,
nourifliing exciting milk;  three or four meals a day, con-
flfting chiefly of warm milk, pure animal  foups, not weak*
with a mixture of flower  or bread of the fame kind; heat
without being carried fo far  as to produce fweat, or too
much rednefs, and free from moifture; laying afide every
fort of evacuation; a great deal of dandling and geftation;
a proper timing of fleep, of food, and of every part of  ma-
nagement of thefe delicate fyftems ; cleanlinefs ; tepid ba-
thing in cold  weather, and cold bathing in warm;  and
pure air, being out in the  fields as often as poflible in all
but moift  weather ; fuch a judicious  attention to defires
and propenfities as not to neglect fcratching any part  that
itches (b).
   DLXXIII. Thefe  direftions  fuit  the  gentler cafes
under confideration.   To remove  the more violent, while
they alfo are not by any means to be neglected; at the fame
time others  to be fubjoined.   When  the  green fcour-
ings, great loofenefs,and boundnefs of belly, are vexatious;
  recourfe muft be had to pure wine, fpirits, more or lefs
                                               diluted
(b) See above DXVUI, 
 3IO       THE   ELEMENTS

diluted as the occafion may require, or if there fhould be
need, not diluted at all: More of the foup that has  been
mentioned and of a richer kind.
   DLXXIV. If thofe fhould not fucceed to the phyfician's
 mind, which will feldom be the cafe;  in the fame affec-
 tions and more certainly in worms, and ftill more certainly
 in the tabes, or general confumption, with the remedies
 that have  been fpoken of,  the more diffufible ftimuli of
opium and mufk fhould be alternated.  Both forts of re-
medies (c), fhould befo accommodated to the violence of
the fymptoms, as not to be dropped till the whole morbid
 tumult is allayed, and the healthy ftate replaced ; which
 will, upon trial, be found more practicable, than has yet
 been imagined from the employment hitherto of the con-
trary plan  of cure, to the great comfort of mankind in their
 fufferings.
   DLXXV. From  what has  been faid  it  will appear,
 that thefe  affections of children, all flow from  the fame
 caufe, are removed all upon  the  fame indication of cure,
 as any other afthenia, or difeafe of debility, that has either.
 yet been, or is to be, mentioned in this work.   The  un-
 happy termination of them hitherto, is to be imputed not
 to their caufe, but to the depravity of the common method
 employed for  their cure (d): Nay, though they do  dege-
 nerate into local affeftions, as in the inftance of the  tabes,
 or general cornfumption,  ending in an obftruction of the
                                             mefentery j
   (c) The durable and diffufible.
   (d) I cannot help repeating again, becaufe the importance of the fub-
ject calls upon me to do fo j that the practice of the new plan of curr,
in all the difeafes of children,  as well as in the others lately fpoken  of,
has evci fucceeded in my hands, as well as in thofe of my pupils,  to a
miracle.  I cannot fay that I ever met with an inftance where it could
be Lid to havefailed.  Let then who will  compare  that account with
the known mortality that is every day the  refult of any other practice
yet thought of in the profeffion. 
             OF    MEDICINE.        3U

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

            Of the gentle Dyfentery and Cholera.

  DLXXVI.  To which, every thing that  has been faid
of thofe kindred ones, will apply : Or, if there be occafion
for any particular obfervation upon them, it will be taken
up, after we comedo treat of them in their more fevere and
violent ftate: Of a fimilar nature to all thefe,  but  of a
degree fo much higher as to merit the next place in rank
below them,  and, at the fame time, not unconnected with
them,  a6  having the feat of  its predominant fymptom in
the fame canal, is the difeafe to which I have given the
name

                      Of Angina.

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

                     Of Scurvy.

  DLXXVII. Scurvy is an evident afthenia: The prin-
cipal fymptoms of which  are, want of appetite, loathing
                                                  of
{c) From DLXVL to the prefent paragraph. 
 3^2      THE   ELEMENTS

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

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

                 Of the gentle Hyfteria.

   DLXXXI. The gentle hyfteria is a form of  -nhenia,
of frequent occurrence among women, but very rarely
happenning to men; in which a noife is  heard in the belly,
and the patient has a fenfation of a ball  rolling within  the
bowels, riling up to the throat, and there threatening the
patient with fuffocation.
   DLXXXIII.  The  ftriking fymptom in this difeafe is a
fpafm, not fixed in a part, but running the courfe juft now
defcribed.  The difeafe attacks in fits, for  the  moft part
leaving  long intervals betwixt them, and often never re-
curring more than once or twice.                   . -
   DLXXXIII. The fits are  foon removed by fmall dofe6
of opium, repeated at fhort intervals: The intervals ihould
be  fecured  from danger by full diet, and a moderate and
naturally ftimulant management.

        Of Rheumatalgia, or the Chronic  Rheumatifm.

   DLXXXIV. Rheumatalgia is an aflherda, not fo much
a fequel of rheumatifm when left to proceed in  its own
                                         fpontaneous 
 3H      THE   ELEMENTS

 fpontaneous courfe, as of the profufion of blood and of
 other fluids employed for the cure of it, and of too debi-
 litating a cure; with a c!>ange of the fthenic  diathefis and
 the inflammation, which is a part of that, into the afthenic
 diathefis and inflammation. Palenefs of the fldn takes the
 place of complexion : The appute is diminifhed, the in-
 voluntary motions are  impaired, debility and torpor pre-
 vail over all. So far the difeafe is underftood to be chronic.
 As in rhematifm, the joints are pained and inflamed : As
 that, which has  been affigned, is the moft  frequent caufe
 of rheumatifm, fo it fometimes arifes not from  a fthenic
 origin, and an excefs in  the means of reducing that.
   DLXXXV. The caufe of the difeafe  is the ufual one
 of any afthenia, predominant in the moving fibres of the
 mufcles, fituated below the fkin over the whole furface of
 theboiy.
   DLXXXVI. Its worft  morbific powers are, penury of
 blood, cold, efpecially with the addition of moifture, im-
 pure air, and befides thefe, as many of the other powers
 that aft by a debilitating operation as happen to be applied,
 contribute, in proportion to the  degree in which they are
 applied to the  morbid  effect.   Of thefe exceffive indo-
 lence and the reverfe are particularly hurtful.
  DLXXXVII.  As all ftimulants contribute to the refto-
 ration of the healthy ftate ; fo the moft powerful of them
 in this cafe is nourifliing food,  friction,  geftation, wine,
 taken in moderation, exercife, rather frequent than violent,
 and being as much as poflible in the open air.   If it is an
 acknowledged fact, that rheumatalgia is one of the reproa-
 ches of phyficians, it is more fo than has been hitherto un-
 derftood;  it being an afthenic  difeafe,  while they at all
times made ufe of the fame kind of cure, as if it had been
                                                 the 
            OF   MEDICINE.          3 I £

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

                  Of the Afthenic Cough.

   DLXXXVIII. The afthenic cough is an afthenia, which
with the conftant fymptoms of the latter, depends upon
a frequent expectoration, that the cough excites; aifeftino
every age which has been under the influence of either
direct, or  indireft debility, and therefore old age, wiiLh
is unavoidably the prey of indireft debility.
   DLXXXIX.  As confifting in  direct debility, it is the
effeft of an exceffive violence of all ftimuli that have been
applied either for a fliort time, or for a great part of life,
their operation coming to the fame amount, that of the for-
mer from  its degree,  and  that of the latter from  its long
continuance (i).  In fo far as  its caufe is direft debility, a
deficiency of all the ftimuli,  leaving the excitability to be
accumulated, allows this form of afthenia to happen from
the fpontaneous tendency of nature, of which life  is only
a forced ftate (k).
   DXC. The cough,  which depends upon indirect debi-
lity,  is cured by reducing the ftimulus which  occafioned
it, gradually and cautioufly to the proper and natural degree.
                                                     And

  (h) If they fhould pretend to fay that their bleeding and other evacu-
ations were more moderate than  in rheumatifm ; the anfwer is, that they
were not  fo  profufe at any gwen time : I:ut, confidering the length cf
time, that rhcumatalgy draws out into, the frequent, and almoft conftant
evacuations,  conjoined with every i'wecies of inanition, made the debili-
tating practice upon the whole f^r exceed that ufci in the fthenic cafe.
No wonder,  then, that mu< h mifchief was done.
  (i) See above XXIX.XXX . ;-.:id CCCCI.
  (k) So great is nature's tendency to that particular encreafe of eser-
tion, which forms the matter cf expec' oration in this difeafe, that every
cafe of death from .. feafe is an infhence cf it.   Hence the dead rattle in ■
the  throat is m•>. ;:rfally. the  cxp rirg  fymptom.  See LXXH. and j
CCCXXW- 
 $l6      THE   ELEMENTS

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

or debilitating remedies; ani thit,inthe feveral trials that
have yet been made,  the firft of thefecifes hi, been evi-
dently affifted, nay frequently completely removed, and the
two latter, thoroughly cured  in numberfels inftances, and
in all in which it has been ufed by the fthenic, or ftimu-
lant plan of  cure ; I fay, befides thefe large and compre-
henfive  fafts,  fo little fignification is there, either in the
quantity or appearance of the expeftoration,  that in cer-
tain fevers, in other difeafes of  debility,  quite free of all
local affection, and finally in this very cough of which we
are fpeaking, there is often a more  violent cough, and a
greater expeftoration of matter putting on every form and
every appearance, than ufually  happens in a confirmed
confumption, and where every ho.ir  is expect .'d to be the
laft.   And yet the whole tumult, hitherto fo alarming,
could be ftopt in a few hours, anil quite cured in as many
days.
   DXCIV.   And, who does  not know,  that there are
many perfons, who have an immoderate cough, and pro-
portional expeftoration for a whole and  long life time,
whofe lungs,  however, are found, and free from any or-
ganic  taint ? How often in phthifipneumony  itfelf after
finifhing its  courfe, and at  laft terminating in death, has
the whole fabric of the lungs been found upon diffeftion
as found as ever happens in death from any Caufe (m) ?
                                               DXCV.
   (m)There are feveral cafes lipon record, of the lungs uLcr death from
a confirmed confumption, having been found perfectly found.  A moft
refpectable pupil of mine went to Lifbon with a young gentlemen (t
confiderable  rank in Scotland, under a confirmed confumption, whom
he brought back perfectly freed from his difeafe. He alio fuved ekhcr
two or three ladies, I am not juft now fure which; equally given up up-
on the common practice. He happened to aflert before the phyfician of
the factory, that a perfon juft dead  of the fame difeafe had no local af-
fection in the lungs, and upon diffection it was found to bt as he had
laid. I have reftored many phthifipneuironiacs.b'-ir am obliged to own,
                                                    that 
3'S
THE   ELEMENTS
   DXCV. The caufe of cough has hitherto been un-
known.  To pafs over the fthenic cough, with which we
have nothing to do in  this part of our fubject (n); the
caufe of thj afthenic, is the  fame as that of any afthenia,
but more vehement in the fountain of expeftoration, to wit,
the exhalant  aud mucus  arteries, the fecreted fluids of
which, infpifllited by ftagnation  in the bronchia, compofe
the matter to be expeftorated.
   «. *. The moft powerful of the afthenic  hurtful agents
in exciting afthenic cough, is cold, juft as  heat has been
demonftrated the moft hurtful agent in catarrh (o). Nay,
in the afthenic  cough, fuch  is the rage  of cold, that the
flighteft breath of air reaching the body, excites a moft
prodigious tumult of coughing, and brings  out the whole
feries of fubfequent fymptoms; and heating the body in the
bed, as foon allays  the cough,  prevents the threatening,
and cures the urgent difturbances.
   DXCVI.  In this  as well  as the fthenic cough, it is the
ferous and mucous fluids that chiefly flow to the bronchia.
Which bear their prelfure  for a little, till, diftended by the
load, they can  bear it  no  longer. The difagreeablefs  of
the ftimulus excites a commotion in the  excitability of the
labouring part, and,  therefore,  over its whole feat, and
roufes  the excitement.  A cough arifes and throws off
its caufe, the collected humours.
   DXCVII. This difeafe is  always to be  treated for  its
cure, firft with ftimulant remedies, and then with fuch  as
                                                  alfo
that I have loft three, to  whom  I was called too late.  Their lofs,how-
ever mortified me, becaufe there were many reafons  for my fetting my
heart upon the cure.   I alfo loft in Edinburgh the m«ft amiable young
man of that kingdom, after curing a prodigious hemorrhagy from his
lun^s.  This was he whom my  pupil two years before brought home
fafe from Lifbon.  But I was prematurely difmiffed in this, and coun-
teracted, in the other cafes.
   (n) Sec CLX. CCXXXIII.  (o) See par. CCCCVII. to CCCCXII. 
             OF    MEDICINE.          319

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

                      Of Chinecwjh

   DXCVIII. Is  given, to be  encountered in  praftic*.
Chincough is attended by a contagious matter; which va-
ries in its degree, but in fuch fort, however,  that a fthenic
plan of cure, adapted to the degree of the difeafe, for cer-
tain cures it. The change of climate or place is a tale, the
practice of vomiting is death (r).  And, fince the difeafe is
                                                      an

   (q) See par. CIH.
   (r) Still to the old tune" Cantiienam eandem canunt " They confef-
fed they kn-.w nothing about this difeafe, yet they ptefcribe change cf
air and place :  If they knew nothing about the difeafe, how couid they
know what would be of fervice ?—Others told them fo.  liat  why do
they  prefcribc vomiting ?—They heard that from their mailer's dtfk
at fchool, and  found,  that the fame authority, was the reafon cf others
for doing the  fame thing. Why ▼omitinv ? For the  Line retfon, and
becaufe a ndique of the doctrine <f morbific matter has run ti .rough ail
their fyftems.  Hence in bleeding difeafes, the ui.iverfal rule has been ta
Heed; in  vomiting to give emetics, in diarrhea to give cathartics, in
                                                 imitation, 
  320       THE    ELEMENTS

  an afthenia,  vomiting,  which is  fo very  debilitating an
  .'.gent, cannot fail to be of the higheft detriment (s).

  Of the Cf.rrhxa, or the w.'.vro.vr Dfcharge from the Bladder of
                          Urine.
    DXCIX.  Cyftcrrhcea U  that mode of afthenia* in
  which,  to the general fymptoms of afthenia, and  the par-
  ticular ones of afthenic' cough, there is  an addition of mu-
  cus, rendering the urine turbid, without any previous pain
  cr fymptom of internal local arfcftion.
    DC.  In fo far as this is  a general affection,  the laxity
  proportioned to the atony muft be removed equally in it,
  as in other cafes of encreafed  excretion ; and particularly
  the ftimuli of health muft be accurately adminiftered.

               Of the Gout of ftronger Perfons.

    DCI.  The gout of ftronger perfons is a  form of afthe-
 nia ; in which, after a long habit of luxury and indolence,
 and efpecially,  when to thofe hurtful powers  direftly  de-
 bilitating, ones have been recently fuperadded, indigeftion,
 or diarrhoea, or rather both  conjoined, with  manifeft figns
 of a diminifhed perfpiration,  precede; then the lower extre-
 mities are affefted with languor.  Of the leffer joints, al-
 moft always the one or other foot is feized with an inflam-
 mation,  which, if not refilled  by a piece of  art quite new,
 will prove moft fevere,  moft painful, and of a fliort dura-
 tfe n, comparatively to its ftate in that refpeft in the after
 part of the difeafe.
              2                                 DCCII.
 imitation,  forfootli, of nature.  The fymptoms of difeafe have  been mif-
 taken for efforts of the conftitution to remove the difcale.  It is nowj
however, proved that there arc no fuch efforts.  Every fymptom, and
particularly every morbid evacuation, is to be ftopt. The contrary prac-
tice is as good fenfe, as it would be  to propofe bringing on a dead rattle
to cure  hemorkJ One.
  (s) See par. CXXXVII. and CCXClV. 
                OF    MEDICINE.        $2,1

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

   (t) There are very few perfons, who at one time or another in their
 life have not experienced painful twiches in fome part or other of one
 of their feet, efpecially when they happened to be in a ftate more languid
 and flug^ifh than ordinary.  Every which cafe may be confidered as a
 gout in miniature.   But when the whole phenomena, except the inflam-
 mation, happen to  any pcifon, call it dyfpepfia, or wh3t you will;  it  is
 to all intents and purpofe» a gout.  Indeed, from all that has been faid
 through this work, general morbid ftate appears to be a very fimple af-
fair,  being  nothing but  an encreafe or  diminution of the caufe of the
functions or powers of life, without any other difference, but that of the
mere appearance of the fymptoms to our fenfes, an appearance by which,
when we 1-rj.l: no further for information, weare alfo conftantiy deceived, 
  J22       THE   ELEMENTS

  been proved to be every thing refpefting difeafe; and, asi:
  i*, therefore abfurd, fo the truth of the latter muft be ad-
  mitted.  The ftamina, or bulk of our fimple  folids, are
  fo given in our  firft confirmation,  that fome  perfons are
  diftinguifhed by a grofs, others by a flender ftate of the
  whole mafs.  That variety of the ftamina,  if the exciting
  powers, upon which the whole phcenomena of the life de-
  pend, be properly directed, admits each its refpeftive ftate
  of health,fuited toits refpeftivenature,and fufficiently com-
  modious, if the excitement fuited to each, from a proper di-
  reftion of the ftimuli producing it, be  properly applied.
  Though Peter's father  may have been affefted  with the
  gout,it does not follow that Peter muft be affefted; becaufe,
  by a proper way of life, that is by adapting his  excitement
  to his ibuniiia,  he may have learned to evade his father*,
  difeafe.
    i. 0. If the fame perfon, who from his  own  fault and
 improper management  has fallen  into the difeafes; after-
 wards by a contrary management, and taking good care of
 himfelf, both prevents  and removes the difeafe, as it has
 been lately difeovered ; what then is become of hereditary
  taint ?
   Laftly, if the gout is the fame difeafe as dyfpepfy,   ari-
 fes from the fame hurtful powers, is removed by the fame
 remedies;  and the only fymptom,  in which it  can  pof-
 fibly be thought to differ, the inflammation, is only a flight
 part of the difeafe, depending upon the fame original caufe,
 and ready to yield to the fame remedies; what fignify di-
 ftinftions about either, that do not appply to both (x)? No-
                                                 thing
  ;s) If I hr.vc kept off my gout for feven years pad, after having been
fiily.-ctcd to the moil fevere nt^e of the difcue, might not I, much more
eafily,  have preve.it-.d it be 1< re :  Put, it may be faid perhaps, that ex-
cruciating  pain nv-l  ; a gre..t difference in the fcale of comparifon of
any two difeafes : The anfwer to that is, that fince the pain is as eafily
removed cs the other fymptoms, the differe;ic£ :s removed, and the
weights in the fcale ccu'-!'«-d. 
             OF    MEDICINE.           323

thing by them further is fet forth, than, that a certain tex-
ture of ftamina  is favourable to certain forms of difeafes,
which (forms) are of no  confequence, in fuch fort, that,
when the excitement is a-lipt.j.1  to the  ftamina, even thofe
forms  can be prevented or cured.
   DCIY.  The  hurtful powers  producing the  gout are,
firft, indirectly  debilitating, nor effectual all  of a  fudden,
nor commonly before the meridian of life, that is,  befors
the thirty-fifth year of one's aire.   Rich food,  too much
eafe, have a very great effeft, drink has lefs.   To that all
that have a tendency, to wear out life, to confume the ex-
citability, contribute.  But the firft fit  fearce comes on till
directly debilitating hurtful powers have been fuperadded
uo the indireft (y). The following are particularly hurtful,
abftinence, vegetable food, the hurtful  effeft of which is in
proportion  to the imbecility of the matter that compofes
it..  The r ir'maceous fubftances,  which are  by no  means
Life (-/), and Ids hurtful than roots, and thefe lefs fothan
greeiio (a).'; but fruits are the moft hurtful of all (b). Cold
                            Y 2                     water,

  (}') My ;;s'it came  on at the thirty fixth year of my age, after five or
fix month's low living :  It returned not again till betwixt five cr fix
years after, becaufe all the intermediate time 1 had been well fupportcd :
/.nil this fecond fit was ufh^rcJ in with low living, immediately previa
ous to it. for near  the fame length of time, as  before the coming on of
the firft fit.  Nay,  no gout ever came on but in confequence of direct
debility ;  the indirect has not fo quick an effect in that refpect; at the
fame time it  has  a tendency to be hurtful, and  therefore fhould be
avoided.
  (z) A nuT- of porridg?, a difh ufed in Scotland, with fmall beer pour-
ed upon it, and taken  over night, would bring on a fit of the gout  next
day.
  (a) The juice of turnips,of cabbage,and even pcafe-pudding art! peafe-
foup, which are commonly reckoned  fubfbantial difhe=,  have the fame
effect:  When thofe fubftances, after being boiled, are ufed with a good
folid meal of meat,  I  have always found them innocent.  Green peaie
;.tc, with  lamb or fowl,art both harmlefs and grattful.
  (h) Apples and ru-ars are fuch :  hut the cold fruits, as nv.ljr..;.  cu-
t° umbers, arc a I moll infiai.tar.cous in their hurtful effect. 
324       THE  ELEMENTS

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

  (c) Sr. CLXXXIV. to CXC. to CCXXXVII.
  (J) This is  one of their many centradictions between theory and
practice.
  (e) At any tinii I can bring on a fit by a fingle dofe of Glauber's fait,
'.nf els I happen to be very ftrong and quite free of ail diathefis.
  if) At an advance? period of age, in perfons who had been vigorous,
                                                     an 
©F   MEDICINE.         325
 Great  heat, by its indireftly debilitating operation,  does
 fome hurt (g), but great cold, by its direft debility, much
 more (h).   Impurity of air is inimical (i), as well as an
 interruption in the train of thinking (k)«,  but hard thinking
 is more hurtful. A deficiency in the ftimulus of paffion is
 a pretty confiderable hurtful power (1)  : but a high inten-
 fity of it will convert this immoderate degree of the gout in-
 to that higheft degree of it, that attacks the head ; lays a
 fnare to life, and brings on certain  death (m).
   DCVI. Long fleep is bad  (n), as producing direft debi-
 lity, by deferring the re-application of the ftimuli, which
 the watching ftate afford; but fhort fleep  is  much more
 hurtful, leaving behind it a degree of fatigue ftill remaining
 from the effeft of the ftimuli of the former day (o). Often
 after the upper parts  of the body have been recruited with
 enough of fleep, after getting  up, the podagric  feeling a
 ftate of languor  in his lower extremities, and a demand
 for  more fleep to them, is obliged to go to bed again, and
 give the unrecruited limbs their  refpeftive fhare of fleep.
 When a perfon is torpid from fhort fleep, how great is the
 luxury to  cherifh again by the heat of the bed-clothes all
 the parts that have been expofed to cold, that is, the whole
 furface  of the body and thighs, but efpecially the legs and
 feet, which laft,  during the prefence of the fit, is the feat
 of the inflammation •, and, how delightful in that way, to
 make up the neceffary complement of the fleep  that is
 wanted.
                                               Dcvir.

rn unnatural  power of execution fometimes, even an 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 is a falfe power, it is a fymptom ef difeafe:
It is like unnarti-al appetite for food amidft a  weaknefs of the powers of
digeftion.
  (g) CXV.            (h) CXVII.         (i) CXLVf.
  (k) CXXXIX.        fl) CXLI.            (m) Ibid.
  (n) UCXLV.        (o) See Pjri II. Chap. VII. CCXXXVII. 
 326       THE  ELEMENTS

    DCVII.  To prolong the intervals of health, and  pre-
 vent a fit,the remedies are all the reverfe of the hurtful pow-
 ers: They  are, rich food taken in plenty (.p), but remain-
 ing within its ftimulant range, confequently of the animrd
 kind, with a rejection of all forts of vegetable matter, or a
 very fparing ufe of it;, ftrong drink, not taken cold, unlefs
 when there is  no danger of the difeafe (q) (at  which time
 cold water is fafe after a good meal), not mixed wi;h acid
 not acefeent, not under a tuibid fermentation while it is ta-
 ken (r)-, geftation (s) exercife fhort of bringing out fweat, or
 giving fatigue (t), a fmall quantity of blood, which is pro-
 cured by food, and the motion juft now mentioned (u), no
 evacuation (x), fparing venery, if that be made good in fuch
 perfons (y), a  moderate temperature (z), kept equally be-
 tween the extremes of direft and indireft debility, and in-
 clining to neither; pure air (a), confequently cleanlinefs, and
 being much in the open fields, a happy train of thinking (b);
                                                      fuch
   (p) Seepar.CCLXVI.
   (q) I know well when I ma-y take cold  drink and ufe feme vegetable
 matter ; it is, when, for fome time paft, I have been well fupported, and
 feel ftrong and vigorous- I alfo know, if I fc.ave, cither in  food or drink,
 taken any thing improper in kind, how  to correct it;  which is, by hav-
 ing recourfe to a proper ftimulus.  By eating an exotic fruit, which had
 a mixture of the qualities  of the water melon the orange and lime, in
 a quarter  of an hour I  had an attack in  my ftomach, in the middle of
 my lecture laft fummer, at  the Devil Tavern.  By io^e 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.  Thia doc-
 trine puts much more in our power : But  we fhould not, therefore, pny
 tricks with it. On the contrary, we have  great  reafon to be thank-
ful for the command it gives us over oar health, and that alfo. Ly the
ufe of means not inelegant, naufeous and clumfy, but quite the contrary.
The old motto of  Afcleiades, tuto, celeriter, et jucunde, is verified a:.d
 improved by the important addition of  falubriter.
  (r) CCLXVIII.       (s) CCLXIX.        (t) Ibid.
  (u) CCXC. CCXCV.   (x)CCXC.          (y)DCXIX.
  (z)CXII.             (a)CCCHI,        (b)DXI!f.DXVi';i. 
            OF    MEDICINE.         327

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

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

   (f)  Such  is the effetJt of the powers operating upon us, 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 the
 demands of the fyftem: Hence, dav-labourers, are fupported upon lefs fti-
 mulus than gentlemen. Again, which is a circumftance liable to happen
 to the;lattcr, if the accuftqnary operation has been exceffive, there will be
 a  neceffity for a continuation  of fome degree of the excefs.  A podagric
 may be ftronger 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 bet-
 terTupported than the labourer, he is worfe  fupported, than the ufual
  ftate of his fyftem requires.  Further, the labourer, though he falls not
  i»to the gout, may, by carrying his moderation too far, fall into indigel-
  tion, or fome other difeafe, in every effential refpectthe fame as the gout.
  A double inference arifes here ; Which is, that, though  both excefs and
  deficiency can be borne to a  certain degree, fo as to require a continu-
  ance of them, or a gradual correction, yet they  fhould both be avoided
  as entailing that fort of neceffity for their continuance while their effect
  makes no fort of compenfation, being, at beft, not the beft ftate, that of
  perfed health, but a ftate of predifpofition to jdif.afc; the one to fthmic
                                                           an 4 
OF    MEDICINE.        329
                    Of the gentle Afthma.

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

                         Of Cramp.

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

 and at laft indirect debility ;  the other to afthenic, as depending on di-
 rect debility.  The perfeet rule for enfuring 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 proportion.   The due degree may be fecured by one or
 a few, but the equality of it over the fyftem can only be fecured by theif
 equal application.  This propofition goes to the  bottom of two extenfive
 doctrines, that of life,  and that of morals; the laft of which has as yet
 not attained to any thing like a fundamental principle. I intend to pio-
 fecute the idea upon fome future occafion.   1 know a book filled with
 valuable ethic facts, but have not yet had time to confider, whether they
 all  point to a general one,  in which they all agree, and which reflects
 proof and confirmation upon them ; without whuh it would fall fliort of
 fcientific exactnefs.
    (c) This has  been proved, both upon other occafions, and particularly
 in the cafe of a young gentleman, who lived with me during my firft ma«
 n i^enicnt of my gout,  See Preface to the Elements. 
33°       THE   ELEMENTS
 fers:  The difeafe is not confined to indireftly debilitating
 powers, as producing it; it  alfo arifes from direftly de-
 bilitating ones,  fuch as abftinence, vomiting, loofe belly,
 r.nd drinking water contrary to cuftom.
   DCXIVt  To  remove this difeafe; when  it does  not
 exceed the gentlenefs that is here underftood, the whole bo-
 dy muft be invigorated by  moderate ftimuli, every moft ur-
 gent exciting power fhould be taken out of the way, ge-
 ftation,  and that exercife, which does not exceed  the
 ftrength,  fhould be put in praftice.  A more fevere degree
 of thedifeafe will by and by be treated under tetanus.

                     OfAnafarca.

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

                  Of Cholic with Pain.

   DCX. Cholic with pain is   a form of afthenia, and a
 higher degree of the cholic without pain ; in which, to
 the figns of debility in common to all the afthenic cafes,
 are fuperadded a greater violence of the fame fymptoms,
 and twifting  pain about the navel,  with pain in fome part
 of the belly,  often  enormous,  and fometimes with a tu-
 mour, that can be felt externally (h).
                                                   Of
  (h) Immediately above the brim of the pelvis,  on the tight-fide,  at
the place of the blind-head of the cct>n, 
t)F   MEDICINE.         33I
       Of the Dyfpepfodynia, or Indigeftion with Pain.

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

                  Of the violent Hyfteria.

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

              OftheGoutcfwea.hned Perfons.

  DCXIII.  The gout of weakened perfons, which is an
encreafed degree of the gout of flrong perfons, is that afr-
hcnia,in which the inflammation runs out  to greater length;,
and at laft, does not form at all; and the general affeftion
encreafes in violence, in  obftinacy, and, at laft, attains
its higheft degree; exhibiting, towards the end of the dif-
eafe,  almoft all the fymptoms of debility, every form of
afthenia, and  fometimes by  a falfe refemblance, counter-
feiting fynocha.
  DCXIV.  As the difeafes affecting the  alimentary canal,
formerly mentioned (i), have, in a  great  meafure,  a com-
mon nature; fo, thefe alio, that is, the coiicodynia (k), the
dyfpepibdynia (1), the violent hyfteria(m),and the gout (11),
                                                  are

 (i) From DLVI. to Vl.XX.Vl.                  (k) DCX.
  H)DCXl.             (m)DCXH.          {»)DCXiII. 
  S32      THE   ELEMENTS

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

  (o) r\ruf the whtlc of Chap- IX. Part II. from numb. CCLXXXI. 
            OF   MEDICINE.        33^

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

                   Of Hypochondriafis.

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

   (p) See again the fame Chapter, which compare with the preceding,
the Vlllthof the lid Part.
   (q) See pari DXCVII.               (r) XLI. 
334      THE    ELEMENTS
 a dry ftate of the furface of the body, a rough fkin,  with
 black hair, and black eyes, and always a dark complexion
 and ferious afpeft.
   DCXVIII. From the definition given of it by hypo-
 chondriacs, it is beyond doubt an afthenia,  as being ac-
 companied with a  noife in the belly and flatulency;  and
 the courfe of the difeafe diftinguifhed by flownefs to paf-
 fion, keennefs in thinking,  and that ftate of the fimple fo-
 lids, which requires a high force of ftimulant operation to
 procure, and keep up a fufficient degree of excitement.
   DCXIX.  Since the ftate of the fimple folids is a ftate
 given by  nature,  and not  to be changed by art,  and the
 only indication of cure left in the phyficians power,  is  to
 fit a certain degree of excitement to that given ftate, which
 is exactly the cafe  in this difeafe ; it follows, therefore,
 that the ftimulus of food, drink, and others, fhould.  be
 employed in the cure of hypochondriafis.   The patient
 fliould be kept cheerful, by being placed in agreeable com-
 pany, and gay entertainments, by  entering upon a journey,
 and amufing himfelf with the various feenes of nature and
 art through which he paffes.  He fliould ride, that in guid-
 ing the horfe, his mind may be more occupied.  His ftu-
 dies and every fubject of his ordinary contemplation fliould
be often changed and varied.   He fliould have generous
wine given him to relieve the fymptoms of his ftomach
 and inteftines, and to raife his animal fpirits.  And if thefe
fhould fail of fuccefs,  the diffufible ftimuli, as  opiates,
fhould have their turn for a time, for the purpofe of ftrik-
ing a ftroke at once.   And their  ufe again gradually  laid
afide in  proportion as die ftrength can now be fupported
by the more natural and accuftomary ftimulants.  Dark-
nefs and bad air fhould be fiiunned ;  pure light,  and  all
lively objects, fliould be fought afu.r.   No hypochodriac,
                                                 oven 
              OP    MEDICINE.        33$

 even in a fit of delirium, fliould be provoked, but by every
 contrivance foothed (f).

                        Of Dropfy.

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

  (f) I have beard of an hypochondriac fo  provoked'at his phyficians,
who maintained that nothing ailed him, that he, on the contrary, to car-
ry his opinion of his difeafe to the utmoft ; at laft took it into his head,
that it had attained its utmoft height, by depriving him of his life.   He
continued ohftinately 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 Inch a clafhing with a great apparatus of inftruinents, provided for
the purpofe he intended,  that  the patient wa; roufed from his obftinatc
fullcuncfs, and allowed, that this gentleman had came nearer to his cafe
than any of the reft ; but.uknowledged, that he now found he had fome
remains of life. 
33&
THE   ELEMENTS
 water, when the body is fatigued,  over-heated, and burn-
 ed up with thirft,  are the moft powerful agents in bring-
 ing on  this difeafe.   The hurtful effeft  of the latter  of
 whiih, in every cafe of debility, when its operation is fol-
 lowed by no ftimulus, has been more than fufficiently ex-
 plained above (t).   Befides, in this cafe, when all the vef-
 fels are open, the water flowing to their moft weak termi-
 nations, paffing out by thefe, and being not at all  tranfmit-
 ted from the exhalants into the abforbents, is collefted in-
 to i.very neighbouring cavity (u).   And hence the com-
 mencement of the urgent fymptom in this difeafe.
   DCXX1II. To this afthenia belong all the watery ef-
 fufions, whi:h do not arife from a  local affeftion, but de-
 pend on pure debility.  And,  therefore, if at any time
 any other form of afthenia, whether from wrong treatment,
 or other hurtful powers, in its progrefs terminates in this
 eflrofion; every fuch cafe fliould be  held as a proper drop-
 fy (x); and \i fhould be ever prefent to our  recollection,
 that there ?.re only two general difeafes, and that the dif-
 finctions hitherto received, are devoid of all folid founda-
 tion.   According^, both from other  improprieties, and
 particularly from bleeding, epilepfy, palfy, the gout, ter-
 minate in real dropfy.  Nay, the fame  is the termination
 of peripneumony itfelf, when it is either  converted into in-
 direct debility, from the debilitating plan of cure having
been pufhed to excefs, or into direft debility, from having
 been left to itfelf, and the body not fufficiently debilitated.
 The affections, confined to parts, which are confidered as
the remote caufes of dropfy, will be treated among the lo-
cal difeafes, to which they belong.
  DCXXlV. After this explanation of the nature of drop-
fy, the cure of it,provided that it be a proper one,and early
                          2                   enough

  (t) See par. CXVII. to CXXIV.         (n) LIX. I.X. LXI.
  (x) See LXXXI, 
              OF  MEDICINE.         337

 enough fet  about, ought by no means to be fo much deft
 paired of, as it fhould be when local affeftion, with a fimi-
 lar elfufion, and the general difeafe are blended together
 without diftinftion, and confidered as one and the fame (y).
 If long before the effufion there was no internal complaint,
 if the difeafe rather came on fuddenly, and in confequence
 of evident  hurtful powers, and yields to the firft part of
 the curative means, there is reafon to doubt of a cure.
   DCXXV.  Befides  the  general indication of  cure  for
 afthenia, that fuited to this cafe muft be particularly directed
 to the whole vafcular fyftem, and efpecially about their ter-
 iriinations,and the commencements of the abforbent veins.
 The remedies are alfo  the  ufual  ones; that  is diet, as
 nourifliing and ftimulant as  poflible; firft in a fluid form,
 when the folid cannot be admitted upon account of the
 debility of the ftomach; then, alfo in a folid; and toge-
 ther with both, ftrong drink, fuch as the beft wine that can
 be got,fermentedfpirit, 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 not yet attained to that high degree that
 conftitutes a local  affeftion,  not to be altered by any ftate
 of the  excitement, this afthenia can be as eafily cured as
 any other.
   DCXXVI. But, when a great quantity of water  has
 now got into fome large cavity, it fhould immediately be
 removed by the catheter ; when that has been done, and
 the emptied cavity fecured with as much care as  poflible,
 and the ftrength fupported by wine, ftrong drink, and any
 ftimulus more diffufible, we muft return to the  manage-
                          Z                     ment

  (y) Sometimes the predominant fymptom rifes to the degree of being
above the^iowcr of the excitement, as in the tumor of fchirrus, and the
effufion here. 
33%      THE   ELEMENTS
ment mentioned a little above.   And if it fhould likewife
fill now, our judgment muft be,  that either the general
difeafe, has degenerated into a local, or that the affeftion
has been local from the beginning.

                     Of Epilepfy.

   DCXXVII.  Epilepfy is an afthenia; the diftinguifhing
fymptoms of which are, fome heavinefs  of intelleft, dul-
nefs in the exercife of the fenfes; and then a very impaired
ftate, or temporary extinftion of the latter,  accompanied
with  various convulfions over the body: Fits, confifting of
fuch  a concourfe of fymptoms ufually return  afterwards
at uncertain fpaces  of time, and each of them terminates in
a foaming at the mouth.
   DCXXVIII.  As all the debilitating hurtful agents are
productive of this difeafe; fo the lofs of the blood and other
fluids, excefs in venery, paffions, fuch as fear,  terror, affi-
duous and intenfe thinking in great geniufes ; a deficiency
of that kind of ftimulus in ftupid perfons, are particularly
fo (z).   Thefe powers that produce the firft fit, more ea-
fily bring on after ones: And befides them, certain unu-
fual impreffions upon the fenfes, fome of them difagree-
able, fome highly agreeable ; fuch as the flavour of fome
 foods,  the fmell of a rofe, have the fame tendency ;  and
 certain poifons (a) are faid to have the fame effeft.
   DCXXIX. But the appearance of fymptoms is a thing
 full of fallacy, and unlefs the nature of the hurtful powers
 producing them, and of the remedies removing them, be
 thoroughly underftood, it is incomprehenfible.  To folve
 the prefent difficulty about poifons, and to fettle the quef-
 tion, v htther the  fymptoms belong to univerfal, or local
 difeafe; we muft confider, whether the latter one produced
                         2                          by
  (z)  See above par. CXXXlV, CXXXVII. CXLII and CXXX1X.
   (a)  See XX. 
            OF    MEDICINE.         33Q

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

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

                        Of Palfy.

   DCXXXI. Palfy  is an afthenia, in  which, with  the
 other proofs of the ufual debility, often with fome  degree
 of apoplectic fit, commonly  all 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 continu-
 ance it terminates in health ;  but the  confequence  of a
 higher degree and greater duration of it is death.
   DCXXXIII,  The hurtful powers,  that ufually  pro-
 duce epilepfy and apoplexy, alfo tend to produce palfy.
                                                      And

  (d) This paragraph is the anfwer to  the iuefti»n propofed in that
which ftands in the Elements, anfwering to the fame number.  Thai
paragraph therefore is erafed, and  this  put in its place.  I  had heard
from fome of my pupils,  that they had been able by their diffufible fti-
muli, to remove epileptic fits.  But in cafe of  any miftake I  would not
venture to mark the fact for certain, which I have now done from my
own perfeft conviction.  A young man lately married had the moft a-
larmingfit of epilepfy that ever was : His cafe wa3 thought  beyond re-
medy : as an extreme one, however, he  got from fome ptrfon 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 fome how or  other.  But was perfectly ftupid and
 fenfelefs for a fortnight.  Upon his falling into another I was  fent for,
and brought him about in twenty minutes, as  I am told, (for  I did not
 wait), fo completely, that he got  out of bed, and ate a hearty meal of
beef ftakes.  Many weeks after, by mifmaiiaging himfelf, and neglecting
directions given him, he fell into  a flighter one, and was cured  in the
 fame way. 
              OF    MEDICINE.        34I

And befides thefe, all the common debilitating powers that
produce any afthenia directly or indireftly; great com-
motion  of the nervous fyftem by means of too diffufible
ftimuli; more  affecting the circumference of the body,
where the  organs of voluntary motion are chiefly feated,
and the internal parts and the brain lefs ;  as is  evident in
ebriety, gluttony, and every fort of intemperauce ; likewife
an indolent way of life, which is  commonly  connected
with thefe  hurtful powers, have all the fame tendency.
   DCXXXIV. When the difeafe has once taken place, as
it is kept up equally by directly or indireftly debilitating
powers; fo
  DCXXXV. For the indication of cure,which is precifely
the fame as in epilepfy as the energy of the caufe operates
more immediately upon  the furface of the body, confe-
quently according  to what was faid upon  the fubjeft
of epilepfy, the principal remedies are thofe, that have the
greateft power in invigorating the furface of the body :
Such are friftion, geftation, that degree of exercife which
the ftrength can bear, for the purpofe of roufing by their
powerful operation, the languid excitement in  the fibres
of the mufcles ; likewife a proper degree of heat of pure
air, and therefore, as much as poflible, the open air; laftly,
as none of the powers endued with ftimulant virtue, by any
means fhould be omitted, in order  that the  excitement,
which is of great confequence in every cure, be more equal
and vigorous all over ; fo in that extreme debility which
produces fuch an impotency of voluntary motion, as it is
of the greateft  confequence  to  make an impreffion upon
the principal fymptom; we fhould, therefore,  employ a
great deal of an opiate,  (CXXX. and CCXXX.) the in-
fluence of which, upon the furface, is  the moft confider-
able of all other powers, and prefs the cure,  till feme com*
mencement of returning motion be procured  ;  and then,
without neglefting  the  affiftance of any of the other fti-
                                                muli, 
342       THE   ELEMENTS
muli, but ufingthem all in concourfe or fucceffion, for the
fake of rendering their common effect more powerful and
more equal, to eradicate the difeafe.
  DCXXXVI. Debilitating and evacuant powers are to
be avoided for this reafon, that it is not vigour, it is not an
over-proportion of blood, but a fcantinefs of the latter, and
a deficiency of the former, that is the caufe.

                     Of Apoplexy.

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

the head lefs in palfy, excepting in the beginning and end,
but greatly in the two others ; and in all the three produ-
cing a difturbance in the organs of voluntary motion. This
difturbance, whether the  motion be deftroyed or  dimi-
nifhed,  in convulfion feemingly increafed, amounts to the
fame thing, and as was formerly explained, depends upon
debility (g).
  DCXL.  The fame here too is the indication of cure;
wifh that, which runs through this whole form of difeafes,
and the force of the remedies is efpecially, and as much as
poflible, to be directed to the parts moft affefted. To pre-
vent, therefore, the fits, in every refpeft alarming and full
of danger,  we ought to recollect, how far indireft debility
has a fhare in producing this difeafe, and how far the di-
rect concurs with it; and alfo confider the  operation of a
greatly advanced age.  All exceffive ftimulus,  therefore,
muft be avoided  in fuch a  manner, that the body may be
invigorated and direct debility guarded againft, the  ftimu-
lant 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,  according to the rule  of nature,  others,  which
the excitability, yet not worn out with refpeft to them, can
receive, fhould be fubftituted, that is, the  kinds of food,
of drink, and of  diffufible ftimuli, fhould be changed all
round, and upon the failure of each lately ufed one, to re-
turn to thofe that have been long ago laid afide (h).
  DCXLI. The  three  difeafes  we  are treating  of, are
commonly  fuppofed  to arife from a  plethora, attacking
the head,  and proving hurtful by compreffioa upon the
brain.   But, befides that, plethora has noexiftence in any
cafe where  it has been fuppofed (i), at that extreme age at
                                               which

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

                    Of the Lock-jaw.

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

affeftipn, only differing in degree (m), having no other ori-
gin ; 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 one.
All the other particulars regarding this fubject will be ta-
ken notice of under the next head of difeafe, tetanus.

                      Of Tetanus.

   DCXLVI. Tetanus is an afthenia, and, therefore,always
affefting perfons under debility, whether direft or indirect;
in which, fometimes with concioufnefs, fometimes not,
fometimes with difficulty, fometimes with freedom of ref-
piration, the whole body, or the neck and its neighbour-
hood only, are bent fometimes forward, fometimes back-
ward, and held faft by a rigid fpafm.
   DCXLVII. Tetanus is the offspring of cold countries,
as the northern parts of Europe,  but  rarely ;  more fre-
quently of the warm fouthern  regions of that divifion of
the world ; but moft frequently of the torrid zone.  The
rare cafe, fuch as that among us, is the fequel of a debili-
ty fearce ufual in other general difeafes : On the contrary,
it almoft always arifes from that unufual debility, which is
occafioned by a lacerating wound, through which fractu-
red bones are dafhed, increafing the fum of that  debility
that exifted before, or that happened to be induced in  the
courfe of the cure.  To produce the more frequent cafe, or
that moft  frequent one of all,  which is quite common in
the torrid zone.  The moft powerful of the debilitating
powers, and a very great many, if not all of them, eon-
cur.  The moft powerful of thefe is, that degree of heat,
which is intolerable,  to perfons engaged in exercife or la-
bour (n), to whom almoft only,and therefore to the flaves,
it is hoftile.  Hence, even under the flighteft corporeal mo-
                                                tion
(m) CCXXVIH.
(n) CXXVII. and the addition 
34^      THE   ELEMENTS
 tion, fatigue, and fweat, are produced (o), and from the
 fweat a fcantinefs of blood  and other fluids.  From all
 thofe arifes a languor over the whole body, and, therefore,
 in the ftomach (p): From the languor of the ftomach there
 is a puny appetite, and food, which is another caufe of
 penury of the fluids,  is  either not taken in, or thrown up
 again.   All  thefe affeftions, as well as that indolence both
 in mind and  body, which is infeparable from fuch a ftate
 of circumftances, are followed by the higheft degree of de-
 bility over the whole body:  And,  as the  moft  noxious
 power, the intenfe heat  diftreffes the head more than any
 other part, as well as the organs of voluntary motion, whe-
 ther in the neighbourhood of the head,  or more diftant
 from it;  that is the  caufe of the urgent fymptom,  the
 fpafm, occupying the  parts that have been mentioned.
   DCXLVIIL As tetanus is occafioned by all the debili-
 tating powers, according to the different degrees in which
 they poffefs that effeft, and, confequently, like every other
 afthenia, depends upon debility  as its caufe;  and, as all
 the aftheniaz, are removed by remedies, exciting the whole
 fyftem in fuch a  manner, as to exert the greateft influence
 poflible upon the labouring part; the fame, accordingly,
 is the  nature of tetanus, however little  that difeafe has
 been underftood, the fame fimplicity of nature is found in
 it: And if there is occafion in it for the very higheft reme-
 dies, that circumftance fliows, that the whole difeafe does
 not depend upon the fpafm, and that the labouring mufcles
 are not its whole feat, but that there is vaft  debility in every
 part, only greater in the mufcles, than in  any other equal
 part, according to the law we have mentioned (q).
   DCXLIX. From what has been faid, after tetanus  has
 taken place, and upon account of the teeth being fhut by
                                                  the
  (o) CXV. CXXVII. and the addition.   (p) CLXXXVl. CXClV.
:o CXCVIII.   (q) XLIX. 
             OF    MEDICINE.          347

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

                   Of Intermittent Fevers.

   DCL.  Paroxyfms, confifting of a cold, hot, and fweat-
 ing fit, are a fort of phcenomena that occur in every inter-
 mittent;  and, in a  certain proportion,  in every remittent
 fever.  They often  come on in confequence of  a  certain
 taint received from neighbouring moraffes, or from a fimi-
 lar ftate of a neighbouring foil; but they alfo happen and of-
 ten too, after an application cf cold only (s); at other times
 after that of heat only (t), when the common afthenic hurt-
 ful  power accompanies either: And they return  with  a
                                               remarkable

  (r)CCXCV. to CCCII.
  (s) as in the vernal intermittent! in Scotland.  In the Mers, or coun-
|y of Berwick, where I laboured three months under a tertian, that is,
from the beginning of March tfi the beginning of June, and in the Carfe
of Gowrie, and fome other places in that country, nothing is more com-
mon than the tertian ague happening at the time at which I was affect-
ed ; and nothing is more certain, than that the cold and moifture arc the
chief powers inducing it.  It is  fomewhat ftrange, that a man born in
that country, if he would patch ui a fyftem of fevers, fhould have over-
looked a form of them, that Occurred to his eye- fight every day, and bor-
rowed his hypothetical courfe from a marfh miafma, fuppofed to be the
produce of great heat and moifture,  though he had only heard or read
of the intermittents of warm Countries.
  (t) In the warm countries agues often occur, when it is eafy to difcern
heat  to be an hurtful power; but when moifture is much lefs prevalent,
for that very reafon that the hc.it is prevalent,  than at other feafons
when the dfeafe does not occur. 
348       THE   ELEMENTS
remarkable exacerbation, after a temporary folution of the
difeafe, or an abatement of it;  in the cold fit, exhibiting
manifeft debility;  in  the hot,  counterfeiting a deceitful
appearance of vigour; and fearce ever obferving any ftrift
exactnefs in the time of their return (x);  but returning
fooner in a higher, and later in a lower  degree of the dik
eafe; and not unfrequently, befides the remittent, alfo gra-
dually affiiming a continued form ; and, on the contrary,
fometimes without interference, oftener  in  confequence
of an improper  method of cure, before the difeafe is ended,
changing into quintans (y), feptans (z), nonans(a) or into
lextans, oftons, and decans (b).
  DCLI. The  fever of this kind, which  returns every
fourth day,  and is therefore called a quartan, is milder that
that which receives the name of tertian, from its recurrence
being on the tliird day, and the latter is milder than that
which, from its return every day, is denominated quotidian.
The difeafe, that degenerates into a remittent or continued
form, is of a worfe nature than that which is regular in its
returns, or that which puts off fits, and protrafts the inter-
vals betwixt them: And,  the form and type of each cafe
being given, the whole fet is both of more frequent recur-
rence, and of a more fevere kind in hot, than cold, climates.
   DCUI. That this fort of  fever  depends upon  debi-
lity throughout the cold fit, is proved  by the fymptoms,
by the exciting hurtful  powers,  and by the method of
cure, whether fuccefsful, or the contrary.
                                              DCLni.
  (i) Dr, Sydenham was content to count the periods by the day, which
was even too particular, but Nofology has refined the matter into the
wonder of exactnefs to an hour.
  (y) Where the fit docs not return till the fifth.
  (z) Where its return is not till the feventh day.
  (a) Where the interniiffion continues till the ninth day,
  (b) That i», prolonged their intermiffion till the fixth,  eighth, or
tenth day. 
            OF    MEDICINE.          349

   DCLIII. Thewhole difeafe,as well as every paroxyfm,
begins with a fenfe of cold, the greateft defire for a warm
fituation (c), with trembling, and that fluking motion in
which the whole body is lifted up from the bed (d), with
palenefs,  drynefs, and  flirivelling of the fkin, with the di-
minution  of tumors and drying up of ulcers, that the pati-
ent may happen to have had before the arrival of the dif-
eafe, with an impaired ftate of  the  intelleftual faculty,  a
want of fteadinefs in its exertions, and fometimes delirium,
with a dulHefs of fenfation, languor of fpirits, torpor of
the voluntary motions, a liftlefnefs of mind and body in all
the funftions, in fine, a manifeft debility.
   DCLIV. If terror, horror, cucumbers, cold melons, fa-
mine, debauch in eating and drinking, food of difficult di-
geftion, have been found for certain, to have a great effect
in bringing back  paroxyfms,  after  a long intermiffion of
them; if in cold fituations,  where cold is the  principal
 hurtful power, it is the poor people, who are ill clothed,
 ftarved in their diet, and enfeebled by labour, who in gene-
ral are only affefted with difeafe; if in warm regions of the
globe, thofe who have been  moft expofed to debilitating
 hurtful powers of all kinds,  who, in preference  to others
 are feized with it (f ); if in  moft places, thofe  who  live
 well in their diet, and cheer  themfelves with their bottle,
 efcape the difeafe (g), and water drinkers and perfons in a
                                                   ftate

   (c) I remember yet, that it was the highsft luxury for me, when the
cold fit came on, to be put in bed, and covered under fuch a load of blan-
kets (for the cold of fheets was intolerable) as would, at any other time,
have oporeffed me.  I was then about eleven years of age-
   (d) Ey authors and lecturers in Latin abfurdly called rigor.
   (f) See DCXLVII.
   (g) 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 not like ths we;.k Rhcnifti wines, and the weak ill ma-
                                                   naged 
3S°       THE   ELEMENTS
 ftate of inanition from low living peculiarly experience it;
 all thefe fafts fhew, how far this difeafe is from depending
 upon  heat and moifture alone; and prove, that it alfo arifes
 from  cold, and not from either alone, but alfo from all the
 ufeal  hurtful powers, like every other afllKnia.  •
   DCLV.  further, if every kind of  evacuation,  as of-
 ten as it has been  tried, is found without the poffibility of
 a doubt, to be hurtful; if no perfon in his fenfes has fcarce-
 ly ever attempted bleeding(h); if, before the Peruvian and
 fome other barks of fimilar operation were found out to aft
 as remedies, a variety of ftrong drinks (i) were ufed. with
 fufficient fuccefe ;  and if it now alfo is found and demon-
 ftrated in faft, that the  diffuble ftimuli are by far more ef-
 fectual than any bark;  nay, that the bark often fails, while
 they are perfectly effeftual in the re-cftablifhnicnt of health;
                                                      from

naged vin dc Bourdeaux, which is a cheap  dirty claret, almoft never fall
into the difeafe at Leydcn, while the Dutch are perpetual victims to it
as often as it is rpidemic.
  (h) They have talked of taking a little  blood in the fpring intermit-
tent*, but that was a theory of Dr. Sydenham's, who divided the difeafes
of thewhole ytar, into inflammatory and putrid, and I do not find, that
that idea has ever been followed in practice.  For though they follow
him moft  fcrvilely in moft refpects, efpecially where he is wrong, their
vanity,  that they may now and then feem  to ftrike opt fomething from
themfelves, difpofes them to differ from  him in others, efpecially where
he is ris^ht, as in the objection of purging  in  fome fthenic  difeafes
(CXXXVI1).
  (i) as ale, wort, wina, fpirits, ftrong punch. Riverius followed this
plan ; and I remember it was cuftomary 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. Stahl and 15oer«
haave, had thrown the bark into difrepute in Britain. And my mother,
" who truflcd  in God, and net in phyficiai's," left me to the courfe of
defircs  ar.d averfions, which were chiefly to avoid cold,  and anxioufly
feek for heat.   She kept me upon a vegetable d^et in the iutetmiflions,
which I even then did not much like. It was the kindly warmth of fum-
mer, which then fet in early, that had the  chiefeft  effect in gradually fi-
nishing th^t cure. 
            OF   MEDICINE.          351

from this fort of argument and certainty in point of faft,
we derive the moft folid conviction, that there is nothing in
this difeafe different from other afthenise, but that it per-
feftly agrees with  them in the exciting hurtful powers, in
the caufe, and in the cure.   And, if it differs in the appea-
rance of the fymptoms, that fhows no difference of nature,
and not even  any thing unufual; as all the aftheniae that
have been mentioned, however much they  have been pro-
ved to be the fame (k), differ notwithftanding, in a fimilar
manner, from each other, and fymptoms lead not to truth,
give no real information.  For, though precifely the fame
found funftions flow from the fame ftate of perfeft health;
yet when the latter is fo changed, as that the excitement is
either encreafed or diminifhed, the funftions are changed
from the ftandard into every fort of appearance, in fuch
fort, however, that they point out no difference in the caufe
as has  been commonly believed,  and not alwavs even a
difference of degree (1).
   DCLVI. Accordingly, the following demonftrated fafts
of fpafm, convulfion, tremor, inflammation from weaknefs,
deficiency of menftruation(m), bleeding difcharges (n), lofs
of appetite, thirft, naufea, vomiting, diarrhaea with pain,
diarrhaea  without pain, and all  the other  afthenic affec-
tions (o), arifing from one and the fame caufe, and being
removed by one and the feme operation of the remedies (p),
and not even in their morbid ftate, expreffing degrees of
debility in  fuch a manner, as that it can  be thought
proper  to take any order of arrangement from that mark;
all thefe ferve to confirm  the obfervation juft new made,
and by  their analogs, to demonftrate, that the fevers alfo
                                                   are
  (k) See par. LXXI. and the addition. LXXXI. DCXXIX.
  (1) DIV. DV1I.      (m) DX1.V. and the following paragraph.
  (n) DXLVIII.      (o) CLXXVI to CXCV.  and to CXCV1T.
  (p)CXXII. DLVI.  DLXI  DLXXl.   DLXXII.  DLXXIV.  to
DCXCV. and from that to DCXL YUI. Look alfo carefully over th-
whole iVth Chapter of the fcco;;J part. 
  352       THE    ELEMENTS

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

   (q) DCL.
   (r) When the gout in the old way, is left to patience and flannel and
low diet and watery drink, it fhews both rcmiffionsand confiderable in-
tcrmiffions.    I have been often mortified,  at finding, in confequence  of
walking a little too freely, when I thought the fit was gone, a more vio-
lent return than the firft part had been ; when I had not yet attained  to
the full knowledge of the nature and management of that difeafe.  Which
is a circumftance, that every podagric, who is ftill treated in the old way,
can bear witr.efs to.  Dr Sydenham  fell a  victim to his ignorace ef its
nature.
  (s) A gentleman in Scotland, came to dine with his brother, who lived
with me and my family, in a houfe in the neighbourhood of Edinburgh.
He ate and drank fo fparingly, that I  predicted, from a knowledge I had
of his manner of living, which was an excefs of temperance and abftemi-
oufnefs to a faulty degree, that if he did not indulge a little more in thefe
reflects, he would foon fall into  a difeafe of debility.  The prediction
was verified in a few days ; when  his brot her having occafion to go to
town, found him, in the intervals of a violence of vomiting, making his
teftainent.   By a good dofe  of the diffufible ftimulus,  he removed the
whole difeafe at once, and enabled him, with the additional help of fome
good foand port and genuine  Madeira, in a few minutes to1 eat heartily
of beef ftakes.  Eefore his brother's arrival ho had been treated in the
ufual evacuant, and, fas they call it,  the antiphlogiftic  way. Upon th«
return of his medical friends a glifter was prtferibed, which threw him
                                                         back 
               OF   MEDICINE.         353

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

back into his 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
tny pupils, is now a moft refpectable man in his profeffion.  Some time
after that, he performed the greateft  cure, that ever happened fince the
firft annals of medicine.  In a very dirty fhip, the Dutton, which was
going to the Eaft fndies, 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.
  (t) See 579.             (v) And from DLXXXVII. to DXCVil.
  (u) All this confirms, and 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
refpeft,  they do not differ from other difeafes of the fame form ; but it
likewife adds additional weight to our fundamental propofition, that we
are nothing in ourfelves, but according tothe powers acting on us. Ma-
ny circumftances in the  courfe of difeafes, that  efcape the obfervation
 both of patients and phyficians, are ofhourly'and momentary occurrence,
and fufficient, when their importance is weighed according to the prin-
ciples of this doctrine, to account for the variations in the progrefs of dif-
eafes.   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 converfion of the cold into the hot, and the
[ hot, into the fweating,  ftages.             (x) See par. IX, 
   354       THE   ELEMENTS

   the variation of the degree of that aftion, is one while en-
   creafed, another while diminifhed,  another while exhibits
   a temporary eruption; juft like what happens in this fort
   of fevers.
     DCLVII. The caufe of them is the common one of
  all afthenia;, whether febrile or not;  but under fuch di-
   rection and application to the fyftem, that, after an interval
  of fome hours, all their morbid energy  departs entirely,
  or in fome degree.   And the reafon of that is, that the
  exciting hurtful powers in the fame proportion are either
  removed, or more gentle in their operation ; in one word,
  the excitement is encreafed for the time.   The variation
  of types is not owing to a  matter, fubjeft to the fame va-
  riation :  For, if that  were the cafe, how could the fame
  cafe run through all the forms, fometimes of intermiffion,
  iometimes of remiffion, and at other  times of nearly going
  on with a continued  movement and the contrary ?  Is the
  matter, which is fuppofed to produce each form, in order
  to produce another form, changed into that matter, which
 is fuppofed neceffary to the latter (y) ?  Is the vapour, or,
 ?.s they call it,  the effluvium, proceeding from animals,,
 which is fuppofed to produce any typhus, or continued fe-
 ver, and, therefore, the Egyptian one,  when this is chan-
 ged into an intermittent, or remittent nature, alfo, together
, with the change of type, changed into a  marfh miafma,
 or defilement arifing from moraffes, which is fuppofed
 to produce that form of fever ? Or rather does the matter,
 which at firft produced each type, ftill continue the fame,
 and become the caufe of another form ?  If any perfon
 fliould fix upon the latter as being the  truth, how fhould the
                                                 fame
   (y ) The ancient3 fuppofed, that every type arofe from a matter fuited
to produce it.  Now, fuppofe a quotidian type to depend upon any giv
en matter, and a tertian upon^any other, different from that; when ci
ther type is changed into the other, are we to fuppofe that the matter is
alfo changed, and fo forth of the reft ? 
            OF   MEDICINE.          355

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

 (z) DCLIH. DfJLIV. DCLV.
 (a) Sec the paragraphs XXII. XXIII. LXII. LXIX. LXX  LXXIL
LXXIH.  and LXXXVIII.
 (b) DCLVI.               (0  DCLVII. 
 3$6        THE   ELEMENTS

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

  (d) 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 depend-
ence is to be had on the  facts  in medicine, as they are delivered from
defks or in books;  from  both which wc have always been taught to be-
lieve, that the Peruvian  bark was a catholicon in intermittent fevers.
But, if it fails in the cure of the mild ftate of that difeafe in this country,
what muft we think of its efficacy in the malignant intermittents and re-
mittents of the tvarm countries f And, if that medicine, with its univer-
fal high  character, fhall turn out next to an impofition, what arc we to
think of teftimonies in favour of any thing? One of the ways of admini-
ftering the bark is in ftrong wine or fpirit, and it can  hardly be doubt-
ed, but in that compound form it may have been of fervice.  But where
fhall we find a panegyrift. on the bark,  who will  make any allowance
for the powerful medicine conjoined with it ?  They talk of it as a ve-
hicle, without allowing it any other credit.  In the fame manner, at all
times, have many powers of great operation been overlooked in the ac-
counts given  us of remedies, and the merit of the cure imputed to the
moft inert.   1 have moft generally found an analogy betwixt the reme-
dies, 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 be-
twixt the fame ordinary fupports of life, thefamc durable and natural fti-
muli, and the bark of a tree, whether brought from South America, er
growing among ourfelves ? I will not pretend to fay, that the bark is de-
void of all virtue; but I  muft have greater proofs of its power over dif-
eafe than I have yet met  with, before I can retract much of what I have
laid. 
OF   MEDICINE.          357
ftrength, thereby gradually drawn forth.  The  heart and
arteries, gradually excited by the fame heat,  acquire vi-
gour, and at laft, excited in their perfpiratory terminations
by  the fame  ftimulus the moft  hurtful fymptom  being
thereby removed,  they reftore the hot fit, and afterwards
carry on the fame procefs to the breaking out of fweat.
  DCLXII.  When  the  force of the difeafe  is greater,
thefe powers are ineffeftual; and, unlefs the moft power-
ful remedies are applied, the difeafe, inftead of  producing
intermiffions, rufhes head-long  into  the  remittent ftate
only, or even into thofe  very obfcure remiffions,  which
give the appearance of a continued difeafe.
  DCLXIII. And,  fince in every cafe of difeafe of any
energy, the difeafe returns, for this reafon, that either the
leffer force, by which it is kept up, is not ftopt  by a leffer
force of remedies,  or the greater force of the former by a
greater force of  the latter (e); the remedies, therefore,
fhould be given both before the cold fit, and during it, as
alfo through the whole courfe of the intermiflion  to the
next paroxyfin, and they fliould be continued even through
this, and after it is  over.  Laftly, like the praftice in every
other cure of afthenic difeafes, we fhould gradually re-
cede from the ufe of the higheft ftimuli, in proportion as
the body can now be fupported by  the leffer and more
natural  (f).

                 Of the fevere Dyfentery,

  DCLXIV. The fevere dyfentery,  or bloody flux, is
an afthenia ;  in which, befides the fymptoms  in common
to that whole form of difeafes, fo often now repeated, there
are pains in the inteftines, gripes, innumerable  dejeftions,
                                               chiefly

  (e) For the curative force muft always be accommodated to the mor-
bific, or caufe of the difeafe.  See above XClI. CIX.
  (f) ,CV. and CV1I. 
558       THE   ELEMENTS

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

                Of the fevere Cholera.

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

                     Of Synochus.

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

          Of the fimple Typhus, er Nervous Fever.

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

              Of the Cynanche Gangrenofa.

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

                Of the confluent Small-pox.

   DCLXIX. The confluent fmall-pox is a typhus chiefly
 depending upon indireft  debility.  It is preceded by
                                               a great
              (g) cexxn, ccxxiv. 
             OF   MEDICINE.          359

a great eruption of the diftinft kind, and an unirerfal cruft
of local inflammation over the whole body ;  which, by
their local and violent ftimulus,  convert the fthenic into
the afthenic diathefis, and the inflammatory affeftion into
a gangrenous one.  Its cure is to be conducted upon the
ftimulant or antifthenic plan, but in fuch a way, however,
as is fuitable to indireft debility.

Of the peftilential Typhus, the jail, putrid, or the  petechial Fcv:r,
                    and the Plague.

   DCLXX.  The  peftilential typhus, or the jail, putrid,
and petechial Fever, is an afthenic difeafe of the higheft de-
bility, fearce excepting die plague itfelf; in which the fur-
face of the body is firft dry, paie, hot,  fhrivelled ; then,
chiefly towards the end,  moift, drivelled with fpots,  and
colliquative fweats, diverfified with vibices, or long ftrokes
like thofe laid on by a  whip, and wafted with colliquative
diarrhoea ; in which the ftomach is affefted  with the want
of appetite, loathing of foodj naufea, often with vomiting;
in which the  belly is firft boundifh, and then, as it has been
faid fubjeft to colliquative evacuation;  in which the in-
tellectual funftion  is firft impaired, then becomes incohe-
rent, afterwards delirious,and that often in the higheft de-
gree  ; in which the fpirits are dejefted and wafted with
fiidnefs  and melancholy; in which the voluntary motions
are early  impaired, and then fo deftroyed, that the patient
cannot  be fupported in his pofture in bed by his own muf-
cles,"or prevented from flipping down, from time to time,
from the  upper to  the lower part, and the fenfes are either
blunted or preternaturally acute.   In fine, the urine, the
fceces, the breath, and all the excrementitious difcharges,
have a lingular foetid  finell.
  DCLXXI. The plague begins, holds on in its courfe,
.and ends  with fimilar fymptoms : To which,  however,
                                           carbuncles^. 
  3^0       THE   ELEMENTS

  carbuncles, buboes, and anthraces,orfiery fores,are added.
  Thefe are moft frequent in the plague, but not fo confined
  to it, as to be excluded from the peftilential fever  (g).
   DCLXXII.  Contagious matter fometimes accompa-
  nies typhus, always the plague  : The former is of a com-
  mon nature, or fuch as is liable to happen in any part of
  the globe; the latter is thought peculiar to  the eaftern part
  of Europe, and the weftern of Afia, poffeffed by the Turks,
  called the Levant.
    DCLXXIII.  With refpeft to the contagious matter
  of typhus ;  the corruption of the fluids is by no means to
  be  imputed to it (h), nor is heat fo much  to be blamed ;
 for cold has an equal power in  producing that effeft  as
  heat (i), as has alfo every thing, as well as heat, that either
 directly, like cold, or indireftly like it,  debilitates  (k).
 Nay, the emptinefs of the veffels, from want of food, or
 from the incapability of the digeftive organs to take it in
 and affimilate it, as alfo that debility which is induced  by
 melancholy and grief, though, in thefe cafes, no matter at
 ail is prefent, admit of the fame  application.  By means of
 that debility in the extreme veffels, internally, as  well as
 externally, and, therefore,  efpecially in thofe of  the ali-
 mentary canal and  in the  perfpiratory veffels, the fluids
 ftagnate ;  and by ftagnating under the heat  of the body,
 degenerate into that foreign quality, which, in a more ex-
 tenfive fenfe, is called corruption, but in a more uncertain
 one, putrefaftion (m),
                                           DCLXXIV.

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

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

 vlaiions from the natural ftate, it is fafer to ufe the general term corrup-
 f  .i.    va> the word acrimony is  too general  as we can by no means
 pretend  t>  fay, that  perfect blandnefs is the natural and healthy ftate of
 <nir fluids : Nay the different ufes and fubferviency to the functions feem
 to require a confiderable deviation from blandnefs ; the urine, the per-
 fpirable fluid, the  bile, and others, being intended, by a certain poignan-
 cy, to anfwer certain purpofes.  Thefe, compared to certain blander
 fluids,may be faid to be acrid; while compared to their ftate in morbid
 degeneracy, they, may be called bland, and the latter acrid.
   (n) Fevers will  require many more vifits from the phyfician than are
 commonly either bellowed or required, and often a good deal of watch-
 ing.  While this  is more  generally the  cafe  in fevers, at 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 debility, endangering life, will claim the
fame circumfpection and vigilance from the judicious  and confcientiuiu
 phyfician,
  (o) See par. CHI.  CVIL
  (P) See CLXXV.  CCXV. CCXVI. CCXVM. CCXVIII.
  (q) CXXX,                  (r) See CXV. 
3O2        THE    ELEMENTS
  luxury (s).   To thefe hurtful powers, thus indireftly de-
  bilitating, all the others may more or lefs be added  (t).
     DCLXXVII. And as  it never happens,  that either di-
  reft or  indireft debility  alone proves hurtful, hence we
  have a third  cafe given,  where we have to combat both
  forts of debility (u).  '
                                                  DCLXXVIII,

    (s) See above par. CXXVlI.   (t) Look for them in Part. I. Chap. I.
    (u) Suppofe any direct debility has occafioned a difeafe, when that is
  eflablifhed, the excitability is fo morbidly accumulated, that the flighted
  exertion of any exciting power  becomes too much for it; which  immedi-
  ately conftitutes an admixture of indirect debility.   The fliiwulus of cor-
  poreal motion, which is a great and rough indirectly debilitating power,
  i,s often  too long continued, after  a typhus fever has begun its  infidious
  attack upon the habit ;  and  hence the after-part of the difeafe  becomes
  more fevere and dangerous.  It is alfo to the fame caufe that we owe the
•  propriety of excluding light and found, when they prove caufes of irri-
  tation,  their ftimulus, though  flight, being too itrong  for their accu-
  mulated excitability.  The guarding againfl ^nts of paffion and emotion,
  as well as mental exertion,  is all upon th~ fame principle.   When a per-
  fon falls unto a fever from exceffive labour and low diet at  the fame time,
  that is an inftance of a mixture of debility from the beginning.  Again,
  when any difeafe, chiefly  of indirect debility,  is treated  by bleeding,
  other evacuations and ftarving,that is an inftance of a fuperinducement of
  direct upon indirect debility.  A judicious practitioner, and who pre-
  1'cribesaccording to the rules that arife from a near acquaintance  with the
  operations of the inanimate  part of matter upon living fyftem^ will find
  plenty of fcope for the cxercife of  his judgment in  thefe and many other
  niceties  ; And he will find that the Brunonian doctrine, as it is now nick-
  named by thofe who know it not, is not a doctrine to be practifed without
  knowledge, without judgement, and without fenfe ; but that it require*
  every part of knowledge requifite to  throw light upon fo extenfive a fub-
  ject, as that of the fcience  of life over all nature, and all the judgement
  and good fenfe of the foundeft underftanding to carry  it into application
;  upon many occafions of nicety and difficulty.  The  trafh that has hitherto
  too often paffed for knowledge,is to be acknowledged not only ufelefs.but
  hurtful.  But the true knowledge of nature muft be  always elegant,  al-
  ways fatisfactory, always  ufefut.  It is to be hoped the day is not far
 tiiftant,  when this doctrine will change itsjprcfent appellation, into that.
                                                                 Of 
             OF   MEDICINE.         363

  DCLXXVIII. The  direftly  debilitating  powers  are
known, to wit, cold (x), low diet, (y), bleeding, and other
evacuations (z),  reft of body and mind, and want of paffion
and emotion (a), and impure air  (b).
  DCLXXIX.  As both thofe fets of  powers aft by de-
bilitating ;  be, at the fame time, on your guard from be-
lieving, that fome of them arefeptic, and prove hurtful by
fermentation, and are to be cured by antifepties, or pow-
ers that refift putrefaftion ; and  that,  among the former,
heat is to be reckoned ;  among the latter, cold, wine, the
Peruvian baik, and acids (c).
   DCLXXX. In the  gentle cafes, as  in the  agues of
cold places,  and efpecially the vernal agues (d), and like-
wife in fynochus, in the fimple typhus, and in the plague
itfelf, when mild ; fearce any ftronger ftimulus than  wine
is required; and the  reft of the cure is  to be condufted
according to the direftions fo often now laid down in the
mild afthenic difeafes.
   DCLXXXI.  In the moft  fevere fevers,  fuch  as the
remittent (e), in the warmer regions of the earth, and in.
the torrid zone, and in the fevere typhus, when it  is pe-
ftilential, in the  very violent dyfentery  and cholera  of the
fame places, and in the moft violent plague itfelf (e), the
caufe of all which affeftions,  is in general direft debility ;
or in gentler cafes of the fame difeafe at firft, and that hava
now acquired a great deal of virulence in their progrefs
                                                  from
of the doctrine of Nature,  over the living part of her productions ; com-
prehending not only the morbid but healthy phoenoniena, and the dif-
tinciions between the living  and the dead ftate.
  (x) See par. CXVII.  (y) CXXVIII.  (z) CXXXIV. CXXXVII.
   (a) CXXXVII. and CXXXIX. and CXLII.
  (b) CXLVI.  Compare the whole with Part II. Chap. X.  all from
CCX& toCCCXH. and from that to par, CCCXV.
  (c) See par. DCLXXIIl.      (d) See DCL. DCL1V- DCLX.
  .(e) DCL. DCLX, DCLXIV, DCLXV. 
 364       JTHE    ELEMENTS

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

  (f) XLI. XLIII. CXIII. DCLX. to DCLXIV.
  (g) This may be exemplified by the treatment of a perfon the next
and fecond day after he hals been hurt by drinking.  His excitability has
been worn out by an unufually ftnmg ftimulus,  the effect of the firft
night's fleep is to allow it to accumulate again :  In this ftate much exer-
cife fatigues, for want of excitement to enable it to be born:  Fluid nou-
rifhment is commonly ufed,  but it is not ftrong enough to wafte the re-
dundance of excitability, and bring the patient back ta his healthy ex-
citement. The dram drinkers know the remedy, but they know not its
bounds.  They have recourfe to a glafs of ftrong fpirit, and they would
be ri^hl if they ftopt at one, two, or a very few, according to the quan-
tity, that their former habit may render neceffary, and take no more
than what  gave them an appetite  for  folid nourifliing animal food ;
which, whatever the quantity that is required to produce it be, is the beft
general rule :  l"»ut they go on,  aud every day till that of their death,
which foon arrives, renew the difeafe.   The rule is to take a little  of
what proved hurtful,  till a return of appetite comes on :  After eating a
little,  a walk or a ride will  add more ftimulus :  The air, in which the
exercife or geftation is performed, will furnifh  another.   In that way,
mere ftrength will be acquired in proportion as a greater number of fti-
                                                       muli 
             OF    MEDICINE.           365

ftimuli, and a greater number of them, till, as was faid juft
now (h), the ftrength can be fupported by the accuftomary
and natural ftimuli (i).
   DCLXXXIII.  To give fome eftimate of  the dofe  in
both cafes (k); in direft debility, where the redundancy of
excitability does not, far  the time, admit of much ftimu-
lus (1), ten or twelve drops of laudanum given every quar-
                                                           ter

muli have wafted more excitability, and with more equality.  A fecond
day's management by applying the ftimuli in ftill  a leffer degree, will
commonly remove all  the complaints.  When a habit of hard drink-
ing has brought on,  as it always will  fooner or later,  a very bad and
confirmed difeafe ;  if the excitability is nearly worn out, and what re-
mains is very unequal, as having been produced chiefly by an alteration
betwixt one ftimulus acting with partial excefs and fleep, either imper-
fectly removing the excefs, or by its length fupcradding direct to the in-
direct  debility, which  the  drink  occafions;  the patient fhould  have
fomewhat  a leffer quantity, than that which at any time  hurts him ;
then the next day ftill lefs; 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.
   (h) DCLXXXI.                  (i) CCCVIII. to CCCXII.
   (k) DCLXXXI. and  DCLXXXIH.
   (1) The abundant excitability of an infant cannot be reduced at once
to that wafted degree, in which the ftrength of an adult confifts; it muft
be by the gradual application, of what it can bear always for the prefent
time that that can be brought about;  and, therefore, not fooner :han a
fpace of time equal to half the individual's given period ofexifter.ee.  In
a  fimilar manner, an excitability that has been accumulated from defici-
ency of ftimuli for a number of weeks or months, will require a fpace of
time, fomewhat proportioned to that, to wear it out in the manner moft
fuitable to reftore the loft vigour.   Some health will be fooner brought
about, but the effectuating of perfect health muft be a work of time.  A-
gain, the direct debility of a few days will be eafily removed in a few
days.  In fevers, and every cafe of high debility, the accumulation of ex-
citability for want  of ftimulant power to produce eAitement, muft be
cftimated by the number of  ftimuli that have been with-held, as well as
the degree of force of each of them.  In a fever, then, the ftimulus of
exercife,of tltc open air, of convcrfatioi), of diverfion of every hind, of
                                                             ai>> 
   366        THE   ELEMENTS

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

 an agreeable flow of fpirits, of a pleafant  train of thinking,  of light and
 found in  a great meafure, as well as of the exercife of all the other fenfes,
 and particularly the ftimulus of a due quantity of blood, and other fluids,
 and moft efpecially that cf nourifliing food, and, at leaft upon the com-
 mon plan of practice, that of wine and exhilarating drink, all thefe, are
 with-held, and, therefore, for want cf them, the diminution of excite-
 ment muft both be great and unequal.  What then is required as to the
 idea of the cure ? Since moft of thofe, which are the ordinary ftimuli, by
 which the ordinary health is fupported, cannot be applied j  the proper
 Llea is to look out for  a power in nature, that can, as nearly as poflible,
 fupply, both the degree andequality of ftimulant operation that is want-
 ed. Such apower  we find in the few diffufible ftimuli, and particularly
 in opium (See par. CXXX.)  Any of thofe act powerfully on  the fto-
 mach, and diffufe  proportional excitement over the  fyftem.   So foon
 and effectually  do they pervade it,  and act with the moft powerful ef-
 fect upon  the furface, that it is often an object of attention in the prac-
 tice to think of means to prevent it from going too far.  By  the bleffed
 ufe of thofe remedies, the excitement of the ftomach is reftored, fo that
 with a  return  of appetite, food can be taken in, and digefted, in fo far
 as the powers of that  organ go ;  which are confined chiefly  to the firft
 part of  digeftion,  or  what is called the  firft concoction.   Next the  ex-
 citement is reftored in the other digeftive organs, in  the duodenum, in
 the biliary veffel;, the  pancreatic duct, in the lacteal veffels, through their
 whole  courfe from the inteftines to their common receptacle, as all the
 veffels  that return lymph from every part 01 the body,  in the veins be-
twixtthe thoracic duct and the heart, in all the cavities of the latter, in
 all the  red arteries,  in the colourlefs terminations  of all thefe, whether
cxhalant or glandular,  and whether only fimply feparating, or alfo chan-
ging the property of the fluid they fecrete," in all the internal cavities of
the body, in  the commencing extremities of the abforbent veffels, and
in  their progrefs through their lymphatic trunks to the receptacle in com-
mon to them with the lacteals, which are a part of  their number, in
the thoracic duct again; as alfo  from that to the heart, and from the
heart to  the extremities of the arteries :  Laftly the influence of excite-
ment is extended to thefe terminations of the arterial fyftem, whether
ex'valant or glandular, which perform the feveral functions of excremen-
 titious  fecrction and excretion, by which every portion of fluids, now be-
                                                             come; 
OF   MEDICINE.
3$7
  long (m) falls into it: After fleep, when now fome vigour is
  acquired both by that and the medicine, and  now fome of
  the exceffive excitability is worn off, a double quantity of
  the diffufible  ftimulus fhould be added, and, in that way,
  gradually encreafed, till the  healthy ftate can now be fup-
  ported by ftimuli leffer  in degree, greater in number, and
  more natural  (n).
     DCLXXXIV. In indirect  debility  an  hundred  and
  fifty drops fliould forthwith be thrown in ; and then the
  fuperaddition  to be made, fhould be lefs  and lefs, till we ar-
  rive at the boundary juft now mentioned (o). Both themea-
  fures recommended (p), are in general applicable to adults;
  but lefs will fuffice at an early or late age.  Nay, the rule
  further varies according to the habit, the way  of life, the
  nature of the place,and the peculiarities of the patient (q).
                                               DCLXXXV.

 come ufelefs, or, if they were  retained, hurtful to  the fyftem, are thrown
 out by their feveral emunctories.  When, by the  ufe of the diffufible fti-
 muli,  the ftomach, aad all the organs can performjtheir refpective func-
 tions, the natural ftimuli begin to be reftored ; the ftomach the intef-
 tines,  the lacteals and blood veffels, and all the other veffels, are gradu-
 ally filled with their refpective fluids ; the  mufcles on the furface,  an J
 the mufcular fibres  recover their tone and denfity;  the brain recovers
 its vigour ;  heat and air can be now reftored to the furface ; exercife can
 now add its ufeful ftimulus ; and all the functions return  to their ufual
 capability of being acted upon by the ufual and ordinary exciting powers.
   (m) Want of fleep is an  indirectly debilitating power ;  and,  in this
 weakened ftate of the fyftem, in this redundancy of excitability,  where
 every exciting power is liable to  be too much for the excitability,  tha
 want of fleep, by not allowing this partial wafte of excitability to be re-
 paired, is the occafion of fo much  more indirect debility being added to
 the direct ;  and hence the fum total  of debility is encreafed.  Theeffect
 of fleep in removing this partial indirect debility becomes fo far an invi-
 gorating power.
  (n) See above par. CIII. and CVII.     (o) DCLXXXI1I.
  (p) in par.DCl.XXXIl. and this.
  (q) When the habit is  delicate, the patient's way of Jife moderate a
lotbe ufe of the ftimuli,  the  place cold, crboth cold  and moift, and
                                                           th5 
368        THE   ELEMENTS
   DCLXXXV. And fince  the ufe of the diffufible ftimuli
 only fucceeds,  when life cannot be preferved by the ufual
 and more congruous to nature,and a due quantity of blood
 and other ftimuli foon become fufficient to finifh. the heal-
 thy ftate ;  we fhould on that account, even from the be-
 ginning immediately give animal food, if not in a folid form
 in which it can neither be taken nor digefted, at  leaft in
 a fluid form, in that of foups ; which fhould be alternated
 with all the dofes of the  diffufible ftimulus : Then,  in a
 gradual way, proportioned to the return of  vigour, firft a
 very little of fomething folid,and afterwards more and more
 fhould be thrown in, and the other ftimuli, each at its pro-
 per time, brought  into play; till the  whole cure termi-
 nate in the  management commonly  obferved  in  good
 health, where there is lefs  occafion for medical injunc-
 tions.
   DCLXXXVI. When the affeftion is more a mixture of
 both forts of debility, thefe proportions of the  dofes muft
 be blended together.
   DCLXXXVII. Contagion, which either adds nothing to
 the effeft of the ufual hurtful powers, or proves hurtful
 by the fame operation by which they are fo, is not otherwife
                             4                        to
 the patient eafily affected with ftimuli of all kinds ; in all thefe cafes the
rule, which common fenfe prefcribes, is to  diminifh the dofe of the dif-
 fufible.  A lady in Edinburgh, who had born and nurfed many children,
 had lived exceedingly moderately, had been and ftill was very affiduous
 in the management of her family affairs, and ufually ftimulatcd with lit-
tle air out of  her own  houfe, fell into a cholic, and, by the evacuant
and ftarving plan, had been kept in it for a  full month,  till the urgent
fymptom of vomiting required further affiftance: When I came, I firft
retarded the vomiting by a glafs of whifky : And,  by two more, with
no other help  but that of a mixture containing 30 drops of the Thebaic
tincture, which the furgeon had been adminiftering in miferable fmall
portions, in  three hours removed the whole difeafe.  As  I have faid
fomewhere before, the difeafe, from  her neglect in fulfilling directions
had very nigh returned next day ; but another glafs repelled it. 
OF   MEDICINE.         369
to be regarded,  than that time be allowed for its palling
out by the pores, together with the perfpiratory fluid, and,
therefore,the perfpiration be properly fupported; which,as
it is effefted by ftimulating, is no addition to the general
indication (r).
   DCLXXXVIII. Laftly, the corruption of the fluids in
the extreme veffels muft be obviated (s), not by means,
that by a direft operation  remove it,but by the powers that
aft upon the excitement  of  the folids, and that encreafe
excitement over the whole body, and therefore, among
other parts upon the labouring vefTels.
   DCLXXIX. Having now run over  the whole  fcale of
decreafing  exciting power from peripneumony to  the
plague, and from death by indireft, to death by direct de-
bility; and having fo executed the work, as to prefent the
public with a new fcience, if not finiftied off in an elaborate,
elegant, and  highly polifhed  manner,  at leaft marked  in
outlines, and,like a rough  ftatue,to be polifhed afterwards,
in fome meafure fafhioned in all its limbs, and embracing
an entire plan of a work, connected in all its parts ; we
muft next pafs over to the confideration of local difeafes.

  (r) See'LXXXVIII. XCVIII.
  (•) CCXXXVI. andCCLXXlV.
Bb
The 
37°      THE   ELEMENTS


The    FIFTH    and   LAST   PART.

         LOCAL   DISEASES.
CHAP.     I.

     Of Local Difeafes.
 DCXC. T  OCAL  difeafes  (a) are divided,  according
         -*-*  to an order of nature, into five parts ;  the
 firft of which confifts of organic affeftions, where no dif-
 feafe over the whole fyftem arifes, none but in the hurt part.
 This is a fort of affeftion, that happens in parts lefs fenfi-
 ble, according  to common language, or  more devoid of
 excitability.
   DCXCI. The  fecond part,  likewife  made  up  of or-
 ganic affections, occurs in parts of thefyftem,whether inter-
 nal, or external, that are very fenfible, endued with a great
 deal of excitability (b); where the effeft of the local affec-
                                                      tion
  (a) V. VI. vn.                   ' •
  (b) The excitability is here not talked  of in its  comparative ftate. ot
abundance or deficiency, but  in the degree in which  any part poffeffes
it in preference to other parts.  It is ufed in the fenfe  of the grratcr or
leffer vitality of parts: Accordingly we can fay, that fome parts poffefs
an exquifitc fenfibility, as the ftomach, the brain, and inteftines, and, I
behove, moft of the interior,  foft, fleftiy parts, and the fhut  cavities;
and externally, the parts immediately under the nails ; that others pof-
Us kfs, as the bones, ligaments, and cartilages and  laments;  and ex-
  ::*>ly, the cuticle, or fcarf-fkin.  It is, with  refpect to the difference 
OF   MEDICINE.         37I
 on is propagated over the whole body, over the whole ner-
 vous fyftem, and where a very great many fymptoms arife,
 fimilar to thofe which are peculiar to univerfal difeafes.
   DCXCII. The third part of local difeafes,  takes place
 when a fymptom of general difeafe, that at firft arofe from
 encreafed  or  diminifhed excitement (c),  arrives at  that
 height of degree, at which, being no longer, under the in-
 fluence of excitement, it cannot be affected by  remedies
 that correct the excitement.
   DCXCIII.  The fourth part, or divifion of local difea-
 fes, confifts of thofe, in which a contagion, externally ap-
 plied to the body, is diffufed over all, without affefting the
 excitement (d).
   DCXCIV.  The fifth part of local  difeafes,  arifes from
 poifons that have been applied to the  body, and flow
 through all the veffels in fuch a manner, that they are un-
 derftood not immediately, nor at firft, to have  any tenden-
 cy either to encreafe or diminifh the excitement, but fal-
 ling upon parts, fome on one, fome on another,  hurt the
 texture of thefe in different manners ; and, after occafion-
 ing that local hurt, by means of it produce difturbance over
 the reft of the body.

of fenfibility, or excitability, or capability, to be acted upon by exciting
powers, that wc  ufe the expreffion  of more  or left excitability.  See
above par. XLlX. and the addition, and LIII. and addition,
  (c) like all the other fymptoms, of which it was one,
  (d) If it affected the excitement its effect would be general difeafe,
which fometimes happens, as in  the fmall-pox, meafles,  contagious ty-
phus, and the plague.
B b  2              CHAP. 
  372       THE    ELEMENTS


                CHAP     IL

 The firfi Part of Organic Local Difeafes,  where no  EffeSl, but
                   in the hurt Part,  arifes.

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

  (a)See DCXUI. and the note.                  (b)  not a living,
  (c) So hurtful is the air and temperature to  parts below the cuticle.
t'vit nothing is a more certain caufe of gangrene than their expofure,
even for a very fhort  fpace  of time: Nor is there any other way of ac-
counting f«r the fiitil effect of flight, fupcrficial, but cxtenfive burning.
Death has been the confequence of a burn, that extended no  farther than
the fore-part of the thorax,  or the breaft, and was not of longer contin-
uance, than the time taken to tear off the burning clothes that pccafioncd
 it. 
              OF   MEDICINE          3^3

animals, or by being burned, or by a very high degree of
cold ; in that cafe a thin, mild,  oily plafter is fufficient for
the cure.
   DCXCIX.  The divifion, therefore, of phlegmafia;, into
phlegmone, or erythema, is without foundation, and mif-
leading, both as to the caufe, and as to the cure, from the
knowledge of the  truth (d): For, however much they dif-
fer in their remote caufe, as they call  it, and in their feat,
and in their appearance; fince the exclufion of the air and
of other ftimuli is their effectual cure ; it,  confequently,
follows, that their caufe is the fame,  that  is, that the na-
ture of all  thefe affeftions is the fame.
   DCC.  In  the  cure of contufion,  compreflion,  and
fprains (e), the fame, in general are the remedies ; and be-
fides them, there is occafion for reft of body, and bland te-
pid fomentation.
   DCCI.  Through this  whole divifion of local  affec-
tions, there is  a certain energy of nature, that tends to the
reflo ration of the healthy ftate; but  it  is noe the celebra-
ted vis medicatrix naturae of phyficians : For in this cafe
nothing elfe happens, but what equally happens in the cure
of general difeafes.  If proper remedies are applied, the
found  ftate in both forts of difeafes follows: If the  reme-
dies be neglected,  the folution of continuity degenerates
into a  worfe and worfe nature, and then into gangrene, or
the death  of the part (f).  It is the excitability,  or that
                                                property

   (d) See the feventh  Genus in Genera Morborum Culleni, where you
will find Linnaeus's prototype of inflammation, that is, of inflammatory
difeafes, or what is in this work called phlegmafia:, or fthenic  difeafes
with inflammation or an approach to it- alfo adopted by this author.  It
is nothing elfe but a collection of local affections,or, in a few cafes, fymp-
toms of difeafe,  and that they almoft all come under this head  of lccaj
difeafes, and  every one of them under one of thefe heads.
   (e) See par. DCXCV,
   (f) Of th» we are  prefented with exaivp'cs in cv.ry day's c-pcri-
                                                     Li.ce 
  374      THE    ELEMENTS

  property of life, by which the functions are produced (g),
  that, wherever life, whether in a part, or over the whole
  body, is hurt, procures the return of the healthy ftate by
  means of the external powers acting upon it.   It is, then,
  the excitability, affefted by the aftion of thofe powers, that
  is to fay, the excitement, that governs the ftate of the fo-
  lids, both in parts, and over  the whole body (g),


               CHAP.     III.

             Tht fecond Divifion of Local Difeafes.

    DCCII.  THE  local  organic difeafes  of  the fecond
 divifion are the inflammation of the ftomach (a), and that
 in the inteftines (b); aa alfo bleeding difcharge, with  an
 inflammation fubfequent to it; and in fine, an inflamma-
 tion  in any  very fenfible part in. confequence of a wound,
 producing commotion over the whole body.
                                                         Of
 ente 5  where we find  the flighted fores* from the neglect of the fimple
 rule of cure laid down here, degenerate into very troublcfome affection*.
   (g) See above par. X. to XIV.   If I cure a peripneumony by bleed-
 ing, other evacuations, and other debilitating powers, that are not eva-
 cuant, it is by diminifhing the force  of exciting powers ; if I cure a fever
 by opiates and other ftimulant powers, whether ftimulating by filling the
 veffels, or without that, it is by encreafing the fame force ; and if 1 cure
 a fore on the furface, by the method  juft now mentioned, I thereby pre-
 vent the force of exciting power from rifing too high, from an excefs of
 ftimuli, or from running either into direct  or indirect debility, from too
 little ftimulus, or an  ultimate excefs.  If either thefe general or local
cures are neglected, or mifmanaged, the cure will  n«t be fupplied by
any effort of the fyftem ; and if the  cure is made out by regulating the
excitement, fuch effort is fuperfluous.  The vis medicatrix then is as
little real in local as  general difeafes.   See above par. LXII. and the
addition.
  (a) or gaftritis,             (b) or enteritis, 
OF   MEDICINE.
375
            Of the Inflammation in the Stomach.

  DCCIII.  The  principal  fymptoms  in gaftritis  are,
pain in the region of the ftomach, a burning heat, deep
fea ted, encreafed by every thing that is either ate or drank,
or in any fhape taken into the ftomach ; hiccup, an incli-
nation to  vomiting, and the fudden throwing up what is
taken in ; and the pulfe foon getting into a ftate of debi-
lity, quicknefs, fwiftnefs,  and hardifhnefs.
  DCCIV. The exciting hurtful powers, and which pro-
duce the folution of continuity in this cafe, are fuch as aft
by cutting, pricking or erofion. Such are the fmall bones
of fifties, ground glafs, or Cayenne pepper and fuch like
things.
  DCCX. Inflammation is a confequence of the wound
or erofion, that are the effeft of the operation of thofe ex-
citing powers : The effeft of  which, in the  very fenfible
organ of the ftomach, is to diffufe the difturbance before-
mentioned (c) over the whole fyftem.  The  burning heat
and pain, infeparable from  every  inflammation,  and the
anxiety (d), are the offspring of the inflammation (e): And,
of them, the anxiety is more peculiar to the ftomach, the
latter being its accuftomary feat (f), and the pulfe becomes
fuch as  has been  related,  becaufe it is peculiar  to every
rude, fixed, and permanent local ftimulus (g); to weaken
and to be fo much  the more liable to that effeft, the greater
the excitability of  the part h.  Hence, in the external parts
of the body, that are lefs endued with excitability, a pretty
confiderable inflammation by no means  affefts the pulfe or
the body any way generally ;  though even there, when a
part is fenfible, as in the cafe  of a burn fpread to any ex-
tent, or of a thorn having been thurft below the nails, r.n
                                                 equal

   (c) DCXCVI.     (d) CLXXI. CCCX1.V.     (e) CI.XXI.
   (f) CVCXLV,     (g) XVII. 
37^      THE   ELEMENTS
 equal difturbance arifes over thewhole body (h), which con-
 firms a former propofition, in which it is afferted, that the
 more abundant the excitability is (i), the lefs ftimulus can
 be born.
   DCCVI. The difeafe is eafily known, both from the
 fymptoms above defcribed, and, with not a little more cer-
 tainty, from the known taking in of the hurtful  powers;
 and over and above, by this particular fign,  that, as it has
 been faid before, without fuch marks, inflammation fearce
 feizes upon an internal and fhut part (1).
   DCCVII. As this is a local  difeafe, and  does  not, like
 the general ones, depend upon the encreafe  or diminution
 of excitement; confequently, the indication fuited  to the
 latter, to wit, to diminifh encreafed, or encreafe diminifhed,
 excitement, over all, will not  apply.  On the contrary un-
 lefs a general difeafe happen to be combined with  it,  no-<
 thing elfe is to be done, but, by throwing in bland, demul-
 cent liquors, to defend the tender part from the rude contact
 of the ftomach's contents, and give the inflammation time to
 finifh its courfe; and, if the phyfician is called foon enough,
 to wafh off the hurtful matter with a diluent drink.

             Of the Inflammation in the Inteftines,

   DCCVIII. The inflammation in the inteftines is a lo-
 cal affection; in which there is an acute pain in the belly,
                                                     and
  (h) CCCXLIV. CCCXLV.       (i) XXXVI.
  (1) CXIII. and CLXVIU.  The ftomach is  fometimes  inflamed from
a fchirrous tumor occupying the pylorus ; and that cafe alfo it  taken in
by the fyflematic and nofological writers, as belonging  to  their gaftritis:
13ut the confideration of it does not belong to this head of local difeafes,
but to the third divifion of them. At  the fame time, both it and the pre-
fent cafe are local difeafes, and not phlegmafiae, differing from the phlegm.
afiae, f0 fully treated of in the third part of this work.  It, as well as en-
teritis, of which we are next to  fpcak, have every mark of difference
from the general difeaies mentioned in the Vfth paragraph.   £cc aJ„*c
Chap. I. of the fifth Part. 
             OF   MEDICINE.        377

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

  (m)  liaron  dc Haller, from fome experiments that he made, found
the inteftines more fenfible than moft parts of the body, more than the
ftomach, and equal in fenfibility to the brain.
  (n)  Sec par. CLXXXVUI. CLXXXlX, 
 378      THE   ELEMENTS

tion :   Which  is a  fact, that if  examined  attentively,
and once rightly confidered will not difturb our diagno-
fis.
   DCCXIII. The cure is precifely the fame as in  the
inflammation of the ftomach.
   DCCX1V. All  the reft of the pretended phlegmafice,
diftinguifhed by the appellation of " itides," as the fpleni-
tis (o), hepatitis (p), the true nephritis (q), the cyflitis (r),
without a ftone, or the hyfteritis, not arifing from fchirrus
(s), and the peritonitis (t), do not belong to this place ; as,
befides the doubt of their ever being inflamed, not arifing
from  ftimulants and acids, neither of  which  have  accefs
to the fliut vifeera (for thefe fubftances are not carried in
the veffels, or can be carried), but from the relics of other
difeafes, of which we are to fpeak afterwards, with the fol-
lowing exception :
   DCCXV. The exception is, that if any one falls from
 a height, if he is run through any part of his bowels with
 a fword, if a poifoned arrow,  thrown by any favage, has
 pierced any of  his inward parts, he will in
   DCCXAT.  The cafe of the inflammation affefting the
 liver, be affefted with a pain in his right hypochondrium,
 with  vomiting  and hiccup:  If
   DCCXV1I.  The inflammation affeft his fpleen, the
 pain will be in his left hypochondrium; in
   DCCXVIII. The cafe of the true nephritis, or inflam-
 mation of one  of the kidnies, he will be pained in  the re-
 gion  of the kidney,  and  feized with vomiting, and a ftu-
 por of his leg; in
                                            DCCXIX.
   (o)   or inflammation of the fpleen
   (p)  or the inflammation of the liver
   (q) or infl&mmation of the kidnies,
   (r)  or inflammation of the  bladder of uiine;
   (s)  or inflammation of the  womb.
   (t)  or inflammation of the peritonaeum* 
              OP    MEDICINE.         379

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

  (u) DCGII.
  (x) The inflammation is frequently not in the womb, but in a neigh-
bouring portion of (he inteftines, or mcfocolon, or in the peritoneum it-
ftlf as diffecti'>n has frequently fhown.  This is a difeafe, than v»hich
 rone has been more enquired into, and none yet lefs underftood.
  (y) Pain and lof* of blood are in one  degree  or another ir.ev ta' le
caufes of debility. 
 380      THE    ELEMENTS

have her belly bathed : And,  if the debility  fhould get
a-head, recourfe muft be had to more wine,  drink ftill
ftronger,  and opiates : The ufe of which laft fhould not
be neglected, even at firft.

                     Of Abortion.

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

enlarged diameters, with wine and opiates, and, in that
way, take off, at the fame time, the atony and laxity, which
arc the principal caufe of the difcharge.

                Of Difficult Child-Labour.

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

                 Of deep-feated Wounds.

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

   DCCXXXI. Becaufe, in this  cafe  afthenic diathefis
is commonly fuppofed to arife over the whole body, upon
account of the irritation from the wound ; the antifthenic
plan of cure is, therefore, always employed through the
whole courfe of the difeafe; and the ufe of opium, which,
in this cafe is conjoined with the antifthenic, or ftimulant
remedies, is admitted only for the purpofe of afting as a fe-
dative and duller of pain, is admitted : Confequently, upon
account of the fear of a fever being to fupervene, though
often a great quantity of blood is loft  by the wound ; ftill
large bleeding is praftifed, the belly is purged, nourifh-
ment is with-held, abftinence enjoined : The moil frequent
confequence of which treatment is death,  r.nd  never a re-
covery that is not owing to accident.
  DCCXXXII.  But all this is a method of cure con-
dufted upon an erroneous theory, which is proved by all
the principles of this doctrine, and by the very unfortunate
iffue of that praftice.  In a perfon, who has loft a great
deal of blood, an over-proportion of" blood, can  ne-
ver  be  the caufe of  fthenic diathefis :  Neither  can
any tolerable reafon be  afligned for  the  profufe  evacu-
ation of the ferous  fluid, or for not rather fupplying new
fluids by the  ufe of food.   It is in  vain to accufe  fre-
quency of the  pulfe, as a fign of an excefs in the quantity
of blood, and of too much vigour, or of any irritation that
wants an antifthenic plan of cure : For, befides its hard-
nefs, if the pulfe is not, at the fame time, ftrong and full;
it has been now often above demonftrated,  that all its cele-
rity depends upon debility and penury of blood (c).   Fi-
nally,  as the afthenic diathefis depends upon  the general
fthenic hurtful powers, as the energy of pain, from local
affeftion, and particularly inflammation, has no tendency to
inducethatdiathefis,butthecontrary one of debilitating (d);
that is another reafon for the fuppofition of the habit, either
                                            remaining
  (c) See par. CLXXIX. to CLXXXI.               (i^ Dfvv 
            0F    MEDICINE.          383

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

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

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

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

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

               CHAP.     IV.

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

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

                      Suppuration.

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

                     Of Puftule.

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

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

                      Of Anthrax.

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

                       Of Bubo.

  -DCCXLIII. Bubo i3 a  glandular tumour, efpecially
affefting the one or the other groin, and of a tendency to
fuppuration.
   DCCXLIV. Thefe two affeftions the  anthrax  and
bubo as well as carbuncle, are almoft always combined with
a general difeafe, to wit, fometimes with typhus, much of-
tcner with the plague.   They depend upon a contagious
matter, and in fo far as they do  not fufficiently yield to the
general remedies, they muft be treated with a very ftrong
fpirit poured upon them, and with laudanum, and opening
 them.
                        CC2                      Of
(a) XXI. LXXVI. XCV1. XCVII. XCVIII. 
   388       THEE  LEMBNTS

                       Of Gangrene.

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

                       Of Sphacelus.

    DCCXLVIII. Sphacelus is a more perfeft and more ex-
  tended gangrene, with  an extinftion of fenfe, motion,
  and heat;  in which the part becomes foft, blackifh, com-
  pletely black, putrid, and at laft thoroughly putrid to the
                                                  very
   (b) The inflammation, out of which gangrene arifes,  is always un-
 fipported, ami the  gangrene always a ftate of either dired or indirect
[ debility :  the high excitement in the phlegmafiae, and the low in fevers,
 caufing that.
   («) CC CXLVII.  DCL. to DCLXXIX. 
              OF   MEDICINE.          389

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

              Of Scrofulus Tumor and Ulcer.

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

                  Of Schirrous Tumor.

  DCCLI.  When the tumor,  which  while it was mo-
 derate, was a part or fymptom of the general difeafe, call-
 ed fehirrhus, has  now attained a certain bulk; if it be ex-
 ternal,  or fituated in the exterior or convex part of the li-
 ver, it fhould be cut  off, and the fyftem invigorated :  If it
 b'e internal, nothing can be attempted,  but to prevent its
 encreafe by ftimulant remedies, and in that way keep the
 patient as long alive as poflible, and in as good health as
 the prelent circumftances will admit of.
  DCCLII.  The two heads of divifion that  remain  (e),
are  of fo obfcure and abftraft a nature, that if ever they
                                                  are
(c) DCXCIII. and DCXCXIV. 
390       THE  ELEMENTS

are to be attempted, they muft be paffed over at  prefent.
The third head  f) is here only imperfeftly fketched and
fearce begun: But  becaufe it both admits of a complete
execution, and when fo executed, will make an important
addition to the work; fhall be prepared for the public pe-
rufal, as foon as I fhall be happy enough to find as much
leifure and feope for thinking as are requifite to refcue the
fubjeft from its prefent intricacy, diforder and obfeurity.

          (f) DCXCII, DCCXXXVII. to DCCLII.
FINIS. 
I
N        D       E        X.
              A.
      ABORTION,  page 380.
       Abftinence, not lefs im-
   moral  and irreligious than
   excefs, 64.
Abftract reafoning,  cautions a-
   gainft,  136. ^
Acid in the alimentary canal
   fymptom, not caufe of dif-
   eafe, 104.
Acrimony, in what fenfe may
   be admitted, 361.
Agents, external, what, 2.
Agriculture, hints reflecting,
   204.
          what fhould be fo
   termed, 1.
Air, atmofpheric, if too  pure
   would be  perhaps injurious,
   77-
     impure, produces afthenic
   diathefis,  ibid.
      inimical to living folids.
   372-
Air, ftimulus of,  neceffary  to
   convalefcents, 198.
Aitiolgy, abfurdity of, 37.
Anafarca, 330.
Angina,putrid, defcribed, 124.
Anthrax, 387.
Antifeptics,  notion  of, to be
   guarded againft,  363.
Apoplexy, 342.
       not owing to plethora,
   TI7-
Appetite, caufe of, 100.
Apyrexiae, flhenic, 248.
Afthenia, meaning of, 30.
Althenicdiatheiis,caufe of,78.
                cure cf, 17c.
                 may be con-
   verted into flhenic, 33.
               fymptoms of,
   9&            ...
               predifpofition
  £0, 95.
           difeafes, 288.
               cure of 363.
 Afthenic plan of cure,different
   parts of,  compared, 4.
 Afthma, advantages of a full
   diet in, IV.
            gentle, 329.
 Author's inducements to tran£
   late his own work, Xi.
             B.
 Bark,  Peruvian, not to be de-
   pended on in  intermittents,
   355-
 Bathing, cold, remarks on, 14.
 Bladder, inflammation of.  See
   cyftitis.
 Bleeding, cautions againft, 98,
   279> 379-
       remarks on, 259, 268.
       fliould always  be  fol-
   lowed by  other evacuations,
   269.
         lingular inftance  of
   benefit from, in typhus, 120.
         when neceffary, 176,
   177,183.
Blifters, in what cafes  ufeful,
   274.
Blood, great extent of the  fti-
   mulus of,  177.
    irritates by its quantity,
   not quality, 66.
         flight  difcharges  of
   from indirect  debility  ap-
   proaching, 142.
         veffels, ufually more
   numerous inmoft fenfible or-
   gans, 227.
Breathing,difficultyof,to what
   owing, 223.
Bubo, 387.
             C.
Calcutta, death  in the black-
   hole  at,  occafioned  by  ty-
   phus, 77.
Canal,alimentary,afthenic dif-
   eafes of, 304.
Carditis, 220, 225.
Catarrh defcribed, 244.
      method of cure of, 275. 
                 I    N    D
       produced by heat, and
   removed by cold, VIII. 172.
 Caufes, inquiry into, to be a-
   voided, 5.
 Changes to be brought about
   gradually, 18.
 Children, difeafes of, 38.
                    generally
   owing to debility, V. 241.
        figns of afthenic dia-
   thefis in, 242.
              fthenic ditto, ib.
 Chincough, 319.
 Cholera, gentle, 311.
   fevere, 358.
 Circulation, howcarriedon,6o*
 Cold, effects of, 14,58,60,170.
     how diminution of bulk in
   animals produced  by, 60.
     remarks on, as a remedy,
   184, 264.
     fucceeding  to   heat, bad
   fymptom, 131.
 Colic, obfervations on, 109.
     with pain, 330.
                cure of, 332.
 Colicanodyne, 307.
 Colliquative fweets, &c. caufe
   of, 57.
 Coma, caufes of,  158.
     remarks on, 167.
 Conftitutions ofindividuals not
  fundamentally different, 165.
 Contagions aft by ftimulus, 6.
         produce a fermenta-
   tion, 229, 231.
         remarks on, 35,  77,
   127, 182, 267,368.
 Contraction and its effects con-
   fidered, 27.
 Contufions, cure of, 373.
 Convalefcent ftate, remarks on,
   199.
 Convulfions,  obfervations  on,
   105.
 Corruption of the fluids, 57.
   58, 360.
 Cough, afthenic,  151,3.15.
       in peripneumony, how
   occafioned, 223.
       fthenic, 82,  148, 244.
Cramp. 329
   E   X.
 Croup, remarks on, 240.
 Cupping-glaffes when may be
   ferviceable. 275.
 Cure,generalindicationsof 43.
     means of, cautions repect <
   ting, 45, 50, 267.
 Cuticle, jnot a living fubftance
   373- "
Cynanche, gangrenofa,  124,
   358.
           fthenic, 238.
                cure  of, 275.
Cyftirrhaea 320.
Cyftitis, remarks on, 282, 378
             D.
Darknefs  debilitates, 203.
Day,alternation of, with night,
   end of, ib.
Death,howbroughtabout, III.
   3,11,17-
       effected  by the powers
   which produce life,  207.
Debilitating powers, in what
   cafes to be ufed, 52.
Debility, direct. 15.
               cure_of, 53.
              leflening ftimu-
   lus in cafes of, carefully tobe
   avoided, 20.
             who  fubjects of,
   50,
          indirect, III. 13.
               cure of 51.
               how progrefs
   to be retarded, 13.
                who  fubject
   to, 50.
Debility, one kind of, never to
   be cured by the other ,50,5 2.
Dcdiriumproducedby deficient
   ftimulus, 98.  118.
                     fupera-
   bundant ftimulus, 172.
Diabetes,  gentle, 292.
Diagnofis, general, 41.
Diarrhoea, 3Q7.
Diet.  See food.
Difeafes, afthenic enumeration
   of, 288.
Difeafes, afthenic, general re-
   marks on, 30, 288. 
                 INDEX.
                method of                  cure of, 254,
cnring 363.                Eruptions, caufe of, m difeafes,
      caufe of, III. 30, 78,     127.
        general and local,                fcabby, 291.
mark of diftinftion between,  Exanthemata* fthenie difeafes,
i, 39.                        210.
             how to diftin-                    explained,
guifh, 42.                     227.
             how  produ-  Excitability; 3.
ced, 40.                               boundaries of, io.
     general principles and               effects of the ex-
method of cure of, VIII. 9.     hauftkm of, 11.
  a9»43-
                  local, 370
               caufes of, 40.
                in what way
  cured, 373.
         fthenic, enumeration
  of, 220.
             method of cure
  of, 229.
                remarks on,
  30, 208, 254.
Drink,abftinence from,recom-
mended, 52.
      cautions refpefting, 51.
  65- 3^4-
       may be  given freely in
       fthenic difeafes, 84.
Dropfy, 335.
Dyfentery, gentle, 311.
             fevere, 357.
Dyfpepfanodyne, 307.
Dyfpepfia, effect of debility, V.
Dyfpepfodynia,  331.
               cure  of, 332.
              E.
Earth, frefh, cap of ufeful in
  phrenitis, 275.
Enteritis,  cure of, 378.
       defcription  of, 376.
       remarks, on, 281.
Epilepfy,  cafe of, converted in-
  to dropfy by bleeding, 136,
           general,  not  par-
  tial, 22,144.
           how increafed or
  diminifhed, 9;
              feat of, 22.
           fuperabundant, to
  be taken off gradually, 18.
            what or how af-
  fefted, unknown, 4.
            when wafted by
  one  ftimulus may be acted
  upon by another, n,  197.
Excitement defined, 4.
           effects of, 29.
          higheft degree of,
  how produced, 9.
           lofs of, from over
  aftion, how to be repaired, 12.
Excitement, lofs of, may be-
  come irreparable, 18.
         proportioned to de-
  gree of ftimulus, 8.
Exciting powers aft  more on
  fome parts than others, 23,
   *5> 37©-
               univerfally 23,
               effefts of, 4.
         what implied by, 3.
Excretions, caufe of temporary
   retention of, 213.
Exercife, obfervations on, 73,
                          179,  192, 198.
  defcription of,  338.   Expeftoration, natural tenden.
owing to debility, 117,     cy to, great, 315.
                                      of pus, not al-
                         ways  owing to organic lefi-
                         on 316.
                                    F.
                       Fermentations, effefts of, 229.
                         231.
Epiftaxis, 303
Eryfipelas, mild,   defcribed,
  237
              method of cu-
  ring, 275.
              violent, 234. 
                  I    N    D
             remarks on, 360.
  Fever, intermittent, 347.
       jail, putrid, or petechial,
    35*9-
        nervous, 358.
        requires more attention
    from phyficians than ufually
    beftowed, 361.
      yellow,  purging  necef-
    fary in, 72.
 Fifh, not a nourifliing food,I V.
 Fluids how produced, 29.
 Food, remarks  on,  III.  IV.
   61, 62.
                 as a remedy,
   184, 186,191, 282.
     fliould be ftimulant to a
   certain degree, 246.
       vegetable, debilitating,
   ibid.
 Force, what, 27.
 Foflils, perhaps, not without
   life, 207.
 Funftions afting on the living
   animal,  2.
       may  be  impaired  by
   fthenic diathefis,  132.
                 increafed by
   afthenia, ibid.
             G.
 Gangrene defcribed, 388.
        to prevent,  148, 185,
 Gaftritis, 348.
         cure of, 40, 376.
        remarks on, 40, 219,
   281.
Gentoos, imbecility of, owing
   to diet, 63.
Globe, great change of, 207.
Gout brought on by low living,
   II.
     cured by ftimuli, III. VI
   125.
     not hereditary, 321.
     of ftronger  perfons, 120,
     of weak  perfons, 331.
              H.
Habits, effefts of, to  be confi-
   dered, 328.
Hemorrhages always owing to
   E    X.
    debility, 68,  142.
                blood deficient
    in cafes of, VII. 142.
               ftimuli falutary
    in, VI. 142.
 Hasmorrhois, 303.
 Health and  difeafe not differ-
    ent ftates, 30.
      good and  bad, defined,
    1,  29.
 Heart, inflammation of.   See
   carditis.
 Heat, a remedy of afthenic di-
   athefis, 187.
     afts more externally than
   internally, 253.
     exceffive, cautions againft
   application of, 188.
     unufual, caufe of, 214.
              fymptom of dif-
   eafe or predifpofition, 130.
 Hepatitis,  remarks on, 281,
   378.
 Hereditary difeafes do not ex-
   ift, 321.
 Hypochondriafis, 333.
                 curious cafe
   of» 335-
 Hyfteria, gentle, 313.
         violent, 331.
                cure of, 332.
Hyfteritis,  remarks  on,  282,
   379-
              I.
Identity of effeft proceedsffom
   identity of caufe, 5.
Imbecility, mental and corpo-
   real, induced by food infuf-
   ficiently ftimulating, 63.
Inflammation, afthenic, caufes
   of,  119, 123.
                     cure of
   123.
                attacking the
   brain at the end of typhus
   doubted, IV.

   in phrentis, not probable,
   92.
         Boerhaave's opinion 
                  I   N   D
  of the tranflation of,  from
  one vifcus to another, erro-
  neous, 222.
             changes  its feat
  fometimes, ib.
            diftinftion of, into
  parenchymatofe  and mem-
  brarious  in phlegmafias, ex-
  ploded, 221.
           erifypelatorus, feat
  of, 88.
           four kinds of, 12 i.
           in general  difeafes
  always external, 82,  89.
           local,  91,  123.
            not the caufe, but
  effeft of diieafe,  VIII. 90.
  215.
           produced by debi-
  lity in various difeafes, V.
           rheumatic, feat of
  88.
            fthenic, caufes of,
  122.
                     cure of,
  123.
Influenza, a fthenic difeafe, 149.
Intelleftual  funftions, failure
  of, owing to debility, 119.
Intermiffions, not peculiar to
  fever, 355.
Inteftines, inflammation of. See
  Enteritis.
Irritation, not owing to extra-
  neous matter, 161.
         ,     J-
Joints fmaller, affefted in gout,
  greater in rheumatifm,  and
  why, 237.
             K.
Kidney, inflammation of.  See
  Nephritis.
             L.
Labour, difficult, 381.
Laflitude, caufe of, 213.
Leannefs, 290.
Leaches, in what cafes  may be
  applied,  275.
Life,  defined, 2.
     different periods  of, diffe-
  rent excitability in, requiring
  different degrees of ftimuli, 9.
   E    X.
     not a natural but a forced
   ftate, 34.
     powers fupporting, differ
   not from thofe which bring
   death,  207.
                        have
   not various qualities, 302.
Light, a ftimulus, 203.
Liver, inflammation of.   See
   Hepatitis.
Lock-jaw, 344.
Lungs,  not always  affefted in
   confirmedcorutimption, 155,
   3*7-
Lungs,  tubercles in, fymptoms
   not caufe of difeafe, 155.
              M.
Mania,  249.
       cure of, 283.
       fometimes arifes from
   fault  of the fubftance qf the
   brain, 249.
Mathematicians,  pedantry of,
   200.
Matter morbific,remarks on ,46.
Meafles,  antiphlogiftic  plan
   ufeful in, VIII. 148.
       mild,defcribed, 248.
       no danger of ftriking
   in by cold, 264.
       violent, 231.
           cure of, 259.
Medicine, fcience  of, what, 1.
Menorrhsea, 302.
Menftruation, caufe of 294.
            impaired, 293.
            retarded, ib.
             fuppreffed, ib.
Mind, exercife cf, to a certain
   degree, neceffary to health,
   7.5-
Moifture increafes hurtful ef-
   feft of temperature, 61.
Mortality, caufes  of, 32.
Motion, inability  to perform,
   may not proceed from debi-
   lity, 32. 138.
Motions, involuntary, 80.
        voluntary, 79.
             N.
Nature, healing powers of,non-
   exiftent, 46, 574. 
                  I    N    D
 Nephritis, remarks  on, 281.
   .378.
 Night, alternation of with day,
   how ufeful, 203.
 Nitre,not fo refrigerant as com-
   monly fuppofed, 275.
 Nofologifts, common,errors of,
   229.
 Nourifhment, folids not always
   neceffary to, 176.
                See food.
             O.
 Oaks perhaps might be planted
   in parts of Scotland with ad-
   vantage, 204.
 Obefity, 253.
          cure of, 284.
 Opium,  an excellent ftimulus,
   VI. 62.
       cold to be avoided du-
   ring the operation of, 59.
     in what dofes  to be given
   in different cafes, 365.
       large  dofe  of given in
   epilepfy, 340.
       prevents mortification,
   147.
     fedative qualityattributed
   to, falfe notion,  141.  148
   167.
         under what circum.
   ftancesfleep produced by, 17
   76.
             P.
   Pain, caufes of, 108. 104.
     occafioned by emptinefs
   as well as fullnefs, 98.
Palfy, 340.
Part moft affefted, in general
   difeafe, not afted on before
   the reft, 26. 214.
Paffions, cautions on  exciting,
   19. 75. i8r. 192.
       or emotions,  ftrongly
   influence our aftivity, 72.
   fometimes  neceffary  to
   be excited, 180. 182. 198.
     termed  oppofite,  differ
   not in nature  but degree, 8,
   7*'
       violent,  produce dif-
  eafe and death, 75,
         X.
 Peripneumony,  220.
              cure of, 40, 259.
                difference   in
   fymptoms cf, not owing to
   feat of the difeafe but degree,
   94.
              not a merely lo-
 cal difeafe, 24.
             fpurious, cure of,
   no.
 Peritonitus, remarks on, 378.
 Perfpiration, diminifhed, caufe
   of, 28, $6$.
              more  difficultly
   brought on  in fthenia than
   the  other  excretions, 213.
            produced by cold,
   J73-
                       by ex-
   treme heat 57.
           to be kept  up in
   difeafes, and by what means
   48.
Phlegmafite, local, cure of, 373.
            fymtoms of, 227.
Phrenitis, 226.
         cure of, 256.
          inflammation  of
   brain, in, not  probable, 92.
Phyfician does notbeftow fuffi-
   cient attention to patients in
   fever,  361.
       province  of, 2.
Plague, 359
Plethora, error of die fchools
   refpefting, 67.
Pleurify, the fame with perip-
   neumony, 220.
Poifon produce  local difeafe,
   37» 77-
       remarks on, 5, 77.
Poor,difeafes of, owing to want
   of ftimulating  food. 63.
Predifpofition, a criterion be«
   twixt local  and general dif-
   eafe, 39. ^
          differs from difeafe
   only in degree, 37.
         knowledge   of, im-
   portant, 38.
          neceffarily precedes
   general difeafe, 35. 
                   I    N
 Predifpofition to difeafe defin-
   ed 2, 35.
 Prognofis, general, 42.
 Pulfe, celerity of, owing to de-
   bility, 97, 382.
     Obfervations on, 211.
 Purging remedies confidered,
   184, 262, 269.
 Puftules produced by contagi-
   on, 94.
       remarks on, 386.
 Pyrexia, 31. 210.
         fcarlet, 246.
               cure of, 275.
       fymptomatic, 220, 280.
             R.
 Remedies, a fingle one never
   to be  trufted to in  violent
   difeafes, 46.
           general and local,
   what, ibid.
        remarks  on the vari-
   ation of, 242.
        feveral in a  moderate
   degree to be preferred to few
   in excefs, 173,175, 184.
         uniform  in their ac-
   tion, 20c.
 Reft neceffary in fthenic  dia-
   thefis, 184.
 Rheumatalgia,  363.
 Rheumatic-inflammation can-
 notbe transferredtoftcrnach,92.
                     feat of,
   88.
 Rheumatifm defcribed, 235.
            metiiod of curing,
   276.
 Rickets,  292.
              S.
 Scarlet  fever.    See Pyrexia,
   fcarlet.
 Schirrous tumor, 389.
Scrofulous tumor  and ulcer;
   389-
Scurvy, 311.
    not cured by  vegetables,
   3*3;
 Sedative powers are but leffer
   degrees of ftimuli, 8.
              do not, as fuch,
   exift in nature,  139.
D   E   X.
  Senfation, not different in dif-
    ferent parts cf its feat, 22.
  Senfes, exercife of, remarks on
    the, 75.
  Shivering  and fenfe of cold,
    caufe of, 213.
  Skin, drynefs of,  how  occa-
    fioned, 213.
  Sleep confidered,  155, 240.
       morbid, how produced,
    158.
        cf convalefcents to be
    attended to, 312.
        owing  to  a ftimulant,
    not fedative power, 163.
        remarks on, producing,
    166.
  Small-pox, 358.
        confluent, a difeafe of
    debility, 126.
          diftinct,  fthenic dif-
    eafe, 35, 127.
          mild, 247.
          cure of, 275, 280.
          rare cafe of, 312.
    241.
          remarks on the debi-
    litating plan in,  129.
          violent,  230.
                 cure of, 259,
  Solids, formation  and preier-
    vationof, 29.
  Spafmodic difeafes, cautions a-
    gainft evacuantsin, VI. 290.
                     owing to
    debility. VI. 210. 289.
  Specifics, idea of,an error, 16.5.
  Sphacelus, 388.
  Splenitis, remarks  on, 373.
  Sprains, cure of, 377.
  Stenia, meaning cf, 215.
  Stenic diathefis, caufe pf, 78.
                 cure of, 170.
                  may be con-
    verted into afthenic, 32.
            fymptomatic, 230.
                 iymptoms of,
    80. 209.
                           of
    predifpofition to, 79.
        plan of cure, different
  parts of compared. 183. 
                  I    N
 Stimuli, cautions on the appli-
   cation of, 18, 51, 186.
          deficiencies  of fome
   may be fupplied by  others,
   17-
        diffufible, cautions on
   the ufe of, 62,  179.
               properties of,
   62.
                 fcale of, 62,
   190.
          durable, 197, 201.
          effefts of may be lef-
   fened by mixture, 7.
       general, affeft moft the
   part to which applied, 23.
     hurtful  effeft  of,  how
   to cure, 52.
       indireft, 62.
       local and univerfal de-
   fined, 4.
       proper  in  a ftate of
   health,6i.
         fum of the aftion of,
   compofed of power multipli-
   ed by continuance, 11.
     what degree  of, neceffary
   in various cafes, 161. 365.
Stomach, moft affefted by inter-
   nal remedies, 23. 85.
        inflammation of. See
   gaftritis.
Studies, the author's, progrefs
   of, I.
Suppuration, 386.
Sweating, utility of, as a reme-
   dy, 178.268. 278.
Symptom-,  apparently very
   different, arife from the fame
   difeafe,  and vice verfa, 150.
       deceitful,  34.
Synocha, fimple,  245.
               cure of, 295.
Synochus, 358.
Syftem, no power inherent in,
   productive of difeafe, 77.
Syilems, ojd, exploded, and a
  new one eftabliihcd, 78.
           T.
Tabes,  308-
D   E   X.
  Temperaments of every indi-
  vidual the fame, 160.
  Temperature,  due return of,
    beft fign of returning health,
    130.
  Tetanus,  defcription of, 133,
    344-
  Thinking has great influence
    on our aftivity, 74.
            ftraining in, may
    prove hurtful, 74.
  Thirft, afthenic 304.
        caufes of, 81, 99, 214.
        not always to be allay-
    ed by the fame means, 53.
  Typhus, occafioned by impure
    air, remarkable inftance  of,
    77-
        peftilential, 334.
        fimple, 358.
              u.
  Urine, rednefs of, how  produ-
    ced, 213.
               V.
  Vegetables fubjeft to the fame
    laws as animals, 2,202, 204.
  Veffels, contracted in  ftate of
    ftrength, enlarged in ftate of
    weaknefs,  29.
  Vigour,  abatement of, not al-
    ways owing to debility, 138.
  Vomiting, caufe of, 84, 101.
        confidered as a remedy,
    184. 262. 269.
               W.
  Watching  caufes of, 158,
            morbid, 159, 250,
                 cure of, 283.
             owing to over-fa-
    tigue, inftance of, 160.
           reftlels, or afthenic,
    291.
  Womb inflammation of.  See
    Hyfteritis.
    Worms, 308.
  Wounds, deep-feated,  or gun-
    fhot, 381.
          irritating fufccptible
  parts,  385.
            neceffity of keeping
    air from, 372.. 
 
 
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