A NEW METHOD Of Curing the APOPLEXY.

WITH An APPENDIX, containing some OBSERVATIONS upon the Use and Abuse of PHYSICK.

BY JOHN CATHERWOOD, M. D.

Juvatque novos decerpere flores.

Lucret.

LONDON; Printed by J. DARBY, for W. TAYLOR at the Ship in Pater-noster-Row, J. BROWNE without Temple-Bar, and EDWARD SYMON at the Black Bull in Cornhill. M.DCC.XV.

TO The COLLEGE of PHYSICIANS.

THE following Discourse of Ar­teriotomy, and the Mis-application of Medicines, being a Sub­ject of no little moment to the Welfare of Man­kind, I submit it entirely [Page iv]to your severest Censure, as being the best Judges both of the Nature and Force of my Arguments. I ask no Favour; for if I am wrong, Favour to me would be Cruelty to the rest of the World; and if I am right, then certainly you, who do Justice to every body, won't deny it to,

GENTLEMEN, Your most Humble, and Most Obedient Servant. John Catherwood.

PREFACE.

A Man who offers to the World any thing not be­fore known, or not ge­nerally understood, must expect to meet with two sorts of Adversaries; who won't fail to as­sault him, tho they are as inconsis­tent with each other, as with the Truth: that is to say, some Peo­ple will deny the Invention as either not practicable, or not useful; whilst others at the same time, who are convinc'd of the Worth of it, will tell you, that it was long before [Page vi]known and practis'd, and that you must not challenge to your self the Glory. Thus our Immortal Har­vey, when he happily discover'd the Circulation of the Blood, was at­tack'd on both sides; and tho I won't pretend to compare what I here offer with his noble Discovery, yet it won't he despis'd when it's consider'd that the Circulation of the Blood is a Speculation not so immediately use­ful as what you have in the follow­ing Sheets, which is to rescue Men in the Agony of Death.

They who say the opening an Ar­tery is not to be practis'd but in ex­traordinary Cases, own it to be a Remedy when all others fail, but at the same time would not have it practis'd till all Remedies are too late.

They who say this is an Operation us'd of old, won't, I hope, quarrel [Page vii]with me for preferring the Antiquity of Truth before the Novelty of Er­ror; at least I won't quarrel with them, being much more intent upon doing Service to Mankind, than ac­quiring Reputation to my self.

They who alledg that Evacuation by an Artery makes a greater Ex­pence of Spirits than by a Vein, will find themselves so fully confuted in the following Treatise, that I need say nothing more here. In short, I take the great and sacred Rule of Physick to be the Observation of Na­ture and her Dictates; Quo Na­tura tendit. Now I would ask my Adversaries to produce one In­stance where Nature ever reliev'd her self by a Vein; and if there he no Instance of it, then to use that Vessel is to cross Nature. Thus we see that the vast Quantity of Blood which often issues from the Nose, as [Page viii]well as the great Discharge by the Piles (as they are vulgarly call'd) is still Arterial Blood. But the most notable Instance is the menstru­ous Blood in Women, which some­times flows from 'em in Streams to an unknown Quantity, and is dis­charg'd from the Arteries in the Ute­rus and Vagina: whereas should it proceed from the Veins, it would be impossible for 'em to subsist under it.

It is plain therefore that the Doc­trine I advance is agreeable to the Dictates of Nature; and if Nature be for me, I don't much care who is against me.

A NEW METHOD Of Curing APOPLEXIES, AND Other Distempers of the HEAD.

NOtwithstanding the va­rious Treatises that have been writ by learned and ingenious Men, as well antient as modern, on this Subject, which have been han­dled with the greatest Accurateness as to the Theory; yet for the Me­thod [Page 2]of treating it thro the whole Course, particularly at its first Ap­pearance, I find nothing writ more forreign from the Purpose: For by bleeding out of the Veins, and other usual Methods of Practice, they prey upon and exhaust the animal Spirits, and confirm the Distemper, rather than relieve the Patient.

But not to detain the Reader with the Measures others have taken, and still persist in; I shall only offer my own Thoughts, and the Method by which for some Years past I've found such happy Success, as well in Flan­ders, as elsewhere, confirm'd by a few Observations. Therefore without any further Introduction, I shall just describe this Disease, and proceed.

'Tis then an Apoplexy when the Body is suddenly depriv'd of the chief Animal Faculties, as well in­ternal as external, and all voluntary Motion, so that the Animal Spirits are either deny'd a Passage from the Brain, or an Entrance into it; the Ventricles or Pores of the Brain be­ing either compress'd from a Contu­sion, [Page 3]or obstructed from a Plethora, Poisons, Medicines endued with a Narcotic Faculty, which so alter the Blood, Lymph, and other Fluids, as to render 'em unfit to pass freely thro the Arteries of the Brain, whereby, thro the violent Impetus of of the Heart, the Blood is so wedg'd in, that it causes a Stagnation; and oftentimes Polypuses are form'd in the Carotids, Sinus's, and Vertebral Arteries, so that all the Spirits in­dulgent Nature can rally to support the Fabric, are detach'd to the Mus­cles of the Thorax, to perform Re­spiration, without which the Patient is inevitably lost.

Now since the Brain is the Seat of this Disease, 'twill not be at all im­proper to take notice of its Struc­ture, as well as its Use, before I pro­ceed any farther. There are then two Substances which constitute the Brain, viz. the Cinericious, being the Exterior, call'd the Cortical; the inner, from its Whiteness and Soft­ness, the Medullary: the former of which, according to Malpigius, is nothing but a Gland of the conglo­merate [Page 4]kind, or a Heap of small o­val Glands contiguous with each o­ther; to each of which is affix'd an Artery that brings the Blood, by the means of which Glands the Mat­ter constituting the Animal Spirits, is secern'd from its purer and sub­tler Parts: from hence the Veins carry back the refluent Blood, that's unfit for generating of Spirits; and then the Nerve, or Root of a Nerve, in which, as in an excretory Duct of a Gland, the Spirits just now perfec­ted, are carry'd into the Medulla­ry Substance, as a Storehouse or Magazine, and from thence thro the whole nervous System, for the Benefit of conveying Sense and Mo­tion to the Animal Oeconomy.

Now since not only the Corti­cal Substance of the Brain, but the Medullary also, and even the Nerves themselves are interspers'd with an infinite Number of exces­sive small Blood-Vessels; whatever causes an Obstruction in them, or makes 'em too turgid, causes an Apo­plexy in some degree or other, by pressing on the Nerves, and so pre­venting [Page 5]the Circulation of their Fluid.

To diminish then the Quantity of Blood from the Veins, is what all have had immediate recourse to as their chief Refuge and Asylum, either from the Frontal, Jugular, Cephalic, or Me­diana for a Revulsion; whereas that is now exploded, the Laws of Cir­culation not admitting it: and if this did not answer their Expecta­tion, the Patient was given over as in a desperate Case; according to this of Hippocrates, speaking of an Apo­plexy, Venae sectio, ni juvet, occi­det; or this of Celsus, to the same purpose, Sanguinis detractio, vel oc­cidit, vel liberat. Which is enough to convince us how prejudicial such Evacuations from the Veins were found, and how uncertain the Prac­tice was observ'd to be, even by the Antients; tho, for want of a better, it has unhappily been persisted in to this present time.

'Twas indeed in many Cases fre­quently us'd by the Antients, but now become so much in vogue, that 'tis order'd almost on all Occasions, [Page 6]except in Cachectic Persons, or those grown Hydropical by impoverish'd Blood, Diseases contracted by Hun­ger, Fatigue, &c.

Let the Obstruction be where it will, tho at the Fingers end, open­ing a Vein must relieve it. I can't indeed wonder that the Antients did it, being in a manner Strangers to A­natomy, and knowing nothing of the Circulation of the Blood: but since, by the indefatigable Industry of the Moderns, that Part of Learning is arriv'd to such Perfection, I admire there's not more notice taken of the Inconveniencies that attend Phlebo­tomy; but 'tis past over as an Ope­ration to be attempted by any Per­son, at any Season, regard being on­ly had to the Strength of the Pa­tient, touching of the Nerve, Ten­don, or its Aponeurosis.

But if by an Obstruction, Apo­plexies, or any Distemper incident to the Head is caus'd; to make a more copious Evacuation, and speedy De­rivation, the Discharge must be made by opening the Jugulars: which O­peration falls so far short of their [Page 7]Intention, that it proves far more dismal in its Consequences; by so much the more effectually confirm­ing the Obstruction, by how much the nearer the Ligatures approach the Part affected.

Experienc'd Surgeons indeed will use no Ligature round the Neck, for fear of Suffocation in Apoplexies and Squinanceys but only let a Stander-by compress the Jugular, on the contrary side, with his Thumb, and fix their own just be­low the Place where they design their Aperture. But too many use Ligatures, and either apply the middle of the Fillet behind the Neck, the two Ends being brought before and twisted; or turn one End over one Clavicle, and under the contrary Ax­illa, and so the two Ends are brought before and fastned: both which are very pernicious, particularly the lat­ter, which by pressing on the Ax­illary Vein, stops the refluent Blood; by which, besides confirming the Obstruction, as before mention'd, Syncopes, Palpitations, Tremors, and the like are caused: for what­ever [Page 8]thwarts or crosses the circular Progress of the Blood, produces these Effects.

But even bleeding in the Arm, the Tediousness of the Operation is such, and the Advantage that can be ex­pected from it so small, I can by no means be reconcil'd to. For first the Ligature must be strain'd, in order to cause the Veins to swell, for the more commodious introducing the Lancet; which perhaps after all re­quires the Surgeon's Frictions, to force the Blood to the intended In­cision: and this is not sufficient, but often there must be hot Cloaths, and the Arm plung'd in hot Water; and then when the Aperture is made, by the Misapplication of the Bandage, the Skin relaxes, the Orifice closes, and obstructs its Passage: and when the Impetuosity of the Blood abates, the Ligature is again slacken'd, that as much Blood may pass into that Part by the Arteries, as will suffice for the intended Evacuation. During which time, the Obstruction is con­firming; for the Blood in the Veins steers an easy Course from nar­rower [Page 9]Passages to broader Channels, thro their soft Tunicles, quite diffe­rent from those of the Arteries; whose Coats being elastic, parti­cularly in the large Trunks, give a Velocity to the Blood, which if in­tercepted, causes the Blood to be so turgid in the capillary Vessels of the Brain, even to extravasate, and obstructs the Spirits in the Sensorium Commune, the first Course of all Nervous Distempers; as Palsies, Cramps, Convulsions, Apoplexies, Emaciations, and insensible Decays, without any visible Cause, that it would even pose Persons of the best Judgment to account for it; as also that Chronical Distemper, the Hy­drocephalus, or watry Humour in the Head, which proceeds from extrava­sated Lymph, occasion'd by the Compression of the Lymphatics.

What has been said will be suffi­cient to convince any unprejudiced Person, of the Inconveniences that attend Phlebotomy. If we reflect on the first Rise of this Operation, 'twill not much heighten our Esteem of it. Pliny, in his Natural History, [Page 10]tells a whimsical Story of the Hyp­popotamus, or Sea-Horse; who, when he finds himself heavy or indispos'd, seeks out the sharpest pointed Thorn, with which he pricks a certain Vein of the Leg; and after a Quantity of Blood is drawn, stops the Wound with Mud: a very poor Precedent, that we are oblig'd to have recourse to for this Operation.

But all the proposed Ends will be answer'd by opening an Artery. Tho I'm well assur'd this Hypothesis will be exploded by the greatest part of the Faculty, it being not only what is uncommon, but also their being un­acquainted how the Operation is to be perform'd, and the hazard of at­tempting it, will occasion the fol­lowing Objections, to render this Method trifling and inconsiderable.

Some fancy with Celsus, that an Artery once cut, by reason of its Systole and Diastole, from the Solu­tion of its Fibres, can't again consoli­date and grow together, but forms a Thrombus.

Others have had Stupidity enough to affirm, that those Vessels must be past through with a Needle and Thread, in order to re-unite them.

Again, there are those who will allow of it in some Cases; yet own that they contract, retire within the Flesh, are cicatrized there, and so cease from their Office of conveying Blood to that Part.

There are also some, that after they have been prevail'd upon to acknowledge the Possibility of their Re-union; yet still object against the Inconveniencies of Bandages, which must necessarily be continued for several Days.

But when these Objections have been answer'd by ocular Demonstra­tion, they'l undertake to prove, that the Blood in the Arteries, and that of the Veins, does not in the least differ in their component Parts; and that both being continued Tubes, it matters not out of which the Eva­cuation is made. Whereas there is no greater difference between the Fluid contain'd in the Lympheducts and Nerves, than between that in [Page 12]the Veins and Arteries: that of the Arteries being of a more lively, flo­rid, scarlet Colour, more subtil and spiritous, and the Vehicle that con­veys the Alimentary or Nutritious Particles, which in their progressive Motion, press upon those Glands whose Pores are adapted to admit of such Juices as serve either for Ac­cretion, Nutrition, or Reparation: whereas the Venal being only the Refuse of those Secretions, returns to the Heart, that so by filling its Coronary Vessels and Ventricles it may be enabled to perform its Mo­tion of Contraction and Dilatation, which, if its Reflux be intercepted by Bandages, it must necessarily be depriv'd of, and consequently such Effects are produc'd as before men­tion'd. So that this Objection is as trifling and frivolous as the rest.

These being so easily answer'd, a­nother unanswerable Objection is started, viz. That that Branch, which we durst attempt to draw Blood from, is so small, as not to admit of a plentiful Discharge.

But the most powerful Argument to answer all these Objections, is De­monstration. I've us'd this Method in all Cases where diminishing the Quantity of Blood is requir'd, whe­ther in Apoplexies, Quinancies, In­flammations of the Lungs, Pleuri­sies, Asthma's; in all sorts of Fe­vers, whether intermitting, continual, or malignant, without the least mis­chievous Accident attending it. But this Precaution must be used, that it be such an Artery as immediately passes over a Bone, which are none but those of the Head; and of these the Tem­poral Artery is the Principal, it being the most considerable Branch of the Carotid, which passing over the Os Temporale, admits of a double Com­press. This may be open'd with less Danger, and with far greater Success than any Vein; and I've frequently seen it run with as continu'd a Stream, as from the Arm.

By this time there's no room to doubt but the chief Difficulties are remov'd; and because so few are ac­custom'd to this Operation, I shall just mention how 'tis perform'd; [Page 14]which is thus. Press your Finger on the Vessel, above the place where you design your Aperture, and your Thumb on the said Vessel beneath, to keep the Skin smooth, and the Vessel from rolling; then introduce your Lancet, raising up its Point to cut thro the Vessels and Teguments, but not by Punction, as too many do in opening the Veins; by which means you may make as plentiful a Discharge as you please, without be­ing liable to the afore-mention'd In­conveniencies that attend Phlebo­tomy.

After which, you have nothing else to do than to place your Thumb on the Orifice, and press it against the Os Temporale; so that if a Throm­bus should arise, 'tis soon dispers'd, and in a few Minutes the Lips of the Orifice will unite. This done, you may either use a Pledgit of Lint with a Plaister, or if you please, the Com­press with the circular Bandage, which is sufficient without the least Occasion of Styptics.

This Aperture gives an immediate Check to the impetuous Velocity of the ascending Blood; which by the Systole or Contraction of the Heart is projected to the Head by the Ca­rotids and Vertebral Arteries, and by means of their Semilunary Valves prevent its Return to the Heart by the same Vessels; so that in an in­stant it relieves the Patient, without preventing the Blood, Lymph, and Nervous Fluid, from performing their circular Tour, which by Ligatures must necessarily be intercepted.

Suppose several Springs send out as many Rivulets, which after various Turnings and Windings unite and form a River, which is receiv'd in a Ba­son; wherein an Engin is fix'd, which, with its repeated projectile Force, throws the Water into several Tubes, in order to be convey'd to and sup­ply all Parts of a City: now should there be an Obstruction in the Pipes, the Engineer may as well expect to remove it by diverting and dimi­nishing the Water in the Rivulets, by a different Current, as a Physician may expect to remove an Obstruction [Page 16]in the Arteries, by ordering bleeding out of the Veins.

But there is no occasion to intro­duce Similies to prove what is so ve­ry obvious.

'Tis the part of a Physician to assist Nature, by observing nicely the various Steps she takes to re­pulse the Enemy. Natura curat Mor­bos, says Celsus. The Dogmatist, that can reason learnedly on a Disease, but has not throughly consider'd the Nature of it, and the Method of Cure, falls far short of a meer Em­pyric, who practises only by Ex­perience without any Foundation of Learning; so that 'tis not the being a learned Philosopher, an accurate A­natomist, that entitles a Man to be a great Physician. That successful Practitioner, Dr. Radcliff, never pre­tended to any of these Qualifica­tions, nay took a Pleasure to disown his Knowledg in them; but who in his time so happy to strike at the Root of a Distemper!

The Father of Physic, Hippocra­tes, when the Art was in its Infan­cy, especially that part of it, Ana­tomy, [Page 17]how ignorant was he of some Parts of Learning, that the Moderns glory in, and value themselves upon? as appears from the confus'd Ac­count he gives, that the Veins take their Rise from the Liver: and speak­ing of an Artery, he means the Aspera Arteria; and then calls the Ureters Veins, and makes a Jumble of Nerves, Veins, and Arteries. But then who so great and successful a Practitioner ever before or since?

Tho I'm not unsensible that seve­ral Authors have touch'd on this Subject, yet what first induc'd me to the Opinion of Arteriotomy, was, that I don't remember ever to have read or heard of Women liable to Apoplexies, unless from Poisons, O­piates, or Mismanagement of some foregoing Distemper. For however Authors differ in their several Hy­potheses laid down to account for the Periodical Purgations of Wo­men, whether this menstruous Blood offends in Quantity or Quality, it matters not to my present Pur­pose; but whenever this Efferves­cence is raised, whether Natural, [Page 18]Periodical, or provok'd by Emena­gogues, it occasions an Aperture of the Mouths of the Vaginal Arte­ries, and not of the Veins.

The Haemorroides, or Piles, by some vitious Ferment irritating the tender Fibres of the Arteries, by them is discharged incredible Quan­tities of Blood. Borellus relates a Story of a certain Tailor, who lost Ten Pounds by those Vessels, and yet recover'd.

How many Instances have we had of profuse Haemorrhagies of the Nose? Bartholin mentions one who bled forty eight Pound in three Days, without the Loss of Life. 'Tis well known that bleeding at the Nose re­moves Obstructions and Pains of the Head, whether proceeding from an Ebullition or Redundancy of Blood. And whence is this Discharge but by an Anastomosis, or Sponta­neous disjoining of the Capillary Arteries, occasion'd by a convulsive Contraction of the Coats of a larger Artery? which must necessarily give an extraordinary Distention to the next, till the Blood can be no longer [Page 19]contain'd, but bursts out with Im­petuosity, even to Pounds; whereas a few Ounces, discharg'd by the Veins, has thrown the Patient into Faintings, Swoonings, and occasion'd even Death it self.

Now since indulgent Nature is so clear in her Dictates, points out an exact Method how we may free her from the Insults of the common E­nemy, Diseases; 'tis unreasonable we should not fall in with her Mea­sures.

By this time I hope any unpreju­dic'd Reader will be reconcil'd to Arteriotomy, and not be byas'd by Custom to prefer that of Phlebo­tomy.

Phlebotomy preceding, the next Intention is exhibiting Emetics; which from Observation I shall prove to be so far from relieving the Pa­tient, that it proves very pernicious.

For before the Vomit is adminis­tred, 'tis easy to suppose to what a de­gree the Glands of the Brain are fil­trated, and perhaps the Sanguiferous Vessels and Lymphatics burst. This [Page 20]extravasated Blood and Lymph dis­charg'd into the Sinus's of the Brain, and there coagulated and lodg'd: what Relief can possibly be expec­ted from an Emetick, which is dia­metrically opposite to their former Intention of bleeding out of the Jugulars? For in this there is some colour of Reason to expect the Re­moval of the Obstruction; from that there's no room to hope for any thing but a Confirmation of the Dis­temper; nor truly in any other Dis­ease, unless when the principal Seat is in the Stomach and Intestines, to discharge the morbific Matter, col­lected in the Primae Viae. Then an Emetic is not altogether unseason­able; tho even then other Measures may be taken less hazardous, and e­qually advantageous. But in this Case: Vomits are as contrary to true Practice, as this Operation to Na­ture; the Fibres of the Stomach being so dispos'd, as to discharge its Contents through the Intestines: but by these irritating Vomits the Dia­phragm, Intercostals, and Muscles of the lower Belly are so stimulated, [Page 21]that by means of their violent Con­traction, they force 'em thro the Oe­sophagus: for what with the violent convulsive Motion of the abovesaid Muscles, together with the Quick­ness of the Organs of Respiration, the Blood is precipitately hurried and projected to the Brain with that Force as to increase the Extravasa­tion. How then it is possible rea­sonably to expect Relief from it, I can't conjecture. An antient Phy­sician, speaking of an Apoplexy and its Cure, lays down this as a Rule: Vomitoria fugienda, ne suffocationis pe­riculum augeatur, et caput repleatur. Nay, in his Purgatives he would not allow the least Quantity of Antimo­ny, it being also endued with a vo­miting Faculty: Antimonium non convenit, cum vomitum simul moveat; such sort of irritating Medicines be­ing sufficient of themselves to pro­duce Apoplexies.

And I, for my part, verily believe, that were the Bills of Mortality nice­ly examin'd into, and the Causes of those Casualties strictly enquir'd af­ter; they would be found more owing [Page 22]to the irregular Administration of improper Medicines, than to any peccant Matter in the Fluids, or any external Cause whatever.

What I have said I shall only con­firm with two or three Observations, and that as concisely as possible.

Obs. 1.

There was one Mr. Roach of Bris­tol, who for a long time had labour'd under an Asthma, attended with a violent Cough till almost suffocated; but after he had expectorated this viscid Phlegm, was reliev'd: but the Disease increasing, and despairing of Relief, he apply'd himself to me, in­form'd me he had been so afflicted for many Years, that at Spring and Fall he had very severe Fits of the Gout; so that what with one and t'other, he was render'd incapable of prosecuting any Business. I exhibi­ted Medicines of a warm attenuating kind, to disentangle and carry off the vitious Matter, promote Expec­toration, fortify the Stomach and Lungs, which effectually compleated the Cure. After which he could en­dure [Page 23]the Fatigue either of walking or riding, was able to dispatch his Affairs with his usual Alacrity and Plea­sure. But since my Removal from Bristol, his old Indisposition returning afresh, he had immediate Recourse to his former Chip-in-Pottage Doctor, that safe Physician that never did him any good nor hurt, till he pre­scribed that innocent harmless Vomit, that extoll'd Indian Root, Ipecacoan­na; which he had no sooner taken with a Draught of Carduus Tea, but presently he complain'd of a Dizzi­ness, and that every thing appear'd to him to have a circular Motion: which he had no sooner said, but he dropt down dead.

Some may imagine that this Acci­dent was not owing entirely to the Emetic, but a Plethora; and had bleeding preceded, in order to have emptied the Vessels, the Patient might have been saved: which Ob­jection, tho I could answer with several Instances, I shall only men­tion one.

Obs. 2.

Mr. Snow, a Broker of about Seventy Years of Age, being on the Exchange, was taken with a violent Fit of an Apoplexy, and fell down as dead; but by means of Cor­dials, after some time began a little to recover; by which time a Sur­geon came, and took away about Sixteen Ounces of Blood from the Arm. I (being accidentally intro­duc'd by a Friend, who desir'd my Advice) prevented his taking away a greater Quantity, but order'd that he might be carry'd home in a Chair; which Motion contributed mightily to a free and uninterrupted Circula­tion, insomuch that he began to have a regular Pulse. I advised that this Motion might be continued, finding a natural Warmth all over his Body, which with administring comfortable Draughts, would be sufficient to an­swer our end. But a certain Apo­thecary coming, whose Advice was more prevalent with the Patient's Friends, administred a Vomit under the pretence of a Cordial: this not [Page 25]immediately operating, in less than half a quarter of an hour was about to repeat it; which he confidently affirm'd would answer his End, and to confirm his Assertion, assur'd his Friends he was that moment come from a Gentleman taken after the same manner, and reliev'd by the same Method; but they had only his own Word for it, to which I could give but very little Credit. This poor unhappy Gentleman however was lost by this Treatment.

I could enumerate Instances of this kind from my own Observa­tion, of the ill Effects of Vomits; whether Bleeding had preceded, or been omitted. I shall give one, to shew that 'tis safer to rely on Nature it self, to observe its various Steps, and endeavour to assist her on­ly with refreshing Cardiac Draughts; than to have recourse to Physicians unacquainted with the Nature of this Disease, as too many are; tho from Persons of such penetrating Judg­ment, ready Wit, and bright Parts, greater things might be expected.

Obs. 3.

William Whittington Esq; of Sta­pleton near Bristol, now High Sheriff of the County of Gloucester, near eighty Years of Age, returning home alone from the City on a gentle Pad, was seiz'd with an Apoplectic Fit, fell back on his Horse, his Legs stiff and extended, and to all Appear­ance dead; but being overtaken by some returning from a neighbouring Market, who took care to convey him to an adjacent Alehouse, where they pour'd Brandy down his Throat, as also a Glass or two of Canary: by which Method, together with re­peated Frictions all over his Body, he came to himself, was sent home in his own Chariot, where he no sooner came, but jocosely calld for his Staff of Life, and Support of old Age, meaning a Bit of Bread and a Glass of Canary. The next Day he took a gentle Cordial purging Draught, and without the use of any other Medicines recover'd; only never mist the returning Fit twice a year, which encreas'd in its Violence Spring and [Page 27]Fall, till a violent Fever follow'd the last, which he not expecting to conquer, sent for me: and having before observ'd what seem'd to be most advantageous, and by what Method Nature was most reliev'd, without cramming him with Medi­cines, I advis'd him to nothing but to drink old Canary as a Ptisan, by which alone he was perfectly reco­ver'd; and ever since has been freed from those kind of Fits.

Not only Phlebotomy, unseasonable Use of Emetics, but Cathartics also, if not well adapted to the Disease, may prove very prejudicial to the Patient. Other Diseases mismanaged may and often do terminate in an Apoplexy.

Obs. 4.

An Inhabitant of Bristol, that kept a Public House on the Castle-Green, labouring under a Dropsy in the Ab­domen, accompany'd with an Asthma and Jaundice, being rather the Ef­fects than Cause of the Disease; em­ploys a Limb of the Law, that is [Page 28]dwindled to an insignificant Branch of Physic; who assumes the Title of Doctor, tho he is much better qua­lify'd for a Jack-pudding, having a Genius peculiarly adapted to Mi­mic, and attempts to ape that great Practitioner Dr. Radcliff in his Prog­nostics, assuring his Patients, that by such a time they need not despair of their being perfectly reliev'd, which generally happens according to his Predictions; for he seldom fails of cur­ing ing 'em of all Distempers, having no less than AEscalapius for a Precedent, who thought it not worth while to attempt prolonging the Lives of those that were enfeebled, and exhausted, lest they should live to beget Chil­dren as infirm as themselves, and so be render'd unfit Members for any Society. He, without a long Demur, pronounces the poor Hydropical Pa­tient to be in a fair way of Recove­ry, gives him great hopes to expect a Cure in a few days, prescribes your Gummy Resinous Cathartics, which render'd the Crasis of the Blood more unfit for assimilating its Serum, by weakning Digestion, and producing [Page 29]Crudities; which brought on a com­pleat Apoplexy, that in six hours time after the Dose was administred, carry'd off the Patient. In the place of which, had he evacuated the Se­rum by proper Remedies, prevented its farther Encrease by fortifying and corroborating the Stomach, re­stor'd and strengthen'd the Crasis of the Blood, dislodg'd the Viscous Mat­ter that adher'd to the Plicae, or Folds of the Stomach, by warm attenua­ting Stomachical Specifics; the poor unfortunate Man might have now been in perfect Health.

Others again mightily rely on the Use of Clysters, and such as are of a sharp, acrid, irritating Nature, to relieve those Affections of the Head, Epi­lepsys, Lethargys, Palsys, Apoplexys, and the like; Revulsionis ergo. But this Method of deriving Humours from one place to its opposite, is now laid aside, as before hinted: for in this Case the Intestines themselves are Paralytically affected, and will scarce retain a Clyster, if at that time injected: if it does remain, it only [Page 30]affects the Inteslines and Primae Viae, and is not the least serviceable in a­verting Vapours from the Head.

Cupping and Scarifying is wonder­fully in vogue with some, for the above Reasons, of Revulsion and De­rivation: but the Attraction of the Cupping-Glass has so little Effect, the Number who use them so few, and those so inconsiderable, 'tis scarce worth while to spend time to con­fute such erroneous Methods.

The next thing that comes to be consider'd, is Blisters; which too many mightily rely on, without re­flecting on the ill Effects they have in some Cases, and on some Constitu­tions; especially those of a Scorbu­tic Habit of Body, in extreme hot Constitutions, when for the want of Serum the Blood boils. In old Per­sons, whose Balsamic Particles of the Blood are for the most part exhausted, and too great a Quantity of corro­sive Serum is left; to such the Appli­cation of Blisters does more hurt than good: for by the too great Action [Page 31]of the Caustic Salts that enter the Pores, and insinuate themselves into the Mass of Blood, the Parts are so stimulated, as to cause violent Stran­guries, voiding of bloody Urine; forcing also Substances of Matter, resembling Fat, so large as would be thought incredible, to pass through so narrow a Passage as that of the Ʋrethra. Now since the Inconve­nience that necessarily attends such Methods is so great, and the Advan­tage that may reasonably be expected from 'em so small; they are fitter for the Practice of Empirics and Scara­mouches, than regular Physicians: But I would not tire the Reader's Pa­tience with a long and tedious Dis­course, and shall therefore only add a few more Observations, and con­clude.

Obs. 5.

A Cornish Man, of about Thirty Six Years of Age, who had been very much addicted to those violent Exercises of Cudgelling, Wrestling, Hurling, for which that County, during the time of their Revels, [Page 32]is very remarkable; quitting his Em­ploy for the more immediate Service of his Queen and Country, goes for Flanders; but being unacquainted with the Fatigue of several Marches, and unaccustom'd to take up with such slender Fare, was seiz'd with a slow lingring Fever, which terminated in a Deprivation of the Use of his Limbs. After which manner he continued in the Hospital during the whole Campaign; at the breaking up of which, he was committed to the Surgeon's Care of the respective Regiment, till the opening of the next Campaign; and then was again receiv'd into the Hospital, in a much worse Condition than when he left it, being perfectly emaciated, having crusty Ulcers on the Backs of his Hands, and on his Shin-Bones, re­sembling Venereal Nodes; the Bones also carious, several Absesses form'd on the Head, with fiery Botches or Carbuncles, occasion'd by the sharp Caustic Lixivious Salts, with which the Blood abounded. He fell under my Care, but all means proving in­effectual, he died in a few days. I [Page 33]indeed suspected his Case at first to be Venereal; but being a Person bearing a good Character, and pro­testing he had been at no time conversant with Women, I thought it would be requisite to endeavour to discover from what Cause those dire­ful Effects arose. In order thereto, I first resolv'd to examine the Brain, and had no sooner made my Incision on the Scalp, but I perceiv'd the Cra­nium to be foul and carious; which, in taking it off, I found had reach'd not only the inner Lamina, but also both Meninges, and even the Corti­cal Substance of the Brain: in per­forming which, notwithstanding there issued a vast Quantity of Serum, yet in the third Ventricle, by the Glan­dula Pinealis, was lodg'd near a Pint of Lymph, and that so very viscous and ropy as to be deny'd the least Passage. In the Infundibulum was also an incredible Quantity of vis­cid Serum, much thicker than the first; and the Glandula pituitaria fil­trated like a cancerated Gland. This Discovery contributed mightily to my Satisfaction; and 'twas very evi­dent [Page 34]that the Train of this poor Fel­low's Misfortunes proceeded not from any Venereal Cause, but from those Falls and Bruises he had for­merly receiv'd; which when Nature was indulged, the Spirits buoy'd up, the Fibres firm and elastic, each part could better perform its Function, and so prevent the ensuing Disease: but when reduced to mean Diet and scanty Allowance, expos'd to Heats and Colds, inseparable Concomitants of a Military Life; the Spirits flag and become languid, the Fibres lose their wonted Elasticity, and become lax, the Blood loses its Tone; in short, the whole Animal Oeconomy is so disorder'd, that the vigorous Attack of a Disease meets with a very feeble Repulse. For by these severe Shocks the Lymphatics and sanguiferous Ves­sels being frequently broke, the ex­travasated Blood and Lymph is dis­charg'd into the Sinus's of the Brain, where it coagulates and becomes so viscous as not to be able to pass those narrow Canals, but lie congested there, and is not only the Source of [Page 35]dreadful Symptoms, but the Cause of Death it self.

Obs. 6.

A certain Gentlewoman of Ghent in Flanders accompanying her Spouse to Batavia, of which he was Major Commandant till his Decease, in her Return from thence was taken very ill; for which Indisposition the Surgeon of the Vessel advised her to the Use of the Cold Bath: but whe­ther owing to his Ignorance or her Neglect, she omitted emerging her Head. She was no sooner got out of the Bath, but immediately her Head and Face was so swoln, as to deprive her both of Sight, Speech, and the Use of all her Limbs. At her Arrival at Amsterdam, Consultations were held by the best Physicians concerning her Case, with very good Success as to the abating the Swelling of her Head, and Recovery of Speech; but as for retrieving the Use of her Limbs, she found no manner of Benefit, but remain'd void of all Sense and Motion. Thus despairing of Help, she return'd to Ghent, and apply'd her self to the [Page 36]Physicians of the French Hospital, who were then in that Garison, but with as little Advantage as the former. In this Condition was she for some Years confin'd to her Bed, and reduc'd to a meer Skeleton; the Bones of the Carpus and Metacarpus, those of the Tarsus and Metatarsus being distorted to a Deformity; nay, the very Pha­langes of the Fingers and Toes were dislocated by the Contraction of the Tendons. She then had recourse to the Town Physicians: but neither their Inunctions of penetrating Oils, camphorated Spirits; their Aroma­tics, or volatile Sudorifics, to cor­rect and discharge this peccant Mat­ter, that intercepted the nervous Fluid; nor their Decoctions of the Woods, Fomentations or Hot Baths, avail'd any thing: of she entertain'd no longer Hopes of being reliev'd.

But after that Memorable Battle at Ramillies, on May 23. 1706. the Victory being obtain'd over the Duke of Bavaria, by that Victorious General, his Grace the Duke of Marl­borough, which occasion'd the speedy Reduction of all the Netherlands, [Page 37]the British Hospital remov'd to Ghent; and I accidentally took Lodgings under the Roof of this miserable Gentlewoman, who being inform'd I belong'd to that Hospital, was ve­ry importunate with me to use my utmost Endeavours to remove her Indisposition.

Her Case being very uncommon, and the Success precarious, I could not promise much to raise her Expec­tations; yet being unwilling to dis­courage her, I took my leave with an Assurance of considering her Case, and get the Opinion of other Phy­sicians, whom I consulted: but their concluding that 'twas a perfect Atro­phy, dissuaded me from attempting that which was so improbable of be­ing accomplish'd.

My last Observation suggested to me, that this Numbness and Dead­ness proceeded from the Obstruction of the nervous Fluid, occasion'd by the viscous glutinous Matter lodg'd in the Sinus's of the Brain; which, if it could be diluted by the Power of Medicine, so as to be carry'd off by its proper Vessels, I then thought I [Page 38]might expect Success: so communi­cating my Thoughts of her Case, and the Method I design'd to prosecute for the Cure, to the ingenious Dr. Laurence, then Physician General to her Majesty's Forces in Flanders, he approv'd of my Method, as the most probable to recover my Patient, and establish my Character.

This encourag'd me to undertake the Cure. What flush'd me more with Hopes of Success, was, that in a short time her Menstrua flow'd; which before, during the whole time of her Illness, were totally suppress'd: after which, in three Weeks time, she was capable (with the Assistance of ano­ther's Arm) to walk to Church, and by degrees acquir'd her former Health and Strength, to the great Surprize of all that knew her deplo­rable Case. In a short time after she was marry'd, and deliver'd of a strong and healthy Child.

This confirm'd me in the Opinion, that let a Chronical Case be ne'er so intricate, 'tis in the power of Me­dicines (if rightly apply'd) to re­move it, supposing there's not too [Page 39]great a Petrefaction, or Loss of Sub­stance in the Parts affected: For the Truth of which, I could produce se­veral Instances, were it not a Di­gression from my present Design.

Obs. 7.

A robust young Fellow, at the Siege of Brussels, Anno Dom. 1706. receiv­ing a Shot thro the Metatarsus; af­ter the Wound was well digested, Suppuration promoted, and he in a fair way of Recovery, only com­plaining mightily for want of Sleep, the Physician, in his Tour of Vi­sits, order'd him a gentle Hypnotic Draught: but the Apothecary's Man, in distributing the Medicines, gave him also to the Quantity of se­ven Grains of Laudanum (Mistakes of which kind in the British Hos­pital are seldom or ever known) the next Morning, to my Surprize, I found him dead. The Nurse in­form'd me what Pills he had taken, how jocose, pleasant, and merrily dispos'd he was, that he sung very cheerfully, and a short while after dozed away.

The next day, in opening his Head to see what Discovery I could make, I no sooner reach'd the Me­ninges, but I found some of the Ves­sels distended to a prodigious degree, others burst, from whence issued an incredible Quantity of Blood; and from the Sinus's came (as near as I could judg) to the Quantity of three Quarts that was extravasated.

Here's an Instance of an Apoplexy from Laudanum, which convinces me that its Narcotic or Hypnotic Fa­culty proceeded neither from an occult Quality, or intense Coldness, either by coagulating or environing the Particles of Blood or Spirits, and so preventing their Motion: for since by a Chymical Analysis we find it gives a copious Quantity of fetid Oil and Volatile Spirit, it plain­ly consutes that Assertion of its be­ing cold; but on the contrary, it dis­solves the Texture of the Blood, ren­ders the Humours more fluid, hur­ries the Spirits into disorderly Mo­tions, and the Heart, by its repeated Systole, projects the Blood with too great a Velocity to the Brain.

Indeed when the Opium begins first of all to insinuate it self, it rarifies the Arterial Blood: this be­ing rarified, the Spirits then, not so much fetter'd with bloody Particles, are in a greater quantity, and with more ease, secern'd by the Glands of the Brain, and convey'd in a greater Copia by the Nerves thro all Parts of the Body; which produces that Pas­sion of the Mind, Joy: but when by this Rarefaction the Arteries are so distended, as to compress the Nerves, and retard the Circulation of their Fluid, Comatose Distempers must there necessarily be produc'd. Hence it is, that administring Opium in the beginning of Fevers, the Small-Pox, and the like, where the Blood is already in too great a Ferment, instead of answering the Intention of composing the Patient, throws him into Deliriums, and even Madness it self, hurries him headlong and dis­tracted out of the World.

Obs. 8.

Mr. Kilbraith, a Merchant of Bris­tol, about Forty Five Years of Age, labouring for many Years under a Hypocondriac Melancholy, continu'd under the Physicians hands for a long time; but was so far from reap­ing the least Benefit from their Pre­scriptions, that he daily declin'd, and lost his Appetite; nay, the very Sight and Smell of Meats were so offensive as to create a Nausea, till at length he had contracted a Complication of Diseases: then he committed himself to my Care, who in a short time had the good Fortune to be the Instru­ment of his Recovery.

Some time after having an Affair at the Bath, and there meeting with a Gentleman of his Acquaintance, he was prevail'd upon to bathe him­self; but what with sweating, the Vitriolic, Sulphureous, or Bitumi­nous Effluvia of the Waters, he be­came faint, heavy, and render'd al­most Lethargic: however relying too much on the Strength of Nature, he neglected the Use of Means, till one [Page 43]Night being taken with a Contraction of the Nerves, and soon after seiz'd with a few Convulsive Paroxysms; I was sent for the Morning follow­ing, and advis'd him to air and ex­ercise himself with gentle Riding: he no sooner attempted to rise, and plac'd his Feet on the cold Floor, but was immediately seiz'd with a violent Fit of an Apoplexy, and in a moment became cold, stiff, and to all Appearance lifeless. At this sur­prizing Accident, the whole Family ran out to rally some of the Neigh­bourhood to their Assistance, left me alone, where I accidentally found a small Bottle of Spirits of Harts-horn, which I pour'd down his Throat; and at their Return I desir'd he might have a Friction all over his Body: which prov'd so successful, that I soon per­ceiv'd a Pulsation and Respiration. I then took Sixteen Ounces of Blood from the Temporal Artery, and in less time than ever I observ'd from the Arm; after which, I prescrib'd what I thought proper for his Case. Other Physicians who were also sent [Page 44]for, came, and to my Face approv'd of my Method of treating him, but after my Departure they ridicul'd it as mischievous and hurtful, saying 'twas the only way to draw the Dis­temper to, and confirm it in the Head. Whether Ignorance or Malice had the Ascendant, or whether equal Parts of both contributed to furnish their Ʋpper Rooms, it matters not: but my Affairs obliging me to go a few Miles from thence, I desir'd the Sur­geon, if he was threatned with a re­turning Fit, to introduce his Lancet into the same Orifice, and take such a Quantity as might be requisite; but at the Attack of the next Fit, these judicious Gentlemen preven­ted the Surgeon, and dissuaded the Friends, by amusing them with the dangerous Consequence that must necessarily accrue, till the Blood flew impetuously out of the Mouth and Nose; and then, when 'twas too late, they consented. Howe­ver, after this second Discharge he immediately recover'd his Sense and Speech. At my Return, his Friends inform'd me what had happen'd, and [Page 45]that 'twas owing to those Physicians, that they had not strictly observ'd my Method; at which being about to leave him, I was prevail'd upon, by his importuning me so earnestly, to tarry. I was entirely of the Opi­nion, that the Vessels of the Brain were burst; but however I desir'd a Consultation with Dr. Bave of Bath, and acquainted him with my Pro­ceedings, which he approv'd of, and gave him my Opinion of the Des­perateness of his Case, which he also fear'd. But the other Physicians, tho their Companies and Opinions were desir'd, yet thought fit, as they had sneak'd off, to abscond, who be­ing too conscious to themselves of the irreparable Prejudice they had al­ready done; giving only this shuffling, trifling Excuse, That truly Dr. Bave was so singular as to consult with none but such as had been educated at Oxford; whereas that ingenious, as well as ingenuous Gentleman, who is a Credit to the University where educated, an Advantage to the Town where he resides, and to such that have Recourse there for [Page 46]the Benefit of the Waters, regards the Qualifications of a Physician more than the Place where quali­fy'd. After some Medicines pre­scrib'd, the Doctor returns without entertaining the least Hopes of his Recovery; but the Patient resting well that Night, his former Physi­cians concluded then he was in a fair way of doing well. I took li­berty to inform 'em how great Stran­gers they were to his present Case; and that when they were in the greatest Expectations of his being out of danger, that then they would have most reason to fear his being snatch'd away: which happen'd ac­cordingly; for the very ensuing Night, whilst jocose and merry with his Friends, he was seiz'd of a sudden, and had just time allow'd him to be­queath his Soul to God that gave it, and so expir'd, snorting and discharg­ing a vast Quantity of Livid Blood from his Nostrils.

This to me is an evident Proof that this Gentleman was entirely lost by this Neglect, the Disease be­ing too violent, and too sudden to [Page 47]be conquer'd by internal Medicines; whereas had the Artery been open'd, as I order'd, it might have prevented the returning Fit.

Obs. 9.

Mr. Jeffrey Pinnel, a very consi­derable Man of the City of Bristol, returning from Morning-Service, and reflecting on the manifold Mercies bounteous Heaven had bestow'd on him, particularly acknowledged the large Share of that inestimable Jew­el, Health, which from his Infancy he had enjoy'd without the least In­terval of Sickness; and that notwith­standing he was so much advanc'd in Years, he could discern no sensible Alteration as to his good Habit of Body: but in the mean time, in­clining his Head with a Design to buckle his Shoe, he fell down as dead on the Floor; which (being a Stone Pavement) made a conside­rable Contusion on his For [...]head. He was immediately lifted up, and what with Frictions and Cardiac Draughts, was recruited to that de­gree, [Page 48]that in the space of three Hours he became very sensible; and amongst several Physicians that were mention'd to him, he was pleas'd to send for me, inform'd me of his manner of being seiz'd, that he was then very Costive, and had a Sup­pression of Urine; but the Pulse be­ing not very irregular, I defer'd o­pening the Artery: so at that time I prescrib'd only Laxatives and Diure­tics, and took my leave, desiring him to acquaint me at the first Appear­ance of the returning Fit; which hap­pen'd the following Morning at Four a Clock: at which time the Fit was so exceeding severe, that he was almost suffocated, and his Face discolour'd like one strangled: the Artery being then turgid and quick (as it always is in those Cases) I immediately took away about Sixteen Ounces, which I had no sooner done, but he ask'd me what I was doing. I order'd him to be rais'd out of his Bed (being there too much confin'd) and con­vey'd into a more airy Room; which occasion'd him to make Water very [Page 49]plentifully: But after a strict Enqui­ry, I found that the Concussion gi­ven the Brain, and the Symptoms attending it were such, that the Ves­sels must necessarily be broke, and that there was but small Hope left to expect his Recovery; which I freely told his Friends, they being very pressing with me to give my real Sentiments, and desirous of a Consultation, which for their Satis­faction I approv'd of. So they sent for Dr. — at Four in the Morn­ing, who, notwithstanding he had given his Word of Honour to be immediately there; yet, after his usual way, kept 'em in expectation till Eleven, at which time assum­ing his usual haughty Air (to in­sinuate himself into the Opinion of the Vulgar) he enters; but being in­form'd who was above, in order for a Consultation, this brazen Oracle turns on his heel, and pronounces these Words, With this I consult, and none else, pointing to his Breast, the Tho­rax being equally as well furnish'd with Brain, as the Cranium. But tho he was mightily reflected on for this [Page 50]imperious Air, 'tis every Person's Duty to judg charitably, and put the most favourable Construction that 'twill bear: I for my part would im­pute it to an innate Modesty, being conscious of his Ignorance in that Case; and that offering his Opi­nion, would be but exposing him­self without the lead Service accru­ing to the Patient: Galen and Hip­pocrates suiting no more his Genius, than Cook or Littleton. But not to harp too long on such an untunable String, I'll wave this, heartily wish­ing (for the Benefit of those unfor­tunate distemper'd Persons that fall under his Care) that for the future he may have better Success, than from his Knowledg in the Faculty of Physic can reasonably be ex­pected.

I continu'd in the Use of proper Means, but for the Reasons before mention'd could not expect his Reco­very; for tho to appearance he was much better, yet the next day about Eleven in the Forenoon, he fell into a cold clammy Sweat, and for the Space of almost an Hour shorted [Page 51]excessively, foam'd at the Mouth, and expir'd.

Some perhaps may say this might have as well been omitted as inser­ted, the Patient dying; but this may serve to confirm my Assertion, that Arteriotomy is so much preferable to Phlebotomy, there being no Parallel Instance, that ever the latter had so speedy an Effect to recal the Senses.

The two following Observations, tho I formerly publish'd them in a Latin Dissertation on this Subject, which is annex'd to this Treatise; yet for the Benefit of those who are not so well acquainted with that Language, being so remarkable, I could not omit giving them a place here in the English Tongue.

Obs. 10.

A certain Person, of about Forty Years of Age, who had lived luxu­riously in his Youth, being reduc'd to Poverty, and from a thriving Tradesman become a private Sen­tinel, went to bed in perfect Health, but the next Morning was found dead. I resolv'd to open and exa­mine [Page 52]his Head, and had no sooner sawn thro the Cranium, and reach'd the Meninges, but the Blood sprung out from those torn Vessels with that Violence, as if an Amputation had been perform'd on the Leg or Arm of a living Person; which had it been timely discharg'd, by open­ing the Artery, his Life might have been preserv'd.

Obs. 11.

A young Fellow about Thirty, who had been sickly for a conside­rable time; but when on the Reco­very, I ask'd him, how he did? he told me, he was tolerably well: but in a quarter of an hours time News was brought me that he was dead. I immediately went to him, disco­ver'd a small Respiration, and could just perceive a Pulsation in the Tem­poral Arteries, which I open'd on each side; and after having bled very freely, he presently began to dis­course with me: two hours after I took more Blood from the same O­rifices, and a third time a considera­ble Quantity: by which means, [Page 53]with the use of warm comfortable Medicines, he perfectly recover'd.

Thus during the time of my be­ing in Flanders, as there were many Cases of this nature offer'd, so I never neglected embracing all Op­portunities by them, which more and more confirm'd me in the Opi­nion of Arteriotomy.

Obs. 12.

I shall only add one Instance more of the Mismanagement of Diseases, and the irregular Administration of Medicines, and conclude. 'Twas on the famous William Penn Esq; who being of a Plethoric Habit of Body, and Lethargic, was one day seiz'd with Convulsions at his Table, and falter'd in his Speech: immediately their Family Physician was sent for, who took the usual Method of treat­ing him, till at length it terminated in an Intermitting Fever, which was so ill manag'd, that 'twas six Weeks before he could be removed to his Country House. Being at Bristol six Months after, he was seiz'd with a­nother [Page 54]Fit of the same kind, but much more severe: a Learned Phy­sician was then employ'd, who, scorning to jog on in the old beaten Lane, Pack-horse like, was more pompous in his Prescriptions; as appear'd by ordering his Antilethar­gic or famous Cephalic Powder, which by virtue of an occult Quality, (could it but have insinuated it self into every Crevice of the Cranium) would have work'd Wonders: but these Circumforaneous Scouts want­ing the Parole, could not pass, the Ports of the Os Crebriforme being so well guarded with Nerves, Veins, Ar­teries, and so closely lin'd with Mem­branes; so that this Specific Powder not answering Expectation, this wor­thy Gentleman left him, who after some moderate days Journeys arriv'd at his Country Seat at Ruscomb near Reading, where he was seiz'd with a third Fit. Their Physician was then sent for from London, who pro­secuted his former Method, only with this difference, that he order'd Cupping, Scarifying; and then ap­plying the strongest Epispastics, this [Page 55]barbarous Treatment caus'd dismal Stranguries; and the little Urine he made was with great Pain and much Difficulty, and of a bloody Tinc­ture, intermix'd with coagulated Matter, resembling Lumps of Fat, so large, that 'twould be thought incredible to pass the Ʋrethra. By this Severity (tho entirely owing to a good Constitution) he was not kill'd, yet it confirm'd a Hydrocepha­lus or Dropsy in his Head, which caus'd a sensible Decay thro all Parts of his Body, depriv'd him of his Speech, and the use of his Senses: and in this desponding State the Doctor left him.

All which Misfortunes might have been prevented by bleeding in the Artery, at the first Appearance of the Disease, and falling in with my Mea­sures before mention'd.

I was then sent for, and succeeded so Well, that in a few days he was apparently better; so I left him to the Care of his Apothecary, and in about ten days time paying him a second Visit, I found him quite a­nother Man: he had reassum'd his [Page 56]wonted Briskness and Alacrity; and thus continu'd for some Months in a very good State of Health, till this unhappy Accident: having two Fon­tinels betwixt the Scapula's, on one of which a Protuberance rose like a Boil, which threw him into a vio­lent Fever; this Tumor encreas'd to a prodigious Size, extending it self from the lower Angle of the Scapula, all over the Clavicle. My being sent for to Bristol, to visit an antient La­dy (who had formerly been my Pa­tient and best Benefactrix) oblig'd him to make use of the former Physician, and a Metropolitan Surgeon: but a Friend of Mr. Penn being very impor­tunate with me, I waited on him with all Expedition, found they had ap­ply'd Cataplasms in order to bring it to Suppuration, and had attempted to lay the Abscess open, but thro Fear had only scratch'd the Teguments. I then took the Probe, and introduc'd it eight or nine Inches, and made a deep Incision, from whence a con­siderable Quantity of Pus discharg'd it self. Then I order'd a Digestive to destroy whatever Fungus might re­main; [Page 57]main; by which means he was im­mediately freed from the Fever, with­out the least Occasion of being cramb'd with febrifuge Draughts, Powders, and Bolus's that lay so plen­tifully prepar'd for him; so I left him to the Care of a Surgeon in Read­ing, an ingenious Man, who com­pleated the Cure effectually: and now he enjoys as large a Measure of Health as ever.

This Operation of Arteriotomy, that the Generality are so timerous and cautious of attempting, I've not only perform'd and order'd for A­dults, but even on Infants them­selves. One particularly who fell un­der my Care, was the Child of a distemper'd Parent, who as soon as born was attended with Con­vulsions, and at six Weeks old was seiz'd with one so violent, that none had the least room to hope for Life: but at the taking away a small Quantity of Blood from the Artery, the Child was in an instant reliev'd, look'd chearful, pleasant, and immediately took the Breast, which for some time before the Fit [Page 58]he had refus'd, and so with the Use of proper Medicines perfectly reco­verd.

This Treatise I don't doubt but will meet with some who will ap­prove of it, as well as other preju­dic'd Persons that will be as ready to contemn and condemn it. But what I've writ was entirely owing to a Sense of my Duty to my Fel­low-Creatures, without either con­sulting the Applause of the former, or valuing in the least the malicious Censures of the latter.

—Si quid novisti rectius istis, Candidus imperti; si non, his utere mecum.
FINIS.

APPENDIX.

MY Bookseller having assur'd me, that a Book without an Appendix is like a Play without an Epilogue, I immediately address'd my self to write one; but the Difficulty was, to fix on the Ar­gument, among so many as offer'd themselves to my Thoughts. At first I resolv'd to demonstrate that the Animalcula did not enter the Ʋterus till they had impregnated one of the Ova in the Ovaria; and when there maturated, fall from thence in­to the Tubae Fallopianae, and lastly in­to the Womb. Then I thought I would expose (as the Practice de­serves) the use of Oils, Syrups and Diuretics in Distempers of the Stone, and confirm my Opinion by un­doubted Observations, showing that [Page 60]such Applications generate the Stone, but never dissolve or carry it off; and instead of Syrups, Oleaginous and Tartarous Liquids, to recom­mend the Use of Malt Liquors: and at the same time to shew that Gravel is not producd from any De­ficiency in the Kidneys, but a Dis­order in the Bowels arising from Indigestion. At another time, I thought it would be no unuseful thing to the Town, to demonstrate that the Consumptions, which we frequently meet with, arise not from any Tendency in Nature, but from the mischievous Effects of improper and ill-apply'd Medicines in venereal Cases.

While I was thus in suspence, a Book casually fell into my hands, of Observations on Bezoar-Stones, with a Vindication of Sugars, &c. in which I saw there was copious Mat­ter to remark upon: but finding in it a Letter from Dr. Cooke of Bristol, which extols this new Chalk Medicine above all others, I shall confine my self to that part of the Book, and show the World, by a few Obser­vations, [Page 61]how little this Medicine de­serves the Praises given it.

Obs. 1.

Mrs. Paget, the Wife of a noted Man in Bristol, had for many Years been afflicted with the Cholick and Stone, but small ones, and at some Seasons of the Year more violent than others. Under this Misfortune she apply'd to Dr. Cook, and his Un­derlings, who in vain us'd their ce­lebrated Medicine, with their Lau­danum Doses, till she was brought upon a Rack, and continud so for six or seven Months. I being sent for (and being appriz'd how she had been us'd) gave her some things of a warm attenuating Nature, by the Help of which she discharg'd vast Quantities of a hard compact Sub­stance, that was generated in her Stomach, with much Choler and Bile. Afterwards she had an Evacua­tion downwards of great Numbers of Stones that were hardned in the Bowels, occasion'd by this Chalk mixing it self with the Flame in the Stomach; by which means they [Page 62]were lapify'd by the Heat of the Liver, as Chalk will be before the Fire when mix'd with Water. Up­on the second Application, many more came away, some smaller, and some greater. The third time she discharg'd one as large as a big Walnut, which I have now by me, and which shows where it was fastned to the Ductus Bilearius, and the Fur­rows made by the Peristaltic Mo­tion of the Guts; and by pricking of it you bring out the very Chalk, as appears from mixing it with Wa­ter, that gives a Colour like other Chalk. From that moment she was reliev'd from all Complaints; and falling asleep for some hours, she wak'd perfectly refresh'd. I us'd some things which I thought proper to recover the Tone of her Sto­mach, &c. She now enjoys a good State of Health, and has continu'd well ever since.

Obs. 2.

Mr. Cooper, Under-Sheriff of Bris­tol, taking a Cold, and thereupon falling into Vomiting, with Pains in [Page 63]his Bowels, sent for Dr. Cook, who order'd him the above-mention'd never-failing Medicine in Powder, with a composing Draught; which was so far from relieving the Patient, that he awakd after two hours Sleep with great Oppressions and conti­nual Reaching. And when upon a Repetition of the Medicine, he grew worse, I was call'd; when I came, and found him in cold Sweats and continual Vomitings, I look'd to see what had been given him, and found half a dozen Papers of this Medicine, and a Vial of cooling Ju­lep, with the Powder at the bot­tom. His Case being past remedy, I took my leave of him, and he dy'd the next Morning.

The following Observation will show how much the Doctor himself depends on the Infallibility of his inestimable Medicine, as he calls it.

Obs. 3.

Mrs. Hannah Alton, Daughter to the Alderman of that Name in Bris­tol, had a Spring-Ague, of which I cur'd her; but by eating unripe [Page 64]Fruit, and taking Cold, she fell into an intermitting Fever with a Cough. In which Case some officious Friends (as such are never wanting) prevail'd with her to put her self into the hands of Dr. Cook, and some of his Understrappers, well enough known in the City; who giving her (secun­dum Consuetudinem, but not secun­dum Artem) Chalk, Milk, and Lau­danum Draughts, the Distemper gai­ned Strength (as how could it do otherwise) and the abus'd Patient threw up great Quantities of Chalk and curdled Milk together; the Cause instead of the Cure of her Disease. These Symptoms puzzled the poor Doctor, and he had no other way to save his own Credit, but by re­commending her to Dr. Slare, then at the Bath, whom he highly ex­toll'd on this Occasion. Dr. Slare continues in the former Method, only adds Bath-Waters to the Plais­tring; but the Compactness of the Substance, before formd in the Sto­mach, being too firm for the Waters to disentangle, in order to expec­torate, they were forc'd down thro [Page 65]the Pyloris, by the Weight of the Waters, which relax'd that Orifice of the Stomach to such a degree, that it could no more contract it self: add to this, that the continual Defluxion of that sharp corrosive Matter that had so long been pent in among the Folds of the Stomach, inflam'd both it and the Guts so greatly, that she fell into continual Purgings till she expir'd. The Doctors had now no way left to excuse themselves, but by charging all upon the Bath-Waters, which, God knows, were very in­nocent of this poor Lady's Death. But the noblest Medicines are hurtful when ill apply'd, and the greatest Blessings are fatal when they pass thro unskilful Hands.

Obs. 4.

Alderman Stephens his Lady of Bristol, having been in an ill State of Health for many Years, and us'd divers Physicians, but especially Dr. Cooke, when she found her self grow­ing worse, sen for me. When I came, I found her reaching, and very much convuls'd; what she [Page 66]brought up, was hard Substances, not properly Pleghm, but somewhat wrapt in Pleghm. Her Vomiting had followd her for some Years past, and would continue with very little Intermission for three Weeks at a time. Upon Enquiry what she had principally took, I found it was the Pouders and Composing Draught. Hereupon I prescrib'd her some pro­per things to disintangle the pre­ternatural Substances generated in the Stomach; which had their Effect: the Convulsions soon abated, and after voiding a number of Worms, and particularly one of half a Yard long, and as sharp at both ends as a Needle, the Convulsion and the Stone both left her. By proper Pre­scriptions afterwards, I cur'd her of one of the most complicated Distem­pers that I have ever met with in my Practice.

Obs. 5.

Mr. Prankara's Wife of Bristol, being attended with Cholick Pains, was disciplin'd by Dr. Cooke in the old manner, with Chalk Medicines [Page 67]and composing Draughts. When I came to her from the Country (where I then was) and found the Course she was in, it being the E­vening, I prescrib'd nothing; but coming the next Morning, found her dead. Upon Discourse with her Mother, I perceiv'd the Doctor had been there again after me, and re­peated his Medicine, which in a few Hours threw her into such Con­vulsions as ended in Death.

Obs. 6.

Mr. Davis of Bristol's Wife being ill of a Complication of Distempers, had at length, by the Care of Dr. Cook's Creatures, a fix'd Pain in her Back, in so much that if she slip'd her Foot by Accident against any thing, she would fall down as dead with the Agony of the Pain. I being sent for, took the same Method which I us'd with Mrs. Paget; that is, I dis­entangled a vast many little Stones that had petrify'd in her Bowels, and upon the Ductus Bilearius: which was no sooner effected, than she re­cover'd [Page 68]and did well, and was after­wards deliver'd of a brave Boy, tho she never had a Child before.

By this Observation it appears how easily the Misapplication of Medicines destroy the Constitution, and the chief Faculties of Procrea­tion; from whence I am of Opi­nion, that there is neither Man nor Woman, but who is qualify'd to procreate, or might be made so: Of which I could produce Instances more than a few, if it were proper.

Obs. 7.

Captain Scot's Wife of Bristol, be­ing an infirm Woman for many Years, and being treated in the same manner as the Persons before-men­tion'd, was at length thrown into a Jaundice and Scurvy, with a Depri­vation of her Limbs, and a conti­nual Strangury; in which deplora­ble State she continu'd for seven Years, and then fell into a Dropsy all over her Body. It was then I was call'd, and by taking Methods sutable to the Dictates of Nature, as I have always done, and by the [Page 69]Grace of God ever shall, she was so wonderfully reliev'd, as to be able to walk a Mile to her Dinner, who could not before move out of her Chamber. I follow'd these happy Beginnings with such Prescriptions as brought her to a perfect State of Health; so that she has been several times since at London. Upon the whole matter I would observe, that the Fault lies not in the Medicines so much as in the unskilful Applica­tions of them; and particularly I affirm, that I have made use of the Bezoar and Gascoin Powder with ad­mirable Success, and have found it to be the best of Cordials. Until there­fore Dr. Slare gives a few Instances of the pernicious Effects of the Be­zoar Stone and Gascoin Powder, for the many I have produc'd of his admir'd Chalk, and many more that I can; I hope he will allow me (at least I shall allow my self) to pre­fer the former.

I have now only one Observation more, to shew how different Effects arise from the same Medicine at dif­ferent Times.

Obs. 8.

Captain James Grant, of Brigadier Grant's Regiment, had a Fever and Ague after the Battle of Mons to a violent degree, and receiv'd no Be­nefit from the Bark; but had his A­gue for six Hours in twelve: at length being brought in a Litter to Brussels, he fell under my Care. I gave him some things proper to dis­entangle and carry off the Load of Matter which oppress'd his Sto­mach, and then waited for the Re­turn of his Fit, which, as I expected, was more moderate than before. Af­ter this, I prescrib'd the Bark, and told him, with some Assurance, that his Fit should return no more; which, tho he did not in the least believe, yet he found it to be true. Thus it is plain, that it is of no conse­quence that a Medicine be a good one, unless it is apply'd in a proper Case, in a due Manner, and when the Patient is fitly prepar'd and dis­pos'd to receive it. If. the Instru­ment of Musick be never so well in tune, yet there will be no Har­mony [Page 71]when the Strings are touch'd by an ignorant Hand. When some Animals play upon Organs, there must needs be hideous Musick. And to be sincere, I am very much a­fraid that this is honest Dr. Slare's Case; of whom and of my Readers I take leave for the present, having first presented the Publick with (the only thing valuable in his Book) his Recommendation of Malt Drink, and Dr. Cook's Letter, which so high­ly applauds this miraculous Medi­cine.

THE Consideration of Grass for Beasts, leads me to Corn; name­ly, the Staff of Life for human Kind; of the four Grains, Wheat, Rye, Barly, Oats; of each of these Bread may be made very wholesom and good. It is true, if you chew and eat any of these, they do not give so signal a Sweet to our Taste, as what is really contain'd in them, and will soon be made to exert that Sweetness. For Example, if you do but wet any of these Corns in com­mon Water, you will stir up some active inherent Principles, which will ferment and swell the Grain, and make it to grow (as the Mal­sters call it.) This gives them no­tice of spreading it abroad to dry, which may be done in the Sun; but for Conveniency is perform'd on a Kiln, by the Admission of Heat from the Fire made beneath it. This is now call'd Malt; if you eat a Grain or two, you will discern it to be sweet; if you boil it in Water (af­ter it has been powder'd or ground) [Page 73]it will give a sweet Tincture, com­monly call'd Wort; you may boil it to the Consistence of a Syrup: And this Product of Corn somewhat a­grees with Mellossus, which if it be spread upon Bread, it adds consi­derable Nourishment to your Bread, and would be esteem'd a good Ban­quet, and pleasant Entertainment, did we not abound with so many other more refin'd and dainty Sweets, and easier to come at. Thus Mel­lossus is commonly given to School-Boys with their Bread; nor can I think it bad Food for Children, be­cause more mischief may be due to­their new spungy or dowy, and not well baked Bread, than to the Indian Sweet. It is this sweet Decoction of Malt that makes your great Va­riety of fine Ales and Beer, much more wholesom, more pleasant and fit for English Bodies, than your ad­mir'd Wines, whether Rhenish, French, or Florence; for these do abound with gritty, tartarous Matter, very apt to lodg in the Kidneys, and lay the Foundation of the most intolerable Distemper in the World, the Stone; [Page 74]or if they be so happy to escape that, the Gout will make an Attack on the Joints of the Toes or Fingers of a potent Drinker, and tear and swell the tender Parts, and sometimes mercifully thrust out those Tophi or Stones into the extream Parts, which otherwise would probably have been cast upon the too sensible and pas­sive Kidneys: but none could ever charge our soft and balsamick Ale with breeding any sort of sandy or tartarous Matter in the Barrel, and I think not in the Body. I cannot forbear mentioning an Observation of my good Friend Dr. Cyprianus, who told me long since, he had cut above fourteen Hundred Persons for the Stone, but never observ'd that he cut any Ale-house Keepers, but many Vintners. He always advis'd his Patients that fear'd the Stone, or were concern'd with that excrucia­ting Disease, to drink soft Ale, the newer the better: for he condemns most or all four Juices, as apt to breed the Stone, or increase it.

Dr. JOHN COOKE of Bristol, to Dr. FREDERICK SLARE at Bach.

Dear Sir,
January 5. 1713/14.

I Receiv'd your kind Letter and the Manuscript, of which I cannot give an adequate Encomium. It is an impartial Trial and Condemnation of Bezoar by the Laws of Chymistry, Reason, and Experience. Oh how useful might our Profession be ren­der'd to the Poor, as well as to the Rich, if all the chargeable part of our Materia Medica was thus exa­min'd fairly; and whatever appear'd insipid, inodorous, unactive and in­dissolvable in mild Menstruums and very gentle Heats, should be judged unworthy to be depended on for the Cure of Diseases! The Reformation of the Errors and Cheats of the Ma­terialists would be a very great Ad­vantage to Mankind, who are too often in as much danger from the true Terra damnata of Medicine, as from those Diseases which Quiet and [Page 76]Abstinence do frequently cure I have now for near thirty Years past us'd the Sal Absynthii, and the Creta you mention, with wonderful Success, in Distempers of the Stomach and Bow­els, and in Fevers: but I always thought Bezoar and Pearl fitter for a Lady's Closet or Neck, than for a Cordial, unless for a profuse and wan­ton Cleopatra. All the precious Gems should be sent back to the Jewellers, Leaf-Gold to the Gilders; nay, I could for my part also return the Musk and Amber-Greese to the Per­fumers. The All-wise and Merciful Creator and Preserver of the Uni­verse has supply'd poor unworthy Mortals with the most efficacious Medicines, to be had in most Coun­tries upon easy Terms; nay, most Endemic Distempers have very pro­per Remedies to be gotten cheap in the same Region. But to return to your most accurate Analysis of this false, tho celebrated and precious Antidote, I will read it over once or twice more; for it will afford still fresh Delight to me, who can scarce forbear interceding with you, that [Page 77]the Respublica Medica, may be made happy in the sight of these most use­ful Discoveries: for all say, Bonum quo communius eo melius. And this being a dear Imposture, it must be for the publick Good to detect it. I hope you will pardon this Free­dom, which your Favours and Friend­ship does encourage me to use. I must beg a sight also of your Obser­tions made on, and the Cures per­form'd by the Bath-Waters; which, together with this excellent Dis­course, shall be carefully return'd, with a due Sense of Gratitude, by,

SIR,
Your most Obliged, and Faithful Friend, JOHN COOKE.
FINIS.

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