Of the hurtful Powers, which produce either Diathesis, Sthe­nic, and Asthenic.

CXI. THE powers producing the state of the body, upon which the predispositions, to sthenic or asthenic dis­eases, or those diseases themselves, depend, that is, that produce the sthenic or asthenic diathesis, are those which were mentioned before^(a).

The hurtful powers producing both Diathesis.

CXII. Heat, which is necessary to the production, the growth, and the vigour of animals and vegetables, as also to the form of the elements^(b) from its action upon the surface of the animal body, directly stimulates the whole; an effect which it also exerts upon vegetables. From this action of heat there is no exception when it keeps within a certain range of scale: but when it is either deficient, where it takes the name of cold, or excessive, its effect [Page 56] varies^(c). This stimulus, in a moderate degree, pro­duces its effect in due proportion, in a degree above that the excess of its action is such as to produce more or less of sthenic diathesis.

CXIII. Because the action of heat is encreased some­what more upon the surface than in the internal parts, where the temperature is nearly stationary, it, therefore stimulates more in the former than in the latter. Hence, in the phlegmasiae^(d), the inflammation is always external, The same agent encreases the tone of the muscular fibres every where, and consequently their density^(e). Hence, as the diameters of all the vessels are diminished, so those of the extreme vessels every where, and especially in the skin, where a greater force of the cause is exerted, are often entirely effaced. But actual suppression of the perspiration is incompatable with predisposition, and arises only from the diathesis, when it arises to the just measure of disease^(f).

CXIV. Hence in the measles and small pox, the irrita­ting matter, together with the perspirable, is detained. And not only in these, but all other sthenic diseases, the perspiration is suppressed, the excitement both upon the surface and in the rest of the body is encreased, and catarrh particularly induced^(g).

[Page 57] CXV. Heat, in extreme excess, whether it it acts hurtfully by its duration or intensity, constantly debilitates by diminishing the tone, and producing laxity instead of density. Which effect is somewhat greater upon the skin, to which the direct energy of heat is applied, than in the interior parts, in which there is little change of tem­perature. Hence arises sweating as in the torrid zone; hence the diameters of all the vessels, and particularly of the perspiratory vessels are enlarged. Hence proceed the colliquative sweats in fevers, and a similar state of the belly. Hence, also, corruption of the fluids, and not from a state of them directly produced by corrupting pow­ers^(h).

CXVI. The same power in the violent measles, in the confluent small-pox, in fevers, and in every kind of asthe­nic⁽ⁱ⁾ disease, in which the perspiration is deficient, does not lesson the deficiency^(k), though it expands and enlarges the vessels, but, on the contrary, encreases it^(l).

[Page 58] CXVII. Cold, inimical to animals, vegetables, and the elements, weakens the rest of the system, and still more the surface, the temperature of which it almost only diminishes, and it produces that effect always by a direct o­peration, always in proportion to its degree. Cold e­qually as excessive heat, produces atony and laxity of the vessels, gangrene, and the other effects of excessive heat^(m).

CXVIII. that these effects of the extremes of tempe­rature arise from debilitating not generating putrefaction, from an affection of the excitement, not of the fluids, plainly appears from this; that other exciting hurtful powers, such as a famine, an overabundance of blood, as in the case of those who die of peripneumony, and similar hurtful powers, which neither have been, nor can be, be­lieved to affect the fluids by any direct operation upon them⁽ⁿ⁾, produce not the symptom of corruption, and all the rest of the symptoms, and the same stimulants, which remove the latter, remove the former. Nay, the supposed antiseptics, such as wine, Peruvian bark, acids, [Page 59] and other things of that kind, are either entirely destitute of that operation, or they ne [...]ther are given, nor can be given, in that quantity, by which they can have any ten­dency to affect the mixture of the fluids: In fine the ef­fects of inanimate matters upon one another are never, with any propriety, transferred to living systems. Though, then, the fluids are frequently corrupted, the corruption is the effect of weak vessels not giving a sufficient mixture or diffusion to them, but is never the cause.

CXIX. The disagreeable sensation both of cold and of heat in extreme, is also hurtful, by diminishing the sum total of stimulant operation, which, in so far as it is agreeable, is serviceable by stimulating⁽ⁿ⁾.

CXX. As cold is naturally so debilitating, and all de­bilitating powers diminish excitement, it is therefore, ne­ver of service but in sthenic diseases, that is, in those which are in their progress towards indirect debility^(o); because the excitability, already too abundant, can never be ren­dered more abundant, nor, when too much wasted, ren­dered more accumulated, without an aggravation of the disease^(p); excitability admitting of less stimulus in pro­portion as it is either more abundant, or more ultimately wasted. When the debility is moderate, a mistake of this kind is less evident: but in a high degree of debility of either sort, a violent disease, or even death itself, may be the consequence of the smallest encrease of debility^(q).

[Page 60] CXXI. As cold as well as excessive heat relaxes, a fact that is seen in the cure of the small pox, and of every sthe­nic disease, from that we are to understand, that the pro­perty of cold in constricting^(r) inanimate matter does not extend to living matter^(ſ). The diminution of the bulk of the surface^(t) arises from debility of the vessels, not sufficiently propelling the fluids, and filling the vessels. In this way does cold produce asthenic diathesis.

CXII. But, as always less and less excitement arises in proportion as stimulant operation has been applied, till at last no more at all is added; cold^(u), as well as any o­ther directly debilitating power, may, according to va­rious degrees of it, produce health, and all the degrees of sthenic diathesis^(x); in the following way, however, only. It stops the waste of excitability, makes the bo­dy more susceptible of stimulant operation, checks the pro­gress to indirect debility, and stems the latter. But it on­ly [Page 61] effects that by checking the career of heat and other sti­muli, 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 shelter of a house, the warmth of a fire, as well as by its own proper motion. Hence also the bracing, by cold, of parts that have been relaxed by excessive heat. Last­ly, hence a remedy for the corruption of the fluids, which consists in invigorating the vessels, not correcting the degene­racy of their contents. This effect of cold upon the surface, which is nearly the only part of the system subject to refri­geration, is somewhat greater than in the internal parts.

CXXIII. the debilitating effect of temperature, and therefore also its hurtful tendency, is encreased by moi­sture.

CXXIV. Of the articles of diet, the only food in dan­ger of being too stimulant, is flesh and land-animal food, used in great quantity. Meat too salt, and hardened, es­pecially when it has now begun to spoil, is an excep­tion.

CXXV. The same thing is to be said of condiment; of which a very small portion, upo [...] account of its high de­gree of stimulus, is sufficient.

CXXVI. Spirituous or vinous drink, in which the al­kahol is always dilated, stimulates, more quickly, and more readily, than seasoned food, and its stimulus is in proportion to the quantity of alkahol that it contains.

[...]. But there are stimuli, which possess an operation as much quicker, and more powerful^(y), than these just now mentioned, and which are the agreeable and proper ones in health, as their [...] is of shorter duration. To these the name of diffusible is to be given. They rank a­bove strong drink in the following order:

[Page 62] π. Next to strong drink, and immediately above it, stands musk; above it volatile alkali; higher than this a [...] ­ther; and the highest of all, as far as experiments have yet reflected light upon the subject, is opium^(z).

ρ. These according to their degree, possess the proper­ty of converting the asthenic diathesis into a cessation of all diathesis in health; this into sthenic diathesis, the sthenic di­athesis into direct debility, and the last into death: all which they accomplish with as much more ease and promptitude, as they are more powerful than the rest of the stimuli^(a).

CXXVII. The stimulus of the articles of diet, not exclusive of the diffusible stimuli, should be denominated direct, because it acts directly and immediately upon the excitability of the part to which it is applied. The direct stimulus, at least in so far as it regards the food, is assisted by another, depending upon a distention of muscular fi­bres, on which account, for the sake of distinction, the latter should be called Indirect. As the latter is affor­ded by the bulk of animal and vegetable food, so the for­mer is produced by a relation of the stimulus to the exci­tability. [Page 63] The indirect acts upon the living solids in so far as they are to be considered as simple; the direct acts upon them as living only. From a long and habitual excess in food and drink, at last indirect debility arises and the group of diseases depending upon it^(b).

[...]. All these stimuli have also a tendency to produce asthenic diathesis.

CXXVIII. All vegetable food^(c), and too sparing an use of animal, as also meat too salt, and deprived of its native juices by keeping, when better nourishing matter is withheld, constantly weaken, and thereby produces asthenic diathesis through all its degrees. Hence ari­ses that remarkable imbecility both of body and mind, which distinguishes the Gentoos, who follow the Brahminan ceremonial of religion. Hence the dis­eases of the poor every where^(d); hence scro­fula [Page 64] ^(e), fevers^(f), epilepsy, cough with profuse expectora­tion and hemorrhage, and the whole band of asthe­nic diseases. The direct debility flowing from this hurt­ful power, affects the stomach somewhat more than any other equal part^(g); the consequences of which af­fection are loss of appetite, stomach sickness, vomiting, very loose belly, and similar disturbances of the first passages.

τ. But while improper aliment produces such effects, these will also be induced by an ultimate excess in the use of food consisting of the proper material; which must b [...]n­ [...]erred from the universal effect of all the other stimulant powers, when their operation has been pushed to the same excess ^(h). The mean betwixt the extremes of the hurt­ful powers, in so far as diet is concerned, is abstinence⁽ⁱ⁾.

[Page 65] CXXXIX. The withholding also of the use of condi­ments, which, without animal food^(k), are not suffici­ [...]nt to give strength, gives an additional weakness.

CXXX. Strong drink, and the diffusible stimuli, are never necessary to young and strong people, upon account of their rapid tendency to indirect debility, from their high stimulant power; nor are they even safe. But, in persons who have been accustomed to them, in the case of those who are advanced in age, and of those who are weak from that or any other circumstance, cold, watery, acid, or fermenting drink, has a great influence directly, and excess in the use of strong drink indirectly, in producing asthenic diathesis.

υ If the diffusible stimuli, after they have been employ­ed, are too quickly withdrawn, they, in the same manner as the more durable, allow the excitability to accumulate, and direct debility to come on, and consequently may be said to produce asthenic diathesis. But asthenic dia­thesis is never the consequence of withdrawing their ope­ration at least worth speaking of, but when that has been habitual. And all the hurtful effects which they have most untruly, to the great detriment of mankind, been said ra­ther, than are now said, to occasion, arise not from them­selves, but from the want of knowledge how to manage them. And as this operation of diffusible stimulus ought to be supported by that of a durable; at the same time, it must not be confounded with debilitating powers. What disturbances, during the operation of opium, will not a breath of cold air, affecting the body, create? And how [Page 66] easily, as well as quickly, are they all removed, by care­fully covering up the body?^(l).

φ. Both the other diffusible stimuli, as well as opium, and the more durable one of strong drink, by an indirectly debilitating operation, produce asthenic diathesis.

CXXXI. A further stimulus is an abundance of chyl [...] and blood; by this the excitement is encreased every where, and particularly in the blood-vessels, and encreased in de­grees proportioned to its degree of abundance. The quali­ty of the blood, at least, as a cause, is of no effect, it is the quantity only that is. The quantity, by its action of distending the muscular fibres of the vessels, acts with a constant impulse^(m). The doctrine of plethora, so no­ted [Page 67] in the medical schools, is only applicable to sthenic diathesis, and takes place in proportion to its degree⁽ⁿ⁾.

CXXXII. The effect of distention^(o) is encreased by the velocity of the blood, both as arising from other sour­ces, and especially from that motion of the body which its own muscles perform, a motion, which, by compressing the veins, carries the blood more quickly back to the heart.

CXXXIII. Nothing is more effectual than these two last mentioned stimuli, in producing sthenic diathesis, and the diseases depending upon it. Those diseases are violent in proportion to the over proportion of the blood, and the rapidity of the force with which it flows; a fact, that is proved by all the exciting powers, all the symptoms of those diseases, and, especially, the pulse of the arteries; [Page 68] it is also proved by the great efficacy of bleeding, purging, abstinence from food, and rest, in the cure of the disease^(p).

CXXXIV. While an over-proportion and velocity of blood is a chief cause of sthenic diathesis; there is nothing more powerful in producing the asthenic, than that penury of blood which the greatest celerity of motion accompanies. Hence, the smallness, weakness, and quickness of the pulse: Hence the excitement is diminished every where, and in preference to other equal parts, in the whole san­gui [...]erous system, and that in exact proportion to the pe­nury.

χ. From this state of the vessels arises the discharge of blood from the lungs, from the uterus, from the anus, or around the anus, from the urinary passages, and through the perspiratory pores. Hence arise disturbances of the stomach, want of appetite, loathing of food, and, there­fore, upon account of want of norishment, and the lan­guor of the digestive organs, always less and less blood arises in the system. So great a penury of blood is the principal origin of bleeding diseases; which never happen but in the asthenic state. The same penury of blood acts in such a manner, and chiefly affects its own vessels, because, according to a law so often mentioned, its debilitating energy chiefly falls upon them. In sthenic diseases, that have advanced to their height, or a little beyond it, a few drops of blood from the nose, or a dropping of blood from the same, or any other part, demonstrate only a predis­position to indirect debility, but not an establishment of [Page 69] it, and that the matter still remains within the operation of excessive stimulus^(q).

[Page 70] ψ. Thus it is not an excess in the quantity of blood, but laxity and atony from its defiency, that upholds the affair of bleeding discharges; which proceed in their course, not with any effort^(r), but a diminution of tone: They are all asthenic, and the asthenic diathesis, as far as it de­pends upon them, consists in direct debility.

ω. But, as every other exciting hurtful power may be converted into indirect debility, so, also may an over­proportion of blood. For the vessels, ultimately distended, and beyond all bounds, may^(ſ), by the excess of that sti­mulus, exhaust their own excitability, and, thereby, put an end to their excitement. Upon which the forcible con­tractions are converted into languid ones, or such as could scarce he called contractions at all; the diameters for­merly effaced, are converted into an extremely patulous state. The finer parts of the fluids flow through the patu­lous extremities of the arteries, wherever they find an outlet, and carry with them, sometimes serum, sometimes, red blood.

In the asthenic, diathesis as well as the sthenic, it is not the quality of the blood, but its quantity, which is to be found fault with, and the fault in quantity here is de­ficiency. The deficient quantity produces the symptoms of the pulse, that have been mentioned above, by not suf­ficiently distending the vessels, and giving them sufficient excitement. Plethora, which has been thought to be­long to this form of diseases only, has absolutely no exist­ence in it The state of the vessels, with respect to the quantity of blood in them, that is pleasant and suitable to health, is the mean betwixt the extremes that have been spoken of.

CXXXV. This state^(t) is the chief origin of asthenic [Page 71] diseases, of which the so very hurtful effects of evacuation, es­pecially bleeding, as well as vomiting, purging the belly, and every other mode of diminishing the bulk and quantity of fluids, give full proof. This proof has of late received a further confirmation, in the singular success of the cure by other stimulants first, and then by every mode of filling the system^(u).

CXXXVI. The different fluids secreted from the blood in different ways, are, by the distention which they give to their respective vessels, also understood to stimulate. In that respective the milk and [...]eed, by the abundance of each in its respective vessels, and likewise the perspirable fluid, have the chief effect, the commotion of the secretory organ^(x), by means of excitabilty, which is one and the same undivided property over all, is easily diffused over the whole body, and, when it rises to excess, is capable, with other powers that communicate an excess of excite­ment, to produce sthenic diathesis.

CXXXVII. The same secreted fluids, when they do not sufficiently distend their respective vessels, when they communicate enough of excitement, make no inconsi­derable [Page 72] part of the hurtful powers, that constitute asthenic diathesis.

Α. For which reason vomiting, purging, and every o­ther evacuation, are powerful inducers of asthenic diathe­sis, which they effect in proportion to the debility that at­tends their operation. The same thing is to be said of excess in venery, which is partly an indirect, partly a direct, always a great, debilitating power^(y).

Β, Sometimes the secretory vessels seem so crammed with a colluvies of fluids, that indirect debility may pos­sibly arise from that source, as is exemplified in that over­flowing of bile, which distinguishes the yellow fever^(z). Here too the debilitating effect, by means of the excitabi­lity, tends to diffuse the diathesis over all.

From this source, arise, a languid action of the extreme vessels^(a), a [...]low, then, no motion of the fluids, a stag­nation [Page 73] and corruption of them. A diminution, or tempora­ry destruction of excitement, over this large space in the sys­tem^(b), by means of the same excitability, communi­cates debility to the rest of the body; and, in conjunc­tion with other hurtful powers that give not enough of ex­citement, produces asthenic diathesis.

Γ. The various sorts of gestation^(c), and of exercise and labour, by rousing the muscles 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 vessels, and, therefore, over the whole system; and the effect may go so far as to produce sthenic diathesis.

Δ. As nothing contributes more to health than moderate and frequently repeated exercise, and its excess acts in the manner that has just now been described; at the same time a [Page 74] degree of it, either greater or less, than the salutary degree, by its weakening effect, the former in wasting the excitabi­lity, the latter in with-holding a necessary stimulus; that is the one by debilitating indirectly, the other directly, produces asthenic diathesis.

CXXXVIII. Thinking, which acts more upon the brain, to which it is immediately applied than upon any other equal part of the system^(d), encreases excitement o­ver the whole body^(e). S [...]aining and thinking, whether in a high degree for once, or often repeated in a lesser degree, or habitual may alone prove hurtful; but, in con­junction with other powers also hurtful from their [...]xc [...]s of stimulus, may become more so, and amount to a degree equivalent to the production of [...] diathesis.

CXXXIX. An evident cause of asthenic diathesis is that state of the intellectual function, in which excess [Page 75] in thinking, by wasting the excitability, ends in indirect debility; or that deficient, weak, vacant state of mind, uncapable of keeping up a train, which produces the same hurtful effect by direct debility. This faulty state of the mind contributes greatly to weaken the system ^(f).

CXL. Violent passions of mind, as great anger, keen grief, unbridled joy, going to such a pitch as to destroy excitability, have the same effect as excessive thinking, and admit of all the same reasoning.

CXLI. A force of passion rising to the height of ex­hausting the excitability, induces that asthenic diathesis, which is occasioned by indirect debility, and diseases of that stamp. Hence epilepsy^(g), hence apoplexy, and that when, the mind has been screwed up to the height of pas­sion, often fatal.

CXLII. On the contrary, when there is a deficiency of passion, as in melancholy, grief, fear, terror, despair, which are only lower degrees of joy, assurance, and hope, and imply no more than a diminution of exciting passions, not emotions of a nature opposite to those, and positive; their tendency is to produce the asthenic diathesis, which depends upon direct debility. The immediate production of this is loss of appetite, loathing of food, sickness at sto­mach, vomiting, pain of the stomach^(h), loose belly with­out pain, the same with pain, indigestion⁽ⁱ⁾, cholic, the the gout, and fevers.

CXLIII. The exercise of the senses, when it is agreea­ble, has a very great effect in exciting the whole body, and [Page 76] in producing emotions, which, together with the hurtful powers mentioned above, may easily contribute to the pro­duction of sthenic diathesis. Those emotions are exem­plified in drinking, dancing, in agreeable entertainments where the eye is dazzled with the splendour of the dishes, of the company, and of all the objects around.

CXLIV. The energy of the same exercise of the senses, when it is excessive, and carries the effects, just now men­tioned, too far, produces indirect debility. On the con­trary, when the senses are either in part destroyed, or in part dulled, or disagreeably affected^(k), the mind is de­jected, and the whole body thrown into a state of languor and direct debility. And, in both cases, especially when there is a concurrence of other debilitating hurtful powers the asthenic diathesis arises.

CXLV. The effect of the air^(l), independent of its qualities, as they are called, or its properties, and its use in supporting respiration, is less obvious to observation^(m); at the same time it cannot be doubted, that its application to the whole surface of the body is a stimulus not to be dispensed with. The air is seldom applied in a pure state: it is commonly blended with foreign matters that diminish its force of stimulus; and, while its salutary stimulus depends upon its purity, at the same time it is uncertain whether e­ver its purity goes so far as to stimulate in excess, and there­by produce sthenic diathesis. The baloons, lately invented, by which men get above the clouds, would serve excellently to throw light upon that matter, if it were not for the cold that [Page 77] accompanies this progress. Be that as it may; since we never live in the purest air, and yet live commodiously e­nough, it is, therefore, credible, that too pure an air has a ten­dency to stimulate in excess, and, therefore, produce sthe­nic diathesis.

CXLVI. But, as nothing is more usual than impurity of air, and every impurity diminishes its stimulus, a very impure air, or air blended with impure matters, without doubt debilitates, and produces asthenic diathesis. Ac­cordingly, impure air is a frequent cause of typhus, as is evident from the [...]ate of those who died in the black hole of Calcutta. Whether ever the air, from an excess of pu­rity, produces asthenic diathesis, is the more doubtful, that, as has been said, it is as yet undecided whether it produces sthenic diathesis or now.

Ε. Contagious matter, in so far as it may have any ten­dency to produce general diseases, in one form produces sthenic, in another asthenic diseases, and, therefore, acts like the ordinary hurtful powers of either sort, and admits of all the same reasoning. But, in so far as it only occa­sions the eruption, without making any change in the ex­citement, it is to be referred to the local diseases.

Ζ. To poisons, if they act as general stimulants, all the reasoning that has been employed with respect to the other hurtful powers, will apply. It is not, however, likely that they are general stimulants.

CXLVII. It is seldom from the separate, almost al­ways from the united operation of all the powers, that both the diathesis, whether as remaining within the range of predisposition, or rising to the degree of actual morbid state are produced, and from no inherent power in the system.

The Description of Peripneumony.

CCCXLVIII. The symptoms peculiar to peripneumo­ny^(c) (under which pleurisy, and, as far as it is a general disease, carditis, are comprehended), are pain somewhere in the region of the chest, often changing its seat; difficult breathing; cough, for the most part bringing up an expec­toration, and sometimes a mixture of blood in the matter of expectoration.

CCCXLIX. The seat of the disease is the whole body, the whole nervous system^(d); which is proved by the dis­ease being produced by an increase of the diathesis, which took place in the predisposition, and by no new circum­stance^(e) by the inflammation within the chest, for the most part following the pyrexia at a considerable interval of time, and never preceding it^(f), and by bleeding and o­ther [Page 221] remedies of similar operation, which affect not the inflamed part, more than any other equally distant from the ce [...]er of activity, removing the disease. The proper seat of the inflammation, which is only a part of the general diathesis, is the substance of the lungs, and a production of the pleura, covering their surface, or any part of that membrane, whether the part lining the ribs, or that con­taining, within the external surface of it, the thoracic vi­scera, different in different cases, and in the same case at different times.

CCCL. Pain, in some part of the chest, depends upon an inflammation of the corresponding internal parts just now mentioned^(g), which is proved by dissection; only that it is oftener occasioned by an adhesion of the lungs to the pleura costalis, seldom to an inflammation of that membrane, as we learn from the same evidence

CCCLI. When the inflammation takes place on the sur­face of the lungs, it is impossible it can be confined either to the substance of the lungs, or the membrane covering their surface. For how can any person suppose, that the points of the same vessels, either as distributed upon the membrane, or plunging into the substance of the lungs, or emerging from it, can alone be inflamed without a communication of the affection to the next points^(h). The distinction, there­fore, [Page 222] of the inflammation accompanying the phlegmasiae into peren [...]hyma [...]ose, or that affecting the substance [...] the vis­cus, and into membranous; as well as the notion which makes the latter case universal, is equally remote from the truth. The reason of neither the membrane contiguous to the lungs, nor the substance of the latter, being always inflamed, but of the inflammation being sometimes com­municated to some part of the nighbouring membrane, is explained by the vicinity of the part inflamed in the last case to that which receives the air, therefore, varies in its tem­perature.⁽ⁱ⁾

CCCLII. The pain often shifts its seat^(k) in the course of the disease, because its immediate cause, the inflamma­tion, is equally liable to change, being disposed to leave its first seat, or in part to remain in it, while in its great­est part it rushes into another. Which is a fact proved by the comparison of the known change of the pain with [Page 223] the traces of inflammation in the corresponding parts, dis­covered after death^(l)

CCCLIII. This fact, added to those already produced, brings another solid argument^(m) in refutation of the opini­on of the disease being produced or kept up by inflamma­tion, or in any shape depending upon it; confirms that here advanced, and proves that the inflammation is regula­ted by a strong general diathesis, and directed by it some­times to one part, sometimes to another; that, as depend­ing on that cause, it encreases and is in a manner multipli­ed. And the same conclusion is confirmed by the inflam­mation abating, becoming more simple, and at last rece­ding from every part it had occupied, in proportion to the progress of the cure in relieving or removing the diathesis. The same fact is confirmed by the nature of rheumatism, the pains of which are severer and greater in number, in proportion as the diathesis runs higher; and milder and fewer in proportion to its gentleness. These pains, that have their dependence upon the general diathesis, and are a part of the general disease, ought to be distinguished from local ones, which often occur, and may accidentally precede this disease⁽ⁿ⁾

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 inspiration, by filling and distending its own, compressing the inflamed vessels.

CCCLV. The cause of the cough is a large secretion and excretion of the exhalable fluid, and mucus, irritating [Page 224] the air vessels, encreasing their excitement, as well as that of all the powers, that enlarge the cavity of the thorax [...] then suddenly suspending it, and thus performing a full in­spiration, and a full expiration, partly in conjunction with the operation of the will^(o).

CCCLVI. The cough is less or none at all at first; be­cause, on account of a strong diathesis occupying the ex­tremities of the vessels, the same fluids flow on in the form of an insensible vapour, are less irritating in that form, and dismissed with less effort.

CCCLVII. Again, the cough is afterwards followed by expectoration; because the accumulated fluids, with their effect, the effort of coughing, are carried forward in the rapid action of the air rushing out, as it were, in a tor­rent^(p). And the mixture of blood with them points out the force of secretion formerly explained.

CCCLVIII. The softness of the pulse, commonly ta­ken into the definition of the disease ^(q), has been here re­jected, because the characteristics of the pulse do not fol­low the inflammation, but the general diathesis^(r). With respect to the diathesis, the proper language is, that the pulse, instead of soft, is less hard; and when the effect, that the cure has produced upon the pulse, is considered, it may then be said to be soft^(s).

CCCLIX. Nor is the varying feeling of pain, which is described as sometimes acute, and pungent, sometimes ob­tuse, gravitative, and rather to be considered as an uneasi­ness than pain, though immediately dependent upon the [Page 225] inflammation, to be considered as of any consequence in pointing out the state or seat of the inflammation: because, however great the inflammation is, wherever it is seated, whatever danger it denounces, the only means of remo­ving it, and of averting the danger, is to remove the gene­ral diathesis. The notion, therefore, of the membrane being inflamed, when the pain is acute, and the interior substance, when it is obtuse, must be rejected as good for nothing, must be guarded against as destructive^(t). For often, when the disease has arrived at an advanced stage, a sudden abatement of the pain taking place, without a pro­portional relief of the breathing, to an unskilful person gives an appearance of a return of health. But the cause of that, while it has nothing to do with the seat or sort of inflammation, is that degree of excitement, which shows, that the excitability is exhausted, the excitement come to an end, and that the vigour, before excessive, is now con­verted into direct or indirect debility^(u). Hence arises in the vessels, especially the labouring vessels, in place of the excessive excitement, with which they were before affected, no excitement at all; and extreme laxity takes place of their former density. Hence, instead of an excretion en­creased by violence, an immense discharge takes place without force, without effort, and merely by the watery part of the fluid, from the inert state of the vessels, leaving the more consistent; and a sudden suffocation takes place, in consequence of an effusion of fluids from all quarters in­to the air vessels.

CCCLX. The carditis, or inflammation of the heart, is a disease of rare occurrence, is ill understood, and for [Page 226] the most part a local affection. When the latter is the case, there is no use for the interference of a physician. And, if ever it be a general disease, it admits of no other definition or cure but those of peripneumony. From pe­ripneumony then, as it arises from the same antecedent hurtful powers, and is removed by the same remedies, it is not to be separated.

The Description of Phrenitis.

CCCLXI. Phrenitis is one of the phlegmasiae^(x), with a slight inflammatory or catarrhal affection of some one, or more joints, or of the f [...]uces, with head-ach, redness of the face and eyes, impatience of light and sound, watch­fulness, and delirium.

CCCLXII. Inflammation, in its proper form, appears not in this case. And yet there is an approach to inflam­matory state in the joints, in the muscles, and especially over the spine, or about the chest, or in the bottom of the throat; or there is a catarrhal state, which is an affection depending, however, upon the same cause, as inflammation, and only differing from it in being less.

CCCLXIII. The head-ach, and redness of the face and eyes, arise from an excessive quantity of blood in the vessels of the brain and its membranes, distending, stimula­ting in excess, exciting in excess, and contracting the vessels, to a degree that gives pain^(y). To the production of which last inflammation is not necessary: independent of which, this excessive action is painful, because it ex­ceeds that mediocrity in which agreeable sensation takes place^(z). The redness both points out and explains the over-proportion of blood. And that the over-proportion gives pain by its distending operation, is shewn by the re­lief [Page 227] that bleeding and every thing that diminishes the quan­tity, and moderates the impetus of the blood, administers.

CCCLXIV. It is the overabundance also that produ­ces the impatience of light and sound. For, as a certain impulse of the blood is necessary to the exercise of every sense, by whe [...]ing the organ of sensation^(a); so, when the cause rises to excess, an equal encrease of the effect must be the consequence. But these very symptoms, with pain, arise in an opposite state of excitement, to wit, the asthenic.

CCCLXV. The vigilance and delirium are occasioned by the same excess of excitement, produced by the excessive stimulus of the abundance of blood and of the other powers. Other hurtful powers, contributing their effect, are intense thinking, and a high commotion of passion. Excited by those, no body, even in health, sleeps; and, therefore, the wonder is the less, that a high degree of them, and under the influence of a violent disease, should repel sleep. Both encreased watching and delirium are symptoms of disturbance.

An Explanation of the Sthenic Exanthemata.

CCCLXVI. The sthenic exanthemata, after the ap­plication of a contagious matter, and of the usual hurt­ful powers which produce sthenic diathesis, appear first in the form of a sthenic pyrexia, or synocha, and then after a space of time, not certain to a nicety, are followed with small or larger spots.

CCCLXVII. That the exanthematic sthenic diseases differ not from the other sthenic diseases not exanthematic, [Page 228] in any circumstance of consequence, is proved by this strong argument; that, except the eruption and the phoenomena peculiar to it, there is nothing in the symptoms, and ex­cept the contagion, there is nothing in the hurtful exci­ting powers, but what happens in any sthenic disease; and the preventatives, as well as the remedies, are the same in all. While that is the state of the fact, it was the height of absurdity, merely for the sake of the eruption and its peculiar phoenomena, to separate the exanthematic from their kindred diseases, and to unite them with the most opposite diseases both to them and to one another^(b). For [Page 229] how, when the usual plan of cure removes the effect of the eruption, whatever that be, and thereby shows it to be the same, can any one imagine, that the cause should be different and not precisely the same? unless we must again have to do with those who maintain, that the same effect may flow from different causes. Truly, the operation of contagion, in so far as it affects general disease, is not of an opposite nature to the general sthenic operation, but precisely the same.

CCCLXVIII. Contagion is a certain matter, im­perceptible, of an unknown nature, and like most of the phoenomena of nature, only in any measure open to our enquiry in its evident effects. Taken from the body of one affected with it, or from any gross matter (such as clothes or furniture, where it happens to have been lur­king), and received into a sound body, it ferments without any change of the solids or fluids, it fills all the vessels, and then is gradually ejected by the pores.

CCCLXIX. And, as no effect, except sthenic diathe­sis, follows it, and the hurtful powers, that otherwise u­sually produce that diathesis, always precede it, and an asthenic or debilitating plan of cure always, and only, suc­ceeds in removing it, and consequently its effect no ways differs from the diseases hitherto mentioned; it is, there­fore, with justice, that the diseases arising from it, are con­joined with those others, as belonging to the same form.

CCCLXX. Betwixt them there is only this difference, that in the exanthematic cases of sthenic disease, the mat­ter requires some time to pass out of the body, which time is different in different cases: and it passes out more copious­ly [Page 230] or scantily, the more free or impeded the perspiration is^(c). But it is impeded by no spasm, by no constriction from cold, and only by the prevalence of sthenic diathesis upon the surface of the body; as is evident from this fact that cold, by its debilitating operation, procuring a free is­sue for the matter, clearly promotes the perspiration^(d). And that it produces this effect, by diminishing the diathe­sis, not by removing a spasm, has been demonstrated for­merly. As the issue of the matter is in this way promoted by inducing a free perspiration; so

CCCLXXI. Whatever part of it is detained below the cuticle, by that delay, it acquires a certain acrimony, pro­duces little inflammation, and conducts them, when pro­duced, to suppuration. Th [...]se, by irritating the affected part, create a symptomatic pyrexia symptomatic sthenic dia­thesis, which should be distinguished from the general pyre­xia and general sthenic diathesis ^(e).

CCCLXXII. The period of eruption is more or less certain, because the operation of fermentation, being in some measure certain and uniform, to that extent re­quires a certain uniform space of time, for being finished, diffused over the system, and reaching the surface of it, as is attested by the effect. Again, it is not exactly certain, because the perspiration, in the varying state of vigour, that must occur, must,at different times, and under different circumstances, be more vigorous or more languid.

CCCLXXIII. The pyrexia, symptomatic of the e­ruption, sometimes takes on the form of an actual fever: The reason of which is, that the high degree of stimulus, which the eruption throws upon the whole surface, produces [Page 231] ultimately excessive excitement, and therefore, pu [...]s an end to it in the establishment of indirect debility^(f).

The Description of the violent Small-pox.

CCCLXXIV. The violent small-pox is a sthenic exan­thema, on the third or fourth day of which, sometimes latter, small spots or points, inflamed, and by and by to be transformed into exact pustules, break out; containing a liquor which, generally on the eighth day after the erup­tion, often latter, is changed into pus, and dwindles away in the form of crusts. The eruption, the degree of which is always in proportion to that of the sthenic diathesis, in this case is the greatest that ever occurs.

CCCLXXV. All these phoenomena are governed by the laws of fermentation, lately mentioned^(g). The num­ber of pustules, being proportioned to the degree of diathe­sis, shows that, without the hurtful powers, that otherwise, and without any co-operation of contagious matter, produce that diathesis, the contagion has not much effect in produ­cing the real morbid s [...]ate, and that it chiefly regulates the exterior form the disease^(h).

CCCLXXVI. But a violent small-pox is distinguished by the following symptoms: Before the eruption there is a very severe pyrexia; this is succeeded by an universal crust of pustules over the whole body. Antecedent to which the hurtful powers are very violent sthenic ones, and par­ticularly heat; the remedies that remove it are very asthe­nic, and in preference to any of them cold.

The Description of the violent Measles.

CCCLXXVII. The violent measles is a sthenic exan­thematic disease⁽ⁱ⁾, beginning with sneezing, watery eyes, [Page 232] dry cough, and hoarseness; on the fourth day of which, or later, there appears an eruption of small numerous pa­pulae or little points; that on the third day, or later, terminate in an appearance o [...] branny scales. This dis­ease, when preceded with a high degree of sthenic diathesis, is proportionally violent.

CCCLXXVIII. The sneezing, watery eyes, dry cough, and hoarseness, are catarrhal symptoms, and, there­fore, depend upon sthenic diathesis^(k). And, since they appear, four days or more, before the eruption, that is, before the matter might seem to have reached the affected parts, and are constant and universal; hence are we to suppose, that the sthenic diathesis follows the hurtful powers, that usually produce it, and not entirely the pecu­liar matter in this case, and that it is indispensably neces­sary to the measles. But though that supposition should be rejected, and it should be contended, that those symptoms arise from the contagious matter; it still must be granted, that this disease differs, however, in nothing from the other sthenic diseases, but equally depends upon sthenic diathesis, and yields to antisthenic or debilitating remedies. And it must be allowed, that, since the matter produces the same affect as the usual hurtful powers, its operation must be absolutely the same, and the cause of the disease the same. Consequently, we find nothing in the indica­tion of cure, but what is in common to this disease with other sthenic exanthematic ones, which is, that time must be given to the matter to pass out of the body, and the perspiration be conducted in the same manner, as the sthenic diathesis is usually treated upon other occasions^(l).

CCCLXXIX. The eruption admits of the same rea­soning that has been delivered^(m). The circumstance [Page 233] of its being a violent disease when preceded by a violent sthenic diathesis, and mild in a degree of that dia­thesis, is a further instance of the little difference that there is betwixt the operation of contagion, and that of the or­dinary powers producing sthenic diathesis.

CCCLXXX. When the diathesis runs so high as to suppress the perspiration, the eruption often disappears 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 disease; and shows, that this matter, in the same manner as the variolous, kindles up a symptomatic in­flammation over the surface of the body, and then, by a further encrease of the diathesis, suppresses the perspira­tion. Hence, with other viscera, the lungs⁽ⁿ⁾ are often inflamed.

[Page 234] CCCLXXXI. The violent state of the small-pox, of­ten from the great stimulus of the eruption, converts both the sthenic diathesis and eruption into the asthenic ones, and thereby produces the confluent small-pox, of which we are afterwards to treat. Whether any thing like that is the consequence of the measles, is not yet ascertained: But, as every excess of excitement, as in the conversion of peripneumony into a dropsy of the chest, is liable to run into indirect debility, it is, therefore, scarce to be doubt­ed, but that the same thing happens to this disease, which is inferior to none in violence.

The Description of the violent Erysipelas.

CCCLXXXII. The violent Erysipelas is a phlegmasia, always beginning with pyrexia, and followed by inflam­mation. The inflammation is seated in some external part of the body, oftenest in the face, sometimes in the throat, with redness, of an unequal edge, somewhat raised, creep­ing from one place to another, and attended with a sense of burning.

[Page 235] CCCLXXXIII. It is peculiar to this inflammation, and foreign from the other general ones, to invade the corpus mucosum. To assign a reason for which is of no consequence; since 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 cause of the redness of the in­flammation, in this as well as in every case, is an excessive quantity of blood in the inflamed vessels; for the question about the degree of redness is of no importance. There is less swelling in the inflamed part, than in other sthenic inflammations, because there is here a free space betwixt the scarf-skin and true skin, allowing the effused humour room to spread and diffuse itself. The same is the cause of the slow motion of the inflammation, and of the ine­quality of its edges. The sense of burning is owing to an acrimony of the contained fluid, acquired by stagnation.

CCCLXXXV. The attack of the inflammation upon the face is not more dangerous than upon any other place, except when the diathesis, upon which it depends, is great, rendering the inflammation proportionally great^(o). In which latter case, whatever part is inflamed, the disease must be held for a severe one; but still severer, if the in­flammation seizes the face; in which case a great tumult of affection internally accompanies the disease.

CCCLXXXVI. When such a sthenic diathesis, and affection of the head depending on it, happens, no disease is more dangerous, none more rapid in its race to death; while in a mild diathesis no disease is milder.

A Discription of Rheumatism.

CCCLXXXVII. Rheumatism is a phlegmasia, es­pecially in that temperament, which inclines to the san­guine. [Page 236] It is a conseqence of [...]eat succeeding to cold, or so alternating with it as to prove the more stimulant: It is accompanied with pain nigh, or between, the joints, chiefly the greater ones, and proportioned to the degree of the diathesis^(p): And the inflammation always comes after the pyrexia.

CCCLXXXVIII. External temperature is hurtful in this disease in the same way, as it has been often now ex­plained^(q).

CCCLXXXIX. The rage of the pain is in the parts that have been mentioned^(r), because it is in these parts that the inflammation, or more encreased part of the gene­ral diathesis^(s), chiefly acts. Which again happens, for this reason, that the nearly most powerful of the exciting hurtful causes, the temperature, that has been mentioned^(t), is only directed thither. There is no translation of the inflammation to the internal parts, for this reason, that these parts, which preserve nearly an equal temperature amidst every change of it externally, are not acted upon by the same hurtful power which annoys the external parts.

CCCXC. Cold, according to the common opinion, is not hurtful in this disease; because the rage of the dis­ease is greatest under the operation of heat, which has an effect quite opposite to that of constriction^(u). This fact is confirmed by stimulant diet, in all its articles, proving always hurtful, and by abstinence being always servicea­ble, and often alone making out the cure. And it brings a sufficient refutation of that mistaken notion, according to which, temperature is alledged to be more hurtful, and sweating more serviceable, than is consistent with the truth; as if there were no other hurtful powers but the former, no other remedies but the latter. In this, as well as in all other general sthenic diseases, it is the general sthenic [Page 237] diathesis alone that produces, and the solution of it alone, that removes the disease. Which is a clear fact, and sup­ported by the evidence of every part of this doctrine that has yet been delivered. The pains of parts, which some­times precede this disease, oftener happen without being followed by it, and that, in both cases, have nothing to do with sthenic diathesis, upon which this disease entirely hinges, are a local affection, or belong to a very different general disease, rheumatalgia, of which more afterwards^(x).

CCCXCI. The reason of the greater joints being affected in this disease, and the lesser ones in the gout, is the following: In rheumatism, because both the rest of the disease and the pains depend upon a violent sthenic diathesis: therefore it is, that the greater joints, which, for the reasons assigned, undergo more of the diathesis, have also a greater share of the disease. But, as the gout consists in debility, its influence will be greatest, where there is naturally the greatest debility, and therefore in the extreme parts, and those most remote from the centre of activity^(y).

A Description of the mild Erysipelas.

CCCXCII. Both the definition and explanation of the violent erypesilas^(z), delivered before, suffice for those [Page 238] of the mild; but in such sort, that the latter, both in its antecedent hurtful powers and symptoms, and in the whole nature of its cause, must be understood to be much mil­der than the former, and not only so, but a remarkably mild disease.

CCCXCIII. It is often not so much a sequel of the sthenic cynanche, which is commonly called tonsillar, or the common inflammatory sore-throat, as a supervention upon it before it has finished its course. It often appears alone and unaccompanied with the cynanche, arising from a similar lenity of the hurtful powers, and manifesting a si­milar mildness of symptoms through its whole course.

CCCXCIV. Nay, in the same persons, in the same state of the hurtful powers, sometimes this erysipelas, some­times cynanche, sometimes catarrh, promiscuously arise, and are all removed by the same gentleness in the method of cure^(a).

A Description of the Cynanche Sthenica.

CCCXCV. The sthenic cynanche is a phlegmasia, with an inflammation taking place in the throat, and especially the tonsils, never preceding the pyrexia. It is accompanied with swelling and redness, and an aggravation of pain in swallowing, especially any thing fluid.

CCCXCVI. The reason for the inflammation occupy­ing the place mentioned here, has been given before^(b). [Page 239] And, when it has once taken place, it is afterwards li­liable to frequent recurrence, because its seat being in the way of the most hurtful power^(c), and less covered than o­ther parts^(d), is exposed: And the vessels first distended by the inflammation, and then afterwards relaxed, take in an over-proportion of blood upon every encrease of its im­petus^(e).

CCCXCVII. As the inflammation, like that of the other phlegmasia never precedes the pyrexia^(f), for the reason assigned^(g); so, if an unskilful person should think it did, the reason of that is the gradual degeneracy of the general sthenic inflammation into a local disease, from its frequent recurrence, and always leaving a taint behind it in the affected part. This latter inflammation may happen, without a general sthenic diathesis, and therefore, without being followed by a sthenic cynanche; and it may acci­dentally coincide with the former, or sthenic diathesis, and, therefore, precede the latter or sthenic cynanche: But, in both cases, it ought to be distinguished from the pure ge­neral case, for the sake of guarding against the commission of a hurtful mistake in the cure^(h). In an asthenic habit, whether succeeding to the former or not, there is again a­nother [Page 240] general inflammation, to be refered to asthenic dis­eases.

CCCXCVIII. If any person can explain why the pain is aggravated in swallowing, he may communicate his knowledge; if he cannot, it is no matter.

CCCXCIX. The cynanche oesophagaea has been here omitted, because it is a rare affection, and admits of the same reasoning and cure as the tonsillar, from which it differs not but in the inflamation being farther down, and in some redness only coming within view. But, as a su­spicion that it may be local, as when the aesophagus hap­pens to be eroded or burnt, by a stimulus, or some acrid matter; the distinctions, therefore, should be attended to⁽ⁱ⁾, and made use of for the sake of practice.

CCCC. There is likewise a rare disease, sometimes happening in certain countries, never in others, called the croup^(k). In it the respiration is laborious, the inspira­tion sonorous, with hoarseness, a ringing cough, and a swelling scarce [...]o be discerned^(l). It is a disease that in­fests very young children almost only. And in all other particulars it is of a doubtful nature^(m).

CCCCI. Concerning which, when it happens to oc­cur in practice, use the following marks of judgment. As the sthenic diathesis, in the degree requisite to the forma­tion of actual disease, which depends upon a high degree of [Page 241] diathesis, happens less, either in the beginning, or to­wards the end of life; because the high degree of excitabi­lity in the former, and the low degree of it in the latter, admit a smaller degree of the effect of the exciting power, that is, a smaller force of excitement⁽ⁿ⁾, than the long pe­riod of human age betwixt these two extremes; yet it is not altogether foreign from either^(o). In childhood, the high degree of excitability compensates for the slightness of the stimulus; while, in old age, the high degree and force of the latter may compensate for the deficiency of the former, and suffice to induce some sthenic diathesis, even to that degree which constitutes disease. In this way infants undergo wonderful vicissitudes of excitement, and within the shortest spaces of time. This day they will show every sign of extreme debility, next day every one of restored vigour; because the operation of any stimulus given them soon rises to its highest, upon account of their high degree of excitability, and sinks as soon to its lowest, upon account of its own small degree^(p). Hence every sthenic diathesis, that happens to them, is short, acute, and soon removed^(q); nor is their asthenic state of long continuance, or difficult to be removed; provided there is no local affection^(r), and a proper method of cure is em­ployed^(s).

[Page 242] CCCCII. The marks of sthenic diathesis at this age are, great frequency of pulse, when compared with that of adults, more frequent than their own in health, dis­tinctly meeting the finger upon feeling it; a boundishness of belly at first, which becomes more free in the progress of the disease; dryness of the skin; burning heat, thirst, watching, strong crying.

CCCCIII. The signs of the asthenic diathesis at the same age are, a pulse not to be reckoned from its frequen­cy, small, falling softly like snow upon the finger of him who reckons it, so that he is uncertain if he touch it at all; a very loose scouring belly, with green matter; fre­quent vomiting; dryness of the skin, heat greater than natural, and greater in some parts than others; interrupted sleep, never refreshing: [...] voice in crying, fit to excite compassion.

CCCCIV. The former diathesis, besides other hurtful powers, is preceded by the use of found milk, animal food, an abuse of opium or strong drink; excessive heat after cold and moisture, which latter encreases the debilitating effect of the former; a strong set of simple solids.

CCCCV. The latter, together with the known hurt­ful powers, is preceded by the use of milk from a weak, sickly nurse; that of vegetable food, with [...]ug [...] in it; wa­tery diet; watery drink; habitual vomiting, habitual pur­ging, both by other means used for the latter, and particu­larly by magnesia, given with the intention of absorbing an acid; cold not followed by heat; a weak mass of simple solids.

CCCCVI. Consider which of these sets of signs pre­cede or accompany the croup, and whether its pyrexia be sthenic or asthenic. Weigh the different sentiments of authors upon the subject. Suspect their theories, but their facts still more. Be on guard not to be misled by the va­nity, emptiness, and rashness of young physicians; as well [Page 243] as by the obstinacy and bigotry of the older sort, that en­creases with their age and practice, to be bent by no force of reasoning, no weight of truth, scarce by the power of God: Regard their minds as bound in the [...]etters of preju­dice: Remember, that a whole age of physicians were in the wrong, except one man^(t), and persisted obstinately in their error, in the case of the Alexipharmac physicians: And, reflect within yourself, good reader! whether the pre­sent physicians, who follow the doctrines delivered in the schools, judge better than their predecessors, and do not run into the contrary extreme of madness, doing as much mis­chief in fevers, and diseases of pure debility, as they did in sthenic diseases, and in fact take a wide range of spreading destruction among mankind. Thus secured against mis­take, consider the cures of this disease that have appeared. If in those, or in any trial that you may make, you shall [Page 244] find that either bleeding and purging, or antispasmodics, as they are called, that is, stimulants succeed; then be as­sured, that, in the former case, the disease is sthenic, in the latter asthenic; of which you will be still more certain, if you shall find that the exciting hurtful powers and symp­toms, which have been enumerated, at the same time agree with the other marks of judgment.

A Description of Catarrh.

CCCCVII. Catarrh is a phlegmasia, in which, to the general symptoms mentioned before^(u), are added cough; hoarseness; and first a suppression, or slight encrease of the excretion from the nose, sauces, and bronchia, fol­lowed afterwards by a further encrease; arising from sti­mulant powers, often heat alone, but chiefly after a pre­vious application of cold; and to be removed by debilitating powers, often by cold alone, guarding against heat^(x).

CCCCVIII. The explanation of the cough is the same as that given before. But it is freer, than in peripneumony, and not avoided, because there is no inflammation in the neighbourhood to aggravate it, and raise pain^(y).

CCCCIX. That the hoarseness is owing to a suppres­sion of the vapour that should be exhaled into the bron­chia, may be known from this; that, when the hoarseness has remained long, almost without expectoration and cough, or with a moderate degree of them, while the sthenic diathesis continued in full force, and did not abate in the bronchia; upon the diathesis giving way, and the expectoration and cough becoming more free, the hoarse­ness abates, or goes off. That this can be effected by a [Page 245] stimulus of that kind and degree, that constitutes sthenic diathesis, is shown by the effect of strained speaking produ­cing temporary hoarseness, by silence removing the hoarse­ness, and cold drink relieving it.

CCCCX. The suppression of excretion is that of the mucus and exhalable fluid, related before^(z), and it ad­mits of the same explanation that was formerly given.

CCCCXI. That stimulants produce catarrh is evident from this, that heat alone, fulness in food, strong drink, and moderate exercise, for certain produce it; cold, cold drink, spare diet, and rest, as certainly and effectually re­move it. It was, therefore, a very unlucky mistake, to think it arose from cold alone, and was to be cured by heat. On the contrary, cold is never hurtful in it, but when its action is succeeded by that of heat, to be explained as be­fore^(a). The occurrence of catarrh so often in summer, where its action can be a thousand times traced back to heat, but not to cold; the influenza never needing the assistance of cold, which catarrh often does, in the man­ner just now said; its never succeeding to pure cold, but immediately to heat, facts known to old women, to shoe­makers and taylors, to sore-eyed persons and barbers, un­known to medical authors and professors, all confirm the same fact.

A Description of the simple Synocha.

CCCCXII. The definition of simple synocha is the same with that of phrenitis^(b), excepting the symptoms affecting the head. It is a slight disease, ending in health, often in one, always in a few days, unless when new hurt­ful powers, either accidentally, or from the use of a stimu­lant plan of cure, have been superadded.

A Description of the Scarlet Pyrexia.

CCCCXIII. The scarlet pyrexia is an exanthema^(c); about the fourth day of which, or later, the face swells somewhat, and at the same time the skin is here and there affected with a red efflorescence, and then checquered with large spots; which are afterwards to unite, and in three days to end in little scales, as if branny ones. This erup-does not arise, but in consequence of sthenic diathesis pro­duced from another source. And there is another similar to this, which accompanies an opposite disease, afterwards to be mentioned.

CCCCXIV. The eruption, appearing at a certain time, and remaining for some time, must be imputed to the fermentation, requiring a certain time, different in different diseases, and is to be explained in a similar man­ner as before^(d).

CCCCXV. The swelling of the face depends upon a greater degree of sthenic diathesis there, than any other e­qual part. And we are to imagine, that, besides the hurt­ful powers that usually produce it, it is encreased by the contagious matter, now approaching the surface.

CCCCXVI. This matter of itself produces no morbid state, only giving the exterior and exanthematic form^(e), and following the nature of the sthenic or asthenic diathe­sis. Hence, after its application, the disease that arises is sometimes sthenic, as this is, of which we have given a definition, sometimes asthenic, as that disease which we are afterwards to mention in its proper place. This view of it serves to reconcile the jarring and contradictory ex­planations, and methods of cure of authors, who have gone into such controversies to settle its nature.

A Description of the mild Small-pox.

CCCCXVII. The definition of the mild and violent small-pox is the same; excepting that there are often veryfew pustules, never exceeding one or two hundred in number: Sometimes the place only, which was inoculated, is be­set with pustules, without any other in the rest of the bo­dy; and besides, these there may be only one.

CCCCXVIII. The number of pustules and crouded eruption is occasioned not by the nature of the contagious matter, nor by its quantity, but by the sthenic diathesis, in so far as it is induced by the sthenic hurtful powers, in which the matter has very little participation^(f). If, therefore, that diathesis be prevented, and especially upon the surface, the eruption will never be crowded; and, af­ter it has appeared, if it be immediately removed, the erup­tion will never be dangerous.

CCCCXIX. As the contagious matter does not con­tribute much towards sthenic diathesis, for the reasons al­ledged^(g); so, that it does contribute something, is pro­ved by a crowded eruption both appearing and encreasing, when the diathesis, after the reception of the contagion, was not encreased by the ordinary hurtful powers^(h).

CCCCXX. And, therefore, while the excitement should be reduced below that degree which suits perfect health; there are, however, certain boundaries, beyond which we should not proceed in the debilitating process.

CCCCXXI For, when, the sthenic diathesis is very much reduced, and the excitement immoderately diminish­ed, [Page 248] there appears over the whole body, an eruption quite unlike the variolous, of a high scarlet colour, and in its progress proceeding constantly from a spotted appearance into a continued sheet of efflorescence⁽ⁱ⁾; which, unless treated upon a stimulant plan, would prove fatal.

A Description of the Mild Measles.

CCCCXXII. The definition of the mild measles is the same with that of the violent. To which all the rea­soning that has been employed about the small pox will apply. If, immediately upon the arrival of the catarrhal symptoms, the asthenic diathesis contrary to every mode of curing this disease hitherto thought of, be removed; often no disease of that kind which affects the whole body, follows. And the disease always proceeds with the same gentleness as the small pox treated in the same way^(k).

CCCCXXIII. The catarrhal symptoms are of the same nature as in the catarrh, and admit of the same cure, that is, asthenic (k).

CCCCXXIV. Catarrh, and simple synocha, are free from all inflammation, whether general or local. The scarlet fever, and the mild small pox and measles, are free from the general, and exhibit upon the surface a local, in­flammation of no consequence^(l).

A Discription of the Sthenic Apyrexiae.

CCCCXXV. The sthenic apyrexiae which are equally, free of pyrexia^(m) and every degree of inflammation, arise [Page 249] from a sthenic diathesis, that has less effect upon the vas­cular system, than the other sthenic diseases. ⁽ⁿ⁾.

A Description of Mania.

CCCCXXVI. Mania is a sthenic apyrexia; in which the mind is disordered, and forms false ideas of every thing.

CCCCXXVII. In so far as mania does not arise from a fault of the substance of the brain, which is a local case that sometimes happens: the powers that have the chief share in producing it, are excessive exercise of the mental function, and a high exuberance of passion. These, however, while they act more upon the brain than any o­ther part, at the same time do act more or less also upon the whole body, though not to the degree of drawing py­rexia after them^(o). Which is proved by the disease be­ing cured by a debilitating plan, and by other stimuli, as well as those just now mentioned, not immediately applied to the brain, but to a distant part of the system from it.

CCCCXXVIII. The most powerful of those stimuli are, spirituous or vinous drink, and opium, and, perhaps, some other things, taken into the stomach, and first acting there. Of the other asthenic hurtful powers, some of them­selves, and operating alone, have less effect in inducing ma­nia, and yet, even they, by their stimulant operation en­crease the force of those, that have that hurtful effect; as is proved by the effect of removing them in relieving the disease.

[Page 250] CCCCXXIX. If poisons sometimes produce mania, without hurting the substance of any solid part, their ope­ration must be supposed the same, as that of the general stimulants, their effect the same, and the disease a general one, and the same^(p). But if these very poisons act by de­stroying the texture of a part, they must be considered as the origin of a local disease^(q).

CCCCXXX. The heart and arteries are less affected in mania, than in any of the pyrexial diseases; because, the hurtful power, which chiefly affects the vessels, too much food, has less concern in the number of the hurtful pow­ers here. And yet that the food, superadded to the other hurtful powers, does prove hurtful even in this disease, is evident from a contrary power, abstinence, being, among other remedies, found of very great efficacy in restoring the healthy state. Which, with what has been said above, proves that mania is not a disease confined to a part, but extended to the whole system.

CCCCXXXI. Although, in the diseases that have just now been mentioned^(r), the pulse is commonly said, and believed, to be not at all affected, that, however is not exactly the truth; for in mania, so long as it continues to be a sthenic disease^(s), more or less of sthenic state can be perceived^(t).

The Description of Morbid Watchfulness.

CCCCXXXII. Pervigilium, or morbid watchful­ness, is a sthenic apyrexia^(u); in which there is no sleep, [Page 251] or no sound sleep, and the mind, in a startled state, is agi­tated with vivid, strong, or uneasy impressions.

CCCCXXXIII. The hurtful powers, that produce perviligium, are the same with those, that produce mania, but inferior in force. It is evidently produced by hard thinking, commotion, or disturbance of mind, in prefer­ence to other hurtful powers. The degree of thought, that has that effect, is not ultimately excessive; for, if it were, by effecting a temporary waste of the excitability, it would produce sound sleep; or if it repelled sleep, it could only act so, by means of indirect debility, the consideration of which is foreign from this place^(x). And the same is the degree of disturbance of feeling, that proves hurtful, in so far as it produces this disease: Every ultimate excess of which^(y), either ends in sleep, or induces that vigilance, of which indirect debility is the cause. But it is not a sin­gle operation of the intellectual faculty, or of the state of any passion, or one that happens but rarely, that proves adequate to the effect. For the effect, in that case, would be either too slight, or of too short continuance; to merit the title of disease. It is an often returning, or deeply af­fecting, irritation upon the brain, and, therefore; one that leaves a lasting impression, which has any considerable force in producing this disease. In this last way, an eager, inordinate, and vast desire for the attainment of high ob­jects of pursuit, the impulse that hurries on to the revenge of a great injury, and the horror that arises upon the per­petration of it, the fear of future punishment for crimes, are held up to us as productive of high commotion of mind, in the examples of Cataline, Orestes, and Francis Spira. As often, therefore, as the mind is so excited in its ideas and passions, as not to be capable of being composed to rest and sound sleep, after a certain short continuance of those, [Page 252] or other stimuli; so often are we to conclude, that this disease takes place.

CCCCXXXIV. As the hurtful powers just now men­tioned^(z), produce this disease; so there are others, which belong not to this place, but are to be mentioned, that al­so repel sleep.

CCCCXXXV. To pervigilium belong all the hurtful powers that have been already mentioned in mania^(a), whether acting within or without the brain, but acting with less force, and which yield to the asthenic plan of cure.

CCCCXXXVI. As the powers stimulating vigour­sly in this way^(b), and without any diminution of their sum of stimulating, produce pervigilium; from that we learn that the cause of this disease is the same with that of the rest of the sthenic form of diseases^(c), and that the same is the state of body in which every one of those diseases consist: Nor is it understood, that different hurtful powers, but precisely the same, with only a variation in the proportion of their force, which often happens to other sthenic disea­ses precede this disease.

CCCCXXXVII. The same fact is also discovered from the functions, of which, though th [...]se diseases are called apyrexiae, or without pyrexial state, the pulse, however, is not altogether free of disease^(d). On the contrary, it is as much stronger than in health, or in the predisposition to asthenic diseases, or in those diseases themselves, as there is more vigour, and more excitement upholding that vi­gour, in the system^(e). And the state of the other func­tions, [Page 253] except those of the brain, that are chiefly affected, is truly the same as in the milder sthenic affections, or in the predisposition to these. But, if the brain in this dis­ease, and in mania, is much more affected than the rest of the body; there is nothing unusual in that circumstance; it being an universal fact with respect to both diseases and the predisposition to them, that some part is more affected than any other part ^(f).

A Description of Obesity.

CCCCXXXVIII. Obesity is a sthenic apyrexia^(g); in which in consequence of an excess of health, rich living, especially in the article of food, and an easy sedentary way of life, the sat rises to the degree of incommoding the func­tions.

CCCCXXXIX. That obesity, so defined, is a disease, is understood from the definition of disease^(h); and that it is a sthenic disease, appears from the certain signs of sthenic diathesis in it. Of which, the strong action of the stomach, whether the apetite or the digestion be conside­red⁽ⁱ⁾, and the strength of the other digestive organs, are a glaring proof.

CCCCXL. And as in this disease, the stimulus of the exciting powers, raises the excitement above that degree of it which suits good health, to that in which sthenic diathesis consists, without which last there could not be such force in the action of the stomach, and of the organs that form chyle and blood; so, it is in common to this with the other diseases called sthenic apyrexiae that the sum of all the stimuli is much less than in the o­ther diseases of the same form, that is, those with pyrexia and inflammation; that it never rises to the extreme height at which indirect debility is produced, and is never indeed [Page 254] so great as to be sufficient to have any considerable effect on the heart and vessels.

CCCCXLI. But it happens to all those diseases, that both these last and all the other functions, get somewhat above the standard of the sound functions, and a great deal above asthenic diathesis. And the sthenic apyrexiae differ from the other sthenic diseases chiefly in this, that the ex­citing powers keep much within that degree of force, that wastes the excitability much; as is perceived from the proof of the effect; for they are diseases of much longer standing than any other asthenic diseases.

CCCCXLII. From which fact, however, much the brain may be affected by its own proper stimuli; however great the quantity of blood in its vessels may be; unless to the excitement arising from these, that excitement, which the other stimulant powers produce, be added, it is cer­tain, that the general effect will be much less, and that the united energy of all the powers has far more effect, than the separate force of any.

CCCCXLIII. The diathesis, then, in these diseases, is, upon the whole, less than in the rest of the sthenic dis­eases; that of a part, as of the brain in mania and pervi­gilium, and of the blood-vessels in obesity, is pretty consi­derable. The whole is in general as great as that in the predisposition to the other diseases, and exceeding its force in the labouring part. Hence it comes out, that, contra­ry to the nature of those other diseases, and similar to the predisposition to them, they are usually of long standing and duration, and for this reason, that the mediocrity of the sum of stimulant operation never consumes the excita­bility, and always produces too much excitement. The great tumult of symptoms in the brain and blood-vessels in these diseases does not imply a great sum of excitement, for this reason, that the affection of a part, however for­midable, compared with the affection of all the rest of the [Page 255] body, is infinitely inferior in its degree^(k). However much, then, any stimulus presses upon a part, and from that spreads at large over the rest of the body; unless, how­ever, other stimuli, applied to other parts, sustain its ope­ration, so as that the sum of the operation of them all may deeply affect the whole body: the effect of the solita­ry stimulus, making a figure in a part, will be less consi­derable in the rest of the body: In fine, it must be kept in mind, that every violent disease always arises from the excitement which the united force of several stimuli has produced.

CCCCXLIV. In these sthenic apyrexiae, as a certain part, the brain in the two first, and the blood vessels in the last^(l), is much more affected, and in greater propor­tion, than in the other sthenic diseases, because the affec­tion of the part is much less supported by stimuli acting upon the other parts; so the stimuli, acting in that way upon the labouring parts, are, however, understood to affect the rest of the body, though less considerably. That this is the fact, is proved by there being in this case, no asthenic diathesis, and evidently such a sthenic one, as up­holds the predisposition to other diseases of the sthenic 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 least expected, that every stimulus that affects a part, affects the whole body, upon account of the excita­bility being one uniform, undivided, property over the whole.

CCCCXLV. With respect to obesity in particular; that the other hurtful powers, as well as food, have more or less effect, one may know from the certain fact of the [Page 256] digestive powers, which depend upon the influence of these powers, being of such force and vigour, as to perform their function [...] more perfectly in fat persons, than in others, who are, nevertheless, not by any means weak. Yet these hurtful powers are applied in a degree short of that, which being ultimately excessive, or approaching nearly to that, puts an end to excitement by wasting the excitability, or which tends, by a high degree of disturbance, to exhaust the body.

CCCCXLVI. Thus passions are not with such per­sons too stimulant; a circumstance known to the generality of mankind, among whom it is an adage, that fat persons are commonly good natured^(m), while morose persons are for the most part lean. Thus it is observable, that fat persons are averse to thinking, which is a great stimu­lus⁽ⁿ⁾. They are averse to bodily motion, by which all the functions, and particularly that of the vessels, are much excited, and the perspiration proportionally promoted; and they have so far reason for it, that all motion is more fatiguing to them than to others. Hence, that quantity [Page 257] of fluids, which under motion is usually thrown off by the pores on the surface, and turned out of the course to the adipose cells, has a great opportunity of quitting the direction to the former, and of turning aside, in a state of rest, to the latter.

CCCCXLVII. After explaining the peculiarities of these diseases; it is now to be observed, that, since the af­fection of a part in general disease, depends upon the gene­ral affection, is of the same kind, arises from the same ex­citing powers, and is removed by the same remedies^(o); it is from that reasonable to believe, that the affection of a part, whether it be inflammation, or a greater affection of the brain or vessels, than of any other part, is not different in different cases, but altogether the same in all; that it only differs in some trifling circumstances of no signification, and by no means requires a different plan of cure, or affords fundamental distinctions; and that a mistake, which has had the most ruinous effect upon the art, must be done away. It is with propriety, then, that all the diseases that have been treated of, have been reduced not first to two genera, and after to species, but, without regard either to genera or species, only to two forms.

CCCCXLVIII. Further, as in all those diseases the whole morbid state, either in so far as it is universal in the system, or confined to a part, proves hurtful by giving too much excitement; and as the remedies, that remove the general morbid state, also remove the portion of it con­fined to a part, and are never to be directed to a part^(p) with the view of removing, by their action upon it, the disease, as if all locked up in it; the meaning of all that is, to lay a sure foundation for the establishment of a cer­tain series, or scale, of encreasing strength from perfect [Page 258] health to the most sthenic disease. In that scale peripneu­mony holds about the highest, and obesity the lowest, de­gree.

CCCCXLIX. Peripneumony and phrenitis in the upper end are followed by two diseases, that sometimes equal them; the violent small-pox and measles. These two are succeeded by a disease, that sometimes vies with them, the erysipelas, when accompanied with a most se­vere affection of the head. Equal to this, not in danger, but for the most part in the degree of diathesis; rheumatism comes next. Next to rheumatism is marked the mild and gentle erysipelas, far short of those above it in violence, and claiming nearly an equal place to the sthenic cynanche, being much more nearly allied to the latter than any of the former. Those are the diseases accompanied with pyrexia and inflammation.

CCCCL. Of these two which stand lowest, the mild erysipelas and the sthenic cynanche, or common inflam­matory sore throat, are of so doubtful a rank with respect to each other and catarrh^(q), a disease without the accom­paniment of inflammation; that it is doubtful which of them all should be set above the others. Below them, however, the simple synocha and scarlet fever, in so far as the latter is an asthenic disease, and in so far as the usual state of them both is considered, are to be placed without any hesitation^(r). The lowest part of the scale of sthenic [Page 259] diseases with pyrexia, is assigned to the small-pox and mea­sles, in their mild state.

CCCCLI. Through this whole scale it is not so much the titles and names, that have been made use of, bu mor­bid energy, that is regarded; it being the certainty derived from the cause, not the uncertain and perfectly deceitful consideration of symptoms, that was to be considered^(s). The investigation of symptoms, which has hitherto been devoid of all benefit, has been of the highest detriment to the art; and as much in medicine the most productive source of fundamental blunders, as the question about ab­stract causes had been in the other departments of philo­phy^(t) must be laid aside, and Nosology damned.

CCCCLII. Below the last mentioned diseases, mania, pervigilium, and obesity are set. Betwixt which, and the diseases mentioned above, is the point of perfect health to be fixed^(u).

The Cure of the Sthenic Form of Diseases.

CCCCLIII. To apply the indication of the cure of the sthenic form of diseases to practice; that mentioned before^(x) will be accommodated first to a violent degree of the diathesis and danger of parts, in such a manner, as that regard only will be had to the degree of force in the reme­dies^(y).

CCCCLIV. When, therefore, a violent diathesis is discerned, as in peripneumony, phrenitis, the small-pox, the measles, and erysipelas, in the highest degree of these three last, immedate recourse must be had to the most powerful [Page 260] and quickly effectual remedy; and so much blood should not be taken, as many who entrust nearly the whole cure of the disease to it, think^(z), but more, however, than others are of opinion, should be taken away^(a)

CCCCLV. No measure suits all cases; the quantity to be taken being different in different cases, as those differ in age, sex, strength, and in the degree of force applied by the exciting hurtful powers. In child-hood, which, ex­cepting the measles, and small-pox^(b), is seldom affected with the diseases we have mentioned, and in a very advan­ced age, which is also in less danger than that at the flower of human life; sparing bleeding succeeds for this reason, that, at both those ages, it is a lesser degree of excitement that upholds the disease as a cause; while in the former, the high degree of excitability, in the latter the necessity for more stimulus or exciting power, than formerly, set bounds to the measure of the remedy.

CCCCLVI. A better rule for limiting the degree of bleeding is the relief, or temporary solution, of the urgent symptoms. If, therefore, after blood has been taken, the great heat, the hardness of the pulse, the affection of the head or of the lungs, and dryness of the surface, shall have gone off, or been much abated; and now the temperature is discerned to be much more moderate, the pulse more soft, and less frequent, and the surface of the body more moist, at least less dry; if the pain is every where quieted, [Page 261] the breathing relieved, and the delirium removed^(c); then it may be looked upon as certain, that enough of the vital fluid has been shed for the time.

CCCCLVII. To obtain that benefit, in the most vi­gorous adult state 10 or 12 ounces, and much less either before or after that period of life, will for the most part be found sufficient. As this rule will not answer in every case, when it fails, recourse must be had to that, which recom­mends the abatement of the symptoms as a direction more to be depended upon^(d).

CCCCLVIII. Since the local affection depends upon the degree of the the general^(e) diathesis, remember, there­fore that there is no occasion for any particular direction with regard to it, any farther, than to take advantage of its being accessible to help the general remedy by an ap­plication of it to the part^(f).

CCCCLIX. When that has been done, and the first vi­olence of the disease is no [...] broken; we must next have recourse to purging the b [...]y, as a great remedy in point of efficacy^(g). To effect which, we should not employ violent means, such as many formerly employed^(h); the stimulus accompanying the first operation of which being liable to be hurtful; but it is the gentle cathartics that should be depended upon, such as Glauber's salts, which are highly debilitating, and carry a great quantity of fluids out of the vessels. Though a man of good sense in the last century used these day about with bleeding; yet, if [Page 262] the violence of the disease should be urgent, there is no­thing to hinder the use of them the same day that the blood has been taken.

CCCCLX. Purging, after a sparing bleeding, has more effect in overcoming sthenic diathesis, than any bleed­ing without it; because, 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 first applied than in any other,) is applied to more parts; and not only to the greater blood-vessels, but also to a prodigious num­ber of their terminations; and the excitability is more ex­tensive, and therefore, with more equality diminished⁽ⁱ⁾.

[...], Vomiting, which, in asthenic diseases, where it is pernicious, has hitherto never been admitted in the common practice, and in sthenic ones, where it is of the greatest benefit, ever neglected, comes in here as a proper part of cure; being of the same evacuant nature, and in another part of the same canal, and admitting of all the reasoning that has been applied to purging.

CCCCLXI. At the same time that the excessive, and therefore hurtful, use of the lancet is superseded by those two last mentioned evacuations; its use, however, is not altogether to be laid aside in the the diseases of excessive ex­citement; and for this reason, that the excitement, by its stimulating operation often rises to that high degree, that, from the consumption of excitability which puts an end to it existence, threatens instant death^(k).

CCCCLXII. Besides, those remedies^(l), the patient should always be required to abstain from every sort of food but vegetable, and in a fluid form, as well as from all strong drink, and indeed all but watery drink, accidulated^(m). [Page 263] This direction does not seem to have been so much ne­glected in words by former writers and authors, as in fact and actual application to the practice; it having been de­livered slightly, by the by, and as if it had been thought of no consequence with such effect, that its force made no impression upon the mind of the reader or hearer. No sti­mulus is more powerful, and, therefore, in this part of the practice, more hurtful, than that of the articles of di­et: Consequently, whatever quantity of blood is taken from its vessels, whatever quantity of serous fluid is carri­ed off by the mouth and anus, if that stimulus is not round­ly guarded against, all this evacuation may easily be frustra­ted. While that is the case, still fluid vegetable matter is not to be discharged, and for this good reason, that wa­tery matter is not kept in the vessels; but, easily entering the smallest of them, flows out in all directions by their va­rious outlets; and, at the same time, supports the efficacy of another remedy⁽ⁿ⁾, by and by to be mentioned.

CCCCLXIII. Conjointly with the use of the first bleed­ing, of the first vomiting and purging, and that of absti­nence and watery drink, it must not be forgot, that parti­cular regard must be paid to temperature^(o): For, if cold always debilitates, and if that is its proper operation^(p), if it only seemingly acts otherwise, because heat succeed­ing to its action, or alternating with it^(q), converts it into a stimulant one, if it alone is adequate to the cure of the small-pox^(r), and prevents the violence of that disease, if it is the best remedy for catarrh^(s), and, when heat is avoid­ed, of the greatest assistence in every sthenic disease; it is not to be doubted, but that it is of the greatest benefit in the diseases of the highest sthenic diathesis.

CCCCLXIV. Its operation in the small-pox, and in the rest of the sthenic diseases, is not different, but altoge­ther [Page 264] the same. Nay, in all the diseases of this form, as cold alone is sufficient to effect the cure; so, whenever the dia­thesis, which is the case in the diseases that make our pre­sent subject, rising to its greatest rage, demands instant re­lief; because, in that case, every moment's delay brings in­stant danger; because the remedies, which we have men­tioned, are sufficient for the solution of the disease, of which we have the direct proof in the practice; because that de­gree of cold, which could produce that effect, is neither al­ways within our reach, nor can be managed by every per­son; and many persons might not be disposed to believe its effects so beneficial: For those reasons we should not desist from the plan of cure here laid down^(t), and do our best for our patient, by taking off the blankets, and other clothes, by cooling the room, and, instead of laying him on a couch or bed, putting him into a chair.

CCCCLXV. This plan of cure should, for the most part, be preferred to that of the most intense cold, for this fur­ther reason, that the shortness of the time in which any one could possibly remain in it, would oblige him immediately to return to higher temperature, which would produce a greater stimulus of excitement, than that he had been under before his exposure, at least too great a stimulus^(u).

CCCCLXVI. Since such is the operation of cold^(x), the power falsely imputed to it of occasioning the striking in of the measles, is to be imputed not to cold alone, but to heat and other stimuli; giving, as has been explained, more excitement^(y), than if it had not preceded. And why not? If cold does not interrupt the eruption in the small-pox; but, on the contrary, by an enlargement of of the diameters of the perspiratory vessels, which are shut up by sthenic diathesis, highly promotes the discharge of [Page 265] that matter^(z): Why, in a most similar case, should its operation be supposed different, not to say, diametrically opposite? Must we again have the trouble to refute the false notion of thinking a cause precisely the same should pro­duce contrary effects? Cold diminishes the eruption in the small-pox: It makes it disappear in the measles. What then? Take a nearer view of the fact: Is its effect in both these cases to be supposed the same, or different? How comes any person to know, that the matter, which has disappeared, is driven into the interior parts? What proof will you bring of that? Confess the truth: And be candid enough to acknowledge, that this is another relic of the alexipharmac doctrine, handed down to us, which supposed, that the stimulus of heat as well as other stimuli promo­ted, and that cold impeded, perspiration. And after a great man had shown the error of that doctrine, both in the small-pox and other diseases^(a), because he did not car­ry the application so far as the measles, neither has any one of his followers, who never could step a nail's breadth be­yond his words. But it might have been observed, if ob­servation had been any part of their employment, that the mea­sles was a sthenic disease as well as the small-pox. Are not all the successful remedies in both of the debilitating kind? And as it was manifest, that in the small-pox also cold debilitated, or in the common language, acted as a sedative; might no [...] some suspicion have, from that very circumstance, occurred to their mind, that cold, in the measles, did not stimulate, or act as an astringent; and in that way, repel the eruption, but performed the same operation as in the small-pox? Is it, to such a degree, difficult and up-hill work, to think and use one's own [Page 266] good sense, that, a great part of mankind, even those who take upon them the business of teaching and taking the lead of others, in no case, ever think of exercising a moment's reflection of their own? But, in this case, it may be con­tended, that the action of cold is peculiar, because, after the eruption, which it is supposed to check, has disappeared, all the symptoms encrease in rage and violence. Con­sider what that circumstance makes for the argument, or whether it makes any thing, and not absolutely against it? Was the action of cold, that is supposed, followed by that of stimulant or debilitating powers? If it was by the former, the cause of the mischief must be imputed to them; which, as has been said just now^(b), produce ex­cessive excitement after a previous application of cold, and more than without it; if the latter, or debilitating powers were used, then there would not be wanting a suspicion, that cold had a concern in the effect. But it is not so: And, in every case, in which the action of cold has been followed by sthenic diathesis, the true cause of that effect is not sufficiently guarding against the stimulus of heat, as well as that of other noxious powers. And this is most clearly proved by the use of heat being positively ordered, instead of being forbid, in the common practice. Nor is that to be wondered at: For if the cause of catarrh^(c) de­ceived physicians so much, the catarrhal symptoms in the measles could not fail to deceive them. And, if doctrines, discarded in words, are often kept up in fact; what was there to hinder this part of the alexipharmac doctrine from meeting with a similar fate?

CCCCLXVII. If cold, therefore, can scarce be so manage [...], as that the effect occasioned by the accompani­ment, the succession, or the alternation, of stimulants [Page 267] with it, may be prevented, whether that be the fault of the physician, or owing to the difficulty of the nature of the thing^(d); it is, notwithstanding, a rule in common to the measles and other exanthemata of the same stamp, to avoid heat, and compensate for the degree by the great­er duration of cold, and to guard with all possible care a­gainst every stimulant power. It is now then most evident, that the opinion of cold being peculiarly hurtful in the measles, both in that and every other disease of the same form, falls to the ground.

A Repetition of the Cure.

CCCCLXVIII. After using the remedies which have been mentioned^(e), when the symptoms are renewed, the same train of medicines must be again gone through: Blood must be again taken, emetics and purgatives again admi­nistered; nor must we desist from the use of the refrige­rant and attenuant plan: And all these particulars must be executed, till the tumult of the symptoms be allayed, and the healthy state, at least for the time, be restored; and perhaps the repetition may be required a third time or oftener: After doing which:

CCCCLXIX. If the diathesis seems now nearly remo­ved, if the affection of the head, of the lungs, or any in­ternal one, seems alleviated or repelled; and yet there is some apprehension of a likelihood of the return of the dis­ease: in that case, recourse must be had to more gentle debilitating powers. Sweating, the stimulus accompany­ing the first operation of which, the body, as the diathesis is now rendered mild or ended, will be able to bear, must be preferred to bleeding, vomiting, and purging. But before proceeding to speak of it, it seems proper to say a [Page 268] few things upon the sum total of blood that should be ta­ken during the course of the disease.

CCCCLXX. As in single bleedings, so also in the whole quantity of blood to be taken, the sum should be a mean betwixt those, which the common run of physicians approve, while some think too much, some too little, should be taken. The reason for this recommendation is strengthened, by the consideration of there being now less occasion for shedding a great deal of the vital fluid, since the cure is now more divided among the other remedies that have been spoken of. The age must be regarded, as was formerly recommended^(f), the former mode of life must be looked to, the quantity of stimulus, that may lately have preceded the morbid state, must be considered, and the state of the body compared with the degree of the symp­toms and the effect of the cure. From those circumstan­ces a judgment should be formed of bleeding and other eva­cuations; and it should be estimated, what further of the same sort may seem 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 less occasion for any one medicine, the more freely others have been brought into use; and it will be understood, that the dan­ger of too great evacuation will be thereby avoided, and the health better secured^(g).

CCCCLXXI. With respect to the kind of bleeding, it should always be made from a very large vein; because the cutting a lesser one, or opening an artery, does not afford a sufficient quantity for the relief of the vessels, and art [...]riotomy is further attended with certain inconvenien­ces^(h). As far as any certain rule, in an affair of such [Page 269] varie [...]y, can be established, two pounds of blood in three or four days, with the assistance of the other remedies, will, for the most part, be sufficient at the middle age of life, and less at a more early or later period.

CCCCLXXII. All bleeding should be followed by vomiting and purging, so long as any considerable part of the sthenic diathesis remains; nor should the other parts of cure, that have been pointed out, be neglected. But purging, a single dose of which can at any time, bring back a fit of the gout; which cures the sthenic cynanche or common inflammatory sore throat, and the mild erysi­pelas, when even the face or head is affected; which is of manifest detriment in fevers; which, in dyspepsia, in as­thma, and every sort of diseases depending upon debility, whether direct or indirect, does very great and conspicu­ous mischief; and is a great part of the very bad, common method of cure over the whole form of asthenic diseases; in proportion as it ought to be avoided in all those diseases, should be as certainly laid hold of in sthenic diseases, and not omitted in any considerable one, such as those are that require bleeding, but be managed according to the direc­tions given⁽ⁱ⁾ lately, and as it was directed to be managed before^(k). And we must, above all things, be on our guard against that diffidence in the use of this remedy, as well as in that of vomiting, where they are seviceable, and that confidence in them when of disservice, both introdu­duced by the spasmodic doctrine; and know that they were both admitted upon a false and absurd principle.^(l).

[Page 270] CCCCLXXIII. As nothing in asthenic diseases has been more used than these two modes of evacuation, no­thing with more hurt, and often with instantaneous de­struction; so, for that very reason, nothing is more hap­py and successful than their use in the cure of sthenic dis­eases.

CCCCLXXIV. It is scarce credible to say, how far the aversion to the alexipharmac method of cure has had the effect of branding the very best medicines, what a de­praved use of them it has suggested, and to what a degree it has perverted their proper use. Not to repeat what has been formerly said of that kind in other instances; sweat­ing, which is of the highest service, and a most efficacious means of cure, in every moderate sthenic diathesis, in every degree of it, that is not the highest, or where it presses not upon any organ of importance to life; that is, in all the diseases of this form, except in the beginning of those of which we are here treating, has, however, of late been completely banished from the cure of every one of them, but one, not only, as useless, but as hurtful; which has chiefly happened since the spasmodic doctrine began to be received into this country, and, for a few years only, gradu­ally to gain ground^(m).

CCCCLXXV. But, in truth and fact, except rheuma­tism (which, at least as produced by one form of a medi­cine, it is allowed to cure), if it most certainly either re­lieves or removes the sthenic cynanche, erysipelas itself, and catarrh, and the simple synocha, in proportion to the more free or sparing use of it; if that be known to the very vul­gar, [Page 271] and most certainly to physicians, of any other than the spasmodic practice; what reason, what certain and well pro­ved fact, will any one bring, to show why sweating should not be used, after the most violent diathesis is much dimi­nished by the other medicines, and is now reduced to that small degree, to which that remedy is adapted; what elo­quence would be requisite to bring any man of sense into such a persuasion?

CCCCLXXVI. They will say, that the heat, which accompanies the first part of the operation of sweating, may be hurtful; for as he never made trial of it, he has it not in his power to say, that for certain it will be hurt­ful⁽ⁿ⁾. As that effect will readily be admitted in an high rage of diathesis, threatening indirect debility^(o); it will not also be granted, that in a moderate degree of the dia­thesis, either from the beginning, or effected by [...] other remedies, and, consequently, after the plan of cure, that we have laid down, has been executed, that such heat will not be compensated by the great profusion of fluids taken away over the whole body; and that, when this part of the [Page 272] vascular system has been freed from a violent stimulus, the diminution of excitement will not be more equal in all the vessels, and over the whole nervous system. If the nume­rous vessels, that open into the intestines and into the sto­mach, are so powerful in diminishing sthenic diathesis, how should a similar evacuation in the similar perspiratory ves­sels have no tendency to produce the same effect? With which reasoning, if the facts just now related be further con­joined, what will any person have to say against the use of sweating, when a degree of heat, not greater than what can­not be avoided, attending the operation of the sweat, can no longer be hurtful, and the sweat itself certainly to be of great service^(p). Let the spasmodic caviller against the use of that remedy, in the cases of sthenic affection where it is admis­sable, mus [...]er up all his facts and all his theories, let him turn himself into all shapes, he will never produce a solid argument against this remedy. But what, again, is all this about? Will there never be an end of running from one extreme of error into the opposite? Shall no mean be found betwixt the Alexipharmac plan of cure, and an equally bad or worse one? If that doctrine hesitated not to pre­scribe sweating in the rage of a peripneumony, and that too by means of the most heating stimulant powers; does it therefore follow that a plan of cure must be admitted, which rejects the certain and safe use of that remedy, when con­ducted by the most gentle means? If it was the opinion of [Page 273] Dr. Sydenham, that heat should be avoided in the cure of sthenic diseases, which was quite right, as heat certainly en­creases the excitement; are we, for that reason, to avoid that tolerable degree of heat, which accompanies a remedy the most powerful in restoring the healthy state, and, there­by, deprive ourselves of great benefit upon the whole? If such persons did not know, that several remedies dimi­nished excitement more powerfully than any one; and, if they were to be forgiven for that; were they also to be ex­cused for not seeing, what any empiric might have seen, that is, that some things were of service, and others of disser­vice; was that want not of genius, which is not required of them, but of common sense, also to be pardoned? If thinking without a leader, and making any sort of disco­very, was too much, and not to be expected from them; is it not somewhat surprising, that out of a thousand per­sons, who had treated of every part of medicine, and enter­tained different sentiments from one another, in some mea­sure right, and, no doubt, wrong too, they could squeeze no information, but always trod in the footsteps of one single man?

CCCCLXXVII. Sweat, therefore, after the manage­ment that has been mentioned, is to be excited, and so much the more determinedly, if there should seem some­thing still wanting to the complete return of health, some degree of sthenic diathesis still remaining, and a spontane­ous tendency to it should appear.

CCCCLXXVIII. When the signs of a spontaneous sweat arising are perceived, nothing more is to be done, but first to lay the clothes about the patient, remove the sheets, put the blankets next to his body, guard against the ap­proach of air, and keep up the discharge for a sufficient length of time, at least ten or twelve hours. If, by this management, there shall ensue a copious and universal flow of sweat, there will be no occasion for giving a me­dicine. [Page 274] After it has succeeded, and encreased the relief formerly procured; if it should sink in towards the end it, should at last be supported by Dover's powder, or by laud­anum alone, covering the body, so as that it may get as quickly as possible to the surface, till the expected bene­fit be obtained. And to this management it must be ad­ded, that, if a draught of cold water be sometimes given, and then the body well covered up and properly managed, the business often succeeds to our wish. But, as in the o­ther cases, that belong to this part of our indication, the sweating must then only be set on foot, when the medio­crity of the diathesis, procured by the other remedies, will permit; so in the small-pox and measles, because there is occasion for a certain time to allow the matter to pass away, we must also keep that in our eye, and never be too early in making trial of this remedy. Lastly, if the heat should happen to prove hurtful, if at any time the flow of the sweat should be attended with less relief, or with some in­convenience, it should be immediately stopped: For it was not for no purpose, but for that of making the reme­dies supply the defects of one another, and of reducing the excitement more equally over the whole body, that a num­ber was recommended.

CCCCLXXIX. In all the cases of a violent diathesis, all the remedies that have been mentioned, are more or less, and differently on different occasions, in proportion as the remaining part of diathesis may require, each in a larger or smaller quantity, to be brought into play, and the curative circle enlarged: And besides them,

CCCCLXXX. Some of slighter consequence, such as acids and nitre; some of uncertain use, such as leeching, cupping, and blistering, are mentioned, as of the first con­sequence. Of these, the acids, in so far as they render the drink more agreeable, and, in an affection of the lungs do not produce cough, and prove, in a certain measure, [Page 275] refrigerant, are to be permitted; and more certainly, if there should be a desire for them. Every body should know, that the refrigerant power of nitre is less than is commonly thought. In rheumatism, and the sthenic cy­nanche if the latter should be unusually severe, blisters, leeches, and cupping-glasses, applied in the neighbourhood of the inflamed parts, may, in some measure, be of ser­vice. Nor does there seem to be any reasonable objection to the clapping a cap of recently dug-up earth upon the head in the case of phrenitis.

The other Part of the Indication of Cure.

CCCCLXXXI. To pass over to the other part of the Indication of cure^(q): When there is a gentler diathesis in the habit, as in the other phlegmasiae, and sthenic affecti­ons, that have not been yet named in the cure; as in the mildest state of erysipelas, of the sthenic cynanche, catarrh, simple synocha, the scarlet fever, and the mild small-pox and measles; a smaller force of debilitating power is re­quired; and, therefore, neither all the remedies that have been mentioned, nor in general so much of each, as in the other part are demanded.

CCCCLXXXII. In all these cases, not even with the exception of rheumatism, which depends upon a very great diathesis, bleeding is not necessary; and with the exception of that disease, bleeding, with any degree of freedom, is hurtful: For, when the excitement is not the greatest, and, on the contrary, is moderate, scarce exceeding that de­gree that produces the predisposition to other diseases; in that case it is absurd to make use of a most debilitating power, by way of a remedy, as if we had to combate a ve­ry violent disease. And, since the intention in bleeding is to prevent an ultimate excess of exciting power from [Page 276] producing a cessation of excitement in death, an event of which there is not the least danger, in a moderate diathesis, such as that, which is the cause of the diseases here in ques­tion; for that reason, the cure must be adapted to the cause, and bleeding must be either abstained from altogether, or very sparingly used.

CCCCLXXXIII. It is not, therefore, only in diseases of debility, which belong to the other form (in most of which it has, nevertheless, been, and still is, the custom, to spill more or less of the vital fluid); but also in all the diseases of this form, except the very violent ones, that the lancet is to be restrained.

CCCCLXXXIV. Though in rheumatism the diathe­sis often runs considerably high, the usual profuse bleeding, is not, however, required. For, as every diathesis is always greater in some parts than in any other equal one, so it is with the sthenic diathesis in this case; which is [...]ound much greater upon the surface of the body, than in any other equal space within. And the reason is, that the most powerful noxious agent, heat, succeeding to cold, or so alternating with it, that its own stimulus is encreased by its effect^(r), directs its principal energy to the surface of the body. Hence, after excessive bleeding, the disease, notwithstand­ing, often obstinately recurs. The cause of which fact, if the principles of this doctrine be well understood, can­not be obscure. Bleeding diminishes the sthenic diathesis chiefly in the red vessels, less in any of their extremities, least of all in the perspiratory vessels, and those disposed of in the tract of the muscles; and still less in the last, because the operation of the bleeding is counteracted by that of heat: Which is an explanation confirmed by the certain testimony of physicians; who often complain that their favorite remedy sails them.

[Page 277] CCCCLXXXV. Upon which account, sweating, which we spoke of so lately, is remarkably adapted to she cure of this disease: To it, therefore, after a previous bleeding to twelve ounces, and observing the rule of tem­perature and diet before directed, must we have immediate recourse, if the diathesis happens to be considerably vio­lent, and is signalized by heat of the body, by pains raging most in the night time, and by a strong and hard pulse. In order to render the sweat universal, and of sufficient du­ration, it should be brought out by Dover's powder, or laudanum, as before hinted, and kept up for twelve hours in full [...]low, and then some hours longer, or till the abate­ment of the symptoms, in the form of a moisture or free perspiration, and repeated when the symptoms return. The rest of the cure must be entrusted to low diet and an exact temperature.

CCCCLXXXVI. In this case, after the sweating course, and also in that of a simple synocha, of the scarlet [...]ever, of the sthenic sore-throat, of catarrh, erysipelas, and the gentle small-pox and measles, when the diathesis is somewhat considerable, but far short of that rage which constitutes the case of cure first taken notice off; we should use either a very small bleeding, and then chiefly the eva­cuations before-mentioned^(s); then a slight and short sweat ought to be kept up not longer than eight or ten hours; and, during the whole time of the cure, we should go on with abstinence, weak drink, rest of body and mind, and cold, unless in the time of sweating, and even then, with as little heat as possible; and, finally, with tranquillity of mind, as these were formerly enjoined: The united use of which is perfectly equal to the removal of any of these diseases; but there will not always be occasion for them all.

[Page 278] CCCCLXXXVII. Often so gentle a diathesis occurs, that one or two of them, once or twice employed, is suf­ficient for the cure: So slight a diathesis that is, in which, unless for a little at first, the shivering, langour, and then heat, is very moderate, pointing out a proportional slight­ness of diathesis upon the surface; in which there is scarce any lassitude, showing the same moderation of diathesis in the organs of voluntary motion; in which the vigour of the stomach remains, manifesting a moderate excess of ex­citement in it; in which, in fine, the other functions, o­ver the whole body are sufficiently calm, and only suffer conspicuously in the labouring part: In these cases, often a single purge with glauber's salt, often, without that, cold, rest, and abstinence, have conducted the morbid ex­citement to its salutary degree. A thousand times has the sthenic cynanche, a thousand times has catarrh and the simple synocha, nay erysipelas itself with affection of the face, been in that way removed. And the scarlet fever is often so gentle as to yield to the same management.

CCCCLXXXVIII. In this way must a constant re­gard be had to the degree of excitement and diathesis in the method of cure, and often terms must be disregarded. For, as it was with this view, that the simple synocha was before distinguished from the phrenitic, and the gen­tle erysipelas from the violent; so, it often happens, that catarrh rises to that magnitude that threatens or brings on a peripneumony, and that the latter proceeds with much more gentleness than usual. In which circumstances, it is the degree of excitement alone, that ought to govern the physician, without respect to names.

CCCCLXXXIX. Another useful caution here is, to judge of the state of the pulse, of the temperature upon the skin, and of the skin in other respects, with good sense, and due reflection upon these principles. The frequency of the pulse in all sthenic diseases is moderate: With that [Page 279] there is conjoined some hardness and [...]ulness. Whenever, therefore, the pulse is very quick, it is to be suspected, that the sthenic diathesis has passed into the asthenic, the excessive excitement into a cessation of excitement, or that the disease has been sthenic from the beginning. To re­move which doubt and ascertain the truth, the habit of body, the age, must be considered, and an enquiry be made to know, whether the disease has been preceded, or not, by contagion. Heat of the skin is in common to these diseases and fevers, which are diseases of an oppsite stamp, and therefore a doubtful mark. Which, as it depends up­on an interruption of perspiration, from whatever source, is never to be strained into a proof of the state of excite­ment. And, since dryness of the skin, which is in com­mon to the same diseases however different from each o­ther, in the asthenic diseases depends upon debility; in order to know the amount of what that symptom means, the other symptoms and the exciting hurtful powers, should be considered. In fine, the only enquiry should be, whether the excitement is abundant or deficient, and all the signs should be consulted with that view; nor are we to judge rashly of any peculiar form.

CCCCXC. When, therefore, the signs, that have been related, are compared with all the rest and with the diathe­sis, we are then to set about the antisthenic or stimulant plan of cure. The violent sthenic diseases, which we first considered can scarce be confounded with the contrary ones; the more gentle are daily confounded. But, while it is easy to distinguish them from the asthenic diseases re­sembling them; if, however, any person should think the marks of distinction ambiguous, let him know, that, up­on account of that gentleness, though the disease under exa­mination should be asthenic, blood is not even to be let, much less under the apprehension that they may turn out asthe­nic to which last so debilitating a power is destructive, as [Page 280] it has so often already been said upon former occasions; and, with that information, let him understand, that his method of cure conducted in that way, will be fenced and secured from all mistake. For, if the diathesis, though sthenic, be slight, bleeding will often precipitate it into the opposite, and will at the best be useless^(t). If, on the contrary, the disease that passes for a sthenic one, should, in its progress, show itself an evident asthenic one; in that case every drop of blood that may have been taken will go to the encrease of the disease^(u). Yet this perni­cious and daily practice sends more men out of this world, than all the curses of human life^(x).

CCCCXCI. As abstinence, cold, and the manage­ment of the belly are sufficient to prevent a gentle state of the small-pox; so when that proper preparatory plan has been neglected, and now a crowded eruption appears; be­sides those, trial must be made also of the other reme­dies^(y), except sweat. But sweat must be avoided, be­cause the tendency of the stimulus accompanying it, by encreasing the sthenic diathesis on the surface, would be to check the perspirable fluid, and detain the contagious mat­ter under the scarf-skin, and produce that pyrexia, symp­tomatic of the inflammation, which is called the secondary fever. This particularity of cure is taken from the parti­cularity of the symptom just now mentioned, and forms [Page 281] no objection to the principles of this work. In perfect consistency with which, though there is all the proof that can be derived from sure practice, that the remedies we have mentioned are sufficient; yet, before the eruption comes on, there is nothing can be objected either to sweat­ing or bleeding, as remedies in common to this with every other sthenic disease^(z). In fine, as the success of low di­et, cold and purging, in this manner, is certain; at the same time, the other remedies, that remove sthenic diathe­sis, in this case likewise operate to the same effect^(a). It was proper to say so much for the sake of showing the un­exceptional steadiness and universality of the principles of this work. Nor are we to think, that the small-pox and measles, differ from other sthenic diseases attended with pyrexia, but in the particularity of their eruption in run­ning a certain course, and not admitting of an accelerated cure.

CCCCXCII. We are not to wait the arrival of the symptoms of debility, that follow a violence of diathesis, and threaten certain death by indirect debility, with the view, forsooth, that, when they have happened, we may cure them: On the contrary, they ought to be prevented by the early administration of the remedies, now so fully commented upon. If that should be omitted, the consi­deration of the diseases that will be the consequence, and which is altogether an asthenic consideration, must be re­ferred to the asthenic form.

[Page 282] CCCCXCIII. As often as sthenic diathesis happens to be conjoined with the pyrexia, which is induced by the operation of stimulants, of acrid substances, of compression, of obstruction, and similar hurtful powers acting upon a sensible part, of which we have examples in gastritis, en­teritis, nephritis, cystitis, hysteritis, hepatitis, or the inflam­mations of the stomach, of the intestines, of the kidnies, of the bladder of urine, of the womb, of the liver^(b); the diathesis, because it aggravates the pyrexia, should be re­moved by its respective remedies, to wit, the debilitating ones. And, when neither it nor the asthenic diathesis is present, nothing should be attempted: But, if the asthenic diathesis should be present, which very readily may hap­pen; the stimulant plan should be proceeded upon, to pre­vent a very bad disease^(c). Nor, when that is as much as possibly attended to, are we to forget, that, in so doing, the principle affection is not touched; that, on the contrary, it is its effect, not its cause, that is tampered with; and that the full consideration of such cases belongs to the local diseases, afterwards to be taken notice of.

[Page 283] CCCCXCIV. Besides all the remedies now mentioned, it is of advantage in every degree of diathesis to keep the mind easy and unruffled with passion or emotion; a prac­tice that in the very high degrees of the diathesis is indis­pensibly necessary. Our attention will especially be di­rected to this particular, when we observe, that the stimulus of thinking and of any passion, carried to a great height, has had a share in the production of the disease.

CCCCXCV. In mania, therefore and pervigilium, this direction must be particularly, and as much as possible, at­tended to. In the latter of which diseases, thinking, and every state of commotion, and more certainly an habitual practice in them, must be shunned, especially before go­ing to bed. When the patient is resting there, he should have stupid books read to him, all inordinate desire, the propensity to revenge, the remembrance of every degree of criminality, of which he may have been guilty, should be diverted from his recollection^(d).

CCCCXCVI. That fact of great consequence, to give corroboration to this whole doctrine, is confirmed by this other, that the same things, which are serviceable in pervi­gilium, or the morbid watchful state, are also serviceable in mania, or madness, only administered in a higher degree, as that is a disease of a higher degree of excitement. Thus, it is not ease and tranquillity of mind that are to be pre­scribed here, both of which are quite gone, but a state op­posite to that high commotion of spirits and irregular vi­gour in the exercise of the intellectual function: And, as an excessive energy of the intellectual powers, or of the animal spirits, or both, are the most noxious powers in this case; for that reason, the patient should be struck with fear and terror, and driven, in his state of insanity, to des­pair: As a remedy against the great excitement of the or­gans [Page 284] of voluntary motion, the labour of draft-cattle should be imposed on him, and assiduously continued; his diet should be the poorest possible, and his drink only water^(e): In water as cold as possible, the patient should be immer­sed, and kept under it, covered all over, for a long time, till [...]e is near killed.

CCCCXCVII. If, in phrenitis the brain, in peripneu­mony the lungs, in rheumatism the external joints, possess more diathesis than any other part; why may not ma­nia and pervigilium consist more in an affection of the brain, upon which the principal noxious powers act, than of the other parts, over which the influence of those pow­ers is less considerable? Lastly, since remedies, the first action of which falls upon other parts, are of service in those diseases^(f), that proves, that not even in them, where you might most be disposed to believe it, the whole morbid affection depends upon the part conspicuously af­fected; but that the whole body is concerned in it, that the excitability is one uniform undivided property over all; that the force both of the exciting hurtful powers and of the remedies is directed to the whole, with the inequality so often mentioned^(g); and that the foundations of this doctrine are sure and stable.

CCCCXCVIII. As these are the principal hurtful powers in mania and pervigilium, and the brain principal­ly affected; so in obesity, the hurtful powers most consi­derable are animal food^(h) and rest, or sedentary life; in consequence of which last, the stimulus of exercise, which, [Page 285] by wearying and fatiguing the body, tends to indirect de­bility, is understood to be wanting. But, since, in con­sequence of using the same food, both in quality and quantity, and the same indulgence in rest and case, some per­sons become fat, others continue lean; from thence it is ascertained, that all the digestive powers have more force in the former, than in the latter, and consequently, that the 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 easy ex­ercise of the intellectual faculty, and tranquillity of mind, which are moderate stimuli, favour obesity; over strained thinking, and habitual indulgence in passion, such as that of anger, the repetition of which constitutes ill nature, oppose it. Corporeal motion, which diminishes the quantity of fluids in the system, and, as often as it is con­siderable, proves fatiguing and debilitating, opposes it. Equally unfavourable to it is hard drinking; which, in a similar manner, wears out the excitement, by constantly wasting the excitability from the high degree or long conti­nuance of its stimulus. On the contrary, the powers that favour it, are those that act gently, and with some excess: but never attain that high degree of activity, that inclines to indirect debility: They are powers that go on softly and pleasantly, that particularly keep up moderation in the perspiration, and thereby fill the vessels with blood; but, because motion is avoided, they do not very much encrease the excitement of the vessels, and by means of the tran­quillity of motion kept up in the latter, allow a fluid, that would otherwise pass off by the external pores of the sur­face, to turn aside into the cells of [...]at. Hence, though, as it has been said before, an abundance of blood is indeed a very great stimulus; yet, without other stimuli, and that most powerful one, which muscular motion affords; it is evident, that a considerable degree of stimulus can be borne [Page 286] without any considerable disease, and that it always pro­duces a predisposition to sthenic diseases, but does not immediately bring them on. Hence, it is understood what place in the scale of excessive excitement, or of sthe­nic diathesis, obesity holds; what the degree of stimulant power is, and what the stimuli in particular, are that pro­duce it.

CCCCXCIX. As the degree of curative force must be accommodated to the degree of force in the cause⁽ⁱ⁾; hence it must be observed, that for the cure also of this disease the common indication is sufficient^(k); that is, that the excess of excitement must be reduced to the salutary degree, and a remedy opposed to every hurtful power, equal to the re­moval of it.

D. In this case, therefore, as food is the principal hurt­ful power, less of it should be given, and more exercise en­gaged in. These are sufficient for the cure^(l).

DI. But, for the sake of bringing both further confir­mation, as well as illustration of this doctrine; it is to be observed, that all the powers, which very much affect the excitement, and in a greater degree, than the hurtful power of this disease mentioned above, and that have a tendency, by their stimulant operation, to indirect debility, have the same effect; that they either prevent or cure obesity, and continue productive of that effect, till they induce that de­gree of meagerness which is connected with debility.

DII. The best method of lowering the diet, is to com­bine a quantity of vegetable matter with a moderate por­tion animal. The next rule to that, is to refrain from the latter, and use the former in greater abundance. The first of these is suitable to all such persons as are liable to diseases of debility, such as the gout, the indigestion that after a long time succeeds to luxury, asthma, epilepsy, and [Page 287] similar others. The latter management is more accom­modated to those, who otherwise enjoy great vigour, are under predisposition to sthenic pyrexia, and in the flower of their age. But, it is not, even in the latter state of the body, to be prosecuted, unless for a time; because, such is the debilitating influence of that practice, that, while it is sufficient to remove any degree of obesity, especially with the addition of exercise, it is found to have signal efficacy in producing asthenic diathesis, and all the diseases depen­ding on that.

Of Leanness.

DVIII, Leanness is an asthenia, less discernible in the other functions, but evident from the weakness of the di­gestive function; in consequence of which, the system, though receiving proper aliment, does not become plump.

DIX. Since the cause of this disease is debility, both in the rest of the system, and in the stomach and other or­gans of digestion; it thence follows, that the general indi­cation for the cure of it, should be chiefly directed to the most languid part, that is, the organs of digestion and the perspiratory vessels. More nourishing food, therefore, should be used, less labour undertaken, and moisture on the surface, or too free perspiration, should be checked by more rest of body, by proper gestation, and rubefaction, and a [Page 291] plan, quite contrary to that which is suited to the cure of obesity should be pursued.

Of Restless Watching.

DX. In the asthenia called inquietudo, or restless watch­ing, the other functions are under some degree of lan­guor, and the patient is affected with a constant necessity to change his posture, and toss about his limbs without be­ing able to fall asleep.

DXI. As the cause in this case, in the same manner as in every other general disease, is universal over the system; so its affects the organs of voluntary motion, and the brain in particular, with the inequality so often formerly menti­oned^(b): Consequently, to remove the disease, ultimate excess in either mental labour, or exertion in any passion, as well as the opposite extreme of deficiency in either, should be avoided; and that stimulus of both, which is agreeable, ultimately excessive corporeal labour when it has proved hurtful, as well as deficient when it has had a concern in the cause, should be guarded against; and the proper medium betwixt the extremes of excessive activity and indolence restored: Or the disease should be repelled by wine, and the other stimuli have, each its proportion, in the cure.

Of the Scabby Eruption.

DXII. In the scabby eruption, the face is pale, the skin discoloured, dry, lank, and variously disfigured with pustules; there is a lowness of spirits, and the functions of the body weak and sluggish.

DXIII. In this case, while the debility is universal, there is a prevalence of it in the perspiratory vessels. And, therefore, the chief parts of cure are, together with the re­medies, [Page 292] the operation of which is directed to the whole sy­stem, such as nourishing food, strong drink, to support the perspiration by its respective remedies; to bathe the surface of the body in tepid water, to render it accessible to air, to order clean linen for the patient, and every thing clean about his cloths.

Of the Gentle Diabetes.

DXIV. In that asthenia, which is named the gentle diabetes, there is an excess in the quantity of urine dis­charged, but the profusion is not immoderate as in the most violent case of the same name. The organ of respiration labours under the same weakness and sluggishness, as in the scabby eruption.

DXV. To remove this affection much more frequent than it has been hitherto believed the system should be sti­mulated by food^(c), by strong drink^(d), and by proper ex­ercise^(e), such as is neither immoderately excessive, and therefore debilitating nor deficient in degree, and therefore, not supplying enough of stimulus: And, above all things, the perspiration should be sustained. The contrivances for checking the flow of urine, which have no existence, are to be passed from.

Of the Rickets,

DXVI. The rickets is an asthenia; to the general symptoms of which are added an unusual bulk of the head, especially the fore part of it, and likewise of the knees and abdomen, a flatness of the ribs and meagerness.

DXVII. The rickets is a disease of children, chiefly arising from uncleanliness, want of dandling or exercise, cold, either without moisture or with it, food not giving suf­ficient nourishment, and bad air.

[Page 293] DXVIII. For its cure the common asthenic indication must be employed; remedies, of an opposite nature to the hurtful powers that excite the disease, must be looked out for; the surface of the body should be kept clean^(f), the perspiration should be carefully restored by the stimulus of pure air and of heat; the child should be more carefully dandled, and kept much in the open air, animal food should be administered, vegetable withheld, and strong drink al­lowed^(g).

Of Retarded Menstruation.

DXIX. Retarded menstruation is also an, sthenia: In which, besides this discharge not making its appearance at that time of life, when it should, other evidences of debility, such as a slender make of body, weakness, laxity of habit, want of appetite, or a craving for things not alimentary, paleness of the skin, and similar symptoms, appear.

Of Impaired Menstruation.

DXX. Impaired menstruation is that state of asthenia; in which after it has appeared, and the flow continued for some time, the discharge is made in too sparing quantity, or after too long intervals of time, with other signs of weakness accompanying it.

Of the suppression of Menstruation.

DXXI. Suppression of menstruation is that degree of asthenia, in which the discharge is totally stopt at any pe­riod betwixt their natural commencement and the time when, in the course of nature, they cease altogether.

CXXII. An enquiry must be made into the cause of na­tural menstruation, before it would be proper to enter upon [Page 294] that of the retardation, or deficiency, of the discharge in any of its degrees.

Of the Cause of Menstruation.

DXXIII. The cause of menstruation is a conformati­on of the vessels that pour out the blood in this discharge, taking place at a certain time of life, that is, about the age of puberty, and a stimulant energy in women, more power­ful than in the females of the other species of animals.

DXXIV. Of other animals there are very few, the fe­males of which undergo any sort of menstruation out of the venereal orgasm.

DXXV. As all the vessels are gradually unfolded in the course of the growth of the body, so the same thing happens to the genital and uterine vessels, but last of all to these. The ends of the latter, terminating, on the sides of the womb about the age of puberty, are at last so very much expanded, as now to transmit first the serous part of the blood, and then, after an effort kept up for some time, pass to formal blood.

CXXVI. At this time of life a great change over the whole system takes place. Now the desire for coition, a stimulus, never experienced before, produces a commotion over the whole body; and, in preference to other parts, in the genitals of both sexes, in the female, over the whole region of the ovaria, womb, and vagina: By this stimu­lus, the uterus, its seat, being nearly incessantly solicited, is the more powerfully affected, the more there is of exci­tability, hitherto acted upon by no such stimulus, existing in the system. Hence, among other organs, the muscu­lar fibres of the next vessels, as well as the nerves interwo­ven with them, undergo the highest degree of excitement: This excitement encreasing over the whole system, again en­creases that in the uterus: The mutual contact of the sexes, [Page 295] whether in kissing, in shaking hands, or otherwise, fires both sets of genitals, and the uterus in a remarkable manner; but the actual embrace produces the highest degree of that effect. The remembrance of each embrace remains, renews the dear idea of the delightful scene, and continues more or less to excite the uterus.

DXXVII. This new affection is further cherished and nourished by every stimulus that is usually applied to the system: Hence, in the absence, in the presence, of the beloved object, at all times generally, scarce with the ex­ception of that which passes in dreaming, a stimulus so stea­dy, and the more powerful, that its novelty implies, that the excitability in this case is entire, rouses the fibres of the vessels, already sufficiently unfolded, to violent con­tractions. The blood is carried into the region of the u­terus with the greatest rapidity, a rapidity momentarily en­creased, in proportion as the blood, by powerfully disten­ding the vessels, and agitating them by its impetuous flow, stimulates the fibres more and more, and thereby encrea­ses the activity by which it is driven on. This is the first cause of menstruation: In that way, the two circumstances, a sufficient enlargement of the diameters of the vessels, and the stimulus acting more powerfully, from its novelty, upon the unwasted excitability^(h), are sufficient for the whole business.

DXXVIII. This state is not inconsistent with other states of the body, but bears an analogy to some well known ones: Accordingly, different vessels, from the mere differ­ence of their diameters, are subservient to different pur­poses: The perspiratory vessels are destined to the trans­mission of a vapour, the excretory vessels of the alimentary canal to that of a thing fluid, the renal vessels to that of a grosser one; so as to take off our surprise at finding vessels [Page 296] fitted, by their degree of diameter, for the purpose of trans­mitting red blood.

DXXIX. The reason that the females of other animals do not menstruate but in their orgasm, and not at other times, is, that it is only at certain times that they are ex­posed to that energy of stimulus which produces menstrua­tion.

DXXX. How much is owing to the stimulus just now mentioned⁽ⁱ⁾, in the production of menstruation, is fur­ther evident from the following chain of facts: Which are, that, the less addicted to love women are, the less they menstruate; the more they give way to that passion, the freer do they experience this discharge within certain boun­daries; that, before puberty, and after the time of life when menstruation ceases (which are the two periods, at which the fitness for effective love has not yet commenced, or is now passed,) the menstrual discharge is constantly wanting; that the privation of enjoyment, which, by its debilitating effect, produces chlorosis^(k) and other similar diseases, is remarkable for bringing on a menorrhoea, or a retention of menstruation; and, finally, that girls, who are of a forward growth, of great strength, and large limbs, and consequently sooner ripe for love, are also more early in menstruation; while those, who are weakly, puny, and of a small size, and, consequently, later in attaining to the period of puberty, are proportionally late in attain­ing the first menstrual discharge. Lastly, if, like all the other functions, that of love is limited at the same time by its duration and degree; and if, as the commencement of the love embraces is more or less early, it is proportionally more early or late in coming to its final termination, and if the duration of menstruation does not usually exceed that period; that fact also, which it certainly is, added to [Page 297] those above, gives weight to our conclusion, and shows, in a clearer point of view, how much menstruation de­pends upon the venereal emotion. It is to be asserted, therefore, again^(k), that, besides the conformation of the vessels, suited to the function of menstruation, and the stimu­lus which has been mentioned(k), there is occasion for no other circumstance to explain either commencement, esta­blishment, or continuation, of the menstrual discharge.

DXXXI. The cause of full menstruation, and that of a moderate degree of it, happening within the boundaries of health, is the same; only differing in degree; the degree of the latter being smaller, and that of the former greater.

DXXXII. And, as the stimuli, mentioned above, ex­plain, why women menstruate more than the females of other animals; so their immoderate operation upon wo­men serves to show, why their effect, the menstrual dis­charge, becomes greater than natural^(l).

DXXXIII. The stimuli that produce abundant men­struation, short of morbid state, are unchaste ideas, and a high energy of passion. In this way, the influence of reading to ones' self, or to others, of conversation, of pictures, contrived to kindle up lustful appetite, and the uncovering of parts that modesty conceals, which all pro­duce a lively impression on the imagination of the thing so much desired; can be indistinctly felt by none perhaps but eunuchs. The same is the effect of nourishing food, and generous drink, and high seasoning; and hence the pro­verb, without meat and drink love starves: Likewise, that degree of exercise, or even labour, that does not prove fa­tiguing, but that keeps within the boundary of stimulant [Page 298] operation; as also an abundance of blood, both from that circumstance and from rich diet; lastly, frequent and ar­dent dalliance, or inconcessa bujus imitatio; all these, en­crease the menstrual discharge, in proportion to the high degree of their stimulus, but still do not carry their effect to morbid excess.

DXXXIV. The same conclusion applies to the effect of these stimuli, which was formerly applied to an over-proportion of blood producing sthenic diathesis: For the ultimate end of all the stimuli, that produce excessive menstruation, is such, that, if excessive menstruation and an encrease of love be the consequence of the excess of the stimuli, one or other of the following must be the effect: that is, it will either be such as remains within the lati­tude of health, or such, as first produces sthenic diathesis, and then, in a higher degree of it, runs rapidly into indi­rect debility.

DXXXV. That this is the fact, is proved by the hurt­ful powers that produce excessive and morbid menstruation; and by remedies, that are stimulant and suited to fill the vessels, removing the disease according to our late discove­ry; and also by the unfortunate effect of the debilitating evacuant plan of cure in the same diseases.

DXXXVI. As it is stimulant operation that produces both proper menstruation and that which goes to a little excess; so, when once menstruation is established, the con­formation and stimulus, that have been mentioned, re­maining, are sufficient to support it. The same opera­tion is renewed during every interval of menstruation: The stimulus acts and quickens the motion of the blood in eve­ry part, but chiefly in that where it is most powerful and most required, that is, in the region of the womb: The blood thrown into quick motion, and rushing with a more rapid flow, encreases its cause, the stimulus: And, as this mutual stimulus continues incessantly to affect the [Page 299] women through the whole interval, when they are allowed scope of love; the uterine vessels are gradually unfolded, till at last, within three weeks, or a lunar month, they are opened to their ultimate extremities: And, when the fluid, first serous for a little, and afterwards sanguine, and afterwards serous again for a little, has flowed one, two, or three days, in healthy persons, the vessels are at last shut up.

DXXXVII. During the whole time of this process, the more excitability there is, and consequently at the begin­ning of each menstrual effort, the more violently the sti­mulus acts, and produces proportionally more excitement: And it has, from this time, always less and less effect to the end, in proportion as the excitability is more wasted; though, till the excitability, in so far as it has a relation to the stimulus, is altogether exhausted, the stimulus always adds something to the sum of excitement,^(m), though con­stantly less and less. The same is the explanation of the operation of food, of drink, and of all the exciting pow­ers.

DXXXVIII. As what has been said of the stimulus, productive of menstruation, is conformable to the effects of all the other stimuli; the same is its conformity to the whole sum of menstrual effect from the beginning to the end of the process. Thus, in the beginning of that long period, the force of stimulus is far the greatest, upon ac­count of its novelty, and the unwasted state of excitability that relates to it. At this period, above all others, love in persons in health is exquisite; and, in consequence of the stimulus which excites it, menstruation, when once esta­blished, is most exactly performed; that is, it does not, either from deficiency or excess, deviate into morbid state.

DXXXIX. But after the beginning of this function, and when now the office of menstruation is established; [Page 300] because in this, as well as every other function, the exci­tability is gradually diminished in the progress of life, the stimulant power also has gradually less, and, at last, no effect: Consequently, in the same gradual way, the power of love in women, and, in proportion, that of menstrua­tion, is diminished, and at last altogether extinguished.

DXL. While both the faculties, that of love as well as that of menstruation, in this way decrease from the begin­ning to the end; so, menstruation is often interrupted, in pregnancy, in suckling, in the diminution or suppression of menstruation. This interruption in the two former i [...] natural, and suitable to health; but in the diminution or suppression of the menstrual evacuation, it becomes mor­bid.

DXLI. Since the stimulus with the conformation of the vessels is the cause of menstruation, and the latter depends upon the former; so again the defect of the stimulus, and, therefore, of the conformation, produces both the retar­dation, diminution, and, at last, the complete suppression of the discharge.

DXLII. Whether ever the defect of menstruation, like that of perspiration, or of any internal excretion, as that in the fauces and alimentary canal, is sometimes to be im­puted to sthenic diathesis, is uncertain, for this reason; that, while the diameters of the small vessels on the skin and in the intestines are more nearly allied to such a contraction for a reason formerly assigned⁽ⁿ⁾; so great a force of excite­ment, so high a degree of sthenic diathesis, as would be suf­ficient to shut up vessels destined to the transmission of blood, is not easy to be conceived. And the doubt i [...] further encreased by a certain fact; which is, that both in the retardation of the menstrua, and in all the degrees of their diminution to their total suppression, when local af­fection [Page 301] is out of the question, there are evident proofs of a debilitating cause.

DXLIII. To ascertain that fact, which is of the great­est consequence for this reason, that it directly interests the method of cure, and, if not explained, would leave a gap in our principles; we have to observe, that, as some men, in consequence of the stimulus of excessive love, in the case of a most beautiful woman being the subject of it, have, by means of sthenic diathesis, been so inflamed as to fall into a temporary fit of impotence, and been cured by bleed­ing; so, besides that that is a rare fact^(o), it is not very pro­bable, that the patulous uterine vessels can be so contracted in their diameters, as to be incapable of transmiting their fluid. Nay facts contradict it: The retardation or defici­ency of menstruation receive a temporary alleviation from the debilitating plan of cure; but the discharge is not usu­ally also brought back, on the contrary it is more kept off: But allowing an over-proportion of blood and an excess of stimulus to be the cause of the first deficiency of menstru­ation, after it has been removed by bleeding and the rest of the debilitating plan of cure, can it again be the cause of a disease, which resists a degree of evacuant and debili­tating plan of cure, that would cure ten peripneumonies? And since any stimulus, as well as that of an over-propor­tion of blood, may, from its excessive force, go into indi­rect debility; why may not the same thing happen in a disappointment in love, and first deficiency of menstruati­on; and, in both cases, atony, ushering in manifest debili­ty, and not excess of tone, be the cause? As peripneumo­ny, where the over-proportion of blood and sthenic diathe­sis is by far the greatest that ever happens, in consequence of indirect debility passes into hydrothorax; why may not a similar cause in this case produce a similar effect?

[Page 302] DXLIV. The cause, then, of deficient menstruation, whether partial or complete, is a languid excitement over the whole body, especially in the uterus, from a deficien­cy of the stimulus of love^(p), and of all those stimuli that support it^(q), and from a penury, or under-proportion of blood.

DXLV. That that is the fact, is proved by the hurtful powers mentioned in the retardation of menstruation, and other debilitating ones in every deficiency of that discharge, producing each disease; it is proved by the stimulant and filling plan of cure removing it, and also by the hurtful effect of the debilitating plan of cure^(r).

DXLVI. The remedies for the cure of retarded men­struation are, rich food, generous drink, gestation, exercise accommodated to the strength, pediluvium and semicupi­um, or the warm bath of the under-extremities, and grati­fication in love^(s).

DXLVII. The same remedies are required for the suppression, and the same, but inferior in their degree of force, for the diminution of menstruation: When there is an unusual force of the disease, either in degree or durati­on, we must have recourse to the assistance of the diffusible stimuli.

Of Menorrhoea, or the excessive Discharge of Menstruation.

DXLVIII. Menorrhoea is an effusion of blood from the uterus, or an over-copious menstruation, or too long a continuance of it in a more moderate degree of the excess, accompanied by all the symptoms of asthenia.

DXLIX. This disease is occasioned not by an over-pro­portion of blood, not by a vigorous state of body, but by [Page 303] an over-proportion of the former, and an exhaustion of the latter. The hurtful powers, therefore, that produce it, are food not nourishing enough, or too small a proporti­on of what is so, watery drink, or that over-proportion of pure strong drink that produces indirect debility, exces­sive heat, or cold not prevented from its debilitating opera­tion by any stimulus, and salacity.

DL. Its remedies are the reverse of the hurtful powers; rich food, generous strong drink, heat acting within its stimulant range, cold kept from direct debility by the stimulus of heat and other stimuli, and gratification in love.

DLI. The effect of the hurtful powers and remedies of which we have spoken, that of the former in producing, and that of the latter in removing, the disease, and the fai­lure in success of the debilitating plan of cure, all confirm the fact.

Of Epistaxis, or bleeding from the Nose.

DLII. Epistaxis is an asthenia; which, besides the ge­neral symptoms of the latter, is distinguished by bleeding from the nose, without any force behind, an affection troublesome at any age, but particularly to young persons under a rapid growth, and to enfeebled old age.

Of Haemorrhois.

DLIII. The characteristic of haemorrhois, or the piles, added to other signs of asthenia, is a flow of blood from the anus, or the parts around it.

DLIV. The same thing, nearly, that has been said of menorrhoea, is to be said of the hurtful powers and reme­dies of this disease.

DLV. The cause of the piles is manifest, from the hurt­ful powers producing it, the remedies removing it, and the unhappy effect of the common asthenic plan of cure; that [Page 304] is to say, it is debility of the whole body, from the defici­ency of other stimuli, and chiefly that of the blood^(t); Which debility, while it relaxes all the vessels, and impair [...] their tone, produces that effect, in a special manner, upon the labouring vessels. The reason of which is, that, in con­sequence of the inequality so often mentioned, the chief prevalence of the cause operates in the feat of the urg [...]n [...] symptom^(u). Nor is it to be thought wonderful, that the blood should flow through the vessels of the uterus that are patulous, and in the habit of pouring out blood, through be pendulous hemorrhoidal vessels, and those of the nose, which are delicate, and weakly supported, in preference to others. In this case plethora, which has no existence^(x), is equally unnecessary to our reasoning^(y).

Of Thirst, Vomiting and Indigestion, as well as the Kindred Diseases of the Alimentary Canal.

DLVI. There is a very frequently occurring affection, beginning with thirst and proceeding to vomiting^(z). It often proceeds no farther than those symptoms; it oftener [...]shers in the most severe affections, such as sometimes dys­pepsia, or indigestion, sometimes colic, sometimes the gout, sometimes proper [...]evers, and many other asthenic diseases. Its most frequent source by far is weakness, being the at­tendant sometimes of too long suckling, sometimes of the diarrhoea incident to women, wasted with a long course both of that and repeated pregnancies.

DLVII. There are two causes of as many affections which have got only one name between them, that of thirst: The one is sthenic, the other asthenic^(a). The former arises from the stimulus of salt, of rich and plenti­ful [Page 305] meals, of heat and labour, and some others; never ending in vomiting till the sthenic state is over, which is seldom. Its cure, with which we have here no concern, is cold water and the several debilitating powers.

DLVIII. The asthenic thirst, which is our present subject, depends always on pure debility, sometimes in­direct, sometimes direct^(b). Its tendency is always to stomach sickness, and, as that encreases, to vomiting^(c); and when the vomiting becomes any way considerable, the consequence is that most acute pain, which a cramp in the stomach produces^(d), and the other affection formerly explained^(e). This progress is spontaneous, direct, and for the most part rapid.

DLIX. The hurtful powers here are all debilitating. The indirectly debilitating hurtful powers are, debauch in eating and drinking^(f), drunkenness, extreme fatigue, ultimately excessive heat^(g), violent passions^(h), excessive exercise of the intellectual faculty⁽ⁱ⁾, debilitating food^(k), an over-proportion of blood now converted into an under-proportion, together with the conversion of the sthenic diathesis that attended the former, into the asthenic, the inseparable attendant on the latter. The following pow­ers act by a directly debilitating operation; cold corrected by no stimulus^(l), cold drink, vegetable food^(m), penury of blood⁽ⁿ⁾, of other fluids^(o), want of pure air^(p), anxie­ty, grief, fear^(q), and in fine, that weakness of the system, which arises from all those. The affection is often of a mixt origin, from a mixture of both these sorts of hurtful powers: For, as direct debility always increases the indirect, so does the latter the former, both in this and all cases^(r).

[Page 306] DLX. A corruption of the common mass of fluids, whether it be called acrimony, or putrefaction, has no con­cern in the cause; because, while life remains, and the ac­tion of the vessels upon their respective fluids continues, such a faulty state of the fluids cannot make its havock over such an extent of the system, that being only the effect of a cessation of motion of the fluids under heat; nor can it happen, but in the extreme vessels and excretory ducts, which, by their atony, do occasion such a cessation of mo­tion, and likewise in the alimentary canal.

DLXI. The cause of this thirst is the common one of every asthenia, but predominant in the throat and stomach, upon account of the atony of the salivary, and other excre­tory ducts^(s).

DLXII. The remedies are also the common ones of every asthenia, to be accommodated to the degree of debi­lity in the cause. In a slighter degree of thirst a glass or two of brandy, or of any similar spirit, or, which is a better rule, given till the complaint is removed, is sufficient. It should be either pure, or diluted with a very little hot wa­ter^(t). That should be followed by eating some animal food^(u); and it should afterwards be supported by other stimulants taken moderately, and in the degree that suits good health. After which the proper practice is, to pro­ceed to the use of the permanent stimuli.

DLXIII. When the thirst, not quenched by these means, proceeds directly to vomiting, and when, by and by, an excruciating pain supervenes upon the vomiting; which, [Page 307] excepting the pain, is an affection, that, together with the symptoms that have been mentioned^(x), should receive the appellation

Of Dyspepsanodyne, or Indigestion without Pain:

And when, besides the pain of the stomach, now indu­ced, the affection going downward to the intestines, some­times produces a loose, sometimes a bound, belly; at other times only a loose belly, and at others only a bound one; which is an affection, when unaccompanied by costiveness that is distinguished by the title

Of Diarrhoea:

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

Of Colicanodyne, or Colic without Pain:

DLXV. In all those cases recourse must be had to a larger dose of the drink: And, when that does not succeed to our wish, we must next fly to opium, and other more diffusible stimuli, if they are not to be found: When, by these, relief is procured, rich and pure soups, without grease, should, from time to time, be poured in, and the canal carefully bathed all over with them. After which, the other stimulants should be added; in the use of which, a straight direction between direct and indirect debility should be held, without the least deviation towards either: And our efforts must always be continued till the disease is ra­dically removed.

DLXVI. The necessity for this direction in the cure is so much the greater; that, by neglecting it, or depending upon the common purgative debilitating plan, the conse­quence [Page 308] is, that often a proper general disease degenerates into a local affection. To proceed to the consideration

Of the Kindred Diseases of the Alimentary Canal.

DLXVII. Among them, besides those that have been mentioned above^(y), there are not wanting, others, which, when compared with them in the similitude and nature of the cure, absolutely claim this place in the scale.

Of the Diseases of Children.

DLXVIII. The diseases of children are, dryness of the skin, sudden slaver, or salivation of short continuance; a similar rejection of milk, without effort^(z); green scour­ing; at other times costiveness; both commonly with gripes; the usual mark of which is, a pulling up of their knees towards their stomach, with very severe crying; un­equal heat. A little more severe than those are the two following cases, the one of which has the name

Of Worms.

DLXIX. Which are distinguished by a thickening of the columna nasi^(a); by a custom of picking the nostrils; by loss of complexion; by paleness of the face and of the rest of the skin; by a swelling of the belly; and, lastly, by the discharge of worms by stool. The most distinct symp­toms of the other affection, or

Of Tabes, or the general Wasting of the Body.

DLXX. Are meagerness all over the body, an unusual bulk of the abdomen, almost constant watching, such a [Page 309] weak, distressed, assiduous, and hoarse manner of crying, as excites tenderness and compassion.

DLXXI. The hurtful powers, producing all those af­fections, are in common to them with every asthenia; that is, they are every thing that has an effect of debilita­ting the whole system, and especially the alimentary canal: Such as, at this age, are, milk not nourishing enough, and at the same time acescent and flatulent; want of food, or made of watery matter and bread; cold, and moisture, the latter encreasing the effect of the former; habitual vo­miting and purging; too little dandling; mistiming sleep, and meals, and every part of management; nastiness; im­pure air; a neglect of natural likings and dislikings.

DLXXII. The remedies are the converse of all those, nourishing exciting milk; three or four meals a day, con­sisting chiefly of warm milk, pure animal soups, not weak, with a mixture of flower of bread of the same kind; heat without being carried so far as to produce sweat, or too much redness, and free from moisture; laying aside every sort of evacuation; a great deal of dandling and gestation; a proper timing of sleep, of food; and of every part of ma­nagement of these delicate systems; cleanliness; tepid ba­thing in cold weather, and cold bathing in warm; and pure air, being out in the fields as often as possible in all but moist weather; such a judicious attention to desires and propensities, as not to neglect scratching any part that itches^(b).

DLXXIII. These directions suit the gentler cases under consideration. To remove the more violent, while they also are not by any means to be neglected; at the same time others are to be subjoined. When the green scour­ings, great looseness, and boundness of belly, are vexatious; recourse must be had to pure wine, spirits more or less [Page 310] diluted as the occasion may require, or if there should be need, not diluted at all: More of the soup that has been mentioned and also of a richer kind.

DLXXIV. If those should not succeed to the physician's mind, which will seldom be the case; in the same affec­tions, and more certainly in worms, and still more certainly in the tabes, or general consumption, with the remedies that have been spoken of, the more diffusible stimuli of opium and musk should be alternated. Both sorts of re­medies^(c), should be so accommodated to the violence of the symptoms, as not to be dropped till the whole morbid tumult is allayed, and the healthy state replaced; which will, upon trial, be found more practicable, than has yet been imagined from the employment hitherto of the con­trary plan of cure, to the great comfort of mankind in their sufferings.

DLXXV. From what has been said it will appear, that these affections of children, all flow from the same cause, are removed all upon the same indication of cure, as any other asthenia, or disease of debility, that has either yet been, or is to be, mentioned in this work. The un­happy termination of them hitherto, is to be imputed not to their cause, but to the depravity of the common method employed for their cure^(d): Nay, though they do dege­nerate into local affection, as in the instance of the tabes, or general consumption, ending in an obstruction of the [Page 311] mesentery; in that of cholic at every age, terminating in an inflammation, tumor, or complication of the intestines; and in those of both cholic and long-neglected diarrhoea, running into a gangrene in the same part; that is a mis­fortune that never happens, when a proper method of cure is early enough used to remove primary disease: And, on the contrary, it most commonly arises from the perversity of that plan of cure, or the neglect of this, which is the proper one. To the same kindred diseases of the alimen­tary canal^(e), further belong the two following ones, under the title

Of the gentle Dysentery and Cholera.

DLXXVI. To which, every thing that has been said of those kindred ones, will apply: Or, if there be occasion for any particular observation upon them, it will be taken up, after we come to treat of them in their more severe and violent state: Of a similar nature to all these, but of a degree so much higher as to merit the next place in rank below them, and, at the same time, not unconnected with them, as having the seat of its predominant symptom in the same canal, is the disease to which I have given the the name

Of Angina.

For the symptoms and method of cure of which turn back to number CCXXII. Where it is introduced, in the explanation of asthenic symptoms.

Of Scurvy.

DLXXVII. Scurvy is an evident asthenia: The prin­cipal symptoms of which are, want of appetite, loathing [Page 312] of food, laxity of the living solids considered as simple so­lids; an oozing of blood, both from other parts, and par­ticularly from the gums; aversion to labour; low spirits, and a languor in all the functions.

DLXXVIII. The hurtful powers producing this dis­ease, are the common asthenic ones, appearing in the fol­lowing form: It is cold in this case, but conjoined with moisture in the northern seas, and, as we may well suppose, in the parts of the southern ocean of the same temperature, that generally produces the peculiar form of the disease. But with it all the other debilitating powers contribute their share: Such are, grief for the loss of liberty, relations, kindred, and friends; a horrid dislike to their present state of life; a longing desire for that which they have parted with; the awe which the severity of discipline keeps them in; the effect of a calm, where there is nothing to do, pro­ducing direct debility on them; a storm, where they have to labour above their powers, as certain a cause of indirect debility; their not having been allowed, till o [...] [...], fresh meat, which is the only nourishing and envigorating^(f) form of i [...]; their being kept upon salted and spoiled meat, and not even corrected by recent vegetable aliment, such as that is^(g); watery or small drink; the terror which the expectation of a battle at sea inspires.

DLXXIX. All those particulars prove, that scurvy is so far from being the effect of one or two hurtful powers, and from resting upon so narrow a basis of the cause pro­ducing it, as has hitherto been imagined; that it is rooted in a multiplicity of debilitating powers, and is a real ast­henia, or universal disease of debility.

DLXXX. And this fact is confirmed by both the true and false method employed for its cure: For, though nearly all the common powers concur in the production of scurvy; if, however, it be considered, how easily, upon the remo­val of the hurtful powers, and the patient getting a shore, [Page 313] the disease is got under, by fresh meat, either with or with­out greens, by wine, gestation, and exercise, in fine, by the recovery of his usual manner of living; it will be impos­sible to entertain a doubt of its being both an asthenia, and by no means a violent one. The pretence of its cure being effected by greens, roots, sour [...]rout, and similar things, so much boasted of lately, which, without the remedies just now enumerated, could not fail, by their debilitating ope­ration, to aggravate the disease, is derived from a noted blunder among physicians, by which they are led to over­look the most certain, simple, and evident facts, and take up in place of them, the greatest falsehoods, or such facts as have a very narrow foundation in truth.

Of the gentle Hysteria.

DLXXXI. The gentle hysteria is a form of asthenia, of frequent occurrence among women, but very rarely hap­pening to men; in which a noise is heard in the belly, and the patient has a sensation of a ball rolling within the bowels, rising up to the throat, and there threatening the patient with suffocation.

DLXXXII. The striking symptom in this disease is a spasm, not fixed in a part, but running the course just now described. The disease attacks in fits, for the most part leaving long intervals betwixt them, and often never recur­ring more than once or twice.

DLXXXIII. The fits are soon removed by small doses of opium, repeated at short intervals: The intervals should be secured from danger by full diet, and a moderate and na­turally stimulant management.

Of Rheumatalgia, or the Chronic Rheumatism.

DLXXXIV. Rheumatalgia is an asthenia, not so much a sequel of rheumatism when left to proceed in its own [Page 314] spontaneous course, as of the profusion of blood and of other fluids employed for the cure of it, and of too debili­tating a cure; with a change of the sthenic diathesis and the inflammation, which is a part of that, into the asthenic dia­thesis and inflammation. Paleness of the skin takes the place of complexion: The appetite is diminished, the involuntary motions are impaired, debility and torpor pre­vail over all. So far the disease is understood to be chronic. As in rheumatism, the joints are pained and inflamed: As that, which has been assigned, is the most frequent cause of rheumatism, so it sometimes arises not from a sthenic origin, and an excess in the means of reducing that.

DLXXXV. The cause of the disease is the usual one of any asthenia, predominant in the moving fibres of the muscles, situated below the skin over the whole surface of the body.

DLXXXVI. Its worst morbific powers are, penury of blood, cold, especially with the addition of moisture im­pure air, and besides these, as many of the other powers that act 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 these excessive indolence and the reverse are particularly hurtful.

CLXXXIII. As all stimulants contribute to the resto­ration of the healthy state; so the most powerful of them in this case is nourishing food, friction, gestation, wine, taken in moderation, exercise, rather frequent than violent, and being as much as possible in the open air. If it is an acknowledged fact, that rheumatalgia is one of the reproach­es of physicians, it is more so than has been hitherto un­derstood; it being an asthenic disease, while they at all times made use of the same kind of cure, as if it had been [Page 315] the most sthenic, or even upon the whole more debilita­ting^(h).

Of the Asthenic Cough.

DLXXXVIII. The asthenic cough is an asthenia, which with the constant symptoms of the latter, depends upon a frequent expectoration, that the cough excites; af­fecting every age which has been under the influence of ei­ther direct, or indirect debility, and therefore old age, which is unavoidably the prey of indirect debility.

DLXXXXIX. As consisting in indirect debility, it is the effect of an excessive violence of all stimuli that have been applied either for a short time, or for a great part of life, their operation coming to the same amount, that of the former from its degree, and that of the latter from its long continuance⁽ⁱ⁾. In so far as its cause is direct deblity, a deficiency of all the stimuli, leaving the excitability to be accumulated, allows this form of asthenia to happen from the spontaneous tendency of nature, of which life is only a forced state^(k).

DXC. The cough, which depends upon indirect debi­lity, is cured by reducing the stimulus which occasioned it, gradually and cautiously to the proper and natural degree [Page 316] And when it originates from indirect debility, the encrease of the stimulus, the want of which occasioned the disease, till the degree of excitement, which constitutes health is repla­ced, effects the cure.

DXCI. Such is the nature of direct and indirect debi­lity; that if the remedies of the former be pushed beyond the boundary, the cough appears again; and the same is the event of the same excess in the use of the remedies of the latter^(l).

DXCII. Frequent and violent cough with copious ex­pectoration has been always held for a sure mark of a vi­tiation or faulty state in the lungs. That faulty state was esteemed to be of a sthenic nature, and to give assurance of the presence sometimes of phthisipneumony, or consump­tion from an ulcer in the lungs, sometimes bastard peri­pneumony, sometimes of a burning inflammation in the alimentary canal. In the former case an ulcer, or, in their way of speaking, and what amounts to the same thing, tu­bercles were believed the cause of the disease; in the se­cond case inflammation either in the intercostal muscles, or a different one from that, which in true peripneumony was, in their opinion, its primary cause, was considered as the cause; and in the last case, no one of them would have hesitated a moment to have ascribed the state of the bowels, to the only inflammation they were acquainted with, that which requires bleeding and evacuation for its cure. And no other enquiry was made, but whether the matter that was spit up, was mucus or pus. To ascertain that premiums were proposed.

DXCIII. But, in fact, besides that no phthisipneumony, no bastard peripneumony, as they call it, no inflammation in the alimentary canal, was ever cured by antisthenic [Page 317] or debilitating remedies; and that, in the several trials tha [...] have yet been made, the first of these cases has been evi­dently assisted, nay frequently completely removed, and the two latter throughly cured in numberless instances, and in all in which it has been used by the sthenic, or stimu­lant plan of cure; I say, besides these large and compre­hensive facts, so little signification is here, either in the quantity or appearance of the expectoration, that in cer­tain fevers, in other diseases of debility, quite free of all local affection, and finally in this very cough of which we are speaking, there is often a more violent cough, and a greater expectoration of matter putting on every form and every appearance, than usually happens in a confirmed consumption, and where every hour is expected to be the last. And yet the whole tumult, hitherto so alarming, could be stopt in a few hours, and quite cured in as many days.

DXCIV. And, who does not know, that there are many persons, who have an immoderate cough, and pro­portional expectoration for a whole and long life time, whose lungs, however, are sound, and free from any or­ganic taint? How often in phthisipneumony itself after finishing its course, and at last terminating in death, has the whole fabric of the lungs been found upon dissection as sound as ever happens in death from any cause^(m)?

[Page 318] DXCV. The cause of cough has hitherto been un­known. To pass over the sthenic cough, with which we have nothing to do in this part of our subject⁽ⁿ⁾; the cause of the asthenic is the same as that of any asthenia, but more vehement in the fountain of expectoration, to wit, the exhalant and mucus arteries, the secreted fluids of which, inspissated by stagnation in the bronchia, compose the matter to be expectorated.

α▪ α▪ The most powerful of the asthenic hurtful agents in exciting asthenic cough, is cold, just as heat has been demonstrated the most hurtful agent in catarrh^(o). Nay, in the asthenic cough, such is the rage of cold, that the slightest breath of air reaching the body, excites a most pro­digious tumult of coughing, and brings out the whole se­ries of subsequent symptoms; and heating the body in the bed as soon allays the cough, prevents the threatening, and cures the urgent disturbances.

DXCVI. In this as well as the sthenic cough, it is the serous and mucous fluids that chiefly flow to the bronchia. Which bear their pressure for a little, till, distended by the load, they can bear it no longer. The disagreeableness of the stimulus excites a commotion in the excitability of the labouring part, and, therefore, over its whole seat, and rouses the excitement. A cough arises, and throws off its cause, the collected humours.

DXCVII. This disease is always to be treated for its cure, first with stimulant remedies, and then with such as [Page 319] also fill the vessels. If indirect debility has been the mor­bific power, still we must stimulate, but at first with a force of stimulus little less than that, which occasioned the disease, and then with still less; and, after changing, from time to time, the form of the stimulus, with less still; till we come down to the stimuli that are agreeable to na­ture, those that suit the most perfect health^(p). In that way is ebriety, in that way is every form of intemperance, to be treated. If direct debility has been the cause, the cure will be a good deal more easy: That is we must go on to stimulate more and more, till we get up to that point of excitement, to which we came down in the case of indirect debility. In this way is the first stage of phthisi­pneumony, as well as its middle course, and also bastard peripneumony, nay, most cases of the debility affecting young people, and the disease to which the name

Of Chincough

DXCVIII. Is given, to be encountered in practice. Chincough is attended by a contagious matter; which va­ries in its degree, but in such sort, however, that a sthenic plan of cure, adapted to the degree of the disease, for cer­tain cures it. The change of climate or place is a tale, the practice of vomiting is death^(q). And, since the disease is [Page 320] an asthenia, vomiting, which is so very debilitating an agent, cannot fail to be of the highest detriment^(r).

Of Cystirrhaea, or the Mucous Discharge from the Bladder of Urine.

DXCIX. Cystirrhaea is that mode of asthenia; in which, to the general symptoms of asthenia, and the par­ticular ones of asthenic cough, there is an addition of mu­cus, rendering the urine turbid, without any previous pain or symptom of internal local affection.

DC. In so far as this is a general affection, the laxity proportioned to the atony must be removed equally in it, as in other cases of encreased excretion; and particularly the stimuli of health must be accurately administered.

Of the gout of stronger Persons.

DCI. The gout of stronger persons is a form of asthe­nia; in which, after a long habit of luxury and indolence, and especially, when to those hurtful powers directly debili­tating, ones have been recently superadded, indigestion, or di­arrhaea, or rather both conjoined, with manifest signs of a diminished perspiration, precede; then the lower extremities are affected with languor. Of the lesser joints, almost al­ways the one or other foot is seized with an inflammation, which, if not resisted by a piece of art quite new, will prove most severe, most painful, and of a short duration, comparatively to its state in that respect in the after part of the disease.

[Page 321] DCII. This disease may be called the indigestion or dyspepsia of the luxurious, that is, depending upon indirect debility; while dyspepsia may be denominated the same disease, that is the gout of persons under direct debility, as having every symptom of the gout, except the inflam­mation^(s). For, in diseases, so little is there in names, that not only those diseases, of which we have been just now treating, but likewise asthma, hysteria, the cholic, and most of the diseases, which have taken their appella­tions from any remarkable disturbance of the alimentary canal, are equally prevented and cured by the same me­thod of cure precisely. Which is indeed the reason why the gout has been ranked in the number of the diseases of the same canal.

DCIII. A taint transmitted from parents to their offs­pring, and celebrated under the appellation of hereditary, is a [...]ale, or there is nothing in the fundamental part of this doctrine. The sons of the rich, who succeed to their fa­thers estate, succeed also to his gout: Those who are exclu­ded from the former, are also from the latter, unless they bring [...] on by their own merit. Nay, [...] there be but on­ly two diseases in the strict sense of the word, they must be either all, or none of them, hereditary. The former supposi­tion makes the hurtful powers superfluous, which have [Page 322] been proved to be every thing respecting disease; and, as it is, therefore absurd, so the truth of the latter must be ad­mitted. The stamina, or bulk of our simple solids, are so given in our first confirmation, that some persons are distinguished by a gross, others by a slender state of the whole mass. That variety of the stamina, of the exciting powers, upon which the whole phoenomena of the life depend, be properly directed, admits each its respective state of health. suited to its respective nature, and sufficiently commodi­ous, if the excitement suited to each, from a proper direction of the stimuli producing it, be properly applied. Though Peter's father may have been affected with the gout, it does not follow that Peter must be affected; because, by a pro­per way of life, that is by adapting his excitement to his stamina, he may have learned to evade his father's disease.

β. β. If the same person, who from his own fault and improper management, has fallen into the disease; after­wards by a contrary management, and taking good care of himself, both prevents and removes the disease, as it has been lately discovered: What then is become of hereditary taint.

Lastly, if the gout is the same disease as dyspepsy, ari­ses from the same hurtful powers, is removed by the same remedies; and the only symptom, in which it can pos­sibly be thought to differ, the inflammation, is only a slight part of the disease, depending upon the same original cause, and ready to yield to the same remedies; what signify di­stinctions about either, that do not apply to both^(t)? No­thing [Page 323] by them further is set forth, than, that a certain tex­ture of stamina is favourable to certain forms of diseases, which (forms) are of no consequence, in such sort, that, when the excitement is adapted to the stamina, even those forms can be prevented or cured.

DCIV. The hurtful powers producing the gout are, first, indirectly debilitating, not effectual all of a sudden, nor commonly before the meridian of life, that is, before the thirty-fifth year of one's age. Rich food, too much ease, have a very great effect, drink has less. To that all that have a tendency, to wear out life, to consume the ex­citability, contribute. But the first fit scarce comes on till directly debilitating hurtful powers have been superadded to the indirect^(u). The following are particularly hurtful, abstinence, vegetable food, the hurtful effect of which is in proportion to the imbecility of the matter that composes it. The farinaceous substances, which are by no means safe^(x), and less hurtful than roots, and these less so than greens^(y); but fruits are the most hurtful of all^(z). Cold [Page 324] water, in the height of the diathesis, given to quench thirst, immediately produces nausea, vomiting, and other distres­sing symptoms of the stomach and of the rest of that canal, and hurries on a formal fit^(a). The mixture of an acid with pure cold water encreases the hurtful effect. Of the strong drinks; those prepared from barley by fermenta­tion, that is, the different ales and beers, all the white wines in common use, except Madeira and Canary; and among the red wines claret, indeed all the French wines, and punch with acid, all these are remarkably hurtful. And as indo­lence helps on with the first fit, so fatigue, especially that of walking, hurry on all future ones. Want of a suf­ficient quantity of blood is so hurtful at all times, that, though the theory of physicians led them to the notion that the disease depended on plethora and vigour, yet no body ever thought of taking blood^(b) ▪ Vomiting is bad, and indeed one of the natural symptoms of a very bad state of the disease; but purging the belly is worse^(c). Every evacuation has a similar bad effect, with this distinction, that the artificial are much more hurtful than the spontan­eous.

DCV. One is to be excepted, that is, excess in venery, to which, though it be a spontaneous and natural, not an artificial, evacuation, gouty persons are so addicted, and so exceed others in power, that in the very middle of a very bad fit, they are not sparing of it. That effort at first is not perceived; but in the advance of age, and after many returns of the disease, it is felt at last with a vengeance^(d). [Page 325] Great heat, by its indirectly debilitating operation, does some hurt^(e), but great cold, by its direct debility, much more^(f). Impurity of air is inimical^(g), as well as an interruption in the train of thinking^(h); but hard thinking is more hurtful. A deficiency in the stimulus of passion is a pretty considerable hurtful power⁽ⁱ⁾: But a high inten­sity of it will convert this moderate degree of the gout into that highest degree of it, that attacks the head; lays a snare to life, and brings on certain death^(k).

DCVI. Long sleep is bad^(l), as producing direct debi­lity, by deferring the re-application of the stimuli, which the watching state afford; but short sleep is much more hurtful, leaving behind it a degree of fatigue still remaining from the effect of the stimuli of the former day^(m). Often after the upper parts of the body have been recruited with enough of sleep, after getting up, the podagric feeling a state of languor in his lower extremeties, and a demand for more sleep to them, is obliged to go to bed again, and give the unrecruited limbs their respective share of sleep. When a person is torpid from short sleep, how great is the luxury to cherish again by the heat of the bed-clothes all the parts that have been exposed to cold, that is, the whole surface of the body and thighs, but especially the legs and feet, which last, during the presence of the fit, is the seat of the inflammation; and, how delightful in that way, to make up the necessary compliment of the sleep that is wanted.

[Page 326] DCVII. To prolong the intervals of health, and pre­vent a fit the remedies are all the reverse of the hurtful pow­ers: They are, rich food taken in plenty⁽ⁿ⁾, but remain­ing within its stimulant range, consequently of the animal kind, with a rejection of all sorts of vegetable matter, or a very sparing use of it; strong drink, not taken cold, unless when there is no danger of the disease^(o) (at which time cold water is safe after a good meal), not mixed with acid not acescent, not under a turbid fermentation while it is ta­ken^(p); gestation^(q), exercise short of bringing out sweat, or giving fatigue^(r), a full quantity of blood, which is procured by food and the motion just now mentioned^(s), no evacuati­on^(t), sparing venery, if that be made good in such per­sons^(u), a moderate temperature^(x), kept equally between the extremes of direct and indirect debility, and inclining to neither; pure air^(y), consequently cleanliness, and be­ing much in the open fields, a happy train of thinking^(z); [Page 327] such a state of excitement as to passion, as keeps between [...] excess and stupid apathy, with as great tranquillity of mind as possible^(a); moderate sleep, rather inclining to be long than short, a rule which should be so much the the more obser­ved, as the disease is of longer standing and greater seve­rity: In fine sleep should be allowed to continue till the most vigorous watching state is procured^(b)

DCVIII. From what has been said it must appear cer­tain, that the gout of stronger persons is not also itself a disease of strength, or a sthenic one; and that it does not depend upon vigour of the constitution and plethora, as it has been commonly hitherto imagined; but that it is ma­nifestly asthenic, like all the rest of the cases belonging to asthenia, and proved to be so by the strongest evidence; and that it is not to be treated by an antisthenic, as it has hitherto been the notion, but by a sthenic plan of cure; and that there is every encouragement for treating it in that point of view.

DCIX. What had hitherto deceived physicians, and passed for a cause of the gout, was the appearance of vigour and an over proportion of blood, in most podagrics, from the bulk of simple solids in consequence of their way of life, and often from great strength. But, good men! they never recollected, that vigour and a great quantity of blood was not a property inherent in animals, but that it depen­ded upon foreign circumstances every day and every hour^(c). If any one,according to that idea, who has happened to get a great bulk of [...] solids, and who has had abun­dance of proper diet, and lived in that way to the thirty­fifth or fortieth year of his age, should all at once be depri­ved of all the articles of diet; and if a dwarf two foot high, who has lived poorly, and is, therefore meager, and slender should equally suddenly be put upon a rich living; will [Page 328] there be the least probability, that the former will, not­withstanding his present absolute want, continue plethoric and vigorous; and that the latter, from being now cram­med with unusual plenty, will continue empty, as he had been before? Is the fundamental proposition of this doctrine, in which it has been demonstrated, that we are nothing of ourselves, and that we are altogether governed by foreign powers, to be forgot? Is a person liable to the gout, who has for twenty years undergone an excess of sti­mulant operation, about the fortieth year of his age, or e­ven afterwards, to be reckoned fuller of blood and more vi­gorous, either than another person who has lived lower, or then himself twenty years before? Where, pray, was the necessity of comparing gouty persons with others free from all bias to that disease, and not comparing them with themselves^(d)?

Of the gentle Asthma.

DCX. Asthma is an asthenia; in which, to the symp­toms in common to all astheniae, there is superadded a diffi­cult respiration, returning at uncertain spaces of time, of­ten unequal, without any unusual expectoration accom­panying the fits.

DCXI. The same are the hurtful and curative powers here, as in the gout: In the same manner are the fits both prevented and removed^(e).

Of Cramp.

DCXII. Cramp is also one of the cases of asthenia; in which, often from pain, often from drunkenness, and not seldom from sweat, and disagreeable soaking heat, some­times the wrists, sometimes one of the calves of the leg, in fine, any external part, are affected: Of the internal parts, it is sometimes the stomach, sometimes some part in the intestinal canal, sometimes the bladder of urine, that suf­fers: [Page 330] The disease is not confined to indirectly debilitating powers, as producing it; it also arises from directly de­bilitating ones, such as abstinence, vomiting, loose belly, and drinking water contrary to custom.

DCXIII. To remove this disease; when it does not exceed the gentleness that is here understood, the whole bo­dy must be invigorated by moderate stimuli, every most ur­gent exciting power should be taken out of the way; ge­station, and that exercise, which does not exceed the strength, should be put in practice. A more severe degree of the disease will by and by be treated under tetanus.

Of Anasarca.

DCXIV. Anasarca is a form of asthenia, distinguished by water betwixt the fill and the flesh, occasioning an ex­ternal swelling of the body, without the signs of any suffu­sion of the same fluid into the interior parts.

DCXV. In the cure, the body must be invigorated, and in that part of it chiefly, where the greatest laxity and ato­ny prevails, that is the skin. This indication is answered by stimulating heat, by friction, by pure and dry air, by nourishing stimulant diet, and the Peruvian bark: No internal local affection gives occasion to it, which may be known from the symptoms yielding to this plan of cure.

Of Cholic with Pain.

DCXVI. Cholic with pain is a form of asthenia, and a higher degree of the cholic without pain; in which, to the signs of debility in common to all the asthenic cases, are superadded a greater violence of the same symptoms, and twisting pain about the navel, with pain in some part of the belly, often enormous, and sometimes with a tumour, that can be felt externally^(f)

Of the Dyspepsodynia, or Indigestion with Pain.

DCXVII. Indigestion with pain is an asthenia, which adds to the symptoms of indigestion without pain, a pain and gnawing feeling in the region of the stomach, and is highly expressive of a very severe disease.

Of the violent Hysteria.

DCXVIII. The violent hysteria is a higher degree of the gentle hysteria: in which, besides the symptoms there des­cribed, mobility and changeability of mind, disposition to sleep, convulsive state, and a great resemblance to epilepsy, are conspicious. The temperament, that favours hypo­chondriasis, is of an opposite nature to this, which is com­monly called the sanguine. Both the temperament and predisposition in this case are produced by a moist, lax, set of simple solids.

Of the Gout of weakened Persons.

DCXIX. The gout of weakened persons, which is an encreased degree of the gout of strong persons, is that ast­henia, in which the inflammation runs out to greater length, and at last, does not form at all; and the general affection encreases in violence, in obstinacy, and, at last, attains its highest degree; exhibiting, towards the end of the dis­ease, almost all the symptoms of debility, every form of asthenia, and sometimes by a false resemblance, counter­feiting synocha.

DCXX. As the diseases affecting the alimentary canal, formerly mentioned^(g), have, in a great measure, a com­mon nature; so, these also, that is, the colicodynia^(h), the dyspepsodynia⁽ⁱ⁾, the violent hysteria^(k), and the gout^(l), [Page 332] are equally participant of the same, differing only from the former in their higher degree of violence. Their most di­stinguished symptoms are either spasm, which takes place in the cholic, and indigestion, both with pain, or a spas­modic convulsive affection, distinguishing the rest. But neither in that respect, do th [...] differ from each other in any thing [...] they a [...], without distinction, de­pend not only on debility, but also nearly upon an equality in the degree of it, as the similarity of their morbific powers and remedies proves. For a very full explanation of spasm and convulsion go back to the following numbers, CLXXXVIII. to CXCV. and from the latter to CCI.

DCXXI. For the cure of them all^(m), abstinence, fa­tigue, evacuations, acids, and acescents, cold, directly and indirectly debilitating passions, the debility arising from exertion of the intellectual function, and impurity of air, must be avoided. The cure of every one of them must be stimulant: When each of them is but slight, beet soup and similar rich ones, which act partly by dilution, partly by a nourishing and stimulant operation, in the weak state of the stomach, and by supporting the system, and after­wards, when the strength is so far recovered, solid animal food, and moderately diluted drink, which, at last, con­firm the strength, are sufficient. In a higher degree of violence of any of them, while the soups should still be continued, at the same time pure strong [...] should be administered. And when the violence of any case baffles this whole form of stimulus, recourse must be [...] to musk, volatile alkali, camphor, aether, and opium. These must be administered in large doses; and all acid and fermen­ting things, every thing cold, though accompanied with stimulus, must be guarded against.

[Page 333] DCXXII. For the patient's management in the inter­vals, all debilitating powers must be avoided, such as fa­tigue, abstinence, cold, and excessive heat⁽ⁿ⁾; and take it for a certain and demonstrated fact, that the fits of recur­rent diseases do not return from any inherent power of na­ture, but from human folly. Accept of that as a joyous piece of news, and such as nobody every expected. The recurrence of fits of the gout itself is not unavoidable^(o); but, by guarding against 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 almost always in as many days, and the state of health secured in every re­spect. In all the same diseases of similar vehemence, whenever any stimulus, from a long continuation of its use, has begun to have less effect, we should lay it aside, and proceed to the use of another, from that still to another, and in that way go over the whole circle^(p).

Of Hypochondriasis.

DCXXIII. The hypochondriasis is an asthenia, in which, with the symptoms of dyspepsy, there is a noise in the bel­ly flatulency, and uneasiness, and a rooted opinion in the patient, of the disease being always worse than it is. The way is paved to the disease by a dry set of simple solids, and that temperament, in which there is a natural slow­ness to passion; which, however, once excited rises to the highest violence, and continues long with obstinacy. It is further distinguished by a fixed attention of mind, where­by the patient is liable to dwell to excess upon any pursuit or study, and not to be easily diverted to another, as also by [Page 334] a dry state of the surface of the body, a rough skin, with black hair, and black eyes, and always a dark complexion and serious aspect.

DCXXIV. From the definition given of it by hypo­chondria [...], it is beyond doubt an asthenia, as being ac­companied with a noise in the belly and flatulency; and the course of the disease distinguished by slowness to pas­sion, keenness in thinking, and that state of the simple so­lids, which requires a high force of stimulant operation to procure, and keep up a sufficient degree of excitement.

DCXXV. Since the state of the simple solids is a state given by nature, and not to be changed by art, and the only indication of cure left in the physicians power, is to fit a certain degree of excitement to that given state, which is exactly the case in this disease; it follows, therefore, that the stimulus of food, drink, and others, should be employed in the cure of hypochondriasis. The patient should be kept cheerful, by being placed in agreeable com­pany, and gay entertainments, by entering upon a journey, and amusing himself with the various scenes of nature and art through which he passes. He should ride, that in guid­ing the horse, his mind may be more occupied. His stu­dies and every subject of his ordinary contemplation should be often changed and varied. He should have generous wine given him to relieve the symptoms of his stomach and intestines, and to raise his animal spirits. And if these should fail of success, the diffusible stimuli, as opiates, should have their turn for a time, for the purpose of strik­ing a stroke at once. And their use again gradually laid aside in proportion as the strength can now be supported by the more natural and accustomary stimulants. Dark­ness and bad air should be shunned; pure light, and all lively objects, should be sought after. No hypochondriac, [Page 335] even in a [...] of delirium, should be provoked, but by every contrivance soothed^(q).

Of Dropsy.

DCXXVI. Dropsy is an asthenia, commonly in the form of an anasarca, with a swelling in some viscus, which, for the most part, at least in the beginning, attacks some place in preference to others, and more than any other.

DCXXVII. The cause of dropsy, in so far as it respects the collection of water, is easily explicable upon this doc­trine, but altogether inexplicable upon any other. For the universal debility, that is laxity and atony, is chiefly predominant in the extreme red arteries, and the exha­lants immediately continued from these, as well as in the commencements of the absorbent veins; and, of the same kind of vessels, it is often urgent in a particular part in preference to others.

DCXXVIII. As all the debilitating hurtful powers con­cur in producing this, as well as any other asthenia; so those powers have the greatest influence in this case, that press most urgently upon the vascular system. Hence, as we see in the conversion of peripneumony into the dropsy of the chest, profuse bleeding, and a large draught of cold [Page 336] water, when the body is fatigued, over-heated, and burn­ed up with thirst, are the most powerful agents in bring­ing on this disease. The hurtful effect of the latter of which, in every case of debility, when its operation is fol­lowed by no stimulus, has been more than sufficiently ex­plained above^(r). Besides, in this case, when all the ves­sels are open, the water flowing to their most weak termi­nations, passing out by these, and being not at all transmit­ted from the exhalants into the absorbents, is collected in­to every neighbouring cavity^(s). And hence the com­mencement of the urgent symptom in this disease.

DCXXIX. To this asthenia belong all the watery ef­fusions, which do not arise from a local affection, but de­pend on pure debility. And, therefore, if at any time a­ny other form of asthenia, whether from wrong treatment, or other hurtful powers, in its progress terminates in this effusion; every such case should be held as a proper drop­sy^(t); and it should be ever present to our recollection, that there are only two general diseases, and that the dis­tinctions hitherto received, are devoid of all solid founda­tion. Accordingly, both from other improprieties, and particularly from bleeding, epilepsy, palsy, the gout, ter­minate in real dropsy. Nay, the same is the termination of peripneumony itself, when it is either converted into in­direct debility, from the debilitating plan of cure having been pushed to excess, or into direct debility, from having been left to itself, and the body not sufficiently debilitated. The affections, confined to parts, which are considered as the remote causes of dropsy, will be treated among the lo­cal diseases, to which they belong.

DCXXX. After this explanation of the nature of drop­sy, the cure of it, provided that it be a proper one, and early [Page 337] enough set about, ought by no means to be so much des­paired of, as it should be when local affection, with a simi­lar effusion, and the general disease are blended together without distinction, and considered as one and the the same ^(u). If long before the effusion there was no internal complaint, if the disease rather came on suddenly, and in consequence of evident hurtful powers, and yields to the first part of the curative means, there is no reason to doubt of a cure.

DCXXXI. Besides the general indication of cure for asthenia, that suited to this case must be particularly directed to the whole vascular system, and especially about their ter­minations, and the commencements of the absorbent veins. The remedies are also the usual ones; that is diet, as nourishing and stimulant as possible; first in a fluid form, when the solid cannot be admitted upon account of the debility of the stomach; then, also in a solid; and toge­ther with both, strong drink, such as the best wine that can be got, fermented spirit, sometimes pure, sometimes diluted. If the disease does not yield to these, after their use has been continued for a proper length of time; recourse must be had to the diffusible forms: By this means, when the effusion has not yet attained to that high degree that constitutes a local affection, not to be altered by any state of the excitement, this asthenia can be as easily cured as any other.

DCXXXII. But, when a great quantity of water has now got into some large cavity, it should immediately be removed by the catheter; when that has been done, and the emptied cavity secured with as much care as possible, and the strength supported by wine, strong drink, and any stimulus more diffusible, we must return to the manage­ment [Page 338] mentioned a little above. And if it should likewise fail now, our judgement must be, that either the general disease has degenerated into a local, or that the affection has been local from the beginning.

Of Epilepsy.

DCXXXIII. Epilepsy is an asthenia; the distinguishing symptoms of which are, some heaviness of intellect, dul­ness in the exercise of the senses; and then a very impaired state, or temporary extinction of the latter, accompanied with various convulsions over the body: Fits, consisting of such a concourse of symptoms usually return afterwards at uncertain spaces of time, and each of them terminates in a foaming at the mouth.

DCXXXIV. As all the debilitating hurtful agents are productive of this disease; so the loss of the blood and o­ther fluids, excess in venery, passions, such as fear, terror, assiduous and intense thinking in great geniuses; a defi­ciency of that kind of stimulus in stupid persons, are par­ticularly so^(x). These powers that produce the first fit, more easily bring on after ones: And besides them, cer­tain unusual impressions upon the senses, some of them disagreeable, some highly agreeable; such as the flavour of some foods, the smell of a rose, have the same tendency; and certain poisons^(y) are said to have the same effect.

DCXXXV. But the appearance of symptoms is a thing full of fallacy, and, unless the nature of the hurtful powers producing them, and of the remedies removing them, be throughly understood, it is incomprehensible. To solve the present difficulty about poisons, and to settle the question, whether the symptoms belong to universal, or local dis­ease; we must consider, whether the latter one produced [Page 339] by a vitiated state of a part, suppose that part either the stomach or brain, such a vitiated state, as in some point of the lower extremities proves the cause of the aura epi­leptica; and whether this vitiated state resists the virtue of the remedies, that perform their cure by changing the ex­citement; or whether all the symptoms are either relieved or removed by the change of excitement. If the former is the cause, the affection must be considered as local^(z); if the latter be the truth, the disease must be held for a ge­neral one, and a true, but a great asthenia. Nor must we forget, that a great many symptoms of general diseases, from the same origin, are dissimilar; and many from diffe­rent, nay, opposite causes are similar; that many local symptoms have a great resemblance to those of general diseases, and that they sometimes, by a most false appear­ance, counterfeit epilepsy, sometimes apoplexy, sometimes certain other general diseases besides.

DCXXXVI. For the purpose of preventing this disease, we must both avoid other debilitating powers, and those that have the greatest power in producing it. The vessels should be filled, by giving food as nourishing, and as effec­tual in producing blood as possible; the indulgence in ve­nery must be moderated, chearfulness and tranquillity of mind must be favoured, and agreeable train of thinking must be found, and all the objects of the senses, which give them disturbance, guarded against; the strength must be fortified by recruiting exercise, by the peruvian bark, if the approach of the fits can be perceived, and by wine and the more diffusible stimuli. A length of sleep, that is a medium betwixt too long and too short a continuance of it, should be kept up. Stimulant heat should be apppli­ed; and all excess of it as well as cold avoided^(a). The [Page 340] purest air, such as that in the fields, which is free from moisture should be sought after. The surface of the body should be excited by friction, and cleanliness, for the pur­pose of cherishing the organs of voluntary motion, that are most closely connected with the animal power in the brain.

CCXXXVII. The same remedies, which radically cure the gout, also cure epilepsy, and precisely in the same manner^(b).

Of Palsy.

DCXXXVIII. Palsy is an asthenia, in which, with the other proofs of the usual debility, often with some degree of apoplectic fit, commonly all on a sudden, the motion of some part of the body, and sometimes the sense of feeling is impaired. When the fit is slight and of short continu­ance it terminates in health; but the consequence of a higher degree and greater duration of it is death.

DCXXXIX. The hurtful powers, that usually pro­duce epilepsy and apoplexy, also tend to produce palsy. [Page 341] And besides these, all the common debilitating powers that produce any asthenia, directly or indirectly; great com­motion of the nervous system by means of to too diffusible stimuli; more affecting the circumference of the body, where the organs of voluntary motion are chiefly seated, and the internal parts and the brain less; as is evident in ebriety, gluttony, and every sort of intemperance; likewise an indolent way of life, which as commonly connected with these hurtful powers, have all the same tendency.

DCXL. When the disease has once taken place, as it is kept up equally by directly and indirectly debilita­ting powers; so

DCXLI. For the indication of cure, which is pre­cisely the same as in epilepsy as the energy of the cause o­perates more immediately upon the surface of the body, consequently according to what has been said upon the sub­ject of epilepsy, the principal remedies are those, that have the greatest power in invigorating the surface of the body: Such are friction, gestation, that degree of exercise which the strength can bear, for the purpose of rousing by their powerful operation, the languid excitement in the fibres of the muscles; likewise a proper degree of heat of pure air, and therefore, as much as possible, the open air; lastly, as none of the powers endued with stimulant virtue, by any means should be omitted, in order that the excitement, which is of great consequence in every cure, be more equal and vigorous all over; so in that extreme debility which produces such an impotency of voluntary motion, as it is of the greatest consequence to make an impression upon the principal symptom; we should, therefore, employ a great deal of an opiate, (CXXX. and CCXXX.) the in­fluence of which, upon the surface, is the most considera­ble of all other powers, and press the cure, till some com­mencement of returning motion be procured; and then, without neglecting of the assistance of any of the other sti­muli, [Page 342] but using them all in concourse or succession, for the sake of rendering their common effect more powerful and more equal, to eradicate the disease.

DCXLII. Debilitating and evacuant powers are to be avoided for this reason, that it is not vigour, it is not an over-proportion of blood, but a scantiness of the latter, and a deficiency of the former, that is the cause.

Of Apoplexy.

DCXLIII. Apoplexy is an asthenia, resembling the two just now mentioned, in its cause and cure, differing in the appearance of the symptoms, which makes no differ­ence in the truth^(c): In which, besides the symptoms in common to it with them and the other astheniae, all of a sudden, sense, intellectual energy, and the voluntary mo­tions, are impaired, the respiration remains, but with s [...]or­ing, the pulse is weak, and the whole fit is finished with the appearance of a profound sleep^(d).

DCXLIV. The heads of the patients are large and not well formed, their necks short and thick: The dis­ease arise from both direct and indirect debility, but chiefly from the latter. Of the indirect debilitating powers, the most powerful is the luxury of food, drink, and sloth, which, after its course of stimulating and filling the vessels is run, is truly debilitating and productive of a penury of fluids: And, as each sort of debility is encreased by the other, and consequently the indirect by the direct, so that is remarkably the case in this disease. Hence the effect of the debilitating plan of cure is so pernicious in apoplexy, that it is received as a rule, that the third fit is not often, the fourth never, got the better of.

DCXLV. The cause of epilepsy, palsy, and apo­plexy, is the same with that of every asthenia; affecting [Page 343] the head less in palsy, excepting in the beginning and end, but greatly in the two others; and in all the three produ­cing a disturbance in the organs of voluntary motion. This disturbance, whether the motion be destroyed or dimi­nished, in convulsion seemingly encreased, amounts to the same thing, and, as was formerly explained, depends upon debility^(l).

DCXLVI. The same here too is the indication of cure; with that, which runs through this whole form of diseases, and the force of the remedies is especially, and as much as possible, to be directed to the parts most affected. To pre­vent, therefore, the fits, in every respect alarming and full of danger, we ought to recollect, how far indirect debility has a share in producing this disease, and how far the di­rect concurs with it; and also consider the operation of a greatly advanced age. All excessive stimulus, therefore, must be avoided in such a manner, that the body may be invigorated and direct debility guarded against, the stimu­lant plan of cure should be set on foot with moderation and accuracy; and, in the place of the forms of stimuli, that have, either from long or excessive use, lost their stimulant operation, according to the rule of nature, others, which the excitability, yet not worn out with respect to them, can receive, should be substituted, that is, the kinds of food, of drink, and of diffusible stimuli, should be changed all round, and upon the failure of each lately used one, to return to those that have been long ago laid aside^(f).

DCXLVII. The three diseases we are treating of, are commonly supposed to arise from a plethora, attacking the head, and proving hurtful by compression upon the brain. But, besides that, plethora has no existence in any case where it has been supposed^(g), at that extreme age at [Page 344] which those diseases happen; or sometimes in epilepsy, when it affects weak and starved 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?

DCXLVIII. As plethora has then no share in inducing those diseases, so neither is an effusion of blood or of se­rum^(h) upon the brain, to be accused to it. Nay, a similar effusion happens in every case of the vessels, from great de­bility as well as in this case.

Of the Lock-Jaw.

DCXLIX. The lock-jaw is a less degree of tetanus, its spasm being confined to the lower jaw and the neigh­bouring parts. This is a rare affection, without others e­qually conspicuous; as being a formidable symptom of fe­vers and wounds. When the former of th [...]se happens, it will be treated of in fevers; when the latter, it will give occasion to an enquiry, whether it belongs to local or ge­neral disease.

DCL. Since it never arise immediately after a wound is inflicted, but usually happens, either when the latter is healed up, or after a considerable interval of time; the inference from that is that it either arises from the vio­lence and duration of the pain, which is always a cause of very much debility, or from that debility, which the usu­al antisthenic plan of cure produces, or from an unknown taint in the substance of the nervous system.

DCLI. That it depends upon debility we have rea­son to believe, from every sort of spasm always depending on debility⁽ⁱ⁾; from tetanus, which is precisely the same [Page 345] affection, only differing in degree^(k), having no other ori­gin; and, in fine, from the success of the stimulant plan of cure in this as well as all other spasms; and the want of success of the antisthenic, or debilitating evacuant one. All the other particulars regarding this subject will be ta­ken notice of under the next head of disease tetanus.

Of Tetanus.

DCLII. Tetanus is an asthenia, and, therefore, always affecting persons under debility, whether direct or indirect; in which, sometimes with consciousness, sometimes not, sometimes with difficulty, sometimes with freedom of res­piration, the whole body, or the neck and its neighbour­hood only, are bent sometimes forward, sometimes back­ward, and held fast by a rigid spasm.

DCLIII. Tetanus is the offspring of cold countries, as the northern parts of Europe, but rarely; more fre­quently of the warm southern regions of that division of the world; but most frequently of the torrid zone. The rare case, such as that among us, is the sequel of a debili­ty scarce usual in other general diseases: On the contrary, it almost always arises from that unusual debility, which is occasioned by a lacerating wound, through which fractu­red bones are dashed, increasing the sum of that debility that existed before, or that happened to be induced in the course of the cure. To produce the more frequent case, or that most frequent one of all, which is quite common in the torrid zone, the most powerful of the debilitating powers, and a very great many, if not all of them, con­cur. The most powerful of these is, that degree of heat, which is intolerable, to persons engaged in exercise or la­bour^(l), to whom almost only, and therefore to the slaves, it is hostile. Hence, even under the slightest corporeal mo­tion, [Page 346] fatigue, and sweat, are produced^(m), and from the sweat a scantiness of blood and other fluids. From a [...] those arises a languor over the whole body, and, therefore, in the stomach⁽ⁿ⁾: From the languor of the stomach there is a puny appetite, and food, which is another cause of penury of the fluids, is either not taken in, or thrown up again. All these affections, as well as that indolence both in mind and body, which is inseparable from such a state of circumstances, are followed by the highest degree of de­bility over the whole body: And, as the most noxious power, the intense heat distresses the head more than any other part, as well as the organs of voluntary motion, whe­ther in the neighbourhood of the head, or more distant from it; that is the cause of the urgent symptom, the spasm, occupying the parts that have been mentioned.

DCLIV. As tetanus is occasioned by all the debilita­ting powers, according [...]o the different degrees in which they possess that effect, and, consequently, like every other asthenia, depends upon debility as its cause; and, as all the astheniae are removed by remedies, exciting the whole system in such a manner, as to exert the greatest influence possible upon the labouring part; the same, accordingly, is the nature of tetanus, however little that disease has been understood, the same simplicity of nature is found in it: And if there is occasion in it for the very highest reme­dies, that circumstance shows, that the whole disease does not depend upon the spasm, and that the labouring muscles are not its whole seat, but that there is vast debility in every part, only greater in the muscles, than in any other equal part, according to the law we have mentioned^(o).

DCLV. From what has been said, after tetanus has taken place, and upon account of the teeth being shut by [Page 347] the lock-jaw, there is neither access to the weaker and less powerful stimuli of food, drink, and such like, which are often sufficient for the cure of diseases of lesser de [...]ity, nor any sense in using them; we must, therefore, immedi­ately have recourse to the most powerful and the most dif­fusible stimuli possible, and continue their use without regard to quantity, not even that of opium itself, till the whole tumult of the disease is allayed^(p).

Of Intermittent Fevers.

DCLVI. Paroxsyms, consisting of a cold, hot, and sweat­ing fit, are a sort of phoenomena that occur in every in­termittent; and, in a certain proportion, in every remit­tent fever. They often come on in consequence of a certain taint received from neighbouring morasses, or from a simi­lar state of a neighbouring soil; but they also happen and of­ten too, after an application of cold only^(q); at other times after that of heat only^(r), when the common asthenic hurtful powers accompany either: And they return with a [Page 348] remarkable exacerbation, after a temporary solution of the disease, or an abatement of it; in the cold fit, exhibiting manifest debility; in the hot, counterfeiting a deceitful appearance of vigour; and scarce ever observing any strict exactness in the time of their return^(s); but returning sooner in a higher, and later in a lower, degree of the dis­ease; and not unfrequently, besides the remittent, also gradually assuming a continued form; and, on the contra­ry, sometimes without interference, oftener in consequence of an improper method of cure, before the disease is ended, changing into quintans^(t), septans^(u), nonans^(x) or into sex [...]ans, octons, and decans^(y).

DCLVII. The fever of this kind, which returns every fourth day, and is therefore called a quartan, is milder than that which receives the name of tertain, from its recurrence being on the third day, and the latter is milder than that which, from its return every day, is denominated quotidian. The disease, that degenerates into a remittent or continued form, is of a worse nature than that which is regular in its returns, or that which puts off fits, and protracts the inter­vals betwixt them: And, the form and type of each case being given, the whole set is both of more frequent recur­rence, and of a more severe kind in hot, than cold, climates.

DCLVIII. That this sort of fever depends upon debi­lity throughout the cold fit, is proved by the symptoms, by the exciting hurtful powers, and by the method of cure, whether successful, or the contrary.

[Page 349] DCLIX. The whole disease, as well as every paroxysm, begins with a sense of cold, the greatest desire for a warm situation,^(z), with trembling, and that shaking motion in which the whole body is lifted up from the bed^(a), with paleness, dryness, and shriveling of the skin, with the di­minution of tumors, and drying up of ulcers, that the patient may happen to have had before the arrival of the disease, with an impaired state of the intellectual faculty, a want of steadiness in its exertions, and sometimes delirium, with a dulness of sensation, languor of spirits, torpor of the vo­luntary motions, a listlesness of mind and body in all the functions, in fine, a manifest debility.

DCLX. If terror, horror, cucumbers, cold melons, fa­mine, debauch in eating and drinking, food of difficult di­gestion, have been found for certain, to have a great effect in bringing back paroxysms, after a long intermission of them; if in cold situations, where cold is the principal hurtful power, it is the poor people, who are ill clothed, starved in their diet, and enfeebled by labour, who in gene­ral are only affected with disease; if in warm regions of the globe, those who have been most exposed to debilitating hurtful powers of all kinds, who, in preference to others are seized with it^(b); if in moist places, those who live well in their diet, and cheer themselves with their bottle, escape the disease^(c), and water drinkers and persons in a [Page 350] state of inanition from low living peculiarly experience it; all these facts show, how far this disease is from depending upon heat and moisture alone; and prove, that it also ari­ses from cold, and not from either alone, but also from all the usual hurtful powers, like every other asthenia.

DCLXI. Further, if every kind of evacuation, as often as it has been tried, is found, without the possibility of a doubt, to be hurtful; if no person in his senses has scarcely ever attempted bleeding^(d); if, before the Peruvian and some other barks of similar operation were found out to act as remedies, a variety of strong drinks^(e) were used with sufficient success; and if it now also is found and demon­strated in fact, that the diffusible stimuli are by far more ef­fectual than any bark; nay, that the bark often fails, while they are perfectly effectual in the re-establishment of health; [Page 351] from this sort of argument and certainty in point of fact, we derive the most solid conviction, that there is nothing in this disease different from other astheniae, but that it per­fectly agrees with them in the exciting hurtful powers, in the cause, and in the cure. And, if it differs in the appea­rance of the symptoms, that shews no difference of nature, and not even any thing unusual; as all the astheniae that have been mentioned, however much they have been pro­ved to be the same^(f), differ notwithstanding, in a similar manner, from each other, and symptoms lead not to truth, give no real information. For, though precisely the same [...]ound functions flow from the same state of perfect health; yet when the latter is so changed, as that the excitement is either encreased or diminished, the functions are changed from the standard into every sort of appearance, in such sort, however, that they point out no difference in the cause as has been commonly believed, and not always even a difference of degree^(g)

DCLXII. Accordingly, the following demonstrated facts of spasm, convulsion, tremor, inflammation from weakness, deficiency of menstruation^(h), bleeding discharges⁽ⁱ⁾, loss of appetite, thirst, nausea, vomiting, diarrhaea with pain▪ diarrhaea without pain, and all the other asthenic affec­tions^(k), arising from one and the same cause, and being removed by one and the same operation of the remedies^(l), and not even in their morbid state, expressing degrees of debility in such a manner, as that it can be thought proper to take any order of arrangement from that mark; all these serve to confirm the observation just now made, and by their analogy, to demonstrate, that the fevers also [Page 352] are distinguished by intervals of freedom from febrile state, sometimes greater, sometimes scarcely perceived in com­mon with what happens to many other diseases, not from a­ny peculiarity in the cause, but from a variation in its force. If fevers sometimes intermit their febrile impulse, sometimes exert it more remissly, and sometimes, by performing the latter imperceptibly, go on almost in a continued career^(m); do they, in that respect, differ from the gout⁽ⁿ⁾, which never goes on with an equal force, but abates from time to time; and even, when it has interposed an interval of health returns with more severity than ever? Or do they differ from asthma, as well as many other diseases, in all which the same thing precisely happens? And what is more usual, in indigestion, and often violent vomiting^(o), ac­companied [Page 353] with a rage of other symptoms, than the inter­vals of the greatest relief? The same is the nature of the chin cough^(p) the same as that of the asthenic cough^(q). In fine, where is there one of all the asthenic diseases, the morbid career of which continues the same from beginning to end? There is none^(r). For, as life in all its states^(s) is always in proportion to the action of the exciting powers, upon the excitability, and both predisposition to diseases, and diseases themselves supervene in proportion to its being greater or less than the proper degree; so the course of diseases follows the same rule; and, according to [Page 354] the variation of the degree of that action, is one while en­creased, another while diminished, another while exhibits a temporary eruption; just like what happens in this sort of fevers,

DCLXIII. The cause of them is the common one of all astheniae, whether febrile or not; but under such di­rection and application to the system, that, after an interval of some hours, all their morbid energy departs entirely, or in some degree. And the reason of that is, that the exciting hurtful powers in the same proportion are either removed, or more gentle in their operation; in one word, the excitement is encreased for the time. The variation of types is not owing to a matter, subject to the same va­riation: For, if that were the case, how could the same case run through all the forms, sometimes of intermission, sometimes of remission, and at other times of nearly going on with a continued movement and the contrary? Is the matter, which is supposed to produce each form, in order to produce another form, changed into that matter, which is supposed necessary to the latter^(t)? Is the vapour, or, as they call it, the effluvium, proceeding from animals, which is supposed to produce any typhus, or continued fe­ver, and, therefore, the AEgyptian one, when this is chan­ged into an intermittent, or remittent nature, also, together with the change of type, changed into a marsh miasma, or defilement arising from morasses, which is supposed to produce that form of fever? Or rather does the matter, which at first produced each type still continue the same, and become the cause of another form? If any person should fix upon the latter as being the truth, how should the [Page 355] same cause produce different effects? But, if he inclines to adopt the former supposition, what proof is there, that can be admitted upon any principle of reasoning, that, as often as the form of the fever changes, so often its cause, the matter, is also changed? It has been already proved, that marsh miasmata, or defilements, are not the cause^(u). And it shall be by and by evinced, that the animal effluvi­um, or vapour, arising from the body, when affected with a continued fever, is not: Nay, it has been proved by the most solid arguments, that neither is any other matter taken into the body, either in this or any case, that which produ­ces the disease, and that the change of excitement alone is the universal source of all general diseases^(x).

DCLXIV. To enquire into the return of fits; it is not peculiar to this form of fevers, to have a return of the general affection after its temporary solution; the same thing happens to the gout, as often as a return of the dis­ease again succeeds to a return of health^(y), and for the same reason^(z): For, as those diseases are repelled by in­vigorating means, so they are brought back by the debili­tating powers, which were their first cause. Accordingly, when the disease is left to itself, when it is treated by a de­bilitating plan of cure, it perseveres in returning; when it is treated with Peruvian bark, and still more certainly by the forms of wine and diffusible stimuli, and when that mode of cure is persisted in, till the strength is quite con­firmed, it never returns.

DCLXV. The tertian vernal fevers of Scotland go off without medicines, in process of time, first in consequence of the heat of the bed, and then, as the summer sets in, by basking in the rays of the sun, and by a moderate use of food [Page 356] and strong drink, their duration commonly not exceeding the space of three months. In all the southern regions, and even in England, the Peruvian bark, when the whole cure is entrusted to it, often fails, and they are not removed but by very diffusible stimuli^(a).

DCLXVI. The debility during the cold stage is the greatest, that of the hot less, and that of the sweating stage, which ends in health for the time, is the least of all. Hence, in a gentle degree of the disease, as cold is the most hurtful power, the consequence is, that its effect is gradually taken off by the agreeable heat of the bed or of the sun, and the [Page 357] strength, thereby gradually drawn forth. The heart and arteries, gradually excited by the same heat, acquire vigour, and at last, excited in their perspiratory terminations by the same stimulus the most hurtful symptom being thereby re­moved, they restore the hot [...]it, and afterwards carry on the same process to the breaking out of sweat.

DCLXVII. When the force of the disease is greater, these powers are ineffectual; and, unless the most powerful remedies are applied, the disease, instead of producing inter­missions, rushes head-long into the remittent state only, or even into those very obscure remissions, which give the appearance of a continued disease.

DCLXVIII. And, since in every case of disease of any energy, the disease returns, for this reason, that either the lesser force, by which it is kept up, is not stopt by a lesser force of remedies, or the greater force of the former by a greater force of the latter^(b); the remedies, therefore, should be given both before the cold fit, and during it, as also through the whole course of the intermission to the next paroxism, and they should be continued even through this, and after it is over. Lastly, like the practice in eve­ry other cure of asthenic diseases, we should gradually re­cede from the use of the highest stimuli, in proportion as the body can now be supported by the lesser and more na­tural^(c).

Of the severe Dysentery.

DCLXIX. The severe dysentery, or bloody flux, is an asthenia; in which, besides the symptoms in common to that whole form of diseases, so often now repeated, there are pains in the intestines, gripes, innumerable dejections, [Page 358] chiefly mucous, sometimes bloody, for the most part with­out the natural matter that passes that way, all which hap­pen often after contagion has been applied.

Of the severe Cholera.

DCLXX. The severe cholera adds to the common symptoms of every asthenia, those of vomiting and purging, alternating with great violence, and for the most part con­sisting of bilious matter.

Of Synochus.

DCLXXI. Synochus is a very mild typhus, and such as chiefly happens in cold countries and cold seasons; in the beginning deceiving physicians by a certain resem­blance to synocha, but a counterfeit one.

Of the simple Typhus or Nervous Fever.

DCLXXII. The simple typhus, or nervous fever, is such a synochus, as appears in warm countries or seasons, but somewhat more severe, and yet sufficiently simple.

Of the Cynanche Gangrenosa.

DCLXXIII. The gangrenous cynanche is a typhus, a little more severe than the simple typhus, or nervous fever, with an eruption upon the skin, and a red tumid inflam­mation of the throat, and with mucous crusts of a whitish colour, and concealing ulcers below them. The end of the angina, formerly mentioned^(d), equals or exceeds the violence of this disease.

Of the confluent Small-pox.

DCLXXIV. The confluent small-pox is a typhus chiefly depending upon indirect debility. It is preceded by [Page 359] a great eruption of the distinct kind, and an universal crust of local inflammation over the whole body; which, by their local and violent stimulus, convert the sthenic into the asthenic diathesis, and the inflammatory affection into a gangrenous one. Its cure is to be conducted upon the stimulant or antisthenic plan, but in such a way, however, as is suitable to indirect debility.

Of the pestilential Typhus, the jail, putrid, or the petechial Fe­ver, and the Plague.

DCLXXV. The pestilential typhus, or the jail, putrid, and petechial fever, is an asthenic disease of the highest de­bility, scarce excepting the plague itself; in which the sur­face of the body is first dry, pale, hot, shrivelled; then, chiefly towards the end, moist, drivelled with spots, and colliquative sweats, diversified with vibices, or long strokes like those laid on by a whip, and wasted with colliquative diarrhoea; in which the stomach is affected with the want of appetite, loathing of food, nausea, often with vomiting; in which the belly is first boundish, and then, as it has been said, subject to colliquative evacuation; in which the intellectual function is first impaired, then becomes inco­herent, afterwards delirious, and that often in the highest degree; in which the spirits are dejected and wasted with sadness and melancholy; in which the voluntary motions are early impaired, and then so destroyed, that the patient cannot be supported in his posture in bed by his own mus­cles, or prevented from slipping down, from time to time, from the upper to the lower part, and the senses are either blunted or preternaturally acute. In fine, the urine, the foeces, the breath, and all the excrementitious discharges, have a singular foetid smell.

DCLXXVI. The plague begins, holds on in its course, and ends with similar symptoms: To which, however, [Page 360] carbuncles, buboes, and anthraces, or fiery sores, are added. These are most frequent in the plague, but not so confined to it, as to be excluded from the pestilential fever^(e).

DCLXXVII. Contagious matter sometimes accom­panies typhus, always the plague: The former is of a com­mon nature, or such as is liable to happen in any part of the globe; the latter is thought peculiar to the eastern part of Europe, and the western of Asia, possessed by the Turks, called the Levant.

DCLXXVIII. With respect to the contagious matter of typhus; the corruption of the fluids is by no means to be imputed to it^(f), nor is heat so much to be blamed; for cold has an equal power in producing that effect as heat^(g), as has also every thing, as well as heat, that either directly, like cold, or indirectly like it, debilitates^(h). Nay, the emptiness of the vessels, from want o [...] food, or from the incapability of the digestive organs to take it in and assimilate it, as also that debility which is induced by melancholy and grief, though, in these cases, no matter at all is present, admit of the same application. By means of that debility in the extreme vessels, internally, as well as externally, and, therefore, especially in those of the alimen­tary canal and in the perspiratory vessels, the fluids stagnate; and by stagnating under the heat of the body, degenerate [...] into that foreign quality, which, in a more extensive sense, is called corruption, but in a more uncertain one, putre­faction⁽ⁱ⁾.

[Page 361] DCLXXIX. As the cause of all these diseases is the same with that of diseases not febrile, to wit, debility; dif­fering only in this, that it is the greatest debility compa­tible with life, and not long compatible with it; so,

DCLXXX. The indication also of cure is the same as that of the other astheniae, but must be conducted with a good deal of more attention than is necessary in them, upon account of their much greater mildness^(k). It is, then, debility alone, that is to be regarded in the cure; and sti­mulant or antisthenic remedies alone, that are to be ad­ministered. Nor is there occasion for any distinction in the method of cure, but what direct or indirect debility requires^(l).

DCLXXXI. The indirectly debilitating powers, are the violent and local stimulus of the eruption in the con­fluent small-pox^(m), so often inducing prostration of strength, and drunkenness⁽ⁿ⁾, heat^(o), or long continued [Page 362] luxury^(p). To these hurtful powers, thus indirectly di­bilitating, all the others may more or less be added^(q).

DCLXXXII. And as it never happens, that either di­rect or indirect debility alone proves hurtful, hence we have a third case given, where we have to combat both sorts of debility ^(r).

[Page 363] DCLXXXIII. The directly debilitating powers [...]e known, to wit, cold^(s), low diet,^(t), bleeding, and other evacuations^(u), rest of body and mind, and want of passion and emotion^(x), and impure air^(y).

DCLXXXIV. As both those sets of powers act by de­bilitating; be, at the same time, on your guard from be­lieving, that some of them are septic, and prove hurtful by fermentation, and are to be cured by antiseptics, or pow­ers that resist putrefaction; and that, among the former, heat is to be reckoned; among the latter, cold, wine, the Peruvian bark, and acids^(z).

DCLXXXV. In the gentle cases, as in the agues of cold places, and especially the vernal agues^(a), and like­wise in synochus, in the simple typhus, and in the plague itself, when mild; scarce any stronger stimulus than wine is required; and the rest of the cure is to be conducted according to the directions so often now laid down in the mild asthenic diseases.

DCLXXXVI. In the most severe fevers, such as the remittent^(b), in the warmer regions of the earth, and in the torrid zone, and in the severe typhus, when it is pe­stilential, in the very violent dysentery and cholera of the same places, and in the most violent plague itself (b), the cause of all which affections is in general direct debility; or in gentler cases of the same disease at first, and that have now acquired a great deal of virulence in their progress [Page 364] from the neglect of the proper, or the use of an improper plan of cure; we ought immediately to begin with the highest diffusible stimuli, such as opium, volatile alkali, musk, and aether, in small doses but often repeated^(c); and afterwards, when the strength is restored, and the force of the stomach confirmed by their use, to proceed to the use of food, drink, gestation, pure air, cheerfulness, and, last of all, to the usual offices and occupations of life.

DCLXXXVII. When indirect debility has had more concern in the cure, as in agues, or more continued fevers, occasioned by drunkenness, and in the confluent small-pox; the same remedies are to be employed, but in an inverted proportion of dose. We should, consequently, set out here in the cure with the largest doses, and which, are next in quantity to that degree of stimulus, which pro­duced the disease^(d); then recourse should be had to lesser [Page 365] stimuli, and a greater number of them, till, as was said just [...]ow^(e), the strength can be supported by the accustomary and natural stimuli^(f).

DCXXXVIII. To give some estimate of the dose in both cases^(g); in direct debility, where the redundancy of excitability does not, for the time, admit of much stimu­lus^(h), ten or twelve drops of laudanum given every quar­ter [Page 366] [...] hour, till the patient, if, as is usually the case, in such a high degree of debility, he has wanted sleep [Page 367] long⁽ⁱ⁾ falls into it: After sleep, when now some vigour is acquired both by that and the medicine, and now some of the excessive excitability is worn off, a double quantity of the diffusible stimulus should be added, and, in that way, gra­dually encreased, till the healthy state can now be suppor­ted by [...] lesser in degree, greater in number, and more natural^(k).

DCLXXXIX. In indirect debility an hundred and fifty drops should forthwith be thrown in; and then the superaddition to be made, should be less and less, till we arrive at the boundary just now mentioned^(l). Both the measures recommended^(m), are in general applicable to adults; but less will suffice 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⁽ⁿ⁾.

[Page 368] DCXC. And since the use of the diffusible stimuli on­ly succeeds, when life cannot be preserved by the usual and more congruous to nature, and a due quantity of blood and other stimuli soon become sufficient to finish the heal­thy state; we should, on that account, even from the be­ginning immediately give animal food, if not in a solid form in which it can neither be taken nor digested, at least in a fluid form, in that of soups; which should be alternated with all the doses of the diffusible stimulus: Then, in a gradual way, proportioned to the return of vigour, first a very little of something solid, and afterwards more and more should be thrown in, and the other stimuli, each at its pro­per time, brought into play; till the whole cure termi­nate in the management commonly observed in good health, where there is less occasion for medical injunc­tions

DCXCI. When the affection is more a mixture of both sorts of debility, these proportions of the doses must be blended together.

DCXCII. Contagion, which either adds nothing to the effect of the usual hurtful powers, or proves hurtful by the same operation by which they are so, is not otherwise [Page 369] to be regarded, than that time be allowed for its passing out by the pores, together with the perspiratory fluid, and, therefore, the perspiration be properly supported; which, as it is affected by stimulating, is no addition to the general indication^(o).

DCXCIII. Lastly, the corruption of the fluids in the extreme vessels must be obviated^(p), not by means, that by a direct operation remove it, but by the powers that act upon the excitement of the solids, and that encrease excitement over the whole body, and therefore, among other parts, upon the labouring vessels.

DCXCIV. Having now run over the whole scale of decreasing exciting power from peripneumony to the plague, and from death by indirect, to death by direct de­bility; and having so executed the work, as to present the pub­lic with a new science, if not finished off in an elaborate, elegant, and highly polished manner, at least marked in outlines, and, like a rough statue, to be polished afterwards, in some measure fashioned in all its limbs, and embracing an entire plan of a work, connected in all its parts; we must next pass over the consideration of local diseases.

The second Division of Local Diseases.

DCCVII. THE local organic diseases of the second division are the inflammation of the stomach^(a), and that in the intestines^(b); as also bleeding discharge, with an inflammation subsequent to it; and, in fine, an inflamma­tion in any very sensible part, in consequence of a wound, producing commotion over the whole body.

Of the Inflammation in the Stomach.

DCCVIII. The principal symptoms in gastritis are, pain in the region of the stomach, a burning heat, deep seated, encreased by every thing that is either ate or drank, or in any shape taken into the stomach; hiccup, an incli­nation to vomiting, and the sudden throwing up what is taken in; and the pulse soon getting into a state of debi­lity, quickness, swiftness, and hardishness.

DCCIX. The exciting hurtful powers, and which pro­duce the solution of continuity in this case, are such as act by cutting, pricking or erosion. Such are the small bones of fishes, ground glass, or Cayan pepper and such like things.

DCCX. Inflammation is a consequence of the wound or erosion, that are the effect of the operation of those ex­citing powers: The effect of which, in the very sensible organ of the stomach, is to diffuse the disturbance before­mentioned^(c) over the whole system. The burning heat and pain, inseparable from every inflammation, and the anxiety^(d), are the offspring of the inflammation^(e): And, of them, the anxiety is more peculiar to the stomach, the latter being its accustomary seat^(f), and the pulse becomes such as has been related, because it is peculiar to every rude, fixed, and permanent local stimulus^(g); to weaken, and to be so much the more liable to that effect, the greater the excitability of the part is. Hence, in the external parts of the body, that are less endued with excitability, a pretty considerable inflammation by no means affects the pulse or the body any way generally; though even there, when a part is sensible, as in the case of a burn spread to any ex­tent, or of a thorn having been thurst below the nails, an [Page 376] equal disturbance arises over the whole body^(h), which con­firms a former proposition, in which it is asserted, that the more abundant the excitability is⁽ⁱ⁾, the less stimulus can be born.

DCCXI. The disease is easily known, both from the symptoms above described, and, with not a little more cer­tainty, from the known taking in of the hurtful powers; and, over and above, by this particular sign, that, as it has been said before, with us such marks, inflammation scarce seizes upon an internal and shut part^(k).

DCCXII. As this is a local disease, and does not, like the general ones, depen [...] upon the encrease or diminution of excitement; consequently, the indication suited to the latter, to wit, to diminish encreased, or encrease diminished, excitement, over all, will not apply. On the contrary, un­less a general disease happen to be combined with it, no­thing else is to be done, but, by throwing in bland, demul­cent liquors, to defend the tender part from the rude contact of the stomach's contents, and give the inflammation time to finish its course; and, if the physician is called soon enough, to wash off the hurtful matter with a diluent drink.

Of the Inflammation in the Intestines,

DCCXIII. The inflammation in the intestines is a lo­cal affection; in which there is an acute pain in the belly, [Page 377] and distention, and sometimes a sort of twisting of the pain around the travel, with vomiting, and an obstinate cos­tiveness, and such a pulse as in the inflammation of the in­testines.

DCCIV. The hurtful powers, exciting this disease, are precisely the same, as those that have been said to excite the inflammation of the stomach, that is:

DCCXV. The inflammation arises in a similar manner, as in the inflammation of the stomach, and the more rea­dily, that the intestines are more sensible than the sto­mach^(l). And hence also, in a similar manner, is a state of disturbance diffused over the whole body.

DCCXVI. The acute pain of the belly depends upon the inflammation: Its distention and the costiveness is the offspring of the detained foeces. The same is the cause of vomiting; for the peri [...]ta [...]ic motion being prevented, upon account of the obstruction, to proceed downward in its usual way, from its re [...]less nature recoils in the direction up­ward; as affecting neither direction, unless in so far as the stimulus, by the impulse of which it is regulated, either commences from above, as health requires, or from below, as happens in other diseases, and in this in particular^(m). The pain twisting about the navel, is produced by the in­flammation, for this reason, that the principal, and by far the greatest part of the intestines, is thrown in a convoluted state about the navel.

DCCXVII. The diagnosis is the same as in the gastri­tis; excepting, that the seeds of fruits, hairs, and similar foreign [...] sometimes upon account of the torpor of the [...] adhering to the sides of the intestinal canal, gradually, by their irritation, kindle up an inflamma­tion: [Page 378] Which is a fact, that if examined attentively, and once rightly considered, will not disturb our diagno­sis.

DCCXIII. The cure is precisely the same as in the inflammation of the stomach.

DCCXIX. All the rest of the pretended phlegmasiae, distinguished by the appellation of "itides," as the spleni­tis⁽ⁿ⁾, hepatitis^(o), the true nephritis^(p), the cystidis^(q) without a stone, or the hysteritis, not arising from schirrus^(r), and the peritonitis^(s), do not belong to this place; as, be­sides the doubt of their ever being inflamed, not arising from stimulants and acids, neither of which have access to the shut viscera (for these substances are not carried in the vessels, or can be carried), but from the relics of other diseases, of which we are to speak afterwards, with the fol­lowing exception:

DCCXX. The exception is, that if any one falls from a height, i [...] he is run through any part of his bowels with a sword, if a poisoned arrow, thrown by any savage, has pierced any of his inward parts, he will, in

DCCXXI. The case of the inflammation affecting the liver, be affected with a pain in his right hypochondrum, with vomiting and hiccup: If

DCCXXII. The inflammation affect his spleen, the pain will be in his left hypochondium; in

DCCXXIII. The case of the true nephritis, or inflam­mation of one of the kidnies, he will be pained in the re­gion of the kidney, and seized with vomiting, and a stu­por of his leg; in

[Page 379] DCCXXIV. The case of the inflammation happen­ing in his bladder, he will have a tumour and pain in the under belly.

DCCXXV. Bleeding discharge, followed by inflamma­tion^(t), such 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 easily distinguished by the pain of the affected part, and by the preceding accident.

DCCXXVI. In the inflammation of the womb, or any neighbouring part, the lower belly is affected with heat, tension, tumor, pain, and these symptoms accompanied with vomiting^(u).

DCCXXVII. The hurtful powers, that excite the hy­steritis, or inflammation of the womb and parts in its neigh­bourhood, all amount to violence done to the womb. Thus using violence during the labour, hurrying the birth, often produce a solution of continuity, and wound the womb with a tearing rudeness.

DCCXXVIII. And, since a great deal of blood is often lost in that way, and the local affection followed by debili­ty of the whole system^(x); for that reason bleeding, ac­cording to the common practice, any mode of evacuation, are not to be practised, nor is the patient to be forbid to eat; but, in the first place, regard is to be had to the affect­ed part, the body must be laid in an horizontal posture, she must be kept from motion, and be allowed rich soups and wine: By and by more solid animal food should be used morsel by morsel, but frequently repeated, and she should [Page 380] have her belly ba [...]hed: And, if the debility should get a head, recourse must be had to more wine, drink still stronger, and o [...]rates: The use of which last should not be neglected, even at first.

Of Abortion.

DCCXXIX. In abortion, the back, the loins, the belly, are pained, like what happens in child-labour; and there is either an unusual flow of the menses, or an extra­ordinary discharge from the vagina.

DCCXXX. The hurtful powers, that force abortion, are [...]a [...]ling from a height, s [...]pping a foot, a rash step, in­tense walking, running, going up and down hill. This disease seldom, however, happens but to persons previously weak; and the most powerful agent in bringing it on, is some taint left since a former abortion, which encreases in proportion to the number of abortions. When the dis­ease happens in consequence of the local hurting powers just now mentioned, in that case it is perfectly local: But wh [...] [...] is blended with the effect of those powers it is a case of combination of general with local affection.

DCCXXXI. The indication for preventing the dis­ease is, to guard against all the hurting powers that induce the disease; to ride out, when the patient has any degree of strength; but, in case of any apprehension of danger from weak­ness, to go in a carriage, which will b [...] more [...] to be upon guard from the third month of pregnancy till the se­venth is passed; to invigorate the system, and keep up the patient's spirits, and intellectual amusements.

DCCXXXII. The indication of cure is, to keep the body in a horizontal position, with the buttocks higher than the head; to be studious to keep the patient easy in body and mind; to repair the loss of blood with soups, to secure the vessels, for the purpose of contracting their [Page 381] enlarged diameters, with wine and [...] and, in that way, take off, at the same time, the a [...]ony and laxity, which are the principal cause of the discharge.

Of difficult Child-labour.

DCCXXXIII. In difficult child-labour, the most common cause of which by far is weakeness, and which always produces weakness when it proves lingering; the laying-in woman should be supported with wine, and when the labour proves more difficult, and is now like to be te­dious, opium should be [...].

DCCXXXIV. When now some part of the u [...]e [...]us is hurt by the hurting powers that have been mentioned^(y), and the child and placenta are now both a livered, the woman should be kept in an horizontal posture, as was recommended in abortion; she should be invigorated by soups, chicken, wine and the still higher stimuli, every thing contrary should be avoided; and the hea [...]ing up of [...]he wound waited for.

Of deep seated Wounds.

DCCXXXV. In deep seated, or gun shot, wounds, when the ball, if a ball occasioned the wound, is now extra [...]ted, or though it still remains in the body, in a place not necessa­ry to life; first of all the whole system is very much irrita­ted, heated, pained chased, and distressed with restlessness and tossing, the pulse is strong, full and more frequent than in health. The cause of all those symptoms is the commotion, which, as we have said, the local stimulus, either of the ball or of the inflammation supervening upon the wound, by its constant irritation of a sensible part, gives to the whole system.

[Page 382] DCCXXXVI. Because, in this case asthenic diathesis is commonly supposed to arise over the whole body, upon account of the irritation from the wound; the antisthenic plan of cure is, therefore, always employed through the whole course of the disease; and the use of opium, which, in this case is conjoined with the antisthenic, or stimulant remedies, is admitted only for the purpose of acting as a se­dative and duller or pain, is admitted: Consequently, upon account of the fear of a fever being to supervene, though often a great quantity of blood is lost by the wound; still large bleeding is practised, the belly is purged, nourishment is withheld, ab [...]inence enjoined: The most frequent con­sequence of which treatment is death, and never a recovery that is not owing to accident.

DCCXXXVII. But all this is a method of cure con­ducted upon an erroneous theory, which is proved by all the principles of this doctrine, and by the very unfortunate issue of that practice. In a person, who has lost a great deal of blood an over-proportion of blood, can ne­ver be the cause of sthenic diathesis: Neither can any tolerable reason be assigned for the profuse evacu­ation of the serous fluid, or for not rather supplying new fluids by the use of food. It is in vain to accuse fre­quency of the pulse, as a sign of an excess in the quantity of blood, and of to much vigour, or of any irritation that wants an antisthenic plan of cure: For, besides its hard­ness, if the pulse is not, at the same time, strong and full; it has been now often above demonstrated, that all its cele­rity depends upon debility and penury of blood^(z). Fi­nally, as the sthenic diathesis depends upon the general sthenic hurtful powers, as the energy of pain, from local affection, and particularly inflammation, has no tendency to induce that diathesis, but the contrary one of debilitating^(a); that is another reason for the supposition of the habit, either [Page 383] remaining such as it was before the wound was received ^(b) or, which is more probable, of degenerating into the asthenic diathesis. Lastly, the true explanation of the distinction betwixt irritation and sthenic diathesis is in confirmation of the same conclusion; the sthenic diathesis being that state of the system, which is produced by all the powers, the ope­ration in common to which is stimulant, over the whole system, and, by fullness in the vessels producing the same effect, and to be removed by debilitating powers weakening also the whole system, and by evacuant remedies acting by the same general operation; whereas, on the contrary, it is ir­ritation or that state, in which the whole body is often, with­out any stimulus, debilitated^(c); and often a local stimulus, such as distention exciting spasm, or a concentrated acid, in­ducing convulsion, or the pain of a wound that producing the general commotion here^(d), and effect enormous moti­ons [Page 384] in a weakened system. But, whether the debility be without stimulus, or excited by it there is never occasion for debilitating evacuant remedies, but always for mode­rately stimulant ones: And we have only to take are, that the sthenic diathesis be not produced by the method employed from the cure, and hereby a general disease, at least, a predisposition to general disease be su [...]radd [...]d to the local, which could not fail to aggravate the latter.

DCCXXXVIII. As, therefore, the an [...]sthenic plan of cure is not to be practised, from an apprehension of a fever being about to come on, with a view to allay the distur­bance arising from it; which has the contrary tendency, that of inducing the fever, and of exciting the disturbance apprehended; so, neither is the stimulant plan to be at­tempted, till the wound is healed, or the disease has arrived at an advanced stage, and a great deal of debility is now induced by the continuance of the pain, least, if that me­thod should be sooner employed, the blood should be carried with more rapidity than the case would admit of, and with an encreased momentum, into the still open terminations of the vessels: For it is understood, that neither diathesis takes place in this case, and that the only affection present is a commotion over the system, depending upon local affec­tion; and that, consequently, there is no occasion for the remedies of either; excepting this single consideration, that, as the loss of blood, in proportion to its degree has a tendency to produce more or less of asthenic diathesis; there will, therefore, in that proportion, be occasion for some sthenic remedies.

DCCXXXIX. During the first days of the disease, be­cause the patient, all at once, does not any longer engage in gestation, exercise, and the other functions both of body and mind, and of passion or emotion, according to custom, and, of course, less nourishment and recruit is now requi­red; therefore, there should be such an abatement in his [Page 385] allowance of the usual stimuli, as to accommodate what is used to the present condition of the system and the state of the wound just now described^(e). Therefore, to prevent too great an impetus in the vessels, silence should be kept around the patient, he should not speak himself, he should lie quiet and without motion, his posture should not be changed, but to avoid the disagreeable feeling of too long continuance of it, and even then it should be done as warily as possible. He should make his water lying, and in an urinal; he should rather use soups, than solid meat; his wound should be examined every day, for the sake of keep­ing it clean; its progress should be observed; it should be dressed with fresh, soft, and bland matter; and if even at this early period, any faintishness appears, a glass of wine should not be withheld.

DCCXC. After some days, which may be more, or fewer, according to the strength of the patient, when now the ha­bit is rushing into debility, upon account of the greatness or long continuance of the pain; in that case, besides the soups formerly allowed, meat as rich and delicate as possible should be given; wine should be administered sparingly at a time, but often, and upon the whole in large quantity; and then at last, recourse should be had to opium, which, in the common practice, is usually given from the beginning of the disease, and to the other diffusible stimuli; and the disease should be treated precisely in the same way as a typhus.

DCCXCI. When very tender external parts are viola­ted by any rude matter, such as happens in that case, where a thorn is pushed below any of the nails, and an inflam­mation spreads from the affected part to a considerable ex­tent, and then, upon account of the great sensibility of the part, the whole body is drawn into consent; the injured [Page 386] part should be fomented with warm water, and dressed with lint and soft, and bland ointment: And as long as the di­sturbance of the system remains, the patient should be kept quiet, and free from motion, and nothing more attempted.

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

DCCXCII. TO set about the treatment of that divisi­on of local, organic, diseases; in which a part, or symptom, of general disease degenerates into a local one; we next proceed to

Suppuration.

DCCXCIII. Suppuration, with which we begin, is for the most part a consequence of any general inflamma­tion, whether sthenic, or asthenic, or that inflammation, which is a symptom of general diseases, or it is a conse­quence of local inflammation, whether sthenic, or asthenic, as a symptom of local affection. In it the pulse is softer, fuller, and a little slower, than in asthenic disease when that precedes it; but a great deal slower, than in asthenic dis­ease, if it happen to supervene upon it, and it is accom­panied with an undulatory, and, as it were, a pulsatory, motion of the labouring part; these symptoms are com­monly preceded by a shivering: If the affection is internal, the patient should be kept quiet, and free from motion, and be stimulated; if it be external, the affected part should, over and above, be fomented, dressed, and covered, and the pus, when ripe, let out.

Of Pustle.

DCCXCIV. A pustle is a purulent vesicle, turgid, and at last of its own accord opening in consequence of ha­ving become tender, and full of pus.

[Page 387] DCCXLV. It follows the small-pox, arising from the contagion peculiar to that disease: In the small-pox the number of the pustules is greater or less in proportion, as more or less sthenic diathesis, occasioned by improper treat­ment, or a neglect of the proper, has preceded^(a).

DCCXLVI. The indication of cure for them is, first to remove sthenic diathesis, and then, if that has passed into the asthenic, to remove it, each by its respective remedies; and to besprinkle the pustles with a strong spirit, or with laudanum, and in the former case to guard against cold, in the latter against heat, and to open the pustles and soment them.

Of Anthrax.

DCCXLVII. Anthrax is a glandular tumour under the skin, gangrenous in the top, and inflamed in its edges all round.

Of Bubo.

DCCXLVIII. Bubo is a glandular tumour, especially affecting the one or the other groin, and of a tendency [...] suppuration.

DCCXLIX. These two affections the anthrax and bubo as well as carbuncle, are almost always combined with a general disease, to wit, sometimes with typhus, much of­tener with the plague. They depend upon a contagious matter, and, in so far as they do not sufficiently yield to the general remedies, they must be treated with a very strong spirit poured upon them, and with laudanum, and opening them.

Of Gangrene.

DCCL. Gangrene is an imperfect inflammation of a part, not terminating in suppuration, discoloured, scarce painful, consisting of pustules of a bad matter, and at last inducing the death of the part.

DCCLI. The hurtful power, that precedes gangrene, is always inflammation, often ultimately violent in a sen­sible part, oftener languid, and occupying a part less sen­sible, less supported by the powers of life^(b); it is some­times a symptom of the phlegmasiae, sometimes of fevers, sometimes of local phlegmone^(c).

DCCLII. The method of cure, when the gangrene is seated in the alimentary canal, is to pour in spirit and lau­danum; when the shut viscera are affected, to place some hope in the same and other stimuli, but much less. And, as the same remedies also suit gangrene, when it is exter­nal, consequently liquid opium should be rubbed in upon the dying part, spirit should be poured upon it, the parts already dead should be cut out, the edge of the living part all round should be stimulated, and an inflammation made in it.

Of Sphace [...]us.

DCCLIII. Sphacelus is a more perfect and more ex­tended grangrene, with an extinction of sense, motion, and heat; in which the part becomes soft, blackish, com­pletely black, putrid, and at last thoroughly putrid to the [Page 389] very bones, thoroughly cadaverous, and shifts rapidly to the neighbouring parts, and quickly extinguishes life.

DCCLIV. The remedies are in general the same as in gangrene, but they should be stronger, and administered in greater quantity, and with greater nicety, and in less ex­pectation of a cure. When any limb is greatly affected, it should be immediately cut off, to prevent the sound parts from being infected.

Of Scrofulous Tumor and Ulcer.

DCCLV. When a scrofulous tumor and ulcer has been of long standing, has disfigured the parotid gland and neigh­bouring parts, and all the remedies, that have any effect in removing scrofula, have been employed; after that no more is to be done, but to keep the ailing part clean, bath it often, and defend it from the injury of the air; unless that, as local debility also takes place here, spirit and lau­danum, applied to the part, may be of service.

Of Schirrous Tumor.

DCCLVI. When the tumor, which, while it was mo­derate, was a part or symptom of the general disease, call­ed schirrhus, has now attained a certain bulk; if it be ex­ternal, or situated in the exterior or convex part of the li­ver, it should be cut off, and the system invigorated: If it be internal, nothing can be attempted, but to prevent its encrease by stimulant remedies, and in that way keep the patient as long alive as possible, and in as good health as the present circumstances will admit of.

DCLVII. The two heads of division that remain^(d), are of so obscure and abstract a nature, that if ever they [Page 390] are to be attempted, they must be passed over at present. The third head^(e) is here only imperfectly sketched and scarce begun: But, because it both admits of a complete execution, and when so executed, will make an important addition to the work; shall be prepared for the public pe­rusal, as soon as I shall be happy enough to find as much leisure and scope for thinking as are requisite to rescue the subject from its present intricacy, disorder and obscurity.