CHAP. I. Of the BONES, CARTILAGES, and other component Parts of the Body.

THE BONES are the hardest, and most solid parts of the human machine, calculated to support those which are soft and less firm, in all their motions and pressures; they are cover­ed with a membrane, or thin bladdery substance, called perioste­um, on account of its covering the bone, which is exquisitely sensible, being plentifully supplied with nerves and blood vessels. The outsides of bones are commonly more compact than the in­ner parts; and are formed of plates, joined together by transverse fibres; their insides are spongy and cellular, in which is con­tained marrow, within membranous bags, filling up the cells; this marrow, being more or less distributed over all the bones, and transuding through their plates and fibres, makes them tougher, and less brittle; the bones are supplied both within and without, with blood vessels and nerves.

CARTILAGES or GRISTLES, are solid, smooth, white, elastic substances, between the hardness of a bone and that of a ligament, (see ligament below) covered with a membrane called perichondrium, because it covers a cartilage, which is akin to the periosteum of the bones; they serve to make the bones, whose extremities or ends they cover, move freely in the joints: they limit the growth of bones, as to their length, by hindering the bony fibres from sprouting out; and, therefore, when the cartilages in the joints are eroded, an immobility is there form­ed, called anchylosis, or stiff joint, by the elongation and coali­tion of the fibres of the bones that are articulated together; sometimes they serve as ligaments to join the bones together, and sometimes they do the office of bones to greater advantage than these would do; as the cartilages of the ribs, which, by their elasticity chiefly contribute towards expiration; the carti­lages that make out brims of cavities, &c.

LIGAMENTS are white, tough, flexible bodies, thicker and firmer than membranes, and not so hard or solid as cartilages, without cavity; difficulty stretched and with little elasticity; they serve to connect parts together, and keep the part to which they are fixed in a proper situation, as appears remarkably in the joints or articulations; they are made up of fibrous layers or strata; the largest and strongest of which run lengthwise.

MUSCLE.—This is the name of the immediate organical in­strument of motion in the animal body, whether voluntary or [Page 22] involuntary; it is called organical, because mere elasticity is the immediate cause of some motions, as in expiration^*.

The general characteristic of a muscle is, to consist of fleshy fibres which, when acting, contract themselves, and become shorter; this contraction, according to different circumstances of the muscle, and the parts to which it is fastened, produces differ­ent effects, and different motions.

If one end of a muscle is tied to a fixed part, and the other to a moveable one, when it acts, its fibres contracting will pull the moveable part to that which is fixed.

If both the parts, to which the extremities of a muscle are at­tached, be moveable, by its action, they will be both drawn to­wards each other.

If the muscle be hollow, and contain a fluid, when it contracts, it will press upon, and endeavour to expel its contents; such a muscle as the heart, and in some measure the stomach, and uri­nary bladder.

If the fibres of a muscle return upon themselves, in the form of a ring, when they contract, they will diminish the area within that circumference, making the circle narrower. Such muscles are employed to shut cavities, and are called sphincters, because they have the power of closing cavities and restraining the exit of any thing they contain.

TENDONS.—These are continuations of fleshy, muscular fibres; each tendon being divisible into as many fibres, or rather bundles of fibres, as the muscle itself is to which it belongs; but the tendinous fibres are more compacted and smaller, drier and harder, than the fleshy fibres; they are not capable of contraction, but serve like ropes to pull, when the fleshy fibres act, for the commodiousness and firmness of insertion, and for the direction of motion.

NERVES.—These are soft white cords, proceeding either from the brain or spinal marrow, and running to every minute part of the body, and are the immediate instruments of sensation, and indispensably necessary for the continuance of muscular mo­tion. They are supposed by many to contain a very subtile fluid, but appear without any cavity discernible even by the finest microscope.

VESSELS in the machine mean the animal tubes or canals [Page 23] through which fluids or juices move; the least imaginable vessel is made of the least membrane, rolled up in the form of a hol­low cylinder, or part of a cone. The vessels, as their coats must be thicker, are composed of thicker membranes, upon which smaller vessels run.

These are divided into ARTERIES, VEINS, ABSORBENTS, SE­CRETORY vessels, and EXCRETORY ducts.

ARTERY.—This is the name of that kind of vessel which, arising originally from the heart, contains a fluid whose motion is directed from thence towards the extremities and surface of the body. The larger and easily visible arteries contain red blood, are of a conical figure—flew, tapering from the heart for­wards, and ramifying variously; in living animals they be [...] or have what is called a pulse, answering to the motion of the heart; their coats look whitish, and are pretty thick and strong.

VEINS.—These contain a fluid whose motion is from the extremities or surface of the body towards the heart; their coats are thinner and more transparent than those of the arteries, and, therefore, they appear of a bluish, livid colour, the blood shining through them. In many places they have valves within them, which open towards the heart, and shut the contrary way.

ABSORBENT VESSELS.—So called, because they absorb or take up fluids, and are divided into LYMPHATICS and LACTEALS, from the particular liquids they convey to other parts—they are similar, only have different origins, and calculated for different purposes, from whence they take their names, the former convey the lymph or aqueous fluids, the latter the milky juice, formed from the aliment in the intestines called chyle; the lymphatics are the general absorbents, and carry the juices to what is called the receptaculum chyli, thoracic duct, and left subclavian vein; the lacteals to the receptaculum chyli, or receptacle of the chyle.

The lymphatics and lacteals are very fine vessels; the former of which arise from the surface of the body, and all cavities or cells of the cellular membrane; the surface of the intestines, of the urine and gall bladders, of the ventricles of the brain, and of all other parts, and carry a pelucid liquor towards the recepta­culum chyli, and the thoracic duct, in which, like the lacteals, do they all terminate.

SECRETORY VESSELS.—These are all those tubuli or mi­nute tubes, in the different organs, which are adapted for the purposes of secretion, presumed to separate and strain off the dif­ferent humours from the general mass of fluids.

EXCRETORY VESSELS are those tubes or ducts which also belong to the different organs of sensation; whose office is to [Page 24] carry off the humours that are separated, and either convey them to their appropriated receptacles, where some of them are depo­sited, or discharge them out of the body.

GLAND denotes in general an organical texture, of a circum­scribed figure, framed so as to separate from the blood, a liquid, different from, and unlike the blood; of these are various kinds, some more simple, others more complex or compounded and are called by the common people, kernel.

MEMBRANE.—This is a web or rather a lamina, or slough formed of a very thin substance, appearing like a bladder, whose thickness bears a very small proportion to its breadth and length. Most, if not all the membranes, we see in the animal body, are composed of; and resolvable into thinner ones.

FIBRE is a small thread or filament, without a cavity, at least without one visible; whose breadth and thickness bears a very small proportion to its length; the least fibre of all is too minute to be perceived by our senses, however assisted. The fibres we can perceive, are no other than so many bundles of smaller ones tied together.

Now these are the different solids of the human machine sim­ply considered, and being differently disposed and united, by means of the cellular membrane, of which we shall soon speak, form the human body. This is divided into the LIVING SOLIDS, called solida viva, and into the INERT SOLIDS, called solida in­ertia, which constitute the hard parts, and help to complete the cellular system.

These are again divided by physiologists, or those who treat of the human body and teach the uses of its various parts, into three systems. The VASCULAR SYSTEM—the NERVOUS SYS­TEM—and the CELLULAR SYSTEM.

The FIRST of these has the heart for its center; that is to say, all the tubes or canals which are comprehended in this divi­sion, either carry fluids out from the heart, or return and convey them to it, and comprehend every species of artery, vein, sinus, duct, and absorbent vessel, and may be distinguished into circula­tory vessels, excretory vessels and absorbents; vessels, through which the blood circulates, by which particular fluids are sepa­rated from it, by which these last are carried from the place where separated, and by which fluids are taken up, and carried into the machine.

The CIRCULATORY VESSELS include all the arteries, which springing from the aorta or large artery of the heart, and that called pulmonary, supplying the lungs, carry out the gene­ral mass of blood, and all the veins, which being reflected back, [Page 25] and uniting at the two great sinuses of the heart, return it, and thus maintain perpetual circulation.

The secretory, excretory vessels, and absorbents, we have before explained.

The SECOND or NERVOUS SYSTEM, has the brain as its basis, from whence issue different portions called medulla oblon­gata, [...]pinalis, and nerves. Some affirm that there are two sets of nerves—the one adapted principally for the purpose of per­ception and sensation, bestowed on the several organs of sense, internal and external; while the other is blended with the mus­cular fibres, because it is observable in certain diseases, that the muscular strength shall be totally exhausted, and yet the powers of perception and sensation remain entire; and on the other hand that the muscles shall sometimes exert prodigious strength, while the senses are all locked up, hence the authority on which is founded the distinction.

But we must observe, that though all animal motion seems to be derived from the nervous system, and although the heart, like every other muscle, can act no longer than the communica­tion through the nerves which are bestowed on it, remains free; yet there is a necessity for distinguishing between the vascular and nervous systems; because it will appear, when we come to inquire into the nature of diseases, that there may be evident disorder in the one, while little or none shall appear in the other; and this consideration will greatly influence us in the directions necessary to be given for procuring relief. THESE form the liv­ing solids.

The INERT SOLIDS, not only constitute such parts of the body as have neither nerves nor vessels; viz. the cuticle and its continuations; the nails; the hair; great share of the sub­stance of bones; cartilages; ligaments; tendons and their membranes: but these inert solids form the connecting medium every where between the living solids, binding together every minute vessel and nervous filament; and there are innumerable nerves and vessels in all parts of the body, except those above mentioned, which no eye can trace; yet, if we reason from ana­logy, and say, that the smallest branches and filaments are like the visible trunks and cords, then the transverse section of these must be circular; and consequently when they come to be in­terwoven or laid together, they must universally leave interme­diate pores, and minute cavities; hence we may understand, that though there may be some parts of the body, which have nei­ther nerves nor vessels, i. e. no living solids, yet there is no place in the whole fabric to which the cellular system does not extend, and where there is not some picture of inert solids; besides u­niting [Page 26] and binding together the different species of vessels, which either rise from or terminate at the heart; and all the nervous cords or filaments, which spring from the brain or spinal marrow, however variously they may be combined, disposed, or interwo­ven; and this fibrous and laminated connecting substance is not endowed, like the living solids, with either sense of feeling or power of motion.

That the CELLULAR SYSTEM extends itself universally throughout the whole frame, and has a general and free commu­nication, seems fully proved by some particular diseases, such as universal dropsy, called anasarca; where water diffuses itself through the whole body; or emphysema, where air occupies the same space, passing from pore to pore, and cell to cell; for this membrane consists of a number of little cells, hence its name, which in many parts communicate with each other.

In the natural and healthy state, the cavities of the cellular system, are either filled with a thin fine fluid called lymph, or with oil—hence it is distinguished into two parts, the lymphatic and adipose, according to the substances it contains.

The pores, or minute cavities of the lymphatic part, are al­ways to be understood as interposed between every nervous fibril; whereas the adipose cells are not so universally extended, the fat or animal oil being always lodged in distinct bags or vesicles, else, was it suffered to diffuse itself as freely through the cellular sy­stem at large, it would be equally distressing and fatal with the spreading of water in an universal dropsy, or of elastic air in an emphysema.

CHAP. II. Of the BRAIN, and the other more complex Parts of the Machine.

HAVING now shewn the solid principles, and the systems of which the human body, aggregately considered, con­sists, we shall take a view of some parts which are formed out of these, with their fluids and uses, and give such accounts as may be requisite for the proper information of our readers, to enable them to discover what parts are affected in particular diseases, and distinguish their nature. We therefore begin with the BRAIN, which is a soft pulpy substance, surrounded by two membranes, one called dura, the other the pia mater—and has also a third called arachnoid, from its fineness, similar to a spider's web—the chief [Page 27] peculiarities to be taken notice of for our purposes are the SI­NUSES, which are nothing more than large veins or receptacles for blood, and the VENTRICLES. Like other parts of the bo­dy it has a variety of arterial branches coming from the heart, which are diffused through its substance, and on the membranes—from this is derived the whole nerves of the human machine, as the spinal marrow is no more than a continuation of the brain through the vertebrae of the back—and this is considered the source of all perception, sensation, and support of muscular mo­tion.—It is not considered in itself very sensible, but can trans­mit most acute sensations to every part of the body by means of the nerves, when in a state of health—and most violent ones when diseased; there is not the smallest portion of the living solids but is materially connected with it—so that it not only gives strong impressions to, but feels strong impression from the smallest por­tions when affected; and it may be considered the fountain of all nervous incitability, by which all the parts dependent upon the nerves are put into motion, or continued capable of persevering in their action.

And here, as we shall often have occasion to speak of NER­VOUS INCITABILITY, and MUSCULAR IRRITABILI­TY, two powers to which we allow the existence of the machine, in a living state, and the action of all its moving solids with re­spect to their continuance, are entirely owing, it will be proper to describe what we mean by these two terms; because they cer­tainly do in some degree exist independent of each other, not­withstanding their intimate union, and in general conjunct action—and also, as by this knowledge, we shall in some cases be able to discover, how from particular defect in these two powers, se­parately attended to, diseases put on different appearances—and are to be prevented, alleviated, or cured by our applications made to them distinctively as well as unitedly.

By INCITABILITY we mean that power in the brain and nervous system, which may be put into action by mental affec­tion, as well as local irritation, and which produces those appear­ances we call sympathetic.

By IRRITABILITY we mean that power which may be put into action by material stimulus locally exerted—yet is obe­dient to the influence of the nerves in general—and cannot, in the living machine, exist for any considerable time without this union.

To elucidate this, we shall observe that many will be thrown into convulsions by uneasiness of mind—we also know that the same complaint will be occasioned by severe irritation on some part or parts of the machine; or that parts themselves only will, [Page 28] from this source, experience such effects—as in cramps. Now as we are totally ignorant how the mind acts upon the brain, and nervous system—how these act upon the muscular fibres—nor can we conceive how immateriality, which we take the thinking faculty to be, can act upon materiality, we can by no means make use of a term which points out specifically the action of these causes productive of morbid effects.

In order then either to prevent, alleviate, or cure the complaint from thence arising, we prescribe such things as may amuse the mind, and keep it free from those painful reflections—and put the body into such a state as to render it less susceptible of im­pressions from this source.

On the other hand, we advert to the part or parts affected, and by our applications locally directed endeavour to remove the irritative cause in order to promote a cure—and with intent to prevent a return, do such things as to render the part or parts incapable of being affected by the cause, or put under such circumstances as to render the accession of that cause impracticable—hence we think the discrimination between the two terms absolutely neces­sary—as we shall in advising remedies always pay the strictest attention to constitutional peculiarities.

The LUNGS are situated in the chest, and there divided into two large portions called LOBES, the one on the right, and the other on the left side, which are separated from one another by a transverse membrane called mediastinum—dividing the chest into two equal separate cavities, that have no communication with one another: but the left lobe of the lungs is considerably less than the right, because the heart with its membrane, called pe­ricardium, from its surrounding the heart, with the great vessels that open into it, are contained in the left division.—The lungs, besides their external membrane, and cellular texture of which they are composed, are a congeries of air vessels from the wind­pipe, which is a firm tube, made up of cartilaginous or gristly rings, joined together by muscular fibres—these rings backwards are incomplete; this descends into the breast almost to the basis of the heart, and there divides into two great branches, the one right, and the other left; which again are divided and subdivid­ed into lesser and lesser ramifications—and so distributed through all the substance of the lungs, terminating at length in small mem­branous, dilatable cells, or vesicles—as well as these, there are vessels which carry blood, and juices derived from the blood; and these two kind of canals are so uniformly dispersed through the lungs, that in every physical point there are branches all over, besides these they are supplied with nerves and absorbents. Various are the uses of this organ.

[Page 29] The most important is that of respiration, by which a trajec­tion of blood is effected through their substance, and circulation completed, in which life consists; by comminuting, condensing, and rounding its particles, and thereby adapting them to flow through the canals of different sizes in the body; creating red­ness in its globules—besides it has several uses which are of the greatest consequence to the animal, for by this means the abdo­minal viscera are with a continuance alternately pressed upon, and freed from that compression; by which means concoction in the stomach and intestines is promoted; and the circulation through the system of the vena portarum, or large vein of the liver, which otherwise would be too sluggish, is urged on. The faeces and urine are expelled by its efforts; smelling is perform­ed by inspiring, or snuffing up air; the foetus is excluded by its assistance; and suction, so necessary for the preservation of the new-born animal, is performed, and without it there could be no such thing as voice or speech brought about. Besides, the lungs are considered as the recipient of animal heat, that is, the quantity of atmospheric air which rushes into the lungs at every inspiration being loaded with those particles creating heat, they are separated from the air and pass into the blood, and by their evolution through the course of circulation form an universal sti­mulus to the vascular system—and at the same time they perform the office of excretion, throwing out such matters which have become useless, and would be hurtful if continued in the habit.

In the middle of the chest between the two lobes of the lungs, rather inclining in its position to the left side, lies the HEART. It is a strong hollow muscle, having two cavities, separated by a septum or division, which are called ventricles, out of which issue the two large arteries of the human machine—one called pulmonary artery, because it serves the lungs; the other aorta, or large artery of the body; near the mouths of these two ven­tricles are two other hollow muscular substances, from their simi­litude to dogs ears, called auriculae, into which the vessels call­ed vena cava descendens, and ascendens, and pulmonary veins open—the two former into the right, the latter into the left. It is also enveloped with a membrane from its situation, surround­ing the heart, called pericardium, by which, and the large ves­sels, it is kept in a fixed position, within this membrane there is a small portion of a serous fluid.

As we have considered the brain to be the source of all incita­bility, so do we the heart one at least, and that the principal source of irritability, whose chief office is to promote the circu­lation of the blood, an account of which may not in this place be improper.

[Page 30] But before we enter on that subject, we must observe, that all the arteries of the machine ramify from the aorta, as branches of a tree from its trunk, dividing themselves into minute ramifica­tions, in which there are no valves, except at the origin; whilst the veins must be looked upon as branches forming a large trunk, in which there are valves inserted, which open to the heart. Now in the former of these vessels there is required no such contrivance, because the blood, having a quick progressive motion from the contractile power of the heart and arteries, has a sufficient force impelling it from behind, which prevents its re­trocession, whilst, on the other hand the slow motion of the blood in the veins and their weaker contractile power, unassisted with a force adequate to that of the heart, have great need of such an invention to prevent its regurgitation, and secure its re­turn to the heart.

Now for a moment let us suppose the heart full of blood, that is, the ventricles have ceased to beat, and that it is put into mo­tion by some cause, what will be the result with regard to the cir­culation? The lesser circulation through the lungs will be per­formed in the following manner; the blood will be propelled into the pulmonary artery from the right ventricle, pass through the lungs, and return to the left auricle by the pulmonary vein; in the same manner in the greater circulation it will also be forced into the aorta, diffused through the rest of the machine, and re­turn to the right auricle by the vena cava, passing through the different glands, in order for them to secrete such fluids as they are destined for; whilst, at the same time, the capillary or hair like tubes, where there is no such glandular contrivance, will pass off the matter of perspiration, the auricles then being filled with blood will contract; eject their contents into each ven­tricle, and the same routine be performed again as above de­scribed.

The particular organs which we have now mentioned must be looked upon as the three most material ones for the support, and preservation of life, and the sources and instruments of incitabi­lity, and irritability, by which they perform their actions, and on which all the moving powers of the machine depend; but into the account we must also take the blood, which, with the lungs, we consider as the recipient and diffuser of that fluid, or those particles which animate nature, and supply an universal stimulus, which occasions the action of these sources and instru­ments of vital motion.

The BLOOD is a red homogeneous or apparently uniform fluid, as it circulates in the vessels, from whence all the other fluids of the human machine are secreted, or separated; but [Page 31] when out of the body, and left to itself, divisible into three dis­tinct substances—serum, gluten, and red globules, by a very sim­ple process; though untouched, appearing only as two, called serum and crassamentum, the latter floating in the former; but the crassamentum is of different degrees of firmness in different subjects.

The SERUM in an healthy state is almost colourless; at other times, it is yellowish, or perhaps of a greenish hue, while the top of the crassamentum has different degrees of firmness, and puts on different appearances with respect to colour, according to the age, sex, and state of health of the subject from whence it is taken. The serum of the blood, like the white [...] egg, coagulates when highly rectified spirit of wine, called alchohol, or any of the mineral acids, are mixed with it, or wh [...] [...]eated to about 160th degree of Farenheit's thermometer; [...] other­wise it continues in a liquid state.

The CRASSAMENTUM is composed of a peculiar sub­stance, which gives redness to the blood, and of, what physiolo­gists term, coagulable lymph, from its coagulating spontaneously: This coagulable lymph may be separated from the red part in two ways; either by stirring the blood which is fresh drawn, with a whisk, when the lymph coagulating in a short time, will adhere to the twigs, and appear like a firm membrane of a whit­ish colour, composed of fibres interwoven with each other; or by placing a piece of crassamentum on a strainer, and pouring on water repeatedly, until the red particles being washed away shall leave only the whitish substance behind.

With regard to the red globules, it is not perfectly agreed of what nature they are; but it is asserted that the red colour is owing to a mixture of some portion of ferruginous or iron mat­ter; in confirmation of which it may be observed, that the blood always becomes florid after a course of medicines of that nature; but whether it arises chiefly from the addition of ferruginous matter, or owing to the increased motion which these medicines always produce, will admit of some dispute, for it is always found that the blood grows more red, in proportion to the action and the strength of the vessels, and these medicines are allowed to produce such effects.

The proportion of the red part is small in respect to the o­ther constituent parts, for one grain weight of this colouring matter, will tinge, in a perceptible degree, a thousand of pure water.

Now as the blood in its healthful state is a tenacious fluid, capable of receiving a greater portion of heating particles in proportion to its tenacity, as it passes through the lungs, so ac­cording [Page 32] to its stronger or weaker tenacity, will it be capable of retaining more or less of these stimulating particles, thus from this cause, will it be more or less stimulant, and assist in produc­ing different deviations in the constitution, besides it is from dif­ferent causes liable to undergo many alterations; hence also will other differences be formed, of which we shall take notice in the succeeding pages.

Indeed we might give some general practical ideas respecting this point; but as many peculiarities arise from the state of other organs in the machine, that are worthy of observation, and necessarily combined with those already pointed out; we must now [...] leave to describe them also with their uses, but first we shall [...] something on—

THE THORAX or BREAST. This is a large cavity, some­what [...] the shape of a cone, reaching from the lower part of the neck to the abdomen or lower belly, from which it is divided by the diaphragm, or midriff. The bones which form this cavity are twelve vertebrae of the back behind, twelve ribs on each side, and the sternum or breast bone before. This cavity is con­siderably shorter before than behind, from the diaphragm slanting downwards, and backwards. The ribs which guard the greatest part of the cavity of the thorax, are all articulated with their respective vertebrae, in such a manner as to admit of a motion upwards and downwards; they are all, except the lowermost or twelfth rib, connected and articulated with the sternum, or breast bone; by the intervention of cartilages, or gristles, so as to ad­mit of the same motion upwards and downwards.

From the structure of the ribs which are more or less arched, being convex outwardly, and concave inwardly towards the ca­vity of the thorax, it follows, that if the ribs are all moved up­wards, round their articulation with the vertebrae, their arched middle parts must be pushed outwards and laterally, and the sternum, to which they are joined, outwards and forwards; and consequently, the cavity of the thorax will be widened and en­larged.

But there is a set of muscles which perform this office, which are called intercostals, from their being situated between the ribs, and are both internal and external; they run obliquely from the edges of one rib to those of the ribs nearest each other, for the whole length of the ribs, and from the highest rib to the lowest: the fibres of the external have a direction contrary to that of the internal, by which contrivance their joint action be­comes the more steady, and the ribs being pulled in the diagon­al of those two directions, endeavour to pull the ribs nearer one another; drawing the inferior ribs nearer the superior, and thus [Page 33] the cavity of the thorax is widened, that the lungs may expand themselves in inspiration.

But there is another contrivance to promote this purpose; the DIAPHRAGM or MIDRIFF. This muscle, which divides the breast from the lower belly, arises from the breast bone be­fore, from all the ribs on each side, from the seventh to the twelfth; and behind from the last vertebrae of the thorax, and the first one of the two loins. Its fibres run fleshy from the cir­cumference to the center some way, and then become tendinous; the whole diaphragm slants, its anterior origins being remarka­bly higher than its posterior ones; it is not plain, but remarka­bly convex towards the thorax, and concave towards the abdo­men; insomuch that its middle or center rises always higher in the thorax than its highest origin at the sternum; when it acts, the fleshy fibres shortening, pulls the tendinous center towards their origin, that is, downwards, thereby rendering it plainer, and less convex, and so lengthening the cavity of the thorax down; hence the enlargement of the breast is promoted two ways, by the intercostal muscles raising the ribs, and making it wider; and the action of the diaphragm rendering it longer or deeper—and by these means the several uses above specified from the action of respiration, is promoted. See page 28.

Immediately under the diaphragm lies the LIVER. It is of an irregular shape—its right part fills almost all, what is called the right hypochondre, or side under the ribs below the dia­phragm, in an adult body, when sound, reaching commonly no lower than the short ribs. In the foetus it is bigger, in propor­tion to the rest of the body, in all its dimensions—its middle part lies in the region over the stomach, called epigastrium; and its left in the upper part of the left hypochondre, not reach­ing so far down as the right; some of its exterior parts are smooth and convex, humouring the concavity of the diaphragm; its under part is concave on the right side answering to the gut called the colon before, and the right kidney behind; its middle part, in which the gall bladder, called the vesica fellis is placed, lies over the gut, called duodenum, which touches the gall blad­der; its left part covers the stomach—it is thick in the middle, and upper substance, towards its sides it grows slenderer, at length terminating in a thin edge; by a furrow in the interior and concave part which receives the umbilical vein, or that of the navel in the foetus, on its anterior part; and by another an­swering to that backwards reaching to the posterior limits of the liver, which receives the venous duct, both which canals are per­vious vessels in the foetus, but in the grown animal degenerate into ligaments, the liver is divided into two unequal parts call­ed [Page 34] lobes; the right being much larger than the left; there is be­sides, a small lobe in its posterior concave part, commonly called the lobule of Spigelius; there is likewise a transverse fossa, or furrow, running along the middle of its concave, and under part, in some measure separating its anterior and larger from its poste­rior and smaller part; it is attached to the diaphragm, and its weight is in some measure supported by ligaments from that muscle, which are productions from the membrane which lines the inside of the lower belly called peritonaeum, where it lines its concave surface, and is united by other such productions, with the neighbouring parts: it is furnished with arteries from ramifications of the aorta, called coeliac, mammary, phrenic, re­nal, and capsular—but it is furnished with veins of two kinds—totally differing from each other, which cannot truly be said of any other part of the body: to wit, the vena portarum, and its branches distributed through the substance of the liver, which perform the office of arteries, carrying blood into it; and the other veins, which carry blood out of it, emptying themselves into the vena cava, like the rest, all over the body.

As the rest of the arteries and veins may be compared to the trunk of a tree with its branches, so may the vena portae and its different ramification, be compared to the root, trunk, and branch­es—for it is formed by a conflux of all the veins, which return the blood from the stomach, omentum, spleen, pancreas, intestines, and mesentery; and answer to the coeliac, and mesenteric, both superior and inferior, arteries.—It is worthy to be observed, that all this venous system, which by its union constitutes the vena portarum is unfurnished, unlike the other veins of the body, with valves; so that from its trunk it may be injected backwards to the minutest origins of small veins, in all the parts just now men­tioned. The trunk of the vena portarum, thus formed, enters the liver between two eminences in the little lobe, called by the ancients, portae—that is, ridges forming a little channel or streight between them: as soon as it is formed into a trunk it is found to have got stronger membranes or walls than other veins, and even tougher than the aorta or large artery of the bo­dy itself. This new and extraordinary strength of the coats of the branches of the vena portarum, they carry with them through­out all the substance of the liver; and they are distributed from trunks to branches, smaller and smaller, in the same manner as arteries are in the other viscera.

Thus is blood brought into the liver by arteries, called hepatic, of the common sort; and besides by the vena portarum, furnish­ed with strong coats, and performing the office of an artery, the only instance of that kind in the whole body. The ultimate [Page 35] small capillary branches, both of the hepatic arteries, and vena portarum, terminate in minute venous twigs, which arising all over the substance of the liver, and forming larger and larger branches by uniting together, at length open by several large mouths into the vena cava about the posterior, or gibbous part of the liver.

The liver is supplied with nerves from the intercostal, and par vagum so called;—they are but small in proportion to its bulk, and therefore it is not liable to violent pains.

The great use of the liver is to separate bile, for many good purposes in the animal oeconomy; and as it is now and then wanted more at some times, than at others, there is in the liver a receptacle for part of this fluid, called the GALL-BLADDER, which is a pretty large hollow vessel, nearly the shape of an ob­long pear—situated in a fovea or furrow, in the anterior concave part of the right lobe of the liver, reaching from before back­wards; attached to the liver in different places by a cellular tex­ture, covered over in its under part, by a portion of the mem­brane of the liver, which reaching beyond it keeps it fast in its situation. Under this, all over its surface, is a cellular texture—next to that, a thin muscular coat, consisting of pretty conspi­cuous, longitudinal, oblique, and circular fibres; under that a second cellular—then a nervous; and innermost of all a villous coat, similar to what is found in the stomach and intestines. There are likewise, especially in its smaller part or neck, pores, which yield a mucous juice, to defend it against the acrimony of the bile: from the same part is produced its duct, which stretch­ing towards the left is inserted into one called the hepatic duct, which arises from the repeated union, and conflux of the biliary ducts all over the liver; the union of these two ducts together forms the duct, called the ductus communis cholidochus, which penetrates into the duodenum, or first of the small guts, just be­low the stomach. Thus we find the bile separated by the pori biliarii of the liver, passes into the hepatic duct, part of which is constantly pouring into the duodenum, and part into the gall-bladder, whose use is to receive the bile, there to retain it, until it be squeezed back again by pressure of the distended stomach, and action of the diaphragm, through the ductus communis into the duodenum;—by staying there, the bile is tendered thicker, some of its aqueous parts being resorbed by the inhaling vessels of its villous coat, and therefore stronger, and of a more saturat­ed yellow; it likewise becomes more sharp, bitter, and rancid, by the heat of the contiguous and circumjacent parts; while the stomach is empty the gall-bladder is at liberty to be distended and filled, and therefore becomes fuller after long fasting; and [Page 36] the fuller it is, the less compression of the stomach is required to squeeze the bile out of it—so that the more we are prompted to eat, and stuff the stomach by violent hunger, the greater quanti­ty of bile will be poured into the duodenum, by the swelling of the stomach during digestion, to promote so much more effectu­ally the coction of the aliments; and the cystic bile will be the sharper, and stronger, by having remained so much the longer in the gall-bladder.

So that we find the duodenum receives two sorts of bile flow­ing into it from the same canal, viz. the hepatic fresh secreted from the liver, which never has been in the gall-bladder, but goes straight on into the intestines, and the cystic also.

Both biles are of the same natures and properties, differing only in degree, insomuch as many species of animals have no gall-bladder, and therefore are only furnished with hepatic bile, as amongst quadrupeds, the elephant, horse, ass, and deer; amongst birds, the ostrich, whose digestion is so strong, the stork, and the pigeon—not to mention some fishes.

The BILE is somewhat viscid; coagulable by heat and alcho­hol; of a saturated yellow colour, inclining to green, extremely bitter; the sharpest, and most stimulating of all the circulating humours of the body, neither acid nor alkali when fresh, but strongly inclining to, and quickly susceptible of, putrefaction; and promoting that disposition in any substances with which it is mixed, if they are capable of it; it mixes readily with water, it flames not in the fire, unless it be dried, and then it burns almost all away; it is a powerful penetrating soap in every respect; it dissolves all gums and resins, being rubbed with them.

By these properties, when poured upon the alimentary mash in the duodenum, it must effect, first, a more intimate dissolution, and mixture of the heterogeneous parts together, as it is readily miscible with water, and renders oil and oily substances so; se­condly, though it is not actually an alkali, yet it nearly approach­es towards it; and must diminish the acescent disposition of the chyle, of which we shall speak hereafter, and render it more si­milar to animal nature, which is alcalescent: and lastly, by its stimulating power, as it is the most acrimonious of all the ani­mal fluids, it, no doubt, helps to excite the peristaltic motion of the intestines, and thereby promote concoction; and, as like a­loes, it is a purgative, which it resembles not a little, it assists in the expulsion of the faeces; so true is it what Lord Bacon says, "that the bile is the incentive and stimulus of many functions of the body."

The PANCREAS, or SWEET-BREAD, so called, is a long, whitish, tender, and friable glandular mass, situated behind the [Page 37] stomach and spleen, under the liver. Beginning at the spleen on the left side, it stretches transversely across the vertebrae, and with its other extremity, is connected with the duodenum. In the human adult, it is about seven or eight inches long, and one or more thick; its end at the spleen is smallest, and it grows gradually broader, at it approaches to the duodenum, where it terminates: it hath arteries from the coeliac; its veins run into the splenic vein, which opens into the vena portarum; its nerves come from the par vagnum, and as they are but small, it hath, like the liver, but small sensation: its structure consists of small round acini or glandular shoots, connected together with much cellular texture; from each of these, there is a small duct sent out towards the middle; all these ducts open into the principal duct, which runs along its axis all its length, and opens into the duodenum, five or six inches from the pylorus, or lower orifice of the stomach, at the same place with the biliary duct.

As the structure of the pancreas is the same with the salivary glands, so its juice perfectly resembles the saliva in every proper­ty—and therefore may be presumed to have the same use—to di­late, open, and dissolve the alimentary mash, and render the chyle, to be made out of it, more similar to animal nature; as it is con­siderably larger than all the salivary glands put together, and si­tuated in a warmer place, its juice must far exceed the saliva in quantity. It is propelled into the intestine by the common im­petus and course of circulation, assisted by the pressure of the adjacent parts upon it in breathing: It is poured into the gut at the same place with the biliary duct, that it may be immediate­ly mixed with, in order to temper and dilute, the bile, which is both thicker and sharper than itself.

The OMENTUM, or CAWL, is a broad membrane, thin and transparent, tender, and easily torn, arising from the anterior and inferior border of the stomach, and falling down commonly as low as the navel, sometimes much lower; then doubling backwards and upwards, is connected with the intestine called the colon, un­der the stomach, thus forming an empty bag. Besides, its prin­cipal connection with the stomach and colon, it is likewise at­tached to the duodenum, to the spleen, pancreas, and mesentery; it lies immediately under the peritoneum forwards. being a pro­duction of its cellular part, and covers part of the stomach, and the greatest part of the anterior surface of the intestines.

It is every where a double membrane—but every portion of the thin membrane, by itself, may be divided into two thinner membranes or sloughs, which are joined together by a thin cel­lular texture, in the cells of which fat is deposited: the secretion here is performed in the most simple manner, their being no o­ther [Page 38] apparatus besides arteries, veins, and pinguidinous ducts, leading to the cells, or vesicles. The fat is distributed in the o­mentum very unequally, being in some places thin and transpa­rent, in others an inch thick in fat; in corpulent persons it con­tains a vast quantity of fat; it hath its arteries from the coeliac; its veins terminate chiefly in the splenic branch, and all of them ultimately in the vena portarum.

The uses of the omentum are, first, to interpose between the peritoneum and the intestines, and part of the stomach—that all three parts may be preserved warm, moist, and slippery, and hin­dered from growing together: and secondly, to furnish oily mat­ter for the bile.

The SPLEEN is situated in the left hypochondre, that is, under the cartilages of the left short ribs; it is connected with the colon, stomach, left kidney, and by its upper part with the diaphragm; its situation is changed by the fulness or emptiness of the stomach; it follows the motion of the diaphragm, and is affected by the inflation or subsidence of the colon. In general it is placed up­wards, and backwards from about the middle of the short ribs on the left side; in its natural and sound state, it is about six or se­ven inches long, about three in breadth, and one in thickness, of an irregular and somewhat oval figure, and of a dark livid colour; it receives arteries from the coeliac, these entering its substance, are divided into innumerable branches, and by their evanescent extremities terminate in minute veins, forming, by their union, the splenic vein, which flows into the vena portarum. The ves­sels of the spleen are very large in proportion to its bulk, and yet it hath no excretory canal but its vein; its nerves are small and few.

As the substance of the spleen is entirely vascular, with a ten­der cellular texture to support the vessels and keep them toge­ther; its chief use has been considered to consist [...] dividing and attenuating the blood that runs into and flows through it; and from its situation, as it is much agitated, this also assists in the circulation and comminution of the blood through it, and thereby rendering it fit to temper the sluggish mass sent from the omentum and mesentery into the vena portarum, and expe­dite the secretion of bile in the liver.

As we consider the OESOPHAGUS and STOMACH continu­ations of the same tube, we shall proceed to describe them toge­ther, and afterwards make some observations on the intestines.

The OESOPHAGUS, or GULLET, begins at, or is continued with the PHARYNX or THROAT, runs down along the poste­rior part of the thorax, behind the wind-pipe, and most common­ly somewhat to its left, passes through the diaphragm, and a short [Page 39] way under it opens into the stomach, into which it conveys the aliments; it is made up of several membranes or coats: the ex­ternal one is cellular—next to that is the muscular coat, consist­ing of two pretty strong plains of fibres, the exterior of which are nearly longitudinal, the anterior nearly circular. When the former act, they shorten and widen the tube—thus fitting it to receive aliment; when the latter exert themselves, they render it narrower and longer, and propel the aliment onwards: this alternate action, begun at the origin of the canal, and continued downwards successively through its different portions, one after another, determines the rout of the aliment into the stomach.

Its innermost coat, called nervous, is tough and strong, fit to resist the hardness and roughness of what may be swallowed; it is lined with short villi, standing up like velvet, somewhat in the manner of those of the stomach and intestines, of which we shall presently speak. There are likewise numerous secretory ducts opening into it, which yield a mucous liquid, by which it is moistened and lubricated, in order to facilitate the passage of the aliment through its cavity.

The STOMACH, or VENTRICLE, is situated in the abdo­men, or lower belly, immediately under the liver, which covers a great part of it above, and laterally; it is placed transversely, in the main, from right to left, but somewhat obliquely, so that its left or upper orifice, called cardia, which is continued to the oesopha­gus, lies more towards the vetebrae; and the right or lower, called pylorus, which opens into the intestine duodenum, more anterior. In figure it resembles a bag-pipe; its thickest part be­ing its left extremity, at the implantation of the oesophagus, from which it tapers to the pylorus. The CARTILAGO ENSIFOR­MIS, or lower part of the breast bone, answers nearly to its mid­dle: the spleen lies contiguous to its lower part, on the left, and the pancreas behind its bottom.

The structure of the stomach is in general the same as the oesophagus, of which it may be considered a dilatation. Its most external membrane is a continuation of the peritoneum; its next is cellular, in which its great branches of blood vessels and nerves run; in it there are likewise conglobate glands and lymphatic vessels. Under this lies the muscular coat—the exte­rior layer is a continuation of the longitudinal fibres of the oeso­phagus, which open and disperse themselves over the stomach—and as the stomach is by much the larger of the two, and of an irregular figure, they must of course be thinner, and less nu­merous in some places than others. They run mostly along the length of the stomach, and terminate at the pylorus; they seem to shorten the stomach, though but in a feeble manner, and [Page 40] widen its middle. The other stratum or layer, answering to the circular fibres of the oesophagus, is by much the stronger of the two; its fibres run in a general way round the stomach, at right angles with its axis, though with considerable and intricate deviations: they seem like the analogous stratum in the oeso­phagus, to lengthen the tube they encircle, and contract its ca­vity, a remarkable plain of this same stratum runs from the left orifice to the right by the shortest way, viz. along the up­per and lesser curvature of the stomach; and appears to coun­teract its other fibres, by drawing the two orifices towards each other. And it is observed, that at the entry of the oesophagus into the stomach, the circular fibres are remarkably thick and strong, which therefore may serve, in some measure, as a sphincter to it, to shuts its cavity there; but, upon the whole, the exact course of the muscular fibres of the stomach is so ex­tremely difficult to be traced and described, that hardly any two anatomists, unless they copy from one another, agree in their account of them. It is sufficient to conceive them to be so fra­med and distributed, as to enable the stomach to press upon its contents every way, and gradually to expel them.—Next to, and immediately under the muscular coat, is another cellular texture, more conspicuous than the exterior one, in which pretty large trunks of blood vessels and nerves run, after having penetrated through the muscular coat. Under it lies that called nervous which is a firm, tough, white, and pretty thick membrane, constituting the principal and most peculiar coat of the stomach. The sixth in number is another cellular web, much thinner and more subtile than the two former—made up of shorter threads and laminoe—The innermost of all is the villous coat, so called, because it hath villi, or pile like that of velvet, standing out from it; these villi are small membranous productions, or sheaths containing minute tubuli, both of the arterial and venous kind, opening into the cavity of the stomach. The arterial tu­buli pour into the stomach a liquor much more subtile than blood, to be mixed with the aliments for the purpose of digesti­on—and when the stomach is empty, this liquor growing sharper concurs with the saliva in exciting the sense of hunger, as has been said; the venous tubuli are absorbent, and resorb liquids from the stomach; the innermost or villous coat being larger than the rest, forms wrinkles here and there, more or less con­spicuous, but at the pylorus there is a remarkable one; where a duplicature of the coat formed by this wrinkle all round the pylorus, and projecting into the entry of the duodenum, serves, together with the circular fibres of the muscular coat, to con­tract, [Page 41] and almost shut that orifice, and let only the thinner parts of the alimentary mash be expelled out of the stomach into the intestine very gradually, and in small quantities at once; over all the inside of the villous coat, there open excretory ducts of mucous glands, seated in the second cellular membrane, which furnish a lubricating liquor, as in the oesophagus, serving to de­fend the acutely sentient inside of the stomach from the acrimo­ny or otherwise hurtful qualities of what we may eat or drink.

The stomach is plentifully furnished with blood vessels; its arteries all come from the coeliac, and its veins all empty them­selves into the vena portarum: it is no less largely supplied with nerves, every branch of which arise from the par vagnum.

Now the use of this organ is for the digestion of our food, in order to promote the nourishment of the other parts of the body, as well as itself—and this it is supposed to promote by heat, moisture, agitation, and fermentation—all which, that it is capable of producing, it will be easy to conceive, when we consider its structure and situation—for we find it is almost covered with the liver, lies contiguous to the spleen and pancreas—is possessed of a muscular coat—has large trunks of blood vessels running thro' its substances—lies close under the diaphragm—and fluids pro­fusely excreted into its cavity, and perpetually pressing down the oesophagus—besides its lying over the aorta, or great artery of the machine—and thus the texture of the aliment is broken, the juices they afford set at liberty, mixed with the gastric juices, or those of the stomach, thrown into a state of fermentation, and changed into materials proper for forming nutritious fluids, as far as the first process extends—which are farther perfected when they pass into the intestines, whose structure is similar to that of the sto­mach—by being mixed with bile, pancreatic, and intestinal fluids; converting them into a white liquor called chyle, which is absorbed by the lacteal vessels, and there in their passage through the lym­phatic glands to the receptaculum chyli further mixed and di­luted with lymph; from this receptaculum the chyle is carried into the vena cava, thrown with the blood into the right auricle of the heart, thence into the right ventricle, which ejects it into the lungs, by the pulmonary artery, in which organ it is further elaborated, thrown from thence into the left auricle and vetricle, and then into the round of the greater circulation, where it meets with fresh attrition; and thus, in a little time, converted into a perfectly nutritive fluid, which is applied to the particular parts for their support as wanted. But the stomach, besides being the instrument for performing the first process of digestion, is possess­ed of another material power, that of promoting sympathic af­fections in the constitution. These are such affections as appear [Page 42] in parts far distant from those, where the action of any substance caus [...]ng such distant affections, are locally acting—as sweat induc­ed by antimonials taken upon the stomach, and only acting im­mediately on that organ—vomiting produced by a stone stimu­lating the kidney, &c.—but of this however we shall speak more at large, when we come to treat particularly on this subject—and now proceed to describe the intestines, and their uses—which have been divided, and are six in number, three small, and three large, viz. DUODENUM, so called from being twelve finger breadths long;—JEJUNUM, from being commonly found emp­ty,—ILEUM, from being supported in part by the bones called ilia—these form the three first, or small guts.

The DUODENUM is wider than the others—as it received all the mash expelled out of the stomach; which cannot be said of the other guts, some part thereof being resorbed by the way, but chiefly on account of its having, for a great part of its length, from its origin progressively, no external tough covering from the mesentery to limit its size; it is likewise redder and more fleshy than the jejunum and ileum, its muscular fibres being thick­er and stronger. About its middle it receives the duct from the pancreas and liver, called pancreatic and biliary, which passing through its coat, obliquely open into it through one orifice; it makes several curvatures—the most considerable is that by which it ascends almost perpendicularly some way, soon after the two ducts open into its cavity, whereby the alimentary mash must needs be somewhat retarded in its passage through it; and the bile and pancreatic juice the more thoroughly mixed therewith, and with one another; in its beginning, its innermost coat is even, with­out wrinkles or furrows, such as are called valvulae conniventes; but in its progress, and towards its terminations, it gets many such; which must further retard the progress of its contents; it is supplied with arteries chiefly from the same trunk that supplies the stomach, viz. the coeliac; some lacteals, though but few arise from it.

The JEJUNUM.—It is not easy to fix exactly the limits be­tween the duodenum, nor ileum, and this gut: one way of dis­tinguishing the jejunum from the ileum, and perhaps the best, is to call all that jejunum, whose circumvolutions are above the umbilicus, or navel; and whose cavities are remarkably furnish­ed with rugae or valvulae conniventes; this will make it about a third shorter than the ileum; it is narrower than the duode­num; its muscular fibres are thinner and weaker; it has some clusters of glands, called Peyer's, from their discoverer, and sends forth numerous lacteals.

The ILEUM makes its windings chiefly below the umbilicus; [Page 43] the lateral foldings are supported by the ossa ilia, above the thigh bones; its structure is much the same with that of the jejunum, except that in it the valvulae conniventes decrease gradually, both in number and size, till at length they disappear. It hath more of Peyer's glands than the two former, especially about its ter­mination, and sends forth extremely numerous lacteal vessels, the jejunum and it furnishing almost the whole of these canals: it is considerably longer than the jejunum, and is continued to the first of the thick guts called colon. Both the jejunum and ileum are furnished with blood vessels from the mesenterica superior. These small guts are the instruments immediately employed in making the chyle: whose coats are pretty much the same with those of the stomach.

The thick or large guts are also three in number—the CAE­CUM, COLON, and RECTUM.

The ileum, the last of the small guts, terminating near the right kidney, opens into the colon; at its junction with the CAE­CUM: this is a short wide sac about three inches long; its diame­ter about thrice as large as that of the small intestines: it is situ­ated under the right kidney, and hid by the last convolution of the ileum, and has an appendix arising laterally from its bottom, called appendicula vermiformis, and is about the same length, but very slender, its diameter commonly not exceeding a quarter of an inch; its termination is shut, and it fluctuates loose.

The COLON from its origin makes a large turn upwards as far as the liver; then proceeds transversely to the left under the gall-bladder, which it touches under the bottom of the stomach, towards the spleen and lest kidney, to which it is fastened; from thence passing, it makes several turns, the whole of them pretty much in the figure of a capital S inverted, then terminates in the rectum; so that it surrounds, in a manner, the whole abdomen, sometimes ascending, sometimes descending; hence it happens that one stool is often succeeded by a second: by this contrivance likewise the faeces are longer kept, and hindered from being eve­ry now and then indecently voided.

The RECTUM or STRAIGHT GUT, so called because its course, if the length of the body is regarded, is straight, though it is bent backwards and forwards, humouring the direction of the os sacrum and os coccygis, bones situated at the lower part of the back, begins where the last curvatures of the colon end, and is terminated at the anus.

It is worthy to be observed, that there is a remarkable con­trivance at the junction of the ileum with the colon and caecum, by which the contents of the small intestines are allowed a free passage into the thick ones, but small regress or retropulsion from [Page 44] the latter into the former is effectually hindered and stopped, this is called, valvuli Bauhini—Tulpii, or—Coli. Its effect in the animal oeconomy is very salutary; for as the contents of the intestines begin to putrify, and become foetid in the caecum, by their being retarded there, both upon account of its capaciousness, and the almost perpendicular ascent of the colon, which is conti­nued from it, if their repulsion into the ileum was not effectually hindered, the chyle in the small guts would be tainted with pu­tridity, and even excrementitious matter thrown up at the mouth in obstinate costiveness; whereas not so much as a faecal halitus, or the subtilest effluvia, can get that way in a state of health, though [...] should be wanting ten or twelve days together, as happens in a common way to many.

The caecum being much wider than the small intestines, and at the same time lower than the implantation of the ileum, the contents must, in some measure, sta [...]nate there, especially as the colon from its origin mounts in a manner perpendicularly as far as the liver in the right hypochondre. By stagnating in so warm a place, their putridity increases there, and they acquire a faecal odour, which is not observed in the contents of the small guts; they likewise become less fluid, and more consistent, by the re­sorption of the more liquid parts through the lacteals and other bibulous veins, still continuing.

The vermicular appendix of the caecum, by the numerous glandular outlets in its cavity, serves, as well as a receptacle for the meconium in the foetus, to lubricate the contents and mem­branes of the caecum, into which it opens, as well as its own, in order to facilitate the propu [...]ion of the faecal matter, and prevent its adhesion to the coats of the caecum and its own, and where it must stagnate longer than it had stagnated hitherto any where in the intestinal tract. This use likewise takes place in the born animal; and besides in obstinate costiveness, by affording more room or stowage for the congested faeces it renders that com­plaint more easy to be borne, and less detrimental than it other­wise might be.

The caecum and colon, besides having a stronger muscular coat than the small intestines, are furnished with three ligament-like bands, running length-ways on their outside, dividing their sur­face into three portions, nearly equal [...]. Though they appear like ligaments externally, they are made up in their inner structure of true muscular fibres, and strengthen the longitudinal fibres of the muscular coat; as they are longer than the proper coats, they keep them drawn up into folds or wrinkles.

Through these intestines is propelled and urged on the remain­der of the alimentary mash, after having undergone the action of [Page 45] the small guts; it consists of the earthy part of the materials tak­en in for food—of the membranous, fibrous, cartilaginous, and bony parts, that could not be sufficiently broken, and comminut­ed by the stomach or intestines so as to be taken up by the lacte­al, and other absorbing vessels; the recrements of the bile, and mucus furnished by Peyer's glands, all mixed together.

The causes of its propulsion are the same as in the small guts, viz. the action of respiration, and the peristaltic motion of the intestines themselves; but its course is slower than in the small guts, upon the account of its thicker consistence, the ascent and windings of the colon, the delay it meets with from furrows within the tube, and the great stop from hard faeces, pent up in the rectum by the sphincter ani. The putridity is increased as it goes on; and as putrefaction generates air, the colon is com­monly found distended with flatulency. The whole is more and more gradually exhausted and robbed of its most fluid parts; and as what putrid miasmata are absorbed by the mesocolic veins, are determined finally into the vena portarum, to contribute towards the rancidity and putrescent disposition of the bile, so that even here the faeces, which are upon the point of being expelled out of the body altogether, are rendered useful and made subservient to the perfection of what is left behind.

The RECTUM begins in the pelvis where the last curvatures of the colon end; its muscular coat is much stronger than in the other intestines; the ligament-like bands, which in the caecum and colon are collected into three portions, are spread equally over its surface, that no part of it may be weaker than another, lest it should give way in the effort of throwing out its contents. Into this intestine the faecal matter, now consistent and shaped by the cylindrical cavity of the colon, especially in its last curva­tures, where it is more uniform, and not so much distended by flatulency, is received and accumulated therein, until, by its in­creased bulk, weight, and acrimony, it becomes troublesome, and would prove hurtful if long retained. Then it is expelled by the muscular powers furnished for that purpose—and strong powers there are and admirably fitted to answer their end.

The INTESTINES are not left to move at random in the ca­vity of the abdomen, but artfully tied down by a membranous web, which prevents their circumvolutions from being entangled in each other—at the same time allowing them a gentle but limit­ed motion. That part of it, which is connected with the small intestines, is called mesentery; the other part fastened to the colon, meso-colon. The rectum has a particular membrane al­lotted to itself for fixing it.

This membranous web, for the mesentery, and meso-colon [Page 46] are one continued membrane, is a double production of the peri­toneum, arising from the vertebrae of the loins; its two laminae are joined together by a cellular texture, in which the lacteals, blood vessels, &c. run, and the mesenteric glands are placed: when this double membrane hath arrived at the intestines, its laminae separate and quite surround them, thus furnishing their external covering.

Upon a slight survey of the uses produced by the mechanism of this part of the human machine, we cannot avoid being struck with wonder at its apparent simplicity, answering so many salu­tary purposes. If we trace the materials thrown into the sto­mach for our support through the intestinal tube, we must more and more admire the excellency of the divine workmanship; for as soon as we take our food it is received into a place, in all points calculated to render it fit for yielding its nutritious con­tents, by mixing with the salivary and gastric juices—having its texture broken by muscular action, not only of its own coats but the organs of respiration, and the quickly repeated shocks of the largest artery in the human machine, and from heat, increas­ed from its situation, soon thrown into the process of fermenta­tion—by all which it is rendered fluxile, and passes, from the contrivance at the lower orifice of the stomach, slowly into the head of the first of the intestines—more capacious than its infe­rior part; it is there mixed with the bile, increased in its quan­tity in proportion only as it is wanted, by the very means of those things which require it, and pancreatic juice, calculated to convert the various portions into a nutritious fluid, by mixing the parts uniformly together, at the same time affording a stimu­lus to promote the propulsive force of the intestines, and conse­quently increase the action of those vessels implanted in the sides of them to convey it through the mesenteric glands, where it re­ceives more liquid, thinner than itself, to increase its fluxility into the receptacle appropriated for this purpose, and from thence into the blood—the faeculent, or thicker part, being at the same time pushed forwards into the larger bowels, from whence there can happen no regurgitation of any, even of its finer parts, tho' delayed for some time, in order that a portion of its alkalescent or stimulating materials may be carried through the vena porta­rum, into the liver, to increase the acrimony of the bile; and as here the faeces acquire a greater hardness, consequently stand in need of a greater force to propel them forwards for their exit, the bowels in this place are possessed of greater strength, and require a stronger stimulus to excite them to more powerful ac­tion, which the putrescent state of the faeces, acquired by delay, affords.

[Page 47] But besides the uses, herein specified, appropriated to the stomach and intestines, there is another very considerable one be­stowed on them, particularly the former, by which very material affections are diffused to almost every part of the machine, and from which all the sensible parts of the body receive very peculiar and extraordinary advantages—I mean that of conveying action to different parts, and feeling the effects from these sympathetic­ally and instantaneously;—for in many cases the stomach not on­ly will experience perceptible effects locally of things received into its cavity, but communicate effect to different parts from that local action; nay, will produce them sometimes without the animal being sensible of any action going forwards in that organ; and will itself be affected by some causes acting on other different parts, with the same unconsciousness of the locality of action, as well as sensible perception of such action—so close an union is there between this organ, and the intestines, with various parts, the most distant as well as the more contiguous.

Opium, the active preparations of antimony, bark, and a num­ber of those medicines called cordial and antispasmodic, will dif­fuse their effects to the machine in general, and some particular parts, from what they exercise on the stomach, particularly itself. Hence will opium produce sleep—take off pain—promote per­spiration or sweat—stop evacuations—alleviate and conquer some convulsive or spasmodic affections.—Antimonials take off cuticu­lar spasms, productive of febrile affections, allay febrile heat—promote insensible perspiration and sweat.—Bark increase the tone and strength of the systems—stop some evacuations—increase o­thers—and give firmness to the muscular fibres.

Cordials invigorate the habit—increase the circulatory powers of the constitution—subdue lowness—fainting—warm the habit—and produce discharges from the skin.

Musk, asafoetida, camphor—take off several convulsion affecti­ons—and all these things are done by the stomach, diffusively communicating effects to the various parts, whose office it is to perform their different operations, or to those where these mor­bid effects may be manifested.

And it will also be affected by the sensations induced on differ­ent parts distant from itself. Spasmodic affections of the pores of the skin will produce sickness, nausea, vomiting—so will a stone in the kidney; violent blows on the head, or [...] on the brain, will occasion similar effects—and a variety of others might be adduced tending to prove the same points; but enough has been here advanced to prepare us for the fuller discussion, and better understanding of these consequential particulars, when we come to speak more fully on them, as they occur repeatedly in [Page 48] the course of the subsequent sheets.—We must now avert to the kidneys.

The KIDNEYS are two pretty solid glandular bodies, situat­ed in the posterior part of the cavity of the abdomen, on each side of the vertebrae of the loins, between the last false rib, and the ossa iliaca or hip bones. The right kidney lies under the great lobe of the liver, the left under the spleen, and therefore is high­er; they are commonly about five inches long, about three broad, and one and a half thick; they are connected with the colon, duodenum, liver, and spleen, by the productions of the peritone­um. They are in shape not unlike a large bean, their circum­ference being convex on one side, and concave on the other—the concave side is turned towards the vertebrae, or back bone.

The Kidneys are surrounded with a loose cellular texture, in which there is much fat; this likewise invests the arteries and veins of the kidneys. The proper coat or membrane of the kid­neys is double, being composed of two laminae, or layers—be­twixt which there is a very fine cellular texture; the external laminae is very thin, and only surrounds the body of the kidney; the internal one penetrates every where by numerous elongations into the substance of the kidney, from which it cannot be sepa­rated without tearing. The substance of the Kidneys is smooth, even, and uniform in adults—in young children divided in a man­ner into several lobes and tubercles, or portions.

They are supplied with very large blood vessels—commonly called emulgents. The arteries arise from the great descending artery of the heart, nearly at right angles, one large trunk for each kidney; they run horizontally to the kidneys, and common­ly without division—and having sent off branches to the external surface of the kidney, the chief trunk enters into its body at its concave part, and is distributed by an infinite number of small branches over all its substance. The veins running along with the arteries open in a large trunk from each kidney into the ca­va descendens, or large descending vein, near that part of the aor­ta where the arteries arise.

If the kidney is cut through its convex, towards its concave part, into two equal portions, there appears a three-fold substance composing its body—the exterior part called cortical, round the whole circumference of the kidney, of a bright, whitish, grey colour;—a middle substance, called medullary, striated, or streak­ed, which terminates in the third, called papillary, as it ends in eleven or twelve papillae, or nipples, from the ends of which the urine drops through several small holes in the cavity of the kidney.

The intimate structure of the kidney is entirely vascular—the [Page 49] small arterial branches proceeding towards the papillae are reflect­ed back with serpentine circumvolutions towards the surface of the kidney, then are bent again towards the papillae and, at length, send off straight urinary ducts perforating the papillae, and tending to the cavity of the kidney called pelvis, which is continued to the ureter, a vessel which runs into the bladder.

The pelvis, which is truly the head of the ureter, is the reser­voir into which the urine drops from all the urinary ducts or tu­buli. It is formed by the confluence of three large urinary ca­nals, into which the small urinary ducts open by holes laterally. This cavity, or pelvis, is straitened at length into the ureter, one to each kidney; so that the kidney may be imagined to be a vas­cular congeries, consisting of arteries, uriniferous ducts, or those which convey urine, and veins, all running together over the substance of the kidney; the urinary ducts opening at length in­to the great urinary reservoir, or pelvis, which terminates in the ureter. In the kidney there are no follicles between the last ar­terial branches, and the first urinary ducts.

By this apparatus is the urine separated in the substance of the kidney and sent into the ureter: the vast largeness of the emul­gent arteries, and their proximity or nearness to the heart shew, that a great quantity of blood comes, in a small space of time, to the kidneys. Now the blood, which is newly come from the heart, must contain a great quantity of water, as, besides our drink, and the stomachic and intestinal juices, almost all the lymph of the body is poured upon the chyle, in its receptacle in the lower belly, and the duct in the thorax, immediately before it is mixed with the blood.

This water is impregnated with the salts of the blood, and some animal oil, attenuated by the process of concoction, or digestion, and circulation, and rendered miscible with water, and united with these salts, together with subtle terrestrious or earthy parts, abraded from the inside of the animal tubes, constitute the mat­ter of urine. The diameters of the urinary ducts are adapted to admit these, and exclude, in a sound state, every thing grosser, as globules of blood, mere oil unattenuated, milk or chyle, and serum or lymph, that is concrescible by fire, urine being not so; at the same time they transmit every thing that is thinner, if it arrives at the kidneys; so that urine is the lixivium or ley, as it were, of the blood; by the separation of which it is edulco­rated. Its salts and oils, which begin by repeated circulations to be more acrid than the tender vessels of the nerves and brain could bear, being washed off, and thrown out by the urinary pas­sages.

The URETERS, arising from the pelvis of the kidneys, run [Page 50] down obliquely, and with a very small inflexion from the kid­neys to the lateral parts of the inner and anterior side of the os sacrum, or lower part of the back, and passing between the rec­tum and bladder, are inverted in the latter. Their structure is much a kin to that of the intestines, though the innermost coat is smooth and membranous, furnished with glands separating a mucilaginous liquor to defend it against the sharpness of the urine; they open into the neck of the bladder on each side, pene­trating obliquely through its coats.

The BLADDER is a membranous and fleshy sac or bag, ca­pable of contraction and dilatation situated in the lower part of the abdomen or belly, immediately behind the joining of those bones, called o [...]a pubis—and opposite to the beginning of the rectum. The figure of it is nearly a short oval—it is broader on the fore and back, than on the lateral parts, rounder above than below, when contracted; and broader above than below when distended. It is conceived, as divided into the body, neck, and bottom, into anterior and posterior, and into two lateral parts, right and left.

The upper part is termed its bottom—its neck is part of its lower portion, with respect to its situation in the body. The bladder is not within the cavity of the peritoneum, that mem­brane only covering a part of its bottom or upper part, and com­ing down no farther anteriorly, but being reflected over the blad­der, descends, covering it, as far down as the insertion of the ureters.

The structure of this organ is nearly the same with that of the ureters, viz. besides the peritoneum, which covers but part of it, there is first an external cellular, under that a muscular coat; then a second cellular, then a nervous coat, and the innermost of all, a coat, in some measure, villous, furnished with glands which separate a mucilaginous liquor, necessary to defend it against the sharpness of the urine, which stagnates within it often, for a ve­ry considerable time together.

The fibres in the muscular coat run in all manner of directions, the outermost, and most remarkable series is longitudinal, run­ning from the neck upwards, and hath been thought to deserve a particular name—detrusor urinae, expeller of urine—the others run obliquely, by different degrees of obliquity, and some alto­gether transverse: the neck, or under part of the bladder, is shut by a muscular sphincter, like that of the anus.

The use of the bladder is to receive the urine which keeps constantly slowing from the urinary ducts and kidneys into the pelvis and ureter—and to retain it; that it may not indecently dribble, and disturb the functions of life. It seems to change [Page 51] its nature no otherwise than by its being kept at rest in a warm place, thereby becoming more acrid and stimulating. The urine is detained in the bladder by its sphincter, till by its distension, and the acrimony of the urine, either or both, we are made, uneasy and endeavour to expel it through the urethra—see page 53, 54, &c.—out of the body, which is done in the same manner as the faeces are thrust out—by the joint action of the diaphragm, and the muscles of the abdomen, assisted by the proper muscular coat of the bladder—and the pyramidial muscles, in a particular man­ner, favour the evacuation of the bladder, as they lie nearly over it.

The UTERUS, or WOMB, the habitation of the foetus, is si­tuated between the urinary bladder, which is placed before it, and the intestinum rectum placed behind it. In a grown woman, not with child, it is about three finger breadths long, two in breadth, where it is broadest, and one in thickness; it is of the figure of a flat flask, convex before and behind, with edges inclin­ing to sharp; its broadest extremity, which is called its bottom, is uppermost; and its small part, called its cervix or neck, is downwards—it is covered over with a production of the perito­neum, two portions of which, one on each side, fasten it to the sides of the pelvis, and are called the ligamenta lata, or broad li­gaments.

The womb, when impregnated, hath but a very small cavity, its walls being very thick; the cavity is, in some measure, of a tri­angular shape, and it is lined with a very thin small membrane.

The womb is made up of a compacted cellular substance, with a copious intermixture of blood vessels—there appears something like muscular fibres amidst the cellular substance, especially in women newly delivered, variously distributed in little circles.

The smaller and lower part of the womb, called its neck or cer­vix, abounds with callous rugae, or folds; in the interstices or spaces of which there are mucous sinuses, and here and there round vesicles full of a pellucid lymph, where it opens into the vagina, described below; it forms a round protuberance, not un­like the glans penis, called the os uteri, mouth of the womb, or os tincae, because supposed, like a tench's mouth, divided by a rimae or chink; on which protuberance there is plenty of a mu­cous, glutinous liquor, furnished by numerous sinuses there: this glutinous liquor serves to shut the os uteri in pregnancy.

The VAGINA, or canal of the uterus, is about six or seven inches long; it is stretched from the mouth of the uterus to the pudendum, or external parts; it is of the same texture with the uterus; cellular, with numerous blood vessels interwoven: its inner surface hath several rugae, or wrinkles; there are likewise [Page 52] nervous papillae spread over it, which render it more sensible; its external orifice is surrounded with muscular fibres, which constrict it.

The uterus, as had been [...]id, is plentifully stored with blood vessels; they are furnished from the hypogastrics, by which, like­wise, the inner and greater part of the vagina is supplied; its outer extremity is furnished from the external haemorrhoidal.

The womb is adapted for the retention of the embryo, and its nourishnent, till the time of birth; and with the vessels of the vagina, for affording the monthly evacuation called menses, or catamenia.

But to the womb, for the purpose of promoting the generation of the human species, there are united two other contrivances on each side, the one called tubae Fallopianae, Fallopian tubes, from the discoverer, Fallopius; the other, ovaria, from their re­taining small round substances of the nature of eggs.

On each side of the fundus uteri the former open by two small orifices, which in a dead subject, with difficulty admit a hog's bristle; from this small opening each tube proceeds somewhat transversely from the fundus towards the lateral parts of the pel­vis, running between the duplicatures of the broad ligaments—their diameters gradually augmenting to their extremities, where they are about a quarter of an inch wide; they run not straight from the womb, [...]ut wind in such a manner as to turn their wide, open extremities towards the ovaria; these extremities are jagged or scollopped; their external membrane, or covering, is from the peritoneum; their proper coat is plentifully furnished with vessels; there are some obscure, seemingly muscular, fibres interspersed, supported by a spongy cellular texture.

The OVARIA are two whitish, oval, flat bodies, situated on the sides of the fundus uteri, to which they are joined by a kind of short ligament, and inclosed, together with the tubae Fallo­pianae, in the duplicature of the broad ligament—their substance is cellular and close, without fat—in it there are found, even in the ovaria of virgins, little round vesicles, called ova, or eggs—of an uncertain number, commonly ten or twelve, full of a trans­parent coagulable fluid. These ova adhere closely to the texture of the ovaria.

The OVARIA and TUBAE Fallopianae, are supplied with blood-vessels from the spermatics, which have nearly the same origin in females as in males—viz. the arteries of the aorta, near the rise of the emulgents, and the veins from the vena cava, and emulgent vein; these inosculate with the vessels that go to the uterus.

These also are supposed to perform particular functions in the [Page 53] propagation and formation of our species—for the ovaria are squeezed by the edges of the tubes, disengage some of the ova, or eggs, which are impregnated, generally one, now and then two, three, or four, which are forced into the tubes and carried into the cavity of the uterus, where they fix themselves and are re­tained, and here the foetus is nourished to the proper time for its birth, which happens almost always in the space of nine months.

We might now, according to what we first proposed respect­ing the nature of our subject, finish our anatomical account, as sufficient has been described to give a tolerable idea of constitu­tions in general; but as we also intend to shew the methods of preventing, or stopping the progress of particular complaints, lo­cal as well as general—we must, before we conclude, speak of the testes, urethra, and penis, the male parts of generation—as they are subject to some complaints which require early atten­tion, by which several disagreeable consequences may be prevent­ed.

The TESTES, or TESTICLES, with regard to their situ­ation, are sufficiently known; they are defended from cold, and other injuries, by several membranes or coats.

The outer one is called the scrotum—which is made up of the epidermis, or scarf-skin;—the skin, and immediately under the latter, a thick cellular texture, closely adhering to it, but with­out muscular fibres: next under this is what they call dartos, from its drawing up the skin. This coat envelopes each testis singly; and by the junction of both together, where their sides are contiguous, make a partition or septum between the two testes: it is likewise wholly cellular, without muscular fibres, and without fat. Under the dartos is the crema [...]er muscle, so called from suspending the testicles; there is one to each, and arise from the tendon of the obliquus descendens, oblique descend­ing muscle of the lower belly; yet some fibres from the obliqu­us ascendens, oblique ascending muscle, the embracing the body of testes all around, serve to raise it, and squeeze it in the act of generation. It is probable, that by the action of this muscle, that the scrotum is gathered up into rugae by cold, as neither it, nor the dartos, are furnished with muscular fibres. Under this muscle is another coat of a loose cellular texture, called vagina­lis, from forming, as it were, a kind of sheath to the testes, be­tween which and the innermost coat of all is a loose space, in some measure like that between the heart and pericardium, where a watery humour is contained—the last and innermost coat is called, from its whiteness, the albuginea; it is a thick, close, strong membrane, immediately contiguous to the kernel of the testes▪ [Page 54] the substance of which kernelly part is of a white colour, and from reason and analogy, it is concluded to be a continuation of the evanescent branches of the artery called spermatic, from its supplying blood to the testes, from whence the semen is secreted, rolled up together. It is divided into more than twenty portions or clusters, separated from one another by as many partitions, which are productions of the albuginea. Each cluster, contain­ed between two partitions, terminates in one duct; which ducts, above twenty in number, meeting together, form a kind of net­work adhering to the albuginea; every duct anastomosing with those contiguous with it: from this duct arise ten or twelve o­ther distinct ducts, which being separated, bent, or folded in a wonderful manner, make as many vascular cones, and by their uniting constitute the head or beginning of the epididymis, or small testicle. This single duct, variously bent and folded into serpentine windings, such as there is no instance of in any other part of the body, its windings being fastened together by cellu­lar texture, makes a roundish body on the upper and posterior part of the testicle, called epididymis, which, at length, termi­nates in a firm and tough cylindrical tube, called vas deferens.

The PENIS consists of two bodies called corpora spongiosa, or cavernosa, spongy or cavernous bodies—part of the urethra, the glans or nut at its extremity, and its integuments. The integu­ments are, first the scarf-skin, and true skin—which being folded back, and adhering round the root of the glans, forms what is called the praepuce, in the inside of which there are small glandu­lar folliculi, which separate an oily substance, serving to make the praepuce slip over the glans, and hinder them from growing together: this substance forms white flakes, and grows rancid and foetid by long stagnation. In hot countries, it is more apt to corrupt and create inconveniences, than in temperate climates. This seems to have introduced circumcision, which was early practised all over the East, and made a part of the Jewish reli­gion. It is performed by cutting off the praepuce quite round, close by the root of the glans.

Under this common integument, the penis hath a proper coat covering all its body, from the glans exclusive backwards and is of a tough tendinous texture.

The TWO CORPORA SPONGIOSA arise from the os pu­bis on each side, and are continued to the root of the glans: they are so called, because they are porous like sponge, and capable of being enlarged by a fluid penetrating their substance, chiefly in the living, by blood—or in the dead subject, by mercury or inflation of air.

The URETHRA is a continuation of the neck of the bladder, [Page 55] and runs in a furrow between the two corpora spongiosa to the extremity of the glans—it consists of two thick spongy membranes, with a spongy texture between them—its beginning is covered by glans called PROSTATE—at its emersion from which, it becomes thicker and wider for the length of an inch, which thick part is called its bulb, from the resemblance it bears to a bulbous root; its inner membranes are pierced with many holes, here and there, through which, from a glandular apparatus in the spongy substance of the urethra, a mucilaginous liquor is furnish­ed, serving to defend it against the acrimony of the urine. Be­sides these orifices, there are three other glands, two near the bulb of the urethra, one on each side, about the size of a pea; each of which sends off a long duct which opens into the urethra, and a third single one, less than the other two, at its bend under the os pubis—which f [...]nds off two ducts opening likewise into that canal. The first two are often found, but sometimes want­ing or very small; the third is but seldom met with—the orifices are called by some lacunae; these glands—Cowper's glands; they both, probably, serve for the same purpose.

The GLANS is a continuation of the spongy substance of the urethra, reflected over its extremity, and expanded in the form we see: it is covered over with a thin epidermis or scarf-skin, under which there are numerous nervous papillae, rendering it extremely sensible.

The penis is plentifully supplied with blood vessels from the ilia [...]s, both external and internal—its nerves come from those of the loins and sacrum.

The use of the parts we have now described are for the pro­pagation of our species, and some for the evacuation of urine.

We shall now conclude what we mean to advert to on the ana­tomical part of the machine, which we have rendered very easy to be conceived, and think will be highly useful in assisting the uninformed readers to have just conceptions of what we mean by particular constitutions in general,—what of general diseases, and those called topical, or confined to some particular part,—and make them perceive the reason why such and such particular re­medies or regimen should be employed in such and such particu­lar cases, as come within the reach of every man's power—whe­ther they aim at preventing the accession, or shortening the pro­gress when begun; all which will be much better, and easier un­derstood, by the sketch, concise as it is, which has been given. For, certainly, laying down rules and directions for a man how to proceed in nervous cases, who has no idea of a nerve; in inflam­mation, who knows not any thing of the vascular system; in jaun­dice, stone, gravel, who is totally ignorant of the liver, spleen, [Page 56] bladder, kidneys, is as bad as leading a man blindfold through a country to discover its beauties, and give him a knowledge of its situation, soil, produce, &c.—And to talk to a man of discover­ing the nature of his constitution, and directing him to proceed agreeable to its disposition, without t [...]lling first of what it is com­posed, and making him sensible of the natural action of its com­ponent parts, would be as vague and useless as chopping logic to a [...]stic—it might confound, but could not inform: and it is for want of true knowledge in these particulars, that men, in other respects sensible, are so often heard delivering a profusion of non­sense on medical subjects. We therefore, in order to correct er­rors so often detrimental in their consequences, have presumed to alter the general plan of publications of this sort; by thus be­ginning anatomically—and shall now proceed to shew the differ­ent constitutions—what they are, and how they may be disco­vered.

But, first, we must take notice of those parts which are called the moving powers, by which all constitutional action is promot­ed, and life preserved; and these are—the brain and nerves—the heart, and vascular system—the lungs and blood—and the muscular fibres.

Now in proportion to the different degrees of power which these possess in their natural state, so may constitutions in gene­ral be properly denominated.

The brain and nerves are considered as the origin of incitability—that is, motion produced in them by mental affections, and sympathy.

The heart, vascular system, and muscular fibres, as the foun­tains of irritability—that is, motion produced by material stimu­lus.

The lungs and blood, the source from whence all animal heat is derived—the universal stimulant of the human machine.

The muscles or muscular fibres, as the instruments of motion.

The stomach, intestines, and other viscera, as parts which may themselves be acted upon, and produce action of some of the ge­neral moving powers, and each on parts distant from them.

But we must observe, that with respect to the term, irritability—it is by all authors equally applied to the nervous and vascular system, as well as muscular fibres, which we have shewn it ne­cessary to alter, and confine it to the two last alone—because, in­dependent of the nerves, they cannot be put into motion without some material stimulus locally applied to them—whilst the nerves may be brought into action by affections purely mental—the precise nature of whose action we cannot describe, and know them not but by effects. Besides, though they are in the habit [Page 57] united closely, they may exist independent of each other, and may be separately affected—shewing those affections belonging to themselves, without disturbing each other in many cases.

It was, therefore, unavoidable to separate the two—that con­stitutions might be precisely and distinctively marked, where the action of one or the other were most prevalent, and hence great confusion prevented; add to this, it empowers us to account more rationally for sympathetic affections, that is, where parts distant from others, shew manifest signs of affection, though the cause producing them lies in some more distant part; or where affections are suddenly produced in the habit, from some exter­nal appearances out of the habit, no matter being at that time inherent that occasions these affections from the locality of irrita­tion. But we must allow also, that the nerves are capable of being put into motion by material stimulus.

Hence then it is clear—that

The nerves are capable of being brought into action by mental affections, sympathy, and material stimulus, themselves abstract­edly considered.

The vascular system, and muscular fibres, under the same con­sideration, only by material stimulus.

That in their combined state, they mutually act on each other, in many cases, or may be separately affected.

Now as the moving powers vary in their different degrees, and different combinations respecting those degrees, so do we conclude constitutions ought to be determined—and so ought different re­gimen, and applications of medicine, be advised—for preserving health, preventing, retarding the progress, and curing of diseases.

CHAP. I. MEDICINES which act upon the INERT SOLIDS by Means of the VITAL PRINCIPLE.

§ 1. THE first of which are NUTRIENTS, from the latin word nutrio, to nourish.—These consist of all such materials as are calculated to be assimilated to our own specific nature, by the action of the digestive powers;—and the applica­tion of which so assimilated, repairs the waste which had been occasioned by the different operations passing on in the human machine—Hence, from their affording nourishment, do they take their name.

But these vary in several respects, either as to their being more or less perfected in themselves towards the nature of animal juic­es.—being of easier or more difficult digestions,—and also with respect to their fluidity or solidity.

But though they are possessed of such various properties, they are all of them reducible to one state, in order to promote sup­port to the animal; and the changes they undergo for this end are brought about by three different ways in the first instance—for first, the solid food is minutely divided, and has its texture in a great degree broken down by chewing, and farther reduced by the action of the stomach and intestines—this is called COM­MINUTION.—It also forms an union with the saliva, air, juices of the stomach and intestines—those of the liver and sweetbread—this is termed COMMIXTURE—and add to these the heat it re­ceives, by which it is thrown into the third mode, or FERMENT­ATION—and all this it undergoes in the first passages.—In the se­cond, it experiences great divisibility, union, and mixture, in passing through the lacteal vessels, and by the force of the lungs;—and, lostly, it is brought into its most perfect nutritive state by the impressive influence of the circulatory system upon their contained fluids. Hence we may concisely say, that the assimi­l [...] or our food, for the purpose of nutrition, is performed by COMMINUTION—COMMIXTURE—and FERMENTATION.

And from this we may understand why all nutritious sub­stances should be adapted, both with regard to their quantity and quality, to the strength and vigour of these powers collectively [Page 133] considered—and also are we taught what mischiefs often arise from the indiscreet indulgence of fond mothers, and ridiculous nurses, who load those, who are weak in some or all these parti­culars, too freely with food, considered in itself so be nutritious, in order that they may acquire strength,—and by these means, destroy the effect, by large quantities being poured into the ha­bit, which smaller proportions of the same food would have in­disputably supplied;—for if the digestive powers are loaded with a superabundant quantity more than they can conquer, they be­come, as it were, diseased; and even the small portion of food, to which their powers were adequate, left in a state too imperfect for affording any nutrition. And this rule is extremely worthy of attention—for valetudinarians, however proper their food, should never take more than they can bear with the greatest ease. Indeed, in people recovering from very severe illness, where the active powers of the habit have been greatly enfeebled, though it is always right to throw in food of the most nutritious nature, the most easy of digestion, and such as sits the most light on the stomach, still should we begin with small quantities, increasing them, and altering the food in proportion as the patient recovers strength; and this for very obvious reasons, which will soon ap­pear, as we examine the nature of our food more minutely than we have done in speaking of the non-naturals.

Though we have before said, that perhaps our first food par­took most of a vegetable nature, yet as all substances are the more nutritious, the more they approach to that of animal, a di­vision seems here requisite, in order to shew the different de­grees they maintain with respect to the nutriment they afford, and the proper modes of best acquiring and applying them to the constitution.

NUTRIENTS, therefore, may not improperly be arranged un­der three heads:

1. ANIMAL 2. VECETABLE 3. MIXED.

Of the FIRST—All those are the most powerfully, and most quickly nutritious, which have the least acidity, and are most elaborated, or brought nearest to the nature of animal fluids—hence the finer juices of the older animals become the most eli­gible, and these are best procured by slight boiling, or infusing, in such a diluted state as the circumstances may require; that is, in proportion to the strength of the digestive powers;—for, as we consider the very fine juices of animal substances the most nutri­tious, because more readily assimilated to our own nature, for very weak debilitated habits, infusion is the most advantageous process, as by these means the subtler parts are preserved, which by long or quick boiling would be dissipated—but for those pos­sessed [Page 134] of stronger digestive powers, there is not so much necessity for this nicety.

Of these materials the most nutritious are, beef—and mutton­tea—as they are called—made in the following manner.

Take of the lean part of beef, or mutton, one pound, cut it in­to thin slices, and let the texture be well broken, by bruising it, then add to this one quart of boiling water, in an earthen or tin vessel, keep i [...] close covered till it is quite cold—or boil them o­ver a quick fire, for five minutes; separate the [...]um, and decant the clear liquor for use;—but should we require more of the stronger parts of them, the liquor may boil ten, fifteen, or twen­ty minutes, and then proceed as before directed.

The juices of the older animals are preferable to those of the younger, because those of the latter are more tenacious, and par­take not so much of the nature of our own fluids, consequently yield, in that respect, to the former.

But when it is requisite that the flesh of animals should be giv­en in its solid form—that of young ones is considered the most proper, as their fibres are much more tender, most easily broken down by chewing, and yield their nutritious part more readily to the acting powers of digestion.

MILK, of which we have before spoken, pages 82, 83, though of a mixed nature, between animal and vegetable, we consider next; for it is a fluid only half perfected, and partakes, in some degree, of each of the other classes. We have, in another place, delivered our sentiments on the allowed degrees of preference one species of milk has to another, and have shewn that of asses to be the best of any which could be procured in proper quantity—we shall here, therefore, only observe, where that cannot be ac­quired, either from the greatness of the expence, or the scarcity, of the animal, the following, called artificial asses milk, is not an inefficacious succedaneum:

Take of candied eryngo root, one ounce; pearl barley, half an ounce; liquori [...]e root, three drams; boil them in two pints of water till they are reduced to one, then add one pint of milk fresh from the cow, boil them gently together, and strain for use. Half a pint of this should be drank, in general, two or three times a day; but should that quantity be too large, it may be reduced, and repeated oftener.

The VEGETABLE CLASS has been considered as more difficult of assimilation than either of the other, because it is more distant in its nature from our fluids; and perhaps those may be found the most nutritious that approach nearer to milk, that is, more impregnated with oil, not essential—saccharine substance—and a small portion of vegetable acid; for it is from these qua­lities [Page 135] that all nutrition, in food of this sort, is supposed to be de­rived.

We have spoken here, and in another place, of these things, merely as appropriated to afford nourishment only to the animal; but they must be allowed to have other properties, which it is necessary to specify, as by these means different changes are pro­duced in the constitution.

ANIMAL FOOD, particularly fish, is more stimulant and al­calescent, because more prone to run into that state, which gene­rates pungent acrimonious salts, consequently becomes more heating.

VEGETABLE, more diluent and acescent, from its being more replete with aqueous particles, and having strong propensi­ties, from their very nature, to become acid—hence more cool­ing.

Milk, in this instance, partakes more of the latter, as it is sub­ject, left to itself, to become acid; besides, vegetables are more emollient and sheathing, as most of them abound not only with watery particles in great proportion, but also with those which are mucilaginous; and seem to have inspissating, or thickening powers, from their mixture with the fluids: hence, if we take in the account the quantity of fixed air with which they are re­plete, we may be convinced of their utility in cases of the sea or true scurvy, and in all those morbid habits, where the fluids have acquired too great degrees of thinness, from inherent or accident­al acrimony. Milk also retains the same properties.

Roasted—broiled—or fried animal food, is more stimulant than boiled, and runs quicker into a state of putrescency—from the different culinary processes they undergo: the first being prepar­ed only by the action of strong heat, by which means the fluids are rendered more pungent, and more highly alcalescent—the last receiving a less degree of heat, and through an aqueous medium, with which part of the animal juices are mixed, rendered more dilute, and less highly subtilized;—but when stewed down, to a great degree, and eat with the [...]luids with which it is prepared, it approaches nearer to the former, than when only infused, or gently simmered; nay, indeed, often exceeds them; and hence becomes also more difficult to be concocted or conquered by the digestive organs.

Of the vegetable class, we have said farinaceous substances are the most nutritious, and those which have undergone some culi­nary process, because their fibrous parts are rendered more ten­der: and those which are most easily assimilated, which contain the must [...], saccharine substance, and a small portion of vegeta­table acid; consequently those which have suffered [...] [Page 136] and fermentation, as they become sweeter, and have their viscid parts rendered thinner, and more flexile, by those means are more easily digestible;—But we must in this place make one observa­tion, which affords an objection to what is advanced.—There are another class of vegetables, which are supposed to be more nutri­tious—and these are the FUNGI, or those fungous extuberances, called Mushrooms, or Champignons—Truffles—Mor [...]es, named by NERO, the Victuals of the Gods—they are considered to afford more nutriment, from yielding, on their chemical decomposition, materials similar to animal food. DR. CULLEN says, ‘if they are truly vegetable matters, of which some have doubted, they are very different from every other vegetable with which we are acquainted—for in the first part of their distillation, without addition, they give out no acid, but a large proportion of vo­latile salt;—and exposed to undergo a spontaneous fermenta­tion, they manifest no acescency, but become immediately pu­trid—hence shew they a very near resemblance to animal sub­stances; and it may be presumed, that they are more consi­derably nutritious than almost any truly vegetable substanc­es.’

I have inserted thus much relative to these fungi, in order that we may be acquainted with their particular uses, not as cor­rectors of animal food, like other vegetables, but rather as ani­mal food itself, and correctors of acidity in the stomach—and on this account become a pleasing delicacy to such, who are forbid the use of all vegetables, on account of a prevalent redundancy of acid in the first passages.

All the acrid—bitter—or highly flavoured vegetables, as they consist of parts which are not readily subdued by the digestive powers, but pass in an unaltered state in the course of circula­tion, come more properly under the class of medicinal sub­stances.

Under this head of Nutrients we shall have no occasion to sup­ply a general catalogue, for all those things fall under this class which we employ as food, and include whatever we eat and drink for the purpose of supporting the animal machine, and re­pairing its waste.—And if we revert to what has been said in treating on aliment, p. 70, and on those liquids we in common drink, p. 80, with what we have here advanced, we shall be supplied with knowledge sufficient properly to direct us in our selection; for I am fully persuaded, that we oftener err by the quantity of food that we take, than the quality; as it is certain, such is the power inherent in our habits, that though our food may be in its own nature in any particulars dissimilar, still if we only supply such quantities as are judiciously approportioned to [Page 137] our digestive powers, whatever the aliments on which we feed, they will all be reduced to the same state, adapted to the preser­vation and nourishing of the machine; we shall therefore advert to our next subject.

§ 2. ASTRINGENTS, from the Latin word astringo, to bind, or condense, which are all such substances as by their action render the softer parts more compact, give a greater firmness to the solids, and a cohesive tenacity to the fluids. Their parti­cular power in condensing the solids is obvious from the effects which they produce in tanning, or making of leather.

BOERHAAVE was of opinion, that, when applied, they bring two distant parts of a moving fibre into closer contact, and into a more firm cohesion, and this by insinuating between each particle of the fibre another of the same kind.

Dr. CULLEN thinks, that as a fibre is composed of solid and fluid, the cohesion of the whole is increased by diminishing the watery, or by addition of the solid substance: but is rather a fa­vourer of the first opinion.

With respect to the addition of any solid substance, it may be the case when acting on the inert solids, free from the influence of the vital, or nervous power; but in the living machine, we cannot suppose medicines of this class derive from this source their operation; for under those circumstances the medicine must be universally diffused, and come in contact immediately with the parts upon which it acts.

This, therefore, cannot be true—if we consider the very small portion of those which shew their general astringent power, when taken upon the stomach, and the very quick mode in which they produce their effects; besides, the variety of sub­stances which manifest a constringent efficacy, when the machine is variously affected from different causes.

In proof of this we shall mention some few particulars:

ALUM, when given in doses of a few grains, has been known to stop profuse bleedings, arising from a relaxation of the solids, in a short space of time.

WHITE VITRIOL—BARK—STEEL—and some other of the strongly acting medicines, have caused the cessation of other discharges, by invigorating the system, and not from the locality of their application.

PUNGENT STIMULANTS have produced instantaneous effects, though not durable, in cases of laxity.

SEDATIVES, or those medicines which manifest their ef­fects by alleviating pain, and abating the quickness of vascular [Page 138] action, have early shewn their power in the abatement of acrid defluxions.

Now it appears evidently that all these produce their influence by their action on the stomach sympathetically conveyed to the machine in general, and to the parts particularly affected, which, as being in a more morbid state, they experience more power­fully.

With regard to the fluids, those medicines which have the power of sheathing acrimonious particles, from whence discharges have proceeded, may be considered as astringents. In fine, what­ever will promote a contraction of the solids, or coagulation of the fluids, come under this class.

But it must be observed, that many of these excite their action instantaneously, but do not give the system the power of conti­nuing the effect;—whilst others act more slowly, still occasion, as it were, a permanency to that action in the constitution.

VOLATILE substances—essential oils, and others of this class promote very quickly the influence of the vital powers, by which means the constitution very early is made sensible of their pow­er, but as soon as they cease to act, which they do in a short space, the morbid effects, they seem to have conquered, are re­produced.—Alum also labours under the same disadvantages.

But the more slowly acting astringents continue their force longer, and appear to give a stronger and more lasting cohesive power to the particles of the solid fibres, as if they increased their attractive influence inter [...]se.

From this knowledge we shall be able to deduce a mode of prescribing, of infinite use in practice, which would at an earlier period have been considered as contradictory, and ridiculous, because deviating from the commonly received opinion—for, from what has been advanced, we see that volatiles and astrin­gents may be judiciously united, and will be the means of assist­ing the effects of each other, by producing them sooner, and making them more lasting—as I have often found in the course of practice, particularly where the constitution has been defec­tive in vascular irritability, and nervous incitability; for, by ad­ding volatiles and pun [...]ent stimulants to bark, in many cases, the wished-for effects have been produced, which could not be attained by bark alone.

To these, where the humors are acrimonious, sheathing medi­cines, called demulcents, may be joined;—and sedatives occasion­ally had recourse to, where spasms attend relaxation of the solids.

But we must here observe, that where the astringent saline minerals, such as those [...]—white, and blue vitriol—the preparations of lead—alum, &c. may be thought proper, vola­tiles [Page 139] must not be joined with them, as they will occasion a de­composition, and render the astringent power of the compound mineral less active, nay, perhaps, destroy it altogether.

The catalogue, presented to us by various authors, is extreme­ly copious, but we shall content ourselves with a few, which are in general allowed to be the most efficacious.

CHAP. II. On MEDICINES which act upon the LIVING SOLIDS by Means of the SAME PRINCIPLES.

THE first of which are,

§ 1. STIMULANTS, so called from the Latin word stimulo, to prick or goad:—and these are all such medicines as increase the oscillatory or vibrating motion of a fibre, or excite the action of the moving fibres in the living animals.

How stimulus increases action we cannot point out the pre­cise mode; but this we know, that all those things which can increase the influence of the vital powers, either diffusively or partially, are real stimulants, and as such must be consider­ed.

They have been concluded to be of two kinds—DIRECT and INDIRECT. The first are imagined to act directly on the mov­ing fibres;—the second on the organs of sense, by which means a perception is excited on the common sensorium, which acting there, determines the nervous power to flow more copiously in­to [Page 144] the whole, or particular parts of the system. These are the most common and universal. But stimulants do excite motion in the moving fibres themselves independent of any connection with the common sensorium; for if the heart, or some other of the muscular parts, are separated from the body, they may have their action excited by the application of particular stimuli: this then is a certain proof of an irritable power inherent in themselves independent of connection with any nervous power. And again, it is as clear; that a stimulus applied to the stomach will diffuse its power to the whole habit; or if to a part, other parts far distant will experience its influence, as in cases of ge­neral heat being occasioned by the use of cordials or volatile sub­stances—vomiting from irritation of the kidneys, &c. Hence then we may fairly conclude, that action is produced by sympa­thy, as well as local stimulus.

Besides, in many of these actions, mental power is the first cause, as we may discover in longings, desire for that food of which we see others eating with uncommon relish; by which means the stomach is stimulated, and a strong sensation of hun­ger is induced, which did not before exist—weeping also from sorrow,—vomiting and sickness from recollection and reflection, &c. These are incontestable proofs of the truth of our asser­tions.

Hence, then, stimulants may be properly divided into three classes:

GENERAL—and these are such materials as are taken into the stomach, and communicate general affection through the system, owing to the connection of that organ with every other part of the machine.

LOCAL—where irritation is produced on the part affected.

MENTAL—where, without the application of any material sub­stances, applied to the stomach, or any other part, similar affec­tions will be produced by the powers of the mind.

Indeed, almost all active medicines might be ranked under the head of stimulants, were we to class them according to their known operations; submitted to different divisions under this general term, agreeable to the effects they produce—but we shall confine ourselves to such substances as invigorate the system, increase the action of the nervous and vascular power locally or universally,

And from hence shall we see their use, by facilitating the pas­sage of the blood through the parts in which it moved too slow, or was morbidly obstructed by augmenting the force and celeri­ty of the circulation—they quicken the senses where morbidly affected, rouse the mental faculties when in a lethargic state, and exhilirate a desponding condition.

[Page 145] They restore the powers of motion where morbidly defective, and also the strength of motion where morbidly weak.

From their uses have they been divided by some authors into such as are diffusable—cordial—and topical by their action—that is, such as have their action conveyed over the system—such as exhilirate the spirits—and such as are applied to some particu­lar parts morbidly affected. Examples of the FIRST have we in

Volatile alkaline salts, Electricity, Heat.

Of the SECOND in Cinnamon, Nutmegs, Wine. Of the THIRD in Mustard, Cantharides, Preparations of mercury.

These we have specified for the ease of selecting the particular substances, according to their uses, from the following catalogue of

STIMULANTS—most of which, when taken internally, have a power of increasing the force of circulation, and invigorating the system—and some proving also more immediately cordial, by revivifying the spirits.

• Horse-radish
• Mustard
• Garlic
• Onion
• Leek
• Turpentine
• Balsams of Copaiba, Gi­lead, Peru
• Gum Guaiacum
• Lavender
• Rosemary
• Pennyroyal
• Pepper-mint
• Aniseed
• Carraway
• Cardamom seed
• Cinnamon
• Cassia wood
• Mace
• Mustard
• Horse-radish
• Cow-itch
• Cantharides
• Euphorbium
• Preparations of mercury
• Myrrh
• Guaiacum wood
• Sassafras
• Contrayerva
• Snake-root
• Cascarilla
• Wake Robin
• Volatile salts.
• Of the SECOND,
• Nutmeg
• Cloves
• Pimento
• Pepper
• Ginger
• Capsicum
• Grains of paradise
• Wine
• Essential oils

Those used topically are Volatile alkaline salts And these made either into plaisters, epithems, cataplasms, ointments, or liniments.

[Page 146] The following, though truly considered as possessing a great­er or less degree of stimulating power, produce not the effects before specified so sensibly:

• Zedoary
• Gensing
• Cascarilla
• Common and Roman wormwood
• Camomile
• Orange and Lemon peel
• Quassia wood
• Hops
• Dandelion
• Millipedes
• Hyssop
• Ground-ivy
• Hedge-hyssop.

All the NUTRIENTS and ASTRINGENTS are of this class; and many others of the succeeding classes, though stimulant, are more particularly appropriated to other purposes, under which heads they will be arranged. The catalogue here given will be suffi­cient to answer the purposes to which stimulants, merely consi­dered as such, are calculated to be of any use.

But as some of them have been thought, by very respectable authority, to possess some peculiar powers, and are easily attaina­ble, we shall beg leave to specify them.

HYSSOP has been reputed to be attenuant, resolvent, pecto­ral, in coughs and asthmas occasioned by viscid phlegm; thought to produce expectoration, drank in form of tea, and sweetened with honey; and to have the power of promoting the menses attributed to it.

GROUND-IVY, drank in the same form, or in decoction, has been esteemed corroborant, aperient, and detergent, used also in coughs and asthmas, to attenuate viscid phlegm and mucus, and to brace and strengthen the vessels of the lungs; formerly much ordered in consumptive cases, and ulcers of the kidneys, as an efficacious remedy.

PENNYROYAL. This has been considered cordial—of great use in hysteric cases—to increase the tone of the system—and the chief vehicle for other medicines, to which were attributed the power of promoting the monthly discharges of the female sex. Indeed, in this last case, by some practitioners, it is held in no little estimation.

SPEAR-MINT. To this has been assigned cordial virtues, and a powerful restrainer of vomiting—tea made of this herb often answering this purpose, where every other effort has failed. It is recommended in flatulent cases, fluxes, worm cases, and ma­ny other disorders; and, though considered as a stimulant, it is not heating, a peculiar advantage it possesses over many other of the cordial class. Pepper-mint seems also to possess the same power.

[Page 147] HEDGE-HYSSOP. This is named a hydragogue, or an e­vacuator of watery humours from the body—hence useful in dropsical cases, and also worms, from its purgative power. In substance it is said to promote vomiting, sweat, and urine, to be of service in maniacal and venereal cases, after mercury had been given freely without effect—the dose, in powder, from 10 to 30 grains.

DANDELION. This has been considered as peculiarly use­ful in visceral obstructions, particularly those of the liver, as it seems calculated from its stimulant deobstruent powers, to pro­mote bilious discharges—and, from experience, has been conclud­ed highly efficacious in all biliary infarctions of the liver.

WAKE ROBIN. Much has been said by men of the first medical authority in favour of this medicine, and used to be re­commended as promoting watery excretions, quickening circu­lation in cold phlegmatic habits, and in diseases from viscid phlegm.

In deep seated, fixed rheumatic pains, it has been given with success, in doses of from ten grains to a scruple of the fresh root two or three times a day.

GEOFFROY and BERGIUS speak highly of its powers, as re­storing lost appetite, curing intermittents. In the jaundice, green­sickness, hysterical, hypochondriacal, and other diseases, it has been found useful. In cases also of obstinate head-achs, which return at intervals, without fever, mixed with alkaline aromatics and absorbents. It is given in the following manner:

Take powder of wake robin, vitriolated tartar, of each ten grains powdered rhubarb, five grains. If these purge too vio­lently, the quantity of the arum may be lessened.

GEOFFROY used to give it in doses of from half a dram to a dram; and by being boiled in vinegar, he says it becomes pow­erfully diuretic.

LEWIS gives from ten grains to a scruple of the fresh root twice or thrice a day, made into a bolus, or emulsion with oily, or mucilaginous substances—it generally produced, whilst the pa­tient was warm in bed, a copious sweat. It is now kept in the shops made into a conserve, half a dram of which may be given as a dose, and gradually increased.

Thus much has it been thought necessary to say of stimulants, in order to furnish a general idea of their extensive utility, under proper management; but as their uses are so multifarious, and almost the whole catalogue become repeatedly under our consi­deration in the succeeding part of this work, wherein we shall-be more particular in the specification of their doses, and the pecu­liar [Page 148] cases to which they are applicable, we shall quit this part of our subject, and proceed to our next head.

§ 2. ANTISPASMODICS, derived from antispasmata, medi­cines which take off spasms, or what are commonly stiled con­vulsive affections of the human machine.

Though there certainly appears a difference between spasm and convulsion, as they never run one into the other; yet there have been many disputes relative to the definition, so that their dis­tinctions may be properly marked.

Some have said, if the solids are drawn into involuntary con­tractions, and they do not continue long, but go off, and frequent­ly return again, these affections are termed convulsions—but if they remain a considerable time, spasms.

GAUBIUS defines a spasm, a violent, involutary, inordinate ac­tion of the moving fibres; and says, they who distinguish a spasm from convulsion, call the first a continued, the latter an alternate contraction of the muscles.

They have been distinguished by the terms tonic and clonic, from the Greek words teino, to stretch or fix, and kloineo, to shake. Hence, by the former are to be understood, such spasms as are continued; by the latter, such as are tremulous;—or, in other words, SPASM we would understand those muscular contractions which, once excited, remain in that state of contractility for some length of time—by convulsion, such as are irregular, and have relaxations and contractions alternating quickly with each other.

Though this distinction is necessary to be known, for the bet­ter understanding the authors who have written systematically on the subject; yet still it will be of little use in a practical view; as we shall find, according to the cause, what will be useful in one species, will also in the other. Indeed, there are such a variety of causes, so very different in their own nature, which may produce spasmodic or convulsive affections, that there will necessarily appear to be a great diversity of medicines which ought to be ranked un­der this head.

SPASMS arising from laxity, are removed by astringents; from an over distension, by emollients, from acrimony, by demulcents, or such medicines as sheath the offending particles; from acidity in the first passages, by absorbent, or alcalescent substances, which, by uniting with the acid, form a third substance, inoffensive in its action, and thus remove the cause; from wind, by those ma­terials which disperse wind by their stimulating powers, and are called curminatives; from worms, by those stiled anthelmintics, or destroyers or evacuators of them, &c.—but these are consi­dered, in regard to their known action, under their respective heads, calculated to operate against, and remove the acting cause. [Page 149] dies, are such medicines as are serviceable, from their influence on the nervous energy, or increased nervous power, by remov­ing spasmodic contractions taking place in different muscles; and by allaying convulsive agitations, where the cause is too latent to be discovered precisely; or, if conjectured at, too obstinate to be removed by medicinal applications with any degree of cer­tainty; so that the constitution being relieved from the violence of these effects, nature may be left more at liberty to exercise her power for the extirpation of the operating morbid cause.

And in our administration we must observe, where the consti­tution appears to have an inflammatory disposition, we must se­lect such as are the least stimulant; where relaxation or debili­ty seems prevalent, those which are more powerful.

Besides, as the class of antispasmodics consist of medicines dia­metrically opposite in some of their sensible properties—some be­ing highly foetid—others as greatly odoriferous—and are consi­dered as medicines of equal efficacy, we might suppose that there is no limitation in our selection—but we shall find that some will be efficacious in one constitution, and not in another—for where foetids agree, the odoriferous ones will, very often do not—and so on the contrary; therefore, where one class has been tried in­effectually, we must have recourse to the other. And here also it will be useful to observe, that very often, for want of giving these medicines in full doses, their effects have not been produc­ed; consequently it is proper to increase them, very often free­ly, till that point can be properly ascertained.

The following supplies the useful catalogue of ANTISPASMO­DICS.

• • PENNYROYAL—
  • Infusion—
  • Distilled water—
  • Essential oil, from 1 to 5 drops.

• Page 151.

  • RUE—Extract, from 10 to 20 or 30 grains.
  • SABINE—Extract, from 6 to 20 grains.
  • Powder, 20 to 30 grains.

• • ASA FOETIDA—from 5 grains to 20.
  • Tincture, ½ dram to a dram.
  • GUM AMMONIAC—from 10 to 20 grains.
  • Milk of, 1 ounce to 1 and 1-2.
  • GALBANUM—Tincture, from 10 drops to 60
  • CAMPHOR—from 5 to 20 grains.
  • Mixture, 1-2 an ounce to an ounce or more.
  • Spirit, for external application.
  • [Page 150] VALERIAN—Powder, from 1-2 dram to 2 drams;
  • Tincture, 1 to 2 drams.
  • Volatile, 1 to [...] and a 1-2 or 2 drams.

• • MUSK—from 10 to 30 grains.
  • Mixture, from 1 to 2 ounces.
  • CASTOR—Powder, from 10 to 20 grains.
  • Tincture, from 20 to 60 drops.
  • AMMOINIA prepared, and SALT OF HARTSHORN, from 3 to 20 grains.
  • Liquor, from 20 drops to 60.
  • Oil, or animal oil, from 5 to 30 drops.

• AMBER—Oil, rectified, from 5 to 20 drops.
• Salt, purified 5 to 15 grains.

Though this salt, notwithstanding it is sometimes given in hy­steric cases, more properly belongs to the diuretic class, as allow­ed to be a promoter of the urinary evacuation.

ROCK OIL—externally applied, as is also the oil of amber, in rheumatic and paralytic cases.

All the essential and empyreumatic oils are of this class.

• AETHER—vitriolic, externally applied—dose from 20 to 60 or 80 drops.
• Spirit of vitriolic aether, 20 to 60 or 80 drops.

To two articles, which we have specified here, besides their an­tispasmodic power, others have been attributed of no less conse­quence—which, as medicines easily attainable, we shall parti­cularize.

RUE has been recommended in cases where viscid phlegm has abounded, and the circulation of the blood been languid. As an attenuant, resolvent, and deobstruent it has been much extoll­ed; also in hysterical cases; and as a promoter of the menstrual discharge. BOERHAAVE had the highest opinion of it. CUL­LEN says, it is certainly an useful medicine. It is best given in conserve, from half a dram to half an ounce, two or three times a day.

SABINE. This is considered as a warm aperient medicine, increasing glandular secretions, and a powerful promoter of the menses. It is a very heating and acrid substance, and therefore requires much caution in the administration. Dr. CULLEN thinks it more powerfully determines to the uterus than any o­ther medicine—of which truth experience has often convinced [Page 151] me. Dr. HOME, out of five patients labouring under obstruc­tions of the menstrual discharge, cured three, or rather four, by giving half a dram of the powder twice a day, though a dram is the dose commonly recommended. Of the extract, from six to twenty grains is a dose. Externally applied, it has been e­steemed a powerful destroyer of fungous excrescences, in taking of venereal warts, where other applications have failed.

§ 3. SEDATIVES. This is derived from the Latin word sedo, to assuage, rest, calm; and they properly belong to such substances as diminish motion in the system, and the force of the moving powers—and also alleviate pain.

Hence, whatever diminishes motion in a part, or in the whole of the system, whether by rendering it insensible to any painful stimulus, or by arresting, by any means, the impulse of the vi­tal powers, may be called sedative. All medicines, therefore, which cool the habit, or take off inflammation—some of the acids—neutral salts—emollients—astringents—and antispasmodics, may properly come under this head, as they diminish motion in the system—but in this place our objects are limited to the con­sideration of such substances only as are thought particularly to act on the nervous power.

With regard to the precise mode of action of those selected to form this class, we can say very little, as our knowledge of the nervous system is so incomplete. However, thus far we may venture to assert, that they act either by having a peculiar power of restraining the violence, or rendering more equal the irregular motions of the nervous power, by their influence on the common sensorium, and its appendages primarily, (56) or by blunting the irritability of the living solids, and thus preventing the same power from exercising too forcibly its influence. And this they do either sympathetically, by having their action more diffusively communicated from the part they first affect; or by the locality of their action, when they are applied to the parts themselves; for it has been proved, that the heart taken out of the body, has been made to act by the application of some sti­mulus, and consequently, that this power of contraction was de­pendent on something foreign to the influence of the common sensorium, or nerves, which was certainly inherent in the mus­cular fibres themselves; and if opium is dissolved and thrown upon the heart so separated from the machine, no action from sti­mulus will take place—which proves, that, by means of this se­dative solution, irritability is destroyed.

And it is commonly known, that if a small dose of opium be taken on the stomach, it will alleviate pains of the extremities, [Page 152] and other parts distant from that organ, very expeditiously, as well as procure sleep.

[...] then we take the influence sedatives have on the common sensorium, and the irritable power, inherent in the muscular fi­bres of the system, we shall be possessed of the most certain known idea of the operation of medicines of this class; and be furnished with the knowledge where, how far, and in what mode, the ap­plication of these substances may be serviceable, or hurtful, in so far as they act as sedatives; but it must also be remembered, that some of them are stimulants.

Hence then, in all cases where there is too great a rapidity in the circulating fluids, or pain, or spasm from an inflammatory cause, they would be hurtful, otherwise they are in general ser­viceable. In cases also of infarction, or strong obstruction, which sometimes happens in the lungs, though attended with spasms, they must be cautiously used. But where neither of these ob­jections occur, they may be allowable, and attended with use in diminishing the force and celerity of the blood's motion, where morbidly augmented, or the impetus of the blood against parts similarly affected, in abating violent pain, and procuring sleep ill cases of preternatural watchfulness, in restraining inor­dinate motions, and moderating excessive evacuations.

But where the circulation is preternaturally languid, or there is a lethargic or drowsy disposition, or a high degree of torpor in the system, to them in these cases we should not have re­course.

According to the purposes they have been given to effect, they have received different appellations—if to alleviate pain, anodyne; if to abate it by their demulcent power, paregoric; if by bring­ing on stupor, narcotic; if by inducing sleep, hypnotic; howe­ver, their action is similar, and requires no such distinction. They are more properly divided into such as produce sleep, as opium, henbane, poppy; and such as alleviate from their cool­ing property, as neutral salts, acids.

Our catalogue of SEDATIVES, of which opium is the prin­cipal, consists of

• POPPY—Syrup of, 2 drams to 1 ounce or more.
• OPIUM—purified, from 1 to 2 grains.
• Tincture, as a sedative, from 5 to 10 drops—as procuring sleep, 10 to 25.
• Camphorated, from 5 to 60 drops.
• CICUTA—Hemlock,
• Inspissated juice, 2 grains and gradually increased.
• Powder,

1 grain to 5 and more.

• Powder,
• Extract,

See page 155.

• Smoke,
• Infusion,
• Glyster,
• Extract,

Of all these medicines, however, we think it necessary to give a more particular account—and, first,

The POPPY HEAD is in use for making a syrup, possessed of virtues to relieve pain, and procure sleep—for these purposes, it is chiefly given to children, in doses of from half a scruple to half a dram or more; and it will be efficacious sometimes, where opium and its preparations are apt to disagree with the consti­tution.

It is also used for making fomentations for alleviating pain, particularly after proper evacuations in inflammations of the eyes and breasts.

OPIUM is anodyne, from its relieving most painful affections—hypnotic, from procuring sleep—incrassant, from thickening the humours—diaphoretic, from increasing perspiration; and, joined with ipecacuanha, antimonials, camphor, volatile salts, and such like, the most powerfully so of any medicine with which we are acquainted—sedative, from allaying the too great irritability of the nervous system—and the most efficacious anti­spasmodic in the materia medica;—taken in too large quantity, it renders the nervous system so totally insensible, produces such general relaxations, that lethargy, convulsions, and death, are the consequences; but, in a variety of cases, given judiciously, it is one of our most noble remedies, particularly where ner­vous incitability, or thinness or acrimony of the humours are too prevalent in the constitution, admit too great degree of fe­ver, or heat, or fixed obstructions, do not contra-indicate its use.

Hence the benefit arising from its administration in hysteric and hypochondriac diseases; in convulsions from violent pain; in too great watchfulness, at the latter end of fevers, small-pox, and measles; in coughs, from acrid, stimulating defluxions; in looseness, and dysenteric complaints, called bloody fluxes, very often. It has been said to cure the venereal disease. That in ir­ritable habits it assists the operation of mercury, by preventing the too powerful exertions of mercurial stimulus, alleviating pain, and promoting insensible perspiration, will not be denied, [...] it [Page 154] being of itself curative, I cannot believe—though, after the hu­mours have been rendered too thin and acrimonious by the use of mercury, I will not dispute its power; for I have seen its good effects in totally removing what have been called rheu­matic pains from that source.

Asa-foetida joined with opium is said to weaken its narcotic effects, and prevent that stupor, heaviness, and vertiginous affec­tions, which opium is apt to occasion after its operation.

Besides, this medicine not only alleviates pain, and takes off spasmodic affections, when administered internally—but when applied externally, as in fomentations, cataplasms, lotions, lini­ments, or injections, it produces the same consequences.

HEMLOCK has been used much in scrophulous, schirrous, and cancerous cases;—in the last highly recommended by Dr. Storck, as a successful medicine, though not answering the expectations of the physicians of this country; notwithstanding which, I he­sitate not to declare, I have found it in some degree serviceable in schirrosity—in scrophulous tumours, joined with bark, it has been useful; as also in ulcers, and foulness of the bones from that cause; in some obstinate rheumatic cases it has been effica­cious, and I have evidently seen it produce good effects in the chin­cough. Joined with mercury, it has been useful in venereal complaints, and has been successfully given in some cutaneous disorders.

It is commonly given in doses from four or five grains to a scruple, and pushed on to one or two drams in twenty-four hours half an ounce has been given in that time; and, in one or two cases, Dr. MONRO says, he has known an ounce. However, Dr. CULLEN remarks, and that with great propriety, that if some sensible effect is not perceived, when the dose is about twenty grains, he should dispute the goodness of the medicine, and have recourse to different parcels of it.

HENBANE. This has been considered as a narcotic, not pro­ducing heat like opium; and, besides, it is, in large doses, laxa­tive—evident advantages over opium. In palpitations of the heart, it has been said to be useful—in cases of mania and con­vulsions, in doses of the extract from one grain to five. Though STORCK extols the remedy in spasmodic affections, and profuse bleedings; yet, from Dr. HOME's experience, it appears in these affections not to produce any good effects. It seldom produces sleep, or alleviates pain, except till the dose is arrived at eight or ten grains, nay, often it has been obliged to be increased to fifteen or twenty; though, in full doses, it is more apt to occa­sion delirium than opium. Sometimes it will agree where opi­um [Page 155] will not; and it is not, except in large doses, that its aperi­ent effects are very remarkable.

From a case related by Sauvages of its curing a cataract. I once, under those circumstances, tried it with evident utility; but during the trial, my patient left town, nor have I heard what was the ultimate result However, such were its effects under my inspection, that I should, in all cases of recent cataractous ap­pearances, recommend the trial.

TOBACCO, though in common use, and certainly considered as a luxury, from being chewed, taken in snuff, and smoked for pleasure, is a deleterious and noxious herb, possessed strongly of those powers producing stupor; hence considered as a narcotic. It is highly stimulant, a powerful emetic, purgative, and promot­er of the salivary discharge;—applied by way of poultice to the stomach, we are told it excites vomiting, and produces the same effects applied to wounds. In the iliac passion, incarcerated rup­tures, and obstinate costiveness, thrown up into the bowels, by way of smoke, or in strong infusion, it has proved efficacious—and also in cases of worms, particularly those very small white worms, called ascarides, which affect the lower part of the large bowel, called rectum, occasioning itching in the anus:—Indeed, it is said that no remedy is more powerful in opening the bowels, procuring stools, and in destroying and bringing away these worms than this—though it must be observed, that given in this me­thod, it will often produce great sickness and vomiting, especi­ally if pushed far into the intestinal canal.

In Sweden it is a domestic medicine, and often given to vomit and purge, in the beginning of putrid fevers. An extract made of it, which renders it more mild in its operation, has long been used in Germany as a pectoral in coughs—and, of late, in this country, recommended as a powerful diuretic, and of great use in dropsies;—but its inefficacy in small doses, and from its pro­ducing severe sickness and vomiting, in large ones, such as were sufficient to make its diuretic effect apparent—from the nause­ousness of its preparations, and the roughness of its action; it has not yet been brought into general use internally. External­ly applied, BERGIUS considers it as efficacious in discussing that tumefaction of the prepuce (55) called phymosis.

§ 4. ERRHINES. This class of medicines, so called from the Greek en in, and rin nasum, the nose, or STERNUTATO­RIES, from producing sneezing, are all such as stimulate the in­ternal membrane of the nose, occasioning a [...]low of mucus from thence, or causing that action from whence they derive their name.

They act altogether by their stimulus; and though they have [Page 156] been said to have effect upon the fluids, they do it in other way, than by increasing the action of the solids on their continued li­quids. Indeed all evacuants are general stimulants. Even these medicines carried into the stomach, or thrown upon other parts of the machine, would produce such effects as were consistent with their irritating power, and might vomit, produce gentle sweat, or urine, or become expectorant, according to their elec­tive properties.

The use of these medicines, though much insisted on by the ancients, have, by the moderns, fallen into neglect, though they may in some cases certainly be of no small service, either in un­loading the parts contiguous to the nose, or removing obstruc­tions by the shocks given to the system in sneezing.

Where the mucus secretion is defective in the nose, produc­ing a morbid diminution, by determining the fluids there, they might be of service; or by occasioning a derivation from parts morbidly affected in the neighbourhood of that organ—also by agitating the system in general, and by obviating nervous affec­tions of the convulsive or spasmodic kind—but where there is great fulness of the habit, morbid debility of the viscera, un­common sensibility of the nose, or ulcerations of that part, and those which are contiguous, the use ought certainly to be forbid.

From considering the operation of these medicines, and the effects likely to be produc [...]d by the application, we may learn how they become useful in rheumatic affections of the head; for temporary relief has not only been acquired by them, but the rheumatic disposition conquered—the tooth-ach also, and other rheumatic affections. In chronic and long-continued inflamma­tions of the eyes, in opacities, or cloudiness of that part of the eye called cornea, beginning cataracts, and in some cases of deaf­ness.

In some complaints of the head of the spasmodic kind, they promise much utility; but in all full habits, or in cases where the [...]e appear any preternatural load in the head, they are not on­ly doubtful, but may sometimes become dangerous.

And notwithstanding it has been asserted, that their use tends to remove lethargies, epilepsies, palsies, apoplexies, head-achs vertigos, catarrhs, gutta, serena, &c. and may, in some particu­lar species of these complaints, where the nervous system is pri­marily affected, be attended with no small advantage; still should there be fullness of habit in people thus afflicted, prudence should direct us to have that fullness taken off before the appli­cation of sternutatories. During their use, we should carefully avoid cold, for that has sometimes produced unpleasing effects; [Page 157] —they should also be administered at intervals of one or two days, and then the patient should be kept warm. From the ge­neral shock they give to the system, they have been said to be more beneficial than vomiting, and hence also greatly useful in removing the remotest obstruction.

ERRHINES consists of two classes—

• MECHANICAL, MEDICINAL.

The FIRST are, dust—feathers—animalcules vellicating the membrane of the nose, and blood accumulated, either from ob­struction or inflammation—whence it happens that in a begin­ning catarrh, the mucus of the nostrils usually flows pretty plen­tifully.

The SECOND—

• Hyssop
• Savoury
• Bete
• Betony
• Marjoram
• —
• Assarum
• Herb Mastich
• Tobacco Snuff
• White Hellebore
• Orrice-root
• Pellitory
• Pepper
• —
• Euphorbium
• Turpeth Mineral
• Corrosive Sublimate.

The first are esteemed the mildest, the seven succeeding more active, and the three last the most violent in their operations;—but corrosive sublimate is considered as invested with the most superior power; for patients who have applied it, have sneezed for some hours, although it has been used in very small quanti­ty.

There are different ingredients added together to form HERE SNUFF,

As the dried leaves of Asarabacca

• Sweet Marjoram
• Syrian Herb Mastich
• Dried Lavender Flowers—

equal parts of each—but three parts of assarum and one of mar­joram, beat into a fine powder, are superior to most of those sold under the name of HERB SNUFF—and indeed are the more agreeable and efficacious errhines. If taken to the quantity of five or six grains at bed time, they are said to operate the suc­ceeding day as a powerful sternutatory, inducing frequent sneez­ing, but still more a large discharge from the nose—and are of­ten employed with great advantage in cases of obstinate head-achs, and inflammations of the eyes, resisting other modes of cure.

[Page 158] Sometimes in obstinate deafness they have been given with success, with the addition of a small portion of turpeth mineral, and repeated at shorter or longer intervals, in proportion to the effect they produce of greater or less violence in their operati­on.

§ 5. SIALAGOGUES—derived from the Greek words, sialon, saliva, and ago duco, to draw forth, comprehend all such medicines as produce a slow of saliva into the mouth, from the glands named salivary, there situated.

They have been divided by some authors into three classes.

The FIRST—such as immediately act upon these glands, as fomentation, friction, and suction, either internal or external of these parts;—hence, moreover, cataplasms applied to those glands, called parotid, from their situation under the ear, and chewing tobacco moisten the mouth;—all pungent stimulants also.

The SECOND, are all such as occasion a flow of saliva into the mouth, by intercepting a flux of moisture into other parts; for it is observable, that if any of the viscera should be obstructed, as the liver, spleen, pancreas, at the same time the kidneys, or intestinal ducts, then is the mouth always moist—whence hypo­chondriac people are called SPUTATORES, from their spitting so much; and, therefore, whatever prevents a secretion of lymph in those places, should be esteemed sialagogue.

The THIRD CLASS takes in all those substances which are suppos­ed to break down the sanguinary mass, and by that means supply the mouth with too great a proportion of fluids, thus dissolved.

Of this tribe quicksilver is the principal, and may be applied in various modes.

From its external application a salivation may be raised, though in its crude state—but it may be applied in form of liniment or fumigation; for if twelve grains of quicksilver are placed upon a fire, or a heated iron, they will emit a smoke, which, received by the nostrils, in two or three days will occasion a spitting. It may be taken internally with the same intent, and succeed, if given in a small quantity; but if in too large, it is apt to pass off by the bowels; if handled much, and for a long continuance, similar effects will be produced, as we learn from gold-beaters, who make great use of quicksilver, falling into salivations.

Quicksilver formed into a salt by sublimation, if taken in small doses, if applied externally to wounds or ulcers, or if attracted by the nose, has similar consequences, from its reception into the habit.

It was the opinion of BOERHAAVE and others, that all these effects were produced by dissolving the fluids, either by its me­chanical action, or by its dissolving or putrescent power.

[Page 159] Had not these doctrines been previously refuted by such argu­ments as are uncontrovertible, from the considerations, that me­chanical force never divides mixts, but aggregates only; that, from the minuteness of the division of gold, even it may be made to become incapable of overcoming the cohesion of water or spi­rit of wine, and be suspended in them—and also that the small­ness of the quantity introduced would be inadequate to produce the effect. And, with regard to its dissolvent or putrescent power, that, during the operation of quicksilver on the habit, no symp­toms of putrescency appear in any part of the system—that there is no alteration of the blood in that respect during a salivation, but its texture appears as strong then as at any other time;—that salivation is attended with an inflammation, and the blood shews an inflammatory crust; and, finally, that after the opera­tion of the salivation is over, no taint appears in the blood, but, on the contrary, the person is in better health than before, and gives marks of a firmer state of it;—one single instance would be sufficient to overturn them, if we consider that a few grains of calomel has in many constitutions raised a salivation very sud­denly, which has continued for some days, nay weeks. Instanc­es of which have fallen within the course of my own observa­tion.

I cannot myself doubt of its producing its action in the saliva­ry glands by the means of its elective stimulus, though it is ca­pable of exerting its stimulus in other parts of the machine, as on the stomach, intestines, kidneys, and perspiratory vessels, pro­ducing, according to the parts affected, vomiting, purging, dis­charge of urine, and gentle perspiration.

Indeed, upon the whole, it should be considered as a stimulant in general, in particular, a salivary one, and an evacuant, more peculiarly of the serous or lymphatic fluid, or both; and one of the most universal aperients and deobstruents we have in the whole catalogue of the materia medica.

In its combined state, forming metallic salts, quicksilver sooner exerts its activity on the system, but less certain, I think, in its effects;—it appears more efficacious, having its parts only divided by some unctuous or oleagmous substances; and, per­haps, its virtue depends upon its being so entirely unconquerable by the assimilating powers of the constitution, and capable of such minute divisibility, for it will pass through any body except glass.

Quicksilver, though here ranked as an internal sialagogue, or a promoter of the excretion of saliva, because its elective power seems to be more determined to the salivary system, than any o­ther part of the machine, may fairly be considered as an univer­sal [Page 160] stimulant, deobstruent, purgative, and general evacuant, in­creasing the whole of the excretions of the human body.

It was thought that, from the great discharge it produced from the salival glands, and the foetor accompanying it, that it dissolv­ed the texture of the blood, and disposed it into putrid acrimo­ny; but experience proves the case to be far otherwise, as we have proved above.

The great effects produced by quicksilver seem to proceed from its increasing the whole of the animal excretions, and thus carrying off the virus of the pox, for the cure of which it is the most remarkable and certain;—and, indeed, it has been, and still continues to be, by many, considered for this disease a SPECIFIC;—but as it will not, by itself, in all cases, cure that complaint, nor prevent the venereal poison from taking effect, even in con­stitutions loaded with it, that idea must fall to the ground.

Though quicksilver, in its original state, is inactive respecting the human machine, and only has been given in this state to con­quer obstinate obstructions of the intestines, though inefficacious­ly, still from mechanical division, as united with viscid, oleagi­nous, or unctuous substances, rubbed down with dry powder calcined, or united with different acids, forming mercurial salts, it has been rendered extremely active; and though preparations of this abound, the chief use are confined to a few.

• GUMMOUS mercurial pill, from 20 to 30 grains.
• MERCURIAL pill, from 8 to 12 grains.
• QUICKSILVER acetated, from 1 to 6 grains.
• Calcined, from ¼ of a grain to 2 grains.
• Muriated, or corro­sive sublimate from 1-8 of a grain to 1 grain.
• Mild muriated CALOMEL prepared, 1-2 a grain to 2 grains or more.
• QUICKSILVER with chalk from 5 to 20 grains.
• White calx of quicksilver, or white precipitate, too acrid for internal use.
• Sulphurated quicksilver, or aethiops mineral, from 10 grains to 40.
• Red sulphurated quicksilver, or factitious cinnabar, used chiefly in fu migation.
• Red nitrated quicksilver, or red precipitate, used as a destroyer of fungous flesh, or for dressing venereal ulcers.
• Vitriolated quicksilver, or turpeth mineral, from 1 grain to 4.
• Quicksilver ointment, from external use—from 1-2 [...] dram [...] 2 drams.

[Page 161] Now several of these preparations are appropriated to differ­ent purposes. The MILDER SORT, as alterants—

• Gummous pill
• Mercurial pill
• Acetated quicksilver
• Quicksilver with chalk;

or the more active preparations in very minute doses, which in this view are considered as the most efficacious.

As a purgative, calomel claims the preference, joined with rhu­barb or some other of that class—in doses of from 3 to 8 or ten grains; and in smaller doses as deobstruent and alterant.

In venereal cases, the gum and mercurial pill—calomel—cor­rosive sublimate dissolved in brandy—calcined mercury joined with opium—are chiefly had recourse to.

Against the itch, the white precipitate, made into an oint­ment.

The quicksilver ointment is also used for raising a sallivation where thought necessary, or loading the constitution sufficiently without producing that effect, for the cure of venereal com­plaints.

Indeed calomel, and some other of the active preparations, have proved efficacious in the early stages of inflammatory com­plaints of the breast, brain, pleura, &c. when g [...]n freely, in repeated doses, sometimes with, sometimes without opi [...] which has been, in these cases, rendered more effectual by joining small doses of the antimonial powder along with it. In spasmodic complaints, united with camphor and opium, they have been said to be effectual—as also in dropsical cases, given in conjunc­tion with diuretics and aromatics, particularly the squill pill. But these we shall particularize more minutely when we come to treat of diseases to which they are appropriated.

Now, from keeping in view the peculiar virtues of this medi­cine, the reason will readily occur why in a variety of complaints it is so beneficial—as in the venereal disease—glandular obstruc­tions—cutaneous complaints—obstructed menses—dropsy—worms—some inflammations of the lungs and other parts, properly ap­plied, and judiciously united with other well-adapted reme­dies.

Thus much have I thought requisite to say relative to this so extensively useful a remedy; though in this place we should con­sider it merely as a promoter of the salivary discharge, in order that we may be better prepared for discovering its utility in a variety of different cases, on which we shall in future treat. Here it stands as a sialagogue, and the only internal one of which we make use—the others in this catalogue are stiled topical, from [Page 162] their promoting the [...]low of saliva from external application—the principal of which are

• Squills
• Tobacco
• Angelica
• Cloves
• Master-wart
• Pellitory.

From what has been said, we shall readily discover their utili­ty to consist in diminishing the force of the blood against parts morbidly affected in the neighbourhood of the salivary glands; and also the action of the vessels when morbidly increased in the neighbouring parts, as in some cases of tooth-ach and rheuma­tic affections; and in promoting the circulation of the blood freely through the salivary glands when morbidly obstructed there:—Besides, as they so freely promote evacuation, they will be beneficial in evacuating morbid accumulations of serum; in producing a thorough change in the fluids of the body when mor­bidly vitiated.

But when there appears to be an uncommon determination to the salivary glands—any praeternatural sensibility in the glands—when the serous part in the circulatory fluids is defective—or there is a high degree of inanition, or general debility of the sys­tem, we must avoid using them.

§ 6. EXPECTORANTS, so named from the Latin word expectora, to throw out of the breast, or expectorate; and are all such substances as expel morbid matter through the windpipe adhering in its branches; called bronchia (28, 29,) of the lungs.

To promote which purpose, several particulars are necessary to be observed. It is required, FIRST, that the matter contained within them should be rendered moveable, and capable of being expectorated, taking care that the most fluid part should not be dissipated, lest the remainder should be lest too viscid, and not easily pumped up from the lungs;—hence medicines to heating and stimulating are hurtful;—SECOND, that the passages of the lungs should be open, cleansed, and lubricated;—THIRD, that the excretion of the offending matter should be promoted, which is best performed by coughing, to which end proper stimulus, and proportionate strength are required;—FOURTHLY, that the obstructed vessels should have rest, by which means they may be relaxed—for should they be continually irritated, the humour from the glands of the windpipe would be ejected with a sort of pain.

To accomplish the FIRST intent, all aromatic bitters, and, at the same time, mild oleaginous substances are necessary, such as hore-hound, hyssop, elecampane, pennyroyal, valerian, &c. and sulphureous medicines mixed with alkalies—all fixed saponace­ous [...] or mixed with milk;—all [Page 163] volatile oily soaps, and volatile fixed salts, and, in general, all diluents and stimulants mixed together.

For the SECOND purpose, we must apply to aperients and de­tergents, as oil of poppi [...]s, almonds, olive [...], honey particularly, as it is aperient, inciding, attenuant, detergent, and lubricating—here also belong emulsions, soaps, yolks of eggs, with oily substances, saccharine substances, at least in small doses; like­wise balsams, as that of turpentine, Pern, Gilead, Copaiva, &c. which act both as stimulant and lubricating—to these we may add all relaxing and emollient decoctions.

For the THIRD are useful all those which excite a cough, as wine, vinegar, acrid spirits, sternutatories, squills, gum ammo­niac, &c.

And, for the LAST, demulcents, anodynes, and narcotics, are proper, of which the principal is opium; for when the windpipe is once excoriated, it is easily thrown into violent spasms, and cough, which cannot be restrained by that powerful sedative.

However, we may in general observe, where there is no in­flammatory tendency, and the moving powers are torpid, some of the stronger stimulants are extremely useful, and are the things which chiefly contribute to promote expectoration; but they should be very cautiously used in diseases of the breast, and particular care taken, that the habit be free from any inflamma­tory disposition, or, at least that no inflammation is fixed there—for where these take place, relaxing the vessels, and taking off the spasms is all that is wanted, for in such constitutions the mucus itself supplies sufficient irritation, either from its acrimony or weight, or distension of the cells of the lungs.

From what has been said, the utility of expectorants appears—when the secretion of mucus in the lungs is obviously dimi­nished, by promoting that secretion, and rendering the mucus thinner, when too thick or viscid—where the excretion is insuf­ficient, by evacuating morbid accumulations of mucus in the lungs, and supplying irritation to that organ when defective.

When the lungs labour under a state of morbid insensibility, by removing that, and promoting a free circulation through them, when it is there morbidly impeded.

But when there is a high degree of increased sensibility in the lungs, and an uncommon quick excretion of mucus from them, the stimulant expectorants ought to be prohibited; and when there is too great a state of torpor, of the relaxing ones we should by no means make use.

Our general catalogue of EXPECTORANTS, of which we shall furnish, for the reasons above advanced, a proper division, con­sists of

• [Page 164] Hyssop, Hore-hound, Ground-ivy, Penny­royal, Colt's foot, chiefly used in infusion or decoction, and sweetened with honey
• Garlic
• Mustard
• Horse-radish
• Onions
• Leeks
• Balsam of Copiava
• Gum Guaiacum Squills
• Myrrh
• Asafoetida
• Gum Ammoniac
• Opium
• Tobacco smoke
• Acid vapours
• Blisters
• Warm baths to the feet
• Watery vapours received into the lungs.

Now, as we find expectoration is to be promoted by different means, agreeable to the cause acting in the lungs; and as our selection here has such different properties, all of which are cal­culated to promote the desired end by judicious application, a division of them, agreeable to their powers, becomes necessary. FIRST, into such as act by stimulating the lungs taken inter­nally.

The infusions of Hyssop,

• Ground-ivy,
• Hore-hound,
• Coltsfoot,
• Pennyroyal, made into tea, and sweetened with honey.
• GARLIC, a clove of it taken now and then in substance, formed in­to pills, or made into syrup.

eat plentifully with other vi­ands.

• Mustard,
• Horse-radish,
• Onions,
• Leeks,

• BALSAM Copiava, Dose, 20 to 40 drops on sugar.
• GUM Guaiacum—
• Powder, from 6 to 20 grains.
• Tincture, 1-2 a dram to 1 dram.
• —MYRRH—Powder, 10 grains to 60.

SECOND, such as act from taking off spasmodic affections—

See catalogue of Antispas­modics.

• ASA foetida
• GUM Ammoniac,

• OPIUM See Sedative.
• BLISTERS,
• WARM baths to the feet,
• WATERY vapour inhaled into the lungs.

[Page 165] THIRD, such as irritate—TOBACCO smoke, ACID VAPOURS.

FOURTH, such as lubricate and relax. See the catalogue of Demulcents, all which belong to this place.

§ 7. EMETICS. This is a Greek word, from emeo, vomo, to vomit; by the Latins they are called vomitoria, and are all such substances which, by their action, cause the stomach to re­ject its contents upwards.

The effects produced by this action have been divided into eight heads; in considering which we shall be enabled to per­ceive the utility to be derived from the application of these re­medies; on which, as we go along, we shall furnish some remarks necessary for the more clear elucidation of different parts of the subject;

FIRST. "Vomiting evacuates the contents of the stomach itself; though it is not easy to know when that is fully perform­ed. Many have got into a method of promoting few repetitions in vomiting, and giving small ablutions; but it has by others been thought that frequent ablutions are required to clear the folds of various matters, or mucus, which may be detained with­in them."

If we wish to evacuate the contents of the stomach complete­ly, frequent and copious ablutions are certainly right; but it is sometimes necessary to give gentle shocks only to promote some particular purposes, and these must be often repeated, so that it would be hurtful to push vomiting to its extent, as, from violent straining of that organ, it would become too relaxed, and our in­tent frustrated; for it is from the repetition of the operation gent­ly, not from unloading the stomach, success is expected.

SECONDLY. "Vomiting causes a flow of liquids to the sto­mach, clears it, and emulges its mucus glands." And,

THIRDLY. "It not only emulges the mucus follicles of the stomach, and promotes a flow of gastric liquor, but has the same effect on the neighbouring glands, especially the sweetbread and the liver."

FOURTHLY. "Whilst the vomiting continues, it not only in­verts the regular motion of the stomach, called peristaltic but also of the intestines, which pour out their mucus to be carried to the stomach, and evacuated with its contents.

"Hence do we find vomits useful in loosenesses and dysente­ries; but, independent of that, they are beneficial, more proba­bly, as purging the intestines, occasioning a greater flow of liquors into the intestinal canal. If the vomiting ceases, the increased secretion is carried off by stool, so that at any rate the adherent [Page 166] foulness is washed away, by squeezing the tract of the intestines."

FIFTHLY. "Vomiting squeezes, and occasions a constriction of the whole abdominal viscera, especially the mesenteric glands, (46) and in consequence pumps the whole Lymphatic system;—on this account increases absorption, as well as from its evacuat­ing property; hence for these purposes emetics answer equally well with purgatives, and may be useful in dropsical cases."

But here we should be careful no strong visceral obstructions hath taken place, or any great acrimony in the humours, and ten­derness of the vascular system, for in these cases they may be productive of the most fatal effects.

SIXTHLY. Dr. Cullen thinks, "vomiting has the power of affecting the kidneys, for as irritation of the kidney will produce vomiting, so, on the other hand, it is reasonable to think, that vomiting may also act upon the kidney—hence it would seem useful in propelling stones in the kidneys."

Notwithstanding some have recourse to such a practice, and it appears imitative of nature, still I should conceive it almost always a dangerous experiment, always doubtful, and often not necessary; for if the stone should be so impacted with the kidney that it cannot pass, irritation on the part would be strongly increased, of course pain and inflammation in similar proportion, most like­ly abscess, and their consequences. Besides, we can never be certain whether the stone is of such a size as to pass through the ureters (50) by any propulsive force; and if it should, by relax­ing the ureters as much as we can, by proper remedies, we are more likely to produce the effect, and certain to avoid all danger from too rash a practice;—however, if the attempt at propulsion was to be made, every means should be previously used to render the passages as distensible as possible before the trial;—but of this we shall have occasion to treat more fully in future.

SEVENTHLY. "But the effects are extended, perhaps, to the viscera of the chest, as expectoration has been promoted by vo­miting."

EIGHTHLY. "It also increases the constriction of the fauces, and forcibly emulges the whole of the salivary glands. It has had the effect of those medicines called masticatories, which, by chewing and increasing a discharge of saliva, relieve rheumatic affections of the head, tooth-ach, &c.

"By preventing inspiration, vomiting occasions a regurgita­tion of the blood at the end of expiration. The accumulating blood, which usually happens, produced by vomiting, is only mo­mentary, and may be soon counterpoised, as will be seen by con­sidering its advantageous effects on the system in general.

"During the time of vomiting, the pulse is small, weak, and [Page 167] intermitting; but when it is over, if the stimulus continues, the circulation is increased, a fullness and softness of the pulse, a de­termination of the fluids to the surface of the body, and sweat;—this last may be supposed to proceed from an increased circu­lation, but Dr. Cullen thinks it may also from the consent of the stomach and surface, and that antispasmodic virtue takes place with regard to the extreme vessels, which is illustrated from this; that emetics combined with other antispasmodics, (148) as opium, increase the power, so that combined they become more efficacious diaphoretics," or promoters of insensible perspiration or sweat, "than each when alone."

These are their primary effects, which, if we consider closely, will be productive of a variety of others, infinitely a greater num­ber, than by any class of medicines with which we are acquaint­ed; and indeed from them I have seen the most serviceable con­sequences accrue. Not but I think their use, in many cases, should be considered with the nicest caution; for advantageous as they are, when properly applied—in the hands of ignorance, or inconsiderate rashness, they become too often fatal.

If we consider the general shock which emetics give to the sy­stem, the evacuations they produce from the stomach, and the effects they have upon the nervous power, we shall be convinc­ed of their utility; by restoring equality to the circulation, pro­ducing lymphatic absorption, and removing obstructions in the system of blood vessels—and in these senses they may be consider­ed as irritators of the habit;—as evacuants, from clearing the sto­mach of its contents, and morbid accumulations of secreted matters lodged there, and discharging also serous accumulations in different parts of the machine:—as antispasmodics, from sti­mulating the nervous system, and the moving powers through the machine in general, and also obviating violent affections of the nervous power.

But in all cases of ruptures, or relaxations of containing mem­branes—in local inflammations of the internal viscera—a high degree of morbid debility in these—and in fixed obstructions, unconquerable by the force of the circulation, it has been advis­ed that their use should be avoided.

Still, notwithstanding all these prohibitions, so apparently well founded, from the consideration of the action of emetics, yet they have been administered in cases of schirrhous viscera, in lo­cal inflammations, and supernatural effusions of blood; though in the two latter they should never be attempted without first bleeding; though perhaps haemorrhages may now and then re­quire this operation; but of these there are very rare instances, [Page 168] as they are almost constantly attended by an inflammatory dispo­sition of the constitution.

In all congestions of the head, they are said to be dangerous, in apoplexy, palsy, and in smaller collections in the veins of the brain. They would, doubtless, be extremely dangerous where these maladies arise from too great sanguinary plenitude; but where from mere weakness of the nervous system, or inability of the moving powers, I should prefer their use to other reme­dies, at least on their first appearance; nor should I hesitate in prescribing them in serous collections, where I was not afraid of any great relaxation of the vessels, or system of the solids.

The class of EMETICS in use are not numerous—indeed, three or four, where we consider their action only in this point of view, are sufficient, arranging them according to their mode of opera­tion, or peculiar appropriation.

If expeditious vomiting is required, without much regard to more extended action,

• White vitriol, Dose, from 10 to 20 grains.
• Blue vitriol, 2 to 6 grains.
• Infusion of tobacco, 1 ounce to a point of boiling water—1 ounce or more to a dose, will be suffici­ent.

If something more is wanted, particularly a determination of the fluids to the skin,

• Tartarized antimony, Dose 1 grain to 5.
• Antimonial wine, 3 drams to 6.
• Wine of tartarized antimony 1 dram to 2.
• Ipecacuanha—Powder, 5 to 20 grains.
• Tincture, 2 to 12 drams:
• And in venereal cases, Vitriolated quick silver, or turpeth mineral Dose 1 to 4 grains.

In large doses, some of the vegetable bitters and cathartics come under this class, as do also squills, asarabacca, fox-glove, mustrad, and horse-radish. Strong infusions of the two last are given with success in torpid, cold, phlegmatic habits.

Systematic writers hence, from their peculiar power, have divided them into

• Tartarized antimony,
• Vitriolated zinc, or white vitriol,
• Quicksilver, or turpeth mineral.

• [Page 169]Ipecacuanha,—Asarabacca,—Squills.
• HEATING—as
• Mustard,—Horse-radish.
• NARCOTIC—as
• Tobacco,—Fox-glove.

§ 8. The next set of medicines in our catalogue are CATHAR­TICS, so named from the Greek word cathairo, purgo, to purge, and comprize all such medicines as evacuate by stool.

Purging, says BOERHAAVE, is an evacuation of all those things which can be thrown out of the body by stool from any part of the machine. And most authors have been very prolix on this subject, as the operation seems to be, and really is, of such ma­terial consequence to the constitution.

However, we shall content ourselves with a more concise view of their effects, and from thence be sufficiently empowered to deduce their utility.

By their operation they unload the intestines, and increase the motion of the bowels downwards; by which means they clear the intestinal glands, and derive a greater quantity of li­quids, into them; they also empty the stomach downwards; they evacuate the pancreas and liver, and affect the spleen, and all the viscera of the lower belly; they promote the absorption of watery and other thin fluids, stagnating in any cavity; and, by continuance, purge the whole body; but in this last case in­duce debility, if too long persevered in; hence are preferable to other evacuants.

They are apt to produce inflammation in the parts on which they immediately act. They cause revulsion from the head, by determining the blood into the large artery of the body, called the descending aorta, (29; 30) and hence may be useful as pro­moters of the menstrual discharge, washing of virulence in go­norrhoea, in ulcers, by evacuating the system in general; and in those of the inferior parts, by causing a greater flow of liquids to the part. They excite, or, at least, increase inflammation in the intestines, nay some propagate the same over the system; and, when thrown into the blood, are most of them expectorant and diuretic, causing evacuation of phlegm from the chest; and urine through the kidneys.

Now these purgative effects are produced chiefly by such things as irritate the fibres and muscular parts of the intestines; but passions of the mind will also promote intestinal discharge; and some will have that occasioned from smell alone, others from ex­ternal application, some from the diminution of insensible perspira­tion, but this happens in a moist thick atmosphere, and others [Page 170] from eternal motion, as that of a ship or carriage;—upon the whole, it is tolerably conclusive, that purging arises from intes­tinal stimulus, either mental or corporeal.

But, notwithstanding the use of purgatives are so very saluta­ry in their different degrees, according to the causes requiring them, yet, by being too frequently renewed, they are apt to wea­ken the tone of the intestines, and indeed their sensibility. Hence are produced, if we add the consequences of evacuation, often irregular spasmodic affections.

Dr. CULLEN says, that all purgatives are endowed with an inflammatory acrimony, not only exciting it in the part to which they are applied, but acting in the same manner, as poisons; their stimulus, extended to the system, produces and aggravates fever, and an inflammatory disposition; and as it is chiefly di­rected to the rectum, they increase the piles, and extend their irritation to the passage from the neck of the bladder, called ure­thra.

We are led to discover, from the concise view we have ta­ken of the subject, from whence their utility arises;—FIRST, as evacuants from removing any morbid retention of the contents of the stomach and intestines—diminishing the quantity of cir­culating fluids, when too abundant for the state of the system at that time—and carrying off morbid accumulations of serum. SECONDLY, as stimulants, by promoting the free circulation through the intestines in those cases where it is morbidly imped­ed—diminishing the force of the blood against parts morbidly affected—removing torpor in the muscular fibres of the intestines—and restraining inordinate motion in these muscular fibres, by stimulating them to regular and more constant action.

But we find that some of these have, besides the powers enumerated, those which are cooling, astringent, and emollient.

Hence, should there be in the bowels any high degree of irri­tability, and the circulation should there be morbidly accelerat­ed, of the stimulating class we should make no use—if the circu­lation should be uncommonly [...]low and languid, those which are stiled cooling will be improper—if habitual costiveness be an er­ror of the habit, the astringents must be wrong—and where un­common relaxation of the intestines is prevalent, the emollient ought not to be applied.

The whole catalogue of PURGATIVES are EVACUANTS, and in this view differ only in degrees of power. The MILDEST of which are all acescent fruits.

Of the SECOND ORDER are

Tamarinds, Cassia, Sugar, Honey, Manna, Water drank [Page 171] copiously, Milk whey, Butter-milk, Spinage, Bete, Cabbage, Succory, Dandelion, Endive, Lettuce, Celery, Asparagus, Artichoke, Mushroom.

Of the THIRD

All mild animal and vegetable oils, Venice Soap, Mustard, Sulphur, Animal Bile, Gum Guaiacum, Tartar, fixed alkaline Salts, neutral Salts, Magnesia, if it meets with an acid, not o­therwise.

Of the FOURTH—or more acrid,

Aloes, Rhubarb, Senna, Jalap, Scammony, Buckthorn Ber­ries, Gamboge, Hedge Hyssop, Bitter Apple, Wild Cucum­ber.

Of the FIFTH—or most acrid,

Solutions of Gold or Silver in particular acids; but these, from the violence of their effects, are out of use.

Emetics also got into the bowels prove purgative.

But as we find great use may be derived from a judicious se­lection under particular circumstances, we shall pursue the sub­sequent divisions.

• • Acescent Fruits
  • Sugar
  • Honey
  • Water drank copiously
  • Milk Whey
  • Butter-milk.
  • Spinage
  • Bete
  • Cabbag [...]
  • Succory
  • Endive
  • Lettuce
  • Asparagus
  • Salary
  • Artichoke
  • Mushrooms.
  • These may be considered as food proper to assist in promoting the desired purpose.
  • TAMARINDS—taken in p [...]i [...]an or decoction.
  • CASSIA—Electuary, dose, 1 to 6 drams.
  • TARTAR—purified, Crystal of Tartar, to 3 drams or more.
  • MAGNESIA, 10 to 30 grains.

• • ACETATED Kali, of diuretic salt, from 1 to 2 drams.
  • TARTARIZED Kali, or soluble Tartar, 2 to 6 drams.
  • VITRIOLATED Kali, or [...] Salt, 1 to 3 drams.
  • [Page 172] TARTARIZED Natron, or Ro­chelle Salt, 6 drams to 1 ounce.
  • VITRIOLATED Natron, or Glau­ber's Salts, 6 drams to 1 ounce.
  • EPSOM Salt, from 4 drams to 1 ounce.
  • SULPHUR—
  • The Flowers washed, from 1 scruple to a dram.
  • Precipitated, or Milk of Sulphur, 1 1-2 scruple to 1 1-2 dram.

• All bland animal and vegetable Oils, the most powerful of which are CASTOR Oil, Dose, from 1 dram to 1 ounce, and, except this, few are given alone with this intent, but only to assist in the operation of other purgatives, where lubricating or relaxing materials are requisite.
• MANNA, from 1-2 an ounce to 2 ounces.

• Though almost all the smart purgatives leave the body cost­ive after their operation is over, the aloetic medicines excepted, still the restringent power, when wished to succeed, is chiefly confined to RHUBARB—Powder,
• Russia, 1 scruple to 1 dram.
• East India, 10 to 30 grains.
• Vinous Tincture, 1-2 an ounce to 1 1-2 ounce.
• Spirituous Tincture, 1-2 an ounce to 1 1-2 ounce.
• ROSES—Syrup of 2 drams to 3 or 4 for children; to adults it is seldom given with this intent.

• MUSTARD— Infused in wine, a table spoonful gently aperient.
• ANIMAL Bile, 1-2 a dram to a dram.
• GUM Guaiacum—Powder, from 10 to 20 grains.
• HEDGE Hyssop—Powder—Extract, 5 grains to 10.
• BITTER APPLE—Compound Extract, 10 to 25 grains.
• WILD Cucumbers—Inspissated Juice, 1-2 a grain to 3.
• [Page 173] ALOES—from 5 to 15 grains.
  • Wine of Aloes, 6 drams to 2 ounces.
  • Tincture of Aloes, 6 drams to 2 ounces.
  • Aloetic pill with Myrrh, 10 to 30 grains.
• SENNA— Powder, Extract, from 1 dram to 2 scruples.
• SENNA—
  • Tincture, from 2 drams to 1 ounce.
  • Compound Powder, from 1 to 2 scruples.
• JALAP—
  • Powder, 10 grains to 20.
  • Extract, 10 grains to 20.
  • Tincture, 2 to 3 drams.
  • Rezin, 5 grains to 10.
• SCAMMONY—
  • Compound Powder, from 10 to 15 grains.
  • Powder with Aloes, 5 to 10 grains.
  • with Calomel, from 8 to 20 grains.
• BUCKTHORN Berries—Syrup, from ½ an ounc to 1 ounce.
• GAMBOGE, from 2 to 10 grains—better mixed with calomel.

Before we close the account of Cathartics, it may be of some use to observe; that, as in all constitutions, and all diseases where too great an intestinal discharge does not constitute the com­plaint; and a moderate evacuation from the bowels is absolute­ly requisite; or in some a more copious one, it is necessary that we should be acquainted with the particular nature of the pur­gative employed: that whilst we are attempting to be of service, by promoting the intestinal discharge, we may know what fluid each medicine will evacuate the most powerfully, and not in o­ther respects be detrimental to the constitution by an improper choice—as in cases of inflammatory complaints, it would be very injudicious to order purgatives highly stimulant; so in those of bilious obstructions of the liver from thick viscid inert bile, to have recourse to the serous and lymphatic purgatives would be injurious; as by these, though the intention respecting the operation might be right, we should rather increase the original cause of the malady, by an improper [...]lection of the medicines of which we made use. However, here we only mention the necessity of such a specification, which we shall point out, on treating of particular defects of constitution, which require the necessary discrimination.

§ 9. DIURETICS, taken from the Greek word diour [...]o, per­in [...]o, to make water, are all such substances us cause urine to be [Page 174] secreted by the kidneys, and excreted by the bladder, which last in the repository for that fluid.

Notwithstanding the great labour different authors have be­stowed in properly selecting this class of medicines, and the con­fidence with which many have spoken respecting their operati­ons, still their effects are indisputably uncertain.

How some things pass off by urine so immediately after be­ing taken into the stomach, is still a matter of dispute.

Some astringents have been considered of the diuretic class, from their action; and doubtless have produced this way very good effects, as the leaves of the bear's wortle berry, and bitters; nay some have publicly declared the power of astringents in expelling a calculus. As diuretics act not by dissolving the blood, but by their local or sympathetic stimulus under some circumstances, I see no reason why astringents may not become diuretics in relaxed and torpid habits—many of the operations of the animal oeconomy may be produced by relieving the parts from any defect they may labour under, which defect may re­tard, or prohibit their action.

Palsy of the kidneys will hinder a secretion of urine; torpid­ity in those parts of the system, or relaxation, will proporti­onally weaken their power, which being removed, they will be enabled to act; and certainly astringents bid fair to produce the desired effect. However, in order to be acquainted with their utility, we must now inquire what are the general effects pro­duced on the system by their application;—where there is a superabundant quantity of serous fluids in the blood, and the ab­sorbents appear to be in too inactive a state, they become bene­ficial, by removing the former, and increasing the absorbent pow­er of the lymphatic system—hence drawing off water accumu­lated and stagnating in any of the cavities of the body. In scor­butic habits, they remove morbid acrimony from the blood, by carrying off the saline and putrescent particles of the mass of blood, which are generally dissolved in the serous part of that fluid—and when there is a superabundance of circulating liquids too great for the state of the system, by diminishing them they become serviceable—hence we find, their chief action is to pro­mote evacuation.

When the natural secretion of urine is morbidly defective, they restore that secretion, by soliciting a flow of fluids to the kidneys, and hence diminish other secretions when morbidly augmented: and hence remove obstructions in the canals of the urinary passages, and from them wash out all acrimony.

But, in order to promote their operation, they should be given [Page 175] in the most dilute state; we might say, it is always proper to throw in with them much aqueous fluid, except in cases of drop­sy; and, even in this case, there have been cures performed by drinking large quantities of mineral and common water. But where the intention of any medicine is to pass off by urine, the patient should walk gently in a cool air, and avoid all situations calculated to produce a determination of fluids to the skin; for there is so intimate a connection between the kidneys and the skin, that diuretic medicines, when thrown into the habit, will often prove strong promoters of insensible perspiration.

According to the particular nature of the separate action of diuretics, we shall be enabled to judge where they are impro­per.

Should there be too high a degree of sensibility in the kidneys, a considerable increase of urine, or any fixed obstructions in the urinary passages, the administration of those which are stimulant must be disadvantageous.

If there should be a deficiency of serous fluids in the system, the above also are improper, and those of the cooling class—but where there is a redundancy of [...]erosity, the prohibition of dilu­ent diuretics are fairly pointed out.

Though we know not of any of this class that will always in­fallibly exert its diuretic power, still the catalogue given us by a variety of authors is extensively prolix;—we shall select such as are considered the most efficacious according to the particular states of the constitutions which may require them;—and these we shall comprise under three heads—of stimulant, cooling—and diluent.

Of the FIRST CLASS, or STIMULANTS, are

• Nasturtium
• Horse-radish
• Asparagus
• Turnip
• Radish
• Onion
• Celery
• Parsley-seed.
• All these may be taken as food, in decoction or infusion.

• Fennel-seed
• Leek

See Expectorants.

• Garlic,
• Balsam of Copaiva,

See Stimulants.

• Hedge Hyssop,
• Wake Robin,

• JUNIPER BERRIES, 1 or 2 ounces in a pint of water, boiled or infused.
• Spirits of, from 1-2 an ounce to 1 ounce.
• [Page 176] Oil, from 2 to 10 drops.
• QUASSIA WOOD—
• Powder, 10 to 20 grains.
• Infusion; 1 or 2 drams to a pint of water 2 ounces the dose.
• BROOM—Infusion, Decoction; 1-2 an ounce to a pint of water—dose 1 ounce.
• Extract, 1-2 a dram to a dram.
• GRASS and ROOTS—4 ounces to a quart boiled to a pint.
• WILD VINE—Powder, 15 to 30 grains.
• Decoction; 4 drams to 1 pint boiled down from 1 1-2 pint—dose, [...] ounces.
• TOBACCO—See Sedatives.
• SQUILLS—Powder, from 1 to 6 grains.
• Fresh Root, 5 to 20 grains.
• Pill, 8 grains to 15.
• MEADOW SAFIRON—
• Oxymel, from 1-2 a dram to a dram.
• Fox-GLOVE—Powder, 1-2 a grain to 2 grains.
• Infusion, 1 dram to 1-2 a pint of boiling water—1-2 an ounce to an ounce the dose.

Stimulant and diluent.

• BATH WATERS,
• HARROWGATE WATERS,

• NITRE—from 5 to 30 grains.
• AEthereal, or sweet spirit of, from 10 to 30 drops.
• AMBER—Salt, from 5 to 15 grains.
• DIURETIC SALT—6 or 8 to 30 grains.
• FIXED SAL AMMONIAC—15 to 30 grains.
• CREAM OF TARTAR—1-2 a dram to a dram.

1 dram to 1-2 a ounce.

• ADIDS—Fermented,
• Native,

• MINERAL ACIDS—3 drops to 6.

The following, of this class, we consider at acting on the prin­ciple of neutral salts, from the union with the acids they meet with in the stomach and intestines:

• [Page 177] TESTACEOUS ANIMALS—

These are taken by way of food.

• Crabs,
• Lobsters,
• Cockles,
• Mussels,
• Orsters,
• Scollop,
• Periwinkle,

• SOAP—1 scruple to 1-2 ounce.
• KALL or vegetable Alkali, from 5 to 30 grains.
• ABSORBENT EARTHS—

from 10 to 30 grains.

• Crabs Claws,
• Eyes,
• Hartshorn prepared,
• Chalk,

• LIME WATER—2 to 4 ounces.

The diluent are—which also may be esteemed cooling—all the sweet acescent fruits:

• Dandelion
• Endive
• Lettuce
• Corn Sallad
• Artichoke
• Potatoes
• Boiled Onion
• Water
• Milk Whey.

WATER,

• MALVERN
• CHELTENHAM

• ACIDULATED WATERS,

§ 10. DIAPHORETICS, derived from the Greek diaphoreo, transfero, to carry through, include all such substances as increase perspiration, or sweat. This class used to be divided from su­dorisics, or such medicines as promoted sensible perspiration, but unnecessarily; for they seem only to differ in their degrees of ac­tion, promoting the same effect, more or less copiously or per­ceptibly. But as different purposes may be answered by the dif­ferent degrees of action of those parts which produce these effects, it may be necessary to make some specification respecting the two.

Insensible perspiration is promoted by all such materials as produce an astringent effect upon, or contract the solids in a mo­derate degree, by occasioning an increase of elasticity or springi­ness of the vessels, and thus promote the circulation—hence [...] bark—all the astringent roots—austere wines—come un­der this division, as do exercise which is moderate, either walk­ing, riding on horseback, or in a carriage—mild stimulants, or those of the stronger class weakened.

[Page 178] Or, by such things as determine the matter of perspiration to the skin, such as moderately warm air, temperate exercise, an e­qual circulation of the fluids when the body is at rest, as well as in motion.

Or, occasion such a temperature of the skin, that it shall nei­ther be too relaxed nor more rigid than requisite—hence fric­tions, lotions, and detersion are recommended; and it is from producing this effect that these things are found so beneficial to the studious, inactive, and those who are advanced in life—un­loading the system by those means, without weakening it in the smallest degree, but, on the contrary, increasing its power.

Now SWEATING is promoted by nearly the same means, for all such things as relax the vessels, and determine powerfully to the skin, will produce this effect, whether internally or external­ly applied.

Hence come under this class all those diuretics which act not upon the kidneys electively—warm water, or barley-water sweet­ened with honey, excite a copious sweat—a glass of cold water drank going to bed—also those things which take off spasm, whe­ther they are demulcent, or moderate or correct acrimony, as o­pium—testaceous powders. All strong frictions, warm vapor, particularly of water, warm bathing, or whatever will render the skin relaxed or soft.

Nitre, and its preparations, and all those substances which dispose the vessels to act upon their contained fluids—thus vine­gar sweetened with honey, and diluted with water, is the best sudorific in acute cases, and was a favourite remedy prescribed by HIPPOCRATES, in the following form, called HYDROMEL, from udor, water, and mel, honey:

each one ounce.

• Take of Vinegar,
• Honey,

Mace, a small portion, to give it an agreeable flavour.

Water, twelve or fourteen ounces; let this be drank in bed after the manner of tea or coffee; and the patient there wait the result.

Care though should be taken, that honey does not disagree with the constitution; for, where there is any natural antipathy, it is apt to produce violent affections on the stomach and bowels; su­gar should therefore, in these cases, supply its place, or treacle will have a better effect. Whatever is taken hot, as well as heat­ing aromatics, opiates, as also violent motion, are highly sudo­rific.

Besides, such things as diminish the external pressure of the air, and those which increase the strength of the heart, with re­spect to its number and force of pulsations, come under the head [Page 179] of sudorifics—such as Rhenish wine, fresh juice of citron, pene­trating aromatics, volatile salts, &c.—those things which stimu­late externally, as all acrid matters applied to the skin, as vine­gar and ginger, which is the most subtile and penetrating, and much recommended by HELMONT—and lastly, whatever, restores impeded motion in the internal parts, as passions and affections of the mind reproduce retarded perspiration.

Though a number of the medicines mentioned above are stiled diaphoretics; still, strictly speaking, and considering them as such, independent of their connection with sudorifics we have no one of which we can speak with any certainty that has been tri­ed by statical experiment, the only mode we have of discovering them, except AS A FOETIDA, as handed down to us by SANCTO­RIUS—yet I should suppose, that the power of all sudorifics weakened might be justly considered as diaphoretics; for we find all those things which can increase the circulation, determine the fluids externally to the skin, and take off the spasm from the minute vessels, are certainly entitled to the character of diapho­retics and sudorifics; and these three particular circumstances should be adverted to, when we want to promote a discharge of this sort for any good purpose; for though stimulants and seda­tives, or medicines possessing both these powers, may in many cases be very proper, they may in some, conjunctively or separate­ly considered, be detrimental—and indeed there may be com­plaints where sweating would be improper, though the promo­tion of gentle perspiration might be useful, as in the scurvy—but in the venereal disease, if the effect could be produced with ease, sweating is the best method of cure, and preferable to ei­ther evacuation by stool, or salivation.

From what has been advanced, we shall find that all general stimulants of the system, as motion and heat, are powerful su­dorifics;—particular ones are either applied to the excretories, those pores from whence the sweat issues, or to the parts consent­ing with them, as the stomach and intestines; hence their action is either general, local, or sympathetic.

• BURDOCK—Decoction, 2 ounces in 3 pints boiled to 2, taken every 24 hours.
• Powder, 1 dram.

• SENECA, or RATTLESNAKE-ROOT—
• Powder, Dose from 20 to 60 grains.
• Decoction, 2 ounces in two pints of water to 20—dose 1 to 2 ounces.
• SNAKE ROOT—Tincture, from 1 to 2 drams.
• [Page 180] Powder, 10 grains to 1-2 a dram.
• GUAIACUM WOOD—
• Decoction, 2 ounces to 3 pints boiled to 2—dose 4 ounces.
• Gum, See Cathartics.
• Tincture, from 1 to 2 drams.
• CONTRAYERVA—
• Powder, from 10 to 30 grains.
• Compound, from 1-2 a dram to 2 drams.
• SARSAPARILLA—
• Decoction, 2 ounces to 4 in 3 pints of water boiled to 2, from 4 to 8 ounces the dose.
• MEZEREON, or SPURGE OLIVE—
• The bark of the root, 1-2 an ounce in 6 pints of wa­ter boiled to 4.—Dose, 1-2 a pint.
• OPIUM—See Sedatives.

See Antispasmodics.

• CAMPHOR,
• MUSK,
• SALT OF HARTSHORN,
• ASA FOETIDA,

• ANTIMONY—Laevigated, dose from 20 to 60 grains.
• Calcined, 10 to 30 grains.
• Tartarized, 1-8 to 1-2 a grain.
• Glass of cerated, 2 to 20 grains.
• Precipitated sulphur of, 3 to 6 grains.
• ANTIMONIAL POWDER—2 to 6.
• Wine, 10 drops to 50.
• ANTIMONY—Tartarized wine of, 20 drops to 40.
• IPECACUANHA—1-4 to 3 grains.
• Wine, 30 to 40 drops.
• WATER—
• WINE—
• VEGETABLE and NATIVE ACIDS—

from 2 to 6 drams.

• ACETATED AMMONIA, called Myndererus's
• Spirits,

• WATER OF AMMONIA, dose 10 to 30 drops.
• PREPARED AMMONIA, 5 to grains.

Essential and Empyreumatic Oils—though they are seldom used in this view, but more as cordials and antispasmodics.

From considering the operation of medicines of this class, we shall find that their utility is derived from diverting the deter­mination of the fluids, and preventing them from crowding the [Page 181] internal viscera—removing various causes, which obstruct or impede the natural state of the circulation on the surface of the body, and there restoring the natural discharge—and also from their evacuating power, lessening the quantity of the circulating fluids, when too great for the powers of the system—restoring lymphatic absorption—and discharging any morbid accumula­tion of serum.

But should the system be uncommonly relaxed, a great in­crease in the determination of fluids to the exterior surface of the machine—a great want of fluids—or the force of the blood on the basis of the brain much debilitated, the prohibition of their use is obvious.

The last of which we have to treat in this section are

§ 11. EMMENAGOGUES, from the Greek words emmena menses, and ago, daco, to produce the menstrual evacuations of women; and all such medicines as have been supposed to pro­duce this effect are comprehended under this title.

A great deal has been written, and much time wasted, by au­thors, in endeavouring to account for the precise manner in which nature performs this operation in the female machine: the only present satisfactory conclusion we have on this head is, that a fullness of the uterine system, from a peculiar determination of the blood to that organ, a permeability in the uterine and va­ginal vessels, and an increased impulsive power, all periodically exerted, are necessary for the salutary promotion of that discharge—and when there arises a deficiency in all or any of these parti­culars, obstructions will take place, which require the aid of that class of medicines of which we are now to treat;—but as there are various purposes often to be answered, e'er we can promote the desired end, different medicines have been pointed out, and formed into divisions according to their action.

Hence have we EMMENAGOGUES,

• Stimulating—as
• Antimony,—Quicksilver.
• Irritating—
• Aloes,—Sabine,—Cantharides.
• Tonic and Astringent—
• Iron,—Cold-bathing,—Exercise.
• Antispasmodic—
• Asa foetida,—Castor,—Bathing the feet,

and a variety of others, possessing similar powers to those here specified.

But in the application of these medicines, one thing is to be particularly observed, that not any of them ought to be used [Page 182] at all times, that is, previous to, and when the menstruating period is at hand, except the astringent class and quicksilver.

The irritating and antispasmodic are only to be called in aid, when there is an aggravation of the symptoms, and an effort of nature at her accustomed time. The reason of which is clear—because the former are considered only as preparatory, that by their operation the constitution may be put into such a state, as to be enabled to feel, and answer to the effects produced by the more powerful and forcible action of such medicines as add vi­gour to the circulatory vessels, push forward the blood quickly and rapidly, and take off any obstructions which may be caused by some spasmodic affections.

According, then, to the difference of the constitution we wish to relieve, so must we make our selection.

If it should be necessary to give strength and firmness to the system.

Astringents may be had recourse to—as iron, and its prepa­rations—bark—and bitters.

If to increase the force in the moving powers in general, Cold bathing and quicksilver. If to produce partial action by the same mode, Local Stimulants—

Partial warm baths—fomentations—stimulant vapor, or fu­migation of tobacco to the uterus—aloetic medicines—foetid gums—cantharides—acrid purgatives—as they may communi­cate their stimulus to the part, either immediately, or communi­cate motion to the vascular system from the exertion of their ac­tion on the contiguous parts.

If to take off constriction. Antispasmodics—Asa foetida—caster—but particularly musk.

There is another class which we must have recourse to parti­cularly where there appears to be a scarcity of the sanguinary mass, in order, as far as in our power, to increase the general volume of fluids, that the peculiar determination may with more ease be brought about, and this is the class of NUTRIENTS, selecting such to which the digestive powers of the constitution appears adequate to assimilate.

If now we call to our recollection what has been delivered—the means by which these appropriate remedies are rendered serviceable, will be—from promoting freely the circulation of the blood in the neighbourhood of the uterus, when too much obstructed there—from increasing the accumulation in the ute­rine vessels themselves, which is necessary to the menstrual dis­charge—and removing morbid obstructions to the passage of blood [Page 183] into the cavity of the uterus—also, from augmenting the strength of the system in general, particularly of the vessels of the uterus, when defective—and removing any spasmodic constriction taken place in them.

But strong objections may often arise to the use of some of this class—if the rectum should be in a particular irritable state—or there should be any local inflammatory affection, we must avoid those which are irritating—If the blood circulates with great force, or there should be particular debility of any other parts, the stimulant must be avoided; nor must those denominated tonic be meddled withal, if there should be any morbid rigidity in the system.

Our catalogue of EMMENAGOGUES supplies the following ar­ticles:

See Antispasmodics.

• PENNYROYAL,
• RUE,
• SABINE,
• ASA FOETIDA,
• GALBANUM,
• AMMONIACUM,

• MYRRH—See Expectorants.
• Tincture, 1-2 a dram to 2 drams.
• QUICKSILVER, See Sialagogues.
• IRON—Rust prepared, from 5 to 30 grains.
• Tincture of muriated Iron, from 10 to 60 drops.
• Wine of, 1 dram to 1-2 an ounce.
• AMMONIACAL IRON—dose from 3 to 15 grains.
• TARTARIZED IRON—10 to 30 grains.
• VITRIOLATED IRON—dose 3 grains to 20.

Cathartics—Diuretics—and Emetics—may, if we consider the nature of their actions, be fairly included, on particular occasi­ons, in the list of Emmenagogues.

CHAP. III.

WE are arrived at the third part of our arrangement, and must proceed now to treat on MEDICINES WHICH ACT UP­ON THE FLUIDS THROUGH THE SYSTEM, in the same manner as we have before spoken on those which acted upon the solids; and these include ATTENUANTS INSPISSANTS—and DEMUL­CENTS—And, first, of

§ 1. ATTENUANTS, from the Latin attenuo, to make thin, [Page 184] perfectly expresses the nature of all the medicines of this class, and comprehends whatever can be understood by diluting, incid­ing, and resolving medicaments; three terms into which this class have been, by many, divided, because they all contribute to render the fluids more thin and fluxile.

Butas this point may be accomplished in two ways, either by substances mixing with a fluid, and rendering it more thin, but not changing or altering the particles of which it was com­posed; or having the power of diminishing the cohesion of the blood, and thus rendering its texture less firm and tenacious; they may be certainly, and ought to be divided, according to their action, into diluent and resolvent.

Among the first we cannot be properly said to have any other than water, which is productive of a variety of good effects up­on the habit—but not merely by its diluting property, it acts more particularly, immediately, and universally, by its coldness. Now, as a diluent, it not only thins the fluids in the way we have above specified, but it assists digestion, (106) quenches thirst—is an universal vehicle for solid food, corrects acrimony—pro­motes fluid secretions—and is by many esteemed, much more than any other medicine, an universal remedy.

Now, as it is clear that all diluents should be more fluid than the humours which are by their intervention to be rendered thin­ner; and have at the same time, when mixed, the property of making them retain their acquired fluidity—we shall find, there is not any thing except water that possesses this power.

Though wine—oil—saline substances—fermented spirits—and some earthy substances have been said to enjoy these vir­tues, still it is obvious, that they are defective, and have not them in that degree so as to become really diluent—for wine, as a diluter, depends upon its watery particles joined with its stimulating power—oil renders the mass of fluids rather more viscid—saline substances resolve by their stimulus—fermented spirits are more apt to coagulate—earths are of themselves solid and inert, and can never be taken in this [...]ew, but as they may mix with some acidities in the stomach and intestines, and thus change their form, and become active from their assuming that of neutral salts, and with them may they be [...]; therefore it is to water we must resort, when we wish to call in aid alone a purely diluting power—to which, it has been said, if we add gentle heat, or saline particles, as sea salt, Polychrest salt, sal ammoniac, or borax, we shall improve its power, by the addi­tion of their stimulating effects, but this is adding a resolvent property—Moderate motion is also said to improve its powers.

[Page 185] But as for resolvents, they act by increasing the force of the moving powers by the stimulus they possess in a limited degree; for should they act violently, they would, by dissipating the thin­ner part of the fluids, render them thicker, and become incrassants; but by gently stimulating, though they produce evacuation, they permit the vessels to act more freely upon their contained fluids, and hence become resolvent.

On considering the action of this class, we shall be empowered to discover, that their beneficial effects arise, from removing any morbid viscidity in the blood, and restoring a free circulation, when in the small vessels it is morbidly obstructed—from increasing the quantity of serous evacuations, when too greatly diminished—and rendering them, when too thick and viscid, more fluid.

But their use must be prohibited in constitutions labouring under too great thinness of the general mass of fluids—having a propensity to morbid serous accumulations—or a remarkable increase of similar secretions.

The catalogue of ATTENUANTS are,

• WATER,
• MILK WHEY,
• ALL LIQUIDS abounding with water,
• CUCUMBERS,
• MELONS,
• BETE,
• SPINAGE,
• BOILED ONIONS,
• CORN SALAD,
• CABBAGE,
• DANDELION,
• ENDIVE,
• WHITE LILY ROOT,
• CELERY,
• ARTICHOKE,
• MUSHROOM,
• ENGLISH MERCURY,
• And some others. All the SWEET A­CID FRUITS.
• ALKALI—

in small doses, and continued for some time.

• Fixed vegetable,
• Fixed fossile,
• Volatile,

• NEUTRAL SALTS—See Diuretics and Cathartics.
• SOAP—See Diuretics.

§ 2. INSPISSANTS—these are also called INCRASSANTS—from the Latin words inspisso and incrasso, to thicken. These terms, like the former, give us a perfect idea of their import—from whence we understand all such substances as give a degree of viscidity, to the circulating fluids.

From experience we know that our fluids do sometimes run into a state of morbid thinness; but by what means, is very doubtful.

[Page 186] Some have supposed it to arise from too great a proportion of fluid aliment; whilst others have been led to believe, it origi­nated from a retention of some of the serous secretions. But if we reflect, that children and many adults live upon food totally liquid almost, yet no such appearance is the result; and that nature always supplies the defect of one secretion by the increase of some other, and the retention must be partial, it cannot be universal; both these opinions seem by no means satisfac­tory.

I rather think that it is occasioned by a relaxation of the sys­tem, particularly of some, or the whole of the digestive organs; for strong, muscular, laborious rustics, whose digestive powers are good, have generally, nay, I believe always, the blood send­ing to the opposite extreme—whilst the more delicate and relax­ed, whose digestive powers are weak, have the sanguinary mass too fluid: indeed people whose blood has possessed a proper tex­ture, have, from illness, had it reduced to a state manifesting a too weak cohesion, and that apparently by the system being de­bilitated.

Whatever may be the cause, it is our business to remedy the effects; and these we attempt by reproducing a proper proportion of viscid fluids, and by increasing their attractive power one with another; and their consequences may, we think, be acquired by the following catalogue of INSPISSANTS:

• Wine,
• Acids vegetable
• —mineral,
• Alchohol,
• Radish,
• Turnip,
• Carrot,
• Parsnip,
• Skirret,
• Potatoes,
• Leeks,
• Comfrey Root,
• Cucumber,
• Poppy, and
• Melon Seed,
• Onions,
• Farinaceous Grain,
• Mucilaginous and Oily
• Substances,
• Sago,
• Salep,
• Almonds, &c.
• Gum Arabic,
• —Tragacanth,
• Starch,
• Isinglass,
• Arrow Root,
• Animal Food,
• Fish,
• Eggs,
• All the Astringents,
• Bark.

It has been remarked by some authors, that acids—wine—al­chohol—and in some measure, the astringents used internally, have been said not to produce their inspissating effect; and should therefore only be employed externally, in cases of profuse bleedings; and that the nutritious and demulcent class, of which [Page 187] we shall next treat, must, for restoring the viscid fluids, be de­pended upon.

However, I cannot avoid thinking the whole, alchohol except­ed, may be used with much advantage; and greatly assistant in rendering those, which act merely on the blood, more quickly efficacious, by invigorating the system, increasing the strength of its vascular power, and consequently the action of the vessels upon the contained fluids.

On this head authors have confined themselves to such sub­stances as were either farinaceous, as barley, wheat, rye, and such—or mucilaginous, as marsh-mallows, gum arabic, isinglass, &c. and conceived their utility to be derived from removing morbid tenuity in the blood—preventing the transmission of red blood through vessels not naturally fitted to receive it—diminishing the quantity of those secretions which were serous, and too copious, and rendering them more viscid where morbidly thin and fluid—and have prohibited their use in morbid viscidity of the blood—preternatural diminution of the secretions in general—and a high degree of debility of the digestive organs.

I am persuaded that in many cases, particularly in those where a weak digestion is prevalent, the use of some of the stimulant aromatics, mixed with the invigorating astringents, such as bit­ters, bark, iron, would greatly conduce to conquer many of those defects for which incrassants are prescribed, and I have repeated­ly seen their good effects; indeed I very often unite them, and find, that, conjoined, they prove more efficacious than when ad­ministered separately.

§ 2. DEMULCENTS, from demulceo, to appease or mollify. These by some have been considered to act in a double capacity, by blunting or sheathing the acrid particles of our morbid hu­mours, or promoting an entire change in such as were offensive from their acrimony, and forming a third substance, perfectly different in its nature with respect to its action. Hence have they been ranked as general and particular demulcents. In the latter class are enumerated all the acids and alkalines, as well as some metals, with regard to their influence on each other; as if one was creative of any disturbance in the habit, by exerting a morbid stimulus from its acrimony, the other on being given proved corrective, and cured the affection; hence was stiled de­mulcent; but these are more properly arranged under other heads, as the antalkaline and antacids, of which we shall soon treat in their separate places.

At present we shall consider them only as obtunders of, or blunting acrimony, by mixing with and preventing the acrid [Page 188] part of the fluids from exerting themselves on the solids, so as to create pain, or other uneasy sensations.

And it will appear then, that of all this class, in this view of the subject, are either mucilaginous, oily, or a composition of both; and these manifest their action immediately in the stomach or intestines; or, after having passed through the circulation, in the secretory organs.

For it is imagined, that acrimony takes not place in the blood vessels, but in the secretions, as the serum is thought to be the vehicle of acrid substances. These demulcents, therefore, mix­ed with the blood are separated with the serous, or thinner parts of the fluids, in those places of the system where secretions hap­pen; and thus, by enveloping the irritating particles, prevent them from stimulating.

Thus they defend the kidneys, the lungs, the vessels of the vagina and uterus, in nephritic or gravelly complaints; in de­fluxions on the lungs; and cases of the whites; and are highly useful in haemorrhages, which are often maintained by acrimo­ny; for increased secretion of mucus is always acrid, till its thinner parts are dissipated, by lying some time—hence their use in coughs, defluxions on the breast, the whites, and those dis­charges after child-birth, called lochial.

Whatever good we may perceive can be derived from medi­cines of this nature, may be acquired from some of the following selection of DEMULCENTS:

• Larger Comfrey Root,
• Seeds of Cucumber,
• —Poppy,
• —Melon,
• Sugar,
• Honey,
• Raisins,
• Dates,
• Figs,
• Hips,
• Liquorice,
• Gum Arabic,
• —Tragacanth,
• Starch,
• Isinglass,
• The Nutrients, Emollients, and Sedatives,

though these last can scarce be said to act in the mode we have described of common demulcents; but rather take off the acri­mony by diminishing the sensibility of parts; and produce a viscosity of the secreted fluids, it is obvious from the appearance of the matter, in those who have taken opiates, after their nar­cotic effects have ceased.

And this I take to be owing to the vessels being by their pow­er thrown into a state of torpor, and thus suffering the secreted fluid to become more dense by its continuance, and consequently less acrimonious from the dissipation of its more serous parts.

They have been divided into LENIENT DEMULCENTS, such as [Page 189] Starch, Gum Arabic, Olive Oil—and those which are DILUENT, as Water, and watery substances; but these last come not pro­perly under this head, without being mixed with some of the former; as they are apt, without such mixture, to pass off too quickly by some of the emunctories.

The use to be acquired from the administration of these mate­rials are, a diminution of the action of the ordinary stimuli upon parts affected with too great sensibility, and a supply of the na­tural coverings of the parts where too defective—diminishing morbid acrimony in the system in general—and rendering more mild those secretions which are praeternaturally, or too violent­ly acrid.

But their administration would be pernicious, if there was any defect of a natural pungency in the secreted fluids—a great degree of viscidity in the coverings of the sensible parts—or an uncommon want of sensibility in the excretory organs.

CHAP. IV.

WE are now come to our fourth division, wherein we pur­pose to consider

MEDICINES WHICH MANIFEST THEIR SENSIBLE ACTION CHIEFLY, IF NOT SOLELY, IN THE FIRST PASSAGES RESPECT­ING THE FLUIDS.

The first of which present themselves to our view are,

§ 1. ANTALKALINES, from the Greek words anti, against, and alkali, alkalies, consequently all acids and acescent materials come under this description; as do all such medicines as conquer alkalies, and destroy their power of action as such. But in this place the acids and acescents are only to be considered as correc­tors of alkalescent substances; for we have before seen the di­versified power they appear to maintain as astringents, stimulants, sedatives, inspissants, cathartics, diuretics, and they will also rank with antiputrescents; at least such of them as have been selected agreeable to the effects they have been thought to produce on the human machine: and here their chief action appears to me to be in the first passages only, where, coming in contact with alkalescent substances, there they neutralize them.

I am of opinion, that where there happens to be, from any disease, an alkalescent state of the fluids, they are not of much service by acting in them merely against, and correcting such al­kalescency; for when our fluids are affected to any considerable degree with this, little is in our power; but in cases of this kind, [Page 190] should they be of any service. I am persuaded it is more from their action communicated to the solids, particularly the mineral acids, than from any other cause. Perhaps the utility derived from the native acids depends more upon the fixed air, with which they are replete; for we have not a more powerful cor­rector of putrescent acrimony than this species of air.

They have been divided into vegetable and saline antalkalines—but the better division is, into native, of which sorrel, barber­ry, and tamarinds, form examples—and into artificial, as the a­cid of vitriol, sea salt, nitre, and vegetable.

The catalogue of ANTALKALINES, with which we are sup­plied, are,

• Pears,
• Apples,
• Oranges,
• Lemons,
• Strawberry,
• Raspberry,
• Barberry,
• Tamarinds,
• Currants,
• Grapes,
• Cherries,
• Raisins,
• Dates,
• Figs, &c.

• Cucumbers,
• Melons,
• Bete,
• Spinage,
• Corn Sallad,
• Salary,
• Asparagus,
• Artichoke,
• Radish.
• Turnip,
• Carrot,
• Cabbage,
• Nasturtium,
• Endive,
• Dandelion,
• Lettuce,
• Parsnip,
• Skirret,
• Potatoes,
• Leek,
• Onion,
• Garlic.
• OLIVE,
• WATER DOCK,
• SORREL, &c.
• WINE,
• VINEGAR, with the ARTIFICIAL MINERAL A­CIDS above specified.
• SALT OF AMBER. See Diuretics.

And likewise the whole class of DEMULCENTS; but these act by mechanical, not chemical mixture—that is, from merely mix­ing with and sheathing the offending particles, not from altering them, by forming a new combination, so that each body loses totally its natural properties, and becomes a third, differing from [Page 191] both—and, perhaps, some others here specified, may act in the same mechanical mode.

It will, from this concise view, appear obvious from whence the whole of the virtues of this class of medicines may be col­lected—and where their use ought to be prohibited—their power of neutralizing alkalies.

For, ON THE ONE HAND, by this power they are capable of removing any sensation of alkalescency in the first passages—re­storing the natural disposition to acidity in the stomach—and correcting in the alimentary canal praeternatural putrescency.—ON THE OTHER, if there should be, from an acid cause, any na­tural disposition in the stomach to that painful sensation, called CARDIALGIA, an uncommonly slow and languid circulation, or any considerable diminution of animal heat, these defects they would increase; consequently, under such circumstances, ought to be prohibited.

§ 2. ANTACIDA, Antacids, from anti, against, and acida, acids. These comprehend all alkalescent substances, most of the absorbent earths, and some neutral salts—and are such substances as counteract acidity in the same manner as acids conquered al­kalies—and are in this light here only to be considered, as we have before taken notice of them with respect to their different operations in the habit, selected agreeable to their various pow­ers, acting as stimulants, antispasmodics, attenuants, antiseptics, ca­thartics, and diuretics—and in this place they seem chiefly to ex­ert their efficacy only in the stomach, now and then, perhaps, in the intestines.

The catalogue of ANTACIDS with which we are presented, sufficient to answer any purpose they are capable of effecting, are TESTACEOUS ANIMALS. See Diuretics.

• ANIMAL FOOD—
• LIME WATER—Dose 6 ounces to 16 in a day.

prepared, from 10 grains to 2 drams.

• CHALK—
• CRABS EYES and CLAWS—

• BURNT HARTSHORN—Decoction of,
• EGG and OYSTER SHELL pre­pared—from 10 grains to 2 drams.
• ALKALI—Vegetable, Fossile, called So­da, or Natron, from 5 to 30 or 40 grains.
• Volatile, from 3 to 20 grains.
• BORAX—from 4 to 10 or 12 grains.
• TARTARIZED KALI, or SOLUBLE TARTAR—12 to 20 or 30 grains.
• [Page 192] SOAP—See Diuretics.
• STIMULANTS—
• ANTISPASMODICS—
• SEDATIVES—and
• DEMULCENTS—

Though most of these act by coming in contact with the prevail­ing acid immediately, without considering the solids—yet those under the general titles, except the demulcents, which become serviceable by their sheathing property, produce their effects by the influence they have on the moving powers, which we have in their proper places before specified.

As the action of these, like the former, is so very limited, on­ly to be considered in this place as counteracting acidity in the first passages, we shall have occasion to say little more than will be sufficient to shew where they will be beneficial, or in what cases their exhibition would be improper.

When there is a morbid prevalence and sensation of sourness in the alimentary canal; when, from the same cause in the sto­mach, the natural appetite is vitiated, and the action of that or­gan and intestines is disordered, they are of service in remov­ing the former, and restoring the two latter to their healthful standard.

But when there is a prevalence of alcalescency in the stomach and bowels, or a tendency to putridity in the general mass of blood, they must be highly detrimental. And, perhaps, in this last case, the mischief which would arise from their use may be more owing to the destruction of the acid in the first passages, than from joining in their alcalescent state with the fluids, as a­cids have been considered antiputrescent.

§ 3. ANTISEPTICS, from anti, against, septica, putrefaci­entia, substances occasioning putrefaction. These include all such materials as obviate the too great putrescency of our fluids.

Now as the putrescency of our humours may be brought on by excess of heat and motion, as well as receiving any putrid ferment into the vascular system—as it, when once fixed, and begun to exercise its deleterious action, induces languor and great debility in the moving powers, we may see the reason of our antiseptic class of medicines, exhibiting, according to the conception we have of their action, such apparently contradictory views—for in the same arrangement we shall find, that we have the volatile salt, and those of the neutral kind—the former con­sidered as highly heating, and a strong stimulant of the moving powers—the other as cooling the system, and mitigating vascu­lar motion.

[Page 193] From thence I presume, that they are only applicable in dif­ferent stages of putrescent action; or in different constitutions affected with putrefaction;—and not unlikely the same may hold good with acids and alkalies, for they are both enumerated under antispasmodics. Of these different substances it therefore behoves us to be careful in the application.

In the first stages, where a putrid tendency may be accompained with high degrees of circulatory motion and heat, or in constitu­tions where these are prevalent, neutral salines and acescents may be the most proper; but▪ in languid habits, or those made such by the continuance of the enervating power of putrid particles, vo­latiles and cordials challenge the preference.

Nitre has been said to be strongly antiseptic, when applied to inanimate animal matter, but not so in the living subject, as it lessens the powers of the vital actions—but this is only applica­ble in the advanced stage of putrescency; and it is to that state of the disease alone they must mean to advert, who advance, that cordials, and whatever invigorates the solids, by increasing the vital heat, are properly antiputrescent, and by what alone relief can be obtained in putrid complaints.

However, our chief intent in these cases is to keep up a due action of the moving powers, and a proper tone of the solids, that is, an active firmness—which effects, we conclude, may be produced by the subsequent selection of ANTISEPTICS:

Those FRUITS which have sweetness coupled with acidity;

• Cherries,
• Apples,
• Oranges,
• And such like,
• Acerb Fruits,
• Quinces,
• Medlars,
• Sloes, &c.
• Wine,
• Vinegar,

Acid,

• Nitrous
• Muriatic
• Vitriolic

• Salt of Amber,

Salts.

• Some Neutral,
• Mentalline, and
• Earthy,

• Essential Oils,
• Empyrematic Oils.
• Acetated Litharge—from 1 to 3 drops.
• Alum—Page 139.
• Nitre—176.
• [Page 194] Alchohol,
• All Vegetable
• Nutrients.
• Astringents,
• Stimulants,
• Sedatives,
• Antispasmodics,
• Wormwood,
• Chamomile,
• Quassia,
• Oil of Turpentine,
• Ale—Porter—Cyder
• —Perry,
• Camphor,
• Asa Foetida,
• Musk,
• Myrrh,

but, in cases of languor, certainly the most eligible are,

• Wine—
• Bark—

dose from 12 to 1-2 dram.

• Extract,
• Resin,

• Decoction, 1 ounce to 2 pounds reduced to 1 pound—dose 2 ounces.
• Bark—
• Powder, 20 grains to 2 drams.
• Tincture, simple, 1 to 2 or 3 drams.
• compound, or Auxham's 1 to 2 or 3 drams.

They have been properly divided into such as are tonic, in­creasing the activity and strength of the system, of which Peruvi­an Bark—Warmwood—and Chamomile are examples.

Such as are cooling—Acid Salines—Neutral Salts.

Stimulant, as Wine—Alchohol—Oil of Turpentine.

Antispasmodic, as Camphor—Asa foetida—Musk.

The utility of these are derived from resisting and correcting putrefaction—by preventing the assimilating quality of any pu­trid ferment received into the machine—correcting the putrid disposition of the humours—obviating the progression of putre­scency taking place in the solids—and restoring to a sound state solids morbidly putrid.

But in cases where a peculiar sensibility of the stomach is pre­valent, those called TONIC are to be avoided—the REFRIGERANT, where a debility of the vital powers are manifest—the STIMU­LANT, when we perceive too great a degree of irritability, cir­culation too highly accelerated, or strong disposition to profuse bleeding—and the SEDATIVE ANTISPASMODICS, when there is a too languid circulation, a lethargic disposition, or a considerable degree of torpor in the system.

CHAP. V.

IN our fifth and last division we include MEDICINES WHICH PRODUCE THEIR CONSEQUENCES BY EXTERNAL APPLICA­TION;—OR ON SUBSTANCES FORMED WITHIN THE MACHINE, THOUGH LODGED WITHOUT THE VERGE OF CIRCULATION. The first of which we shall consider are,

§ 1. EPISPASTICS, or VESICATORIES, from episp [...], to draw, and vesicatorium, as raising a blister. They are therefore stimulants, in the first sense, locally such; and, if continued, be­come evacuants.

But their action is not confined to those places where they im­mediately act; they communicate that action to the system in general, and often in particular to the urinary passages; but this effect is chiefly produced by cantharides, or Spanish flies.

They have been formed into three divisions, viz.

1. Such as only occasion heat in the part—of which class may be considered the slighter stimulants.

2. Such which create heat, with some degree of inflammation, as Horse-radish—Mustard—Volatile alkali.

3. Those which raise blisters, as cantharides, Euphorbium;—to which may be added a fourth.

4. Those which produce a discharge of pus, as Setons and Issues.

They are often applied with different intents, either as they act on the nervous power, alter the balance of circulation, or produce evacuation; hence are their particular uses discoverable;—in removing torpidity, or languor in the system—conquering the effects of more than usual sensibility—decreasing violent pain—weakening the circulatory force of the blood against any part morbidly affected—and also of action in vessels of the neigh­bourhood of those to which they are applied. They also decrease the volume of the circulating fluids when too great in the habit, and evacuate morbid accumulation of serum.

But should the system be in general highly irritable, the blood praeternaturally thick, or the fluids in general too defective in quantity, these circumstances demand the prohibition of their use.

§ 2. PHLEBOTOMIA, bleeding, from phleps, vena, a vein or artery, and t [...]o, seco, to cut.

Under this term are arranged all those modes by which blood is evacuated from the machine by the medical art; and thes [...] operations are considered as either producing general or partial [Page 196] effects, by relieving the system in general, or only in some of its parts.

The division of this class has commonly been general, and to­pical, or local; and instanced, in opening a vein, or an artery, a [...] belong to the first; as to the second, scarifications, or cupping-glasses, which are called cruentae, from the drawing blood—and the application of leeches; but the terms, it has been thought, would be more judiciously confined to the quantity taken, as veins or arteries must in all cases of blood-letting be opened. In ge­neral bleeding we commonly take away such a quantity as will in some degree decrease the power of the system—in local, such a proportion only as may contribute to relieve a part of the system near which the operation is performed—or, we ought to make such distinctions, for the sake of propriety, by which we should understand, that in general bleeding, the larger branches of the veins or arteries are opened—in local, only the capillary, or ve­ry small branches.

From whence the use accruing from this operation is derived may be easily conceived—as it proceeds either from lessening the quantity of blood, altering the state of its motion, or changing its course.

Hence it relieves in all cases where the mass of blood abounds too much in quantity; or, when there is a too great tension or distension of vessels in the system, when the force of circulation is highly increased, or the heat immoderate, or when in particu­lar blood-vessels there is a morbid increase of action, or the force of the blood is too great against parts morbidly affected.

But where there is too great a scarcity of blood, the circula­tion remarkably weak or languid, or too great a debility in the voluntary motions—these are powerful objections to its use.

Though from this operation it is apparent that the highest ad­vantages may accrue; and indeed, in many cases which are in­flammatory, or arise from sanguinary congestion, nothing can be done efficaciously without it; still I think it is made infinitely too free use of, especially in those places and climates where people are liable to fall into putrid, and some malignant com­plaints.

Where the patient is strong and athletic the pulse full and tense, and there appear evident signs of too great plenitude, it is univer­sally right to bleed, otherwise there is some caution required; for it very often hurries the habit into such a state of extreme debility, in some fevers, that nothing can compensate the mischief it occasions.

In all doubtful cases, therefore, where it may be thought ne­cessary for blood to be taken away, I would advise the operator [Page 197] to lay his [...]inger on the pulse of the opposite wrist to that where­in the operation is performed; if, during the slowing of the blood, the pulse rises, it is an indication to persist; if it should flag, we should immediately desist.

§ 3. ANTHELMINTICS, worm medicines, from anti, a­gainst, and elmius, vermis, a worm: or VERMIFUGES.—Thus are called such substances as destroy or expel worms, whe­ther situated in the gullet, in the passages to the stomach, the stomach itself, or the intestines; but, though it has been said, worms are formed in various parts of the machine, and have been found in different places, as the liver, kidneys, lungs, membrane surrounding loosely the heart, brain, cavities of the teeth, &c. we confine ourselves to medicines which perform their office on those which lodge in the first passages.

BOERHAAVE used to divide this class into two, viz. those which destroy and those which expel worms;—but there may be cases where the exhibition of these may be improper, because of the particular state of the stomach and intestines being unable to bear their action—hence modern authors have more judiciously divid­ed them into four heads:

FIRST. Those which are supposed to destroy, by poisoning the worms, termed venenosa, poisonous as

• QUICKSILVER—See Sialagogues.
• TIN—Powder, dose 6 to 20 grains or more,
• SULPHUR—Flowers of, See Cathartics.

SECOND. Those which expel worms, or cathartics,

See Cathartics.

• SCAMMONY—
• JALAP—
• ALOES—
• GAMBOGE—

THIRD. Those which have lubricating properties, called lu­bricantia, lubricating, as

• OIL OF OLIVES—
• LINSEED OIL—

FOURTH. Medicines supposed to have a tonic power, or giv­ing activity and strength to the bowels, named tonica, as

• SABINE—See Emmenagogues.
• WORM SEED—Powder, dose 1-2 a dram to a dram.
• TANZEY—Infusion, ½ a pint to 1 pint in 24 hours.
• Powder, 10 to 30 grains or more.

Besides these there are a number of other articles exhibited for this purpose—

• INDIAN PINK ROOT—
• Powder, 8 to 40 grains.
• FERN ROOT—Powder, 1 dram to 3.
• [Page 198] COWHAGE—the hairy part scraped off the pods, and mixed with syrup, to the consistence of an elec­tuary, dose 1 to 2 tea-spoon [...].
• SALT—in strong solution.
• CAMPHOR—See Antispasmodics.
• BITTERS—OIL IN GLYSTERS—
• HARROWGATE WATERS.

But I believe Calomel in general one of our most superior vermifuges.

The utility of these medicines naturally result from their ac­tion on the worms themselves—also on the system—by which means they either destroy, expel, or prevent their generation in the machine.

But some exceptions may very properly arise to the use of each under particular circumstances—if the intestines should be in an inflamed state, or be abraded, the venenosa, or poisonous, should be avoided—the lubricantia, lubricating, if there should be accumulation of sordes in the first passages—if a peculiar sen­sibility of the stomach, the tonica—and the cathartic, if any to­pical inflammatory affection should occupy the intestines, or should the constitution labour under any deficiency of fluids.

§ 4. LITHONTRIPTICS, from lithos, lapis, a stone, and [...]rup [...]o, frango, to break. By this term we should mean all such materials as dissolve the [...]one;—but our catalogue, under that idea, would not, I fear, comprehend any, notwithstanding the variety of pompous pretensions some have published on the certain existence of medicines endowed with this solvent proper­ty. But it is the general opinion of the candid and rational prac­titioners; that those who write now on the power of medicine, though they retain the term, only mean such substances as pos­sess a power of removing the disposition in the body to the form­ation of calculi, or stony concretions.

Indeed, we have had much said on the dissolving power of al­kalies and quick-lime—soap ley taken in broth freed from its sat—Mrs. Stevens's solvent, and lime water—for a long series of time; still few have found the wished for success; but how far they may act as preventive remedies, as well as some others, cannot be possibly determined. From the use of bitters and the uva ursi, or leaves of bear's wortle berry, in this view, I have known some benefit to arise in patients subject to gravelly com­plaints, from a collection of stony or gouty matter. Much is said at present of, and indeed the many experiments lately made seem to prove the utility of a solution of the VEGETABLE AL­KALI, called kali, impregnated with fixed air, half a dram of the [Page 199] [...] given at each dose, dissolved in any proper liquid, twice a day, and this increased to two drams or more, and continued for some time.

They have, however, been divided into such as are ANTA­CID, as

• LIME WATER—6 ounces to 16 in the day.
• SOAP—20 grains to 1-2 an ounce.

in veal broth—10 to 30 drops.

• CAUSTIC ALKALI—
• SOAP LEY—

• KALI with fixed air, in infusion, 2 ounces to a quart of water—dose, 6 to 8 ounces.

Such as have an ASTRINGENT POWER, as

• BITTERS—

• See Astringents.
• • UVA URSI, or Bear's Wortle
  • Berry,

But it has been alledged, that all alkalies in general possess this stone-dissolving power, therefore in their caustic state they are by some rejected; because they are apt to disagree with the stomach, and from thence are they obliged to be employed in too small doses.

As solvents, I am of opinion, little can be said of the use of the class here enumerated; but as preventives, having a power to obviate the generation of stony concretions in the machine, they may be considered to be beneficial in two ways—in alter­ing the state of the solids, by preventing a particular state of laxity of the stomach, and in the kidney—and in producing such an effect upon the circulating fluids, that they become less liable to furnish stony materials to be secreted by the kidneys.

But certain objections will arise to the use of the antacids, if in the stomach there should be a disposition prevalent to generate alcalescency—to the astringents, if there should be a rigidity, or contraction in the coats of that organ.

On vermifuges and lithontriptics we have been more concise than on other parts of our subject; because they each are appro­priated here only to the alleviation of single complaints specifi­ed under their respective heads; of which, when we come to treat hereafter, we shall be obliged to speak more fully; and enlarge more on the particular nature of the remedies in each case administered: at present it has therefore been thought suf­ficient to furnish a general idea, in order to prepare our readers properly for more easily understanding what we have to deliver on these heads.

And now we must observe; that, notwithstanding, in treating on medicines, we have enumerated a great variety, which many [Page 200] professors have thought essentially necessary to be produced; there have not been wanting some in the medical world, who seem to despise all this labour, as well as the authority of Hip­pocrates, Boerhaave, and all the men of eminence, who have been considered as shining ornaments of their profession; and pub­licly avow, that a very few medicines, properly applied, will serve every purpose of the medical a [...]t—and there are,

• CANTHARIDES, used
• chiefly as blisters,
• CALOMEL,
• TARTARIZED ANTI­MONY,
• ALOES,
• SENNA,
• JALAP,
• SALTS,
• OPIUM,
• With the use of nutritious diet and domestic cordials.

However, we cannot avoid confessing, that we think this cata­logue infinitely too concise; particularly as there are some me­dicines omitted which have surprising effects, for which we can­not so readily account; but whose efficacy has been confirmed to us by practice; and others of which, from daily experience, we are forbid to doubt the utility. I would, therefore, in order to render the catalogue more complete, subjoin the following arti­cles:

• OIL OF CASTOR,
• ANIMAL OIL,
• OIL OF AMBER,
• VOLATILE ALKALI,
• FLOWERS OF ZINC,
• WHITE VITRIOL,
• PERUVIAN BARK,
• ASA FOETIDA,
• MUSK,
• CAMPHOR,
• IPECACUANHA,
• IRON,
• RHUBARB,
• SABINE.

Before I quit this subject, I would beg leave farther to observe, that though I have placed the doses of medicines as usually ad­ministered to adults; in all active medicines, I should recom­mend them to be given in small doses at first, and gradually in­creased, till we have arrived at the fullest that the constitution can bear with ease, as the only mode of trying what good effect may be produced by their powers: and here we shall often find a surprising difference in the quantity necessary to promote the end desired—for I have known two grains of a very active me­dicine produce as powerful an effect on the constitution, as eight or ten would on another; and this knowledge can only be obtain­ed by particular experience. Indeed, I have known complaints cured by the very same medicine under the management of one practitioner, that had failed in the hands of another; which on­ly [Page 201] arose from the different modes of management respecting the quantity administered.

With regard to the forms in which medicines ought to be exhibited, the intent to be answered should be particularly con­sidered; whether the expeditious or permanent action is most eli­gible—if the former, they should be given in liquid—if the lat­ter, in solid forms—because in their diffused state they act most quickly.

For a very great variety become effectual by communicating their power from the stomach to the rest of the machine sympa­thetically; consequently the larger surface of the stomach they touch at the same time, and stronger their action, the quicker and more powerful will be their effect—In acute cases, therefore, these purposes will be best answered in a state of solution: but, on the contrary, in chronic cases, solid forms are preferable; be­cause they occasion medicines to act slowly, and, of course, make that action more durable, by remaining longer on the stomach;—besides, all medicines which are not easily suspended in any liquid, should be administered in form of bolus—pill—electuary—or powder mixed with syrup or some other viscid substance;—those which are volatile, very light, or readily miscible with any menstruum, should be given in mixture or draught. Where a greater proportion of any vegetable body is required than the stomach can bear in powder, and where the active part can be extracted by water, decoction or infusion is the most proper;—and all oleaginous substances require the addition of some inter­mediate viscid body, to make them properly incorporate with watery fluids, or syrups, and are most elegantly administered in form of emulsion or linctus.

Though some small difficulty may arise to readers slightly con­versant in medical researches, on the perusal of this part of the work which treats on medicine—still, by bestowing a little pains on each division—from the advantage they will receive, they will not find their labour ill bestowed—for they will be taught the simplest, most easy, and certain mode of prescribing, as well as the most powerful—they will also understand, from the know­ledge of the different powers of medicine, not only where they are likely to be serviceable, but where they will be of danger­ous consequences—a species of information which every man ought to possess, who dares venture to prescribe either for him­self or others:—for the first law of physic is, NOT TO DO HARM IN ALL OUR EFFORTS TO DO GOOD; of which no man can be certain without he knows precisely the active properties of such medicines as he administers; and whether they are properly [Page 202] adapted to the constitution, under the circumstances of the mor­bid attack which he labours to remedy.

CHAP. I. FEBRILE AFFECTIONS IN GENERAL.

ALL those are so considered where there is an alteration respect­ing the pulse and heat; for the most part, an increased quickness of the former, and the latter augmented in some degree;—many of the functions of the machine injured—particularly the strength of the limbs diminished; attended with chillness, lan­guor, lassitude, and other marks of weakness, without any local primary disease.

Under this head are comprehended all the fevers, of whatever nature, by which the human frame is afflicted; but, as they put on different appearances, they are divided under distinct heads, according to those appearances, as

• 1. CONTINUED, or CONTINENT,
• 2. REMITTENT,
• 3. INTERMITTENT,
• [Page 204] 4. HECTIC, and
• 5. ERUPTIVE.

In which order we shall pursue them;—but we should first re­mark, that all those are called CONTINUED FEVERS, where they continue from their commencement to their termi­nation without any intermission, remarkable remissions, or exa­cerbations, that is, increase of violence in the symptoms. To this class belong

Fever.

• 1. The simple continued
• 2. Inflammatory
• 3. Nervous
• 4. Putrid
• 5. Anomalous, or mixed

These fevers in general begin with lassitude—coldness—shiver­ing, but without tremor or grinding of the teeth, and heaviness of the head—then the heat increases every day till the height, with prostration of strength, and a constant desire of lying down—head-ach—and thirst—no exacerbation or increase of febrile af­fection, except from some perceptible cause. At the decline of the disease, there appears a moisture, sweat, or some other eva­cuation.

With respect to sensation, the symptoms discover themselves by a sense of weariness all over the body—a heaviness, attended with giddiness of the head—head-ach—bad taste in the mouth—often an imperfect, or depraved smell—a difficulty and tottering in motion—unwillingness to speak—a desire to keep in an horizontal posi­tion—a total want of, or scarce any appetite—great [...]—loath­ing of animal food, or any solids—a desire for watery acidulated cold liquids—no lascivious inclination.

In the cold state, breathing is small, quick, oppressed;—in the hot, deeper and frequent;—in the cold state, the pulse is small, in­termitting, interrupted, and frequent;—in the hot, full and fre­quent;—in the declension, full and undulating.

The saliva is small in quantity, clammy;—the mucus of the tongue, gums, and lips is greyish, rather yellow, and sometimes black—the urine in the course of the disease becomes hotter and turbid—there is a moisture in the skin and a sweat in the declen­sion of the fever—the stools are liquid, yellow, often foetid—the mucus of the nose trifling; and sometimes from thence haemor­rhages issue.

Fevers of this kind are often ushered in with a coldness of the extremities and paleness of the face—very often without any shaking of the limbs;—after that there is a constant uniform [Page 205] heat, for the most part, except that it is greater towards the height; there is also in the declension a softness of the skin.

This is the history of the continued order of fevers in general, with such things as appear in the vital and animal functions with respect to sensation, voluntary motion, appetite, respiration, and the pulse; and also in the excretions and qualities of the solid parts.

Now as all the fevers of this kind have a greater or smaller number of these symptoms attendant, under each head we must enumerate such as will best inform us to which it particularly belongs, that we may be best enabled to make proper distinctions; and as the simple continued fever is the least complicated, we shall begin with that.

CHAP. I. ON INFLAMMATION.

IN a former section we have spoken of inflammatory fever, (201.) which we have said depended upon a peculiar state of the vascular system and blood, the moving powers, or part of them, put into too strong motion, and supported in the violence of their action by the peculiarity of that state: here the affections were general, produced not by, or dependent upon, any other disease.

But in this place we are to treat of local affections, having a fever for their associate; hence it is to be considered, not as a primary, but as a secondary disease, produced by, o [...] dependent on, some other; consequently only a sign that some other mala­dy reigns in the habit—the first of these fevers is called IDIOPA­THIC, the second SYMPTOMATIC.

[Page 293] Now, in inflammation there are some particulars observable, which, on examination, will lead us to the cause, and enable us to lay down certain rules for the cure.

In a part under a state of inflammation there are more than na­tural heat, redness, tension, pain, and swelling.

The FIRST is produced by the blood circulating to the part with more than usual force, and being there collected in too great quantity; and wherever that is the case, there is a proportionate increase of warmth—the SECOND is owing to the blood being pushed into those vessels, which, in an healthful state, are only permitted to carry the serous or thinner fluids strained from the sanguinary mass—the THIRD arises from a too great quantity of fluids crowding into the containing vessels, by which they are distended, and their fibres distracted, which produces the FOURTH, or PAIN—and the FIFTH deduces its origin from the distension, and the fluids being too freely pushed into the cellular membrane; or exuding through the coats of the vessel, by their natural parts being too permeable, from the superabundant quantity of liquids they contain.

Now all these effects may be produced by stimulus of some nature applied to the parts affected, increasing the action of the vessels, which solicits the fluids to these parts too rapidly, and produces distension.

Hence it appears obvious, that these two causes are adequate to create these effects—one of which acting will occasion only a slight degree of inflammation, of no long continuance—but if they both are conjoined, then arises an inflammatory disease of greater violence and duration; inasmuch as, from these two causes co-operating, the effects produced will be more vehement.

But in the parts which are most solid, or in which the vessels continue their course in a straight direction, should any inflam­mation arise, there will consequently be greater degree of pain, than if it happens in the softer viscera, or glandular parts; be­cause there is always a higher degree of tension in the vessels—hence in firm membranous parts, the skin, ligaments, tendons, cartilages, and bones, (21, 22. 24.) inflammations are found more acutely painful, whilst in the softer parts before-mentioned, the pain is sometimes slight, and always inferior to that of the other.

But external accidents will, by producing the two causes as­signed, (298.) create local inflammatory symptoms, whilst the vascular system in general shall perceive no disturbance, which will not at all be indicated by the pulse, or other febrile affecti­ons; so that if a fever should arise, as it generally does in all considerable inflammations, it is to be considered as owing its ori­gin [Page 300] to this cause, and is a consequence, therefore only esteemed a symptoms; for excessive heat, thirst, and restlessness, are conco­mitants of vascular affection, and generally attend inflammatory diseases, independent of any fever, except what they themselves create; whilst weakness and loss of appetite, essential symptoms attendant on primary or idiopathic (298.) fevers of any continu­ance, are wanting, and seem to belong to affections of the ner­vous system.

But some inflammations owe their origin to fever, and may be occasioned by peculiar causes; either from the elective power of morbid matter thrown into the habit, that is, a predeliction for fixing on some peculiar part or parts in preference to others, as in the small-pox, meazles, gout, rheumatism, &c. or from lo­cal constitutional imperfection—hence we find, different parts may become the seat of inflammation from general causes also; for if the resistance of any part is supernaturally increased, and a stimulus should be applied to them from acrid humours circu­lating in the mass of fluids, and fixing there, an inflammation will be the unavoidable consequence—and these very often terminate fatally, should it in fevers fix in some of the nobler parts; and to these is often to be attributed in many fevers the death of the patient.

If we reflect on the cause of inflammation, we shall find, that every part of the human machine, which is plentifully supplied with blood vessels interwoven in their texture, is subject to this affection—and mostly so are those parts which are liable to be ex­posed to external injuries; or to stimulating materials, which circulate and are buoyed up in the atmosphere; though some of the very thin membranes, the scarf-skin, hair, and nails, may be considered as exceptions.

Hence, according to the consequence of the part affected, will be the disturbance of the constitution, and the degree of danger; and these will manifest themselves according as the use of those parts is most immediately connected with those actions of the constitution on which life is immediately dependent, by which the machine is nourished, and its parts kept in proper order, and from whence it has its power of motion, distinguished by the terms vital, natural, and animal—upon all which, acting in uni­son, is constituted the welfare of that machine.

With respect to the termination of inflammation, there are five modes, RESOLUTION, EXUDATION, SUPPURATION, MORTIFICA­TION, and SCIRRHUS.

Inflammation is considered to terminate in RESOLUTION when, in the first instance, the flow of blood is diverted from the part affected, the violence of vascular action allayed, and strength giv­en [Page 301] to the coats of the vessels, so that they may be properly sup­ported, and the dissipation of the load of fluids which have been collected be procured; or they may be resorbed into the habit—by EXUDATION, which occurs only in superficial inflammations on the skin, and membranes lining internal cavities or passages, or covering the different viscera, when distension of the arteries, and an enlargement of the pores of their sides takes place, by the rapidity of motion producing more than usual force on the vessels in an inflammatory state, occasioning great increase of heat, and expansion of the contained fluids.

In this manner frequently ends erysipelas, by pushing forth little pustules or blisters, and freeing the vessels which are in­flamed—so also in burns and wounds matter exudes, which is termed digestion; and as this comes on and continues, so are the parts affected alleviated, and totally cured. Nature also makes use of this expedient in catarrhal and other slightly inflammatory complaints of the lungs, as well as in the gonorrhoea virulenta, or clap; for all these are superficial inflammations—by ABSCESS, or SUPPURATION, when neither of these processes takes place, but the violence of motion continues or increases, and the weakness of the vessels still remains; then the fluids which have been col­lected in the cellular membrane are either too copious, or become so thick and viscid, that they cannot be absorbed and received back into the circulating fluids, nor pushed out, and thus evacu­ated through the pores of the skin—amongst these another pro­cess takes place, termed FERMENTATION, wherein the vessels, cellular membrane, and muscular fibres are melted down, and a white thick matter is formed, called pus; but this happens chiefly in more deep seated inflammations in some viscous, fleshy, or glandular parts—by MORTIFICATION, when the force of cir­culation is so violent against the sides of the inflamed vessels, that the coats are ruptured; or when the arterial coats are so very weak, that the blood bursting into the cavities of the cellular membrane there stagnates, and quickly corrupts, forming what is called in medical language GANGRENE, or SPHACELUS; the first considered by some as mortification in its incipient state, the last when it is perfectly formed; but others, when the skin and cellular membranes are the parts affected, give it the former name; when the muscular, the latter; when the bones, it is called CA­RIES; so, in fact, they are all truly mortifications, though only of different parts.

When mortification takes place, there is a cessation in the part of all pain, from the destruction of the living solids; hence the protrusion of blood, which becomes of a darker colour than be­fore, or has a livid appearance, hence its stagnation and corrup­tion [Page 302] and deprivation of its natural colour—after this, a sponta­neous separation of the parts which compose it takes place, the thinner part is driven forwards towards the surface, and elevates the cuticle into blisters.

From what has been said, we may form a judgment why mor­tifications are most likely to occur in those whose fluids are in an acrid state, old people, and those of dropsical habit; because the solids are soon broken down, and many slight accidents are suffi­cient to produce these dangerous, and often fatal effects, which we at first observe with an unsuspicious eye, when they are at­tacked by inflammations of some force; for, indeed, in constitu­tions not labouring under these defects they rarely happen.

The last termination we shall mention is, SCIRRHUS, here con­sidered as a hard indolent tumour only, and chiefly presents itself in the spongy viscera, as the lungs, mesentery, womb, and par­ticularly the glands in various parts of the machine.

And this generally arises from the circulation in the glands, generally being too languid—hence are obstructions formed from the fluids inspissating within the small capillary, or hair like tubes, and only producing vascular distension so gradually, that there is no great excess of pain, nor any violent increase of heat, so that proper power is wanting to create that process which in­duces suppuration, and also force sufficient to break down the vessels, and produce mortification, which in these parts are said seldom to take place, except from acrimony of the sharpest na­ture pouring down on the vessels of any particular gland, and being there deposited.

Inflammation then may be considered only as one cause of scirrhus, which induce these tumours by imperceptible degrees, and very slow beginnings, which are attributed to some peculiar indescribable defect of the humours, terminating frequently in cancerous affections.

They are, besides, productive of great mischief from the com­pression of the neighbouring parts, as palsy, impeded deglutition, barrenness, and many other complaints.

From what has been said on this subject of inflammation, we shall be readily and forcibly struck with the most eligible modes of termination.

The first is by resolution, the second by exudation, if the mat­ter exuded can have a free exit out of the habit; but in those inflammatory affections which make the membrane that lines the cavity of the breast, and abdomen, or belly; or which cover the different viscera contained in them—the objects of their attack; and if the matter which from that cause exudes from their sur­face should remain there, a hectic fever will be the consequence, [Page 303] though the original pain ceases, and a fresh concourse of symp­toms will then succeed. But suppose neither of these termina­tions can be brought about, we then wish for ABSCESS, because only the inert solids suffer chiefly, and seldom have any perma­nent bad effects, if they can only be permitted to clear themselves; for then the parts heal up; nor have the nerves or blood-vessels suffered any material destruction, though the last may have been distended, and suffered greatly from such distension; yet, once freed from the impelling cause, soon recover their tone, suffici­ently to perform properly their constitutional action; and as for the inert solids, they are again soon supplied, by the digestive powers of the machine forming fresh materials from nutriment, in order to renew the substance lost, by the application of homo­geneous particles poured into the interstices of the celullar mem­brane.

In all our attempts to cure inflammatory complaints, our first aim is resolution, whether the part affected be exter­nal or internal; the former of which is obvious to ocular demon­stration; the latter, by heat and pain affecting some inward part, accompanied with general febrile affections; of which we shall speak more particularly when we come to treat on parts labouring under this complaint [...] at present we shall shew how we attempt to bring about resolution, when any considerable in­flammation calls for our assistance.

If it occurs in habits which are plethoric and strong, the pulse full and quick, and much increase of heat, we pursue the same course as was delivered when treating on inflammatory fever, § 2. Section VIII. attempting to allay the intenseness of motion in the vascular system, and abating the excess of heat, which is the natural concomitant.

But here sometimes the complaint yields not to general bleed­ing, we then should have recourse to local, by the application of leeches or cupping-glasses near the part affected, which will ve­ry often succeed; and as there is too great a flow of fluids to the part, we endeavour to lessen that by smart cooling purges, (No. 3. 22 to 24.) giving freely in the intermediate times be­tween the purges, nitrous powder, (No. 2.) mixed with small doses of antimonials, (180.) gentle aperients, (171, 172.) and o­ther cooling saline diuretics, (176.) applying to the parts them­selves fomentations, (No. 85.) with which let the part affected be fomented three or four times a day, and continued at each time for half an hour, or longer, taking care not to apply it too hot, but only moderately warm.

Afterwards the inflamed part should be covered with a white bread poultice, in which a sufficient quantity of ointment of marsh­mallows [Page 304] has been used—some advise a poultice of bread boiled in litharge water, called vegeto-mineral water; others of wine­lees thickened with bran; and several prefer that of bean-meal and simple oxymel, softened with oil of roses—and should the tu­mor and inflammation be by these means dissipated, the poultices should be changed for st [...]pes moistened with the camphorated lo­tion, (No. 86.) and occasionally applied to the parts.

By these means commonly resolution will take place, the hu­mours collected in the part being dissipated, and the remainder absorbed back into the habit, by the lymphatic system being freed sufficiently, and stimulated to a reproduction of its action in the part affected.

But, notwithstanding our efforts, if the common symptoms should gradually increase, such as great heat, throbbing in the part affected, suppuration will take place, and an abscess be form­ed—here, then, our mode of cure must be altered, and we must aim at soliciting the matter externally, and freeing the habit in a proper time, by the application of those things which promote suppuration, thin the external skin, and determine the contained matter towards the surface.

Hence poultices made of mallow leaves, boiled in milk with linseed, or linseed itself—boiled lily roots, or onions—the matu­rating cataplasm—or the gum plaister, will answer the purpose; for these, by clogging the pores of the skin, prevent the dissipa­tion of the humours, increase the heat of the contained fluids, promote the process of fermentation, and render the humours more active in dissolving, or melting down the solid parts, as well as soften the integuments, and, by their stimulus, solicit the fluids to push outwards.

From these applications, then, the abscess will soon he in a pro­per state for opening; which must be performed in the most de­pendent part, if the swelling is equally soft throughout, and the skin of a similar thinness; if not, where the part is softest, and the fluctuation of the matter most perceptible; and the aper­ture should be made of sufficient width, in proportion to the size of the tumor, that a free egress may be allowed for the mat­ter.

After this, the healing of the wound in good constitutions is seldom attended with any difficulty—dry lint placed gently in the part, and that covered with the ointment of yellow resin, spread thin upon lint or tow, are the general dressings at first; and from these fresh granulations will appear; and in time fill up the ca­vity occasioned by the loss of substance; but should the sore ap­pear soul, covered at the bottom with a white or brown appear­ance, instead of red granulated flesh, we must apply some of those [Page 305] things considered detergent, or cleansing; as the ointment of gum elemi, of yellow resin, mixed with a proper proportion of red precipitate, or green basilicon; these will cleanse the ulcer; and then dry lint as before, and proper bandages, will in common perform a perfect cure.

But sometimes, instead of a thick well-coloured laudable mat­ter, there will be a thin ichorous discharge, occasioned by an acri­monious state of humours, while, at the same time, there will be febrile hectic symptoms.

Under these circumstances, in order to produce a laudable sup­puration, and take off the hectic affections, in relaxed habits, joined with an acrid state of the fluids, bark is the most effica­cious remedy; but where the discharge depends more upon the state of the fluids, in order to correct or evacuate the acrimony, a course of mercurial medicines, as the alternative mercurial pills, two of which may be taken twice a day, with one or two pints of the decoction of the woods, (No. 87, 88.) bid fairest for success.

There is a species of complaint very common belonging to this place, which here calls for our attention, and that is, a

BOIL, or BILE, though this seldom terminates by resolution, but commonly maturates—it is a hard circumscribed tumour, rising to a point, hot, red, and very painful, which, maturating, may be let out, or left to burst, from whence a small portion of matter only will issue forth, in proportion to the swelling, leav­ing a slough behind, which is called a CORE, and must be cast off before the wound can be healed.

In its hard and painful state, we can have no expectations of discussions; our endeavours, therefore, are to be confined to has­tening the suppuration, as we have before directed, (304.) or ap­ply bean-meal and honey, which is a favourite remedy with some—when it is opened or burst, we must proceed as before under the same circumstances in abscess (304.)

But these eruptions very often originate from a depraved state of the fluids, which occasion their frequent returns, and are ex­tremely trouble some—here we must have reference to the altera­tive course before recommended, (305.) which must be persisted in for some time, now and then interposing gentle cooling purgatives.

Thus far we have spoken of those inflammations which lie su­perficially, and are alleviated by appeasing applications; but sometimes the seat of the complaint will be too internal for them to become effectual, we then apply over the part stimulants, which have been found highly efficacious in producing resolu­tion—indeed, where complaints have been slight, applications of hot sand or salt, stimulating cataplasms, as of mustard, pelli­tory, horse-radish, Burgundy pitch, volatile liniments rubbed well upon the part, have been found serviceable auxiliaries; but [Page 306] when the symptoms have been more severe, blisters applied over the part contribute the most readily to promote resolution.

These remedies, and the sedatives and emollients we have be­fore spoken of, where the cause has been excess of the vibratory motion of the vessels dependent on some stimulus, and external remedies can be applied, have been thought necessary—or when inflammation proceeds from fractures, wounds, contusions, or such like causes, discutient fomentations, (No. 85.) are most of all to be relied on—when it depends on local relaxation, or a decrease of vascular resistance, as it sometimes does, particularly in inflam­mations of long standing—bleeding and purging should be cau­tiously advised, and all emollient poultices and fomentations omit­ted; for these, by their relaxing properties, will add to the cause a contrary plan must be adopted, calculated to give strength and acti­vity to the vessels, that the offending cause may be repelled.

For local applications, alum, white vitriol, acetated litharge, lapis calaminaris, and turty prepared, mixed with rose-water, are occasionally used; as are also tincture of roses, and slight decoctions of bark, and eye-waters; gargles made of these well adapted to relieve inflammatory complaints arising from a debi­litated and relaxed state of the vessels—and where the general state of the habit is so relaxed, as to demand the use of tonics, or such things as invigorate the system, bark and cold bathing are highly useful.

By the modes we have laid down, we shall almost always be able to conquer any common inflammation; or conduct our patient through with the greatest ease and safety, if abscess should take place—but there are some niceties to be observed, which we shall particularize.

Fomentations should never be pushed too far; for, after tak­ing off the violence of vascular motion, if continued, they induce a state of relaxation in the fibres, from which succeed debility, and obstinate tumours—instead, therefore, in persevering in their use, when excess of vibratory motion is subdued totally, and it many cases when it is allayed, corroborants then become necessa­ry, (No. 86.) or something of a similar nature.

With regard to abscesses, we must observe, that they all point, and the contained matter endeavours to make its way to the parts where it finds the least resistance—hence those formed in the lungs rupture internally; those in the viscera of the belly move externally—those which are deep seated, and formed under strong tendinous expansions, run along the spaces between the muscles, and appear at a considerable distance from whence they first originated.

Besides, they do not all originate from inflammation preserv­ing its regular course; they are sometimes critical, the effect of [Page 307] nature freeing the constitution from some morbid matter, by throwing it out of the circulation, and depositing it in some lo­cal situation, which is attended with the most happy consequenc­es, admit the vital organs, or the parts of high importance in the habit escape, from its being deposited in them. Abscesses of this kind are generally preceded by some fever; and this depo­tion of matter is called metastasis, or translation, which occurs chiefly in parts where the vessels labour under some uncommon weakness, from some cause which has left them in that state.

Under this circumstance, as soon as ever the skin is in a proper state of thinness, the matter must be let out by incision, if it can be come at, else would it, by too long continuance, dissolve too much of the solid parts, destroy the texture of the nerves and blood-vessels, produce a caries, or mortification of the bones, by penetrating through the membrane which covers them, and lay the foundation for a hectic fever, from the matter being taken up by the absorbent vessels, and carried into the habit.

In cases of EXUDATION, (300.) where the surface appears on­ly excoriated, not ulcerated, we can give the happiest assistance, when it shews itself externally by internally exhibiting such things as tend to promote resolution; and having recourse externally to such as are calculated to cleanse, heal up, and [...] then.

And when such is the circumstance on the membranes of the breast, of the belly, or the external surface of the viscera, as it sometimes is, we are assured, from the appearances on dissection, where there has been no perceptible ulcerations or destruction of the solids, though matter has been found in these cavities; by early advice judiciously given, many might be saved from some of our most fatal complaints, pulmonary, and some other con­sumptions; for many of these arise not, in the first instance, from ulcerations or little glandular tumors in the lungs, called tuber­cles, but from matter exuded from membranous surfaces, which acquire a degree of acrimony, and then, by melting down the so­lids, cause ulcerations: and I have no doubt but by a very early application tosuch modes as we have specified for resolution, these mischiefs might be often prevented—but here the great misfor­tune is delay; patients, in the infancy of this complaint, by dabs, nostrums, and old family prescriptions, losing the favourable op­portunity which ought to be given to the well-informed physi­cian, applying for such aid only when some of the internal parts have suffered irrecoverable injury.

Though we have before spoken of the erysipelas, or Saint An­thony's fire, which arises from a febrile cause, there is another sort which sometimes succeeds external injury; and in this, if the inflammation runs high, bleeding and purging are highly ef­ficacious; and in the intermediate times, betwixt the administra­ting [Page 308] of purgatives, I depend upon saline diuretics, (176.) and even those purgatives which I prefer, are such as most powerfully eva­cuate the serous humours, such as vitriolated natron, Rochelle salt, regenerated tartar, jalap, syrup of buck thorn, &c.

The external applications in these cases should be such as will expel the obstructed fluids through the pores of the skin; hence diluent fomentations are recommended, decoction of linseed, and white poppy heads, with elder and chamomile flowers, and a pro­per proportion of soap liniment, one ounce and a half to two ounces to a quart, whilst there is no break upon the skin—chalk, or fine flour, spread upon the part, and confined with a fine rag—and lotions of the vegeto-mineral water are thought by some highly serviceable, where resolution is the aim.

But when pimples or painful blisters make their appearance, equal parts of lime-water, oil, vinegar, and comphorated spirit of wine, form an efficacious composition to lay on the inflamed part, by means of a rag dipped into, and well loaded with it—or the ointment called unguentum tripharmacum, or that of a­cetated ceruss, have been considered as proper applications.

We must now proceed to speak on MORTIFICATION, another termination of inflammation, (301.) which generally proceeds in the following manner. At first the swelled part begins at the point to grow yellow, the pain is mitigated, and a dingy colour comes on; the skin is flabby and soft, retaining the impression made by a finger upon it, it loses almost all sensation, and grows livid—a tumid elevation of the part is perceived, which diffuses itself around—there appears pustules of a thin yellowish acri­monious liquid, which are black at their basis—then the skin and parts underneath corrupt, become dead, black, losing all sen­sation, and dissolve into a foetid stinking sanies—the mortification creeps onwards, and seizes the neighbouring parts—at length shivering, fever, cold sweats, small and weak pulse, and faint­ing, bespeak the approach of death.

In the beginning, when the source of this mischief has been external injury, and there is much strength of constitution, in­dicated by a full, hard, quick pulse, high degrees of heat, pain, and dryness, the cooling method is to be pursued, as if resolu­tion was to be brought about; and though in this we cannot hope to succeed, we are warranted in this mode of procedure, by the extreme violence of the symptoms, with intent to bring on a state of suppuration, by checking the vehemence of the circula­tion, and preventing the vessels from being ruptured—besides, exudation would be favoured from the continuance of relaxing and emollient fomentations.

But mortifications arise from very different sources, and affect different constitutions—should they happen to patients, there­fore, [Page 309] whose blood is in a thin, acrid, putrescent state, which will be indicated by debility of the pulse, loss of strength, lowness of spirits, foetid thin acrimonious discharges, and, should blood be taken, by its texture being very weak, we must have recourse to invigorating and cordial remedies; as bark, wine, mineral acids, and such like, in order to prevent the access of gangrene, and produce a separation of the part affected; and, in cases of great pain, opiates have been advised with very fortunate ef­fects; indeed, whether the cause is internal or external, the free use of opium is directed, and considered as the greatest internal cordial known—as an external application, the antiputrescent lo­tion, (No. 90.) is recommended to be applied frequently, warm, as it is also stimulant and digestive—cataplasms of cummin-seed, and the carrot poultice, are much approved; but if emollients are mixed with antiseptics, (192.) they are said to assist in the separation of the putrid parts, and stopping mortification.

The last termination of inflammation is SCIRRHUS, (302.) or indolent tumor, which arises from obstructions forming in some of the glandular parts, as before described, where either no sup­puration takes place, or if it does, it is in no small a degree, that it has not power to melt down the solids sufficiently to remove the induration—or it may be brought on by the too long use of warm fomentations, soliciting too free and long continued flux of humours, relaxing the vessels of the parts, hence occasioning haro swellings, which are not easily removed.

Now these swellings which we here consider are totally free from all acrimony of any peculiar nature, and, as the fluids are in a sound state, it is often the most eligible practice not to in­terfere by any applications—because in young subjects they will very often gradually wear away; in older ones continue gene­rally without creating any uneasiness or inconvenience—but should the hardness be so considerable as to require particular at­tention, warm vapour or steam directed to, and confined to act upon the part affected, is one of the most efficacious applications in this case.

Sometimes these tumors are soft and flabby, then frictions, and well adapted bandages, where they can be applied, are useful; or letting cold water fall from some height upon the part, or pumping upon it, seems best calculated to succeed.

Thus far has it been necessary to premise, before we enter on the inflammation of the different parts, wherein the treatment of the inflammatory symptoms will be nearly similar; but there will be some deviation necessary on account of the parts affected—for the INFLAMMATION OF THE BRAIN will require a differ­ent treatment from that of the eye—OF THE EYE from that of [Page 310] the lungs—OF THE LUNGS from that of the intestines, &c. to which we shall new proceed.

CHAP. II. INFLAMMATIONS OF THE HEAD AND NECK.

CHAP. II. INFLAMMATIONS OF THE BREAST.

CHAP. I.

CHAP. I. ALVINE EVACUATIONS.

THESE may all come under the term LOOSENESS—DIAR­RHOEA from dia, per, and rheo, to flow, though they are by authors divided into different species, either from the nature of the affection, or from the appearance of matters which flow through the bowels in too large quantity—the first of which is [...] DIARRHOEA, or COMMON LOOSENESS, when there is a constant and remarkable evacuation by stool of liquid matters without much pain or uneasiness; but when there is an evacua­tion of slimy matter, sometimes bloody, attended with febrile affections, severe gripings, nausea, or sickness, and frequent pro­ [...]sity to go to stool, with very small evacuations from such ef­forts, it is called DYSENTERY, DYSENTERIA, from dus, male, and enteron, intestinum, intestine.

When the disease is very acute, attended with a continual vo­miting of bilious matter, and at the same time a violent loose­ness, or at least a nausea, and strong propensity to go to stool, with loss of strength, and very often cramps of the thighs and legs, it is called CHOLERA MORBUS, from kole, bilis, bile.

When there is a frequent purging of bloody serum, as if raw flesh had been washed in some liquid, supposed to flow from the liver, it is called INDOLENT, because unattended with any se­vere pain, great sickness, or remarkable loss of strength—this evacuation is therefore named HEPATIRRHOEA, from epar, je­cur, the liver, and reo, fluo, to flow.

If there is a frequent purging, in which the aliments appear scarcely to be changed by the digestive powers, and comes on immediately, or soon after eating, it is termed LEIENTERIA, from leios, laevis, smooth or slippery, and enteron, intestinum, intestine

Should there be a frequent evacuation of white matter, sup­posed to be chyle, it is termed COELIACA, from hoilia, [...]enter, [Page 382] the stomach, or first bowels, where the first digestion takes place, and forms chyle, which chyle is supposed to give the appearance from whence this disease is nominated.

If of black matter, or of a deep red colour, is then called ME­LAENA, from melas, niger, black, unattended with any putrid smell, sudden deprivation of strength, or remarkable degrees of pain, or nausea.

However, it will be sufficient to take notice only of two of these, as the rest may be cured by the same means made use of in some of the stages.

CHAP. II. HAEMORRHAGES,

FROM the Greek words aima, sanguis, blood, and rennumi, e­rumpo, to break out, or [Page 390] SANGUINARY EVACUATIONS.

All these effusions of blood are considered as morbid, which either flow from particular parts not naturally accustomed to pro­duce such evacuations; or, though producing them periodically, still afford them in too great quantity, or return at too quick periods, that the machine, by these means, is so injured, as to experience some defect in executing its functions properly, and consequently falls into a diseased state, attended with a greater or less degree of danger, according to the violence of the effu­sion, or to the consequence of the part from whence it flows.

Now all haemorrhages arise, either when the circulatory pro­pulsive powers are increased to a great degree of violence; or that the resistance of the blood on its part and the vessels should be diminished; or that each of these things should happen at one and the same time.

Hence, then, we find, that complaints of this nature may be occasioned in four different ways—by the vessels being ruptured, dilated, or eroded; or, by the blood having lost its natural vis­cidity, and becoming to thin—under any of these circumstances, the vessels not being capable of confining the blood within its proper channels, occasion haemorrhage—whence arise a variety of these complaints, taking their names from the places from whence the blood issues; or the action of the parts producing, instead of their natural, these sanguinary discharges.

Hence BLEEDING OF THE NOSE, named EPISTAXIS; from the Greek word epistaz [...], sanguinem e nasibus stillo.

SPITTING OF BLOOD—HAEMOPTYSIS, or HAEMOPTUON, from aima, sanguis, blood, and ptuo, to spit.

VOMITTING OF BLOOD—HEMATEMESIS, aima, sanguis, and emeo, to vomit.

MAKING BLOODY URINE—HAEMATURIA, aima, blood, and ouron, urine.

PILES—HAEMORRHOIDS, aima, sanguis, blood, and rheo, [...]luo to flow.

MAENORRHAGIA, mene, menses, and rheo, to flow.

In all morbid effusions of blood, from whatever place they is­sue, we endeavour to find out the proximate or acting cause be­fore enumerated, and form the modes of cure accordingly;—but as effusions of blood from the lungs is of the most dangerous nature, we shall select that, in order to point out the particular mode of proceeding, and occasionally advert to what deviations may be necessary on account of the difference of situation of the part affected.

CHAP. III. ON FLUXES. When the Serum or Lymphatic Part of the Fluids are evacuated in too copious Quantities.

ALL fluxes may be said to be of the serous kind, which de­pend upon an evacuation of some of the secreted fluids, and are neither of the alvine nor sanguineous class. In this place, however, we shall treat only of the DIABETES, from diabaino, permeo, to pass through, or a

CHAP. I.

CHAP. II. PASSIVE NERVOUS AFFECTIONS.

THE nervous diseases of which we have before treated are ob­viously of the active sort; but there are others which are associated with inactivity, with respect to muscular motion, and constitute a class of diseases opposite to the former. These are ranked by authors under the terms DEBILITIES and PRIVA­TIONS; because of the loss of, or weakened action of particu­lar powers in the constitution, which are the distinguishing cha­racteristics of these diseases.

Dr. CULLEN arranges these under nervous diseases; and are known by that propensity to sleep, muscular relaxation, and in­sensibility, which are their constant concomitants.

But, in order to give a proper idea of these diseases, we should consider the cause of the three predominant symptoms. If we revert back to what has been said, page 27, on nervous in­citability, and muscular irritability, and to the introductory part of nervous affections, we shall not be at a loss to account for two of the symptoms.—As for the unnatural propensity to sleep, it is supposed to arise from the nerves not being suffici­ently supplied with their proper fluid, either from a defect of the general mass of this enlivening liquid, or from some com­pression on the nerves, by which its free distribution is imped­ed.

Hence extreme cold, excessive discharges of blood—congestion, and over distensions of the vessels of the head, of sanguinary or serous fluid in the ventricles, (27.) and cellular interstices of the brain—extravasated blood within the cranium—depression, o [...] fracture of the skull, forcing it upon the brain, so as to compress the medullary part, and prohibit the circulation of the nervous fluid from thence to the several organs of sensation, and instru­ments of voluntary motion, may give rise to this symptom of somnolency, or unnatural propensity to sleep.

Now, where this symptom predominates over the rest, those diseases come under the general term COMATA, comatous or som­nolent, [Page 423] from the Greek word koma, somnus profundus, a deep sleep—and are defined as diminution of voluntary motion, at­tended with sleep, or a deprivation of sensation.