In STRONG, ROBUST CONSTITUTIONS,

The muſcular ſtamina are firm, and well compacted; powerful and agile in motion; the pulſe ſtrong and full; the nerves equable and forcible in their influence; the circulation of the blood free, and the texture of that fluid poſſeſſed of great tenacity; the complexion healthful, and the whole habit in a ſtate of ſtrong activity.

In WEAK, RELAXED, and DELICATE,

The reverſe of theſe occur—the muſcular ſtamina are weak and looſe, imbecile in motion, and ſoon wearied; the pulſe ſmall and quick; the nerves irregular and debilitated in their influence; the circulation of the blood languid, its texture looſe; the complection pale or fellow; and the whole habit in a ſtate of debility.

In the NERVOUS—the conſtitution is like the l • tter in a great degree, but the nerves are eaſily in • itable from ſlight cauſes, creating ſpaſmodic affections in different parts. People of this conſtitution are generally timid—have great variability of ſpirits, and much ſubject to hyſterio fits, cramps, and flying pains,—putting on the appearance of various complaints, according to the parts affected; the urine is commonly pale, ſometimes made in ſmall quantities, then becomes turbid—or in large quantities, then remains limpid. In theſe, therefore, the nervous ſyſtem is in ſuch a ſtate, ſo as to be quickly incitable, and readily and frequently thrown into morbid action.

In the IRRITABLE,

There is a ſtrong propenſity in the vaſcular ſyſtem, and muſcular fibres, to be thrown into quick ſtates of contraction—the conſtitution being in an intermediate ſtate, between the robuſt and relaxed, and participating, in ſome degree, of the nervous. Theſe are ſubject to have the circulation of the blood readily increaſed—fluſhings in the face—are iraſcible, and eaſily moved to anger—they are ſoon heated by any ſtimulant taken internally.

Oppoſite to this conſtitution is the

TORPID.—In theſe the circulation of the blood is languid, ſeems rather to creep, or undulate, than circulate; the extremities are generally cold, and they feel, without any cauſe very often, internal oppreſſion; dreading, and fearful of imaginary calamities—they are naturally inactive, and indolent, unleſs rouſed by ſome pleaſurable purſuit; irreſolute, mutable, and very often timid in the extreme, where any difficulties are to be ſurmounted, and the habit is generally coſtive.

The PHLEGMATIC.

In theſe the lungs, ſtomach, and inteſtines, are apt to be loaded with too great a quantity of viſcid phlegm—from the digeſtive organs being in too weak a ſtate, and wanting a due ſecretion of bile—the habit coſtive—in general cold—ſubject to chronic coughs, and expectoration of tough viſcid phlegm—the circulation of the blood ſluggiſh—the breathing laborious—the muſcular fibres and vaſcular ſyſtem torpid—though corpulent, they very often are groſs, and frequently ſubject to oedematous, or paſty ſwelling of the legs.

The PLETHORIC.

Theſe are ſuch whoſe conſtitutions is apt to breed a great quantity of blood, and are chiefly of the irritable claſs, more inclining to the robuſt and athletic. In theſe the digeſtive powers are good—the appetite ſometimes voracious, ſometimes moderate—frequently haemorrhages occur, and very often copious evacuations of different ſorts—alſo head-aches of the dull, heavy kind, attended with frequent giddineſs—they are liable to become often drowſy and ſleepy, and fond of that ſpecies of indulgence—and theſe generally ariſe from too great plenitude in the ſanguinary ſyſtem.

The BILIOUS.

Are ſuch as have a very copious ſecretion of bile, which is apt to collect in its repoſitory the gall-bladder, nor be regularly excreted, or paſs into the duodenum, or firſt inteſtine—by which means, ſtagnating there too long, perhaps from its viſcidity, it acquires a degree of acrimony, which, when poured into the inteſtines, occaſion bilious colic, cholera morbus, or a vomiting up and purging of bile—bilious looſeneſs. In theſe, the complection has generally a ſallowiſh caſt; they complain frequently of bitteriſh taſte in the mouth—are commonly coſtive, and have deep-coloured urine often, depoſiting a yellow ſediment; their appetite is very variable, and their digeſtion, for the moſt part, weak.

The COSTIVE.

In theſe conſtitutions, ſome of them are naturally ſo inclined—but if not, it depends on particular ſtates of the inteſtines, abdominal muſcles, and the different viſcera that pour forth their contents into the bowels; in theſe caſes, the inteſtines are either in a ſtate of too great torpidity, or there is a deficiency of the internal fluid—pancreatic juice—or bile, which laſt may be too inert—or the abdominal muſcles may be too relaxed—which occurs ſometimes in women who have had ſeveral children.

The contrary of which happens in

The LAX;

for in them the inteſtines may be in too irritable a ſtate—ſlightly moved, or may be too ſlippery, from an increaſed diſcharge of the pancreatic and inteſtinal glands—or the bile may be too acrimonious—or acrid humors may be too conſtantly poured into the inteſtines, and ſtimulate them to too ſtrong and quick repeated action.

The FLATULENT

Are ſuch as have too great a quantity of wind, or air, in the habit, in a looſe unfixed ſtate—particularly in the ſtomach and bowels, which is diſcoverable very often by flying, wandering pains, increaſed on warmth by its rarefaction—by diſtenſion of the ſtomach and inteſtines—a • umbling noiſe in the bowels—emiſſions of wind upwards and downwards—and theſe may occur from a weak digeſtion—allowing particular materials to emit their air, and the juices formed from them incapable of re-abſorption—from their not being properly elaborated in the firſt paſſages: from being alſo too tight laced, women often induce this complaint—and by the too common and frequent uſe o • warm • lyſters—by a relaxed ſtate of the ſtomach and inteſtines—and by feeding conſtantly on flatulent food, and keeping long faſts.

The SCORBUTIC.

Such are indiſcrimately ſo ſtiled, who have the appearances of eruptions on the ſurface of the ſkin of different 〈◊〉 — 〈◊〉 pimples, nettle-raſh, or dry ſcurfy ſcales—the • e truly indicate a prevalent acrimony in the habit of ſome ſort; but the true ſcorbutic conſtitution is known by other marks—black, or livid, or yellow ſpots, on the ſurface of the ſkin—tender gums—bleeding on the ſlighteſt touch—ſallow complection—rank fetid ſweats—looſe texture of the fleſhy parts appearing puffy and flabby—and this owes its origin to the texture of the blood being in a broken or very looſe ſtate—whilſt the former depends more upon acrid humors in the habit—obſtructed, or rather diminiſhed, perſpiration—weak digeſtive powers, and feeding on unwholeſome food, or eating and drinking too freely and luxuriouſly.—Theſe, therefore, are better divided into acrimonious and ſcorbutic—the firſt where the acrimony of the fluids is indefinite and cannot be ranged under any known ſpecies.

The GOUTY

Are ſuch as are troubled with flying pains, occupying chiefly the ſmall joints of the hands and feet—and having regular fits of that diſeaſe—being ſubject frequently to indigeſtion, and to be ſeized with pains of the joint of the great toe—or having pains of the ſtomach and kidneys, alternating with thoſe of the hands and the feet—ſubject, from the ſame cauſe, to be teaſed with pains in various parts before the fit of the gout has become regular, or has retroceded, or is miſplaced, owing often to debility of the active powers of the conſtitution—particularly the ſtomach and vaſcular ſyſtem.

The RHEUMATIC.

Theſe are ſuch conſtitutions as are replete with rheumatic acrimony, which fixes itſelf in different parts of the machine, chiefly on the large joints, and runs along the courſe of the muſcles—or fixes itſelf alſo on the membranes of the muſcles, ſometimes affecting one, ſometimes another—and flies conſtantly from place to place, aſſuming different appearances according to the peculiarity of the habit in which it reſides—becoming in ſome acute and inflammatory, particularly in the robuſt and athletic, who have ſtrong ſtamina, and are readily irritable—in others, painful and chronic—in ſuch whoſe conſtitutions are more debilitated or torpid.

The SCHROPHULOUS.

Are ſuch, in which that taint called ſcrophula, or King's evil is inherent, manifeſting itſelf by glandular tumors, chiefly of an indolent kind, in the neck, for the moſt part, but alſo in other places of the body, where the lymphatic glands are diſperſed, particularly in the lungs and meſentery—attacking the fair complectioned and delicate moſt commonly—ſhewing itſelf alſo by an enlargement of the upper lip and alae naſi, or ſides of the norſtrils—and ſwelling of the belly—a preternatural ſlight heat generally attending the whole habit—and febrile affections—and ſometimes a ſhort tickling cough.

The HOT and COLD

Depend upon the quantity of blood, in an healthful ſtate and different degrees of vaſcular action—if the habit is full, and the veſſels are in a ſtate of irritability, the conſtitution will be of the former claſs—if there is a paucity of that fluid, or no redundancy, and the vaſcular ſyſtem is in torpid ſtate, whereby circulation is not duly performed, it will be of the latter—for where the blood is moſt ſuperabundant, and irritability of the vaſcular ſyſtem great in degree there will always be the moſt heat, and vice verſa.

The CONSUMPTIVE.

Theſe are generally ſuch whoſe texture of ſolids are very delicate—the vaſcular ſyſtem irritable, and ſome degree of acrimony in the humors—pale complectioned—narrow cheſted—long necked—ſubject to febrile heats, imitating hectic—eaſily thrown into pulmonic haemorrhages—and frequently affected with ſlight tickling coughs—their teeth clear, with an appearance like tranſparency—their eyes often bright, ſometimes towards evening languid—the ends of the fingers rather bulbous—and the nails curved inwards, particularly when they approach near a morbid ſtate.

We have here attempted to point out what is to be underſtood by the terms commonly made uſe of in applying them to particular conſtitutions; but we find that ſome have alluſion to, and involve general ideas—whilſt others are only confined to ſingle or particular ones, and of which no uſe can be made, whilſt in ſuch a vague, and unſettled ſtate—for in order to be of ſervice, either in our preventive or curative plan, we muſt advert to thoſe particulars which form conſtitutions in general—for it is by the regulating of them we muſt adminiſter relief, when afflicted with diſeaſes to which they are prone—and prevent thoſe whoſe ſeeds are diſſeminated through the habit from becoming active, and by that means conſtituting complaints to which they are ſpecifically adapted—we, therefore, form conſtitutions into ſeparate diviſion • —ſuch as are ſimple and general—mixed and general—and ſuch as are peculiar.

SIMPLE, and GENERAL are, 1. Strong and robuſt. 2. Nervous. 3. Irritable. 4. Torpid. 5. Weak, relaxed, and delicate.

But theſe may be combined—and form others, As STRONG—ROBUST—and Irritable, Torpid, Nervous. Though the firſt of theſe is what moſt commonly takes place.

The WEAK, DELICATE, and RELAXED—may alſo be ſubject to the ſame combinations— Nervous, Irritable, Torpid; Apt to take place in the order here ſet down—with regard to the moſt general mode.

The MIXED and GENERAL—are 1. Plethoric. 2. Hot. 3. Cold, 4. Conſumptive. 5. Acrimonious. For theſe may be combined with any of the former—but depend upon the quantity and quality of the blood—and the greater or leſs degree of the irritability, or incitability of the vaſcular or the nervous ſyſtem.

The PECULIAR are, The 1. Lax. 2. Coſtive. 3. Bilious. 4. Phlegmatic. 5. Scorbutic. 6. Gouty. 7. Rheumatic. 8. Scrophulous. And 9. Flatulent. Any of which may be combined with thoſe which are ſimple and mixed—as a conſtitution may be

Strong, robuſt, plethoric, hot, coſtive, gouty—ſo may the weak, relaxed, and delicate—though plethora is moſt generally the concomitant of the former.

It will be unneceſſary to form any other combinations in this place, as the reader will very readily conceive them himſelf; we ſhall only, therefore, obſerve, that there are ſome which can never exiſt in a combined ſtate, viz.

The ſtrong and robuſt, with the weak, relaxed, and delicate—the hot and cold—the irritable and torpid—the lax and coſtive.

Now as there is certainly ſuch a diverſity of conſtitutions, many of them diametrically oppoſite to each other; and as there is alſo a variety of accidents and diſeaſes which will affect the different conſtitutions in ſimilar modes, how can it happen that one and the ſame application ſhall be proper to all? For it is owing to the operations of the habit that diſeaſes are prevented—made milder, or cured; and it is to our applications, that theſe ſalutary operations are often brought about where nature is defective—and, conſequently, obliged to our aſſiſtance. We muſt, therefore, ſelect our remedies, and appropriate them to the particular conſtitutions; and let our directions be formed, with reſpect to diet and conduct, conſiſtent with the ſame conſtitutional points—and more eſpecially where our attempts are levelled at the prevention of morbid attacks; in completing of which we are to aim at keeping the conſtitution in a ſtate of health, adequate to the powers with which it was originally endowed; ſo that the common cauſes of diſeaſes may not be enabled to produce their effects; which originate from different qualities and changes of the air; called conſtitutions, climate, morbid effluvia, and intemperance or indiſcretion; under which laſt we comprehend all thoſe actions which, in their regulations, depend upon our own power, or are deduced from neceſſity.

Or, that ſuch diſeaſes, as are unavoidable, may be made to produce their influence on the machine in the moſt mild and gentle ſtate; ſuch as, ſmall pox, meaſles, and various fevers, and other complaints of the infectious or contagious claſs; or thoſe which ariſe from an hereditary cauſe: in accompliſhing which purpoſe, it will chiefly depend upon the proper uſe and application of what are called the NON-NATURALS; which, before we can be enabled to give proper directions in theſe points, we muſt examine, and ſhew the peculiar influences they are capable of producing in the habit.

AIR.—And here we mean not to enter into philoſophical or chemical ſubtleties of the nature of this fluid, but confine ourſelves to that of atmoſphere, whoſe different ſtates and changes produce perceptible effects on the conſtitution—and which all ages have conſidered as one of the occaſional cauſes, and that very material, of health or diſeaſes, according to its good or bad properties, affecting the body by inſpiration, as well as its circumambiency. It is a fluid poſſeſſed of ſpecific gravity, elaſticity and tranſparency, and compreſſible—it ſurrounds the earth, and when agitated, or driven in currents, forms wind: it is extremely ſubtile, penetrates, and mingles with every part of the body, and by its elaſtic property, gives an inteſtine motion to all the fluids, and a lively ſpring to all the fibres, which promote circulation; it is never abſolutely pure, but always mixed with heterogeneous particles, and that air which we call pure, is ſuch as is not overcharged with any ſteams.

It has its varieties, and differs with reſpect 1. To its weight or levity. 2. Heat or coldneſs. 3. Dryneſs or moiſture. And 4. Purity or impurity. Now theſe properties of the air ſeparately, or by their different combinations, produce many unpleaſant effects on the conſtitution—give riſe to and aggravate many ſymptoms in particular complaints—as well as are the origin of many diſeaſes themſelves.

1. For if the air is too heavy, it produces inflammatory affections of the membranes in the cheſt and lungs, called pleuriſy and peripneumony, head-ach and giddineſs, &c. by preſſing upon the ſurface of the body—obſtructing the pores of the ſkin, hence impeding perſpiration—accelerating the motion of the blood—occaſioning it to crowd on the internal parts, and there circulate too rapidly—hence it is impelled too forcibly upon the lungs, and too copiouſly upon the brain—impeding, indeed, the natural functions of thoſe organs which lie remote from the ſurface of the machine.

2. If it has too much levity, its elaſticity, is increaſed, and hence produces, by vaſcular diſtenſion retarding the circulation of the blood, and by diminiſhing the reſiſtance of the fluids contained in the pulmonary veſſels, diſcharges of blood from the lungs—hyſteric, and hypochondriacal affections—rheumatiſm—gout, &c.

3. Should the air be too hot, by rarefying the humors, and weakening the fibres, it increaſes the circulation, and augment; perſpiration, in which it is greatly aided by its additional ſtimulus on the vaſcular ſyſtem—whence acrimony is induced in the remaining fluids.

If too cold—local inflammations—as quinſeys, pleuriſies, peripneumonies, are brought on by over diſtending the lungs from its gravity—increaſing the tone of the veſſels by conſtringing their fibres—condenſing or thickening the humors—and leſſening perſpiration. And ſhould this ſtate of the air ſuddenly ſucceed too long-continued heat—ardent, bilious, and other fevers are the conſequence—by producing its effects on the conſtitution, where the blood is in too rarefied and acrimonious a ſtate, and the humors participating of that acrimony with which the ſanguinary maſs is ſo replete.

4. Too dry an air ſhrivels 〈◊〉 the ſolids, incraſſates or thickens the fluids, and diſpoſes to febrile affections—whilſt too great moiſture in that fluid, relaxes, and debilitates, leſſens perſpiration, renders the blood too watery—and by theſe means becomes extremely injurious, laying the foundation for coughs, aſthmas, dropſies, intermittent and nervous diſorders.

From the combination of ſome of theſe different qualities of the air, different affections found their origins.—Coldneſs and moiſture are offenſive, we find, to the conſtitution—but heat, moiſture, and levity, are more pernicious, becauſe theſe, acting together, ſupply the habit with a putreſcent tendency, from whence many of our moſt dangerous complaints ariſe, as vomiting and purging of acrid bile, called cholera, bilious looſeneſs, malignant fore-throats, and putrid fevers.

5. The purity and impurity of the air depends upon the greater or ſmaller quantity of heterogeneous particles; theſe are particles which belong not to the air in its natural ſtate, which float in it—hence it has, beſides the above evident qualities, others which eſcape detection by the ſenſes, though from their deletrious or miſchievous effects, ſufficiently manifeſt—ſuch are from infections of various kinds—as ſmall-pox, meaſles, ſcarlet fever, &c. malignant effluvia, exhalations, &c.

With regard, however, to the ſalubrity of the air, we muſt obſerve—that is moſt ſalutary, which is pure, dry, and temperate, untainted with noxious damps, or putrid effluvia, from any cauſe whatever; but the ſureſt mark of good air in any place, is from the longevity of its inhabitants.

The evident marks of a bad, or inſalubrious air in any houſe, are dampneſſes, or diſcolouring of plaiſter or wainſcoat;—mouldineſs of bread, wetneſs of ſponge, melting of ſugar, ruſting of braſs or iron, and rotting of furniture:—and nothing is more conducive to render air noxious, load it with putrid ſteams, and breed bad diſtempers, than permitting common and crowded burial places to be within the precinct, of populous cities; or numbers of poor people living in uncleanlineſs, collected together in ſmall houſes, or narrow ſtreets.

Valetudinarians experience the moſt agreeable ſenſations when the wind is weſterly, though when at north, or north eaſt, it is accounted bracing and healthful. Indeed ſo powerful an effect has the influence of the winds, agreeable to the quarters in which they were fixed, been ſuppoſed to have, that it has been aſſerted, our diſpoſitions and tempers are greatly affected by them;—long continued eaſterly winds make people, who are naturally cheerful, very irritable and moroſe. Nor does our tempers being affected by the different ſtates of air, ſeem at all improbable, inaſmuch as the body and mind are linked together in ſuch cloſe and intimate bonds of union, that they reciprocally affect each other: for as corporeal affections will, we know, alter the natural diſpoſitions of people—making the placid and ſweet tempered, often petulant and peeviſh—the courageous, timid, fearful, and irreſolute—the moſt patient, reſtleſs and unquiet—the lively and volatile, languid and deſponding—and the moſt active, indolent,—ſo may the air, as it conduces to throw the conſtitution into ſtates nearly morbid, produce, in ſome degree, ſimilar effects—as has been repeatedly experienced by men, not diveſted of obſervation.

A weſt wind, in general, is eſteemed the moſt ſalutary—then a north-weſt—after which ſucceeded, in degrees of ſalubrity, in the following order—eaſt, north-eaſt, and laſt, ſouth and ſouth-eaſt—and theſe may be accounted for, from the different qualities of the air, in proportion to the exceſs or deficiency of heat, coldneſs, moiſture, dryneſs, weight, or levity—or the different noxious or contrary combinations they bring along with them.

From what has been advanced, the ſituation of our habitations will be a very material conſideration, in conducing to the preſervation of our health.

The moſt healthy expoſure, we have been told, in any place fixed for reſidence, is to be found by cutting one of the trees near the place where the houſe is to be built, tranſverſely with a ſaw, then cloſely to obſerve the rings which appear on the ſurface of the ſection; the ſide of the tree on which the diſtance of the rings from each other is greateſt, is the moſt healthful expoſure. And this is obvious, becauſe there has been the greateſt accretion of matter by the healthful diſpoſition of thoſe parts ſo made, from always being blown upon by air from the moſt ſalubrious quarter, which it faces, and being hid from that which comes from the oppoſite, which ſeems to produce a different effect—and it is an admitted fact, that in all places, or parts of country, where vegetation is moſt vigorous, manifeſted by the ſtrength and richneſs of the vegetable claſs; there will alſo animals enjoy the ſame conſequences—hence ſhould the windows of the houſe, all other circumſtances being the ſame have a ſimilar aſpect.

That houſe is conſidered as healthy which is ſituated on riſing ground, or ſide of a hill, and gravelly ſoil, becauſe it is leſs expoſed to damps and ſtagnant waters, in an open dry country; the rooms ſhould not be ſmall, but rather large—though not cold; the expoſure prudently adapted to the nature of the climate, but ſo contrived, that it may be perflated by the eaſt and north winds, whenever you pleaſe, which ſhould be at leaſt once a day—to blow away animal ſteams, and other noxious vapours;—but the air of the bed-chamber, eſpecially, ſhould be pure and untainted, not near the ground, or any kind of dampneſs. We may in general conclude, thoſe ſituations are moſt ſalutary, where theſe different properties of the air commonly attend in degrees of mediocrity, ſteering in a medium between two extremes—nor will it be a ſmall addition, if they are near a river or brook, whoſe ſtream is conſtantly running over a gravelly or ſandy bottom—for ſtanding water is always detrimental.

The country is more healthy than cities, or large towns, which are populous, from the greater purity of the air, if they are in ſimilar ſituations; but ſome countries are extremely unwholeſome, from the noxious vapours with which the air is impregnated—as thoſe near the marſhes of Eſſex, fens of Cambridge-ſhire, or contiguous to lead mines, and ſmelting houſes; for in grounds cloſe to theſe two latter, animals which graze there are often deſtroyed, and vegetation greatly impeded: indeed the miners, ſmelters, and people in the vicinity, are ſubject to the dry or convulſive colic, and paralytic affections.

Theſe are the principal effects of the air—we muſt proceed to examine

2. ALIMENT;

Under which term is comprehended all thoſe eſculent animals and vegetables, as well as liquids, by which we are ſupported, and which we uſe in common for the purpoſe of nutrition; and theſe are ſuppoſed to poſſeſs different degrees of nouriſhment, moſt of them having paſſed through ſome culinary proceſs, more or leſs adapted to our nature, before they are received into the ſtomach, but which have particular portions proper to be aſſimilated, and form parts congenial with thoſe of the human machine to which they are applied.

But before we enter on the particular nature of our various, aliments, as we are writing to people who are not thoroughly converſant with the animal oeconomy, it may be neceſſary to premiſe ſome account for their information, of the different proceſſes nature has affixed towards the completion of this aſſimilation.

As ſoon as the morſel is put into the mouth, it undergoes, by the teeth, and action of the muſcles of the jaws, a conſiderable diviſion, by the office of maſtication or chewing, in order that its texture may be broken, and mixed with a due proportion of ſaliva, before it paſſes into the ſtomach—ſome more fluid being acquired in its deſcent;—when it arrives at the ſtomach, it there gets blended with the juices of that organ, ſuppoſed, and proved by Spallanzolli, to be a powerful ſolvent of our food, and ſome ſmall portion of bile; and, during its reſidence there, experiencing the effect of heat, and muſcular action, from the coats of the ſtomach, and motion of the diaphragm, lungs, intercoſtal and abdominal muſcles, and the large blood-veſſels and parts which lay contiguous; it thence paſſes gradually over the pylorus, or lower orifice of the ſtomach, and the • e meets with the bile from the gall-bladder and liver in much larger quantity—the pancreatic juice, or that of the ſweet-bread, ſimilar to the ſaliva, but rather more viſcid—and the fluids ſeparated by the inteſtines; and here it is ſubſervient to the further action of the muſcular coat of the inteſtines, and their periſtaltic motion—churning, as it were, their contents and minutely mixing and blending together, the food taken in; and the different juices, which it has received in its ſtate of comminution and ſolution—from all which a milky juice is formed called chyle—this is ſeparated from the faeculent ſordes, and taken up by a ſet of ſmall abſorbent veſſels called lacteals—which open upon the inner coat of the inteſtines, and paſs through the medium of the meſentery, which is the connecting membrane of the bowels, to the lower vertebrae of the loins, and there empty themſelves into a veſſel, called the thoracic duct, or receptaculum chyli—but there are, through the meſentery, various glands interſperſed, through which theſe lacteals paſs, and where the chyle is mixed with a thin lymph ſeparated there for this purpoſe, in order to rend it more fluid. It is by theſe lacteal veſſels, the motion of the inteſtines, and the force of the circulation unavoidably carried forward to the thoracic duct, as it cannot regurgitate, on account of the valves in various parts of theſe lacteals, which prevent its retroceeding motion—becauſe they open only forwards—and are ſhut cloſer by any fluid preſſing backwards: thus then is the chyle thrown into the receptacle—which continues its courſe, to the ſubclavian vein, along the vertebra—into which it enters, and from whence the chyle i • poured, and thence immediately thrown into the right auricle and ventricle of the heart, where it mixes with the blood, and paſſes into the lungs—here it receives a conſiderable trituration, receiving material alterations from thence, and from what it receives from the atmoſpheric air inſpired into that organ;—from the lungs it returns through the pulmonary vein into the left auricle of the heart, then into the ventricle—from whence it paſſes, mixed with the ſanguinary maſs, into the aorta, or large artery; and is diffuſed univerſally through the machine, where it is completed for the purpoſes of nutrition—being perfectly aſſimilated into the nature of animal juices—and by its proper application to particular parts, wanting the addition of nutrient fluids, renews what has been abraded, and thus keeps the machine in a ſtate adapted to the performance of its neceſſary functions, ſupplying portions proper for the requiſite ſecretions. By theſe various means is this aſſimilating effect produced—a contrivance, which nothing but divine and beneficient Wiſdom could be adequate to beſtow—for let the animal be fed upon food, ever ſo various, and diſſonant in their own peculiar properties, ſtill that power can convert materials ſo diſagreeing to the advantage of the creature feeding upon them; nay ſome, ſuch as goats and aſſes, will be nouriſhed by the products of nature—which, to horſes, oxen, ſheep, &c. prove the moſt fatal poiſon.

It is moſt probable that our firſt food was of the vegetable claſs, in the ſelection of which, man was directed by experience, led to it from the ſmell and taſte; and the ſupport and increaſe of ſtrength from thence conſequent, would confirm their uſe. But beaſts being troubleſome to the cultivators of the earth, and vegetable diet not being proper to ſupport ſufficiently thoſe who were employed in ſuch labour, the fleſh of animals made a neceſſary addition; of which we find a great variety at preſent are appropriated as common food, and the catalogue of which luxury hath, in no ſmall degree, augmented.

Notwithſtanding food is required to repair thoſe particles which have been worn away, and diſſipated by perſpiration, ſtill a conſtant and quick repetition is alſo requiſite; for the blood, from its own diſpoſition apt to run into the nature of lixivial ſalts, continually approaches near to putri •• nous acrimony, from the circulatory motion and heat it perpetually ſuffers, by which the animal humors are greatly diſpoſed to putrefaction.

But the blood alſo from perſpirable matter paſſing off, acquires a diſpoſition to coagulate, and the reſtitution of the watery fluid; that its globules may be ſeparated, and preſerved in a ſtate of ſtupidity; and conſequently the reſt of the humors in a proper diſpoſition for ſecretion.

Theſe truths are demonſtrable, not only by their cauſes, but the appearance of men and animals, who die of hunger—for it is common for them to have an acrid, fetid, offenſive breath; their teeth looſened by corroſive ſaltneſs—violent pain in the ſtomach—acute fevers, and delirium.

The nutritious part of the food, from animals, conſiſts of a gelatinous lymph;—from vegetables of a farinaceous ſubſtance—in which is a portion of vegetable acid, oil, and ſaccharine or ſugary matter; conſequently, where the digeſtive powers are perfect, thoſe which abound moſt with ſuch matter in their reſpective claſſes, are the moſt nutritious.

But animal lymph, or the fineſt or moſt ſubtile part of the fluids, affords the quickeſt and ſtrongeſt nouriſhment, as it is nearly elaborated into juices ſimilar to our own; vegetables 〈◊〉 ſo, as moſt of the eſculent roots, plants, and fruits, are of an aceſcent nature, few are alcaleſcent, or replete with ſtimulant or aromatic particles; few are poſſeſſed of gelatinous lymph, and only are nutritious from their farina; not many changing into thoſe humors called indigenous, or natural, after having paſſed often through the courſe of circulation.

Notwithſtanding which, it would be extremely improper for men to live alone on animal food; leſt a habit ſhould be induced too full of blood, and too replete with putreſcent juices; creating ferocity, ſcurvy, faetor, leproſy, and all kinds of lixivial corruption; as in the caſe among the anthropophagi, or thoſe who feed on human fleſh; all which miſchiefs, by change of diet, and living ſolely on vegetable food, are conquered.

Hence, in warm conſtitutions, hot climates and ſeaſons of the year, men who are indiſpoſed, as well as thoſe in health, have a greater propenſity to aceſcent vegetables, in proportion as the heat is more or leſs exceſſive; and hence men in very hot countries, commonly live on vegetables, ſeldom or not without danger, on animal diet; but in cold countries, the practice is ſafer, and more free from inconveniences: for this reaſon, bread, or farinous ſubſtances analogous to bread, is univerſally made uſe of; but we ſhould obſerve, that vegetable food, beſides its aceſcent property, is replete with fixed air.

From what has been ſaid of the nature of aliment, the utility of mixed diet, vegetable, and animal, will be obvious; as they are correctors of each other; hence likewiſe will be allowed, the propriety of uniting acids, or four ſauces with high-ſeaſoned diſhes, or eating them with the fleſh of animals, whoſe juices tend to promote ſaline acrimony; as fiſh, wild fowl, &c. and we may deduce alſo the following concluſion:—That ANIMAL FOOD is muſt nutritious, heating, and ſtimulant, diſpoſing to putrefaction.—VEGETABLE—leſs nutritious, cooling, diluent, aceſcent, ſlightly aperient, and corrective.

We muſt now advert to our third point—

3. EXERCISE and REST.

And when we ſpeak of exerciſe, we include that of the mind, with the body; for theſe two are ſo intimately connected, that they produce a variety of effects one on the other.

To exerciſe, the ancients have, as well as the moderns, indeed ever attributed great utility, particularly in purſuing it with propriety, and have allowed, that great conſtitutional miſchief may be derived from its abuſe or neglect.

It has with great juſtice been conſidered the ſole inſtrument of the cure of many diſeaſes, eſpecially thoſe of the glandular ſyſtem; and SYDENHAM had ſo high an opinion of it, particularly riding on horſeback, that he affirms, Mercury for the lues venerea, nor the bark for intermittents, are not more certain ſpecifics, than riding on horſeback for a conſumption; though here he ſeems to be ſanguine in his opinion, and has given too great latitude to the ſalutary effects of this remedy; for, certainly there are caſes of conſumption where riding becomes injurious—but the conſideration of the ſubject belongs not to this place—we ſhall ſpeak more minutely of it, when we come to give particular directions on that complaint.

Exerciſe conſiſts in local motion of the body, and that motion more powerful of the limbs. It has been divided into ſerious, and amuſing: that belonging to labour is of the firſt claſs—diverſions the ſecond. GALEN hath written pretty copiouſly on the ſubject, and pointed out when it might be ſalubrious, and otherwiſe.

Severe exerciſe, when we exert quick motion, called gymnaſtic, extenuates the body; the contrary renders it groſs; long continued, diſſipates its moiſture, and occaſions dryneſs; moderate makes it fat. However, well-regulated exerciſe, we find, in general, produces a freedom of circulation, aſſiſts digeſtion, promotes perſpiration, and increaſes glandular ſecretion and excretion; by which mean ſuch as is proportioned to the ſtrength—carried beyond that, it occaſions fatigue, and becomes inſtrumental in producing thoſe evil conſequences, it otherwiſe is calculated to remedy; for when too freely uſed, it is the ſource 〈◊〉 loſs of appetite, great thirſt, loathing of food, heat in the bowels, coſtiveneſs, chillneſs, rigors, and fainting. And this muſt be the caſe, when we conſider the effects produced in the ſyſtem, by that which is judiciouſly adapted; as by increaſing the oſcillatory motion of the veſſels; that is, making 〈◊〉 contractions and dilatations quicker, their contents are properly comminuted; all crudities deſtroyed—the blood rendered blank and mild—the fordes, or groſs part, thrown out of the habit— 〈◊〉 the vaſcular ſyſtem ſtrengthened, by which the nervous power becomes equable in its action, and, conſequently, the ſolids of the animal firm, and the fluids pure.

The mind alſo has its influence, for though by its exerciſe it may be made ſtronger—ſtill, if not kept within proper bound it brings on fatigue, and hebetates, or renders the moving powers of the machine inert and dead. Hence the exerciſe intended 〈◊〉 promote and preſerve health, ſhould be ſuch, as is united with mental amuſement, rather than labour—inaſmuch as in the former, the mind is exhilirated; will communicate agreeable ſenſations, and give firmneſs to the moving powers.

REST is alſo neceſſary to relieve both the mind and body ſuch as is ſufficient to free the veſſels from the ſtronger exertions of their elaſtic force, recruit their ſtrength, and ſet thinking faculties at reſt from their labour. But this, if carried to exceſs, becomes indolence, and lays the foundation for thoſe diſorders, which ariſe from inactivity—and this brings on univerſal relaxation of the ſolids—glandular obſtructions:—enervates the ſyſtem, vitiates the humors, creates pains in the ſtomach, flatulencies, indigeſtions, &c. and renders the affections of hypochondriac people, and thoſe who are gouty, in a great meaſure incurable.

From what has been advanced on this ſubject, the ſubſequent deductions may be drawn—

That EXERCISE and REST may be conſidered mental as well as corporeal; the FIRST, in moderate, degrees, ſhould be eſteemed properly ſtimulant, a ſtrengthener of the ſyſtem, promoting digeſtion, circulation, ſecretion, and excretion; the SECOND, reſtorative chiefly, but both in extremes, debilitating.

The next of the non-naturals which preſent themſelves to our conſideration, are,

4. SLEEP and WAKEFULNESS.

And theſe produce nearly the ſame effects as the former—only muſcular force is leſs employed in wakefulneſs than exerciſe, and the animal receives moſt of his detriment from vaſcular action, and debilitating the nervous influence; and by too much ſleep the body is apt to become ſooner relaxed—have the mind more inert, and, conſequently, more liable to thoſe complaints which ariſe from univerſal indolence—though theſe, in moderate degrees, are eſſentially neceſſary and ſalutary; for moderate ſleep increaſes perſpiration, promotes digeſtion, cheriſhes the body, and exhilirates the mind—whilſt the contrary extreme renders the habit phlegmatic and inactive, lo • ds it with crude humors, renders the vaſcular ſyſtem ſluggiſh and inert, diſpoſes the ſolids to relaxation, impairs the memory, and ſtupefies the underſtanding:—on the other hand, exceſſive watching diſſipates the ſtrength, produces fevers, dries and waſtes the body, and anticipates old age. It has been thought that different ages of life, as well as conſtitutions, require more or leſs ſleep—for youth, o • manhood, ſix or ſeven hours for infancy, or old age, eight or nine; but the infirm ought not to be limited, they ſhould be permitted to indulge in ſuch a meaſure, as is found from experience neceſſary for refreſhment.

From the general effects produced by ſleep and wakefulneſs, they may be conſidered as nearly ſimilar to thoſe of exerciſe and reſt, and may alſo be conciſely marked down—as ſtimulant and ſedative—producing every good effect by their moderate uſe, and proper adaption; and a variety of miſchiefs by their abuſe, or exceſs.

The next in order follows the fifth ſeries—

5. REPLETION and EVACUATION.

But little can be ſaid relative to theſe in this place—for if what ſhould be evacuated is retained too long, or in too great quantity; if what ſhould be retained is evacuated too freely, they all conſtitute diſeaſes—and will be treated under their reſpective heads.

If perſpirable matter paſſes off not as it ought, but is obſtructed—plethora, or too great plenitude, fevers, head-ach, giddineſs, inflammations, &c. will enſue.

If what we eat lies too long on the ſtomach—indigeſtion, heart-burn, pains of the ſtomach, flatulence, &c.

If there is any retention in the lungs—coughs, inflammation, aſthma, &c.

If in the liver—inflammation.

In the gall-bladder—jaundice &c.

In the bowels—coſtiveneſs, and its conſequences.

In the bladder—difficulty in making water, inflammation, &c.

As the retained matters, from their delay, may acquire different properties according to their nature, and may create diſorders confident with their acrimony, viſcidity, quantity, or weight.

If too great a flux happens from the ſalivary glands—it conſtitutes a ptyaliſm, or ſalivation.

If from the liver, pancreas, or ſweet-bread, or inteſtines—cholera morbus, or vomiting and purging of bilious matter, alim ent • ry flux, white flux, looſeneſs.

If from the bladder—diabetes, or morbid efflux of urine.

If from the genitals—ſeminal gleet.

If from the ſkin—morbid ſweating, called ephidroſis, beſides a variety of others, which may produce general affections, either by ſympathy or acquired acrimony, as the nettle-raſh, infantile hectic fever, &c. And theſe retentions or evacuations are to be remedied by ſuch applications as the medic art affords. Nor need theſe have been mentioned here, only to ſhew their conſequence in the animal oeconomy—as for the well being of the machine, it is neceſſary that parts where theſe retentions and evacuations occur, ſhould perform their functions properly.—Of theſe nothing more can be ſaid, we ſhall, therefore, advert to our laſt ſubject.

6. PASSIONS, and AFFECTIONS OF THE MIND.

Every man is truly ſenſible of the • ll effects ariſing from giving way to thoſe variety of affections which we call paſſions; and fatal experience often convinces and makes them lament being ſo prone to act obedient to their impulſes. So ſtrongly do they affect the human machine, that the moſt ſurpriſing conſequences have been known to originate from theſe ſources on the corporeal, or ſolid parts, as well as the ſyſtem in general.

There are innumerable inſtances of fear creating a ſudden and powerful action of the bowels and urinary paſſages. Fright has put off a fit of an intermittent, when all remedies had failed; a piſtol fired in the chamber of James the Firſt had this effect, occaſioning alſo a ſudden action of the inteſtinal canal downwards; it has alſo given riſe to an indiſſoluble tumor in a woman's breaſt; exceſs of joy has cauſed fainting and ſtupor; anger, induced apoplexy and phrenzy.

We cannot account for the preciſe mode in which theſe happen for a certainty. Hence, ſays a learned author, We muſt content ourſelves with knowing they are poſitive facts, for, till we are informed by what means the mind and body are united, we cannot even form a probable conjecture, how the operations betwixt them are performed.—In theſe caſes, however, I think that the peculiar ſtate of the conſtitution, with regard to its nervous incitability, vaſcular irritability or torpor, renders people more or leſs liable to feel theſe impreſſions, if not totally, ſtill in a very great degree; for all thoſe, which we call nervous, are more ſubject to manifeſt the action of theſe ſudden or mental affections, than thoſe who have an apparent firmneſs of the nervous ſyſtem, and whoſe veſſels are not ſo irritable as very readily to feel the impulſes of their affections—to me it has appeared to be univerſally the caſe.

However, with reſpect to the paſſions themſelves, they may be medically reduced to two heads—volatile and ſaturnine; or active and ſedative.

But as diſquiſitions of this ſort would lead us more into the field of ſpeculative curioſity, than practical utility, I ſhall content myſelf with taking a quotation or two from a judicious writer on this ſubject—and from thence make the application to aſcertain the propriety of the diviſion.

Fear, grief, and thoſe paſſions which partake of them—as envy, hatred, malice, revenge, and deſpair, are known by experience to weaken the nerves; retard the circular motion of the fluids; hinder perſpiration; impair digeſtion; and often to produce ſpaſms, obſtructions, and hypochondriacal diſorders; and extreme terror has ſometimes brought on death.

Theſe I term—ſaturnine or ſedative—becauſe they affect the nervous ſyſtem in ſuch a manner, as to impede its influence in general—conſequently, the action of all thoſe parts that are dependent upon it, and where any of them ſeem to act ſupernaturally, that action is occaſioned more by irritability, or pre-diſpoſition of the part, than from any other cauſe.

Moderate joy or anger, on the other hand, and thoſe paſſions and affections of the mind, which partake of their nature—as cheerfulneſs, contentment, hope, virtuous and mutual love, and courage in doing good, invigorate the nerves, accelerate the circulating fluids, promote perſpiration, and aſſiſts digeſtion:—but violent anger, which differs from madneſs only in duration, creates bilious, inflammatory, convulſive, and ſometimes apoplectic diſorders, eſpecially in hot temperaments—and exceſs of joy deſtroys ſleep, and often has fatal and ſudden effects.

Theſe I term volatile or active—becauſe they ſo affect the ſyſtem of the nerves, that they increaſe its influence—conſequently the action of all the parts dependent upon them, which, whilſt moderate, produces ſalutary effects; but when too violent, neceſſary deleterious or dangerous ones, from too great an exceſs of action.

Hence, though we cannot influence the mind in the particular manner we wiſh always, we ſhould endeavour to raiſe ſuch ſenſations, as may be productive of thoſe purpoſes, we are deſirous by other means of promoting.

Where the action of the vaſcular ſyſtem is too violent, we ſhould attempt to inculcate fear—where too torpid, cheerfulneſs; for theſe may in ſome degree, have effects on the moving powers.

In treating of the non-naturals, though we have ſpoken of the ſolid aliments by which we are nouriſhed, we have not ſaid any thing of the liquids we in common uſe, we muſt, therefore, in order to render our labour completely uſeful, advert to them, as much benefit is to be derived from a thorough knowledge of their properties and effects, and no ſmall degree of miſchief avoided.

It is indeed a melancholy conſideration to reflect, that, though health is the only foundation of all pleaſure, and may, by eaſy methods, be preſerved, men ſhould neglect theſe means, which would enable them to purſue their darling Goddeſs through all her varied ſcenes of rational delight; but ſo it is, for notwithſtanding innumerable authors have written profeſſedly on the dioetetic regimen, from the unwillingneſs valetudinarians have in complying with rules, which lay a reſtraint upon the gratification of their appetites, though calculated to preſerve health, it has been too much neglected.

Election treats, Pariſh dinners, Seſſion and City Feaſts, and free luxurious indulgence, have numbered many with the dead, which proper abſtinence might have preſerved. However, as men will not refrain, but rather become ſlaves to exceſs, duty calls upon us to apprize them of their danger, at leaſt to inform them in what things they may exceed with the leaſt poſſible inconvenience. In addition, therefore, to what has been already advanced, it appears neceſſary to take a ſurvey of the properties of thoſe liquids we in common drink—which have been conſidered with regard to their powers—as either DILUENT, SHEATHING, NUTRITIVE, STIMULANT, ANTISPASMODIC, or SEDATIVE, which in their order we ſhall now attempt to explain.

1. The DILUTING LIQUORS—are all ſuch, as added to the circulating maſs of fluids, renders them more fluxile—by producing no other effects than what ariſe from mere mixture and diviſibility of the integrant parts, and ſolution of the acrimonious and ſaline particles therein inherent.—Of this claſs therefore, we conſider Water, Small Beer and Tea.

The former of which appears to be the moſt eligible beverage, as it is free from ſaline matter, and abounds not with air, in ſuch a proportion as might occaſion fermentation: that is preferable which flows from mountains through ſandy ſoils; is the coldeſt, limpid, moſt light, and inſipid to the taſte—as it is better calculated to afford a well-diluted chyle: but of all, that which is diſtilled is the moſt eligible, as being thrown into a ſtate of vapour by heat, it is diveſted almoſt totally of thoſe earthy, heterogeneous materials with which other waters are apt to abound—hence, conſequently, in its pureſt ſtate.

This fluid, beſides thinning the blood, and diſſolving the ſaline and ſcorbutic acrimony of the juices, renders the circulation eaſy and uniform by attenuating any viſcidity; it reſtrains, by by its coolneſs, the quick motion, and intenſe heat of the humours, moiſtens, and mollifies rigid fibres—and if a glaſs of cold water is taken going to bed, it promotes perſpiration, and often brings on gentle ſweats.

Good ſmall beer has the ſame properties, but is more apt to occaſion fermentation from the ſaccharine ſubſtances with which it is, though ſlightly, impregnated, and is more viſcid—and from theſe it may be conſidered as rather more nutritious.

Tea is alſo a proper diluent, and aſſiſts digeſtion, drank a proper time after dinner; where it does not diſagree with the ſtomach, as in ſome peculiar conſtitutions, affecting the nerves of that organ, and the ſyſtem of them in general, ſo as to occaſion ſickneſs, tremors, and fainting.

2. Thoſe liquids are called SHEATHING which are mixed with mucilaginous ſubſtances, and produce their good effects, by involving the acrimonious particles of the blood—increaſing its viſcoſity, and preventing them from producing, of at leaſt leſſening their ſtimulating powers on the vaſcular ſyſtem in general—or guarding the ſtomach and inteſtines from feeling the effects of any irritating materials which may be therein contained—the principal of which are water mixed with oatmeal or wheat flour, called gruel—or with hartſhorn ſhavings, ſalop, ſagoe, tapioca—and boiled till the mucilaginous parts of theſe are diſſolved, and then are conſidered as emollients or demulcents—or where ſubſtances are replete with oleaginous particles, ſuffering ſimilar ſolution in the ſame menſtruum—hence partake they alſo of a nutritious property: here then to the liſt may chocolate be added—fat • broths—milk mixed with fuel—the laſt, a food not uncommon, and very uſeful to ſuch as are ſubject to conſtant diarrhoea, or looſeneſs, from acrimonious humours poured upon the bowels—which is improved by the addition of a little ſtarch—and all theſe are conſidered much more nutritious than thoſe of the former claſs.

3. The NUTRITIOUS—are all ſuch whoſe particles are capable of being aſſimilated to the nature of the animal juices by the digeſtive powers of the conſtitution, and partake of theſe properties in a greater or leſs degree, as their parts approach nearer to, or are more diſtant from, the nature of our fluids, before they are taken into the habit:—hence the moſt nutritious are—beef, mutton, or veal tea, as replete only with the finer juices—ſoups, broths—the ſoups ſometimes, in the firſt digeſtion, are more ſtimulant, owing to the ſpices with which they are ſeaſoned, conſequently the moſt heating. Any of theſe above, however, made from the fleſh of the older animals, are moſt nutritive—as they partake leſs, of vegetable nature, and have their juices more perfectly elaborated, and leſs ſubject to promote viſcidity, than thoſe from the younger ſpecies—and here may be enumerated thoſe made from hartſhorn, or the jelly from that and iſinglaſs.

The next is milk, which approaches very near to the nature of chyle, whilſt in the breaſt of the animal, though more cloſely allied to its perfect juices. It is diviſible into ſerum or whey, cream, curds—of which laſt is formed common cheeſe.

Milk when cold loſes ſome of its finer parts, and boiling robs it of more, by more copiouſly diſſipating them: it is demulcent and nutritious, and partakes of a middle nature, between vegetable and animal, and is apt to curdle on the ſtomach, if it meets with a ſtrong acid, too ſuddenly, or in many febrile diſorders.

To ſome conſtitutions it is perfectly agreeable, creating no uneaſineſs, be the ſtomach in what ſtate it may; ſtill in others it increaſes acidity in the firſt paſſages—it, in ſome, produces diarrhoea—others it renders coſtive; in ſome it occaſions the headach; in others an uneaſy ſenſation in the ſtomach, and pain—and many cannot enjoy the leaſt eaſe, till it is ejected by vomiting: but where it agrees, no food can be more pleaſant or ſalutary, where it does not increaſe corpulency. It has been the food of ſeveral adults for a ſeries of time—and thoſe who refrain totally from animal food, in this acquire an agreeable ſubſtitute.

The milk of an healthful young woman is, to the human frame, infinitely the moſt preferable, ſo is that of any animal to thoſe of their own ſpecies, as more completely finiſhed to their particular nature.—For medical uſe next ſucceed, the milk which has the greateſt affinity with that of woman—in which reſpect theſe are thought to purſue the following order—aſſes, mares, goats, that of ſheep and cows.

The next which ſucceeds to this is—

Chocolate—though it partakes not of animal nature, ſtill from its being more replete with oil and ſaccharine ſubſtance, it is not only nutritious but demulcent—though it is apt ſometimes to • it uneaſy on the ſtomach, if it is made too thick, or not well milled or ground—but more particularly when the nut is badly prepared, or when it is decayed, greaſy, and rancid—made thin, it is light: therefore when chocolate, from its richneſs, creates any uneaſy ſenſations on the ſtomach, a glaſs of water taken afterwards, by rendering it more dilute, will prove a remedy—but from its abounding with a quantity of oil, it requires the powers of digeſtion to be very active for its aſſimilation: hence, it ſhould never be drank in too large quantities at a time. The leaſt nutritious of this claſs are ſome of the ſheathing liquids we before mentioned, as gruels, ſago, ſalop, tapioca—becauſe they partake ſolely of vegetable nature, and are not ſo replete with oleaginous or ſaccharine ſubſtances, but are merely mucilaginous.

4. The STIMULANT are—

Coffee, wine, punch, perry, cyder, ardent ſpirits; taken in moderate quantities—in larger, they exert ſedative effects perceptibly; but as we conclude they always exert this laſt effect, though in a degree only proportionate to the quantity taken, we think it right to take a view of them in their ſtate of combination to avoid perplexity—and therefore we mark them down as

STIMULATING and SEDATIVE.

The firſt of which conſiſt of ſuch materials, as by their active powers, irritate the ſtomach, occaſion warmth there, communicate it to the conſtitution in general, either by ſympathy or vaſcular irritation—increaſe the circulation of the blood for a time—exhilirate the ſpirits, increaſe perſpiration, and invigorate the whole ſyſtem—or, taken in large quantity, produce ſuch effects ſympathically upon the common ſenſorium, or force the blood ſo copiouſly and powerfully upon the brain, that it is incapable of feeling the effect of pain or rather uneaſy ſenſation—indeed, ſometimes this inſenſibility may be carried ſo far from this cauſe, that people become apoplectic from the increaſed preſſure on the brain—or from impeding ſympathically, or mechanically, the power of nervous influence, expire.

Of this claſs, we conſider

Coffee—though never attended with any of theſe violent conſequences, muſt be ranked under this head, as one of the ſlighteſt kind—for it is of a more heating nature than tea—gently ſtimulant, aſtringent, and reſiſts putrefaction; it alſo moderates alimentary fermentation—though, like tea, it is not agreeable to every conſtitution; as in ſome it will produce, particularly in thoſe who are delicate, nervous ſymptoms: it decreaſes corpulency, and is ſerviceable to groſs, phlegmatic habits.

Dr. Cullen, ſpeaking of coffee and tea, ſays,

Their effects, in my opinion, are very much mixed, depending on the warm water;—the aſſiſting digeſtion—relieving the ſtomach from a load of aliment—from crudities—alleviating head-achs ariſing from them—promoting the ſecretion of urine, and, perhaps, perſpiration, may all fairly be attributed to the warm water. Theſe are the chief virtues to be attributed to tea and coffee.

The weakening the tone of the ſtomach by frequent uſe—and the ſyſtem in conſequence, inducing tremors and ſpaſmodic affections, are the effects of the tea itſelf, though, in ſome meaſure, of the warm water. And, certainly, great miſchiefs are done by drinking them too hot—a very common practice by very delicate conſtitutions; for, by theſe means, the ſtomach is brought into too great a ſtate of relaxation—indigeſtion occaſioned—crude chyle thrown too freely into the habit—obſtructions formed in various parts, and a general ſtate of debility, with a variety of painful conſequences, occaſioned through the whole ſyſtem.

Wine, ſpirits, ale, porter, cyder, perry, punch—may all come under the ſame deſcription with regard to their powers, if we make ſome allowances with reſpect to a few trifling peculiarities which occur; for they all of them are ſtimulants to the ſtomach and ſyſtem in general; poſſeſs ſome antiſpaſmodic powers, and increaſe circulation.

Spirits are more powerfully ſtimulant than wine, leſs antiſpaſmodic, and not diſpoſed to run into the acetous fermentation.

Wine is endowed with ſtronger antiſpaſmodic effects; cyder and perry next; porter and ale the leaſt. Wine is more powerfully ſtimulant than theſe; leſs diſpoſed to acidity, if pure, than cyder and perry—and all of them free from that tenacity or viſcidity in ale and porter.

Ale and porter are apt to load the ſtomach more, and require ſtrong digeſtive powers to aſſimilate them; porter is ſuppoſed to poſſeſs ſtronger diuretic effects than ale—though they all have them in ſome degree—but amongſt the ſpirits, that called Geneva ſhews them the moſt manifeſtly—of which the common ſort, • o • med of ardent ſpirits, impregnated with terebinthinate ſubſtances, is the ſtrongeſt—thoſe impregnated with juniper berries the weakeſt.

But, as we can never get wine, though ſo valuable an article, whether conſidered as a luxury, or a medicine, completely perfected, even that eſteemed the mo •• 〈…〉 and as it is made ſuch general uſe of—it will be advantageous to examine the parts of which it conſiſts, by which means, we ſhall be enabled to diſcover how its action may be varied; and, perhaps, the ſame holds good in all the reſt, except ſpirits, though moſt probably in an inferior degree.

WINE has for its baſis ſaccharine ſubſtances, of which it is formed by the proceſs of fermentation, which converts the whole, not at once, but progreſſively, into a vinous fluid; one part remains unaſſimilated—one is aſſimilated—and one becomes acid.

Hence wine is compoſed of three parts.

Muſt, pure wine, and vinegar.

Muſt, HIPPOCRATES deſcribes the juice of grapes, recently expreſſed, crude, flatulent—only having one good property, it is aperient; and if it does not act as a laxative, it becomes ſo much the more noxious to the body. It is, perhaps, owing to this that new wines, or other fermentable liquors, drank too early, prove purgative as they generally do.

Some authors have ſaid, that muſt is, properly ſpeaking, what is called ſweet wines. It ſhould, with more propriety, be conſidered as ſomething different, formed by the fermenting proceſs; becauſe, by fermentation of ſugar on the ſtomach, a ſubtile fluid, called by the ſcholiaſts, gas ſylveſtre, and conſidered by them as a fixed, factitious, and fixable air is produced, which acts on the bile, proves laxative, &c. But muſt acts in a leſs quantity than ſugar, and therefore muſt be ſomething altered from the ſaccharine ſubſtance, now changed in its properties:—whatever it is, it deſtroys the tone of the ſtomach—diſpoſes it to ſpaſmodic contractions, and, conſequently, diſturbs and interrupts digeſtion. If acidity is produced, it will join with the gas ſylveſtre in weakening the ſtomach—the acid thus formed will unite with the bile, produce a ſtrong ſtimulus—thus occaſion a flow of mere bile to the inteſtines, and cauſe what is called the cholera morbus, a copious evacuation of bile upwards and downwards, with violent ſpaſmodic affections—but theſe effects are ſeldom produced to ſuch a degree of vehemence.

The active part of the juice of the grape is called ALCHOHOL, or the ſpirit of wine, but weakened in its action in its compound ſtate. This exerts itſelf on the nervous ſyſtem, chiefly, if not altogether, by means of the ſtomach; hence it is ſtimulant, increaſing circulation, and the force of the nervous power univerſally.

In large doſes—ALCHOHOL DESTROYS THE MOBILITY OF THE NERVOUS POWER—WHENCE, FROM ITS STIMULANT AND SEDATIVE EFFECTS—confuſion of ideas and delirium; STILL REPEATED, the nervous flow is arreſted—voluntary and involuntary motions deſtroyed—ſleep, lethargy, apoplexy, and death, are the conſequences.

In WINE, the effects are almoſt never ſo rapid, on account of their dilute ſtate, and ſmall doſes in which the alchohol is throws in; on which account it proves only more ſtimulant and exhilirating—it may produce ſtupor, but as it is apt to be rejected by the ſtomach, and by other matters with which it is mixed, the powers of alchohol is moderated.

PUNCH, which is only an artificial wine, is leſs noxious than alchohol and water, though more ſo than wine.

Though an acid is evolved, and enters into the compoſition of wine, and alchohol, ſtill another, and more copious and ſeparate, is formed—which is

VINEGAR.—This commonly contains ſome ſugar, may be laxative—have the effects of unconverted ſweet wine—generate gas ſylveſtre, that ſubtile fluid; and, in ſhort, have all the properties of freſh juices: when thoroughly converted, it determines other vegetable juices to aceſcency—weakens the ſtomach—prove ſpaſmodic—and has all the conſequences of acids there generated.

But combined with wine, theſe qualities are more innocent; as the action of muſt, alchohol, and vinegar, ſeparately may prevent each other's ſimple and deleterious effects; and alſo the water may, in the proportion in which it is mixed, have its efficacy in weakening the properties of the other component parts.

CYDER and PERRY may be conſidered as having the ſame properties, though in much leſs degree than wine, with regard to their ſtimulant and ſedative effects; but are more replete with aceſcency—generate too great degrees of flatulency, run quicker into the acetous fermentation, and produce uneaſy gripings, and more painful ſenſations of the bowels, beſides being more productive of calculous complaints, and the convulſive colic; or dry belly-ach, terminating often in palſy.

From this review we can eaſily judge of the effects, whether advantageous or otherwiſe, which are likely to enſue from wine, and alſo from the different compoſitions ſold by our retail venders and wine merchants, under that title; which produce diſagreeable conſequences to thoſe who drink freely of it—laying the foundation for a variety of dangerous, lingering, and fatal complaints. In order to ſhew which, we have been at the pains of going more minutely into this ſubject, that we might explain the particular parts of which wine was compoſed—declare the properties of them ſeparately—manifeſt what were ſalutary, what otherwiſe; as alſo the neceſſity of a proper combination to form their utility; and hence be enabled to diſcover how the poiſonous compoſitions, ſold under that appellation, muſt invariably produce their baneful effects; for theſe are made of the unfermented juices of ſome vegetables—ſweet raiſin wine, cyder, and Britiſh ſpirits; and this jumble is coloured with ſome ingredients agreeable to the wines intended to be imitated—with the addition, ſometimes of a ſmall portion of wine, and conſtantly of that noxious material called ſugar of lead, or lead itſelf, forming this ſubſtance by the union with a portion of acid they contain. Now compounds like theſe muſt be replete with thoſe miſchiefs which we have enumerated under muſt and vinegar—and others brought on by the ſedative aſtringent powers, occaſioned by preparations of lead—rendering the action of the ſtomach and inteſtines torpid, relaxing theſe organs, obſtructing the exit of materials which ought to be thrown out of the body—filling the machine full of crude and acid humors—contaminating the whole maſs of fluid—and preventing digeſtion, that parent of almoſt all chronic diſeaſes. When we, therefore, ſpeak of wine, we would not be underſtood to mean theſe baneful compounds; but that which is pure, as can be imported, which MACKENZIE ſays, is an admirable liquor, and, uſed in moderate quantity, anſwers many purpoſes of health; and beer, well brewed, light, of a proper ſtrength and age, if we except water and wine, is, perhaps, the moſt ancient and beſt ſort of drink in common uſe among mankind.

But with reſpect to wine we may carry the matter further, for it is generally allowed to be the moſt agreeable and powerful cordial we can have recourſe to in the laſt ſtage of ſome fevers, completing of itſelf the cure. In low nervous, and putrid fevers, it is beneficial throughout—when there appear ſymptoms of great debility—and it may be very often taken in large quantity, where the moving powers of the ſyſtem abate much of their ſalutary action, and the fluids ſeem to be running rapidly into a ſtate of putreſcency.

How much, therefore, is it to be lamented, that we ſhould be deprived of ſo valuable a liquor—replete with ſo many uſeful properties by the avarice of a ſet of beings, who are ſuffered to impoſe upon, and injure the public with impunity, and amaſs fortunes, by ſelling poiſons for our deſtruction, inſtead of wine for our preſervation and recovery of our health. For, I am perſuaded, thouſands have fallen devoted victims to this illicit and infamous practice. In lieu of theſe, where people are under the neceſſity of purchaſing wines, rather than depend upon the worldly integrity of theſe dealers, I would recommend the wine properly made of raiſins, or the fruits of our own country, they are infinitely leſs noxious, nay, indeed, may be made equally efficacious to the others in their purer ſtates.

5. The next which are to be ſpoken of, are theſe inveſted with

DILUTING and NUTRITIVE POWERS.

And theſe are chiefly all thoſe where water abounds, and are, impregnated with farinaceous, ſaccharine, and animal ſubſtances; in which will be included, gruels and weak broths—the latter of which, as alſo ſoups, when thrown into the habit, may be conſidered as poſſeſſing ſome degree of ſtimulus, adequate to the nature of animal food in its ſolid ſtate, but weaker in degree: and theſe will be more or leſs diluting and nutritious, in proportion to the quantity of water and other ſubſtances they contain—the diluent property depending upon the former—the nutritious upon the latter; the particulars, relative to each of which, may be collected from what we have delivered in our firſt and third ſection on this ſubject.

6. Our laſt are,

The NUTRITIVE, STIMULANT, and SEDATIVE;

Such as, in ſome degree, poſſeſs theſe ſeparate properties—which may be confined to

Ale and Porter—the ſtimulant and ſedative powers of which have been ſpoken of when we treated of wine, of which theſe may be conſidered as ſpecies, made of malt—though to porter there is a mixed and ſtrong ſedative power, inaſmuch, as it appears to have ſome narcotic ingredient infuſed it, as the cocuſus indicus, the Indian berry, opium, or ſome materials of a ſimilar nature. However, that they are very nutritious, needs no arguments to prove, we have only to depend upon facts; for it is obſervable, that all who drink copiouſly of theſe liquors, are corpulent, if they have powers of digeſtion adequate to their aſſimilation—common porters, coal-heavers, chairmen, &c. chiefly exiſt on this—drinking ſome gallons in a day; and indeed ſuch, whoſe labour is very ſevere, require it: but in all ſuch, it is neceſſary for their digeſtion to be extremely good, for theſe liquids abound with a great ſhare of viſcidity, which requires great conſtitutional ſtrength, and ſtrong labour to ſubdue. To delicate, relaxed habits, whoſe ſtomachs are weak, they create great load and oppreſſion, much heat, and febrile affections temporarily induced.

What we have here delivered, perhaps may be by ſome thought of too trivial conſequence; and is by many too much, even in the practice of medicine, neglected—ſtill will be found, on experience; worthy of very cloſe attention: for the knowledge from thence to be collected, and properly applied, as we ſhall ſoon have occaſion to ſhew, forms one part of medicine, comprehending that which is ſtiled—prophylactic or preventive—is, in many caſes, ſolely curative, and ſhould in all go hand in hand with the adminiſtration of the more active and powerful remedies in the cure of diſeaſes. Indeed ignorance in theſe points, or an injudicious diaetetic courſe, will counteract remedies the moſt ſalutary on the one hand, whilſt, on the other, an accurate knowledge, and proper combination, will greatly add to their efficacy.

Having now laid down the principles on which we ſhall proceed through the courſe of the ſubſequent work, almoſt ſolely in that part which is intended as the preventive, and, in a great meaſure, in the curative—we ſhall proceed to the former, after recapitulating ſome particulars, in order to form general rules for our proceedings, and render all our directions eaſy and intelligible.

With reſpect, then, to the firſt of theſe Conſtitutions; 1. The ſtrong, robuſt, and irritable.

They are ſubject to many inconveniences, chiefly from the rapidity of the blood's motion; hence are liable to fall into violent continued fevers, and inflammatory diſorders. To prevent which all exceſſes of hot or cold air ſhould be avoided; ſtimulating aliment, high ſeaſoned diſhes, and ſuch as are extremely nutritious; too ſudden and violent exerciſes, repletion, and the more boiſterous paſſions. They ſhould obſerve temperance in all things, and eſpecially keep free from immoderate drinking, and take care that none of the natural evacuations, ſhould be checked, or obſtructed, ſuch as that of perſpiration, urine, faeces. They ſhould have recourſe to occaſional bleeding, when the head feels loaded, giddy, or when they are drowſy, and prone to ſleep, or ſymptoms of general fullneſs are prevalent, but not uſe in unneceſſarily, or too frequently, and empty the habit now and then by purgatives; they ſhould drink diluting liquors, as water, or ſuch where that is ſuperabundant; in general be ſparing of animal food, and rather eat freely of vegetable diet, for theſe are apt to be plethoric, or loaded with too great a proportion of ſanguinary maſs: for ſuch, a moderate, warm, and moiſt atmoſphere is the moſt eligible ſituation; in fine, nothing ſhould be allowed them that will increaſe too powerfully the action of the living ſolids, or occaſion too great an increaſe of the fluids. Theſe Conſtitutions are in general warm.

2. The ſtrong, robuſt, and torpid.

Where, though the ſtamina are firm in too great a proportion there is a defect of irritability the vaſcular ſyſtem being in too torpid a ſtate. Theſe require not any particular attention, as from the want of proper ſenſibility they will not be expoſed to feel particular changes ariſing from common cauſes, or ſuch as would effect thoſe which are more irritable. Theſe conſtitutions bear all evacuations well, as they are not apt eaſily to have their ſolids too much relaxed, but are rather prone to become plethoric, from indulgence, which they are apt to run into, from not feeling thoſe effects, which people of different habits ſo frequently experience. They ſhould endeavour to prevent an overfulneſs either by abſtinence, or proper evacuations, which they bear in general without inconvenience, though bleeding in theſe is leſs adviſeable than purging, owing to the torpid ſtate of the ſyſtem; and, which, being neglected, ſhould a plethora be the conſequence, ſome of the internal parts of the habit, as the brains, lungs, &c. might be affected by dangerous, or at leaſt troubleſome oppreſſions, and we very often find men of this Conſtitution for want of timely care, and from indiſcretions, afflicted with ſudden vertigos or giddineſs of the head, coughing, or ſpitting of blood, apoplexy, &c. and theſe are ſometimes of a cold habit, though plethoric, and apt to fall into hypochondriac affections from viſceral accumulations, and languid circulation.

3. The ſtrong, robuſt, and incitable.

This Conſtitution ſometimes, though more rarely occurs, and when it does, it generally is united with vaſcular torpidity. In this there is too great incitability of the nervous ſyſtem; and men of this habit are ſubject to a mixture of hyſteric, and hypochondriac diſeaſes; iraſcible at trifles, deſponding nearly approaching to melancholy, they are apt to be afflicted with various ſpaſmodic affections, particularly of the throat, inteſtines, and ſtomach; ſometimes make profuſe quantities of pale, limpid water; at others, ſmall, but turbid and high coloured; they are frequently tormented with flatulence, and perplexed with whimſical and inconſiſtent ideas; the extremities are generally cold, and moving from place to place, or any motion almoſt is performed with languor—moſt of the evacuations are leſſened, or irregularly performed; ſleep is imperfect, they are troubled with frightful dreams, and are ſubject to the incubus, or what is called the night-mare, and all theſe are derived from the ſame conſtitutional ſources, when torpor attends; for from the want of due power of the muſcular fibres, the circulation of the blood is not carried on with full freedom to the extremities, the internal parts conſequently are loaded, hence in thoſe parts there is an additional fullneſs and ſtimulus, for the ſtimulus is always in proportion to the quantity of blood flowing to a part or collected in it, from the evolution of the heat, and the ſuperabundance of acrimony, for the fluids of theſe conſtitutions generally abound with acrimony, particularly ſuch as is productive of the nettle-raſh; hence, then, the internal parts become more ſenſible to the nervous influence, conſequently ſolicits it the more freely; and hence ariſes the appearances above enumerated.

In theſe habits—frictions on the extremities, warm cloathing, warm bath, riding on horſeback, are eſſentially neceſſary; generous diet, wine, ſtimulating vegetables ſhould be adhered to, food of eaſy digeſtion, the mind ſhould be kept perfectly at eaſe, cheerful company, change of ſcene, and ſuch amuſements as divert the attention, produce a moderate degree of mental hilarity, ſhould be procured; and as for medicines, they ſhould be ſuch, as at the ſame time, that they allay the incitable power of the nervous ſyſtem, diffuſe a general warmth through the habit, and theſe given occaſionally, as aſafoetida, muſk, vitriolic, aether, camphor, but all opiates muſt be avoided, becauſe they are apt to render the muſcular fibres too torpid—in general chalybeates may be perſiſted in, and Bath waters ſhould be recommended.

But where inſtead of torpor, vaſcular irritability is a concomitant, beſides being ſubject to inflammatory complaints, and continued febrile affections from ſlight cauſes, they are ſubject to permanent ſpaſmodic affections, ſuch as thoſe which are denominated by medical men, tetanic complaints, where, when ſpaſms ariſe, the muſcular fibres remain in a fixed ſtate, not contracting and relaxing alternately, nor fugitive as in common convulſions: theſe are liable to be ſeized with a locked jaw, and continued muſcular rigidity. In theſe conſtitutions, warm baths are peculiarly uſeful, gentle and conſtant exerciſe, cooling diet, and copious dilution with aqueous liquids, thin aceſcent wines, milk and vegetable diet, evacuations of all kinds ſhould be conſtantly and moderately produced, particularly perſpiration, and the body ſhould never be coſtive; I have ſaid moderately, becauſe in endeavouring to abate the irritability of the ſyſtem, we muſt be careful not to increaſe the incitability, which is apt to be the caſe, from evacuations too copious. Opiates are in theſe habits extremely uſeful, and may be freely given under particular circumſtances. With regard to regimen, what we have ſaid before in the beginning of this ſection may be adhered to, taking eſpecial care to avoid all mental uneaſineſs. Theſe conſtitutions are apt to be plethoric and attended with heat.

What we have delivered appertains to thoſe who are conſidered to poſſeſs ſtrong degrees of muſcular firmneſs, differently combined. We muſt now proceed to ſuch as have a WEAK, RELAXED, DELICATE HABIT, JOINED WITH TOO GREAT INCITABILITY. And this circumſtance generally occurs in theſe habits, that they have alſo too great a ſhare of irritability. Theſe are ſubject to painful and ſpaſmodic diſeaſes; and the more delicate ſex of this conſtitution are prone to hyſteric affections from the relaxation and irritability of their habits. They alſo are conſtantly a tacked on every ſlight cold, with ſlow fevers, and have their digeſtive powers loaded with faburra, or different kinds of ill digeſted matters in the ſtomach and bowels, making their way into the habit in this noxious form.

To theſe, a dry, clear air is eſſentially neceſſary, moderate exerciſe, particularly riding, cold bathing, and chalybeate waters; animal food eaſy of digeſtion, and free from fat, and a temperate uſe of aſtringent wines. Vegetables ſhould be adminiſtered ſparingly, and thoſe of the leſs flatulent kinds; food and liquids, viſcid and tenacious, ſuch as flour puddings, potatoes, oyſters, ſtrong ſoups, and malt liquors, ought to be prohibited. Every thing calculated to ſtrengthen the tone of the ſyſtem, and preſerve it in an equable ſtate ought to be had recourſe to, and all things likely to weaken it muſt be deſiſted from. Cheerful company and moderate amuſements are ſerviceable, but purſued too freely, the reverſe; for all fatigues, both of body and mind, are prejudical—the cuſtom of taking vegetable acids too copiouſly is alſo pernicious—hot tea, or any thing drank too warm—for theſe all contribute to relax and load the ſtomach and inteſtines, with foul, viſcid materials, which produce therein internal ſtimulus, create flatulence, and communicate general irritability through the ſyſtem. Blood ſhould never be taken from people of this habit, but upon the moſt urgent occaſions, and then only ſparingly, in which cupping is preferable to the lancet; and it is ſafer to take it away at two operations, than at one, ſome little diſtance of time from each other, if more than ſix ounces ſhould be required. All ſudden changes ſhould be avoided with the utmoſt caution, either with reſpect to cloathing or diet, the mind kept free from anxious cares—hence watering places are uſeful, where thoſe impregnated with chalybeate particles, or iron, may be drank; in fine, every thing ought to be adviſed, which, in a moderate degree, can exhilirate the ſpirits, and contribute to give ſtrength to the ſolids. Theſe conſtitutions are generally warm, ſubject to irregular fluſhing heats, and have for the moſt part no ſmall degree of acrimony in the habit. But there are ſome who poſſeſs too great a ſhare of torpidity, and then they form that kind.

2. Where a WEAK, RELAXED HABIT IS JOINED WITH A DEFECT OF SENSIBILITY; and theſe are ſubject, not only to nervous affections, but to chronic and deſtructive diſeaſes; for the circulation in all theſe is languid, and the abſorbent ſyſtem acts not with proper freedom. Hence will ariſe thoſe complaints which depend on an acrimonious ſtate of the humors, and an accumulation of the fluids in the whole, or particular parts of the ſyſtem—as dropſy, jaundice, corpulency, ſcorbutic complaints, green-ſickneſs ſo called, obſtructed menſes, glandular tumors, &c.

In theſe torpid habits, ſtimulants are uſeful, as alſo are evacuants; to theſe, a dry air and high ſituation are moſt ſuitable, with a generous diet of the more pungent claſs—ſuch as the juices of the older animals, fiſh, muſtard, horſeradiſh, cabbage, and all of that claſs: briſk exerciſe on horſeback, emetics, and frequent purging, in order to ſhake the vaſcular and glandulous ſyſtem, prevent accumulations, remove obſtructions, hinder the bile from ſtagnating, and the mucous fluids from collecting. All the natural evacuations ſhould be kept free from ſuppreſſion, to accompliſh which, the ſyſtem ought to be perpetually rouſed to action; hence indolence and indulgence in bed is to be particularly avoided; the thinner ſtimulating liquids, as white wine diluted with water, ſhould be the common beverage, and the mind kept in a ſtate of cheerful activity, free from all gloomy and deſponding reflections.

Were the rules here laid down obſerved before our maſs of humours had been contaminated by indiſcretions and various ſpecies of debaucheries, which weaken and diſturb the ſyſtem in its performance of the proper offices alloted to her various parts, perhaps there would be little occaſion to conſider of thoſe things, which are neceſſary to prevent diſeaſes ariſing from a default of the natural humors of the machine; but as that is not the caſe, they call upon us for our conſideration, as well as thoſe which are fortuitouſly thrown into the Conſtitution. And thoſe we ſhall divide into ſuch as are firſt,

NATURAL, And thoſe which are

ACCIDENTAL. The natural fluids are diviſible into General, or Partial.

§. 1. In the firſt or general, the blood offends by its too great quantity or ſtate of acrimony. From the too copious ſtate of this fluid, a variety of complaints may ariſe, and, therefore, when ſymptoms of oppreſſion appear from this cauſe, which will generally manifeſt itſelf by languor, a ſenſe of weight or fullneſs in the head, when riſing in the morning from bed, or in ſtooping, and fullneſs alſo of the pulſe; abſtinence, indulging leſs than uſual in ſleep, increaſing the natural evacuations, and uſing more exerciſe, will effectually reduce the body to its proper ſtandard, if theſe things are had recourſe to in due time, and perſevered in for a proper period; the diet ſhould be the leaſt nutritious, more of the vegetable than animal claſs, the laſt eat of ſparingly, confining themſelves to one diſh, and having it only once a day, and water ſhould be the only beverage; but ſhould inanition, or a want of a proper quantity of blood be induced by any cauſe, nutriment ſhould then be given of the moſt quick and eaſy digeſtion—as teas, and broths made of the fleſh of older animals, thin jellies, and the fleſh of the younger animals, as chicken, rabbits, lamb, veal, &c. and in ſuch quantities, though that can be readily converted into chyle—for it is a miſtaken notion, to ſuppoſe the larger the proportion of nutrition thrown into the habit, the ſooner it will be recruited; the reverſe will happen, for by theſe means the digeſtive powers being overloaded, will be weakened, and conſequently even a ſmall portion be prevented from being properly aſſimilated, or reduced to the nature of our own healthful fluids, which they muſt be before they can anſwer the purpoſes for which they are intended—as on the contrary, it ſo much is only given as thoſe powers can conquer, they will gain freſh ſtrength every day, by the application of that which has been converted into a nature peculiarly adapted to the end propoſed; and this quantity may be repeated as often as the conſtitution requires it. By this a further waſte will be prevented, which may alſo in this view be aſſiſted by the uſe of ſtomachics, which chiefly conſiſt of bitters—as gentian, orange peel, 〈◊〉 wood, ſlight chalybeates, gentle aromatics, and ſuch like.

§. 2. But the blood may become acrimonious, and this acrimony may be conſidered of different natures They have been divided into acid, putreſcent and muriatic, ſo called from MUR •• brine, a liquor made of common ſalt, which this muriatic humor is ſuppoſed to reſemble; but we ſhall not pretend to advance this as a certainty, but confine ourſelves to the effects of ſome acrimony, which ſeems different from the two former.

The firſt then, or the aci • , is ſuppoſed to ariſe from weak bowels, and particularly obſerveable in our infantile ſtate, and, perhaps, the ſtomach and inteſtines are the only place where ſuch acidities are to be fou • d. To prevent which, we muſt endeavour to ſtrengthen the digeſtive powers that they may make good chyle; hence after clearing the bowels with the ſal polychreſt, or ſmall doſes of calomel, and rhubard and gentle emetics, ſlight doſes of chalybeates may be had recourſe to, mixt with rhubarb to keep the bowels gently open—weak broth ſhould be given once or twice a day—panada, with a ſmall portion of ſome agreeable aromatic well boiled; and ſuch things as have in themſelves the leaſt tendency to acidity; frictions on the abdomen or lower belly, ſtomach, legs, and feet, with ſmart exerciſe, will be highly ſerviceable—as theſe will invigorate, the ſyſtem, promote a briſk circulation, and increaſe the action of thoſe organs intended to promote the formation of good chyle.

The ſecond, or putreſcent; where the fluids tend to a ſtate of putridity, ſhews itſelf generally by the face being puffed up, as it were, and tinged with a hue, ſomewhat approaching to livid; the breath offenſive; the gums ſpongy, and bleeding on the ſlighteſt touch, nay, ſometimes voluntarily:—here freſh air, auſtere wines, ſuch as give a ſenſe of roughneſs, or aſtringency to the taſte, vegetable diet, ripe fruit, water impregnated with fixable air, ſmart motion, and corroborating bitters, with abſtinence from animal food, particularly fiſh, promiſe fair for ſtopping the effects, which might otherwiſe ariſe, by checking the putrefactive diſpoſition, and meliorating the fluids; moiſt, warm ſituations ſhould in this caſe be particularly avoided—and living in cloſe places much crowded with inhabitants—for nothing conduces more to bring on, and increaſe ſuch a ſtate of the conſtitution as theſe—by relaxing the ſolids, and furniſhing a conſtant ſupply of putreſcent effluvia.

The third, or what has been ſtiled the muriatic, is indicated by hot eruptions, which itch much, attended with uncommon thirſt and • luſhing heats; to alleviate which, the ſulphureous, ſaline waters are recommended, particularly thoſe of Harrowgate; Thorp-Arch, and thoſe of Moffat, avoiding at the ſame time all heating, acrid food—ſuch as turtle, high ſeaſoned diſhes, and rich ſoups—whey and milk in theſe caſes are extremely beneficial, the SCORBUTIC JUICES, made of the juice of garden ſcurvy graſs, water creſſes, both expreſſed from freſh herbs, and of Seville oranges, two pints, ſpirituous nutmeg water, half a pint, theſe are to be mixed together, and after they have ſtood till the feces have ſubſided, the clear liquor muſt be poured off for uſe.—Of theſe juices, from two table-ſpoonsful to eight, may be taken two or three times a day; or a DECOCTION OF THE WOODS, made of guiacum, or lignum vitae ſaw-duſt, three ounces; raiſins of the ſun, two ounces; ſaſſafras wood, ſhaved liquorice ſliced, each an ounce; water, ten pints:—the guaiacum and raiſins are to be boiled over a gentle fire, to the conſumption of one half, adding towards the end the ſaſſafras and and liquorice; ſtrain off the liquor, and having ſuffered it to reſt for ſome time, pour off what is clear—a quarter of a pint of this may be taken two or three times a day, and all ſuch as are diuretic, and cooling; hence ſome of thoſe waters are of ſervice, which abound with ſaline ſubſtances, that are gently aperient, and move the urinary paſſages—as Epſom waters, thoſe of Cheltenham, Stoke, or Jeſſop waters, thoſe of Pancras, Holt in Wiltſhire, Stretham, and ſome others.

All coſmetics and repellent lotions are dangerous; for if the acrimony cannot be corected or carried out of the habit, its moſt ſalutary ſituation muſt be external; and, perhaps, it may be the only means which nature has to unload the habit, or prevent the deleterious effects, which would be occaſioned, were any of the more noble organs ſubjected to the depredation of humors ſo inveterate. To valetudinarians of this deſcription a cool air ſhould be recommended, and ſummer ſituation near the ſea-coaſt;—all ſalted meats and fiſh ſhould be prohibited; the body kept cool by ſaline aperients, and the mind unruffled by violent paſſions, and all exceſs in drinking refrained.

Theſe conſtitute the firſt claſs of natural humors—the ſecond are the

PARTIAL.—Where they only affect ſome parts of the conſtitution, and are not diffuſive, but produce particular diſeaſes from a peculiar ſpecies of morbific matter; and theſe are either generated in the habit ſpontaneouſly, or ſeem to ariſe from errors in diet, indulgencies, or irregularities with reſpect to the management of the animal oeconomy; but theſe, if incapable of being eradicated, may be alleviated, and in ſome degree prevented.

The FIRST of which we ſhall mention is the gout; reſpecting which, though ſo painful, ſo dangerous and common a malady, I believe little doubt remains but it may be weakened in its attacks, even in thoſe who have been long ſubject to it, by temperance; that is, by properly regulating conſtitutions conſiſtent with the powers they poſſeſs: and I am firmly perſuaded it may be prevented from returning in the younger claſs of mankind, would they, on its firſt onſet, preſcribe to themſelves and follow ſuch regulations, as experience has, in many ſimilar caſes, proved to be conducive to the •• ends.

Adhering ſtrictly to a milk diet has in many caſes put a ſtop to returns of the gout; and regularity of living, with proper exerciſe—abſtaining from wine and high-ſeaſoned diſhes, pickles, and other incentives, that ſtimulate the appetite, and occaſion men to overload, and weaken the tone of the ſtomach, and digeſtive powers, have rendered this malady infinitely more mild in its paroxyſms. Men, with this propenſity to the gout, ſhould avoid every exceſs that has the leaſt tendency to reduce the habit below the proper ſtandard of health—either in eating, drinking, or venereal enjoyments: for it is by the ſlaviſh and conſtant purſuit of theſe particulars, and the great indulgence which they allow themſelves, that we ſee ſo many martyrs to gouty devaſtation.

Early riſing, moderate exerciſe, and that daily; bland mild food: abſtinence from inebriating liquids, or a very moderate uſe of them, as alſo of concubinage, will ever be ſucceeded with ſuch conſequences, as will amply repay us for philoſophic forbearance.—People of this conſtitution ought to refrain from weighty cares—the labours of the mind—much thought, anxiety, and ſolicitude: they ſhould avoid all vexation, particularly as no thing diſpoſes more to bring on fits of the gout, by occaſioning crudity, and indigeſtion, from weakening and rendering the action of the ſtomach too torpid.

Various modes have been recommended for preventing the acceſſions of the gout—but what ſeems to have gained credit from the experience of ſeveral intelligent men, is the uſe of ſulphur; of which a drink is made by impregnating water with a proper proportion of it, and this has proved ſalutary, in not only mitigating fits of the gout, but ſome ſay of totally preventing their return. Indeed if we conſider the action of ſulphur on the habit, we ſhall not be averſe to think favourably of its uſe.

Dr CULLEN ſays, It is certainly a mild and ſafe cathartic, never producing any conſiderable evacuation, but keeping up the natural excretion by the inteſtines, without any irritating or heating effect.—And Dr. LEWIS—That pure ſulphur, in doſes of from ten grains to a dram or more, gently looſens the belly, and promotes perſpiration; it ſeems to paſs through the whole habit, and manifeſtly tranſpires through the ſkin, as appears from the ſulphureous ſmell of thoſe who have taken it, and ſilver being ſtained in their pockets to a blackiſh hue, as by the vapour of ſulphureous ſolutions.

But we muſt obſerve in this, as in every other conſtitution, we muſt be directed in our ſpecific courſe by the particular nature of the habit, according as it tends to one or the other, which we have before ſpecified. Hence in this caſe we muſt ſometimes enforce an abſtemious regimen altogether from animal food—ſometimes allow its moderate uſe, proportioning the degrees of exerciſe to the degrees of tone, or ſtrength of the ſyſtem, always prohibiting the uſe of wines and other fermented liquors, except in caſes of great debility, or long habit; and preſerving the ſtrength of the ſtomach and digeſtive organs.

2d. RHEUMATIC.—In theſe, the ſame rules will hold good as in the former, and not be attended with diſſimilar effects, and thoſe very often more certain; for it has ſometimes been prevented by wearing a flannel ſhirt, which keeps up an increaſed degree of inſenſible perſpiration, and uſing the cold bath or ſea-bathing without interruption.

3d. That diſeaſe, which in inland countries we ſeldom or never ſee affect the natives, called the PUTRID SCURVY—by exerciſe, warm cloathing, drinking aceſcent wines, and living chiefly on freſh vegetables, or eating freely of them, will be prevented. It generally affects thoſe who live on ſea-coaſts, and feed on fiſh, and ſailors:—hence ſour crout has been conſidered as preventive. I have heard captains of ſome ſhips ſay, great benefit has been derived from vinegar, and they give it the preference to lemon or lime juice—why, I know not, unleſs from the ſaccharine ſubſtance in vinegar, a degree of fermentation takes place, and affords ſome portion of fixable air, from whence poſſibly ſome antiputreſcent effects may be produced.

4th. Where we have reaſon to fear a ſcrophulous taint, or the ſeeds of that diſeaſe called the king's evil predominate in the habit—thoſe means exerted, which give ſtrength to the ſolids, begun in time, bid fair to act as preventive in this caſe; at leaſt hinder the offenſive matter from producing its unhappy effects in a violent degree.

Living in a free country air, particularly on the ſea-coaſt, taking exerciſe and nutritious diet; moderate uſe of wine and a courſe of gentle chalybeates, or drinking the chalybeate waters once or twice a year, might anſwer the intention.

5th. Where there is a redundancy of bile, or a collection, thoſe conſtitutions, we have ſaid, are called bilious, and have often a bitter taſte in the mouth. The ſtomach and bowels of ſuch ſhould be always kept clear, by taking aperient medicines every now and then, and ſuch as are not likely to leave the body coſtive after the operation. In theſe habits, aloes and ſoap are uſeful, caſtor oil, ſaline purgatives—as Glauber or Epſom ſalt, or the natural purging waters—as thoſe of Thorp-Arch—Northaw—Colcheſter—Dulwich—Epſom—Action—and Cheltenham.—Fat and oily ſubſtances ſhould be ſparingly, if at all thrown into the habit. Exerciſe ſhould be perſiſted in, and ſome ſpecies of vegetable food preferred to any other, as the dandelion—endive—and ſuch like.

6th. The ſtomach and bowels are apt to be loaded with different kinds of noxious materials, called ſaburra—and theſe are either acid, rancid, or viſcid. In all conſtitutions that have one or more of theſe particular tendencies, they generally ariſe from weak, digeſtive powers. Emetics and purgatives are now and then to be preſcribed on that account, and thoſe things which give force to the weakened organ.

If the acid is moſt prevalent, which will diſcover itſelf by ſour belchings and heart-burn—animal diet is moſt proper; crude vegetables, milk, butter, and other oleaginous ſubſtances ſhould, be foreborn, and alſo fermented liquors; the moſt proper drink is water alone, or warmed with a little ardent ſpirits, or having ginger infuſed in it—ſtomachic bitters with elixir of vitriol, or bark; abſorbent powders, as hartſhorn burnt and prepared, chalk, magneſia, are uſeful for immediate relief. In all relaxations of the ſtomach we muſt aim at ſtrengthening its tone, preventing fermentation, and promoting the expulſion of its contents;—the alkaline waters, as thoſe of Upminſter, Brentwood, Seltzer, and Tilbury, may be recommended.

If the eructations ſhould be rancid, or occaſion a putrid, offenſive taſte; called nidorous, like that of bad eggs, and nauſea attend, with the throwing up of liquids, that will blaze in the fire like oil, a diet containing a large proportion of aceſcent vegetables will be proper, with a very ſparing quantity of butter and oil—made diſhes ſhould not be allowed, nor rich ſauces, or much gravy—acid fruit, ſuch as are ripe may be indulged in, and water is generally the propereſt liquor to drink.

But if the matter ſhould be viſcid and ropy, that is there generated—ſuch things as will aſſiſt in dividing in carrying it off, are the mo •• eligible—as calomel and rhubarb occaſionally, or aloetic purges—elixir proprietatis with bitters, or pilulae Ruffi with Venice ſoap—exerciſe, chiefly riding, is neceſſary, and all things which have in their own nature too tenacious a viſcidity, ſuch as puddings, thick gruels, potatoes, ſhould be avoided—the fleſh or juices of older animals are preferable to thoſe of the younger ſort—and alſo vegetables of the warmer claſs, muſtard, horſe radiſh, water creſſes, &c.

And in all caſes where the digeſtive powers are too languid, where there is not too great an acrimony of the humors, and the habit is not liable to be heated from ſlight cauſes;—chalybeate waters, ſuch as Pyrmont—Tunbridge—Hampſtead—Iſlington,—and the ſulphureous, as Buxton—Bath—Aix-la-Chapelle— Harrowgate—and Llandridod, will always promote ſome good purpoſe in this reſpect, without being in others detrimental.

But ſometimes the lungs will be ſubject to be loaded with viſcid, tough kind of phlegm, in order to prevent which, the mode above laid down will be highly conducive, and what will contribute much towards being more ſucceſsful—are emetics taken occaſionally.

§ 3. Beſides what we have above deſcribed, there are fluids which get into the habit from contagion or infection, and will produce diſeaſe by the action of their morbid matter, if not prevented, before they have manifeſted their effect—and theſe we call

ACCIDENTAL.—The FIRST of which we ſhall take notice of, is that creative of the lues venerea—or pox; and where there is ſtrong ſuſpicion of having had commerce with an infected object, the malady may be prevented by ſuch applications, as will waſh off all the natural mucus of the parts, and thereby carry away the virus, or venereal poiſon, which lies entangled in it; and theſe are ſolutions of the cauſtic alkali; ſoft or common ſoap, corroſive ſublimate, &c. in water, with which the external parts ſhould be well waſhed, as ſoon as may be after coition, at leaſt within the ſpace of ſix or eight hours; and ſome ſhould be injected within the urethra; but great care ſhould be taken not to make the ſolution too ſtrong, leſt the parts ſhould be excoriated, and inflammation brought on by that means, with its painful and diſagreeable conſequences. It will be ſufficient if the ſolution is of ſuch a ſtrength only, as will give a ſlight ſenſation of pungency on the tongue or inſide of the lips.

The SECOND—the poiſon of the viper.—The ill conſequences generally attending the bite of vipers, by which means they pour their virus into the wound, and ſo communicate it to the habit, have been prevented, it has been aſſerted, by the immediate application of the fat of that reptile to the wounded part.—It was, in the more early periods, conſidered as a ſpecific in that caſe—but olive oil has been known to anſwer the purpoſe full as effectually.—Theſe means may alſo be uſeful in abating the pain originating from the ſtings of waſps—bees—bugs—gnats—or preventing the effects from burns, or ſcalds, before the ſkin is raiſed into bliſters; but the more effectual modes are the immediate application of ſpirits of hartſhorn, or of ſal ammoniac, or ſpirit of wine, and continued ſome time.

The THIRD.—The ſaliva of a mad dog, or another mad animal, communicated by a bite, gives riſe to the moſt dreadful of all human calamities; and its effects, if not prevented, generally terminate fatally: but theſe have been ſaid to be warded off, by uſing the cold bath, and perſevering for ſome time in taking the PULVIS ANTILYSSUS,See 〈…〉 Lewis's New 〈◊〉 , 8 • o. 〈…〉 . a dram and a half of which was to be taken in half a pint of cow's milk in the morning, on an empty ſtomach, for four mornings together, and occaſionally perſiſted in, ſo much recommended by Dr. Mead—or applying to the Ormſkirk medicine; but theſe have ſo repeatedly failed, that I ſhould not depend upon them—but where people are ſtrongly wedded in opinion to theſe compoſitions, I ſhould adviſe their adminiſtration—but not till after the following mode had been completed:—Immediately after the wound was given, I would adviſe it to be ſucked ſome time, which may be done with the greateſt ſafety, the mouth of the operator being guarded with oil, for his ſatisfaction, and the ſaliva not ſwallowed; then the part, where it can, ſhould be cut out, or burnt with a hot iron, deeper, and more extended than the wound itſelf;—after which, the wound ſhould be filled with mercurial ointment, and a bliſter applied over the part—kept open for ſome time—and mercury thrown into the habit, ſo as to raiſe, and maintain a ſalivation, for ſome weeks. For by theſe means, the poiſon will be prevented getting into the habit; and ſhould a portion of it have made its way inwards, by the quick action of the abſorbent veſſels, it might be thrown out, by quickly and conſtantly promoting ſalivary ſecretions and excretion.

The FOURTH—The noxious particles, which by infection occaſion malignant ulcers of the throat, putrid fevers, or dyſentery—and which are generally uſhered in with ſhiverings, ſickneſs, and ſudden loſs of ſtrength, have had all their conſequent miſchiefs prevented, by the inſtantaneous exhibition of emetics; and ſhould theſe fail, ſo that the whole ſymptoms do not immediately go off, a large bliſter applied between the ſhoulders has commonly removed them. Nurſes, in the naval hoſpitals, have, it is ſaid, from the moſt undoubted authority, by this mode prevented miſchief.

The FIFTH, and LAST of which I ſhall take notice in this place, are the putrid particles, apt to be taken into the habit, by perſons wounding themſelves by diſſecting of putrid bodies, or parts mortified—and of which many inſtances have recently occurred, where the unfortunate, though praiſe-worthy, curious inquirers, have fallen ſacrifices to the deleterious effects.

In caſes where, under theſe circumſtances, wounds occur, I ſhould recommend ſucking the part immediately, and having it well waſhed with vinegar; then the application of ſtrong mercurial ointment, and mercurial purges, taken occaſionally at proper intervals; for I know of no medicines which ſo effectually clear the ſerous, and lymphatic ſyſtem as mercury.—And in the intermediate days a cour •• of antiputreſcent medicines and diet ſhould be perſiſted in—as bark—moderate quantities of wine—or vinous liquors—and vegetable diet—and bark may be very judiciouſly united with ſuch other materials as promote perſpiration, and theſe ſhould be inſiſted on, and perſevered in for ſome time, and I have little doubt but they would prove a ſecurity from future danger.

Having now delivered fully what may be thought neceſſary for underſtanding the nature of conſtitutions in their ſimple, and mixed general ſtate, and alſo peculiar, with the modes neceſſary to be purſued, in keeping them in an healthful ſtate, or of preventing diſeaſes, as far as reſpect theſe particular points; we would obſerve to the young practitioners, or thoſe who thirſt after medical information, or love to engage in practice from motives of philanthropy, where medical advice may be far diſtant, that the eye ſhould not only be carried to theſe conſtitutional points in caſes where prevention of diſeaſes is ſtudied, but particular attention ſhould be paid to them in diſeaſes, wherein they will be found altered from their natural ſtate, and ſome different combinations taking place from the effects of the malady itſelf; which deviations, when diſcovered, ſhould regulate the conduct; and it will be perceived that medicines highly proper in the beginning of a complaint, are as improper in the concluſion, and ſo on the contrary, and this alone owing to the alteration made in the habit: for inſtance, in inflammatory remittent fever, where at the onſet, the conſtitution is poſſeſſed of great firmneſs—ſtrong vaſcular irritability—and equable nervous incitability—to give bark would be madneſs, little leſs than butchery, becauſe it would too much increaſe the already too heightened powers, and occaſion the worſt conſequences: but at the latter end, or during the progreſs in its later ſtage, the ſame is a cure, owing to the conſtitution being altered by the violence of the diſeaſe at this time; for it loſes its firmneſs—increaſes vaſcular weakneſs—and induces too great nervous incitability, all which are conquered by bark augmenting the tone of the ſyſtem. But as we have examined particular conſtitutions in an healthful ſtate, and pointed out their variability, and ſpoken of ſome points neceſſary to be obſerved in our conduct, in order to preſerve them in that ſtate, we ſhall now make the application on a more extenſive ſcale.

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 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 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 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 〈◊〉 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 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 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 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 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.

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.

Of the FIRST CLASS are 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.

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.

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 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. 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.

From the Vegetable Kingdom. 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. VALERIAN—Powder, from 1-2 dram to 2 drams; Tincture, 1 to 2 drams. Volatile, 1 to 〈◊〉 and a 1-2 or 2 drams. From the Animal Kingdom. 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. From the Foſſile Kingdom. 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 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, 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, HENBANE— 1 grain to 5 and more. Powder, Extract, TOBACCO— 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 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 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 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; —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.

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.

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 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.

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 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 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

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.

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 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 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, 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 IRRITATING EMETICS—as Tartarized antimony, Vitriolated zinc, or white vitriol, Quickſilver, or turpeth mineral. EVACUATING—as 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 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 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.

COOLING APERIENTS AND PURGATIVES. 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. NEUTRAL SALTS. 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. 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. EMOLLIENT APERIENTS AND PURGATIVES. 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. ASTRINGENT APERIENTS AND PURGATIVES. 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. STIMULANT APERIENTS AND PURGATIVES. 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. 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 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 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. 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, The COOLING CLASS are, 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: 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.

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 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.

The catalogue of DIAPHORETICS contains 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. 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 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 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 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, 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.

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.

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 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 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 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, 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, SWEET ACESCENT FRUITS. Pears, Apples, Oranges, Lemons, Strawberry, Raſpberry, Barberry, Tamarinds, Currants, Grapes, Cherries, Raiſins, Dates, Figs, &c. MOST OF THE CULINARY PLANTS. 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 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. 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.

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, See Diuretics, 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. 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 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 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. 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 〈◊〉 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 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 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 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, 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 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.

§ 1. SMALL-POX, or POCKS.

Becauſe we call a ſingle puſtule pock—this ſeems to be derived from the Saxon word pocca, pocket, or the French poche, a ſmall bag. The Latins gave the diſeaſe the term variolae, becauſe from the eruptions it altered the appearance of the ſkin.

This complaint is occaſioned by morbid matter of a peculiar nature abſorbed into the habit from the external air, from contact of a perſon infected, or from inoculation, either by the inhaling veſſels of the ſkin, lungs, membranes of the noſe and mouth, or firſt paſſages—and has been divided agreeable to the cuticular appearances, into diſtinct, confluent, coherent—or into common, cryſtalline eruptions full of thin ſerous matter—verrucous, reſembling warts—or bloody, filled with red fluid, or blood in a broken ſtate.

However generally now we adhere to the terms diſtinct and confluent; but this ſeems of little uſe in practice; for they may be diſtinct, yet of a very bad kind; and confluent, yet very good; therefore the more eligible diviſion appears to be into ſimple and malignant—the firſt comprehending thoſe which are the leaſt, the laſt, thoſe which are the moſt dangerous.

This diſeaſe has four ſtages: the firſt, the febrile, which continues three days—2d, the eruptive, two days—3d, the ſuppurative, five or ſeven—4th, the exſ • ccative, or ſtage in which the puſtules dry, two or four days—or ſometimes another fever comes on, called the ſecondary.

DESCRIPTION. It generally commences with ſymptoms of an inflammatory fever, from whence the particles of the morbid virus are conſidered not only highly ſubtilized, but inflammatory and ſtimulant, attended with nauſea or vomiting—pain in the head and back—tightneſs about the pit of the ſtomach—the patients are very drowſy, ſometimes delirious—in grown people often ſweats break out on the firſt days, and infants are apt to be ſeized with convulſions—the ſkin though, in general, is rather moiſt and ſoft—the upper orifice of the ſtomach ſometimes acutely painful, and alſo the ſides.

Theſe ſymptoms continue three or four days, on which appear ſmall red ſpecks like flea-bites; which, when preſſed with the finger, may be felt hard in the ſkin, and thus may be diſtinguiſhed from other eruptions, particularly the meaſles, which, on their firſt appearance, are very ſeldom ſo hard, or can be felt in this manner, as not elevating the cuticle ſo much; firſt on the face, and ſcattered on the hands, neck, and breaſt; and with theſe commences the ſecond ſtage; from which period the puſtules keep continually increaſing, and diffuſing themſelves over every part of the body; at which time the fever goes off when the eruption is completed; after this they inflame, begin to be prominent above the ſkin, are painful, hot, and fill about the fifth day; and have round their baſis a circular florid redneſs—the throat alſo is painful, and inflamed commonly—the face begins to ſwell and puff up, for the moſt part, on the ſeventh day, ſo much, that they generally cloſe the eyes, and occaſion blindneſs.

At this period, the commencement of the third ſtage, as if from external irritation, ſoliciting the perfect and complete diſcharge of morbid matter, freſh febrile ſymptoms ariſe, which continue to the ninth, tenth, or eleventh day, according to the ſeverity of the diſeaſe, or quantity of the eruption. The puſtules having acquired their full ſize, moſt of them as big as peaſe, are filled with a whitiſh or yellowiſh matter; this concludes the third ſtage; and then the matter •• zes out at the top of the eruptions, dries, turns of a dark colour, and forms hard ſcabs, and this is in the ſame order in which they made their appearance—and, as the face ſubſides, the feet and hands ſwell, and ſubſide not totally till the fourteenth day, at which period the diſeaſe is conſidered to have completely finiſhed its courſe, which forms the concluſion of the fourth ſtage.

This is in general the progreſs of the ſimple or mild ſpecies—though ſometimes another fever, called SECONDARY, will come on, when the eruptions have run ſo together, that they form one uniform cruſt, and by that means obſtruct perſpiration; ſo that, inſtead of the quantity of variolous matter paſſing out of the habit, it is again re-abſorbed, and the inteſtines are loaded with an offenſive collection of acrid materials, which create a fever of the remittent claſs that often proves fatal.

But in the confluent ſort there are ſome peculiarities which ought to be ſpecified; and, therefore, we muſt obſerve, that in theſe the puſtules break out ſooner, on the ſecond or third day; the febrile ſymptoms run on with a greater degree of violence—and on the appearance of the eruptions, or a day or two after, which happens now and then in the diſtinct ſort a ſpitting will come on, gradually increaſing to a ſalivation in grown people—in infants a looſeneſs ſupplies the place—though in common the attendant fever of the ſmall-pox is of the inflammatory kind, yet, in the more complicated ſort, the fever aſſumes a different type, and puts on the appearance either of—1ſt, an inflammatory remittent—2dly, nervous—3dly, putrid fever—or is aſſociated, 4thly, with ſymptoms of ayſentery.

IN THE FIRST, the febrile affections run very high, with exceſſive heat, and great proſtration of ſtrength—the ſkin is dry and hot—the arteries, called carotids, running through the neck into the ſuperior parts, throb—the tendons, (22.) grow ſtiff—the eyes are bright, vivid, and full of blood—the head and loins are painful, often without any delirium or drowſy diſpoſition—when the eruption is finiſhed, if the patient dies not before the completion, which, from the violence of the fever, is ſometimes the caſe, the head-ach, pain in the loins, vomiting, and other ſymptoms, are relieved; but the fever revives its former force, or continues, and has increaſe of febrile affections every thirty-ſix hours—hence termed tertian;—at this period there ariſe want of ſleep, delirium, anxiety—there alſo come on bleeding of the noſe, copious ſweats—then heat, and dryneſs of the ſkin—very often miliary eruptions break out in ſpaces between the puſtules, or ſmall purple ſpots like flea-bit—ſometimes an eryſipclatous inflammation will occupy the head and face, and occaſion a large inflammatory ſwelling—the febrile and other ſymptoms increaſe in the ſuppurating ſtate, with toſſing and delirium—the puſtules ſubdue not, nor ſeem to be of a very bad ſort—ſometimes though they grow black and mortify—then the patients lie in a ſtate of aparent ſleep, and convulſions cloſe the ſcene.

IN THE SECOND, at the commencment, there is great proſtration of ſtrength, lowneſs of ſpirits, obſcure febrile ſymptoms, extreme nauſea, ſickneſs, and oppreſſion.

The puſtules never puſh forth perfectly, nor maturate kindly, but many lurk in the ſkin; and thoſe which elevate themſelves a little above it, are flat and depreſſed, containing a thin aqueous fluid, and have a ſmall black ſpot in the middle—the face, when the eruption is copious and runs together, never ſwells, but looks as if covered with a yellowiſh ſkin, ſomething like a macerated, bladder of that colour.

A thin ſerous looſeneſs generally comes on—if not, convulſions put a period to the unfortunate patient's exiſtence.

IN THE THIRD, the ſymptoms preceding the eruptions are nearly ſimilar to the former; but the puſtules are black; the bottoms of which are in a mortified ſtate; indeed, the texture of the blood is ſo broken by the putreſcent acrimony, that it runs off by urine, and various other haemorrhages; the ſpaces between the puſtules are black, and large broad ſpots, called vibices, or ſmall ones, like flea-bites, are formed on the ſkin; beſides, the red portion of the blood not only mixes with the ſerum, and fills the eruption, but it raiſes large bliſters elſewhere.

Theſe puſtules, which are only a little elevated, beginning to appear upon the ſecond day, are black; the urine, for the moſt part, is bloody; as are alſo the ſtools, ſpittings, vomitings, and in ſome even the tears; the fever is violent, and the febrile fits almoſt inſupportable.

IN THE FOURTH, which was called DYSENTERIC, becauſe it happened in the year 1670, at the time of the epidemic dyſentery, and partook, in ſome degree, of its nature; or, becauſe the matter of the ſmall-pox was often thrown out of the conſtitution by inteſtinal evacuation, when treated by the warm regimen, not uncommon in thoſe days.

In this the eruption does not occur, as in the mild ſort, on the fourth, but on the third day; the puſtules are of a leſs ſize always, and are ſharper, or more pointed at the top, and grow blackiſh towards the concluſion—beſides, a copious diſcharge of ſaliva, as in the confluent kind, is often a concomitant. Should the acrimony of the putrid, which produces the alvine flux, that forms the characteriſtic ſign of this ſpecies of ſmall-pox, be very copious and active, occaſioning the diſcharge to be violent, it almoſt always proves mortal.

CAUSES. The remote or inducing of this, as well as of every other ſpecies of infectious or contagious fever, is a prediſpoſition, or peculiarity of the conſtitution to feel the impreſſions made by the morbid matter, productive of diſtreſs in the moving ſolids, and alteration of the fluids of the machine.

The proximate or immediate, contaminating particles, peculiar to the ſmall-pox, abſorbed into the habits, and theſe producing febrile effects, which vary according to the nature, or particular ſtate of the conſtitution at that time.

CHARACTERISTIC SIGNS. The only certain ones are the eruptions themſelves, with their progreſſive concomitant ſymptoms, the appearance of which may be ſuſpected in the firſt ſtage, it the attack ſhould be ſudden—if the ſmall-pox ſhould be the reigning epidemic, or the patient ſo ſituated, that he has been thrown in the way of this ſpecific infection—if pain ſhould affect the back part of the head, ſauces, loins, particularly the pit of the ſtomach, attended with vomiting, and that pain increaſed on preſſure.

CURE. The indications are, to diminiſh the aſſimilating or contaminating power of the morbid matter, and keep the fever within ſuch bounds, that nature ſhall be enabled to ſeparate from and throw out of the habit the offenſive materials that cauſe the diſtreſs, which is done by ſo regulating the motions of the nervous and vaſcular ſyſtems, that the conſtitution may be put into a ſtate to mitigate and ſupport the ſucceeding conteſt with the greateſt eaſe, and freedom from danger.

And this knowledge we ſhall acquire, by conſidering the ſituation of the habit, the mode of living, and ſeaſon of the year, with reſpect to the weather or conſtitution of the air, as theſe will diſpoſe more or leſs to the production of inflammatory, nervous, or putreſcent febrile affections; for I am certain, that, according to the nature of the fever, ſo are we to regulate our conduct, and hence obſerve thoſe rules which have been previouſly laid down in the management of thoſe different fevers ſpecified in our eighth and ninth ſections.

Sometimes the diſeaſe is ſo extremely mild, that there is no need of medical aſſiſtance, though at the cloſe, in order to clear the firſt paſſages from any foulneſs or offenſive matter which may have been collected there during the progreſs of the complaint, it would be right to give two or three purges. (No. 3. 19 to 24.)

At others, it is of a very dangerous nature, and requires the aſſiſtance and ſagacity of no ſmall ſhare of medical knowledge, as it is accompanied with ſuch a variety of threatening ſymptoms.

Should the ſmall-pox attack ſtrong, hale, robuſt habits, where inflammatory ſymptoms run high, which they ſometimes do to ſuch a degree, as to affect the brain, throat, or lungs, ſo as to produce delirium, ſuffocation, and extreme difficulty of breathing; according to the violence of the ſymptoms we muſt have recourſe to bleeding, and that repeated, if they give not way to the firſt operation—indeed, if the pulſe is hard and full; the heat conſiderably above the natural ſtandard; the urine high-coloured; the pain in the head, back, and loins acute; the bleeding at the beginning ſhould be copious—and, under theſe circumſtances, blood may be taken even at the height, or any intermediate ſtage—we may alſo give antimonials, nitrous and cooling medicines, and ſuch other things as have been adviſed in cure of inflammatory fevers, (210, &c.) for the ſame reaſons.

If the head ſhould be violently affected, the feet may be bathed in warm water, and warm fomentations, or poultices, applied to them; for theſe will ſolicit a freer circulation downwards, a more copious eruption into the extremities, and diminiſh the quantity of variolous matter, which otherwiſe would appear in the more ſuperior parts.

After once or twice bleeding, a gentle emetic, (No. 11, 12. 38.) would be uſeful, and clearing the firſt paſſages with ſome mild aperient, (No. 3. 22 to 24.) or at leaſt repeated glyſters every, or every other day, (No. 25, 26.)

By the means above directed, we reduce the active power of the ſyſtem, that it may not be hindered from throwing off the matter of the ſmall-pox, by the too great diſturbance and diſtreſs occaſioned by the rapidity and violence of febrile action.

But ſhould the train of ſymptoms be ſuch as indicate the preſence of a nervous fever, (325.) we muſt endeavour to rouſe the vaſcular motions, and increaſe the activity of the nervous ſyſtem, in the manner we have directed in nervous fever, (216.) for, without this, there will only be a partial ſeparation of the variolous matter thrown out upon the ſurface of the body; and the internal parts, ſuch as the brain, ſtomach, lungs, and bowels, be more loaded, and the fluids not perfectly free from morbid particles. To obviate theſe inconveniencies, we muſt not do any thing that is likely to turn the humours upon the bowels, nor take away any blood; for theſe would weaken the ſyſtem, already in too debilitated a ſtate, and render the fluids too acrimonious; we muſt try to invigorate the conſtitution, in order that the blood may circulate with proper freedom externally, by wine, wine-whey, volatiles, and cordials, (218.)

The load, nauſea, anxiety, and oppreſſion, which are almoſt always conſtant concomitants in this ſpecies of febrile affection, might be relieved by an emetic. (247.) for the ſhock would tend in ſome degree to rouſe the ſyſtem, and promote the eruption by that means.

Should the fever attendant be of the putrid kind, and betray ſymptoms of prevalent putreſcency in the humours, we muſt not have recourſe to the lancet; for bleeding would hurry the conſtitution rapidly into all thoſe miſchiefs which ariſe from extreme debilitated nervous action, and broken texture of the blood, as before explained when treating on putrid fever, (223.)—here we muſt depend upon bark, and ſuch things as were ſpecified when treating on that malady.

In order to promote ſucceſs in treating this complaint, in the beſt manner we can, by procuring a ſeparation and expulſion of the morbid matter, we muſt, indiſputably, pay attention to the preciſe nature of the fever; for it is by properly regulating that from whence we can hope for perfect and laſting relief.

Particular occurrences preſent themſelves frequently, which call for our attention in an eſpecial manner, added to the general plans we have ſpecifically pointed out, in which we muſt attempt to imitate nature in her operations.

When inſenſible perſpiration is too much impeded by the puſtules crowding ſo cloſe together, and obſtructing the pores of the ſkin, ſhe produces either a copious ſpitting, free diſcharge of urine, or looſeneſs, to make up that defect, or lodges the aqueous fluid in ſome part of the cellular membrane (26.) of the hands and feet, which at that time put on dropſical appearances—hence is pointed out to us the neceſſity of ſerous evacuations.

It is therefore incumbent upon us to endeavour to promote the ſlow of urine from the completion of the eruption to the turn, by the uſe of diuretics; the ſafeſt of which is aethereal ſpirits of nitre, (176.) and taking the patients now and then out of bed, and expoſing them to the cool air.

Small doſes of calomel, under theſe circumſtances, have been attended with ſome ſucceſs, as they often promote a ſpitting, or increaſe the diſcharge of urine; or, ſhould we be afraid of determining the humours too much to the bowels, it may be thrown into the habit in form of ointment, rubbed in above the knee, or on the inſide of the thighs.

But if theſe diſcharges are defective, or ceaſe altogether, and there is no ſwelling in the extremities ſufficient to counterbalance the decreaſed or obſtructed evacuations, the ankles or wriſts muſt be bliſtered, by inſinuating ſome bliſtering ointment into the ſpaces between the puſtules—and if this ſucceeds, by creating a free diſcharge, the danger which before threatened may be happily prevented—if not, we ſhall have reaſon to fear a fatal concluſion.

Sometimes reſtleſſneſs will be occaſioned, and the febrile ſymptoms increaſed, by irritation on the ſurface of the body, creating pain, as the puſtules proceed to perfect maturation and dryneſs—here opiates (151.) (No. 4, 5.) procure eaſe and ſleep, forward ſuppuration, expedite ſeparation and expulſion, by preventing internal diſturbance in the ſyſtem from the cauſes above ſpecified. But, perhaps, by their uſe the body may be rendered coſtive; or if ſo, at this period, from any other cauſe, gentle aperient medicines have been recommended; but glyſters, (No. 25, 26.) every day till the dryneſs of the pocks takes place, are more eligible, as from them there can be no danger of creating the ſmalleſt diſturbance in the habit, nor of determining the fluids too much to the inteſtines, ſo as to run the leaſt riſque of inducing a looſeneſs; and they will alſo effectually aſſiſt in preventing an increaſe of febrile diſtreſs, which might ariſe from collections of acrimonious matters in the firſt paſſages.

Sometimes after the incruſtation is perfectly formed, from the reſorption of pus, offenſive acrid matters in the firſt paſſages, or the abſorption of acrimonious or foetid particles from foul linen, the ſecondary fever is apt to ariſe. In order to prevent which, the patient ſhould have his linen changed, be put into freſh ſheets well aired, every thing be removed from him which can be ſuppoſed to harbour offenſive matter, and a purge, (169, &c.) (No. 19 to 22.) given as ſoon as the cruſt is actually formed.

Though ſome conjectured, with equal if not with more probability, that this fever ariſes from the imperfect ſeparation or expulſion of the variolous matter, and that it becomes the inſtrument of nature to free the habit from what remains.

However, be the caſe which it may, if it runs high, and is attended with violent head-ach, great oppreſſion, and difficulty of breathing, bleeding may be neceſſary, and ſo long as the pulſe can ſupport the operation well, it may be repeated—bliſters ſhould afterwards be applied—and purgatives adminiſtered, if the pulſe does not flag—and vegetable acids ſhould be mixed with common drinks—but ſhould the ſtrength fail, we muſt have recourſe to cordials.

If it goes not off by theſe means, it will, in all probability, put on the appearance of a remittent fever, and as ſuch muſt be conſidered—for the ſubduction of which, we muſt, as in caſes of thoſe fevers before ſpecified, (252.) apply to the bark, (253) and with reſpect to the quantity to be applied, the age of the patient, and violence of the diſeaſe, muſt regulate our judgment.

Some, in order to mitigate or prevent this fever, have adviſed the puſtules, as ſoon as they are fully matured, where they are of the confluent kind, to be opened as they ripen, in the order they make their appearance. I am, however, far at preſent from recommending the adoption of ſuch a plan, as I ſhould be fearful of the moſt dangerous conſequences enſuing from ſuch a practice, particularly where the fever, after the eruption, ſtill continued with any degree of force; for it is very probable that, from thence, there is not a due ſeparation of the morbid materials, and that the ſecondary fever is very often, at leaſt, an effort of nature to throw what remains out of the habit—and that by the irritation on the ſkin this purpoſe might better be effected, than by its being taken off; for from ſuch attempts, there has been reaſon to believe death the conſequence. Much miſchief has accrued from applications made to gouty limbs, from the impetuoſity of the ſufferers to take off the pain ariſing from that cauſe, before the whole of the gouty matter had been depoſited; and in theſe two caſes the reaſoning is nearly ſimilar, as well as ſome others; and it is well known, that nature frequently makes pain ariſing from ſome irritating power the ſole cauſe of conſtitutional relief. I would therefore adviſe great circumſpection on the preſent point, which only can be warranted by practical certainty, not whimſical, though ingenious, conjecture.

Sometimes the ſmall-pox will be attended with a remittent fever, (250, &c.) verging to the inflammatory claſs; then the diſeaſe muſt be treated in the ſame manner as we have delivered when treating on that fever. (210.) (See 252.)

Sometimes the eruptions will put on different appearances, (265.) which from thence are called CRYSTALLINE, and be attended with a nervous fever; in this caſe therefore, we chiefly depend on bliſters and vinous cordials, with ſuch other aids as we have ſpecified in the treatment of the ſlow nervous fever. (216.) Or SANGUINEOUS or BLOODY, and have for their concomitant a putrid fever; in which caſe, without ſome ſervice can be done in the beginning, not one ray of hope remains for our ſucceſs—for which purpoſe we muſt depend upon bark, and ſuch other antiſeptics, (192.) as are ſuppoſed to have the moſt powerful and immediate action, the principal of which is alum, (137, &c.) (No. 56.) and purſue the mode of management throughout, as recommended in the putrid fever. (223.)

Or, they are attended with extreme pain, and violent flux from the bowels, putting on the appearance of dyſentery, (268.) —in this caſe we muſt endeavour to retard the flux, by ſome gentle cordial antacids, of the ſhell or earthy kind, (19 • .) called abſorbents, (No. 42, 43.) or the white decoction, with red port or claret, or aſtringent draughts. (No. 75, 76.)

But in this complaint much nicety is required—for alvine fluxes are not always to be conſidered morbid, they are ſometimes critical, and the means of which nature makes uſe to carry morbid virus out of the habit—if, therefore, the pulſe does not ſink, but continues to move with ſtrength and greater freedom, and the oppreſſive ſymptoms are all alleviated, the uſe of aſtringents ſhould be cautiouſly adminiſtered. It would be more adviſable, to ſupport the patient by mild cordials, and exhibit ſuch medicines as would ſheath the bowels, and ſuffer the matter to paſs through them with the leaſt uneaſineſs—ſmall doſes of ipecacuanha (No. 57.) will be beneficial, and preparations from the claſs of the demulcents, as mixtures of gum tragaoanth, Arabic, ſtarch, and ſuch like; and, towards the concluſion, 〈◊〉 , joined with ſome of the mild aſtringents, might be uſed. (No. 77, 78.)

With regard to the diet, it is always to be adapted to the nature of the fever, during its continuance, which may be collected from what has been ſaid on this head, when treating of the inflammatory, nervous, and putrid fevers. The apartments muſt be kept cool, and the patients fit up ſome hours every day, if the circumſtances of their caſe will permit—and after the complaint has finiſhed its courſe, purgatives ſhould, at proper intervals, be repeated, to clear the habit of any remains of morbid particles; and the ſame courſe purſued for the recovery of the ſtrength, as after the concluſion of other fevers, where the conſtitution has been much harraſſed.

Long experience have enabled practitioners to make the following obſervations reſpecting the good and bad omens in this diſeaſe:

The later the ſmall-pox make their appearance in winter the leſs dangerous they will be—they are alſo more mild in the young ſubject than the ſtrong adult—the longer the firſt, or febrile ſtage, continues before the eruption, ſo much more mild; the ſhorter, ſo much the more violent may we expect the diſeaſe to be—ſhould there be an acute pain in the ſide, or in the upper orifice of the ſtomach, they are bad ſigns—the more the puſtules crowd together, the more numerous they are in the face and trunk of the body; the more flat or depreſſed, the ſlighter the remiſſion in the ſecond, or eruptive ſtage, ſo much greater will be the danger—a delirium ſucceeding the eruption imports no little miſchief—deficiency of the ſalivary diſcharge, in the depreſſed or confluent ſort, is one of the worſt ſymptoms—the more florid the ſpaces between the puſtules are, the greater may be our hope; p • leneſs there affords us no flattering proſpect.

If the matter in the puſtules be white, viſcid, and full, it is a fortunate appearance; but if, on the contrary, it ſhould be brown and thin, and the puſtules grow yellow, or have their tops indented, it is the reverſe—if the ſpaces between the puſtules, and they themſelves, are livid, death is at hand.

It is alſo a bad omen if the ſecondary fever appears before the retroceſſion of the puſtules—if the face ſubſides, and the ſalivation or ſpitting ceaſes, and the hands and arms ſwell not in the ſame proportion, in the confluent ſort, it is a ſign of death.

If, on account of being too heated, the patient cannot bear the bed-cloaths upon him, it portends a delirium—great inflammation of the ſauces, quickneſs in breathing, clear urine, with little cloudineſs floating in it, grinding of the teeth, picking of the flocks from the bed cloaths, threaten diſſolution—nor are we to build any hopes on the remiſſion of delirium, if the fever continues in the ſame ſtate.

Before we cloſe this part of our ſubject, we muſt beg leave to make one general obſervation reſpecting all eruptive fevers, as well as the ſmall-pox—that as many, though their eruptions ariſe from the conſequence of their peculiar action on the conſtitution, and produce ſpecific cuticular appearances, are uſhered in by ſome fever, either of the inflammatory, nervous, or putrid kind, in general; yet, ſhould they he attended, as ſometimes they are, with thoſe of the mixed claſs, where we cannot perfectly diſtinguiſh to which of the more ſimple ſort they belong, we muſt treat them according to the ideas given in the mixed fevers. (240, &c.)

§ 2. INOCULATED SMALL-POX.

It is rather ſingular, that after ſo many years experience of the advantages accruing from inoculation, that there remain any ſo blinded to their own intereſt and happineſs, as to be deſirous ſtill of abrogating the practice—which is the preſerver of life, beauty, and health, ſo perfectly clear to common obſervation.

The mere recital of the benefits annexed to it are ſo conſpicuous, that reaſoning is unneceſſary.

It ſupplies us with the opportunity of having the body properly prepared for the reception of the morbid matter; ſo that it may be freed from ſuch materials as would ſupply an active cauſe to increaſe and prolong febrile affections; and thus prevent the fever, which always attends in the ſmall-pox, from running too high, or producing otherwiſe dangerous effects, according to the nature of the conſtitution—it occaſions a ſmaller quantity of eruptions, and the puſtules to be more ſuperficial—hence not leaving thoſe deep pit., and often unſeemly ſcars as in the natural ſmall-pox—it ſupplies us with a knowledge of the diſeaſe at the firſt onſet, and enables us to provide againſt its conſequences—it empowers us to throw in the matter into the conſtitution from places far diſtant from the vital parts, and prevents the lungs being primarily affected—and, what is of great conſequence, it enables patients to eſcape the ſecondary fever, ſo fatal to numbers; for in this artificial ſort it rarely attends—add to this, the operation is ſo extremely trifling, that it is performed almoſt without the ſlighteſt pain, in the following manner:

The ſcarf-ſkin, of one or both arms, is elevated by a lancet, upon which ſome of the infectious matter, taken from a patient labouring under the ſmall-pox, remains, then preſſing the ſcarf-ſkin upon the lancet, and with drawing it from under that preſſure, the variolous matter is left upon the true ſkin, and taken into the habit by the abſorbent inhaling veſſels, which open upon its ſurface.

Subjects of every age may be inoculated, even ſuch as are at the breaſt; by ſome eſteemed the beſt time of life; but it ſhould be before they begin to cut their teeth—certainly their conſtitutions are at that time in the moſt proper ſtate—and, could we be aſſured that no accident would occur that might need the aid of medicine, there could not be a moment's heſitation reſpecting the preference; but, on this account, I ſhall rather recommend inoculating at two years old, when complaints could not ariſe from teething when the conſtitution was not in ſo irritable a ſtate as to be inconvenienced by ſlight cauſes—and, in caſes of neceſſity, ſhould they ariſe, the application of medicines would be leſs reſiſted.

With regard to the ſeaſon, practitioners have differed in that point—the hot months in ſummer I conſider as the moſt exceptionable, and give the preference to thoſe which are the moſt temperate—the ſpring, or latter part of autumn, taking care, during theſe periods, to avoid performing the operation when inflammatory or putrid fevers or other acute complaints were epidemic, for very obvious reaſons.

The modes of preparation ſhould be adapted to the conſtitution of the patient.

Generally living cool and temperate for three weeks, feeding on aceſcent food, with now and then a gentle mercurial purgative, for thoſe of healthful habits, will in common be ſufficient—but thoſe of puny conſtitutions, whoſe ſyſtem is relaxed, ſhould live more freely, and be allowed animal food once every day, of the light and eaſily digeſtible kind, and in moderate quantity, mixed with aceſcent vegetables.

In fine, preſerving the conſtitution in a moderate degree of ſtrength, clearing the firſt paſſages, removing glandular obſtructions, making that ſyſtem act with freedom, and loading the machine, as much as may be, with aceſcent fluids, ſeems the moſt rational mode of putting the body into the beſt ſtate.

By theſe means, the nervous and vaſcular ſyſtem will be enabled to perform their functions properly, and the humours not become prone to run into an acrimonious or putreſcent ſtate—hence nature will not meet with any impediment to prevent her from ſeparating and throwing out the offenſive matter, after it has produced its effects on the maſs of circulating fluids.

It has been thought, and I am of opinion, rightly, that it is immaterial from what ſort of ſmall-pox the inoculating matter is taken, as the different kinds produced depend not upon the nature of the morbid particles, but the conſtitution into which it is thrown—for there will be a bad ſort ariſe from matter that has every mark of mildneſs, and a good ſort from ſuch as appears more of a malignant nature; nay, indeed, different people inoculated with the ſame matter taken from the ſame puſtule, have been known, and that commonly, to have different ſorts of the ſmall-pox.

However, I would always adviſe it to be taken from ſuch ſubjects as labour under the diſeaſe in its mildeſt ſtate, and have the moſt favourable appearing pus—for it is our buſineſs to take matter from thoſe conſtitutions which, by the appearance of the pocks, beſpeak the greateſt purity, and freedom from any morbid taint—for all people are not agreed upon what the malignity of this complaint depends; and many conclude that other diſorders may be inoculated with the ſmall-pox—theſe, therefore, furniſh arguments ſufficient for great cautions in our election.

DESCRIPTION. After the punctures are made in the arms, on the ſecond day, if the parts are examined by a good magnifying glaſs, there appears commonly about the puncture an orange-coloured ſtain, whilſt the ſkin around it ſeems to contract; but ſometimes an inflammation takes place on the ſecond day, then diſappears totally—this, though, may ariſe from irritation from the puncture, trifling as it is; we remain, therefore, doubtful whether or not infection has taken place—but if it has ſucceeded, on the fourth or fifth day from the operation, a hardneſs and itching, with an apparent inflammation of the part, is perceptible; and a kind of bliſter, filled with a tranſparent liquid, is obſervable.

On the ſixth day, a pain and ſtiffneſs affects the arm-pits.

On the ſeventh, but more frequently upon the eighth, ſymptoms which precede the eruption make their appearance; and theſe are commonly ſuch as ſhew themſelves in general at the commencement of fevers—cold chills and heat alternate with each other, a ſlight degree of languor, heavineſs of the eyes, and ſlight pains in the head and back, are, now and then, perceptible; and theſe remain pretty conſtant till the ſmall-pox manifeſt themſelves.

The inflammation now begins to ſpread very faſt, and, round the punctured part, a great number of ſmall eruptions may be ſeen crowding together, which increaſe during the courſe of the diſeaſe.

Surrounding the inciſion, and extending itſelf half way round the arm, but more commonly deſcribing the breadth of a ſhilling, a circular, or oval, effloreſcence is obſervable. The larger this inflammatory appearance is, which is ſmooth to the touch, and not painful, the fewer are the general puſtular eruptions—and, indeed, I have obſerved, when the thread was made uſe of, this was the caſe, if the diſcharge from the inciſion was very copious—now all the ſymptoms ceaſe, and the buſineſs ſeems to be perfectly finiſhed.

UNFAVOURABLE SYMPTOMS. Though this is the progreſs of the diſeaſe in general, yet it ſometimes happens that there are deviations, and that we have not inflammatory appearances on the wounded arm till the eighth day, then it will ſuddenly ſhew itſelf, with the other concomitant ſymptoms—this is not recorded as a favourable omen—ſtill it ſometimes is in this point deceptive.

But if the colour around the puncture continues pale, though it is barely perceptible that inoculation has ſucceeded, inſtead of becoming red or inflamed—if the edges of the wound ſpread but little, and remain flat, unattended with itching, or any kind of uneaſineſs—if, inſtead of a red inflammation about the inciſion, it ſhould have a purpliſh caſt; if red, and the circle round the puncture ſhould be narrow and deep, and the incruſtation around it ſhould be depreſſed and concave in the center, they are conſidered us unfavourable ſigns.

FAVOURABLE SIGNS. On the other hand, if on the ſecond day there ſhould be an orange-coloured ſtain round the inciſion—an itching there in two or three days—a kind of elevation of the ſcarf-ſkin, reſembling a bliſter, without much inflammation, on the third or fourth day—a pain or ſtiffneſs in the pit of the arm, a large effloreſcence round the puncture, on the tenth or eleventh day, or ſooner—a hardneſs ſpreading circularly from the puncture, the inflamed part of the arm elevating itſelf, and forming a point, terminating in a dry ſeal; theſe are ſaid to form very pleaſing prognoſtics, and flatter us with the moſt agreeable expectations of a happy concluſion.

CAUSES. Theſe are ſimilar to what we have before recited in the ſmall-pox—for if the conſtitution is not poſſeſſed of the prediſpoſing cauſe, no effect will be produced, though the variolous matter ſhould be thrown into the habit.

CURE. In the evening after the puncture is made, it hath been thought adviſeable to give a few grains of the calomel powder, as much as will procure two or three evacuations, purging it off in the morning with ſome gentle cathartic. (No. 79, 80.)

Or, inſtead of the laſt, a doſe of Glauber's or Polychreſt ſalt, proportioned to the age and conſtiution of the patient—theſe are adviſed to be given every ſecond morning and evening, till the appearance of the eruption. This is ſuperfluous, two doſes will be in all common caſes ſufficient, immediately after the operation, and a day or two before the attack. If the inflammation is ſlight at the puncture, the doſe of calomel muſt be increaſed.

Afterwards we have nothing to do but to guard againſt the febrile ſymptoms, which are in general ſo mild, that there is little occaſion for medicine.

At the commencement, if neceſſary, what has been juſt above preſcribed are adviſed; and repeated two or three times, if the diſeaſe appears to be of a late or unfavourable ſort.

In the intermediate days, ſhould the fever run high, Clutton's febrifuge ſpirit, or the aethereal ſpirit of vitriol dropt into any aqueous fluid, ſo as to make it agreeable, may be taken often in the day.

As ſoon as the ſymptoms of the eruptive fever come on, the patients ſhould continue to be expoſed to the cool air as much as poſſible; for it is the beſt cordial and corrector of febrile affection in this caſe, as I have repeatedly experienced. Indeed, when the febrile ſymptoms appear to be violent at the onſet, great good has occured from the adminiſtration of an antimonial emetic and purgative.

Where the fever appears to be languid, and the patients are of weak and delicate conſtitutions, ſome caution is here neceſſary; for theſe, perhaps, it will be ſufficient to be kept in a large well ventilated room, eſpecially if the weather ſhould be very cold; and they ſhould be ſupported on ſomething of a more cordial and ſtimulating, nature, than if things were otherwiſe, and the patients more robuſt, who ſhould be kept, during the eruption, on a mere aceſcent diet.

After the eruptive ſtate is over, and the puſtules begin to maturate, ſmall broths, jellies, white wine whey, or ſuch like materials, may be allowed.

In this ſtate of the diſeaſe, the weakly and more delicate may require to be kept in bed, and ſupplied with more cordial applications, in order to perfect the ſuppuration of the puſtules, and totally free the conſtitution from any remains of the variolous matter.

If we proceed in this prudent manner, adapting our mode to the particular conſtitution of our patient, we ſhall very ſeldom have much trouble; but ſhould there ariſe uncommon complaints now and then in the inoculated ſmall-pox, it will be neceſſary for us to proceed as directed in the natural diſeaſe, (265, &c.) obſerving whether it verges to the nature of inflammatory nervous, putrid, or mixed fever, and conduct ourſelves conſiſtent with what the ſymptoms point out to our judgement.

§ 3. MEAZLES.

Called by the Latins morbilli, as being a diſeaſe of leſs conſequence than the ſmall-pox; as by morbillus, we underſtand morbus parvus, a trifling diſeaſe—they have alſo been named rubeolae and roſeolae, from the redneſs attending the eruption, or putting on a colour ſimilar to roſes—like the ſmall-pox, this diſeaſe appears to be a native of the Eaſt, and has certainly a great affinity with that complaint, as they are both generally of an inflammatory nature, equally infectious, and never affect the conſtitution twice—ſome authors ſay, except very rarely indeed—becauſe the habit cannot be brought a ſecond time into ſuch a ſtate, as to feel the effects of either of theſe infectious particles, ſo as to reproduce the diſeaſe, ſhould they circulate ever ſo plentifully in the fluids a ſecond time.

They generally make their appearance in the month of January, rage moſt violently about the vernal equinox, and diſappear in July.

They commonly attack children; but all conſtitutions, which have never before felt their influence, are the objects of this infection—hence, in the more advanced ſtages of life, many with them are afflicted—they are propagated by the particular conſtitution of the air, and become highly epidemic.

Some have conſidered the attendant fever of the ſimple inflammatory ſort; others as a catarrhal, or inflammatory remittent; ſome ſay it is of the peripneumonic kind, and conceive the eruption, not as critical, but ſymptomatic, as the cough and affections of the lungs will remain after that is over.

According to my conception, it is in general a febrile diſeaſe of the inflammatory kind, always infectious, electively affecting that membrane, called ſcheiderian, which lines the inſide of the noſe, throat, and lungs, and, in its progreſſion, the ſkin—though I have ſeen the affection of the lungs ſo extremely ſlight, as not to call forth the leaſt attention, where there was a diarrhoea attended through the whole courſe of the diſeaſe.

DESCRIPTION. Its progreſs is divided into three ſtages—the firſt precedes, the ſecond attends, and the laſt ſucceeds the completion of the eruption.

At the commencement there are chillneſs and heat alternately ſucceeding each other—ſoon after, on the ſecond day, the fever increaſes, attended with conſiderable ſickneſs, great heat, thirſt, languor, and loſs of appetite—the tongue is white—there is a heavineſs of the head, and drowſineſs—ſneezing—brightneſs of the eyes, from whence flow a thin humour—the eye-lids ſwell, and, moſt commonly, there is a dry and very troubleſome cough—ſometimes vomiting and looſeneſs are aſſociates with theſe, the laſt of a green colour, when children are getting their teeth—and all theſe ſymptoms gradually increaſe till the ERUPTIVE, or SECONDARY STAGE begins, which occurs generally on the fourth day; about which time ſmall red ſpots, like flea-bites, make their appearance in the face, which run into cluſters, forming larger ſpots, riſing above the ſkin, perceptible only to the touch, not the ſight; afterwards broad ſpots ſpread over the body downwards; not quite ſo prominent, though of a higher colour than thoſe of the face—when the eruption is finiſhed, the vomiting ceaſes, but the fever increaſes; and the cough, with the difficulty of breathing, become more violent—a ſweat and diarrhoea now and then ſupervene.

On the ſixth day, or thereabout, the THIRD STAGE commences, on which the ſpots on the face grow dry, and give it a rough appearance; and in three days more they totally diſappear from the whole body; for on the ninth day nothing is to be ſeen, except a dark coloured fine farina, or appearance like bran all over the ſurface of the ſkin—at this period, the fever and cough are ſometimes alleviated; ſometimes increaſed, and terminate in a dangerous peripneumony—and not unfrequently a looſeneſs ſucceeds the diſeaſe.

After this we are not to conclude the patient free from danger, unleſs, during its courſe, ſome conſiderable evacuation has taken place, either by ſweating, vomiting, urine, or looſeneſs; for without ſomething of this kind occurs, the cough will continue, the fever will return with additional violence, and the ſtrength not be recovered except with great commotion in the ſyſtem, and, conſequently, extreme danger.

Though what we have deſcribed is the moſt frequent mode of the meazles appearance and progreſs to their termination, yet ſometimes they differ ſo much, that authors have denominated them ANOMALOUS, or IRREGULAR, as deviating from the common courſe, or as in the eruption putting on the appearance of the ſmall-pox—both which we ſhall deſcribe before we proceed to the cure.

The anomalous differ from the mild ſort, becauſe the eruption happens not on the fourth day, but ſometimes before, and ſometimes after—the ſymptoms preceding, as well as accompanying the eruption, are more ſevere—the eruption does not begin ſo much on the face as on the ſhoulders and trunk of the body—and becauſe it is attended by more dangerous conſequences.

Beſides the ſymptoms which are common in ſevere fevers, there are ſome which are more peculiar to eruptive ones of this ſort; for here the pulſe is ſmall and frequent—reſpiration is ſhort and quick—there is an oppreſſion of the hypochondres—(33. 38.)—the urine pale—a great drowſineſs—twitching of the tendons—ſpaſms—delirium, with redneſs and watery appearance of the eyes—load on the eye-lids—and pricking pain in the ſkin—ſoreneſs of the throat comes on, with a ſhrill hoarſeneſs, and violent cough, in which children appear almoſt ſuffocated, vomit up their food, and grow black in the face—when, after ſo ſevere a ſtruggle, the eruption appears, the fever in part depoſits its malignity, the diſeaſe is at its height; and the fever perſiſts in the ſame manner to the drying of the ſpots, which yet, according to SYDENHAM, did not ſeem to put on that branny appearance as before deſcribed.

The event of this fever is often dreadful and deadly; for, on the eruption receding, the fever and difficulty of breathing are augmented—a peripneumony and diarrhoea, occaſioned by the ſtriking in of meazly particles, comes on; which laſt is not without danger, as happens often in the milder ſort, becauſe here it is acrid, dyſenteric, and excruciating—ſometimes a cough, difficulty of breathing, and hectic fever ſucceed—at other times, a general dropſy, but oftener obſtinate inflammatory affections of the eyes.

The OTHER is ſaid to be common at PARIS, wherein the eruption is different from that of the common regular meazles; for they are more prominent, ſuppurate perceptibly like the ſmall-pox, and occaſion the face to ſwell conſiderably; but then they are attended with the cough, watery eye, and other affections, ariſing from defluxions, which chiefly diſtinguiſh them from the ſmall-pox.

CAUSES, whether inducing or proximate, are ſimilar to thoſe of the ſmall-pox, (269.) the peculiar particles only creative of the diſeaſe being altered.

CHARACTERISTIC SIGNS. An infections inflammatory fever for the moſt part, with which are aſſociated, a defluxion of a thin watery humour from the eyes, tickling in the noſe, ſneezing, dry cough, more or leſs violent—on the fourth day, ſometimes ſooner, ſometimes later though rarely, ſmall ſpots running together, perceptible to the touch on the face, but broader on the body not perceptibly elevated above the ſkin, break forth, which in three days after are converted into branny ſcales in part, and totally diſappear upon the ninth day.

CURE. In ſo mild a manner will the meaſles ſometimes affect patients, that little is neceſſary to be done, except abſtinence from all animal food, or heating applications; and drinking freely of thin watery aceſcent liquids, ſuch as common fig drink, made agreeably acid with lemon-juice, apple water, or ſome ſuch like fluids.

But ſhould the febrile ſymptoms run high, we muſt proceed as directed in the ſmall-pox, (26.)—but great attention muſt be paid to the affection of the lungs—oily emulſions and linctures, (No. 81 to 83.) may therefore be preſcribed occaſionally, in conjunction with the other remedies, calculated to keep the febrile affections within proper limits.

Should oily medicines diſagree with the ſtomach, as is ſometimes the caſe, we muſt have recourſe to the claſs of demulcents, (187.) (No. 84) uſing the pectoral decoction, or that of linſeed as common drink.

After the eruption is completed, ſlight opiates are ſerviceable—but as nature generally performs her criſis either by ſweats, looſeneſs, or urine, we muſt obſerve what way ſhe directs her efforts, and proceed as we have before directed in cures of this kind, where they occur in fevers not eruptive.

As ſoon as the redneſs of the ſkin goes off, and the ſpots begin to die away, gentle purgatives muſt be adminiſtered, at proper intervals, and the patient return to his uſual mode of life gradually, (209.)—care alſo ſhould be taken, that patients expoſe not themſelves too early to the cold air, for theſe are apt to bring on a very diſagreeable cough, aſthma, and conſumption, from affections of the lungs, o • of ſome other parts.

Some perplexing ſymptoms, notwithſtanding all our attention, will now and then preſent themſelves, which aſk for our utmoſt exertions.

Should a delirium come on the fourth day, wherein the pulſe is ſmall, it is an unfavourable omen; ſtill by the application of leeches to the temples, it may be mitigated or ſubdued.

It is alſo a bad ſign if the fever ſhould increaſe and become violent, accompanied with intenſe thirſt, about the termination of the diſeaſe—and ſhould there appear great danger of ſuffocation, as will ſometimes happen from too great an afflux of ſerous humours on the lungs on the ninth day, we muſt fly to bleeding, according to the ſtrength of the patient, and apply bliſters, to prevent an inflammation coming on from that cauſe—which, if it cannot be done, ſuffocation may be the immediate conſequence—or, eſcaping that abſceſs will probably ſucceed, a hectic fever and conſumption.

A diarrhoea, or dyſentery, is apt to come after vomitings of green materials; and continue, though the meazles have finiſhed their courſe—theſe complaints yield only to bleeding.

The meazles which put on the appearance of the ſmall-pox, require the ſame mode of treatment as the mild ſort.

But in caſes of the anamolous ſpecies, we muſt be directed by the nature of the fever, and proceed in our modes of cure, as pointed out in our treatment of the different kinds of the ſmall-pox.

A moderate looſeneſs, with a ſoftneſs and gentle moiſture of the ſkin, alleviate all the febrile ſymptoms—but the flower the eruption, ſo much greater will be the danger—of which alſo we may have ſtrong ſuſpicion if they make their appearance on the ſecond, or the fifth and ſixth day from the attack—if they ſhould retrocede, and be aſſociated with delirium, or become livid, the worſt is to be dreaded—too high a degree of redneſs or paleneſs of the puſtules, great proſtration of ſtrength, vomiting, great reſtleſſneſs, difficulty of ſwallowing; or other ſpots, purple-coloured, like flea-bites, are alſo dangerous appearances—the contrary of all which will flatter us with moſt pleaſing expectations.

Few people have thought the meazles to be a diſeaſe of ſufficient conſequence, to avail themſelves of thoſe aſſiſtances which, as in the ſmall-pox, might be derived from inoculation in this complaint. As for my own part, practically I cannot ſay any thing on the ſubject; but if we may believe the authority of ſome who have made the experiment, or be allowed to depend on reaſoning from analogy, our labours might be happily rewarded—for it is aſſerted, and appears probable, that from inoculation from infected blood, on the ſixth day a ſlight fever manifeſts itſelf moſt commonly, though it is very moderate, unattended with loſs of ſleep and inflammatory ſymptoms; and it is neither ſucceeded by a hectic fever, cough, nor inflamed eyes; ſo that we find we ſhould be freed from a train of the moſt dangerous ſymptoms, and conſequently relieved, in many caſes, from the moſt diſtreſſing apprehenſions.

§ 3. WATER-POX.

This obviouſly takes its name from the fluid with which the puſtules are filled.

DESCRIPTION. This is a diſeaſe which attacks children about two or three years old, without any remarkable febrile ſymptom or indiſpoſition; it chiefly appears on the face, in ſmall red puſtules full of a clear or whitiſh watery fluid, about the ſize of a lentile; ſome of which dry off in two days, whilſt others increaſe; and all fall off in a dry ſtate within the ſpace of four, generally leaving no pits in the ſkin, as they are commonly attended with no inconvenience.

There is another variety which frequently affects infants a week old, and puſh forth ſimilar watery puſtules, about the navel, arm-pits, and ſingers, which grow dry within three or four days, and fall off in a ſcab.

The cure left totally to nature is always ſufficient; and nothing more neceſſary, than, if it is cold weather, keeping in bed, living upon gruels, weak broths, and warm liquids.

§ 4. CHICKEN, OR SWINE-POX.

Having had in the courſe of practice ſo little opportunity of attending the complaint throughout, and when called, there being ſo little to be done, I confeſs it ſcarce ever awakened my obſervation, as nature, after the ſtomach and bowels were cleared, if ſuch attempts appeared neceſſary, always performed the cure. I am happy to have it in my power to ſupply my readers with an account drawn by the pen of ſo accurate an obſerver as Dr. HEBERDEN, who ſays, in enumerating the

SYMPTOMS, that the pocks in many break out without any previous ſigns or illneſs; in others they are preceded by a ſlight degree of chillneſs, laſſitude, cough, broken ſleep, wandering pains, loſs of appetite, and feveriſh for three days—the puſtules in moſt of them are the common ſize of ſmall-pox; but ſome are leſs—they are never confluent or numerous.

On the firſt day of the eruption they are reddiſh—on the ſecond there is at the top of moſt of the puſtules a very ſmall bladder, about the ſize of a millet-ſeed; this is ſometimes full of a watery and colourleſs liquor, ſometimes it is yellowiſh, contained between the cuticle and ſkin—on the ſecond, or at the fartheſt, on the third day from the beginning of the eruption, is many of theſe pocks as are not ruptured ſeem arrived at their full maturity, and thoſe which are fulleſt of that yellow liquor very much reſemble what the genuine ſmall-pox are on the fifth day.

A thin ſcab is formed at the top of the puſtule from the cuticle being burſt, on the firſt or ſecond day, which contains this thin fluid, by accident, or, perhaps, from rubbing to allay the itching; the ſwelling of the other parts abates without its being ever turned into pus—thoſe which eſcape being burſt, have the little liquor turn yellow and thick, and dries into a ſcab—on the fifth day of the eruption they are almoſt all dried and covered with a cruſt.

The patients ſuffer little, except ſome languor of ſpirits, ſtrength, and appetite.

This diſeaſe wants no remedies.

It is diſtinguiſhable from the ſmall-pox by the appearance on the ſecond or third day, from the eruption full of ſerum upon the top of the pock.

From the cruſt alſo, which covers the pock upon the fifth day, at which time the ſmall-pox is not at the height of its ſuppuration.

But of this diſorder there appears a more malignant ſort.

For three or four days all the ſymptoms which precede the eruption run much higher—on the fourth or fifth day the eruption appears, with very little abatement of the fever—the pains, likewiſe, of the limbs and back continue—to which are joined pains of the gums—the pocks are redder than the common chickenpox, ſpread wider, and hardly riſe ſo high, at leaſt not in proportion to their ſize—inſtead of one little head, or vecſile of a ſerous matter, there have been from four to twelve—they go off juſt like the chicken-pox, and are diſtinguiſhable from the ſmall-pox by the ſame marks.

Beſides, the continuance of the pains and fever after the eruption, and the degree of both theſe, though there be not above twenty pocks, are not obſervable in the ſmall-pox.

From the ſimilarity of the chicken, or ſwine, and ſmall-pox, we may be able to account for the tales we have had of people being affected with the ſmall-pox twice, or having them after being inoculated, and ſucceeding—for ſome may have been inoculated from the chicken, inſtead of the ſmall-pox—and this is one of the ſtrongeſt reaſons that has induced me to inſert this account, that the error may be avoided—as very little is neceſſary in this caſe to be done by medicine more than what has been before recited—taking care, that if the febrile ſymptoms run high, to treat it in the ſame manner as the ſmall-pox under ſimilar circumſtances.

It is alſo worthy of obſervation, that thoſe who have had the ſmall-pox may have the chicken-pox; but thoſe who have had the chicken-pox cannot be infected again by it; though, to ſuch as never had the diſtemper, it is as infectious as the ſmall-pox.

§ 5. SCARLET FEVER.

This takes its name from the ſcarlet coloured effloreſcence upon the ſkin.

This fever is inflammatory, and attended with different kinds of eruptions; whence it has been divided into two ſpecies—one called SIMPLE SCARLET FEVER—the other, SCARLET NETTLE RASH FEVER, from its eruptions being ſimilar in appearance to thoſe marks left by the ſtinging of nettles.

DESCRIPTION. At the commencement the ſymptoms attend which we find in continued fevers, among which there is no great degree of ſickneſs; but on the fourth day the face ſwells, the eruption manifeſts itſelf externally, which are red, more copious, broader, and of a much more florid colour, but not at the ſame time ſo uniform as thoſe which attend the meazles; but they ariſe without any cough or watery eye, which diſtinguiſhes them from the meazles; they appear and recede two or three times during the diſeaſe; beſides, the redneſs ſhews itſelf to be uniform, as if the ſkin was ſuffuſed with red wine, not breaking in cluſters of puſtules upon the breaſt as the meazles do—in three or four days it entirely ceaſes—the ſcarf-ſkin ſoon after peels off, and there continues on the ſurface of the body fine bran-like ſcales, which are ſucceſſively ſupplied for two or three times.

Sometimes eruptions break out on the face and reſt of the body like the ſtinging of nettles, with much itching, which are elevated above the ſkin, ſoon increaſe, of a pale roſe colour; ſometimes with protuberances almoſt eryſipelatous, and roughneſs like te • ters—ſometimes, on the fever remitting, they diſappear; but about the evening ſhew themſelves, with fever, and a troubleſome hot itching—and, in three or four days, like the former, entirely ceaſe, when extremely ſmall ſcales ſeparate from the ſkin.

CAUSES. The ſame may be advanced here as in the meazles. (283.)

CHARACTERISTIC SIGNS. This is an infectious inflammatory or remittent fever, of ſhort duration, with a ſwelling of the face on the fourth day, attended with a florid redneſs all over the ſkin, with broad ſpots, running at laſt together, not elevated above the ſkin; or with ſpots like the ſtinging of nettles, which in three, four, or five days diſappear, occaſioning the ſcarf-ſkin to peel off, and covering the ſurface of the body with fine branny ſcales.

CURE. This is of the moſt ſimple nature—abſtinence from animal food, keeping out of the cold air, free uſe of watery liquids, thin gruels, and moderate warmth whilſt in bed; but ſhould the ſymptoms run very high, and the pulſe be very quick, full, and ſtrong, bleeding may be neceſſary, once, perhaps, and the uſe of ſaline mixture, (No. 1.) or ſmall doſes of antimonials, (180.) or nitrous powders, (No. 2.) keeping the body gently open, by the uſe of the mildeſt aperients, if coſtive, (171, 172.) (No. 3. 22 to 24.) and, after the whole is over, and the ſcarf-ſkin begins to peel off, two or three doſes of gentle phyſic ſhould be given. (172.) (No. 19 to 22.)

But ſometimes convulſions, or great drowſineſs may come on in the beginning, particularly with infants, a large bliſter may be applied between the ſhoulders, and a quieting draught, ſimilar to No. 4, given every night, agreeable to the age and conſtitution of the patient—uſing, for common drink, milk and water, balm tea, in which may be diſſolved ſome gum arabic, and ſmall portions of nitre.

Doubts have ariſen about the exiſtence of this fever, Dr. CULLEN having never ſeen it in its ſimple ſtate—however, it certainly does exiſt, and as deſcribed by SYDENHAM, of which repeated experience has convinced me; nay, indeed, I have known it ſeize ſeveral children in the ſame family, and moſt generally at the end of ſummer.

There is another ſpecies arranged here by ſome authors, ſtiled the MALIGNANT SCARLET FEVER—but of that we ſhall take the opportunity of ſpeaking under the head of Sore Throat, as that is one of its peculiar and diſtinguiſhing ſymptoms, and may probably be derived from that ſource.

§ 6. MILIARY FEVER.

This receives its name from being attended with eruptions in ſize and appearance like millet ſeed, which are ſometimes red, at others white—the firſt filled with a coloured ſerum; the laſt with a tranſparent fluid, called lymph, accompanied with ſcarce any redneſs at all.

Though the exiſtence of this fever has been doubted by many, ſtill, it is generally now allowed, that there is a fever of this peculiar kind, originating from ſpecific infectious particles getting into the blood, and producing its effects upon the machine—yet it may, and often does ariſe from the injudicious management of other fevers, by treating them with too heating a regimen—hence it is conſidered alſo ſymptomatic, and often joined with the ſmall-pox, meazles, and other fevers.

Like ſome other of the eruptive claſs, this is ſimple and complicated.

DESCRIPTION. At the commencement there is a chillneſs ſucceeded by no extraordinary heat—the fever is mild, attended by an uneaſy and copious ſweating—there is no general pain, but the head appears ſlightly affected—no thirſt—the appetite continues—the pulſe depreſſed, and rather hard—and the urine appears healthful.

The patient ſoon after, on the ſecond day, begins to be fearful and apprehenſive, conſtantly ſighing, from a ſenſe of weight and tightneſs at the pit of the ſtomach—has uneaſy dreams—dejection of ſpirits—the head confuſed—his ſweats perpetually ſmell ſour—there are a variety of ſudden and involuntary motions, and conſtant reſtleſſneſs—the pulſe is ſmaller, and increaſed in quickneſs—and there is a certain ſenſation of tingling numbneſs in the fingers—and the urine pale and limpid.

On the third or fourth day, ſeldom later, red or white eruptions break out on the neck, breaſt, and back, ſeldom on the face, preceded by pricking pains, ſometimes itching—at this period chillneſs and heat ſucceed each other repeatedly, and the ſweating becomes profuſe—from thence, for about the ſpace of thirty hours, eruptions continue to come out, which are filled with a thin ſerous fluid, having round their baſe an inflammatory appearance. The ſymptoms now begin to be alleviated—the ſweating continues, though not ſo profuſely—the mind begins to be leſs oppreſſed—the urine puts on a higher colour—the pulſe becomes more ſoft and regular—and about the ſeventh day the puſtules for the moſt part grow dry, the ſcarf-ſkin peeling off in ſcales.

This is a pretty accurate deſcription of the mild ſpecies of this fever, in which we may expect the eruptions will very ſoon make their appearance, when there are an uncommon dejection of ſpirits, watchings, confuſion of the head, much oppreſſion on the breaſt, with a weak quick pulſe; for theſe are conſidered as the certain ſymptoms of their near approach.

CAUSES. Both the inducing and immediate are ſimilar to what we have delivered when ſpeaking of the meazles. (283.)

CHARACTERISTIC SIGNS. A mixed fever, attended with anxiety—dejection of ſpirits—frequent involuntary ſighing—ſtrong ſmelling ſweats—and pricking of the ſkin—ſmall diſtinct ſpots, for the moſt part of a red colour, breaking out moſt frequently on the third or fourth day on the neck, breaſt, and back, ſeldom on the face, whoſe tops reſemble, after one or two days, very minute puſtules, which continue only for a ſhort ſpace of time.

CURE. The indications of cure are the ſame as in other eruptive fevers.

Now this fever muſt in this place be conſidered of a mixed nature, (240.) verging rather more to the nervous than inflammatory claſs—however, if they attack thoſe of ſtrong, robuſt, full habits, and there ſhould be a great degree of vaſcular action, bleeding may, perhaps, be neceſſary, but that rarely—we ſhould rather proceed as we have directed when ſpeaking of the ſimple continued fever, to the uſe of ſaline mixtures, with ſmall doſes of antimonials, (181.) (No. 6 to 9.) from whence, if the ſtomach ſhould be ſoul, a vomiting will enſue; this will abate the ſickneſs, take off the oppreſſion, produce a gentle perſpiration, determine the morbid matter to the ſkin, moderate the febrile ſymptoms, and occaſion, though not a leſs copious, a more expeditious eruption—and before that, cooling purgatives are beneficial, though not afterwards. (171, 172.) (No. 3. 22 to 24.)

Bleeding, it muſt be obſerved, is only admiſſible in the firſt ſtage of this diſeaſe—afterwards it is ſo far from being of any uſe, that convulſions and death itſelf are often the fatal conſequences.

Cooling acids may be alſo allowed in the beginning; but when the eruption has appeared they are prejudicial—diluting, emollient, and aceſcent liquids may be uſed—and from fomenting the feet and legs with tepid fomentations, great advantages have been derived.

But ſhould the conſtitution be different from what we have ſpecified, that is, rather debilitated than languid, and the nervous ſyſtem appear to be in too inactive a ſtate, we muſt apply to ſuch things as are of more cordial nature, to ſupport and invigorate the conſtitution; but out of them we muſt ſelect thoſe of the milder ſpecies; for, by ſtimulating the habit too violently, we ſhould prevent the ſeparation and expulſion of the morbid matter, and be inſtrumental in occaſioning it to fall upon ſome of the nobler parts internally.

Hence, then, ſuch cordial volatile medicines as we have deſcribed in the nervous fever, or ſome things ſimilar, ſhould be adminiſtered—and wine and water, or white wine whey may be allowed to be drank occaſionally.

Bliſters ſhould alſo be applied; and as ſoon as one has ceaſed to diſcharge, another muſt be laid on, becauſe it is obſervable that the evacuation produced by them, as well as keeping up the ſtimulus, affords great relief; for, on the evacuation ceaſing, all things wear a more favourable aſpect, which are always altered for the better, on the reproduction of the diſcharge.

But ſometimes, inſtead of the convulſive ſymptoms being mitigated after the eruption, they increaſe, attended with ſuch a train of ſymptoms as are indicative of greater degree of danger.

For the febrile affections grow more violent, increaſing about mid-day and at night—the ſleep is diſturbed with dreadful dreams—the ſweating decreaſes—the ſkin is hot and inflamed—the head is affected with pain, producing the ſenſation of inward diſtenſion—the face appears fuller—the tongue is dry and white—the pulſe ſmall and quick—and the urine copious, thin, and watery.

On the third day of the eruption there appears a great augmentation of violence throughout—the heat is burning—the puſtules ſubſide—the ſweat ceaſes—the ſkin becomes rough—the tendons ſtart—the patients are extremely reſtleſs, forward, and loquacious—they grow delirious, and are convulſed—they become thirſty—the pulſe is hard and quick—and the urine copious, and like water.

The belly, which before was coſtive, is now the reverſe, evacuating foetid bilious ſtools—ſhould any ſweat return, this violence on the puſtules breaking out again is mitigated—and on the ſucceeding day the eruptions become more copious and larger, the former beginning now to dry—notwithſtanding which, about the third day the ſecond crop creates new and ſimilar diſtreſs, though in a milder degree than the former—a third and fourth crop will ſucceed, until the laſt ſtage of declenſion, ſimilar to what occurs in the milder ſpecies.—Still in this ſtate of the diſeaſe there is a bilious foetid looſeneſs, with rolling of wind in the bowels, which continues—the urine ſometimes feels hot, and appears like milk whey without any ſediment.

Patients afflicted with this fever ſeldom recover before the fifteenth or twenty-firſt day.

This fever has been by ſome conſidered of the inflammatory claſs; by others it has been called the acute malignant—but it appears to be truly of the mixed kind, and might properly be looked upon as a malignant miliary mixed fever.

Sometimes the progreſs of this fever is ſlower, and longer continued, the puſtules not ſtriking out with a proper redneſs, but ſinking down in the ſkin or retroceding inwardly, liable to return at ſome other time, and occaſioning a ſlow recovery; and ſometimes death; but its progreſs is different in ſome degree.

This fever is apt to ſeize the delicate and relaxed, who have a thin and acrimonious ſtate of fluids.

In addition to the puſtular appearance above ſpecified, the tendons ſtart continually—a delirium and convulſions come on—the head-ach, though conſiderable, is not very acute—the tongue trembles—the velocity of the pulſe is not ſo great in the eruptive ſtage; but the freedom and quickneſs are irregular; ſometimes it almoſt intermits—the urine is various, ſometimes thin or higher coloured, but oftener turbid and ſmall in quantity—but a viſcid ſweat breaking out which is foetid, having for its aſſociate ſome larger veſicular eruptions, and puſtules of ſize more conſiderable, putting on an appearance almoſt ſimilar to the ſmall-pox, alleviate theſe ſymptoms.

After this ſtage, now and then the patients become extremely drowſy, and have continual twitchings of the tendons, and convulſive eructations, then become ſtupid, forgetful, and fall into a ſtate of lethargy; to which ſucceed convulſions, which are followed ſlowly by ſnoring and death.

This fever, ſhould the patient recover, is apt to return about the ſame time in the ſucceeding year, and often ſeizes women during their lying-in—whence there is a ſuppreſſion both of their milk and thoſe diſcharges after child-birth, called lochia.

The mildeſt ſort of the miliary fever generally terminates in ſeven, the malignant mixed in fourteen, and this in about twenty-one days.

There can be little doubt of the nature of this fever, if we pay attention to the ſymptoms, for they beſpeak it truly nervous—hence, for the cure, we muſt refer to what we have ſaid on the nervous fever, (216.) making, perhaps, a freer uſe of bliſters, and obſerving a quicker ſucceſſion, for the reaſons advanced; (290.)

Sometimes, added to the miliary eruptions, ſuch a train of ſymptoms will attend, as clearly to ſhew its diſpoſition to be of the putrid kind; little deviating from what we have recited when ſpeaking of putrid fever, (221, &c.) and conſequently will require ſimilar applications—but ſtill, though much cannot be expected from bliſters in ſymptoms ſimply putreſcent; yet ſuch is the alleviation they bring in miliary eruption, that to neglect them would be an error of no trifling conſequence—and, if to theſe we add the uſe of bark, mineral acids, and wine, little more can be expected to be done in this fever, as theſe are the principal materials from whence we can expect any conſiderable ſucceſs.

Should a looſeneſs come on under any of the circumſtances of this fever, we muſt proceed in the ſame manner as we have before directed, taking care not to be too buſy in putting a total ſtop to it by the uſe of aſtringents; for if that happens, we may expect a great increaſe of febrile affections, which is invariably the ca • e; we ſhould rather attempt to ſolicit a ſlow of humours to the ſkin, by ſmall doſes of ipecacuanha, (181.) (No. 57.) and ſupport the ſtrength of the patient by wi ••• , and other generous antiputreſcent cordials.

Thoſe ſigns which portend a favourable concluſion are,

If convulſions begin with, or precede the eruption, and, upon ceaſing, the pulſe becomes ſoft and full, the puſtules filled with ſerum grow large—if they are of the red kind, and manifeſt themſelves with a gentle perſpiration, free and eaſy reſpiration, and the pulſe as above ſpecified, the fever having remiſſions.

But if the ſweat ſhould be violent and premature, particularly if the pulſe at the ſame time ſhould be ſmall, they indicate miſchief.

A tingling ſtupor or numbneſs in many places, ſhews that the morbid matter is copious; but if it is ſlight, attended with watery urine, ſweats, and a ſmall pulſe, it not only indicates the ſame, but ſhews the virus not eaſily determined to the ſkin; hence dangerous.

Should there be great dejection of ſpirits, the patient become very fearful, loſe all hope, riſe up terrified, theſe are bad omens—nor is it a promiſing appearance if the ſkin does not ſwell from the eruption, nor be affected from the application of bliſters or cupping-glaſſes.

If the head-ach goes off before the fourth day, in thoſe of full habits particularly, it is an unfavourable ſign; and a ſmall pulſe, growing more ſo after the eruption, with tenſion, and quickneſs increaſing, denotes convulſions, and diſſolution, or extreme danger.

If the urine is conſtantly watery, or changes to that from a reddiſh colour; this affords no good ſign; but it beſpeaks a long continuation of the diſeaſe if it is like milk-whey.

Drops of blood from the noſe at any time beſpeak great danger; and, when drawn, if it ſhould be of a ſcarlet colour continually without ſerum, it is a bad ſign.

If, at the concluſion of the diſeaſe, the ſcarf-ſkin peels not off at all, or only ſparingly, the convulſive ſymptoms ſtill continuing, we may expect a relapſe.

WITH REGARD TO THE ERUPTION, the red are more favourable than the white; and the ſooner they make their appearance, ſo much the worſe; for thoſe which appear upon the third or fourth day often prove mortal on the ſeventh or eighth; they are leſs dangerous if they break out on the ſixth; the later the ſafer; for the ſooner they appear, the diſeaſe proportionably of longer continuance, and more apt to return.

After the eruption all oppreſſive convulſive ſymptoms are ominous, and thoſe which follow the ſubſiding deſtructive.

If the puſtules are ſmall, and very numerous, they beſpeak danger—nor is it a favourable ſort which do not prick, but itch when they are puſhing out of the ſkin—but if they recede, and afterwards the patient vomits, ſees badly, has a rattling noiſe in ſwallowing, hiccoughs, and ſtammers in talking, theſe import extreme danger.

By how much more copious and prominent are the puſtules, by ſo much ſooner will death make its approach, if they ſubſide—and thoſe which ſometimes ſubſide, and ſometimes appear, indicate a long continuance of the diſeaſe.

§ 7. ERYSIPELAS, or SEROUS INFLAMMATORY FEVER, commonly called SAINT ANTHONY'S FIRE.

This is conſidered as an inflammation of the ſkin, and ſubjacent fat, attended with an inflammatory fever, originating from an acrimonious humour and inflamed ſtate of the thinner part of the blood, from which nature endeavours to free herſelf by expelling the morbid portion from the habit, and depoſiting it on ſome external part, chiefly the ſkin, in broad red ſpots, which creep from place to place—hence its name, from the Greek words • ruo, to draw, and p • las, into the vicinity.

DESCRIPTION. It generally commences with chillneſs and ſhivering, which in a day or two are ſucceeded by a violent ſudden redneſs, and pain, attacking ſome part or other, chiefly the face; and has for its aſſociates an acrid heat, roſy-coloured effloreſcences, with great tightneſs of the ſkin, ſlightly ſwelled, which is broad and diffuſed, not circumſcribed—the febrile affections increaſe, with heat, anxiety, thirſt, often alſo a white tongue and ſtrong breath.

But it is often attended with greater degrees of violence—then it begins with great ſhiverings, ſucceeded by a burning heat, acute head-ach, retching and vomiting, till the eryſipelas appears, which is ſometimes deferred to the ſecond or third day; when the febrile ſymptoms are alleviated, and the ſickneſs ceaſes, tho', not unfrequently, they continue in a ſlighter degree to the height—ſometimes, when the diſeaſe runs high, the fever continues, the brain is oppreſſed, delirium comes on, and matters wear an unpromiſing aſpect.

Upon the tumid part veſicles ariſe, and run along the forehead hairy ſcalp, eye-lids, neck, forming a circle round them, which, if injudiciouſly treated, become gangrenous, and creates delirium—ſometimes the humour filling the puſtules, and iſſuing from thence, inſtead of being thin and ſerous, is thick and gluey, and forms a thick ſcurf or cruſt, continuing fixed before they fall off, for many days.

The diſeaſe frequently terminates in ſeven days; but ſometimes it will proceed in a ſimilar manner for eight, ten, or twelve days, and at laſt go off by a copious ſweat, of which reſtleſſneſs, with concomitant ſhivering, and ſome anxiety, though not much, for a ſmall ſpace of time, will be ſometimes the forerunners; and from thence may the critical effort be prognoſticated. During the progreſs of this complaint, the whole ſkin and inſide of the mouth is very dry.

CAUSES. The remote or inducing are ſaid to be, violent mental affection, particularly anger and fear—a ſudden cooling of the body, heated before by the ſtrong power of the ſun—drinking of, or bathing in, too cold water—a ſuppreſſion of the natural or artificial evacuations—moiſt and rainy ſeaſons—and, in fine, whatever occaſions the obſtruction of perſpiration.

The proximate or immediate, acrimonious and heating particles derived from humours that are contaminated and retained, which ought to be thrown out of the habit.

CHARACTERISTIC SIGNS. An inflammatory fever, for the moſt part, of a few days continuance, with a ſuperficial, ſolitary, diffuſive ſwelling, of a red roſe colour, going off upon preſſure, and returning; of an uniform ſmoothneſs, unleſs made rough by eruptions; and is attended with an acrid burning, or itching heat.

CURE. As this diſeaſe, though neither infections nor contagious, evidently ariſes from ſome acrid humours ejected out of the maſs of fluids, and collected in the cuticular veſſels, through which it ought to eſcape out of the habit, we muſt be very cautious not to lower the fever too much by exceſſive evacuations; nor hinder the exit, or cauſe the retroceſſion when diſcharged upon the ſkin by the injudicious adminiſtration of cold or aſtringent applications; for the indications of cure are, ſo to regulate the moving powers, as to enable them to throw the offenſive matter out of the conſtitution, and prevent any retroceſſion on the internal and vital parts.

Hence, therefore, muſt we proceed, as in other caſes, conſiſtently with the ſtrength of the habit. If it attacks thoſe of ſtrong full conſtitutions, we bleed in proportion to the ſtrength, and give the cooling cathartics, ſuch as purge off the ſerous humours in the moſt certain and eaſieſt mode, as vitriolated natron, acetated tartar, Polychreſt ſalt, Epſom ſalt, manna, tamarinds, cryſtals of tartar, jalap, &c. (171, 172.) (No. 1. 22 to 24.) and, on the intermediate days, we ſhould give at intervals antimonials joined with nitre, acetated tartar, or the ſaline mixture; to which gentle aperients may be added, if neceſſary.

Emetics in this caſe have been found efficacious—muſtard poultices applied to the feet, and bathing the legs and feet in warm water are very beneficial, where the head and face are affected—and, under this circumſtance, bleeding and purging may be repeated, till an alleviation of the ſymptoms are produced.

In all our endeavous we ſhould attempt to promote gentle evacuation by the ſkin with cooling diaphoretics.

There have been different opinions with reſpect to local applications to the part affected; ſome adviſe mild and ſoftening applications to the part affected, as freſh cream, the ointment of elder leaves, tepid watery fomentations, or the uſe of the water of acetated litharge—however, the fine powder of fenugreek, or wheat flour, ſprinkled upon the part, and lying in bed—or, if a fluid begins to ooze out of the veſicles, chalk or ſtarch may be ſprinkled on a ſoft cloth, and thus applied; for all repellents, whether of an aqueous or oily nature, are hurtful.

Should the ſwelling be ſuddenly depreſſed, from a retroceſſion of the offenſive matter, attended with internal oppreſſion and anxiety, and at the ſame time the pulſe becomes weak and ſinks, we muſt immediately apply bliſters, and have recourſe to vinous and other cordials; wine may be exhibited freely, volatile and other ſtimulants, which have more permanent action, ſuch as the nature of the circumſtances require.

Sometimes this diſeaſe attacks the trunk, cheſt, ſhoulder-blades, or ſides, and frequently makes its appearance lower, encircling the middle of the body, like a belt—hence called by the Greeks ZOSTER and ZONA, a belt; and by the Engliſh SHINGLES, from the Latin word cingulum, a girdle.

In this complaint little yellowiſh pimples, but more frequently of a livid hue, ariſe which are went to corrode, like a tetter, which ſpecies they reſemble.

The fever which is the aſſociate of this eruption is only ſlight; but, ſhould the pimples be puſhed back, ſymptoms of greater conſequence preſent themſelves.

There have been inſtances where the eryſipelas has begun with ſhivering, heat, delirium, violent pain of the back, head, and other parts of the body, where there was no inflammation; but upon the third or fourth day, the hot burning humour was depoſited in the glands under the arms, or in the groin, and there formed abſceſſes; or deſcended into the feet, and brought on mortification; and from a retroceſſion of the morbid matter, life was in the moſt extreme danger.

For if this matter cannot be made to re-appear, the peccant humour is depoſited upon the brain or breaſt, and death is ſhortly the conſequence—if the depoſition happens upon the brain, delirium immediately ſucceeds, the viſage is fluſhed, the eyes ſparkle very quick, then follows madneſs, terminating fatally in lethargy; but ſhould it be upon the lungs, the heat and anxiety is intolerable, of which no words are adequate to convey a perfect idea.

Notwithſtanding theſe appearances, our modes of cure vary not from that which we have before deſcribed.

Though, in general, the eryſipelas very ſeldom comes to ſuppuration, ſtill, when that is the caſe, it does not maturate kindly, and frequently forms diſagreeable and ill-conditioned ulcers.

Sometimes a mortification will threaten, then muſt we apply ſuch things as are calculated to ſtop its progreſs, as decoction of bark, lime-water mixed with camphor and ſpirits of wine, or camphorated ſpirits of wine, with tincture of myrrh.

In the ſlighter kinds of eryſipelas there is no great danger; but if a violent inflammation, attended with ſtupor, drowſineſs, or delirium, ſhould ſeize patients with an acrimonious ſtate of fluids, much are the conſequences to be dreaded.

Should the inflammation recede or be repelled, it brings on delirium, internal inflammations, aſthma, convulſions and mortification; or ſhould the tumid part grow livid, we may conclude the latter of theſe affections at hand. With reſpect to the puſtules, the thicker and whiter the matter, the leſs will be the degree of danger; but ſhould it be thin and pale, ſo much more in proportion will it be increaſed.

The PLAGUE, and that fever called PEMPHIGUS, from the Greek word p • mphix, bulla, a bubble or veſicle, or BULLOUS OR VESICULARY FEVER, ſhould be next treated on; but as I have had no experience in the former, I ſhall proceed to ſpeak on the latter only as far as it has fallen under my obſervation, as the diſeaſe itſelf ſeems not to be perfectly ſettled by authors.

§ 8. PEMPHIGUS, BULLOUS OR VESICULARY FEVER.

This takes its name from the bliſters with which it is accompanied breaking out on the ſurface of the body, of the ſize of hazle nuts.

In three inſtances they were attended with a fever of the continued kind, purely inflammatory; and in one it appeared to be contagious, attacking the wife of one man labouring under the diſeaſe a few days after the eruption, who would not ſleep from him during his illneſs. It was in theſe caſes treated as an inflammatory fever, free uſe being made of the ſaline diuretics, particularly the acetated kali.

The other two had ſcarce any febrile ſymptoms, but copious eruptions filled with yellow ſerum, which went off, and returned at different periods—diuretics in theſe two caſes were uſed in the beginning, and, at the concluſion, bark was joined along with them, and cordials, there appearing obvious remiſſions of the febrile affections, which were ſlight, and ſeemed to point out the nervous ſyſtem to be the ſeat of the diſeaſe, from the languor and lowneſs with which the complaint was attended, and the pulſe at the ſame time being weak, ſmall, irregular, and quick.

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.

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 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 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 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, 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 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 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 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 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 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, 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 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.