19 m THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES THE SYDENHAM SOCIETY INSTITUTED MDCCCXLIH LONDON OF THOMAS SYDENHAM. M.U. TKANSLATKl) FROM THK LATIN EDITION OF DR. GREENH1LL A LIFE OF THE AUTHOR R. G. LATHAM, M.D. KTC. KTC. ETC. IN TWO VOLUMES VOL. II. LONDON I'RINTEI) FOR THE SYDENHAM SOCIETY M DCCC !.. C. AND J. A I) I, A K D, I' II I N I K K : "R 5^2*; V- > CONTENTS OF VOLUME II. EPISTLE I. EPIDEMIC DISEASES. PAGE To the most illustrious Doctor Thomas Sydenham, M.D. . . . 3 To the most excellent and learned Dr. Brady, M.D., Master of Gonville and Caius College, and Regius Professor of Medicine in the University of Cambridge . . . . . .5 EPISTLE II. VENEREAL DISEASE. To my good friend Dr. Thomas Sydenham, M.D. . . . . 29 To the most learned and illustrious Henry Painan, M.D., Fellow of St. John's College, Public Orator of the University of Cambridge, and Professor of Medicine in Gresham College . . . .31 EPISTOLARY DISSERTATION. To the most worthy Dr. Thomas Sydenham, M.D. Letter to Dr. Cole A TREATISE ON GOUT AND DROPSY. To the most learned Dr. Thomas Short, M.D., Fellow of the College of Phy- sicians, London ...... 121 I. On Gout . . . 123 II. On Dropsy . . 103 Postscript . . . 182 SC1IEDULA MON1TORIA. To the most excellent and learned Charles Goodall, M.D., Fellow of the College of Physicians in London . . 187 I. On the Appearance of anew Fever . . . 11)0 II. On the Putrid Fever subsequent to the Confluent Smallpox . . 211 III. On Bloody Urine arising from a Calculus impacted in the Ridnrxs . 221 CONTENTS. PROCESSUS INTEGRI. PAGE CHAP. I. On the Affection called Hysteria in Women ; and Hypochondriasis in Men . . . . . .231 CHAP. II. Of the Depuratory Fever of the Years 1661, 1662, 1663, 1664 . 236 CHAP. III. On the Pestilential Fever of the Years 1665, 1666 . . 237 CHAP. IV. On Intermittent Fever . . . .238 CHAP. V. On the Stationary Fever from 1685 to 1690 . . . 240 CHAP. VI. On Infants suffering under the Stationary Fever . . 242 CHAP. VII. On the Scarlet Fever . . . ib. CHAP. VIII. On Pleurisy ..... 243 CHAP. IX. On Bastard Peripneumony . . . . 244 CHAP. X. On Rheumatism ..... 245 CHAP. XI. On Erysipelatous Fever . . . . 247 CHAP. XII. On the Pocky Itch, and such other inveterate Eruptions of the Skin, as do not yield to Venesection and Catharsis . . 248 CHAP. XIII. On the Quinsy . ... 249 CHAP. XIV. On the Measles . . . 250 CHAP. XV. On Smallpox . . . . 251 CHAP. XVI. On St. Vitus's Dance . . 257 CHAP. XVII. On Apoplexy . ... 259 CHAP. XVIII. Of Ophthalmia . . 261 CHAP. XIX. On Procidentia Uteri . ib. CHAP. XX. On a Nephritic Paroxysm .... 262 CHAP. XXI. On Bloody Urine from a Calculus impacted in the Kidney . 263 CHAP. XXII. On Dysentery, Diarrhoea, and Gripes . . . ib. CHAP. XXIII. On Bilious Colic . . . 265 CHAP. XXIV. On Cholera Morbus . . . .266 CHAP. XXV. On Colica Pictonum . . . . . 268 CHAP. XXVI. On the Iliac Passion .... ib. CHAP. XXVII. On immoderate Menstrual Flow . . . . 269 CHAP. XXVIII. On Hysterical Colic . . 270 CHAP. XXIX. On Jaundice not following Colic . . . . 272 CHAP. XXX. To prevent Abortion .... ib. CHAP. XXXI. On an immoderate Flow of the Lochia . . . 273 CHAP. XXXII. Suppression of the Lochia . . . 274 CHAP. XXXIII. On Dropsy . . .275 CHAP. XXXIV. On a Virulent Gonorrhoea . . . . 278 CHAP. XXXV. On the Lues Venerea , 280 CONTENTS. vii r U;K CHAP. XXXVI. On Fluor Alhus . 2S2 CHAP. XXXVII. On Diabetes . . 28;} CHAP. XXXVIII. On Piles . . ib. CHAP. XXXIX. On immoderate Heinorrhoidal Discharges . . 284 CHAP. XL. On the Epilepsy of Children . . ib. CHAP. XLI. On Rickets . . . 28.") CHAP. XLII. On Fever arising from Dentition . . . . 28t> CHAP. XLIII. On the Hectic Fever of Infants . . 287 CHAP. XLIV. On the Convulsive Cough of Children . . . ib. CHAP. XLV. On Hemorrhage from the Nostrils . . ib. CHAP. XLVI. On the Green-Sickness . . 288 CHAP. XLVII. On Suppression of the Menses . . i'>. CHAP. XLVI II. On Vomiting and Spitting of Blood . . 28'J CHAP. XLIX. On the Puncture of a Tendon . 290 CHAP. L. On Burns ... . ib. CHAP. LI. On common Mania ... . ib. CHAP. LII. On Bruises . . . . . 291 CHAP. LIII. On a Scalded Head . . 292 CHAP. LIV. On the Bite of a Mad Dog . . ib. CHAP. LV. On an Ulcer of the Bladder . . . it). CHAP. LVI. On inveterate Asthma in Patients of a sanguine Temperament 293 CHAP. LVII. On Palsy . . . .201 CHAP. LVIII. On Coughs and Phthisis . . . . ib. CHAP. LIX. On Scorbutus .... 29> CHAP. LX. The Description and Cure of a Decline . v . . 297 CHAP. LXI. On Gout 300 Al'PKNDtX. INDKX. ERRATUM. P. I.IK, line -2K, for I.ucan mi,; Lucian. EPISTLES TO DR. BRADY, AND DR. PAMAN. ii. EPISTLE I. TO THE MOST ILLUSTRIOUS DOCTOR THOMAS SYDENHAM, M.L). MOST LEARNED SlR, No physician, hitherto, has attentively considered the force and influence of the atmosphere upon human bodies; nor yet has he sufficiently ascertained the part it plays in prolong- ing; human life. No one either hath noted the force it exerts in fermenting, altering, and circulating the blood. Finally, in respect to the manifold changes and alterations of its natural tem- perament, changes and alterations which you have properly called constitutions, both writers on medicine and writers on natural history have been so far from investigating them diligently, that they have hardly touched upon them. Considering, however, that the air works its way into all parts of the body (even the most secret), it follows of necessity that such changes and alterations, which the atmosphere undergoes from matters with which it is impregnated, must also be communicated to the blood and juices of the body, and be impressed upon the same ; so that such and such depraved dispositions of the blood originate in such and such depraved constitutions of the atmosphere. Well, then, have you, in your ' Medical Observations/ con- sidered the various constitutions of the different years, and the different parts of years ; since it is in these that the actions of the air upon the blood, juices, and especially the spirits, arc beheld. Indeed they may possibly be the matter of the spirits themselves. Little doubt have I but that the observation of the charac- ters of fevers, as determined by the character of the year in 4 EPISTLE I. which they prevail, constitutes the most useful (if not the only) way for establishing a method of practice. Proceed then in your Observations and, if any still remain upon the fevers of the years lately elapsed, lay them before the public. So shall you consult the interests of humanity. In the fifth chapter of the first section of your book, 1 you have treated briefly on the use of the Peruvian bark, and the method of exhibiting it. For my own part, I know physicians of no small note, who give it in large doses often repeated. Others again contrive extracts and infusions ; and then, out of the infusions, juleps and emulsions. Thus they profess to cure not only intermittent but continued fevers also. In the former the remedy is doubtless a great one. For twenty years (more or less) I have myself used the bark in various forms, in manifold preparations, and with the greatest success. If, however, you know anything peculiar in respect to its pro- perties, or have been better taught by experience than myself, oblige the world by proclaiming it. In the treatment of rheumatism you have proposed free and frequent bleedings. 2 I would ask whether some method less prodigal of human blood, and (at the same time) equally cer- tain, may not be discovered. I know, Most Worthy Sir, that you will experience the rebukes of malevolent men and the calumnies of the envious. These will attack your reputation, now as before. Liberal and candid men, however, whose nature it is to despise such de- tractors, will defend you. These they are Avho, if they wish to work out the history of fevers, as shown by long practice, their essences, their causes, their differences, and the true mode of treating them, will take you to lead them on their way ; since few or no other methods of investigation and treatment can be assigned to any one but yourself. Proceed then as you have begun. Scorn the sarcasms of sciolists. Excite the spirits of honest men. It is you who have pointed out the way. Let those who dislike it find a better. Farewell. Do this, and every physician will be beholden to you. No one more than your deservedly devoted friend, 11. BRADY. CAMBRIDGE; Dec. .'30, 1(570. 1 33. [G.] Sect. VI, Chap. V, p. 4. [G.] TO THE MOST EXCELLENT AND LEARNED DR. BRADY, M.D., MASTER OF GONVILLK AND CAIL'S COLLEGE, AND REGIUS PHOFESSOK OF MEDICINE IN THE UNIVERSITY OF CAMBRIDGE. 1. THAT I, of all men now alive, should be pre-eminently ready to impart to any one, who might ask of me such small matters, as in the treatment of disease, I may have discovered, is simply what is right and proper. For if what is known to me be nothing but what is known to the world at large (a fact of which I am only too well convinced), it will not hurt me to publish such common-place and evcry-day pieces of information; whilst if I have really attained anything which is advantageous to medicine, and which paves the way to a more certain treat- ment of disease, the publication of the same is less praiseworthy in me than it would be in others ; since, for thirty years (more or less) I have been a sufferer from the gout, and for a long time from the stone as well. Hence I feel, on my own part, how seriously rejoiced I should be if the suggestions of others might bear upon the relief of my own afflictions. 2. Since, however, the great God hath allowed to few upon earth the mighty privilege of serving their kind to its benefit, and that only to those who are of earth's best mould " Queis mcliore luto finxit praccordia Titan." 1 I must make up by good wishes what I want strength to effect in full. For I have always thought (and not without reason) that to have published for the benefit of afflicted mortals any certain method of subduing even the slightest disease, Avas a matter of greater felicity than the riches of a Tantalus or a Croesus. I have called it a matter of greater felicity ; I now call it a matter of greater goodness, and of greater wisdom. For what more abundant instance of wisdom and goodness can any ' Juvrnal, Sat. xiv, 3 I. f> EPISTLE I. one display than (seeing his own share of our common nature) to continually refer such things as he has accomplished, not to his own glory, but to the advantage of the world at large, of which he himself is so small and contemptible a particle. The author that I most admire, as the great teacher both in thought and language, the greatest genius of his own, and perhaps of all ages, the admired Cicero, 1 writes, " Ut enim leges omnium salutem singulorum saluti anteponunt, sic vir bonus et sapiens, et legibus parens, et civilis officii non ignarus, utilitati hominnm, plus quam unius alicujus, aut suse, consulit." Besides this, it is clear, that just as it is a crime to murder a man, so is it the part of virtue and honesty to save our fellow-beings when we are able, as well as to arm others with such safeguards as we have ourselves learned. And these we may leave to the world after our death. Those who hold that it is no matter what happens after them, hold a wicked and inhuman doctrine. 3. All this, however, I will now pass over, and I will confess that, small as those matters are which I have been revolving in my mind, and concerning which it has pleased you to honour me with inquiries, it is to you that I am in duty bound to unfold them ; to you, whose illustrious qualities make you worthy of that learned body which you adorn, even as the Spartans adorned Sparta; and you, to whose erudition, probity, and candour of spirit I, for my part, only pay those high enco- miums which are paid by the university which you illuminate. I also pass over all those debts of gratitude due from me to you. To you that undeserved abuse wherewith I am harassed by many is a vexation and sorrow ; whilst, of those who utter it, this I may safely say, that if a harmless life, hurting none by word or deed, had been sufficient to protect me from their tongues, they never would have thundered against me. Since then, it is from no fault of mine that these calumnies have fallen on me (and, as I hope, never shall be), this is my resolution : viz. that I will not afflict myself because other men have done wrong. All that I shall deem my duty is, as far as my small means will allow me, to do the work of an honest man and of a good physician. 4. I will now, then, meet your wishes, in laying before 1 DC Fin. Hon. H Mai. iii, 19. [G.] EPIDEMIC DISEASES. 7 you such observations upon those diseases winch are the objects of your inquiries, as have occurred to me ; and I shall begin with the intermittent fevers which are now epidemic. For this reason, it will not be foreign to my purpose to run over them in a cursory way, and in their order of suc- cession in which they followed the year with which I closed my ' History of Acute Diseases/ these being the diseases of fifteen years. I shall also, by the way, touch upon a few points of treatment already noted. By this means, the time and progress of the- present constitution of fevers, and the rate at which it has crept upon us, will be made all the clearer. 5. The year 1676 brought forth the same diseases with that constitution which was last named in the ' Medical Ob- servations/ namely, the constitution of the years 1673 (in the autumn of which it began), 1674, and 1675. As this consti- tution, however, was going out, the diseases that belonged to it were less frequent, mild of their sort, and not so epidemic in their character, the peculiar disposition of the year notwith- standing. This, in respect to the manifold qualities of the air, was very different from the years that went before it, inasmuch as both the heat of its summer and the cold of its winter far surpassed the heat and cold of any twelvemonth within the memory of man. Nevertheless, vast as was the difference of the seasons, the diseases of the seasons were alike ; a clear proof, that the condition of the atmosphere which favours epidemic diseases is less a manifest than an occult condition. At the same time it must be owned, that, in respect to certain of their symptoms, these self-same diseases depended upon a diathesis manifest rather than occult. This is proved both by the measles and the cholera morbus. Each of these diseases set in during the year in question, and each of them shall be briefly noticed by me. 6. The measles began at the beginning of the year. They were not very epidemic ; yet they had this peculiarity, that they ran on longer than usual. Usually they set in in January, and go on increasing till Lady-day. They then gradually diminish, and expire about Midsummer. Now, in the present year, they lasted till the autumnal equinox, and, unless I am mistaken, they took strength and obstinacy from the heats of summer. Notwithstanding this, the treatment was the treatment of measles in general. 8 EPISTLE I. 7. As the summer came to a close, the cholera morbus raged epidemically, and being promoted both by the unusual heat of the weather, it brought with it worse symptoms, in the way of cramps and spasms, than I had ever seen. Not only, as is generally the case, was the abdomen afflicted with horrible cramps, but the arms and legs, indeed the muscles in general, were afflicted also ; so much, that the patient would at times leap out of bed, and try to ease the pain by stretching his body in every direction. 8. However much the disease might require the usual treat- ment for diseases of the same sort, I still thought it well to give my anodynes in larger and more frequent doses than usual. For instance, I was called in, along with my friend Dr. Charles Goodall, the mention of whose name reminds me of his candour, probity, friendship, and medical skill, to a patient who was almost killed by cramp of the kind described. The vomiting was enormous, the sweat cold, the pulse almost imperceptible. I gave him twenty-five drops of laudanum out of a spoonful of strong cinnamon-water, fearing lest a larger quantity of the vehicle should so far increase the vomiting as to make him reject it altogether. I then sat by his bedside, and watched the effects of the medicine. It was not strong enough to check either the spasm or the sickness. This made me repeat it in a larger dose ; and this I did more than once, waiting only such time, before the second dose, as might inform me of the effect of the first, until the symptoms gave way. The least motion, however, had a tendency to bring them on again. I then strictly enjoined rest for a few days, and the opiate in smaller doses and at longer intervals, to be continued even after his convalescence. It succeeded as I wished. 9. Let no one call me rash for thus throwing in laudanum so confidently. Experience has taught me, that in any of the three great symptoms requiring opiates intense pain, vomiting or purging, and dejection of the animal spirits the dose must be regulated, both in respect to its quantity and frequency, by the circumstances of the case only, since a dose that is strong enough for one system may be too Avcak for another ; and a dose that will endanger the life of one patient, may save that of another. 10. Now these are the diseases that did the mischief during EPIDEMIC DISEASES. 9 the year in question ; the same as those of the preceding ones. What they were in 1677 I am unable to say. At that time I suffered so much from bloody urine, that the least motion dis- tressed me. This was succeeded by gout, where, in addition to the extreme pain in my joints, my appetite failed, and my strength was prostrated. Swellings, too, of my legs, and other symptoms equally dangerous, supervened. Had I died at that time, death would have taken me away from the bitters of this world, not from its sweets ; nor should I have resisted. I was compelled, however, to keep the house for three mouths, and then, for the sake of restoring my health, to retire to the country for a like time. In autumn I returned to my family, and then learnt from my friends that intermittent fevers had been scattered here and there. Of these, however, the greater part had not attacked residents in London. Now, as my health would not allow me to visit my patients during the year in question, I think it best to pass it over in silence altogether. 11. The constitution of the following year, viz. 1678, was so favorable to intermittent fevers, that they might again take the name of epidemics. Since the year 1664 they had nearly been banished from London, so that for thirteen years they had at- tacked only a few patients sporadically, or else had been brought up from the country places. As they are at present, so will they be. Nay, they will extend their limits, until the atmo- spheric diathesis upon which they depend shall have reached its height. Now, however much these so-called interrnittents may have occurred more rarely during spring, by the end of summer and at the beginning of autumn they were pre-eminently preva- lent; so much so, as to exclude all other diseases from the name of epidemic. During the winter, however, they yielded little by little, and, at last, gave place to the smallpox, and other epi- demics, which ruled paramount until such time as the season for intermittents returned. 12. I will now give at large such results as I obtained from sedulous observation upon the causes and nature of these fevers. First, I must note, that although quartans were, at first, most common, tertians or quotidians are the commoner now ; unless, indeed, we choose to call these last double tertians. In like manner, these same tertians or quotidians, setting in with chills and shivers, followed by heat, and closing in sweats, ended, 10 EPISTLE I. for awhile, in a complete apyrexy, only attacking the patient after a stated interval. Nevertheless, they kept this course only until the third or fourth fit ; especially if the patient took cordials, kept his bed, and so, as the saying is, added fuel to fire. Afterwards, they so far assumed a severity foreign to their nature, that, instead of an inter-mission, there was only a re- mission. From this they went on to the type of continued fever, and at length affected the brain, and proved mortal to many. 13. As to the treatment, I have known, for many years, the extreme danger of attacking tertians and quotidians (forms which, whilst fresh, and without any fixed type, are easily in- duced to take that of a continued fever) by means of sudorifics; since, however much it may be a well-known fact, that as soon as the sweats break out the symptoms decrease, and an apyrexy succeeds (so that the inference is, that they should be indulged to some extent, at any rate not checked, especially when the fit is giving way) ; the real truth is, that by over- sweatings intermittents become continued. Then " Periculosse plenum opus aleae." The patient lives or dies, as his luck is good or bad. Unless I am deceived, the reason is this : a sweat beyond a certain amount of profuseness, exceeds the degree necessary for the despumation and subsequent elimination of the febrile matter thus increased by the heat of the paroxysm. Hence, all that portion which answers to the fit being expended, the re- mainder stands over for the purposes of exciting inflammation. As I was thinking over the inefficacy of such measures as bleeding and purging, measures which by weakening the blood protract the disease, the Peruvian bark became my sheet-anchor ; concerning which, in spite of the prejudices of many learned men, as well as those of almost all the vulgar, I may safely affirm that I have neither seen nor suspected any evil effects, except only such as I noted in my chapter on Rheumatism, wherein I remark, that those who have undergone long courses of it, are liable to a certain sort of scorbutic rheumatism. This, however, is rare, and when it happens is easily cured. 14. If I were only as sure of the permanence of the effect as I am of the harmless character of Peruvian bark, I should EPIDEMIC DISEASES. 11 look upon it as the prince of medicines ; since it not only shows eminent efficiency in agues, but is also useful in affections of the stomach and womb. So far is it from being prejudicial. 15. I think that for its bad repute there are two reasons. 1st. Many of the terrible symptoms that accompany inter- mittent fevers after they have long continued their afflicting in- fluences on the patient, and in cases where no bark has at first been taken, are often attributed to the very fault of the bark, when it is given. 2d. As the bark dispels the disease without any sensible evacuation, the opinion gains ground that, as there is something which ought to be expelled, and which is not expelled, such a something must needs remain in the system imprisoned, as it were, by bark, and liable to create fresh troubles ; so that the patient is not free of the disease, but still drags his ch;dn. Those who thus argue fail to observe, that as fast as there is any sensible morbid matter accumulated during the intervals between the fits, it is cleared off by the sweating stage of the fit that it occasions ; so that all that can remain must be the germ of the disease, waiting for time to ripen it. Now as the bark presses hard upon the retiring paroxysm, and as it thereby intercepts the fuel that the disease requires as a fresh supply, all that remains in the blood at all remains in embryo. Hence, the bark neither acts by smothering anything, nor as an ob- struction; though such are the charges laid against it. 16. But how can we prove that bark owes its virtue to its astringency ? Let those who think this, try other astringents. / know none that take effect. "What, too, shall we say to cases where it purged, and yet cured ? Such cases have happened. There is but one sort of true wisdom ; that is, to take a true measure of one's self, and not to throw dust in one's own eyes, by fancying that we are endowed with other faculties than those which are subservient to the perception of Natural Theology, of Moral Philosophy, or lastly, of the medical, mathematical, and mechanical arts, of Natural Theology, in order that we may duly, humbly, and in prostration of spirit, honour God, the great Architect and Governor, of the other arts, that we may help the common interests of our race. Let those who think otherwise, select any hypothesis out of the schools of Natural Philosophy, and solve thereby the secret 12 EPISTLE I. of a single specific difference in the whole Rerwn Natura. Let him say, for instance, why all grass is green, &c. &c. If he do this, I will serve under his flag. Till this be done, I must limit the function of a physician to industrious investigation of the history of diseases, and of the effect of remedies, ;is shown by the only true teacher experience; attention being directed to that method only which right reason, based upon common sense and not upon sneculation, dictates, I will now say what I have learned by experience, concerning the use of the Peruvian bark. 17. The Peruvian bark, commonly called Jesuit's bark, has, if I rightly remember, been famous in London for the cure of intermittent fevers for upwards of five and twenty years, and that rightly. The disease in question was seldom or never cured by any remedy before it. Hence agues were justly called the opprobria medicorum. A short time back, however, it went out of use, being condemned on two grounds, and those not light ones. Firstly, when given a few hours before the fit, as was the usual practice, it would sometimes kill the patient at once. This happened to an alderman of London, named Underwood, and also to a Captain Potter. Now this terrible effect of the powder, although rare, frightened the more prudent pli3 r sicians, and that rightly. Secondly, the patient who by the help of the bark had been freed from an impending fit, would, at the end of a fortnight, generally have a relapse, as if the disease was still fresh, and had not abated in violence by running its cotirse. All this shook the generality in their good opinion of the bark, since they considered it no great gain to put off the fit by endangering the life of the patient. 18. Now for many years I have been reflecting on the remarkable powers of this bark, considering, that with care and diligence, it was really the great remedy for intermittents. Hence I looked at two things, the danger to life, and the chance of a relapse. Guard against these, and I could cure the patient perfectly. 19. In respect to the danger to life, I laid it less to the bark than to its unseasonable administration. During the days when there is no fit, a vast mass of febrile matter accumulates in the body. Now, if in this case, we give the powder just before the fit, we check the method by which nature would get EPIDEMIC DISEASES. 13 rid of it ; so that being kept in, it endangers life. Now this I thought I could remedy by checking the generation of any new febrile matter. Hence I gave the powder immediately after the fit. This allayed the succeeding one. Then on the days of intermission I repeated it at regular intervals, until a fresh fit impended. Thus, by degrees, I brought; the blood under the healing influence of the bark. 20. The relapse, which generally happens at the end of a fortnight, seemed to me to arise from the blood not being sufficiently saturated with the febrifuge, which, efficient as it was, could not exterminate the disease at once. From whence I concluded, that to guard against this I must repeat the powder, even where the disease was overcome for the present, at regular intervals, and before the effects of the preceding dose had gone off. 21. On these principles my method was and is as follows: If 1 visit a patient on (say) a Monday, and the ague be a quartan, and it be expected that day, I do nothing, I only hope that he will escape the fit next after. Then on the two days of intermission, the Tuesday and Wednesday, I exhibit the bark thus : R Peruvian bark, very finely powdered, 5} ; Syrup of cloves, or Syrup of dried rose-leaves, q. s. Make into an electuary ; to be divided into twelve parts, of which one is to be taken every fourth hour, beginning immediately after the paroxysm, and washing down with a draught of wine. If the form of a pill be preferred R Hark, finely powdered, ^j ; Syrup of cloves, q. s. Make into moderately-sized pills. Take six every four hours. With less trouble and equal success you may mix an ounce of bark with two pints of claret, and give it as before, in doses of eight or nine spoonfuls. On Thursday the fit is expected. I do nothing; generally the fit keeps off. The remnants of the febrile matter have been cleared away, and thrown off from the blood, by the sweats of Monday's fit, and new accu- mulations have been checked by the use of the bark in the interval. :!2. To prevent the disease from returning on the eight h 14 EPISTLE I. day, exactly, after the last dose, I give another exactly as before. Now though this ofteii puts an end to the ague, the patient is all the safer for repeating the process three or even four times, especially if the blood be weakened by the previous evacuation, or the patient have exposed himself to the cold air. 23. Now, although bark is no purgative, it sometimes happens in certain idiosyncrasies that it pui'ges. In this case, so foreign to its usual action, laudanum should be added, otherwise the bark may pass off from the bowels, and fail to do its work. Ten drops of laudanum out of wine is the dose which is to be taken after every other dose of the powder, as long as the diarrhoea lasts. 24. The aforesaid method is my method for iutermittents of all sorts, quartan, tertian, or quotidian. 1 attack them all after the fit, and press on my medicines in the intervals. The only difference is, that a quartan takes an ounce of bark to cure it ; whereas the others are either cured or relieved by six drachms. 25. Now though tertians and quotidians after one or two fits may appear to intermit, they will frequently, as stated above, take the appearance of continued fevers, and only remit, and that upon the days when we might expect an intermission, espe- cially when the patient has been kept to his bed, overheated in his regimen, and distressed by attempts to sweat out the fever. In this case, my only chance is to take advantage of a remission, however slight, and to give the bark immediately after it, and to continue it every fourth hour, not stopping for the fit, other- wise the time would be too short for the febrifuge power of the bark to impart itself to the blood. 26. Although the fevers that now rage after the second or third fit would pass as continued, they are still intermittents. I do not, however, hesitate to give bark even when they are most continued. Repeated doses will cure the patient, provided only that no hot cordials, and no continued lying in bed, have lit up fever afresh. If so, bark is useless. As to the wine given with the bark, I have never seen it increase the fever. On the contrary, heat, thirst, and other febrile symptoms, have disappeared under its use, and when it has been given in sufficient quantities. Here I may remark, that just as the fever, either spon- taneously or under an over-hot regimen, becomes continued, the EPIDEMIC DISEASES. 15 bark is to be given freely. I have seen cases that have required an ounce and a half, or even two ounces of it. 27. Some persons, however, cannot take the bark, either as a powder, a pill, or an electuary. To these I give a cold in- fusion, viz. two ounces of bark, coarsely powdered, steeped for some tsuc in two pints of Rhenish wine. This being strained through a jelly-bag, becomes clear and palatable. Four ounces of this, after standing a few days, are as strong as a drachm of powder. As it is neither ungrateful to the taste nor oppressive to the stomach, it can be used twice as long and twice as often as any of the other formulae. 28. It sometimes happens, that when the ague is irregular, and has not taken the true form of typhus, the patient is so continually sick, that he cannot keep down the bark at all. He-re we must check the vomiting before we give the bark. With this view I give, six or eight times in two hours, a spoon- ful of freshly-squeezed lemon-juice, with a scruple of salts of wormwood ; afterwards sixteen drops of liquid laudanum, in a spoonful of strong cinnamon-water. Then shortly after, if the vomiting has ceased, I begin with the bark. 29. For infants, whose tender age will scarcely bear the remedy in this form, and still less in the quantity sufficient to destroy the disease, I order the following julep : K Black cherry-water, Rhenish wine, a a ^ij ; Peruvian hark, very finely powdered, 5iij ; Syrup of cloves, .5.). Mix, and make into a julep. Take one or two spoonfuls, according to age, every four hours, until the fits no longer occur: adding, in case of diarrhoea, one or two drops of liquid laudanum to every other dose. 30. 1 must observe, that the short intervals between the fits in tertians and quotidians hardly allow time for the blood to be fully saturated by the febrifuge virtue of the bark. Hence we cannot expect, as we do in quartans, that the patient should escape a fit immediately after beginning the medicine. In tertians and quotidians the medicine must have two full days to effect its promised cure. fl. If, notwithstanding the cautions above, the patient still relapse, which he is less likely to do in quartans than in quo- 16 EPISTLE I. tidians and tertians, the prudent physician will not be bigoted to the bark, but will use his judgment as to other methods. Of these, the best is the so-called bitter decoction. 32. As to diet and regimen, the patient need be forbid nothing that suits his stomach, except only green fruit and cold drinks, which weaken the blood, and help to bring bfcck the fever. Juicy and digestible meats make the best diet, with wine for an ordinary drink. By this means alone I have restored many whose systems, from frequent relapses, were proof against the healing effects of bark. Until the blood has regained its full vigour, the patient should not expose himself to the cold air. 33. Here I must remark upon what I have said elsewhere. Speaking of intermittents, I have recommended steady purging after the disease has gone. Now, this purging applies only to cases that have been cured either spontaneously or by medicines other than the bark. The cure by the bark neither requires purging, nor bears it ; since the bark itself, single-handed, re- lieves the fits, and relieves the dyscrasy of the system as well. All evacuations, therefore, should be avoided, even the mildest. A clyster of sugar and milk is sufficient to bring on either the risk of the disease or the disease itself. 31. Here I may mention, that during the first days of this constitution, a remarkable symptom sometimes supervened on the intermittents. Instead of chills and shivers, followed by fever, the patient would have the symptoms of a true apoplexy. Nevertheless they were only the symptoms of the fever of ague attacking the head. One proof of this was the colour of the urine. This, in ague, is of a deep red, as in jaundice, with a brickdust sediment. Now, in this case, however much evacua- tions, for the sake of creating a revulsion of the humours from the brain, the primary indications in apoplexy, may appear to be called for, they are wholly out of place. The symptoms are the symptoms of intermittent fever, and for intermittent fever the treatment for apoplexy is often fatal. Wait till the fit has gone off of itself, then give the bark as soon as possible, and repeat it at intervals till a recovery. 35. Sometimes (though rarely) it happens, that old men who 1 Medical Observations, Part I, Chap. V, p. 41. EPIDEMIC DISEASES. 17 have had ague, and have been bled and purged improperly, be- come diabetic, even after the fever has wholly departed. This is because their blood is so far weakened as to be incompetent to the assimilation of the juices of the ingesta, so that these seek an outlet in a crude and unconcocted form by the urinary ducts. Then the excessive loss of urine weakens the frame, and the whole substance of the body passes off by this channel. In this affection, as in all sorts of diabetes, no matter how originating, the curative indications must be wholly directed towards re- storing and invigorating the blood, and so restraining the pre- ternatural flow of urine. R Venice treacle, Jiss ; Conserve of orange-peel, J|j ; Diascordium, 3ss ; Candied ginger, Candied nutmeg, aa 3iij ; Gascoigne's powder, 3iss ; Pomegranate bark, Angelica-root, Prepared red-coral, Lozenges of terra Lemnia, ail 3j ; Bole armeniac, 9ij ; Gum arabic, 3ss ; Syrup of dried roses, q. s. Make into an electuary ; of which take a part about the size of a large nutmeg every day at five p.m., and at bedtime. Continue for one month. Wash down with six spoonfuls oi the following infusion : R Elecampane, Masterwort, Angelica, Gentian, aa ^ss ; Roman wormwood, White horehound, Lesser centaury, Calamint, au a handful ; Juniper-berries, _^j. Slice small, and steep in five pints of Canary wine. Let the infusion stand in a cool place. Strain when wanted. The diet should be digestible meats, such as veal and wether -mutton, &c. No vegetables and no fruit. Sherry wine at meals. 36. This cures a disease equally obstinate with diabetes, ii. 2 18 EPISTLE I. fluor albus. Different as this is from diabetes, its indications are the same. In fluor albus, however, one bleeding, and a purging with the pil. coch. maj,, in two-scruple doses, thrice repeated, should precede the restoratives. They may then be wholly omitted, since each evacuation undoes what the tonics had done. But this is by the way. 37. This is what I have to say in general concerning the Peruvian bark. I have no wish to make a pompous display of remedies. Those who add to it anything beyond what is necessary as a vehicle for getting it down into the stomach are, in my mind, either ignorant or dishonest dishonest in a way that a good man would despise. No good man would injure his fellow-creatures for his own benefit. In respect to the method itself, if the age had but con- descended to attend to what I wrote upon the subject four years ago, in my ' History of Acute Diseases' (and it is very credible that I was aware of what should be done before that time), many would be alive who are now under ground. This is as follows t 1 it was written for the service of the world at large, and contains, in brief, what I shall enlarge upon in the sequel. 38. " The first thing to look to is this we must not lay it on too soon, i. e. before the disease has, in some measure, ex- hausted itself by its own action ; certain cases, however, in an exhausted and debilitated condition of the patient, may indi- cate an earlier adoption of it. In giving it too soon, we have not only to fear lest its premature exhibition may render its action nugatory, and so disappoint our hopes, but we must consider that the very life of the patient may be endangered, if we suddenly stop that despumation of the blood which the whole effort of fermentation is aiming at. " In the next place, no part of the febrile matter must be withdrawn from the system by purging, and much less by ve- nesection, with the notion of promoting the action of the bark. With the corporeal economy weakened on both sides, the pa- roxysms return all the more readily, and all the more certainly, when the virtues of the powders have once for all been expended. To me it seems better to imbue the blood with the aforesaid 1 Med. Obs., Part I, Chap. V, 34, 35. EPIDEMIC DISEASES. 19 drug moderately, gradually, and at long intervals before the fits, than to attempt, by a single blow, to cut short the paroxysm at its accession ; since, by so doing, we give the remedy a longer time to do its work in ; and we avoid all those risks which might arise to the patient from any sudden and unseasonable check, whereby we attempt to suppress the paroxysm during its full development, and during the putting forth of all its activity. " Finally, the powder must be repeated at short intervals, so that the first dose may not have lost its effect before the exhibition of a second. By it a frequent and good habit of body will be recovered, and the disease be wholly dispelled. " Upon this ground I prefer the following form to any other : Mix one ounce of Peruvian bark with two of the syrup of red roses, of which the patient must take a bolus, of the size of a nutmeg, night and morning, every day when there is no genuine paroxysm ; he must continue to do so until the whole of the confection has been taken. He must repeat this once a fortnight, three times. 39. " Much as the medicine in question bears the bell, I have still found that spring tertian in young and strong subjects may be cured by the following method : bleed on the day when there is no fit ; then, a few hours after, but on the same day, give an emetic of the croc, met all., so timed that the vomiting may be done with before the next paroxysm. As soon as this is over, try R Extract of gentian, Extract of wormwood. Extract of lesser centanry, aa 5ij. Mix, and divide into nine doses: one of which is to he taken every four hours. Wash down witli Hitter decoction (without purgatives), White wine, ila ^iij. '10. " For poor men, where we must resort to cheap medi- cine, there is another way K Virginian snake-root (finely powdered), -)j ; White lime, ^iij. Mix. To he taken two hours hefore the fit. The patient must then sweat under the blankets for three or 20 EPISTLE I. four hours. This he must do again, twice, when the fit is coming on." 41. The following year (1679), about the beginning of July, the same fevers took fresh strength, and increasing day by day, raged fiercely, and caused avast mortality in August. Of these I have already treated ; I will only add, that in November they wholly yielded to a fresh epidemic, itself dependent upon a manifest crasis of the air. 42. With the month of November, coughs set in more epi- demically than I have ever seen, almost every family suffering from them. Some required no medicine at all ; some fell so violently on the lungs, that the patient must occasionally vomit from the violence of his cough; besides this there was giddi- ness. During the first days the cough was more dry than moist, nothing of importance being spit up. The expectoi'ation, how- ever, increased a little. Now, the drier the cough, the more violent was the effort, and the longer the fit ; and in proportion to the extent of these symptoms, the cough was, in my mind, akin to the convulsive cough of children, except that it was somewhat milder. In one respect, however, it was severer ; it was attended by fever and its symptoms. This I never saw in the cough of children. 43. Usual as it is for coughs to set in towards winter, every one wondered at their frequency during this year. I think the reason was as follows : the October had been excessively showery, and men's blood tallying with the character of the season, had imbibed abundance of crude and moist particles; the tran- spiration through the pores of the skin having been checked by the cold. Nature, then, throwing this serous load upon the windpipe, created a cough. 44. As to the cure, if medicine was wanted at all, I bled and purged. For ejecting redundant particles of serum, there is nothing like bleeding and purging, so thoroughly do they empty the vessels. 45. Pectoral remedies, except so far as they satisfy the patient, do little to remove the cough ; their only action is to thicken the matter when it is too thin to be spit out, or to dilute it when too viscid. I am certain that much time is lost by trusting to them, and that the blood is so weakened by the retention of serous particles inimical to nature, and that the EPIDEMIC DISEASES. 21 lungs are so irritated by the cough, and so shaken by the violent and continued motion, that the way is paved to a decline. Now against this the patient ought to be ensured by the speediness of his cure. Sudorifics are not much safer. Sometimes they cause fever ; sometimes the inflamed particles fall upon the pleura, and pleurisy is lit up. This, during the course of the so-called epidemic cough has created much danger to many men. 46. I take a moderate quantity of blood from the arm; I apply a large and strong blister to the nape of the neck. This acts as a derivative to the peccant matter. I then give a mild purge of senna, rhubarb, manna, or solutive syrup of roses ; this I repeat every day until recovery or improvement. If this dis- agree, I give instead, two scruples of the pil. cock. maj. every morning, at five o'clock a.m. After this the patient should take a nap. 47. By this method, and this alone, is the convulsive cough of children, otherwise so obstinate, cured. What happens to others I cannot say. For my own part I have only wasted my time when I have treated it differently. The purge should be proportionate to the age ; mild, and given in spoonfuls. This mode of evacuation, the so-called evacuatio, KUT' i-rriKpcHnv, cures the coughing in question, by stopping the influx of the hot and spirituous exhalations from falling upon the lungs, and it does this by carrying them off by the bowels ; since without doubt it is these same exhalations that excite the severe fits of coughing in infants. 48. Be the epidemic what it may, provided its attack be fresh, we must guard against purging without bleeding pre- viously. All diseases dependent upon the epidemic constitution of the atmosphere, either are fevers already, or easily become so. From any tumult of the blood or humours, from any, even the mildest, purge, from a slight access of heat, fever is easily lit up fever that otherwise Nature would have got rid of by some usual evacuation, by a catarrh, by an epidemic cough like the one in question, or by that form of diarrhoea which attends fever when epidemic. The same applies to any other constitution of the atmosphere by which the body is determined to any particular form of fever. This docs not 22 EPISTLE I. always show itself in act and deed. On the contrary, so be- nignant is Nature, that she gets rid of the germ of the disease through the mediation of some appropriate evacuation. This I affirm, that common as is the custom of purging before we bleed, there is but one practice fraught with more danger, that is, omitting to bleed at all. 49. It may be argued that the feculent matters in fheprimee vice will be propelled into the veins if bleeding precede the purging : be it so. No preliminary evacuation can make good the injury done to the blood by the disturbance of a purge without bleeding. Besides this,, it cannot be denied that a purge taken soon after bleeding acts more mildly, and heats and disturbs the blood less than a purge given first. From this being either unknown or neglected, many, infants more especially, have perished. 50. Experience has taught me this Experience, the best guide and teacher that a physician can follow; indeed, if he fail to follow her, he had better be no physician at all. The game is too serious to be played with impunity ; when, on the one hand, we have empirics, who, knowing neither the history of diseases, nor their methodus medendi, practise on the strength of recipes alone ; and, on the other, empty sciolists, who rest all their claims upon an affected pretension to art, and on speculations that may be worked either way. Two such sources of mischief, when their strength is united, kill more than disease would kill without them. 51. That practice, and that alone, will do good which elicits the indications of cure out of the phenomena of the disease itself. This made Hippocrates divine. Even if this method of medicine could be handed down by tradition, although the cure of one or two diseases might become clear to any one, the whole art would require prudent and skilful men, as much as they are required at present ; and the art itself would be equally honorable. True practice consists in the observa- tions of nature ; these are finer than any speculations. Hence the medicine of nature is more refined than the medicine of philosophy. 52. Fevers, which form two thirds of medicine, prove this, and any man of moderate reflection shall be my judge. Who, EPIDEMIC DISEASES. 23 even of the weakest empirics, could not cure a fever if he had only to satisfy the two common indications, namely, to ex- terminate the morbific matter by sweats, and to meet the symptoms arising from such evacuations. Venice treacle, Gascoigne's powder, plague water, &c., taken internally along with hot regimen, can produce sweats, and this is all a man wants, provided that he talks about malignity. Then as to symptoms, he has laudanum for sleep, and purges for constipa- tion. Nevertheless he cannot, either by himself or from the teaching of others, ascertain the species of fever which he strives to conquer ; that is, if we believe as our posterity will believe, that they are several species of fevers, each requiring peculiar treatment, and that one and the same fever, of what- ever genus, must be treated in one way at its commencement, in another during its subsequent stages. 53. How will a man, not knowing the natural history of a disease, the only true guide to its treatment, borrow his indi- cations of treatment from the different less prominent phe- nomena which may arise from the disease, or which may arise from the treatment, but of which he knows nothing ? I have no time to enumerate the varied and subtle and minute obser- vations in the treatment of this and other diseases. They are, however, so numerous, and they so illustrate the infinite variety of Nature, and they so truly suggest the modes of treatment, that our sons and sons' sons will be employed in adding to their number. Under this view, Art is honoured rather than vilified, enhanced rather than depreciated, and, as such, admits none but the wise and prudent amongst her sons. But this by the way. 54. The aforesaid coughs, if treated badly, light up a fever like the epidemic of the winter of 1G75. However, as this fever was only the offspring and effect of the epidemic cough, I treated it as the cough had been treated, by bleeding, a blister to the neck, and a purge three mornings running. The cough without the fever required no time to be fixed for the con- tinuance of the cathartics ; they were given until convalescence or recovery. However, in the fever dependent upon the cough, three days' purging was fully sufficient. F>5. Here I must note that, although troubles and defluxion 24 EPISTLE I. on the lungs accompanied this fever when it first showed itself, after a month or two, when the serous flux had been gradually eliminated from the blood, a fever, evidently of the same cha- racter, though without a cough, became troublesome. This was treated like the fever that accompanied the cough, and it was due to the permanence of the original impression upon the blood. 56. This fever extended itself in the manner described to the beginning of the present year, 1680, when intermittent fevers began their appearance as the year began. Then to the beginning of 1685, the year of this my second edition, the same fevers continued. Although, in London, they are less epidemic and more mild than during the four preceding years, they are just as bad elsewhere. Even the general constitution is favor- able for the production of intermittents, so much so, that I venture to say that the only cases of continued fevers that I have seen, have been transformed into intermittents, or else were some of so-called intercurrent fevers that occur every year. So steadily does this constitution conduce to the pro- duction of intermittents of the sort in question, that this sort must lose ground before the continued depuratory fevers will have a chance of becoming epidemic. In the production of intermittents, Nature works hastily, and gets over in less time than is regular the processes whereby she first tempers, and afterwards discharges the morbific matter. Depuratory fevers are different. Thirteen or fourteen days elapse before the ap- pearance of any sign of the concoction of the febrile matter; which is then to be ejected by sweats, or rather by a somewhat free transpiration. 57. Bearing this in mind, I have no doubt but that the depuratory fevers of 1661-62-63 and 64, were merely the dregs of the intermittents of several I cannot say how many years before ; when the constitution which gave birth to these last changed and laid aside its violence, lost its strength, and pro- duced only humoral and earthy fevers, fevers which cleared the blood but slowly, whilst the fevers which were earlier in date, subtle in principle, and intermittent in type, did their work more rapidly. If this be true, it is likely that, when the present constitution has abated, this same depuratory fever will return, EPIDEMIC DISEASES. 25 that it will last a certain time, and possibly be followed by the plague. 58. During the whole of the three years wherein these fevers raged, intermittents appeared at times, sometimes almost as epidemics. This was when any manifest property of the air favoured them. "Whether bark would have cured them, as it now cures agues, I cannot say. In plague, and the continued epidemics which succeeded in turn, bark is likely to do as little as it does in pleurisy, peripneumony, or quinsy, &c., that is, it is likely to do more harm than good. Be this as it may, if Nature retain the same sequence which she has retained the last twenty-four years, the epidemics will follow each other as I have described. 59. This is nearly all which I have observed concerning the epidemics of the last years. Respecting the treatment of rheumatism, concerning which you put some questions, I, like yourself, have lamented that it cannot be cured without great and repeated losses of blood. This weakens the patient at the time ; and if he have been previously weak, makes him more liable to other diseases for some years. Then the matter that created the rheumatism falls upon the lungs, in case the patient take cold, or from any other slight cause. By this the latent disposition exhibits itself in act and deed. For these reasons, I determined to try whether any other method, besides that of repeated bleeding, would cure the disease. Reflecting upon this, and arguing that the disease arose from inflammation, a fact, of which one proof out of many is the pleuritic character of the blood, I judged it likely that diet simple, cool, and nutritious might do the work of repeated bleedings, and save the discomforts arising therefrom. Hence I gave my patients whey, instead of bleeding them. 60. Last summer, a respectable and very intelligent apothe- cary, a neighbour of mine, Mr. Malthus, sent for me. He suffered miserably from rheumatism. The first two days he was lame in the hip ; the next two he suffered from oppressive difficulty of breathing ; then came headache ; then pain of the right hip, the one first affected; afterwards all the joints of the leg and arm, after the nature of the disease, were affect rd. Being of a weak and dry habit, I feared lest I should pull him 26 EPISTLE I. down too much by bleeding ; the more so, as the summer was advanced, and the Avinter might interrupt the restoration of his strength ; so I ordered him whey, and nothing else, for four days. After this he had, besides the whey, a little fine wheat bread once a day, instead of dinner, until he recovered. On this diet he continued eighteen days, except that towards the end he took a little bread for supper. The whey was the whey of eight pints of milk daily, and it fed him sufficiently ; afterwards, as he Avent out in the air, I let him have some roast fowl, and other such digestible meats ; nevertheless, every third day he was limited to the whey. He recovered his full strength, escaping all such discomforts as ten years before a similar attack, which 1 treated by bleeding, had entailed upon him. 61. Should any one despise this method for its simplicity, I would let him know, that weak minds only scorn things for being clear and plain ; besides which, I am fully prepared to serve my kind at the price of a little discredit. I say this because, if it were not for the prejudices of the vulgar, there are other diseases which this treatment would suit. The usual pomp of medicine exhibited over dying patients is like the garlands of a beast at the sacrifice. 62. I will now show how despised trifles, with due skill, may save lives ; a fact disconnected from and foreign to the present disease, but not foreign to my object. Two months ago, a neigh- bour asked me to see a servant who had swallowed a great quan- tity of corrosive sublimate, either ignorantly, or, as I afterwards learned, being lovesick. It was nearly an hour since he took it ; his mouth and lips were swollen ; he was violently sick ; he had burning pain in the belly, and was all but dead from fever. I ordered three gallons of warm water to be taken as quickly as possible ; and as often as any was vomited up, fresh draughts. I also wished that the bowels should be well Avashed out with warm Avater, Avithout any addition, thrown up as a clyster, the moment that griping told me that the poison Avas working its Avay doAvnAvards. The poor felloAV, greedy of life, obeyed my orders, and drank some pints more than I prescribed. As the case \vas a strange one, his friends sat by him, and learned that Avhat he first threw up tasted acrid, as if saturated Avith the salt; that Avhat followed was less so; and that, at last, there A\as no EPIDEMIC DISEASES. 27 taste at all. As to the gripes, the warm water alone eased them. Thus simply, by the blessing of God, he recovered Avithin a few hours, except that his lips remained swollen, and his mouth was raw from the contact of the poison he had vomited. These symptoms, however, under a diet of milk alone for four days, soon disappeared. I preferred water to oil, and to all other liquors, because it seemed fitter than any thick fluid for taking up the poisonous saline particles. 63. To return to the rheumatism. Though the whey diet may suit young men, and those who have lived steadily, it will not suit men of advanced age, nor yet free livers. With them it weakens the stomach, chills the blood, and paves the way for dropsy. In such cases the treatment must be that which I have described in my book on ' Acute Diseases' (vi, 5, 4). Excepting only that, since that was written, I have learned from experience that, after the second, or at most the third bleeding, it is better to purge than to trust to bleeding single-handed. Through the helps afforded to the bleeding by the catharsis, the necessity of any great loss of blood is diminished ; besides which, a way is prepared for the use of paregorics. Otherwise these were inad- missible, however great the pain ; since by admitting them the disease would have been fixed, and have become all the more resistant to venesection. The purgatives, however, should be simply lenitive tamarinds, senna, rhubarb, manna, and the solutivc syrup of roses. Scammony, jalap, and the like, excite pain and disturbance. Every evening, after the purging is over, an early dose, consisting of an ounce of syrup of poppies, should be given. 64. Here I may remark, that I have seen a certain affection under the present constitution taking the appearance of rheu- matism, and besides this, become not unlike to pains in the kidneys, in respect at least to the severity of the suffering in the lumbar region. As this is wont to follow intermittent fevers, it may be due to a translation of the febrile matter to the muscular parts of the body. It should be treated like the fever from which it arises ; frequent bleedings, and all kinds of evacuations, make it worse. I have mentioned this lest any one should be deceived in it. 05. Thus far, most illustrious friend, have I been enabled to 28 EPISTLE I. answer those questions which you have honoured me by asking; and if my answers have either pleased you or profited others, I am well satisfied. At least, I may congratulate myself on having had an occasion of showing, to the best of my humble powers, an example of the respect with which any desire on the part of one so conspicuous as yourself is attended to by your most humble and devoted servant, THOMAS SYDENHAM. LONDON ; Feb. 7, 1679. EPISTLE IT. TO MY GOOD FRIEND DR. THOMAS SYDENHAM, M.D. MOST LEARNED SlR, A GREAT light arose upon the medical world when your ' History of Acute Diseases' \vas given to it a work written, not with a view to either lucre or notoriety, but based upon sedulous observation and trustworthy experience, and the fruit of an honest and candid mind. To you it is enough to have done your duty, and to have helped your age. For my own part, I have all along concealed what I most have wished for ; still you may have a notion of what I desire. He who praises you for what is done, presses for ground of fresh praises. Concerning acute diseases it is difficult to write. So rapidly revolves the wheel, that unless seasonably checked, life is lost, beyond remedy and beyond redemption. You, however, have noted each change, and have taught what each instant requires a great work, but still incomplete. Its complement, however, you have promised, viz. a notice of the chronic diseases. These give a truce both to the patient and the physician, allowing time for examination and judgment. We have often spoken of the so-called venereal disease, an ailment so disgraceful, that the nations of Europe deny its origin amongst themselves, and in order to throw a shade over its rise and progress, make it over to the distant Indies. The scourge of the lecherous, the punishment of the fornicator, it is slow in progress perhaps, for the sake of giving time for re- pentance. He who openly expressed the wish that this impure malady should be curable in the first instance only, was touched by a lively perception both of the disease itself and of human nature. 30 EPISTLE II. As it is, its treatment is now with the quacks, barber-surgeons, and mountebanks; and as such men, partly from want of skill and partly from want of honesty, protract the cure, the ex- pense and trouble become so great, that the miserable patient, under the hands of his tormentors, becomes sick of life, and thinks worse of the cure than the complaint. I remind you then, but in a friendly way, of your promises. As an instal- ment, send something upon the diseases in question. Kindly and openly explain the method by which an afflicted patient may be easiest relieved. To suffer at the hands of GOD is enough ; no need that the physician torture him as well. By doing this you Avill oblige many ; to myself, also, credit will redound for having, by my urgent request, been instru- mental in bringing such a work to light. I am, in all duty bound, Your most obedient servant, H. PAMAN. LAMBETH PALACE; Feb. 12, 1C79. TO THE MOST LEARNED AND ILLUSTRIOUS HENRY PAMAN, M.D., FELLOW OP ST. JOHN'S COLLEGE, PUBLIC ORATOR OP THE UNIVERSITY OP CAMBRIDGE, AND PROFESSOR OK MEDICINE IN QRESIIAM COLLEGE. MOST ILLUSTRIOUS SlK, 1. ALTHOUGH you have so far honoured my lately-pub- lished treatise ' Upon Acute Diseases/ as, in your courtesy and friendly kindness, to speak of it as a work of consummate merit, I am still so conscious both of my own imperfections and of the small merits of the work in question, that, in my own eyes, I am only a guide and pioneer to surer observers than myself, who may better be able to investigate the history and cure of diseases : . " fungor vice cotis, acututn Reddere quae fcrrum valet, exsors ipsa secandi." ' 2. And, in truth, so varying, manifold, and (if I may use the term) so delicate is Nature, and so much does she sport in the prodiiction of diseases, that it is not the work of one man's lifetime (long as it may be) to graphically depict their varied phenomena, and their appropriate cures. Did I say one man's lifetime ? Ten men, succeeding each other through ten life- times, would not do it not even though they had, each and all, unrivalled genius, unwearied industry, and the skill arising from long and manifold practice. So far am I from considering myself as one who lias reached the height of the medical art, that, " Mncum habito, et novi quam sit milii curta supcllex." * 3. In respect to such chronic diseases as I gave you reason to expect that I intended to write upon, so thoroughly has the 1 Hor., Kp. ad I'is., :t04. [G.'J I'crsius. S;it. iv, :>2. , (J.J 32 EPISTLE II. desire of doing so settled in my mind, that, unless I am mis- taken in my own wishes, there is no reason which would induce me to pray for a long life, so much as the opportunity thereby given me of doing something towards the benefit of my fellows by a work of that kind. Every day, however, teaches me the difficulty of the undertaking " Periculosae plenum opus ales." Difficult to any one, it would be doubly difficult to me, who am so imperfectly endowed with the necessary acumen and sagacity. Besides this (if we except the divine Hippocrates and a few others), there are scarcely any guides whereby the dense and thorny way may be made clear ; such authors as have professed to light the path, being ignes fatui rather than true beacons, and leading to quagmires and precipices, rather than towards the true and genuine investigation of nature. All that has been written has been hypothesis ; the unbridled wantonness of fanciful art. Indeed, the very phenomena of those diseases, which their histories are bound to describe, are forgeries of the same mill : all are hypothetical. Hence even their practice squares with the hypothetical postulate, and not with the facts of nature. Can any better method of de- stroying the human race be devised ? The judgments of nature are but as dust to the feet. It is the speculative brainworms of the writer that run wild over every page. Notwithstanding, if it so please God, I will try " Quid valeant humeri." At present, in order that you may understand how wholly I am at your disposal, I make an offer of the present dissertation on the Venereal Disease. It is brief, and is all that I have prepared for publication still it may pass as a sample of the work which 1 have in contemplation. 4. As a preliminary, however, I must remark that I have met with many persons who, either from the praiseworthy desire of terrifying the unchaste by the fear of future trouble, or for the sake of claiming credit for continence on their own part, have not hesitated to argue that the cure of the venereal disease should not be taught. With such I disagree. If we reject all cases of affliction which the improvidence of human beings has VENEREAL DISEASE. 33 brought upon themselves, there will be but little room left for the exercise of mutual love and charity. God alone punishes. We, as we best can, must relieve. Neither must we be too curious in respect to causes and motives, nor too vexatious in our censorship. Hence I will state what I have observed and tried in the disease in question ; and that not with the view of making men's minds more immoral, but for the sake of making their body sounder. This is the business of the physician. 5. The lues venerea was introduced into Europe A.D. 1493, from the West Indies, it being, before that time, unknown even by name. Hence the disease is usually considered as endemic to the American colonies. In my mind, however, it is rather referable to the coast of Guinea, or to some portion of the Negro country thereabout. This I think because many of my countrymen have told me that, in slave-ships, even before they have reached America, the disease breaks out also that it breaks out with the natives in the country itself, and that independent of any previous unclean intercourse. Indeed, in some cases, it afflicts a whole family men, women, and children. The disease that thus comes spontaneously is, in no respect, different from the true venereal lues. The symptoms, the pain, and the ulcers are the same making allowance for the dif- ference of climate only. The name, however, is different. The African disease is called the yaws. Though the name be different, the treatment is the same. Mercurial salivation cures each ; notwithstanding the great accredited virtues of guaiacum and sarsaparilla ; there, in their native country, and with their virtues (as is not the case with us,) unimpaired by a long passage. 6. I therefore think it likely that those Spaniards who first imported the disease into Europe, took it from the Negroes of Africa, whom they purchased as slaves ; and as the inhuman practice of selling their fellow-creatures is prevalent on many parts of the coast, the countries in question may be the original localities where the ailment is endemic. Be this as it may, the lues venerea, having found its way into Europe, has spread itself with such rapidity, that if it kept up the rate at which it made its way at first, it would be all over with the human race within a very few generations ; or, ii. :5 34 EPISTLE II. if not, we all should be so laid up in hospitals as to be unable to follow the necessary employments. Fortunately, however, like some vegetable which, when transplanted to a foreign soil, loses the vigour of its growth, the disease in question has de- clined in strength since it took root in Europe, so that, day by day, its rate of increase is diminished, and its symptoms become milder. Whilst it was but a recent visitor, it tainted the blood throughout, and showed itself in various pains both of the head and joints; in foul ulcers as well. A century ago, however, it took the form of avirulent gonorrhoea, and this is the form it takes now. In such cases, the most manifest symptom is the presence of a small ulcer, commonly called a shanker, on the private parts ; this being the first sign of the disease. In case, however, the virus be not sufficiently eliminated by means of the gonorrhosa, the mass of the blood is quickly tainted and pervaded. 7. The venereal disease is propagated by generation, in which case the taint of either parent is transmitted to the miserable offspring. Or it may be transmitted by contact, as when some soft part of the body is touched by an inflamed and virulent surface. Instances of this sort are as follows : The child may give to the nurse through the pores of the nipples ; or the nurse may give to the child though the lips and mouth. Infants may take it from adults by the mere contact of the skin, as when they lie naked in the same bed with diseased persons. Adults, indeed, would not take it under such cir- cumstances, but only from impure coitus. Infants, however, have laxer frame and a finer skin, and so take the venom. This I noted more than once in the case of children who have slept with diseased parents. The commonest source of lues, however, is the contact of the parts during an impure coitus. The penis is turgid with spirits dedicated to generation, and, from any venereal ulcer or venereal pustule concealed in the vagina, is easily impregnated with the taint. Now either of these sources of poison may be in the vagina of an apparently healthy woman ; since the poison may so be entangled by the secretions of the part as to act slowly on the blood ; or else it may be diluted by the menstrual flux, and (so far) exterminated. VENEREAL DISEASE. 3.-, 8. The contagion first attacks the fleshy substance of the penis. This it disposes, firstly to inflammation, secondly to an ulcerative diathesis. Hence the discharge which we call gonorrhoea, gradually distils into the urethra. The following facts induce me to think thus. I have seen instances of the virulent matter in question exuding through the porous part of the glans penis, instead of through the urethra, and that when there was not so much as a single ulcer on even the prepuce. Afterwards, it penetrates more deeply, and attacks the prostate gland with an angry ulcer. This is often seen in the dead bodies of those who have died of the disease. 9. The progress of the disease is according to the following stages. Sooner or later as the woman with whom there had been intercourse was diseased, and as his temperament is slow or quick to receive the miasma the patient is afflicted with an unusual pain in the genitals, and with a feeling of rotation, as it were, in the testicles. Afterwards, unless the patient have been circumcised, a spot, about the size and colour of a measle, appears on some part of the glans. Immediately after the appearance of this, a discharge appears from the urethra, like semen at first, but, day by day, losing both the colour and con- sistence of semen, until, at length, it take the hue of the yolk of an egg, except that it is paler. If the disease be virulent, it looks greenish, and is moreover mixed with a watery matter, or even tinged with blood. Meanwhile the aforesaid pustule becomes an ulcer. At first it resembles the aphthae in the mouths of infants. It spreads, however, day by day, becoming broader and deeper, whilst the edges grow r hard and callous. Observe that the pustule is rarely attended by gonorrhea, in patients who have either had gonorrhoea before, or have been circumcised. In this last case, the glans being hardened by exposure to the atmosphere, and by the frequent rubbing of the linen, is more proof against infection. Hence those who have been circumcised, and those whose foreskin is naturally re- tracted, have a comparative immunity against ulcers. All they have is gonorrhoea. 10. Other symptoms now follow. Great pain during erections, just as if the penis was violently squeezed sideways. This is worst at night, when the patient is warm in bed. This painful constriction is pathognornonic of the disease. Thefnunum 30 EPISTLE II, being contracted; the peuis is bent down. When this curve is straitened by erection the pain is most acute. Ardor urines now occurs. During the passage of the water it is not so sharp. When, however, the patient has finished making water, a burning pain is felt all along the urethra, and is worst in the parts within the glans. Sometimes this acrid discharge excoriates the urethra. In such cases Nature, being overhasty in re- pairing the lost flesh, replaces it by a loose spongy tissue, which growing and hardening, becomes a caruncular excrescence, and so blocks up the urethra as to stop the passage of the water. Then the carunculse may themselves become ulcerated, and discharge a sanious ichor. In this case the physician is beset with difficulties, and the patient almost looks on death as a relief. The virulent matter w r hich should have been discharged by the gonorrhoea, either from violent movements, or from the use of astringents, often falls on the scrotum. Then there is intense pain, and inflammation of all the parts. Either or both sides may swell enormously. Meanwhile the gonorrhoea decreases, and the ardor urince continues. Such are the common symptoms of the disease during this stage. 11. If, however, from the obstinacy of the disease, or from its delay about the parts in question, the contagion move upwards, and impress itself gradually upon the blood, or if, from the unseasonable use of astringents, the virulent matter be so retained within the system that the humours grow putrescent, true lues arises. Then we have tumours (or buboes) in the groin, and these constitute the first stage. Pain, meanwhile, extends itself generally and severely to the head, and to the shoulders, arms, and ankles ; that is, in the last case, to the joints, and the junctures of the joints. They arise irregularly, and at intervals. During night, however, when the patient is warm in bed, they are worst, and towards morning they disap- pear. Crusts and scabs appear on the skin. These may be distinguished from crusts and scabs of a different origin by their colour. They are yellow like honeycomb. They occupy the different parts of the body with a broad outline, just as the leprosy is described in medical books. The worse the eruption the easier the patient. The other symptoms grow worse, espe- VENEREAL DISEASE. ;t; cially the pain. So violent are its exacerbations, that the miserable patient cannot keep himself in bed. He leaps out and runs about the chamber restlessly till morning. Add to all this that, from the violence of the pain, the bones of the skull, the shin-bones, and the arm-bones, are raised into hard tubers or e.vostoses, like those osseous excrescences on the fetlocks of horses called commonly spavins. These tubers that thus beset the bone, are accompanied with continued pain, and when inflammation sets in, the bone becomes carious and putrescent. Phagedaenic ulcers, also, destroy different parts of the body, generally beginning with the fauces; gradually spread- ing along the palate to the cartilage of the nose. This they eat away ; so that the bridge sinks in and the nose flattens. As the ulcers, day by day, increase, and the pain increases also, the patient, partly wasted away by the continual torture, partly eaten up by putridity and ulceration, drags on an existence, which pain, foetor, caries, and shame alike render wretched; indeed, far worse than death of any kind. At length, limb by limb perishing away, the lacerated body, a burden to earth, finds ease only in the grave. 12. The intrinsic nature of the disease and by intrinsic I mean essential as far as it is illustrated by the symptoms just depicted, is, in my mind, no better known than the essence of any plant or animal. Nevertheless, whatever may be the case in this respect, it is an assured fact, that the humour which determines it, is of a highly inflammatory kind. Hence this long catalogue of ills; and hence, also, it is clear that the humour must be eliminated. There is 110 specific by which lues has been cured, unless evacuation have preceded. Mercury is no specific, nor yet are the so-called drying-woods. Before they can be considered such, cases must be brought of a lues being cured by either, without salivation on one side or diaphoresis on the other. Besides this, as I have learned from experience, that the common sudorifics will cure lues as well as the decoction of the woods, so I believe that when an equally power- ful excitant of salivation has been discovered in either the animal or the vegetable world, it will cure as well as mercury. Since, however, the disease, in its gonorrhoea! form, is a very different disease from the true venereal lues that lias infected the whole blood, so, also, the evacuation \\hich eliminates I hi' matter 38 EPISTLE II. of gonorrhoea, is not the evacuation for eliminating the matter of a full-formed lues. 13. Gonorrhoea, so far as my experience has hitherto gone, is to be cured by cathartics. These will either carry off the peccant matter altogether, or else act as a derivative to those juices of the body which feed it. Now any purge will do this. Still, those which do it best are those which are most drastic, i. e. those which most energetically bring away bile and serum. Jalap alone has cured such poor patients as the " Bes angusta domi" has precluded from more expensive medicines. Nevertheless, as the disease is attended with a notable amount of inflamma- tion, the purgatives that are best applied are those of the cooling sort, and these we should begin with, proceed with, and end with. ]4. Hence, I generally prescribe R Pil. coch. maj., jiij ; Extract of rudium, 5J ; Resin of jalap, Diagrydium, aa 5ss ; Opobalsum, q. s. Make six pills out of every drachm of the full mass. Four of these are to be swallowed every morning at four or five a.m., so that the patient may sleep upon them. He must do this for twelve or fourteen days, until the ardor urince, and the yellow colour of the discharge have materially decreased. If this take place, the pills may be taken every other day. This he does for another fortnight. After this, twice a week is often enough. Twice a week, however, the pills must be taken, until the discharge from the urethra has wholly ceased. This rarely takes place except after many days. However much it may be generally believed that those few drops of discharge which may be squeezed from the urethra of a morning, after the heat on making water and the yellow hue of the excretion have disap- peared, are nothing more than the results of weakness of the parts, arising from the persistence of the virous matter, many a patient has found out, to his cost, that they arc something m0 re that they are the remains of the contagion not wholly eradicated, but only partially subdued. Hence any new excite- VENEREAL DISEASE. 39 nient may cause a uew train of troubles ; ami, after any over- indulgence in drinking, or any unusual exercise, the gonorrhoea may return. Such is the case where the patient has pre- ferred to escape a little purging, rather than to eradicate his ailment. 15. If after a purge of this kind the gonorrhea will not give way, it will be advisable, especially with such patients as are hard to move, to help the pills with something more potent. Such is the following formula, which has done more, by a single administration, to eradicate a gonorrhoea than any milder laxative given frequently. R Tamarinds, ^iss ; Senna-leaves, 5ij ; Rhubarb, 3iss ; Water, q. s. Boil. Strain and add Manna, Solutive syrup of roses, aa ^j ; Syrup of buckthorn, Rose-juice electuary, aa 5ij. Mix, and make into a potion. If the cure still be delayed, give the turbeth mineral, in eight-grain doses, once or twice a day, at intervals sufficient to guard against ptyalism. This takes the lead of all medicines as a cure for gonorrhoea. Or, twice a week, the following R Pilulae e. duobus, 535 ; Calomel, 9j ; Opobalsam, q. s. Make into four pills ; to be taken the first thing in the morning. 16. At times the patient is so repugnant to the aforesaid catharsis, and to its repetition, as to be unable to bear the sight or scent of his remedies. At times, too, the system has that peculiar idiosyncrasy which renders it so liable to be weakened by catharsis, as to become unable to eliminate the necessary amount of peccant matter. Hence, whilst we are wasting our labour in this direction, a lues may creep on. This is oftencst the case with those whose bodies resist purgatives. When this happens, we must work with clysters. These act in two ways. They purge the humours, and they effect a derivation from the 40 EPISTLE II. affected part. Of the two, perhaps, this method is the quicker; but it is not, in my mind, the safer. The first, although slow, best guards against the likelihood of any remnant of the virus lurking behind in the viscera ; and, if it do so, fresh troubles will be created. Hence, the safest and quickest way is to reconcile the two plans, i. e. to purge by the mouth on those days when the clyster is not given. 17. Hence, I act thus: The pills aforesaid (or some similar ones), I give for two or three mornings running. Then I order a clyster in the morning at five p.m. This is thrown up daily, until the symptoms have wholly ceased; except, only, that once or twice during the week I omit the clyster, and purge instead. R Rose-juice electuary, 5vj ; Venice treacle dissolved in the yolk of egg, 553 ; Barley-water, Oj. Dissolve. Strain and add Diacatholicum, Jij. Mix, and make into an enema. Every night I order twenty-five drops of opobalsam, or of balsam from Mecca, to be dropped on sugar, and to be given at bedtime. This partakes of the nature of the finer and purer turpentines, and shares with them the power of guarding the genitals against the tendencies to ulceration. If, however, neither can be had, I substitute the Chian turpentine, giving about as much as is the size of a hazel-nut, at the time in question. 18. As the cure, no matter under what method, proceeds, I lay an interdict upon all salted or otherwise indigestible meats; such as beef, pork, fish, cheese, radishes, and salads. I also forbid the fruits of the season. Instead thereof, wether mutton, veal, chicken, rabbit, and other light meats are allowed. These, however, are allowed but sparingly, in quantities just sufficient to guard against a loss of strength. For drink, whey made with one of milk to three of water, takes the place of wine and spirits. At dinner, however, and at supper, the patient may indulge in a draught of small beer. To ease the inflammation, and to abate the ardor urince, an emulsion of the following sort taken frequently between the intervals of purging, is useful : VENEREAL DISEASE. -41 R Seeds of melon, Seeds of gourds, Seeds of white poppy, aa 3ij ; Sweet almonds (skinned), viij. Bruise together in a marble mortar. Pour upon them gradually Barley-water, Oss. Strain and add Loaf-sugar, q. s. Mix, and make into an emulsion secundum artem. 19. With a sanguine temperament, and with an obstinate complaint, when the purging has been continued for a month (there or thereabouts) I generally take eight or nine ounces of blood from the right arm. Earlier I do not recommend it ; lest, perchance, the contagion take a deeper root. Injections into the urethra I put low. Being either pungent or styptic, their acrimony oftener does harm than good. A little rose-water towards the end of the disease, is, however, allowable. 20. I know of no better treatment of gonorrhoea than this. It has generally succeeded, especially when there has been a re- sistance to the action of purgatives. In such cases, the cure is slow, though still certain. We must then bleed, and purge both oftener and longer. We must also use clysters as aforesaid. Catharsis is all in all. In gonorrhoea, too, if in any disease whatever, the following rule is a true one, viz. that cleanliness is medicine. Only keep from mineral waters. What with their astringency, and what with their over-sanitary action, they confine and nail down, as it were, into the system the remnants of the disease. Hence tumours of the scrotum take rise when mineral waters are drunk at the beginning of a gonorrhoea, and warts when they are taken towards the end. This I confidently affirm, however much it may be the present custom to prescribe them. 21. I am well aware how certain practitioners vaunt them- selves for their treatment of the disease how they cure it in a short time, and how they cure it by means of the most notable recipes. At the same time I have observed the evils that arise from the use of astringents. They cork up the virus in the system, and lues is the result. The use of the so-called drying-woods is less dangerous ; but then it is unprofitable. Under the name of specifics, medicines arc given which inflame the body in general, and inflame the part in particular. This was heated enough 42 EPISTLE II. before. Sometimes, indeed, as I have myself seen, the discharge which has stopped will set in afresh under the use of them. 22. In some cases, where the gland is covered by the prepuce, this last may become so tumid, hard and callous, as to become incapable of being retracted. Now, under such circumstances, to attempt a cure by means of catharsis is to labour in vain. They may be strong, and they may be repeated ad nauseam ; but unless the part itself be reduced to its natural condition, there will be a fresh incentive to the disease, and no good will be done. In this case I use the following fomentation : R Marshmallow-root, Lily-root, aa ^iss ; Mallow-leaves, Mullein-leaves, Elder-leaves, Henbane-leaves, Chamomile flowers, Melilot, aa a handful ; Linseed, Fenugreek, aa 555 ; Spring-water, q. s. Boil, and make into a fomentation. Apply to the part affected once or twice during the day, for one day. When the fomentation is ended, anoint the part with fresh linseed oil. Then apply a mucilaginous plaster, spread upon a piece of lambskin leather, around the orifice of the prepuce. If, however, there be any ulcer, either 011 the prepuce itself, or on the gland beneath, by reason of which the foreskin cannot be drawn back, we must use, besides the aforesaid fomentation, the following liniment : R Basilicon, 5vj ; Tobacco ointment, jij ; Red precipitate (washed in rose-water and finely pulve- rized), 5ss. Mix, and make into a liniment. Lay it on lint, and apply it to the ulcer immediately after each fomentation. 23. In cases where the gonorrhoea has been checked over- soon, or when improper exercise, or some similar cause, has transferred the disease to the scrotum, and when that part has become swollen, I apply the aforesaid fomentation twice a day to the tumour, that is, provided that the usual poultice of VENEREAL DISEASE. 43 oxycrat and bean-meal have not abated both the pain and swelling. This is what I do out of doors. Meanwhile I attack the enemy within by means of cathartics and refrigerants, and by means of a diet of the kind described. Neither do I, by any means, scruple about bleeding from the arm (on the side of the testicle affected) to nine or ten ounces, in cases where the pain and swelling indicate the propriety thereof. So much for the gonorrhoea. 24. The disease, however, may be more than gonorrhoea. It may be a venereal hies ; in plain language, a confirmed pox. Here we have a hard knot, for which we want a hard wedge. Whatever may be loosely said by learned or unlearned men to the contrary, there is (to my knowledge) no true instance of this disease having been extirpated except by means of saliva- tion excited by mercury ; and as such salivation does all that is recjuired, I find it incumbent on me to show at large the results of reason and observation as to the manner of exciting and of regulating it. 25. Taking the question at its beginning, I cannot even guess at the import of all those serious precautions in respect to the preparation of the system for a course of mercury the cathar- tics, the digestives, the baths, and even the bleedings ; to which latter a paramount importance has been assigned. What is the real fact ? Even this. That salivation is to be induced ; that a poison is to induce it ; that no medicine not poisonous has that effect ; that without such au effect of a poison there is no safety for the patient. I ask, then, in the name of truth, whether the evil effects of such a poison are likelier to be withstood by an unimpaired system, and by a system competent to meet them, or by a frame weakened by a low regimen, and by the loss of blood ? Pru- dence and consideration alike answer that, in such a case, it is better to do nothing than to do too much. And what answers experience ? Why ! that those who have been weakened by neither evacuations nor any other methods of treatment, better bear up against the effects of a salivation than those who, like men that have been maimed before a battle, have been weakened and pulled down. 26. Waiving, then, all these mischievous preliminaries, 1 44 EPISTLE II. prescribe, as soon as I am called in, an ointment of one ounce of crude mercury, and two of hog's lard. I add to this none of the heating oils whatever ; the effect of which is either nought or else detrimental nought if they fail in checking the effect of the unguent ; detrimental if they do so. Indeed, in respect to the so-called correctives, it is highly probable that all additions so denominated have just the effect here as they have in pur- gative medicines. There they gripe, and add difficulty to the catharsis, there being a struggle between the purge and the antidote ; whereas, in reality, the whole efficacy of the former consists in the extent to which it is adverse and hostile to the human system. I order, then, the patient to rub in with his own hands, on his arms, thighs, and calves, for three nights running (including the one on which the prescription is written), a third part of the ointment. This he must do thoroughly ; avoiding carefully to touch the groin or the axilla, and defending his belly from contact by means of a flannel bandage, sewn up behind. After the third inunction the gums generally swell, and ptyalism sets in. If, however, within three days after the last rubbing-in, no salivation take place, then there must be taken eight grains of the turbeth mineral in the conserve of red roses ; and after each vomit or stool, a draught of warm posset. When the spitting has begun, the physician must carefully regulate its amount, taking care lest, by rashly over-encouraging it, he jeopardize the life of the patient. The due amount of ptyalism is about four pints in the twenty-four hours. When this is reached, or when (without the amount being thus much) the symptoms have vanished (a change which often occurs on the fourth day of the salivation), the patient's shirt and bed-linen are to be changed ; care being taken that the fresh linen has been well aired since its last washing. This shift is necessary, because the old linen, being impregnated with the ointment, is likely to keep up or to increase the salivation ; thus carrying it beyond the point beneficial to the patient. If, on the other hand, the salivation flag before the symptoms have wholly dis- appeared, it may be kept up or brought on afresh by a scruple of calomel given as a single dose. 27. Sometimes, in susceptible constitutions, after only one or two rubbings-in, the blood becomes touched with the mercury, VENEREAL DISEASE. 45 and Nature attempts its expulsion by means of the bowels. Then arise gripes and slimy stools, just as in dysentery. Then, also, the cure of the patient is retarded ; since salivation, and salivation alone, is the method that effects it. In such cases the mercury, both externally and internally, must be stopped, until the symptoms have disappeared. To this end the liquid laudanum, in doses repeated and increased as occasion requires, is the best remedy for the flux. Failing, this, a drachm and a half of diascordium may be taken as often as is needed. The flux generally sets in before the salivation begins. When the former has been checked, the latter (al- though previously it has shown no signs) will proceed. 28. When the patient has so far recovered as to complain of nothing beyond the soreness of his mouth (the true effect of a ptyalism), the salivation, which will of itself, day by day, de- crease, is not to be interfered with, neither by purges, nor by aught else ; since it may easily happen that, after the cessation of the pain, and the healing of the ulcers, some sparks of the disease may still be kept alive. Now these may give fresh trouble, unless the salivation run its course; Avhilst the latter will, in its turn, disappear as the patient recovers, and as he exposes himself to the fresh air. Hence I consider it dangerous to hasten the departure of an evanescent salivation by either purges or the decoction of the woods ; practice which, under the idea of either eliminating the mercury from the system, or of correcting its malignity, is but too common ; and practice which accounts for the frequent relapses which are suffered by such miserable patients as, having undergone pain, and trouble, and hope deferred, long (though in vain) for their recovery. So true is that, that, rather than check a salivation prematurely, it would be advisable to prolong it by doses of calomel, given once a week, even after the recovery of the patient, and after he has ventured out in the open air. This is what I have myself often done, and continued to do for some months. 29. Much, however, as I may shrink from purging under a salivation of the kind in question, there are times when it. neither should nor can be avoided. When things have gone so bad as to endanger life, it is safe, nay it is necessary, by means of purging, to bring down the ptyalism to a degree which may make it tolerable. That being done, it may be left to itself. 46 EPISTLE II. 30. Now if any one ask whether, when the salivation is over, we should be satisfied with the bare ptyalism, or whether we should begin a course of purging, or some similarly usual treat- ment, I answer (in addition, and to the reasonable and tried arguments already adduced), by asking a question myself. Why should we purge after salivation a bit more than we salivate after purging? Purgatives (the scammony cathartics most especially) are more or less malignant, and leave more or less trace of such malignity in the system. This, however, we leave to Nature, and Nature subdues it. All that is needed is for the patient to resume his usual diet, exercise, and air. Again, too, I would ask, how can we expect to expel the mercury by catharsis, when we have overlooked and even checked the sali- vation? the salivation, which is the true and genuine process for its elimination ? Hallucinations of this kind are the merest sparks of reason. Such as they are, however, they often satisfy us, miserable mortals, who have to look for truth in a well, and who often, like Ixion, embrace a cloud in place of a goddess. Then we talk ourselves into a belief of our dreams and fancies, mistaking them for demonstrative truths. A specimen of this, unless I am mistaken, is the doctrine just noticed. 31. Still, the method just explained may be adhered to, the ointment may be rubbed in three nights running, the turbeth mineral may be taken, the calomel may have been given when the salivation has either failed or flagged. All this may be done, yet the peculiar idiosyncrasy or temperament of the patient may be such, that not only shall there be no true genuine salivation, but the gums shall not even be made sore ; all this being no more than what happens with purgatives. Many resist their action ; and it so happens, that those who do so, are those who resist mercury as well. With such con- stitutions, we must guard against doing violence to Nature, and not be too obstinate in our attempts. When Nature is re- sistant, you may kill the patient in forcing her. Hence, all that will come of internal doses, and external applications, doubled and redoubled, will be gripes and dysenteric stools ; such being the method by which Nature gets rid of the poison not by the way of the mouth. To these will be added cold sweats, and other bad symptoms ; so much so, that the patient will not only die, but die painfully. VENEREAL DISEASE. 47 32. What may be done is this : after waiting four or five days after the last mbbing-in, he may repeat it, giving also the turbeth mineral, but leaving a few days between each inunction. If this fail he must be scrupulous in going farther. The first sign of pain in either the stomach or bowels is a warning for him to hold his hand, and so he must do as long as the least symptom of the sort remain. Nature is against him ; and with such an adversary, the quickest accumulation of the strongest sialagogues will only bring on dysentery, and dysen- tery death. Festina lente a scruple of calomel, once or twice a week, either alone, or (in case there be a tendency to diarrhoea) with a drachm of diascordium, will land the patient safe. The spitting indeed may be less than that of true ptyalism. Still it will be more than that of the natural state: it will also have the true odour which should accompany it. However scanty it may be, it will have this ; proof sufficient that the blood has put on that condition (putrefaction or alteration, as the case may be) which either creates salivation, or arises along with it. By this method all the symptoms of the disease may be subdued, provided only that due time be given. 33. I must now remark, that although in the cure of a lues salivation bears the bell, in the cure of gonoiThcea concurrent with a lues, it is ineffectual. The lues may have ceased, whilst the gonorrhoea continues. Now this shows that it is not by any truly specific power that mercury cures the venereal disease. An indirect (mediate) specific it may be, but only in a loose sense of the term, just as I have hinted elsewhere, 1 that a lancet is a specific to a pleurisy. The bleeding cures the one disease, the ptyalism the other. 34. However, to return. When lues and gonorrhoea co- exist, the cure of the latter must be attempted either before the salivation or after it. Of these two opportunities I prefer the latter. A gonorrhoea with a lues is more curable than a gonorrhoea without one ; besides which, it is the effect of the previous salivation to reduce its virulence. As long, however, aa there is the least remnant of salivation, cathartics must be eschewed. Hence, turbeth mineral given once or twice a week, is a safer remedy than any purgative whatever. It promotes 1 Mod. Ohs., Prrfarr to (he Third Kilitiou. 2.H.- ;<;.] 48 EPISTLE II. the excretion of the matter that determines the gonorrhea. It favours the salivation as well. 35. It must further be observed, that, if a tumour of the sort called exostosis fix upon a bone, and remain so long as for the bone to be affected with caries, it will be wholly vain to attempt a cure of the disease either by means of salivation or by any other method, unless the cure of the exostosis be at- tempted also. With this view the bone must be laid bare by means of caustic, and exfoliation (as the term is) must be en- couraged by means of the remedies usually resorted to with that intention. 36. "When the mouth becomes ulcerated (a common occur- rence in salivation), so that the patient cannot put up with the pain, or when the excoriation is accompanied by bleeding, relief may be obtained by washing it out, night and day, either with rose-water, with milk and water, or with a decoction of barley, marsh-mallow root, and quince- seeds. This ulceration of the mouth is the only notable symptom, as far as my knowledge extends, which attends salivation, provided only that it be duly managed. Saving this, and if by any means it could be kept off, the cure of this disease would be no harder than the cure of many other diseases less talked about. 37. As to diet and regimen, I consider that, in salivation, at least, until towards the end, they may be the same as with purgatives. Hence, just as a man who has been purged need only keep to his bedroom and take the more digestible sorts of food, so, also, I can see no reason why a man under salivation must lie in bed and deny himself moderate food ; food which may help Nature in her struggle with the poison, giving her strength and spirit ; since, if she flag, and if the spirits and the vital strength be Avholly exhausted by diaphoresis, purging, and fasting (to say nothing of the mischief done by the mercury), the unfortunate patient will be worn to death. Very often, too, when the disease has been repelled, the patient has wanted the strength and spirits necessary for restoring him to health. And so he has died from mere weakness. Even if he escape the grave, he buys his life at the price of so much torture that it is not worth having. So true is what a late poet writes - " Graviora morbis patimur reracdia, Nee vita tanti est, vivere ut possis, mori." VENEREAL DISEASE. 49 38. This is a place for meeting the following objection : " How is it that persons in the stage in question of this disease must go to France to be cured ?" As far as I can make out, the reason is as follows, the strength of their system is impaired, and the thick damp air of England is ill adapted for recruiting it. That of France, however, is so adapted, being clearer and more healthy. This explains it. French practi- tioners, skilful though they may be, understand the method of conquering the disease neither better nor worse than the English ones. But to return to the diet. 39. I think and experience favours my view that, besides oatmeal porridge, panado, milk with beer, and warm small beer, &c., broths of veal, chicken, and other such light meats may be allowed to the patient. Indeed, I think that they ought to be allowed. Afterwards when the swelling of the gums has so far subsided as to allow him to close his teeth, he may indulge sparingly in rabbit, chicken, or lamb. He may be in bed or sit by the fire, as he likes best ; since, as the disease is to be cured not by diaphoresis but by ptyalism, I cannot imagine why the patient, without any reason, should be smothered with heat. 40. The aforesaid method is both quicker and, in my certain belief, easier and safer than any other. There is less chance of a relapse, there is less waste of time in preparing the system for salivation, and there is less of purging and the adminis- tration of decoctions when the salivation is over. Any one, familiar with the other practice, may verify what I say by trying this. With me it has always succeeded as I wished ; and that with numerous patients, who had, more than once, undergone all the pain and tedium of a salivation, and had relapsed after- wards. This was on account of the reasons aforesaid. 41. I have, however, no reasons, most candid Sir, for thus anxiously soliciting your confidence by long and roundabout ways of speech. You have long ago formed your opinion of me; and have condescended to favour my reputation. I will therefore say no more on this disease. It is not, and it has not been my habit, to involve simple matters in circuitous and irrelevant discourse; and so to conceal the matter in hand, as the Nile conceals its sources. Small, however, as may be the present treatise, both in size and value, I recommend it to your n. 1 50 EPISTLE II. favorable consideration. It has been written that it might, in some manner, benefit my kind ; but it has also been written that it might stand as a monument of the respect I bear towards yourself. High as I place you, I and others ought to place you higher; knowing as we do your learning, your kind- ness of manners, your candour and your other excellent virtues. It is not in flattery that I speak of the friendship with which you have honoured me ; and when I say that I hold it amongst the highest and the most honorable of my winnings. Amongst other matters which I have observed within the brief space of human life, I have ever noted, and I have impressed it upon my son, that the intercourse of men eminent from their probity and other virtues, has always been a credit and gain. On the other hand, the company of the vicious, or rather I should call it their combination even where neither word nor deed has been meant to do harm, has, in some unknown matter, in- variably done some mischief to either me or mine. Long may you live to honour with your friendship, Your most respectful servant, THOS. SYDENHAM. LONDON; March 10, 1679. EPISTOLARY DISSERTATION DR. COLE. EPISTOLARY DISSERTATION. TO THE MOST WORTHY DR. THOMAS SYDENHAM, M.D. MOST ILLUSTRIOUS SlR, You will perhaps wonder at my importunity in breaking upon and disturbing your own more important affairs. I trust, however, that when you know the reason, you will grant me your pardon. My sense of gratitude, my wish to express it, and my reverent admiration of your character, are the reasons why I disturb you. So much do I own to having received benefit by your most elaborate commentaries 'On Acute Diseases,' that I feel myself entirely bound to return my thanks to the author. So accurately have you observed the respective con- stitutions of those years, which, as an observer in a new field, you undertook to treat upon ; so truly have you hit the genuine and readily admitted indications of treatment ; such a splendour of genius have you thrown over the whole work ; and so much admirable sagacity have you combined with unwearied labour, that the patient and the physician are equally beholden to you. Now, although whatever you have treated, you have treated in such a perfect manner as to extort praise from any one upon each point, that part, above all others, wherein I have the greatest difficulty to contain my admiration, is your method in the treatment of smallpox. Under this I could confidently hope that that hitherto deadly distemper would (unless there be some malignity, or some other counteracting cause) lay aside its terrors, and become one in the list of the most curable dis- eases, were it not only for the interference of the nur.ses (a tribe hostile to health of man), who, with their hot regimen and drugs, undo all that can be done, ensuring premature death to 54 EPISTOLARY DISSERTATION. so many victims, that you, who lend yourself as a guide to such unfortunates, as in the extreme danger of their lives, and in utter uncertainty, place themselves under your direction, well deserve the title of the champion of the human kind. To speak, however, of my more humble self, much as I have feared to trust to my own calculations, I have, nevertheless, long believed that the eruption of smallpox was not the disease itself, but the crisis of the fever, and that, on the principle of all physicians, and in the manner of all other crises, the whole matter should be intrusted to Nature, so long as everything went regularly and, in a disease like smallpox, as long as the blood has not been over-agitated, all does go well. After, how- ever, that I had read your golden book, I felt that those fears which had so long retained me and others, were a panic : and then, in obedience to your precepts, but against the voice of many medical men, as well as others, I treated my patients ac- cordingly ; and, as often as I found them obedient, so much success did I meet with that I deemed myself the most fortunate of men in finding the treasure that I found. Nay, more when called in to patients with the confluent disease, I had no hesitation, even when they seemed on the point of death, in relying upon your authority and resorting to paregorics ; and, though cases of this sort were not common, I Avas so far from repenting of my method, that I wondered at my own success. Upon this point, then, you seem to have taught me so much already, that I fancied that there must be nothing more standing over as an exercise for the ingenuity of others, or even for your own. Nevertheless, that most learned man, my excellent friend and your approving admirer, Mr. Kendrick, has told me that you have hinted that certain other observations upon the same subject have occurred to you. Now, as these are yours, they must be of great value ; and, unless you publish them, you wrong the world. Let the prayers of an individual dispose you, most Illustrious Sir, to lay them before the public. Neither will I stop here. Mr. Kendrick also says that you have observed some rare facts concerning the so-called hysterical diseases. These have long exercised (and tired) the wits of physicians. They have also (alas) eluded the recognised methods of treat- ment ; well showing how unsafe it is in our philosophy to trust to simple reason, except in those matters of which we may EPISTOLARY DISSERTATION. 35 ascertain the certainty by means of our senses. Well will you deserve, most worthy Sir, both of the present age and of pos- terity, if you will condescend to publish what you have con- sidered upon these points. This, at least, I hope you will allow me to claim, viz., that you take in good part that a person, although unknown to you, should not be afraid of asking a favour for the sake of the public rather than himself. May you also, amongst those innumerable admirers who most es- pecially have respect for you, consider as one of the most respectful, Your most obedient humble servant, WILLIAM COLE. WORCESTER; Nov. 17, 1681. LETTER TO DR. COLE. MOST ILLUSTRIOUS AND LEARNED SlR, 1. IF I so far indulged my own vanity as to take credit to myself for praise that is not my due, I should find it difficult to be other than elevated at the honours showered on me by one whose lucubrations have made him so well known in the world of literature as yourself. Lauduri a laudato may well make any man proud. As, however, you have thought me fit, un- worthy as I am, to be selected for so great an honour, I can only put it down to the account of your kindness and humanity; since Nature has ever endued the best and greatest men with a feeling of kindness to those who are not guilty of any gross error. Nay more, in taking occasion to speak favorably of the studies of inferior inquirers, they only follow the bent of their own ingenious and candid disposition. Of this you have shown an illustrious instance, and one which I gratefully ac- knowledge in your notice of myself, and in your notice of those trifling works which I have dedicated to the welfare of the public. 2. In respect to those subjects upon which you wait for in- formation, whether the smallpox which I have written on before, or the hysterical affection concerning which I may have some new observations, I have thus much to say. The first I have reverted to in order to patch up, from the suggestions of an increased experience, those parts wherein I was before found wanting. Hysterics I treated because, next to fever, they are the commonest of diseases, and because I thought that my humble observations might be useful. I will further own that, over and above my wish to benefit the public, I wished so to pass the long tedious nights of winter as to make my leisure serviceable; since I am now getting too old to go beyond my own house or company. But whatever Avere my motives, I felt myself less equal to the task than I expected ; my mind being unfitted for continuous thought from the effects of gout, which has long EPISTOLARY DISSERTATION. 57 distressed me, and which gets worse as I grow older. Hence your letters have reached me opportunely, since they enable me to dispatch in the brief form of an answer, the points, which I intended to treat in full. 3. Beginning therefore with the smallpox, this must be premised, namely, that that species of intermittent fever which began in 1G77, and is still raging during the present year, 1G81 this species I say, like epidemics in general, raged most during those years which best agreed with its disposition. When a different season came on, it gave Avay to other epidemics that such seasons favoured more. For example, at the approach of winter, cough, inflammations on the lungs, with the fevers dependent thereon, and, lastly, the smallpox took their place. However, when spring returned, the fever returned also. Hence in 1680, after the fever had raged during the whole autumn, winter came, and the smallpox raged instead. Then at the turn of the year in 1G81, the intermittent fevers broke out afresh with diminished violence, indeed, and less epidemic than before. Hence the smallpox showed itself in places springing up here and there. When summer came the smallpox became more common. At last it became an epidemic, and an epi- demic of no common mortality. 1. In 1G81 it was clear as the sun at noon that the patient ought not to be kept to his bed during the day until the whole eruption had shown itself. During both spring and winter the dry weather lasted longer than had ever been remembered by the oldest man so much so that all the grass was withered up. Now in this case such moisture as the blood should have got from the atmosphere was missing, and this made the inflammation of the smallpox violent beyond its usual nature, and all other symptoms severe in proportion. For this reason purple blotches frequently anticipated the full eruption of the exanthemata, and the inflammation which forced them forward, so disturbed and interrupted the due crasis of the blood the crasis that was necessary for the expulsion of the morbific matter that premature deaths were brought about. The chief cause that promoted the mortality was the great tendency which arises from the aforesaid reason on the part of the pustules to become confluent. In this case the unfavorable constitution of the atmosphere did by itself what it generally leaves to quacks 58 EPISTOLARY DISSERTATION. and sciolists, that is, it did the work of a hot regimen and un- seasonable cordials. The whole matter turns upon the amount of the exanthemata, and the patient lives or dies just as it is much or little. At the same time it must be owned that both bloody urine and purple spots, the surest signs of death, some- times occur when no variola have shown themselves, or, at best, but few. Generally speaking, they accompany the eruption at its worst. At times, however, they set in so soon that they take off the patient before a pustule has appeared. This I already noted. 1 5. In my mind it is easy to see why the danger of the patient depends upon the number of the pustules. Each is originally a phlegmone, though small. Then it becomes an aposteme, How, then, can there fail in being a secondary fever with so much pus in fieri ? and how can this fail to be proportionate to the exacerbations of the disease, and the stage wherein the pus is excreted ? This is, in the mildest form of confluent small- pox, the eleventh, in an average case the fourteenth, and in the worst cases the seventeenth day, of the disease counting from its first attack. Now the confluent smallpox is as much worse than the distinct, as the plague is worse than the confluent. The three sorts of confluent are also different in their degrees of danger. Much of this depends on age and sex. All know, that a young man in the prime of life has a worse chance than a female or a person under puberty. But this is by the way. 6. No one will wonder at the ratio between the extent of the eruption and the danger of the disease, who considers the case of a common boil on the arm or shoulder. The more the pus, the more the fever ; since, the absorption of the pus into the blood, through the veins, according to the laws of the circu- lation, supplies the fuel of the disease. Just in proportion as the physician finds the face of the patient, during the first days of the disease, thick-set with pustules like pin-heads, he may safely prognosticate that, one or the other of the aforesaid days, death will come down upon him ; the reason being the violence of the secondary fever. This must, needs, be proportionate to the quantity of pus thrown upon the blood by the innumerable apostemes. This sad end may be foreseen days beforehand ; 1 Mcd. Obs., Sect, III, Chap. II, 21, 23. [G.] EPISTOLARY DISSERTATION. 59 well as the patient may appear to be doing to the friends and bystanders. 7. Hence, if laying aside the purple blotches, and the bloody urine the only danger that arises to the patient arise from the simple abundance of the crop of pustules, I reflect upon the cause that may have given rise to it, and (if the thing can be done safely) address myself to the checking of it. This is the best I can do " Periculosre plenum opus alcas." If the patient survive, he may attribute it to some lucky acci- dent frequently a profuse epistaxis but not to any skill of mine. The cause of this over-thick eruption is the over-hasty assimilation of the variolous matter ; and this arises from the nature of the patient, which may be so overflowing with heat and spirits, as to act like the artificial heat of an exciting regimen. Or it may be from the regimen itself; since hot cordials, spirituous liquors, and lying continually in bed, may over-exalt the fermentation. By each and all of these pro- cesses, the blood becomes disposed to receive, and admit in intimate conjunction with itself, the impressions of the disease ; and Nature, herself -fnriis auitata and in the plenitude and exuberance of the variolous matter, strives her utmost to eject the juices in the shape of exanthemata. 8. Nothing promotes this inordinate eruption so much as being kept to the bed before the sixth day from the first access of the disease, or the fourth from the breaking-out. By such time, all the pustules that mean to appear, have appeared, and no more need be expected. Even after the sixth day, the warmth of a bed is a little too favorable to the supervention of frenzy, watchfulness, and other such symptoms. Still they can be guarded against by judicious prescriptions. The great danger, however, of the eleventh day, arising out of the number of the pustules, is beyond the powers of any medicine. 0. This has to be guarded against. Hence, the patient is, by no means whatever, to be allowed to be in bed during the daytime, until the evening of the sixth day. This \\ill strengthen him much. From the sixth day forwards he will scarcely be able to do otherwise than be abed ; especially if the 60 EPISTOLARY DISSERTATION. assemblage of pustules be remarkably thick. The acridity of the pustules will harass him, and the sitting posture will pro- bably make him faint. Putting these observations together, I fancy that I discern the finger of Nature, and that it is Nature who determines when we should, and when we should not keep the bed, uninterruptedly. 10. To prove the truth of this problem, so important in diminishing the danger of smallpox, and in order to take my sub- ject at the starting-point, and go with it throughout, I will draw a sketch of the whole disease, and diligently determine its nature, and the method of its treatment. In this I shall look for the solution of my question, to the careful observations of facts under the cognisance of our senses, and not to the flimsy fancies based upon the uncertain foundation of opinions. 11. In the first place, then, its essence as far as essences can be known at all seems to be comprehended in a certain inflammation of the blood, whereby, during the first few days, Nature exerts herself in the preparation and digestion of certain inflammatory particles, in order that they may, the more easily, be eliminated from the body. During this time, there is movement, and confusion, and fever cannot but be present. Moreover, the particles of the blood, are angry and enraged, and they create disturbance over the whole domain of the circulation. Then follow sickness, shooting pains of the head, weakness of stomach, and all such symptoms as, needs, must precede the expulsion of such morbific matters as fall upon the different parts of the system, under the influence of the movement and agitation. If, however, Nature succeed in throwing such parti- cles from the inner parts of the body, upon the surface, the mischief that had begun in the blood, goes on in the flesh. As Nature has but one way of getting rid of peccant matter, that way being fever of the blood ; so she also has but one way of getting rid of foreign bodies ; that way being apostemes of the flesh. We see this in the case of a thorn. It is only got away by exciting an abscess in the circumjacent parts. Now these particles when they at first nestle in the fleshy part, create phlegmonse of no great size, which lie concealed under the skin. They increase, however, in size every hour, and become more angry and more inflamed. At length they end in pus and vomicse. Meanwhile it cannot but happen that EPISTOLARY DISSERTATION. 61 some part of them be absorbed by the circulation into the mass of the blood. If the sanies be over-much, it lights up a fever, which is too strong for the constitution of the patient. It does more. It affects the whole mass with a putrid taint. Nor is this all. During the latter days of the fever the ptyalism, which is of constant occurrence as an inseparable concomitant of confluent smallpox is checked suddenly, and the life of the sick man is cut short. On the other hand, if the aforesaid purulent matter be poured sparingly upon the blood, the powers of Nature are sufficient to meet, without trouble, the secondary fever : so that, the little abscesses day by day dry up, and the patient recovers. 12. If this view be true, a blind man may sec that the treatment of the first days is all-important as regards the event. Inflame the spirits by cordials and bedclothes, and their power of assimilation, already too great, becomes greater still. Add to this that the blood and the other humours, heated by such processes, yield all the easier to the violent impression of the morbific particles. Hence arise more pustules than were wanted, and danger to the patient's life. Contrariwise, the opposite regimen, and the free, fresh air, soften down the violence of the fevered and acrid particles, and confirm and condense the humours, by strengthening them against the morbific spirits, so as to withstand their attack ; whence no more variolous matter is secreted than is proportionate to the genius of the disease. 13. The assimilation of a superfluous amount of morbific matter, and the exaltation of the ferment of the disease, are not the only mischiefs that torment the patient who always keeps his bed. The same source gives rise to bloody urine, and to purple spots ; these being the commonest in summer-time, with patients in the prime of life. Each of these symptoms arises from the uncontrolled fury of the blood ; which breaks all bar- riers, showing itself as bloody urine when it reaches the kidneys, and as purple blotches when it strains through the fleshy parts which terminate in the extremities of the muscles, and on the skin. Now these two symptoms must be guarded against during the first days of the disease (those days whereon they usually break out) by a diet and regimen more cool than hot. When however they have appeared in reality, the physician who 62 EPISTOLARY DISSERTATION. tries to cure them by hot cordials and confinement to the bed, is like an old woman who will stop the boiling of her kettle by putting fresh coals on the fire. 14. To speak the truth (however much ignorant dogmatists, who are necessarily bad judges, may be scandalized), so far is bed, during the first days of the disease, from being a good thing to the patient who is continually kept to it, that in certain cases he should be altogether exposed to the fresh air. Such is the case if the season be hot, if the patient be in the prime of life, if he drink freely, and most of all if such free drinking be the cause of the complaint. In these cases I doubt whether the over-hasty eruption of pustules can be sufficiently checked by abstinence from bed and cordials. The blood without any such help is largely supplied with a store of fervid spirits, and spirits akin to the disease. Hence it explodes as it were; moreover, such a mass of humours breaks out into exanthemata, and so great is the abundance of pus thrown upon the blood at the end of the disease, that the patient is, as it were, over- whelmed, and dies. 15. Frequently the immoderate exaltation of the ferment, creates so much variolous impurity, that the patient dies before the disease has fully formed itself. In this case the morbific matter, partly from its own great abundance, partly from the confused and excited state of the blood, is unable to extricate itself. Hence come bloody urine and purple blotches as pre- ludes to the fatal catastrophe. The same happens in measles and scarlet fever, when the encouragement of the eruption has been more successful than well-timed. 16. Neither does bloodletting in my mind, although re- sorted to at times, so efficiently check the over-hasty accumu- lation of variolous matter as does the action of the air. This cools it, whereas the effects of bloodletting are often marred by putting the patient to bed at once, and giving him hot cordials, means whereby the blood is rendered more susceptible to the impressions of any addition of heat. I assert upon my con- science that the worst case of confluent smallpox which I ever saw, and one which proved fatal on the eleventh day, was that of a young lady who had just before been cured of rheumatism by the usual method of copious and repeated bleedings. This first showed me that bleeding was not so good a means of EPISTOLARY DISSERTATION. (tt bringing the variola? within due limits us I thought it was. Purging, however, I have frequently observed to have this effect, and when repeated before the blood got tainted, it lias brought out the subsequent variola} in the favorable form of the distinct disease. 17. I am aware that many objections may be against my doctrine in this respect, and that, to the generality of mankind, and to those who have but little experience in practice, they may appear important. Such men pass as judges, and faulty theories become recognised on their authority ; theories which square better with the comprehension of their followers than the matured reflections of more ingenious thinkers. All this is part of human nature which ever loves thus to contemplate the exterior surface of things, better than to make itself cog- nisant of the deep and more concealed truths, which require labour in the extraction. Hence dabblers in science lean upon the opinion of the vulgar, and, so, have things their own way ; whilst the closer observers are received with calumny and ill-words IloXXoi yap vapOt]KO(t>6f)ot, iravpoi it TI fiK\oi. Such, however, they bear with equanimity, satisfied with the approval of a wise minority. 18. The first objection is that, to keep out of bed for the first few days will impede the eruption of the pustules, and, by consequence, protract the discomfort of the patient, and all the other symptoms dependent upon the repression of the erup- tion. This I deny. Common experience is against it. The point to settle is, which of two dangers is the gravest, i. c. whether it is worse to check the eruption for a time, and, so doing, protract the discomfort which it might have cased, or to so accelerate its assimilative tendencies, as to create a ferment, which shall kill the patient on the eleventh day. Now, if we weigh the matter rightly, we shall (1 think) find that very few have died because the exanthemata failed in coming out ; except, indeed, those few whose blood was so over-heated, and over-disturbed (maddened as it were), as not to allow time for the gradual excretion of the morbific matter a view which is more on my side than against me. II). There is no fear but that, even in cases where \vc do 64 EPISTOLARY DISSERTATION. nothing at all, the variolous matter (however much, during the first days of the disease it may fly from part to part, and distress such parts as it lays hold on, creating grave symptoms, such as vomiting, pains and the like) will eventually be overcome by the triumphant powers of Nature, and so be thrown out upon the surface of the body ; particularly when the constipated state of the bowels (as is generally the case), ensures the eruption certain though late. On the other side how numerous are the ways to death when the pustules are forced, and hastened ! The whole list is too long to go through. A few only shall be named. 1st. Increase in the number of pustules, with a corresponding increase of secondary fever, and corresponding danger. 2d. Bloody urine, and purple spots ; both arising from extra- vasated blood " Qua data porta ruit." 3d. The total suppression of the eruption arising from the inordinate efforts to force it. This has been noticed above. 1 Now such inordinate efforts are as much out of place in medicine, and constitute as bad a method of bringing out a regular eruption, as a train of gunpowder let off in a crowded room would be for emptying the room gradually and regularly. The only result would be, that there would be a crowd towards the door, and the doorway would at once be blocked up. 20. It may now be asked why, during the first days, the eruption may not be promoted by a moderately warm bed, as well as by total abstinence from bed by daytime? This may be met by another question. How is it that a bed without a fire, in winter, is warmer than warm clothes and a fire to boot out of bed? The difference between the facts is undeniable. Which then supplies the best means of checking the exuberant agitation of the variolous ferment, the first aim of the physician, and the intention which he must satisfy before he has a chance of succeeding with any of his medicines? 21. A source of fallacy to the unwary is the following. A patient may be seen to break out into spontaneous sweats, and these, as long as he lies in bed, flow regularly, and, as long as they flow regularly, ease the patient ; whilst, where there are no 1 Sec 1 r>. [f;.] EPISTOLARY DISSERTATION. f,/> sweats there is no such relief. Now first let us consider, why we take such pains in checking the fever, when the fever is Nature's regular instrument both for the preparation and the elimination of any hostile matters lurking in the blood. Who can fail to see that in forcing the sweat to ease the fever, we throw out the humours in a crude and undigested form like over-hasty fruit and, by those same sweatings whereby we thus force them, supply fresh occasions for a severer subse- quent fever; inasmuch as, by so doing, we drive off the scrum of the blood, whereby, as well as by the blood itself, the fresh and hot variolous particles are diluted. Hence, the particles them- selves take strength and severity since the mass of serum that should temper them, is washed out. In one word, forced sweats and premature pustules are equally bad for fevers ; and, more than any other causes, bring on death on the eleventh day. 22. Now all my cautions against confining the patient to bed, go upon the notion that the threatened disease is of the confluent kind. As for the distinct sort, even if it can be seen beforehand, bed is so much out of the question, that in- junctions against it are superfluous. The scanty number of the exanthemata makes matters safe either way. 23. Still I cannot so far flatter myself as to wish these views to be received simply on the authority of my own humble judgment. Indeed, I think so little of opinions of any sort, that I distrust my own when they conflict with any one else's. And I should distrust them in this case, were it not that the phenomena of practice support the judgment of reason. Laying aside practical observations, one man's opinion is as good as another's ; that is, it is a mere opinion, and mere opinions are only the shadows of the shade of reason. The more I mix with men, the more I satisfy myself of the great danger to which even the greatest wits are exposed, when they allow their brains to become heated and agitated by the perpetual speculation upon matters of science, without resorting to facts as the test and touchstone of the truth. Now, such opimonists, as they are called by Cicero, in purely speculative controversies, are infinitely wide of the mark ; and that, because, the ideas which the mind conceives are no touchstones of truth ; so that, without facts and to these such speculators do not, resort they have no means of putting themselves on the right road 11. -") 66 EPISTOLARY DISSERTATION. when once they begin to stray. Now, surely, I have a right to observe as a fact the different effects, in the way of the mildness or severity of the disease, which follow the different modes of treatment, and to form an opinion in unison with the evidence of that fact. Let others do as much, and I am satis- fied. It is the height, however, of injustice for a man who, during his whole practice, has never once tried how far good or evil comes from forbidding a patient to keep his bed, to attack me as a retailer of falsehoods. Had such freedom of abuse been always allowed against those whose opinions, how- ever true, were contrary to the received doctrines, no man would have tried to benefit his race by new discoveries. And yet why should I thus expose myself to these calumnies. Why unless it were that frequent and almost daily experience had forced upon me the superiority of the present method over the common ones. I am not so devoid of sense as to seek for notoriety from taking up any exploded doctrine of men, who, if I sought for applause, would have been those at whose hands I should have sought it. Still less am I so hardened in malice as to lay traps for those who may come after me, so that even unborn beings may suffer from the influence of my name-^if, indeed, it be destined to become an influence and, horrible even in idea! I may myself be a murderer after death, as well as during life. 24. Be this as it may, my children and my dearest friends have thus been treated. If I have done wrong at all, it has been in giving way to the obstinate pertinacity of others ; whose decided and contrary opinion I have sometimes been unwilling to oppose, lest, in so doing, I should be harsh and stiffnecked. As witnesses to this I call those who know me best. To crown, however, my misfortunes, it has sometimes hap- pened that, after the standers-by had rejected my advice throughout the whole disease, I have still been held answerable for the loss of the patient ; and this has happened after I have talked myself hoarse against the heating treatment of the friends and nurses. For reasons like this, I have often thought that it would be better for me never to undertake a case of small- pox, than to oppose the insuperable prejudices of the ot Tro'XXoi. 25. I will own that sometimes smallpox will become con- fluent under any treatment. Then, they are always dangerous, EPISTOLARY DISSERTATION. <>7 be as careful as you may. This, however, experience enables me to assert. The patient who has kept out of bed during the day, and taken cooling drinks only from the first, has a better chance than the one who has been heated by cordials, and covered with bedclothes. The former method checks the over-abundance of the crop of pustules, and, by consequence, checks also the immoderate effervescence of the secondary fever; fever which kills on its own account, and checks the ptyalism ; which check kills also. What, too, if by cool treatment we can guard against bloody urine, and purple spots ; symptoms which, generally, appear during the first days, and before any manifest eruption ; just as is the case in measles, scarlet fever, and other acute diseases originating in intense inflammation. I say nothing about the feeling of refreshment which the patient ex- periences when his surface is freely pervaded by the cool air of heaven, after leaving a hot bed ; a feeling which many have acknowledged to me with gratitude; as if by such cool draughts they had taken life and spirit afresh. 26. This has often made me draw a difference between the deceptions of reason (so-called) and the realities of our senses ; from whence I infer that provided that they be not absolutely unreasonable, and deadly much more than is usually given should be allowed to the appetites and sensations of the patients themselves. These are better than the treacherous rules of art. E. g. a fever-patient ardently longs for cooling drinks freely bestowed. Art denies them. Art has a theory of its own. Art has an end and aim of its own. Art assumes that cool liquors are adverse to its doctrines ; and so starves an appetite, giving a cordial instead. The same patient loathes all food, unless accompanied by diluent drinks. Art the art of nurses and lookers-on contends that he must eat. After a long languor, he probably asks for something absurd, or prejudicial, and asks earnestly. Art is again in the way, and threatens death in case of disobedience unless, indeed, the artist be wise enough to remember Hippocrates More bad than yood, whether food or drink, if palatable, is preferable' to more (juod than bad, if v tip al 'at able. 1 27. All these aberrations of Nature a man of moderate 1 Aphorism, ii, 38, tom. iii, |>. "17. [CJ.] 68 EPISTOLARY DISSERTATION. medical practice, but of diligent observation, will freely own, that many patients who have spurned physic and followed their own inventions, have been the better for doing so. Nor will any one wonder at this who considers that the All- wise Architect and Ruler of all things has reared the fabric of the world in such exquisite order, that even as the imperfections of Nature beau- tifully conspire to the harmony and symmetry of the whole work, so have they each and all some divine contrivance in- herent in their proper essences whereby they ward off injury; a phenomenon very visible in the natural terminations of acute diseases (acute meaning those of which God is the author, chronic meaning those that originate in ourselves), and visible also in the propensities which accompany the same propen- sities or natural instincts which liberate the patient from those dangers which Art in the hands of foolish men creates. This is fortunate for our race. Badly, indeed, would it have fared had it been otherwise, in those early times when the whole knowledge of medicine was limited to the narrow barriers of Greece ; a country that is to the dimensions of the world at large what a little country village is to those of Great Britain. What, too, shall we say of countries wholly destitute of medi- cine ? of all Asia, all Africa, and, with the exception of a few thinly-peopled colonies, all America ? Just as the comic writer elegantly distinguishes men of reason and worth from their more deraded fellow-creatures who live the foul life of brutes so the Art of Medicine if Art it really be is the greatest of all gifts appertaining to human life, and preferable to all others in the same proportion as life itself is the greatest of enjoy- ments. 28. To return. Notwithstanding my previous cautions, there are cases where the patient should be kept to his bed even before the breaking-out of the eruption. For instance, an infant, who has passed his teething, is seized with a sudden spasm. In this case we must reflect whether such a convulsion may not depend upon an effort of Nature, whereby she is striving to drive to the surface, smallpox, measles, or scarlet fever, diseases which, at present, lurk under the skin. In order to meet so formidable a symptom, the patient should be put to EPISTOLARY DISSERTATION. 69 bed, and blistered on the nape of the neck. Then a cordial, with a little paregoric mixture, must be given. This will act potently on the cause of the disease, helping to eliminate it. It will also allay the tumult from which the paroxysm arises. As to the form for a boy three years old, five drops of laudanum out of a spoonful of plague-water may be given. I think nay I am sure that thousands of infants have died because their physician was not aware that convulsions of the kind in question are nothing but the forerunner of some eruptive disease ; so that, as long as practitioners carelessly mistook such symptomatic phenomena for essential diseases, and treated them accordingly with repeated clysters, and other evacuations, they threw obstacles in the way of the eruption, and rendered the fits all the more permanent. This they did by striving so hard to cut them short. Had the pustules broken out, they would have been cut short of their own accord. I have already stated that such infantile variolre as begin with a spasm are rarely confluent a well-omened phenomenon. 1 This is a reason why lying abed during the first days is less injurious. 29. On the other hand, I have observed that variola? after attacks of coma are pre-eminently confluent. In such cases I prefer a vesicatory or a paregoric to continual lying in bed, before the eruption. I have also noticed, though very rarely, that such convulsions precede the fits of intermittent fever. Lastly, I have seen attacks of coma and spasms go together, and this both in infants and adults. In such cases no particular treatment is required. The fever alone is the essential disease ; and the essential disease alone requires care. If I spent my skill upon subduing the coma, the concomitant of the fever, and, so doing, resorted to bleeding, purging, and repeated clysters, in conquering the lethargy, I should aggravate the fever ; and then the coma would increase in proportion to such aggravation. So far, then, from removing it, I should run a chance of making it everlasting. By attacking the fever, how- ever, I attack all dependent symptoms. This should be noted. Fatal errors may otherwise ensue. I have enlarged on it, how- ever, elsewhere. 2 30. At times, however great may be the comfort of keeping ' Mcil. Obs., Sect. Ill, Chap. II, 2. [<;.] 3 Ihiil., Sect. Ill, rii;i]>. II, fi'2; Sect. V, Chap. II, S - i(i. 70 EPISTOLARY DISSERTATION. awhile out of bed, it must be denied the patient ; since it may be contraindicated by great disquiet, intense fever, violent vomiting, vertigo, rheumatic pains in the limbs, &c. All these symptoms in young and sanguine patients more especially prognosticate an inordinate assimilation of variolous matter, and danger proportionate ; danger arising from the press of the pustules to find an exit, and the flux that will arise there- from. Whilst therefore I do my best to curb this exorbitant ferment, when, on the one side, confinement to bed will increase its violence, and, on the other hand, the patient will be greatly discomforted unless he have some similar support, I find myself obliged, under such circumstances, to bleed from the arm, and a few hours afterwards, to exhibit a thorough-going emetic of the crocus metallorum. This not only drives out the matter from Avhence the inordinate discomfort has arisen, but so restores the patient that he can leave his bed like a healthy man. Neither is this the only method whereon we must rely for breaking the violence of the fermentation, Over and above the aforesaid evacuations, the free addition of some spirits of vitriol to some thin drink goes far to help the patient out of danger; this should be continued until the full eruption of the pustules. Notwithstanding these evacuations, and this cooling drink, the patient must lie in bed at night only; if possible. All that has been mentioned is far less effective in checking the over-hasty assimilation of the variolous matter, than is a cooling action upon the blood of fresh air renewed by the lungs. This relieves, as I have often found by experiment, the aforesaid symptoms wonderfully and at once. This some- what unusual method is only absolutely necessary with persons in the prime of life, of sanguine temperament, and whose blood has been inflamed by wine ; in those persons, too ex- cepting always infants at the breast who, besides having small- pox, have the aforesaid grave symptoms also. When the blood is not so much inflamed, and when the symptoms are milder, so that the likelihood of an over-assimilation of variolous matter is less, it follows, as a consequence, that the aforesaid evacua- tions, and the spirits of vitriol may be dispensed with. 31. I have enlarged on all this, because I well know that the chance of a patient's death or recovery depends chiefly, if not wholly, upon the treatment of the first few days. When, how- EPISTOLARY DISSERTATION. 71 ever, the whole crop of pustules has shown aud this takes place on the sixth day from the attack, or the fourth from the first eruption the lying abed must, then, be uninterrupted through- out. It can, now, no longer be delayed, any more than, earlier, it should have been resorted to that is, provided the case be confluent. This, observe, is the disease I am dealing with. With few pustules, and those of the distinct sort, the treatment is immaterial ; provided there is no gross error. The disease is a slight one. The ignorance of the physician who aims at nothing so much as the promotion of heat, can alone make it dangerous. Dangerous, too, it has been made ; since in such cases the doctor, though unconsciously, helps the disease. 32. From the sixth (or fourth) day the pustules begin to increase, the body grows hot, and the head aches. Hence unless he be an infant the patient is watchful and unquiet. This is the point of the next importance in smallpox. The quieter the blood, the better will the pustules acquire their due size and growth. The greater the orgasm and tumult, the more are they like to shrink, and be checked. This stops the elimination of the peccant matter. It also disturbs the economy and crasis of each phlegmon. Hence they either fail to ripen, or contain ichor instead of true pus, and a black liquor instead of the proper honey-like matter. All this is an excretion foreign to the true and genuine variolous pustule. Hence, paregorics are in my mind as fit remedies in smallpox as they ;ire in any disease whatsoever: indeed they are quasi- specific, like Jesuit's bark in agues. I say quasi-specific, because I am aware that they act as paregorics rather than as absolute specifics. Still, they satisfy the simple indication to which we attend, viz. the quieting and regulation of the blood and spirits. It is this inordinate move- ment of the blood and spirits the inseparable attendant of the confluent smallpox of adults which, pre-eminently, calls for the use of anodynes. To refer the need of them to simple wake- fulness is to mistake the genius of the disease. Just as a man who is unable to sleep may keep his spirits quiet and composed a fact that we often see after taking laudanum so, also, he may be able to sleep whilst his spirits are so agitated as to interfere with the laudable breaking-out of pustules. This is worth notice. 3.'3. 1 will now speak of the kinds of anodynes. Although 72 EPISTOLARY DISSERTATION. for many years I have given tlieliquid laudanum for the symptoms with fair success, I prefer the syrup of poppies. Both act towards the same end, but laudanum heats ; which syrup does not, when its dose is adapted to the age of the patient and the symptoms. What will suit a man of a quiet and regulated spirit, will be insufficient for one of a more turbulent tempera- ment. Now let us call six drachms a fair dose in ordinary com- plaints. In smallpox, if wanted at all, it will be wanted in ounce doses. This applies to adults. With infants the dose may be diminished according to their age. Infants require pare- gorics less than adults. They are more prone to sleep. Still even with infants, if the symptoms were dangerous, I should be afraid to withhold them. What however I most wish to say is, that be the case what it may, the dose of a paregoric is difficult to be determined. Indeed when given for any inordinate movements of the spirits, for violent vomiting and looseness, or for severe pain the three affections wherein I have already said paregorics are most wanted they should be given in such a manner, that if the first dose fall short of its full effect, another and another should be taken at the due time, until the end is accomplished. In this way the effect and not the quantity regulates the dose. Even when the action has become favorable, free as has been the previous exhibitions of anodynes, they must not be discon- tinued too soon. All that should be done is to give the doses at intervals ; so regulated as to enable us to ascertain the effect of one before we administer another. When, however, our end is gained, the dose must be decreased according to the decline of the disease. 31. I can prove all this by many examples. I will give, however, but one. Oil the 13th of April, 1681, a Mrs. Crosse called on me, asking me to visit her son, 10 years old, smitten, as she feared, with smallpox. Being ill of the gout I asked an apothecary to see him for me, and report upon the case. He told me that his mother had followed some friends' advice, and given him the Countess's powder, and other heating drugs ; had overlaid him with blankets in order to promote sweat, the sheet- anchor of the mother and her advisers ; and had dosed him with posset made of marigold-flowers and hartshorn. All this had so increased the fever that the patient had become delirious, and EPISTOLARY DISSERTATION. 73 was held down to his bed, where he kept moauiiig and mur- muring to himself. As for the eruption, it was not visible or sparingly so. It raised however the skin, as if a thick crop were finding its way outwards. This was from the treatment. It had checked the eruption which it was meant to promote. I ordered him to leave his bed at once ; and forbid him to get into it again, except at night-time, before the sixth day was over. Then 1 pre- scribed half an ounce of syrup of poppies. This did no good. I repeated it at the end of an hour. In vain. So violent was the orgasm of the blood, that nothing under two ounces and a half allayed it ; given in half-ounce doses, at such intervals as enabled me to watch the effects of each. After this I ordered half an ounce to be taken every night until the end of the disease. This maintained that composure of the spirits, which the previous larger doses had effected. 33. Now be the dose thus given ever so large and re- peated, provided that the turbulence of the blood, and the agitation of the spirits be excessive, it will not do its work unless the patient be taken out of bed. The heat of bed so exasperates the fever, that nothing but a narcotic, stronger than the consti- tution will well bear, can allay it. This is what happens though with less danger to life with bark in agues ; a reason, in my mind, why the cure of such fevers has, often, been unnecessarily prolonged. At times, too, when the fever has /f-mitted rather than inter-mitted, so great has been the increase of its intensity, that death has but barely been escaped. 36. Laying aside extraordinary cases, wherein the paregoric may be taken during any stage of the disease, I recommend the present paregoric to be taken for the first time, on the night of the sixth day that is, the first time the patient is wholly con- fined to his bed. It should, then, be continued until the seventeenth, or till the danger is over. On the sixth day the flesh has become inflamed ; so that the head begins to be disturbed and to wander, from the heated humours. 37. The anodyne in smallpox should be taken earlier than in other diseases ; since it is in the evening when the fits of heat and restlessness set in. Sometimes it happens, that if, dining the latter days of the disease, it be delayed, the patient \\ill suddenly become heavy, complain of discomfort, grow fevered, and die much to the astonishment of his sanguine friends, 74 EPISTOLARY DISSERTATION. who had formed hopes of a recovery. An anodyne given in time might have saved this. Hence, on these days, the eleventh especially, I order the anodyne to be given early in the evening, at four or six p.m. ; so that its action may be ready when wanted, in case of any sudden attack. I am satisfied, that certain persons, well known to me, have died for the want of such a remedy under such circumstances. Had they had it they would have lived. How truly then may we say Occasion stays for no man} 38. There is then a double danger. The narcotic may be given too late. Or it may be given too early. In this last case its action has passed away before the occasion has come. Hence, during the last, and most dangerous, days, it should be given at stated hours morning and evening. Neither will the aforesaid ounce-dose always be sufficient. The blood may be so inflamed, and the spirits so disturbed, that it may have no more action than half an ounce in other cases. Experience, then, has shown me, that an ounce and a half is the dose particularly with young men, and hot temperaments. This can be repeated, until convalescence, morning and evening, with impunity, nay with benefit. 39. In the very worst forms of confluent smallpox I have found it necessary to give three paregorics during the day, i. e. one every eight hours ; since, so great has been the orgasm of the spirits, and so much discomfort has arisen there- from, that longer intervals were not allowable. Now if the diacodium as it sometimes does create nausea, the liquid laudanum must be substituted. Of this, sixteen drops have the same effect as an ounce of the syrup ; that is, if it be prepared as I have elsewhere directed. 2 40. Those who disapprove of this method will object that, by a narcotic so largely and so frequently given, the peccant matter will become fixed and salivation be checked. To this I reply, that it is true that the salivation may be diminished ; still, it will never wholly cease. Nay, more, some time after the anodyne has been given it will break out afresh. From this accrues a double advantage. The patient, having been re- stored by the anodyne, is all the stronger for the expectoration. 1 '() Kftipur; dii'C- Hipp., Aphor. i, 1. [(!.] 2 Med. Ol>*., Sect. IV, Chap. Ill, $ 11. [G.] EPISTOLARY DISSERTATION. 75 The excreted saliva, although scantier, is all the better excocted. In the next place, the decrease of the ptyalism is well made up for by the increased swelling of the hands and face. This is all the surer and all the freer for the repetition of the nar- cotics, especially on those days when the swelling most regu- larly takes place, this being, for the face, from the eighth to the eleventh (after which it begins to subside) ; for the hands from the eleventh day until the ripening of the pustules by which they are beset. In respect to these, I confidently assert that no competent judge can deny that the absence of these swell- ings, on the days on which they are due, is a worse omen than the interruption of the ptyalism. For my own practice, I would rather risk a check to the ptyalism than a check to the swelling, and I think that this is so thoroughly required by the disease, that the practitioner who debars his patient of sucli an auxiliary has but little observed the complaint. 41. I must not, however, be mistaken so far as to be sup- posed to recommend the daily use of diacodium, in the proper dose, in the case of tender infants suffering under the confluent disease except, only, in very seriously dangerous cases. This for two reasons : Firstly, infants have less warmth than those with whom the torch of life is more fairly lit. Secondly, the tender age of infants ill bears narcotics. Add to this that, left to themselves, infants escape the troubles of most diseases through sleep. Notwithstanding this, as often as there is brain fever, and as often as the pustules are ill conditioned, anodynes are indicated ; either of these symptoms sufficiently proving that the movement both of the blood and animal spirits is disturbed. 42. The two points that I have treated are the cardinal points in the treatment of Variola firstly, the regulation of the over- hasty assimilation of the morbid matter during the first days ; and secondly, the moderation of the movement of animal spirits under the inordinate influence of the inflammation of the ex- ternal parts. These they are which, when neglected, originate those terrible symptoms which bring the disease to a tragical end. These being dealt with, nothing more remains to be done by the physician. Nevertheless, the writer of recipes may find work. Between, however, these two arts, faculties, or />/'- rinn-s (call them which we will) there is a world-wide ditlc-rencc. 76 EPISTOLARY DISSERTATION. 43. One point I must still add if a blister is to be applied it should be large, and should be placed on the nape of the neck. As to the time, this should be so contrived as for the epispastic not to have lost its power before the eleventh day; whilst on the other hand, it should not be applied on that very day. If so far delayed, it may do more harm than good and that, on account of the heat and disturbance which, in conjunction with the secondary fever, it creates to the blood. The best time then, is the night previous to this great crisis of the disease, immediately after the paregoric then to be admi- nistered. AVith a blister thus laid on, the pain which it causes will have ceased before the day of distress and danger ; and an exit will be given to the peccant matter at the very time neces- sary for subduing the bad symptoms then due. I have already 1 fully shown that at this time the face hitherto swollen begins to go down, and that the salivation, which has hitherto flowed abundantly, decreases; the humour which excited it being now condensed and secreted with difficulty. Furthermore laying out of the account the fact that, to a certain degree, the blister in question is a substitute for the going down of the swelling of the face and for the diminution of the salivation, it also con- duces towards the abatement of the secondary fever. This now rages the blood being overwhelmed and poisoned through the resorption of the pus of so many little abscesses. So true is this, that I have remarked that a pulse, which could be ft-lt at the wrist on the tenth and twelfth days, was imperceptible on the eleventh. 44. In respect to those things which ease the head, either as derivatives or revulsives, nothing, in my mind, works so w r ell as an onion laid on the sole of the foot. That this really draws is clear, from the blisters which it often raises, and from the intolerable pain which, in drawing the humours to the parts in question, it sometimes (though rarely) excites. I have, indeed, occasionally had to ease it with a poultice of white bread-crumbs and milk. In adults, then, with the confluent smallpox, I slice an onion, wrap it in linen, apply it to their feet on the eighth day (the clay on which the face first swells), and renew it every day until all danger is over, 1 Mcd. Ohs., Sect. Ill, Chap. II, it 14-22. [G.] EPISTOLARY DISSERTATION. 77 45. Throughout the disease the patient must abstain from meat ; thin well-hopped small beer alone being allowed for drink. This with oatmeal porridge and roasted apples will well sustain life. "When, however, the ripening of the pustules begins, so that the purulent particles regurgitating upon the blood infect it with their own venom, it will be advisable to indulge the patient with a few spoonfuls of wine every morning and evening. As to his bedclothes and blankets, they should be neither more nor fewer than he used during health. More- over, he is free to move about in the bed as he likes, since by so doing he checks those symptomatic sweats, which I consider that I have proved to be injurious to the patient. In like manner, he will also ensure himself against the over-violent inflammation of the eruption sure to be excited whenever the patient lies, as if fixed by a stake, on one part of the bed only so overheating his flesh. 46. As a sample of the entire practice I will give a very recent case. This winter, the noble Lady Dacres sent for me to attend her grandson, Mr. Thomas Cheut, in the flower of his age, and of a very sanguine temperament. The day previous he had sickened. He had also vomited a vast amount of bilious matter. His back was in severe pain. To ease all this, he went to bed, and tried, during the whole day, to force a sweat by loading himself with bedclothes, and by drinking hot liquors. In vain. The vomiting (which was violent), and the diarrhrea (which was but moderate) mocked the sudorifics ; whilst fuel had been added to the flame, by the encouragement thus given to the fever. This had much increased. That smallpox was coming on, and that it would be confluent, I sus- pected from the time of life, and from the extent to which the blood had been heated in the attempt to force a sweat (had it been in summer there would have been purple blotches and bloody urine), as also (and this most especially) from the vomiting, distress, and pain. When these with young men are excessive the pox will flux. Finding that 1 could leave no stone unturned, I ordered him up from bed ; keeping him thereto at the usual bed-hours only. The next day (the third), as the smallpox did not appear, I bled him, in the morning, to eight ounces from the right arm. The blood was of good quality, and florid ; inasmuch as it had only just taken the EPISTOLARY DISSERTATION. spirituous taint (piaa/ma) instead of being putrefied. This it is, when the disease is of long standing. And so it shows after convalescence. At five p.m. I ordered an ounce of the crocus metallorum. On this he vomited freely; and was so far relieved from distress that he got up from his bed; whereas before he hardly allowed himself to be torn from it so much did he suffer from weakness and giddiness. On the fourth morning I found the eruption coming; and that in such numbers that I feared their excessive confluence would endanger life. I took great care to keep him from being kept close to his bed. I gave him, too, for drink a little small beer acidulated with spirits of vitriol. So I kept on till the sixth day. During the whole time he was well enough to breathe the fresh air, and to take strength from doing so. His bowels, however, were somewhat loose. About noon, however, he was no longer able to keep from bed ; such being usually the case. So he kept it till the end of the disease, and that with leave from me ; inasmuch as, for all that I had done, the pustules had broken out, and were of the confluent kind in the greatest degree ; less numerous, perhaps, than I have seen in cases where the patient has died, but more numerous than any where I have known recovery. I now gave him an ounce of syrup of poppies out of cowslip water at bedtime, and repeated it every night. I allowed him no more than his usual bedclothes. He might eat oatmeal porridge and barley broth, and, occasionally, a roasted apple. He might drink a little small beer. On the eighth day, I laid an onion, wrapped in linen, on the soles of his feet, and renewed it every day until he was out of danger. After this, everything went on in the way that was to be expected from the increase of the pustules up to the tenth day. I, then, upon visiting him in the morning, detected (although he was doing pretty well) some premonitory symptoms of secondary fever along with some uneasiness. Fearing danger I gave the paregoric already mentioned. 1 All became quiet. The same night I ordered an ounce and a half of syrup of poppies. The next morning (i. e. that of the eleventh day) the effect of the anodyne over night was going off, so that he again was getting restless. I now threw in an ounce and a half of dia- i $ 3f>. [G.] EPISTOLARY DISSERTATION. 79 codium at once, and repeated the same in the evening, and so I did night and morning till he thoroughly recovered. The patient obeyed my orders, and no further symptoms frightened us, except that at times his urine, which he had to pass kneeling in bed, was suppressed a common occurrence in young subjects. In respect to the salivation, however much the amount of spitting might be interrupted by such free and frequent anodynes, the patient, nevertheless, expectorated a more con- cocted phlegm, and his face and hands swelled as we wished them, and at the due time. On the eighteenth day he got up, when I allowed him some chicken broth, from which he gradually went to his accustomed diet. On the twenty-first day lie was bled from the right arm to eight ounces. The blood was ns the blood of pleurisy, and almost like pus. Lastly, he was purged four times, with intervals between. 47. Whenever in these pages I talk of the sixth, the eleventh, or any other day, I do not mean to be understood to say that the confluent smallpox always breaks out on the third. I know well that it sometimes so happens that, even in the most con- fluent form, the eruption is somewhat later. Generally, however, it is on the third. Hence a person first seized 011 a Monday, will show the first signs of the eruption on Wednesday, and on Thursday week the dangerous eleventh day will have arrived. 48. All this applies to the confluent smallpox only. With the distinct sort they have nothing to do. Those who boast about curing cases where the rash has been scanty, deceive them- selves and others. If they really wish to test their skill, let them take a confluent case in a young subject who has drunk hard ; and not so far blunder as to fancy that, in their easier practice, they have saved the lives of patients whom it would have been a hard matter to have killed. 49. I cannot conclude without giving an account from my good friend Dr. Charles Goodall, M.D., Fellow and Censor of the College of Physicians, with which he favoured me whilst I was upon the present work. I do it all the more readily, because it confirms what I have said here and elsewhere concerning the petechiaj and the bloody urine, viz. that each of these symptoms occurring in acute diseases, is due to over-violent inflammation 80 EPISTOLARY DISSERTATION. of the blood, and demands cooling remedies. The case was as follows : 50. "A youth, of about 27, of a thin habit, and hot tempe- rament, was seized with a violent continued fever in June 1681. The tongue was dry and rough, the thirst great, the pulse quick. There was great pain in the pit of the stomach, and greater in the back. Here it was pre-eminently permanent. His urine was occasionally bloody. Petechise of dark colour thickly beset the neck, chest, and wrists. The physician (who first saw him on the sixth day), judging from the bloody urine that life was in danger, took, as the first indications of treat- ment, the cooling and the thickening of the blood, and then the closing of those vessels of the kidneys which were relaxed and open. 51. "Beginning with a bleeding, and a laxative bolus, I ordered him to keep from bed; little doubting but that the heat thereof favoured the bloodiness of the urine. I also bid him sleep on a cushion covered with leather. He was not to lie on his back, except very rarely. He was allowed milk-and- water, panado, rice-milk, roasted apples (either by themselves or mashed up with spring-water and sugar). The medicines were R: Flowers of red roses, 3vj ; Inner bark of the oak, Jss j Plantain-seeds (roughly bruised), 5iij ; Spring-water, Oiij ; Spirits of vitriol, q. s. Add these last so as to make the draught agreeably acid. Heat slowly in a closed vessel for four or six hours. Strain, and add Cinnamon-water with barley, Jiij ; Finest white sugar, q. s. Flavour to taste. Drink frequently, night and morning. "A clyster of milk with syrup of violets was thrown up at two p.m. At bedtime the following draught : R Cowslip-water, Plantain-water, Cinnamon-water with barley, asi Jss ; Distilled vinegar, 3ij ; Syrup of poppies, 3vj. Mix. " On the seventh day, as the symptoms had scarcely abated, EPISTOLARY DISSERTATION. 81 I ordered the clyster to be thrown up every day. The follow- ing emulsion and draught were also prescribed : R Chicory-seeds, Endive-seeds, Lettuce-seeds, Purslane-seeds, aa 5ij ; Quince-seeds, White poppy-seeds, aa 5iss; Sweet almonds (peeled), iv. Bruise in a marble mortar, dropping in by degrees of Barley-water, Oj. Strain. Add of crystalline sugar, q. s. Make into an emulsion ; of which twelve spoonfuls are to be taken every four hours. R Cowslip-flower water, Water-lily water, Oak-bud water, Plantain-water, aa j^ss ; Distilled vinegar, Cinnamon-water with barley, aa Siij ; Confection of hyacinth, 5ss ; Syrup of poppies, jy. Mix, and make into a draught, to be taken at bedtime. 53. " On the eighth day, the urine continued bloody, and the petechice were numerous; so that, judging that all this came from the heat, thinness, and acrimony of the blood, I bled a second time ; and allowed a free use of small beer flavoured with spirits of vitriol. This being distasteful, a posset of lemon-juice and milk was allowed, as well as the pulp of lemon divided into squares, and covered with sugar. The following was added : I\ Conserve of Lujula, Conserve of dogrose, aa ^ss ; Confection of hyacinth, ,"iij ; Diascordium, 5iss ; Red coral (prepared), Dragon's blood, Hole Armeniac, aa 9j ; Syrup of comfrey, Syrup of Mouse-ear, iia <]. s. Make into an opiate. Of this take a portion about the si/r of a hazel-nut every six hours. Wash down with whey and lemon - juice, sweetened, or with the Vulnerary Decoction acidulated with spirits of vitriol. ii. ; V, 4. [G.] EPISTOLARY DISSERTATION. 85 at this time of year, that if I were to indulge in auy very deep train of thought, I should bring on an attack of gout. I will, therefore, despatch my subject briefly ; keeping to my usual method. First, will come a short history of the disease according to the phenomena of Nature. Secondly, my method of practice ; as taught by no untrust- worthy instructress Experience. 59. Of all chronic diseases hysteria unless I err is the commonest; since just as fevers taken with their accompani- ments equal two thirds of the number of all chronic diseases taken together, so do hysterical complaints (or complaints so called) make one half of the remaining third. As to females, if we except those who lead a hard and hardy life, there is rarely one who is wholly free from them and females, be it remem- bered, form one half of the adults of the world. Then, again, such male subjects as lead a sedentary or studious life, and grow pale over their books and papers, are similarly afflicted ; since, however, much, antiquity may have laid the blame of hysteria upon the uterus, hypochoudriasis (which we impute to some obstruction of the spleen or viscera) is as like it, as one egg is to another. True, indeed, it is that women are more subject than males. This, however, is not on account of the uterus, but for reasons which will be seen in the sequel. 1 60. The frequency of hysteria is no less remarkable than the multiformity of the shapes which it puts on. Few of the mal- adies of miserable mortality are not imitated by it. Whatever part of the body it attacks, it will create the proper symptom of that part. Hence, without skill and sagacity the physician will be deceived ; so as to refer the symptoms to some essential disease of the part in question, and not to the effects of hysteria. 01. For instance attacking the head, it causes an apo- plexy, ending in palsy, just like the apoplexy of the old and plethoric. This latter, however, arises from the investments of the brain being overloaded with an excess of phlegm, whereby the tracts and pathways of the animal spirits are stopped tip. The former has no such origin ; since it often occurs imme- 1 ^ 78. [c;.] 86 EPISTOLARY DISSERTATION. diately after delivery, and with a great loss of blood, being due to either a difficult labour or to some violent mental emotion. 62. At times it creates terrible spasms, like epilepsy ; when the belly, and the parts about the throat swell, and when the struggles are so violent, that a naturally weak individual, has to be held down by the united efforts of the bystanders. Mean- while, she shrieks irregularly and inarticulately, and strikes her breast. Such females as are most subject to this (so-called) strangulation of the womb are, generally, of a sanguine tem- perament and masculine habit. 63. Oftentimes, it attacks the exterior of the head, creating intolerable pain between the cranium and pericranium ; so iso- lated, however, as for Ihe thumb, laid across, to cover it. Here it keeps fixed. Violent vomitings accompany it. This is the Clavus Hystericus pre-eminently common with the chlorotic. 61. Falling upon the vital parts it creates such a palpitation that the patient makes sure that the sound of the heart beating against the ribs can be heard by the bystanders. This is com- monest with the weakly and pale, and those who look con- sumptive. So, also, it is with those who have the green-sickness. 65. When it falls on the lungs the patient coughs continu- ally, but without spitting ; and, although this cough may not shake the chest so much as the true convulsive sort, the fits are much more frequent, and the patient is less able to master them. Women, with an excess of phlegm are most liable to this cough ; which, otherwise, is very rare. 66. Descending to the colon, and the parts below the pit of the stomach, it inflicts a pain well-nigh as unbearable as that of the Iliac Passion, When vomiting follows, the matter brought up is green, bilious, and like (as they say) leeks; sometimes of a still more unhealthy colour. After this, it may happen that, after suffering pains that would vex a Stoic, and after being worn out by continual vomiting, the skin becomes of the saffron hue of jaundice, and the fit goes off. Meanwhile, all hope of recovery dies away ; the despair thus arising being as true a symptom of hysteria as either the pains or the vomitings. Crude and lax constitutions suffer most in this way. So do such mothers as have, with great pain, and labour, and loss of stamina, given birth to over-sized infants. EPISTOLARY DISSERTATION. 87 67. Falling upon one or other of the kidneys hysteria may cause the acute and intense pains of nephritis; pains not only simple and confined to the region of the kidneys, but accom- panied with vomitings, and pain along the ureters. Then the diagnosis is difficult. It may be hysteria or it may be a cal- culus; and unless there have been some antecedent mental emotion, or else the aforesaid porraceous vomiting, the former may be mistaken for the latter. The bladder, too, may help in the deception ; since pain may be present, and the urine may be suppressed. All this is just as if there were a calculus. No calculus, however, may exist. Of the two forms, the one imitating inflammation of the kidneys, and the other like a stone in the bladder, the latter is the rarer. Each, however, is commonest in such females as have suffered repeated shocks, and been weakened proportionately. 68. Hysteria on the stomach will create continued vomiting ; on the bowels, diarrhoea ; in each case pain being absent, how- ever much there may be of the aforesaid green juice. These symptoms, also, are the symptoms of patients who often have been attacked. 69. Just as this disease attacks almost all the internal parts, so also does it sometimes take possession of the external ones ; namely, the muscular flesh of the jaws, shoulders, hands, legs, and ankles ; sometimes causing pain, sometimes swelling. Of such swellings, that of the ankles is the most remarkable, differing in two ways from that of dropsy. Dropsical swellings are, in the first place, greatest towards the evening ; in the second, they retain the mark of the finger just like wet paste. In hysteria, there is 110 such impression ; and the puffiness is greatest in the morning. Generally, also, it is only one ankle that swells. In respect, however, to size and shape, hysterical and dropsical swellings are so much alike, that the patients can rarely be undeceived as to their nature. 70. Strange to say, the teeth themselves are not free from attack. Without the smallest cavity, without any perceptible discharge, there shall be all the severe and intractable pains of toothache. Still, both the pains and swellings of the external parts are chiefly the lot of those who have been so worn out by continual and violent attacks, as to find life a burden rather than a blessing. 88 EPISTOLARY DISSERTATION. 71. Of all pains, however, the most certain is the painjin the back. The least touch of the complaint brings (it on. Furthermore the aforesaid pains all agree in this. The part which they had attacked is, even after their departure, so tender, as to feel as if it had been well beaten with sticks, and not to bear touching. However, this tenderness gradually goes off. 72. It is very remarkable that, in many cases, a notable sensation of cold over the external parts precedes these symptoms ; a sensation which not unfrequently lasts throughout the fit. More than once I have found this coldness to be like that of a corpse ; the pulse meanwhile being natural. Again almost all the hysterical women that I have ever seen complain of a dejection (a sinking as they call it) of the spirits ; and, when they wish to show where this contraction (or sinking] exists, they point to the chest. Lastly, that hysterical women break out into immoderate fits, sometimes of laughing, sometimes of crying, and that with- out any manifest cause, is known all the world over. 73. However, of all phenomena, the most peculiar and inseparable is this that the patients, at various times, void a great quantity of limpid urine, clear as the water from the rock. By detailed inquiries I have ascertained that, for hypochon- driasis of males, as well as for the hysteria of females, this sign is pathognomonic. In males, even a few seconds after passing water of the true straw-coloured hue, a sudden and violent mental emotion may produce the discharge of an abundant flow of urine not straw-coloured, but of crystalline clearness. As long as the urine is of this colourless character, the fit is on the patient, and he suffers accordingly. 74. Hysterical patients and hypochondriacs agree also in having rancid or nidorous eructations after meals, no matter how moderately they have eaten. Sometimes they are sour, like vinegar. This is because the digestion is impaired, and the juices are perverted from their natural state. 75. Nor are the unhappy sufferers from this disease affected and shaken in body only shaken so, as like a ruined building, to appear upon the eve of falling but their mind sickens more than the body. An incurable despair is so thoroughly the nature of this disease, that the very slightest word of hope EPISTOLARY DISSERTATION. 89 creates anger. The patients believe that they have to suffer all the evils that can befall humanity, all the troubles that the world can supply. They have melancholy forebodings. They brood over trifles, cherishing them in their anxious and unquiet bosoms. Fear, anger, jealousy, suspicion, and the worst passions of the mind arise without cause. Joy, hope, and cheerfulness, if they find place at all in their spirits, find it at intervals "few and far between," and then take leave quickly. In these, as in the painful feelings, there is no moderation. All is caprice. They love without measure those whom they will soon hate without reason. Now they will do this, now that ; ever receding from their purpose. That which the Roman orator remarks upon the superstitious, squares with the behaviour of the melancholic : " Sleep is naturally the refuge from all labour and anxiety; from the sleep of the superstitious, however, cares and fears originate." 1 So also here. All that they see in their dreams are funerals and the shadows of departed friends. Thus they are racked both in mind and body, even as if life were a purgatory wherein they expiated and paid the penalty of crimes committed in a previous state. In all this, it is neither the maniac nor the madman that we write about. Saving and excepting the hallucinations aforesaid, those who thus suffer are persons of prudent judgment, persons who in the profundity of their meditations and the wisdom of their speech, far surpass those whose minds have never been excited by such stimuli. Hence, it is not without reason that Aristotle has observed, that melancholy men are the men of the greatest genius. 7(5. Nevertheless, a state of mind thus horrible is the miser- able lot of those only, who after a long and severe struggle with the complaint, have fairly given in ; especially if change of fortune, mental disturbance, anxiety, over-study, or excessive exertion, conspiring with the impaired diathesis of the body, have added fuel to the flame. 77. To simply enumerate all the symptoms of hysteria would be the work of a long day ; so numerous are they. Yet not less numerous than varied, proteiform and chameleon-like. Hence I agree in the calculation (though not in the view of ' Cicero, dc Divinat., ii, 72. [(;.] 90 EPISTOLARY DISSERTATION. the nature of the disease) of Democritus ; who writes, in his letter to Hippocrates, that the " womb is the cause of in- numerable sorrows and troubles." Not only are they thus numerous ; but they are also multiform in type, and (unlike the habit of other diseases) are a farrago of disorderly and irregular phenomena. Hence it is exceedingly difficult to describe a histoiy of the disease. 78. The remote or external causes of hysteria are over- ordinate actions of the body; and still oftener over-ordinate commotions of the mind, arising from sudden bursts of anger, pain, fear of other similar emotions. Hence, as often as females consult me concerning such, or such bodily ailments as are difficult to be determined by the usual rules for diagnosis, I never fail to carefully inquire whether they are not worse sufferers when trouble, low-spirits, or any mental perturbation takes hold of them. If so, I put down the symptoms for hysterical ; a diagnosis which becomes all the more certain whenever a large quantity of limpid crystalline urine has been voided. To such, and such like mental emotions bodily de- rangements may be added, e. g. ; long fasting and over-free evacuations (whether from bleeding, purging, or emetics) which have been too much for the system to bear up against. 79. Leaving the description of the disease, as determined by its leading phenomena, the matters that come next under consideration are the efficient, internal, and immediate causes. These I will, as far as is possible, work out from the conjoint circumstances already described. The affection which I have characterised in females as hysteria, and in males as hypochondriasis, arises (in my mind) from a disorder (ataxy) of the animal spirits. This precipitates them on the different parts of the system; so that bearing down violently and multitudinously upon particular organs they excite spasm and pain wherever the sensations are exqui- sitely acute ; deranging and perverting the functions both of the parts they leave, and of the parts they fall on. No wonder. The irregularity of the distribution is opposed to nature ; and the economy takes therefrom no small damage. 80. Of this derangement, or ataxia, the origin and antece- dent cause is the weakened crasis of the spirits, whether natural or adventitious. Hence, the slightest occasion dissi- EPISTOLARY DISSERTATION. 91 pates them, and the system is pulled down without difficulty. Just as the outer man is built up as a framework of parts visible to the outward sense; so, also, is it the inner man simi- larly constituted of parts, however, consisting in the due and proper arrangements of the spirits, an arrangement cognisable only to the eye of reason ; an arrangement, too, which is so united and intimately combined with the temper of the body, that it stands or falls according to the firmness of the consti- tuent principles. For this reason we see more females than males, hysterical ; the female being endowed by Nature with a more fine and delicate habit of body, as being destined to a life of more refinement and care. Man, on the contrary, is born to labour at the tillage and pasture of the earth, and at the capture of beasts for food. This makes him of a stronger and more muscular body. 81. That this ataxia is the true cause may be proved by the phenomena already described ; of these I will treat upon the chief; beginning with the well-known hysterical affection called the strangulation of the womb. Here the spirits con- gregated into a mass in the lower belly, rush in a troop, and with all their impetus upon the fauces, exciting spasm along the whole tract that they traverse, and blowing up the belly to the size of a vast globe. This, however, is nothing more than the convolution and conglobation of the part affected with spasm, which can only be restrained and repressed by the exertion of considerable force. Meanwhile, the external parts, and the mass of the flesh are so deprived of their due share of spirits (these being diverted elsewhere), as to become as cold as death, a phenomenon which occurs in all other forms of hysteria as well as this. This, however, has been already stated. 1 The pulse remains natural ; and, unless the chill has been preceded by any enormous evacuation, there is no danger to life. 82. The same may be said concerning that violent kind of hysteria which looks like bilious colic, or even like the iliac passion. Here, the pain around the pit of the stomach is intolerable, and the vomiting of matters as green as grass is immense. These symptoms, in my mind, arise from nothing flse but the vehement impulse of the densely-conglomerated 92 EPISTOLARY DISSERTATION. spirits upon the parts in question ; giving rise to pain, to spasm, and to the total abolition of the faculties. 83. Now the fact that the matters thus brought away, whether by retching or purging, are of the green colour in question, is no direct proof that the disease belongs to the humours, or that any excessive acrimony thereof, by tearing the parts to which it is confined, creates the excess of pain. Still less are we to hold that this is the source of the disease, and to give cathartics and vomits to get rid of it. Sea-sickness, which arises from the effect of a turbulent and unquiet sea in agitating the animal spirits, brings up from the stomachs of men in health just such coloured egesta; even where half an hour before they were at sea there was no such (so-called) leeky bile about them. Do not also infants (subjects in whom the animal spirits play an important part) void like-coloured matters both from the stomach and the bowels ? Does not also daily ex- perience show that, whether with women or children, we either purge or vomit, the colour remains unaltered ; and that both in the vomited matters and the motions ? Again, the more we give such medicines the more the green matter increases ; and this because the ataxy of the spirit is, in both cases, promoted. Whether, however, it acts by destroying and perverting the fermentation of the parts in question, or whether, through the force of the spasms, it forces into the stomach and intestines some juice foreign to their nature, and capable of thus staining the humours, is uncertain. The chemists, although in the curing of disease, the medicines which they make up in their elaborate apparatuses, are neither better nor worse than the medicines which are boiled in pots, or bruised in mortars, are, still, capable of so juggling a feat as, out of two perfectly clear and limpid fluids, to bring a single dark-coloured one ; indeed, so slippery and evanescent is the speculation of colours, that nothing certain concerning the nature of the bodies in which they appear can be discovered from their presence. Hence, it is no more necessary for all green things to be acrid, than for all acrid things to be green. Putting which facts together, I look upon the excessive pains, and the rejection of the green matter as referable to a single cause, and that, the over-violent incursion of the animal spirits upon the parts about the pit of the stomach. These they contract to spasm. EPISTOLARY DISSERTATION. 93 84. To the same cause I also refer what I have already noticed as the clavus hystericus. Here the spirits from the body at large are concentrated upon a certain point of the pericranium, so limited, so boring, and so severe, as to feel as if an iron nail were being driven in. This also is attended by a notable vomiting of green matter. Now the concentration of the spirits from the different parts of the body is not unlike the collection of the sun's rays under a burning glass; and just as these latter, from their united force, have power to scorch, so do the former, from the same reason, create pain, by joining in the laceration and discerption of the membranes. 85. From the same ataxia, also, and from the extent to which it disturbs the blood, arises that symptom which we have already spoken of as being common to hysteria and hypochondriasis, viz. the clear and, at the same time, copious urine ; inasmuch as the serum of the sick person, which requires a certain time to become impregnated with those salts which gave it its natural lemon-coloured hue, is, from the interruption of the animal economy, voided before it has been sufficiently retained ; a fact proved by what we see every day with persons who take in over- much drink of any especially of the weak and thin sort. The urine that they pass is of the clearest kind. In all such cases the blood has more serum than it can retain ; so that, being unable to keep it in, it lets it out before its due time, and before it has become coloured by the juices of the body. 86. Three years ago a nobleman consulted me. He seemed to suffer from hypochondriac colic, so violently as to look like a patient under ileus. The pain was intense ; the vomiting ex- cessive. The disease had harassed him so long and so severely, that he well-nigh was sinking under it. Now I observed, throughout the disease, that just in proportion as he was worse his urine was clear, and just as he was better yellow. One day I found him with the urine of three successive voidings, in three different charnber-pots, and all were yellow or lemon-coloured. He was in such good spirits, and his appetite was so good, that I allowed him, at his own request, some digestible food. At this point, however, some one coming in interrupted him. This so put him out that he called at once for a chamber-pot, which he almost filled with urine as clear as crystal. 87. Perhaps the salivation of hysteria has the same cause. 94 EPISTOLARY DISSERTATION. For weeks together patients spit a thin fluid, just as if they were under mercury. This may come from the disturbed state of the blood, when Nature, unable to carry on the proper method of excretion, reverses the movement of the serum, and instead of unloading it by the usual way of the kidneys, deposits it, through the extremities of the arteries, upon the glands ; from whence, in the form of saliva, it escapes through the salivary ducts. The same applies to the profuse night-sweats of hysterical patients. The ataxy of the blood determines the serum to the surface. 88. The cause of the cold chills is clear as day. The animal spirits leave their proper station for some other. So also the cries and bursts of laughter. There is no ostensible reason for either ; only that the animal spirits fall with great violence upon the parts that are subservient to these functions. 89. I may remark, by the way, that males though rarely are liable to this kind of crying. A gentleman, to whom I was called, equally favoured by nature and fortune, and who, under the direction of a previous attendant, had, but a few days be- fore, recovered from fever, after having been bled, been purged, and been forbidden animal food, was found by me out of bed, with his clothes on, and talking reasonably. Upon asking why I was sent for, I was told by one of his friends that / should soon see. So I sat down, and began to converse with him. In a short time, I observed that he pouted his lower lip, moved his head backwards and forwards just like a fro ward child and finally burst out in such a flood of tears, accompanied with sobs and groans almost convulsive, as I had never seen before. The torrent, however, soon subsided. I laid his complaint partly to the disorder of his spirits, partly to the length of the previous fever, partly to the evacua- tions that had been necessary to its treatment, and partly to the interdiction of animal food, by which his physician was guarding against a relapse. Hence, I pronounced him free of all fever ; and, laying his symptoms to the inanition only, recommended a roasted fowl for dinner, and allowed him a moderate share of wine. This he took ; and went on afterwards with animal food in moderation. He never again so suffered. 90. To finish (fur I leave out at present all the other pheno- EPISTOLARY DISSERTATION. 95 mena of this disease), it is from this irregularity of the spirits that the disturbance and inconsistency both of the mind and body, which are so prevalent with both the hysterical and the hypochondriacal, take birth. Both want that firmness of the animal spirits which, in the strong and in those whose faculties are actuated by a regular supply of fresh spirits, is never missing. Hence they cannot bear disagreeable impressions. Hence they are suddenly over-excited by cither anger or pain ; so that they are just as irritable as those whose governing principle has either been made too unsteady and too weak by Nature originally, or else has been rendered so by a long series of troubles. Verily, the strength and constancy of the mind, so long as it lies in this our bodily crust of clay, depends most especially upon the strength and constancy of the spirits that lodge along with it ; spirits which are at the top of the scale of matter, and on the very verge of the immaterial entity. Just, too, as the frame- work (so to say) of the mind is a structure far more skilful and delicate than that of the body, a structure consisting in the harmony of eminently excellent and almost divine faculties, so, whenever the constitution of the same shall, by any means, have become interrupted and broken down, the ruin will be great in proportion to the excellence and beauty of the workmanship during the period of its integrity. Now this is the state of those dejected miserables whom we have described ; a state which the dogma of the most insolent Stoic will relieve just as much as a toothache is relieved by a resolution forbidding one's jaws to give pain. 91. It is clear then, to me, that it is not any corruption of either the semen or the menstrual blood, to which, accord- ing to the statements of many writers, this disease is to be referred. It is rather the faulty disposition of the animal spirits. There is no malignant halitus towards the parts affected, no perverse depravation of the juices, no congestion of acrid humours. There is the cause I have assigned, and no other. A single instance shows that the disease is not referable to any material source. A female (no matter how good her health), provided only she be of a delicate and tender habit of body, shall, from some error of diet, from an emetic, or from a strong purge, be so weakened as to suffer from one or more of the symptoms of the disease in question. Now if 96 EPISTOLARY DISSERTATION. the cause of the disease were in the humours the evacuation (purge or vomit as the case might be) would have done good. The same applies to any immoderate loss of blood; whether from bleeding or in childbed. The same to inanition, or to pro- tracted abstinence from animal food; all which causes would guard against, rather than encourage hysteria; if its source were material. On the contrary, nothing brings it on more. 92. However much it may be clear that the origin of hysteria is by no means lodged in the humours, it must, nevertheless, be admitted that that ataxia of the spirits, to which the disease is due, begets an accumulation of putrid humours, whereby the function of the parts whereon they are so violently borne, and the parts from which they are removed is wholly perverted. Such parts are chiefly organs of separation, designed for the recrementitious parts of the blood. Hence, if their functions be impaired, it follows, perforce, that a vast colluvies of im- purity must accumulate. Had the organs done their duty, this would have been eliminated, and the blood purified accordingly. To this cause, then, I attribute the cachexy, the anorexy, and the chlorosis (a truly hysterical complaint) of hysteria a sea of troubles wherein such unfortunates as have long been afflicted have to struggle. In all such cases putrescent juices first accumulate in the blood, and then fall upon particular organs. Dropsy of the testicles in females is of this sort. The hysteric affection has been of long standing. The depraved juices are thrown upon the organs. The functions of these are impaired. The female becomes barren. The whole economy breaks down. Sanies and serum are produced. These gorge the nodules and the ova of the testicles. They work their way also between the interstices of their coverings. Vast swellings follow. All this is shown in the dissections of such as die of the disease. Meanwhile it is the hysterical diathesis which is the primary cause of all such and such like humours ; however much they may, in other respects, belong to a different family of maladies. 93. A quartan ague is in the same predicament. A man with the health and strength of a wrestler, shall expose himself for no more than two or three days to a marshy atmosphere. At first it shall be a spirituous miasma which is impressed upon the blood. If, however, it continue the whole economy shall EPISTOLARY DISSERTATION. 07 suffer, the juices of the body shall become tainted, the dispo- sition of the system shall change. The patient shall then all the more if he be approaching the limits of old age grow liable to cachexies of all sorts, and to all such other evils as supervene upon intermittenta of long standing. Nevertheless, it is not the evacuations which best expel morbid humours that cure such an ague as this. It is the proper specific for the disease. 94. All which shows that the chief curative indication is the restoration of blood the fount and source of the spirits. These must keep that even tenor which best fits the economy of the different parts. Still, when this has been so long deranged that the ataxia of the spirits has had time to vitiate the humours, we may providing the strength of the patient permit diminish their amount by bleeding and purging before we gird up our loins for the great work of invigorating the blood ; an end which we shall hardly gain as long as the fecu- lent colluvies of humours is in the way. At times, too, the intense pains, the diarrhoea, or the vomiting may be so great as to allow us no opportunity for beginning with our primary intention the fortification of the blood. In such cases our first step must be, to administer an anodyne. This being done, the weak crasis of the spirits the cause of the disease may be dealt with, and the symptoms that they originate be treated. And here experience tells me that many drugs, by means of their fetid exhalations, are effectual in repelling the spirits which cause trouble, and in keeping them to their proper places. For this reason they are called hysterical remedies. As often then, as we meet the aforesaid symptoms, these arc what we must have recourse to. 95. AVith this view I bleed. I then purge for three or four mornings running. Meanwhile, the patient is so far from improving that she gets worse. Such is the disorder excited by the evacuations. Hence I warn her against being dispirited ; to which the nature of the disease leads her. He this, however, as it may, the vicious humours which we suppose to have become accumulated during the disease must, in some degree, be drawn off, before we can well satisfy our primary intention. ( .X5. After these evacuations, I comfort the blood and tin- spirits belonging to it by giving a chalybeate thirty days ii. 7 * 98 EPISTOLARY DISSERTATION. running. This is sure to do good. To the worn-out and languid blood it gives a spur or fillip, whereby the animal spirits, which before lay prostrate and sunken under their own weight, are raised and excited. Clear proof of this is found in the effects of steel upon chlorosis. The pulse gains strength and frequency, the surface warmth, the face (no longer pale and deathlike) a fresh ruddy colour. Here, however, I must remark that with weak and worn-out patients the bleeding and purging may be omitted, and the steel be begun with at once. 97. This is best given in substance ; in which form I have neither seen nor heard of it doing mischief. Nay, the simple substance effects a cure both more surely and more quickly than any of the current preparations. With steel, as with other more famous medicines, the officious sedulity of the chemists has not only failed in adding to its activity, but has succeeded in diminishing it. I have heard a statement, which, if true, strongly sustains this assertion namely, that the crude ore itself, as dug out of the bowels of the earth, operates more effectually in our victories over disease than steel which has been exposed to the fire and suffered fusion. For this, however, my in- formant is answerable. All that I know myself is that every choice and noble remedy, wherever found, receives its principal virtues from Nature. Hence, the gratitude of antiquity has well named the nobler medicines the hands of God, rather than of men. That native goodness is of more importance than artificial forms is shown by a noble pair of witnesses opium and bark. Indeed, medical skill is less shown in the prepara- tion of remedies than in the appropriate selection of those which Nature elaborates single-handed, and supplies liberally. Our business is simply to reduce medicines to that form which is best for imparting to our bodies, if not their substance, at least, their force and efficacy. To this end our faculties are more than sufficient. Next to steel in substance, I prefer a syrup. This is made by steeping iron or steel filings in cold Rhenish wine. When the wine is sufficiently impregnated, strain the liquor; add sugar ; and boil to the consistency of a syrup. 98. It is not my practice to exhibit at stated intervals, during the time that my patient is taking steel, any purgative. EPISTOLARY DISSERTATION. 99 This, both in hysteria and hypochondriasis, weakens and inter- rupts the effect of the chalybeate. My chief object is to reduce the spirits to order, and to restore and strengthen their system. Now a single purge will undo in a (Lay the work of a week ; so that to pull down what I have built up, and to build up what I have pulled down, is just to do the work of a mounte- bank, deceiving both myself and my patient. Purging under a course of mineral chalybeates, I look upon as equally detrimental; not that no one has been cured even when cathartics, instead of being given at intervals, have been made a daily dose. I know all this ; but I also know, that such cases say more for the virtue of the iron than for the skill of the doctor. Without the purge the cure would have been speedier. 99. There are many diseases besides hysteria where the good effects of such repeating purging are doubtful ; or rather, where their bad effects are visible. True, indeed, it is that they free the bowels from impurities. They also extract somewhat of such noxious matters as may lodge in the blood. On the other hand, it is equally sure that in many cases those of weak constitutions, and tender infants they do harm. They bring a vast colluvies of humours into the intestines. These bring on unnatural ferments. Hence come swellings of the lower belly; and these increase just in proportion to the purging. Then it happens that the parts in question, in the want of their native heat, and under the overwhelming influence of the waters, become affected with wasting, and grow putrescent. This brings on those glandular swellings of the mesentery which are so truly the children of struma, and the vaunt- couriers of Death. Hence, in infants, I hold it safest, after a mere general purge and that a mild one to direct my treatment to the comfort of the blood. This may be done by means of sherry wine, either alone or with strengthening herbs steeped in it ; of which a few spoonfuls, according to the patient's age, may be given night and morning, and continued for some time. Again, as external applications easily penetrate the tender system of infants, it is Tiseful in case of abdominal swellings, whether scrofulous or rachitie, to rub in such liniments as may fortify the blood and bowels, and such as may also have the effect of destroying anv morbific taint. 100 EPISTOLARY DISSERTATION. R Leaves of common wormwood, lesser centaury, white horehound, germander, ground-pine, scordium, common calamint, feverfew, meadow-saxifrage, St. John's wort, golden-rod, wild thyme, mint, sage, rue, St. Benedict's thistle, pennyroyal, southernwood, chamomile, tansy, lily of the valley (all fresh gathered), of each a handful. Hog's lard, ftiv ; Mutton suet, Claret wine, aa tbij. Steep in an earthen pot over hot ashes for twelve hours. Boil to drive off the water. Strain, and make into an unguent. Rub with the same the belly and hypochondres, night and morning, for thirty or forty days running. Also the armpits on each side. 100. As to rachitic tumours, however, it must be remarked, that, in the case of infants, where they have arisen after a long attack of intermittent fevers (in which case they put on the appearance of true rickets), repeated purging is altogether indi- cated ; inasmuch as, previous to the use of the Peruvian bark, the fevers had become protracted, and had, moreover, deposited a sediment, the cause of the tumour, which nothing short of catharsis can remove. In true rickets such catharsis has no place ; a purge, or two, previous to the use of alteratives being all that is admissible. During the time that the liniment is used, wine should be taken in the manner aforesaid, or, better still, the patient may drink small beer in which a sufficient quantity of the above-named herbs (some or all) have been laid to soak. This is important. I have known many infants and children killed by repeated purging in cases where the belly has been EPISTOLARY DISSERTATION. 101 swollen the swelling itself having been, perhaps, the effect of the catharsis. But this by the way. 101. If any one object, that, without previous purging, iron filings in the intestines may do mischief, I answer that such mischief has yet to be observed by me. Indeed, it is much more likely that, by becoming invested with the mucus and the excre- mentitious matters of the alimentary canal, they should be got rid of at once, than that they should be moved about and dispersed by purgative medicines, without causing gripes and contortions. Nay more the particles themselves may become impacted in the coats of intestines, and permanently fixed therein. 102. During the administration of such chalybeates as are given for the sake of strengthening the blood and animal spirits, those remedies which are usually called hysterical should be given, not generally, but occasionally. And they should be given in the form which best suits the patient. When they can so be swallowed, the solid form is the best better than any decoction or infusion. So taken they better keep the spirits in their due place ; inasmuch as the substance itself affects the stomach with its flavour, and penetrates the body more effectually. 103. I will sum up by adding a few of the commoner formulae. They profess but little. Still they generally do what is wanted. Bleed from the right arm to eight ounces. R Of galbanum dissolved (and strained) in the tincture of castor, Jiij ; Tacamahacca, 5ij. Make into a plaster, and apply to the navel. Next morning begin a course of the following pills : R Pil. coch. maj., 9ij ; Castor (powdered), gr. ij ; Balsam of Peru, llt' v - Make into four pills, to be taken at five a.m. Sleep after taking them. Repeat two or three times, cither every or every other morning, ac- cording to their effect, and the way in which they are borne. R Water of black cherries, Rue-water, Compound bryony-water, iia ^lij ; Castor (tied up in knot, and hung in the bottle), 3ss; Crystalline sugar, q. s. Make into a julep; of which four or five spoonfuls arc to bo taken every time a fainting fit comes on. In case the tit be severe, add to the first dose xx drops of hartshorn. 102 EPISTOLARY DISSERTATION. 104. After the purging pills aforesaid the following should be used R Iron-filings, gr. viij ; Extract of wormwood, q. s. Make into two pills, to be taken the first thing in the morning, and to be repeated at five p.m., for thirty days. Wash down with a draught of wormwood wine. Or for daily use R Iron-filings, Extract of wormwood, aa ^iv. Mix, and keep for use. Take, at the same times as before, sixteen or twenty grains, in the form of three pills. Or, if the form of a bolus be preferable R Conserve of Roman wormwood, Conserve of orange-peel, aa 3J ; Candied angelica, Candied nutmeg, Venice treacle, aa ^ss ; Candied ginger, 3ij ; Syrup of oranges, q. s. Make into an electuary. R Of the electuary as above, 3iss ; Fine iron-filings, gr. viij ; Syrup of oranges, q. s. Make into a bolus, to be taken in the morning and at five p.m. Wash down with wine of wormwood. R Picked myrrh, Galbanum, aa 5iss ; Castor, gr. xv ; Balsam of Peru, q. s. Make each drachm into twelve pills, of which three are to be- taken every night. Wash down with three or four spoonfuls of the compound bryony-water ; continuing to do so during the whole course. If, however, these pills purge, which, on account of the gum contained in them, is often the case with systems easily acted on, the following may be substituted : R Castor, 5j ; Volatile salts of amber, 3ss ; Extract of rue, q. s. Make into twenty-four small pills, of which three must be taken every night. EPISTOLARY DISSERTATION. 103 105. Here I must observe that with many females, chaly- beates, whatever be their form, excite considerable disturbance; and that, not merely during the first days of their use, but throughout. In this case, we must not at once desist from employing them. By mixing a little laudanum in some hysterical water, giving it every night at bedtime, and continuing to do so, the system will be brought to bear them. 106. In mild cases, where the cure can be effected without taking steel internally, I hold it sufficient to bleed, and then to open the bowels for three or four days. After this, the afore- said hysterical pills may be taken, night and morning, for ten days. In light cases this method rarely fails. Sometimes, indeed, the pills, without either bleeding or purging, will effect a cure. 107. Another fact is of serious importance. Some females have so peculiar an idiosyncrasy, as to feel an absolute repugnance to all the so-called hysterical medicines the true and usual modes of relief in such a complaint. In this case, then, they do harm instead of good. Omit them therefore entirely. What says the divine old man, " With Nature against us, all is vain/' 1 So important is this idiosyncrasy, that if due respect be not paid to it, the patient may run a risk of dying ; a risk that occurs, under similar conditions, in other ailments besides hysteria. Of this I will give an instance. Certain females, suffering from the smallpox, are unable to take syrup of poppies without vertigo, vomiting, and other affections which, naturally, are the affections that syrup of poppies would allay. Even whilst I am writing this, a young lady of noble family, to whom on the sixth or seventh evening I gave syrup of poppies when she was ill of smallpox, exhibited the symptoms aforesaid ; the due inflammation of the pustules, meanwhile, being checked. Next day I gave laudanum instead ; when, to my great joy, the symptoms ceased, the face swelled properly, the mental and bodily anxiety departed, and the strength and spirits soon re- turned. This by the way. 108. Thus are cured hysterical complaints. Thus also the so-called female obstructions ; especially chlorosis, or green- sickness, and retention of the menses. Still if the blood be so 1 'ln'nn-if (it rurpcirroi'irrjc Ktvfii nfiirii. llijip. Lex., t. i, \i. 1. _ ( '-j 104 EPISTOLARY DISSERTATION. effete, and the spirits so atactic that iron will not avail to cure them, strong chalybeate waters must be resorted to, like those of Tunbridge, or others more recently discovered. The great quantity in which these waters can be taken, and the extent to which they approach Nature, determine them to mix with the blood more readily, and to subdue disease more effectually than any of the so-called noble preparations of art whatever the would-be chemists may say to the contrary. 109. This, however, must be observed. If, during drinking the waters, any ailment approaching the symptoms of hysteria supervene, they must be stopped, until its departure. As long as it lasts it checks the transit of the waters. Much as these same waters are less likely than even the mildest cathartics to agitate the humours and induce a disturbance of the animal spirits, they have still in so far as they are diuretic some- what of a tendency in that direction ; to say nothing about their liability to disturb the bowels. Now if even waters like these are sufficient, by agitating and disturbing the blood, to prevent their own proper transit through the system, how much more must purgatives be so ! and hoAV wrongly do those men practise who once or twice a week would give a cathartic along with a chalybeate ; nay, mix the two together. In chalybeates, then, as in other mineral waters, the operation is, by such means, checked rather than forwarded. 110. I will now venture an opinion that, although in such waters iron in its soluble principles is present, so that what we drink is neither more nor less than iron in a liquid form, the waters themselves are merely simple waters, except so far as they are impregnated by the minerals through which they pass. This will be clear if we only throw some horseshoe nails in a few gallons of common water. By afterwards adding powder of galls, tea-leaves, or the like, we shall find that the colour is just that of mineral waters with the same mixture. Provided, too, that they be taken in summer and in a healthy atmosphere, the artificial waters will have the same effect with the inartifi- cial or natural call them which you will. 111. Be this as it may, if the affection be too strong for chalybeates, the patient must have recourse to the hot sul- phurous waters, like those at Bath. These she must take inter- nally for three days running ; the next morning bathe in them, EPISTOLARY DISSERTATION. 105 and the day after that drink them again ; so going on, bathing and drinking, and drinking and bathing, for two whole months. In this, as in other matters, the cure must be continued not only until relief be felt, but until convalescence be complete. Otherwise a relapse will soon occur, and all the symptoms return. 112. Venice treacle, by itself, if taken often enough, is a great remedy in this disease, and not only in this but in many others arising from a defect of heat ; since for the purposes of concoction or digestion, it is the most potent remedy hitherto known distasteful as it is to many. 113. If the patient be not of a thin and bilious habit of body, sherry wine, in which there has been an infusion of gentian, angelica, wormwood, ccntaury, orange-peel, and other restora- tives, taken to the amount of some spoonfuls three times a day, promotes recovery. Indeed, a free draught of sherry at night has been very useful to many hysterical patients. The whole habit of the body has become more robust, and the females themselves have become fresh and lively, instead of pale and cachectic. 114. Peruvian bark is discovered to have wonderful power in strengthening the blood and spirits; and I have, myself, observed, both in hysteria and hypochondriasis, that a scruple taken night and morning for some weeks restores the system to health and strength. In no form, however, of hysterics, does it succeed better than in those attacks of spasms where the patient beats her breast with strains and struggles beyond the strength of a female. Still it must be owned, that bark in hysteria is less of a remedy than bark in ague. Here it works wonders ; and, when occasion requires, we give it to our wives and children. Nevertheless, Avith many persons it is in disgrace at present for being so sure a cure, just as it was in disgrace at first for being so new a one the common fate of both the best men and the best remedies. There is one touchstone by which we may try whether a man's disposition be good or bad. It is the one or the other in proportion as he shows joy or sorrow at any new benefit granted by the favour of the Deity. 115. If any of the aforesaid remedies disagree (as they may do in delicate and bilious constitutions), a milk dirt may be resorted to. Wonderful as it may seem to many, females who 106 EPISTOLARY DISSERTATION. have long struggled against hysteria, and have mocked all the efforts of medicine, have taken to an exclusively milk diet, and recovered. In what is called hysterical colic this has been the most remarkable. Here opiates alone give ease; and when opiates have become habitual, the pain returns as the effect wears off. The strangest part of the milk cure is, that milk being such a cold and crude aliment, should still be strength- ening and restorative. Yet the mystery ceases, if we remember that milk, being the simplest of nutriments, gives Nature least trouble in digesting it ; being, in this respect, unlike the more composite meats and beverages. That an equable crasis of the blood and spirits should follow a perfect concoction is only natural and necessary. Again the cause of hysteria is less the absolute debility of the spirits, than their debility in relation to the blood. The spirits of an infant may suit an infant's blood, but fall short of what are required for an adult. Weak and crude, then, as milk is, provided that the blood become tractable and tender also, all goes well. The spirits are equal to it. Nevertheless, there are those who, much as they would otherwise be benefited, can never get the full benefit from milk; so much does it, during the first days of its use, either coagu- late in the stomach, or depress the strength. 116. Of all remedies that I know, nothing so cherishes and strengthens the blood and spirits, as riding on horseback, long distances, every day. Here all the exercise falls upon the lower belly, and, in the lower belly lie all the excretories which Nature keeps up for eliminating the feculent lodgements of the blood. Now what weakness, or what perversion of function can with- stand the innumerable succussions of a day's riding and that in the open air ? Whose natural heat has so cooled down as not to boil afresh at such an excitement ? What lurking substance can be so unnatural, what juice so depraved, as not, under such exercise, to either return to the state that Nature requires, or else to be eliminated, dissipated, dispersed ? Surely, the blood thus continually shaken and tossed about, must needs take strength and vigour. Women, perhaps, who, from their sedentary life are liable (especially at first) to be injured, are the less fit of the two sexes for such regimen. For men it is pre-eminently healthy and restorative. EPISTOLARY DISSERTATION. 107 117. A friend of mine, in holy orders, a man of great judgment and erudition, after a course of study so long and excessive as to overwork his naturally great abilities, fell into hypochondriasis ; which lasted so long as to vitiate all the ferments of the body, and wholly destroy his digestion. He had more than once gone through the trouble of a course of chalybeates. Of mineral waters he had nearly exhausted the list. Purging he had tried along with them. So he had antiscorbutics, powdered shells, and the like sweeteners of the blood. At last, partly through the disease, partly through the medicines, both of which had been continued for some years, he was seized with colliqnative diarrhoea, which in a decline and in most other chronic diseases, where the digestive powers are wholly subverted, is the precursor of death. He consulted me ; when I saw at once that there was no room for medicines. These had been tried too long and too much in vain as well. I recommended riding on horseback ; at first in short rides, such as his health would allow. Had he been a man of a less acute judgment, he would never have been induced to try it. However, I asked him to persist in it until recovery. He in- creased the length of his exercise every day, until at last he took a journey rather than a ride. Indeed, like a traveller, he took no care of regular meals, nor yet of the weather. He just took them as they fell out. So he went on, until he got to twenty or thirty miles a day ; and finding himself, after a few days, much better, kept on for some months. Indeed, as he told me himself, he rode more than 1000 miles, by which time he had gained perfect health and vigour. 118. Riding is as good in a decline or in phthisis as in hypochondriasis. It has cured patients whom many medicines would have benefited as much as many words and no more. This, too, not only in mere cases of cough and weakness, but after wasting, night-sweats, and colliquative diarrhea have sig- nified the approach of death. " Ultima linea reruin." Indeed, deadly as phthisis is, killing two thirds of those who die of chronic diseases, it has a specific in riding, as truly as ague has in bark, or the venereal disease in mercury ; provided only that the journeys are long enough, and the beds at night 108 EPISTOLARY DISSERTATION. are well aired. Those, too, who have passed middle age, must keep it up longer than those below it. Besides horse exercise, driving in a carriage has had wonderful effects. 119. To return. This is the general method of cure for this disease, which arises from a weakened crasis of the blood. It finds place, however, only when the fit is not on. As often, however, as the paroxysm comes on, accompanied with one or more of those symptoms which, as aforesaid, will not brook delay and allow us to beat about the bush in restoring the blood and spirits, we must have recourse to those so-called hysterical medicines which are of strong and fetid odour, and which will remand back to their proper places the exorbitant and wandering spirits. These may be taken internally, snuffed up through the nose, or rubbed on the skin; and they are assafoetida, galbanum, castor, spirits of sal ammoniac, and other similar strong-smelling substances. 120. This is what I mean to say. Whatever has a fetid odour, whether natural or artificial, has this effect ; so that, unless I am mistaken, spirits of hartshorn, human blood,, urine, bones, and the like, all agree in having contracted from the fire in which they were prepared a certain strong-scented empy- reumatic odour, which is, as it were, annexed to their most intimate essences. The same is the case with the smoke from burnt hides, feathers, and the like animal substances. All agree in this. Whilst burning they emit a strong unpleasant smell ; which, if the heat be increased, and proper vessels for condensing it be applied, is converted into those liquors which are called volatile spirits, and which have properties wholly different from those of the substances that supply them, being, instead, the productions of the fire alone. Provided, too, that they be of animal origin, the properties of all are the same. 121. The next thing to be observed is, that if any intolerable pain in any part of the body, if any excessive vomiting, or any diarrhoea accompany the fit, laudanum must be resorted to. Laudanum alone can check these symptoms. Still, in allaying cither such pains or such vomiting, we must take care, that, unless the suffering exceed human patience, neither laudanum nor any other paregoric be used, except pre- ceded by the due evacuations. In the first place, there is often such a congestion of blood and humours (especially in females EPISTOLARY DISSERTATION. 109 of a sanguine and masculine habit), as to check the operation of even the strongest and the most repeated narcotics. This makes a previous bloodletting and catharsis necessary. \Vithout these a full dose will be useless. After them a small one will serve. Again I have been taught by manifold experience, that a female who, without the previous necessary evacuations, has gradually accustomed herself to laudanum, shall so find that, after its effects have gone off, the pain returns, and she becomes forced to return to it, and to persist in the use of it so long as to have all her natural functions impaired, and her digestion spoiled. Yet, I do not perceive, that laudanum immediately hurts either the brain or nerves, nor yet the animal faculties. 122. I judge then that evacuants should precede anodynes. Thus, with plethoric and masculine women a vein should be breathed, and the bowels opened, especially if it be some time since they last had a fit. If, however, the temperament be different (i. e. weak), and if there has been a fit frequently before, it is enough to wash out the stomach with a gallon (more or less) of milk and beer, followed by an emetic, and then to order a full dose of Venice treacle, or of the Orvietan electuary. This may be followed by a few spoonfuls of some pleasant- tasted spiritous liquor, with a few drops of liquid laudanum. 123. If, before the physician is called in, the patient have been sick already, and there is a fear lest by an emetic the spirits should be so far excited as to depress the patient's strength too much, laudanum must be given at once ; and the dose must be large enough, and repeated enough to meet, and more than meet, the symptoms. It must subdue them. 124. Two points must be noted. First when, after the due evacuations, we use laudanum, the dose must be so large, and so often repeated, as to leave no symptom unconquercd ; and the space between each must be such as to allow us to tell the effects of a first before we administer a second; a matter which I have treated more at large elsewhere. 1 Secondly when the laudanum is fairly begun with, there must be no disturbance, no evacuation. A mere sugar and milk clyster may undo all that the paregoric has done; so that a relapse shall take place, and the pain and vomiting be brought back . 1 Epist i, R, 9. 110 EPISTOLARY DISSERTATION. 125. However much the preceding pains may demand au anodyne, there is another symptom which requires one still more. Sometimes the peristaltic motion is so reversed, and the ingesta which were meant for the lower bowels are so forced upwards, that, before any good can be done by the narcotic, it is thrown up by vomiting. In such a case, the opiate must be given, as occasion requires, after each vomit, and it must be given in a solid form ; if in the liquid, in as little of the vehicle as possible, so as to be too slight in quantity to do more than just soak into the stomach, and not be brought up. Such a vehicle is a spoonful of strong cinnamon- water or the like. The patient, after the anodyne, must be advised to keep herself perfectly quiet, and, especially not to Stir her head. The least movement of this part brings on vomiting, and does away with all the benefits of all the medi- cines that have been swallowed. Moreover, even when the vomiting has been so subdued as to cease, it is well to continue the anodyne, night and morning, for a few days ; so to check it wholly, and to guard against a relapse. The same applies to a narcotic given after an hysterical attack of pain, or after diarrhoea. 126. This cures pain, and vomiting when symptomatic ; phenomena, which so often wear the garb of other diseases that they deceive the practitioner oftener than anything that requires his judgment. For instance in that sort of hysterical affection which has been described as simulating a nephritic attack, how close is the resemblance, and how much are the symptoms on a level ! the same pains, in the same parts, and vomiting in both cases. Yet how different the treatment, and how little the parity of the methods ! What helps in the one, hurts the other. For stone, or gravel, creating pain, wearing away the substance of the kidney, and causing vomiting from the consent of the parts, nothing is so beneficial as the full and frequent revulsion of the antecedent cause by means of bleeding ; whereby the passages through which the calculus is excluded are both enlarged and loosened to which end emollient clysters, frequently repeated, are subservient. To these may be added diuretic and lithotriptic medicines. If, however, instead of a stone impacted in the kidney, there be but an overflow of the spirits to those organs, in that case it EPISTOLARY DISSERTATION. Ill is paregorics only that are indicated; whilst it is enemata which, after the first evacuations, can never be given harm- lessly. To overlook this difference is to play with the health of your miserable patient, and to jeopardize her precarious existence. 127. The same may be said of that hysteric affection which simulates bilious colic, or the iliac passion. Assuming that this latter be the disease (different as it is from hysteria), assuming, too, that it has arisen from an acrid humour excreted into the bowels through the mouths of the mesenteric arteries (a mis- take into which the intolerable pain as well as the green colour of the fecal aud vomited matters might, equally, lead the in- experienced physician,) what method would be so suitable, as that wherein we strove to temper the acrimony of the humours by means of refrigerant aud thickening remedies? And what would be more natural than to eliminate the humours from the intestines by the frequent use of enemata and cathartics ? Amongst which last what would be more adapted to the complete eradication of the morbific matter than calomel and scammony? Yet how dangerous would all this be, if, instead of colic, the disease were hysteria or hypochondriasis ? In each of these diseases, after the preliminary general evacuations, dedicated to the clearance of such putrescent masses as the ataxia afore- said had engendered, nothing remains but the assuagement of the tumultuous spirits, until, by the help of those anodynes for which the evacuations paved the way, the symptoms wholly disappear. These having gone, we may then order iron, or any other medicine which, by invigorating the blood, may wholly extirpate the malady. It is no wish of mine to recount the innumerable calamities which have befallen females when hysteria has been treated as bilious colic. All I say is that the evacuations fit for the latter complaint arc hurtful rather than helpful in the former. They promote the irritation of the spirits; which is the true cause of the disease. Then the complaint becomes prolonged to a period of some months ; when a metastasis may take place to the brain, end in spasm, and kill the patient. This is most likely when, on the strength of the green colour of the fieces and vomitings, remaining un- altered by a repetition of purges, an emetic has been ordered. In one word the greatest caution must be used in the diagnosis 112 EPISTOLARY DISSERTATION. of hysteria, lest the symptoms be confounded with those of some other disease like it. 128. Here I must add that, besides the errors enumerated which may endanger the lives of hysterical females, there are others which may become fatal from overlooking the extent to which a disease which, in and of itself, is not dangerous may, either from the time of its occurrence, or from the violence of its sequela?, become deadly. Thus a female of a delicate frame may give birth to an infant, and all things go well ; when the midwife (either from want of skill, or for the sake of display- ing her management) may persuade her to get up a few days after delivery, and to leave her bed for awhile. The patient obeys ; and on the first movement of her body is seized with an hysterical affection. The lochia at first diminish, then cease ; and the series of symptoms that follows, unless checked by the interference of medical skill, soon proves fatal. Or a frenzy may set in, cause spasm, become day by day worse, and then cause death. Or a frenzy may be escaped ; whilst a low kind of insanity, in its stead, may continue during the remainder of life. Sometimes this suppression of the lochia may bring on fever ; and this may become of the character of the prevailing epidemic, or at least be allied to it in origin, Lastly, the hys- terical affections that checked the lochia may grow worse ; even as if the suppressed lochia had caused the hysterical affections. 129. I have long thought, that of all the deaths that occur in childbed, less than a tenth (speaking within bounds) origi- nate in either a deficiency of the necessary strength, or from the labour-pains. The most come from getting out of bed too soon, which produces hysteria and checks the lochia ; a sup- pression which brings on a whole train of unavoidable bad symptoms. Hence, all that I can persuade, I recommend to keep the bed till the tenth day ; especially if they are, other- wise, subject to what is called the vapours, or are weak-bodied. Besides the degree to which the rest and quiet ensure them against the well-known perils of their condition, the uninter- rupted warmth refreshes the spirits which the previous pains, and the customary evacuations, have broken and depressed. Moreover, it helps Nature, and digests and clears off all those crudities which had accumulated during pregnancy. 130. If, however, from any such error, any of the aforesaid EPISTOLARY DISSERTATION. 113 symptoms arise, the curative indications are to allay the restless and unquiet movement of the spirits, and to bring on the lochia afresh, the suppression of these being the proximate and immediate cause of the mischief. Still we must not be over- pertinacious in our endeavours ; so that, if the remedies which are usually successful, fail, we should hold our hands. Strong remedies are out of place, whilst the broken and prostrate strength of women in childbirth forbids the continued use of the milder ones. For instance when the lochia stop, the patient must be put back to bed forthwith, an hysterical plaster must be laid on her navel, and the following electuary must be given next morning : R Conserve of Roman wormwood, Conserve of rue, aa 3] ; Myrrh lozenges, 51) ; Castor, English saffron, Sal volatile, Sal ammoniac Assafcetida, aa 533 ; Syrup of the five roots, q. s. Make into an electuary ; of which take a portion about the size of a nutmeg, every three hours. Wash down with four or five spoonfuls of the following julep : \\ Rue-water, Compound bryony-water, Sugarcandy, q. s. Mix, and make into a julep. These, if given immediately after the suppression, generally effect their purpose. If not, and if, when the whole quantity has been taken, it still continue, laudanum (for once at least) is to be resorted to : since laudanum, although, in and of itself, astringent, checks the perturbation of the spirits, this pertur- bation being the cause of the lochia ceasing. Hence, when emmenagogues have been ineffectual, laudanum has restored them. A combination, however, is best, i. c. of narcotics with hysterical remedies, and with emmenagogues. Thus, fourteen drops of liquid laudanum in the compound bryony-water, or, else, a grain and a half of the solid opium made up, with half a scruple of assafoetida, into two pills. 131. If this fail, we must take an arrow from another 11. 8 114 EPISTOLARY DISSERTATION. quiver not repeat the opium, as would and should be done in other cases ; since repeated paregorics so effectually check the lochia that they can never be brought back again. Hence, after waiting awhile, in order to ascertain what has, or has not, been done, we should go back again to a conjunction of hyste- rical and emmenagogue medicines, and then to the sugar-and- milk clyster. To the last, however, the observation that applied to the opium applies also; viz. that failing the first, no good will come of a second. One gently solicits the humours, and cause the flow desired. More than one diverts them elsewhere. 132. This being done (and it must be done gently), the physician should wait, looking to Time as his best ally. Each day puts matters more out of danger ; and, when the twentieth is past, all is safe. Then, when the disease (whatever it may have been) has given the patient a fair respite, and when she has regained a share of strength, that method will be borne which is best fitted for warding off the symptoms which are the sequels of the suppression of the lochia ; since, the obstinate repetition of remedies, when no good whatever has been done by those that preceded, may increase not only the disease itself, but the perturbation of spirits upon which the disease depends. This I would have carefully noted. 133. A married lady, of equal birth and manners, called me in immediately after delivery hysteria had caused a total sup- pression of the lochia. I tried to bring them on again, by the aforesaid medicines but in vain. The hysteria defied every- thing. Seeing, then, that I could only provide for her safety by leaving her to the prince and pattern of physicians Time I did nothing, a method that answered until the fourteenth day ; inasmuch as, although I saw her every day, I never saw her growing worse. Now, however, her female attendants, whom I had hardly restrained from effecting an injury under the guise of attention, persuaded her husband to lose no time in getting her bled from the right foot. This was no sooner done than the hysteria returned, which was followed, a few hours after, by spasms, which were followed in their turn by relief the relief of death. 134. To speak the truth, I have long been one of those who think, that, not only in the aforesaid puerperal complaints, but in all acute diseases, whenever I find that, from the medicine EPISTOLARY DISSERTATION. 11.-) which I have thought fit to use, I am unable to give the patient reason to expect any definite benefit, I do no more than my duty as an honest and conscientious physician, when I just do nothing at all simply visiting the patient from day to day, to see that he be no worse to-day than he was yesterday, nor yet likely to become worse by to-morrow. If, however, on the contrary, I try remedies whose efficacy is equivocal, there will be as much danger in the experiment as ever there was in the disease ; the perils being just double lo what they would have been otherwise, and the chances of escaping them just half. However little, in the first instance, there be either sign or symptom of incipient convalescence, I am well assured that it is not in the nature of any acute disease to continue for any lengthened period. Hence, every day does one of two things it either adds to the safety of the patient, or else gives the physi- cian an opportunity of discovering what means he has more certain of destroying the disease than his previous ones. This, which applies to all acute diseases, applies particularly to the puerperal. Here slight errors create fatal dangers. Here, too, we have a natural evacuation which we cannot regulate, and which must not stop. 135. Hysterical affections, due to causes other than the primary one of natural debility of the spirits, may occur. In- deed, the cause of vapours may be adventitious. Now of all such, the most frequent is an immoderate menstrual flux whether during childbed or not. Of these, the former comes on during the first few days after delivery, especially if it have been of the laborious kind, and the train of hysterical symptoms which follow it is a long one. Just, however, as it comes on during such certain few days only, so, also, it departs speedily. Diet of the more thickening sort easily dispels it. To this may be added the following drink : R Plantain-water, Red wine, iiii Oj. Mix, and boil down to two thirds. Sweeten with a sufficiency of the finest white sugar. Take of this, when cool, half a pint once or twice a day. In the meanwhile one of the milder hysterical juleps may be taken occasionally, and the following plug be applied to the nostrils : 116 EPISTOLARY DISSERTATION. R Galbanum, Assafcetida, aa 5ij ; Castor, 5iss ; Volatile salt of amber, 5ss ; Ur R Spirits of the ammonia, 5ij. To be smelt frequently. 136. In respect to the second kind, that which is inde- pendent of childbed, it may occur at any time. It generally, however, comes on a little before the time when the menses would cease of themselves ; i. e. about 45, when they began early, 50 when late. Just as a candle, before it goes out, emits a brighter flame than usual, so may the courses, before their final disappearance, break out over-abundantly, and by the loss of blood throw the unfortunate patients into paroxysms of hysteria. Here, although hysterical remedies, both external and internal, may occasionally be resorted to (provided always that they be not of a sort so strong as to provoke a fresh flow), the whole treatment turns upon checking the menstruation, which must be done after the following method. 137. Bleed to eight ounces. Next morning give the common purgative potion. Repeat this every third day, twice. Every night, throughout the disease, give an ounce of syrup of poppy as a paregoric. R Conserve of dried rose-leaves, Jij ; Lozenges of terra Lemnia, 5iss ; Pomegranate rind, Prepared red coral, aa 3ij ; Bloodstone, Dragon's blood, Bole armeniac, aa 9j ; Syrup of coral, q. s. Make into an electuary; of which take a portion, the size of a large nutmeg, every morning, and at five p.m. Wash down with six spoonfuls of the following julep : R Water of oak-buds, Plantain-water, aa 5iij ; Cinnamon-w r ater with barley, Syrup of dried roses, aa ^j ; Spirits of vitriol (to flavour), q. s. Mix. R Plantain-leaves, Nettle-leaves, aa q. s. Bruise, together, in a marble mortar. Squeeze out and clarify the juice. Cool. Take six spoonfuls three or four times a day. EPISTOLARY DISSERTATION. 117 After the first purge apply the following plaster to the lumbar region : R Eiuplastrutn diapalmae, Emplastrum ad herniaui (equal parts). Mix. Spread upon a leather, and make into a plaster. 138. The diet must be cool and thickening. Once or twice a day a draught of claret is allowed. Although, as being likely to excite the ebullition, it may be prejudicial, it still has the good effect of restoring strength. This method, good for females affected as aforesaid, is also good for females likely to miscarry ; except that, here, the purges and juices are omitted. 139. Another cause (though a rare one) of hysterical affections is this. After a laborious birth there may be a procidentia of the womb. This brings in its train a long catalogue of ills. Still it is easily and quickly cured. H Oak-bark, Jij. Boil in four pints of spring-water, down to two. Towards the end, add Pomegranate-bark (bruised), 3} ; Red roses, , Pomegranate-flowers, aa two handfuls. Add half a pint of red wine. Strain, and keep as a fomentation, to be applied to the parts affected, on a woollen rag, every morning two hours before getting out of bed, and every night at bedtime, until the symptoms have wholly gone. But more than enough has been said on these points. J40. You have now, most courteous Sir, the sum of my observations hitherto made upon both the history and the cure of this disease. It only remains that, for any casual errors, in the way of imperfect description, I may express a hope to find your pardon ; also that you may take in good part a work which lias been composed with the view of returning my best thanks for the approval with which you have not disdained to visit my other efforts such as they were. Approval of this sort has so little been my lot, that, either I have done nothing to deserve it, or else, the men who have been sufficiently favoured by Nature to have sufficient candour to show gratitude, are " vix totidem quot Thebaiuiii porta:, vel divitis ostia Nili."' 1 Juvenal, Sut. .\iii, 20. [(I.] 118 EPISTOLARY DISSERTATION. Notwithstanding this, I continue, and will continue, to learn and to promote, to the best of my powers, the methods for the treatment of diseases, and to instruct others (if such they be) who have less skill in practice than myself. Meanwhile, my fame is in the hands of others. I have weighed in a nice and scrupulous balance, whether it be better to serve men, or to be praised by them, and I prefer the former. It does more to tranquillize the mind ; whereas fame, and the breath of popular applause, is but a bubble, a feather, and a dream. Such wealth as such fame gives, those who have scraped it together, and those who value it highly, are fully free to enjoy , only let them remember, that the mechanical arts (and sometimes the meanest of them) bring greater gains, and make richer heirs. For each to look to himself alone, is what the brute beast can do, and what they do to the best of their power ; without, however, having a nature capable of performing acts of virtue and rectitude of their own free will. And like to a brute beast is the man who has ends and aims other than the advantage of his fellow-creatures . Commend me to our common excellent friend the learned and sagacious Dr. Kendrick. It is he Avhom I must thank for being informed of your friendly spirit towards me, and who first brought me the welcome news of your good opinion. I will do my best to requite his service, and to repay his good offices with others like them, remaining, most excellent Sir, Your bouuden and most respectful servant, THOS. SYDENHAM. LONDON; Jan. 20, 1681-2. A TREATISE GOUT, AND DROPSY, TO THE MOST LEARNED DR. THOMAS SHORT, M.D., P1SLLOW Of THE COLLEGE OF PHYSICIANS, LONDON. MOST COURTEOUS SIR, I send you a short tract upon Gout and Dropsy, instead of the thicker volume which, in my own mind, I had deter- mined on : viz. a history of such chronic diseases as my practice has most especially met with. By applying my mind, however, to its utmost, and by bringing all my powers of thought on the subject, I brought on a fit of gout such as I had never before suffered from ; so that the fact itself warned me to lay aside, even against my own will, such lucubrations, and to take care of myself; well satisfied with having, in some measure, dealt with these two diseases. Whenever I returned to my studies the gout returned to me. Be pleased, then, to receive this little work, such as it is, which I dedicate to you for two more particular reasons ; firstly, because, although others de- spised the observations which 1 previously published, you had no hesitation in attributing to them some utility and that not only before my face but behind my back ; secondly, because our mutual intercourse and our habits of consulting together for the benefit of our patients, have led me to discover that you possess a genius pre-eminently made for the practice of medi- cine, and that, illustrious as you are in learning of all sorts, your proper nature is to prefer the niceties which arise out of practice to vain and empty speculations ; matters which, except in the rare cases where they meet in the same person, are as far apart as the serious wisdom of men and the playthings of children. It is this sagacity of yours joined to the opportunity which a vast amount of cases for the confirmation of your ex- periments supplies, that has raised you to the height of our Art; a place which the courtesy of your manners will retain. If this dissertation escape blame both from you and those other few (but tried and honorable men) whom 1 call my friends, 1 shall 122 ON GOUT. care little for the others. They are hostile to me, simply be- cause what / think of diseases and their cures differs from what they think. It could not be otherwise. It is my nature to think where others read ; to ask less whether the world agrees with me than whether I agree with the truth; and to hold cheap the rumour and applause of the multitude. And what is it, indeed ? is it any great thing for a man to do his duty as a good citizen, and to serve the public to his own private loss, and to take no glory for doing so ? If I take a right measure of the matter, I am now so old that to study my own glory is to study the glory of a nonentity. What will it help me, after my death, for the eight letters which make the name SYDENHAM to pass from mouth to mouth amongst men who can no more form an idea of what I was than I of what they will be ; of men who will know none of those (then dead and gone) of the generation before them ; of men who, from the inconstancy and vicissitude of all things human, will be changed in manners and changed in language ! Why should I be anxious about the judgment of others ? If any exertion of mine in promoting the knowledge of diseases and their cure has deserved praise, it is praise that I shall not long enjoy. On the other hand, if there are those who disapprove of my writings, I am hardly likely to compose fresh ones. My health prevents me from troubling the world much more with medical treatises. In the one I am now publishing my hand trembles too much to hold the pen ; and I gratefully thank Mr. John Drake, Bachelor of Medicine of Christ's College Cambridge, my good and kind friend, for the help he has lent me ; a man whom the natural candour of his manners and the integrity of his life have made a valued friend, and whom Nature and education will equally render the benefactor of his kind, when he shall come to prac- tise that Art which he so well understands. As to the rest I entreat you, Most Illustrious Sir, to pardon me in case I have been troublesome to you in these my tokens of respect referring them only, to what they really arise from, the well-deserved and sincere admiration of Your most devoted and humble servant, THOMAS SYDENHAM. LONDON ; My 21, ON GOUT. 1. EITHER men will think that the nature of gout is wholly mysterious aud incomprehensible, or that a man like myself, who has suffered from it thirty-four years, must be of a slow and sluggish disposition not to have discovered something respecting the nature and treatment of a disease so peculiarly his own. Be this as it may, I will give a bona fide account of what I know. The difficulties and refinements relating to the disease itself, and the method of its cure, I will leave for Time, the guide to truth, to clear up and explain. 2. Gout attacks such old men as, after passing the best part of their life in ease and comfort, indulging freely ity high living, wine, and other generous drinks, at length, from inactivity, the usual attendant of advanced life, have left off altogether the bodily exercises of their youth. Such men have generally large heads, are of a full, humid, and lax habit, and possess a luxurious and vigorous constitution, with excellent vital stamina. 3. Not that gout attacks these only. Sometimes it invades the spare and thin. Sometimes it will not wait for the advance of age. Sometimes even the prime of life is liable to it. This happens most where there is an unhappy hereditary tendency ; or, even where (without such being the case) the patient has over- indulged in premature venery. The omission, too, of any cus- tomary violent exercise brings it on. So, also, does the sudden change from over-hearty diet in the way of meats and drinks, to a low regimen and thin potations. 4. When it attacks a person worn out by old age, it is neither so severe as it is when it takes hold of a young man, nor has it such stated periods. They say it is because generally life passes away before it comes to a climax, and also because the native heat and vigour of the body being diminished, it breaks out upon the joints both less regularly and less vehemently. 124 ON GOUT. But if it attacks any person late in life, although it neither fix upon its seat so regularly, nor handle him so severely, it still takes its ground by degrees, so as to lay down a law for itself and choose a type. This it does both in respect to the time of the year in which it intends to open the campaign, and in respect to the duration of the fit. Uncertain as are its periods, slight as may be the torture for a fe\v days, irregular as may be its invasion and retreat, it is still gout, and its later attacks are worse than its earlier. 5. Concerning this disease, in its most regular and typical state, I will first discourse ; afterwards I will note its more irre- gular and uncertain phenomena. These occur when the un- seasonable use of preposterous medicines has thrown it down from its original status. Also Avhen the weakness and languor of the patient prevent it from rising to its proper and genuine symptoms. As often as gout is regular, it comes on thus. Towards the end of January or the beginning of February, sud- denly and without any premonitory feelings, the disease breaks out. Its only forerunner is indigestion and crudity of the stomach, of which the patient labours some weeks before. His body feels swollen, heavy, and windy symptoms which increase until the fit breaks out. This is preceded a few days by torpor and a feeling of flatus along the legs and thighs. Besides this, there is a spasmodic affection, Avhilst the day before the fit the appetite is unnaturally hearty. The victim goes to bed and sleeps in good health. About two o'clock in the morning lie is awakened by a severe pain in the great toe ; more rarely in the heel, ankle, or instep. This pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them. Then follow chills and shivers, and a little fever. The pain, which was at first moderate, becomes more intense. With its intensity the chills and shivers increase. After a time this comes to its height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. Now it is a violent stretching and tearing of the ligaments now it is a gnawing pain, and now a pressure and tightning. So exquisite and lively meanwhile is the feeling of the part affected, that it can- not bear the weight of the bedclothes nor the jar of a person walking in the room. The night is passed in torture, sleep- lessness, turning of the part affected, and perpetual change of ON GOUT. 125 posture ; the tossing about of the body being as incessant as the pain of the tortured joint, and being worse as the fit comes on. Hence the vain efforts, by change of posture, both in the body and the limb affected, to obtain an abatement of the pain. This comes only towards the morning of the next day, such time being necessary for the moderate digestion of the peccant matter. The patient has a sudden and slight respite, which he falsely attributes to the last change of position. A gentle perspi- ration is succeeded by sleep. He wakes freer from pain, and finds the part recently swollen. Up to this time, the only visible swelling had been that of the veins of the affected joint. Next day (perhaps for the next two or three days), if the generation of the gouty matter have been abundant, the part affected is painful, getting worse towards evening and better towards morn- ing. A few days after, the other foot swells, and suffers the same pains. The pain in the foot second attacked regulates the state of the one first attacked. The more it is violent in the one, the more perfect is the abatement of suffering, and the return of strength in the other. Nevertheless, it brings on the same affliction here as it had brought on m the other foot, and that the same in duration and intensity. Sometimes, during the first days of the disease, the peccant matter is so exuberant, that one foot is insufficient for its discharge. It then attacks both, and that with equal violence. Generally, however, it takes the feet in succession. After it has attacked each foot, the fits become irregular, both as to the time of their accession and duration. One thing, however, is constant the pain increases at night and remits in the morning. Now a series of lesser fits like these constitute a true attack of gout long or short, according to the age of the patient. To suppose that an attack two or three months in length is all one fit is erroneous. It is rather a series of minor fits. Of these the latter is milder than the former, so that the peccant matter is discharged by degrees, and recovery follows. In strong con- stitutions, where the previous attacks have been few, a fortnight is the length of an attack. With age and impaired habits gout may last two months. With very advanced age, and in con- stitutions very much broken down by previous gout, the disease will hang on till the summer is far advanced. For the first fourteen days the urine is high-coloured, has a red sediment, 126 ON GOUT. and is loaded with gravel. Its amount is less than a third of what the patient drinks. During the same period the bowels are confined. Want of appetite, general chills towards evening, heaviness, and a troublesome feeling at the parts affected, attend the fit throughout. As the fit goes off, the foot itches intole- rably, most between the toes ; the cuticle scales off, and the feet desquamate, as if venomed. The disease being disposed of, the vigour and appetite of the patient return, and this in proportion to the violence of the last fits. In the same proportion the next fit either comes on or keeps off. Where one attack has been sharp, the next will take place that time next year not earlier. 6. This is gout with its true and regular phenomena. When, however, either undue treatment or the prolonged delay of the disease has converted the whole body into a focus for the pec- cant matter, and when Nature is incompetent to its elimination, its course is different. The true seat of the disease is the foot so much so, that when it appears elsewhere its character is changed, or else the constitution is weak. Then, however, it attacks the hands, wrists, elbows, knees, and other parts, the pains being as the pains of the feet. Sometimes it distorts the fingers, then they look like a bunch of parsnips, and become stiffened and immoveable. This is from the deposit of chalk- stone concretions about the ligaments of the knuckles. The effect of these is to destroy the skin and cuticle. Then you have chalk-stones like crabs' eyes exposed to view, and you may turn them out with a needle. Sometimes the morbific matter fixes on the elbows, and raises a whitish tumour almost as large as an egg, which gradually grows red and inflamed. Sometimes the thigh feels as if a weight were attached to it, without how- ever any notable pain. It descends however to the knee, and then the pain is intense. It checks all motion, nails the pa- tient down to his bed, and will hardly allow him to change his posture a hair's breadth. Whenever, on account of the rest- lessness so usual in the disease, or from any urgent necessity, the patient has to be moved, the greatest caution is necessary. The least contrary movement causes pain, which is tolerable only in proportion as it is momentary. This movement is one of the great troubles in gout, since, with perfect quiet, the agony is just tolerable. 7. Up to a certain time, the gout comes on towards the end ON GOUT. 127 of winter, lasts for two or three months, and retires regularly. Afterwards, however, it lasts throughout the whole year except only the hottest months of the summer. Furthermore, the longer the attack, in general the longer is each individual fit. Instead of a day or two, they last a fortnight. Instead of the feet, they attack any joint indifferently. Lastly, on the first or second day after, the patient, besides the pain, has loss of appetite and general discomfort. 8. Until the disease has reached a certain degree of severity, the patient enjoys long intervals between the fits, and during these intervals, good health. Eventually, however, the limbs become drawn up and contracted, so that although a patient may just be able to stand, or even to walk, his walk is so lame and painful as to be little better than a stand-still. The more, too, the patient strives to walk, under the idea of strengthening his feet, and thereby rendering them less liable to the disease, the more likely is the peccant matter, which has never yet been fully discharged, to be thrown upon the inward parts. Herein is great danger. Nevertheless, although it cannot be freely discharged upon the feet, the feet are still painful more or less. 9. Other symptoms arise piles amongst others. Also indi- gestion, with rancid tastes in the mouth, whenever anything indigestible has been swallowed. The appetite fails, so does the whole system. The patient has no enjoyment of life. The urine, no longer high-coloured, is pale and copious, like the urine of diabetes. The back and other parts itch, most at bedtime. 10. When the disease is confirmed, the ligaments of the ankle-bones feel as if wrenched or squeezed by a strong hand, when the patient stretches himself of a morning. At times, without any stretching at all, there is this pain, and just as the patient is going to sleep, he feels as if the ankle-bone were suddenly crushed by a heavy blow, and he awakes with a cry. The tendons of the muscles of the ankle arc seized with a pain so intense, that if it were permanent it would wear out human patience. 11. After many dreadful torments, when death is about to relieve the patient, the fits become milder. Partly because nature is oppressed by the peccant matter, and partly because old age is ill able to throw it vigorously and regularly upon the 128 ON GOUT. extremities. Then instead of the usual pain, there is uneasiness, pain in the stomach, weariness, and sometimes a tendency to diarrhoea. These symptoms ease the pain. The pain abates these symptoms. So that the pain and discomfort alternate, and the fit is prolonged. When gout has gone on for many years, the fits grow easier, and the patient is worn out by weak- ness rather than by pain. The worst pain he now suffers is not a tithe of what he suffered when in full health. Nevertheless, the severity of the earlier disease was made good by the length of the intermissions and the full recovery during the interval. The pain was the sharp remedy of Nature, and the worse the pain the shorter the fit. The shorter the fit the longer and more complete the intermission. 12. Pain, lameness, and the long list of enumerated sym- ptoms are not all. Gout produces calculus in the kidney. This may arise from the patient lying so long on his back, or it may arise from the secreting organs having omitted their functions so long. Lastly, the calculus itself may be part and parcel of the morbific matter. Be this as it may, the patient has fre- quently to entertain the painful speculation as to whether gout or stone be the worst disease. Sometimes the stone, in passing from the kidneys to the pelvis, and from the pelvis through the ureters to the bladder, kills the patient, without waiting for the gout. 13. The body is not the only sufferer, and the dependent con- dition of the patient is not his worst misfortune. The mind suffers with the body ; and which suffers most it is hard to say. So much do the mind and reason lose energy, as energy is lost by the body, so susceptible and vacillating is the temper, such a trouble is the patient to others as well as to himself, that a fit of gout is a fit of bad temper. To fear, to anxiety, and to other passions, the gouty patient is the continual victim, whilst as the disease departs the mind regains tranquillity. 14: Lastly and this is the sad catastrophe the peccant matter lodges in the viscera, involves their structure, impairs the organs of secretion, leaves the blood stagnant, thick, and feculent, prevents the discharge of the gouty matter on the ex- tremities, makes life worse than death, and finally brings in death as a relief. 15. For humble individuals like myself, there is one poor ON GOUT. 129 comfort, which is this, viz. that gout, unlike any other disease, kills more rich men than poor, more wise men than simple. Great kings, emperors, generals, admirals, and philosophers have all died of gout. Hereby Nature shows her impartiality : since those whom she favours in one way she afflicts in another a mixture of good and evil pre-eminently adapted to our frail mortality : " .... nihil est ab omni Parte beatum." 16. Gout attacks women but rarely, and then chiefly the aged and the masculine. Where you have the symptoms of gout in slender females, they are really the symptoms of hysteria, or else of rheiimatism imperfectly eliminated. Neither have I seen gouty minors or gouty children. The most I have observed has been a slight foreshadowing of a future attack, and this has been in the younger branches of gouty families. Here ends the history of the disease. 17. The more closely I have thought upon gout, the more I have referred it to indigestion, or to the impaired concoction of matters, both in the parts and the juices of the body. Gouty patients are, generally, either old men, or men who have so worn themselves out in youth as to have brought on a prema- ture old age of such dissolute habits none being more common than the premature and excessive indulgence in venery, and the like exhausting passions. Add to this the intermission or the sudden abandonment of those exercises to which from their youth upwards they had been accustomed. Whilst these were kept up the blood was invigorated, and the tone of the body rendered firm and steady. When however they were dropped, the animal spirits gave way, the frame lost tone, and the assi- milation became imperfect. Hence the recrementitious portion of the juices of the body, which had hitherto been cleared off by the exercise in question, accumulated in the vessels and sup- plied the germ of the disease. Sometimes also serious study and prolonged meditation have increased the evil. This they have done by diverting the volatile spirits from their proper function of assimilation. 1H. Add to this that great eaters are liable to gout; and, of these, the costive more especially. Eating as they used to cat when in full exercise, their digestion is naturally impaired. n. 9 130 ON GOUT. Even in these cases simple gluttony, and the free use of food, although common incentives, by no means so frequently pave the way for gout as reckless and inordinate drinking. This annihilates the ferments due to the different digestions, it throws down the digestions themselves, and through the over- abundance of adventitious vapours subdues and disperses the natural spirits. Then at one and the same time the energy of the spirits which are the instruments of digestion is dimi- nished. Then also a vast mass of humours oppresses the blood. Then, too, the different concoctions are imperfectly performed. Then the respective viscera are overworked, and then the spirits, which have long been giving way, are prostrated. If it were not so, if it were a simple weakness of the spirits, children and women, and the victims of long illnesses would be equally gouty. On the contrary, however, it is the hearty and robust. These it attacks only during the decline of their heat and natural spirits. When this takes place a congestion of the humours supervenes. From the two together the due concoctions are vitiated and perverted. 19. Moreover, as all the aforesaid causes promote indigestion, so, also, do most of them promote a laxity of the habit and muscles, and this opens a gate to such crude and undigested humours as force their way towards the surface. AVhen these have lurked so long in the blood as to have increased in bulk, and to have taken on a vicious disposition, they acquire a putrescent heat ; and when Nature can no longer regulate them, they break out, fall upon the joints, and excite exquisite pain, heat, and acridity in the ligaments and membranes which cover the bones. These being shaken and weakened by age or intemperance give way. Hence a fit of gout takes place sooner or later, according to circumstances. 20. In respect to the treatment, if we look to the humours themselves, and the indigestion from which they arise, it seems at first that we have to evacuate the aforesaid humours, and to guard against their increase by strengthening the concoctions; which is only what is to be done in all humoral complaints. In gout, however, it seems as if it were the prerogative of Nature to exterminate the peccant matter after her own fashion, to deposit it in the joints, and afterwards to void it by insensible perspiration. In gout, too, but three methods have been pro- ON GOUT. MI posed for the ejection of the causa continens bleeding, purging, sweating. Now none of these succeed. 21. In the first place bleeding, however much it may pro- raise great things, both in the evacuation of those humours which already have attacked the joints, and those which are ready to attack them, is still clearly contrary to that indication which is required by the antecedent cause. This is indigestion arising from the deprivation and defect of the spirits, a deprivation and defect which bloodletting increases. Hence it is not to be ap- plied either to ease a fit, or to guard against one, especially with old people, not even though the blood be that of pleurisy and rheumatism, diseases wherein bleeding does so much good ; inasmuch as, if blood be taken during an intermission, however long after a fit, there is danger lest the agitation of the blood and humours bring on a fresh one, worse than the one that went before it. This is because the strength and vigour of the blood, that might serve to get rid of the peccant matter that supplies the disease, are weakened. If, on the other hand, a vein be opened soon after a fit, there is great risk lest Nature, whilst the blood is still weak, be so broken down as to open the door for a dropsy. Nevertheless, if the patient be young and have drunk hard, blood may be drawn at the beginning of the fit. If, however, it be continued during the following fits, gout will take up its quarters even in a young subject, and its empire will be no government, but a tyranny. 22. Then as to any catharsis either above or below, we must remember, that it is the inviolable rule of Nature, interwoven with the essence of the present disease, to throw the peccant matter upon the joints. If so, all that can be done by purges or vomits, is to throw what Nature would eject through the extremities into the blood. Hence it happens that what was meant for the joints, takes hold of one of the viscera. Then the patient's life is in danger. This is often observed in those who, either to ward off a fit, or what is worse, to allay one, have used themselves to purgatives. Nature diverted from her own good and safe method of depositing the peccant matter in the joints, as soon as the humours are solicited towards the in- testines, instead of acute pains with little danger, induces sick- ness, griping, fainting, and other irregular symptoms, which will nearly destroy the patient. 132 ON GOUT. 23. Sure am I that all purging, mild or sharp, intended to relieve the joints, is mostly injurious, whether it be during a fit, to diminish the peccant matter, at the end of one, to dissipate the remnants of the disease, or during an intermission, to guard against the occurrence of one. From myself and others I have learnt, that purges bring on what they were meant to keep off. In the first place, if given during the fit, they interrupt the work of Nature. Nature would separate the morbific matter, and deposit it on the joints. Purging excites a confusion of the animal spirits. Hence not only has the fit become worse, but the patient has become endangered. After a fit, a purge shall perhaps be given to work off the remains of the disease. It will just bring on a fresh one equally bad ; in which case the patient, mocked by a false hope, makes for himself troubles which would never have occurred had the humours been left alone. This I have found in my own person, when I have unreasonably looked to medicine for the extermination of the remains of the disease. Lastly, in respect to purging at certain intervals, and whilst the health is good, given with a view of warding off or ensuring against the fit, although the present danger of a fresh fit is less than before, it must still bring one on, and that for reasons already given. If it fail in doing this, it by no means carries off the disease. I have known some gouty persons who would purge every autumn and every spring, every month and every week, and yet remain gouty, their attacks being worse than if they had left themselves alone; inas- much as, although the catharsis may take off some of the pec- cant matter, it is so far from strengthening the digestion that it weakens it, weakening Nature also. Hence, as it does away \vith one cause only, it meets only half the disease. 24. Add to this, that the same defect of strength which impairs the digestion of the gouty, lessens and weakens the whole system of the animal spirits, so that a concussion and agitation arise from the slightest cause that dejects or disturbs the mind or body. This often happens with the hysterical and hypochondriac. Gout follows the slightest evacuation, the tone of the body is loosened, the spirits which, whilst in vigour, kept it firm and steady, give way, the peccant matter breaks down all barriers, takes its own course, and inflicts a blow upon the system. The fit follows. ON GOUT. m 25. Nevertheless this method, bad and mischievous as it is, has made the reputation of many empirics, who nevertheless have made a secret of the purge they use. For it must be noted, that whilst the catharsis goes on, the patient suffers either not at all, or very slightly ; and provided that it can be kept on for a few days, if no fresh fit supervene, the original one will go off. Sooner, however, or later, he will pay a tremendous penalty, arising from the disorder into which Nature has been forced headlong by the aforesaid agitation of the humours. 26. The evacuation of the peccant matter by sweats, although less mischievous than the other two forms, is still prejudicial. It does not throw the disease on the viscera. On the contrarj', it throws them upon the surface. Still it is dangerous for the following reasons. 1st. It takes the humours whilst they are yet crude, and not sufficiently tempered for due separation, forces them upon the limbs, and so solicits a fit before its due time, and in spite of Nature. 2d. If it take place during a fit, it drives and forces the morbific matter too violently upon the joint affected, and so creates intolerable pain. Then if the amount of peccant matter be greater than the part affected can admit, it throws it upon other joints, so creating an ebullition and exaestuation both of the blood and of the other humours. Lastly, if the body be over full of the serous matter that generates gout, apo- plexy may come on. 27. Hence in gout, as in all other diseases where the sweats intended for the expulsion of the morbific matter are forced rather than natural, it is very dangerous to bring them on too violently, and to solicit them beyond that degree of concoction to which the humours requiring an elimination have arrived of their own accord. So teaches Hippocrates : " Cocta, non cruda, sunt movenda et medicanda." 1 This applies to sweats and purges alike, as is clear from the sweats that end an ague-fit. If pro- portionate to the febrile matter concocted by the preceding paroxysms, they relieve the patient notably. If beyond the limits of Nature, and forced by bedclothes, fresh flume is lit, and continued fever sets in, just as the original fever was on the point of being extinguished. Similarly, the gentle moisture of 1 Aph. i, 22, toin. iii, i>. 711. [<;.] 134 ON GOUT. the skin in gout, which generally arises towards morning after each of the slighter fits (which slighter fits I have shown in my fifth section to constitute the single full one), relieves the pain and restlessness which afflicted the patient during the whole night. Now, slight as is this perspiration, and fugacious as is its charac- ter, as soon as it becomes protracted, and as soon as it becomes disproportionate to the peccant matter concocted by the pre- vious fit, it exasperates the disease. Hence, in this as in all other diseases, the plague only excepted, it is no part of a phy- sician to force a sweat, since we have no means of ascertaining what proportion of the peccant matter is fit for separation, and consequently no rule for regulating the sweat we would provoke. 28. If evacuants are out of place in gout, what are the in- dications of treatment ? Two points are most particularly to be considered. The first is the causa antecedens, or the indi- gestion of the humours, arising from a defect of spirits. The other is the causa continens, or the heat and exeestuation of the same, when, from their prolonged delay in the body (a delay arising from the aforesaid inconcoction), they have become putrid and acrid. These two are as far as the poles asunder. What helps one hurts the other. Hence the difficulty of treatment. If we strive by heating medicines to subdue the indigestion, we run the risk of inflaming the humours ; whilst moderate diet and cooling medicines, which allay the heat and acridity, cause indigestion, and impair the natural warmth. Now that which I here call the causa continens is not only that which actually takes hold of the joints, and so forms a paroxysm, but also that which lurks in the blood, and is incom- petent to the due separation. Few fits are either so long or so severe as to eliminate in toto, by a single effort, the whole of the morbific matter, and to clear away from the system even the last remnants of it. Hence we must look to each of these causes, both during the fit and between fits. The elimination of the materiel continens is the work of Nature ; and it must be done according to Nature's own method. All that can be done in the way of help, is to keep clear of such medicines and modes of diet as are of a hot nature, and thereby likely to inflame the humours. Anything beyond, in the way of an attempt to assuage the hot and acrid humours, ON GOUT. 135 is an injury to the digestion of them ; the greatest and chief intention being their due concoction. This I shall now dis- cuss ; touching, however, during the course of my dissertation, as occasion may require, upon those remedies which have a value in either cooling the heat of the humours or abating their acridity. 29. Whatever, therefore, helps Nature in the discharge of her functions, either by comforting the stomach, so that it shall rightly digest its aliments, or by strengthening the blood to the due assimilation of the chyle brought to it, or by restoring the solid parts in such a manner as to fit them for the con- version of the juices destined for their growth and increase into their own proper substance, are properly called digestives. So also is whatever preserves the different organs of excretion and the various emunctories of the body in their proper status, whereby in due time the recrements are voided in their due order. I say, that whatever fulfils these intentions, whether medicine, diet, exercise, or change in the non-naturals, is a digestive. 30. Medicines of the kind in question are, to speak gene- rally, medicines which are moderately warming, and which, when tasted, act pungently on the tongue. Such are grateful to the stomach, curative to the blood, comfortable to the parts at large. Some of them, amongst many, are the roots of angelica, elecampane, wormwood-leaves, the lesser centaury, germander, ground-pine, &c. &c. To these may be added the so-called anti-scorbutics, as horseradish, garden scurvy-grass, watercress. These last, however, though warming to the stomach, and auxiliary to digestion, from their acridity and pungency, act as incentives to the disease. They increase the heat, and so stimulate. Hence they must be used more sparingly than the others. With them, the moderate heat and the mild bitterness restore the stomach, and render the mass of the blood more fresh and more lively. 31. Different species of these herbs, in the form of a skilful mixture, do better than any particular ones alone. However much the rule of the simpler the better may apply to specifics, as often as we purpose to cure the patient by satisfying any particular intentions, a variety is best. Each ingredient takes a part in the cure. The more numerous the simples, the more 136 ON GOUT. potent the medicine. Hence, out of a list like the preceding, various formula; may be prepared. For my own part, I prefer an electuary of the complex character of Venice treacle, wherein the mutual fermentation of the simples heightens their virtue, producing a tertium quid, of which the virtue, as a whole, is greater than the virtue of the sum of its elements. I leave, however, both the choice and the formulae to the skill of the physician ; inasmuch as I have nowhere undertaken to write what they call recipes. All I undertake is the notification of those indications to which our curative endeavours must be directed. To overstep this limit is (as I have said elsewhere) 1 to give a handle to the empiric. For the sake, however, of beginners, I will publish the form which I most use. It is as follows : Be Root of angelica, sweet-flag, masterwort, - elecampane, Leaves of mugwort, lesser centaury, white horehound, germander, ground-pine, scordium, calamint, feverfew, meadow-saxifrage, St. John's wort, golden-rod, wild thyme, mint, sage, rue, carduus Benedictus, pennyroyal, southernwood, Flowers of chamomile, tansey, lily of the valley, English satFron, Seeds of pennycress, garden scurvy-grass, caraways, Juniper-berries, aa q. s. Collect the herbs, flowers, and roots at the season most favorable for their respective virtues. Dry, and keep in paper-bags until they fall into a fine powder. Take six ounces of each. Mix, and make up with a sufficient quantity of the best clarified honey, and Canary wine. Make into an electuary of the due consistence secundum artem. Two drachms to be taken night and morning. 1 Med. Observ., V, (5, 8. [G.] ON GOUT. 137 Or (if this cannot be had) use R Conserve of garden scurvy-grass, ^iss ; Roman wormwood, Orange-peel, iia 5) ; Candied angelica, Candied nutmeg, ail Jss ; Venice treacle, jiij ; Compound powder of cuckoo-pint, 5ij ;. Syrup of oranges, q. s. Make into an electuary. Two drachms to tte taken twice a day. Wash down with five or six spoonfuls of R Sliced horseradish, Jiij ; Garden scurvy-grass, xij haudfuls ; Watercress, Brooklime, Sage, Mint, iia iv handfuls ; The peel of six oranges ; Bruised nutmegs, ij ; Brunswick mum, Oxij. Distil in a common still, until six pints are given oft". 32. Of the common medicines Venice treacle is the best. Still, as it contains so many spices, and opium as well, the foregoing is an improvement on it. Care, however, must be taken that, whatever the preparation be, it be palatable. It has to be continued so very long, that if distasteful it will be useless. Of simple medicines the Peruvian bark is the best. A few grains taken morning and evening restore and freshen the blood, 33. In gout, as in most other chronic complaints, those remedies which most comfort the blood do most good pro- vided always, for reasons to be given below, that their warming properties are not due to vinous spirits. This is because, un- less I am mistaken, all the diseases in question are referable to one general cause, viz. the indigestion of the humours. 34. Nothing proves this more than the difference between acute and chronic diseases ; a difference which I will ask leave of the reader to enlarge upon, although, in doing so, I must digress a little from my subject. Just as those diseases which quickly come and quickly go, being quickly brought to con- coction, are called acute, so are those which attain the same concoction, either very slowly or not at all, called chronic. This difference is shown by the nature of the thing itself, as well as 138 ON GOUT. by the terms used. The cause of the difference, however, be- tween these two diseases lies deep, and is not easily discovered. We shall not waste our time in staying a little to examine it, since a clear and distinct knowledge upon these points is of great importance towards discovering the true indications of these diseases. 35. Whether the inward bowels of the earth undergo various changes by the vapours which exhale therefrom, so that the air is tainted, or whether the atmosphere be changed by some altera- tions induced by some peculiar conjunction of any of the heavenly bodies, it is a truth, that at particular times the air is stuffed full of particles which are hostile to the economy of the human body, just as at other times it is impregnated with par- ticles which disagree with the bodies of different species of brute animals. At these times, whenever we draw in with our breath such noxious and unnatural miasmata, mix them with our blood, and fall into such epidemic diseases as they are apt to engender, Nature calls in fever as her usual instrument for expelling from the blood any hostile matters that may lurk in it. Such dis- eases are usually called epidemic. They are acute and brief, their movement being quick and violent. But besides these diseases excited by some external cause, there are others equally acute,arising from some particular inflammation of the blood, and this is produced by some anomaly or dyscrasis of particular bodies, rather than from any general atmospheric influence. These I call intercurrent or sporadic, inasmuch as they may occur during any year whatever. 36. Chronic diseases have a different nature. However much an unhealthy atmosphere may favour their generation, they are not atmospheric in origin. The common cause of them all is the indigestion of the humours. When the prin- ciples of Nature, either from old age or from long and repeated errors concerning the six non-naturals (meat and drink most especially), have been weakened, or when the secretions have been so far impaired as to be wholly unequal to the elimination of the superfluities which it is their function to strain off from the blood ; in such cases the afflux of humours is too abundant and too much increased for the strength of the individual to bear up against. And now the aforesaid humours are kept prisoners, undergo fermentations, undergo putrefactions, and ON GOUT. 139 finally break out in such a manner as to create different species of diseases, according to the different species of depravation. Just as these depraved juices vary in their disposition, so do they vary in the part to which they are determined, one part being more ready to receive them than another. The long series of sym- ptoms that then succeeds partially arises from the nature of such juices, partly from the ataxy of the parts. These two to- gether constitute that irregular condition of Nature which we terra a chronic disease. 37. That this inability of Nature to concoct the humours is the chief cause of most chronic diseases becomes clear, if we consider the cases of old men. Their digestions are weakened. The spirits instrumental thereto are wasted by the repeated functions of a long life, hence they are more liable to chronic diseases than young men. Here the flame of life burns brighter, and dissipates all recrementitious accumulations. Here the organs of secretion are supplied by a continual source of natural warmth. Here the function of depuration can always meet the amount of matter to be purified, excepting only those cases where there is absolutely an oppressive and suffocating excess of humours. Another argument towards the same conclusion is the fact, that winter causes chronic diseases more than summer. True it is, that chronic diseases in some cases do not show them- selves in act and deed until towards the end of winter. Never- theless the supply of humours upon which they depend has ac- cumulated during the winter, has been favoured by the cold, and has been increased by the languor of Nature, and the insuf- ficient administration of the animal economy. 38. Hence men who are healthy during the summer, have gout, asthma, coughs, &c. &c., during the winter. Hence also warm climates cure the diseases that cold ones produce. Hence also the stupendous and incredible advantage derived in many chronic diseases, and in consumption most, from riding on horseback ; a kind of exercise which strengthens and invigorates the different digestions, lights up afresh the animal heat, acts upon the organs of secretion by a healthy succussion, and so promotes the depuration of the blood. From all this must needs arise a restoration of the lost digestion, and an excellent crasis of the whole body. 39. It is now clear, that in other chronic discuses as wrll as 140 ON GOUT. in gout, we may, when no manifest symptoms contra-indicate, expect great advantnge from the use of warming herbs. These warm the blood even in the middle of winter, and are useful even in the summer as a preventive. Indeed, to wait for the winter before we use them, and to let the foul matters accumu- late, is to shut the stable-door after the steed is stolen. 40. I have stated already, that gout has this peculiarity : cathartics not only do no good, but are injurious to it. In most other chronic diseases, however, bleeding and purging must precede restoratives and digestives. "When, however, the patient has once begun them, he must keep on and allow no evacuations to intervene. This a rule whenever we rely upon restoratives, evacuations do harm. Finally, I will not say that digestive medicines are the best medicines that exist. I will only say, that he who tries them will find them surpass his expectations. 41. Now this must precede all that I have to say concern- ing the treatment of gout, viz. that be our digestive remedies what they may (medicines, diet, exercise), they must not be taken by the by, but must be steadily and diligently adhered to. In gout, as in other chronic diseases, the cause is a change and new nature of the system. Now, no sensible man can believe that any light and momentary change can remedy this. The system must be transformed. The man must be made anew. It is not as in acute disease, where a person in full health is smit with fever, and falls headlong into a dangerous disease. Gout is different. For years together a man has drunk and feasted has omitted his usual exercise has grown slow and sluggish has been over-studious or over-anxious, in short, has gone wrong in some important point of life. In this case he has, as it were, taken trouble to pervert the various ferments of the body, and to smother the animal spirits, which are the primary instruments of concoction. Hence the humours, preternaturally accumulated, break forth, after having become exalted in the highest degree. They destroy the system. The muscles are softened and the joints relaxed, so that the affluent humours are readily received. A new nature is now super- induced, the original and natural economy of the body being altogether broken up and destroyed. The fits that seem so important in the eyes of the hasty, are nothing more than the ON GOUT. 141 series and order of symptoms which Nature uses in the expulsion of the morbific matter. Hence, to use any medicine for a time is a waste of labour. The weakness of all the digestions, and the loss of natural strength in the several parts, are the essence of gout. Each must be dealt with. The strength of the diges- tion and the restoration of the parts must be gradual propor- tionate to the original and natural economy of the body. To do this fully and perfectly is impossible. The system is slow to transform itself, and old age is the usual attendant of the dis- ease. Still what age and weakness allow must be done, and the more we can do the more we mitigate the tyranny of the disease. 42. This must be noted peptic or digestive remedies, whether medical or dietetic, must be given between the fits, and as long before the paroxysm that is expected as possible. Time and patience only will suffice for the restoration of the concoctions, and for the renovation of the impaired ferments. The blood and viscera require strength : weakness, however, is the lot of old age. 43. However much these and the like remedies may do good, they are insufficient single-handed, AVe must look beyond medicine. Wise men do this in gout, as in all other chronic diseases. In the first place, then, moderation in meat and drink must be observed, so that the stomach receive no more food than it can digest, and so that no fresh fuel be added to the disease. The other extreme, however, as I have found in my own person, is equally injurious. Abstinence weakens the parts, by with- holding from them their due proportion of that aliment which is necessary for supporting their strength and vigour. Again: although digestible food be better than indigestible, the palate of the patient must be consulted, since it is a matter of ob- servation, that indigestible matters which the stomach craves, are easier concocted than digestible matters which create dis- taste. Nevertheless, things essentially indigestible must be taken sparingly. I think, too, that one sort of food for each meal is best ; since a mixture of meats cause more trouble to the stomach than an equal quantity of one sort. Sa\ingof meat, the patient may eat ad lilntmn (except that his food must not be sharp, nor salted nor spiced), without injuring the diges- 142 ON GOUT. tion. Salt and spice supply fuel to the disease, and consequently are so far injurious. 44. As to meal-times, it is best not to take supper ; as bed being properly dedicated to the digestion of the humours, is not to be devoted to the concoction of the food. Gouty men, then, may take a free draught of small-beer instead of a meal ; the more so as the same subjects are liable to renal calculi, and small-beer at supper-time is an excellent preventive to these. It cools and washes out the kidneys. 45. A milk diet (the milk being either raw or boiled), with nothing besides but a little bread, has prevailed for the last twenty years. It has done good as long as it has been rigidly attended to ; the moment, however, that the patient swerves from it a hair's breadth, and the moment he betakes himself to the diet of a healthy man (no matter how mild and simple), the gout returns worse than ever. This is because the prin- ciples of Nature have been weakened, so that the disease be- comes more obstinate and dangerous in proportion as the patient is unable to resist it. Whoever, then, would put himself under a milk diet must seriously consider within himself whether he is likely to be able to persist in it all his life long. Resolute as he may be, he may fail in this. I once knew a nobleman who lived a whole year on milk alone, and liked it. During the year his bowels were moved once or oftener every day. Suddenly his habit of body changed ; he became costive, his stomach sickened at milk, and although his mind was as good as ever, he was obliged to leave off. Again : certain hypochondriacs, of a heavy habit of body, or who have long used themselves to spirituous liquors, cannot bear the use of milk. Meanwhile, the brief and fugacious benefit which those who bear milk derive from its use arises, not only from the fact of its being the simplest diet, but from its making the blood milder and sweeter ; tempering, as it does, the acri- mony of its particles. I have little doubt, but that if the stomach would bear it, barley-broth would do the same. Again : milk is a diet wholly insufficient for adults. Hence it represses that turgescence or virosity of blood to which gout is due ; so that those few with whom it agrees are free from gout as long as they take it exclusively no longer. To the primary and ON GOUT. 143 original cause of gout, which is weakness of the ferments and the concoctions, it is wholly adverse ; hence, in this respect, it does as much harm on the one side as good on the other. This, however, has been overlooked, and many and deadly errors have arisen therefrom. The causa contlnens of the disease has been the heat and acridity of the humours. Those, however, who have treated this alone, have weakened the concoctions and prostrated the natural powers altogether. 46. As to liquors, those are the best which neither sink to the weakness of water, nor rise to the generosity of wine. Such is the London small-beer, either hopped or without hops. First as to the wine. The old saw is that " if you drink wine you have the gout, and if you do not drink wine the gout will have you." The first part is true enough. It is proved by the experience of patients that wine is absolutely hurtful. Much as it may help in forwarding the concoctions the weak- ness whereof has been mentioned before as the antecedent cause of the disease the causa continents, the hot state of the humours, is increased by it. Here lies the force of the disease ; and this we aggravate and inflame. Again : even for the promotion of the con- coctions we are not in the habit of giving wine as an ordinary drink, except in cases where the use of it has been habitual ; inasmuch as, although it may in its passage impart a certain degree of warmth, it still, beyond doubt, weakens the ferments of the body, by diverting the natural spirits from their natural parts. This shows why hard-drinking and bad-living profligates are so often taken off by gout, dropsy, palsy, or similarly cold diseases. Add to this the effect of wine (habitually taken), in making the body soft and loose, like that of females ; whereas temperate liquors so give tone and strength to the constitution, that water-drinkers scarcely know what gout is. Another fact is this amongst men, those are most liable to gout, who, from a certain luxuriance of the system, make blood too fast, and form flesh out of their aliments in an imperfect state of di- gestion. Now, such a habit is favoured by wine-drinking, which both increases the new mass of matters taken in, and applies (as it were) a torch to the smouldering accumulations, which break out into flame, and bring on the disease. Further- more, the blood of gout is the blood of pleurisy. It were 144 ON GOUT. madness, then, to add fuel to flame in the shape of ardent spi- rituous liquors. Neither is the other extreme safe. Over-cooling draughts undermine the concoctions, extinguish the natural heat, and add to the mischief. They do not, indeed , cause pain, as wine does. They cause death. This is shown by old men, who, after drinking wine all their lifetimes, have suddenly gone from wine to water instead. In no long time they go from life to death. 47. This is a rule for the gouty. They may take those liquors which neither chill the stomach nor intoxicate in any moderate quantity. Such is small beer in our own country, which in foreign countries may be replaced by weak wine and water. Water alone is bad and dangerous, as I know from personal experience. When taken, however, as the regular drink from youth upwards, it is beneficial. Indeed it is the natural drink of the greater part of mankind more happy they in their poverty than we in our wealth and abundance ! The vast host of diseases which afflict our bodies are standing wit- nesses to this gout, stone, apoplexy, palsy, and others innu- merable. Then there are the bad effects upon the mind. This is warped from its right direction by wine-drinking. The spirits of the adventitious liquors, complicated with the spirits subservient to the formation of thought, disturb and volatilize the mind, filling it with vain and empty fancies instead of solid and serious thoughts. This makes a wit a babbler. Nevertheless, shadow is not more different from substance, than a quick tongue from a wise brain. 48. Now, although, during a moderate attack, the patient may take his choice between small beer and wine-and- water, whenever the whole substance of the body has become inflamed by gout, but little progress will be made towards curing it, unless there be a total and absolute abstinence from all (even the weakest) fermented liquors. Each and all of these possess more or less of pungency and acridity ; and (what is worse) each and all, being fermented, impart their nature to the humours, and just like yeast in other mixtures, engender and keep up a perpetual fermentation. Diet-drinks, therefore, of the usual and appropriate sort, must form the ordinary beverage. This should not be strong; else it will act upon the humours and inflame them as much as wine. Nor yet too weak ; else it will ON GOUT. 145 chill and weaken the natural functions. A beverage of this sort, provided that it be made with ingredients which are not distasteful to the patient, although, for the first week or two it may, from being so continually taken, pall upon the palate, will, after that time, become as grateful as any other ordinary drink. Far from impairing the appetite, it will improve it ; in such wise, too, that it shall be more natural and genuine than it would have been under the use of wine or beer. Another advantage will also accrue from it. Those who take a diet- drink instead of beer, may allow themselves greater latitude in the points of regimen. No man wholly avoids errors in diet. There is a way, however, of correcting and making up for them. Far more important, however, than any of these matters, is the extent to which a regimen like the preceding is a safeguard against that almost inseparable companion of gout the stone; an ailment which acrid and attenuating liquors seem made for the very purpose of engendering. The following formula gives a drink pleasant both to the eye and the palate : R Sarsaparilla, ^vj ; Sassafras, China-root, Hartshorn-shavings, ua ^ij ; Liquorice-root, Jj. Boil for half an hour in two gallons of spring-water. Cover up, and leave to simmer for twelve hours. Boil down to two thirds. Remove from the fire, and add half an ounce of aniseed. Set by for two hours. Strain, and leave to settle. Bottle the clarified liquor for use. 49. This drink is best begun with when the patient has just recovered from a fit, and it should be continued both during the fits and in the interval between them, throughout the re- mainder of the patient's life. It is far from sufficient to just enter upon a change of system when the disease is at its height; since then it is, that, from the ataxia and inordinate motion of the humours, Nature least bears the substitution of inert and unfermented liquors for the more lively and spirituous ones. At the same time, the aforesaid electuary may be used. This is to be taken thenceforward, every day, both during the fits and between them. The heat of this will, to a certain n. 10 146 ON GOUT. extent, make up for the watery character of the diet-drink. It will ensure a due degree of heat to the blood and bowels, and it will do this without that agitation which is usually excited by the turbulence of fermented liquors. 50. If any one object that, with total abstinence from wine and other fermented liquors, life is not worth having, I answer that they must consider, on the other hand, the still greater and still more intolerable misery of being daily racked by the torments of inveterate gout since in no other disease do I require a like abstinence. Besides this use sweetens habit ; and water is a drink as natural as universal. Surely, then, the patient who has once been gouty, provided that he be a man, and not a two-legged brute, will not doubt which way to go. 51. Nevertheless, if the patient, from either too long and too excessive a use of intoxicating liquors, from being advanced in life, or from excessive debility, cannot digest his food without either wine or some other fermented liquor, it is dangerous to forbid him wine suddenly and abruptly, an errorwhich has been the death of many> Hence, in these cases, the dietetic apozen is to be deferred; and, if used at all, used after a gradual pre- paration for it. Meanwhile, until the patient become accus- tomed to it, he may take a little wine at meal-times, but that as a medicine rather than as a drink. In which case sherry is preferable either to Rhenish or French wines. These last, although agreeable to the stomach, favour the exacerbation of the humours, and increase the fames of the disease. Besides which, being nearly as crude, and almost as little concocted as English cider, they are not so cordial and warming as the wines of Spain. Thus much concerning the meat and drink of gouty subjects. 52. There is another matter also, which, although considered unimportant, is nevertheless of great moment, both in digesting the fames of the disease during the fit, and in ensuring against the generation of the morbific matter when the fit is over ; and this is going to bed early, especially in winter. Next to bleeding and purging, nothing undermines the forces of Nature like late hours ; a fact which every delicate person who has tried it will vouch, provided that he seriously consider how much more fresh and lively he is of a morning, after an early bedtime, than he is after sitting up late. He is then ON GOUT. u; languid and enervate. However much, too, it may seem to be all one whether we go to bed early or late, provided that we lie an equal time (that is, whether we go to bed at nine and get up at five, or get up at seven and go to bed at eleven), the real difference is great, and that for this reason : in the day time the spirits are dissipated by exercise, either bodily or mental, and these, with invalids, are so infirm and weak, that they need the refreshment of sleep early in the evening. Now, as the approach of night brings on a certain relaxation of the body, which, during the day, has been kept fresh by the in- fluence of the sun, the warmth of the bed (especially in the winter) must be substituted for that of the sun. In the morn- ing, however, the spirits being refreshed and invigorated, both by the rest of the previous night and the warmth of the bed, early rising, although it may rob the patient of an hour or two of his morning sleep, injures Nature less than an additional hour or two of watching over night ; besides which, when day comes upon a person out of bed, it favours the strength and steadiness of the body. Hence I advise gouty patients, espe- cially in winter, to go to bed very early and to rise betimes, however much their shortened slumbers may induce them to seek a morning's sleep by lying in bed ; the more so, as every morning slumber subtracts so much from the next night's rest, and so does violence to Nature. Perversely to turn day into night, and night into day, is to despise her prudent economy. 53. Moreover, the tranquillity of the mind is to be established by all possible means ; since all perturbations, if once they break their bounds, favour the dissolution of the systasis of the spirits, which are the instruments of the digestions, and so encourage gout. Wisely, then, will the patient act who well considers his liability to the common lot of mortality, and is not foolish enough to think himself free from the troubles that fol- low it. Whether from any fault of his own or others, ho nourish a discontented spirit, he will not lay clown the law for the world at large ; which hitherto has never invariably humoured any one, however wise or powerful. Neither to any man have all things succeeded according to the promises of ;i vain imagination. On the contrary, many a one has died sud- denly amidst the stir of business, exhibiting an instance of the frailty of humanity, and unnecessarily depriving himself of tin" 148 ON GOUT, brief enjoyment of life. The same mischief follows the over- application of the mind to serious matters and deep study. Melancholy, so called, is pre-eminently the inseparable com- panion of gout. Hence those who are liable to it are so wont to tire and overwhelm the animal spirits by long and deep thought, that excessive exertion of this sort, even without the artificial aid of reading, makes the proper preservation of the economy of the body an impossibility ; for which reason (as seems to me) gout rarely attacks fools. Those who choose may except the present writer. 54. Far above everything else, however, as a check to the primary cause of gout the indigestion of the humours and, on the other hand, as an aid to the restoration of the blood, and as a strengthener to the parts, is bodily exercise. To this, however, one remark applies, viz. that in gout, as in all chronic diseases, where the whole habit of the body requires change, unless daily, exercise will be useless. Exercise by fits and starts, whilst it does next to nothing towards changing the habit of the body, which from inertness and indulgence is be- come languid and effeminate, may, perchance, do absolute injury, by bringing on a fit when fits have begun to cease. Not that the exercise should be violent. On the other hand, it should be that which best suits old men, the usual subjects of gout. Undue movement of the body dissipates the spirits too much, and, consequently, hurts the concoctions ; whilst moderate and regular exercise strengthen them. Hard as this may seem to a man w T ho, besides old age, inaptitude of body, and (more especially) the sluggishness which is so natural to the disease, suffers from pain besides, it is still true, that if neglected, nothing hitherto discovered will do good. Now, just as the interval between the fits can never be long, unless the body be regularly exercised, so also is sloth favorable to the generation of a calculus, a disease more dangerous and more painful than gout itself. 55. Add to this a fact, which ought to have great weight ; namely, that by long rest the matter that forms chalk-stones is increased, these being deposited in the joints of the body, par- ticularly in those of the fingers ; so that at length they are entirely deprived of motion. However confidently some may assert that the matter of these chalk-stones is nothing more ON GOUT. 149 than the tartar of the blood transmitted to the joints, it will soon become clear, upon attentive reflection, that whilst the accumulation of the inconcocted matter which creates gout falls upon the joints and renders the parts about them permanently swollen, it must at length happen, partly th:it the assimilative power of these parts becomes checked, and partly that, from the smothering obstruction which the sluggish humour there engenders, the aforesaid matter is generated. This is converted into a substance of the kind in question by the heat and pain of the joint ; and it increases day by day, converting into its own proper substance both the skin and flesh. The deposit now lies bare, and may be picked out. It has been compared to crabs' eyes, chalk, and other similar matters. Now this may be guarded against by daily exercise, whereby we obtain the due diffusion over the whole body of the humours that generate gout, instead of their accumulation on any particular part of it by preference. I have found in my own person that long and daily exercise not only stops the generation of chalk- stones, but even dissolves old and hard ones already formed ; provided only that they have not gone so far as to have con- verted the outer skin into their own proper substance. 56. In respect to the kind of exercise, riding on horseback, unless forbidden by either old age or a calculus, is by far the best. Indeed I have often thought within mvsclf, that if any O v ' * person knew a remedy of which he wished to make a secret, equally efficacious in gout, as in most chronic diseases, with regular and steady riding on horseback he might make a fortune. Where this cannot be done, driving in a carriage comes to the same thing, which is a blessing to gouty people ; inasmuch as that very wealth which fostered the luxury which brought about the disease supplies the means of keeping a vehicle, whereby those can take the one sort of exercise when they could not take the other. Exercise and a healthy atmosphere is far better than exer- cise in an unhealthy one, and better in the country than in the town where the air is full of the smoky exhalations from the different workshops, and where the streets are crowded with houses. Such is London, a city (as far as our certain knowledge goes) by far the largest in the world. The differ- 150 ON GOUT. ence between exercise in the town and exercise in the country may be felt at once by any one who has the gout. 57. As to venery, a gouty man, who is an old man as well, acts just as foolishly in indulging in fornication as a traveller would act who, at the beginning of a long journey, should consume all his viaticum at starting. The abundance of spirits which promoted the due concoctions has long ago been ex- hausted; so that, without any adventitious drains upon the system, the joints and the parts about them are already weak, and over-weak. Again over and above the damage which he brings on himself, by neglecting to check the now languid desires of waning life, he denies himself the privilege of enjoy- ing that jubilee which by the special and kind gift of Nature is conceded to old men ; of whom it is the natural and happy lot to be emancipated from the control of those lusts, which, during youth, attacked them, day and night, like so many savage beasts ; especially as the satisfaction of such appetites can never outweigh the long train of troubles by which they are either followed or accompanied. 58. Now, however much these rules (or rules like them) re- specting diet, and other points of regimen, provided that they be religiously observed, may preserve a gouty subject from the more violent onslaughts of the disease, and however much they may bring about that firmness of the blood and solid particles, which best ensures an immunity from that catalogue of ills, whereby the disease is rendered not only painful beyond the bounds of human endurance, but fatal as well, they will not prevent him from suffering occasional attacks, after certain intervals, especially during the winter. Although in the summer season, whilst the tone and vigour of the blood are excited by the heat of the sun and preserved in their proper status, and whilst the due elimination of the humours through the pores of the skin proceeds favorably, it needs must be that the concoctions take place far better than in winter; never- theless, when the cold season sets in and the strength of the blood is impaired, and the perspiration through the pores of the skin is impeded, it follows of necessity that a vast heap of in- digested matter gets accumulated, that after a considerable delay it breaks out in specie, that it exhibits itself in its ON GOUT. lol proper symptoms, and, lastly, that it brings ou a fit as soon as either the motion of the humours, the nearer approach of the sun, the drinking of wine, over-exercise, or any other evident cause, may supply an opportunity. 59. From what has just been said it is clear, that the man who would cure himself of gout must change his whole habit of body, and restore it, as far as age and other circumstances will permit, to its original constitution ; a point at which he must aim, both in the fits and between the fits ; since, when the fomes of the disease is not only generated but has fixed itself in the joints, it is too late to attempt either its alteration or its elimination by any other way. No other method will eject it but that which Nature points out ; and it is to Nature alone that it can be intrusted. This is what we must do with intermittent fevers ; where we abstain from remedies till the heat has been allayed. Indeed, it is just as absurd to exert our whole strength in easing the heat, thirst, and restlessness of agues, as it is to consider that we have cured the gout when we have merely checked its symptoms, a result which only renders the true cure more difficult ; since the more the pain is eased the more the concoction of the humours is obstructed, and the more the lameness is taken off, the more the expulsion of the morbific matter is hindered. Again, just as the fury and sharpness of the fit is beaten back, the longer will the fit become ; and not only that, but the space between the fits will be shorter, as \vell as less free from every degree of those symptoms which give so much deadliness to this disease. No one who has well weighed what I have elsewhere exhibited in the history of the ailment in question will deny this. (50. Now, although during the fit, nothing beyond the removal of those symptoms, which a false method of cure some- time occasions must be attempted, nevertheless, considering that every one allows that it is from an abundance and an exuberance of humours that gout proceeds, it may, perhaps, be convenient for the patient to abstain for a few days, after his first seizure, from meat, and take, in place of it, barley-broth, or some similarly light food; a thin diet of the sort conducing much towards the lessening of the morbific matter, and giving Nature an opportunity of digesting it more speedily. Simv, however, there is a vast difference between the body of one 152 ON GOUT. person and that of another, some persons being so unable to bear abstinence from animal food, as to be seized with a confusion of the animal spirits, fainting, and other such symptoms as befall hysterical women, we shall, with a patient of this sort, do more harm than good if we keep them from flesh beyond the time that their stomach loathes it. This rarely exceeds the first or second day of those particular fits, which (as I have already hinted), all joined together, make a whole one. Whether, however, he take it soon or late, he must, during the pressure of the disease, be seriously cautioned against taking more of it than is necessary for the support of Nature. And like care must be taken as to its quality. In the intervals between the fits, and more especially during the fit itself, the patient must use the greatest caution lest he commit any error in the quan- tity or the quality of either his meat or drink. Nor is care to be taken in these matters alone. I have elsewhere shown more at large, that, between fits, every point of regimen is to be looked to with no common attention. Moreover, much as the pain and the great inaptitude for motion may seem to contraindicate that remedy which I have so extolled exercise it must still be iindergone; since, although at the beginning of a fit it may appear impossible for the patient even to be carried to his carriage, much less to bear the motion of it, he will, nevertheless, provided that he make the attempt, in a short time feel as little pain when driven about in his coach, as when seated in an elbow-chair at home. Another advantage is this : to sit at home all day ensures a sleepless night ; whereas exercise in a carriage in the morning and at noon, will have the effect of driving off the pain for the greater part of the night by sleep ; since, when a person has the gout, a very little exercise is sufficiently tiring to send him to sleep. Again, exercise guards against the stone ; which a sluggish life favours. More important, however, than all or any of these points is the extent to which steady and continued exercise obviates the tendency of the joints to that total impotence, which may arise after one or two protracted fits of gout, wherein the ten- dons of either the hams or knees become contracted. This happens because, when the pains of gout take hold of the knee the patient is unwilling to stretch his legs, indulges in the relief that is afforded by long rest, and remains ever afterwards ON GOUT. 153 deprived of the use of his legs and feet, both in the intervals between the fits, and in the fits themselves which last they, by no means, for this reason, escape. Moreover, in those pld men whose concoctions are exceedingly vitiated, and who, from the prolonged afflictions of the disease, have, as it were, the whole substance of the body turned into gout, it is not to be hoped that, without exercise, the disease can ever be brought to a digestion. For when the disease is too strong for Nature, they often die of languor and sickness, which the abundance of the morbific fomes incapable of being digested produces; and by this incoucoctile matter, so wholly incapable of assimilation, they are destroyed as by poison. 61. Nevertheless, notwithstanding what has been said con- cerning the utility of exercise in the fits of the gout, if, from the excessive violence of the paroxysm at its first onset, the patient be laid prostrate, we must, in case we confine him to the chamber, confine him to his bed also, at least for the first few days, until the vehemence of the pain shall have abated. Here the bed will in some degree make up for the want of exercise ; inasmuch as, by continually keeping it, the morbific matter will be more potently digested in a few days, than by merely keeping the bedroom for many ; especially at the beginning of the disease : provided always that the patient can abstain from flesh with- out faiutness and other bad symptoms, remaining content with only oatmeal-gruel, small-beer, and the like. Now, the state of things that most frequently requires this treatment occurs with those in whom the gout has just come to its height, and has not yet been mitigated by a course of many years. But now we must not omit to notice, that if the gout be inveterate, and incline the patient to fainting, gripes, diarrhoea, and such-like symptoms, he will scarcely escape being destroyed by one of the fits, unless he take exercise, and that in a free and open air. This is all the more important, from the cir- cumstance of a great many gouty people having died from these symptoms ; to which they have become liable by being confined to their chambers, and especiallyto their beds : whereas, had they been willing to put up with the fatigue of riding in a carnage for the greater part of the day, they would not have yielded to their fate so soon ; since, though he that is troubled with only pain in the joints may shut himself up in his bedroom, if he 154 ON GOUT. who, instead of violent pain, is afflicted with sickness and the other aforesaid symptoms, should imitate him by doing the same, he would throw himself in danger of his life. Well is it for us, that when the pain is so violent that the patient can least bear motion, he least wants it ; the pain itself, which is the bitterest remedy of Nature, securing his life. 62. As to the symptoms of gout, it is to those whereby the life of the patient is endangered that we must first apply our- selves ; such being weakness and faintness of the stomach, with gripes, as if from wind. These befall those Avho have either been subject to gout for many years, or else have brought it upon themselves by suddenly changing spirituous for thin and cooling liquors ; or, finally, have applied repellent plasters to the parts afflicted to assuage the pain. For any or all of these reasons, the material cause of the disease, which might have been put off upon the joints, is thrown upon the bowels. I have, during the fits of the last years, tried many things to lessen the symptoms. Nothing, however, effected my purpose so much as a small draught of Canary wine, taken now and then, when the faiutness and sickness were most oppressive. Neither red French wine nor Venice treacle, nor yet any other cordial whatever, is (as far as my present knowledge goes) equally effectual. We must not, however, imagine, that either the wine in question or any other cordial can at all preserve the patient, if exercise be neglected. 63. If, however, some grave symptom, requiring immediate attention, suddenly appear upon the retrocession of the gout, and threaten death to the patient, neither of the aforesaid remedies, wine or exercise, must be relied on. In such a case, provided that any of the natural and vital parts, other than the head, be attacked, we must have immediate recourse to lauda- num, i. e. twenty drops of the liquid laudanum, out of draughts of epidemic water, must be taken, and the patient must go to bed, and do his best to sleep. 64. It may happen, that the matter occasioning the gout, from the fact of its not having been thrown out upon the joints, shall bring on diarrhoea. If this be not the crisis of a particular fit, and if, notwithstanding the laudanum and the exercise (the first remedy to which we must resort in diarrhoea), that have just been recommended, the bowels be still purged, and the ON GOUT. 155 purging be accompanied by gripes, &c., the only remedy known to me is a sweat, brought oiiby the appropriate medicines. If this take place for two or three days running, and for two or three hours on each day, morning and evening, the diarrhoea will generally be checked, and the fomes of the disease will be forced upon the limbs. In this way I cured myself, some years ago, after I had imprudently thrown myself in the way of danger, by having taken cold water as my ordinary drink ; and that after I had sought help from cordials and astringents in vain. 65. I have seen another though a rarer symptom, viz. the metastasis of the peccant matter to the lobes of the lungs ; taking place when a winter cough, originating in a cold taken about the time of the fit, has gradually drawn off, in the way of translation, the morbific matter from the limbs to the lungs leaving the latter either partially or wholly free from pain and swelling. In this case the curative intention is not to be directed to the gout itself, but to the pulmonary symptom ; and this is to be treated like an absolute peripneumony (viz. by frequent bleedings, and a cool and thickening diet and me- dicines) ; inasmuch as the blood which is drawn is altogether like the blood of pleurisy. Between the bleedings the patient should be purged by lenitive potions, whereby the filth that has fallen on the lungs may be got rid of. As far as encouraging a sweat, however powerful it may be in forcing the fomes of the disease upon the limbs, it now does more harm than good, since it hardens the matters impacted in the lungs. These generate small abscesses, and then the certain death of the patient follows. G6. Moreover, it is to be noted, that all gouty subjects, when they have struggled a long time with the disease, are liable to stone in the kidneys, and arc wont (sometimes in the status, but generally during the decline of a fit) to be afflicted with nephritic pains. This brings weakness as well as pain, although the strength was but too much wasted before. In this case, neglecting all other remedies, let him take a gallon of posset-drink at once, wherein have been boiled two ounces of marsh-mallow roots, and then let the following clyster be thrown up : 156 ON GOUT. R Marshmallow-root, Lily-root, aa j\j ; Mallow-leaves, Pellitory, Bearsbreecli, Chamomile-flowers, a handful of each ; Linseed. Fenugreek, aa Jss ; Water, q. s. Boil down to half a pound. Dissolve in the strained liquor Kitchen sugar, Syrup of marshmallows, aa ^ij. Mix, and make into an enema. 67. If any one reqiiire external remedies for easing the pain of gout, I know of none to give them. Except the refrigerants and repellents (the use of which I have shown to be dangerous), I have tried a great many in my case as in those of others. Nay more I confidently affirm that the greater part of those who are supposed to have died of gout, have died of the medicine rather than the disease a statement in which I am supported by observation. If, however, any one will try the virtue of such external medicines as are reputed to be undoubted ano- dynes, let him guard against imposing on himself by applying them towards the decline of a particular fit, a time when the pain is about to cease of itself, but rather when a fit is coming on. He will then see the rottenness of his support, and the vanity of his expectations ; since epithems, like those in ques- tion, are useless for good, although sometimes powerful for mischief. For this reason I have for many years wholly eschewed them. A poultice made with white bread, saffron, and a small quantity of the oil of roses, has done me more good than aught else. Nevertheless, at the onset of a fit it did nothing. Hence, if the pain be very violent, the patient will do better by lying in bed until it have somewhat remitted, than by using anodynes. Nevertheless, it will not be amiss to take a little laudanum in the evenir.g, if the pain be above bearing. Otherwise, it will be better omitted. 68. As, however, I am speaking of external remedies, I must say something of a certain Indian moss, called Moxa, which has, of late years, got a great name in tiie cure of gout, i.e. if it be used for singeing the part affected. Though this sort of remedy is referred to the East Indians, and is considered as ON GOUT. 157 having been wholly unknown to Europeans, it is certain that, if we look into the writings which Hippocrates left us more than two thousand years ago, we shall find that it is still older with us. In his excellent treatise, De Affectionibiis, when treating of sciatica, he says : Ei ?e (^ si> rt TJ OOUV7) Kat rwyjivy Eouera ij oouvTj.J i. e. viuoa si in uno aliquo loco firmiter constiterit dolor, neque medicamentis ex- pellatur, quocunque loco dolor forte extiterit, cum lino crudo inurito." And, shortly after, speaking of gout: Av/nQtoti E KOI I r \ > \ ,\ " ' fl ' S ' >v \ > ravrij [TO. aura a KCII T>I acupiTici, Kat /naKpi] fjitv KUI aim; rj Kcil tTTiVorog, Oararwotj^ CE oiV ijv ce TO/CTI GaKTV\oiffli> ; yKraraXfiTTETai, KO.VGO.I rat; ^>At/3ac TOV $aKTv\ov virtp row KOV$V\OV uXiyov' Kaittv Se w/uoXii/(u.] i. e. " Huic eadem quae articulari morbo conferunt, et longus quidem hie morbus est et gravis, minime tamen lethalis : quod si in digitis dolor re- nianeat, venas in digito paulo supra articulum inurito ; ustio autem per linum crudum fiat." 1 I imagine that no one can think that the difference between the flame excited on common flax and the flame excited on this Indian moss is of a specific kind : so that the one should be a bit more useful in the cure of gout than the other. This would be like thinking that afire made of oaken was different from one of ashen billets. This singeing of the parts affected does what it pretends to do in relieving the pain, since it calls forth the most subtle and the most spirituous part of the morbific forms deposited in the joints. Nevertheless, relief of this sort cannot but be transitory in its effects ; since it leaves untouched the antecedent cause of gout the indigestion. It is needless, too, to add that its use finds place only when the complaint is incipient. As soon as ever, either from the length of the disease, or from the unseasonable and undue use of medicines, the gout (as is some- times the case) is turned upon the inward parts, *o that it is from gripes and similar symptoms, rather than from pain, that the patient suffers, it stands to reason that the use of fire is out of the question. G9. You have now all that I have hitherto discovered in the treatment of this disease. If any one object that there are many specific remedies for gout, I am free to confess that they 1 Pp. 448-9. 158 ON GOUT. lie beyond my knowledge, and I also fear that those who possess them are equally ignorant with myself. Indeed it is a sad thing, that a noble art like medicine should be thus dis- graced by the nonsense which either the ignorance or wicked- ness of writers lays out before the credulous. In almost every kind of disease, such things are cried up by those who make a trade of trifles, as if they were divine ; and, what is more won- derful still, this mad notion prevails not only in diseases which have a type, but in such also as are wholly unformed, proceed- ing from injury of the organs, or from some external accident. All this, which imposes upon men who are otherwise sensible, is well shown in those things which are commonly accounted specifics for contusions, such as spermaceti, houseleek, and the like ; the effect of which is only to divert the true method. This may be proved by any one who will only try how soon and safely such accidents may be cured by bleeding and purging, used alternately, until recovery ; those trifles, which are usually resorted to after the first bleeding, being wholly neglected ; and the sweatings also which go along with them being equally neglected as well. Of these, the only effect is to over-heat the parts before too inclined to inflammation, and so to endanger the life of the patient without reason. 70, Now if, when all the remedies which I have brought forward have turned out useless, I appear either deficient in sagacity or niggardly in my list of medicines, I will lay before my reader a long and full catalogue, collected by Lucan in his Tpa-yoTToSaypa ; out of which he may choose, either for inward or outward use, such as he pleases ; little doubting that he will find them just as efficacious as the greater part of those which are so highly praised by many people. In the Play in ques- tion, Gout is one of the dramatis persona, and she addresses as follows the pretenders to some secret remedies, whereby they profess that she could be overcome. Tig rt}v AVIK^TOV [/ SHTTTOTIV TTOVMV OVK dldf. YloSdypav rwv eni ^QovoQ fSporoJv ; "Hv ovTt \ifidvaiv CIT/IIC; tiXav, Oir TTttTc o oij3ov 7ToXv/ia(h;c ' ArTK\r)irtot;. ON GOUT. ir.9 'E ov yii(> ityvi) irpu>roi> tiv9pwTroi ytj'Of, ToX/fi(':KivTov, "AXXoi iiKoi>c 'pipovai rove tK rtX/tarwv, Xrfi^fXTi'ov itytibv, o\ ci v\\a HipniKuJ)', 'YooKvapov, niiKuva, /3oX/3ovc, olia, tyv\\iov, \ifiavQV, piL.av i\\i(36pov, viTpov, T/JXtv pir' oivov, yvpivqv, KO\\dp., K.pdfj.(3r]C, aTrityQov QvXXa, -yv-fyov IK ydpoti, 'SirvpdGovf; 6piiaf alybf, dv9pi!)Trov Koirpov, "AXfi'pa Kvdfiiav, uvQog 'Aaiov XiOov "E4/oo(Ti (jtpvvovf, /twyaXcif, aavpag, yaX<;, BaTpdj^ovc, ixiivaf, r/aaytXa^ot'C) dXwwtKOC- IloToj' /itraXXov ow irnrupaTai ftporoi^ ', Ti'c oi'^i X^^Ci iroiov ov civCpov Sdiepv ; Z(^a>i' aTravrwi' o, ro ^ ^t* tTrra TrXtioi'tf. "AXXof ^i irivwv n)v itpdv KaQaiptrai, "AXXof tTraoiOaTg tTriOtToJv tfnrai'^erai, 'lovHiriog trtpov fuapbi' i^fdft \aj3tav 'O f f Qepairiiav t\a/3t Trapa ri/c KOtpavov. 'Kyaj il TOVTOIQ IfUffl)' oifllilZtlV Xfyw. Kai ro?f 7roio(5 drvxovvTwv, MfXerat ck TTOVUV ical TO avvi]Qtg Toiif; TroCpaypuivraf Trnpa^iv9ti9v[iti)(;, w eri'y/c\?jjOO(, Aijatff9t 7r6viiJi>, El TO. COKTlBiVT OVK tTt\f.(fBr], Toig S' aroKjyroif Tropov ivpi Qtoc- ,fiivos KCII frKdnrrofitvof Toiov yap tv Todi Trpajfia. v. 322 sq.] ON GOUT. 161 i. e. " Lenera, vibique gentium celebrata, afferas nobis dolorem, Podagra, Levera, facilem, nou acutum, brevera, baud saevientem, Tolerabilem, facile desineutem, parum validum, ambulationes nou iiupedientem. Multi sunt modi miserorum, Sed exercitia dolorum et consuetude Fodagricos solentur. Ideoque aequo animo, O complices, Obliviscimini dolorum : Si ea quae placet non fiunt, Tainen etiam practer spem accidentibus viain invcnirc solet Ileus. Quivis sustineat Podagra laborantium Deludi ct derideri ; Talis enim hujus morbi natura est." 71. To conclude, the method which I here publish rests upon the evidence of the aforesaid phenomena; a method which I have followed both with myself and others, and experienced relief. As for a radical cure, one altogether perfect, and one whereby a patient might be freed from even the disposition to the disease this lies, like Truth, at the bottom of a well ; and so deep is it in the innermost recesses of Nature, that I know not when or by whom it will be brought forward into the light of day. Nevertheless, I hope that I have, in this treatise, con- tributed something towards the benefit of the human kind; even if I have only faithfully pointed out those rocks upon which both 1 and many others have suffered shipwreck ; and also if I have exhibited the best method hitherto known. More than this I do not promise ; however much the long train of thought, which has been all but forced upon me, may have induced me to believe, that some such remedy may at some future time be discovered. If such ever take place, it will re- buke the ignorance of dogmatists, and will show the great extent to which they have hallucinated, both in distinguishing the essences of diseases, and in choosing the medicines for their cure. Of this we have a sufficiently clear instance in the dis- covery of that great specific for intermittent fevers the Peru- vian bark. For how many years did sagacious men exercise their arts in investigating the causes of these fevers ! and how readily did each adapt his practice to the theory which they had respectively worked out ! Vet, how little sueh practices verified theories may be collected from what is fresh in the memory of sill, viz. the habit of referring the different species 11. 11 162 ON GOUT. of intermittents to the different redundant humours in different parts of the body, and of directing the treatment towards the alteration and evacuation of them. That all this was an unfor- tunate and fruitless attempt has been shown in nothing better than in the success which attended the use of the bark itself : by means of which we can, at the present time, regardless of all humours, and careless in the way of diet and regimen, carry our point, simply by observing the proper method in the exhi- bition of the powder ; failing only when, without any necessity, we confine the patient to his bed during the time that he is taking it ; and even then, such is the power of the remedy, that, notwithstanding the inconvenience which is caused by the warmth of bed in encouraging the fever, the recovery will, generally, take place in spite of the obstacles that should pre- vent it. Meanwhile, until a discovery, which may fairly be expected to delight me above all other physicians, shall have been made, take the present little work in good part. If others do not, I know the temper of men too well to be much disappointed. I also feel too strong a principle of duty to despond. If the severe torment, the inability to move, and the other bodily evils which I have suffered for the greater part of my life (to say nothing of the pecuniary loss which my bad health, by so often preventing the exercise of my profession, has caused), shall have the effect of procuring for others ease and freedom from pain, I shall consider that I have reaped some advantage from the afflictions of this life, when the time comes for changing it for a better one. ON DROPSY. 1. EVERY age, and each sex, is attacked, at times, by dropsy. Women, however, are more liable than men. Men it takes hold on as they decline in years ; women when they get past child-bearing if they be barren, sooner. The first sign is that the ankles pit under the finger, more evidently at nightfall, less towards morning ; a sign worth more with men than with women, inasmuch as the latter are liable to the same occurrence when they are with child, and when their courses arc checked. However, even with men it is not absolute. An old man of a full habit, who has laboured many years under asthma, may be suddenly freed of the same, and that at winter time. Now in such a case the muscles of his lower leg shall become greatly swollen, and this swelling shall be a swelling like dropsy. This shall be worse in winter than in summer, worse in moist weather than dry. Furthermore, it shall go on without any notable inconvenience, except that it >hall continue till death. Laying this, however, out of the question, and speaking generally, we may say that, with men, swollen legs and puffy ankles arc signs of the supervention of a dropsy : the more so in proportion as they cause a difficulty in breathing. Such a swelling will day by day grow larger, so that the feet shall be unable to contain the water. Then the water will go to the legs and thighs, and lastly up into the belly itself. This will swell, and swell, under the gradual aillux of blood and serum, until its whole capacity is filled up. It shall so come to contain several gallons. " (Jnii data porta riiiiut." At times, they press upon the navel, and vent themselves by an umbilical rupture. J. In the mcanuliik- three symptoms accompany this disease 1G4 ON DROPSY. a difficulty of breathing, scantiness of urine, intensity of thirst. The difficulty of breathing arises from the pressure of the water on the diaphragm, and the check so put upon its natural motion. The urine is passed sparingly, because the serum of the blood, which in the ordinary course of Nature should be excreted by the urinary ducts, is diverted into the cavity of the abdomen, and into such other parts of the body as are fit for its reception. The thirst comes from the putre- faction of the serous colluvies, which lies over its time in the body, contracts heat and acridity, and subjects the patient to fever and thirst as aforesaid. 3. In proportion as the patient enlarges in the part which the disease has appropriated, he falls off elsewhere ; and, at length, when the vast mass of water can no longer be contained within the cavity of the abdomen, an attack takes place upon the nobler parts, and the citadel of life, so that the sick man dies, as it were, under a cataclysm. 4. The cause of the disease, generally speaking, is weakness of the blood. This is not able to convert into its own substance the matters taken as aliments from without. So it vents them upon the extremities and the pendulous parts of the body, and lastly into the abdomen itself. Here, as long as it is dispersed here and there in small quantities, Nature fabricates for it small vesicles to contain it. At length it oversteps all bounds, and is limited by the peritoneum only. 5. Now the weakness of the blood is promoted by excessive bloodlettings, by evacuations of all sorts, by any long illness; and, most especially, by the terrible habit which we have amongst us of swilling spirituous liquors ; whereby the natural ferments of the body are destroyed, and the spirits dissipated. Hence it is that tipplers and gluttons are most attacked by this ailment although, for an ailment, it is a cold one. On the other hand, the use of water is equally mischievous in persons who have long been used to generous beverages. 6. In women a matter to bear in mind there is a dropsy of a wholly different origin, arising from impurities or ob- structions collecting in one or other of the testicles, and so gradually subverting its crasis. In the said testicle, Avhere the focus of the disease is to be found, the tunic enlarges in a AVOII- derful manner; and when this is all but bursten. Nature then ON DROPSY. If,;, developes certain vesicles for the reception of the humours. Of these, one or more may give way ; and then there is an out- break of water into the cavity of the abdomen, and the symptoms are the symptoms which we have already described. Concerning this, however, we have already written. 1 7. Besides this, there are two sorts of tumours amongst women which take the form of dropsies. One is a preter- natural excrescence of the fleshy part within the belly, which will raise the abdomen just as truly as it is raised by water. The other arises from wind ; and this last, in other matters as well as in the swelling which it causes, looks like pregnancy. This is commonest with widows, and with persons who become advanced in life before they are married; and such persons, partly on their own judgment, but much more on that of their oracles the midwives fancy the motion of a foetus, sicken like women in the family-way, swell about the nipples, have a show of milk, and, on the strength of all this, order baby-linen for the child that is to be, and prepare things for its reception into the world. The belly, however, decreases as it increased, and so undeceives them. It is neither of these ailments that I am treating of. 8. The true and genuine indications of treatment, arising truly and naturally out of the aforesaid symptoms, consist in our attempts to evacuate the water lodged in the abdomen and elsewhere, and to restore the strength of the blood, so that fresh returns be guarded against. 9. As to the evacuation of the water, it is of great im- portance to observe that all those cathartics which act either slowly or inefficiently, do more harm than good. All cathartics that purge the body are, as such, inimical to Nature, and, to a certain degree, weaken and damage the blood. Hence, unless they pervade the body rapidly, and get carried off readily, they agitate the blood tumultuously, and swell the tumour. They disturb without eliminating things that, like Camarina of old, 2 were never meant to move. This is shown by the legs and feet of such unfortunates as have in such manner been blandly and gently purged. Hence, in order to do good by means of 1 Disscrtat. Epislolaris, 92. [G.] ' . . . "falls iiuii(|iiam conccssa inovcri Apparel Camarina procul." .Ku. iii, 7di). 166 ON DROPSY. cathartics, we must ask whether the patient's body be amenable to their action, or the contrary. On this the whole case hinges ; making all the difference as to whether the cure is to Be effected with great trouble, or with next to none. As often as hydragogues have to be used, we must carefully inquire how far the system is obedient to their action or not. This can only be got at by finding how far it has been amenable to catharsis at other times. When there is any particular idiosyncrasy in this respect, the life or death of a patient may depend iipon it ; and this may all turn upon the observation of the physician. To look only to the present sensible tem- perament and state of the body is wrong. Men who are perfect athletes often yield easily to purges. Men who are thin and spare often resist them. Hence comes a caution which applies not only to hydragogues, but to all other sorts of cathartics. I have seen hypercatharsis arise from mild medicines ; and this because the doctor neglected his duty, and forgot to inquire as to the susceptibility or the non- susceptibility of the constitution to the action of purgatives. Now, above all other diseases, dropsy requires quick and sharp purging; so that catharsis per ewiKpaaiv, which suits other diseases does not suit it nay, does harm ; since it increases rather than diminishes the swelling. Hence, an over-strong dose is better than one which is ever so little too weak ; the more so, as we can always resort to laudanum, the surest check to over-purging. 10. With all cathartics dedicated to the cure of dropsical patients, one thing above others must be looked to, viz. that the waters be drawn off at as rapid a rate as the patient's strength will bear. Indeed, he should be purged every day, unless prevented by debility of body, or by the over-action of the previous doses. Then a day or two may be missed. If we purge only at long intervals, however great may have been the previous evacuations, we give the water time to accumulate. Of this time it will take advantage ; and so that, like men who are unable to make use of a victory, we shall be beaten by the disease, and that shamefully. Again, there is danger lest the waters by being confined within the viscera turn foul, and so corrupt the parts that hold them. Finally, and this is no light matter there is a tendency in the previous purgations ON DROPSY. 167 to excite, disturb, and predispose to mischief the waters that are left behind, so that these arc all the more dangerous for not having been left quiet. For these and other reasons, the intention that we must first satisfy is the one in respect to the serous colluvies which is shut up within the system. This we must get off as speedily as possibly. And at this, without let or stop except in some urgent case of necessity must we strive and labour. 11. It is a fact learned by practice, that hydragogues, from their own peculiar action, when exhibited alone, in cases where there is an indisposition to their action, fail to operate; and that this failure is not amended by increasing the dose. All that then ensues is no catharsis, but a disturbance of the blood, whereby the swelling enlarges rather than decreases. Hence, in such systems, the only advantage of hydragogues lies in the extent to which they will act as auxiliaries to milder medicines. Nevertheless, where they do act, they act very quickly and very effectively. 12. Hence in those who yield easily to purgatives, syrup of buckthorn even alone will bring away an abundance of water ; and it will bring away water alone ; abundantly, indeed, but without disturbing the blood, and without deepening the urine, as other purgatives would do. All the inconvenience arising from the syrup of buckthorn is that it creates excessive thirst during its action. With those, however, Avho are acted on with difficulty, it will bring away but few dejections, and those few anything but as watery as they should be. 13. I well remember the first case of dropsy to which I was called in. It was twenty-seven years ago ; to a respectable married woman, living at Westminster, named Saltmarsh. I never saw such a dropsy ; and 1 could not believe in such a size of an abdomen. I gave her as was then the practice an ounce of the syrup before dinner. The quantity of water that this brought away in stools, and the little disturbance it excited, are incredible. The patient scarcely lost strength. This gave me confidence to continue it every day. This I did, missing a day occasionally when the patient seemed somewhat weakened. The waters were thus drawn ofT by degrees. Tfie belly decreased, and the patient whollv 168 ON DROPSY. 14. In the confidence of youth and inexperience I fancied that I had now a sovereign remedy for dropsies : one that would subdue all alike. A few weeks undeceived me. I was then called into a female patient who laboured under a dropsy that had supervened on a quartan ague. I prescribed the syrup ; repeated it ; exasperated the disease. After a time, as the water remained the same, the purging continued, and the tumour increased, the lady changed my services for those of another physician, who after my dismissal gave her more appropriate remedies, and cured her accordingly. 15. When it is clear that the patient is of that habit in which the milder purges will neither act quickly, nor without occasioning distress, the stronger ones must be tried. Hereon I have already remarked that, though few of them, single- handed, will answer our purposes, when added as adjuncts to the milder ones they are efficacious acting, as it were, as a spur. For constitutions like the one in question the following potion has often been prescribed by me with success : R Tamarinds, 555 ; Senna-leaves, Jij ; Rhubarb, 5ss. Boil, in spring-water, to Jiij. Strain, and dissolve in the liquor Manna, Solutive syrup of roses, aa jj ; Syrup of buckthorn, 555 ; Electuary of rose-juice, 5ij. Mix, and make into a potion. This is only fit for strong patients. These it will purge when other means have failed. Or R White wine, Jiv ; Jalap (very finely powdered), 5j ; Ginger (in powder), gr. x ; Syrup of buckthorn, 5]. Mix, and make into a potion; to be taken the first thing hi the morning, and to be repeated each or every other day, according to the strength of the patient. 16. The next formula is useful where the patient will not well bear repeated cathartics ; inasmuch as it warms and strengthens him between the purges. ON DROPSY. If)!) R Jalap-root (bruised), Herniodactyle, aa % ^ss ; Crude scamniony, jyij ; Senna-leaves, 5ij ; Liquorice-root, Aniseed, Caraway-seeds, aa Jss; Wormwood-tops, Sage-leaves, aa a handful. Steep in three pints of cold usquebaugh. Strain as wanted for use. Take one spoonful at bedtime, and two next morning ; increasing or diminishing the dose according to its action. 17. Two medicines yet stand over; and they bear the bell from all that I have named or know I mean elaterium and the crocus metallorum. They are eminently drastic. Elaterium, or the fecula of the wild cucumber, acts in very small doses, and acts powerfully exciting the bowels, and bringing away serous and watery faeces ; so much so, that two grains (generally speaking) are sufficient for most constitutions. My own usual formula is one scruple of the pihdae e duobus, with elaterium, made into three small pills, and taken early in the morning. 18. As to the infusion of the crocus metallorum, an ounce and a half, or, where the system is very resistant, two ounces, given in a morning, and repeated according to the strength of the patient (although, at first, it only gives promise of clearing out the impurities of the intestines), at last, acts on the water. Of this, and of the pressure it exerts, it relieves the abdomen. Having acted as an emetic, it acts as a purge down- wards when the vomiting is over. No wonder so great has been the agitation and concussion both of the stomach and bowels, arising from the afflux of waters hedged in all around them, that the ducts allotted by Nature for their evacuation require an inordinate effort for their thorough opening. How- ever, if the aforesaid vomit have not sufficiently unloaded the lower belly, I am in the habit of adding, after the third or fourth dose of the simple infusion, the syrup of buckthorn as well as the rose-juice electuary. I do not do this often; when I do, the form is thus : II Aquae cardui Benedict!, ^iij ; Infusion of the crocus metallorum. ^ss; Syrup of buckthorn, ^ss ; Rose-juice electuary, ^ij. Mix, and make into a potion. 170 ON DROPSY. 19. That there exist small, blind passages, whereby the waters in the cavity of the abdomeii become transferred to the sur- face of the intestine, is clear from the facts now noticed. Every day's observation tells us that hydragogue medicines bring away, in the shape of stools, whole volumes of abdominal water, just as naturally as if they had belonged to the intes- tines themselves ; a knotty question of physic, concerning which I can only quote the best and wisest of physicians. " Some say, both physicians and sophists, that it is not possible for a person to comprehend the art of healing, unless he know what man is, how he first existed, and in what way he ivas framed. 1 But I think that, upon these matters, all that has been said by sophists or physicians, as well as all that has been written about Nature, has less to do with the art of healing than ivith the art of painting." 20. Lest, however, the divine old man who has thus written should become liable to the imputation of error, and lest em- pirics should find an excuse for their ignorance, I will state plainly, that, as far as I can discover by the most attentive thought, and from what I observe in practice the touch- stone of those who profess medicine it is very necessary for a physician to know well and thoroughly the structure of the human body ; so that he form true ideas concerning Nature, and concerning the causes of certain diseases. How can one who knows not the structure of the kidneys, and the ducts that lead from them to the bladder, see his way to those sym- ptoms which arise from a calculus ; impacted either in the pelvis or the ureters ? A surgeon should know anatomy equally. Otherwise, how can he in operations avoid vessels and other parts which he should keep clear from ; and which, if divided or injured, will kill the patient? Nay, he cannot even set a limb, or reduce a dislocated joint to its natural position, unless he have curiously inspected and well understood the bony framework of the body, which is called the skeleton. 21. So necessary is this knowledge, that he who wants it is like a man fighting blindfold, and a mariner without a compass. ovm ct TiviQ Kai 'Ijrpoi KCU aofyiarai UQ OVK tvi Cwarbv 'ltjTpiKt}v ilptvai, r) oliv o ri tririv dvOpioTrot;, Kai o/rw tytvtro Trpu>rov,Kai OTTUQ avvnrdfi]' TOVT'HIIV jJLtv ouft TI.VI t'ifj~ai noQitrry / 'l/jrjO(p / yf yp(>. To return. "Whatever may be the pores and passages 174 ON DROPSY. by which the water of the abdomen may find its way into the intestines, I am quite sure that vomiting is a way to get rid of it and that not only by stools downwards, but by sickness upwards, and by the way of the mouth ; since, after two or three vomitings, the waters appear to come forward not in the way of secretions, and as if under the secernent power of the medicine, but fully and freely, and in full streams, as if all the bolts and bars that kept them close had been unloosened. This is shown by a fact of frequent occurrence, viz. that between the intervals of the vomiting they will thus break forth and come away. 27. Last August a poor woman aged 55, asked my advice. She had had ague a long time, and was then in prison three years ; where she suffered much from cold. I never saw so swollen a belly. I gave her an ounce and a half of the infusion of the croc, metal, every day for three days ; then every other day, according to her strength, until she had taken six doses in all. At first, after the vomiting, the urine was suppressed ; then she made it occasionally, but very seldom. The oftener she took the emetic the more water she got rid of, and, towards the end, more by stools than vomits. However, after the third dose, the tumour began to diminish and subside, and at the end of a fortnight for I had her body measured with a string she was thinner by three feet, and had, from above and below, got rid of some gallons of water ; so that she could now lay her head on the pillow in a recumbent posture, and turn herself on either side. Before she had to have her shoulders raised, in order to breathe. The emetics acted so violently as to bring on what is called the vapours. When these had gone so far as to make it unsafe to attack the disease further by the same remedies, the water still remaining in sufficient quantity to swell the belly, to fluctuate when the patient moved, and to leave the marks of the finger on the ankles, I was then forced to treat the re- mainder of the disease by cathartics. Hence I gave either the purging potion of my loth section, or some other hydragogue. This I gave often or seldom, as there was strength to bear it, and as the vapours ceased to trouble her. Such was the case at times; since cathartics iu tin: action on the bowels will bring them on as well as emetics, only not so often. ON DROPSY. 17 j In this way I went on until she had wholly recovered. 28. Meanwhile I chiefly observed the following facts : 1st. On those days when the bowels had a holiday, she fre- quently excreted a vast mass of water from her bowels, and, at last, by the urinary passages, as much as a gallon ; although the fluids I allowed her drink were under two pints ^er diem. From this I concluded that all the ways and passages were well open. 2dly. It was remarkable that, when the cure was nearly completed, as often as any vapours arose from the purges, and created trouble, the belly swelled most in its upper parts, as if filled by a fresh supply of water. This I thought could not be the case, since I allowed but very little to drink ; so that I put it all to the flatus brought about by the disturbance or aram of the catharsis. The event proved me right. Even on the days when she got rid of a gallon of water, if it were also a day on which she was purged, the swelling took place soon after ; and it continued without abatement, rising up towards the throat, and affecting the respiration, until the body, no longer harassed by the purges, returned to its natural state of rest. When this happened, the tumour and other symptoms went off; nor would they return until brought on by a fresh purgation. Finally, I must make this additional remark, viz. that the woman in question, being more than 55 years old, had not had any menstrual discharge for some years. It now, however, broke out abundantly ; and this loss of blood helped the previous evacuations in bringing about a vast number of hysterical symptoms ; violent pains in the back, and in the region of the spleen, headache, and a terrible cough. Add to all this, that great as was the loss of water by vomiting, by stools, and by urine, instead of there being no appearance of any being left behind, the belly was just as swollen as it was before the evacuations began. Hence, to allay these movements, which lasted as long as a week after the last purge, and gave trouble, I was obliged to prescribe an ounce and a half of diacodium for four nights running; and. unless sleep followed within three hours, the dose was to be repeated. By these means all became quiet, and the tumour disappeared. 2'J. This 1 have noticed, that inconsiderable tumours are 176 ON DROPSY. less acted on by the crocus metallorum than large ones, when there is true ascites, and water in great abundance. The volume of fluid itself, shaken up and agitated by the action of the emetic, is a wonderful help towards its own evacuation. Hence, unless the belly be largely swollen, purging from below is the better form of evacuation. 30. There is also another medicine, which, although very common, cures a dropsy on the principle we have just dealt with, viz. three handfuls of the inner bark of the elder, scraped from the wood, in two pints of milk and water, boiled down to a pint. Of this decoction take half in the morning and half in the evening, every day, till recovery takes place. This ex- cites both vomiting and purging, just like the crocus metal]., and expels the disease upon the same principle ; not by any specific action, since, if it do neither one nor the other, or either, or both, only sparingly, it is useless. On the other hand, when one of its two effects follow, it does much when both, wonders. 31. At times the water is thrown down not only into the legs and ankles, but even into the cavity of the abdomen, and remains unimpregnably fixed, both under purging and vomit- ing up or down. Now, when the swelling supervenes upon a continued phthisis, or arises from any taint or putridity of the viscera ; or is dependent upon a relaxation and destruction of the tone (so to sav) of the blood : or is referable to an ex- \ V I * haustion of the animal spirits ; or is attended with the sanious discharge of fistulas in the fleshy parts ; or, finally, has been brought on by excessive debility, arising from evacuations these being salivations, sweatings, purgings, low-living, and the over-strict regimen of venereal and of other lowering diseases, in such cases the patient will be so far from bearing the ca- tharsis, that his blood will be impoverished, and he will him- self be the worse for it. When matters stand thus, the whole treatment will turn upon the improvement and restoration of the blood and viscera; and amongst the means of so doing, over and above the usual restoratives, change of air, or exercise in the open air, such as the patient can best take, is the best fitted to meet the indications. This breathes a new life into the jaded spirits, and recalls the excernent organs to their allotted duties. ON DROPSY. 177 32. At times, independent of any such causes as these, neither purging nor vomiting will clear off the water. This happens when the patient is of a weakly frame, or when she is a female liable to vapours and disorders of the animal spirits. Here cathartics are out of place, and emetics still more so. Hence the work must be done by diuretics. Numerous as these are in medicine, I know no efficacious ones ; indeed, I know none of any sort, except the lixiviated salts ; the vegetable that sup- plies them being unimportant. However, as no herb is easier got than the broom, and as the plant has a good name in dropsies, I soak a pound of the tops in four pints of Rhenish wine, cold ; and throw in a handful or two of the leaves of wormwood. I then strain, and order four ounces to be taken in the morning, at five o'clock p.m. and at bedtime, every day, regularly, as long as the swelling lasts. By this remedy alone have I seen dropsies that were called incurable cured ; and that with patients whose crasis was too weak to bear purgatives. 33. We have evacuated the water, the proximate cause of the disease. Let us now look to the second intention of our method : since, unless the fresh formation of fluid can be guarded against, by a long and continued use of restorative and corroborant medicines, whereby the primary cause of the com- plaint, the weakness of the blood, may be remedied, we have only done half our work. With young subjects, indeed, it may happen that, after the due evacuation of the waters, conva- lescence may follow without further treatment; when the pres- sure being removed, the natural heat of the body is sufficient, and when it does, single-handed, the work of the doctor. With patients, however, whose age is advanced, and whose strength is broken, it is quite necessary that, as soon as the water has been thoroughly cleared off, recourse should be had to such simples as warm and invigorate the blood. 34. Amongst such means, but in addition to others hereafter to be mentioned, are the cautions noticed in my 'Treatise on Gout/ 1 both in respect to remedies and in respect to the six non- naturals, with a single exception in the matter of wine. In gout this must be shunned. In dropsy it is so far from being hurtful, that it is sufficiently beneficial to be recommended as 1 Sec $ 29. [(;.] n. 12 178 ON DROPSY. an ordinary drink. However, the two diseases have so much in common, that the same restorative medicines are antidotes to the original cause of the disease. Meanwhile it must be owned, both from the manifest phenomena of the disease, as well as from the juvantia and l&dentia, that these, as well as other chronic diseases, originate in indigestion and weakness of blood; and also that our knowledge of them is limited. Indeed we only get to the rind of the matter. The essential differences, and the specific depravations of the humours arising from the particular forms of indigestion (all being shapes of wow-digestion), are mysteries which we cannot unravel. Just so, also, are we unable, in acute diseases, to determine the va- rious specific forms which arise from one and the same cause inflammation of the blood. Hence, in these diseases, and in chronic diseases as well, we are compelled, in the absence of specific remedies, to direct our treatment towards some general cause of the particular ailment, rather than to the essential nature of the disease, varying our method, occasionally ; some- times following the clue that Nature gives us, when she shows the method that she herself uses in the elimination of disease, and sometimes following the evidence of experience in respect to the sorts of treatment that the different diseases yield to most readily. 35. Now, towards the fulfilment of this intention, viz. the strengthening of blood whether it be by means of purging, diuresis, or vomiting, that the water have been evacuated, nothing is more necessary than that the patient should be allowed wine during the treatment, or, if not wine, good ale ; all that need be guarded against being, that he be not put on his wine before the passages for the water have been set free " Qua data porta ruat." Thin and cooling liquors best please the palate, and ease the thirst, which is almost always present : whilst, in the way of mischief, they create phlegm, and engender fluid. Allow them therefore but rarely. On the contrary, so potent are generous liquors spirits being exccpted that, in many cases, they promote the recovery single-handed. This they do best at the beginning of the disease, and before the belly has swollen vcrv much ; and they do it, all the more, if they have been ON DROPSY. 179 impregnated with warm herbs. With those who suffer from the res angusta domi, and who can ill afford expensive drugs, strong beer, with horse-radish root, wormwood-leaves, garden scurvy- grass, sage, lesser centaury and broom-tops, steeped therein, has done the work of a whole drug-room. Rich men may take Canary wine, with the like herbs in soak; a draught being taken twice or thrice a day between the above-named remedies. If this is not liked, a little wormwood-wine may be taken instead. Of this the patient should swallow nine spoonfuls after two drachms of the digestive electuary, this last being taken three times a day, i. e. in the morning, at four in the afternoon, and at night. This electuary far surpasses all other restoratives in satisfying the intention now under consideration. 36. It is highly important that the patient drink as little of any weak liquor as possible. It only helps the water. Some have been cured by total abstinence from drink. At any rate, whatever is drunk, should be drunk sparingly. Still, on account of his thirst, the patient is allowed as follows : He may wash his mouth with cold water acidulated with the oil of vitriol. He may keep tamarinds in his mouth. He may suck a lemon. But he must not swallow any of these, since their coldness favours the disease. 37. First amongst the corroborants is iron. It invigorates and warms the blood. So does garlic. I have cured dropsies with garlic alone. 38. A dropsy that has only swollen the feet, and deposited a little water in the belly, need not be cured by emetics and catharsis. The aforesaid restoratives will be enough. Whilst, however, M T C are attacking the disease by corroborants, or even by lixiviated salts, no purging, mild or sharp, must go on at least so long as the strengthening of the blood is in hand. The purge will pull down what the restorative has built up. A man may be convinced of this, even against his will, if he will only observe what often happens, viz. that a swelling which had decreased under restoratives increases under catharsis. Whilst we are evacuating the Avatcrs, restoratives may be given occa- sionally. Whilst we are restoring the blood, evacuauts may be given in no case. 31). We may, however, satisfy both indications without curing the patient; that is, we may clear ofV the water, and 180 ON DROPSY. strengthen the blood against its reproduction. In vain. It often happens that ascites last many years. When such is the case, it so soaks and parboils the intestines, that it perverts their substance. It also wholly corrupts the bowels and the parts about them, generating preternatural glands, and vesicles turgid with sanies. In short, it converts all the contents of o * the abdomen into a mass of putrefaction. This is shown by dissection in the bodies of those who have died after an inve- terate dropsy. A disease thus advanced is beyond the aid of art. Never- theless, as the physician can never tell the exact amount of intestine mischief, he must do what he can with evacuants and corroborants, allowing neither himself nor his patient to despair. This he must not do ; inasmuch as, in many affections, Nature, who day and night watches over our frame, and advises for us better than we advise for ourselves, after the fuel of the malady has been fully cleared away, has, in a manner wonderful to witness, so contrived for the comfort of the patient, as to guard him against the destructive remains of the disease. Hence, far as an ascites may have gone, and injuriously as it may have worked, all we can do is to treat it as it would have been treated in the first instance. 40. Topical or external remedies do no great good. Those in the form of cataplasms or discutient liniments are least hurtful. Still I fail to see their discutient action on the water. Other remedies (so-called) are not only useless, but mischievous. Such are all strong cathartic unguents applied to the belly. Such, too, are blisters on the thighs and legs, in such parts where the skin is tightest, and Avhere it seems as if water wanted drawing off. Both methods are bad. The first determines the cathartic action of the simples to the muscles and membranes, and so hypercatharsis arises, which no remedy can check. The blis- ters a favorite application of the quacks wholly extinguish the natural heat, sufficiently impaired already by the press of the water,and the deficiency of the animal spirits. This brings on gan- grene, an over-common occurrence. Nothing, indeed, is more incurable than a wound, however slight, in a dropsical leg, especially if it hang down ; and that because the parts are so soaked with moisture, that the continual running stops the con- glutination of the wound. ON DROPSY. 181 In my mind, too, tapping and acupuncture (famous as they are) are just as useless and just as dangerous as blisters. 41. To conclude however much this disease, when turned into confirmed ascites, is hopeless, it is still clear, that, treated by the aforesaid method, provided that the viscera be uninjured, it is as manageable as many other ailments with a less bad name. 42. As to the man who accuses my remedies of being simple and inartificial, I may accuse his manners and honesty, in dis- liking that others should be so treated, when, for his own part, he would be glad that himself, his wife, or his children, might, in case of sickness, be cured by even the most contemptible means. Such a trifler deceives himself: " cquitans in aruadinc longa." The pomp and dignity of the medical art is less seen in neat and elegant formulae than in the cure of diseases. 43. This is what I have had to say concerning these two diseases. Perhaps they arc the last I shall deal with. As to what I have written, I shall be sorry if any man take them up to read once and once only. Let him read and re-read them ; let them lie " altu meute repusta. 1 ' Then, and then only, will his advantage bear any proportion to my toil. "Whether they be true or false, can only be known by him who tests them by the same practice which supplied them and then, he must be as careful and as curious as I have been before him. If, in the little I have written, I have been no man's follower, but Nature's only, I am sure that the wise will give me their sanction : since such best know that there are two sorts of men who more especially are lets and hinderaiices to medical progress. 44. First come those who, adding nothing to medicine of their own, are angry at the most trifling additions of another ; masking their sluggishness under the show of a reverence for the ancients; from whose practice they dare not swerve the breadth of a nail. Yet how can we argue that whilst other arts touching the interest and benefit of mankind have been advanced by moderns, without discrediting the ancients, medi- cine alone was perfected by them? Could the mariner's 182 ON DROPSY. compass have been discovered, except by the neglect of those authorities whose best means of navigating were the constella- tions, and the coast-lines ? Is not the naval architecture of western Europe better than that of the shipwrights who made the navies of Actium ? And if these be so, are Antony and Augustus, therefore, bad captains? The improvements of moderns upon the ancients are innumerable. And those who take credit for them are no more supposed to violate the repu- tation of their ancestors, than the son who increases his paternal estate insults the father who left it. 45. Another sort affects the title of uncommon wisdom, by overloading practice with impractical speculations. There are bird-witted men who do so ; will-o'-the-wisps rather than true lights. Nature has given them just Avit enough to tra- duce her with. Sense enough to show that she is only to be understood through the testimony of experience she has denied them. So much is human genius limited, by the limits of human nature, that we just know what our five senses teach. Prudent a man may be. A philosopher in the most august sense of the term no man can be. The whole philosophy of medicine consists in working out the histories of diseases, and applying the remedies which may dispel them ; and Experience is the sole guide. This we attain by observing (as noted else- Avhere 1 ) the method that right reason dictates the suggestions of common sense rather than of speculation. POSTSCRIPT. 1 . I trust that the reader will excuse me if I add an observa- tion of some importance both in the diagnosis and treatment of fevers, which, if it had not escaped my memory, would have appeared elsewhere. I have observed that, every year, from the beginning of winter to the middle of spring, a fever sets in ; which, in respect both to its symptoms and treatment, is clearly different from the stationary fever, stationary meaning 1 Epist. Respon., i, 1C. [G.] POSTSCRIPT. 183 the epidemic of the generally prevalent constitution. Hence it must be classed amongst the inter currents. 2. It seems to originate from the coldness of the air, com- bined with its thickness and moisture. This closes the pores of the skin, which checks the transpiration, and so overloads the blood with a serous colluvies. Hence, it becomes putrescent from confinement ; and then is easily determined, either by cold or any slight occasion, to fever. If this colluvies be copious, the fever is of the nature of the bastard pcripneumouy already described. 1 If scanty, the symptoms are as follows 3. The patient, during the first day or two after the attack of the fever, is hot and cold by turns. He complains of head- ache ; also of pain in the limbs, and general discomfort. The tongue is white. The pulse is nearly the pulse of health ; the urine turbid, and deep red ; the blood pleuritic. Cough is generally present ; whilst the difficulty of breathing, tightness of the chest, and splitting pain of the head during the fits of coughing, the true signs of bastard peripneumony, are absent. Hence as the fever, although in many points like a peripneu- mony, is not so altogether, it may be called the winter fever. 4. This disease at first looks like a simple cold : yet, if ill- treated, it brings on a long chain of evils, and lastly death itself. Keep the patient to his bed, heat him with cordials, sweat him for the sake of loosening the fever, in short, follow the com- mon line of practice, and delirium, lethargy, weak and irregular pulse, with a dry tongue, and red or even livid spots, will show themselves. Some call these signs of maliynity. Truth calls them signs of bad treatment. The fever is inflammatory enough of itself. Bedclothes and cordials make it more so. Hence the animal spirits are forced into an inordinate disorder, the morbific matter drives to the brain, and all things go to wreck and ruin. 5. In treating this fever, I lay down as my object, the re- vulsion by means of bloodletting, and repeated catharsis of those loads of phlegm which the winter has accumulated. To do this, I bleed, at once, to nine or ten ounces. Next day, I order some such bland purgative potion as the following : 1 Mcd. Ol>s., VI, 1. 184 ON DROPSY. R Tamarinds, 355 ; Senna-leaves, 3ij ; Rhubarb, 3ss. Boil, in a sufficient quantity of water, to three ounces. Strain. Add to the strained liquor Manna, Solutive syrup of roses, aa Jj. Mix, and make into a potion. Afterwards I repeat this twice, with the interval of a day between each purge, provided that any symptoms remain. The night after I order an ounce of the syrup of poppies. The days when I do not purge I prescribe, in case the cough remain, the pectoral decoction, with the oil of sweet almonds, syrup of maiden-hair, and syrup of violets to be taken occasionally. If the fever be violent, I allay the blood by the emulsion of the cold seeds, and by the following julep : R Water-lily water, Purslane-water, Lettuce-water, aa ^iv ; Syrup of lemons, 355 ; Syrup of violets, Jj. Mix, and make into a julep ; to be taken ad lib. 6. Meanwhile I order the patient to keep out of bed during the bedtime, and to abstain from animal food. Then, after the second purge, I allow a little weak chicken-broth. This, how- ever, should be remarked, if any serious symptoms, such as difficulty of breathing, splitting headache while the patient coughs, or any other such symptoms, indicative of bastard peri- pneumony appear, we must then resort to bleeding and purging, repeated till the disappearance of the symptoms, according to my directions in the chapter on that disease. However this amount of fever is but rarely seen ; one bleeding and three purges being in general all the evacuations required. But enough on this head. I have thought it right to say thus much, for the sake of separating this winter fever from the common stationary fever, epidemic to any particular con- stitution. From this distinction being either unknown or neglected, many men, to my certain knowledge, have died. SCHEDULA MONITORIA " Nou fingendum, aut e.vcogitandum, sed inveniendum, quid Natura facial, aut ferat." BACON. TO TIIE MOST EXCELLENT AND LEARNED CHARLES GOODALL, M.D., FELLOW OP THE COLLEGE OP PHYSICIANS IX LONDON. MOST LEARNED AND ILLUSTRIOUS SlR, When. I determined upon publishing the observations which I had lately made concerning the fever of the present constitution, I selected you as one to whom I might dedicate ray little work for two reasons first, because you have always been my good friend, constantly by my side, and one whose patronage 1 has protected me against all who have opposed me. This you did not so much from any merit of mine, as from a feeling with which your spirit is deeply imbued : " incoctuin generoso pectori honestuni."* Such is the greatness and probity of your disposition, that it has ever prompted you to adopt, without hesitation, all great and ascertained truths, and to treat my own individual doctrines as such, at a time when all the world were sharpening their tongues against me. In all this there was nothing at which I should be angry nor am I angry since so many wicked quacks, puffing off their fictions and crotchets, in order to spread abroad their fame, and imposing so often on the world, made it necessary that men of judgment and sagacity should not admit at once, and without examination, those things which I pub- lished ; repugnant as they were in many things to the received mode of practice. Nevertheless, my debt to you is the same, and I deem it my duty to show publicly the extent to which I am moved by gratitude ; a virtue that becomes human nature in its noblest form more than almost any other. Kven as kings strive to illustrate by means of titles and honour those ' Compare Dibscrtat. Epist., 5j. [(!.] a I'tTiius, Sat. 188 SCHEDULA MONITORIA. whom they favour, so doth Nature, upon those whom she wishes to raise above the low and common herd of men, impress the sense of gratitude, as the mark and character of a loftier genius. 1 Another reason why I particularly inscribe this work to you is this : the familiar and daily intercourse which has had place between us so many years, has informed you, more than any man living, of the amount of labour which I expended upon those notices respecting the history and cure of diseases which were the subjects of my previous dissertations trifling as they were. These I published, not all together, and once for all, but with intervals of some years between, according as I could obtain my knowledge. So that I look upon these observations of mine as lame and imperfect, and am more likely to take shame than credit for them. Be this as it may, one thing may be urged in my excuse. Although the period of thirty years, during which I worked diligently at the observation of disease, may to some seem a time wherein more progress could have been made than was made by me, I nevertheless venture to assert, that although such time was more than enough to confound the brain with theories, fancies, and fictions collected out of books theories, fancies, and fictions, which have as much to do with treating sick men as the painting of pictures has to do with the sailing of ships four times the space would not have been suf- ficient for accomplishing the whole circuit of the wide domain of medicine. For my own part, I did my best, according to my humble abilities, to collect my observations as accurately as I could, and to print them at once ; so that if there were any good in them, the public might have the advantage of it without delay. Having done my duty in this way as well as I could, my mind is at ease, and I am in nowise anxious as to what place my writings may take in the opinions of other men. This only will I add, that just as the person who neglects them altogether will not injure me one jot, so will he who reads them no oftener than once get no great good for himself. However, waiving all these matters, I entreat you, in your singular humanity, to take my little treatise in good part, so that it may stand as a witness of the respect I pay you, a re- spect which others pay you also, though they know your good 1 Compare Dissert. Epist., 40. [G.] SCHEDULA MONITORIA. 189 qualities less than I do. No one, I am sure, will think that in this I natter you. I have 110 need to do so. I am only free to confess, openly, that just as you are second to none in the art you practise I speak within bounds so also you are one whose equal I have never yet met for thorough honesty and integrity. Long may you live when I have ceased to be. High may you stand in medicine. May you show posterity how the difficulties under which the art of medicine groans and labours can be overcome a higher aim than mere scraping together of money for your sons and sons' sons, a low and sordid ambition, if contrasted with the noble one that I have just mentioned. Labour at this, and you erect a superstructure on the foun- dation that I have laid ; yet so labour, that when you are better taught by a more repeated and a more extended experience, you may freely and openly correct those errors in my own observations, whether of history or treatment, into which human imperfection may have led me. In doing this you will not hurt, after death, the memory of one who, during life, post- poned all things to the advancement of medical knowledge no matter by whom : provided always that it was sought for in the sure and steady methods of treatment, and not in the erudite commentaries, with which we have long been filled and sick- ened, upon the nature of diseases. Health and long life to you, from your most respectful friend and servant, THOMAS SYDENHAM. September 29, 1G8G. SCHEDULA MONITOBIA. ON THE APPEARANCE OF A NEW FEVER. 1. ALTHOUGH my advanced age, and weakened constitution, may fairly give me a title to spare myself the pain and labour of any intense thought and meditation, I am unable to resist the desire of serving the world at the expense of myself. This I do by notifying to my countrymen the appearance of a new form of fever, varying in many and material points from those which have been prevalent under any previous constitution. 2. It must be remembered that, A.D. 1677, the intermittent fevers first showed themselves (and that in autumn) ; that they grew rife and common more and more each year (became indeed more epidemic), that, at length, they reached their climax, and lastly gradually disappeared ; so that during the latter years of the present constitution, they could hardly pass at all as epide- mics. It must also be remembered, that the last two years of the last constitution were years wherein the winter was most excessively severe especially the last but one (1683), when the cold was more severe than it had ever been within the memory of man. So cold was it that the noble river Thames was frozen up, so that carriages could pass upon it, and shops be opened, and business done just as in a street so great was the number of persons who were on the river, Avalking on the solid ice as on a pavement. And it bore them easily. The next year (1 68 1 ) was not so cold, either in respect to duration or intensity. It was not, however, much below it. Then, at the beginning of the year 1685, the frost broke up in February. And then was the time when the fever, which I am now prepared to treat upon, arose. I deem it a new species, and one quite different from those of the last eight years. 3. Whether this change in the constitution be due to the manifest change in the properties of the atmosphere, which has taken place during the last two winters, is more than I know : NEW FEVER. 191 inasmuch as I am certain that atmospheric alterations, so far as they can be determined by any sensible characters, may be very considerable, and yet no new species of epidemic originate. However much one year of a series may differ from another in this respect, the fever produced may be the same throughout. Seriously attending to this, it suggested itself to me (as I have notified elsewhere), 1 that changes in a constitution arose from some certain secret and hidden alterations taking place within the bowels of the earth and pervading the atmosphere ; or that, perhaps, it might chiefly depend upon some influence of the heavenly bodies. Nevertheless, I must remark, that when the depuratory fever of 1G61 took leave, there was a remarkably sharp dry frost, which bound up all things, and never gave way until March was far advanced. Then, as soon as the ground began to thaw, the pestilential fever first, and the plague next set in. Be this, however, as it may, the fever that I now speak of showed itself first in February 1685, and, during the current year, is ravaging all parts of England, as a true epidemic ; bad here in London, but worse in many other places. 4. When I was first called in to this fever, I imagined that it belonged to the genus of intermittents, rather than to that of the stationary fevers ; the intermittents being fevers which arise promiscuously, in one year as well as in another. Indeed, I looked upon it as nothing more than the bastard pcripneumony which I have already described in my book on ' Acute Diseases/ 2 The only difference was this. In the present fever some of the more pathognomonic symptoms of fever did not always occur. By these, I mean the violent cough, the racking pain in the head during the fits of coughing, the gid- diness from every slight motion, and the excessive dyspnoea, all of which generally attended the bastard peripneumony. On these grounds, when my publishers asked for a new edition of my " Treatises," I thought it well to append my notions upon the present disease in the form of a Postscript. In this I now think I have been in error. The fever, as I then observed it, was the fever of the bastard peripneumony, which occurs in all winters alike. The summer following it re- appeared ; but as the summer generally dispels all such 1 Tract. I, 5 35. 3 SOP Mod. Ohscrv., VJ, J. 192 SCHEDULA. MONITORIA I. peripneumonies, whilst the fever continued, I have become aware of my error, and now accordingly I reduce the fever in question to the fever of a new constitution. 5. The symptoms, as far as I can ascertain them by a dili- gent investigation, are, and have been, as follows : the patient has chills and flushes in turn ; frequently complains of pain in his head and joints ; has a pulse not unlike that of a healthy man ; has blood, which, when drawn, is not unlike that of pleurisy ; has generally a cough. This cough goes off early or late, just in proportion as the attack of the disease has taken place a long or a short time after winter. What applies to the cough applies to all the other symptoms which the fever has in common with a favorable form of Peripneumony. There is pain also in the neck and fauces, less than in quinsy, but still pain ; and it comes on when the disease first makes its attack. The fever is continued. Nevertheless it has exacerba- tions towards bedtime ; just like a double tertian or a quo- tidian. The patient is in danger if he always lie in bed no matter how light his bedclothes be. So doing, he may deter- mine the fever to the brain, and convert it into a frenzy. So liable is this to be the case, that, of its own free will, with- out any encouragement whatever, the fever will so transform itself. Still the frenzy, when it does occur, is not of that in- tense and ardent kind that patients suffer from with smallpox and other fevers. It is rather a tranquil delirium, where the sick man mutters inconsistently and occasionally. If cordials be used unseasonably, and if the regimen be overheating, petechiaj will show themselves ; and with young and sanguine subjects there will be purple blotches. When these occur, we have the surest sign of a high state of inflammation, in all other acute diseases as well as in this particular one. Some- times, the so-called miliary eruptions are scattered over the body, not unlike measles, except that they are redder, and that, when they go off, they leave no such branny scales as may be seen after the departure of measles. If these come at all, they come oftener from being forced by hot bedclothes and cordials than of themselves. The tongue is dry or moist, according to the regimen enjoined. If it be dry, it will be brown in the middle, with a white fringe on each side ; if moist, white altogether, with a rough pale fur. The regimen chiefly deter- NEW FEVKK. 193 mines this. If over-hot, the tongue will he brown and dry. If not, white and moist. The same applies to the sweat. It depends on the regimen. If the patient be heated, the per- spiration will be clammy, and will flow from the head most. Furthermore, however much it may flow, the relief will be little a proof that such sweats are not critical. During the first days of the fever, a forced sweat will throw the morbific matter, not indeed into the head, but on the limbs. If, how- ever, the head be seized, and frenzy have set in, the symptoms of fever disappear all save the pulse, which is sometimes quick, sometimes slow. At length, however, when matters have been so mismanaged that the spirits are wholly thrown into confusion, an inordinate pulse sets in. AVith this there is jerking of the limbs, and then death takes place speedily. (5. As to the treatment, 1 may say, that those signs of peri- jmeumony which accompanied the fever of the February in which it appeared, induced me to venture to place the disease in that family. So I took to the treatment of peripneumony as described in my chapter 011 this disease, and in the aforesaid appendix. And, as this turned out well, both in those cases which my own ill health allowed me to visit, and in those where I recommended it to others, I thought well of it. Nevertheless, whatever might have been my motives for that practice, I now am satisfied that the fever in question is nothing more than a simple inflammation of the blood. This I infer, from the phenomena of the disease, and from the temperature of the year that followed the two cold winters. The winter, perhaps, of these years, has been no winter at all ; since it has brought with it no notable degree of cold. The treatment now becomes the treatment of the aforesaid inflammation. 7. On this principle, I bled from the arm to ten ounces ; since, however much the blood may be the blood of pleurisy, repeated bleedings are badly borne : unless, indeed, dyspnoea, and headache during the cough, connect the ailment more closely with peripneumony. Then, indeed, bleeding may In 1 repeated, and purging resorted to, until the symptoms ha\e \\liolly gone. This I have explained under the head of Peripneumony, and this I wUIi to be particularly noticed. H. In the evening, I apply an epispastic or blister to tl:e ii. l.'5 194 SCHEDULA MONITORIA I. nape of the neck. The next morning I order the following lenitive draught : R Tamarinds, ^ss ; Senna-leaves, 5'j ; Rhubarb, 5ss. Boil down to Jiij. Strain. Dissolve in the strained liquor Manna, Solutive syrup of roses, aa 3]. Mix, and make into a potion ; to be taken the first thing in the morning. This cathartic I order to be taken every other day, until the third time. At bedtime, after the purging, I order the fol- lowing, or some similar, paregoric : R Cowslip-flower water, ^ij ; Syrup of white poppies, 3J ; Lemon-juice (freshly squeezed), two spoonfuls. Mix, and make into a draught. To one point I always look most closely. I watch lest the tumult and agitation which purgative medicines create in the blood and humours of fever-patients bring the sick man to a state of coma since such may arise from the confusion of the animal spirits. This symptom is best guarded against by an hypnotic. Hence in the comatose fevers of the year 1673, I never dared to prescribe a cathartic, but contented myself with clysters, well knowing that purgatives at such a time would bring on coma. Had I, however, at that time, thought of the counter-influence of narcotics, it might have been different. 9. When there has been no purge, no hypnotic at bedtime should be allowed. It may check the operation of the purge of the next morning. This it often does ; sometimes stopping it wholly, sometimes limiting its action. In this, as in all other epidemic fevers, I make it a rule not to disturb the bowels at the beginning or during the stains of a fever, unless blood- letting have preceded. Violate this rule, and you Avill consign hundreds to the grave infants more especially. This caution I have given elsewhere. 1 10. Now it must be remarked, that although, generally speaking, evacuations may be used in the treatment of this fever, there are many instances where the patient especially if young or an infant after a single bleeding and a full purge, 1 Observat. Mi-din., V, 2, 9. 11. NEW FEVER. i;j;, recovers at once. The fever, in this case, is beaten ofl' at the beginning, and the patient is no longer to be fretted by reme- dies. At times, and that often, after such a recovery, the fever may come back after a fe\v days, and a relapse take place. Now a purge, repeated four times, will carry off this. When such relapses occur, they generally arise from aphthae, which beginning about the conclusion of the first attack, attain their height a few days afterwards, and then bring back the fever. So that this secondary fever is only symptomatic. It brings with it, however, an occasional hiccup, and this hiccup may last some days after the fever has gone. The hiccup, however, will go away too as the patient gains strength. This is to be noted ; because from such hiccup, coming on as the fever wanes, no danger need be apprehended. The only danger is from the mischievous oflieiousness of the treatment. Overload the patient with remedies and death will ensue. Both hiccup and aphtha?, one or both, if they show no signs of going off spon- taneously, but become protracted, are easily got rid of by the use of the Peruvian bark, i.e. of one ounce with syrup of red poppies sufficient to make an electuary, and given in the way that I have directed in my Letter to Dr. Brady, 1 with a draught of skim- milk to follow. Or the bark may be given as pills. This remedy I have found from experience to hit the mark better than any other, however vaunted always provided that the patient's strength be not broken by lying in bed. 1 1 . On the days when no purge is given I prescribe R Conserve of Lujula, Conserve of hips, iia TJ ; Conserve of berberries, ,^ss; Cream of tartar, 3] ; Syrup of lemons, q. s. Make into an electuary; to be taken in a bolus about tbe size of a nutmeg. Wash this down with six spoonfuls of the following: Purslane-water, Lettuce-water, Cowslip-flower water, iifi t-iij ; Syrup of lemons, ^s ; Syrup of violets, ;;j. Mix, and make into a julep. 196 SCHEDULA MOXITORIA I. {-*T Spring-water, Ib.j ; Rose-water, Lemon-juice, Best white sugar, aa Jiv. Boil over a slow fire to clarify. Take three ounces at a time ad libitum. Spirits of vitriol, cooling as it is, I always avoid. It is so styptic as to be ill adapted for diseases that should be cured by evacuations, to say nothing of its mineral character. 12. It often happens, especially towards the close of the fever, that under the method in question, the patient will occa- sionally melt away in spontaneous night-sweats. All the symptoms are much relieved by this. Nevertheless, we must not trust so much to the diaphoresis as to intermit the treat- ment ; since, if the patient give way too much, and too long to these same perspirations, the fever, which had been broken by the purging, will take fresh strength ; and if the diaphoresis be protracted beyond the time necessary for the full dispersion of the febrile particles, previously prepared thereto by the due concoction, the subsequent sweats serve only to light up the inflammation afresh. Hence, although those sweats which might come of themselves were, perhaps, critical, and helped towards the expulsion of such of the febrile matters as were prepared for elimination, others that came after them were, perhaps, only symptomatic, and, as such, did more harm than good. In one word, when such sweats came at night, and come spontaneously, a moderate warmth of bed is best suited for them. For this reason, the blankets should be neither more nor fewer than are used in health ; and no heating cordials should be given. All that the patient should do, is to lie in bed a little longer than usiinl next morning. After that let him be kept to the aforesaid method. 13. The diet is oatmeal-gruel, barley-broth, and roasted apples now and then ; and, after the second purge, a little chicken-broth. For the ordinary drink I order sinall beer (but not, by any means, warmed), and the white decoction (so-called) made out of an ounce of hartshorn shavings, boiled in three pounds of water, and then sweetened with the finest white sugar. 14. After the second purge there is no necessity, as above stated, 1 to forbid chicken or such like digestible meats. The 1 Sco 5 0. NEW FEVKR. 197 plan of treatment by means of purges gives us a latitude here, which would not be allowed otherwise. Moreover, after the last purge (provided the fever have burnt down, and that it do uot^take the type of an intermittent), three or four spoonfuls of Canary wine, night and morning, as well as after dinner, may be drunk. So doing, the strength comes back quicker, and fresh attacks of fever arc kept off. 15. Of all the fevers I have ever seen, this attacks the brain most, and cannot be detached from it without great trouble and danger. Hence I advise my patients not to undress for bed except for night. If ever they are so weakened by disease as to be unable to sit upright, I get them to lie on a bed or pallet with their clothes on and their head a little raised. And I allow no fire in the bedroom beyond what the patient is used to when well. 1C. This regimen must be kept to throughout in all cases of this fever, with the exception of lying-in women, during the first few days after delivery. With patients whom you attend, where from an over-heating regimen either pctechue or purple spots have appeared (or indeed any other signs of violent inflam- mation), it is absolutely a matter of necessity ; since, however much blood may be drawn, however cool the surface may be kept, however many cooling draughts may be thrown in, the fever will not be allayed before the patient has abstained from bed for a short time during the day. In bed, the heat of the circumambient air confined beneath the blankets over-excites. J5esides this, the position of the recumbent body drives the blood violently towards the head. Even when bad treatment has brought on a brain fever, and the brain fever has become so obstinate that it cannot be got rid of at once (it being unsafe to attempt to cure it by bleeding beyond the limits described, and by purges), it will at its own good time go away under the aforesaid regimen. To promote this there is nothing like shaving the head. This I always order; neither do I lay on a plaster. I only recommend a little cap to make up for the hair that has been shaved off, and just to keep off the external cold. By these means the brain is much refreshed and restored, so that by slow degrees it overcomes those hot im- pressions that excite frenzies. 17. \Vliat 1 have said about frenzies applies to coma, where 198 SCHEDULA MONITORIA I. the mischief flies to the head, and wherein, except the white tongue, there are no signs of fever ; so that the patient appears to enjoy an apyrexy. In this affection as in the other, purges, sweats, blisters, and the like, are not only useless but dan- gerous. Nay, such evacuations oftener bring death than relief. Hence, after the general evacuations of bleeding and purging, however much the symptoms may frighten the standers by, all may be left to Nature. Even though the patient lie a long time in a stupor, he will recover after a certain number of days, providing only that he do not tie himself doAvn to his bed, but get up every day, and lie a little on a pallet or sofa, with his clothes on. Meanwhile shave the head, and towards the end of the illness give three or four spoonfuls of Canary wine twice a day. But all this I have treated more at large in the fifth section and second chapter in my book upon Acute Diseases. 18. In respect to fever, the physician must not be deterred from the aforesaid evacuations, even if by chance he feel a jerking of the limbs and convulsive movements while he feels the pulse ; since in certain nervous affections bleeding and purging, even though often repeated, are not only harmless but necessary. I will mention an observation of this kind which I met with in a case of that sort of convulsions Avhich is called Saint Yitus's dance. I saw five ill at once, and I cured all by bleeding and purging at intervals. Concerning this disease I take this opportunity of saying a few words which may verify the truth of what I say. 19. Saint Yitus's dance is a sort of convulsion which attacks boys and girls from the tenth year until they have done growing. At first it shows itself by a halting, or rather an unsteady movement of one of the legs, which the patient drays. Then it is seen in the hand of the s:tine side. The patient cannot keep it a moment in its place, whether he lay it upon his breast or any other part of his body. Do what he may, it will be jerked elsewhere convulsively. If any vessel filled with drink be put into his hand, before it reaches his mouth he will exhibit a thousand gesticulations like a mountebank, lie holds the cup out straight, as if to move it to his mouth, but has his hand carried elsewhere by sudden jerks. Then, perhaps, he contrives to bring it to his mouth. If so, he will drink the liquid off at a gulp; just as if he were trying to amuse the spectators by his antics. NEW FEVER. lyy Now this affection arises from some humour falling on the nerves; and such irritation causes the spasm. Jlence the treatment is first to bleed and purge, and then to restore the strength. To this end I act thus : I bleed from the arms to seven ounces, more or less according to the patient's age. Next day I order half (or more) of the previous purgative of tama- rinds, senna-leaves, &c. ; the quantity being regulated by the age, habit, and aptitude for purgative medicines of the patient. In the evening I order as follow : R Water of black cherries, ;;.i ; Aqua cpileptica Langii, ^iij ; Venice treacle (old), 9j ; Liquid laudanum, tlpiij. Make into a draught. 20. This cathartic draught I repeat three times on alternate days, with a paregoric the same three nights. Then I bleed afresh ; then purge. So I bleed and purge, in turns, until a vein has been breathed three or four times, with purges pro- portionate this being regulated by the strength of the patient. All the while, however, I look carefully, lest, between the alter- nate evacuations, any bad symptoms should arise. The days when there is no purging I order l\ Conserve of Roman wormwood, Conserve of orange-peel, fifi ^j ; Conserve of rosemary, ^ss ; Venice treacle (old), Candied nutmeg, fia jiij ; Candied ginger, 5] ; Syrup of lemon-juice, q. s. Make into an electuary; of which take a part tin- >i/e of a nutmeg, every morning at five p. m. Wash this down with 1'ieony-root, Elecampane, Masterwort, Angelica, fia ^j ; Rue-leaves, Sage, Hctony, Germander, White horeliouud, Tops of It'SM'i' Ci'iitaun . <>l c Junipcr-lierrio, ~,\j ; Tlir I ind of 1 \\ (i 0 1 cured throughout the whole series of years from '77 to '85, by the Peruvian bark, attacked the present fever with that remedy. Now, reasonable as the practice was, experience has been more against it than in favour of it. As compared with previous years, it has failed. I have examined the facts closely, and the result at which I have arrived is, that even large doses have done little good. Hence, where recovery has really taken place, I have laid it to some piece of good fortune, rather than to the bark. So much has it fallen from its former influence. All this applies only to the fever that takes the guise of a quotidian. When, it takes the type of a genuine tertian, the bark is as useful as ever. This proves the difference between this and previous fevers. They are as far as the poles asunder. IJark and wine do no good here. Bark and wine did good be- fore, with the fever as well as with the fits. "21. This too must be noted. Whilst the present fever was raging during the summer (especially that of the present year), it showed its presence (in many cases) less by the true pathogno- monic signs of fever (heat, restlessness, &c.) than by gripings of the belly sometimes dry, sometimes with stools. Neverthe- less, it was fever that lay hid under this mask ; fever wherein the inflammatory exhalations of the blood, instead of forcing their way, as usual, towards the external parts of the body, turned inwards, towards the bowels of the lower belly, by the way of the mesenteric arteries. Sometimes they took the way of the cieliac arteries, and then they were deposited in the stomach. When this was the case, vomiting took place, especially after taking drink, or any solid food. Nevertheless, however much the fever may thus mask itself, the true and genuine method is the method that would apply to fever in its proper form ; and that in respect both to the bleeding and repeated purgation, except only, that when the fever so harasses the stomach as to render the patient unable to retain what he drinks, there may be given, instead of the mild purgative potion, the jriluhe cock'uc inajorcs, which, in doses of two scruples, never fail to find their passage out by the way of the intestines. These should be taken at four a. m., and the patient should sleep upon them. Then a somewhat full hypnotic should be allowed, e. g. one grain and a half of the solid London laudanum, with an equal part of gum-mastich, divided 202 SCHEDULA MONITOEIA I. into two pills, and taken the same night. Or else eighteen or twenty drops of liquid laudanum, in an ounce of barley-water, with cinnamon, or any other generous vehicle. From these the stomach takes strength. Besides which, it is less irritated from their lesser bulk. Hence it rises less against its medicines. Still, if, by any means whatever, the aforesaid purge and the diacodium can be kept upon the stomach, they are to be wholly preferred to the pills and laudanum. They do their work as well, and heat the body less. 25. Speaking of gripings of the belly, 1 here caution my countrymen against the effects of mineral waters, in gripes, diarrhoea, vomiting, or any other complaint of the belly and bowels, originating in fever. True, they are prescribed ; but they do harm, as frequent experience has taught me. So subtle and spirituous is the nature of fever, that such minerals serve only to disturb it. Hence, instead of the true symptoms that properly accompany fever, they bring in a series of ano- malous accidents, and these do nothing towards the extirpation of the disease. This I have often observed. 26. An observation that may save many from the grave is the following. Notwithstanding all that has been said, as often as the aforesaid gripings and purgings have taken the form of dysentery dysentery with blood and slime as well as gripes and stools the method of attacking the disease, by first evacuat- ing and then tempering the acrid humours, is too protracted to be safe. The cure of the dysentery is to dispose of it at once and to check it quickly and surely, by means of laudanum. Of the various kinds of astringents, and the various forms in which they may be taken, of clysters abstergent, and of clysters con- solidating, thrown up at sundry times of all this I say nothing. Dysentery is a sharp and formidable disease ; and when it has oi*ce become confirmed, you cannot proceed to purging. Do so, and the ailment will take strength, bring on an incredible ferment, distress the patient thereby, and possibly kill him. 27. When called in, therefore, I order about twenty-two drops of the liquid laudanum to be taken twice in the twenty- four hours out of plague-water, aijiia wirabHis, or some similar vehicle. If this, taken night and morning, be not enough to check both the gripes and the bloody stools, it must be taken ofteuer, and at regular intervals. NEW FEVER. 203 When the motions have become more solid and consistent the true sign of improvement and when the symptoms have been dispelled, I still think it safe for the patient to go on as before, taking oft' a few drops of the laudanum every time, until there is no need of any at all. Furthermore, I keep him to bed more than usual ; because, when paregorics are being taken, the slightest elevation disturbs the brain, unless the patient procure a good long sleep afterwards. 28. As to diet, if the patient have been used to wine, I allow him some Canary wine, well diluted with toast and water. This is to keep cool in a pitcher ready for use. The white decoction (i. e. hartshorn shavings and water) may also be taken freely. For food, barley-broth, boiled chicken, a poached egg, or any- thing equally digestible, is admissible. To a better diet than this, and to more generous drinks, the patient must, however, ascend by degrees. At any rate, no excessive vacuity or inani- tion must bring on cither the disease from which he is recovering, or any of the signs and symptoms peculiar to itself. This too must be noted that, although under the present constitution laudanum will subdue a dysentery single- handed, in those years when dysenteries were epidemic, and when they took the lead of other ailments, it was necessary to have recourse to previous and preliminary evacuations, for which I refer my reader to my chapter on dysentery. 1 29. Now, just as in the true and rooted dysentery it was impossible for the remedy, which was meant only for the fever out of which the dysentery arose, to clear oft' the dysentery at once, it is also impossible in the dysentery which I have just described. For instance, it sometimes happens that a person is seized with cold and shivers, succeeded by flushes of heat, and that these alternate with one another. Now this is a true sign of impending fever. Then he is tormented by gripings of the bowels, arising from the attack and access of the febrile matter. He ought now to be bled and purged, to the extent already indicated. Instead of this he Hies to some unknown cordials, takes them inwardly, and uses heating applications externally. lie; does this to dispel the wind, to which he attributes his discomfort. So he goes on, until the pain iu- 1 Mfd. Obs.TV., IV, :*, H. 204 SCHEDULA MONITORIA I. creases, and becomes, as it were, impacted in the bowels, from delay. Then the peristaltic motion becomes inverted and unnatural, so that their contents come upwards. Hence the torture becomes afflicting, vomiting becomes violent, and the disease proves iliaca passio. Hence, as far as the treatment of the fever, out of which all this originates, is concerned, the most that the physician can do is to proceed to the single prelimi- nary bleeding from the arm. As for the cathartics, however much you may administer them, they fail to act as such. They become emetics, and act upon the bowels the wrong way. So much are they thrown up by the mouth, that out of a great number of strong doses, the merest fraction will find its way to the bowels, and act upon them. 30. Matters being thus, I think it best to bleed at first ; then, an hour or two after, to throw up one of the more active sorts of clyster. The best of this kind known to me is tobacco- smoke, strongly driven from a large bladder through a pipe. This may, after a time, be repeated ; unless, indeed, the previous one have acted, loosening the bowels, and unlocking the way downwards. Failing this, difficult as it may be to work a way out, something more drastic must be tried : 11 Pilulae e duobus, gr. xxxv ; Calomel, 3j ; Balsam of Peru, q. s. Make into four pills ; to be taken out of a teaspoonful of syrup of violets, no other liquors being drunk afterwards, lest it be thrown up. Now if the patient reject this by the mouth, we must proceed as follows. Take twenty-five drops of liquid laudanum out of half an ounce of strong cinnamon- water, and repeat the same a few hours after. When, from the effect of this, the tendency to vomit and the pains of the belly have remitted, the previous cathartic may be given. By this time it will be retained and do its work thanks to the laudanum. If, however, the effect of the anodynes be so broken as to allow the tendency to vomit and the pain to return, the cathartic meanwhile lying idle in the stomach, all present hope of dejections from below must be abandoned, and recourse must be had to the paregoric first mentioned. This we must repeat every fourth or sixth hour until the bowels keep quiet, and the proper movement down- NEW FEVER. 205 wards be accomplished. During this time the cathartic, which has been kept in the bowel by the contrary motion of the in- testines, will have found time to effect a motion by the way of stools, however much the supposed opiates may have seemed to militate against such a result. At the very time that I am writing this, I have the case of a nobleman before me. He had severe ileus. The acrid humours that determined the disease and the retention of the sharp cathartics brought on aphtha;. These were got rid of by the use of the Peruvian bark, and by washing the month with the following gargle : II Crab-apple juice, Ib.ss; Raspberry-juice, ^j. Make into a juice. 31. The natural ducts are now open, and so the patient may have a holiday from purging, resting a fcAv days until the tumults of the bowels shall have wholly subsided. The time thus spared may properly be given up to the dilution and tempering of the heat and acrimony of the humour. This being done, the purging on alternate days may be taken up afresh, and kept on, as long as the least signs of fever remain. But enough upon these points. 32. If the patient be an infant, two leeches should be applied behind the cars, then a blister to the nape of the neck, then a purge of rhubarb out of small-beer. If, after the purging, the fever take the appearance of an intermittent, a julep with Peruvian bark, as recommended for infants in my chapter on the Intermittent Fever, 1 may be exhibited. 33. This is a place for remarking that, although infants arc equally liable to this disease with adults, and although their treatment is the same (excepting only such differences as are required by their tender age in the matters of bleeding and purging), it is still a matter of serious consideration whether the fever thus treated be really the fever of the present consti- tution, or one of another species. This is a matter to be deter- mined by a diligent study of the fevers of infants under all constitutions : since it is a well-known fact, that infants are often thrown into fever by teething, and tint such fevers arc not easily distinguished from those of another sort. As to the 206 SCHEDULA MONITOEIA I. treatment of these I have long been harassed in mind ; so much so, that it is only within the last few years that I have made out whether such little patients as I had charge of reco- vered through my skill, or from happy accidents. At length, however, I adopted a remedy of no great celebrity; indeed, one held cheap from its very commonness, but one wherein I was well-advised of its beneficial action. This met my wishes more than any medicine, however famous, with which I am ac- quainted. It is this : two, three, or four drops of spirits of hartshorn the dose accommodated to the age in one or two spoonfuls of black-cherry Avater. This, or some similar appro- priate julep, may be given every four hours, five or six times. 34. There is another symptom in infantile complaints, very different both from the fevers of different constitutions, and from the present, and very troublesome. It is a sort of hectic. This afflicts infants a long time. Those who suffer from it fall off, but without any notable heat. The appetite fails, the limbs and body waste. The simplest form of treatment is as follows two drachms of picked rhubarb, cut into squares, are put into a glass bottle holding two pounds of thin small beer, or any other liquid the infant may take of his ordinary drink. This is corked up, and kept to be drunk night-times and day- times, with food and without, as the case may be. When this is finished, two more pints of small beer are poured over the rhubarb, and when this is finished, the same is done a third time. The rhubarb has then lost its strength, and the child its malady. Now, lest the small beer of the first infusion be too strong of the rhubarb, and purge too much, the second pint may be added when the first is finished. Afterwards, how- ever, no fresh beer must be added until all that was first put in be drunk out. 35. To return to the fever of the present constitution. In this sort of fever, as in rheumatism and the other numerous diseases that are caused by evacuations alone, if AVC keep on with the aforesaid purgings and bleedings so pertinaciously as to wait for the disappearance of all the symptoms, we shall wait till the patient dies. It is by no means rare for certain unimportant symptoms, the remnants of the expiring fever, to continue during the disappearance of the disease. They create, however, no danger of a relapse, and as the strength comes NEW FEVER. 207 back, go off of themselves. Wliat if these be only the true progeny of the repeated evacuations wherewith the physician attacks the disease ? What if we may add to these the ina- nition arising from the denial of the accustomed food? AYhcn influences like these affect a system weakened and almost worn out by disease, you may have the vapours, as we call them, in men just as in women, and that for the same reason, vi/. a weakened, broken, and dejected system of the animal spirits. Hence, after the evacuations that clear off the disease, the pru- dent physician will hold his hand, and wait a little, to sec what Time, the best and most successful of doctors, may do with the lighter and less important symptoms. Generally, at the end of a disease of this sort they will give way to a paregoric, taken for two or three nights, at bedtime, with nothing besides, as I have ascertained by repeated observations. 30. This method far surpasses all that I have tried. If it fail in removing the fever, it makes it intermit. The work may then be done by Peruvian bark. To some, the catharsis may seem prejudicial. I atlirm, however, that, preceded as it always should be by bleeding, it restores the patient be- yond all other remedies. The purge, it is true, on the day it is taken, may, by disturbing the blood, and giving intensity to the fever, at first seem mischievous. The good, however, that follows more than outweighs this. Experience bears witness that catharsis, after bleeding, is the quickest cure. It clears away that foul colluvics by which, as by an antecedent cause, the fever was lit up ; or, if not, those humours which, without being absolutely peccant, were still so hot, concocted, and thickened, as to contribute much to its persistence. Besides these, it paves the way for a paregoric ; which always works better and more surely after the peccant humours, which would check its influence, have been eliminated. 37. Then, on the other hand, the method of attempting the elimination of the febrile matter by means of sweats, through the pores of the skin, has so much of trouble and delay, that it often protracts the fever to some weeks; and brings the patient to the verge of the grave, if not to the grave itself. Besides this, it entails whole troops of remedies throughout all the stages of the ailment remedies for the remedy rather than for the disease itself. How should it be otherwise'' The 208 SCHEDULA MONITORIA I. cure of the disease, which pre-eminently requires cooling mea- sures, is attempted by heating medicines and by a hot regimen. Nevertheless, the self-called professors of a misnamed art must needs make themselves free of all rules, despise the evidence of their senses, and tax their skill to transform a short and easy malady into one both long and difficult. Fluctus in simpulo is their motto. They have, however, as much need to do so as the sailor, who, with an open sea before him, must " Sail too near the sands to show his wit." All this may win him the credit of being a clever steersman, provided he save his vessel. Whether saved or not, he will not earn the name of a prudent man. 38. Upon these reasons I am induced to speak with a well- grounded confidence upon the superiority of the aforesaid method of treatment by means of bleeding and purging, over all other ways of overcoming a fever. Diaphoresis may, indeed, in a certain sense, be called Nature's own method ; a method whereby she expels the fever, and one which, for that reason, is pre-eminently genuine and appropriate. And so it is, as long as Nature does the work in her own way ; which is to digest the febrile matter in the first instance, and then to expel it gently, when thus duly concocted, by the surface of the body. As practical physicians have often seen cases where fevers arc driven off by sweatings, they have come to dogmatise over- confidently, and to lay down, as a general rule, that all fevers can thus be dispelled and that they ought to be so. This may be granted. Yet it by no means follows, that Art is so good an imitator of Nature as to follow her processes in this respect, and so expel fever by diaphoresis. In the first place, she knows not how the peccant matter is to be duly digested and concocted in the way of preparation for expulsion. In the next, even if this were known, there arc no certain signs that give notice of the due preparation being complete. Hence the fittest time for exciting perspiration must needs remain un- known. That a rash forcing of sweats, before the concoction is complete, is of all things the most dangerous, no one but a wrangler will maintain. The crude matter presses on the brain, and to promote this is to add fuel to fire. Hippocrates' maxim I have before noticed "Coctu non eruda sunt medi- NEW FEVER. 209 canda et movenda;" 1 a maxim which I believe applies to artificial diaphoresis rather than to catharsis. No one, however little may have been his practice, can have failed to see what numbers suffer, under the hands of old women and quacks, from this prepos- terous abuse of sudorifics ; whose plan is, to confine the patient to his bed, and force sweats, the moment lie complains of shivers and pains in the limbs the usual premonitory sym- ptoms of fever. Yet, so far is this from guarding against the fever, that it frequently makes it worse, and reduces it to a confirmed and rooted disease ; when, very likely, by the loss of a few ounces of blood it would have disappeared at once, and of its own accord. 40. Leaving, however, the qiiacks and old women, it is well known, that just as those sweats which come of themselves at the beginning of a fever are symptomatic rather than critical, so also are those that are forced wholly unavailing towards the cure. The two sorts are in the same predicament, i. e. both equally useless. Then, as Art knows nothing as to the fit time for eliciting them, she is equally ignorant as to the length of time they should last and be encouraged. Yet mischief will arise from prolonging it ; inasmuch as if the matter which creates the disease be got rid of before the diaphoresis have ceased, there is a loss of those humid particles whereby the blood should be cooled and tempered ; and thus the fever is both protracted and increased. It is clear, then, that all this is slippery ground. With bleeding and purging, however, the physician can use his judgment. Add to this, that in the latter treatment, even though the physician fail to cure, he incurs no danger to the patient ; whereas, in the sweating method, there is always danger unless there is convalescence. In such cases, being kept to the bed to say nothing about the effect of cor- ' dials beyond his usual hours, confounds the economy of Nature, and brings on convulsive movements of the limbs and other anomalous symptoms. These I do not describe, because they do not fall within the history of the disease. They arise, however, from the additional tumult and confusion wherewith Nature is oppressed, whenever we thus attempt the cure of the complaint. The vulgar, however, put all this down to the score of inuliynify. ' Uiiroi'a tpappaictvHv Ktn icifinr, fii/ w/ui. \\t\\. i, 22, I. iii, |>. 71 I.- <> II. II 210 SCHEDULA MONITORIA I. 41. Malignity. Whether this be a name of a real thing, or a mere idea, it is the opinion of the present writer that it has killed more men than gunpowder. Those fevers are more especially called malignant wherein a greater degree of inflam- mation is observed. Hence physicians have betaken them- selves, at once, to cordials and alexipharmics ; to expel, so to say, the venom through the pores of the skin this being what they mean, if they mean anything. Hence they adopt the hottest regimen for a disease that calls for the coolest. Smallpox, the hottest of all diseases, as well as certain other fevers, proves this. They fall into error, being, generally, misled by the sight of the petechise and purple spots, and other like phenomena. All these are really referable, in most cases, to the intensity of the inflammation ingrafted on the overheated blood. Still they are rare phenomena when they break out spontaneously ; and they do so only in cases of plague, or of smallpox of the confluent kind, a kind partaking of the most intense sort of inflammation. Here, indeed, we have livid blotches appearing in different parts of the body along with the pustules themselves ; whilst, at the same time, the patient is distressed by passing blood by the kidneys, and from the sur- face of the lungs; blood which has so been disturbed and excited by the orgasm of the inflammation that it breaks all holdings, arid finds its way by force to the cavities of the body. Now although the purple spots of the fever in question may not arise from a heat of blood so intense as that of the hemor- rhage just noticed, they are still the products of inflammation of the same kind, although less in degree. And, as often as there is no incurable excretion of blood, they easily give way to the cooling regimen. 42. Some persons may infer the malignity of a fever not so much from the purple spots, as from the fact of its having proved fatal in a manner disproportionate to the inten- sity of its symptoms, and the time of its duration. To these I would answer that the process has been as follows : on the first onset of the disease Nature was, as it were, so much dejected and oppressed, as to be incompetent to exhibit the natural and regular phenomena consonant to the disease ; so that all the phenomena which have shown themselves were anomalous. The NEW FEVER. 211 animal economy being disturbed and thrown down, the fever becomes depressed. Had Nature taken its own course, the fever would have been developed. A rare proof of this happened many years ago, in the case of a young man to whom I was called in. Although he seemed dying, the temperature in the external parts of the body was so natural to the touch, that, when I said that he was suffering from fever, his friends disbelieved me. However, he was so suffering ; the fever being unable to show itself visibly, from the great oppression of the blood, by which it was forbidden an exit, and so was smothered internally. I said that if he were bled, the fever would show itself. He ivas bled freely, and the fever did show itself. I never saw a worse. It yielded only to the third or fourth bleeding. 43. Now if the present reasons be insufficient to prove ab- solutely that my view is the right one, I shall be contented with the evidence of experience. This says that fevers like the present yield very slowly to the sweating treatment; which is enough since it is not reason but experience which teaches us what fevers are cured by diaphoresis, and what by other evacuations. As to speculative reasons, no wise man, who knows the nature of either men or things, will fail to see that there is no certain experiment by which they can be tested. He will, therefore, hesitate "jurare in verba magistri." He may also observe that matters of speculative reason are so varied and subtle, that a man may propound a theory, based upon sufficient arguments, or plausibly adapted to take the judgments of the lookers-on, and so extort their approval. After this, one more favoured by Nature than himself may take him up, pull down his fine and well-supported doctrine, and, by dint of a more cogent logic, prove that it is a mere brainworm wherein all belongs to fancy, and nought to Nature. Then he will introduce a new hypothesis of his own, more plausible, and more neatly put together. And this will last until some third disputant as much more knowing than the second, as the second was wiser than the first, step in ; and then it will die like its predecessor. So it will go on until it come to him 212 SCHEDULA MONITORIA I. who is the climax of all earthly wisdom. Now to find such a person, and to distinguish him from all others, is a hard matter unless, indeed, a person is mad enough to think that it is himself. But then there may be beings in those brighter orbs, which are scattered over the infinite expanse of the universe, whose intelligences far exceed those of finite man. Man, indeed, may so have his intellectual faculties shaped by Nature, as to be enabled to perceive not what is absolute truth, but only that which is necessary for him to know, and fitted to his nature. This applies to those whose medicine consists in vain speculations rather than in that solid experience which rests upon the basis of the senses. 44. Should any one object and say "but do not facts and experience show that fever is often cured by means wholly different from those which you recommend?" I answer, that a method by which the patient sometimes has his recovery ensured, and a method which generally cures, and wherein the practical phenomena incident to the disease are disposed of, differ from one another toto coelo. Thus, in smallpox, many recover under the hot, many under the cool regimen. How shall we decide ? Even thus. By one method I find that the more I heat the patient, the more I increase and promote the fever, disquiet, and delirium; by the other, the more he is moderately cooled, the more is his temperament allayed, and the less is he vexed by fever and other symptoms. To this I add, that the more the due temperature of the flesh, best fitted for the augmentation and development of the pustules, is preserved, the larger is the pustule; the converse happening when the patient is suffocated in bed. Putting these two alternatives together, the true method becomes clear. 45. Similarly, in the fever in question, I find that the more the patient is heated, the more he becomes liable to frenzy, purple spots, petechise, &c. &c., and the more the fever itself becomes attended with all sorts of irregular and anomalous symptoms. Take another patient, and treat him differently, and he escapes them. Reason now decides between the two methods, even when each cures. The simplest test, however, is the proportion of deaths, upon which I decline an opinion, from my unwillingness to make up a case for myself and my own views. NEW FEVER. 213 46. Thus much concerning this species of the fever. How long it will last I do not guess. It may be a spirituous and subtile beginning of somewhat else the germ, perhaps, of the depuratory fever, now exploded, but which the plague followed. There are phenomena which lead me towards this belief. Intermittents, properly so called, quartans more especially, still hang about ; whilst certain other fevers of the continuous kind have a tendency, especially during autumn, to take the intermittent type. I say little about the exacerbations of the present fever. In more cases than one they have looked like the paroxysms of mtermittents, more especially in the tendency to vomit ; hence I will give out nothing positive. How the depuratory fever began I know not. What I wrote upon it in my work on ' Acute Diseases }l was as follows : " How long a continued fever of this character had prevailed in the year 1661 I am unable to state. Up to that time I had found enough to do in observing the general symptoms of fevers ; I had not become aware that they were distinguished from one another according to the different erases of different years, or according to the seasons of one and the same year." 1 Sect. I, Chap. Ill, $ 4. 214 SCHEDULA MONITORIA II. ON THE PUTRID FEVER SUBSEQUENT TO THE CONFLUENT SMALLPOX. 1. As my advanced age and waning years, as well as my im- paired health, may, perhaps, deny me an opportunity of laying before the world such observations as I have lately made late indeed in my life concerning a fever secondary to the con- fluent smallpox, the reader will, I trust, excuse me if I add a few words about it, different as it is from the disease just described. 2. I have elsewhere demonstrated the difference between confluent and discrete smallpox ; showing how the latter is generally got over, without much medical assistance, and how Nature does the work herself, excepting only where diaphoresis and lying a-bed have been continually indulged in : what I wrote being as follows : l " In a case of discrete smallpox, the patient thinks that because he sweats freely, as (according to a previous statement) adults generally do sweat, all is going well ; he believes that the virus of the disease is passing off through the pores of the skin ; he keeps up this same sweat by taking cor- dials inwardly, and by heating diet ; he does this all the more readily because he seems at first to mend upon it, and because it tallies with the unfounded judgments of his friends. Now that which is eliminated by this diaphoresis is, in reality, the particles which should supply the elevation of the pustules, and the swelling of the face; so that, on the eighth day, the face, which ought properly to begin to swell, and to become inflamed in the pustular interspaces, becomes flaccid ; whilst the inter- spaces become pale. Meanwhile the pustules themselves may keep their colour and elevation, but this they may do when the patient is dead. Moreover, the sweat, which up to this time had flowed freely, now suddenly and spontaneously checks itself: the warmest cordials being unable to bring it back. In the meanwhile the patient becomes delirious, anxious, restless, distressed. He passes his urine frequently, and in small quan- 1 Med. Obs., Sect. Ill, Chap. II, $ 20. PUTRID FEVER. 215 titles. Within a few hours he disappoints the hopes of his friends, and expires/' Had he left matters to Nature, and taken to no regimen at all, he would have recovered, and that without danger to his life. 3. In confluent smallpox it is different. They create little terror at first ; unless, indeed, there be a loss of blood either from the lungs, or urinary passages during the first days of the complaint. Neither are they, at first, dangerous. It is when the disease draws to a close that the peril comes on. Then there is a sudden change for the worse, and it is mere chance whether life or death be the result. 4. Of the days thus dangerous the eleventh is the worst counting from the accession of the disease. It is the worst in the least crude form of the disease. In the second or cruder form the worst day is the fourteenth ; in the crudest form of all, the seventeenth. In those rare cases where the patient lives on till the twentieth, the pustules become so dried, thickened, and incrusted, that to detach them from the surface especially the face is beyond the means of art. However, on the sixteenth day, the patient generally begins to be in danger. His fever is worse, inquietude increases, and other symptoms set in at the same time symptoms which prognosticate death and that not distant. Here, unless Art save him, the patient dies. If he escape the eleventh, the two other aforenamed days still stand over as days to be feared. Every evening, so long as he lives, from the eleventh to the seventeenth, as evening draws in, he is harassed by a paroxysm of severe unrest, and death attacks him vi et armis. 5. I have given the reason for the difference of danger between the different sorts of smallpox. In the discrete kind, the phlegmonae, or inflamed tumours, such as are all pustuL s at their commencement, are few. Hence there is but a small quantity of pus to be thrown upon the blood, according to the laws of the circulation, at the time when they begin to ripen. Hence there is no fear of the fever being excessive. The amount of pus is but small ; so is the impression which it makes on the blood. Hence, too, Nature can regulate it. In the confluent smallpox, on the other hand, the whole body is covered with these phlegmonae ; which afterwards become little abscesses : and so much pus on those days wherein, under the guidance of 216 SCHEDULA MONITORIA II. Nature, the pustules attain either their height, or their due maturity is brought back through the veins into the blood, and so great a quantity of putrid exhalations from the whole surface of the body now under suppuration finds its way into the sys- tem, that the fever thereby excited beats down the powers of Nature, and then the patient dies partly by the fever, partly by the poison that has tainted the mass of the blood. 6. Wherefore, when danger arises from the number of the pustules, whilst there is a chance of recovery in proportion as they decrease, common sense, as well as reason, suggests to the skilful physician the propriety of using all his efforts in repress- ing the subtile and inordinate inflammation, rather than, at the beginning of the disease, by propelling it violently by hot regi- men and cordials; means which assimilate the whole system to the morbific matter contained in the blood, and convert the whole substance of the body into a focus to the disease. Hence he first draws a little blood from the arm, in case he have any suspicions, from the youth of the patient, from his habit of heating himself with generous liquors, from sharp pains in any part of his body, or, lastly, from excessive vomiting, that the smallpox coming out is referable to the confluent species. He then gives an emetic, and aims at the same ob- ject. Now, as nothing so heats a patient, and so promotes the over-abundant assimilation of the variolous matter, as continued lying in bed, I forbid him to do so during the day for the first six days from the invasion of the disease, or for the first four from the breaking out of the pustules ; by which time all the eruption has shown itself. After this I keep him to his bed to the end of the disease ; but I do not allow him more or thicker blankets than he usually sleeps under, nor yet a fire in the room ; whilst I do allow him the liberal use of thin small beer, and of other cooling, grateful drinks. 7. Since, however, even under the most moderate regimen, flushes, delirium, and troublesome disquiet will frequently occur, I order an opiate every night, to be taken a little earlier than usual, inasmuch as in this disease a paroxysm or aggravation of the heat and disquiet appears every evening. Now, this method is very fit both for guarding against any excessive crop of pustules (the chief cause of danger, as I have shown before), and for en- suring a due growth and proper ruutimition for those that 21 ON BLOODY URINE ARISING FROM A CALCULUS IMPACTED IN THE KIDNEYS. 1. HOWEVER little it may be the part of a wise and cautious man to scatter his observations abroad, when they rest only upon the experiences of his own proper person, I still think that no fair judges will be offended at a man, like myself, who has suffered long and severely from bloody urine arising from a calculus impacted in the kidney, being so far moved by com- passion towards his fellow-beings, who may also be fellow-suf- ferers, as to point out those remedies common-place as they may be, and cheap as they may be held which have in any degree assuaged his sufferings. 2. A. D. 16GO, I was attacked by gout ; and the fit was both far severer, and far more lasting than any one which has pre- viously afflicted me. On account of this, I lay, during the summer, either in or on a softish bed for two months con- tinuously. Towards the end of the attack I began to feel a dull, heavy pain, principally in the left, sometimes (though rarely) in the right kidney. As the gout went off, this pain in the kidneys stuck to me, warning me of the condition of those parts at intervals, as yet tolerably endurable, and by no means severe. That acute pain which follows the course of the ureters in the direction of the bladder, and that violent vomiting which is the attendant of a nephritic paroxysm, I had yet to experience. Still, however much such signs of a calculus in the kidney might be wanting, I still had good reason to believe that such was the case ; and that, from being of a size too great to pass from the pelvis to the ureters, it caused the symptoms in question. That this was no vain fancy was shown many years afterwards. In the winter of 1G76, after a long walk, imme- diately upon a thaw following a most excessive frost, I passed blood in my urine; and this became, afterwards, habitual, as often as I either went a long way on foot, or drove in a carriage (no matter how slowly) over the paved streets. On an nn- paved road, however, I might drive as far as I chose-, and no such harm would occur. 222 SCHEDULA MONITORIA III. 3. The urine which I then excreted, although it took the ap- pearance of nearly pure blood, after a time, and when the bloody portions had settled at the bottom of the chamber-pot, became natural in appearance, and clear on the surface. In the way of treatment, I took care to be freely bled from the arm, and, after some general purges, I resorted to the use of a variety of refrigerant and astringent medicines. Meanwhile my diet agreed with the treatment, and all acid, sharp, and attenuant liquors were avoided. Neither this nor any of my numerous resources did good ; so that fearing to provoke the protrusion of the stone (which I thought was large) by the use of mineral waters, I lost all hopes ; the more so because I had observed that some aged men of my acquaintance had hastened their end by attempting in vain to cure the disease by such remedies. I therefore made up my mind to try no further ; and only guarded against the affection by avoiding, as much as I could, all motion of the body. 4. "Recollecting, however, at last (and that by accident), how wonderfully some sung the praises of the lithontriptic virtue of the seeds of the ash, I imagined that if the seed had all these virtues, it was no more than likely that the manna of the ash had them still more ; the manna of the shops being, as we are taught by that most excellent botanist Mr. Ray, as well as by other writers, no etherial honey, and no heavenly dew ; but rather a liquid exuding from both the leaves and trunk of the ash trees that grow in Calabria ; of the truth of which Mr. Ray was assured by a very learned physician, whom he met during his travels in Italy, who had, himself, often gathered it from the leaves and twigs, after they had been carefully covered with linen ; the manna being the concrete juice. (See Ray's f Cata- logue of English Plants.') With the intention, therefore, of making the experiment, I drank two ounces and a half of manna, dissolved in a quart of whey, taking now and then, during the time of the purging, a little lemon-juice. By this means I quickened the purging, which is generally slow, and rendered the manna more pleasant to the stomach. It is impos- sible to say how much benefit I derived from the use of this medicine ; although the kidneys, instead of being in continual pain, as before, were simply affected with a dull, troublesome BLOODY URINE. 223 feeling. Hence, as it had answered so well, I repeated it, at stated days, every week, and continued it for some months ; during which time I found myself so much better after each purge, that I could at last bear the rough shaking of a car- riage so thoroughly was I liberated from the symptom. This lasted till last spring. When, however, that season drew nigh, having suffered from gout during the winter, and from the unusual inactivity of body consequent thereon, the bloody urine returned. Here I hesitated, doubting whether I should again betake myself to the purging, since, during the late years, the whole substance of my body had been so perverted into the seat and fomes of gout, that a cathartic, however mild, was certain of bringing on a long attack of the disease. At length it occurred to me, that if I were to take a paregoric every night after each purge, by which the tumult excited by the cathartic would be allayed, I could safely resume my original method of taking manna once in the week. I therefore took, in the morning, two ounces and a half of manna, dissolved in two pints of whey, and in the evening, upon going to bed, I added sixteen drops of liquid laudanum to some thin small beer ; and so I repeated the manna and the laudanum twice a week, six times. After that I used the manna only once in the week ; the mass of humours being so freely drawn off by the purge, that there was less danger from the gout. My reason then dictated, that if the manna were endowed with any dissolving or lithontriptic power, it needs must be, that a strongly astrin- gent medicine like laudanum, should, to a certain extent, im- pair its powers. Hence I thought it better to omit the hypnotic, since I was now taking a purge only once a week. 5. In this method I continued some months, always dedi- cating the same day in the week to the catharsis ; and allowing myself, on no pretence whatever, to depart from it. Although from the first dose of this remedy the pain in the back remitted as before, nevertheless, within a short time after, the repeated purging brought on signs of gout, which threatened war, some- times in the limbs, sometimes in the bowels. The laudanum, however, strongly repressed these attempts of the disease. Now as this method did good thus far, I determined to persevere in it, both for the sake of guarding against a recur- rence of the bloody urine, and of diminishing the fomes of the 224 SCHEDULA MONITORIA III. calculus. This also proved successful. From the time when I first published this treatise the hemorrhage stopped, and I wholly laid aside the marina. 6. As to purging if, when there is bloody urine, nothing but a lenitive cathartic, such as the manna, be used, and if such be only given according to the method above delivered, I must now retract the opinion which I published in my treatise on Gout ; viz. that it is unfit for gouty persons to be purged, either at the beginning, the declination, or during the intervals of a fit. " nee si raiserura Fortuna Sinonem Finxit, vanum etiam mendacemque improba finxit." 1 It had not then come into my mind that the fit, which was occasioned by the disturbance of the purge, could be checked by giving an hypnotic towards night. Nevertheless, if we look to the gout only, all evacuations whatsoever do much harm, and, for that reason, are by no means to be admitted, unless the aforesaid symptom decidedly require the use of them. 7. Concerning the regimen and manner of diet which seem suitable for those who labour under either of these diseases, I add the following remarks ; being unwilling to pass by anything which may be of use to such as are afflicted like myself. On getting out of bed, I drink a dish or two of tea, and ride in my coach till noon; when I return home, and moderately refresh myself (for moderation is all in all) with some sort of easily digestible meat that I like. Immediately after dinner, I drink somewhat more than a quarter of a pint of Canary wine, to pro- mote the concoction of the food in the stomach, and to drive away the gout from the bowels. After dinner I ride in my coach again, and (unless prevented by business) am driven out for two or three miles in the country, for change of air. A draught of thin small beer serves for supper, and I repeat this, even after I have gone to bed, and am about to compose myself to sleep. I hope by this julep to cool and dilute the hot and acrid juices lodged in the kidneys, whereby the stone is occa- sioned. Both at this time, and for dinner, I prefer the hopped small beer to that which is not ; for, although the latter may, ' .Kn. ii, 79. [G.] BLOODY URINE. 225 from its greater smoothness and softness, be fitter to carry off the stone from the kidney, the former, on account of the styptic quality which the hops impart to it, is the less apt of the two to occasion sandy and stony matter; in uuhopped beer the substance being more muddy and slimy. I take to going to bed early, especially in the winter ; nothing being better than early hours to accomplish a full and perfect concoction, and to pre- serve the order and tenor due to Nature. On the other hand, late watchings lessen and corrupt all the concoctions of such old men as have been long suffering under some chronic disease, and inflict an all but incurable wound upon their vital principle. To prevent bloody urine, I take care, as often as I drive any distance over the stones (for on the common road I can take any journey without discomfort), to drink a free draught of thin small beer, upon getting into my coach, and also, if I am out long, before my return a precaution which has always been sufficient. 8. In respect, however, to gout, I will add this one ob- servation. During one of these later years, from some error in respect to the six non-naturals, a retrocession of the gouty matter befel me, the signs of which are great discomfort, a tendency to vomit, and some pain in the belly. The limbs, meanwhile, become of a sudden free from pain, and can be moved with more than the accustomed ease. In this case I drench myself with more than a gallon of posset, or else of thin small beer; and, as soon as I have got rid of the whole by vomiting, take a small draught of Canary wine, with eighteen drops of the liquid laudanum, and, going to bed, compose myself for sleep. By this method I have escaped imminent death more than once. 9. Now, although it may scarcely be becoming for a man like me, concerning whom it matters little to any one whether he be alive or dead, to mention himself so often, I do so with the wish of being of service to others whose life is of greater weight and moment than my own. 10. Lastly, I must notice that those who, either in stone or gout, are in the habit of incautiously taking their manna out of chalybeate waters, throw themselves into great danger, inas- much as, although, when thus exhibited, the manna acts both with greater rapidity and with less nausea, these benefits are more than counterbalanced by the disadvantages. n. \"> 226 SCHEDULA MONITORIA III. If the calculus be of such a size that it cannot be propelled through the ducts of the ureters into the bladder, chalybeate waters generally bring on a fit, which will continue, to the great pain and peril of the patient, until the calculus shall have gone back into the pelvis. Hence, chalybeate waters can only be taken safely when the patient is assured that the stone is small enough to either find or make a way along the ureters ; knowledge which, as far as I know, is to be obtained by one means only. This is by considering whether the patient have at any time before suffered from a nephritic paroxysm, accom- panied with its usual severe pain in each kidney propagated along the ducts of the ureters, and with excessive vomiting. If so, it is certain that instead of a single large stone in the pelvis there is a mass of small ones, one of which, at a time, finds its way into the ureter, and causes a fit which lasts until the stone is pushed forward into the bladder. When this, however, is the case, nothing is more efficacious, both for guarding against the growth of the smaller calculi, and for favouring their protrusion into the bladder, than the use of chalybeate waters taken freely and regularly during each suc- cessive summer. 11. It may happen, however, that a patient may be seized by an attack without having the opportunity of flying to mineral waters, or at a time of year when their use is unsea- sonable. In such a case, the following compendious method must be applied, and that without any further apparatus of remedies. If the patient be of a sanguine temperament, and not in the decline of life, ten ounces of blood must be taken from the arm of the same side with the kidney affected. After this, a gallon of posset-drink, wherein two ounces of marsh- mallow root have been boiled, must be taken without loss of time, followed by the injection of the following enema : R Marshmallow-roots, Lily-roots, aii 3] ; Mallow-leaves, Pellitory, Bearsbreech, Chamomile flowers, of each a handful ; Linseed, Fenugreek, aii 555 ; Water, q. s. Boil down to half a pint. Strain. Dissolve in the clear liquor Kitchen sugar. Syrup of tnarshmallows, aii ^ij. Mix, and make into a clyster. BLOODY URINE. 227 As soon as the patient has vomited up what he took by the mouth, and when the clyster has returned, a full dose of twenty drops of liquid laudanum must be given, or else fifteen or six- teen grains of Mathews's pills. However, with aged men broken by any protracted disease, and with elderly women inclined to the (so-called) vapours (especially if at the beginning of the fit they have voided a dark gravelly urine), the bleeding must be omitted. In other matters, however, they must proceed exactly according to the method aforesaid. 12. To return, however, to the matter in hand, viz. the single stone of large size. If, from the patient having pre- viously been free from an attack, we conclude that the calculus is too large to escape from the pelvis, we must consider mineral waters not only as useless, but (for the reasons already given) as exceedingly dangerous. Nor is the use of them better for gouty people ; especially if, as is generally the case, they be stricken in years, and of a weak and phlegmatic habit of body. Here, the forces of Nature are so crippled, that it is much to be feared that a great quantity of water may so overwhelm them as for them to give way altogether. Whether or not this be the reason of such injuries as have befallen men of the consti- tution and habit in question, it is certain that very many so broken and worn out by gout have been killed by the use of chalybeates. 14. And this is, in a manner, the sum of all that I have found out concerning the cure of diseases, up to the day on which I write, viz. the 29th of September, 1680. PROCESSUS INTEGKRI. PHOCESSUS INTEGRI. CHAPTER I. ON THE AFFECTION CALLED HYSTERIA IN WOMEN; AND HYFOCHONDRIASIS IN MEN. 1 . WHEN, from some grave accident, the human system suffers any discomfiture, the animal spirits become atactic. The urine is excreted in abundance, and is limpid. All hope of getting better dies away. The patient anticipates all sorts of troubles. This ailment may attack any part of the body. Whatever part it does attack, it afflicts with symptoms coincident with the exciting cause. In the head there will be apoplexy, or hemi- plegia arising soon after deliveries. Spasms, too, like epilepsy, vulgarly called strangulation of the womb, wherein the belly and stomach, and parts towards the throat swell up, occur. Clavus hystericus, or a racking pain in the head, so limited as to be covered by your thumb, accompanied by the vomiting- up of green matter, like rancid bile, may also be one of the pains attendant. 2. The fit may simulate palpitation of the heart, cough, the iliac passion, colic, nephritis, or suppression of the urine. It occasionally excites violent vomiting and diarrhoea. Externally it brings on pains or swellings in the muscular parts of the flesh, the ankles swelling as from dropsy. Even it attacks the teeth. The pain in the back is most severe. The extremities are so cold that the body becomes corpse-like. Tears and laughter succeed each other. Neither from any ostensible cause. Ptyalism may simulate the action of mercury. Hysterical pains attack all parts alike ; leaving behind them a sensation of tenderness to the touch, just as if the parts had been beaten. 3. Bleed to 'viij. Apply a galbanum plaster to the navel. Next morning give 232 PROCESSUS 1NTEGRI. R Pil. coch. maj., 3ij ; Castor in powder, gr. ij ; Peruvian balsam, f)|_iij. Make into twelve pills. Take four every or every other morning, according to the strength, at four or five a. m. Sleep upon them. R Rue-water, 3iv ; Compound bryony-water, 31) ; Castor tied in a knot, and hung in the glass, 3ss ; Loaf-sugar, q. s. Make into a julep. Take four or five spoonfuls whenever the spirits are low. 4. After the pill the following should be used : R Iron-filings, gr. viij ; Extract of wormwood, q. s. Make into three pills ; to be taken at five p. in. for thirty days. Wash down with wine of wormwood. 5. If the form of a bolus be preferable : R Conserve of Roman wormwood, Conserve of orange-peel, aa Jj ; Candied angelica, Candied nutmeg, Venice treacle, aa Jss ; Compound arum -powder, 5iij ; Candied ginger, 51] ; Syrup of lemon-juice, i or (failing this) > q. s. Syrup of orange-juice, J Make into an electuary. R Of the electuary as above, 3ij ; Iron-filings, gr. viij ; Syrup of oranges, q. s. Make into a bolus ; to be taken night and morning. Wash down with wine of wormwood, or with six spoonfuls of the following infusion : R Root of angelica, Root of elecampane, Root of masterwort, aa. Jj ; Leaves of common wormwood, Leaves of lesser centaury, Leaves of white horehound, Leaves of germander, aa a handful : Peel of two oranges (sliced). Pour over it sherry wine so as to cover all to the depth of two fingers. Strain as wanted. HYSTERIA. 233 6. With delicate persons the iron may be given as a powder: R Iron-filings (fine), ^j ; Compound arum-powder, 5YJ ; Coriander-seeds (prepared), Aniseed, Fennel-seeds, aa ^ss ; Cinnamon, Red coral (prepared), a 5iij ; Nutmeg, 5ij. Heduce to a very fine powder. Add as much white sugar as equals the weight of the other ingredients. Take, out of a spoon, 553, twice a day for four days; then jj, twice a day for forty days. Wash down with six spoonfuls of the wine of wormwood, or of the fol- lowing julep : R Aqua lactis alexiteria, ^xij ; Compound gentian-water, ^iv ; Aqua absinthii niagis comp., jij ; Finest white sugar, q. s. Make into a julep. R Rheinish wine, with wormwood, Os ; Compound gentian-water, Jij ; Syrup of cloves, 5J. Make into a julep. R Picked myrrh, Galbannm, Assafostida, aa 5J ; Castor, 355 ; Balsam of Peru, q. s. Make into pills; twelve to each drachm. Three to he taken every night. Wash down with three or four spoonfuls of compound bryony-water. Continue to do this throughout. 7. If the pills purge, use R Castor, 5) ; Volatile salts of amber, 355 ; Extract of rue, q. s. Make into twenty-four pills. Three to be taken every night. \Vah down with three or four spoonfuls of the julep for hysteria. 8. If the disease still continue obstinate : R Lozenges of powdered myrrh, 9j ; balsam uf sulphur and turpentine, ))[\\ ; Gum ammoniac (dissolved), q. s. Make into four pills. To he taken morning and evening. Ua.sli down with four or five spoonfuls of the julep for hysteria alon^ witii twelve drops of spiriu of haribhorn. 234 PROCESSUS INTEGRI. The auti- scorbutic electuary may be taken with the water described 1 in company with it, also the restorative electuary, with the addition of conserve of garden scurvy-grass, and six drachms of the compound powder of cuckoo-pint. Wash down with the aforesaid water. 9. If the disease still continue, chalybeate waters must be tried. If these fail, sulphuric, such as those of Bath. 10. During the drinking of chalybeate waters, this must be observed : If any grave symptom occur, referable to their use, they must be stopped, until it goes away. Six weeks or two months is the least time wherein benefit can be expected. Candied ginger, caraway seeds and sugar, may be taken occa- sionally, to warm the stomach. Also three pills for hysteria may be swallowed for the first ten nights ; washed down with four or five spoonfuls of the julep for hysteria. 11. As to the Bath water, this must be drunk for two days ; and, on the third, used as a bath ; and so on, in turns, for six weeks or two months. 12. If the chalybeates overheat, there may be taken, every fourth morning, four pints of purgative mineral waters. These, although they move the bowels, cause less disturbance than the purges of the shops. 13. If the disturbance be excessive, a little laudanum may be taken, out of some anti-hysterical water, every night, for some time. 14. When the strength and spirits are much dejected by the disease, bleeding and purging are not to precede the steel. It may be put on at once. 15. When the symptoms are mild, bleeding and purging for a few days are sufficient. The pills for hysteria should then be given, night and morning, for ten days. 16. When the pain is violent, as well as the vomiting and diarrhrea, laudanum is to be given, and the spirits to be restored. If, however, the strength will bear, the laudanum should be preceded by a bleeding and purge, particularly in women of a masculine habit, and of a sanguine temperament. With weak subjects, and with subjects who have lately had the fit, it is sufficient to wash out the stomach with a gallon of posset After this has been thrown up by vomiting, a large 1 Epistol. Dissert., 103. HYSTERIA. 235 dose of Venice treacle, or of Orvietan electuary should be giveu ; which should be washed down with a few spoonfuls of some spirituous liquor, and with a few drops of laudanum. If the patient have all along vomited, so that the further action of an emetic may be dangerous, laudanum must be given in a dose sufficient to overcome the symptom. This must be repeated after each vomit, it being giveu in the solidest form possible. If liquid, in a very small quantity of the vehicle, e. g. a few drops of laudanum out of a spoonful of strong cinnamon* water, the patient, meanwhile, being perfectly quiet, and keeping her head quiet. Even when this symptom has been thoroughly subdued, the use of the laudanum may be continued for a few days. 17. These two points must be noted Firstly, when we have ouce begun to use laudanum, it must be used in such doses, so often repeated, as to entirely subdue the symptom. A little space, however, may be allowed between each, just to let us know what one dose has done before AVC hurry on to another. Secondly, that whenever we treat by means of laudanum, nothing is to be moved, nothing to be disturbed, not even by the mildest enema. 18. Venice treacle, used long and often, is a sovereign remedy in this, as in all other diseases arising from a want of due heat and concoction. 19. Sherry wine, medicated with gentian, angelica, worm- wood, centaury, orange-peel, and other restoratives, if taken, by three or four spoonfuls at a time, two or three times a-day, helps other remedies, provided only that the patient be not of a lean or bilious habit. 20. Peruvian bark, in simple doses, taken morning and evening, for some weeks, has great virtue especially in hysteric spasms. 21. With thin and bilious habits a milk diet may be adopted, especially in hysterical colic, provided that the dis- comfort of the first few days cau be got over. During that time it coagulates in the stomach, and is, consequently, less fit for keeping up the status of the body. Nothing, however, keeps up the spirits, and warms the blood, like plenty of riding on horseback every day. Carriage journeys are also useful. 236 PROCESSUS INTEGRI. CHAPTER II. OF THE DEPURATORY FEVER OF THE YEARS 1661, 1662, 1663, 1664. 1. IF the patient be young, bleed from the arm; and, a few hours after, or the next day, two hours after dinner, order an emetic of the croc, metall. Have ready six or eight pints of posset, so that he take a draught as often as he is sick or purged. After the operation of the emetic, give the following, or some similar paregoric : R Black-cherry water, %iss ; Plague-water, jss ; Liquid laudanum, tftxvj ; Syrup of cloves, 3ij. Mix, and make into a draught. Emetics of the croc, metall., even in the smallest quantity, are not safe for children, or persons under the age of adolescence. 2. After this, inject the following enema every morning, until the eleventh or twelfth day : R Common decoction for clysters, Milk of the cow, Brown sugar, Syrup of violets, aa Jij. Make into an enema. 3. The bowels may now be allowed to remain confined, in order that the febrile matter may be all the more quick ly concocted. To this end, even moderate cordials are conducive, R Gascoigne's powder, gr. xiv ; Egg-electuary, gr. x ; Syrup of cloves, q. s. Make into a bolus ; to he taken every eighth hour. Wash down with five or six spoonfuls of the following julep ! R Aqua lactis alexiteria, Black-cherry water, aa ^iij ; Plague-water, Syrup of cloves, ftfi ,\i- Mis. and make into a julep. PESTILENTIAL FEVER. 237 4. After adhering strictly to this method, you will find, about the fifteenth day, both from the improved excretion of urine, and from the manifest remission of the symptoms, that it is seasonable to give the common purging potion. 5. It happens, at times, especially with old men, that after the fever has been cured, and the body been purged, the patient remains very weak, and expectorates a vast quantity of viscid phlegm, sometimes with cough and spitting. In this case he may take some old Malaga wine with a toast in it. 6. If passio iliaca supervene, a scruple of salts of wormwood may be prescribed out of a spoonful of lemon-juice morning and evening : in the intermediate times a few spoonfuls of dis- tilled mint-water without sugar may be taken. Meanwhile a live puppy should continually lie on the belly. When the pain and vomiting has ceased for two or three days, a drachm of the pil. coch. maj. dissolved in mint-water may be given. The puppy is not to be removed before the pills are used. 7. To guard against a relapse, the patient must persist in the use of the aforesaid water for some time, and keep off the cold by doubling folds of flannel on his belly. CHAPTER III. ON THE PESTILENTIAL FEVER OF THE YEARS 1665, 1666. 1. BLEED the patient in bed. Then cover him with bedclothes. Tie up his forehead with a linen rag. If vomiting do not commence, exhibit the following or some similar sudorific : R Venice treacle, 35$ ; Egg-electuary, 9j ; Gascoigne's powder, gr. xv ; Cochineal, gr. viij ; Saffron, gr. iv; Kermes, q. s. Make into a bolus; to be taken every six hours. Wash down with six spoonfuls of the following julep: R- Aqua cardui Benedict!, Aqua scordii comp., iia ^iv ; Aqua thcriacalis stillatitia, Jij ; Syrup of doves, ^j. Mix, and make into a julep. 238 PROCESSUS INTEGRI. If vomiting be present, the sudorific may be put off until perspiration begins to flow from the mere weight of the bed- clothes, the face being kept under the blankets. When such sweating begins, it must be kept on for twenty- four hours by repeated draughts of sage-posset, or \vith small beer in which a little mace has been boiled. The strength of the patient may be kept up by means of restorative broths. When a tumour has begun to show itself do not dare to bleed. For twenty-four hours after the end of the sweats, the patient must keep to his bed, in order to avoid cold. His shirt must be allowed to dry on his back. All his drink must be luke- warm. The sage-posset must be continued. Next morning a purgative potion should be given. The years 1667-8 produced a variolous fever, and variolae. The years 1669-72 produced a dysenteric fever. The years 1673-5 produced a comatose fever. The treatment of these I do not now touch upon. I have done this in my description of the fever of 1685. CHAPTER IV. ON INTERMITTENT FEVER. 1. THE fit begins with chills and shivers, succeeded by heat. A sweat then follows, and an apyrexy succeeds. During, however, the first days of the disease, especially in autumn, there is a remission rather than an m/ermission. During both the cold and hot fits the patient feels sick, is uneasy, and has thirst and a dry tongue. In children, a swelling of the belly ; in adults, a swelling of the legs indicate the breaking up of the fever. Pain of the tonsils, hoarseness, hollowness of the eyes, and the fades Hippocratica are signs of death. R Peruvian bark (finely powdered), Jj ; Syrup of cloves, or Syrup of dried roses, q. s. Make into an electuary, to be divided into twelve doses. One to be taken every four hours. Wash down with a draught of wine, im- mediately after each fit. 2. If this purge, give ten drops of liquid laudanum every or every other time the bolus is given. INTERMITTENT FEVER. 239 To prevent a relapse, especially in quartans, repeat this process every week three times. If the form of a pill be preferred R Peruvian bark (finely powdered), 5] ; Syrup of cloves, q. s. Make into moderate-sized pills. Take six every four hours. R Bark in powder, Jij ; Rhenish wine, Oij. Soak in a cool place, and strain through a jelly-hag. Take three ounces every three or four hours. 4. If the vomiting be so continued as to prevent the bark being swallowed, a scruple of salts of wormwood, out of a spoon- ful of lemon-juice, should be taken six or eight times in two hours. Then sixteen drops of liquid laudanum, out of a spoonful of strong cinnamon-water. Soon after the vomiting has ceased begin with the bark. 5. In spring intermittents, an emetic so given as to act before the access of the fit, does great good. Sometimes a clyster thrown up during the days between the fit, three or four times, has effected the cure. This may also be attempted thus : R Virginian snake-root (finely powdered), gr. xv ; White wine, Jiij. To be taken two hours before the fit. The patient then must sweat under bedclothes for three or four hours. This he must do twice before the fit. 0. If weakened by repeated paroxysms, the patient may take R Conserve of borage-flowers, Conserve of bugloss-flowers, ail Jiss ; Conserve of rosemary, ^ss ; Candied lemon-peel, Candied nutmeg, Venice treacle, ail 5iij ; Kcrmes confection, 5ij. Mix. Take a portion the size of a ha/el-nut night and morning. Wash down with a few spoonfuls of simple plague-water, sweetened. No clyster allowed. 7. If, towards the end of the disease, dropsy set in, and that before the fever has departed, purgatives are not to be used, but instead thereof infusions of horse-radish, wormwood-tops, 240 PROCESSUS INTEGRI. lesser centaury, juniper-berries, broom-ashes, &c. When the fever is over, cathartics may be given. 8. For the ague of infants R Black-cherry water, Rhenish wine, aa ^ij ; Bark (finely powdered), 5iij ; Syrup of cloves, q. s. Mix, and make into a julep. Take one or two spoonfuls, according to the age of the patient, every four hours until the fits cease. In case of diarrhoea, add, every other time, one or two drops of liquid laudanum. CHAPTER V. ON THE STATIONARY FEVER FROM 1685 TO 1690. 1. FLUSHES and chills in turns. Pain in the head and limbs. Pulse natural. Occasional cough. Pain about the neck and jaws. Increase of fever towards night. Disquiet. Thirst. The tongue, either moist, or coated all over with a white rough fur; brown in the middle, with a white fringe at the edges. Coma and frenzy if the patient always keep his bed. Petechise, purple spots, miliary eruptions, redder than those of measles, if he be overheated as to regimen. Also inordinate pulse, subsultus tendinum, and death. The sweats at the beginning are symptomatic. If forced, they come from the head most, and are clammy. They also transfer the morbific matter to either the head or the limbs. 2. Bleed from the arm to ten ounces. Repeat the bleeding in case of dyspnoea, racking headache during the cough, or any notable sign of bastard pleurisy. In which case, repeat the bleeding and purging until recovery. 3. In the evening apply a blister. Next morning give a lenitive potion. Repeat this three times every other day. At bedtime, on those days Avhen the purge has been given, prescribe R Cowslip-flower water, ^iij j Syrup of poppies, 5] ; Freshly-squeezed lemon-juice, tsvo spoonfuls. Mix, and make into a draught. 4. Aphthae and hiccup, coming of their own accord after the STATIONARY FEVER. 241 cure of the fever, go off of their own accord. If they continue, an ounce of bark (with syrup of the red poppy, q. s.), made up in the form of an electuary or of pills, clears them off. Take, after the pill or electuary, a draught of skimmed milk. This is a sure cure, unless interfered with by lying in bed. 5. On the days when there is no purging : R Conserve of lujula, Conserve of hips, Conserve of berberry, aa ^ss ; Cream of tartar, 3) ; Syrup of lemons, q. s. Make into an electuary. Take a portion, the size of a nutmeg, three times a day. Wash down with six spoonfuls of the following julep : R Purslane-water, Lettuce-water, Cowslip-flower water, aa Jiij ; Syrup of lemons, 353 ; Syrup of violets, 3). Mix, and make into a julep. f\ r R Spring-water, Oj ; Rose-water, Lemon -juice, Best white sugar, aa Jiv. Boil over a slow fire, until all is clear. Take three ounces ad libitum. The following gargle may be prescribed : R Crab-juice, Oss ; Raspberry-syrup, Jj. Mix, and make into a gargle. 6. If the fever be so bad that the patient cannot take a draught, two scruples of the pil. coch. mag. may be given instead. After this an opiate, e. g. a grain and a half of the solid London laudanum, with an equal quantity of gum mastich ; or eighteen drops of the liquid laudanum, out of an ounce of barley-water with cinnamon. 7. For drink the white decoction and weak small beer, ad libitum. The white decoction is an ounce of burnt hartshorn, boiled in a pint of spring-water, and sweetened with the best white sugar. 8. After the second purge the patient may eat a little chicken. After the last, he may take three or four spoonfuls of Canary wine (provided that the fever have abated) night and morning, and also after dinner. This he may do for some days. 11. 10 242 PROCESSUS INTEGRI. 9. In frenzies and and coma there is nothing like shaving the head. No blister. Only a light cap. 10. If as is often the case with hysterical females after the repetition of the bleeding and purging, the fever still con- tinue, provided that there be no signs of peripneumony, or of inflammation about the vital parts, a paregoric may be given every night, and anti-hysterical medicines two or three times a day. CHAPTER VI. ON INFANTS SUFFERING UNDER THE STATIONARY FEVER. The Treatment. Apply two leeches behind the ears, on each side. After this, lay a strong blister on the neck. Purge with the infusion of small beer and rhubarb. If, after the purging, the fever intermit, administer the julep with Peruvian bark, as directed for infants, in chapter iv. CHAPTER VII. ON THE SCARLET FEVER. THIS attacks infants most, and that towards the end of summer. Shivers and chills at the commencement ; but no great depression. The whole skin is marked with small, red spots, more frequent, more diffused, and more red than in measles. These last two or three days. They then disappear; leaving the skin covered with branny squamulce, as if powdered with meal. R Hartshorn, Gascoigne's powder, ail Jss ; Cochineal, gr. ij ; White sugar, 5J. Mix, and make into a very fine powder. Divide into twelve papers. Take one every six hours. Wash down with two or three spoonfuls of R Black-cherry water, Aqua lactis alexetcria, aa ^iij ; Syrup of lemon-juice, 3J. Mix, and make into a julep. Apply also a blister to the neck. Order, too, a paregoric of syrup of poppies to be taken every night. Purge when the symptoms have ceased. PLEURISY. 243 CHAPTER VIII. ON PLEURISY. THIS is most prevalent between spring and autumn. It begins with chills and shivers. Thirst, heat, discomfort, and the other symptoms of fever follow. A few hours later, the patient is seized with a violent stabbing pain in the side, which spreads towards the shoulder-blades, the spine, or the front of the chest. The cough is frequent and afflicting. The matter spit up is at first scanty and thin. As the disease advances it becomes more copious, more concocted, and more mixed with bloody particles. As the cough, the spitting of blood, and the pain increase, and as the expectoration becomes freer, the fever abates. The bowels are sometimes loose, sometimes confined. The blood, when cooled, is like melted suet. 2. Bleed from the arm of the side affected, to ten ounces. R Red poppy-water, Jiv ; Sal prunella, 5J ; Syrup of violets, Jj. Mix, and make into a draught, to be taken directly after the first bleeding. R Sweet almonds (blanched), v; Melon-seeds, Gourd-seeds, aa 535 ; White poppy-seeds, 5iij ; Barley-water, Oss ; Rose-water, 5ij ; Sugar-candy, q. s. Fiat emulsio secundum artem. Four ounces to be taken every four hours. R Pectoral decoction, Oij ; Syrup of violets, Syrup of maidenhair, aa 553 ; Sugar-candy, q. s. Mix, and make into an apozem. Half a pint to be taken every day. R Oil of sweet almonds, ^ij ; Syrup of violets, Syrup of maidenhair, aa ^j ; Sugar-candy, q. s. Mix, and make into a linctus. To be taken frequently. 244 PROCESSUS INTEGRI. Oil of sweet almonds, or fresh linseed oil, may be taken alone. R Oil of sweet almonds, Oil of lilies, Ointment of marshmallows, aa ^j. Mix, and make into a liniment ; to be rubbed in on the affected side night and morning. Lay a cabbage-leaf over the part. 3. Repeat the bleeding, in the same quantity, three times more, so as in all to make four days, as long as the pains and dyspnoea continue. CHAPTER IX. ON BASTARD PERIPNEUMONY. 1. THIS shows itself as winter approaches, often towards the end of it. At the first attack the patient is hot and cold by turns. The least movement makes him giddy. The cheeks and eyes are inflamed. He coughs, and during the act there is a racking pain of the head. He throws up what he drinks. The urine is thick and intensely red. His blood is the blood of pleurisy. He pants and gasps ; the chest being, meanwhile, in pain. This disease differs from the dry asthma, in the latter being imaccompanied with fever. Such symptoms are always pre- sent here. Still they are always milder than in true peripneumony. 2. Bleed to eleven ounces. Next day order R Extract of cassia, jj ; Liquorice, 5ij ; Four fat figs ; Senna-leaves, 3ijss ; Agaric lozenges, Jj. Boil in a sufficient quantity of water down to four ounces. Strain and add Manna, ^j ; Solutive syrup of roses, Jss. Mix, and make into a potion. If he cannot take this, let him take two scruples of the pil. cock. maj. instead, at 4 p.m. RHEUMATISM. 245 Next day bleed again, to the same quantity. The day after purge again. Repeat the purge every other day, or at longer intervals, according as there is strength to bear it. If the symptoms still continue, bleed; twice if necessary, only at an interval of some days, according to circumstances. Generally, however, two bleedings are enough. Meanwhile, during the days when no purgatives are given, the pectoral decoction, the linctus, and the oil of sweet almonds may be given according to the directions for pleurisy. CHAPTER X. ON RHEUMATISM. 1. RHEUMATIC patients suffer from chills and shivers, and from all the signs and symptoms of fever. After a day or two, sometimes sooner, a sharp pain, now in this, now in that joint, (but most in the wrists, shoulders, and knees) shifts about, leaving redness and swelling in the different parts as it takes them in turn. The fever gradually abates, whilst the pain remains ; sometimes, indeed, it abates even whilst the pain increases. In rheumatic lumbago there is an intense pain in the lumbar regions, simulating nephritis, except that there is no sickness. The patient cannot lie down. He may spring from his bed; or he may sit erect upon it, moving his body backwards and for- wards painfully. The blood is the blood of pleurisy. 2. Bleed from the arm of the side affected to ten ounces R Water-lily water, Purslane-water, Lettuce- water, a a Jiv ; Syrup of lemons, Jss ; Syrup of violets, 3J. Mix, and make into a julep. To be taken ad libitum. 3. Prescribe the emulsion of the four cold seeds. Apply to the part in pain a poultice of the finest white bread with milk and saffron. 4. Next day bleed to the same amount as before. Bleed again a dav or two after. Bleed as often as four times, oftener 246 PROCESSUS INTEGRI. if necessary ; observing only that, after the second, the intervals between the venesections be prolonged. 5. On the days when the bleeding is omitted, throw up an occasional clyster of milk and sugar. R Common decoction for clysters, Ib.j ; Syrup of violets, Brown sugar, aa ^ij. Mix, and make into a clyster. 6. If the weakness of the patient will not allow him to be repeatedly bled, the treatment after the second or third vene- section must be as follows. 7. Every other day the common purgative potion, until he recovers, and on the evenings of the same the syrup-of-poppy paregoric must be given. 8. If these fail, and the patient be too weak for further eva- cuations, let him have recourse to the electuary and to the aqua-antiscorbutica, as in scurvy ; such treatment being good for scorbutic rheumatism also. 9. With young persons, and those who have not over-in- dulged in wine, rheumatism may be dispelled simply by spare, and very cooling diet, provided that it be moderately nourishing. This will often do as well as repeated bleedings, which are but badly borne. E. g. 10. Let the patient live on nothing but whey for four days ; afterwards taking, besides the whey, some fine wheaten bread once a day as his dinner, until he is thoroughly convalescent. During the last days he is allowed a little bread at supper. When the symptoms are giving way, he may take a little tender chicken boiled, or some similar digestible food. Every third day, however, he must be limited to the whey alone and this until his strength has wholly returned. ERYSIPELATOUS FEVER. 247 CHAPTER XL ON ERYSIPELATOUS FEVER. THE whole surface, especially the face, swells, becomes painful, and is deep red. Thick pustules, small, and becoming vesicular, then appear, and spread over the head and forehead. The eyes are closed by the swelling. Chills and shivers, and other signs of fever, are present. In another form of the fever, supervening upon the free use of attenuant liquors, slight fever is present, with pustules resembling nettle-stings, some- times rising into vesicles, sometimes receding, concealing them- selves under the skin like tubercles, itching exceedingly, and showing themselves most when scratched. There is a third form. This is generally on the breast ; where there is a broad blotch, scarcely rising above the skin, porri- ginous, with yellow squamulce. Whilst this lasts the patient is well. As it goes off he sickens a little. The urine is yellow and turbid. It yields to the same remedies as the pocky itch. Wine and digestible meat should form the diet. 2. Bleed to nine or ten ounces. Next day take the common purgative potion. R Marshmallow-rool, Lily-root, aa a handful ; Mallow-leaves, Elder-leaves, Mullein-leaves, Chamomile flowers, Melilot, St. John's wort tops, Tops of lesser centaury, aa a handful ; Linseed, Fenugreek, aa Jss ; Water, q. s. Boil to three pints. Strain. Add when used, Spirits of wine, Jij. Apply linen rags soaked in this lotion, and well squeezed out, hot, twice a day to the parts affected. Then anoint with Spirits of wine, Oss ; Venice-treacle, Jij ; Long pepper (in powder), Cloves (in powder), aa 3ij. Make into a mixture. Soak a piece of blotting-paper in the same, and apply to the parts affected. 248 PROCESSUS INTEGRI. If the disease do not yield to the first bloodletting, repeat it. If it still continue, bleed to even the fourth time, with one day's interval between the bleedings. On the days when there is no bleeding, an enema of milk, with syrup of violets, a cooling emulsion, and a cooling julep are to be prescribed. CHAPTER XII. ON THE POCKY ITCH, AND SUCH OTHER INVETERATE ERUPTIONS OF THE SKIN, AS DO NOT YIELD TO VENESECTION AND CATHARSIS. R Venice treacle, 3ss ; Egg-electuary, 9j ; Virginian snakeroot (finely powdered), gr. xv ; Bezoar of the East, gr. v ; Syrup of candied citron, q. s. Make into a bolus ; to be taken every night for twenty-one days. Wash down with R Aqua cardui Benedict!, Plague-water, Aqua theriacalis stillatitia, aa ^'j ; Syrup of cloves, ^j. Mix, and make into a julep. Every morning a pint and a half of posset, so as for the patient to sweat afterwards for an hour. After this, if the pustules have not disappeared, the following ointment for the parts affected : R Ointment of the sharp-dock, ^ij ; Pomade, 5J ; Flowers of sulphur, J iij ; Oil of rhodium, t|]_ x. Make into a liniment. None of the aforesaid medicines should be used unless bleeding and purging have preceded. QUINSY. 2-19 CHAPTER XIII. ON THE QUINSY. QUINSY comes on mostly between spring and summer. The access of the fever is followed by pain and inflammation of the fauces. Then follows swelling of the uvula, tonsils, and larynx, so that the patient can neither swallow nor breathe. Bleed freely from the arm. Touch the parts affected with honey of roses, with spirits of vitriol or spirits of sulphur added in such a proportion as to give the greatest possible sharpness. Or else touch with spirits of vitriol alone. Then use the follow- ing gargle ; not in the usual manner, but by keeping it in the mouth, without any moving about, until it gets warm. Then spit it out, and repeat it again at various times. R Plantain-water, Red-rose water, Frog-spawn water, aa ^iv ; The white of three eggs beaten up with water ; Crystalline sugar, 5iij. Mix, and make into a gargle. The cooling emulsion prescribed for pleurisy (c. viii), may be taken every day. The next morning, unless the fever and pain in swallowing have remitted, the bleeding should be repeated, and the purge put off till the next day ; otherwise, a lenitive cathartic should be taken. If the disease still continue (which, however, it very rarely does), repeat the bleeding and purging, and apply a large and strong blister to the nape of the neck, after the first blood- letting. Every morning, except on the days for the purging, the cooling and emollient clyster is to be injected. The patient must live on low diet, and be out of his bed a few hours every day. In all these fevers, which I call intercurrent, as well as in those which are of the stationary kind, care must be taken that .the patient keep out of bed a great part of the day, live upon barley-broth, oatmeal-gruel, and the like, taking \vcll-hopped thin small beer, and milk and water for his ordinary drink. 250 PROCESSUS INTEGRI. CHAPTER XIV. ON THE MEASLES. THE measles generally attack children. On the first day they have chills and shivers, and are hot and cold in turns. On the second they have the fever in full disquietude, thirst, want of appetite, a white (but not a dry) tongue, slight cough, heaviness of the head and eyes, and somnolence. The nose and eyes run continually ; and this is the surest sign of measles. To this may be added sneezing, a swelling of the eyelids a little before the eruption, vomiting and diarrhoea with green stools. These appear more especially during teething- time. The symptoms increase till the fourth day. Then or sometimes on the fifth there appear on the face and forehead small red spots, very like the bites of fleas. These increase in number, and cluster together, so as to mark the face with large red blotches. They are formed by small papula3, so slightly elevated above the skin, that their prominence can hardly be detected by the eye, but can just be felt by passing the fingers lightly along the skin. 2. The spots take hold of the face first ; from which they spread to the chest and belly, and afterwards to the legs and ankles. On these parts may be seen broad, red macula, on, but not above, the level of the skin. In measles the eruption does not so thoroughly allay the other symptoms as in small- pox. There is, however, no vomiting after its appearance ; nevertheless there is slight cough instead, which, with the fever and the difficulty of breathing, increases. There is also a running from the eyes, somnolence, and want of appetite. On the sixth day, or thereabouts, the forehead and face begin to grow rough, as the pustules die off, and as the skin breaks. Over the rest of the body the blotches are both very broad and very red. About the eighth day they disappear from the face, and scarcely show on the rest of the body. On the ninth, there are none anywhere. On the face, however, and on the extremities sometimes over the trunk they peel off in thin, mealy squa- mulae ; at which time the fever, the difficulty of breathing, and SMALLPOX. 251 the cough are aggravated. In adults and patients who have been under a hot regimen, they grow livid, and afterwards black. R Pectoral decoction, Oiss ; Syrup of violets, Syrup of maidenhair, ail ^iss. Mix, and make into an apozem. Of this take three or four ounces three or four times a day. R Oil of sweet almonds, ^ij ; Syrup of violets, Syrup of maidenhair, aii jy ; Finest white sugar, q. s. Mix, and make into a linctus; to be taken often, especially when the cough is troublesome. R Black-cherry water, 51) ; Syrup of poppies, jj. Mix, and make into a draught; to be taken every night, from the first onset of the disease, until the patient recovers: the dose being in- creased or diminished according to his age. 3. The patient must keep his bed for two days after the first eruption. 4. If, after the departure of the measles, fever, difficulty of breathing, and other symptoms like those of pcripneumony supervene, blood is to be taken from the arm freely, once, twice, or thrice, as the case may require, with due intervals be- tween. The pectoral decoction and the linctus must also be continued ; or, instead of the latter, the oil of sweet almonds alone. About the twelfth day from the invasion the patient may be moderately purged. 5. The diarrhoea which follows measles is cured by bleed- ing. CHAPTER XV. ON SMALLPOX. 1. SMALLPOX is either distinct or confluent. In the dis- tinct smallpox there are chills and shivers, intense heat, violent pain of the head and back, inclination to vomit, a great ten- dency to sweat (a sign which is commonest in adults, and one from which we may infer that the disease will not be confluent), 252 PROCESSUS INTEGRI. pain at the pit of the stomach when pressed by the hand, stupor, drowsiness, and at times especially in infants epileptic fits. With these, a fit is so sure sign of smallpox, that if, after teething, they have one, you may predict variola so much so, that a fit over-night will be followed by the eruption next morning. This, however, will be generally mild, and in nowise confluent. 2. On the fourth day (inclusive) from the attack (sometimes later, rarely earlier), the rash breaks out ; at which time the other symptoms either abate or disappear. In the eruption itself the first thing that appears is reddish pustules, like the pricks of the finest needles, spread irregularly over the face, the neck, the breast, and the whole body. Then comes pain about the jaws, which increases as the pustules rise. 3. About the eighth day from the first attack, the interspaces between the pustules, which were at first white, begin to look red, to swell, and to give a painful feeling of tension. The eyelids become puffed like a bladder, and close the eyes. Next to the face, the hands take on and swell, and the fingers become stretched. The pustules of the face, which were before smooth and red, now appear rough and whitish the first sign of maturation. Besides this, they give out a yellowish juice, not unlike the colour of the honeycomb. The inflammation of the hands and feet, which is now at its height, exhibits between the pustules a florid colour, like that of a damask rose, and the milder the disease, the more truly is this the exact colour, both of the pustules themselves, and of the interspaces between them. The pustules of the face become rougher and yellower, accord- ing to the degree of maturation ; those of the hands, and the rest of the body being less rough, and more white. 4. On the eleventh day, the swelling and inflammation of the face go down, and the pustules, which have now attained the proper maturity and size (that of a largish pea), dry, and fall off, and, on the fourteenth or fifteenth day, go off altogether. On the hands, however, the eruption is more obstinate; the pustules remaining white and fresh, for a day or two longer than those of the rest of the body. At length, however, they break. Now those of all the other parts desquamate, whilst the desqua- mation of the face is succeeded by branny scales, and pitting. 5. Throughout the disease the bowels are either wholly SMALLPOX. 2J3 bound, or costive. The majority of those who die, die on the eighth day of the discrete, and the eleventh of the confluent smallpox. In the former case, from the effects of the sweats which have been forced by a hot regimen and cordials, the face, on the day aforesaid, which ought properly to be swollen and inflamed in the interspaces between the pustules, becomes pale and flaccid, the pustules themselves being red and elevated, and remaining so even after the death of the patient. The sweat, too, which thus far had flowed freely, now stops suddenly. The patient, meanwhile, is taken with frenzy, anxiety, rest- lessness, and general disorder. He, then, passes his urine frequently and sparingly ; and, lastly, a very few hours after, dies. G. In the confluent sort the symptoms are the same, but worse. The fever, the anxiety, the disquiet, the tendency to vomit are all greater. The tendency to sweat, however, is less. Diarrhoea sometimes precedes the eruption, and it may continue for a day or two after it. This is rare in the discrete sort. On the third day, or sooner (rarely later), the eruption breaks out ; and the earlier it does so the more likely is it to be con- fluent. At times the eruption is delayed till the fourth or fifth day, on account of some severe symptom, such as (for instance) sharp pain in the loins, like that of nephritis, sharp pain in the side, like that of pleurisy, or sharp pain in the limbs, like that of rheumatism ; along with which there may be great uneasiness at the stomach, and vomiting. In confluent smallpox the eruption has less effect upon the other symptoms than in the discrete. Instead of being allayed by it, the fever and the other ailments become worse for some days after its appearance ; this being sometimes that of ery- sipelas, sometimes that of measles. From both these, however, it differs in point of time. As the disease goes on, the pustules do not so much rise to any notable height, as run together, especially in the face, which they cover as with one large red vesicle, and which they raise to a swelling earlier than is the case with the discrete sort. Afterwards, they become glued to the face, like a white pellicle ; never, however, rising much above the level of the skin. 7. After the eighth day the white pellicle grows rougher and rougher, darker and darker. The pain of the skin becomes 254 PROCESSUS INTEGRI. more acute ; and, in the more violent forms of the disease, the desquamation is delayed until the twentieth day. It then takes place in broad lamina. The more the pustules approach a brown hue the worse they are, and the slower they will go off ; whereas the yellower they are the better. They are also the more likely not to flux, as well as to disappear early. 8. When the cuticle first falls off there is no roughness of the face. Soon afterwards, however, there appear branny squamufa, of an exceedingly corrosive character, which leave pittings, and often scars. Sometimes, even the back and shoulders are peeled of their cuticle. The danger of the disease is to be calculated by the amount of pustules on the face. Those of the hands and feet are the largest. The farther you find them from the extremities the smaller they are. 9. In adults salivation, in infants diarrhoea are the usual, though not the universal, concomitants of confluent smallpox. The ptyalism sometimes begins as the eruption breaks out, sometimes two or three days after ; when the patient spits up a thin matter, which, on the eleventh day, becomes viscid, and is hawked up with great difficulty. The patient is thirsty, hoarse, drowsy, and overpowered by stupor. He coughs when he drinks, and the liquid returns through his nostrils. The salivation now for the most part ceases ; and, unless the swelling of the face and hands (which, although it should, according to the nature of the disease, remit a little, will not wholly go down until a day or two later), by showing itself more notably or by continuing longer, make up for what is lost in the ptyalism, the patient will die. Now diarrhoea does not begin so early with infants as ptyalism does with adults. 10. In each sort of smallpox there is fever from the first attack until the eruption. It then abates so as to allow of the ripening of the pustules. When this is over it ceases. From bad regimen anomalous symptoms supervene symptoms such as flaccidity and sinking-in of the pustules, brain fever, coma, purple spots interspersed among the pustules, with smaller and sunken black spots in their centre, bloody urine, and bloody sputa at the beginning of the disease lastly, suppression of the urine. 11. The period of separation is the first three or four days, SMALLPOX. 255 and it is accompanied with febrile ebullition. The period of expulsion is the remaining time of the disease. This takes place by means of small abscesses in the flesh. 12. The day of the greatest danger is the eleventh, from the first attack. This is the case when the disease is not remark- ably crude, and when its violence is average. When it is very crude, the day of peril is the fourteenth ; when crude to the highest degree, the seventeenth. In some few cases the patient lives until the twenty-first. Moreover, during all the days be- tween the eleventh and seventeenth, there is an increase of fever as evening approaches. 13. Bleed, on any of the first three days from the invasion, to nine or ten ounces, and afterwards give a vomit of an ounce or an ounce and a half of the infusion of the crocus metallorum. 14. During these first few days the blood may be diluted by allowing the patient thin small beer, with a little spirits of vitriol, until the full eruption of the pustules. 15. When the eruption is complete, which is generally the case on the sixth day from the invasion, an ounce of syrup of poppies maybe given in the afternoon; to be repeated every night until the tenth day. Then increase it (if the disease be con- fluent) to an ounce and a half. Continue this (an ounce in a morning, and an ounce and a half in the evening), until convalescence. 16. If the syrup of poppies disagree, the liquid laudanum may be substituted ; viz. eighteen drops for one ounce of the syrup, and twenty for an ounce and a half. Meanwhile this must be observed if the paregoric, which is thus given twice every day, be unable to restrain the orgasm (a common occurrence in pox that is remarkably confluent), it must be given every eight hours, or oftener if need be. 17. For the discrete smallpox a paregoi'ic at night only, in a moderate dose, after the eruption has become complete, is sufficient. 18. Be the smallpox of whatever sort it may, and be its stage what it may, if frenzy supervene, the inordinate move- ment of the spirits must be checked ; so that if one dose of the paregoric fail, another and another must be given, until the tumult be wholly allayed. Between each, however, there must 256 PROCESSUS INTEGRI. be time enough allowed to let us see what one dose does, before another is given. 19. For suppression of the urine the patient must get out of bed, and walk about the room. 20. If the saliva be too viscid to spit up, a gargle must be given through a syringe. It should be made of thin small beer, or barley-water, with the honey of roses, or R Elm-bark, 3ij ; Liquorice-root, %iss ; Raisins (stoned), xx ; Red rose-leaves, two handfuls ; Water, q. s. Boil down to Oss. Strain. Dissolve in the strained liquor Simple oxymel, Honey of roses, aa Jij- Mix, and make into gargle. 21. If a blister be needful, it should be large, and it should be laid on to the nape of the neck the night before the great crisis of the disease. Soon, too, after the exhibition of the paregoric an onion may be laid to the soles of the feet, which should be renewed every day, from the eighth day until the end of the disease. 22. If an infant, who has got through teething, be suddenly seized with spasm, we must consider that this may possibly be an effort of Nature, whereby she attempts to throw out upon the surface, smallpox, measles, or scarlatina as the case may be. In this case put the patient to bed at once ; blister his neck, and give a cordial with a little paregoric, e. g. for a boy three years old, five drops of liquid laudanum in one spoonful of plague-water. 23. If on the eleventh day, or on any day subsequent to the eleventh, the secondary fever, with its accompanying restless- ness, disquiet, and other symptoms be carried to such a degree, as not to be checked by paregorics of any kind, and if, in con- sequence, death impend, blood must be drawn directly, and that to the amount required, i. e. to twelve ounces or there- abouts. This may be repeated once or twice during the fol- lowing days, if the symptoms demand it ; but not otherwise. Moreover, a mild purge may be given on the thirteenth day (not before), or on any day after, provided that bleeding have preceded. ST. VITUS'S DANCE. 257 The purge may be au ounce of lenitive electuary dissolved in four ounces of succory-water, or the aqua lactis alexiteria. However, neither bleeding nor purging forbids paregorics; which may be given to their full amount, and in their due frequency, notwithstanding the evacuations aforesaid. Paregorics are our sheet-anchors. 24. When the pustules have completely dried up, the face may be anointed with equal parts of oil of sweet almonds and pomatum, for two days not longer. 25. On the twentieth day after the attack, bleed from the arm. The next day purge. Repeat this, every other day, until the third time. 26. In respect to regimen, the patient must be kept out of bed until the sixth day from the first attack. He must then keep in bed till the seventeenth. His bedclothes must be as usual. 27. His diet must be oatmeal-gruel, barley-broth, roasted apples, and thin small beer; and after the eleventh day, four or five spoonfuls of sherry wine may be given twice a day, pro- vided that the patient wish it. 28. If the swelling of the legs do not abate under the afore- said evacuations, it is easily got rid of by means of a fomentation of mallow-leaves, mullein-leaves, elder-leaves, and laurel-leaves, with flowers of the chamomile and the melilot boiled in milk. 29. If, during the first days, the patient suffer from spitting of blood, or if he pass bloody urine, the powder and tincture of c. 18 must be given, every six hours, until these symptoms wholly disappear. Then a full paregoric may be administered. CHAPTER XVI. ON ST. VITL'S'S DANCE. Tins is a kind of convulsion, which attacks boys and girls from the tenth year to the time of puberty. It first shows it- self by limping or unsteadiness in one of the legs, which the patient drays. The hand cannot be steady for a moment. It passes from one position to another by a convulsive movement, however much the patient may strive to the contrary. Before ii. 'l7 258 PROCESSUS INTEGRI. he can raise a cup to his lips, he makes as many gesticulations as a mountebank ; since he does not move it in a straight line, but has his hand drawn aside by spasms, until by some good fortune he brings it at last to his mouth. He then gulps it off' at once, so suddenly and so greedily as to look as if he were trying to amuse the lookers-on. 2. Bleed from the arm to eight ounces, more or less accord- ing to age. 3. The next day give half (more or less as the age of the patient requires it) of the common potion. At evening the fol- lowing should be taken : R Black-cherry water, t-j ; Aqua epileptica Langii, 5iij ; Venice treacle, 9j ; Liquid laudanum, ff[viij. Make into a draught. Repeat the cathartic every other day three times, and the paregoric on the same nights. 4. Blood must again be drawn the next day, and the catharsis repeated ; and so, bleeding and purging must alter- nate, until the third or fourth time, provided only that there be sufficient time between the alternate evacuations to ensure the patient against danger. 5. On the days when there is no purging R Conserve of Roman wormwood, Conserve of orange-peel, afi Jj ; Conserve of rosemary, ^ss ; Venice treacle (old), Candied nutmeg, aa 5iij ; Candied ginger, 5] ; Syrup of lemon-juice, q. s. Make into an electuary, of which a portion the size of a nutmeg is to be taken every morning and at five p. in. \Vas>h down with five spoonfuls of the following wine : R Peony-root, Elecampane, Masterwort, Angelica, fiii jj ; Rue-leaves, Sage, Betony, Germander, White horehouml, Tops of lesser centaury. of each a handful ; Juniper-herries, ?vj ; Peel of 1\vo oniiigrs. Slice, and steep in six pints of cold Canary wine. Strain, and lay )>y for use. APOPLEXY. 2.19 R Rue-water, Jiv ; Aqua epileptica Langii, Compound bryony-water, aii Jj ; Syrup of peony, 5\-j. Mix, and make into a julep ; of which four spoonfuls may he taken every night at bedtime, with the addition of eight drops of spirits of hartshorn. 6. Apply to the sole of the foot the emplastrum e car anna. 7. To guard against a relapse, bleed and purge for a few days that time next year, or a little earlier. 8. It is probable that this treatment may also cure the epilepsy of adults, but I have not tried. In adults, however, the bleeding and purging should be freer, since St. Vitus's dance is a disease of tender years. CHAPTER XVII. OF APOPLEXY. 1. PROFOUND sleep, utter loss of sense and motion, with the exception of that necessary for respiration. This is laboured and stertorous. 2. Bleed from the arm to twelve ounces, as soon as possible. Then from the jugular veins to eight ounces. Then give an emetic, consisting of an ounce and a half or two ounces of the croc. met. 3. Apply a large and strong blister to the nape of the neck. Apply rectified spirits of sal ammoniac to the nostrils. AVhilst this is done, the patient must sit upright in his bed, with but few bedclothes. 4. When the vomiting is over give, at times, three or four spoonfuls of the following julep : R Hue-water, jiv ; Compound bryony-watcr, Aqua cpilcptica Langii, aa ^j ; Spirits of hartshorn, \\\\\ ; Crystalline sugar, q. s. Make into a julep. Inslcad of this, a single spoonful of compound -spirits of 260 PROCESSUS INTEGRI. lavender may be given twice or thrice during the fit, at intervals of half an hour. 5. Care must be taken not to follow the usual custom of giving over-hot and over-frequent cordials. Whatever may be their specific virtues, they do more harm than good; since they are likely to draw forth the humours, and so to increase the disease. The same arises from too many bedclothes. 6. When the fit is over, a relapse may be guarded against by Be Pil. coch. maj., 9ij. To be taken every third day, at four p. in. Sleep after taking them. Continue to the sixth time. R Conserve of sage-flowers, Conserve of rosemary, aa Jj ; Conserve of orange-peel, jvj ; Candied nutmeg, Candied ginger, ail ^iss ; Venice treacle (old), 51) ; Powder of the electuarium diambrae, Powder of the electuarium diamoschi dulcis, aa 5J ; Syrup of preserved citron, q. s. Make into an opiate. Take a portion the size of a chesnut night and morning. Wash down with two spoonfuls of the aqua epileptica Langii. R Ambergris, 5ss ; Distilled oil of aniseed, Oil of cinnamon, Oil of nutmeg, aa HIVJ ; Oil of cloves, mj ; Sugar dissolved in four ounces of orange-flower water, ^iv. Make into lozenges secundum artem. To be taken ad libitum. 7. All generous drinks are to be eschewed The diet must be oatmeal-gruel, barley-broth, chicken-broth, and, occasionally (especially between purging-times), the flesh of chickens, lamb, or other similarly digestible aliments. PROCIDENTIA UTERI. 2(i] CHAPTER XVITT. OF OPHTHALMIA. THIS is manifest from the inflammation of the eyes. Bleed to ten ounces. Next day order the common purga- tive potion. Repeat this twice, at intervals of two days. On the nights of the same give a paregoric, consisting of an ounce of syrup of poppies. On the days when there is no purging, the patient must take, three or four times a day, four ounces of the emulsion of the greater cold seeds and white poppy. R Plantain-water, Red-rose water, Frog-spawn water, aft _^j ; Prepared tutty, 5j. Make into an eye-wash, of which pour a few drops, twice a day, into the eye, but not previous to the first purge. If the disease do not yield to these remedies, repeat the venesection once or twice especially if the blood be the blood of pleurisy and also the catharsis. The patient must abstain from wine, and all generous bever- ages ; also from all indigestible and salt meats. On the days between the purges he must drink boiled whey. Observe ophthalmia may often resist both bleeding and purging, however often repeated. In this case give a pare- goric of an ounce of syrup of poppies each night. This will effect a cure single-handed. CHAPTER XIX. ON PROCIDENTIA UTI'RI. R Oak -hark, ij. IJoil in four pints of spring-water down to two. Towards the end of the boiling, add Jlruised pomegranate-bark, _^j ; Red roses, Pomegranate-flowers, iiii a handful. Add of red wine a pint. Strain, and keep as a fomentation, to lie ap- plied to the part affected, on a linen rag, every morning, two hours before rising, and, at night, after going to lied, until I lie tymptoms entirely go off. 262 PROCESSUS INTEGRI. CHAPTER XX. ON A NEPHRITIC PAROXYSM. HERE we find a fixed pain in the region of the loins, bloody urine, the excretion of small calculi or gravel, numbness of the leg on the side of the kidney affected, retraction of the testicle on the same side, nausea, and vomiting. The pain of colic is in many points the pain of nephritis. In many it differs, as may be seen below. 1 If the patient be of a sanguine tempera- ment, bleed on the side of the kidney affected to ten ounces ; then order a gallon of posset, in which two ounces of marsh- mallows have been boiled, to be taken as quickly as possible. Follow this up with the following clyster : R Marshmallow-root, Lily-root, aa Jj ; Mallow-leaves, Pellitory, Bearsbreech, Chamomile-flowers, aa a handful ; Linseed, Fenugreek, aa Jss ; Water, q. s. Boil down to half a pint. Mix, and make into an enema. After the emetic and the clyster have been thrown up again, a full and sufficient dose of liquid laudanum should be given, or else fifteen or sixteen grains of Mathews's pills. With old men, however, and with constitutions broken down by long disease, and with old women subject to the vapours (especially if, at the beginning of the disease, they have passed a black and sandy urine), the bleeding may be omitted. In respect, however, to the other matters, the method is the same in all cases alike. 1 Chapter XXIII. [G.] DYSENTERY, DIARRHOEA, ETC. 263 CHAPTER XXI. ON BLOODY URINE FROM A CALCULUS IMPACTED IN THE KIDNEY. THE patient must take, on some stated day of the week, two ounces and a half of manna, dissolved in two pints of whey. Sometimes a free draught of small beer is advantageous. When the calculus is large the pain is dull and heavy, not easily increased, and sufficiently tolerable. Nor is it accom- panied by a nephritic paroxysm. The patient cannot freely take to mineral waters, unless he previously have ascertained whether or not the calculus is too large to pass through the ureters. This can be ascertained as a certainty by one means only, i. c. by considering whether the patient have at any time before suffered from a nephritic paroxysm, accompanied with its usual severe pain in each kidney propagated along the ducts of the ureters, and excessive vomiting. If so, it is certain, that instead of a single large stone in the pelvis, there is a mass of small ones, one of which, at a time, finds its way into the ureter, and causes a fit which lasts until the stone is pushed forward into the bladder. When this is the case, nothing is more efficacious than the use of chalybeate waters. If, however, the patient have never been previously afflicted, and the stone be too large to pass along the ureters, chalybeates arc to be avoided. CHAPTER XXII. ON DYSENTERY, DIARR1KKA, AND GRIPES. CHILLS and shivers, followed by heat of the whole body. Soon afterwards, gripings of the belly, and frequent slimy (sometimes stercorous) stools. Great torture, and descent of the bowel, at every motion. Streaks of blood in stools generally, but not always. Sometimes none throughout. As the disease ad- vances pure blood is passed, and tbe bowels are affected with incurable gangrene. If the patient be in the prime of life, or have heated himself with cordials, there is much fever. The 264 PROCESSUS INTEGRI. tongue is whitish, with a thick fur, sometimes black and dry. The strength is exhausted, the spirits low, there are aphthae on the lining of the mouth and throat, especially when the peccant matter has been kept in by the improper use of astringents, and the due evacuation by means of catharsis has not been completed. At times, though the fever be absent, the gripes lead the way, and the other symptoms follow. 2. In diarrhoea the excrementitious waters are voided with- out blood and without inflammation of the bowels. 3. In tenesmus there is the constant wish to stool, when nothing but scanty bloody mucus, or even purulent matters are voided. 4. Bleed at once, and give a paregoric the same night. Next morning the common purgative potion. Repeat the two, on alternate days, twice. A paregoric after each, when the catharsis is over. On days when there is no purging, the same both morning and evening. 5. After the first bleeding and purge, the following must be given throughout the disease : R Black- cherry water, Strawberry-water, aa Jiij ; Plague-water, Aqua scordii comp., Barley-water, with cinnamon, aa Jj Prepared pearls, Siss ; Crystalline sugar, q. s. ; Damask rose-water, 553 (to taste). Mix, and make into a julep ; of which four or five spoonfuls are to be taken when the patient feels weak, or ad libitum. 6. The patient's drink must be boiled milk with three parts water, or the white decoction, as R Calcined hartshorn, White bread-crumbs, au 51] . Boil in three pints of spring-water to two. Sweeten with white sugar q. s. 7. If the weakness require it, two pints of spring-water boiled with half a pint of Canary wine, and cooled, may be taken as a drink. 8. After the second or third purging, the cure has to be effected by laudanum taken twice or thrice a day ; except that, at times, an enema of milk from the cow (half a pint), and BILIOUS COLIC. 265 Venice treacle (an ounce and a half), may be thrown up. This greatly improves the evacuations. 9. When the flux rises only to the height of a diarrhoea, the bleeding and purging may be omitted, and the following bolus given every morning and evening: R Powdered rhubarb 5ss (more or less, according to the strength of the patient) ; Diascordium, q. s. Make into a bolus. Add two drops of the essential oil of cinnamon. 10. The next night a paregoric of fourteen drops of liquid laudanum, and of barley-water with cinnamon may be given. 11. When there are dry gripes without stools, the bowels must be washed out by whey, drunk cool, and thrown up as a clyster, warm. In cholera, the same must be done, with chicken-broth, or milk with beer. 12. If this disease continue, and fix upon the rectum, so that there is constant desire to stool, a restorative diet and cordial drinks must be resorted to. As strength returns the tenesinus departs. 13. If a dysentery have been imperfectly cured, the pains may stand over for many years. In this case bleeding will restore the patient to his former health. 1-1. In constitutions that are unfavorable to the disease, the evacuations may be omitted, and the complaint be cured by laudanum alone. This is to be given night and morning until all the symptoms have gone. It may be given, if needed, even three times in the twenty-four hours. CHAPTER XXIII. ON BILIOUS COLIC. 1. TtKRiKLK pain in the bowels. The fever that ends in this disease distresses the patient for some hours. The pain is cither as if the body were drawn by a bandage, or else a boring pain as if pierced with an auger. This, at times, remits, at times becomes exacerbated. At first, it is not so certainly fixed to a certain spot, nor yet is the vomiting so frequent, nor yet do the bowels so obstinately resist the effect of purgatives. 266 PROCESSUS INTEGRI. However, as the pain increases, the more it fixes itself to a point, the more frequent is the tendency to vomit, the more obstinate the constipation. At length it becomes passio iliaca. It is distinguished from nephritis by the following signs : 1st. Nephritis is felt in the region of the kidneys, along the line of the ureters, and in the testicle. Colic is either unfixed or else limited, like a girdle, to the middle belly. 2d. Colic is increased by taking food, nephritis is rather relieved. 3d. In colic, both stools and vomits relieve more than in nephritis. 4th. In nephritis the urine is at first clear and thin. After- wards there is a settling. Lastly, gravel appears. In colic, the urine is thick from the beginning. Bleed freely, and three or four hours after give an anodyne. Next day purge with the lenitive electuary. Continue this every other day until the third time. If the disease have arisen from the over-free use of the fruits of the season, or from any other imprudence in food, the stomach must be washed out at once by a large draught of milk with beer. After this an anodyne must be given. The next day a vein must be opened, and the method afore- said be proceeded with. When this disease has been unskilfully treated, so as to con- tinue to distress the patient, and almost wear him out, the free use of either plague-water, aqua nurabHis, or some similar drink that he has liked during health, will do so much good as to surpass our most favorable expectations. CHAPTER XXIV. ON CHOLERA MORBUS. 1. THIS is limited to the month of August, or to the first week or two of September. Another similar, but different disease, appears at any time of the year, originating in gluttony or over-drinking, and is cured in the same way. Violent vomiting, accompanied by the dejection of depraved humours, difficulty in passing them, vehement pain, inflation CHOLERA MORBUS. 2G7 and distension of the bowels, heartburn, thirst, quick, frequent, small, and unequal pulse, heat and anxiety, nausea, sweat, cramps of the legs and arms, faintings, and coldness of the extremities, constitutes the true cholera and it kills within twenty-four hours. 2. Boil a tender chicken in three pints of spring- water, so that the liquor be but just flavoured by the meat. Of this decoction (or, if it cannot be procured, of posset-drink) the patient must take several cupfuls warm. He must use the same as a clyster as well. To these the draughts and clyster an ounce of the syrups of lettuce, violets, purslane, water- lily, or some similar adjunct, may be added. 3. This takes three or four hours. When finished, a pare- goric will complete the cure. 4. If the physician be not called in before the patient has become so exhausted from the continued vomiting and purging, that his extremities have become cold, recourse must be had to liquid laudanum, and that in considerable doses; e. g. twenty-five drops to an ounce of cinnamon-water. Even when the symptoms have ceased, this must be repeated night and morning (though in a smaller dose) until the patient wholly recover his original strength. 5. There is a sort of cholera morbus exceedingly fatal to infants. It arises either from overfeeding or from teething. G. Here, their tender age forbids the use of free diluent drinks, and, still more, the disturbance of the humours that would be effected by catharsis. Hence, the cure must be attempted by laudanum alone, i. e. with two, three, four, or more drops, according to the age of the child, taken out of a spoonful of small beer, or some other appropriate liquor, and repeated as the case requires. 268 PROCESSUS INTEGRI. CHAPTER XXV. ON COLICA PICTONUM. THIS is a sort of colic, which is wont to degenerate into palsy, depriving the patient of the use both of his hands and feet (a fact noted by Riverius 1 in his chapter on Palsy), and which is extremely common in the West Indies, where it destroys many persons. Balsam of Peru, in large and frequent doses, is the cure for the pain. Twenty, thirty, or even forty minims dropped upon a lump of fine white sugar should be given twice or thrice a day. This, however, will not cure the palsy. CHAPTER XXVI. ON THE ILIAC PASSION. 1. THE peristaltic motion of the intestines is reversed, so that purges and clysters are thrown up like emetics, and the fseces of the bowel are passed through the mouth and throat. 2. Bleed to nine or ten ounces from the right arm. After a few hours give R Scammony, gr. xij ; (or if not to be had, jalap ;) Calomel, 3j. Mix, and make into a powder; to be taken out of a spoonful of milk from the cow. Wash down with a spoonful or two of the same. 3. Or if the form of a pill be preferable R Pil. e duobus, 3ss ; Calomel, Dj ; Balsam of Pern, q. s. Make into four pills ; to be taken out of a spoonful of syrup of violets. 4. If, however, the patient reject this by the mouth, twenty- five drops of the liquid laudanum in half an ounce of strong 1 Praxis Medica, i, 5. [G.] MENSTRUAL FLOW. 269 cinnamon-water must be given directly. When this has allayed the vomiting and the pains of the belly, the aforesaid purge must be repeated. If, however, the virtue of the anodynes be wholly thrown away, so that the pain and vomiting return, and the cathartic remain in the body, we must return to the paregoric already described, which must be repeated every fourth or sixth hour, until the motion of the intestines be perfectly quieted. The purge will then act naturally, i. e., will produce stools. 5. It will also be well, an hour or two after the bleeding, to throw up one of the stronger clysters, e. g., tobacco-smoke forced up the bowel through a pipe from a large bladder. This may be repeated after a few hours, unless the passage down- wards be properly opened. (). "When the action of the purge has ceased the following must be taken : R Strong cinnamon-water, jj ; Liquid laudanum, ti^xxv. Mix, and make into a draught. This is to be repeated, twice, thrice, or oftener during the day, until the pain and vomiting have wholly ceased. Even when these symptoms have departed, the cure will be confirmed by taking the same paregoric, in a smaller dose, at bedtime. CHAPTER XXVII. ON IMMODERATE MENSTRUAL FLOW. THE natural flow of the menses would fill a vessel the si/c of a goose's egg. "When inordinate, there is difficulty, weak- ness, anorexia, cachexia, cadaverous complexion, and swelling of the feet. Bleed from the arm to eight ounces. Next morning give the common purging potion. Repeat this twice every other day. Each night, alter the purging, give a paregoric of the syrup of poppies. On the days \\hcn there is no purging, give 270 PROCESSUS INTEGRI. R Conserve of red roses, ^ij ; Lozenges of terra Lemnia, 3iss ; Pomegranate bark, Red coral (prepared), Bole armeniac, aa 9ij ; Bloodstone, Dragon's blood, aa 9j ; Syrup of quinces, q. s. Make into an electuary, of which a portion, the size of a large nutmeg, is to be taken every morning and every day at five p. m. Wash down with six spoonfuls of the following julep : R Oak-bud water, Plantain-water, aa ^iij ; Cinnamon-water with barley, Syrup of dried roses, aa Jj ; Spirits of vitriol, q. s., to give an agreeable acidity. R Plantain-leaves, Nettle-leaves, aa q. s. Bruise, squeeze, and clarify. Of this take four or five spoonfuls fre- quently, ad libitum. After the first purging apply the following plaster to the lumbar region : R Emplastrum de minio, Emplastrum ad herniam, aa equal parts. Spread on a leather skin, and apply as a plaster to the loins. CHAPTER XXVIII. ON HYSTERICAL COLIC. THIS is a remarkable and common symptom of the hysterical affection as much as a separate disease. It consists of agonizing pain at the pit of the stomach, accompanied by the vomiting of green matters. 2. First, in order that the mass of vicious humours within the stomach may not impede the efficacy of a paregoric, a great quantity of posset-drink should be taken first. This will be rejected by vomiting. As much as a gallon and a half may be given. When the vomiting is over, twenty-five drops of liquid laudanum must be given in an ounce of strong cinnamon- water, of plague-water, or of any similar vehicle. 3. This paregoric must bo continued and repented until HYSTERICAL COLIC. -271 every symptom has departed ; a due time between each dose being allowed, in order that the effects of one may be seen before we give another. 4. If the patient be of a sanguine temperament, and it be the first attack, blood may be taken from the arm before the emetic is given. 5. Clavus hystericus is similarly treated. If, however, the hysteric colic be obstinate, and come on in paroxysms, we must, then, in the intervals between, use the following : R Zedoary (very finely powdered), 5j ; Syrup of candied citron, q. s. Make into a bolus ; to be taken morning and evening for thirty days. Wash down with R Sliced zedoary, ^ss ; Canary wine, 5!%'. Steep for twelve hours in the cool infusion. Strain, and keep for use. Or the balsam of Peru, as in colica pictomtm, may be used. 0. What applies to hysterical colic applies also to the colic of hypochondriasis, a fact to be noted. Each ailment requires us to try one medicine after another, until we hit upon the one to "which the disease gives way. Generally, however, chalybeates do great good. 7. Colic, both with hysteria and hypochondriasis, often ends in jaundice. This, however, goes off of itself. If not, give R Madder-root, Turmeric, fiii Jj ; Greater celandine, Tops of the lesser centaury, aa a handful. Boil in equal parts of Rhenish wine and spring-water down to two pints. Dissolve in the strained liquor Syrup of the live roots, ^ij. Mix, and mukc into an apozem ; of which half a pint is to be taken warm, morning and evening, until convalescence. 272 PROCESSUS 1NTEGRI. CHAPTER XXIX. ON JAUNDICE NOT FOLLOWING COLIC. THE whole body, especially the whites of the eyes, is yellow. Everything also seems yellow to the patient. Itching, lassi- tude, and indisposition to move. A bitter taste in the mouth, bilious vomiting at times, hiccough, white stools, deep yellow urine, which stains linen, when dipped into it, of the same colour. Order the common purgative potion. Go on with the fol- lowing giving, every fourth day, the purge aforesaid : R Conserve of Roman -wormwood, Conserve of orange-peel, aa Jj ; Candied angelica, Candied nutmeg, Compound powder of cuckoo-pint, Iron prepared with vinegar, aa 555 ; Extract of the lesser centaury, Extract of gentian, Cream of tartar, aa 5ij ; Saffron (finely powdered), 3ss ; Syrup of the five roots, q. s. Make into an electuary. Of this take a portion the size of a large nutmeg every morning and every day at five p. in. Wash down the morning draught with four pints of purgative mineral waters ; the evening one, with half a pint of the apozem ordered for hysterical colic. Instead of the electuary, the chalybeate and pills may be taken. If signs of dropsy appear, the apozem must be taken after each bolus evenings and mornings as well. If the disease still continue, recourse must be had to chaly- beate waters drunk from the spring. CHAPTER XXX. TO PREVENT ABORTION. THE same treatment as for an immoderate flow of the menses, except that the purging and juices must be omitted. FLOW OF THE LOCHIA. >;;{ CHAPTER XXXI. ON AN IMMODERATE FLOW OF THE LOCHIA. THE natural lochial discharge consists of three elements : 1st. Pure blood, which flows for the first three days. 2d. A watery blood, like the washings of meat, lasting the next four days. 3d. A viscid and mucilaginous discharge, mixed with but little or no blood, beginning about the fifth or seventh day, and lasting till the end of the month. That the flow is too great is ascertained from the following signs loss of strength, fainting, a grumous character of the blood, dislike to food, pain in the hypochondres, tension of the belly, weak and frequent pulse, mistiness of vision, singing in the ears, and convulsions. The diet must be restorative, to which the following drink must be added : R Plantain-water, Red wine, aa Oj. Boil down to two thirds. Sweeten with the finest sugar, q. s. Set to cool. Of this take half a pint twice or thrice a day. Meanwhile some hysterical julep (which must, however, be of the mild sort) may be given occasionally, and the following plug applied to the nostrils : R Galbanum, Assafoetida ; Castor, aa 5iss ; Volatile salts of amber, 3ss. Mix, atid make into a plug. Or R Spirits of sal ammoniac, 3!]. To be frequently smelt. ii. 18 274 PROCESSUS INTEGRI. CHAPTER XXXII. SUPPRESSION OF THE LOCHIA. THE belly swells. There is a heavy bearing-down pain in the lower belly, the groins, and loins. The face becomes red, the respiration difficult, the eyes wild. There are chills, and fever, faintings, cold sweats, a sense of heat and throbbing in the womb, palsy of the lower limbs, and at times, epilepsy. Order the patient to bed at once, and apply to the navel an hysterical plaster. Give, then, the following electuary : R Conserve of Roman wormwood, Conserve of rue, aa 3J ; Myrrh lozenges, 3ij ; Castor, Saffron, Sal volatile, Sal ammoniac, Assafoetida, aa 5$s ; Syrup of the five roots, q. s. Make into an electuary. Of this take a piece the size of a nutmeg every four hours. Wash down with four or five spoonfuls of the following julep : R Rue-water, ^iv ; Compound bryony-water, Jij ; Sugar-candy, q. s. Make into a julep. Or take a scruple of the myrrh lozenges every four hours. If the whole of the aforesaid medicines have been taken, and the lochia still continue suppressed, laudanum must be given once at least ; either as fourteen drops of liquid lau- danum out of the compound bryony-water, or as a grain and a half of the solid laudanum, made into a pill with ten grains of assafoetida. If all these means fail, a clyster of sugar and milk must be thrown up once at least. DROPSY. 275 CHAPTER XXXIII. ON DROPSY. 1. THE finger, if pressed upon the lower part of the legs, will leave a mark, especially towards evening. In the morning the impression is less distinct. This is the first sign of the disease, especially if there be difficulty of breathing besides. Not unfrequently, however, pregnant women, and women with whom the menstruation has ceased, as well as men suddenly freed from inveterate asthma, have swellings of the same sort. When the feet and legs are stretched to their utmost, the waters rush into the abdomen, and this they gradually distend to its full capacity. At length, they reach the nobler viscera, and the patient dies. In proportion as the parts occupied by the disease increase, the rest of the body loses flesh, whilst dyspnoea, scantiness of the urine, and intense thirst, supervene. Dropsy attacks men in the decline of life, women when they become past child-bearing. 2. The curative indications are directed, first, to the eva- cuation of the waters, next, to the restoration of the strength of the blood, so as to guard against a fresh generation of the fluid. R White wine, ^iv ; Jalap (finely powdered), 5J ; Ginger (powdered), gr. x ; Syrup of buckthorn, 5). Mix, and make into a potion ; to be taken the first thing in the morn- ing, and to be repeated every or every other day, according to the strength of the patient, until the parts affected have gone down. Or- R Tamarinds, ^ss ; Senna, 5ij ; Rhubarb, jiss ; Water, q. s. Boil to three ounces. Strain, and dissolve in the strained liquor Manna, Solutive syrup of roses, ua ^j ; Syrup of buckthorn, ^ss ; Rose-juice electuary, 3iij. Mix, and make into a potion. To be taken as above. 276 PROCESSUS INTEGRI. Or R Pilulae e duobus, 9j ; Elaterium, gr. iij ; Chemical oil of cloves, tfljj. Make into three pills. To be taken the first thing in the morning, and to be repeated if necessary. Or R Gamboge, gr. xv ; White wine, Succory-water, ail 3iss ; Syrup of buckthorn, Jss. Mix, and make into a potion ; to be taken as above. Or R Inner bark of the elder (scraped from the wood), three handfuls. Boil in equal parts of milk and water from two pints to one. Strain. Take one half of the strained liquor every morning, and the other every evening, until recovery. But this remedy, except in bodies very easily moved, does but little good. 3. Concerning the use of cathartics in this disease, these three points must be noted : 4. First. Whether the patient's body is acted upon by cathartics easily or with difficulty. In the former case an ounce of the syrup of buckthorn will bring away abundance of the waters. In the latter, the strongest of the above-named purgatives will scarcely succeed. 5. Secondly. All purges which act but slowly, do more harm than good. Hence, a dose a little too strong is better than one a little too weak. 6. Thirdly. The Avaters should be drawn off as quickly as the strength of the patient will bear; lest, by allowing over- long intervals between the purges, they accumulate afresh. 7. There are, however, cases where all purgatives Avhatever are out of place. This is when the patient is weak, or a female subject to vapours. In such cases the cure is to be intrusted to diuretics alone ; of which the most potent are the lixiviated salts, as R Broom ashes, Ib.j. Steep in a cold infusion of four pints of Ehenish wine. Strain through a filter. Three ounces to be taken every morning, evening, and at five p. m., until the liquor be finished. DROPSY. 277 8. When the water is thoroughly evacuated, warm corro- borants are to be used, as R Radish root, Garden scurvy-grass, Common mugwort, Sage, Lesser centaury, Broom-tops. Steep in ale, and take as an ordinary drink. This may be used at the beginning of a dropsy, even without purging, and it will do good. Or as follows : R Conserve of garden scurvy-grass, Conserve of Roman wormwood, ail 5] ; Extract of gentian, Extract of mugwort, Extract of lesser centaury, aa 3iij ; Syrup of citron, q. s. Make into an electuary ; of which a portion the size of a large nutmeg must be taken every morning, at five p. m., and at evening. Wash down with four ounces of the following infusion : R Gentian root, Broom-tops, Lesser centaury, Common mugwort, aa a handful ; Fennel-seed, Rock-parsley seed, aa 3ij. Cut up small, and add four pints of Rhenish wine. Steep in the cold infusion. Strain, as wanted for use. 9. Note. When the patient is under restorative treatment he must not be purged, at least whilst we are aiming at the strengthening of the blood. This must also be the rule whilst he is taking the lixiviated salts, at which time he must strengthen himself by taking R Radish-roots, ^iij, Leaves of garden scurvy-grass, Leaves of common mugwort, Sage, Lesser centaury-tops, Broom-tops, aa three handfuls ; Three sliced oranges. Steep in six gallons of strong ale, not hopped during fermentation. Take this as an ordinarv drink. 278 PROCESSUS INTEGHI. CHAPTER XXXIV. ON A VIRULENT GONORRHCEA. 1. AN unusual pain iu the parts of generation, and a rotation of the testicles ; with those who have not been circumcised, a spot like that of the measles on the glans. As soon as this appears, there is a discharge from the urethra of a liquor like semen, which, every day losing its original colour and appear- ance, becomes at last like the yelk of an egg, except that it is paler. If the disease be virulent, it looks greenish, and is moreover mixed with a watery matter, or even tinged with blood. Meanwhile the aforesaid pustule becomes an ulcer. At first it resembles the aphthae in the mouths of infants. It spreads, however, day by day, becoming broader and deeper, whilst the edges grow hard and callous. The pustule is rarely attended by gonorrhoea in patients who have been circumcised. 2. Great pain during erections, just as if the penis was violently squeezed sideways, now occurs. This is worst at night, when the patient is warm in bed. The frsenum being contracted, the penis is bent down. When this curve is straitened by erection the pain is most acute. Ardor urince now occurs. During the passage of the water it is not so sharp. When, however, the patient has finished making water, a burning pain is felt all along the urethra, and is worst in the parts within the glans. The presence of caruncles stops the passage of the urine, and pain and inflammation of the scrotum sometimes supervene. R Pil. coch. mag. 3iij ; Extract of rudiuni, 3j ; Jalap, Scammony, fia 3ss ; Opobalsam, q. s. Make six pills out of every drachm of the full mass. Four of these are to be swallowed every morning, until the ardor urines and the yellow colour of the discharge have materially decreased. If this take place, the pills may be taken every other day. This the patient docs for another fortnight. After this, twice a week, until the discharge from the urethra has wholly ceased. VIRULENT GONORRHOEA. 2/9 3. In patients who are hard to move, an additional purge may be intercalated. This should be the common purgative potion, with two drachms of the syrup of buckthorn, and the rose-juice electuary. Or, if the cure be still imperfect, the turbith mineral may be given twice a day, in doses of eight grains, and at intervals of four days. Or, instead of the turbith mineral R Pilulae e duohus, 553 ; Calomel, 9j ; Opobalsam, q. 8. Make into four pills ; to be taken the first thing in the morning. 4. If the patient be repugnant to the aforesaid catharsis, he must, after taking the pills in question three mornings run- ning, throw up the following clyster every morning and at five p.m., except once or twice a week, when the following purge may be substituted : R Rose-juice electuary, Venice treacle, in yelk of ecrg, au Jss ; Barley-water, Oj. Strain, and add Syrup of violets, ^ij. Mix, and make into a clyster. 5. Every night, 25 drops of opobalsam, or of the balsam of Mecca, on a lump of sugar. If this cannot be had, Cyprian turpentine (about as much as is the size of a hazel-nut) may be used instead. The drink must be whey, and small beer at meals. G. Or R Pilulae e duobus, 5ss ; Opobalsam, nuij. Make into three pills. To be taken at four, a. in. Sleep after taking them. Repeat every other, or every third clay. 7. On the days where there is no purging, throw up tin- aforesaid clyster at five p. m., and in the morning. 8. As the cure proceeds (no matter what be the method) blood must be drawn when the patient is about half way through the treatment ; and this once or twice. A cool and thickening diet, too, must be prescribed, as well as the medicines of like virtue, e. g. the whey, and the emulsions of the cool seeds, &c. 280 PROCESSUS INTEGRI. 9. If the penis swell, R Marshmallow-root, Lily-root, aa 3iss ; Mallow-leaves, Mullein-leaves, Elder-leaves, Henbane-leaves, Chamomile-flowers, Melilot, Fenugreek, aa 353 ; Water, q. s. Make into a fomentation, to be applied to the part affected, one' hour, twice or thrice a day. When the fomentation is over, smear the penis with fresh- drawn linseed oil. Then apply the emplastrum e mucilaginibus, on a skin, to the tumid lips of the prepuce. 10. If there be an ulcer in the lips of the prepuce, or in the gland itself, give R Basilicon, 3vj; Tobacco ointment, Sij ; Red precipitate (washed in rose-water and finely pul- verized), 3ss. Mix, and make into a liniment. Lay it on lint, and apply it to the ulcer immediately after each fomentation. 11. If the scrotum swell, bleed at once from the arm, and apply the aforesaid fomentation twice a day. Add with each application a spoonful or two of brandy, or a poultice of oxycrat and bean-meal. 12. Meanwhile purges and refrigerants are to be taken internally. CHAPTER XXXV. ON THE LUES VENEREA. 1. WHEN a gonorrhoea has been protracted, or when, from the undue use of astringents, a taint has been imparted to the blood, lues arises. Buboes appear on the groins. There is pain in the head, limbs, and joints, especially when the patient is warm in bed. There are crusts and scurves in various parts of the body, which are yellow, like honeycombs. The worse the scabies the easier the pains. On the pericranium, the shin- bones, and arms there are exostoses. There is inflammation LUES VENEREA. 281 and caries of the bones. Phagedenic ulcers in various parts of the body, most hi the fauces. These spread gradually along the fauces and palate, and destroy the cartilage of the nose, which then falls in. The caries, ulceratiou, and pain increase. Limb by limb the patient drops off, and his lacerated body, a burthen on earth, falls into the grave. R Hogs' lard, Crude mercury, iia 3J- Mix, and make into a liniment, to be divided into three equal parts, one of which is to be rubbed in on the arms, thighs, and calves, three nights running, by the patient with his own hands. 2. If, three days after the last inunction, there be no saliva- tion, eight grains of turbith mineral must be given out of con- serve of red roses ; in weakly bodies, a scruple of calomel. If the salivation set in, but fall off before the disappearance of the symptoms, it must be stimulated by an occasional dose of calomel. 3. It ought so to be managed as to give about four pints of saliva in twenty-four hours. 4. If it go too far, and be attended with excessive inflam- mation, and similar symptoms, it must be checked a little by means of cathartic medicines, until it attains its proper degree of intensity. 5. As soon as the symptoms have ceased, change the shirt and sheets, and put as fresh ones those that have been used before. 6. If diarrhoea supervene (as it does sometimes before the salivation has come out fully), it must be checked with liquid laudanum, given in increased doses until it has done its work. 7. If the mouth be ulcerated, let it be washed with damask rose-water, or with milk and water, or with the following decoction : R Marshmallow-root, Cleansed barley, aa Ijj ; Quince-seeds, 353; Water, q. s. Boil to two pints. Mix, and make into a gargle. To be used frequently. 8. The diet and the rest of the regimen must be the same as whilst the patient purged; except that for the first few days ho may take barley-broth, oatmeal gruel, posset-drink, or thin small beer warmed. 282 PROCESSUS INTEGRI. 9. When all this has been done, and when the symptoms seem to have gone off, we must guard against a relapse, by giving a scruple of calomel once a week for three weeks or a month, however well the patient may be, and although he may be able to go about in the open air. CHAPTER XXXVI. ON FLUOR ALBUS. 1. THE discharge is white, pale, yellow, green, or blackish. At times, acrid and corrosive ; at times, foul and bad-smelling. The face is discoloured. The spine of the back is in pain. The appetite falls off. The eyelids and feet swell. 2. Bleed from the arm to eight ounces. R Pil. coch. maj., 9ij ; Castor, gr. ij ; Balsam of Peru, Ityij. Make into four pills ; to be taken at four a. m. Sleep afterwards. Repeat twice, leaving intervals of one or two days, according to the strength of the patient. R Rue-water, %iv ; Compound bryony- water, Jij ; Crystalline sugar, q. s. Make into a julep ; of which take three or four spoonfuls when faint and weak. Then R Venice treacle, Jiss ; Conserve of orange-peel, jj ; Diascordium, ;$ss ; Candied ginger, Candied nutmeg, aa 5iij ; Gascoigne's powder, Jiss ; Pomegranate rind, Angelica, Red coral, Lozenges of terra Lemnia, aa 3j ; Bole armeniac, 9ij ; Gum arable, 3ss ; Syrup of dried roses, q. s. Make into an electuary ; of which a portion the size of a large nut- meg must be taken every morning at live p. m. and at night, for a whole month. Wash down with DIABETES PILES. , -J83 R Elecampane, Masterwort, Angelica, Sweet-flag, ita Jss ; Roman wormwood, White horehound, Lesser centaury, Calamint, Sage (dried), aa a liandful; Juniper-berries, Jj. Slice small. Steep in four pints of Canary wine. Let them stand in the cold infusion. Strain when wanted. 3. The diet must be digestible meats, without fruit and vegetables. Sherry wine at dinner. CHAPTER XXXVII. ON DIABETES. THE juices of the blood make a way out through the urinary passages, in an unconcocted form. Hence the strength gradually lessens, and the body weakens, its substance being, as it were, pumped out through the common sink of the bladder. Then there are thirst, heat of the viscera, swelling of the legs and hips, and the frequent expectoration of a viscid and frothy saliva. The treatment is that of fluor albus, with the omission only of the bleeding and purging. CHAPTER XXXVIII. ON PILES. INTENSE pain at stools, the stools being streaked with blood. At times, tumours like warts lurk under the sphincter, or appear on the margin of the anus. Bleed to ten ounces from the right arm. R Melon-seeds, Gourd-seeds, aa ^ss ; White poppy-seeds, 5ij ; Sweet almonds (peeled), v. Pound in a marble mortar, dropping in gradually 284 ^ PROCESSUS INTEGRI. Barley-water, Oss ; Rose-water, 3ij ; Best white sugar, q. s. Fiat emulsio secundum artem. Of this three ounces are to be taken frequently. R Flowers of sulphur. Liquorice, Sage (in powder), aa 5j ; Balsam of Lucatelli, q. s. Make six pills out of each drachm. Of these take three a day. Wash down with six spoonfuls of the emulsion : R Frog-spawn-water, Jiv ; Dissolve in this two drachms of litharge ; Opium, 9j. Make into a mixture. Of this apply a little to the part affected on a linen rag ; or if the tumour be internal, let three spoonfuls of the same be injected as a clyster. Milk, boiled with water, or barley-water, is the ordinary drink. No meat. Every night a dose of diacodium. CHAPTER XXXIX. ON IMMODERATE HEMORRHOIDAL DISCHARGES. THESE are made manifest by the prostration of the patient's strength, by the abundance of the blood, by the duration of the hemorrhage, and by the unnatural hue of the body, which becomes lemon-coloured, approaching the hue of jaundice. Cachexy follows this, and dropsy the cachexy. Excepting only the catharsis, the treatment is the treatment of the immoderate menstrual flux. CHAPTER XL. ON THE EPILEPSY OF CHILDREN. 1. THIS may begin so early as the first month, from over- frequent alvine evacuations. In this case diascordium, (about as much as a grain of pepper) dissolved in saxifrage-water, or in the mother's milk, is a most excellent remedy. RICKETS. 285 Or it may come on during teething, between the seventh and nineteenth months, accompanied by cough, or by (what is much worse) green vomit (like that of hysteria), and diarrhoea. 2. At times the fit comes on without warning. The face becomes livid, the eyes and mouth distorted, the limbs con- vulsed. At times it is indicated beforehand by a contraction of the finger, or by a fixed and strange immobility of the eye- balls. Sometimes sooner, sometimes later, the fits break out ; at times at regular intervals, at times at vague and uncertain periods. In cases where they allow a truce, the infants are drowsy until a fresh attack resuscitates them. Apply a blister to the nape of the neck at once. R Aqua epileptica Langii, 3iij ; Liquid laudanum, tflJ ; (ij or more according to age ;) Syrup of poeonies, 5j. Mix, and make into a draught ; to be taken as soon as possible. R Rue-water, Jiij ; Aqua epileptica Langii, Compound bryony-water, aa ^j ; Syrup of cloves, 553. Mix, and make into a julep ; of which a spoonful is to be taken every hour, in case the draught last prescribed have not dispelled the fit. CHAPTER XLI. ON RICKETS. IN rickets there is a softness and laxity of the parts, weak- ness and languor, sluggishness and torpor, and, besides this, unequal nutrition. Thus the head is over-sized, the face over- florid and over-full, whilst the parts below are emaciated. The joints project in nodes, the wrists somewhat more than the ankles. The ends of the ribs swell. The bones become curved, especially the tibia and fibula. Sometimes this is the case with those of the ulna and radius, and even of the thigh and huraerus. The teeth come late and painfully, are loose in their sockets, and fall out in bits. The chest is narrow at the sides, and pointed in front, the belly being full and the hypo- chondres tense. Cough and weakness of the lungs supervene. In lying down, the patient sometimes favours his right, some- times his left side. 2SG PROCESSUS INTEGRI. R Leaves of common mugwort, lesser centaury, white horehound, germander, scordium, calamint, feverfew, meadow-saxifrage, St. John's wort, golden-rod, wild thyme, mint, sage, rue, St. Benedict's thistle, pennyroyal, southernwood, chamomile, tansey, lily of the valley (all fresh gathered and cut up small), aa a handful; Hog's lard, ft iv ; Mutton suet, ft ij ; Claret, Oij. Soak in an earthen jar over the hot ashes for twelve hours. Then boil until the liquor is consumed. Strain, and make into a liniment. Anoint the belly and hypochondres morning and evening, as well as the limbs affected, for thirty or forty days, or until convalescence. R Of each of the aforesaid, two handfuls. Soak in four gallons of unhopped beer. Use the cold infusion as a drink. In tumours occupying the bellies of infants arising from excessive evacuations, the blood and viscera must be comforted by restorative herbs, just as in true rickets, except that, in this case, the armpits on each side must be anointed but not the limbs. CHAPTER XLIL ON FEVER ARISING FROM DENTITION. THREE or four drops of spirits of hartshorn, according to the age of the patient, must be given every four or six hours, out of one or two spoonfuls of black cherry-water, or any other fit vehicle. HEMORRHAGE FROM THE NOSTRILS. 287 CHAPTER XLIII. ON THE HECTIC FEVER OF INFANTS. THEY pine away, without any notable heat. The appetite falls off. The limbs and trunk become emaciated. Steep two drachms of sliced rhubarb in a glass bottle holding a quart of beer, and give this as an ordinary drink. When this is drunk out, add another quart of beer to the same rhubarb. Afterwards, a third. If the beer become too soon saturated with the rhubarb, add a second pint, when only half the first bottle has been taken. CHAPTER XLIV. ON THE CONVULSIVE COUGH OF CHILDREN. THIS is only subdued by bleeding and repeated purges, and is a disease otherwise most obstinate and incurable. Still the cathartics must be mild, and given only in spoonfuls according to the patient's age. CHAPTER XLV. ON HEMORRHAGE FROM THE NOSTRILS. SHOOTING pain and heat in the fore part of the head. Bleed frequently. Let the diet be of the cooling and thickening sort. Let cooling and thickening juleps be given. Throw up a cooling clyster every morning. Every night give a paregoric of syrup of poppies. Purge with the common potion every day. Fold a linen rag in four folds. Soak it in a cold solution of sal prunella. Squeeze it out gently. Apply it to the head aud back of the neck, several times a day. After the evacuation 288 PROCESSUS INTEGRI. R Hungarian vitriol, Alum, aa Jj ; Phlegma vitriolicum, Oss. Boil until everything is dissolved. Filter the cooled liquor, and sepa- rate it from the crystals. To the remainder add a twelfth part of the oil of vitriol. Or, which is better, R Plantain-water, ^iij ; Bole armeniac (finely powdered), Jss. Mix thoroughly. Steep a plug of linen in the mixture and leave in the nostril from which the bleeding comes for two days. If this fail, dissolve some Roman vitriol in cold water. Plug the nostril with the same. Linen rags, steeped in this liquor, stop bleedings from the external parts as well. CHAPTER XLVI. ON THE GREEN-SICKNESS. THE face and body lose colour, the face also swells ; so do the eyelids and ankles. The body feels heavy ; there is tension and lassitude in the legs and feet, dyspnoea, palpitation of the heart, headache, febrile pulse, somnolence, pica, and suppression of the menses. The patient must take the chalybeate pill, or else the chaly- beate powder described in the account of the hysterical affection. The dose must be regulated by her age. She may also take the restorative infusion, with angelica, described in chap. i. Un- less very weak, she may be purged before the use of the cor- roborants. CHAPTER XLVII. ON SUPPRESSION OF THE MENSES. DISLIKE to food. Discoloration of the face. Heaviness of the whole body, pain in the fore part of the head, loins, legs, and lower belly. Swellings of the feet. The prescriptions are the same as in the hysterical affection, VOMITING AND SPITTING OF BLOOD. 289 and in case they do not yield to these, the following must be prescribed. Every morning, and at four p. m., she must take five spoon- fuls of the hysterical julep, without the castor, with the addition of twelve drops of hartshorn. Every night, at bedtime, she must take a scruple of the myrrh lozenges, made into the form of pills, or a bolus with syrup of wormwood. CHAPTER XLVIII. ON VOMITING AND SPITTING OF BLOOD. 1 . IN spitting of blood there is heat and pain in the chest, accompanied by weakness. 2. Bleed from the right arm to ten ounces. Next morning give the common purgative potion, and, the same night, a paregoric of an ounce of syrup of poppies out of three of black - cherry-water. 3. After this, order as follows : R Bole armeniac, Jj ; Powder of comfrey-root, 5ij ; Terra sigillata, Bloodstone, Dragon's blood, ail 5J ; Finest white sugar, as much as all the rest. Mix, and make into a very fine powder. Of this take a drachm every morning, at five p.m., and at night. Wash down with four ounces of the following apozem : R Plantain-leaves, Blackberry-leaves, Yarrow, aii a handful ; Water, q. s. Boil to half a pint. Dissolve in the strained liquor two ounces of syrup of comfrey. Mix, and make into an apozem. Or six spoonfuls of the following tincture : R Flowers of the red rose, 3vj ; Inner bark of the oak, 355 ; Plantain-seeds (but little bruised), 3iij ; Spring-water, Oij ; Spirits of vitriol, q. s. to give acidity. Put into a close vessel, and boil, at a gentle heat, for four hours. Strain, and add Barley-water with cinnamon, ^iij ; Finest white sugar, q. s. Sweeten to taste. II. 11) 290 PROCESSUS INTEGRI. 4. If there be a repugnance to the powder, the electuary of Chap, xxvii may be given. 5. A clyster every day, and diacodiura at bedtime. 6. Bleed as occasion requires, once, twice, or thrice, at the intervals of a few clays. The purgative potion to be repeated frequently, if needful. 7. A cool and thickening diet must be observed. CHAPTER XLIX. ON THE PUNCTURE OF A TENDON. AN aqueous humour, or ichor, is continually oozing from the orifice of the vein. R Lily-roots boiled in milk until soft, and then bruised, ^iv; Linseed-meal, Oatmeal, aa 311] ; Boil to the consistency of a poultice in the same milk in which the roots were boiled. Apply to the parts night and morning. CHAPTER L. ON BURNS. FOMENT the parts with linen rags dipped in spirits of wine, until the pain departs. Dip the rag afresh, and apply it two or three times a day to the part affected. CHAPTER LI. ON COMMON MANIA. 1. THIS arises from too vivid and exalted a crasis of the blood. There is also another sort of mania, which succeeds long-con- tinued intermittent fevers, and at last degenerates into idiocy. This comes from weakness and vapidity of blood, brought on by over-long fermentation. 2. Prescribe the warmer cordials, such as Venice treacle, egg- electuary, the Countess' powder, Sir Walter Raleigh's powders, BRUISES. 291 out of plague- water, treacle- water, or other fit vehicles. Let the diet, moreover, be analeptic. 3. In young patients bleed from the arm to eight or nine ounces, once or twice, with three days between each venesection. Then bleed from the jugular vein. After this, the treatment will consist wholly in the following purge, which must be given every third or fourth day, until convalescence ; observing only, that after the patient has been purged eight or ten times, the exhibition of the cathartic may be omitted for a week or two. R Root of the white bryony in powder, jj ; Milk, ^iv. Or R Of the same, $ss or 5vj ; White wine, ^iv. Steep for a whole night. Strain. Dissolve in the strained liquor Syrup of violets, 5} ; Mix, and make into a potion. Or R Gamhoge, gr. xiv ; Black-cherry-water, ^iij ; Syrup of cloves, * ss. Make into a potion. CHAPTER LII. ON BRUISES. BLEED from the side affected to ten ounces. Next morning give the common purging potion. Then bleed and purge in turns till recovery. Throughout the sickness, if the inward parts be hurt, give R Pectoral decoction, Oiss ; Syrup of violets, Syrup of maidenhair, aii jij. Make into an apozem; of which half a pint is to he taken three times a day. A spoonful of the oil of sweet almonds, freshly expressed, may be taken frequently. R Oil of sweet almonds, Marshmallovv ointment, Pomatum, iifi $j. Mix, and make into a liniment; to he applied to the part affected morning and evening. Cover with a calihage-leaf. 292 PROCESSUS INTEGRI. CHAPTER LIII. ON A SCALDED HEAD. THE common purge twice. Then R Oil of bitter almonds, Oil of laurel, Ashes of the southernwood, aa Jj- Mix well together, and make into a liniment. With this,. rub the whole of the head every morning, carefully. Cover with a pig's bladder. The head must be shaved as soon as possible, and the scales must be carefully rubbed away every morning, as they become likely to fall off. CHAPTER LIV. ON THE BITE OF A MAD DOG. AFTER forty days or more melancholic symptoms appear, thirst, fever, hydrophobia, and, at last, convulsions of the extremities. R Spirits of wine (rectified), ^iv ; Venice treacle, jj. Make into a mixture, to be rubbed OR the part affected thrice a day. Cover with a linen rag steeped in the same. CHAPTER LV. ON AN ULCER OF THE BLADDER. FETID pus, or blood, and sometimes squamulse or membrana- ceous pellicles (like branny crusts), are passed along with the urine. If there be an ulcer in the kidneys, minute and some- times even large-sized pieces of flesh are voided. A continual dysuria and pain affect the urinary organs, although, if the mischief be in the kidney, there are clear and definite intervals of both ; whilst the pus which is excreted is white, smooth, and scarcely at all fetid. The urine is like milk, and some time ASTHMA. 293 after it has been passed the pus separates and settles at the bottom of the chamber-pot. K. Plaster of the flos unguentoruni, 5iss. Make into nine pills. Of these three are to be taken at the usual hours. Wash down with six spoonfuls of R Fennel-root, Bindweed, Birthwort, Clove-gill flower, ail ^iij ; Agrimony-leaves, St. John's wort, Bugle, Sanicle, Plantain, fia six handfuls. Cut small, and soak in White wine, Milk, aaOiv. Distil to two pints. Root of the larger bindweed, Gum arabic, afi Jy ; Barley-sugar, Jij. Make into a powder. Of which take a spoonful t \\icc a day. CHAPTER LVI. ON INVETERATE ASTHMA IN PATIENTS OF A SANGUINE TEMPERAMENT. THIS is divided into three sorts 1st. Dyspnoea or difficult respiration, in which the breath is drawn heavily and frequently. This arises from infarction of the lungs, and is without stertor. 2d. Asthma, in which the respiration is laborious and frequent, and in which the diaphragm and intercostal muscles, along with the muscles of the abdomen are violently moved, and where there is stertor and sibilus. In the first of these kinds the substance of the lungs, in the second the bronchi are stuffed up. 3d. Orthopnoea. This is the most extreme form of difficult respiration, where the patient can only breathe by having his head and shoulders raised. The muscles, too, of the chest and shoulder-blades are violently agitated. 294 PROCESSUS INTEGRI. Bleed from the right arm to ten ounces. The next day take the common purgative potion, and repeat it every third day for two more times. On the days when there is no purging : R Aniseed (very finely powdered), 3ij ; Balsam of Locatelli, q. s. Make six pills to the drachm. Of these take three every morning, and at five p.m. Wash down with four ounces of the bitter decoction, warm, and without its purging ingredients. If the symptoms con- tinue, repeat the whole process a second time. CHAPTER LVII. ON PALSY. SENSE and motion, one or both, are either wholly lost or impaired in the parts affected. Pil. coch. maj. in doses of two scruples, every other morning, for six times. Then two drachms of antiscorbutic electuary. Wash down with six spoonfuls of the aqua antiscorbutica. R Unguentum nervinum, Compound spirits of lavender, Spirits of garden scurvy-grass, aa 5' ss - Mix, and rub in on the parts affected, e. g. the spine of the back, night and morning. Most of the prescriptions for scorbutus suit paralysis ; since they pre-eminently dissipate and volatilize the crude and fixed humours. CHAPTER LVIII. ON COUGHS AND PHTHISIS. THE cough betrays itself. The phthisis comes on between the eighteenth and thirty-fifth years. The whole body becomes emaciated. There is a troublesome hectic cough, which is increased by taking food, and which is distinguished by the quickness of the pulse and the redness of the cheeks. The matter spit up by the cough is bloody or purulent. When burnt, it smells fetid. When thrown into water, it sinks. Night sweats supervene. At length the cheeks grow livid, the COUGH AND PHTHISIS. 29o face pale, the nose sharp. The temples sink, the nails curve inwards, the hair falls off, and there is colliquative diarrhoea, the forerunner of death. 2. If the cough be still recent, and if it have not yet brought on fever, bastard peripneumony, or any other proper phthisical sign, or if it have not arisen out of the remains of a pleurisy or a peripueumony, whereof, from insufficient bleeding, the cure was imperfect, it will be sufficient for the patient to abstain for a few days from wine and meat, and use ad libitum such remedies as the following : 3. Of the balsam of sulphur with anise, ten drops out of a spoonful of crystalline sugar. The following tablets, which the patient should carry about with him, and take, one at a time, frequently. R Sugar-candy, Ib.iss; Spring-water, q. s. Boil until the sugar sticks to the ends of the fingers. Then add Liquorice-root, Elecampane, Aniseed, Angelica (the seeds), aa Jss ; Orris-root, Flowers of sulphur, aa 3ij ; Essential oil of aniseed, 9ij. Make into tahlets sccundum artem. Label them as household medicines. 4. In the meanwhile the following eclegma may be used : R Oil of sweet almonds, Syrup of maidenhair, Syrup of violets, fia ^j ; Sugar-candy, q. s. Make into a lohoch ; to he taken off a stick of liquorice, whenever the cough is troublesome. 5. When the defluxiou is of the thin sort, thickening * o eclegmata may be given. G. If the cough will not yield to those remedies, and when it has arisen from peripneumony, or from pleurisy, or is ac- companied by fever (and this is generally the case), it is folly to trust to pectorals. The disease must be attacked by bleeding and purging, as directed in the chapter on Bastard Peri- pneumony. 7. If, notwithstanding the latter method, the cough not only continue, but so shake the lungs as to have paved the way for phthisis, the treatment must be as follows : 296 PROCESSUS INTEGRI. R Balsam of Peru, n\x. To be dropped into a spoonful of ground-ivy, or (if that be disagreeable to the taste) a spoonful of crystalline sugar. To be taken three times a day. To be washed down with four ounces of the bitter decoction without its purging ingredients. If ever, when thus given, it move the bowels, three ounces only must be taken. 9. But of all the remedies for phthisis, long and continued journeys on horseback bear the bell ; in respect to which it must be noted, that if the patient be past the prime of life, more exer- cise of the sort in question must be taken than if he were a youth or boy. Bark is no surer a cure for ague, than riding for phthisis. CHAPTER LIX. ON SCORBUTUS. WEARINESS, independent of exertion, heaviness of the body, dyspnoea, especially upon moving about, putrefaction of the gums, foul breath, frequent loss of blood from the nostrils, difficulty in walking. The legs sometimes swell, sometimes waste ; with livid, leaden-coloured, yellow, or violet-coloured spots. The face is generally of a sallow paleness. 2. Bleed to six ounces, unless there be dropsy. Next morn- ing give the common purging potion, and repeat it every third day twice. 3. On the days when there is no purging, and also a month or two after, the patient must take R Conserve of garden scurvy-grass, Jij ; Conserve of lujula, j ; Compound powder of cuckoo-pint, 3vj ; Syrup of oranges, q. s. Make into an electuary ; of which a portion about the size of a large nutmeg is to be taken every morning at five p. m., and at night. Wash down with six spoonfuls of the aqua raphani composite, or else of R Horseradish-root (rasped), Ib.ij ; Cuckoo-pint-root, Ib.j ; Leaves of garden scurvy-grass, twelve handfuls ; Mint, Sage, Watercress, Brooklime, iia six handfuls ; Seeds of the garden scurvy-grass (slightly bruised), Ib.ss ; Nutmeg, 355 ; White wine, Ib.xij. Distil in a common still, so as to give no more than six pints for use. DECLINE. 297 4. Or, the leaves of fresh garden scurvy-grass alone may be distilled for the same purpose. Moreover, the following beer must constitute the ordinary drink : R Horseradish-root (newly sliced), 3ij ; Leaves of garden scurvy-grass, xij ; Raisins (without the stones), vj ; Half an orange. Soak in a quart bottle of thin small beer, and cork closely. 5. In this way should be prepared, in the first instance, six bottles, and, after a few days, six more, to be ready when the first are finished. 6. Or, instead of this beer, three or four spoonfuls of the following mixture may be added to the patient's ordinary drink : R Horseradish-root, Seeds of the garden scurvy-grass, aa ^ss ; Leaves of the same, two handfuls ; The pulp of one orange. Beat together in a marble mortar, and add gradually half a pint of white wine. Squeeze it moderately in the straining, and set by for use. 7. The same remedies, with the omission of the bleeding and purging, are very efficacious in both scorbutic and hysterical rheumatism. CHAPTER LX. THE DESCRIPTION AND CURE OF A DECLINE. 1 1. THERE are many kinds of tabes. The first arises from cold taken during winter. A little before the winter solstice many persons take it. When any of such have weak lungs, it is only natural that the continued effort of coughing should weaken them still more. Hence, from a faulty diathesis, they become incompetent to due assimilation of their proper aliment. Then a vast mass of crude phlegm accumulates, which, from continual coughing, and from the vehement efforts of the lungs, is rejected by the mouth. The lungs, replete with pus, disperse purulent miasmata over the whole of the body. Hence arises putrid fever, which is worst towards the evening, whilst, in the morning, it bathes the patient in copious and debilitating sweats. To crown nil, ' In the Latin tabes. 298 PROCESSUS INTEGRI. diarrhoea sets in, partly from putrid humours deposited and excreted by the mesenteric arteries in the intestines, partly from the weakened and depraved tone of the viscera. Hence the patient dies during the following summer, the winter's cough having paved the way to his death. This is the chief sort of tabes or decline. 2. The blood, at the season in question, is loaded with humid particles, and the perspiration through the pores of the skin being checked by their sudden contraction, the aforesaid particles become dispersed along the branches of the pulmonary artery, or else are deposited by the salivary ducts in the glands which occupy the fauces. The humour then finds its way from the trachea to the lungs, like a catarrh, and the frequency and vehemence of the cough produce the debility and the symptoms which have been already noticed. The lungs can now no longer retain their natural status and economy, so that glandules and tubercles arise. Hence, in patients who have died of this disease, we find, on inspection, that they are distended with a purulent sanies. 3. AVhen this disease has taken strong root, medicines are generally of no avail. Still treatment may be tried, e. g. bleeding from the arm, arid mild catharsis for the sake of diminishing the defluxion with pectoral medicines, accommodated to the different stages of the disease ; incrassant where the humour is of such subtlety and tenuity as to be incapable of expulsion, attenuant when it is thick, and brought up labo- riously. Then the hectic fever must be checked by cooling remedies. Of this sort are asses' milk, aqua lactis stillatitia, emulsion of sweet almonds, of melon-seeds, of gourd-seeds, of white poppy, of cowslip-flower-water, &c. Lastly an attempt must be made to cure the ulcer for which purpose the liquid turpentine, called opobalsam, is particularly adapted. 4. The treatment of the disease is, in my mind, as follows. Bleed in the first instance, then purge for three days running, either with the pil. coch. maj. or with the lenitive decoction already noticed. On the third night give half an ounce of the syrup of poppies. After an interval of two or three days, ac- cording to circumstances, repeat the purge, and do this as often as is necessary ; i. e. until the symptoms either wholly or partially disappear. After each purge give two drops of opo- DECLINE. 299 balsam on a large lump of sugar. Drink nothing after them. Take in their stead a pill of Chian turpentine with sugar-candy. The opobalsam is not to be taken except after previous eva- cuations. Instead of this an electuary of balsam of Lucatelli, liquorice powder, aniseed, and turpentine may be substituted. After the evacuations, great care must be taken to allay the cough, lest the lungs be harassed by the continual irritation. The aforesaid syrup does this. It may be given in the following formula : R Pectoml decoction, Oj ; Syrup of poppies, Syrup of maidenhair, aa Jij. Take five spoonfuls three times a day. 5. This will prevent the catarrh from falling on the lungs, and, unless the change has gone too far, will bring them to their previous state of health. It will also promote the concoction of the purulent matter. C. The palmary remedy, however, is daily riding on horse- back which is all in all. Do this, and you may neglect the rules of diet, and deprive yourself of no sort of meat or drink. In some cases of recovery, thus brought about, there is a swelling of the neck, not unlike that of scrofula. 7. There is another sort of decline, which arises from coughs beginning at a very different period of the year, viz. during the beginning of the summer. It occurs in young patients, whose system is weak, and whose humours are hot and acrid. If they have over-indulged in wine, such subjects will spit blood. They feel pain or discomfort in the chest. Unless such sym- ptoms be relieved by appropriate remedies, there will come from them first soreness, next an ulcer, and lastly pus. 8. This sort of decline is easily subdued, at least in the beginning, by bleeding and purging, alternately, twice repeated ; provided that the patient use a cooling and thickening diet, and wholly abstain from animal food. 9. The three sorts of this disease originate in the matter of fever becoming deposited in the lungs, just as the fever itself is giving way. The patients being weakened are harassed by the aforesaid symptoms. 10. Sometimes it arises from the purulent sanies, which in pleuritic patients has not been thoroughly expectorated. In such a case the treatment is that of an rinpyrina. 300 PROCESSUS INTEGRI. 11. Lastly, tabes may arise from the weakness consequent on inordinate evacuations. Here there are hectic flushes, chiefly towards the evening, after meals. Here, too, aphthae are particularly common. CHAPTER LXI. ON GOUT. 1. TOWARDS the end of January, or the beginning of February, about two o'clock in the morning, the patient is awakened by a severe pain in the great toe ; sometimes in the heel, ankle, or instep. Then follow chills and shivers, and a little fever. The pain becomes more intense. With its intensity the chills and shivers increase. About midnight the agony is at its worst. Now it is a violent stretching and tearing of the ligaments now it is a gnawing pain, like that of a dog, and now a pressure and tightening. So exquisite and lively meanwhile is the feeling of the part affected, that the sufferer cannot bear the weight of the bed-clothes nor the jar of a person walking in the room. The pain is not abated before two or three o'clock in the morning of the next day (twenty-four hours having elapsed from the first attack), when a gentle perspiration is succeeded by sleep, and the patient on awaking is freer from pain, and finds the part recently swollen. The next day, perhaps for two or three days after, the foot affected is painful, being worse towards the evening, but better towards the dawn of day. A few days after, the other foot swells, or suffers the same pain. After this has attacked each foot, the fits become irregular, both as to the time of their accession and duration. Now a series of lesser fits like these constitutes a true attack of gout long or short, according to the age of the patient. In strong constitutions, where the previous attacks have been few, a fortnight is the length of one. With age and impaired habits, gout may last two months. With very advanced age, and in constitutions very much broken down by previous gout, the disease will hang on till the summer is far advanced. 2. For the first fourteen days the urine is high-coloured, GOUT. 301 has a red sediment, and is loaded with gravel. The bowels are confined. Want of appetite, general chills towards evening, heaviness, and a troublesome feeling at the parts affected, attend the fit throughout. As the fit goes off, the foot itches intolerably, most between the toes ; the cuticle scales off, and the feet desquamate. 3. Up to this time, the disease has attacked the feet only. When, however, either undue treatment or the prolonged delay of the disease has converted the whole body into a fomes for the peccant matter, it attacks the hands, wrists, elbows, knees, and other parts. Sometimes it distorts the fingers till they look like a bunch of parsnips, and become stiffened and immoveable from the deposits of chalkstone concretions about the ligaments of the knuckles, like crab's eyes. Sometimes the morbific matter fixes on the elbows, and raises a whitish tumour, almost as large as an egg, which gradually grows red and inflamed. Sometimes the thigh feels as if a weight were attached to it, without, however, any notable pain. The knee, which is next attacked, is more painful. The patient's limbs are now wholly crippled and contracted, so that he can scarcely crawl about, and all motion is distressing. The urine has the hue of the urine of diabetes. The back and other parts itch ; especially at bedtime. 4. After many dreadful torments, the fits, as far as the pain is concerned, become milder ; partly because Nature is oppressed by the peccant matter, and partly from old age. Then, instead of the usual agony, there is uneasiness, pain in the stomach, weariness, and sometimes a tendency to diarrhoea. These symptoms disappear whenever the pain attacks the joints ; so that, sometimes from the pain, sometimes from the weakness, alternately affecting the patient, the fits become protracted. 5. Gout very often produces a calculus in the kidneys. It attacks women but rarely, and then chiefly the aged and mas- culine. Nor is it common with minors and children. G. The curative indication turns upon improving the con- coctions. This is done by removing the indigestions, either by medicines, by diet, by exercise, or by any change in the six non-naturals. 7. Bleeding, purging, and diaphoresis will not attain the object ; although with those who suffer from a calculus in the 302 PROCESSUS INTEGRI. kidney, and from bloody urine, originating therein as well as from gout, it may not be inexpedient to open the bowels once a week with manna, and to give a paregoric at bedtime after each purging. 8. The medicines which satisfy this indication are those which are moderately warming, and which, when tasted, act pungently on the tongue. Such are the roots of angelica, elecampane, wormwood-leaves, the lesser centaury, germander, ground-pine, &c. &c. To these may be added the so-called antiscorbutics, as horseradish, garden scurvy-grass, watercress. These last, however, because they increase the heat (and so stimulate), must be used more sparingly than the others. With them, the moderate heat and the mild bitterness restore the stomach. The following electuary is useful : R Conserve of garden scurvy-grass, jiss ; Roman wormwood, Orange-peel, aa 3J ; Candied angelica, Candied nutmeg, aa ^ss ; Venice treacle, 5iij ; Compound powder of cuckoo-pint, 5ij ; Syrup of oranges, q. s. Make into an electuary. Two drachms to be taken twice a day. Wash down with five or six spoonfuls of R Sliced horseradish, ^iij ; Garden scurvy-grass, xij handfuls ; Watercress, Brooklime, Sage, Mint, aa iv handfuls ; The peel of six oranges ; Bruised nutmegs, ij ; Brunswick mum, Oxij. Distil in a common still, until six pints are given off. 9. These digestive remedies must be used constantly and with all diligence, and are chiefly to be applied during the intervals of the fits. 10. Moderation in meat and drink must be observed, so that on one hand the stomach receive no more food than it can digest, and that, on the other, abstinence do not weaken the parts, by withholding from them their due proportion of that GOUT. 303 aliment which is necessary for supporting their strength and vigour. Again, in the quality of the food, the palate of the patient must be consulted. One sort of food for each meal is best. Saving of meat, the patient may eat ad libitum, except that his food must not be sharp, nor salted nor spiced. It is best not to take supper, but to drink a free draught of small beer instead of a meal as a preventive to the concretion of a calculus. 11. As to liquors, those are the best which neither sink to the weakness of water (so as to chill the stomach), nor rise to the generosity of wine. Such is the London small beer, or weak wine-and-water. Water alone is dangerous. When the whole substance of the body has degenerated into the fomes of gout, all fermented liquors, however weak, must be abstained from, and the diet-drink of sarsaparilla must be used from the time that the patient recovers from the fit to the day of his death. 12. Nevertheless, if the patient, from either too long and too excessive a use of intoxicating liquors, from being advanced in life, or from excessive debility, cannot digest his food without either wine or some other fermented liquor, he may leave off the diet-drink, and take a little sherry at meals. 13. The patient must go to bed early, especially during the winter, must keep his mind quiet, and not be too intent upon serious matters. 14. Far better, however, than anything else, is daily exercise, provided it be moderate, and that the patient persevere in it. As to the sort of exercise, riding on horseback is the best ; provided that neither extreme old age nor the presence of a calculus forbid it. It is best in the open air. Driving in a carriage is also useful. Gouty men must not indulge in venery. External applications are not to be applied. 15. Although nothing of magnitude is to be attempted during the paroxysms, it may still be good for the patient to abstain from animal food for some days, and to take onlv oatmeal-gruel, or some similar aliment. If, however, there be any ataxia of the animal spirits, it is not well to abstain from meat longer than the stomach loathes it. Still there should be no errors in respect to the quantity of either the meat or drink. 304 PROCESSUS INTEGRI. 16. Those symptoms which threaten the life of a patient must be met. Of such, the commonest is languor of the stomach with gripes, as if from wind. Nothing suits this better than an occasional draught of Canary wine. Exercise, too, must be taken. If, however, any other symptom, graver still, and one which will not allow of delay, present itself, we must (provided always that the head be not affected) have recourse to laudanum. Of this the patient should take twenty-five drops out of plague- water, and compose himself to sleep. In this way did our most illustrious author himself escape imminent death, when, from some error connected with the six non-naturals, the gout fell upon the stomach, and pain, with violent vomiting, was the effect ; the limbs meanwhile being wholly free from pain, and even more free for movement than usual. He thus treated himself: he swallowed a gallon of posset, or of small beer, threw it up by vomiting, and took eighteen drops of liquid laudanum out of a moderate draught of Canary wine. If the symptoms do not yield to this remedy, a sweat must be brought on by the usual method, and medi- cines, and be continued, morning and evening, for two or three hours, until the third or fourth day. 17. But if there be a metastasis to the lobes of the lungs, whilst the limbs are free from pain and swelling, the symptom is to be treated like absolute peripneumony, i. e. by repeated bleeding, by cooling and thickening diet and remedies, and by lenitive purging potions between the bleedings. It is injurious, however, to force a sweat. APPENDICES. ii. 20 APPENDICES. APPENDIX A. THE following is from a MS. in the Public Library of the University of Cambridge, to which the attention of the editor had been directed by a reference in the ' Biographia Britannica,' under the title Sydenham. The MS. is in a more modern hand- writing than that of Sydenham's time, and is headed "Theohgia Rationalis by Dr. Thomas Sydenham." Beyond this, the Editor has not found either any illustration of its history, or evidence of its authenticity. According, however, to the usual rules of criticism a work must be considered to belong to the author to whom it is attributed, until reason be shown to the contrary. T1IEOLOGIA RATIONALIS. THE question is, How far the light of Nature, if closely adverted to, may be extended toward the making good men ? Towards the determining of which this is all that shall be taken for granted by me, viz. that he is a wise and thinking man, whoever he may be, that sets upon this inquiry. Such a man must needs think thus with himself. I see that there is a most perfect and exquisite order in the several natures of the world fully conducing to the preservation of their individual beings, and to the propagation of their kinds. In all which they contribute nothing themselves by their own counsell or contrivance, as not knowing how they are made or how continued in their beings. And therefore I am enforced to think that something w th is partaker of admirable wisdom and power, is the contriver and maker of them. But further, considering not onlcy the artifice, by which those par- ticular bodies w dl I see and converse w'J 1 are made with respect 308 APPENDIX A. of each of them to its selfe; but likewise that artifice, by which each of them hath some subservience one to another for safeguard, food, and other convenience, I am still led into a greater certainty, that there was some Supreme Nature, which (without and differing from all these) did as he made them so, put them into this order in reference to one another. But extending my thoughts yet further, and considering those in- numerable and immense celestial bodies, which I can take in w th my natural eye, and those yet as many more w c !' I can take in w*'? 1 the help of glasses, and all these put and preserved in motion so swift and so regular, both for the convenience of each of themselves and for the convenience of the whole, as cannot enter into the heart of the wisest man to conceive, how can I less doubt the being of a Nature infinitely wise and infinitely powerful, by whose contrivance hath been performed and is continued the exquisite order of the stupendous fabric of the universe, then I doubt my own being ? And it may be well conceived that the utmost I can find out, by adverting to the great theatre, beares but a very inconsiderable share in the divine opifice, w ch is still more exquisite and more great then I (wholly groveling upon the dirt of this earth) have faculties to comprehend. And tho' by the late discoveries not before known, and by the inventions of new arts (such as sailing w 1 ! 1 a needle touch'd w tk a loadstone and others) w ! 1 seem altogether impossible to have been lost and to have been found out again (w ! 1 yet in an infinite series of time they must have been), it is very probable that the world was made in time, and the same of no much ancienter date then is as- signed unto it ; yet admitting the eternity of the world, never- theless the order thereof (tho' from such eternity) cloth no less demonstrate the being of an Infinite wisdom and power without it. In a word, there being such order in those parti- cular bodies, whether sublimary or celestial, both in reference to one another and to themselves, and not being the least foot- THEOLOGIA RATIONALIS. soy steps of councill or reason to be found in any of them, by w ch they can contribute any thing toward the production of this admirable order which we call Nature : the same must be the contrivance of a wise powerfull being, both without them and in a condition above them, which we call God. But what am I, who thus think? and for what was I made? For being part of that universe, w ch the Supreme Artificer hath made, I am to conform to those eternal laws, under w ch He hath constituted my being; which (examined what it is) I find that I am a mixt animal, partly consisting of rational faculties, and partly of brutall. But forasmuch as, in the scale of beings, I find that the rational faculties are so much more excellent and superior than brutall ones, as these are above vegetables, my chiefest business and the employment for w ch I were sent into the world is to exert acts that flow from reason and not from sense. And these arc comprehended under the obligations, in which by the laws of my superior nature I stand to the Supreme Being, to humane society, and to myself, considered as an intellectual creature. For I can't see how it can possibly be, that whilest inferior natures are put under laws, by which they are determined to such or such operations suitable to the ends of their several being*, intellectual natures only (tho' the very top of Divine workmanship) should be put under no laws suitable to the ends of their most excellent beings ; but should be left at random, and be, as it w ere, out- laws in the policie of the world. Wherefore as to the first obligation incumbent 011 me, as an intellectual creature, I con- sider that neither air, fire, water, nor earth, nor the more mixt bodies, as minerals and vegetables, nor yet the more advanced compositions of matter, brutes, are able to exhibit to the Supreme Being that profound adoration, which is due to him upon the score of his wisdom and power; and I being the only creature upon this globe of earth, w ch is my habitation that am able to doe it ; it seems to me that I was put here on 310 APPENDIX A. purpose to be a contemplator of this His admirable wisdom and power, and that therefore both for myself and for those other inferior beings, w ! 1 are not endowed with faculties to do it, I am to yield and pay to Him, upon the score of his ad- mirable wisdom and power. But now, as from the consideration of what I see, I am naturally led up into the knowing that there was a Divine Architect or Maker of the World, w dl obliges me to pay my utmost adoration and thanks ; so, from the same consideration, I am engaged to look up to him for all those things which my nature, whether intellectual or brutall, stands in need of, and for the diverting all those evils that are contrary to it. And looke how natural it is to me to believe that he gave me my being ; so natural is it to believe that my well-being depends upon him : nor can I excuss out of my thoughts any more the opinion of the one, then of the other, in the way of thinking incident to me as I am a man. And tho' the Supreme Being, w c . h has so fix'd the na tt a! constitution of the universe, as that it may be unreasonable for me to expect, that for my sake, and at my request, this external establishrn 1 should be put out of order, as that, being old, I should pray for the strength and vigor of youth, or such other things which, in the course of Nature, are put under a necessity of not being able to come to pass ; yet it cannot be supposed, but that in all events, not crossing the establishment of the natural constitution, he hath preserved to himself the power and disposition of them ; as tho' it cannot be but if I shall be shipwrackt far at sea, I must needs be drowned, yet towards the preserving me from this mischief, he may be pleased so to dispose the previous circumstances of my will, and other things, as to prevent my going to sea, and so in this, and in other things, he may hinder the occasions leading to my destruction. Nor indeed can I entertain any thoughts more derogatory from the majesty of this Divine Being, then not supposing THEOLOGIA KATlONAUs. .ill liim to be a free agent ; but having once put all his works out of his own hands, to be concluded within the limits of his own establishing hath determined irrational beings to act in some uniform course, suitable to the good of themselves and the whole. And tho' he hath set up certain lights in intel- lectual natures, wh ( ' h may direct them to pursue ends suitable to their natures, yet having given these a liberty of will inci- dent to the very nature of reasonable beings, he retains his power of inclining or not inclining such intellectual natures to pursue courses leading to their welfare. And truly, in the natures of intellectual creatures seems to be the special domi- nion of the Divine Agent, wh dl tho' he doth not determine in their operations as he doth inferior beings, yet he doth, when he pleaseth, make their lights set up in their minds more illustrious, or else, by a peculiar iucitem! of thoughts, render them more disposed to comply w th their own good, and to avoid their own unhappiness ; so laying in the mean time all the train of circumstances without them, as that they may conduce to this end. But now the footsteps of this moral providence of God in the world do not seem all together so visible as those of his natural ; w ch is clearly disceruable in everything that we be- hold. Yet neither are those totally hid from us, but may be often discovered beyond all reason of doubt, in several events, both relating to whole countries, and likewise to parti- cular men. As when God hath designed any great revolutions to be made in kingdoms and states, not only some person is raised up, that is fitted with peculiar endowments for this work ; but an infinite number of opportunities likewise and circumstances have at the same time concurr'd to produce this alteration. Nor less may any particular man be able to trace out by most remarkable footsteps in Divine Providence, in the course of his own life, wherein he will find such and such events, w rh could not be the effects of chance; so many cir- 312 APPENDIX A. cumstances, and these of so different natures, having concurred toward the producing of them, as did shew that they conspired together in this work by some superior direction. For it is no less in these moral events then it is in the works either of nature or art, in which, if we see so great train of things all concurring to the same end, we reasonably believe they made not themselves, or come by chance, but were effected by some intelligent agent. But how certain soever we may be that such moral events in matters of fact did proceed from a su- perior direction ; yet we can't understand the final causes of them, they being hid in the mind of the Supreme Being, who hath preserved to himself the prerogative of overruling the moral establish* of the world as he pleaseth, and therefore are past all reach of humane wit, whilest many times we can't but perceive that all things happen indifferently, and the same things to fools as to wise, to good as to bad, wch. things yet are not the effect of chance, but of a superior direction. And tho' all such events have had causes suitable to their produc- tion, yet have not causes their events always suited to them. As tho' riches, generally speaking, are acquired by industrie, and health by temperance, yet industrious men happen often to be poore, and intemperate to be healthy. Wherefore, to this eternal, infinitely good, wise, and power- full Being, as I am to pay all that adoration, thanks, and worship w c . h I can raise up my mind unto ; so to him, from the consideration of his providence, whereby he doth govern the world, myself, and all things in it, I am purd Integra et incorruptd mente to pray for all that good which is necessary for my mind and body, and for diverting all those evils which are contrary to their nature ; above all, desiring that my mind may be endowed with all manner of vertue. But in request- ing things relating to my body and its concerns, having always a deference to the will of the Supreme Being, who knows what is best for me, better than I do myself. And tho' my THEOLOGIA RATION ALIS. 313 requests to these bodily concerns of mine are not answered, nevertheless, herein I worship him, by declaring my depend- ence upon him ; and forasmuch as that, in many respects, I have transgressed his divine laws written upon my nature, I am humbly to implore his pardon, it being as natural for me to do it, as it is to implore the pardon of a man whom I know I have offended. In all w ch requests of mine, and all his creatures, how many soever they be in number, and how dis- tant soever they be in place, he being infinite, is as ready at hand to hear and to help as any man who is but finite, is at hand to administer food to his child that craves it. Next, considering myself to be part of the common nature of mankind, hewed, as it were, out of the same block, and likewise, out of gratitude to the common father of us all, I find myself engaged not to hurt, but by all the means I can, to benefit, mankind. And forasmuch as I am so made that I cannot preserve myself in my being without the help and assistance of others, my condition being above that of brutes, who stand in need onely of those few things w. h the earth of its own accord doth yield to them ; and forasmuch, also, as I am not able to de- fend myself from the injuries w c . h those of my own kind, led by pride, anger, covetousness, and such like brutish passions, may do to me, I find myself engaged to comply with the laws of humane society, which is the bond by which the good of men is held together, and to fill up the several duties of my condition in reference to that society. Lastly, concerning the obligations under w. h I stand in re- ference to myself. I consider that in this conjunction of my intellectual and brutall nature, forasmuch as I find my soul to be a far more excellent being than my body, I am to pre- serve entire to my mind the dominion w ch is given to it over my body, in repressing the sensual appetitions thereof, which are against my reason. Nor less am I to preserve to it, in all 314 APPENDIX A. other things, its own dignity, not permitting any labes dedecoris to cleave to it, not suffering it to he dejected when things without me, and which are not in my power, go cross to me ; nor to be vainly elated when things of the like nature succeede, in regard that neither adversity make me a worse man, nor prosperity a better. And tho' because I consist likewise of a body whose appetitions I am not to contradict, when they are not against my reason, if I might have my choice, I am to desire a prosperous condition ; yet when I am under circum- stances of misery w c . h seem vile and contemptible to fools, even in this I have an opportunity to exhibit a specimen of the excellency of my superior nature by suffering w 1 ! 1 patience those evils ; there being not in the whole world a more glorious spectacle than the seeing a good man oppress'd with great and insuperable difficulties, and yet bearing them with patience, as things w c . h happen promiscuously to good and bad men, in the frame and constitution under which the Supreme Being hath put all earthly things, and as being by no means hurtfull to any particular man, whilst they are good for the whole. And this contemplation of the excellence of my mind above my body, as it is productive of the vertues last mentioned, so it is of this also that I embrace verity in all my words, as discerning the comeliness there is in making my tongue to be the faithfull interpreter of my mind, and the turpitude that there is in causing it to belye the same. Also, from the same consideration it is that I am neither to thinke, speake, or act anything that is indecorous or disgrace- full to this divine inmate, whose excellency above my body, Nature hath tacitly pointed out, by impressing upon me a verecundia, or being ashamed of many actions of my body, w dl therefore, I hide from those of my own species. But now, forasmuch as I consist likewise of a body w c . h is submitted to the same conditions with other animals, of being nourished and propagating my kind, and, likewise, w ch wants many other THEOLOGIA RATION AIJS. 313 conveniences of clothing, housing, and the like, which their nature requires not ; all those likewise are to be respected by me, according to ray several wants ; but still with a subser- vience to my reason, which is my superior part, and acts flowing from the same, my chiefest business; as an embassador who is sent into a foreign country, is not sent to cat and to drink, tho' he is enforced to do both. This seems to be my nature, and these the laws imprinted on it, in obeying of which do consist acts of virtue, and in disobeying them those of vice. But now tho' I must thus think or not think at all, yet forasmuch as I find myself to be strongly diverted from obeying those laws written upon my intellectual nature, by the suggestions of my sensual part, which are apt to corrupt my reason by their enticements, and seem to bid fairer in many important necessities of life, for acceptance, than the other ; therefore I enquire, whether there be no assistance to be had for my mind ; by w ch it may grapple with my body, and by w'. h it, and all the concernes thereof, may be subservient only to herself, and to her most excellent end, which is to obey those divine lawes : I find that to excite my mind, and to encourage it is this conflict. I have great reason to believe, that Avhcn I die, 1 shall not extinguish, but that there shall abide to my better part a condition of happiness or misery, suitable to my having lived in conformity to the lawes aforementioned, or having lived otherwise. How my soul (w'l 1 I look upon to be an immortal being in me, that is, the principle of thinking) should extinguish with my body, I cannot in any reasonable way of thinking, conceive. But that it is immaterial, appears hence, viz., that the imme- diate actions, which arc thinking, have not the least ailinity with matter, nor often do those actions, when exerted, termi- nate in it. As when I think of time, or when I think this present thought w' 1 ' is my present subject, viz., that my soul is immaterial. And indeed mo.st of those idea* \v' h thc art of logic in the \\holp latitude thereof, furnishes me \\ithall, are 316 APPENDIX A. totally removed from matter, and yet are so necessary, that unless I have them either by nature or art, I cannot think true without them. If it shall be thought, that whatsoever is, must needs be material, and whatsoever is not so, must be nothing at all; I would enquire, whether by matter we do not under- stand that w c ! 1 is the object of some one or other of our senses? if so, whether there be not many things in the universe, that come not under any sense that we are endowed w*! 1 ? For suppose an oyster had the faculty of reasoning, ought he then to conclude, because Nature hath endowed him with that one sense of tasting, and perhaps w 1 ? 1 that other of touching, that therefore there were no other object in the world than those w ch answered to his two senses ? so to think would be more like an oyster than a man, who must needs suppose, that it is not only possible, but likely also, that in the universe there are an infinite number of beings, w c . h by no means come under his five senses ; but which nevertheless are the objects of other senses, w 1 ? 1 which other creatures may be endowed, amongst which beings more may be incorporeall than those w ch partake of matter ; w c . h things, tho' I cannot know to be so, yet I can conceive better, than I can know all things in the universe can be one nature only, to wit, matter. And cannot I by an easy train of thoughts conceive immaterial beings ? when I conceive how much finer air is than earth, and how much aether than air, till at length I rest in something w . 11 is removed altogether from matter, and yet no less a being than that ? or is it more difficult for me to think that the immense interspaces between the globes, whether suns or planets, scattered up and down in the expanse of the universe (w c . h bear no proportion to the globes themselves), are perfectly disjunct from matter, these being thrown down, and constituting the gross substance of such globes, and the substance of those exhalations which issue from them and proceed no great way above them ? And that in such interspaces may reside infinite more species of immaterial natures, altogether free from any mortall filth, then THEOLOGIA RATIONALIS. 317 there are material ones residing upon the globes themselves? But however this be, I am sure it is difficult to conceive how so almost divine a thing as thinking, can proceed from matter, w 1 !' w applicenter capiti calide ; et brachia quoq. ac maims eo abster- gantur, et crura ac pedes ipso fricentur. R 01. castor., Euphorb., aa t ^j ; Pulv. sinap., Pulv. euphorb., aa 5J ; Aceti cocbl., j ; Cerae, s. q. M. et f. ung. illinend. capiti calidu. The tongue, palate, and nostrils, I order to be rubbed with old theriac. dissolved in aq. coolest, or aq. antepil. Lang. Also the chemical oils of amber, lavend., rorism., cloves, &c., mixed with ol. nuc. mosch. expr., may be used for the same purpose. Aq. coelest. et aq. antepil. may be given after general eva- cuations have been used before. If the fit be not removed by these remedies, the old remedy of a hot frying-pan held so close to the head that it may not burn the skin is very effectual, but still not to be attempted before evacuation. The fit ceasing I take great care to prevent the return thereof; for as to diet I enjoin a very spare one, and that too, drying : and I order the patient to forbear suppers and the use of wine totally, but yet some fermented liquor (if not strong) may be allowed them. Likewise I order this head- pill :- n. 23 354 APPENDIX C. R Pil. macr., Aloes ros., aa 5J ; Rudij, 555 ; 01. anis. chym., gutt. iv ; Bals. Peruv., gutt. ij. M. et cap. 555 singulis matutinis per 6 dies ; vel capiat pil. coch. maj. 3ij per totidem dies. And after that time I order him to take of either of the said pills the same quantity the day before every full moon for six times. To comfort the stomach : R Fl. salv., Rorism., aa Jj ; Zinzib. cond., Cort. citri cond., aa 5!] ; Nuc. mosch. cond., 355 ; Myrobal. cond., n j ; Theriac. androm., Alcherm., aa jiij ; Pulv. diambr., Diamosch. dulc., aa jj ; Syr. de condit. cort. citri, s. q. M. et cap. sing, matutinis q. nuc. moschata: aut castaneae, super- bibibendo aq. antepil. Lang, cochl. ij. Yel R Ambrsegrysiae, 535 ; 01. anis., Cinnam., Nuc. mosch., aa gutt. ij ; 01. Caryophyll., gutt. j ; Saccar. in aq. naph. solut., %i\. M. et f. tab. quas capiat ad libitum. I)E ABORTU. 355 SEQUENTIA EXCERPTA SUNT EX ORE D.I). SYD. ANNIS 1G82-3. DE ABORTU. 1 CAP. I. MULIERES qusc abortum pati consueverunt, certa quadam pcriodo ut pluriraum abortiunt, et hujus aftcctus cura tota in praccautione vcrsatur. Idco quandocunque symptomata abor- tuin rainantia ingruunt, tune ad pnecautionem V.S. imprimis celcbranda ; vcrum quserendum est prius num aigra naturalem aliquam antipathiam liabeat ad V.S., et an ipsam jam abhorreat : in tali casu abstinendum est a V.S., alias enim post ipsam celebratam mox abortiet, Statim a A .S. propinatur Syr. de Mecon. ad ,fj vel 5Jss, qui repetatur hora sonmi si opus sit, et quotidie repetatur, ut hoc ipso framo coerceatur abortus. Applicari potest empl. astringens, et refrigcr. et corroborans lumbis, et preescribatur etiam elect, astriug. et incrass. cujus basis sit cons. ros. rubr. vitriolat., addend, pulv. subtil, corall. rubr., bol. arm., mastich., ros. rubr., sem. papav. albi &c. Interdum abortiunt mulieres ratione imbecillitatis, quod facile dignosci potest, et a medico intelligi debet ; et re sic se habente nihil aeque proficuum est ac liaustus liberalior vini clareti alicujus generosi exliibend. hora somni et mane, et inter prandendum. Interdum conqueruntur mulieres de posi- tione humili sive subsidentia foetus versus os uteri, quod est imbecillitatis signum et curatur etiam cum vino, uti jam dictum. Sed quandoq. a contraria causa abortiunt, nempe a plethora et humorum plenitudiue. Nota autem tales mulieres esse plethoricas ac robustas, et (quod sedulo ab ipsis quserendum est) menstrua iis in magna copia proflucre solere. II ic imprimis convenit V.S. cum diacodio &c. praedictis. Apprime etiam conveniet V.S. cclebrare singulis mensibus usq. ad Gtum aut septimum ingravidationis mensem, idq. ante statuni tempus quo menstrua ipsi.s iluerc consucvcrunt. 1 Compare I'roccssus Intern, cap. \\\. [(!.] 356 APPENDIX C. DE MANIA.' CAP. II. DU/E sunt manise species, quarum priraa (magis proprie sic dicta) oritur a principiis corporis nimis exaltatis, et hac specie ssepius corripiuntur juvenes athletici: curatur autem V.S. semel, aut bis, vel (si seger admodura sanguineus fuerit) saepius repetita, et dein purgetur per 3 aut 4 dies, vel ssepius pro re nata. Et postea purgetur semel in septimana certo quodara die periodico, v. g. diebus lunse, idq. per 10 vel 12 septimanas, vel per 4 aut 5 menses. Altera datur mania3 species quse exinde oritur quod materia morbifica post morbum acutum fuerit in cerebrum translata : in ipsius cura respectus habendus est ad morbum primarium ; nam quod curabit febrem illud etiam ssepe maniam curabit. Preemitti tamen possunt V.S. et purg. ut materia a capite derivetur, et inuratur etiam fontanella, &c. D. Lucy juvenis athleticus post febrem non bene curatam incidit tandem in maniam, pro qua omnibus fere remediis usus est sine ullo fructu, et laudani doses vel amplissimse nihilum valebant, nam nee somnum nee quietem inducebant ; tandem ab usu quotidiano fotus sequentis per aliquot hebdomadas suborta est salivatio, ita ut interdum spatio nycthemeri Ibj, salivse ex- pueret, et salivatione perseverante ad septimanas aliquam-multas aeger tandem rediit ad sanam mentem. Fotus erat liujusmodi. R Fol. major., Beton., Rorism., iia f^ss ; Ros. rubr., ny ; Cinnam., Nuc. mosch., aa Jj; Sp. vini comm., Ih. iss. M. et f. s. a. tinctura cui add. aq. meliss. Ib. ij, et ipsa foveatur raput tepide sing, noctibus, et bora sotnni bibet liaustum liquoris possetici impraegn. rore marino. Compare Processus Integri, cap. li. fG.] 1)E ARTHRITIDE. 3;>7 DE AMBUSTIS.' CAP. III. APPLICETUR quamprimura linteum in sp. vini immersum, sp. vini de iiovo affuudeudo subindc ; ct hoc continuetur per 2 horas plus minus, donee dolor ac calor cessaverint. Si vero jam tempus aliquod elapsum fuerit, ct suppurari incipiat pars (in hoc casu etiam locum habeat sp. vini) tune c re erit V.S. facere, et purgans dare, et dixtam refrigerantem ac incras- sentem imperare. Continuetur applicatio sp. vini (superimpo- neudo lin teum rarum) per 2 aut 3 dies bis aut ter in die : et si oborta3 sint vesicular, ne rumpantur aut abscindantur (alias enim dc novo excitabitur acutissimus dolor) sed sibi permit- tantur ut aqua intus contenta tranpiret insensibiliter quod brevi fiet. DE ARTHRITIDE. 3 CAP. IV. CONSILIUM sequens dedit D. Syd. arthritico cuidani. ty jj theriacse nostrse Aiiglicanse singulis diebus partitis vicibus, super- bibcndo liquorem appropriatum, \iz. infus. tlie;e aut simile. Observes sedulo ut lecto te committas prima nocte i. e. ante aut circa horam nouam; uam magni momcnti est hrec in- junctio ; ab excubiis enim attcruntur spiritus ac vires, et partes debilitantur, ac inferiores praecipue partes materise mor- bificse appulsum recipiunt, uti in tumoribus hydropicis sub noctem videre est : sed in lecto partes omnes corroborantur, et coctiones cunctse felicissime absolvuntur. Lcctum ingressurus ebibas haustum liberationem cerevisiae tenuis. Horse 2 aut 3 tcmporis a.m. impcndantur equitationi in curru, aut equo si tolerare id possis, et tantuudem etiam temporis p.m. eidein usui destinetur : et in exercitio hocce improbc perseveres per aliquot septimanas, imo menses, alioquin nihil juvabit. Xc in 1 Compare 1'rocesMis Intcgri, cap. 1. [(.;.] ll)id., caj). Ixi. [C;.] 358 APPENDIX C. pastu misceas diversi generis carnes ; hinc enim in coquendo naturae minus facesses negotii : bubulam tamen et vitulinam, ut et ovinam et agninara comedere licet, et item ejusdem generis carnes licet vario paratas modo. A pomaceo et vinis in solidum abstineas. DE COLICA HYPOCHOXDRIACA. 1 CAP. V. IN curatione colicse (prsesertim hypocondriaca?) post V.S. ac purgationem repetitas, et violentiam symptomatum dein per laudanum sedatam, aggrediatur seger statim usum chalybis. Ad confirmandum tonum intestine-rum, &c. usus assiduus cerevisiee Brunswicensis est remedium non vulgare. DE PARTU DIFFICILI, ET ALIIS AD PARTUM ATTINENTIBUS. CAP. VI. AD partum promovendum nihil pene valent medicamenta ad hanc rem a medicis vulgo destinata : sed prse omnibus queeratur quo prsecipue liquore delectabatur segra tempore valetudinis, viz. pomaceo, cerevisia, aut vino, et quo genere vini. Et hujus liquoris, quicunque sit, detur haustus liberalior, nam sic erigentur vires ad fcetum expellendum, quod est opus solius nature. Hac metliodo D. Syd. olim comitissse salisburiensi suppetias attulit, exhibendo ipsi haustus cerevisise lupulatse (Anglice March-beer) post quern erectis viribus peperit intra octavam horse partem ; nam partus difficilis vel oritur a pravo situ infantis (et tune opus est obstetrice) vel ab imbecillitate matris aut infantis, et huic occurrendum per methodum jam dictam. Mulieres interdum (licet raro) corripiuntur apoplexia post partum laboriosum, et huic occurrendum est per antihysterica omuino, viz. aq. bryon. comp.,, sp. castor., aq. paeon, comp. &c. ; 1 Compare Proccsssiis Integri, cap. .\.\viii. [G.] DE PARTU DIFFICILI, ETC. 359 interdum mox a partu immodice fluit sanguis, adeo ut subito de vita periclitetur puerpera ob lipothymias : in hoc casu exhibe haustum ex vini rubri partc una simul cocta cum aq. font, partibus tribus aut 4, et exhiberi ctiam convcnict syr. de mecouio. Infanti recens nato detur imprimis cochl. j vini canarini. Mulieres a primo puerperio non omnino aut quam rarissime tentantur enixibus illis (vulgo the after-throwes dictis), uti in puerperiis sequentibus semper solent ipsis corripi, et hinc est quod in primo puerperio minus prompte ipsis descendant lochia ; nam ab uuoquoque tali enixu egeritur portiuncula san- guinis grumosi : atque adeo quo plurcs sunt hujusmodi enixus eo melius. Si vero dolores nimis violenter urgcant ut tolerari vix queant, tune exhibe longos haustus posseti tepedioris impraegn. chamaem., artemis. et puleg. ; vel admove hypogastrio calide panem tostum et respersum aceto, pulv. nuc. mosch. &c v quod est probatissimum remedium. Lochia Nimia. 1 Copiose fluunt lochia ad 3 aut 4 dies et moderate per 14 dies, et aliquantulum per mensem, ab initio coloris sunt splendidioris, sed tandem colorem ilium amittunt. Ad immodicum lochiorum fluxum f. V.S. brachii si vires ferant, et exhibe elect, incrass. ac astring. superbibendo vinuni rubrum astriug. coctum cum dupla parte aq. papav. rh. et aq. plantag., et de hoc bibat sa3piuscule. Maximam hie speni facere videntur opiata, caute tamen danda sunt. Vcrum praedictis non proficientibus ad ipsa confugiendum : exhibe syr. de mecon. hora somni, et interdiu etiam si res postulavcrit ; applicetur item regioni lumborum empl. ex mass. cmpl. ad herniam et de minio ana part. aeq. De lochiorum suppressione abunde disseritur in epist. ad D. Cole, p. 1G9. 2 Accidit autem aliquaudo ut puerpcne 1 Compare I'rocossus Intrgri, cap. xxxi. [(!.] 3 Vix.. in c, ;uis\vmiiir to Dissert. Lpist.. j \:W, pp. :V.t7. iJ'.'S. in c.l. 1841. ro.i 360 APPENDIX C. a loch, suppress, comatosse fiant, idque non sine ingenti peri- culo; et in hoc casu miranda prsestitit catharsis circulatoria, nempe exhibita potionis portiuncula tertia aut quarta quaque hora ad diem unum vel alterum, aut quousq. visum fueritj nam sic continue derivatur a capita. Eadem hsec methodus in apoplexia miranda prsestitit. Interdum accidit ut nulla omnino ope moveri possint lochia ; et ideo aliquando V.S. brachii ssepius repetita eorum vicem feliciter subiit ; alias tamen in muliere tenera ac hysterica, et potissimum si diutius decubuerit, V.S. lethalis fuit, mox enim convulsiones attulit. In his casibus non raro " cunctando restitues rem." Nota, mulieres versandas esse in lecto per vices, et monendas ut crura dilatent interdunr, alioquin sanguis in transitu per rugosum meatum cervicis uteri moras nectit, et in grumos concrescit. Et hocce consilio D.D. Syd. olim suppetias tulit comitissse salisburiensi cui lochia suppressa fuerant jam per octo horas, idq. primo a partu die; nam postquam situm corporis in lecto mutasset rediere lochia intra quadrantem horse. DE OONTUSIONIBUS. 1 CAP. VI. PRO contusione primo fiat V.S. ex eodem latere, idque ad S. q. exhibe medicamentum aliquod huic rei appropriatum ac specificum (quod nempe sanguinem contemperat refriger. et a coagulatione ac extravasatione prseservat) quale vulgo perhibe- tur tegula hibernica, sp. ceti, et sal vulgare in aq. font, solutum pro haustu, vel potius syr. papav. rhoeacl. cum aq. ejusdem. Vitentur ante omnia sudores, qui nequaquam provocentur. Proximo mane cap. purg. lenitiv. quod repetatur die seq., et si 1 Compare Processus liitcgn, cap. lii. [G.] DE PLEURITIDE. 361 affectus vehemens fuerit, aut fcbris suboriatur, V,S. repetatur, et die etiam seq. purgans, donee seger convaluerit, et extra periculum empyematis, plithiseos, aut alterius affectus mail constitutus sit. Jam locum habeat paregoricum, quod ante evacuationes factas non ita conveniebat ; a calefacientibus et atten. sedulo caveatur. Pro affectus vehementia repetenda erunt V.S. et purg. ; purgetur autem cum lenitivis ; nam forti- ora, ut scammoniata et similia, sanguinem nimis exagitarent ac in partem affectam prsecipitarent. Detur ergo potio communis, addend, iusuper cassias % j ut ad pleniorem catharsin assurgat. Primo f. V.S. et die seq. purg., et si post haec non cedant symptomata turn die pros, repetatur V.S., et dein per 2 aut 3 dies vel saepius purgetur aeger pro re nata. Interdiu a lecto abstineat, et reg. calidum, medicam. calida, et vinum sedulo vitet, hsec enim sanguinem exagitent, ac in partes affectas extravasari cogant. Illinatur pars affecta bis aut ter in die linim. ex ung. pector. aut dialth. cum S. q. ol. chamaemel. ; incredibile dictu est quantum valeat haec methodus in abscessu pulmonum, empyemate et similibus. DE PLEURITIDE.' CAP. VII. IN pleuritide postquam V.S. bis celebrata fuerit, non abs re erit rem aliquatenus committere purgat. cum lenitivis : sed si adhuc vehementius urgeat febris, conveniet V.S. reiterare: si vero (uti ssepe accidit) magna humorum saburra in pulmones decumbat, et copiose expuat 33ger, tune post V.S. eliminetur omniuo, ac subducatur materia per purgat. cum aq. mineralibus purgant. aut lenitiva potione factam. In pleuritidibus hyema- libus plcrisq. (ut et peripneumonicis) praecipuc si a susccpto frigore ortui fuerint et adsint signa indicantia humores praepollere iuflammationi, purgetur ajger post V.S., et, nisi 1 Compare I'rocmus Integri, cap. viii. [U.] 362 APPENDIX C. febris vehementer urgeat, res tola purgation! committi poterit ; potissimum si ipsi cedat morbus ; nam ad juvantia et Isedentia attendendum sedulo hie et ubiq. In pleuritide autem vere essentiali, et in qua vehement, urgent symptomata, nempe si V.S. tempestive facta fuerit et ssepe ut debet repetita, tune nulla omnino aut parca admodum succedat expectoratio, spes tota sita est in V.S. In hoc casu autem utendum est refriger. ac incrass. modice, cavendo tamen a narcoticis, et fugienda sunt ea quae nimis attenuant, quia humores in pulmones prompte nimis conjiciunt. Si vero morbus aliter tractatus fuerit, adeo ut ulcuscula generentur in pulmonibus, et suborta est expectoratio, tune nihil inagis ad humores educendum confert quam ol. amygd. dulc., quod interea non multu attenuat, nee humores ad pulmones sollicitat : sed si pulmones magna humorum saburra onerentur, tune praecipua spes sita est in purg. lenitivis. Occurrit satis frequenter affectio qusedam, quse non male NQTIQ2I2 1 venarum seu plethora appellari possit, et in ipsa urgent fere sympt. quse sanguinis copiam indigitant, cum doloribus vagis, in latere (prsesertim) et circa pleuram : desunt autem sympt. quse hystericum affectum esse suaderent. Illi qui vitam sedentariam agunt laborant hoc morbo; curatur vero per V.S. semel celebratam, et dein per purg. bis aut ter repetitam pro re nata. DE ASTHMATE. 2 CAP. VIII. AN asthma is a difficulty of breathing, proceeding sometimes from some fault in the lungs themselves, as from preternatural glandules and the like : but for the most part it proceeds from 1 Probably a mistake for vavrLwut^- Tbe expression vavffiwffic 0\/3wj/ occurs in Hippocrates (De Fract., 11, torn, iii, p. 84, eel. Kiihn), and is explained by Galen (Comment, in Hippocr., De Fract., ii, 24, torn, xviii, pt. ii, p. 459 ; Glossar. Ilippocr., torn, xix, p. 124) to signify effusion or extravasation of blood, the metaphor being taken from vomiliny. [G.] 2 Compare Processus Integri, cap. Ivi. [G.] DE ASTHMATE. 363 pituitous matter that is discharged by the branches of the vena arteriosa upon the substance of the lungs, and insinuates in upon the bronchia, causing a wheezing and difficulty of breathing. The cure of this is to be taken at evacuations of the antecedent cause, by bleeding at the arm, vesications to the neck, and fontanells in the arms (if it be an inveterate asthma), and by purging with the pil. cephal. and the jj/ileymayoya, and as to alteratives, by giving attenuating pectorals, and now and then oL amygd. dulc. ct syr. diaUh. by spoonfuls, to keep the breast open. Hcec ex MS. D. Syd. exarato ante annos 12. Asthma duplex est, siccum et humorale. Asthma siccum videtur oriri ab ataxia spirituum in prsecordiis ; nam adsunt magnse turn pulsus, turn respirationis inordinationes ac in- sequalitates sine ulla, aut saltern, cum paucissima interim ex- creta materia : viros habiliores corripit ac per paroxysmos invadit. In oura asthmatis hujus sicci cavendum est ab omni evac. per purg. in ipso morbi iuitio, nam vel enema segrum in vitse dis- crimen conjiciat : sed imprimis f. V.S. brachii, et tune propina haustulum vini Canar. cum julap. hyster., et dein frequenti in usu sit dec. pector. ut cum linctu atten. qui prsecordia dilatet, et respirationem faciliorcm reddat ; ct in hunc finem adde ol. amygd. necnon ol. chym. anisi in satis magna copia ; capiat item pil. ex sem. anisi pulv. factas, applic. vcsicat. nucluu, et die tertio tutum erit ac necessarium dare purg. ex pil. coch. maj., et die seq. lenitiv. cum cassia, atq. item tertia vice. Asthma humorale sub hyemis adventum fere invadit, cum jam sanguis particulis aquosis ac crudis inferciri incipit, et in ipso V.S. et purg. ssepius repetita locum habent. Decoctum tune sarstepar. et simil. utatur per tempus aliquod, et quotidie cum pastu sumat haustum vini, ut sang, interim roboretur et pul- moncs contra humorum incursum muuiantur. 364 APPENDIX C. DE PARALYSI.' CAP. IX. THE solution of an apoplexy is often by a paralysis on one side, wherein the matter of the apoplexy is impacted into the nerves, and thence, by the impedition of the influx of the animal spirits, there is either a perfect abolition or else a diminution both of sense and motion. The cure of a paralysis (whether it proceeds from the solution of an apoplectic fit, or whether it comes alone, invading any part whatsoever) in the common method, is by purging with pil. coch. maj., aut mm., or pil. foetid. &c., for many days together; as also by giving alteratives of sundry kinds, composed of cephalics, as beton., rorism., salv., HI. convall. &c., and by anointing the spine of the back with ol. succ. and ung. nerv., and by fomenting also the spine with aq. Regince Hungar., and by the use of fomentations with cephalic ingredients. But forasmuch as the palsy is for the most part caused by sharp matter falling in upon the nerves, I conceive that after the patient has been blooded once, and purged five or six times, it would be best to put him upon a milk diet. Ex MS. D. Syd. ante annos 12. DE CRAPULA. CAP. X. CRAPULA ortum suum debet potui aut cibo assumpto peccanti quantitate aut qualitate, unde veiitriculus aggravatur admodum, et succus crudus segre domabilis illabitur in sanguinem, qua de causa febris ibidem accendi solet, qua? est machina soleniiis qua utitur Natura ad expcllendum quicquid in suo simi inimi- cum contineat. Ad curationem crapuloe, ut pars oneris detra- hatur, V.S. celebranda est, et dein (si ventriculus valde gravetur, et nausea aut vomit, infestetur seger) propirietur emeticum, et die prox. detur purg. lenitiv., rcpetend. per 2, 3, aut 4 vices 1 Compare Processus lutcgri, cap. Ivii. [C.] DE KUEMORRHOIDIBUS. 365 pro re nata; nam V.S. et catharsis repctita fere solrc rem ex- pediunt. Diseta sit tcnuis et excarnis (prrccipue) si febris urgeat, et potus refrig. sit in usu. Crapula levis, quse ex cibo incongruo aut crudo contingere solet, facile curatur per haust. mediocr. liquoris alicujus cardiaci, praecipue si seger super- dormiat ; nam somnus super omnia coctiones juvat et crudi- tates quascunq. subigit. DE ILEMORRIIOIDIBUS APERTIS ET C.ECIS. 1 CAP. XI. THE flux of the hemorrhoids proceeds from hot and sharp humours excreted out of the mass of the blood by the hemor- rhoidal veins upon the anus ; and it is cured by making revul- sion by bleeding at the arm, and by derivation with lenient purges, and by cooling and incrassating medicines and diet, and by topics that are astringents ; amongst which a fomen- tation with a decoction of tapsus barbatus in aq, f errata is com- mended, as also this : R Mastich., Bol. arm., Pil. lepor., aa s. q. ; and with whites of eggs make it up into a cataplasm. Hsemorrhoides csecae sive dolentes proceed from the said cause, and are cured by satisfying the same indications, ex- cepting that the topics in being astringent should be such as are proper for the taking away inflammations, and for the dis- cussion of the tumour, and easing of pain : such as arc anointing with pomat. or popul. and fomenting with discut., as the dec. of jl. samb, in milk. I find that to sit upon a cloth dipped in rose-water, and gently wrung out, gives great ease. Ex MS. D. Syd. ante 12 annos exarato. Hsec sunt excerpta ex ore Syd. pro luemorrhoidibus. F. V.S. brachii, ct die prox. purgetur cum lenitiv., sed aloe 1 Compare Proccssus Intcgri, cap. xxxviii, xxxix. [G.] 366 APPENDIX C. et simil. evitentur : diseta sit refrig. et incrass. omuino, et carnis expers : potus ordinarius sit aqua et lac simul coctae. Parti effectse applicetur linteum rarum in aq. ros. et ca3ter. intinctum. Vitet acria, salsa, et aromatizata, post V.S. et purg. semel aut bis pro re nata repetit. sedulo detur syr. de meconio, et hoc frseno coerceatur ac sedetur tumultus ac orgasmus sang, qui ad partem affectam impetuosius quam par erat viam fecit, et hoc tarn in dolore cseco, quam in fluxu locum habet. Chaly- beata in hoc morbo ssepe suppetias ferunt. DE HYDROPE.' CAP. XII. NOTA illos hydropes qui a compotatione nimia sp. vini oriuntur periculosissimos esse ; quia tales liquores pessundant coctiones, dissipant calidum nativum, et fermenta omnia de- struunt. Et hi qui a tali prophasi incidunt in hydropem corri- piuntur primo tumore abdominis (quasi tympanitico) una cum pectoris inflatione et respirandi difficultate, cruribus interim a tumore immunibus. Tales autem pro deploratis habendi sunt ; sed si curam aggrediaris incipiendum primo est a V.S., et sanguis eductus erit instar pleuriticorum, dein per anti-scor- butica oppugnetur morbus, et per ea quse fermenta partium restituant, ac vigorem sanguini concilient : detur nempe cere- visia medic, cum absynth., cent, min., rad. raph. rustic., fol. cochl. hort., bacc. junip. &c. DE MENSIUM FLUXU IMMODICO, ET MENSIBUS CUM DOLORE FLUENTIBUS. 2 CAP. XIII. FLUXUM mensium immodicum maxime patiuntur matronse setate provectiores, idq. eo potissimum tempore quo fluxus hicce foeminis valedicit ; in aliis temporius, in aliis vero serius, prout 1 Compare Processus Integri, cap. xxxiii. [G.] 2 Ibid., cap. xxvii. [G.] DE VARIOUS CONFLUENTIBUS. 367 temporius aut serius in juventute prirao profluxerant ipsis menstrua. Morbus hie rarissime lethalis est, sed sua spoute sistetur : methodus autem curationis optima est ilia quac de- scribitur in libro D. Syd. 1 Quibusdam focminis non sine dolore ingenti (qualis parturientibus familiaris est) fluunt menstrua, et talibus maximum juvamen afterunt aq. minerales cathartics?, si dentur per 8 aut 10 dies in intervallo inter menstruationis tempora. DE MENSIUM SUPPRESSION. 2 CAP. XIV. MENSIUM suppressio plerunq. ortum ducit a statu sanguinis depauperate, et quasi vappido ; et hac de causa foeminae qua3 morbo quovis diuturno attrita? sunt menstrua non habent, nee opus est ut proritentur. Ad menses ergo movendos convem'unt ea qua? sanguinem ferment o vivido inspirant, et ipsum depau- peratum restituunt ; unde motum circularem magis vegetum ipsi inducunt. Specifica quse emmenagoga perhibentur, qualia sunt artemis., schoenanthus, &c. raro aut nunquam votis re. spondent, verum methodus sequens plerunq. aut semper rem facit. Nempe imprimis f. V.S. brachii potius quam pedis ad J iv aut vi, et dein per 2 aut 3 vices purgetur pil. ruffi, aut aliis aloeticis, et tune aggrediatur usum chalybis per mensem aut diutius (nam interdum necessarium est ut sumatur per 6 septimanas) donee effectum votis respondeat. Eodem modo curatur chlorosis. DE VARIOUS CONFLUENTIBUS. 3 CAP. XV. As to the cure of the flux-pox which happened in the year 1G70/ I found myself much puzzled, and at a great loss; for 1 Viz. Dissert. Epist., 135, &c. [G.] 3 Compare Processus Intogri, cap xlvii. [('.] 3 Ibid., cap. xv. [G.] 4 See Observ. Med., iv, fi. [(;.] 368 APPENDIX C. (observing that their rising out of bed, together with a mode- rate keeping and diet did not do the business) I began to ques- tion my whole practice in this disease, and was in some doubt whether the old and usual ways by cordials and hot regimen were not fit to be employed about the cure of this sort at least : but at last, finding the success even of this to be worse than the contrary regimen, I was inclined to believe that this pox was to be managed in a colder way than I ever yet had ordered any, and I found (though to my own reproach) that a down- right cooling regimen did deliver the patient not only from the danger but also from the sickness of the disease ; therefore I very strictly commanded that he should be taken up every morning, and sit up all day during the whole time of his disease, even though his blindness and inexpressible soreness made his rising no less troublesome to him than scandalous to myself, only when upon sitting up he was apt to faint, I permitted him to lie all along upon his bed, or (which heats less) upon the couch, with his usual clothes on, and no more ; and so neces- sary was this to be done, that I observed almost in every patient with whom I had to do, that whilst he was out of bed he was very well, setting aside the soreness only ; but as soon as the approach of the night called for his being put to his naked bed, then presently came on ill symptoms of feverishness, inquietude, yea and some degrees of a phrensy, insomuch that the nurses themselves (though at first wholly disallowing the practice) have at last taken up the patient in the morning much sooner than I appointed, and that with present relief as to the symp- toms mentioned. For his diet, I ordered him to drink nothing but cold whey, and that in as large quantities as he desired, and in the summer I set the bottles of whey into cold water ; and I have known some to have drunk six quarts and more in twenty-four hours. Besides the allaying the inflammation of the blood, the ptyalism also was much promoted by the use of whey, and likewise made so easy, that sometimes this symptom, DE VARIOUS CONFLUENTIBUS. 369 which uses to be very pressing and viscous on the eleventh day, was scarce then discernible. Yea, I have often observed, that this way hath succeeded so well, that those pox that have come out with the highest and worst signs of fluxing, have, in the progress of the disease, become distinct even \ipou the face ; and likewise instead of turning up first red, afterwards black glare, have become perfectly shining yellow, and from a small, angry, pimpling, and depressed pox, they have come to be a large pox, and in all respects very well conditioning. If the patient were not content with whey only, I permitted him to eat buttermilk, with crumbs of bread therein, or raw milk with pulp of roasted apples bruised therein. I met with none that had an antipathy to whey, or whom drinking thereof was wont to purge in their health; if I had (I suppose), instead of whey, I should have ordered to such aq. hordei. AYhen, notwith- standing my cooling regimen, the patient was still hot, and could not sleep, I ordered diacodii ^ ss to be given once or twice hora somni, but seldom oftener, for fear of totally sup- pressing the ptyalism. In the year 1672 I found out a way of curing the smallpox less liable to scandal, and also more conducing to keeping up the pustules, especially in a flux-pox, viz. I ordered the patient to sit up till the pox appeared, as judging it not fit so early to force them out, and then to keep in bed with his arms in, till the disease was over. Yet I allowed him to remove from one side of the bed to the other for his refreshment, and to avoid sweating. Till the smallpox appeared I allowed him to eat water-gruel, panado, roasted apples, or the like, and to drink small-beer lightly warmed with a toast ; afterwards, instead of small- beer I ordered him dec. album, either cold or very lightly warmed ; but in case he had any aversion to this drink, 1 per- rnittcd whey instead of it (provided I did find the same was not wont to purge him when in health), and three parts of water, boiled with one of milk, is a liquor not inferior to either ii. ;>! 370 APPENDIX C. of these, nay, perhaps better : it is to be drunk cold. Upon any great inquietude, delirium, or other alarm, I ordered 3 vj or 3 j diacod., and how free soever he was from any accident, I gave the same diacod. on the seventh night, in order to pre- pare the face to swell ; and judged it the safest course to con- tinue it every night after, till he was quite out of danger. This way I judged to be far the best and safest I ever yet met with, but yet when, through violently hot keeping and cordials, the patient is under so high a fever, phrensy, suppression of urine, or other importune accidents that there is no time to allay them by the regimen or medicine here mentioned, I know no remedy but taking the patient out of bed, upon the doing of which I have observed, by reiterated trials, all accidents to have been cured in a moment which depended upon the too high ebul- lition of the blood, and not upon the going away of the sali- vation in a flux-pox before the eleventh day, or of the swelling of the face before the thirteenth day ; in either of which cases not rising, but observing the method above mentioned, does best ; especially if to the abatement of the swelling of the face there is added no rising, but, e contra, a withering of the pus- tules on the hands, which in the last days of this pox (but not before) should rise up high, grow big, and look fresh. DE METHODO MEDEXDI MORBOS PER ACCUBITUM JUNIORIS." CAP. XVI. MAY the 19th, 1662, I was called in the night to Mrs. Change, whom I found very ill of a cholera morbus ; she had many ugly symptoms, as coldness of the extreme parts, talking a little idly, intolerable sickness, and felt a tingling in her fingers and flesh outwardly. I judge it dangerous to use dilutients, especially by clysters, in a woman so green (she having not lain in a month) and the disease pressing so hard 1 Compare Observ. Med., i, 4, $ 40. [G.] DE METHODO MEDENDI, ETC. 371 upon my heels ; so I ordered her to take a warm cordial, and that a good draught of it, and her husband to lie close to her back naked, and her son of twelve years close to her belly, and to lay on more clothes, and to warm her legs and hands with hot cloths : she immediately fell into a moderate breathing, and all symptoms ceased ; and after enjoining her to keep her bed the next day, and to eat and drink nothing save a small quantity of barley-broth a day for two days, she perfectly recovered. February, 1G61, I was called to Mrs. Hulston, who, after a very chronical fever, was fallen into a very fatal-like diarrhoea ; I saw it was to no purpose to give astringents, seeing the dis- ease proceeded from a decay of natural heat, therefore I took this course, viz. I caused her son, a plump hot lad of thirteen years of age, and her nurse's son, of six or seven years, to go to bed to her naked, and to lie the one close to her belly, the other close to her back, which they did, and as long as they continued with her she had no stools ; but the boys rising at any time, the looseness would immediately return. I com- manded that she should persist in the course till her cure should be complete (the boys relieving one another by turns in the daytime), and so she fully recovered, not only of her looseness, but also of her sickness in general. The very same course I took with one Mr. Little, who had a fever about seven weeks, and at that time, August 1GG2, so far spent that his doctors judged him a dead man ; he was ancient, and having been much purged with violent medica- ments, he was as weak as ever I saw any that recovered ; I (having to no purpose made attempts to lay his fever by in- ward medicines, and to raise his strength by cordials) told his wife that nothing could preserve his life thebut putting a boy to bed to him; so she procured a link-boy to lie very close to him all night, and the next morning I found his fever almost off, and his eye and countenance more lively, upon which I 372 APPENDIX C. pronounced all danger to be over, yet afterwards upon my giving him a clyster, and upon the recess of the boy, he began to relapse; but the boy being got again, and I giving no more clysters, he perfectly recovered. The very same way had I cured before Bishop Monk's 1 lady, who was an aged woman of a very feeble and thin habit of body, and had an ague, which (though gone) had so weakened her that her physician, Dr. Ridgley, 2 looked upon her as dead ; when I was sent for she had also spitten some purulent matter and blood, which they showed me (in abundance) upon the napkin. I told the doctor that I apprehended that nothing could save her life but a speedy transplantation of some young spirits upon her, to which he readily agreed, and a girl of thirteen was put in close to her breast, upon this she recovered very speedily both of her unspiritedness and her coughing; but the girl fell sick, which was attributed to her lying with the lady, though I was confident to the contrary, having never known any mischief that way ; however she had first coming out upon her petechise, and afterwards large ulcers upon her breech; but Dr. Ridgley and I recovered her. MS. D.D. SYD. DE EPILEPSIA PUERORUM. 3 THIS disease, as it is more common to children than any disease whatsoever (the smallpox and measles excepted), so it is more dangerous than those and all others ; for according to the most modest computation as many die thereof as escape, and it is too well known that all the children of some families, as fast as they are born, die thereof in some time or other of 1 Probably Nicholas Monk, brother of the Duke of Albemarle, who was Bishop of Hereford for about a year in 1G61. [G.] a Dr. Ridgley's name does not appear in the Catalogue of Oxford and Cambridge Graduates in Medicine, published in 1695, nor in that of the London College of Physicians. [G.] 3 Compare Processus Integri, cap. xl. [G.j DE EPILEPSIA PUERORUM. 3/3 their infancy. Sometimes it comes without any p*esension at all, suddenly distorting the mouth and eyes, and causing the face to look black, and convelling the several artus ; at other times there is first a prescnsion of the paroxysm by drawing up the fingers together, as one that wrings his feet, and by a certain steadiness in the ball of the eye, so that it moves not up and down as in the ordinary state of health ; which symptoms are succeeded with the other before mentioned. The fits con- tinue sometimes longer, and sometimes shorter, and sometimes they invade at no constant time, coming and going irregularly ; but at other times they observe a regular motion, as coming once in twenty-four hours, and sometimes every third and fourth hour, or at other times one fit comes on as fast as the other is gone, especially when the infant is almost worn out with that which is common to them all when there is any dis- tance between them, that as soon as the fit is off they fall asleep, and continue very drowsy, and sometimes do wake into another fit. The one and the same thing seems to me to be the general cause of convulsions which happen to children, viz. the pertur- bation and shatteredness of the systasis of animal spirits, yet this shatteredness is brought on from several occasions, the chiefest of which I shall here mention ; because from these are to be denominated the several species of epilepsies in infants. First, there is an epilepsy (which though more rarely happening) doth invade during the first month they are born. This happens to infants that are more than ordinarily weak, and that are of a less firm habit of body than usual, and that are not born of healthy parents, who use labour and converse in good air, for in these through too excessive softness, to which also weakness is joined, the systasis of the animal spirits is easily dissipated, and upon their dissipation they huddle in upon the origin of the nerves, and the brain in infants (being not strong enough to resist the impetus of the spirits in motion and the 374 APPENDIX C. orgasmus of them), it yields to their impression, contrary to what is found in hypochondriacal persons that are adult, when the brain is not seized till the disease hath almost acted its tragedy, and the brain not able any longer to resist such huddling in of spirits. Secondly, another species of epilepsy, and that most common of all others, is that which uses to attack infants about the time of dentition, which is commonly about the eighth or tenth month ; for it is to be observed that most children do breed their teeth in one of these three ways, viz. either by a cough, which is the best way of all; or by vomiting and looseness (and the vomit and stools are most commonly green, as in hysterical people), which is more dan- gerous ; or by the epilepsy, which of all three is the most dangerous. And it is here to be noted, that for the most part it happens that all the children of the same father and mother breed their teeth after the same manner, in one of these ways only, and not in different ways. But in those who breed their teeth by epileptic fits, there are two times of putting forth their teeth which occasion paroxysms, as first when the tooth opens the bone of the jaw, and then when it cuts the outward flesh of the gingivse ; for it is frequently to be observed that a child, about the time of teething, goes into fits, and no tooth appears or is to be felt, but the fits going off the child is well for some weeks, after which come on other fits, which usher in the tooth's piercing the outward skin of the gingivse, and cease as soon as that skin is cut ; and this double misery are some children enforced to undergo for every tooth they have. As to the cure it was wanting in this MS., only after a blank left follow these words. And my reason tells me, besides my experience, that this is the safest way of managing convulsion-fits in children. But to put the cure upon I know not how many sorts of specifical remedies I understand not the ground, nor do I find the success ; such as the several parts of animals, and amongst them the cranium of a man, Mhich I find DE EPILEPSIA PUERORUM. 375 to be a main ingredient in many of the remedies which pretend to be specifical in the cure of this disease : but I see not why (if there be such specific virtue in a human skull) there should not be enough in the patient's own, which is so closely applied to the brain, the part affected in this disease ; but there must needs be recourse to a few grains of another man's skull, and the same dead. Pro cura epil. motuum puerorum vide MS. D.D. Syd. ad filium suum. 1 In another of his manuscripts written several years before the former are contained these following things. Convulsions take children sometimes within the month, but most often about the seventh or eighth month, which is the time of dentition, both which sorts are caused from an ataxy, or inanition. The first sort does for the most part proceed from an immoderate number of stools, and in this case give the infant a little diascordium about the bigness of a pepper corn dissolved in saxifrage water or breast-milk ; but if it be of the second sort which proceeds from dentition, then the usual course is to apply a blistering plaster to the hinder part of the neck, and to anoint the temples and neck with ol. succin., and to give aq. antepil. laug., pulv. de gutt., racl. pjeoii. and other antepil. medicines : and some likewise use revulsions by vomiting, purging, and cupping ; but I should suppose that a spoonful of the dec. of cort. peruv. would far excel any of these remedies. 1682 ET 1683 EXCERPTA EX ORE D.D. SYD. Epilepticis motibus maxime corripiuntur infantes, et non raro vel rccens nati : cujus causa videtur esse debilis ac infirma spirituum systasis a parentum labe ac miasmate saepe siupius oriunda. Indicantur ergo hie corroborantia ac pacifica. Detur guttula minima vcl gutt. ss laud, liquid., quod cst experientia 1 Perhaps what was afterwards published with the title ' PrutT>Mi;> lutrgri,' &c. 376 APPENDIX C. probatum : maxime vero omnium motibus convulsivis tentantur infantes circa 10 aetatis mensem et dentitionis tempus, sive oc^us sive serius id fiat, idq. duobus prsecipue temporibus, nempe cum per maxillam perrumpit dens, et cum per carnem maxillam obtegentem ; circa haec tempora corripi solet infans vel tussi, quod optimum, eaq. saepius convulsiva : vel diarrhoea, quod pejus ; vel ipsis convulsionibus, quod pessimum. Haec omnia ortum suum debent insigni spirituum animalium ataxiae, nee medicamenta ulla efficacius curationis scopum attingunt quam ea quae spiritus demulcent ac confortent ; cui intentioni nihil melius satisfacit quam laud, liqu., modo in justa dosi exhibeatur, v. g. infanti 6 aut 7 menses nato da gutt. ij. laud. liqu. ex cochl. j. vini canar., et capiat item vini canar. per se bis aut ter in die. Interdum corripiuntur infantes motibus convulsivis mox a partu, et saepe intra primum mensem, qui ortum suum debent naturali debilitati infantis, et ideo nullae hie evacuationes instituendse sunt, (nisi forsan per vesicat.) sed e contra robo- rantia omnia imperanda, nempe vinum generosum, &c., et laud. liqu. si res postulet. Epilepticis motibus etiam corripiuntur interdum infantes, tanquam prodromis vario- larum, morbillorum aut febris scarlatinee, idq. cum dentitio peracta est. Sive igitur sit epilepsia ab imbecillitate staminum vitse orta, quse infantes ante dentitionis tempus compere solet ; sive ea quae oritur ab ataxia spirituum quam invehit dentitio ; sive ea quse est conatus nature unam ex tribus praedictis febribus foras propellere laborantis ; hasc est methodus tutissima simul ac efficacissima, nempe applicctur vesicat. nuchae, et quam primum exhibe laud. liqu. in aq. epid. aut aq. paeon comp., et lecto committatur seger, praecipue si unam ex febribus praedictis secuturam praevideas ; in quo casu etiam indulgere possis medicam. aliquod cardiacum, ut et regimen moderate calidum, nempe ut nutrix juxta puerum in lecto accumbat, nam. sympt. periculosissimo primo occurrendum est, viz. epilcpsiae, quae TINCTURA ALEXIPHARMACA. 377 expellendo matcriam morbificam curatur : ncc multura hie imminet periculi a tarn calido rcgimine ; si cnim subsequautur variolae, erunt boni moris ac inter 2i horas se prodent. Si autem pro convulsivis motibus pra3cedentibus dictarum febrium quamlibet V.S. iraperes ; ut et eiiemata et purgantia (ut vulgo fieri solet), infans in manifesturn vita? discrimen conjicietur; quia talia materiae peccantis separationem, et ad corporis habitum expulsionem prorsus impediunt : quinetiam ataxiam ac convulsiones promovent ; imprimis ergo in parcgorico et tune in vesicatorio spes tota collocatur. TINCTURA ALEXIPHARMACA D.D. SYD. R. Flor. sive summitat, florescentium absynth., acctos., agerati, agrim., alchymill., argent., artemis., auric, muris, becab., beton., bellidis maj. et inin., bistortae, borrag., bugloss., bugulne, calamenth., cardam., caryoph., centaur, min., chamaedr., cliamtepyteos, (\iz. folia ejus, quia flores sunt adeo parvuli) chelid. maj., cichor., coclilear. hort., consolid. maj., chciri, croci, cyani maj. ct min., dentis leonis, ecbii, ciidiv., enuhe, cryng. (viz. folia), erysimi, eupliras., fumar., hed. tcrrestr., hyper., hyacinthi anglicani, lamii albi et rubri, levistici, liliorum alb. et convall., malvie, marrhub. albi, matricari?e, melilot., meliss., month, aquat., millefol., morsus diab., nasturt. aquat., nepetae, nympha^se, origani, papav. rhoead., paralys., pentaphyll., persicariae, pimpinelkie, puleg., sanicuhc, saxifr. alb., scabiosae, scordii, serpilli, tanacet., tormentill., tussilag., valeriame, verbasci, verbenas, veronicae maris, violari;e, virga; aurcic, et ulmaruc ; fl. priedict. in cucurbit, affimdatur sp. vini anglicani s. q. ut humectet fl. hosce, scd non supcrnatet iisdem ; sic enim validior est tinctura, et clicitur (juasi succus florum. Stent simul jxir 2 menses, ct turn demum f. colat. ipsius. In cong. ( J hujus tinctunc dissolv. opii tlicb. 3 J S9 > i- e - 378 APPENDIX C. 3 ss. ad pint. unam. Dosis est cochl. ij, vel ad summum eochl. iij in die. Vires. Optime valet pro debili, flatulento, aut frigido ventriculo ; et egregie facit pro spleneticis, quorum paroxysmos subito tollit. Eximiarum virium est etiam pro hystericis, prsecipue si adsit colica qusevis ventriculi aut intestiiiorum. Ipse in Scotia (?) consumpsi congium ipsius, nee unquam vidi provocasse somnum cuivis, nempe exhibemus in tarn parva dosi ad cochl. j pro vice. TINCTURA EADEM EDITIONIS ULTIMO. R. Fol. sice, absynth. vulg., agrim., alchym., slth., artemis., bugnlse, calamenth., caryophill., cent, min., chamsedr., cha- msepit v chelidon., euphras., fumar.^ lied, terrestr , hyper., marrhub. alb., millefol., menth. aquat., ophiogloss., origan., pilosel.j pimpanell., plantag., puleg., sanic., scabios., succis., serpill., tormentill., verbasci, verbense, veronicee, virga3 aurea3, ana M iv vel 3 iv. R Flor. sice, bellismaj. et min., borrag., bugloss., chamsem., croci, consolid. maj v cyani maj v laraii ; matricar., malv., melil v nyrnphffiee, papav. rhcead., paralys., primulse veris, saxifr. alb. ; tussil., violarum, ulmarise, verbasci. ana M iv vel 5 iv. Commisceantur hsec orania et infundantur per mensis spatium in sp. vini anglicaui seu hordei cong. ix. admiscendo simul opii theb. dissolut. in pauxillo sp. hordei (nam eo intimius commiscetur cum reliquis) 3 j ss - M. Et postquam simul steterint per mensem f. colatura. NOTES. 379 NOTE A. [From the MS. of the College of Physicians (see Life, p. Ixxvii.) ] PAROXYSMUS NEPIIRITICUS. Tins disease observes no time of the year, nor age of persons, though it invades most commonly men that are past their prime, who drink wine, especially those wines which are most attenuating, as French or Rhenish ; as likewise those who, having used a sedentary life, do sud- denly engage upon hard riding. They feel, first of all, a great pain in one or both kidnies, upon which they fall into a great and troublesome vomiting, attended with very great sickness. After some time, the pain extends itself down the sides of the belly towards the os pubis, following the ductiis of the ureter, belonging to the affected kidney, in the whole length thereof, and sometimes fixes upon and remains in one small part of it. During this time, the patient very often is troubled with stoppage of his urine, but sometimes he is free therefrom till after the nephritical pain begin, at what time, upon a sudden, his water totally stops, until such time as he voids a stone. How great soever the pain is, and how alarming soever either to the patient or by- standers the sickness, yet it very seldom kills, or runs out into any great diuturnity, provided fitting remedies are applied thereunto. That which occasions these symptoms, is oftentimes some gravel or stone, grating upon the pelvis or ureter, and wherever it strikes, either at the top, middle, or insertion of the ureter into the bladder, there it causes acute pains. The bigger it is, the sharper and more ragged its corners are, the greater still is the pain, and the longer and more diffi- cult its passage through the ureter. Sometimes the stone being re- moved out of the place it grew in the kidney, and lying upon the top of the ureter, after it hath for some time caused pain and stoppage of urine in that side, returns again to the place it was conveniently lodged in before, and there remains a long time without doing any harm, or giving any trouble, unless it be a little sense of heaviness and heat about the affected kidney. But I conceive that a nephritical fit is not always occasioned by a stone (much less by gravel) in those parts, but sometimes by an inflammation only of the kidney, wherein the kidney and ureter, and perhaps the bladder likewise, in consent with the other, may suffer the same effects as if a stone in the kidney or ureter had produced them ; which I am induced to believe, for that I have frequently observed these fits to have gone oil' without \oiding a stone, 380 NOTES. or the least appearance of any gravel coming from them, all the symp- toms of the stone of the kidneys, nevertheless, having attended the same, which is evident, further, in some hysterical fits, which, when seizing upon the kidneys, are followed with the whole train of symptoms accompanying a nephritical fit, and do, by the similitude they have with the same, not seldom impose even upon wary physicians, and, furthermore, are not to be cured by any other medicines than such as are suitable to the allaying fits of the mother, but to these, duly ad- ministered, they easily yield ; nor is it of no moment in this argument, that the blood taken in this distemper is oftentimes found to be such as is taken in pleurisies, and other diseases proceeding purely from inflammation. Till it shall please the infinitely great and wise God to discover a remedy to dissolve the stone, the curative indications are to be directed first to the relaxing and mollifying those parts through which the stone is to have its passage ; and, in the next place, to the allaying the in- flammation which is either the attendant or sometimes, as hath been said, the cause of the pain ; and lastly, to promote the expulsion of the stone. This, therefore, I do : I cause, first of all, blood to be taken, eight or ten ounces, more or less, according to the strength or other circum- stances of the patient. Then I order the following clyster : R Rad. althaeae, liliorura, aa J j ; Fol. malvse, parietar., branc. urs. verbasc. aa manip. j ; Flor. chamomel., meliloti, aa P. j; Sem. lini, fcenugraeci, aa ^ss. Coq. s. q. aq. Colaturse, Ib. j. dissolve Sacchari culini, Syr. dialthaese, aa Jiij. F. clyster. After the voiding of this, I cause the following to be put : R 01. lilior., Chamomeli, aa Ib. ss ; Ol. rutae, 3 ij ; scorpion, raathioli, j ; M. f. clyster. And so these clysters I order alternately to be put up twice, or give the one immediately after the rejection of the other. I prescribe, at the same time, this ointment : R Rad. lilior. 01. amygd. dulc. Ung. dialtbffiffi, aa 5 j ; 01. scorp. math., 3$$. M. f. liniment, quo inung. partes dolentes mane et sero. When the clysters have done working, and the passages thereby suffi- ciently mollified, I attempt the expelling the stone by enjoining the pa- NOTES. 381 tient to drink very large quantities of posset drink, even to a gallon or two, in which likewise may be boiled some marsh-mallow roots, which liquor, taken in so great a quantity, not only distends and opens the passages, but, by causing great retching, to vomit, and thereby strain- ing of all parts of the body, contribute much to the expelling the stone or gravel, which also is propelled by the force of the liquor coming to the bladder in so great a quantity. The next day, provided the symp- toms still continue, I take blood again, in as large a quantity as the patient's strength will bear, which likewise after I repeat once, nay, twice more, if the severity of his pain, and the continuance thereof, require it, as for the most part it will, where the blood that is taken appears to be like that which is drawn in pleurisies, viz., resembling on the top the colour of pus, or rather of lantern's horn, and a coat of the thickness of a crown piece, and of a very tough consistence, may, when the blood is cold, be separated from the rest, and appear through- out of the said colour. By the way, I observe, that although in this disease often, in pleurisies and rheumatisms always, the blood, if rightly taken, is found to be of the colour before mentioned, yet if in bleeding the stream spouts not out forward, but runs downward, though in as large a stream as the other, the blood that is so taken will not be of the colour described, but very laudable and fresh ; it is, therefore, my constant custom to order the chirurgeon to make another orifice, if he is not able so to manage the former as to make the blood spout out forward. But to return to my business : the clysters likewi.se before mentioned are frequently to be injected whilst the pain lasts, though not so many as the first day. During all this time, I prescribe oil of sweet almonds, fresh drawn, either alone or mixed with si/r. althietv comp. to be frequently taken, and very strictly forbid the drinking of wine, ale, beer, or any other fermented liquor, instead whereof I order barlev-xvater, cither alone or wherein hath been boiled a small quantity of liquorice and althaea roots, for his constant drink, and I enjoin him to keep to a fleshless diet, as barley-broth, water-gruel, panada, &c. I prescribe, likewise, the following emulsion : R Had. eringii camlefacti, % ^ij ; Amygdalarum dulc. iia vj ; Scni. melonum, Peponum, Papav. albi, Lactucae, aft 3ij ; Aq. hord. Ib.jss. Sacchari cristall. ^j; Coletur et leniter coquatur. F. emulsio, cap. ^iv, altcrnis horis. Also towards forcing the stone, after that the passages are sufficiently mollified by clysters, and the other things prescribed, 1 do now and then give this medicine : R Aq. parictariic, ^iv ; Spir. Mills, g. xij ; Sal. primclkr, 3 j*s ; Syr. .lithir.f cump. ^ j. 382 NOTES. Or tliis : R Aq. parietariae, Vim Rhenaris, Allae tenuis, aa Ib. ss ; Affundant. rad. petroselini, Jij. Contundantur in mortar Colaturae adde Syr. de 5 radicibus, 01. amygd. dulc. aa ^jss. M. f. haustus cap. semel in die post clysteris completam operationem. Sometimes, notwithstanding the use of these remedies, I am enforced to use the following bath, especially when a stone is come down from the kidney, and sticks in the bladder. R Rad. althaeas, Ib.j ; Rad. symphyti, Ib. ss ; Fol. verbasc., malvae, althaese, aa manip. iv; Flor. cbamomel., Meliloti, Hygiri, Sambuci, Ros. rubr., aatfjj ; Furfuris mari, r)| vj ; Sem. lini parum contus. Jij. Incidantur et includantur sacculis duobus qui transversim intersuantur. Incoquantur sacculis predictis in congiis 6 aq. ad consumptionem unius, sub finem adde lactis rem mulcti cong. 2 f. semicupium quod ingrediatur aeger, et sit unus sacculus in loco pulvinaris in balnei in sessu. When the pains and all other symptoms are perfectly gone, I order some lenient purge, but to purge the patient sooner, nay, even to mix the least purgative ingredient with his clysters, doth much harm, by irritating the parts already vexed with the disease, and causing in them and the humours a high tumult, besides that a purging medicine, though very strong, given in the height of this disease, will hardly work, or, if it doth, will increase the pain. Now although this disease, managed as hath been here delivered, is wont for the most part to go off in three or four days at most, yet I think fit to intimate that oftentimes I have cured it in a nearer and more easy way, viz. by the use of Northall, Barnet, or Lusom waters, enjoining the patient to drink three quarts in a morning, for several days together, warmed if the season be winter, cold if summer : upon the taking of which the first time, great ease hath ensued, and upon the persisting in the use of them for a longer time, a perfect cessation of all other symptoms, without the observation of any diet, regimen, or any more ado whatsoever. And how prejudicial soever the signifying this may be to practitioners, yet, it being for the benefit of the whole, those that are wise and honest will hold me excused. NOTES. NOTE B. [From the MS. of the College "of Physicians, p. Ixii ; in a different handwriting from the Extract of NOTE A.] APOPLEXIA EX SANGUINE. To this disease are apt men from fifty upwards, of full and gross habits of body, and ruddy complexions, large bellies, that drink wine, and live sedentary lives. These men, between the winter solstice and the vernal equinox for the most part, but often also at other times of the year, from occasion of a high debauch, unwonted exercise, or any- thing else that gives an unusual and sudden motion to the blood, do (sometimes with a presenting of a fulness and giddiness in the head, but often without any warning at all) fall down, are taken with a deep sleep with snoring, are deprived of all sense and motion, respiration excepted. The first time of their being attacked happens to be in the morning. This disease is for the most part deadly, and kills the first fit. This sort is caused by extravasation of blood upon the brain, as is often found by dissecting those that die thereof, and therefore admits not of cure but by large bleeding in the very act of extravasation, if then. But is most certainly and easily prevented by doing of the same any little time before. Those, therefore, whose age and habit of body, and imprudent manner of living threaten this great danger, ought in the first place to take a large quantity of blood from the right arm, suddenly after the winter solstice, every year, it being dangerous to delay the same till the ad- vance of the spring ; and the next day I order a lenient purge to be taken. The reason why I would have the taking of blood to precede purgation is, for that there would be danger that the purge given upon full veins would, by the tumult that it raises in its operation upon the blood and humours, hasten the mischief which it was designed to pre- vent. When it has been done, I advise the patient wholly to abstain from the eating of flesh, or drinking any strong liquor, for the space of a week, entertaining himself in the mean time with panado, water- gruel, roasted apples, and such like, and after that time to repeat the same purge again, and from thenceforward to observe such a diet during his life as may secure him from this disease, which every day renders him more liable to than others. I order him, therefore, above all things to avoid the use of wine, or any other strong liquor whatsoever, which, though at all times very hurtful to such persons, yet the ill efl'ects they produce will he much increased by taking them in the morning. In his diet 1 direct him to avoid multiplicity of dishes at the same meal, and at suppers to forbear the eating of flesh. 384 NOTES. APOPLEXIA EX PITUITA. To this disease are inclined persons under the same circumstances with the other before mentioned, saving that they are not altogether so sanguine ; and they are taken in the same manner, and upon the same occasions and seasons also. But the causes are different; in that the disease of these proceeds from a gross, thick, phlegmatic humour in the blood, which, either obstructing the capillary arteries in the brain, and so hindering the access of blood for the supply of animal spirits, or else being protruded out of the arteries into the cortex of the brain and the meatuses does there hinder both the generation and motion of the animal spirits, upon either of which accidents all the symptoms will be produced which are observable in this kind of apoplexy. To which maybe added, those ramifications of viscous coagulated matter in the arteries, which, taking root in the heart, and growing like branches of coral in those vessels, do by degrees fill up the passage of the blood, and at last hinder its due and necessary afflux to the brain. Before the invasion of the fit there hath been, for the most part, a presention of a fulness and hoariness in the head, a more than ordinary disposition to sleep, and a decay of memory. This sort, though very dangerous, doth not yet so certainly infer death as the other ; there happening, oftentimes, a solution thereof by way of a palsy, the matter of the disease being thrown upon the beginning of the spinal marrow, and these obstructing all or part of the fibres of it, makes the palsy more or less universal, though that for the most part it makes a deadness of one side. For the cure. In the first place, if, by the patient's having indulged in the use of wine, especially if the late plentiful drinking thereof gave occasion to the fit, if he be not too far advanced in years, and be mode- rately sanguine, blood is to be taken, though yet I do it in a less quantity than in the other sort. But, for the most part, bloodletting is contraindicated, and the indications are to be taken from evacuating the gross humour, to which purpose I take the following course. First, I order a good strong clyster to be injected, e. g. R Decoct, com. pro clyst. Ib.jss; Diaphajn., 3 j ; Hier. pier., Jss ; Mel. anthos, Jij ; Sal. com., ^ij. F. Clyst. statim injiciend. Or the following : R Fol. salv., Origan., Rut., Calaminth., Centaur, min., ail manipul. j ; Fl. stacad., lavaiul., iia mss ; Sem. earth., ^ss ; Baec. junip., _^iij ; Sem. feenic., NOTES. 38J Sem. cumin, aa 3ij ; Agaric., Pulp, colocynth., in eadem petia inclusae, ua 3jss ; Coq. in s. q. aq. ad Ih.jss; Colatura dissolve. UiaphaMiic., J j ; Hier. pier., ^s; Benedict, laxat., 5ij ; Pil. coch., H[j. M. f. clyst. If the clyster does not work (which very often happens in this disease), then I appoint this following suppository to be put up : R Pulv. hier. pier., 5ij ; Pil. colocynth., agar., iia 3ss ; Diagrid., 9j ; Sal. gem., 5j. Mel. anthos. ad del)itam consistent coct. q. s., ut f. suppositoria, quorum uuuin indatur. As soon as they have injected the clyster, I give a purge of R Pil. coch. maj., 9ij; Pil. dc agar., -jj ; Trochisc alkandal diagrid., Ol. castor., aa gr. iij. F. raassa cum melle anthos. qua dissolvatur in aq. salv., ^iss ; Addendo syr. ros. cum agar., ^s. F. potio qua; in gulam ex coch. Lnfundatur. Or this R Fol. sen., 5iij ; Agar., Turbith. elect., aa 3jss ; Zinz, 5s : Coq. s. q. aq. salv. ad ^ijss; Colatura dissolve. Elect, diacathol., 3ij ; Castor., 9ss; Oxymel. simpl., Jss. F. potio. When the purging medicine is exhibited, even before the same doth work, or whilst it is in working, I use revulsions of all sorts ; as rubbing and binding tbe limbs, cupping-glasses to the scapula, arms, and thighs, vesicatories to the poll and scapula. Amongst all things that awaken and recover them to their senses, the blowing tobacco in their mouths is of greatest efficacy. The purging being over, I endeavour to evacuate the head, sensibly and insensibly. As R Rad. irid, Fol. anagall., Beta', an manip. ij ; Fol. rut., mauip.j ; Castor., 3s. Terantur in niort. mar. scusim afTundcml. Yin. all)., ^iv ; Aceti, ^ij. Imprimatur succus, rui addc Mel. ros., 3Js. F. crrhin. uaribus injicicnd. bix vcl tci cum spring. \cl I'ol. nico- tian.T naribus iiumittaii'iu. 1 1 . XT) 386 NOTES. R Fol. major., Salv., Rosismarin. sice., aa s ; Rad. pyreth., Helleb. alb., aa 9j ; Castor., gr. vj. M. f. sternutator. quod penna tubulo naribus insuffietur. But here it is to be cautioned, that the use of sneezing medicines is very dangerous, where sufficient evacuation hath not preceded, since by them the matter is more forcibly driven upon the brain. To discuss the humour, I order these following remedies : R Baccar. lauri, Junip., aa 5'ss ; Rad. angel., Zedoar. imperator, aa Jj ; Fol. salv., Rosismarin., aa tt| j ; Rutae, Satur. maj. Fl. lavend., aa ft]ss. Coq. s. q. acet. Hoc decocto spong. aut linteum imbuatur, et super, capiti calidi applic. Bracbia quoq. et manus eo abster- gantur, et crura et pedes fricentur. R 01. castor., Euphorb., aa Jj ; Pul. sinap., Eupborb., aa 5J- Aceti coch. Cerae, q. s. M. f. ung. capiti calido illinend. The tongue, palate, and nostrils, I order to be rubbed with old Venice treacle, dissolved in aq. ccelest aut antepileptica Lang. The chemical oils, likewise, of amber, lavender, rosemary, cloves, &c., mixed with the expressed oil of nutmegs, may be used for the same purpose. Aq. ccelest. et antepileptica may be given, after general evacuations. If the fit be not removed by these remedies, the old remedy of a hot frying-pan, held so close to the head that it may not burn the skin, is very effectual, but still not to be attempted before evacuation. The fit ceasing, I take great care to prevent the return thereof, to which the patient will be very liable, and that is to be done partly by diet and partly by medicine. As to diet, I enjoin the patient a very spare one, and that, too, drying; to forbear suppers, and the use of wine totally, at all times ; but yet, nevertheless, some fermented liquor, if less strong, maybe allowed him. As to medicine I order the following head-pill : R Pil. macr., Aloes, aa 3j ; Extract, rud., 3] ; Ol. chym. sem. anis, gt. iv; Balsam. Peruv., gt. ij. M. f. pil. cap. 5J ; singul. raatut. per 6 dies, vel pil. coch. maj., 9ij ; per totidem dies. And after that time, I appoint him to take of either of the said pills the prescribed quantity the day before every full moon, for six times. To comfort the stomach NOTES. 337 II Fl. salv., Knsismarin., aa'^j ; Zinz. condit., Cortic. citri condit., ua 3vj ; Nuc. muscat, coiuiit., 5$ ; Mirob. condit., N j ; Thcriac. veter., Confect. alchurm., it a Siij ; Fulv. elect., Diambr., Diamosc. d., ft ft 5J. Cum syr. cunditura cortic. citr. f. opiata. Cap ad magnitudinein castanea: singulis inatutinis superbibendn coch. ij aq. antopilrpt. Lang. Vel 1\ Anihr. gris., '^s ; Ol. delph., anis. cinnain. Nuc. muse., aii gt. ij ; Caryophyl., gt. j ; Sacchar. in aq. fl. aurant. solut., ^iv. F. tabella. 1 , cap. i, ad libitum. I N D E X. AIIRUKVIATIONS. E. D. T. E. means Epistle Dedicatory to the Third Edit inn of the Medical Observations E. I). F. E., ditto to the First Edit inn P. F. E.. Pre- face to the First Edition P. T. E., Preface to tht> Third Edition M. O.. Medical Obxerrationx Ep. I, First Epistle, i. c. to Dr. Brady Ep. II, Second Epixt/e, i. c. to Dr. Paman E. I)., Epistolary Dissertation T. G., Treatise on (iuitt T. D., Treatise on Dropsy S. M., Scheiltda Monitoria P. I., Processus lutegri. Abortion, to prevent, P. I., 30. Abscess, M.O., ii. 2, 21; iii, 3, 5 ; E. D., 11. Actium, T. D., 11. Acupuncture, useless in dropsy, T. D., 40. Acute. See Diseases. .Kstuation. See Fermentation. Ague. See Intermittent. Air. See Constitution. Altomarns, M. ()., ii, 2, 27. AMKRICA, Ep. II, 5. Anatomy, its use to physicians and sur- geons; opinionofHiPPOCRATEs; limits to our knowledge of it, T. D., 19-22. Ancients, undue admiration of the, T. I)., 44. Andernachus, M. 0., ii, 2, 27. AXXESLEY, M. O., iv, 7, D. Antidotes, M. O., ii, 2, 17. Antimonials, unsafe as emetics for chil- dren, M. O., i, 4, 1'J. Antony. See Augustus. Aphtha-, in dysentery, signs of approach- ing death, M. O., iv, 3, 3; 4, 2: in the fever of '8:>, S. M. I, 10. Apoplectic symptoms in intermittents, Ep. I, 34. ' Apoplexy, in the fever of '78 ; Ep. I, 31 ; E. D.," 62 ; T. G., 26 ; P. I., 1 7, 1 , \c. A|>osteme. See Abscess. ARISTOTLE, E. D., 75. Ascites. See Dropsy. Asthma, inveterate, of patients, with a sanguine temperament, three sorts, P. I., . r )6. Astringents not safe in cholera, M. ()., iv, 2, 2 ; in gonorrlura, Ep. II, 10,21. Atmosphere. See Constitution. Augustus. Sec Actium. H.vcox, I.oiiD, P. T. E., 1. HARRINGTON, M. O., iv, .'), '.). II. Hark. See Peruvian Hark. Hastard peripneumony. See Peripneu- mony. Hath waters, E. D., 111. HKI.KK, Dr., his case, M. ()., iv, 3, 12. Helvoir Castle. See Annesley. Hilious. See Colic. Hladder, ulcer of, P. I., 55. BOKTIIIVS, M.O., i, 1,2. HoTAi.i.rs, ii, 2, 27, quoted 28. HOYLE, E. D. F. E. BRADY, Dr.. his letter to SYDEXHAM, vol. ii, p. 1. SYDKXHAM'S epistle to, vol. i, pp. 1-28, S. M. I, 10. Bruises, I'. I., 52. Bubo in plague, M. ().. ii, 2, passim. In lues, Ep. II, 11. Burns, P. I.. 50. Butter, M. O.. iv. 3, 17. Calabria, S. M. Ill, I. Calculus, simulated by hysteria, M. ()., iv. 7, 18 ; E. D., (J7 ; an effect of gout, T. G., 12; impacted in the kidney, S. M. Ill, et jiaxfiiin. Camariiia, allusion to, T. D., 1). Carbuncles, M. ()., iii, 3, 5. Caruncles in the urethra. Ep. II, 10; P. I., 34, 1. CATO, E. 1). F. T. Cause; causes of disease immediate and remote, P. T. E., 20. Chalk-stones, T. (i., 55. Chalybeate pill, P. I., 1 and 111; clial>- beate powder, 1 and 4(5. Clialybcatcs, in hysteria, E. D. '.Ill; iron in substance, in a syrup, '.17 ; when un- necessary, 10(1; when injurious, I OS ; what they are, 1 10. Charon, M. O., iv, 5, 7. CIIKI-T, Mr.. K. D.. Hi. Childbed, causes i.f death in, E. 1)., 12S. Chlorosis. See Green Sickness. 390 INDEX. Cholera morlms, the season of its appear- ance, M. 0., i, 2, 12 ; of 1769, M. O., iv, 11, 1, &c. ; its symptoms, 1 ; treat- ment, 2-6 ; the kind that may appear at any time of the year, 7. Cholera of 1673-6, Ep. I, 5; its treatment, 8 ; P. I., 24, 1 ; the treatment, 2 ; of in- fants, 5. Chorea. See St. Yitus's Dance. Chronic. See Diseases. Cicero, quoted, Ep. I, 2, E.D.,23,asthe Roman orator, 75. Circumcision, ho\v far preventive to go- norrhoea, Ep. II, 3, P. I, 34. Clavus hystericus. See Hysteria. CLENCH, Mr., his case, M. 0., v, 4, 12. COLE, Dr., his letter to SYDENHAM, vol. ii, pp. 53-55; SYDENHAM'S to Dr. COLE, pp. 56-118. Colic, bilious, of, '70-2, AI. 0., iv, 7, 1, &c. ; description, 2 ; causes, 3 ; treat- ment, 4-8; case, 9; P. I., 23. Colic, hysterical, M. O., iv, 7, 16; de- scription of, 17 ; akin to the vapours, 18 ; what treatment is prejudicial, 20 ; tendency to end in jaundice, 22 ; E. D., 115; P." I., 28, 1; the treatment, 2; clavus hystericus, 5 ; affinity to hypo- chondriasis, 6 ; ends in jaundice, 7. Colica pictonum, P. I., 25. COLLINS, Mr., M. 0., iv, 6, 5. Coma, in smallpox, M. 0., iii, 2, 23 ; 62 ; in the fever of 1773-4-5, v, 1, 3 ; 17 ; the fever called febris comatosa, 26 ; in the confluent variola;, E. D., 29 ; in the fever of 1786, S. M. I, 5. Commotion. See Fermentation. Concoction, in fevers, what, M. 0., i, 4, 27. Constitutions, effect in producing speci- fically different diseases, M. 0., i,2, 5, &c. Epidemic constitution of 1661- 62-3-4 in London, M. 0., i, 3, 1-7 of '65-6, M. 0., ii, 1, 1 of '67-8 and part of '69, M. O., iii, 1, 1- 4 of part of '69-70-1-2, M. 0., iv, 1, 1-9 of '73-4-5, M. O., v, 1, 1, &c. of '76, Ep. I, 5; mea- sles of, 6; cholera of, 7. Constitution of '77, not observed by SYDENHAM, 1 ; of '68, 11 ; the fevers of, 12, &c. Constitution of '79, 41; coughs, 41- 54. Constitution of '80-5, 56. Continued. See Fevers. Convulsions. See Epilepsy. Convulsive cough of children, Ep. I, 47 ; P. I., 44. Conysby, a patient so named, M. 0., v, 2, 24. Cordials, strong, moderate, M. O., i, 4, 30. Costaeus,M. 0., ii, 2, 27. Coughs, P. I., 58. COXE, Dr., E. D. T. E. CRCESUS, Ep. I, 2. CROSSE, Mrs., E. D., 34. DACRES, Lady, E. D., 46. Decline, P. I.', 60. DEMOCRITUS, E. D., 77. Dentition, convulsions during, M. 0., iv, 5, 8 ; treatment of fevers from, S. M. I, 33 ; fever, P. I., 42. Depuration by means of fermentation. See Fermentation. Depuratory. See Fever. Despumation. See Fermentation. Desquamation, of the measles of 1670, M. O., iv, 5, 4; of '74, v, 3, 1 ; of scarlatina, vi, 2, 1. Diabetes after ague, Ep. I, 35 ; P. I., 37. Diarrhoea in fever, how dangerous, how to be treated, M.O., 1, 4, 10, 11 ; 51, 52; of the continued fevers of 1667, '69, iii, 3, 11-14 ; colliquative in tabes, P. I., 60. See Dysentery. DIEMERBROEK, M/0., ii, 2, 26, 44. Diseases, their history, P. T.E., 6 ; their description, 7-9 ; peculiar and constant phenomena, 10 ; effect of seasons on them, 11 ; deficiencies in their natural history, 13 ; dictum of HIPPOCRATES, 15 ; how the treatment can be im- proved, 17 ; ^lethodus medcndi, 21 ; what it is, M. 0., i, 1 , 1 ; division into acute and chronic ; fevers pre-emi- nently acute, 4 ; chronic, 5 ; acute and epidemic, 6 ; intercurrent and sporadic, 7 ; species of diseases as well as of ani- mals, ii, 2, 9 ; have periods for their disappearance and prevalence, v, 4, 16 ; diseases in fieri, where the type is not yet formed, vi, 5, 9 ; relation of fevers to other diseases mode of observa- tion, Ep. I, 52, 53 ; difference between acute and chronic, T. G., 34 ; not to be ascertained by hypothesis, T. D., 24. Dissections in dropsy of the testes of females, E. D., 92; of dropsical sub- jects, T. D., 39. Diuretics in dropsy, T. D., 32 ; P. [., 33, 7. DRAKK, Dr. J., assists SYDENHAM ; Epistle dedicatory to the T. G. Dregs. See Flowers. Dropsy, T. D., passim ; whom it attacks ; symptoms, dyspnoea, scanty urine, thirst, 1-3 ; cause, 4, 5 ; of females, 6 ; tumours simulating dropsy, dropsy simulating pregnancy, 7 ; rules for purging, 9, 10, 11 ; case, 12; purging INDEX. Dropsy (continued). with elaterium aial croc, met., 17; syrup of buckthorn, 18; case, 27; elder-bark, 30 ; restoratives, ;il ; wine corroborants, 34-38 ; topical remedies, -10, 1'. ]., 33 ; its signs, 1 ; treatment, 2 ; use of cathartics, 3-(i. Drying woods, Ep. II, 12. Dunster, ii, 2, 27. Duties of the physician, P. F. E., 1. Dysentery of 1GG9. '70, '71, and '72, M. O., iv, 3, 1, &c. ; syni|)toms, 1; time of year, 2; description, treat- ment, complications, 3, 4 ; Irish dysen- tery, 5 ; how far a fever, 8 ; principles of treatment, 9; how cured in Mo- rocco, 17; case, 18; S. M. I, 2(i ; diarrhoea and gripes, P. I., 22, 1 ; with tenesmtis, 2; the treatment, -1; dry gripes without stools, 11. Ebullition. Sec Fermentation. Elaterium, its great use in dropsy, T.I). 17. ELLIOT, Mr., case of, M. O., v, 4, 11. Empirics, P. T. E., 29; M. ()., v, 0, 8 ; their mischievous tendency to experi- ment, Ep. I, 50; T. G. 23, '31. Empyema, P. I., GO, 10. Epidemic diseases, M. (.)., i., 2, 1 ; ditl'er with the constitution of the year, 5 ; irregular, 8; vernal or autumnal, 10; vernal, 11. Epidemic constitution of 16G1-2-3-4, 3, 1, &c. Epidemic constitution of 1GG5-G, M. ()., ii, 1, 1, &c. of 1GG7-8, and part of iii, 1, 1, &c. Epidemic coughs, of '75, M.O. v, 5, 1 , &e. ' ErriKpctiric, cathamii PIT intKpctffii', T. J)., 9. Epilepsy, forerunner of the eruption, smallpox, M. O., iii, 2, 2 ; (luring teething, iv, 5, 8 ; after scarlatina, vi, 2,3; preceding confluent variola-, D.E., 28; can it be treated like St. Vitus's dance, S. M. I, 21. pilepsy of children, P. I., 40. pistaxes, M. ()., i, 4, 48. P. I., rysipelatous fever, vi, G, 1, &e. scui.AiMt.s, the Egyptian, P. T tiologv MO i 5 5 45. E., 1. xfoliation, Ep. II, 35. xostoses, Ep. 11, 35. P. I.. 35. Facies Hip|)oeratica, M. O., i, .">, 52. Ferdinand. Sre Tuscany. Fermentation, M. ()., i, I; \\hat best called A'///i//i/iV>//, fiiniH'itioii, \e. 2; rlepuration by iln-i/n. by finim-x. 52. treatment. ; (ie attenant arrira, 9; emetics, when useful. 1') ; venesec- tion. 22 : cordials, 2." ; malignity, so- called, 38; cough, epistaxis, \c. 4G, 49; hiccup, 51 ; diarrhoea. 52 ; ileus, 53, 57 ; of 'G7-8, and part of'G9, iii, 3; - , s P. I., 12; hectic, 43. Fits. See Epilepsy. Hysteria. Flowers, in fermentation, i, 4, 52. Fluor alhns, Ep. I, 3G, P. 1., 3G. Fonscca, ii, 2, 27. Forestus, ii, 2, 27. France, \\liy venereal patients go there, Ep. II, 38. Ep. II, 38. French, T. G., 51, G2. GALEN, M. O., i, 5, 39. Garlic in dropsies, T. D., 37. Goddard's Drops, P. T. E., 25. Gonorrhoea, Ep. II, 10; how different from lues, 12; to be cured by cathartics, 13-15 ; clysters, where useful, 1G; diet, 18; bleeding in sanguine tempera- ments, 19; importance of cleanliness, 20; when the prepuce cannot be drawn back, 22 ; swollen scrotum, 23; P. I., 34, its siirns, 1 ; treatment. 3. Goon.M.i.. Dr. tC P. T. E.. 25 ; Ep. 1,8; eases of, E. 1)., 49-54; praise of, 55 ; preface to the Schedule Monituri ; beer and ine. 4>< ; 392 INDEX. Gout (continued). total abstinence, diet-drinks, 48 ; how far wine allowable, 51 ; late hours, 52; exercise, 54 ; riding, 56 ; continence, 57; in the stomach, 62 ; external ap- plications, 07; Moxa, 68; gout per- sonified in the TpayoTrocaypa, 70, 71. P. I., 61. Green sickness, chlorosis, felris alba, predisposes to the clavus hystericus, E. D., 63 ; a sort of hysteria, 92 ; treatment, 108. P. I., 46'. Gripes. See Dysentery. Guinea, coast of, Ep. II, 5. Haematuria. See Bloody Urine. Haemoptoe, P. I. ,48 ; vomiting of blood, ibid. Haemoptysis. See Hasmoptoe. Haemorrhoids. See Piles. Hemiplegia, E. D., 61. Hiccup, M. 0., i, 4, 50. HIPPOCRATES, P. T. E., 3, 13; recom- mends bellows in colic, 31; quoted, M. O., i, 1, 3; quoted as the divine old man, v, 2, 16 ; v, 4, 15 ; his pro- gnosis in pleurisy, vi, 3, 3 ; taught by experience, Ep. I, 51 ; quoted, E. 1)., 26, 78, 107 ; T. G., 27, 68 ; T. D., 19, 21, 22, 23; S. M. I, 39. History of a disease, its conditions, P.T.E., 5-12. Hooping-cough, M. 0., iv, 5, 8. HOWARD, M. 0., iv, 3, 17. Hydragogues, T. D., 9. Hydrophobia, P. I., 54. Hypercatharsis, best controlled by lau- danum, sometimes arising from mild purges, T. D., 9 ; from purging un- guents, &c., 40. Hypochondriasis, its affinity to hysteria, E. D., 73 ; mental symptoms, 75 ; P. 1., 28. Hypothesis, when legitimate, T. D., 25. Hysteria, E. D., 58, ad fincm ; its fre- quency, 58, 59 ; its variety, 60 ; what it simulates, 61-70; green vomiting, 66, 83; mental symptoms, 75; limpid urine, 86 ; case in a male, 86 ; saliva- tion, 87; chills, 88; crying, 89; ori- gin, 91 ; hysterical colic, 115; simu- lates nephritis and bilious colic, 126 ; P. I., 1, 1-21; clacus fiyxlericus, strangulation of the womb. 2 ; treat- ment, 3. Hysterical remedies: the fetid, E. D., '94, 102, 103; when injurious, 107; taken as crrhines, and externally, 11!); their nature, 120. Idiosyncrasy, to be particularly observed in hysteria, E. D., 107. Ignis sacer, M. 0., ii, 2, 13, 14, 15. Iliac passion. See Ileus. Ileus in fever, M. 0., i, 4, 53; its causes, obstruction, true and false ileus, 54 ; obstruction, treatment by leaden bul- lets, 55 ; true method, 56, 57 ; diet and regimen, 59. Ileus, simulated by hysteria, E. D., 66; in fever, S. M. L, i," 29; P. I., 26, 1; the treatment, 2-6. Indian moss, or Moxa, 68. Intermittent fever, P. T. E., 19 ; M. 0., i, 2, 14 ; of the years 1661-4, 5, 1, ftc. ; the stages, 6 ; double fits, 7 ; kinds of, 8 ; vernal, 10 ; autumnal, 13 ; quartans change their type, 14,21; treatment of spring agues, 16 ; use of emetics, 1 7; bleeding, 18 ; autumnal agues more obstinate, 19; duration of tits collec- tively, 24 ; nature of the fermentation, 26; use of bark, 33; sequelae of au- tumnal, numerous, 41; dropsy, 46; swollen bellies of infants, 49 ; mania, 56 ; tertians and quartans of 1678, Ep. I, 12; action of bark. See Peru- vian bark, P. I., 4, 1-7. Inunction, mercurial in lues, Ep. II, 26. Irish. See Dysentery, Iron. See Chalybeates. Itch, P. I., 12. " Jaundice, M. 0., iv, 7, 21 ; arising from confinement to bed in the fever of 1673-5, M. 0., v, 2, 13 ; not follow- ing colic, P. I., 29. Jesuits' bark. See Peruvian bark. King's evil. See Rickets. Kind's Mews. See Conysby. KENDUICK, Dr., 54 ; E/Dj 140. Laudanum; formula for the liquid, M.O., iv, 3, 14 ; its strength, E. D., 39. London, id uc solid. , the solid, when preferable to the liquid and to syrup of poppy, S. M. II, 14. Lixiviated salts, T. D., 32, 38 ; as diure- tics, P. I., 33, 7. Lochia, excess of, P. I., 31 ; suppressed, E. 1)., 128; P. I., 32. LOCKE, E. D. T. E ; his Latin verses to SYBENHAM, 27. \ui[n!)C)], the constitutions of 1665 and 1666 such, M.O., ii, 2, 3, 7. LUCIAN, T. G., 70. LrcKETius, quoted E. 1). T. E. INDEX. Lues, Ep. II, passim ; how far the vene- real disease should be cured, 4 ; its origin, 5, 7 ; contagion, 8 ; progress and common symptoms, 9; complica- tions, ej-ost oses, 11 ; nature, 12; when a confirmed po.v, 24 ; treatment, 25 ; mercurial inunction, 20; ptyalisin, 27 ; purging, 30; coexistent with gonor- rhoea, 33, 34 ; French treatment what, 38; diet, 39; P. I., 35; signs of, 1 ; treatment, 2-9, &c. Malignity, another name for ignorance, M. O., i, 4, 38, ii, 2, 1 ; considered, M. O., v, 5, 12-16, Ep. I, 52, S. M. I., 40, 41. MALTHUS, Mr., Ep. I, 60. Manna, what is it, S. M. Ill, 4 ; its use in gout, gravel, calculus, and bloody urine, 5-8. MAI-LKTOFT, Dr., E. D. T. E. Mania, of the intermittents of 1661-1, M. O., i, 5,53; common, P. I., 51. Massa, ii, 2, 27. Mathew's pills, P. I, 20, 2. Maturation of pustules in smallpox, M.O., iii, 2, 3. Measles of 1070, M. 0., iv, 5; time of year, 1 ; description, 2; evilsof an over- hot regimen, 4 ; how far akin to small- pox, 5 ; of infants, 7 ; concomitants and sequela;, 8-10; of 1074, M. <>., v, 3 ; their anomalous character, 1 ; fever, 4 ; measles, P. I., 14. Measly fever, M. O., v, 3, 4. Melancholy, in hysteria, E. D., 75: in gout, T. (i., 53. Menses, flow of, during smallpox, M. ()., iv, 0, 1 1 ; in hysteria, E. D., 135 ; sup- pression of, P. i., 47 ; immoderate tlow of, P. I., 27. Mereatus, ii, 2, 27. Mercurialis, ii, 2, 27. Mercury, how far a specific in the vene- real disease, Ep. II, 12. Metellus, E. U. T. E. Method, or praxis, its conditions, P. T. I-;., 16. Miasma, M. O., ii, 2, 4, 7. Milk diet, E. 1)., 115. Mi 1.1.1 NCJTON, Dr., M. ()., iv, 0, 11. Morocco, M. O., iv, 3, 1 7. MOKIUCK, Dr., iii, 3, 10. Moxa, use of, in gout, T. (i., 08. Nature, quotation from IhrrociiATEs concerning, P. T. E., 15; operation in chronic diseases, 23 ; her mode of eliminating drlcterious influences, M. ()., i, I, 3 ; conceals the essences of Nature (continued). diseases, ii, 2, 9 ; what is meant by the expression, ii, 2, 4S ; hmv far myste- rious, E. D., 50, T. D., 22 ; her watch- fulness, 39. NKKDHAM, Dr., E. D. T. E. Negroes, Ep. II, 5. Nephritis, a nephritic paroxysm, P. I., 20 Non-naturals, M. O., i, 2, ; 4, 4 ; 5, 25, T. D., 34, P. I., 61. Not, Mrs., a patient of SYDKXHAM'S, v, 2, 21. Onion, applied to the soles of the feet in smallpox, E. 1)., 44. Ophthalmia, I'. I., 18, 1, &c. Orthopna-a, P. I., 50. Oxford, E. D. T. E. O.xycrat, P. I., 34, 11. Palpitation of the heart in hysteria, E. D., 04. Palsy, P. I., 57. PAMAN, Dr., his letter to SYIJKNHAM, vol. ii, 29; SYDKMIAM'S to PAMAN, vol. ii, 31-50. I'ASCHALIUS, ii, 2, 27. Passio iliaca. See Ileus. Pereda, ii, 2, 27. Peripneumony of 1075, v, 5, 1 ; atKnities with fever, postscript to T. D., 2; different from pleurisy in degree only, M. O., vi, 3, 5; bastard, vi, 4; tin.e of year and constitutions attacked, 1 ; description, 2; treatment, 3 bastard, P. I., 9. Pertussis, iv, 5, 8. Permian bark, use in agues, M. ().. i, ,">, 33-37 ; value in thefe\ersof 1070 and '78, Ep. I, 13,14; why distrusted. 15; is virtue not owing to its astringeney, 111; its (late, 17; mode of adminis- tration, 19-31, and 37-10 ; in hysteria. E. D., Ill; use in gout, T. (i., 71 ; cautions, S. M. I, 10, 32-30. Pestilential lever. Xcc Plague. PKTWOKTH. .W Morricc. Phaeton, M. ()., iv, 3. f>. Phagedenic ulcers, P. I., 35, 1. Phren/.y, M. ()., i, 4, 42; in the fevers of 1073-75, v, 2. 22 ; of delivery, E. !>., 12'.l ; in the fever of 1085, S. M., 5. Phthisis kills two thirds of tho-e \\lio die of chronic disease; good riled* of riding, E. 1)., IIS; description. .\< .. P. I.! 58. Si-r Tabes. Piles, condition of liemorrhoidal \cins in. T. O., 9 ; pain of, P. 1., 38 ; iniiiM'd,-- rate hemorrhage of, 39. 394 INDEX. Plague, M.O., ii, 11, 1; of 1665 and '66, its cause, constitution, 3 ; its essence unknown, 9; sui generis, 10; like the ignis sacer, 13. Pleurisy of 1675, v, 5, 1, &c. Pleurisy, vi, 3 ; time of year for invasion of, 1 ; temperaments attacked, 2 ; his- tory of disease, supervenes on fevers, 3 ; blood of pleurisy, 4 ; treatment, 6-12 ; dry pleurisies, prognosis of Hip- pocrates, 13 ; description and treat- ment, P. I., 8. Poisoning, case of, Ep. I, 62. POLITIAX, E. D. T. E. Porrigo. See Scald-head. Post-mortem appearances. See Dissec- tions. Praxis. See Method. Prepuce not to be retracted, Ep. II, 22. Procidentia uteri, P. I., 19. Purging, when injurious in hysteria, E. D., 99. Putridity : on putrid fever following the confluent smallpox, S. M. II ; comes on on the eleventh day, 8 ; treatment, 9 ; petechise and bloody urine, 13. 3>X6yw<7(c., M. 0., ii, 2, 5. Quinsy, M. 0., vi, 7, 1, &c. P. I., 13. RAY, his account of manna, S. M. Ill, 4. Rheumatism, M. O. vi, 5 ; time of attack, history of, 1, arthritic, 2; lumbago, 3; treatment, 4 ; anodynes, when to be avoided, 6 ; purges, when useful, 7 ; scorbutic rheumatism, 9, 13 ; how far bleeding can be dispensed with, Ep. I, 58, 64 ; description and treatment of, P. I., 10. Rickets, true and false, E. D., 100; de- scription and treatment, P. 1., 41. Riding, in hysteria and hypochondriasis, E. D., 116; in phthisis, 118. Riverius, P. I., 25. Rose, the. See Ignis sacer. Salisbury, M. 0., i, 5, 56. SALISBURY, Countess of, M. 0-, v, 3, 3. SALISBURY, Lord, M. O., iv, 4, 11. Salivation, how promoted in the variolae of 1667-9, M. 0., iii, 2, 51 ; becomes viscid and incomplete, 61 ; in the fever of '67-9, 3, 14 ; in the smallpox of '74-5, v, 4, 1 1 ; in lues, Ep. II, 27, &c. P. I, 35. SALTMARSH, case of Mrs., T. D., 13. Scald-head, P. I., 53. SCALIGKR quoted, M. O., v, 5, 12. Scarlet fever, vi, 2 ; time of year, 1 ; treatment, 2 ; convulsions, 3 ; descrip- tion and treatment, P. I., 7. Scorbutic rheumatism, M. 0., vi, 5, 9 ; its connexion with dropsy, 10; treat- ment, 11-13 ; description and treatment of, P. I., 59. Scrotum, when swollen in gonorrhoea, Ep. II, 23. Septalius, M. 0., ii, 2, 27. Seneca, E. D. T. E. Shanker, Ep. II, 6. SHORT, Dr., SYDEXHAM'S dedication to him of the 'Treatise on Gout,' vol. ii, pp. 121, 122. Smallpox of 1667, '68, and part of '69, M. 0., iii, 2; regular in character, division intoconfluent and distinct, 1,2; eruption, distinct sort, 3 ; confluent, 6 ; salivation, 13; critical days, 19; frenzy and coma, 23 ; purple spots, 24 ; bloody urine, 25 ; period of sepa- ration and expulsion, 30 ; curative in- dications, 32 ; mischief of a hot regi- men, 34; treatment, 42; discrete smallpox not dangerous, 48 ; treat- ment of symptoms, 57-65; anomalous of, 1670-1-2, iv, 6, 1-8; treatment, 9; irregular, of 16/4-75, v, 4, 1; exces- sive putridity, 2 ; different indications of cure, 5; cases, 11, 12; of 1680-81, E. D., 3, &c. ; eruption, 4 ; confluent worse than distinct, 5 ; danger of, bed injurious, 8, 9 ; nature of smallpox, 1 1 ; mischief of cordials, 12; bleeding and purging, 16; theories and practice, 23-27; coma, 29; use of anodynes, 33-41; case of Mrs. Crosse, 34; re- vulsives, 44 ; critical days, 47; treat- ment and description, P. I., 15, 1-29. Somerset. See Dunster. Spawn. See Exostosis. Sparta, Ep. I, 3. Species of disease, P. T. E., 18. Starstruck, M. O., vi, 6, 1. Specifics, P. T. E., 21-24 ; in lues, Ep. II, 12 ; none for gout, T. G., 69; bark in ague, 71; T. D., 34. Speculations, how unstable, E. D., 56 ; opposed to practice, S. M. I, 43. Stationary fevers, Postscript to T. D. ; description of sort previously omitted, 3, &c. ; like bastard peripneumony, 3; a winter fever, 3; fevers of 1677, S. M. I, &c. ; similar to but different from intermittents, 4 ; symptoms, 5. Strangulation of womb, E. D., 62, 81. St. Giles. See Collins. Strmna, E. D., 99. St. Vitus's dance, S.M.I, 19; P. I., 10, 1. INDEX. SYDEXHAM, Dr., his family; Life, xiii; birth-place, xv ; enters at Oxford, par- liamentarian connexion, xvi ; notices of, by himself, by Sir K. BI.ACKMORK, by Dr. LETTSOM, xviii, et seq. ; fellow of All Souls, xxiii; at Montpellier, (?) xxiv ; degree of B. A., xxv ; licentiate of College of Physicians, xxvi ; first publication, notice of, xxvii; letter of BOYLE, xxxi ; verses of LOCKE, xxxiii ; letter from his nephew, xxxv; literary history, xxxvii ; review of his treatise on Dropsy, xxxviii ; not a Member of the College of Physicians, xliii ; death, tombstone, xliv ; family, xlv. ; portrait, xlvii ; authorship of the works in Latin, 1 Ixiv ; growth of reputation, Ixv ; treatment of smallpox, Ixviii ; letter to BOYLK, Ixxii; his use of bark, claims of TAI.BOR, view of Sir G. BAKKR, Ixxiv Ixxxi ; medical logic, and effect on medicine, Ixxxi Kxxix. SYDEXHAM, W., Dr. SYDENIIAM'S bro- ther, E. D. T. E. SYDEXHAM, W., Dr. SYDEXHAM'S son, M. O., iv, 0, 12. Syrup of poppy, compared with the liquid and the solid laudanum, S. M. II, 14. Tabes, or decline, P. I., CO. TACITUS, TITUS, E. D. T. E. Tantalus, Ep. I, 2. Tapping, when useless, T. D., -10. Tendon, a punctured, P. I., 49. Testcs of females, dropsy of, E. D., 92; T. D., G. Thames, the, S. M., II. THOMAS, Dr., M. 0., i, 5, 5G. TpciyoTroCi'iypii, T. G., "0, 71. TiuxcAVELLirs, ii, 2, 27. Tuscany, M. O., ii, 2, 7. Urine, bloody, in confluent smallpox, M. 0., iii, 2, 2"); in the putrid fever consequent on confluent smallpox, S. M., 13 ; treatment, 14 ; arising from Urine (continued^. a calculus impacted in the kidneys, S. M. Ill, passim ; SYDENHAM'H own sufferings, 2; use of manna, 4 ; treat- ment, 5, 14. Vapours, M. O., iv, 7, 17, E.I). . 12'.- 135; brought on by emetics, T. I)., 27 ; described, S. M. I,' 22. Variola. See Smallpox. Venereal disease. See Gonorrhcra and Lues. Virulent gonorrhoea. See Gonorrhoea. Treatment, Ep. II, 13; prepuce inca- pable of being retracted in, 22 ; ulcers in, 23. Volatile spirits, their nature, E.D., 120. Waters, Bath or sulphuric, E.D., 111. Waters, chalybeates, effect and nature, E. D., 110; when to be used, and when not, in bloody urine, S. M. Ill, 3, 10. Waters, Tunbrid^c, M. 0., iv, 7, 23; E. D., 108, 109. WIXDHAM, Mr. THOMAS, and Sir FRANCIS, M. ()., v, 5. 10. Wine, Canary, M. O., iii, 2, 47; use in gout, T. G'., G2 ; in dropsy, T. D., 3:> ; S. M. I, 14, 17, 28; I'. I.; how it benefited SYDEXHAM, P. I, 01, 1G. Wine, Falernian, M. ()., i, 4, .'50. Wine, Malaga, M. ()., i., 4, 37 ; v,2. '.V.. Wine, muscatell, M. O.. i, 4, 30. Wine, Uhenirsh.T.G., 51 ; T. D..32. Wine, Spanish (sherry), Ep. I, .'!"; T. G., 51. Winter, winter fever, P., 3 ; cold of 1CS3 ; S. M., 2; 1GS4, ibid. WYXDHAM, Captain FRANCIS, ii.2, 27. Yaws, how different from the venereal disease, Ep. II, .">. Zacutus lusitamis, ii, 2,27. TIIF. KNU. I'RIXTKD IIY C. AM) J. API.ARD. IIAHIIIOJ.OMMT CI.cisl. from which it was borrowed LOS ANGELES A 001 158 616 R llli 59 8 w v.2 BOUND DV WESTLEVS * C , > \ ] \. S ; - ; U: