k^

ilr

A N

ESSAY

O N

BILIOUS FEVERS^

OR, THE

HISTORY

O F A

BILIOUS EPIDEMIC FEVER

At LAUSANNE,

In the Year MDCCLV.

By S. A. D. TissoT, M. D.

Apfello Veritatem ipfamqiie naturam^ Medicorum Nimina in perpetuum Colenda, Ben net.

Tranflated into Englifh,

LONDON:

Printed for D. Wilson and T. Durham, at Plato's- Head in the Strand. MDCCLX.

THE

PREFACE.

I Here offer to the candid reader a faithful hiftory of a fevere and tedious difeafe of the putrid kind, which was epidemical at Laufanne in Switzerland, particularly in the year 1755. To fpeak of the utiHty of the defign would be an affront to his judgment 3 but it is neceffaiy to premife fomevvhat concerning the me- thod which I have followed.

He, who compiles bare hiftories, and relates them fimply, is worthy of praife 3 but it is the bufinefs of a labourer to collect materials to be put in order by an artift ; for from a colle6lion of obfervations upon epidemicks, a rational phyfician draws praftical canons appHcable to different kinds of diftempers. A fimple narrative teaches a young man nothing, unlefs the fame fymptoms occur again 3 and when does that happen? I have therefore endea- voured to throw this treatife into fuch a

A 2 form

[ iv ]

form that a method may be pointed out of curing not only a diftemper moft nearly refembling ours, but all putrid gaftric dif- eafes, every where fupported by experience, theory, and authority; this is the reafon of the title I have given to this fmall v/6rk.

No medical work can be fupported with- out theory and experience. Thofe who are by no means fond of reading will perhaps condemn the multitude of quota- tions to juftify their own indolence, but I fliall never agree with them. He is an unhappy man who is taught only by his own experience. Should we refufe to learn from our predeceffors? By no means, for what will be the confequence of that re- fufal ! As I owe my knowledge to the wif- dom of others, I did not think it unbe- coming to quote my teachers. Thus the doftrine acquires the greater authority ; and often the work is rendered more ele- gant ; for I have in this manner adopted the v/ords of great men, that laying afide my own, they might deliver my fentiments in a neater drefs. Nothing procures greater certainty to phyfick, nor better removes all

•doubts

doubts about what is to be done, than that wonderful harmony among the moft ce- lebrated phyficians of all nations and ages; I therefore believed it ufefid to add to the faithful relation of what I obferved and of my pra6lice, the motives by which I was induced to take fuch meafuies.

The quotations from the antients will be difpleafing to thofe, who have never converfed with their works, they will ac- count them as a blind idolatry, rather than a judicious veneration. I confefs I do not reverence the authorities of the antients fo much as fome others do, and I readily af- fent to what is faid by the illuftrious Maty-f-, whom I reckon with pleafure and pride among the number of my friends-; but I would except Celfus, Aretssus, fome books of Galen, Alexander of Tralles, and cfpecially Hippocrates, whom I admire

t ^' It is to be feared that the advantage, which ^*' may be reaped from feveral of ihefe works is but *' little proportioned to the time, which is fpent in *' reading them; befides a young man runs a rifle of *' making no good choice and perhaps of confounding, *' rather than informing his judgment.'^ Eflai fur le caraiSlere du grand Medccin, ou Elrge critique de Mr. Boerhaave, p. 25. An eflay well worth reading.

A 7 above

[ vi]

above all other phyficians, and have more frequently quoted than all the reft ; for if

we depart from Hippocrates alone ^ who is left equal to hitn f

I EVERY where fuppofe the reader a phy- fician, and previoufly acquainted with what ought to be known ; nor have I been of the number of thofe, vv'ho, relating the Trojan war, begin with the egg of Leda; for I know nothing more tedious than to find in all books the obvious elements; no- thing is more prejudicial, for a great deal of precious time is loft in reading over and over the commoneft things. I have feldom and only from neceffity introduced theory; I collecled feveral particular obfervatipns which appeared important, and could not be ranged more properly any where elfe.

Perhaps fome might have chofe a dif- ferent m.ethod, but after mature delibera- tion I could not find a more convenient or.e. I thought fit to treat of fome reme- dies, which I did not make ufe of, becaufe fome men, otherwife of great chara61er, prefcribe them in difea fcs of the fame kind with ours. It is indeed to be lamented

that

[vii]

that from the confufion of names in phy- fic, different difeafes are defcribed by the fame appellation. 2. That praftical trea- tifes have been often wrote by men, who were well fkilled in medical learning, but who were not in the lead converfant with pra6tice. 3. That feveral others being wedded to an hypothefis, founding all their pra6lice folely upon hypothefis, and blinded by it, without the leaft difingenuity, have in their writings afligned difeafes to caufes, and certain virtues to medicines very dif- ferent from the true. Hence I fometimes found myfelf under a neceffity of pointing out the errors of thofe venerable men. It was my great rule all through this work to relate what I obferved and to admit for true only what was taught by unerring nature, or the confent of the greateft men. What an otherwife valuable author recom- mends, if it feemed repugnant to nature, or the obfervations of feveral men of cha- racter, or contrary to demonftrated max- ims, I treated as falfe, or at befl very doubtful. The art of phyfick in its rife confifting of a very few obfervations, was deflitute of every other guide, and parti- cular obfervations are often imperfeft,

often

[ ^i'li ]

often fallacious; in procefs of time by comparing them with large colleftions af- terwards made, men of genius and learn* ing deduced canons, which are the true elements of phyfick, and the touch-ftone to which the later ones ought to be ap- plied, that the imperfeft may be diftin- guifhed from the more perfeft. Innume- rable are the fatal confequences of the neg- le6l of this caution, for the imperfect are in great abundance, and have authority with men, who are entirely ignorant of the principles of the art, and who, mifled by falfe reafoning and deceived by the ex- ternal refemblance between diftempers to- tally different, have already, and continue daily to bring many to their graves.

I HAVE inferted no forms of prefcrip- tion ; I made ufe of few, and thofe very fimple; and every phyfician, who is ac- quainted with the caufe of the diftemper and the virtues of the remedies, will very readily prefcribe the befl in each particular cafe 5 nor are we deftitute of fuch already compofed by men remarkable in the art, Boerhaave, Gorter^ and Gaubius.

Thb

[ ix ]

The language will be found void of rhetorical flowers, and affected ornaments, which would have ferved no purpofe. I jftudied eale, avoided pompous words, and have endeavoured to fliun improprieties ; perhaps feveral have crept in, for which I crave indulgence. I fubmit the whole trea- tife not to the niultitude of thofe, who pretend to be judges, but to the fmall number, who deferve that name^ if they approve it I fliall perhaps be encouraged to attempt fomething moie confiderable on nature confidered in a medical view, and the fmall-pox.

Laufanne, January 2, 1758.

CONTENTS.

^T^H E conjliiutton of the air* P^gc I

Hi/lory of the Difeafe. 4

Of the clafs to which it belongs^ and its

caufe. 18

I'he examination of a dead body, 27

^he Method of cure, Firjl Species, 32

— — • Second Species, 55

Jhird Species. 74

I'he Diet of the Patient. g^

Relapfes, 105 Confequences of the Difeafe^ a meiajlajis. 108

Relicks. Obftru&ions. 112

' Debility. 132

0/

xii CONTENTS.

Of bleeding in bilious fevers. p. 158

An examination of the virtues of abforbents.

205

Of SudorifickSy Diureticks. 208

^Cardiacs. 214

Narcotics. 217

I'be Prophylactick fnethod. 221

TraStical Canons^ 2^3

'm^

The HISTORY

O F T H E

EPIDEMIC BILIOUS FEVER

At LAUSANNE, 1755.

The Conjlitution of the Air.

TO the violent heats in fummer 1754 fucceeded a hot autumn j in the beginning of winter, we had either perpe- tual fhowers or fogs, and the feafon warm. The weather remained thus till the third day of the following Year, when there fud- denly came on that violent cold, which by the 5th and 6th of January grew fo intenfe over all Europe almoft, that it fell but B little

[ 2 ]

little fliort of that remarkable and fince un- paralltled froft of the year 1709. It con- tinued very fevere to the 14th of the month, then it abated fomewhat, tho* the fame froft ft ill lafted till the 20th of February. March was ftiowery ; April fo hot, which is vei7 uncommon in our country, that happening at that time to attend patients in the fmall-pox, I was obliged to renew the air in the chambers from all quarters, and moiften the boards frequently with cold water. In the beginning of May, the fevere cold returned with a northerly wind, and was very pernicious to the tender leaves and bloflbms. The weather was unfettled dur- ing the whole month. Violent heat com- menced with the month of June, and con- tinued to the 23d of July.

The greens coUeded in cellars perifliing by the winter's cold, the ufe of animal food was more plentiful than in other years. The city is byilt in fuCh a man- ner, as to ftand much expofed to the in- fluence of the weather.

X Whoever

[ 3 ]

Whoever is acquainted with the laws of the animal oeconomy, and the efFeds of the air, as well as of different foods up- on the human body, will very readily ap- prehend three confequences from the cir- cumftances mentioned: ift, a difpofition of the humours to putrefaftion j 2dly, a difordered and obftrufted perfpiration 5 3dly, the refuniption of pungent and pu- trid matter to the prima i/7>, and confe- quently an interruption of the mteftinal difcharges, for there the putrid ferment was collefted, which being put in motion by the fummer heats produced that epidemic fever, which prevailed fo univerfally here^ that hardly a fourth part of any family ef- caped it; and in feveral houfes, two, three, nay fix were fick at one time *.

B 2 The

» This would not be a proper place to treat largely on the produdion ofdifeafes from the air. Excellent obfervations on this article are to be found, among many others, in Hippocrat. de aere, aquis & locis ; de hu- morib. ; Aph. lib. 3. in Epidem pafTim. Edinb. Med. Ef- fays ; Mem. Academ. Par. from 1746, by the celebrated Du Hamel and Malouin ; the ingenious Burton on Non- naturals ; theilluftriousF. Hoffman in Obfervat. Barom. meteorol. in patholog. p. 3. c. 7. and many other places through his works : Nothings fays he, corrupts the bile,

renders

[ 4 ]

The difeafe was not equally violent in all; but the fymptoms of a putrid ca- cochymy opprelling and irritating the di- geftive powers, to be found in every pa- tient, demonftrated the diftemper to be of the fame kind. With regard to its vehe- mence, It may be accurately enough divid- ed into three fpecies. Thefirft was attended with no danger, unlefs by being neglefted it degenerated into a chronic diftemper: The fecond, tho' not void of danger, yet as far as I know never proved mortal, ex- cept when either by wrong management, or no care at all, it was changed into the third. The third by the bleffing of God was very rare, but always very threat- ning, and fometimes fatal.

The Hi (lory of the Difeafe. In the firft fpecies, patients complained firft of a laditude, weaknefs, weight par- ticularly of the head, loathing of food, an uneafy and almoli conftant fenfation of

renders it impure, and fills It with cauftic [alts more than an ohjlru^ton of the natural di [charge by the fur face of the body* Whenever fuch caufiic bile is found in the prima via it creates finverivg^ anxieties, vomiting and febrile pa- roxyfm-. De Bile medicin. et ven. eorp. hum. § 31. T. 6. p. 159. Above all in the celebrated Huxham's bookde Acre et morb. Epidem.

cold.

[ 5 ]

cold, infomuch that during the dog-days they would go with great pleafure to a kitchen fire; they were drowfy without fleeping; their mouth ilimy; and their tongue foul with a whitifh-yellow tena- cious covering. After three or four days, fometimes later, a fliivering came on to- wards evening, which harafied them for an hour or two, fometimes longer : This was followed by a heat not vehement indeed, but troublefome and pungent, which com- municated a fmart heat to the fingers of the phyfician ; in fome this continued till morning, and then gradually went off with- out any fenfible evacuation ; in others after fome hours a gentle fweat came on, for I never faw it profufe, but it did not bring that placid interval, which fucceeds the fweats of true intermittents. I heard frequent complaints of the head in the time of the paroxyfm, but none of the breath. In the firft days the pulfe hardly differed from a natural one, except by it's weaknefs ; in the time of the fliivering it was very fmall, during the heat quick, contracted, and frequent, yet not exceeding an hundred pulfations in a minute in an adult wo- B 3 man.

[ 6 ]

man**. When the paroxyfm was ended, the patients remained in the fame ftate of lan- guor, which I defcribed before, riling in- deed out of bed, but unfit for all kinds of employment, torpid, lazy, dragging them- felves from their chair to the bed, and from the bed to the chair, and not walking without reluctance. The paroxyfm return- ed every day, but frequently varied from it's firft hour ^ neither was it always fimi- lar to itfelf in other circumftances. Nay^ there were feme patients, who without re- gard to any period, fhivered and grew hot often in one day 5 I knew feveral in whom I could hardly fufpeft any exacerbation, unlefs from a little more anxiety and debi- lity in the evening, but they were never- free from the oppreffionof the languor, nor were they fooner cured than others. There were fome, particularly of the older women, who fcarcely complained of any thing elfe befide debihty, loathing of food, and want

*> Excellent obfervations concerning the number of pulfations during a given time^ in a found man, and one labouring under a fever, have been publifhed by the illuftrious Haller in his valuable eflay on the motion of the blood, Mem. fur le mouv. du Sang. chap. 8. p. 36.

of

[ 7 ]

of fleep. Some were diftreffed with a pain of their flomach ; and what was common to them all, they did not recover till after fome weeks. There were feveral patients whom, no fuch violent fymptoms appear- ing as required the fpeedy aid of a phyfi- dan, I did not fee till fifteen days after they had been feized, and I found httle or no difference m their fymptoms from the others, fave that the heat and debility had increafed, and by that time brought them in danger of a flow fever. In the beginning of the diflemper, the belly was bound, to- wards the end a little more lax -, the urine during the interval was thin and crude, in the violence of the paroxyfm a little more red ; upon the decline of the difeafe it be- came concocted with a fediment. I found very few who had much thirrt. Boys, wo- men, and old people v/ere principally fub- jeft to this fpecies, men very rarely. Old men efcaped thefecond. The third attack- ed only young men in the flower of life, from 1 5 to 40, and generally carried off - the more robuft '.

B4 The

^ An obfervation of this nature was not milled by Hip- pocrates, for he noted an epidemical difeafe in which

thofs

[ 8 3

The beginning of the fecond fpecies was not very different from that of the firft ; but after fome days every thing was more aggravated, the weaknefs increafed, a nau- fea followed the loathing of food, but the fick very rarely vomited fpontaneoufly ; the heat was more brifk, and the paroxyfms more violent; at the beginning they did fhiver, tho' gently, but afterwards fcarce any coldnefs was perceived before the pa- roxyfms ; but the heat grew gradually more intenfe, generally in the evening } the pulfe was more frequent, and upon trial, in fome perfons I was able to count one hundred and fixteen ftrokes in a minute. At this time feveral were diftrefled with moft acute head-achs. After three, four, or five hours the fever remitted, and, as in the firft fpe- cies, without a fweat. Nor w^ere fweats very defireable, for upon the decline of the diftemper they did good, but during it's height, both in this, and in the third fpe- cies they were prejudicial; for the more p'rofufe they were, the more fevere was

thofe patients chiefly died, who were in the vigour of lik, Epidem, Jib. i. Stat, tert. Foef. p. 955.

the

[ 9 ]

the fucceeding paroxyfm. The patient had not a peifeft interval, and this was the pa- thognomic fymptom, whereby we might diftinguifli the fecond fpecies from the firft^ The urine was fmall in quantity, thin, and reddifli ; the natural ftools few and fmall, the tongue dry, and covered with a yellow mucus ^ they had fcarce any fleep, but what was turbulent, with anxiety, and not at all refrefhing ; the third was more troublefome than in the firft fpecies, and yet not fo great as might have been expeft- ed from the heat -, the patient was quickly emaciated with a pale yellow face. The paroxyfms were not fo irregular as in the firft fpecies. By bad management the tran- fition was eafy from the fecond to the third fpecies : A remarkable change of this kind it gave me pain to obferve in a weaver and his wife. Their daughter, a girl of ten years old, had laboured under the fame dif- temper ; her fymptoms were a burning heat, a very frequent and quick pulfe, with an ex- cruciating pain of the head in the time of the paroxyfm, and drowfinefs without fleep during the remifllon ; by a potion which worked upwards and downwards, by the 3 ufe

[ 10 ] .

life of diluent and acefcent drinks, and a fecond purging, ifhe was beginning to re- cover, when her father took to his bed ; upon coming to him I did not find him ex- tremely ill, I ordered a medicine to vomit and purge, and an antifeptic ptifan, four ounces of which he was to drink every hour night and day. At that time I left the city to vifit my dear mother, who was attacked with a nervous fever ; returning after three days, I found him raving, fliort-breathed, convulfed, with an inflated abdomen, and a very frequent pulfe 5 there were no eva- cuations by flool, nor of urine. Acciden- tally I perceived a potion flanding upon a table by the bedfide, and looking at it, I found it to' be the emetic medicine I had prefcribed four days before. Upon my alking the reafon of this negleft, A was told that thofe about him had judged him too weak to bear an evacuation ; laying afide at the fame time the acidulated drink, and with an intention to fupport his fl:rength as they thought, they had crammed the man, againfl his will, with flrong beef foups, fweet bread made of flour, eggs, and fugar, ftrong red winej and with a

view

[ " ]

view of promoting a fweat had given Venice treacle, with a decoflion of Scordium ; hence that number of cruel fymptoms, which made the cafe almoft defperate. But that I might not fecm to leave the patient to die, I ordered emoUient and gently cathartic clyfters to be injected every fix hours. I prefcribed alfo acefcent drink of the fame tendency, and blifters to be applied to the foles of his feet. The following night he grew more compofed, had three ftoois and made water plentifully, when we entertained fome hope -, I direfled the continuance of the fame medicines, being again obliged to go out of town. What was the confequence ? his relations, endeavouring to fupport his ftrength (his delirium rather) declining to- gether with the fever, threw afide the me- dicines a fecond time, as I learned from the apothecary, and having recourfe to I don't know what poifons, compounded under the fpecious title of Cardiacks, by a cruel death put a period on the feventh day of the dif- temper to the life of this unhappy man, who was born to more days if he had been deflitute of all help : His wife fnatched a- way by a like fate, fcarcely furvived him

three

[ 12 ]

three days. And fuch was one origin of the third fpecies, which, otherwife however, appeared to bq a diftinft dif- temper by itfelf ; for in feveral, although they made ufe of the beft remedies from the firft attack of the difeafe, and their dif- order feemed to be reftrained by them, yet on the fixth, feventh, or eighth day, all the more alarming fymptoms came on. When I had left a perfon in the evening with the hopes of a milder paroxyfm, I often found him next morning dangeroufly ill after a fevere night, with a frequent and very quick pulfe, a beginning delirium, and a flatu- lent fwelling of the abdomen, which two fymptoms diftinguifhed the third fpecies from thefecond; then the paroxyfms fcarce any longer preferved the leaft order in their attacks, but came on irregularly at all times; the pulfe became fo frequent, that the ftrokes could hardly be counted ^ there was a general fubfuljus of the tendons 3 the anxiety and reftlefriefs were without inter- miflion, the eyes fierce, twinkling and gum- my : the delirium increafing, made fome brilk, and approached almoft to a phrenzy, in others it was more calm, and refembled

[ 13 ]

a lethargy, in both cafes it was dangerous' The firil talked inceflantly, the others were filent and morofe, and made not the leaft complaint of the diftemper, tho' by hold- ing their hand frequently to their forehead, it was plain they had a violent head-ach. When the phyfician aflced how they did, they looked ftedfaftly at him and anfwer- cd in a brifk tone of voice. Very welL "^ They did not know their friends, the fla- tulent fwelling increafcd daily, efpecially a- bout the hypochondria. ' The breath grew

fliort,

^ How dangerous this kind of delirium is, befides the original diftemper, the phyficians of all ages have remarked ; for it (hews the brain to be totally obflru(ft- cd, and all fenfation depraved : The words of an emi« nent phyfician which I fhall quote here, deferve notice. If the patient be reduced 1o fv.ch ajlate as to fay I am very well, (nearly the fame as I have defcribed) vje tremble at this word alone^ he is delirious, Mcdicin. Experiment. Part I. Chap. v. p. 123.

* This fwellins: arifes from flatulencies generated bv putrefadlion, and not from an inflammation as fome would falfely imagine. This did not efcape Galen : Sometimes the Ilia are diji ended without an irfammation properly fo called. Comment, in prjEnot. text 30 Open ex Froebenedit. t. iv. p. 751. Which fpecies of inflation I would have accurately confidercd, that we may not have immediate recourfe to bleeding with the hopes of removing an inflammation, when there is none. How

much

> [ H 3 fhort, fo that they almoft conftantly pant- ed; a cough was an uncommon fymptom j their ftools were irregular, liquid, fat, col- liquative, and fometimes bilious, which was good ; often white and frothy, which was always a very bad fign \ for it implied the retention of the morbid matter, and a fpafmodvc difgrder in the motions of the inteftines. Some few however were feized with a purging at the beginning; nor did things go better with them : Nay, I faw a young woman in this diftemper, which proved fatal, who, as I was told, had been afflifted with a ferous difcharge by ftool for two months before the difeafe ; and what

much danger attends a tenfion of the Ilia from any caufe. We learn from Hippocrates ibid. § 33 & 63. Prorretic. lib. i. § 127. Inflated bellies in dangerous diftempers he numbers among the fymptoms of death, • Lib. viii. Aph. 17.

*" In dange^'ous and bilious di/femperSy very white and frothy excrements are bad. Hippocr. Prorret. lib. I. § 53. Foes p. 7f, ibid. § 21. Compare with this Gorter. medicin. Hippocr. comment, in aphor. 355,* and in Celfus there is a paffage very much to the pur- pofe. A lientery is dangerous if thejlools be frequent ; if the belly difcharge at all timesy both with noife and without it ; if it be alike in the day and the night ; if the difcharge be frude. De Medicin, lib. 11. cap. viii. p. 74. Read alfo Profper. Martian. 345. E.

ad.

[ '5 1 advantage could be obtained by thefe eva- cuations which do not carry off the mor- bid ferment ? In general a purging, which came on at the beginning, was hurtful, for it was always fymptomatic ; and altho' it was very fetid, yet it left the caufe of the difeafe untouched 5 fo that with the in- creafe of thefe evacuations, the difeafe grew worfe, to the aftonifliment of the by-ftand- ers % The urine was always crude -, in o- ther refpefts different every day, white, thin, fat ^ turbid, refembling that of cattle, red and colliquative ; if there was any cloud it always occupied the upper part, which Hippocrates condemns '. From paralytic fphinfters and the delirium, the evacuati- ons were involuntary and unperceived by

s Excellent obfervatlons concerning the Mifchief of fetid difcharges, which do not move the morbid matter, are to be found in Hippocr. de humorib. § 14. 31. Foef. 47, 48. Aph. lib. § 2. 25. lib. iv. § 2. 3. It has been obferved alfo by the famous Walcarenghi that a diarrhoea in the beginning of a bilious fever with petechias was fa- tal, towards the end falutary. Medicin, ration. Tom. i. §267.

^ fVe ought to condemn fat fuhjlances fwimm'ing near the furface tikejpiders-zvebs, for they denote colliquation, Prs« not. § 79. Foef. p. 40.

^ Ibid. § 80, and elfewhcre in many places.

them.

[ i6.] them. In five I met with purple fpots, to all whom they were mortal ^ 5 there were either no hemorrhages at all, or they w^ere fatal, no thirft, tho' the tongue was dry, black, and tremulous ; the voice was ihrill, and there was a univerfal tremour \ a ga- thering of the clothes, and catching at flies "". After the greatefl reftlefnefs came on the higheft debility, which was followed by

k When any purple or livid pujlules appear on the Jk'in^ the hypochondria being tenfe and inflated, the patient gene- rally dies, Boerhav. Aphor. 735-

* The ancients were not ignorant how much danger was to be apprehended from a tremor joined to a deli- rium. Hippocrates obferved the fame iymptoms, which appeared in our epidemic diftemper. Raving with a (brill voice and a tremulous convulfion of the tongue^ a tremh- ling voice alfo, are proofs of a very firong' delirium. Prorretic. lib. i. § 19- Fcef. 68. Tremors coming en after a violent delirium are fatal Coac. Praenot. § 88, 93,97. Trembling tongues with a black colour portend death, ibid. 223. A tremor in difeafes always fhews the debility of the vital powers ; the reafon therefore is plain why it ihould be reckoned fo bad a fign.

m Mout the motion of the hands m,y opinion is this. In acute fevers, or pains of the head, when the patients imagine fomething to be befre them, and are hunting after it, and father m^tes, or pull wool off the clothes, and catch at flraws on the wall ; all thefe are bad, and portend death, Praenot. & I- All which fymptoms this great manhad obferved \n a bilious fever. Vid. de dieb. judicat. § 3. Foef. p.

^7

death,

L 17 J

death. Sometimes, when the diftempef was difguifed in the beginning by the mildeft fymptoms, I was led to fufpe6t fome lurking mifchief from the fmall and quick pulfe, a very gentle, but uni- verfal tremor, a fudden change of the countenance, and a certain kind of anxiety and morofenefs, quite oppofite to the mildnefs of the fymptoms. I remember a man addidled to drinking, upon whom the diftemper gained ground fo fail, that he appeared even on the third day to be beyond hope, with a very bad pulfe, a fhortnefs of breath to the higheft de- gree, and a delirium ; he was relieved in a fhort time by a vomit. In this, as well as the other fpecies, the paroxyfms with regard to their vehemence, followed the form of a tertian, fo that I have al- ways obferved the fymptoms more aggra- vated every other day, and they died on the worft day, from the feventeenth to the twenty-fifth day. I know of only two perfons who died after the thirty- fifth.

C Thess

[ 1 8 ]

These are the principal and pathogno- mick fymptoms of our epdemic dlftem- per: Some varieties and more remark- able cafes 1 leave till afterv^^ards, to avoid repetition. The greateft violence of it continued from the beginning of June, to the end of October 5 feveral hov^ever were ftill feized with it in the following winter, which being rainy and warm, fa- voured epidemic difeafesj fome fcvere in- ftances I met with in fummer 1756, and fpring 1757. There is then no year altogether fo favourable, whei'e fimilar diftempers do not occur.

Of the Clafs fo which the difeafe belongs ^ and its caufe.

I have feen many febrik diftempers, and have perufed many accurate hiftories of fevers J and the more I confider the fubje6l in my own mind, the more I am perfuaded, that all primary fevers, with- out any exception, are either intermittent, inflammatory, putrid, or compounded of thefe. Nor can any objeilion to this doc- trine be drawn from that enormous ca- 1 talogue

[19]

talogiie of fevers, which has indeed re- tarded the improvement of phyfick, but has not in the leaft, by heaven's bleffing, increafed the number of difeafcs. For the very fame diftemper has been oftea diftinguiflied by different names 3 at other times, which is moftly the cafe, the name has been drawn from the fymptoms with- out any regard to the caufe, and this h^s introduced as many appellations, as there are found violent fymptoms in febrile dif- orders. While^ notwithftanding this, e- very body knows, that the fame caufe may produce innumerable fymptoms, in ap- pearance very different, according to the degree pf its violence, the variety of its feat, the peculiar conftitution of a pa^ tient, the difference of climate, feafon, an4 above all, the different methods of prac- tices and yet all thefe are to be deftroyed by the fame weapon : the words of the great Boerhaave are very much to our purpofe. It appears that thefe difeafes in- finitely various if we regard their fymptoms do not fpring from fo complex an origin, C 2 nor

[ 20 ]

nor do they require fuch a 'variety either in their remedies or method of cure. "

It is eafy to perceive that this epide- mick difeafe of Laufanne, cannot belong to the clafs either of intermittent or in- flammatory fevers, but that it v^as of the putrid kind: and our three fpecies agree very well with the triple Syneches of the antients ; one pituito-bilious, a fecond bi- lious, and the third atrabilious. For in all the patients we found the fymptoms of a putrid ferment, or as the immortal Boerhaave chufes to call it, a fpontane- ous alcali, fometimes more, fometimes lefs exalted. The origin of fuch a caco- chymy was threefold, i. A retention of the perfpirable matter, which is always of a putrefcent nature, and by the laws of the human oeconomy generally falls upon the inteftines. 2, The relicks of animal food which has a natural tendency to putrefaftion > and laftly the bile itfelf, "which of all the humours mojl quickly turns piiiridy fo that as foon as any putrefa^ion

^ Aphor. 1056.

arifes

[ 21 ]

arijes i?i the prima vic^y the bile is prefent-- ly changed °, and whenever it has become putrid, it very quickly corrupts every thing elfe. Seeing then thefe three kinds of putrefaction agree perfedly in their effefts, the difeafes produced by them may not unjuftly be termed bilious. For where any putrid humour has produced a volatile fait and caujlic oil it is called by the antients acri- moiious bile ^j and if we compare our epidemick with thofe which the beft phy- ficians have defcribed under the title of bilious fevers, v^e fliall prefently difceni the fimilarity , fuch are the hemitritei and tritophise of the antients; the mefenteric of the moderns, nay and all typhi, the lypiria, afodes, hungaric, gaftric, and the ardent fever \ all which, phyficians have C 3 with

° 111. Van Swieten § 85. T, I. p. 121.

p III. Gorter. Compend. T, 37. § 13.

*i All the antients and moft of the moderns enume- rate the caufus or ardent fever among bilious fevers ; Albert! fays that a caufus is the highefl: degree of a bilious fever. Junker, not to mention others, treats of the bilious fever and caufus in the fame chapter. But the illuflrious Boerhaave by the caufus or ardent fever, underdands a general inflammation of the mafs of blood J which I would have obferved, left it produce

an

with one confent attributed to bile ac- cumulated about the praecordia, and have cured with medicines of a quality con- trary to bile '. A bilious fever with a de- lirium, refembling ours has been even de- fcribed by Hippocrates, in his book de AffeBionib \ Several like cafes are found in his epidemics, and it will be entertain- ing to quote what we meet with in his book de Prifca Medicma. If there be an effufion of any bitter humour y which we com- monly call yellow bile^ what anxieties^ heats^ and debility enfue ? What pains and fevers ? and where acrimonious and eruginous humours prevail^ what perturbations of mind do they produce ? what Jhooting pains of the bowels and breajiy and what deprefjion of fpirits * ?

^n error in praf^ice ; for the treatment of an inflam-f matory caufus, and a bilious caufus differs widely.

"■ Some of the antients believed that a putrefaction never exifted in the vefTels, but always in the primae viae j they were perfuaded of this by the efFe6ls of a vomit, which often entirely removes a fever.

* Foes. p. 5.^.

* Foes, p. 16. In many other places Hippocrates has accurately defcribed bilious diftempers, nor does he mention any other fo frequently. See particularly Aphorifm pallim, and Galen Comment. Oper. T. 7. Pe Nat. horn, § 88 and elfewhere, Foes, p. 230. De di^b. judic. § 4, 5. Foes 57,

If

[ 23]

If wc have recourfe to the fhort but elegant defcriptions of the illuftiious Gorter, wc fhall find our difeafe entirely fimilar to thofe which he deduces from morbid bile: A morbid humour^ that is oily^ faponaceous^ Jharp^ heatings bitter ^ and oj a yellow colour^ is called bilious -y this retained in the body creates loathings naufea^ putrid belching^ a dry ajid bitter tongue^ ajixiety^ bilious dyfentery^ Jhivering^ watchi?2gs^ a jiupidity or delirium ^ head-ache^ deafnefs^ winking of the eyes^ tre- mour^ a quick or frequent pulfe^ a pungent heat ", and the want of a crijis *. The ce- lebrated Huxham to whom upon many- accounts phyfic has been fo much obliged, has thefe words. In the month oj Auguft 1 74 1, we had many putrid fevers (perhaps mefenteric) chiefly among/I the lower people and failors^ fome attended with a high phren^ zyy and thefe were by far the moji quickly fatal. Such patients moflly had their bellies

" Phyficians have always efteemed that pungent heat, the pathognomic fymptom of putrid fevers. Hippocra- tes calls thofe fevers pungent to the touch, which are produced by a putrefaction of the humours, Pallas de Febrib. cap. 30. nor is the reafon obfcure.

* Efp.ecialiy Syftem, praxeos Medic. § 130, 230.

C 4 fwelled

[24]

[welled and were coftive ; thus the morbid mat-- ter was retained in the bowels. It was par^ ticularly wonderful to obferve the great quan- tities of atrabile evacuated upwards afid downwards ^. Excellent obfervations are alfo to be found in L- Tralles his ufeful treatife on the Inutility of Abforbents ^. But the excellent F. Hoffman has in my judgment befl explained their generation, I prefume It will be altogether acceptable to quote his words. Amongjl dijlempers from bile^ corrupted and mixed with the bloody particularly fevers^ and thofe named bilious deferve to be reckoned. And though fevers themfelves generate biky yet there is no doubt that they arife alfo from corrupted bile. We have for this doctrine the authority of Hip- pocrates, For in the firjl place it cannot be difputcd^ and we find alfo the confent cj anti- quity to ity that the proper feat and origin of moft fevers efpecially intermittent ^ ardent ^ and thofe called bilious is in the firji region of the bcdyy about the pracordidy fmaller inteftines^

y Obfervat. de acre & morb. epidem. T. 2. p. 72.

» Virium quae terrcis reme4iis gratis ha£^enus ad-

fcriptae funt examen Rigorofius, c. xvii. § 88. p. 330.

cavities

[ 25 ]

cavities of the liver^ fpleen^ pancreas^ omen'- tum\ becaufe in theje parts the circulation of the blood is more JloWy impurities are ge- nerated^ and corrupt acrimonious humours JJow from the pancreas into the intefiines^ and not only excite the fpafmodico-febrile com- plai?2ts common in hypocho?idriac people, but fevers alfo : for the fyfnptoms which ufually accompany thefe fevers, begin generally in that region ^ Who is ignorant of the fymp- toms of a fpontaneous alcali pointed out by the great Boerhaave, and the excellent illuftrations of his pupil \ Among phy- ficians who have treated of epidemick dif- tempers, no body has defcribed a difeafe more like to ours than the famous Wal- carenghi, a moft fuccefsful phyfician at Cremona J it would be tedious to tran- fcribe the fymptoms ; he afcribes its caufe to the various tumults oj outrageous bile 3 and at the fame time to inteflinal and paver eatick lymph of the worji qualities, which by ad- hering to the fecerning duBs of the liver part^

» De Bile medicin. & Venen. corp. human. § 27, oper. T. 6. p. 158.

*> Aphor, 85, 86, T. I. p» 119, 120, 130.

[ 26 ]

ly the cyjiic^ partly the fides and folds of the intejiines^ and the ftomach itfelf chiefiy its lower orifice^ corrugates in various ways its fibrils ^ and forces them into violent contract tions by its ftrong irritation \ Neither will the violence of the dijlemper appear furprifng^ as the bile was predominant in it^ for this humour being from its own nature more eafily

fet in motion, more adiive and penetratingy wherever it is confined^ greatly diflends the

^arts^ and by its Jirong ebidlitions irritates ^ vellicates^ lacerates^ and excites a more ardent fever and 7nore acute painSy by forcing the component fibrils oj the folids into more vio- lent vibrations ^.

It now feems to appear very plain, from what we have advanced, that the true caufe of the epidemick diftemper at Laufanne was a putrid, alcalefcent, and bilious humour, endowed with a greater or iefs degree of acrimony, having its feat in, and irritating the ftomach, fmaller in-

' Medicin. Ration. T. I. § 52. ^ Ibid. § 154. This being true in regard to the caufe and effect, may perhaps be a little out with re-

fpcft to the manner.

teftines.

[ 27 ]

teftines, particularly the duodenum, liver, gall bladder and dufts, mefentery and the other contents of the abdomen ; and by length of time, ftrength of the difeafe, or bad management infe6ling at laft all the humours, as is manifeft from the hif- tory of the difeafe.

Examination of a dead body.

The difleftion of dead bodies, which in many cafes expofes fo clearly to view the latent caufes of diforders, was not fo ne- cefTary in our difeafe, where there was no doubt concerning the caufe ; and this in- deed was lucky J for to the irreparable lofs of phyfick and mankind, there are few, who are fo far fuperior to erroneous prejudices as to admit of it. I fhall brief- ly relate, what appeared at the only op- portunity which was given, as I had it from that ingenious phyfician my friend and coUegue D. J. D'Apples, for I was then abfent. The body was that of a man of forty years old, whom we had jointly attended for fome time in this dreadful diftemper, till about the 24th day,

he

he was delivered by his relations into the hands of a quack; who harraffed him with the moft violent draftic mercurial medicines, under the title of an infallible panacea, and bhlrers till he killed him ; I fhall add fome remarks of my own to the relation of this cafe, i . T'/6^ external Jkin was lividy upon moving the body there was a great difcharge of blood from the ulcer ^ which the bUftering plaifters had produced in his back. In the thighs and legs were red fpots and purulent humours like boyls. The colour of the fkin, the hemorrhage and red fpots prove a compleat colliquation of the blood. And indeed blifters were a very bad ap- plication at the end of a bilious difeafe, when the machine was already falling to pieces by a putrid difTolution. The ufe of mercurial remedies was not more proper, whofe tendency is to diffolve and putrify every thing; but what then! Folly is in- feparable from the character of a quack : the purulent tumours (hall be taken notice of afterwards. 2. There was a flight ecchy* mofis in the teguments and mufcles of the ab- domen on the right fide ^ below the navel. This coincides with the firft article, 3. The fat

was

[ 29 ]

was yellow and tinged with bile in every part of the body. This fhews the efFufion of the bile every where, and a total corrup- tion of the fat. 4. I'he liver and fpleen were joundy the gall bladder turgid with a great quantity of bile^ the mefenteric glands nvtre enlarged and oj a reddijh yellow colour , the ftomacb was diflended^ and as it were di- vided into two bagSy jull of a black liqucr^ the intefiines were inflated^ but they were not opened. This article contains feveral things, which give light into the caufe of the dif- temper. Opening the intefiines w^ould probably have diCcovered an injury in the duodenum, for that was generally the principal feat of the diftemper. The di- vifion of the ftomach into two bags occurs lb frequently, that it can hardly be placed among the morbid alterations. Several other obfervations, very judicioufly and accurately made upon the contents of the thorax and head, I Ihall entirely omit, be- caufe they do not in the leaft illuftrate the nature of the difeafe. If any body fhould wonder that the parts about the praecordia

were

[ 30 ]

were not found in a worfe ftate, let him attend to the words of the famous J. A. Borelli in that epiftle, where he relates ta the celebrated Malpighi the hiftory of an epidemic fever, refembling our bilious one, which raged at Pifa in the year 1661. In four bodieSy at the dijje^lion of which I was prefenty there was no remarkable injury to be feen in the lungs^ excepting a drynefs produced perhaps by the heat of the fever 3 in other re^ fpc5ls they appeared found. The mefentery in like mamie'r and its glands were neither putrid nor corrupted as was fufpedled. The fubftance of the liver alfo and fpleen was not in the leaf tainted. The gall bladder was remarkably turgid (did this happen from the fpafmodic conftridlion of the bilary du5ls) and bejides in the jiomach there jk ate d a bilious humour ^ and in fome the intefiines were tinged with a yeU low colour I. From the obfervations upon fevers in that immenfe coUeftion of the difledions of dead bodies, long ago pub- IHhed by Bonetus it is eafily feen, that in very many cafes the morbid appearance

« Vid. Malpighi oper. pofthum, 410/1700. p, 27. and fqq,

. afligned

[ 3^

afllgned for the caufe of the difeafe was evej-y way inadequate to the produ6lion of it, and that the true one was not difcovered, becaufe hardly perceptible. Nor will this appear ftrange to any body who knows, 1. The fenfibility and irritability of the whole inteftinal fyftem. 2. How very dif- ficult it is to difcover the morbid altera- tions of the humours, which fcldom fall under the cognizance of our fenfes. 3. What confiderable changes in refpecl of the tenfion of the fibres, and the place of the fluids follow upon death. 4. With what violence, a caufe,, fcaRely difcernible to the external fenfes, may aft upon a liv- ing body, if it be in contaft with denu- dated nerves or mufcles. 5. In fine, how quickly a period may be put to life by an injury done to veflels fo minute, that they have hitherto efcaped the fight of men who have feen fo many fmall ones, Ruyfch, Morgagni, Albinus, and Haller. It muft be confeflTed however, that other obferva- tors have difcovered greater injuries in fimilar diftempers. Thus while Lancifi and Guideti examined the bowels of thofe who had died by bilious fevers, they found

the

[ 32 ]

the cyfiic bile not only become blacky but alfo fometimes concreted like pitchy frequently very fetidy and depraved in a thoufand other waySy and the liver particularly of a brownijh co^ lour ^ But let this fuffice for the caufe of the diftemperj we fhall now proceed to the cure of it.

The Method of Cure. The firft Species;

There are fome diftempers, in which if we neither fuffer the vital ftrength to ex- ceed its due bounds, nor grow deficient, and prefcribe a proper diet, the morbid matter is fpontaneoufly concocted, and af- ter that expelled by a natural crifis. Such are all true inflammatory difeafes, in which even now as well as in the days of Hip- pocrates, any perfon will obferve a regular order in their crifes, if he have learned their nature and method of cure from Hippocrates, and will neither rafhly nor improperly raife any commotion, or force

*■ Bianchi Hiftor. hepat. Part III. p. 231.

any

[ 33 ]

any evacuation, but will be content with the mildeft diluents alone, applied in all forms ; beginning at firft with bleeding, if it be neceflaiy, which is feldom the cafe; and not be follicitous to expel, by vomit- ing, purging, urine, or the more fubtile outlets of the body, the cutaneous pores, the phlogiftic blood obftrufted in the brain, breaft, or other vifcera : nor attempt to re- folve the humours infpiflated by thebrifker vibrations of the fohds, by thofe acrimo- nious folvents, which irritate the fibres to new motions. I have often with pleafure admired thefe critical changes appearing at the prefixed time, and not varying in the leaft from that feries, which has been point- ed out by the parent of phyfick. But I muft confefs, I never obferved them, unlefs both I and the patient remained inadlive. And I frequently did fo, being v/ell afllired, that fometimes the beft remedy is to make no attempts by medicine ^ But this would not always prove fuccefsful, nor would it have fucceeded in our dillempcrj for re-

2 Hippocr. de Articul. Wife men are not ignorant

what it is to be ina»Slive in a medical fenfe.

D peated

_ [ 34 ]

peated experience has taught us never to expe6l a crifis in putrid, eryfipelatous, and malignant fevers. In the cure of mefenteric fever Sy I have often feen^ fays Baglivi, that it 'was to no purpofe to attend to the critical days their influence and power ^: and Junker has obferved, that bilious fevers ?7iay be re^ f erred to thofe kinds of diforders in which the power of nature herfelf is obliged in fome mea^ fure to yield to art \ It is as I ah'eady faid an inflammatory difpofition, which being gradually fubdued by mild dilution and a continued moderate aftion of the vital powers, is fpontaneouily evacuated ; on the contrary, the fuel of putrid fevers becoming continually more pernicious by the action of the vital powers, and procefs of time, produces daily more dreadful fymptoms, unlefs art fupply what is deficient in na- ture; for it is neceflary to procure thofe evacuations, which in inflammatory cafes follow fpontaneoufly. Whence then arifes. this difference? whether from the different ftrufture of the parts affefted ? or from the

* Prax. Med. L. I. de febrib. malig. & mefent. p. m. 52.

^ Conrpsdl. Medij:. theoret. pra6t. tab. 62. p. 510.

different

I 35 ]

different nature of the morbid matter ; or iaftly from this, that the a6lion of the nerves is totally depraved by the putrified humours? Indeed he who deduces this difference from thefe caufes conjun6lly, is, in my opinion, not greatly miftaken. But of thefe perhaps I fliall treat more copioufly elfe where.

The caufe, we have mentioned, pointed out two indications, either to correft the putrid ferment, that is, to change its quality fo, as to prevent its being noxious ; or to evacuate it; Jor corrupted bile ^ accumulated about the prcecordia^ brings on dreadful fevers y which are never to be cured unlefs that putvid ferment can be removed ^, An alterative method is fufficient, when the morbid mat- ter being fmall in quantity, is only hurtful by its acrimony; thus in the difeafes of in- fants arifing from an acid, abforbents are the beft cure. But this was not our cafe, for the morbid humour was prejudicial both by its acrimony and quantity. Any evacuation is fufficient, if by it the caufe

^ Van Sw'eten, § 99. T. I. p. 141.

D 2 of

[ 36 ] .

of the diftemper can be entirely and at once difcharged, which was impoffible in our difeafe, while all the humours lodged in moft of the abdominal vifcera beyond the laws of the circulation were infefted by the morbid taint. It behoved the phyfician therefore conftantly to endeavour to alter the quality of the morbid matter in fuch a manner, that if he could not entirely de- ftroy its deleterious quality, he might at leaft weaken it much ; and as foon as it be- came capable of motion, evacuate it. For the principal remedy in this fever is a timely evaciiatioji of the caufiic bile, for the confe^ quence of that is, that the violence of the fe^ ver abates ; on the other hand there is a very great danger in delaying this excretion ^ Ace- fcent drinks were fufficient for the altera- tive indication. There was no room to hefitate concerning the particular kind of

^ Mich. AJberti Praxis Univerfal. itdi, ix. cap. vi. § 4. I would obferve that this good man has fcveral ufeful cautions concerning bilious fevers, and at the iimz time many grofs errors arifmg from the fyftem about the corruption of bile, which he believes to be acid, when the truth is, acids totally deftroy it; the fame error attends the dodrine of all the antient Stah- Itans, which is worth remembring.

evacuation,

[ 37 1

evacuation; that was undoubtedly the bcft? which operating both upwarcs and down- wards, evacuated in two ways at once. Nature pointed it out, and Hippocrates had even taught, that bihous difeafes are not to be cured but by carrying off the bile by vomiting and purging '". The loathing and naufea abundantly demonftrated the bad condition of the ftomach; nor was vomiting ferviceable only by evacuating, but it was alfo very iifeful from the con- cuffion which it gave to the abdominal vif- cera; for by thefe m.eans the morbid mat- ter impacted in the folds of the inteftines is attenuated, diffolved, and fqueezed out. T'he very adlion of vomiting alfo, fays Hux- ham, whom I have already commended, and in whofe praife I can never exceed, is apt to open obftruBions even in the inmofl re- cejjes of the body\ attenuates all the humours^ and promotes all the fecretions\ and idhilji the liomach loaded either with an acid mucus or bilious colluvies^ hath almojl quite lojl its tone^ like an inert bag imbued with a putrid jerment^

" Ardent fevers are not removed but by vomiting and purging bile. Praenot. § 120. Confer. Bagliv. libj citat. p. 56, 57.

D X it

[ 38 ]

it corrupts every thing which is put inp ity and conti?2ually foments the difeafe till it is thoroughly cleanfed ". Vomits are con- fidered in the fame light by many otherSj, the following, men of charader in the pro- feflion, Fernelius, Riverius °, Friend % Boerhaave \ Ludwig'. The words of Fer- nelius in particular excellently illuftrate our prefent doclrine. Eafy moderate vomit- ing is very falutary^ and the mofi eligible of all evacuations^ for it forces out and evacuates the noxious humours unmixed from their very fources'y every kind of filth in the cavity or coats of the flomach^ it peculiarly cleajifes away y draws out from the membranes of the prcecor- diay the cavities of the liver and fpleen, and from the pancreas all kinds of redundant hur- mours without any mixture \ which for the mofi part neither hiera picra^ nor any other the mojl violent remedy^ even frequently re-

" Obferv. de Aer & morb. epidem. T. I. p. 21, 23, 25.

° inftitut, lib, 5. P. I. Se£l:. 2. cap. iv. p. m. 131.

P Com. de Febrib. No. iv. p. m. 19.

5 Aphor. 1244.

'^ Inftit. § J54I5 42.

peated^

[ 39 ]

peated^ is able to force downivards by flool \ How neceflary evacuations are in thefe dif- tenipers all antiquity acknowledges, and above 2000 years ago Hippocrates has pre- fcribed them ', and after him Galen, and all the reft; particularly in the 4th cen- tury' Alexander Trallianus ". The mo- derns have adopted a like method of cure. Borelli obferves that no body efcaped but after an evacuation of bile ""^ which how- ever he did not attempt to promote by a vomit, which gave occafion to the follow- ing judicious refleSlion of the ingenious Glafs, / cannot but wonder^ fays he, that Malpighi and Borelli never thought of dijlodg- ing the bile and evacuating it from the Jlo^ mach by a vomit ^ when they were fat isficd that the ivloole of the diforder refded in the bile. Surely it is fair to conclude from the hifiory

' De Morb. eorumque cauf. lib. iii. cap. 3. oper. om. p. m. 210.

* /fs long as the bile continues within^ is not conco^ed nor cor remedy neither the pains nor fever can by any art be rem(.med, De Prifca Mediclna, cap. 35. Foes, p. 16. Confer. Foes, p. 396, 473, 489, 519, 534, 547, 1139^ 1152.

" 'De Arte Medic, lib. vii. cap. xvi,

"" Loc. citat. confer. Bianchi hiftor. hepat. p. 282, 702.

D 4 of

[ 40 ]

of the difeafe that many perified for want of it ^. The illuftrious Hoffman has two in- dications ^ to cleanfe the primae viae, and obtund the bile ^. What particular me- thod, in conformity to thefe principles, I followed in each fpecies I muft now relate.

All the fick had been ill for feveral days before they fent for a phyfician, fo that I often prefcribed a vomit at my firft vifit ; it operated v/ell enough, yet did not always anfwer my wifhes ; for the evacuations were not fufficient in quantity, nor were the anxiety and naufea removed; and three or four times when the fever firft began to grow epidemick, it was neceflary to pre- fcribe'a fecond dofe after an interval of fome days, which was not the cafe after- wards \ for when I was confidering with myfelf the caufe of this phaenomenon, I received fome light from Hippocrates's doc- trine of concoftion, and the following ju- dicious obfervation of Van S wieten. I well

y Comment de febrib, 7. p. 116. Read alfo the in- genious Grainger's Hiftor, febr. Anom. Batav p. 73.

* De duoden. mult. morb. caufa § 20. oper. T. 6. J). 194.

remem-

[ 41 ]

remember^ fays he, when after a mojl i^tGlent hotjiimmer, bilious fevers were epidemical and attended with a troublefome nanfea^ and an aU moji conflant vomitings that I fometimes gave a vomit immediately^ without any relief-, but when for one or two days 1 had made ufe of cxymel or fuch like medicijies^ diluted with a large portion of water, the corrupted bile was frequently evacuated by a fpontaneous vomiting, infpijjated almoji like glue-, or it was eafily ex- pelled by a gentle emetick given afecond time *. Paying no regard therefore to the trifling objeftions of fome moderns, I appUed my- felf to forward the concoftion. That we may the better underftand what concoc- tion in a bihous difeafe is, I fliall make fome obfervations concerning concoftion and turgefcence in general.

Concoction in difeafes, for we don't treat here of the a£tion of the ftomach, ought to be reckoned of two kinds -, the one refpcfts a mitigation, and the other an evacuation ; for it is fometimes fufficient to correct the noxious quaUties of the mor-

a § 644, 1. 2. p. 225.

bid

[ 42 1 bid humour; then it is faid to be concoct- ed, although no evacuation follow; nay fuch a conco6tion often renders the hu- mour unfit for an evacuation^ to thisclafs belongs concoction in difeafes of the folids. Again, a conco6tion refpeftirig an evacua- tion is alfo of two kinds; for fometimes it is necefTary to attenuate and render fit for motion, the morbid matter, when it is grofs, glutinous, and tenacious, before it is fafe to attempt its expulfion; and while the humour is thus diffolved, an acrimony is frequently generated, whence it appears, that a concoftion in refpecl of the difeafe, is really different from that towards eva- cuation. On the contrary, we more often find the morbid humours fo aftive and acrimonious, that we mufl forbeai' evacu- ants as w^e would avoid poifon, left by railing even the moft flight irritation, they become ungovernable, and being impelled every where with the greateft violence, bring on quickly irreparable miichiefs. In fuch circumftances their acrimony is to be mitigated, and their tendency to motion reftrained ; this fpecies of concoftion for evacuation, refembles that in refpeft of a

difeafe.

[ 43 ]

difcafe. The firfl: kind of crudity may be called a crudity below evacuation j the fecond a crudity above evacuation.

TuRGESCENCE IS Ukcwife of two kinds, one refpefls quantity, and the other mo- tion. The humours are turgid, whether crude or concocted, if by their quantity they impede either all, or only fome of the animal fun6lions; they are alfo faid to be turgid, and that in refpeft of motion, when by their acrimony and aftivity they violent- ly ftimulate the parts, and caufe irregular motions, even though their quantity be fmall^

From the few particulars with which Hippocrates was acquainted, and which diligent obfervation has confirmed, it is eafy to perceive that the humours in our firft fpecies, were turgid principally by their quantity, and were in the ftate of crudity

^ The celebrated GJafs defines turgefcent matter as pmething iroublefome Jlagnating in the prima via, which may be dif charged either upwards or downwards, and which frequently Jiirnulates the Jlomach or intejiines to its own ex- puljion. Comment, de febrib. 7. p. 102.

below

[ 44 ] below evacuation \ I was obliged then to ren- der them fluid and fit for motion before evacuation; unlefs there was the higheft turgefcency which was feldom the cafe; I attempted this by the ufe of attenuating and antifeptic remedies of the clafs of thofe called digeftives ", and this was generally

• Digeftives are thofe medicines, by the proper figni- fication of the word, which affift the a6lion of the fto- mach in the conco61ion of the aliments j and as this word is ufed in two fenfes, thence alfo they ha\e called thofe medicines digeflives which promote the concoc- tion of morbid humours ; and not improperly indeed ; but as they confidered only the erudite below evacuation^ they have confined the clafs of digefi:ives to faline, at- tenuatirig and pungent medicines, or ufelefs abforbents, which is certainly a great error, for there are as many claffes of digeftives, as there are fpecies of crudity ; and in a crudity ab:ve evacuation there are no other kind of digeftives, but fuch as have the power of condenfing, fheathing, and reftringing, as will appear afterwards, and was well known to Hippocrates ; for his doctrine concerning conco6tion was, that the morbid humour ftiould have fuch an aptitude for motion, as to yield eafily to e vacua nts., and yet not to exceed in that fo, that any mifchief could follow from its ebullition. Ga- len is tK'try v/here of the fame opinion j he concodled the bilious humcmr v;ith cold water, and the pituitous with pepper. Method. Medend. L. II. Ad Glaucon. Lib. IJ. De Sanitat. tucnd. Lib. IV. Sennertus has alfo fome valuable obfervations on the fame fubjeft, though defpifed by moft of the moderns, de febrib. Lib. II. c. vii.

the

C 45 ]

the form of the prefciiptlon, that they fliould take a paper of powders every three hours, and drink after it four ounces of a decoftion. The powder was compofcd of Tartar, regenerat. tartar, vitriolat. crem. tartar, and other things of a hke tendency; I frequently alfo prefcribed the Sulphur Aurat. Antimon. prepared in Untzer's method, and mixed with fugar and one of the fore- mentioned falts, which fucceeded very well. The decodion was made from the roots of grafs, forrel, wild fuccory, or the leaves of maidenhair with tartar, re- generat. or oxymel fimpl. fome flices of frefh citron peel correft very well the naufeous tafte of the grafs, and are, for that reafon, not to be omitted, if we do not add the oxymel. Where the form of an eleftuary was more agreeable, it confid- ed of the acefcent preferves of forrel, wood forrel, the liquid extraft of dandelion, and fome neutral or acid fait ; for the propor- tions of the compound were alv/ays di- refted by the fymptoms, which indicated the greater or lefs exaltation of the bile or the degrees of vifcidity. If after two, three, or four days, the fhivering grew

j milder.

1 46 ]

milder, the covering upon the tongue lefs tenacious, the urine turbid, the belchings fetid, and the naufea frequent ^ if there were wind and rumbling in the bowels, and the ftools were more copious, it appeared, that the humour had obtained an aptitude for motion; and I then prefcribed an emetick potion. At firft for fome time, I ufed Ipecacuan, but I prefently found that this celebrated root had not in this cafe fuf- ficient force ; it had befides this bad pro- perty, that after the evacuation was over, it left the patient coflive and fometimes thirfty; I was therefore glad to change it for the emetick tartar, which I hardly ever drop'd after that: the dofe, being pro- portioned to the age and other indications, was diffolved in eight or ten ounces of water, with an addition of a fixth part of fyrup of Capillaire. I direfted the whole to be drank at two, three, or four draughts 3 and this method of dividing the potion fucceeded happily in fo great a variety of fick people as I attended, the generaUty of whole particular conftitutions, I was till then entirely unacquainted with. And I particularly remember that a noble foreign- er.

[ 47 ]

er, whom I had ordered to drink a fourth part of the medicine every half hour, after the firft draught, was with great faciUty for two hours with a continued ftream almofl, purged both upwards and downwards, and his health reftored in a fliort time; now this patient would undoubtedly have fuf- fered a violent fuperpurgation, if he had taken the whole dofe at once, as it is often prefcribed. There was another advantage attending this medicine, that being pala- table it was not in the leaft naufeous, even to children and more delicate people. I fometimes made an addition of manna, though the folution of tartar alone feldom failed to procure ftools, which I always reckoned of great importance; for befides, that in this way the much larger quantity of morbid matter is evacuated, it is the method nature points out for difcharging the relicks of the morbid matter ^ The

^ The celebrated Pringle has made the fame obfer- ▼ations. Th^ vomits that are alfo productive of jlooh^ are the mjl ufeful^ hut efpecially if they are powerful tnough to procure a pUntiful di [charge upwards or down- wards of the corrupted bile. By this means they fometimes effect a cure, without farther medicines, Obf. on DiC- cafesof the Army, P. III. ch. IV. § 5.

3 efFe<5l

[ 48 1

efteft of the remedy was, that generally in little more than half an hour^ that is, fome time after the fecond draught, there was an inclination to retch, which was followed by vomitings and if the quantity of the difcharge was judged fufFicient, the remainder of the potion was not ufed -, if not, it vv^as drank -, the vomiting brought up vifcous matter mixed with yellow, bit- ter bile 'y then followed ftools of liquid, yellow, fetid, excrements. I often en- couraged the vomiting, by plentiful draughts of hydromel^ when it ceafed, I promoted copious ftools by giving at a fpoonful each time what remained of the potion diluted in a large vehicle. Thus after the evacuation was over, the patient found himfelf better, with regard to his anxiety, debility, and fleep. The fame method was followed by that celebrated praflitioner, Walcarenghi, and has been recommended to pofterity by G. E. Stahl, for the method of cure^ adequate to. the re- moval of the peccant matter in thefe fevers^ can be no other than vomiting and purging *.

• De febre biliofa, § 46.

«

And

[49]

And I can truly fay that I have very often feen one vomit accomplifh, what repeated purges have failed in. I remember a wo- man, who, without calling a phyfician, had taken five times, at the diftance of two days each, a purging draught which fhe generally made ufe of, confiding of rhubarb, Sedlitz fait, and citron, and found not the leaft benefit from it 5 but fhe was prefently relieved by a vomit.

After the firft evacuation the digeftive remedies, mentioned before, were again prefcribed; for when the conco6led mat- ter was expelled, it was requifite to matu- rate what continued crude; and I never failed to obferve, tliat thofe medicines, which before had hardly proved cathartic, having their force encreafed by the dimi- nution of the morbid matter, produced at this time two or three flools every day, al- ways of a putrid nature. The languor was gradually diminiihed, and alfo the length of the paroxyfm. After three or four days, if a'plentiful difcharge of urine afforded the figns of a concoftion, we had recourfe to purging by falts, manna, E tamarinds,

[ 50 ]

tamarinds, and now and then a fmall dofe of fenna. Sometimes when there was reafon to expe6l that ftools would be eafily procured, it fufficed to diflblve two ounces of manna with fome fait in their com- mon drink in the morning -, and a copious difcharge of excrements following from that, there fcarcely remained the form of a paroxyfm; the Ikin grew foft, their fleep became compofed^ they no longer loathed their food, though they had not yet any defire for it. The natural heat was more flowly reftored, and they were almoft always cold. Then they took only a dofe or two of their medicines every day; all the fymp- toms went off gradually, the bilious ftools which were fo falutary ftill continued, and both evacuated the morbid matter, and fliewed that the vifcera recovered their tone; for it was with us, as the famous Galla- rotti obferved it to be at Cremona, we could jafely hope for a compleat terminatioji of the fever ^ only while the ftools continued bili- ous ^ And indeed if we fell fhort of this

® happy

*■ MeihoL Aur, fehr, profllgand. De febr. tertian, ^c. § 17. A ufeful treatife to be found at the c*d of

Wal-

[5x ]

happy appearance, I was obliged both to give the digeftives longer, and in a larger dofe, and to repeat the cathartic a third time, nay fometimes, but very rarely, a fourth time. I don t remember an inftance of a fifth purging being ufed. In lax con- ftitutions, which laboured more under a vifcofity than acrimony, I fometimes avoid- ed aqueous liquors after the firfl purging, and ordered a potion compofed of a large dofe of tartar, regenerate a fmall quantity of Elixir proprietat. with the diftilled waters of Succory and Citron-peel, and compound fyrrup of Succory, adding Oxy- mel, when the circumftances required it.

I did not in all cafes prefcribe a vomit, for there were fome patients, in whom I found contra-indications to forbid it ; but then before the catharticks properly fo called were given, it was neceffary to con-

Walcarenghi. How little to be trufted a mitigation of the fymptoms is in ardent bilious fevers as long as there are no bilious ftools, we may learn from the cafe of Herophytus, who laboured under fuch a diftemper with various remiffions till after the hundredth day, when he had great plenty of bilious ftools. De morb. vulg« Lit). J. § 3. agr. 9. Foes 1 106. .

E 2 tinue

[ 52 ]

tmue the digeftives for a loiigei Tie. For thofe who were purged too icon vvithcut a previous vomit, generally fuifered for it. I was inclined to order the emetick tartar to a venerable man, who was ill, on the fixth day of the diftemper (for I had not been called at the beginning) but the method be- ing changed by the advice of another phy- fician, the patient took a purging medicine; the difeafe proved tedious, and was follow- ed by pains of the ftomach, and a mucous dyfentery in Autumn, which I do not re- member to have happened to any of thofe, who took a vomit and were properly treated after it.

They who refufed medicines, and after the firft vomit laid afide all remedies unlefs perhaps toad: and water or lemonade, of whom there were many, having the morbid matter leflened by means of the diet, which their loathing directed them to, gradually got the better of the fever indeed, but they recovered their health flowly, and imper- feftly; and feveral of them w^ere obliged after fome months to have recourfe to me- dicines, but of thefe afterwards. I thrice

obferved

[ 53 ]

obfcrved in younger people that fymptom, which Sydenham mentions ^ to wit, a tu- mid abdomen, when the diftemper was go- ing otr favourably at Laufanne as ar Lon- don; bat our patients complained of an increafe of pain upon touching the tegu- ments, which was not the cafe in London.

If it was dangerous to give over evacu- ations too foon, it was alfo dangerous to continue them too long; and a man would be mifcrably deceived, if he imagined they were to be perfilted in, till the appetite and flrength were entirely reftored. The inap- petency and debility arofe in the beginning of the diftemper from the cacochymy op- preffing the ftomach and primas viae; and now at the end of the difeafe they were ovvmg to a laxity of the fibres, the languor of the fecretions, and a defeat of good juices in the body. We muft therefore here attend to the caution of Boerhaave, what does good at one titne^ may yet be hurtful^ if given at another y though in the fame difemper ^,

« Oper. Se6t. I. cap. V. p. m. 60. * Aphorifm 849.

and

[ 54 ]

and we had a fad proof of this by experi- ence. For while fome continued the open- ing medicines with a view of difcharging the morbid matter, which they blamed for thefe complaints, I have feen the difeafe protraded, the debility increafed j and the excefijve irritation of the gaflric and intef- tinal nerves followed by the whole train of irregular fpafmodick fymptoms. Thefe I never obferved, if the catharticks were dif- mifTed in proper time, and a fuitable diet with exercife in the country, and fome ftrengthening medicines were made ufe of. An infufion of bitters in wine was taken with great fuccefs. Sydenham in a like cafe ufed opiates \ but I thought it more

* De Nov. febr. ingrefTu, p. m. 367. In many cafes where the cure ts wholly performed by evacuations ^ if we perfijl too chjiinately in thetriy till fuch time as we have removed all the fymptoms^ ue more frequently kill than cure our patient^ &c. and no wonder j an appetite is the fun(flion of a vigorous ftomach, which is never found, where that is weak and languid ; while then the appetite is deficient, the digeftion muft be fo too; nor will cathartics, fo deftru£tive to the flrength of the flomach create one. This I would have attended to by thofe, who immediately draw indications of eva- cuating from a loathing, naufea, anxiety, diarrhea, and Lentery j and thus make bad worfe.

X cautious

C 55 ]

cautious to abftain from them^ fo'r they are hurtful in a debility, and are but a bad cure for tumultuous commotions.

The fecond Species.

In the fecond fpecies the vifcofity of the morbid matter was lefs, but its tendency to motion greater; evacuations fucceeded more eafily, and it was often proper to make them at firft; for there was fome- times danger in a delay. At other times however, it did good to give the diluent digeftives with hydromel acidulated for twenty-four hours. If there was reafon to fufpeft a great degree of acrimony from the troublefome heat, thirft, wandering pains of the bowels, and the urine, I add- ed to the folution of emetick tartar, pulp of Cadia, or citron-juice, inftead of the capillaire. For the firft days frequently, before a vomit was given, fcarce any time of remiflion could be obferved; afterwards the appearances were much changed for the better. A fervant maid of about fix or eight and twenty years old, of a good conftitution, after fhe had been extremely E 4 cold

[56 ]

cold with a trembling for fome hours, was feized with a violent head-ach, a quick r and contrafted pulfe, a burning heat in the fkin, frequent naufea, third, paucity of urine, and coftivenefs; an apothecary be- ing fent for prefcribes a cathartick, nitrous powders, emulfions, and bathing the feet in warm water, but all to no purpqfe, the violence of the diftemper does not in the leafl abate : On the fifth day I vifited the patient, and ordered her emetick tartar with twenty ounces of water, and two of citron- juice. Of this fhe was to drink three ounces every quarter of an hour j fhe difcharged an immenfe quantity of excre- mentitious matter upwards and downwards > the following night fhe flept ; on the fixth day her pulfe was fofter, higher and lefs frequent j Ihe had only a flight head-ach, and her thirfl was gone, fhe had then a remiflion; in the evening the paroxyfm re- turned. On the feventh, the former draught with half the quantity of tartar, and (kank at longer intervals, procured fe- veral flools, the evening paroxyfm was milder; on the eighth and ninth day fhe took only lemonade, and on the ninth had

C 57 ]

a clyfterj on the tenth the purging ptifan o-iven on the feventh was repeated, and flie mifs'd the paroxyfm. On the eleventh, twelfth, and thirteenth days, every thing went on profperoufly ; lemonade was all that file required; her ftools were bilious, a fure fign of returning health. And now file had the uncommon good fortune to recover her appetite, which however fhe indulged t^o much; the confequence of which was, that on the night of the thir- teenth day, the fever recurred, with a pun- gent heat, and violent head-ach, which continued for a whole night and day ; up- on the remiffion of the paroxyfm, I gave her manna with tamarinds, flie recovered very well, and more quickly than any other perfon.

For the mofl: part, after the firfl evacu- ation I feldom prefcribed any thing elfe, except ftrong lemonade, or a decoftion of the roots of quick grafs, with an addition of the expreffed juices of common forrel or wood forrel; for the juices of citron and forrel refijl futrefadlion^ are of peculiar eji^ cacy tojirengtben the hearty corre^ the febrile

heat'y

[58]

beat', and pojfefs an cpening quality ^. They drank this or fuch like liquors to the quan- tity of two ounces every half hour or oft- ner, for I never approved of giving lick people plentiful draughts at long intervals. The method of drinking frequently and little at a time, was highly approved by the antients^ and after falling into difufe, for what reafon I cannot tell, was reftored by fome excellent phyficians of the fix- teenth and fcventeenth century, and Boer- haave eftablifhed the pra6tice upon folid principles j 'tis worth while to read his il- luftrious commentator ^ upon the advan- tage of this method. Such as refufed the drinks mentioned before, received benefit from barley water mixed with fyrrup of rafberries, or acid cherries. In fine all

^ Sennert. de fehrlb. Lib. ii. cap. vii. p. 221. You'll find in the fame place what's worth obfervation, that jomei.mei the putrefa5i'ion and hiat vc ere predominant^ at other times other diforders. In the firft cafe I ufed citron juice, in the fecond preparations of forrel.

^ § 640 t. 2. p. 215. Albcrti treating particularly of the bilious fever, fays. Let the quantity of drink be fufficicnt^ only not given in large draughts^ "'tis bejl to fuck it iuy or take it by a fpoonful at a time, but to repeat it frequently. Prax. gener. Lib. ix. cap, vi. § 9 and 25.

acid

[59]

acid drinks, that were not too emollient, anfwered extremely well. Of this kind the beft is prepared from the juice of fummer fruits with water and fugar ; nor do I know a more excellent remedy in all bilious, nay and inflammatory diftempers than the fa- pcnaceous acid juices of mulberries, bram- ble berries, rafberries, currants, ftrawber- ries, cherries, and grapes too, provided they are not too ripe; their virtues are the fame, as all acefcents, they corre6l every kind of putrefaftion, and by their fapo- naceous quality refolve all bilious and in- flammatory concretions, and promote all the fecretions; nor do they relax the folids too much, for they even polTefs, from their grateful flavour, and fragrant odour, a cardiac virtue. The juice of ripe fruits re^ quires no preparation^ removes thirfl^ allays heat, promotes urine and fiools, and affords the highejl cordial to the ftomoch laiiguijloing from putrid bile ™. In the month of July 1756, I cured an amiable young lady, who was very ill, by the ufe of cherries and fome opening medicines. Neither in

» Van Swieten, § 88. t. I. p. 126.

this

r 60 ]

this do I boafi: of any new invention; even antiquity proclaims tiie falutary effecls of fruits, and w^h at wonder ! when pcnbns in fevers are taught nothing more plainly by a falutary inftin6l. Alexander of Tralies has in many places given excellent rules for their ufe, fcarce to be equalled among the moderns. 'Tis true indeed there lived in Iiis time, and before him a peftilent race of men, who found fault with every thing that was laudable, as appears from a pafTage of the fame author"; nor were there wanting afterwards phyficlans of great charader, who declared againfl: them, from the moil trifling reafons; the only one which deferves confideration, is drawn from the aphorifms of Sanctorius, for he fome- where ° mentions melons, figs, and grapes as obftrufting perfpiration. The anfwer to this is obvious; fruits have not the fame effect on every body, and I would be far from recommending them to all; for as they afford an acid water to the body, they hurt all thofe, whofe ftomach is opprefTed

■ De Arte Medica, Lib. xii, cap. vi.

* Aledicin. Stat. Lib. IIL Aphor. 25, 27,

with

[ 6I ]

with an acid, vvhofe blood Is thiri) fibres too lax, and nerves langviid; by cherifhing the caufes of the diforder they undoubted- ly do great mifchicf, diflurb the fecretions and excretions, interrupt perfpiration, in- creafe the acid acrimony, and I have more than once feen the ufe of them followed by dyfuries, itchings, and wandring pains. But if the circumftances be changed, their effefts alfo vary^ and while in bilious cafes they remove the caufe of the diftemper, by reftoring health, they reftore alfo its func- tions, and among the reft peri'piration too. Boerhaave the reftorer of fo many good remedies recalled into the praflice of phy- lick, not without the clamours of envious ignorance, the ufe of fruits, which had been laid afide ^ Nor have I forgot that while I attended the forementioned young lady, a clamour was railed, which could be filenced only by the fuccefsful events A ftudent at Leyden was ieized v;ith fo great a ftupor night and day, that even when he was playing at billiards, he would often fall afleep; there are fome phyficians, vvho

' Van SAieten, ibi«l.

w^ould

[ 62 ]

would have ordered him vomits, fmart purges, ftirnulants, viper-broth, and things of a like nature ; he went to Boerhaave j that great man prefcribes cherries for his food, to the quantity of ten pounds and upwards in the day, and nothing elfe, with lan intention no doubt, of fubduing the phlogiftick denfity of his blood, the caufe of his diftemper; the worthy young man found himfelf better^ and a fhort time af- ter he pafled in great plenty turbid and thick urine with a fediment, and perfeftly recovered his health \

After the vomit, if I found by a care- ful examination of the fymptoms, by the ftate of the abdomen and the excretions, that the remaining part of the morbid matter was not very fit for motion, I or- dered no evacuating medicine but a clyfter in cafe the patient had not a ftool each day, and in this method I perfifted for four days } after which I gave a potion with ta-

q This truly ufeful obfervation communicated by the patient himfelf, and not extant either in the works of Boerhaave, or his pupils, I thought would be acceptable to every body.

marlnds.

[63]

marinds, manna, and tartar, regenerat. to the better fort of people, with a decodion of grafs and an acid fyrrup. This d'lC- charged plenty of fetid matter, and the more the better, for the fymptoms remitted, and there often followed a perfeft inter- mifTion for fome hours, which I did not othervvife obferve before the third evacua- tion, about the eleventh or twelfth day of the diftemper. Then the acid drink was prefcribed in fmaller dofes, and the ftrength being in fome degree reftored, they were not fo rigidly confined to their fpare diet, and about the 19th or 20th day, they took their leave of medicines by the fourth dofe of purging phyfick ; the relicks of the dif- eafe were fubdued by diet and exercife; but they did not however recover their health perfectly, fooner than fix or fcven weeks ; after which time I again gave them a gen- tle cathartic, if they had indulged their appetite,

I have obferved, and no practitioner is ignorant of it, that there are fome parti- cular conftitutions, which will not yield to catharticks in a liquid form : in fuch

cafes

[ 64 ]

cafes I had recourfe to bolufles of tama- rinds, and Caffia, to which I added as a ftimulus a few grains of diagrydium. Thofe people may exclaim againft this, who learn the virtues of medicines from certain modern compilers ^ but they who are accuftomed to practice, and acquainted with the writings of the antients,, know very well that diagrydium is the beil re- medy, wherever tenacious bile is to be dif- folved and difcharged; and that Hip- pocrates never treats of the evacuation of bile without prefcribing diagrydium \ And indeed whenever I ordered it, the fuccefs was anfwerable to my wifhes, for it pro- cured bilious ftools in great plenty, with- out producing any gripes or heat.

If the morbid matter had a greater dif. pofition to motion, I then gave every two daysj or even every day, a weak purging decoction with tamarinds, to the quantity

' Confer, v. g. de Natura muliebr. Foes, p. 575. De Mo;b. Mul. ib. 642. De AiFedib. De intern. afFed. ib. ';48, 558, 560. Alex. TraJlian. Lib. vii. c. xvi. .^tius Tetrab. 3. S. 4. c. xxviii» — Galen dc <;onipof. Pharmac. Lib. IL cap. xi.

of!

[ 65 ]

of three ounces at fix, eight, and ten o* clock, nor did we ever mifs of two or three large ftools in the afternoon; by the ufe of fuch a ptifan alone I cured a patient, the hiflory of whofe difeafe I beg leave to relate, A young man of twenty and up- wards, who lived in the country, was ta- ken ill near the end of autumn; at firft the fever was continued, with exacerbations eyery day; the perfon, w4io attended him, being deceived by the regularity of its form, gave it the name of an intermittent, and firft prefcribed purges of fenna and rhu- barb, then bitters of all kinds, particularly conferve of Juniper, and Peruvian bark in a large dofe; as he grew worfe I was fent for on 'the i8th day, when I was informed that the paroxyfm came on about two or three in the afternoon, and lafted till fix next morning, with a burning heat, a vio- lent head-ach, cough and continued watch- ing. From fix in the morning to two in the afternoon, he was free from the fever, but he had an anxiety, morofenels, and loathing of food, with a quick pulfe, and a dry Ikin ; he was greatly emaciated, his cheeks were red, he coughed, was coftive,

F his

[ 66 ]

his urine red, and fmall in quantity, was extremely weak, and in danger of a con- fumption. Omitting the bitters and bark, I combated the caufe of the diftemper by evacuations only, and prefcribed four ounces of a decoftion of grafs roots, for- rel, and pulp of tamarinds, with fait of forrel and fyrrup of rafberries, to be taken four times a day. This brought on bilious (tools 5 the fecond day after this method was begun, the paroxyfm was milder; on the third he flept, had an appetite, and was eafy; in ten days he was perfedly re- covered : now this fame perfon in a fliort time would have died from an atrophy, if he had continued the bark, which, though a very falutary medicine, was in this cafe improperly adminiftered. Baglivi ', has already condemned the bark in difeafes arifing from infar6lions of the mefentery and bowels. Without doubt there is not a more excellent ftrengthener than the Pe- ruvian bark, nor any medicine of equal

» Prax. Med. Lib. I. de febrib. mefent. p. 58. dc £br. motric. fpec. tr. pofter. libr. cap. 13. p. 388. Confer, illuftr. Oofterdik Inftit. medic. pra(5l. fedt. I. cap. iv.

virtue

[ (>7 ]

Virtue to it in quieting difordered motions of the nerves; its effetts aftonifli every- body in relaxations, and irregular tumults; but w^hat can the moft powerful corrobo- rants do againft diftempers, whofe cure de- pends upon evacuations. There is a proper time for giving bitter flrcngthners in our malady, but that is never in the beginning of it.

The famous Walcarenghi employed a method of cure fimilar to ours 3 that is medicines compofed of grafs, faccory, and citron, all of the acefcent kind. There is one remedy however that he ufed fre- quently, which I never dared to make trial of, I mean oil of fweet almonds, v/hich he prefcribed after the firft evacuations, unlefs there was tenacious and vifcid bile near the bilary du5ls^ and in the inteflijies themfdves \ This great man had taken it for granted, that wherever the morbid humour flagnated^ it created a great dijlenfwn of the parts ^ irri^ tatedy pricked^ and lacerated them. That is true, but is it a juft inference from thence,

« Medicin. Rational. § 341.

F 2 that

[ 68 ]

that we muft give oily medicines? I be- lieve not 5 they have indeed the power of relaxing tenfe and rigid parts; but in the prefent cafe by increafing the ftrength of the irritating caufe, their efFeft is quite different. For fuch is their nature, that whenever there is great heat in the body, they quickly lofe their emollient and footh- ing quality, and acquire a rancid acri- mony; and thus verify the proverb of add-- ing oil to the fire. Their ufe in bilious dif- tempers is difcouraged even by the obfer- vation of Hippocrates, that thofe who abound -with jat^ generate yellow bile ". Galen in- forms us, that in his time there were feve- ral difputes about the ufe of oil, fome be- lieving it to be acrid and heating; others foothing; and this he has intimated to de- pend upon the variety of the conftitutions where it is given ''. I perceive the Italian phyficians in general are fond of oil, not- withftanding Baglivi condemned it; yet there are fome few amongft them who a- grce with him; thus Bianchi, in treating

» Epidem. Lib vi. § 6. Foes, iigo. A.

^ De Simpl. medicam. facuh. toto fecundo libro.

of

[ ^9 3

of bilious fevers, fays / have obferved that ajter taking oil of almonds in broth many peo- ple had their heat much increafed^. Prime- rofe was fufpicious of oily medicines and almonds in fevers, for fear of their ranci- dity ^, and in a v^ord the' moft celebrated pra£litioners, in diflempers attended with a great heat, are afraid of oils; for the truth of this we may appeal to Van Swie- ten \ How carefully then ought they to be avoided, when the very center of the febrile heat is the part, to which they are applied; where the putrid ferment is pre- pared to forward their corruption; when there is danger of an obflruclion in the liver, which they will promote. Lafi: year in autumn I was witnefs to the death, ra- ther than phyfician to the diftemper, of a woman who perifhed by a violent inflam- mation of the liver, which flie had brought upon herfelf by eating hardly any thing

y Hiftor. hepat. P. 3. p. 698. Vid. loc.

2 Defebrib. Lib. II. cap. ix. p. m. 143, 145.

* /iph. 35. p. 46. Acthifig is worje than any the

mildeft oil ivhin co' rupted. ^he mojl fweei oil exprefed

from a!mondi is fo cortvpttd in a few days, that from be^

ing mild, it becomes moft caujiic^ and when fivallowedy in

a manner bwns thefauces* lb. Aph. 89. p. 130.

F 3 elfe

[ 70 ]

el:e for feveral weeks except walnuts, and diinkingof coffee four times a day to re- move that load which they left on her fto- mach. I have frequently feen oils, pre- fcribed to patients neither in a putrid nor inflammatory diftemper, with a view of foothing and relaxing the irritated nerves, produce quite oppofite effefts; for they occafioned a fenfe of heat, acrimony, and pain in the bowels, deftroyed the appetite, and rendered the body coftive, both from the peculiar acrimony arifing from their rancidnefs, and alfo from their corrupting the bile, and preventing its proper opera- tion on the inteftines. Let oils therefore be rejefted wherever there is a putrefaction of the bile, heat, and relaxation ; and in other cafes let them be prefcribed with cau- tion. The art of making them into emul- fions guards againft their bad effefts and admirably preferves thdr virtues; for when cily feeds are triturated ninth water they af- ford a very foft milky liquid^ in which this fame oil is contained^ but fo much changed (by the farinaceous part no doubt) that it will not turn rancid^ but grows acid very

3 >«

[ 71 ]

foon *. And it is true that emulfions will entirely cure inflammatory diftempers ^ but in bilious cafes I found it better, a few in- ftances excepted, to refrain from them ; for though I was not afraid of their turn- ing rancid; yet when there was no hope to obtund fo great a quantity of putrid matter, it ^-as much better to give ftronger acids, which would correfl: and at the fame time attenuate it. The fii'il intention the emulfions would have anfwered with dif- ficulty, and the fecond not at all. I alfo dreaded their relaxing quality; for not- withftanding the fibres were irritated by a ftimulus, yet there was always a relaxation, which never fails to accompany putrefac- tion, highly noxious, and which the emul- fions would have increafed. For it is a fcandalous and pernicious error both here and in fome other cafes to attempt the cure of an irritation from a ftimulus by relax- ing medicines, in the fame manner, as a tenfion from rigidity \

F 4 There

^ Ibid, Aphorlfm 88. p. 127. * Junker has obferved that it is dangerous to ufe the fame method in putrid, and in inflammatory difeafes.

Confp.

[ 72 1

There is another kind of remedies in thefe dlforders very much commended, which I could not pafs over in filence with- out giving my reafons for not ufing them more frequently; I mean milk- whey, and butter-milk, ivhich by its acid favour ^ af- fords fo agreeable a?tdfalutary a remedy in all putrid difeafes ^ The firft is an excellent diluent, and vegetable foap, which I fome- times gave with tamarinds and a fmall dofe of emetic tartar, with a defign to purge j for common I very feldom prefcribed it ; i. becaufe fick people are very apt to naufeate it; 2. it relaxed too much, and I know feveral patients, who complained after it of weight in the ftomach and anxiety ; 3. the remedies mentioned before were much more efficacious, as being far more

Confp. Med. tbcor. pra£l. tab. 62. If however z perfon is obftinaiel^ addided to the ufe of emulfions, he will find a very good formula in Boerhaave's little book upon the Materia Medica. § 88. No. 5.

^ Van Swieten Aph. 88. p. 126. See alfo concern- ing the excellent virtues of this remedy, the teflimonies of thefe iiluftrious men, J. Gorter, Medicin. Hippocr. Aphor. 257. Tralles de Cholera morbo, p. 297. Pringle on camp difeafes, part. 3. chap. 3. Kloekhof hiftor. febris culenb. paffim. De Haen de deglutit. impedit. p. 47.

acefcent ;

[ 73 ]

acefcentj 4. I have more than once ob- ferved, that although its firft change be into an acid, yet it often becomes putrid foon after, and I met with fome patients, in whom after a few hours it produced fetid belchings ; but this as well as the emulfions had its ufe, if there were any- inflammatory fymptoms. Thus lafl: fpring I reftored to health a young man of a bili- ous conftitution (who in the beginning of winter had taken aftringents and great quantities of rhubarb for removing a dy- fentery) at that time extremely ill of a bi- lious fever, and a rheumatick humour fet- tled upon his diaphragm, by the continued and copious ufe of milk-whey impregnated with tamarinds, and barley-water with juices of forrel, and the greater creeping houfe-leek % fweetened with fyrrup of acid cherries, giving at the fame time clyfters j and applying blifters to the foles of the feet.

• There are feveral fpecies of houfe-leek. The fedum majus & minus ^re poflcfled of a cooling antifeptic vir- tue. The acrid houfe-leek which is antifcorbutick, is hardly to be ufed for fear of a fatal error, for which

confult

I 74 ] I was prevented from making a gene- ral ufe of butter milk, whofe virtues I found much greater in bilious diftempers, both by the common method of preparing it in this country, where it is not freed from its oil, which is very prejudicial 3 and alfo by the diftance of the places from whence it was to be brought: but by God's blefljng, we did not want fubftitutes for thefe, as appears from what has been already faid.

Ttbe third Species.

In the third fpecies the caufe was the fame as in the fecond, but more violent; the method of cure was in like manner the fame, but more violent; the evacuations were carried on in a fmiilar way, except where there was that kind of crudity above evacuation^ for then it was requifite to con-

confult the botanical authors, 111. Ludwig, Defnit, plantar. N, 613. Linnaeus Gener. plant de dodecandris po?ygyiiiis. Alio Dale's ufeful Pharmacologia, Lib. IL § 16. where he thus commends the greater houfe- leek, its principal ufe inwardly is in bilious fevers j /"/ af Jwages thirjiy and allays heat,

cocl

t 1^ ]

co6l the humours, and after conco6tion to give a vomits afterwards the body was kept open by barley water, with leaves or fait of forrel, and a very fmall quantity of red rofe leaves and tamarinds. The firft vomit was never omitted without great mifchief, the neglect being always foUov/ed by that fetid purging, which I mentioned before, and which agrees exactly with the obfer- vations of Sydenham \

With regard to drink, in the worft kind of fevers at Cremona, Walcarenghi gave juice of pomegranates, diluted in a large quantity of water, an excellent me- dicine, and commended before by the an- tients, particularly Alexander ^, and ap- proved by all phyficians; for befides its poffeffing an antifeptick virtue in an emi-

* Sc£l. I. cap. iv. p. m. 31.

« De Art Medic. Lib. vii. cap. xv. But perhaps it may be objected that the juice of pomegranates is aflrin- gent ; is it then fit to give aftringents in fuch a diforder ? No perfon who is well acquainted with the theory of his art, can be ignorant of the proper anfwer, and Alexander has given it already. The juice of pome- granates makes people in health coftive, but has not the fame eiFed upon the fick. Id. Lib. viii. cap. viii.

nent

[ 76 3

nent degree, being at the fame time ftreng- thening and in^cralTating, it was preferable to other vegetable acids in our cafe, the moft of which relax too much, for it ad- mirably corrects the exceffive acrimony of the putrid fluid; and at the fame time com- inunicates new ftrength to the fibres, which enables them to refill the diftenfion created by the putrid flatulencies, to which is ow- ing as I faid before that tympanitic infla- tion that was fo bad a prefage, for it fhews at once both the highefl puti*efa6tion of the morbid ferment, and the greateft debility of the folids of the abdomen. It is to be lamented that for want of pomegranates, we were deprived of that excellent medi- cine; infliead of them I fubftituted with very good fuccefs, the dulcified acid mi- neral fpirits of fea fiilt, nitre, vitriol, and efpecially fulphur; for ivhere there is a pu- trefatlion together icith an excejjhe dijjolution of the humour Sy or any apprehenfion oj it in a fiort time, then the acid fpirits obtained by the force of fire from marine fait ^ nitre ^ and ^7- trioly are highly ufcful', for they 7?ioft power- fzdly re/ift all putrefaBion^ and at the fame time do not dijfohe, ^ but rather coagidate our

humours.

[ n ]

humour s» '^hh intention is excellently a?7fwer^ ed by the fpirit oj fulpbur per campan, which yields the purejl fojjil acidy containijig nothing metallic in it \ And indeed if they are good in any cafe, certainly here, where the putrefaction, dillblution, and relaxa- tion are ib great -, I prefcribed them either in pure fpring water, or in a decoflion of the root and leaves of forrel, red rofe leaves, and fometimes with fyrrup of bramble- berries ; barley water, with an addition of red rofe leaves, w^as a very convenient ve- hicle : they drank two ounces every two hours, and we could give no other carmi- natives in fo great an inflation, nor was it pofTible to find any better '\

There was an alarming fymptom In this fpecies unknown to the two former^ that is a continued delirium, not only as affording a very bad prefage, but being pernicious in its confequences, for the pro-

^ Van Swieten, Aph. 88. p. 127. Confer. Boerhav. Chem. t. 2. proc. 151. p. m. 270. Sennert de febrib. Lib. II. cap. vii. where he has very good obfcrvations upon the ufe of mineral acids.

^ Van Swieten, Aph. 650. t. 2. p. 241.

digious

[ 78 ]

digious tolling which it generally occafion- ed, totally prevented fleep, increafed the heat, anxiety, and reftlefsnefs, and often rendered the patients refraftory with re- gard to their medicines. It may be attri- buted to many caufes, i. the violence of the fever; 2. the tumid inflation, which ob- ftructed refpii ation, and the want of fpace for the expanfion of the lungs (whence the greateft fliortnefs of breath ^) by which the pulmonary artery was imperfeftly eva- cuated, and the right auricle being turgid, could not receive the blood of the afcend- ing cava, and thus prevented the emptying of the vertebral and jugular veins 5 3. to an acrid bilious humour tranflated to the feat of thought; laftly to fympathy, for obfervation taught the antients that the brain fuffered by confent from an irritation of the abdominal and phrenic nerves ; the caufe of this was difcovered by the induf- try of the moderns, and what Senac par- ticularly has wrote upon the fubjecl de-

^ For the diforders of refpiration from infardions in the abdomen, confult the elegant difiertation de Refpi- ratione difficih*, (§ 163, 166, 167.) lately publifhed by the celebrated F. de Sauvages.

ferves

[ 79 ]

ferves an attentive reading '. By removing the caufe of the diftemper, we cured the delirium at the fame time, and Hippocrates has faid that in a bilious delirium proper attention muft be paid to the lower belly, and we muft give vinegar honey and water "". Our whole method confifted in moderating the fever, evacuating and cor- refting the bile, both in the primse via?, and in the blood, and in repelling the in- flation j it remained therefore to remove the fymptoms which were brought on by fympathy, and as by the conftitution of the human frame, a difeafe from confent of nerves is mitigated by a contrary irri- tation, theory directed us to an irritation of the inferior parts. Among the known ftimulants, none are fo much ufed nor operate fo quickly as Cantharidesj thus

' EJpjys de Phyfique capitulo hi mouvemens fympathi^ gues ; fevcral others worth reading have wrote upon fympathy. F. Bayle, C. Walther, H. Rega, E. Buchner, D. Langhans; the illuflrious Haller with that fagacity and accuracy, by which all his works are diftinguifhed, has divided the various fympathies into clafTes, Lin. Phyfiol. § 555. His principles have been adopted, and do6trine explained by Langhans.

» De Afte<5lion. Foes, p. 518.

led

[ 8o j

led away by cuftom, I at firft ordered blis- tering plaifters, but they did not anfwer my wifhes, and I remembered afterwards, that they fucceeded no better with Walca- renghi, at leaft I could never truji blijlers fo much as others tjidifcriminately do ". In like manner Borelli fays, that blijiers gave no re- liej] for all the patients were carried to their graves with their arms^ feety and other parti ulcerated °. I recolle6ted an obfervation of a great praftitioner C. Richa, who in a ufeful but not fufficiently known work up- on a putrid fever at Turin, fays, that the application of blijiers was fowid to be unfuc-^ cefsfuL And a Uttle after he adds, when the humours have a tendency to colliquation, when they are acrid and tumultuous y when the

■ Medicin. Rational § 351.

° Epiftol. ad Malpighi, p. 28. Glafs obferves on this place (Comment, p. 116.) how iifelefs were blijiers applied to the fkin^ to evacuate corruptid humcurs flag' nating about the Jiomach ; but this great man does not fufficiently attend to all the efFe^fbs of ftimulating medi- cines ; the principal of which is a contrary irritation ; befides a plentiful fuppuration difcharges many bilious fpicula mixed with the blood ; neither Borelli nor any one elfe ever believed, that a cacochymy in the abdo- men was evacuated by them-, as Glafs would feem to infmuate,

blood

[ 8' ]

blood is rather to be quieted than Jlimulated^ there is nothing more hurtful^ nothing more pej^nicious ^. Van Swieten, fo frequently quoted, obferves, that when the humours are colliquated, acrid^ and tending to putrefadtiony and there is viole?it motion^ it does nof appear fo fafe to life them '*. And the famous Gui- deti fupported both by reafon and experi- ence affirms, that blifters are not good in any kind of bilious fevers even thd obfiinate^ ^fp^~ daily if the bile be acrimonious and fervid^ and it affeB thefoUds and the blood \ There- fore prefently changing my method, and laying afide cantharides, I had recourfe to cataplafms made of leavened parte, the ftrongeft vinegar, and a large quantity of muftard feed, which I ordered to be applied to the legs, but more frequently the foles of the feet '. Nor did they irritate with lefs

P Conftit. Epldem. Taurln. ann. 1720. § 32. Con- fer. Bagliv. deUf. & Abuf. Vefic. p. m. 647, &c.

^ Aphor. j^. p. 108.

' Bianchi hiftor. hepat. p. 3. p. 307. Vid. loc,

* I remember very well to have read once in Galen, but I cannot find the place, that patients whofeftomach is diftended with flatulencies, receive benefit by apply- ing a rpunge dipt in the moft pungent vinegar to th« arms and feet, till it produced phlyctaenae.

G force

[8.]

force thanbliflers, and they were not pro-* duclive of the fame mifchiefs as cantha- rides, whofe more fubtile alcaline part bei ing abforbed and mixed with the blood, promotes its putrefaflion, and thus aggra-^ vates putrid diftempers 5 while on the con---, trary the acid particles of the fmapifm,. being conftantly inhaled by the bibulous veins, obtund the force of the putrid mat- ter, which is continually corrupting the -numours. The event confirmed the theory, for I often faw with pleafure (I wifli it had been always the cafe) the foles of the feet become extremely red in twelve hours, and before the end of thirty, very large veficles were raifed, which copioufly dif- charged a» yellow liquor. After the firft day and night, if we were to hope for a favourable ifllie, the reftlefnefs, and fub- fbltus of the tendons fenfibly remitted; the delirium was not then entirely gone, but the patients were more quiet, and in three days recovered their fenfes; the opening medicines had a greater effect, and they now began to get fome fleep. The irri- tation ftill did good, even when it had happened either by want of care, or ful-

lennefs.

[ 83 ]

lennefs, that the finapifms came ofF, before they produced blifters; and during the time, that the morbid matter was moved and agitated about, there was a prodigi- ous conflux of the fharpeft ferum to the ipotted places, which would otherwife have fallen upon the more noble parts; hence appears the ufe of this remedy, and it is confonant to the aphorifm of Hippocrates, if any part is pai?iful before a difeafe^ there the difeafe fixes itfelf\

Till fuch time as the thick epidermis, which every body has in the foles of their feet, feparated, I did not forbear the ufe of the finapifm, which always evacuated a great quantity of ferum, and thin puru- lent matter. When after fix or feven days it had entirely come off by piecemeal, the mildeft balfams were applied till it was perfeftly healed, nor would the Ikin, covei ed by a new epidermis io thin, have bore a pungent application.

' Lib, iv. Aphor. 33.

G 2 There

C 84 ]

There is another remedy which Is ufed with the fame view as finapifms, but is very different in its efFeft, and which is often follicited for by thofe about a patient, and has been prefcribed by fome weak ; phyficians, that is, hving animals, or parts of animals apphed to the foles of the feet, with an intention of drawing out the ma- lignity ; and for a proof that they do fo, they appeal to the great putrefaftion with which they are quickly tainted; not re- flecting that the fame corruption would have followed in any other place equally warm and moifl. What hope is to be en- tertained from fuch an application? None at all, for it does not give any irritation, and therefore makes no revulfion; it con- tains nothing antifeptic, which being ab- forbed can correft the putrid colliquation of the humours; it does riot caufe any evacuation ; there is no way then in which it does good; but it is hurtful, both as it foments the noxious heat, and as turning quickly putrefcent, it becomes the fource ^ of putrid effluvia, which being fucked in ! by the abforbent veflels, increafe the vio- ; lence of the diftemper.

If

[ 85 ]

If about the 15th or 17th day, by the ufe of remedies external and internal, there was great plenty of fpontancous llools, that were concocted and bilious > if the delirium had entirely ceafed, and there remained only a weaknefs of the brain ; if the urine, lofing its oily appearance, was firft equally turbid, and afterwards depofit- ed a fediment "; if the tongue grew moift, if the gum in the eyes, and the fordes a- bout the teeth were leflened ; and what was always a very favourable prefage, if the Ikin grew foft, without that clammy and cold fweat, which is the forerunner of death y then I reckoned the patients to be in a very fafe way; and in a fhort time, without changing their medicines, only lefTening the dofe, they grew well. On the contrary if, notwithftanding the ufe of the befl: means, all the fymptoms, defcribed

" The urine was not fufficient for a crifis; but the concocftion of the morbid matter and its falutary excre- tion was proved by the ftools ; and at the fame time by the urine was evacuated that part of the morbid fer- ment, which had been tranfmitted to the vefTels ; for as the antients rightly obferved crifes of the veflels are made by the kidneys, and health never followed ftools, fo long as the urine continued crude.

G 3 in

[86]

in the hiilory of the difeafe, continued and were protra£ted beyond the feventeenth day, there remained little, if any hope. I remember ho wever that about the end of Sep- tember, I was called to a woman of thirty, of a llender habit, who had been ill twelve days, in whom the difeafe varied fomewhat from this form : my worthy colleague men- tioned before, had attended her; fhe had all the worllfymptoms, except purple fpots, and fo judicious was the method which he had purfued, that I could find nothing to alter; notwithftanding fhe reaped na be- nefit from the moft powerful remedies. Her ftools were copious, fanious, very fetid, and came away without her being fenfible of it; her delirium was conftant, the inflation very great, and her pulfe ex- ceeding bad. We gave her agreeable acid drink, and every two days an eleduary of caflia and rhubarb, ufed by the famous Kloekhof ''. The reafon has flipt my me- mory, why in the beginning a vomit was omitted, and afterwards the finapifms. She continued in fuch a condition every

^ Opufcula Medic, p. 104.

5 . day,

[ 87 ]

(lay, as gave us reafon to cxpefl fhe would die the next, till the 26th day, when at laft, together with all the favourable fymp- toms taken notice of before, flie had very great difcharges by ftool, not cadaverous as formerly, but truly bilious, which in a fliort time reftored her to health. On the 2oth of March 1756, I faw another wo- man forty year^ old, the mother, if I am not miftaken, of feven children, who had then been ill nine days, and I was furpri- zed to fee her countenance quite altered, and almoft cadaverous ^ 3 by fomebody's advice fhe had taken a purge of fenna and falts, and afterwards warm cardiacs had been given plentifully to remove her weak- nefs and the languor of the ftomach. I found her pulfe weak, irregular, and her ftrength entirely wafted; flie was delirious but quiet, had no ftools for two days, and an almoft conftant tremor. I gave her a gentle vomit much diluted; ftie difcharged by it greenifli-black ftuff, but as her belly continued bound, which I don*t remem- ber to have happened to any body elfe,

y Vid. Foes. p. 231. Lib. vii.

G 4 and

[ 88 ]

and which no doubt proceeded from the drynefs of the inteftines occafioned by the life of the hot medicines, I was obliged to order feveral clyfters^ fhe recovered a Httle ftrength, and her pulle rofe, but the fymp- toms increafed with the fever ; her drink was made very acefcent: lorderedfinapifmstobe apphed, but as they afted flowly and there was need of a fpeedy revulfion, I caufed others to be put to her legs fprinkled with cantharides ; for fome hours every thing feemed to grow worfe ; nay altho' there was a copious difcharge of ferum from the legs, and feveral blifters were already raifed in the foles of the feet, which being opened, difcharged the like humour plen- tifully ^ yet (which I attributed to the fmall quantity drank by the patient, who was extremely fullen) for two days the diftemper did not in the leaft remit: on the eighteenth, I gave her tamarinds and man- na a fecond time, fhe had flools fufficient, but no remiflion s on the twentieth, there Sfppeared reafon to apprehend the greateft danger from the inflation, delirium, weak pulfe, flupor, refllefnefs, fliortnefs of breath, and difficulty of fwallowing j but when I found her fkin fofter, that there

were

[ 89 J

•were no purple fpots, that It was near the twenty-firll: day, and that there was wind runribling in the abdomen j I ventured to encourage the hopes of her friends, beUev- ing that the morbid matter was concofted, put in motion, and haftening to a crifis. I ordered her lemonade with a little wine, if it was pofTible to get it down ; for at fuch times as I expected a crifis, I omitted the mineral acids, nor did I repent it. About the middle of the night fhe difchar- ged by ftool copioufly, and with violence, but inienfible of it, and without intermif- fion almort for half an hour. This was followed by the greateft debility, and feveral intermiflions of the pulfe ; her refpiration was not difficult, but fcarce perceptible ^ the ftupor very great, and every body looked upon her as dying % Early in the morning the furgeon being fent for to drefs the blifters, thought it needlefs; I came a little after, and found the appearance of fleep, rather than deaths her refpiration was flow, but eafy, her pulfe very fmall, but foft and regular ^ and the inflation of

» Hippocrates relates a cafe not unlike this, of Timo* crates. Epidem. Lib. v. Foes, p, 1142.

the

[ 90 ]

the abdomen had fubiided. I perfuaded them to drefs her legs, and to put into her mouth now and then lemonade with half the quantity of wine; and to apply linnen cloths wet in equal parts of warm wine, vinegar, and water, to the abdomen and breaft every hour, andtomoiiten frequently with the fame liquor, the parts where the larger veffels were fituated. Her pulfe was gradually reftored, the colour returned to her face, and jQie enjoyed a calm fleep, and did not awake till next day, fix and thirty hours after the crifis, and near three days after the firft attack of the ftupor^ flie grew well foon by the difcharge of bilious ftools : agreeably to what Hippocrates fays, who reckons fleep among the crifes of a febrile head-ach % for the lethargic ftate

was

* Coac. praenot. § 172. Foes. p. 145. Duret. Lib. II. cap. I. § 13. p. 88. There Is another pafTage of Hippocrates fuitable to our purpofe, where he fays, prorret. Lib. L § 63. It is to be carefully conjideredy whether a "profound deep feep is in any cafe to be condemn- edf from whence 'tis fufficientJy plain, that fome ob- fervations have given rife to this doubt ; the fame fen- tence is found in Coac. No .178, but as all the books don't perfectly agree among themfelves, and in fome y\po(.yi is wanting, other interpreters as well as Foefius

read

[91 ]

was the firft relief our patient had before any other crifis. A fecond fleep followed the crifis, which was very good, becaufe it fliewed her fafety. Sound and quiet Jl",eps prove the compleatnefs of a crifis ^.

There was another inftance to confirm the truth of Hippocrates's doftrine, which it is worth while to repeat ; it occurred in that man whofe body was diflecled ^ for during the laft days of his diftemper, his whole body was covered with purulent puftules, which gave his relations hopes, that were encouraged by the quack 3 but on the authority of Hippocrates, I con- cluded them a certain prefage of death ; jor the appear ajice of piijlides all ever the body in continued fevers is mortal ^

read fimply, A profound and deep JJerp is iindouhtedy bad. But Duretus retains the fpirit of Hippocrates^ (as Bag- livi exprefles it) and preferves the doubt in his reading. Wheiher jleep Is in any cafe bad? p. 91. But the con- troverfy is ended by experience, which teaches, that fleep coming on is always good, provided it be not oc- cafioned by a metaftafis to the brain, for while the tu- mult is thus compofed, the critical evacuations proceed better.

^ Coac. praenot. 151. This aphorjim needs no ex- planation.

^ Coac. § irp. Duret. p. 59.

This

[ 92 ]

This then was the hiftory of the dif- cafe, and the remedies s fome perhaps will wonder at, or rather condemn the conftant adherence to one remedy, without fo much as frequent changes of the form, during the whole courfe of the difeafe. But what then? fhall we imitate thofe, who with- out attending in the leaft to the caufe of the difeafe, and regarding only the fymp- toms, are by that means continually making blunders, and at every vifit prefcribe feve- ral formulas often oppofite either to each other, or to what was given before? A man of a vigorous conftitution lives healthy and ftrong upon bread, water, and milk, to 150, while thofe, who ftudy nothing elfe every day but new varieties of food, hardly reach the age of fifty, with frequent fickneffes too. Is then the human body fo much changed by a difeafe, that it can hardly be relieved for a few weeks together by the fame remedies? By no means, na- ture likes neither a change nor compofition of medicines i nothing terrifies patients more, whofe naufea goes off by cuftom. I have often cured diftempers both acute and chronical by one fmgle formula 5 by

' another

[ 93 ]

another I have prevented a relapfe; I never regretted my conftancy, but I have re- pented of my inconftancy, which a judi- cious fpeflator laughs at, and v^hich de- ftroys all the confidence of the patient. The antients gave nothing elfe but ptifan, oxymel, and a very few other medicines. Why fo many changes then? what mif- chiefs have followed thence? a perpetual uncertainty about the virtues of medicines, an increafe of the dillemper, the difgrace of the phyfician, and fears of the patient. When the caufe of the difeafe is known, let the phyfician immediately employ the beft method, and if he has hit the cafe, let him not vary in the leaft. Ignorant by- flanders may brand a remedy with the title of ufelefs, becaufe it has not removed a fe- vere diftemper in a few hours ; but a judi- cious phyfician knows that a diftemper has its periods, and that even the moft power- ful medicines fignify nothing, when they are prematurely adminiftred ; he is not ig- norant that there are fome difeafes beyond all the power of phyfick. Nor is a re- medy for this reafon to be always rejected, becaufe it cannot prevent a difeafe from 2 ter-

[ 94 ]

terminating in death. Let us conftantly then remember the precept of Hippocrates, and the advice of his admirable interpreter Gorter. He who adls upon a rational plan^ mufl not change it^ when things dorit fiicceed according to his wifies^ if the circumflances are the fame as appeared at fir jl ^. For where the known caufe of a dijiemper does not yield to approved remedies^ it mufl not he attempted by U72certain ones. And as foon as a rational phyfician endeavours by vague trials to remove the caufe of a difeafe^ he differs not the leaft from an ignorant and rajh man^ who tries every thing for experiment's fake \ A great deal more may be faid upon this im- portant article, which there is neither time nor room for. It will afterwards appear, that in our malady, except the remedies made ufe of, which have been mentioned, there were none elfe, which would not have done harm.

Aphor. Lib. ii. § 52.

Medlcin. Hippocr. Cement, ibid.

Th

oe

[ 95 ]

The Diet of the Patient.

Diet includes the air and food of the patient. The air, fo far as was in my power, I kept cool, and had it frequently- renewed in the chamber ; for nothing ]3ro- motes putrefaftion more, nor does greater hurt to refpiration, than a hot air^ and that caufe alone is fufficient to aggravate prodi- gioufly the fever, anxiety, and delirium ; it is flill more prejudicial, if it be heated with the putrid effluvia of the patient and thofe about him, which is always the cafe, when- ever the air is not changed feveral times in a day. There are hardly any diflempers more peftilent than thofe, which are gene- rated in places where many people are con- fined to breathe the f^me air, without hav- ing it renewed. Nor is any one thing more hurtful to the common people than their fcrupulous exaftnefs, in keeping the win- dows of their chambers conftantly fhut, both from lazinefs and fear of cold, by which means they perpetually breathe in an atmofphere polluted with the effluvia of human bodies, beafts, food, and ex- crements.

[ 96 ]

crements. The vapour of vinegar was often very ferviceable.

With regard to food there are two rules, from which a phyfician muft not recede, firft that the quantity be not too great for the digeftive powers j and fecondly that the quaUty of it be oppofed to the caufe of the difeafe.^ In.'our cafe the thinned diet was pointed out both by the ftomach, which loathed every thing, and by reafon too > for when the ftomach was diftended by putrid fordes, all the digeftive powers were perverted i what benefit then from food ? It is prefently thrown up again by vomit- ing, which happened oftner than once; or what was far worfe, it was retained, and furnifhed frefh matter of opprefTion to the ftomach; a new ftimulus and frefh fuel to the fever. . Nothing nourifhes, but what is digefted; and the ftomach can concofl little or nothing, when it abounds with a bilious humour. But thefe things are not com- prehenfible by the relations of the patients, a peftilent fet of people ; for they cannot be perfuaded, that there is a very wide dif- ference betwixt cramming and nourifhing,

and

[ 97 1

and that, whatever does not nourifli the patient, feeds the difeafe. Impure bodies^ the more you 7iouriJh them^ the more you hurt them \ I do not know a better aphorifm in Hippocrates, nor one more frequently tranfgreffed to the deftruflion of man- kind.

The ftrength of the ftomach was not equal to the concoftion pf folids> I there- fore gave only liquids of very eafy digef- tion, always obferving Hippocrates's rule ; the more violent the fever, the thinner muft be the diet.

It was our next bufinefs to phufe a nu- triment, which being oppofed to the caufe of the diftemper, would not putrify : the great mafter of our profeffion ufed his two kinds of ptifan, which were nothing elfe but decoctions of barley : the beft in our difeafe was undoubtedly oat grits, for no farinaceous fpecies is found by experience fo powerful as oats^ tofubdue an alcali quickly ^.

^ Aphorifm. Lib. II. § lo.

s Boerhaav. Praxis Medic. colIe6^ed by an unknown pupil. T. I, p. 193.

H Accord-

[ 98 ]

According to the famous Van Swieten, Rye is not inferior to it, but as the method of preparing it is not common here, I made ufe of oats, not however with that obfti- nacy as not to admit other preparations from acefcent grains, but the flavour of our gruel was agreeable to mofl people's palates. The beft method of preparing it was boiling the grits in water, then ftrain- ing it, and afterwards adding a little fugar, a moft mild, antifeptic, refolving fait, not at all dangerous here; and then giving three ounces every three hours. I had no ob- 3 eftion to the addition of part of a young hen or chicken to the gruel, while it was boiling 3 for they being fed upon oats or other grains afford an acefcent juice. I aU ways advifed againft the ufe of butter, for the fame reafons, that I declared againft oily medicines: fometimes too chicken broth, with a little of the exprefTed juice of forrel proved excellent nourifhment. The celebrated Lud. Mercatus, phyfician to Philip the fecond, treating of putrid fe- vers, recommends things of the fame na- ture. The common nourijhment fays he of all^ is chicken broth with lettuce or gourde and we

found

[ 99 ]

found a mixture of chicken broth and fugar^ "with lemon juice or 'vinegar ^ very agreeable to their tajie-, the moji excellent food is ?nade of panado andfiigar^ with a fmall proportion of lemon juice \ There is nothing 1 hate more than the ftrong foiips of beef, fowls, and pidgeons, fo admired by the relations of a patient, but affording an indigeftible mafs to a bilious ftomach; and whofe clan- deftine ufe oftner than once occafioned vio- lent exacerbations, nay killed feveral. They may do good, where the flomach labours under an acid cacochymy, which they cor- re6l by a fpontaneous putrefaction, but in putrid diftempers they deferve no other name than poifon. What fliall we fay of milk? We anfwer from Hippocrates; that^ it is bad to give milk in the head-ach. It is had alfo to thofe in a fever ^ and who have wind in the hypochojidres and to thofe who are thirjlyy it is prejudicial where there are bilious flools or acute fevers \ And the reafon is plain, for there is much oily nourifhment in milk, which is highly detrimental.

^ Oper. Medic, T. II. p. 386. Compare FerneL p. 389. Primerofe and others, i Lib. 5. Aph. 64.

H 2 They

[ »oo ]

They made ufe of no other drink than the ptifans mentioned, which they always fw allowed cold 5 for warm draughts do as much harm in putrid lax difeafes, as they do good in too great rigidity, fuch as in- flammatory diforders; for any thing hot pro- duces loathingy diminijloes the appetite^ is of- Jenjive to the bowels^ and dejlroys their tone^ weakehs the nerves, Jlupijies the mind , andprO" duces Jain tings and hemorrhages ^» When the febrile heat was not too great I readily prefcribed wine, for I don't know a more excellent or more pleafant cardiac, at the fame time that it is antifeptic and diluent \ and I obferve it was approved by Walca- renghi; // was often proper to allow pure Malmfey wine, by the ajjijiance of which the fibres of the flomach and inteftines being ren- dered more elaftic expelled the bilious humour

^ Lib. 5. Aph. 16. Galen In Comment de Sanltat. tuend. & paffim.

^ Even in inflammatory diftempers, when the crifis was approaching, it has often fucceeded admirably with me to give the patient one fpoonful of foft, agreeable, cardiac wine every three hours ; for thereby the ftrength was raifed without any tumult, and the hoftile matter moft eafily expelled.

with

f ^01 ]

wkh greater facility *". Hippocrates every where proclaims the praifes of wine, and Galen has even fliewed us the way in a bi- lious fever, and given excellent cautions for its ufe. Wine mnjt be entirely for born till the diftemper be concodled, but when the conco^ion has begun^ one may give water with a [mall quantity of wine^ and when the difeafe is de^ cliningy it may be ufed more freely ". And in fome patients I did not find any medicine equal to an ounce of Syracufe wine, and a like quantity of fpring water, with half an ounce of fyrup of acid cherries given three or four times a day : a draught which far from increafing, rather mode- rates the heat, creates an appetite, raifes the ftrength and fpirits, afiifts concodlion and the iecretions, and which I have fuc- GefsfuUy ufcd, and would prefcribe in all bilious languors. Inftead of the fyrup of cherries, any other, or citron juice may be added. Another drink alfo belongs to the dietetick branch, which I often ordered

■ Medicin. Ration. § 345.

° De Ration, medend. ad Glaucon. Lib. I. c. g. T. vi. p. 377.

H 3 v^'hen

[ 102 ]

when the patients were recovering, with a view to brace the lax fibres of the ftomach, and at the fame time entirely deftroy the putrid relicks if there were any, this was, fpirit of fait with fyrup of orange fkin and fpring water, or the fimple water of black cherries.

When the diftemper was gone off, and the patient was free of all febrile fymptoms and complained only of weaknefs, a more plentiful diet was required, which muft be fuch as affords a foft nutriment (for the fibres of the flomach and inteftines would not bear any thing pungent) eafily extra6led;, not quickly putrefcent, nor too relaxing. Well fed veal roafled, was ex- tremely fuitable^ alfo calf's tongue and fweet-bread, young lamb, chickens ; of the fifh kind perch, young pike, trout, fal- mon, falmon trout, grayling, and river carp, in fuch places as they are to be found, provided all of them are not dreffed in fuch a manner, as to deftroy their natural quali- ties, by fat, or too large quantities of aro- maticks. Of the vegetable tribe we ufed the roots of young Ikirret, yellow goats

beard.

[ 103 ] beard, fcorzonera, and fome of the carrot kind; leaves of fuccory, forrcl, lettuce, and fpinage; of the two Lift I would have it obferved, that they are often too relaxing and cooling, or elfe they are long retained in the ftomach undigefted, or they occafion a diarrhea which brings them off uncon- cofted °. Afparagus, the leaves and even the tender ftalks of artichokes are not to be defpifed 3 but the bottoms are too ftrong for a weak ftomachy and care muft be taken in all cafes, that what is judicioufly prefcribed by the phyfician be not rendered hurtful to the patient by the cook ^. The fummer fruits, whofe expreffed juices w^ere fo good a medicine in this diftemper, af- forded a very falutary nourifhment in the recovery, provided they were ripe, and

° The antlents to correal the laxative quality of ve- getables, added to them fait and vinegar.

P I would quote on this occafion the words of a man to whom we fliall find few equals in the former or fuc- ceeding agre. If^e hc^vey faysJie, infociety two orders cf men^ fhyjicians^ and cooks, one of which labours incejfantty to prejcrve our health , and the other todejiroy it -, with this difference, that the lafi are much fur er of gaining their pint than the firjl, Diderot. Encyclop. Art. of fa^ foning,

H 4- eaten

i 104 ]

eaten raw; for by baking, the virtues of moft of them are deftroyed; they entirely lofe their agreeable aromatick flavour, and by that means their cardiac, ftimulating, antifeptic quality, and become loading, re- laxing, and flatulent, befides producing the mifchiefs following from heat or warmthJ Authors of great charafter bear teftimony to the cure of many fevere difl:empers per- formed by the ufe of raw fruits, and I am aflxired of it by my own experience ; but there are no infl:ances of their fuccefs when baked. I know feveral people who cannot bear them in that way, with whom they agree very well raw.

I avoided the ufe of meat abounding v\^ith blood (for the more blood it contains fo much the more it nouriflies, and has the greater tendency to putrify) fuch are all thofe which they call black ; eggs alfo were improper; the cakes too both pre- pared by the paftry cook, and at home were very bad; by pleafing the blunted ap- petite, they have a very pernicious efte6l upon the health, produce many diforders in the flomach, and obilruftions in the

bowels,

[ 105 1

bowels, from whence proceed incurable languors; nor are common cakes much better, a food fo agreeable to many peo- ple and eftablifhed by cuftom, though they be prejudicial to the ftomach, and which every body ought to forbear, who labours under a weaknefs of that organ or lax fibres. What purpofe can the cuftom ferve to drown the juice of flefh in water, fpoil bread by toafting it, and fubvert the conco6live power of the ftomach, at a time when it v/ants to be raifed, by that large dofe of hot and emollient pulfe. But enough of this, innumerable errors prevail in the diet both of found and fick people, to explode which, would be a very ufeful undertak- ing, of fome learned practitioner of the profeflion.

The ufe of wine was always attended with great fuccefs; hot drinks were ever hurtful. Exercife in the country air finifti- cd the cure.

Relapfes,

While the famous Kloekhof with his ufual judgment and learning, praclifed a-

mong

[ io6 ]

niong the people of Culembourg, he met with feveral relapfes, that were long and tedious, and no way different from the firft difeafe, except that they were lefs fevere ^ We had not the fame misfortune ; fome- times our diftemper grew milder, and quickly after returned with greater violence ; but that has no connection with relapfes, which were extremely rare when the pati- ent had begun to recover, nor did they laft above two days, during which time he was opprefled with a naufea, head-ach, heat, fever, and debility; I never met with them, but after an error in the diet, delay of purging, agitations of mind, or upon a change of weather. In the fecond cafe, during the paroxyfm, clyflers were of ufe, and as foon as the remiffion followed, an evacuation by ftool was neceffary. In the firft, if a fpontaneous vomiting or purging came on, all was well ; if not, a cathartic draught removed at once the caufe and the malady, and I feveral times faw the dif-

t Which occafloned his writing that elegant book upon relapfes, which as well as all the author's works, deferves repeated reading.

order

[ ;o7 ]

order terminated without any evacuation, only by the conco6lion of the crude mat- ter, which the divine Hippocrates has alfo taken notice of '. I once faw an infufion of carduus benedi£l. prove a moft fpeedy relief to a woman, who being but weak then, had eat for breakfafl fome hot roll buttered, which was followed by naufea, pain of the flomach, anxiety, head-ach, and debility, to fo violent a degree, that thofe about her were afraid of the ifiue; fcarce half an hour after fbe had vomited copioufly, fhe was very wellj a clyfter alone was often fufficient. The third and fourth cafe hardly required any afliftance from medicine. A clyfter, or draught of baulm water, with the anodyne mineral liquor of Hoffman, frequently removed the tumults occafiojicd by the padionss oft- ner they ceafed of themfelves. The cafe was harder with old men, for a tumult from whatever caufe is more pernicious to" them, and I remember an old man, at that time getting perfe6lly well, who by a vio- lent fit of paffion was thrown into a ftupor

' Pforreticor. Lib. II. § i6. Foes. p. 85.

truly

[ io8 ]

truly apopleftic, as appeared by the con- comitant palfy of the left fide, from which he was reftored with difficulty after feveral weeks: in this cafe the fore-mentioned draught was of great fervice; nor was any thing requifite, but clyfters, or rather per- haps fuppofitories, and the mildeft lenients, that were at the fame time agreeably car- diac. The ufe of wine reftored the ftrength impaired by a relaxation of the fibres, proceeding from rainy weather and fouth- erly winds.

Confequences of the Dijeafe,

After the removal of the fever, there frequently remained fome morbid relicks, if the method of cure was either begun too late, or badly purfued, or too foon laid afide. The relicks of diftempers are always owing, either to the morbid matter not being evacuated, or to debility brought on by the violence of the difeafe. The morbid matter being retained, either flag- nates in the parts originally afFefted, as when an inflammation is not refolved, the part either fuppurates and an abfcefs fol- lows.

[ 109 ]

lows, or it grows fchirrous^ or leaving the place where it was generated, it is tranfla- ted to another, which is called a metaftafis. Thus I once faw in the hofpital of St; Eloy at Montpelier, a young robuft fol- dier afflifted with a moft violent pain in his left arm ; the part was hardly fwelled or red, he could not pofllbly move it, pref- fure gave him pain, and he had a pretty brifk fever ; the phyfician prefcribed bleed- ing feveral times, clyflers, cooling drink, and emollient cataplafmsj but the pain in- creafed. After three days, perhaps about half an hour after the departure of the phyfician, as I was told by the furgeons of the hofpital, it fuddenly ceafes; they fuf- pecl a gangrene, and apply aromatick fo- mentations 3 in fcarce half an hour, he grows cold, fhivers, complains of a pain in his head, is prefently feized with a de- lirium, becomes lethargic, and dies in lefs than four hours. Next day his body was opened, and feveral more as well as myfelf, obferved the external mufcles of the arm feparated from the periofteum of the hu- merus, their adipofe membrane diffolved, and the traces of pus formerly collected in

this

[ no ]

this part: the mufcular fibres of the ex- tenfor longus eubiti had loft all connexion with one another. The ventricles of the brain contained matter, which drop'd out from the whole bafe of the cranium. This is a very ufeful hiftory, and however foreign to our prefent purpofe, will be acceptable to every body.

Such metaftafes happen of courfe much more frequently in inflammatory, than in putrid gaftric diftempers ; for the morbid matter, as foon as it is conco6led has al- ways prepared for it the long inteftinal canal, from which it is fpontaneoufly eva* cuated ; this is the reafon, why in above 300 patients and upwards, I met with only one metaftafis. A woman of a good con« ftitution about twenty-five years of age, was taken ill in the month of July 1755, the evacuations by purging v/ere neglected in the beginning, and fudorificks admini- ftred 5 thus the morbid matter being neither correfted nor difcharged, but abforbed by the lymphatics or lafteals, infefted the whole mafs of humours, and was the caufe of many diftrefies to the patient, and much

trouble

I "I ]

trouble to me ; however the diflemper grew milder by the continued uie of acefcent eccoproticks, and the patient was near get- ting well. Being feniible from the crudity of the urine, the deficiency of bilious ftools, the languor and want of fleep, that the crifis was imperfect, I advifed the continu- ance of the medicines, which fhe utterly refufcd. Three weeks after, on the day file went firft abroad, fhe was feized with a fliivering, which was followed by a very painful eryfipelatous tumour in the left leg. Her languor went off, fhe flept, and except the fwellingy had no other complaint 3 flie fpent feveral days treating the tumour in a wrong method 3 at laft I was again fent for, and found that by the application of oily tilings the fwelling had been mifmana* ged, and was aftually fuppurated : a fluc- tuation upon the tibia was perceptible to the touch : the tumour is opened by a lan- cet, and a thin yellow purulent matter is difcharged, there remained for feveral months a tedious ulcer, which was only fubdued by internal alteratives. Is not this hiftory conformable to the doftrine of Hip- pocrates? for thus the venerable old man

has

[ iia ]

has obferved, In fuch whofe urine is thin and crude for a long time together^ and the other Jigns falutary^ we may expeB abfcejfes below the diaphragm^ ', and perhaps an at- tention to the cafe of Pythion among others gave rife to this aphorifm, whofe urine even at the crijis was fomewhat thin^ and who on the fortieth day after the crijis had an abfcefs formed near the anus \

Relicksfrom obJlruBions in the bowels.

Hippocrates has obferved above two thoufand years ago, that an objlrudlion of the fpleen was formed y when from fevers and the bad management of them^ biky or phlegm^ or both ftagnated about the fpleen ". In every age the fame obfervation has been repeated, and Primerofe fays, that obfiinate obftru6liom of the bowels often happen in J ever s, which

• Praenot. No. 78. Foes. p. 40. Coac. praenot. 582, Foes. 213. dejudicat. Foes. p. 54.

' He laboured under an acute fever of the bilious kind, and very little bile had been difcharged by ftool, ivhich was our patient's cafe alfo. Epidem. III. § i. jegr. T. Foes. 1059.

» De Affe<5tioniD. cap. xxi. Foes. 521.

an

[ "3 ]

are to be cured by laxatives *. Gianella rec- koned obftrudions amongft the confequen- ces of fevers ^, and what is more to our purpofe upon account of the fimilarity of the diftempers, Walcarenghi had recourje to diluent and refohent medici?ies prepared from grafs and fuccory^ and mineral waters^ that he might prevent obftruBions being left in the vejjels of the liver ^ Jpleen, and mejentery^ by the corrupted and tenacious bile ^. The famous Pringle treats feparately of the re- licks of the bilious fever in the camp, and recites two cafes, an afcites and tympanitis, both of them arifing from obftruclions -f*. With refpeft to our patients, I was con- fulted by many, of the poorer fort efpeci- ally, in whom I found the liver enlarged and indurated, and the other bowels not quite found ; their ftrength was impaired, the ftomach languifhing, the fkin yellow, and there was an almoft conftant fullen

* Dc febrib. Lib II. cap. ix. p. 167. Compare Ferncl, Heredia, Mercatus, Sennertus, Lancifi, and fe- veral others.

y De Succeflione Morborum, Lib. II. cap. 4, p. 77.

* Medicin. Rational. Cap. xxi. Foes. 521.

f Difeafes of th^ army, he. P. 3. chap. iv. § 6,

I anxiety.

[ "4]

anxiety. As far as I could learn from the accounts of the patients, this happened from thefe caufes. i. If cathartics were given in the firft fpecies, but the concoftion by means of digeftives neglected, as alfo a vomit, which by the obfervation of the fa- mous Grainger, certainly prevents obftruc- tions fo frequent in an autumnal epide- mick *. Their production was particular- ly favoured by giving immediately after the firft purging, cardiacs or ftrengtheners, which ftrongly impafted the crude matter in the bowels, particularly the liver, which was always the principal feat of thediftem- per. 2. Obftruftions were formed in the fecond and third Ipecies, if the more fluid part of the morbid matter was difcharged by repeated cathartics, and that with too great precipitation, or without copious di- lution, while the groffer part remained fixed in the more remote bowels. Laftly, they followed the fever, if it was too foon flopt by the ufe of aftringents, the Peruvian bark and narcoticks, which happened to three women in the fame houfe, from taking an

> Hiftor. febr. Anomal. p. 74.

eleftuary

[ «'5 ] ■

cleftuary of confcrve of rofes, bark, and Venice treacle. I fliall not now give a de- tail of the fymptoms of obftruftions in the vifcera, or their method of cure, for they are articles very well explained in authors of the beft chara6ler; I would only take no- tice of fomething more particularly to our prefent purpofe.

Bilious tumours howeverhard, are more eafily cured than a fchirrus from lymph coagulated and indurated by inflammation; for there are ir.ore folvents for bile, than lymph, or adipofe concretions j when the bile has acquired even a flony hardnefs, there is ftill fome hope from refolvents, as daily obfervations concerning bilary ftones teftify ; on the contrary, a true fchirrus, the offspring of inflammation, or a fl:eatom are hardly ever diflfolved. This is the rea- fon, v/hy wefind many tumours of the liver perfe6lly cured, and but very few fchirri 'm other parts; and bilious tumours are often more formidable by the corruption of the - bile, which flrongly corrodes every thing, than by their hardnefs. Hence in practice, we mufl: be careful to adminifter, accord- I 2 ing

ing to the greater or lefs degree of acri- mony in the obftrufting humour, remedies more violent or milder. Thus when I met with obftruftions from the firft caufe, I boldly prefcribed pills of galbanum, myrrh, extrafh of the greater celandine, and Ve- nice foap ; or upon occafion that of Starkey, giving after them fome fuch draught, as that mentioned in the firft feftion, alfo friction of the right hypochondre, or even the whole abdomen, and I now and then interpofed gentle laxatives, if the fymptoms indicated the refolution of the morbid mat- ter in part. But when we are fenfible that there is a great degree of acrimony, in- fpiffated atrabile, calculi already indurated, fpafms and pains, then we muft aft in a far milder way: laying afide the gums, antifcorbuticks, alcalefcent foaps and the more pungent falts, we muft have recourfe to acefcent faponaceous vegetables. The beft remedies in fuch a cafe are the recent exprcfled juices of fuccory, dandelion, fu- mitory, fow thiftle, groundfel, and grafs ; and their leaves alfo reduced to a pulp with any acid fyrup; milk-whey and butter- milk, a ftrong decoction of quick grafs,

and

and above all that excellent medicine of Hippocrates, fimple hydromel, than which there is nothing better in diforders of this kind; which was buried in oblivion by the vaia boafts and avarice of chymifts, but reftored again to ufe in our own age '. Some years ago I attended a patient of an atrabilary habit, who had a hard tumour

* I don't know by what unlucky fate the miftake concerning the ufe of honey crept into phyfick, to which even men of character in tiie profellion have given their fanflion ; to wit, that honey is of a bihous nature, and therefore hurtful in bilary diforders ; Hippocrates, inftru6lcd by accurate obfervations, was of a different opinion, and every where prefcribes honey in bihous diftempers, (vide among other places, Foes, p. 547, 558, 560, 575, 636, 642,) and fo were Alexander, (Lib. vii. c. xvi.) Fernelius, (p. 289.) ill. Boerhav. (Chem. proc. 42. T. II. p. 102. Aphor. & Comment.) I would recommend particularly, what his faithful pu- pil De Haen has wrote, de imped deg'ut. p. 49. and which every phyfician ought to remember. Honey is the moft mild juice of plants ; a foft acefcent foap, de- ftrudlive of all putrefaction, refolving bihous inflamma- tory and vifcous concretions, and prejudicial to none but weak people, troubled with an acid. Inflammatory dif- eafes, and bilious, both acute and chronic, are cured by honey and water alone ; and with an addition of aro- matick diureiicks it removes difficulty of breathing in old men ; mixed with chalybeat aromatic decoClions it will perform, in chronic difeafes, relaxation, and ob- ftruitions, what you would never obtain from other mcdicineSi

I 3 in

in his liver, violent gripes, yellow colour, want of fleep and debility, and diftreffed with fo obftinate a coftivenefs, that he would often be twenty days without a llool, and it might juftly be applied to hini what was faid to Furius*

—Cuius tibi purior falillo eft

Nee toto decies cacas in anno:

Atque id durius eft faba et lapillls.

Quod fi tu manibus teras fricefque

Non unquam digitum inquinare poffis -f*.

I advifed him to take every two hours through the day, three drachms of an elec- tuary confifting of the tender leaves of groundfel and dandehon, pulp of caflia, manna, and fyrup of raft)erries^ and ab- ftaining from all animal food to live en- tirely upon greens and fruits : and to drink water with a Imall quantity of honey in it. For the fpace of three months he regularly obferved this courfe, and was perfectly reftored to health, after having loft all hopes of a cure for two years. He hardly

f Catullus, Carmin. to.

received

[ 119 3

received any benefit the firft month, and then his gripes and anxiety being much in- creafed, I prefcribed him milk*whey to drink very plentifully, which procured the evacuation of moft abominable ftufF^ pre- fently after the appearances were agreeably changed, and his fpirits were raifed by the daily fuccefs.

I have often obferved that ftimulatin^; or purging medicines render many ob- ftruftions irrefoluble, which would have been totally removed by a milder method. There is a fpecies of obftruclion from re- laxation and ftagnating juices not yet con- creted, which may be removed by bracing medicines, but there are many more which are increafed by giving ftrengthners too ibon. Where there is a drynefs of the fkin, or the patient is emaciated or old, the unguarded ufe of the gums, aloes, fteel, and fpirits never opened one obftrud:ed vef- fel, but has ^oftcn brought on an atrophy and palfy.

In the fecond cafe, I frequently made

ufe of the infpiffated juice of dandelion

I 4 with

[ 120 ]

With cream of tartar, vitriolated tartar, and a decoflion of grafs fweetened with honey. In both cafes the proper time for bracing medicines is, when the obftruftion is removed i and though the unfeafonable life of them is hurtful, yet a total neglect is often dangerous. Every part where there has been an obftruflion remains weak and relaxed, after the obftru6ling matter is dif- fipated; and unlefs it be ftrengthened the diftemper eafily returns ^ We have daily opportunities of feeing patients, who are freed from obftru6lions by the ufe of re- folvents, and fome months after are feized again, and fometimes cured by the Uke means, till at laft the difeafed part is fo ir- reparably tainted as to exclude all means of relief. I have had feveral dropfical pa- tients who confirmed me in this; they had eafily cured the firft attacks of the difeafc by drinking fome laxative decoftion, but afterwards the relaxation being much in- creafed, it was impoffible to reftore them; when they might have prevented all re-

^ I only intend here an obftrudlion from infardlions in the cavity of the yeffsls,

lapfes,

[ 121 ]

lapfes, if after the removal of the firft at- tack, they had proceeded to the ufe of ftrengtheners.

The diet was lean meat and principally vegetables ; the drink white wine and wa- ter J they avoided hot aqueous liquors, ef- pecially tea, and coffee; and chocolate, w^hich being a fat aromatick food, can by no means be good. Riding on horfeback was very ferviceable, but was not within the reach of the poorer fort.

When the cure was undertaken in pro- per time, it generally reftored them to per- fect health; but when the malady was negle6led in the beginning, there was no preventing a fatal iffue. A man about the age of fifty, of a bilious conftitution and a hard drinker, who had formerly indulged all his pafTions, and been oppreft with cares of every kind, about fifteen years before had laboured under a quartan ague, and afterwards a fever that he called malig- nant, but which from the hiftory of the fymptoms, I fufpecled to be bilious, and which had left behind it bilious vomitings

return-

[ 122 ]

returning frequently, proofs of a beginning infarction in the liver. He was feized with a new diftemper in fpring 1756 ; it begun with a fliivering, then followed loathing of victuals, naufea, anxiety, an obtufe pain under the right breaft, a violent cough, and a flight fever, as I was told, and a yellow ikin. The apothecary who attended, had endeavoured to remove the cough by lenients, the want of fleep by narcoticks, and the fever by Peruvian bark. The patient lived in the country, and I vi- fited him on the twentieth day of the dif- eafe. The fever had remitted, but the pulfe was ftil! quick, fmall, and frequent ^ the pain lefs fevere; but there was a jaun- dice, loathing of victuals, debility, watch- ing and a cough 3 in the morning he vo- mited bile^ and a careful feeling difcovered the liver to be hard. What then was my idea of the diftemper? His liver was weakened by the quartan ague formerly, and ftill more by the bilious fever, and ob- ftructions were formed. All the fymptoms of the new diftemper indicated a partial inflammation of that bowel, which was not refolved, and threatned greater dangers. I

pi^-

[ »23 ]

prefcribed the ufe of vegetable faponaceous acefcents, and lean meat, for diet and me- dicines; nor did I ever hear of him 'for a year after; and then I found that my ad- vice had been neglefted ; to gratify a deli- cate palate, he had fed upon a favoury, juicy, aromatick diet. The fymptoms had abated a little, he recovered fome degree of ftrength, and followed for a time his ufual employment, but was always weak; vomit- ing bile, and troubled with a cough. In the beginning of December, by the advice of a foreign phyfician, who had been im- perfeftly informed of his cafe by letter, he took pills of Caftile foap; he grew worfe every way: being called to him in the mid- dle of January 1757, I found him tor- mented with a conftant cough, efpecially in the night, with a prodigious expectora- tion of vifcid bilious fluff; his abdomen was diflended with water; he flept none, had great anxiety, his urine was in very fmall quantity and red, he had great loath- ing of vicluals, a thirfl:, the jaundice be- ginning to turn black, and his liver fwelled and hard. All hopes being gone either of a cure, or palliating the difeafe, I could

hardly

[ 124 ]

hardly prevail upon myfelf toprefcribcany thing ; a very eminent phyfician being con- fulted, anfwrers thus, that for the patient' % quiet it was perhaps necejfary to prefcribe fome^ what, which would not hurt and might look like the appearance of ajjijiance ; that mild aperient antifeptics, contrary to a bilious fu- irefadiion^feemed to be indicated-, nor will the fymptomatic cough be removed if the caufe re- jifts', and I dare fay it will refiji. Contriving a prefcription of this nature, and the ope- ration of the paracentefis being performed upon account of the threatening fufFoca- tion, the unhappy man drew out, for fe- veral weeks after, a miferable Hfe, which in all probability might have been longer, if after the firft bilious fever the proper reme- dies had been adminiftered; and if the in- flammation of the liver laft year had been difcovered and rightly managed ; if he had followed the direftions given at that time; and laftly, if he had not taken the foap pills, which are to be avoided whenever the humours are putrid.

It will be worth while to relate a more melancholy cafe from the relicks of bilious

fev€r:

[ 125 ]

fevers neglected. At Chriftmas 1751, my advice v^as defired by the relations of an unmarried woman above fifty years old* In the courfe of ten years (he had been fe- veral times afflifted w^ith a bilious fever, which was always accompanied with a de- lirium. The lafl, about three years before, had left her body torpid, and her mind ful- Icn, had brought on a weaknefs of fight, and a melancholy, which was increafed from religious caufes, and from a fudden fright changed into a violent delirium, flie was tormented with the moft dreadful ima- ginations ; fhe was fufpicious of her rela- tions and fervants ; and when fhe was a- wake, often fancied herfelf to be dead. Her pulfe was quick, foft, and the anxiety conftant; (he had no fleep. When I con- lidered every thing attentively, I foon dif- covered the caufe. The hepatick veflels ob- ftru6led by preceeding diforders, the brain weakened by febrile deliriums, and at pre- fent irritated both fymptomatically by the difeafe in the hypochondres, and pri- marily alfo by the bile mixed in the 3 blood.

[ 126 ]

blood \ The knowledge of the caufe point- ed out the method of cure. The collec- tion of irritating bile was to be evacuated, the obft;u6lions of the abdominal vifcera opened ; and the whole vafcular and ner- vous lyftem to be ftrengthened. I was obliged to confent at the earned: requeft of thofe about her to venefeclion, waich (lie impetuouily infifted on, and at the fame time refufed every thing elfe; little blood was taken away 5 it neither did the leaft good, nor much harm. An agreeable di- luting acefcent drink removed her thirft for two days, an emetic laxative draught dif- charged a great quantity of bilious matter ; and by the plentiful ufe of pills from acef- cent foaps, the decoftion of grafs, and the juice of groundfel, which was then fortu- nately to be had green, (he recovered her health very well, but laid afide her medi- cines fooner than was fit. Next fummer fhe drank the waters of the village of Vals

« In twenty deliriums (I would except a natural idiocy) both acute and chronic, eighteen arife from the hypochondria ; which is to be well remembred, that wCv may not hurt patients who are with fo much difficulty and fo rarely relieved.

in

[ 127 ]

in the Vivarois, for fevcral days In fmall quantities; the year following, 1753, in the fpring, flie had a fecond attack, but not fo violent as the firft, which yielded to acef- cent laxatives. A phyfician being confulted at a diftance, advifed the warm bath for twenty days, and ordered her to drink fix pints of milk-whey everyday, with a pow- der compounded of nitre, cream of tartar, and fugar. What advantage could be ex- pelled from the warm bath in this cafe ? In a (hort time it brings on a violent pa- roxyfm. The furgeon, taking upon him to prefcribe, opened a vein, which changed the circumftances much for the worfe. The obftru6lions, prevalence of the bile, weak- nefs, and irritability were increafed. The patient unknown to every body endeavour- ed to procure fleep by naicoticks ; the con- fequences of which were very mifchievous: the relaxation was heightened, the caufe of the diftemper more firmly rooted, and all the fecretions ftop'd, the brain entirely debilitated, and the melancholy greatly aug- mented; fhe received fome relief from an ele6luary of cream of tartar and extract of dandelion, with a decoction of grafs, in

which

[ ^28 ]

which a fmall quantity of black hellebore was boiled, and a little citron-juice. But her fullennefs increafing, and all the reme- dies being thrown afide, the paroxyfms be- came more frequent. During fix months every year fhe was delirious, and for other fix was not altogether fenfiblej the violence of the delirium was once appeafedby the cold bath, the frequent ufe of which I had re- commended. At laft, from the inclemency of the weather, fhe catched a peripneu- mony by fitting on the cold ground, and as far as I could learn was carried off in a few days. She was extremely fond of emulfions, and flie never took them with- out fuffering for it next day, for the flo* mach, being diftreflTed, affected alfo the i brain. Let thofe learn their miftake, who imagine bleeding and all kind of cooling medicines to be indicated by a delirium ; Hippocrates was not of their opinion, who has obferved and accurately defcribed a dif- temper very hke this, which he directs to be cured by black hellebore, water, honey, and vinegar ^

^ He calls it a grofs dijlempcr from biky when the htU flows to the liver ^ andjiagnates in the head, De Intern, afFea. Cap. LI. Foes. p. 558.

Some

[ 129 ]

Some examples I have obferved of a dif- ferent appearance in obflructions of the livery one cafe I fhall recite. A bulky woman, fixty years of age, in the year 1755, being feized with the epidemic fever and cured by a furgeon, never perfectly re- covered her health, but was always weak, and heavy, often fhort breath'd, and at other times troubled with a loathing of vie* tiials. From the month of June fhe was more feveiely diftrefTcd by the foregoing fymptomsi and a fliarp biUous purging came on which often returned ; her belly frequently fwells as if fhe had a tympanitis, and almoil conftantly gives her pain, fo that file cannot bear the leaft tightnefs of hercloathsj her appetite is entirely gone, and (he naufeates meat particularly ^ Ihe is often thirfty, fleeps very little 3 the region of the liver is fwelled; her urine fmall in quantity and turbid. What then is the caufe of the diftemper? a biUous obftruc- tion left in the liver two years ago; and now the morbid matter being colliquated, putrified, and fet in motion, occafions all the foregoing fymptoms, and will probably produce more dreadful ftill ; for the liver

K will

t 130 ]

will totally putrify ; and there will follow an hepatick confumption, a tympanitis, afcites, jaundice, and death; unlefs the violence of the diftemper can be reftrained by remedies, which I doubt-. I thus direft- ed the method of cure , her diet to be of acefcent vegetables; the medicines made from the acid foaps, with drink of the fame nature, to correft the putrefaction, and not prevent the evacuation of the putrid matter. They feem to do good; I fliall a- void draftic purges for they would ruin

every thing. 1 wrote this above two

months ago, but while the firft fheets by the printer's delay were ftill in the prefs, a fatal ifTue confirmed the truth of my prog- noftick, and the patient, remaining in extremity for three days, died this day.

There are exceptions of fome cafes which require a peculiar method of cure; a girl of eighteen, of a fcrophulous family, was feized with the epidemick diftemper in win- ter 1756; the was put into the hands of a quack of the loweft kind, and though fhe had the diftemper very favourably, yet it left behind it a deafnefs, and affeded her

mind

C 131 ]

mind fo as to lefleii the qulcknefs of her apprehenfion, fo that fhe was not fo fenfible as before ) her fkm was alfo frequently dif- figured with itching puftules of a dry kind of fcab ; I believed that in this cafe I muft pay a greater regard to her fcrophulous dif- order, than to the bilary obftru6lion of the liver : for fuch is the nature of the fcro- phulous poifon in adults, that it is increa- fed and not fubdued by a fever and pro- duces infarftions in moft of the fmalleft vef- fels. I emptied the primae vise and prefcri- bed Plummer's alterative, with millepedes, fugar, and camphor. This is not above fifteeen days ago and fhe finds herfelf bet- ter already ^

c See the author's paper concerning this ufeful re- medy, and a tranflation of it, which the illuftrious WcrlhofF a man of great chara(Rer in the profefTion has publiflied in a book by itfelf, together with his own animadverfions upon it; it fucceeded better with me in the form of a powder; it is fuccefsfully mixed with fu- gar and millepedes. The camphor I added upon ac- count of its virtue in preventing a falivation, which I am well convinced of both by my own experience and that of others. But I would not have it from thence imagined, that I always avoid a falivation in fcrophu- lous diforders, for I have happily cured many fcrophu^ Jous tumours of the tracheal, jugular, and maxillary glands by that evacuation.

K 2 Relicks

\

[ ^3^ ]

Relicks from Debility.

I mentioned a third kind of relicks, namely, thofe which proceed from a re- laxation of the fibres : for the bowels contra^ a debility both from the fever and from the medicines^ whence follows a relaxation of the partSy which requires aftringents and corrobo- rants "^'y Sennertus among the indications in a putrid fever reckons rejloring the parts debilitated by the febrile heat and morbid mat- ter to their natural temperament andflrength *. Laxity of the fibres is generated in fome parts after too great tenfion, in others after too frequent vibrations, in all by heat, de- fe6l of good nutriment, and the influence of putrid humours. This is not a proper place to enumerate the pernicious confe- quences, w^hich attend a lax fibre; but the principal fymptoms which appeared in our cafe were, i. a certain dulnefs of the fenfes; and this was only in fuch as had been ex- tremely ill 3 neither were they all affecled

^ Primerofe de febrib. Lib. II. c. 9. p. m. 166. * De febrib. Lib, II, cap. iv. p. 146.

thus ;

[ ^33 ]

thus 3 // was attributed to the brain's being weakened by the jebrile heat^ and it always ceajed in a few weeks ^^ and generally the vigour of the mind returned in equal pace with the flrength of the body, fo ftrifi: is their connexion -, nor would a perfon have fulpe£ted two diftinft fubftances, if he had been taught by phenomena alone, and had liftened folely to reafon.

Our minds as v/ell as bodies feel

The power of medicines that change, or heal -f .

2. The ftrength was recovered more flow- ly than is common after acute difeafes, for this reafon, if I am not miftaken, that the flomach, and other parts fubfervient to digeftion, had fufFcred much more da- mage in this difliemper than in other acute cafes, by the morbid matter continually oppreffing and irritating them : the repeat- ed evacuations alfo by ftool increafed the debility, for they are always hurtful to the

^ Kloekhof. loc. cit. p. 113. t Lueret. by Creech, Lib. 3,

K X ftomach

[^34 ]

ftomach and inteftines. And while the di- geftion is impaired, the ftrength cannot be reftored. In fome, where the nerves were greatly weakened, (and their ftrength is clofely conne6led with the vigour of the ftomach) I could obferve a tendency to ir- regular motion and its fymptoms, elpeci- ally involuntary tears. Their meagernefs went off when they recovered ftrength, fometimes fooner, and I perfectly remem* ber to have feen feveral, who prefently af- ter the return of their appetite grew fat on a fudden ; but it was a foft turgid kind of fat grofsly elaborated from the nutriti- ous matter, and having its particles imper- feilly united together. Nothing did more good in that cafe than exercife. A boj who Vv^as a ftranger, was afflided with al- moft all the fymptoms proceeding from de- bility; he was ekven years old, of a weak texture, and delicate conftitution, and had recovered, as I v/as informed, with diffi- culty from the meafles a few months be- fore. In the beginning of July he was feized with a debility, lafiitude, and loath- ing in the fame manner as all the reft; but what was peculiar to himfelf, he had at the

firft

[ ns ]

firft attack of the difeafe an erruption hardly to be defcribed in the middle of the anterior part of his neck. In its nature and quality it refembled the herpes, but its figure was very uncommon, for it confift- ed of two concentric circular fafciae, which could not have been more accurately d^-* lineated by the moft expert mathematician. Each fafcia was three lines broad; the di- ameter of the internal circle (including the breadth of the fafcia) was almoft two inches, the correfpondent one of the exter- nal was equal to three inches. I prefcri- bed a vomit of Ipecacuan with half an ounce of manna; he grew better, and the erruption becoming gradually dry, difap- peared entirely in a few days; and his ap- petite was reftored; not eight days after, he went into the warm bath without con- fulting me, upon which his diforder fud- denly returned with more violence; every thing was done, which the circumftances required, without neglefling his particular conftitution; neverthelefs he was very ill for fix weeks; oppreifed with a continued fever and daily exacerbations of it, the greateft averfion to food, and an almoft K 3 con-

[ 136 ]

ftant purging. From the fecond week his brain was weakened, he faltered in his fpeech, and his memory was impaired ; when he got out of bed, he had forgot how to walk, and fhed tears without any rea- fon; his appetite was craving, but if he indulged it too much, it was foon followed by a lientery or the fever, nor was his ftrength reftored for three months after, and being weak, he ftill kept by the fire fide \ He had grown much before the dif- temper, he grew while it was upon him, and he continued growing in his own coun- try; and I heard he had fcarce recovered his health in half a year, which appears to be owing to his too quick growth -, for m fuch circumftances, nutrition is but im- perfe6lly carried on, the nutritious particles are brought near to each other, but not compacted, the fibres remain lax and unfit for all functions. Crude humours are col- lefted and ftagnate every where, for a ca-

^ I leave It to the judgment of others, whether the imperfect crifis of the meafles did not contribute its (hare in this diftemper. Indeed I think that can hardly be doubted when it is confidered what happened before the diforder, what were its fymptoms, duration, and coiifequences.

chexy

[ 137 ] ohexy always follows debilitated fibres; and by many inftances which I have caretully collefted, this fudden growth has always appeared both in fevers and at other times to conceal under it fomething very perni- cious; I have feen many weakened by it and languifliing for feveral years; fome arc feized with a fatal confumption, and in others the diforder being propagated to their more advanced years, has brought on a bad ftate of health for all their lives after. Nothing does fervice in this cafe but corroborants of all kinds, both by diet and medicine. Ex- ercife, friflions, ligatures, aromaticks, fteel, bark, and generous wines are found to be of admirable ufe. Nothing worfe than evacuations of all kinds; nothing better than the cold bath, that noble remedy, w^hich, guided by nature, wife antiquity both prefcribed and admired ; whofe falu- tary effects are pointed out by phyfics, and confirmed by the daily practice of thofe nations, whom we call barbarous, that is, not yet corrupted in our way; alfo by the obfervation of the Englifli, and my own . experience; for whenever there is a relax- ation (and where do we not meet with it in

thefe

t 138 1

thefe days ?) and the diforders which ac* company it, impaired concoction and di- geftion, weaknefs, and irritability of the nerves, the whites, and the numerous con- fequences of thefe; provided we are not deterred from its ufe by incurable obftruc- tions or vomicae, there is no remedy equal to it from the firft dawn of life " even to old age; and I do not fcruple to affirm, that unlefs its ufe be reftored, that degeneracy of the human frame, which every body fees and deplores, but none remedy, will grow worfe and worfe; on the contrary, it is increafed by the perverfe and deftruftive cuftom (except in a few cafes) of hot bath- ing, which deftroys in a fhort time the ftrength of a Hercules, and by bringing on debility paves the way for a thoufand complaints, for he who is weak is next door to one who is fick \ But to return from this

" Unreafonable prejudice carries mothers too far, when they dip their infants in cold water ; but I know feveral inftances, where a milder method has anfwered "stxy well ; wafliing the child all over twice or thrice a day, beginning at the head, with a fponge dip'd in cold water; and thus they are greatly ilrengthened ; and all the difeafes prevented which proceed from debility.

^ Hippocrates de Prifca Med icin. Foes, p. 12.

digreffion^

C 139 ]

digreffion. I durft not venture to gwc what we call aftringents to the weak pa* tients, left they (hould immediately bind the body, which muft be kept open for a long time. But my hopes were anfwered by mild bracing medicines, generous wines, friftions of the abdomen, which are never to be neglefled in lax cafes, and exercife, care being taken at the fame time not to overload the ftomach with a quantity of food, for nothing is a greater hindrance tQ digeftion, nor confequently increafes the debility more; nor was it always eafy to manage this point, when the patients, af- ter long abftinence, were poflefTed with fuch a defire for food, that it was hardly poflible to reftrain the younger people ef- pecially ; but they very quickly fufFered for their tranfgreffion.

Some were tormented with pains of the ftomach, which were eafily cured by any bitters infufed in wine, or an elixir to ftrengthen the bowels.

I obferved another fymptom exceedingly troublefome, that is, obftinate watchings,

or

[ I40 ] or at leaft unkindly deep, which I attri- buted to three caufes. i. To the diforderly motion of the nervous fluid, which always harafles people who are recovering. 2. To difufe ^ for repeated obfervations have fliewn, that fleep habitually prevented for fome time even in perfeft health is reftored with difficulty, which I myfelf can teilify to my forrow. 3. To the weaknefs of the flomach ; for Jleep depends entirely upon the Jlomacb °, which but too plainly appeared

from

° Boerhaav. Refponf. Confult. circa Dyfent. Caf- trens. Confult. T. 2. p. 22. Conferant. illuftr. Haller Lin. Phyfiolog. § 578, where he defends our opinion. Other Phyfiologifts of equally great name, the illuftri- ous Boerhaave, Senac, and many more reckon a quan- tity and the vifcidity of food among the caufes of fleep ; is nature then different from herfelf ? or are thefe great men miftaken ? Neither ; for natural fleep always fol- lows a certain defect of animal fpirits, and a compofed motion of all the other humours, or a freedom from anxiety and pain. When any of thefe conditions are "wanting it cannot fucceed. Now then a fluffed fl:o- mach in a found robufl: man, from the ftimulus of the aliment draws to itfelf a greater afflux of fpirits, whence they are deficient for the other fundtions : nor is it fuch an irritation as creates the fenfe of pain or anxiety ; for in a found man the fpirits are always compofed, 'tis no wonder therefore that fleep follows, but in a weak patient the cafe is quite different, the fpirits are deficient, and yet fleep is wanted too ^ from what rea-

fon ?

[ HI ]

from the bad fuccefs of thofe, who en- deavoured to procure fleep by emulfions, nitrous medicines, narcoticks, and bathing the feet in warm water, for they thus every day chafed away fleep farther from them, brought on a languor of the ftomach and general debility. This watchfulnefs re- quired no other cure than the flrengthening one fufhciently defcribed before, victuals of eafy digeflion properly drefs'd, a light fup- per, and abftinence from hot aqueous li- quors ^. Malaga wine or that of Alone

fon ? becaufe there is not a compofed regularity in the nervous motions, for from crudity, as I faid before, proceed irregular motions ; befides all the functions arc a kind of labour to a weak perfon ; if then the ftomach be loaded, which in a found man by giving a gentle ftimulus, would have procured fleep, in a fick perfon on the contrary by ftimulating too much, and occa- fioning a univerfal labour, and increafmg the crudity it brings on pain, anxiety, irregular motions, and watch- fulnefs. Laftly, we may obferve, that although fatiety fometimes produces fleep, it is very feldom that placid, fweet, and refrefhing fleep, which follows fobrlety. Nor will any perfon believe that Boerhaave himfelf was ignorant of our diftin<5lion, if he compares the place quoted with that admirable chapter upon fleep in his Inftitutes.

P Sleep is prevented by the continued flow mixture of hot aqueous liquors with the blood. Boerhaav. Inft, § 592.

before

[ H2 ]

before dinner and in the evening fucceeded admirably. Sometimes upon the autho- rity of Boerhaave I ufed the Flor. Mar- tial ^. and with fuccefs; and what has a nearconneftion with the prefent cafe, I remember to have cured fome years ago a lady who every night, and often in the day time too, had been tormented for fixteen months with a mofl: violent tooth-ach, and obftinate watchfulnefs. Venefe6lion, ca- tharticks, bathing, mineral waters, and all kinds of cooling medicines, not only gave no relief, but incr eafed the diforder. I advifed her to take twice a day and at bed time, an in- fufion of aromatick and ftrengthening fto- machicks in wine: the fymptoms foon abated, andinlefs than a month, the pains went en- tirely off, and her fleep returned. I was in- formed very lately by the illuftrious Haller, whom I never converfed with, without learning fomething from him, that after thofe eryfipelatous fevers, with which, to the great grief of all good men, he is of- ten afflidled, his fleep, which all cooling xne<iicines prevented, was beft reftored by

^ Chcmia Pfocefe, 169^ T. II. p. 286.

that

[ H3 ]

that generous Spanifh wine, which goes under the name of mountain.

When our patients were compleatly re- covered, they enjoyed a much more pro- found fleep, than they had done before the diftemper, and the caufe of this is pjain.

I FOUND in fome, efpecially the younger fort, the fymptoms of a flight fever in fome meafure refembUng a heftic, which I ima- gined to arife from no other caufe, than the labour in nutrition; nor was it the fe- ver we were to cure but the debility ; un- lefs we were unfuccefsful with regard to the latter. And that pernicious praftice ought to be here condemned, which from the fenfation of heat infers the neceffity of refrigerants, as they are called by the wri- ters on the Materia Medica, for that fen- fation very frequently arifes from the acri- mony and crudity generated by relaxation and the deficiency of good juices; and of- ten a fever is caufed by a defeft in the cir- culation. How many people every day have their health deftroyed, by having re- 3^ courfe

[ ^44 3 courfe in fiich a cafe to venefeftlon, re- frigerants, clyfters, and warm bathing; the debility, crudity, acrimony, and trouble- fome heat increafej and at laft a true hec- tic fever comes on, which might have been prevented by corroborants, Peruvian bark, fteel, wine, and the cold bath. Nothing occurs more commonly in praclice, than patients complaining of a heat, echauje^ merit as they call it) and phyficians are grosfiy miftaken if they proceed upon the antiphlogiftick method 5 for no art what- ever is perhaps able to raife in fuch patients that inflammation, which they endeavour to remove. A true heat^ par- don the expreflion, is a flight inflamma- tion; but a falfe one difl^ers from an in- flammation; fome fymptoms at firfl: fight are common to both ; if then in both cafes, deceived by the outward appearance you employ the fame method, which alas too often happens, in the one you will cure your patient, and in the other kill him.

'Tis hardly worth while to mention a fymptom, which alarmed the patients

greatly,

4

[ '45 ]

greatly, but was not attended with any danger, I mean an univerfal anafarca, which many of the older people were at- tacked with; it generally vanifhed fpon- taneoufly as the ftrength recruited; I nei- ther faw nor heard of any body who in this cafe remained truly dropfical; the cor- roborant medicines fo often mentioned be- fore were fiifficient for the cure. In an oedematous fwelling of the legs, which was a little more obftinate, I ufed the acid tin6lure of fteel, and likewife rolled the parts with linnen bandages moiftened with brandy and vinegar, which were drawn a little tighter every day. Such a method would have been hurtful, as will appear afterwards, in a fwelhng caufed by ob- ftrucHons.

If this difeafe, improperly or imperfeflly cured, entailed troublefome relicks on fc- veral, it procured to others more confirm- ed health.' For by purfuing the proper method, all the fordes adhering to the bowels were evacuated, all obftruftions cleared, and every acrimony flieathed, and I may affirm of the fever at Laufanne, L what

[ ^46 1

"wKat has been faid concerning intermittent fevers by Dr. Kirkpatrick, to whom man- . kind are greatly indebted for his excellent book upon inoculation ', that it prepared the patients for a favourable fmall pox. I attended three boys in the epidemic fe-, ver, and did Hot leave them till they were perfectly cured y in lefs than a month they had the fmall pox fo favourably as not to fend for me, and I faw them accidentally; two were of ten years, and one of thir- teen. Laft fpring a noble German twenty two years old was feized with the fame tilious fever, at the time when he was under a regimen for inoculation; I re- moved the diftemper, and advifed him to eat as much fruit as was agreeable to him, the whole fummer. Giving nothing elfe but a laxative potion on the 14th of Sep- tember, I had him inoculated with a va- riolous thread on tke 1 6th ; a milder fort of the difeafe cannot be defired than his,

' Perhaps a late recovery from fuch a moderate inter' mhtent as. had left no infarSfions of the vifcera behind ity wight conflitute a temperament that would not violently co-operate with the variolous infc^lion^ &c. The Analyfis ©f Inoculation, p. 219.

although

[ H7 ]

although he had above two hundred puf- tules, and they came to maturity perfedly turgid with a fine matter *. Nor will this appear ftrange to any one, who has ferioufly confidered this point ; for the fecret of in- oculation confirts in giving the variolous infeftion to a body free from all rigidity, relaxation, debility, obftruftions, cacochy- my, poyfon, and every other diforder -, m a word to a found, but not an athletic body. The art of preparing is to pro- cure fuch a habit to the patient, and to remove by various remedies the feveral dif- orders mentioned 3 but let thofe be left to an unhappy fate, who labour under any incurable difeafe. Any one may eafily per- ceive that our patients, who were cured, pofTeffed all the requifite conditions ; a bi- lious cacochymy ' is to be feared beyond every thing, and none were more diftant from it, than they when properly cured.

« I had taken this thread on the 17th of July I75'5> that is twenty-fix months before; I have not heard that they have been ufed fo old ; and it is of importance to know, that fuch an age does not impair their virtue 5 for the patient began to grow ill on the 22d of Sep- tember.

* Kifkpatrick, ib. p. 233.

L z Having

[ 148 ]

Having thus gone through the hiftory, method of cure, and relicks of the difeafe, it remains to relate the cure of fome fymp- torns,^ and examine into certain remedies, ufed by others, which I entirely omitted with defign.

T'he cure of the fymptoms,

A Phyfician, who undertakes the cure of fymptoms, ought to remember Bennet's rule 5 take heed that the trunk does not groWy while you are lopping off the branches ", and the caution of that great phyfician Gau- bius, direB the cure not to every fymptom^ but only the mofl urgejit : for the effects of the dijlemper ceafe^ when itfelf together with its en life is removed ^ and the fymptoms are fome^ ti?nes fo different y nay and oppofite as to give contrary ijidi cations ''. And indeed the fymptoms are not many, which require a peculiar treatment, nor is any thing ever to be given, which is calculated to aggra-

" Theatr. Tabid. Exercit. 27. de ufu perdulcium, p. m. 91.

* De Method, concinnand. formulas Medicas, § 45.

^ vate

[ H9 ]

vate the caufe of the diftemper. An in- cautious perfon may be very eafily decei- ved, by the various appearances of a dif- eafe, but contraindications occur more rarely, than is perhaps credible, and thofe fymptoms, w^hich at firft fight feem con- trary to the genius of the diftemper, have the fame origin v/ith all the reft, and are happily removed by continuing the prin- cipal remedy. Depending upon thefe axioms, I very feldom paid any particular regard to the fymptoms. Stools were the only relief for the head-ach, it was miti- gated a little by the women applying lin- nen cloths wQt vt^ith vinegar. My reafon for rejecting narcoticks in the moft cbfti- nate watchfulnefs, will appear afterwards. , Paintings were extremely rare, and a phy- fician feldom meddles with them. The purging neither required, nor would have bore any other remedies, but evacuants and acids. Endeavouring to create an ap- petite by hot aromaticks, would have been abfolutely wrong. That changeable me- thod of cure is ridiculous and pernicious, which being directed fometimes to the head, fometimes to the breaft, now to the L 3 kidneys,

[ I50 ]

kidneys, and then to the inteftines, does no good at all but a great deal of harm. I have therefore only one cafe worth re- lating in which I attended to the fymp- toms.

A German ftioemaker, of Zurich, if I remember right, was feized with the epi- demick fever in the month of Oftober 1755. I was fent for on the third day, and ordered a vomit on the fourth, and other fuitable medicines ; but the obftinate man drank very little, being averfe to it, nor did he obferve fuch a diet as I had prefcribed; on the eighth day I purged him^ on the tenth the tumid inflation was fo great, that the fkin of the abdomen be- gan to grow red from the violent diften- lion: his breath was very fhort from the impoffibility of the defcent of the dia» phragm, his pulfe was fmall, and what furprized me, he was almoft free from a delirium. Being afraid of the mifchievous confequences from a compreflion of all the bovi^eis, and an obftrucled refpiration; finding no other caufe but air rarefied by the bile, whofe putrefaction he had not

fufficiently

r 151 J

fufficiently correfled by drinking, and be- ing fatisfied from feeling the abdomen be- fore, that there was no obftruftion prior to the diftempers and having to do with a fallen patient who would hardly conform to rules, and employing my thougjits in fearching for a remedy, which would moil quickly ftrengthen the fibres, reftrain the flatulency, and Hop the putrefaction ; I re- colle6led the obfervations of the antients and fome moderns, and my own experi- ence with refpect to cold water. Having weighed them all carefully, I ordered a lin- nen cloth, twice doubled dipt in cold fpring water, to be applied over all the abdomen, and to be changed every quarter of an hour ^, and the patient to drink as often L 4 three

y In an ardent bilious fever Hippocrates prcfcribes the fame remedy ; fy/jen the heat is very greaty apply hnnen cloths d^pt in cold water to the party where the patient complains of the heat beintr mji violent, de In- tern. afFeft. cap. xlii. p. 553. Confer. Alexander de Arte Medend. Lib. vii. cap. xv. Coelius Aurelian. de Acut. paflion. Lib. iii. cap. xxi. ^Etius Tetrab. 3. Serm. 4. Cap. xxvii. xxviii. Th. Bartholin de Ufu Nivis, Cap. xxiv. Bianchi p. 582. Zacutus Lufit. cured a young man of a very bilious habit by this means, after all other remedies had been tried in vain.

When

[ 1.52 ]

three ounces of the fame water. In two hours the fwelling of his belly fubfided, his refpiration became eafierj in lefs than three hours a flight colick came on, which produced many large bilious ftools, with a continued difcharge of wind 5 the linnea

IVhen the pain fays he, was very violent^ and the thir/I t'Oublefomc^ I made an application of fnow to the painful p^rt^ and gave the colde/i water with fugar to drinky fcarce half an hour paffed till the patient cried out he was well, Prax. admir. Lib. II. Obftrv. 23. p. m. 195. It may be objected perhapr, that he treats here of a colick, and not a flatulent fwelling ; but I make the conclufion a fortiori-, where the caufe is the fame, what does the variety of fymptoms fignify? it is not our bulinefs to explain, why the fame bilious cacochy- niy produces at different times a colick, cholera, iliac paflion, dyfentery, and apoplexy ; but reafon dictates, and experience has proved the fame remedy to fucceed in alL cafes. Nor are we deftitute of obfervation% which bear a near refemblance to our cafe, principally that recited by the famous Combalufier in his ufeful Pneumatopathologia. A wcj-nan laboured under a tympanitis, the choireft remedies had no efFe(?c, and Dr. Raft a judicioL^s and experienced phyfician at Lyons, cured her by the external appl.cation, and drinking of cold water. I know feveral, who have cured violent cholick pains, after other medicines were tried in vain, by applying cold water in a fit of defpair. A rafh attempt undoubtedly ; for a violent remedy ufed cautioufly may do great ftrvce, but improperly, it is likely to produce the worft difeafes. A cure is pru- der.i.y condudled by a prudent phyfician^ meddle not if you he ignoia..t cf the method,

cloths

[^53]

cloths were taken away, the following night he flept, and next day his belly was foft, the fever much abated, and in a (hort time he got well, without changing his drink, which I often found exceeding fa- lutary; and it is to be lamented that the ufe of water has grown obfolete. We give nothing now, unlefs it be prepared, and often fpoiled by the apothecary's art. The wiler antients, when the concoftion v/as perfcfted gave cold water, an excellent llrengthener, and as much of it as the pa- tient was willing to drink, as appears from the works of Hippocrates, Aretaeus ^, Ga- len % Alexander \ Caelius Aurelianus \ and others. Galen has even reproached his co-temporaries for neglecting the ufe of cold water, and calls them Hydrophobi. Among the moderns Fernelius **, HofF-

^ Lib. IF. cap. vlii.

* Method. Meclend. Lib. ix, cap. vi. well worth reading.

^ Lib. vii. cap. xv. Lib. xii. cap. ii.

^ Ue Acut. paffionib. Lib. IIL cap, xxi.

^ Method. Curand. fsbres Cap. II. Oper. p. 389.

maa,

man \ Van Swieten ', Kloekhof \ Grain- ger ^, and many others have prefcrlbed cold water, and added cautions, for its ufe.

. Convulsive motions of the limbs ari- fing from the fympathy, v^hich is caufed by the connexion between the Exth pair of nerves, and all thofe of the fpine re- quire no particular remedies, and with fome the ufe of antifpafmodic animal fub- ftances had a very bad efFeft, though fome- times the fpafmodic fymptoms appeared to be the principal diforder. A worthy cler- gyman laboured under a fever, headach, and naufea, but no fymptom was fo trou- blefome as violent convulfive (bakings fre- quently returning, which being propagat- ed from the diaphragm, or fome conti- guous plexus, greatly difordered the whole body; at other times the tremulous mo-

*^ De Method. Med. Se6l. II. cap. xi, p. m. 469. De Inteftin. dolorib. Obf. iv. & v. t. 4. p. 293. Edit. fol.

• Aphor. 640. Tom. II. p. 21 5. where he treats with his ufual judgment upon the ufe of cold water in fevers, ib. Aphor. 730. p. 422. ApH. 743, p. 494.

f Opufcul. p. 18.

« Febris Anomal. Batav. p. 79.

tion

[ '55 ]

tion afFe£led only one or two particular members. If I had adminiftred the me- dichies called nervous, I would foon have brought my patient to his grave ; but pay- ing no regard to the fymptom, I evacu- ated the bilious cacochymy by vomiting, catharticks, and acids. The famous AU berti took the fame method ; When convuU five motions threaten^ particular care miijt be taken that the bile be properly excreted^ that the belly be open^ or kept Jo by clyjiers ^. And many ages before Alberti, Galen has given us admirable obfervations : In Jome fevers we have J c en ^ fays he, patients fuddenly feized with a convulfiony when there was no preceed- ingfigntoprognofiicateit^ and by the coming on of a bilious vomitings they have been im- mediately freed from all danger^ and fome of them thus afeBed have vomited fluff of a brown colour^ and others a liquor refembling juice of leek'\ And if we look into Van Swieten, who has been fo frequently quot-

^ Ubi. fupra p. 770.

* De AfFea. Loc. Notit. Lib. V. cap. v. Oper. omn. T. IV. p. 125. In which place, nay in the whole book will be found valuable obfervations hardly to be jnet with among the moderns,

ed.

C '56 ]

edj and who cannot be too often quoted, we fhall find that ivhile the acrid bile fluBu- ating in plenty about the prcecordia^ dijlurbs the functions of the brain^ giving a vomit will quickly remove fuch a caiife of a febrile convul- fion ''. After the evacuation of the bilious coUuvies, I prefcribed corroborants, being affured that all diforders of the nerves ea- fily become habitual, if their tone is not reftored 5 which caution being neglected after acute diftempers often paves the way for a nervous languor; nor indeed, by the way, do I know any other cure for ner- vous difcafes. If there is any ftimulating fubftance, which by continual irritation caufes the paroxyfins, let it be taken a- w^ay, and then Jet fti*engthners be made life of. If there be no fuch thing, then corroborants will fully anfwer the purpofe, v\rithout any ftrong evacuants which are to be avoided.

^ Aph. 713. T. I r. p. 359. You will find rides againft the abufe of fpecificks which cannot be too much inculcated ; for convulfions immedi,ite!y fernfy the relations, they earneftly call for remedies and ad- jpiinifter them \ and a Vv'eak. or wavering phj-fician fuins all.

I

[ 157 ]

I WOULD not clofe the account of the diftemper without obferving, thaft the bile, or a putrid cacochymy often occafionsmore mild and fhorter fevers ^ every body has met with an ephemera, or fimple fyno- chus from this caufe ; for if it have a ten- dency to motion, be fmall in quantity, and have its principal feat in the intef- tines, it will raife a fever, violent indeed, but foon ceafing either by fpontaneous or procured evacuations ; feveral being ha- raffed for a night and a day are perfectly reftored, if they clear their ftomach and bowels by one or two plentiful evacua- tions, if the caufe is more fixed, the lan- guor is protracted for three or four days. But It is tedious to infill on thefe things.

Of

Of Bleeding in Bilious Fevers.

THOSE people, who are fond of veneftftion, attribute every difeafe to the blood, and are inceflantly talking of a plethora and ftagnation, and omit bleed- ing iri no diftemper, will be amazed, that I have not made the leaft mention of it, though we frequently had heat, drynefs of the ikin, headache, a violent delirium, and acute fever, which might feem to require fuch an evacuation. But it is a fad mif- fortune to thofe, whofe phyficians make no enquiry after the caufe, and are for- ward to flop all violent fevers by bleeding ; for when the fever is increafed after the operation, it kills the patient \ It is now four years fince I publifhed my opinion "", that venefeftion is never ufeful when there is not a plethora ; I may add, except in the beginning of an inflammatory diftem-

* Such an indication is entirely oppofite to the doc- trine of Hippocrates, who was fo much afraid of bleeding upon account of a fever ^ that he often fhought proper to forbear it for that reafm,

" Inoculation juftified, p. 49,

per.

[ 159 ]

per, or while It is in a crude ftate, after violent exercife, being heated in the fun, a fall, and in people only, that ftriftly are not plethorick, but robuft, fanguineous and florid. And far from changing my mind fince that time, I every day meet with the mifchievous confequences of bleed- ing, where thefe conditions are not found, I grant that redundancy of blood may bring on diftempers, which indicate bleed- ing ', but the blood repells diftempers that do not arife from itfelf ; for the more a perfon has of this vital fluid, provided he is not plethorick, and that is not frequently the cafe now-a-days, the better is his fituation, and he is the more able to refift the pro- duflion and attacks of other difeafes. The more blood therefoie he lofes, the more obnoxious he will become to them ; for it is abfolutely certain, that an evacuation of blood from a found man who is not plethoric, difpofes what is left to a caco- chymy, depravity, and the diforders pro- ceeding from putrefaclion. But let us confider the point more attentively with regard to the bilious fever, by examining

firft

[ i6o ]

firfi: whether the lancet can do any good, and fecondly, whether it can do harm.

The indications were to evacuate the morbid ferment, fituated without the laws of the circulation in the veffels of the flo- mach, inteftines, mefentery, and liver; to correct the putrefaction which was generated, and to ftrengthen the bowels. What could bleeding contribute to thefe ends ? That will appear by examining its efFe£ls. i ft. It diminiflies the quantity of blood, and thus removes diftempers arifing from a redundancy. 2dly, When, from the too great ftrength of the veffels, and the increafed force of the circulation, from any caufe, in a robuft body, blood in- flamed and condenfed is accumulated and ftagnates in the arteries or veins, venefec- tion by leffening the impetus, relaxing the veffels, and emptying the fmalleft ones, promotes the refolution and repulfion of the impafted matter, or its reforption if it bediffdfed. 3dly, It produces relaxation, and from thence debility with its confe- quent diforders, increafes the irritabiUty and paves the way for irregular commo- tions,

[ i6i ]

tions, as we learn by innumerable obfer-* vations. For who has not feen bleeding followed by faintings, tremors flatulent fpafms, as they are called, univerfal, or partial ; a delirium, fever and convulfions : when improperly ufed to feveral girls for fainting fits, or hyfleric fufFocations, it has brought on real and dreadful convuU five motions. I very lately faw fuch a cafe, where a furgeon afting the phyficiaa had prefcribed bleeding in the arm, a clyfter of aftringent red wine, and a draught with yolk of egg, oil, and feveral other things of the fame nature ; by this means (and it was not poffible it fhould be otherwife) the convulfions were hardly re- moved in feven days. Whereas if he had been quiet, that paroxyfm like feveral o- thers would have gone off fpontaneoufly, and left an opportunity for adminiftring preventive medicines. Whoever then will compare the indications in our difeafe with the effefts of this remedy, will foon be fa- tisfied, that it could not in the leaft pro- mote them ; for there was neither pletho- ra, inflammation, nor rigidity; Now let us confider whether it did not augment M the

[ l62 ]

the violence of the dlftemper ? It is very eafy to prove it did.

ift. Every remedy and efpecially bleed- ing, where it does not do good, is preju- dicial 5 for whenever it does not remove the caufe of the difeafe, it waftes the ftrength, the prcfervation of which is fo important, fcr notbijjg conduces more to a certain cure^ than that the ftrength of the patient be unJJmken : it is therefore to befup- ported by all means'''. For the more the ilrength of the patient, which is all the remains of his health, is weakned, the greater will be the violence of the difeafe.

2dly, Bleeding relaxes ; and from re- laxation follow two very bad fymptoms> quite, contrary to the indications, an in- creafe of the putrefaftion ° and weaknefs of the bowels, whereas it was our aim to ftrengthen the bowels, and deftroy the putrid cacochymy. But ta prevent ob-

^ Van Swieten Aphor. 598. I. 2. p. 96.

o Whatever relaxes in general, difpofes to corruption* Pringle's difeafes of the army, p. 182. Confer. Baglivi de £br. motr. lib. poft fp. cap. 17. p. 394.

jec-

je6lions from cavillers, we muft enter into a fhort difquifition which the intelligent reader will pardon. By a violent inflam- matory fever, fay they, the whole mafs of blood grows putrid, and this putre- faction is prevented by bleeding, in what way then does it promote putrefaftlon in another acute fever ? The anfwer is plain, changing the ^circumftances, the effe£ls alfo vary ; the indications in an acute in- flammatory, and an acute putrid fever are widely different. In the firft, a purulent or gangrenous putrefaflion is generated in the fanguineous vefTels from an excefs of motion, and violent heat. In a putrid gaftric diftemper, we have to do with fordes depofited without the veffels of cir- culation, which are accumulated there by reafon of the fluggifhnefs of the folids, and by their fpontaneous putrefcence, relax all the parts and produce flatulencies 3 whic