as the first, the principal, and often the only remedy made use of by this great physician to answer most of the intentions above mentioned: by means of it he opposed the moist to dry, hot to cold, &c.; and what he looked upon to be the most considerable point was, that thus he supported nature, and assisted her to overcome the malady. The dietetic part of medicine was so much the invention of Hippocrates himself, that he was very desirous to be accounted the author of it; and the better to make it appear that it was a new remedy in his days, he says expressly, that the ancients had wrote almost nothing concerning the diet of the sick, having omitted this point, though it was one of the most essential parts of the art.

The diet prescribed by Hippocrates for patients labouring under acute distempers, differed from that which he ordered for those afflicted with chronic ones. In the former, which require a more particular exactness in relation to diet, he preferred liquid food to that which was solid, especially in fevers. For these he used a sort of broth made of cleansed barley; and to this he gave the name of ptisan. The manner in which the ancients prepared a ptisan was as follows: They first steeped the barley in water till it was plumped up; and afterwards they dried it in the sun, and beat it to take off the husk. They next ground it; and having let the flour boil a long time in the water, they put it out into the sun, and when it was dry they pressed it close. It is properly this flour so prepared that is called ptisan. They did almost the same thing with wheat, rice, lentils, and other grain: but they gave these ptisans the name of the grain from whence they were extracted, as ptisan of lentils, rice, &c., while the ptisan of barley was called simply ptisan, on account of the excellency of it. When they wanted to use it, they boiled one part of it in 10 or 15 of water; and when it began to grow plump in boiling, they added a little vinegar, and a very small quantity of anise or leek, to keep it from clogging or filling the stomach with wind. Hippocrates prescribed this broth for women that have pains in their belly after delivery. "Boil some of this ptisan (says he), with some leek, and the fat of a goat, and give it to the woman in bed." This will not be thought very singular, if we reflect on what has been hinted above concerning the indelicate manner of living in those times. He preferred the ptisan to all other food in fevers, because it softened and moistened much, and was besides of easy digestion. If he was concerned in a continual fever, he would have the patient begin with a ptisan of a pretty thick consistence, and go on by little and little, lessening the quantity of barley-flour as the height of the distemper approached; so that he did not feed the patient but with what he called the juice of the ptisan; that is, the ptisan strained, where there was but very little of the flour remaining, in order that nature being discharged in part from the care of digesting the aliment, she might the more easily hold out to the end, and overcome the distemper, or the cause of it. With regard to the quantity, he caused the ptisan to be taken twice a-day by such patients as in health used to take two meals a-day, not thinking it convenient that those who are sick should eat oftener than when they were well. He also would not allow eating twice a-day to those who ate but once in that time when in health. In the paroxysm of a fever he gave nothing at all; and in all distempers where there are exacerbations, he forbade nourishment while the exacerbations continued. He let children eat more; but those who were grown up to man's estate, or were of an advanced age, less; making allowance, however, for the custom of each particular person, or for that of the country.

But though he was of opinion that too much food ought not to be allowed to the sick, he did not agree with some physicians who prescribed long abstinence, especially in the beginning of fevers. The reason he gave for this was, that the contrary practice weakened the patients too much during the first days of the distemper, by which means their physicians were obliged to allow them more food when the illness was at its height, which in his opinion was improper. Besides, in acute distempers, and particularly in fevers, Hippocrates made choice of refreshing and moistening nourishment; and amongst other things prescribed orange, melon, spinach, gourd, &c. This sort of food he gave to those that were in a condition to eat, or could take something more than a ptisan.

The drink he commonly gave to his patients was made of eight parts of water and one of honey. In some distempers he added a little vinegar; but besides these, they had another sort named κυκλος, or mixture. One prescription of this sort we find intended for a consumptive person; it consisted of rue, anise, celery, coriander, juice of pomegranate, the roughest red wine, water, flour of wheat and barley, with old cheese made of goats milk. Hippocrates did not approve of giving plain water to the sick; but though he generally prescribed the drinks above mentioned, he did not absolutely forbid the use of wine, even in acute distempers and fevers, provided the patients were not delirious nor had pains in their head. Besides, he took care to distinguish the wines proper in these cases; preferring to all other sorts white wine that was clear and had a great deal of water, with neither sweetness nor flavour.

These are the most remarkable particulars concerning the diet prescribed by Hippocrates in acute distempers; in chronical ones he made very much use of milk and whey; though we are not certain whether this was done on account of the nourishment expected from them, or that he accounted them medicines.

There were many diseases for which he judged the bath was a proper remedy; and he takes notice of all the circumstances that are necessary in order to cause the patient receive benefit from it, among which the following are the principal. The patient that bathes himself must remain still and quiet in his place without speaking while the assistants throw water over his head or are wiping him dry; for which last purpose he desired them to keep sponges, instead of that instrument called by the ancients strigil, which served to rub off from the skin the dirt and nastiness left upon it by the ungents and oils with which they anointed themselves. He must also take care not to catch cold; and must not bathe immediately after eating and drinking, nor eat or drink immediately after coming out of the bath. Regard must also be had whether the patient has been accustomed to bathe while in health, and whether he has been benefited or hurt by it. Lastly, he must abstain from the bath when the body is too open, or too costive, or when he is too weak; or if he has an inclination to vomit, a great loss of appetite, or bleeds at the nose. The advantage of the bath, according to Hippocrates, consists in moistening and refreshing, taking away weariness, making the skin soft and the joints pliant; in provoking urine, and opening the other excretories. He allows two baths in a day to those who have been accustomed to it in health.

In chronical distempers Hippocrates approved very much of exercise, though he did not allow it in acuter ones; but even in these he did not think that a patient ought always to lie in bed; but tells us, that "we must sometimes push the timorous out of bed, and rouse up the lazy."

When he found that diet and exercise were not sufficient to ease nature of a burden of corrupted humours, he was obliged to make use of other means, of purgation was one. By this word he understood all the contrivances that are made use of to discharge the stomach and bowels; though it commonly signifies only only the evacuation by stool. This evacuation he imagined to be occasioned by the purgative medicines attracting the humours to themselves. When first taken into the body, he thought they attracted that humour which was most similar to them, and then the others, one after another.—Most of the purgatives used in his time were emetics also, or at least were very violent in their operation downwards. These were the white and black hellebore; the first of which is now reckoned among the poisons. He used also the Chilian berries, encorium peplum, thapsia; the juice of hippophaë, a sort of rhannus; elaterium, or juice of the wild cucumber; flowers of brass, coloquintida, scammony, the magnesian stone, &c.

As these purgatives were all very strong, Hippocrates was extremely cautious in their exhibition. He did not prescribe them in the dog-days; nor did he ever purge women with child, and very seldom children or old people. He principally used purgatives in chronic distempers; but was much more wary in acute ones. In his books entitled "Of Epidemical Distempers," there are very few patients mentioned to whom he gave purgative medicines. He also takes notice expressly, that these medicines having been given in cases of the distempers of which he was treating, had produced very bad effects. We are not, however, from this to conclude, that Hippocrates absolutely condemned purging in acute distempers; for in some places he expressly mentions his having given them with success. He was of opinion, for instance, that purging was good in a pleurisy when the pain was seated below the diaphragm; and in this case he gave black hellebore, or some peplum mixed with the juice of la-serpition.

The principal rule Hippocrates gives with relation to purging is, that we ought only to purge off the humours that are concocted, and not those that are yet crude, taking particular care not to do it at the beginning of the distemper, lest the humours should be disturbed or stirred up, which happens pretty often. He was not, however, the first who remarked that it would be of ill consequence to stir the humours in the beginning of an acute distemper. The Egyptian physicians had before observed the same thing. By the beginning of a distemper, Hippocrates understood all the time from the first day to the fourth complete.

Hippocrates imagined that each purgative medicine was adapted to the carrying off some particular humour; and hence the distinction of purgatives into hydragogue, cholagogue, &c., which is now justly exploded. In consequence of this notion, he contended that we knew if a purgative had drawn from the body what was fit to be evacuated according as the patient was found well or ill upon it. If we found ourselves well, it was a sign that the medicine had effectually expelled the offending humour. On the contrary, if we were ill, he imagined, whatever quantity of humour came away, that the humour which caused the illness still remained; not judging of the goodness or badness of a purge by the quantity of matters that were voided by it, but by their quality and the effect that followed after it.

Vomits were also pretty much used as medicines by Hippocrates. We have already seen what those were which he prescribed to people in health by way of preventives. With regard to the sick, he sometimes advised them to the same, when his intentions were only to cleanse the stomach. But when he had a mind to recall the humours, as he termed it, from the inmost recesses of the body, he made use of brisker remedies. Among these was white hellebore; and this indeed he most frequently used to excite vomiting. He gave this root particularly to melancholy and mad people; and from the great use made of it in these cases by Hippocrates and other ancient physicians, the phrase to have need of hellebore, became a proverbial expression for being out of one's senses. He gave it also in defluxions, which come, according to him, from the brain, and throw themselves on the nostrils or ears, or fill the mouth with saliva, or that cause stubborn pains in the head, and a weariness or an extraordinary heaviness, or a weakness of the knees, or a swelling all over the body. He gave it to consumptive persons in broth of lentils, to such as were afflicted with the dropsy called lencoptilemmatta, and in other chronic disorders. But we do not find that he made use of it in acute distempers, except in the cholera morbus, where he says he prescribed it with benefit. Some took this medicine fasting; but most took it after supper, as was commonly practised with regard to vomits taken by way of prevention. The reason why he gave this medicine most commonly after eating was, that by mixing with the aliments, its acrimony might be somewhat abated, and it might operate with less violence on the membranes of the stomach. With the same intention also he sometimes gave a plant called scamnoides, and sometimes mixed it with hellebore. Lastly, in certain cases he gave what he called soft or sweet hellebore. This term had some relation to the quality of the hellebore, or perhaps the quantity he gave.

When Hippocrates intended only to keep the body open, or evacuate the contents of the intestines, he made use of simples; as, for example, the herb mercury, or cabbage; the juice or decoction of which he ordered to be drank. For the same purpose he used whey, and also cows and asses milk; adding a little salt to it, and sometimes letting it boil a little. If he gave asses milk alone, he caused a great quantity of it to be taken, so that it must of necessity loosen the body. In one place he prescribes no less than nine pounds of it to be taken as a laxative, but does not specify the time in which it was to be taken. With the same intention he made use of suppositories and elysters. The former were compounded of honey, the juice of the herb mercury, of nitre, powder of colocynth, and other sharp ingredients, to irritate the anus. These they formed into a ball, or into a long cylindrical mass like a finger. The elysters he made use of for sick people were sometimes the same with those already mentioned as preventives for people in health. At other times he mixed the decoction of herbs with nitre, honey, and oil, or other ingredients, according as he imagined he could by that means attract, wash, irritate, or soften. The quantity of liquor he ordered was about 36 ounces; from which it is probable he did not intend that it should all be used at one time.

On some occasions Hippocrates proposed to purge the head alone. This practice he employed after purging the rest of the body, in an apoplexy, inveterate paics pains of the head, a certain sort of jaundice, a consumption, and the greatest part of chronic distemper. For that purpose he made use of the juices of several plants, as celery; to which he sometimes added aromatic drugs, making the patients snuff up this mixture into their nostrils. He used also powders compounded of myrrh, the flowers of brass, and white hellebore, which he caused them put up into the nose, to make them sneeze, and to draw the phlegm from the brain. For the same purpose also he used what he calls tetragonon, that is, "something having four angles;" but what this was, is now altogether unknown, and was so even in the days of Galen. The latter physician, however, conjectures it to be antimony, or certain flakes found in it.

In the distemper called empymema (or a collection of matter in the breast), he made use of a very rough medicine. He commanded the patient to draw in his tongue as much as he was able; and when that was done, he endeavoured to put into the hollow of the lungs a liquor that irritated the part, which raising a violent cough, forced the lungs to discharge the purulent matter contained in them. The materials that he used for this purpose were of different sorts; sometimes he took the root of arum, which he ordered to be boiled with a little salt, in a sufficient quantity of water and oil; dissolving a little honey in it. At other times, when he intended to purge more strongly, he took the flowers of copper and hellebore; after that he shook the patient violently by the shoulders, the better to loosen the pus. This remedy, according to Galen, he received from the Cnidian physicians; and it has never been used by the succeeding ones, probably because the patients could not suffer it.

Blood-letting was another method of evacuation pretty much used by Hippocrates. Another aim he had in this, besides the mere evacuation, was to divert or recall the course of the blood when he imagined it was going where it ought not. A third end of bleeding was to procure a free motion of the blood and spirits.

Hippocrates had also a fourth intention for bleeding, and this was refreshment. So in the iliac passion, he orders bleeding in the arm and in the head; to the end, says he, that the superior venter, or the breast, may cease to be overheated. With regard to this evacuation, his conduct was much the same as to purging, in respect of time and persons. We ought, says he, to let blood in acute diseases, when they are violent, if the party be lusty and in the flower of his age. We ought also to have regard to the time, both in respect to the disease and to the season in which we let blood. He also informs us, that blood ought to be let in great pains, and particularly in inflammations. Among these he reckons such as fall upon the principal viscera, as the liver, lungs, and spleen, as also the quinsy and pleurisy, if the pain of the latter be above the diaphragm. In these cases he would have the patients bled till they faint, especially if the pain be very acute; or rather he advises that the orifice should not be closed till the colour of the blood alters, so that from livid it turn red, or from red livid. In a quinsy he bled in both arms at once. Difficulty of breathing he also reckons among the distempers that require bleeding; and he mentions another sort of inflammation of the lungs, which he calls a swelling or tumor of the lungs arising from heat; in which case he advises to bleed in all parts of the body; and directs it particularly by the arms, tongue, and nostrils. To make bleeding the more useful in all pains, he directed to open the vein nearest the part affected; in a pleurisy he directs to take blood from the arm of the side affected; and for the same reason, in pains of the head, he directs the veins of the nose and forehead to be opened. When the pain was not urgent, and bleeding was advised by way of prevention, he directed the blood to be taken from the parts farthest off, with a design to divert the blood insensibly from the seat of pain. The highest burning fevers, which show neither signs of inflammation nor pain, he does not rank among those distempers which require bleeding. On the contrary, he maintains that a fever itself is in some cases a reason against bleeding. If any one, says he, has an ulcer in the head, he must bleed, unless he has a fever. He says further, those that lose their speech of a sudden must be blooded, unless they have a fever. Perhaps he was afraid of bleeding in fevers, because he supposed that they were produced by the bile and pituita, which grew hot, and afterwards heated the whole body, which is, says he, what we call fever, and which, in his opinion, cannot well be evacuated by bleeding. In other places also he looks upon the presence or abundance of bile to be an objection to bleeding; and he orders to forbear venesection even in a pleurisy, if there be bile. To this we must add, that Hippocrates distinguished very particularly between a fever which followed no other distemper, but was itself the original malady, and a fever which came upon inflammation. In the early ages of physic, the first only were properly called fevers: the others took their names from the parts affected; as pleurisy, peripneumony, hepatitis, nephritis, &c., which names signify that the pleura, the lungs, the liver, or the kidneys, are diseased, but do not intimate the fever which accompanies the disease. In this latter sort of fever Hippocrates constantly ordered bleeding, but not in the former. Hence, in his books on Epidemic Distempers, we find but few directions for bleeding in the acute distempers, and particularly in the great number of continual and burning fevers there treated of. In the first and third book we find but one single instance of bleeding, and that in pleurisy; in which too, he staid till the eighth day of the distemper. Galen, however, and most other commentators on Hippocrates, are of opinion that he generally blooded his patients plentifully in the beginning of acute disorders, though he takes no notice of it in his writings. But had this been the case, he would not perhaps have had the opportunity of seeing so many fevers terminate by crisis, or natural evacuations, which happen of themselves on certain days. Hippocrates, in fact, laid so much weight upon the assistance of nature and the method of diet, which was his favourite medicine, that he thought if they took care to diet the patients according to rule, they might leave the rest to nature. These are his principles, from which he never deviates; so that his writings on Epidemical Diseases seem to have been composed only with an intention to leave to posterity an exact model of management in pursuance of these principles. With regard to the rules laid down by Hippocrates for bleeding, we must farther take notice, that in all diseases which had their seat above the liver, he bled in the arm, or in some of the upper parts of the body; but for those that were situated below it, he opened the veins of the foot, ankle, or ham. If the belly was too loose, and bleeding was at the same time thought necessary, he ordered the looseness to be stopped before bleeding.

Almost all these instances, however, regard scarcely anything but acute distempers; but we find several concerning chronic diseases. "A young man complained of great pain in his belly, with a rumbling while he was fasting, which ceased after eating: this pain and rumbling continuing, his meat did him no good; but, on the contrary, he daily wasted and grew lean. Several medicines, as well purges as vomits, were given him in vain. At length it was resolved to bleed him by intervals, first in one arm and then in the other, till he had scarcely any blood left, and by this method he was perfectly cured."

Hippocrates let blood also in a dropsy, even in a tympany; and in both cases he prescribes bleeding in the arm. In a disease occasioned by an overgrown spleen, he proposes bleeding several times repeated at a vein of the arm which he calls the splenic; and in one species of jaundice, he proposes bleeding under the tongue. On some occasions he took away great quantities of blood, as appears from what we have already observed. Sometimes he continued the bleeding till the patient fainted: at other times he would bleed in both arms at once; at others, he did it in several places of the body, and at several times. The veins he opened were those of the arm, the hands, the ankles, on both sides, the hams, the forehead, behind the head, the tongue, the nose, behind the ears, under the breasts, and those of the arms; besides which, he burnt others, and opened several arteries. He likewise used cupping-vessels, with intent to recol or withdraw the humours which fell upon any part. Sometimes he contented himself with the bare attraction made by the cupping-vessels, but sometimes also he made scarifications.

When bleeding and purging, which were the principal and most general means used by Hippocrates for taking off a plethora, proved insufficient for that purpose, he had recourse to diuretics and sudorifics. The former were of different sorts, according to the constitution of the persons: sometimes baths, and sometimes sweet wine, were employed to provoke urine; sometimes the nourishment which we take contributes to it: and amongst those herbs which are commonly eaten, Hippocrates recommends garlic, leeks, onions, cucumbers, melons, gourds, fennel, and all other things which have a biting taste and a strong smell. With these he numbers honey, mixed with water or vinegar, and all salt meats. But, on some occasions, he took four cantharides, and, pulling off their wings and feet, gave them in wine and honey. These remedies were given in a great number of chronic distempers after purging, when he thought the blood was overcharged with a sort of moisture which he calls ichor; or in suppressions of urine, and when it was made in less quantity than it ought. There were also some cases in which he would force sweat as well as urine; but he neither mentions the diseases in which sudorifics are proper, nor lets us know what medicines are to be used for this purpose, except in one single passage, where he mentions sweating, by pouring upon the head a great quantity of water till the feet sweat; that is, till the sweat diffuses itself over the whole body, running from head to foot. After this he would have them eat boiled meat, and drink pure wine, and being well covered with clothes, lay themselves down to rest. The disease for which he proposes the above-mentioned remedy is a fever; which is not, according to him, produced by bile or pituita, but by mere lassitude, or some other similar cause; from whence we may conclude that he did not approve of sweating in any other kind of fever.

Other remedies which Hippocrates tells us he made use of were those that purged neither bile nor phlegm, but act by cooling, drying, heating, moistening, or by closing and thickening, resolving and dissipating. These medicines, however, he does not particularly mention; and it is probable they were only some particular kinds of food. To these he joined hypnotics, or such things as procure sleep; but those last were used very seldom, and, it is most probable, were only different preparations of poppies.

Lastly, besides the medicines already mentioned, which acted in a sensible manner, Hippocrates made use of others called specifics; whose action he did not understand, and for the use of which he could give no reason but his own experience, or that of other physicians. These he had learned from his predecessors the descendants of Esculapius, who, being empirics, did not trouble themselves about enquiring into the operation of remedies, provided the patients were cured.

Of the external remedies prescribed by Hippocrates, fomentations were the chief. These were of two kinds. The one was a sort of bath, in which the patient sat in a vessel full of a decoction of simples appropriated to his malady; so that the part affected was soaked in the decoction. This was chiefly used in distempers of the womb, of the arms, the bladder, the reins, and generally all the parts below the diaphragm. The second way of fomenting was, to take warm water and put it into a skin or bladder, or even into a copper or earthen vessel, and to apply it to the part affected; as, for example, in a pleurisy. They used likewise a large sponge, which they dipped in the water or other hot liquor, and squeezed out part of the liquor before they applied it. The same use they made of barley, vetches, or bran, which were boiled in some proper liquor, and applied in a linen bag. They are called moist fomentations. The dry ones were made of salt or millet, heated considerably, and applied to the part. Another kind of fomentation was the vapour of some hot liquor; an instance of which we find in the first book of the Distempers of Women. He cast, at several times, bits of red-hot iron into urine, and, covering up the patient close, caused her to receive the steam below. His design in these kinds of fomentations was to warm the part, to resolve or dissipate, and draw out the peccant matter, to mollify and assuage pain, to open the passages, or even to shut them, according as the fomentations were emollient or astringent.

Fumigations Fumigations were likewise very often used by Hippocrates. In the quinsy, he burned hyssop with sulphur and pitch, and caused the smoke to be drawn into the throat by a funnel; and by this means he brought away abundance of phlegm through the mouth and through the nose. For this purpose he took nitre, marjoram, and cress-seeds, which he boiled in water, vinegar, and oil, and, while it was on the fire, caused the patient to draw in the steam by a pipe. In his works we find a great number of fumigants for the distempers of women, to promote the menstrual flux, to check it, to help conception, and to ease pains in the matrix, or the suffocation of it. On these occasions he used such aromatics as were then known, viz. cinnamon, cassia, myrrh, and several odoriferous plants; likewise some minerals, such as nitre, sulphur, and pitch, and caused the patient to receive the vapours through a funnel into the uterus.

Gargles, a kind of fomentations for the mouth, were also known to Hippocrates. In the quinsy he used a gargle made of marjoram, savory, celery, mint, and nitre, boiled with water and a little vinegar. When this was strained, they added honey to it, and washed their mouths frequently with it.

Oils and ointments were likewise much used by Hippocrates, with a view to mollify and abate pain, to ripen boils, resolve tumours, refresh after weariness, make the body supple, &c. For this purpose, sometimes pure oil of olives was used; sometimes certain simples were infused in it, as the leaves of myrtle and roses; and the latter kind of oil was in much request among the ancients. There were other sorts of oils sometimes in use, however, which were much more compounded. Hippocrates speaks of one named Sosinum, which was made of the flowers of the iris, of some aromatics, and of an ointment of narcissus made with the flowers of narcissus and aromatics infused in oil. But the most compounded of all his ointments was that called octopon, which he made particularly for women; and consisted of a great number of ingredients. Another ointment, to which he gave the name of ceratum, was composed of oil and wax. An ointment which he recommends for the softening a tumor, and the cleansing a wound, was made by the following receipt: "Take the quantity of a nut of the marrow or fat of a sheep, of mastic or turpentine the quantity of a bean, and as much wax; melt these over a fire, with oil of roses, for a ceratum." Sometimes he added pitch and wax, and, with a sufficient quantity of oil, made a composition somewhat more consistent than the former, which he called cerapissus.

Cataplasms were a sort of remedies less consistent than the two former. They were made of powders or herbs steeped or boiled in water or some other liquor, to which sometimes oil was added. They were used with a view to soften or resolve tumors, ripen abscesses, &c. though they had also cooling cataplasms made of the leaves of beets or oak, fig or olive-trees, boiled in water.

Lastly, To complete the catalogue of the external remedies used by Hippocrates, we shall mention a sort of medicine called collyrium. It was compounded of powders, to which was added a small quantity of some ointment, or juice of a plant, to make a solid or dry mass; the form of which was long and round, which was kept for use. Another composition of much the same nature was a sort of lozenge of the bigness of a small piece of money, which was burnt upon coals for a perfume, and powdered for particular uses. In his works we find likewise descriptions of powders for several uses, to take off fungous flesh, and to blow into the eyes in ophthalmies, &c.

These were almost all the medicines used by Hippocrates for external purposes. The compound medicines given inwardly were either liquid, solid, or lambative. The liquid ones were prepared either by decoction or infusion in a proper liquor, which, when strained, were kept for use; or by macerating certain powders in such liquors, and so taking them together, or by mixing different kinds of liquors together. The solid medicines consisted of juices insipidated; of gums, resins, or powders, made up with them or with honey, or something proper to give the necessary consistence to the medicine. These were made up in a form and quantity fit to be swallowed with ease. The lambative was of a consistence between solid and fluid; and the patients were obliged to keep it for some time to dissolve in the mouth, that they might swallow it leisurely. This remedy was used to take off the acrimony of those humours which sometimes fall upon this part, and provoke coughing and other inconveniences. The basis of this last composition was honey. It is worth our observation, that the compound medicines of Hippocrates were but very few, and composed only of four or five ingredients at most; and that he not only understood pharmacy, or the art of compounding medicines, but prepared such as he used himself, or caused his servants prepare them in his house by his directions.

We have thus given some account of the state of medicine as practised and taught by Hippocrates, who, as we have already observed, has for many ages been justly considered as the father of physic. For when we attend to the state in which he found medicine, and the condition in which he left it, we can hardly bestow sufficient admiration on the judgment and accuracy of his observations. After a life spent in unwearied industry, he is said to have died at Larissa, a city in Thessaly, in the 101st year of his age, 361 years before the birth of Christ.

After the days of Hippocrates, medicine in ancient Greece gradually derived improvement from the labour of other physicians of eminence. And we may particularly mention three to whom its future progress seems to have been not a little indebted; viz. Praxagoras, Erasistratus, and Herophilus.

The first physician of eminence who differed considerably in his practice from Hippocrates was Praxagoras. Celsus Aurelianus acquaints us, that he made great use of vomits in his practice, insomuch as to exhibit them in the iliac passion till the excrements were discharged by the mouth. In this distemper he also advised, when all other means failed, to open the belly, cut the intestine, take out the indurated feces, and then to sew up all again; but this practice has not probably been followed by any subsequent physician.

Erasistratus was a physician of great eminence, and flourished in the time of Seleucus, one of the successors of Alexander the Great. According to Galen,

he entirely banished venesection from medicine; though some affirm that he did not totally discard it, but only used it less frequently than other physicians. His reasons for disapproving of venesection are as follow: It is difficult to succeed in venesection, because we cannot always see the vein we intend to open, and because we are not sure but we may open an artery instead of a vein. We cannot ascertain the true quantity to be taken. If we take too little, the intention is by no means answered: if we take too much, we run a risk of destroying the patient. The evacuation of the venous blood also is succeeded by that of the spirits, which on that occasion he supposes to pass from the arteries into the veins. It must likewise, he contends, be observed, that as the inflammation is formed in the arteries by the blood coagulated in their orifices, venesection must of course be useless and of no effect.

As Erasistratus did not approve of venesection, so neither did he of purgatives, excepting very rarely, but exhibited clysters and vomits; as did also his master Chrysippus. He was of opinion, however, that the clysters should be mild; and condemned the large quantity and acid quality of those used by preceding practitioners. The reason why purgatives were not much used by him was, that he imagined purging and venesection could answer no other purpose than diminishing the fulness of the vessels; and for this purpose he asserted that there were more effectual means than either phlebotomy or purging. He asserted that the humours discharged by cathartics were not the same in the body that they appeared after the discharge; but that the medicines changed their nature, and produced a kind of corruption in them. This opinion has since been embraced by a great number of physicians. He did not believe that purgatives acted by attraction; but substituted in the place of this principle what Mr Le Clerc imagines to be the same with Aristotle's *fuga vacui*. The principal remedy substituted by him in place of purging and venesection was abstinence. When this, in conjunction with clysters and vomits, was not sufficient to eradicate the disease, he then had recourse to exercise. All this was done with a view to diminish plenitude, which, according to him, was the most frequent cause of all diseases. Galen also informs us, that Erasistratus had so great an opinion of the virtues of succory in diseases of the viscera and lower belly, and especially in those of the liver, that he took particular pains to describe the method of boiling it, which was, to boil it in water till it was tender; then to put it into boiling water a second time, in order to destroy its bitterness; afterwards to take it out of the water, and preserve it in a vessel with oil; and lastly, when it is to be used, add a little weak vinegar to it. Nay, so minute and circumstantial was Erasistratus with regard to the preparation of his favourite succory, that he gave orders to tie several of the plants together, because that was the more commodious method of boiling them. The rest of Erasistratus's practice consisted almost entirely of regimen; to which he added some topical remedies, such as cataplasms, fomentations, and unctious. In short, as he could neither endure compounded medicines, nor superstitious and fine-spun reasonings, he reduced medicine to a very simple and copious art.

With regard to surgery, Erasistratus appears to have been very bold; and as an anatomist he is said to have been exceedingly cruel, insomuch that he is represented by some as having dissected criminals while yet alive*. In a scirrhouss liver, or in tumours of that organ, Caelius Aurelianus observes, that Erasistratus made an incision through the skin and integuments, and having opened the abdomen he applied medicines immediately to the part affected. But though he was thus bold in performing operations on the liver, yet he did not approve of the paracentesis or tapping in the dropsy; because (said he) the waters being evacuated, the liver, which is inflamed and become hard like a stone, is more pressed by the adjacent parts which the waters kept at a distance from it, so that by this means the patient dies. He declared also against drawing teeth which were not loose; and used to tell those who talked with him on this operation, That in the temple of Apollo there was to be seen an instrument of lead for drawing teeth; in order to insinuate that we must not attempt the extirpation of any but such as are loose, and call for no greater force for their extirpation than what may be supposed in an instrument of lead.

Herophilus, the disciple of Praxagoras, and contemporary of Erasistratus, followed a less simple practice: he made so great use of medicines both simple and compound, that neither he nor his disciples would undertake the cure of any disorder without them. He seems also to have been the first who treated accurately of the doctrine of pulses, of which Hippocrates had but a superficial knowledge. Galen, however, affirms, that on this subject he involved himself in difficulties and advanced absurdities; which indeed we are not greatly to wonder at, considering the time in which he lived. He took notice of a disease at that time pretty rare, and to which he ascribes certain sudden deaths. He calls it a *palpy of the heart*; and perhaps it may be the same disease with what is now termed the *angina pectoris*.

According to Celsus, it was about this time that medicine was first divided into three branches, viz. the dietetic, the pharmaceutical, and the chirurgical medicine. The first of these employed a proper regimen in the cure of diseases; the second, medicines; and the third, the operation of the hands. The same author informs us, that these three branches became now the business of as many distinct classes of men; so that from this time we may date the origin of the three professions of physicians, apothecaries, and surgeons.—Before this division, those called physicians discharged all the several offices belonging to the three professions; and there were only two kinds of them, viz. one called *αρχιτεκτονικοι*, who gave only their advice to the patients, and directions to those of an inferior class, who were called *δημοσιογραφοι*, and worked with their hands either in the performing operations, or in the composition and application of remedies.

The first grand revolution which happened in the The Empiric medicinal art, after the days of Herophilus and Erasistratus, was occasioned by the founding of the empiric sect by Serapion of Alexandria about 287 years before Christ. The division into dogmatists and empirics had indeed subsisted before; but about this time the latter party began to grow strong, and to have champions. Serapion publicly asserting its cause. Galen informs us, that Serapion used Hippocrates very ill in his writings, in which he discovered an excess of pride, self-sufficiency, and contempt for all the physicians that went before him. We have some sketches of his practice in Cælius Aurelianus, from which we may infer that he retained the medicines of Hippocrates and the other physicians who went before him, though he rejected their reasoning. We know not what arguments he advanced for the support of his sentiments, since his works are lost, as well as those of the other empirics; and we should know nothing at all of any of them, if their adversaries had not quoted them in order to confute them.

The empirics admitted only one general method of obtaining skill in the medical art, which was by experience, called by the Greeks ἐμπειρία. From this word they took their name, and refused to be called after the founder or any champion of their sect. They defined experience a knowledge derived from the evidence of sense. It was either fortuitous, or acquired by design. For acquiring practical skill they recommended what they called ἐμπειρίας, or one’s own observation, and the reading of histories or cases faithfully related by others. Hence they thought that we might be enabled to know a disease by its resemblance to others; and, when new diseases occurred, to conclude what was proper to be done from the symptoms they had in common with others that were before known. They asserted, that observation ought principally to be employed in two different ways; first, in discovering what things are salutary, and what are of an indifferent nature; and, secondly, what particular disease is produced by a certain concurrence of symptoms; for they did not call every symptom a disease, but only such a combination of them as from long experience they found to accompany each other, and produced such disorders as began and terminated in the same manner.

On the other hand, the dogmatist affirmed, that there was a necessity for knowing the latent as well as the evident causes of diseases, and that the physician ought to understand the natural actions and functions of the human body, which necessarily presupposes a knowledge of the internal parts. By secret or latent causes they meant such as related to the elements or principles of which our bodies are composed, and which are the origin of a good or bad state of health. They asserted that it was impossible to know how to cure a disease without knowing the cause whence it proceeded; because undoubtedly it behoved diseases to vary prodigiously in themselves according to the different causes by which they were produced.

The next remarkable person in the history of physic is Asclepiades, who flourished in the century immediately preceding the birth of Christ. He introduced the philosophy of Democritus and Epicurus into medicine, and ridiculed the doctrines of Hippocrates. He asserted, that matter considered in itself was of an unchangeable nature; and that all perceptible bodies were composed of a number of smaller ones, between which there were interspersed an infinity of small spaces totally void of all matter. He thought that the soul itself was composed of these small bodies. He laughed at the principle called Nature by Hippocrates, and also at the imaginary faculties said by him to be subservient to her; and still more at what he called Attraction. This last principle Asclepiades denied in every instance, even in that of the loadstone and steel, imagining that this phenomenon proceeded from a concourse of corpuscles, and a particular disposition or modification of their pores. He also maintained, that nothing happened or was produced without some cause; and that what was called nature was in reality no more than matter and motion. From this last principle he inferred that Hippocrates knew not what he said when he spoke of Nature as an intelligent being, and ascribed qualities of different kinds to her. For the same reason he ridiculed the doctrine of Hippocrates with regard to crises; and asserted that the termination of diseases might be as well accounted for from mere matter and motion. He maintained, that we were deceived if we imagined that nature always did good; since it was evident that she often did a great deal of harm. As for the days particularly fixed upon by Hippocrates for crises, or those on which we usually observe a change either for the better or the worse, Asclepiades denied that such alterations happened on those days rather than on others. Nay, he asserted that the crisis did not happen at any time of its own accord, or by the particular determination of nature for the cure of the disorder, but that it depended rather on the address and dexterity of the physician; that we ought never to wait till a distemper terminates of its own accord, but that the physician by his care and medicines must hasten on and advance the cure.—According to him, Hippocrates and other ancient physicians attended their patients rather with a view to observe in what manner they died than in order to cure them; and thus under pretence that Nature ought to do all herself, without any assistance.

According to Asclepiades, the particular assemblage of the various corpuscles above mentioned, and represented as of different figures, is the reason why there are several pores or interstices within the common mass, formed by these corpuscles; and why these pores are of a different size. This being taken for granted, as these pores are in all the bodies we observe, it must of course follow that the human body has some peculiar to itself, which, as well as those of all other bodies, contain certain minute bodies, which pass and repass by those pores that communicate with each other; and as these pores or interstices are larger or smaller, so the corpuscles which pass through them differ proportionally as to largeness and minuteness. The blood consists of the largest of these corpuscles, and the spirits, or the heat, of the smallest.

From these principles he infers, that as long as the corpuscles are freely received by the pores, the body remains in its natural state, and, on the contrary, it begins to recede from that state, when the corpuscles find any obstacle to their passage. Health therefore depends on the just proportion between the pores and the corpuscles they are destined to receive and transmit; as diseases, on the contrary, proceed from a disproportion between these pores and the corpuscles. The most usual obstacle on this occasion proceeds from the corpuscles embracing each other, and being retained in some of their ordinary passages, whether these corpus- Among the diseases produced by the corpuscles stopping of their own accord, Asclepiades reckoned phrenics, lethargies, pleurisies, and burning fevers. Pains, in particular, are classed among the accidents which derive their origin from a stagnation of the largest of all the corpuscles of which the blood consists. Among the disorders produced by the bad state and disposition of the pores, he placed deliriums, languors, extenuations, leanness, and dropsies. These last disorders he thought proceeded from the pores being too much relaxed and opened; the dropsy in particular, he thinks, proceeds from the flesh being perforated with various small holes, which convert the nourishment received into them into water. Hunger, and especially that species of it called *fames canina*, proceeds from an opening of the large pores of the stomach and belly; and thirst from an opening of their small ones. Upon the same principles he accounted for intermittent fevers. According to him, quotidian fevers are caused by a retention of the largest corpuscles, those of the tertian kind by a retention of corpuscles somewhat smaller, and quartan fevers are produced by a retention of the smallest corpuscles of all.

The practice of Asclepiades was suited to remove these imaginary causes of disorders. He composed a book concerning common remedies, which he principally reduced to three, viz. gestation, friction, and the use of wine. By various exercises he proposed to render the pores more open, and to make the juices and small bodies, which cause diseases by their retention, pass more freely; and while the former physicians had not recourse to gestation till towards the end of long continued disorders, and when the patients, though entirely free from fever, were yet too weak to take sufficient exercise by walking, Asclepiades used gestation from the very beginning of the most burning fevers. He laid it down as a maxim, that one fever was to be cured by another; that the strength of the patient was to be exhausted by making him watch and endure thirst to such a degree, that, for the two first days of the disorder, he would not allow them to cool their mouths with a drop of water. Celsus also observes, that though Asclepiades treated his patients like a butcher during the first days of the disorder, he indulged them so far afterwards as even to give directions for making their beds in the softest manner. On several occasions Asclepiades used frictions to open the pores. The dropsy was one of the distempers in which this remedy was used; but the most singular attempt was, by this means, to fulll phrenetic patients asleep. But though he enjoined exercise so much to the sick, he denied it to those in health; a conduct not a little surprising and extraordinary. He allowed wine freely to patients in fevers, provided the violence of the distemper was somewhat abated. Nor did he forbid it to those who were afflicted with a phrensy: nay, he ordered them to drink it till they were intoxicated, pretending by that means to make them sleep; because he said, wine had a narcotic quality and procured sleep, which he thought absolutely necessary for those who laboured under that disorder. To lethargic patients he used it on purpose to excite them, and rouse their senses: he also made them smell strong-scented substances, such as vinegar, castor, and rue, in order to make them sneeze; and applied to their heads cataplasm of mustard made up with vinegar.

Besides these remedies, Asclepiades enjoined his patients abstinence to an extreme degree. For the first three days, according to Celsus, he allowed them no aliment whatever, but on the fourth began to give them victuals. According to Caelius Aurelianus, however, he began to nourish his patients as soon as the ac-cession of the disease was diminished, not waiting till an entire remission; giving to some aliments on the first, and some on the second, to some on the third, and so on to the seventh day. It seems almost incredible to us, that people should be able to fast till this last-mentioned term; but Celsus assures us, that abstinence till the seventh day was enjoined even by the predecessors of Asclepiades.

The next great revolution which happened in the medicinal art, was brought about by Themison, the disciple of Asclepiades, who lived not long before the time of Celsus, during the end of the reign of Augustus, or beginning of that of Tiberius. The sect founded by him was called *methodic*, because he endeavoured to find a method of rendering medicine more easy than formerly.

He maintained, that a knowledge of the causes of Themison's diseases was not necessary, provided we have a due regard to what diseases have in common and analogous to one another. In consequence of this principle, he divided all diseases into two, or at most three, kinds. The first included diseases arising from stricture; the second, those arising from relaxation; and the third, those of a mixed nature, or such as partake both of stricture and relaxation.

Themison also asserted, that diseases are sometimes acute, and sometimes chronical; that for a certain time they increase; that at a certain time they are at their height; and that at last they were observed to diminish. Acute diseases, therefore, according to him, must be treated in one way, and chronical diseases in another; one method must be followed with such as are in their augmentation, another with such as are at their height, and a third with such as are in their declension. He asserted that the whole of medicine consisted in the observation of that small number of rules which are founded upon things altogether evident. He said, that all disorders, whatever their nature was, if included under any of the kinds above mentioned, ought to be treated precisely in the same way, in whatever country and with whatever symptoms they happen to arise. Upon these principles, he defined medicine to be a method of conducing to the knowledge of what diseases have in common with each other.

Themison was old when he laid the foundation of the methodic sect; and it was only brought to perfection by Thessalus, who lived under the emperor Nero. Galen and Pliny accuse this physician of intolerable insolence and vanity, and report that he gave himself the air of despising all other physicians; and so intolerable was his vanity, that he assumed the title of the conqueror of physicians, which he caused to be put upon his tomb in the Appian way. Never was moun-tebank (says Pliny) attended by a greater number of spectators. Thessalus, spectators than Thessalus had generally about him; and this circumstance is the less to be wondered at, if we consider that he promised to teach the whole art of medicine in less than six months. In reality, the art might be learned much sooner if it comprehended no more than what the methodics thought necessary; for they cut off the explanation of the causes of diseases followed by the dogmatics; and substituted in the room of the laborious observations of the empirics, indications drawn from the analogy of diseases, and the mutual resemblance they bear to each other. The most skilful of all the methodic sect, and he who put the last hand to it, was Soranus. He lived under the emperors Trajan and Adrian, and was a native of Ephesus.

One of the most celebrated medical writers of antiquity was Celsus, whom we have already had occasion to mention. Most writers agree that he lived in the time of Tiberius, but his country is uncertain. It is even disputed whether or not he was a professed physician. Certain it is, however, that his books on medicine are the most valuable of all the ancients next to those of Hippocrates. From the latter, indeed, he has taken so much, as to acquire the name of the Latin Hippocrates; but he has not attached himself to him so closely as to reject the assistance of other authors. In many particulars he has preferred Aselepiades. With him he laughs at the critical days of Hippocrates, and ascribes the invention of them to a foolish and superstitious attachment to the Pythagorean doctrine of numbers. He also rejected the doctrine of Hippocrates with regard to venesection, of which he made a much more general use; but did not take away so much blood at a time, thinking it much better to repeat the operation than weaken the patient by too great an evacuation at once. He used cupping also much more frequently, and differed from him with regard to purgatives. In the beginning of disorders, he said, the patients ought to endure hunger and thirst: but afterwards they were to be nourished with good aliments; of which, however, they were not to take too much, nor fill themselves suddenly, after having fasted long. He does not specify how long the patient ought to practise abstinence; but affirms, that in this particular it is necessary to have a regard to the disease, the patient, the season, the climate, and other circumstances of a like nature. The signs drawn from the pulse he looked upon to be very precarious and uncertain. "Some (says he) lay great stress upon the beating of the veins or the arteries; which is a deceitful circumstance, since that beating is slow or quick, and varies very much, according to the age, sex, and constitution of the patient. It even sometimes happens that the pulse is weak and languid when the stomach is disordered, or in the beginning of a fever. On the contrary, the pulse is often high, and in a violent commotion, when one has been exposed to the sun, or comes out of a bath, or from using exercise; or when one is under the influence of anger, fear, or any other passion. Besides, the pulse is easily changed by the arrival of the physician, in consequence of the patient's anxiety to know what judgment he will pass upon his case. To prevent this, the physician must not feel the patient's pulse on his first arrival: he must first sit down by him, assume a cheerful air, inform himself of his condition; and if he is under any dread, endeavour to remove it by encouraging discourse; after which he may examine the beating of the artery. This, nevertheless, does not hinder us from concluding, that if the sight of the physician alone can produce so remarkable a change in the pulse, a thousand other causes may produce the same effect." But although Celsus thought for himself, and in not a few particulars differed from his predecessors, yet in his writings, which are not only still preserved, but have gone through almost innumerable editions, we have a compendious view of the practice of almost all his predecessors; and he treats of the healing art in all its branches, whether performed manu, victu, vel medicamentis. His writings, therefore, will naturally be consulted by every one who wishes either to become acquainted with the practice of the ancients prior to the fall of the Roman empire, or to read medical Latin in its greatest purity.

About the 131st year after Christ, in the reign of Galen, the emperor Adrian, lived the celebrated Galen, a native of Pergamus, whose name makes such a conspicuous figure in the history of physic. At this time the dogmatic, empiric, methodic, and other sects, had each their abettors. The methodics were held in great esteem, and looked upon to be superior to the dogmatists, who were strangely divided among themselves, some of them following Hippocrates, others Erasistratus, and others Asclepiades. The empirics made the least considerable figure of any. Galen undertook the reformation of medicine, and restored dogmatism. He seems to have been of that sect which was called eclectic, from their choosing out of different authors what they esteemed good in them, without being particularly attached to any one more than the rest. This declaration he indeed sets out with; but, notwithstanding this, he follows Hippocrates much more than any other, or rather follows nobody else but him. Though before his time several physicians had commented on the works of Hippocrates, yet Galen pretends that none of them had understood his meaning. His first attempt, therefore, was to explain the works of Hippocrates; with which view he wrote a great deal, and after this set about composing a system of his own. In one of his books entitled, "Of the establishment of medicine," he defines the art to be one which teaches to preserve health and cure diseases. In another book, however, he proposes the following definition: "Medicine (says he) is a science which teaches what is sound, and what is not so; and what is of an indifferent nature, or holds a medium between what is sound and what is the reverse." He affirmed, that there are three things which constitute the object of medicine, and which the physician ought to consider as sound, as not sound, or of a neutral and indifferent nature. These are the body itself, the signs, and the causes. He esteems the human body sound, when it is in a good state or habit with regard to the simple parts of which it is composed, and when besides there is a just proportion between the organs formed of these simple parts. On the contrary, the body is reckoned to be unsound, when it recedes from this state, and the just proportion above mentioned. It is in a state of neutrality or indifference, when it is in a medium between soundness and its opposite state. The salutary signs are such as indicate present health, and prognosticate that the man may remain in that state for some time to come. The insalubrious signs, on the contrary, indicate a present disorder, or lay a foundation for suspecting the approach of one. The neutral signs, or such as are of an indifferent nature, denote neither health nor indisposition, either for the present, or for the time to come. In like manner he speaks of causes salutary, unsalutary, and indifferent.

These three dispositions of the human body, that is, soundness, its reverse, and a neutral state, comprehend all the differences between health and disorder or indisposition: and each of these three states or dispositions has a certain extent peculiar to itself. A sound habit of body, according to the definition of it already given, is very rare, and perhaps never to be met with; but this does not hinder us to suppose such a model for regulating our judgment with respect to different constitutions. On this principle Galen establishes eight other principal constitutions, all of which differ more or less from the perfect model above mentioned. The four first are such as have one of the four qualities of hot, cold, moist, or dry, prevailing in too great a degree; and accordingly receive their denomination from that quality which prevails over the rest. The four other species of constitutions receive their denominations from a combination of the above mentioned; so that, according to his definition, there may be a hot and dry, a hot and moist, a cold and moist, and a cold and dry, constitution. Besides these differences, there are certain others which result from occult and latent causes, and which, by Galen, are said to arise from an idiosyncrasy of constitution. It is owing to this idiosyncrasy that some have an aversion to one kind of aliment and some to another; that some cannot endure particular smells, &c. But though these eight last-mentioned constitutions fall short of the perfection of the first, it does not thence follow, that those to whom they belong are to be classed among the valetudinary and diseased. A disease only begins when the deviation becomes so great as to hinder the due action of some parts.

Galen describes at great length the signs of a good or bad constitution, as well as those of what he calls a neutral habit. These signs are drawn from the original qualities of cold, hot, moist, and dry, and from their just proportion or disproportion with respect to the bulk, figure, and situation, of the organical parts. With Hippocrates he establishes three principles of an animal body; the parts, the humours, and the spirits. By the parts he properly meant no more than the solid parts; and these he divided into similar and organical. Like Hippocrates, he also acknowledged four humours; the blood, the phlegm, the yellow bile and black bile. He established three different kinds of spirits; the natural, the vital, and the animal. The first of these are, according to him, nothing else but a subtle vapour arising from the blood, which draws its origin from the liver, the organ or instrument of sanguification. After these spirits are conveyed to the heart, they, in conjunction with the air we draw into the lungs, become the matter of the second species, that is, of the vital spirits, which are again changed into those of the animal kind in the brain. He supposed that these three species of spirits served as instruments to three kinds of faculties, which reside in the respective parts where these faculties are formed. The natural faculty is the first of these, which he placed in the liver, and imagined to preside over the nutrition, growth, and generation, of the animal. The vital faculty he lodged in the heart, and supposed that by means of the arteries it communicated warmth and life to all the body. The animal faculty, the noblest of all the three, and with which the reasoning or governing faculty was joined, according to him, has its seat in the brain; and, by means of the nerves, distributes a power of motion and sensation to all the parts, and presides over all the other faculties. The original source or principle of motion in all these faculties, Galen, as well as Hippocrates, defines to be Nature.

Upon these principles Galen defined a disease to be "such a preternatural disposition or affection of the parts of the body, as primarily, and of itself, hinders their natural and proper action." He established three principal kinds of diseases: the first relates to the similar parts; the second, to the organical; and the third is common to both these parts. The first kind of diseases consists in the intemperature of the similar parts; and this is divided into an intemperature without matter, and an intemperature with matter. The first discovers itself when a part has more or less heat or cold than it ought to have, without that change of quality in the part being supported and maintained by any matter. Thus, for instance, a person's head may be overheated and indisposed by being exposed to the heat of the sun, without that heat being maintained by the continuance or congestion of any hot humour in the part. The second sort of intemperature is when any part is not only rendered hot or cold, but also filled with a hot or cold humour, which are the causes of the heat or cold felt in the part. Galen also acknowledged a simple intemperature: that is, when one of the original qualities, such as heat or cold, exceeds the natural standard alone and separately; and a compound intemperature, when two qualities are joined together, such as heat and dryness, or coldness and humidity. He also established an equal and unequal temperature. The former is that which is equally in all the body, or in any particular part of it, and which creates no pain, because it is become habitual, such as dryness in the hectic constitution. The latter is distinguished from the former, in that it does not equally subsist in the whole of the body, or in the whole of a part. Of this kind of intemperature we have examples in certain fevers, where heat and cold, equally, and almost at the same time, attack the same part; or in other fevers which render the surface of the body cold as ice, while the internal parts burn with heat; or, lastly, in cases where the stomach is cold and the liver hot.

The second kind of disorders, relating to the organical parts, results from irregularities of these parts, with respect to the number, bulk, figure, situation, &c., as when one has six fingers, or only four; when one has any part larger or smaller than it ought to be, &c. The third kind, which is common both to the similar and the organical parts, is a solution of continuity, which happens when any similar or compound part is cut, bruised, or corroded. Like Hippocrates, Galen distinguished diseases into acute and chronic; and, with respect to their nature and genius, into benign and malignant; also into epidemic, endemic, and sporadic.

After having distinguished the kinds of diseases, Galen comes to explain their causes; which he divides into external and internal. The external causes of diseases, according to him, are six things, which contribute to the preservation of health when they are well disposed and properly used, but produce a contrary effect when they are imprudently used or ill disposed. These six things are, the air, aliments and drink, motion and rest, sleeping and watching, retention and excretion, and lastly the passions. All these are called the pro-catarctic or beginning causes, because they put in motion the internal causes; which are of two kinds, the antecedent and the conjunct. The former is discovered only by reasoning; and consists for the most part in a peccancy of the humours, either by plenitude or cacochymy, i.e. a bad state of them. When the humours are in too large a quantity, it is called a plethora; but we must observe, that this word equally denotes too large a quantity of all the humours together, or a redundance of one particular humour which prevails over the rest. According to these principles, there may be a sanguine, a bilious, a pituitous, or a melancholy plenitude: but there is this difference between the sanguine and the three other plenitudes, that the blood, which is the matter of the former, may far surpass the rest: whereas, if any of the three last-mentioned ones do so, the case is no longer called plenitude, but cacochymia; because these humours, abounding more than they ought, corrupt the blood. The causes he also divides into such as are manifest and evident, and such as are latent and obscure. The first are such as spontaneously come under the cognizance of our senses when they act or produce their effects: the second are not of themselves perceptible, but may be discovered by reasoning: the third sort, i.e. such as he calls occult or concealed, cannot be discovered at all. Among this last he places the cause of the hydrophobia.

He next proceeds to consider the symptoms of diseases. A symptom he defines to be "a preternatural affection depending upon a disease, or which follows as a shadow does a body." He acknowledged three kinds of symptoms: the first and most considerable of these consisted in the action of the parts being injured or hindered; the second in a change of the quality of the parts, their actions in the mean time remaining entire: the third related to defects in point of excretion and retention.

After having treated of symptoms, Galen treats of the signs of diseases. These are divided into diagnostic and prognostic. The first are so called because they enable us to know diseases, and distinguish them from each other. They are of two sorts, pathognomonic or adjunct. The first are peculiar to every disease, make known its precise species, and always accompany it, so that they begin and end with it. The second are common to several diseases, and only serve to point out the difference between diseases of the same species. In a pleurisy, for instance, the pathognomonic signs are a cough, a difficulty of breathing, a pain of the side, and a continued fever; the adjunct signs are the various sorts of matter expectorated, Orius which is sometimes bloody, sometimes bilious, &c.—The diagnostic signs were drawn from the defective or disordered disposition of the parts, or from the diseases themselves; secondly, from the causes of diseases; thirdly, from their symptoms; and lastly, from the particular dispositions of each body, from things which prove prejudicial and those that do service, and from epidemical diseases.—The prognostic signs be gathered from the species, virulence, and peculiar genius of the disease: but as we have already spoken so largely concerning the prognostics of Hippocrates, it is superfluous to be particular on those of Galen.—His method of cure differed little from that of Hippocrates: but from the specimen already given of Galen's method of teaching the medical art, it is evident that his system was little else than a collection of speculations, distinctions, and reasonings; whereas that of Hippocrates was founded immediately upon facts, which he had either observed himself, or had learned from the observation of others.

The system of Galen, however, notwithstanding its defects and absurdities, remained almost uncontradicted for a very long period. Indeed it may be considered as having been the prevailing system till the inundation of the Goths and Vandals put an almost entire stop to the cultivation of letters in Europe. But during the general prevalence of the system of Galen, there appeared some writers to whom medicine was indebted for improvements, at least in certain particulars. Among the most distinguished of these we may mention Oribasius, Aëtius, Alexander, and Paulus.

Oribasius flourished about the year 362, and was physician to the emperor Julian. He speaks very fully of the effects of bleeding by way of scarification, a thing little taken notice of by former writers; from his own experience he assures us that he had found it successful in a suppression of the menses, defluxions of the eyes, headach, and straitness of breathing even when the person was extremely old. He tells his own case particularly, when the plague raged in Asia and he himself was taken ill. On the second day he scarified his leg, and took away two pounds of blood; by which means he entirely recovered, as did several others who used it. In this author also we find the first description of a surprising and terrible distemper, which he termed λυσαθημα, a species of melancholy and madness, which he describes thus. "The persons affected get out of their houses in the night-time, and in every thing imitate wolves, and wander among the sepulchres of the dead till day-break. You may know them by these symptoms: Their looks are pale; their eyes heavy, hollow, dry, without the least moisture of a tear; their tongue exceedingly parched and dry, no spittle in their mouth, extreme thirst; their legs, from the falls and the bruises they receive, full of inearable sores and ulcers."

Aëtius lived very near the end of the fifth, or in the beginning of the sixth century. Many passages in his writings serve to shew us how much the actual and potential cautery were used by the physicians of that age. In a palsy, he says, that he should not at all hesitate to make an eschar either way, and this in several places; one in the nape, where the spinal marrow takes its rise, two on each side of it; three or four Alexander, four on the top of the head, one just in the middle, and three others round it. He adds, that in this case, if the ulcers continue running a considerable time, he should not doubt of a perfect recovery. He is still more particular when he comes to order this application for an inveterate asthma, after all other remedies have been tried in vain. One, he says, should be made on each side near the middle of the joining of the clavicle, taking care not to touch the wind-pipe: two other little ones are then to be made near the carotids under the chin, one on each side, so that the caustic may penetrate no further than the skin: two others under the breasts, between the third and fourth ribs; and again, two more backwards towards the fifth and sixth ribs. Besides these there ought to be one in the middle of the thorax, near the beginning of the xiphoid cartilage, over the orifice of the stomach; one on each side between the eighth and ninth ribs; and three others in the back, one in the middle, and the two others just below it, on each side of the vertebra. Those below the neck ought to be pretty large, not very superficial, not very deep: and all these ulcers should be kept open for a very long time.

Aetius takes notice of the worms bred in different parts of the body, called *draconculi*, which were unknown to Galen. He seems also to be the first Greek writer among the Christians, who gives us any specimen of medicinal spells and charms; such as that of a finger of St Blasius for removing a bone which sticks in the throat, and another in relation to a fistula. He gives a remedy for the gout, which he calls the *grand drier*; the patient is to use it for a whole year, and observe the following diet each month. "In September, he must eat and drink milk: In October he must eat garlic; in November, abstain from bathing; in December, he must eat no cabbage; in January, he is to take a glass of pure wine in the morning; in February, to eat no beef; in March, to mix sweet things both in eatables and drinkables; in April, not to eat horse-radish, nor in Mayt he fish called *polyphus*; in June, he is to drink cold water in a morning; in July, to avoid venery; and lastly, in August, to eat no mallows." This may sufficiently show the quackery of those times, and how superstition was beginning to mix itself with the art.

Alexander, who flourished in the reign of Justinian, is a more original author than either of the two former. He confines himself directly to the describing the signs of diseases, and the methods of cure, without meddling with anatomy, the materia medica, or surgery, as all the rest did. He employs a whole book in treating of the gout. One method he takes of relieving this disease is by purging; and in most of the purges he recommends hermodactyls, of which he has a great opinion. In a causus, or burning fever, where the bile is predominant, the matter fit for evacuation, and the fever not violent, he prefers purging to bleeding, and says that he has often ordered purging in acute fevers with surprising success. In the causus also, if a syncope happens from crude and redundant humours, he recommends bleeding. In a syncope succeeding the suppression of any usual evacuation, he recommends bleeding, with frictions. The diagnostics upon which he founds this practice are the following: viz. a face paler and more swelled than usual, a bloated habit of body, with a small sluggish pulse, having long intervals between the strokes. In tertian, and much more in quartan fevers, he recommends vomits above all other remedies, and affirms that by this remedy alone he has cured the most inveterate quartans. On the bulimus, or canine appetite, he makes a new observation, viz. that it is sometimes caused by worms. He mentions the case of a woman who laboured under this ravenous appetite, and had a perpetual gnawing at her stomach and pain in her head: after taking hiera she voided a worm above a dozen of cubits long, and was entirely cured of her complaints.—He is also the first author who takes notice of *rhubarb*; which he recommends in a weakness of the liver and in dysentery.—Alexander is recommended by Dr Freind as one of the best practical writers among the ancients, and well worthy the perusal of any modern.

Paulus was born in the island Ægina, and lived in Paulus. the 7th century. He transcribes a great deal from Alexander and other physicians. His descriptions are short and accurate. He treats particularly of women's disorders; and seems to be the first instance upon record of a professed *man-midwife*, for so he was called by the Arabians: and accordingly he begins his book with the disorders incident to pregnant women. He treats also very fully of surgery, and gives some directions, according to Dr Freind, not to be found in the more ancient writers.

After the downfall of the Roman empire, and when the inundation of Goths and Vandals had almost completely exterminated literature of every kind in Europe, medicine, though a practical art, shared the same fate with more abstract sciences. Learning in general, banished from the seat of arms, took refuge among the eastern nations, where the arts of peace still continued to be cultivated. To the Arabian physicians, as they have been called, we are indebted both for the preservation of medical science, as it subsisted among the Greeks and Romans, and likewise for the description of some new diseases, particularly the smallpox. Among the most eminent of the Arabians, we may mention Rhases, Avicenna, Albuscias, and Avenzoar. But of their writings it would be tedious, and is unnecessary, to give any particular account.—They were for the most part, indeed, only copiers of the Greeks. We are, however, indebted to them for some improvements. They were the first who introduced chemical remedies, though of these they used but few, nor did they make any considerable progress in the chemical art. Anatomy was not in the least improved by them, nor did surgery receive any advancement till the time of Albuscias, who lived probably in the 12th century. They added a great deal to botany and the materia medica, by the introduction of new drugs, of the aromatic kind especially, from the east, many of which are of considerable use. They also found out the way of making sugar; and by help of that syrup, which two new materials are of great use in mixing up compound medicines.

With regard to their practice, in some few particulars they deviated from the Greeks. Their purging medicines were much milder than those formerly in use; and even when they did prescribe the old ones, they gave them in a much less dose than the Greek and Roman physicians. The same reflection may be made concerning... concerning their manner of bleeding, which was never to that excessive degree practised by the Greeks. They deviated from Hippocrates, however, in one very trivial circumstance, which produced a violent controversy. The question was, Whether blood in a pleurisy ought to be drawn from the arm of the affected side or the opposite? Hippocrates had directed it to be drawn from the arm of the affected side; but the Arabians, following some other ancient physicians, ordered it to be drawn from the opposite one. Such was the ignorance of those ages, that the university of Salamanca in Spain made a decree, that no one should dare to let blood but in the contrary arm; and endeavoured to procure an edict from the emperor Charles V. to second it; alleging that the other method was of no less pernicious consequence to medicine, than Luther's heresy had been to religion.

In consequence of the general decay of learning in the western parts of the world, the Greek writers were entirely neglected, because nobody could read the language; and the Arabians, though principally copiers from them, enjoyed all the reputation that was due to the others. The Arabian physic was introduced into Europe very early, with the most extravagant applause: and not only this, but other branches of their learning, came into repute in the west; insomuch that in the 11th century, the studies of natural philosophy and the liberal arts were called the studies of the Saracens. This was owing partly to the crusades undertaken against them by the European princes; and partly to the settlement of the Moors in Spain, and the intercourse they and other Arabians had with the Italians. For, long before the time of the crusades, probably in the middle of the 7th century, there were Hebrew, Arabic, and Latin professors of physic settled at Salernum; which place soon grew into such credit, that Charles the Great thought proper to found a college there in the year 802; the only one at that time in Europe. Constantine the African flourished there towards the latter end of the 11th century. He was a native of Carthage; but travelled into the east, and spent 30 years in Babylon and Bagdad, by which means he became master of the oriental languages and learning. He returned to Carthage; but being informed of an attempt against his life, made his escape into Apulia, where he was recommended to Robert Guiscard, created in 1066 duke of that country, who made him his secretary. He was reputed to be very well versed in the Greek, as well as in the eastern tongues; and seems to have been the first who introduced either the Greek or Arabian physic into Italy. His works, however, contain nothing that is new, or material; though he was then accounted a very learned man.

From this time to the end of the 15th and beginning of the 16th century, the history of physic furnishes us with no interesting particulars. This period, however, is famous for the introduction of chemistry into medicine, and the description of three new distempers, the sweating sickness, the venereal disease, and the scurvy. The sweating sickness began in 1485 in the army of Henry VII. upon his landing at Milford-haven, and spread itself at London, from the 21st of September to the end of October. It returned there five times, and always in summer; first in 1495, then in 1506, afterwards in 1517, when it was so violent that it killed many in the space of three hours, so that numbers of the nobility died, and of the commonalty in several towns often the one-half perished. It appeared the fourth time in 1528, and then proved mortal in six hours; many of the courtiers died of it, and Henry VIII. himself was in danger. In 1529, and only then, it infested the Netherlands and Germany, in which last country it did much mischief. The last return of it was in 1551, and in Westminster it carried off 120 in a day. Dr Caius describes it as a pestilent contagious fever, of the duration of one natural day; the sweat he reckoned to be only a natural symptom, or crisis of the distemper. It first affected some particular part, attended with inward heat and burning, unquenchable thirst, restlessness, sickness at stomach, but seldom vomiting, headache, delirium, then faintness, and excessive drowsiness. The pulse was quick and vehement, and the breath short and laborious.—Children, poor and old people, were rarely subject to it. Of others, scarce any escaped the attack, and most of them died. Even by travelling into France or Flanders they did not escape; and what is still more strange, the Scots were said not to be affected; abroad the English only were seized, and foreigners in England were free. At first the physicians were much puzzled how to treat this disease. The only cure they ever found, however, was to carry on the sweat for a long time; for, if stopped, it was dangerous or fatal. The way, therefore, was for the patient to lie still, and not expose himself to cold. If nature was not strong enough to force out the sweat, it was necessary to assist her by art, with clothes, wine, &c. The violence of the distemper was over in 15 hours; but there was no security for the patient till 24 were passed. In some strong constitutions there was a necessity to repeat the sweating, even to 12 times. The removing out of bed was attended with great danger; some who had not sweated enough fell into very bad fevers.—No flesh-meat was to be allowed in all the time of the distemper; nor drink for the first five hours. In the seventh, the distemper increased; in the ninth the delirium came on, and sleep was by all means to be avoided. However terrible this distemper appeared at first, it seldom proved obstinate, if treated in the above-mentioned manner.

In the beginning of the 16th century, the famous Paracelsus introduced a new system into medicine, founded on the principles of chemistry. The Galenical system had prevailed till his time; but the practice had greatly degenerated, and was become quite trifling and frivolous. The physicians in general rejected the use of opium, mercury, and other efficacious remedies. Paracelsus, who made use of these, had therefore greatly the advantage over them; and now all things relating to medicine were explained on imaginary chemical principles. It will easily be conceived that a practice founded in this manner could be no other than the most dangerous quackery. At this time, however, it was necessary; for now a new disease overran the world, and threatened greater destruction than almost all the old ones put together, both by the violence of its symptoms, and its baffling the most powerful remedies at that time known.—This was the venereal disease, which is supposed to have been imported. The revival of learning, which now took place throughout Europe, the appearance of these new distempers, and the natural fondness of mankind for novelty, contributed greatly to promote the advancement of medicine as well as other sciences. While at the same time, the introduction of the art of printing rendered the communication of new opinions as well as new practices so easy a matter, that to enumerate even the names of those who have been justly rendered eminent for medical knowledge would be a very tedious task. It was not, however, till 1628 that Dr William Harvey of London demonstrated and communicated to the public one of the most important discoveries respecting the animal economy, the circulation of the blood. This discovery, more effectually than any reasoning, overturned all the systems which had subsisted prior to that time. It may justly be reckoned the most important discovery that has hitherto been made in the healing art: for there can be no doubt that it puts the explanation of the phenomena of the animal body, both in a state of health and disease, on a more solid and rational footing than formerly. It has not, however, prevented the rise of numerous fanciful and absurd systems. These, though fashionable for a short time, and strenuously supported by blind adherents, have yet in no long period fallen into deserved contempt. And notwithstanding the abilities and industry of Stahl, Hoffman, Boerhaave, and Cullen, we may confidently venture to assert that Moderns, no general system has yet been proposed which is not liable to innumerable and unsurmountable objections.

Very great progress has indeed been made in explaining the philosophy of the human body, from ascertaining by decisive experiment the influence of the circulating, the nervous, and the lymphatic systems in the animal economy. But every attempt hitherto made to establish any general theory in medicine, that is, to conduct the cure of every disease on a few general principles, has equally deviated from truth with those of Hippocrates and Galen; and has equally tended to mislead those who have adopted it. Many systems of our own days, such for example as that of Brown, though adopted with enthusiasm by the young and inexperienced, have evidently been attended with the most pernicious consequences in practice. Indeed we may with confidence venture to assert, that from the very nature of the subject itself, medicine does not admit of such simplicity. No one can deny that the human body consists of a very great number of different parts, both solids and fluids. It is, however, equally certain, that each of these is from many different causes liable to deviations from the sound state. And although some slight changes may take place without what can be called a morbid affection, yet we well know, that every change taking place to a certain degree in any one part will necessarily and unavoidably produce an affection of the whole. Hence we may without hesitation venture to affirm, that every general theory which can be proposed, attempting to explain the phenomena, and conduct the cure of all diseases on a few general principles, though for some time it may have strenuous advocates, will yet in the end be found to be both ill-grounded and pernicious.

The art of medicine has been much more usefully improved by careful attention to the history, theory, and practice of particular diseases, and by endeavouring to ascertain from cautious observation the symptoms by which they are to be distinguished, the causes by which they are induced, and the means by which they are to be prevented, alleviated, or cured. On this footing, therefore, we shall endeavour to give a brief account of at least the most important affections to which the human body is subjected, delivering what appear to us to be the best established facts and observations respecting each.

But before entering on the consideration of particular diseases, or what has commonly been styled the practice of medicine, it is necessary to give a general view of the most important functions of the animal body, and of the chief morbid affections to which they are subjected; a branch which has usually been named the Theory or Institutions of Medicine.

**Theory of Medicine, or an Account of the Principal Functions of the Animal Body.**

WHILE the functions of living animals, but particularly of the human species, are very numerous, the accounts given of these both in a state of health and disease are very various. Without, therefore, pretending to enumerate the contradictory opinions of different authors, we shall here present the reader with a view of this subject, subject, chiefly extracted from the *Conspectus Medicinae* of the Holy Theoretice of Dr James Gregory, who has collected from other writers the opinions at present most generally adopted.

In this work, which was first published in 1780, and afterwards reprinted under an enlarged form in 1782, Dr Gregory introduces this subject by observing, that some functions of the human body relate to itself only, and others to external things. To the latter class belong those which by physicians are called the *animal functions*; to which are to be referred all our senses, as well as the power of voluntary motion, by which we become acquainted with the universe, and enjoy this earth. Among the functions which relate to the body, some have been named *vital*, such as the circulation of the blood and respiration; because, without the constant continuance of these life cannot subsist; others, intended for repairing the waste of the system, have been termed the *natural functions*: for by the constant attrition of the solids and the evaporation of the fluid parts of the body, we stand in need of nourishment to supply the waste; after which the putrid and excrementitious parts must be thrown out by the proper passages. The digestion of the food, secretion of the humours, and excretion of the putrid parts of the food, are referred to this class; which, though necessary to life, may yet be interrupted for a considerable time without danger. This division of the functions into animal, vital, and natural, is of very ancient date, and is perhaps one of the best that has yet been proposed.

A disease takes place, when the body has so far declined from a sound state, that its functions are either quite impeded, or performed with difficulty. A disease therefore may happen to any part of the body either solid or fluid, or to any one of the functions; and those may occur either singly, or several of them may be diseased at the same time; whence the distinction of diseases into *simple* and *compound*.

We have examples of the most simple kinds of diseases, in the rupture or other injury of any of the corporeal organs, by which means they become less fit for performing their offices; or, though the organs themselves should remain sound, if the solids or fluids have degenerated from a healthy state; or if, having lost their proper qualities, they have acquired others of a different, perhaps of a noxious nature; or, lastly, if the moving powers shall become too weak or too strong, or direct their force in a way contrary to what nature requires.

The most simple diseases are either productive of others, or of *symptoms*, by which alone they become known to us. Every thing in which a sick person is observed to differ from one in health is called a *symptom*; and the most remarkable of these symptoms, which most commonly appear, define and constitute the disease.

The causes of diseases are various; often obscure, and sometimes totally unknown. The most full and perfect proximate cause is that which, when present, produces a disease, when taken away removes it, and when changed, changes it.—There are also remote causes, which physicians have been accustomed to divide into the *predisponent* and *exciting* ones. The former are those which only render the body fit for a disease, or which put it into such a state that it will readily receive one. The exciting cause is that which immediately produces the disease in a body already disposed to receive it.

The predisponent cause is always inherent in the body itself, though perhaps it originally came from without; thus heat or cold, a very sparing or a very luxurious diet, and many other particulars, may operate as causes of predisposition, inducing plethora, inanition, or the like. But the exciting cause may either come from within or without.

From the combined action of the predisponent and exciting causes comes the *proximate* cause, which neither of the two taken singly is often able to produce.—A body predisposed to disease therefore has already declined somewhat from a state of perfect health, although none of its functions are impeded in such a manner that we can truly say the person is diseased. Yet sometimes the predisponent cause, by continuing long, may arrive at such a height, that it alone, without the addition of any exciting cause, may produce a real disease.—The exciting cause also, though it should not be able immediately to bring on a disease; yet if it continues long, will by degrees destroy the strongest constitution, and render it liable to various diseases; because it either produces a predisponent cause, or is converted into it, so that the same thing may sometimes be an exciting cause, sometimes a predisponent one, or rather a cause of predisposition; of which the inclemencies of the weather, sloth, luxury, &c. are examples.

Diseases, however, seem to have their origin from the very constitution of the animal machine; and hence many diseases are common to every body when a proper exciting cause occurs, though some people are much more liable to certain diseases than others. Some are hereditary; for as healthy parents naturally produce healthy children, so diseased parents as naturally produce a diseased offspring. Some of these diseases appear in the earliest infancy; others occur equally at all ages; nor are there wanting some which lurk unsuspected even to the latest old age, at last breaking out with the utmost violence. Some diseases are born with us even though they have no proper foundation in our constitution, as when a fetus receives some hurt by an injury done to the mother; while others, neither born with us nor having any foundation in the constitution, are suckled in with the nurse's milk. Many diseases accompany the different stages of life; and hence some are proper to infancy, youth, and from old age. Some also are proper to each of the sexes; and especially the female sex, proceeding, no doubt, from the general constitution of the body, but particularly from the state of the parts subservient to generation. Hence the diseases peculiar to virgins, to menstruating women, to women with child, to lying-in women, to nurses, and to old women. The climate itself, under which people live, produces some diseases; and every climate has a tendency to produce particular diseases, either from its excess of heat or cold, or from the mutability of the weather. An immense number of diseases also may be produced by impure air, or such as is loaded with putrid, marshy, and other noxious vapours. The same same thing may happen likewise from corrupted aliment, whether meat or drink; though even the best and most nutritious aliment will hurt if taken in too great quantity; not to mention poisons, which are endowed with such pernicious qualities, that even when taken in a very small quantity they produce the most grievous diseases or perhaps even death itself. Lastly, from innumerable accidents and dangers to which mankind are exposed, they frequently come off with broken limbs, wounds, and contusions, sometimes quite incurable; and these misfortunes, though proceeding from an external cause at first, often terminate in internal diseases.

Hitherto we have mentioned only the dangers which come from without; but those are not less, nor fewer in number, which come from within. At every breath, man pours forth a deadly poison both to himself and others. Neither are the effluvia of the lungs alone hurtful: there flows out from every pore of the body a most subtle and poisonous matter, perhaps of a putrescent nature, which being long accumulated, and not allowed to diffuse itself through the air, infects the body with most grievous diseases; nor does it stop here, but produces a contagion which spreads devastation far and wide among mankind. From too much or too little exercise of our animal powers also no small danger ensues. By inactivity either of body or mind, the vigour of both is impaired; nor is the danger much less from too great employment. By moderate use, all the faculties of the mind, as well as all the parts of the body, are improved and strengthened; and here nature has appointed certain limits, so that exercise can neither be too much neglected, nor too much increased, with impunity. Hence those who use violent exercise, as well as those who spend their time in sloth and idleness, are equally liable to diseases; but each to diseases of a different kind; and hence also the bad effects of too great or too little employment of the mental powers.

Besides the dangers arising from those actions of the body and mind which are in our own power, there are others arising from those which are quite involuntary. Thus, passions of the mind, either when carried to too great excess, or when long continued, equally destroy the health; nay, will even sometimes bring on sudden death. Sleep also, which is of the greatest service in restoring the exhausted strength of the body, proves noxious either from its too great or too little quantity. In the most healthy body, also, many things always require to be evacuated. The retention of these is hurtful, as well as too profuse an evacuation, or the excretion of those things either spontaneously or artificially which nature directs to be retained. As the solid parts sometimes become flabby, soft, almost dissolved, and unfit for their proper offices; so the fluids are sometimes inspissated, and formed even into the hardest solid masses. Hence impeded actions of the organs, vehement pain, various and grievous diseases. Lastly, some animals are to be reckoned among the causes of diseases: such, particularly, as support their life at the expense of others; and these either invade us from without, or take up their residence within the body, gnawing the bowels while the person is yet alive, not only with great danger and distress to the patient, but sometimes even producing death itself.

Man, however, is not left without defence against so many and so great dangers. The human body is possessed of a most wonderful power, by which it preserves itself from diseases, keeps off many, and, in a very short time, cures some already begun, while others are by the same means more slowly brought to a happy conclusion. This power, called the autocratiea, or vis medicatrix naturee, is well known both to physicians and philosophers. This alone is often sufficient for curing many diseases, and is of service in all. Nay, even the best medicines operate only by exciting and properly directing this force; for no medicine will act on a dead carcase. But though physicians justly put confidence in this power, and though it generally cures diseases of a slighter nature, it is not to be thought that those of the more grievous kind are to be left to the unassisted efforts of the vis medicatrix. Physicians therefore have a twofold error to avoid, either despising the powers of nature too much, or putting too great confidence in them; because in many diseases these efforts are either too feeble or too violent, insomuch that sometimes they are more to be dreaded than even the disease itself. So far therefore is it from being the duty of a physician always to follow the footsteps of nature, that it is often necessary for him to take a directly contrary course, and oppose her efforts with all his might.

After a general view of the functions of the animal body, of the nature and causes of disease, and of the analysis of powers by which these are to be combated, Dr Cirey proceeds to treat of the solid materials of which the body is formed. He tells us, that the animal solid, when chemically examined, yields earth, oil, salt; water, phlogiston or inflammable air, and a great quantity of mephitic air. These elements are found in various proportions in the different parts of the body; and hence these parts are endowed with very different mechanical powers, from the hardest and most solid bone to the soft and almost fluid retina. Nay, it is principally in this difference of proportion between the quantities of the different elements, that the difference between the solid and fluid parts of the animal consist, the former having much more earth and less water in their composition than the latter. The cohesion, he thinks, is owing to something like a chemical attraction of the elements for one another; and its cause is neither to be sought for in the gluten, fixed air, nor earth. This attraction, however, is not so strong but that even during life the body tends to dissolution; and immediately after death putrefaction commences, provided only there be as much moisture in it as will allow an intestine motion to go on. The greater the heat, the sooner does putrefaction take place, and with the greater rapidity does it proceed; the mephitic air flies off, and together with it certain saline particles; after which, the cohesion of the body being totally destroyed, the whole falls into a putrid coluvies, of which at length all the volatile parts being dissipated, nothing but the earth is left behind.

This analysis, he owns, is far from being perfect, and is by no means in the language of modern chemistry. try. But no modern chemist has ever been able, by combining the chemical principles of flesh, to reproduce a compound anything like what the flesh originally was; yet, however imperfect the analysis may be, it still has the advantage of showing in some measure the nature and causes of certain diseases, and thus leads physicians to the knowledge of proper remedies.

The solid parts are fitted for the purposes of life in three several ways; namely, by their cohesion, their flexibility, and their elasticity, all of which are various in the various parts of the body. Most of the functions of life consist in various motions. In some the most violent and powerful motions are required; and therefore such a degree of cohesion is necessary in these parts as will be sufficient for allowing them to perform their offices without any danger of laceration. It is therefore necessary that some of the solid parts should be more flexible than others; and it is likewise necessary that these parts, along with their flexibility, should have a power of recovering their former shape and situation, after the removal of the force by which they were altered.

These variations in flexibility, within certain limits, seldom produce any material consequence with regard to the health: though sometimes, by exceeding the proper bounds, they may bring on real and very dangerous diseases; and this either by an excess or diminution of their cohesion, flexibility, or elasticity. By augmenting the cohesion, the elasticity is also for the most part augmented, but the flexibility diminished; by diminishing the cohesion, the flexibility becomes greater, but the elasticity is diminished.

The cause of these affections, though various, may be reduced to the following heads. Either the chemical composition of the matter itself is changed; or, the composition remaining the same, the particles of the solid may be so disposed, that they shall more or less strongly attract one another. As to the composition, almost all the elements may exist in the body in an undue proportion, and thus each contribute its share to the general disorder. But of many of these things we know very little; only it is apparent, that the fluid parts, which consist chiefly of water, and the solid, which are made up of various elements, are often in very different proportions: the more water, the less is the cohesion or elasticity, but the greater the flexibility; and the reverse happens, if the solid or earthy part predominates.

The remote causes of these different states, whether predisposing or exciting, are very various. In the first place, idiosyncrasy itself, or the innate constitution of the body, contributes very much to produce the above-mentioned effects. Some have naturally a much harder and drier temperament of the body than others; men, for instance, more than women; which can with the utmost difficulty, indeed scarce by any means whatever, admit of an alteration. The same thing takes place at different periods of life; for, from first to last, the human body becomes always drier and more rigid. Much also depends on the diet made use of, which always produces a corresponding state of the solids in proportion to its being more or less watery. Neither are there wanting strong reasons for believing, that not only the habit of the body, but even the disposition of the mind, depends very much on the diet we make use of. The good or bad concoction of the aliment also, the application of the nourishment prepared from it, and likewise the state of the air with regard to moisture and dryness, affect the temperament of the body, not a little; and hence those who inhabit mountains or dry countries, are very different from the inhabitants of low marshy places. Lastly, the manner of living contributes somewhat to this effect: Exercise presses out and exhales the moisture of the body, if in too great quantity; on the contrary, sloth and laziness produce an effect directly opposite, and cause a redundancy of fluid.

But, putting the chemical composition of the solid parts out of the question altogether, they may be affected by many other causes. The condensation, for instance, or compression of the particles, whether by mechanical causes or by means of cold or heat, makes a considerable alteration in the strength and elasticity of every solid body. How much mechanical pressure contributes to this may be understood from the experiments of Sir Clifton Wintringham: and hence also are we to deduce the reason of many facts of the highest importance in the animal economy; namely, the growth, state, decrease of the body; its rigidity daily increasing; and at last the unavoidable death incident to old age from a continuance of the same causes.

Perhaps the different density of the solids is in some measure owing to Nature herself; but it seems to depend more on the powers of exercise or inactivity in changing the state of the solids, the effects of which on the body, whether good or bad, may hence be easily understood.

Heat relaxes and expands all bodies, but cold renders them more dense and hard; the effects of which on the human body are well known to most people. Though the body is found to preserve a certain degree of heat almost in every situation, yet its surface must unavoidably be affected by the temperature of the circumambient atmosphere; and we have not the least reason to doubt that every part of the body may thus feel the effects of that temperature. What a difference is there between one who, exposed to the south wind, becomes lazy and languid, scarce able to drag along his limbs; and one who feels the force of the cold north wind, which renders the whole body alert, strong, and fit for action?

That these various causes, each of which is capable of affecting the constitution of the body when taken singly, will produce much greater effects when combined, is sufficiently evident. The experiments of Bryan Robinson, the effects of the warm bath, and indeed daily experience, show it fully.

It is not yet certainly known what is the ultimate structure of the minutest parts of the animal-solid; whether it consists of straight fibres or threads, whose length is very considerable in proportion to their breadth, variously interwoven with one another, as Boerhaave supposes; or of spiral ones, admirably convoluted and interwoven with one another, as some microscopical experiments seem to show; or whether the cellular texture be formed of fibres or laminae, and from thence the greatest part of the body, as the celebrated Haller hath endeavoured to prove. The cellular texture is observed throughout the whole body: it surrounds and connects the fibres themselves, which are sufficiently apparent in many of the organs; and slightly joins the different parts which ought to have any kind of motion upon the neighbouring ones. By a condensation of this substance also, the strongest, and what seem the thinnest, membranes are formed; the most simple of which being accurately examined, discover the cellular structure. This cellular substance sometimes increases to a surprising degree, and all parts formed of it, membranes, vessels, &c., especially by a gentle distension; for a sudden and violent distension either breaks it altogether, or renders it thinner. Sometimes also it grows between neighbouring parts, and joins those which nature has left free. Preternatural concretions of this kind are often observed after an inflammation of the lungs or of the abdominal viscera; and these new membranes are found to be truly cellular. This substance, when cut, or by any other means divided, grows together of its own accord; but if, by reason of very great inflammation and suppuration, a large portion of the cellular texture has been destroyed, it is never again completely renewed, and an ugly scar is left. It is even said, that this substance, in certain cases, is capable of joining the parts either of the same body with one another, or of a foreign body with them; and upon this, if on any foundation, rests the art of Taliacotus and that of transplanting teeth, lately so much talked of.

The cellular texture is in some places merely a kind of net-work, in others filled with fat. Wherever too great bulk or compression would have been inconvenient or dangerous, as in the head, lungs, eyes, eyebrows, penis, scrotum, &c., there it collects no fat, but is lax, and purely reticulated; but between the muscles of the body and limbs below the skin, in the abdomen, especially in the omentum and about the kidneys, very much fat is secreted and collected.

The fat is principally a pure animal oil, not very different from the expressed and mild vegetable ones; during life it is fluid, but of different degrees of thickness in different parts of the body. It is secreted from the blood, and is often suddenly reabsorbed into it, though pure oil is very rarely observed in the blood. It is indeed very probable, that oil, by digestion, partly in the prime viva, and partly in the lungs, is converted into gluten, and this again into oil by means of secretion; though no glandular organs secreting the fat can be shown by anatomists. It is, however, probable, that there are such organs; and that the cellular texture has some peculiar structure in those parts which are destined to contain the fat already secreted, without suffering it to pass into other places; for it never passes into those parts which are purely reticulated, although the cellular texture is easily permeable by air or water over the whole body from head to foot.

The fat is augmented by the use of much animal-food, or of any other that is oily and nourishing, provided the digestion be good; by the use of strong drink, especially malt-liquor; by much rest of body and mind, much sleep and inactivity, castration, cold, repeated blood-letting, and in general by whatever diminishes the vital and animal powers. Much, however, depends on the constitution of the body itself; nor is it possible to fatten a human creature at pleasure like an ox. A certain degree of fatness, according to the age of the person, is a sign and effect of good health; but when too great, it becomes a disease of itself, and the cause of other diseases. It may always be very certainly removed by strong exercise, little sleep, and a spare diet. The fat commonly makes up a considerable part of the bulk of the body; and sometimes by far the greatest part. Its use seems to be to make the motion of the body more easy and free, by lessening the friction of the moving parts, and thus preventing the abrasion of the solids, which would otherwise happen. It is also of use to hinder the parts from growing together, which sometimes happens, when by an ulcer or any other accident a part of the cellular texture containing the fat is destroyed. Besides all this, the fat contributes not a little to the beauty of the body, by filling up the large interstices between the muscles, which would otherwise give the person a deformed and shocking appearance. It is thought to be nutritious, when absorbed from its cells into the blood; but of this we have no certain proof. It seems to have some power of defending from the cold; at least, nature has bestowed it in very great quantity on those animals which inhabit the colder regions, as whales, bears, &c.

Those parts of the body which enjoy sense and mobility, are called living or vital solids. They are the brain, cerebellum, medulla oblongata, spinal marrow, the nerves arising from these and diffused throughout the whole body, and which are distributed through the various organs of sense and through the muscles, and lastly the muscles themselves. Sensation is much more general than mobility, as being common to all the parts already mentioned. Mobility is proper to the muscular fibres alone: wherever there is sensation, therefore, we may believe that there are nerves; and wherever there is mobility, we may believe that muscular fibres exist. Nay, even mobility itself seems to originate from the connection which the muscles have with the nerves; for soon after the nerves are compressed, or tied, or cut, the muscles to which they are distributed lose their faculties; which happens too when the brain itself, or the origin of the nerves, is affected. Some reckon that the muscles are produced from the nerves, and consist of the same kind of matter. Both indeed have a similar structure, as being fibrous and of a white colour: for the muscles, when well freed from the blood, of which they contain a great abundance, are of this colour as well as the nerves; neither can the nervous fibres by any means be distinguished from the muscular fibres themselves. Both have also sensation; and both stimulants and sedatives act in the same manner, whether they be applied to the muscles themselves or to the nerves. These circumstances have led Dr Cullen and many others to consider the muscular fibre as being merely a continuation of nerve. But to this opinion there are many strong objections; though there can be no doubt that the contraction of the muscular fibre is intimately connected with nervous influence.

It is difficult for us to discover the origin of many parts of the body, or to ascertain whether they are produced all at the same time or one after another: yet it must be owned, that many of the muscular parts are observed to have attained a remarkable degree of strength,

trength, while the brain is still soft and almost fluid; and that the action of these muscular parts is required for the action and growth of the brain. The muscles are also of a much firmer contexture than the nerves; and enjoy a power of their own, namely, that of irritability, of which the nerves never participate. Of necessity, therefore, either the muscles must be constructed of some kind of matter different from that of the nerves; or if both are made of the same materials, their organization must be exceedingly different. But if the substance of the muscles and nerves be totally different, we may easily be convinced that much of the one is always mixed with the other; for it is impossible to prick a muscle, even with the smallest needle, without wounding or lacerating many nervous fibres at the same time. Since, therefore, there is such a close connection between the muscles and nerves both as to their functions and structure, they are deservedly reckoned by physiologists to be parts of the same genus, called the genus nervosum, or nervous system.

After treating of sense in general, Dr Gregory proceeds to consider particularly each of the senses both external and internal. He begins with the sense of feeling, as being the most simple, and at the same time in common to every part of the nervous system. In some places, however, it is much more acute than in others; in the skin, for instance, and especially in the points of the fingers. These are reckoned to have nervous papillae, which by the influx of the blood are somewhat erected in the action of contact, in order to give a more acute sensation; though indeed this opinion seems rather to be founded on a conjecture derived from the structure of the tongue, which is not only the organ of taste, but also a most delicate organ of touch, than upon any certain observations.

From the sense of feeling, as well as all the other senses, either pain or pleasure may arise; nay, to this sense we commonly refer both pain and almost all other troublesome sensations, though in truth pain may arise from every vehement sensation. It is brought on by any great force applied to the sentient part; whether this force comes from within or from without. Whatever, therefore, pricks, cuts, lacerates, distends, compresses, bruises, strikes, gnaws, burns, or in any manner of way stimulates, may create pain. Hence it is so frequently conjoined with so many diseases, and is often more intolerable than even the disease itself. A moderate degree of pain stimulates the affected part, and by degrees the whole body; produces a great flux of blood to the part affected, by increasing the action of its vessels; and it seems also to increase the sensibility of the part affected to future impressions. It often stimulates to such motions as are both necessary and healthful. Hence, pain is sometimes to be reckoned among those things which guard our life. When very violent, however, it produces too great irritation, inflammation and its consequences, fever, and all those evils which flow from too great force of the circulation; it disorders the whole nervous system, and produces spasms, watching, convulsions, delirium, debility, and fainting. Neither the mind nor body can long bear very vehement pain: and indeed Nature has appointed certain limits beyond which she will not permit pain to be carried, without bringing on delirium, convulsions, syncope, or even death, to rescue the miserable sufferer from his torments.

Long-continued pain, even though in a more gentle degree, often brings on debility, torpor, palsy, and rigidity of the affected part. But if not too violent, nor accompanied with fever, sickness, or anxiety, it sometimes seems to contribute to the clearness and acuteness of the judgment, as some people testify who have been afflicted with the gout.

Anxiety is another disagreeable sensation, quite different from pain, as being more obtuse and less capable of being referred to any particular part, though frequently more intolerable than any pain. But we must take care to distinguish between this anxiety of which we treat in a medical sense, and that which is spoken of in common discourse. The latter does not at all depend on the state of the body, but belongs entirely to the mind; and arises from a sense of danger, or a foresight of any misfortune. The former is truly corporeal; and derives, no less than pain, its origin from a certain state of the body. Notwithstanding this difference, however, it is very possible for both these kinds of anxiety to be present at the same time, or for the one to be the cause of the other. A very great bodily anxiety will strike fear and despondency into the most resolute mind; and mental anxiety, on the contrary, if very violent and long-continued, may induce the former, by destroying the powers of the body, especially those which promote the circulation of the blood.

Anxiety, in the medical sense of the word, arises in the first place from every cause disturbing or impeding the motion of the blood through the heart and large vessels near it. Anxiety, therefore, may arise from many diseases of the heart and its vessels, such as its enlargement, too great constriction, ossification, polypus, palpitation, syncope, inflammation, debility, and also some affections of the mind. It is likewise produced by every difficulty of breathing, from whatever cause it may arise; because then the blood passes less freely through the lungs: anxiety of this kind is felt deep in the breast. It is said also to arise from the difficult passage of the blood through the liver or other abdominal viscera.

A certain kind of anxiety is very common and troublesome to hypochondriacal people; and arises from the stomach and intestines being either loaded with indigested and corrupted food, or distended with air produced by fermentation and extricated from the aliments. By such a load, or distention, the stomach, which is a very delicate organ, becomes greatly affected. Besides, the free descent of the diaphragm is thus hindered, and respiration obstructed. Anxiety of this kind is usually very much and suddenly relieved by the expulsion of the air; by which, as well as by other signs of a bad digestion, it is easily known. In these cases the anxiety is usually, though with little accuracy, referred to the stomach.

Anxiety also frequently accompanies fevers of every kind, sometimes in a greater and sometimes in a lesser degree. In this case it arises as well from the general debility as from the blood being driven from the surface of the body and accumulated in the large vessels: as in the beginning of an intermittent fever. Or it may arise from an affection of the stomach, when The sense next to be considered is that of taste, the principal organ of which is the tongue; the nearer the tip of it, the more acute is the sense, and the nearer the glottis so much the more obtuse. It must be owned, however, that some kind of acrid substances, the taste of which is scarcely perceived upon the tip of the tongue, excite a most vehement sensation about its roots, or even in the throat itself. The tongue is endowed with many large and beautiful nervous papillae, which seem to be the chief seat of this sense, and in the act of tasting are elevated and erected, in order to give the more acute sensation.

Nothing can be tasted which is not soluble in the saliva, that, being applied in a fluid form, it may pervade the involucra of the tongue, and affect its nervous pulp; and hence insoluble earths are quite insipid. Neither is it sufficient for a body to be soluble that it may be tasted: it must also have something in it saline, or at least acid, in order to stimulate the nervous substance; and hence, whatever has less salt than the saliva is totally insipid.

The taste is rarely found to be too acute, unless through a fault in the epidermis which covers the tongue. If this be removed or wounded, or covered with ulcers, aphthæ, &c., then the taste, becoming too acute, is painful: or sometimes, no other sensation than that of pain is felt. It may be impaired, as well as the sense of feeling, from various diseases of the brain and nerves; of which, however, the instances are but rare. In some people it is much more dull than in others; and in such the sense of smelling is usually deficient also. The taste is most commonly deficient on account of the want of saliva; for a dry tongue cannot perceive any taste: hence this sense is very dull in many diseases, especially in fevers, catarrhs, &c., as well on account of the defect of saliva as of appetite, which is of so much service in a state of health; or by reason of the tongue being covered with a viscid mucous.

The taste is frequently depraved; when, for example, we have a perception of taste without the application of anything to the tongue; or if any thing be applied to it, when we perceive a taste different from what it ought to be. This happens for the most part from a vitiated condition of the saliva, which is itself tasted in the mouth. Hence we may perceive a sweet, saline, bitter, putrid, or rancid taste, according to the state of the saliva: which may be corrupted either from the general vitiated condition of the mass of humours, or the glands which secrete it; of the mouth itself; or even of the stomach, the vapours and excretions of which rise into the mouth, especially when the stomach is diseased.

Besides the faults of the saliva, however, the taste may be vitiated from other causes; as, for instance, the condition of the nervous papillæ. This, however, is as yet but little known to us; for the taste is sometimes plainly vitiated, when at the same time the saliva appears quite insipid when tasted by other people.

Physicians, in almost every disease, but especially in fevers, inquire into the state of the tongue; not, indeed, without the greatest reason: for from this they can judge of the condition of the stomach; of the thirst, or rather the occasion the patient has for drink, when, on account of his delirium or stupor, he neither feels his thirst, External thirst, nor is able to call for drink. And, lastly, from an inspection of the tongue, physicians endeavour to form some judgment concerning the nature, increase, and remission of the fever.

After the sense of taste, we shall next treat of that of that smell. Its seat is in that very soft and delicate membrane, filled with nerves and blood-vessels, which covers the internal parts of the nose, and the various sinuses and cavities proceeding from thence. This sense is more acute about the middle of the septum, and the ossa spongiosa, where the membrane is thicker and softer, than in the deeper cavities, where the membrane is thinner, less nervous, and less filled with blood-vessels; although even these do not seem to be altogether destitute of the sense of smelling.

As by our taste we judge of the soluble parts of bodies, so by our smell we judge of those very volatile and subtle parts which fly off into the air; and like the organ of taste, that of smell is kept moist, that it may have the more exquisite sensation, partly by its proper mucus, and partly by the tears which descend from the eyes.

Some kinds of odours greatly affect the nervous system, and produce the most surprising effects. Some gratefully excite it, and immediately recruit the spirits when almost sinking; while some produce fainting, nay, as it is alleged, even sudden death. To this head also are we to refer those antipathies, which, though truly ridiculous, are often not to be subdued by any force of mind.

This sense is sometimes too acute, as well from some disease in the organ itself, which happens more rarely, as from the too great sensibility of the nervous system in general, as is sometimes observed in nervous fevers, phrenitis, and hysteria. It is more frequently, however, too dull, either from diseases of the brain and nerves, as from some violence done to the head, or from some internal cause; or it may proceed from a dryness of the organ itself, either on account of the customary humours being suppressed or turned another way, or from the membranes being oppressed with too great a quantity of mucus or of tears. Of both these cases we have instances in the cattarh, where at first the nostrils are dry, but afterwards are deluged with a thin humour, or stopped up with a thick one. But in these, and many other examples, the membrane of the nose itself is affected with inflammation, relaxation, or too great tension, by which the nerves, which constitute a great part of it, must be vitiated. It is evident also, that whatever obstructs the free entrance of the air into the nostrils, or impedes its passage through them, must prove detrimental to the sense of smelling.

The sense of hearing is more frequently vitiated than almost any of the rest, as having a more delicate organ, and one composed of many and very small parts, of which an account is given under the article Anatomy.—It frequently becomes too acute; either from the general habit of the body being too irritable, such as often happens to hysterical and lying-in-women; or from too great a sensibility of the brain itself, which is not unfrequently observed in fevers, as well as in phrenitis, and sometimes in the true mania; or it may be from a disease of the ear itself, as when it is affected with inflammation, pain, or too great tension.—It may be rendered dull, or even be altogether destroyed, so that the person shall become totally deaf, from the same causes acting with different degrees of force. This happens especially from the want of the external ear; or from the meatus auditorius being stopped up with mucus, wax, or other matters; or from the sides of the canal growing together, as sometimes happens after suppuration or the small-pox; or by the membrane of the tympanum becoming rigid or relaxed, or being eroded or ruptured; or the tympanum itself, or the Eustachian tube, may from certain causes be obstructed; or some of the little bones or membranes, or some of the muscles of the labyrinth, may be affected with concretion, spasm, palsy, or torpor; or, lastly, it may happen from diseases of the brain and nerves, all the organs of hearing remaining sound. Hence deafness is often a nervous disease, coming suddenly on, and going off spontaneously. Hence also it is common in old people, all of whose solid parts are too rigid, while their nervous parts have too little sensibility.

Persons labouring under fevers, especially of the typhus kind, often become deaf. When this comes on along with other signs of an oppressed brain, and a great prostration of health, it may be a very bad symptom; but for the most part it is a very good one, even though accompanied with some degree of torpor or sleepiness.

A very common disease in the sense of hearing is when certain sounds, like those of a drum, a bell, the falling of water, &c., are heard without any tremer in the air, or without a sound person's hearing anything. This disease is called tinnitus aurium, of which various kinds have been observed. For the most part it is a very slight transient disorder; but sometimes it is most obstinate, long-continued, and troublesome. It often arises from the slightest cause, such as any thing partially stopping up the meatus auditorius or Eustachian tube itself, so that access is in part denied to the air; whence it happens that the latter strikes the membrane of the tympanum, or perhaps the interior parts, unequally, and with too much force. Hence bombi, a kind of tinnitus, are heard even by the most healthy when they yawn.

A much more frequent and troublesome species of tinnitus accompanies many diseases both of the febrile and nervous kind. This is occasioned partly by the increased impetus of the blood towards the head, with an increase of sensibility in the nervous system itself, so that the very beatings of the arteries are heard; and partly from the increased sensation and mobility of the nerves and muscles of the labyrinth: whence it happens, that the parts which ought to be at rest until excited by the tremor of the air, begin to move of their own accord, and impart their motion to other parts which are already in a morbid state of too great sensibility.

A tinnitus sometimes arises from any vehement affection of the mind; sometimes from a disorder in the stomach; sometimes from a rheumatic disorder affecting the ears and head; or from a catarrh, which commonly affects the Eustachian tube. Sometimes, however, the tinnitus alone affects the patient; and even this is a disease of no small consequence. These various causes, however, both of this and other disorders of the hearing, Concerning the nature of the sense of sight, the reader may consult the articles Anatomy and Optics. Of this sense some slight disorders, or rather varieties, are often observed. Those persons are called short-sighted who cannot see distinctly unless the object be very near them. This disorder arises from too great a refraction of the rays by reason of their being too soon collected into a focus by the crystalline lens, and diverging again before they fall upon the retina, by which means they make an indistinct picture upon it. The most common cause is too great a convexity of the eye or some of its humours, as too prominent a cornea. It is a disorder common to young people, which is sometimes removed when they grow older. As soon as the first approaches of short-sightedness are observed, it is supposed it may be obviated by the person's accustoming himself to view remote objects, and keeping his eyes off very small and near ones: as, on the contrary, it may be brought on by the opposite custom; because the eye accommodates itself somewhat to the distances of those objects which it is accustomed to view. But a concave glass, which causes the rays of light to diverge more than naturally they would before falling upon the cornea, is the most simple and certain remedy.

Long-sighted people are those who cannot see an object distinctly unless it be at a considerable distance from them. This arises from causes contrary to the former; namely, the eye being too flat, so that there is no room for refracting the rays and bringing them into a focus. Hence this defect is common in old people, and remedied by the use of convex glasses.

Those are called nyctalopes who see better with a very weak than with a strong light. It is a defect very seldom to be met with in the human race, though every person is sensible of it who hath been long kept in the dark and is then suddenly brought into the light. The disease arises from too great a sensibility of the retina, and the pupil being too open.

The sight is liable to many and grievous disorders. It is sharpened beyond measure, so that the person either perceives nothing distinctly or with great pain, from the same causes that induce a similar disorder in the other senses; namely, excessive sensibility in the general habit of body; or a particular state of the brain common in phrenitis, or even in those afflicted with fevers arising from inflammation or too great excitement; though more frequently from the condition of the eye itself, one becomes unable to bear the light. The inflammation of the tunica adnata, and the forepart of the sclerotica, is communicated to the back parts of it, and from thence to the choroides and retina itself. Hence the light becomes intolerable, and vision is attended with pain and great irritation, sometimes inducing or augmenting a delirium.

The sense of seeing is made dull, or even totally abolished, by age; the aqueous humour not being supplied in sufficient quantity, and the cornea and lens, or the vitreous humour, becoming shrivelled or decayed. It may likewise happen from the cornea becoming dry and opaque; which is to be imputed to the languid motion of the blood, and to great numbers of the small vessels being obstructed or having their sides concreted;—or from the crystalline lens becoming yellow like amber, and the retina itself less sensible, for old age diminishes every sensation. It is totally abolished by injuries of the brain, the optic nerve, or the retina, even though the structure of the organ should remain sound. This disease is called an amaurosis; and is easily known by the dilatation and immobility of the pupil, the humours of the eye remaining clear. It is commonly owing to congestion of blood; and sometimes, where no congestion of blood can be discovered, to mere torpor of the nerves. If it be only a torpor of part of the retina, we see black spots in those things at which we look; or flies seem to pass before our eyes, a very bad sign in fevers, and almost always mortal. The sight is abolished also by the obscurity or opacity of any of the parts through which the rays ought to pass and be refracted; as if the cornea lose its transparency by being covered with spots; or the aqueous humours become corrupted with blood, serum, or pus; or the lens (which often happens, and which is called a cataract) becomes of a gray or brown colour, or the vitreous humour be in like manner corrupted; or, lastly, when all the humours being dissolved, confused and mixed together, by inflammation and suppuration, either do not suffer the light to pass at all, or to pass imperfectly and unequally; whence either no image is formed on the retina, or it appears obscure, distorted, imperfect, and ill-coloured.

The sight is also depraved, when things appear to it of a colour different from their own, or even in another situation and of another shape than they ought to have. This happens from the humour being tinctured with any unusual colour, as is said to happen in some instances of jaundice; or from an extravasation and mixture of the blood with the aqueous humour. A surprising depravation also, or constant and perpetual defect of vision, is not unfrequently observed in men otherwise very healthy, and who see quite clearly; namely, that they cannot distinguish certain colours, green, for example, from red. Another depravation is, when, without any light being admitted to the eyes, sparks, small drops of a flame or gold colour, and various other colours, are observed to float before us. This is generally a very slight and transient disorder, common to those whose constitutions are very irritable; and arises from the slight impulse, as it would seem, on the retina, by the vessels beating more vehemently than usual. A fiery circle is observed by pressing the eye with the finger after the eyelids are shut. The same reason, perhaps, may be given for those sparks which are seen by persons labouring under the falling sickness, and increasing to the size of an immense and luminous beam before they fall down in convulsions. A similar beam those who have recovered from hanging or drowning testify that they have observed: for by reason of the respiration being suppressed, the vessels of the head swell and compress the whole brain and nervous parts of the head. Sparks of the same kind, and these too of no good omen, External omen, are observed in patients labouring under a fever, where a phrenitis or fierce delirium is at hand; and likewise in those who are threatened with palsy, apoplexy or epilepsy.—A distinct but false perception, namely of visible things which do not exist, is to be imputed to some injury of the brain, to madness or a delirium, not to any disease of the eye.

A very frequent defect of vision remains to be mentioned, namely, squinting. A person is said to squint who has the axes of the eyes more oblique than usual, and directed to different points. Hence a great deformity, and often an imperfect and confused vision by which the objects are sometimes seen double. It is an evil for the most part born with the person, and often corrected by those attempts which an infant makes to see more pleasantly and distinctly; and this even without being conscious of its own defects. It is also easily learned, especially in infants, even without their own knowledge, by that kind of imitation which has a great influence over the human race, especially in their tender years.—It is by no means, however, so easily unlearned.

Squinting is frequently occasioned by a spasm, palsy, rigidity, &c., of the muscles which manage the eye; by epilepsy; by certain diseases of the head, the hydrocephalus especially; or by any great injury done to the head. Sometimes, though very rarely, it comes on suddenly without any known cause. It is very probable, however, that squinting often arises from a fault of the retinae, when their central points, for instance, and those similarly placed with respect to the centre, do not agree. In this case there must be a contortion of the eye, that the object may not be seen double. This seems also to be the reason why squinting is much increased when the person brings the object near his eye in order to view it more perfectly. Or if the central point of either, or both, of the retinae be insensible, or nearly so, it is necessary for the person to distort his eyes that he may have any distinct vision of objects. If the optic nerve had not entered the retina obliquely, but passed directly through its centre, we would all either have squinted or seen double.

Physicians have referred to the sense of vision that most troublesome sensation which we call a vertigo; though it seems rather to belong to that of feeling, or of consciousness; for in many instances the disorder is not removed either in the dark or by shutting the eyelids. The vertigo takes place when external objects really at rest seem to reel, to whirl round, to tremble, or to move in any manner of way. If the disorder be very violent, the person is neither able to see, on account of a dimness of sight; nor can he stand, as the powers fail which ought to govern the limbs. A nausea also usually accompanies the vertigo, and the one generally produces the other.

This disorder is observed to be both the symptom and forerunner of some dangerous diseases; such as apoplexy, epilepsy, hysteria; hemorrhages from the nose and other parts; suppressions of the menses; plethora; fevers, as well such as are accompanied with debility as those in which there is an increased impetus of the blood towards the head. An injury done to the head also, but rarely one done to the eyes, unless as it affects the whole head, brings on a vertigo. A vertigo may be likewise produced by a very great and sudden loss of blood or other fluid; by debility; syncope; various diseases of the alimentary canal, of the stomach especially; poisons admitted into the body, particularly of the narcotic kind, as opium, stramonium, wine, &c. and hence vertigo is a symptom of every kind of drunkenness. Various motions also, either of the head or the whole body, being tossed in a ship, especially if the vessel be small and the sea runs high, produce a vertigo. In these and similar examples, the unusual and inordinate motions of the blood are communicated to the nervous parts which are in the head; or these being affected by sympathy from the neighbouring parts, produce a confused sensation as if of a rotatory motion. Nay, it is often produced from an affection of the mind itself, as from beholding any thing turned swiftly round, or a great cataract, or looking down a precipice, or even by intense thought without looking at any thing.

Though a vertigo be for the most part a symptom and concomitant of other diseases, yet it is sometimes a primary disease, returning at intervals, increasing gradually, and equally impeding and destroying the functions of the body and mind.

After having treated of the external senses, we shall next proceed to consider those properly called internal; which are the memory, the imagination, and the judgment. The first is lessened, disturbed, or even totally destroyed, in many diseases, especially those which affect the brain; as in apoplexy, palsy, internal tumours of the head, external violence applied, fevers, especially those in which there is an increased motion of the blood towards the head, or where the brain is any other way very much affected. It is very rarely, however, depraved in such a manner that ideas are not represented to the mind in their proper order; or if at any time such a disorder occurs, it is considered rather as a disorder of the imagination, or as a delirium, than a failure of the memory. The mind is said to be disordered when the perceptions of memory or imagination are confounded with those of sense, and of consequence those things believed to be now present which are really past or which never existed; or when the sense of the person concerning ordinary things is different from that of other people. The general name for such disorders is vesania: if from fever, it is called delirium. A general fury without a fever, is called mania or madness: but a partial madness, on one or two points, the judgment remaining sound in all other respects, is called melancholia. There is, however, no exact and accurate limits between a sound mind and madness. All inmoderate vivacity borders upon madness; and, on the other hand, a sorrowful and gloomy disposition approaches to melancholy.

Delirium accompanies fevers of many different kinds. Sometimes it is slight, easily removed, and scarce to be accounted a bad sign. Often, however, it is very violent, and one of the very worst of signs, requiring the utmost care and attention.

A delirium is either fierce or mild. The fierce delirium is preceded and accompanied by a redness of the countenance, a pain of the head, a great beating of the arteries, and noise in the ears; the eyes in the mean time looking red, inflamed, fierce, shining, and unable to bear the light; there is either no sleep at all, all; or sleep troubled with horrid dreams; the wonted manners are changed; an unusual peevishness and ill-nature prevail. The depravation of judgment is first observed between sleep and waking, and by the person's crediting his imagination, while the perceptions of sense are neglected, and the ideas of memory occur in an irregular manner. Fury at last takes place, and sometimes an unusual and incredible degree of bodily strength, so that several attendants can scarce keep a single patient in his bed.

The mild delirium, on the contrary, is often accompanied with a weak pulse, a pale collapsed countenance, and a vertigo when the patient sits in an erect posture; he is seldom angry, but often stupid, and sometimes remarkably grieved and fearful. The loss of judgment, as in the former kind, is first perceived when the patient is half awake; but a temporary recovery ensues upon the admission of the light and the conversation of his friends. The patient mutters much to himself, and attends little to the things around him; at last, becoming quite stupid, he neither feels the sensations of hunger or thirst, nor any of the other propensities of nature, by which means the urine and excrements are voided involuntarily. As the disorder increases, it terminates in subsultus tendinum, tremors, convulsions, torpor, and death. The other species of delirium also frequently terminates in death, when the spirits and strength of the patient begin to fail.

The symptoms accompanying either of these kinds of delirium show an unusual, inordinate, and unequal motion of the blood through the brain, and a great change in that state of it which is necessary to the exercise of the mental powers. It is very probable, that an inflammation of the brain, more or less violent and general, sometimes takes place, although the signs of universal inflammation are frequently slight. This we learn from the dissection of dead bodies, which often show an unusual redness of the brain or of some of its parts, or sometimes an effusion or suppuration.

The state of the brain, however, may be much affected, and delirium induced, by many other causes besides the motion of the blood. In many fevers, typhus, for instance, the nervous system itself is much sooner and more affected than the blood's motion; and though the morbid affections of the nervous system are as invisible to the senses as the healthy state of it, the symptoms of its injuries plainly show that its action, or excitement, as some call it, is unequal and inordinate. In this way, too, delirium is produced by several poisons.

The pathology of melancholy and mania is much more obscure; as coming on without any fever, or disturbance in the blood's motion. Often also they are hereditary, depending on the original structure of the body, especially of the brain; the fault of which, however, cannot be detected by the nicest anatomist. But it is well known, that various diseases of the brain, obstructions, tumors, either of the brain itself, or of the cranium pressing upon it, any injury done to the head, and, as some physicians relate, the hardness and dryness of the brain, and some peculiar irritations affecting the nervous system, are capable of bringing on this malady. And indeed so great are the irritations affecting the nervous system in mad people, that they often sleep little or none for a long time.—Yet even this so defective and imperfect knowledge of the diseases of the brain and nerves, is by no means free from difficulties. For though we know that the brain, or a certain part of it, is hurt, or that it is irritated by a swelling, or a pointed bone growing into it, nobody can foretell how great, or what may be the nature of the malady from such a hurt: for examples are not wanting of people who, after losing a large part of the brain, have recovered and lived a long time; there are many instances also of persons who have perceived no inconvenience from a large portion of that viscus being corrupted, until at length they have fallen suddenly down and died in convulsions.

Another disease of the internal senses, quite different from these, is fatuity or idiotism. Those are called idiots who are destitute either of judgment or memory, or else have these faculties unequal to the common offices of life. A weak memory, however, is by no means essential to idiotism. For there are some instances of idiots who have had very correct and very extensive memories. A kind of idiotism is natural and common to all infants; neither is it to be accounted a disease; but if it last beyond the state of infancy, it is a real disease, and for the most part incurable. It has the same causes with the other diseases of the internal senses; although these can scarcely be detected by the eye or by the knife of the anatomist. It frequently accompanies, or is the effect of, epilepsy. Hence, if the epilepsy derives its origin from causes not seated in the head, as from worms lodging in the intestines, the fatuity may be cured by dislodging these, and removing the epilepsy. It is not unlikely that the fatuity of children, and the dotage of old men, may arise from the brain being in the former too soft and in the latter too hard; or perhaps in the one case not evolved, and in the other somewhat decayed.

The muscular power may be diseased in a great number of ways. The mobility itself may be too great; but this must be carefully distinguished from vigour. By mobility is meant the ease with which the muscular fibres are excited into contraction. The vigour, on the other hand, is that power with which the contraction is performed. They are sometimes joined, but more frequently separate, and for the most part the excesses of each are owing to contrary causes.

Too great mobility is when motions are excited by a very slight stimulus, or when very violent motions are produced by the customary stimulus. A certain habit of body, sometimes hereditary, renders people liable to this disease. Women have a greater share of mobility than men. Infants have a great deal of mobility, often too great; youth has less than infancy, but more than man's estate; though old age has commonly too little. A lazy, sedentary life, full diet, a suppression of the usual evacuations, fulness of the blood-vessels, and sometimes their being suddenly emptied, laxity, flaccidity of the solids in general, but sometimes too great a tension of the moving fibres, the use of diluents, especially when warm, or heat applied in any manner, produce too great mobility. And this may be either general or particular, according as the causes have been applied to the whole body, or only to a part of it.

Vigour in general is rarely morbid; although sometimes certain muscular parts appear to have too great strength. In maniacs and phrenitics, an immense strength... strength is observed in all the muscles, especially in those which serve for voluntary motion; this is not unjustly reckoned morbid. The reason of this excess is very obscure; however, it is plainly to be referred to a diseased state of the brain.

A more frequent and more important excess of vigour is observed in those muscular fibres that do not obey the will, such as those which move the blood. Its circulation is thus often increased, not without great inconvenience and danger to the patient. But a slighter excess of this kind, pervading the whole body, renders people apt to receive inflammatory diseases, and is usually called a phlogistic diathesis. But this is better observed when local, as in inflammation itself.

Too great vigour of the muscular fibres may arise from the nervous power increased beyond measure, as in mania, phrenitis, or violent affections of the mind; from too great a tension of the fibres, by which they more easily and vehemently conceive motions, as of the arteries when filled with too much blood; from catching cold, by being exposed either to cold or heat, as usually happens in the spring; or, lastly, though the nervous power and tension of the fibres should not at all be changed, their action may become too great, from a stimulus more violent than usual being applied, or from the usual stimulus, if the fibres themselves have already acquired too great a share of mobility.

The opposite to too great mobility is torpor, and to too great vigour is debility. Torpor is such a diminution of mobility as renders the parts unequal to their functions. It arises from causes directly opposite to mobility; such as, a harder and more rigid contexture of the parts themselves, or even sometimes from one too lax and flaccid; from old age; from some peculiar temperament of body, such as one phlegmatic, frigid, or insensible; too great and incessant labour, cold, spare diet, and an exhausted body. This evil is the more to be dreaded, because, the powers of the body being deficient, nature is neither able to make any effort of herself, nor are the remedies, in other cases the most efficacious, capable of affording her any assistance.

Debility takes place, when the motion of the muscles, either voluntary or involuntary, is not performed with sufficient strength. A greater or lesser share of debility, either general or of some particular part, accompanies almost all diseases, and is indeed no small part of them: for it is hardly possible that a disease can subsist for any length of time without inducing some degree of debility. When a state of debility is induced, it renders a man obnoxious to innumerable disorders, and throws him as it were defenceless in their way. It often depends on the original structure of the body, so that it can be corrected neither by regimen nor medicines of any kind. A different degree of strength also accompanies the different ages of mankind; and thus, in some cases, debility cannot be reckoned morbid. But a truly morbid and unusual debility arises from the nervous energy being diminished; from diseases of the brain and nerves, or of the muscles through which they are distributed; from a decay of the nerves themselves; from a want of the due tension of the fibres, or the fibres themselves becoming torpid; from the body exhausted by spare diet, want, evacuations; or, lastly, from diseases affecting the whole body, or some particular parts of it.

The highest degree of debility, namely, when the strength of the muscles is altogether or nearly destroyed, is called paralysis or palsy; and is either universal, Palsy, or belonging only to some particular muscles. An universal palsy arises from diseases of the brain and nerves, sometimes very obscure, and not to be discovered by the anatomist; for the nervous power itself is often deficient, even when the structure of the nerves remains unhurt; yet often a compression, obstruction, or injury of the vessels, extravasation of blood or serum, collections of pus, swellings, &c. are discovered. It frequently arises from certain poisons acting on the nerves; from the fumes of metals; from the diseases of parts, and affections of the muscles, very remote from the brain, as in the colic of Poictou. A palsy of single muscles, but less perfect, often arises without any defect of the brain or nerves, from any violent and contained pain, inflammation, too great tension, relaxation, rest, or destruction of the texture of the parts, such as commonly happens after the rheumatism, gout, luxations, fractures of the bones, and ischuria.

An universal palsy, however, as it is called, seldom affects the whole body, even though it should originate from a disease of the brain. We most commonly see those who are paralytic affected only on one side, which is called an hemiplegia. It is said that the side of the body opposite to the diseased side of the brain is most commonly affected. If all the parts below the head become paralytic, it is called a paraplegia. In these diseases the senses for the most part remain; though sometimes they are abolished, and at others rendered dull. Sometimes, though rarely, and which is an exceeding bad symptom, the motion, sensation, pulse, and heat of the paralytic limbs are lost; in which case the arteries themselves become paralytic. A palsy of the whole body, as far as regards the voluntary motions, with anaesthesia and sleep, is called an apoplexy. This proceeds from some injury of the brain; though a state very similar to it is induced by narcotics, opium, wine itself, or any generous liquor taken to excess; and lastly, by breathing in air corrupted by noxious impregnations, such as a large proportion of carbonic acid, hydrogenous gas, or similar active aciform fluids.

Another disease to which muscular motion is liable, and that neither slight nor unfrequent, is called spasm. This is a violent and irregular motion of the muscles. Of spasms there are two kinds, the tonic and clonic. The latter is frequently called a convulsion; in order to distinguish it from the other, which is more peculiarly called spasm.

Spasm, therefore, is a violent, constant and preternatural contraction of the muscular fibres; but a convulsion is an unusual and violent contraction alternated with relaxation. People are rendered liable to spasm by too sensible a habit of body, or too great mobility; and hence it is a disease common in women, in infants, and in weak, luxurious, lazy, and plethoric people. It is brought on those already predisposed to it, by any kind of stimulus applied to the brain, or to any nerve, muscle, or nervous part connected with it. Disorders of which we have examples in dentition; worms lodged in the intestines, and irritating them; any acrid matter infecting the blood, or much affecting the stomach and intestines; the irritation of any nerve, or of the brain itself, by an exostosis, swelling, too great fulness of the vessels, pain, vehement affections of the mind, sudden evacuation, or poisons admitted into the body. Frequently, however, the malady originates from slight causes, little known, and not easily observed.

Spasm is both the cause and effect, and frequently constitutes the greatest part, of many diseases. It is often very difficult either to be known or cured; because it is so multiform, and produces as many different symptoms as there are organs affected; of which it surprisingly disturbs, impedes, or increases the functions. It is a disease seated in the original stamina of the constitution; and neither to be removed by slight remedies, nor in a short time.

With regard to sleep, its use is sufficiently apparent from the effects which it produces in the body. It restores the powers both of mind and body when exhausted by exercise, giving vigour to the one, and restoring its wonted alacrity to the other. It renders the muscles again active and moveable, after they have become wearied, rigid, painful, and trembling by hard labour. It moderates the quickness of the pulse, which usually increases at night, and brings it back to its morning standard. It seems also to assist the digestion of the aliment; lessens both the secretions and excretions; and renders the fluids thicker than otherwise they would be, especially in a body endowed with much sensibility and mobility. Hence sleep is not only useful, but absolutely necessary for preserving life and health; and is a most excellent remedy both for alleviating, and totally removing, many diseases.

Want of sleep is hurtful in many different ways, especially to the nervous system. It renders the organs of sense both external and internal, as well as those of every kind of motion, unfit for performing their offices. Hence the sensations are either abolished, or become imperfect or depraved; and hence imbecility of mind, defect of memory, a kind of delirium, mania itself, pain of the head, weakness of the joints, an imperfect or inordinate action of the vital organs, quickness of pulse, heat, fever, depraved digestion, atrophy, leanness, and an increase or perturbation of the secretions and excretions.

Sleep may be prevented both in healthy and sick people from various causes; such as strong light, noise, pain, anger, joy, grief, fear, anxiety, hunger, thirst, vehement desire, motion of the body, memory, imagination, intense thought, &c. On the other hand, sleep is brought on by a slight impression on the organs of sense, or none at all; by the humming of bees, the noise of falling water, cold and insipid discourse; or lastly, by such an exercise of the memory as is neither too laborious nor disturbing to the mind.—Too great an impulse of the blood towards the head, such as often happens in fevers, prevents sleep; but a free and equal distribution of the blood through the whole body, especially the extreme parts, frequently brings it on. Whatever weakens the body also favours sleep; and hence various kinds of evacuations, the warm bath, fomentations, sometimes heat itself, are useful for promoting it. It also comes on easily after taking food, or indulging venery; the violent sensation being then quieted, and the body itself somewhat weakened. Cold produces a deep sleep of long continuance, not easily disturbed, and often terminating in death. Lastly, There are certain substances which, when applied to the body, not only do not excite the nervous system, but plainly lay us asleep, and render us unfit for sensation; of this kind are those called narcotics, as opium and the like; among which also we may reckon wine taken in too great quantity. Lastly, Watching itself is often the cause of sleep; because while a man is awake he always more or less exercises the organs of his body, by which the nervous influence is diminished, and thus the more violently the body is exercised, in the same proportion is the person under a necessity of sleeping.

Sleep is deficient in many diseases; for there are few which do not excite pain, anxiety, or uneasiness, sufficient to prevent the approach of sleep, or to disturb it. Fevers generally cause those who labour under them to sleep ill; as well on account of the uneasiness which accompanies this kind of disease, as by reason of the impetus of the blood towards the head being frequently increased; and likewise from the stomach being disordered, loaded with meat, or distended with drink. Hence also we may see the reason why many hypochondriac and hysteric patients sleep so ill; because they have a bad digestion, and their stomach is disposed to receive many though frequently slight disorders; the slightest of which, however, is sufficient to deprive the patient of rest, provided the body be already irritable, and endowed with too great a share of mobility.

Want of sleep will hurt in diseases as well as in health; and for the same reason; but in a greater degree, and more quickly, in the former than in the latter; and is therefore not only a very troublesome symptom of itself, but often produces other very dangerous ones.

Too much sleep, on the other hand, produces many mischiefs, rendering the whole body languid, torpid, and lazy; and it even almost takes away the judgment. It also disturbs the circulation, and diminishes most of the secretions and excretions. Hence plethora, fatness, flaccidity, and an inability for the common offices of life.—The causes of this excess are, either the usual causes of sleep above mentioned increased beyond measure, or some fault in the brain, or a compression of it by an extravasation of the humours; or sometimes, as it would seem, from great debility produced by an unusual cause, as in those who are recovering from typhous fevers and other diseases. In these examples, however, this excess of sleep is by no means hurtful; nor even, perhaps, in those cases where an excess of grief continued for a long time, or a great fright, have produced a surprising and unexpected somnolency. Lastly, Many people have accustomed themselves, and that not without a great deal of hurt to their constitutions, to sleep too much. Nor are there examples wanting of some who have passed whole days, and even months, in sleep almost uninterrupted.

With regard to the manner in which the circulation of the blood is performed, and the various principles of which it is composed, see the articles Blood, and Anatomy. As for the disorders to which the blood and its circulation are subject, it has been observed, Disorders that in our younger years the veins are much more dense, firm, and strong, than the arteries; but the latter, by reason of the continual pressure upon them, and the strength which they exert, become daily more firm, hard, and strong, until at last they equal or exceed the veins themselves in strength; and it is not uncommon in old men to find some part of the arteries converted into a horny substance, or even into a solid bone. Hence in the state of infancy the greatest part of the blood is contained in the arteries, and in old age in the veins; an affair indeed of no small moment, as it shows the reason, in some measure, of the state of increase and decrease of the body. Besides, if any disease happens from too great a quantity of blood, it thence appears that it must show itself in young subjects in the arteries, and in old ones in the veins; and this is the reason of many diseases which accompany certain periods of life.

In most, if not in all species of animals, the arteries of the females are much more lax and capacious when compared with the veins, and the veins much less, than in the males of the same genus. The design of nature in this conformation, is probably, that they may be the better able to nourish the fetus in their womb. The same likewise seems to be the reason why women are more inclined to plethora than men; and to this greater capacity of the arteries and smallness of the veins are we to ascribe that beauty and elegant shape of the arms in women, not disfigured or livid with veins as in men.

The blood is also distributed in various proportions to the different parts of the body, and that proportion too differs at different periods of our lives. At first a great quantity is sent to the head, because that part of the body is first to be evolved and fitted for its offices; but as soon as the parts begin to make a considerable resistance to the efforts of the blood, and the vessels cannot easily be further dilated, it is necessarily sent off to other parts; by which means the rest of the body increases in bulk, and becomes fitted for performing its proper functions. The effect of this change is also very soon observed, namely, when none of the blood passes through the navel, and of consequence a greater quantity is sent by the iliac arteries to the inferior extremities. These, though so small and slender in the fetus, increase very suddenly; so that often in not many months, the child can not only stand on its feet, but even walk tolerably well. And during the earliest periods of infancy, the inferior extremities grow more rapidly than any other part of the body.

Physicians are wont to judge of the state of the circulation by the pulse, which indeed is very various, as well with regard to its frequency, as to the strength and equality of its strokes and intervals.—Its common quickness in a healthy adult is about 70 strokes in a minute. In a fetus, perhaps, it is more than double; and in an infant a few months old, hardly less than 120. As we grow up, this quickness gradually diminishes; so that in extreme old age it sometimes does not exceed 50, or is even slower. This rule, however, is not without exceptions: for many, especially those of an irritable habit, have the pulse much quicker; while others, even in the vigour of their age, have their pulse remarkably slow. It is for the most part somewhat quicker in women than in men.

The pulse is also rendered quicker, both in a healthy and diseased body, by the application of stimuli of many different kinds. Exercise especially, by accelerating the return of the blood through the veins, increases the quickness of the pulse to a surprising degree. Various kinds of irritations affecting the nervous system, as intense thinking, passions of the mind, pain, heat, stimulating medicines, wine, spices, &c., likewise produce the same effect. The acrimony of the blood itself also is thought to quicken the pulse.

When a person first awakes in the morning, the pulse is slow, but becomes quicker by degrees on account of the many irritating matters applied to the body. Its quickness is increased after taking food, especially of the animal kind, or such as is hot or seasoned with spices. In the evening a slight fever comes on, for which rest and sleep are the remedy. These things, however, are scarcely to be observed in a healthy person, but are very evident in one that is feverish, especially when the fever is a hectic.—Again, even debility itself often renders the pulse quicker than usual; because the ventricle of the heart not being quite emptied, it is the sooner dilated again, and of consequence contracts the sooner. For this reason a physician can never judge of the strength of the circulation from the frequency of the pulse.

Lastly, In all fevers, however different from one another, the pulse is found to be too quick, partly perhaps from debility, partly from the acrimony of the fluids, and partly from the repulsion of the blood from the surface of the body, and the accumulation of it in the large vessels where it acts as a stimulus; though it must be owned, that a great deal of this is obscure, if not totally unknown; nor in truth are we able to understand in what manner the autocrateia acts with regard to the frequency of the pulse.

The pulse is seldom observed too slow, unless when the mobility of the body is much diminished, as in decrepid old age, or from a compression or disease of the brain, as is exemplified in the second stage of hydrocephalus; but a greater compression of the brain usually produces a still more remarkable slowness of the pulse, as in the third stage of hydrocephalus.—Sometimes also the pulse is too slow in those who are recovering from tedious fevers. But this is a matter of little moment, and seems to be owing to some kind of torpor. Indeed it has generally been considered as a mark of a thorough and complete solution of the fever; for it is commonly observed, that when this state of the pulse takes place, the patient seldom suffers a relapse.

While the frequency of the pulse continues the same, its strokes may be either full, great, strong, and hard; or soft, small, and weak. A full, great, and strong pulse takes place when the ventricle strongly and completely empties itself; throwing out a great quantity of blood into the arteries, which fully distends them and stimulates them to a strong contraction. A pulse of this kind is common in strong healthy men, and is seldom to be accounted a symptom of disease. But if it be too strong, and strike the finger of the person who feels it violently and sharply, it is called a hard pulse. This hardness is produced by a sudden and violent contraction of the heart and arteries, which distends even the remote branches, as those of the wrist, too suddenly and A hard pulse therefore denotes too great an action of the heart and arteries. It may arise from various causes; in the first place, from too great a tension of the vessels; for instance, from their being too full, and by that means more prone to motion, and the more fit for receiving violent motions. It may arise also from too great a density and firmness of the solids; and hence it is most frequent in cold countries, among strong robust people and such as are accustomed to hard labour. It may likewise arise from various causes irritating the whole nervous system, or only the heart and arteries. Lastly, It accompanies many fevers, as well as most inflammatory disorders, whether the inflammation arises from a general stimulus applied to the whole body, or from the irritation of particular parts, by degrees extended over the whole body. In such a state of the circulation, the patient frequently stands in need of blood-letting, and almost always bears it well.

A small, weak, and soft pulse is generally owing to causes opposite to the former, and indicates a contrary state of the circulation and nervous system. It frequently requires stimulants; nor does it generally require blood-letting, or easily bear it. Sometimes, however, a pulse of this kind is observed even in the case of a dangerous inflammation, of the stomach for instance, or intestines. But in these and the like examples we ought to attend to the nature of the malady, much more than to the state of the pulse.

The pulse is said to intermit, when the stroke does not return after the usual interval, and perhaps not till after twice, thrice, or four times the usual space. A pulse of this kind seems to be almost natural and constant in some animals, and is common to some men even in the most perfect health; and if these happen to be seized with a fever, the pulse sometimes becomes regular, nor can the disease be removed before the intermission has returned.

Moreover, in some people, though their pulse beats equally while in health, yet the slightest illness makes it intermit; and in others, especially those who have a great deal of mobility in their constitution, such as hypochondriac and hysteric people, the intermission of the pulse is felt, without applying the finger to the artery, merely by the uneasiness which they perceive in their breasts during those intervals in which the pulse is deficient. An intermittent pulse likewise occurs in many diseases of the breast, especially when water is collected in it; and the like happens in the end of all diseases, especially fevers, when the strength is nearly exhausted, and death approaches, of which it is frequently the forerunner.

An intermitting pulse therefore seems to arise from an unequal influx of the nervous power into the heart, or from the decay and exhaustion of the nervous power, by which means the heart is not able to contract till it has been distended beyond its due pitch. Or, lastly, It may arise from diseases of the organ itself, or the neighbouring parts; from swellings, water, &c. pressing upon them, and impeding the action of the heart: which is indeed is a very dangerous disorder, and almost always mortal.

Many other variations of the pulse are enumerated by physicians, but most of them are uncertain, and not confirmed by experience. We shall therefore now consider the motion of the blood, which may be either too great, too small, or irregular.

A quick pulse, ceteris paribus, produces a more rapid circulation, because the sooner that the ventricle of the heart is emptied, the more quickly is the blood thrown into the arteries; and their actions must answer to this stronger stimulus. Hence exercise, heat, stimulants, plethora, every kind of irritation, passions of the mind, and fever, increase the circulation. The effect of this increase is a distention of the vessels, a stimulus applied to the whole body, an increase of heat, and often a debility. The secretion of sweat is increased while the other secretions are diminished, and the various functions of the body impeded; thirst comes on, the appetite is lost, the fat consumed, and a disposition to putrescence introduced. Sometimes the smaller vessels are burst; whence effusions of blood and hemorrhages. But we are by no means to forget, that this violent motion of the blood, however hurtful it may seem, is among the best remedies made use of by nature in curing many diseases.

The motion of the blood is diminished, especially by debility, torpor, the want of irritation, or of exercise; the same thing happens to all the fluids, if there be any obstruction in the vessels, or any cause by which their return is hindered or rendered more difficult. Thus, from the very weight of the blood itself, if a person has stood long on his feet, the humours return more slowly from the inferior extremities. Any disease of the heart and arteries also, as an aneurism, contraction, ossification, must necessarily obstruct the circulation. The same thing happens from obstructions of the veins, or interrupted respiration, by which the passage of the blood through the lungs to the left side of the heart is impeded.

But, from whatever causes this diminution of the circulation takes place, the bad consequences are perceived chiefly in the veins, because in them the blood always moves more slowly than in the arteries. Hence varices, and congestions of blood, especially in those parts of the body where the veins are destitute of valves, and of consequence where the motion of the muscles cannot assist the circulation. Hence also arise dropsies from an impeded or languid motion of the blood; because the resistance of the veins being increased, the blood is received into them with the greater difficulty, and more of the thin humour is driven into the exhaling vessels, and by them deposited in such quantities as cannot be reabsorbed by the lymphatics. These diseases, as well as all others proceeding from defects of the circulation, are also more difficult of cure than others, because all the vital powers are weakened at the same time.

Another disorder of the circulation is where the blood is carried to one part of the body in too great quantity, by which means the other parts are deprived of their due proportion. This irregular distribution of the vital fluid frequently arises from a stimulus applied to the part itself, or to the brain, or at length acting on the mind, which, according to the laws of sympathy, produces a certain definite distribution of Disorders the blood. It arises also not unfrequently from a spasm of Circulation taking place in some other parts, which drives the blood out of its ordinary course.

In proportion to this irregularity of the circulation are the consequences; heat, swelling, redness, inflammation, rupture of vessels, hemorrhages, effusions, destruction, corruption, and suppuration of the cellular texture and adjoining parts, &c. Even this evil, however, nature often converts into an excellent remedy; and physicians, following her steps, frequently attempt to direct the distribution of the blood in particular diseases, well knowing that a change in the distribution of the blood is frequently efficacious either for radically curing some diseases, or relieving their most urgent symptoms.

Lastly, Some disorders in the motion of the heart itself, and those of no small consequence, remain yet to be taken notice of, namely, palpitation and syncope. A palpitation is a violent and irregular action of the heart, such as for the most part is perceived by the patient himself, and that not without a great deal of uneasiness and oppression at his breast; and it is also manifest to the by-standers, if they apply their hands, or look at his naked breast; the pulse of the arteries in the mean time being weak, unequal, and intermittent. This is a spasmodic disorder; and is induced by various causes affecting either the nervous system in general, or the heart in particular. Every disease of the organ itself, such as a constriction of its valves and blood-vessels, an ossification, enlargement, or polypus, hindering the free action of the heart, and evacuation of blood from it, are capable of exciting it to violent and unusual contractions. The same effect will also follow plethora, or too violent an impulse of the blood. The heart will likewise frequently palpitate from a violent excitement of the nervous system, especially where the constitution is endowed with a great deal of mobility. Hence palpitations arise from any affection of the mind, and in hysteric women. Palpitation may likewise arise from an affection of the stomach, occasioned by worms, a surfeit, flatus, or stimulation by various acid substances. It frequently also accompanies the gout when repelled, or even when a fit is coming on. Sometimes it arises from debility, whatever may be the cause; frequently from any difficulty in breathing; and many of these causes may be joined at the same time, or some of them produce others.

Hence we may see why the evil is sometimes slight and of short continuance; at other times altogether incurable, and certainly mortal in a longer or shorter time; why it sometimes returns at intervals, often coming on and being increased by every kind of irritation and exercise, and sometimes relieved or totally removed by stimulants or exercise.

A syncope takes place when the action of the heart, and along with it that of the arteries, is suddenly and very much lessened; whence the animal powers, the senses, and voluntary motions, immediately cease. This may be produced by almost all the causes of palpitation; because whatever can disturb and disorder the motion of the heart, may also weaken or suspend it. The vitiated structure of the heart itself therefore, violent passions of the mind, whether of the depressing kind, or those which suddenly and vehemently excite, various kinds of nervous diseases, those of the stomach, every kind of debility and evacuation, especially a great loss of blood, excessive and unremitting labour, long watching, heat, pain, many kinds of poisons, &c. produce fainting.

Hence we see, that whatever weakens the motion of the blood through the brain tends to produce fainting; and, on the contrary, whatever tends to augment that motion, also tends to refresh, and to prevent the person from fainting. Hence also we see how the mere posture of the body may either bring on or keep off fainting, or remove it after it has already come on. We likewise see how this disorder may sometimes be of little consequence and easily removed; at others very dangerous, not only as a symptom, but even of itself, as sometimes terminating in death; and lastly, how it may be used as a remedy by a skilful physician, and artificially induced, either to free the patient from violent pain, or to stop an immoderate effusion of blood scarce to be restrained by any other method.

With regard to the disorders of the blood itself, the Buffco glutinous part of it, or, more properly, its fibrine separated from the red particles, produces that buff-coloured appearance often seen upon blood drawn from people afflicted with inflammatory disorders, and even sometimes when no such diseases are present. This crust indeed is nothing else than the fibrine of the blood taking longer time than usual to coagulate, by which means the red particles have an opportunity of falling to the bottom. This indicates no lentor; density, thickness, or tenacity of the blood, as was formerly thought; but rather its thinness, or at least a less tendency in it to coagulate. It arises for the most part from a violent agitation and conquassation of the blood within the body; and hence it accompanies many fevers, all inflammations, sometimes hemorrhages, exanthemata, plethora, pain, and many irritations. It must, however, be allowed that in several of these diseases it is rendered highly probable at least, from experiments apparently accurate, that the quantity of the fibrine of the blood is really increased in the proportion which it bears to the other parts. This crust, however, is not always to be accounted morbid, as it often happens to the most healthy; and may even be produced or destroyed by the slightest causes while the blood is running from the vein, so that frequently we shall see a very thick and tenacious crust on the blood flowing into one cup, while that which runs into another has little or none at all. In general, however, the appearance of this crust shows, that the patient will bear blood-letting well, though those have been in a great mistake who have directed this operation to be repeated till no more crust appeared on the blood.

The coagulable part of the blood also frequently produces those masses called polygi, which sometimes take place during life, but more frequently after death, in the large vessels near the heart, or even in the cavities of that organ. Similar masses also are frequently formed in the uterus, and are called moles.

The quantity of blood contained in a healthy body Plth. is very various, and difficult to be ascertained. Many diseases, however, may arise from its being either too scanty or too abundant. Too great a quantity of blood is produced by the use of rich, nourishing diet, strong drink, accompanied with a good digestion; from a lazy, sedentary life, or much sleep, especially of the vessels being relaxed beyond their usual pitch, and not making a proper resistance. Besides, in this case, the lymphatics are so far from absorbing more than usual, that partaking likewise of the general debility, they are scarcely fitted for performing their proper offices.

Nature, however, has taken care, by the most simple means, to provide against so many and so great evils; for neither does the blood so easily become thin as some have imagined, nor when this quality takes place does it want a proper remedy. For almost instantly, if the person be otherwise in health, the excretions of watery matters are greatly augmented, and the whole mass of blood in a short time becomes as thick as formerly.

The opposite to this, namely, too great a thickness of Morbid thickness of the blood, though often spoken of by physicians, is very rarely if ever observed; and those fevers and inflammations which have been thought to arise from thence, are now found to originate from other causes. The following would seem to be the law of the human constitution. As soon as the blood has attained the due degree of thickness, or gone in the least beyond it, the excretions are either suppressed or diminished, the body attracts more moisture from the air, the person is thirsty, and drinks as much as is necessary for diluting the blood. But if water be wanting, and the person cannot satisfy his thirst, then the blood is so far from being thickened, that by reason of a putrefaction begun or augmented, it is much dissolved, becomes acid, and is with difficulty contained in the vessels.

The acrimony of the fluids has afforded a large field for declamation to speculative physicians, and of the upon this slender foundation many perplexed and intricate theories have been built. It is certain indeed, that the blood in a state of health has some small share of acrimony; and this acrimony, from certain causes, may be a little increased so as to produce various diseases of a dangerous nature. This we are assured of from the increase of motion in the heart and arteries, and the similar augmentation of the action of the secretory organs, when certain acid substances are taken inwardly. The same thing also appears from the unusual acrimony of the secreted fluids in such cases, by which the vessels are sometimes greatly stimulated, and sometimes even quite eroded. Very many acid substances, however, are daily taken into the stomach; so that these must either be corrected in the prime via, or changed by digestion before they pass into the blood; or at least by dilution with much water, or being blunted by an admixture with gluten, oil, or different gases, they must deposit much of their acrimony, and at last be thrown out of the body as noxious substances. Thus a vast quantity of salts, acid, alkaline, and neutral, may pass through the body, without in the least affecting the health; though these salts, if taken in very large quantity, undiluted, or not thrown out of the body, will do much hurt.

Moreover, even while life continues, putrefaction is going on, and produces much of that substance called animal salt; for into this a great part of our food is converted, and passes off by urine. But if this putrefactive disposition be too great, it will produce too large a quantity of animal salt; especially if much of any saline substance is otherwise thrown into the body without Disorders without proper dilution; and this kind of disease is well known to sailors who have been long at sea, without having an opportunity of getting fresh provisions.

For this spontaneous putrescence, nature has suggested a proper remedy, namely, fresh meat, especially of the vegetable and acetic kind, and such as is much impregnated with acid, which it may impart to the body. But where this kind of food is wanting, the putrefaction goes on apace, and a very great thinness and acrimony of the juices take place; especially if there be also a scarcity of urine, or the excretions which ought to carry the putrid matters out of the body languish, either from cold, sloth, torpor, depressing passions of the mind, or from the constitution being broken by diseases; or, lastly, from too great heat, which always favours putrefaction.

Besides, it would seem, that sometimes a disposition to putrefaction is much increased by the reception of a putrid ferment into the body; of which we have examples in some infectious fevers, where the contagion is very much assisted by heat, animal diet, certain kinds of salts, debility and nastiness.

Lastly, Any single part of the body may putrefy from various causes, as from inflammation, cold, &c., and thus may the whole body be infected; although for the most part the disease proves fatal before the corruption has spread over the whole body.

But when the mass of blood begins to putrefy greatly, it not only becomes very acrid, but thin, also, so that it either will not coagulate at all, or shows only a slight and very loose crustamentum. Nay, even the red globules are broken down and destroyed; in which case it necessarily follows, that the blood must become very acrid, as well on account of the evolution of the salt, as by reason of the rancid and putrid glutten, which stimulates, and frequently even erodes, the vessels; producing spots, first red, then livid and black, tumours, and ulcers scarce possible to be cured, without first removing the putrescent disposition of the humours. From the same causes proceed hemorrhages from every part of the body, hardly to be restrained; a most intolerable fetor of the breath and all the excrements; the highest debility and laxity of the solids; the putrefaction acting as a poison to the nervous system, and at length bringing on death.

An acrimony of the acid kind never takes place in the human blood, nor in any of the humours secreted from it; though one of them, namely the milk, turns acid spontaneously in a very short time after it is drawn from the breast. Neither does an alkaline acrimony seem ever to take place in the blood. Putrescence indeed tends this way, and at last terminates in it; but scarcely while the person lives, though the nature of the urine, even while recent, seems to be but little distant from that of an alkali.

Many kinds of acrimony may exist in the blood from too liberal an use of spices, wine, spirits, &c., but of these we know nothing certain. We well know, however, that the body is often infected with various kinds of morbid acrimony, which bring on many and dangerous diseases, as the small-pox, measles, cancers, lues venerea, &c., of which the origin and manner of acting are very little understood, though the effects are abundantly evident. In most cases, nature has taken no less care to provide against the acrimony than against the too great viscosity of the blood. Sometimes an antidote is afforded, either by the excitement of thirst, that the acrid substance may be diluted with plenty of drink; or by increasing the evacuations, that it may be thrown out of the body; or lastly, by exciting various motions and actions of the vital powers, by which it may be either subdued, changed, rendered innocent, or expelled from the body by new and unwonted passages.

With regard to respiration, it may be obstructed from various causes seated either in the lungs themselves, or in the surrounding parts. But from whatever cause this obstruction may arise, it undoubtedly produces all those diseases which proceed from an interrupted circulation. The lungs themselves also being at length compressed, and not suffered to dilate sufficiently, cannot throw off the vapour which arises from them; and hence they are frequently oppressed with moisture. At the same time they are irritated, so that a greater quantity of mucus, and that of a thicker kind than usual, is secreted; by which means the passages through which the air enters them are stopped up, till a violent cough at length throws off the load.

The respiration is also subjected to some other disorders, as a cough and sneezing, which, though at first sight they may seem very dangerous, are not destitute of use, and may even be reckoned among the most salutary attempts of nature to relieve the patient. Often, however, they are attended with danger, or very great uneasiness; namely, when they are either too violent or exerted in vain. At any rate, it is necessary for a physician to know the nature, causes, and effects of these, that he may be enabled to promote them when necessary, to moderate them when too violent, and to stop them when noxious or of no use.

A cough is a violent, frequently involuntary, and sonorous expiration, suddenly expelling the air with great force through the glottis somewhat contracted. The convulsion of the muscles serving for expiration, gives a great force to the air, while the contraction of the glottis produces the sound. It is often long continued, being repeated at certain intervals, during each of which the inspiration is imperfect and obstructed by reason of the contraction of the glottis. It is excited by any kind of acrid substance, either chemically or mechanically applied to those passages through which the air enters. These are lined with a membrane so exceedingly delicate and impatient of stimulus, that it cannot even bear the touch of the mildest substance, such as a small drop of water, without throwing the muscles serving for expiration into a violent convulsion; the glottis at the same time contracting by means of the sympathy between it and the neighbouring parts. Thus the air is thrown out with such violence, that it drives the irritating substance along with it; and thus a cough becomes not only useful, but absolutely necessary for the preservation of life, as being able to free the lungs from every kind of irritating substance or foulness, which might soon bring on a suffocation. Hence a cough is almost an inseparable companion of every inflammation of the lungs, as well as every difficulty in respiration; and even frequently accompanies the entrance of the purest air when the trachea... Disorders trachea and bronchiae are excoriated, or become too sensible. Examples also are not wanting, where a violent and troublesome cough has arisen from an irritability of the nervous system, or even of some particular part, of the ear, for instance, the stomach and intestines, the liver by inflammation, &c.

Coughing may also be voluntarily excited, and may then be managed at pleasure. Even when involuntary, it may be moderated, or suppressed, by a contrary effort: though a violent fit of coughing cannot by any means be resisted. When it is once excited, the cough goes on till the irritating substance be expelled, or the sense of irritation abolished, or perhaps overcome by a more uneasy sensation than even the cough itself; after which the irritation again returning at a certain interval, the cough also returns. Hence we are taught a method of allaying and quieting this most troublesome malady, though frequently it is not in our power to remove the cause of it altogether.

A very violent cough is often dangerous: For by the retention of the breath, and the strong efforts made in coughing, a great quantity of blood is collected in the lungs, of which the vessels are distended, and frequently broken; and hence there sometimes happens a violent and even fatal hemorrhage. More frequently, however, it is the cause of a slower, though equally fatal, disease. Nay, a frequent and troublesome cough, without any great hemorrhage, or even without any hemorrhage at all, may injure the lungs to such a degree, especially if they be of a more tender structure than usual, as to lay the foundation of a phthisis almost always incurable.

Again, by a long-continued and violent cough, the passage of the blood through the lungs being impeded, it must necessarily flow through the veins towards the head: hence redness and lividness in the countenance, hemorrhages, palsies, apoplexies, and sometimes fatal convulsions. Lastly, by a violent cough the abdominal viscera are compressed with remarkable violence; and if any part happens to be weaker than usual, a hernia, prolapsus uteri, abortion, or similar accidents, may happen.

Even when the cough is more gentle, if it happens to be importunate and frequent, although we have nothing of this kind to fear, yet the patient is by no means free from danger; as he is thereby agitated, fatigued, has his constitution broken, is deprived of rest, has a fever brought upon him, his lungs are shaken and irritated, digestion and all the other functions are impeded, till at last he sinks under a complication of maladies.

Sneezing is somewhat similar to cough, as consisting of a very full inspiration, to which succeeds a most violent expiration, by which the air is driven out through the nostrils with immense violence, and sweeps the passage through them as it goes out. It is a convulsion much more violent than a cough, and is besides very difficult to be stopped when once a propensity to it has taken place. As a cough proceeds from an irritation of the glottis, trachea, bronchia, and lungs, so sneezing arises from an irritation of the membrane of the nostrils, but rarely from sympathy with any distant part. It is sometimes of service, as well as a cough; though it is also sometimes prejudicial, for the reasons which have been already assigned.

The last affections of which we shall here speak, are those arising from a bad digestion, disordered motion of the intestines, and some of the principal secretions. The first of these are sometimes very troublesome, though seldom dangerous. The principal symptoms are oppression, anxiety, pain at the stomach; eructations, by reason of air extricated from the fermenting aliments, and irritating the stomach; nausea and vomiting, from the irritation and distention of the same organ; the belly sometimes too costive, and sometimes too loose; a defect of nourishment; a general debility; relaxation of the solid parts; too great thinness of the fluids; all the functions impeded; pain of the head; vertigo, syncope, asthma, palpitation; great sinking of the spirits, especially if the patient has been of a peculiar constitution; sometimes the gout, sometimes a dropsy, or a slow fever which may prove fatal.

The motion of the intestines may be either too great or too little; and hence proceeds either costiveness or looseness. The former is frequently not to be accounted morbid; but, when it is, it may arise from the structure of the intestines being injured, or from their being shut up or obstructed by spasm or otherwise, or from a deficiency of those humours which moisten the intestines; or, it may arise from mere debility, from a palsy of the fibres, perhaps, or from a deficiency of the usual stimulus, of the bile, for instance, or from too dry or slender a diet.

The consequences of long-continued costiveness, are, first, an affection of the alimentary canal, and then of the whole body. The stomach is diseased, and does not digest the aliments properly; the whole body is left destitute of its usual stimulus; the blood is corrupted, perhaps from the resorption of the putrid matter into it. The circulation through the abdominal viscera is impeded; hence frequent and irregular congestions, varices of the veins, hemorrhoids, &c. Nay, the intestines themselves being overloaded, distended and irritated by an heavy, acrid, and putrid load of aliment or other matters, are excited to new and unusual contractions, which, if they do not get the better of the obstruction, bring on tormina, colic, or an iliac passion, inflammation and gangrene, fatal in a very short time.

Looseness, or diarrhoea, is a malady extremely common; being sometimes a primary disease, and sometimes only a symptom or an effect of others. Sometimes it is a salutary effort of nature, such as the physician ought to imitate and bring on by art. It is also familiar to infants, and to people of a certain constitution; and to them costiveness is very prejudicial. It may arise, in the first place, from something taken into the body, or generated in the intestines; from a fermentation and corruption of the mass of aliments; from the bile being too abundant and acrid, or from blood or pus poured into the intestines; from the intestines themselves being eroded, or deprived of their natural mucus; from the humours being driven from the surface of the body towards the inward parts, as by cold, especially when applied to the feet; or from a general corruption of the whole body, as in the phthisis, hectic, or putrid fever, especially towards the end of these disorders. In fevers it is sometimes salutary, or even puts an end to the disease altogether, or at least renders it milder; more frequently, however, deriving its origin from putrescence, it is of no service, but rather exhausts the strength of the patient.

A diarrhoea likewise, almost incurable, and often fatal in a short time, frequently arises after the operation for the fistula in ano. Some have their intestines so extremely weak and moveable, that from the slightest cause, such as catching cold, any violent commotion of the mind, &c. they are subject to a violent diarrhoea. Lastly, whatever be its origin, if it has continued for a long time, the viscera are rendered so weak and irritable, that the disease, though often removed, still returns from the slightest causes, and even such as are not easily discovered.

A diarrhoea proves very pernicious, by hindering digestion and the nourishment of the body; for the stomach is commonly affected, and the aliments pass through the intestines so quickly, that they can neither be properly digested, nor are the lacteals able to absorb the chyle from them as they go along. Such a violent evacuation is also hurtful by exhausting the body, and carrying off a great quantity of the nutritious matter from the blood. Neither indeed, is it only the alimentary mass which is thrown out sooner than it ought to be; but at the same time, a great quantity of the fluids secreted in the intestines, so that the whole body quickly partakes of the debility.

Sometimes a violent and long-continued diarrhoea rises to such a height, that the aliment is discharged with little or no alteration. Sometimes also, though rarely, from a similar cause, or from the obstruction of the mesenteric glands, and its other passages into the blood, the chyle itself is thrown out like milk along with the excrements; and this disease is called the fluxus cælicus.

A dysentery is attended with very severe gripes in the belly, a frequent desire of going to stool, and vain efforts, when nothing is excreted besides the mucus of the intestines mixed with a little blood; it is also accompanied with excessive debility, and frequently with putrescence and fever. It is thought to arise from the constriction of some part of the intestines, of the colon especially: by which means the bowels, though ever so much irritated, can pass nothing; neither can the disease be removed, until the belly has been well purged by proper medicines.

A tenesmus is a frequent and insatiable propensity to stool, without being able to pass any thing, notwithstanding the most violent efforts. It may be occasioned by any kind of irritation, either of the rectum itself or of the neighbouring parts, by acrid substances taken into the body; by some of the stronger purges, especially aloes, a substance very difficult of solution, which will pass even to the rectum with very little alteration; by a violent and obstinate diarrhoea, dysentery, haemorrhoids, worms, fistula, calculus, ulcer in the bladder, urethra, &c. It is often very pernicious, both from the excessive uneasiness it occasions to the patient, and from its exhausting his strength, by the frequent and vain efforts bringing on a prolapsus ani, and communicating the violent irritation to the neighbouring parts, as the bladder, &c.

A nausea and vomiting are disorders very common, and owing to almost innumerable causes; not only to affections of the stomach itself, but also to affections and irritations of the remotest parts of the body which may act upon the stomach by sympathy. Every irritation and distention of that viscus therefore, a load of crude aliment, an obstruction about the pylorus, all acrid substances taken into it, diseases of the liver, intestines, kidneys, uterus, the head, the feet, the skin, or indeed the whole body, inflammation, the stone, king's evil, schirrus, apoplexy, compression of the brain, fracture of the skull, vertigo, syncope, violent pain, the gout, especially when repelled, fevers, passions of the mind, disagreeable imaginations or discourses, frequently induce nausea and vomiting.

These affections are often serviceable by freeing the stomach from something with which it was overloaded; promoting spitting in some cases where the lungs are overcharged with mucus, blood, pus, or water; producing sweat, and a free and proper distribution of blood to the surface of the body; partly, perhaps, by the great straining which accompanies vomiting, but rather by that wonderful sympathy which takes place between the stomach and skin: and hence, in many diseases, vomiting is a most excellent remedy. It is however in some cases hurtful, if too violent or too frequently repeated, partly by debilitating and making the stomach more easily moved; and partly by fatiguing the patient with violent strainings, which occasion hæmias, abortions, &c.

Sometimes we find the motion of the intestines totally inverted, from the anus to the mouth; a most dangerous distemper, which hath obtained the name of the iliac passion. It most frequently arises from some obstruction in the alimentary canal hindering the descent of the excrements, as schirrus, spasm, inflammation, &c.: though the most perfect iliac passion takes place without any obstruction, so that clysters will be vomited; and even after this has continued for several days, the patients have at length recovered.

A slighter degree of the iliac passion, namely the inversion of the peristaltic motion of the duodenum, always takes place in long-continued and violent vomiting, as in sea-sickness, or when a person has taken too large a dose of an emetic; by which means a vast quantity of bile frequently ascends into the stomach, and is discharged by vomiting.

An excessive vomiting with looseness is called a cholera, when the matter discharged has a bilious appearance. It arises from a very great irritation of the alimentary canal without any obstruction; and is for the most part occasioned by too great a quantity, or from an acrimony of the bile, from whence it takes its name. It may originate from several causes, as too strong a dose of an emetic and cathartic medicine, eating too great a quantity of summer-fruits, &c. and is a very violent malady, often killing the patient in a few hours, unless proper remedies be applied in time.

From a suppression of any of the secretions, or a disorder of any of the secretory organs, many mischiefs may arise. A diminution of perspiration produces plethora, lassitude, languor, depression of mind, bad digestion, loss of appetite, and even a general corruption of the humours from the retention of such a quantity of putrescent matter.—The more suddenly the diminution or suppression of the perspiration takes place, This suppression of perspiration may arise from many different causes; as from cold suddenly applied to the body when very hot; sometimes from very violent passions of the mind; or from spasmodic diseases, as the hysterics, &c. It may be suppressed also by that kind of constriction of the vessels of the skin which is produced by various kinds of fevers, the nature of which has hitherto been but little known.

Excessive perspiration or sweating is injurious by debilitating the body, relaxing the skin, and exposing the patient to all the evils which arise from catching cold. It may even be carried to such a height as to produce fainting and death; though it must be owned that we cannot easily bring examples of people having, from this cause, their blood inspissated, corrupted, or being thence made liable to inflammations and fevers.

A suppression of urine is still more dangerous than that of perspiration, and unless relieved in a short time will certainly prove fatal. This disorder, which is called *ischuria*, may arise from various diseases of the kidneys, ureters, bladder, urethra, &c. Thus any obstruction or irritation of one or other of the kidneys or ureters, by a stone, gravel, mucus, blood, inflammations, spasm, suppuration, schirrus, swellings of the neighbouring parts, &c. may either prevent the urine from being secreted, or may give rise to a scanty or depraved secretion, or, finally, may obstruct its passage into the bladder after it is secreted.

The urine also, after it has entered the bladder, is there frequently suppressed, by reason of various disorders to which that organ is liable, as an irritation or inflammation, spasm, acrid substances injected, or sympathy with the neighbouring parts; or by reason of the texture of the bladder itself being destroyed, or from a palsy, schirrus, ulcer, &c. in the bladder. Or, lastly, the urine may be retained in the bladder from a general stupor, as from a disease of the brain, which happens in some fevers, when the patient is neither sensible of the usual stimulus, nor even of one much greater, so that the fibres can scarcely be excited to contraction by any means whatever. This, in fevers, is always a bad sign, and sometimes even proves fatal.

A suppression of urine for any length of time produces an immense distention of the bladder, oppression, uneasiness, and pain, not only of the part itself, but of the surrounding ones, and even of the whole body; a spasm, or insuperable constriction of the sphincter; an inflammation, gangrene, or laceration of the bladder itself; a violent irritation of the whole habit; then a nausea, vomiting, vertigo, general stupor, and an impregnation of the whole mass of blood with a humour of an urinous nature, which at last being poured out into various cavities of the body, especially of the head, soon brings on a deep sleep, convulsions, and death.

From the same causes, but acting with less force, proceeds that disease called a *dysuria*, when the urine passes with difficulty and pain, and is frequently red, black, bloody, purulent, mucous, and sandy; the reason of all which appearances is very much unknown.—The most frequent complaint, however, in making water, is where the patient has a continual and violent desire of passing his urine, while at the same time only two or three drops can be passed at once, and that not without some pain. This may be occasioned even in healthy people, by some acrid substance taken into the stomach; and is very common to old people, who are generally subject to disorders of the kidneys and bladder. It arises also frequently from a stone irritating the bladder, or from an inflammation of it, or of its being deprived of its mucus, or this last being somehow or other corrupted; or lastly, from certain diseases, or some particular state of the neighbouring parts, as of the uterus, vagina, urethra, prostate gland, &c.

Akin to the strangury is an incontinence of urine, when the patient's water either comes away against his will, or altogether without his knowledge. This disorder may arise from debility, palsy, an ulcer or wound, or any long-continued and violent irritation of the bladder, especially of its sphincter, as from a stone, a general palsy, or in females difficult labour, injuring the neighbouring parts.—This symptom occurs in a great number of diseases, especially in the hydrocephalus.—Sometimes the urine is expelled with violence, either by reason of universal spasms, or by violent contractions of the muscles of respiration, as in sneezing, laughter, &c.

Among the disorders incident to the urine we may reckon the production of calculi, which frequently bring on the most excruciating and dangerous diseases. The urine, besides the water and salts, contains no small share of the glutinous part of the blood already somewhat corrupted, and still inclined to farther corruption. Hence the urine even of the most healthy people deposits a sediment after it has stood for some time; and though none of this sediment be formed in a healthy body, yet if the smallest particle of foreign matter be introduced into the bladder, a crust soon gathers round it, and it is sure to become the basis of a concretion, which by degrees grows to a very great size. It is not unlikely, also, that some unknown faults of the fluids may contribute to the production of those calculi, as the stone is well known to be an hereditary disease, and to be born with the patient. Calculous persons also are commonly subject to complaints of the stomach, especially to an acidity of it; and many have received no little relief from alkaline or alkaline medicines.—From the same causes may calculi be formed in the kidneys; from which proceed a horrid train of symptoms described in the subsequent part of this treatise.

It is now found, by accurate experiments of the most able chemists, that urinary calculi do not, as was once supposed, consist almost entirely of an earthy matter. Their principal constituent is a peculiar acid, approaching more nearly to the phosphoric found in the bones than to any other. But the acid of calculus being in some respects peculiar in its nature, has among modern chemists obtained a peculiar name, and been distinguished by the appellation of the lithic or uric acid. It is highly probable that this acid present in the circulating mass, is precipitated and disengaged by the introduction of other acids, and thus thrown off in greater quantities by the kidneys. Thus, then, we can understand the influence of acids as tending to the generation of calculus, and of alkalies as tending to prevent it.

The last disorder here to be taken notice of is a disorder of the glands themselves, owing to some kind of obstruction, and is one of the most dreadful diseases incident to human nature. Hence happens a great swelling and surprising hardness, not only without pain, but sometimes even with a diminution of sensation in the part affected; and when the gland is thus affected, it is called a schirrus. Sometimes it remains in this state for a long time; but sooner or later produces the most excruciating torment. By degrees it is infected with a slow and malignant suppuration, degenerating into an horrid ulcer, consuming not only the part itself, but eating away the neighbouring ones, and corrupting the whole body with the most acrid and incurable poison. This disease is called a cancer, of which the causes are very little known.

Of the organs in both sexes concerned in the function of generation, and of that function as far as we yet know any thing respecting it, an account has already been given in Anatomy; and after what has been said of the different functions, and of the morbid affections, to which these are subjected, we may conclude our remarks on the theory of medicine, with mentioning the remarkable versatility of the human constitution; which more than that of any other animal, is capable of accommodating itself to every climate and to all kinds of diet. Hence we may conclude, that a large proportion of the diseases to which we are subjected are produced by ourselves.

Practice of Medicine, or an Account of the principal Diseases to which the Human Body is subjected.

We have already defined medicine to be the art of preventing, curing, and alleviating, those diseases to which mankind are subjected. While these affections, however, are in number almost infinite, each in its progress is subjected to almost endless varieties from differences in climate, constitution, treatment, and a variety of other particulars. Hence we may readily explain both the difficulty of distinguishing morbid affections from each other in actual practice, and the diversity of names which have been affixed to them in the writings of ancient physicians. It may readily be supposed, that in this, as well as other subjects, there has been a gradual improvement from the progressive labours of industrious and ingenious men. And although much yet remains to be done in the proper arrangement and distinction of diseases, or what has been called methodical nosology, yet there cannot be a doubt, that during the course of the 18th century, this subject has received very great improvements. For these, we are, in the first place, highly indebted to the labours of Franciscus Boissier de Sauvages, an eminent professor of medicine at Montpelier, who, following out an idea suggested by the sagacious Dr Sydenham of England, first successfully attempted to arrange diseases, as botanists had done plants, into classes, orders, genera, and species. Since the publication of the Nosologia Methodica of Sauvages, this subject has been successfully cultivated by several ingenious men, particularly by Sir Charles Linnaeus of Upsal, to whose genius for arrangement every branch of natural history, but botany in particular, has been so highly indebted; by Rudolphus Augustus Vogel, an eminent professor at Gottingen; and by John Baptist Sagar, a distinguished physician at Iglaw in Moravia: But of all the systems of arrangement yet presented to the medical world, that published by the late illustrious Dr William Cullen of Edinburgh, may justly be considered as the best. In treating, therefore, of the principal diseases to which the human body is subjected, we shall follow his plan, endeavouring to deliver the best established observations respecting the history, theory, and practice of each. In treating of particular genera of disease, although we follow the arrangement of Dr Cullen, yet for the satisfaction of the reader, we shall often point out the classes to which the same affection is referred by the other eminent writers whom we have mentioned. And on this account, it may not be improper briefly to enumerate the general classes to which each of them have referred the affections of the human body.

The Classes of Sauvages are,

1. Vitia. 2. Febres. 3. Phlegmasiae. 4. Spasmi. 5. Anhelationes. 6. Debilitates. 7. Dolores. 8. Vesaniae. 9. Fluxus. 10. Cachexiae.

The Classes of Linnaeus are,

1. Exanthematici. 2. Critici. 3. Phlogisticici. 4. Dolorosi. 5. Mentales. 6. Quietales. 7. Motorii. 8. Suppressori. 9. Evacuatorii. 10. Deformes. 11. Vitia.

The Classes of Vogel are,

1. Febres. 2. Profluvia. 3. Epischesces. 4. Dolorcs. 5. Spasmi. 6. Adynamiae. 7. Hypercrestheses. 8. Cachexiae. 9. Paranoiae. 10. Vitia. 11. Deformitates.

The Classes of Sagar are,

1. Vitia. 2. Palge. 3. Cachexiae. 4. Dolores. 5. Fluxus. 6. Suppressiones. 7. Spasmi. 8. Anhelationes. 9. Debilitates. 10. Exanthemata. 11. Phlegmasiae. 12. Febres. 13. Vesaniae.

Besides Besides these, two other systems have been presented to the public, which may be considered as deserving attention; those, viz. of the late learned Dr M'Bride of Dublin, and of the late ingenious Dr Darwin.

The Classes and Orders of M'Bride.

Class I. Universal Diseases. Or. 1. Fevers. 2. Inflammations. 3. Fluxes. 4. Painful diseases. 5. Spasmodic diseases. 6. Weaknesses or privation. 7. Asthmatic disorders. 8. Mental disorders.

Class II. Local Diseases. Or. 1. Of the internal senses. 2. Of the external senses. 3. Of the appetites. 4. Of the secretions and excretions. 5. Impeding different actions. 6. Of the external habit. 7. Dislocations. 8. Solutions of continuity.

Class III. Sexual Diseases. Or. 1. General proper to men. 2. Local proper to men. 3. General proper to women. 4. Local proper to women.

Class IV. Infantile Diseases. Or. 1. General. 2. Local.

The Classes and Orders of Darwin.

Class I. Diseases of Irritation. Or. 1. Increased irritation. 2. Decreased irritation. 3. Retrograde irritative motions.

Class II. Diseases of Sensation. Or. 1. Increased sensation. 2. Decreased sensation. 3. Retrograde sensitive motions.

Class III. Diseases of Volition. Or. 1. Increased volition. 2. Decreased volition.

Class IV. Diseases of Association. Or. 1. Increased associated motions. 2. Decreased associated motions. 3. Retrograde associated motions.

After this short view of different classifications, we shall next present to our readers a more particular account of the arrangement of Dr Cullen; which, although it can by no means be represented as free from errors or imperfections, is yet in many respects the best that has hitherto been published.

Cullen's Arrangement.

Class I. PYREXIÆ. A frequent pulse coming on after a horror; considerable heat; many of the functions injured; the strength of the limbs especially diminished.

Order I. FEBRES. Pyrexia without any primary local affection, following languor, lassitude, and other symptoms of debility.

Sect. I. Intermittentes. Fevers arising from the miasma of marshes; with an apyrexia, or at least a very evident remission; but the disease returns regularly, and for the most part with a horror or trembling.

. Tertiana. Similar paroxysms after an interval of about 48 hours, coming on most commonly at mid-day. A tertian hath either;

I. An apyrexia interposed. 1. Varying in the duration of the paroxysms. A, The tertian whose paroxysms are not extended beyond 12 hours. B, The tertian with paroxysms extended beyond 12 hours. 2. Varying in the return of paroxysms. C, The tertian returning every day with unequal paroxysms alternately similar to one another. D, The tertian returning every third day with two paroxysms on the same day. E, The tertian returning every day, with two paroxysms on every third day, and only one on the intermediate ones. F, The tertian returning every day, with an evident remission interposed between the odd and the even days, but a less remarkable one between the even and the odd days. 3. Varying in its symptoms. G, The tertian accompanied with a disposition to sleep. H, Accompanied with spasms and convulsive motions. 1. Accompanied with an efflorescence on the skin. K, With phlegmasia. 4. Varying in being complicated with other diseases. 5. Varying as to its origin. II. With the interposition only of a remission between the paroxysms.

Genus II. Quartana. Similar paroxysms, with an interval of about 72 hours, coming on in the afternoon.

I. With the interposition of an apyrexia. 1. Varying in the type. A, The quartan with single paroxysms, returning every fourth day, none on the other days. B, With two paroxysms every fourth day, and none on the other days. C, With three paroxysms, every fourth day, and none on the intermediate days. D, Of the four days having only the third free from fever, with similar paroxysms every fourth day. E, The quartan coming on every day, with similar paroxysms every fourth day. 2. Varying in its symptoms. 3. Varying in being complicated with other diseases. II. With a remission only between the paroxysms.

Genus III. Quotidiana. Similar paroxysms with an interval of about 24 hours, coming on commonly in the morning.

I. With the interposition of an apyrexia. 1. Varies in being solitary. A, Universal. B, Partial. 2. Complicated with other diseases.

II. With a remission only between the paroxysms.

Sect. II. Continua. Fevers without evident intermission, and not occasioned by marsh miasmata; but attended with exacerbations and remissions, though not always very remarkable.

Genus IV. Synocha. Great heat; a frequent, strong, and hard pulse; high-coloured urine; the functions of the sensorium a little disturbed.

Genus V. Typhus. A contagious disease; the heat not much above the natural; the pulse small, weak, and for the most part frequent; the urine little changed; the functions of the sensorium very much disturbed, and the strength greatly diminished.

The species are, I. Typhus petechialis. Typhus for the most part with petechiae. Varying in degree. 1. Mild typhus. 2. Malignant typhus. II. Typhus icterodes. Typhus with a yellowness of the skin.

Genus VI. Synochus. A contagious disease. A fever compounded of synocha and typhus; in the beginning a synocha, but towards the end a typhus.

Order II. Phlegmasiae. A synocha fever, with inflammation or topical pain, the internal function of the parts being at the same time injured; the blood drawn and concreted exhibiting a white coriaceous surface.

Genus VII. Phlogosis. Pyrexia; redness, heat, and painful tension, of some external part.

The species are, I. Phlogosis (phlegmone) of a vivid red colour; a swelling well defined, for the most part elevated to a point, and frequently degenerating into an abscess, with a beating or throbbing pain. The variations are, 1. In the form. 2. In the situation. II. Phlogosis (erythema) of a reddish colour, vanishing by pressure; of an unequal and creeping circumference, with scarce any swelling; ending in the scaling off of the cuticle, in pustules, or blisters. The variations are, 1. In the degree of violence. 2. In the remote cause. 3. In being complicated with other diseases. The consequences of a phlogosis are, an imposthume, gangrene, sphacelus.

Genus VIII. Ophthalmia. A redness and pain of the eye, with an inability to bear the light; for the most part with an effusion of tears.

The species and varieties of the ophthalmia are, I. Idiopathic. 1. Ophthalmia (membranarum), in the tunica adnata, and the membranes lying under it, or the coats of the eye. A, Varying in the degree of the external inflammation.

B, In the internal coats affected. 2. Ophthalmia (tarsi), of the eye-lids, with swelling, erosion, and glutinous exudation.

II. Symptomatic. 1. From a disease of the eye itself. 2. From diseases of other parts, or of the whole body.

Genus IX. Phrenitis. Violent pyrexia; pain of the head; redness of the face and eyes; inability to endure the light or any noise; watchfulness; a furious delirium, or typhomania.

I. Idiopathic.

II. Symptomatic.

Genus X. Cynanche. Pyrexia sometimes inclining to a typhus; difficulty of swallowing and breathing; with a sensation of narrowness in the fauces.

The species are, I. Cynanche (tonsillaris) affecting the mucous membrane of the fauces, but especially the tonsils, with redness and swelling, accompanied with a synocha. II. Cynanche (maligera) affecting the tonsils, and mucous membrane of the fauces with swelling, redness, and mucous crusts of a whitish or ash-colour, creeping, and covering ulcers; with a typhous fever and exanthemata.

III. Cynanche (trachealis) attended with difficult respiration, noisy and hoarse inspiration, loud cough, without any apparent tumour in the fauces, somewhat difficult deglutition, and a synocha.

IV. Cynanche (pharyngea) attended with redness in the bottom of the fauces, very difficult and painful deglutition, respiration sufficiently free, and a synocha.

V. Cynanche (parotidea) when great swelling in the parotids and maxillary glands appearing on the outside; the respiration and deglutition but little injured; a synocha, for the most part mild.

Diseases of this genus are symptomatic, either from external or internal causes.

Genus XI. Pneumonia. Pyrexia, with a pain in some part of the thorax, difficult respiration, and cough.

The species are, I. Peripneumony, with a pulse not always hard, but sometimes soft; an obtuse pain of the breast; the respiration always difficult; sometimes the patient cannot breathe unless in an upright posture; the face swelled, and of a livid colour; the cough for the most part moist, frequently bloody. 1. Simple idiopathic peripneumonies. Varying in degree. 2. Idiopathic peripneumonies complicated with fever. 3. Symptomatic peripneumonies. II. Pleurisy, with a hard pulse; for the most part attended with a pungent pain of one side, augmented chiefly during the time of inspiration; an uneasiness when lying on the side; a most painful cough, dry in the beginning of the disease, afterwards moist, and frequently bloody. 1. Simple idiopathic pleurisies. 2. Pleurisies, complicated, (1.) With fever, (2.) With catarrh. 3. Symptomatic pleurisies. 4. False pleurisies. The consequences of pleurisy are a vomica or empyema. Genus XII. Carditis. Pyrexia; pain about the heart; anxiety; difficulty of breathing; cough; unequal pulse; palpitation of the heart, and fainting.

I. Idiopathic. II. Symptomatic.

Genus XIII. Peritonitis. Pyrexia; pain of the belly, exasperated by an upright posture, without the proper signs of other abdominal phlegmasiae.

I. Peritonitis (proprius), situated in the peritoneum, properly so called, surrounding the inside of the abdomen.

II. Peritonitis (omentalis), in the peritoneum extended through the omentum.

III. Peritonitis (mesenterica), in the peritoneum spread through the mesentery.

Genus XIV. Gastritis. Pyrexia inclining to a typhus; anxiety; pain and heat of the epigastrium, augmented when any thing is taken into the stomach; an inclination to vomit, and an immediate rejection of every thing swallowed; an hiccup.

I. Idiopathic. 1. From external causes. A. Gastritis (phlegmonodæa), attended with acute pain and violent pyrexia. 2. From external causes. B. Gastritis (erysipelas), with a less violent fever and pain; an erysipelas redness appearing on the fauces.

II. Symptomatic.

Genus XV. Enteritis. Pyrexia of a typhous nature; pungent pain of the belly, stretching and twisting about the navel; vomiting; the belly obstinately bound.

I. Idiopathic. 1. Enteritis (phlegmonodæa), with acute pain, violent fever, vomiting, and constipation of the belly. 2. Enteritis (erysipelas), with less acute fever and pain, without vomiting; but accompanied with a diarrhoea.

II. Symptomatic.

Genus XVI. Hepatitis. Pyrexia; tension and pain of the right hypochondrium; sometimes pungent like that of a pleurisy, but more frequently obtuse; a pain reaching to the clavicle and top of the right shoulder; a difficulty of lying on the left side; dyspnoea; dry cough, vomiting, and hiccup.

Genus XVII. Splenitis. Pyrexia; tension, heat, and swelling of the left hypochondrium, the pain increasing by pressure; without the signs of nephritis.

Genus XVIII. Nephritis. Pyrexia; pain in the region of the kidney, often following the course of the ureter; frequent discharge of urine, either thin and colourless, or very red; vomiting; stupor of the thigh; with a retraction or pain of the testicle of the same side.

The species are, I. Idiopathic. Spontaneous. II. Symptomatic.

Genus XIX. Cystitis. Pyrexia; pain and swelling of the hypogastrium; frequent and painful discharge of urine, or ischuria; and tenesmus. The species are, I. Those arising from internal causes. II. Those from external causes.

Genus XX. Hysteritis. Pyrexia; heat, tension, swelling, and pain of the hypogastrium; the os uteri painful when touched; vomiting.

Genus XXI. Rheumatismus. A disease arising from an external and frequently very evident cause; pyrexia; pain about the joints, frequently following the course of the muscles; infesting the knees and other large joints rather than those of the feet or hands; increased by external heat.

The species are either idiopathic or symptomatic. The former varies in situation. A. In the muscles of the loins. B. In the muscles of the coxendix. C. In the muscles of the breast.

Genus XXII. Odontalgia; a rheumatism of the jaws from a caries of the teeth.

Genus XXIII. Podagra. An hereditary disease, arising without any evident external cause, but for the most part preceded by an unusual affection of the stomach; pyrexia; pain of a joint for the most part of the great toe of the foot, at least infesting chiefly the wrists and ankles; returning by intervals; and often alternated with affections of the stomach and other internal parts.

I. Podagra (regularis), with a pretty violent inflammation of the joints remaining for some days, and by degrees going off with swelling, itching, and desquamation of the affected part. II. Podagra (atonica), with an atony of the stomach, or some other internal part; and either without the usual inflammation of the joints, or only with slight and wandering pains; and frequently alternated with dyspepsia, or other symptoms of atony. III. Podagra (retrograda), with the inflammation of the joints suddenly disappearing, and an atony of the stomach and other parts immediately following. IV. Podagra (aberrans), with the inflammation of an internal part either preceding or not, and suddenly disappearing.

Genus XXIV. Arthropoosis. Deep, obtuse, and long-continued pains of the joints or muscular parts, frequently following contusions; with either no swelling, or a moderate and diffused one; no phlogosis; pyrexia, at first gentle, afterwards hectic, and at length an imposthume.

Order III. Exanthemata. Contagious diseases; affecting a person only once in his life; beginning with fever; after a certain time appear phlogoses, for the most part small and in considerable number, and dispersed over the skin.

Genus XXV. Erysipelas. A synocha of two or three days, for the most part attended with drowsiness, often with a delirium. In some parts of the skin, most frequently the face, appears a phlogosis. The species are, I. Erysipelas (vesiculosum), with erythema, redness creeping, occupying a large space, and in some parts ending in large blisters. II. Erysipelas (phlyctænodes), with an erythema formed of a number of papules, chiefly occupying the trunk of the body, ending in phlyctænes or small blisters.

The disease is also symptomatic.

Genus XXVI. Pestis. An exceedingly contagious typhus, with the highest debility. On an uncertain day of the disease buboes and carbuncles break forth. It is various in degree, but the species are uncertain. Genus XXVII. Variola; a contagious synocha, with vomiting, and pain on pressing the epigastrium. On the third day begins, and on the fifth is finished, the eruption of inflammatory pustules, which suppurate in the space of eight days, and at last go off in crusts; frequently leaving depressed cicatrices or pockpits in the skin. The species are,

I. Variola (discricta), with few distinct, turpid pustules, having circular bases; the fever ceasing immediately after the eruption.

II. Variola (confluenis), with numerous, confluent, irregularly shaped pustules, flaccid and little elevated; the fever remaining after the eruption.

Genus XXVIII. Synocha. Synocha; papulae breaking out after a short fever, similar to those of the smallpox, but hardly ever coming to suppuration; after a few days going off in small scales, without leaving any mark.

Genus XXIX. Rubeola. A contagious synocha, with sneezing, epiphora, and dry hoarse cough. On the fourth day, or a little later, break forth small, clustered, and scarcely elevated papule; after three days going off in very small branny scales.

I. Rubeola (vulgaris), with very small confluent coriaceous papule, scarcely rising above the skin.

Varying,

1. In the symptoms being more severe, and the course of the disease less regular.

2. In being accompanied with a cynanche.

3. With a putrid diathesis.

II. Rubeola (variolodes), with distinct papule, raised above the skin.

Genus XXX. Miliaria. Synochus with anxiety, frequent sighing, unctuous sweat, and a sense of pricking as of pin points in the skin. On an uncertain day of the disease, break out red, small, distinct papule, spread over the whole body as well as the face; the apices of which, after one or two days, become very small white pustules, remaining for a short time.

Genus XXXI. Scarlatina. A contagious synocha. On the fourth day of the disease the face swells a little; at the same time an universal redness occupies the skin in large spots, at length running together; after three days going off in branny scales; frequently succeeded by an anasarca. The species are,

I. Scarlatina (simplex), not accompanied with cynanche.

II. Scarlatina (cynanchica), with an ulcerous cynanche.

Genus XXXII. Urticaria. A quotidian fever. On the second day of the disease, red spots resembling the stinging of nettles, almost vanishing during the day, but returning during the evening with the fever, and after a few days going off altogether in very small scales.

Genus XXXIII. Pemphigus. A contagious typhus. On the first, second, or third day of the disease, blisters break out in several parts of the body, of the bigness of a bean, remaining for many days, and at last pouring out a thin ichor.

Genus XXXIV. Aphtha. Synochus; the tongue somewhat swelled and of a livid colour, as well as the fauces; sores first appearing in the fauces, but at length occupying the whole internal parts of the mouth, of a white colour, sometimes distinct, often running together, quickly growing again when taken off; and remaining for an uncertain time.

The species are,

1. Idiopathic. 2. Symptomatic.

Order IV. Hemorrhagiae. Pyrexia, with a discharge of blood, without any external violence: the blood drawn from a vein hath the same appearance as in phlegmasia.

Genus XXXV. Epistaxis. Pain or weight of the head, redness of the face; a discharge of blood from the nose.

I. Idiopathic.

Varying according to the time of life.

1. Epistaxis of young people, with symptoms of an arterial plethora.

2. Epistaxis of old people, with symptoms of a venous plethora.

II. Symptomatic.

1. From internal causes.

2. From external causes.

Genus XXXVI. Hemoptysis. Redness of the cheeks; a sensation of uneasiness, or pain, and sometimes of heat in the breast; difficulty of breathing; tickling of the fauces; either a severe or less violent cough, bringing up florid and frequently frothy blood.

The idiopathic species are,

1. Hemoptysis (plethorica), without any external violence, and without being preceded by any cough or suppression of any customary evacuation.

2. Hemoptysis (violenta), from external violence applied.

3. Hemoptysis (phthisica), after a long-continued cough, with a leanness and debility.

4. Hemoptysis (calculus), in which some calculous molecules, for the most part of a calcareous nature, are thrown up.

5. Hemoptysis (vicaria), after the suppression of a customary evacuation.

Besides these, there are a number of symptomatic species mentioned by different authors. The consequence of an hemoptysis is,

Phthisis. A wasting and debility of the body, with a cough, hectic fever, and for the most part a purulent expectoration. The species are,

I. An incipient phthisis, without any expectoration of pus.

II. A confirmed phthisis, with an expectoration of pus.

Both species vary,

1. As to their remote cause.

2. As to the origin of the purulent matter.

Genus XXXVII. Hemorrhhois. Weight and pain of the head; vertigo; pain of the loins; pain of the anus; livid painful tubercles, from which for the most part blood flows out; which sometimes also drops out of the anus, without any apparent tumor. The species are,

1. Hemorrhhois (tumens), external from mariscere.

Varying,

A. Bloody.

B. Mucous.

2. Hemorrhhois (procidentis), external from a procidentia ani.

3. Hemorrhhois (fluens), internal, without any swelling, or procidentia ani.

4. Hemorrhhois 4. Hemorrhoids (cæca), with pain and swelling of the anus, without any profusion of blood.

Genus XXXVIII. Menorrhagia. Pains of the back, belly, and loins, like those of child-birth; an unusual copious flux of the menses or blood from the vagina.

The species are,

1. Menorrhagia (rubra), bloody in women neither with child nor in child-birth. 2. Menorrhagia (abortus), bloody in women with child. 3. Menorrhagia (lochialis), bloody in women after delivery. 4. Menorrhagia (vittorum), bloody from some local disease. 5. Menorrhagia (alba), serous, without any local disease, in women not pregnant. 6. Menorrhagia (Nabothi), serous in women with child.

Order V. PROFLUVIA. Pyrexia, with an increased excretion, naturally not bloody.

Genus XXXIX. Catarrhus. Pyrexia, frequently contagious; an increased excretion of mucus, at least efforts to excrete it.

The species are,

1. From cold. 2. From contagion. 3. Accompanied with worms. 4. With the excretion of small fleshy or sebaceous bodies. 5. With an intermittent fever. 6. Without blood. 7. With a miliary fever.

Class II. NEUROSES. A preternatural affection of sense and motion, without an idiopathic pyrexia or any local affection.

Order I. COMATA. A diminution of voluntary motion, with sleep, or a deprivation of the senses.

Genus XLI. Apoplexia. Almost all voluntary motion abolished, with sleep more or less profound; the motion of the heart and arteries remaining.

The idiopathic species are,

1. Apoplexia (sanguinea), with symptoms of universal plethora, especially of the head. 2. Apoplexia (serosa), with a leucophlegmatia over the whole body, especially in old people. 3. Apoplexia (hydrocephalica), coming on by degrees; affecting infants, or those below the age of puberty, first with lassitude, a slight fever and pain of the head, then slowness of the pulse, dilatation of the pupil of the eye, and drowsiness. 4. Apoplexia (atrabilaria), taking place in those of a melancholic constitution. 5. Apoplexia (traumatica), from some external injury mechanically applied to the head. 6. Apoplexia (venenata) from powerful sedatives taken internally or applied externally. 7. Apoplexia (mentalis), from an affection or emotion of the mind.

Order II. ADYNAEMÆ. A diminution of the involuntary motions, whether vital or natural.

Genus XLII. Syncope; a diminution, or even a total stoppage, of the motion of the heart for a short time.

I. Idiopathic.

1. Syncope (cardiaca), returning frequently without any manifest cause, with violent palpitations of the heart during the intervals.—From a fault of the heart or neighbouring vessels. 2. Syncope (occasionalis) arising from some evident cause.—From an affection of the whole system.

II. Symptomatic; of diseases either of the whole system, or of other parts besides the heart.

Genus XLIV. Dyspepsia. Anorexia, nausea, vomiting, inflation, eructation, rumination, cardialgia, gastrodynia, more or fewer of those symptoms at least occurring; for the most part with a constipation of the belly, and without any other disease either of the stomach itself, or of other parts.

I. Idiopathic. II. Symptomatic.

1. From a disease of the stomach itself. 2. From a disease of other parts, or of the whole body.

Genus XLV. Hypochondriasis. Dyspepsia, with languor, sadness and fear, without any adequate causes, in a melancholy temperament.

Genus XLVI. Chlorosis. Dyspepsia, or a desire of something not used as food; a pale or discoloured complexion; the veins not well filled; a soft tumor of the whole body; asthenia; palpitation; suppression of the menses.

Order III. SPASMI. Irregular motions of the muscles or muscular fibres.

Sect. I. In the animal functions. Genus XLVII. Tetanus. A spastic rigidity of almost the whole body.

Varying according to the remote cause, as it rises either from something internal, from cold, or from a wound. It varies likewise, from whatever cause it may arise, according to the part of the body affected.

Genus XLVIII. Trismus. A spastic rigidity of the lower jaw.—The species are,

1. Trismus (nascentium), attacking infants under two months old. 2. Trismus (traumaticus), attacking people of all ages either from a wound or cold.

Genus XLIX. Convulsion.—An irregular clonic contraction of the muscles without sleep.

I. Idiopathic. II. Symptomatic.

Genus L. Chorea, attacking those who have not yet arrived at puberty, most commonly within the 10th or 14th year, with convulsive motions for the most part of one side in attempting the voluntary motion of the hands and arms, resembling the gesticulations of mountebanks; in walking, rather dragging one of their feet than lifting it.

Genus LI. Raphania. A spastic contraction of the joints, with a convulsive agitation, and most violent periodical pain.

Genus LII. Epilepsia. A convulsion of the muscles, with sleep.

The idiopathic species are,

1. Epilepsia (cerebralis), suddenly attacking without any manifest cause, without any sense of uneasiness preceding, excepting perhaps a slight vertigo or dimness of sight. 2. Epilepsia (sympathica), without any manifest cause, but preceded by the sensation of a kind of air rising from a certain part of the body towards the head. 3. Epilepsia (occasionalis), arising from a manifest irritation, and ceasing on the removal of that irritation.

Varying according to the difference of the irritating matter. And thus it may arise,

From injuries of the head; pain; worms; poison; from the repulsion of the itch, or an effusion of any other acrid humour; from crudities in the stomach; from passions of the mind; from an inmoderate hemorrhagy; or from debility.

Sect II. In the vital functions.

In the action of the heart.

Genus LIII. Palpitatio. A violent and irregular motion of the heart.

In the action of the lungs.

Genus LIV. Asthma. A difficulty of breathing returning by intervals, with a sense of straitness in the breast, and a noisy respiration with hissing. In the beginning of the paroxysm there is either no cough at all, or coughing is difficult; but towards the end the cough becomes free, frequently with a copious spitting of mucus.—The idiopathic species are,

1. Asthma (spontaneum), without any manifest cause or other concomitant disease. 2. Asthma (exanthematicum), from the repulsion of the itch or other acrid effusion. 3. Asthma (plethoricum), from the suppression of some customary sanguineous evacuation, or from a spontaneous plethora.

Genus LV. Dyspnœa. A continual difficulty of breathing, without any sense of straitness, but rather of fulness and infarction in the breast; a frequent cough throughout the whole course of the disease.

The idiopathic species are,

1. Dyspnœa (catarrhalis), with a frequent cough, bringing up plenty of viscid mucus. 2. Dyspnœa (sicca), with a cough for the most part dry. 3. Dyspnœa (aëria), increased by the least change of weather. 4. Dyspnœa (terrea), bringing up with the cough an earthy or calculous matter. 5. Dyspnœa (aquosa), with scanty urine and oedematous feet; without any fluctuation in the breast, or other signs of an hydrothorax. 6. Dyspnœa (pinguedinosa), in very fat people. 7. Dyspnœa (thoracica), from an injury done to the parts surrounding the thorax, or from some malformation of them. 8. Dyspnœa (extrinsecu), from evident external causes.

The symptomatic species of dyspnœa are consequences,

1. Of diseases of the heart or large vessels. 2. Of a swelling in the abdomen. 3. Of various other diseases.

Genus LVI. Pertussis. A contagious disease; convulsive strangulating cough reiterated with noisy inspiration; frequent vomiting.

Sect. III. In the natural functions.

Genus LVII. Pyrosis. A burning pain in the epigastrium, with plenty of aqueous humour, for the most part insipid, but sometimes acrid, belched up.

Genus LVIII. Colica. Pain of the belly, especially twisting round the navel; vomiting; and a constipation.

The idiopathic species are,

1. Colica (spasmodica), with retraction of the navel, and spasms of the abdominal muscles. Varying, by reason of some symptoms superadded. Hence, a, Colica, with vomiting of excrements, or of matters injected by the anus. b, Colica, with inflammation supervening. 2. Colica (pictorum), preceded by a sense of weight or uneasiness in the belly, especially about the navel; then comes on the colic pain, at first slight and interrupted, chiefly augmented after meals: at length more severe and almost continual, with pains of the arms and back, at last ending in a palsy. Varying according to the nature of the remote cause; and hence, a, From metallic poison. b, From acids taken inwardly. c, From cold. d, From a contusion of the back. 3. Colica (stercorea), in people subject to costiveness. 4. Colica (accidentalis), from acid matter taken inwardly. 5. Colica (meconialis), in new-born children from a retention of the meconium. 6. Colica (callosa), with a sensation of stricture in some parts of the intestines, and frequently of a collection of flatus with some pain; which flatus also passing through the part where the stricture is felt, gradually vanishes; the belly slow, and at last passing only a few liquid faeces.

7. Colica (calculosa), with a fixed hardness in some part of the abdomen, and calculi sometimes passed by the anus.

Genus LIX. Cholera. A vomiting of bilious matter, and likewise a frequent excretion of the same by stool; anxiety; gripes; spasms in the calves of the legs.

I. Idiopathic.

1. Cholera (spontanea), arising in a warm season, without any manifest cause.

2. Cholera (accidentalis), from acrid matters taken inwardly.

II. Symptomatic.

Genus LX. Diarrhoea. Frequent stools; the disease not infectious; no primary pyrexia.

I. Idiopathic.

1. Diarrhoea (crapulose), in which the excrements are voided in greater quantity than naturally.

2. Diarrhoea (biliosa), in which yellow feces are voided in great quantity.

3. Diarrhoea (mucosa), in which either from acrid substances taken inwardly, or from cold, especially applied to the feet, a great quantity of mucus is voided.

4. Diarrhoea (caeliaca), in which a milky humour of the nature of chyle is discharged by stool.

5. Diarrhoea (lienteria), in which the aliments are discharged with little alteration soon after eating.

6. Diarrhoea (hepatirrhoea), in which a bloody serous matter is discharged without pain.

II. Symptomatic.

Genus LXI. Diabetes. A chronical profusion of urine, for the most part preternatural, and in immoderate quantity.

I. Idiopathic.

1. Diabetes (mellitus), with urine of the smell, colour, and taste of honey.

2. Diabetes (insipidus), with limpid, but not sweet, urine.

II. Symptomatic.

Genus LXII. Hysteria. Rumbling of the bowels; a sensation as of a globe turning itself in the belly, ascending to the stomach and fauces, and there threatening suffocation; sleep; convulsions; a great quantity of limpid urine; the mind involuntarily fickle and mutable.

The following are by Sauvages reckoned distinct idiopathic species; but, by Dr Cullen, only varieties of the same species.

A, From a retention of the menses.

B, From a menorrhagia cruenta.

C, From a menorrhagia scrofa, or fluor albus.

D, From an obstruction of the visceræ.

E, From a fault of the stomach.

F, From too great salacity.

Genus LXIII. Hydrophobia. A dislike and horror at any kind of drink, as occasioning a convulsion of the pharynx; induced, for the most part, by the bite of a mad animal. The species are,

1. Hydrophobia (rabiosa), with a desire of biting the bystanders, occasioned by the bite of a rabid animal.

II. Hydrophobia (simplex), without madness, or any desire of biting.

Order IV. Vesaniae. Disorders of the judgment, without any pyrexia or coma.

Genus LXIV. Amentia; an imbecility of judgement, by which people either do not perceive, or do not remember, the relations of things. The species are,

I. Amentia (congenita), continuing from birth.

II. Amentia (senilis), from the diminution of the perceptions and memory through extreme old age.

III. Amentia (acquisita), occurring in people formerly of a sound mind, from evident external causes.

Genus LXV. Melancholia; a partial madness, without dyspepsia.

Varying according to the different subjects concerning which the person raves; and thus it is,

1. With an imagination in the patient concerning his body being in a dangerous condition, from slight causes; or his affairs in a desperate state.

2. With an imagination concerning a prosperous state of affairs.

3. With violent love, without satyriasis or nymphomania.

4. With a superstitious fear of a future state.

5. With an aversion from motion and all the offices of life.

6. With restlessness, and an impatience of any situation whatever.

7. With a weariness of life.

8. With a deception concerning the nature of the patient's species.

Dr Cullen thinks that there is no such disease as that called daemonomaniæ, and that the diseases mentioned by Sauvages under that title are either,

1. Species of melancholy or mania; or

2. Of some disease by the spectators falsely ascribed to the influence of an evil spirit; or

3. Of a disease entirely feigned; or

4. Of a disease partly true and partly feigned.

Genus LXVI. Mania; universal madness.

1. Mania (mentalis), arising entirely from passions of the mind.

2. Mania (corporea), from an evident disease of the body.

Varying according to the different disease of the body.

3. Mania (obscura), without any passion of mind or evident disease of the body preceding.

The symptomatic species of mania are,

1. Paraphrosyne from poisons.

2. Paraphrosyne from passion.

3. Paraphrosyne febrilis.

Genus LXVII. Oncirodynia. A violent and troublesome imagination in time of sleep.

1. Oncirodynia (activa), exciting to walking and various motions.

2. Oncirodynia (gravans), from a sense of some weight incumbent, and pressing on the breast especially. Class III. Cachexiæ; a depraved habit of the whole, or greatest part of the body, without primary pyrexia or necrosis.

Order I. Marcores; emaciation of the whole body.

Genus LXVIII. Tabes. Leanness, asthenia, hectic fever. The species are,

1. Tabes (purulenta) from an external or internal ulcer, or from a vomica.

Varying in its situation: hence,

2. Tabes (scrophulosa), in scrophulous constitutions.

3. Tabes (venenata), from poison taken inwardly.

Genus LXIX. Atrophia. Leanness and asthenia, without hectic fever. The species are,

1. Atrophia (inanitorum), from too great evacuation.

2. Atrophia (famelicorum), from a want of nourishment.

3. Atrophia (cacoctymica), from corrupted nourishment.

4. Atrophia (debilium), from the function of nutrition being depraved, without any extraordinary evacuation or cacoctymia having preceded.

Order II. Intumescentiae. An external swelling of the whole or greatest part of the body.

Sect. I. Adipose.

Genus LXX. Polysarcia; a troublesome swelling of the body from fat.

Sect. II. Flatusa.

Genus LXXI. Pneumatosis; a tense elastic swelling of the body, crackling under the hand. The species are,

1. Pneumatosis (spontanea), without any manifest cause.

2. Pneumatosis (traumatica), from a wound in the breast.

3. Pneumatosis (venenata), from poison injected or applied.

4. Pneumatosis (hysterica), with hysteria.

Genus LXXII. Tympanites; a tense, elastic, sonorous swelling of the abdomen; costiveness; a decay of the other parts. The species are,

1. Tympanites (intestinalis), from a tumor of the abdomen frequently unequal, and with a frequent evacuation of air relieving the tension and pain.

2. Tympanites (abdominalis), with a more evident noise, a more equable tumor, and a less frequent emission of flatus, which also gives less relief.

Genus LXXIII. Physometra; a slight elastic swelling in the epigastrium, having the figure and situation of the uterus.

Sect. III. Aquose or Dropies.

Genus LXXIV. Anasarca. A soft, inelastic swelling of the whole body, or some part of it. The species are,

1. Anasarca (serosa), from a retention of serum on account of the suppression of the usual evacuations, or from an increase of the serum on account of too great a quantity of water taken inwardly.

2. Anasarca (opilata), from a compression of the veins.

3. Anasarca (exanthematica), arising after exanthemata, especially succeeding after crysipelas.

4. Anasarca (anemia), from the thinness of the blood produced by hemorrhage.

5. Anasarca (debilium), in weak people after long diseases, or from other causes.

Genus LXXV. Hydrocephalus. A soft inelastic swelling of the head, with the sutures of the cranium opened.

Genus LXXVI. Hydrorachitis. A soft, slender tumour above the vertebrae of the loins; the vertebrae gaping from each other.

Genus LXXVII. Hydrothorax. Dyspnea, paleness of the face; oedematous swellings of the feet; scanty urine; difficult lying in a recumbent posture; a sudden and spontaneous starting out of sleep, with palpitation; water fluctuating in the breast.

Genus LXXVIII. Ascites. A tense, scarce elastic, but fluctuating swelling of the abdomen. The species are,

1. Ascites (abdominalis), with an equal swelling of the whole abdomen, and with a fluctuation sufficiently evident.

Varying according to the cause.

A, From an obstruction of the viscera.

B, From debility.

C, From a thinness of the blood.

2. Ascites (saccatus), with a swelling in the abdomen, in the beginning at least, partial, and with a less evident fluctuation.

Genus LXXIX. Hydrometra. A swelling of the hypogastrium in women, gradually increasing, keeping the shape of the uterus, yielding to pressure, and fluctuating; without ischuria or pregnancy.

Genus LXXX. Hydrocele. A swelling of the scrotum, not painful; increasing by degrees, soft, fluctuating, and pellucid.

Sect. IV. Solide.

Genus LXXXI. Physconia. A swelling chiefly occupying a certain part of the abdomen, gradually increasing, and neither sonorous nor fluctuating. The species are,

Physconia hepatica.

Physconia splenica.

Physconia renalis.

Physconia uterina.

Physconia ab ovario.

Physconia mesenterica.

Physconia intestinalis.

Physconia omentalis.

Physconia polysplachna.

Physconia visceralis.

Physconia externa lupialis.

Physconia externa schirrhoea.

Physconia externa hydatidosa.

Physconia ab adipc subcutaneo.

Physconia ab excrescentia.

Genus LXXXII. Rachitis. A large head, swelling most in the fore part, the ribs depressed; abdomen swelled, with a decay of the other parts.

Varying,

1. Simple, without any other disease.

2. Joined with other diseases.

Order III. Impetigines. Cachexies chiefly deforming the skin and external parts of the body. Genus LXXXIII. Scrophula. Swelling of the conglomerate glands, especially in the neck; swelling of the upper lip and of the nose; the face florid, skin thin, abdomen swelled. The species are,

1. Scrophula (vulgaris), simple, external and permanent. 2. Scrophula (mesenterica), simple, internal, with paleness of the face, want of appetite, swelling of the abdomen, and unusual fetor of the excrements. 3. Scrophula (fugax), most simple, appearing only about the neck; for the most part proceeding from the resorption of the matter of ulcers in the head. 4. Scrophula (Americana), joined with the yaws.

Genus LXXXIV. Syphilis. A contagious disease; ulcers of the tonsils, after impure venery, and a disorder of the genitals: clustered pimples of the skin, especially about the margin of the hair, ending in crusts and crusty ulcers; pains of the bones; exostoses.

Genus LXXXV. Scorbutus; in cold countries attacking after putrescent diet, especially such as is salt and of the animal kind, where no supply of fresh vegetables is to be had: asthenia; stomacace; spots of different colours on the skin, for the most part livid, and appearing chiefly among the roots of the hair.

Varying in degree. a, Scorbutus incipiens. b, Scorbutus crescens. c, Scorbutus inveteratus. Varying also in symptoms. d, Scorbutus lividus. e, Scorbutus potechalis. f, Scorbutus pallidus. g, Scorbutus ruber. h, Scorbutus calidus.

Genus LXXXVI. Elephantiasis; a contagious disease; thick, wrinkled, rough, unctuous skin, destitute of hairs, anaesthesia in the extremities, the face deformed with pimples, the voice hoarse and nasal.

Genus LXXXVII. Lepra; the skin rough, with white, branny, and chopped eschars, sometimes moist beneath, with itching.

Genus LXXXVIII. Frambosea; swellings resembling fungi, or the fruit of the mulberry or raspberry, growing on various parts of the skin.

Genus LXXXIX. Trichoma; a contagious disease; the hairs thicker than usual, and twisted into inextricable knots and cords.

Genus XC. Icterus; yellowness of the skin and eyes; white faeces; urine of a dark red, tinging what is put into it of a yellow colour.

The idiopathic species are, 1. Icterus (calculosus), with acute pain in the epigastric region, increasing after meals; biliary concretions voided by stool. 2. Icterus (spasmodicus), without pain, after spasmodic diseases, and passions of the mind. 3. Icterus (hepaticus), without pain, after diseases of the liver. 4. Icterus (gravidarum), arising during the time of pregnancy, and going off after delivery. 5. Icterus (infantum), coming on in infants a few days after birth.

Class IV. Locales. An affection of some part, but not of the whole body.

Order I. Dysæsthesiæ. The senses depraved or destroyed, from a disease of the external organs.

Genus XCI. Caligo. The sight impaired or totally destroyed, on account of some opaque substance interposed between the objects and the retina, inherent in the eye itself or the eyelids. The species are, 1. Caligo (lentis), occasioned by an opaque spot behind the pupil. 2. Caligo (corneæ), from an opacity of the cornea. 3. Caligo (pupillæ), from an obstruction of the pupil. Varying according to the different causes from which it proceeds. 4. Caligo (humorum), from a disease or defect of the aqueous humour. Varying according to the different state of the humour. 5. Caligo (palpebrarum), from a disease inherent in the eyelids. Varying according to the nature of the disease in the eyelids.

Genus XCII. Amaurosis. The sight diminished, or totally abolished, without any evident disease of the eye; the pupil for the most part remaining dilated and immovable. The species are, 1. Amaurosis (compressionis), after the causes and attended with the symptoms of congestion in the brain. Varying according to the nature of the remote cause. 2. Amaurosis (atonia), after the causes and accompanied with symptoms of debility. 3. Amaurosis (spasmodica), after the causes and with the signs of spasm. 4. Amaurosis (venenata), from poison taken into the body or applied outwardly to it.

Genus XCIII. Dysopia. A depravation of the sight, so that objects cannot be distinctly perceived, except at a certain distance, and in a certain situation. The species are, 1. Dysopia (tenetrarum), in which objects are not seen unless they are placed in a strong light. 2. Dysopia (luminis) in which objects are not distinctly seen unless by a weak light. 3. Dysopia (dissitorum), in which distant objects are not perceived. 4. Dysopia (proximorum), in which the nearest objects are not perceived. 5. Dysopia (lateralis), in which objects are not perceived unless placed in an oblique posture.

Genus XCIV. Pseudoblepsis; when the sight is diseased in such a manner that the person imagines he sees things which really do not exist, or sees things which do exist after some other manner than they really are. The species are, 1. Pseudoblepsis (imaginaria), in which the person imagines he sees things which really do not exist. Varying according to the nature of the imagination. 2. Pseudoblepsis (mutans), in which objects really existing appear somehow changed. Varying according to the change perceived in the objects, and according to the remote cause.

Genus XCV. Dyseceea. A diminution or total abolition of the sense of hearing. The species are,

1. Dyseceea (organica), from a disease in the organs transmitting sounds to the internal ear.

Varying according to the nature of the disease and of the part affected.

2. Dyseceea (atonica), without any evident disease of the organs transmitting the sounds.

Varying according to the nature of the cause.

Genus XCVI. Paracensis; a depravation of the hearing. The species are,

1. Paracensis (imperfecta), in which though sounds coming from external objects are heard, yet it is neither distinctly nor in the usual manner.

Varying,

a. With a dulness of hearing.

b. With a hearing too acute and sensible.

c. When a single external sound is doubled by some internal causes.

d. When the sounds which a person desires to hear are not perceived, unless some other violent sound is raised at the same time.

2. Paracensis (imaginaria), in which sounds not existing externally are excited from internal causes.

Varying according to the nature of the sound perceived, and according to the nature of the remote cause.

Genus XCVII. Anosmia; a diminution or abolition of the sense of smell. The species are,

1. Anosmia (organica), from a disease in the membrane lining the internal parts of the nostrils.

Varying according to the nature of the disease.

2. Anosmia (atonica), without any evident disease of the membrane of the nose.

Genus XCVIII. Agheustia; a diminution or abolition of the sense of taste.

1. Agheustia (organica), from a disease in the membrane of the tongue, keeping off from the nerves those substances which ought to produce taste.

2. Agheustia (atonica), without any evident disease of the tongue.

Genus XCIX. Anæsthesia; a diminution or abolition of the sense of feeling. The species from Sauvages, adopted by Dr Cullen, are,

1. Anæsthesia à spina bifida.

2. Anæsthesia plethorica.

3. Anæsthesia nascentium.

4. Anæsthesia melancholica.

Order II. Dysorexiæ; error or defect of appetite.

Sect. I. Appetitus erronei.

Genus C. Bulimia; a desire for food in greater quantities than can be digested.

The idiopathic species are,

1. Bulimia (helluonium), an unusual appetite for food, without any disease of the stomach.

2. Bulimia (syncopealis), a frequent desire of meat, on account of a sensation of hunger threatening syncope.

3. Bulimia (emetica), an appetite for a great quantity of meat, which is thrown up immediately after it is taken.

Genus CI. Polydipsia; an appetite for an unusual quantity of drink.

The polydipsia is almost always symptomatic, and varies only according to the nature of the disease which accompanies it.

Genus CII. Pica; a desire of swallowing substances not used as food.

Genus CIII. Satyriasis; an unbounded desire of venery in men. The species are,

1. Satyriasis (juvenitis), an unbounded desire of venery, the body at the same time being little disorder-ed.

2. Satyriasis (furens), a vehement desire of venery with a great disorder of the body at the same time.

Genus CIV. Nymphomania; an unbounded desire of venery in women.

Varying in degree.

Genus CV. Nostalgia; a violent desire in those who are absent from their country of revisiting it.

1. Nostalgia (simplicis), without any other disease.

2. Nostalgia (complicata), accompanied with other diseases.

Sect. II. Appetitus deficientes.

Genus CVI. Anorexia. Want of appetite for food. Always symptomatic.

1. Anorexia (humoralis), from some humour loading the stomach.

2. Anorexia (atonica), from the tone of the fibres of the stomach being lost.

Genus CVII. Adipsia; a want of desire for drink. Always a symptom of some disease affecting the sensorum commune.

Genus CVIII. Anaphrodisia; want of desire for, or impotence to, venery.

The true species are,

1. Anaphrodisia paralytica.

2. Anaphrodisia gonorrhoeica.

The false ones are,

1. Anaphrodisia à mariscis.

2. Anaphrodisia ab urethrae vitio.

Order III. Dyscinesiæ. An impediment, or depravation of motion from a disorder of the organs.

Genus CIX. Aphonia; a total suppression of voice without coma or syncope. The species are,

1. Aphonia (gutturalis), from the fauces or glottis being swelled.

2. Aphonia, (trachealis), from a compression of the trachea.

3. Aphonia (atonica), from the nerves of the larynx being cut.

Genus CX. Mutitas; a want of power to pronounce words. The species are,

1. Mutitas (organica), from the tongue being cut out or destroyed.

2. Mutitas (atonica), from injuries done to the nerves of the tongue.

3. Mutitas (surdorum), from people being born deaf, or the hearing being destroyed during childhood.

Genus CXI. Paraphonia; a depraved sound of the voice. The species are,

1. Paraphonia (puberum), in which, about the time of puberty, the voice from being acute and sweet, becomes more grave and harsh. 2. Paraphonia (rauca), in which, by reason of the dryness or flaccid tumor of the fauces, the voice becomes rough and hoarse.

3. Paraphonia (resonans), in which, by reason of an obstruction in the nostrils, the voice becomes hoarse, with a sound hissing through the nostrils.

4. Paraphonia (palatina), in which, on account of a defect or division of the uvula, for the most part with a hare-lip, the voice becomes obscure, hoarse, and unpleasant.

5. Paraphonia (clangens), in which the voice is changed to one acute, shrill, and small.

6. Paraphonia (comatosa), in which, from a relaxation of the velum palati and glottis, a sound is produced during inspiration.

Genus CXII. Psellismus; a defect in the articulation of words. The species are,

1. Psellismus (hesitans), in which the words, especially the first ones of a discourse, are not easily pronounced, and not without a frequent repetition of the first syllable.

2. Psellismus (ringens), in which the sound of the letter R is always aspirated, and, as it were, doubled.

3. Psellismus (lallans), in which the sound of the letter L becomes more liquid, or is pronounced instead of R.

4. Psellismus (emolliens), in which the hard letters are changed into the softer ones, and thus the letter S is much used.

5. Psellismus (ballutiens), in which, by reason of the tongue being large, or swelled, the labial letters are better heard, and often pronounced instead of others.

6. Psellismus (acheilos), in which the labial letters cannot be pronounced at all, or with difficulty.

7. Psellismus (lagostomatum), in which, on account of the division of the palate, the guttural letters are less perfectly pronounced.

Genus CXIII. Strabismus; the optic axes of the eyes not converging. The species are,

1. Strabismus (habitualis), from a bad custom of using only one eye.

2. Strabismus (commodus), from the greater debility or mobility of one eye above the other; so that both eyes cannot be conveniently used.

3. Strabismus (necessarius), from a change in the situation or shape of the parts of the eye.

Genus CXIV. Dysphagia; impeded deglutition, without phlegmiasia or the respiration being affected.

Genus CXV. Contractura; a long-continued and rigid contraction of one or more limbs. The species are,

1. Contractura (primaria), from the muscles becoming contracted and rigid.

a. From the muscles becoming rigid by inflammation. b. From muscles becoming rigid by spasm. c. From muscles contracted by reason of their antagonists having become paralytic. d. From muscles contracted by an irritating acrimony.

2. Contractura (articulare), from stiff joints.

Order IV. Apocenoses. A flux either of blood or some other humour flowing more plentifully than usual, without pyrexia, or an increased impulse of fluids.

Genus CXVI. Profusio; a flux of blood.

Genus CXVII. Ephidrosis; a preternatural evacuation of sweat.

Symptomatic ephidroses vary according to the nature of the diseases which they accompany, the different nature of the sweat itself, and sometimes the different parts of the body which sweat most.

Genus CXVIII. Epiphora; a flux of the lachrymal humour.

Genus CXIX. Ptyalismus; a flux of saliva.

Genus CXX. Enuresis; an involuntary flux of urine without pain. The species are,

1. Enuresis (atonica), after diseases injuring the sphincter of the bladder.

2. Enuresis (irritata), from a compression or irritation of the bladder.

Genus CXXI. Gonorrhoea; a preternatural flux of humour from the urethra in men, with or without a desire of venery. The species are,

1. Gonorrhoea (pura), in which, without any impure venery having preceded, a fluid resembling pus, without dysuria or propensity to venery, flows from the urethra.

2. Gonorrhoea (impura), in which, after impure venery, a mucous humour flows from the urethra with dysuria. The consequence of this is,

Gonorrhoea (mucosa), in which, after an impure gonorrhoea, a mucous humour flows from the urethra with little or no dysuria.

3. Gonorrhoea (laxorum), in which an humour for the most part pellucid, without any erection of the penis, but with a propensity to venery, flows from the urethra while the person is awake.

4. Gonorrhoea (dormientium), in which the seminal liquor is thrown out, with erection and desire of venery, in those who are asleep and have lascivious dreams.

Order V. Epischeses; suppressions of evacuations.

Genus CXXII. Obstipatio; the stools either suppressed, or slower than usual. The species are,

1. Obstipatio (debilium), in lax, weak, and for the most part dyspeptic persons.

2. Obstipatio (rigidorum), in people whose fibres are rigid, and frequently of an hypochondriac disposition.

3. Obstipatio (obstructorum), with symptoms of the colica, 1st, 2nd, 4th, and 7th, above-mentioned.

Genus CXXIII. Ischuria; an absolute suppression of urine. The species are,

1. Ischuria (renalis), coming after a disease of the kidneys, with pain, or troublesome sense of weight in the region of the kidneys, and without any swelling of the hypogastrium, or desire of making water.

2. Ischuria (ureterica), coming after a disease of the kidneys, with a sense of pain or uneasiness in some part of the ureter, and without any tumour of the hypogastrium, or desire of making water.

3. Ischuria (vesicalis), with a swelling of the hypogastrium, pain at the neck of the bladder, and a frequent stimulus to make water.

4. Ischuria (urethralis), with a swelling of the hypogastrium, frequent stimulus to make water, and pain in some part of the urethra.

All these species are subdivided into many varieties, according to their different causes.

Genus CXXIV. Dysuria; a painful, and somehow impeded emission of urine. The species are,

1. Dysuria. 1. Dysuria (ardens), with heat of urine, without any manifest disorder of the bladder.

2. Dysuria (spasmatica), from a spasm communicated from the other parts to the bladder.

3. Dysuria (compressionis), from the neighbouring parts pressing upon the bladder.

4. Dysuria (phlogistica), from an inflammation of the neighbouring parts.

5. Dysuria (irritata), with signs of a stone in the bladder.

6. Dysuria (mucosa), with a copious excretion of mucus.

Genus CXXV. Dyspermatismus; a slow, impeded, and insufficient emission of semen in the venereal act. The species are,

1. Dyspermatismus (urethralis), from diseases of the urethra.

2. Dyspermatismus (nodosus), from knots on the corpora cavernosa penis.

3. Dyspermatismus (preputialis), from too narrow an orifice of the prepuce.

4. Dyspermatismus (mucosus), from mucus infecting the urethra.

5. Dyspermatismus (hypertonicus), from too strong an erection of the penis.

6. Dyspermatismus (epilepticus), from a spasmodic epilepsy happening during the time of coition.

7. Dyspermatismus (apraetodes), from an imbecility of the parts of generation.

8. Dyspermatismus (refluus), in which there is no emission of semen, because it returns from the urethra into the bladder.

Genus CXXVI. Amenorrhoea. The menses either flowing more sparingly than usual, or not at all, at their usual time, without pregnancy. The species are,

1. Amenorrhoea (emansionis), in those arrived at puberty, in whom, after the usual time, the menses have not yet made their appearance, and many different morbid affections have taken place.

2. Amenorrhoea (suppressionis), in adults, in whom the menses which had already begun to flow are suppressed.

3. Amenorrhoea (difficilis), in which the menses flow sparingly, and with difficulty.

Order VI. Tumores; an increased magnitude of any part without phlogosis.

Genus CXXVII. Aneurisma; a soft tumor, with pulsation, above an artery.

Genus CXXVIII. Varix; a soft tumour, without pulsation, above a vein.

Genus CXXIX. Ecchymoma; a diffused, little eminent, and livid tumour.

Genus CXXX. Schirrus; an hard tumour of some part, generally of a gland, without pain, and difficultly brought to suppuration.

Genus CXXXI. Cancer; a painful tumor of a schirrous nature, and degenerating into an ill conditioned ulcer.

Genus CXXXII. Bubo; a suppurating tumor of a conglomerate gland.

Genus CXXXIII. Sarcoma; a soft swelling, without pain.

Genus CXXXIV. Verruca; a harder scabrous swelling.

Genus CXXXV. Clavus; a hard, lamellated thickness of the skin.

Genus CXXXVI. Lupia. A moveable, soft tumor below the skin, without pain.

Genus CXXXVII. Ganglion. A hard moveable swelling, adhering to a tendon.

Genus CXXXVIII. Hydatis; a cuticular vesicle filled with aqueous humour.

Genus CXXXIX. Hydarthrus; a most painful swelling of the joints, chiefly of the knee, at first scarce elevated, of the same colour with the skin, diminishing the mobility.

Genus CXL. Exostosis; a hard tumor adhering to a bone.

Order VII. Ectopie; tumors occasioned by the removal of some part out of its proper situation.

Genus CXLI. Hernia; an ectopia of a soft part as yet covered with the skin and other integuments.

Genus CXLII. Prolapsus; a bare ectopia of some soft part.

Genus CXLIII. Luxatio; the removal of a bone from its place in the joints.

Order VIII. Dialyses. A solution of continuity; manifest to the sight or touch.

Genus CXLIV. Vulvus; a recent and bloody solution of the unity of some soft part by the motion of some hard body.

Genus CXLV. Ulcus. A purulent or ichorous solution of a soft part.

Genus CXLVI. Herpes; a great number of phlyctenous or small ulcers, gathering in clusters, creeping, and obstinate.

Genus CXLVII. Tinea; small ulcers among the roots of the hair of the head, pouring out a fluid which changes to a white friable scurf.

Genus CXLVIII. Psora. Itchy pustules and little ulcers of an infectious nature, chiefly infecting the hands.

Genus CXLIX. Fractura; bones broken into large fragments.

Genus CL. Caries; an ulceration of a bone.

Having thus presented to our readers Dr Cullen's general systematic view of all the diseases to which the human body is subjected, we next come to give a more particular account of the more important affections, treating of them in the order in which Dr Cullen has arranged them.

Class I. PYREXIÆ, or the Febrile Diseases.

Order I. FEBRES, Or Fevers strictly so called.

Sauvag. Class II. Vog. Class I. Sagar. Class XII. Morbi Febriles Critici, Lin. Class II.

Sect. I. INTERMITTENTS.

Intermittentes of many authors; Sauv. Class II. Order III. Lin. Class II. Order II. Vog. Class I. Order I. Sag. Class XII. Order III. The remittences of others, Sauv. Class II. Order II.

Exacerbantes, Lin. Class II. Order III.

Continuae, Vog. Class I. Order II.

Genus I. TERTIANA; the TERTIAN FEVER.

(Tertiana, Sauv. G. 88. Lin. 16. Hoffm. Stahl. Cleghorn. Senac.)

The Genuine TERTIAN.

(Tertiana legitima, Sencrt. Hoffm. Cleghorn, Minorc. Sauv. Sp. I.)

1. Description. This disease, in its most regular form, consists of repeated paroxysms, returning every second day, the patient during the intermediate period enjoying apparently a state of good health. This is the most common form of ague, as it is commonly called in Britain. Each paroxysm consists of three parts, the cold, the hot, and the sweating stages. The paroxysm commonly begins with a remarkable shivering, increasing frequently to a convulsive shaking of the limbs. The extremities are always cold, sometimes remarkably so. The cold for the most part is first perceived about the lumbar regions, from thence ascending along the spine it turns towards the pit of the stomach. Sometimes it begins in the first joint of the fingers and tip of the nose. Sometimes it attacks only a particular part of the body, as one of the arms, the side of the head, &c. This cold is often preceded by a heavy and sleepy torpor, languor, and lassitude, which we are partly to ascribe to real weakness and partly to mere languor. To these symptoms succeed yawning and stretching; after which the cold comes on as above described, not unfrequently with a pain of the back, and a troublesome sensation of tension in the precordia and hypochondria. To this succeed nausea and vomiting: and the more genuine the disease, the more certainly does the vomiting come on; by which a great deal of tough mucous matter, and sometimes bilious stuff or indigested food, is evacuated during the first paroxysm. In some there is only a violent straining to vomit, without bringing up any thing; sometimes, instead of these symptoms, a diarrhoea occurs, and this chiefly in weak, phlegmatic, and aged people, or where an indigested mucous salivary has long remained in the primæ vis.

When these symptoms have continued for an hour or two, the cold begins to go off, and is succeeded by a lassitude, languor, and flaccidity of the whole body, but chiefly in the limbs, with an uneasy soreness as if the parts had been bruised; excepting in those cases where the nausea continues for a longer time. After this languor, a heat comes on, the increase of which is generally slow, but sometimes otherwise, with pain of the head, thirst, and bitterness in the mouth. The pulse is quick and unequal; sometimes beating 130 strokes in a minute. As soon as this heat has abated, a little moisture or sweat is observed to break forth; not always indeed in the first, but always in the succeeding paroxysms, and the urine lets fall a quantity of latertious sediment. The whole paroxysm is seldom over in less than six hours, more frequently eight, and in violent cases it extends to 12 hours; but that which exceeds 12 hours is to be reckoned a spurious kind, and approaching to the nature of continuous fevers. All these symptoms, however, are repeated every second day, in such a manner that the patient is quite free from fever for at least 24 hours. The paroxysms return much about the same time, though sometimes a little sooner or later.

2. Causes of this disease and persons subject to it. The genuine tertian attacks men rather than women, young people rather than old: the latter being more subject to anomalous tertians. It likewise seizes the lusty and active, rather than the lazy and indolent. Those, however, who are apt to nauseate their meat fall easily into a tertian fever. The cause, according to Dr Cullen, is the miasma of marshes, and that only. Other physicians have taken in many more causes, almost everything indeed which debilitates the body: but the Doctor denies that any of these, though they may dispose the body for receiving the disease, or may augment it, can by any means produce it without the concurrence of the marsh miasma, and it cannot be denied, that it is a disease almost peculiar to marshy situations. Thus we find it very frequent in the fenny counties of Britain, although in other parts of this island it may be considered as a very rare disease; nay, in many it may perhaps be said that it never occurs. And it is also well known that intermittents have almost entirely disappeared in many parts of Britain, in which they were very common before the marshes of these places were drained.

3. Prognosis. The genuine simple tertian, unless improper medicines be administered, is generally very easily cured; nay, the vulgar reckon it of such a salutary nature, that after it they imagine a person becomes more strong and healthy than before. Hippocrates has observed, that these fevers terminate of their own accord after seven or nine paroxysms. Juncker tells us, that it frequently terminates before the seventh paroxysm, but rarely before the fourth. He also denies that anything critical is to be observed in its going off; but in this he differs from Vogel, who tells us, that the urine, for some days after the fever is quite gone off, appears slimy, and lets fall much sediment. The latter also informs us, that besides the common crisis by sweat and urine, the tertian hath one peculiar to itself, namely, dry scabby ulcers breaking out upon the lips. These sometimes appear about the third or fourth paroxysm; and then we may venture to foretel that the disease will go off spontaneously after the seventh. But though the disease be never dangerous, in cold climates, at least, when properly treated; yet the improper use of hot and stimulating medicines may change it into a continued fever, more or less dangerous according to the quantity of medicines taken and the constitution of the patient; in which case the prognosis must be regulated by the particular symptoms which occur. In warm climates, however, the tertian fever may be considered as a much more alarming disease; and unless the most powerful remedies be employed, the patient is in danger of falling a victim to every paroxysm.

A variety of theories have been proposed for explaining the phenomena of this affection; but we may assert, that every thing hitherto said upon the subject is highly unsatisfactory. For although it be now almost universally admitted, that this fever does arise from the effluvia of marshes, yet in what manner the action of those effluvia induces fever, and particularly why this fever returns in regular paroxysms, are questions with regard to which we are still totally in the dark. Dr Cullen, with much ingenuity, attempted to prove, that the remote causes of this, as well as of other fevers, operate by inducing a state of debility; that this debility gives rise to spasm, which induces increased action, from which the phenomena are to be explained. But this theory is liable to no less numerous and unsurmountable objections than the exploded hypotheses which had before been proposed by others. For it is an undeniable truth, that debility often exists, even to the highest imaginable degree, without any fever; nay, that when fever has taken place, the debility is often much greater after it is entirely gone than at any period during its course. When spasm and increased action do take place, we have no reason to view them in any other light than merely as symptoms of the disease; and while they are often absent in this affection, they frequently occur in others where the sickness, anxiety, and other characterizing symptoms of fever are entirely absent: and, upon the whole, a probable or rational theory of intermittents, as well as of other fevers, still remains to be discovered.

Cure. The treatment of all genuine intermittents, whether tertians, quotidians, or quartans, being almost precisely the same, the general method of cure applicable to all of them may be here given, to which it will be easy to refer when we come to describe the others.

In treating intermittent fevers, physicians have formed indications of cure according to their different theories. The followers of Boerhaave, Stahl, &c., who imagined that the disease proceeded from a leuor or other disorders in the blood, always thought it necessary to correct and evacuate these peccant humours by emetics and purgatives, before they attempted to stop the disease by the Peruvian bark or any other medicine. Cinchona indeed, among some, seems to be held in very little estimation: since Vogel affirms, that this medicine, instead of deserving to have the preference of all other febrifuge medicines, ought rather to be ranked among the lowest of the whole; and for this reason he ascribes the cures, said to be obtained by the use of the Peruvian bark, entirely to nature.

According to Dr Cullen, the indications of cure in intermitting fevers may be reduced to the following:

1. In the time of intermission, to prevent the return of the paroxysms. 2. In the time of paroxysms, to conduct these in such a manner as to obtain a final solution of the disease. 3. To take off certain circumstances which might prevent the fulfilling of the two first indications.

The first indication may be answered in two ways: 1. By increasing the action of the heart and arteries some time before the period of accession, and supporting that increased action till the period of accession be over, and thus preventing the recurrence of that atony and spasm of the extreme vessels, which he thinks give occasion to the recurrence of paroxysms. 2. By supporting the tone of the vessels, and thereby preventing atony and the consequent spasm, without increasing the action of the heart and arteries, the recurrence of paroxysms may be prevented.

The action of the heart and arteries may be increas- of the stomach or other cause, he advises it to be Tertiana given in oysters, in which form it is, he tells us, as efficacious as when taken by the mouth. For this purpose the extract is most proper with the addition of a sufficient quantity of the tinctura thebaica, in order to its being longer retained. For children labouring under intermittent fevers, Dr Lind orders the spine of the back to be anointed, at the approach of the fit, with a liniment composed of equal parts of tinctura thebaica and liniment sapon, which has often prevented it. If this should not produce the desired effect, he informs us that two or three tea-spoonfuls of syrup è mecon given in the hot fit will generally mitigate the symptoms. But for the entire removal of the disease, after purging with magnesia alba, he prescribes a dram of the extract cinchona with a few drops of tinct. thebaic in a oyster, to be repeated every three hours for a child of about a year old. When the stomach is oppressed with phlegm, the magnesia frequently occasions vomiting, which should be promoted with warm water. The constant heaviness of the head occasioned by those fevers in such tender constitutions is best relieved by the application of a blister to the back.

Cinchona has also proved effectual for the cure of intermittents in children, even when externally applied, by putting the powder of it into a quilted waistcoat. Of its efficacy in this way several instances are related by Dr Samuel Pyc in the second volume of Medical Observations and Inquiries. In short, so effectual was it found in removing these fevers when properly applied, that of between four and five hundred afflicted with them in the year 1765, Dr Lind lost only two, neither of whom had taken this medicine.

In all these cases, a vomit was administered whenever the patient complained of a sickness and retching to vomit, or was seized with a spontaneous vomiting; and cinchona was never given till this sickness was removed, or a purgative taken to clear more perfectly the whole alimentary canal. In those patients who were troubled with a cough, attended with a pain in the side affecting the breathing, when the pain was not relieved by warm fomentations, the balsamum anodynum, or by a blister, Dr Lind generally ordered a few ounces of blood to be taken away, and endeavoured to stop the fever as soon as possible by the administration of cinchona; having found that every return of the fever increased all such pains.—When the headache was very violent, and harassed the patient during the intermissions, the success of cinchona was rendered more complete by the application of a blister to the back.—A giddiness of the head, which is the symptom most commonly remaining after even a slight intermittent fever, was generally relieved by the sal C. C. and cinchona in wine. The former of these was administered in the following manner.

R. Aq. Alex. Simp. 3vii. Sal C. C. 3ss. Syr. è Cort. Aurant. 3i. M. f. julep. Cap. cochlear. ij. subinde.

If from the continuance of the fever the patient was distressed with a flatulence, a distention of the abdomen, and a swelling of the legs, a spoonful of tinctura saura, with the addition of 30 drops of the spirit lavend. compos, was ordered to be taken every night.—A continuance of cinchona, a change of air, and the cold bath, were often found requisite to prevent a relapse.

Such is the method of cure recommended by this experienced author, who has also discovered the efficacy and success of opium in intermittent fevers. He informs us, that he has prescribed an opiate to upwards of 300 patients labouring under this disease; and he observed, that, if taken during the intermission, it had not the least effect either in preventing or mitigating the succeeding paroxysm: when given in the cold fit, it once or twice seemed to remove it; but when given half an hour after the commencement of the hot fit, it generally gave immediate relief.—When given in the hot fit, the effects of opium are as follow: 1. It shortens and abates the fit; and this with more certainty than an ounce of cinchona is found to remove the disease. 2. It generally gives a sensible relief to the head, takes off the burning heat of the fever, and occasions a profuse sweat. This sweat is attended with an agreeable softness of the skin, instead of the burning sensation which affects patients sweating in the hot fit, and is always much more copious than in those who have not taken opium. 3. It often produces a soft and refreshing sleep to a patient tortured in the agonies of the fever, from which he awakes bathed in sweat, and in a great measure free from all complaints.

Dr Lind has always observed, that the effects of opium are more uniform and constant in intermittent fevers than in any other disease, and are then more quick and obvious than those of any other medicine. An opiate thus given soon after the commencement of the hot fit, by abating the violence and lessening the duration of the fever, preserves the constitution so entirely uninjured, that, since he used opium in agues, a dropsy or jaundice has seldom attacked any of his patients in those diseases. When opium did not immediately abate the symptoms of the fever, it never increased their violence. On the contrary, most patients reaped some benefit from an opiate given in the hot fit, and many of them bore a larger dose at that time than they could do at any other. He assures us, that even a delirium in the hot fit is not increased by opium, though opium will not remove it. Hence he thinks it probable, that many symptoms attending these fevers are spasmodic; but more especially the headache. However, if the patient be delirious in the fit, the administration of the opiate ought to be delayed until he recovers his senses, when it will be found greatly to relieve the weakness and faintness which commonly succeed the delirium. Dr Lind is of opinion, that opium in this disease is the best preparative for cinchona; as it not only produces a complete intermission, in which case alone that remedy can be safely administered; but occasions such a salutary and copious evacuation by sweat, as generally to render a much less quantity of cinchona requisite. He commonly prescribes the opiate in about two ounces of tinctura sacra, when the patient is costive, who is to take the cinchona immediately after the fit. By these means the paroxysm is shortened, and the intestines are cleansed, previous to the administration of cinchona; as the opiate doth not prevent, but only somewhat retard, the operation of the purgative. When a vomit is given immediately before the paroxysm, the administration of the opiate should be postponed till the hot fit be begun.

In the administration of cinchona, care should be taken that it be of a good quality. And different opinions have been entertained with respect to the choice, even where there is no reason to believe that it has been adulterated by the mixture of other articles. For a long time, the preference was given to small quilled pieces of pale-coloured bark; but of late the red bark, which is generally in larger masses, of an apparently coarser texture, and evidently of a more resinous nature, has been highly celebrated by Dr Saunders and others. And in cases where it does not disagree with the stomach or excite looseness, it is admitted by the most accurate observers to be more powerful in preventing the return of intermittents. Whether the red bark be the product of a different species of the cinchona, or be obtained as well as the pale quilled bark from the cinchona officinalis, is not yet ascertained with sufficient accuracy. Cinchona of a yellow colour has lately been imported into Britain and highly extolled. Its botanical history is not ascertained. It contains more bitter extractive matter, and more tannin and gallic acid, than either the pale or red; but less gum than the pale, and less resin than the red. It seems to produce the same medical effects in smaller doses. And it has sometimes succeeded in the cure of intermittents where the pale and red cinchona have before been employed in vain.

A species of cinchona, distinguished by the title of cinchona Jamaicensis, has been discovered in Jamaica and other islands in the West Indies. A very accurate description of it has been given by Dr Wright of Jamaica in the Philosophical Transactions of London. The bark of this species also has been recommended in the cure of intermittents; but the advantages of it have not hitherto been sufficiently confirmed by experience.

The barks of various trees readily cultivated in Britain, particularly different species of the salix, the prunus, the fraxinus, and the quercus, have by some been represented as no less efficacious than the cinchona. But we may safely venture to assert, that although several of them may possess some power in stopping intermittents, yet that none hitherto tried can be considered as in any degree approaching to the cinchona in point of efficacy.

But although the Peruvian bark be the best cure for intermittents hitherto discovered, yet while it can by no means be represented as the only cure, it is very certain that other remedies have in different cases succeeded after the cinchona has failed. Cures have often been obtained by the use of different aromatics, bitters, and astringents. Many articles from the mineral kingdom also have been employed with advantage. And intermittents have unquestionably been in certain cases stopped by different preparations of iron, zinc, copper, lead, and mercury. But of all the articles of this nature, arsenic of late has been the most celebrated. Arsenic is on good grounds conjectured to be the basis of an article much employed in the cure of intermittents in some of the countries where they are most prevalent, and sold under the title of the tasteless ague drop. The great success attending the use of this article, led Dr Fowler, an ingenious physician of Stafford, to examine it with particular attention. And in a treatise which he has lately published, entitled Medical Reports on the effects of arsenic in the cure of agues, he has given a formula for an arsenical solution, solution, which he has found very successful in affections of this kind, and which is probably very nearly the same with the tasteless ague drop. Dr Fowler's mineral solution, as he styles it, is formed by dissolving 64 grains of arsenic and as much fixed vegetable alkaline salt in a pound of distilled water. This solution is given in doses from three to 12 drops, varied according to the condition of the patient, and repeated two or three times a day. And where the cinchona has failed in stopping intermittents, it seems to be one of the most powerful remedies yet discovered. But after all remedies prove ineffectual, intermittents are often stopped by a change of season and situation.

But besides the remedies employed in tertians and other intermittents, with the view of preventing the return of paroxysms, it is often also necessary to employ powerful articles with other intentions, particularly to mitigate and shorten the paroxysm when present; to obviate urgent symptoms, especially those of an inflammatory or putrid nature; and to obtain a complete apyrexia or intermission from fever after the paroxysm has ceased. With these intentions, recourse is not unfrequently had to emetics, laxatives, blood-letting, opium, diluents, or sudorifics, as the circumstances of the case may require.

The Irregular or Spurious Tertian.

Sp. I. var. 1. B. Tertiana notha sive spuria, Sauv. sp. 2. Sennert. Cleghorn. Hoffman.

The characteristic marks of this fever are, that its paroxysms last longer than 12 hours, and consequently it inclines more to the quotidian or continued fever than the former. Its paroxysms have no stated hour of attacking. The cure, however, is precisely the same with that above described, observing the proper cautions already mentioned with regard to the use of the cinchona.

The Double Tertian. Sp. I. var. 2. C. Tertiana duplex, Sauv. sp. 13. Vog. G. 12. Sennert. Cleghorn. Duplicita, Lin. 18.

The double tertian comes on every day; but differs from the quotidian in this, that its paroxysms do not answer to each other singly, but alternately. The first day, for instance, the fit will come on in the forenoon, in the second in the afternoon, the third in the forenoon, and the fourth in the afternoon.

Of these fevers we shall give the following description from Cleghorn's treatise on the diseases of Minorca: "They are called double tertians when there are two fits and two intervals within the time of each period. But commonly there is some difference between the two fits, either in respect of the hour they come at, the time of their duration, or the nature and violence of their concomitant symptoms. Some double tertians begin in this manner.—On the evening of Monday, for example, a slight fit comes on, and goes off early next morning; but on Tuesday, towards the middle of the day, a more severe paroxysm begins, and continues till night. Then there is an interval to Wednesday evening, when a slight fit commences a new period of the fever, which proceeds in the same manner as the first; so that according to the way physicians calculate the days of diseases, (by beginning to reckon from the first hour of their invasion,) both paroxysms happen on the odd days, while the greatest part of the even days is calm and undisturbed. But in most double tertians the patient has a fit every day of the disease; the severe one commonly appearing at noon upon the odd days, the slight one towards evening on the even days; though sometimes the worst of two fits happen on the even days.

"There is a tertian fever sometimes to be met with, during each period of which there are three different fits, and as many intervals. For example, towards Monday noon the patient is seized with a paroxysm, which declines about five or six o'clock the same evening; a few hours after, another fit begins, and continues until morning; from which time there is an interval to Tuesday evening, when a third fit comes on, and lasts most part of the night. On Wednesday there are again two paroxysms, as on Monday, and on Thursday like that of Tuesday; and thus the fever goes on with a double fit on each of the odd days, and a single fit on the even days.

"In double tertians, that interval is the most considerable which follows the severe fit; for the slight fit oftener ends in a remission than intermission, and frequently lingers till the other approaches: Hence it is, that the night preceding the vehement fit is much more restless than that which comes after it, as has been observed by Hippocrates. In double tertians, the vehement fit often comes on a little earlier in each period, while the slight fit returns at the same hour, or perhaps later and later every second day; so that the motions of one have no influence on those of the other; from whence it appears that each of these fits hath its own proper independent causes."

Duplicated Tertian. Sp. I. var. 2. D. Tertiana duplicata, Sauv. sp. 14. Jones. River.

This hath two fits on the same day, with an intermediate day on which there are none. This also does not differ in any remarkable particular from those already described.

The Triple Tertian. Sp. I. var. 2. D. Tertiana triplex, Sauv. sp. 15. Cleghorn. Semiteriana, Hoffman. Semiteriana primi ordinis, Spig.

This differs from the former in having a single and double fit alternately: thus, for instance, if there be two fits the first day, there is only one the second, two the third, one the fourth, &c. Its cure is the same as before.

The Semi-Tertian. Sp. I. var. 2. F. Hemitritaeus, Cels. Semiteriana, Cleghorn. Semiteriana secundi ordinis, Spig. Amphimerina hemitritaeus, Sauv. sp. 8. Amphimerina pseudo-hemitritaeus, Sauv. sp. 9.

The semiterian is described by Dr Cullen as having only an evident remission between its paroxysms; more remarkable between the odd and even day, but less so between the even and odd one. For this reason, he adds, that possibly some semiterians ought rather to to be classed among the remittents; and owns that it is difficult to settle the boundaries between them. But Cleghorn, whom he quotes, describes it in the following manner. "A fit begins on Monday noon, for example, and goes off the same night. On Tuesday afternoon a second fit comes on, and gradually increases till Wednesday night, when it terminates. On Thursday morning there is such another interval as happened on Tuesday morning: But on Thursday afternoon another long fit like the preceding commences; and returning regularly every second day, leaves only a short interval of ten or twelve hours during the eight and forty.

Concerning the cure of these fevers Dr Cullen observes, that though no entire apyrexia occurs, cinchona may be given during the remissions: and it should be given even though the remissions be inconsiderable; if, from the known nature of the epidemic, intermissions or considerable remissions are not to be expected, and that great danger is apprehended from repeated exacerbations.

The Sleepy Tertian. Sp. I. var. 3. G. Tertiana carotica, Sauv. sp. 10. Werthof. Tertiana hemiplegica, Sauv. sp. 20. Werthof. Quotidiana soporosa, Sauv. sp. 8. Car. Pis. Febris caput impetens, Sydenham, ep. ad. R. Brady.

This, according to Vogel, is a most dangerous species, and very commonly fatal; for which reason he ranks it amongst those intermittents which he calls malignant. Sometimes he tells us the alarming symptom of a sleepiness comes on, not at the beginning of the disease, but will unexpectedly occur during the third, fourth, fifth, or sixth paroxysm. It commonly begins with the cold fit, and continues during the whole time of the paroxysm, and, becoming stronger at every succeeding one, at last terminates in a mortal apoplexy. Sometimes fevers of this kind rage epidemically. Vogel relates, that he saw a simple tertian changed into one of these dangerous fevers. The patient was a woman of a delicate constitution, and the symptoms appeared in consequence of her being put in a violent passion: however, it occurred but once, and she recovered. Hoffman mentions a carus in a double tertian occurring seven times without proving mortal; though Vogel says, that the powers of nature are very seldom sufficient to conquer the disease.

In 1678, Dr Sydenham tells us that intermittents raged epidemically at London, where none had appeared before from 1664. Of them "it is to be noted (says he), that though quartans were most frequent formerly, yet now tertians or quotidians were most common; unless the latter be entitled double tertians; and likewise, that though these tertians sometimes began with chillness and shivering, which were succeeded first by heat, and soon after by sweat, and ended at length in a perfect intermission, returning again after a fixed time; yet they did not keep this order after the third or fourth fit, especially if the patient was confined to his bed and used hot cardias, which increase the disease. But afterwards this fever became so unusually violent, that only a remission happened in the place of an intermission; and approaching every day nearer the species of continued fevers, it seized the head, and proved fatal to abundance of persons."

From this description of Sydenham's we may have an idea of the nature of the disease. As to its cure he strongly recommends cinchona; telling us, that, even in the most continued kind of intermittents, "the nearer the intermittent approaches to a continued fever, either spontaneously, or from using too hot a regimen, so much the more necessary is it to exhibit a larger quantity of the bark; and that he took advantage of a remission, though ever so small."

The Spasmodic or Convulsive Tertian. Sp. I. var. 3. H. Tertiana asthmatica, Sauv. sp. 6. Bonnet. Tertiana hysterica, Sauv. sp. 8. Wedel. A. N. C. Dec. I. A. II. obs. 193. Hysteria febricosa, Sauv. G. 135. sp. 8. A. N. C. Dec. I. Ann. II. Tertiana epileptica, Sauv. sp. 16. Calder. Lautter. Quotidiana epileptica, Sauv. sp. 3. Edinb. Essays, vol. v. art. 49. Eclampsia febricosa, Sauv. G. 139. sp. 17. Epilepsia febricosa, Sauv. G. 134. sp. 9. Tertiana tetanodes Med. Beobacht I. Band. Tetanus febricosus, Sauv. G. 122. sp. 10. Sterk. Ann. Med. II.

Tertians of this kind occur with very different symptoms from those of the true ones, and sometimes even with those which are very extraordinary. In some they are attended with symptoms of asthma, in others with those of hysterics, in others with convulsions. Where the symptoms of asthma occur, the disease must be treated with diuretics and antispasmodics joined with cinchona. In the hysteric asthma the fit comes on with cold, yawning, cardialgia, terror and dejection of mind. The disease is to be removed by mild aperients and antihysterics joined with cinchona.

Of the convulsive tertian we have a most remarkable instance in the Edinburgh Medical Essays, vol. v. The patient was a farmer's son about 26 years of age, of a strong plethoric habit of body. He had laboured under an ague half-a-year, and had taken a great deal of Peruvian bark. While he was telling his case to the surgeon (Mr Baine of Pembroke), he was suddenly taken with a violent stamping of his feet; and the convulsions gradually ascended from the soles of the feet to his legs, thighs, belly, back, and shoulders. His head was then most violently convulsed, with a total deprivation of speech; but he had a most dismal vociferation, which might have been heard at a considerable distance, his abdomen and thorax working and heaving violently and unusually in the mean time. This fit having lasted half an hour, a profuse sweat broke out over all his body, which relieved him; and he then became capable of answering such questions as were put. These extraordinary fits, he said, had been occasioned by a fright, and his neighbours had concluded that he was bewitched. They returned sometimes twice a-day, and always at the times the ague used to return. During the paroxysm his pulse was very high and quick, his face much inflamed, and his eyes ready to start out of his head. After the fit was over, he complained of a most torturing pain of the bowels. His tongue was generally moist, and he had a suppression of urine.—This formidable disease, however, was totally subdued by the use of cinchona, mercurials, antispasmodics, opiates, and saline draughts.

The Eruptive Tertian. Sp. I. var. 3. I. Tertiana petechialis, Sauv. sp. 4. Donat. Lautter. Tertiana scorbutica, Wedel. A. N. C. Dec. I. A. II. obs. 193. Tertiana urticata, Sauv. sp. 22. Plancho. Journ. de Med. 1765. Cleghorn. Tertiana miliaris, Sauv. sp. 21. Walthieri de Med. Ger.

This species of tertian is accompanied with red or livid blotches on the skin, or an eruption like that occasioned by the stinging of nettles. In the latter case Dr Cleghorn says the disease is very dangerous; and as the former indicates an incipient dissolution and putrefaction of the blood, it must also be reckoned of very dangerous tendency.

The Inflammatory Tertian. Sp. I. var. 3. K. Tertiana pleuritica, Sauv. sp. 4. Vales. Lautt. Pleuritis periodica, Sauv. G. 103. sp. 14. Tertiana arthritica, Sauv. sp. 5. Morton. Lautt.

Sauvages informs us, that he has seen a true and genuine pleurisy having all the pathognomic signs of the disease, but assuming the form of an intermittent; that is, the patient is one day affected with the pleurisy, and the next seemingly in perfect health. He also tells us, that in the month of May 1760, a tertian raged epidemically, which after the third fit imitated a pleurisy, the pain of the side, and difficulty of breathing coming regularly on, and the fever from an intermittent becoming remittent; the blood had also the same appearance with that of pleuritic persons, and the distemper yielded to bleeding and gentle cathartics.—Morton also informs us, that he has observed similar disorders a hundred times, which were always certainly and safely cured by the Peruvian bark.

The Tertian complicated with other Disorders. Sp. I. var. 4. Tertiana scorbutica, Sauv. sp. 9. Etmutler, Timaeus. Tertiana syphilitica, Sauv. sp. 17. Deidier. Tertiana verminosa, Sauv. sp. 18. Stisser. in act. Helmstad. Lancis. de noxius palud. Pringle. Ramazzini. Van den Bosch. de const. vermin.

The scorbutic tertian, according to Sauvages, is exceedingly anomalous, its periods being sometimes much anticipated, and sometimes much postponed. It is exceedingly obstinate, and will return if the body be not cleared of its scorbutic taint. The patient is affected with lancinating pains of a wandering nature. The urine lets fall a dusky red sediment, or a thick branny matter is copiously scattered up and down in it, seemingly tinged with blood. The usual symptoms of scurvy, viz. livid spots, and rotten fetid gums, also frequently occur. For this the Peruvian bark is very useful, both as a febrifuge and antiscorbutic.

A tertian accompanied with worms is taken notice of by Sir John Pringle in his treatise on the diseases of the army. The worms, he tells us, were of the round kind; and though we are by no means to reckon them the cause of the fever, they never failed to make it worse, occasioning obstinate gripings or sickness at stomach. In these cases stitches were frequent; but, being flatulent, were not often relieved by bleeding. The worms were discharged by vomiting as well as by stool. For discharging these worms, he commonly gave half a dram of rhubarb with 12 grains of calomel; without observing any inconvenience from such a large dose of mercury. Anthelmintics, which act slowly, had little chance of doing good; for though worms will sometimes lie long in the bowels without giving much uneasiness to a person otherwise well, yet in a fever, especially one of a putrid kind (to which his intermittents always seemed to incline), the worms being disturbed by the increase of heat, and the corruption of the humours in the prime viae, begin to move about, and struggle to get out. Lancisius, who makes this remark, adds, that upon opening the bodies of some who had died at Rome of fevers of this kind, wounds were found in the intestines made by the biting of the worms; nay, that some of them had even pierced through the coats of the guts, and lay in the cavity of the abdomen. Pringle never had any instance of this; but knew many cases in which the worms escaped by the patient's mouth, though there had been no previous retching to bring them up. One soldier was thrown into violent convulsions, but was cured by the above-mentioned powder.

The Tertian varied from its Origin. Sp. I. var. 5. Tertiana accidentalis, Sauv. sp. 12. Sydenham. Tertiana a scabie, Sauv. sp. 12. Juncker, tab. 80. Hoffman, II. p. 12.

The existence of fevers of this kind, as we have already observed, is denied by Dr Cullen; the accidental fever of Sauvages was said to arise from any slight error in the non-naturals, and consequently was very easily cured. That which arose from the repulsion of the itch, was cured as soon as the eruption returned.

The Tertian with only a remission between the fits. Sp. II. Tritzophya, Sauv. Gen. 85. Sug. p. 695. Triteus, Lin. 21. Hemitritea, Lin. 23. Tertianae remittentes et continue Auctorum. Tertianae subintrantes, proportionatae, subcontinue, Torti. Tertiana subcontinua, Sauv. sp. 19. Quotidiana deceptiva, Sauv. sp. 2. Amphimerina semiquintana, Sauv. sp. 24. Tritzophya deceptiva, Sauv. sp. 10. Causus Hippocratis. Tritzophya causus, Sauv. sp. 2. Febris ardens Boerhaavi, aph. 738. Tertiana perniciosa, qua simulata tertiani circuitus effligie lethalis, et nulle accidentibus periculosissimis implicata, existit. Lud. Mercatus. Tertiana pestilens, P. Sal. Diversus. Tertiana maligna pestilens, Riverti. Morbus Hungaricus, Lang, Lemb. Sennert, Jordan. Languor Pannonicus, Cober. Amphimerina Hungarica, Sauv. sp. 10. Hemitriteus pestilens, Schenck, ex Corn. Gamma. Febris pestilentiae Ægyptiorum, Alpin. Febris tertiana epidemica, Bartholin. Febris epidemicæ autumni 1657 et 1658, Willis. Febris syneches epidemica ab anno 1658 ad 1664. et postea ab anno 1673 ad 1691, Morton. Febris autumnales incipientes, Sydenham. Affectus epidemicus Leidensis, Fr. Sylvii. Morbus epidemicus Leidensis, 1669, Fanois. Tertianæ perniciosæ et pestilentæ, et febres castræs epidemicæ, Laneisi. Febris intermittentes anomalaæ et mali moris, Hoffman. Febris choleraica minus acuta, Hoffman. Febris epidemicæ Leidensis, anno 1719, Koker apud Haller, Disp. tom. v. Amphimerina paludosa, Sauv. sp. 19. Febris paludum, Pringle. Bononiensis constitutio hiemalis 1729, Beccari in A. N. C. vol. iii. Amphimerina biliosa, Sauv. sp. 22. Febris castrensis, Pringle. Febris putrida epidemicæ, Huxham de aëre ad ann. 1729. Febris biliosa Lausanensis, Tissot. Tritæophya Wratislaviensis, Sauv. sp. 3. Hahn.

erna Wratislav. in App. ad A. N. C. vol. x. Tritæophya Americana, Sauv. sp. 12. Febris anomala Batava, Grainger. Morbus Naronianus, Pujati. Febris continua remittens, Hillary’s diseases of Barbadoes. Febris remittens Indicæ Orientalis, Lind. diss. inaug. 1768. Febris critica et febr. biliosa æstatis, Rouppe. Febris remittens regionum calidarum, Lind on the diseases of hot climates. A. Tertiana choleraica sive dysenterica, Tort. Therap. Special lib. iii. cap. i. Lautter. Hist. Med. cas. 6. 16. 17. 20. Morton, App. ad Exerc. II. B. Tertiana subcruenta sive atrabiliaris, Tort. ibid. Never seen by Cleghorn. C. Tertiana cardiaca, Tort. ibid. Lautter. Hist. Med. cas. 15. 16. 23. Amphimerina cardiaca, Sauv. sp. 5. Tritæophya assodes, Sauv. sp. 6. Febris continua assodes, Vog. 27. D. Tertiana diaphoretica, Tort. ibid. Tritæophya typhodes, Sauv. sp. 4. Tritæophya elodes, Sauv. sp. 5. Febris continua elodes, Vog. 21. E. Tertiana syncopalis, Tort. ibid. Lautter. case ii. 12. 13. 15. 16. Tritæophya syncopalis, Sauv. sp. 1. Amphimerina syncopalis, Sauv. sp. 4. Amphimerina humorosa, Sauv. sp. 6. Febris continua syncopalis, Vog. 29. F. Tertiana algida, Tort. ibid. Lautter. cas. 13. Amphimerina epiala, Sauv. sp. 3. Amphimerina phricodes, Sauv. sp. 7. Tritæophya leipyria, Sauv. sp. 9. Tertiana leipyria, Sauv. sp. 23. Valcarenghi Med. Ration. p. 18. Febris continua epiala et leipyria, Vog. 19. et 24. G. Tertiana lethargica, Tort. ib. Tritæophya carotica, Sauv. sp. 7. Lautter. i. 7. 14. Tertiana apoplectica, Morton. Exerc. I. cap. ix. hist. 25. Tertiana soporosa, Werlhof de febr. p. 6. Febris epidemicæ Urbevetana; Lancis. de noxiis pal. effluv. I. II. c. 3.

The remittent fevers are much more dangerous than the true intermittents, as being generally attended with much greater debility of the nervous system and tendency to putrefaction in the fluids than the latter. Sauvages divides his tritæophya, a remittent tertian, into the following species:

1. Tritæophya syncopalis, or that attended with fainting. It begins like a tertian, with cold succeeded by heat and profuse sweating; but attended with much more dangerous symptoms, such as cardialgia, enormous vomiting, great weakness, small contracted pulse, coldness of the extremities, and, unless timely assistance be given, kills during the second or third paroxysm.

2. The causur, or burning fever of Hippocrates, returns every third day without any new sensation of cold; and is attended with great thirst, heat, but without diarrhoea or sweat, and continues only for one week or two at the utmost. It attacks chiefly young people of a robust and bilious habit of a body, who have been accustomed to much exercise, and exposed to the sun during the heats of summer, and have also used a phlogistic regimen. The tongue is dry, sometimes black; the urine of a red or flame colour; together with pain of the head, anxiety, and sometimes other symptoms still more dangerous.

3. Tritæophya Wratislaviensis, was a pestilential disease occasioned by famine, during which the people fed on putrid aliment: the air was infected by the vast number of bodies of those slain in battle, and the inhabitants were also dejected by reason of being deprived of their harvest, and other calamities; to all which was added the continuance of a calm in the atmosphere for a long time. It began with an acute fever, leipyria or coldness of the external parts and a sensation of burning heat inwardly; general weakness; pain of the head and precordial; serous or bilious diarrhoea; a delirium, in some furious, and accompanied with a dread of being exposed to the air; on the second day the thirst was violent, attended with a bilious vomiting, as well as diarrhoea, tough viscid spitting, fainting, burning heat in the bowels, the tongue dry and seeming as if burnt with a hot iron, a suppression of the voice, anxiety, stupor, after which quickly followed convulsions and death. In some fevers leipyria came on with an exceeding great cold of the extremities, presently followed by an intolerable heat of the viscera, with symptomatic sweats, violent diarrhoea, followed by a very itchy miliary eruption. On the fourth day came on copious sweats, spasms of the lower jaw, nausea, involuntary passing of urine, slight delirium, a flux of ichorous matter from the nostrils, an exceeding tough spitting, an epilepsy, and death. Professor Halin, who gives the history of this disease, was himself attacked by it, and suffered in the following manner: On the first day was a violent feverish paroxysm without rigor, a sharp pain in the occiput, and immediately an inflammatory pain over the whole head; the feet were extremely cold, and the extremities rigid with spasms. The pain continued to increase daily to such a degree, that the contact of the air itself became at last intolerable; a dejection of mind and incredible weakness followed; he passed restless nights with continual sweating, heavy and pained eyes, and an universal sensation of rheumatism over the whole body. On the third day the pains were assuaged, but he had a very bad night. On the fourth day all the symptoms were worse, the feet quite chilled, the hands very red and agitated with convulsive motions; he was terrified with apprehensions of death, and had a vomiting every now and then; this day sponges dipped in cold water were applied over the whole body, and he used cold water for his drink. On the eighth day the pulse was convulsive; and the pains were so violent that they made him cry out almost continually. On the ninth day he was delirious, and threw up some grumous blood. On the 11th his pulse was more quiet, and he had a sweat; a decoction of cinchona was given: his voice was broken, his speech interrupted, and his teeth chattered upon one another. On the 12th his jaw was convulsed, he had a risus sardonicus, and deafness; after which the paroxysms returned less frequently, and only towards night. On the 14th he had a chilling cold over the whole body, a cold sweat; frequent lotions were applied, and all the symptoms became milder. On the 18th he had a quick delirium, but fainted as soon as taken out of bed; a sensation of hunger, followed by copious sweats; profound sleep; an aversion from noise; everything appeared new and extraordinary. On the 36th a cholera; on the 48th a scaling off of the skin, and falling off of the nails. This epidemic carried off above 3000 people at Warsaw. Frequent lotions of the body either cold or tepid, watery glysters, and the copious introduction of watery fluids under the form of drink, were of service. But the most favourable crisis was under the form of some cutaneous eruption.

4. Tritaeophya typhodes. The principal symptom of this fever was a continual sweat with which the patients were almost always wet; with paroxysms returning every third day. Sauvages tells us, that he had twice an opportunity of observing this fever; one was in the teacher of an academy, about 40 years of age, and of a melancholic temperament. He sweated every second night so plentifully, that he was obliged to change his linen nine times; and even on the intermediate days was never perfectly free of fever, and had his skin moistened with sweat. The other was of a woman who went about in man's clothes, and was discovered only after her death. The disease began with a slight sensation of cold, after which she sweated for eight hours. It was attended with the highest debility, anxiety, and at the same time an insatiable hunger.

5. Tritaeophya elodes, was an inflammatory epidemic, but not contagious, terminating about the 13th or 21st day. The disease came on in the night time, with disturbed rest, universal weakness, watchings, great heat and sweat, redness of the face and almost of the whole body, sparkling eyes, the tongue dry and white; a hard, teuse, and turgid pulse: about the third day a kind of frenzy frequently came on with the feverish paroxysm, the forerunner of an universal miliary eruption; or, what was worse, with purple spots so close together, that they looked like an erysipelas of the whole body. Sometimes blisters of the size of small pearls, filled with acrid serum, appeared on the neck, armpits, and trunk of the body, which were of all the symptoms the most dangerous. There was a variety of the disease, which Sauvages calls the humoralis, and in which the pulse was soft and feeble, with greater weakness over the whole body, and the disposition to sleep more frequent than in the other; the eyes languid; the tongue very white, but not dry; and worms were sometimes discharged.

6. Tritaeophya assodes. This species arose from a foulness of the primea vis, and the effluvia of waters in which hemp had been steeped. It began with rigor, followed by great heats, restlessness, tossing of the limbs, faintings, immoderate thirst, dryness of tongue, delirium, and at length excessive watchings; these last, however, were less dangerous than vertigo or a comatose disposition, which brought on convulsions or apoplexies.

7. Tritaeophya carotica. This had exacerbations every other evening; and its distinguishing symptom was an excessive inclination to sleep, preceded by a severe headache, and followed by delirium, and sometimes convulsions; the tongue was black, and the patient insensible of thirst after the delirium came on. In those cases where the disease proved fatal, a subtultus tendinum and other alarming symptoms, came on.

8. Tritaeophya lecyria is only a variety of the tritaeophya causus, already described.

9. Tritaeophya deceptiva. This species at first assumes the appearance of a continued fever; but afterwards degenerates into a remittent, or even an intermittent. It is described by Sydenham, but attended with no remarkable symptoms.

10. The last of Sauvages's species of Tritaeophya belonging to the remitting tertian is the Americana. This, according to Sauvages, is the ardent fever with which the Europeans are usually seized on their first arrival in America, and generally carries off one half of them. Of this there are two varieties, the very acute and the acute. The very acute ends before the seventh day. It comes on a few days after the person's arrival, with loss of appetite, with dyspnea and sighing from weakness, headache, lassitude, and pain of the loins: a pyrexia succeeds, with great thirst, sweat, and heat; the sickness increases, nausea comes on, with vomiting of porraceous bile; the tongue rough, the extremities often cold; watching, furious delirium; and the patient frequently dies on the third day. Copious sweats, and a plentiful hemorrhage from the nose on the fifth day, but not sooner, are serviceable; but a bilious diarrhea is the best crisis of all.

The acute kind terminates most frequently on the ninth, but very rarely goes beyond the fifteenth day. Death frequently comes on between the fourth and seventh days. It begins with headache, pain in the loins, and sometimes shivering; great lassitude, dys- pncea, thirst; burning fever, increasing every third day; inflation of the abdomen, pain at the pit of the stomach, nausea, and bilious vomiting. Such is the state of the disease within twenty-four hours. The eyes are red, and full of tears; the urine pelucid; there is a low delirium, and continual anxiety; the tongue is dry and red, and sometimes, though rarely, black, which is a still worse sign; the pulse, formerly strong and full, sinks about the fourth day, and becomes tense and spasmodic: if a carus then comes on, the patient dies the fifth or sixth day; but if the pulse keeps up, and no carus comes on, a crisis is to be expected by sweat, by a copious hemorrhage from the nose, or, which is still more safe, by a bilious diarrhoea, which is never salutary if it comes on before the fifth day.

To the remitting tertian also belong the following species mentioned by Sauvages, viz.

1. Tertiana subcontinua. This begins like a genuine tertian, and at first hath distinct paroxysms; but these grow gradually more and more obscure, the disease acquiring daily more of the appearance of continued fever, by which it is to be distinguished from the other varieties of this species. It is not unfrequently joined with those symptoms which attend the fatal fever already mentioned; as cardialgia, cholera, syncope, &c., but in a much less degree. The disease commonly begins with little or no sense of cold, but rather a sensation of heat; when the tertian is doubted, it has first a slighter and then a more severe fit; and thus goes on with an exacerbation on the even days: and though it should change from a double into a single tertian, we are still to suspect it, if a weak fit is the forerunner of a very strong one. This change of the tertian into a continued fever is also to be prognosticated if a heat remarkable to the touch is perceived on the day of intermission, together with some disturbance of the pulse, thirst, and dryness of the tongue; all of which show a tendency to inflammation: the same is foretold by the urine being in small quantity, and very red, or of a saffron colour; also an ulcerous or aphthous inflammation of the throat, with difficulty of swallowing, or any very severe symptom coming on in the beginning of the disease, excepting only a delirium, which is easily removed.

2. Quotidiana deceptiva. This is a disorder of an inflammatory kind, with a strong tendency to putrescence, and sometimes assumes the form of a quotidian. In it the patient frequently complains of cold when he really is hot, and the remission is very indistinct. The disease is known by the great languor of the patient and the foulness of his tongue.

3. Amphimerina cardiaca is an acute malignant fever, with daily exacerbations, attended with fainting and vomiting of green bile. Afterwards, the weakness increasing, the patient's extremities grow cold, and a profuse sweat comes on, which is frequently succeeded by death on the fourth day. Another species resembling this Sauvages calls the syncopalis; but the cardiaca differs from it in being attended with cardialgia.

4. Amphimerina paludosa. This is the fever described by the British physicians under many different names, and appearing under various forms, according to the different constitutions of the patients. This fever in the East Indies, according to Dr Lind of Windsor, generally comes on suddenly, and begins with a sense of debility and a very great lowness of spirits. These tertian symptoms are attended with a greater or less degree of chilliness, vertigo, nausea, very acute pains in the head and loins, and a trembling of the hands; the countenance is pale, the skin commonly very dry and corrugated, the eyes dull and heavy, the pulse quick and small, the breath generally difficult, and interrupted with hic-cough.

As the paroxysm increases, the chilliness now and then gives way to irregular heats, which soon become violent and permanent; the nausea likewise increases; and in some there comes on a vomiting, in which they throw up a great deal of bile. Sometimes bile is likewise voided by stool. The skin grows red; the eyes appear small, and sometimes not a little inflamed. The pulse becomes fuller, and the breath more difficult, attended with great restlessness and a troublesome thirst; notwithstanding which (so great is the nausea) the patient cannot endure any kind of liquids. The tongue becomes foul, and the pain of the head and loins more violent; a delirium then follows; a slight moisture appears on the face, and from thence spreads to the other parts; whilst the violence of the other symptoms abates, and shows the beginning of a remission, which is completed by plentiful sweats.

On the fever's remitting, the pulse returns almost to its natural state; the pains of the head and loins still continue, though somewhat less violent, as likewise the nausea and want of appetite. When the disease gains strength, the remission is scarcely obvious, and is immediately followed by another paroxysm; which begins, not indeed with so great a shivering, but is attended with a greater pain of the head, the greatest anxiety, a heartburn, nausea, vomiting, and bilious stools. The matter most commonly evacuated by vomit and stool is whitish like chalk and water, or curdled milk which is vomited by sucking children, when the curd is much broke down. A heat, immoderate thirst, and delirium now come on. The tongue becomes more foul; the teeth and inside of the lips are covered with a black crust; the breath grows hot and fetid: another remission ensues, attended with a sweat; but this remission is both shorter and less obvious than the first.

This second remission is succeeded by a paroxysm, in which the symptoms are far more violent than in the former; that which the patient discharges by vomiting and purging is more fetid; the mouth, teeth, and inside of the lips, are not only covered with a black crust, but the tongue becomes so dry and stiff, that the patient's voice can scarce be heard. Violent delirium, with restlessness and anxiety, come on chiefly during the paroxysm; nor do these symptoms abate till the fever remits, and the patient sweats.

When the fever becomes so violent, during the third fit, as to end in death, which is often the case, some of the sick have a coma; in others the delirium becomes more violent. The discharges now become more fetid, and have a cadaverous smell; the stools are involuntary; the pulse is so quick, small, and irregular, that it is scarce to be counted, or even felt; a cold sweat is diffused over the whole body, especially the head and neck: the face becomes Hippocratic and convulsed; the patient picks the bed-clothes; a subsultus tendinum comes on; the sick lie constantly on their backs, and insensibly insensibly slide down to the foot of the bed; their extremities grow cold; they are then seized with convulsions, with which the scene closes.

In this fever, the urine, which at the beginning is pale, becomes of a deeper colour by degrees, but without depositing any sediment. There seldom or never appear any petechiae, and the prickly heat which was before on the skin vanishes on the first appearance of the fever. But though these were the general symptoms of this disorder, they varied in the different subjects, and at different seasons of the same year. The pulse, for example, in some, was quick in the beginning of the disorder; in others, it varied with the other symptoms. The skin was generally dry in the beginning of the fit; but in some it was moist, and covered with sweat from the very beginning of the disease. In the month of September, when the disorder raged most, the remissions were very imperfect and obscure; but, on the return of winter and the healthy season, they became more regular, and the disease assumed the appearance of an intermitting fever, to such a degree as at length not to be distinguished from it. In some the remissions could scarce be perceived, and the fever continued for two weeks without any material change for the better or the worse. At this time numbers were seized with it. When the disorder continued for any time without a change, it generally ended in death; while the weather grew better, it sometimes, in the space of a few days, from a common fever became an intermitting one, and the patient recovered, unless his liver, which was sometimes the case, happened to be affected. The cure of an inflammation of the liver proved uncertain and tedious; as it was commonly followed by a colligative diarrhoea, which generally endangered the patient's life.—Every succeeding paroxysm was observed to be more dangerous than the preceding; the third generally proved fatal; some died during the first. When this happened, the fever, in the language of the country, was called a puca, that is a strong fever.

This disease, according to Dr Lind of Haslar hospital, is the autumnal fever of all hot countries, the epidemic disease between the tropics, and the disease most fatal to Europeans in all hot and unhealthy climates. All authors agree that intermittents in general, but particularly this dangerous kind of them, are produced by heat and moisture, but particularly the evaporation of moisture from marshes. Dr Lind of Windsor remarks, that the European seamen are very subject to the fever above mentioned when they happen to arrive at Bengal in autumn. They are predisposed to it from the nature of their food, their confinement on board, the very great heats to which they are exposed during the voyage, and their lying for hours together exposed to the night colds.

Most of the meat used by the crews of those ships is salted, and often in a putrid state, without any fresh vegetables, they having only biscuits, and some other farinaceous matters. The quantity of the vinous or spirituous liquors allowed them is, in his opinion, by far too small to subdue the putrescent disposition of their animal-food. Their fluids consequently become, from day to day, more and more putrescent, and of course more apt to breed and contract this disorder. This disposition is likewise induced by their being stowed very close together, and that for a considerable length of time, and in a foul air, especially when the weather happens to be too stormy to permit the hatches and port-holes to be kept open.

Though the heats they endure in the voyage to India are less considerable than those of the country itself, yet they are too much for an European constitution to bear. The general heat at sea within the tropics is about $84^\circ$ Fahrenheit's thermometer, which is sufficient to relax them, and promote a corruption of their humours, especially when it coincides with the above causes. It likewise creates a languor and indolence, which alone are sufficient to increase that putrescence. These causes are apt to be considerably aggravated by the men's being often exposed, when on duty, for hours together, to rain, damp, and cold air; a circumstance which frequently happens to them when working their ships up the river Ganges in the night-time. Hence the perspiration is checked, and the excrementitious fluid which used to be discharged by the skin being retained in the body, contributes, he thinks, very much towards the predisposition to this disease.

But the most powerful of all the remote causes is justly thought to be the effluvia of marshes replete with putrid animal-substances. We have not, however, been able to determine from what kind of putrid animal-substances these effluvia derive their virus. For that every kind of putrefaction has not such an effect appears from this, that neither practical anatomists, nor those who by their trades are exposed to the putrid effluvia of animals, for instance such tanners and butchers as keep their shops and stalls very dirty, are more subject than others to putrid diseases. Nor are the ship-stewards and their servants, whose business it is to deliver out the provisions to the ships crews, and who spend the most of their time amongst the putrid and rancid effluvia of the places in which those provisions are kept, more subject to putrid fevers than their ship-mates. But whatever be in this, we are well assured that some particular putrid fermentations produce noxious vapours, which, united with those of marshes, render them more pernicious. Hence evidently proceeds the extreme unhealthfulness of a place called Culpi, on the eastern bank of the Ganges. The shores about it are full of mud, and the banks covered with trees. Opposite to the place where the ships lie there is a creek, and about a mile from its entrance stands the town of Culpi: the ships lie about a mile from the shore. None of the sailors on board the ships stationed at this place enjoyed their health. The burying ground also contributed not a little to spread the infection. The ground being marshy, the putrid water flowed from the old graves into the new ones, which infected the grave-diggers and those that attended the funerals; and from this cause many were suddenly seized while they were performing the last duty to their companions. This place has ever been remarkable for the unhealthfulness of its air. It was once customary to send some of the Company's servants here to receive the cargoes of the ships, and send them to Calcutta; but so many of them died on this duty, that the Company was at length obliged to dispense with it.

Hence it plainly appears, how apt putrid animal and vegetable substances are to render the effluvia of fenny places more pernicious than they would otherwise be. The reason why great inundations of the Nile and Ganges are followed by a healthy season is, that by this means the putrid animal and vegetable substances dispersed over the contiguous countries are carried off into the sea.—The noxious vapours arising from fens spread but a little way. Dr Lind has often known ships crews at a very little distance from the shore quite free from this disorder. But although these marshy miasmata first bring on the disease, yet contagion particularly spreads it, and renders it more epidemic. Thus the Drake East Indiaman continued free from the disorder for two weeks together, when she had no communication with the other ships; but as soon as the disorder was brought on board, many were seized with it within a few days in such a manner as to leave no room to entertain the least doubt concerning its contagious nature.

Dr Lind of Haslar hospital has given a very curious and learned account of the appearance of this fever throughout the various parts of the globe. It was very common in England in the years 1765 and 1766, one obvious cause of which was the prevalence of the eastern wind. This wind in England is often said to bring with it a fog from the sea; but the truth of the matter is, that in many places of this island the eastwind frequently raises a copious vapour from water, mud, and all marshy or damp places. To this exhaling quality of the eastern wind Dr Lind has often been an eye-witness. When the wind changes to the east, the mud sometimes sends up a vapour as thick as smoke; and the doctor has observed two fish-ponds in his neighbourhood, one of fresh and the other of saltwater, which on the approach of an easterly wind sometimes also emit a dense vapour, as from a pot of boiling water. In order to view this phenomenon distinctly, the person should stand at about 100 yards distance from the mud or ponds. If the sun shines when the wind changes to the east, he will observe a constant steam of vapours arising out of the ponds, from about five to ten yards in height, while the air about him remains serene. As the vapour or fog arising from other bodies glides along the surface of the earth, and is brought by the easterly wind to the ponds, he will still be able, for some time, to distinguish the vapours ascending perpendicularly out of the ponds from those which are carried in an horizontal direction by the wind; especially if the sun continues to shine, though faintly.

This evaporating quality of the east-wind seems to manifest itself also by its effects both on the thermometer and the human body; for a thermometer hung over a damp piece of ground during the fogs or exhalations arising from it, will often indicate a degree of cold below the freezing point. The chilliness of the body, so sensibly perceived when in this situation, seems to proceed from the same cause, and to produce nearly the same sensations, which the damp arising from the wet floor of a chamber communicates to those who happen to be in it.

Winds are not constant in their effects. As we have sometimes warm weather with a north-wind, and sometimes very little heat with one blowing from the south; so the fogs attending an east-wind are not constant, neither is the evaporation above-mentioned at all times to be perceived. It is possible, however, that in all this there may be a deception; and that instead of supposing the quantity of vapours exhaled to be increased by an easterly wind, the coldness of that wind may only condense and render visible the vapours in the air at that time. But even this supposition is liable to great objections, as our coldest north-winds seldom or never produce such an effect, but on the contrary are attended with dry and serene weather.

Be this as it will, however, an east-wind is usually accompanied with a cold, damp, and unwholesome vapour, which is observed to affect the health both of animals and vegetables, and in many places to produce obstinate intermitting fevers, and also to occasion frequent relapses. In particular spots of the low damp island of Portsea, the ague frequently prevails during the autumnal season, and in some years is much more frequent and violent than in others. It is also observable, that this disease always attacks strangers, or those who have formerly lived on a drier soil, and in a more elevated situation, with greater severity than those who are natives of the island.

The year 1765 was remarkable, not only for the long continuance of the easterly winds, but for an excessive degree of heat, which produced a more violent and general appearance of those diseases than had been known for many years before. In the month of August the quicksilver in Fahrenheit's thermometer often rose to 82° in the middle of the day. This considerable addition of heat, together with the want of refreshing rains, greatly spread the fever, increased its violence, and even changed its form in many places. At Portsmouth, and throughout almost the whole island of Portsea, an alarming continual or remitting fever raged, which extended itself as far as Chichester. At the same time, the town of Gosport, though distant only one mile from Portsmouth, enjoyed an almost total exemption from sickness of every kind; whereas in the neighbouring villages and farm-houses, a mild regular tertian ague affected whole families. The violence of the fever, with its appearances in a continued, remitting, or intermitting form, marked in some measure the nature of the soil. In Portsmouth the symptoms were bad, worse at Kingston, and still more dangerous and violent at a place called Half-way Houses; a street so named, about half a mile from Portsmouth, where scarcely end in a family escaped this fever, which generally made its first attack with a delirium. In the large suburb of Portsmouth called the Common, it seemed to rage with more violence than in the town, some parts excepted; but even whole streets of this suburb, together with the houses in the dock-yard, escaped its attack.

The marines, who were three times a week exercised early in the morning on South-sea beach, suffered much from the effect of the stagnant water in an adjoining morass. Half a dozen of them were frequently taken ill in their ranks when under arms; some being seized with such a giddiness of their head, that they could scarcely stand; while others fell down speechless, and upon recovering their senses complained of a violent headache. When such patients were received into the hospital, it was observed that some few had a regular ague, but that far the greater number laboured under a remitting fever, in which sometimes indeed there was was no perceptible remission for several days. A constant pain and giddiness of the head were the most inseparable and distressing symptoms of this disease. Some were delirious, and a few vomited up a quantity of bile; but in all the countenance was yellow. A long continuance of the fever produced a dropsy or jaundice, or both. Even a slight attack reduced the most robust constitution to a state of extreme debility; and this weakness, together with the giddiness, continued for a long time after the fever. A scabby eruption now and then made its appearance on the lips and the corners of the mouth: but dry itchy spots over the whole body, resembling much the common itch, and seeming to partake of the nature of that disease, were more frequently observed in the patients at Portsmouth, where there was not the least reason to suspect any infection.

Such is the appearance of the remitting fever occasioned by marsh miasmata in England. In the Netherlands its symptoms are not much different. Dr Lind informs us, that at Middleburg, the capital of West Zealand, a sickness generally reigns towards the latter end of August, or the beginning of September, which is always most violent after hot summers. It commences after the rains which fall in the end of July; the sooner it begins the longer it continues, and it is only checked by the coldness of the weather. Towards the end of August and beginning of September it is a continual burning fever, attended with a vomiting of bile, which is called the gall-sickness. This fever, after continuing three or four days, intermits, and assumes the form of a double tertian; leaving the patient in a fortnight, or perhaps sooner. Strangers that have been accustomed to breathe a dry pure air do not recover so quickly. Foreigners in indigent circumstances, such as the Scots and German soldiers, who are garrisoned in the adjacent places, are apt after those fevers to have a swelling in their legs and a dropsy; of which many die.

These diseases, the doctor observes, are the same with the double tertians common within the tropics. Such as are seized with the gall-sickness have at first some flushes of heat over the body, a loss of appetite, a white foul tongue, a yellow tinct in the eyes, and a pale colour of the lips. Such as live well, drink wine, and have warm clothes and good lodgings, do not suffer so much during the sickly season as the poor people; however, these diseases are not infectious, and seldom prove mortal to the natives.

Sir John Pringle observes, that the prevailing epidemic of autumn in all marshy countries, is a fever of an intermittent nature, commonly of a tertian form, but of a bad kind; which, in the dampest places and worst seasons, appears as a double tertian, a remitting, or even an ardent fever. But however these fevers may vary in their appearance according to the constitution of the patient and other circumstances, they are all of a similar nature. For though, in the beginning of the epidemic, when the heat or rather the putrefaction in the air is the greatest, they assume a continued or a remitting form, yet by the end of autumn they usually terminate in regular intermittents.

In Zealand where the air is more corrupted than in other parts of the Netherlands, this distemper is called the gall-sickness; and indeed both the redundancy and depravation of the bile is sometimes so great, that it has been generally ascribed to the corruption and overflow-

Tertiana.

ing of that humour. But though it cannot with justice be said to originate from corrupted bile, it is certain that the disease may be continued, and the symptoms aggravated, by an increased secretion and putrefaction of the bile occasioned by the fever. In proportion to the coolness of the season, to the height and dryness of the ground, this distemper is milder, remits or intermits more freely, and removes further from the nature of a continued fever. The higher ranks of people in general are least liable to the diseases of the marshes; for such countries require dry houses, apartments raised above the ground, moderate exercise, without labour in the sun or evening damps, a just quantity of fermented liquors, plenty of vegetables, and fresh meats. Without such helps, not only strangers, but the natives themselves, are sickly, especially after hot and close summers. The hardiest constitutions are very little excepted more than others; and hence the British in the Netherlands have always been liable to fevers.

By this distemper the British troops were harassed throughout the whole of the war from 1743 to 1747. It appeared in the month of August 1743; the paroxysms came on in the evening, with great heat, thirst, a violent headache, and often a delirium. These symptoms lasted most of the night, but abated in the morning, with an imperfect sweat, sometimes with a hemorrhagy from the nose or a looseness. The stomach from the beginning was disordered with a nausea and sense of oppression, frequently with a bilious and offensive vomiting. If evacuations were either neglected, or too sparingly used, the patient fell into a continued fever, and sometimes grew yellow as in a jaundice. When the season was further advanced, this fever was attended with a cough, rheumatic pains, and visy blood. The officers being better accommodated than the common men, and the cavalry who had cloaks to keep them warm, were not so subject to it; and others who belonged to the army, but lay in quarters, were least of all affected; and the less in proportion to their being little exposed to heats, night-damps, and the other fatigues of the service.

In this manner did the remitting fever infest the army for the remaining years of the war; and that exactly in proportion to their distance from the marshy places, of which we have several notable instances in Pringle's observations. In Hungary the same disease appears with still more violence, and is readily complicated with fevers of a truly pestilential nature, by which means it becomes extremely dangerous. Hungary is acknowledged to be the most sickly climate in Europe, and indeed as bad as any in the world. Here it was where the crusaders in only marching through the country to invade Asia, often lost half their number by sickness; and where the Austrians not long since buried, in a few years, above 45,000 of their best troops, who fell a sacrifice to the malignant disposition of the Hungarian air. The reason of this uncommon malignity is, that Hungary abounds with rivers, which, by often overflowing, leave that low flat country overspread with lakes and ponds of stagnating water, and with large unwholesome marshes. So great is the impurity of these stagnated waters, that by them the rivers, even the Danube, whose course is slow, become in some places corrupted and offensive. The air is moist, moist, and in summer quite sultry. In the nights of harvest, Kramer tells us, it was so very damp, that the Austrian soldiers could not secure themselves from the moisture even by a triple tent-covering. Here epidemical distempers begin constantly to rage during the hottest months of the year; which are July, August, and September: and these complaints, according to the observations of the physician above mentioned, are the same with those which are epidemic upon the coast of Guinea, and in the sickly climates of the East and West Indies, of which malignant fevers of the remitting and intermitting kind are the most common and dangerous.

The heat of the sun in Hungary is more intense than in any other country of Europe; and in proportion to the heat is the pestilential quality of the marshy exhalations. It is constantly observed, that the nearer any city or fort is to a morass or a large river with foul and oozy banks, the more unhealthy are the inhabitants. At such seasons and places, the air swarms with numberless insects and animalcules, a sure sign of its malignant disposition; and the hotter the summer, the more frequent and mortal are the discases. In short, this country, on account of its unhealthiness, has been termed the grave of the Germans; and in Italy, the Campania of Rome is almost equally unhealthy. Lancisius, physician to Pope Clement XI, furnishes us with a very striking instance of the malignant quality of the air of Campania. Thirty gentlemen and ladies of the first rank in Rome having made an excursion, upon a party of pleasure, towards the mouth of the Tyber, the wind suddenly shifting, blew from the south over the putrid marshes, when 29 were immediately seized with a tertian fever, only one escaping.

The island of Sardinia is annually visited with an epidemical sickness, which rages from June to September, and is called by the natives the intemperies. In some years there is a want of rain for four or five months; and then it is that this sickness exerts its utmost violence, being always more fatal in some places than in others, and in particular to strangers. Of this the British had a severe proof in 1758.—Admiral Broderick, in the Prince ship of war, anchored in the bay of Oristagni, where 27 of his men, sent ashore on duty, were seized with the epidemical distemper of this island; twelve of them in particular, who had slept on shore, were brought on board delirious. All of them in general laboured under a low fever, attended with great oppression at the breast and at the pit of the stomach, a constant retching, and sometimes a vomiting of bile; upon which a delirium often ensued. These fevers changed into double tertians, and terminated in obstinate quartan agues. It is worthy of remark, that in this ship, which lay only two miles from the land, none were taken ill but such as had been on shore, of whom seven died. The prior of a convent, making a visit to the English officers, informed them, that the intemperies of the island were a remitting or intermitting fever, and that he himself had suffered several attacks of it. Sardinia was formerly so remarkable for its unwholesome air, that the Romans used to banish their criminals thither; and it is at present but thinly peopled, owing to the mortality occasioned by this annual sickness. For although it is about 140 miles long, and in several places 75 miles broad, yet it is computed that the whole number of its inhabitants does not exceed 250,000: an inconsiderable number, when compared with the inhabitants of the lesser, but comparatively more healthful, island of Corsica; though even there the French lost a number of their troops by intermitting and remitting fevers. In the island of Minorca, too, Dr Cleghorn informs us, that fevers of this kind prevail exceedingly; that their types are various, their symptoms violent, the intermissions fallacious, and that they frequently and suddenly prove fatal. It is more than probable, he adds, from the accounts of several physicians and travellers, that epidemical tertians are not wholly confined to the coasts and islands of the Mediterranean, but that they are equally frequent and destructive in many other parts of the globe; and perhaps may be deemed the anniversary autumnal distempers of most hot countries in the world. And though in the mild climate of Britain, a tertian may easily be cured when it is discovered; yet in warm climates, such is the rapid progress of the distemper, that it is necessary to know it in the very beginning, which is very difficult for those who have never seen any but the tertians usually met with in Britain.

From Dr Cleghorn's account of Minorca, however, it doth not appear why that island should be so much infested with fevers of this kind, since it is far from being a marshy country; nay, on the contrary, is very dry. The south wind, he observes, is very unhealthy; and it is the prevalence of this wind which brings on the fever: but still the difficulty is not removed, because the sea air is so far from bringing on such dangerous diseases, that it is one of the greatest preservatives against them. As to the moisture which must necessarily accompany an insular situation, that cannot reasonably be admitted as a cause of this or any other disease. In the London Medical Observations we find a paper on a subject very similar to the present, namely, the mischief produced by lying in damp sheets, or being exposed to moist vapour. The author tells us, that he hardly knows a distemper the origin of which has not by some been ascribed to lying in a damp bed, or sitting in a wet room; and yet he does not know any one which will certainly be produced by these causes, and people frequently expose themselves to such causes without suffering any ill effects. "It must be owned indeed," says he, "that the vapours arising from the bilge-water of ships tend to produce a scurvy. The swampy plains also near the mouths of great rivers which are often overflowed, and low grounds which cannot readily be drained, and those tracts of land where the thickness and extent of the woods keep the ground moist and half putrid for want of ventilation, are destructive to the neighbouring inhabitants, by occasioning obstinate intermittents in the colder climates, and pestilential fevers in the hotter regions. But all this mischief arises not merely from moisture, but from an unventilated and putrid moisture; for the inoffensiveness of mere wetness, untainted with putridity, may be reasonably inferred from the following considerations. The air is often fully saturated with moisture; and yet neither is any epidemical distemper produced by it, nor are those remarkably aggravated with which the sick happen at that time to be afflicted. The air from rivers and from the sea is probably more replenished..." MEDICINE.

People are more exposed to vapours than inland countries cleared of their woods: yet the most celebrated of the ancient physicians recommended the bank of a running river for the situation of a house, on account of its peculiar healthfulness; and many invalids are sent by the modern physicians to the sea side, only for the benefit of the sea air.

"Where the sailors are cleanly, and not too much crowded, they are often as healthy during long voyages at sea, as they would have been on any part of the land. Venice is not observed to be less healthy than London or Paris.

"Those who are much disposed to sweat, lie many hours in bedclothes impregnated probably with a less wholesome moisture than would have been left in the sheets half-dried after washing; and there is no reason to think that any remarkable injury was done to the health by the continuance of such sweats almost every night for weeks, and for months, except what arose from the too great copiousness of this evacuation.

"Children, and such as are troubled with the stone, and those who, from other infirmities or age, constantly wet their beds with their urine, do not appear to suffer in their health on this account.

"It is a common practice, in some disorders, to go to bed with the legs or arms wrapped in linen cloths thoroughly soaked in Malvern water, so that the sheets will be in many places as wet as they can be; and I have known these patients and their bedfellows receive no harm from a continuance of this practice for many months. Nor can it be said that the Malvern water is more innocent than any other water might be, on account of any ingredients with which it is impregnated; for the Malvern water is purer than that of any other spring in England which I ever examined.

"The greatest valetudinarians do not scruple to sprinkle lavender-water upon their sheets; and yet, when the spirit is flown off, there is left what is as truly water as if it had been taken from the river.

"Is it observed, that laundresses are peculiarly unhealthy above other women, though they live half their time in the midst of wet linen, in an air fully saturated with vapours? Many other employments might be mentioned, the persons occupied in which are constantly exposed to wet floors or pavements, or to be surrounded with watery vapours, or to have their clothes often wet for many hours together.

"Is it the coldness of wet linen which is to be feared? But shirts and sheets, colder than any unfrozen water can be, are safely worn and lain in by many persons, who, during a hard frost, neither warm their shirts nor their sheets.—Or does the danger lie in the dampness? But then, how comes it to pass, that a warm or cold bath, and long-continued fumigations, can be used, without the destruction of those who use them? Or is it from both together? Yet we have long heard of the thickness and continuance of the cold fogs in the seas north-west of England, but have never yet been told of any certain ill effect which they have upon those that live in these countries."

With regard to the causes of fevers, however, Dr Lind is of opinion, that noxious vapours arising from the earth are for the most part to be blamed. Even in countries seemingly dry, and where violent rains are not frequent, he thinks the air may load itself with putrid exhalations from the ground; and that, except in the burning deserts of Arabia or Africa, people are nowhere exempt from diseases occasioned by putrid moisture. In most of the hot countries the pernicious effects of the putrid vapours are by no means equivocal. In Guinea, they seem to be more extraordinary than anywhere else in the world; neither indeed can it be supposed, that a hot and moist atmosphere can be without putrescence. It may in general be remarked, that in sultry climates, or during hot weather, in all places subject to great rains, where the country is not cleared and cultivated, but is overrun with thickets, shrubs, or woods, especially if there are marshes or stagnating waters in the neighbourhood, sickness may be dreaded, and particularly the remitting fever of which we now treat. The fens, even in different counties of England, are known to be very prejudicial to the health of those who live near them, and still more so to strangers; but the woody and marshy lands in hot countries are much more pernicious to the health of Europeans. In all those unhealthy places, particularly during fogs or rains, a raw vapour, disagreeable to the smell, arises from the earth, and especially in the huts or houses. But of all the vapours which infect the torrid zone, the most malignant and fatal are harmattans: They are said to arise from the conflux of several rivers in the king of Dormoed's dominions at Benin (the most unwholesome part of Guinea), where travellers are obliged to be carried on men's backs for several days journey, through swampy grounds, and over marshes, amidst stinking ooze, and thickets of mangrove trees which are annually overflowed. These vapours come up the coast to a surprising distance, with the south-east and north-east winds; and it has been observed, that in their progress they have often changed both the course of the winds and of the sea-currents. The times of their appearance at Cape Coast are the months of December, January, or February. The north-east and south-east winds are always unhealthy, but particularly so during the harmattan season. In some years this vapour is scarce perceptible; but in others it is thick, noxious, and destructive to the blacks as well as whites.—The mortality is in proportion to the density and duration of the fog. It has a raw putrid smell; and is sometimes so thick, that a person or house cannot be discerned through it at the distance of 15 or 20 yards; and it continues so for 10 or 14 days; during which it opens the seams of ships, splits or opens the crevices of wood as if shrunk or dried with a great fire, and destroys both man and beast.—In the year 1754 or 1755, the mortality occasioned in Guinea by this stinking fog was so great, that in several negro towns the living were scarce sufficient to bury the dead.—Twenty women brought from Holland by a new governor to the Castle del Mina, perished, together with most of the men in the garrison. The gates of Cape Coast castle were shut up for want of sentinels to do duty; the blacks dying at this time as well as the white people. It is lucky that it is only in some years that harmattans are so very thick and noxious, otherwise that part of the country would be depopulated. It is observed that all fogs are extremely unhealthy in those parts, particularly before and after the rainy seasons; but the above account of the harmattans appeared so very extraordinary and incredible to some of Dr Lind's readers, that he thought proper to publish publish a further corroboration of the facts above mentioned. "A gentleman (says he) who had long resided at Cape Coast castle, informed me, that during the time of this fog, being in the upper chambers of the fort, the boards of the floor shrunk so much, that he could discern the candles burning in the apartments below him (there are no plaster ceilings used in those hot countries), and that he could then even distinguish what people were doing in the apartments below; the seams of the floor having opened above half an inch while the fog lasted, which afterwards, upon its being dispelled, became close and tight as before."

In Africa the rains and dews seem to be possessed of qualities almost equally pernicious with the fogs. This much is certain, that in Guinea, many of the principal negroes, and especially of the mulatto Portuguese, take the utmost precaution to avoid being wet with those rains, especially such as fall first. At the setting in of the rainy season, they generally shut themselves up in a close well-thatched hut, where they keep a constant fire, smoke tobacco, and drink brandy, as preservatives against the noxious quality of the air at that time. When wet by accident with the rain, they immediately plunge themselves into salt water, if near it. Those natives generally bathe once a day, but never in the fresh water rivers when they are overflowed with the rains: at such times they prefer for that purpose the water of springs. The first rains which fall in Guinea are commonly supposed to be the most unhealthy. They have been known, in 48 hours, to render the leather of the shoes quite mouldy and rotten, they stain clothes more than any other rain; and soon after their commencement, even places formerly dry and parched swarm with frogs. At this time skins, part of the traffic of Senegal, quickly generate large worms; and it is remarked, that the fowls, which greedily prey on other insects, refuse to feed on these. It has been farther observed, that woollen cloths wet in those rains, and afterwards hung up to dry in the sun, have sometimes become full of maggots in a few hours.—It is also probable, that as in some of those countries the earth, for six or eight months of the year, receives no moisture from the heavens but what falls in dews, which every night renew the vegetation, the surface of the ground in many places becomes hard and incrusted with a dry scurf, which pens up the vapours below; until, by the continuance of the rains for some time, this crust is softened, and the long pent up vapours set free. That these dews do not penetrate deep into the earth is evident from the constant dryness and hardness of such spots of ground in those countries as are not covered with grass and other vegetables. Thus the large rivers in the dry season being confined within narrow bounds, leave a great part of their channel uncovered, which having its moisture totally exhaled, becomes a solid hard crust; but no sooner the rains fall than by degrees this long parched up crust of earth and clay gradually softens, and the ground, which before had not the least smell, begins to emit a stench, which in four or five weeks becomes exceedingly noisome, at which time the sickness is generally most violent.

This sickness, however, is not different from the remitting fever which has been described under so many various forms and names. An inflammatory fever is seldom observed, during the season of sickness, in this part of the world; and we shall conclude our description of the *amphimerina paludosa* with some extracts from the surgeon's journal in a ship that sailed up the rivers of Guinea.

"On the 5th of April we sailed up the river of Gambia, and found all the English in the fort in perfect health. The surgeons of the factory informed me, that a relaxation of the stomach, and consequently a weakened digestion, seemed to bring on most of the diseases so fatal to Europeans in the sickly season. They were generally of a bilious nature, attended with a low fever, sometimes of a malignant, at other times of a remitting kind.—On the 12th of April, after sailing 30 miles up the river St Domingo, we came to Catchou, a town belonging to the Portuguese in Lat. 20° N. In this town were only four white people, the governor, and three friars. The number of whites in the trading ships was 51. One morning towards the latter end of April, a little rain fell. On the 13th of May there was a second shower, accompanied with a tornado. On the 18th of May it rained the whole day; and the rain continued, but with short intervals, until the beginning of October.

"In the month of June almost two-thirds of the white people were taken ill. Their sickness could not be well characterised by any denomination commonly applied to fevers: it however approached nearest to what is called a *nervous fever*, as the pulse was always low, and the brain and nerves seemed principally affected. It had also a tendency to frequent remissions. It began sometimes with a vomiting, but oftener with a delirium. Its attack was commonly in the night; and the patients, being then delirious, were apt to run into the open air. I observed them frequently recover their senses for a short time, by means of the heavy rain which fell upon their naked bodies. But the delirium soon returned: they afterwards became comatose, their pulse sunk, and a train of nervous symptoms followed; their skin often became yellow; bilious vomitings and stools were frequent symptoms. The fever reduced the patient's strength so much, that it was generally six weeks or two months before he was able to walk abroad. A consuming flux, a jaundice, a dropsy or obstructions in the bowels, were the consequences of it. Of 51 white men, being the companies of four ships which were at Catchou, one-third died of the fever, and one-third more of the flux, and other diseases consequent upon it; and of these not one was taken ill till the rains began.

"I believe, on the whole face of the earth, there is hardly to be found a more unhealthy country than this during the rainy season: and the idea I then conceived of our white people was by making a comparison of their breathing such a noxious air, with a number of river-fish put into stagnating water; where, as the water corrupts, the fish grow less lively, they droop, pine away, and many die.

"Thus some persons became dull, inactive, slightly delirious, at intervals; and, without being so much as confined to their beds, they expired in that delirious and comatose state in less than 48 hours after being in apparent good health. The white people in general became yellow; their stomach could not receive much food without loathing and retchings. Indeed it is no wonder that this sickness proved so fatal, that recove- ries from it were so tedious, and that they were attended with fluxes, dropsies, the jaundice, ague-cakes, and other dangerous chronic distempers. It seems more wonderful to me that any white people ever recover, while they continue to breathe so pestiferous an air as that at Catchou during the rainy season. We were, as I have already observed, 30 miles from the sea, in a country altogether uncultivated, overflowed with water, surrounded with thick impenetrable woods, and overrun with slime. The air was vitiated, noisome, and thick; insomuch that the lighted torches or candles burnt dim, and seemed ready to be extinguished: even the human voice lost its natural tone. The smell of the ground and of the houses was raw and offensive; but the vapour arising from putrid water in the ditches was much worse. All this, however, seemed tolerable, when compared with the infinite numbers of insects swarming everywhere, both on the ground and in the air; which, as they seemed to be produced and cherished by the putrefaction of the atmosphere, so they contributed greatly to increase its impurity. The wild bees from the woods, together with millions of ants, overran and destroyed the furniture of the houses; at the same time, swarms of cockroaches often darkened the air, and extinguished even candles in their flight; but the greatest plague was the musquitoes and sand-flies, whose incessant buzz and painful stings were more insupportable than any symptom of the fever. Besides all these, an incredible number of frogs on the banks of the river made such a constant and disagreeable croaking, that nothing but being accustomed to such an hideous noise could permit the enjoyment of natural sleep. In the beginning of October, as the rains abated, the weather became very hot; the woods were covered with abundance of dead frogs, and other vermin, left by the recess of the river; all the mangroves and shrubs were likewise overspread with stinking slime."

After so particular a description of the remitting fever in many different parts of the world, we presume it will be needless to take notice of any little varieties which may occur in the warm parts of America, as both the nature and cure of the distemper are radically the same: neither shall we lengthen out this article with further descriptions of remitting fevers from the works of foreign authors, as, from what we have already said, their nature cannot easily be mistaken.

Cure. The great difficulty in the cure of remitting fevers arises from their not being simple diseases, but a complication of several. Fevers, properly speaking, have but three or four different appearances which they can assume without a complication. One is, when they are attended with a phlogistic diathesis; another is, when they assume the form of genuine intermittents; a third is, when they produce a great debility of the nervous system; and the fourth is, when along with this debility there is also a rapid tendency to putrefaction. If, therefore, all these species happen to make an attack at once, the most dangerous fever we can imagine will be produced; and however contrary it may be to our theories to admit the possibility of such an attack, the truth of the fact is too often confirmed by fatal experience. In the beginning of remittent fevers, for instance, the symptoms indicate a high degree of inflammation; but if the practitioner attempts to remove this inflammation by blood-letting Tertiana, or other evacuations, the pulse sinks irrecoverably, and the person dies with such symptoms as show that the nervous system has been from the beginning greatly affected; at the same time the high stimulants and cordials, or cinchona, which would have conquered the nervous part of the disease, increase the inflammatory part of it to such a degree, that, by a too early exhibition of them, the patient also dies, but after another manner.

In the remitting fever of the East Indies, Dr Lind of Windsor formed the following indications of cure.

1. To allay the violence of the fever. 2. To evacuate the putrid humours, and take great care to prevent the body from inclining to putrefaction. 3. To keep up the strength of the patient as much as possible during the disorder. 4. To lose no time in preventing the return of the paroxysms.

To allay the violence of the fever, every thing that can contribute to increase it ought to be carefully avoided or removed; such as great heat, too strong a light falling on the eyes, noise, and motion. If during the paroxysm the head and loins be affected with violent pains, the pulse be full and hard, and the heat intense, bleeding may be used, but with the greatest caution: for, however useful this operation may be in cold climates, the success of it in warm ones is so far from being certain, that the lives of the patients have been often very much endangered, nay even destroyed by it. Dr Badenoch, and the surgeon of the Ponsborne, endeavoured each of them to relieve two patients by blood-letting; and the consequence was, that each of them lost one patient. Dr Lind bled two patients; one of whom was Mr Richardson, the first mate of the ship, who complained of a most violent pain in his head, with a full hard pulse. About four or five ounces of blood were taken from him, by which he was greatly relieved: nor was the cure retarded by it; nay, the fever afterwards became less irregular. At the time the other patient was bled, the disease was exceedingly frequent and violent. He was so earnest for bleeding, that he fired all the rest with the same desire, swearing, that by refusing them this only remedy, every one of them would be sent to their graves. To quiet them, therefore, and get quit of their importunities, the doctor complied with their request, and took about five or six ounces from him who had been the first to require it. The consequence was, that he immediately lost his strength; and in less than an hour, during which time he made his will, was carried off by the next fit. It is necessary, however, to observe, and indeed the doctor himself makes the observation, with regard to this patient, that he was bled at an improper time, namely, between the fits; whereas, had he been bled in the hot fit, it is possible he might have been relieved.

In support of the advantages to be derived from bleeding under proper circumstances, we have the authority both of Cleghorn and Pringle. As Dr Cleghorn practised in a very hot country, his observations must in the present case have greater weight than those of Pringle, who practised in a colder one. The former acquaints us, that if he was called in early enough, unless there was a strong contra-indication, he always used to take away some blood from people. Though in these diseases there is a great quantity of Tertian putrescent bile collected in the body, yet it seems much more probable that this is the effect than the cause of the disorder; and therefore, though we carry off the quantity collected ever so often, more of the same kind will still be produced by the putrescent disposition of the other fluids, at the same time that the strength of the patient must necessarily be diminished by repeated evacuations, when it ought rather to be kept up by all possible means. We ought well to observe, however, that the mineral acids have not that property of sweetening putrid bile which the vegetable ones have; and therefore the same relief will not be given by them which might reasonably be expected from vinegar or lemon juice.

In order to keep up the strength of the patient, good food is absolutely necessary. Dr Lind allowed the sick small messes of panada made with boiled rice and barley mixed with currants or raisins and prunes, seasoned with sugar and a little wine, especially claret. During the paroxysms, they had gruel made of flour and rice, with sugar and the juice of acid fruit; and when the fit went off, a little wine was added to this mixture.

The shirts and bedding must be very often changed and well aired; their stools, and all filth and nastiness, are to be immediately removed; the places where they are lodged should be well aired and frequently sprinkled with vinegar; and, in the last place, the sick must be exceedingly well nursed. Blisters, according to Dr Lind, should never be used till the fever has been of long continuance, or the spirits and pulse of the patient have begun to flag. But here our author has implicitly followed Dr Huxham, whose theory concerning the use of blisters is now found to be erroneous. According to that celebrated author, blisters are capable of doing considerable hurt in all cases where there is a tendency to inflammation, by increasing the motion of the fluids and the oscillatory power of the vessels, both of which are already too great. They are also improper, according to him, when there is a considerable tendency of the fluids to putrefaction; because he supposes the salts of these flies to operate in the same manner with volatile alkalies, that is, by dissolving and putrefying the blood still farther. But Sir John Pringle has shown, that, in inflammatory fevers as well as those of the putrid kind, both blisters and volatile salts may be of service; the latter, particularly, he hath experimentally proved to be so far from promoting putrefaction, that they are exceedingly strong antiseptics.

In the East Indies, Dr Lind found it absolutely necessary to exhibit the Peruvian bark in large quantities, and as early as possible. By this method he not only secured the patient from the imminent danger of death to which he was exposed at every fit, but likewise conquered those obstructions which were apt to ensue in the abdominal viscera, and which are to be attributed to the continuance of the disorder, and not to the bark employed to cure it. He always gave the cinchona during the second remission, as all his care was during the first to cleanse the prime vice. He observes, however, that it is to no purpose to give the bark till the necessary purgations are over; but assures us, that it never fails, unless from the coming on of a vomiting or diarrhoea it cannot be taken in sufficient quantities before the return of a paroxysm. To prevent the medicine from vomiting or purging, he mixed a few drops of liquid laudanum with every dose of it. Half a dram was given every half hour in some convenient vehicle, beginning as soon as the fever had considerably abated, and the pulse was returned nearly to its natural state; both which generally happened before the sweats were over. An ounce of the bark was sometimes found too little to check the fever, but an ounce and a half never failed. It must be continued daily in small doses till the patient has recovered his strength, and then a greater quantity must be given, especially at the season when the rivers overflow the country.

Dr Pringle found the autumnal remittents in the Netherlands complicated with a great many inflammatory symptoms; for which reason it was generally found necessary to open a vein in the beginning. The vernal and later autumnal remitting fevers are accompanied with pleuritic and rheumatic pains from the coldness of the weather, and on that account require more bleeding. A physician unacquainted with the nature of the disease, and attending chiefly to the paroxysms and remissions, would be apt to omit this evacuation entirely, and give the cinchona too soon, which would bring on a continued inflammatory fever. In these countries a vein may be safely opened either during the remission or in the height of a paroxysm; and our author also found good effects resulting from bleeding in the hot fits of the marsh fever, even after it had almost come to regular intermissions. After bleeding, a purgative was usually exhibited, of which he gives us the following formula.

\[ \text{R. Infusi senae commun. } \frac{3}{2} \text{iij.} \] \[ \text{Elect. Lenitiv. } \frac{5}{2} \text{ss.} \] \[ \text{Nitr. pur. } \frac{3}{2} \text{i.} \] \[ \text{Tinct. sen. } \frac{3}{2} \text{vi. M.} \]

Of this only one half was taken at once; and if it did not operate twice in four hours, the remainder was then taken. This potion agreed with the stomach, purged plentifully, and therefore was a very useful composition. Next morning, when there was almost always some remission, he gave one grain of emetic tartar rubbed with 12 grains of crabs-eyes, and repeated the dose in two hours, if the first had little or no effect; or at any rate in four hours. This medicine was intended not only to vomit, but also to operate by stool, and excite a sweat. If these evacuations were procured, the fever generally became easier, and was even sometimes cured. This he prefers to the ipecacuanha, and therefore in the latter years of his practice disused that root entirely. The same medicine was repeated next day or the day following; or if not, a laxative clyster was thrown up; and this method was continued till the fever either went off altogether, or intermitted in such a manner as to be cured by the cinchona.

A similar method was followed by Dr Huck in the remitting fevers of the West Indies and North America. In the beginning he let blood; and in the first remission gave four or five grains of ipecacuanha, with from half a grain to two grains of emetic tartar. This powder he repeated in two hours, taking care that the patient should not drink before the second dose; for Tertiana, then the medicine more readily passed into the bowels after it had operated by vomiting. If, after two hours more, the operation either way was small, he gave a third dose, which commonly had a good effect in opening the first passages; and then the fever either went quite off, or intermitted in such a manner as to yield to the bark. On the continent, he found little difficulty after the intermission; but in the West Indies, unless he gave the cinchona upon the very first intermission, though imperfect, the fever was apt to assume a continued and dangerous form.

In the remitting fevers of hot countries, however, it must be observed, that the lancet must in all cases be much more sparingly used than in similar diseases of the colder regions; and we must also be sparing of venesection in those countries where the marsh effluvia are very strong and prevail much. For this reason Dr Lind of Haslar greatly condemns the practice of indiscriminate bleeding when people first arrive in hot climates. The first diseases indeed which occur in a voyage to the southward are, for the most part, of an inflammatory nature, and owing to a sudden transition from cold to hot weather. This occasions a fulness and distention of the vessels; whence all Europeans, on their first arrival under the tropic, bear evacuations much better than afterwards. The practice of indiscriminately bleeding, however, a number of the ship's company when they first come into a warm latitude, is by no means found to answer the purpose of a preventive. In such cases, indeed, as plainly indicate a plethoric disposition brought on by the heat, blood-letting is certainly useful. The signs of this are a pain and giddiness in the head; a heaviness and dulness of the eyes, which sometimes appear slightly inflamed; there is also commonly a sense of weight and fulness in the breast, the pulse at the same time being quick and oppressed.

But the case is quite different after a longer continuance of sultry weather, and when the constitution is in some measure habituated to the hot climate. For it is then observed, that the symptoms of inflammations in the bowels, even the most dangerous, are not near so severe in such climates as in cold countries; nor can the patients bear such large evacuations. The physician, however, must take care not to be misled by the apparent mildness of the symptoms; for he will find, notwithstanding such deceitful appearances, that the inflammation makes a more rapid progress in hot countries than in cold, suppurations and mortifications being much more suddenly formed; and that in general all acute distempers come sooner to a crisis in the warm than in colder regions. Hence it is an important rule of practice in those climates, to seize the most early opportunity, in the commencement of all threatening inflammations, to make frequent though not copious evacuations by blood-letting. For by delay the inflammation quickly passes from its first to its last or fatal stage; at least, an imperfect crisis in such inflammatory fevers ensues, which fixes an obstruction in the viscera extremely difficult to remove.

It is indeed a general maxim with some physicians in the West Indies, that in most acute distempers bleeding in that country is prejudicial. This is founded upon a supposition that the crassamentum of the blood is thinned, and the solids greatly weakened, by the heat of the climate. It is therefore objected, that bleeding in such an habit of body weakens the powers of nature, and withdraws the strength which is requisite to support the patient until the crisis of the fever.

This reasoning is partly just; but, like all general maxims, will admit of exceptions. First, with regard to sailors, it is to be remembered, that they are more exposed to quick vicissitudes of heat, cold, damps, and to various changes of the air and weather, than most of the other inhabitants of the Torrid Zone. Add to this, that their intemperance, and the excesses they are apt to fall into whenever it is in their power to commit them, render them more liable to inflammations than any other set of people. Hence their diseases require more plentiful evacuations than the land-inhabitants of those parts of the world, and generally they bear them better. But with regard to the natives of the country, or those who have remained long there, it must be proper to bleed them very sparingly, making allowance for the different seasons of the year, the temperature of the air, and the situation of the places where they reside. Thus, in some parts, even on the island of Jamaica, at particular seasons, the weather is cool; wherefore, in these places, and at such seasons, the inhabitants having their fibres more rigid, and a firmer crisis of their blood, bear venesection much better.

In cold countries the state of the air greatly assists in restoring the impaired spring of the fibres; whereas every thing almost in warm weather, such as heat, moisture, &c. concur to relax and weaken the habit of body. Thus we may daily see persons in Britain, after having suffered a most severe fit of sickness, recover their strength and spirits in a few days, and in a very short time their natural constitution. But the case is very different in the sultry regions of the Torrid Zone, or indeed in any part of the world where the heat of the season causes the mercury to stand for any length of time at the 77th degree and upward of Fahrenheit's thermometer. During such an excess of heat, debility after fevers is apt to remain with European constitutions for several months. In Jamaica, the convalescents are sent to the cool summits of the mountains; but a retreat to a more northern climate is often absolutely necessary to recover their wonted tone and vigour of body. It is a well-established observation, that the negroes and aborigines of the Torrid Zone cannot bear plentiful evacuations by the lancet. They commonly mix the most stimulating poignant spices with their ordinary light food, and this is found by experience suitable to their constitutions.

As proper preventives for the dangerous fevers of which we are treating, Dr Lind on all occasions recommends the avoiding of stagnant water, or putrid marshes; the use of proper food, cleanliness, and sobriety. Of the propriety of removing from the neighbourhood of those places whose pestilential effluvia produce the disorders, we cannot possibly entertain a doubt; and of the efficacy of proper food in preventing putrid disorders he gives a remarkable instance in the Sheerness man of war, bound to the East Indies. As they went out, the men being apprehensive of sickness in so long a voyage, petitioned the captain not to oblige them to take up their salt provisions, but rather to permit them to live upon the other species of their allowance. It was therefore ordered, that they should be served with salt-meat only once a-week; and the consequence was, that after a passage of five months and one day, the ship arrived at the Cape of Good Hope without having a single person sick on board. As the use of Sutton's pipes had been then newly introduced into the king's ships, the captain was willing to ascribe part of such an uncommon healthfulness to their beneficial effects; but it was soon discovered, that, by the neglect of the carpenter, the cock of the pipes had all this while been kept shut. This ship remained in India some months, where none of the men, except the boats crew, had the benefit of going on shore; notwithstanding which, the crew continued to enjoy the most perfect state of health; they were, however, well supplied with fresh meat. On leaving India, knowing they were to stop at the Cape of Good Hope, and trusting to a quick passage, and the abundance of refreshments to be had there, they ate their full allowance of salt meats, during a passage of only 10 weeks; and it is to be remarked the air-pipes were now opened. The effect of this was, that when they arrived at the Cape, 20 of them were afflicted in a most miserable manner with scrofulous and other disorders. These, however, were speedily recovered by the refreshments they met with on shore. Being now thoroughly sensible of the beneficial effects of eating, in these southern climates, as little salt meat as possible when at sea, they unanimously agreed, in their voyage home from the Cape, to refrain from their too plentiful allowance of salt flesh. And thus the Sheerness arrived at Spithead, with her full complement of 160 men in perfect health and with unbroken constitutions, having in this voyage of 14 months and 15 days buried but one man, who died in a mercurial salivation.

Thus we see, that a free and pure air is not a sufficient preservative against a putrescent state of the fluids, without proper food; and, on the other hand, we have a very remarkable instance of the inefficacy of the most salutary food to prevent putrid diseases, in a very noxious state of the atmosphere. In the year 1717, at the siege of Belgrade in Hungary, the fever of the country, and the flux, occasioned a most extraordinary mortality among the troops. The dread of these diseases caused every one, as may naturally be supposed, to have recourse to different precautions for self-preservation. Prince Eugene, the commander in chief, had water and the provisions for his table sent him twice a week from Vienna. The pure stream of the river Kahlenberg was regularly brought to him: he avoided all excesses, and lived regularly or rather abstemiously; refreshed himself often by eating a cool melon; and mixed his usual wine, which was Burgundy, with water. Yet, notwithstanding his utmost care, he was seized with a dysentery; which would have quickly put an end to his life, had not the speedy conclusion of that campaign permitted him to make a quick retreat.

At this unhealthy season, when hardly one imperial officer, much less their several domestics, escaped those malignant diseases, the renowned Count Bonneval and his his numerous retinue continued in perfect health, to the surprise, or to use the words of Dr Kramer, to the envy, of all who beheld them. The only precaution he used, was to take, two or three times a day, a small quantity of brandy in which the Peruvian bark was infused; and he obliged all his attendants and domestics to follow his example. It is no less remarkable that the count, placing his certain preservation in the use of this single medicine, lived for many years afterwards in the most unhealthy spots of Hungary, without any attack or apprehension of disease; and continued to enjoy a perfect state of health during the hottest and most sickly seasons. And thus, with an unbroken and sound constitution, which is seldom the case of those who reside long in such climates, he lived to a great age. There is an instance produced by the same author, of a whole regiment in Italy having been preserved by the use of cinchona from the attack of these malignant diseases, viz. the flux, and bilious fever as it is frequently called, when the rest of the Austrian army, not pursuing that method, became greatly annoyed with them.

The intemperance and irregular living of those Europeans who visit the hot climates is frequently accused as the cause of their destruction; but, our author thinks, without sufficient reason; for though intemperance will make the body more liable to receive such diseases, it will not bring them on. It must by no means, however, be imagined, that in those climates Europeans may with impunity be guilty of excesses in eating or drinking: for the least error in that way will often prove fatal by debilitating the body, whose utmost strength in time of full health was perhaps scarce sufficient to resist the pestilential miasmata of the atmosphere.

It appears, therefore, from the concurrent testimony of the most eminent physicians, that the most proper medicine to be used, either as a preventive or cure for remitting and intermitting disorders, is the Peruvian bark, administered with proper precautions and after the prime via have been evacuated of the putrid bilious matter collected in them. In those species of tritaeophyta, &c. belonging to this class, enumerated by Sauvages, the same remedies only were useful; but in that pestilential distemper which he calls tritaeophyta Vratislaviensis, he tells us, that washing the body with water sometimes hot, sometimes cold, watery clysters, and plenty of aqueous drink, were likewise of use.

**Genus II. QUARTANA; the Quartan Fever.**

Quartana auctorum, Sauv. Gen. 89. Lin. 17. Vog. 3. Sug. 711. Hoffm. II. p. 23. Junck. tab. 81.

The Genuine Quartan, Sp. I. var. 1. A. Quartana legitima, Sauv. sp. 1. Sydenham de morb. acut. cap. v.

**Description.** The genuine quartan, according to Juncker, keeps its form more exactly than other intermittents; scarcely coming on at any other time than four or five in the afternoon. The cold is less violent than in the tertian; but is very perceptible, though it doth not proceed to such a height as to make the limbs shake; it continues for about two hours. It is preceded and accompanied by a languor both of body and mind. There is seldom any vomiting unless when the stomach is manifestly overloaded with aliment; neither is there any diarrhoea, but the belly in general is rather bound, not only on the days on which the paroxysm takes place, but also on the intermediate ones. The heat, which slowly succeeds the cold, is less troublesome to the patient by its violence than by the uneasy dryness of the skin, which is scarcely ever moistened with sweat. This heat rarely continues longer than four or five hours, unless perhaps at the first or second paroxysm. It is accompanied also with a giddiness and dull pain of the head. On the termination of the paroxysm, the patient returns to a middling state of health, and continues in the same for the rest of the intermediate days; only there remains somewhat of a loathing, and a deep-seated pain as if the person was all over bruised or broken, which kind of sensation the physicians are wont to call osteocopias. The fit returns every fourth day, and precisely at the same hours, being rarely postponed.

**Causes of, and persons subject to, this disorder.** The same general causes concur in producing this as other intermittents, namely marsh miasmata, and whatever can dispose the body to be easily affected by them. Studious people, and those of a melancholic turn, are said to be particularly subject to quartans; but what are the immediate causes which produce a return of the fits every fourth day, instead of every day, or every third day, must probably lie for ever concealed, as depending upon the secret and inexplicable mechanism of the human body.

**Prognosis.** A simple quartan, where there is no reason to dread any induration of the viscera, may very certainly admit of a cure; and the prognosis can never be unfavourable, unless in cases of extreme weakness, or where the distemper hath been unskilfully treated.

**Cure.** This does not in the least differ from that which hath been fully laid down for the simple tertian, and which it is therefore needless to repeat here.

**The Duplicated Quartan.** Sp. I. var. 1. B.

Quartana duplicata, Sauv. sp. 4. Bonet.

This is entirely similar to the duplicated tertian already mentioned; proper allowance being made for the difference between the type of a tertian and quartan.

**The Triplicated Quartan.** Sp. I. var. 1. C.

Quartana triplicata, Sauv. sp. 16.

This hath three paroxysms every fourth day, while the intermediate days are entirely free from fever.

**The Double Quartan.** Sp. I. var. 1. D.

Quartana duplex, Sauv. sp. 3. Vog. sp. 13.

In the double quartan, the fits come on every day except the third; but so that the first paroxysm answers to the third, the second to the fourth, and so on.

**The Triple Quartan.** Sp. I. var. 1. E.

Quartana triplex, Sauv. sp. 5. Vog. sp. 14. Bartholin. II. anat. c. 1. 95.

This comes on every day, but the quartan type is still still preserved by the times of accession; that is, the time of the fourth paroxysm's coming on answers to that of the first, the fifth to the second, the sixth to the third, &c.

The Quartan, accompanied with Symptoms of other diseases. Sp. I. var. 2.

Quartana cataleptica, Sauv. sp. 7. Bonet. polyalth. vol. i. p. 805. Quartana comatosa, Sauv. sp. 15. Werlhof. de febr. C. Pisonis Observ. de morbis à colluvie seros. obs. 166, 167, 168, 169, 171, 172, 173, 174. Quartana epileptica, Sauv. sp. 8. Scholzii Cons. 379, 380. Quartana hystrica, Sauv. sp. 10. Morton, Pyret. exerc. i. cap. ix. H. 10, 11. Quartana nephralgica, Sauv. sp. 9. Quartana metastatica, Sauv. sp. 17. Quartana amens, Sauv. sp. 12. Sydenham de morb. acut. cap. v. Quartana splenetica, Sauv. sp. 2. Etmuller, Coll. consult. cas. 25.

The Quartan complicated with other Diseases. Sp. I. var. 3.

Quartana syphilitica, Sauv. sp. 6. Plateri, observ. L. III. p. 676. Edin. Ess. art. xlvii. obs. 8. Quartana arthritica, Sauv. sp. 11. Musgr. de Arthr. sympt. cap. ix. H. 4, et 5. Arthritis frisequsa, Sauv. sp. 10. Arthritis febricosa, Sauv. sp. 10. Werlhof. de febr. Cockburn de morbis navigantium, obs. 19. Quartana scorbutica, Sauv. sp. 14. Barthol. de med. Dan. diss. iv. Tim. L. VIII. cas. 18.

The Remitting Quartan. Sp. II.

Tetartophya, Sauv. gen. 85. Sag. 699. Lin. 21. Quartana remittens auctorum.

Var. 1. Tetartophya simplex, Sauv. sp. 1. 2. Amphimerina semiquartana, Sauv. sp. 23. 3. Tetartophya semitertiana, Sauv. sp. 5. 4. Tetartophya maligna, Sauv. sp. 6. Lautter. Hist. med. cas. 21. M. Donat. L. III. cap. 14. ex M. Gatenaria Horst. L. I. obs. 15. 5. Tetartophya carotica, Sauv. sp. 4. Werlhof. de febr. Bianchi Hist. hep. pars III. const. ann. 1718, p. 751. 6. Tetartophya splenalgaica, Sauv. sp. 2. 7. Tetartophya hepatalgica, Sauv. 3. Cor. Pis. in prefat. p. 33. 8. Amphimerina spasmodica, Sauv. sp. 16.

To the tertian or quartan fevers also belong the Er-raticae of authors. As all those above mentioned differ only in the slight circumstance of the type from the intermitting and remitting tertians already described at length, it is unnecessary here to take up time in describing every minute circumstance related by physicians concerning them, especially as it could contribute nothing towards the laying down a better method of cure than what hath been already suggested.

Genus III. QUOTIDIANA; the Quotidian Fever.

Quotidiana auctorum, Sauv. gen. 86. Lin. 15. Vog. I. Hoffm. II. 33. Junck. tab. 79.

The Genuine Quotidian. Sp. I. var. 1. A.

Quotidiana simplex, Sauv. sp. 1. Quotidiana legitima, Sennert. de febr. cap. 18.