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DISSERTATIONS 
 
 ON 
 
 INFLAMMATION. 
 
 VOLUME I. 
 
 CONTAINING, 
 
 PRELIMINARY DISSERTATION-ON SOME OP THE LAWS OF THE 
 ANIMAL ECONOMY. DISSERT. II-ON THE HISTORY, CAUSES, 
 AND CONSEQUENCES OF SIMPLE INFLAMMATION. 
 
 BY JOHN BURNS, 
 
 SURGEON IN GLASGOW. 
 
 'o' 
 
 PUBLISHED BY E. F. BACKUS, 
 
 AT THH ALBANY BOOKSTORE, NO. 45 STATE STRSBX. 
 
 C S. Van Winkle, Printer, Neni-York. 
 1812; 
 
 ALBANY: 
 
CONTENTS. 
 
 VOL. I. 
 
 Preliminary Dissert. — On some of the Laws of 
 
 the Animal Economy, . . . . . 13 
 
 Dissert. II. — On the History, Causes, and Termi- 
 nations of Simple Inflammation, . . .131 
 
 VOL. II. 
 
 Dissert. II. continued. — On the Treatment of Sim- 
 ple Inflammation, and its Consequences, . 3 
 Dissert. III. — On the Phagadenic, and some other 
 
 Species of Inflammation, . . . .118 
 
 Dissert. IV. — On the Spongoid Inflammation, . 132 
 
 Dissert. V. — On the Scrophulous Inflammation, 145 
 
 Dissert. VI. — On the Cancerous Inflammation, . 177 
 
r 
 
 PREFACE. 
 
 THE foundation on which medical reasonings 
 are built, is a knowledge of the laws and opera- 
 tions of the living principle ; but as our acquaint- 
 ance with these is exceedingly imperfect, the opi- 
 nions which are formed from this must be fluctuat- 
 ing, and frequently very uncertain. 
 
 When physic first became a science, the doc- 
 trines of its teachers were, of necessity, rude and 
 chimerical ; and even after it had been studied for 
 many hundred years, it continued to be obscured 
 by a multitude of idle theories. As these were 
 founded not on facts, but on what the imagination 
 of their inventors believed to be probable, it is not 
 wonderful, that each succeeding teacher should 
 change and modify the doctrines of his predeces- 
 sor : But even these changes, however highly they 
 might be valued by the school which effected them, 
 embraced only a very small extent. The more 
 trifling parts of the system alone suffered an alter- 
 ation; and the great outlines of former opinion 
 seemed to be beheld, for ages, as boundaries mark- 
 ed out by a Superior Being to the human under - 
 
 Vol. I. B 
 
landing, and marked with the character?, Hitherto 
 shalt thou come, but no farther. For by far the 
 longest period of medical history, we find these out- 
 lines to be drawn on a wrong foundation ; the prin- 
 ciples of pathology being taken from the proper- 
 ties and conditions of the different fluids of the 
 body. In the first ages of knowledge, the mind 
 was impressed with material objects alone, and 
 was able to reason only concerning objects of sense. 
 That the grosser part of matter must have some 
 more subtle power acting on it, m order to make 
 it perform its operations, appeared evident to all ; 
 but of this they could form no idea, otherwise 
 than by supposing an intelligence which, by its 
 active qualities, could operate just as man moves 
 and regulates the machines which he makes. The 
 nature of this intelligence they also endeavoured 
 to explain ; but, by having their minds tied down 
 wholly to material objects, the ancient philosophers 
 could form no conception of a principle purely 
 spiritual. They, therefore, chose the most subtle 
 matter with which they were acquainted ; and be- 
 lieved heat, or a principle to which they gave this 
 appellation, to be the soul of the universe, from 
 which emanations went forth to enliven the indi- 
 viduals of the creation. Such being the doctrines 
 of the philosophers, medical reasonings came natu- 
 rally to be founded on the properties and changes 
 of the material part of the frame, which changes 
 were again referred to the operation of an intelli- 
 gent and sentient principle. 
 
Xi 
 
 It was the discoveries of the immortal Newton, 
 which first paved the way for the real improve- 
 ment of medical science ; for he, in one great 
 branch of natural knowledge, banished completely 
 the mechanical interference of intelligent agents, 
 and taught the existence of a principle purely im- 
 material, and which, without any wisdom or voli- 
 tion, could act by being acted on. The mind now 
 Came gradually to be weaned from reasonings to- 
 tally material and mechanical ; and physicians, by 
 degrees, began to attribute the operations of the 
 animal frame, not to a thinking power, which pre- 
 sided with wisdom over the system, but to a prin- 
 ciple, which was implanted in man at his creation, 
 and which, through the medium of the nerves, in 
 which it was supposed to be lodged, carried on his 
 functions,, according to a rule established from the 
 beginning, without possessing either knowledge or 
 judgment. It required, however, a step farther 
 to banish the doctrines of the changes of the fluids, 
 and the belief in these as the cause of disease ; and 
 so strongly have these notions taken hold of the 
 mind, that they are not yet altogether given up. 
 
 An examination into the properties and source 
 of this living principle, or nervous energy, as it 
 has been called, forms the subject of the Prelimi- 
 nary Dissertation, in which I have endeavoured to 
 explain some of the principal laws and operations 
 of the animal economy. The subsequent Disser- 
 tations contain an inquiry into the nature and mode 
 of treatment of some of the different species of in- 
 
Xli 
 
 flammation, founded upon those laws or properties 
 of the living principle. These are part of a course 
 of lectures which I read upon surgery, three years 
 ago, in the Royal Infirmary, in Glasgow. 
 
 I offer them now to the Public with much diffi- 
 dence ; but, at the same time, with a sincere hope 
 that they may be useful to others, in considering 
 the same subjects, which are of the very first im- 
 portance to every surgeon. If, in any part, I shall 
 appear to be unnecessarily tedious, I beg it to be 
 remembered, that some of these positions differ 
 from those commonly maintained, and, therefore, 
 require to be more fully illustrated. I do not 
 write to surgeons who already understand these 
 subjects, but to students, who as yet have their 
 knowledge to acquire, and to whom many illus- 
 trations are useful, which to others, who know 
 more, may appear to be unnecessary. 
 
DISSERTATIONS 
 
 ox 
 
 INFLAMMATION- 
 
 PRELIMINARY DISSERTATION ON SOME OF THE LAWS OF 
 THE ANIMAL ECONOMY. 
 
 Introduction. 
 
 NATURAL historians have divided the objects of their 
 examinations into three great classes, which have been called 
 the kingdoms of oature ; the animal, the vegetable, and the 
 mineral. 
 
 Amongst all the different individuals of these divisions, an 
 organised form regularly prevails. A stone or a salt assumes 
 uniformly an appearance which continues always the same in 
 similar species. The vast rocks of Basaltes, which stand as 
 so many monuments of the dreadful cause which produced 
 them, consist of large pillars, having five sides of equal di- 
 mensions. Silicious crystals exhibit the form of hexagonal 
 pyramids, whilst the zeolite assumes the figure of a beautiful 
 star, and the amianthus that of regular and parallel fibres. 
 
 The vegetable has likewise its appropriate construction, 
 which, as in the other kingdoms, continues always the same ; 
 but in this respect it differs from the mineral, that to a regu- 
 lar figure there are conjoined organic vessels to maintain and 
 
14 
 
 increase that form, according to the uniform action of a cer- 
 tain principle which they possess, and which has been called 
 life. If the plant be cut through level with the earth, we 
 soon find that the loss is supplied, and new sprouts formed, 
 which produce leaves, flowers, and fruit, exactly similar to 
 those which were cut down. If we apply a stimulus to it, a 
 particular effect is produced, according to the nature of the 
 application, or of the part acted on. If it be light, the organs 
 of motion become affected, and the leaves turn toward the 
 ray, or the flower-leaves open to admit the light and air to the 
 parts of fructification. If heat be applied to the plant, in a 
 slow and regular manner, it supports and assists the exercise 
 of its functions, and consequently contributes to its strength 
 and increase. But if it be applied hastily, and to a great de- 
 gree, it disorders the action of that power which preserves 
 the plant, and either disease or death is the result. The laws 
 and operations of this power are few and simple ; but when 
 we ascend to the animal creation, we find, that not only the 
 structure is more complex, but also the modes of action are 
 much more numerous. 
 
 The individuals of the last class have promiscuously re- 
 ceived the name of dead matter, because, when compared 
 with the other classes, they appeared to be inanimate. But 
 by a more accurate examination, we shall find, that there is 
 in reality no individual whatever in any of the kingdoms or 
 classes of nature which can be called inert, or truly dead. 
 For, from the largest masses of matter down to the most 
 minute corpuscles, we distinctly perceive the operation of an 
 active and immaterial principle.* 
 
 * The particular nature of this principle, as we shall afterwards see, never can 
 he ascertained. We are, however, sufficiently assured, by the phenomena whicli 
 we observe, that in all the classes of nature such a principle does exist. But the 
 relation which the enlivening or vital powers of one class bears to that of another, 
 cannot yet, if ever, be determined. Whether the same principle only exists in dif- 
 ferent degrees of perfection in these classes, or whether its nature be essentially 
 diflferent in each, will admit of much discission. In this paper, however, I can 
 anry give a general statement of the i'Jea which I annex to the principle of life, and 
 
15 
 
 This principle has received different names, according as it 
 manifests itself. The power which supports the functions, 
 (if I may use the expression,) and regulates the motions and 
 actions of the different parts of the universe, has been called 
 gravitation ; whilst the property whkh makes one particle 
 unite with another, and which modifies the form, and produces 
 the increase of the smaller bodies, has received the name of 
 corpuscular attraction. The principle, again, which regu- 
 lates the intestine changes, and determines the combinations 
 and specific states of existence in matter, has been denomi- 
 nated elective, or chemical attraction. 
 
 How matter, which by itself, and viewed abstractedly, must 
 be considered as inert and dead, should Be capable of com- 
 bining with this active and immaterial power, it is impossible 
 to say. But having from the creation perceived this union, 
 we find it to be now impracticable to form a conception of 
 matter unconnected with this property. 
 
 Without this enlivening principle, all nature must be dead ; 
 and matter deprived of it must either cease to exist, or exist 
 in a way which we cannot possibly comprehend. The union 
 of the whole universe must be dissolved, and the beautiful de- 
 pendence of one part on the rest for ever destroyed. We 
 know, and are taught to believe, that the Great Being who 
 formerly sent forth this active vital power, and bade the 
 worlds live, will one day recal his gift. Matter shall then 
 cease altogether to be, or shall return to that unknown chaotic 
 state which poets have imagined, and vainly attempted to 
 describe.* The particular laws and operations of attraction, 
 
 afterwards mention, in so far as will be necessary for understanding the following 
 Dissertations on Inflammation, some of the operations and qualities of the Jh:Ti£ 
 principle in man. 
 
 * " Ante, mare et tellus, et, quod tegit omnia, ccelunjj 
 " Unus erat toto nature vultus in orbe, 
 " Quern dixere chaos ; rudis indigestaque moles ; 
 14 Nee quicquam, nisi pondus iners; congestaque eodf>m 
 " Nod beae junctarv(m discordia senjina rennn." 
 
 Ovp. 
 
16 
 
 or the life qf mailer, belong for investigation to the natural 
 philosopher; and therefore it will here only be proper to re- 
 mark, that I consider animals, vegetables, and what is called 
 inanimate matter, as all possessing an immaterial principle, 
 differing greatly indeed in its nature and effects in these dif- 
 ferent classes, but still deserving, in all of them, the name of 
 life, being of equal value to each, and absolutely requisite for 
 their preservation. 
 
 This power, we have seen, is exceedingly simple in com- 
 mon matter ; but when we mount to the next class, that of 
 vegetables, we find a much greater degree of perfection in 
 the life, and much more complicated actions. We have not 
 only the same properties which are possessed by matter, but 
 also additional and very surprising powers. We find them 
 always in a progressive stale of growth or decay, endowed 
 with the property of changing foreign matter into a peculiar 
 fluid, which is continually circulated through their vessels, 
 and converted into a great variety of products. They are 
 farther distinguished, by having within themselves the powers 
 of motion, and of multiplying their species to an endless de- 
 gree. We then find, that vegetables possess not only the 
 principles proper to matter, but also a life peculiar to them- 
 selves, and which, I may say, is built upon the former ; for 
 without attraction there can be neither growth nor organiza- 
 tion. 
 
 When we ascend to animals, we find them possessed of a 
 third species of life, built upon the other two. In this class, 
 beside attraction, or the preserving and active principle of 
 matter, we find reproduction, and the other properties of ve- 
 getable life ; but these properties are exhibited with a differ- 
 ent modification, and are united with others, which of them- 
 selves would, independent of the presence of mind, distin- 
 guish them from vegetables. 
 
17 
 
 We have, then, in the three classes of nature, three dif- 
 ferent species of life, each more perfect than the other, and 
 increasing gradually in their delicacy and intricacy. The 
 most simple, or that of matter, is the most permanent, and 
 on it the other two are built. I do not, however, mean from 
 this to say, that attraction,* or the vital principle of matter, 
 acts in the higher classes merely as attraction ; or, in other 
 words, that it remains unchanged in its properties. On the 
 contrary, a very great alteration takes place ; and, although 
 it still possesses the quality expressed by the word attraction, 
 making the parts adhere together, it yet is so far changed 
 and perfected, as to exhibit many other phenomena and new 
 actions, of which, before this elevation, it was incapable. It 
 is rendered not only more perfect, in this respect, of gaining 
 new properties, but even its original quality of producing at- 
 traction is much improved ; for a living muscle will bear a 
 greater weight, without laceration, than one newly dead, or 
 one called, in common language, dead ; which proves, that 
 the vital principle, in animals, has a greater power of pro- 
 ducing the effect called attraction, than the vital principle of 
 common matter. 
 
 The three classes run imperceptibly into each other ; and 
 thus we have a complete chain of existence established, from 
 the most simple to the most complicated body. Those spe- 
 cies of amianthus, which are called mountain cork, although 
 minerals, yet resemble vegetables so strongly, that they link 
 the classes together ; whilst the coralines, although animals, 
 resemble both minerals and vegetables. The fungi, though 
 plants, consist of the same principles with animals. Some 
 of the fuci resemble hair, and other cartilage ; whilst the 
 sponge, although an animal, grows like a vegetable. Not 
 only the external and chemical qualities, but also the vital 
 
 * This term is used sometimes for the cause, and sometimes for the effect j but 
 < he sense will always show how it is to be understood, 
 VOIr. I. C 
 
T8 
 
 principle, and its phenomena, form a regular gradation in fhe 
 different classes. Even in a single individual of the two' 
 higher classes, we perceive the gradual elevation of one spe- 
 cies of life into another. This change uniformly begins in 
 the fluid part of the individual. In the plant, the first change 
 produced on common matter, or the aliment, is its conver- 
 sion into vegetable juices, which exhibit certain vital pheno- 
 mena, different from common fluid matter : afterwards or- 
 ganization is added, in which the vegetable life is exhibited 
 with most perfection. In animals, again, there is a greater 
 gradation, and more complicated change, before animal life 
 be imparted in its greatest perfection. The food is first con- 
 verted into chyle, which has a lower species of life than the 
 blood, which again is more imperfect io its vitality than the 
 organized parts. The living principle of the blood differs, 
 both in degree and kind, from that which belongs peculiarly 
 to the animal ; but these two are connected, and react on 
 each other. 
 
 No substance or piece of matter, whether simple or com 
 pound, has of itself a tendency to decomposition, or change 
 of state. For effecting this, the principle of attraction must 
 be acted on by the addition of olher substances, and then 
 a new condition will take place. This is the foundation of 
 chemistry, which is a science wholly built on the effects of 
 attraction. Some have attempted to explain the changes or 
 diseases of living animals by the same law* ; but this method 
 cannot be admitted, until it be proved, that their life does 
 not give them properties different from common matter, and 
 make them subject to another set of laws. When they are 
 deprived of this life, then they become liable to the habi- 
 tudes of matter, and may, by the agency of other substances, 
 be decomposed, and differently combined ; but, until their 
 specific life be lost, they bid defiance to such changes ; and. 
 therefore, the system of pathology which ha? been built ur> 
 on it must be fakes 
 
19 
 
 Life is a principle which we can only detect and judge of 
 by its operations or actions ; and, when these are not exhibit- 
 ed, we are apt, though sometimes erroneously, to conclude, 
 that the body is dead. The leading property of life, is to 
 -communicate a preservative power to every individual with 
 which it is connected. This is sometimes effected by very 
 evident and intricate actions ; but, at other times, is exerted 
 without any sensible operation. The crystal resists, to a 
 certain degree, mechanical impressions, which would destroy 
 its form. The blood when newly drawn, the sap of vegeta- 
 bles, the living egg, resist cold, by an imperceptible opera- 
 tion, to a much greater degree, when alive, than after their 
 peculiar life departs. They resist all the efforts of chemical 
 agents which act on common matter ; nor is it possible to de- 
 compose or injure them in this way, until they lose therr 
 specific life, and descend in the scale of existence. This 
 simple preservative power is a discriminating mark of the 
 presence of life ; but we cannot detect it until we apply de- 
 stroying causes : It is the uniform and universal effect of the 
 combination of life with any substance, whatever its nature or 
 structure may be : It is the essential characteristic of life, 
 which it must show whenever it is present. But, when we 
 find vital power united with a certain organization,* then 
 more varied phenomena take place ; and these are called ac- 
 iions of the vital principle. f In the plant, the bud expands, 
 the stem shoots up, the food is absorbed, digested, and cir- 
 culated ; air is thrown out, and particular secretions take 
 place. In the animal, these actions are still more evident, 
 but more intricate, and infinitely more varied. They are 
 ihe support of our health, and the source of all our disease. 
 
 * I am only here considering animal life, without any connection with an in- 
 telligent principle or soul, which is quite a different thing from vitality. 
 
 t Every operation of the vital energy is called an action, and whatever agent 
 excites this action is called a stimulus. The aptitude of the system to be acted 
 •en has been expressed by the term irritabijit- 
 
20 
 
 In the two first classes, the enlivening principle seems to 
 be equally united with and dependent on every part ;• but in 
 animals, to whom I will now confine my attention, the prin- 
 ciple which performs these actions is more directly connect- 
 ed with certain organized portions of the body, called brain 
 and nerves, which supply every part, though so minutely, 
 that we often cannot trace their course. 
 
 Of the Brain and Nerves. 
 
 The brain* is a soft globular substance contained within 
 the cranium, of a dusky colour without, but white in the cen- 
 tre. It is from this white or medullary portion, that we find 
 all those elongations arising, which have been called nerves, 
 and which are just portions of the brain diffused over the 
 body, and exerting there the peculiar properties of the sys- 
 tem to which they belong. 
 
 * Were we to proceed regularly to investigate the various phenomena of animal 
 life, we would naturally begin by examining the composition and structure of the 
 different parts of the body. By this examination, we should become acquainted 
 with some fundamental facts, but should still be in the dark with regard to that 
 principle which animates the whole, and enables the various functions to be car- 
 ried on. An inquiry into the general laws of this energy, which is found to re- 
 side in the brain and nervous system, would, therefore, naturally become the 
 second object of our attention. Being acquainted with these, we would next ex- 
 amine the particular functions of man, and the operation of the nervous energy in 
 supporting them. The gradual growth and increase of the animal, the deposition 
 of new matter, and the absorption of the old, would be the first subject of conside- 
 ration in this part of the examination, and would naturally involve an inquiry 
 into the process of digestion, and the formation of the blood, with its qualities and 
 uses. The powers of motion, the influence of the mind, and the history of the dif- 
 ferent senses and various functions of man, would conclude this part of the inqui- 
 ry. Having become acquainted with the healthy condition of the system, and 
 the causes which maintain it, we would apply this knowledge to the investigation 
 of the different derangements, or diseased actions of our body, and their cure. 
 
 Such might be a proper plan for examining regularly the economy and diseases 
 of an animal ; but this would be greatly too extensive for the present purpose. It 
 must here be taken for granted, that the student is acquainted with the structure 
 of the body, and with its different functions, by which he will be able to under- 
 stand the following general observations on the properties of the living principle, 
 and apply the doctrines more par ticularly himself 
 
21 
 
 These nerves possess different qualities, according to the 
 portion of the brain from which they arise, and the or- 
 ganism of the part to which they go. Those which go out 
 first, arising from the mamillary processes, and which are 
 called olfactory nerves, are the source of the sense of smell- 
 ing. The second pair, arising from a particular protube- 
 rance, or little brain, called the optic bed, give the important 
 sense of seeing ; and, in order to connect those two cerviculae, 
 or beds, we find their elongations joined, before they proceed 
 out of the skull. The third, the fourth, the first branch of 
 the fifth, and the sixth pair of nerves, all arise from the cere- 
 brum, and are distributed on the different parts of the eye, 
 serving chiefly for the purposes of motion. The soft portion 
 of the seventh pair arises from the fourth ventricle, and con- 
 stitutes the auditory nerve. None of these nerves support 
 the vital functions ; they are all destined either for the organs 
 of sense, or the simple parts about the head. 
 
 The nerves which serve for carrying on the vital functions, 
 all arise either from the medulla oblongata, or spinal marrow. 
 I have seldom, in dissections, found derangements of those 
 parts of the brain, but have often observed very great 
 disease in the cerebrum. In one case, the cerebrum was 
 hard and schirrus, but the cerebellum was sound and 
 healthy. This man died comatose, after being long tor- 
 mented with violent head-aches. In another instance, al- 
 though the lateral ventricles were so much^distended with 
 water, that the hemispheres of the brain were converted into 
 little else than two bladders full of fluid, yet the child was 
 sensible nearly to the time of death, which was produced 
 more by the pressure on the cerebellum, which was not dis- 
 eased, than by the derangement of the cerebrum. In num- 
 berless instances, we find the skull beat in upon the cere- 
 brum, or foreign bodies lodged in its substance, or abscesses 
 Formed in consequence of blows and falls, and still the patient 
 
22 
 
 surviving all the injury.* The physiologist has even re- 
 moved this part of the brain altogether, in birds and other 
 animals, without death being occasioned ; the senses alone 
 were destroyed. But it is equally well attested, that the 
 cerebellum cannot be injured with the same impunity ; for, 
 from the history of those who are killed by blows on the 
 head, and by experiments upon brutes, we find, that, in very 
 £ew instances, does the animal survive, if this part of the 
 brain be injured. f 
 
 We shall next find, that the cerebellum, comprehending 
 its production, the medulla oblongata,]: joined by a few 
 branches from the cerebrum, is expanded or diffused over 
 the whole body. It passes out of the skull, and seeks de- 
 fence in the vertebral canal, from whence it sends out elon- 
 gations to all the different parts of the body, which, with 
 those which pass out from it in the skull, support the exist- 
 ence of the animal. 
 
 * I do not mean to maintain, that wounds of the cerebrum are not attended 
 with great danger. I only wish to prove, that they are by no means so fatal as 
 those of the cerebellum j and, consequently, that the cerebrum is not so immedi- 
 ately necessary to the continuance of life. Spindler, and others, report instances 
 of people walking about with part of the cerebrum gangrenous. Many instances 
 of recovery from severe injuries done to this part, are mentioned in the Memoirs 
 of the Academy of Surgery ; and every practical surgeon must have observed, 
 how long a patient often survives the most terrible accidents of the head. 
 
 f Although Zinn, Fallopius, Veslingius, and others, consider wounds of the ce- 
 rebellum as curable, and have cured individuals who were supposed to have thi3 
 part of the brain injured ; and although the illustrious Baron Haller mentions, 
 that he had once seen the cerebellum schirrus ; yet the observation of Bohnin?, 
 and others, who have wrote expressly on the subject, that these wounds are almost 
 inevitably fatal, cannot be considered as invalidated by those solitary instances of 
 recovery. 
 
 \ The medulla oblongata is just a part of the cerebellum, and is of the same im- 
 portance to the living system. We see it supporting life in insects, who are with- 
 out a brain, and in acephalous monsters. Wounds of it are fatal and dangeroup, 
 in proportion as they are near the head ; or, in other word , according to the value 
 ff the nerves which originate beneath them. 
 
23 
 
 These elongations,* or nerves, possess a degree of energy, 
 or vital power, in themselves, independent of what they re- 
 ceive from the brain as their source. They are neither more 
 nor less than continuations of the brain, possessing the same 
 power, and endowed with a similar quality, It would, in- 
 deed, from reflection, independent of experiments, be reason- 
 able to conclude, that the nervous energy must be diffused 
 over all the body, although it resides in a greater proportion 
 in the brain, from whence it is sent to support the other 
 parts of the system- In genera!, the quantity of energy in a 
 nerve is proportioned to its size ; it is greatest in the brain, 
 and less in all the elongations, in a degree correspondent to 
 their magnitude. j The small nerves have a dependence 
 upon the great, and these again upon the brain : An universal 
 connection is thus established, no one part of the body being 
 of itself sufficient for living.i 
 
 The delicacy of the nervous system is proportioned to the 
 perfection of the animal ; and, therefore, it is chiefly by ex- 
 periments on the individuals of the lower ranks, that this doc- 
 trine is to be confirmed. At the same time, some assistance 
 may be derived from what we occasionally observe in the 
 more perfect animals. We find, for instance, that children 
 
 * Aristotle believed, that the nerves originated from the heart; and his suc- 
 cessors taught, that the blood-vessels which proceeded from the heart, were con- 
 verted, in the brain, into nerves. It is on this account, says Van Horn, that in 
 anger, the blood boils, and the eyes flash with fire. 
 
 t We must carefully distinguish betwixt energy and action, tfhich do -not al- 
 ways correspond. The brain, which most likely contains the greatest quantity of 
 energy, considered absolutely, exhibits less action than many small nerves ; for I 
 do not consider the operations of the mind as an action of the nervous energy in 
 the brain. Mind and nervous energy are totally different ; and, once for all, I 
 beg to mention, that I consider the soul or spirit as di?tinct,and altogether out of 
 the present question concerning vital power, and its action*. 
 
 t Although the inherent quantity of energy appears to Correspond to the quan- 
 tity of nervous medulla, yet the action does not, being gicatest in the extremities, 
 or rather almost entirely confined to the extremities, which draw their energy 
 from the trunks These seem to secrete the power, whilst the extremities «z- 
 ?en^ it. 
 
24 
 
 have been known to grow and live in the womb without any 
 brain, receiving their vital energy from nerves alone; which 
 proves, that a brain is by no means essential to the mere 
 presence of vitality in an animal. On the other hand, we 
 observe, that particular nerves may lose their energy, al- 
 though the brain remains sound, as we see exemplified in 
 paraplegia and partial palsy. At other times, we find both 
 the brain and the nerve sound, but the connection subsisting 
 betwixt them destroyed ; in which case the nerve has only 
 its own inherent energy, and derives no assistance from the 
 brain, or parts above. This is daily seen in curvature of the 
 spine.* The doctrine may also be confirmed, by the case 
 of a gentleman, who was paralytic from the head downward, 
 but the heart and bowels continued their action. Here the 
 spinal marrow only was diseased ; and that portion of the 
 brain which gave off the intercostal and sympathetic nerves, 
 as well as those nerves themselves, was healthy. But it is 
 most beautifully proved, by the well-known experiments of 
 applying zinc and silver to the nerve of an amputated limb, 
 by which we produce contractions of the muscles, and make 
 the apparently dead member move upon the table. It has 
 been long known, that if we tie a ligature upon the phrenic 
 nerve of a dog, the motion of the diaphram ceases ; but if we 
 stimulate the nerve below the compressed spot, by stripping 
 it either upward or downward between our fingers, the con- 
 traction of the diaphragm, for a time, returns. By experi- 
 ments upon the amphibious and reptile tribe, the doctrine is 
 ascertained to be true beyond all dispute. It is well known, 
 that a frog will live, for a couple of days, after his head is cut 
 off; that he will jump about, and will even, if we may credit 
 
 * It is necessary, how ever, that this interruption take place gradually, in order 
 to accustom the nerve to e vert itself, if I may use the expression, independent of the 
 brain: For, if we cut the nerve suddenly, we find, that the difference betwixt the 
 energy inherent in thenervo, and that which it waswontto receivefrom the brain, 
 is «o great, that the parts cam lot exist . The change is too great and too sudden. 
 
25 
 
 the Abbe Spallanzani, return to the embraces of his mistress, 
 if the decapitation has taken place during the payment of his 
 addresses. It is also known, that if we divide the spinal mar- 
 row, the crural nerves being no longer assisted by the parts 
 above, become weakened, having only their own energy, and 
 the limb is palsied ; but still there is energy sufficient to con- 
 tinue the circulation ; and " the bones, if fractured, will 
 unite." If we cut a frog across, we may make the legs move 
 for hours, by applying the zinc and silver ; or, if we suspend 
 the lower half, by a wire, from the conductor of an electrical 
 machine, we shall, by taking sparks from the legs, exhibit a 
 very grotesque dance. 
 
 The tortoise will live, after decapitation, for many days ; 
 and, if we may credit naturalists, has been known to survive 
 the extraction of the brain for half a year. The bodies of 
 some serpents will move about, when irritated, even after be- 
 ing deprived of the head, skin, and heart. Kaau tells us of a 
 cock, who run thirty feet after decapitation ; and many other 
 instances, of a similar nature, might, if necessary, be added. 
 From all these facts, it appears, that the nervous system is 
 one great whole, having its energy universally diffused over 
 it, and inherent in every part. 
 
 A doctrine similar to this has occurred to many, and, 
 among the rest, to the ingenious Dr. Whyte ; but he ascribes 
 to the soul what is here attributed to the nervous energy ; 
 and, by this theory, is obliged to involve himself in metaphy- 
 sical reasonings, concerning the extensibility of the soul, as 
 taught by Gassendi, and others. According to him, when a 
 muscle is removed from the body, and placed at ten yards 
 distance from the body, the soul extends to it over all that 
 part of space, and enables it to contract. When this muscle 
 dies, then we must either suppose that part of the soul is lost, 
 or that it retracts itself again within the body; which being 
 vor:. tk d 
 
2(J 
 
 Jess than formerly, must have a greater proportion of soul > 
 both of which suppositions would be ridiculous.* 
 
 Of the Nervous Energy. 
 
 Many have undertaken to ascertain the precise nature of 
 the nervous energy, and the manner in which it is produced ; 
 but I apprehend, that no argument will be necessary to prove 
 the vanity and absurdity of the attempt: It eludes all our re- 
 searches ; it does not come under the cognisance of our 
 senses ; and we might just as reasonably attempt to describe 
 and comprehend a new sense, or detail the intimate nature of 
 an unknown substance. 
 
 The ancients believed this energy to he of a gaseous na- 
 ture, and maintained, that it was formed in the ventricles of 
 the brain, from the air which we inspired.f This air, ac* 
 cording to some, operated in part indirectly, through the 
 medium of the lungs ; but it was allowed by aU, to act chief- 
 ly, by a direct ascent to the brain, through the cribriform la- 
 mella of the ethmoid bone. Those who were resolved to 
 adopt implicitly whatever the ancients desired them to be- 
 lieve, were glad to forget the olfactory nerve, which filled 
 these holes up completely, and chose rather to remember the 
 pretended experiment, in which tobacco was found to tinge 
 the brain, by being snuffed up the nose.t This supposition 
 being, as they thought, proved, physiologists began to push 
 the doctrines of the ancients still farther : They took up the 
 conjecture where they ended, and attempted to explain the 
 particular nature of the aeriform principle. Some called it 
 a very Ihin air, impregnated with nitre ; others, a mixture of 
 air, sulphur, and saline matter : And, as every one is fond of 
 
 * Vide Whj-te's Worksop. 202. " Of the Vital and other Involuntary Motion? " 
 f Galen de Util. Respir. cap. 5. 
 1 FracasBatus d« Cerebro, p. 328. 
 
27 
 
 making his own discoveries as important as possible, we find 
 Mayow attributing this property to his nitro-aerial or oxyge- 
 nous principle. This supposition was, in a manner, repeated 
 by Barbieri, and has, of late, been revived by Dr. Girtanner, 
 who can fill bottles, as well as nerves, with this principle of 
 life and irritability. / 
 
 Not less ridiculous than these conjectures, was that of 
 Mistichelli, who imagined, that the nervous energy was pro- 
 duced by a kind of fermentation taking place, between what 
 he called the sulphur of the blood, and a particular kind of 
 air ; or the conjecture of those who believed, that hartshorn 
 was the true nervous spirit.* 
 
 Those who attended less to chemistry, and more to anato- 
 my, disbelieved these notions, and taught their own disciples, 
 that the nervous spirit was not so very volatile ; that it bore 
 a more near resemblance to the other fluids of the human 
 body, artd consisted entirely of a finer portion of the 
 lymph.f 
 
 The Cartesians, who loved wonders, called it pure flame, 
 or a kind of neutral substance between flame and air ;J whilst 
 the Newtonians, forgetting the accuracy which mathematics 
 might have taught them, imagined their aether to be the prin- 
 ciple of life. The supposition which Sir Isaac Newton 
 threw out, in the form of a query, was adopted by many, and, 
 amongst others, by Dr. Mead, who observes, that " this fluid. 
 (the nervous energy,) so far as we can discover by its effects, 
 is a thin volatile liquor, of great force and elasticity, being in- 
 deed most probably a quantity of the universal elastic matter 
 (aether,) incorporateb! with fine parts of the blood, separated 
 in the brain, and lodged in the fibres of the nerves. This is 
 
 * Cheyne in the Phil. Princip. of Religion. 
 
 t Berger, p. 269. 
 
 t Although they believed this, yet they were foolish enough to talk of valves 
 in the nerves, as if this matter could be obstructed or regulated by valvular folds. 
 Vide, Descartes de Homine. 
 
28 
 
 the instrument of muscular motion and sensatien, a great 
 agent in secretions, and indeed in the whole business of the 
 animal economy."* 
 
 Other physiologists rejected this conjecture, concerning 
 the action of a suppositious principle, and referred life to the 
 operation of causes with which they were better acquainted. 
 Magnetism and electricity were too wonderful agents to be 
 overlooked : The last was by many supposed to constitute 
 the nervous energy, and even of late we find some support- 
 ing a similar doctrine.f 
 
 Partly, perhaps, from the absurdity of these notions, and 
 partly from chimerical principles, the very existence of a 
 nervous fluid was denied, and the agency of the soul or mind 
 became more attended to. That the phenomena of life de- 
 pended upon the rational soul, without the assistance of any 
 other energy, was the opinion of some ; whilst others allowed 
 the existence of a peculiar power in the nerves, but main- 
 tained, that this was, to the utmost extent, under the con- 
 troul of the soul, which presided, as an aiitocrator, with wis- 
 dom, over all the operations of the living body. 
 
 Having given up the doctrine of a nervous fluid, it be- 
 came necessary to explain how the nerves performed their va- 
 rious offices, particularly those of motion and sensation, and 
 how external stimuli acted on them. This they endeavoured 
 
 * Mead's Works, 8vo. p. 14. 
 
 f See the experiments of Valli, Galvani, and others, on this subject. " The 
 similarity of the texture of the brain to that of the pancreas, and some other 
 glands of the body, has induced the inquirers into this subject to believe, that a 
 fluid, perhaps much more subtle than the electric aura, is separated from the blood 
 by that organ, for the purposes of motion and sensation. When we recollect that 
 the electric fluid itself is actually accumulated and given out voluntarily by the 
 torpedo and gymnotus electricus ; that an electric shock will frequently stimulate 
 into motion a paralytic limb ; and, lastly, that it needs no perceptible tubes to 
 convey it, this opinion seems not without probability ; and the singular figure of 
 the brain and nervous system seems well adapted to distribute it over every part 
 of the body." 
 
 Darnin's Zoonomia, vol. i. p. 10. 
 
29 
 
 to do, upon the mechanical supposition of tremors and oscil- 
 lations, which were excited by the impressing cause, and pro- 
 pagated along the whole course of the nerve. Much time was 
 spent in examining the fibres of the nerves, and their direc- 
 tion; nor is there almost any course or direction which was 
 not attributed to them.* 
 
 Another set of physiologists united the two theories, and 
 admitted both the existence of a nervous fluid, and the action 
 of tremors.f 
 
 Concerning the absurdity of all these opinions, I think it 
 unnecessary to make any observation. The doctrines sur- 
 vived, for only a very little time, their inventors ; and th& 
 more intelligent part of investigators soon came to confess 
 their ignorance of the nature of this principle. 
 
 If the notions which the older physicians entertained con- 
 cerning the nature of the nervous energy were erroneous, we 
 are not to expect that their explanation of its operation, or 
 their application of their knowledge to the cure of diseases. 
 should be more perfect. Their systems were full of quick 
 motions and £ slow motions of the nervous spirit, and tensions. 
 and contractions, and relaxations of the nerves themselves, 
 and fermentations, explosions, impulses, and pre-established 
 harmonies. We may wonder how this could be suffered by 
 men of sense, or how they could possibly explain diseases oc 
 
 * Some supposed that the nerve consisted of spiral fibres, which could shorten 
 and elongate ; others, that it had rugae, which might be made greater or smaller ; 
 and that on this depended the action of the nerves. Whenever the nerve was 
 tight, than the sensation was acute ; and vice versa. 
 
 f This opinion has been in part revived by Dr. Darwin, who supposes that the 
 vital spirit produces motions or contractions ; and builds his theory on the differ- 
 ent kinds of motion. 
 
 t Part of the nervous spirit was, in their opinion, exhaled into the cavities 
 of the body, or, by insensible transpiration, from the body ; the rest was re- 
 turned from the nerves, by the veins, to the heart, and sent from thence to 
 the brain. Others supposed, that it passed into glands, or was condensed into 
 lyniph, and thus returned to the head through the medium of the heart. See 
 the Works of Regius, Segerus, Gavet, Lancui, Targirus, &c. 
 
30 
 
 these principles ; but the wonder ceases, when we know that 
 the j founded their system of pathology more on the blood 
 and imaginary humours, than on the nerves : their doctrines 
 were either chemical or mechanical, and they knew nothing 
 of the peculiar and varied action of the nervous system. 
 
 Concerning the true and precise nature of the nervous 
 energy, nothing ever can be said ; because it never can come 
 under the cognizance of our senses; and even concerning its 
 production and operations a very great deal is conjectural. 
 We know, however, that there is such a principle, and that 
 this principle, by the application of certain stimuli, exhibits 
 certain actions or operations which are essential to life, and in 
 which it consists. These actions, in the aggregate, may be 
 called the natural and healthy action* of the system ; and the 
 presence of this action is absolutely requisite for the continu- 
 ance and support of the energy ;f for, whenever the action 
 becomes changed, either in degree or nature, weakness is the 
 consequence ; and this weakness is proportioned to the differ- 
 ence betwixt the diseased and natural action of the system. 
 
 * It is not easy to give such a definition of the natural actions as shall not be 
 liable to be misunderstood. It does not consist of digestion, secretion, kc. con- 
 sidered as a group of separate and distict functions, but in a peculiar inde- 
 scribable condition, which exists in health, and of which these operations are 
 effects, rather than parts : still, as the right performance of all these functions 
 depends upon the natural and healthy action of the system, these, taken col- 
 lectively, may give some idea of this action. Part of the natural action con- 
 sists in the renewing or producing of the nervous energy, which is to be con- 
 sidered as a species of secretion. 
 
 + It may be said, in objection to the supposition that the renewal of the en- 
 ergy is an immediate and direct effect of the natural action, and flows neces- 
 sarily from it, that, were this the case, an increase of the natural action should 
 not produce weakness in the end. But this idea proceeds from not rightly 
 understanding the natural action, which is not a distinct assemblage of func- 
 tions, but a general and peculiar condition, of which these functions make a 
 part , and, therefore, although an increase of a particular function, such as 
 muscular motion, does expend more energy than is produced, and consequent- 
 ly weakens, yet a general increase of natural action, if it be not to such a 
 degree as to change its nature, and thus impair it, does augment the quantity d 
 -.nepgy, and produces strength ; if it be changed, then it weakens. 
 
31 
 
 The brain has, by almost every physiologist, been consi- 
 dered as the preparer and source of this energy ; and, even 
 in the present day, is ranked amongst the secreting glands. 
 That this energy exists in the brain and nerves, and that it 
 exists in greater and less quantity, at different times, is un- 
 doubted. The embryo contains less energy than the child, 
 and the child much less than the adult. He who is reduced, 
 by abstinence and long sickness, has much less energy than 
 the healthy and robust man. These facts require no proof; 
 for the imbecility of the natural action of those people, and 
 their inability to support disease, proves it beyond doubt.* 
 it is necessary, however, here to remark, what will be after- 
 wards more folly explained, that we are not to confound an 
 appearance or feeling of weakness with real and absolute di- 
 minution of energy ;f because certain temporary morbid ac- 
 tions may take place, which, by their diminution of the na- 
 tural action, for a time, give the appearance of weakness. 
 This proceeds sometimes from a simple diminution or sus- 
 pension of natural action ; at other times, from the energy 
 
 * It is likewise certain, that particular parts of the body have less energy 
 than others, and, consequently, less action. A part is only capable of acting 
 by means of its energy ; and the degree of the one must always correspond to 
 that of the other. The capability of supporting disease is proportionate to the 
 strength or degree of natural action; hence children bear disease worse lha» 
 adults, and weakened parts worse than those which are strong ; at the same 
 time, we cannot expect to see the diseased action so great in them as in the 
 strong, although it is such as to destroy them ; because the energy which is to 
 support it is less. Still, although it be not considered as absolutely a9 strong 
 or great, yet, relatively considered with regard to the power, it is greater. 
 
 f Whenever the natural action is lessened, weakness is felt ; and this is more 
 observable, in proportion as the diminution is sudden. Emotions of the mind, 
 and many other causes, by lessening suddenly the natural action of the sys 
 tem, produce syncope ; but, in a few minutes, the person is often as strong a* 
 ever. Here we cannot suppose a sudden loss and restoration of energy ; it was 
 only the action which was affected; but, had this action continued for any 
 considerable time, then real lo»s of energy would have followed, upon the prind- 
 nlea already laid down 
 
32 
 
 being employed in an action dissimilar to the healthy one. 
 At the same time, if this action does continue for any con- 
 siderable time, real diminution of energy will take place ; be- 
 cause a certain action is necessary for the support of the en- 
 ergy ; and, in health, this action always bears an exact pro- 
 portion to the degree of energy. The action of the energy 
 is often very suddenly lessened, in which case, weakness or 
 syncope is the consequence ; and often it is as suddenly re- 
 stored, in which case our strength returns. Energy may be 
 suddenly lessened, but it never can be suddenly restored. 
 
 This energy is not produced in consequence of the strucr 
 ture of the nerve, or by any power proper to the nerve, and 
 necessarily connected with a medullary texture. If it de- 
 pended on structure alone, man should live as long as his fa- 
 bric remained unimpaired ; and if it depended on any pecu- 
 liar power of the nerves, distinct from the action of the energy 
 itself, we must acknowledge a new principle ; we must ob- 
 serve its operations, and ascertain what causes influence it, 
 which will only multiply difficulties. 
 
 It may perhaps be supposed, that the energy remains al- 
 most always the same, and that its action or operation only 
 changes ; but, in this case, whenever any action ceased or 
 decreased, the quantity of energy should accumulate, which 
 is an absurd idea. . Some suppose an accumulation of the 
 living principle ; but the idea is ridiculous ; for energy can 
 never exist without action. Action requires energy ; it con- 
 sumes the energy, which must be replaced. If this were 
 not the case, we need only excite the action by stimuli, and 
 life should go on. As long as the blood circulated, action 
 and life should be kept up, even without food. Death indeed 
 would at last take place, from want of materials to supply the 
 body, considered mechanically ; but still the man should live 
 for a long time, and until he consisted of little else than bones, 
 nerves, and vessels. Man might, upon this supposition, be 
 rendered immortal. 
 
33 
 
 Of the Blood. 
 
 For the support and production of the nervous energy, a 
 certain substance, namely, arterial blood, is requisite. This 
 fluid, by its circulation, not only acts as a natural stimulus to 
 the nerve, exciting and supporting its action, and thus ena- 
 bling the energy to subsist, but it also affords the materials 
 from which the energy is drawn. It was formerly mention- 
 ed, that there is nothing which can be called truly dead ; 
 that a vital principle pervades every substance, and extends 
 its influence over the whole universe. This principle, it was 
 mentioned, exists, in different degrees of delicacy, in the 
 different classes of nature, and exhibits a regular gradation of 
 perfection, in the different individuals. Common matter pos- 
 sesses a peculiar kind of life : When this matter is taken into 
 the vegetable, not only its organization, but also its life, is 
 changed, and we observe a very different appearance, both in 
 the mechanical and vital system ; but, when the vegetable is 
 destroyed, then it becomes again, both in its substance and 
 life, the same with common matter. When the vegetable is 
 taken into the animal system, we likewise find a change, both 
 in life and texture. We have then a certain gradation, which 
 remains uniform ; the material part of the one class forms the 
 material part of the other, and the vital principle of the one 
 forms the vital influence of the other.* This change uni- 
 formly begins in the fluids. In the vegetables, the sap, and 
 in animals, the chyle, which forms the blood, is the first step 
 towards the change of life. These substances consist of mat- 
 ter, having a life proper to itself, differing as much from the 
 active principle of common matter, as it does from the pecu- 
 
 * It must here be observed, that there is a material distinction betwixt life and 
 soul, or mind : They differ fisserttially in their nature and operations. 
 vol. r. v 
 
34 
 
 liar life of the individual, considered as an organized body, 
 and a whole. 
 
 From the blood is formed the material part of the animal, 
 and likewise its life, or nervous energy. Neither the mate- 
 rial part of vegetables can be converted directly into animal 
 substance, nor their vital principle into nervous energy : 
 There must be intermediate steps, and these are the chyle 
 and blood. Vegetables, when alive, differ from animals, in 
 composition, in organization, and in the qualities of their life. 
 When taken into the stomach, and in a state of digestion, 
 they differ from animal substances, in the same circumstances ; 
 but, when the living power of the animal has begun to operate 
 in the formation of chyle, the distinction no longer subsists, 
 at least to the same extent. A new substance is formed, 
 and from this another, which is the blood ; and from this an 
 organized substance results, possessed of a more intricate 
 structure, and a higher species of life.* 
 
 Besides this source of the living principle, arising from the 
 conversion of food into blood, and the consequent change of 
 the one kind of life into the other, the blood likewise derives 
 vitality from the air, during respiration. It may be consider- 
 ed as a fact, that whenever matter becomes part of a vegetable 
 or animal, its active principle likewise becomes changed or 
 elevated into the specific life of the individual of which it be- 
 comes a part. Now, we know that, in the course of 24 
 hours, about 8640 cubic inches of oxygenf are combined 
 
 * Every part of the body dies, and rs replaced. If even a small part be re- 
 moved, it is reproduced, and the new matter possesses the properties of the old 
 The nerves themselves, if divided, will unite; and the uniting substance is, to aH 
 intents and purposes, nerve. See Dr. Haighton's Paper in the Phil. Trans, on the 
 Reproduction of Nerves. 
 
 f It is computed by chemists, that, besides the portion of oxygen, which com- 
 bines with the carbone and hydrogen, in respiration, 360 cubic inches of that air 
 disappear in an hour. This oxygen changes its state in the blood ; for I know of 
 no experiment which proves, that it is found in a gaseous state in the blood. This 
 opinion, of respiration being subservient to the production of vitality, is also 
 adopted, in one respect, by Dr. Darwin, who supposes, that an ethereal fluid i* 
 
35 
 
 with the blood, and become a constituent part of it, which 
 affords a very abundant supply of vitality. The constant 
 action of the system requires a much more frequent renewal 
 of life, than we can suppose to be yielded by the food, when 
 converted into chyle and blood. We likewise find, that, in 
 many diseases, no food, or almost none, is taken into the sto- 
 mach, for weeks, although the action of the system be very 
 great.* Respiration is a constant and uniform source, from 
 which the expenditure of energy can be, in some respect, 
 supplied ; because the active principle, in oxygen, is thus 
 conveyed to the blood, during its combination with that 
 fluid ; but respiration alone, without food, is not adequate to 
 the necessities of man, both because the life thus attained is 
 not equivalent to the demand, and also because the materials 
 of nourishment are withheld. The vitality yielded by the 
 food is, if I may so speak, more permanent, and is united 
 with the structure of the body, when the deposition of new 
 matter is made by the blood. The vitality furnished by the 
 air seems to be yielded to the nerves, during the course of cir- 
 culation, for the immediate performance of the actions of the 
 system. 
 
 As the elevation of life, or the conversion of the lower 
 into the higher, begins in a fluid state, so also does its des- 
 cent. The solid parts of animals are continually changing 
 into a fluid or lymph, which is thrown out of the body,f as 
 
 yielded by the air to the blood, and secreted from it again by the brain. 
 Zoonomia, Vol. 1. p. 471. 
 
 * The drink used during illness, may reasonably be supposed to assist in the pro- 
 duction of vitality; but it cannot of itself yield enough. By being long boiled 
 with a little farinaceous substance, water yields more nourishment, and more life, 
 than either it or the farina would do separately and unboiled j but, in sickness, it 
 is not employed in this form. See Goun,t Rumford's Essays. 
 
 f This lymph is, along with the chyle, poured, by a common trunk, into the 
 subclavian vein. It is then, after passing through the lungs, circulated along the 
 body, and is, most probably, the substance from which the different excretions are 
 formed : It is thus thrown out of the body, and begins to assume new states and 
 conditions, and to answer other purposes, in the general and extensive operations 
 of nature, 
 
36 
 
 unfit again to become organized animal substance, until it has 
 undergone new changes, and been converted either into vege- 
 table matter, or animal substance of a lower degree. Even the 
 nerves themselves terminate directly in a soft and fluid mat- 
 ter ; and perhaps it is only when the nervous energy is leav- 
 ing the body, that it is capable of action ; at least, we find, 
 that action is uniformly attended with an expenditure of 
 energy ; and the greater the action, the more speedy is the 
 loss of energy : We likewise know, that it is only the ex- 
 tremities of nerves which act. 
 
 I have said, that for the production of this energy, and the 
 support of its action, the presence of arterial blood is neces- 
 sary. This is one of the natural stimuli to the system, and 
 excites those operations of the nervous energy which are ne- 
 cessary for life, and which, in the aggregate, are called the 
 natural action. This action is, in common language, called 
 life,* whilst the energy which produces it, being unseen, is 
 overlooked. The continuance and presence of this action, is 
 necessary for the preservation of the energy in the body, and 
 for its production. Arterial blood, then, is of the utmost im- 
 portance, as it not only affords the material from which life is 
 drawn, but also is one great cause or exciter of that series of 
 operations, which are necessary for the renewal of the ener- 
 gy, and its preservation in the system. 
 
 This fluid has, at all times, received particular attention 
 from physicians, and its composition has been examined with 
 more accuracy than perhaps was necessary for the practice 
 of physic. But, as formerly the systems of pathology were 
 founded almost entirely on the different states, real or sup- 
 posed, of the blood, we cannot wonder at the attention which 
 was paid to it. Notwithstanding the many observations which 
 
 * This expression came to be used, from observing, that whenever this action 
 ceased, the body was dead. In the same way, we apply the word heat to the 
 sensation or action which it produces, oftener than to the principle which causes 
 it, which of itself is not hot. 
 
37 
 
 were made upon this fluid, and the various opinions whit li 
 have prevailed concerning it, it is only of late that i( has been 
 supposed to differ from common matter, or to possess any 
 living principle. 
 
 Mr. Hunter, who was the first who taught that the blood 
 was alive, founded his opinion, not upon general reasonings on 
 the nature and extensive operations of a living principle, or up- 
 on the necessity of the thing, but upon the observation of cer- 
 tain particular phenomena, and especially on the coagulation 
 of the blood. This living principle he supposes to be the 
 with that of the rest of the body, and that something similar 
 to the brain is distributed through the blood,* which he calls 
 the diffused matter of life. This conjecture cannot be ad- 
 mitted ; because, in the first place, it supposes, that life de 
 pends upon a particular substance or species of matter; and, 
 in the second, we cannot see how, or by what power, this sub- 
 stance is to be formed in the blood. I have already mention- 
 ed my idea of life, and its gradation ; and also, that the blood 
 seems, in a perfect animal, to be the first step toward the 
 conversion of common and vegetable matter into a substance 
 possessed of animal life ; but that this life differs as much 
 from the peculiar life of the animal, as it does from that of 
 the matter from which it is formed. Blood is to be consider- 
 
 * « J would consider, that something similar to the subrtnnce of the brain ii 
 diffused through the body, and even contained in the blood, and between this and 
 the brain the communication is kept up by nerves." Hunter on the Blood and 
 Inflammation, p. 89. — Are we then to consider that the brain is a mass of life, 
 and that a similar matter is diffused over every part of the body, and floats in the 
 blood; that the nerves are quite different in their nature from the brain, and con- 
 sist of different materials, and are endowed with a different and distinct power or 
 principle, acting merely as connecting lines betwixt the life of the brain and the 
 life of the body, or literally as chordae internuntise ? Does life indispensably re- 
 quire, for its presence and existence, something similar to the substance of the 
 brain p and does it exist wherever this medulla is to be found :' Do we observe any 
 thing like this in plants? Do we see it in muscles, in ligaments, in bones ? or h:n 
 it ever been detected in the blood ? Vitality may exist in substances, with very 
 different structures and organization; and I have already mentioned, that the 
 living principle itself Varies very much in different individuals and classes. 
 
38 
 
 ed, in one respect, as extraneous to the body, operating and 
 exciting to action as an extraneous body, and yet possessed 
 of powers which show it to be endowed with a peculiar life. 
 We are to consider it in Iwo views ; first, absolutely, as a 
 fiving animal substance, having peculiar properties, and con- 
 sisting of different parts, kept together by life, and separat- 
 ing, when dead or dying : Second, relatively, as the source 
 of increase and nutrition, and as making a part of the animal 
 body, acting upon it as a stimulus, and being itself acted upon 
 by the vessels which contain it. This reciprocal action and 
 reaction is absolutely necessary for the preservation of each; 
 for, if either fail, both die. As long as the blood is alive and 
 perfect, it produces the life of the animal, and supports its 
 action ; and, as long as the animal and its vessels are living 
 and healthy, the blood is kept perfect and alive. When the 
 animal becomes diseased, the life of the blood becomes also 
 affected, and its peculiar quality is injured. The proper cha- 
 racteristic of blood, considered absolutely as a living sub- 
 stance, is its tendency to become solid, or coagulate. If its 
 vitality be not previously injured, it uniformly becomes firm, 
 and its parts separate, as soon as it is removed from the ac- 
 tion of the vessels ; and, whenever this coagulation takes 
 place, it ceases to be blood ; it dies. Mr. Hunter supposes, 
 that this coagulation is to serve a useful purpose with regard 
 to the body, and particularly, lhat it becomes the means of 
 nourishment : But nourishment and increase depend upon a 
 much nicer process ; and coagulation never can, and never 
 does, serve any useful purpose, otherwise than mechanically' 
 stopping a hemorrhage ; in which case, it is precisely similar 
 to any other dead body ; and, whenever coagulation does take 
 place, it becomes absolutely useless to the animal, in any 
 other point of view, and can no more serve the purposes of 
 blood, than the curd of milk can. Mr. Hunter, however, is 
 of a very different opinion ; for he believes, that the coagu 
 
39 
 
 lum is still alive, and possessed of the power of action within 
 itself; that it can form vessels, unite itself to the surrounding 
 parts, and assifme actions and appearances according to the 
 nature of the surrounding parts. " The moment it is at rest, 
 (says he,) it begins to form itself into a solid, and changes in- 
 to this or that particular kind of substance, according to the 
 stimulus of the surrounding parts, which excite this coagulum 
 into action, and make it form within itself, blood-vessels, 
 nerves,"* &c. If this were the case, an aneurism ought 
 never to burst ; because, when the blood coagulates, the old 
 coat of the vessels ought to assimilate it into a new one. 
 Every observation confirms the opinion, that, when the blood 
 coagulates, it dies ; but how or why it does coagulate, never 
 can be ascertained, more than how or why other actions are 
 performed, the utility of which we do not clearly discern. 
 Arterial blood coagulates rapidly, and into a mass : Veinous 
 blood coagulates slower ; the serum separates freely, but the 
 red globules are mixed with the lymph. In some diseases, it 
 is still slower, and a buffy crust is formed from the separation 
 of the globules. In others, it never takes place ; the blood, 
 from the action of the body, being almost deprived of its vi 
 tality, before it can come into a state of rest. This we see in 
 the effects of great fatigue, lightning, poisons, bad fevers, .S:c 
 The complexity of the vascular system appears, in every 
 animal, to be proportioned to the perfection of the nervous 
 system ; and the purity of the blood uniformly corresponds to 
 the delicacy of the living principle. It would be useless here 
 to mention all the mechanical variations which take place in 
 the heart and vessels of different animals : It will be sufficient 
 to observe the particular conformation which affects the puri 
 ty of the blood. In every animal, where the living principle 
 is naturally of a low degree, (by which I mean, of a kind inca- 
 pable of exhibiting the actions of an animal, in the perfect 
 
 * Hunter on the Blood, &c. p. 86. 
 
40 
 
 manner in which they are performed in man,) the blood i* 
 impure. 
 
 In the frog, we find a hearl, consisting of one auricle and 
 one ventricle : The blood, being returned from the body by 
 the veins, goes into the auricle, and from thence into the ven- 
 tricle: This sends out a large trunk, which soon divides into 
 two : These again, shortly after the first division, subdivide 
 into other two branches : One of these branches, on each side, 
 goes to the lungs, and the other turns down, to join Avith the 
 one arising from the other side : These last uniting, form a 
 large aorta : The branches, which are distributed on the lungs, 
 or bladders of air, carry their blood thither, from which it is 
 returned into the auricle. But I have already said, that all the 
 veinous blood from the body was also returned to the auricle : 
 There must, therefore, be in the heart a mixture of arterial 
 blood from Ihe lungs, and veinous blood from the body; and 
 it is this impure blood which circulates in the arteries, and 
 supplies the body. 
 
 In the turtle, we have distinctly two auricles and two ven- 
 tricles, forming a double heart, similar, in this respect, to the 
 heart of man ; but, as these two ventricles communicate by a 
 hole in their septum, they are to be, in reality, considered 
 only as one cavity. From the right ventricle, or, more pro- 
 perly speaking, the right side of the joined ventricle, arise the 
 aorta and pulmonary artery ; the one supplying the body, 
 the other running directly to the lungs, from which the blood 
 is returned, by the pulmonary vein, into the left auricle ; 
 from this it is sent into the left ventricle, and thence, through 
 the hole in its septum, into the right ventricle ; so that, set- 
 ting aside all this round-about course, we may say, that the 
 blood is returned from the lungs into the right ventricle. The 
 blood, again, which is sent out by the aorta, is returned, by 
 the vena cava, into the right auricle, and from this into the 
 tight ventricle, Avhere it meets with the blood from the lungs. 
 
41 
 
 There is, then, a mixture of veinous and arterial blood in the 
 turtle, just as in the frog ; and this mixture is sent again, in 
 part, through the lungs, and the rest through the body. 
 
 In the crocodile, the same happens ; only, the two ventri- 
 cles have no septum, but form one bag, without any division. 
 
 The consequence of this construction, in these animals, is, 
 that the blood, which is sent to the lungs, is never entirely 
 veinous, but partly veinous and partly arterial, by which the 
 supply of air will last longer, and the animal require to breathe 
 less frequently. But, secondly, the effect of this construc- 
 tion, and the consequent impurity of the blood upon the sys- 
 tem, is, that the life of the animal is of a less delicate nature, 
 than that of those animals, where the blood is pure : Their 
 action is not raised to such a degree, as in the higher classes; 
 and all the operations of their system are of a lower nature. 
 This, which is an imperfection in one sense, is, however, a 
 degree of perfection, greater than We find in man, if we view 
 life only with regard to its preservative powers ; for those 
 animals, whose life is of so low a kind, that it is not suscepti- 
 ble of quick actions, are a long time of being destroyed, by 
 such causes as would instantaneously kill any of the higher 
 classes : We may remove their brain, and thus materially in- 
 jure that system, in which the specific life is resident; we 
 may cut out the heart, and thus destroy the circulation ; or, 
 We may prevent the purification of the blood, by removing or 
 cutting up the lungs ; and yet the animal, under any or all 
 of these causes, will continue to live for many hours, some- 
 times for months. 
 
 Where the life is of the highest kind, but its quantity na- 
 tuially small, and the action required, at a particular time, is 
 very little, we likewise find the blood impure. This we see 
 to be the case in the fetus in utero, where the action required 
 is very trifling, and where the heat produced* (which gene- 
 
 * As the foetus is placed in a medium as warm as itself, very little heat is ne- 
 cessary to be produced, in order to keep it at its proper standard. 
 VOL. I. F 
 
42 
 
 rally bears a proportion to the natural purity of the blood) i» 
 little. 
 
 In the child in utero, *" the blood is received pure from 
 the placenta by the umbilical vein, and is conveyed by it to 
 the navel of the child. Here the vein enters, and passes in- 
 to the liver, dividing in it into many branches, which ramify 
 through the substance of that gland, whilst the continuation of 
 the trunk runs forward, and terminates in one of the branches 
 of the vena ports. Thus, we find, that one portion of the 
 pure blood of the umbilical vein is distributed to the liver, 
 whilst the rest is sent directly to the right auricle of the 
 heart ; but, previously, it is mixed in its passage with the 
 impure blood in the vena portae and vena cava. 
 
 " There is, then, by this contrivance, a mixed blood in the 
 right side of the heart, which is purer than the veinous blood 
 of the foetus, but much less arterial than the blood of the arte- 
 ries after birth ; from which we may infer, that a very great 
 change takes place in the system and constitution of the child 
 after delivery. When the right ventricle contracts, the blood 
 is not sent through the lungs, as it is after birth, but directly 
 into the aorta, at its curvature, by a vessel running from the 
 pulmonary artery into the aorta. By thi3 construction, we 
 see that very little blood should enter the left auricle ; and, 
 consequently, that the whole left side of the heart should be 
 almost empty. But, to prevent this circumstance from hap- 
 pening, we find an opening or valve in the septum, betwixt 
 the auricles of the heart, which permits the blood to flow from 
 the right to the left side directly, and then the whole heart is 
 equally filled. It is for preserving the heart in a state fit for 
 acting after birth, that we have both a foramen ovale, an^ a 
 ductus arteriosus. Either of these, individually, would have 
 served the immediate purposes of the foetal circulation : but, 
 
 * Anatomy of the Gravid Uterus, p. 135. et seq. 
 
43 
 
 by thus dividing the blood, both the pulmonary artery and 
 the left side of the heart are kept of a proper size, and in a due 
 state of action.* 
 
 " By the aorta, this semi-arterialized blood is distributed 
 to the body ; but, instead of the whole blood in the descend- 
 ing aorta being conveyed to the viscera and inferior extremi- 
 ties, one half of it is sent directly to the placenta ; for the in- 
 ternal iliac arteries turn upward to the navel, through which 
 they pass, and form the two umbilical arteries. The blood, 
 therefore, which is returned to the placenta, is as pure as that 
 which circulates in the arteries of the child, and, therefore, 
 requires a less change to convert it into the state in which we 
 find it in the umbilical vein." 
 
 If, by any means, the blood be not sufficiently purified, or, 
 in other words, if it do not possess, to a sufficient degree, the 
 properties of blood, we find, that the powers of life are small, 
 the actions of the whole system are imperfectly carried on, and 
 the individual sinks prematurely into the grave. When, as 
 has been already mentioned, the adult heart remains in the 
 same state with that of the fetus ; when the pulmonary arte- 
 ry is deficient ; when the two ventricles communicate, and 
 the aorta arises from each ; or, when the lungs themselves are 
 injured, or ill formed, then the most distressing symptoms 
 
 * " The use of the sides of the heart is, in one respect, the reverse in th e 
 foetus of what it is after birth* In the foetus, the right side receives the purest 
 blood, whilst the left receives it after birth. In the adult, the blood which hin a 
 r state fit for circulation, is collected in the left side ; and therefore, the great artery 
 of the body arises from that side. On this account, there must of necessity be a 
 communication betwixt the aorta and the right side of the foetus, which performs 
 the functions of the left side of the adult heart. If thi3 communication does not 
 close up after birth, then the contents of the right side continue still to be sent in- 
 to the aorta. But as the quality of the blood of the right side is now materially 
 different, very different consequences take place from those which resulted from 
 the same mechanism before birth. The whole blood of the body is now rendered 
 impure, the purposes of circulation are only half performed, and the unfortunate 
 individual drags on a most miserable existence, until he sinks prematurely info 
 the grave. One man, from whom I procured a preparation of this kind of heait. 
 iived this unhappy life for forty years." 
 
44 
 
 lake place ; distressing, on account of the general condition 
 of the system, but still more painful, from the local affection 
 produced in the chest. The effect, however, of the want of 
 arterial blood, is more immediately seen in cases of suspend- 
 ed respiration. In hanging or drowning, death is produced 
 by the want of arterial blood ; and the universal method of 
 cure has been, to attempt the restoration of respiration, al- 
 though this has not always been done upon the true principle. 
 By inflating the lungs, respiration is often restored, but it also 
 very frequently fails ; because the mere blowing in of ail- 
 neither infallibly excites the action of the lungs, nor does it, 
 as some suppose, change the blood; for this change is an ac- 
 tion dependent on life, and cannot be imitated by the chemist 
 more than digestion. The alteration of the blood does not 
 depend, as many imagine, merely on the presence of air ; a 
 peculiar action of the lungs, or their vessels, also is necessary. 
 Food and air are to be considered in the same light, both 
 oniy supplying materials for the system to act on, and not 
 themselves acting independently of the animal. When in- 
 flating the lungs does not very speedily restore their action, 
 and consequently the change of the blood, we ought to trans- 
 fuse arterial blood from another animal, and thus reduce the 
 person to the state of the fcetus, whose blood is purified by 
 lungs out of the body. 
 
 Of the Putee. 
 
 I have said, that it is the pure or arterial blood alone, 
 which is valuable to the system, considered as a whole, and 
 which preserves the life, and yields the nourishment of the 
 body. This is sent out from the heart, as a source to all the 
 different parts of the body, by regular and continued contrac- 
 tions of the heart and arteries, and is returned by the gentler 
 action of the veins. These contractions depend upon the 
 
45 
 
 living principle, connected with the muscular coats, and must 
 be influenced, in their frequency and force, by the state or 
 action of the energy of the system in general, with which they 
 sympathize in a very great degree.* 
 
 The nervous and vascular system mutually react on each 
 other ; and, therefore, we find it of use, in disease, to attend 
 to the state of the vessels ; because, as the changes induced 
 on them are some of them of a mechanical nature, we can 
 more easily detect them than the nicer alterations in the ac- 
 tion of the nervous system, were we to confine our attention 
 to that system alone. The state of the pulse, then, is of im- 
 portance to be attended to, and will lead us to ascertain the 
 presence, and sometimes the nature, of many morbid actions 
 and deviations. 
 
 There are several parts of the vascular system, by the ac- 
 tion of which, individually, the pulse may be affected. The 
 heart, and great artery, the smaller arteries, and the veins, 
 all influence the pulse ; and it is easy to ascertain to what 
 degree any of these parts operate. 
 
 The heart is the origin of motion, and gives to the pulse 
 its particular feeling, with respect to motion, such as regulari- 
 ty, frequency, slowness, intermission, fluttering, Scc.-f 
 
 * Many disputes have taken place concerning the action of the heart ; some 
 referring it to the influence of the nerves, and others of a vis insita. If I nave been 
 right in my position, that the energy is universally diffused and inherent in every 
 part of the nervous system, I apprehend that the arguments in support of the ex- 
 istence of a vis insita will not have much weight. This controversy is to be found 
 stated in Haller's Elementa Physiologiae, tome I. 
 
 Praxagorus referred it to a vis pulsitica, or peculiar pulsatory power ; others to 
 an innate heat, which rarified the blood, whilst the air cooled it, and that this al- 
 ternate operation produced pulsation ; others ascribed it to fermentation. 
 
 f These particular states of the pulse always depend upon the heart. In all in- 
 creased actions of the living principle, the heart is affected, and contracts oftener. 
 In all instances where the heart is affected locally, we have irregular contractions 
 or intermissions, as we find to be the case in spasmodic affections of the heart, or 
 its great vessels, malconformation of the heart, diseases of the aorta, or pulmona- 
 system, &c. 
 
46 
 
 The arteries act partly by their elasticity, and partly by 
 their muscular power : The muscular power is greatest in 
 the smaller arteries, and the elasticity in the larger ; the 
 one diminishing as the other increases : The aorta is the 
 most elastic, and the least muscular ; and, therefore, its 
 action depends chiefly upon that of the heart, to which 
 it is to be considered as an appendage : The action of 
 the smaller arteries, again, depends much upon their own 
 contracting power ; but not entirely on this ; for the elas- 
 ticity of their coats likewise operates, unless the artery be 
 very small, in which case it has no elasticity. 
 
 There are, then, in the arteries of the arm, for instance, 
 two causes, operating in producing and influencing the pulse : 
 First, the elasticity of the artery; and this cause is affected 
 by the heart : Second, the muscular contraction of their 
 coats ; and this is affected only by their own condition, inde- 
 pendently of the force of the heart. As the heart, then, 
 gives to the pulse its particular feeling, with respect to motion, 
 so does the contraction of the artery give to it the particular 
 feeling, with regard to size and quickness of contraction, pro- 
 ducing the conditions of fulness, smallness, hardness, soft- 
 ness, &c. 
 
 The veins, like the arteries, act partly by elasticity, and 
 partly by muscular contraction ; but the order is reversed in 
 them ; for the greatest veins seem to have most muscular ac- 
 tion, whilst the small ones have none, or almost none. 
 
 The auricles of the heart belong to the veinous system, 
 and the ventricles to the arterial. The action of these two 
 parts of the heart is alternate ; and, therefore, the action of 
 the arteries and the veins is likewise alternate^ the one dila- 
 ting, whilst the other contracts. In health, the action of the 
 veins and arteries correspond exactly, and a regular and equa- 
 ble circulation of the blood is kept up ; but, in disease, they 
 often disagree, at least in the commencement of the diseased 
 
47 
 
 action ; for the veins are less irritable than the arteries, and 
 are longer of being affected.* 
 
 There are, then, three causes which affect the pulse ; and, 
 by attending to the state of the vascular system, we may as- 
 certain the proportion in which these operate, in any particu- 
 lar case : First, the heart and aorta ; second, the branches 
 of the aorta, or arteries of the body ; third, the veinous sys- 
 tem. 
 
 A healthy pulse contracts slowly and regularly, and the 
 pulsations do not exceed about seventy in the minute : We 
 feel the artery rising softly against the finger, with a moderate 
 degree of fulness. In disease, the pulse becomes either 
 slower, or more frequent, full, small, hard, weak, or strong.f 
 
 * External heat, and many other agents, induce a fulness of the veins for a 
 lime, until the equilibrium be restored ; and, in many instances, we feel the acoi- 
 inulation of blood in the larger and internal veins. This state is often attended 
 with a small quick pulse, marking a contracted state of the arterial system. The 
 skin is pale, and the body often appears to be shrunk, as we see in the commence- 
 ment of febrile diseases. 
 
 f Practical writers have admitted of an almost infinite variety of pulses, which 
 .ire now believed to be, in a great degree, imaginary, and therefore are overlook- 
 ed. As a specimen of this, I shall only subjoin an extraet from the Compend. 
 Med. of De Gorter, who, although he enumerates many distinctions, which we 
 now set aside, yet has not given the third part of what many others mention. 
 
 " Si cor singulis ictibus majori vi contrahitur, sanguis celeriori impetu in latera 
 arteriarum ruens eas dilatat solito magis, qua? dilatatio digitis percepta, si non 
 multo major solito, robustus forluque pulsus dicitur et validus ; notans cordis vigo- 
 rem, et copiam sanguinis singulis ictibus ejecti : in morbis bonum praesagium, nisi 
 ob cerebrum compressum at in apoplectici3, et contusione cranii, animi deliquio 
 scorbuticorum, aut ob compressionem notabilem rami arteriosi hujusmodi fiat 
 pulsus. 
 
 " Vehemens autem pulsus, digitos veluti removens ab arteria, nee quiescens for- 
 tiori digitorum compressione, ut in sanis fieri solet, fortissimam cordis contractio- 
 nem, qua spiritus consumuntur, et motum humorura velocissimum solida destruen- 
 tem indicat. Omnia ergo mala, qua? ex his fieri solent, praesagit, et videri possuni 
 in aucta circulatione. In morbis acutis inflammatoriis et erysipelatosis ob- 
 servatur. 
 
 " Quando arteria iastar chorda? tensa? dura, contra digitos attollitur, Durvs 
 dicitur pulsus, fortem indicat arteria? impletionem, cum impedito transitu sangui- 
 nis per arteria? extrema, membranarum internarum, ut pleura?, et meniDgum, in- 
 flfenimrvtioDi comes. Si arterise simul constringuntur magis, est durus et parvus : 
 
48 
 
 These conditions it is impossible here fully to describe. I 
 shall, however, keeping the general observations already 
 
 alias dtirub et magnus, qui melior : prasagia ex inflammatione, febreque acuta 
 ardf-nte petenda. 
 
 " Si, lmo, cordis consti ictio imbecillis sit. It in cerebri coiupressione phreniti- 
 corum, lethargicorum, (Mirantiuiu, tttanieorura, soporosorum, vol ex defectu 
 spirituum in perinCi mis, morbid vehementissimis vires corporis superantibus. '2>lo, 
 Si intercipiatur fluxus sanguinis ad cor, ut in peripneumonia, tubevculo pulmonum, 
 pleuritide validissima, sufficientem pulmonis explicalione iuhibente ; vel per bepar 
 eo sc. obstrueto, aut iuflammato, vel nimia quanlitate sanguinis evacuala extra 
 corpus, vel collecta in cavis, aut vasis dilatatis, ut in hydropicis, empyricis : hu- 
 Bioris nimia evacuatione, a partu, ruptioneque vasorum interna. 3iio, Laxatus 
 tonus solidoruni in scorbuticis, hystericis, stomaclii debilitate laborantibus, rachi- 
 tide, in parte paralytica, leucophlegmaticis, doloribus flatulentis. 4to, Inflainraa- 
 tio et febris ardens, in gangraenara vel sphacelum abiens. 5to, In principio inva- 
 sionis febrium, pulsus minori vi digitos applicatos percutit et attollit, et a com- 
 pressicne eorum paulo mnjori omnino suffocari potest ; pulsus hie debilis dicitur a 
 Medkis. Quandoque talis videtur fieri, si multa pingucdiue vel tumore aquo9o 
 arteria tecta sit. Talis pulsus, quia arteria minus atlollitur, humilis; minus per- 
 cipi potest, obscurus; arteriam minus dilatat, cxilis, gj-acilis, exiguus, parvus; 
 minus implet, vacuus ; tandem in summo gradu deficiens et deletus dicitur, quorum 
 omnium cognitio et praedictio ex his clara. 
 
 " Alterum quod in singulis pulsibus animadvertitur, est celeritas et tarditas. 
 Celeritas pulsuum, quamvis a multis Celeritas cum frequentia confundatur, omnino 
 distinguenda videtur, intelligimus enim per celeritatem, si ab initio diiatationis 
 usque ad integram, et ab ea iterum ad quietem, minori temporis spatio peragitur, 
 quam in sanis pulsibus fieri debet; quod exploratione digitorum facile percipien- 
 dum. Si vires deticiunt cum humorum defectu, atque quodam stimulo irritante, 
 cor miniino momento, veluti ictitans, se contrahens, citissime dilatat arteriam 
 brevi tempore subsidentem. Ut plurimum in cholera, febre et temperamento bili- 
 oso, atque febre erysipelatosa obser/atur. Dicitur etiam velox et ictitans quan- 
 doque. 
 
 ** Huic opposilus est, qui vocatur tardus et lenius, in visciditate humorum fre- 
 quens observatur, ut in cachecticis, scorbuticis, leucophlegmaticis, quod ob san- 
 guinis lentorem longius tempus insumatur, antequam integre arteria impleri potest, 
 et cor evacuari. 
 
 " Cordis actio in pluribus pulsibus aut frequentius, aut rarius exercetur. Qua; 
 pulsationes inter unumquemque ictum brevius spatium temporis relinquunt, seu si 
 eodem temporis spatio sapius pulsant, pulsus dicitur frequens, a quibusdam celeris 
 et velox dictus, sed perperam, indicat cordis frequentiorcm contractionem. Quod 
 fit, lmo, ab irritatione phlogistica, ut in pleuritide, phrenitide, et membranarum 
 inflammatione, quando et frequens et durus. 2do, A materia acri biliosa, ut in 
 febribus biliosis et erysipelatosis et frequens et celer. 3tio, Defectu virium, ut in 
 principio jnvasionis febrium, et circa statum, quando pessimus, phthisiris, perinfir- 
 mis, et similibus et frequens et debilis; si vero, Ito, vires adaugeantur, ut ex usu 
 
49 
 
 made in remembrance, make one or two remarks upon some 
 particular states of the pulse. 
 
 Chalybis in chlorosi, singulis ictibus corde inajorem copiam sanguinis ejiciente, 
 pulsus fit frequentior et major. 
 
 " Huic contrarius est, qui longiori intervallo vibrat, rarus dictus, a multis etiam 
 lentus et tardus, quamvis talis ad praecedens genus potius pertineat. Blandum in- 
 dicat humorem, hoc si ex humorum optabili indole provenit, vasisque apertb, 
 magnitudine compensatur parvitas. Verum si ob visciditatem, cerebrum aut cere- 
 bellum obsessum tenentem, ut in pituitosis, leucophlegmaticis, catarrho suffocative), 
 syncope, et sopore, atque catalepsi laborantibus, fiat rarus et parvus aut debilis, 
 Eummum periculum imminet, totum cerebellum obstructum iri. 
 
 " Prater cuncta haec pulsuum genera, qui aequales dicuntur, aliud est quod inae- 
 quales continet, lmo, in unoquoque ictu, et 2do, in multis simul. Omnes hi pulsus 
 nunquam quidquam boni indicant, non semper tamen mortis indicium : quibus- 
 dam enim satis familiares, in pulmonum morbis et scorbuto frequentes, etin quibus 
 post mortem in corde polypus fuit inventus, aut pericardium cordi adnatum. 
 
 " Pulsus singulis ictibus inaequalis, tribus ad minimum digitis dignoscendus, et 
 qui cum aliqua duritie percipitur, serratus a Medicis dicitur. Indicat magnam 
 cordis constrictionem, et inaequalem et variis in partibus arteria; resistentiam. 
 Mem imo pejora, ut pulsus durus prasagit. 
 
 " Si satis magna sanguinis quantitas e corde pulsa arteriam non nimis resisten- 
 tem undas ad instar successive attollat, undosus vocatur : talis observatur in hu- 
 morum abundantia, morbisque acutiset inflammatoriis, si crisin per sudorem natu- 
 ral moliatur, et quando in suppurationem abeat; in morbis autem Chronicis mate- 
 riam alicubi harentem in sanguinem receptam esse indicat. 
 
 ** Si cor minori vigore contrahitur, et singulis ictibus insqualiter, minor quanti- 
 tas e corde in arterias mittitur, qua arteria successive attollitur, ac si vermis sub 
 digitis serperet, vermicular is pulsus dicitur. 
 
 " Qui minorem adhuc vim cordis, et quantitatem sanguinis indicat, simili modo 
 formicans appellatur. 
 
 " Sed vero qui versus cor magis : et versus extrema minus dilatatur, quod cor 
 non valeat, vel deficiat tantus liquor, ut tota arteria impleatur, (Auxgos , ex simili- 
 tudine caudas muris a veteribus dicitur. Qui omnes in omnibus morbis periculosi 
 sunt habendi pulsus. 
 
 " Qui pulsus plusquam semel videntur attolli, et digitos ferire, Dicroti vocantur 
 si simul debiles ; verum si magis robustus, Caprizans appellatur, raro nisi inperin* 
 firmis observatur, et agone mortis. 
 
 " Huic quoque referendus vacillans et tremens, inaequalem et inordinatam arte- 
 riarum impletionem indicans, ex denominatione facile definiendus; vires vitae 
 fragiles et caducas indicat. 
 
 " Inaequalium alterum genus duas continet species, lmo, Intermiltentem, qui 
 una alterave vice intercalatur seu deficit; in membranarum inflammatione gan«- 
 granam indicat, in acutis pessimus, in poeris vero dormientibus, plethoricis, seni- 
 bus, praesertim mulierculis familiaris, et quibus cor pericardio accretum est. 
 
 " 2do, Mvx'gov, qui singulis ictibus minor sentitur, ut in moribundis, quern ite- 
 rain ulteriussine necessitate in decurtatos, reciptocos, et recurrentes distmguunf-. 
 VOI,. I'. fi 
 
50 
 
 In all cases where the pulse becomes suddenly small, we 
 may infer, that the proper balance no longer exists betwixt 
 the veinous and arterial system, but that the one is acting 
 more than the other. We are not to infer from this state of 
 the pulse, any thing with regard to the quantity of blood iu 
 the system; nor are we to suppose, that the blood necessa- 
 rily circulates so fast through the lungs, as we would at first 
 suppose ; because, if there be an accumulation in the veinous 
 system, the same quantity will not pass through the lungs, at 
 each contraction of -the heart, as passed in health ; and, 
 therefore, more will not necessarily pass in a given time. 
 
 We are not always, from a small pulse, to infer, that the 
 person is very weak, and requires cordials. On the con- 
 trary, whenever this stale of the pulse is conjoined with a 
 hardness, we may pursue a contrary plan, and detract blood ; 
 because the smallness and hardness of the pulse depends upon 
 the complete contraction of the coats, and marks an action 
 very greatly increased, and which must soon kill, if it be not 
 checked. By opening a vein, we render the pulse slower, 
 softer, and fuller, as we see in abdominal inflammation. When- 
 ever there is an increased contractile power, producing hard- 
 
 " Mollis fit pulsus, lmo, si sufficienter non impleatur, defectu sanguinis, ut in 
 peripneumonia, aliisque pulinonum morbis, atque hepatitide, qui tunc semper 
 malus. 2do, Arteria nimis laxata, ut in scorbuto, leucophlegmatia, quando main*. 
 3tio, Minori intluxu spirituum, ut in quiete corporis et somno, bonum indicat ; sed 
 in sopore, cerebri oppressionem. 4to, Sedato impetu spirituum in fibras motrices, 
 cum corporis viribus auctis, et pulsus plenitudine, bonus in febribus. 
 
 " Quantitas humorum in corpore contenta, et singulis ictibus e corde in arteri- 
 am ejecta, pulsum magnum, ■plenum, altum, latum, manifestum exhibet, et palpi, 
 tntiouem. Qui boni, nisi fiant a nimia copia humorum, vel iinpedito transfluxu 
 spirituum per cerebrum, ut in apoplexia, lethargo, phrenitide : vel ab obstruction* 
 rami notabilis arteriffi. 
 
 " Sed singulis cordis ictibus minor quantitas in arterias derivata, pulsum par- 
 vum, vacuum, gracilem, obscurum, debilet*, et etiam dejicicntem, facit; hoc si fiat 
 defectu virium, ut in sphacelo, catarrho suffocativo, syncope, iiifirniilato, defectu 
 sanguiuis,valde malum: sed in obesis, arteria ran It a pinguedine tec 
 dicat." 
 
 J 
 
51 
 
 ness, we may infer the existence of an action, in some part 
 of the system, of an inflammatory nature, and will often be 
 led to bleed, from this mark alone, when, from other cir- 
 cumstances, we would deem venesection improper. 
 
 In general, the pulse is smaller and harder in inflammation, 
 in proportion as the system is affected ; and hence we may, 
 from its smallness, judge of the danger. In inflammation of 
 the lungs, we have seldom, except in robust and plethoric 
 people, a full pulse ; at least, if the inflammation be very 
 acute. In inflammation of the brain, the pulse is likewise 
 hard, and seldom full ; though the state of the pulse is not so 
 often uniform in phienitis ; for great variations take place in 
 this disease. In gastritis, the pulse is very small, and quick. 
 The same is the case in inflammation of the small intestines ; 
 but it is rather fuller, when the great intestines alone are af- 
 fected, and inflammation in them is not so dangerous. In 
 cuticular inflammation, the pulse is fuller, but, of consequence, 
 proportionally slower. 
 
 If we are not to be misled by a small, neither are we to be 
 deceived by a full pulse ; for this is often felt, even very near 
 dissolution.* In these cases, the artery is contracting very 
 feebly, and is approaching to the nature of a vein. In dan- 
 gerous apoplexies, the pulse is likewise often full, from the 
 diminished power of the artery. 
 
 When the pulse is very weak, and very slow, we may 
 infer, that the general action of the system is much diminish- 
 ed, and that syncope, or death, is at hand ; for, immediately 
 before death, we find a considerable interval betwixt the 
 feeble contractions of the heart. 
 
 A slow pulse, conjoined with local pains, shows, that no in- 
 
 * In acute diseases, it is a very bad sign to find the pulse full, and the beat very 
 frequent ; for this marks, that the artery is unable fully to contract: We feel a vi- 
 bration, rather than a contraction. 
 
52 
 
 flammation is present, but that the sensation proceeds from a 
 different cause, often a convulsive action of the part. 
 
 The state of the stomach, and abdominal viscera, influences 
 the circulation greatly, producing, very frequently, a remark- 
 able slowness of the pulse. 
 
 Deviations, in the function of circulation, are not to be con- 
 sidered as diseases in themselves, unless they depend upon 
 some local affection of the organs of circulation ; and, there- 
 fore, we are not always to direct our remedies to the removal 
 of these alterations alone : On the contrary, we more fre- 
 quently attend to them, as marks, by which we may know 
 what kind of action is going on. If, .however, the diseased 
 action be very much connected with the circulation, (as in- 
 flammation,) we attempt the cure by remedies directed to the 
 vascular system, the state of which is one chief and dangerous 
 symptom of the disease. 
 
 We have several methods of affecting the vascular system ; 
 such as, cold, bleeding, sweating, stimulants, &c. ; and these 
 are to be employed with two views : First, to restore the ba- 
 lance between the veinous and arterial system, when this is 
 destroyed ; and, for this purpose, sweating is the best remedy 
 which we can employ : Second, to obviate some particular 
 conditions ; such as, weakness, hardness, frequency, &c. ; and, 
 for this purpose, we must apply the appropriate remedies ; 
 such as, cordials, bleeding, &c. ; or, if possible, remove the 
 Cause. 
 
 Of the Equilibrium of Action, and Sympathy. 
 
 Having proceeded thus far in the account of the living 
 principle, and having mentioned, that it is diffused, in an equa- 
 ble degree, over the whole body,* I may next observe, that, 
 
 * Although I maintain, that the vital energy is diffused, in an equable manner, 
 over the whole body ; that is, each part having as much, in proportion to its ne- 
 
53 
 
 m a state of health, the action of eacli part is proportioned 
 to that of the rest, the whole acting equally. All the body 
 is sympathetically connected together, and dependent, the 
 one part upon the rest, constituting a general sympathy : But 
 sometimes we find particular parts more intimately depend- 
 ent upon each other, than upon the rest of the body, consti- 
 tuting a particular sympathy. Action cannot be greatly in- 
 creased, in any one organ, without being diminished in some 
 other ; but certain parts are more apt to be affected, by the 
 derangement of particular organs, than others ; and it was 
 the observance of this fact, which gave foundation to the old 
 and well-known doctrine of sympathy,* which was said to 
 proceed, " turn ob communionem el similitudinem generis, 
 turn ob viciniam."f 
 
 It may be thought, that this position, of action being di- 
 minished in one organ, by its increase, either in the rest, 
 or in some other part, is contradicted, by the existence 
 of general diseases, or actions, affecting the whole sys- 
 tem : But, in them, we find, in the first place, that there is 
 always some part more affected than the rest. This local af- 
 fection is, sometimes, the first symptom, and affects the con- 
 stitution, in a secondary way, either by the irritation which 
 
 cessities, as another ; yet I do not mean to say, that each part possesses absolutely 
 the same quantity : The reverse is the case ; but each part is, in health, as per- 
 fectly supplied with it a« the rest, considered with regard to its own functions and 
 demand. 
 
 * Many ridiculous explanations were given, of the consent of one part with 
 another, such as, similarity of intimate structure, anastomosis of blood-vessels, 
 connexion of nerves, &c. The theory which Hippocrates had of sympathy, is to 
 be found in his book, De Locis in Homine : " Corpus porro ipsum sibiipsi idem 
 ac fimile est, et ex iisdem compositum est. Similiter autem habet et parvas et 
 magnas partei, itemque infernas ac supernas. Et, si quis minimam corporis par- 
 tem acceptam male afficere velit, totum corpus affectionem sentiet, qualiscunque 
 tandem ea fuerit ; propterea quicquid tandem minima pars pertulerit, a gentilita- 
 tem refert ac transfert, unaqua?que aff suam, sive bonum sive malum id fuerit ; et 
 proptejea, corpus etdolet et laetatur cum minima gente, quia in minima omnes in- 
 sunt partes, ethae ad gentiles sibiipsis singula transferunt, et omnia denunciant." 
 
 f Laurentii Opera, p. 323, 
 
54 
 
 it produces, or by an extension of the specific action- At 
 other times, the local affection is coeval with the general dis- 
 ease, and forms a part of the direct effect of the exciting 
 cause which produced the derangement. In the first case, the 
 general disease is called sympathetic ; in the second, idio- 
 pathic. We observe, in the second place, that, as there is 
 some part which is always more affected than the rest, so also 
 is there some organ which has its action, in consequence of 
 this, diminished lower than that of the rest of the system, 
 and, most commonly, lower than its natural standard. From 
 the extensive sympathy of the stomach, with almost every 
 part of the body, we find, that this most frequently suffers, 
 and has its action diminished, in every disease, whether ge- 
 neral or local, provided that the diseased action arises to any 
 considerable degree. There are also other organs, which 
 may, in like manner, suffer, from their association or con- 
 nexion with others which become diseased, as will be imme- 
 diately explained. Thus, for instance, we see, in the general 
 disease called puerperal fever, that the action of the breasts 
 is diminished, by the increased inflammatory action of the 
 uterus. 
 
 In consequence of this balance of action,* or general con- 
 nexion of the system, a sudden pain, consequent to violent 
 action of any particular part, will so weaken the rest, as to 
 produce fainting, and, occasionally, death. But this depend- 
 ence appears more evidently, in what may be called the small- 
 er systems of the body, or those parts which seem to be 
 
 * The theory of a balance, of any kind, existing in the system, was first, J be- 
 lieve, decidedly pointed out by the late Dr. Irvine, whose chemical knowledge has 
 deservedly raised his name higli among the philosophers of Europe : But he only 
 imagined, that a balance of sensibility or sensation exists in the body, which is a 
 doctrine very different from the present, which supposes a balance of action. The 
 ancient and common doctrine of sympathy, Vas very different from this, which I 
 have attempted to establish ; because it was believed, that the part sympathizing 
 became affected with a disease, similar, or nearly similar, to that of the part ori- 
 ginally injured. 
 
55 
 
 more intimately connected with each other, than they are 
 with the general system. Of this kind is the connexion of 
 the breasts with the uterus of the female ; of the urethra 
 with the testicles of the male ; of the stomach with the liver ; 
 of the intestines with the stomach, and of this again with 
 the brain ; of the one extremity of the bone with the other; 
 of the body of the muscle with its insertion ; of the skin 
 with the parts below it. 
 
 Of these smaller systems, or circles, I shall treat regularly ; 
 but, first, it may be proper to observe, that these are not 
 only intimately connected with themselves, but also with the 
 general system, an universal sympathy being thus esta- 
 blished. 
 
 That there is a very intimate connexion between the 
 breasts and uterus, has been long known, but it has not been 
 very satisfactorily explained. Fallopius, and all the older 
 authors, declare plainly, that the sympathy is produced by 
 an anastomosis of vessels ; Bartholin adding, that the child 
 being born, the blood no longer goes to the uterus, but is di- 
 rected to the breasts, and changed into milk. But none of 
 ail those who talk of this derivation assign any reasonable 
 cause which may produce it. 
 
 In pregnancy, and at the menstrual periods, the uterus is 
 active ; but, when the child is delivered, the action of the 
 uterus subsides, whilst the breasts, in their turn, become ac- 
 tive, and secrete milk. If, at this time, we should again pro- 
 duce action in the uterus, we diminish that of the breasts, 
 . and destroy the secretion of milk, as is well illustrated by 
 the case of inflammation of the uterus, which is incident to 
 lying-in women.* When the uterus, at the cessation of the 
 menses, ceases to be active, or to secrete, we often find, that 
 
 * In puerperal fever, when the uterus becomes inflamed, the secretion of miLt 
 disappears, until the action of the uterus ceases. See the Anatomy of the Gravid 
 Uterus, p. 73. 
 
the breasts have an action excited in them, becoming slowly 
 inflamed, and assuming a cancerous disposition. The uterus 
 and breasts seem to be a set of glands, balancing each other, 
 in the system, one only being naturally active, or secreting 
 properly, at a time ; and, accordingly, we seldom, if ever, 
 find, that, when the uterus yields the menstrual discharge, 
 the milk is secreted in perfection, during the continuance of 
 that discharge ; nor do we ever find them both inflamed at 
 the same time. 
 
 The uterus has not only this connexion with the breasts, 
 but it has also a very particular sympathy with the stomach, 
 which again sympathises with the brain ; and thus we see how 
 a disorder of the uterus may induce an extensive series of 
 affections, each dependent on the other. * 
 
 The uterus has been known, ever since the foundation of 
 physic, to produce very extensive disease in the nervous 
 system ; and it is amusing to hear how this was explained. 
 The disease called " Suffocation of the Uterus," with many 
 other hysterical ailments, were attributed to the swelling or 
 choaking up of the uterus, by winds and vapours generated 
 from the retention of the menses, or by the corruption of the 
 semen, and putrefaction of the bad humours, which came there 
 to be discharged ; for this organ was considered by many as 
 
 a common cloaca. f These " ventosities" being once gene- 
 
 • 
 
 * When the uterus has its action increased, at the menstrual period, the sto- 
 mach is often much affected, and, along with it, the brain, and whole nervous sys 
 tern, producing hysteria. There is, at this time, every symptom of weakened sto- 
 mach ; such as, vomiting, belching, and, not unfrequently, spasmodic contractions. * 
 This state of the stomach will, in its turn, affect the brain, in the same way as it 
 does after a debauch, or in violent dyspepsia ; that is to say, it will produce head- 
 ach or dizziness. This affection of the head is not the immediate consequence o^ 
 the action of the uterus, but depends upon the disease of the stomach, induced by 
 the uterus. Thus we see that organs may come to suffer, by the derangement of a 
 particular part, although they do not directly sympathise with that part. A re- 
 collection of this may be of use in investigating the nature of some complicated 
 diseases. 
 
 f " Cctte partie est comme un cloacae ou sont envoyez tous les excrements <tu 
 corps." Ambrose Pare. 
 
57 
 
 sated, it was believed, that they mounted up to the s'omach, 
 the liver, and, at last, to the brain. The cute consis ed in 
 expelling these ; and one of the remedies which was employed 
 for this purpose, was warm aromatic fumes, conveyed, by 
 tubes, to the os uteri ; for there was no safety, they imagin- 
 ed, until this vile stuff was discharged ; this " occuli odour," 
 as Van Helmont calls it. 
 
 The organs of generation in the male, form likewise a li :le 
 system, in whi< h all the parts exhibit this sympathy wi.h ea^h 
 other. They likewise give us a very good instance of the 
 association of action, or sympathy, in the common acceptation 
 of that word. 
 
 Sympathy has been divided into the contiguous, where 
 parts become affected from vicinity, and the remote, whee a 
 distant part becomes affected. It will be more conformable 
 to the present doctrine, which I apprehend to be true, to di- 
 vide it into, first, the sympathy of equilibrium, in which one 
 part is weakened, by the increased action of another ; and, 
 second the sympathy of association, in which two parts act 
 together, at the same time. 
 
 The sympathy of association of distant parts is produced 
 suddenly, and for a short time : The sympathy of equilib ium 
 is produced more slowly, and continues to operate for a much 
 longer time. 
 
 It is curious enough, that most, or, at least, many of those 
 organs, which seem to be connected by the sympathy of equi- 
 librium, exhibit likewise more or less of the sympathy of as- 
 sociation, when under the circumstances in which this can 
 lake place. 
 
 The sympathy of association may be divided into the in* 
 terrupted, or the sympathia consociationis interrupta, in which 
 distant parts are affected, whilst sound parts intervene be- 
 twixt them; and the spreading, or the sympathia consocia- 
 tionis serpens, in which the action spread* inch by inch witfc 
 
 vol. I. H 
 
more or le^s rapidity; The interrupted sympathy generally 
 is induced quickly, and, in many cases, does not last long ; 
 the spreading takes place more gradually, and is, in every in- 
 stance, of considerable duration. It may also come to affect 
 parts which were formerly influenced by the interrupted 
 sympathy, and may overcome the natural tendency of parti- 
 cular parts to exhibit the sympathy of equilibrium. The in- 
 terrupted sympathy is sometimes the forerunner of a general 
 action, the brain or stomach sympathizing before any other 
 part of the system. 
 
 The sympathy of equilibrium is seen in the effects of in- 
 flammation of the end of the urelhra, on the testicle, which 
 often diminishes its action, and produces a very disagreeable 
 sensation of dulness ; or, if this inflammation be suddenly di- 
 minished, the action of the testicle is as suddenly increased, 
 and swelling takes place. The same is seen in the connex- 
 ion of the urethra with the bladder and prostate gland, as 
 will be more fully mentioned in the dissertation on gonor- 
 rhoea. These parts, likewise, affect the stomach greatly, 
 increased action in them weakening that organ much.* This 
 is seen in the effects of swelled testicle, on excessive venery, 
 or inflamed bladder, or irritation of the bladder, from a stone; 
 all which weaken the stomach, and produce dyspepsia. The 
 same remark applies to the kidney ; vomiting and flatulence 
 being produced by nephritis. 
 
 The sympathy of association, or an instance of sympathy, 
 in the common acceptation of the word, is likewise seen in 
 the connexion betwixt the glans and testicles, in coition ; 
 but, for this purpose, the action in the glans must be sudden, 
 and of short duration ; for, if continued long, weakness of the 
 
 * The effects of excessive venery, in producing dyspepsia, and, consequently, 
 gout, is very well known. Unless this cause be removed, it is impossible for pa- 
 tients ever to recover from diseases of the stomach. Lord Chesterfield mention?, 
 that when he consulted Booerhave, that celebrated physician added, by way of a- 
 note to lils prescription, " Venus rarius colatur.'' Letter cxxx- 
 
59 
 
 testicles, or diminished action, is induced.* In those pans 
 which exhibit this natural association of action, if the action of 
 one part be suddenly, and for a short time, increased, the 
 action of the sympathising part will likewise be increased, as 
 we see, in the instance already given, of coition, and likewise 
 in paroxysms of the stone, in which the glans penis, after 
 making water, becomes very painful : But, if the action be 
 more slowly induced, and continued for a long time, then this 
 association is set aside, by the stronger and more general prin- 
 ciple of the equilibrium of action, and the sympathizing part 
 is weakened. Hence, violent inflammation of the end of the 
 urethra, produces a weakness and irritability of the bladder, 
 dulness of the testicles, &c. 
 
 There is also an evident sympathy of equilibrium betwixt 
 the stomach and lower tract of in'.estines, which two portions 
 may be said, in general, to balance each oiher, in the abdo- 
 men. When the action of the intestines is increased, in di- 
 arrhoea, the stomach is often weakened, and the patient tor- 
 mented with nausea. This will be cured, not so easily by 
 medicines taken into the stomach, as by anodyne clysters, 
 which will abate the action of the intestines. When the in- 
 testines are inflamed, as in strangulated hernia, vomiting is a 
 never-failing attendant : When, again, the stomach is inflamed, 
 the intestines are affected, and obstinate costiveness takes 
 place.f Even in hysterical affections of the stomach, the 
 intestines are often deranged. Injections of cold water fre- 
 quently relieve these affections of the stomach, by their ac- 
 tion on the intestines. 
 
 * It is on this principle, that, if emission does not take place quickly, in coitu, 
 it either does not take place at all, or with difficulty. If the state of the glans be 
 such, as to prevent a sudden and great action, iu that part, no emission follows . 
 and this is one cause of impotence. 
 
 f It might be thought, that, as inflammation of the intestines produces nausea 
 or vomiting, so gastritis ought to be attended, uniformly, with looseness. But it 
 ■ is to be remembered, that the same causes produce rery different effects on diff.r- 
 
60 
 
 The livfcr and stomach are also connected with one an- 
 other. When the liver is inflamed, or has its action increas- 
 ed, the stomach is weakened, and dyspeptic symptoms take 
 place. When the stomach is weakened, as, for instance, by 
 intoxication, then the action of the liver is increased, and a 
 gea.er quantity han usual of bile is secreted. The same 
 takes place in warm climates, where the stomach is much de- 
 bilitated. If the liver has its action thus frequently increased, 
 it assumes a species of inflammation, or becomes, as it is called, 
 schirrus. This is exemplified in habitual dram drinkers, 
 and in those who stay long in warm countries, and use 
 freedoms wiih the stomach. The liver likewise sympathizes 
 with ihe brain ; for when this organ is injured, and its action 
 mu h impaired, as in compression, inflammation and suppu- 
 ration have been often known to take place in the liver. # 
 
 Besides this connexion of the stomach with the liver, it is 
 also ve>.-y intimately dependent on the brain, being weakened 
 when the action of the brain is increased, as we see in inflam- 
 mation of that organ. The brain, again, is affected with 
 pain, when the stomach is weakened by intoxication, or other 
 causes ; and this pain will be often relieved by slowly renew- 
 ing ..he action of the stomach by such stimuli as are natural 
 to it, such as small quantities of soups frequently repeated. 
 A slight increase of a-.tion in the stomach, at least if not of a 
 moibid kind, affects the brain so as to produce sleep, dimin- 
 ishing its action. This we see in the effects of a full meal, 
 and even of a draught of warm water. The stomach like- 
 
 ent parts. What produces mortal sickness in one part of the alimentary canal, oc- 
 caions violent pain in another; and the sensation and consequence of diminished 
 action is different in different parts. Dyspepsia produces squeamishness in the 
 stomach ; but the same cause, affecting the intestines, occasions costiveness. 
 
 Gastritis may be accompanied with looseness; but, in this case, there must be 
 gome irritating cause in the intestines. 
 
 * Mem. de L'Acad. de Cbirurg. Tom. III. 
 
CI 
 
 wise sympathises with the throat, squeamishness and anor- 
 exia being often produced by inflammation of the tonsils. 
 This inflammation is frequently abated by restoring or in- 
 creasing the action of the stomach. Hence the throat, in 
 slight inflammation, is frequently easier after dinner : Hence, 
 likewise, the effect of emetics in cynanche. 
 
 The extremities of bones and muscles also sympathize in 
 the same manner. When one end of a bone is inflamed, the 
 action of the other is lessened, and pain is produced ;* for a 
 painful sensation may result both from increased and dimin- 
 ished action. When the tendon of a muscle is inflamed, the 
 body of that muscle often is pained ; and vice versa. 
 
 Lastly, the external skin sympathizes with the parts be- 
 low it. If it be inflamed, as in erysipelas, the parts immedi- 
 ately beneath are weakened, or have their natural action di- 
 minished. If this inflammation affect the face or scalp, then 
 the brain is injured, and head-ache, stupor, or delirium mite, 
 supervenes. If it attack the skin of the abdomen, then the 
 abdominal viscera are affected, and we have vomiting and 
 purging, or obstinate costiveness, according to circumstances, 
 as explained in a note to a former part of the text. This is 
 illustrated by the disease of children, which is called by the 
 women the bowel hive, in which the skin is inflamed, as they 
 suppose, from some morbid matter within. 
 
 If the internal parts be inflamed, the action of the surface 
 is diminished ; and, by increasing this action, we can lessen 
 or remove the disease below, as we see daily proved by the 
 good effects of blisters. When the stomach, intestines, or 
 kidney, have been very irritable, I have known a sinapism 
 act like a charm ; and in the deep-seated inflammations of the 
 breasts, bowels, or joints, we know of no better remedy, af- 
 ter the use of the lancet, than blisters. The utility of issues, 
 
 • : To give only one example ; in morbus coxarius, the knee is painful.- 
 
till 
 
 in diseases of the lungs, the liver, and the joints, is to be ex- 
 plained on the same principle. In these cases, we find, that 
 issues do little good unless they be somewhat painful, or be in 
 the state of healthy ulcers. An indolent flabby sore, how- 
 ever large the discharge (which is always thin, and accompa- 
 nied with little action,) does no good, but only adds to the 
 misery of the patient. We may, however, err on the other 
 hand, by making the issues too painful, or by keeping them ac- 
 tive too long ; for, after they have removed the inflammatory 
 disease below, they will still operate on these parts, lessening 
 their action, and preventing ihe healing process from going on 
 properly. This is seen in cases of curvature of the spine, 
 where, at first, the inflammation of the vertebra is diminished 
 by the issues ; but if they be kept long open after this is re- 
 moved, they do harm. We often see the patient recover 
 rapidly, after his surgeon has healed the issue in despair, 
 judging that it could do no farther service, but only increase 
 tiie weakness of his patient. 
 
 It is a well established fact, that when any particular action 
 disappears suddenly from a part, it will often speedily affect 
 that organ which sympathizes most with the part which was 
 originally diseased. This is best seen in the inflammatory 
 action, which, as practical writers have well observed, occa- 
 sionally disappears quickly from the part first affected, and 
 then shows itself in some other.*. 
 
 From the united testimony of all these facts, I may cer- 
 tainly maintain the doctrine which I proposed to prove, and 
 introduce it into pathological reasonings. In the whole of the 
 
 * In the cynanche parotides, the testicle* or breasts often swell in proportion 
 as the inflammation leaves the parotid gland. There are many instances in which 
 the increased action of the parotid gland, in mercurial salivation, has subsided 
 suddenly, and affected the stomach with intolerable irritability. The cessation of 
 the inflammatory action of the urethra in gonorrhoea, and its consequent appear- 
 ance in the testicles, has been already mentioned, and will afterwards be mere 
 fully considered. 
 
t>3 
 
 animal economy, we discover marks of the wisdom of the Cre- 
 ator; but, perhaps, in no part of it more than in ihis, of the 
 existence of the sympathy of equilibrium : for, if a large part 
 of the system were to have its aclion much increased, and all 
 the oilier parts to continue acting, in the same proportionate 
 degree as formerly, the whole must be soon exhausted, (for 
 increased action would require, for its support, an increased, 
 quantity of energy.) But, upon this principle, when action is 
 much increased in one part, it is, to a certain degree, dimin- 
 ished in some other. The general sum or degree of action in 
 the body, is thus less than it otherwise would be, and, conse* 
 quently, the system suffers less. 
 
 Of the Actions of the Nervous Energy. 
 
 Having made these general observations upon the nervous 
 system, I come now to consider, more particularly, its differ- 
 ent operations or actions. These, we have seen, are always 
 induced by agents, which are to be considered as external ; 
 and these agents are called stimuli. The action or operation 
 which is produced, depends, first, upon the nature of the stim- 
 ulus ; and, second, upon the property of the nerve.* 
 
 Every state of the system is produced by an operation of 
 the nervous energy ; and this operation is called an action. 
 
 Almost every substance produces some change upon the 
 system ; and these changes may all be called diseases, if, by 
 this term, we understand a condition of the nervous system, 
 not entirely the same with the natural state. 
 
 * There are many nerves, which have, ab initio, a certain function or property 
 allotted to them, which h excited by the application of some particular or specific 
 stimulus. But after this peculiar action of the nerve is fully established, it is not 
 always necessary, for the performance of these actions, that the specific stimulus 
 be applied. Light, for instance, is not always requisite, for the sensation or action 
 of vision, nor air for hearing; the application of zinc and 6ilver, Ac. being capable 
 of producing these 
 
m 
 
 It has been already mentioned, that the living principle, if 
 aot acted on, would exh bit no phenomena; and that, although 
 it should be present in any body, we should still, were there 
 no aciion produced, conclude that body to be dead. The 
 term life, in common language,- is applied, not to the living 
 principle, but to its evident operations, or actions. These 
 are produced by certain fixed and determinate agents, which 
 act constantly, and produce what is called the healthy, or 
 natural action, (or, in common language, life.) If we apply 
 other agents than those which are namral, we modify, or 
 change the action ; and, in proportion as the new action dif- 
 fers from the natural one, so is it dangerous to the system. 
 These actions may be considered as different varieties of 
 life, if we use this term in its vulgar acceptation ; but these 
 varieties, or, at least, many of them, not being fitted to our 
 frame, we cannot exist long with them, more than we could, 
 were the specific life, or congeries of actions of a quadruped, 
 to be excited in us by any magical power. 
 
 It must evidently appear difficult, to every one who thinks* 
 upon the subject, to say, how foreign agents operate on the 
 living principle of man, or how a small particle of matter, 
 taken from the bowels of the earth, should excite a dangerous 
 and mortal action of the vital power of an animal. In order, 
 in some degree, to explain this, I may observe, first, that no 
 two inert bodies can act on each other ; or, in other words, 
 that matter alone cannot act on matter, unless it be possessed 
 of some active power : Neither is it possible for an inert body 
 to act on one possessed of this enlivening principle ; for the 
 very capability of producing or exciting action, implies ac- 
 tivity. Unless, then, both agent and actor possess some pro- 
 perty different from mere matter, or matter truly dead, no 
 change can be produced. Were the sun to lose its active 
 power, or attraction, it could no longer act on any of the 
 planets j and* were any of the planets to lose their power, 
 
05 
 
 they could no longer be acted on by the sun, or by other 
 planets. If, then, it be admitted, which none will deny, hat 
 action can only be produced in a body which is alive, and by 
 an agent possessed of an active principle, it will follow, that 
 no action can be excited in an animal, except by means of 
 the active principle of the agent which immediately ex- 
 cites it. 
 
 I shall, secondly, observe, that, as the vital principle, in 
 animals and vegetables, admits of modifications, in the differ- 
 ent individuals with which it is connected, so also does the 
 vital or active principle of common matter ; and it is these 
 modifications which produce the essential and characteristic 
 qualities of the different individuals, or different kinds of 
 matter. Chemistry teaches us, that there are not many kinds 
 of matter radically different; and, it is not extravagant to 
 believe, that, were science improved, or, were the whole 
 mystery of creation unfolded, we might find, that there was 
 only one radical kind of matter, which, by its modification, 
 yielded different products. The specific, or differential 
 qualities of matter, never can be supposed to depend upon 
 any cause, inseparably connected with mere matter, but must 
 depend upon the operation of a distinct and active principle. 
 We may mix different species of matter together, taken fronv 
 the vegetable or mineral kingdoms ; but we shall not make a 
 new substance, unless the active principle operate, and be- 
 come modified, converting the whole into a new individual. 
 
 In the third place, I remark, that a modification of a cause 
 must produce an alteration in the effect. 
 
 From these three observations, I think we may understand, 
 first, how foreign agents are capable of acting on the body ; 
 and, second, why different agents should excite different ac- 
 tions. 
 
 I may further observe, that it is only the attractive princi- 
 ple, or life of matter, which operates on animal Kfe, exciting 
 
 vol. i. i 
 
66 
 
 it to action ; and it is only in so far as living animals, or ve- 
 getables, possess properties in common with common matter, 
 that they can excite action in another animal. Hence, when 
 applied to the body, or taken into the stomach, they can only 
 excite the simple actions productive of the sensation of feel- 
 ing : But, after the animals, or vegetables, die, that is to say, 
 part with their specific life, and become the same with com- 
 mon matter, then they can excite peculiar and varied actions ; 
 then, but not until then, can they be changed, and rendered 
 useful as food, and not until then, do they ever act as medi- 
 cines. 
 
 It is upon the principle now mentioned, of agents, or sti- 
 muli, acting only on the body, by means of their active prin- 
 ciple, that we are to explain the influence of these larger 
 masses of matter, the sun and moon, upon the human body. 
 That these affect the body, both during health and disease, 
 has been so fully admitted, by so many attentive physicians,* 
 that I shall consider the fact as established, and requiring no 
 farther evidence in this place. 
 
 The operation, or action, of the system, in the healthy 
 state, can scarcely be described ; because it comprehends 
 and produces every circumstance connected with health ; 
 such as, sensibility, muscular contraction, absorption, nutri- 
 tion, digestion, and all the other functions of the body. 
 These operations, taken collectively, may give some idea of 
 the natural or healthy action. This action is much too ex- 
 tensive and intricate to be described, or defined ; but it may 
 be understood, by observing the general condition of a 
 healthy person. 
 
 The presence of this action, seems also to be requisite for 
 the support or renewal of the energy which produces it ; for, 
 if the action be suspended, or totally changed, the functions 
 
 * See the Works of Mead, and, more lately, the Observations of Jackson, 
 Salfour, &e. 
 
67 
 
 cease ; all energy is lost, and death takes place. Whilst the 
 action, then, depends upon the power, the power depends, 
 for its continuance, upon the action.* Hence, when agents 
 capable of exciting an action, very different from the natural 
 one, are applied, we may readily perceive, how weakness 
 ought to be the consequence : On the contrary, if the na- 
 tural action be gradually increased, and remain unchanged, 
 strength will be produced.f If, however, the increase of 
 action has been more sudden, and to a greater degree, we 
 find, that it is changed in its nature, and is no longer healthy, 
 as we see in inflammation, in which we have no production 
 of strength, but, on the contrary, an expenditure of power. 
 The same thing happens, when particular functions are in- 
 creased in their action ; such as, muscular motion, secre- 
 tion, &c. 
 
 The nervous system has its energy supported, and it* 
 healthy actions excited, by arterial blood, which may, there- 
 fore, be called a natural stimulus. Heat, air, and food, are 
 likewise necessary stimuli ; but these all act, either by pre- 
 paring the blood, or imitating its operation. Food and air 
 give to the blood its most valuable qualities ; and heat, appli- 
 
 * We have seen, that the vitality of animals is received from common matter, 
 the active principle of which is gradually changed, and rendered more perfect. 
 It is from the life of the blood, that all energy is immediately derived, being, in 
 the brain and nerves, elevated to the greatest degree of perfection. This is, un- 
 doubtedly, the effect of some action ; for it is not done by any innate quality, in- 
 separably connected with vitality itself; otherwise, we might find it raising itself 
 to different degrees of perfection, in the very lowest orders of the creation. This 
 action is not seated in the blood ; otherwise, we should find the life more perfect 
 than it is, in the blood ; but it is to be found in the nervous system, which perform-. 
 all the actions and operations of the body, by means of a living principle, which, 
 by its operation, enables it to renew the energy, or power. The nerves alone can- 
 not do this; for it implies an active operation, which they cannot perform without 
 life. 
 
 t If, by any means, the energy could be increased, without a previous increase 
 of action, (which, however, is impossible,) we should, in all probability, have an 
 immediate increase of action. Increase of energy, and increase of natural action^ 
 singly, ought to produce the same effect. 
 
62 
 
 ed externally, only co-operates wiih that fluid, which pro-; 
 duces it in a certain quantity, by the action of the living 
 system. 
 
 When other agents operate on the system, a different state 
 from that produced by the blood, is induced in the body. 
 Wine, opium, contagions, mercury, &c. being all capable of 
 operating on the system, produce an action, which, of neces- 
 sity, must be different from the natural action, inasmuch as 
 these agenis differ from the natural agent. 
 
 New agents sometimes appear to increase the natural ac- 
 tion, but this, it is evident, they never can do, without chang- 
 ing or modifying it in some respect ;* and, therefore, the 
 opinion that they produce diseases, consisting entirely of 
 different degrees of strength, or natural action, is absurd. 
 When any stimulus has been applied to a part, so as to pro- 
 duce inflammation, it has been supposed merely to increase 
 the vigour of the part, or, in the language of Dr. Brown, to 
 increase its s henic diathesis. But the whole series of symp- 
 
 * No agent can excite an action perfectly similar to the natural one, unless it 
 be a stimulus, which is habitually present, such as, arterial blood and heat. Elec- 
 tricity appears to increase the natural action, or whatever action is going on at 
 the time of its application, in the game way with heat ; but we cannot call elec- 
 tricity a new agent; for it certainly operates, habitually, on our system, although 
 as yet, we are much in the dark respecting it. 
 
 Those agents which are natural to the system, are found to increase every ac- 
 tion which is going on, whether healthy or diseased. Hence, blood and heat will 
 support, not only the natural action, but also any other which has been induced. 
 This may explain to us the u9e of heat in medicine, and may also inform us, 
 what effects we are to expect from it. In warm climates, some functions, or parts 
 of the natural action, are increased, beyond that relation which ought to subsist 
 betwixt them and the power, and weakness is produced. All the secretory ac- 
 tions are increased, at least, such as are not incompatible with each other ; such 
 ai the secretion of urine, and sweat, which cannot both be increased in quantity 
 at the same time. All morbid actions are increased ; and hence the danger of dis- 
 eases in warm climates. The fever is violent, and runs its course rapidly : The 
 action in ulcers is far beyond the power, and the destruction is great .- The con- 
 tagion of dysentery acts powerfully, and a few hours decide the fate: Blood, liko 
 heat, increases actions ; and hence the truth of the old observation, " That ful!- 
 Uooded people bear disease worse than the spare." 
 
69 
 
 foms, In that disease, show, that a new action is produced, 
 diftering-^ery much from the natural one, both in its progress 
 and consequences, as will be evidently seen, when we come 
 afterwards more fully to examine it. The vai iolous matter, 
 again, at the same time that it induces the inflammatory ac- 
 tion, modifies it, and, in a very striking manner, changes its 
 nature. 
 
 Some actions appear to arise without any evident cause, 
 or to be repeated, by what is called habit ; but, in order that 
 this may take place, it is necessary, first, that the action have 
 been, at some former period, strongly excited, or long con- 
 tinued, or frequently repeated : Second, that either some 
 stimulus be applied, which has been frequently applied dur- 
 ing the former continuance of the action, and which had been 
 accustomed to increase it ; or, that some stimulus be applied, 
 which, in its effects, bears a resemblance to some part of the 
 former diseased action, which is thus renewed. Thus, if a 
 person has once had an ague, he is apt to have a return of it, 
 whenever he is exposed to much cold, which induces a state 
 similar to the former cold lit. 
 
 In all morbid actions, we have three periods to attend to : 
 First. The period of formation, in which the animal is 
 weakened, by the diminution of the natural action, or func- 
 tions, during the time that the new action takes to form ; for 
 diseased actions never take place suddenly, (unless the excit- 
 ing cause be very powerful, and applied only to a particular 
 part, producing local disease,) but a certain time is required 
 for their formation. The weakness induced in this way, will 
 be observable in every general action, and even in those 
 which, when fully formed, are called inflammatory. The 
 symptoms which take place, during the formation of an action, 
 are lassitude,* anorexia, coldness, head-ach, and thirst. 
 
 * This proceeds, in a great measure, from the diminution of the action of the 
 muscles. In many instances, this diminution of natural action is productive of a 
 
70 
 
 These always occur, ami precede aciions, the most dissimilar 
 one to the other. 
 
 Second. The period in which the action exists in perfec- 
 tion, and fully formed, marked by the peculiar characters' 
 of the action ; such as, heat, pain, and redness, in inflamma- 
 tion ; eruptions, in the exanthemata? ; peculiar indescribable 
 condition in typhus, &c. 
 
 Third. The termination. All new actions terminate by a 
 secretion. In the inflammatory action, we have either a se- 
 cretion of matter, similar, or' nearly similar, to the natural 
 substance of the part, producing adhesion, or resolution, as 
 it is called ; or a secretion of a fluid, called pus, serum,* &c. 
 In many other actions, however, we have no new secretion 
 formed, but only an augmentation, and perhaps, slight change, 
 of some natural and accustomed discharge ; such as, sweat, 
 mine, or, occasionally, the intestinal mucus. These dis- 
 charges, or secretions, are sometimes in small quantity ; but, 
 at other times, they are more considerable and evident. By 
 the attentive ancients, they were called critical, as they were 
 often seen to occur in the end of the disease. 
 
 Although all actions terminate in a secretion, yet it does 
 not follow, that, whenever the secretion appears, disease is 
 to end. The reverse is too often the case ; for, in many 
 species of inflammation, the secretion continues permanent, 
 unless we interrupt it by art. In all acute diseases, however, 
 or in those which are called febrile, the secretion does not 
 continue permanent ; and, in all eruptive actions belonging 
 
 very painful sensation, which is felt in most of the muscles, and which causes the 
 patient to complain of pain in his back and in his bones, whilst in reality it is the 
 muscles alone which are pained. Sometimes this diminution of natural action is 
 productive of spasmodic affections. I have known fevers ushered in by convulsions 
 of the whole muscles of the body, especially of the spine, and these continued 
 during the period of formation. 
 
 * Pus is the most common secretion, terminating inflammation ; but it may also 
 end in a eecretion of thin fluid, like serum, producing a dropsy of the affected part. 
 This is too frequently fatally seen in the head and chest. 
 
71 
 
 to this class, the action terminates, whenever this secretion Is 
 completed ; and the patient is then subject only to the weak- 
 ness which the action may have induced, and to the effects 
 which the eruption, considered as simple ulcers, may now 
 produce. This is seen in the small-pox, chicken-pox, &c* 
 Actions are only known and distinguished by their effects ; 
 and many of these are of such a nature, as not to be cognizable 
 by the senses ; such as, the peculiar or specific state of the 
 body, in typhus fever, small-pox, &q. The precise nature 
 of these conditions, can neiiher be described nor understood ; 
 because they cannot be brought under the examination of 
 any of our senses. Some have, therefore, denied their ex- 
 istence ahogether, or have not perceived it. 
 
 In almost every system of nosology, they have been en- 
 tirely overlooked, the classification being founded upon such 
 general and sensible deviations, as occur in every action, over 
 and above the peculiar condition ; such as, affection of the 
 circulation, pains, eruptions, &c. 
 
 Some actions are confined to a particular part of the body, 
 whilst others affect the whole system ; and, therefore, nosolo- 
 gists have uniformly separated these diseases from each other ; 
 and, at first sight, we might conceive, that the primary and 
 great division of diseases might be taken from this source. 
 But, by maturer consideration, we shall find that the distinc- 
 tion is erroneous ; because there is no local disease whatever, 
 which, if either increased in degree, or continued for a long 
 time, will not affect the constitution, and induce a general 
 ailment. On the other hand, there is no action which affecte 
 every part of the body equally ; and, therefore, there is no 
 general disease without a local one ; or, in other words, there 
 is always some part of the body, in every disease, more af- 
 
 * I have seen the measles appear, before the pustules of the chicken-pox were 
 quite gone, which could not have happened, unless the generaldisease^orpeculiar 
 arctJOD, had disappeared, when the secretion took place. 
 
72 
 
 fected than the rest. In the exanthemata?, the skin is most 
 affected ; in fevers, strictly so called, the head is generally 
 most affec'ed, although sometimes the lungs or abdominal 
 viscera suffer most. Of all the parts of the body, however, 
 the brain generally is affected in the greatest degree, unless 
 the disease be induced by some cause acting locally on other 
 parts ; but, even in this case, if the disease be violent, an af- 
 fection of the head is superadded to the other local disease. 
 This is exemplified, in the case of those who die after 
 wounds or operations ; in which event, the brain is common- 
 ly found turgid, and the patient, not unfiequently, is affected 
 with coma before death. In certain diseases, we observe a 
 series of aptitudes of the different parts of the body to be 
 affected, as will af:ei wards be particularly illustrated in the 
 venereal disease. In all actions, the least sensible parts 
 suffer latest. This we see in the case of the bones, tendons, 
 and cartilages. 
 
 Actions produce different symptoms, according as they 
 are extended over the body. Such as affect the whole sys- 
 tem, produce undefinable uneasiness, frequency of pulse, 
 heat, and the oiher symptoms of what is called fever. But, 
 when action appears in one part more than the rest, as it al- 
 ways does, that part is affected with what we call pain ; and, 
 if the action be still more increased in it, we have a species 
 of inflammation induced. This is illustrated by every dis- 
 ease which we know of ; for, in common fever, in small-pox, 
 and every specific action, we find inflammation produced, 
 whenever action becomes much concentrated in any part.* 
 
 * Inflammation in a part, is intimately dependent on the state of the vessels. 
 AU actions, which produce perceptible disease, affect the vessels, making thera 
 contract more or less frequently, and more or less strongly. We may, therefore, 
 gee how aDy action, when greatly mcraasod in a part, may induce inflam.*- 
 motion. 
 
173 
 
 Instead of adhering to the more established modes of class- 
 ing diseases, it will better answer the present purpose, to di- 
 vide actions into the six following classes.* 
 
 CLASS I. 
 A. Naturales. 
 
 Alterations in the performance of the natural action of a 
 part of the body, or of the whole system, but not to such a 
 degree, as materially to change its nature, or render it 
 new.f 
 
 Order 1. Imperfecta. — A diminution, interruption, or 
 irregularity of the performance of some part, or the whole of 
 the natural action. J 
 
 $* This arrangement will, it is true, bring together diseases, which have often 
 heen far separated ; and is likewise very imperfect, because no more than an out- 
 line of the classification can be given here. The minuter subdivisions, arising 
 from the action being general or local, and from the function, chiefly impaired, or 
 other circumstances, cannot be noticed in this sketch. If these were inserted, 
 v which would take more room than can be properly spared to it,) many of the 
 Imperfections and apparent inaccuracies would disappear ; but no system of noso- 
 logy ever has, and, until our knowledge be increased, ever can be free from fault. 
 As for the circumstance, of bringing together diseases or actions formerly separa- 
 ted, I have uuly to remark, that the dame license ought to be allowed for uniting 
 them, as for separating them, both proceeding on arbitrary or assumed principles. 
 In this arrangement, the actions are classed, not altogether according to their 
 cause, but chiefly according to their evident effects or symptoms, which is the 
 most useful way ; the object of medicine as yet being almost totally confined to 
 the removal of symptoms. To comprehend all the diseases of the human body, 
 another class, consisting of actions of the mind, ought to be added. 
 
 f We shall afterwards find, when we come to consider inflammation, that if the 
 whole natural action of a part be much increased, it becomes changed in its na- 
 ture and effects : But the present class comprehends these changes only, which 
 take place to such a degree, as not to alter the nature, or destroy the character- 
 istic marks, of the natural action. 
 
 \ This order may be subdivided, according as it affects the different functions, 
 &c. and comprehends spasm, epilepsy, palpitation, asthma, dyspepsia, cholic, 
 rhlorosis, torpor from cold, &c. 
 
 TOL. I. K 
 
74 
 
 Order 2. Accrescentes. — Some part of the natural 
 action morbidly increased, without being materially changed 
 in its nature.* 
 
 Order 3. Inequales. — A loss of balance betwixt some 
 part of the natural action.f 
 
 
 CLASS II. 
 A. Transposita. 
 
 A transposition of the natural action of some part of the 
 body to.anoiber part, which, in health, possesses a different 
 action. 
 
 Order 1. Formantes. — A transposition of the action 
 which forms the part. J • 
 
 Order 2. Secernentes. — A transposition of some secre- 
 tory act ion. || 
 
 Order 3. Sympathetic^e. — Actions transferred, by sym- 
 pathy, from the diseased part to one which was formerly 
 healthy.** 
 
 * This will comprehend cholera, diarrhoea, menorrhagia, &c. 
 
 j This comprehends the different varieties of dropsy. la this disease, the se- 
 cretion and absorption do not balance each other. 
 
 \ When the muscle-forming action is lost in the arteries, and membrane is 
 produced in its place, aneurism is the consequence. When the action of forming 
 bone is transferred to the heart, a very serious disease takes place. When the ac 
 tion of the vessels of the tunica sclerotica is transferred to the crystalline lens, ca- 
 taract is produced. 
 
 !| There are instances recorded, of the purulent secretion being transferred to 
 some part which formerly was sound. There are many cases, where the menstrual 
 discharge has come from different parts of the body. 
 
 ** This order is founded on the doctrine of the sympathy of equilibrium, which 
 haa been already explained. 
 
75 
 
 CLASS III. 
 
 A. Similes. 
 
 Actions which, when analysed, are found to bear a resem- 
 blance to the natural action, which is increased to such a de- 
 gree, as to become changed in its nature.* 
 
 Order 1. Inflammat.e. — Actions producing heat, red- 
 ness, pain, and more or less swelling, in some particular or- 
 gan, often attended with pyrexia.f 
 
 Order 2. Stimulantes. — A general increase of action, 
 (without such a local affection as to produce true inflamma- 
 tion in the part,) marked by frequency of pulse, heat of the 
 skin, thirst, and pain or confusion in the head.J 
 
 Order 3. San guin antes. — A discharge of blood from 
 the vessels of a part, without any artificial wound, accom- 
 panied with a general action of the system. || 
 
 Order 4. Tonics. — Actions consisting in an increased 
 contractile power, nearly, though not entirely, similar to the 
 natural action. *# 
 
 * The change of the nature of an action, from a change of its degree, will be 
 afterwards illustrated, in the dissertation on inflammation. 
 
 f This order comprehends the phlegmasia of nosologists. 
 
 i This comprehends the slight febrile attack called ephemera ; the action in- 
 duced by wine, spirits, hartshorn, &c. In these there is always some part more 
 affected than the rest; but this superior affection must not be to such a degree 
 as to produce inflammation ; otherwise the action will belong to the order in- 
 flammation. 
 
 || This comprehends the order hemorrhagia of nosologists. The subdivisions 
 are founded on the part affected. Apoplexy belongs to this order, being produced 
 by a hemorrhagic action in the brain. 
 
 ** This is entirely confined to the effects of those agents called medicines ; such 
 as, alum, galls, bark, bitters, &c. These are often used to strengthen the body ; 
 because they excite an action nearly similar to the natural one ; and, if given 
 gradually, they do in the end in reality increase the healthy action, by having 
 for so long induced one in an increased degree, which nearly resembles it. 
 
76 
 
 Order 5. Hecticje. — Frequent pulse, weakness, sweats, 
 and purging, heat of the skin, flushed face, thirst, wasting of 
 the body, without any specific action.* 
 
 Order 6. Mechanics. — General action, dependent 
 chiefly on some local cause, acting mechanically-! 
 
 CLASS IV. 
 A. Dissimiles. 
 
 Actions very dissimilar to the natural action, and which 
 may be called specific. J 
 
 Order 1. Intermittentes. — Actions which alternately 
 disappear and return, or remit and increase, for a certain 
 time. 1 1 
 
 Order 2. Typhoides. — Great prostration of strength ; 
 pulse frequent, sometimes full at first, but always small, after 
 the disease has continued for a short time ; pain in the head, 
 with disturbance of the mental faculties ; urgent thirst, with 
 foul tongue.** 
 
 Order 3. Venenos.e. — Great weakness, often attended 
 with eruptions, or other local affections, produced by the ap- 
 plication of what are called poisons. f f 
 
 * The different species of phthisis, attrophy, fcc. are to be placed here. 
 
 f Of this kind is jaundice, proceeding from biliary obstructions. 
 
 X These are, of all actions, the most dangerous, on account of the great and 
 rapid weakness which most of them induce. Some call the agents productive ol 
 these, sedatives ; but the name is improper, for they are very far from soothing. 
 Agentes dissimiles, is, from the poverty of language, the best I can fix on. 
 
 || Such as the different varieties of intermitting fevers. 
 
 ** Comprehends typhus, plague, cynanche maligna, the disease produced by the 
 application of putrid matter to the body, &c. 
 
 rf The bite of many snakes, the effects of lead, laurel, &c. 
 
77 
 
 CLASS V. 
 
 A. Mixta'. 
 
 Actions which are of a mixed nature, resembling in part 
 the class Similes, but having also some peculiar or dissimilar 
 action united to this. 
 
 Order 1. Erupturje. — Actions producing numerous in- 
 flammations of the surface, combined with a specific action, 
 often ending in ulceration.* 
 
 Order 2. Immupjd^. — Actions consisting in specific in- 
 flammation, not necessarily confined to the surface, and ge- 
 nerally ending in ulceration.f 
 
 Order 3. Glandttlares. — Specific actions, producing a 
 change in the quality and appearance of some natural secre- 
 tion, which is, at the same time, generally increased in quan- 
 tity.J 
 
 Order 4. TJlcerantes. — Actions consisting in simple 
 ulceration of a part, without any specific condition being con- 
 joined.|| 
 
 Order 5. Connatje. — Morbid actions which are re- 
 ceived at conception.** 
 
 Order 6. Narcotics. — Actions producing frequency 
 of pulse, stupor, or sleep, with a disturbance of the imagina- 
 tion, and an inflammatory or hemorrhagic action of the brain, 
 if excited to a sufficient degree. ff 
 
 * Such as small-pox, measles, scarlatina, cow-pox, &c. 
 
 f Such as syphilis, cancer, elephantiasis, frambcesia, phagedena, &c. 
 
 X Gonorrhoea belongs to this order. 
 
 H This order comprehends ulcers, succeeding to simple inflammation, which may 
 properly enough be placed under the class Mixta, as the granulating action is' a 
 natural one, and the purulent action an unnatural one. 
 
 *** Such as scrophula. 
 
 ■■ff Such as the actions of opium, hyocyamus, belladona, &c. 
 
7& 
 
 Order 7. Diminutje, — The natural action chronically 
 impaired, and some peculiar or specific action conjoined.* 
 
 Order 3. Adaucta. — An increase of some function, or 
 part of the natural action, conjoined with some specific con- 
 dition.f 
 
 Order 9. Irritate. — Increased and specific actions of 
 the system, productive of local inflammation, if excited to a 
 sufficient degree.J 
 
 CLASS VI. 
 A. Meniales. 
 
 Morbid conditions, seated either entirely in the mind, or 
 operating on the body, through the influence of the mind, or 
 on the mind, through the influence of the body. 
 
 Order 1. Idiopathic^. — Conditions consisting entirely 
 in some mental derangement, without any considerable altera- 
 tions in any of the functions of the animal. 
 
 Order 2. Corporeje. — Alterations in the functions of 
 the body, in consequence of some morbid operation of the 
 mind. 
 
 Order 3. Symptomatica. — An affection of the mind, 
 dependent on some disease of the body. 
 
 * Such as scorbutus. 
 
 •j- Pertussis, diabetes, &e. 
 
 $ This differs both from the order Inflammatse and the order Stimulantes, by 
 having a specific action conjoined with the general or local increase. It compre 
 tends the actions of mercury, arsenic, copper, nitrous acid,&c. 
 
79 
 
 Every new or morbid action has naturally a certain course 
 which it is inclined to run, or a certain series of symptoms or 
 effects which must be produced, before it can be removed. 
 When this course is accomplished, and the action has become 
 complete, many of them disappear, and the natural action re- 
 turns in perfection. This is illustrated by the actions of 
 wine, of common inflammation, of mercury, and of typhus 
 fever. Others, as, for instance, intermitting fevers, having 
 run one course, begin another, exhibiting a series of alterna- 
 tions betwixt health and disease. In syphilis, again, and 
 some other diseases, we find, that the action, when completed 
 and made perfect, continues in that state without diminishing 
 or disappearing. 
 
 By a knowledge of the facts already mentioned, we cure 
 diseases, or remove dangerous actions. Certain actions, we 
 have seen, disappear spontaneously, after having run their 
 course : These we may, therefore, either altogether neglect, 
 or, if this be imprudent, on account of their violence, we 
 may attempt to make them run their course more speedily. 
 When a part becomes inflamed, we find, that the symptoms 
 continue increasing for a time, and then lessen, leaving the 
 part either healthy, or in possession of another action, called 
 the purulent. In this disease, then, we have an augmentation, 
 an acme, and a decline. When we attempt to diminish this 
 action, we make that period, in which we begin our treatment; 
 the acme, and the subsequent one the decline. In this case, 
 it is often, though not always, comparatively speaking, of 
 little consequence, whether we endeavour, by art, to com- 
 plete the action speedily, or allow it to follow its course more 
 extensively and tediously. But, in the typhus fever, the 
 danger is always increasing, in proportion to the duration of 
 the action ; and, therefore, we ought, if possible, to complete 
 it speedily. This we endeavour to do, in the very begin- 
 
80 
 
 aing, by an emetic, which, inducing the hot and sweating 
 stages, often terminates the action. 
 
 There are other actions, however, which, we have seen, 
 have no tendency to disappear, after all the stages are gone 
 through. Of this kind, amongst many others, are intermit- 
 tent fever and syphilis. In these diseases, then, we must 
 unavoidably follow, in every instance, that course, which, in 
 inflammation, we may or may not pursue, as circumstances 
 direct ; namely, diminish the morbid action, by artificially re- 
 storing the natural one. In inflammation of strong parts, we 
 might, by induction, discover the method of restoring health; 
 for, if the disease consists in the natural action, increased to 
 such a morbid degree as to change its nature, it is plain, that 
 whatever would, in health, diminish the natural action, must 
 here be of service. But, in the cure of the diseased actions 
 at present under consideration, we can derive no such assist- 
 ance from reasoning or judgment, because we are not so well 
 acquainted with the nature of these actions. We have, ac- 
 cordingly, been altogether indebted to empyrism for a cure ; 
 but now, that the remedies are discovered, we can ascertain 
 the principle on which we proceed. In these diseases, it is 
 impossible to restore directly the natural action ; because the 
 morbid one will not yield to it. We are, therefore, obliged 
 to destroy the diseased action, by inducing another which is 
 able to displaee it, in the same way as it had removed the 
 natural one. But this is not all which must be done ; for we 
 should still have only exchanged one disease for another, 
 unless we had been careful to remove the first and obstinate 
 diseased action, by another which would disappear, after 
 having run its course, and allow the natural one again to ap- 
 pear.* To apply this to syphilis ; it may be observed, that 
 
 * Jn the cure of diseases, we ought not only to attempt removing the mor- 
 feid action, by inducing such another general condition as shall answer our in- 
 tention ; but also, to attend to the removal of particular symptoms of the ac- 
 
ai 
 
 the nuarcurial action is as dissimilar to the venereal action, as 
 this last was to the natural one ; and, therefore, will remove 
 it in the same way, and exactly on the same principle on 
 which the venereal action had taken place of the natural one. 
 This being done, the patient is cured of one disease, but still 
 labours under another, namely, the mercurial action. When 
 this subsides, he is well. In the same way, bark, arsenic, 
 &c. cure agues. 
 
 Unfortunately, we are not able practically to apply this 
 doctrine to the cure of many diseases ; but this inability re- 
 sults not from any fault of the doctrine itself, but from our 
 own ignorance of the nature of various actions, which pre- 
 vents our opposing one to another with success.* Antimo- 
 ny has, by some, been proposed for removing the typhus ac- 
 tion, cicuta for removing the cancerous disease, whilst the 
 scrophula has been promised to be cured by the muriated 
 barytes, and the small-pox to be prevented by mercury. 
 But melancholy experience testifies the inefticacy of all these 
 proposals, and the impossibility, as yet, of inducing an action 
 capable of displacing these terrible diseases. 
 
 tion, which will much co-operate with our general plan. In those actions, 
 which we cannot yet cure by general remedies, we are confined entirely to 
 this removal of symptoms ; and a proper interference, in this respect, by the 
 application of such remedies as shall do so, without, at the same time, tending 
 to increase the morbid action, considered as a whole, requires the greatest dis- 
 cernment of the physician. In fevers, and many other diseases, people are 
 .much weakened; but he who should, from the beginning, attempt to obviate 
 this by wine, would find the general action much increased by it, and his 
 patient rendered worse. 
 
 * It is a great loss to medicine, that distinctions have carefully been made 
 betwixt what are called diseases, and what are called remedies. Do not the 
 agents called medicines, and those which produce what we call disease, act 
 all on the same principle ? Do not both .-lasses produce diseases, or unnatu» 
 ral actions ? Might we not sometimes derive benefit from the actions which 
 we call diseases, and which, in this case, we should find to be useful remedies ? 
 This has, in part, been admitted by many, who have wrote on the good effects 
 <»f fevers in removing other diseases. It would, however, be requisite, that we 
 should never induce a more dangerous action, in ordet ir destroy one les?. 
 V"OL. I. L 
 
82 
 
 To conclude these observations, I may remark, that, al- 
 though we may remove one action by inducing another, yet 
 this cannot be done, un'iil the first has gone through all the 
 essential stages to become perfect. Thus, mercury will not 
 cure the venereal action, until inflammation, which is essen- 
 tial to the perfection of that action, has taken place. The 
 typhus action cannot be removed, without sweating, or mois- 
 ture on the surface, or some other secretion. The natural 
 action, being always at its acme, or always complete, can be 
 removed at any time ; and the same may be said of the in- 
 flammatory. 
 
 Of the different Systems of Pathology. 
 
 From what has l>een said, it may appear, that we are to 
 ascribe both the health and disease of an animal to the ope- 
 ration of the living principle. Until within these few years, 
 however, physicians have been too apt to imagine, that the 
 diseases of man were similar to the changes induced on com- 
 mon matter, referring them entirely eilher to an augmentation 
 or diminution of his fluids, or to a depravation of the hu- 
 mours. 
 
 The different fluids of the body were all divided, by the 
 ancients, into the natural, the secondary, and the unnatural 
 humours. The natural humours, they said, were four in 
 number : First, the phlegm, or pituita, which was prepared 
 from cold and crude aliment, and in greatest abundance in 
 old age, or the winter season, when the low degree of heat 
 favoured its production. This pituila was formed in the 
 brain, from whence it descended, to lubricate the joints, and 
 dilute the blood : It ftom ished and supported the brain, 
 and the cold parts of the body.* Second, the choler, or 
 
 • The different parts of the body were supposed to be either hot or cold, dry 
 
83 
 
 yellow bile, ..which was prepared in the liver: It was of a 
 very hot and fiery nature ; and, therefore, nourished the hot 
 parts, at the same time that it corrected the pituita, and 
 purged the intestines. Third, the atra bilis, or melancholic 
 humour : This was prepared in the spleen, which it nourish- 
 ed, as well as the drier parts of the body ; it likewise pro- 
 moted appetite. Fourth, the blood, which was prepaied in 
 the liver, from whence it was sent to all the different parts 
 of the body, going out by day to the extremities, and return- 
 ing by night to the more noble parts.* 
 
 These humours were supposed to operate more at one 
 time than another, or to reign alternately ; and, upon this 
 conjecture, they explained, why certain diseases were worse 
 at particular hours ; the humour which produced them being 
 then in its greatest force. The blood reigned from three 
 o'clock in the morning until nine ; the choler, from nine in 
 the morning until three o'clock in the afternoon ; the black 
 bile, from this hour until nine in the evening ; and the pitni- 
 ta, from nine until the blood began again its reign. 
 
 The secondary humours were the invention of the Arabi- 
 ans, and were said by them to be the different steps toward 
 nourishment : They were furnished by the blood, when it 
 came to the part which was to be nourished. 
 
 ov humid. The brain was one of the cold parts, and was supposed, by Aristotle, 
 to moderate the heat of the heart. Aristot. de Part. Anim. cap. vii. lib. 2. 
 
 * " Mundus quatuor ex elementis consistit, igne, aere, terra, et aqua : calido 
 videlicet huinido, frigido, et sicco. lisdemex elementis quatuor totidemque humo- 
 ribustt homo consistit ; sanguine scilicet, pituita, flava, et atra bili. Et sanguis 
 quidem aeri, pituita aqua?, flava autem bilis igni, atra veroterrae simulatur. San- 
 guis enim gu;tu dulcis est ; pituita, salsa ; flava bilis, amara ; atra vero ascetosa, 
 et flavescens. Sanguinis autem locus, et spiritus in corde est. A dextris quidem 
 ejus sanguis, a sinistris vero, spiritus consistit. Flava? bilis in jecinore ; atrae in. 
 lierte ; pituita quidem in cerebro, locus. Sanguis autem calidus et humidus; pitui- 
 ta frigida et humida j A ava bills, calida et sicca ; atra vero sicca et frigida." 
 
 Hippocr. dt Horn, Struct ad Perdicam, Sec. 
 
84 
 
 The unnatural humours were those which were perverted 
 and diseased ; and then, whatever might have been their 
 former quality, they become hot. The blood* and melan- 
 choly corrupted only in the veins ; the other two humours 
 corrupted out of the vessels. 
 
 These humours were supposed to possess different quali- 
 ties, which they communicated to the body, and upon which 
 depended the peculiar properties of the body, considered 
 either as a whole or a part. These states were called con- 
 ditions, or temperaments, or constitutions ; terms which are 
 still retained, and meant to express the peculiar habit of 
 body ; as, strong, weak, scrophulous, &c.f 
 
 The peripatetics, by the term temperament, or temperies, 
 meant the condition of the body, with regard to the propor- 
 tion of elements which it contained. The blood was said to 
 be hot and moist ; melancholy, cold and dry ; choler, hot 
 and dry ; phlegm, cold and moist. According, then, as 
 these humours preponderated, the body was said to possess a 
 cold, hot, dry, or moist quality, condition, or temperament : 
 And as these states were produced by the presence of the 
 humours, physicians at last came to name the temperament, 
 from the humour which produced it, instead of the quality 
 which it imparted. Thus, we had the sanguineous, choleric 
 (or bilious,) melancholic (or atrabilian,) and phlegmatic (or 
 pituitous) temperaments, with many admixtures of each 
 other, as, for instance, the sanguineo-choleric, &c. 
 
 When the doctrines of the ancients came to be more fully 
 commented on, the temperaments were more minutely sub- 
 
 * When the blood corrupted in its thicker part, it turned into melancholy ; but 
 when its thinner part was in fault, then it became choler. 
 
 t Instead of adhering to the old names, which depended upon the ancient theo- 
 ries of physic, practitioners have substituted a variety of new ones, corresponding 
 to their own opinions ; such as, phlogistic, caheetic, sthenic,, asthenic, irritabje. , 
 
85 
 
 divided and explained. The temperies bona consisted, in a 
 due proportion of all the qualities capable of being possessed 
 by a body ; such as, heat, cold, dryness, moisture, density, 
 rarity, hardness, softness, viscidity, volatility, &c. The tem- 
 peries was called moderate, when the qualities were of a mo- 
 derate degree ; immoderate, when they went beyond mode- 
 ration. It was called total, when it affected the whole body ; 
 and this, again, was divided into the sanguineous, melancho- 
 lic, bilious, and pituitous, according as these humours pre- 
 dominated. It was called partial, when the condition of dif- 
 ferent parts was considered individually. Thus, the brain 
 was cold and moist ; the heart, hot and moist ; the bone, 
 dry and cold ; and a regular gradation, or series of changes, 
 was established betwixt these, consisting of parts which pos- 
 sessed these qualities in an intermediate degree ; the carti- 
 lage, for instance, was not so dry or cold as the bone, &c. It 
 was called native, when it was received at conception ; com- 
 municated, or unnatural, when changed after birth : And 
 the chief causes which induced these changes, were age, the 
 season of the year, climate, and habits. It was called per- 
 manent, when it depended on the formation of the part ; 
 temporary, when it depended on the fluids. 
 
 The intemperies, or bad temperies,* was divided into the 
 manifest and occult. The manifest was either simple, when 
 only one quality was morbidly increased, producing the 
 warm, dry, or cold intemperies, for example ; or complex, 
 when more than one was in fault, producing the dry and hot 
 intemperies, Sue. The occult was produced by some hidden 
 vice ; such as poison, contagion, &c. 
 
 Besides the natural humours, upon which the tempera- 
 ments depended, and which were the cause of most diseases, 
 
 * " Bona temperies est pars sanitatis, quse in qualitatum conveniente constitu- 
 tione consistit." — " Intemperies est morbus, qui in qualitatum colons inconveni- 
 entia consistit." Regii Lib. Med. p. 5. et 21. 
 
86 
 
 the ancients likewise admitted the existence and operation of 
 three different spirits, the natural, the vital, and the animal ; 
 and also the same number of faculties, called by the same 
 name, which were the efficient causes of the different actions, 
 in the performance of which the spirits were the instru- 
 ments. 
 
 The natural spirit was supposed to be some fine exhalation 
 from good blood, or some very delicate substance, prepared 
 in the liver, from the blood and air.* This was the thickest 
 and poorest of all the spirits, and was contained in the veins : 
 It was the source of nutrition, and conducted the blood 
 and natural faculty to all the different parts of the body. 
 Some physicians, from considering, that no air could reach 
 the liver, or, if it did, that there were no cavities in it, to 
 form the natural spirit, doubted of its existence, and were 
 confirmed in their scepticism, by observing, that there were 
 no ducts leading fiom the liver capable of conveying it away ; 
 for they could not believe, that the thin coats of the veins 
 could contain it. These difficulties, however, were readily 
 overcome ; for, as Hippocrates had declared, that " omne 
 corpus transpiiabile est et transfiuxile," it followed, that the 
 air might reach the liver, through the diaphragm ; and as this 
 spirit was thick, it followed, that the veins might contain it ; 
 and, being slowly produced, that no cavity was requisite for 
 its formation. 
 
 The vital spirit was prepared in the left side of the heart, 
 from air and blood ; and it was ihis union which produced 
 the pulse. Physicians readily explained, how the air, taken 
 in by inspiration, was prepared in the lungs, and conveyed, 
 by the arteria venosa, or pulmonary vein, to the left auricle 
 of the heart : But they found it more difficult to settle the 
 
 * Every spirit was supposed to be formed from the blood, the thickest parts 
 farming the lowest kind of spirit. These spirits were called the vehicles, through 
 which the different faculties operated. 
 
87 
 
 controversies which arose concerning the way in which the 
 blood reached that cavity. According to Galen, the blood un- 
 derwent some attenuation and preparatory change in the 
 right side, whence part was sent, by the pulmonary artery, 
 to nourish the lungs ; while the rest was transmitted, through 
 small foramina in the septum, to the left side. Columbus de- 
 nied these pores to exist, and maintained, that the blood 
 went from the one side to the other, by the circulation, which 
 is now admitted and established as a fact. Botallus invented 
 a particular duct for this purpose ; whilst Ulmus laughed at 
 all these conjectures, and taught, that the blood underwent 
 its preparatory change in the spleen, from which, by means of 
 the aorta, it reached the left side of the heart. The blood and 
 the air having, then, by some means or other, got together, they 
 formed the vital spirit, which was contained in the arteries, 
 where it could be felt bounding and jumbling, and by which it 
 was conveyed to every part of the body, vivifying and pre- 
 serving those parts which had been already formed by the na- 
 tural spirit- " It maintains the heat, (says Laurentius,) brings 
 out whatever is lurking, and recruits the exhausted. It 
 shines by its own light, and displays itself in every part of 
 the theatre of the human body ; and, being diffused over it, 
 every part rejoices, and appears with a rosy colour. When 
 destroyed or intercepted, the whole shivers, becomes pale, 
 and dies."* 
 
 The animal spirit was tbe finest of all, and could not be 
 confined within the coarser vessels. It was supposed, for a 
 long time, to be prepared in the anterior ventricles of the 
 brain, from the vital spirit, which ascended by the carotid 
 and cervical arteries, and the air which was taken in by the 
 nostrils during respiration. That this was the case was con- 
 
 * I.aurentii Opera, p. 509. 
 
83 
 
 sidered lo be proved ; because, whether the carotid Were 
 tied, or the breath of the nostrils stopped, the same effect, 
 namely, apoplexy, was produced, the generation of this spirit 
 being, in both instances, equally checked. When the circu- 
 lation of the blood was discovered, and the arteries were 
 found to be full of arterial blood, then this doctrine of the 
 ancients was new-modelled- The arterial blood, which was 
 full of spirit, was sent, by the vessels, to the brain, where its 
 watery part was separated, and passed off by the pituitary 
 gland, whilst its spirit, or finer part, formed the animal 
 spirit.* 
 
 Some denied the existence of this spirit, and thought that 
 the vital spirit was sufficient for the operation of the body. 
 Amongst these was Argentei ius, who accused Galen of in- 
 accuracy and contradiction; because, in one place, he at- 
 tributes the generation of this spirit to the blood ; in another, 
 lo the air ; and in a third, to the vital spirit, which was said 
 to form it, at one place, in the anterior ventricles ; at another, 
 in the plexus, or substance of the brain. But Laurent iusf 
 undertook to do away all these objections, and reconcile the 
 apparent contradictions, by observing, that as the blood was 
 necessary for the production of the vital spirit, and this 
 spirit and air necessary for the generation of the spirilus ani- 
 malis ; therefore, all the three might properly be mentioned 
 by Galen ; and as for the objection, on account of the differ- 
 ent places in which it was said to be produced, this also was 
 a quibble ; because it was prepared in the plexus and anterior 
 ventricles, refined in the third ventricle, peifected in the 
 
 -' De le boe Sylvius Opera Medica, p. 20. 
 
 •J- Laurent. Opera Omnia, p. C52. — This author was particularly angry at Ar 
 genterius, because he had denied, that the fluid which came down the nose, was 
 the peculiar excrement of the brain, but was generated in the liver. " Meher- 
 cule, (says he,) iu doctiina Argcnterii nullus est iufuadibuli. et gtanduhc pituita- 
 ike in ccrebro tcmperati.-dmo usus." p. Gb'4. 
 
89 
 
 fourth, and diffused finally through all the substance of the 
 brain and nerves. 
 
 This spirit, says Van Helmont, is the impetum faciens of 
 Hippocrates, which holds the key of life in its hand. In the 
 brain, it produced what are called the internal senses ; when 
 carried out of it by the nerves, it was the cause of motion, 
 and the external senses. It has been already mentioned, 
 that it was equivalent to the nervous energy of the modern 
 schools. 
 
 Upon these humours and spirits, then, did the ancients 
 found their system of physic.* Obstruction to the free mo- 
 tion of the animal spirit, produced palsies, apoplexies, and 
 convulsions ; whilst, when the vital spirit was affected, the 
 heat of the parts, and their life, could no longer be support- 
 ed, and mortification took place. A redundancy of blood 
 produced phlegmon : The pituita caused dropsy ; or, when 
 the blood was full of it, from " multiplied crudities," then 
 it fell upon the joints, and swelled them : The choler pro- 
 duced jaundice, dysentery, and erysipelas ; whilst the atra 
 bilis, or melancholic humour, caused cancers ; and, by " its 
 fuliginous vapours ascending to the brain," brought on many 
 disorders. These diseases were produced chiefly by an in- 
 creased quantity of these humours ; but, when they corrupt- 
 ed or changed, then no one pretended to estimate the evil 
 which might follow. Nay, not satisfied with corrupting them- 
 selves, these humours enticed foreign contagions to combine 
 with them, the venereal virus lurking in the pituita, whilst 
 the measles lodged in the choler. 
 
 The practice which naturally followed from this theory, 
 was to expel the morbid humour ; but this they could not do, 
 until by remedies, or the process of nature, it was concocted' 
 and prepared for evacuation. 
 
 * Disease, said they, is produced, by either a bad temperies, or by mfalfenrij- 
 tion of a part. 
 
 VOi. I> M 
 
90 
 
 Although these were the prevailing doctrines concerning 
 the cause of diseases, in the ancient schools, yet most phy- 
 sicians admitted the co-operation of an intelligent principle.* 
 To this principle, Hippocrates gave the name of nature, 
 which he considers as of an excellent, and almost divine 
 quality. This principle, we are informed, is heat ;f by 
 which term, however, we are not to understand him as mean- 
 ing common fire, but a principle sui generis ; for the ancients 
 used this term in a very extensive sense. Thus, Aristotle:}: 
 tells us, that the soul of man is heat ; but cautions us from 
 believing, that he means exactly any thing which we have 
 ever seen in another situation. By comparing some passages 
 of Hippocrates with each other, and with the writings of the 
 philosophers who lived about that time, we shall find it to be 
 most probable, that, by the operations and interference of na- 
 ture, he meant the agency of the soul ;|| a doctrine which 
 
 * " Mediciaa id quod molestat tollit, id a quo homo aegrotat auferens, sanuia 
 facit. Natura eadem sua sponte novit." Hip.de Dieta. 
 
 j The original theory of animal heat, was, that a calor nativus, or innate heat, 
 existed in the left ventricle of the heart, which went out by the vessels, and sup- 
 ported the body. 
 
 t " There is a certain animal heat diffused through the universe, so that all 
 things are, in a manner, full of mind ; on which account, they may be quickly 
 completed into animals, when they have received a portion of this heat. This is 
 not fire, nor any thing like it, but a spirit which is in the semina, or elementary 
 principles of bodies." Aristotle de Generut. A?iim. lib. iii. c. 11. et lib. ii. c. 3. 
 
 jj The left ventricle is larger than the right, and is, as it were, gnawed. " Nanfe 
 insitus a natura iguis non est in dexti#. — " Mens enim hominis in sinistro ven- 
 triculo insita est, et reliquae animfe imperat." De Corde. 
 
 " Et videtur sane mibi id quod calidum vocamus, immortale esse, et cuncta in- 
 telligere, et videre, et audire, et scire omnia turn praesentiii turn futura." 
 
 . De Carnibus. 
 
 " Ignis enim omnia peF omnia movere potest. De Dieta. 
 
 Some were unwilling to admit, that Hippocrates really supposed that the soul 
 had its seat in the breast, and imagined, that he either said so incompliance with 
 common language, or because the great instrument of the mind (heat) resided 
 there : But by comparing his words with the ideas of Aristotle, concerning the 
 nature of the soul, it will appear, that he really believed the heart to be the seat 
 Of the aniina, although its mental operations, or faculties, were exercised in the 
 
91 
 
 was more expressly repeated by StaW, and adopted by 
 Mead,* and many of the more modern physicians. 
 
 The notion of all the humours being diseased, was at last, 
 in a great measure, overlooked, or attended to only by the 
 bye ; and the state of the blood began to be considered as 
 almost the only immediate cause of disease. The pathology 
 of Sydenham was founded entirely on the condition of the 
 blood, and the operation of the vis medicatrix naturae. 
 When a contagion was introduced into the blood, then nature 
 excited a fermentation, in order to concoct, and finally expel 
 it. This she did, sometimes quickly, sometimes more slow- 
 ly, generally by the help of a fever, terminating by looseness, 
 or sweating. But in this, as well as in every other theory 
 which admits the assistance of nature, we find, that the cause 
 of the disease is most ridiculously misapplied ; for they by no 
 means prove, that the peccant matter taken into the blood, 
 would of itself be fatal ; but they most abundantly allow, 
 that the interference of nature, which excites a dangerous 
 disease, is often mortal, and, not unfrequently, the cause of 
 the most lasting calamities. " What is gout, (says Syden- 
 
 brain ; and also, that the anima consisted of a somewhat, which he denominated 
 heat. 
 
 Anaxagoras, more decidedly, said, that nature was the mind or soul, " mentem 
 appellat." Galen said, that nature was a warm spirit, "Natura item est spiritus 
 ualidus." Zeuo, more bold, declared it to be common fire. 
 
 * " Such is the composition of our fabric, that when any tiling pernicious has 
 got footing within the body, the governing mirJd gives such an impulse to those in- 
 struments of motion, the animal spirits, as to raise those commotions in the blood 
 and humours, which may relieve the whole frame from the danger in which it is 
 involved." On the Small Pox. 
 
 In pestilential fevers, " the mind hurries to the assistance of the labouring 
 frame, fights against the enemy," &c. Med. Precept. 
 
 " Quis non videt in acutis pulsum vibrare vehementius, sanguinem fervfire, 
 turbari omnia ? Haec ipsa vero virtus natune est, qu<e alienum et cruduni sic po- 
 tentius subigit et suis nocendi viribus exuit, vel si exnere penitus non potest, ne 
 novas turbas moliatur,tanquam indignum arvis suis caloruin variis viis inter criti- 
 pa, ut vocant, molimina expellit." RichUri Opxtscula^ torn, i. p. 313. 
 
62 
 
 ham,) but a contrivance of nature to purify the blood of old 
 men, and to purge the deep parts of the body." Few peo- 
 ple would thank Dame Nature for this friendly purgation. 
 
 The idea of concoction, and assimilation, was likewise 
 adopted by Boerhaave, and is taught still by some modern 
 authors. But this great physician called in the additional aid 
 of other principles, namely, the viscidity and lentor of the 
 blood, and the error loci of its globules. This doctrine, 
 which will be more particularly illustrated in the theory of 
 inflammation, had, in its principle, occurred to Asclepiades, 
 who made disease consist in a want of proportion betwixt his 
 atoms and the pores through which they were to pass. 
 These doctrines of the origin and cause of disease, produced 
 the most unhappy practice. Venesection, emetics, purges, 
 and sudorifics, were rapidly prescribed, one after another, to 
 avert the danger, and the urine carefully 'examined, to mark 
 the progress of the concoction ; whilst ^uch remedies as 
 tended more effectually, and directly, to check the disease, 
 were proscribed and forbid, because they produced no sen- 
 sible evacuation. 
 
 The whole of these conjectures were evidently founded" 
 upon ignorant and mistaken views of the animal economy. 
 Unacquainted with the true laws of the living system, they 
 reasoned upon the supposition of the blood being subject to 
 the same changes, when circulating in the vessels of a man, 
 as when collected and preserved in their phials and matrasses. 
 They knew not the true* history of our functions, nor the 
 real cause of all the varied phenomena of life. Their heads 
 were full of nothing but spirits, and humours, and ferments ; 
 and their systems were built entirely on plethora, and inani- 
 tion, and cacochymy. 
 
 When, at last, they began to see more clearly the agency 
 of the nervous system, and to abandon their belief in the co- 
 operation, of different spirits to produce the actions of life a 
 
93 
 
 they found it necessary to allow, that diseases have their 
 chief seat in the nervous system ; but being sill unwilling to 
 give up their favourite doctrine of morbid humours, they as- 
 serted, that these still existed, but operated through the me- 
 dium of the nervous energy. Hoffman maintained the seat 
 of diseases to be in " ihe living solid ;" but avowed the 
 agency of diseased blood. Cullen, who improved this theo- 
 ry, acknowledged, in many instances, the derangement of 
 the fluids : Nor is there almost any system, even in the pre- 
 sent day, in which it is not more or less allowed. 
 
 That medicines may, in several instances, be absorbed, 
 and mixed with the blood, will be allowed by all ; but that 
 they thus exert the whole of iheir influence, cannot be ad- 
 mitted ; nor will it, by any means, be considered as true, 
 that either medicines, or contagions, act by changing the na- 
 ture, or altering the properties of this fluid, until it be proved* 
 that the blood is not circulating in vessels possessed of a 
 power of acting on it, and until it be established, that the 
 blood is completely an extraneous substance, subject to all 
 the laws of foreign matter, and making no part of the living 
 system. That in disease the blood does change, to a certain 
 degree, is ascertained ; but these changes are not the con- 
 sequence of any direct action upon it, by contagions, or me- 
 dicines; they are analogous to the alterations which take 
 place in the rest of the system, and depend upon the same 
 cause, namely, a general affection of the living principle. 
 One of the most evident changes induced upon the blood, 
 and one which might be supposed to favour the doctrine of 
 chemical changes, being induced directly by contagion, is its 
 conversion from veinous into arterial, and from arterial into 
 veinous ; but even these changes are very far indeed from 
 being proved to depend upon chemistry, independently of 
 the living principle. It is considered as proved, that the 
 veinous blood is rendered arterial, by the oxygen of the at- 
 
94 
 
 mosphere being combined with certain principles of the 
 blood, and carrying .hese off, and that it is again rendered 
 veinous, by the addition of these substances ; but it is far 
 indeed from being proved, that these combinations, and ad- 
 ditions, take place independently of the action of !he vessels ; 
 nor is it even ascertained, that the use of respiration is to 
 purify the blood from these substances. Had this been all 
 which was requisite, they could have been removed by some 
 particular excretion, as we see, in part, exemplified in the 
 formation of the bile. The production and extrication of 
 these substances, are, however, very much connected with 
 the process of respiration ; for, we find, that whenever the 
 arterial blood is converted inio veinous, which transition 
 takes place suddenly, certain substances are found in it ; and 
 these again are evolved, during the instant of its being 
 changed into arterial. I formerly mentioned my supposition 
 of the production of vitality being the main intention of the 
 Function of respiration. This principle seems to be yielded 
 to the nerves, by the minute arteries ; and, at the same in- 
 stant, the blood becomes black and veinous. There is then 
 this connexion betwixt the purification of the blood from car- 
 bone and hydrogene,* and the arterialization of it, or the 
 furnishing of the vital principle, that both take place at the 
 same time, and that the one process is, perhaps, instrument- 
 al in producing the other, f 
 
 The blood is to be considered as a living substance, pos- 
 sessed of peculiar properties, and endowed with the power 
 
 * Some deny that hydrogene is found in the Wood ; but other experiment* 
 prove, that it does make a part of veinous blood. 
 
 t In the foetus, these changes on the blood took place without the assistance of 
 the air, by the peculiar operation of the placenta, in which the blood is both 
 freed from its carbone and hydrogene, and likewise acquires vitality, and the ma- 
 terials of nourishment. Some suppose, that this depends upon the foetal blood 
 coming in contact with the maternal in the placenta ; but this is by no means 
 proved. 
 
95 
 
 of preserving its specific nature, in common with other bodies. 
 It is only whilst it remains in this living state, that it is use- 
 ful to the system ; for, if its nature be changed, it is no long- 
 er that fluid which is requisite for life. It cannot even be 
 rendered all veinous, which is the most natural and easy 
 change which it can undergo, without immediate death being 
 the consequence to the animal. How unphilosophical, how 
 absurd, then, must it be, to talk of fermentations, assimila- 
 tions, and putrefactions of the blood ; and how thoroughly 
 ignorant of the animal economy must they be, who can use 
 such language, or have recourse to those miserable explana- 
 tions of the cause of disease ! 
 
 From the whole of these considerations, we may reasona- 
 bly conclude, that we are to look for the origin and seat of 
 disease, not in the ideal habitation of humours and spirits, 
 not in the chemical changes or fermentations of the blood, 
 but in the nervous system. 
 
 Some of those who attended most to this system, attri- 
 buted much to spasmodic actions ; some admitted peculiar 
 and varied actions of the nervous system; whilst others re 
 ferred disease entirely to the different degrees of excitement, 
 as they called it, of the living principle. 
 
 The first of these suppositions was very ably supported 
 by Dr. Cullen, who believed, that, in many instances, the vis 
 medicatrix natura*, in order to get quit of some noxious pow- 
 er, formed a spasm on the extreme vessels, the consequence 
 of which was, an increased action of the heart and arteries, 
 in order to overcome this, and cure the disease.* How far 
 this theory explains the different circumstances attending in- 
 flammation, and, consequently, how far it is founded upon 
 facts, and good reasoning, will afterwards come to be con- 
 sidered; and, therefore, to prevent repetition, I shall only 
 
 * Ffrst lines, &c. vol. i> chap.fi. 
 
96 
 
 observe, in this place, that the Cullenian doctrine is subject 
 to this objection, in common with others, which admit the 
 operation of an intelligent principle in the cure of diseases ; 
 that the whole series of dangerous symptoms, or, in other 
 words, the disease itself, is produced, not directly by the ap- 
 plication of hurtful agents, but by the supposed interference 
 of the healing power of nature, quod erat absurdum. 
 
 Mr. Hunter has given us no regular system of pathology ; 
 but, by gleaning his works, we learn, that he considers, first, 
 that every operation of the body is an action of the living 
 principle ;* second, that no two actions can take place at the 
 same time, and in the same part, more than two different mo- 
 tions in a piece of matter ;f third, that a disease is pro- 
 pagated from a £art to the whole, by means of the sympathy 
 which exists through the whole body, by the diffused prin- 
 ciple of life. This principle " is, as it were, diffused through 
 the whole solids and fluids, making a necessary constituent 
 part of them, and forming with them a peifect whole, giving 
 to both the power of preservation, the susceptibility of im- 
 pression, and, from their construction, giving them conse- 
 quent reciprocal actions. This is the matter which prin- 
 cipally composes the brain."J 
 
 Upon the two first propositions I shall make no remark, 
 because I have already endeavou ed io establish and illustrate 
 them. They are, in my opinion, the most rational foundation 
 upon which a system of physic can be reared, and are so 
 self-evident, that they occurred o me soon afiei I began to 
 study medicine, and before I had any oppo. tunuy of know- 
 ing that they were proposed by Mr. Humer. Upon ,he 
 third proposition, I have only to repeat the remark which I 
 formerly made, that it teaches a very confined idea of life, 
 
 * Hunter on the Blood, &c. p. 3. 
 
 f Ditto. 
 
 1 Ditto, p. 69 
 
97 
 
 which, according to this supposition, can only be. united with 
 a certain structure, the existence of which, in many cases, is 
 far from being proved. 
 
 Dr. Brown attempted to simplify medicine, and reduce 
 every disease to one of two causes.* He began by observ- 
 ing, that " a certain quantity of excitability (or living prin- 
 ciple) is allotted to every one at birth."f — " That this is 
 acted upon by different powers, which are termed exciting 
 powers ; and their effect on the excitability is called excite- 
 ment."^: — " This mutual relation obtains betwixt excitability 
 and excitement, that the more weakly the powers have acted, 
 or the less the stimulus has been, the more abundant the ex- 
 citability becomes ; the more powerful the stimulus, the ex- 
 citability becomes the more exhausted."|| — " In both of these 
 circumstances, weakness takes place, which, in the first case, 
 is called direct, in the second, indirect."** — " It is the ex- 
 , citement aloney through its varying degrees, that produces 
 either health, disease, or recovery."ff — " The general dis- 
 eases, arising from excessive excitement, are called sthenic ; 
 those that originate from a deficient excitement, asthenic. 
 Hence there are two forms of diseases, and both are always 
 preceded by predisposition."JJ — " That this is the only 
 real origin of diseases and predisposition,||!| is proved, by 
 the same powers which produce any disease or predisposi- 
 tion, also producing the whole set of diseases to which it be- 
 longs ; and by the same remedies which cure any disease or 
 
 * This doctrine had, in its principle, occurred to Themison, the founder of the 
 Methodic sect, who maintained, that diseases depended upon either an overbra^ 
 Sag or a relaxation of the system. 
 
 f Elements of Medicine, Par. xviii. p. 7. 
 
 \ Par. xvi. p. 'j. \\ Par. xxiv. p. 13. 
 
 ** Par. xxxv. and xlv. ft P ar - kdi« p. 50. 
 
 \\ Par. lxvi. 
 
 ||!| " Predisposition is a state intermediate betwixt perfect health and disease. 
 The powers producing : .' are the same- with thosp which pro^irp disease." Pa*- 
 Ixxiii. p. 59. 
 
 rot. !<• S 
 
predisposition, also curing all the diseases and predisposition* 
 of its respective form."* The operation of all contagions 
 is stimulant, and " no remedies, but those that cure diseases 
 produced by the usual noxious powers, remove those sup- 
 posed to be induced by contagion."! — " Though. the fluids 
 may be corrupted, yet this is not a cause, but an effect of 
 weakness. Wine, bark, &c. by strengthening the vessels, 
 purify their contents."^: In the indication of cure, the only 
 regard to be had to morbific matter, is to allow time for its 
 passing out of the body ; and that, whether it stimulates or 
 debilitates, or gives the peculiar form to the disease, thereby 
 adding a local to a general complaint ; for, if the general dis- 
 ease be properly healed, the eruptions, inflammation, ulcers, 
 will give way to the happy effects of the general cure.|| 
 
 To conclude, " the whole and sole province of a physician, 
 is not to look for morbid states and remedies, which have no 
 existence, but to consider the deviation of excitement, from 
 the healthy standard, in order to remove it by the proper 
 means."** — " Such is the simplicity to which medicine is 
 thus reduced, that when a physician comes to the bed-side 
 of a patient, he has only three things to settle in his mind ; 
 first, whether the disease be general 01 local ; secondly, whe- 
 ther it be sthenic or asthenic ; third, what is its degree."ff 
 
 Upon this system I would have expected, that very little 
 observation would have been necessary to show its absurdity ; 
 and I should have done no more than merely state it, were 
 we not every day told of the progress which it is making. 
 One great and leading error, which every one will observe, 
 is, that he supposes the more life or excitability that any per- 
 son has, the nearer he is to death.^ Here the dependence 
 
 * Par. lxvii. p. 51. f Par. xxi. p. 10. 
 
 X Par. cxviii. \\ Par. xcvii. p. 81. 
 
 •* Par. cxlix. p. 138. ft Par.lxxix. p. 6-1. 
 
 it Par. xxiv. 
 
•99 
 
 of energy for its production, upon the continuance of natural 
 action, is overlooked. When the action is too little, energy 
 is not produced ; when the action is too great, or in a morbid 
 degree, its production is not only injured, but more is ex- 
 pended than can be generated. These are the effects pro- 
 duced by a deficiency or increase of action, to a morbid de- 
 gree. There can be no accumulation of life, or, were it to 
 take place, as from want of food, for instance, then it follows, 
 that any stimulus given before death, should preserve life; 
 and the living power being very abundant, the person ought 
 easily to bear a strong stimulus, which is far from being the 
 case. 
 
 . This, however, is a very trifling mistake, when compared 
 to the next error, which teaches, that all diseases consist en- 
 tirely in different degrees of excitement of this life, and not 
 in any new and peculiar operation or action which it per- 
 forms. Do not all the phenomena of fevers, small-pox, sy- 
 philis, and almost every disease, controvert this doctrine in 
 the strongest manner 1 Will every stimulant cure the vene- 
 real inflammation ? Will wine cut short the progress of a 
 fever ? Is it debility alone that is to be regarded in the 
 treatment of a fever, and stimulants alone that are to be ad 1 - 
 ministered?^ I will venture to affirm, that if this practice 
 be followed out, no mart can estimate the lives whic^i shall be 
 lost. If debility alone produces fevers, I will demand of the 
 Brownonian, why, in the course of a fe«' hours, the pulse 
 falls from its great frequency almost to the natural standard, 
 and that without any stimulant Mng exhibited, or the patient 
 feeling in the least degree stronger, or being able to make 
 one greater exertion ? I shudder when I recollect the 
 scenes which I have witnessed, and the miserable effects of 
 the blind Brownonian practice. Wine and opium, I do most 
 
 * Par. dclxxx. 
 
100 
 
 sincerely believe, are, in the hands of Brown's disciples, 
 what fire and sword are in the battles of the cruel. 
 
 From the apparent simplicity of this theory, the student 
 is led to neglect the various operations of the system, and 
 disregard the niGcr symptoms and distinctions in diseases, 
 being taught, that his sole province is to inquire into the de- 
 gree of excitement, that he may bleed in one case, and 
 give wine in another. And, to remove any scruples which 
 may still remain in his mind, concerning the radical differ- 
 ences of diseases, he is assured, in the strongest manner, that 
 in no respect are they different, except in the circumstances 
 of strength or weakness ; that there are no specific opera- 
 tions of the living system, no alterations even in the fluids, 
 (which were to the humouralist what the nervous system 
 ought to be to the true physiologist,) modifying the disease ; 
 and that, therefore, he need not, on this account, think of 
 varying his treatment ; for all eruptions and conditions, thus 
 Induced, will yield to the sthenic or asthenic plan. 
 
 From this leading error in the system, it is astonishing how 
 little able many Brownonians are to distinguish betwixt two 
 dissimilar diseases, which have some general symptoms in 
 common. This, it may be said, ought to be placed to the 
 account of the stupidity of the physician; but, certainly, 
 the doi^rines which this system teach, are well calculated to 
 increase th^ natural stupidity, by giving little incentive to 
 investigation. 
 
 Of late, this theory has been modified, by the introduc- 
 tion of chemical principles, mall y diseases being attributed 
 to an increase, or deficiency, of oxygen, as well as a devia- 
 tion from the due state of excitemem. Whether oxygen be, 
 or be not present, in greater and less quantities, at different 
 times, is a point which I shall not inquire into ; but I think 
 it is pretty evident, that if, in any disease, there be too much, 
 or too little, of any chemical principle present, or employed 
 
101 
 
 in the whole system, or a part of it, the mere addition or 
 subtraction of part of that principle will not inevitably cure 
 the disease, because we do not thus alter the action which 
 constitutes the disease ; and this redundancy, or deficiency, 
 is a symptom, and not a cause. We never can prevent the 
 introduction of what may be called the chemical elements 
 into the body by any means whatever. They are all essen- 
 tial to our existence, and the modification which they receive 
 will continue as long as the action exists which regulates or 
 produces it, whatever chemical or mechanical contrivances 
 we may fall upon to prevent it. If phthisis depended upon 
 the presence of too much oxygen in the blood, which is not 
 proved, we could not cure it by breathing an impure air, be- 
 cause the oxygen which the atmosphere did contain would 
 be more completely consumed ; and if we gave less than the 
 quantity necessary, respiration would cease to be properly 
 performed, just as it would in health be injured by a propor- 
 tionate diminution. It is likewise a very mistaken notion, 
 that because hydrocarbonate, and other airs, mixed with that 
 which we breathe, give relief sometimes, therefore a dimin- 
 ished quantity of oxygen is useful. They forget that these 
 airs are very powerful medicines, and act independently of 
 their mechanically lessening the quantity of oxygen, by oc- 
 cupying its place. The proper argument would be, to prove, 
 that" the poor, in their low, ill aired habitations, live longer in 
 consumption than the rich, winch few will believe. It is 
 likewise conjectured, that, by adding the chemical principle 
 in superabundance, we induce the disease or condition, which 
 is supposed to depend upon the presence of this ; as, for in- 
 stance, it is supposed that too much oxygen will produce 
 phthisis ; if so, the purest air ought to be most unhealthy, 
 and those who live in the country, and on mountains, ought 
 to be most subject to consumption. So sanguine is one gen- 
 tleman in his belief of this doctrine, that he hopes, cbemi- 
 
102 
 
 cally, to suspend the laws of nature, and make the trees distil 
 butter and cream. This would be a valuable discovery for 
 the Hindoos ; for, by a similar process, they might procure 
 beef and mutton, without taking existence from an animated 
 being. I know only one story which can match this, and in- 
 deed the whole theory, and that is, the old tale of a town, 
 where roasted pigs run through the streets with knives and 
 forks stuck in their posteriors, crying, Come eat us ! Come 
 eat us .' 
 
 The last theory which I shall take notice of, is that of the 
 very ingenious Dr. Darwin ; which, in one respect, is simi- 
 lar to the Brownonian doctrines, but differs in the particular 
 steps, leading to the general principles. 
 
 To examine this theory fully, would, on account of its 
 complexity, require more time than is compatible with my 
 present purpose. I can, therefore, only give here the out- 
 lines, and most fundamental parts of the doctrine. 
 
 " The whole of nature* (according to Dr. Darwin") may 
 be supposed to consist of two essences, or substances, one of 
 which may be termed spirit, and the other matter. The 
 former of these possesses the power to commence, or pro- 
 duce motion, and the latter to receive and communicate it. 
 So that motion, considered as a cause, immediately precedes 
 every effect ; and, considered as an effect, it immediately 
 succeeds every cause." — " The motion of matter may be 
 divided into two kinds, primary and secondary. The secon- 
 dary motions, are those which are given to, or received from 
 other matter in motion." — " The primary motions of matter 
 may be divided into three classes ; those belonging to gra- 
 vitation, to chemistry, and to life ; and each class has its 
 peculiar laws." — " This last class of motion is the subject 
 of the following pages." Motion, which is defined " to be 
 
 * Zoonomia, vol. i. p. 5. 
 
103 
 
 a variation of figure,"* is divided, in the animal body, into 
 two classes : 
 
 First, Sensorial motions, or those peculiar to the sensori- 
 um, which constitute the sensation of pleasure and pain, and 
 which constitute volition, and cause the fibrous contractions, 
 in consequence of irritation, or association. These motions 
 are not fluctuations of the spirit of animation, nor vibrations, 
 nor equilibrations, but changes, or motions of it, peculiar tor 
 life.f They are the faculties, or motions of the sensorium, 
 to be afterwards mentioned. 
 
 Second, Fibrous motions, which include the motions of 
 the muscles, and organs of sense, J which are contractile, and 
 which, by their various configurations, give us ideas. 
 
 The spirit of animation is the immediate cause of the con- 
 traction of animal fibres. It resides in the brain and nerves, 
 and is liable to general and partial diminution, or accumula- 
 tion. It is also called the sensorial power.|| 
 
 The stimulus of external bodies is the remote cause of this 
 contraction. 
 
 A certain quantity of stimulus produces irritation, which 
 is an exertion of the spirit of animation, exciting the fibres 
 into contraction. 
 
 A certain quantity of contraction of animal fibres, if it be 
 perceived at all, produces pleasure ; a greater, or less quan- 
 tity of contraction, if it be perceived at all, produces pain. 
 These constitute sensation. 
 
 A certain quantity of sensation produces desire, or aver- 
 sion. These constitute volition. 
 
 All animal motions, which have occurred at the same time, 
 or in immediate succession, become so connected, that, when 
 
 * Zoonomia, vol. i. p. 15. 
 
 f Ditto, p. 33. 
 
 t Ditto. 
 
 )' Ditto, p. 30. 
 
104 
 
 one of them is reproduced, the other has a tendency to ac- 
 company or succeed it. When fibrous contractions succeed 
 or accompany other fibrous contractions, the connexion is 
 termed association : When fibrous contraction succeeds 
 sensorial motions, the connexion is termed causation : When 
 fibrous and sensorial motions reciprocally introduce each 
 other, it is termed catenation of animal motion. All these 
 connexions are said to be produced by habit, that is, by fre- 
 quent repetition.* 
 
 The spirit of animation acts in four different ways, or 
 " possesses four different faculties ;"f and the contraction of 
 all the fibrous parts of the body depends upon the exertion 
 of these powers. The property, or capability, of causing 
 fibrous contractions, in consequence of the irritation of ex- 
 ternal bodies, is called irritability, and the effect irritation ; 
 which is defined to be an exertion, or change of some ex- 
 treme part of the sensorium, residing in the muscles or or- 
 gans of sense, in consequence of the appulses of external 
 bodies. 
 
 The faculty of causing fibrous contractions, in consequence 
 of the sensations of pleasure and pain, is termed sensibility, 
 and the effect sensation ; which is an exertion, or change of 
 the central parts of the sensorium, or of the whole of it, 
 beginning at some of those extreme parts of it which reside 
 in the muscles or organs of sense. 
 
 The power of causing fibrous contractions, in consequence 
 of volition, is called voluntarity, and its effect volition ; 
 which is an exertion, or change of the central parts of the 
 sensorium, or of the whole of it, terminating in some of these 
 extreme parts of it, which reside in the muscles or organs of 
 sense. 
 
 y Zoonomia, vol. i. p. 31 f P 32. 
 
105 
 
 The capability of causing fibrous contractions, in conser 
 quence of the association of fibrous contractions with other 
 fibrous contractions, is termed associability, and the effect 
 association ; which is an exertion, or change of some extreme 
 part of the sensorium, residing in the muscles or organs of 
 sense, in consequence of some antecedent, or attendant 
 fibrous contraction. 
 
 As these faculties, at the time of their exertion, may be 
 termed motions (for we cannot pass from a state of insen- 
 sibility or inaction to a state of sensibility or exertion, with- 
 out some change in the sensorium, and every change includes 
 motion,) they may be called sensorial motions. 
 
 The fibrous motions of the animal, then, are of four differ- 
 ent kinds, irritative, sensitive, voluntary, and associate. 
 
 In every contraction of a fibre, there is an expenditure of 
 the sensorial power, or spirit of animation ; and, when the 
 exertion of this sensorial power has been for some time in- 
 creased, and the muscles, or organs of sense, have, in conse- 
 quence, acted with greater energy, there is an exhaustion of 
 the quantity of power : On the contrary, when there has 
 been less exertion, it becomes accumulated in the inactive 
 part.* 
 
 Strength is the consequence of the presence of a great 
 quantity of stimulus and sensorial power ; for the quantity of 
 motion produced in any particular part of the animal system, 
 will be as the quantity of stimulus, and the quantity of sen- 
 sorial power, residing in contracting fibres. 
 
 If the quantity of sensorial power remain the same, but 
 the quantity of stimulus be lessened, then debility from de- 
 fect of stimulus, or direct debility, of Dr. Brown, is pro- 
 duced ; in which case the contractions are feebler, and often 
 retrograde. 
 
 * Zoonomia, vol. i. p. 72. 
 VOL. I. O 
 
106 
 
 If the quantity of stimulus remain the same, but the quan- 
 tity of sensorial power be lessened, then debility from defect 
 of sensorial power, is produced, or indirect debility.* 
 
 Disease is the consequence of any deviation of these mo- 
 tions from the healthy state ; and, therefore, are divided into 
 diseases of irritation, sensation, volition, and association ;f 
 for an account of which, as well as of the minuter parts and 
 illustrations of the theory, I must refer to the work itself. 
 
 In examining the truth of this theory, it is proper, first, to 
 consider, how far the doctrine of simple motions will explain 
 the phenomena of life ; and, second, how far their derange- 
 ment will account for the different diseases. It would be 
 endless to follow the application of this theory through the 
 whole animal economy. I shall deem it sufficient to attend 
 only to one or two functions, particularly digestion and se- 
 cretion. 
 
 The whole system, says Dr. Darwin, consists of extremi- 
 ties of nerves ; and all the filaments either do possess, or once 
 possessed, the power of contraction.^ By the motion of 
 these fibres, are all the operations of the living system, and 
 all its functions, immediately performed. Now, these mo- 
 tions can only consist either in contraction or dilatation, in 
 various directions. This, I apprehend, must be admitted ; 
 and no other kind of motion is proposed by Dr. Darwin, ex- 
 cept sensorial motions, which give pleasure and pain. The 
 operation of sensation, or the sensorial motions, is indeed 
 very fully admitted in this theory, and supposed to regulate 
 many of the functions ;|| but still these must, in the end, 
 
 * Zoonomia, vol. i. p. lb. 
 
 f P. .361. et seq. 
 
 t Zoonomia, vol. i. p. 463. 
 
 || " If the food which we swallow is not attended with an agreeable sensation, 
 it digests less perfectly; and, if a very disagreeable sensation accompanies i;, 
 such as a nauseous idea, or very disgustful taste, the digestion becomes impeded, 
 
107 
 
 operate upon the fibrous contraction, which I can conceive 
 only to admit of two slates, namely, relaxation and contrac- 
 tion. Now, these never can explain the varied phenomena 
 of life, and all its intricate and peculiar actions ; neither can 
 it possibly account for the diseases to which we are subject, 
 even although we admit of all the complications of motion 
 which Dr. Darwin supposes to exist. 
 
 If I have succeeded in establishing the doctrine of varied 
 and constant actions, in the living system, then Dr. Darwin's 
 theory, of the effects of simple motions, is necessarily un- 
 founded; and if the effects of actions upon the body, de- 
 pend not altogether upon their quantity or degree, but also 
 upon their species, or similarity or dissimilarity to the na- 
 tural action, then the supposition made by Dr. Darwin and 
 Dr. Brown, that the expenditure of power or weakness, is 
 proportioned exactly to the quantity of exertion, motion, or 
 excitement, is unfounded; and if the doctrine, of the pro- 
 duction of energy being dependent upon the due presence of 
 action, be admitted, the supposition of the accumulation of 
 excitability, or spirit of animation, must likewise be unsup- 
 ported. 
 
 Before quitting this subject, I shall, for the satisfaction of 
 the reader, take notice of the explanation which is given 
 of fever. ^ 
 
 or retrograde motions of the stomach and cesophagus, succeed, and the food is 
 ejected." Zoonoraia, vol. i. p. 390. — " Every kind of gland must possess a pecu- 
 liar kind of irritability, and, probably, sensibility, at the early state of its exist 
 ence, and must be furnished with a nerve of sense, or of motion, to perceive, and to 
 select, and to combine, the particles which compose the fluid it secretes." P. 516. 
 " It would seem, that all the glands in the body have their secreted fluids affected, 
 in quantity and quality, by the pleasurable or painful sensations, which produced' 
 accompany those secretions ; and that the pleasurable sensations, arising from 
 these secretions, may constitute the unnamed pleasure of existence, which is con 
 trary to what is meant by tedium vitae, or ennui." P. 518. 
 * Zoonomia, vol. i. p. 380. et seq. 
 
108 
 
 When, by the application of cold, inanition, fear, &c. a 
 torpor, or quiescence, of any considerable part of the circle 
 of irritative motions, is induced, the whole class of them is 
 more or less disturbed, by their irritative associations ; or, in 
 other words, if any such debilitating cause be applied to a 
 part, the rest quickly sympathises, and becomes weakened. 
 From the quiescence of the particular organs concerned in 
 producing the various functions, we have diminution of these 
 functions, sickness, vomiting, paleness, coldness, weak and 
 small pulse, &c. 
 
 But, " as soon as this general quiescence ceases, either by 
 a diminution of its cause, or by the accumulation of sensorial 
 power, which is the natural consequence of previous quies- 
 cence, the hot fit commences." Every gland is now stimu- 
 lated into stronger action than is natural ; there is a supera- 
 bundance of all the secretions, and, in consequence of this, 
 an increase of heat ; the skin becomes red, and the perspira- 
 tion great ; but, as the absorption is still great, the sweat is 
 not perceived, until, in the decline of the hot fit, the mouths 
 of the absorbents of the skin are exposed to the cooler air, 
 or bed-clothes, by which they lose their increased activity, 
 and cease to absorb more than is natural ; but the secerning 
 vessels act for some time longer, being kept warm by the 
 circulating blood ; and, therefore, we have a sweating stage. 
 
 When the contractile sides of the heart and arteries per- 
 form a greater number of pulsations, in a given time, and 
 move through a greater area at each pulsation, whether these 
 motions be produced by the acrimony or quantity of the 
 blood, or by association with other irritative motions, or in- 
 creased sensorial power, or by any stimulus, we have synocha, 
 or irritative fever, with strong pulse.* When, again, the 
 contractile sides of the heart and arteries perform a greater 
 
 * Zoonomia, vol. i. p. 361. 
 
109 
 
 number of pulsations, in a given time, but move through a 
 less area at each pulsation, from defect of stimulus, or of sen- 
 sorial power, we have typhus mitior, (or nervous fever,) or 
 irritative fever, with weak pulse.* Besides these febrile mo- 
 tions, induced by irritation, it frequently happens, that pain 
 is excited by the violence of the fibrous contractions, and 
 other new motions are superadded, in consequence of sensa- 
 tion. This, which occasions inflammation, gives a different 
 form to the fever, which is called sensitive,! and, like the ir- 
 ritative fever, will naturally be of two kinds, having the strong 
 and weak pulse ; the first is called inflammatory fever, the 
 second, typhus gravior. This is farther explained, by ob- 
 serving, that, when the motions of any part of the system, in 
 consequence of previous torpor, are performed with more 
 energy than in the irritative fever, (or than is compatible 
 with the existence of simple irritative fever,) a disagreeable 
 sensation is produced, and new actions, of some part of the 
 system, commence, in consequence of this sensation, con- 
 jointly with the irritation ; which motions constitute inflam- 
 mation ; and, according as this has taken place, in one or 
 other of the species of irritative fever, so shall we have either 
 inflammatory or putrid fever. J. 
 
 Upon this subject, I shall only remark, that the general 
 account of the production of the symptoms of fever, is not 
 satisfactory, and that the causes assigned will not produce 
 the effect, as will, I presume, sufficiently appear, from what 
 has been already said in this dissertation. Cold, applied to 
 the system, may sometimes produce fever; but, upon this 
 supposition, it ought uniformly to do so, which is not the 
 case ; and farther, every debilitating cause, as venesection, 
 poor diet, want of food, &c. ought always to he followed by 
 
 * Zoonomia, vol. i. p. 362. 
 t Ditto, p. 301. 
 J Ditto, p. 412. 
 
110 
 
 paroxysms of fever, in consequence of the quiescence which 
 they induce. There is, likewise, no proof, lhat sensation af- 
 fects the nature of a fever, and produces local inflammation ; 
 but there is very abundant evidence, that peculiar agents, 
 acting on the living system, may induce fever, and modify 
 the action, to an almost endless degree, producing the whole 
 tribe of febrile diseases. 
 
 Summary of the Laws of Action. 
 
 Having made these observations upon the different systems 
 of pathology, and having, in the course of this dissertation, 
 endeavoured to establish the necessity of attending to the 
 actions of the living system, and of ascribing to them the 
 phenomena of health and disease, instead of indulging in spe- 
 culations concerning the fluids, or their changes, or about 
 simple excitement, or motions of the system, I shall now 
 conclude this part of my subject, with a short summary and 
 illustration of the doctrine. For which purpose, I observe, 
 
 First. That the nervous energy, unacted on, can exhibit 
 no phenomena, nor perform any operations. 
 
 Second. Arterial blood seems to be the natural and indis- 
 pensible stimulus to this nervous system, or agent, enabling 
 the energy to perform its operations. It is likewise the 
 source of renewal to this energy. 
 
 Third. In a state of health, there is a particular action 
 present in the system, upon which that state depends. This 
 may, therefore, be called the natural action, and consists, col- 
 lectively, of all the operations or phenomena necessary for 
 the existence of the animal. 
 
 Fourth. This action is an operation of the nervous energy, 
 which is, therefore, employed and expended in ils perform- 
 ance ; on which account, there must be a regular renewal of 
 
Ill 
 
 power ; and this renewal is dependent upon the proper ac- 
 tion of the nerves.* 
 
 Fifth. All external agents, or foreign bodies, capable of 
 operating on the body, must induce an action, more or less 
 different from the natural one ; or, in other woids, will change 
 the action of the system to a greater or less degree. As it 
 is certain, that no two actions can be separately performed by 
 the same part at once, more than the tongue can articulate 
 two languages at the same moment, f it follows, that the new 
 action, thus induced by foreign agents, must be a complica- 
 tion of the new action with the natural one; or, to speak 
 more properly, the natural action becomes modified by the 
 new stimulus ; and the more that this action is changed, or 
 becomes diseased, the more must the part suffer. From ob- 
 servation fourth, it will appear, that the production of energy 
 must be thus injured ; and it will be at once evident, that if 
 health and strength consists in the due existence and per- 
 formance of the natural action, if this action be changed, 
 weakness and disease must be the consequence ; and, like- 
 wise, that these diseases are most dangerous in which the ac- 
 tion is greatly changed ; whereas, in these in which it is less 
 altered, the danger is less, and they may subsist longer with- 
 out producing death. 
 
 Sixth. It is necessary, that every new agent, or stimulus, 
 should have a certain degree of strength ; or, in other words. 
 
 *In some diseases, we find, that the nerves do not take from the blood as much 
 life as it is capable of yielding. In this case, the blood in the veins is redder than 
 usual, and, when drawn, coagulates, almost totally, into a mass, containing, like 
 j lie coagulum of arterial blood, the greatest quantity of the serum, blended with 
 the other principles. In many diseases, proceeding from derangement of the 
 stomach and bowels, and in approaching syncope, this fact may be observed. 
 
 f Although no two actions can exist separately in the same place, and at the 
 <ame time, yet they may sometimes become blended, producing an action differ- 
 ent from either. Some actions, however, cannot be. thus blended, but the one wiii 
 displace the other, or will not tnk^ place at all 
 
112 
 
 possess a certain quantity of the peculiar power by which it 
 operates, in order to act upon the living system ; because the 
 natural action, if I may use the expression, keeps its ground, 
 with a certain degree of tenacity, and will only yield to a 
 certain force. For example, a grain of ipecacuanha, a drachm 
 of glauber salt, a drop of laudanum, or contagious matter, 
 much diluted, will produce no effect upon a man. Were 
 this not the case, we never should enjoy health ; because the 
 small quantity of contagious matter, which we may suppose 
 to be often contained in the air, should uniformly affect us. 
 The less energy that a person has, the weaker is the natural 
 action ; and, the weaker that the natural action is, the easier 
 is it changed, or destroyed. Hence, the child is more easily 
 injured than the adult ; and he who is reduced by fatigue, 
 abstinence, or previous disease, than the healthy and robust 
 man. This law likewise obtains, with regard to the actions 
 of sense, as every one knows who has attended to the phe- 
 nomena of seeing, hearing, tasting, Sec. 
 
 Seventh. Certain agents, which may have strength enough 
 (by which I mean capability) to change the natural action, 
 will not be sufficient to affect it, if it has already been modi- 
 fied by the previous application of a different agent. It is 
 on this account that contagions often fail, at particular times, 
 to produce their effect : Because the presence of some other 
 agent has previously modified the action, more or less ; and, 
 until the effects of this be gone off, no new disease takes 
 place, unless the new stimulus be very dissimilar indeed to 
 that which induced it. We have an instance of the one 
 case, in small-pox not displacing measles ; of the second, in 
 mercury destroying the venereal action. 
 
 Eighth. The agent in general operates most on the part 
 to which it is immediately applied, if that part be susceptible 
 of its operation, and in a less degree upon neighbouring parts. 
 The degree, however, to which these agents may extend 
 
 
113 
 
 their action, is very various. Some, for instance, when 
 taken into the stomach, extend their action over the whole 
 system, whilst others act only upon the stomach itself, and 
 produce no effect on the rest of the body, except such as 
 take place in consequence of the sympathy of equilibrium. 
 When heat is applied to a part, it inflames that part, 
 but acts likewise, in a less degree, on those which are 
 near it ; so that if one spot, to which most heat was ap- 
 plied, mortifies, or forms an eschar, those near it shall only 
 exhibit a moderate degree of inflammation. Cantharides 
 likewise extend their action beyond the spot to which they 
 are applied, but in a much less degree than heat. Conta- 
 gions, however, producing specific inflammation, are more 
 confined in their operation than simple inflaming causes. 
 Specific inflammation generally terminates more abruptly 5 
 that is to say, it does not diffuse itself so far as simple in- 
 flammation ; but sometimes it is surrounded by simple in- 
 flammation. Thus the variolous inflammation is surrounded 
 by a simple erysipelatous inflammation. 
 
 Ninth. The impressing cause, or stimulus, must not only 
 be of a certain strength, but it must also be applied for a cer- 
 tain length of time before it can produce its effect. That: 
 some time is necessary for the formation of an action is evi- 
 dent ; because, setting all other reasons aside, we observe a 
 certain interval betwixt the first derangement of the natural 
 action and the appearance of the new action, in its full and 
 proper state. This period of formation is always marked by 
 symptoms of weakness, such as lassitude and chilliness ; and 
 the effects of impaired functions, such as anorexia, thirst, 
 and head-ache, even although the action, when fully formed, 
 should be such as to require bleeding, and what are called 
 sedatives, as we see illustrated by the history of inflamma- 
 tion. These symptoms do not precede those actions alone 
 which are called diseased ; for we find similar effects pro* 
 
 vol. 1. r 
 
114 
 
 duced during the formation of those actions which are after- 
 wards to become permanent and natural. Thus the child 
 during dentition, the young animal during the shooting foth 
 of his horns, the peacock when he gets his crest, and the 
 turkey when the fleshy excrescences on the head are formed, 
 have all a diminution and affection of the natural action, pro- 
 ducing disorder of the system, and sometimes even death 
 itself. The time which is required for the formation of these 
 actions is various ; nor can the exact duration, in evcy in- 
 stance, be easily ascertained. It may, however, be observ- 
 ed, in general, that the more dissimilar the new action is to 
 the old or natural one, and, consequently, the more danger- 
 ous that it is, the sooner is it formed j* but as many causes 
 (particularly the previous existence of other actions, or mo- 
 difications of the natural action, although so slight as not to 
 be much attended to) may tend to interrupt and postpone 
 the establishment of the action, the period of formation in 
 the same action may be different at different times. And, 
 farther, as the constitution or natural action of no two peo- 
 ple are exactly alike, the time of formation will vary in dif- 
 ferent people ; and, in some, particular actions may never, or 
 very seldom take place, although they be fully exposed to 
 the exciting cause. f 
 
 But besides this time which elapses during the formation 
 of an action before it fully appears, there is likewise an in- 
 terval betwixt the application of the cause and the com- 
 mencement of the formation; but this is much less in some 
 diseases than in others. It is natural, however, to suppose, 
 that this interval bears some proportion to the quickness of 
 the formation. The coniagion of very bad typhus fevers, 
 
 * The fevers, vulgarly called putrid, that is, very bad fevers, come on with a 
 shorter cold fit than those which are milder. The position is likewise illustrated 
 by many other diseases. 
 
 f Some neople n re much less subject to fevers, to .syphilis, &c. than others ; and 
 'Some never take the small-pox. 
 
115 
 
 for instance, operates much sooner than that of the common 
 ne vous fever, as it is called. 
 
 A knowledge of the different times required, by certain 
 agents, to produce these effects, is of no small importance, 
 be ause we may thus be able to escape their action, in many 
 cases. By washing off some contagions shortly after their 
 application, we prevent the disease, as we see illustrated by 
 syphilis. In cases whe.e poisons a;e taken into the stomach, 
 we can prescribe an emetic, which operates more qui kly, 
 and thus removes them ; and for this pU) pose, we employ 
 white vitriol rather than emetic tartar, because the one acts 
 more speedily Shan the other. 
 
 Tenth. The same siimulus will always produce actions ra- 
 dically the same ; but varying the degree of stimulus will 
 of: en so affect the action, as to make it apparently different. 
 Thus, heat, in a small degree, makes the natural action be 
 carried on more perfectly, and gives pleasure; but, in a 
 greater degree, it increases the action so much, as to change 
 its appearance, or visible effects and symptoms, producing in- 
 flammation, which, from analysis, we learn to be an increase 
 of .he natural action. 
 
 Eleventh. The action remains for some time after the 
 agent is withdrawn. If this were not the case, we should al- 
 ways be able to cure a disease, by removing the exciting 
 cause, which no one expects to be able to do. Removing a 
 blistering plaster, for instance, will not immediately remove 
 the inflammation which it has produced. There is, however, 
 no certain rule for the duration of these actions ; because one 
 continues much longer than another ; and some seem even to 
 have no tendency to decrease or disappear after any dura- 
 tion, however long.* 
 
 * It is impossible, in the present state of our knowledge, to ascertain the im- 
 mediate cause of this. We cannot, for instance, say why the variolous inflam- 
 mation subsides spontaneously in a few days, whiht the venereal action remain* 
 
116 
 
 Twelfth. All actions affect one part of the body more 
 than the rest. Sometimes there is only one organ affected, 
 producing a disease entirely local ; at other times, the whole 
 system suffers ; but, in this case, there is always one part in 
 which the action chiefly exists. 
 
 All morbid actions, which are extended over the system, 
 aflect the circulation, and produce frequency of pulse ; and, 
 when fully formed, heat of the skin. These, when concen- 
 trated in any part, or when they affect any organ to a great 
 degree, produce a species of inflammation ; and it is easy, 
 from the connexion of the inflammatory action with the state 
 of the vessels, to see how this should take place. If the ac- 
 tion exists to less degree than this in the part, then it does 
 not produce inflammation, but only pain, and a state border- 
 ing on inflammation. 
 
 Thirteenth. When specific inflammation is induced in any 
 part, the susceptibility of the neighbouring parts, for assum- 
 ing this, is lessened ; and they seldom do assume it, unless 
 some stimulant be applied to them. Thus, a certain number 
 of pustules are produced in small-pox, by which the rest of 
 the surface is less subject to the variolous inflammation. If, 
 however, other stimulants be applied, such as heat, then, not- 
 withstanding the diminished susceptibility, the inflammation 
 is excited, and a great eruption is produced. 
 
 Fourteenth. Those agents which induce actions nearly si- 
 milar to the natural one, or which change its nature little, at 
 least comparatively speaking, may be called agentes similes : 
 These, which have also been named stimulants, uniformly 
 produce weakness, after their operation is over, unless it sub- 
 side very slowly, and thus allow the natural action gradually 
 to regain its perfection before their artificial action disap- 
 
 unabated through life ; neither can we tell why the action induced by opium 
 subsides in a few hours, whilst that of typhus continues for days ; why some ac- 
 tions disappear and return alternately, for a length of time, and others remain 
 constantly the same. 
 
117 
 
 pears, and, consequently, before the system can be reduced 
 to an inactive condition, as we see in the effects of great and 
 sudden muscular exertions, which weaken more than a long 
 continued, but gentler action, though this, in the sum, be 
 greater than the other. 
 
 As these actions resemble, in some degree, the natural ac- 
 tion, they also, in some degree, supply its place ; and we often 
 do not so readily, during their continuance, perceive the weak- 
 ness which they induce ; but, at other times, we can readily 
 detect its existence, at least in particular functions. Thus, 
 for instance, the presence of inflammation uniformly impairs 
 the function of the inflamed part, as we see in the case of 
 muscular motion, which is diminished in rheumatism ; for, in- 
 dependent of the pain, we could not make the same exertion 
 as formerly ; and, in synocha, we cannot walk, nor eat, nor do 
 what we used to do. If, however, the action be still more 
 nearly resembling the natural action ; or, if the nature of the 
 healthy action be still less changed, then we do not perceive 
 the weakness as long as it continues, as we see in the case of 
 the vinous action ; on the contrary, the person can make a 
 greater exertion during it, because it differs very little from 
 the natural action.* 
 
 When the action of any part is much increased, its power 
 is expended ; and, therefore, in order to prevent farther 
 weakness, after the operation of the stimulant is over, we 
 find, that the action of the system is diminished in propor- 
 tion to the diminished power, and both are only slowly in- 
 creased or renewed. This fact is overlooked by the Brown- 
 
 * According to the Brownonian doctrine, stimulant actions should not produce 
 weakness until their operation be over. But experience proves, that the reverse- 
 is the case ; and I have endeavoured to show why it does not appear in every 
 period of an action, and in which actions we are to expect it We do not observe 
 it in the vinous action, if it exist only in a slight degree; but if it be greater, it 
 becomes evident. We observe it uniformly in inflammatory diseases, and, in- 
 deed, during the contiuuance of every stimulant action, if it be induced to a con- 
 •idtrable degree. 
 
118 
 
 onians, who give stimulants in this case, as they say, to in- 
 crease the excitement. But this practice is evidently im- 
 proper, in most cases ; and, where it is admissible, the quan- 
 tity of stimulus must be very small, and must be of such a 
 kind as tends to excite the natural action of the part ; as, for 
 instance, soups for the stomach, &c. 
 
 The more quickly that the stimulant action is induced, and 
 the greater its degree, the more quickly does the weakness 
 appear, and the greater is it. This evidently must be the 
 case; because action requires power or energy;* and the 
 more quickly that it is raised, the less able is the nerve to 
 supply this energy.f When a part is scalded with water, 
 there is a very great action instantaneously induced ; and, 
 therefore, there is a weakness of the part very quickly in- 
 duced ; and the inflammation requires the application of 
 gentle stimulants for its cure, as will be afterwards mention- 
 ed. If the 'degree of heat has been still greater, then im- 
 mediate death, or mortification of the part, takes place, and 
 an eschar is formed. 
 
 From these remarks, it is evident, then, that increased ac- 
 tion, in consequence of the application of stimulants pro- 
 ducing diseases, as well as an increased exercise of particu- 
 lar functions, will produce weakness, which will be sensibly 
 perceived, unless the stimulant action very nearly resembles* 
 the natural one, and subsides very gradually. The vinous 
 action, unless it has been moderate, and, consequently, les- 
 sens gradually, produces weakness ; muscular exertion fa- 
 tigues ; too much food taken into the stomach weakens it, 
 and vomiting, or temporary dyspepsia, take place ; heat over- 
 powers the system, and causes fainting. 
 
 * It is easy, from this, to see how weakened parts should bear disease worse 
 than the strong. 
 
 f One cause of this, amongst many others, is, that the more abrupt the transi- 
 tion is, from one state to another, the more is the function injured. 
 
119 
 
 Fifteenth. Those agents which induce actions very dissi- 
 milar to the natural action, may be called dissimiles, and pro- 
 duce great weakness very quickly ; whereas, in many instan- 
 ces of stimulant actions, when they do not arise to a great de- 
 gree, the sensible weakness is not perceived for a considera- 
 ble time, and until ihe stimulant action has subsided. 
 
 The agentes dissimiles, or what have been improperly call- 
 ed sedatives, may, like the agentes similes, or stimulants, in- 
 due very violent actions, and will often require the use or 
 such remedies as tend to abate action in general ; such as 
 cold and blood-letting. These actions are always attended 
 with an inflammatory affection, when they exist, in a great 
 degree, in any organ. That typhus is always attended with 
 an inflammatory affection of the head, and sometimes of the 
 lungs, or abdominal viscera, must be acknowledged by every 
 one, who is conversant in dissection : that the plague and yel- 
 low fever are attended with inflammation, is equally certain ; 
 that lead induces inflammation, is so well known, that bleed- 
 ing is frequently used, with success, in the cholic which it 
 produces : laurel water produces an inflammatory or haemorr- 
 hagic action of the brain, marked frequently by delirium, red 
 eyes, and turgidity of the vessels. It must, therefore, ap- 
 pear, that the medicines, called sedatives, have no title to 
 that appellation, which belongs only to such agents as tend to 
 abate action in general ; and, therefore, can only be properly 
 applied to venesection, and cold, and abstinence, which, un- 
 der certain circumstances, abate action, not indeed by any 
 positive power, or peculiar quality, but negatively, by remov- 
 ing causes, which keep up action. 
 
 Notwithstanding the utility of bleeding, in the beginning of 
 many actions belonging to this class, it yet must be remem- 
 bejed, that the practice is hurtful, if employed too late, and 
 after any very considerable weakness is induced, by the con- 
 tinuance of the dissiinUar action : opposite remedies will then 
 be of use. 
 
120 
 
 The actions belonging to this class are by much the most 
 dangerous, as will appear from one or two examples. 
 
 When a person is bit by a serpent, we invariably find very 
 great weakness produced, with more or less rapidity. The 
 countenance becomes pale, a tremor seizes the whole body, 
 the breathing becomes hurried and oppressed, and the pulse 
 weak and irregular : convulsions close the scene. These are 
 the general effects of the bite of venomous animals ; but we 
 find different modifications taking place, according to the 
 specific difference of the poison. The bite of some serpents 
 is fatal in less than an hour, whilst that of others does not 
 kill for a much longer time. Some produce violent convul- 
 sions, others a stupor ; some cause excruciating pain, whilst 
 others kill with an easy insensibility. 
 
 The poison generated by rabid animals, is likewise a very 
 powerful agens dissimilis, producing great languor and dejec- 
 tion, and weakness of all the functions, attended with spasmo- 
 dic affections of the muscles, and particularly of those of the 
 throat, which become convulsed, from very slight causes. 
 
 The dissimilar agent, however, which we most frequently 
 meet with, is the contagion of typhus fever, concerning the 
 nature and operation of which there have been many disputes. 
 Some have considered the putrefaction of animal and vegeta- 
 ble matters as the cause producing contagion ; others have 
 referred it to an unknown state of the air ; others, to certaia 
 alterations in the atmosphere, which might be ascertained and 
 imitated by chemical processes ; whilst some have denied 
 altogether the existence of typhus contagion. There have 
 been still more disputes about the nature of the disease, which 
 this contagion induced. Some called it the effect of fermen- 
 tation; others, of spasm ; others, of pure weakness ; but the 
 wisest part of physicians allow it to be a peculiar action, which 
 they cannot imitate or produce, by any of those general 
 causes. 
 
121 
 
 As all these agents produce great weakness, it might be 
 supposed, that the cure ought to consist entirely in prescrib- 
 ing, from the very first, such medicines as would lend to pro- 
 duce an action as nearly similar to the natural one as possi- 
 ble ; such as wine, or other fermented liquors. But it is to 
 be remembered, that, in the first place, those actions will not, 
 in the beginning, yield to the natural one : they have already 
 destroyed it ; and, therefore, it is not to be expected, that 
 such agents, as tend only to excite an action somewhat simi- 
 lar to the natural one, should be capable of displacing these. 
 
 There is, hoAvever, a still more serious objection to this 
 practice: the proposal is made, without attending to the cir- 
 cumstance of, what are called, sedative actions, being, in their 
 commencement, sometimes so violent, * as to require the ap- 
 plication of such causes as tend, in general, to abate all ac- 
 tions indiscriminately ; such as bleeding, and the use of cold, 
 to a moderate degree. It is likewise to be observed, that as 
 wine cannot displace the typhus action at first, it will, by its 
 operation, tend to increase it ; and as bolh the contagion and 
 the wine act more upon the head than on other parts, in pro- 
 portion to their size, it will readily be seen, why the early use 
 of wine, in fevers, so frequently produces phrenitis ; for it has 
 been already mentioned, that whenever any action was much 
 increased, or concentrated in a particular part, it induced a 
 species of inflammation. Wine, however, is useful, after the 
 first stage of the disease is over, and the more immediate vio- 
 lence of the action has subsided, and the weakness is making 
 progress against us. In this case, it is as useful, as it formerly 
 was hurtful. 
 
 * There is, in the beginning of these actions, a state somewhat approaching to 
 i he condition in inflammation ; and this state, of violent or increased action, con- 
 tinues longer or shorter, in different sedative actions. In some, it lasts only a 
 few hours, and the?e are the most dangerous. 
 VOL. I. Q 
 
122 
 
 Sixteenth. Removing the sensible effects of any particu- 
 lar action, has a tendency to destroy the action itself. Thus, 
 such applications as abate the pain of the head, in typhus fe- 
 ver, tend to abate the fever ; such as abate the heat in inflam- 
 mation or fever, abate these diseases. This is called practis- 
 ing according to symptoms, and is a method, at all times, to be 
 followed, even in the cure of those actions or diseases, for 
 which we possess specific remedies, as the operation of those 
 remedies will be greatly assisted by it. 
 
 Seventeenth. Diseases are often cured also, by removing 
 the particular state of the system, which gives to them their 
 peculiar inveteracy or danger.* Thus, inflammation of weak- 
 ened parts is removed, by strengthening the part ; that is to 
 say, increasing its energy ; which we do, by such remedies 
 as act on the whole system, at the same time that we apply 
 such agents to the part itself, as shall tend to change the ac- 
 tion. It may be thought, that increasing the action of the 
 system, in this species of inflammation, should be prejudicial, 
 and should increase the inflammatory action ; because this 
 was perhaps originally produced by the communication of ac- 
 tion from the neighbouring parts : but the remedies which we 
 employ, tend not to induce an inflammatory action in those 
 parts, but one more nearly resembling the natural action, and 
 thus augment the energy, and diminish the inflammation. If, 
 however, the inflammation has happened from a morbid in- 
 crease of action, in a part already strong, then such remedies 
 as tend to increase this shall do harm. 
 
 Eighteenth. Actions which are suddenly induced, in heal- 
 thy parts, are more dangerous than those which are excited 
 mo; e gradually ; or, in other words, the more speedy the tran- 
 sition is, from healJi to disease, the more does the animal suf- 
 
 * Disease is often so connected with the state of the system in which it occur?, 
 ".Mt removing that state of the system, shall remove the disease 
 
123 
 
 fer. It is, for instance, observed, that people bear amputa- 
 tion better, if it be performed on account of some disease of 
 long standing, than if we operate on account of some sudden 
 acsident; one cause of which is, that the constitution had 
 formerly been accustomed to a diseased state, or inflammatory 
 action ; and, therefore, suffers less by the one which our ope- 
 ration induces. 
 
 Nineteenth. The more the system, at the time of the ap- 
 plication of any new ageut, approaches to the general condi- 
 tion which that agent tends to induce, the more dangerous will 
 the action of the agent be, and the more readily will it ope- 
 rate. Thus, typhus fever tends to produce great weakness, 
 and, therefore, will be more dangerous when it attacks those 
 who have been formerly much reduced than tho3e who have 
 Hot. Those, again, who are very vigorous, may be said, as 
 Mr. Hunter observes, to have their action as high as it can be 
 without disease being induced ; very trifling causes may, 
 therefore, operate on them. Inflammation will be very high 
 in them ; and wounds, or accidents, extremely dangerous. 
 They will even be more easily acted on by the agentes dissi- 
 miles, or sedatives, as they have been called, than those whose 
 action is less, and nearer the proper medium, because they 
 are more easily rendered diseased, and the inflammatory state 
 which these agents tend to excite will be more violent in 
 them. 
 
 Twentieth. Contiguous parts sympathise with each other 
 to a certain degree. Hence, if the action of any part be in- 
 creased, the increase spreads in a less degree to the neighbour- 
 ing parts, unless these parts exhibit the sympathy of equili- 
 brium ; such as the skin and liver, for instance. Hence also, 
 if a part be weakened by cold, the action of the neighbouring 
 parts spreads to it after the cold is withdrawn, and communi- 
 cates to it a greater degree of action ihan its weakened state 
 can bear ; the consequence of which is inflammation, which 
 
124 
 
 ends frequently in gangrene. Upon the same principle, a part 
 draws support from the contiguous parts, and bears disease 
 fflnii longer, on this account, than it otherwise would do. 
 Hence, when causes act locally on a part, in such a way as to 
 kill it, the neighbouring parts are weakened ; or, if it be a large 
 part which is affected, the whole system is injured. 
 
 Twenty-first. When an increased action is induced in one 
 part, it has a tendency either to diminish action in some other 
 part, or to increase it for a time in that part, according to cir- 
 cumstances, which have been already explained in treating of 
 the sympathy of association, and the sympathy of equilibrium. 
 Contiguous parts, of a similar structure, most frequently ex- 
 hibit the sympathy of association, and the action spreads 
 more rapidly in them ; contiguous parts, of dissimilar struc- 
 ture, exhibit, in the same circumstances, most frequently, the 
 sympathy of equilibrium. It is evident, therefore, why all 
 local actions extend themselves farthest, and most quickly in 
 those parts which are similar to the spot in which they com- 
 menced. Hence, as Mr. Hunter has observed, when one 
 portion of a gland becomes inflamed, the rest also becomes 
 quickly inflamed ; but the surrounding cellular substance, or 
 skin, is much longer of becoming affected. Hence, also, we 
 may sometimes check the progress of some cutaneous actions, 
 by applying caustic round the diseased spot, so as to enclose 
 it as with a ring ; for the nioibid action does not extend itself 
 deeper than the skin, and it does not overleap the destroyed 
 or altered substance produced by the caustic ; it is therefore 
 checked. 
 
 Twenty-second. Contagious matter, generated by animals, 
 has a greater tendency to affect animals of the same species 
 win h produced it, than others ; and the same parts in another 
 individual which have produced or secreted it in one, rather 
 than parts of a different nature. Thus, the contagious matter 
 produced by the glands of the urethra in gonorrhoea, has a 
 
125 
 
 greater tendency to affect other secreting parts, than parte 
 whi> h do not secreie. 
 
 Twenty-: hird. Whenever an accustomed stimulus is 
 withdrawn from a part, or the whole, the action becomes im- 
 perfect and irregular, because an agent which was wont to 
 contribute to its production is absent. This produces pain; 
 for all new and irregular actions excite disagreeable sensa- 
 tions. 
 
 Twenty-fourth. The mind has the capability of perceiv- 
 ing and taking cognisance of the actions of the body ; but if 
 these actions be constantly repeated, we at last do not perceive 
 them, or receive any sensation. Thus, we have no sensation 
 from the performance of all the healthy functions, or parts of 
 the natural action : or from the mo lion of the heart and arte- 
 ries. But if the action be either imperfect, or in any respect 
 new, then it produces a sensation, which, if violent, we call 
 pain.* If the heart contracts irregularly, or in a different 
 manner from what it formerly did, then we feel it, and call it 
 palpitation. All new general actions are attended with an in- 
 describable uneasiness. When an ulcer is painful, we may 
 be certain that the healing action is not going on ; and, ac- 
 cording to observation sixteenth, we may often cure it by 
 such remedies as tend to abate the pain. 
 
 Twenty-fifth. Some actions are continued by habit alone. 
 Any action which has continued long becomes in a manner 
 natural, that is, excited and supported by the natural agents 
 which were operating when it was first induced, and dur- 
 ing the continuance which the action necessarily had on ac- 
 count of the strong action of the original exciting cause. 
 
 * We are not always to judge of the danger of an action by the pain which it 
 produces, because some slight imperfections and irregularities in the action of a 
 part will produce a much more acute sensation than some very dangerous actions. 
 It is an old observation, that pain without inflammation may be borne long with- 
 out very great injury to the system. 
 
126 
 
 Many actions are thus kept up longer than tbey otherwise 
 would be, and may then be interrupted by causes which, 
 formerly, would not have operated to poduce this effect. 
 Other actions are said to be renewed, or restored by habit ; 
 an explanation of which has been already given. 
 
 Twenty-sixth. All general actions exhibit a certain revo- 
 lution, or exacerbation and remission, at particular times or 
 periods. In a state of health, we observe, that the power or 
 energy of the system is greatest, and the action most perfect, 
 in the morning. In the evening, the action is more imper- 
 fect, and the power less, in so much, that in very weak peo- 
 ple, we even find a degree of fever induced. During rest,* 
 the performance of the functions, or the different parts of the 
 natural action, is lessened, and the operations of the mind, 
 which consume much energy by their continuance, are lull- 
 ed or suspended. There is then a regular revolution, which 
 must take place from the very first day in which we begin to 
 observe regular periods of sleeping and working ;f and this, 
 by long continuance, and frequent repetition, comes to be so 
 permanently established, that even although we remain the 
 whole twenty-four hours without exertion, and in a recumbent 
 posture, we should be sensible of the changes. This revolu- 
 tion, which takes place during health, continues also, by ha- 
 bit, during disease, al hough no greater exertion be made dur- 
 ing the day than during the night ; and, hence, we may ac- 
 count for the greater frequency of ihe pulse, and the exacer- 
 bation of many diseases toward the evening. The same ob- 
 
 * Man, in a state of nature, would uaturally suspend his operations when the- 
 *un set, even although he was not led to do so from fatigue. He worXs through the 
 day by the light of the sun; and retires, during the darkness of the night, to rest 
 from his labours. 
 
 f In the infant, there are no regular periods for retiring to rest ; but the child 
 sleeps repeatedly during the twenty-four hours, at no stated intervals. The young- 
 er the child, the more sleep is required ; that is to say, the less action can it su c . 
 tain. 
 
127 
 
 servation may also teach us, why we not unfrequently per- 
 ceive remissions toward the evening, in diseases of an inflam- 
 matory nature ; because the natural action is naturally less 
 toward night ; and, as the inflammatory action, in healthy 
 people, consists in a morbid increase of the action, we 
 may understand how there should be a diminution of this 
 at night. The pulse, in acute rheumatism, is often quicker 
 through the day than in the evening: but if the inflam- 
 mation be of a different kind, it may be increased by the 
 same cause which, in acute rheumatism, diminished it. In- 
 flammation of strong parts, in healthy people, is increased by 
 whatever increases the natural action, and vice versa; but in- 
 flammation of weakened parts, or in reduced and weak bodies, 
 is diminished by whatever tends to improve and strengthen 
 the natural action. The one disease will be worse, the other 
 better in the day than at night. 
 
 The state of the sun, but particularly the moon, with re- 
 gard to our planet, likewise affects the human body ; and the 
 way in which it does so has been already mentioned. When 
 the attractive power of the moon operates most, the actions 
 of the system, whether healthy or diseased, are most excited, 
 that is to say, there is at that time an agent acting in a great- 
 er degree upon the body than at another time ; and, conse- 
 quently, the action must, at that time, be greatest. When 
 the attractive power is least, diseased actions are most easily 
 overcome, if all the other causes be alike ; but, if other 
 causes interfere, as often happens, this diminution will not be 
 perceived. If this account be true, we shall see why, at 
 certain periods of a lunation, diseases ought to subside most ; 
 but every disease, in every person, will not subside equally ; 
 for those which have recently commenced, will not be so 
 much diminished as those which have continued longer, and 
 are nearer their natural termination. If near the end of a 
 disease, the termination may be hastened br the diminution 
 
128 
 
 • 
 of the attraction of the moon ; if, on the contrary, the dis- 
 ease be increasing, it will be aggravated by the other state of 
 the moon, in which it acts most, and may thus prove fatal 
 sooner than it otherwise would do.^ This being the case, I 
 do not see that the doctrine of critical days can be explained 
 by this general principle, which must either be allowed to 
 act equally on all, and produce a crisis in every disease on the 
 same day ; or, as I have supposed, must operate differently 
 according to the state of ihe disease, without any reference to 
 the completion of a regular period, or certain number of 
 days. 
 
 Conclusion. 
 
 From the whole history of the nervous system, its pro- 
 perties appear to be wonderful indeed, and its delicacy seems 
 to be so great, that we would at first suppose, that it should 
 be perpetually subject to derangement, from the action of 
 even the most trifling cause. But by a more attentive ex- 
 amination, we perceive here, as in other cases, with admira- 
 tion, the workmanship of an infinitely wise and powerful 
 Creator, who has established such laws in the animal econo- 
 my, that, in many cases, these huriful powers operate for 
 their own destruction. When a foreign body is applied to 
 the nose, it is expelled by sneezing : When it ge;s into ihe 
 eye, the lachrymal gland, by its stimulus, pours out more 
 tears, and the substance is washed out : When cantharides 
 are applied to the skin, the cuticle becomes elevated, and 
 
 * The increased attraction of the moon will operate most visibly on the diseases 
 which are increasing, whilst the effects of diminished attraction, will be most 
 perceptible when the disease is declining. 
 
129 
 
 the source of irritation is removed far from the true skin ; 
 or, if it should reach to it, pus is soon formed, and the sti- 
 mulus is again removed, more disagreeable effects being thus 
 prevented. When a hurtful matter is received into the sto- 
 mach and bowels, ils first operation produces vomiting or 
 purging, and thus causes its own expulsion, as is some limes 
 seen in over doses of arsenic, or dher poisons. When 
 much of the skin is inflamed, the action of the internal parts 
 is diminished, the action of the heart is weakened, and the 
 blood is sent less forcibly to the surface. The inflammation, 
 which would otherwise soon have terminated in mortification 
 thus more readily admits of resolution. When, on the other 
 hand, the action of the cuticular nerves is weakened, the 
 heart has its action increased, the blood is more powerfully 
 propelled, and the nerves of the surface are soon again sti- 
 mulated to their proper action. Equal nicety is displayed 
 in the natural actions of the different parts of the animal. 
 When, for instance, the light is faint, the iris opens to admit 
 the most to the retina ; but when it is vivid, then the iris 
 contracts, and allows a smaller portion of rays to enter. 
 
 These properties of the animal evince so much wisdom, 
 that many have been led to imagine, that some intelligent 
 agent presided in the system, and regulated all its actions. 
 This agent has, by some, been believed to be the rational 
 soul, and, by others, a certain preserving power of nature ; 
 and, accordingly, the vis conservatrix naturae has, at all 
 times, held an eminent situation in the schools of physic. 
 But the truth is, that the nervous system is so formed, that 
 these happy effects take place regularly from the immediate 
 action of stimuli, and not by the intermedium or direction of 
 any third power. We are, accordingly, not led up to any 
 visionary ai cheus, as a source of action ; but we are directed 
 to admire the wisdom of the Almighty Framer of man, 
 who established, in his system, the laws by which these ope- 
 
 VOL. I. R 
 
130 
 
 rations are produced, when he " breathed the breath of life 
 into his nostrils." 
 
 Nor is this all which we have to admire in the economy 
 of life ; for the whole history of it is full of wonder ; from 
 the womb even to the grave. The conception of the foetus ; 
 its growing from the uterus, like the leaf from the plant ; con- 
 nected to its parent by only a very slender vessel ; its in- 
 creasing by the nourishment of the mother ; and its union 
 with an immaterial and immortal spirit ; are all mysterious, 
 and truly wondeiful points; but not more so, than its re- 
 ceiving, after birth, foreign matters into the stomach ; its 
 changing their life into its own, and converting them finally 
 into a part of itself; its gradual increase from an imper- 
 ceptible point to a full grown creature ; and its equally slow 
 and regular progress from maturity to dissolution ; are topics 
 which are, indeed, worthy to be seriously contemplated by 
 the most exalted mind. 
 
 " Fearfully and wonderfully are we made." 
 
DISSERTATION II. 
 
 •N SIMPLE INFLAMMATION, AND ITS CONSEQUENCES- 
 
 Of the Definition and Division of Inflammation. 
 
 BY (he term inflammation, is generally understood that 
 state of a part, in which it is painful, hotter, redder, and 
 somewhat more turgid, lhan it naturally is; which topical 
 symptoms, when present to any considerable degree, or when 
 they affect very sensible parts, are attended with fever, or a 
 general diseased action of the system. 
 
 The most obvious division of the action of inflammation, is 
 into ihat affecting strong and healihy parts, and that affecting 
 those which are weak ; and, therefore, the order inflammatse 
 will consist of two genera, the inflammatio valida, and the in- 
 fiammaiio debilis : the specific distinctions will be the same in 
 boih of these genera, being founded upon the part affected : 
 the varieties depend upon the duration and activity of the 
 action : that which runs its course rapidly and actively, is 
 called inflammatio activa, sive acuta ; that which continues 
 longer, and seems to have become, in a manner, habitual to 
 the part, is termed inflammatio passiva, sive assuefacta. 
 Some of the species wijl naturally admit of only the first 
 variety. 
 
L3'2 
 
 It is the inflamniatio valida et acuta which is here to be 
 considered at greatest length : the inflammatio debilis will 
 come to be attended to, in examining the causes and treat- 
 ment of mortification : the little which is necessary to be said 
 concerning the inflammatio assuefacta, will be mentioned in 
 the conclusion of this dissertation. 
 
 Of the Stages and Terminations of Inflammation. 
 
 In every extensive inflammation, we may always observe 
 two stages, which are marked by different symptoms, those 
 of i he one being common to every new action, during its for- 
 mation, whilst those of the other are peculiar to the disease at 
 present to be considered. 
 
 In the first stage, the patient is weak and languid, and com- 
 plains of coldness ; the pulse is frequent and small ; the 
 tongue parched ; the head somewhat confused or pained, and 
 the functions of the stomach deranged. 
 
 In the second stage, the pulse becomes harder ; the thirst 
 continues ; the coldness is succeeded by heat, and the patient 
 bei omes restless and uneasy. Whenever these symptoms 
 appear, the local disease manifests itself, and keeps pace with 
 the general affection : the part becomes red, painful, and 
 swelled,* at the same time that its function is impaired. 
 
 When this topical affection supervenes, the fever seldom, 
 except in some specific diseases, abates ; but, on the contrary, 
 often becomes nioie violent, and continues until the local dis- 
 ease be either removed, or its nature be changed. 
 
 W hen inflammation is suddenly produced by any powerful 
 cause acting locally, we find, that the local affection comes on 
 first, after which the febrile symptoms appear. If, however, 
 
 * The softest parts swell most ; those which are harder swell less, with the saint 
 degree of inflammation, 
 
133 
 
 the local complaint be slight, and induced by a trifling cause, 
 we do not find, that any general disease is induced, but the 
 affection is entirely topical. 
 
 When the fever does not come on until after the establish- 
 ment of the inflammatory action in a part, ii is called sympto- 
 matic, being dependent entirely on the local affection : but 
 when the fever precedes the topical inflammation, or is co- 
 eval with it, then it is said to be idiopathic, being produced 
 by the direct operation of the same causes which induce the 
 topical disease. In all cases, perhaps, the fever becomes 
 symptomatic in the end. 
 
 When the local inflammation can be removed, without any 
 very remarkable change being induced in the part, it is said 
 to be resolved, or to terminate by resolution ; a term wh h 
 originated from the ancient doctrines on this subject. This 
 is known to have happened, by the diminution at first, and af- 
 terwards the complete removal of the different symptoms, 
 whilst the part slowly returns, apparently, to its natural figure, 
 although, most* frequently, there are adhesions formed with 
 the contiguous parts. 
 
 When the pain, heat, and redness, disappear, but the part 
 remains hard and swelled, the inflammation is said to end in 
 schirrus. This termination is most frequent in glandular 
 parts. 
 
 If, on the contrary, the pain, redness, and heat, continue 
 great for some time, and then abate, the first becoming still 
 more of the pulsatory kind, at the same time that the part re- 
 mains swelled, but becomes gradually soft and fluctuating;, and 
 especially if this change be preceded by dullness, we may 
 be certain, that the structure of the part is destroyed, and a 
 
 * Adhesions are formed in every instance where the inflammation is produced by 
 mechanical injuries; but where it depends upon some general cause, adhesions do 
 not always take place. This is exemplified by rheumatism, where adhesions are not 
 necessarily produced. 
 
134 
 
 new secretory action established, producing pus, which fills 
 the cavity formed by the destruction of the inflamed parts. 
 In this case, the inflammation is said to terminate by suppu- 
 ration : at other times, especially in inflammation of mem- 
 braneous parts, which, in health, secrete a particular fluid, a 
 liquid, different from pus, and resembling more the natural se- 
 cretion of the part, is formed. In this, as in the other case, 
 the inflammation diminishes ; but the patient has seldom any 
 chills; nor is the structure of the part injured, at least farther 
 than by mere distension, if it be a cavity. The functions of 
 the part are, however, often injured, from the presence of 
 the fluid. This termination, which has been improperly 
 called effusion, is not uufrequent in pulmonic affections, pro- 
 ducing hydrothorax : It likewise produces the thick discharge 
 from the nose, in catarrh, and the purulent looking discharge 
 which takes place from the urethra, after the application of 
 acrid matters. 
 
 Lastly. Violent inflammation in a part may kill it, in which 
 case it is said to end in mortification. We are to apprehend 
 this termination, when the inflammation is very violent, com- 
 pared to the power of the part, and when it manifests no ten- 
 dency to any of the other terminations. We are still more 
 to dread it, when the colour of the part becomes of a darker 
 hue, and the pulse more frequent and feebler, at the same 
 time that the general strength sinks. In these circumstan- 
 ces, if the disease be not checked by proper remedies, the 
 "mortification soon appears : the part becomes first of a purple, 
 and then of a black colour: it loses its heat; the cuticle rises 
 up in blisters, and the part soon becomes soft, putrid, and 
 quite senseless. This termination does not take place with- 
 out much pain ; for although the part, after it mortifies, has 
 no feeling, yet, during the process, the sensation is very 
 acute ; and, even after the mortification is complete, the parts 
 in the immediate vicinity are excessively irritable, being 
 
135 
 
 nearly in the same state in which the mortified part was before 
 it died. 
 
 When the mortification effected only the cellular substance, 
 it was supposed to be of a milder nature, and was called gan- 
 grene; bu! when it penetrated deeper to the muscles or 
 blood-vessels, it was called a sphacelus. 
 
 Of the Exciting Causes of Inflammation. 
 
 Whatever increases the action of a part, beyond that rela- 
 tion which ought to subsist betwixt the action of a part and its 
 power, is productive of inflammation. The causes which 
 effect this may be divided into two classes ; first, those which 
 act directly on the part to which they are applied ; second, 
 those which are not applied to the part which becomes in- 
 flamed, but which act indirectly on it. 
 
 The first kind admits of \wo divisions. First, those foreign 
 agents which operate by what is called their stimulant power, 
 su h as cantharides, heat, &c. This operation having been al- 
 ready explained in the preliminary dissertation, it will be un 
 necessary to make any further remark on it liere. Second, those 
 causes whi h act mechanically, such as bruises and wounds. 
 B'uises act, I apprehend, in the same way with cold, when il 
 appears to inflame the part to which it is applied ; and, there- 
 fore, their action will be explained in considering the opera- 
 tion of cold. If wounds be put into a proper situation of 
 uniting, we generally find, that no inflammation takes place ; 
 but ihe stru sure of the part is directly renewed, by the 
 operation of the same power which nourishes the part in 
 health, and renews its structure when absorbed : But if Horn 
 any cause this be prevented, then inflammation comes on, 
 from which we may presume, that the prevention of the ac- 
 tion of nutrition produces the inflammatory action ; for if, 
 by removing the sides of the wound from each other, or by 
 
136 
 
 any other cause, we inevitably prevent the natural action of 
 deposition, or nutrition, then the most trifling cause will in- 
 duce the inflammatory action ; even the circumstance of 
 being in an unusual situation, will be sufficient to excite the 
 action to a morbid degree.* On the other hand, the pre- 
 sence of the inflammatory action, will be sufficient to pre- 
 vent the action of nutrition, if it should be excited by the 
 operation of the cause which produced the injury ; for the 
 wound is often inflicted in such a way, or with such pain, as 
 to increase the action to such a degree as to form inflamma- 
 tion ; and this cause will more especially operate, where we 
 interrupt the uniting process, or action of nutrition : It is even 
 often sufficient to cause inflammation, when we use every 
 precaution to forward the uniting process. Cold is very 
 often found to inflame the part to which it is applied ; but it 
 has not been deemed easy to give such an explanation of its 
 action as would be applicable to every case. It was, at one 
 time, supposed to operate, by producing stagnation of the 
 blood, or humours in the part ; but the two opinions which I 
 shall at present mention, are, 1st. That it acts as a stimulant; 
 2d. That it acts as a sedative. 
 
 In support of the opinion, that cold is a stimulant, it may 
 be urged, that it produces pain, when applied in too great 
 quantity ; that it reddens the skin, and often inflames the 
 part on which it acts ; and, finally, that it invigorates the 
 system, when applied in moderation. 
 
 It must, however, be evident to every one, that cold 
 lessens the action, either of the whole system, or of a part, 
 according to the mode of its application ; and that, if it be 
 long enough continued, it will produce, first, torpor, and then 
 death. This is so fully established, that it is unnecessary 
 
 * Mr. Hunter supposes, that the " stimulus of imperfection immediately calli 
 forth the action of restoration," which is effected by means of inflammation. 
 
 Hunter on Inflammation, p. 190 
 
137 
 
 to insist upon it ; and must prove, that cold is not a stimulant. 
 Pain is produced, both by an increase and diminution of ac- 
 tion; and, therefore, we are not to be surprised, that cold 
 should be productive of a very unpleasant sensation or pain. 
 The absence or diminution of any accustomed stimulus, must 
 be productive of pain ; and this pain will be violent, in pro- 
 portion to the extent and continuance of the diminution. 
 The want of food produces, 1st. Slight uneasiness, and then 
 more acute pain ; and the same may be said of heat. 
 Whenever any natural and accusJomed stimulus is withdrawn, 
 the action of the part is performed irregularly, and becomes 
 imperfect, which is always attended with a disagreeable sen- 
 sation : But, besides this cause of pain, there is also another, 
 which comes to operate after the cold has been applied for a 
 considerable time, namely, that the action of the neighbour- 
 ing parts is communicated by sympathy to the cold part, 
 which occasions an action in it greater than the power can 
 sustain, and, consequently, produces a species of inflamma- 
 tion.^ There are, likewise, several causes which may be 
 applied at the same time with the cold, and which will tend 
 to excite action, and, consequently, produce pain in the 
 weakened part. Thus, the percussion of the air stimulates 
 and causes pain ; hence, rain or snow, drifted in the face, 
 produces much more pain than when it flies more gently, al- 
 though, in both cases, the temperature be the same. 
 
 That cold produces redness, is no proof that it is a stimu- 
 lant ; for this redness is, at first, produced by a diminished 
 circulation, the blood remaining longer in the veins ; and, 
 therefore, the part becomes of a purple hue, which is very 
 different from the bright red, produced by the direct action 
 of a powerful stimulant. 
 
 • See Prelim. Divert, p. 133, 
 VOL. I. S 
 
138 
 
 It may also be said, that cold stops bleeding, and lhat alco- 
 hol does the same, therefore cold is a stimulant ; but it is to 
 be remembered, that there exists this material difference, that 
 cold s'ops active, and alcohol passive haemorrhage. Cold has 
 likewise been supposed to be a stimulant, from ihe invito at- 
 ing effects of the cold bath ; but, in order that cold may in- 
 vigorate, it is necessary that it be applied for only a short 
 time, and be frequently repealed ; it thus, by diminishing the 
 '% action of the surface, increases that of the internal parts, and 
 
 thus strengthens. That cold does not inflame, by its stimu- 
 lant power, will be immediately seen. 
 
 Those who main Iain cold to be a sedative, have been under 
 the necessity of maintaining) that it never inflamed unless 
 some direct stimulant was afterwards applied; or that, by re- 
 laxing the vessels, it made them admit more blood, and thus 
 produt ed a kind of inflammation ; but it is to be remember- 
 ed, thai in the living syslem, blood does neither accumulate 
 in a pari, nor is its quantity diminished by any general mecha- 
 nical cause operating on o. her parts, or by any affection of the 
 propelling cause, but that ihe state of the vessels, with re- 
 gard to blood, depends upon their own condition. Weak- 
 ness, in any part of the arterial system, ought to diminish 
 the quantity of blood in that part : Weakness, in the veinous 
 system, will indeed produce accumulation of blood ; but this 
 cannot produce inflammation. Cold, then, cannot act by its 
 relaxing power. Experience likewise proves, that cold may 
 induce inflammation, wishout requiring, for this purpose, the 
 subsequent application of heat, or any other artificial stimulus. 
 
 Cold may operate on a part, and destroy it in three dif- 
 ferent ways. Fiist, it may be applied in such a degree, and 
 for su.h a length of time, as to destroy the vitality of the 
 part directly ; in which case, sloughs are formed. Second., 
 it may be applied in a less degree, or for a shorter time ; and 
 afterwards a stimulant, such as heat, may be applied, which 
 
139 
 
 will excite inflammation. The production of inflammation, 
 by any agent, depends, in a great degree, upon the sudden- 
 ness of the operation of the agent which exci.es it; for a 
 quantity of stimulus, which, if suddenly applied, will produce 
 inflammation, may be applied slowly with impunity. F.om 
 which ii will follow, thai any given stimulant mus, more easi- 
 ly produce inflammation, in a part which has a low action, 
 than in one having a vigorous action, ihere being a greater 
 disproportion in the one case than in the other, betwixt the 
 action induced by the agent and ihe previous action of the 
 part. Hence, very slight stimuli will induce inflammation; 
 in parts which have been weakened by cold. Thid, it has 
 been already mentioned, that a part sympathises ve<y much 
 with those which are contiguous to it. If a part be weaken- 
 ed, by having its action reduced, and if then the debilitating 
 cause be removed, the action of the part will be increased, 
 or excited, by its sympathy wi^ he neighbouring aeting 
 parts: But, as the action ought to be very liiie, ihe power 
 being small, it will follow, thai disease, or inflammation, must 
 arise from this cause, the ac ion being increased beyond the 
 power. We ought, therefo;e, in this case, to diminish the 
 action of the neighbouring parts, in order to prevent their 
 extending their action to a part which is not able to bear it 
 without becoming diseased. 
 
 These remarks may suffice, with regard to the causes of 
 inflammation which belong to the fust class. I come now to 
 consider those of the second kind, or those which operate, 
 not upon the part to which they are applied, but upon distant 
 parts, the chief of which causes is cold. 
 
 Cold, applied to the surface of the body, often inflames 
 the internal parts. This has been often observed, and vari- 
 ous explanations of it have been attempted ; whilst others 
 have denied the existence of the fact. 
 
140 
 
 Dr. Brown supposed, that cold, at no time, produced in- 
 flammation of internal parts, unless it were applied to those 
 parts, and had heat applied after it ; or, in other words, that 
 cold acted always in one way, and never on any part to which 
 it was not directly applied. He, therefore, classed the lungs 
 amongst the external parts, in order to account for peripneu- 
 mony being produced by cold. He did not remember, 
 however, that the pain and cough sometimes make their ap- 
 pearance, whilst the patient is still exposed to the cold, and 
 before heat has been allowed to operate. He likewise for- 
 got, that the temperature of the lungs is not affected by the 
 temperature of the surrounding air, being neither warmed by 
 warm air, nor cooled by cold air. The lungs are to be con- 
 sidered as the centre of the circulation, with regard to animal 
 heat, the heart being only a muscle subservient to them. 
 But, granting that the lungs could be warmed or cooled, it is 
 to be remembered, that a person riding in a cold night, will 
 often have a sore throat, or pain in his breast produced, (if 
 the integuments covering these parts have been exposed,) 
 before he alight, and, consequently, before he could be ex- 
 posed o heat. If this take place in one instance, the theory 
 must be false. 
 
 Dr. Cullen supposes, that cold inflames distant parts, by 
 affecting >he course of (he fluids. When applied to the sur- 
 fa e, it inflames the lungs, in his opinion, by obstructing the 
 perspiration, and vhus determining lo the lungs. Cold is 
 likewise applied, he supposes, to the lungs themselves, at 
 the same time.* Now, wc;c this the case, the lungs ought 
 not to be affected : for if cold were capable of acting on the 
 lungs, ii should obstruct the exhalation from them, as well 
 as the perspiration from the skin ; therefore, some intermedi- 
 ate point, and not the lungs, would be injured. 
 
 * Cullen's First Lines, &c. Vol. I. par. 345. 
 
141 
 
 The same idea, although with some modification, is adoptr 
 edby Mr* Abeme.hy,* who supposes, that air is thrown out 
 from !he blood, along with the matter of perspiration ; and, 
 tl: be, ;hat when the perspiration is diminished, the de- 
 q of Quids to the lungs is particularly to be expect- 
 ed ; because, as ihe air whi h went off with the perspiration 
 is now retained, i; goes to the only oiher place where it can 
 ge; otii, namely, the lungs, "where the secretion is similar to 
 the one vjbtch has been suppressed;" by which suppression 
 the blood has " become su barged with air, to which the 
 Jungs o.ily *an affo d an ou:iei." — " Thus, an accumulation of 
 fluids, in the pulmonary vessels, will ensue." 
 
 These explanations of the action of cold, evidently over- 
 look the aciion of the nerves, and the true his lory of diseases ; 
 for no "increased determina; ion of fluids" can take place 
 without increased nervous action. The sympathies of fluids 
 and vessels, wee once indeed, favourite doctrines in the 
 schools ; and ihe trifling and un -eriain anastomosis of arte- 
 ries or veins were anxiously looked for. But the fluids must 
 now be considered as subordinate agents, and the changes 
 and diseases of the living system traced to a higher source 
 than hydraulic principles. 
 
 Seeing, then, that none of these opinions give a satisfacto- 
 ry explanation of th manner in which cold, when applied to 
 the surface, inflames the internal parts, we must have re- 
 course to another principle, or to the sympathy of equilibrium, 
 by which, I apprehend, the fact may be sufficiently ex- 
 plained. 
 
 Cold, applied in a moderate degree, to the whole surface, 
 diminishes, for a time, the action of the skin, but raises that 
 of the internal parts, and thus produces strength, if the ap- 
 plication be frequently repeated ; these parts being the most 
 
 * Abcrnothy's E^ays, p. 150. 
 
142 
 
 essential to the animal, and those on which its health and 
 vigour < hiefiy depend. 
 
 This effect of < old, in raising or exciting the action of the 
 internal parts, when applied Jo the surface, is also seen in the 
 benefi which is derived from dashing cold water on the thighs 
 and legs, in cases of cosliveness or suppression of mine, de- 
 pending on torpor of the intestines or bladder. Upon the 
 same principle, we may account for the occasional bad effects 
 of the cold baih, when applied partially ; fo , in his ase, ! he 
 parts which are out of he water, may have iheii action mor- 
 bidly increased, by the diminution of ac ion in those pa-ts 
 which were immersed. Hence, ihe popular opinion, ha' if 
 bathers do not plunge the head under he water, hey will 
 have head-a he produced, is not ! otally withou: foundation. 
 
 If the cold be applied !o the surface for a considerable ime, 
 or to such a degree as to reduce ihe temperature of ihe skin 
 considerably below that which obtained befo-e the appli a- 
 tion, inflammation is very frequently produced, in some inter- 
 nal part, owing to the morbid increase of aciion which is thus 
 produced in it. What part shall suffer thus, will, in a great 
 measure, depend on the portion of the surface which is ex- 
 posed, each part of the skin sympathising chiefly with ihe 
 organs immediately under it. Cold and damp, applied to 'he 
 feet, are very apt to produce inflammation of the throat. 
 
 Cold will most readily produce inflammation, when the 
 
 surface has had its action previously much increased by heat. 
 
 When the skin of the throat or breast is very warm, and is 
 
 suddenly exposed to cold, cynanche or pneumonia is, in nine 
 
 v cases out often, pioduced. 
 
 From these remarks we may understand, firstj how cold 
 applied to the surface, in a certain degree, and for a certain 
 time, inflames the internal parts ; second, how, when it is ap- 
 plied to a greater degree, and continued for a longer time, it 
 inflames the part itself on which it directly acts. 
 
113 
 
 It is observable, that some people are more subject to in- 
 flammation than ohers; and, by examination we shall find, 
 thai, these are the most vigorous and plethoric. This con- 
 dition, from i!s propensity to inflammation, has been named 
 the phlogistic diathesis. This slate is induced by the use of 
 stimulating and highly nourishing diet, invigorating exercise, 
 and Uie application of cold in such a way as to prove tonic. 
 
 Inflamma.ion is readily induced in such people, and is worse 
 borne by : hem, because, as Mr. Hunter has observed, their 
 action is already as high as it can possibly be, without caus- 
 ing disease. A very trifling increase, then, which will be 
 easily indued, must be productive of inflammation. Hence, 
 operations are borne worse by healthy people than by those 
 who have been ailing for some time. Thee is, however, 
 ano.her <:ause which co-operates with this, and renders ope- 
 ra >;ons safer in those who have had local diseases of long con- 
 tinuance, than in those who have met with sudden accidents, 
 namely, that the constitution has been long accustomed to 
 diseased or lnflamma o.y aaion, and therefore, is better able 
 to endure ihe action which is induced by the operation ; for 
 mo bid actions, which are suddenly excited in a healthy sys- 
 tem, aie more dangerous than those which come on more 
 slowly. Even if the previous action had not been inflamma- 
 toiy, ii was of a morbid naiuie, and therefore, should make 
 the a-.tion induced by the operation less dangerous; be-ause 
 we have still only exchanged one diseased action for another, 
 and not excited it in a s} stem formerly healthy. 
 
 Of the Proximate Cause of Inflammation* 
 
 Concerning the proximate cause of inflammation, a very 
 great diversity of opinion has p evailed ; but still almost 
 eve y theory has agreed in admitting the agency of an ob- 
 structing cause. 
 
144 
 
 For several centuries, the opinions which were held on this 
 subject were very much the same, and received no maerial 
 change until «he dis-ovcy of ihe immortal Ha vey. 
 
 Whilst the circulation of ihe blood was unknown, and 
 whilst the hypothetical notions of ihe powe of ,he live , in 
 preparing and sending forth this fluid, continued o p erail, it 
 is not astonishing that the theories of physic should be ex- 
 ceedingly imperfect. So fully persuaded we e physicians of 
 the existence and agency of different humours and spirits, 
 and so litile did hey know of he regular and constant motion 
 of the blood, that they believed in the possibility of deposi- 
 tions and congestions of the blood, ihe bile, or the lymph ; 
 and acknowledged these as the cause of inflammation. Their 
 anatomists taught them, and their professors of physic sup- 
 ported the opinion, that the liver was the centre of the vascu- 
 lar system, from which the blood went forth by day to the 
 extremities, and returned again by night. If, then, any pec- 
 cant matter irritated the liver, then the blood was sent out 
 more forcibly ; and if, at the same time, any part of the body 
 were weakened, or otherwise disposed to receive a greater 
 quantity of fluid than the rest, then a swelling was produced 
 by the flow of the humours to this place. Fluxions, or flows 
 of humour to a place, might happen either by weakness of the 
 part, which allowed ihe humours to enter more abundantly, or 
 by the place attracting the humours, in cousequence of the 
 application of heat, or other agents. When the fluxion was 
 produced by some irritating cause applied to the source of the 
 blood or humours, and a weakness of the part affected, then 
 the part was said to be passive ; but when the fluxion arose 
 from some cause, acting directly on the part, and making it 
 attract the humours, then it was said to be active. Tht- 
 teachers of medicine, then, had two great heads for com- 
 menting on ; first, the stale of the part transmitting ; and se 
 cond, the condition of the part receiving. The peculiar na- 
 
14£ 
 
 hire of these tumors depended upon the humour which was 
 sent in the greatest abundance ; blood, for instance, produ- 
 ced the true phlegmon ; bile produced erysipelas, &c. 
 
 It was likewise believed, that at other times, the part might 
 somehow allow the blood or humours to stagnate slowly in it, 
 from a want of expulsive power ; or might detain the fluid, 
 " quae in loco affecto gignitur." The tumor thus produced, 
 was called a congestion, to distinguish it from the one which 
 arose from the sudden flow of humours from a distant part, 
 and which was called a fluxion or cleflvxion. The first was 
 formed gradually, without much pain, or the feeling of pulsa- 
 tion, and run its course slowly ; the second appeared sudden- 
 ly, was very painful, had a pulsatory feeling, and run its course 
 rapidly. , 
 
 As the blood was supposed to possess very little motion, 
 and to have its course easily diverted or changed, by very 
 trifling causes, it became an established rule, that in fluxions, 
 we should endeavour to alter the direction, or "dete;mina- 
 tion," of this fluid. In recent inflammation, they laid it down 
 as a fixed principle, to bleed from some part which was dis- 
 tant from the seat of the disease, by which they imagined, 
 that the current was changed, and a. revulsion made. If the 
 inflammation was above the liver, which they said, was the 
 centre of the body, considered medically, they took blood 
 from some part below it; when one side was affected, Ihen 
 they bled from the other. They likewise made a catalogue 
 of the different veins which purged the different parts, or de- 
 tracted from them ; and this assisted them in their practice. 
 The cephalic vein evacuated the head ; the basilic, the parts 
 farther down; whilst the median detracted from both parts: 
 the left arm evacuated the spleen, and the right one the 
 liver. * 
 
 * The natives of Thibet and Boutan still retain similar sentiments: they bleed 
 in the neck, when they wish to cure pains in the head ; the cephalic vein is orxn 
 VOL. I. T 
 
146 
 
 A revulsion was also effected, by raising a tumor in some 
 other part, by means of ligatures, cupping glasses, &c; or, 
 by giving nature an opportunity of discharging the humours 
 from distant parts, by applying leeches or blisters to these : 
 hence, sinapisms were applied to the feet, in diseases of the 
 superior parts. 
 
 If it were not convenient, or if it were not judged proper, 
 to make a complete revulsion, then blood was drawn from the 
 neighbourhood of the parts,* and this was called derivation, 
 which differed from revulsion only " in the measure of the 
 distance to whi?h ihe humour was drawn." As this, how- 
 ever, was supposed raiher to draw more fluid to the part, 
 than to draw from it, most people considered it as dangerous 
 to use derivation in the beginning of the disease. 
 
 At the same time that bleeding was used copiously, they 
 also applied repellents to the pari, in order to co-operate with 
 the other remedies. These consisted of astringents, mixed 
 with an innumerable quantity of inert diugs. If, on the con- 
 trary, il was thought improper to repel the matter, then the 
 tumor Mas to be resolved by " discussion," or a " breathing 
 out of the humour, by insensible transpiration ;" and this was 
 effected by applications, which were said to be " hot, subtle, 
 and powerfully penetrating ; such as, althea, camomile, nitre, 
 alkali," &c. This method, however, was generally reprobat- 
 ed, in the commencement of inflammation. When neither 
 of ihese plans would succeed, then the matter was to be con- 
 cocted, the tumor suppurated, mundified, deterged, incarned, 
 and finally cicatrized. 
 
 Bleeding was directed to be less frequent in the congestion 
 than in the fluxion ; but then the purges were to be stronger, 
 
 ed, when the arm or shoulder is injured ; the median detracts from the breast or 
 side ; the basilic from the belly, and the veins at the ankles from the two inferior 
 extremities. Vide Phil. Trans, vol. LXXIX. 
 
 * In inflammation of the throat, forinstance, blood was taken from the lingual 
 vein?. 
 
147 
 
 and given with a more liberal hand.* Along with the ex 
 hibition of purgatives, the hot remedies, called discutients, 
 were to be applied to the part itself; such as, thyme, galba- 
 num, sal ammoniac, &c. 
 
 At last, the doctrine of fluxion began to lose ground, and 
 the physicians slowly to perceive, that their boasted theories 
 of derivation and revulsion were absolutely incompatible with 
 the true history of the circulation of the blood. The cause 
 of inflammation was now sought for, more universally, in the 
 part itself, and obstruction declared, more decidedly, to be 
 the parent of disease. 
 
 It was the opinion of Boerhaave,f that inflammation was 
 caused by an obstruction to the free circulation of the blood, 
 in the minute vessels; and this obstruction, he supposed^ 
 might be caused by heat, diarrhoea, too copious flow of urine, 
 and sweat, or whatever could dissipate the thinner parts of 
 the blood, and produce a thickness or viscidity of that fluid. 
 Where this lentor did not exist before the production of in- 
 flammation, he imagined, that the larger globules of the blood 
 got into the small vessels, and thus plugged them up. When, 
 for instance, the perspiration was stopped, the fluid being re- 
 tained, dilated the vessels, and allowed some of these mis- 
 chievous globules to enter, and produce a more permanent 
 obstruction. This circumstance was termed an error loci, 
 and was one of the chief causes assigned for inflammation. 
 But whether the obstruction arose from the viscidity of the 
 blood, or, independently of it, from an error loci, the same 
 effect was supposed to be produced, namely, a resistance to 
 the circulation, which, of course, increased it in the other 
 vessels, proved an irritation to the heart, and increased the 
 
 * In fluxions, purging was considered as a dubious remedy, at least, where the 
 liver was in fault; because it was tliought to draw all the foul a"nd noxious mnt. 
 ten to that quarter. 
 
 f Aph. 375. ef » 
 
148 
 
 force or attrition of the blood, in that part of the vessel 
 which was behind the obstruction ; this, again, caused heat 
 and pain, whilst the accumulation of the blood produced red- 
 ness ; which three symptoms are the essence of the disease. 
 But, besides this obstruction, he also brought into account an 
 acrimonious state of the fluids ; and, when this occurred, re- 
 solution was out of the question ; nay, if the acrimony were 
 great, gangrene was almost unavoidable.* 
 
 The viscidity of the blood cannot be admitted as the 
 proximate cause of inflammation ; because we have no proof 
 ihat this state ever exists ; or, granting that it did, it would 
 not explain the phenomena. In inflammation, the blood, so 
 far from being deranged in the proportion of its component 
 parts, or from one portion having a greater quantity of coagu- 
 lable lymph (which alone could make it thicker) than another, 
 seems to have its principles more intimately united ; for it 
 requires a longer time to separate them by coagulation ; and, 
 therefore, no variation can take place, in any particular part 
 of the body. If, then, a viscidity takes place, it must exist 
 equally in every portion of the blood ; and, if so, it must af- 
 fect every part of the body alike ; and, therefore, cannot be 
 supposed to produce only a local disease. But, granting it 
 to be possible for viscidity to induce inflammation, it remains 
 to be demonstrated, hew this lentor is occasioned, by causes 
 which bring on inflammation suddenly, without affording 
 time for changes of the fluids to take place. It also remains 
 to be proved by experiments, that such a thickened state of 
 the blood ever does exist, either in infkrmmaiion, or in any 
 other disease. 
 
 With regard to the doctrine of error loci, or of red glo- 
 bules going into vessels which did not formerly transmit them, 
 the fact must be admitted, at the same time that the con- 
 
 * A ph. 383. 
 
149 
 
 dusion is denied. When the eye becomes inflamed, the 
 tunica conjunctiva is seen, with its vessels full of red blood, 
 which, in health, is not the case ; but this redness never ap- 
 pears until the inflammation has commenced ; it is therefore 
 to be considered as an effect, and not as a cause. Nor does 
 this error loci occasion any obstruction in these vessels ; for, 
 if they be divided, the blood flows freely, which shows, that 
 they are large enough to allow of an easy circulation, a cir- 
 cumstance which is altogether incompatible with the notion 
 of obstruction : For, were this obstruction to take place, the 
 flow of blood must be checked ; it must either move much 
 more slowly, and, therefore, stimulate less; or, it must take 
 another course ; for it is well known, that, whenever a vessel 
 is obstructed by pressure, by adhesion, or by a globule 
 plugging it up, that less blood must go that way, and more by 
 another course ; the consequence of which is, that the part 
 will rather be weakened than inflamed. 
 
 As for the supposition of the co-operaticn of an acrimony 
 of the fluids, it may be sufficient to observe, that the pro- 
 portion of the saline matter of the blood has never been proved 
 to be greater in this than in any other state of the body, and 
 that the very idea of cacochymy is diametrically opposite to 
 the laws of the living system. But enough has been former- 
 ly said, in the preliminary dissertation, concerning the lui- 
 moural pathology ; and more will be afterwards adduced- 
 The subject may, therefore, for the present, be dismissed. 
 
 Professor Vacca,* was likewise of opinion, that an ob- 
 struction to the motion of the blood was the cause of in- 
 flammation ; but this he attributed, not to lentor, or error 
 loci, but to a debility of the inflamed part, which prevented 
 it from propelling the blood as formerly, and produced an ac- 
 cumulation of it in the weakened vessels, the consequence of 
 
 * Vacca de Inflate. Morb. &<•. 
 
V)0 ' 
 
 wMch, in his opinion, was a species of combustion, or real in 
 flammaion. He begins by observing, that there are four 
 principal fluids in the body ; the blood, the lymph or serum, 
 the fat, and the nervous fluid. The lymph, being watery > 
 cannot be inflamed or burnt ; the blood is slightly inflamma- 
 ble ; the fat is altogether so ; but the nervous fluid, from its 
 volatility, cannot bear enough of heat to inflame it. It is 
 also laid down as a principle, that no inflammation can take 
 place without the aid and operation of atmospheric air, which 
 both draws inflammable matter to the part, and inflames it. 
 Without fatty, or phlogistic matter, then, and air, no in- 
 flammation can take place. This inflammation is begun by 
 the accumulation of blood, which is to be considered as a 
 heated, or ignited body. The accumulation and " semistag- 
 nation" of the blood, uniformly depends upon a weakness of 
 the part, either real or absolute ; real, when its power is po- 
 sitively diminished ; relative, when it is not diminished, but 
 the strength of the rest of the system preternaturally in- 
 creased above it.* 
 
 In consequence of this weakness, the blood not only moves 
 more slowly, but more also flows in, which produces a swell- 
 ing of the part. This is farther increased, by the extrica- 
 tion of air from the stagnant matter, in consequence of the 
 heat, by which the part is distended, and still more humour 
 and phlogistic matter is allowed to flow in. 
 
 Upon the humoural part of this theory, I deem it to be 
 unnecessary to make any observation ; and, upon the position, 
 that debility of the inflamed part is the cause of inflamma- 
 tion, I think it sufficient to observe, first, that many of the 
 
 * " Inflammatio cujusv is partis human! corporis, numquamsit, nisi in ipsa parte 
 sanguis coacervetur, et fere quie?eat." — "Coacervatio et semistagnatio sanguinis, 
 vrl alius humoris corporis humani, in quacumque ipsius corporis parte minime 
 centingere potest, Fioe ijrius partis absoluta, vel relativa debilitate." Vacca, 
 p. 18-. 
 
151 
 
 exciting causes evidently have no tendency to weaken, when 
 they induce inflammation : Heat, for instance, frequently 
 inflames before it can possibly be supposed to have produced 
 any weakness. Second, all the symptoms of inflammation 
 evince an increased action. Third, bleeding, and other 
 causes, which diminish action, cure inflammation. 
 
 Dr. Cullcn considers the proximate cause of inflammation 
 to be " a spasm of the extreme arteries, supporting an in- 
 creased action in the course of them." This theory, there- 
 fore, differs from that of Dr. Boerhaave only in the cause 
 which is assigned for the obstruction. A detection of the 
 fallacy of the one supposition will, therefore, be sufficient to 
 disprove both. But, as Dr. Cullen was a man who formed 
 no opinion without a plausible reason, it will be proper to at- 
 tend more minutely to his doctrine ; and this is very plainly 
 laid down in the two hundred and forty-fourth and two hun- 
 dred and forty-fifth paragraphs of his Outlines. " Some 
 causes of inequality (says he) in the distribution of the blood, 
 may throw an unusual quantity of it upon particular vessels, 
 to which it must necessarily prove a stimulus. But, farther, 
 it is probable, that, to relieve the congestion, the vis medica- 
 trix naturae increases still more the action of these vessels ; 
 and which, as in all other febrile diseases, it affects, by the 
 formation of a spasm on their extremities." — " A spasm of 
 the extreme arteries, supporting an increased action in the 
 course of them, may, therefore, be considered as the proxi- 
 mate cause of inflammation ; at least, in all cases not arising 
 from direct stimuli applied ; and, even in this case, the sti- 
 muli may be supposed to produce a spasm of the extreme 
 vessels." 
 
 These paragraphs contain three positions ; 1st. That there 
 is, originally, a congestion, or accumulation of blood ; 2dly. 
 That this is removed by the formation of a spasm ; 3dly. 
 That this spasm is the work of the vis medicatrix naturae. 
 
Iu2 
 
 Upon the first of these positions, it will be sufficient to re- 
 mark, that this accumulation of blood is considered as the 
 cause of inflammation, and not as an effect ; whereas, it is 
 evident, that it exists only as a symptom. When, for in- 
 stance, we apply heat, a blister, or any acrid substance, to 
 the surface, the part is stimulated, that is to say, the action 
 of its nerves is increased, which must, consequently, in- 
 crease the action of its vessels, and, of necessity, the quan- 
 tity of blood. But, most assuredly, this increased quantity 
 of blood is not the primary cause of inflammation ; it is the 
 consequente of an increased action of the blood-vessels, 
 which, again, is meiely an effect of the increased nervous ac- 
 tion. The first position is, therefore, erroneous ; for this 
 accumulation of blood is not an original, or primary cause, 
 but depends upon a disease already induced. At the same 
 time, it is certain, that this increased quantity of a stimulus 
 must react on the nerve, and augment still farther its action, 
 and, therefore, increase or keep up the inflammation already 
 induced. 
 
 The second position takes for granted that the first is es- 
 tablished, and that the congestion is to be removed by the 
 formation of a spasm ; or, in other words, that the accumu- 
 lated quantity of blood is to be propelled, or dismissed, by 
 rendering the extremity of the passage narrower, and the 
 circulation more difficult, which is a contradiction in terms. 
 The obvious effect of this constriction must be, to destroy 
 the free communication of the artery with its returning vein. 
 The blood already in the part must stagnate, and become 
 veinous, or it must escape by a retrograde motion, the exist- 
 ence of which, to any extent, is not proved. Whenever a 
 vessel is constricted, either by a ligature, or any other cause, 
 we uniformly find, that the course of the circulation is alter- 
 ed, more being sent through the branches of ihe artery 
 coming off above the obstruction ; therefore;, the part direct- 
 
153 
 
 \y supplied by the obliterated or constricted artery must, for 
 a time, be weakened. It may be said, that though the part 
 supplied by the obstructed vessel may be debilitated, yet 
 those parts which, in consequence of this obstruction, must 
 receive mote blood, will be inflamed : But we daily find, that, 
 even tying a large vessel, does not of itself produce this dis- 
 ease ; how much less, then, will constricting the extremities 
 of a few twigs be capable of affecting it I The uniform 
 effect of obstruction must be, to retard the circulation, and 
 produce torpor, circumstances altogether incompatible with 
 the existence of inflammation, which implies more powerful 
 contractions, and a more complete and forcible circulation. 
 Phlegmon is also attended with an effusion into the cellular 
 substance from the extremities of the arteries, a circum- 
 stance not easily explained upon the principle of obstructed 
 circulation. 
 
 The third position is, that the formation of the spasm is 
 the work of the vis medicatrix naturae ; but, having denied 
 the truth of the former position, it follows, that the present 
 supposition requires no answer ; because it is unnecessary to 
 show the absence, or insufficiency of a cause, if the exist- 
 ence of the effect be disproved. Still it may not be impro- 
 per to remark, that the spasm induced, or the agency of the 
 vis medicatrix, is considered as producing the most serious 
 part of the disease, ll is not the congestion of blood which 
 is held out as the proximate cause, but the attempt which 
 the healing, or preserving power of nature makes to get quit 
 of it. The blood is here considered as an exciting cause, 
 but is by no means understood to operate directly ; on the 
 contrary, it only gives notice to the preserving power, which, 
 in order to get rid of it, occasions a spasm, followed by dis- 
 ease. Nay, so far does Do;tor Cullen carry his theory of 
 spasms, and preserving powers of nature, that he imagines, 
 Jhat even siimulan's, opevmijpg direct ly on a part, such a.* 
 vol. i. r 
 
154 
 
 cantharides, mezereon, or red precipitate, induce inflamma- 
 tion, in the same round-about way. But, by a very little at- 
 tention, we shall find, that all these agems operate primarily 
 on ihe nerves, increasing their action, and changing it, and, 
 of consequence, the action of the vessels supplied by them. 
 This action, however, is very different indeed from spasm or 
 obstruction. 
 
 The celebrated John Brown taught a doctrine, which was 
 new to the Edinburgh Professors, and diametrically opposite 
 to the theories which were maintained in their schools. Dis- 
 eases, according to his system, were all divided into two 
 classes, those which consisted in a morbid degree of strength, 
 and those produced by the varied degrees of weakness. 
 This theory was, to appearance, simple ; it was built entirely 
 on the sthenic and asthenic diathesis, and admitted of no in- 
 tricate actions of the living system. Little labour, then, was 
 demanded of the student, and not much reflection of the 
 practitioners. It was addressed, in a peculiar manner, to 
 the indolent dispositions of mankind, and, therefore, met wi'.h 
 considerable su ess, which perhaps was not a little inc* eased 
 by he plea of persecution. 
 
 Inflammation was said, by Dr. Brown, to depend either 
 upon 'oo inu h strength, or too much weakness. In the first 
 case, the vessels contracted with great force, and pushed on 
 theii contents with fury. In ihe second, the vessels were 
 too weak o arry on the circulation properly, but relaxed 
 freely, to allow as much blood to be pushed into them, as the 
 vis a te go was able io do. This, however, is by much too 
 mechanic al an idea, and cannot be admitted, now that the 
 reasonings of ihe mathematical physicians have sunk into 
 oblivion. The whole se. ies of symptoms, together with the 
 circumstances which f equenJy atSend the accession of in- 
 flamma ion, as well as its ending in other actions, disprove 
 the supposition. If inuammation depended, in one case, 
 
155 
 
 upon too much contractile force of the vessels, and, in 
 another, upon their relaxation, then, in order to give consis- 
 tency to the doctrine, it ought to be admitted, that secre'ions 
 were formed by filtration; and that these slates of :he ves- 
 sels, after a certain duration, came to strain through pus. 
 Mere increase of streng:h, excitement, or contractile power, 
 without a change of action, never can produce the pheno- 
 mena of inflammation, nor account for adhesion, suppuration, 
 or ulceration. Partial debility of the vessels cannot, on the 
 other hand, produce the second species of inflammation : be- 
 cause this debility should, at the very utmost, produce only 
 a slower circulation, and not an inflammatory action; neither 
 ought it to be the cause of swelling and turgidity of the arte- 
 ries, by allowing more than the due quantity of blood to be 
 forced into them; for the quantity of blood in a vessel, does 
 not depend upon the proportion betwixt its contractile power, 
 and the propelling power of the rest of the system, but upon 
 its own action entirely ; otherwise, we should find paralytic 
 limbs always turgid with blood. Farther, the Brownonian 
 theory will not explain the phenomena of inflammation in 
 weakened parts ; for here there is a great action, with little 
 power ; and hence the part is almost immediately killed. 
 The progress of this is stopped by bark and opium, with 
 proper local applications. From the treatment, then, the 
 Brownonian would say, that the inflammation depended upon 
 weakness. But will simple relaxation explain why death should 
 so rapidly take place ? 
 
 According to Mr. Hunter, " inflammation is to be consi- 
 dered only as a disturbed state of parts, which requires a new, 
 but salutary mode of action, to restore them to that state, 
 wherein a natural mode of action alone is necessary. F om 
 such a view of the subject, therefore, inflammation, in itself, 
 is not to be considered as a disease, but as a salutary opera- 
 
156 
 
 rion, consequent either to some violence, or some disease/" 1 
 " The act of inflammation is to be considered, as an increas- 
 ed action of .he vessels,"f which at first consist simply in 
 " an increase or distention beyond their nalural size." J This 
 increase seems to depend npon a diminution of ihe muscular 
 power of the vessels, at the same time that the " elastic pow- 
 er of the artery must be dilated in the same proportion."§ 
 This is, therefore, something more than simply a common re- 
 laxa'ion ; we must suppose it an action in the parts, to pro- 
 duce an increase of size, to answer particular purposes ; and 
 this I should call an action of dilatation." The whole is to be 
 considered, " as a necessary operation of nature. "l| Owing 
 to this dilatation, there is a greater quantity of blood circulat- 
 ing in the part, " which is according to the common rules of 
 the animal economy ; for, whenever a part has raoi e to do, 
 than simply to support itself, the blood is there collected in 
 larger quantity."'** The swelling is produced by an extra- 
 vasation of coagulable lymph, with some serum ; but this 
 lymph differs from common lymph, in consequence of pass- 
 ing through inflamed vessels.ff It is this lymph which be- 
 comes the uniting medium of inflamed parts ; vessels shoot 
 into it ; and it has even the power of becoming vascular it- 
 self. Xt The pain proceeds from spasm. 55 The redness is 
 produced, either by the arteries being more dilated than the 
 veins, or because the blood is not changed in the veins. |||j 
 "When a part cannot be restored to health, after injury, by 
 inflammation alone, or by adhesion, then suppuration, as a pre- 
 paratory step to the formation of granulations, and the conse- 
 quent restoration of the part, takes place.*** The vessels 
 
 * Hunter on Inflammation, p. '219. 
 
 ■f P. 278. \ P. 279. } P. 282. 
 
 i| P. 282. ** P. 280. ft P. 311. 
 
 U P. 309. {$ P.386 |M P381 
 
 "* P. 371. 
 
157 
 
 are nearly in the same slate as in inflammation ; but they are 
 more quiescent, and have acquired a new mode of action.* 
 
 Inflammation, according to this, as well as some other doc- 
 trines, is to be considered, not as a disease, but as a salutary 
 operation of some wise and provident power, performed in or- 
 der to rid the system of some impending evil, or to renew a 
 structure, which could not otherwise be restored. But I hold 
 it to be an established point, that there is no supposition more 
 directly contrary to true philosophy, or to ihe principles 
 which reason teaches, than the opinion, that certain events 
 take place, merely because these evenis are useful; as, for 
 instance, the coagulation of the blood in mortification ;f 
 whether we refer these events to the agency of some peculiar 
 power called nature, or to ihe mo^e extensive operation of 
 some general principle. 
 
 Inflammation is, in many cases, so far from being a " saluta- 
 ry mode of aciion," that, in a great majority of instances, it is 
 a most dangerous and a most troublesome disease ; and I shall 
 presen.ly endeavour to show, that it is not though the inter- 
 ference of this action, that divided parts unite ; but that, on 
 the contrary, whenever the action becomes inflammatory, that 
 then no union and no restoration take place, but the sides re- 
 main separa'.e. until the disease subside. 
 
 Inflammation is considered as " an increased action of the 
 vessels," which chiefly consists in a greater degree of dilata- 
 tion, the power of muscular contraction seeming to give way. 
 This allows more blood to enter ; which greater quantity of 
 blood is not considered as a symptom or part of ihe disease, 
 
 * Hunter on Inflammation, P. 372. 
 
 f " For this purpose, (coagulation,) it (blood) requires rest, either by extrava- 
 sation, or being retained in the vessels, till the utility of circulation is lost, or till 
 it can answer some good purpose by its coagulation, as in mortification." Hunter 
 onlhr Shod, kc. p. 86. 
 
158 
 
 but as one of the contrivances of nature, the part having more 
 to do than simply to support itself. 
 
 How far the loss or diminution of muscular power will ac- 
 count for this dilatation, will afterwards be examined. Here 
 I shall only observe, that the doctrine of ihe simple increase 
 of action, (circulating action,) in a vessel, or simple dilataiion, 
 never can explain the production of inflammation, which is to 
 be considered as a state which is new and diseased, and to- 
 tally different, both in its na'ure and consequences, from he 
 condition which subsists in health. The other parts of the 
 theory will come afterwards to be consideied. 
 
 According to Dr. Darwin, when any part is excited " into 
 such violent motion, that a quantity of pleasurable or painful 
 sensation is produced, it frequently happens, bm not always, 
 that new motions of the affected organ a;e genera ed, in conse- 
 quence of the pain or pleasure, which are termed inflamma- 
 tion. These new motions aie of a peculiar kind, tending to 
 distend the old, and to produce new fibres, and thence to elon- 
 gate the straight mus les, which serve lo. o-mo. ion, aud to 
 form new vessels, at the ext- entities or sides of .he vas, ular 
 muscles."* Upon this theory I shall only make three ob- 
 servations: First, the effect of inflammation or sensation, is 
 considered as its cause : Second, we very frequently have 
 highly pleasurable sensa.ions, or great pain, ex iied in a part, 
 without any production of inflammation ; theiefo e, if the sup- 
 posed causes of inflammation have existed, and r.o cir uni- 
 stances have occurred : apable of counte acting their ope a- 
 tion, it will follow, that these causes are not real, but imagi a- 
 ry : Third, the motions which are supposed ,o ake pla e, 
 are not sufficient to explain the phenomena of he disease. 
 
 From an attentive examination of the ope at ion of <he ex- 
 citing cause of inflammation, and from a view of its difte.ent 
 
 * Zoonomia, Vol. I. p. 395, 396; 
 
159 
 
 symptoms, we canned admit the proximate cause to consist 
 in vis idi y, or e; o loci of the blood, or spasm, or simple in- 
 ci se of s heni" or as henic diathesis, or actions of dilata- 
 tio.., o increased sensation, but must, upon the principles 
 al eady lasd down, consider it as a new and distinct action of 
 the living system. When this action is uncombined with any 
 othc morbid condition, the disease is-simple inflammation ; 
 bu when to this another action is united, or when the inflam- 
 matory action is modified, the disease is no longer simple, but 
 specific inflammation. 
 
 In examining new actions, we find it to be of use to compare 
 them with those which they resemble most, and with which 
 we are better acquainted. It has been already mentioned, 
 that whatever tended greatly or suddenly to increase the na- 
 tural action of a part, changed it, and produced, inflammation. 
 This we learn, from examining the exciting causes of this dis- 
 ease ; and, by analysis, we find some similarity betwixt this 
 and he natural action. 
 
 The esseuiial symptoms of inflammation, are redness, 
 swelling, heat, and pain, which in some instances, are preced- 
 ed, and in others, followed by a general disease. These 
 symptoms, when taken together, differ very materially from 
 the natural state and condition of the part ; and, therefore, 
 although they may have been produced by causes which 
 tend to inc ease the natural action, yet we must conside- this 
 action as materially changed, in consequence of the morbid 
 inc; ease. 
 
 Akhough this be the case, and although many new actions 
 do not admit of analysis, yet the different symptoms of in- 
 flammation may be explained, or the action analysed ; and this 
 J shall proceed now to do. 
 
no 
 
 Of the Ratio Symptomatum. 
 
 Redness. — The redness of the inflamed part, is evidently 
 owing to the presence of a greater quantity of blood than 
 usual ; and this augmentation seems to be produced, both by 
 the vessels whkh formerly conveyed the blood being more 
 distended, and also, by the enlargement of the small vessels, 
 which formerly contained only lymph, but which now receive 
 red blood. It is the enlagement of these small vessels, 
 which have made some suppose, that new vessels were form- 
 ed by inflammation ; a supposition which is evidently con- 
 tradicted, by observing, that heat, and many other causes of 
 inflammation, operate so quickly, that no new vessel can have 
 time to be formed ; and yet the redness is as great, and the 
 inflammation as perfect in a minute, as in an hour or a day, 
 after their application. The formation of a perfect and regu- 
 larly organised substance, by a strongly diseased action, is 
 likewise incompatible with the usual laws of the animal eco- 
 nomy. 
 
 There is, likewise, another cause, which will co-operate 
 with this, in producing ihat bright redness which attends many 
 inflammations, namely, that owing to the diseased action, the 
 arterial blood is not so thoroughly converted into veinous, as 
 in healih.* Another consequence of which, as has been for- 
 merly mentioned, is, that less life or energy is yielded to the 
 part, and therefore it sutlers more than it otherwise would do. 
 
 As the vessels are supposed to act more powerfully in in- 
 flammation, it has been thought, that they ought to contract 
 to a greater degree ; and, therefore, ought rather to allow less 
 
 * This fact has been mentioned by Mr. Hunter ; but he accounts for it upon 
 the principle of its motion being accelerated, which is certainly a mistaken vier 
 of the subject. P. 281. 
 
1G1 
 
 Wood than formerly to enter, than to become turgid. Borne 
 have, therefore, supposed, that inflammation was uniformly 
 produced by weakness of the part ; and this idea is, in one 
 view, adopted by Mr. Hunter, who supposes, that the mus- 
 cular power of the vessels is diminished in inflammation, 
 which, therefore, can be more fuliy dilated. But, certainly, 
 the continuation of the circulation, implies a continuation of 
 the powers which carry it on. Mr. Hunter even allows, iliat 
 the blood circulates faster than usual, which cannot well hap- 
 pen, if the muscular power gives way. The blood is carried 
 from the heart along all (he vessels; first, by the percussive 
 force of the heart, and nest, by the contractions of the arte- 
 ries, which co-operate with the original projection. Without 
 muscular contraction in every part of the vessels, we must either 
 suppose the heart to possess a force beyond all belief, or we 
 must allow the circulation to proceed only a very li;tle way ; 
 for the amplitude of a projected body is always as the square 
 of the impetus. Were the arteries only elastic, they could 
 only react on the blood, and propel it onward, in a degree 
 proportioned to the original action of the heart, and, at every 
 inch, the velocity must become less, because the communica- 
 ted force must be diminishing. Mr. Hunter, who allows 
 both muscularity and elasticity to the arteries, admits, that 
 the elasticity diminishes with the size, whilst the muscular 
 power increases as the other diminishes. If, then, the muscu- 
 lar coat of the extreme vessels be destroyed or weakened, 
 then the circulation must be stopped, and the part become 
 to'-pid, instead of in (lamed, because the;e is little or no elas- 
 ticity to assist the circulation. Mr. Hunte likewise suppo- 
 ses, that, in inflammation, " the elastic power must be dilated ;" 
 by which, I suppose, he means the elastic: coat. This coat, 
 granting it to exist in the minule vessels, must then, by this 
 dilatation or over-stretching, be deprived of i ? s fela'siic proper- 
 
 VOL. It x 
 
162 
 
 ties, and, therefore, the circulating power of the artery be 
 still more destroyed. 
 
 Some, who have had recourse to the supposition of weak- 
 ness producing inflammation, have conjectured, that the 
 power or force of the upper part of the artery was increased, 
 in proportion to the weakness of the extremity ; and, there- 
 fore, that, by the vis a tergo, the circulation was carried on, 
 and the part likewise became more turgid. But this goes 
 upon the supposition, that the exciting causes of inflammation 
 can always act more upon parts at a distance, than upon the 
 inflamed part ; and reduces the whole nearly to the old doc- 
 trine, of a part sending and a part receiving. 
 
 It must then be evident, that the muscular power of the 
 artery continues strong and vigorous, and that the contrac- 
 tions are more forcible. The dilatation of the artery is pro- 
 portioned to the contraction; for, unless in spasmodic dis- 
 eases, the two properties of a muscle, contraction and dila- 
 tation, balance each other. * 
 
 Swelling. — The swelling of an inflamed part may be as- 
 cribed to two causes ; 1st. To the increased quantity of 
 blood in the vessels ; 2d. To the deposition of new matter. 
 As the first of these has been already noticed, I shall only 
 here attend to the second. 
 
 In every part of the body, there are two sets of vessels, 
 (though many, for particular purposes, have more :) The 
 one set secretes the matter which forms the parts, or deposits 
 new organic particlesf as the old ones are absorbed ; the 
 
 * It may perhaps be said, that as muscles, when iuflamed, become rigid, so the 
 muscular power of the arteries, in inflammation, ought to be diminished. But it 
 is to be remembered, that the state of the vessels, and the state of the inflamed 
 parts, are not exactly similar, and that the same effects are not produced in each. 
 This must be evident. In the same way, the state of the vessels in an ulcer, and 
 the state of the ulcer, or the condition of the vessels in any gland, and the state 
 of the gland itself, are distinct in their effects and phenomena. 
 
 t By organic particles, I understand matter secreted or deposited in an organi- 
 sed state, so as to repair the waste of the body. By the same term, the Commie 
 
i6a 
 
 other excretes a particular fluid into the interstices, betwixt 
 the different organic particles, in order to preserve the ne- 
 cessary degree of softness and mobility.* Now, it must be 
 evident, that if the action of a part be changed, the functions 
 of the part, and its secretions, must also be more or less af- 
 fected. 
 
 In inflammation, the action is not only increased, but 
 changed ; the secretions, therefore, are also changed, and in 
 part increased. 
 
 The interstitial fluid (or the fluid which softens the parts) 
 is increased in quantity, but it is also different from what it 
 was in health ; It is less perfectly prepared, (if by perfection 
 we mean the state which was originally intended,) and ap- 
 proaches nearer to the nature of the lymph or serum. All 
 the secretions are formed from the blood ; and, therefore, the 
 less perfectly that they are formed, the nearer must they ap- 
 proach to the nature of the fluid from which they derive 
 their origin. 
 
 The same cause which affects the production of the in- 
 terstitial fluid, must likewise, in a certain degree, affect the 
 formation of the new or organic particles of the part. These, 
 in inflammation, will be deposited, like the interstitial fluid, 
 in greater quantity, but they will likewise be less perfect ; 
 for both the perfection and the longevity of the particles de- 
 pends upon the arteries performing their functions regularly 
 and slowly. 
 
 The swelling, then, depends, 1st. Upon the presence of 
 a greater quantity of blood than usual ; 2dly. Upon the in- 
 crease and change of the interstitial fluid ; and, 3dly. Upon 
 
 de Buffon understands molecules, which exist every where in the 3ame form, and 
 do not receive their organization at the part which they are to join. 
 
 * This fluid is even to be found betwixt the particles of bone; but it differs in 
 them from the fluid which eoftens mufcles, and this again from tti3t whirU be- 
 'ongs to the brain, 4"C-- 
 
164. 
 
 lire deposition of more organic particles, in an imperfect 
 staie.* The second cause operates much more than the 
 other two; for where there is little interstitial fluid, the 
 swelling is less. 
 
 Mr. Hunter supposes, that the swelling is chiefly produ- 
 ced by the extravasation of coagulable lymph, which under- 
 goes some changes, by passing through inflamed vessels ; and 
 that -his change " obliges it to coagulate" sooner than it 
 otherwise would do-t But this operation, as he himseif ac- 
 knowledges, should rather retard the coagulation, than acce- 
 lerate it. 
 
 Pair.. — In the preliminary dissertation,^, it was mentioned, 
 that every new or imperfect action is productive of sensation 
 in the mind,j| and ii is upon this principle, that we are to ac- 
 count for the pain which attends inflammation. The more 
 violent that the inflammatory action is, compared to the pow- 
 er of the pari, or its previous state of action, the more acute 
 is the pain. When inflammation takes place in a part, whose 
 action naturally is small, such as cartilages and bones, or 
 whose action, owing to the operation of other causes, ought 
 to be very low, as, for instance, parts which have been 
 weakened by cold, then the pain is very violent. The pain 
 is likewise extremely acute, when parts are inflamed, which, 
 in health, are very sensible.*^ Hence, inflammation of the 
 
 * Owing to this cause, and to the greater thickness of the interstitial fluid, the 
 part feels hard. 
 
 Hunter on Inflammation, p. 311. 
 
 | 1' c 'iiuinary Dissertation, p. 125. 
 
 i| !;i some rare instances, the change of action does not produce sensation, or at 
 least, the sensation does not amount to pain. Dissection proves, that, in certain 
 cases, inflammation has existed, and lias produced suppuration, without giving any 
 
 ■ > p uuful sensation to the patient. 
 
 . hat i^- to say, parts which have action easily excited in them. Some parts 
 have their action increased slowly, and %vilh difficulty, such as tendons, bones, 
 dec. which ma j be torn or broken without much pain, until the inflammatory ac- 
 tion bi? slowly induced, and then the sensation is acute. If parts, whose action >* 
 
I(x3 
 
 intestines is attended with violent pain. In general, the 
 pain, in simple inflammation, is greatest dining the diastole of 
 the artery. 
 
 Some ascribed the pain to the mechanical cause of disten- 
 sion ; but we must ascribe it rather to the peculiar condition 
 of the nerves, or their state of acting ; because, otherwise, 
 we should find the pain to be in proportion to the degree of 
 distension, which is not the case. Even the pulsatory fee?, 
 which attends inflammation, is not entirely dependent upon 
 simple distension and contraction, but upon the peculiarity 
 of the action ; for, in some species of inflammation, that is to 
 say, some modifications of the inflammatory action, this sen- 
 sation is not produced. 
 
 Heat. — Some have explained the production of animal 
 heat entirely on mechanical or chemical principles, and have 
 too much overlooked the agency of the living principle : 
 But, whatever means may be employed for this purpose, we 
 must acknowledge them to be entirely dependent on the ac- 
 tions of life. Common matter is capable of existing, with- 
 out the aid of other matter ; but animals and vegetables, 
 which exhibit move varied phenomena, and perform more nu- 
 merous actions, depend upon other substances for their 
 growth and support, and become afterwards, in their turn, 
 subservient to the necessities of other individuals : They re- 
 ceive their increase from the conversion of other mailers in- 
 to a part of themselves, and have thfcir life renewed, by 
 changing the life of these matters into their own. Keat is 
 likewise a principle, which is necessary to their existence ; 
 and this also they derive from without, by processes which 
 depend upon the presence of life. During respiration, the 
 air, which is combined with the blood, and with some of the 
 
 naturally low, could have it easily and quickly increased, they would become 
 diseased from very trifling causes; because these would readily induce an actios 
 much greater than the natural or previous action of the part. 
 
166 
 
 substances which it contains, gives out part of its heat to the 
 arterial blood, which unites with it, and from which it is again 
 separated by the action of the living principle, in a quantity- 
 proportioned to the degree or extent of the action in 
 general. 
 
 Those actions which, although different from the natural 
 one, do not rise in degree or violence beyond it, produce 
 Iiitle or no increased quantity of heat. Those actions which 
 sink below this medium, produce less heat, and those which 
 rise beyond it, more, than is natural.* The production of 
 heat is not exactly on the same footing with other secretions, 
 which depend not so much on the degree, as on the peculiar 
 nature of the action ; for this being a simple substance, can- 
 not be changed by the change of action, but can only be af- 
 fected, with regard to quantity, by the degree of action in 
 the vessels.f 
 
 The most current opinion, on this subject, is, that the pro- 
 duction of animal heat, depends upon the difference in the 
 capacity of arterial and veinous blood, for combining with 
 heat : That, in the extreme vessels, the arterial blood is com- 
 bined with certain substances, in consequence of which its 
 capacity is diminished, and heat is given out. On the other 
 hand, when veinous blood is freed from these substances in 
 the lungs, its capacity is increased, and the heat, which is 
 given out by the decomposition of the air which we inspire, 
 is absorbed. But, granting all these facts to be proved, it 
 still must be admitted by every one who reasons on the sub 
 ject, that these changes cannot take place spontaneously, or 
 of themselves, but must be dependent upon the operations of 
 
 * By low or violent action, I mean the state of action, or its degree, consider- 
 ed relatively with regard to the power of the part, or to the proportion which 
 ought to subsist betwixt action and energy. 
 
 t It is chiefly at the surface, that the action produces a variation in the degre* 
 *f actual heat. 
 
167 
 
 the nervous energy. It will, then, be nearer the truth, if 
 we consider these changes rather as effects of the general 
 operatiou which produces heat, than as direct causes upon 
 which this production depends. The generation of heat in 
 an animal, is truly a secretosy process, as much as the forma- 
 tion of bile or gastric juice, there being only this difference 
 betwixt them, that, in the one case, a substance is separated 
 from the blood, which formerly existed perfectly in it, and 
 which exists in perfection in every piece of matter, whilst, 
 'in the other, the living power produces a new combination, 
 and different arrangement, of the principles of the blood, 
 forming a substance which neither existed in it, nor else- 
 where. Neither the one nor the other process depends upon 
 any active changes originating in the blood itself, nor upon 
 chemical principles alone, but both are to be referred, for 
 their production, to the intricate and inexplicable operation 
 of the vital energy. The production of animal heat, then, 
 does not depend directly upon the diminution of the capacity 
 of veinous blood for combining with heat, or retaining it, 
 more than the formation of bile depends upon the diminished 
 ability of the blood in the liver, to retain the principles of 
 which it consists. 
 
 The feeling of heat, then, in inflamed parts, will be great 
 or little, according to the capability of the part for producing 
 heat, and its capability of receiving the sensation. 
 
 From these remarks, we may understand, how a greater 
 quantity of heat is produced by an inflamed part, than that 
 part, without acute inflammation, would produce. * We may 
 
 * It must be remembered, however, that although the heat of a part be aw 
 increased in inflammation, yet we are not to judge of the degree by the sensaticu 
 which is produced; because, owing to the increased sensibility of the pari, a given 
 stimulus will produce a greater effect than formerly. Hence, the contact of a 
 foreign body gives pain, and the presence of little more than the usual quantity of 
 heat will give the sensation of burning. We are to judge, then, of the rea 1 de- 
 
168 
 
 also understand, how, in approaching mortification, the heat 
 is little, because the action is low, although it yet be suffi- 
 cient to kill the weakened part. We can also see, why the 
 ioflammatio assiiefacta, or what has been called passive in- 
 flammation, should produce much less heat, than the inflam- 
 matio valida ; because the action rises little beyond the na- 
 tural one, in degree, when compared to the power of the 
 part, and has indeed become almost habitual to it. 
 
 The inflammatory action natually terminates by a secre- 
 tion, the nature of which varies in different circumstances. 
 Whenever this takes place, then the heat of the part 
 falls, more or less, from its morbid degree ; because, although 
 the action be still unnatural or diseased, yet its violence is 
 less. 
 
 Even the presence of any secretion, although not depend- 
 ent on disease, will prevent the heat from being raised so 
 high, by the inflammatory action, as it otherwise would be ;* 
 one cause of which perhaps is, that the secretion carries off 
 a quantity of heat ; another is, those parts which secrete 
 most fluid, have least capability of producing heat. 
 
 We uniformly find, that the inflammatory action of the 
 parts which secrete least, is attended with the production of 
 most heat. The skin secretes less interstitial fluid than other 
 parts ; and, although it sometimes secretes perspiration co- 
 piously, yet, in inflammation, this does not take place. It is, 
 therefore, to be considered, with regard to inflammation, as 
 one of the parts which secrete least ; and, on this account, 
 the heat is much greater in inflammation of the skin, than of 
 other parts : But. the. sensation is not always greater ; for, in 
 
 gree of hrnt, not by the sensation of the patient, but by the feelings which it 
 produces in another pefsoft, when lie touches the inflamed part, or by the applica- 
 tion of the thermometer. 
 * Hence, inflammation cf the urethra is attendee! witfi less heat tlian inflanjnia- 
 ■ the skin. 
 
169 
 
 ententes, the sensation is very acute, owing to the nature of 
 the part affected, or its sensibility, although the actual in- 
 crease is perhaps not above one or two degrees more than its 
 natural standard. 
 
 All increased degrees of the natural action give the sensa- 
 tion of heat, whether more heat be really present or not ; 
 because the effect of heat, or increased action, is produced. 
 The sensation, and the substance which we call heat, are two 
 different things, the one being an effect, the other a cause j 
 or the one an action, and the other an agent. Now, the 
 same effect may be produced by various causes : Thus, the 
 application of zinc and silver, in a particular manner, to the 
 mouth, will produce the sensation of light, as certainly as 
 light itself. It must, however, be remembered, that, with 
 respect to the sensation of heat, as well as other sensations^ 
 different parts have different susceptibilities. The sensation 
 of touch is peculiarly confined to the cutis, that of hearing 
 to the ear, &c. In the same way, some parts have a greater 
 susceptibility for receiving the sensation called heat, than 
 others. This sensation is strong in the skin and bowels ; 
 but, in the brain, muscles, bones, &c. heat produces a some- 
 what different effect, and gives a sensation of a different na- 
 ture. This is conformable to what we observe, in other in 
 stances, of the effects of foreign agents ; for tin re is no fact 
 better ascertained than this, that agents often produce differ- 
 ent effects, when applied to different individuals, or different 
 parts of the same individual. Hence, in simple inflammation 
 of glands, or other parts lying below the skin, with which it 
 does not exhibit immediately the sympathy of association, 
 we find, that there is first pain, with little heat, and then 
 more heat, in proportion as the inflammation affects the cutis. 
 As long as there is pain, without much heat, we may con- 
 clude, that the inflammation is not making a rapid progress 
 toward suppuration ; for, unless in some specific inflamma- 
 
 vol. i. y 
 
5:70 
 
 fcions, the surface always becomes affected, before matter i% 
 formed in the gland. 
 
 Fiom these remarks, which are supported by facts, it will 
 appear, ihat, in inflammation of the surface, the heat is pro- 
 duced in greatest quantity by the cutis, whilst the pain pro- 
 per to inflammation is seated chiefly in the cellular sub- 
 stance. 
 
 Actual heat, in inflammation, is chiefly produced by the 
 cuticular vessels ; and, unless these be affected, the degree 
 of heat is not greaily increased, although, in very delicate 
 parts, the sensation often is.* The sensibility, With regard 
 to heat, of the cellular substance, the muscles, the parenchy- 
 matous substance of the lungs and the liver, the substance of 
 tendons, ligaments, brain, &c. is not great ; and, therefore, as 
 the inflammatory action in them is not attended with the 
 production of much actual heat, these, when inflamed, give 
 more the sensation of simple pain, than of heat. On the 
 other hand, the pleura, which is more sensible than those 
 parts, with regard to heat, when inflamed, gives both 
 the sensation of sharp pain, and also of moderate heat. 
 The intestines, again, are, in this respect, highly sensible, 
 and, when, inflamed, give the sensation of intolerable heat, 
 which is a pathognomonic symptom of ententes. 
 
 It is impossible to account for the variations which take 
 place in the production of heat, by the inflammatory action., 
 upon the mechanical principles which were once maintained, 
 and which still are adopted by some. It was the opinion of 
 Boerhaav€,f and others,! who wrote after the discovery of 
 the circulation of the blood, that the heat was produced, by 
 the attrition of the red globules, against the sides of the ves- 
 
 * It has been ascertained by Mr. Hunter, that the actual heat of the muscles,, 
 or viscera, is very little increased by inflammation. 
 i Boerhaave, Aph. 332 
 ^auvagp. -N'oso'ofia Method, toin.i. p. 383 
 
Hi 
 
 sels ; and the same is embraced by a modern author,-' as one 
 <-ause of i his symptom. But, by the philosophy which ii 
 now taught, it appears, that a fluid may flow with the utmost 
 velocity, through a pipe, for a thousand years, without pro- 
 duciag a single degree of heat : And our mechanics, regard- 
 less of the authority of either Pitcaim or Bell, seem still to 
 believe, that, if they keep their machinery moist, there is 
 very little danger of its being inflamed by the friction. 
 
 Fever. — The last of the primary symptoms of inflammar 
 tion, is the general fever, or affection of the system, which 
 often attends it. This is sometimes idiopathic ; that is to 
 say, it sometimes is produced at the same time with the local 
 inflammation ; and by the same causes. At other times, it 
 is symptomatic ; that is to say, it is produced, not directly 
 by the causes which originally produced the inflammation, 
 but sympathetically by the local inflammation. Both of these 
 species of fever are, in this disease, produced exactly in the 
 same way, although by different exciting causes ; and the 
 manner of their production may be understood, from the 
 principles which are laid down in the preliminary disserta- 
 tion. The idiopathic fever is always preceded by coldness, 
 because the action is always formed slowly. This coldness 
 is in the commencement real, and afterwards only sensitive. 
 There is at first, owing to the diminution of the natural ac^ 
 tion, a diminution in the production of heat, and, consequent- 
 ly, a feeling of coldness. This sensation continues for some 
 time after the actual heat, in consequence of the incipient, 
 but imperfect action, begins to be increased, which has been 
 attributed to a derangement in our sensitive faculty : But it 
 may be explained in a different manner ; for, as increased ac- 
 tion is productive of the sensation of heat, as well as frequent- 
 ly of the increase of actual heat, in those organs which are 
 
 • Bell's Treatise on Ulcers, p. 28. 
 
172 
 
 peculiarly fitted to secrete it, so imperfect or diminished ac- 
 tion is productive of the sensation of cold. During the first 
 formation of an action, there is actual coldness produced ; 
 but, after the action has begun to take place, there is heat 
 produced in a certain quantity ; but, from the imperfection 
 of the action, cold is still felt ; because the same state which 
 cold, or the privation of heat, produces, is present, namely, 
 an imperfect state of action. The sympathetic, or sympto- 
 matic fever, sometimes appears to be formed without any 
 coldness ; because, from the violence of the exciting cause, 
 or local inflammation, or the quickness of its operation, it is 
 excited so quickly, that we do not attend to the symptoms of 
 formation ; but these, nevertheless, do take place, although, 
 owing to this cause, their continuance be short. If, however, 
 the local inflammation be more slowly induced, and, conse- 
 quently, operate more gradually on the system, then the 
 coldness is evidently perceived.^ The symptomatic fever, 
 induced by scalding or burning a part, is quickly produced, 
 and we have very little time to attend to the period of forma- 
 tion. On the other hand, the symptomatic fever, induced 
 by wounds, is excited more slowly, and the period of forma- 
 tion is longer. 
 
 This fever is not produced by inflammation, if it affects 
 parts only to a slight degree ; but it uniformly appears, if the 
 local inflammation be considerable, or, what is the same thing, 
 affects very sensible parts ; and, in these cases, the presence 
 of this fever is a criterion of the presence of inflammation, 
 in parts where we would be led to suspect it, but cannot say 
 decidedly from other symptoms. Thus, if after lithotomy, 
 the patient complain of pain in the abdomen, we will be led 
 
 * Coldness is felt not only in the whole body, if a general action be slowly in- 
 duced, but it is also felt in a particular part, in local actions, if these be gradually 
 induced. Thus, before eruptions appear on particular parts of the skin, those por- 
 tions are often felt cold. 
 
 
173 
 
 to conclude, that this proceeds from inflammation of the \ i- 
 cera, if it has been preceded by coldness, and accompanied 
 with heat ; but if no shivering has taken place, and the pulse 
 be not much affected, it proceeds most probably from a dif- 
 ferent cause. 
 
 The degree to which this fever will be excited, depend* 
 not upon the absolute quantity or violence of the inflammato- 
 ry action, but in a great measure, upon the degree of the lo- 
 cal inflammatory action, compared to the natural power and 
 action of the part. Those parts whose action is naturally 
 low, and, consequently, whose energy is also small, are ex- 
 tremely painful, when inflamed, and the system sympathises 
 greatly with them, although the real quantity of inflammatory 
 action, considered absolutely, be trifling. Hence, inflamma- 
 tion of tendons, bones, or ligaments, affect the constitution 
 greatly ; and, from the same cause, it will appear, that agents 
 which induce violent inflammation in joints, (by which I mean 
 absolutely great inflammatory action,) will rapidly produce 
 sloughs of the part, and death to the patient, in no very long 
 time, if it be not subdued. If, on the other hand, the agents 
 have acted less powerfully, then sloughs are not produced, 
 but the system is as much affected as it would be by a much 
 greater degree of local inflammatory action in some other 
 parts. Those parts, again, which are very sensible, affect 
 the constitution greatly, in the same way, and on the same 
 principle nearly, as those whose action is naturally low ; be- 
 cause slight causes induce the same disproportionate action 
 in them; and hence they are soon destroyed. In this way, 
 inflammation of the bowels affects the system greatly, and lo- 
 cal mortification is also rapidly produced. 
 
 There is, however, another cause co-operating with this 
 one, in the present instance, to produce a general sympathy, 
 namely, the natural sympathy which exists betwixt the sto- 
 mach and intestines, and the rest of the body, by which inju- 
 
m 
 
 ries clone to them affect the system very rapidly ; a slight 
 disorder of the stomach, for instance, sometimes producing 
 syncope. This does not depend, as Mr. Hunter* supposes, 
 upon the stomach being the receptacle of, what he calls, sim- 
 ple life ; because the existence or such a receptacle is con- 
 trary to the general nature of the animal economy ; and I 
 know of no proofs which establish its existence. 
 
 Of the Consequences of Inflammation. 
 
 Having made these remarks upon the production of the 
 symptoms of inflammation, I shall now proceed to consider 
 its most frequent consequences or terminations, which have 
 generally been said to be, adhesion or resolution, suppuration, 
 and mortification. 
 
 Adhesion. — To illustrate the important process of adhe- 
 sion, or the union of two living parts, which have once been 
 divided, it may not be improper to attend to the cause of re- 
 production in general, or the replacement of those particles 
 which are daily absorbed. Neither absorption nor reproduc- 
 tion can take place in a dead body, but depend entirely on 
 the action of the living principle. If this action be impaired, 
 these functions are imperfectly performed. If, on the other 
 hand, it be too high, then those processes are too rapidly car 
 
 **' AH the parts that may, in one sense, be called vital, do not produce the same 
 " effect mpon the constitution; and the difference seems to arise from the differ - 
 " ence in their connections with the stomach. It is to be observed, that vital parts 
 w may be divided iuto two; one , which is in itself immediately connected with 
 " life, as the stomach; the other, where life only depends upon it in its action or 
 *' use: The heart, lung-', and brain are only to be considered in this last light."— 
 " If the stomach is inflamed, the patient feels an oppression and dejection through 
 ** all the stages of the inflammation. Simple animal life seems to be hurt or lessen 
 " ed, just as sensation is lessened when the brain is injured." 
 
 Hunter on Inflammation, p. 324, 323. 
 
 " The stomach is the seat of simple animal life, and thereby the organ of univer- 
 '-' sal sympathy of the materia vitae." P. 402. 
 
175 
 
 ried on, and the new matter which is deposited, is incom- 
 pletely organized ; its life is likewise less perfect, and its con- 
 tinuance is short. This is illustrated, by what we observe 
 in ulcers and inflamed parts. The new matter, or the organic 
 particles, are furnished entirely by the arteries, and deposit- 
 ed by them, under the direction of the nerves ; and the na- 
 ture and organization of this matter varies with the action.* 
 These particles are furnished, at the moment of their forma- 
 tion, with the specific life of the animal, in a degree propor- 
 tioned to the perfection of the formation ; and their natural 
 longevity observes the same ratio. They live and die from 
 the same causes which influence the life of the body, consi- 
 dered as a whole ; but their duration is infinitely shorter than 
 that of the body. They quickly perish, or descend in the. 
 scale of existence; they are alternately absorbed and replac- 
 ed. There is, thus, a continual round of death f and repro- 
 duction going forward in the animal frame. 
 
 In order that this process may go on, or that reproduction 
 may take place, it is necessary, that a void be formed, by the 
 absorption of the old matter ; which void is filled up by new 
 particles, which adhere together, and preserve the organiza 
 tion of the part. If this void, instead of being made slowh 
 by absorption, and being filled up the moment that it is form 
 ed, be made suddenly, and of a considerable size, by incision. 
 the same effect is, in the end, produced. The arteries which 
 we cut, pour out their blood, but the quantity is gradually 
 
 * The action, at the surface, forms skin, and that in the muscle, forms : 
 As long as the actions of the part remain the same, then a similar matter 
 nished ; but when the action changes, then the matter also change?. Thus, for in 
 stance, bone is sometimes formed in the place of membrane, Lc. 
 
 t Death is the descending of any substance from a higher to a lower species oi 
 existence, or from a more perfect to a less perfect vitality; for there can be i>c- 
 such thing as absolute death, that is to say, complete deprivation of a vital prir. 
 ciple, until the same Great Power who original 1 ;.' gave existence A .^ -^:r 
 pleased, by his sovereign will, to annihilate it 
 
176 
 
 diminished, until it ceases altogether, and a different and 
 more limpid matter drops out. This has been called, by 
 some, the lymph, and by others, the serum, which filtered 
 through the contracting vessels. But, were this mechanical 
 notion true, then, by varying the degree of pressure, and 
 thus changing the diameter of the vessels, we should, at plea- 
 sure, make the discharge either red or limpid. It is more 
 probable, that this is one of the most simple secretions which 
 the blood yields, and that the appearance is regulated by the 
 action of the vessels. If the edges of the wound be laid 
 closely together, we next find, that the divided vessels, which 
 have now become extremities, receive the action which the 
 extremities formerly used to have, when a void was formed 
 by absorption. * They throw out matter nearly the same 
 with that which was formerly yielded, and the structure of 
 the part is restored. I have said nearly ; because, from the 
 attending circumstances, the action cannot be so perfect as 
 formerly ; and, therefore, the matter furnished will not be at 
 first exactly the same, and the deviation will be proportioned 
 to the degree in which the action, in consequence of the in- 
 jury, is increased beyond what it was in health. Hence, in 
 parts where the action was slow in its performance, and small 
 in quantity, the deviation will be most. Thus, when a bone 
 is fractured, the callus is much softer than old bone ; it is 
 formed in greater quantity than formerly, and it requires 
 aome time before it is formed in the necessary degree of per- 
 fection, to enable the person to make use of the bone. But 
 a similar injury done to the skin, or a muscle, will not be at- 
 tended with the same effects ; for the action is there, in health, 
 much quicker and much greater : The deviation is, therefore, 
 from the first, trifling, and soon ceases. 
 
 * If, however, the void he larger than it -night to be, owing to the sides of the 
 wound not being laid closely together, then this process does not take place, but 
 the part inflames, as has been formerly explained. 
 
m 
 
 Some have considered the process of adhesion in a more 
 mechanical light, and have supposed, that the lymph was 
 poured out, and glued the parts together, and afforded a bed, 
 into which the vessels from the opposite surfaces might ra- 
 mify, by which union was produced. This takes place, in 
 the opinion of Mr. Hunter, owing to the vitality of the blood ; 
 but I apprehend, that it is fully proved, that whenever blood 
 is extravasated, it loses its animal life, and proves a stimulus 
 to the wound, preventing it from uniting, unless the quantity 
 be very small, in which case it is absorbed, and is thus re- 
 moved. It is our great care, in surgical operations, to tie the 
 vessels, and clear the surface from blood, in order to procure 
 union, which ought to be attended with an effect contrary to 
 our wishes, were adhesion to depend upon the uniting medium 
 of the blood. Mr. Hunter likewise supposes, that coagula 
 have the pow r er of becoming vascular of themselves, and thus 
 more firmly uniting the parts ; but this is assuredly ascribing 
 the actions of one species of life, and of one body, to that of 
 another : We might as well attribute the actions of the life 
 of a quadruped to the living principle of the polypus. 
 
 The perceptible operations of the life of the blood are very 
 £ew, and quite distinct from those of an organized animal. If 
 it ever were to perform other actions, and assume an orga? 
 nized form, then it must cease to be blood, and become a sub- 
 stance with which we have no acquaintance ; for, hitherto, 
 we know of no substance which can become a part of an ani- 
 mal, and receive a regular form, except through the interven- 
 tion of the nerves and vessels, which by regular gradations, 
 change foreign matters into part of the animal. It has, in- 
 deed, been said, that clots of blood have been injected ; but, 
 by the same experiment, we might also prove, that a sponge, 
 or a bit of woollen cloth, were also vascular. 
 
 Adhesion appears to be a more delicate process, than join- 
 ing parts with mucus, lymph, or any intermediate substance 
 
 vol. i. z 
 
178 
 
 whatever. It appears to be nothing less than the action of 
 that power, which is always operating in the system, and 
 restoring the waste of the body ; but, from the circumstances 
 under which it is exercised, and the causes which tend to 
 make it imperfect, the substance which is thrown out is not 
 always perfectly similar to the adjoining parts, at least in ex- 
 tensive wounds. 
 
 This process, which, when carried on in health, is called 
 nutrition, has, in disease, been named the adhesive inflamma- 
 tion. But the term is improper; for adhesion never takes 
 place, until inflammation subsides ; and it often is produced 
 without auy previous inflammation, and quke independent of 
 it, without heat, without pain, and without extensive redness. 
 Whenever a wound inflames, its lips separate, and pain is 
 produced: When the inflammation is removed,, then the parts 
 adhere, and the pain .eases. Adhesion is, in this case, sy- 
 nonymous with resolution ; indeed, resolution is almost al- 
 ways attended with adhesion. There is, however, this differ- 
 ence betwixt them, that adhesion may take place without 
 previous inflammation, whereas resolution implies the exis- 
 tence of that disease. If, however, inflammation has preced- 
 ed adhesion, then it is exactly the same wilh resolution, be- 
 ing a termination of the inflammatory action. He, then, who 
 would talk of the adhesive inflammation, is just as much mis- 
 taken, as he who would speak of the resolving inflammation. 
 
 In the natural state of the body, we find skin adhering to 
 cellular substance, and this to muscle, and this again to bone ; 
 and the same union takes place in disease, two dissimilar sub- 
 stances often joining together, or adhering ; but, for this pur- 
 pose, it is necessary that both be alive, and that the actions 
 of both be in a proportioned degree. 
 
 These observations on adhesion, will serve to explain the 
 termination of inflammation, called resolution; and, therefore, 
 little more will be required to be said on that subject. Reso- 
 
J 79 
 
 iution is, by some, said to be merely a cessation of inflamma- 
 tion, the parts returning gradually to their former state, with- 
 out any intermediate condition. But, if we attend more mi- 
 nutely to the subject, we shall find, that the inflammatory ac- 
 tion, like every o'.her new action, uniformly terminates by a 
 secretion. Some actions terminate in new secretions, whilst 
 others only increase the quantity of old ones. When the in- 
 flammatory action subsides, we have an increased discharge 
 of the proper secretion of the part, or inteisti ial fluid, which 
 is also considerably changed in its nature, and becomes thin- 
 ner than it was during the continuance of the inflammatory 
 action.* The part, therefore, remains swelled, until this flu- 
 id be absorbed ; but the swelling is more diffused and cedoma- 
 tous, and the pain is gone, together with the redness. The 
 organic particles are likewise deposited in greater perfection, 
 and may be said to be a secretory termination of inflamma- 
 tion; because, during the violence of the inflammatory action, 
 they were furnished in a very imperfect state, and were dif- 
 ferent from what they ought to be : But, when resolution is 
 accomplished, they become again natural, and produce either 
 adhesion, if there has been a division, or a renewal of the 
 proper structure which has been destroyed by the inflamma 
 tion, rendering the formative or nutritive action imperfect. 
 
 Suppuration. — If resolution do not take place, owing to 
 the original violence of the inflammatory action, or from any 
 other cause, then, if the part be not killed, a secretion of a 
 different kind takes place, and the inflammation is said toter 
 minate by suppuration. 
 
 Concerning the formation, nature, and uses of pus, many 
 opinions have prevailed ; but, by much the most universal, is 
 founded on the ancient doctrines of fermentation. Bv the 
 
 * It is owing to this, that, duriag resolution, the part becomes softer, although 
 Uie swelling be much the same as formerly. 
 
180 
 
 Grecian physicians, pus was considered as a concoction of 
 the blood or humours, effected by the powers of life, or by 
 nature ; and, therefore, the state of ulcers was attended to 
 very much by Hippocrates, in forming his prognosis, as he 
 thus ascertained the degree of vital power, and the extent of 
 the operations of nature. When the blood was effused into 
 the cellular substance, then it was supposed to undergo a spe- 
 cies of putrefaction or concoction, and to become converted 
 into pus.* 
 
 When the component parts of the blood came to be well 
 understood, and when the humoural pathology came to be il- 
 lustrated by experiments, attempts were made to discover 
 which part of the blood yielded the purulent matter. From 
 some observations on the serum of the blood, Sir John Prin- 
 gle was led to believe, that pus was formed by a concoction 
 of the serum ; for, by exposing this fluid, for some time, to a 
 heat equal to that of the human body, a deposition was form- 
 ed, bearing some distant resemblance to pus, from which it 
 was considered as allowable to conclude, that inflammation 
 produced an effusion of serum, and that this serum was by 
 heat converted into pus. This opinion was keenly maintain- 
 ed by Mr. Gaber, who adduced many experiments similar to 
 that just mentioned, in order to prove the doctrine. Upon 
 these authorities, the doctrine of fermentation was adopted 
 by Dr. Cullen, and copied from him by Mr. Bell, neither of 
 whom seem to have remembered, that the productions which 
 are yielded by an animal, either in health or disease, are 
 yielded by processes peculiar to animal life, and which they 
 cannot possibly imitate by any skill, or by the most elaborate 
 concoction. That heat will coagulate a small portion of the 
 serum, and make it furnish a precipitate, is a well-known 
 
 * " Suppurantur autcm alterato sanguine ac calefacto, donee putrefactus taliuic 
 ulcerium pus Gat." Hippoc, it Ulceribib. 
 
181 
 
 fact ; but it does not thence follow, that it deposits pus. If 
 the mere circumstances of becoming white and thick, were 
 considered as the only necessary changes which a fluid must 
 undergo, in order to be converted into pus, then the lymph 
 would be a much better subject for experiment-makers to 
 work upon, than the serum. Even the urine itself might be 
 proved to be the source of pus ; because Sir John Pringle,* 
 the great authority upon this subject, allows, that this excre- 
 tion, in health, yields a precipitate entirely the same with 
 that which is furnished by the serum, and which, he suppo- 
 ses, is a redundant portion of the nutritious matter escaping 
 by the kidneys. But a positive proof against this opinion of 
 concoction, is obtained, by considering the situations in which 
 pus is formed ; for we find it covering ulcers speedily after 
 they have been wiped clean. Now, had pus been formed 
 from serum, this serum could never have had time to have 
 been digested, and it would have been absorbed by the dress* 
 ings which were applied. Again, when the lungs become 
 inflamed, in people who have water in the chest, or when en- 
 tentes is conjoined with dropsy, we find fhe inflamed viscera 
 covered with pus ; but, unless inflammation has been present, 
 we never find pus in hydrothorax or ascites alone. It must, 
 then, in the cases where we find it, be considered as a secre- 
 tion produced by inflammation, and not the result of concoc- 
 tion, otherwise we should find it in every case of dropsy. 
 
 Some have supposed, that pus was produced by the disso- 
 lution of the inflamed part ; but the putrefactive fermenta- 
 tion yields a very different product from pus : Besides, in 
 ulcers, we daily observe an abundant flow of matter, without 
 the smallest loss of substance. 
 
 It has been already mentioned, that the inflammatory ac- 
 tion changes very much the nature both of the interstitial 
 
 * Observations, &c. p. 33D. 
 
182 
 
 fluid and Organic particles; and these changes may be con 
 sidered as approximations toward the production of pus, it' 
 we consider this as the ultimate secretion which is to be 
 formed. From the continuance and degree of the inflamma- 
 tory action, the interstitial fluid becomes still more different 
 from what it ought to be, and the organic particles become 
 so imperfect, that they cannot supply the waste of the part, 
 •?r renew its structure : The form of the part is then destroy- 
 ed, and the cavity filled with a double secretion,* called pus.f 
 These observations apply to parts of a simple nature ; that is 
 to say, parts which only form matter, to renew their loss by 
 absorption, and interstitial fluid. But there are other parts, 
 which have a third set of vessels, which are intended to se- 
 crete a matter not immediately subservient to the support of 
 the part. When these parts are inflamed to such a degree, 
 as to induce the purulent secretion, then this fluid will also be 
 changed, and form a third component part of pus, as we ob- 
 serve, for instance, in the mamma?, during lactation,! if the 
 true glandular part has suppurated. If, however, the in- 
 flammation has been less violent, then the inflamed gland still 
 continues to yield a milky secretion ; but the milk yielded by 
 that gland is not the same with that furnished by the rest. 
 At other times, those third set of vessels yield the greatest 
 
 * Namely, the new or imperfect substance yielded by the vessels, which former- 
 ly deposited organic particles, but especially the changed interstitial fluid : These 
 nniting, form otte substance, which is called pus. 
 
 f Pus has been considered as a peculiar fluid, of a simple and homogenous na- 
 ture; but, from this doctrine, which I apprehend to be true, it will appear to be a 
 roQipoand body, consisting often of more secretions than one, and differing in dif- 
 ferent organs. The appellation of pus, however, is generally confined to a yellow - 
 i.a bland fluid, of the consistence of cream, which, like other animal secretions, 
 contains a quantity of globules. 
 
 J If the breasts be not in a secreting !state when inflamed, then they are to be 
 ♦oosidered just as the simple parts above mentioned. They are likewise, even 
 daring lactation, to be considered as simple parts, if the cellular substance alone 
 1»e inflamed, as is frequently the case; for ike glandular portion does not always 
 suffer in these cases. 
 
183 
 
 part of the secretion in inflammation, as we see in the ure- 
 thra ; but, in this case, the inflammatory action is moderate, 
 and the organic particles and interstitial fluid are not much 
 affected ; the first of these, at least, forming no part of the 
 discharge, being perfect enough to remain as constituent parts 
 of the organ. 
 
 This process takes place, in different species of inflamma- 
 tion, with different degrees of rapidity ; and the proportion 
 of the different substances which form pus also varies. In 
 simple inflammation, the quickness of the process depends, 
 in part, upon the nature of the organ affected, but chiefly 
 upon the violence of the action. The component parts, 
 again, depend chiefly upon the nature of the part affected, 
 but also, in part, on the degree of action. When bones in- 
 flame and suppurate, which they do slowly, it is chiefly the 
 interstitial fluid, in a changed state, which is furnished, the 
 discharge being thin, and often greasy.* Tendons yield 
 both the interstitial fluid, and part of the organic particle.-. 
 but chiefly the fluid which lubricates their surface. Muscles, 
 the brain, parenchymatous substance of the lungs, liver, Sec 
 and cellular substance, yield both interstitial fluid, and or- 
 ganic particles, in the same proportion, in equal degrees of 
 inflammation ; and the discharge is little different, to appear- 
 ance, in these different parts. Lymphatic glandsf yield 
 chiefly the interstitial fluid, but also partly the organic mat 
 ter, and most likely part of the lymph which they transmit - 
 The conglomerate glands yield both the interstitial fluid and 
 organic particles ; but the latter, unless in violent inflamma- 
 tion, are in small quantity : They also yield their own pecu 
 
 * We must distinguish betwixt the fluid which comes from the bone, and thai 
 which is furnished by the ulcer of the soft parts which cover i' 
 
 f Lymphatic glands are, in one view, to be considered as secretory organs; for 
 they undoubtedly give out the lymph in a different state from that in '5!»^l^'' , 
 tared them: otherwise we can percei** no rise for them 
 
184 
 
 liar secretion, in an altered state. The testicles, for instance, 
 when they suppurate, give a discharge, which consists of 
 these three substances, but chiefly of the first, next of the 
 last, and in least quantity the organic matter. Along with 
 this is discharged the old substance of the testicles, (which 
 has not been yet absorbed,) like threads. Mucous mem- 
 branes, when they suppurate, yield chiefly their usual dis- 
 charge, in an altered state, next the interstitial fluid, in a 
 smaller quantity, with scarcely any organic matter, the in- 
 flammation being seldom so high as to destroy its organiza- 
 tion. 
 
 The chills which precede extensive suppuration, or suppu- 
 ration in delicate parts, are to be accounted for upon the 
 general principle already mentioned, of every new action be- 
 ing preceded by symptoms of weakness during its formation. 
 Mr. Hunter supposes, that the stomach is the great cause of 
 those rigours, in consequence of its being " the seat of simple 
 animal life, and thereby the organ of universal sympathy of 
 the materia vitae." It is, therefore, affected in all diseases ; 
 and the same effect is produced, as if directly injurious 
 causes were applied to itself; which " disagreeable applica- 
 tions" produced coldness : But it surely does not follow, that, 
 because whatever excites squeamishness, induces a tempora- 
 ry feeing of cold, therefore cold is always induced, in disease, 
 by a similar state being excited. 
 
 The coldness which precedes suppuration, is great or little, 
 according to the same causes which influence the degree of 
 the cold fit which precedes inflammation, namely, the extent 
 and degree of the action, and the delicacy of the part affect- 
 ed. The effect upon the system, of the purulent action, 
 after it is fully formed, is likewise proportioned to these cir- 
 cumstances. Every local action, if extensive or violent, or 
 if it exist in delicate parts, must affect the constitution, and 
 induce a general disease. This is uniformly an affection 
 
185 
 
 somewhat similar to the local action, although the symptoms 
 be in a much less degree, and sometimes different. Thus, 
 the local inflammatory action produces pain, heat, redness, 
 and swelling ; but the general action produces only heat, 
 slight redness, and uneasiness, partaking rather of the nature 
 of anxiety than pain. In the same way, the purulent action, 
 which is a depraved action of the formative vessels of a part, 
 produces, when it affects the system, an universal affection 
 or derangement of these vessels, or a diseased action in them, 
 marked by frequency of pulse, and emaciation ; the function 
 of nutrition, or the deposition of organic particles, not being 
 properly performed.* It is to this cause, I apprehend, and 
 not to the mere formation of a quantity of fluid, called pus, 
 that we are to attribute the bad effects of extensive suppu- 
 ration, or ulcerations, or suppurations of the vital parts ; for 
 we cannot suppose, that weakness, or hectic fever, is induced 
 by these abscesses or ulcers acting merely as drains, destroy- 
 ing a certain quantity of blood, or nutritious fluid ; otherwise 
 the effect must always be proportioned to the quantity of 
 matter, which is not uniformly the case. 
 
 When matter is formed in a part, it is sometimes removed 
 by absorption : The sides of the abscess are thus allowed 
 to come together, whilst the purulent action abates, and the 
 nutritive one returns, in consequence of which the part is 
 again restored to its proper condition. But, more frequent- 
 ly, the purulent action extends toward the surface ; (for alt 
 actions tend thither ;) which, consequently, has its organiza- 
 tion destroyed, the vessels of the cellular membranes and 
 cutis forming pus ; so that, at last, at some particular part 
 where the purulent action has advanced most, the matter 
 
 * Hectic fever is never produced, except by such causes as affect the action of 
 nutrition ; such as the purulent action, swelling of the mesenteric gland?, dia 
 betes, &c. 
 
 VOL. I. 2 A 
 
186 
 
 comes to be covered only with the cuticle, which soon bursts, 
 and allows the pus to escape : The abs r ess is then healed, 
 in the same way as in the former instance, and bo h in the 
 same way nearly as ulcers, which will be immediately illus- 
 trated ; and, therefore, I shall not explain here the mode by 
 which abscesses are healed. 
 
 It is in consequence of the tendency of all actions to af- 
 fect the surface, and approach to it, that abscesses spread 
 outward, instead of extending laterally, or inward.* The 
 matter has been supposed to be prevented from spreading 
 through the neighbouring parts, by a coat of coagulated 
 lymph, which lined the abscess ; but it rather appears, that 
 the whole of the inflamed part does not suppurate, but that 
 suppuration begins first either about the centre, or rather 
 somewhere between the centre and the external surface, 
 leaving a hard portion below, and on every side of it : This 
 gradually grows less ; but still the purulent action has reach- 
 ed the surface, before it has affected the lateral margin ; and, 
 therefore, there is always a hardened portion surrounding the 
 abscess, until it bursts, and for some time afterwards : But 
 this hardened circle, or stool, as it has been called, is not 
 formed by an effusion of lymph, induced for the purpose of 
 confining the matter, but is the consequence of the whole of 
 the inflamed part not having yet assumed the purulent ac- 
 tion. 
 
 When a considerable portion of the surface has assumed 
 the purulent action, then the abscess becomes exposed, and 
 an ulcer is said to be formed, which is healed by the same 
 process which heals an abscess, when it discharges its matter 
 
 * Mr. Hunter attributes this to absorption, produced by pressure, which acti 
 more upon the external surface, than the sides or bottom, owing to " a redness in 
 the parts to be freed from a disease already existing-" The cellular substance 
 is likewise fuppos^d to be " more susceptible of this irritation" than other parts, 
 and, consequently, is more quickly absorbed. 
 
187 
 
 by a small opening, or when the matter is absorbed ; namely, 
 the natural action slowly returns, the purulent one disappear- 
 ing, and the proper organic particles being again replaced. 
 
 The vessels which deposit organic particles, seem to re- 
 ceive their natural action first, throwing out what are called 
 granulations, whilst the vessels which secrete interstitial fluid, 
 are longer of receiving their proper action, and still yield a 
 purulent discharge ; but this is not, as must be evident, ex- 
 actly the same with the pus of abscesses. 
 
 Even the whole of the vessels which furnish organic par- 
 ticles, do not receive the action at the same time ; but one 
 vessel after another seems to lose the purulent action, and de- 
 posit proper granulations, which, from the vascularity of the 
 part, are soft, and of a red colour. These, from the imper- 
 fection of the action which forms them, in the beginning of 
 the healing process, die soon, and are quickly absorbed ; but 
 they are as speedily reproduced, and every day renders 
 them more perfect, and brings them nearer to their natural 
 longevity. The formative action seems, at first, to balance 
 the absorbing action, and the part remains, to appearance, 
 the same ; but, after a little, the granulations are formed faster 
 than they are absorbed ; the ulcer is, therefore, filled up, and 
 the excavation obliterated. When the ulcer is filled up to 
 the level of the surrounding parts, or nearly so, we then find 
 the action of increase stop, and the part remain stationary. 
 This depends upon the original laws of the conformation of 
 the system, by which a certain structure is, in every part, 
 produced ; and, being once produced, has a tendency to con- 
 tinue. The granulations are also prevented fiom rising 
 higher, by the action of the surrounding parts, of a similar 
 nature, each portion of an oigan sympathising with the rest, 
 and having its action regulated, to a certain degree, by that 
 of the rest. It is owing to these causes, that the granula- 
 tions, iu a healthy ulcer, c(o 7ioi shoot beyond the surface. 
 
188 
 
 but become covered with skin, the skin-forming action of the 
 neighbouring surface spreading to the ulcer, whenever it be- 
 comes nearly level with it ; that is to say, whenever it is sus- 
 ceptible of receiving this communication of action. The 
 cicatrizing process begins first at the margins, both because 
 the depth is originally less there, and, therefore, the granula- 
 tions sooner rise to the proper level, and also, because they 
 are in the immediate vicinity of the sound skin, and, conse- 
 quently, have the action first communicated to them. Some- 
 times, indeed, the cicatrizing action is assumed by different 
 spots, on the surface, or disk of the ulcer ; but, in this case, 
 it is frequently diseased, an unhealthy covering being pro- 
 duced, which soon dies. 
 
 The cicatrix is at first thinner and softer than sound skin, 
 and consists only of one layer, called cutis ; but, afterwards, 
 the action becomes more perfect, and both cuticle and rete 
 mucosum are produced. This gradation toward perfection, 
 begins, owing to the communication of action, at the margins ; 
 and, therefore, the cicatrix seems to grow less and less, or 
 contract itself, owing to new circles of perfect skin being 
 slowly formed. 
 
 When the ulcer is unhealthy, then this process of healing 
 is interrupted, imperfect granulations are thrown out, and the 
 cicatrizing action is also diseased, a thick insensible substance, 
 called callus, being formed in the stead of thin cutis. The 
 same cause which affects the formation of the granulations, 
 affects also the discharge, which becomes different from what 
 it was in the healthy state, being sometimes thicker, but 
 oftener thinner. 
 
 A healthy ulcer is not attended with much pain, but rather 
 with a kind of smarting, part of which, perhaps, may be at- 
 tributed to the dressings, or other causes, acting mechanical- 
 ly on it : But, when the ulcer becomes unhealthy, from a 
 change in the action, then pain is, in many cases, produced. 
 
189 
 
 Suppuration and ulceration are actions complete in them- 
 selves, and quite different from the inflammatory one, being 
 no otherwise connected with it, than as depending upon it 
 originally for their production. Whenever an ulcer assumes 
 the inflammatory action, then the ulcerative action subsides,* 
 and the suppuration lessens,f in a degree proportioned to the 
 violence of the inflammatory action. 
 
 The ulcerative action consists of two parts, the granula- 
 ting and the purulent: The first is a natural action, the last 
 a morbid one ; but these two are so connected, as to render 
 it impossible that the one should be rendered unhealthy, with- 
 out the other also being affected, botli conjoined forming a 
 perfect and distinct action, different from the inflammatory 
 one in its nature and consequences, and different also from 
 the suppurative one ; for, in this, no granulations are formed, 
 but the vessels which used to deposit them, secrete a fluid, 
 or purulent matter. These actions, although distinct from 
 each other, may yet be converted the one into the other. 
 
 The inflammatory action naturally terminates in the suppu- 
 rative ;J and this may either continue for some time sta- 
 tionary, and then terminate in the ulcerative, or it may con- 
 tinue to increase. In the first case, the superficial vessels of 
 the abscess, or wound, throw out pus, whilst those immedi- 
 ately below it, retain nearly their natural action, or form or- 
 ganic particles. In the second case, one layer of vessels 
 
 * The term ulcerative, does not necessarily imply a continuance of the destruc- 
 tion of parts, or any corroding property, otherwise these remarks would not be 
 just ; for inflammation may destroy the substance of the ulcer, and make it larger, 
 by a species of mortification, although the ulcerative action be injured and les*- 
 >ened. 
 
 f This has been observed so long ago as the days of Hippocrates, w'.io takes no- 
 tice of the bad effects which follow from the inflaming of wounds in ulcers: " Ig- 
 neum enira fervorem hoc inducit, ubi honor et pulaatio accesierit." Dc Ulct- 
 ribus. 
 
 \ The suppurative action belongs to the order Glandulares of the class 
 Mixtio. 
 
190 
 
 after another, if I may use the expression, assumes the sup- 
 purative action, and the excavation increases, from the loss 
 of power to form organic particles. When the suppurative 
 action terminates in the ulcerative,* then the vessels which 
 used to form organic particles, regain their naiural action 
 slowly, and one after another ; whilst the other set of vessels, 
 or those which threw out interstitial fluid, yield still purulent 
 matter.f If the ulcerative action be perfect and healthy, 
 then the structure of the part is slowly renewed, and the in- 
 terstitial fluid of the restored part becomes natural ; the 
 quantity of pus, therefore, gradually diminishes, its source 
 being lessened. 
 
 If, however, from any cause, the ulcerative action should 
 be converted into the suppurative, then granulations are no 
 longer formed, and the part either remains stationary, or the 
 ulcer spreads, according to circumstances. 
 
 Simple ulcers, or ulcers where there is no morbid or spe 
 cific action conjoined with the ulcerative, may be divided in- 
 to five genera, which consist of several species and varieties, 
 which will be attended to in considering the cure. 
 
 First. The healthy, or healing ulcer, in which the ulcera- 
 tive action exists in perfection. 
 
 Second. The indolent ulcer, in which the action is dimin- 
 ished, and, consequently, rendered more or less imperfect. 
 
 Third. The overacting ulcer, in which either a part, or 
 the whole, of the ulcerative action is increased. This is di- 
 visible into two species : First, when only a part of the ac- 
 tion is increased ; such as the granulating, forming fungus : 
 Second, when the action, considered as a whole, is increased, 
 and carried on with greater quickness ; in which case, the 
 
 * The ulcerative action, when simple, belongs to the order Ulcerantes of the 
 class Mixta?. 
 
 f It is by the ulcerative action that all abscesses are healed, and that all loss of 
 substance is replaced: 
 
191 
 
 granulations are formed very imperfectly, and with very little 
 longevity ; the discharge also is changed. 
 
 Fourth. The inflammatory ulcer, in which the ulcerative 
 action is changed into the inflammatory. 
 
 Fifth. The suppurative ulcer, in which the ulcerative ac 
 tion is changed into the suppurative.* 
 
 The symptoms and consequences of these changes will be 
 attended to, when the cure comes to be considered. 
 
 It has been supposed by some, that ulcers healed rather 
 by the circumjacent parts sinking down to the level of the 
 bottom of the sore, than by the formation of granulations, 
 and the renewal of the lost substance. This doctrine was 
 particularly maintained by M. Fabre, a French surgeon, who 
 supposes that the depth of an ulcer depends chiefly upon 
 the swelling of the surrounding parts, and very little upon 
 the real loss of substance ; and, therefore, that the cure must 
 be accomplished chiefly by the subsiding of the neighbouring 
 parls, which is produced either by amaigrissement or suppu- 
 ration. When the parts have subsided as much as possible, 
 then a cicatrix is formed, which is somewhat hollow, or con- 
 cave, owing to the loss of substance, which has not been re 
 newed ; but this hollow soon disappears, owing to the fatten 
 ing of the parts below it. 
 
 This doctrine may, in part, be admitted ; for, in many 
 cases, we observe the amaigrissement of the parts very dis- 
 tinctly. In all cases, it may be observed to a certain degree ; 
 for, in every instance, a swelling at first accompanies the ul- 
 cer ; and this often, although not always, makes it appear to 
 be deeper than the real loss of substance would occasion. In 
 extensive ulcers in large members, we also observe, tliat, by 
 
 * These two last genera cannot properly be called ulcer?, if we confine this 
 term to parts possessed of the ulcerative action ; but if we adhere to the commou 
 acceptation of the word, or consider them merely as solutions of continuity, 
 yielding a purulent discharge, ^hen the division is sufficiently correct. 
 
192 
 
 the emaciation of the part, the sides approach nearer togeth- 
 er, and the ulcer is healed with less difficulty, than it other- 
 wise would be ; and we often find it useful, by proper banda- 
 ges, to assist this process. But, that granulations are formed, 
 and that they are the chief source of the healing of the ulcer, 
 is a point established beyond all controversy, and which may 
 be ascertained by looking at any ulcer on the tibia. 
 
 Mr. Hunter supposes, that the healing of an ulcer is much 
 accelerated, by what he calls the " contraction of the granu- 
 lations." The edges of the ulcer, he imagines, are brought 
 nearer to each other, by the granulations contracting, like lit- 
 tle muscles, the effect of which is increased, by some of the 
 granulations being absorbed ; in consequence of which the 
 rest fall closer together. " Besides, the contractile power of 
 the granulations, there is also a similar power in the surround- 
 ing edge of the cicatrizing skin, which assists the contraction 
 of the granulations, and is generally more considerable than 
 that of the granulations themselves, drawing the mouth of the 
 wound together, like a purse."* 
 
 Were granulations to contract themselves, by any muscu- 
 lar power, they must certainly have this process instantane- 
 ously accelerated, by the application of stimuli, and must ex- 
 hibit periods of relaxation, which they are not observed to 
 do. Were the contraction of the sore to depend upon any 
 power of the margin to act as a sphincter, we should find, that 
 the same cause ought to make an ulcer consequent to a cru- 
 cial incision larger, and prevent it from healing so soon, or 
 with so small a cicatrix, as it otherwise would do, which is 
 not observed to occur. Were the contraction to depend up- 
 on interstitial absorption allowing the particles to fall nearer 
 each other, or collapse, by the power of gravity, then it must, 
 in its degree and effect, be regulated entirely by the perma- 
 
 * P. 4&4. 
 
193 
 
 nent posture of the limb, or situation of the ulcer; for, at one 
 time, it must make the sides fall nearer each other, and, in 
 opposite circumstances, they must recede ; but this, like the 
 former occurrence, we do not observe. 
 
 Granulations, when new-formed, are more vascular, and 
 more luxuriant, than afterwards ; and, therefore, when they 
 become more natural, or less spongy, they will occupy less 
 space, and may tend, if the skin be relaxed, to bring the sides 
 nearer together, by their condensation. The granulations, 
 some time after they are produced, both receive less blood, 
 and have less interstitial fluid : The interstices of the sore 
 must, therefore, approach nearer together, and will, by the 
 attractive power of the life which they possess, cohere more 
 firmly together.* They likewise possess a more perfect life 
 than at first, and, therefore, have a more perfect union. On 
 these accounts, the disk of the ulcer may be lessened, by the 
 approximation of its different particles. The sides may also 
 approach together, in extensive ulcers in large members, by 
 the emaciation of the parts, which lessens the diameter of the 
 limb, and, consequently, allows the skin to cover more of the 
 ulcer. 
 
 The contraction of the superficies, dependent on the ope- 
 ration of these causes, is different in degree, in different in- 
 stances. It is not, however, so great as it appears at first 
 sight to be ; because the cicatrix, which is first formed at the 
 margins, is very thin and imperfect; but, in a short time, the 
 action becomes more perfect, and the absorbed matter is re- 
 placed with skin more exactly resembling the neighbouring 
 
 * It has been mentioned in the preliminary dissertation, that the life of animals 
 still retains the property termed attraction, and which belongs to the vital princi- 
 ple of matter, from which it is derived. It was likewise mentioned, that this pro- 
 perty seems to be increased, by the elevation into a higher species of life. It is by 
 this property, that the different parts adhere together ; and the degree of adhesion 
 depends upon the quantity and perfection of the life, and the proximity of the or- 
 ganic particles to each other. 
 
 VOL. I. 2 B 
 
194 
 
 surface. We, therefore, imagine, that the old skin is con 
 tracting, or approaching inward, whilst it is in reality the new 
 skin which is becoming similar to the old. 
 
 The ulcerative action, chiefly perhaps in consequence of 
 the purulent one, Avhich makes a part of it, has a tendency to 
 affect the constitution, and induce a general action, called 
 hectic. The symptoms of this disease are, alternate chills 
 and feelings of heat, accompanied by a frequent, small pulse, 
 which is also generally at first sharp ; by loss of appetite, 
 thirst, diarrhcea, colliquative sweats through the night, ema- 
 ciation of the body, with great weakness : The urine is gene- 
 rally pale.* This action is always greatest at the time when 
 the natural action is naturally lowest, namely, in the evening ; 
 and these exacerbations are generally preceded by chills ; for 
 all actions which are renewed at stated periods, or experience 
 considerable augmentations, exhibit, in a greater or less de- 
 gree, the symptoms of the period of formation. This action 
 is dangerous, in a degree, or proves fatal with a rapidity, pro- 
 portioned to the quickness with which it is induced ; and 
 hence, when, by any cause, it is speedily produced in peo- 
 ple who previously were tolerably healthy, it often proves 
 fatal in the course of a few days. I have known a man die 
 within a week after opening a lumber abscess, although, at 
 the time of the operation, he was pretty strong. 
 
 This disease has been attributed to the absorption of matter 
 from the sore ; but, when we consider, that the hectic is not 
 produced by sores, wi'h a certainty proportioned to their 
 size and absorbing surface, but is dependent chiefly upon the 
 nature of the part affected, and the specific qualities of the 
 local action, we will be led to drop this opinion, and will ra- 
 ther ascribe it to an extension of the action, or a general 
 mo. bid condition, induced sympathetically by it, in the me- 
 
 * The cheeks are also generally flushed before death. 
 
195 
 
 tfood already mentioned, when treating of suppuration. As 
 a confirmation of his, it is to be remarked, that the degree 
 and continuance of the local action, and he nature of the 
 part affected by it, have the chief influence in producing 
 the hectic. 
 
 The same causes which regulate the effect of the inflamma- 
 tory action upon the constitution, regulate also the effect of the 
 ulcerative action. When this action, therefore, takes place 
 in the lungs, heart, stomach, joints, &c. then the hectic is 
 very certainly induced. It is likewise produced by the long 
 continuance of this action, if extensive, in parts which are 
 less delicate, and which do not act quickly upon the system ; 
 such as the cellular substance ; but it is much more readily 
 induced in the former case, when delicate and vital parts 
 are injured. The peculiar state of the action itself, like- 
 wise influences the production of this disease ; for healthy 
 ulceration is less apt to occasion hectic, than the dis- 
 eased or unhealthy "Ulcerative action, although, in both 
 cases, the same spot be affected. Hence, scrophulous 
 ulcers affect the constitution more than many others of 
 the same size ; and hence also, the influence of the exter- 
 nal air in producing hectic, by injuring the ulcerative 
 action. Whenever an agent operates on any part which is 
 not accustomed to its action, or to which it is not to be con- 
 sidered as a natural stimulus, then disease is produced, or the 
 aciion is changed, unless he power of the agent be very in- 
 considerable. The air is to be considered as a natural sti- 
 mulus only to the lungs and surface of the body ; and, when- 
 ever it operates on any other part, it tends to injure the na- 
 tural action of that part. When atmospheric air is taken into 
 the stomach or bowels, or is blown into the cellular substance, 
 the action of these parts is slightly injured ; when introduced 
 into the blood-vessels, a more serious evil is frequently in- 
 duced. But the bad effects of the air is more clearly seen. 
 
196 
 
 when the part on which it operates is previously under the 
 influence of a diseased action. The suppurative and ulcera- 
 tive actions, are merely the formative actions of the part, or 
 its natural action rendered morbid ; and these formative ac- 
 tions are naturally carried on without the presence of the air, 
 which would tend to impede them ; but it will operate still 
 more visibly and powerfully, in changing the nature of the 
 actions into which they are transformed by disease, render- 
 ing these actions still more imperfect and unhealthy ; that is 
 to say, different from the condition which enables them to 
 terminate again in the natural formative actions, by the 
 alteration of which they were produced. When an 
 abscess is opened, and the air thrown in, the discharge 
 becomes thin and copious, and the healing process is in- 
 terrupted. When an ulcer of the surface is exposed long 
 to the action of the air, then it becomes foul and unhealthy.* 
 When an abscess of an internal part, or cavity of the body, 
 is opened, or bursts externally, so as to allow the air to come 
 in contact with it, then the constitution becomes affected, the 
 hectic action is ushered in with shiverings, the appetite fails, 
 and, although the health has been previously good, yet the 
 patient often dies in a few days. 
 
 There are, then, three causes which tend to produce hec- 
 tic : First, the existence of the suppurative or ulcerative ac- 
 tion, in delicate or vital parts ; and this tends quickly, at 
 least, comparatively speaking, to induce the hectic action. 
 Second, the long continuance of the ulcerative action, to a 
 considerable degree, in less delicate parts ; such as the cellu- 
 lar substance, &c. : This acts much more slowly than the 
 other causes. Third, the specific or peculiar qualities of the 
 action ; such as scrophulous action, or deviations consequent 
 
 * This change of the ulcer is not so apt to produce hectic, as a similar change ol' 
 the internal ulcers or abscesses; because the one naturally produces le=s effer' 
 upon the constitution than the other. 
 
197 
 
 to the action of the air upon parts where it is to be consider- 
 ed as unnatural. The effect of the qualities will be much in- 
 creased by the nature of the part affected ; for the same 
 causes operating upon ulcers of the surface, will not produce 
 the same effect on the constitution, as when they act on ulcers 
 of internal and vital parts. Hectic will likewise be sooner 
 produced in those who have an irritable habit, than in those 
 who sympathise less quickly and less easily. 
 
 The hectic fever, from whatever cause it may be induced, 
 always exhibits certain symptoms which are essential to it, 
 and which have been already mentioned. But, in addition 
 to these, others may also occur, owing to the peculiarly of 
 the cause ; and perhaps no two hectics (induced by different 
 causes) are exactly similar in every circumstance, although 
 the difference may be such as cannot be perceived or detect- 
 ed. There may be, for instance, and undoubted!}' is, a dif- 
 ference in the hectic induced by a simple ulcer, from that 
 occasioned by a scrophulous one, or a cancerous one. I 
 have seen the hectic, or diseased formative or nutritive ac- 
 tion, accompanied by an emphysema, when it was induced 
 by an abscess, which had an emphysematous action. A man 
 had a seton passed through a tumor on the neck, but very 
 little discharge took place immediately. In the course of 
 four and twenty hours, the tumor yielded more fluid, which 
 issued along with a bubbling of air ; at the same time, 
 hectic came on, and air was extricated into every part of the 
 body. He died within two days after being taken ill ; and, 
 on opening him, I found air contained in the heart, veins, 
 scrotum, and every cavity of the body, and through the 
 whole cellular substance. The tumor had not the smallest 
 communication with the trachea ; and, therefore, neither the 
 local nor general emphysema, could be attributed to Ihe me- 
 chanical introduction of atmospheric air. Here, then, was 
 
198 
 
 an instance of a peculiar modification of the hectic, owing to 
 the peculiarity of the local action, which could be better ob- 
 served than many of the less sensible qualities. 
 
 Mr. Hunter supposes, that hectic is a diseased state, in- 
 duced by an incurable disease, or, " a constitution now be- 
 come affected with a local disease, or irritation, which the 
 constitution is conscious of, and of which it cannot relieve it- 
 self, and cannot cure."* But, setting other arguments aside, 
 against this opinion, we find, that, in very irritable people, 
 abscesses sometimes produce hectic, for a week or two, which 
 goes off when the abscess naturally heals. In consequence 
 of this opinion, Mr. Hunter supposes, that the affection of 
 the constitution, which takes place when a sore as, for in- 
 stance, a compound fracture,) has gone the length of forming 
 granulations, that is to say, begins to cure, is not true hectic, 
 but a disease, which he calls " dissolution," by which he 
 means the state ushering in dissolution. But this, I appre- 
 hend, from the view which has been given of the subject, will 
 appear often to differ, in no respect, from hectic ; only, it 
 proves fatal sooner than this disease, in some other instances, 
 does. At other times, indeed, the sore may induce the state 
 of simple weakness, ushering in death, without hectic ; and, 
 in this case, the term " dissolution" may be sufficiently 
 proper. 
 
 There are, therefore, two states which may be induced by 
 inflammation, and both terminate in death ; the hectic state, 
 and the state of simple weakness. The first is illustrated by 
 the effect of ulceration ; the second, by the effect of inflam- 
 matory fever. It is merely the forerunner of death, and, 
 therefore, will succeed almost every diseased action. But, 
 although it, in most cases, precedes death, yet death does not 
 universally succeed it ; for, as will be immediately mentioned, it 
 
 * P. 497. 
 
199 
 
 may be induced by the sudden cessation of actions, when 
 there is still power to recover by proper assistance. 
 
 The condition of the body immediately before death, is, 
 I believe, generally that of simple weakness, unless when in- 
 duced by mortification, or similar diseases, as will be present- 
 ly mentioned. It is, at least, so far a state of simple weakness, 
 that in most cases, the specific diseases disappear ; and, could 
 the patient be restored to strength by any power, he would, in 
 all probability, be free from the peculiar morbid action which 
 formerly existed.* This weakness, as Mr. Hunter has ob- 
 served, may affect one part of the body, or particular func- 
 tions, less than others. On this account, the circulation is 
 often carried on with more strength, or apparent strength, 
 than is proportioned to the state of the system ; and, there- 
 fore, death may be nearer at hand than we would imagine. 
 
 In the preliminary dissertation, it was mentioned, that all 
 actions which subside suddenly weaken most. This state 
 may, therefore, be quickly and unexpectedly induced, by 
 such causes, seen or hidden, as produce a sudden diminution 
 of the morbid action. It may, therefore, take place, al- 
 though the patient be recoverable; that is to say, although 
 the powers of life be not absolutely exhausted, or worn out. 
 
 If long continued and extensive ulceration be productive of 
 injury to the constitution, by exciting a general action, at- 
 tended with a deviation in the nutritive action, in a manner 
 already explained, so is also, in many instances, the sudden 
 loss or absence of this ulcerative action injurious. If the 
 constitution have been long accustomed to this secretory ac- 
 tion, the stoppage or cessation of it is apt to induce, in some 
 other organ, an excretory action, although of a somewhat dif- 
 ferent kind, at least if there be any tendency to this, on ac- 
 
 * This is farther confirmed, by observing, that this state, when it is curable, is cured 
 by such remedies as are used against simple weakness, and not by the remedies 
 which vre employ against the specific disease which produced it. 
 
200 
 
 count of age, constitution, &c. Thus the hemorrhagic action 
 may supervene, upon the cessation of the purulent action, and 
 may affect either the brain, lungs, or stomach, according to 
 circumstances; or the action of exhalation, into particular 
 cavities, may be produced, giving rise to hydrothorax, asci- 
 tes, &c. These effects, however, are less apt to be produ- 
 ced, if hectic have been induced by the ulcer before it was 
 healed ; because then the general action seems to diminish the 
 tendency of particular parts to be affected. If we amputate 
 on account of a large ulcer, the patient is more apt to become 
 apoplectic, if he has had no considerable degree of hectic, 
 than if this disease has made a greater progress ; but, at the 
 same time, if we have allowed it, on the other hand, to go too 
 far, then the system cannot recover, although we remove the 
 exciting cause, but the operation will rather tend to accele- 
 rate the death. 
 
 The bad effects of healing old sores, without proper pre- 
 caution, has been attributed to the stoppage of a quantity of 
 fluid, which produces a redundance, or plethora ; and, there- 
 fore, " adequate drains," or issues, have been proposed ; But, 
 although issues may be proper, in many cases, to prevent, by 
 the continuance of an ulcerative action, the production of a 
 secretory action, in more important parts, yet it does not fol- 
 low, that issues act by draining off the fluids, as Mr. Bell sup- 
 poses, nor that the healing of ulcers produces a plethora. If 
 so, we must produce an issue almost as large as the old sore ; 
 at least, a small issue will do no good. We might also, by 
 spare diet, abstinence from fluids, bleeding, purging, &c. pro- 
 duce the same effect with an issue, which nobody expects 
 will be the case. 
 
 Some have supposed, that when old sores were healed, a 
 peculiar morbid humour, which they were wont to discharge, 
 was retained ;* but this opinion is now almost abandoned. 
 
 * Morgagni de Sed. et Caus. &c, Epist. LV. a. 13. 
 
201 
 
 Mortification.— Mortification, strictly speaking, implied 
 nothing more than merely death ; but, in its general accepta- 
 tion, it is made also to comprehend the putrefaction of the 
 part which is killed ; for, as the dead portion still adheres to 
 the living, until this process takes place, the putrefactive fer- 
 mentation has been always considered as synonymous with 
 mortification, and as constituting one of its necessary symp- 
 toms. This disease, then, will be induced by whatever can 
 kill the part, whether by subducting directly stimuli necessa- 
 ry for life, or by exciting an action greater than the power of 
 the part can continue to perform. An instance of the first 
 we have in the effects of long continued cold, compression 
 of the arteries, &c. In those cases, the parts being de- 
 prived of necessary stimuli, die slowly, and run gradually 
 into the putrefactive fermentation.* This, however, only 
 happens from the subduction of necessary stimuli, when tire 
 injuring cause is very powerful, or when some agent excites 
 an action afterwards in the weakened parts ; in which case 
 it belongs to the next division, which is illustrated by the 
 effects of lightning, inflammatior, or whatever can increase 
 the action beyond what the power is able to sustain. 
 
 Mortification is most likely to succeed to inflammation in 
 four different circumstances. 
 
 First. When the inflammation is very violent and extensive, 
 occurring in parts which were formerly healthly, and not remark- 
 ably delicate, possessing naturally a considerable degree of ac- 
 
 * In some rare instances, the part becomes quite dry and hard, constituting 
 what has been called the dry gangrene, to which tbe epithet white 1ms been added 
 when the parts preserved their colour. The term gangrene, however, is here ira; 
 properly applied. I have known one instance, in which the limb became cold, in- 
 sensible, and quite black, but not dry. It evidently, however, was not gangre- 
 nous; because it afterwards recovered its power?, to a certain degree, and lost th»> 
 Hack colour, becoming of a yellow tinge. 
 
 vol. i*. 2t' 
 
202 
 
 (ion, as, for instance, the cellular substance, &c; Mortifica- 
 tion more arely takes place in this case. 
 
 Second. When the inflammatory action occurs to any con- 
 siderable degree in parts where the action is naturally little, 
 as, for instance, in tendons, &c. ; or where it ought in conse- 
 quence of previous disease, to be little, as, for instanre, in 
 parts which have been weakened by cold, or in people who 
 have had fever or palsy, ike. 
 
 Third. When the inflammatory action affects parts which 
 are naturally very sensible, and very susceptible of having 
 action easily induced in them, such as the intestines, the 
 cutis, &c. 
 
 Fourth. When the inflammatory action is complicated 
 with some other morbid condition, being produced by one of 
 the agentes dissimiles, such as pestilential carbuncle, &c* 
 
 Mortification may, in one point of view, be compared to 
 the natural process of the dissolution and absorption of the 
 different parts of the body, the organic particles of which 
 enjoy a longer or shorter life, according to the power which 
 they originally received, and the strength and nature of the 
 agents which operate on them. When these particles are, 
 from the very first, weak, a small stimulus must soon destroy 
 the little life which they possess, and their longevity will na- 
 turally be shorter, even although no disproportionate ac- 
 tion be excised in them. The same law which ^prevails 
 with regard to these particles, obtains also in the larger por- 
 tions of the body; for a degree of inflammation, easiiy sus- 
 tained by a strong part, will destroy the same part, if it has 
 been previously weakened. The chief difference betwixt 
 
 • Some gangrenous affections are epidemic, whilst others are endemic. Mor- 
 gagni mentions from Brunnerus, a particular gangrene of the legs, to which the in- 
 habitants of the Black Forest were subject, and which they were willing to attri 
 'bute to the use of bad rye. £pist. LV. a. 24. 
 
203 
 
 these processes is, that, in the one case, the particles are ab- 
 sorbed, and immediately replaced, whilst, in the other, from 
 the magnitude and degree of the destruction, and the exten- 
 sion of the loss of all vital action, the part cannot be absorb- 
 ed, but remains, and putrifies.* Both processes likewise re- 
 semble each other, in this, that the death is dependent upon 
 an action of the vital principle, which has this for iis object. 
 Death has been considered as merely a privation of life, or a 
 cessation of action ; but this negative state docs not consti- 
 tute absolute death. Death is the descending of the vital 
 principle of one species, to the condition of that of another 
 of a lower degree, and, therefore, must imply activity, or a state 
 of change and conversion, referable to an action of the vital 
 principle itself. There is, however, this intimate connexion 
 betwixt a cessation of action, or apparent death, and real or 
 absolute death, that when the vital principle is not employed 
 in some o her action, it has a natural tendency to assume the 
 action of descent, or sink down to a lower species. This 
 descent would appear to take place more or less rapidly, ac- 
 cording to the absolute quantity of life which exists together, 
 in the oigan or part which is to die ; for wherever the quan- 
 tity is very small before the action of descent commences, 
 then it takes place very quickly. Hence, when a number of 
 organic particles are contained in any portion, and have their 
 life strong, and in due quantity, then they retain it for a consi- 
 derable time, and descend only very slowly, at the same time 
 that they are absorbed and converted by the living power of 
 the vessels which take them up, into a substance different 
 
 * When a particle dies in a healthy part, or in an action of a part, then the ab- 
 sorbents change it into a peculiar fluid, by an action of their vital power : But 
 when a great number of particles die at once, in the immediate vicinity of each 
 other, nnd the absorbents have their action suspended, and begin themselves to die 
 ilien the part cannot be absorbed or changed into a fluid, by the vital power Of, 
 the animal, but it remaius, and undergoes the putrefactive fermentation, as wjH 
 afterward? be meulioncd. 
 
204 
 
 from their former condition. But if their life be in too small 
 quantity, or only a few insulated particles be taken to act on, 
 then the descent takes place quickly. Hence, if we kill an 
 animal instantly, and cut out a muscle, it will retain its animal 
 life much longer, if the animal be healthy and strong, than if 
 it be weak and diseased. Hence likewise, an animal will 
 putrify soonest, if it die from the action of any of the agentes 
 dissimiles, than from other causes ; or, in other words, the in- 
 terval betwixt apparent and real death is shorter. An 
 amputated limb of a strong man will longer exhibit contrac- 
 tion, by the application of the zinc and silver, than the limb 
 of a man who* labours under plague, or cynanche maligna, 
 were amputation to be performed in these diseases ; because, 
 in the one case, there is more real animal life remaining, at 
 the time of cessation of evident action, or apparent death, 
 than in the other ; and, therefore, the action of descent takes 
 place more slowly, and real death is longer of being produced. 
 This descent may be accelerated, after apparent deaih, by 
 such causes as tend to destroy still more the remaining vitali- 
 ty) by exciting an action in it, although this action be not at- 
 tended by coniraction, or other mechanical and very evident 
 effects. Electric shocks, heat, putrid matter, tossing about, 
 &c. will hasten this, and induce the putrefactive fermentation, 
 which does not take place in the solid fibre, until the descent 
 be produced ; because no such extensive chemical changes, 
 and new arrangements or combinations, peculiar to common 
 matter, can take place, as long as animal life remains. But, 
 although the muscular fibres of the muscle will not putrify, 
 until real death take place, yet the interstitial fluid, which 
 has less life, and consequently, dies soonest, may begin to un- 
 dergo this process, before the fibres, or solid and organized 
 part, be dead ; but, almost immediately afterwards, the whole 
 dies ; because putrid matter tends to destroy animal life ; 
 and, therefore, the interstitial fluid in the muscle hastens the 
 
205 
 
 death of the fibre. Hence, ceteris paribus, the less inter- 
 stitial fluid that a part has, the longer will it live ; because 
 then one agent, tending quickly to excite universal descent 
 of vitality, is absent. 
 
 We may, from these remarks, understand, first, why a 
 part which dies in consequence of inflammation, should pu- 
 trify much sooner than the same part, if cut out of the body 
 in health, and kept equally hot ; because the quantity of life, 
 before apparent death takes place, is very small : Second, 
 why the mortification tends to spread, even independent of 
 the continuance of its cause, or inflammation ; for the putrid 
 matter, which is already generated, tends to excite a fatal ac- 
 tion in the surrounding parts, and is to be considered as an 
 agens dissimilis. If putrid matter be applied to a wound, 
 that wound never heals without sloughing. 
 
 The bad effects of mortification on the system, are not to 
 be attributed altogether immediately to the original inflamma- 
 tory action, or to the fever, overpowering, as it were, the 
 constitution ; because we often find these continue much 
 longer, and equally violent, where no mortification takes 
 place, without the same injury being produced. It has been 
 already mentioned, that all local actions have a tendency, 
 sooner or laier, to extend themselves, and produce a general 
 disease. The suppurative and ulcerative action produces 
 hectic, in a way which has been formerly explained. In the 
 ^pame way, local mortification tends to induce a general and 
 very dangerous disease, exciting that general state which we 
 find induced by the application of putrid matter to delicate 
 or divided parts, and inducing the tendency to the action of 
 descent, on account of the peculiar nature of the local ac- 
 tion.*" This general disease is also sometimes induced, by 
 
 * That the danger arising from mortification is owing to the sympathetic exten- 
 sion of the local action, and not to the absorption of putrid matter, and a general 
 >' depravation of the fluids," is evident, from this circumstance, amongst many 
 
206 
 
 the action of an agens dissimilis, which operates on the sys« 
 tern, at the same time that the local action is produced, and 
 may, in this case, be said to be idiopathic. This is illustra- 
 ted by cynanche maligna. The induction of this general 
 state, is one great cause of the rapidity with which gangrene 
 sometimes spreads ; because, if I may use the expression, it 
 prepares the parts for its reception. It diminishes the quan- 
 tity of life and of natural action, and tends to induce the ac- 
 tion of descent, in every particle. Very slight causes, then, 
 will make a number of particles die at once. Hence, the 
 local action can spread with ease. 
 
 The local action is marked by Iividity of the parts, which 
 gradually become black ; the cuticle rises up into blisters, 
 and an abominable smell is produced ; the mortified part is 
 quite cold and insensible ; but the parts which are only as- 
 suming the gangrenous state, and which may still be said to 
 be inflamed, are extremely painful, because the action is 
 much greater than the power. 
 
 The general action is marked by great frequency and 
 feebleness of the pulse, unusual weakness, which rapidly in- 
 creases ; by thirst, squeamishness, foul tongue, and teeth 
 covered with sordes ; heavy languid eye, and sharp anxious 
 features. Before death, the urine and stools frequency come 
 away involuntarily, and the patient lies in a kind of comatose 
 slumber. At the same time, the action of descent commen- 
 ces, wherever the lite is lowest ; and, owing to this, many 
 of the animal excretions become foetid. Sloughs also are 
 formed, where the operation of foreign agents is greatest, as, 
 for instance, where the pressure opperates most> as on the 
 
 others, that the general action is greater when the local action affects delicate 
 parts, with which the rest of the system sympathises rapidly, than when it affects- 
 other parts, although in both cases the absorption may be supposed to be alike. 
 
207 
 
 shoulders, hips, &c.# Before death, the pulse sometimes 
 becomes full ; but then the artery has almost lost its power, 
 and become similar to a vein, with respect to contraction. 
 We feel it rather moving than beating, and it is impractica- 
 ble to count any regular pulsation. When this happens, 
 it is impossible that recovery should take place. f 
 
 It has been supposed, that mortification was produced by 
 some peculiar acrimony of the fluids, £ or putrid ferment. 
 Others maintain, tliat it is produced by the violence of the 
 action of the vessels, which throw out red blood in place of 
 serum ; and that, as this red blood cannot be converted into 
 pus, it putrifies, and causes gangrene. 5 But these doctrines 
 overlook the peculiar action of the living principle, and attri- 
 bute to the changes of the fluids, that which really belongs 
 to the operations of life. The generation of putrid matter, 
 has been too often considered as a cause, and not a conse- 
 quence of disease. The humoural pathology has even been 
 carried so far, that it has been maintained, that the blood it- 
 self might, by some causes, become putrid, and thus excite 
 diseases. But if blood be necessary for the continuance of 
 life, what must we think of the theory, which talks of so 
 complete a destruction and change of this fluid, as putrefac- 
 tion must produce, and yet allows that the patient lives, and 
 supports a diseased state ! That the blood, like the rest of 
 
 * Tulpius records an instance of universal gangrene, or mortification, which af- 
 fected the whole body. Obs. Med. Lib. III. c. 46. Many similar instances are 
 on record. 
 
 t In mortification, no one ever recovered from this state ; because the action of 
 descent is then very nearly induced, and the tendency to it is so great now, that, 
 independent of the correspondent weakness, recovery is impossible. But, when this 
 state is induced by some other specific disease, such as fever, it is possible, though 
 barely so, for recovery to take place ; for, in this case, the specific disease i« most 
 probably gone, and simple weakness alone remains, as has been mentioned, when 
 treating of the prelude to dissolution. 
 
 X Valsalva tells us, that the serum, in a case of mortification, was so acrid, that 
 •when he tasted it, his tongue smarted, for a whole day. 
 
 f Bell on Ulcers, p. 100. 
 
208 
 
 the body, may be reduced to such a state, as to putrify very 
 quickly, after being drawn, or after apparent death, is evident, 
 and will be easily understood, from what has already been 
 said ; but this is very different from a putrefaction of the 
 blood, when circulating in the living body, and a consequent 
 disease. 
 
 Of the Modifications of the Inflammatory Action produced 
 by the Nature of the Affected Part. 
 
 In the course of this dissertation, it has been mentioned, 
 that, in many instances, the symptoms of inflammation are 
 modified by the state of the part which it attacked. In 
 some, the swelling is greater than in others : Some parts are 
 much more pained, and some feel much hotter than others. 
 
 In the brain, inflammation produces simple pain, without 
 heat, a feeling of tightness and confusion, aggravated during 
 the diastole of the artery. The eyes are red and ferocious, 
 or unsettled, and very sensible with respect to light. These, 
 symptoms proceed from the connexion betwixt the eye and 
 brain, by means of the short optic nerve. The intellectual 
 senses are impaired, and the power of supporting ourselves 
 in an erect posture is lost. The brain is rendered redder by 
 inflammation, and more turgid. The formation of organic 
 particles is less affected than in many other parts ; and, 
 therefore, the intimate structure of the inflamed part is less 
 altered ; but still there is a change produced, the matter being 
 tougher, and more like polypus. The terminations are either 
 resolution, or gangrene, (in which case the portion becomes 
 softer and thinner, and of a more dusky colour, or black, 
 where there are membranes,) or suppuration ;* in which 
 
 *• If suppuration does not take place, either the interstitial or the exhalent fluifv 
 is thrown out in greater quantity, and dropsy is produced. 
 
209 
 
 case, a thick yeUow pus is formed, and coma is produced. 
 If this abscess be opened, the patient sometimes recovers, 
 and the ulcerative action commences. The granulations are 
 red, and very vascular, which we learn, by finding them, after 
 death, to be of a dark bloody colour. The pulse is always 
 quickened, and becomes hard ; but its condition, with re- 
 spect to fullness and smallness, is uncertain. 
 
 When the eye is inflamed, the vessels become red and 
 turgid ; but the eye itself does not become larger. The sen- 
 sation is partly that of a foreign body being in it, and partly 
 of heat, or the same uneasy itchy sensation which heat pro- 
 duces, when it acts on the eye. The termination is general- 
 ly an increased secretion of exhalent fluid. 
 
 The inflammation of the tonsil produces swelling, redness, 
 and the sensation of simple pain, with very little heat. If, 
 however, the action has been chiefly confined to the cover" 
 ing of the tonsil, or has been erysipelatous, then there is a 
 sensation of heat and dryness. Any of the terminations 
 may take place here ; but that of gangrene is very rare in 
 simple inflammation. When suppuration or ulceration take 
 place, then the quantity of exhalent fluid, which is slightly 
 changed, is increased, and the mouth is filled with a tough 
 slaver. When the internal part suppurates, or the surface 
 ulcerates, thick yellow pus is formed. Sometimes the super- 
 ficial vessels throw out a thick yellow substance, like coagula- 
 ted lymph, (owing to a slight excoriation,) producing specks. 
 The pulse is quickened, but is not in general very hard, 
 Sometimes it seems to be quickened, rather by the simple ir- 
 ritation, or pain, than by the sympathetic fever, and, in this 
 case, it is soft. 
 
 Inflammation in the chest produces acute pain, aggravated 
 at each inspiration. The sensation of heat is very moderate; 
 
 vol. r. 2 d 
 
210 
 
 The terminations take place without any peculiarity.* The 
 pulse is hard and full, if the inflammation be moderate ; but 
 if it be excessive, or if it occur in weak people, the pulse is 
 smaller. 
 
 Inflammation of the trachea, urethra, nostril, &c. produces 
 a sensation of smarting, with a slight degree of heat. The 
 natural discharge is increased in quantity, and rendered 
 thicker, and yellow. When this happens, the pain abates. 
 If the inflammation be more violent, then this termination does 
 not take place, but the parts become more turgid and painful ; 
 the exhalent fluid, or natural discharge, is either obstructed, 
 or is thrown out, like the interstitial fluid, thick and changed, 
 as in other parts, forming a lining to the canal. If the in- 
 flammation be still more violent, then the organic particles 
 also are affected, and become imperfect, or ulceration takes 
 place. 
 
 When the stomach is inflamed, the pain is generally acute, 
 and often of the burning kiiiu ; whilst, from the increased 
 sensibility of the stomach, every thing is thrown up. The 
 pulse is small and hard : The anxiety and oppression are 
 great. The termination which is most likely to take place, 
 is gangrene. 
 
 Inflammation of the small intestines produces nearly the 
 same symptoms, only the vomiting is not so excessive. The 
 heat is always considerable, and often excruciating, as we ob- 
 serve in those who take arsenic. When the great intestines 
 are inflamed, the heat is commonly less ; and, if the inflam- 
 mation be slight, it is even not at all perceived. The pain, 
 however, is acute, and generally of the lancinating kind. The 
 pulse is frequent and hard, but not so contracted as when the 
 small intestines are affected. The termination most frequent- 
 ly is gangrene, if resolution be not obtained ; but, in some 
 
 * Auhcsioa is the most frequent termination. 
 
i 
 
 n 
 
 211 
 
 cases, suppuration and ulceration take place, which is sel- 
 dom, if ever, the case, when the small intestines are inflamed. 
 The intestines may also have their internal surface chiefly 
 affected; in which case, they are similar to the urethra, &c. 
 only the system suffers more. This is productive of a dy- 
 senteric affection, or increased discharge of thin slime, and 
 consequently, is less dangerous than inflammation of the peri- 
 toneal covering, or of the whole substance, without this se- 
 cretion. The same effects are produced in the bladder ; for 
 if its internal surface be chiefly affected, then the termination 
 is most commonly an increased discharge of the slime ; but 
 if the whole substance be affected, then gangrene or suppura- 
 tion is piifrluced. The organic particles and interstitial fluid 
 are more affected than in the intestines ; for we find a thick- 
 ening produced ; and within the pores of the thickened sub- 
 stance, there is a gelatinous fluid, which is the changed inter- 
 stitial fluid. 
 
 When bones are inflamed, the nature of the organic parti- 
 cles is changed, and they become much softer: The intersti- 
 tial fluid is also altered, and resembles thin fat soup. W*~*» 
 this flows out, they are said to suppurate. The pain is great. 
 
 When cartilages or tendons are inflamed, the pain is like- 
 wise great. The part swells, and becomes redder, and more 
 pake, losing the shining appearance ; and the interstitial fluid 
 grows rather thicker. When suppuration takes place, the 
 pain does not abate so much as in some other parts ; because 
 the action still is greater than the natural power of the part 
 would produce. Inflammation here may also produce sloughs 
 or gangrene. 
 
 Inflammation of membranes is also very painful : Their ap- 
 pearance, from the change of the nature of the organic parti- 
 cles, is always altered : They uniformly become thicker and 
 more opake ; and this structure they often retain, after the 
 inflammation goes off, as we see in the lurid cornea of the eye. 
 
212 
 
 When muscles are inflamed, they swell ; the organic parti- 
 cles are in part affected ; the interstitial fluid becomes thick- 
 er, and the power of motion is greatly diminished. The most 
 frequent termination here is a secretion of the interstitial fluid, 
 similar to that in health, but in rather greater quantity.* If, 
 however, the inflammation has been more violent, which sel- 
 dom happens in rheumatism, owing to the diffusion of the ac- 
 tion, then the suppurative action is produced, as we observe 
 in wounds,f &c. The sensation is more of the wringing or 
 pricking kind, than of heat or warmth, although there some- 
 times be a kind of confused sensation, or resemblance to 
 warmth. 
 
 The peculiarities of glandular inflammation, with regard to 
 suppuration, have been already mentioned. They have, hj 
 general, a considerable tendency to this termination ; and, 
 therefore, it is more difficult to have the inflammation resolv- 
 ed ; but the same cause makes it almost impossible for gan- 
 grene to take place. The pain is generally pricking, or lan- 
 cinating, although in some particular glands, as, for instance, 
 the testicle, it is more of the gravitating kind. 
 
 When the cellular substance is inflamed, the swelling" is 
 considerable, and the sensation chiefly that of tension, or the 
 same as if a person were rudely handling a very delicate part ; 
 but when the cutis becomes affected, the redness is great, 
 and the feeling of heat very acute. All the terminations of 
 inflammation may take place in the cellular substance ; but 
 the inflammation of the cutis generally ends either in a slight 
 discharge of perspirable matter, followed by a desquamation 
 of the cuticle, or in gangrene. 
 
 * When a muscle is inflamed at the time of death, we find the interstices full 
 of a lymphatic interstitial fluid. 
 
 t Wounds likewise act by suddenly producing a void, which, as has been alrea- 
 dy mentioned, excites the purulent action, even with a very moderate degree of 
 previous inflammation. 
 
213 
 
 These modifications of simple inflammation, dependent on 
 the nature of the part affected, are likewise affected by spec! 
 fie modifications of the inflammatory action itself. Some of 
 these induce ulceration in every part indiscriminately. Some 
 never end in suppuration. Others tend chiefly to produce 
 mortification. Some are attended with the sensation of heat 
 more than others, Kr. 
 
 ESD of vol. i. 
 

 I 
 
DISSERTATIONS 
 
 ON 
 
 INFLAMMATION, 
 
 DISSERTATION II. 
 
 CONTINUED. 
 UN SIMPLE INFLAMMATION, AND ITS CONSEQUENCES 
 
 Of the Cure of Inflammation. 
 
 IN attempting the cure of inflammation, or its consequen- 
 ces, we must naturally be directed to the means of removal 
 by the nature of the action itself, and the object which we 
 have in view. The treatment of the inflammatory action 
 may be considered in two points of view ; first, as this action 
 consists in peculiar changes of the natural action, which 
 changes we wish to remove; and, secondly, as this action na- 
 turally tends to disappear, and produce other actions, which 
 require a peculiar treatment. The observations, therefore, 
 which are to be made upon the method of cure, may be ar- 
 ranged under the heads of the different terminations of in- 
 flammation. 
 
 Of the Treatment necessary to procure Resolution. 
 In the treatment of most wounds, our chief intention is to 
 prevent the accession of inflammation, and procure adhesion ; 
 
 VOL. II. A 
 
which is, in one respect, analogous lo resolution. When in 
 flammation has taken place, either in wounds, or in other ca- 
 ses, our great object is, to remove or lessen it as quickly as 
 possible, which we effect, first, by removing the exciting 
 causes of inflammation, or such causes as tend to increase the 
 action ; and, secondly, by applying such remedies as tend 
 directly to abate the inflammatory action. 
 
 Upon the propriety of removing the exciting causes, and 
 the manner of doing so, very little requires to be said. If any 
 acrid, or stimulating substance, 1 has been applied to the skin, 
 or any extraneous body been forced into it, these must be 
 removed before the inflammation can be resolved ; because, 
 if they be allowed to remain, they will keep up the action so 
 long, and to such a degree, that suppuration will be produc- 
 ed, or gangrene, if the part be very sensible, (as, for instance, 
 the cutis; or if the exciting cause be very irritating. Acrid 
 substances are to be removed by ablution with water, which 
 is in general much better than the solutions which are pro- 
 posed upon the principle of chemically combining with the 
 acrid ; because these generally are likewise acrid, or stimu- 
 lating, and increase still more the inflammation which has ta- 
 ken place, before they can combine with the substance which 
 was formerly applied, and become neutralised. This may be 
 illustrated by the operations of acids and alkalis. If heat 
 have been applied, so as to induce inflammation, we must re- 
 move the superabundant quantity of heat, but must not apply 
 cold ; because we then do mischief, as will be afterwards 
 mentioned. 
 
 When a substance is forced into the skin, so as to stimulate 
 mechanically, we must endeavour to lay hold of it, and pull it 
 out ; but if it have penetrated so deep as to make this imprac- 
 ticable, we must then enlarge the wound, and remove it ; be- 
 cause we thus may enable the wound to heal by the first in> 
 tent ion. If, however, the injury done be great, if the part 
 
5 
 
 be much bruised, or the extraneous substances be numerous, 
 we may be less anxious about the extraction of such as require 
 much trouble ; because the irritation which is thus given will 
 tend to increase the degree of inflammation, and, very proba- 
 bly, its extent, at the same time, that from the original inju- 
 ry there is little prospect of adhesion being procured, or sup- 
 puration prevented. We are then chiefly to search after, 
 and extract foreign bodies, when we apprehend that their re- 
 moval may permit the inflammation to be resolved, and adhe- 
 sion to take place, and when we expect that their presence 
 will excite a greater action than our endeavours to extract 
 them will do. This is a rule which ought to be carefully re- 
 membered by every surgeon, and especially by those whose 
 situation makes them be daily called to take the management, 
 of gunshot wounds. They are not brought to their patient 
 to show how much they can do in the way of cutting and 
 probing ; it is their duty to administer relief, and act so as to 
 prevent and abate the inflammatory action, which they will 
 often do most effectually by letting their patient alone, and 
 throwing aside their ball-screws and forceps. 
 
 The circumstance of being in an unusual situation, in 
 which the natural action cannot possibly be continued, is also 
 a very frequent cause, producing inflammation, and prevent- 
 ing its resolution. We ought, upon this principle, which has 
 been formerly mentioned, to endeavour, in almost every in- 
 stance, to bring the sides of the wound together, if a wound 
 has been the exciting cause of Inflammation, by which we 
 shall much more readily prevent or overcome the inflamma- 
 tory action ; because we thus bring the parts nearly to iheir 
 natural situation, with respect to interstice, and thus make 
 the organic particles be moie readily thrown out.* This 
 
 * Bringing two surfaces in contact, although theynaturally werenot so, will have: 
 -ho same eflert 1 . TmiP.ifUK 1 sKri be faV?«n off 'h^ pt»jcs of our h'TTSrer 5 . arid fhe 
 
practice ought to be pushed farther than is often done. Even 
 in many contused wounds it will be useful ; because, although 
 union may not be immediately produced, yet, when the con- 
 tused part is either recovered, or absorbed, the inflammato- 
 ry action may be prevented, or removed, by the restoration 
 of the natural action, if the part be in absolute contact- It 
 must, however, be remembered, that if much difficulty be 
 experienced in bringing and retaining the parts together, ow- 
 ing to the swelling, from the previous existence of the dis- 
 eased action, then our endeavour will be hurtful ; because 
 the irritation which we thus give, has a greater power to in- 
 crease the action, than the circumstance of the parts being 
 in contact, has to diminish the inflammation, and restore the 
 natural action. 
 
 By removing, then, the exciting causes of inflammation, 
 before the action be induced, we shall frequently prevent it 
 altogether from being formed ; but, even although we should 
 be disappointed, we, by this removal, render the disease mild- 
 er, less extensive", and much more easily overcome ; for, as 
 long as the exciting causes continue to operate, it is impossi- 
 ble to procure resolution ; but the action will be kept up un- 
 til some other termination, or consequence, be induced. But, 
 although we thus prevent the action from being raised to so 
 great a degree as it otherwise would be, yet we do not. imme- 
 diately overcome or destroy it; because the action, when 
 once induced, has, like every other action, a tendency to 
 continue for some lime after its cause is withdrawn. This 
 
 side of the one be applied to the side of the other, adhesion will take place, an<i 
 no inflammation will be produced. When a part is inflamed, and one portion is 
 brought in contact with another, we uniformly find, that the inflammation is less 
 ■where the parts were in contact than elsewhere. Thus, when the intestines are 
 inflamed, the parts suffer least which touch other intestines, whilst the angle be 
 twixt the folds is most affected. This fact is observed by Mr. Hunter, but explain- 
 ed upon the principle of contiguous sympathy; or, " a mutual harmony being pr< - 
 di.'rod, which prevents their being inflamed." 
 
continuance may be longer or shorter, according to circura 
 stances, and its termination may be more or less unfavoura- 
 ble. We are, therefore, under the necessity of employing 
 such remedies as have a power of directly diminishing or re- 
 moving this action. It has, however, been doubted, whether 
 they ought, in every instance, to be employed ; or, in other 
 words, whether resolution ought uniformly to be desired. It 
 has, for instance, been deemed unsafe to check those inflam- 
 mations which depended upon a general or constitutional 
 specific disease, or occurred during its existence. But this 
 opinion, which was evidently founded upon the supposition 
 of the operation of morbid humours, cannot be maintained, 
 now that this is given up. Granting inflammation, in every 
 one of these cases, to be dependent upon the general disease, 
 and to exist as a symptom of it, no harm can accrue from re- 
 solving it ;* because, if the inflammation have once taken 
 place, the full effect of the general disease is produced, 
 which, therefore, cannot be affected by the peculiarity of 
 the termination of this inflammation, unless it be proved, that 
 some humour be sent there to be concocted and thrown out. 
 In many instances, inflammation occurs in a general disease, 
 merely as an accidental circumstance ; but, even in those, 
 cases where the local inflammation is most decidedly depen- 
 dent on the general action, and is perhaps essential to it, we 
 find, that no bad effects follow from resolving the inflamma- 
 tion ; and, if this be the case with regard to specific inflam- 
 •jiation, we may still more certainly extend the principle to 
 the treatment of the simple inflammatory action, with which 
 we have at present a more immediate connexion. There 
 are, however, some inflammatory affections which we some- 
 times cannot put back; such as those tumors which succeed 
 
 * If we attempt, without fear, to cure i lie general dhe.ise, why mi;' ire nfo* 
 H \-r. pr,^ Pavo ,, r rn (, a tt nr , f^r. tfTminatina ^ r Ipcal disease" 
 
8 
 
 the small-pox ; but, when we do succeed, no bad consequence 
 follows ; and the failure of some of our attempts can be no ar- 
 gument against the general plan, more than our failure in 
 many other instances. 
 
 Resolution is the quickest termination of inflammation, 
 and, therefore, ought, perhaps in every instance, to be at- 
 tempted, unless in cases where the injury is such that suppu- 
 ration is unavoidable ; as, for instance, extensive bruises, &c. 
 It is our great object, even in those inflammations which we 
 raise intentionally ; as, for instance, in the operation for hy- 
 drocele. At one time, however, this was not admitted with- 
 out limitation ; and suppuration was, in many instances, anx- 
 iously sought for, being considered by some as the only way 
 of obtaining a cure. " Union, (says Mr. O'Halloran) with- 
 out suppuration, by an immediate coalescence, or by the first 
 intention, is merely chimerical, and is opposite to the rules 
 of nature. Inflammation (contrary to the received canon) is 
 not the time for a re-union of divided parts : This happy 
 minute follows, not precedes suppuration." It was timidity, 
 with regard to the prevention of suppuration, and want of 
 knowledge of the powers of the animal frame, which so long 
 retarded the progress of surgery, and prevented the improve- 
 ment of its operations. 
 
 The remedies which we employ, with the intention of 
 abating and removing the inflammatory action, are either ge- 
 neral or topical. 
 
 General remedies are perhaps only useful, or have only a 
 superiority over topical ones, when a general disease, or fe- 
 ver, accompanies the local inflammation. Topical ones are 
 only to he trusted to alone, when the disease is entirely local. 
 The general remedies, are naturally such as tend to abate 
 action in general, or to diminish the natural action ; and there 
 fore, will consist of bleeding, cold, purging, sweating, nan 
 seating medicines, and some of the agentes dissimiles. 
 
9 
 
 Bleeding is justly considered as the most powerful, and the 
 most useful of all those remedies ; and, in many cases, is the 
 only one which can accomplish a cure. The quantity of 
 blood which it is necessary to detract, will be regulated by 
 the effect of the inflammation upon the system, and by the 
 previous condition of the person, with regard to strength ; for 
 those who are weak bear bleeding worst ; and in them we 
 cannot repeat it so frequently, as in the robust. Delay in 
 them is, however, more dangerous ; because the inflamma- 
 tion makes a more rapid progress, and, therefore, we ought 
 sooner to push our remedies. 
 
 When the system is affected, in consequence of inflam- 
 mation of vital parts, the general action is greater than when 
 other parts are affected, and, therefore, bleeding must be used 
 earlier, and with more freedom. Mr. Hunter observes, that 
 when these parts are inflamed, the patient bears bleeding 
 worse than when parts are affected which are not vital : but 
 this observation must not be admitted indefinitely. When 
 these parts are affected, the action is so violent, that the 
 power cannot long support it ; and, therefore, we must have 
 early recourse to the lancet, and allow the blood to flow un- 
 til the pain diminishes, and ceases to abate any more, and un- 
 til the pulse becomes softer, and perhaps fuller. This is the 
 time to stop ; but, whenever the pain returns, or the pulse 
 becomes hard, the orifice should be again opened, although 
 we had bled only half an hour before. The system, in this 
 way, is not weakened, nor the action sunk so low as to injure 
 the power of recovery, which might be the case, were we 
 to bleed too copiously at once. This remark applies, in a 
 particular degree, to inflamma.ion of the bowels ; but it may 
 also be extended to pulmonic inflammation ; only, in this 
 case, we can detract more blood at a time than in the other 
 instance ; because the system sympathises less strongly with 
 the lungs, and, therefore, general evacuation will be longer 
 
10 
 
 of operating on the local disease. The same cause, however, 
 makes the danger less ; because the general action is not rais- 
 ed so high, and the part itself not being so delicate, can sup- 
 port the action longer, and, consequently, the danger is less. 
 It is an established point, that no action can subside, or be 
 destroyed suddenly, and the patient become free from dis- 
 ease. All morbid actions must subside, more or less slowly, 
 and, therefore, bleeding ought not at once to be pushed so far 
 as to produce fainting, unless the patient be very liable to 
 faint. This sudden cessation of general action does not destroy 
 the specific nature of the action which is going on when it is 
 induced, but rather leaves the parts stationary, the tendency 
 to morbid action still continuing, although the capability to 
 act be suspended for a moment.* In place, then, of bleeding 
 so as to exhaust the strength quickly, and endeavour, as it 
 were, by the quantity of the discharge, to destroy the dis- 
 ease by one bleeding, it will be much better to bleed just un- 
 til we produce the feeling of weakness to a moderate extent, 
 and abate, to a certain degree, the pain and hardness of the 
 pulse ; stopping, whenever we find that we are not abating it 
 farther, distinguishing, however, betwixt real abatement and 
 syncope, or want of power to act and feel. We then repeat 
 the evacuation, whenever the hardness of the pulse and pain 
 return ; and thus, perhaps in one day, and with infinitely 
 more benefit, bleed much more frequently, and, perhaps, to 
 a greater extent, than is sometimes done in a week, by those 
 who bleed more copiously at once, and repeat it seldomer. 
 
 Concerning the exact quantity of blood, which ought, in 
 the different varieties of inflammation, to be detracted, I hold 
 it, from the above principle, to be ridiculous to give any di- 
 
 * When we are obliged to stop our bleeding, on account of fainting, before wr- 
 would otherwise do it, we will find it necessary to repeat the venesection soonti 
 than if this did not happen. 
 
11 
 
 rection ; because no general rule can be given, by which we 
 may, a priori, determine the quantity. We are to bleed 
 until we procure an abatement of the action ; and to stop 
 whenever this abatement ceases to be really progressive.* 
 We are to renew the bleeding, whenever the action again in- 
 creases, and stop, as before, whenever it is abated, remem- 
 bering, that, after some time, a more sparing detraction will 
 produce a greater effect, than a more copious one would do, 
 in the commencement of the disease. It must also be at- 
 tended to, that, owing to the weakness induced by the dis- 
 ease, and by the bleedings, we must, toward the end, bleed at 
 longer intervals ; for, if we continue to bleed in the same 
 way as formerly, we would either kill the patient, or at least 
 prevent the act of restoration from taking place ; because we 
 would thus diminish the power, or vital energy, which was to 
 perform this act. Those, then, who order a certain number 
 of ounces to be taken away, must reason upon probability, 
 and prescribe less efficaciously, than those who direct no der 
 terminate quantity, but regulate their practice by the effects. 
 It is equally foolish in those who order bleeding, pro viribus ? 
 and are satisfied with this until their next stated visit ; be- 
 cause bleeding until fainting takes place, and not repeating it 
 for some time afterwards, may be doing a great deal too 
 little. 
 
 As there is a proper time»for stopping each individual eva- 
 cuation, so also is there a period at which we ought to stop 
 the general plan of cure by bleeding, or at least to intermit it. 
 And to determine when this period is come, is sometimes a 
 pretty nice point, and one of much importance ; because, if 
 we stop too soon, we allow the action still to go on, and, per- 
 
 * We must distinguish, as has been already mentioned, betwixt a real abatement 
 of the inflammatory action, and a mere temporary suspension of action, or syh 
 cope. 
 
 ror,. li. « 
 
12 
 
 haps, to terminate fatally. On the other hand, if we bleed 
 too long, we sink the parts below the state necessary for re- 
 covery, and even accelerate the unfavourable termination. 
 When, for instance, from the state of the pulse, and other 
 circumstances, we apprehend the accession of gangrene, 
 bleeding will not abate pain, but will bring on the mortifica- 
 tion sooner, and make it spread farther, as will be afterward? 
 mentioned. 
 
 As the accession of inflammation depends upon a change 
 of the natural action of the vital principle, so does its re- 
 moval depend upon the reconversion of this into the natural 
 action, which implies activity, or an active state. If, then, 
 we bleed in the end of inflammation, we lessen the powers of 
 the part so much, as to prevent restoration ; gangrene, there- 
 fore, will take place : Or, if the part be less delicate, and the 
 progress of the action consequently slower, the inflammation 
 may continue stationary for a considerable time, and become 
 chronic, or habitual. This state is not to be cured by bleed- 
 ing, but will rather be made worse by it. AVhenever, then, 
 after inflammation has continued for a length of time, we find, 
 that venesection does not produce the usual abatement ; or, 
 whenever, although there be a temporary abatement, the 
 pain increases afterwards to a greater degree, we may be 
 certain our treatment is improper. We likewise find, thai 
 the longer bleeding has been delayed, in the beginning of 
 the disease, the sooner must we stop, and the less quantity 
 must we take at a time ; because, in this case, the inflamma- 
 tory action is nearer its termination, and is more ready to 
 produce gangrene, if the parts be delicate, or the action 
 great, or, if otherwise, the inflammatio assuefacta. We are 
 also to refrain from bleeding, when we find that the inflam- 
 matory action is about to terminate in another action ; as, 
 for instance, the suppurative ; because, in the first place, 
 Weeding, in this new action, can do no good, but, by weaken- 
 
13 
 
 tng, will do harm ; and, secondly, if there be only a tenden- 
 cy to this action, the action not being yet formed, or be- 
 ginning to form, we may, by bleeding, interrupt the progress 
 of the inflammation, and convert it into a more tedious dis- 
 ease, or the inflammatio assuefacta. 
 
 Bleeding has been used, not only as a cure for inflamma- 
 tion, but also as a preventive ; but this must be consider- 
 ed as proper, only in particular instances. When, for in- 
 stance, a wound has been inflicted, or an operation necessa- 
 rily performed, on a robust person, bleeding immediately, or 
 very soon after it, may be useful; because it will tend to 
 lessen the chance of the natural action being carried so high 
 as to become changed. These people cannot have their ac- 
 tion much increased without disease; and, therefore, it is 
 necessary to lessen it, and bring it down to a more proper 
 medium. But there are other cases, where the action is na- 
 turally rather too low, and the patient weakly. In these 
 cases, bleeding can do no good, but much harm ; because it 
 increases the previous weakness, and makes the inflamma- 
 tion, if it does occur, more dangerous, on account of the 
 little power which there is to support the action. These 
 people even bear bleeding worse than others, when inflam- 
 mation has actually taken place. It ought never to be prac^ 
 tised, in order to reduce the natural action, before disease 
 has taken place ; and, after the inflammatory action is in- 
 duced, it ought to be used cautiously, and only to such an 
 extent, as may be necessary for removing the tendency to 
 immediate bad consequences. It ought, however, to be used 
 very early in the disease ; because, in weak people, the ac- 
 tion does more harm in a given time, than in the strong ; 
 but it ought likewise to be sooner abandoned, otherwise we 
 either hasten morliGration, or prevent the act of restoration 
 from taking place, 
 
14 
 
 Bleeding is rarely necessary in inflammation of the cellu- 
 lar substance alone, unless the action be extensive ; in which 
 case, the system is so affected, as to require our inter- 
 ference. When the cutis is inflamed, producing erysipelas, 
 the system suffers considerably ; but, as this frequently ends 
 in mortification, bleeding has been neglected by many ; but 
 it is evident, that, if the disease be simple, and not depend- 
 ent upon any specific agens dissimilis, or epidemic conta- 
 gion, venesection is the proper cure, provided it be early 
 employed, as we thus diminish the action more certainly 
 than by any other means. If, however, the disease have 
 been neglected, and the action be nearer a termination, then 
 we must either do nothing in the way of general treatment, 
 or must give opposite remedies from bleeding, according to 
 circumstances. When muscles are inflamed, bleeding is 
 often necessary to a very great extent, as we observe in 
 rheumatism ; and, in the beginning, we must take a greater 
 quantity at a time, in order to procure an abatement, than 
 in many other cases. When the viscera are inflamed, 
 bleeding is uniformly necessary, and generally requires to 
 be frequently repeated. 
 
 It is a common opinion, that the blood ought to be taken, 
 if possible, from a vein which arises from, or near the affect- 
 ed part ; that, for instance, in phrenites, we should bleed hi 
 the jugular vein ; in inflammation of the feet, we should bleed 
 in the leg, &c. And, when this can conveniently be done, it 
 may be preferred ; because, it not only possesses all the ad- 
 vantages of general bleeding from any other vein, but also 
 may be supposed to produce, in a slight degree, a topical 
 evacuation. If, however, the veins be so small, that we can- 
 not detract enough of blood, and sufficiently quick ; or if, 
 from any other cause, we cannot do so, then, if the general 
 action be violent, we must have recourse to another vein, as 
 $be Ipss to be sustained, by confining ourselves to this vein, 
 
15 
 
 is infinitely, greater, than any good which can be derived 
 from it, as a local evacuation. Indeed, when we consider 
 the laws of the circulation, we must allow, that very little 
 good can be done in this way, as a local detraction ; because 
 one vein does not lose more blood than another, except dur- 
 ing the moment of the flow. 
 
 The blood, when drawn during inflammation, has always a 
 buffy coat, which is, in general, thicker, and more concave, 
 in proportion to the violence of the inflammatory action ; 
 and the continuance of this condition, is one circumstance 
 which points out the necessity of continuing our evacuation : 
 But the mere existence of a buffy crust, is not, without these 
 circumstances, any infallible sign of the necessity of bleed- 
 ing; because this crust is to be found on the blood, after the 
 inflammation has begun to become passive ; and it is to be 
 found also, when mortification is approaching; we observe it 
 likewise very frequently upon the last cup of blood which 
 we find it necessary to take away. In these cases, however, 
 the crust is much softer, generally thinner, always flat, in- 
 stead of concave, and looser in the texture ; it is also more 
 of a greenish hue. These circumstances, conjoined with the 
 state of the pulse, will enable us to judge, whether we should 
 totally desist from, or continue our evacuations with caution. 
 Most frequently they forbid farther bleeding. 
 
 Cold, or the subduction of heat, is chiefly useful as a topi- 
 cal application; but it is also proper to be applied, in mode- 
 ration, for the abatement of the general fever, unless we be 
 desirous of procuring perspiration. The quantity of bed- 
 clothes ought to be lessened, cold drink should be allowed, 
 and a free circulation of cool air into the room. The appli- 
 cation of cold, however, ought, in general, only to be carried 
 to such an extent as shall be sufficient for diminishing the 
 morbid degree of heat, and not so far as to produce sensible 
 ♦jold, or the sensation of cold ; because this, in many instan- 
 
16 
 
 ces, will be pernicious, upon the principle of the sympathy 
 of equilibrium, the action of the internal parts being increas- 
 ed by the speedy application of cold to the surface ; and, 
 therefore, if the internal parts be inflamed, their morbid ac- 
 tion must be still farther increased. If the cold be long ap- 
 plied, to any considerable degree, it will likewise, by the 
 sympathy of association, weaken the whole system too much, 
 and injure the act of restoration. As bleeding is to be used 
 only until it restores a natural state, and abates pain, so also 
 is cold only to be applied in such a degree as may be neces- 
 sary for diminishing the preternatural heat, and sensation of 
 the surface ; which it does, by lessening the morbidly in- 
 creased action, and reducing it to the natural state. The 
 degree must therefore gradually be diminished, in proportion 
 as the general disease subsides, otherwise we injure the sys- 
 tem, and prevent recovery. There is, however, this differ- 
 ence betwixt bleeding and the application of cold, that the 
 first may be used suddenly, and to a considerable extent at 
 once, whereas, the second ought, especially in all cases of 
 internal inflammation, to be employed more slowly, and its 
 degree regulated by the degree of the general heat of the 
 surface. 
 
 Nauseating medicines are also very useful, independently 
 of the sweating which they frequently induce ; and are a 
 very powerful mean of abating action in general.* Employ- 
 ed, after bleeding has been used once or twice, they are pro- 
 ductive of considerable benefit ; but there are some affec- 
 tions, in which they cannot be used, such as inflammation of 
 the stomach and intestines ; but in inflammation of the lungs, 
 •f the throat, muscles, or surface, they may often be pre 
 scribed with benefit. The remedies usually employed for 
 this purpose, are, small doses of emetics, given without drink. 
 
 * Nausea has often been employed with success, in checking active hemorrhage, 
 
17 
 
 It must, however, be remembered, that these frequently 
 produce considerable evacuations, either from the skin or 
 bowels, and, therefore, may occasion a permanent weakness. 
 We must likewise avoid raising the sickness to a great de- 
 cree, and keeping it long up ; because the same objection 
 applies nearly to this as to bleeding ad deliquium. 
 
 Purging is frequently employed in the cure of inflamma- 
 tion, especially such purgatives as are called cooling, which, 
 in this case, is an imaginary quality; but, unless in so far as 
 they tend to abate the irritation of costiveness, they can do 
 no more than bleeding can, and are, in many respects, infe 1 - 
 rior to it. They are, in one view, to be compared with the 
 application of cold, which is only indicated when there is 
 much heat ; both are intended to diminish action, chiefly by 
 removing stimuli from the part to which they are applied. 
 Purging is very uncertain in the effects which it produces 
 on the system, and in the degree of weakness which it cau- 
 ses; and, therefore, never can be put in competition with 
 bleeding, as a general remedy ; and, wherever bleeding is 
 improper, or its propriety doubtful, purgatives are still more 
 injurious. They operate likewise so slowiy, at least com- 
 paratively speaking, that they do not influence the local ac- 
 tion so much, as the loss of such a quantity of blood, as would 
 produce an equal effect on the body, will do, unless in parti- 
 cular cases, when they act upon the principle of the sympa- 
 thy of equilibrium ; as, for instance, in pulmonic inflamma- 
 tion, when they sometimes are of service, by increasing the 
 action of the intestines, and diminishing that o:' the lungs.* 
 fn the same way, emetics sometimes cure slight inflamma- 
 tion of the tonsils. One of the best and pleasantest saline 
 purgatives, is the phosphate of soda, which may be given to 
 an adult in the dose of an ounce, in order to obviate the ef- 
 
 ■ Thi- action is, in tMh respect; similar to that of Milters, 
 
18 
 
 fects of costiveness. If we wish to use it, upon the princi- 
 ple of the sympathy of equilibrium, we must give two ouni^es, 
 or more. The same cautions which were given, with regard 
 to bleeding, apply also to purging. 
 
 Sweating, considered as a mean of abating general action, 
 is, in most cases, inferior to bleeding ; and can never, when 
 the general inflammatory action is considerable, be trusted 
 to alone ; but, after the use of the lancet, it is generally 
 serviceable. It is useful, in particular, when the local dis- 
 ease is not confined to a small spot, but affects a considera- 
 ble surface, or different parts of the body ; as, for instance, 
 in the rheumatism ; but it acts, in these cases, rather by the 
 sympathy of equilibrium, than by any other mode. At the 
 same time, the induction of a sweat, preceded by Weeding, 
 (which tends to abate the local action as well as the general 
 one) will sometimes be useful, by giving a secretory termina- 
 tion to the general disease, and hastening its conclusion. In 
 the first point of view, sweating may be used early in the 
 disease, especially if preceded by bleeding. In the second, 
 it will be chiefly useful toward the end, as it will then ac- 
 celerate the termination, and thus influence the local action ; 
 for the abatement of the general action must also produce 
 an abatement of the action of a particular part. Sweating, 
 as well as purging, must be used with caution in weakly peo- 
 ple, or in those who are reduced by disease ; because, al- 
 though the action of particular parts may be increased by 
 it, yet, partly in consequence of this temporary increase, 
 and partly on account of the fluid which is discharged, gene- 
 ral weakness is induced. One of the best sudorifics is the 
 pulvis ipecacuanha comp. ; of which we may give ten grains 
 every hour, until sweating be produced, giving warm lemon- 
 ade along with it. The tartar emetic is also a very useful 
 
sudorific ; the sixth part of a grain may be given every half 
 hour, until the proper effect be produced.* 
 
 Some of the agentes dissimiles may be considered as pro- 
 per remedies in this complaint ; such as, digitalis, laurel wa- 
 ter, lead, &c. : But they are certainly inferior to blood-let- 
 ting; and have been so little employed in this way, that 
 their effects are not ascertained.f 
 
 Bleeding, of all the general remedies, is the best ; and, 
 next to that, cold, and nausea, which may be considered as 
 useful adjuvants. Sweating and purging are mostly to be 
 used when particular indications present themselves, as may 
 be understood from what has been already said. The first 
 of these remedies, act chiefly by producing a universal 
 abatement of action ; and, of these, bleeding produces the 
 most permanent effect on the body, and the most certain ef- 
 fect on the local disease. The two last are perhaps more 
 useful, upon the principle of the sympathy of equilibrium, 
 than that of abating action in general, which is only a se- 
 condary operation ; and, therefore, they may be considered 
 as remedies, acting rather topically than generally ; for, ac- 
 cording to this view, they act chiefly on the affected part. 
 These two kinds of remedies may, in many cases, be use- 
 fully conjoined, producing thus a greater effect than either 
 would do singly. 
 
 Before quitting this subject, it may not be improper to at- 
 tend to the proposal which has been made, of exhibiting 
 anodynes immediately after bleeding, in order to remove the 
 pain. " The most effectual remedy for this purpose, (says 
 Mr. Bell) is opium, which, when pain and irritation are con- 
 
 * One grain of emetic tartar may be dissolved in five ounces of saline julep, and 
 a table spoonful given every half hour, as long as may be necessary. 
 
 f Some of these agents might perhaps only change the nature of the inflamma- 
 tion, and render it specific? 
 
 VOL. II. t 
 
20 
 
 siderable, as in extensive inflammations very frequently hap- 
 pens, should never be omitted. In large wounds, especially 
 after amputations, and other capital operations, in punctures 
 of all kinds too, large doses of opium are always attended 
 with remarkably good effects. In all such cases, however, 
 opium, in order to have a proper influence, should, as we 
 have observed, be administered in full doses, otherwise, in- 
 stead of proving serviceable, it seems rather to have the 
 contrary effect ; a circumstance which is perhaps the chief 
 reason why opiates in general have been very unjustly con- 
 demned, in every case of inflammation." That, in every 
 case of inflammation, opiates are hurtful, is what no one can 
 assert ; and their utility will afterwards be fully manifested. 
 But, that opium is useful, or even harmless, in the inflamma- 
 tio valida, which we are at present considering, cannot be 
 admitted ; because daily experience, independent of every 
 theory, proves, that, by their use, the general fever is in- 
 creased, and the local action aggravated. Even given as a 
 preventive of inflammation, after operations, anodynes are 
 almost uniformly hurtful,* producing restlessness, heat, and 
 thirst, and afterwards head-ache, sickness, and frequently 
 troublesome vomiting. I have therefore now, after almost 
 every operation, laid aside their use, and find, that the dis- 
 eased action,f subsequent to the local irritation, runs its 
 progress with much less disturbance, and is much milder, 
 
 * Opiates may indeed abate the smarting, or soreness, which is consequent to 
 the immediate mechanical injury of wounds, or operations ; but this relief is com 
 monly only temporary ; for the general action is very apt to be afterwards in- 
 creased, and, consequently, union by adhesion is less likely to take place. 
 
 f There are two general diseases which are connected with local actions, and 
 which opium is supposed to cure, or prevent from taking place; the inflammatory 
 fever, dependent on a wound, and the febrile state, consequent to a temporary in- 
 creased action, or exertion of a particular part, or the whole of the system ; as, 
 for instance, the effect of part uritior.. The first of these is always aggravated by 
 opium; the second, if It be not increased, cannot possibly be cured by it. 
 
21 
 
 and shorter, than where anodynes have been administered ; 
 and, in general, the sleep is much more composed, and al- 
 ways more refreshing. I have therefore, after lithotomy, 
 amputation, the extirpation of the mammae, and after labours, 
 in almost every instance, omitted them. 
 
 The local applications are such as tend either simply to 
 abate action in the part, or such as tend to change its na- 
 ture, by exciting a specific change, or such as act in both 
 ways. The first comprehends cold, the second the agentes 
 dissimiles, and the third topical bleeding. 
 
 Cold, applied directly to the inflamed part, is a most use- 
 ful remedy, diminishing the action to a natural state ; but, 
 for this purpose, it must not be applied in too great a degree, 
 otherwise we diminish the action so much, and so suddenly, 
 (and, consequently, the power of the part) that recovery 
 cannot take place. If we apply much cold to a healthy 
 part, we sink its action so far, that it is irrecoverable ; if 
 we apply cold to an inflamed part, so as to diminish its ac- 
 tion equally sudden, and in the same proportion, we pro- 
 duce the same effect. Poultices of ice, or snow, are there- 
 fore highly dangerous ; and even water, although it cannot 
 be made nearly so cold as these. The same direction which 
 has been given, with regard to the application of cold as a 
 general remedy, ought also to be remembered, when we use 
 it as a local application, namely, it ought to be carried just 
 to such a degree, as shall diminish the morbid sensation, and 
 ought to be so adjusted, as to keep the part nearly in its na- 
 tural degree, or at least very little lower. For this purpose, 
 it must be applied in moderation, repeatedly, and with assi- 
 duity ; and not, as is commonly done, in a considerable de- 
 gree at once, and renewed only at. long intervals. Cold has 
 been supposed to be useful as an active astringent, producing 
 a contraction in the vessels ; but it does not seem to possess 
 any active power in producing such a state in the vessels to 
 
22 
 
 which it is applied. Where injury is taking place, from ex- 
 cessive action, cold, by abating it, may strengthen, and pro- 
 duce more natural contractions ; but, when applied to a 
 healthy part, it diminishes the action of that part, the blood 
 is less forcibly circulated, and the part shrinks ; it therefore 
 stops active hemorrhage in the part on which it acts. When 
 cold is applied suddenly, or to delicate parts, it excites an 
 universal action, or contraction, or shrinking, from weakness ; 
 and, therefore may likewise stop hemorrhage from distant 
 parts. In many cases, when this shrinking, or temporary 
 contraction, is suddenly induced by cold, it becomes con- 
 verted into the natural muscular contraction of the part ; 
 thus, for instance, if cold be applied to the uterus itself,* 
 when torpid, after delivery, we find, that after the first ef- 
 fect, or shrinking of the vessels, a more natural contraction 
 takes place. If, however, cold be long applied, we find, that 
 the contraction thus induced ceases, owing to the diminution 
 of action which is occasioned by its continuance, and the 
 original state of collapse, or shrinking, alone remains. 
 
 Blisters likewise act by simply abating the action of the 
 part ; but differ from cold, in requiring to be applied, not to 
 the part which is affected, but to some other, with which it. 
 exhibits the sympathy of equilibrium ; as, for instance, to 
 the integuments of the thorax, in pulmonic inflammation ; to 
 the skin of the knee, in affections of the joint, &c. It is, 
 however, necessary, when a general disease, or fever, is in- 
 duced, that bleeding be fully employed, before we have re- 
 course to blistering ; because, if it be not, the inflammation 
 excited by the blister, co-operates to increase the fever, 
 along with the original disease, which it has not had time to 
 overcome, or lessen. Blistering likewise acts more effect u- 
 
 * When applied to the skin of the abdomen, it acts chiefly by exciting action. 
 on the principle of the sympathy of equilibrium. 
 
23 
 
 ally, when the local action has been already diminished, by 
 previous bleeding. The size of the blister should be pro- 
 portioned to the probable extent of the diseased action ; a) 
 the same time, we must set bounds to this magnitude ; be- 
 cause, if loo large, they may not only produce, or keep up a 
 general disease, but also, by lessening the action of the in- 
 ternal parts too much, and too quickly, they may prevent 
 recovery.* It is therefore better to apply them of a mo- 
 derate size, and renew them frequently, than to apply one 
 too large at once. It must, however, be remembered, that 
 inflammations of every part are not equally readily over- 
 come in this way ; and, therefore, one will require a larger 
 blister than another ; thus, the same quantity of inflamma- 
 tory action in the brain, will be more difficultly subdued, 
 than in the breast ; and, therefore, we must apply, in that 
 case, a larger blister. As it is the inflammatory action, in- 
 duced by the blister, and not the discharge, as was once sup- 
 posed, which is useful, it follows, that the same blistered 
 place should not be kept too long from healing, or in the stale 
 of an issue, but that we ought rather to apply a succession 
 of blisters ; and this succession should be pretty rapid. 
 There is indeed one case, in which issues are admissible, 
 namely, where, from the nature of the inflamed part, or the 
 peculiarity of the inflammation, if it he specific, or scrophu- 
 lous, the progress of the action is very slow. In these cases, 
 a rapid, and continued succession of blister would, doubtless, 
 be most useful, but, from the duration of the treatment, 
 would scarcely be submitted to : Issues, which are 'ess pain- 
 ful, and less troublesome, are, therefore, generally preferred. 
 We have an instance of this in many diseased joints. 
 
 Were this not the case, we should enre pulmonic inflammation, with tin 
 greatest certainty, by covering the n-hoh thorax with a blister. 
 
24 
 
 The remedies which tend to diminish the inflammatory 
 action, by producing a peculiar, or specific change, are, the 
 agentes dissimiles, of which, for this purpose, lead is the 
 best, and the one which is most frequently employed. Lead, 
 in the state of an oxyde, was long ago used ; but it does not 
 appear, in this condition, to have much activity ; and, there- 
 fore, the saline preparations are now introduced into use. 
 The acetite of lead, on account of the supposed power of 
 vegetable acids in abating inflammation, has been considered 
 as possessing a great superiority over other forms ; but its 
 chief recommendation over other soluble preparations, is its 
 cheapness ; for the nitrate of lead seems to be equally pow- 
 erful. The acetite of lead may be employed, either before 
 or after crystallisation ; but, if we use the crystals, they 
 must be redissolved; for which purpose, soft, or distilled 
 water, must be employed, otherwise a decomposition takes 
 place. The strength of the solution which we apply, must 
 be determined by the natural delicacy of the part, and its 
 morbid sensibility, in consequence of inflammation. In the 
 inflammatio valida, in which alone it is proper, the solution 
 never ought to be so strong as to produce pain. When the 
 eye, urethra, and other delicate parts, are inflamed, the ap- 
 plication ought to be just so strong as to produce sensation, 
 and should be very frequently repeated. When the cellu- 
 lar substunce is inflamed, and we begin the application before 
 tins cutis be much affected, the solution will not require to 
 be so strong as to produce sensation ; because, were it to be 
 so, the action excited might, from the quantity required to 
 Produce the effect, be so great, and so suddenly induced, 
 that the powers of recovery would be lost, or a specific in- 
 flammation be occasioned, as we observe, when the solution 
 is very much concentrated, in which case, even sloughs are 
 sometimes produced. On the same account, we must renew 
 the application frequently, at least if we use pledgets, other- 
 
25 
 
 wise the evaporation of the solvent increases the strength 
 more than we desire. For incipient phlegmon, we may em- 
 ploy a solution consisting of three pounds of rain or river 
 water, and five drachms of sugar of lead ; or the following, 
 which is more elegant : 
 
 R. Cerussa Acetatae dr. iii ss. 
 
 Aceti Vini unc. iii. Solve super focum dein adde. 
 Aq. Distill. Frigid, lb. i ss. 
 Aq. Rosar. unc. iv. 
 
 This may be applied by means of pledgets of linen ; or part 
 of it may be made into a poultice, with crum of stale bread. 
 
 Saturnine poultices ought always to be applied cold ; be- 
 cause we thus receive both the benefit of the cold, and of 
 the lead. The directions which have already been given, 
 with regard to the application of cold, are to be attended to- 
 here. 
 
 Lead has been supposed to act as an astringent ; but, if 
 astringents were useful, alum would be more effectual than 
 any of the preparations of lead. 
 
 The vegetable acids have been considered as sedatives, 
 and are generally employed in the cure of inflammation •, but 
 it would rather seem, as if they belonged to the class of 
 agentes similes ; for, in moderate quantities, they increase 
 the appetite, &c. which no sedative, or agens dissimilis, ever^ 
 does :* They also excite a general action, which is different 
 from that induced by sedatives, and which is useful in cur- 
 ing many of the actions induced by these agents. We like 
 wise find, that they are not serviceable, as local applications, 
 
 * Like other agents of this kiad, they may kill speedily, if drunk in toogrea - . 
 tjuantities; and, after death, the vitality, from the previous great action, is fouad 
 completely destroyed. 
 
26 
 
 in the cure of inflammation, unless in so far as they become 
 the vehicle for applying cold. The surface is not very sus- 
 ceptible of their action; and, therefore, those who are in- 
 clined to continue their use, may do so without injury, and 
 even with benefit, if they be cold ; but then the same benefit 
 will be derived from cold water. 
 
 Alcohol is likewise considered by some as a sedative, and 
 introduced as a remedy, in the enumeration of those which 
 are applicable in inflammation ;* but, whatever its use may 
 be in the inflammatio debilis, it must be allowed to be evi- 
 dently hurtful in the inflammatio valida. 
 
 The last division of local application, contains those which 
 tend, both simply to abate action in general, and also to ex- 
 cite, to a certain degree, a specific change of the action. To- 
 pical bleeding is the chief remedy belonging to this division. 
 Bleeding with leeches, or the scarificator, is employed in 
 two different circumstances : First, when we detract directly 
 from the inflamed part ; as, for instance, from the surface of 
 a phlegmon : Secondly, when we detract only from the neigh- 
 bourhood of the inflamed part ; as, for instance, from the skin 
 which covers an inflamed joint. When we employ topical 
 bleeding, in the first case, we may suppose, that the aper- 
 ture, and effusion from the extremities of the inflamed ves- 
 sels, produces, to a certain degree, a change of action. Every 
 action of the vessels is performed at their extremities, and 
 the trunks and branches may be considered as canals subser- 
 vient to the extremities, and which contract and dilate, in a 
 degree proportioned to the general and local action. If, dur- 
 ing health, we open a number of the extremities of these ves- 
 sels, we induce the hemorrhagic action, which continues 
 longer or shorter, according to circumstances, and which 
 gradually terminates in a serous discharge, or secretion. If, 
 
 * Hunter ou Inflammation, p. 350. 
 
 
a 
 
 during inflammation, we open a number of the extremities oi 
 vessels, either in the inflamed part, or immediately contigu- 
 ous to it, we induce a similar hemorrhagic action, which is 
 different from the inflammatory one, and, therefore, tends to 
 diminish that action in the part. We likewise, by inducing 
 the serous secretion, tend to produce a termination to the in- 
 flammatory action. 
 
 Topical bleeding will also, in part, operate, by simply 
 abating the action, in consequence of the mere loss of blood ; 
 for, as the blood is withdrawn immediately, by different ori- 
 fices, from the vessels of one part, that part, and those near 
 it, may be supposed to suffer sooner, and to a greater degree, 
 than the rest of the system. The branches which yield the 
 blood, will even suffer considerably, for a time, although the 
 loss of blood be very trifling, and produce no effect on the 
 system. Thus, if one small artery be divided, we find, that, 
 although the quantity of blood which flows from it be very 
 inconsiderable, yet it is sufficient to produce evident changes 
 rn that vessel, making it contract, and become smaller, al- 
 though the vessels in other parts be not at all affected. This 
 depends upon the peculiar* action of the individual artery 
 being affected,f and the contracting state of the orifice, 
 spreading along the branch and trunk by degrees,J by which 
 
 * By peculiar action, I do not here mean what is commonly understood by the 
 term specific, but the action which is proper to the artery, considered as an indivi- 
 dual, in opposition to the action of the heart and arteries, considered in general as 
 an entire circulating system ; for one part of this system may act less powerfully 
 than another, and may be more dilated, &c. 
 
 t The distance to which this will extend, depends chiefly upon the quantity of 
 blood which is lost, and the size of the vessel which is affected. 
 
 } This depends upon the operation of the sympathy of association. Sympathy 
 was, in the preliminary dissertation, divided into that of association, and that of 
 equilibrium; and it was mentioned, that the same parts might be made to exhibit 
 either of these, but that naturally the sympathy of association is chiefly, and 
 most easily exhibited by those parts which are similar in structure, and contiguous 
 to each other; and, in them, the action spreads fastest. At the same time if the 
 action continues long, or be very strong, it may be propagated to dissimilar par'v, 
 
 yor,. n. p 
 
20 
 
 less blood is made to circulate through it. Bleeding from a 
 vein, however, has not the same effect ; because the quantity 
 of blood in a part, is not so immediately dependent upon the 
 state of the veins ; and because veins are not the seat of 
 much action. When we divide a small vein, we find, that 
 it, by degrees, contracts, and transmits less blood, or closes 
 completely ; but the blood from the part does not circulate 
 i'aster, nor is less blood sent to that part than formerly ; 
 therefore, topical bleeding from veins near the affected part, 
 can have no great superiority over general bleeding. 
 
 The division, then, of a number of small arteries, may cure 
 inflammation in two ways ; first, by inducing a different ac- 
 tion; secondly, by possessing Ihe general properties of 
 bleeding, namely, a simple diminution of action. The first 
 will operate chiefly, when we apply the leeches on part of 
 the inflamed portion. The second will operate, when we 
 detract only from the immediate vicinity ; and, in this case, 
 the quantity of blood which is taken away, must be greater ; 
 because the effect has to be extended some way, the vessels 
 not being in the inflamed part. The quantity must likewise 
 be greater, because the effect depends entirely upon this ; 
 whereas, in the other case, it depended, in part, upon the pe- 
 culiarity of the action, which was produced. 
 
 The number of leeches which it is necessary to apply, 
 will depend upon the violence of the action, and the place 
 on which they are set ; for, the greater the distance from 
 the inflamed part, the more numerous ought they to be. It 
 is therefore impossible to give any particular rule for the 
 extent of topical bleeding. It may, however, be proper to 
 observe, that we ought not to be satisfied with one applica- 
 
 .iikI produce either a very extensive, or an universal action, which is just a great- 
 er decree of the sympathy of association. In this case, it ha?, however, been call- 
 ••d universal sympathy. 
 
29 
 
 lion, more than with one venesection, for a general disease 
 but ought to repeat the local bleeding, whenever it may be 
 necessary, although it may be twice or thrice in a day, 
 founding our indications upon the same principle on which 
 we use general bleeding. It is by a too sparing application of 
 leeches, and their not being repeated sufficiently frequent, 
 that we so often fail in removing inflammations, which, by a 
 more active treatment, we might resolve. In general, the leech- 
 es ought to be applied as near the affected part as passible, or 
 upon it. If, hoAvever, the seat of the inflammation be chief- 
 ly in the cutis, as in erysipelas, it will perhaps be more prudent 
 not to apply them upon the spot ; because the subsequent 
 irritation is apt to increase the action afterwards, on account 
 of the great delicacy of the part. There may even be some 
 doubt as to the propriety of applying leeches to the vicinity 
 of the inflammation ; for the irritation of the bites may pro- 
 duce erysipelas in the part, or cause the original disease to 
 spread. 
 
 The scarificator may be used where leeches cannot be 
 obtained ; but it is not so useful, when applied to the inflam- 
 ed part, on account of the irritation which attends its appli- 
 cation, and the cupping ; but it is equally proper, where we 
 detract not from the part itself, but from its vicinity. 
 
 Of the topical remedies, bleeding is the most powerful ; 
 and, next to that, cold solutions of lead- Where these can- 
 not be employed, owing to the internal situation of the in- 
 flamed part, blisters must be used in their place. 
 
 Many other remedies used to be recommended, under the 
 name of discutients, repellants, &c. ; some of which have 
 been formerly mentioned, when considering the ancient the- 
 ories of inflammation ; these, however, are now laid aside. 
 Hut many practitioners still have an idea, that benefit will 
 foe derived from mechanically softenmg the paHs by mean- 
 
3G 
 
 -of oils, or what they call emollients ; and seem to consider 
 that poultices are chiefly useful for the same purpose ; at 
 least they only direct, that they shall be removed before 
 they turn "stiff or hard." But inflammation must be at- 
 tributed to a different cause than increased attrition, and its 
 cure must be effected by different agents from those which 
 we employ for softening a piece of dead skin. Oils and lini- 
 ments, in so far as they form a basis for other applications, or 
 are used along with gentle friction, may be occasionally proper 
 in the inflammatio assuefacta: but in the inflanimatiovalida, 
 they must be considered as absolutely useless. 
 
 There are also some remedies, recommended with the inten- 
 tion of absorbing acrimonious excretions ; such as, flour or 
 magnesia, in erysipelas. But these seem to act entirely by 
 ' allowing the action to run its course, without interuption, af- 
 fording a softer defence than could otherwise be obtained. 
 From the quick progress of violent cuticular inflammation, 
 the applications which are usually made in other inflamma- 
 tions have been forbid here, and are said to be pernicious ; 
 but this rather appears to arise from the application not being 
 properly timed, than from any peculiarity in the disease. It 
 is not easy to give any good reason why cold saturnine solu- 
 tion of a proper weakness,* and sufficiently early applied, 
 should not be useful ; nor do we find, that they are in reality 
 hurtful in simple erythema. Where this, however, attends 
 wounds, or is not an original disease, these are improper ; be- 
 cause it is in general, in these cases, an attendant upon the 
 inilammatio debilis, or a symptom of it, and requires either 
 
 * The solution must, upon the principles already laid down, be both weak, 
 and only so cold as to reduce the sensation of the.pa.rt to its natural condition, 
 that is to say, so as to abate the morbid feeling of heat; because, if we make it 
 otherwise, we may injure the powers of recovery, and perhaps induce gangrene. 
 •The application ought not to be so cold as to excite the sensation of coldness, at 
 least in any considerable degree 
 
31 
 
 to be let alone, or to have stimulating applications made to it, 
 at the same time that we give bark internally.* 
 
 These remarks upon the resolution of the inflammatio vali- 
 da, may be concluded, by observing, that the diet ought to 
 be low and sparing, in a degree proportioned to the violence 
 of the action. Such motion as affects the local action, must 
 at all times be prevented : but when a general action like- 
 wise exists, then general quietude must also be insisted on. 
 
 Of the Remedies which are necessary for inducing 
 Suppuration. 
 
 Suppuration is a new action, the exciting cause of which 
 is inflammation ; but, that it may take place, it is requisite, 
 that the inflammatory action be prevented from subsiding too 
 soon, or too suddenly ; in which case, either resolution, or 
 inflammatio assuefacta, takes place : Whilst, on the other 
 hand, we must prevent the action from rising too high, and 
 proceeding too rapic.ly ; in which case, mortification is 
 caused. 
 
 In these cases, in which resolution cannot be obtained, sup- 
 puration will generally take place, without any interference 
 on our part, provided we prevent the action from terminat- 
 ing in gangrene. This we observe in many internal inflam- 
 mations. At the same time, we may sometimes accelerate 
 this process, by a proper regulation of the original action. 
 
 The remedies proper for moderating and removing the in- 
 flammatory action, have been already mentioned; but these 
 sometimes fail to produce resolution ; in which case, either 
 
 * Bark is useful and necessary in every case of erysipelas, after the inflammatio 
 valida has abated- Local applications, of a stimulating nature, are also useful 
 at this period, as will afterwards be mentioned, when the inflammatio debiljs 
 comes to be considered, 
 
32 
 
 suppuration, or mortification, takes place. When the symp- 
 toms of suppuration take place, (which have been already no* 
 ticed,) all that is perhaps essentially necessary, is, to give up 
 the resolving plan, and not interrupt the natural progress of 
 the action. If, however, the inflammatory action continue 
 longer stationary, and seem neither to be resolving, nor de- 
 cidedly inducing the suppurative action, then such remedies 
 as increase the action, and accelerate its progress, are essen- 
 tially requisite. These remedies, however, are, in general, 
 indiscriminately applied in both cases. 
 
 For the purpose of inducing, or accelerating the suppura- 
 tive action, it was formerly the practice to apply liniments, 
 cataplasms, and fomentations, composed of stimulating sub- 
 stances, such as garlic, turpentine, galbanum, .Scc^ but of late 
 these have been almost entirely abandoned. Heat and elec- 
 tricity have the property of increasing the performance of 
 every action which is existing at the time of their applica- 
 tion, and, therefore, are the remedies chiefly to be employ- 
 ed in the present instance. 
 
 Heat may be applied in two ways, with or without mois- 
 ture. In the first, it increases action more suddenly, and 
 perhaps more simply. In the second, its effects are more 
 gradual, and are likewise complicated with those of moisture, 
 which certainly is an agent capable of operating on the liv- 
 ing system, and generally tends to excite a secretory action, 
 or to give a secretory termination to those increased actions, 
 which are induced by agents operating along with it. Dry 
 heat is therefore evidently improper in the inflammatio vali- 
 da, because it will tend to produce mortification ; but, if mois- 
 ture be conjoined, then the suppurative action is excited. 
 When, hoAvever, the action has made an approach to the in- 
 flammatio assuefacta, then it may be useful to raise the action 
 simply by dry heat, for a little, before we apply heat and 
 moisture ; because, if we apply moisture at first, the pro 
 
33 
 
 gress is more tedious, and the action is less certainly excit 
 ed.* Electricity is similar in its operation to heat and dry- 
 ness, and may be usefully employed in similar cases ; but 
 we must, if we expect any benefit, repeat its operation fre- 
 quently, and continue each application for a considerable 
 time.f 
 
 There are two forms in which we employ heat and mois- 
 ture, namely, fomentations and poultices. Fomentations]: 
 have this superiority over poultices, that the same degree of 
 heat is always kept up' during their application; whereas, 
 when we use poultices, the heat subsides, as they are renew- 
 ed only at considerable intervals ; but fomentations require 
 longer attendance, and more trouble ; and, therefore, are on- 
 ly employed for a short time, and commonly betwixt the in- 
 tervals at renewing the poultices. 
 
 Poultices are generally made of bread and milk boiled to- 
 gether, so as to form a thick kind of paste, to which is 
 added, so much olive oil as will preserve it from hardening 
 quickly.^ These ought to be applied, either of the same 
 temperature with the inflamed part, or hotter, according to 
 circumstances. When the inflammation seems to be natu- 
 rally and quickly tending toward suppuration, it is, as has 
 been already mentioned, by no means essential, that any ap- 
 
 * From what has been said in the preliminary dissertation, we may understand 
 how moisture should tend to induce a secretion. Agents frequently excite condi- 
 tions somewhat similar to their general properties : Thus, putrid matter tends to 
 induce the action of descent, and consequent putrefaction. We likewise experi- 
 mentally find, that if moisture be applied during a general increased action, it in- 
 duces perspiration, unless it be conjoined with cold, which lessens the action. 
 
 t The proper way to use electricity, in this case, is to draw scintillae from the 
 part, the patient being insulated. 
 
 { Fomentations are made, by applying a soft cloth, dipped in any warm fluid, 
 (commonly water) to the part. Sometimes the cloth is wrung hard, in which case 
 it is chiefly steam which is applied. 
 
 J Poultices may also be made, by boiling pounded linseed-cake, orfrom potatoes, 
 or mashed vegetable leaves (which are the cheapest for hospitals,) such as tussila- 
 r.«, 4c. 
 
34 
 
 plication be made externally, in order to induce the suppu 
 rative action ;* but still poultices are used, and, in many 
 cases, accelerate the progress. In this case, the poultices 
 should only be applied so hot as not to give any considera- 
 ble sensation of heat, otherwise we increase the action too 
 much, and too rapidly, and, if early employed, may even 
 interrupt, or stop the incipient purulent action, renewing 
 the inflammation, and perhaps making it terminate in partial 
 gangrene. Poultices, then, should not be applied very hot 
 at first, especially when the action seems to be such as to 
 make us expect that it shall run its course without any as- 
 sistance. But when the inflammatory action has been more 
 tedious, and does not terminate in the suppurative one so 
 soon, and so decidedly as we would wish, then poultices 
 must be applied, with a different intention, being meant, not 
 solely to prevent the action from sinking, as in the first case, 
 but also to raise it, and make it brisker. The heat must 
 therefore be greater, and such as to give a considerable sen- 
 sation ; and the poultices, instead of being changed only 
 when they begin to grow hard,f which is perhaps all that 
 is necessary in the first case, must be renewed very fre- 
 quently, in order to keep up the increased degree of heat, or 
 the agent which supports the action, and accelerates its pro- 
 gress. They ought, in this case, to be taken off and warm- 
 ed or renewed almost every hour, at least when the action is 
 
 * The inflammatory action, when moderately strong, acts naturally as an ex- 
 citing cause, inducing the purulent action, which is therefore said to be a termina- 
 tion of inflammation. It is therefore as unnecessary to interfere in the produc- 
 tion of this secretion, when the action is of proper strength, &c. as it would be to 
 attempt to increase, by local means, the vesication which is produced by a blister. 
 Poultices are, in this condition, perhaps chiefly useful, by removing the causes 
 which tend to abate the action at an improper time, such as those which produce 
 resolution, as cold, &c. 
 
 f They keep up the heat of the part, and keep it moist until this happens, and 
 prevent the action from flagging suddenly, which is all that is required of them, 
 wheii the action is going on of itself in a proper decree. 
 
35 
 
 tedious, that is to say, when they are most required. We 
 are then not to lay down any certain degree of heat which 
 is to be employed, nor fix any particular number of times at 
 which the poultices must, in every instance, be changed, 
 but regulate our practice entirely by the nature of each par- 
 ticular instance, taking the progress and degree of the action 
 as our guide, in this respect, and interfering exactly in pro- 
 portion to the necessity for interference. It may not, how- 
 ever, be improper to remark, that, caeteris paribus, the 
 heat must be greater in proportion to the depth of the in- 
 flamed part below the skin ; or, in other words, we must ap- 
 ply more heat, when we are obliged to act on a part not yet 
 inflamed, than when we act directly on the inflamed part 
 itself. When an abscess forms at a distance from the sur- 
 face, the parts betwixt it and the surface gradually come, as 
 was formerly mentioned, to assume the purulent action ; and 
 the sympathy of equilibrium, which naturally exists betwixt 
 the surface and the parts below, gives way to the sympathy 
 of association,* the parts coming by degrees, to perform one 
 uniform action together, which spreads from within to with- 
 out. When we apply heat to the surface, at this place, we, 
 by continuance, likewise induce the sympathy of associa- 
 
 * When two parts are affected at the same time, in consequence of an agentope- 
 rating quickly on one of them, they commonly exhibit the sympathy of association, 
 which takes place suddenly, but generally at first lasts only for a short time, if the 
 parts be distant ; but, if the original disease still continue, it may spread, inch by 
 inch, until it arrives at the part which was formerly affected, and which i3 again 
 aflected more permauehtly, by the same kind of sympathy taking place, but in a 
 different way. In the first case, we have the sympathiaconsociationis intermpta; 
 in the second, the sympathia consociationis serpens. It is this last which is the 
 cause of the cxten.-ion of all action in a part, and which, when strongly excited, 
 overcomes the natural tendency to the exhibition of the sympathy of equilibrium. 
 It is, bowever, more difficult for local action to spread by degrees to parts which 
 evince the sympathy of equilibrium than other part? ; and these, in general, are 
 longer of being affected. Thus, when inflammation begins in the skin, it can much 
 more easily spread along: the skin than dip down to the muscles. 
 
 VOL. II. E 
 
36 
 
 tion, and the increased action spreads and operates on the 
 disease ; but there is this difference, that the action of the 
 heat spreads from without to within, and thus accelerate* 
 the progress of the suppurative action. 
 
 When the suppurative action has existed a certain time, 
 we find, that it gradually extends itself to the skin, purulent 
 matter being formed, instead of organic particles ; on which 
 account, the cavity enlarges, and the covering becomes daily 
 thinner. At last, the action reaches even to the cutis, 
 which becomes white and flaccid, first at a point, and then 
 to a greater extent.* When this happens, the thin covering 
 is either torn by the pressure of the contained fluid, acted on 
 -by the surrounding parts, or acting by its own weight ; or, 
 if this does not take place, the suppurative action still pro- 
 ceeds going through the cutis, the organization of which, 
 like that of the parts below, is lost : The thin cuticle now 
 rises up into a little blister, and then gives way. The mat- 
 ter runs gradually out, the sides collapse, and come nearer 
 by degrees to each other, at the same time that the ulcera- 
 tive action succeeds to the suppurative. The quantity of 
 the discharge, therefore, daily lessens ; the internal surface, 
 or sides of the abscess, come in contact ; and the granula- 
 tions at the margin or circumference unite ; those belonging 
 to one side uniting with those of the other, and thus pro- 
 ducing recovery by successive circles of reunion, which 
 form rapidly, or more slowly, according to circumstances. 
 
 Such is the natural progress of an abscess ; but it has 
 been proposed, that it ought not to be allowed to follow this, 
 but ought to be opened before it bursts spontaneously ; and 
 
 * In proportion as the action extends outward, it also becomes more concentra- 
 ted. An abscess is therefore somewhat conical, or at least hemispherical, the 
 base being turned inward, and the apex outward. When the action reaches the 
 surface, it is first at a single point ; but, by degrees, it becomes extended, and the 
 .1 Dex becomes broader. 
 
37 
 
 this opening has generally been desired to be pretty large, 
 chiefly perhaps on the principle of allowing a free evacua- 
 tion of the matter. Where abscesses are seated over cavi- 
 ties into which they may burst,* instead of opening exter- 
 nally, there can be no doubt of the necessity of making an 
 early evacuation ; and, in these cases, we ought to open them 
 before the skin becomes white ; or, in other words, before 
 the action reaches the surface ; because, if the abscess be 
 seated equally betwixt the skin and the cavity below, we 
 may suppose, that, if it be extending itself in all directions, 
 or toward the cavity, f in the same proportion as outwardly, 
 that the parts below will become almost irreparably diseased 
 before it can reach the surface, and will give way afterwards, i 
 even although an opening be made externally. Where, 
 from the confinement of the matter, it seems to be spread- 
 ing, or diffusing itself, by its gravity, through the cellular 
 substance, or among the muscles, it will likewise be necessa- 
 ry to open the abscess early ; but, in this case, the abscess 
 is unhealthy ; for, were it otherwise, the matter would be 
 confined by the circle of diseased organic matter thrown out 
 during the inflammatory action, and which is only removed 
 
 * Such as the thorax, trachea, &c. Instances have happened of suffocation be- 
 ing thus produced. 
 
 f Although, in general, an abscess has little tendency to extend itself deep 
 down, but rather moves toward the surface, although so far from it originally, 
 that, had the action extended equally in all other directions, the size of the ab- 
 scess must have been immense; yet, when it is situated over a cavity, it may pro- 
 ceed toward that as if to an external surface. Even, however, in this case, the 
 general law, of all actions tending to the skin, obtains ; for the progress outward 
 is much quicker than that inward ; but, if the action commenced near the surface 
 of the cavity, as is commonly the case, the difference of the distance will com- 
 pensate for the superior tendency to extend outward ; and, therefore, the abscess 
 may burst at the internal surface into the cavity. 
 
 i. In abscesses seated on the thorax, I have known the intercostal muscles and 
 pleura continue the suppurative action, after the external surface had opened, 31;'-} 
 thus an opening came to be formed into the thorax. 
 
gradually; In this case, the suppurative action has extend- 
 ed itself laterally, and perhaps downward, more quickly than 
 in health, and has not observed the same ratio, with regard 
 to the extension toward the surface ; the action, therefore, 
 reaches parts which were not formerly inflamed (by the 
 sympathia consociationis serpens,) before the surface gives 
 way ; and, therefore, the matter spreads or diffuses itself 5 
 for, by the spreading of the action, the confining barrier is 
 removed, and the matter mechanically extends itself. This 
 is an unhealthy abscess, and the action is of the phagedenic 
 nature. Opening the abscess will not always stop this mor- 
 bid action ; but, by removing the matter, it will lessen the 
 chance of diffusion. We must, however, continue the free 
 evacuation, and place the member in a proper posture ; be- 
 cause, if the action continue, the matter which still is form- 
 ed will lodge, and form sinuses. 
 
 In healthy abscesses, where we do not apprehend any de- 
 triment to the neighbouring parts, the question comes to be, 
 whether opening them will accelerate the cure ? Perhaps 
 much of the diversity of opinion on this subject, has arisen 
 from .'lot attending to the condition of the abscess which we 
 have been managing, and thus we apply the prognosis and 
 treatment of one kind of abscess to different ones. When 
 an abscess has been formed slowly, and runs its course rather 
 tediously, we may suppose, that the action shall continue for 
 a considerable time without being converted into the ulcera- 
 tive one ; and, therefore, the abscess shall remain long with- 
 out healing. In this case, a free incision, or the irritation of 
 a foreign body, may excite the ulcerative action, and thus 
 accelerate the cure ; for these abscesses have come to ap- 
 proach toward the nature of common encysted tumors, and 
 require the same treatment. But, where abscesses are run- 
 ning their progress with due celerity, and the action is pro- 
 ceeding through its proper course, there is not the same 
 
39 
 
 cause for interference. If, in this case, we open them before 
 the action has gained the surface, we derive no benefit ; be- 
 cause the action still proceeds, and the same events and cir- 
 cumstances take place as if we had allowed it to burst. If 
 we make a large aperture, when the abscess i* ready to burst, 
 we, by the irritation, interfere with the process which was 
 going on, and delay the cure. The admission of the air to 
 the abscess, owing to the free exposure, is one cause of this 
 delay; for it changes the nature of the purulent action, and, 
 if the ulcerative action takes place, frequently renders it un- 
 healthy ; the consequence of which, if the abscess be large, 
 or situated in vital parts, is hectic. We likewise, in large 
 abscesses, by the sudden evacuation of the matter, and re- 
 moval of the distension, sink the action of the parts, and 
 make recovery more tedious.* When the absce>;, then, is 
 healthy, and the action strong, it will be more proper to al- 
 low it to follow its natural course, and burst spontaneously, 
 than open it, by a large incision, or by the introduction of a 
 seton : If we do open it, the orifice should not at iret be 
 Jarge, but should just comprehend the diseased or whitened 
 surface. 
 
 Sometimes, after an abscess has burst, or been opened, it 
 continues in a progressive state of amendment for some 
 time, and then becomes stationary, continuing to dischurze 
 matter without healing. This either takes place from the 
 whole surface, or from a particular part of it, forming a sinus, 
 the treatment of which will afterwards be mentioned, being 
 the same with those which succeed ab-i o--e> which are ori- 
 ginally unhealthy. 
 
 After an abscess bursts, the proper application is a warm 
 poultice,! which should be continued in general as long as 
 
 * This likewise affects the system, and produces syncope, if the mechanical 
 support be withdrawn suddenly from the pans. 
 
 f This poultice does not require to be so ho', re: c'.iiriitd so frequently, si 
 befere the full formation of matter. 
 
40 
 
 there is any stool, or hard margin; that is to say, until the 
 increased quantity of diseased organic particles, which were 
 formed during the inflammation, be absorbed, and the vessels 
 at that part have either assumed the suppurative or natural 
 action. After this, the orifice ought to be covered with a 
 slip of lint, and moderate pressure applied over the surface 
 of the abscess,* by which the sides are kept in constant 
 contact, and reunion is accelerated. Good diet is also ne- 
 cessary, for we thus increase the powers of recovery, or 
 keep up a proper action, and renew the vital principle, the 
 quantity of which has been lessened during the inflammation, 
 both by the continuance of a state of overaction, and by the 
 remedies which are employed to diminish the action ; for a 
 state of real and permanent weakness is thus induced. 
 
 It sometimes happens, that suppuration takes place very 
 slowly, and the action seems to be performed with little vi- 
 gour. In this case, if the abscess be allowed to burst of it- 
 self, we both lose time, and are often, in the end, disappoint- 
 ed in a cure, the healing process not taking place. It is 
 therefore useful, in these cases, to have recourse to other 
 agents besides heat. If the pain be trifling, and the suppu- 
 ration be what may be called chronic, or approaching to it, 
 we will perhaps succeed, by applying gentle pressure on the 
 abscess, by means of a thin roller, and laying a warm poul- 
 tice over this. But, when this fails to increase the action, 
 we ought to pass a seton, by which we evacuate the matter, 
 and keep up the subsequent action to a degree sufficient for 
 producing recovery. In doing this, however, it is necessary 
 to attend to the state of the tumor ; because, if, in every in- 
 stance, we pass it from the highest to the lowest part, we 
 shall sometimes make the part give way in a third place. If, 
 
 * If this produces pain, we may in general conclude that it has been used 
 too goon. 
 
41 
 
 tor instance, the abscess be much thinner at the apex than 
 elsewhere, or, if the action have made considerable progress 
 toward the surface, then the stimulus of the action increases 
 the performance of the natural process which was going on, 
 and the action continues to extend itself until the part gives 
 way. In these cases, then, we ought to pass the seton from 
 the thin part to the lowest part ; and this, in general, will, 
 from the sympathy of association, be sufficient to excite the 
 action of the whole internal surface. 
 
 When we resolve to use the seton, the following is the 
 easiest method of introducing it : Make a puncture with a 
 lancet either into the upper, or the thinnest, and most 
 prominent part of the tumor, according to circumstances ; 
 and, into this puncture, introduce, using the lancet as a di- 
 recter, a probe, having a piece of tape passed through its 
 eye. The lancet is then to be withdrawn, and the probe 
 pushed down to the under part of the abscess, where its 
 point will be felt under the skin. A small incision is here 
 to be made upon the knob of the probe, which is next to be 
 passed through, and the tape drawn after it. The matter is 
 then to be slowly pressed out ; the tape is to be folded ; and 
 the abscess bound up with a compress and roller, so as to 
 make moderate pressure upon it. Next day, the dressings 
 are to be removed, and a clean piece of the tape drawn 
 through, after which, pressure is again to be applied. 
 
 The size of the tape, the time which the seton ought to 
 be employed, and the degree of pressure to be used, must 
 be regulated by backwardness of the action, and the imper- 
 fection of the healing process. 
 
 If, either from improper management, or the morbid cond: 
 tion of the action, the abscess, after it bursts spontaneously, or 
 is opened by art, continue to suppurate, without undergoing 
 the ulcerative action preparatory to healing, then we find, 
 
that either the sides remain quite separate, producing a 
 cavity, extended more or less, or one particular portion re- 
 mains open, forming a sinus. Both of these cases require a 
 treatment, which in its principle, is the same, namely, the 
 indication of the ulcerative action. 
 
 In the first case,* we shall frequently succeed by means 
 of the seton, especially if we use pressure along with it ; 
 for, by keeping the internal surface in close contact, we tend to 
 check the purulent, or suppurative action, and produce orga- 
 nic particles.f We may also succeed, by using stimulating 
 injections, of such a strength as to produce a moderate de- 
 gree of smarting. Of this kind are, wine and water, solu- 
 tions of white vitriol, corrosive sublimate, &c. These ought 
 to be used frequently in the course of the day, and pressure 
 employed during the intervals. Incision, or laying the part 
 open, is, being the most severe, the last remedy which is to 
 be had recourse to. Small chronic abscesses may be laid 
 open during their whole diameter ; but larger ones require 
 only to be cut up for a certain length. 
 
 The second case, has generally been considered as a spe- 
 cies of ulcer, and has been named the sinus ulcer ; but, al- 
 1 hough the orifice may sometimes possess the diseased ulce- 
 rative action, yet the sinus itself still continues in the suppu- 
 rative state, and, therefore, cannot heal. These sinuses de- 
 pend, in different instances, upon very different causes, and, 
 therefore, require a variation in the treatment. The most 
 simple species of sinus may be called mechanical, and is pro- 
 
 * This is exactly similar to an encysted tumour which has been opened, and re- 
 quires the same treatment. The internal surface becomes thick and somewhat, 
 j;ard, like that of a cyst. It differs from an encysted tumour only in its cause and 
 origin. 
 
 f If pressure be employed early, to a considerable degree, the irritation of the 
 means employed produces pain, and a morbid increase of action, unless we keep 
 down the action by cold, as will be explained when considering the treatment 
 of ulcers. 
 
43 
 
 duced by matter flowing from a neighbouring cavity, and 
 which cannot be freely discharged: Thus, for instance, if a 
 deep abscess open at the highest part, or at a point above the 
 level of its bottom, the matter constantly oozes out, and 
 keeps the canal open. This is most apt to occur, when ab- 
 scesses are formed deep among muscular parts ; in which 
 case, although the matter point at the centre, yet an accu- 
 mulation must take place below, and the matter must conti- 
 nue to be discharged by the aperture, when it becomes so 
 abundant as to be raised to the level of the opening ; or, be- 
 ing once raised, it continues to flow out. The cure of this 
 may at first be attempted mechanically, by tight bandages, 
 which press out the matter, and keep the sides in contact ; 
 but, if the disease have been of long duration, then, whatever 
 may have been its nature at first, we find, that the suppurative 
 action extends along the mechanical sinus, which then be- 
 comes affected with a chronic action ; in which case, it be- 
 comes similar to the second species of sinus. We must, in 
 this species, make an opening at the most dependent part, 
 and employ the means which will be now mentioned in consi- 
 dering the second species, or that produced in consequence 
 of the suppurative action becoming chronic or habitual, in- 
 dependent of any mechanical cause. This may take place, 
 although the aperture have been originally in a proper place, 
 and the matter, instead of being retained, and keeping up the 
 disease, shall have been regularly discharged. The case in 
 which this is most likely to happen, is that in which the abscess 
 has been very tedious in its progress, and the action has been 
 from the first, slow. The distinction betwixt this species, 
 and those which remain to be mentioned, is founded upon the 
 absence of the symptoms which they possess, and by our ex- 
 amination with the probe, which points out the cause and ex- 
 tent, and informs us whether we be near a bone. The orifice 
 is flabby, and has the appearance of the indolent ulcer. The 
 
 VOL. II. F 
 
44 
 
 cure of these sinuses is to be attempted, by pressing out the 
 matter by means of proper bandages, or by making a depen- 
 dent opening, which is generally necessary, at the same time 
 that we raise the action of the part to a proper degree, and 
 render the suppurative action acute and vigorous ; in which 
 ease, it naturally terminates in the ulcerative, and thus the 
 part has its structure restored. This is most easily effected, 
 by passing a seton, and applying a proper degree of pressure, 
 diminishing the size of the seton gradually, and in proportion 
 to the vigour of the action and the approximation toward 
 health. When, from the situation of the sinus, Ave cannot 
 pass a seton (which rarely happens in this species of sinus,) in- 
 jections of wine may be used frequently, and pressure ap- 
 plied during the intervals. When these means fail, which is 
 seldom the case, the part should, if its structure permit, be 
 laid open. If this sinus have remained long open, its surface, 
 like that of the chronic abscess, becomes changed, and a 
 coat is formed like the cyst of a tumour. When this is thick 
 and hard, the sinus has been called a fistula, and it has been 
 deemed necessary to dissect out the tube ; but it is in gene- 
 ral sufficient to use the remedies which increase the vigour 
 of the action, and make it run its natural progress ; such as 
 the seton, or a free incision, if the parts be superficial, or 
 no considerable vessel or nerve runs the risk of being wound- 
 ed. 
 
 The third species of sinus is that in which the suppura- 
 tive action is kept up by the operation of some adventitious 
 cause ; such as a caries bone, diseased cartilage, or the 
 lodgement of a foreign body ; as, for instance, a ball, a splin- 
 ter of wood, bit of cloth, &c. This species is distinguished 
 by our feeling the extraneous body, or diseased bone, with 
 the probe, and by the fungous protuberance, or papilla, which 
 shoots out from the orifice, In addition to the method of cur- 
 
45 
 
 ip.g other sinuses, we must here endeavour to remove the 
 adventitious cause, which is generally very difficult to be 
 done. If the foreign body be deep, or if the diseased bone 
 lie deep, and the sinus be narrow, we can do little in this 
 way ; sometimes, indeed, by enlarging the external part, we 
 can come at the foreign body with a pair of small forceps, 
 and may extract it, or may accelerate the exfoliation of 
 the diseased bone ; but we can have no certainty of suc- 
 cess. If, however, the sinus be superficial, which sometimes 
 happens in caries of the tibia, &c. it ought, in every instance, 
 to be fully laid open, and the bone exposed, and treated in 
 the way immediately to be mentioned. When this cannot 
 be done, we may sometimes, by conveying the proper reme- 
 dies through a tube down to the bone, procure exfoliation ; or 
 may by setons, injections, and pressure, procure a tempora- 
 ry cure ; but, as long as the adventitious cause remains, we can- 
 not expect a permanent recovery. It is observed, that sinu- 
 ses, when they can be healed in these circumstances, break 
 out again upon very trifling exertions, and very frequently 
 are renewed, after a short interval, in spite of all our precau- 
 tions ; such as rest, warmth, &c. 
 
 A caries* of the bone is at all times a disease which is 
 difficult to manage, both on account of the mechanical ob- 
 stacles which we have to overcome, and the slowness with 
 which the affected parts perform their actions either of dis- 
 ease or recovery. The divisions of this disease have gene- 
 rally been taken from the appearance of the caries, and its 
 extent. We have the dry caries, the worm-eaten caries, the 
 
 * When a bone becomes carious, the periosteum is completely detached, and, 
 therefore, it is felt to be rough by the probe. Its colour becomes first of a dull 
 white, or dirty yellow, which it either preserves, or changes for the intermediate 
 hues betwixt these and black. It is generally more porous than formerly, and 
 lighter; but these qualities vary, from rery slight degree-, to fhc appearance; »f a 
 light coralline> 
 
46 
 
 spongy, or carnous caries, &c. and we have the deep and super 
 ficial. But, as the cure of these is to be conducted on the 
 same principles in all of them, and as they are most proba- 
 bly different degrees of the same complaint, it will be more 
 useful to divide them into those which affect bones lying 
 deeply, and those which affect the more superficial bones ; 
 because these different cases are attended with very different 
 circumstances and symptoms. The first is preceded by an 
 abscess, which forms generally with much pain, runs its 
 course slowly, and does not burst for a considerable time. 
 When it does open, its sides do not ulcerate, at least univer- 
 sally, but a sinus remains, the mouth, or exposed part of 
 which only, assumes the ulcerative action. The second is 
 more rarely preceded by any abscess, but is either coeval 
 with the ulcer of soft parts, (both being produced by me- 
 chanical violence) or it succeeds the ulcer, and is caused by 
 it. This ulcer belongs to the third genus, and will be after- 
 wards described. 
 
 In treating of the cure of caries, the first thing is, to de- 
 termine by what means the disease of the bone may be re- 
 moved ; and, secondly, what modification our treatment must 
 undergo, in consequence of the caries belonging to the 
 first or second species. From the very earliest periods, we 
 find the application of stimulating and corrosive remedies 
 recommended in this disease. The actual cautery, euphor- 
 bium, mineral acids, scalding oil, the essential oils, and warm 
 balsams, have been universally employed, and frequently al- 
 ternated with rasping and perforating the bone. This pro- 
 ceeded from observing, that, on the one hand, mild applica 
 tions had no effect, and, on the other, that the natural slow- 
 ness of exfoliation was overcome by the use of these more 
 powerful remedies. A caries of a bone is correspondent to 
 a mortification of a soft part ; and, therefore, it is impossible 
 
17 
 
 to restore the diseased part to health, or lite. Our chief ob- 
 ject, then, must be to prevent the disease from spreading, 
 and to procure a speedy separation of the dead portion. 
 The first is much less under our power than the second ; for, 
 it is most probable, that, in the majority of instances, al 
 least of those of a simple nature, the disease, from the first, 
 extends a certain length, affecting a portion of the bone, and 
 that it afterwards makes very little progress. There is, 
 however, a specific disease which affects the bone in com- 
 mon with the soft parts. The bone becomes rough, and 
 suppurates ; and the soft parts have a fiery appearance : 
 This has been called the phagedenic caries. Cancer, scro- 
 phula, lues, and other specific actions, also spread after they 
 are once induced. The second object is to be effected by 
 such means as operate upon the vitality and action of the 
 part, and those which act mechanically. Those which tend 
 mechanically to remove the dead portion, are perforations 
 down to the sound part, which we know has happened, by 
 the bleeding which ensues ; or, we may saw down this length 
 Avith a trephine. We thus, by cutting off the communica- 
 tion of part of the diseased surface with the adjacent parts, 
 kill it completely, sooner than could otherwise happen, and 
 likewise stimulate the parts below to assume the ulcerative 
 action, and throw it off. We may also sometimes be able to 
 turn out these portions with a levator. Those which act 
 more exclusively, by affecting the action of the part, are sti- 
 mulating applications ; such as heat, acids, &c. The actual 
 cautery is so terrifying to the patient, that it is now laid 
 aside ; and it is likewise liable to this objection, that it may, 
 by its operation on the neighbouring parts of the bone, pro- 
 duce disease in them. The potential cautery is more use- 
 ful, and may frequently be employed with advantage, either 
 in a solid form, as to callus, &c. or dissolved in water, and 
 
43 
 
 applied with a pencil.* M. Sue, in his notes to Ravaton's 
 Practique, ike. recommends l'eau mercurielle, or solution 
 of mercury, in nitrous acid. By these means, the sound 
 part below assumes the ulcerative action, its connexion with 
 the diseased portion is then destroyed, and reparation takes 
 place. The ulcer of the bone is red, and its surface cover- 
 ed with innumerable granulations, which rise up to the level 
 of the surrounding parts, after which a cicatrice is formed. 
 These granulations in the bone are absorbed, and others more 
 perfect are deposited in their place, until at last they be- 
 come completely osseous.f 
 
 The next point which merits our attention, is the situation 
 of the bone, and the circumstances which attend the caries. 
 When superficial, a fungous ulcer is produced, and the mo- 
 dification which this situation requires in the application of 
 the general plan will come afterwards to be attended to ; 
 the modification in the treatment which is required in sinuses 
 has been mentioned above. It may here only be remarked, 
 . that, where the sinuses are superficial, they may be laid open, 
 which will induce the ulcerative action in their course, and 
 allow us to apply the proper remedies to the bone ; but 
 where they run deep, we must either allow the disease to 
 run its natural progress, and treat the constitution according 
 
 s If we use the solution, we must, if the bone be very porous, or spongy, apply 
 only a little at once, otherwise it may sink down, and injure a part which we do 
 not wish to act on. 
 
 f There is a curious case of cariesj which is frequently met with : The diseased 
 part, instead of being cast off, is surrounded by a covering of new bone, (except ai 
 one portion, where a sinus and ulcer is formed in the soft parts) and may be fell 
 rattling within it. In this case, there is necessarily a permanent enlargement of 
 the part, from Use additional bony matter ; and this, together with the sinous 
 openings, and the internal caries, being felt with the probe, form the character of 
 the disease, which has been called necrosis, a term which formerly implied merely 
 mortification. The cure of this complaint is to be accomplished by extracting the 
 diseased part, when it beeomes loose, if the opening in the case be sufficiently 
 large ; if not, it is to be enlarged with the trephine, &c. See the works of Ruysch. 
 Desault, &c. : and. more lately, the publication of Mr. Rus'sel. 
 
49 
 
 to the effects produced, or, by means of a canula, convey a 
 piece of caustic to the diseased part, in the same way as we 
 treat obstinate strictures of the urethra, &c. When, with 
 the probe, we feel the bone loose, we may assist its exit with 
 the forceps, or by enlarging part of the sinus, according to 
 circumstances. 
 
 When these sinuses communicate with joints, uid depend 
 upon diseased cartilages, tendons, or articulating surfaces of 
 the bones, we can do very little in the way of curing them 
 by injections or incisions ; because we cannot thus remove 
 the disease of the joint, but may increase it. Issues placed 
 over the joint, with rest, cleanliness, and good diet, country 
 air, Sec. are the remedies chiefly to be employed in these 
 cases ; or, if hectic be induced, and these remedies fail, we 
 must remove the diseased part, if this, on account of its si- 
 tuation, be practicable. When, however, these sinuses are 
 superficial, and depend upon tendons not immediately con- 
 nected with the articulation, it may be useful to lay them 
 open, and treat the disease of the tendons with caustic, like 
 a caries of a bone, or with escharotics, and stimulating ap- 
 plications. 
 
 The fourth species of sinuses, are those where a specific 
 action exists,* and prevents the healthy ulcerative action 
 from forming. Of this kind is the scrophulous sinus, which 
 is generally accompanied with a caries bone, or diseased 
 cartilage, and, therefore, is a complicated sinus.f This is 
 distinguished, where the bone is diseased, by a shining or 
 polished red skin, like a cicatrix, surrounding the fungus 
 papilla at the orifice of the sinus, or the scrophulous-looking 
 sore which exists there. When no caries bone exists, we 
 
 * These sinuses cannot be considered in this dissertation, 
 f This may sometimes be produced by the formation of an abscess, without any 
 evident cause; but at other times it is produced by wounds, &c. in schrophulous 
 
 habits.- 
 
$0 
 
 have no papilla, but only the diseased ulcer at the orifice. 
 In both cases, there are generally the marks of a scrophulous 
 habit. In the first case, Ave are to treat the sinus as if it 
 were of the third species. In the second case, we are to 
 treat it as if of the second, conjoining the proper remedies 
 internally, as will be mentioned in considering the cure of 
 scrophulous action. These sinuses, although healed, have a 
 tendency to break out again, especially in the spring or sum- 
 mer. 
 
 The effects of the suppurative action upon the constitu- 
 tion, may be divided into those which are dependent upon 
 the formation of the action, such as coldness, listlessness, 
 .^c. which are common to all new actions ; and those which 
 are peculiar to the action when fully formed. The first set 
 requires no particular treatment, with an immediate refer- 
 ence to their removal ; but their presence indicates the ne- 
 cessity of changing our method of cure, if we have not alrea- 
 dy done so. In conjunction with proper local applications, 
 we must give light nourishing diet, with or without wine, ac- 
 cording to the extent of the action and the weakness of the 
 patient. Rest, and general warmth, are also necessary ; 
 but the heat ought not to be carried so far as to produce any 
 considerable sensation, or sweating. Diaphoretics have been 
 recommended ;* but there does not appear to be any neces- 
 sity for their exhibition ; because the coldness, . and other 
 symptoms winch we intend to relieve, depend upon the state 
 of the local action, and are only to be removed by fully 
 forming this action. Heat will not cure this coldness, or 
 shivering, when the action which causes it is extensive ; but, 
 on the contrary, will frequently increase it, by accelerating 
 
 : Mr. Hunter supposes that these are useful, " because the)' endeavour to kee,i 
 up an universal harmony, by patting the skin in <rood humour, which quiets every 
 v mpathising part, and by counteracting the effects of irritabi!iiy." P. 281. 
 
51 
 
 the formative process. The immediate effects, then, or the 
 primary symptoms of suppuration, require no particular 
 treatment, with a view to their own removal, but are to be 
 attended to as marks which point out the necessity of a 
 change of treatment, with a view to keep up the action which 
 induces them, and to prevent it from producing bad conse- 
 quences afterwards to the constitution. Sometimes, indeed, 
 in delicate people, suppuration at this period produces hys- 
 terical symptoms, such as languor, flatulence, or sometimes 
 starting, tremors, and hysteric paroxysms, more or less dis- 
 tinct. The slighter affections of this kind may be frequently 
 removed by a little warm wine and water ; the more severe, 
 by anodynes, conjoined with aromatic waters. 
 
 The second set of symptoms, or effects, are those which 
 have been already described under the name of hectic, the 
 production of which has formerly been explained. This ac- 
 tion, when slight, has been called weakness, and has been 
 considered as dependent upon the quantity of the discharge; 
 but, for the reasons formerly mentioned, this cannot be ad- 
 mitted. The cure of this state is to be attempted, by les- 
 sening the local action, at the same time that we give soups, 
 and other articles of nourishing diet, with a moderate pro- 
 portion of wine, if this do not quicken the pulse, &nd pro- 
 duce heat of the skin. Anodynes in the evening, by procur- 
 ing rest, will also be useful ; but none of these remedies will 
 produce their proper effect, unless the patient respire a pure 
 air. Bark is considered as useful in these case? ; but, unless 
 good diet be conjoined, it is not of much benefit. If, how- 
 ever, we give the means of increasing the quantity of vital 
 power, bark, by inducing an action more nearly resembling 
 the natural one, will be serviceable; but, fur this purpose, 
 it must be exhibited in full doses. It is from giving this me- 
 dicine too sparingly, and in cases wher<; other caused, tend- 
 ing to counteract its effects, such as poor diet, bad air, &c- 
 
 ror. n. g 
 
52 
 
 are allowed to remain and operate, that bark has been brought 
 into disrepute. 
 
 When the general action is very considerable, then the 
 exquisite hectic is induced, and the situation of the patient 
 becomes alarming. When the local action is simply the sup- 
 purative or ulcerative action, we may consider that the ge- 
 neral disease is also simple, and are to attempt the cure by 
 the remedies which have been just now mentioned. In con- 
 junction with such local applications as tend to check the 
 local action, we must have recourse to all those means which 
 tend to strengthen or renew the natural action of the system 
 in general ; for which purpose, we must attend, in the first 
 place, to all the particular functions, or individual parts ; and, 
 in the second, to the whole in the aggregate. Under the se- 
 cond head are included bark and wine, with moderate exer- 
 cise,* and proper diet ; in the choice of which, we must be 
 directed by the nourishment which is yielded, and by the 
 capability of digesting the articles which we employ. In 
 general, milk, soups, and jellies, answer best. Under the 
 first head are included such remedies as tend to promote 
 digestion, such as steel, bitters, mineral acids, &c. although 
 in general the bark will supersede their use. The state ot 
 the bowels must also be attended to, avoiding costiveness on 
 the one hand, and diarrhoea on the other. The secretion of 
 the skin must also be regulated, stopping the colliquative 
 sweating, if possible, by getting up for some time when it. 
 Commences. f Lessening the quantity of bed-clothes, for a 
 few minutes, will also sometimes interrupt it ; but when it 
 
 * Exercise may be used either on foot, or on horseback, or in a carriage; and 
 its degree must be regulated by the strength. There are few patients who cannot 
 boar moderate exercise (were it no more than walking half a minute in a garden,) 
 and who will not be the better of this. 
 
 f Acids are supposed to check it; but {hey can only act by increasing the 
 strength in a secondary way. 
 
53 
 
 has continued long, it can only be checked by removing the 
 diseased action.* A full dose of the bark given before the 
 accession of the sweat, may sometimes, by influencing the 
 morbid action, prevent the discharge. The respiration must 
 in particular be attended to ; for, by breathing country and 
 pure air, the action of respiration is more fully performed, 
 and, consequently, the source of vitality is increased, and the 
 effects of our other remedies are increased. The impor- 
 tance of a change of air can only be known by those who 
 have observed how fast patients have recovered from opera- 
 tions when removed to the country, and clean lodgings, with 
 well-aired beds, although before this they were daily sinking. 
 Indeed no capital operation, which is likely to induce the 
 suppurative action, ought to be performed, where cleanliness, 
 and a free circulation of air, free from fetor, cannot be pro- 
 cured. 
 
 It is not yet discovered that any remedy has a specific 
 power of removing the hectic, or diseased formative action, 
 more than the local purulent one ;f and, therefore, we are 
 obliged solely to trust to these already mentioned, which 
 have a natural tendency to increase the healthy action, or 
 induce one nearly similar to it, and especially to a proper 
 local treatment, by which we remove the exciting cause. 
 
 When these remedies fail, and the disease seems to conti- 
 nue, or increase, in spite both of general and local remedies, 
 then we must, if it be practicable, remove the diseased part 
 by an operation ; and, in doing so, we must remember, that 
 delay beyond a certain period is dangerous ; because the ge- 
 neral action becomes so rooted, and the strength so reduced, 
 
 * Sweating is perhaps to the general hectic action what the suppuration is to 
 the local one; and, therefore, can only be stopped by influencing this action. 
 
 t A diet solely animal lias been proposed in that peculiar species of hectic which 
 Accompanies diabetes ; but whetta/ it would be equally useful ia other species ie- 
 ;iiaios to bn determined. 
 
54 
 
 that recovery cannot take place. Operating in these cir- 
 cumstances, therefore, can only hasten death. The wound 
 will not unite nor heal, and the general action will continue 
 unabated. 
 
 When the local action is specific, the general one is also 
 different from the simple hectic ; and, therefore the reme- 
 dies which are useful in simple hectic will not be of equal 
 advantage in these cases, unless a specific remedy be con- 
 joined, as, for instance, mercury prudently exhibited in the 
 venereal hectic, dependent upon a neglected local complaint. 
 The most frequent instance of specific hectic is the scrophu- 
 Ious ; for the cure of which we possess no remedy which 
 acts with certainty. Whenever, therefore, the local com- 
 plaint cannot be cured, and the hectic increases, we must, if 
 possible, remove the diseased part ;* after which, the gene- 
 ral action, notwithstanding its specific nature, most commonly 
 declines ; but the constitution still remains, as formerly, 
 scrophulous, or even more so than before. That this is the 
 case, would appear from the following fact : If a person 
 slightly scrophulous, although originally sprung from a scro- 
 phulous stock, or in whom the constitutional disease seems 
 to be disappearing, in consequence of intermarriages, &c. 
 has, by means of a local injury done to a joint, Sec. the scro- 
 phulous action excited, and consequent hectic, that person 
 will, after cure, have the tendency to scrophula stronger in 
 him than formerly; and the disease will even frequently be 
 communicated to his children with its original violence. 
 
 * When this disease attacks the lungs, as it too frequently does, then, until a 
 specific remedy for scrophula be discovered, no cure can be obtained. Simple ulce- 
 ration, or suppuration of the lungs, however, and consequent hectic, may be cured, 
 though not in every instance. 
 
DO 
 
 Of the Treatment of the Ulcerative Action. 
 
 Suppuration is a natural termination of inflammation; 
 and the ulcerative action is invariably induced by the sup- 
 purative, unless this remain chronic. The ulcerative action 
 is to be considered as in part a restoration of the natural one ; 
 for we find that it produces a restoration of the structure, 
 granulations being formed by the vessels which formerly sup- 
 plied the organic particles, whilst the interstitial vessels still 
 yield a morbid fluid, called pus ; but this they cease to do, 
 whenever they again are placed in the natural situation ; that 
 is to say, whenever they become covered with the granula- 
 tions, or are rendered interstitial. In proportion, then, as 
 granulations are formed, a certain number of vessels are ren- 
 dered interstitial, so that the discharge gradually diminishes, 
 until at last it ceases ; for, when we come to the formation 
 of a cuticle, we have very few interstitial vessels left, the 
 skin having naturally few. At this time, the one set of ves- 
 sels having completed their action, and the part being re- 
 stored, the other also resume their action, and a thin exhalent 
 fluid is thrown out by the new cuticle, which keeps it soft 
 and moist, and which is the natural insensible perspiration. 
 The action of the two sets of vessels, then, is dependent on 
 each other ; and, whenever one is diseased, the other be- 
 comes also more or less so. 
 
 GENUS I. 
 
 Of the Healthy Ulcer. 
 
 From these remarks, as well as from those which were 
 formerly made, it will appear, that a healthy ulcer Iras a na> 
 
56 
 
 Jural tendency to heal, and that we ought only to be care- 
 ful not to interrupt the natural progress, nor allow the action 
 to flag. 
 
 In this genus of ulcers, the bottom of the sore seems to 
 be paved with a number of small fleshy points, with minute 
 interstices betwixt them, or surrounding their bases. These 
 are of a red colour, with a slight shade of the purple, and 
 are wet with a yellowish fluid, which is called pus ; but 
 which must of necessity differ from the fluid yielded by 
 suppuration. This separates freely from the surface, when 
 it is wiped or touched with a sponge, and then the granula- 
 tions may be distinctly observed.*" The margins are 
 smooth, thin, and a very little rounded, that is to say, are al- 
 most imperceptibly raised above the granulations, a circum- 
 stance which is essential to this ulcer, because, were they 
 both on the same level, it would show, that the cicatrizing 
 process did not go on properly ; for, whenever the granula- 
 tions rise to the level of the surface, they ought instantly to 
 form skin. This cicatrix, which extends gradually from the 
 circumference to the centre, is of a pale red colour ; but 
 the integuments immediately beyond it are white, and of the 
 natural appearance. Sometimes, from a slight deviation or 
 imperfection, one spot of the disk rises to the level sooner 
 than the rest ; but, in this case, it immediately skins, and 
 the cicatrix extends from this in the same way as from the 
 circumference, until they both meet. The sore is free from 
 pain, the only sensation being a slight degree of smarting, or 
 itchiness. 
 
 The treatment of this ulcer is very simple ; for, in most 
 cases, it is only essentially necessary that we prevent the 
 operation of hurtful causes. We defend the part, by cover- 
 
 * Whenever the discharge does not separate completely from the surface, wheu 
 it is wiped, but part of it remains lite a film, or jelly, betwixt the granulation", 
 or on particular spot?, we may be sure that the action is not healthy. 
 
57 
 
 ing it with a soft pledget of lint, and keep it warm. When 
 the cicatrization has commenced, it may be assisted by using 
 an ointment containing any harmless powder, in such a pro- 
 portion as to form a paste or scab upon the part,* by which 
 we afford an artificial covering, which remains in close con- 
 tact with the granulations ; and, by thus bringing them 
 nearly into the same circumstances as when skin is formed, 
 the cicatrizing action is accelerated. The same effect is 
 sometimes produced, by allowing the pus to form a scab over 
 superficial sores, by exposing them to the air, without any 
 covering. 
 
 Dry lint is a very useful application ; but, as it is apt to 
 stick to the granulations, and tear them, when tender, it 
 ought always to be well moistened before removal, which 
 should be attempted slowly. 
 
 Mild ointments, such as the simple cerate, are frequently 
 employed ; but they must be free from all rancidity, other- 
 wise they fret the skin, or injure the sore. In general, they 
 are less useful than dry lint. When we do employ them, 
 they ought to be applied only to the granulations and cica- 
 trix; and not to the sound skin. More frequently we use 
 these ointments spread on a pledget of linen, to keep the 
 dry lint on the sore. 
 
 Poultices are also recommended in these cases ; but they 
 possess no peculiar advantage, and are apt to make the part 
 feeble, and more likely to break out asain. 
 
 Moderate pressure, by keeping up the action, is generally 
 of service; but it is still more necessary when the action 
 begins to flag, or becomes stationary. In this case, a com- 
 press ought to be placed over the sore, and the whole ;m m- 
 
 * Simple ointment, rubbsd up with a fourth part, of its weight of finely le- 
 vigated calamine, or flowers of zinc, makes a useful application. Mr. Bell re 
 commends, among other remedies, a saturnine ointment; b:it, if this produces 
 any specific operation, it must be a hurtful one. injuring the action 
 
38 
 
 ber rolled firmly round with a cotton bandage; or, what will 
 be still more useful, the part should be encircled with strips, 
 spread with adhesive plaster, in the way which will after- 
 wards be mentioned. Pressure acts by taking away the 
 condition of vacuity ; it forms an artificial covering and in- 
 terstices for the superficial granulations, by which the natu- 
 rar process of forming granulations and skin is greatly assist- 
 ed. The parts are, in this way, not only more quickly 
 formed, but also in greater perfection ; and their powers of 
 action are greater. The cure is therefore more permanent, 
 and the part is not so apt to die, or ulcerate again, as when 
 healed with simple dressings. 
 
 This practice, which is useful in ulcers which from the 
 first are healthy, is still more necessary in curing those which 
 were formerly diseased, but have now become healthy ; be- 
 cause, in them, the action is still more apt to flag. 
 
 The healing of large healthy ulcers which succeed to 
 wounds, &c. will also be much hastened, if we artificially di- 
 minish the size of the cavity, and procure contact. When- 
 ever one part can be brought in contact with another, it 
 ought to be done, if Ihe figure and functions of the part- be 
 not thereby injured, or if pain be not produced by doing so. 
 
 The older authors, from a mistaken theory, never allowed 
 the action to proceed uninterrupted, or never co operated 
 with it in a rational manner. In every ulcer, it was neces- 
 sary, first, to digest, or suppurate it, which was done with 
 turpentine, or basilicon ; next it was to be deterged with tur- 
 pentine, mixed with yolk of eggs, or by the red precipitate ; 
 then it was to be incarned by sarcotics, such as tincture of 
 myrrh and aloes, balsam of Peru, frankincense, &c. ; lastly, 
 the surface was to be dried into a callus, with dragon's blood, 
 white-lead, chalk, &c. These plans have, however, been 
 long laid aside ; but some practitioners still advise the use of 
 styptics and spirit of wine to produce a cicatrix ; they for- 
 
59 
 
 get, however, that skin is formed by a different process than 
 corrugation. 
 
 The diet ought to be good, in all cases of ulcers ; but 
 spirituous liquors, and the irregularities of life, must be 
 avoided. 
 
 In ulcers of the legs, if pressure be employed, rest is not 
 absolutely requisite ; but, if this be not used, no cure can be 
 obtained, if the patient walk about. Even if the adhesive 
 plaster be applied, Ave ought not to allow of so much motion 
 as to produce fatigue, or any uneasiness in the sore. 
 
 The treatment, then, of this genus of ulcers, may be com- 
 prised in two aphorisms. 
 
 First. When the action is, from the first, healthy and vi- 
 gorous, and is continuing so, all which is essentially neces- 
 sary, is to defend the part, and prevent the operation of any 
 cause which might injure the action, such as cold, too much 
 heat, mechanical irritation, &c. This may be done, by ap- 
 plying a bit of dry lint, or a rag spread with simple ointment, 
 and wrapping the limb round with a flannel roller. But, if the 
 action begins to flag, as it often does in large ulcers, or if the 
 process become stationary, we must then indispensably have 
 recourse to gentle pressure. 
 
 Second. When the action has, at any one period, been 
 diseased, or too low, but has been restored to a proper state* 
 we must of necessity continue gentle pressure, and treat the 
 sore as if the action were stationary, although it may not be 
 so. 
 
 VOL. II. 
 
m 
 
 GENUS II 
 Of the Indolent Ulcer. 
 
 In this genus, the action is diminished, and, consequently, 
 rendered imperfect and diseased. 
 
 Indolent ulcers, like those of the next genus, are divisible 
 nito two species : First, that in which both parts of the ul- 
 cerative action, namely, the granulating and purulent, are 
 equally diseased, and equally imperfectly performed : Se- 
 cond, that in which one part is more affected than another.* 
 
 The first species is distinguished by the following symp- 
 toms, which appear in greater or less degrees, according to 
 the diminution and imperfection of the action. 
 
 The granulations are pale and imperfectly formed, par- 
 taking less of the firmness and organization of the healthy 
 Qeshy granulations in proportion to the affection of the ac- 
 tion. They are obtuse, and scarcely at all elevated ; and, 
 therefore the surface loses its dotted, or red pointed appear- 
 ance. The discharge is thin, and of a whitish colour, at the 
 same time that we frequently observe isolated spots of lymph 
 interwoven here and there with the imperfect granulations. 
 Although these granulations are said not to be elevated, yet 
 the surface often exhibits a species of fungus ; but the indi- 
 vidual granulations are not elevated, or pointed. This fun- 
 gus never rises higher than the twentieth part of an inch 
 above the level of the surrounding skin,f and often appears 
 
 * The circumstance of one part of an ulcer being more affected than another,. 
 will be more fully noticed in considering the next genus, in which it is of more 
 practical consequence. Ulcers generally belong to this species, before they as- 
 sume the characters of the second (for they frequently change from one species, or 
 genus to another; in which case, the treatment must also be changed.) 
 
 f The cause why these granulations rise, even this trifling height, above the 
 level of the skin, is the indolence of the action, which prevents a cuticlefrom.be 
 ing formed in due time- 
 
(51 
 
 m\\y at particular parts of the surface. It is pale, and seme 
 what of a gelatinous appearance. The pain is trifling. 
 
 In more advanced cases, the whole disk is covered with a 
 thin layer of lymphatic substance, which adheres firmly, and 
 gives the idea of a thin pellicle being thrown over the granu- 
 lations, which are seen imperfectly and irregularly through 
 it. The discharge is generally thin, like serum, and con- 
 siderable.* The edges are hard and tumefied, sometimes 
 of a light purple colour, at other times white.f The sur- 
 rounding integuments are also hard and thickened, at least 
 in old ulcers, and the veins are generally more or less vari- 
 cose. 
 
 These appearances vary in -degree from the soft pale sur 
 face, and thin whitish purulent discharge, with slightly thick 
 €ned edges, to the state now described. The pain, when 
 compared to the size of the ulcer, is not considerable. 
 
 This genus may occur, in a slight degree, in recent sores. 
 from neglect, &c. ; but it is chiefly after ulcers have been 
 of long standing, that they assume these appearances in the 
 greatest degree. They may then be said to have become 
 chronic or habitual ; and, in many instances, it is absolutely 
 impossible to restore the action to its natural state, and pro- 
 duce recovery. J 
 
 The second species is distinguished by the paleness and 
 imperfection of the granulations, whilst the discharge is tol- 
 erably good ; but it never can be equal to that of the healthy 
 
 * Indolence of the action does not imply that the quantity of a discharge should 
 be lessened, but only that its nature should be changed. In this species, the dis- 
 charge is much the same in quantity as in a healthy ulcer of the same size, but its 
 perfection is greatly less. 
 
 t Sometimes the granulating action and the cicatrizing one seem to be con- 
 founded, the surface exhibiting a fibrous fleshy appearance. This I have seen moSL 
 frequently in the calf of the leg ; but it may occur in other parts. 
 
 \ These ulcers, after long continuance, frequently induce a disease in the boner 
 or mnscles seated below them, as will afterwards be mentioned, 
 
62 
 
 ulcer ; because, when one part of the action is affected, the 
 other is also more or less affected. This species does not 
 require any more particular observation or mark, because it 
 is to be treated exactly as the first, of which it is often just 
 a slighter degree, or a forerunner ; for it is frequently the 
 first change which takes place in a healthy ulcer. When it 
 becomes diseased, it does not continue long ; for both parts 
 soon come to suffer in the same proportion ; in which case, 
 the ulcer belongs to the first species. For this reason, we 
 never find old ulcers belonging to this species. 
 
 Chronic ulcers sometimes induce a disease of the bones, 
 &c. below ; but, in this case, they generally are converted 
 into a different genus. They also come naturally, in conse- 
 quence of the great imperfection of their action, and the con- 
 sequent want of power, to act beyond the due proportion 
 betwixt action and power; and, therefore, most ulcers of 
 this genus come at last, if neglected, to belong to the next. 
 
 The most effectual remedy for these ulcers is pressure. 
 This has been long employed, by means of tight rollers 
 wound round the limb, or by the laced stocking. But, of 
 late, a more effectual method has been proposed, namely, a 
 bandage of adhesive plaster, which applies itself closely to 
 the surface, and produces a state of artificial contact and co- 
 vering. This has been recommended by Dr. Darwin in the 
 form of a many-tailed bandage, and by Mr. Baynton in the 
 form of strips, wrapped round the limb. The following is 
 the method of applying them : A strip of adhesive plaster, 
 about an inch broad, and so long as to encircle the limb and 
 cross at each end, is to be warmed, and the middle of it ap- 
 plied to that part of the limb which is exactly opposite to 
 the sore ; both ends are now to be brought forward, and one 
 of them laid tightly over the under part of the sore (if it be 
 so large as not to be covered with one strip,) whilst the other 
 is brought firmly over this from the opposite side, and dou-^ 
 
63 
 
 bled down upon it. The ends of the strip thus fold over 
 each other at the ulcer. Another strip is then to be applied 
 to the part of the sore contiguous to this which is not yet 
 covered, and so on in succession, until the whole be cover- 
 ed. This is the best way of applying the strips, if the in- 
 teguments be firm ; but, if they be loose and yielding, it will 
 be useful to push forward the loose skin from behind, with 
 the strips, as we bring them forward ; and, instead of laying 
 down first one end, and then the other over it, make the two 
 ends cross each other at the same time, and lay them down 
 upon the skin, and not on each other, the under end covering 
 the lower part of the sore, and the upper the part next it. 
 The same strip, therefore, covers two portions of the surface, 
 whereas, in the first way, it covered only one ; but, in this 
 case, the strip must be longer, as it must fairly cross the 
 ulcer on each side, and be retained by sticking to the adja- 
 cent skin. When the ulcer is deep, the strip will press on- 
 ly on the margins ; and, therefore, it will be useful to fill up 
 the surface with a fold of soft lint. A thin cotton roller is 
 now to be wound firmly round the limb, begining at the ex- 
 tremity, and continuing the bandage to the next joint above 
 the sore. 
 
 By this contrivance, we obtain a firm covering to the 
 granulations, and bring a substance in contact with each 
 individual. We then restore, as it were, the natural state 
 of the parts, each granulation having a substance in contact 
 with it ; and a slight interstice is left between each, owing 
 to their pointed structure. They become, therefore, similar, 
 in this respect, to the organic particles of internal parts ; on 
 which account, healing goes on more quickly, and the or- 
 ganic particles, or granulations, are deposited in greater per- 
 fection, and with greater powers of action ; for the unusual 
 and morbid condition of exposure and want of contact is 
 now removed. The same circumstances promote cicatriza- 
 
64 
 
 tion, when the "granulations have risen to a proper height. 
 This is more evidently seen in the cure which is effected of 
 the smaller ulcers, by dusting them with chalk, &c. or dress- 
 ing them with an ointment made thick with some mild pow- 
 der, by which a scab, or covering, is formed, which operates 
 clearly independent of pressure. Pressure, applied with 
 this view, ought to be moderate and permanent, and may be 
 used with utility in almost every case of solution of continui- 
 ty, however healthy the action may be. But, besides being 
 of use in this way, pressure also produces a second set of ef- 
 fects, by mechanically exciting action in the part to which 
 it is applied. Applied to the skin, it increases the cuticular 
 action, and the skin is formed thicker. Applied to a weak- 
 ened part, it increases the natural action of that part, and 
 strengthens it : This is seen in the instance of debilitated 
 muscles, &c. But, if the pressure be loo great, then a mor- 
 bid increase of action takes place, which even goes the 
 length of inflammation, if the pressure be considerable ; and 
 this inflammation is either strong or weak, according as the 
 pressure has operated ; for, if many vessels be obstructed, 
 as is commonly the case, then the power of the part is in- 
 jured, and the action is weak ; or, the same happens if pres- 
 sure be applied in any manner to a weak part, or if the con- 
 stitution be weak ; as, for instance, from previous disease. 
 
 Pressure, applied to a part, increases in particular the 
 functions of absorption and deposition. If moderate, these 
 functions are moderately increased, and the structure of the 
 part continues either the same, or it augments in size, as we 
 observe, in the effects of walking, on the skin of the feet ; 
 hut, if the pressure be greater, then these functions are mor- 
 bidly increased, the particles are deposited imperfectly 
 formed, and are as quickly taken up. The structure is there- 
 fore destroyed, and a vacuity formed. These effects are 
 produced more easily upon diseased than healthy structures : 
 
65 
 
 because their powers of acting, and sustaining action, are 
 Jess- Friction is in this respect similar to pressure. 
 
 From these remarks, we may understand the mechanical 
 utility of pressure in the cure of ulcers ; for, when in a pro- 
 per degree, it causes the absorption and destruction of the 
 callous edges, or diseased substance, and likewise makes, if 
 moderate, the diseased granulations be taken up, and more 
 healthy ones be formed. We may likewise perceive, that, 
 if the degree be too great, the action will become of an in- 
 flammatory nature, and injury will be done. We are there- 
 fore frequently under the necessity of counteracting this 
 hurtful effect ; for, the degree of pressure which is requisite 
 for answering the first intention in old sores, or inducing ac- 
 tion, in consequence of bringing the granulations or particles 
 into the natural state of being in contact with some body, or 
 covered by it,* is often attended with such mechanical irri- 
 tation, that the one effect would destroy the other, unless we 
 kept the action within due bounds, by applying cold to the 
 part. In healthy ulcers, the pressure necessary to produce 
 its first set of effects, or to accelerate healing, by producing 
 contact, is so trifling, that no counteracting effect takes 
 place by the production of the second set of effects ; and, 
 therefore, no cold requires to be applied : But, in old ulcers, 
 the pressure must be greater ; and, therefore, cold water 
 
 * The degree of pressure necessary for producing this effect is proportioned t« 
 the susceptibility of the granulations, or organic particles, for receiving the im- 
 pression of being in contact. When a part is healthy, the mere circumstance 
 of juxtaposition is sufficient for this purpose ; and, in a healthy ulcer, the weight 
 ©f the body applied, such as powdered chalk, or plaster of Paris, or at least the 
 gentle pressure of a stocking, or easy bandage, is all that is necessary. But, when 
 the action is too low, and the granulations are consequently imperfect, both in 
 their structure, power of acting, and capability of receiving impressions, the con- 
 tact, in order to operate, must be nearer, and more complete ; or, in other words, 
 the pressure must be greater. In these cases, bandages not only act on the sur- 
 face, but also on the parts below, and, therefore, increase the degree of contact 
 «f the newly-formed, organic particles, and thus strengthen the part, 
 
66 
 
 must be constantly applied to the bandage orer the sore, by 
 means of a sponge. We thus indeed lessen the effects of 
 pressure on the absorbing system, and, therefore, the callus 
 will be longer of being destroyed ; but we, on the other hand, 
 prevent the action of the granulations from being rendered 
 morbid. 
 
 The good effects of pressure, applied in a degree propor- 
 tioned to the effect which we wish to produce, and to the 
 state of the sore, are so universal, that it is unnecessary to 
 give any examples of its success and utility. But, at the 
 same time, it must be observed, that in old ulcers, and even 
 in many of a more recent date, which have been much neg- 
 lected, no application whatever will produce an uninterrupt- 
 ed cure ; for, after some time, it ceases to produce the same 
 effect upon the action. The part seems, by continuance, to 
 be less acted on by the agent ; the action is less affected, 
 and slowly returns to its former state of imperfection. It is 
 therefore necessary, either that we from time to time increase 
 the power of our application, or vary our remedies, when- 
 ever the process becomes stationary. The latter is general- 
 ly the most effectual way ; and the remedies which we al- 
 ternate with the effects of pressure, are those of what have 
 been called the stimulating kind ; but which of the indivi- 
 duals of this division ought to be employed, cannot always 
 be determined, because one succeeds better in a particular 
 instance than in another. It would, however, be of much 
 importance, to ascertain which in general operated most ef- 
 fectually ; because, if we employ one which does no positive 
 good, we sustain positive harm ; for the action is allowed to 
 persevere in a retrograde process. I, therefore, paid parti 
 cular attention to the operation of these applications, in the 
 patients who were under my care in the Glasgow Infirmary. 
 
 Heat is found to increase almost every action ; and, there- 
 fore, in indolent ulcers, it is sometimes of use, especially for a 
 
67 
 
 days after we begin the management of the sore, as it paves 
 the way for the action of other agents, by beginning a change 
 of the action. Poultices are the vehicle by which it is most 
 frequently applied, and answers, in general, better than other 
 forms. Fomentations are much used by many practitioners, 
 who employ decoctions of different kinds of vegetables ; but 
 they have no superiority over poultices. Dry heat was 
 used by M. Hevin, who held ignited charcoal near the sore ; 
 and it is sometimes of use to repeat this practice betwixt each 
 dressing. 
 
 Electricity is of little service ; because it cannot be con- 
 stantly employed ; and, therefore, its operation is only tem- 
 porary. 
 
 It is worthy of observation, that although this kind of ulcer 
 may be sometimes completely cured by the use of heat, that 
 yet the action is not so perfect, and consequently the struc- 
 ture and power of the part is weaker, than when stimulating 
 dressings are employed. Exercise, or any other cause, is 
 therefore more apt to injure the part afterwards, and make it. 
 again break out into an ulcer. 
 
 The red precipitate, mixed with resinous ointment, in the 
 proportion of a drachm of the former to an ounce of the lat- 
 ter, is a very useful dressing ; but the ung. hyd. nit. mixed 
 with four times its weight of hog's lard, forms an ointment 
 which is still more generally useful. 
 
 Ten grains of the cuprum ammoniatum, rubbed up with 
 an ounce of basilicon, or simple ointment, is sometimes use- 
 ful, but cannot be depended on. The same may be said of 
 an ointment composed of an ounce of ung. simplex, and ten 
 drops of the oil of cloves, or of savin. 
 
 Cloths dipped in the aqua zinci vitriolati, or the solution 
 of cuprum vitriolatum, diluted with water, so as only to smart 
 moderately, are likewise of service, but not so frequently as 
 weak solution* of the nitrates of silver, zinc, copper, bis- 
 
 VOL. II. I 
 
(53 
 
 muth, and many other metallic salts, such as muriate of mer- 
 cury, &c. 
 
 Solution of common salt, or of nitre, of such a strength as 
 to produce a moderate smarting, are of temporary advantage, 
 but will not continue their effect long. Indeed, all solutions 
 of saline substances, whether alkaline or metallic, are most 
 useful when applied only for half an hour at a time, when the 
 sore is dressing. 
 
 Mixtures of Thus, elemi, turpentine, canadine balsam, 
 &c. with wax, or oil, have no advantage over the common 
 ung. resinosum.* 
 
 The bile, either by itself, or diluted, or mixed with yolk of 
 eggs, does not seem to be of much service. 
 
 Lemon' juice, or the mineral acids, particularly the nitrous, 
 diluted so as to be of equal strength with the juice, are fre- 
 quently of service.f Port wine is also an useful lotion. 
 
 Infusion of Cayenne pepper, in vinegar, added to water, in 
 such a quantity as to smart, forms also a very useful appli- 
 cation. 
 
 Of all these remedies, the ointments composed of the 
 nitro-metallic salts, particularly the mercurial, are most gene- 
 rally useful : And the cure seems to be accelerated, by ap- 
 plying cloths dipped in weak solution of metallic salts, or 
 weak acids, during the intervals of dressing. Whenever 
 these applications fail, they must be dropped : And those 
 which fail first, and soonest, seem to be the watery, or fluid 
 applications ; and, next to these, the simple resinous oint- 
 ments. 
 
 * An ointment composed of these resinous substances is much recommended in the 
 Acta Med. Berolrn. Tom. VII. p. 58. 
 
 f These acids coagulate the pus, and thus afford an artificial covering, or film, 
 which remains in close contact with the granulations, and thus, by producing the 
 natural circumstance of contact and covering, the effects of which hare been al- 
 ready mentioned, as well as by creating a more vigorous action by their specific 
 action, they frequently briDg those sores into a healthy state. 
 
69 
 
 These remedies generally produce their effect first at the 
 margins. When this takes place we must diminish the strength 
 of the application at that part, in proportion to the activity 
 of the action, which is marked by the redness and pointed- 
 ness of the granulation, and the cicatrizing state. The cir- 
 cumference, and the rest of the surface, must, in this case, be 
 dressed with different strips of linen, spread with different 
 ointments. Soft linen, spread with simple cerate, or dry 
 lint, which is preferable, should be applied to the cicatrix, 
 and cicatrizing granulations, whilst a stimulating substance. 
 is applying to the rest of the surface. 
 
 When the surface is obstinately diseased, or the action 
 very torpid and imperfect, caustic has been applied ; but, al- 
 though I have often used it, and even applied cloths dipped 
 in solutions of metallic salts, so strong as to form an universal 
 eschar, or slough, yet no benefit whatever was derived ; for 
 we do not thus change the nature of the action, but only re- 
 move a layer of the surface, and leave that below in possession 
 of the same mode of action with the former. Caustic is more 
 useful, when applied to callus edges ; but even these are more 
 effectually removed, by remedies which act more permanent- 
 ly, and gradually, particularly by pressure. The ancients 
 used to extirpate these with the knife, but few will consent 
 to its use. It is indeed more speedy and effectual than the 
 caustic ; but, unless the action be afterwards properly sup- 
 ported, it will be of no permanent service- 
 
 The hard and thickened state of the surrounding integu- 
 ments, in old ulcers, is best moderated by pressure ; but thi* 
 must be long continued. 
 
 Varicose veins were, by the ancients, considered as canals 
 running into the sore, and furnishing the discharge ; but, 
 when we consider that these varices frequently occur with- 
 out any ulceration, or discharge, the opinion must be aban- 
 doned. In such cases as occur along with ulceration, it witi 
 
70 
 
 be more natural to consider the affection of the vein as & 
 disease dependent originally on the ulcer, and induced by it, 
 in the same way as the structure and functions of other 
 neighbouring parts are changed and impaired by the con- 
 tinuance of a tedious aud diseased ulcerative action. This 
 state of the vein being once induced in any part of it, and 
 even in a slight degree, two consequences follow : First, 
 from the power or property of the vein being impaired, the 
 blood is not duly propelled, but circulates slowly, and can- 
 not overcome readily the weight of the blood above, which 
 presses more powerfully, in consequence of the valves being 
 rendered imperfect by the distension of the vessel. The 
 disease, therefore, gradually increases ; for, every day, the 
 power of acting properly diminishes, at the same time that 
 the mechanical necessity for acting, or the resistance of the 
 column of blood increases. On account of the dilatation of 
 the vessels, and the morbid or abortive effect to propel what 
 they are unable to do, pain is produced, in the course of the 
 varix, whenever the legs are kept in a dependent posture, or 
 exercise is used. This pain is confounded with the uneasi- 
 ness arisiug from the ulcer ; and, therefore, these ulcers are 
 said to be painful, and to be attended with pain in the course 
 of the veins. 
 
 The second consequence is, that, as the veins which are 
 more immediately connected with the ulcerated part, are 
 diseased, and do not perform their part in the circulation 
 properly, the functions of the part must be still more injured, 
 and the varix, which originally perhaps was produced by the 
 ulcer, comes in its turn to act on the sore, and prevent its 
 healing; for the vein not acting properly, and conveying the 
 blood fully, the action at the capillaries must be injured, and 
 the artery and vein cannot act healthily. If this be the 
 case, the power of forming granulations must be impeded. 
 
71 
 
 and these never can be deposited in the necessary degree 
 of perfection. 
 
 Two modes of cure have been proposed, the one pallia- 
 tive, and the other radical. The first is effected by means 
 of rollers, or bandages, which prevent the vein from being 
 distended, and, therefore, enable it the better to carry on its 
 circulatory function. In this way, we prevent, to a certain 
 degree, the hurtful operation of the vein upon the ulcer, and 
 are often enabled to heal it up. But, as we do not thus re- 
 store the vein to its natural powers, unless in young people, 
 who continue the support or pressure for years, we can oh 
 tain no permanent cure of the varix ; and very frequent ly 
 the parts again ulcerate ; because, whenever the pressure or 
 support is withdrawn, and the patient walks about, then the 
 function of the part becomes affected, the organic particles 
 are not deposited in the same state of perfection, and the ac- 
 tion which is induced by exercise, causes the destruction 
 of these granulations ; or even the very circumstance of 
 their being formed imperfectly is sufficient to produce their 
 destruction, and the opening of the part ; for all parts which 
 have been formerly ulcerated are most ready to assume this 
 action again, and the organic particles of that part are less 
 perfect, and less able to bear action. 
 
 The second is obtained, by obliterating the diseased vein, 
 or interrupting its communication with the trunk above, by 
 which wc make the blood take a different course, and l>e 
 transmitted by healthy veins. If we now cure the sore, we 
 find, that the same effects are produced as if we used per- 
 manent pressure ; and, therefore, the functions of the part 
 are more properly performed, and the organic particles pos- 
 sess greater power of acting, and sustaining action. The 
 older surgeons proposed to effect the radical cure, by tying 
 the vein at the two extremities of the diseased part, and 
 cutting out the intercepted portion, or by laying it open, and 
 
digesting it, as they said. This, however, was, as they con- 
 fess themselves, very seldom submitted to in ulcers of the 
 legs ; and was rather inserted to complete their treatises, 
 than from a belief that the operation ought to be insisted on. 
 Of late, it has been proposed by Mr. Home, to tie only the 
 upper extremity of the diseased portion,* by which adhe- 
 sion takes place at that spot, and the circulation is there 
 stopped. The pressure of the blood above is thus taken 
 off, and the blood from below must circulate, in a greater 
 degree, through vessels which are better able to perform 
 their functions ; and, therefore, the actions of the capillary 
 vessels, whether nutrition, absorption, or conversion of the 
 blood from arterial into veinous, must be more naturally per- 
 formed. After the veins are tied, they gradually become 
 smaller ; for the pressure being permanently removed, the 
 diseased veins can more fully propel their blood by lateral 
 branches, at the same time that they receive less blood, 
 more going by other vessels- 
 It is a curious circumstance, that although ulcers may 
 have remained in an indolent state for many years, and have 
 become almost habitual, that yet, the cause of the indolence 
 being removed, they recover their powers rapidly, and with 
 very little assistance. Thus, when a varix, which originally 
 was produced by the ulcer, reacts on the sore, and prevents 
 it from healing, we find, that if this cause be removed, the 
 Ulcer frequently heals quickly, owing to the sudden removal 
 of a principal cause of indolence, although a similar ulcer, 
 without varices, would not be cured by the same application 
 in the same time ; because then all the usual causes of inda- 
 
 * This operation is performed by making an incision through the skin which 
 covers the vena siphena below the knee ; a ligature is then passed under the ves- 
 sel, by me\ns of a blunt needle, and the vessel is tied. In two or three days the 
 ligature may be removed, its circle beiDg previously divided with a pair of scis- 
 tars. 
 
73 
 
 lence would still remain to be removed, or their effecfa 
 counteracted ; but, in this case, having suddenly removed 
 one great cause, the action rises so much, that it can over- 
 come the rest, although, without this alleviation, the healing 
 process would not be commenced, nor continued. It may 
 be useful to attend to this circumstance in every case of in- 
 dolent ulcers, whether attended by varices or not ; because, 
 if we can remove any particular cause, we do much toward 
 producing a cure. Thus, callus edges, and diseased, or 
 thickened integuments, &c. although originally dependent on 
 the ulcer, yet react on it, and prevent it from healing. If, 
 t^ten, by pressure, or otherwise, we remove these causes, we 
 accelerate the cure. 
 
 As an instance of the good effects of tying varices, I shall 
 transcribe the following case from Mr. Home's Observations: 
 " A man, sixty years of age, had, for many years, gained hia 
 livelihood by going on messages, having been rendered unfit 
 for any more laborious employment by a large ulcer on the 
 left leg, just above the inner ankle. The complaint was of 
 twelve years standing : It had been sometimes much better 
 than at others, but had never been well during the whole of 
 that period. In the year 1792, it became so bad as to con- 
 fine him entirely. It was at this time I first saw him. Upoii 
 examining the limb, the veins were extremely large, and vari- 
 cose ; and the trunk of the vena saphena, at the knee, ap- 
 peared almost the size of the little finger. The size of this 
 vein led me to the idea of taking it up at that part, with a 
 view of relieving the lower branches from the pressure of 
 the blood, which I believed to be the cau%e why the pari* 
 remained weak, and the ulcer could not be healed. I ex- 
 plained my opinions upon this subject to the patient, and 
 told him, that, if he thought it worth while to try it, I was 
 very ready to do it for him. The man's desire to get well 
 was such, as to induce him to embrace the offer of any mode 
 
71 
 
 of treatment which afforded the smallest chance of it. The 
 vein was taken up in the way that I have mentioned : He 
 complained of very little pain, no improper degree of in- 
 flammation was brought on by this operation, the ligature 
 came away in nine days, and in fourteen the wound was 
 healed. 
 
 " The ulcer upon the leg was dressed with dry lint ; it 
 put on a better appearance on the second day after the ope- 
 ration ; on the fourteenth it had diminished in size one half ; 
 and in twenty-eight days was completely healed. He was 
 also freed from a pain in the course of the veins of that le^, 
 to which he had been subject for many years, whenever he- 
 used any exercise. 
 
 " He returned to his business of carrying messages, and 
 called upon me a year after, perfectly well ; his leg having 
 continued sound." 
 
 Issues have been proposed for the cure of this genus ol 
 ulcers ; but, upon the principles which have been already 
 mentioned, it must be evident, that they can be of little or 
 no service ; and, I am sure, that I never saw the smallest in- 
 fluence exerted by them over an ulcer. They are useful, 
 however, after the ulcer is healed, by keeping up a secreting 
 action, diminishing the risk of apoplexy, &c. ; but then they 
 ought never to be introduced until the sore be nearly healed, 
 or until we have reason to suppose that the sore will heal, 
 and that they will be required. 
 
 The treatment of this genus of ulcers may be comprised 
 In the following aphorisms : 
 
 First. When the action of an ulcer becomes too low and 
 imperfect, pressure is the best remedy for restoring it to its 
 proper state, and for accelerating the cure. 
 
 Second. Whenever this ceases to produce any farther ef- 
 fect, or the action relapses, and begins to go backward, we 
 must lay aside the pressure for a time, and dress the sor^ 
 
• 75 
 
 with some of the stimulating applications above mentioned, 
 particularly the nitro-mercurial salts; and these, in their 
 turn, must be laid aside, when they cease to produce a good 
 effect, and the pressure be again had recourse to. 
 
 Third. When we use stimulating dressings, we must at- 
 tend to the effects which they produce on different parts of 
 the sore, and dress these differently, according to their con- 
 dition. We must likewise proportion the strength of appli- 
 cation to the state of the general action. Our remedies ought 
 to smart most when the action is most torpid, and the smart- 
 ing ought to continue longest ; but, when the action has be- 
 gun to be more perfect and vigorous, the same application 
 will often be too strong. 
 
 Fourth. We must, in conjunction with this general plan, 
 attend to particular morbid structures, which may be pro- 
 duced by the particular state of the ulcer, and which may re- 
 act on it. The chronic thickness and hardness of the integu- 
 ments, are best removed by pressure, and gentle frictions ; 
 but the restoration of the natural structure is very tedious. 
 Callous edges are likewise best removed by pressure. When 
 this fails, caustic must be repeatedly applied. Varicose 
 veins may be palliated by firm bandages, but are, in general 
 after they have continued long, only to be cured by an ope- 
 ration. 
 
 Fifth. When chronic ulcers can be healed, it is useful to 
 form an issue, in order to keep up the accustomed secretory 
 action; but these issues have little effect in advancing the 
 cure. 
 
 vol. it. 
 
76 
 GENUS in. 
 
 Of the overacting Ulcer. 
 
 Tiiis genus comprehends two species : First, that in which 
 I he granulating, or purulent process is morbidly increased, or 
 ihe two parts of the ulcerative action, the granulating and 
 the purulent, do not. correspond, or bear the same propor- 
 tion to each other that they do in a healthy ulcer : Se- 
 cond, that in which a state of general acute overaction takes 
 place, both parts of the ulcerative action being equally affect- 
 ed, and rendered diseased. 
 
 For the illustration of the first species, I may remark, that 
 there are some actions performed by particular parts of the 
 body which are apparently simple ; but there are others which 
 are complicated, and consist evidently of different parts, 
 which, in the aggregate, form a peculiar action, but which 
 action may be modified according to the degree in which 
 these different parts exist. Thus, there are various parts 
 which, when taken together, form the inflammatory action, 
 heat, redness, swelling, &c. ; but these may, in certain cases, 
 exist in different proportions. The ulcerative action is a 
 complicated one, and consists of the secretory and organizing 
 action, or the purulent and granulating. These, in a healthy 
 ulcer, bear a certain relation to each other, and are at al! 
 limes so connected, that when one part is injured, the other 
 is also affected ; but the one part maybe affected more than 
 the other. In the indolent ulcer, or that in which the ac j 
 lion is too low, both parts are most commonly (at least after 
 some time) equally affected, and a state of universal diminu 
 tion, and consequent imperfection, takes place ; but, in the 
 beginning of this state, that is to say, when the healthy ulcer 
 is first becoming diseased, and when the unhealthy condition 
 
77 
 
 has made little progress, it is not uncommon to observe an 
 inequality in the action, or the granulations more affected 
 than the discharge. In this genus of ulcers, however, the 
 inequality is more striking, and frequently more permanent. 
 
 It is worthy of remark, that though the granulating action 
 may be increased beyond the purulent one, that yet the puru- 
 lent one never exists in a state of overaction without a cor- 
 respondent affection of the granulating action ; in which case, 
 very different effects and symptoms are occasioned, and the 
 second species of overacting ulcers is produced. 
 
 The first species has generally been described under the 
 name of the fungous ulcer, or ulcer with hypersacosis. 
 The ganulations are soft and indistinct. They are imper 
 fectly formed, and, therefore, do not possess the pointed 
 appearance which they exhibit in health ; nor have they 
 equal powers of action, nor longevity. They are formed 
 quickly, and rise to a greater or less height above the level 
 of the surrounding skin. The margins are generally soft, 
 tumid, and of a dull red colour. The discharge, if there be 
 no carious bone, is tolerably thick, and of a white colour, 
 and not in greater quantity than would be yielded by a 
 healthy ulcer of the same size: The quantity is even some- 
 times less. The pain, unless when a bone is diseased, is 
 seldom considerable. This species admits of two varie 
 ties. In the first, the granulating process is increased, in 
 consequence of some affection of the action, which is inde- 
 pendent of any mechanical cause. In this case, the fun- 
 gus is generally pretty firm, but commonly pale, and the dis- 
 charge tolerably good. In the second variety, the granula- 
 ting process is increased in consequence of some mechanical 
 irritation underneath, such as a piece of carious bone ; and, in 
 this case, the fungus is softer, and less firm ; it is of a redder 
 and more lively or fiery colour, and is sometimes covered, 
 in particular parts, .with spots of lymph ; it bleeds upon the 
 
i lightest touch. The sore is generally painful, and the dis- 
 charge thin, serous, and of a foetid smell, while we cau fre- 
 quently perceive at least one small foramen on the surface 
 which leads down to the bone, and through which it may be 
 felt to be rough. Out of this is discharged a thin matter from 
 the bone of a brownish colour, somewhat like soup, and more 
 or less different from the discharge from the rest of the sur- 
 face. These luxuriant granulations, however, must not be 
 confounded with those which, at a later period, come from 
 the bone itself, after it has begun to ulcerate. These are 
 generally of a more florid red colour, though sometimes 
 pale, and rise up either through chinks of the bare caries, or 
 from such portions as are denuded by a previous exfoliation. 
 They have in general, a more pointed appearance than those 
 which arise from the soft parts, so that in many cases, the 
 fungus resembles the surface of a strawberry, being rough. 
 This variety may be induced quickly, the bone being injured, 
 at the same time that the soft parts arc affected ; but, at 
 other times, and perhaps more frequently, the bone becomes 
 diseased, in consequence of the continuance of a simple ulcer 
 immediately over it ; as, for instance, on the tibia. In this 
 case, the ulcer, which perhaps was formerly indolent, now 
 changes its nature. 
 
 The second species exists in various degrees, and its symp- 
 toms admit of modification from the previous state of the ul- 
 cer. Sometimes an ulcer, although previously healthy, has 
 its furface excited into a state of overaction, by exercise, 
 or other causes. In this case, the sore becomes painful, and 
 the granulations assume first a kind of light crimson colour, 
 and then a brownish hue, from a species of mortification. 
 They do not indeed become gangrenous, and slough, but they 
 approach to a state nearly resembling death, and are absorb- 
 ed. The edges are slightly erysipelatous, and the discharge 
 watery. This may be called the first degree or stage of th$ 
 
79 
 
 disease ; and the ulcer frequently recovers soon from this, 
 and reassumes its healthy condition. But if it be neglected, 
 or the injuring causes still continue, the state of overaction 
 is increased, and becomes more perfect;* that is to say, the 
 actios which was injured in its different parts, and rendered 
 unconnected by the incipient or new condition, becomes 
 more compleatly and connectedly performed in its differ- 
 ent parts, in an increased degree. The overacting state, 
 which, in the first stage, took place, perhaps only for a few 
 hours, or at least if it continued, did not rise to any great 
 degree, or receive an augmentation in this stage, continues 
 with violence, and generally with exacerbation. The gran 
 ulations are absorbed almost as soon as they are deposited ; 
 because, owing to the overaction of the part, they are veiy 
 imperfectly organized, and possess very little life and power 
 of supporting action.f They evidently appear to be in a 
 state of overaction ; for they are fiery, and their colour, 
 whether it be red or brownish, is bright or clear, and quite 
 opposite to the dull hue which even the same colour may have 
 in a different kind of sore. These bleed upon the slightest 
 touch ; on which account, the discharge is generally bloody. 
 The margins are red and ragged, as if they were bitten by 
 a mouse ; and they are evidently in an ulcerating state. The 
 surrounding skin is hot and erysipelatous, the discharge is 
 thin and serous, and the pain great, generally somewhat of 
 the burning kind. This sore, from the destruction of the 
 granulations, and the propagation of a morbid degree of 
 action, spreads as long as this condition continues ; but the 
 progress, as long as the ulcer belongs to this genus, or as 
 granulations are formed, is not very rapid. 
 
 * By this I mean more perfect in its state of overaction. 
 
 t In highly overacting ulcers, the granulations seem to possess a middle state, be- 
 twixt proper organic particles and the morbid substance, called pus. 
 
80 
 
 It not unfrequently happens, that, after a sore which ha» 
 been indolent has begun to heal, it, from fatigue, or some less 
 evident cause, has a state of overaclion induced, in which 
 rase, different appearances are exhibited, according to the 
 previous state of the sore. If it has begun to form a natural 
 cicatrix, this gives way, the surface becomes livid, the dis- 
 charge thin, and the pain considerable. A thin slough of 
 the granulations is then generally formed, and comes off in 
 portions mixed with the discharge. If this state be not 
 checked, it frequently comes to exhibit the acute symptoms 
 of the overacting ulcer which was last described. More 
 frequently, however, it occurs when the sore is still indolent, 
 and not in the healing state, and when the edges still remain 
 callous, and the granulations foul and unhealthy. If, at this 
 time, a disproportionate, or overaction be induced, by exer- 
 cise or otherwise, we find, that the surface becomes dark and 
 gloughy, the granulations flat and indistinct, the discharge is 
 increased, and the margins become tumid, and of a modena 
 colour, whilst the surrounding integuments are of a dull red 
 mottled colour, or erythematous ; and the foot, if it take 
 place in the leg, is frequently cold, and the pain darts down 
 to the toe. 
 
 This state is not unfrequently produced in old ulcers, by 
 a disease of the parts below,* which has been induced by 
 
 * This affection of the ulcer, produced by a disease of the parts below, is in- 
 duced with a frequency nearly proportioned to (he aptitude of the part below for 
 becoming diseased, by the continuance of an ulcer over them. Tendons and 
 bones are particularly apt to be injured in this way; and, therefore, ulcers seat- 
 «d over tendinous part", or bones thinly covered, are more apt to affect these, 
 and to be reacted on themselves, than when seated over fleshy parts. On the 
 same account, ulcers on the foot, or ankle joint, are worse to heal than those a. 
 little farther up the leg ; and the difference is greater than ean be explained whol- 
 ly, by the circumstance of distance from the heart, and possessing less power of 
 performing action properly. Recent ulcers likewise heal easily on the feet, by 
 proper treatment. It is old ulcers alone which are difficult to manage, and th,t 
 'ause is obviou?. 
 
81 
 
 the long continuance of the ulcer, which renders the bone 
 carious, if it lie immediately under it (in which case, the first 
 species of overacting ulcers is produced ;) but, at other 
 times, by the sympathy of association, a diseased formative 
 action (owing to the diseased formative action in the ulcer, 
 or the imperfect granulations which are formed) is induced 
 in the neighbouring parts, the muscles become pale, and have 
 less of their fibrous texture, or the bone becomes rough, or 
 pointed, like shagreen, and also becomes thickened, but 
 without any appearance of caries. This diseased condition 
 of the parts reacts on the ulcer, and induces overaction. 
 
 This state of overacting may also be induced in old ul- 
 cers, without any malformation of the parts below, but 
 merely in consequence of continuance ; for, after an ulcer 
 has remained long indolent, it comes to act so imperfectly, 
 that it naturally goes beyond its power. This may be said 
 to be a spontaneous change, or conversion of one genus into 
 another. 
 
 We have then two varieties of this species: First, the 
 state of overaction induced in an ulcer which was previously 
 healthy ; and this admits of two stages, the incipient and 
 confirmed : The first sometimes consists only of one 
 short paroxysm ; the second continues for a longer time, 
 and generally depends upon the neglect of the first attack. 
 Second, the state of overaction induced in an ulcer which 
 has previously been indolent ; and this admits of two sub- 
 divisions, which arise from the condition of the ulcer at the 
 time of its overacting, namely, whether it have been heal- 
 ing and cicatrizing, or the edges have been callus, and the 
 action imperfect and morbid. 
 
 The observations on the cure of this genus of ulcers must 
 naturally be arranged under the different species and varie* 
 ties of these ulcers. 
 
si 
 
 in the first variety of the first species, our object is to re- 
 move the supernumerary, or fungous granulations, and to re 
 place them with others, which are formed more slowly, and 
 in greater perfection. 
 
 Pressure, applied in the manner already explained, is one 
 of the most useful remedies in this variety, and ought always 
 to be tried first. The luxuriant granulations are quickly ab- 
 sorbed, and the succeeding ones are rendered more compact 
 and healthy, and the cicatrix begins to be formed. If, how- 
 ever, we apply pressure in this, or indeed in any sore, to 
 such a degree as to produce its specific effect, we must 
 counteract its irritation by cold. If we do not, this sore is 
 frequently converted into the second variety of the second 
 species of this genus. 
 
 Caustic, and escharotics, have been sometimes applied t» 
 these sores ; but they only remove a layer of granulations, 
 without affecting the formation of the succeeding ones so 
 much as some other remedies. 
 
 Stimulating applications are more useful ; for, as they act 
 more slowly, they produce a greater influence on the action. 
 
 The cuprum vitriolatum, mixed with simple ointment, in 
 the proportion of a drachm to the ounce, is frequently ser- 
 viceable ; but the ung. hyd. nit. is still more useful. One 
 drachm of this may be mixed with an ounce of hog's lard 
 and a scruple of camphor. Red precipitate, mixed with 
 resinous ointment, is also often of service. 
 
 The application of powdered rheubarb is recommended 
 L>y Mr. Home, and is frequently of service. 
 
 Lotions of port wine, solutions of white vitriol, or roso 
 water, containing as many drops of l'eau mercurielle* a^ 
 will make it moderately pungent, maybe usefully applied be 
 fore the dressing. 
 
 • L'eau mercuriellc is a solution of mem?r7 in nitrous acid. 
 
Poultices seem to increase the diseased state ; and mild 
 dressings do not counteract it, but allow it to go on. 
 
 The second variety is only to be cured by removing the 
 caries bone ; but the same remedies which are used in the 
 first variety may be employed here, as palliatives, or the 
 means of preventing the ulcer from becoming worse. By a 
 continuance of these applications, in cases of slight caries, 
 a cure may, after some time, be obtained ; for the thin layer of 
 diseased bone, either comes away in fragments through an 
 opening in the ulcer,* or it is sometimes absorbed. This 
 last event, the absorption of the bone, is particularly indu- 
 ced by pressure, applied by means of the adhesive plaster ; 
 and, therefore, where the disease is not extensive, it is al- 
 ways proper to have recourse to this ; but if, upon trial, we 
 find it to fail, or to convert the sore into the second species 
 of this genus, which it sometimes does, we must omit it. 
 
 As it is only in slight cases of caries that absorption of 
 the bone is to be expected, we may consider it as necessary, 
 in general, as a preparatory step toward healing, that the 
 diseased portion of the bone be separated, and come away 
 externally. It is therefore of advantage to endeavour to ac- 
 celerate this ; because, whatever does so, hastens the cure. 
 Our attempts, with this view, are made at two different 
 stages, and with different intentions. First, when the bone 
 has separated, or exfoliated from the part below, by making 
 an incision through the ulcerated surface, we remove the 
 dead part, and allow the sore to heal. This stage may be 
 discovered, by pushing a probe through the opening, if 
 
 * In the description of this variety, it was mentioned, that there frequently 
 was a small opening in the surface, which communicated with the bone ; but, even 
 where this is not the case, the layer of dead bone, when it exfoliates, comes 
 through the granulations ; for the granulations of the sound bone below raise it 
 up, in consequence of which, pressure 1*6 made from within outward upon the ul- 
 cer, by which absorption is produced at that part, in a greater degree than depo 
 sition ; and, therefore., a vacuity is produced. 
 VOt. II. L 
 
84 
 
 there be one, or through the granulations, down to the layer 
 of bone, which we find to be elastic when we press on it. 
 But, even although the incision be made before this stage 
 has taken place, no harm is done, because it is of use in the 
 first stage. Second, when the carious bone has not yet ex- 
 foliated, but remains in contact with the rest of the bone, 
 ulceration of the sound part not having yet taken place, it 
 will be useful to make an incision down to the bone, and, as 
 soon as the bleeding stops, or lessens, to apply caustic freely, 
 in the whole course of the incision, so as to act upon the 
 caries, or rough portion ; or we may use the trephine, or 
 other remedies, which have been formerly mentioned. It 
 sometimes happens, that the soft parts are, at particular por- 
 tions, and often to a considerable extent, removed by absorp- 
 tion, and the bone, at these parts, is left bare. In this case, 
 no incision is necessary, except occasionally through some 
 bauds of granulations which extend across the bare bone ; 
 and, therefore, we can at once apply our remedies to the 
 bone, or make perforation with the trephine. 
 
 The second species requires to be treated differently, ac- 
 cording to it3 varieties. 
 
 As the incipient stage of the first variety frequently con- 
 sists of only one short paroxysm, it would often be unnecessa- 
 ry to have recourse to any peculiar treatment ; but, as it is 
 impossible, a prior?, to say whether the state of evacuation is 
 to continue, it is requisite, in every instance, to vary our 
 treatment, and apply the proper remedies for the disease. 
 
 Poultices are frequently useful in this kind of ulcer, when 
 the surface is dark coloured, and the integuments are not 
 yet affected. They have sometimes an effect of checking 
 the morbid state, if this be not already done ; but they 
 more generally promote the absorption of the morbid granu- 
 lations, after which the surface becomes healthy. If, how- 
 ever, the action be still greater, and more permanent, theix 
 
85 
 
 the ulcer is tending toward the confirmed, or perfect state 
 of overaction, and poultices are not of equal service ; they 
 are even sometimes hurtful. 
 
 Gentle pressure, accompanied with the use of cold water, 
 is of service in the same cases in which poultices are em- 
 ployed ; that is to say, when the action has not become per- 
 fect, but has rather begun to subside, and the granulations 
 remain dark coloured, and in a dying state. They are ab- 
 sorbed, and replaced with more perfect and healthy granu- 
 lations. 
 
 When, however, the action still continues in the same 
 state of overacting, or seems to be increasing, these remedies 
 are rather hurtful ; and we will derive more benefit from 
 using applications of a gentle stimulating nature, which re- 
 store the action to a more perfect and natural state, in the 
 same way as they cure the inflammatio debilis. For this 
 purpose, one *)f the best applications is the following : 
 
 R. Opii drachmas duas, 
 Camphora? scrupulum. 
 
 Vini Albi uncias quatuor. Macera per triduum, 
 dein cola. 
 
 This may be applied by means of a bit of lint to the sore. 
 It generally produces considerable smarting for a few minutes, 
 after which the pain abates. The application is to be re- 
 peated every hour, or every two hours, until the sore begins 
 to look healthy, and the pain abates. The adhesive plaster 
 ought then to be substituted in its place. 
 
 Laudanum may also be employed with the same intention^ 
 but it is inferior to the other. 
 
 Lemon juice is also sometimes useful, and may be employ- 
 ed where the opiated wine fails, or is not at hand. 
 
8fr 
 
 When the state of overaction becomes confirmed, and 
 progressive, the sore spreads, becomes very painful, and as- 
 sumes the appearances which have been already described. 
 In this case, the application of carrot, or turnip poultices, is 
 frequently useful. These vegetables are sometimes made 
 into a poultice by boiling them, and, at other times, by rasp- 
 ing them down raw. 
 
 Camomile flowers, boiled in milk, and then expressed, 
 yield a decoction, which, when made into a poultice with 
 crumb of bread, frequently abates the pain. Sometimes the 
 application of cloths, dipped in fine oil, give relief. 
 
 These sores are also frequently reduced to a more healty 
 state, by applying cloths dipped in the following mixture ; 
 
 R. Amnion. Hepatizatae* guttas decern. 
 Aq. Font, uncias octo. 
 
 This produces a moderate degree of smarting for a little 
 time, during which the former painful sensation arising from 
 the sore lessens, and does not return for some time. When 
 the peculiar pain of the ulcer again manifests itself, the so- 
 lution is again to be applied. 
 
 An ointment, consisting of two drachms of powdered opU 
 urn, and one ounce of simple cerate, is also a very useful ap- 
 plication. 
 
 Sprinkling the sore with red precipitate, or touching the 
 surface with caustic, frequently stops the disease. 
 
 The kind of erythematous affection, which frequently af- 
 fects the surrounding skin, is best removed by stimulating 
 applications, which abate the pain or hot sensation, and make 
 it less apt to ulcerate. The following is a very useful ap- 
 
 * The ammonia hepatizata is prepared by passing a stream of hepatic gas 
 through the aqua ammoniae. 
 
87 
 
 plication for this purpose. The affected part is to he light 
 ly dusted with it occasionally : 
 
 R. Hyd. Precip. Rub. line. i. 
 Pulv. Opii semiunc. 
 
 Cretae Ppt. unc. ii. Tere simul ut fiat pulvis sub- 
 tiliss. 
 
 When, by any of these applications, the state of overac- 
 tion is overcome, pressure is the best remedy for pic- 
 serving our ground, and producing a cure ; for, remedies 
 which may be useful in the diseased state, will be hurtful 
 when this state is removed. 
 
 In this sore, anodynes are to be freely employed internal- 
 ly ; for, given sparingly, they do no good.* 
 
 All the applications ought to be made gently, and lightly ; 
 because any mechanical irritation increases the disease. 
 
 The second variety of this species is a very troublesome 
 ulcer, and admits, as has been already observed, of two di- 
 visions : First, it not unfrequently happens, that, after an in- 
 dolent ulcer has been in a healing state for some time, a state 
 of overaction is induced, by fatigue, or other causes, parti- 
 cularly by the natural inability of the newly formed, and 
 not completely perfect granulations, to sustain the action 
 which is necessarily induced in them by their connexion 
 with other parts (upon the principle of the communication 
 of action.) In this case, the sore becomes foul, dark colour- 
 ed, and painful, whilst the cicatrix ulcerates, and the new 
 granulations die, so that, in a short time, the ulcer regains 
 
 * No external application whatever will produce the same good effect, if used 
 by itself, as when such a general action is induced as shall co-operate with the 
 local remedies. In slight cases, thirty drops of laudanum may be given twice a- 
 day ; but, when the overartinn is more violent, ibe dose must be more frpqurn'tr 
 •repeated. 
 
38 
 
 *ts original size, and even spreads slowly to a greater extent. 
 Second, an old ulcer may, without having been previously 
 in a healing state, become converted into the overaciing ul- 
 cer ; because the surface has its power so weakened, that 
 common agents, which naturally excite action in the pari, 
 excite a disproportioned and morbid action in the ulcer ; 
 but this action is of the low kind, and bears somewhat the 
 same relation to the first species, (or overacting ulcerative 
 action, in ulcers previously healthy,) that the inflammatio 
 debilis does to the inflammatio valida. In this case, the 
 surface is bloody, and the half-formed granulations are of a 
 livid colour ; the callus edges are of a dusky red, or mode- 
 na colour ; the integuments are generally mottled ; the in- 
 ferior part of the limb is cold and painful. 
 
 In the cure of the first division, we must enjoin rest, as in 
 the second variety of the first species, and apply cloths, 
 dipped in a mixture of two parts of laudanum and one of 
 camphorated spirit of wine, which produces at first consi- 
 derable smarting ; but the sensation is different from the 
 former pain; and, although uneasy, is yet more tolerable 
 than the peculiar pain of the ulcer. This application ought 
 to be renewed two or three times in the course of the day, 
 until the surface becomes of a better appearance, and the 
 pain abates. 
 
 The application of the powder of bark to these sores is 
 sometimes, but very seldom, of service.* 
 
 A poultice, formed of decoction of camomile flowers, opi- 
 nm, and charcoal,f is, frequently of use, and should be cm- 
 
 * This was probably recommended on account of the sphacelated appearance 
 ■which these sores somefiines have. 
 
 t Let two ounces of camomile flowers be boiled in three pounds of water down 
 to two. \\ hen this is cold, it ought to be strained, and half a drachm of opium 
 ■diffused in a pound of the decoction. Of this, a sufficient quantity is to be added 
 i*o powdered charcoal, in order to form a poultice. 
 
89 
 
 ployed when the laudanum and camphorated spirit fail. This 
 should be applied cold. 
 
 In the second division, the fermenting poultice* is often 
 of service ; but it must, like all other applications, be con- 
 tinued no longer than the state which it was intended to re- 
 move remains. Jf we continue it too long, we do hurt ; for, 
 if it be kept on when it produces continued pain, it induces 
 a state of overaction, similar to that which it was intended 
 to destroy. Whenever the surface becomes redder, and the 
 pain less, it may be useful to employ some other application, 
 such as laudanum, &c. 
 
 The same observations apply to the use of the gastric 
 juice. Cloths dipped in this sometimes make the overacting 
 surface slough oft*, and leave the parts below more healthy. 
 The same may be said of the expressed juice of sorrel. 
 
 Lime water sometimes operates in the same way. 
 
 Red precipitate, mixed with its weight of powdered opium, 
 and half its weight of camphor, may be usefully sprinkled 
 over the surface. 
 
 A pound of the recent leaves of hemlock, boiled for half 
 an hour in two pounds of milk, and then expressed, forms an 
 application which sometimes abates the pain, and renders the 
 action more healthy. The juice is to be made into a poul- 
 tice with crumb of bread. 
 
 Decoction of the walnut tree leaves, applied by means of 
 pledgets of linen, or made into a poultice with bran, is oc- 
 casionally of service. 
 
 When, by any of these applications, the morbid state of 
 the ulcer is removed, it is to be dressed according to the 
 genus into which it is then converted. 
 
 * The fermenting poultice 19 made by adding a spoonful of yest to an oatmeal 
 poultice, and placing it before the fire until it begins to emit air, or rise up Hi a 
 babbling way. It is then fit for applying to the sore. 
 
90 
 
 After these remarks, the treatment of this geims of ulcers 
 may be comprised in the following observations : 
 
 First. In the first variety of the first species, or the sim- 
 ple fungous ulcer, the cure is to be attempted by pressure, 
 and gentle stimulants, which render the action more natural, 
 and the granulations, in consequence, more perfect and com- 
 pact. 
 
 Second. In the second variety of this species, we are to 
 employ the same remedies, as palliatives, or as means which 
 may promote the exfoliation of the bone. But, if the dis- 
 ease in the bone be more extensive and tedious, we must cut 
 down through the ulcer, and apply caustic, or mechanical 
 cures, such as perforation, to the caries. 
 
 Third. In the incipient stage of the first variety of the 
 second species, we must avoid motion, and all other such 
 causes as tend simply to increase action. When the disease 
 has consisted of one short paroxysm, which has terminated, 
 we must promote the absorption of the diseased granulations, 
 and the process of replacing them with others which are 
 more perfect, which is effected by such remedies as render 
 the action which forms them more natural. This is best 
 done by gentle pressure, and sometimes by poultices. If, 
 however, the paroxysm continue longer, but in a moderate 
 degree, we must use such applications as tend more directly 
 1o change the action, and diminish the morbid condition ; 
 such as camphorated and opiated preparations, and sometimes 
 the vegetable acids. 
 
 Fourth. When this state becomes confirmed and progres- 
 sive, the action being violent, we must use remedies nearly 
 similar to those which are employed in the last case, and 
 which are useful in the cure of the inflammatio debilis, at 
 the same time that we enjoin rest, and keep the part as easy 
 as possible. In some instances, the action cannot be over- 
 come directly by any application, but is rather increased by 
 
91 
 
 them. In this case, wo must lay these aside, and use mild 
 and light applications ; such as fine oil, fresh cream, &c. ; at 
 the same time that we avoid the general causes tending to 
 increase action ; such as motion, heat, spirits, Fee. 
 
 Fifth. When this state occurs in chronic ulcers, we must 
 use such remedies as tend to remove the dead or dying gra- 
 nulations which frequently cover the surface, and such as at 
 the same time produce a more natural action, and restore to 
 the succeeding granulations greater powers and perfection, 
 and a more healthy mode of acting. Stimulating applications 
 frequently have this effect ; such as the fermenting poultice, 
 precipitate ointment, &c. ; at other times, narcotic applica- 
 tions ; such as cicuta, &c. are useful. 
 
 Sixth. In these ulcers, the redness and pain of the skin 
 which surrounds the ulcer, is to be treated as the inflamma- 
 tio assuefacta, by being dusted with the powder which has 
 been already mentioned, or by similar remedies. 
 
 Seventh. In all of these ulcers, where the action is violent, 
 much benefit will be derived from inducing the general nar- 
 cotic action to a considerable extent. Anodynes are there- 
 fore to be freely administered, at the same time that we em- 
 ploy the proper local remedies. 
 
 Eighth. Whenever the ulcer becomes more healthy, and 
 the action less morbid, the strength of the application is to 
 be diminished; and, when the slate of overaction is destroy- 
 ed, it must be treated as the indolent ulcer, because the 
 granulations are still feeble. Pressure is most useful in this 
 case. 
 
 VOL. II. M 
 
 
92 
 
 GENUS IV. 
 
 Of the Inflammatory Ulcer. 
 
 It sometimes happens, that the ulcerative action becomes 
 converted into the inflammatory ; the discharge diminishes, 
 and sometimes ceases ; the surface is red ; and the edges 
 and surrounding skin are elevated and inflamed. This, 
 which has been called the phlogosis ulceris,* strictly speak- 
 ing, does not belong to the division of ulcers, because the 
 ulcerative action is destroyed ; but, as it is preceded, and 
 very quickly followed by this action, and as the solution of 
 continuity, and other external appearances continue, this af- 
 fection may be allowed to rank as a genus among ulcers, in 
 conformity to common language. 
 
 When the pain and inflammation are considerable, leeches 
 are frequently applied with utility in the vicinity of the 
 sore ; but it is more generally useful to apply warm poultices, 
 which restore the secretory state, and the ulcerative ac- 
 tion. 
 
 GENUS V. 
 
 Of the Suppurating Ulcer. 
 
 This genus, like the last, accurately speaking, does not 
 belong to the class of ulcers ; but, as it is so intimately con- 
 
 * Siccitas rubid&et j<hiogosis ulceiis facile cognoscunter ; dolore, pruritu, calore 
 stipaatur; ea impediunt carnis excrescentiam, adeogue indicant reuiedia emolli- 
 cntia," &c. Sauvage Nosol. Meth. torn. ii. p. 613. 
 
93 
 
 nected with it, both in its causes, and treatment, and appear- 
 ances, it is of some practical utility to admit the arrange- 
 ment. 
 
 When an abscess is opened before the ulcerative action is 
 induced, we have an open suppura? ing sore ; but this is not 
 the sore which is meant to be described here. 
 
 The suppurating ulcer is, when simple, and independent 
 of any specific action, most frequently only a high degree of 
 the overacting ulcer ; but, as its symptoms are somewhat 
 different, and as it nearly resembles some specific sores, dif- 
 fering from these only in the absence of the peculiar action, 
 resulting from the application of a poison, it may be proper 
 to consider this as a separate genus. 
 
 When the ulcerative action is very imperfectly carried 
 on, which often arises from overaction, we find, that the or- 
 ganic particles are thrown out, not in the form of granula- 
 tions, but in a more inorganic state, and lie upon the surface, 
 mixed with the discharge from the other set of vessels. 
 This has the appearance of very thick tough pus, and the 
 sore which yields it may properly be considered to be in a 
 suppurating state. This ulcer is distinguished by the pain 
 which attends it, by a redness which surrounds the margin, 
 and a hardened base, whilst the cavity of the ulcer is filled 
 up with a thick straw-coloured substance, somewhat like 
 lymph, which adheres firmly to the surface. This is impro- 
 perly called a slough. 
 
 This appearance and condition may be excited in a simple 
 ulcer, without any apparent application of contagion ; but 
 it is still more frequently the consequence of some morbid 
 matter acting on the part, and producing specific ulceration, 
 which will be afterwards considered. I may only here ob- 
 serve, that it has, in some of these cases, been considered as 
 a species of gangrene, as, for instance, in the cynanche ma- 
 ligna ; but, whatever may take place in the advanced stages 
 
 
94 
 
 of this disease, there is at first no grangrene, but a suppura- 
 ting ulcer, wh;ch throws out imperfect granulations, or 
 rather a morbid purulent discharge, (for the one runs natu- 
 rally into the other,) which forms what is called a slough. 
 
 The treatment of this ulcer consists first in procuring a 
 separation of the tenacious covering, by such remedies as 
 shall at the same time that they do this, make the action 
 more healthy. 
 
 A pretty strong solution of the argentum nitratiun, or 
 l'eau mercurielle, diluted with equal parts of distilled water, 
 applied by means of a brush, frequently produce the desired 
 effect. 
 
 The acetous infusion of Cayenne pepper applied in the 
 same way, is likewise useful. 
 
 Poultices made of decoction of camomile flowers, and equal 
 parts of charcoal and barley meal, are sometimes of service 
 in removing the matter, and rendering the action more truly 
 ulcerative. 
 
 Opiates ought to be freely administered. 
 
 When this state of the sore is removed, the ulcer must be 
 treated according to the condition of the ulcerative action. 
 Most frequently it belongs first to the overacting genus, and 
 must be treated accordingly, and then to the genus of indo- 
 lent ulcers, in which case, pressure is to be employed as a 
 termination to the cure. 
 
 When an overacting ulcer has, without the assistance of 
 local applications, ceased to overact, it not unfrequently sup- 
 purates ; that is to say, no granulations are formed, but the 
 two sets of vessels throw out an inorganic matter, and the 
 surface of the sore has a lymphatic appearance. 
 
 The best dressing for this state is dry lint with a pledget 
 spread with cerate laid over it. 
 
 
95 
 
 Of the Effects of the Ulcerative action on the 
 Constitution. 
 
 The condition and qualities of an ulcer, do not, in every 
 instance, depend upon causes which are entirely local, but 
 frequently are connected with some general state, or mode of 
 action, of the system. General weakness must, for example, 
 influence the performance of any action in a particular part ; 
 and, therefore, an ulcer in those who are infirm, and exhaust- 
 ed, cannot readily perform the necessary healthy action, or 
 proceed quickly toward a cure ; nor is it easy, in these circum- 
 stances, by any local applications, to communicate the neces- 
 sary action, and the correspondent power, which shall ena- 
 ble the part to heal. In the same way, there are some people 
 so irritable, that an ulcer shall very readily assume the over- 
 acting state which can only be removed by such remedies as 
 act on the general system. Besides those which may be con- 
 sidered as simple conditions, there are many other actions, 
 which are peculiar and unnatural, which influence the ulcer, 
 or in which ulcers often appear as symptoms. These ulcers 
 are specific, and must be afterwards considered. 
 
 As the state of the system has a considerable influence oft 
 the condition of an ulcer, so also has the state of the ulcerative 
 action an effect on the constitution. A healthy ulcer, un- 
 less very extensive, has little effect on the system ; but, 
 unhealthy ulcers, or those which are very large, although the 
 action may be sufficiently perfect, produce a greater or less 
 degree of the general diseased formative action, or what is 
 called hectic. 
 
 From the principles which have already been laid down, il 
 may easily be understoood how an unhealthy ulcer should in 
 duce hectic. When considering the doctrine of suppuration, 
 fhe effects of this on the constitution, or the production & 
 
a general diseased formative action were attended to. It was 
 also mentioned, when considering ulceration, that the ulce- 
 rative action had a tendency to produce similar effects ; and 
 this it does, with a certainty proportioned, caeteris paribus, to 
 the unhealthy condition of the action, or its approximation 
 to the suppurative action; for the less perfect that the ulce- 
 rative action is, the more nearly does it resemble the suppu- 
 rative one. 
 
 Healthy ulcers, if very extensive, produce likewise con- 
 siderable effects on the constitution. This is chiefly per- 
 haps owing to the purulent action, which makes a part of the 
 ulcerative one ; for this morbid local secretory action in- 
 duces a general change, in the same way as other acute 
 changes, of either the formative action itself, or any other in- 
 timately connected with it, such as the interstitial. But, 
 besides this cause, the granulating action, although healthy, 
 co-operates with the diseased interstitial action, or the pu- 
 rulent part of the ulcerative action; because, although the 
 granulations, or organic particles, be healthy, yet they are 
 formed in an unnatural situation, and with greater rapidity, 
 and in greater numbers, in a given time, than naturally they 
 ought to be ; and, therefore*, the action of the part requires 
 greater power for its continuance than is possessed. There is 
 consequently, then, weakness produced, which, by association 
 affects the system, and co-operates with the diseased forma- 
 tive action, increasing the general disease. The consequence 
 of this state, likewise, is, that the ulcer comes, after some 
 time, to be rendered unhealthy, owing to the deficiency of 
 power to support the necessary action ; in which case, the 
 granulating action comes to be also diseased, and co-operates 
 still more with the former morbid condition of the interstitial 
 vessels or the purulent action, which, although a part of a 
 healthy ulcerative action, is yet itself a morbid secretion, and 
 an unnatural action. 
 
97 
 
 The effects of the ulcerative action on the constitution, are 
 to be alleviated by good diet, free air, and the other reme- 
 dies which have been pointed oat when formerly considering 
 hectic, to which I now refer. I shall oniy observe, that 
 some of these remedies are employed occasionally with little 
 judgment, and when they are not indicated. It is, for in- 
 stance, a common practice with some, to prescribe the bark 
 for the cure of every ulcer, whether the constitution be affect- 
 ed or not. But from many trials, I am confident, that it is of 
 very little service, unless when a general disease, whether it 
 be called weakness or hectic, exists. 
 
 When the proper remedies for the cure of hectic, con- 
 joined with necessary local applications, fail, the diseased 
 part must be removed ; but, before doing so, it is, in every 
 instance, proper to form a pea issue, in order still to keep up 
 a secretory action, the good effects of which have been al- 
 ready noticed. 
 
 The restlessness, and febrile symptoms, which are some- 
 times produced by painful sores, are best relieved by ano- 
 dynes. 
 
 Of the Cure of the Infiammutio Debilis, and the Treatment 
 of Mortification 
 
 The causes and nature of mortification having been alrea- 
 dy explained, I shall now consider the means of prevention, 
 and the method of cure. The remedies necessary for pro- 
 curing the resolution, or suppuration of the inflammatio vali- 
 da, having been formerly enumerated, it will be unnecessary 
 here to make any repetition, or to say more that that we are 
 to prevent mortification by endeavouring to induce one or 
 other of the other terminations, and that the remedies which 
 do so are to be employed with a promtitude and assiduity 
 proportioned to the greatness of the action compared to the 
 
98 
 
 powers of the part ; and, therefore, that in the intestines, 
 &c. we must pursue our course speedily, if we expect to 
 prevent gangrene. 
 
 Mortification, however, is still more apt to succeed the in- 
 flammatio debilis, or inflammation of weakened parts ; and, 
 therefore, the treatment of this will now more naturally 
 come to be considered, as forming a part of the prophylaxis 
 of mortification, than in any other place. 
 
 The most frequent instance which we have of the inflam- 
 matio debilis, is the inflammation of parts which have been 
 previously benumbed with cold ; but it may also be produced 
 by the action of any of the common exciting causes of in- 
 flammation, in weak and reduced habits, or by bruises in 
 sound parts, &c. 
 
 When a part has been exposed to much cold, it may in- 
 flame, from two causes: First, the communication of action ; 
 secondly, the application of subsequent stimulants, more es- 
 pecially heat. Both of these tend to excite an action in the 
 part, which is greater than its power would naturally per- 
 form, and, therefore, it becomes diseased, or inflammation is 
 produced, and the little energy which did remain is soon de- 
 stroyed. The operation of the first cause is prevented by 
 lessening the action of the surrounding parts, by the applica- 
 tion of moderate cold, whilst we avoid motion, and whatever 
 may tend to act directly on the part, and co-operate with 
 this cause. The operation of the second cause is prevented 
 by keeping away every agent which will tend to excite ac- 
 tion, or at least those which tend to do so suddenly. In the 
 generality of cases, it is perhaps most proper at first to do 
 nothing ; because, whatever we apply, tends to excite a 
 greater action than can be sustained ; we ought, therefore, 
 to delay any remedy until the part has begun to recover it- 
 self, and the action and corresponding power has begun na- 
 turally to increase ; we may then interfere, by applying such 
 
99 
 
 remedies as increase the action, which are perhaps now more 
 useful, by preserving the ground which is gained, than by 
 increasing still farther the action. Of this kind is heat, 
 which must, upon this principle, be applied with great cau- 
 tion, and must, in its degree, be nicely adjusted to the exist- 
 ing state of action. When a part, then, is benumbed with 
 cold, we ought at first to apply a degree of heat, very little 
 above that which the parts were formerly exposed to, which, 
 in one sense, may be said to be doing nothing ; for this step 
 is intended merely to prevent farther injury. When this is 
 continued for a short time, we may suppose that the part has 
 begun to act a little more in a natural way, which is attend- 
 ed, as was formerly explained,* with a correspondent in- 
 crease of injury* We then increase the heat, but very 
 slowly, and taking a long time to bring the part near its 
 natural temperature, being regulated by the progress which 
 the part itself is making ; for the application of heat may be 
 considered in two points of view, in this case ; first, as the 
 removal of the injuring cause ; and, secondly, as a stimulus 
 to action. If, then, the part do not recover itself, in pro- 
 portion to the removal of the hurtful cause, but remain sta- 
 tionary, it is evident that a farther removal is at present use- 
 less, and the stimulus which is consequently given is highly 
 dangerous. By these means, then, we proceed slowly to- 
 ward recovery, and keep up the ground which we have 
 gained. 
 
 If, however, the action of the part have been sunk very 
 low, then recovery is impossible, there being little or no en- 
 ergy, and so little action, that it cannot increase itself to- 
 ward the natural state. In this case, our endeavours must 
 fail, and will even kill the part sooner than if we had let it 
 alone ; for the least increase of action destroys the life of 
 
 * Sec the preliminary dissertation: 
 
 vol; ft. x 
 
100 
 
 the part, which may, in this case, be compared to a dying 
 taper, which gives one brighter flash before it becomes for 
 ever extinguished. 
 
 If, on the other hand, the action have not originally been 
 sunk so low as to make the process toward death continue 
 progressively, but the remedies have been applied too quick- 
 ly, or, from any cause, have failed to produce this effect, 
 then the action becomes inflammatory The pain becomes 
 of a burning kind, there is a feeling of pulsation, and the 
 part becomes redder, or livid, whereas, before, it was bluish ; 
 from the stagnation of the blood, there was no feeling of pul- 
 sation, or arterial motion, and the sensation was that of a 
 painful cold and weight. The inflammatio debilis is now in- 
 duced, and the danger is great, but still there is a possibility 
 of recovery, which is exactly in proportion to the degree of 
 previous diminution of action, and to the rapidity with which 
 the subsequent inflammatory action was induced, and the 
 degree to which it is raised ; or, in other words, the danger 
 is proportioned to the disparity betwixt the action and the 
 power. 
 
 The remedies for this disease are such as tend to induce 
 an action similar to the natural one, by which we remove the 
 diseased one ; for we know of none which excite the natural 
 action directly, otherwise they would be of universal utility, 
 and would, in the present instance, be preferred to every 
 other. The remedies which we employ with this intention, 
 are bark, opium, &c. internally, and vinous, or spiritous ap- 
 plications externally. These, however, would be pernicious, 
 were there no inflammation present, because they would, by 
 exciting action, tend to induce this ; but, when the inflam- 
 matory action is once induced, then, as they excite one more 
 nearly resembling the natural one, they are useful ; for, on 
 the one hand, they destroy the morbid one, and, on the 
 other, increase the power of recovery ; but, for this pur- 
 
101 
 
 pose, internal medicines, and good diet, must be given, as a 
 source whence the energy is to be renewed, by the renewal 
 of the natural action. Heat is of the most pernicious ten- 
 dency in this complaint ; because it simply increases the 
 exciting action, and, therefore, makes the inflammatory ac- 
 tion still more violent. The applications, therefore, ought. 
 to be cold, as long as the morbid action continues ; but, when 
 it is abating, and recovery is going forward, they may be 
 made a little warmer, as they will thus accelerate the heal- 
 ing process which is taking place ; but this requires much 
 prudence. 
 
 Spirit of wine is one of the best applications in this dis- 
 ease, and is one very generally employed. Camphor is fre- 
 quently added to it, and appears to increase its efficacy. 
 Pledgets dipped in camphorated spirit of wine, and applied 
 to the part, will, if frequently renewed, in many cases, re- 
 move the inflammation, and prevent gangrene ; but, in every 
 instance, it at least relieves the pain, which uniformly re- 
 turns, if, when the inflammation is violent, we omit the ap- 
 plication, or use a weaker spirit, such as the proof spirit. 
 
 Essential oils, particularly that of turpentine, which is 
 easiest procured, are also useful, but are inferior to the alco- 
 hol. 
 
 Laudanum, in slight cases, is useful as a topical applica- 
 tion ; but, if the inflammation be more severe, it must be 
 mixed with rectified spirit. A very useful application may 
 be prepared by adding two ounces of laudanum to a pound of 
 the spt. vin. camph. of the pharmacopoeia. 
 
 Internally, the bark must be exhibited in full doses, with 
 such a quantity of wine as the feebleness of the pulse points 
 out ; but we must be prudent in this respect, because, if we 
 give too much, we may increase the local disease. As long 
 as it does not increase the pain, or quicken the pulse, it is to 
 be considered as useful. 
 
102 
 
 Opiates are extremely necessary in the inflammatio debilis, 
 and, in general, require to be given freely. 
 
 Soups, and other articles of nourishing diet, are absolutely 
 requisite, and ought to be given in small quantities at a time, 
 but frequently repeated. 
 
 By these means we may frequently resolve the inflamma- 
 tion completely ; but, at other times, when we have gained 
 a certain ground, the inflammation terminates in the suppura- 
 tive action ; or, in other words, when the parts have gained 
 more strength, and the action has come more nearly to resem- 
 ble the inflammatio valida, which has continued for some 
 time, a similar termination takes place. This event cannot, 
 perhaps, in these cases, be prevented, and, although it may 
 occasionally protract the cure, yet it diminishes the danger, 
 making mortification less to be dreaded. The best treat- 
 ment, in these cases, perhaps, is to continue our usual appli- 
 cations, avoiding warm poultices until the action be fully 
 formed ; then moderate heat may accelerate the progress of 
 the abscess toward the surface. The same internal medi- 
 cines must be exhibited, the anodynes, however, being 
 gradually diminished as the pain (which marks the necessity 
 for their use) abates. 
 
 It too frequently, however, happens, that either our reme- 
 dies fail, or the proper ones are not assiduously and judicious- 
 ly employed, in which case mortification takes place. This 
 requires the same treatment, in whatever way it is induced, 
 only its progress is, from certain causes, more rapid* in one 
 case ihan in another, and, therefore requires the more free 
 use of the appropriate remedies ; but the general principle is, 
 in every case, the same, and, therefore, I shall here consider 
 the disease indiscriminately, whether it succeeds the inflam- 
 
 * It is ..'Ore rapid in the inflammatio dobilis than in tbe inflammatio valida, and 
 la very delicate parts than in parts which are less so. 
 
1Q3 
 
 matio valida, or debilis ; because, in both instances, the case 
 is exactly the same, only, in the first, the weakness which in- 
 duces mortification, is produced by the inflammation alone, 
 whereas, in the second, it existed to a great degree before 
 the inflammation was excited. 
 
 Mortification is to be prevented from succeeding the in- 
 flammatio valida, by timely bleeding, and the use of the 
 agentes dissimiles, by which we procure resolution, or at 
 least make the induction of the purulent action more easy. 
 In the inflammatio debilis, it is to be prevented by remedies 
 of an opposite nature. 
 
 When, however, these remedies fail, and mortification 
 does take place, our great object must be to prevent it from 
 extending far, and from injuring the system. These inten- 
 tions are answered by the same remedies which cure the in- 
 flammatio debilis ; because the local treatment of mortifica- 
 tion is merely that of the inflammatio debilis ; for it is only 
 Ihe parts which are still alive, or inflamed, which can be 
 acted on by our remedies. 
 
 The remedies are either general or topical, and may be 
 ronsidered under these divisions ; but both must be used at 
 the same time. 
 
 Many of the older writers, proceeding upon the humoural 
 theories, began their treatment of gangrene by bleeding and 
 purging, after which they prescribed theriaca, and other sti- 
 mulating applications. Some modern authors still adhere, 
 in part, to this practice, and consider the loss of blood to 
 be advantageous in cases of incipient gangrene. Mr. Bell, 
 who is one of the latest writers on this subject, informs us, 
 that, when the " general symptoms of inflammation, particu- 
 larly a quick, full, or hard pulse, still continue violent, and 
 especially when the patient is young and plethoric, it then 
 becomes absolutely necessary, even although mortification 
 may have commenced, to empty the vessels a little by one 
 
101 
 
 general blood-letting," which, * in such cases, may in re- 
 ality be considered as an antiseptic ; and it does often in- 
 deed, in this particular situation of mortification, prove more 
 powerfully so, than all the different articles in general enu- 
 merated as such." If, however, we consider the nature of 
 mortification, and the circumstances under which it is most 
 likely to occur, we must look upon this practice as dange- 
 rous, and must be permitted to doubt whether the full hard 
 pulse is to be met with after the commencement of inflam- 
 mation, or whether the symptoms of the iuflammatio valida, 
 (in which alone bleeding is admissible) still continue violent, 
 after one portion of the inflamed part is evidently gangre- 
 nous. Is it reasonable to suppose that one portion of the 
 inflamed part shall be already dead, or dying, and that yet 
 the rest shall not have begun to suffer ? or that the action 
 shall not have become converted into the inflammatio debilis, 
 (if it were not originally this I) This surely is not the time 
 for bleeding, purging, and debilitating remedies ; but the 
 part must be considered as possessing the low inflammatory 
 action, and the patient as requiring suitable remedies. It 
 may indeed be said by some, in favour of bleeding, that the 
 bark, in some instances, does not check the progress of the 
 disease ; but it surely does not thence follow, that it does 
 positive injury, and that remedies of an opposite nature are 
 useful. 
 
 The peruvian bark is, in many cases, one of the most use- 
 ful internal remedies. It was originally introduced into me- 
 dicine, about one hundred and fifty years ago, as a cure for 
 intermittent fever ; and its utility in gangrene is said to have 
 been discovered by its curing this disease in a person who 
 had it combined with ague, and who was taking the bark on 
 account of the latter complaint. For many years after it 
 was known in Europe, great prejudices prevailed among phy- 
 sicians against its use, partly on account of its having been 
 
105 
 
 improperly administered, but still more because it was so un- 
 fortunate as to cure diseases without necessarily either 
 sweating or purging the patient, a fact which could be only 
 ill explained, or rather scarcely allowed to be possible, by 
 the prevailing theories of physic. Accordingly, although 
 the cases in which it had been successful were by no means 
 a secret, and although several had the courage to employ it, 
 in spite of all speculative arguments, yet neither Dr. Boer- 
 haave, nor his commentator, Van Swieten, thought it expe- 
 dient either to recommend or prescribe it. Renewing the 
 motion of the stagnating blood by venesection, and the ex- 
 hibition of trifling remedies, which could scarcely be called 
 cordial, although sometimes dignified with that epithet, to- 
 gether with the external application of ardent spirits, or oil 
 of turpentine, constituted the current practice in gangrene. 
 These prejudices against the bark, which originated in igno- 
 rance, and were supported by attention to a foolish theory, 
 continued long ; but the want of a better remedy began at 
 last to make them gradually give way, and the success of 
 empyrics who used the bark soon completed their downfall. 
 The bark induces an action nearly similar to the natural 
 one, which is greatly injured, and, therefore, it gives a check 
 to the progress of the disease ; but, if its operation be not 
 assisted by nourishment, £cc. its good effects soon subside, 
 because the materials whence new energy can be drawn are 
 withheld, and, therefore, the system cannot profit so much 
 by the establishment of the new action, and by the restora- 
 tion of the power of converting the vital principle of foreigu 
 matter into nervous energy. The bark, then, is of service, 
 in two points of view: First, it changes directly the action 
 of the system, it induces, in a considerable degree, an action 
 somewhat similar to the natural action, and, therefore, coun- 
 teracts the general action of descent which was taking place. 
 Secondly, by inducing this action, it, to a certain decree* 
 
J 06 
 
 produces the same effects for a time which would have been 
 produced by the natural action itself, or increases the power 
 of renewing vitality ; for, in the preliminary dissertation, it 
 was mentioned, that the production of energy was exactly 
 proportioned to the perfection and healthiness of the exist- 
 ing action. The good effects of bark, then, cannot be ob- 
 tained without nourishment and free air. 
 
 It uniformly happens, however, that, in many instances, 
 where the action of the bark would be most beneficial, it is 
 impossible to induce it, owing to several causes, but particu- 
 larly to its effect on the stomach ; for, in many instances, it 
 produces sickness, or nausea, in which case it can do no 
 good, and ought to be abandoned. Momentary sickness, 
 after taking a dose of bark, is indeed a very general effect, 
 and does not materially injure its operation ; but, whenever 
 it is either frequently vomited, or produces a sickness of 
 considerable duration, it must either be given in smaller 
 quantities, or in a different form, or at longer intervals ; or 
 if all of these fail, it must be laid aside completely, because 
 it not only cannot produce its specific effect, but will even 
 injure the remaining powers by its effect upon the stomach. 
 
 The best form in which bark can be prescribed is that of 
 powder, which is more effectual than any tincture, or the 
 extracts. This ought to be exhibited in as great quantity 
 as the stomach will bear, which cannot be reduced to any 
 certain scale. In general, an adult ought, if possible, to take 
 half a drachm, or two scruples, every forty minutes, in the 
 most palatable vehicle ; for much depends upon the taste, 
 owing to the sympathy betwixt the mouth and the stomach ; 
 and, for this reason, the same vehicle ought seldom to be 
 used more than twice in immediate succession ; because, by 
 changing the vehicle, we not only change the taste, which 
 has a tendency to prevent loathing, but also modify the im- 
 mediate action on the stomach, changing, to a certain degree^ 
 
107 
 
 the former impression, which was perhaps beginning to pro- 
 duce sickness. Lemon juice and water, the different kinds 
 of wines, punch, pimento, cinnamon, and peppermint waters, 
 milk, rose water, beer, &c. afford us a variation which may 
 be usefully employed. 
 
 The tincture and watery infusion of the bark, either se- 
 parately or mixed together, are frequently employed, when 
 the powder is vomited ; but, as they must be given in very 
 considerable quantities, in order to produce any good effect, 
 they are very apt to produce sickness, and are likewise so 
 inferior in power to the powder, that they are very little to 
 be trusted. 
 
 The extract with resin, is a better form than the tincture, 
 or infusion ; and, where the powder is rejected, may be 
 made into pills. 
 
 When the stomach rejects every form and preparation, it 
 has been proposed to give the bark in clysters, and this 
 ought certainly to be done rather than lose the effects of the 
 remedy ; but, ,given in this way, its effects are more uncer- 
 tain. From two drachms to half an ounce of the powder of 
 bark, may be diffused in three ounces of soup, or mucilage, 
 with fifteen or twenty drops of laudanum, and given as an 
 enema. This must be repeated at least every hour and a 
 half, or two hours, until the stomach can retain the medir- 
 cine. 
 
 The wine is very usefully conjoined with the bark, and is 
 even of considerable use by itself, when the bark is reject- 
 ed. Its operation is more speedy than that of the bark, 
 but it is perhaps more fugacious. The quantity which is 
 necessary to be given depends upon the effect of the local 
 disease upon the system, and on the inability to bear other 
 remedies. A table spoonful may be given in general every 
 quarter of an hour, unless it increase the pain, and frequency 
 of pulse, and produce restlessness, and heat of $e skhi. Tn 
 
 Tol, n. o 
 
108 
 
 these circumstances, we may be certain that we have in- 
 creased the quantity beyond the necessity.* 
 
 Opium is likewise an useful remedy in this disease, and 
 ought never to be omitted ; because it not only diminishes 
 the irritability, and, consequently, the pain, but likewise, 
 like the wine and the bark, counteracts, by the induction of 
 its peculiar action, the progress of the inflammatio debilis, 
 and, consequently, tends to check the mortification. This 
 medicine is most usefully exhibited in full doses, which not 
 only procure ease, but also frequently make the stomach 
 more readily bear other remedies. One grain of the extract, 
 or twenty-five drops of the tincture, may be given at once, 
 and the dose repeated whenever the action of the former 
 subsides. After some time, each dose must be increased 
 one half, and presently doubled, in order to produce the 
 same effect as it did at first. 
 
 These remedies may give a temporary check to the dis- 
 ease ; but, unless nourishment be conjoined, in every possi- 
 ble form, they will not of themselves be able to effect a 
 cure, if the disease be tedious. Soups, jellies, milk, sago, 
 &c. must be assiduously given in small quantities, and eveu 
 thrown up as clysters, if the stomach cannot bear them. 
 
 Vegetable acids, fixed air, wort, &c have been recom- 
 mended in this disease, probably upon the supposition of the 
 existence of a putrescent matter, or from their utility in 
 scurvy. Wort, however, and fixed air, do not appear to be 
 of very great benefit in this disease, at least they are by no 
 means to be put in competition with other remedies of more 
 approved efficacy, or allowed to interfere with their exhibi- 
 tion. The acid of lemons seems to be more generally useful 
 
 * The necessity for this, and other remedies, is in general proportioned to the 
 continuance of the disease, and the progress which it has made. In this, as in. 
 every other disease, we must be attentive to the effects of oot remedies, and con- 
 sider these in forroiog ouropiffjen.- 
 
10$ 
 
 than the carbonic acid ; and, perhaps, the nitrous acid 
 would be equally useful with the citric acid. These acids 
 do not operate by counteracting putrefaction, but by coun- 
 teracting' the action of descent, inducing a more healthy 
 action, and tending to excite ulceration, which is the mean 
 employed for separating the dead part, and producing re- 
 storation. For this purpose, however, the acids must be 
 given freely, otherwise no good is done. 
 
 The local treatment is to be conducted on the same prin- 
 ciple as in the cure of the inflammatio debilis. Pledgets, 
 dipped in the oil of turpentine, tincture of myrrh, or rather 
 in camphorated spirit of wine, which is one of the best ap- 
 plications which can be used, ought to be made use of. 
 
 These remedies can do little service when applied to the 
 dead portion ; but, as the whole part does not die at once, 
 there are always some portions which are still in the inflamed 
 state, and on which they act. They likewise prevent the 
 progress of the disease, by operating on the skin which is 
 contiguous to the gangrene. Every mortification, in gene?' 
 ral, attacks the skin first ; or, in other words, the inflamma- 
 tio debilis spreads faster along the skin than along the deeper 
 parts ; but, when once the skin is inflamed, and mortifies, 
 the disease extends to a greater or less depth below the sur- 
 face. Whatever, then, operates on the surface, and pre- 
 vents the progress of the inflammation, or cures the part 
 which is already inflamed, will tend to check the extension 
 of the disease, especially if the proper internal remedies be 
 made use of with a view to prevent the extension of the ac- 
 tion of descent. 
 
 Formerly, in order to allow these remedies to come in con- 
 tact with the living parts, it was customary to make incisions 
 through the dead portion, and not unfrequently through part 
 of the living substance. But as these cannot prevent the 
 extension of the disease over a greater surface, and, as the 
 irritation which is given, and the exposure of parts which 
 
110 
 
 have not yet assumed the ulcerative action, tend to increase 
 the inflammatio debilis, the practice must be considered as 
 improper. # It is now indeed almost universally laid aside, 
 owing, in a great measure, to the observations of the ingeni- 
 ous Mr. Pott. 
 
 Antiseptics, such as decoction of camomile flowers, &c. 
 have been recommended as external applications ; but, what- 
 ever effects they may have on the matter which is already 
 dead, it is evident that they can be of no service in preserv- 
 ing the living parts from suffering death. All that can be 
 expected from them is to check the putrefaction of the dead 
 substance, which they have very little power to do ; and, 
 therefore, they can never come into competition with more 
 valuable remedies, such as the camphorated spirit of 
 wine, &c. 
 
 W hen, by the use of the remedies already mentioned, the 
 progress of the gangrene is stopped, the ulcerative action is 
 induced in the part immediately adjoining to the dead portion, 
 and a red line of separation appears. By means of this ulce- 
 rative action, which takes place in every point where the 
 mortification stops, the dead part is separated from the liv- 
 ing, and comes away as soon as the bonds of dead muscular 
 fibres, tendons, &c. which unite them, are destroyed by pu- 
 trefaction. When this separation takes place, or when it is 
 advanced so far as to permit us to accelerate it by dividing 
 the loose tendons, vScc. the exposed part must be dressed as an 
 ulcer, or wrapped up in a poultice of the same temperature 
 with the human body. 
 
 If, however, the disease have penetrated deep, and destroy- 
 ed the limb so much as to render it impossible to cure it, or 
 useless, if it were possible, then amputation must be perform- 
 
 * The hot and almost boiliug oil?, which were poured into these Incision?, cbii- 
 tributed not a little to increase the disease. 
 
Ill 
 
 -ed; but this, whatever desire the patient may express, must 
 not be practised until the mortification be fully stopped, and 
 the ulcerative action induced ; because if performed sooner, 
 the mortification seizes the stump, and the patient is quickly 
 killed. The system is likewise in such a state as to be una- 
 ble to sustain the action which is necessarily produced by 
 the operation. It is even improper to cut too near the dis- 
 eased portion; because the parts here, although the mortifi- 
 cation be stopped, are so weakened, that they are less apt to 
 unite. The vessels often break out soon after they are tied, 
 and a new mortification is by no means an unlikely occur- 
 rence. Even when the amputation is performed pretty far 
 up the limb, the corners of the stump frequently mortify, or 
 become livid; but a few doses of bark and wine stop the pro* 
 gress of the disease. 
 
 Although it is a general rule that amputation is necessary 
 whenever the member is so destroyed as to become useless, 
 and although this must not be performed until the ulcerative 
 action be induced, yet it must not invariably be performed, 
 whenever this action takes place, because sometimes at this 
 period the patient is unable to sustain the general action 
 which the operation would produce. We must, therefore, 
 if the patient be much reduced by the extent, or long con- 
 tinuance of the disease, rather delay until, by good diet, 
 wine, &c. we have procured an increase of strength ; but, if we 
 find that either the patient loses ground, or his weakness re- 
 mains stationary under this treatment, we must then ampu- 
 tate ; because, it is probable, that the continuance of the 
 dead portion in contact with the living is tending to induce 
 still the general action of descent.* 
 
 * As an illustration of this rule, I may mention the following case : A man, du- 
 ring a voyage to a cold climate, had both his feet frost-bit, in consequence of 
 which mortification ensued. In this state he continued for two or three weeks, du- 
 ring which he received very little medjeal aid. When I saw him, both his feet 
 
112 
 
 When we do not deem it advisable to amputate Very soon 
 after the induction of the ulcerative action, it is sometimes 
 useful to cut off part of the black mortified portion, or per- 
 haps to remove a joint, by cutting through the remaining 
 ligaments. In this way, we lessen the fcetor, and make the 
 patient more comfortable. 
 
 After making these observations on mortification, I shall 
 conclude with the following case : 
 
 A young woman, who lived at a considerable distance from 
 Glasgow, was in May 1797, seized with erysipelas of the right 
 foot and leg, which, by her account, had been extremely 
 violent, and very much neglected. On the tenth day of the 
 disease she was brought to town, and admitted into the hospi- 
 tal. The foot was quite cold, the leg livid, and extremely 
 painful. Pledgets dipped in camphorated spirit of wine, 
 were applied to the parts, and bark, wine, and opium, 
 were prescribed, together with oranges, &c. and gradu- 
 ally increased in quantity, until at last she came to drink* 
 besides soup, a couple of bottles of wine daily, at the same 
 time that she took eight grains of opium, and a very consi- 
 derable quantity of bark, in the twenty -four hours. By these 
 means, the pulse was soon brought down from one hundred 
 and forly to one hundred and eighteen strokes in the mi- 
 
 <»cre mortified, from the toes to about three indies above the ankle joints, his pulse 
 Tvas feeble, very frequent, and intermittent, the strength was greatly impaired, and 
 Mie countenance sunk and ghastly. The ulcerative action had been induced 
 ;'or some time, but the want of wine and proper diet had prevented the system 
 from gaining by the cessation of the local disease. He began the use of the bark, 
 opium, wine, and soups, which he took very liberally, in consequence of which his 
 nulse became slower, and his strength increased. In two days, one of the ankle 
 .joints was removed by clipping through the tendons, and, in a few days more, the 
 rtther came away. Amputation was now performed below the knee of the right 
 leg, the constitution, instead of gaining, rsther beginning to lose ground. The 
 subsequent affection of the system was by no means great, and, in about a week, 
 he was much stronger ; but, as the bones of the ankle joint of the other leg were ca- 
 :ious, he again began to sink. Amputation was therefore performed on the left 
 side, in about three weeks after the first. During the cure, the wine, opium, and 
 Nourishing diet, were freely prescribed. 
 
113 
 
 uute ; but it was not until twenty days after her admissioti 
 that the ulcerative action was evidently induced. The 
 quantity of the medicine was now gradually diminished ; and,, 
 in a few days more, the separation being complete, the limb 
 was amputated above the knee. During the operation, I 
 paid particular attention to the saving of blood ; and the cir- 
 culation being destroyed in the parts below the knee, there 
 was scarcely any lost; At this time, she was still taking a 
 bottle of wine, with a considerable quantity of bark and 
 opium, daily. The wine was omitted after the operation ; but 
 she had a drachm of laudanum, and continued to take the bark. 
 In the evening the same quantity of laudanum was repeated. 
 Next day she was quite easy, and had slept well ; the pulse 
 beat only one hundred in the minute. On the third day 
 the stump was dressed, when it was found ^as was to be ex- 
 pected,*) that only a very imperfect adhesion had taken 
 place : One of the corners was also livid. The bark was 
 therefore freely continued, and six ounces of wine added 
 daily ; but the pulse having, on the fifth day, risen to one 
 hundred and ten, and the spot becoming of a darker colour, 
 she was allowed a pound of wine, which made the pulse falf, 
 and soon produced a separation of a small slough. In a 
 short time she went to the country cured. During the 
 whole period of the cure, the opium and wine which she 
 took produced neither stupor, nor the slightest appearance 
 
 * It is very seldom that a stump unites at first, if amputation be performed oo 
 account of mortification ; at least if the operation be not delayed until the health^ 
 and strength be fully re-established : But this can very seldom be the case ; for, 
 in most cases, the state of tke bones, and the disease of the part itself, prevents 
 recovery from taking place beyond a certain degree, and also prevents us from 
 delaying beyond a limited time. The system, therefore, is not allowed to recovf i 
 fully from the tendency to the action of descent, and union does not take place 
 In the case which was formerly mentioned, the first stump did not adhere fully, 
 but the second succeeded better, because then the system suffered more from the 
 state of the diseased bones, &c. than from the previous mortification, and, there- 
 fore, it had not the same inability to undergo the healing action-., 
 
114 
 
 of intoxication. I at one time, when the pain had for a cou- 
 ple of days been moderate, was willing to ascertain the ef- 
 fects of a milder preparation than the camphorated spirit, 
 and substituted proof spirit in its place ; but, in an hour, it 
 was obliged to be renewed, the pain having greatly increased. 
 
 Of the Treatment of the Injiammatio Assuefacta. 
 
 After the inflammatio valida has continued for a considera- 
 ble time, if neither suppuration, nor any other termination 
 be induced, it is very apt to be converted into the state 
 which has been called passive inflammation, or which, on ac- 
 count of its most frequent cause, I have called the inflam- 
 matio assuefacta. This action is, in several respects, dif- 
 ferent from the acute inflammation, and resembles it only in 
 its general appearance. It may, therefore, in one respect, be 
 considered as a termination of inflammation, being, strictly 
 speaking, a new action, or spurious inflammation. 
 
 This action succeeds the acute inflammation, sooner or 
 later, in different places ; and, when once induced, each suc- 
 ceeding inflammation of the same part is apt very quickly to 
 terminate in the same condition ; or, if the renewal of the 
 inflammation be very frequent, this is at last induced with- 
 out any previous acute inflammation. 
 
 A state somewhat similar to this, if not exactly the same, 
 precedes acute inflammation, as well as follows it ; for, during 
 the period which intervenes betwixt the first formation of 
 the action and its perfection, the part remains in this state. 
 We can sometimes observe the augmentation and diminution 
 of the redness and pain during the systole and diastole of 
 the arteries ; and, by the use of the same remedies which 
 cure the inflammatio assuefacta, we can sometimes prevent 
 the farther progress of the disease. 
 
116 
 
 Thus, pepper boiled in milk, is frequently used by the 
 country people as a cure for cynanche, during its incipient 
 stage. 
 
 Bleeding, saturnine applications, and the other remedies 
 which are useful in the inflammatio valida et acuta, are 
 hurtful here, and increase the disease. 
 
 The agentes similes, on the contrary, are useful, and may 
 be used internally, or topically. 
 
 Internally, the bark, wine and opium, with good diet, 
 ought always to be employed, if the part affected be very 
 delicate, and sympathize greatly with the constitution, or if 
 the extent of the disease be great. 
 
 Locally, stimulating applications are the proper remedies ; 
 and the strength and nature of these must depend upon the 
 natural or acquired delicacy of the part. 
 
 When the skin, or cellular substance, is affected with the 
 inflammatio assuefacta, spirit of wine by itself, or with the 
 addition of a little camphor, is a very useful application. 
 
 When the skin is not directly affected, but only the parts 
 immediately below it, as, for instance, the muscles in chronic 
 rheumatism, or the articulating surfaces of joints, we may 
 sometimes, by applying cloths dipped in laudanum, or strong 
 diffusion of opium, propagate, from the surface to a certain 
 distance, the narcotic action, and alleviate the disease ; but, 
 most frequently, we are obliged to trust entirely to the ef- 
 fect of the sympathy of equilibrium, diminishing the action 
 of the internal parts, without any considerable change of na- 
 ture, by increasing that of the surface. Blisters and rube- 
 facients, such as volatile linamentol. terebrinth. cum cam- 
 phora, &c. are the remedies for this purpose. 
 
 The inflammatio assuefacta, when it affects delicate parts, 
 covered only with a thin skin, such as the throat, forming 
 one of the most frequent species of cynanche, is cured by 
 
 VOL. II. p 
 
116 
 
 gargling with port wine, infusion of capsicum, and similar re- 
 medies. 
 
 When it affects the eyes, the use of stimulating and opia- 
 ted preparations have been long in use. The following is 
 one of the best : 
 
 R. Vini Albi uncias duas. 
 Opii drachmam. 
 
 Pulv. Gall, scrupulum. Macera per dies tres dein 
 cola. 
 
 A drop or two of this may be let fall into the eye three 
 times a day. 
 
 Electricity is recommended in the cure of this kind of 
 inflammation ; but this, as well as heat, are doubtful reme- 
 dies ; for both seem to increase actions without changing 
 them, except in so far as the change depends upon an in- 
 creased degree. Cold, on the other hand, lessens the power 
 of recovery, if carried to any great degree ; but, when slight, 
 it assists the operation of other remedies, by lessening the 
 performance of the existing action, which is morbid. All 
 applications, therefore, ought in general to be a little below 
 the temperature of the part. 
 
 Whenever an inflammation does not manifest a tendency 
 to any other termination, but continues stationary, or per- 
 haps becomes worse, under the use of the remedies which 
 we employ for the cure of the inflammatio valida, we may 
 consider that this action (or the inflammatio assuefacta) has 
 taken place, and that the nature of our applications must be 
 changed. Bark and wine, with anodynes, may be given in- 
 ternally, whilst, if the situation of the part permit, suitable 
 applications must be made to it. By continuing this treat- 
 ment, we frequently resolve the inflammatio assuefacta ; but, 
 occasionally, it becomes again converted into the true acute 
 
117 
 
 inflammation, in which case the continuance of the same re- 
 medies will do hurt. The appropriate local remedies, such 
 as cold, saturnine preparations, &c. must be had recourse to, 
 if the part be external, whilst, if the pulse become hard, and 
 more frequent, or fuller, general remedies, such as bleeding 
 in small quantity, may be useful ; but both local and general 
 remedies must be used with moderation, and pushed only a 
 certain length, otherwise we defeat our intention, and again 
 speedily induce the inflammatio assuefacta, by interfering 
 with the powers of recovery. If this happen, we must 
 again have recourse to the proper remedies. 
 
DISSERTATION III. 
 
 ON THE PHAGEDENIC, AND SOME OTHER SPECIE? OF 
 SPECIFIC INFLAMMATION. 
 
 When any peculiar modification of the inflammatory action 
 takes place, specific inflammation is said to be produced ; 
 that is to say, the action possesses some peculiar or specific 
 qualities, independent of the simple condition of inflamma- 
 tion ; and these are generally productive of evident and vi- 
 sible effects, which are characteristic of their presence ; but, 
 until these effects, which are chiefly observable in the ap- 
 pearance of the consequent ulceration, appear, it is frequent- 
 ly impossible, from the symptoms of the inflammation alone, 
 to say that it is specific ; because the evident effects, or 
 symptoms of the inflammatory action, such as heat, pain, 
 redness, Stc. admit of few specific alterations, varying only 
 in degree, and this variation taking place often without any 
 specific affection of the action.'* 
 
 The effects of the ulcerative action admit of greater varia- 
 tions than those of the inflammatory, and, therefore, more rea- 
 dily show the presence of specific action. The healthy ulcera- 
 tive action exhibits certain appearances which have been al- 
 
 * In most specific inflammations-, if not in every one, the redness is never of the 
 bright scarlet colour, but always more or less purple, or dusky ; but this m?'. 
 take place without any specific action. The sensatioD is also sometimes different 
 
119 
 
 ready described, and which are easily known. The simple de- 
 viations which have been treated of, in considering the differ- 
 ent genera of ulcers, are also discoverable by the effects, or 
 peculiar symptoms. The specific deviations dependent upon 
 the presence of previous specific inflammation, or the appli- 
 cation of a morbid agent, after simple ulceration has been in- 
 duced, may also, in many cases, be detected and ascertained, 
 by the variations which take place in the aspect of the sore, 
 the appearance of the granulations, discharge, &c. ; but these 
 variations and appearances consist so much in peculiar hues 
 and qualities of the granulations, which we have no Words to 
 convey an idea of, that it is impossible to give an accurate 
 description of a specific sore, but must see it in order to 
 obtain an idea of it. We may indeed say, that a sore is 
 ragged, has a fiery look, is surrounded with an erysipelatous 
 margin, and discharges a thin foetid matter, but still we shall 
 not convey the idea of the specific appearance of the ulcer. 
 It is this specific appearance alone which characterizes a 
 specific ulcer ; and this, in each peculiar ulcer, is different ; 
 and a knowledge of it can only be obtained by an attentive 
 examination of many sores. On this account, it is extreme- 
 ly difficult, in many instances, to distinguish a specific ulcer, 
 because the discrimination depends altogether upon the re- 
 rollection of the practitioner, and the improvement which 
 he has made of his former observations. It is indeed, it 
 may be thought, an easy matter to distinguish a simple ulcer 
 by negative characters, or the want of the peculiar aspect ; 
 but, as this aspect is very arbitrary, and as the appearance 
 of simple ulcers is, as has been already described, very va- 
 rious, it is difficult to say, without much judgment, whether 
 the sore be simple or specific ; for the appearance of the one 
 and of the other run imperceptibly into each other. Even 
 it' it be ascertained to be specific, it is difficult often to dis- 
 tinguish betwixt particular specific diseases, in so much, that 
 
120 
 
 many are forced to take mercury for the cure of syphilis, 
 who never had that disease. 
 
 Besides the appearance of the sores, specific action like- 
 wise produces a perceptible effect upon the scab which 
 covers them, or the cicatrix which is formed. Thus, scro- 
 phula is marked by a particular appearance of the cicatrix, 
 or of the scab. The venereal ulcer has likewise a particular 
 scab, and many cutaneous ulcers are best distinguished by 
 the scab. Other actions produce no considerable ulcera- 
 tion, but only successive desquamation of the cuticle. 
 
 We may also sometimes discover specific action by the 
 sensation of which the action is productive. Thus, for in- 
 stance, cancer produces a burning kind of pain, which never 
 attends simple ulceration. 
 
 Specific ulceration is also always surrounded with more 
 or less simple inflammation, or erysipelas, of the surrounding 
 skin. In some cases the margin is hard, in others ragged, 
 .Sec. 
 
 It were much to be wished, that some more certain, and 
 less arbitrary criteria, than those which we possess of the 
 presence of specific action could be discovered ; but, as yet, 
 we know of no other which can be applied universally. 
 Some kinds, indeed, are so well marked, and so peculiarly 
 distinguished from simple sores, that they can be tolerably 
 well described, and easily discovered to be specific ; but, 
 there are others which it is more difficult to ascertain, owing 
 to the difficulty of fixing the character of each individual 
 action. 
 
 The number of specific inflammations is very great, and 
 the causes which produce them are often obscure. In the 
 preliminary dissertation it was mentioned, that, whenever 
 any action existed strougly in any one part, it tended to in- 
 duce an inflammatory state. There are, therefore, no gene- 
 ral, or febrile diseases, which may not be attended with pe- 
 
121 
 
 culiar inflammations. That typhus fever is attended with 
 local inflammatory action is pretty certain ; but the presence 
 of specific inflammation is still more evidently seen in the 
 different exanthematous diseases. The diseases called cuta- 
 neous, afford us also numerous instances of specific inflam- 
 mation. 
 
 From the difficulty of discriminating betwixt diseases, 
 which, although essentially different from each other, yet 
 possess a very great similarity, we find, that the number of 
 specific inflammations is confined much within the true limits ; 
 for we find many confounded under the name of herpetic, &c. 
 which are radically different from each other. 
 
 Phagedena has been used by medical writers in a very ex- 
 tensive sense, and has been made to comprehend diseases, 
 which, strictly speaking, cannot be considered phagedenic. 
 
 The phagedena is a suppurating sore, dependent upon the 
 application of a peculiar contagion. No granulations are 
 formed, but both sets of vessels yield a thin fluid. The sur- 
 face of the sope has a jagged appearance, dependent upon the 
 irregularity of the absorption, and not upon the deposition of 
 organic particles, or granulations. The colour of the surface 
 is dark, but clear, or fiery. The surrounding integuments 
 are erysipelatous. The discharge is thin and serous, and 
 the pain considerable. This is divisible into two varieties : 
 First, the true phagedenic, which does not go deeper than 
 the skin, but spreads rapidly along the surface. This kind 
 frequently stops in its progress suddenly, arid skins over as 
 fast as it spread. Second, the noma, or penetrating phage- 
 dena, which extends deeply, penetrating sometimes perpen- 
 dicularly down through the cellular substance to the muscu- 
 lar fascia ; at other times, proceeding more irregularly, pene- 
 trating deeper at one part than another, and having its mar- 
 gins ending less abruptly in the neighbouring skin. This 
 never cicatrizes rapidly ; but, sometimes, when the sore as- 
 
122 
 
 sumes a healing appearance, it suddenly becomes again dis- 
 eased, and a considerable portion sloughs off. The alterna- 
 tion of proceeding a certain length in the cure, and relapsing, 
 is frequently repeated, and often renders the disease very 
 tedious. 
 
 The best application for the common phagedena is an oint- 
 ment consisting of an ounce of ung. resinos. and a drachm of 
 red precipitate. 
 
 The application of caustic to the surface also frequently 
 stops the progress of the disease. 
 
 The hepatized ammonia, much diluted, is also very useful 
 as a lotion. 
 
 The penetrating phagedena is more difficult to cure ; for 
 even after the diseased action is removed, the ulcer remains 
 in an irritable, or overacting state. The application which 
 I have found most useful is powdered opium, mixed with sim- 
 ple ointment, in the proportion of two drachms of the former 
 to an ounce of the latter. After the phagedenic action 
 ceases, the sore must be treated according to the genus of sim- 
 ple ulcer to which it belongs. 
 
 When the sores seem to pursue their ravages obstinately, 
 the most effectual mean of stopping their progress (until we 
 discover a specific remedy, or one which can change the 
 nature of the actiou,) is to apply the caustic to every part, 
 and so freely, as to produce a pretty thick slough. Whenever 
 this appears to separate, precipitate must be applied, in or- 
 der, if possible, to prevent the recurrence of the diseased 
 action. 
 
 When any considerable vessel is eroded, by the continu- 
 ance of this disease, it must be tied beyond the diseased 
 part ; but we must be careful that no matter from the sore 
 gets upon the wound, otherwise it will become diseased also. 
 I have a preparation, in which a part of the femoral artery 
 was opened at the groin by this kind of sore, which succeed- 
 
123 
 
 ed a venereal bubo. No operation, I understand, was at 
 tempted, but compression alone used. The man died in a 
 short time. Whether tying the iliac artery, by cutting 
 through Poupart's ligament, would have saved him, is diffi- 
 cult to say. 
 
 The true phagedena seems always to confine its action to 
 a particular spot ;* but many of these diseases, which have 
 been described under the same name, appear to be capable 
 of inducing a general action, similar to the venereal disease, 
 affecting different parts of the body in succession. A case 
 of this kind is related by Mr. Adams, in his Observations on 
 Morbid Poisons : A gentleman who had a small pustule on 
 the prepuce, squeezed it so as to make it burst, and soon 
 afterwards had connexion with a woman whom lie had long 
 known. The sore remaining without healing, he applied a 
 solution of caustic, and had recourse to mercurial frictions. 
 But, notwithstanding these, the ulcer spread, and soon reach- 
 ed the scrotum. The mercury was now laid aside, and 
 bark, with a good diet, was substituted, after which the ul- 
 cer put on a healing appearance ; but, before cicatrization 
 took place, a feverish fit supervened, with violent pain in 
 the part. In the course of a short time, however, the un- 
 favourable symptoms disappeared, and a healthy condition 
 was again apparently induced. These paroxysms of fever, 
 and subsequent amendment, alternated with each other for 
 a considerable time, and each relapse was preceded by a 
 livid appearance round the sore. These appearances at last 
 went off, and the sore assumed more the aspect of the true 
 phagedena. The cicatrizing process now began at the upper 
 part, and proceeded rapidly until almost the whole sore was 
 covered. But, nearly about this time, copper coloured spots 
 
 * The neighbouring glands sometimes swell and suppurate, but they hf»al kifld 
 ly, and the disease proceeds no farther. 
 VOL. II. Q 
 
124 
 
 appeared on the hands, and the inside of the right thigh ; 
 and, in a day or two afterwards, an ulcer appeared in the 
 throat, with " bumps" on the head. Shortly afterwards a 
 node appeared on the tibia, and the patient became bandy. 
 The blotches speedily began to ulcerate, and another ap^ 
 peared on the sternum. Mercury was now given freely, 
 and at first with apparent success, for the ulcers looked bet- 
 ter, and no new affection appeared ; but, whenever the mer- 
 curial action was beginning to be fully induced, the granula- 
 ting appearance of the surface was destroyed, and it be- 
 came of a dusky colour, discharging " bloody sanies." The 
 bones remained stationary. The medicine was now discon- 
 tinued, and the patient went to the country ; but, on his re- 
 turn, in about a fortnight, " his throat was again ulcerated.* 
 Such of the old external ulcers as had not healed, threw up 
 a kind of fungus granulations." The sore on the penis, 
 which never had been completely well, had spread to the 
 size of a shilling, but had no phagedenic, or specific appear- 
 ance. Mercury was afterwards tried, and some bones exfo- 
 liated from the nose. The ulcer healed ; but, as soon as he 
 recovered from ihe effects of the mercury, new blotches and 
 ulcerations, with a new enlargement of the tibia, took place. 
 " He is now under his fifth mercurial course." 
 
 In this case, mercury evidently was prejudicial, except 
 toward the end. It does not appear that the caustic had 
 been freely applied to the original local disease, which might 
 have destroyed it. These affections, which were by some 
 considered as venereal, evidently differed from that disease, 
 in the rapidity of its progress, in the appearance of the pri- 
 mary sore, and in the history of the whole of the symptoms. 
 We are as yet in the dark with regard to a specific remedy 
 for these, and similar affections. 
 
 ' From this, it would appear, that his throat had been at one time healed. 
 
125 
 
 There are several other ulcers, which appear upon the 
 penis after coition, which probably depend upon the applica- 
 tion of a peculiar contagion. These* are sometimes super- 
 ficial and phagedenic ; they spread fast, and heal rapidly, 
 frequently in the course of a night after precipitate has been 
 applied. At other times they are deeper, and more like a 
 little cup ; the surface is smooth and glossy, without any 
 appearance of granulations ; the discharge is thin, and the 
 base and margin quite soft. The best remedy is the caustic, 
 with the subsequent application, precipitate, or ung. hyd. 
 nit. dilut. When buboes form, I have always found them 
 heal without the use of mercury. If, however, the bubo be 
 the first symptom which appears, as is sometimes the case, 
 (for the morbid agent is occasionally absorbed before it ex- 
 cites action in the part to which it is applied,) then it is 
 generally much more difficult to heal than when it is pre- 
 ceded by a local action, and induced by the absorption of 
 matter generated there. 
 
 If these local, or primary symptoms, be not speedily re- 
 moved, a general disease is induced, as we see in the case 
 already mentioned, and as is proved by numberless other in- 
 stances. These general affections are marked by ulcerations 
 of different parts ; and the ulcers have a different appear- 
 ance, according to the nature of the morbid agent. In some 
 cases they are better and worse at intervals. Mercury has, 
 in almost all these cases, been used ; but, although some are 
 ameliorated by it, yet others resist its action. At first, in- 
 deed, they generally appear to heal ; for the mercurial ac- 
 tion, when forming, interrupts the progress of the former dis- 
 eased action ; but, whenever the mercurial action is fully 
 
 * Many of these have been confounded with the venereal disease, and treated 
 accordingly. 
 
 It were much to be desired that they should be accurately described, and one 
 land distinguished from another, for there .ire probably many different s ; ecies 
 
126 
 
 induced, we sometimes find that the appearances change, 
 and the progress generally becomes quicker than formerly.* 
 
 There is a disease which is not unfrequently confounded' 
 with syphilis, but which is distinct from it ; I mean small ul- 
 cers about the mouths of children, which are more like aph- 
 tha? than any thing else ; but, soon after their appearance, 
 small blotches appear in the body, which become first raised 
 into a little flat vesicle, and then ulcerate superficially. These 
 ulcers have a watery appearance, not much unlike tetters : 
 but the appearance of the vesication, and dark colour of the 
 preceding blotches, prevent any confusion. Nurses who suckle 
 these children have generally small calyciform ulcers on the 
 nipples, of a pale colour, and discharging a thin watery mat- 
 ter. I have had no opportunity of ascertaining what, constitu- 
 tional symptoms would be produced by the continuance of 
 the disease in the nurse, as I have generally found that the 
 application of diluted citrine ointment to the nipple produ- 
 ced a cure, without any internal medicine. The constitu- 
 tional symptoms in the children were cured by the same lo- 
 cal applications, with small doses of calomel internally. f 
 
 I have likewise observed ulcers on the lips, throat, and 
 mouth, which at first had a very doubtful appearance ; but 
 
 * Some actions cannot be induced during the continuance of others. Other ac- 
 tions can, in these circumstances, he formed, and displace completely the former 
 action. A third set seem to give a modification to the original disease : They 
 change it to a certain degree; but the change is not salutary, and they never dis- 
 place it. The mercurial action, when induced during the existence of so;rre of 
 the diseases which I am describing, comes under the last, or third class. At first, 
 during the formation of the mercurial action, the former diseased action is inter- 
 rupted, in the same way as the natural action is injured during the period of for- 
 mation of other actions, when no peculiar disease previously existed. On this ac- 
 count, the sore assumes a better appearance; and, if the action be nearly ter- 
 minating naturally (as some actionu do, and as the primary action in these dis 
 eases more readily does than the secondary,) it quickly heals up ; but, if this be 
 not the case, the appearances soon change, ?.nd the disease becomes much worse. 
 
 f There are some cases, described by different authors, of affections of the nipples 
 •iud breasts, in which the ulcers appear to have been chiefly of the phagedenic kine: 
 
127 
 
 they evidently are distinct from syphilis, and belong to the 
 suppurating sores. When superficial, thebuiT-coloured mat- 
 ter, or inorganised substance which covers them, has a fi- 
 brous, or thready appearance, the margins are slightly tumid, 
 and of a florid, or kind of pink colour. The application of 
 caustic, or burnt alum is often sufficient of itself to cure 
 these; but small doses of mercury sometimes accelerate the 
 cure. At other times these sores penetrate deeper, and af- 
 fect the bones. The surface, which is deep, is covered with 
 a thick yellow slough, like an overacting ulcer. The mar- 
 gins are tumid, ragged, and of a light, or pink colour. Some- 
 times the disease spreads along the gum, which becomes soft, 
 ulcerated, and separates from the teeth, which very frequent- 
 ly become black, and, when the sockets are affected, drop 
 out. I have not had an opportunity of observing these sores 
 go the length of inducing constitutional symptoms. It is not 
 easy to ascertain the cause of these sores ; sometimes they 
 succeed the use of mercury ; but at other times, it is impos- 
 sible to blame any evident agent. The transplanting of teeth 
 sometimes has been the mean of inducing sores similar to 
 these ; and, in these cases, the disease has generally passed 
 for syphilis.* But although the venereal disease may have 
 been inoculated in this manner, it is certain, from the appear- 
 ance of the ulcers, from their rapid progress, and from the 
 sudden effect produced by a very smali quantity of mercury, 
 that the disease, which is commonly induced by transplanting 
 teeth, is not syphilitic. 
 
 Sibbens is another disease which has been very frequently 
 confounded with syphilis, and is by many considered to be 
 only a variety of that disease ; but they evidently are differ- 
 ent, as appears from the mode of infection, and the properties 
 
 * Cases of this kind may be found in Mr. Hunter's Treatise on the Venereal 
 Disease, and in the third volume of the Medical Transactions. 
 
128 
 
 of the contagion,* the appearance of the ulcers, their pro- 
 gress, and certain circumstances in their cure, particularly 
 their requiring less mercury than venereal ulcers in the same 
 state, and from their yielding readily to preparations of mer- 
 cury, which do not accomplish a cure of syphilis. 
 
 This disease appears first on the part which is most di- 
 rectly acted on by the contagion. This part becomes red 
 and inflamed, having an erysipelatous appearance. Ulcera- 
 tion quickly takes place on a particular spot, and spreads 
 rapidly along the whole inflamed part. The disease then 
 advances more slowly ; the erysipelatous appearance spreads 
 around the margin of the ulcer, and ulceration follows upon 
 the inflammation. In the course of some time (the precise 
 period is not fixed,) the skin becomes affected with blotches, 
 or sometimes clusters of small pustules, the intervening 
 space betwixt each being affected with an erysipelatous in- 
 flammation. These spots soon ulcerate, and the surface 
 rises up into a fungous, which is irregular, and has an aspect 
 somewhat betwixt the look of the venereal sore and a very 
 bad scrophulous ulcer. The bones next become affected, 
 particularly at the articulating surfaces, which swell, and be- 
 come carious. It is said that the secondary ulcers in gene- 
 ral appear first upon the genitals ; but, of all those whom I 
 have examined, no affection of these parts had taken place, 
 from which I would infer, that the disease has no peculiar 
 tendency to affect these in preference to other parts. It is 
 likewise said that the disease sometimes disappears from one 
 part, whilst it breaks out in another ; but this also I have 
 never witnessed. The primary ulcers also have no tenden- 
 cy, like some others, to change their appearance, and become 
 
 * This disease is communicated even by drinking out of the same vessel with an 
 infected person, even although that person, have no sores on the lips, but only in 
 the throat. The contagion then must either be dissolved in the saliva, or remain 
 very powerful, even when reduced to a state of haiku?. 
 
129 
 
 milder, or heal by continuance, but spread, destroying the 
 nose, orbits of the eyes, and face. The constitution seems 
 to suffer much more from this disease than from syphilis, in 
 the same length of time ; for the patient soon assumes a pale 
 sallow look ; and hectic comes on much sooner than in sy- 
 philis. 
 
 The cure of this disease is effected by washing the sores 
 with solution of corrosive sublimate, or dressing them with 
 precipitate ointment, at the same time that we use mercury 
 internally, without which no escharotic, or local application 
 whatever will effect a cure. In general, less mercury cures 
 this disease than syphilis ; and it is worthy of remark, that 
 permanent cures may be obtained by the hyd. mur. corros. 
 which is not the case with syphilis. When the bones are 
 affected, we must, in conjunction with the specific remedy, 
 use such applications as the state of the bone, considered as 
 a simple affection, will require. 
 
 The cynanche maligna, and scarlatina, are also diseases 
 producing ulceration in the throat. The sores are of the 
 suppurating kind, a thick lymphatic-looking, or inorganized 
 substance being thrown out, instead of organic particles, or 
 granulations. This, in the former disease, very soon be- 
 comes black, and putrefies ; but the slough so formed differs 
 materially from that caused by gangrene ; for, in this disease, 
 unless in the very last stages, there are no real gangrenous 
 sloughs. It is unnecessary here to make any particular ob- 
 servations on these diseases. 
 
 Herpes* is a disease which is very frequent, and often 
 prevents large ulcers from healing, as these come to assume 
 the action of herpetic ulcers, although, from their magnitude 
 
 * There are many different divisions of herpes; as, for instance, into the scur- 
 fy, scabby, miliary, &c. ; but. for a description of these, I must refer to the writers 
 on the diseases of the skin. 
 
130 
 
 and depth, they do not put on the same appearance as when 
 the disease is confined to the skin. The large ulcers are of 
 a dark sloughy appearance, discharge thin matter, are pain- 
 ful, and are surrounded with herpetic ulcers, and scabs in the 
 skin. This is a very frequent disease on the legs, and is 
 very tedious. Bathing with warm sulphureous water is of- 
 ten of service, at the same time that we dress the parts in 
 the intervals with camphorated ointment. Citrine ointment 
 is also very useful ; but the following liquor is one of the 
 best, and most effectual applications : 
 
 R. Pulv. Calcis Vivi Recen. unciam. 
 Flor. Sulph. semiunciam. 
 
 Aq. Font, sesquilibram. Coque ad dimidiam dein 
 cola. 
 
 This ought to be applied with cloths to the parts. 
 
 When, by these means, the disease of the skin, and the 
 specific action of the ulcer is removed, pressure is often of 
 service in completing the cure. 
 
 There is a specific ulcer, which is met with most frequent- 
 ly on the legs, and which is very troublesome. The skin 
 becomes in several points inflamed, or of a dark red colour. 
 These parts speedily ulcerate, and the sores belong to the 
 suppurating kind, for no distinct granulations, or organic par- 
 ticles, are formed ; but the surface is smooth and glossy, and 
 the discharge thin and copious. These sores are generally 
 pretty deep, in proportion to their extent, or of a cup-like 
 appearance. They not unfrequently occur in scrophulous 
 habits. Mercury, exhibited in small doses internally, ap- 
 pears to be useful. Precipitate, as a local application, gene- 
 rally answers very well ; but, when the sores become irrita- 
 ble, or spread under this treatment, hemlock poultices suc- 
 ceed better. 
 
131 
 
 There is a small ulcer, which sometimes is met with on the 
 foot of an irregular shape, fiery appearance, and surrounded 
 with thick jagged margins, which, in particular parts, are 
 white, and callous. The neighbouring integuments are of a 
 dark red colour. The discharge is thin, and the pain con- 
 siderable. Caustic, and afterwards, the application of the 
 adhesive plaster, are the best local applications. Internally, 
 the use of hemlock is sometimes of service. 
 
 It occasionally happens, that, nearly about the same time, 
 most of the patients in a ward of an hospital shall have their 
 ulcers rendered unhealthy. They become foul, dark colour- 
 ed, and spread : The discharge is thin, and the pain is great- 
 er than formerly. The application of cloths dipped in gas- 
 tric juice is sometimes of service in these sores, and is one 
 of the best remedies ; but, not unfrequently, the patient must 
 be removed to a different situation before a cure can be ob- 
 tained. 
 
 Having made these detached remarks on some specific ul- 
 cers, I shall, in the succeeding dissertations, consider, at 
 greater length, others, which are, in the general estimation* 
 considered as more dangerous and alarming. 
 
 vol,, if, 
 
DISSERTATION IV. 
 
 ON THE SPONGOID INFLAMMATION'. 
 
 The disease which I am now going to consider, has either 
 not been described at all by any author, or lias, when it was no- 
 ticed, been considered as of a cancerous nature. It is per- 
 haps one of the most alarming diseases to which we are sub- 
 jected ; because, as yet, we know of no specific remedy ; and 
 an operation can only be useful at a time when it is very dif- 
 ficult to persuade the patient to submit to it. 
 
 I have named it the spongoid inflammation, from that spon- 
 gy elastic feel which peculiarly characterises the disease, 
 and which continues even after ulceration takes place. 
 
 This disease begins with a small colourless tumour, which, 
 if there be no thick covering over it, such as the fascia of a 
 muscle, or the aponeurosis of the foot, is soft and elastic, but 
 tense if otherwise. It is at first free from uneasiness ; but, 
 by degrees, a sharp acute pain darts occasionally through it, 
 more and more frequently until the sensation becomes con- 
 tinued. For a considerable time, the tumour is smooth and 
 even, but afterwards it projects irregularly in one or more 
 points ; and the skin at this place becomes of a livid red colour, 
 and feels thinner. It here readily yields to pressure, but in- 
 stantly bounds up again. Small openings now form in these pro 
 
133 
 
 jee iions, through which is discharged a thin bloody matter. 
 Almost immediately after these tumours burst, a small fun- 
 gus protrudes, like a papilla, and this rapidly increases, both 
 in breadth and height, and has exactly the appearance of a 
 carcinomatous fungus, and frequently bleeds profusely. The 
 matter is thin, and exceedingly foetid, and the pain becomes 
 of the smarting kind. The integuments, for a little around 
 these ulcers, are red, and tender. After ulceration takes 
 place, the neighbouring glands swell, and assume exactly the 
 spongy qualities of the primary tumour. If the patient still 
 survive the disease in its present advanced progress, similar 
 tumours form in other parts of the body, and the patient dies 
 hectic. 
 
 On examining the affected parts after death or amputation, 
 the tumour itself is found to consist of a soft substance, some- 
 what like the brain, of a greyish colour, and greasy appear- 
 ance, with thin membranous-looking divisions running through 
 it, and cells, or abscesses, in different places, containing a 
 thin bloody matter, occasionally in very considerable quan- 
 tity. There does not seem uniformly to be an entire cyst 
 surrounding the tumour, for it very frequently dives down 
 betwixt the muscles, or down to the bone, to which it often 
 appears to adhere. The neighbouring muscles are of a pale 
 colour, and lose their fibrous appearance, becoming more like 
 liver than muscle. The bones are uniformly caries, when in 
 the vicinity of these tumors. If large, they are found rough, 
 and broken off info fragments ; if small, they are generally 
 soft and porous. This tumour is sometimes caused by exter. 
 nal violence ; but often it appears without any evident cause. 
 
 I know of no remedy which has a power of checking the 
 progress of the complaint, or removing it. Friction, with 
 anodyne balsams, sometimes gives relief in the early stages; 
 but it does not seem to retard the progress of the disease. 
 
134 
 
 Extirpation is the only remedy which has a prospect of be- 
 ing successful ; but it is only advisable in the early stages, 
 whilst the disease is entirely local, and has not extended to 
 the neighbouring glands ; for, after they become affected, 
 the chance of recovery is greatly diminished. It is, how- 
 ever, sometimes difficult to persuade patients at this time to 
 submit to amputation, or extirpation, because the pain and 
 inconveniences are inconsiderable ; but the operation ought 
 to be urged with all the eagerness which a conviction of its 
 absolute necessity, and its precarious issue, if delayed, will 
 inspire. 
 
 After making these observations, I shall illustrate the sul> 
 ject with the following cases ; the first of which is intended 
 to show the difficulty of extirpating the disease, when the 
 operation is delayed after the first appearance of the tumor. 
 In the second, we see the destruction which the bones suffer 
 by it, and the extent of parts which it may affect. The 
 third gives us an instance of the affection of the glands : 
 And the fourth, of the most advanced stage, or that in 
 which distant parts have suffered. The last is an instance 
 of the good effects of an early operation. > 
 
 CASE I. 
 
 William Stirling, without any very evident cause, per- 
 ceived a small tumor on the top of the shoulder, about mid- 
 way betwixt the termination of the neck and the articula- 
 tion of the humerus. This gradually increased for some 
 months, and by the time when I saw him was larger than a 
 goose's egg : It was spongy and elastic, and attended occa- 
 sionally with pain. 
 
 Although the duration of the tumor was an unfavourable 
 circumstance, yet I undertook the operation. I made an 
 incision through the whole length of the skin, and dissected 
 
135 
 
 it off the tumor, (the upper part of which was covered with, 
 a coat, or cyst,) down to its base ; but, when I now began to 
 separate it from the parts below, I found that it had no de- 
 fined bottom, but penetrated down betwixt the muscles, 
 which were soft, pale, and had lost their fibrous structure. 
 I therefore cut off the tumor close by the muscles, and then 
 separating them with the back of the scalpel, I removed with 
 the finger as much of the tumor as I could observe. Seve- 
 ral arteries sprung ; but these were pretty readily tied, al- 
 though the vessels were very tender. A troublesome oozing, 
 however, took place from many points of the diseased mus- 
 cles. This was moderated by applying the sponge dipped 
 in cold water, after which the skin was laid down, and its 
 lips brought close together. 
 
 On dressing the patient on the third day after the opera- 
 tion, the skin was found not to have united ; but its lips 
 were red and inflamed. In this state it continued for several 
 days, when the part began to grow tumid, and discharge a 
 thin foetid matter. The skin then retracted still more, and 
 a fungus protruded, which gradually increased ; but it was 
 smooth and regular, and of a pale colour, so that it rather 
 had the appearance of a superficial ulcer, raised up by a tu- 
 mor from below, than the ulcerated surface of a diseased sub- 
 stance itself. In this state it continued for two or three 
 months, when irregular projections appeared on the ulcera- 
 ted surface of the new tumor. These soon burst, and a 
 fungus protruded, of a carcinomatous appearance, and bleed- 
 ing very frequently and profusely. Swellings of the axillary 
 glands succeeded this, and the patient became much en- 
 feebled, and evidently hectic. As I have not heard of him 
 for several weeks, I suppose that he has died. 
 
 In this case a second tumor succeeded to the first, owing 
 to the impossibility of extirpating the whole, and this exact- 
 ly resembled the original one, except in having its surface 
 
13ti 
 
 covered from its commencement with an ulcer ; but this 
 nicer was not the specific one of the spongoid inflammation 
 
 CASE II. 
 
 John Overend was attacked with pain in the right thigh 
 and loins, which were considered as rheumatic. Shortly 
 after the thigh was observed to be elongated, and issues were 
 applied over the hip joint, upon the supposition of its being 
 a common case of morbus coxarius. Biu no considerable 
 relief was obtained by this ; on the contrary, the upper part 
 of the thigh swelled, whilst the lower part wasted, his appe- 
 tite diminished, his pulse was quickened, and he passed 
 sleepless nights. The thigh was rubbed with anodyne bal- 
 sam, and draughts with laudanum were given every night, 
 but only with temporary benefit. For the course of some 
 months these complaints continued, with occasional remis- 
 sion and aggravation. At last lie began to complain of diffi- 
 culty in making water ; and this soon ended in a complete 
 retention. The catheter was attempted to be passed ; but 
 although its point was bent, and directed so as to correspond 
 to any deviation of the prostrate gland from its right situa- 
 tion, it could not be introduced. By examining per anum, 
 a large elastic tumor could be felt in the pelvis, which was 
 considered as the bladder. A trocar was therefore passed 
 up the rectum, and the bladder attempted to be tapped. A 
 considerable quantity of bloody fluid came away ; but he 
 complained of no pain at the glans, which most patients do 
 when the bladder is wounded ; and a considerable quantity 
 of high coloured foetid urine was voided by the urethra, and 
 continued even afterwards to be passed, although with some 
 difficulty. Within a week after this the patient died. 
 
 On dissection, I found the hip joint to be complely sur- 
 rounded with a soft matter, resembling the brain, inclosed in 
 
137 
 
 thin cells, and here and there cells full of thin bloody water ; 
 the head of the femoral bone was quite carious, as was also 
 the acetabulum. The muscles were quite pale, and almost 
 like boiled liver, having lost completely their fibrous appear- 
 ance, and muscular properties. On opening the abdominal 
 cavity, the same kind of substance was found within the 
 pelvis ; and the greatest part of the inside of the bones of 
 the affected side were quite carious. Large cells were 
 found in this diseased substance, containing bloody water ; 
 and it was into one of these that the trocar had entered 
 when the bladder was attempted to be tapped. 
 
 CASE III. 
 
 James Walker received a stroke upon the outside of the 
 foot, immediately below the ankle joint. A small tumor in- 
 stantly formed, which continued stationary for several weeks, 
 and gave him little uneasiness ; but afterwards it began to 
 increase, and was attended with a shooting pain. The tu- 
 mor was elastic, pretty tense, and rather irregular in its ap- 
 pearance. I was anxious to operate, but the man would not 
 give his consent. I therefore advised frictions with ano- 
 dyne balsam, which at first gave him relief, but soon lost its 
 effect. For several weeks I heard nothing of him ; but, at 
 the end of this time, he again applied to me. The irregu- 
 larities of the tumor were much greater, more prominent, of 
 a red colour, and one of them had burst : From this a soft 
 half-organized fungus protruded, and a bloody fluid run out 
 constantly. An operation was again urged, but the timidity 
 of the patient made him again refuse. A month after this 
 he came under the management of another surgeon. There 
 were now three openings in the tumor, from each of which 
 protruded a broad cauliflower-looking fungus, covered with 
 thick fcetid matter ; there wa^ likewise a thin red serum dis 
 
138 
 
 charged from the margins of the ulcers. The tumor was as 
 large as a child's head, and one of the inguinal glands was a 
 little swelled. The man now consented to lose his limb, 
 and amputation was accordingly" performed. Whenever the 
 turniquet was applied, a very copious stream of veinoua 
 blood issued from the tumor ; but this ceased when the veins 
 had emptied themselves. Unluckily it was considered as 
 unnecessary to extirpate the diseased gland. 
 
 On examining the leg, all the bones of the ankle joint 
 were found to be quite soft and carious ; the tumour consist- 
 ed of a soft substance, resembling the brain, with light mem- 
 branous intersections. The cyst on the upper part was hard 
 and thick, but beneath it was entirely wanting, having either 
 never been formed betwixt the tumor and the tendons of 
 the muscle, or having been destroyed. The former opinion 
 is the most probable ; for I have never in any stage found 
 the cyst continued over the under or back part of the tumor, 
 but it always terminated imperfectly in the part on which 
 the tumor was seated. 
 
 The wound healed as well as could be desired, but the 
 gland became rather larger, notwithstanding which no opera- 
 tion was urged. Two months after this I was requested to 
 visit him. The gland was now as large as the head of a 
 new-born child ; it was soft and spongy, and had at one part 
 an irregular prominence, but the skin was not coloured. 
 The pulse was about one hundred and thirty, and the 
 patient completely hectic. In this situation I proposed no- 
 thing excepting nourishment. He died in the course of a 
 week after I saw him,. 
 
139 
 
 CASE IV. 
 
 The following case shows this disease in its most advanced 
 stage. It is extracted from the fifth volume of the London 
 Medical Journal, and is intituled, " An Account of the 
 Fatal Effects produced by attempting to remove a Ganglion 
 by Seton." It was drawn up by Mr. W. Dease, surgeon in 
 Dublin. 
 
 " In July, 1781, a clergyman, aged thirty-seven, consult- 
 ed me about a moveable ganglion, of the size of a small nut- 
 meg, situated between the fore-finger and thumb of his right 
 hand, near the wrist. He was eager to have it removed, 
 and had been advised, for this purpose, to have a seton pass- 
 ed through it, as the best and most certain method ; but, as 
 he was apparently a robust healthy man, and the ganglion 
 was attended with no pain, I advised him to consider it as a 
 matter of no consequence, and not to meddle with it. Four 
 months after this I was desired to visit him, and found him 
 in a melancholy situation. A seton had been passed through 
 the ganglion, and the consequences were, that the back of 
 his hand had inflamed violently, that the ganglion had rapid- 
 ly and amazingly increased, and that the openings made by 
 the seton were filled with an ill-conditioned fungus, which 
 sprung up as fast as it was removed, and was attended with 
 frequent hemorrhage, and much pain. In consultation, it 
 was agreed to remove this fungus by a free incision, which 
 was done, and the metacarpal bones appeared bare and 
 rough Auother opening was made through the thenar, and 
 a seton passed through it, in order more effectually to pre- 
 vent the growth of fungus. The bark was administered in 
 large quantities, an opiate was given at night, and due atten- 
 tion was paid to the regimen of the patient. This method 
 
 VOL. Uk s 
 
140 
 
 seemed to promise the most happy event. The fungus ap- 
 peared to be entirely destroyed, a laudable suppuration took 
 place, the swelling of the hand subsided, and the sores in a 
 short time were so contracted as to indicate their speedy 
 cicatrization. These favourable appearances, however, were 
 not of long continuance ; for, after some time, the fungus be- 
 gan gradually to rise again, and any mode of keeping it down, 
 either by caustic, cutting, or pressure, seemed to produce 
 no permanent good effect, as it increased rapidly, and at 
 length degenerated into the most frightful cancerous fungus 
 I have ever seen. Every local application that has been re- 
 commended in similar cases was tried in this, but without 
 success ; and internal remedies proved equally inefficacious. 
 He took, for a considerable length of time, two ounces of 
 bark in substance, in the course of twenty-four hours, so 
 that he took, in the whole, twenty-eight pounds of that me- 
 dicine. The extract of hemlock had also a fair trial, but 
 produced no apparent effect. 
 
 " When he had laboured under this complaint fifteen 
 months, he was advised to undergo the amputation of his 
 hand ; but before he would consent to submit to this opera- 
 tion, he chose to have an account of his case transmitted to 
 the Royal Academy of Surgery at Paris, that he might 
 have their opinion of it : The result of which was, that the 
 members of the academy pronounced the fungus not cance- 
 rous, but merely scorbutic. This decision, by the by, 
 should make us extremely cautious in delivering our senti- 
 ments on similar occasions, without seeing the patient, as 
 much depends on the general appearance of the sores in 
 cases of this sort. The academy were of opinion, that the 
 disease was entirely local, and required only local treatment. 
 For this purpose, they advised that the fungus should be 
 taken down by means of euphorbium, savine, &c. and after- 
 wards washed with salt water. If this method proved inek 
 
14! 
 
 fectual, recourse was to be had to the actual cautery, from 
 the application of which they seemed to expect the most 
 decisive advantages. To this mode of treatment the un- 
 happy sufferer submitted ; and, during the space of six 
 Weeks, the fungus was almost every day burnt down with 
 the actual cautery ; but his complaint all the while continu- 
 ed to gain ground apace ; so that being now disappointed in 
 all his expectations of relief from regular practitioners, he 
 had recourse to quacks of every denomination. The arse- 
 nic plaster of Plunket was applied, and he was salivated for 
 seven weeks. At length, after undergoing the operation of a 
 variety of nostrums, he again placed himself under my care. 
 In consultation, it was much doubted whether amputation 
 should now be thought of, as the patient seemed to be in 
 the last stage of a cancerous consumption. His limbs were 
 swelled, and his whole habit was wasted by the repeated he- 
 morrhage from the fundus, which was now so increased in 
 bulk as to weigh down his arm, and entirely cover the back 
 of his hand. In short, after every return of hemorrhage, it 
 was apprehended that the next would put a period to his 
 sufferings. 
 
 " The hazard of the operation, and the little chance he 
 had of its proving successful, being explained to him, the un- 
 fortunate man earnestly begged to be relieved from so hide- 
 ous a load, even though he should die under the operation. 
 I therefore yielded to his entreaties, and took off the hand a 
 Rttle above the wrist, in November, 1782, although there 
 was a small indurated gland above the elbow. On dissecting 
 the hand immediately after I had taken it off, the fungus, on 
 being cut, appeared to be extremely similar to the substance 
 of the brain, and to arise from the metacarpal bones of the 
 middle and fore-finger. These bones were in part dissolved, 
 and the other bones of the hand were also in a morbid 
 state. 
 
142 
 
 " No accident occurred during the amputation ; but soon 
 after it, a colliquative diarrhoea came on, which seemed to 
 be increased by opiates and astringents, but was at length 
 checked with draughts of fixed alkaline salt and lemon juice, 
 swallowed in the act of effervescence. He afterwards took 
 the bark, drank seltzer water, and was allowed a liberal use 
 of wine. The suppuration for some time was ichorous and 
 bad, but he gained strength daily. At the end of seven 
 weeks, the stump was completely cicatrized, and the indu- 
 rated gland above the elbow had disappeared. He went into 
 the country, drank goat's whey, bathed in the sea, became 
 very corpulent, and seemed to be in perfect health, but had 
 somewhat of a sallow bloated appearance. He continued 
 well till July, 1783, when he began to complain of pains in 
 his back, attended with rigidity. These pains, as they in- 
 creased, extended down his thighs and legs, and occasioned 
 him to sleep ill at night. He grew feverish, his pulse beat 
 extremely quick, and his countenance acquired a shining 
 yellowish red colour, an appearance which I have remarked 
 to be characteristic of a cancerous habit. He now began 
 to walk with difficulty. I took a small quantity of blood 
 from him, and found the texture of the crassamentum ex- 
 tremely loose, and the serum in too great quantity. He 
 was very difficult to purge, and unfortunately was under a 
 constant necessity of taking medicines to procure the ne- 
 cessary discharges. Antimouials in a variety of forms were 
 given, and the bark was again tried, as were all the medicines 
 that are usually prescribed in rheumatic cases. Blisters 
 were applied, and issues cut in his thighs, but all to no pur- 
 pose. He was obliged to take to his bed in August, and 
 never after quitted it. 
 
 " It is difficult to form an idea of the constant and ex- 
 cruciating pain this poor man suffered. Opium, though 
 given in large doses, afforded him but little relief, and at last 
 
143 
 
 none at all. He generally lay on his back, fixed, as it were, 
 to the bed, the least motion occasioning the most intense 
 pain. As the disease advanced, he complained of a difficul- 
 ty of passing his urine, which was loaded with a viscid mu- 
 cus, and he once discharged an oblong calculus ; but at last 
 he voided his urine involuntarily, and sometimes even his 
 feces, but the latter only rarely, when he had taken a pur- 
 gative, which, as I have already mentioned, Avas required to 
 be of the most active kind, otherwise it produced no ef- 
 fect. 
 
 " During the whole course of the disease, his pulse was 
 rapid, but his tongue was remarkably soft and florid. He 
 was never delirious. Latterly, he spit blood once or twice ; 
 his lower extremities became very cedematous, and his back 
 was covered with eschars ; but these dropped off, and the 
 sores suppurated and healed kindly. Two months before 
 his death, his pains abated considerably. He died without 
 pain, March 4, 1784, which was about two years and nine 
 months from the time the seton was passed, and a year and 
 four months from the time he underwent the amputation. 
 
 " His body was opened a few hours after his death. The 
 abdominal viscera appeared to be perfectly sound, and of 
 their natural colour, except the liver, which had a small 
 steatoma on its convex surface, but was in other respects 
 healthy. The gall bladder was rather fuller of yellow bile 
 than it is generally found to be. The left kidney was en- 
 larged, and on dividing it longitudinally, much red gravel 
 was found in its pelvis, and the ureter seemed much lessen- 
 ed. The urinary bladder was contracted, and its coats un- 
 commonly thickened, but no sabulous concretions were ob- 
 served in it. 
 
 " On each side of the vertebra? lumborum, the lumbar re- 
 gions were rendered convex by a large cancerous deposition, 
 which elevated the psose muscles ; and when the cellular 
 
144 
 
 investitures, which were condensed into a cyst, were opened, 
 the cancerous matter appeared in a large quantity, in colour 
 and consistence exactly resembling the fungus of the hand, 
 and not unlike the substance of the brain. The whole 
 weighed about five pounds ; and when this was removed, the 
 last vertebra of the back, and the three first of the loins, 
 were found to be in a softened, eroded, and in some parts a 
 totally dissolved state. There appeared not the least mark 
 of ichor, sanies, inflammation, or hardness of the soft parts ; 
 nor were the mesenteric glands at all affected. The mat- 
 ter seemed to have been really a cancerous exudation, and to 
 be formed chiefly of coagulable lymph. This cancerous 
 mass seemed to possess a remarkable dissolving power, which 
 was exerted wholly on the bones, and did not as usual in 
 cases of this sort, cause any schirrous hardness of the sur- 
 rounding soft parts." 
 
 CASE V. 
 
 A woman, some time after receiving a blow on the leg, 
 perceived a small moveable tumour. It was soft, elastic, and 
 seated on the outside of the leg, about half way betwixt the 
 knee and ankle joint. I made a small incision through the 
 skin down to the tumour, and dissected it off to its base. I 
 then dissected the substance off from the facia of the muscle, 
 and brought the skin together with adhesive plaster. It 
 united readily, and the patient was cured. The tumour was 
 soft, like brain, of a greyish colour, and greasy consistence. 
 
DISSERTATION V. 
 
 OK THE SCROPHULOUS INFLAMMATION. 
 
 Scrophula is a morbid condition, which has been called the 
 opprobrium of surgery, much more justly perhaps than any 
 other disease, cancer itself not excepted, for even this most 
 dreadful disorder may be removed by an early operation ; 
 but the nature of scrophula admits of no treatment equally 
 successful. 
 
 From the obscurity in which its causes are involved, and 
 from no certain method of cure being known, I can only make 
 a few unconnected remarks on this disease. 
 
 A scrophulous system is generally marked by a fine skin, 
 delicate complexion, light blue eyes, with opake sclerotica, 
 and frequently a swelling of the upper lip. At other times, 
 especially in those who belong to what has been called the 
 melancholic temperament, the complexion is darker, and the 
 skin coarser ; but in these, at least when young, the face is 
 generally tumid, and the look unhealthy. 
 
 In these systems, as will presently be observed, almost 
 every disease is different, in some points, from the same dis- 
 ease when it occurs in a healthy person ; but the action which 
 more decidedly manifests this modification, is Ihe inflammato- 
 ry, insomuch, that, by some, scrophula and scrophulous in- 
 flammation have been confounded ; and this disease has been 
 described only in so far as it has appeared conjoined with in- 
 flammation. We have therefore almost always in the de 
 scription of scrophula a ^swelling of the glands, and subse- 
 quent ulceration, or inflammatory affections of other parts of 
 the body, detailed as necessary and essential symptoms. 
 
146 
 
 The scrophulous inflammation is marked by a soft swelling 
 of the affected part, which very frequently is one of the 
 lymphatic glands. The covering, or coat of the gland, be- 
 comes slightly thickened, and its substance more porous and 
 doughy.*' The swelling increases, and the doughy feel 
 changes by degrees into that of elasticity, or fluctuation, and 
 a firm stool, or circumscribed hardened margin, can be felt 
 round the base of the tumour. The skin is slightly red. If, 
 at this time, an incision or puncture be made, either no mat- 
 ter, or very little, is evacuated, the lips of the wound inflame 
 and open, displaying a sloughy -looking substance within, and 
 betwixt this and the skin a probe can often be introduced 
 for some way all round. If, however, the disease have been 
 farther advanced, then there is very little elasticity in the 
 tumour, it is quite soft, rather flaccid, and fluctuates freely ; 
 the skin becomes of a light purple colour, and small veins 
 may be seen ramifying on its surface. In some time after 
 these appearances are observed, the skin may be felt becom- 
 ing thinner at one particular part, and here it also generally 
 becomes of a darker colour, then it bursts, and discharges a 
 thin fluid like whey, mixed with a curdy matter, or thick 
 white flocculi. The redness of the skin still continues, but 
 the aperture enlarges in proportion as the tumour subsides, 
 forming the scrophulous ulcer. The margins are smooth, 
 obtuse, and overlap the ulcer ; they are of a purple colour, 
 and rather hard and tumid. The surface of the sore is of a 
 light red colour ; the granulations are flabby and indistinct ; 
 and the aspect is of a peculiar kind, which cannot be de- 
 scribed. The discharge is thin, slightly ropy, and copious, 
 with curdy-looking flakes. The pain is inconsiderable. 
 
 When this ulcer has continued for some time, it either 
 begins slowly to cicatrize, or more frequently the discharge 
 
 * When the conglomerate glands are affected, the tumour U generally hard anti 
 firm until matter forms. 
 
147 
 
 diminishes, and becomes thicker; it then hardens into an 
 elevated scab, of a dirty white, or yellowish colour. This 
 continues for a considerable time, and then crumbles oil", 
 leaving the part covered with a smooth purple cicatrix. 
 This description corresponds to the mild scrophula, or the 
 struma mansueta of the older writers ; but occasionally, es- 
 pecially if a bone be diseased below the ulcer, the sore has 
 a more fiery appearance, the surface is dark coloured, the 
 margins soft, elevated, and inflamed, and sometimes retorted. 
 The discharge is watery, the pain very considerable, and 
 the surrounding skin inflamed. This has been called the 
 struma maligna, and was said to be marked by the greater 
 degree of hardness and inequality in the tumour, varicose 
 veins, and pulsatory pain : It was likewise said to be conta- 
 gious. But although occasionally this state of the scrophu- 
 lous ulcer be preceded by a hard and painful tumour, yet it 
 is not necessarily so, but rather seems to depend upon a dis- 
 ease of the parts below, which generally are bones, cartilages, 
 or tendons in a morbid state ; and hence this overacting 
 scrophulous sore is most frequent over the smaller joints, 
 particularly the toes. 
 
 Sometimes the scrophulous abscess, after bursting, forms 
 a sinus, the mouth of which ulcerates, and assumes the ap- 
 pearance of the specific ulcer; but the track of the sinus 
 remains in a suppurating state. This not unfrequently is 
 connected with a diseased bone, or cartilage, or tendon. 
 
 Scrophulous tumours and ulcers more readily disappear 
 during the winter, and return again on the approach of sum- 
 mer ; but this is by no means an universal law of the dis- 
 ease. 
 
 It is likewise observable, that swellings of the glands are 
 very apt to subside pretty rapidly in one place, and appear 
 equally quick in some other glands, in the vicinity of those 
 
 vol. fi. T 
 
148 
 
 originally affected. Ulcers likewise frequently heal upon 
 the appearance of the disease in other parts. 
 
 When the joints become affected, the cartilages swell, 
 and the quantity of the lubricating matter is increased ; the 
 tendons are surrounded with a glairy matter, like the white 
 of egg ; and, lastly, the bone becomes enlarged. These ef- 
 fects are attended with stiffness and pain in the joint, which 
 is sometimes intolerable, especially during the night, and con- 
 fined to a single spot, from the disease residing chiefly there. 
 In some time after this, small abscesses form in different 
 parts of the inflamed joint, which gives it a spongy elastic 
 feel. These bursting into one another, form a larger cavity, 
 which communicates with the articulating surface of the 
 bones, and reaches to the skin, through which a fluctuation 
 may be felt. This abscess at last bursts, and discharges a 
 curdy matter. Long before this happens, the bone general- 
 ly ulcerates, and becomes rough. This disease is uniformly 
 attended with hectic, which terminates the patient's misery. 
 
 Not unfrequently, in scrophulous people, eruptions appear 
 on different parts of the body, especially on the face, which 
 is covered with pustules of a dark red colour, suppurating 
 slowly, and sometimes never. 
 
 At other times, we find incysted tumours on different parts 
 of the body. These may appear in any habit ; but when 
 they occur in scrophulous people, they assume the specific 
 action of the constitution ; in which case, instead of con- 
 taining an uniform fluid, like thin jelly, of a yellowish colour, 
 as the simple incysted tumour does, they are filled with a 
 thick curdy purulent-looking matter, or with serum, con- 
 taining white flakes, or little lumps, of a white substance. 
 
 All the causes capable of inducing simple inflammation 
 will of consequence induce the scrophulous inflammation, 
 provided that the inflammation be not induced in such a 
 way, and in such organs as make it heal rapidly, as will be 
 
149 
 
 afterwards noticed. Specific inflammation is likewise modi- 
 fied when it takes place in a scrophulous constitution, and is 
 much more tedious in its cure. This is evidently seen in 
 the small pox and venereal disease. 
 
 Although the effects of a scrophulous constitution, in mo- 
 difying action, be most distinctly observed in the inflamma- 
 tory action, yet it does not operate exclusively on this ; on 
 the contrary, we find, that typhus fever, and some other ac- 
 tions, which may exist without any perfect local inflamma- 
 tion, are, ceteris paribus, more violent in scrophulous habits 
 than in others. 
 
 This constitution is more easily acted on by certain agents, 
 particularly such as tend to induce inflammation, than 
 healthy constitutions in the same circumstances. It would 
 likewise appear, that, on the contrary, there are other agents 
 which operate with more difficulty. It is in general ob- 
 servable, that scrophulous people are less easily affected 
 with mercury. On a few, indeed, it operates readily ; but, 
 when we attend to the general habitude of these people, we 
 must consider the aptitude of some individuals to assume 
 the mercurial action to depend on some peculiarity of con- 
 stitution, unconnected with the scrophulous condition. 
 
 By the ancients, and many of the moderns, the pituita 
 was considered as the cause of scrophula, producing tume» 
 faction, by stagnating in the glands. When any of the bile 
 became mixed with the pituita, then the inflammation was 
 more violent, and the ulceration deeper. Some latter wri- 
 ters, convinced that a simple redundancy of any particular 
 humour could not produce scrophula, had recourse to the 
 supposition of an acrimony, which was productive of swell- 
 ing and ulceration, and which might " taint the whole fluids 
 of the body,"* 
 
 * Cullen's First Lines, vol. ir. 
 
150 
 
 Others attempted to explain this disease, upon the prin- 
 ciple of debility existing in the whole body, but particularly 
 in the lymphatic system.* This is an idea still more pue- 
 rile than the doctrine of morbid humours, which, however 
 unfounded, had several plausible arguments to support it,, 
 and which was incontrovertible until the laws of the animal 
 economy were better understood. Simple debility never 
 can give rise to the marks of the scrophulous constitution : 
 h cannot produce ulcers of a nature and appearance so pe- 
 culiar; neither can it explain why particular parts are more 
 apt to be affected than others ; because, if debility exist 
 equally in every part of the absorbent system, then every 
 part ought to be alike diseased; and if it exist only in par- 
 ticular parts, then it is necessary to point out some cause of 
 this partial debility. We likewise frequently observe very 
 great debility in this system, owing to general weakness, and 
 yet no symptoms of scrophula appear in consequence. 
 
 Scrophulous people possess a peculiar constitution, and 
 may therefore be said to constitute, in one respect, a distinct 
 variety of the human race. This state is produced by a 
 peculiar condition of the semen (owing to the peculiarity of 
 the system which forms it,) or of the female organs of gene- 
 ration, which possess the same general nature with the body, 
 of which they form a part. When the organs of genera- 
 lion in both sexes are healthy, that is to say, similar in na- 
 ture to what may be considered as the proper nature of the 
 human race, taken as a distinct class of animals, then the 
 semen stimulates the ovarium to the formation of a healthy 
 child, or one which possesses a constitution, or susceptibili- 
 ty of performing, and having actions induced in it, similar 
 to that of the majority of mankind. In this process, the 
 ovarium is to be considered as a gland, and the semen as its 
 
 * Bell's Treatuc on Ulcer?, p. 42?. 
 
peculiar stimulus. If, however, either the nature of the 
 gland, or of its stimulus be changed, it is evident that the 
 action induced must be more or less modified, and the se- 
 cretion or product changed to a greater or less degree in its 
 nature and properties. Were it possible for a progeny to 
 be produced by an intercourse betwixt the human and the 
 brute creation, they would possess a nature different from 
 both, or perform actions of a mixed kind. This may be ob- 
 served with regard to mules among brutes. In the same 
 way, a healthy and scrophulous person must produce a child 
 which differs from a healthy one, in having a certain pecu- 
 liarity of constitution. 
 
 Agents produce different effects in different animals ; thus 
 the matter of cow-pox applied to the cow and to man pro- 
 duce very different appearances. Agents likewise, in the 
 same genus of animals, produce different effects, according 
 to the peculiar constitution of the individual. Thus, the 
 matter of small-pox in some men produces only a slight local 
 sore, whilst in the generality it produces a general disease, 
 and eruption. The same disease affords an instance of 
 changes taking place in the constitution after birth, by the 
 establishment of certain actions ; for it is rendered unsus- 
 ceptible of the same action being induced afterwards ; and, 
 in this respect, is brought to resemble the constitution of a 
 different genus of animals, with regard to that disease-. 
 There are some constitutions, such as those called irritable, 
 in which certain symptoms of febrile, and other actions, are 
 much more violent than in people of a different description. 
 In them, for instance, typhus fever is attended with a very 
 frequent pulse, and yet the other effects of this action are 
 not violent in the same proportion. 
 
 Peculiarity of constitution is often manifested by no evi- 
 dent sign, and the modifications of actions induced are often 
 marked by no perceptible diseased phenomena, which mar 
 
152 
 
 be considered as belonging exclusively to that constitution. 
 But, in the scrophulous constitution, there are, in almost 
 every instance, perceptible modifications of the formative 
 action,* producing a peculiar appearance of the eye, coun- 
 tenance, &c. as has already been mentioned ; and although 
 some diseased actions, which receive modifications from this 
 peculiarity of constitution, may not be attended with obvi- 
 ous alterations, yet others, especially such as are attended 
 with an inflammatory condition, are distinctly changed. It 
 is these changes which constitute what in common language 
 has been called scrophula, which is merely a peculiarity of 
 a common action, (namely, inflammation,) which is depend- 
 ent, not upon any particular nature of the agent or exciting 
 cause, but upon the peculiarity of constitution, which is 
 susceptible, by these agents, of such an action. 
 
 From what has been said it will appear, that I consider 
 Uie scrophulous inflammation, or what has in common lan- 
 guage been called scrophula, merely as an accidental circum- 
 stance, occurring in a scrophulous constitution ; but it is by 
 much the most dangerous and troublesome effect of the pe- 
 culiarity of constitution. It has likewise a very evident ef- 
 fect in increasing this condition of the system ; for we find, 
 that the probability of scrophula appearing in a child is, ce- 
 teris paribus, correspondent to the presence or absence of 
 scrophulous inflammation in the parent ; or, in other words, 
 
 * The morbid condition of the formative action is very frequently manifested 
 in the bones, which are less perfect, that is to say, softer, containing less calcare- 
 ous earth, and later of being formed.' Thus, the teeth are longer of appearing ; 
 the bones of the head are soft and yielding, and hence the head is large ; the long 
 bones bend and lose their shape, or their extremities swell, and, from being more 
 vascular than their nature is fitted for, inflammation is very apt to be induced. 
 The yielding and increasing of the bones of the cranium is likewise attended with 
 a similar effect, for the brain becomes too large in proportion to the rest of the 
 body, and is very apt to inflame, and have effusions formed into it. At other 
 times, the diseased state of the formative action appears most distinctly at the 
 surface, the skin being rough, and very apt to df sqaamate. 
 
153 
 
 that those who have either at the time of marriage, or before 
 it, had scrophulous inflammation, are more likely to have 
 their children strongly scrophulous, than others of the same 
 family, who have not had inflammation. It is likewise cer- 
 tain, that if, by any cure, we can, for one or two generations, 
 prevent the appearance of scrophulous inflammation, the 
 children will become less and less diseased, or have less pe- 
 culiarity of constitution ; but if, by any accident, scrophu- 
 lous inflammation be in one of the descendants excited, even 
 in a slight degree, his immediate progeny will be more dis- 
 eased than he himself before the induction of the inflamma- 
 tion.* 
 
 "With regard to the exciting causes of scrophulous inflam- 
 mation, I may remark, that they are similar in kind to those 
 capable of inducing simple inflammation ; but they frequent- 
 ly operate more powerfully ; that is to say, causes which 
 would scarcely induce inflammation in a healthy person, 
 may induce a local disease, and inflammation, in a scrophu- 
 lous habit ; because the different parts of the body perform 
 their functions less healthily in a strongly scrophulous per- 
 son, and are more easily deranged. In every system, those 
 parts which are most delicate, or require the greatest per- 
 fection of action in order to keep them right, are most easily 
 deranged. Now, in scrophulous people, the natural action 
 being modified, the body becomes more delicate, and is more 
 susceptible of derangement, especially those parts which na- 
 turally are delicate,f or require a perfection of action. The 
 glands seem to be among the most delicate organs ; for they 
 have not only to perform the formative, or nutritive func- 
 
 * Some gentlemen have denied that scrophula was a hereditary disease ; but it 
 is unnecessary to offer any argument on this subject. 
 
 f This term is used here in a different sense from its common one, which signi- 
 fies sensibility, or delicacy with regard to sensation, and capability of being act- 
 ed on. 
 
154 
 
 tion, in common with every other part, but they have also 
 to perform a separate and distinct function, or change the 
 nature of certain fluids which are brought to them. It is on 
 account of the natural delicacy of ihe glandular system be- 
 ing increased by the diseased condition of the general sys- 
 tem, and of the exposure of the lymphatic glands to the ac- 
 tion of stimulating maiter, taken up by the absorbents on 
 the surface, as, for instance, matter from scabs on the head 
 of children, that this species of inflammation most common- 
 ly appears in the lymphatic system ; but this system does 
 not seem to be the peculiar seat of the diseased condition, 
 as some suppose, nor to be otherwise predisposed to scro- 
 phulous inflammation, except in so far as its natural delicacy 
 is increased by the diseased condition which it possessed, ab 
 initio, in common with the rest of the body ; and consequent- 
 ly, it is rendered less able to perform its functions properly, 
 the effect of which is, the induction of a new local diseased 
 action, or slow inflammatory action, by the slightest cause. 
 
 Besides the common exciting causes of inflammation, the 
 particular formation of organs may induce this disease, or at 
 least make very slight causes produce it. Thus, for in- 
 stance, in people with a very small narrow chest, the circu- 
 lation of the blood must be performed with greater action 
 than in other circumstances, and thus may tend to induce 
 an inflammatory state. When the bones are very vascular, 
 and imperfectly formed, they are apt to have a morbid de- 
 gree of action excited in them by very slight causes ; and 
 the same holds true with regard to any other part of the 
 body which is imperfectly formed, or which is not exactly 
 fitted for the support and performance of its requisite ac- 
 tion.* 
 
 * Parts which are improperly organized, or which are not in every respect simi- 
 lar, both in their structure and constitution (by which I mean, mode of acting in 
 
155 
 
 Scrophulous inflammation is in general dangerous and te- 
 dious, in a degree proportioned to the effects and duration of 
 simple inflammation upon the same parts. Thus, simple in- 
 flammation of one of the conglobate glands of the neck, is 
 tedious, but not dangerous ; and the same holds true of scro- 
 phulous inflammation ; but the duration of this is much long- 
 er. Simple inflammation of the lungs, again, is dangerous; 
 and scrophulous inflammation is infinitely more so. Such 
 parts as heal easiest, when affected with simple inflammation, 
 or ulceration, recover soonest from scrophulous inflamma- 
 tion ; and the same causes which retard the one will retard 
 the other also. Thus, the same cause which renders a su- 
 perficial simple ulcer unhealthy and chronic, will prevent a 
 superficial scrophulous ulcer from healing: But, if none of 
 these causes operate, then scrophulous inflammation, or ul- 
 ceration, will heal pretty readily, provided that simple in- 
 flammation, or ulceration of the same parts, would do so ; but, 
 for this purpose, it must be quickly induced ; for all inflam- 
 mation, or ulceration, which is slowly induced, is slowly re- 
 moved. As a confirmation of these positions, we find, that 
 a blister on a scrophulous person will heal readily, because 
 the inflammation is induced acutely, or with a certain degree 
 of quickness, and has, when the affection is simple, a prompti- 
 tude to heal, which manifests itself also in scrophulous peo- 
 ple. In this instance, the difference in the time required to 
 heal the inflammation in a sound and a scrophulous person is 
 not perceptible ; because the affection, if simple, has a ten- 
 dency to heal immediately. But, in a deep wound, espe- 
 
 general,) to what naturally they ought to be, are not only less capable of perform- 
 ing their actions aright, but likewise are to be considered as in some respect ex- 
 traneous to the human body, or, as it were, insulated, and do not correspond ex- 
 actly to other parts. They therefore receive less support from the neighbour 
 ing parts, and, consequently, have their power diminished. The imperfection ol 
 action consequent to these causes is proportioned to £h* morbid condition of tire 
 part. 
 
 VOL. II. V 
 
J-JG 
 
 dally ii contused, we find the difference more marked; be- 
 cause here, although the constitution be healthy, the dura- 
 tion of the disease is considerable; and, in a scrophulous 
 person, the cure is protracted still longer, and the sore as- 
 sumes a specific appearance. In diseases of the glands, the 
 difference is still more perceptible : because the disease, al- 
 though simple, is longer in duration. In affections of the 
 bones and cartilages, the same is observed. When a bone 
 is fractured in a healthy person, it unites without inflaming ; 
 and, in a scrophulous person, unless the diathesis be exceed- 
 ingly strong, it likewise does so, but the union is longer of 
 taking place ; but, if a bone inflames in a sound person, the 
 disease is very tedious ; and, in a scrophulous habit, it is in- 
 finitely more so. The same holds true with regard to ten- 
 dons and cartilages ; and hence the greater danger of a sprain 
 m a scrophulous than a healthy person. From these, and 
 other facts, which it is altogether unnecessary to mention, it 
 fully appears, that scrophulous inflammation is tedious and 
 dangerous, in proportion to the progress and effects of sim- 
 ple inflammation and its consequences, when it attacks the 
 same parts ; but this proportion is not regular and uniform ; 
 but the duration increases, in a higher ratio, in proportion as 
 the simple inflammation and ulceration of the same parts, 
 and in the same circumstances, is tedious. Thus, a deep 
 wound in a healthy person is pretty long of healing ; but, in 
 a scrophulous person, it is much more so. Simple inflam- 
 mation of a gland is still more tedious than the same extent 
 of inflammation in cellular substance ; and scrophulous in- 
 flammation is still longer of running its progress ; but the 
 proportion betwixt the duration of the scrophulous inflam- 
 mation, in these two cases, is not exactly as the duration of 
 the simple inflammation of the two, compared with each 
 other, but is in an increased ratio. 
 
157 
 
 When scrophulous inflammation is excited in the vicinity 
 of a part already possessing this action, it occasionally re- 
 moves the action from that part, in the same way as inducing 
 simple inflammation by a blister in one part cures the same 
 disease in another part in the vicinity. It was an observa- 
 tion of this fact which made it be considered as part of 
 the description of scrophulous tumours and ulcers, that they 
 not unfrequently disappear in one place, whilst they show 
 themselves in another ; but, in every instance, this disap- 
 pearance is an effect, and not a cause ; for we uniformly ob- 
 serve, that, before it takes place, the new part has begun to 
 inflame or swell. 
 
 With regard to the diagnosis of scrophula, it is impossible 
 to say any thing satisfactory; because, as long as the in- 
 flammation remains trifling, ami the skin sound, it is very 
 difficult, if not impossible, to distinguish a scrophulous swell- 
 ing from any other of a different kind. Much assistance has 
 been supposed to be derived from the situation of the tumours, 
 most of those which appear in the neck being considered as 
 scrophulous ; but this is certainly a false principle. From 
 the same method of reasoning, most swellings in the groin 
 have been considered as venereal, whilst many are of a very 
 different nature, and not a few scrophulous. The best plan 
 is to attend to the appearance of the body in general, and to 
 the presence or absence of the sign of a scrophulous system ; 
 next, whether any ulceration be present, by the absorption 
 of matter, from which these swellings may have been pro- 
 duced. If these be present in a system not possessing the 
 marks of scrophula, the probability of the tumour being 
 scrophulous is less ; but, if the system be evidently scrophu- 
 lous, then we must consider, whether the glands, originally 
 swelled by the absorption of matter, have assumed the slow 
 inflammation of a scrophulous nature, or have assumed a dif- 
 ferent species of inflammation, dependent upon the peculi- 
 
158 
 
 aiity of the matter ; for they can scarcely be supposed to be 
 simply inflamed. Scrophulous swellings of the lymphatic 
 glands are generally soft and doughy, and frequently give 
 the feel of containing a fluid long before suppuration has 
 taken place. They are at first free from pain, and, in mild 
 cases, even toward the end, the pain is inconsiderable. 
 When matter is formed, the skin generally becomes purple^ 
 and then gives way in a small spot. Swellings of the secre- 
 ting glands are to be distinguished from schiro-cancer, by 
 the hardness being less, the pain very inconsiderable, the 
 presence of a scrophulous habit, and by the feel of fluctua- 
 tion much earlier than takes place in cancer. Upon the 
 whole, the presumption of any affection being scrophulous, 
 is to be formed by the presence of the marks of a scrophu- 
 lous diathesis, and the absence of such symptoms and ap- 
 pearances, whether antecedent or present, which character- 
 ise inflammation of a different species, or make us suppose 
 it to have taken place, whether this be simple or specific. 
 Scrophulous ulceration is distinguished by its peculiar as- 
 pect, joined with the marks of a scrophulous habit. 
 
 Of the Treatment of the Scrophulous Inflammation. 
 
 If the foregoing reasoning be just, it will appear, that, in 
 scrophulous habits, our great attention ought to be directed 
 to the prevention of the scrophulous inflammation, which 
 is to be done by avoiding, as far as lies in our power, the 
 operation of any agent tending to excite inflammation. It 
 has been observed, that in scrophulous systems, very slight 
 causes were sufficient to produce disease ; because the parts 
 on which they act, possess a peculiar constitution, and are 
 less capable of performing their natural and healthy func- 
 tions properly, and therefore are sooner rendered diseased. 
 
159 
 
 Inflammation may also be induced by the structure of the 
 part being such as to prevent it from carrying on its func- 
 tions properly, and therefore the same effect is produced 
 as in the former case, where the constitution, or mode of ac- 
 tion, and not the evident structure or mechanism of the part, 
 was affected. 
 
 The lungs are to be prevented from assuming the scrophu- 
 lous inflammation, by avoiding, in the first place, all the com- 
 mon exciting causes of pneumonia, such as cold, damp, &c. 
 It is, in the next place, to be prevented, by avoiding such 
 causes as tend to increase the circulation in the chest, or af- 
 fect the function of respiration. Hence, violent exercise, 
 climbing ascents, intoxication, thick hazy atmosphere, are to 
 be guarded against. 
 
 The lymphatic glands are to be prevented from inflaming, 
 by avoiding exposure to cold, and to the other common causes 
 of inflammation, but especially by preventing the absorption 
 of irritating matter, such as matter from sores, and the like. 
 A neglect of this is perhaps one of the most frequent causes 
 of scrophulous inflammation, for swellings of the glands of the 
 neck can very often be distinctly traced to scald head, to ul- 
 cerations about the ears, little sores in the mouth, caries of 
 the teeth, or to the absorption of particles of food allowed to 
 remain and undergo fermentation in the mouth. The greatest 
 attention ought therefore to be paid to cleanliness. The 
 head ought in scrophulous children, to be washed daily, and 
 the sweat removed from behind the ears ; vermin ought to be 
 diligently removed : but mercurial and acrid preparations, 
 frequently used with that intention, ought to be avoided. 
 
 The mesenteric glands are to be prevented from inflaming, 
 by supporting the action of the bowels, and preventing the 
 formation of irritating matter, which, when absorbed, may 
 swell these glands. Nourishing digestible diet, conjoined 
 with rhubarb, and such remedies as act as tonics, at the same 
 
time that they keep the belly easy, are of use in this view ; 
 for the whole process of digestion is thus supported, and nei- 
 ther the feculent part of the food, nor the mucus of the intes- 
 tines, become morbidly irritating. 
 
 The other parts of the body are to be prevented from in- 
 flaming, by avoiding the usual causes of inflammation, and the 
 action of whatever may injure the healthy condition of the 
 part, or impede the natural action. Thus, the knee and 
 ankle joint, occasionally become affected with scrophulous in- 
 flammation after fatigue, which injures the healthy condition 
 of the parts. 
 
 Besides these precautions, which are necessary in those of 
 an evidently scrophulous constitution, with regard to particu- 
 lar parts, it is likewise useful to preserve as vigorous and per- 
 fect a performance of the natural actions of the system, con- 
 sidered in the aggregate, as possible, by which we lessen the 
 risk of anyone part becoming diseased; for, whatever impedes 
 or diminishes the performance of the natural and healthy ac- 
 tion of a part (and in this case, the whole body is to be consi- 
 dered as made up of parts,) renders that part more susceptible 
 of disease, or derangement of its actions. Cleanliness, pure air, 
 warm and sufficient clothing, nourishing and digestible diet, 
 invigorating exercise, and a due proportion of sleep, are there- 
 fore very powerful preventives of this species of inflamma- 
 tion, insomuch, that Dionis remarks, that seventy-five out of 
 the hundred, who came to be touched by the king, were chil- 
 dren of the poor peasants. 
 
 When scrophulous inflammation does take place, then this 
 invigorating plan is had recourse to as a cure, whilst, in 
 truth it is most useful as a prophylactic. The invigorating 
 plan, which consists in the use of good diet, moderate exer- 
 cise, sea bathing, Sec. is indeed useful at this period, both 
 because it tends to make the disease more easily overcome, 
 and prevents other parts from being injured ; but its utility 
 
161 
 
 .is still greater as a prophylactic ; and it does not appear to 
 have any certain efficacy in promoting the resolution of scro- 
 phulous tumours, because these have naturally a strong dis- 
 position to advance slowly to suppuration, and therefore are 
 not readily affected by such means as tend simply to 
 strengthen the system, or support its actions, because these 
 do not change its peculiarity, or morbid modification, which 
 existed, ab. origine. But, when the tumours have proceed- 
 ed the length of ulceration, then they have gone a step far- 
 ther to a natural termination ; and, although the means which 
 strengthen the system cannot remove the scrophulous dia- 
 thesis of the system, they may nevertheless accelerate the 
 cure of a chronic tedious ulcer, which is slowly tending of it- 
 self to a termination. 
 
 The remedies called agentes similes operate more direct- 
 ly on the scrophulous mode of action than those means 
 which tend simply to strengthen the system, and may be 
 usefully conjoined with them, because these agents tend to 
 induce an action different from the scrophulous one, at the 
 same time that it possesses a certain coincidence with, 
 or general resemblance to, the natural or healthy action, 
 Hence, the bark has been frequently found to be useful in 
 the cure of scrophulous inflammation, but oftener of ulcera- 
 tion than tumefaction of the glands, for the reason mention- 
 ed above. It does not appear, however, to possess, by any 
 means, that certain power of curing scrophulous affections 
 which is attributed to it by Dr. Fothergill, and several other 
 authors ; nor are we to suppose that it shall infallibly cure 
 scrophulous inflammation, or ulceration of parts, which, even 
 when affected with simple inflammation, are very difficult to 
 be cured. If we find it difficult to cure a simple inflamma 
 tion, or ulceration of a tendon, cartilage, or bone, we must 
 not be disappointed if even a specific remedy for scrophula 
 C^rantin^ s.nch a one ever to be discovered) were to prove 
 
162 
 
 ineffectual in procuring a speedy restoration to health. 
 The bark is likewise often ineffectual, because it is impro- 
 perly administered. Given in small quantities, once or 
 twice a-day, as is frequently done, it may prove a stomachic, 
 and increase, like other tonic bitters, the power of the sto- 
 mach, or the functions dependent on it ; but we never can 
 thus obtain the benefits of the specific action of the bark on 
 the system. For this purpose, it must be given liberally, 
 in as great doses, and as frequently repeated as can be done 
 without producing continued sickness, or vomiting ; and this 
 must be continued regularly, late and early, not for days, 
 but perhaps for weeks, at the same time that w r e prevent the 
 action of such causes as w r ould counteract the effects of the 
 bark, such as poor diet, bad air, confinement,* &c. Ad- 
 ministered in this way, the bark may be rendered really use- 
 ful, not only in the cure of scrophulous ulceration, but per- 
 haps of many other diseases, whilst, in the common way of 
 prescribing it, little or no benefit is derived from it. 
 
 The muriated barytes has been recommended by Dr. 
 Crawford,f and has of late been tried in France by M. 
 Pinel^: and others. It does not appear to have any influence 
 on tumid glands, or scrophulous tumours ; but occasionally 
 it is serviceable in scrophulous ulceration. It is, how T ever, 
 a medicine on which very little dependence can be placed, 
 and which fails in a great majority of instances. || 
 
 * See what has been said on this subject when treating of the cure of morti- 
 fication. 
 f See the second volume of Medical Communications. 
 X Nomographic Philosophique, vol. ii. p. 238. 
 jj When it is wished to prescribe it, the following is a very good formula : 
 
 R. Terra> Ponder. Salit. Chryst gr. x. 
 Aq. Font. 
 
 Aq. Cassia utriusque uncias iii. 
 Syrupi Auient. uncias ii. 
 
 Half an ounce of this may be given at first, twice or three times a-day, and gra- 
 dually increased to such quantity as the stomach can bear without sickness. 
 
163 
 
 The muriate of lime has been proposed by M. de Four 
 croy; it is given more liberally than the miniated barytes, 
 but it is not more efficacious. 
 
 Iron by itself, or mixed with the fixed or volatile alkalis, 
 has also been frequently employed, but with very little 
 benefit.* 
 
 Burnt sponge, millipedes, vitriolated tartar, and many 
 other trifling remedies, which were at one time in repute, are 
 now deservedly neglected. 
 
 Cicuta has been greatly recommended by Dr. Fothergill 
 and others.f It has very little effect on scrophulous tu- 
 mours, or mild ulcers ; but, when administered freely, it is 
 sometimes of service in the irritable fiery ulcer, which was 
 by the older writers called struma maligna. 
 
 Mercurv is another remedy, which at one time was much 
 employed in this disease ; but few expect any benefit from it 
 now. Gentle, or what has been called alterative courses, 
 are, however, still recommended by many, with a view to 
 satisfy the patient. Various preparations have been used. 
 Some exhibited the corrosive sublimate, others the calomel, 
 whilst the acetite of mercury, mixed with the powder of 
 vipers and earth-worm, with the rust of iron, was much em- 
 ployed on the continent. % Antimony has frequently been 
 conjoined with this, but without much benefit. 
 
 Nitrous acid has, I believe, in some cases, a considerable 
 power over scrophulous ulcers. From the trials which I 
 have made with it, I am inclined to attribute some effect to 
 it in promoting the suppuration of scrophulous glands, or 
 
 * This metal was one of the principal ingredients in a remedy used by the 
 Marechal de Rougeres, which consisted of filings of iron, sal ammoniac, salt of 
 tartar, 6:c. Journal deMed. toiu. kI. p. 219. 
 
 f This is highly recommended by M. Martcau. Journ. de Med. torn, iv 
 ;.. 121. 
 
 t Pratique Moderne dc Chirurgcr, par Ravaton, torn. H. p. 33. 
 
 VOL. II. X 
 
/ 
 
 164 
 
 f 
 
 tumours, and in disposing ulcers to heal. Two or three 
 drachms may be given daily, and continued for a fortnight, 
 provided no bad effect be produced by it, such as pulmonic 
 affections, &c. If, within this time, no melioration appear, 
 we may give up this medicine. 
 
 The hepatised ammonia, in the dose of eight or ten drops, 
 three times a-day, is sometimes useful in abating the pain, 
 and changing the fiery appearance of the irritable ulcer, or 
 struma maligna. 
 
 The breathing of oxygene has been proposed as a cure 
 for this species of inflammation ; but it will be extremely 
 difficult for the advocates of pneumatic medicine to point 
 out any authentic case in which it was really of benefit. 
 
 Much has been written concerning the local treatment of 
 ecrophulous tumours and ulcers ; but we are still very much 
 in the dark'with respect to any efficacious method. For- 
 merly, the extirpation of the gland, or tumour, was advised 
 by all ; but, more lately, doubts have been started concerning 
 the propriety of the practice ; and, by most practitioners, it 
 is now deemed unnecessary, if not dangerous. 
 
 In the writings of the ancients, as well as many of the old- 
 er writers on surgery in our own country, particularly in the 
 works of Mr. Wiseman, this practice is freely inculcated ; 
 and many cases are detailed in which the tumour was extir- 
 pated with success. Even in the present day, no surgeon 
 dreads the consequence of removing scrophulous joints, 
 which, with regard to the present question, are to be consi- 
 dered in the same light with the glands. 
 
 It is supposed, that, by extirpating superficial tumours, 
 the disease may be transferred to some of the more noble 
 parts, and produce a more fatal complaint. But, if it be ad- 
 mitted that these tumours do not appear as necessary parts 
 of scrophula, as the eruption of measles does of the ru- 
 beolous fever, but only as accidental circumstances, or for- 
 
165 
 
 tuitous inflammations, rendered tedious and specific by the 
 peculiarity of the constitution, this supposition will appear 
 to be groundless. Even granting that scrophulous tumours 
 did appear without any local exciting cause, and were, in 
 every respect, similar to the eruption of exanthematous 
 fevers, it will not thence follow, that removing the local dis- 
 ease, after it has appeared, will make another part become 
 diseased ; unless it be said that scrophula depends upon a 
 particular morbid humour, which, if denied an outlet in one 
 place, must accumulate in another, which is a supposition I 
 will not trouble myself to refute. 
 
 The arguments, then, against the excision, are not to be 
 drawn from its danger, but from the pain which it produces, 
 and from the number of glands which must frequently be re- 
 moved, and which might perhaps be resolved without com- 
 ing to suppuration. It is likewise at times dangerous to ex- 
 tirpate these tumours, on account of their situation. 
 
 On the other hand, when only one gland is affected, when 
 it is superficial, and has continued so long, in spite of our re- 
 medies, that there is little probability of resolving it, then, 
 by extirpation, we procure a speedy cure, and avoid a tedious 
 disagreeable ulcer, and unseemly cicatrix. The existence 
 of the scrophulous inflammation, and particularly the ulcera- 
 tion, has a tendency to increase the scrophulous diathesis, or 
 peculiar mode of action of the system. By cutting this short, 
 therefore, we prevent that evil, and render the system less 
 susceptible of the scrophulous inflammation, and the chance 
 of communicating the disease to the progeny less. 
 
 It may also be said, that the wound, after the extirpation, 
 might not heal readily ; but the testimony of many writers, 
 as well as what I have observed myself, convince me that 
 this is not the case ; for the readiness with which the skin 
 unites and heals, when not previously diseased, produces a 
 speedy cure ; whereas, had the diseased gland remained he 
 
166 
 
 low, and the specific inflammation been propagated to the 
 skin, the ulceration must have been tedious. 
 
 Upon the whole, then, in determining on the propriety of 
 extirpation, we must consider whether there be only one 
 gland affected, or an incipient disease in a chain of glands; 
 and, if only one, whether there be a probability of this one 
 suppurating; and whether the advantage of an early removal 
 of the affected part will not be counterbalanced by our losing 
 the chance of restoring the part, and of preserving its func- 
 tions and utility, as, for instance, in scrophulous inflammation 
 of the breasts, testicle, joints, &c. 
 
 Caustics have been proposed with the same view as the 
 incision ; but they are more tedious, produce extensive ulce- 
 ration, greater pain, and are much less certain than the ope- 
 ration. 
 
 Issues are recommended as a general remedy, to act as a 
 drain to the constitution, and to render the drying up of the 
 ulcer safe. In this point of view, they appear to be altoge- 
 ther useless and unnecessary ; but, when employed as part of 
 the local treatment, they are much more useful. The be- 
 nefit arising from the use of issues, in the cure of scrophu- 
 lous inflammation of the bones and joints, is now so fully 
 established, by the practice of every surgeon, that it is 
 useless to insist upon it here. In these cases, it is necessary 
 to insert the issue, which is generally made with caustic, as 
 directly over the affected part as possible ; and the size of 
 this issue ought in general to be correspondent to the extent 
 of the disease. There are two circumstances which greatly 
 tend to render this practice efficacious, and which ought to 
 be fully attended to : First, that the disease be allowed to 
 gain as little ground as possible before the insertion of the 
 issue, or that the issue be inserted as early after the disease 
 is observed as the patient will permit. Second, that, during 
 he cotntintiance of the issue, every circumstance be avoided 
 
167 
 
 which may counteract its use, such as much use of the joint, 
 or other species of irritation. In diseases of the lower ex- 
 tremities, therefore, whatever exercise produces pain must 
 be carefully avoided ; and, for the same reason, in diseases 
 of the spine, proper contrivances to relieve the diseased bone 
 from pressure are necessary to be conjoined with the issue. 
 It sometimes happens, that matter has either formed before 
 the insertion of the peas, or some time afterward. In this 
 case, it either comes to be discharged by an opening through 
 the ulcerated surface, or issue, or it bursts at a more de- 
 pendent part. In the first situation, no change of treatment 
 is necessary ; in the second, it is of service to insert a pea 
 over the mouth of the aperture, which has a tendency to heal 
 the part below, and prevent the formation of a tedious sinus. 
 When the part becomes free from pain, and the soft parts 
 have subsided in their swelling, and matter does not appear 
 to be forming, or does not continue to be formed, if it had 
 already been, secreted, we may consider that the effect of 
 the issue is now produced, and may begin gradually to dimi- 
 nish its size. 
 
 Issues, employed as a local remedy, have hitherto been 
 chiefly used in diseases of the bones and joints, and some- 
 times in scrophulous affections of the liver, or lungs ; but 
 it is reasonable to suppose that they ought likewise to be use- 
 ful in the cure of enlargements of the glands, and other scro- 
 phulous tumours, if inserted in tb^ immediate vicinity of the 
 part. The only objection to their use is the cicatrix which 
 they leave, and which, in certain situations, we would wish 
 to avoid. When the tumour is thickly covered with the in- 
 teguments, the issue may be made directly over it, by means 
 of a blister, kept open by savine ointment,* or any other ir- 
 
 * This ointment may be prepared by macerating one part of recent savine 
 feaves bruised, in four parts of ung. resinos. ; it is then to be strained. 
 
lea 
 
 ritating preparation; but, when the tumour is thinly covered, 
 thi?= will not succeed, as the inflammation consequent to the 
 iflsertion of the issue will be communicated to the gland 
 which is in immediate contact with the ulcerated surface. 
 In this case, a small pea issue, or seton, may be inserted by 
 the side of the tumour. In scrophulous inflammation of the 
 glands of the neck, this remedy is not advisable, owing to 
 the scar which it leaves ; but in affections of the mammae, and 
 some other parts, it may be useful. 
 
 Blisters, frequently repeated, are sometimes in slighter 
 cases of affections of the joints, used in place of issues. 
 
 Preparations of lead are frequently employed, and, where 
 the tumour is painful, are often of service. When the lym- 
 phatic glands are inflamed, a saturnine solution,^ applied cold 
 to the part, by means of a compress of linen, and frequently 
 renewed, has a tendency to abate the pain, and resolve the in- 
 flammation. These solutions are sometimes employed warm, 
 particularly in affections of the bones or joints ; but they do 
 not, in these cases, seem to have any considerable superiority 
 over fomentations with warm water. 
 
 Cloths dipped in cold water, sea-water, or weak vegetable 
 acids, have also been used, and have a tendency to abate pain, 
 but are inferior to the saturnine solution. 
 
 Ether, applied with a pencil to the part, is also sometimes 
 of service. 
 
 Sea salt, mixed with bile, has been recommended, but has 
 very little effect. 
 
 Camphorated liniment is very frequently used, in which 
 case the part is generally kept warm with flannel. It does 
 not, however, appear to possess any very great power of dis- 
 
 The following may be used for thi9 purpose : 
 R. CerufF. Acetat drachmam unam. 
 
 Aq. Eosar. uacias ©ct». Solve, deia cola. 
 
169 
 
 cussing these tumours ; but the friction which is made use of 
 with these sometimes hastens the removal of these tumours, 
 and may be usefully alternated with the use of the saturnine 
 lotion. A mixture of ether and linimentum opiatum may be 
 employed for the same purpose. 
 
 Hemlock poultices were at one time in repute, but they 
 have now lost their character. 
 
 By these means, even after a small quantity of matter is 
 formed in the gland or tumour, we may discuss the tumour, 
 or make it less ; but, if the quantity of matter should continue 
 to augment, we may consider resolution as out of the ques- 
 tion. Our object must then be to bring the part to suppura- 
 tion as quickly as possible ; because we not only thus shorten 
 a process which must be completed before the parts can be 
 healed, but also render the ulcerative action more healthy, 
 and easier induced ; for the more quickly that the suppura- 
 tive action is performed, the sooner does the ulcerative ac- 
 tion take place, and the more vigorous is it, provided that 
 no new cause rend&hit unhealthy, as has formerly been men- 
 tioned. 
 
 This advice, however, must not be adopted without some 
 exceptions, and must be chiefly confined to affections of the 
 glands and cellular substance, and ought not to be extended 
 to the joints. In these cases, even although a small quanti- 
 ty of matter form, we ought still to endeavour to prevent 
 general suppuration, and the bursting of an abscess ; because 
 this would, instead of accelerating the cure, as is frequently 
 the effect in the other case, be attended with dangerous 
 consequences ; we must therefore rather continue the use of 
 the issues, and endeavour to procure the absorption of what 
 matter is already formed. 
 
 The means employed for promoting suppuration were 
 formerly poultices of lily roots, honey, &c. alternated with 
 fomentations prepared from pomegranate seeds, and myrrh, 
 
170 
 
 and cypress leaves, or, occasionally, stimulating plasters ; 
 but now the common bread and milk poultice is advan- 
 tageously substituted in place of these remedies. When 
 the process is very tedious, electricity is useful along with 
 the poultices. 
 
 When these tumours have suppurated freely, and an ab- 
 scess occupies the whole of the gland, it is useful to evacuate 
 the matter by a small opening with a lancet, if there be no 
 appearance of the abscess bursting quickly, and the sooner 
 this is done the better. When this is done, a poultice should 
 be applied until next day, the part is then to be wiped clean 
 and dry, and a small bit of lint, spread with simple ointment, 
 applied on the orifice. The surrounding red skin is to be 
 dusted with powdered cerussa,* and then covered with dry 
 lint. A compress is to be laid over the whole, and moderate 
 pressure employed. These applications are to be renewed 
 every day, or twice a-day, according to the quantity of the 
 discharge, and other circumstances ; and, at each dressing, 
 the parts may be bathed with spirit of &ne. If this mode 
 of dressing does not produce a cure, but the opening en- 
 larges, and the surface ulcerates, we must then employ the 
 dressings for a scrophulous sore. 
 
 When, notwithstanding the use of issues, matter is formed 
 in joints, or, when these fail to procure the absorption of what 
 was formed before they w T ere introduced, then one of two 
 things must happen; either the abscess must be punctured, 
 or it must be allowed to burst of its own accord. In gene- 
 ral, I believe, it is most advantageous to allow the abscess to 
 burst without any interference, except the continuance of 
 the issue, or the establishment of such new ones as circum- 
 
 * Keeping this skin dry has a tendency to prevent ulceration, aud abate the 
 redness and inflammation. The cerussa may sometimes be advantageously mixed 
 with an eighth part of powdered camphor, which promotes the removal of the 
 superficial inflammation. 
 
171 
 
 stances, particularly the situation of the pain, may point out. 
 If, however, it were at any time deemed proper to evacuate 
 the matter, this ought to be done with a small trocar, at dif- 
 ferent times, in the manner recommended by Mr. Aberncthy 
 for the cure of lumber abscess. This is infinitely preferable 
 to the barbarous practice which even some surgeons high in 
 reputation advise and make use of, I mean the insertion of a 
 seton through the abscess of the joint.* 
 
 "When the scrophulous suppuration ends in the ulcerative 
 action, the cure is generally tedious. It is even doubted by 
 some how far it is safe to attempt a speedy termination to 
 the ulcer, as it is supposed, that, in this case, the disease 
 may be driven to some other part : And so fearful are they 
 of this dreadful event, that they are careful, by issues and 
 new artificial sores, to continue the discharge after the ori- 
 ginal ulcer is healed. 
 
 If I have been right in my view of this disease, it will ap- 
 pear, that this reasoning is false, and that the practice is 
 both useless and troublesome. Even those who propose and 
 defend the practice, do so, not upon the principles of reason 
 and judgment, or from logical deductions from the theory 
 which they give of the disease, but upon imaginary appre- 
 hensions. We find, for instance, Mr. Bell saying, that, 
 " till the disease is eradicated from the habit, all that should 
 in general be done to the sores, is, to give as free and open 
 vent to the matter as possible."! From this, we should, 
 without doubt, expect, that he considered scrophula as de- 
 pendent upon some peculiar humour which was to be ex- 
 pelled ; but just before we are told, that this disease depends 
 upon debility, particularly of the lymphatic system ; a con- 
 dition which it is not customary to talk of eradicating, or 
 
 * Bell on Ulcers, p. 471. 
 t Bell on Ulcers, p. 427. 
 
 vol. ii ; v 
 
172 
 
 footing out, or expelling. Upon the common principles ol 
 reasoning, Mr. Bell ought only to have forbid healing the 
 sores, until the system was strengthened, otherwise the 
 weakness would be driven or determined to some other part. 
 
 Moderate pressure, by means of adhesive plaster, con- 
 joined with the application of cold water, is one of the best 
 remedies for the mild scrophulous ulcer, when it is situated 
 so that this can be used. When it is not, then dusting the 
 part thickly with cerussa, containing a sixth part of powdered 
 alum, may be had recourse to. A piece of dry lint is next 
 to be applied, and a compress bound down with such pres- 
 sure as can be used. It is sometimes useful to dip the com- 
 press in cold water, and renew it frequently. 
 
 The ceratum e lapide calaminari forms a very good dress- 
 ing for this sore, when it is intended to leave it to follow its 
 own course. 
 
 As a stimulant, the unguentum resinorum, either alone, 
 or mixed with red precipitate, is often used ; but it seldom 
 is of service, and often makes the sore irritable. If, however, 
 the ulcer become very indolent, this, or the citrine ointment, 
 properly diluted,* may be of service. The same may be 
 said of the other common stimulating applications. 
 
 Poultices, made of bread and sea water, have been recom- 
 mended, but seem to possess little power of accelerating the 
 cure. 
 
 Solutions of alum, of blue vitriol, corrosive sublimate,f of 
 the nitrites of copper, bismuth, and silver, are sometimes 
 Useful to wash the sore with. 
 
 * This application forms a very useful remedy for the scrophulous ulceration of 
 flie eye-lids, which we so frequently meet with. 
 
 f This substance is the basis of a celebrated lotion for the face, which k some- 
 times useful in chronic pustules, which are frequently of a scrophulous nature. It 
 promotes suppuration, the pustule then scabs, and, when thii falls off, the part is 
 sometimes found sound below. It in made by dissolving corro^m- sublimate in as 
 emulsion of bitter almonds. 
 
173 
 
 The recent leaves of the wood sorrel bruised, and applied 
 raw to the sore, is sometimes useful. The same may be 
 said of cloths dipped in lemon juice, or vinegar and water. 
 
 Saturnine ointment is much employed by some, for abating 
 heat and pain ; but is inferior to compresses dipped in cold 
 water. 
 
 Sometimes only the anterior part of a scrophulous tumour 
 suppurates and ulcerates, and the deeper part of it remains 
 swelled and hard. Jn this case, the bottom is generally co- 
 vered with a slough, which comes slowly away piecemeal, 
 and is renewed for some time, until the tumour subsides, 
 partly by sloughing, partly by absorption, and partly by the 
 subsidence of the remaining inflammatory action. In this 
 case, sprinkling the surface lightly with precipitate, or blue 
 vitriol, is of service ; and this may be alternated with the 
 common warm poultice. When the surface becomes cleaner, 
 dry lint forms a very good dressing ; and this may be cover- 
 ed with a pledget of linen spread with cerate. Afterwards 
 pressure is useful. 
 
 The irritable overacting sore, or what has been called the 
 struma maligna, is very difficult to manage, especially as it 
 is frequently connected with a diseased state of the bones or 
 tendons below. 
 
 The hepatized ammonia, diluted in the manner formerly 
 iuentioned, or simple ointment, mixed with opium, are some- 
 times of use. 
 
 Poultices of bitter almonds, beat up with a little olive oil 
 into a fine pulp, and then warmed, occasionally relieve the 
 pain, and make the ulcer more healthy. 
 
 Carrot poultices, or warm poultices made of bread and 
 strong decoction of camomile flowers, are also sometimes of 
 use. 
 
 Carbonic acid gas, or carbonated hydrogene, are some- 
 times of temporary, rarely of permanent advantage. 
 
174 
 
 Anodynes, internally, are useful here, as in other painful 
 
 sore ■ 
 
 In all cases of scrophujous inflammation or ulceration, it is 
 useful to exhibit, along with the proper local treatment, such 
 internal medicines, and to attend to the constitution, in such 
 respects as may be deemed proper. Upon these points I 
 have already made some observations. 
 
 When the local disease cannot be cured, and has induced 
 the scrophulous hectic ; when this cannot be removed by 
 the means commonly employed, and which have been men- 
 tioned in the dissertation on simple inflammation, then the 
 diseased part must be removed, if its situation permit. This 
 must not, however, be rashly done, but must be delayed un- 
 til we ascertain that our remedies, general and local, (which 
 must be used with assiduity and care) are of no avail. It is 
 not sufficient that the hectic continues, and that other ap- 
 pearances are almost stationary ; they ought to be augment- 
 ing, in order to justify amputation of a useful and important 
 part; because every practitioner must have observed the 
 recoveries which take place, even after the hectic fever has 
 made considerable progress. On the other hand, we must 
 not allow the constitution to suffer too much, but must in- 
 terfere, whenever we perceive that our labours are fruitless, 
 and that the hectic is regularly and progressively increasing, 
 and the strength sinking. When this is observed, the only 
 chance for life is an operation ; and every day this is delay- 
 ed adds to the risk attending it ; for there is a degree of in- 
 jury, more than which the constitution cannot sustain, and 
 which will prove fatal, even although the exciting cause be 
 removed. To fix the proper period requires judgment in 
 the surgeon ; but he may be enabled to do so, by attending 
 carefully to the state of all the symptoms ; for whenever 
 these continue progressively to become worse, and have re- 
 duced the patient already to a state of weakness, which can- 
 
175 
 
 not be much increased without danger, he may consider it 
 as impossible to delay amputation longer with any hopes of 
 success. 
 
 Having made these observations on this species of scro- 
 phula, I shall now conclude, by shortly mentioning the mode 
 of treatment adopted by the older practitioners. 
 
 Bleeding, which at first was made use of according to the 
 custom of the day, was soon laid aside, on observing, that, in 
 many cases, it was manifestly hurtful, and in every instance 
 useless. But although the plan of general depletion was 
 given up, yet local evacuations were much insisted on ; for 
 they held it as absolutely requisite, that the brain should be 
 purged of its pituita, (the redundancy of which produced the 
 disease) by errhines, fomentations to the ears, and the appli 
 cation of issues and sinapisms to the head. The stomach 
 was cleared of viscosities, by emetics of mustard or broom 
 seed ; the bowels, by aloes ; and the skin and kidneys, by 
 sudorifics and diaphoretics. 
 
 Having thus procured a sufficient evacuation, the patient 
 was desired to smell a pomum odoratum, composed of styrax, 
 amber, myrrh, aloes, and many other ingredients ; the va- 
 pours of which were supposed to get up to the anterior ven- 
 tricles of the brain, and dry them. Hunger and thirst, by 
 drying the juices, were decreed to be salutary. Every 
 thing was rendered nauseous with medicine. The bread 
 was seasoned with anise and fcenugrek seeds, and the drink 
 consisted of decoctions of guaiac and mastic wood, which 
 last was " a friend to the brain and viscera."* As a condi- 
 ment to these medicated meals, Arnoldus de Villa Nova 
 treated his patients to the burnt sponge, mixed with salt and 
 pepper. 
 
 * Laurent. <lc Strum. IVat. p. 67. 
 
116 
 
 But these, and indeed all the medicines yielded by the 
 materia medica, were considered as trifling, and of no avail, 
 when compared to the miraculous power possessed by the 
 king, who, with one touch of his hand, could banish this 
 dreadful disorder, and dry up all the sores. So valuable did 
 this royal prerogative appear in the eyes of many, that it 
 became a national controversy, whether it belonged to the 
 French or English ; whilst the Romish and Protestant 
 churches reciprocally urged this prerogative of the king of 
 the country where they were established, as a manifestation 
 from heaven of the justice of their cause. 
 
 In France, the king touched publicly, at four stated feaste 
 in the year, preparing himself the day before by prayer and 
 fasting; then entering the apartment, where the sick were 
 arranged, the patients were individually presented by the 
 chief physician to his majesty, who placed his hand upon 
 their head, pronouncing these words, " Le Roy te touch, et 
 Dieu te guarit." The sick then retire, and soon find a 
 manifest amendment- " In some the ulcers dry up ; in 
 others the swellings diminish ; and, wonderful to relate, in a 
 few days, more than 500 out of 1000 are perfectly cured !" 
 " Hie hcerant philosophi, coecutiunt medici, stupet propha- 
 num vulgus." 
 
 Upon reading these accounts, we smile at the credulity of 
 mankind; but we pity them, when we learn, that near a 
 thousand every year made weary and expensive pilgrimages, 
 from very distant countries, to purchase this imaginary be 
 fcefit. 
 
DISSERTATION VI. 
 
 OX THE CANCEROUS INFLAMMATION. 
 
 The cancerous inflammation generally comes in slowly, 
 in some glandular part, which becomes rather harder, and 
 somewhat larger,* than it ought to be ; but the pain, for the 
 most part, at first is trifling. By degrees, both the hardness 
 and swelling increase, and a pain, like the pricking of nee- 
 dles, is felt in the part. This pain, after some time, be- 
 comes more violent, darting through the whole of the gland, 
 and leaving a sensation, as if the part had been rudely wrung 
 or twisted. The tumour still remains moveable under the 
 skin, which is of the natural colour ; but when the disease 
 has continued a little longer, a greater degree of inflammation 
 lakes place, and adhesions are formed betwixt the skin and 
 the gland, or the gland and the parts below, at the same 
 time that the pain becomes more continued. The skin now 
 becomes puckered, or drawn inward, and of a dirty or leaden 
 hue, which in time acquires more of the red, but is never of 
 a bright colour. The veins are varicose, and the tumour is, 
 with difficulty, moveable. When the skin becomes red, we 
 may be able to discern a superficial fluctuation, which pro- 
 ceeds from part of the gland forming an abscess.f This at 
 
 * Although the affected gland becomes rather larger, yet the surrounding cel.- 
 lular substance sometimes diminishes, and the neighbouring glacdi are rather con- 
 tracted, in which case the part seems to be shrunk. 
 
 t This abscess sometimes, though very rarely, occupies the whole of the gland,. 
 ha* oftener only a part of it: aoH if the gland be largf, (here arc; sometime* 
 
178 
 
 last bursts, and discharges a thin yellowish matter, which 
 frequently oozes out in very considerable quantity ; the 
 orifice enlarges, and the sore penetrates, for a little way 
 downward, pretty rapidly, and the edges become hard, and 
 overlap a small part of the disk of the sore ; but, soon after 
 this, a fungus rises up ; and although, in some places, the 
 ulcer may become deeper, yet its chief progress is later- 
 all}. 
 
 The cancerous ulcer increases more or less rapidly, and 
 is soon attended with a burning pain ; the surface is unequal, 
 excavations appearing in some parts, whilst in others a fun- 
 gus rises up. The colour is brown, but glistening or fiery. 
 The granulations very soft and indistinct. A thin ichor, of 
 an abominable fcetor, is discharged in great plenty, mixed 
 with blood ; whilst, in many parts, small pellicles, like lym- 
 phatic exudations, cover the sore. The surrounding skin 
 is of a dark purple colour, and the adjacent parts very hard. 
 The margins, which at first were overlapping the sore, in 
 the course of a few days are uniformly elevated, and fre- 
 quently retorted and unequal, as if they had been bitten by 
 an animal ; and over these the fungus frequently shoots or 
 protrudes, so that the sore assumes the appearance of a cauli- 
 flower. This ulcer bleeds a little upon the slightest touch, 
 so that at every dressing the cloths are generally bloody ; 
 but, at times, this bleeding is more alarming, proceeding 
 from the bursting of the diseased veins. These hemorr- 
 hages are, in some instances, very frequent, and reduce the 
 patient to the greatest weakness. Sometimes they sudden- 
 ly relieve the unhappy persons from all their wo. 
 
 Some time after the abscess forms, and frequently before 
 ulceration takes place, the neighbouring lymphatic glands 
 
 several abscesses, of considerable size, which form unconnectedly with each otber, 
 and burst separately. 
 
179 
 
 swell, and become affected with a similar action, and follow 
 the same course with the original sore ; only in them the pro- 
 gress is generally more rapid. 
 
 After ulceration takes place, sometimes before it, if the 
 abscess be considerable, hectic fever takes place ; the coun- 
 tenance becomes sallow and unhealthy ; the pulse quickens, 
 and becomes small and sharp ; the strength fails ; night 
 sweats come on, and colliquative diarrhoea hastens death. 
 
 The parts in which cancer most frequently appears, are 
 the under lip, the breasts of women, and the testicles of 
 men : But there is no one part of the body in which it may 
 not occur, although most frequently it is, in its original at- 
 tacks, confined to secreting glands. 
 
 In the breasts, parotid glands, and some other conglome- 
 rate glands, the disease begins as has been described ; but on 
 the skin, and in some other parts, the progress is somewhat 
 different. The skin, particularly that of the face, is apt to 
 have a small chronic pustule formed on it, by the inflamma- 
 tion of one of the sebaceous glands, which, by degrees, be- 
 comes harder, firmer, and more elevated. Soon afterwards, 
 it becomes rough, and of a warty appearance : It then ul- 
 cerates on the surface. This is covered with a scale or 
 scab, which repeatedly falls off, and forms again upon the 
 part, until it assume the appearance and character of the 
 cancerous sore. But, more frequently, the disease is not al- 
 lowed to follow this progress, the wart either being rubbed 
 off accidentally, or removed by ignorant persons. The 
 part then forms a superficial ulcer, which is slightly hollow- 
 ed. It is of a glistening flabby appearance, and the margins 
 are hard, tumid, and a little turned back : But after the dis- 
 ease has continued some time, the flabby appearance of the 
 sore is converted into fungus. We may, therefore, from 
 this, and other cases, conclude, that cancerous ulcers, which 
 
 VOI,. II. 7. 
 
180 
 
 are formed without previous abscess, form fungus more slow- 
 ly than those which are formed with them. 
 
 When the lips become cancerous, there is generally first 
 perceived an indurated, lump, of greater or less bulk. The 
 skin over it becomes tender, frets, and is covered with a 
 scurf or scab, which gradually becomes elevated. Part falls 
 occasionally off, but it is soon replaced. This by degrees 
 extends itself over the prolabium, and, after some time, falls 
 off entirely, leaving the part with all the common characters 
 of the cancerous ulcer. The pain is burning. 
 
 When the testicle becomes cancerous, it sometimes follows 
 the common course of cancer in other glands, beginning with 
 hardness and shooting pain in some part of the testicles or 
 epidydimis, which gradually forms an abscess, and ulcerates. 
 But, at other times, soon after the testicle becomes diseased, 
 an effusion takes place within the tunica vaginalis. In this 
 case, the disease of the testicle becomes complicated with 
 hydrocele. It is distinguished by our feeling the hardness 
 of the epidydimis behind, or the hardness and inequality of 
 the testicle, when the water is drawn off. It likewise, after 
 some continuance, becomes more painful than a common 
 case of hydrocele. If the testicle be not extirpated in due 
 time, the cord becomes hard and swelled, and comes to ul- 
 cerate. 
 
 Cancer in the penis generally begins by a kind of warty- 
 tHmour, and follows the course of cancer in the face. Some- 
 times the penis becomes just like a cauliflower, a large fun- 
 gus extending from its ulcerated extremity. 
 
 The uterus, in elderly women, is very frequently affected 
 with cancer.* It begins with a feelin«; of weight and unea- 
 
 * It has been said, that genuine cancer is very rare in the uterus, and that the. 
 cases which pass for such are phagedenic. But although the uterus may be affect- 
 ed with scrophulous inflammation, and phagedenic, as well as some other specific 
 arTecti^r)?, yet it must be admittf-d, from an .examination of case?, that the uterus 
 
131 
 
 siness in the lower part of the belly, and the natural dis 
 charge of the parts is increased, so that the disease passes 
 for fiuor albus. By examination, however, we may general- 
 ly discover a hardness, and sometimes an inequality, about 
 the os uteri, and may discover the uterus to be unequally 
 enlarged. After some time, ulceration takes place, and mat- 
 ter, mixed with a bloody fluid, is discharged. Occasionally, 
 considerable hemorrhages take place, which are not unfre- 
 quently confounded with menorrhagia ; but it may be dis- 
 tinguished by the continued discharge of a bloody sanies 
 during the intervals of the hemorrhage ; by the continual 
 pain, and especially by our feeling the projection of the os 
 uteri into the vagina, in some places hard, and in others soft, 
 but rough, which shows ulceration. After some time, the 
 glands about the vagina swell ; and that canal, in many 
 places, becomes considerably straitened. Hectic terminates 
 the sufferings of the patient. On opening the body, we find 
 the uterus generally, though not always, considerably enlarg- 
 ed, with abscess and ulcers in different parts of its substance. 
 These ulcers, as well as those of the ovarium, and, so far as 
 1 know, every gland in the internal cavities of the body, 
 have a less tendency to fungate, than cancerous ulcer on the 
 surface of the body. 
 
 When inflammation attacks any organ, or part of the body, 
 and leaves a chronic tumour, this may assume, as will after- 
 wards be mentioned, a new inflammation, and may become 
 affected with cancer ; though it more frequently happens, 
 that it assumes the pseudo-cancerous action. The symp- 
 toms and progress of cancer are much the same here as in 
 the breast. 
 
 When the eye becomes cancerous, it, unless the disease 
 begins in one of the glands, such as the lachrymal, or those 
 
 is very frequently attacked with true cancer. Its substance is found enlarged* 
 hard, and containing cancerous abscesses in different parts. 
 
182 
 
 of Meibomius, is first of all affected with simple inflamma- 
 tion, which destroys the whole texture of the eye, and makes 
 it of a different structure, rather resembling a confused mass 
 than a well organized body. The lucid cornea becomes 
 opake, and protrudes ; the eye enlarges, is affected with a 
 violent deep-seated pain, and at last bursts, generally on the 
 apex : From this a fungous substance protrudes, which mani- 
 fests all the symptoms of the cancerous ulcer, and in a short 
 time arrives at a great size. 
 
 When the nose becomes cancerous, the disease either be- 
 gins on the outside, with a small, tumour or wart, as in other 
 parts of the face, or within, by a firm and somewhat painful 
 polypous projection, which frets on the surface, and soon as- 
 sumes the cancerous ulceration. 
 
 The diagnosis of this disease is of the utmost importance ; 
 because if we mistake cancer for some other disease, we not 
 only neglect the proper practice, but frequently are led to 
 prescribe remedies which do infinite harm. If, on the con- 
 trary, we mistake another disease for cancer, we neglect the 
 necessary means of cure, and may even be Jed to extirpate 
 a part which might be easily cured by gentler treatment. 
 
 Cancer may be confounded with scrophula, syphilis, and 
 some other affections, which have received no particular 
 name. 
 
 There is an affection* which begins like cancer, by a hard 
 schirrus, either of a gland, or still more frequently of one of 
 the chronic tumours, which has been already mentioned as 
 succeeding slow inflammation. This remains, for a conside- 
 rable time, hard, and free from pain, and there is no pucker- 
 ing of the skin over it. By degrees, some part of the sur- 
 face becomes of a purple or livid colour, and ulcerates. 
 
 * To this specific affection, we may give the name of pseudo-cancer, for wnn r 
 of a better designation. 
 
183 
 
 This ulcer remains long superficial ; the edges arc hard and 
 rounded ; the discharge is thin ; the surface is gloss}', and 
 no distinct granulations can be seen ; the pain is slightly 
 smarting, but not burning, and, instead of being fungous, the 
 sore is slightly hollowed out below the level of the surround- 1 
 ing skin. By the continuance of this affection, the gland is 
 apt to shrink and diminish in size ; and generally where this 
 takes place, the sore contracts and heals with a very pucker- 
 ed unequal cicatrix, having, in some places, a thick dark co- 
 loured scab covering it.* The neighbouring glands become 
 affected ; but they are soft, and rather resemble the spon- 
 goid inflammation than schirrous hardness : But I have never 
 had an opportunity of observing them proceed the length of 
 ulceration. If the continuance of the sore be long, the con- 
 stitution is affected, and the patient becomes hectic. f This 
 kind of ulcer may be distinguished from cancer, if we attend 
 1o the absence of the fungous, and peculiar appearance of 
 I he cancerous sore, and the want of the burning pain : But, 
 before ulceration takes place, the two diseases may be con- 
 founded ; because there are no certain characteristics of 
 schirro-cancer. 
 
 This disease may attack the uterus, and is very apt to be 
 confounded with cancer; nor is it easy to distinguish them, 
 as the parts are unseen. There is never much enlargement. 
 The ulcer is pretty smooth, and the margins circular, hard, 
 and glabrous. The pain is not very considerable. The dis- 
 
 * Of this nature was probably the ulcer mentioned by Mr. Wiseman, at least if 
 •ve may judge from his very short description : " It hnd eat deep into her left 
 breast, and was fixed to the ribs, but not with much pain. In progress of lime, the 
 lips inverted, and united, as it were, and lay covered with a crusty scab; the hu- 
 mour in the mean while spent itself upon the nerves, iVc. She lived long, and, in 
 her latter age, tolerably healthful." Chirurg. Treatises, vol. i. p. 165. 
 
 t Extirpation is the only certain cure of this disease ; and it is at all times 1 1: r 
 quickest and the best; but, by eschoritics, we may sometimes procure cicatii v 
 tion, at least if the gland have shrunk, and most of its substance been destroyed. 
 
134 
 
 charge is thin, copious, and of a yellowish colour, but seldom 
 blood}', unless when the disease has continued very long. 
 
 The spongoid inflammation has been considered as cance- 
 rous by those who have seen it ; but the distinction betwixt 
 the two is sufficiently obvious : The one begins with a spongy 
 elastic tumour, the other with a firm hard lump. 
 
 Scrophula may be mistaken for cancer, when it appears 
 in one of the secretory glands, such as the breasts; at least 
 as long as it remains without ulceration. But the tumour 
 generally enlarges more rapidly than cancerous tumours, at 
 least such as are not very painful. It is pretty soft and 
 doughy, the pain is inconsiderable, and we may generally 
 perceive the marks of a scrophulous habit. When ulcera- 
 tion takes place, the opening is, for some time, sinous, and 
 the matter discharged is curdy, and without fcetor. When 
 the ulceration extends along the skin, it has not the fungous 
 appearance of cancer, but the aspect of a scrophulous sore, 
 and the gland below appears sloughy. The pain is not very 
 considerable, and is not of the burning kind. 
 
 Scrophulous inflammation may also attack the uterus, 
 bladder, and any of the internal organs. The uterus and 
 bladder become thickened, and contain abscesses in differ- 
 ent parts, which point on the surface of these viscera. They 
 are filled with a thick Avhite cheesy-looking matter ; and 
 when they burst, they produce ulcers, with a foul surface, 
 and having the margins notched, and lying for a considerable 
 way over the disk of the sore. 
 
 The distinction betwixt cancer and the venereal ulcer is 
 so very striking, that it is scarcely possible for these dis- 
 eases to be mistaken for each other, if the discriminating 
 marks of each be attended to. The cancerous sore is al- 
 ways dark coloured ; the surface fiery, yet of a fungous na- 
 ture ; the discharge foul, and of an intolerable smell ; and 
 the bottom and surrounding parts are hard and painful. If 
 
1X5 
 
 there be not an open running sore, the part is covered with 
 a dry elevated scab, of a dark colour ; the skin around this 
 is livid, and the neighbouring parts indurated. The base of 
 Ihe venereal sore is much softer, the discharge is of a differ- 
 ent nature, and its aspect-so peculiarly unlike the cancerous 
 sore, that it is impossible to confound them.* 
 
 There is another disease, which is very apt to be con- 
 founded with cancer, and which, at one period, resembles it 
 very much. It begins with a small tumour, like a phleg- 
 mon, of a dull colour, and without much pain. This soon 
 assumes a soft elastic feel, and bursts at the top ; a blood v 
 rnatter oozes out, the lips of the orifice become tumid, and 
 the integuments ulcerate. The whole has a convex surface, 
 the ulcerated part being most prominent ; and the sloping 
 margins are red and painful : The ulcer itself is foul, of a 
 dark fungous appearance, and covered with thick offensive 
 matter, with sloughs in different parts ; the margins are 
 hard, and lie, in a serrated manner, over part of the sore : 
 The pain is smarting. This sometimes spreads to a consi- 
 derable extent, and cuts off the patient. At other times., 
 by the use of mild dressings, good diet, and opium inter- 
 nally, the fungous surface sloughs off by degrees, and shows 
 a smooth red bottom, somewhat striated, and of a glossy ap- 
 pearance, which contracts, and scabs over, like the pseudo- 
 
 * It is to be regretted, that some who belong to our profession, reason upon the 
 nature of ulcers, not from appearances anil characteristic marks, but from the pa- 
 tient's manner of life, or the idea which t'ney have formed of the country whence 
 they coma. I remember two instances of people who came from the Hebrides, the 
 one with \ cancer of the lip, the other with a cancerous nicer on the neck, both 
 fungous, and possessing the burniog pain, and every character of cancer; but as 
 the sibbens unluckily prevailed in that country, it was thought that the patient* 
 might have received this infection, and accordingly were, by a full consultation of 
 aurgeons, condemned to undergo a course of mercury. The lip was, jo three day*, 
 greatly worse; the mercury was omitted, and the patient cured by an operation-. 
 The sore on the neck was instantly exa«perated, and the patient] to u<e thi 
 t»f Hildantis, " had her soul speedily sent to heaven." 
 
186 
 
 cancer. The fungous, in this ulcer, never rises high ; it is 
 generally slightly convex, being most prominent at the cen- 
 tre, and has never the retorted trumpet-like appearance of 
 some cancers. 
 
 Phagedena has sometimes, particularly on the yard, been 
 confounded with the cancerous sore. It has indeed the 
 brown fiery colour, and smarting pain, possessed by the can- 
 cerous ulcer ; but it wants the fungous appearance, which 
 the cancer very soon assumes. It spreads with greater ra- 
 pidity, and is not surrounded by the same hardness. It be- 
 gins likewise more suddenly, and without any previous hard 
 tumour. We frequently hear of venereal buboes becoming 
 cancerous ; but this seldom, if ever, happens ; and phagedena 
 has, iu this case, been confounded with cancer ; for that 
 spreading fiery honey-comb-like ulcer, which venereal bu- 
 boes sometimes turn into, is evidently of the phagedenic 
 nature. 
 
 It was from allowing too great latitude to the description 
 or definition of cancer, as well as from the numerous divi- 
 sions admitted by the older writers, such as mild, raging, 
 and the like, that many diseases have come to be considered 
 as cancerous, which are in their nature perhaps radically 
 different from it. 
 
 The mild cancer was said to begin slowly, with little pain, 
 to continue long indolent, and to ulcerate slowly : The ul- 
 cer was not very painful, and frequently healed with a scab, 
 or remained long stationary. This evidently was not a can- 
 cerous disease, but the one which I have described above. 
 On cutting into this tumour, after extirpation, we find it to 
 be of a firm texture, the interstices filled with a kind of 
 oily matter, and no cavities with thickened sides in its sub- 
 glance. 
 
 The malignant, or true cancer, begins with a hard schir- 
 rous tumour, with frequent lancinating pain ; the skin soon 
 
187 
 
 adheres to the gland, and becomes slightly puckered, and of 
 a livid or leaden colour ; the veins are more or less varicose, 
 although the tumour be not large ; and the nipple, when the 
 disease is in the breast, is generally drawn inward. The in- 
 teguments next become red, and a small opening forms, 
 through which is discharged a bloody serous-looking matter, 
 generally in very considerable quantities. The ulcer which 
 succeeds this is, at first, superficial, affecting only that part 
 of the integuments which covered the pointing of the glandu- 
 lar cyst or abscess. It is dark coloured and fiery, like pha- 
 gedena ; but the edges are hard and ragged, and overlap ir- 
 regularly, in different spots, small parts of the surface of the 
 sore. In the course, however, of a few days, sometimes in a 
 few hours, a fungus protrudes, and increases more or less rapid- 
 ly, at the same time that the sore spreads laterally. This 
 fungus is very irregular, of a dark colour, and covered with 
 sloughy-looking pellicles. It generally sprouts out most to- 
 ward the circumference, so that the sore has often the ap- 
 pearance of the mouth of a trumpet ; or if the cavity in the 
 middle be less, the fungus being less turned out, it resembles 
 a cauliflower. This fungus uniformly projects over the 
 margins, which are hard and red. The matter discharged 
 is thin, bloody, and exceedingly foetid. On examining these 
 glands, we find them, in the commencement, to be hard, like 
 a substance intermediate betwixt gland and cartilage, and of 
 an indistinct granulated structure. Soon afterwards, we per- 
 ceive small abscesses or cavities in different parts, which 
 are filled with a serous fluid, and the sides of which are hard 
 and firm, like gristle. These enlarge gradually, and new 
 ones form ; so that were we to cut the gland, we should find 
 it containing a great number of these cavities.* Those 
 
 * These are sometimes very irregular in their shape, and have their sides very 
 thin ; so that, at first sight, they appear like cavities formed by the separation of 
 he fibres of the part. 
 
 VOL. II. A 2 
 
]88 
 
 which are nearest the surface of the gland, generally enlarge 
 most ; and sometimes only one gains any considerable size. 
 Before this bursts, its sides become more opake, and more 
 blended with the rest of the gland, (which, where it sur- 
 rounds the abscess, becomes softer, rather more vascular, 
 and more porous or spongy than in other parts, and than it 
 formerly was,) unless it distend beyond the substance of 
 the gland, pushing the skin outward. In this case, when it 
 bursts, a great quantity of lymphatic matter is discharged, 
 and the part collapses, and then exhibits the usual appear- 
 ances of the cancerous ulceration : But, more frequently, we 
 find the abscess remain altogether in the gland, and only dis- 
 tend the skin a little at the apex, where it points. When the 
 abscess bursts, more or less fluid is discharged, and immedi- 
 ately the inner surface begins, like the orifice, to ulcerate. 
 A fungus is produced from the sides of the abscess, which 
 fills up the cavity, and then protrudes from the orifice. We, 
 therefore, find, that when the cancerous abscess bursts, the 
 orifice at first assumes the appearance of a cancer which be- 
 gins in the cutis j* but very soon a fungus protrudes, and the 
 ulcer gradually becomes more convex, or more like a cauli- 
 flower. 
 
 These abscesses, with thick sides, are characteristic of 
 cancer, and are never found wanting in a cancerous gland. 
 When they are not present, we may be certain, that the tu- 
 mour is a difierent kind of schirrus. But although these be 
 always found in the glands, and form in them a certain mark 
 of cancer, yet they are not necessary to the existence of that 
 disease ; for the cancerous ulcer, like common ulcers, may 
 
 * That is to say, the sore is rather flabby than fungous ; for cancerous ulcers 
 which begin superficially, and without previous abscess, remain a considerable 
 time without forming fungus; but when an abscess bursts, and the skin ulcerates 
 inconsequence, then the sore is not superficial, but communicates with the ab- 
 scess, which forms fungus quickly. 
 
189 
 
 begin without previous abscess, as we observe in the cancer 
 of the skin, which, in nine cases out of ten, begins with ex- 
 crescences like warts. 
 
 By attending to these circumstances, we may generally 
 form a pretty just diagnosis. At the same time, it must be 
 admitted, that, occasionally, cases do occur, in which it is 
 impossible to deliver a decided opinion : Nor is it doubtful, 
 that many ulcers are considered as cancerous, which are of 
 a different nature, and some of which admit of a cure. In 
 forming our judgment, we must be directed by the nature of 
 the first symptoms, and the history of the schirrous stage ^ 
 by the appearance and aspect of the fungus, and the other 
 circumstances which have been already described. 
 
 Concerning the peculiar state of the parts in cancer, or the 
 proximate cause, many opinions have prevailed ; but these, 
 however they might differ in certain points, have almost 
 unanimously agreed in admitting obstruction as the chief 
 cause of this disease. 
 
 Until lately, the melancholic humour was supposed to be 
 the fluid which was obstructed, and accumulated, in conse- 
 quence of which it fermented, and produced a burning ulcer ; 
 and whatever promoted the generation of this humour, was 
 currently admitted as a remote cause of cancer. Women, 
 says Ambrose Pari', are more subject to schirrus than men ; 
 " because their liver is warmer, and their spleen being weak- 
 er, is less able to purge the blood of choler." Grief and cha- 
 grin, by promoting the formation of this fiery fluid, were ac- 
 cordingly considered by the celebrated Heister, as very apt 
 to induce the " cancerous diathesis ;" and he slyly adds, by 
 way of corollary, that " old maids, and women who do not 
 breed, are very subject to cancer in the breast."* 
 
 * Heister's Iostitut. Vol. I. p. 229, 
 
190 
 
 Concerning the particular changes which took place its 
 (he nature of this obstructed humour, many different opi- 
 nions prevailed. Some thought it necessary, that the black 
 bile should be charged with an acid, and that this produced 
 ulceration, when " its sharp cutting points had surmounted 
 and destroyed the volatile smegmatic and balsamic salts of 
 the blood." Others conjectured, that by an " adustion or 
 over-concoction," it grew sharp and burning : But Wiseman 
 observes, that it is more probable that it becomes somewhat 
 arsenical. It would, however, be useless to enumerate the 
 different changes which this imaginary humour was supposed 
 to undergo* It is sufficient to observe, that these were al- 
 most universally believed to depend upon the previous stag- 
 nation, in consequence of obstruction ; and this leading point 
 has uniformly been insisted on by every succeeding author r 
 whatever might have been his particular notion with regard 
 to the nature of the obstructed fluid, whether bile, blood, or 
 lymph; and even Ihe anatomical structure of the part has 
 been brought in support of the doctrine of obstruction. One 
 of the latest writers,* 1 though he talks nothing of " coagula- 
 ting acids,"f yet insists fully on this mechanical cause as 
 the origin of cancer; " for," says he, " the circulation in the 
 glands being carried on by a set of vessels much more minute 
 than those with which other parts of the body are supplied, 
 (let this be proved,) obstruction will much more readily and 
 easily occur in them than in other parts." — " When the 
 substance of a gland happens to be the part, a determination 
 is made to this, being neither, as is found by experience, 
 so proper as the cellular substance, for the formation of pus, 
 nor, from its softness,J so susceptible of inflammation, as a 
 membrane ; an indolent hard swelling, called a schirrus, comes, 
 
 * Bell on Ulcers, p. 3ia 
 
 f Dioni's Cliir. p. 2-48. 
 
 t Does inflammation depend upon the hardness or softness of the inflamed part? 
 
191 
 
 merely by the obstruction and distension* of its different 
 vessels, very naturally to be produced." 
 
 Some surgeons, perhaps from a desire of singularity, or 
 from a defect of their organs of sight, declared, that they 
 had detected little worms in the parts, which, eating it up, 
 produced all the disagreeable symptoms of cancer ; and that 
 to their introduction the disease was owning. The cure 
 which they confidently proposed, was applying a piece of 
 cold veal to the part, which would tempt the animals to quit 
 their devastation. Others, perhaps originally from ridicule, 
 though latterly in sober earnest, told their readers, that 
 there were no worms, but a little wolf in the part, which 
 might be made occasionally to show its head, by holding a 
 piece of meat before the ulcer. 
 
 Strange as this doctrine of living creatures producing 
 cancer may appear, it is nevertheless adopted by a late 
 very ingenious writer. When hydatids find their way into 
 " a solid substance," the consequence, in his opinion, will be 
 cancer ; and the success of an operation will, he conjectures, 
 depend, in a great measure, upon these animals being con- 
 fined in a common cyst, for then they may be all removed ; 
 whereas, if they be unconnected, some of the smaller ones 
 may be allowed to remain. f From the surface of the cyst, 
 which contains the animal, a fungus shoots out, and thus acts 
 as a barrier between it and the skin ; or, if the animal have 
 been in the stomach, it separates it from the coats of that 
 viscus, " preventing suppuration in the one instance, and ab- 
 sorption in the other.":}: This suppuration, "and disposition 
 
 * One should expect, that the distension of the vessels would diminish the cause 
 of obstruction, or remove it altogether. 
 
 It is rather unlucky, that the advocates for obstruction have made it the cause 
 of simple inflammation, scrophula, cancer, &c. ; and therefore all these diseases 
 ought to be nearly, if not entirely, similar in their nature, and to require exactly 
 the same means of cure. 
 
 t Adam's Observations on Morbid Persons, p. 184. 
 
 t Idem, p. 185. 
 
192 
 
 to fungate before the skin is broken," if I understand him, is 
 produced by the death of the animal ; for, says he, " if hy- 
 datids possess the principle of vitality during their transpa- 
 rent state, and their opacity is the effect of the loss of that 
 principle, would they not, in the latter stage, stimulate the 
 part in which they are situated to suppuration, as we find 
 the case with the Guinea worm when dead?"* Concerning 
 the manner in which these animals produce the symptoms of 
 cancer, we are told, that " this enlargement of a foreign body, 
 in a solid substance, and so extremely sensible as the breast, 
 cannot but be attended with intense pain, and frequent in- 
 flammation."! A doctrine not far removed from that taught 
 in the humoural schools, which maintained, that the coagula- 
 tion and inspissation of the fluids distended the follicles of 
 the glands, producing many cavities, and much pain. J 
 
 That hydatids may be formed on a cancerous gland, I 
 shall not dispute ; but that they are generally to be met 
 with, or are in any respect essential to the disease, I can- 
 not admit. In all the cancerous breasts, testicles, and tu- 
 mours, which I have examined, I never saw any thing which 
 could be considered distinctly as a hydatid ; so that I sus- 
 pect, that under this name have been described the small 
 cancerous abscesses, with thick cartilaginous sides, which 
 we so universally meet with in schirro-cancerous glands. 
 We likewise find cancer take place in circumstances in' 
 which no hydatids can be found. Thus, for instance, a can- 
 cerous wart being knocked off the face, a cancerous ulcer is 
 produced ; but no hydatid is to be found at the base of the 
 wart to produce this. 
 
 When cancer has continued some time, it was believed 
 that the matter was absorbed, taken into the blood, and that 
 
 * Adam's Observations on Morbid Persons, p. 184. 
 
 f Idem. p. 161. 
 
 t Van Swieten's Commentaries, article Cancer. 
 
193 
 
 all the humours were speedily assimilated ; and it was by this 
 absorption and assimilation that they explained the fatal and 
 rapid progress of relapses, after an apparent cure had been 
 obtained. That matter is absorbed, is an undeniable fact : 
 but the only effect which is produced by this, is on the lym- 
 phatic glands,* which intervene betwixt the sore and the 
 heart ; for, beyond these, the matter does not pass qua virus, 
 but is changed in its nature and properties, as is the case 
 with every other part or production of the animal, which is 
 absorbed and formed into part of the blood. Neither can- 
 cerous matter, nor variolous matter, nor syphilitic matter, 
 ever are formed in the blood, or ever can enter into it, un- 
 less by means of a wounded vessel. This point I shall con- 
 sider more fully, when I come to treat of the venereal inflam- 
 mation. Here I shall only observe, that were the reverse 
 true, then the contagious matter must pass through every 
 gland, and every portion of the human form, in as much as 
 the blood circulates in every point ; and, therefore, every 
 spot should become diseased, and every part, in the same 
 circumstances, should become diseased at the same moment.f 
 Disease is not spread in the living system mechanically, by 
 the absorption of matter, which is conveyed over the whole 
 body, but by the sympathetic connexion of parts, which has 
 
 * Mr. Hunter supposes, that the mere absorption of schirrous substance before 
 matter be formed, will affect the glands; but it is difficult to ascertain the certain- 
 ty of this, as small abscesses are formed very early. I have formerly mentioned, 
 that every part of the animal is changed in its nature, at the moment of being ab- 
 sorbed: If so, schirrous substances lose all specific property, and cannot affect the 
 glands. Pus, again, being a foreign matter, is absorbed unchanged, and continues 
 so until it reaches the glands. 
 
 f It may be said, that different parts have different susceptibilities of assuming 
 the morbid condition ; that the bones are longer of becoming affected than the soft 
 parts, &c. Admit this, and still it must be explained, why every part of a similar 
 structure, &c. should not be affected at the same moment. All the glands should 
 become diseased at once; all the bones should inflame at the same time; and, in- 
 stead of finding one or two organs affected, in consequence of the previous existence 
 of a local disease, we should find the whole system rapidly becoming diseased. ^ 
 
194 
 
 tjeen already explained, and which will afterwards be farther 
 illustrated. It is in consequence of this, that a distant part 
 shall become diseased, and yet all the rest remain healthy ; 
 and even where every part becomes affected, and a general 
 disease is suddenly produced from a local sore, as, for in- 
 stance, in small-pox, there is no diffusion of matter, nor is it 
 ever conveyed beyond the lymphatic glands. 
 
 In this particular complaint, the consequence of sympa- 
 thetic action, or the propagation of action, is sometimes the in- 
 duction of the same disease in other parts ; but most common- 
 ly the effect is the establishment of the hectic, or diseased 
 formative action ; for an explanation of which I refer to the 
 dissertation on simple inflammation. 
 
 By examination, we find, that, in many instances, cancer 
 is evidently produced by the same causes which are capa- 
 ble of producing simple inflammation ; and, in every instance, 
 I apprehend, that although the causes may be obscure, yet 
 they are exactly of the same nature. It is, however, a ge- 
 neral opinion, that this disease arises frequently from some 
 unknown and mysterious cause which we cannot detect, and 
 which, therefore, has been resolved into some constitutional 
 taint, or cancerous ferment. But, so far as we know, the 
 constitution is perfectly healthy in the commencement of 
 this disease ; nor is there the smallest proof that it resem- 
 bles scrophula, in depending upon any peculiarity of consti- 
 tution, before the causes operate. 
 
 Blows, bruises, and other exciting causes of inflammation, 
 are apt to produce cancer ; but, in many instances, we can 
 detect no evident local cause acting directly on the part. 
 In the breast, for instance, we frequently perceive cancer 
 commence without the interference of any topical agent. In 
 these cases, however, we may uniformly detect an irregu- 
 larity or disappearance of the menstrual secretion. It was 
 r ormerly observed, that the uterus and mammae exhibited 
 
195 
 
 very powerfully the sympathy of equilibrium ; and it is upon 
 this doctrine, which it is unnecessary farther to illustrate, 
 that we are to explain the affection of the breast, which so 
 frequently takes place in consequence of the cessation of 
 the menses ; for when the active state of the uterus is los.t, 
 the action of the mammae is preternaturally increased, and a 
 species of slow inflammation is induced. It is upon this 
 principle only that we can explain why cancers are so fre- 
 quent at the cessation of the menses.* It is ridiculous to 
 suppose that this discharge acts as a drain to the constitu- 
 tion, and carries off impurities, which would otherwise col- 
 lect elsewhere, and produce local diseases. The breast is al- 
 most the only organ which becomes thus affected without 
 any agent acting directly upon the part alone ; for, inmost 
 other instances, we may detect the operation of such causes 
 at least as tend to induce simple affections of the same part ; 
 but, in both instances, the modus operandi of the cause is 
 alike, only circumstances are somewhat varied. 
 
 When the inflammatory action is slowly induced, whether 
 by a bruise, or any other cause, acting directly on the part, 
 or by sympathetic union with another part, we find, that the 
 tumour which is consequent to this, seldom manifests a dispo= 
 sition to remove quickly, or assume the healing process. 
 The part neither performs airy distinct and acute inflamma- 
 tory action, nor does it resume its natural condition and ap- 
 pearance, but remains in a new state, different from either, 
 which I will call the state of simple schirrus.f If this state, 
 
 * It was supposed, that wheu the menses were obstructed, the impurities were 
 sent by communicating vessels to the breast, where they lodged, and produced 
 cancer. Vide, Vesalii Opera, p. 1092. Fabricius de Turn. p. 118. 
 
 Le Dran observes, that when schii rus, from any cause, takes place in the breast, 
 before the cessation of the meuses, it uniformly becomes more painful when any 
 irregularity of that discharge occurs. Vide, Memoires de l'Acad. de Chirurg, 
 torn. iii. p. 22. 
 
 f Warts <\re, with regard to their power of acting, to be considered in the sattfe 
 'ight with simple schrtrt 
 
 vol. rr. 2 u 
 
196 
 
 which may follow the application of the common exciting 
 causes of inflammation in any part, take place in cellular sub- 
 stance, or similar parts, which are possessed of no glandu- 
 lar structure, then a chronic tumour is produced, which is 
 either slowly diminished by absorption, or at last unable to 
 carry on its actions in perfection, being, in some respect, in- 
 sulated, and deprived of the support of the surrounding 
 parts ;* a diseased action, or morbid performance of its ac- 
 tions, takes place ; a slow inflammatory condition is pro- 
 duced,! an d a * last ulceration succeeds. This, in general, 
 forms pseudo-cancer, provided that the constitution be sim- 
 ple, that is to say, healthy : But if it take place in a scro- 
 phulous habit, the tumour is apt to become scrophulous, 
 having its morbid actions modified by the morbid condition 
 of the system. If this event take place in a lymphatic 
 gland, instead of the cellular substance, then the tumour is 
 still more apt to become affected with scrophulous inflam- 
 mation, in consequence of even a very trifling scrophulous 
 modification of the habit. If this state be produced in a 
 secretory gland, the affection is somewhat different from that 
 in simple parts, or those which do not secrete ; because the 
 inflammatory action becomes somewhat modified by the na- 
 tural secreting action of the part ; and, in this point of view, 
 the gland may be considered as possessing a specific consti- 
 tution, although the general constitution be simple ; for, na- 
 turally possessing a peculiar mode of action, it follows, that 
 new actions induced iu such a part, ought to be performed 
 in a different manner from the same actions in parts which 
 naturally do not possess this peculiarity, and that the actions 
 ought to be specifically different. When these parts are at- 
 
 * See the Note to p. ] 54. 
 
 t The simple schirrua now assumes that specific mode of inflammatory action 
 which ii is to continue, and may now be called the scrophulous or cancerous in- 
 Tamed schirma. 
 
197 
 
 tacked with acute simple inflammation, it differs from in- 
 flammation in the cellular substance in certain circumstances, 
 and particularly in being much more tedious ; but when the 
 nature of the part is still farther altered by the accession of 
 a slow inflammatory action, which operates in the manner 
 above described, then it assumes a specific inflammation, 
 which ends in ulceration. The exact, or specific nature of 
 this, is various ; and the state, which we call cancerous, is 
 probably only one of the varieties of this morbid inflamma- 
 tory action ; and whether the part shall assume this variety, 
 or some other variation, as, for instance, pseudo-cancer, de- 
 pends probably upon local circumstances, which we cannot 
 as yet detect or explain. If, however, the constitution pos- 
 sess any specific mode of action, the tumour generally as- 
 sumes nearly the same mode ; and, therefore, in scrophnlous 
 people, these tumours more frequently become affected with 
 scrophulous inflammation, than with cancer: At the same 
 time, if the previous change on the gland, induced by the 
 slow inflammatory condition, have been great, the scrophu- 
 lous condition, which it possesses in common with the rest 
 of the system, becomes modified in it, in the same way as 
 the simple condition, in healthy habits, is modified by the 
 new or schirrous state of the gland ; and, therefore, the 
 scrophulous inflammation is sometimes different, and the ul- 
 ceration more fungous than in other parts. 
 
 The causes, then, of simple inflammation, when they ope- 
 rate slowly, or leave the part in a state neither inflamed nor 
 healthy, give rise to a chronic enlargement, and change of 
 nature, which I have called simple schirrus.* This per- 
 
 * Schirrus has generally been enumerated as one of the terminations of inflam- 
 mation ; but it cannot, properly speaking, l>e considered as such. There are only 
 two kinds of termination, one in death, as, for instance, gangrene ; tlie other in re- 
 covery, which is accomplished either directly by resolution, or indirectly by sup- 
 puration. Schirrus is not produced by a perfect and complete cessation of inC.am 
 
193 
 
 forms, like every other part, certain actions, which are in- 
 tended for its own support, and which must make a part of 
 the general action of the system, or be in unison with the 
 rest of the body. But as its actions are different in nature 
 from those which any part of the body naturally ought to 
 perform, and as originally this organ, (which, from the 
 changes induced on it, is to be considered as new and extra- 
 neons,) formed no part of the human frame, there is not that 
 connexion betwixt it and the rest of the system, which is 
 necessary for its support. It, therefore, does not derive the 
 same aid and support from the neighbouring parts which na- 
 tural organs do, (for no part, or individual organ, can exist 
 and support itself singly, and independent of the rest,) and, 
 accordingly, must soon come to suffer. It is unable to per- 
 form its necessary actions in perfection ; they become mor- 
 bid, and of an inflammatory nature. The tumour is now an 
 inflamed schirrus ; and this inflammation either assumes a 
 modification, from the specific nature of the constitution, or 
 from the peculiar nature of the tumour itself, which, as has 
 been explained, is different from the healthy state of the tu- 
 mid part. We have, therefore, the scrophulous, the cancer- 
 ous, the pseudo-cancerous inflamed schirrus ; and the symp- 
 toms of these different kinds of schirri, and the appearance 
 of the ulceration, will, 'caeteris paribus, be modified by the 
 nature of the part affected. The same disease, therefore, 
 exhibits slight variations in different organs, as has been 
 described in the history of cancer, and might, therefore, were 
 we inclined to multiply distinctions, fee considered as so many 
 different diseases. 
 
 mation, but by a continuance of a low degree of inflammation, which renders the 
 state of tumefaction which attends it natural to the part, before it goes off. This 
 state, then, is not a termination of inflammation, but a consequence of its continu- 
 ance. 
 
199 
 
 This disease is most apt to take place in elderly people, 
 (in so much that some consider it as peculiar to old age ;) be- 
 cause in them, parts sustain injury of their actions worst, or 
 are less able to recover from them. Hence, two consequen- 
 ces follow: First, Simple schirrus is more easily produced, 
 resolution of inflammation being more difficult, especially in 
 parts which are, at all times, rather tedious in their recovery, 
 when inflamed : Second, The simple schirrus is more apt to 
 inflame, or have, what may be called, its necessary actions 
 impeded and deranged. It must, however, be remembered, 
 that there is no age whatever exempted from this disease : I 
 have seen it distinctly marked, and attended with a fatal 
 event, in children of five years old.* 
 
 It is a controverted point, how far it is possible to produce 
 cancer by inoculation ; some maintaining, that the applica- 
 tion of cancerous matter to a sound part will induce the dis- 
 ease ; others, that rt is altogether harmless. Analogical 
 evidence is certainly in favour of the first opinion ; because 
 the majority of specific ulcers may be inoculated, and have 
 been so by accident. But, at the same time, it must be ad- 
 mitted, that there are few well established cases of this par- 
 ticular point. We find, however, that, like the venereal 
 matter, the cancerous, when absorbed, induces a disease in 
 the lymphatic glands, of a cancerous nature. We would, 
 therefore, be led to conclude, that if the matter be capable 
 of inducing cancer by absorption, in a distant part, it ought 
 likewise to be capable of producing the same disease in 
 another person by inoculation. The same may be said of the 
 spongoid inflammation, &c. 
 
 * I have known two cases of this kind; in both the eye was affected. One boy 
 had his eye extirpated; but a small part being left by the surgeon at the angl^, 
 the disease returned, and proved fatal. In another, the disease was in its incipi 
 cut stage ; hut Urn relations would not submit to an operation. 
 
200 
 
 From these observations, it will, I presume, appear, first, 
 That when a pari is incapable of performing the actions ne- 
 cessary for its preservation in a state of health, it generally 
 slowly assumes the inflammatory state, which goes on to ul- 
 ceration ; but the part being unable to support its natural 
 action, can much less perform the actions necessary for re- 
 storation from this morbid condition, which, therefore, con- 
 tinues permanently and progressively increasing ; that the 
 nature of this unhealthy action is not always the same, but 
 admits of variations dependent upon certain conditions in 
 the previous state of the part affected, with regard to which 
 we are greatly in the dark. Cancer, pseudo-cancer, spon- 
 goid inflammation, &c. are some of these variations. 
 
 Secondly, Cancer, and all these variations, are originally, 
 in the strictest sense of the word, local diseases, depending 
 neither upon any constitutional affection, nor the presence of 
 any general cause. They do, however, in progress of time, 
 affect not only parts in their vicinity, but also the system in 
 general, producing, by means of sympathetic actions, speci- 
 fic hectic affections, as has been formerly explained, when 
 treating of simple hectic. They likewise spread over more 
 surface in the part at first affected, and produce the same 
 morbid actions without variation, by means of the sympathia 
 consociationis serpens. They also induce a similar disease 
 in the nearest lymphatic glands, by absorption. 
 
 Of tut Prevention and Treatment of Cancer. 
 
 Prom what has been said, it will appear, that cancer is to 
 be prevented by using the most vigorous means for the re- 
 moval of simple schirri, upon their first appearance. Of 
 these, local bleeding is the most powerful, and ought to be 
 freely employed. Next to this, an issue in the neighbour- 
 hood of the part ought to be most depended on ; and these 
 
201 
 
 two remedies must be employed early, and continued care- 
 fully. Whenever a simple schirrus arises, we ought to be 
 on our guard, in whatever situation it may be placed ; but, 
 if it occupy a secretory gland, we require to be doubly vi- 
 gilant. This, at first, is not painful, at least the patient only 
 complains of slight uneasiness shooting for a moment through 
 it. This circumstance too frequently prevents the patient 
 from attending to it; for where there is no inconvenience 
 sustained, there is little inducement to apply for assistance ; 
 and, not unfrequently, an ill-judged modesty contributes to 
 this delay. But although the patient may be little concern- 
 ed at this period, yet the surgeon must not observe the same 
 indolence. Aware of the dangerous consequences of allow- 
 ing the tumour to follow its natural course, he will apply 
 leeches once and again, and insert an issue as near the part 
 as possible. The remedies called discutient have been 
 much recommended at this stage ; such as sal ammoniac dis- 
 solved in vinegar ; and this is sometimes useful, but perhaps 
 not more so than the vegetable acid by itself: When it does 
 not interfere with bleeding, it may be usefully employed. 
 By means of these remedies, we may frequently remove re- 
 cent tumours, which depend merely upon the enlargement 
 of an organ, without any other considerable change of struc> 
 ture. But it is more difficult to remove tumours which are 
 not produced by the mere enlargement of a part, but de- 
 pend upon a change of structure, or the formation of new 
 parts ; as, for instance, warts, polypi, &c. The small in- 
 dolent tumours, however, which take place in the cellular 
 substance, may sometimes be removed by the early use of 
 these remedies. 
 
 When these means have either been neglected, or fail 
 when employed, and the schirrus begins to inflame, there is 
 little hope of performing a cure by either local ox general 
 applications ; and extirpation affords the only chance of re- 
 
202 
 
 covery which can be depended on. But, as it is not always 
 at the very first certain that the schirrus has assumed the 
 cancerous inflammation, and is not curable, the operation 
 ought not to be advised in the first instance, or upon the 
 very first appearance of the pain, or symptoms of com- 
 mencing inflammation ; on the contrary, we ought to have 
 recourse to local bleeding, the use of issues, mild diet, and 
 perhaps the use of cicuta; but if these remedies do not 
 evidently arrest the progress of the disease, diminish the 
 pain very considerably, and make the tumour perceptibly 
 softer and less, in the course of a few weeks, we ought, 
 without hesitation, to advise the removal of the part, which 
 I shall presently consider. 
 
 The local bleeding is to be performed with leeches, which 
 are preferable to the scarificator, being attended with less ir- 
 ritation. Three leeches may be applied to the part every 
 second day, as has been proposed by some writers on this 
 disease. This practice must be continued for a considera- 
 ble time ; and, during the intervals of bleeding, cloths dipped 
 in cold water ought to be applied. If, in the course of a 
 month, the tumour becomes freer from pain, and softer, we 
 may apply the leeches only every third day, and continue 
 this for another month, and afterwards either persist for 
 some time longer in the same way, or repeat the application 
 at longer intervals, according to circumstances. But if, on 
 the contrary, the tumour become rather larger, and more 
 painful, as sometimes happens, when the disease is farther 
 advanced before we begin, and if the constitution suffer by 
 the repeated evacuations, we must desist. 
 
 Issues may be formed, either by introducing a small seton 
 superficially on ea£h side of the tumour, or by blistering the 
 part, and afterwards keeping it open with savine ointment. 
 The latter of these methods is not admissible, when the dis- 
 ease has proceeded so far as to make^the skin adhere to the 
 
203 
 
 gland and become puckered ; indeed, at this period, issues 
 formed in any way ought never to be advised, unless the ope- 
 ration will not be consented to ; because the chance of their 
 producing a cure is very little, and we lose time by trusting 
 to them. 
 
 Mild and spare diet has a very considerable influence 
 over this disease, in almost every period, and contributes 
 greatly to retard its progress. It ought therefore rigidly to 
 be conjoined with the bleeding and issues, in the commence- 
 ment of the disease, and will tend to abate the action in the 
 part, and promote its resolution. The diet ought to consist 
 of stewed apples, or prunes, panada, and weak broths, with 
 bread. It has even been proposed to prohibit almost- en- 
 tirely the use of solid food, and to allow the patient nothing 
 but water for the course of several weeks. This was much 
 recommended by M. Pouteau, who was led to make trial of 
 it by the success attending the empirical practice of an ec- 
 clesiastic. It was afterwards enforced by Callison ; and 
 more lately abstinence has been favourably mentioned by Mr. 
 Pearson, who relates some cases of cancer, or appearance of 
 cancer, in the uterus, in which it produced very astonishing 
 effects, abating the pain, diminishing the swelling, and re-es- 
 tablishing the general health. 
 
 By means of these remedies, we may sometimes succeed 
 in removing by degrees a schirrus, after it has evidently be- 
 gun to inflame, and threatens to become cancerous. But if, 
 notwithstanding these remedies, the disease evidently con- 
 tinues to increase, or if, in the course of a few weeks, they 
 do not produce an evident effect, we cannot with propriety 
 delay the operation, which is the most certain method of 
 cure, and one which succeeds in a majority of instances, if 
 early and properly performed ; nor ought any other method 
 of treatment to be proposed in opposition to it, unless in the 
 very commencement of the inflammatory state ; aud it is in 
 
 VOL. II. 2 c 
 
204 
 
 this period only that I propose the above treatment, unle3» 
 the patient absolutely decline the operation ; for when the 
 skin becomes puckered, and the inflammation has continued 
 clearly for a considerable time, without any measures being 
 taken to remove it, the success of any local or general re- 
 medy is exceedingly precarious, and delay is not only useless, 
 but frequently dangerous. It has, however, been doubted 
 by some very ingenious surgeons, whether it was proper to 
 advise the operation at any period, they believing, from the 
 number of relapses, that it was almost useless ; whilst other* 
 have been against the early performance of it, on the prin- 
 ciple, that some parls already diseased might not have, at 
 this period, become evidently affected ; and, therefore, 
 might inadvertently be allowed to remain. 
 
 The late Dr. Monro,*" from observing, that almost all the 
 patients on whom, to his knowledge, the operation had been 
 performed, relapsed, is inclined rather to adopt the palliative 
 treatment, than the extirpation. He takes for granted, that, 
 in the generality of cases, cancer depends upon some internal 
 cause. In these cases, he is decidedly averse from the ope- 
 ration, and advises it only when the disease occurs owing to 
 blows or hurts in young and healthy people. But, in consi- 
 dering this opinion, we are to remember, that a great many 
 of these cases may be supposed to have been very far ad- 
 vanced before any operation was performed ; and likewise, 
 that the method of operating, in that period, was extremely 
 unfavourable to a cure, the wound being kept open, and sup- 
 purations and ulceration rather encouraged than avoided. 
 More lately, Mr. Hill of Dumfries has published an account 
 of cases, where the operation was performed in more favoura- 
 ble circumstances, and of these not a seventh part suffered a. 
 relapse. The present Dr. Monro gives even a more favourable: 
 
 * Med. Essays, Vol. V. p. 422. 
 
205 
 
 account ; for, if I am not much mistaken, he observes, in his 
 lectures, that not one-third of the cases in which he had 
 been consulted, had relapsed. From my own observations, 
 I cannot judge very accurately ; because many of those on 
 whom I have operated, came from parts at a great distance, 
 and with which I had no intercourse ; consequently, I could 
 not hear of the result of those cases : But of the cases, the 
 sequel of which I have heard, not a fifth part have relapsed ; 
 and in those the operation was performed at a period whep 
 the axillary glands had become diseased, but were not evi- 
 dently so ; and, therefore, were not extirpated ; for, in all of 
 them., the disease reappeared in the lymphatic glands. But, 
 even from this relapse, the patients may be cured by a se- 
 cond operation. We may, therefore, conclude, that, if the 
 operation be early performed, the majority will recover ; and 
 even although the disease should afterwards appear in the 
 lymphatic glands* the patient is not incurable ; for we fre- 
 quently succeed in extirpating cancers, when the glands are 
 very much affected before we are applied to. I have ope- 
 rated in cases where I was obliged to dissect the glands, 
 from the axillary artery along almost all its course in the 
 arm-pit, and which reached well nigh to the articulation. 
 
 With regard to the argument against the early extirpa- 
 tion, founded upon the possibility of the disease having af 
 fected parts in the vicinity, which have not yet evidently 
 become diseased,* I may observe, that, upon the same prin- 
 ciple, Ave ought not to operate until the axillary glands 
 swell; because they may be affected, although they be not 
 yet evidently enlarged ; and, therefore, may give rise to a 
 relapse. If we only remove the single gland in the breast, 
 which is hard, we doubtless run a great hazard of a relapse ; 
 but, I apprehend, that this ought never to be done, and that 
 
 "* -Tract. Obs. on Cancerous Complaints, by Mr. Pearson, p. 50, 
 
•206 
 
 the whole of the glandular part of the breast ought to be re 
 moved at once ; because we thus more certainly prevent a 
 return of the disease, which we cannot otherwise, with any 
 certainty, do. The additional pain is very inconsiderable ; 
 and we can derive very little advantage or benefit from leav- 
 ing a part of the mamma behind. 
 
 The caustic has been proposed, instead of the knife, for 
 the removal of cancer or schirrus ; but it is much less cer- 
 tain, more tedious, and even more painful. Instead, there- 
 fore, of recommending itself to timorous patients, this prac- 
 tice is still more to be dreaded, than the excision, which is 
 more terrible in anticipation, than in the actual performance 
 of it. 
 
 The caustic most commonly, and indeed almost universal- 
 ly, employed, is arsenic mixed with various inert substances, 
 and formed into a paste or ointment.* This has been ap- 
 plied in two ways ; first, directly upon the skin, covering 
 the schirrus, and then, after this is destroyed, upon the 
 schirrus itself, destroying it layer by layer ; second, direct- 
 ly upon the skin, and then, instead of applying it to the 
 gland, to put it round it on the surrounding cellular sub- 
 stance, and by gradually destroying this round the gland, to 
 turn out the schirrus entire. This was the practice of Mr. 
 Guy, who gained considerable credit by his success ; and, 
 since his time, it has occasionally been performed with suc- 
 cess by some others. f 
 
 * Arsenic mixed with sulphur, and powdered crow-foot, and made into a paste 
 with yolk of egg, forms Plunket's composition. Mixed with forty times its weight 
 of powder of belladona, it forms an application which gome time ago was much ia 
 repute in North America. 
 
 f Justamond on Cancers, p. 111. This gentleman relates a case, in which, by 
 destroying the skin with lunar caustic, and then applying arsenic, he removed the 
 gland. The arsenic, in this instance, was fused with antimony, in proportion of 
 two parts of the first to one of the last. This was powdered and mixed with equal 
 parts of powdered opium, and made into a liniment with yolk of egg. 
 
207 
 
 This method, however, is liable to several material objec- 
 tions : It is uncertain in its issue ; for, if the gland be not 
 completely removed, the disease makes a rapid progress af- 
 terwards. It frequently happens, that some smaller gland* 
 around the large one are affected ; and these are greatly irri- 
 tated by the action of the caustic in their vicinity : It is 
 more painful than the operation with the knife; and the sub- 
 sequent process of healing, even granting the method to suc- 
 ceed in removing the diseased part, is much more tediou* 
 than when the incision is employed, and union by the firsi 
 intention procured. 
 
 On all these accounts, but most especially on account of 
 its uncertainty, the method of cure by caustic can never be 
 sanctioned by any modern surgeon, much less can it ever be 
 held up in opposition to extirpation by the knife. 
 
 This practice, which has had many advocates for its em- 
 ployment in schirrus, has been equally recommended in cases 
 of cancerous ulcers ; but here it is still less admissible ; for 
 the extent of diseased parts is generally greater ; the neigh- 
 bouring parts are affected lo a greater distance ; indurated 
 and diseased lymphatics frequently extend from the breast 
 to glands in the axilla. It is, therefore, next to impossible 
 to turn out the morbid parts, as " nuclei," by destroying 
 the substance around them ; and it is equally improbable 
 that we shall, unless the sore be very small, and the caustic 
 very strong, be able to make it slough off in successive layers. 
 Farther, we can propose no advantage to ourselves, from em- 
 ploying caustic in preference to the scalpel ; because in 
 every instance in which we can destroy the parts by means 
 of this, we can equally safely, infinitely more speedily, and 
 with much less pain, remove the parts with the knife. There 
 is only one case in which caustic is useful, and that is 
 merely as an appendage to the operation of excision When 
 we dissect off ulcers from parts where, owing to the want of 
 
208 
 
 cellular substance, the skin is not lax enough to be brought 
 over the parts, or when so much of this has been removed, 
 that, although lax, it cannot be made to cover it, we may 
 find it of service to rub the bottom of the wound with lunar 
 caustic, as we thus stop the oozing of blood, and destroy any 
 little portions of the diseased part which we may have left. 
 For the purpose of destroying cancerous ulcers, many 
 caustics and escharotics have been proposed, such as the 
 arsenic, corrosive sublimate, lunar caustic, Sec. Of these 
 no one seems to possess a preference over the rest, if we 
 consider only their local action ; but some of them, espe- 
 cially arsenic, are apt to produce bad effects, and that very 
 nnexpectedly, on the constitution. 
 
 After making these remarks upon the method of cure, I 
 shall conclude with some observations on different reme- 
 dies, which have been proposed as palliatives, where the 
 operation is not admissible, or will not be consented to, and 
 which have even been supposed capable of changing the 
 mode of acting altogether, and producing of themselves a 
 cure. These remedies I shall divide into general and to- 
 pical. 
 
 Of the general remedies, those which have been most fre- 
 quently, and with the greatest confidence, employed, are 
 narcotics, such as the cicuta, opium, night-shade, &c. 
 
 The cicuta is a medicine which was, at one time, in very 
 high repute, and owed its reputation to the experimenting 
 talent of Storck, who has written several libelli on this 
 plant. According to him, cicuta possesses very evident 
 powers over cancer, and has cured a great many cases ; but, 
 in less prejudiced hands, it has been much less successful ; 
 and even in many of the instances adduced by Baron Storck 
 of its utility, it is by no means proved, that the disease was 
 really cancer. The present opinion of the public seems to 
 he very unfavourable with regard to this medicine ; and from 
 
209 
 
 the numerous instances in which it has failed, this opinioa 
 •eeras to be very just. Along with the proper local appli- 
 cations which have been formerly noticed, it sometimes is of 
 service in removing simple schirri ;* but I have never found 
 it of any service when the schirrus had assumed the cancer- 
 ous inflammation, much less when it has proceeded the length 
 of ulceration. In the last case, I have never found it even 
 produce the temporary melioration which many talk of. 
 
 The common way of exhibiting the hemlock, is to begin 
 with small doses, and increase these gradually, until they 
 produce vertigo : For this purpose, we may begin with two 
 grains of the extract, or four of the powder, recently prepared, 
 twice or thrice a-day, and gradually increase the quantity .f 
 In this way, we find that some patients have come to take an 
 ounce of the extract daily ; but if a much less quantity than 
 this produce no good effect, we may consider it as useless to 
 continue a remedy, which, in this dose, must injure the con- 
 stitution every day that it is continued. On the continent, 
 the hemlock has been used in the form of a bath ; but it is so 
 disagreeable, that few can be brought to use if. 
 
 The belladona has been much recommended by Lamber- 
 %en, who tried it in many cases of cancer; but these trials, 
 when repeated with attention, have not been greatly in favour 
 of the remedy. During its use, he kept the bowels open 
 with clysters, administered every second day. The dose, 
 at first, ought to be a grain of the dried leaves, made into a 
 
 " If I am not mistaken, the present Dr. Monro mentions, ia hi» lectures, one 
 Instance, in which a small schirrus appeared to be removed by it; but whether 
 this was simple or cancerous, I do not know. 
 
 t As different parcels of this medicine may not be of the same strength, it is 
 prudent, when we begin a new supply, that we diminish the dose at first, if it 
 have formerly been very considerable. Br net attending to tbh, fatal effects have 
 Allowed. 
 
210 
 
 pill. This, in the beginning, is to be given morning and 
 evening, and afterwards more frequently. 
 
 The hyocyamus has also been frequently used in cancer, 
 and was very much in repute with the ancients. - 1 have 
 tried it occasionally, but with very little effect. The dose 
 with which we begin, is two grains of the extract. 
 
 The aconitum is a more powerful and dangerous narcotic, 
 in so much that a quarter of a grain of the extract is gene- 
 rally the dose with which we begin. 
 
 The solanum dulcamara, Paris quadrifolia, phytolacca, &c. 
 have been likewise recommended and employed, but are 
 now so little used, that it is unnecessary to take any notice 
 of them here.* 
 
 The laurus cerasus is a very powerful narcotic, and has 
 been used, in this particular complaint, by Richter, but 
 with very little success. The most common preparation of 
 this medicine, is the distilled water ; but the dose of this is 
 very uncertain. Some have, therefore, proposed to give, 
 for a dose, four or five grains of the fresh leaves infused in a 
 little water. 
 
 The digitalis has a considerable power of abating vascular 
 action, and may, therefore, be of use, in the same point of 
 view with abstinence, bleeding, &c. in abating the action of 
 schirri ; but concerning its real utility in this disease, I can- 
 not say any thing with certainty. 
 
 Opium is seldom employed with an intention of curing 
 this disease, although it is probable, that it possesses just as 
 much power over cancer, as those other narcotics which 
 have been more frequently used. It is, however, liberally 
 employed with a view to abating the pain of cancerous ul- 
 eers. 
 
 * I have tried the hepatized ammonia, but without any benefit. 
 
311 
 
 Tonic remedies have frequently been used in this disease ; 
 but although they may sometimes improve the general 
 health, yet they never produce any effect upon the local 
 disease. On this account, they are now very seldom em- 
 ployed. 
 
 Arsenic is a medicine, which has, by some, been consi- 
 dered as a specific against cancer ;* but even those who 
 maintain this, add, that although they,beliere and think so, 
 yet they have not been able to administer it in such quanti- 
 ties as to produce any good effect. 
 
 Mercuryf has also been recommended ; but there is no 
 fact more certainly ascertained than this, that mercury uni- 
 formly exasperates this disease, especially when it has pro- 
 ceeded the length of ulceration. In this case, the sores en- 
 large rapidly, become much more painful, and bleed frequent- 
 ly. It is worthy of observation, that those who are affect- 
 ed with cancer, have in general the mercurial action induced 
 very easily and very speedily ;£ and the changes which 
 take place on the ulcer are equally rapid. This circumstance, 
 of mercury increasing the disease, in so marked a manner as 
 it usually does, ought not only to make surgeons careful of 
 exhibiting this remedy, upon slight suspicions of the sore 
 being venereal,|| but may likewise be attended to as a step 
 toward the discovery of a better mode of treatment for can- 
 cer than we yet possess ; because if, at any time, we dis- 
 cover the means of directly displacing and counteracting the 
 mercurial action, we may perhaps find the same to be useful 
 in abating the cancerous ; these two actions appearing to pos- 
 sess some general coincidence, from their mutual effect in 
 increasing each other. 
 
 * Justamcrad on Cancers. 
 
 f Along with this, it was customary to prescribe decoctions of gnaiac sarsapa. 
 ▼ilia, &c. 
 
 \ It likewise continues very long after giving up the use of the mercury. 
 || Some cases of this kind I have already mentioned. 
 VOL. ft. D 2 
 
212 
 
 Copper, in the form of cuprum vitriolatum, has been used 
 in cancer ; and one case is recorded, in which it is said to 
 have produced a cure ; but in every other case it has failed ; 
 and, from the violent effects which it is apt to produce, con- 
 siderable danger attends its exhibition. 
 
 Muriated barytes has been proposed as a cure for this dis- 
 ease; but now none employ it with this expectation. 
 
 The same remedies which internally have been supposed 
 to cure cancer, have also been proposed as local applica- 
 tions. 
 
 Among the older practioners, narcotics were very cur- 
 rently employed as a dressing for cancerous sores. Vesali- 
 us used cloths dipped in the juice of the solanum; whilst 
 others employed it mixed with oil of roses, and preparations 
 of lead and antimony. Others had recourse to the hyocy- 
 amns ; whilst of late the cicuta poultices seem to have super- 
 seded the use of most other narcotic preparations. These 
 have, undoubtedly, in many cases, abated the pain, and di- 
 minished the foetor ; but this is all which can reasonably be 
 expected from them ; and even this expectation will not al- 
 ways be realized. 
 
 Carrot poultices are still more useful, as they possess the 
 property of abating the foetor, in a degree superior to the 
 hemlock, and give generally as much ease. This foetor 
 has been long compared to the smell of hepar sulphuris, and 
 lately has been supposed to arise altogether from the forma- 
 tion of a substance of this nature, consisting of sulphur and 
 volatile alkali. As it has been too much the case in medi- 
 cine, to overlook causes, and attend to effects, so we are not 
 to be surprised if we find some physicians proposing to cure 
 cancer, by remedies which shall decompose the matter which 
 is yielded in that disease, or destroy the effect of the mor- 
 bid action, whilst the action itself is overlooked.* From 
 
 * Although the foetor may depend upon the presence of hepatized ammonia, yet 
 
213 
 
 experiments made upon the hepatized ammonia, it was found, 
 that the oxygenated muriatic acid was the best agent for de- 
 composing it, and destroying its smell. This fluid was, 
 therefore, highly recommended as an application for cance- 
 rous sores ; and, in many instances, it will indeed be found 
 to correct the foetor, which is certainly one advantage ; but 
 it never will perform a cure. 
 
 Carbonic acid has been said not only to correct the foetor, 
 but also, in some instances, completely to cure the disease. 
 It was long ago proposed by M. Peyrilhe, and of late it has 
 again been brought forward by Dr. Ewart, who has publish- 
 ed a case in which it produced cicatrization ; but although, 
 upon his recommendation, it has been frequently employed, 
 yet it has very seldom been of any considerable service, and 
 I have heard of no instance in which it produced any per- 
 manent amendment. It would rather appear, that the 
 ©pinion of M. de Fourcroy was the just one : " After the 
 first applications, (says he,) the cancerous sore appears to 
 assume a more favourable aspect, the sanies which flowed 
 from it becomes whiter, thicker, and purer, and the flesh has 
 a redder and fresher colour ; but these flattering appearances 
 are deceitful, nor do they continue long, for the sore speedi- 
 ly returns to its former state, and its progress goes on as be- 
 fore the application." The best method of applying this, 
 is by means of a bladder, the mouth of which is fastened 
 round the sore, by means of adhesive plaster. The air is 
 introduced by a pipe inserted at the other end. When first 
 applied, the gas produces a sensation of coldness, which is 
 soon followed by a glowing heat, and abatement of the pe- 
 culiar pain of the sore. At other times, it, from the first, 
 produces a smarting, and makes the patient rather more un- 
 
 this does no harm to the ulcer. On the contrary, I have sometimes found the ap- 
 plication of this fluid, when mixed with water, hare the effect if abating the 
 ptfin.- 
 
214 
 
 easy. This is especially the case if we use the fermenting 
 poultice, instead of the air already extricated. 
 
 Digitalis, applied either in poultices or infusion, has been 
 said to abate the pain, and meljorate the appearance of the 
 sore ;' but, in this respect, it seems to be very much on a le- 
 vel with cicuta. 
 
 Tar ointment, gastric juice, absorbent powders, and many 
 other applications, which it is unnecessary to enumerate, 
 have been proposed; but as their utility is by no means 
 evinced, I shall not detain the reader with any remarks upon 
 them. 
 
 Caustic, and escharotic preparations, have been already 
 considered. 
 
 Upon the whole, when the ulcer does not admit of being 
 extirpated, all which can be done, is to keep the sore clean, 
 by washing it carefully, and dressing it with some mild oint- 
 ment, or using some of the poultices or lotions already men- 
 tioned, if these do not gall the skin, at the same time that 
 we keep the patient easy by administering x>pium. 
 
 Having now concluded these observations on the cancer- 
 ous inflammation, I should next proceed to the consideration 
 of the venereal inflammation ; but the dissertations on this 
 subject must be reserved for another volume. 
 
 EXD OF VOL. II. 
 
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613.57 B967 7a 
 
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