'LIBRARY OF CONGRESS. -S& in I t t UNITED STATES OP AMERICA. t THE DOCTEINE OF PURGATION. €mhttxtksfxam %mxmt uvfo Utokm ITitatet A COLLECTION OF QUOTATIONS ON THE USE OF PURGATIVES, FROM HIPPOCRATES, AND OTHER MEDICAL WRITERS, COVERING A PERIOD OF OVER TWO THOUSAND YEARS, PROVING JJargation 10 % €orner-0tone of all duratisea. COMPILED BY B. 'BRANDRETH, M. D., SING SING, N. T. SECOND EDITION. NEW YORK: BAKER & GODWIN, PRINTERS, PRINTING-HOUSE SQUARE. 1871. ^ * «\\ Entered, according to Act of Congress, in the year 1871, by BENJAMIN BRANDRETH, M. D., In the Office of the Librarian of Congress, at "Washington. v. INTRODUCTION TO AUTHORITIES FOE DOCTKINE OF PURGATION, ABB OPINION AS TO CAUSE OF DISEASE AND PREMATURE DEATH. Life may be considered the union of soul and body. It is one of the most impene- trable secrets of Him who lives in all things, and in whom all live, and move, and have their being ; who, in His goodness, has led man, as by the hand, to the path whereby he may arrive at a knowledge of his bodily infirmities and death ; and how he may reduce the one, and thereby keep the other at bay. All nature is God's work, but man is the only living creature that appears to be endowed with cumulative reason. The Bible tells us he is fallen from his primitive condition of happiness, and in con- sequence of this fall, he receives at his birth a germ or principle of corruptibility, which continues to be propagated throughout all time. For the child receives from his parents the principle of his life, and also that of his death — corruption. From long study and experience, we are convinced that ihe death principle is corruption, or therein contained. The examination of the dead proves this ; the putrefaction we observe tells us plainly that if that had been removed in time, life would not have been extinguished. The principles of life and death occupy the same body, and one or the other must rule. In order, therefore, that we continue in health, the principle of life must have the balance in its favor. Our method teaches this impor- tant knowledge. Some writers fix old age at between fifty and sixty years. Every five years that a man lives after this period may be set down as a degree added to old age. If there are so few who reach an advanced period of life, it is because the innate principle of corruption becomes active, and disease breaks out with more or less malignity, and the proper means not being employed, death may follow, the individual not having reached that age he should and ought to have attained from the principle of life which he possessed. We look upon this as premature, not nat- ural death. Natural death is a cessation of all the faculties ; the man or woman falls asleep, ceasing to exist without effort or struggle. It is true that all men must die, but no one need die of disease. Even now, hu- man beings have a longer average of life than was their lot in the last century. This may be the consequence of a better knowledge of the laws of life. Let it be com- prehended that we carry within ourselves the cause of disease and death ; let us admit this fact, and not wait until convinced by the terrible manifestations of pain and inflammation. To apply the remedy in time is the knowledge needed. It is worthy of remark, and we see with surprise, that young persons, apparently in the full vigor of health, whose complexions seem to indicate the most robust constitution, are oftener attacked by severe disease than persons always pale and feeble. These persons have more vitality, which occasions a quicker waste or change in the material of their bodies, so that when they are sick, unless the secretions are restored immediately, the death principle gaixs the ascendency. Prompt measures in the right direction are all that is needed, and in such cases purgation means life, and the want of it means death. 4 THE DOCTRINE OF PURGATION. Some persons are peculiarly blessed with health '. In their constitutions no im- purity shows itself, often taking one hundred years or more to wear out the " spark of life." In others, life has ceased before birth, and the child is still-born. All the solid parts of our bodies are made from fluid ; first derived from the blood of the mother, then from the mother's milk. Thus solids and fluids constitute our material being. WASTE AND REPAIR. The body wears. Movement causes waste. The hardest steel wears away when used. So also the body wears away, but, unlike the steel, it is renewed faster than it wears away in a child, which is the occasion of its growth. It is a great truth, we die daily ; but the food consumed also supplies us with new life daily. These are marvelous facts ; this decay and renewal are among the wonderful mysteries of the Almighty. We know the hair and nails grow. Mark your finger nail near the root. Day by day it advances toward the end ; at length we pare the mark away. The whole nail has been renewed, the growth was supplied, the waste was repaired. The same waste, the same renewal occurs in the nose, and all other parts, though we cannot mark the change as in the finger nail. WHERE THE REPARATIVES ARE. The substance which is to form the nail is in the blood ; as perfectly mixed as a grain of salt is dissolved in a glass of water. As the blood circulates in the small vessels at the root of the nail, this nail substance deposits and organizes itself, and replaces what is worn away. The hair is also renewed by materials from the blood deposited in the roots of the hair ; so the bones ; and so the flesh ; and so with all other tissues and parts of man's body. Each part receives its needed supply of new material. Thus the eye retains its fire, the tongue its power of utterance, the brain the power of thought. Analogy tells us even the brain, the organ of thought, wears, and is renewed by the blood, which circulates and renews all the parts of the body alike, whether it be brain, spinal cord, the eye, the bones, the flesh, the hair, or the nail. The blood carries new material to repair the waste, and it reloads itself with worn-out parts which it discharges through the appropriate vents. When the new materials are greater than the waste, the child grows ; or the man spreads. When the waste is exactly equal to the new material, the body remains of the same size and weight. These facts indicate that all substance of all the organs and parts of a living body are present in the blood. It is therefore important to our well-being that this life fluid should be free from imperfections. For if the blood does not contain all the needed ingredients, or if it should contain more, it cannot renew the different parts according to their requirements. Deformed and ill-made people owe their infirmities to the blood of their parents ; pure blood cannot do otherwise than make perfectly organized beings, thus we may estimate the value of certain means to make the blood perfect. Food, by its organ the stomach, supplies all the parts of which blood is made. We now speak of this conversion. DEFINITION. SUBSTANCES WHICH CONTAIN AND SUPPLY NUTBITION ARE POOD. Healthy food possesses substance, because the stomach cannot grind it well with- out it possesses this quality. Too fine food makes the stomach weak ; it cannot INTRODUCTION. 5 use its muscular power, and debility of the stomach follows. If we do not walk, our legs soon become weak. To be strong, organs need exercise. When food is digested, part makes blood ; the refuse passes off by the bowels, the kidneys, and the skin. Our stomach, if properly supplied, continually prepares new blood, which renews all the organs, carrying vitality to the hair and nail as well as to the head, with its master-organ the brain. Every part is each moment of our lives changing, the worn- out parts earned away, and new parts supplied, whether good or bad. Here we see the necessity of eating and drinking several times a day. We constantly wear and constantly repair. Such is the law of our being. WORN-OUT PARTS MUST BE EXPELLED. The worn-out parts must be expelled from the body daily, or the blood will be- come impure. We may comprehend this by an inquiry respecting new-born chil- dren. They have taken no food by the mouth, and yet when born their bowels and bladders are full. Whence did these secretions come ? They came evidently from the blood of the mother, which made their bodies. We also know that sick persons, who eat no food for days, have evacuations by the kidneys and bowels. These parts are also the worn-out parts of the blood. The blood is, in fact, a messenger which takes to every part of the body what it needs for renewal, and also carries back to the bowels, kidneys, and skin, worn-out substance to be expelled from the body. We therefore must admit that every part of a human body is made from blood; and that it wastes and is repaired ; that food makes blood, which is distributed with singular intelligence to all the various organs. HOW IMPURE BLOOD IS DEVELOPED. The bowels may be costive ; in this case there is an absorption into the circulation, of gases and gummy substances, which are a great cause of poison to the blood. Should the kidneys fail to do their work, another source of poison to the blood is developed. Again, should the perspiration be checked, matters flow back upon the blood which soon load it with impurities. Suppose only the feet, by cold, cannot perspire, and their fetid exhalations j^)wback upon the blood. If all these outlets — the skin, the kidneys, and the bowels — do their work even imperfectly only, for a short time, it is evident that the blood will be burdened with noxious matters, which must interfere seriously with the circulation, and soon clog up the smaller vessels, so that only a small amount of blood can pass. Soon the lungs, the intestines, the stomach, and the brain will sound an alarm. You will have pleurisy, inflammation of the bowels or severe cholic, violent headache, or sick stomach. Because the worn-out parts of the body, instead of being carried out by those avenues nature designed, are shut up, poisoning the blood, thus causing it to become impure. Other causes besides these produce impurity of blood. The food may not be healthy ; digestion may be imperfect; troubles, grief, anxiety, miasmas from swamps or other exhalations; breathing close air in crowded rooms; staying in too hot rooms; all these causes tend more or less to vitiate the blood. Grief, fear, and anxiety, hurt, by making the Hood to circulate slower, and soon produce a very serious injury to the composition of the blood, occasioning stubborn fevers, and various derangements of the body and mind. The best part of food makes chyle, which is absorbed into the circulation, to repair the waste the blood sustains in rebuilding the body, and in forming bile and 6 THE DOCTRINE OF PURGATION. all the other fluids of the body — for all the fluids are made from the blood. The coarse portions, and those not needed, are expelled daily by the bowels, the kidneys, and the skin. The fluids, or as some writers call them, the humors, are as natural and necessary as the blood. It is not from humors we are sick, but from the humors becoming unsound ; from infection, or absorption of fungi, or other poisonous vapors or matters. These produce a putrid fermentation, or chills and fever, or fevers continued or in- termittent. It is supposed that in the humors resides the germ of corruptibility, which is aroused into activity by the above causes. To have humors is as natural as to have blood. It is not having humors that causes us to be sick, but because they become corrupted. . The humors absorb infection, in consequence of their being the seat of the innate germ of corruption. When this germ or root, from any cause, receives an increase, it may show itself by colds, ca- tarrhs, tumors, or other effects, by which life may be shortened, or a serious attack of some specific disease produced. Corrupted humors always cause sickness ; they cause death. If they are removed in time, the sickness is cured, and death prevented. We know they can be removed, and should not corruption be quickly removed from a living body ? Their infec- tious smell tells of their hurtful nature to a living body; cleanse, sweep out from the bowels and blood the unhealthy parts, and your disease will soon be cured. While in health, the humors and the blood are sound ; but so soon as you do not feel well, be sure the humors and blood are getting deranged in their sound quali- ties ; and when painful sensations are felt, we should at once take steps to prevent serious trouble. These steps usually are evacuation, for we cannot recover health until the blood and the humors are freed from all acrid and unhealthy qualities, however acquired. The humors, after becoming corrupted, soon accumulate a degree of acrimony or burning heat, that the burning sensation is often almost insupportable. They often resist great quantities of purgatives, but outward applications are really useless without evacuation of the bowels. Two hundred medical writers, running through a period of over two thousand years, agree as to the means of reducing this ^eath principle — agree as to a general indication — agree as to the perfect innocence of purgation. We hold that this evidence is important in our intelligent age, and hope it may lead to a more uniform and a more humane method of treating patients. Perhaps a wise regard for the im- provement of the human race will make purgation the principal curative reliance ; other means should be only secondary. Physicians may soon be governed by this rule, because purgation may be set down as the magnet, the guide, the star of safety. Purgation corrects errors in the digestive organs ; and Dr. Abernethy observes (in Surgical Observations, p. 22): "By correcting the obvious errors in the state of the digestive organs, local diseases which had baffled all attempts at cure by local means, have speedily been removed." When local applications are applied, they should be in harmony with purgation, and incapable of doing injury. We can remove disease in two ways : ' by the upper and by the lower passages — by vomiting and by purging — purging when the patient is weak, vomiting only when he is strong. We will define purgation as " cleansing," and apply to both the upper or lower ways. INTRODUCTION. For forty years I have directed my attention to the cure of disease on this plan, and facts derived from experience have long since confirmed me in the belief that this is calm Nature's own method of cure, because it assists her in removing impuri- ties by the means and outlets she has so wisely provided for herself. Believing that all mineral and chemical agents which can act on foreign or im- pure matters in the blood, invariably injure the organization of the blood itself— destroying its corpuscles, besides injuring the coats of the stomach, and producing serious effects upon the bones — I have therefore discarded minerals and chemicals entirely, and trust to vegetable remedies alone. That which I have principally employed to enforce this theory has been Brand- reth's Pills, whose permanent and wide-spread success is the strongest evidence of their distinguished merit. The question has been asked, If the value of this medicine is so great, is it not a duty to make known its true components, so that physicians and others could pre- pare it ? To this it may be answered, that if Brandreth's Pills certainly would be made the same as they are now, and all their healing, cleansing and innocent quali- ties retained, one of the reasons for their remaining a secret medicine would be removed. But every man knows, who knows anything of the drug and medicine business, that not one box in a hundred would be prepared of such medicines as are incorpo- rated in the Brandreth Pills prepared by me. It is true the pills might be composed of ingredients called 1y the same name, but the name would be all the resemblance they would possess to the pure extracts and medicinal preparations which comprise the composition of Brandreth's Pills. Therefore, for the sake of the lives and health of men — for the sake of the GREAT SANATORY THEORY OF PURGA'IION — the manner of preparing Brandreth's Pills will never be divulged, until the time arrives when all the drugs of the stores shall be true and uniform preparations. I am not without examples for this decision : Dr. James, the celebrated author of James' Powder, left his prescription to Messrs. Newbery & Sons, of London, more than a hundred years ago, by whom they are yet made. The great Stahl and Hoffman, of Germany, Professors of Physic at Halle, without scruple confined many medicines to their own private practice. And even in our own time, there are few medical men of extensive practice who have not rem- edies which they carefully retain in their own families, who are more likely to prepare them with reference to securing their curative effects, without regard to profit, than they would be in the hands of strangers. The quotations from the writings of medical men, embodied in this pamphlet, prove the talent that has been at work upon this Theory of Purgation for over a period of two thousand years— and in vain. Then what has prevented its complete success ? Simply this, in my opinion : Not a single writer has given a medicine which, out of their own hands, would successfully and safely enforce the purgative theory. The public, in Brandreth's Pills, have a medicine which it is intended shall ever be within its reach, always certain to purge only impurities from the blood, and when the upper ways require cleansing, occasion vomiting ; and that is safe for both 8 THE DOCTRINE OF PURGATION. sexes and all ages. Composed of vegetable preparations entirely — indeed, the Pills are guaranteed to contain no mineral in any form — they may, if the requirement of the constitution need them, he taken daily for any length of time, without a possi- bility of producing any bad effects, on the body, and must reduce the sum of disease. WABEANTEE. That Brandreth's Pills, in all future time, are warranted to possess and contain those purgative, those cleansing and innocent qualities, which they have always heretofore possessed in so eminent a degree. The principle of curing disease by the use of purgatives is beginning to be exten- sively recognized as indispensably necessary for the recovery of health by many intelligent families and individuals. To prove to them and to the world at large, as well as to physicians of all schools, the broad and deep foundations and authority this principle of cure possesses, I have printed the following extracts which, as in a mirror, is exhibited the views, and experience, and sentiments of medical men, dur- ing a period of over two thousand yeaes. They possess a peculiar significance for those who desire to investigate this sub- ject, so important to the lives and health of men, because they throw a flood of light on the application of purgatives as a means of removing disease from the system. The great aim by many of these writers is, that in the administration of medicine, we should do good possibly, but never harm. Bleeding, Mercury, Tartar Emetic, Antimony, Veratria, Strychnine, Morphine, and a host of similar remedial agents may, nay generally do, a great deal of harm, and often are the occasion of fatal mistakes ; while the great advantage of using Brandreth's Pills in sickness is, that they never make any mistakes, often prolonging, never shortening life. In pleurisy, in inflammation, in fevers, and where pain is present, their prompt and energetic administration is often life-saving, and it is in evidence they have often effected cures when physicians and friends had given up all hope. Then what risk does any man or woman incur in using a medicine like Brandreth's Pills, which are the adopted remedy of millions of families living in every part of the civilized world ? The facts given in the following pages prove that fevers, inflammations, and severe pain are only, in reality, so many evidences of healthful constitutional power, and that if purgation is enforced according to the necessities of the case, the fever, severe pain, or inflammation will be removed, provided no sedatives or narcotics are employed. B. BRANDRETH. Sing Sing, June 1, 1871. HlPPOCKATES. Purgation the Corner-stone of Curatives. Hippocrates. — Aphorisms, written about 400 b. c. Edited by Elias Maries, M. Z>., New York, 1818. 1. Life is short, art long, occasion brief, experience fallacious, The golden judgment difficult. It is requisite that the physician exhibit what is essential, and that the patient, attendants, and all which surrounds .him, concur therein (1, sect. I). 2. In diarrhea and spontaneous vomiting, if the matter voided be of n Diarrhea. a nature that ought to be expelled, let the patient be purged, for in this case the evacuations are beneficial and are easily supported (2. sect. I). rurpation in- dicated by The power 3. The greater the evil the more vigorous the remedy (6, sect. I). ° f the reme * 4. In acute diseases the most violent symptoms supervene ; the on Diet, severest regimen is, therefore, to be observed. But if these symptoms be wanting, a more generous diet is to be permitted, only we are to have recourse to it in proportion to the subsidence of the malady (7, sect. I). In the choice of regimen, more evil results from abstraction _ The nutri- than from a small excess. A thin, frugal, and over-exact regimen cure. plan ° f accords not even with the man in health, who grievously supports the privation. Hence, in general, the superiority of a due refection over that which is deficient {5, sect. I). 5. In those diseases which quickly arrive at their climax, a thin Diefc t0 be regimen should immediately be adopted. In those which attain it at a regulated ao- -it • i i i J a. i J* i -it » cording to somewhat later period, we should at or before that period, subtract from the charac- their diet \ m but, until then, sufficient nourishment should be allowed, disease. te that the strength of the patient may be supported (10, sect. I). G. That which is excrementitious should be drawn off at the point to which it most tends, by the most convenient outlets (21, sect. I). Diurei * ' SudoriGca. Purgatives, 10 THE DOCTRINE OF PURGATION. when to 7. Purgatives should be administered after the food on the stomach gire g purga- ig concocte( } ? no t w hil e it i s yet crude (22, sect. I). Note by the Editor. — There is no danger in administering a purgative before or after a meal, provided there be pain or dizziness, which symptoms are relieved by purgation . 8. Depletion is not to be estimated by its copiousness but by its how to di- being judiciously used and easily supported. When it is necessary to rect the pur- extend it " ad deliquium animi," let it be done, but previously consult emg * the resources of the patient (23, sect. I). Note by Editor. — Where there is danger of congestion, purgation may be enforced to fainting with Brandreth's Pills (see paragraph 55). 9. If the convalescent acquire not strength from the food he takes, it shows that the body needs a more plentiful supply. But if the same eifect arise from an inability to partake of food, it sufficiently evinces the necessity of purgatives (8, sect. II). 10. When it becomes necessary to purge, the evacuations ought to ev2cSn.° f be l00Se and free ( 9 > Sect - I][ )- 11. Impure constitutions, when most nourished, are most injured rect the nou- (10> SQCt. H> rishment. Relapses 12- The (morbid) matter remaining in the body after the crisis is SeS in m m &- P as ^ °ft en produces a relapse (12, sect. II). tion. Chan e of ^« ^ n a l yme fluxes, a change in the dejections, unless they assume dejections, a vicious appearance, is beneficial (14, sect. II). Tubercles. 14. When the fauces are affected, and tubercles arise therein, we J?8too£ tion ought to examine the excretions ; when they are of a bilious nature, the entire body is affected ; but if they be as in health, we may safely impart nourishment (15, sect. II). Disease 15. Excess of food produces disease, and at the same time points out pe^nce ter in "the remedy (17, sect. II). The sickness which arises from repletion is dink- pur- CUTe & by evacuation ; and that which arises from evaluation, by reple- gation' the tion. Thus, opposites are counteractives of each other (22, sect. II). 16. Evacuation, repletion, frigeration, and calefaction — these, or sudden ac- any other correspondent modifications of body, when excessive, or too nXre ga pro- suddenly accommplished, are dangerous — nature being ever opposed to must dinsS be ex t remes - That which is gradually done is safely done, whether we gradual pass from one extreme to another, or otherwise (51, sect. II). E very- Sad. c ° n m ~ thing which is judicious being done, without success, we are not, there- fore, to recede from our plan, while we still entertain the same views as we did at first (52, ibid). THE DOCTRINE OF PURGATION. 11 17. Some diseases accord tetter with some constitutions than others ; Prcdispo- and this also obtains with certain ages, as connected with season, climate SnstTtutionf and aliment (3, sect. III). In the various seasons, if cold and heat fre- 8& a J2/23l quentlv alternate with each other, we must look forward to autumnal fo ° d ; c ^ an s 9 1 . t - ' of tempera- diseases (I, ibid). ture. 18. Those suffering from phthisis should avoid vomits (8, sect. IV). em^tiS* inju- rious. 19. The melancholic should be copiously evacuated downwards ; and, Purgatives from the same principle of reasoning, those of a contrary temperament wbere^toTe should be differently treated (9 sect. IV). used - 20. Sound Doctrine. — In very acute affection, attended with turg- acuujlu escence, purgatives are immediately to be used ; to procrastinate here is dangerous (10,* sect. IV). cases, purge without de- lay. 21. Those who are tormented with severe gripings, pains about Griping^ the umbilicus, and in the region of the loins, and who are neither purgatives relieved bv purgatives, or anv other means, usually fall into tympanites (11, sect. IV). useful. 22. If there be pain immediately above or below the diaphragm, the former demands vomiting, the latter purging (18, sect. IV). ft£J£ and Internal pains— vom- in the abdomen purgation 23. Those who, during the operation of purgatives, have no thirst, Degree ought to be purged until thirst be induced (19, sect. IV). purging. 24. Pain in the lower region of the abolomen, with griping and ach- p a %n ing of the knees, unattended with fever, indicate the necessity of pur- gatives (20, sect. IV). 25. Dark-colored dejections, resembling black blood, coming on Evacua- spontaneously, either with or without fever, are very unfavorable ; and the more so if the color of these dejections become, with their continu- ance, still more depraved ; but if the evacuations assume a more healthy complexion, or, if their dark color be the effect of purgatives, less evil is to be apprehended (21, sect. IV). tions criti- cal. 26. The expectoration of blood, how small soever in quantity, is Evacuation injurious ; but the evacuatio advantageous (25, sect. IV). injurious; but the evacuation of black blood downwards is (frequently) eJeSncha- 27. "With, those who are deaf, a coming on of bilious evacuations Deafness,. generally removes it (28, sect. IV). evacuations 28. If, in those recovering from indisposition, there occur any local Pain symp . pain, it foreshows the formation of an abscess (32, sect. IV). tom of ab- ■*■ 7 . \ 7 j ecesses. 29. From whatsoever part of the body sweat breaks forth, it fore- sweats and shows a determination of the disease to that part (38, sect. IV). h6at > B y m P* 12 THE DOCTRINE OF PURGATION. tomatic of In whatever part of the body heat or cold arises there the disease cate^hene- seats itself (39, ibid). Where there occur alternate changes of cold and heat, and the com- plexion undergoes various changes of color, we may predict extended illness (40, ibid). Profuse sweats, during sleep, without any manifest local affection, may arise from a too plentiful diet ; but if they take place notwith- standing the observance of a frugal regimen, it shows the necessity of evacuation (41, ibid). cessity of Purgation, 30. In fever, where abscesses have not been dispersed during the be purged primary stages of the disease, they 'foreshow extended illness (51 away - sect. IT). Fwer, in- 31. "When, with existing fever, a thick, gummy, scant urine is fol- tne a uriSe. y lowed by a thin and copious discharge, it is beneficial ; but it is the more so, when, at the commencement of disease, or a little time after, the urine deposits a sediment (69, sect. IY). pr?gnfncy in 32. "With pregnant women, venesection ^produces abortion, especially causes abor- «f g es t a tion be far advanced (31, sect. Y). Brandreth's Pills are safe at every period of gestation with the generality of females. Irregular , * , , memtrua- 33. Discolored and irregular menses indicate the necessity of purga- Uon requires ,. , nn , T7 - x ° tf x o purgation. tlVeS (36, Sect. V). beScki S 'or 34. Tumors which have a soft feel are beneficial ; those which are malignant, hard and callous are unfavorable (67, sec. Y). ^IT^ 35. In dropsy, if the water pass off into the intestines, by means of purgation , . - -S.* 7 ' /H . l ^ T ^, ' J the cure. tne veins, the disease ceases (14 sec. VI). Purgation brings it* to the intestines and so causes the water to be evacuated. the Eyes 36. Diarrhea supervening in ophthalmia is beneficial (17, sect. YI). Pupation. Pains of the eyes are relieved by pure urine, bathing, fomentation, venesection, and purging (31, sect. YI). Fever the 37. Pains in the hypochondrium, unattended with inflammation, are naturalcure. re l ieved by f ever ^ gect yi). Effects of 38. Long-continued dysentery, supervening in affections of the spleen, glected purgation. induces either dropsy or lientery, and consequent death (43, sect. YI). Purging in 39. Those with whom purgatives agree should have recourse to Spring. fa^ ^ ^ s ^p r i n g (^ g ect . YI). wheninfiam- 40. Those attacked with the gout are entirely freed of it in forty purg°daway. days after the subsidence of the inflammation (49, sect. YI). More effects 41. In atrabilious affections the translation of the humors to various pul-gauott* parts has a tendency to produce the following diseases : apoplexy, onania, convulsion and blindness (56, sect. YI). THE DOCTRINE OF PURGATION. 13 42. "WTien a serous collection, attended with pain, takes place be- Accm/mia- tween the abdomen and diaphragm, without its having an issue in either inXSs r^ cavity, if the fluid be drawn out of the body bj means of the veins, the Ton Qpu ' aa ~ disorder ceases (54, sect. VII ; vide Aph. 14, sect. YI). 43. Excessive perspiration, cold or hot, continually going on, is in- dicative of redundant moisture within ; we ought, therefore, to evacuate it from the system either by vomiting, if the patient be strong, or by purgation if he be weak (61, sect. VII). Sweat — in- dicative of fluid accu- mulations. Cure, Pur- gatives. 44. He should attend to the urinary discharge in order to ascertain whether it be conformable to what takes place in health ; in proportion as it departs from the healthy state is the severity of the disease, and " vice versa " (66, sect. VII). If, on suffering the urine to remain, without disturbing it, we ob- serve a deposit resembling sawdust, the greater or less quantity of this deposit is indicative of the severity or mildness of the disease ; in either case, it is necessary to have recourse to purgatives • in proportion as we neglect these, for a nutritive regimen, will be the augmentation of the disease (67, sect. VII). The urine a criterion of health or dis- ease — its tur- bid condition indicative of Purgation. 45. In continued fever, the expectoration of a livid, bloody, bilious, Continued or foetid' matter, is alike unfavorable ; but, if the expectoration be good, rTn^nduri- and in due season, it is favorable. The same may be said of the alvine ^omlaZ and urinary discharges ; furthermore, any excrementitious matter re- and \P wr ' maining in the system, and not coming away with the evacuations, quired! re proves injurious (69, sect. VII ; vide Aph. 12, sect. II). Hippocrates, the genuine works of. Transl. by Francis Adams, ZL.D., and printed for the /Sydenham /Society. 2 vols. London, 1849. 46. Medicine is, of all arts, the most noble ; but, owin^ to the is:no- Medical ranee of those who practice it, and of those who inconsiderately form a 1 s aor&nce - judgment of them, it is at present far behind all the other arts (The Law, p. 784, vol. I). 47. When nature opposes, everything else is in vain. physician of diseases (p. 102, vol. I). Nature is the Nature - 48. The physician must have his special object in view with regard to diseases, namely : to do good or to do no harm. The art consists in three things : the disease, the patient, and the physician. Ttte physician is the- servant of nature, and the patient must combat the disease along with the physician (Epidemics, Book 1, § 5, p. 360, vol. II). The phy- sieiari's spe- cial object. The ser- vant of na- ture. 49. Gentle purging of the bowels agrees with most ulcers, and in uicers. wounds of the head, belly, or joints, where there is danger of gangrene, tiy. rge gcn * in such as require sutures, in phagediac, spreading, and in otherwise inveterate ulcers (On Ulcers, pp. 796-7, vol. II). 14 THE DOCTRINE OF PURGATION. Purge in 50. Disorders arising from repletion are removed by evacuation (On plethoric the Nature of Man, p.' 262, vol. I ; Aplior, 22, sect. II) Fevers pass 51. When the discharges become thicker, more concocted, and are the y onorMd freed from all acrimony, then the fevers pass away, and the other symp- toms which annoyed the patient (Ancient Medicine, p. 174, vol. I). matter is re moved. Mnnypain 52. When there is an overflow of the bitter principle, which we call fui^symp- yellow bile, what anxiety, burning heat, and loss of strength prevail ! ntoved by ^ u ^ ^ relieved from it, either by being purged spontaneously, or by artificial or means °f medicine seasonably administered^ the patient is decidedly re- purgation, lieved of the pain and heat. But while these things float on the stomach cure? nytrue unconcocted and undigested, no contrivance could make the pains and fever cease ; and where there are acidities of an acrid and eruginous character, what varieties of frenzy, gnawing pains in the bowels and chest, and inquietude prevail ! And these do not cease until the acid- ities be purged away (p. 174, vol. I, ibid.) The bad 53. The coction, change, attenuation, and thickening into the form m iSriou8 ° of humors, take place through many and various forms (p. 174, ibid.) m , 54. We must purge and move such humors as are unconcocted (p. What to Hr . n , TT . r fe> vr purge. 703, VOL 11). Purge until evacuations 55. The evacuations are not to be judged of by their quantity, but whether they be such as they should be, and how they are borne. And even tof aha- when proper to carry the evacuation to " liquidium animi " (faintness), ms * this, also, should be done, provided the patient can support it (p. 704, vol. I ; Aph. 23, sect. I). Note by Editor. — To give the patient an opportunity of doing so, have gruel or light broth ready for him to sip a little at a time. Intelligent nursing must go alongside of the purgative method, then success is moderately certain. purgative 56. If the matters which are purged be such as should be purged, axiom. the evacuation is beneficial (p. 704, vol. II ; Aph. 2, sect. I). 'ects of 57. Bodies not properly cleansed, the more you nourish, the more ton y°u in J nre (p- ^ 06 5 v °i- u ; Aph- 10 5 sect - H)- What remains in diseases, after the crises is past, is apt to produce relapses (p. 707, vol. II ; Aph. 12, sect. II). insuffic purgation, Purgative 58. In purging we should bring away such matters from the body as it would be advantageous had they come away spontaneously (p. 723, vol. II). axiom. ■ov. wwr Doctrine. — In very acute disease, purge on the first day, for bad thing to procrastinate in such cases (p. 724, vol. II ; 59. Our easesTpurge it is a very bad thing to procrastinate Aph. 10, sect, IY) only. THE DOCTRINE OF PURGATION. 15 60. In convalescents from diseases, if any parts be pained, there are Deposits deposits being formed. But if any part be in a painful state previous jjjy SgJ£ to the illness, there the disease fixes (p. 728, vol. II ; Aph. 32, sect. IY). tion > 61. N\ B. — The translator says : " Hippocrates was strictly the phy- Experience sician of experience and common sense." am common x sense. 62. Nature finds out ways for herself without consultation ; nature, Nature's untaught and without learning, does what is needful (Epidem., lib. VI, S. 5, fidinb. ed.) ways to 63. Asclepiades, about 100 years B. C, the earliest hydropathist, con- simpieam trived easy methods, and such ones as any one might use without the JgJ ^ml a ' help (and cost) of a physician. This made them very acceptable, and -,-, i • -1 i • ~\ • t •• /» ■mentitious dulling the body by immoderate eating and drinking, and omission 01 ma ers. exerc i se or anv accustomed evacuation, as suppression of the hemor- rhoides and courses, for hence are such like excrementitious humors drawn into the nerves with which they, being replete and filled, are dilated more than is fit, whence, necessarily becoming more short, they pw^atiwi suffer convulsion. ... It is cured by discussing and evacuating remedies, a medidnes al as P ur g m g> digestive local medicines, exercise, frictions, and other things &c. which may consume the superfluous excrementitious humors that possess the substance of the nerves and habit of the body (pp. 329, 30). Note. — Allcook's Porous Plasters applied along the spine from neck to os sacrum, and Brandreth's Pills two every two hours, is good treatment for lockjaw. from^Struc- ^' P^V- — The cause are humors obstructing one of the ventricles tion bymor-" of the brain, or one side of the spinal marrow, so that the animal ma er. f acu ]t Y — the worker of sense and motion — cannot, by the nerves, come to the part to perform its action (p. 332). Purgation In the cure of the palsy we must not attempt anything, unless we have first used general remedies, diet and purging, all which care lies upon the learned and prudent physician (p. 333). Erysipelas ^' ^ r y 8 W e ^ as : — The cure of such an effect must be performed by Purge, but two means ; that is, evacuation and cooling with humectation. If bile do not bleed. a i one cause this tumor, we must easily be induced to let blood, but we must purge him with medicine evacuating bile (p. 353). Note. — Bleeding must never be resorted to in Erysipelas ; it is dangerous, never does any good, and is certain to retard the cure. r 78. The cure of gangrene, caused by the too plentiful and violent TherapSau* defluxion of humors suffocating the native heat, by reason of great phlegmons, is performed by evacuating and drying up the humors, which putrify by delay and collection in the part (p. 456). ... If the body be plethoric, or full of ill humors, you must purge (p. 455). ous humors must be eva cuated. Ulcers re quire always 79. An ulcer has one, and 'that a simple indication, that is, exsicca- tion. . . . Before you do anything about the ulcer, you must first use Ih2? a xt^ £ enera l m eans; for in Galen's opinion, if the whole body require prepa- naiappiica- ration, that must be done first, for in some ulcers purgation alone will be tlons - sufficient (p. 470). . . . Dry ulcers you shall correct by humeating medicines, as, fomenting it with warm water, &c, but always you must first purge. . . . Then you must have recourse to refrigerent things (p. 471). Note. — The Gum Elimi Universal Cerate should be procured. We can recommend it. It contains no grease or oil, but is a vegetable production, and very useful in all affections of the skin ; as an application to a felon or otherwise it is superior to bread or linseed meal as a poultice. t£fofiht 80, Ophthalmia can proceed from different causes, external and eyes. Purge internal, producing the settling of humors to the eye. The evacuations THE DOCTRINE OF PURGATION. 19 of the matter flowing into the eye, shall he performed by purging medi- cines, cupping the neck and shoulders with scarification or without-, and lastly by frictions, as the physician shall think it fit (p. 645). Allcock's Porous Plasters are superior, applied to back and shoulders, to cupping, scar- ifications or frictions. 81. The Diabetes is a disease wherein presently, after one has drunk, the urine is made in great plenty, hy the dissolution of the retentive fac- ulty of the veins, and the deprivation or immoderation of the attractive faculty. The causes are the inflammation of the liver, lungs, spleen, hut especially of the kidneys and bladder. . . . For the cure of so great a disease, the matter must be purged which causes or feeds the inflammation (p. G88). Diabetes. Evacuate the morbid mat- ter which causes in- flammation. 82. Whenever the guts, being obstructed or otherwise affected, the excrements are hindered from passing forth, if the fault be in the small guts, the effect is termed " Yoloutus, Iteos, or miserere mei ;" but if it be in the greater guts, it is called the " colic," from the part affected, which is the colon. Therefore Avicen rightly defines the colic as "a pain in the guts, wherein the excrements are difficultly evacuated by the fundament." Taulus Eleginata reduces all the causes of colic to four heads, to wit : to the grossness or toughness of the humors impact in the coats of the guts ; flatulencies hindered from passage forth ; inflammation of the guts ; and, lastly, the collection of acrid and bit- ing humors. . . . Over-eating and taking in of nourishments that do net agree with each other, or with the constitution of the body, produce crudity and obstruction, and at length the collection of flatulencies, whereon a tensive pain ensues. . . By the use of crude fruits and too cold drinks the stomach and guts are refrigerated, and the humors and excrements therein contained are congealed, and, as it were, burned up (p. G89). . . . Colic. The causes and physiol- ogy. 83. There is also another cause of the colic which is not so common, to wit, the twining of the guts, that is, when they are so twined, folded and doubled, that the excrements, as it were, bound in their knots, can- not be expelled.* . . . The colic is cured, the humors being first atten- uated andj diffused, and at length evacuated by medicines taken by the mouth and otherwise (pp. 690, 91). Enter ocele. Cure by pur- gallon. * Some sweet oil, followed by a dose of Brandre to relieve such painful state of the bowels. Also, should be given. h's Pills, is the simple remedy by which clysters of water, about summer heat, 84 Arthritis, or Gout, is a disease occupying and harming the sub- Gout. stance of the joints by the falling down and collection of a virulent *£ ^{t\l°l matter and humors. "When there is a great abundance of humors in a genera^ dis- body, and the patient leads a sedentary life, not some one, but all the festingitBeiit joints of the body are at once troubled with the gout (p. 097). ioca£ nt 20 THE DOCTRINE OF PURGATION. Tlie causes. Intemper- ance, un- timely sleep, want of ex- ercise, pro- duce accum- ulation of morbid mat- ter. Imperfect purgation in diseases also pro- duces gout. 85. The causes. of gout are unprofitable humors which are generated and heaped up in the body, and in the process of time acquire a virulent malignity. Such humors arise from an inordinate diet : they offend in feeding who eat much meat, drink strong wine, sleep presently after their meals, and use little exercise. For hence a fullness and obstruc- tion of the vessels, crudities, and the increase of excrements, especially serous, and, if they flow down into the joints, without doubt they cause this disease. Besides, also, the suppression of excretions accus- tomed to be voided at certain times. . . . Those who recover of great and long diseases, unless they be fully and perfectly purged, these humors falling into the joints, which are the relics of the disease, make them become gouty. The humor impact and shut up in the capacities and cavities of the joints, it cannot .be easily digested and resolved. The humor then causes pain by reason of distention or solution of continuity, distemper, and besides the viru- lency and malignity which it acquires. The concourse of flatulencies and hinderance of transpiration increase the morbific painful distention in the membranes, tendons, ligaments and other bodies of which the joints consist (p. 700). Cure: Purgation, regular to be had in spring and autumn. 86. To cure the gout there are two indications : the first is the evacu- ation and alteration of the peccant humors, the other the strengthening of the weak joints, accompanied by a fit diet. ... A fit time for purg- ing is the spring and autumn, because gouts reign chiefly in these seasons (p. 704 ; cf. Hipp. Aph. 55, S. YI). GOLDEK WOEDS. Purgation must be strong, gradually increasing. It cures also the incident fever, and is the treat- ment requir- ed through- out the course of the disease. 87. N"ow, it is convenient that the purge be stronger than ordinary, for if it should be too weak it will stir up the humors, but not carry them away, and they thus agitated will fall into the pained and weak joints, and cause the gout to increase. . . . The fever accompanying the gout easily becomes continual, unless the belly being first gently purged, nature be freed by stronger purges of the troublesome burden of the humors. . . . Seeing that physic is the addition of that which nature wants, and the taking away of those things that are superfluous, and the gout is a disease that has its essence from the abounding humor, certainly, without the evacuation of them, we cannot hope to cure either it or the pain which accompanies it. Metrius, in his treatise of the gout, writes, that it must be cured by purging, used not only in the declination hut also in the height of the disease, which we have found true BY experience (p. 710 ; cf. Hipp. Aph. 23, sect. I, and Aph. 8, sect. II.) sciatica. 88. Sciatica. — Strong purgatives are here also useful, such as used in purged and phlegmatic causes. Often vomitings do not only evacuate the humors, but also make a revulsion (p. 720). vomits. 89. The heat or scalding of the water arises from repletion, inanition or contagion. That from repletion proceeds from too great abundance THE DOCTRINE OF PURGATfON. 21 of blood, causing tension and heat in the urinary parts, whence proceeds the inflammation of them and the genital parts. . . . Purgings are cmebjput convenient, and a diet abstaining from heating articles, together with Q ati °n- cooling external applications (pp. 738, 740). Buboes. 90. Bilboes, or Swellings in the Groins. — The matter of these for the most part is abundance of cold, tough and viscous humors, as you may Senate the gather from the hardness and whiteness of the tumor, the poverty of the 'purgation. pain and contumacy of cure ; which also is a reason why the yirulency of this disease may be thought to fasten itself in a phlegmatic humor. The cure shall be performed by detergent medicines, and the humor evac- uated by a purging medicine (p. 746). Tetters, Jiing-uorm, Small- Pox and JIe-( isles om impu- ity of the, 91. Tetters, Ring-worms or Chops. — For general remedies, the distem- per of the liver and habit of the body must be corrected. This may be done by diet conveniently appointed, by purging and alterative- medi- &c" u i>ur'g7. cines, as they acquire their matter from salt phlegm or adust bile (p. 754). 92. !Now, the Small-Pox is pustules, and the Measles spots, which arise in the top of the shin, by reason of the impurity of the corrupt blood sent there by the force of nature (p. 757). You must neither purge nor draw blood, the disease increasing or being at its height, unless perad- /' venture there be a great plentitude, or else the disease complicate with uSoSt others, as with a pleurisy, inflammation of the eyes, or a squinancy* which require it, lest the motion of nature should be disturbed, but you shall ^au^f think it sufficient to loose the belly with a gentle clyster ; but when the pu ' 9a height of the disease is over, you may with cassia, or some stronger medicine, evacuate part of the humors and the relics- of the disease (p. 759). * Quinsy. Parey was plainly unacquainted with the good effect of jDurgation in the early stao-e of Small-Pox, when the purgative employed was efficient yet innocent. In many thousand cases the Brandreth Pills have been administered, more or less dur- ing the course of Small-Pox, and with evident advantage in every case. These Pills are very useful where ])atients cannot obtain a doctor, and there are thousands of towns in the United States where there is not a medical man within one hund- red miles. The following letter from Daniel Bissell, of Xewcomb, Essex County, New York, who was supervisor of the town for twenty years, may be important. I consider it my duty to publish it here : MR. BISSELL' S LETTER. Four persons cured of Small-Pox by purging with BraJKdretKs Pills. Newcomb, Essex Co., IS t . Y, Sept. 13th, 1861. Doctor Benjamin* Brandreth, New York. Dear Sir: In our family we have used your excellent Pills for several years, and have found them to be a never-failing remedy in mild and severe cases of sickness, but their full value we did not fully appreciate until last winter, when the Small-Pox visited so many fam- ilies in this and the surrounding towns. I was first attacked, and supposed I had a cold ; took four Pills and some warm drinks ; next day no better, look four more ; still no better, and my wife said I should take eight—did so, and then the Small-I'ox began to show itself. On the fifth day took to my bed, and in less than four days was covered from head to foot with pustules. I continued to use the Pills daily, and took no other medicine whatever 22 THE DOCTEINE OF PURGATION. except your Vegetable Universal Pills. The Pox was less than four days in coming to a head, and in about the same time they dried up. I began to attend some to my stock in about two weeks, but in three weeks I was attending to my regular farming business, having quite recovered my usual health. I took eighty Pills during my sickness, in doses of four to eight Pills, according to effect, being careful to procure two or three evacuations a day ; and though covered from head to foot with the disease, yet it has not left a mark upon me, which is one of the benefits said certainly to be secured by the U3e of Brandreth's Pills. I and my family found this to be so in our experience of their effects in this fell disease. My wife, well known as Aunt Polly for one hundred miles around us, was attacked with the disease about the time 1 was getting well of it. From the first she understood it was the Small-Pox, and prepared herself to combat its virulence by a free use of the Pills. In six days, and while confined to her bed, and scarcely able to move from excessive weakness, she used twenty-six Pills, or a little over an average of four Pills per day. And what was the consequence of this continued purging with Brandreth's Pills ? On Tuesday she was obliged to take to her bed; by Friday the pustules were all filled; and by the following Tuesday she had dressed herself! and in one week after was attending to her regular house- hold duties, to the astonishment of all her neighbors. One fact deserves notice : although she was covered with the disease, yet it has left no mark whatever on her skin, which bears no evidence of the awful ordeal it has passed under. Mrs. Wctherbee, my daughter, her husband, and their only child, were all stricken down by the Small-Pox. Mrs. W. had it light, and only some seven pustules came out. She used thirty Pills in fourteen days. Alonzo, her husband, had a severe attack, and took the Pills all through it, the number not noted. They both recovered in fourteen clays from its com- mencement. Their little boy, Daniel, about fifteen months old, had the disease badly ; we had little hope to save him. He was covered from head to feet ; he was like a huge scab; and for days he lay insensible. TVe all supposed he would die — that nothing could save him. His bowels had been confined for several days, and my wife said this must be reme- died — that perhaps if the boy could be purged he might revive. She read over yours and Dr. Lull's experience, and gave him one Pill, crushed, in some warm water. The Pill pro- duced no effect, but she was impressed with your remarks upon the necessity and import- ance of having the bowels purged in Small-Pox, and in all serious sickness whatever ; so she gave him another Pill. Still no effect. She then pounded three Pills, and added warm water, and gave them to the boy at once. Still no effect. There the little sufferer lay with- out motion, except the rapid breathing and peculiar signs of speedy dissolution evident to all. If he died, it would be said he might have got well had his bowels only been opened, and we then commenced to give him. three Pills in two hours, or at the rate of one and one- half per hour. When this child of fifteen months had taken thirteen Pills, they operated, and most fully. The stools were black as pitch, and most offensive. Every one was satisfied that it was death and mortified matter which the Pills had brought away, and that the Pills had saved another Kfe, through the Providence of God. In an hour after the Pills commenced to operate he began to revive, and took some re- freshment. He continued to improve until he got well. He is not marked with the disease. It seems proper to state that, though it took thirteen Pills to open his bowels, yet two days after he had a full natural evacuation without medicine, and his bowels have been regular up to this day, which is nearly nine months from the time of his sickness, nor has he u^ed a Pill since. He is as lively, intelligent, and healthy a boy as can be seen. His parents will ever be grateful to you, and they and myself and wife desire you to publish this letter, which, if need be, can be certified to by all the residents of. this and the adjoining towns. I am, respectfully, yours, DANIEL BISSELL, For many years Supervisor of the Town. We certify to the truth of the above. (Signed) — Polly Bissell; Aloxzo Wetherbee; Mary Wethkrbee; Russell Root, Postmaster, Schroon River; Erastus P. Root; Thomas R. Carey, Justice of the Peace, Town of Long Lake ; Cyrus H. Kellogg, Supervisor of Town of Long Lake, 1860; William Wood, Commissioner of Roads, Town of Long Lake ; Josiah Wood, Raquette Lake ; ^Vm. Helms, Forked Lake; W. H. Plumbley, Forked Lake ; Amos Hough, Forked Lake ; Ezekiel Palmer, Long Lake Hotel. ANOTHER CURE OF SMALL-POX. HOW TWO MEN WERE TREATED. I may also in this connection introduce the following statement of Joseph Daily, of No. 4 Union Square, New York : Joseph^ Malone and Henry Downs, acquaintances, on the same day were taken sick. Mai one too'k ten Pills of Brandreth's ; next day, feeling no better, he took six more: still feeling no better, he took four more the third day ; fourth day better, got up and dressed himself, when, to his great astonishment, he observed large pimples on his face ; it was in THE DOCTRINE OF PURGATION. 23 fact covered with Pox. Upon a further examination he found that they were coming out all over him; even the soles of his feet were full. Malone used the Pills more or less every day until he was perfectly recovered, which was within three weeks from the first day of sick- ness, when he was again at his business. Though covered from head to foot with the Pox they did not leave a mark behind. Henry Downs when taken sick called in a doctor, who discovered on the third day the true nature of the disease, and sent his patient to the Small-Pox Hospital on Blackwell's Island. There he remained two months, and then was discharged cured. €Ie lost an eye while in the Hospital, and was so marked that his nearest friends hardly knew him. These facts will bear the strictest investigation. WOKMS. 93. A gross, viscid and crude humor is the material cause of worms, which having got the beginning of corruption in the stomach, is quickly carried into the guts, and there it putrefies, having not acquired the form of laudable chyle in the first concoction. This, for that it is viscid, STKmKm- tines ; eject- ed by pur- gatives. Worms from 'viscid humors ac- cumulated tenaciously adheres to the guts, neither is it easily evacuated with the other excrements ; therefore, by delay it further putrefies, and by the efficacy of heat, it turns into the matter and nourishment of worms (p. 765). In this disease there is but one indication, that is the casting out of the worms forth of the body, as being such that in their whole kind are against nature. . . . Now as such things breed of a putrid matter, the patient shall he purged, and the putrefaction repressed. . . . Oil of olives kills worms, and so do all bitter things (p. 767). Brandreth's Pills are infallible as a cure for worms, with or without olive oil. 94. Leprosy proceeds from impurity of Mood. — You must understand that the cause of the leprosy by the retention of the superfluities, happens uaJt h m'' because the corrupt blood is not evacuated, but regurgitates over the Leprosy— whole body, and corrupts the blood that should nourish all the members, "rSy 'ofTte wherefore the assimilative faculty cannot well assimilate by reason of S/tSTm- the corruption and default of the juice, and thus, in conclusion, the P urit y a ? ii leprosy is caused. The antecedent causes are the ' humors disposed to regeneration adustion and corruption into melancholy by torrid heat. . . . Galen (ad Glauconem, lib. 1, cap. II.) defines it : " An effusion of troubled or gross blood into the veins and habit of the whole body " (pp. 769, 70). A cooling diet and purging shall be prescribed to evacuate the impurity of the blood and mitigate the heat of the liver (ibid. ; cf. 68 ; cf. 71, 82, 93 ; Hippoc. 42, 60). • 95. Hydrophobia. — Such as have not their animal faculty as yet nydropho- overcome by the malignity of the raging venom must have strong pur- p^f^es gatives given them. For it is a part of extreme and dangerous madness f'? m h ^ in - to hope to overcome the cruel malignity of this poison already admitted into the bowels by gentle purging. . . Neither shall they let blood, lest Bleeding so the poison should be drawn further into the veins. But it is good ta-werous. that the patient's body be soluble from the very first (p. 789). Xote. — Brandreth's Pills, four every two hours, until twenty pills be taken, is the best means, and will hardly fail if resorted to in season. 24 THE DOCTRINE OF PURGATION. 96. The general and natural causes of the plague are absolutely two, from agU cor- that is the ^nfection of corrupt air, and a preparation and fitness of lnd te predis- corrupt humors to take that infection (p. 819). the Sod 1, ° f Humors -putrif y either from fullness which breeds obstruction, or by distemperate excess, or by admixture of corrupt matter (p. 820). 97. I say that the pestilence does depend on the default of the air ; Abscesses this default, being drawn through the passages of the body, does at nature™ length pierce into the entrails, as we may understand by the abscesses that break out, by reason that nature using the strength of the expul- sive faculty, drives forth whatever is noisome and hurtful (p. 845). 98. The physician must not let blood, for when nature is debilitated by this evacuation and the spirits, together with the Hood, exhausted, the ^weeding venonloIls a i r w m soon pierce and be received into the empty body, where it exercises its tyranny to its utter destruction. ... If there be strong great fullness in the body, especially in the beginning, . . then it is Mate Twg- lawful to purge strongly. ... If you call to mind the proper indica- ing saves, tions, purging shall seem necessary, and that must be prescribed as the case requires, rightly considering that the disease is sudden, and requires medicines that may with all speed drive out of the body the hurtful humor wherein the noisome quality does lurk and is hidden (pp. 84:6, 47). 99. Concussion of the Brain. — By a heavy blow or the like occasion, the veins and arteries of the head may be broken. From hence pro- Concussion C eeds the afflux of blood running between the skull and membranes, or Purgation else between the membranes and brain. The "bload congealing there, indicated. causes vehement pain, and the eyes become blind, vomiting is caused, the mouth of the stomach suffering together with the brain, by reason of the nerves of the sixth conjugation, which run from the brain thither, and from thence are spread all over the ventricle ; whence, becoming a partaker of the offense, it contracts itself, and is presently, as if it were, overturned ; whence first these things that are therein contained are expelled," and then such as may flow thither from the neighboring parts, as the liver and gall, from all which bile is first expelled (p. 351). Brandreth's Pills in these cases purge in from thirty to sixty minutes. 100. To cure a hroken and dislocated hone is to restore it to its in frac- former figure and site ; that is, first to restore the bone to its place ; tones and an second, to bring it to stay, being so restored; third, to hinder the operations increase of malign symptoms and accidents, or else if they happen to SfySeWood temper an d correct their malignity. . . . For this purpose we drive away the defluxion ready to fall down upon the part by medicines, repel- ling the humor and strengthening the part, or by appointing a good diet, hinder the begetting of excrements in the body, and divert them oy purging (pp. 565, 66). "Note. — The importance of purging and the reasons therefor are strongly presented by Ambrose Parey, and will have weight with sensible men, in or outside of die profession THE DOCTRINE OF PURGATION. 25 Sa^ctoeius, M. D., Prof, of Physic at Venice ; Ars. de Statica medi- cina, Venice, 1614. Aphorisms, translated by John Quiney, 31. D. London, 1720 101. If there daily be an addition of what is wanting, and a sublrac- The great tion of what abounds, in due quantity and quality, lost health may be he a wt p - le0 { restored, and the present preserved. (Aph. 1, sect. 1.) systematic disorgani- zation and reorganisa- tion. He only who knows how much and when the body does more or less insensibly perspire, will be able to discern when and what is t© be added or taken away, either for the recovery or presentation of health (Aph. 3). Note. — Nature herself does all these things, provided we relieve the body by purgation ; for innocent purgatives take out no humors but those which are depraved. 102. Insensible perspiration is either made by the pores of the body, which is all oyer perspirable, and covered with a skin like a net, or it is performed by resp)iration through the mouth, which usually in the space ffonTiiow it of one day amounts to about half a pound (Aph. 5). isperorme . Note. — Should either of these processes of the skin or the lungs be partially suspended, we have only to increase by purgation the activity of the bowels, this organ measurably taking upon itself their work, they partially resting the while ; then both lungs and skin will soon regain their healthy functions. Insensible perspira- 103. If the body increases beyond its usual weight without eating or stntic me . drinking- more than customary, there must either be a retention of the dici j ie • i ta . •it i • r> l • -i i a 1 fundamental sensible excrements, or an abstraction ot the perspirable matter (Aph. 9). principles. The body continues in the same state of health as long as it returns to its wonted weight, without any increase of the sensible evacuations ; but if it comes to its standard by larger discharges, either by stool or urine, than ordinary, it then begins to decline from its former health., (Aph. 10; cf. Parey, 71, 82, 93, 94 ; cf. Hippoc, 44, 45.) 104. From too great fullness arise bad qualities, but none vice versa Plethora (Aph. 18). Too great a weight and fullness may be lessened by sensible requires or insensible evacuations, either of digested or undigested matter, and it is good so to do (Aph. 19). evacuation. Sweat (or 105. That perspiration which is beneficial, and most clears the body of superfluous matter, is not what goes off with sweat, but that insensi- ble steam or vapor (Aph. 21). . . . which becomes sensible when there visible per- is too great a supply, or upon faintings, or upon violent motions (Aph. unheamy. 22). Insensible perspiration accompanied with sweat is bad, because sweat diminishes the strength of the fibers. (Aph. 23 ; cf., Hipp. 29, 43.) When persons faint from severe purging, I have always observed that when they came to, the countenance appeared relieved from great anxiety ; perhaps a congestion was broken up, or some troublesome humor removed. 106. The body is not presently thrown into a disease by an external injury, unless some of the viscera be first disposed to receive its impres- Predispo- 26 THE DOCTRINE OF PURGATION. sition for, sions, which predisposition may be known by a greater or less weight ?5£« ofa§- than is customary, and that not without some considerable uneasiness vancing du- (Aph. 39). The first impressions of a disease are much more easily mov'ecrudi- discernible from the changes of an unusual perspiration, than from the ^Ztdtmte disorders of any of the other functions (Aph. 42). If, upon weighing, turn pwrga " the perspirable matter appears to have been obstructed, and there is neither increase of sweat nor urine for some days after, there is a great deal of danger of a putrefaction of the detained crudities (Aph. 43). If the obstructed matter can neither be removed by nature nor a feverish heat, there is immediate danger of a malignant fever. (Aph. 46 ; cf. Hipp. IT; cf. Hipp., 37.) 107. The excrements of the guts which are well digested, are large Evacu«- %VCL hulk, but light in weight ; they swim because of the included air, *°% wlien and what is ejected at once seldom exceeds the third of a pound (Aph. 72). 108. Importance of Ventilation to Imperceptible Pores. — Nothing more tends to prevent a corruption of the humors than plentiful ventila- tion 01 ^ 6 the tion; not only by that which is drawn in by the lungs, but what is potS (active drawn in through the imperceptible pores. (Aph. 120; cf. Hipp., 10, and nega- 55 ano l 13, 26.) tive). ' J 109. The plague is communicated not by any immediate contact, but PestiUn- either by drawing in infectious air or the steams of tainted furniture ; ?£ l n, *Yow an( ^ it i s thus : the vital spirits are infected by the air, and from the propagated, infected spirits the Mood is coagulated, which produces black spots, car- ani ve cured bunches and buboes, and if not sufficiently discharged, occasion death; but uon. purga " if it he all thrown out, they escape. (Aph. 127; cf. Parey, 94). The above shows the absolute necessity of Brandreth's Pills in Plag-ue, because they purge safely. Air-~\is HO* The external air which passes through the arteries into the influence body may render the body heavier or lighter : lighter if it be subtle upon the ^ d ,, . -i ^ i • i t ° . / * -P ~ tt\ t body. and warm, and heavier when thick and moist (Aph. 3, sect. 11). In a foggy air perspiration is lessened, the pores are obstructed, and the fibers weakened and not rendered more firm ; and the weight of the retained matter is both perceivable and injurious. (Aph. 8 ; cf. 103, 106, 109.) Summer- Ill. Temperate persons weigh in summer time about three pounds less hoTit"en- tDan * n ^ e wmter (Aph. 23). 'That lassitude or weariness which is per- sues. its cure ceivable in summer time is not because the body is then heavier, but %rging nt to because it is then rendered weaker (Aph. 24). "in summer time the re 7t7ucted b ' D °d.y is not uneasy from the heat of the air immediately, for every part matter. of the body is even then hotter than the external air, but because at such times there is not a sufficient coldness to concentrate the natural heat. ~By which means it becomes so scattered that it cannot drive out the perspirable matter, in its own nature hot, by insensible steams ; which matter, by being retained, acquires a sharpness, and is really the cause of that uneasiness we are under from a sense of the summer heat (Aph. 27, sect. 1) THE DOCTRINE OF PURGATION. 27 112. When to Purge. — The autumn is unhealthful, both because per- Autumnal spiration lessens upon the supervening cold, and because that which is ob- SSStowS structed acquires an acrimony and a corrosive quality (Aph. 42). They |£ evdcuat- who are accustomed to a distemper in winter, that arises/ wm a fullness numtmu «c- ^ humors, ought to purge in autumn (Aph. 48). tS™ U ' Note. — Our experience is, purge only when the body calls for it — when we have pain or oppression, or the bowels are costive. 113. But for such diseases as* arise from noxious qualities, -purging spring the ought rather to be used in the spring than autumn, because in the hot puTJing/Z weather such qualities grow worse more than in the winter (Aph. 49 ; J^*""*'*" cf. Pare j, 86). 114. If the obstructed perspirable matter acquires an acrimony, it pro- . Acrimony duces fevers and inflammations ; but when it offends onl y in quantity, and ™ it causes aposlumations, distillations, and cachexies (Aph. 51). corrected per- abundance carried off by purga- tion. 115. When a full meal is not perfectly digested, it is to be known by an insensible increase of weight, for the body will not then perspire well ; but an exdetton- 6 empty stomach is Med with vapors (Aph. 12, sect. 3 ; cf. Apo. 5, sect. 1.) |. h b J im e( ij Robust persons discharge their food for the most part by perspiration ; pending _ on those not so strong by urine ; and the weak chiefly by an indigested ai°strS#h. n " chyle (Aph. 14). A full or an empty stomach lessens perspiration ; for a full one diverts it by corruption of the aliment, and an empty one draws it back, that it may be filled (Aph. 11), and the obstructed mat- ter will acquire a sharpness, whence the body will be subject to distem- pered heat (Aph. 15). 116. When a person seems to himself lighter than he really is, it is a sensation very good sign, because it arises from a perfect digestion of all the juices of health. (Aph. 19). 117. That sort of food bast perspires, and affords the most suitable what la nourishment, whose weight is not perceived in the belly (Aph. 28). / ^ itable 118. Nothing more frequently interrupts sleep than a putrefaction of watchful- the food, such is the sympathy between the stomach and the brain (Aph. morbid S 40, sect. 4). From eating comes sleep ; from sleep digestion, and from te H^?% digestion a good perspiration (Aph. 59 ; cf. Parey, 99). stomach aml 119. By exercise bodies are rendered lighter ; for all the parts, espe- Digestion cially ligaments and muscles, are cleared of their excrements by motion ; SXeof 5S the perspirable matter is fitted for exhalation, and the spirits rendered body - firmer (Aph. 9, sect. 5). Exercise promotes both the sensible and in- sensible evacuations ; but rest only the insensible (Aph. 10). 120. The heavy part of the perspirable matter being more than usuallv " x?™™*- i • ,i -l i •, 'ii t i i* i ■• J ness 1 from retained m the body, it will dispose a person to tear and sorrow ; but obstructed the lighter part being obstructed, to anger or joy (Aph. 5, sect. T). Therefore" purge. 28 THE DOCTRINE OF PURGATION. Harvey, William, Dr. — The works of, written 1628-51; transl. by Robt. Willis, M. D., and published by the Sydenham Society. London, 1846-47. Harvey on 121. The blood acts with forces superior to the forces of the elements. the olood. . n i /-*{ ttt- i /y> • i As the instrument of the Great Workman, no one can ever sufficiently extol its admirable, its divine faculties. . . It penetrates everywhere, and is ubiquitous ; abstracted, the soul or the life, too, is gone, so that the blood does not seem to differ in any respect from the soul, or the life (anima) itself. At all events it is to be regarded as the substance whose act is the soul or the life. . . In one way the blood is part of the body, but in another way is the beginning and cause of all that is contained in the animal body. . . That which is abundantly nourished by it, in- creases ; what is not sufficiently supplied, shrinks ; what is perfectly nourished, preserves health ; what is not perfectly nourished, falls into diseases (pp. 510, 11). vitiated 122. Vitiated states and plethora of the blood are causes of a whole Mood. h ost f diseases (p. 391; cf. Hippocr. Works, p. 262, Yol. I., Aphor. 22, sect. 2 ; cf. Parey, 68-99). Nature the 123. The physiological consideration of the things which are accord- teacher of { n g | nature is to be first undertaken by medical men, since that which is in conformity with nature is right, and serves as a rule both to itself and to that which is amiss (p. 90 ; Hippocr. Works, p. 102, Yol. I., p. 360, Vol. I). The timid . 124. Not yielding implicitly to the truth, he fears to speak out thrnewdoc°- plainly, "lest he offend the ancient physic" (p. 91). trine. 125. Who will not see that the precepts he has received from his pie/of Ha!" teachers are false; or who thinks it unseemly to give up accredited vey'stime. p m i ons . or w h regards it as in some sort criminal to call in question doctrines that have descended through a long succession of ages, and carry the authority of the ancients ; to all these I reply : that the facts cognizable by the senses wait upon no opinions, and that the works of iva^ nature bow to no antiquity^ ; for, indeed, there is nothing either more authority. 63 ancient or of higher authority than nature (p. 123 ; cf. Hippocr. 47). The iiood 126. The blood is the generative part, the fountain of life, the first to again. Iwe^ the last to die, and the primary seat of the soul (p. 377). The blood is both the author and preserver of the body • it is the principal element, moreover, and that in which the vital principle (ani- ma) has its dwelling place. . . The blood, moreover, is that alone which lives and is possessed of heat while life continues (p. 379 ; cf. pp. £10, 11). THE DOCTRINE OF PURGATION. 29 Collins, Samuel, M. D., System of Anatomy. London, 1685. 127. Cathartics do not only affect the blood at a distance, but also the How pur- gative medi- the stomach and intes- tines, by irri- tation of the intestinal nerves, stim- villous coat and nervous filaments, which do immediately disturb them cines^act on with troublesome stroaks proceding from the pungent particles of pur- gatives, vellicating the inward coat of the stomach as a tender compage beset with nervous fibrils, which, irritated by sharp medicines, spew out serous liquor out of the excretore ducts, derived from the glands of the uTating • , .• peristaltic mtestmeS. motion and The purgation extract of medicines first produced by the ferments tne an m u!ous of the stomach, and afterwards imparted to the intestines, does highly matter. excite the nervous and carnous fibers, and gives a most troublesome sensation to the inward coat of the guts finely dressed with fibrils ; and afterwards affects the excretory vessels of the pancreas and hepatic ducts with a kind of convulsive motion, making them disgorge their pancreatic and bilious recrements, into the larger receptacle of the intestines. And not only the feces of the olood, secreted from it in the glands of the liver and pancreas, are thrown into the guts by the excitement of the nervous and carnous fibers, but also the extremities of the arteries and excretory vessels belonging to the glands, are opened by the sharp and aperient qualities of the purgatives, unlocking the secret pores of the inward coat of the intestines lined with a mucous matter, which is scraped off by the cleansing qualities of purgatives, leaving the intestines exposed to the active power of raking medicines, which force open the extremities of the arteries (p. 369, vol. 1). 128. The concoctive faculty of the intestines is disaffected; first, as it pathology is wholly abolished, when no chyle, or very little, is extracted in the tines. stomach or intestines. This evil proceeds from the want of natural heat deficient primarily in the blood, and from a defect of good succus pan- f r ^ enUr lt creations, and bilious liquor, and a laudable serous and nervous juice, f^ c ^ n at f c not being imparted by the extremities of the arteries and nerves to the andpancre- crude aliment lodged in the guts. This disorder is commonly called cuVebyjwr- lienteria, an unnatural excretion of the aliment, little or no ways altered, o ative9 - wherein its compage is not well opened by due ferments, and a secretion made of the alimentary liquor from the grosser feces (p. 370). This obstruction of the hepatic and pancreatic ducts is cured by aperient medi- cines (p. 371). Cartiac ■ffection is imperfect digestion from defee- 129. Another disorder of the intestines near akin to the former, as differing from it in degree, is the lessened concoction, commonly styled caeliac affection, wherein the food is in some sort digested, and remains confused, as not secreted from the gross parts, because the chyle is not u"7 compo well attenuated by the pancreatic and bilious liquor, and serous and ^Si&Sg nervous "juice, which are destitute of volatile salt, oily and spirituous ^*f£? particles, so as to render the chyle fluid m the intestines ; whereupon the ive medi- clammy chyle embodying with the crude aliment, is excreted by the ex- pulsion faculty (p. 370). This distemper is cured by the same means as a lienteria (p. 371). 130. The third indisposition of the concoctive faculty of the intestines imper/ect digestion 30 THE DOCTRINE OF PURGATION. from acrid is its depraved action, produced by ill ferments of sharp bilious, and acrid Pwol ™' pancreatic liquor, vitiating the extracted aliment in the guts, and after- wards spoiling the mass^of blood, when it is received into association with it in the blood-vessels (p. 370). It denotes gentle aperient medicines (p. 371 ; cf. Parey, 94). indiges- 131. Another disaffection of the intestines, and that none of the least Ssorders r °S because it concerns the nutrition of the whole body, is when the ^twTfacui- distributive faculty of the chyle is either wholly taken away or much ty of the lessened, which may proceed either from the clamminess of the chyle, vucokty of or from the grossness of pituitous humors, more or less obstructing the orifices of the lacteal vessels seated in the intestines. The cure of this disease may be assisted with a light diet and medicines promoting the digestion (p. 371). humors. 132. The intestines are also incident to divers diseases in reference to their expulsive faculty, when the peristaltic motion is too slow, or too Slowness of excretion from inact- iveness of quick, or aggrieved with the discomposure of pain nai nerves. The slowness of the motion of the guts proceeds either from the Pl stSia?e torpid indisposition of the nervous coat, not resenting the irritation by t vS'. toacU ' g ross excrements, when the nervous fibrils inserted into the inward coat of the intestines have their acute sense lessened, proceeding from the want of animal spirits intercepted first in the fibrous parts of the brain, and- by consequence in the nerves of the guts, produced by cephalic diseases, compressing or obstructing the fibrils seated in the brain. This dis- affection is cured by proper methods and medicines relating to the dis- eases of the head (p. 371). In all the diseases of the brain, Collins recommends purgatives to a greater or less extent (pp. 1133, 1134, 1138, 1145, 1153, 1163, 1169, 1181, 1194, 1199 ; vol. II; cf. Sanctorius, 118). Torpor of 133. The slowness of the peristaltic motion, incident to the guts, may fines *?rom ^ e a ^ so derived from narcotic medicines, dulling the acute sense of the narcotics nerves which terminate into the inward tunicle of the intestines, where- movX' by upon they are not sensible of their burden, when they are oppressed with gau!m. pur ' excrements. This disease may admit a cure by strong purgatives and sharp clysters (p. 372). Hardened 134. The remissness of the expulsive power of the guts may also moTed™ by arise from the viscid and indurated contents, produced by ill concoction ; purgatwes. ^q other from the heat of the guts, exhausting the liquid parts of the excrements ; the guts being overcharged with excrements, purgatives mav be advised (p. 372; cf. Hippocr. 13^25, 26). Lientery, 135. The over-hasty motion of the guts is made in a lientery and mfeanaidi- caeliac disease, proceeding from the quantity of crude and indigested Sited pe°r?- aliment provoking the nervous and carnous fibrils to excretion. This staitio mo- disaffection of the guts is visible also in diarrhea proceeding from salt by * purga- phlegm and from bilious and serous excrements discomposing the tender tvoe8 ' compage of the guts, and irritating them to expulsion. The cure of THE DOCTRINE OF PURGATION. 31 this disease is performed by lenient and astringent purgatives (p. 372 ; cf. Sanctorius, 103 ; Hippocr. 44, 45). 136. Inflammations of the guts producing dysenteries are most com- Dysentery monly seated in the great gut, which, proceeding from a quantity of m £iTn$™~ blood impelled by the mesenteric arteries into the intestines, some part of ^agnation which is stagnant in the substance of the bowels, and other parts are of impure transmitted sometimes into the small guts, where it seldom makes any io°weis. n long stay, as, being thrown from there into the colon, wherein the blood is long retained ; whereupon the tender frame of the coats is corroded by the sharp blood confined in the deep cavities of the colon (p. 372). The vitiated expulsive faculty of the guts coming from inflammations, and from an ill mass of blood, is cured by clysters made of healing medicines and by purgatives (p. 373 ; cf. Sanctorius,103, 106, 109, 110). Iliacpas- sion, or pains in the 137. The iliac passion proceeds from divers causes, sometimes from the small guts, twisted, other times entangled and tied in knots, and also when they shoot downwards and upwards into one another. It may be ^maii '"guts derived from astringents unduly used, and from a stoppage of the intes- Sattontf tines by viscious matter from hardened excrements, and from flatulent {ene^i'iy^c- matter contained in the guts intercepting the passage of the gross companied feces. . . Now and then the upper shoots into the lower, and sometimes ness of thl the lower into the upper part of the small intestines, which are much W Mch *2 re- distended in several places, and in other parts contracted for some space ™jj. w b y both above and below ; whereupon the free play of wind being checked, medicines. the patient is highly tortured with pain," and, to ease himself, puts his body in divers postures by various agitations -and flexures of it. A re- laxation is made of some part of the guts adjoining the contracted parts, which, being moved forward by the pressure of wind toward the relaxed intestines, force them into the next expanded parts of the guts, which are afterwards closed up by the duplicature of them, entirely intercept- ing the passage of excrements. And when in this miserable distemper the lower part of the guts is thrust into the cavity of the upper, the pressing down of the excrements, made by art in purgative medicines, discharges the insinuation of the lower gut into the upper (pp. 375, 76). . The iliac passion may arise out of a gross alimentary liquor or phlegm concreted in the intestines, wholly shutting up the passage of them ; whence ensues a recoiling of the excrements upward, produced by the irregular contraction of the fleshy fibers (p. 377). This disease often happens upon a long suppression of natural evacuations oy stool, gener- ated by a load of hard excrements, long residing in the guts, productive of intolerable pains (p. 378 ; cf. Hippocr. 38, 41, 44). 138. The colic is near akin to the iliac passion in the situation of the ret rarey. subject and in the cause of the disease, both proceeding from sharp S3) humors productive of vexatious pains, and from the great obstruction and tension of the guts, caused by a quantity of gross excrements, and more thin and flatulent matter (p. 379). This disease takes up its man- sion, if not solely, yet chiefly, in the colon. Colic pains are generally felt in the Icrwer apartment of the abdomen, accompanied with nausea, vomiting, suppression of stools, pains in the hack, &c. . . Colic, accom- panied with heat and beating pains, arises from blood impelled out of JtH 6?/mp . Colic: Ac- cumulation of stagnat- ing "bloody excrvnit-Ti/i- tioiix matter &n(\fl ar e m uch alike in their cures, too. . Strong purga- gation. tives may be given, and after a purgative has been celebrated, vomito- ries may be administered (pp. 1131, 1132, 1133). vertigo- 145. Vertiginous symptoms arise from irritation of the nervous K^ofSel nbrils of the stomach, intestines, liver, pancreas, spleen and kidneys, t^ainerves. proceeding from sharp recrements, which, offending the fibrils of the viscera, taking their origin from the brain, give a lightness to it (p. 1136) ; and as to the preservatory indication in an ill habit of the body, purgatives may be applied (p. 1138 ; cf. 132). DeiiHum 146. In phreuitis and paraphrenias, produced by an undue effer- iti vescence of the blood caused by heterogeneous particles, or by the blood o£ihe bow- being poisoned with malignant qualities (p. 1140), which is induced by serous recrements vitiating the nervous liquor (p. 1143), clysters are THE DOCTRINE OF PURGATION. 33 very successful to empty the towels of excrements and winds (p. 1145 ; cf. IParey, 94 ; Sanctorius, 109). 147. Melancholy being produced by vitiated Hood and corrupt humors jJ^SSw in the viscera (pp. 1150, 1151), is cured by vomitories and purgatives, morbid removing the gross plilegm from the stomach and discharging gross, m blood! 71 acid, and saline recrements from the blood (p. 1153). 148. Mania borrows its first rise from an ill mass of blood, caused Mania, by the distemper of the hepatic glands not secreting the bilious from iiZd y by the more laudable parts of the blood (p. 1159). /Strong purgatives are f a u v % pur ~ used with advantage in this stubborn malady, as they purify the blood and nervous liquor (p. 1163). 149. Frequent and large doses of opiates incrassate the mass of the Opiates blood (p. 1167) and nervous liquor, rendering tbem effete and vapid, so pishness that the brain cannot accomplish the acts of sense and reason, making men mopes and sots. To refine the blood, purging medicines, prepared with cephalics, may be very proper in those diseases (p. 1169). stupidity. 150. The indication to take away the cause of epilepsy is principally fro ^%ti. founded in rectifying an ill mass of blood and nervous liquor, which a * ed state of depends much upon a laudable state of the viscera, so that the ill diathe- sis of the blood and viscera is taken away by vomiting, purging, and bleeding (p. 1181). toward cure ; purgation. 151. Palsy. — The motive faculty is impeded or abolished, because Paisyivom. the origins of the nerves are obstructed by the grossness of the nervous f teXThe" liquor, which may arise from a thick, feculent, albuminous part in the %°fy ? r °- blood (p. 1193). A palsy sometimes succeeds severe pains of the stomach imperfect and intestines (p. 1194), which are produced by an accumulation of bilious The>>2sfe P and excrementitious matter and hardened feces and dilatation by flatu- lency, compressing the beginning of the vertebral nerves and intercept- ing the current of the circulating fluid (p. 1195). The antecedent cause of palsy is an ill mass of blood generated by a bad diet, hard of digestion (p. 1196). Vomitories may be advised in a foul stomach, but purgatives and alteratives for a habitual palsy (p. 1199). In a palsy derived from an evident cause — a fall, stroke, or wound — the apertion of a vein may be proper, after an emollient and discutient clyster has been administered and rejected (p. 1198; cf. 139 ; Parey, 83 ; cf. 136, 137, 13i>). Sydenham, TnoMAs, M. D. TJie whole Works of that excellent practical Sydenham. Physician, written about 1686. Transl. Dr. Pechey. London, 1701. 152. Though a purge does for the present raise a greater tumult in Purgatives the blood and other humors, on the day it is taken, and in the operation, soonest* ai." than was before, yet this injury will be sufficiently made up by the ad- best - vantage that presently follows; for it is found by experience that purg- ing quells a fever sooner and better than any other remedy whatever, both as it expels those filthy humors from the body, by which, as the ■ 'lent cause, the fewer was occasioned} and if they were not peccant before, yet, at length being heated, concocted and thickened by the, fever, 34 THE DOCTKINE OF PURGATION. Filthy hu- d muc ] 1 to render it more lasting (p. 432 ; cf. Hipp. Works, I., 174 ; ?e r cedent n " W. Harvey, 391; Sanctorius, 103, 106, 109, 110; Collins, 136-138, 151). Sweating 153. Purging preferable to Sweating. — . . . On the contrary, as ing ^com- that method which is busied in eliminating the febrile matters through Sougk na- "the pores of the skin is less certain, so it is more troublesome and feZts Cur h tedious ; for by it the disease is very often protracted many weeks, and sweating, the life of the patient thereby endangered. . . . For this reason I insist, cw-e-bjpu!- upon good grounds, that purging is more powerful than any other method for the subduing levers of most kinds, for though sweating is nature's own method by which she casts out febrile matters, and is more The rea- given genuine and commodious than the rest, when nature is left to itself most excel- ^ £ rg ^ ^ggg^g -^be aforesaid matter, and then, when it is well concocted, gently expels it through the- habit of the body. Yet art, how much soever it may seem to imitate nature, cannot arrogate to itself the privilege that it is able to cure fever certainly by sweating. For, first, art knows not by what means the peccant matter should be fitly prepared to undergo expulsion ; and if it should know this, yet it has no certain signs by which it should be admonished of the due preparation of it ; so that also it is unavoidably ignorant of the fit time for provoking sweat, which it is very dangerous to provoke rashly; while if the physician should, by purging, miss his aim in curing the patient, yet he will not hurt him (pp. 432-34 ; cf. Cxid. Harvey, p. 286 ; cf. Hipp. 29, 43 ; Sanctorius, 105 ; Parey, 69 ; Hipp. 9.) ggP The above a highly important article. PcSZ?o° ral ^^' ^ ^ e niimors are retained longer in the body than they ought, DiLases^va- either because nature cannot concoct them and afterwards expel them, pSn 11 pr t°o or because they have contracted a morbific disposition, they become quality 7 an d f exalted into a substantial form or species, which discovers itself by this morbid mat- or that disorder, that is agreeable with its own essence. ters. Like pro- The symptoms of disease, though to the less wary they may seem to arise from the nature of the part which the humor possesses, are really disorders arising from this or that specific exaltation or specification of some juice in the body. For nature is as methodical in producing and ripening these as of plants and animals, unless the order of it be dis- turbed by some extrinsic thing (as purgation). The species of diseases depend on those humors from whence they were generated. (Preface.) in chronic 155. Chronic Diseases. — Nature has not an effectual method in these fistnaZrV.' diseases, to eject the morbific matter, as in acute, whereby, we assisting and aiming at the right mark, the disease may be cured. (Preface.) Note. — Purgation usually changes the chronic into an acute disease by assisting nature to expel impurities ; thus the blood becomes endowed with grea'ter vitality. Disease— 156. A disease is nothing but nature's endeavor to thrust forth, with a effort"!? 1 all her might, the morbific matter for the health of the patient, though cure - the cause of it be contrary to nature (p. 1 ; cf. Hipp. Aph. 2 ; sect. I ; Sanctorius, 106.) THE DOCTRINE OF PURGATION. . 35 157. Impurities mixed with the blood affect the whole with a mor- why na - bific contagion, partly from the various ferments or putrefaction of ^peiimpu- humors which are detained in the body beyond their due time, because rities - it was not able to digest or evacuate them, either upon the account of their bulk being too great, or the incongruity of their quality (pp. 1, 2). 158. What is the Gout but Nature's contrivance to purify the blood Gout - of old men (p. 2) ? 159. Purification— r lNature performs this office, sometimes quicker, Fevers- sometimes slower, for when she requires the help of & fever, whereby she STf™™" may be able to separate the vitiated particles from the blood, and after- Wher \ , she i it liTi ••i • i i* -i i i cannot from wards expel them, the whole business is done m the mass of the blood, cannot from any cause and that by violent motion of the parts. . . . When this kind of matter thtse Vl hn P v- rities, Pal- sies, &c , and Chronic Diseases fol- is fixed to any part which is unable to exclude it, either upon the ac- count of its conformation, as it is in the morbific matter of a palsy that the nerves are stuffed with, or upon the account of a continued flux of Yo*Tl£m new matter, wherewith the blood is vitiated, which is only disposed to £2^? carry it off, does oppress and overwhelm the part. 1 say in these cases the matter is very slowly or not at all concocted, and so diseases that proceed from such unconcocted matters are, and are called, chronic (pp. 2, 3 ; Cf. p. 402 ; 19. ; W. Harv. 90, 391 ; Sanctorius, 112). 160. He will not be mistaken much who should affirm that more diseases arise hence, viz., from the omission of purging after autumnal diseases, than from any other cause whatever (p. 21 ; Cf. Hipp. Aph. 12, II. ; 43, 56, VI. ; Works, 707, II. ; 728, II. ; Aph. 32, IY). Diseases from want of purga- tion. 161. All means to avoid disease or infection are useless, if the body is furnished with humors disposed to receive the infection (p. 59 ; cf. dise°ase, sc the HippOC. W. 102, I). oe°pur, mUSt 162. Cholera. — Should I restrain the first effort with narcotic medi- choiera- cines and other astringents, whilst I hindered natural evacuation, and de- ^ ingent8 tained the humors against nature, the sick would undoubtedly be destroved by the intestine war, his enemy being kept in his bowels (p. 115 ; cf. Hipp. Aph. 2, I. ; 21, I ; Collins, 142). 163. Sydenham on Hippocrates, Nature and Disease. — The excellent Hippocrates' Hippocrates who arrived at the top of physic, laid this solid foundation SS^ewS for building the art of physic upon, viz., nature cures disease, and he ijjjjj^jjj delivered plainly the phenomena of every disease, without pressing any piyadescrip- hypothesis into his service. He also delivered some rules gathered from Jure. °Ar?of the observation of that method that nature uses in promoting and "^S ne JJz° removing diseases, and of these things consisted the theory of the divine tnrecm\yby old man . . . This theory was nothing else but an exquisite description anTsimpie! of nature ; it was reasonable that in practice his only aim should be to relieve her, when she was oppressed, by the best means he could ; and therefore he allowed no other province for art than the succouring of nature when she was weak, the restraining her when she was outrageous, 36 THE DOCTRINE OF PURGATION. and the reducing her to order, and to do all this in that way and manner, whereby nature endeavours to expel diseases ; for the sagacious man per- ceived that nature judges diseases, and does in all, being helped by a few simple forms of remedies, and sometimes without any (preface ; cf. pp. 432,2-3; W. Harvey 123). 164. Scarlet Fever. — I reckon this disease is nothing else than a moderate effervescence of the blood, occasioned by the heat of the fore- going summer, or some other way, and therefore X do nothing to hinder the depuration of the blood and the 'ejecting of the peccant matter through the pores of the skin, which is easily done by the blood itself. Puraaiives 1^5. ^^ wnen -th e scales are gone off and the symptoms ceased, I think cure, other it proper to puege the sick with some gentle medicine that is agreeable to remedies e- ^ g ^^ an( ^ strength ; and by this simple and plain natural method, this name of a disease, for it is scarce anything more, may be easily and safely removed. Whereas, on the contrary, if we disturb nature by cordials and other needless remedies too learnedly thrust in secundum artem, the disease is hightened and the sick dies by the over-omciousness of the physician (pp. 189-90). 166. I think pleurisy is a fever originating in a proper and peculiar aSaTat- inflammation of the blood, an inflammation by the means of which tempt to cure nature deposits the peccant matter in the pleurae. Sometimes she lavs by elirm»at- , , , * , x r # i t -..^J ing morMd it on the lung itself, and then there comes a peripneumonia. This diners Zeliood,° m from the pleurisy only in degree. It exhibits the results of the same cause with greater intensity. (Society's Ed., vol. I., p. 247.) Harvey Gideon, M. D. The Vanities of Philosophy and Physick. 3d edit. London, 1702. 167. 1st. Things in philosophy and medicine which we do not know, uncertain- are beyond all manner of comparison more than those things we do ty in medi- knOW. 2d. The greatest part of these things in medicine, which we pretend to know, is conjectural and uncertain. 3d. Many if not most of these things which we do peremptorily affirm to be this or that, to be caused by this or that, or to cause and effect this or that, are or may be proved to be false (pp. 7, 8 ; cf. Parey, 66 ; cf. W. Harvey, 124-126). The Nood 168. The antecedent causes of most diseases are the fluid parts of the Seas? ° f blood, the fluid animal lympha, the glandulous lympha, and the blood being vitiated (p. 139 ; cf. F. Harvey, p. 391). Theory of 169. How True. — The weakness of the stomach and its faintly per- disease. forming its office, is only occasioned by the debility of the stcmach- nerves, and their various branches, by being plastered up by too much fleam, gross and acid dregs, indigestible meals, or offensive drinks, or other matter admitted into the stomach, which, by lodging there too long, assume a corroding quality. . . . (cf. Sydenh., Prof.). THE DOCTRINE OF PURGATION. 37 Strength- eners " do 170. This supposed, I do believe, and have experimentally observed, that all those corroborations of the stomach, whose virtue is commonly asserted to consist in a gentle restrictive and warming quality — whereby not strength these slimy humors are more firmly cemented — so far from contributing the least strength to the stomach, being long continued, do carry danger with them (p. 227). 171. The only means I have hitherto found to strengthen the stom- ach are proper abstersive medicines, gently wiping off those clammy sub- stances from the tunic of the stomach, and the terminations of the nervous branches. . . . Do only keep your stomach clean, you will certainly pre- serve its strength, and prevent most diseases (p. 228 ; cf. Hipp. Aph. 8, sect. II. ; Parey, 87). Purgatives the only strength- ened. 172. Herodotus (in Euterpe) who was contemporary with Hippoc- rates, tells us that the Egyptians, to whom the first invention of physic is ascribed, used to take purging-physic, for three days together every fj^lf^ month, for no other purpose than to cleanse their stomachs, knowing they among the could be subject to no diseases but what the foulness of their stomachs Egyptians, might occasion, in regard their bodies were strong, and their air the most clear and temperate in the world, (p. 232). 173. It is not to be understood, where a heap and weight of crudities is accumulated, that gently absterging remedies can have power to disen- gage the stomach, any more than a wet mop can be supposed to rid a room ot a heap of rubbish, — in which case something more stimulating is re- quired, that may be used in all seasons of the year, be it sultry or freezing, without the inconvenience of confinement to diet or warmth of air, or without offence to the stomach, or putting the body into any disorder ; to which purposes the pill I here now describe, I have experimentally found to be effectively answering in most respects, (p. 228). Full pur' gation. Brandretk's Pills are superior to the following in all the elements of cleansing physic. 174. Take one ounce of the clearest shining aloes ; powder it in a mortar, covered over with a brown paper having a hole in the middle for a passage to the pestle. Observe to anoint thinly the bottom of the mortar and pestle with a little Florence oil, to keep it from sticking to the bottom. When it is reduced to a gross powder, by grinding it with the pestle you must bring it to a smooth fineness. Put the powder into a small glazed flat-bottomed earthen pan, that will contain about half a pint, pouring upon it about a quarter of a pint of water, wherein has been dissolved 2 drams of Spanish juice of Liquorish, which is done by slicing it very small and setting the water in a porringer over a gentleheat ; place this same earthen pan into one somewhat bigger, having sand in the bottom to the height of an inch, and afterwards filling it up to the brim. Set them over two piles of bricks of three or four bricks laid flat. The piles must stand at such a distance, that they may reach the edges of the bigger pan to support it. Then make a moderate fire of charcoal un- der it, to heat the same, to cause the superfluous moisture to be evaporated, The Har- vey nu. 38 THE DOCTRINE OF PURGATION. until the aloes is brought to the thickness of honey. Or you may, by drop- ping two or three drops on the back-side of a plate, to cool, make a trial whether it be reduced to the consistence of dough ; for if it be over- done, the mass being rendered brittle, will not only lose most of its virtue, but also its aptness of being framed into pills ; and if it be not evaporated enough, it will be sticky, and not apt to be brought into a mass. The lesser pan being taken off, when the evaporation is sufficient, before it is quite cold, you must with a spatula or slice take out the mass, and between your fingers, being a little anointed with Florence oil to pre- vent the sticking, roll it into a round ball, w T hich you may keep in a sheep's-bladder, being likewise thoroughly wetted over on the inside with the same oil, for many months, if necessary. A small piece of this mass being formed into 6, 7, 8, or 9 little pills of the bigness of a pepper-corn, is a dose sufficient to give two or three motions. The safeness of this medicine adds much to its character, since the taking of one pill, or two, more or less, imparts as little hazard, as the taking it very often, or in any kind of season, be it hot or cold, &c. . . . By the addition of the use of Liquorish, the aloe is designed to be obtused in its too purgative qualities, whereby it is apt to raise the piles, and become somewhat less precipitating, &c. The same correction may be obtained by taking a large handful of Bug- loss or Borrage-leaves, and stirring half a pint of warm water with them in the bruising, and clarified by subsidence in letting it stand in a cellar for a day or two, and pouring it off the feces or dregs in the bottom. This evaporated in the same manner, will produce a mass almost equal in goodness to the former, (pp. 223-75). The whole of what follows in Paragraph 175 is equally applicable to Brandreth's Pills, whose virtues far exceed all other cleansing medicines the world has yet seen. 175. I cannot but heretofore observe, that the use of these pills, though frequently taken, according to the time the stomach, by reason of its degree of weakness in the digestive faculty, may require, does in anywise Purgatives debilitate those that may properly use them ; but on the contrary, rath- er corroborate their stomach by assisting it, to throw off that heap of rub- bish and crude humors,, which those that eat and drink plentifully, and either live sedentary lives, as many that are educated to professions, or others that are not used to exercise or labor, are subject to engender, especially if naturally of a weak constitution or of an advanced age. (p. 235). (cf. Hipp. Aph. 8. Sect. I). . . For three or four days succeed- ing the use of these pills, a good Elixer projyrietatis taken morning and evening, in a proportionate dose, has, by my observation, ever had the good effect of preserving health and preventing disease, (p. 235.) (cf. Sydenh. 153). 176. As lesser purgatives do rather contribute strength, by their con- Puraatives sequence, so the greater, being properly used, do not carry that danger strengthen with them people commonly imagine, since I have known many that, weaken. for three months successively, have taken strong churlish purging pills, ev- ery morning, some few days only omitted. I may say some have swallowed a bottle of strong purgative pills in a few years, and lived in full health do not weak. en. THE DOCTRINE OF PURGATION . 39 to a remarkable old age, and not without a libertine mode of eating and drinking. Whence it is apparent, that the toughness of the nerves, upon which the strength and action of the bowels only depend, does suffer as little by the strongest purgatives, as an Indian cane by a thousand times bending, which notwithstanding will recover its former figure and full strength, (p. 236), (cf. p. 223). Our experience and the experience of all who have used Brandreth's Pills confirm these remarks on bleeding. 1 77. It were to be wished that bleeding could be admitted with the same safety, of which it may be justly said, that the lancet has, and does in proportion kill more men, than the sword ; and it is as commonly observed, that those physicians who do so generally practice it, know little else what to do. (p. 236.) ... It is a consequence an idiot infers, because a person having been bled eight or ten times in a great distemper, does recover his health, he owes the benefit of it to the bleedings, whereas it ought rather to be said, neither the distemper nor the bleeding could kill him. (p. 237). ON LAUDANUM. 178. I stand amazed at the folly of mankind that is so easily allured, by vain boasting and mendacious encomiums upon Laudanum Mquidum, plainly prepared or disguised ; to the frequent and constant use whereof a man being once debauched, under the pretence of ease, and quieting himself of a few gripes, fumes or vapors, he can no more leave it off for a fortnight, a week, or a day, than a laborer his bread and cheese, or a man throw off his coat and waistcoat in a hard winter, or a brandy- drinker forsake his spirits and return to small-beer. Using onesself to such plain or disguised opiates, after some months or a few years, is like making a contract with the, devil to live easy and well for a few years, upon condition he shall have his soul to torment afterwards. For certain it is, that the familiar use of opiates, after some months or- very few years, does wholly desist from being friendly, by suffering your trouble or distemper to return in a more horrible manner, or create a new one incomparably worse than the former, or strangles you with an apoplexy, or some other soporous distemper, which is most amply proved by those that make opium their sacred refuge in every fit of the gout, colic or stone, who seldom or never fail of a speedy exit, by some incurable dis- ease of the brain in very few years. And those that do advise such a lethiferous remedy for a common use to their patients, have a greater title to a halter labelled with an inscription of " Mathews' Pills," or " Pacific Drops," than those that murder a man on the highway, (pp. 237-38.) ... In short all strong narcotic medicines occasion weakness of the stomach-nerves, numbness, palsies, lethargies, loss of memory and dullness of understanding, diminish and deprave all the offices, actions or operations of the bowels, suppress the appetite, occasion a wildish countenence and paleness, and at last, upon long usage, usher in death (pp. 238-39.) (cf. Collins, 133). Bleeding. Laudanum — its evils. 40 THE DOCTRINE OF PURGATION. Purgation preserves and pre- vents. 179. To preserve health and prevent disease in valetudinary consti- tutions — for strong, vigorous bodies stand in no need of other preserva- tions or preventives, than moderation in their nonnaturals, the know- ledge and sense whereof nature has implanted in all other animals, as well as in man — no better ways and means can be used, than applying at certain intervals to those cleansers and abstersers before mentioned, (p. 239). LTemorr- Aoides. Harvey's Liniment. 180. For those subject to LTemorrhoides, the following Liniment Electuary is recommended. Four ounces best Cassia Fistularis, newly drawn and evaporated to a consistency — the manner of doing it you may read in a treatise called the " Family Physician and House Apothecary " — Rhubarb, powdered, while Mechoacan, grated and powdered, and clean Rhenish (not cream of) Tartar powdered, of each a quarter of an ounce, Sweet Fennelseeds, powdered, a dram and a half, Syrup of Mash- Mallows, as much as will suffice to make them into an electuary, (pp. 239-40). Take half an ounce or an ounce, dissolved in a quarter of a pint of thin gruel, barley-water, posset, or thin chicken-broth, according to directions given concerning the aloetics. (p. 240). Harvey\ Emetic. 181. In Headaches from over-eating or drinking, in Apoplexies, Palsies, Fevers, <&c, when purging medicines are too tedious in their transportation through so long a space, as the roundabout of the guts, a vomit that will throw up immediately through the gullet, by a short passage, the whole burden at once and operate kindly, without disturb- ing any of the other bowels, or raise a mud in the humors — antimonial vomits are excluded, as being too long before they operate, too churlish in disturbing all the bowels, and exciting a violent commotion in the humors. Ipecacuanha, that new fangle, brought by the French from the West Indies, is the root dried of a mere common juncas whereof, in the places where it grows, you may buy a cartload for a two-penny looking- glass, or a penny-worth of bugles, though at Paris they have the confi- dence of selling it at thirty or forty livres a pound, — which, notwith- standing, our asarum-root does far exceed in the operation — than which there can not be a more unacceptable drug to the taste in the world, &c. . . Take the purest White Vitriol, one and a half ounce, being pow- dered and ground very fine, put it into a glass bottle-bolt-head, pour upon one and a half pint of springwater, and half a pint of clean English Spirits, once rectified, which they call Double Spirits. Close your bolt- head with a cork and a wet bladder over it, tied with packthread. Place the bolt-head standing upright in a sandbath and let it digest, with a moderate warmth, twenty-four hours. But remember to shake the bolt-head very well, before you place it in the sand. After this digestion decant the liquor gently into a glass funnel, wherein is placed a coffin of cap-paper folded according to art, and so let it filtrate into a glass bottle. When it is almost quite passed through to the quantity of a spoonful, take out the funnel and throw away what is left. If you filtrate it a second time over, it will be the clearer and more depurated. This is a very easy, gentle and safe vomit, operates nimbly, and for cheapness ex- ceeds all others. It may be kept always ready upon every occasion, without making any bustle, and so lasting, that its virtue continues for THE DOCTRINE OF PURGATION. 41 many years ; and for the most part it will move a stool or two, whereby it carries off those crudities that are remaining in the stomach, or that are escaped into the guts. When you find occasion for using the vomit, you must pour out three, four or five spooufuls, according to your easi- ness or difficulty to vomit; but commonly three spoonfuls is enough. This must be mixed with double the proportion of warm small-beer or warm water, wherein a little Carduus has been boiled, or thin gruel ; then drink it off. If this do not operate in a quarter of an hour, take a spoonful or two more, or you may load yourself with carduus boiled in water until you vomit. This may be taken safely in the beginning of most distempers without any further consultation, (pp. 244-45). Gideon makes a grave mistake in respect to Ipecacuanha. It is one of the best and most safe roots ever applied to the use of man, as a vomit or purgative. It is one of the ingredi- ents of Brandreth's Pills. When a vomit is needed take four Pills, and drink hot boneset tea, and your stomach will surely discharge its contents. 182. About throwing off the febrile matters by sweat . . . Whether diaphoretics ought to be used before the declination theirSSand of a fever, at. which time only they appear to be healthful in assisting f mparedf s nature to throw off, for it must be owned by all experienced practition- ers that the causa febr His, be it vicious humors, heterogenous particles, or what other offensive they are pleased to allow, must be first sub- dued, or digested and separated, before it can be expelled by sweat ; and therefore, should you exhibit the largest doses of diaphoretics that nature can possibly bear, and second them by loading the patient with a num- ber of bedclothes, he will scarcely be brought to sweating ; and if, per- adventure, he should happen to be forced into a sweat at the augment or state of the fever, it must be a very great detriment. . . Supposing, fictitiously, that diaphoretics were proper, the tmcertainty of their oper- ation would often occasion a failure of the effect that is expected from them. Purgatives and vomitories seldom or never fail in their operation, if justly dosed, but sudorifics and diuretics very often, though adminis- tered in great quantities (p. 286 : cf. Sydenh., pp. '432-434). The advantage of Brandreth's Pills is that they require no care, and whether taken in large or small doses are sure to be of service. In full doses the beneficial effects in all se- vere diseases are at once evident. And when the system requires a vomit they usually act on the upper passages of the stomach. But the additional use of hot boneset tea, after a dose of four or six pills, is sure to act as an emetic and without any danger. Some gruel should be ready for the patient to take after the vomiting is over ; this is needed, when sleep will follow. ■ Harvey, James, M. D. Prcesagium Medicum. London, 1720. 183. In delirious distempers great hopes of recovery are had from all sorts of evacuations, chiefly because they check the velocity of the D p ff e in blood, diminishing its quantity, take off* its obstruction, and relax the nerves (p. 10). 184. Pains, especially if they be fixed a long time in any of the 42 THE DOCTRINE OF PURGATION. noble viscera, impair the strength of the patient, and obstruct the circu- imp^5±ies. n lation of the blood, concoction, and secretion of the humors. . . But in acute disease it is accounted a sign of recovery when pains invade the legs and feet, and happen upon a crisis or signs of it. 185. But though such pains speak an impetus of the blood and force The Crisis. f na ture to throw off the matter of the disease upon those more igno- ble parts, yet, when they go off without any apparent cause, as the ad- ministration of medicine, or natural evacuations, the humors may be justly suspected to have returned into the mass of blood* by which the case is rendered more dangerous than it was, and a happy event of a crisis in acute distempers, depending upon mere chance, or a favorable turn of nature, is always uncertain and never to be relied on (p. 30 ; cf. Sydenh. 432 : M. Harv. 391 ; G. Harv. 139 ; Collins, 130V How na- 186. In the ordinary and natural motion of fluids that serve 'either imYrS™ ^ or n " Q trition or excretion there are necessary passages or channels or otherwise through which they run easily, but in extraordinary cases, as all diseases them. 363 ° f are, nature finds out extraordinary ways by which it throws out the noxious matter, or at least puts it in a less dangerous place (p. 43 ; cf. Hippoc, Edinb. ed. Epidem., lib. ii., sect. 5 ; Parey, 69). 187. The- animal life depends upon many and different causes, and Life^maith an integrity of all the parts of the body, especially those that are prin- Disease. cipal, as the head, heart, arteries, and veins, and the liquors that run in them, namely, the blood, chyle, &c. But because our bodies cannot always continue in the same state, its parts, both solid and fluid, being worn, consumed, and dissipated by continued motion, there must be a continual supply of food for its reparation, as well as proper instruments and vessels, in which it may be prepared and made fit for that nurpose. 188. Nature, therefore, has contrived the stomach, intestines, and The stom- ^ an ^ s -> m which, by a wonderful mechanism, our food is pounded and ach. ' concocted, and its grosser parts separated from those that are more fine and subtle, the one for the preservation of life, and the other as the useless, to be thrown out by emunctories ordained for that end. But when those instruments are defective — which often happens — and the muscular force of the stomach is insufficient to grind the food and make a chyle of fine parts, that which we receive for nourishment and repara- tion of our todies not being duly prepared, is so far from being useful that it is rather hurtful to us. For this unconcocted food or crudity entering into the mass of blood, renders it viscious, tough, and of a clary substance, unfit for motion and circulation, and the cause of most dis- eases (cf. Collins, 137 ; Sanctorius, 109, 101*). . . 189. Whatever, therefore, is useless to the. body, or inconsistent with the blood, must be separated from it, that it may be preserved in a per- At these times an extra dose of Brandreth's Pills should be administered. THE DOCTRINE OF PURGATION. 43 feet state. Hence the endeavors of nature, and the contrivance of the intestines, cuticular glands, and other emunctories appropriated indeed tines, J anT to their peculiar excrements, but sometimes common to all or most of them SS.JSSf*" (p. 92 ; G. Harvey, 163). 190. Evacuations by sweat are to be attempted with the greatest caution, not. indiscriminately by all persons nor at all times. For if medicines to procure it be given when the blood is of a texture not open enough — which it cannot be near the beginning of most feverish dis- turbances — or when too heterogeneous substances abound in it, forced sweats often er dispose the blood to stagnate in the tender vessels of the brain and nerves than to separate its noxious particles at the designed secretory parts (p. 129 ; cf. Sydenh., pp. 432-434 ; Gid. Harv., p. 286) Forced Sweats — their danger. 191. Nature — by which I mean the effects of matter and motion, according to the laws and constitution of animal economy — is indeed the great physician and cure of disease ; so that now-a-days several dis- turbances are happily taken off by the slightest remedies, or by a mere abstinence from them. But, in acute diseases, the die is cast for life or death, and in this case nature is not to be altogether relied on ; neither must we, as the advocates for the doctrine of crisis, patiently wait for the issue of the conflict between nature and the disease, the peccant humors of some fevers being sometimes so stubborn, that art must in- terpose to promote their evacuation some other way. (pp. 207-8.) (Cf. p. 92 Sydenham, 163, 166.) Assist na- ture by pro- moting evac- uations. "Will ax, J., M. D., An Essay on the King^s Evil. London, 1735. 192. The diminution of the morbific matter, both in the primae vim and whole body, is to be effected by cleansing that canal, and evacuating the morbific matter out of it ; and by this means we cannot fail of lessening its quantity in every other part of the body. (p. 21.) (Cf. J. Hamilton, 218.) Diminish the morbid matter, and you lessen th e cause of disease. Purging with Brandreth's Pills infallibly lessens the quantity of impurities; and as they are harmless to the most tender age, or the weakest or most feeble, they can be used every or every other day, reducing the sum of unhealthy matters contained in the body, and thus taking an extinguisher or weight from the blood, whose vitality becomes thereby increased, and all the parts of the body be duly nourished into e renewed life and vigor. Pren'gle, Sie John, 1753. 3d Ed., 1761. M. D., on the Diseases of the Armies. London, 193. Early Sweats. — It has been usual to give the theriaca, or some Mout other hot medicine for this purpose ; but all such increase the fever, if sweats. they fail in bringing out the sweat (p. 131). ness 194. The bilious or remitting fever of the camp begins with chilli- » ;K lassitude, pains of the head and bones, and a disorder at the stom- and remit- tent fevers — ach. At night the fever runs high, the heat and thirst are great, the symptoms! 44 THE DOCTRINE OE PURGATION. Nature's effort at cure complete when evacu- ations are tongue is parched, the head aches violently, the patient gets no better and often becomes delirious, but generally in the morning a perfect sweat brings on a remission of all the symptoms ; in the evening the paroxysm returns. These periods go on daily, till the fever changes insensibly either into a continued, or into an intermitting form. Some- times loose stools carry of the fit and supply the sweats. Although the fever most frequently appears in the form of a quotidian, yet sometimes it is to be seen in a tertian shape I remember of no natural evacua- tions making a complete cure, unless when a violent discharge super- vened of the corrupted bile, or other humors which seemed to be the cause of the disease (pp. 165-67). (Cf. J. Harvey, 190.) Sweat. 195. When the sweat is abundant, the putrid parts of the blood are, either wholly or in some degree, expelled, after which the fever is either entirely cured, abated or brought to intermit, (p. 183,) (cf. 194.) Evaeua-' 196. On bilious fevers in Britain. — Instead of evacuating or correct- ions pre- i n ~ w h a t is amiss, we often neglect it, till it ends in obstructions of the vent many p 7. & J t • . • t *h forms of viscera, oo that hence may proceed nervous complaints without lever, or fevers of a nervous hind, instead of fluxes, intermitting or remitting thorough cor- fevers, the common consequences ruption of the humors, (p. 200.) of a more sudden and (Cf. Collins, 132, 135.) why the 197. We may observe that the fibres are more relaxed in the spring the 'fittest is than in the winter; hence that the body becoming more plethoric, the humors will then be apter to corrupt, upon any suppression of perspira- tion. And this may perhaps be forwarded by the effluvia arising from all putrid substances which, being locked up during the cold of winter, are then set at liberty by the greater heat of the sun. (p. 201.) sett son to purge. Dysentery. Excellent ob- servations concerning the use of purgatives. Opiates and astrin- gents are most danger- ous pallia- tives. 198. Dysentery. — We must at all times attend less to the dose than to the effects, which are never to be judged of by the frequency but by the largeness of the stools, and the relief the patient finds from tlie gripes and tenesmus after the operation. The motions are generally more fre- quent from the disease alone than from the purgation. As on the one hand, the physician must avoid all the rough and stimulating purges, so on the other hand, he is not to spare those of a lenient kind. (p. 240.) The necessity of continuing the physic is to be determined more by the obstinacy of the gripes and tenesmus, than by blood in the stools. Without such frequent evacuations, it is in vain to attempt a cure / as all opiates and astringents by themselves only palliate and lender the disease more fatal in the end. (p. 241.) (Cf. Sydenham, 162 ; Hippocr. 8. Gr. Harvey, 175, 176.) Opiates " fix the cause " of the disease. 199. As to opiates, it were better they were never used at all, than given before the first passages were thoroughly cleansed ; for though they afford some ease, yet by penning up the wind and corrupted humors, they fix the cause. This I presume to affirm from repeated experience. 1 am well assured, that the fluxes I have seen in the army, are never to be cured without evacuations, (p. 241-42.) (Cf. J. Harvey, 191.) THE DOCTRINE OF PURGATION. 45 200. In some cases the patient would seem likely to recover, but Hardened would relapse upon voiding hard scybala which, coming away in small f eC es the parcels for several days together, made a constant irritation. These, therefore, were to be speedily removed by a full dose of rhubarb with removed be manna, or by some other lenient physic, (pp. 245-46.) (Cf. Collins, lescence en 134, 139, 151.) sues. 201. Palsy. — Of purgatives the most active should be selected, and such as influence most energetically the principal secreting viscera ; as p a uy— calomel, colocynth, jalap, scammony, &c. In paraplegia, and even in q^Ions. pur " hemiplegia, the bowels are very torpid, and require repeated and full ^' e ^ e f a doses of those, and even of still more energetic cathartics, as croton-oil, gia. or elaterium, in some obstinate cases. In many cases recourse should also be had to purgative enemata. It is not merely necessary regularly to evacuate fecal matters by means of these, but to employ them so, as to derive from the cerebro-spinal axis any increased flow of blood to it, which may have occasioned, or prolonged the attack. Indeed, with these conjoined objects, they are advised by Halle, Dalberg, Brodie, and others, who have insisted on their use. (p. 242.) (Cf. J. Harvey, 183 ; J. Harvey, 171, 175, 179.) I have advertised the above sentiments for forty years, at an outlay of more than a mil- lion of dollars, and long before I saw the above able remarks. I now insert the following testimony, which applies well to Sir John's remarks. The following was published in 1863. It tells its own story: SANITARY COMMISSION. " What is it doing to economize the Life and Health of our Soldiers ?" " Is it using all the means Providence has placed within its reach, or is it stiff-necked, and determined that so great a remedy as BRANDRETH'S PILLS shall not be used to econ- omize the life and health of our Soldiers ?" Sagacious men believe that the administration of BRANDRETH'S PILLS, in its " Homes" and as " Special Relief " would more than quadruple the present value to the "Life and Health of our Soldiers." Let the following testimony from sixty returned volunteers be studied by members of the United States Sanitary Commission. If the statements be true, can they be doing their duty as Christian Men in not using the means Providence has placed within their reach ? FRIENDS OF SOLDIERS— READ ! JBrandreth's Pills protect from the arrows of disease, usually as fatal to soldiers as the bul- lets of the foe. Sing Sing, October 26, 1863. We, the undersigned, surviving members of Company F, Seventeenth N. Y. Volunteers, hereby certify that we have used Brandreth's Pills during our two years' service, and to them we attribute the fact that our constitutions are uninjured by the necessary hardships and privations of a soldier's life in the field. In costiveness, colds, chills, diarrhoea, dysen- tery, and typhoid fever, their prompt use cured us in a few days. Our health was often restored without having been entered on the sick list ; in fact, a single dose of four or five pills usually cured what, under the regular treatment, would have been a serious sickness. Others, who appeared to be sick in noway different to us, but who used the remedies pre- scribed by thr- regimental surgeon, either died or were sick for weeks in the hospital. When we left Sing Sing, in June, 1861, you gave us a supply of these Pills, and we feel sure, from our experience, that if every soldier was supplied with this medicine, the gen- eral health of the army would be greatly improved. For ourselves, it is our sole remedy, answering all our wants in the way of physic, and we have known and tested it from our childhood, and our parents before us. 46 THE DOCTRINE OF PURGATION. John Vickars, Captain ; J. J. Smith, 1st Lieutenant ; William See, 1st Sergeant ; G. H. Dearing, 2d Sergeant ; Dennis Shay, 3d Sergeant; Patrick Cullen, 4th Sergeant; Benj. F. Brown, 1st Corporal ; fm. Mathers, 2c? Corporal ; Noah W. Miller, 3d Corporal ; Theodore Crofut, Drummer ; Geo. B. Coe, Drummer. Francis J. Jenning, William W. Campbell, William J. Charlton, Albert Wesley, John W. Griffin, William Holmes, William W. Rider, Martin See, George Ackerly, Hiram Seagle, Alfred Wilkins, William Griffin, George Ayles, William J. P. Hewett, John L. Branden- burgh, Thomas A. Barlow, Henry Hannah, William Waldron, John Conover, Jacob Baker, Lewis B. Coy, Albert Lane, Ellis Jones, Wm. Van Wert, James B. Crofut, Roscoe K. Wat- son, Frederick Hunt, William Tuttle, Jotham Carpenter, Charles Wright, Sanford Olmstead, Fuller Carpenter, James Bentley, Robert W. Westcott, Jacob H. Dyckman, John M. Bodine, James N. Hines, Edward Waldron, Warren Wright, David Baker. T. B. Lane, 1st Lieut. 38th N. Y. Vols. ; M. C. Larle, 1st Sergt. Co. D, 17th N. Y. Vols. ; Wm. Knight, Co. I, 6th N. Y. Artillery ; Millard F. Lanning, Musician, 1st IS. Y. Vols. ; Wm. Kenney, Co. R. Berdan's Sharpshooters; Cassius Bishop, Co. E, 38th N. Y. Vols.; Elliot See, Co. B, 38th N. Y. Vols. ; Daniel Gillis, Sergt. Co. B, 3d N. Y. Vols. ; Caleb S. Frisbie, Co. B, 5th N. Y. Vols. State of New York, Westchester Co., ss. : I, William M. Skinner, a Notary Public, duly commissioned and sworn, residing in the Tillage of Sing Sing, County and State aforesaid, do hereby certify that the names of the sixty persons subscribed to the Certificate hereto annexed, dated October 26, 1863, concern- the value and efficacy of Brandreth's Pills, beginning with Capt. John Vickars and ending with Caleb S. Frisbie, were signed in my presence, and that I, at their request, witnessed their signatures to said Certificate. I further certify that I am well acquainted with all who signed said Certificate, and know them, individually, to be men of truth and veracity. In witness whereof, I have hereunto subscribed my name and affixed my official seal, this eleventh day of January, one thousand eight hundred and sixty-four. WM. M. SKINNER, Kotary Public. State op New York, County of Westchester, ss. : I, Hiram P. Rowell, Clerk of the County aforesaid, and also Clerk of the Courts in and for said County, do hereby certify that Wm. M. Skinner, Esq., whose name is subscribed to the Certificate of the Proof or acknowledgment of the annexed Instrument, and indorsed thereon, was, on the day of the date of the said Certificate, a Notary Public, in and for said County, residing in the said County, appointed and sworn, and duly authorized to take the same according to the laws of the said State. And further, that I am well acquainted with the handwriting of the said Notary Public, and verily believe that the signature to the said Certificate is genuine. In-testimony whereof, I have hereunto set my hand, and affixed the seal of the said Courts and County, the 12th day of January, 1864. HIRAM P. ROWELL, Clerk. Cullen, William, M. D., First principles of medicine , London, 1777. Fevers. 202. Fevers. — Sweating employed to prevent intermittent fevers, has ofuT l dun- often changed them into continued fever, which is always dangerous. gerous. ^ ^^ Urging the sweat, may produce hurtful determination to some of the internal parts, and may be attended with very great danger, (p. 166. f-) Robertson, Robert, M. D., An essay on fevers, <&c. &c. JBooinson, 1790. 203. Idiopathic fever. — Whenever men complain of being seized with chilliness, or alternate chills and heats, headaches, sickness at stom- THE DOCTRINE OF PURGATION. 47 ach, universal pains, or as the sick express themselves "pains all over them ; or pains in all their bones, or joints, especially in their loins and nf^'erai back, with less or more debility ;" and if their countenance is at the same charact ^- time obviously diseased, whatever the other symptoms accompanying these are, I can, from experience, assure the reader, that a most virulent infection is present (p. 59). 204. Whatever has a tendency to debilitate the system., may either fe ^"is % be a remote or aproximate cause of fever, according to the constitution of that *f>iiv- the patients. A sufficient reason may be assigned for many people being tem. seized with fever at the same time ; which is, their being exposed to the same debilitating powers of heat, cold, draught, or wet, or sudden changes of these (p. 88). Miller, Edward, M. D., Inquiry concerning cutaneous perspiration and the operation and uses of sudorific remedies. New York, 1793. Medical Keposltory, 1T98, vol. II; See Med. <& Phys. Joum. 1799, Vol. I. 205. That sudarifics can not be usefully employed as a general remedy jr everftare in fevers, is apparent from the fatal course pursued bv many of these not cured by diseases, notwithstanding the most copious, universal, and continued sweats, spontaneously taking place. The memorable sweating sickness, which first appeared in England, towards the close of the fifteenth cen- tury, and was one of the most fatal epidemics on medical record, affords ample proof of this position (Journ. p. 288). 206. On the whole it may be concluded, that much of the use of Errors n . n i • i* • j_ i a j • ji j_ i? about siceat- sudorifics has arisen irom mistaken doctrines, concerning the nature oi ing. perspiration and of fever, particularly from the erroneous opinions, that the matter of perspiration is excrementitious ; that its occasional obstruc- tion is noxious ; that it ought as much as possible to be eliminated from the system ; and that it is only carried off, in considerable quantity, when discoverable by sight or touch (ibid). 207. It may be also concluded, that sudorific remedies, especially those of the more powerful kind, are, in general, highly unsafe, and cal- U n" a fTand culated to augment the violence of inflammatory and malignant fevers ; injurious. and, that though they may succeed in some cases of less violence, or by a favorable concurrence of circumstances, yet they are so constantly liable to produce mischief, and exasperate the disease, that the abuse, on the whole, must be pronounced greatly to overbalance the use (ibid). Selle, H., M. D., Professor in the University of Berlin ; new con- tributims to physical and medical knowledge, Berlin, 1798. See Med. & Puts. Journ. 1799, Vol. I. 208. Puerperal fever. — This disease originates in an accumulation of corrupted humors in the abdomen, which humors have either been al- ready separated in the form of milk, or intended by nature to be so. "X'"- "'"'"- Puerperal fever, from accumula- tion of mor- bid matter 48 THE DOCTRINE OF PURGATION. The causes of this accumulation may be various, but are principally an epidemic miasma, passions, sudden cold, and inflammation (Part III. p. 92). In corroboration of Professor Selle's theory," Dr. Hermbsteadt has proved by chemical experiments, that the fluid matter found in the cavi- ties of the abdomen was virtually milk. It deserves, however, to be remarked, that the fat of the omentum and the mesentery, being dissol- ved by the febrile heat, may combine with the extravasated lymph, so as to produce a fluid of a more or less viscid consistence, and resembling milk in its external characters (Journ. p. 387). Bache, "William, M. D.. On a successful case of Asthma, Birming- ham, 1799. See Med. & Phys. Jouen. 1 < 99, Vol. II. Asthma. Acidity of the secretion 209. I became convinced that an acid pervaded the whole of the circulating system, and I presumed that it existed in a morbid degree, the cause, either as to quantity or strength, and was the exciting cause of the spasmodic affections observable in the lungs, and other membranous parts, to which it might occasionally be applied, probably sometimes in a gase- ous state, and at others in a more dense and concentrated one, and per- haps variously combined. The indications of cure suggested to my mind were to restrain its influence, and my attention was principally directed to the state of the stomach, the bowels, the expectorations, the kid- neys and the skin (p. 141). Coneadi, D. G. C, M. D., Resident Physician ai Northeim, Ger- many. Practical remarks on the most prevailing species of cramp in the stomach. See Med. & Phys. Jouen.. 1799, _Vol. I. 210. The affection is not violent in the beginning, but a pressure, and Cramp in stricture, and griping, rather than an acute pain, is felt in the region of *its S Sse^" the stomach. The patient has an oppressive sensation, as if something, neglect of no t unlike a nail, were fixed behind the stomach : if the attack increases KeoawSdi- in violence, he complains of stitches in the breast and towards the back, causl by the and endeavors to procure relief by shifting his posture. The principal paroxysms are observed to take place generally in the afternoon, in con- sequence of bodily exercise immediately after dinner, the use of acid food and drink — and particularly after giving way to gusts of passion, such as terror, anger, grief, and anxiety. This affection is often contracted by persons subject to passionate emo- tions, on their neglecting to take an emetic occasionally • it is not, in general, attended with acidity, but rather and most frequently is pro- duced by a bilious acrimony ; and it at length almost invariably degene- rates into a nervous habit (Jour. p. 49). THE DOCTRINE OF PURGATION. 49 Dexmax, Thomas, 31. D., On a case of dropsy in the ovarium. See Med. & Phys. Jouebt. 1799, Vol. II 211. After giving the history of a female patient, who had suffered Dropsy of from violent pains in her bowels, tension of the abdomen, and much i-omcon™?- soreness on pressure, accompanied with vomiting, constipation, and fre- P ation - qnent fainting, symptoms which were chiefly relieved by clysters and gentle purgatives, hemorrhages from the uterus, violent pain in the low- est part of the back, and, on pressure upon the sacrum or hip, in the neighboring parts, Dr. Denman says : There was great tension and pain above the " ossa pubis," and the whole hypogastric region was full and hard. She discovered a large hard tumor, extending to the right side of the navel, the increase of which was so rapid that in the course of a few days it occupied the whole abdomen. She was then freed from pain in all the parts contained in the pelvis, could lie on either side, and walk much better. She frequently after this had slight shivering fits, and a sense of coldness down her back, followed by restlessness and feverish heat, especially in her hands and feet in the evening, which went off with a free perspiration toward morning. Her pulse was at all times very quick. TJwugh one or more stools had oeen regularly procured evenj day, an immense quantity of hardened fences, of a large volume, were now discharged for three or four successive days, by which her size was much lessened. She had been treated for sciatica. When I first Regular visited her, the whole abdomen was distended by a circumscribed tumor evacuation springing from the right side, near the groin, thence extending across, 2J3T 1 * accu- and high up in the abdomen, and I thought I conld feel an obscure fine- Nation tuation in it. 1 could also feel an angle of the tumor in the posterior part of the pelvis, by which the " os uteri " was projected so high and so far forwards as to be almost beyond my reach, as is the case in the retroversion of the uterus. She was not pregnant. I did not therefore hesitate in the opinion that it was a dropsy of the ovarium ; and by sup- posing this, early in the disease, to have dropped low down in the pelvis, and afterwards to have risen according to its increase, all the symptoms which had occurred could be satisfactorily explained. I directed only a strong purging draught. On the following day, she informed me that after suffering considerable pain in the bowels, she had four or five cox-)ious motions, and that after every motion she was sensible of her size decreasing. The motions were unusually offensive, and, before they came away, the desire to expel them was unnaturally urgent and pain- ful. On examining them, I found that they almost wholly consisted of a gelatinous fluid, with many streaks of blood, and with little or no mix- an [°Z e ?>{^i- ture of faeces. Instead of feeling weakened by the evacuation, the f£iff* r0a ~ patient felt herself very much relieved. The medicine was continued for two days more, producing the same number of motions ; the swelling of the abdomen had gone, the os uteri had descended into its proper posi- tion, and no tumor whatever remained in the cavity of the pelvis. I concluded that, in consequence of preceding inflammation, an adhesion had taken place between the cyst 01 the tumor and some part of the in- testine, probably the rectum, the adhering portion of the bowels had given way, and, by that opening, the contents of the tumor had been evacuated. She was perfectly restored to health (pp. .20, 22). Let the reader examine the Van Wart case at the end of these quotati 50 THE DOCTRINE OF PURGATION. Henderson, Stewart, Surg. Practical remarks on the diseases which occurred on hoard of II. 31. Ship Astrea, on the Jamaica station, (&c. See Med. & Phts. Jotjrn. 1799, Vol. I. 212. Remittent or Marsh-fever. — This fever, the legitimate offspring /eo/r^from of all hot climates, especially where marshes abound, is the autumnal marsh efflu- g^ sease f m ost parts of Europe, only appearing in a milder degree. It "there is h as "b een described under various names — bilious, yellow, Jamaica, Sene- vEK,"butun- gal, and in Bengal, pucka — but multiplying distinctions which do not mld>fica- mt exist only serves to perplex and mislead, for it will be found to ~be the tions. same individual disease, under different modifications, depending on constitution season of the year, and local situation. The cause of this fever, in all its varieties, is marsh effluvia. We find that in some places at the Cape of Good Hope, where no such cause exists, this fever is un- known. We likewise find that strangers are more liable to be affected by this noxious effluvia, and have the disease in a more formidable de- gree, than the natives of the country, whose constitutions acquire a cer- tain power of resisting it from habitual exposure : at the same time, its effects on them are obvious, by shortening the duration of life. I do not think that the original disease produced by this miasma is infectious, but that it may alter its type and become highly contagious from con- current causes ; as from too many diseased bodies being crowded to- gether, without paying sufficient attention to ventilation and cleanliness, (p. 141.) This noxious exhalation enters the system either by the lungs, the skin, or stomach ; but the manner in which it produces those symp- toms of disease which characterize the fever does not appear to be well understood. We can only perceive its general effects on the system; and that it may lurk for a certain time in the habit before morbid move- ments take place (ibid). iJSff+S 213. In men not below nor above the common standard of health, bilious secre- although there were marks of irritation and inflammatory diathesis, it gatves P cZ- seemed not sufficient to justify blood-letting; which I considered would ry it away. ] iave diminished the vital power. Antimonial emetics were not used, having always observed that they increased the irritability of the stom- ach, which is the most troublesome symptom attending this form of the fever. I, therefore, thought it more advisable to employ mercurial pur- gatives, which had a very good effect in carrying off the bilious sordes collected in the first passages / emetics were sometimes given ; James' powder with camphor, to promote perspiration, and effect a complete re- mission (p. 143). -S!m«2! ^^' Dy sen t er y- This disease is not limited or peculiar to any cli- and wet ob- mate, nor is there any natural cause known to produce it : if it were oc- peKplration 6 casioned by any particular quality in the air, the natives, as well as sea- fng d tbTflow inen an d soldiers, would be attacked with it, but we find this is not the of fluids to the intes case. For, when the dysentery was raffing anions; the British troops at tines. the Cape of Good Hope, not one of the inhabitants were seized with it, nor is it a disease known among them. Whenever it becomes epidemic among the inhabitants of any country, it may always be traced to infec- tion -introduced ; it being the constant attendant on camps, and the The cure scourge of an army more destructive than any other enemy. I, there- ^l on el b y G Th'e lore, consider it an artificial disease. Cold and dampness, when the mouth and "b dy is not sufficiently covered, by obstructing perspiration, and increas- anus. THE DOCTRINE OF PURGATION. 51 ing the determination of the fluids to the intestines, sometimes combined with febrile miasma, produce the whole phenomena of dysentery. In the treatment of this disease, I generally began with an emetic of ipecac- uanha ; bleeding was never employed, unless the patient was of a strong plethoric habit ; purges of salts or rhubarb with calomel were frequently repeated ; emollient injections and fomentations were of use, when the pains were wandering, and large blisters in every instance removed the pain where it was fixed (p. 237). 215. Diarrhoea generally arose from relaxation brought on by eating J ,iorr ^a unripe fruits, and committing other irregularities. It was easily re- cu? e U s! sai moved by lenient purgatives (ibid). 216. Hepatic complaints were brought on by violent exercise in the sun, joined to the abuse of spirits. Symptoms: pain in the side, some Liver Com- difficulty in respiration, pulse full and frequent, sometimes pain in the p cSfby shoulder, and about the region of the liver, which, when pressed, was at- ™ acuation > tended with a catching and troublesome cough. Bleeding, calomel purges, a blister to the side, sometimes mercury in small doses, were alternately resorted to, until health was perfectly restored (ibid). 217. Spasmodic affections were mostly confined to the abdominal Cramp of viscera, and brought on by lying on the deck in the night. The patients the sirTng h ' complained of excruciating pain and stricture, commonly about the um- ^med the bilical region, nausea, and sometimes vomiting. If fomentations did not cure the pain, a large blister was applied ; calomel with jalap taken in- ternally and clysters given, until stools were procured, which removed the complaint (p. 23S). Huggast, A., M. D., On the Croup, Plymouth, 1799. See Med. & Phts. Jottrn. 1800 Vol. III. 218. In a manuscript copy of the late Dr. Gregorys Lectured, I found Croup. a caution respecting bleeding in children, even with leeches, as apt to bring on fits. Now, if the learned professor's admonition was the re- sult of experience — and a case which I myself once saw, leaves me little ,#JJJ room to doubt it — what have we not to dread from taking blood away vr ous to in a large stream from infants? (p. 57.) . . . With regard to blood-let- altogether an ting in general, as a means of cure in inflammation, synocha, <&c, let me 2S^25& ask, whence the necessity of diminishing the quantity of blood in such Ynnumma in diseases? or what proof have we that the quantity of blood being increas- t'on as wen ed, — allowing, however, that it actually is so, — is the increase of it the & * intyphua - cause of evil f By taking blood away we undoubtedly lessen the quan- tity of it, but do vie really diminish the bulk of the circulating fluids, find contract the size of the bloodvessels? This is but doubtful; for, it is more than probable that from the loss of blood the secretions are dimin- i a ?E?2So- ished, and absorption of moisture from the atmosphere increased, (p. JS^^gJJJ* 58.) . . From the prevalence of bleeding in inflammatory diseases, some ojteh sunt have, either from prejudice in its favor, or from want of proper discrim- ™s fatal' ination, used it copiously in genuine typhus, accompanied, as it some- times is, with thoracic pains, dec. The result of such practice will be obvious (p. 59). 52 THE DOCTRINE OF PURGATION. Upon the whole I think that I am sufficiently warranted, from experi- ence, to draw the following conclusions respecting the use of venesection in the practice of medicine, viz. : That it is never necessary, seldom SAFE, OFTEN HURTFUL, AND SOMETIMES FATAL (p. 60). Miller, E., M. D., On the effects of Abstinence on the approach of Acute Diseases. See Medical & Physical Journ. London, 1799, Vol. I. Moderate habits. of ease. 219. If the art of preserving health and prolonging life chiefly con- ufe prevent s j s t in Si frugal and sparing use of stimuli, and adapting them with cau- l p^ Q erve tion and skill to the fluctuating circumstances of the vital principle, we health. gnall surely And still stronger motives to apply this doctrine at the ap- proach and in the treatment of diseases, when noxious powers of such preternatural violence invade the body, baffle every remedy, and stimu- late it to death. The regulations of this vital principle, here denomina- ted excitability, the preservation of it when present, and its restoration when deficient, the restraint of the excitement within the bounds of moderation, the prohibition of all wasteful and undermining excesses, will probably hereafter, at some more enlightened era of medicine, form a system of rules for the management of health and the prevention of disease, for the enjoyment of sense and the refinement of intellect, which, instead of the present feverish dream of human life, will present a con- summation of improvement and happiness which we now ascribe to su- perior beings (Journ. p. 45). 220. If I do not mistake, it has been proved, that abstinence will be of Ab a S ii n6 aff- often a complete, generally a useful, and almost always a safe means Spt8 th^ad- of obviating the approach of acute diseases. And, in a word, if it were vance of dis- possible to offer to mankind a maxim of universal application to the treatment of incipient fevers, in all their variations and circumstances, I should be inclined to hazard the following aphorism : When symptoms denoting the approach of acute diseases are discovered, abstain, for a proper length of time, from all aliment (ibid). In the place of abstinence from all aliment, purgation is the method which experience has proved safe and effectual, both as a preventive and cure for acute or chronic or incipient affections. Brandreth's Pills and weak oat-meal gruel for a few days will do more good than abstaining from food, or half starving for weeks. And purging with these pills never weak- ens the vital forces, which cannot be said of the other plan. I think that the starving method is next in evil effects to bleeding. One takes the life out, the other prevents its renewal, i It is effete matters, impure humors, floating in the blood or settling upon some organ, that :\ cause all general or local disease. Purging takes these out, and, being done, the health is •aS" often restored at once. If you have poisonous matters about you, get rid of them as soon as possible. This is the sensible way. Starving does not get rid of them, it only reduces your life, your power to feel, that is all ; places you nearer the grave. While every dose of Brandreth's Pills takes the death principle away, and places a greater distance between the sick and the grave. Nooth, J., M. D., Superintendent- General of the hospitals in British America. Letter on the treatment of dysenteries and other autumnal dis- eases, to Dr. Mitchell, Quebec y Jan. 24, 1799. See Medical Expository, Vol. LL.p. 437, quoted in Med. & Phys. Journ. 1799, Vol. LL 221. Having seen, in the course of mj practice, a great number of THE DOCTRINE OF PURGATION. 53 dysenteric cases, and having experienced the inefficacy, in general, of the usual mode of practice, I was induced to try the effects of the several M 5 y * e !S2! purgatives now in use, with the view of ascertaining how far any one JJ^"^ was preferable to the others, in the treatment of dysenteric /patients, purgation Experience soon taught me that the neutralized tartarit of potass was the cure ' the most salutary in its effects ; and of course I have always, since that discovery, had recourse to it in dysenteries and other autumnal diseases, with the greatest success, both in children and adults (Journ. p. 181). Seremshtee, J., 31. D., Cases of Fractured Skull, Wisbeach, 1799. See Med. & Phts. Journ. 1800, Vol. III. Fractured skull. 222. A boy four years of age had fallen from a height of ten feet upon a brick pavement. He vomited soon after he was taken up, and complained of a bruise on his head, but seemed otherwise quite well. There was a very evident depression of the right temporal bone, and fracture* of the right parietal bone. Merely a spirituous embrocation and a gentle laxative was given. On the next day the depression was Purganves, considerably less. ]\ T o one bad symptom had come on, but as the physic a they°°S>e- a had not operated, I ordered an enema, took six ounces of blood from the l'^ e] ° s n ^ arm, and ordered a strictly antiphlogistic regimen for three weeks ; in f 0Te ' the a few days the depressed bone had risen to its natural situation, and in fomsatS- a few weeks every trace of it had disappeared (Journ. p. 28). iSteSS" Another boy, nine years of age, fell from a cart-horse upon a stone pavement and the wheel of the cart passed over his head. I found the whole left side of his head very much flattened, the temporal and great part of the parietal bone being very much depressed ; besides, there was a fracture of both bones, which crossed the squamose suture. The boy was comatose, but roused for a moment when spoken to. His breath- ing was laborious, pupils dilated, pulse of natural velocity, but intermit- ting. He had vomited several times, had bled much from the nose, and likewise from the right ear. Trepanning was proposed, but the parents objecting, the antiphlogistic plan was all that was left us. He, accord- ingly, was bled and an enema administered. The clyster had not oper- ated, neither a purgative given on the second day ; the depression kept on lessening, but the boy remained comatose ; another aperient was given, and on the third day a purgative enema produced a copious stool ; the symptoms abated, and disappeared after a repetition of the enema, the bowels now being opened (Journ. pp. 28-29). Sutton, T., M. D., Considerations Regarding Pulmonary Consumption. London, 1799. See Med. and Phys. Journ., 1801, vol VI. 223. The first symptoms of disease were in the bowels, and by degrees the disorder became a confirmed phthisis pulmonalis. Hence I was led thn pro- to suspect the emaciation and debility to be induced by some disease of sympathy the abdominal viscera^ which, however, I could not account for in any fl 3£ ft ?t£T other way except by supposing the mesenteric glands to be obstructed, & *2S? , fr Si as the symptoms led to no suspicions of any other cause or causes that diteaee could be considered as adequate to produce such effects. I have seen °/ e !y* me * en ' several cases where affections of the bowels preceded the pulmonic symp- Cor>fmm>p- 54 THE DOCTRINE OF PURGATION. toms. It is a very common thing for patients, in protracted dysenteries, to have pulmonic affections before death/ and it frequently happens that diseases of the abdominal viscera are, in their latter stages, accompanied by pulmonary consumption. By writers on this disease the " tabes rne- senterica" is mentioned as sometimes accompanying it. . . Hence, it ap- pears to me that phthisis pulmonalis is caused by a disease in the mesen- teric glands, and that the tubercles in the lungs, and some other of its symptoms, are excited by sympathy (Journ., pp. 89, 90). cie. eme lcs 224. For, an increased action may be produced by exciting an in- creased motion in the contiguous parts, which may be effected by the use of emetics and purgatives, which promote a greater motion in the intes- tinal canal, and, from their contiguity, in all probability, communicate some of it to the mesenteric glands (Journ., p. 90). White, W., Surg., Remarks on Hydrocephalus Internus. Bath, 1799. See Med. and Fhys. Journ., 1800, vol. III. nydroce- 225. Case of hydrocephalus given. He took small doses of calomel ?ii a/ dro l sil combined with digitalis. As purgatives produced no effect in stimula- by ting the intestines, clysters were resorted to for that purpose. After a fortnight, evident symptoms of amendment took place, and he soon re- caused an abun- dance of fluid cannot remove the cause of bS covere d (Journ., p. 113). Dr. Whytt, to whom we are greatly indebted sorbed. for a very minute description of the symptoms usually attendant on the disease, observes : '' The immediate cause of every kind of dropsy is the same, viz., such a state of the parts as makes the exhalent arteries throw out a greater quantity of fluids than the absorbents can take up." Which Purgatives state, from what he afterwards mentions, he evidently considered as con- sisting in debility (p. 117). Purging is necessary, not only on account of lessening the determination to the head, but particularly as the symp- toms, which proceed merely from fullness in the stomach and bowels, have been frequently soon removed by evacuating the bowels (p. 119). Carson, William, M. D., Letter on the Applicability of Mercurial Prep- arations in Children^ Diseases. Birmingham, 1800. See Med. and Fhys. Journ., 1800, vol. IV. 226. For several years I have been dissatisfied with the general and indiscriminate use of calomel in the diseases of children y I am not more certain of any one fact that pertains to medicine than that I have seen many children who have fallen a sacrifice to the improper application of Calomel this medicine. Calomel, when mixed with susrar, forms a medicine never snie ' ^^ * in minute agreeable to the palate of the child ; its exhibition is easy to the mother a° poison? 53 or nurse, and it may with safety be given as a purge, when a purge is indicated. When given as a purge, its action is confined to the first pas- sages ; but when the dose is frequently repeated, either for the purpose of obviating habitual costiveness, or with any other intention, it is absorbed by the lymphatics, and enters the system, by the action of which it is de- composed, . . . and that state of the system produced which is called mercurial fever. Although mercury does not appear to have so power- ful an action on the salivary glands of children as it has on adults, yet I apprehend its general effects upon the system are greater. The mer- curial fever in adults soon runs into indirect debility. Infantile diseases. Hydro- cephalus is rather i?i- duced than THE DOCTRINE OF PURGATION. 55 227. The injurious consequences likely to flow to children from the high degree of excitation and extreme succeeding debility produced by a mercurial course I wish to impress upon your readers. Mercury has been erroneously held forth as a specific in hydrocephalus, and is often cured or pre- given as a preventive of that fatal malady. Hydrocephalus appears to merturi/. 7 be the result of debility succeeding too high an action of the vessels of the brain. If so, can any medicine more powerfully produce hydro- cephalus than mercurial calces? (Journ., p. 411.) Chapman, John, Sur., Cases of Injuries of the Head, with Observations. Ampthill, 1800. See Med. and Phys. Journ., 1800, vol. III. 228. The fondness for trepanning, so much inculcated by Mr. Pott, and so very anxiously supported by Mr. Benjamin Bell, has justly met with two very able antagonists in Mr. John Bell and Mr. Abernethy (p. 31, Journ). Every man, previous to applying the trepan, ought to ask himself for what he is going to trepan ? " To think that a fractured skull is a chief cause, or even an absolute sign of danger, is a very erro- i Q injuries neous notion ; it is not the damage done to the skull, but the iniurv to °f. the ¥ a ?> J ^ * *J *' criiru.r or ic2,l the brain, that is the cause of danger; and the fracture of the skull is •operation but a faint, uncertain mark of the harm done to the brain " (J. BelVs pQnld* p £ Discourses on Wounds of the Mead, p. 137). Again : " There is still S( '^£™to y but one motive for applying the trephine, viz., to relieve the brain from purge, sua. • n /m • i -t a a\ tnereby de- compression' (ibid., p. 144). urmine ^the Now, I am speaking of affections of the brain, I cannot forbear ob- serving that I have long been dissatisfied with the Edinburgh treatment of concussions of the brain, viz., with cordials, wine, and stimulants. My ideas on this subject are so exactly consonant to what has been said by Mr. Abernethy (Surgical Essays,- vol. Ill, pp. 59, 60), that I shall therefore refer my readers to his Essays (Journ., pp. 33, 34). iT. B. Abernethy employs purgatives, bleeding, and antiphlogistic regimen. Fowle, William, M. D., A Practical Treatise on the Different. Fevers of the West Indies, and their Diagnostic Symptoms. london, 1800. See Med. and Phys. Journ., 1800, vol. IV. 229. Very early after my arrival in the country I observed that per- sons attacked with fevers, in almost any situation, very generally became Yeiioxofe yellow. This soon led me to conceive it merely a concomitant symptom and by no means such as could be sufficiently characteristic of any one blood from the head. ver a denom- ination without par- icular mean- ease a com- monfever. fever to give it a particular denomination ; it also led me to discover the ing-the dfe cause of the variety of symptoms attributed by different authors to the yellow fever, and to account for successful methods of cure which were often diametrically opposite to each other. The longer 1 remained in the country the more I was convinced of the danger attendant on giving a name to one disease from a symptom common to so many (Journ., p. 355). Dr. Fowle divides the fevers of the West Indies according to their appearances into intermittents, remittents, ardent fever, and the malig- nant or jail fever. purges. 56 THE DOCTRINE OF PURGATION. Geoghegajs", Edward, Surg., On Strangulated Hernia. Dublin, 1800. See Med. and Phys. Journ., 1800, vol. IV. 230. Let us for a moment consider the state of the parts : A portion of the intestine lies without an aperture, through which it is too large to ttdhernia' pass ; the question then arises, what occasions its bulk ? Surely, the «*^of*the natlire °f ^ ne part, the touch, and all the circumstances of the case, case indicat- clearly evince it to he flatus, and sometimes together with excrement and tion™ acua ~ an inflamed intestine, whose functions are so far deranged that it cannot act upon its natural contents, so as to move them in their ordinary course. . . Nothing can be more obvious than that every effort should be made to lessen the bulk of the hernia, and none to push it through the ring ; it will pass in of itself after the air has been extracted (Journ., p. 318). Purging with Brandreth's Pills is what is needed. Magennis, J., M. D., On Epilepsy. Birmingham, 1800. See Med. and Phys. Journ., 1800, vol. IV. Th^ l tl P r S por 231. I observed in these patients, and in most others who have long acii th and°S- labored under this untoward disease, a dullness of apprehension, a par- testines re- ticular stare and vacuum of countenance, a dilated pupil, and an inabil- qmres pow- ^ ^ ^ e -j r i s ^ con tract on the admission of light, accompanied with stupor and a general irritability of the muscular liber. This torpor ex- tends to the stomach and intestinal canal, as those people subject to the disorder usually require the most active cathartics and emetics to excite the primas vise into action (Journ., p. 419). Reeve, R., Surg., On a Successful Case of Hydrocephalus. See Med. and Phys. Journ., 1800, vol. Ill 232. Hydrocephalus internas. — The author's own child, at the age of eight months, in December, 1798, could stand alone, and had every ap- pearance of a healthy, forward child. His temper was unusually placid, case of and his spirits invariably good. Towards the end of the month he be- cephaiis' ' came extremely costive, and though medicine for a time relieved him, ^ece^uy^oi ne was frequently and violently seized with pain in the abdomen, which full, contin- was generally mitigated by a clyster. . . He ceased to grow, except the fui ' purga- head, which, towards the end of January, 1799, was perceptibly increased ll< intestinai e in size, and his costive n ess was become so obstinate as scarcely to yield canal. ^o the most active purgatives. It was this singular state of the alimen- tary canal, which had existed upwards of six weeks, that first led me to suspect some material derangement in the state of the brain. On the 12th of February he was convulsed in the night, took antimon tartaris in small doses, with little, or no effect, and on the following day castor oil, which was repeated a second time, before any motion was produced ; the abdomen was very hard, and of an extraordinary size ; the stools of a clay color, and of such an adhesive nature that they could not easily be separated from his napkins ; his urine high-colored, secreted in large quantities, and gave a yellow tinge to his linen. James' powders were given, but fever and delirium set in, with a voracious appetite, and all the symptoms of hydrocephalus. Calomel given as purgative in the be- THE DOCTRINE OF PURGATION. 57 ginning of March was charged with mercurial friction, but all hope of his recovery was lost ; he cried much, had much pain in his bowels, which were distended by flatus to an alarming degree, and the only relief that could be obtained was by clysters. A blister that was applied to the anterior fontanelle was kept open and discharged copiously, and in April he commenced slowly to recover. . . Now his bowels "are quite restored, and he has left off all medicine (Journ., pp. 61-64). Brandretk's Pills could have saved all this pain and suffering. * Uxwixs, David, Surg., On Febrifuge Medicines. See Med. and Phys. Joubn., 1800, vol. IV. 233. A derangement of the nervous system, occasioning general de~ Fever, bility, is an invariable attendant on fevers of every denomination, and to but H onb vS this single cause, debility, are all the symptoms which occur under differ- VER >" °>ie , y «/? 9 «yX # cause but ent circumstances of constitution, situation, habit, &c, of the patients different to be referred ; for, notwithstanding the minute division and extensive t font Jesta ~ classification which have been adopted by nosological and systematic ■ writers on febrile affections, there appears to be no specific or abstract difference in the diseases themselves, the variety of appearance which they assume being totally dependent upon the state of the constitution receiv- ing the affection. Thus, the same causes operating upon a person of a sanguine temperament and plethoric habit will occasion the disease which has obtained the appellation of inflammatory fever, with symptoms of vascular excitement, which, on a patient of a contrary description, will be productive of a typhus or nervous fever (p. 54). 234. When the quickness, smallness, and irregularity of arterial pul- thf^nSt- sation, distressing pains in the head, extreme oppression of the mind, } y attending " oJ: -I'li'i j? svmptoin re- and other symptoms are present, denoting the highest state ot nervous moved, debility, a dose of powdered antimony, in such quantity as to create a sympathy, 6 * slight nausea of the stomach, will often reduce the pulse to its proper standard, and, by inducing a regularity and due proportion between the eiomach action and reaction of the system, will effectually arrest the further pro- gress of the disease. Woodward, W., Surg., On Infantile Diseases. See Med. & Phys. Joubn. 1800, Vol. IV. 235. There is a liquor in the bowels of infants and many other ani- mals, when they are born, which is necessary to be carried off; the medi- infantile cine which nature has provided for that purpose is the mother's first *'fii*tSd* milk; this, indeed, answers every purpose, and effectually; but we e 'X eh l^ lk think some drugs forced down the child's throat will do much better — medicine. the composition of which varies, according to the fancy of the good woman who presides at the birth. . . . We see that notwithstanding the many moving calls of natural instinct in the child to suck the mother's \ yet the usual practice is to deny that indulgence till the third day after the birth ; by that time, the suppression of the natural evacuations by stimula- ting the 58 THE DOCTRINE OF PURGATION, of the milk usually brings on a fever, the consequence of which is often rai Ivacua- fatal to the mother ', or puts it out of her power to suckle the child at *and pre cures S tnat time. The sudden swelling of the breasts, which commonly hap- miifc-fever. pens about the third day, is another bad consequence of this delay. When the breasts become thus suddenly and greatly distended, a child is not only utterly unable to suck, but, by its cries and struggling, fa- tigues and heats both itself and the mother ; this is another cause which prevents nursing. . . . The gentlemen of the Lying-in-Hospital in Lon- don ordered the children to be put to the mother's breast as soon as they showed a desire for it, which was generally within ten or twelve hours after birth ; this rendered the usual dose of physic unnecessary ; the milk-fever was prevented ; the milk flowed gradually and easily into the breasts, which before were apparently empty, and things went on in the natural way. If a mother is determined not to nurse her own infant, she should, for her own sake, suckle it at least three or four weeks, and then wean it by degrees from her own breast. In this way the more immediate danger arising from repelling the milk is prevented (pp. 43-44). The vital 236. There is, in truth, a greater luxuriancy of life and health in en diiidren n infancy than in any other period of life. Infants, we acknowledge, are J^aduits^ 11 more delicately sensible to injury than those in advanced life ; but to Bleeding compensate this, their fibres and vessels are more capable of distension, riout to J lt, their whole system is more flexible, their fluids are less acrid, and less Sl? ation disposed to putrescence ; they bear all evacuations more easily, except that of blood / and, which is an important circumstance in their favor, they never suffer from the terrors of a distracted imagination. . . . Children recover from diseases under such circumstances as are never survived by adults ; if they waste more quickly under sickness, their re- covery is quick in proportion and more complete than in older people ; in short, a physician ought never to despair of a child's life while it con- tinues to breathe (p. 43). Moore, James, Surg., A case of Synocha, London, 1801. See Med. & Phys. Jotjen., 1801, Vol V. is a common 237. Synocha, or pure inflammatory fever, is a disease so rare in this offigh 0X dl- country that many experienced practitioners have doubted its existence. £tion° f and Here follows a case : — The treatment employed during the Ave days he longer dura- was under my charge consisted simply of two purgatives, and a draught of one-fourth of a grain of tartar emetic, and two drachms of the acetate Purgation, ammonia water, which was exhibited regularly every six hours. ( Journ. ' p.<233.) Synocha certainly very much resembles the symptomatic fever at- tendant upon phlegmon ; the common ephemera is undoubtedly of the same species, and the synocha seems to be precisely the same malady, in a more violent degree, and running on for a longer period, (ibid. p. 234.) THE DOCTRINE OF PURGATION. 59 Peicaeds, J., Surg.) On Hydrocephalus, Brentford, 1801. See Med. & Phys. Jotjkn., 1S01, Vol. V 238. Case of a boy, 8 years of age, strong purgatives given : This produced very brisk evacuations at each time of repeating it (every other Hydro- cephalus. morning) ; after each repetition, however, he appeared better and more SS& pur- gation re- stores health system. lively. The plan was continued for several weeks, during which every symptom of the disease gradually subsided, until his pristine state of "and vigor, health was completely renewed. (Journ. p. 344.) weakens"the Therefore it appears to me, that drastic purgatives, frequently ad- ministered, have a much fairer chance of success by increasing very pow- erfully the action of the absorbents, while they do not produce that debility of the system which is the consequence of mercury (ibid. p. 345). Savaeesi, A^toeio, M. D., Physician to the French Army in Egypt, on the Cure and Prevention of the Endemic Ophthalmia of that Coun- try. Transl. by G. Blane, M. D., London, 1801. -See Med. and Puts. Joeex., 1801, vol. VI. 239. Dr. Savaresi first divides this complaint into the sthenic and asthenic ; the one depending on an excess, the other on a defect, of tone, ophthalmia The former effects the bulb of the eye ; the latter sometimes the " sar- Heties, 66 sus," sometimes the "tunica conjunctiva." ffistfemfty In the beginning I purge in all the three species, without distinction, u P° n wh j^ with an ounce of magnesia vitrolata, otherwise called Epsom salts. The sthenic ophthalmia requires very close and strict attention, inasmuch as the cure depends on the efficiency of the first remedies. After this, top- ical remedies, as emollient colly ria, are employed, and low diet. As preventive, he recommends avoiding exposure to the sun with the head uncovered, and to the night dew, abstaining from salted food, avoid- ing cold after being heated, and attention to the intestinal evacuations (Journ., pp. 357-359). Taln-sh, "W., Surg., Account of Some Cases of the Plague, which occur- red on board of a British ship-ofwar on the coast of Syria. See Med. and Phys. Jouen, 1801, vol. V. 240. Plague. — Mr. Tainsh employed, after removing all clothes from the patients, and washing them with soap over the whole body, Plng powerful repeated evacuations of the bowels by emetics and laxative clys- £*** ters. The sick used to discharge "an enormous quantity of bile, viscid S /"'•» sordes, and tough phlegm," and the stools gave the sick evidently much ^ relief; when a bitter taste and nausea continued, emetics were repeated, which cleared the stomach of a large quantity of disagreeable matter, which gave great ease. After thus removing the cause of the disease, a strengthening treatment was pursued, and the buboes treated by poul- tices (Journ., pp. 539-541). Powerful and repeat- tii >ii removes GO THE DOCTRINE OE PURGATION. Vage, T., M. D., Criticisms on the Treatment of Yenereal Diseases. London, 1801. See Med. and Phys. Journ., 1802, vol. VIII. Opium re- laxes the ■nervous sys- tem, and di- minishes chyh'fica- tion. 211. Opiates are usually and properly given, in the intention of mitigating severe pains in the venereal disease ; but, notwithstanding their utility, a free and frequent use of them always induces a relaxation of the system, and debilitates the chylific organs, which are primary things to guard against in mercurial courses. Although both these effects of opium appear to spring from one common source, by producing a ner- vous, sedative stupefaction, yet some observation in practice inclined me to suppose that ease may be procured without any concomitant debility (Journ., p. 8). Mercury breaks down, the blood. Axiom. 242. Mercury, however, with all its anti- venereal properties, is natu- rally inimical to the nervous system, and exerts its injurious effects, in some degree or other, in. the most judicious use of it. When it is ex- hibited too copiously, and suddenly, it is apt to produce violent effects, as great swelling of the head and tongue, apoplexy, &c, because it breaks down the blood before any outlet is prepared for its evacuation. When its use is gradual, these effects will be moderate, but they will accumu- late in time to considerable injuries of the same nature. The most vio- lent and mildest effects of remedies are produced upon the same princi- ple, and the former are frequently the only index to explain the latter, which would otherwise be too minute for observation (Journ., p. 9). The two causes of mercurial Parallel between lead, and mercury. 24:3. The infirmities which arise from the use of mercury appear to originate from two principal sources: one is its dissolution of tJie blood, by which a redundance of serum is forced into the interstices of the cel- lular substance of the muscular, vascular, and nervous systems ; in con- sequence of which the gluten, which gives strength and stability to the solids, becomes relaxed, and the different functions of the animal economy so debilitated as to be incapable to be properly actuated by the nervous influence, while the nervous system itself may remain in a tolerable condition. The other source of infirmity, on the contrary, is when the nervous system has been left impaired and cannot invigorate these f mic- tions, which may not have suffered any considerable detriment. For, it is experimentally ascertained, that if the nerves of any part are injured, either at their origin or in their course, that part will become propor- tionally inert in its office (Journ., p. 9). The effects of mercury are somewhat similar to those of lead ; both have power to produce paralytic affections ; both, in a weaker degree, abate inflammations and mitigate pain ; and the imbecility of both re- main after they have been quite expelled from the habit (Journ., p. 10). 211. In considering the dyspeptic symptoms of this or any other dis- Dyspeptic ease, it appears to be generally conceived that the cause of them is the fSsynwar weakness of the stomach alone. This opinion has probably led to some thy between important mistakes in practice ; for this organ is not less subject to be liiVandthe affected by causes, and the condition of parts remote from itself, than it wiwu sys- ^ ca p a ])i e f affecting the whole system. Thus an indolence of the in- Purgatives remove the symptoms nndtn rigor- ate intesti- nal- action, promoting the elabora- tion of good THE DOCTRINE OF PURGATION. 61 testines, or a diminution of their action in any part, from the pylorus to the rectum, will produce nausea and indigestion, even when the stomach itself may be in a good condition; and hence it is that often a cathartic will remove these symptoms by giving an additional irritation to the obstructed and enervated parts. In general, however, here the stomach participates of the mercurial debility, and corroborating aperients be- come requisite. In regard to the inertness of the intestinal action, it b i /e ,^ the may be further noted that it frequently proceeds from a deficiency of the Hon. bile, which a cathartic stimulus is likely to prevent, for undoubtedly this secretion depends much upon the proper action of the duodenum. But the chief utility of the bile results from its chylific property, which ap- pears to consist, in a great measure, of mixing the oily and aqueous parts of the aliment, and assimilating them into a uniform liquid. This great importance of the hepatic secretion, whenever it appears de- fective, demands immediate assistance by active purgative medicine (p. 172). Auld, Isaac, M. D., of Edisto, S. C, Case of Acute Bilious Fever read before the Medical Society of South Carolina, 1802. See Med. akd Phys. Jouun., 1808, Vol. XIX 215. Case. — A young man who had spent a month in the country, on the morning after his return complained of slight chilliness and a i us U /evYr dnllpai?i at the pit of his stomach, which soon after terminated in exces- iow^ S fever) sive vomiting, violent fever, and intense pain in his head. These symp- symptoms:' toms continued without abatement until about three o'clock in the preceding afternoon, when they suffered considerable remission. At this time I f°^ few*' saw him. I found that so general a suffusion of bile through the System fUi.^/S: o M «/. ,© J t parns in the had taken place as to resemble a person laboring under jaundice, with bead and the exception of the eyes, which were slightly inflamed. His bowels vomiting, were obstinately bound, having been in a state of constipation for the ^ ellowness ' two or three previous days. His tongue was moist, the edges inflamed, the top white, excepting the middle, down which ran a yellow streak (Journ., p. 106). Cure : Powerful 216. Treatment. — As his pulse, which was slow and irregular, seemed now to forbid the lancet, though there was still some pain in the head, and costiveness and debility appeared to be the principal inconveniences under which he labored, I contented myself with leaving for him two ^ urg H™ n -i -i-i'i •ii» • -i • t removing smart purges ot calomel and ."jalap, with directions to take one immedi- the cause, ately, and the other in four hours, if the first did not procure eight or mutation of ten copious stools. On visiting him again, about nine o'clock, I found anf'fam that lie had taken both his purges with the happiest effect ; they were then f ace *> operating briskly, and had already produced several large evacuations of hard, dark, and very foetid faces. The pain had entirely left his head, his pulse had become regular and more full, a gentle moisture had over- Natural spread his skin ; his stomach had recovered much of its usual tone, and ^SjjLmor- this was accompanied with desire for food. On the next morning he had *>id ejacua- left his bed with an assurance that he felt himself quite free from indis- ab«oiuteiy position. The discharges from his bowels were still kept up, but had ^w?SttS entirely lost their foctor, and appeared to consist chiefly of healthy-look- pu J{j£tawnt 62 THE DOCTRINE OF PURGATION. ing bile. His skin had become much clearer, as had his urine, which before was of a deep bilious hue. I suggested the propriety of his taking gentle purgatives for a day or two longer ' out this advice, from the comfortable state of his feelings, he declined, and I, of course, left him. On the third morning after this Awful con- I was sen ^ ^ or "k° attend in all possible haste, as the patient was supposed sequences of to be dying. I found him speechless, his jaws were fixed, as also were purgat.ln. his eyes, which were nearly closed ; he had no pulse at the wrists, his feet, legs, and knees were perfectly cold, and his stools, which were black and very offensive, came from him involuntarily ; his breathing had been very laborious, but now it appeared to be free from anxiety. I was informed that the day I left him the pain in his head and the fever had returned with its former violence, and had continued without any dimi- nution until this morning, when it terminated in the comatose state de- scribed. The cure was hereafter effected by nitric acid and blisters, which restored the vitality of the patient, and by a continued applica- tion of that acid and strong purgatives, which carried off large masses of very foetid, hardened faeces (Journ., pp. 106-109). Eruptive disease of the head. Physiology. Treatment by cleanli- ness, with spare diet and purga- tion. Badger, John, Surg., On a singidar kind of Eruptive Disease. See Med. and Phys. Journ., 1802, Vol. VIII. 217. The first opportunity of witnessing this disease was at Putney, in the month of July, 1801 ; it seemed to be confined to children only of a certain age, having never seen a child affected with it before seven nor after fifteen years, though equally exposed, as it was evidently infec- tious to them. It commences with a slight fever, which continues three or four days ; it then increases ; nausea, and sometimes vomiting, attend (in one or two instances I have observed the patients to complain of vio- lent sickness after they were put to bed), with pain in the head and loins ; it is then succeeded by an eruption containing a well-matured pus ; the pustules are large and very thick about the head, resembling those of small-pox ; and in every case I have seen they have been con- fined to the head, particularly to the scalp. The bowels during the pro- gress of the disease were unusually constipated, and, in one or two in- stances, not only the body but the face likewise was much swelled. The first two or three cases I had not an opportunity of seeing till after the eruption had taken place to a great extent, covering almost the whole of the scalp. 218. The hair was shaved off as close as possible, tar ointment and a mild purgative applied ; but this treatment produced no amendments, the ointment rather increasing the number of pustules. I ordered, there- fore, the head to be kept clean with warm soap and water, the patient to use a spare diet, and the bowels kept open with an active purgative once or twice a week, or " pro re nata," and a few drops of antimonial wine given once in four or six hours, till the feverish symptoms had sub- sided. This plan was pursued for several clays without having at all mitigated the complaint, though it seemed, under every circumstance, to be the best mode of treatment that could be adopted. Accordingly it was continued for a few days longer, at which period the pulse became regular, the pain in the head and loins was removed, the pustules began THE DOCTRINE OF PURGATION. 63 to dry off, and in about a week the complaint entirely ceased (Journ., pp. 106, 107). Cueeie, "William, M. D., Observations on the Treatment of the Malig- nant Yellow Fewer which prevailed partially in the City and Liber- ties of Philadelphia in the summer and autumn of 1802. Phila- delphia, 1802. See Med. and Phts. Journ., 1803, Vol. IX. 219. Mercury was generally employed both internally and externally for the purpose of exciting salivation as speedily as possible, both at the _ Yeiiowfe- hospital and in private practice ; but, if I can trust my observations, seldom with, success, excepting where employed at the very commence- ment of the disease, and so conducted as to affect the mouth before the dangerous symptoms of the second stage had time to make their appear- ance. "When employed in the second stage of the disease, at which time the ■^ t fa t ** predominant symptoms are generally disordered stomach, restlessness, op- aisoiJfly pression, and deep sighing, and a countenance that denotes great misery, l^'Tecond it constantly aggravated the disease, and hurried on the fatal symptoms stage - of black vomiting. In this stage of the disease, when the recited symptoms predomina- ted, the frequent exhibition of mild laxatives in small doses, particularly Eochelle salts, soda phosphorata, soluble tartar, castor oil, senna, and aSfJSJJSSJJ cream of tartar, and when these could not be obtained, laxatives and drinlT ' ter Mercury seldom use- re- in ore the worst symp' toms. clysters, were the most successful remedies, especially when aided by blisters to the stomach, wrists and ankles, at the same time. A solution of carbonate of soda in water, which is much more pal- atable than the vegetable alkali, followed immediately by a tablespoon- ful of diluted lemon juice, or cream of tartar in water, had also some- times the effect of allaying the distressing propensity to puke. But these, as well as every other means that I have seen tried, too frequently failed of affording relief (pp. 98, 99 Journ.) [If mild laxatives were frequently apt to allay the worst symptoms, it is reasonable to expect complete success from active purges J] 250. In this state of the stomach the internal use of mercury, either alone or when combined with opium, always increased the distressing andTpium propensity to puke ; and, when it failed to operate by stool, it aggravated every symptom of the disease (Journ., p. 100). aggravate the symp- 251. In cases where the disease began with strong action of tlie arte- ries, severe pain in the head, bach and limbs, with little or no sickness at Active stomach, bleeding, purging with active medicines, and the strict observ- ^JjJjJJid ance of every part of the antiphlogistic regimen, generally occasioned with de P le a partial solution of the fever on the third, and a complete solution on the fifth, day from the attack (Journ., p. 101). tion cures. 64 THE DOCTRINE OF PURGATION. Heberde^, "William, M. D., Commentaries on the History and Cure of Diseases. London, 1802. 252. A diarrhoea arises from a variety of causes, most of which are void of all danger, and are easily removed. It is often Drought on by that marrhaa, I ower which is exerted in every part of the body of freeing itself from Nature'sWy anything painful and oppressive. Not only the mischief from the nox- ious qualities and improper quantities of what has been taken, and im- mediately offends the stomach, are carried off by means of a diarrhoea, but likewise many disorders of remote parts or of the whole body are, by the self correcting powers of an animal body, determined to the bowels, and thence discharged by diarrhoea. It is frequently useful to cooperate with nature in promoting this evacuation. (Chap. XX VII.) (Cf. Coll. 136, 143 ; Pringle, 200.) of cure. Co-operate with nature. ters 253. Dysentery. — The usual methods of treating this malady, with Dysentery which I was acquainted, of ten failed of procuring ease, and of preventing by remov T its ending fatally. It appeared that in a dysentery some hurtful humors ufic n mat- hud been deposited in the intestines, which threw them into such disor- derly agitation as to hinder the expulsion of what had offended them Purgatives were administered with the double good effect, both of afford- ing present ease, and afterwards of entirely removing, by effectual evac- uations, the cause of the disorder. (Chap. XXXI.) 254. Icterus (Jaundice). — Good effects may with reason be expected from purging medicines, by their increasing the natural motions of the jaimdice. intestines and soliciting a greater flow of bile as well as of all the other Avoid mer- humors which are poured into them. Mercurial purges have been pre- iSe'otherand fer^ed by some practitioners, but there appears 7iothing in the known safe purga- powers of mercury peadiarly useful in dislodging a biliary concretion, and the preference should be given to those purges wich act with the most ease, and may be continued with the greatest safety. (Chap. L.) (Cf. 254.) Colic. 255. Ileus (Colic). — The peculiar and distinguishing symptom which characterizes the inflammatory colic in the very beginning is cos- Purgatives tiveness, which it is always extremely difficult, and too often impossible, eure - to conquer. As soon as a discharge downwards can be . procured in a e a ua copi 0113 manner, the patient perceives a quick abatement of all his mis- uons must ery, and is often restored to health. But it is not from one or two small u\d™nd n ~co- evacuations that we can entertain much hope of the distemper beginning P m!ert°cov- *° E^ ve wa y- This has happened on the first or second day, from the ery- excrement which was lodged in or near the rectum, far below the seat of mischief. And later in the distemper, a very small portion of that liquid matter with which the bowels are deluged has seemed to have been forced downwards, while the disease was every hour growing worse. Such inefficacious evacutions have been observed more than once or twice in the course of this illness, without saving the patient's life Warm baths, fomentations, &c, are serviceable helps in dis- posing the bowels to yield to the power of cathartic medicines, by the fail- ure or sticcess of ivhich the life or death of the patient must at last be determined. (Chap. LI.) (Cf. Hipp. 12, 38, 41, 45, 57. Parep, 85, 87.) THE DOCTRINE OF PURGATION. 65 * Tyeo. — On Apoplexy. See Med. & Phts. Jo urn., 1802. Vol. YIII. {Controversy between Mr. Crowfoot and Dr. Lang slow on the question whether emetics or bleeding be applicable in apoplexy f 256. In addition to the testimonies adduced by Pyrrho (one of the writers participating in the controversy), I shall only add, that Baglivi, Apopievv. who divides apoplexy into sanguineous and pituitous, observes : f™\^'{!^ 1 - " Arcanum in sanguineis est phlebotomia. In pituitosis contra emeti- eia by pur- cum, aid pur gains vehimens. Sunt qui apoplexia (pituistosa scilicet) lib- wmuing\ erati sunt, hausto singulis mensibus vomitivo ex infuso prsedicto (inrus. p^mmT croc, metal cum vino)." a . . . .Aretaeus does not recommend emetics, but observes : " if the sacred purge should excite vomiting, it is not to be restrained, because it evacuates pituita, the cause of the disease, and rouses the patient by imparting a degree of vigor." Bairhaave, among the general evacuants to be used in this disease, mentions vomits and strong purges*, though he adds, there is something uncertain in their action. Vanswieten, also, in his Commentaries upon this Aphorism (1026), observes, that emetics ought not to be condemned in this dis- ease, and are often useful, because they evacuate pituita ; though he afterwards thinks purgatives less objectionable. (Journ., pp. 6&-69.) Baedsley, Samuel Aegent, M. D., Physician to the Manchester In- firmary, Dispensary and Lunatic Hospital. An Account of the Epidemic Catarrhal Fever or Influenza in Manchester, dec. See Med. akd Phys. Jouen., 1803, Vol. IX. 257. Emetics were found highly beneficial on the first attack ; in- deed, the frequent occurrence of spontaneous nausea and sickness pointed infiuenm, out their use. They scarcely ever failed to relieve the urgent symptoms ff of pain in the head and stricture of the breast. To obviate costiveness and at the same time to cleanse the primse vise, moderate doses of calo- symptoms mel, with rhubarb and antimonial powders combined, were exhibited with excellent effects. . . Opiates were seldom employed during the first stage them - of the disorder, as they had a tendency to exasperate the complaints of the head and chest, and increase restlessness and feverish heat (Journ., pp. 525, 526). Kexglake, TtosERT, M. D., On Influenza. Bee Med. and Phys. Jouen., 1803, Vol. IX. 258. My experience authorizes me to say that the benefit of abstract- ing heat, by atmospheric exposure, light bed-clothes, copious dilution with cold water, and avoiding stimulants of every description, will pShgSia almost certainly rescue the patient from danger, and leave nothing mor< for medicine to do than gently to move the bowels in case of costiveness, w^^ and, at most, to aid the refrigerant plan by the milder sudorifics (Journ p. 520). Evacuation atomacJi and bowels reli"ve the Opium in- creast the o n 1 1/ medicine re- a In the sanguineous, phlebotomy is the arcanum. In the pituitous, on the contrary, emetics or strong jmrgativex. Some people remain free from apoplexy by taking every month a draught of aforesaid vomitive infusions. (Inf. croc, metal, c. vino.) 66 THE DOCTRINE OF PURGATION. The re/rig- erativaplan contended for. 259. It is an erroneous notion that occasional refrigeration and ab- stinence in disease weaken more than a heating and stimulating treat- ment. The native energy of healthy power is certainly reduced both by the abstraction and increase of excitement, but by its due diminution vital force may be said to be nursed, while undue stimulant agency tends to dissipate it even to extinction ; hence a moderate negation of excite- ment debilitates much less directly than its excessive employ does indi- rectly (Journ., pp. 519, 520; Eemark). Our method for the cure of Influenza is to purge very freely with Bran dreth's Pills, six pills every twelve hours the first day. Keeping in bed as much as possible ; oatmeal gruel or light broth ; if the head is very painful, feet in hot water with mustard or wood ashes; if throat is sore, gargle with weak alum-water ; outward applications are the Allcock Plas- ter, mustard poultice, red pepper, or any stimulating liniment. When the skin of the throat becomes a little red, the outward applications dispensed with. Should a choking sensation be felt, or the breathing- be difficult, four Brandreth's Pills must be taken every four hours, or even oftener, until relief is experienced. Yellow fe- ver. Its com- mencement, symptoms and general course. Anomalies and sudden changes. Thefavor- able symp- toms. O'Berne, P., Surg., Observations on the Fevers in Hot Climates. Lon- don, 1803. See Med. and Phys. Journ., 1803, Vol. X. 260. The more severe in symptoms, and dangerous in effect, any dis- ease is, the more necessary the investigation of, and researches after, methods of cure must be fully impressive on every mind ; it is scarcely necessary to add that perhaps none comes more strongly under this de- scription than that generally termed yellow fever / none, therefore, more interesting claims our attention. In the commencement, generally nausea, pain in the head, loins and hams, succeed ; dry surface, increased pulse, but not to be depended on, varying from 80 to 140, chills, anxiety, sighing, prostration of strength ; vomiting soon takes place, and not unfrequently is the first indication of the disease. The vessels of the tunica conjunctiva become turgid, and a yellow tinge of that membrane takes place, frequently extending over the body. Notwithstanding this circumstance gives rise to the name usually given this complaint, it is by no means a constant attendant, and in many totally wanting. Watchfulness and desire to sleep, without being able to effect it ; whilst in others constant dozing, pain and sensa- tion of heat in the stomach, great thirst ; vomited matter gradually changes from yellow to dark green, and at length perfect black. Clammy skin, sometimes petechia, but unfrequent ; stupor or violent delirium succeed ; paroxysms of vomiting become more rapid, and many expire in one of those paroxysms too shocking to describe, whilst others placidly resign exhausted nature (Journ., pp. 36, 37). 261. No disease perhaps exhibits a greater variety of symptoms, and often less to be depended on, than this ; sometimes it goes on with every favorable appearance, suddenly changes to the worst, and patients, ap- parently almost in a state of convalescence, expire in an hour or two. This is a melancholy fact (Journ., p. 37). 262. The symptoms that we may call favorable are, settled state of the stomach, lessened headache, eyes lively, formation of pustules over the surface, or that eruption known in tropical climes by the name of prickly heat, I have ever remarked as almost a certain indication of re- covery ; bilious flux, copious and high-colored urine, free perspiration, and sound sleep (ibid.) The dan- gerous THE DOCTRINE OE PURGATION. 67 263. The dangerous, and, I am sorry to add, most common, symp- toms, are severe headache, frequent vomiting, heat increasing to a burn- ing sensation, extending down the trachea and alimentary canal ; matter symptoms. vomited and faeces becoming dark, frequent sighing, dull or glassy eye, pale and little mine, dark fur on the tongue, muscular and nervous de- bility, intermittent pulse, clammy feet, cold sweats, stupor or violent delirium, singultus, coma (ibid.) 264. That dark matter vomited, termed hlach vomit, it may be neces- sary to remark, although laid down by most authorities as a certain fatal sign, is by no means so, as I have seen many recover after it; it is also The Mack said " that a diarrhoea almost precludes any hopes of recovery." If by X d7arrhTa diarrhoea is understood a simple {or bilious) flux, I have ever observed it / u °tli AT sy m L . a decided fortunate event; certainly a flux of putrid dark fasces is ex- toms - tremely bad, and yet even that I have many times seen prove salutary (ibid.) 26'5. Out first and principal attention should be directed to clearing the first passages, and to keep them free during the disease being of the greatest importance. M en£ Emetics are by many laid entirely aside, on the principle of increas- ing the already irritable state of the stomach. That a great deal of ig the caution and discrimination in their use is extremely necessary must be purgation allowed ; but I am decidedly of opinion much benefit is to be obtained by them. Where nausea or slight vomiting occurs, ipecacuanha is the best ; but if the vomiting be more severe, an infusion of chamomile will caution, answer every intention. Cathartics. — Calomel, combined with powder of jalap, is perhaps one of the best ; the irritating quality of the neutral salts seldom makes them advisable. 266. Blood-letting has been advised by some of the most respectable Bleeding authorities ; I shall therefore only observe that I never saw it used with ItlVyThwt- advantage ; on the contrary, I always thought it of disservice (Journ., fuI - p. 38). The TREAT- AT ALL EVENTS ; emetics ad- missible with In the sec- ond stage, 267. Our next intentions must be directed towards lessening the irritable state of the stomach, supporting the strength, and resisting that tendency to putrescency that exists in this disorder. pSS •pi- ate* applica- ble only con- ditionally. Opium was also inadmissible in all its forms, unless toward the latter state, when fever did not contraindicate its prescription for the cough, which was often the last troublesome symptom, and seemingly occa- sioned by the action of a small portion of the pulmonary vessels (Journ. p. 314.) Power, George, Surg., Assistant Surgeon to the Twenty-third Regiment of Foot, Royal Welsh Fusileers. Attempt to investigate the cause of the Egyptian Ophthalmia, dec. See Med. and Phys. Journ., 1803, vol. IX 274. The next local cause of Ophthalmia in Egypt is the custom of sleeping at night in the open air, imbibing with every inspiration, and absorbing at every pore, the putrid virus contained in the descending dews. . . . Thus in a system peculiarly debilitated, and unable to resist all its powers combined, it produces that highly putrid fever called plague. In a patient less relaxed, as the habit of the body determines the disease either to the surface of the skin or to the intestines, an erup- tive fever or dysentery is produced ; and when the putrid virus is but partially applied, to the eyes for instance, or to the month, or even on the surface of the body, ophthalmia, ulcerated fauces, or ichorous blotches on the skin ensue (Journ., p. 78). Ophthal- mia. Influence of n i uTi t-dew in hot cli- mates pro- ducing differ- ent diseases, according to predisposi- tion. 275. As the author freqently refers to a treatise of the French Sur- geon Bruant, it will be of interest to know what this writer says on the cure : " This disease is frequently cured by the simple operation of na- ture, and without any assistance from art ; and indeed we may affirm with truth that nothing so much opposes the cure as too great a profusion of remedies, especially topical. Some patients have been relieved by an eruption coming on at the temples ; others, and the greater number, by a slight diarrhoea ; and hence, to act conformably to the views of nature, I have encouraged a discharge from the bowels during the whole dura- tion of the disease, by employing tamarinds or other laxative titans (Desgenettes Histoire Medicale de l'armee de l'Orient. — Journ. p. 580). Nature in- dicates the cure by evacuation. Wadley, T. "W., Surg., on the Prevailing Epidemic Influenza. Stow on the Wold 1803. See Med. and Phys. Journ., 1803, vol. IX. 276. First, the exhibition of an emetic was always promised, which seldom failed of evacuating the stomach of a dark colored, greenish, and most offensive fluid. Aperients were always rejected when given before Hon of fetid dark- color- ed excre- ments 70 THE DOCTRINE OF PURGATION. irlmuwms an eme ^ c j an ^ an enema was found of no service. The pain in the (iccumuia-^ 'head was constantly lessened and frequently removed by the vomit, and a freer expectoration sometimes relieved the cough. When costiveness was a very urgent symptom an active purgative was given, which never cure by failed of being followed by stools of a peculiar footor and black color, ?he cause. and this state of the alvine discharge often accompanied the disease throughout (Journ. p. 516). Medicus, Practical Observations on the Treatment of the Scarlet Fever and Bore Throat. Bee Med. and Phys. Journ., 1804, vol. XII. 277. It is well known that many pass very safely through the scarlet ve™ r wLn fever, in its mild state, with little or no medical assistance. But when quires' Tut m tna ^ s * a te medicines are administered, I fear the cure is, by the inge- nttie medical nious theoretical practitioner, ascribed too often to their effects and not to the mildness of the disease, especially if some fashionable medicine has been prescribed. Hence remedies undeservedly creep into prac- tice, and, I fear, in serious cases frequently supersede the use of those which have long stood the test of sound practical experience. The cause I pretend not to account for the source or origin of the scarlet fever ~mntui d \xi an ^ sore throat, but am well satisfied that the " fomes morbi " of the the bowel*— disease, however generated, lurk in the bowels. Under this conviction "moved 6 by 6 I enjoin them to be well cleared, in whatever stage or however violent the purgatives. di sease ma y oe ^ w hen I first see the patient, if I suspect that such necessary treatment has not been before observed. The very f ootid smell of the evacuation, and the relief such evacuation immediately procures, strongly prove to me the necessity of purgatives, and I may add, from reiterated observations, that the longer they are delayed the more severe proves BHsh^r- the disease. Many practitioners, alarmed at apparent debility, are de- not hurt, but terred from exhibiting brisk cathartics lest their operation should irre- ^thevUai* coverably sink the patient. Such apprehensions would be justly power. founded if purgatives were administered without due discriminating attention to age, constitution, and immediate state of the patient. But where such attention is paid, I have never seen any mischief arise; on the contrary, the most salutary effects have taken place merely from the bowels being relieved from the contained accumulated foetid foeces, and hence every febrile symptom becomes milder, and the vital powers invigorated, not debilitated (Journ., pp. 25, 26). Patterson, W., M. D., Case of Brainular Affection from an Internal Cause. londonderry, 1804. Bee Med. and Phys. Journ., 1804, Vol XII. 278. A gentleman, aged above sixty years, was suddenly attacked Apoplexy, with a severe pain in his forehead, accompanied with so much megrim e ?- & Ti efa- an0 ^ stomach sickness as would have caused him to fall had he not re- touscharac- ceived support \ to these symptoms was added coldness. He was put to Ur ' bed; blood-letting pretty ' largely in the arm; purging, and blistering the back, legs and head, in succession, were employed. Four days after the seizure, when I was called, I found him in bed complaining grievously THE DOCTRINE OF PURGATION., 71 of a violent pain in the forehead, together with an irksome stricture in the eyeballs and surrounding teguments. The functions of the brain were gSrgtg^ impaired by a degree of stupor, attended frequently with incoherent diving the mutterings. His pulse was unequal, laboring, and accelerated with a tMeactS tenseness in the vessel ; the temporal arteries throbbed considerably, but if^S&b- were uniform in their action. The countenance was sometimes pale, r iu > } \? f -,-,.-, ^ t . rv. n . i t -I . i -i circulation. sometimes reddish, and at other times surrased with a bluish tinge ; the eyes were languid, and the sense of vision much diminished, at periods almost lost. The temperature of the skin was sometimes pretty high, more frequently below the medium warmth, and generally felt languid and flaccid. There was sometimes an urgent thirst, but for solids little or no appetite. His stomach, indeed, continued to have a loathing, and so retrograde a disposition as to approach vomiting, which he himself considered to proceed from vitiated bile. His bowels were sluggish, and had not emptied themselves since the operation of the laxative medicine, which was a space of thirty-six hours before I saw him. He was rest- less, and when he seemed to sleep it was a morbid comatose state rather than a salutary repose. The organs of respiration did not appear par- ticularly engaged, and the urinary organs were equally unaffected. From the preceding phenomena I concluded that there existed a de- termination of blood to the head, with increased tension of the arteries of the part. Under this impression, I ordered local evacuations, by means of numerous leeches to the temples, and a brisk cathartic to excite and empty the bowels, as well as to promote an equilibrium in the gen- eral circulation. The first application of leeches procured a sensible relief, and therefore it was repeated. The cathartic was not active enough in its operation, and accordingly a stronger one, composed of calomel and aloes, was given, and with manifest advantage. The stupor in a short time decreased, and was succeeded by a loud talkative raving, accom- panied with unconsciousness of persons and things around him, of which inattentive state a remnant continued for several days. The delirious condition lasted for some hours, and was followed by a profound sleep, attended with a stertor resembling that of apoplexy, but distinguishable from it by softness and equable movement in the pulse. This change was the harbinger of convalescence, which gradually but slowly took place. Considering the phenomena of this case, I am led to conceive that we would be justifiable in setting it down as a decided instance of apo- plexy ; but certainly it was rather of an anomalous description, as it assumed many of the features of a species of erysipelas which takes place in the membranes and vessels of the brain in the evening of life (Journ., pp. 109-111). Pearson, A., Surg., in the service of the East India Company. Some Observations on the Pathology and Prevailing Diseases of Warm Climates. London. 1804. See Med. and Puys. Journ., 1804, Vol. XL 279. On Acclimation. — In the first change from a cold to a hot cli- mate it was formerly the practice to bleed indiscriminately ; It is now per 72 THE DOCTRINE OF PURGATION. haps too generally omitted, as it might be often employed to obviate or issa}!lst and remove disease arising from inflammatory congestion. Purging has also Ti^vrefen- heen recommended for universal adoption • and when we reflect that the live of eii- constitution both admits and requires this evacuation more frequently in easesf ** warm than in cold climates, and bears it better, its utility will be found as probable as experience proves it to be. The neutral salts have been generally prescribed, and these are certainly of the most universal appli- cation and use ; but vegetable purgatives will be best for frequent use. (Inf. sennse et temarind, p. rhei. et kali tartar, separately or combined ; of the former 3j. to § i-, and § j.to J ii. of the latter.) Occasionally four or five grains of calomel may be taken with much advantage, from its effect in stimulating the mucous or biliary excretories, when some of the laxatives above specified ought to be given next morning. The day on which any of these remedies are given ought to be one of peculiar mod- eration, and dilution with barley-water or rice gruel attended to. "With regard to the use of tonics, or antiseptics, the indications for Deuuty employing them, and their utility, are much less than is generally sup- farity^S posed. The feeling of debility is often fallacious, and produced by the cretion. organs being overloaded, or a biliary absorption (Journ., pp. 161, 162). 280. In the warm climates the attacks of febrile disease are gener- ic™ ^J accompanied with symptoms of bilious absorption, and torpor oft/ie The symp- intestinal canal, and with a greater or less tendency to remission. The cate pw-ga- treatment recommended by authors is very contradictory ; some advising g\nni f ng mbe " a continued and severe evacuant plan, while others administer bark on every appearance of remission, and even without waiting for it. If purging with calomel and neutral salts is assiduously practiced in the first days, giving intermediately mild diaphoretic and antimonial medi- cine, the use of bark will be found unnecessary (Journ., p. 201). 281. I am doubtful if the genuine remittent fever appears without a Miasmata previous exposure to the exhalation of marshes, or that from rank vege- ^dhowS-V? Nation ; and the distinct remissions and exacerbations described in books act upon the are not frequently to be met with. . . It is frequently some time after prSng the the application of the remote causes before the disease comes on. . . The "S3o? d debilitating effect of the marsh-miasmata is generally recognized, and it activity. is probable that the nervous energy and muscular irritability are much and suddenly impaired by their impression upon the sensorium ; the powers of circulating the mass of blood are for a time diminished ; from that, irregular actions of the vessels of different viscera, a relative degree of plethora and inflammation takes place, while, from the excretories being similarly affected, the power which the economy possesses to rid itself of an excess of heat is abated. In such a state it is not surprising that congestions should take place in the brain and glandular viscera (Journ., pp. 201, 202). Bennion, Thomas, Surg., on the Gibraltar Fever. Gibraltar, 1805. See Med. and Phys. Journ., 1805, vol. XIV. ramffel'er 282. In the first the patient is seized, without any previous notice, a species of with giddiness, pain of the head, slight sickness at stomach, darting Ing oTthe pains from the head to the back, and spasmodic affections of the calves pui a gue, ter y ei f of the legs. The breathing was very hot, incessant sighing, the greatest t^hul eraud dejection of spirits. The tongue was in the beginning white; a bad THE DOCTRINE OF PURGATION. 73 taste was complained of; the sense of smelling was imperfect or de- praved ; the visage extremely distressed, and unwillingness to speak. The countenance on the first attack became suddenly sallow ; in a very short time, however, it became red, full and bloated, with the exact ap- pearances of intoxication. Drowsiness and sleep followed in a few hours, when a little moisture came out on the skin. This appearance, however, at this stage was delusive ; it suddenly left the patient, and was succeeded by the most intense heat, that gave a smarting sensation to the fingers when applied to the skin. There was at this time a most uncommon and offensive smell from the whole body. The eyes were now much inflamed; there was violent pain in the temples and over the arches of the eye- brows, darting to the orbits. The pulse from first to last was greatly increased, but never so strong and firm as in inflammatory diseases ; the thirst less than generally in acute diseases. There was strong pulsation in the carotid arteries, and an evident enlargement of the jugular vein. The color of the skin approximated that of the lilac, cocklicoque, violet or poppy, and changed as the disease advanced to a deep yellow. By the early administration of strong emetics and purgatives on the first attack, the yellowness seldom appeared, and every other had symptom was averted (Journ., pp. 137-138). 283. When these had not been exhibited, and in cases where the dis- ease from first appeared in a more aggravated form, the second set of symptoms soon appeared ; the patient was very comatose, much tremor of the limbs, frequently an incessant vomiting of black matter, with convulsive hiccough ; the eyes were drawn in a direction alternately from the nose to the temples in a frightful manner, with nearly total blind- ness. The skin was now parched with burning heat, or covered with a clammy offensive sweat. The body was covered with petechias and vibices, swellings appeared in the armpits and groins, often degenerating into abscesses ; foul gangrenous sores on the back, and carbuncles on different parts of the body. There were hemorrhages from the nose, ears, mouth, and pores of the body, with every appearance of a total dissolution of the blood-vessels. Then the fasces and urine were passed involuntarily, and the other usual symptoms indicated speedy dissolu- tion (Journ., p. 138). 284. My first step was invariably to put the patient into a warm bath, then to rub the body well with soaped flannel, and put him to bed. If the powers of life were strong a solution of tartar emetic and glauber salts was given, which generally operated smartly both on stomach and bowels, so that I frequently had little more to do but remove the debil- ity, the patients being often well on the third day. If the solution, per- severed in, did not operate, the stomach arid bowels being very insensible, I gave calomel either alone or combined with jalap and the compound extract of colocynth. I endeavored by all means to keep up the divine discharge ; when obtained, the patient was perfectly relieved and free from fever ; if not, the fourth or fifth day put an end to all enquiry. After procuring evacuation, I prescribed saline medicines, when little fever remained ; but when the disease continued after the third day, it turned out to be the severest typhus. Opium or bark did not succeed ; when liberally given, I perceived them evidently doing mischief (Journ., p. 139). Symptoms of the first stage avert- ed by emet- ics and strong purges. The symp- toms of the second stage and the close. The treat- ment by full evacuation of stomach and bowels. n THE DOCTRINE OF PURGATION. Dysentery. Enemas of emetic sub- stances. Also in piles and in- flammation of the rec- tum, &c. The man- ner how they operate. They in- crease the secretion of mucous and carry it off per (mum, without pro- ducing' vom- iting, and re- move the in- flammation from the in- testinal ca- nal and rec- tum. Their ap- plication. Clark, Thomas, Surg., Observations on the Nature and Cure of Fevers and Diseases of the West and East Indies, and of America, <&c. Edinburgh, 1805. See Med. and Phys. Jottrn., 1806, Vol. XV. 2S5. Dysentery. — Having, in violent cases, often found the remedies now described, or any others that I had tried, ineffectual, I at last had recourse to the use of emetic substances in the way of injections. I did not adopt these, however, till I had reflected very seriously and reasoned very fully on the subject. The other remedies already mentioned, except injections, were administered at the same time. From much experience I do not hesitate to assert that they have been, and, I believe I may venture to say, will be, found extremely beneficial in dysentery. It ap- pears to me more than probable that they will also prove useful in cases of piles, and, in short, in all Jcinds of inflammation affecting the rectum and parts adjoining. When given early in the disease they generally afford immediate relief, and sometimes one or two injections effect a cure. When they have not been used until the advanced stages the patients experience more uneasiness from them, particularly on their first being thrown up ; but if they can be prevailed upon to keep them for a min- ute or two, the uneasiness in a great measure ceases, and they are often able to retain them for a considerable length of time. The manner in which these injections operate is for the most part as follows : In the incipient stages of the disease, even when attended with vio- lent pain and tenesmus, and all the more violent symptoms of this dis- ease, immediate relief is almost constantly experienced from them ; and they are commonly retained for a considerable length of time with little or no uneasiness. At length an effort to go to stool comes on, and several copious natural evacuations, mixed with mucous, are procured ; and in the more violent cases several evacuations of slime, or mucous alone, or intermixed with blood, succeed to the natural stools, accompanied with little or no straining. After this, the patient commonly remains for a number of hours without any symptoms of disease, and in some in- stances it does not return. Those injections do not appear to occasion vomiting, or even to in- crease the irritability of stomach that may have previously existed. They probably assist in increasing perspiration, however. I do not believe that they operate very powerfully in that way ; at least, in some cases, I have found it impossible to produce a copious perspiration by ipecacuanha, both in the form of injection, and also at the same time given by the mouth, in considerable quantities. The salutary effects of these injections appear to me to depend chiefly upon their exciting a copious secretion of mucous from the internal coat of the great guts, and thereby removing the inflammation affecting them. I have known a few ounces of this injection give immediate and permanent relief in several instances of very painful inflammatory affec- tions about the extremity of the rectum ; a copious secretion of mucous, resembling the white of eggs, being produced. I generally have given two, and sometimes three, in the course of twenty-four hours. The best general rule, I believe, is to administer injections whenever the more violent symptoms of dysentery return, or threaten to do so. THE DOCTRINE OF PURGATION. 75 Strangury, which frequently accompanies violent cases of dysentery, ■will be found very seldom troublesome when these injections are used ; rf47velTby the reason why it is not so must appear obvious to every one. 1 ! lis iD J ec - The form of injection which I have found to answer best has been about three drachms of ipecacuanha root, bruised, and boiled down in a Thepre- quart of water to one pint, and given at dnce as a clyster. From ten to the enem °* twenty grains of tartar emetic, dissolved in a pint of warm water, will produce nearly similar effects (Journ., pp. 85-87). Dysentery and Diarrhoea. — These affections of the bowels are Nature's efforts to expel diseased matters from the blood, and must never be suppressed ; but nature must be assisted bv a free use of Erandreth's Pills, which are absolutely certain to cure if used before the powers of life are exhausted. Dr. Clark's method is vastly superior to opium or any of the astringent remedies so readily prescribed by the generality of medical men. But Brandreth's Pills are certain and commit no mistakes. If convenient, an ejection of pure water, about summer heat, will be found to comfort the bowels, but the cure depends upon purging the humors from the blood. Hamilton, James, M. J)., Physician to the Royal Infirmary and various Hospitals in Edinburgh. Observations on the Utility and Admin- istration of Pxirgative Medicines in Various Diseases. Edinburgh, 1805, 8th edit., 1833. 2^6. The history of medicine clearly shows that theory or reasoning has contributed in no small degree to impede its progress. EE SS7 Let it be our endeavor, by circumspect induction from facts, to estab- ^f s ' AD - lish sound principles which may lead to the discovery of other facts, and medicine. these again to the introduction of more general doctrines, or a compre hensive and connected theory of medicine (p. 21). TJie colon. 2 ; 7. The nutritious part of our food is prepared and separated by T he mode the changes which it undergoes in the mouth, oesophagus, stomach, and, of ^r/^»- with the assistance of fluids secreted from the liver,- pancreas, and spleen, of the etom- is perfected in the smaller intestines ; while the lacteal vessels, opening Sines! 1 m * on their internal surface, absorb and convey the nutrimental fluid into the circulating system. The residue of the food, which is not adapted to afford nourishment, constitutes part of the fecal evacuation which is made directly from the intestinal canal (p. 21). 288. This fecal residue is discharged into the more capacious colon, where the ilium enters it by a lateral opening, so contrived that the contents of the colon cannot be returned. This circumstance makes a distinction between the functions of the smaller and larger intestines, The big and which is not commonly noticed. The former complete the preparation J™^ 1 int * 8 - of the nourishment, and afford opportunity of its being absorbed; while the latter receive and detain the fecal part till after it has accumulated, and, perhaps, undergone certain changes, when it is voided in a given quantity and at stated intervals (p. 22). 289. Besides, the intestines exhale and throve off fluids which have BouoU become noxious in consequence of changes which they undergo in the function of body. The intestinal canal, therefore, serves the double purpose^ the tiu D e3 ? 9 " repairing waste and of preventing decay. In this latter function, which I am solely to consider, the intestines co-operate with the other secretory Vicarious function of Pretention of fecal matter causes dis- ease ; regu 76 THE DOCTRINE OF PURGATION. organs, the skin, the lungs and kidney. All these organs have, in re- spect of this their common relation to the system, a dependence upon one organs. another, and any of them will compensate, to a certain extent and for a limited time, the interrupted action of the others. Nevertheless, their full activity is necessary to the enjoyment of perfect health, and the contin- uance of life ; and the regularity of the intestinal evacuation is connected in a particular manner with the well-being and healthy state of the stomach and intestines themselves. The urine and perspirable matter pass off immediately after being secreted, and do not load the organs la,- diges- wn ich separate them. The unnatural detention of these excretions has lion neces- . , -, L n i n n t tv i i sary for indeed a more or less remote, and often fatal, enect upon the general heam. B j S t em? "but the skin and the kidney remain uninjured. It is otherwise with the intestines : secluded from that communication with the atmos- phere by which the perspirable matter is carried off, and unprovided with an appendage resembling the urinary bladder connected with the kidneys, they are the reservoirs of fecal matter as it is poured out, which they retain till the accustomed period of evacuation comes round. Dif- ferent circumstances are apt to induce irregularity in this evacuation ; . these, together with the facility with which the larger intestines admit of distension without uneasiness being excited, give frequent oppor- tunity for a progressive accumulation of faeces, whence arise interrupted action of the stomach and smaller intestines, and consequent dangerous and fatal ailments (p. 22). Evacua- 290. In infancy, the alvine evacuation is frequent, and the faeces are Set** - a abundant and fluid. In mature years the body is generally moved once pearance in twenty-four hours, and the faeces, although soft, preserve a form too * of either 6 well known to require description ; they are of a yellow color, and they rangemen?of em ^ a peculiar odor. When, therefore, the faeces are evacuated less the bowels, frequently than the age of a person demands ; when they are indurated ; when they change their natural color and odor, derangement of the stomach and bowels is indicated, and the approach of disease, if dis- ease be not already formed, is to be apprehended. For it is not to be imagined that organs of so great importance in the animal economy as the stomach and bowels are, can be long in a state of inaction, and the general health remain unimpaired (p. 23). 291. The propulsion of the contents of the intestines is effected by Peristal- means of a vermicular, or, as it has been called, a peristaltic motion of the' bow- the bowels from above downwards ; hence torpor, or loss of tone in the muscular coat of the intestines, by which this motion is thought to be co'Ztipa J -^ interrupted, is understood to be the cause of much distress, and tonic or stimulant medicines are employed to remedy this torpid state. I use this language, and speak of torpor of the bowels, although my ideas producing respecting it do not correspond with those of others. I am inclined to tic viotion of els, if inter- rupted by constipa- tion, causes excrementi tious a ecu ■inula tit. ,li its cure by think that the symptoms referred to loss of tone proceed, in many purgation. occas i o;ns? m0 re directly from the impeded peristaltic motion, the conse- quence of constipation. In this situation we may easily understand that the distended colon cannot, for want of space, receive the contents of the smaller intestines, which will of course stagnate throughout the whole canal ; the action of which being thus interrupted, will soon alto- gether cease, and be at last inverted. The various ailments which THE DOCTRINE OE PURGATION. 77 thence ensue, are daily before onr eyes ; and the relief which, under these circumstances, we observe to follow soon after the exhibition of a purgative, and the cessation of complaint which takes place upon its operating freely by stool, are in proof that this opinion is well founded. If, again, we farther consider that the greater part of the exhalations made into the cavity of the intestines is excrementitious, and will, if re- tained, beyond the usual period, undergo changes and acquire injurious acrimony : and if, moreover, we advert to the sympathy which many of the organs of the complicated animal frame have with the stomach and intestines, we cannot but recognize the great influence which these must possess over the comfort, the health, and the life of the individual (p. 24). 292. These are weighty considerations, and ought to excite our attention to any irregularity of the divine evacuation. The necessity of this will farther appear when we reflect that many circumstances, unavoid- able in social life, expose mankind in a peculiar manner to constipation ; such as improper food, intemperance, sedentary occupations in confined or otherwise tainted air. Besides, in a therapeutic view, we are encour- aged to exercise this attention. It is admitted that diaphoretic and diuretic medicines employed to remedy interrupted secretion by the skin and kidney, operate circuitously, often possess deleterious qualities, or are uncertain and irregular in their effects ; while the means of re- moving constipation act directly on the seat of disease, are safe, and seldom disappoint us in the attainment of our object (p. 25). Constipa- tion — its causes Constant attention to the state of the diges- tio7i recom- mendable. 293. In the dawn of physic, purgatives were employed. But, although they have been recommended by the earlier as well as by later writers, and although the indications they are meant to fulfill have been an object of attention to the practitioners in all ages, yet I do not think that the extent of their utility has been always clearly perceived, or that their administration has been always properly directed (p. 27). The pur- gative meth- od, however ancient, not sufficiently appreci- ated. 294. Another objection to the use of purgatives is urged with a force that seems to carry conviction along with it. It is observed that the constant application of stimulating articles creates a habit not only of using them, but entails also the necessity of occasionally increasing their stimulating power. Habit or custom will indeed reconcile us to the im- pression produced by unusual stimuli, and will counteract their effect in such a manner, that if the stimulus be suddenly withdrawn, or, which is the same thing, be not gradually increased, the functions of the organ to which it had been applied will become languid and irregular. This law of the economy no doubt extends to the promiscuous use of purga- tives given unnecessarily during the enjoyment of perfect health. In many instances, however, of disease, constipation and accumulation of faeces demand this stimulus to restore the healthy state of the intestines, and to promote the expulsion of their indurated contents. In propor- tion as these objects are accomplished, the stimulus from the same pur- gative becomes more and more powerful ; and so little is the necessity for continuing it, or for increasing its dose, that, on the contrary, were How to regulate the application of purgative medicines. Purgation KEMOVES bility. 78 THE DOCTRINE OF PURGATION. not the activity of the purgative diminished, or were it not withdrawn altogether, as convalescence advances, we should be in danger of in- ducing weakness by an excess of purging (p. 29). (Cf. Hipp. 16.) 295. Purgative medicines, properly administered, will not induce at debility J on the contrary, the bowels being excited to propel their con- tents, their functions are restored, appetite and digestion improved, and the patient, so far from being weakened, is nourished, supported, and strengthened. (29.) 296. Purgative medicines have also been thought unnecessary on this account, that in many diseases little food is taken ; and, therefore, regular alvine evacuations are neither requisite nor to be expected. The mentitfous residue of food unfit for the purpose of nutrition contributes, no doubt, its a ton7are" share of feculent matter / yet the abundant secretion from different or- P without 9 an s, an d the exhalation of excrementilious fluids made into the cavity Tf h ' foo fC- °f ^ e intestines, constitute the bulk of the fceces collected within them. & uon P fasti So long, therefore, as fluid is supplied, and so long as the circulation. is fied ' supported, it is equally easy to understand how faeces are produced, independently of much solid food, as to perceive the necessity of their daily evacuation during the course of fever, and of other diseases of long continuance (p. 30). 297. I refer the superior utility of purgative medicines in typhus fever to the circumstance of their operating throughout the whole extent fever Vhm of the intestinal canal, the healthy functions of which are essential to Purgation t j ie recovery, in a manner that is consonant to the course of nature, by cures, ana •/ " . 5 J why conso- propelling its contents from above downwards, and to their moving and SurL ° na ~ completely evacuating the feculent matter, which in this case becomes offensive and irritating (p. 35). How excre- 298. More extended experience confirmed these conjectures ; and I was gradually encouraged to give purgative medicines during the course mug to end. f typhus from the commencement to the termination of the disease (ibid.) Purgation from b-g^n Full pur beneficial 299. I have directed a strict attention to this practice for a long time, and I am now thoroughly persuaded that the full and regular L" evacuation of the bowels relieves the oppression of the stomach, cleans the loaded and parched tongue, and mitigates thirst, restlessness, and heat of surface, and that thus the later and more formidable impression on the nervous system is prevented, recovery more certainly and speedily pro- moted, and the danger of relapsing into fever much diminished (ibid.) Purgation 300. For many years past I have found wine to be less necessary (in s £ per irfre- typhus fever) than I formerly thought. . . This chiefly attributed to the moving ae- purgative medicines which I employed with freedom, obviating and re- moving symptoms of debility. This doctrine is at variance with that bility THE DOCTRINE OF PURGATION. 79 which is commonly entertained, but I am confident it is consonant to the fact (p. 36). 301. The complete and regular evacuation of the bowels, in the course SSg * needful in Jever\ of fever, is the object to be obtained (ibid.) 302. The early exhibition of purgatives relieves the first symptoms, g,nhm V ln prevents the accession of more formidable ones, and thus cut's short the axiQm - disease (p. 37). 303. I had learned that the symptoms of debility which take place in Purgation typhus fever, so far from being increased, were obviously relieved by the JJ^fJi %- evacuation of the bowels. I have never in scarlatina, in a long course of ***•; euws experience, witnessed sickness and fainting, which some authors have so ver, and much dreaded ; neither have I observed revulsion from the surface of the body and premature fading, or, in common language, " striking in" of the efflorescence, to follow the exhibition of purgatives (p. 45). Accordingly no variety of the disease has hitherto prevented me from following out this practice to the extent which I have found neces- sary (p. 46). causes no striking in. 304. Purgative medicines are useful in removing dropsical swellings D^rmsicai the consequence of scarlatina, when the weakness of the patient is often steeling very great. Purgatives also afford a means of preventing this swelling, aKemoved and other derangements of health (ibid.) by purga- tion. 305. When I consider the languor and lassitude which precede mar- asmus, instead of adopting the common opinion of its being occasioned by worms, I am more disposed to think that a torpid state, or weakened action of the alimentary canal, is the immediate cause of the disease. From this proceed costiveness, distention of the bowels, and a peculiar irritation, the consequence of remora of the fazces; and I have accord- ingly been long in the habit of employing purgative medicines for the cure of marasmus ', the object is to remove indurated and foetid faeces, the accumulation perhaps of months, and as this object is accomplishing, the gradual return of appetite and vigor mark the progress of recov- ery (p. 59). Marasmus from torpid bowels, con- sequent, dis- eases and their cure by purgatives. Purging the, -first step to be taken. 306. Epilepsy, than which no disease is so afflicting to the patient, is Epilepsy. frequently the effect of particular irritation of the mind or body. Prac- titioners enumerate worms in the intestines, or marasmus, among the causes of epilepsy. Surely this will induce us, on the first attack of epi- lepsy in children, arising from an uncertain cause, to set on foot the 'moist decided and active course of purgative medicines, lest we perad venture allow the disease to strike root, while we are idly employed in the exhi- bition of inert and useless vermifuge medicines, or are groping in the dark in quest of other causes of the disease, or of uncertain remedies for their removal (pp. 63, 64). Chlorosis Fearful re- 80 THE DOCTRINE OF PURGATION. 307. Chlorosis. — The slightest attention to the history of the disease evinces that costiveness precedes and accompanies the other symptoms. Costiveness induces the feculent odor of the breath, disordered stomach, uufts of cos- loss of appetite, and impaired digestion. These preclude a sufficient supply of nourishment at a period of growth when it is most wanted ; hence paleness, laxity, flaccidity, the nervous symptoms, wasting of the muscular flesh, languor, debility, the retention of the menses, the suspen- sion of other secretions, serous effusions, dropsy, and death (p. 71). 308. The greater capacity of the female pelvis gives more room for that part of the intestinal canal which is contained within it to dilate, require full and, of course, to admit of greater accumulation of feadent matter, which, more a iu&n in proportion to its remora, becomes more and more abundant, and more men. impacted. Hence costiveness is more obstinate, and chlorosis and other dise isei originating in costiveness, are more severe and are of more diffi- cult cure in the female than the male (p. 72). to escape ^09. Great attention and assiduity is requisite in the exhibition of failure purgative medicines in chlorosis, and the frequency of its repetition must fylid'/Zr- be varied according to circumstances, which can only be ascertained by ussiy. £| ie i nS p ec tl on qf the " al/vine egesta" The practitioner who is not aware in pect °*' ^" S > an( ^ who, yielding to the importunity of his patients, or the the stools, caprice of their relations, does not steadily pursue his plan of cure, will be disappointed, his abilities will be called in question, and his practice vilified and neglected (p. 73). and 310. The symptoms (of hysteria) undoubtedly denote a preternatural d^aSTus affection of the stomach and alimentary canal. In my opinion they S m™ved mS b re a ff° r d conclusive evidence that this affection is primary, and that the purgation, other multifarious symptoms of hysteria depend upon it (p. 87). The first purgatives that we use may seem on some occasions to aggravate g ative pi irri- * ne symptoms, but the practice must not be deserted on that account. tation soon The additional irritation which purgatives may give in the first instance soon passes away, and perseverance in the use of them removes that irrita- tion which gave rise to the disease, which, of course, disappears in pro- portion as me bowels are relieved of the oppressive mass of accumulated faeces (p. 88). 311. St. Vitus' Dance. — Powerful purgatives must be given in suc- cessive doses, in such manner that the latter doses may support the effect st ntus' qf the former, till the movement and expulsion of the accumulated mat- Let the ter are effected, when symptoms of returning health appear. Whoever Tronfhiuld undertakes the cure of chorea by purgative medicines must be decided smiiT doses an( ^ nnn t° ms P ur P ose - The confidence which he assumes is necessary dangerous, to carry home to the friends of the patient conviction of ultimate suc- Sperseve- cess. Their prejudices will otherwise throw insurmountable obstacles in eSSSuL** hi s wa ,7- Half measures in instances of this kind will prove unsuccess- ful, and were it not for perseverance in unloading the alimentary canal, the disease would be prolonged, would place the patient in danger, and thus bring into discredit a practice which promises certain safety (p. 97). of medical practice." THE DOCTRINE OF PURGATION. 81 312. The agonizing spasms, the prominent symptoms of tetanus, have arrested the notice of every one. To resolve the spasm and to cure the caSST" disease have been conceived to be one and the same thinq. Accordingly, „ cur . e . d b ^ opium, musk, warm bathing, cold bathing, and mercury, have been em- modic3," ployed in tetanus. But have they mitigated the severity of tetanus or Md 7 Juu obviated its fatal tendency ? " The records of physic bear a sad testi- ww* 10 "- mouv in the negative." "However just these observations may be, I should yet have been sorry to have advanced anything to shake the tot- tering fabric of medical practice in tetanus unless I thought it had been in my power to substitute one more efficacious, originating in other t^"^^^ views of the disease. These views, I apprehend, will warrant the expec tation of considerable benefit from the full and free exhibition of pur g a tive medicines (pp. 107, 108). 313. Under the impression which I entertain of the utility of pur- irydro- gative medicines, and of the inefficiency of the tonic plan of treatment p Ant£>as- in tetanus, no doubt remains with me respecting the mode of attempt- SJmoiS" ing the cure of hydrophobia, which has hardly in any instance yielded to the most powerful antispasmodics. Purgatives are proposed to remove a cause which frequently induces, and which may always aggravate spasmodic affections (p. 123). 314. Palpitation of the heart merits particular notice in this place. I have witnessed the efficacy of purgative medicines in the most forbid- Paipita- ding and apparently desperate instances of the ailment, in so much, hea"rt.° f The that I am not now disposed to despair of any case, till 1 am satisfied JJJJj that purgative medicines have been fully employed, and employed in vain (p. 122). 315. I am persuaded that the preservation of regularity in the alvine evacuation, will at all times prevent the accession of those diseases (pre- ^VI™^ viously enumerated). If these expectations be not too sanguine, it is 4 classks: likely that the marasmus and chlorosis, the vomiting of blood, chorea, bowels reg^ and hysteria, of which I have spoken, will rarely, if ever, appear. It prJSA^S is fitting, therefore, that this observation should be widely spread, that ft«ns of da- it should be conveyed to mothers and nurses, to superintendents of nur- series, of manufactories, and of boarding-schools, and to all instructors and protectors of children and young people, and strongly impressed on their minds, by such of their medical advisers as think with me, and who will acknowledge that to prevent disease is the paramount duty (p. 125). (Cf. Sanctorius, Aph. 1., Sect. I.) 316. The practice which leads to this conclusion (the free use of pur- gatives in the case of diseases), is presented in a simple form. It is nei- ga uve plan ther disguised by hypothesis, nor obscured by the simultaneous employ- {jjf^JJ^i ment of various remedies. At the same time it is supported by proofs ^fiaga- of unquestionable authenticity, which are not surpassed by any in the records of medicine. On these accounts, the truth or fallacy of my opinions may be easily investigated, and an adequate judgment of them cased cured. 82 THE DOCTRINE OF PURGATION. readily formed (p. 114). Here follow upwards of fifty cases of cure in various diseases, extracted from the records of the Royal Infirmary. Chronic diseases re- quire the fullest pur- gation. Half meas- ures bring discredit on the cause. 31 7. The steady exhibition of purgative, medicines is absolutely nec- essary to the success of the practice in chronic diseases. The puny state of the sufferer may on some occasions excite alarm in the breast of the practitioner. ; and -the caprice of his patient, and the whims of relatives, may oppose obstacles to his conducting the cure in the most advantage- ous manner. But these he must disregard ; for unless he can suppress his own improper feelings, and overcome the unreasonable objections of others, he had better not adopt measures which, to prove successful, must be conducted with firmness. A contrary conduct will necessarily term- inate in the vexation of the practitioners, in the disappointment of the patient and of his relatives, and in the discredit of that practice which it has been my wish and study to recommend (pp. 124, 125). Location determines the nature of the disease. 318. Diseased actions depend on the nature of the impressions, the parts on which they are made, and on the constitution of the patient. The same impression applied to different parts of the body may produce different actions ; cold to the extremities producing chilblains, or gan- grene ; to the head catarrh ; to the chest cough or pleurisy (p. 125). Facts alone establish re- liable sci- ence. Practical experience must super- sede theoret- ical schemes, and simple remedies the rubbish of the materia medica. 319. To conclude, the reader must have observed the beneficial effects of purgative medicines, in diseases apparently different, and inci- dent to people at various periods of life. The facts are undeniable, and serve to prove the extent and importance of the subject ; but of these I do not feel it to be incumbent on me to give any explanation at present. Such an attempt might be premature. I am satisfied to have established certain leading facts, and to have opened views which, if properly pros- ecuted, must give an opportunity to extend our knowledge respecting the utility and administration of purgative medicines. It will then be time to generalize the facts, and to form a system of medical doctrines at once clear and comprehensive, and thence to deduce practical pre- cepts useful in proportion as they will be simple and precise. When THESE EXPECTATIONS ARE FULFILLED, OUR POSTERITY MAY SEE DECEPTIVE REASONING, HOW INGENIOUS SOEVER, BANISHED FROM THE SCHOOLS OF MEDICINE, AND FROM THE PRACTICE OF THE HEALING ART A MULTIFARIOUS PRESCRIPTION OF INERT AND NAUSEOUS MEDICLNES (pp. 125, 126). IMPOKTAJSTT SEKIES. McMullin, Joan, M. D., On the treatment of Chorea Sti. Viti, by purgatives. See Edinb. Med. and Surg. Journ., 1805, Vol. I. plan ure. 320. Many diseases of symptomatic debility, which have resisted the The ton'c use of tonics, have either been considered as incurable, or our failure has been ascribed, not to our pursuing an erroneous method of treat- ment, but to our means having been too feeble, or employed too late ; and obstinately persisting in the tonic plan, on each succeeding occasion, THE DOCTRINE OF PURGATION. 83 we push it with greater vigor and with the same want of success. There are, however, fortunately, practitioners who act more philosophically, and regarding with distrust theories which do not stand the test of experi- ence, endeavour to advance the science of medicine by the slow hut sure method of observation and induction. It is in this way that we some- times find a disease yielding to a plan of treatment diametrically oppo- site to that which the established opinions concerning its nature would have suggested (p. 25). 321. With the view of alleviating the sufferings of those laboring st , under similar complaints, and of correcting the erroneous ideas enter- dance. tained of the nature of the disease, I am induced to publish some observations which occurred to me in consequence of having witnessed the cure of some cases of Chwea Sancti Viti in the Royal Infirmary of this place (Edinburgh). In these cases, a mode of treatment was adopted cure by which no opinion of the disease hitherto published seemed to authorize ; f a a tk^f— r ' although in every instance it was attended with the most marked advan- ^jJZ not 5_. . & . .. „ , , 7 . . debilitate, tages. 1 his treatment consisted m the repeated frequent exfnoition of &*** drastic purgatives, which will appear on perusing the following cases stren ° thm - not to have had the effect of debilitating still more an apparently debili- tated system ; but on the contrary, during their employment the patient recovered strength, the involuntary motions gradually abated, and by persisting in this treatment for a short time, a perfect cure was effected. What is particularly worthy of observation, is the appearance of the di- vine discharges, which in every instance was black and fetid (p. 26). Here follow five cases. 322. From these cases, the following facts seem to be established : General 1. From the exhibition of even two or three cathartics, the involun- advantages 77,7 from purga- tary motions and other symptoms were muck abated. Hon. 2. Although the cathartics tvere continued daily for a considerable length of time, the patient, instead of becoming more debilitated, became stronger and walked with a firmer pace. 3. During the progress of the cure, if at any time the cathartics did not produce an evacuation, the involuntary motions recurred, and all the symptoms were aggravated. 4. The faeces before the exhibition of the cathartics, were small in quantity, required a large dose of the purgatives, and in every instance were black and fetid. -And lastly, 5. When the disease was cured, the appearance of the fceces became natural (p. 30). 323. Upon the whole, the connection of the disease with the state of the intestinal discharges seems evident ; and as in all the five cases fetid, urease dark-colored evacuations preceded the cure, it would appear that, with }{^i im ^. them, the cause of the disease was removed. We may, therefore, legit i- riUe8 - mately conclude that the involuntary mottims, debiMty^ and other symp- toms,, were in these cases prod/uced by local irritation in the bowels, which was afterwards communicated to the whole system, through the medium of the nerves (p. 31). The tonic purga- plans compared. 84 THE DOCTRINE OF PURGATION. 324. All systematic writers have considered chorea as a disease of and he purga C - debility, and the same opinion has been almost universally adopted by practical physicians, who, seeing their patients laboring* under evident debility, have ransacked the whole materia medica for tonics and anti- spasmodics. Under this treatment, chorea has always been considered very difficult to cure. Now, when we compare the frequent failures of the tonic plan of cure with the invariable success of the purgative, we must conclude, in direct opposition to the hypothetical dogma of Brown, that the symptoms of chorea do not depend primarily on debility, but that the debility is merely symptomatic qj the disease. But in whatever' manner the phenomena of these cases may affect the theory of the dis- ease, they establish incontrovertibly a much more important conclusion — that it yields readily to the repeated and continued use of drastic purgatives (pp. 33, 34). Abejrnetht, John, M. D., Sicrgical Observations on the Constitutional Origin and Ireatment of Local Diseases. London, 1806. Eighth Edit, 1826. 325. That the stomach and bowels are disordered by injuries and dis- Sympathy ea ^es of the parts of the body has been remarked by various persons ; between the fo^t the subject has never been extensively surveyed, nor viewed with other parts that accuracy of observation which its high importance merits. It has of the body, j^^ observed that sprains of tendinous or ligamentous parts produce sudden sickness ; and Mr. Hunter has attributed that shivering which is consequent to accidents, and attendant on some diseases, to the state of the stomach. It is known that in some local injuries from accident or operations, the stomach has appeared to be the part principally affected. But remarks on the affections thus induced in the digestive organs have been made only in a cursory manner. ... It also appears to me, that the connection of local diseases with the state of the constitution in gen- eral is either not sufficiently understood, or not duly regarded by the gen- erality of practitioners (p. 5). 326. The operation for hernia (in a certain case) was followed by mmia g enera ^ disorder of the system, manifested by a full and strong pulse, from accu- furred tongue, great anxiety, restlessness, and total want of sleep. The fetid matter stomach was particularly affected, being distended, uneasy on compres- Zfplrs'ver- S ^ 011 ' an d ejecting everything that was swallowed. Tie was bled largely ance in the i n the evening, and took saline medicines, but could not be prevailed % 'Ian? l upon to swallow anything else except some toast and water. The sick- ness had in some degree abated on the next day, a solution of sulphate of magnesia in mint- water was prescribed, in small doses, given at regu- lar intervals, in order to relieve the disorder and distension of the stom- ach by procuring discharges from the bowels. In the course of the day the salts were administered which were not rejected by the stomach ; yet he could scarcely be prevailed upon to take anything else. The tongue was still covered with a thick yellow fur ; the skin was hot and dry, and the pulse frequent. As there was no particular tenderness about the epigrastic region, he was not again bled. The second night was passed without sleep. As the salts had produced no effect, the same THE DOCTRINE OF PURGATION. 85 medicine was ordered in an infusion of senna, with the addition of some of its tincture, which by being given in very small doses, was retained. When, however, it seemed likely that no effect would result from this medicine, a grain of calomel was given at night, and repeated on the following morning. Still the loathing of food continued. The third night passed like the former ones without sleep, and in great anxiety. On the next morning two pills, containing five grains of the pil. colo- eynth and the same quantity of the pil. aloes cum myrrha, were given every fourth hour. They procured no stool, nor produced any sensation which inclined the patient to believe they would operate. Again he passed a sleepless night, but toward the morning he felt his bowels apparently filling, to use his own expression, and a profuse discharge ensued. A dozen copious, fetid and black evacuations took place between jive and ten o'clock, and he had several others in the course of the day j after which his appetite returned, his tongue became clean, and a sound and pleasant sleep succeeded, from which he awoke appa- rently well (pp. 7-10). 327. It is most probably the disorder of the brain first affects the stomach • but the reaction of the latter affection is liable to increase and Th&wiwU maintain the former, by which it had itself been produced. The effects •?«<«» s f m " that result from the sympathy of the whole constitution with local with its C ev- disorder vary greatly both in nature and degree (p. 8). I could relate ery part# numerous cases in support of the inference, that local irritation acting on the nervous system may affect the digestive organs in a very serious manner, and thereby create great disorder of the whole constitution, which is afterward alleviated in proportion to the amendment that en- sues in the state of those viscera. Such cases of great local irritation must frequently occur to every one ; it is, therefore, unnecessary to adduce more instances to support the opinions here delivered (p. 12). 328. With respect to the treatment of cases of this description, it may be right to acid, that the primary object should be to produce secre- 0l fi Vomu- tion from the irritable organs. In the case which has been related, and i? '^ r ° e ^ he in many others recorded in this volume, the effect of secretions from the opium but disordered organs in relieving their irritable state is very manifest. In l u V es purga " many instances opium will not prevent the continual efforts to vomit, yet when by sulphate of magnesia, or purgatives administered in the form of pills and clysters, stools are procured, the vomit ng ceases, the stom- ach retains both food and medicine, and general tranquillity of consti- tution is as suddenly restored (p. 13). 329. A slighter degree of disorder occurs in the advanced stages of lumbar abscesses, diseased joints, compound fractures, and all kind of local disease, which impart considerable and continued irritation to SSaajn the whole constitution. We also find a less important disease, as, for instance, a fretful ulcer, keep up a disorder of the system in general, or s an3 and of the digestive organs in particular, which subsides as the irritable state of the ulcer diminishes (p. 17). 330. If the brain and nervous system should be disordered, without The nerv- any apparent local disease, similar derangements may be expected to J£S take place in the functions of the digestive organs (p. IS). gjjw or " Every ex- ternal dis- nection n Itb the digestive 86 THE DOCTRINE OF PURGATION. exarai of the tient neces- sary. " Restless- n ess and n ervous- ness" from disordered digestion. 331. Patients commonly declare that they are in good health," except SnaSon that they feel disturbed by their local complaints ; yet they are found, P a - on inquiry, to have- all the symptoms which characterize a disordered state of the digestive organs. The mind is frequently irritable and des- pondent ; anxiety and languor are expressed in the countenance. The pulse is frequent or feeble, and slight exercise produces considerable fatigue and perspiration. The patients are sometimes restless at night, but when they sleep soundly they awaken unrefreshed, with lassitude, and sometimes a sensation as if they were incapable of moving! Slight noises generally cause them to start, and they are, to use their own ex- pression, " very nervous." These circumstances seem to indicate weak- ness and irritability of the nervous and muscular systems, which, in addition to the disorder of the digestive organs, are the chief circum- stances observable relative to the general health. By correcting the obvious errors in the state of the digestive organs, by the judicious administration of purgatives, local diseases, which had baffled all attempts at cure by local means, have speedily been removed, and the patient has acknowledged that such an alteration has taken place in his general health as greatly excited his surprise (pp. 21, 22). Imperfect digestion — various ef- fects : pro- duces gas ; impoverish- es the blood; disorders the brain, the muscu- lar system,, (&c. ; i. e. causes local diseases. 332. When digestion is imperfect, gaseous fluids arc extricated from the alimentary matters. Vegetable food becomes acid, and 'oils become rancid. Uneasy sensations are also felt, and undigested aliment may be found in the feces (p. 24). Imperfect digestion must influence the qualities of the blood, and all parts of the body may be affected from this source (p. 65). Disorders of the digestive organs may produce, in the nervous sys- tem, a diminution of the functions of the brain, even so as to produce apoplexy and hemiplegia (p. 70). It may produce, in the muscular sys- tem, weakness, tremors, and palsy, or the contrary affection of spasms and convulsions. It may excite fever, by disturbing the action of the sanguiferous system, and cause various local diseases, by the nervous ir- ritation which it produces, and by the weakness which is consequent on nervous disorders or imperfect chylification (pp. 71, 72). 333. Indigestion or constipa- tion — fur- ther effects of. Being in a warm and moist place, the undigested food will un- dergo those chemical changes natural to dead vegetable and animal mat- ter ; the vegetable food will ferment and become acid, the animal will grow rancid and putrid. . . These effects must continually take place, unless, by the digestive power of the stomach, the food is converted into ajiew substance which is not liable to these chemical changes. Such irritating compounds cannot fail to be detrimental to the whole tract of the alimentary canal. Part of the food thus changed will be absorbed from the bowels and render the blood impure, from which there is no outlet for various kinds of matter but through the kidneys, and this may prove a cause of foul urine, as well as of the presence of many sub- stances in that fluid not natural to it (pp. 74, 75). ah ur- 334:. Persons may be purged without having their bowels cleared of games are the fecal matter which may be detained in them. We should therefore efficient 1 * y endeavor to ascertain what kind or combination of purgative medicine will excite a healthy action of the bowels (p. 89). THE DOCTRINE OF PURGATION. 87 335. The principle that should govern our conduct in the adminis- iiowtore- tration of purgatives may be briefly stated ; the excitement is to he re- SKstrs? 6 peated till the requisite action is induced, yet no single excitement being jjjg^ pur " such. as may prove an irritant to the organs (ibid.) 336. I am aware that laxative medicines may relieve irritation merely by augmenting the natural secretions of the viscera, and thus unloading Laxative their vessels ; and also by determining the fluids from the head, when ^St effect" the nervous symptoms are aggravated by a plenitude of the vessels of the brain. As I have found the lenient plan of treatment — that of ex- The lenient citing the peristaltic action of the bowels, so as to induce them to clear p an ' out the whole of their contents, without irritating them (so as to produce what is ordinarily called purging), particularly successful — I have rarely deviated from it. I am not, therefore, warranted from experience in speaking decisively respecting the more free use of purgative medicines (pp. 90, 91). 337. The most judicious treatment will not remedy the disease if the Disease exciting causes continue to operate — such as improprieties of diet, agita- 'JJeTlhiie tion of mind, sedentary habits, or impure air (p. 96). its caus& 338. It is necessary to the cure of disorder, first, that the stomach should thoroughly digest all the food that is put into it ; secondly, that the residue of the food should be daily discharged from the bowels teeweV (pp. 99, 100). 339. The profuse discharges which sometimes follow the continued exhibition of purgatives consist of morbid secretions from the bowels f Ch f^* e ^ themselves, and not of the residue of alimentary matter detained in those organs (p. 35). The stools, which resemble pitch, are principally composed of diseased secretions from the internal surface of the intestines (p. 36). What is necessary of evactia- tions. Tetanus from consti- pation. 340. All the experience which I have had relative to the treatment of tetanus (locked-jaw) has convinced me that more benefit is obtained by correcting the errors of the digestive organs than by any other means. It J Purgation may be useful to mention one case as a striking proof of this fact : A au^eSemai man who had been wounded in the foot, was brought about ten days ,e8Ions - • after the accident to the hospital, and so violent and general were the spasms that it was scarcely expected he could be taken to his bed alive. The jaw was fast clenched, and the muscles of his back and belly rigid ; convulsive actions came on frequently, and then all his limbs were vio- lently affected. His bowels had not been relieved for many days. When, after twenty hours, his bowels were purged, the discharges were not like faeces, and so extremely offensive that the patient could not stay in the ward. From this time, however, there was a complete subsidence of the Bpasm, and the patient recovered seemingly in proportion as the digestive organs regained their healthy functions (p. 130). 341. A female patient, about twenty-seven years of age, was lately Paralysis admitted into the hospital for paralysis of the arm, which had come on lected state suddenly. She complained of much pain when pressure was made along ^l' 1 ", !,';'%- 88 THE DOCTRINE OE PURGATION. cont'nued purgation. Chronic croup Purge* re- move the cause. the outer margin of the scalene muscles, where the nerves emerge that form the axillary plexus. Her digestive organs were greatly disordered, and, in one week, by means that could only operate directly on those organs, she regained the use of her arm (p. 132). A gentleman of the medical profession, whose digestive organs haa been long disordered, suddenly lost the use of his right arm, without any apparent disturbance of the cerebrum. A professional friend asserting that the paralysis was a consequence of the disorder of the digestive organs, the patient promised strictly to adhere to any course of medicine that his friend would prescribe. The only medicines ordered were pills, containing two grains of calomel, at night, and purges on the following morning, for one week. The bowels were cleared daily. On the sixth day, however, several copious, dark-colored and offensive discharges took place, and the patient immediately regained the use of his arm (p. 132). Blegborough, Henry, Surg., On Chronic Croup. London, 1806. See Med. and Phts. Journ., 1806, Vol. XV. 342. When the disease has subsisted some days there is generally thick and short breathing, with heat of skin and frequent pulse ; but as these symptoms are always relieved by a calomel purge, I conclude they are produced by loaden bowels. Being removed, they always in a few days return, and are, by the same means, again and again relieved (Journ., p. 509). Bradley, James, Surg., On Hernia. Huddersfield, 1806. See Med. and Phts. Journ., 1806, Vol. XVI. 343. Mr. Bradley gives seven cases of hernia in patients of different ages, sexes and constitutions, demonstrating his method of employing the taxis in inguinal or scrotal hernia. Generally costiveness precedes the hernia, and vomiting accompanies it. On the employment of pur- gative medicines he says : In case seventh, the cathartic solution was administered from evident symptoms of enteritis; and here, as well as in case tirst, where this medicine was administered, I could not perceive any of those unpleasant effects ascribed to purgatives in general. The small quantity taken into the stomach not proving sufficient to increase the disorder of that organ, and the position in which the patients were placed, might tend, perhaps, in some measure to obviate any increased distress arising in that quarter. I gave this medicine, not with a view of obtaining any laxative effects, but as a cooling sedative, calculated to abate irritation in the first pas- sages, under the circumstances of a quick pulse, considerable thirst, and great pain in the abdomen. I was led to adopt this remedy in prefer- ence, from observing its good effects in enteritis, and in obstinate con- stipations of the bowels attended with colic, which I have seen it fre- quently remove, before ant laxative effects have been produced Journ., p. 48). Morgan, Charles, M. D., On the Use of Purgative Medicines. See Edinb. Med. and. Surg. Journ., Vol. II, 1806. Purgation 344. Debility is itself an effect of disease, and, when the disease is biuty. e ' removed, the strength and vigor of the system will return. Have we PTern>'a. Purgatives useful as cooling sed- ative, re- moving the irritation in the primes vite. and pro- moting the reduction. of THE DOCTRINE OF PURGATION. 80 not often seen the debility which attends some of the complaints of in- fancy removed, as well as the disease of which it was a symptom, by evacuating the bowels j and nausea., and anorexia, with all the depress- ing symptoms of dyspepsia, how often alleviated by a brisk purgative? (p. 100). 345. If we would follow out this practice on general principles, we must calculate the whole effect of onr remedies. Sometimes we empty the Effects bowels simply ; at others we promote an increased secretion of fluids by v J^ot P u* purgative medicines. In some cases it appears sufficient to unload the n trusting to remedies that have long failed, or rather let him lay aside the practice of medicine altogether. It is only by daily ■/ion of the stools that t/i^jjurgi/nj can, be regulated • for, as long as they exhibit mokuid appearances, so long abb purgatives nboessaky, and no longer. When the stools are not seen, tlie patient conceives that he is discharg- ing far more than you are aware of, and more than his constitution can bear. By an earnest inquiry after them and a strict injunction that the whole may lie saved, together with an occasional appeal to the patient, whether such matters can remain in the body wiih impunity, I have never tailed in inducing a cheerful submission to the plan, and the pa- 90 THE DOCTRINE OF PURGATION. tient at last looks for the repetition of the doses as a sure relief from the misery he is suffering. Having premised these remarks, which arise from the objections of several medical friends, I proceed to the relation of two cases, not picked out as proving more than others, but as exhib- iting the obstinacy of the disease, and the ultimate advantages derived from a steady perseverance in the purgative plan (p. 145). Here follow the cases : Walsh, E., M. D. An account of a malignant fever, which appeared in the Garrison of Quebec during the Autumn of 1805, with some preliminary observations on the diseases of the Canadas. London, 1806. See Mel>. and Phys. Journ. 1806, vol. XV. Lake fever. 349. Lake Fever. — The cure of this fever is not less easy and cer- Ernekc and tain at its commencement, than difficult in its advanced stages. An ns purg an ti mori i a i emetic, followed by a brisk purge, with attention to regimen for two or three days, seldom failed of curing it on the access. But if this was neglected, and the disease far advanced, such a torpor of the system was induced as frequently rendered ineffectual the most active medicines (Journ., p. 448). Dr. Walsh characterizes the malignant fever at Quebec exactly like Mr. Bennion describes the fever at Gibraltar, and has employed the same remedies against it ; confer, therefore, Bennion on the Gibraltar Fever (Journ., pp. 451-453). Cheyne, J., 31. D. Observations on the Effect of Purgative Medi- cines. London, 1808. See Edinb. Med. and Surg. Journ., 1808, vol. LV. Fits and 350. Case of a youth who, in consequence of a fall, was subject for inability to a year to most distressing fits, intense pains, etc., and who, in conse- by purga- quence, had lost the power of walking. (Case given.) This boy in Uves - about two months was restored to health. During this period lie used a great quantity of strong cathartic medicine. A scruple of aloes and ten grains of gamboge were given daily for several weeks before his stools became natural ; and as his stools became large, loose and natural, the fits left him and he recovered the use of his limbs. About the end of my attendance, when his bowels were acting more naturally, one pill of the same kind, of which it before required sometimes ten to produce the desired effect, was a sufficient dose (pp. 310, 311). In this case our practice is supported by analogies drawn from the successful treatment of other diseases where, along with convulsions or a%cZnf w spasmodic affections, we have also been able to detect a great degree of foulness in the bowels. It is in compliance with a common idiom that I use the expression of foulness of the bowels. I am persuaded that such a state cannot, with any propriety, be said to exist. Take the In mmlni S ^ 0W ^ n f an ^ e remittent of Dr. Batter, or the marasmus of Dr. LLam- marasmus. ilton — we lvave a train of symptoms supposed to be induced by foulness of the bowels ; and the appellation seems to be countenanced by what is observed during the cure, the effects of. the purging medicines retid stools, employed. By these medicines stools are procured, at first dark, slimy THE DOCTRINE OF PURGATION. 91 and fetid, which perhaps, for a considerable time, have nothing of the appearance of natural fasces ; the evacuations seem merely a collection of vitiated secretions, but at last, by pursuing the purgative plan, large natural stools are evacuated, and it is generally supposed that these stools have been all the while lodged in the intestines, and, that our medicines were not powerful enough at once to expel them — that the dis- ease was solely from an accumulation of fecal matter (p. 312). 351. But the fact is, that these critical stools are produced by the restoration of the viscera to a healthy condition. The purgative medi- cine employed is useful, not so much by removing the accumulations, but that it stimulates the bowels. By the steady application of this stimulus the visceral functions are restored. The bilious and slimy stools are expelled, the light food is concocted, and from the fecal resi- duum, with the increased supply of gall, of gastric and pancreatic fluids, and the secretions from the large intestines, in consequence of the reno- 'vation of the organs supplying these fluids, the large natural stools are produced and tlte disease resolved. Were the bowels in a healthy con- dition, they would be acted upon by what at all other times is their natural stimulus, and, consequently, they would not admit of this sup- posed accumulation. If there be accumulation, the torpid state of the intestines is the cause of it ; but the disease may exist without any accu- mulation whatever (p. 312). Powerful purgation. Critical evacuations by stool. Critical or fetid stools indicate re- inoval of dis- ease and re- turn of healthy ac- tion. 352. In dysentery, where hardened faeces are lodged in the bowels, we see a constant succession of unsatisfactory stools, and of these stools the hard fasces or scybala would seem often to be the cause. For, it is observed by every practical writer, that when, by proper purgatives, the scybala are evacuated, there is immediately a remission of the most urgent symptoms, in particular of the tenesmus, and frequent mucous stools (p. 313). Dysentery from scybala. 353. Hydrocephalus. — The cure. The exhibition of the largest dose which can be safely prescribed of some powerful cathartic medicine, two, three, or four times a day; and this continued for several days, or until natural stools are produced. The advantage of keeping the intes- tinal canal under the continual influence of a stimulus, I have, in various instances, found to be so great, that I am induced to repeat the declaration of my belief, that the happiest result may be expected from this measure. {Essay on Hydrocephalus Acutus, Edinb., 1808 ; ibid., p. 316.) Gay, M., M. D., An Essay on the Nature and Ireatment of Apoplexy. Paris, 1808. Translated by Ed. Copeman, Surg., with an Ap- pendix. London, 1843. See Brit, and For. Med. Rev., 1813, Vol. XVI. Water in the brain — cure by the fullest pur- gation. 351. This treatise proves that bleeding is injurious in^ all cases of N A J^S t apoplexy, and that the primary cause is always to be found in the primse hmpurge' viae ; that purgatives are indicated in every ease, except when t lien I taclc follows a full meal, when emetics should be first administered (Rev., 272). 92 THE DOCTRINE OF PURGATION. Halliday, Andrew, M. D., On Epilepsy. and Phys. Journ., 1808, Vol. XIX Blandford, 1808. SeeTAisD. Epilepsy from worms. Continued •purgation removes the cause by carrying off accumula- tion of morbid matter in the intes- tines. 355. Case given of a girl of five years old who was subject to fits with violent contraction of the limbs, had an unnaturally voracious and de- praved appetite, and could articulate but very few words, however she understood what was said to her. Upon an attentive consideration of this case, it occurred to me that purgatives were likely to be of service, and from my intimate acquaint- ance with the practice of that justly-celebrated physician, Dr. Hamilton, of Edinburgh, I entered upon the treatment with great confidence, and did not hesitate to promise success to the parents of the girl if they would faithfully and implicitly follow my directions. I confess that I had my fears lest there should be some organic disease ; yet the pulse, though rather slow, was regular. The bowels, I was told, were very irregular, but- generally costive; I felt the abdomen very tumid; and notwithstanding the feebleness and emaciated state of the patient, I felt convinced that no time was to be lost ; I therefore ordered an active purgative. The fits recurring and no stool being procured, infusion of senna was given, one ounce every half hour, which produced several scanty, fluid motions, of a greenish color, and highly fetid. Both medicines were continued for four days, without alteration in the state of the patient or her bowels, several lumbrici were voided, the fits had rather increased in violence; on the fifth day she had two motions, the last very copious, consisting chiefly of hardened scybala, and containing two worms ; fits returned ouly during the night. Three days more brought more large evacuations of the same kind, diminished voracious- ness, and less severity of fits which occurred during the nights. From this time (the 6th of January) to the 20th, I continued the exhibition of calomel and rhubarb, and the senna occasionally, never intermitting more than one day. The quantity of feculent matter which she passed during that period is beyond conception. Her appetite began to nag about the 14th, and on the 16th her mother informed me that she had not had a fit for twenty-four hours ; on the 17th she had one very severe fit, but remained free from them again till the 20th, when she had one which did not continue above ten minutes. During this period she had voided three lumbrici. The fits gradually abated, the appetite became natural, while purging pills were continued so as to secure a regular alvine discharge (Journ., pp. 305-308). Large doses and perse- verance se- cure SUCCESS. 356. Thus far the purgatives have fully answered my expectations. The child appears to be cured of her fits, but I am afraid she will remain an idiot while she lives. The doses of medicine that were necessary to move her bowels were very large, and also the length of time which elapsed befom the bowels could be said to be properly moved, for I con- ceive that she had no proper motion till the seventh day. The large doses of medicine which were necessary may be accounted for, perhaps, from the state of the sensorium ; and the difficulty which there was in moving the bowels was, no doubt, owing to the great accumulation which had taken place (p. 308). THE DOCTRINE OF PURGATION. 93 357. Though the fits are removed at present, I fear they will be apt to return, unless great care is taken to keep her bowels open for some considerable time, until the predisposition from habit is overcome, and the bowels are restored to their natural tone y but it' this is attended to, I am certain the cure will be complete. This case, then, I would say, tends to corroborate the very valuable observations of Dr. James Ham- ilton, but indeed those observations stand in no need of any such testi- mony ; for Dr. Hamilton has proved every position which he has advanced by facts that never can be controverted. The novelty, the sim- plicity, and the efficacy of Dr. Hamilton ] s practice attracted much notice on the first appearance of his invaluable work ; and as the doctor did not venture to give his discoveries to the world till experience had most fully confirmed them, he was able to speak with certainty ; and I will venture to affirm that if purgatives have failed in any instance to pro- duce the efiects which Dr. Hamilton's observations have so incontestibly proved them capable of producing, that that failure is to be attributed more to the prescriber than to the medicine prescribed (Journ p. 309). It is neces- sary to estab- lish regu- larity of al- vine evacua- tions in ol- der to. secure health. The pit rela- tive, plan of treatment and Hamil- ton , s doc- trine vindi- cated. dication of the purga- live, plan and Hamil- ton's prac- tice. 358. I nave often heard it argued, by those who were unwilling to Typhus. give too much credit to Dr. Hamilton, as was generally allowed, that though no doubt the cases which he had related seemed to prove the good efiects of purgatives, yet that many of those cases — for example, Fu-ther vm his cases of typhus fever — were so trifling that any other remedy would have done as well as purgatives. And, moreover, it has been often hinted that though this practice may do very well in the north, and in the Royal Infirmary of Edinburgh, yet that it is by no means calculated for the delicate constitutions of this country. I shall only say, that those who have witnessed Dr. Hamilton^ practice have been fully con- vinced of the good efiects of purgatives in severe as well as slight cases of fever ; and, indeed, had the doctor felt any anxiety about this, he might have filled the second number of his appendix with cases more severe than any he has given. With regard to the second hint, I can add my testimony to that of Dr. Morgan, of Dover. (See Edinb. M. and S. Journ., 1807, April 1.) I have prescribed purgatives in different diseases since my residence in England, and have found their efiects uniformly the same as in the north. While I resided at Ilalesworfh, in Suffolk, I attended Robert White, of Walpole, with Mr. Walker, surgeon, in one of the worst - of typhus I ever saw. The disease was speedily subdued by pur- gatives. The bolus jalapre compositus had the same good eifect in Suf- folk as in the Royal Infirmary of Edinburgh (Journ., pp. 309, 310). Watt, Robert, M. D., Cases of Diabetes, Consumption, dec, with Ob- servations on the History and Treatment of Disease in general. DoAsley, 1808. See Edinb. Med. & Surg. Jour., 1809, Vol. V. 359. The fi/Mctions of the lungs are twofold : to assimilate the new T1be Iwn(/M; materials supplied by the digestive organs, and to preserve the blood in "^j* 1 ^""' 1 a healthy state. In health there must be a due balance between the di- gestive and assimilative organs. If this balance be disturbed, disease ensues (p. 93). 94 THE DOCTRINE OF PURGATION. chyle. 3go. If more chyle be thrown upon the lungs than they can assimi- late, it must remain an incumbrance upon the system, or be discharged by one or other of the excretories (p. 94). 361. The Mood may be deteriorated, and yet support life, in an im- perfect manner. The vessels which increase and repair the solids may be in want of proper materials, though the system were overcharged with blood. The nervous system being deprived of its natural support . from these vessels, acquires a depraved sensibility, and all the phenomena follow which we have described as attending a diseased habit. The greatest number of secreting organs are idle for the want of arterial blood, the only stimulus which can call them into action. The liver receiving its stimulus from venous blood, has more to do than in health ; hence arise " bilious complaints " which, with low spirits, prostration of strength, &c., generally mark the first stage of disease (p. 94). 362. If the system possesses sufficient vigor, reaction takes place, and goes on to a proper crisis. ... In place of fever the balance is often restored by a critical evacuation. If the superfluous matter take to the intestines, it produces diarrhoea / if to the kidneys, diabetes / if to the uterus, menorrhagia / if to the skin, profuse perspiration. If the re- action fail to produce a salutary crisis, the system falls back, collects new vigor and resumes the conflict, as in intermittent fever, and other periodical diseases. In other instances, such as hypochondriasis, it re- peats the same thing over again, or tries other means of relief, and is thus said to counterfeit every disease ; that is, it employs many efforts to throw off the incumbrance, but is generally unequal to the task. Af- ter a longer or shorter struggle, a confirmed phthisis, diabetes, diarrhwa, dropsy, or some other disease, termi mites the patient's sufferings (p. 95). 363. In every period of the history of medicine, there has not only been practice opposed to practice and theory to theory, but one fashion has succeeded another with astonishing rapidity. One practitioner treats burns and scalds by heating, another by cooling applications ; one cures the gout by carefully wrapping the feet in flannel, another by plunging them in cold water ; one combats fevers with wine and opium, another by gruel and purgatives. These, though abundantly striking, are but a small sample of the oppositions in medicine. To notice the fashions would be to enumerate the various articles which, from time to time, have entered the materia medica, and almost every possible man- ner in which these can be prepared and compounded. (Journ, 1810, Yol. VI, p. 287.) 364. From a belief that there is no disease without a corresponding remedy, medical men have been much in search of antidotes. The task of finding a specific for each disorder, reminds me of the labor of the Chinese in inventing a distinct character for every word in their lan- guage. However numerous and diversified the hair-splitting systems of nosology may represent diseases, the means of cure, like the simple sounds in language, are few and obvious. Galen remarked that bleed- ing and purging were the two legs of physic, and it is doubtful how rwgattoes f ar ^ e ar ^ ^ ias ^ een improved by the legs which have since been added the"legso/ (ibid.) phywe." x ' The blood. The nerves. Secreting organs. The liver. " Bilious com- plaints" debility. Reaction. Critical evacuation: IMarrhcea — intestines ; Diabetes — kidneys ; Menorrhagia — uterus ; Perspiration — skin. Hypochon- driasis — its causes, course, and end, if im- purities are not remov- ed, Vagaries o medical practice. About " cifics THE DOCTRINE OF PURGATION. 95 Bkiggs, H., M. D., Physician of the Royal Dispensary of Liverpool ; History of a case of tetanus eared by purgatives. Liverpool, 1809. See Edinb. Med. & Surg. Joukn., 1809, Vol. V. 365. Remarkable case of Lake Gaskell, given in detail. — The cure was perfect in four weeks. On the fourth day of the case, Dr. Briggs '—remark™ says: — " I had all along been aware of the awful responsibility. I in- c J?eby5^- currred by departing so widely from the usual practice in tetanus, and e 'f ( ' ( l t /™ r ' now my resolution failed me altogether. I was terrified with the ap- "Niuespe- prehension that I had already delayed the free exhibition of opiates too long, while yet I was loth to relinquish the use of purgatives (p. 154). On a cool review, I asked myself whether, if the case should prove fatally, as I then feared it would, I could with justice affirm, that purga- tion had been fairly tried and failed, whether on the contrary the ex- acerbations that had occurred ought not to be ascribed to the interrup- tion of the plan, rather than to the plan itself? (p. 155). Finally, I con- cluded to adhere to the plan of purgation, and to discontinue the inter- nal use of opium (ibid). 366. After the cure, he says : — " If there be any point in medicine, spa*™* of on which, after having been engaged in dispensatory practice for sixteen th6Stomach - years, I have arrived at any certain conclusion, it is this, that in gastro- dynia, and many other spasmodic affections, brisk purgatives will be found incomparably better antispasmodics than any of that tribe to theSest" which this epithet is usually applied. I believe, too, that their operation "jj^c?."*" is strictly antispasmodic — that their first effect is, to supersede the spasmodic action ; for I have often known complete relief to be obtained before a stool was procured, in so much, that I have more than once been asked by patients, ' if I had not given them laudanum V " (p. 161). I am inclined to think, that the more drastic purges were laid aside for no sufficient reason. . . The more active purgatives appear literally p"% to have possessed antispasmodic virtues (p. 162). The quantity of medicine taken from first to last for twenty-five days is certainly very large, as follows : — calomel 320 grains, scammo- nv 340 grains, gamboge 126 grains, powdered jalap 6 ounces, infusion of senna with tincture lOf pounds, colocy nth-pill nearly 2 ounces, of which the greater part was taken within the first week. During forty-eight hours (on the 5th and 6th days) was given scam- mony 210 grains, gamboge 89 grains, jalap 1^ ounce, infusion of senna 2^- pounds, calomel 80 grains; and all this without causing sickness or griping, but on the contrary with most decided benefit (ibid.) , 367. In short, if a remedy be indicated at all, surely the dose should be 77^, effect, regulated, not only by' weight and measure, but by the effect. And when n $y h 2n£e there is such a strong concatenation of morbid actions, as in tetanus, it Jjjjajjijj might perhaps have been expected, a priori, as it has proved in fact, that nothing hit tie most active purges, in large doses, and, frequently re- peated, would avail to break tJie train (p. 163). The whole quantity of vpvum taken was 100 drops in two days, and so far from answering any good end, it seems manifestly to have prevented sleep, as well as to have impeded the operation of the purgatives (p. 164). This i< the most important evidence, in respect to purgatives, we have yet published. Our directions for the use of Brandreth's Pills need no modification. Dose, from 2 to 20, or any quantity required to purge. Drantic 96 THE DOCTEINE OF PURGATION. Rush, Benjamin, M. D., Medical Inquiries, 4 vols. Philadelphia, 1809. Disease a 368. There is but one fever. However different the predisposing, remote, or exciting causes of fever may be, still I repeat, there can be but one fever (vol. III., p. 16). unit. aii forms 369. I infer the unity of fever, further, from the sameness of the ° f & , ' > . r r - ; . r J m > / . Mi ' asthma, etc., notha, asthma, hemoptysis, consumption; m the tliroat, inflammatory an diseases angina ; in the uterus, hemorrhagia uterina ; in the kidneys, strangury, froT c ^m! m diabetes, and calculi ; in the liver, inflammation, suppuration, melea, schirrhus, gall-stones and jaundice (ibid., pp. 258, 259). All these dis- eases have but one cause, and they are exactly the same, however differ- ent the stimulus may be from which they are derived (ibid., p. 261). 379. Thus rheumatism, the gout, the measles, small-pox, the different Local ajfeo- species of cynanche — all furnish examples of. the connection of local ^™«?2L alfections with general diseases ; but the apoplexy and the pneumony ease. furnish the most striking analogy of local affections succeeding a general disease of the system (ibid., p. 86). 380. Pneumony is apoplexy of the lungs, allowing only for the dif- pneumom,. ference of situation and structure (ibid., p. 87). 381. After the production of predisposing debility of the system unity of di*. fYom the action of remote causes, the fluids are determined to the weak- ^onsSai? est parts of the body. Hence the effusion of serum or blood takes place (tl - in the lungs. When serum is effused, apituitous or purulent expectora- tion takes place; when 1)1 ood is discharged a disease is produced which >cen called hemoptysis. The pneumony is produced by remote exciting causes which act on the whole system (ibid.) . . The expectora- tion which terminates the disease in health, is always the effect of effu- sions produced by a general disease (ibid., pp. 87, 88). 382. Who lias not seen the pulmonary symptoms alternately relieved aon-naturp and reproduced by the appearance or cessation of a diarrhoea or pains in by^^oS the bowels 1 (Ibid., p. 85.) 1 98 THE DOCTRINE OF PURGATION. The unity of disease. The recog- nition of this doctrine is of the highest importance to human- 383. Science has much to deplore from the multiplicity 'of diseases. It is as repugnant to truth in medicine as polytheism is to truth in reli- gion. The physician who considers every different affection of the dif- ferent systems in the body, or every affection of different parts of the same system, as distinct diseases, when they arise from one cause, resem- bles the Indian or African savage who considers water, dew, ice, frost and snow, as distinct essences ; while the physician who considers the morbid affections of every part of the body, however diversified they may be in their form or degrees, as derived from one cause, resembles the philosopher who considers dew, ice, frost and snow, as different modifications of water, and as derived simply from the absence of heat (vol. III., pp. 146, 147). •Humanity has likewise much to deplore from this paganism in medi- cine. The sword will probably be sheathed forever as an instrument of death before physicians will cease to add to the mortality of mankind by prescribing for the names of diseases (ibid., p. 147. Account of the bilious yellow fever of 1793). experience of Dr. Rush. Franklin Oil YELLOW- ' Purgation in- dispensable. The abdom- inal viscera chiefly af- fected. 384. How Dr. Hush came to believe in the efficacy of purgation. — Condensed from pp. 222-230, vol. III. : I gave gentle purges and vomits, bark in all its usual forms, applied blisters to the limbs, neck and head, attempted to rouse the system by wrapping the whole body in blankets dipped in warm vinegar (p. 223), rubbed the right side with mercurial ointment, with a view of exciting the system through the liver ; none of these remedies. were of any service. I returned to bark, wine, and the use of cold water (p. 224). . . Had the authority of Dr. Oleghorn for the former, who says : " The bark, by bracing the solids, enables them to throw' off' the excrementitious fluids by the proper emunctories," &c. No better success, however, attended my efforts (p. 225). . . I ransacked my library, and pored over every book that treated of yellow fever (p. 226). . . I recollected that I had among some old papers a manuscript account of the yellow fever as it uscripi which Purgation promotes sweat by re- prevailed in Virginia in 1741, which had been put into my hands by Dr. Franklin, a short time before his death. I now read it a second time, and paused upon every sentence. I was struck with the following passages (p. 227) : 385. (Dr. FranMin, loquitur): "It must be remarked that this evacuation (meaning the purges) is more necessary in this than in most other fevers. The abdominal viscera are the parts principally affected in this disease, but by this timely evacuation their feculent corruptible contents are discharged before they corrupt and produce any ill effects ; and their various emunctories and secerning vessels are set open, so as to allow a free discharge of their contents, and consequently a security to the parts themselves during the course of the disease. By this evacua- tion the very minea of the disease, proceeding from the putrid miasmata fermenting with the bilious and other humors of the body, is sometimes eradicated by the timely emptying the abdominal viscera, in which it first fixes, after which a gentle sweat does, as it were, nip it in the bud " (ibid.) 386. " When the primm via), but especially the stomach, is loaded with an offensive matter, or contracted and convulsed with the irritation THE DOCTRINE OF PURGATION. 99 of its stimulus, there is no procuring a laudable sweat till that is re- moving i m - moved ; after which a necessary quantity of sweat breaks out of its own whff^pr* accord, these parts promoting it, when, by an absterging medicine, they Jgjj exuda- are eased of the burden or stimulus which oppresses them" (p. 228). 3ST. " All these acute putrid fevers require some evacuation to bring , au fevers them to a perfect crisis and solution, and that even by stools, which must Ration. 1 ™ be promoted by art, when nature does not do the business herself" (ibid.) 388. " On this account, an ill-timed scrupulousness about the weak- ness of the body is of bad consequence in these circumstances ; for it is that which seems chiefly to make evacuations necessary, which nature is ever attempting, after the humors are lit to be expelled, but is not able to accomplish for the most part in this disease. And I can affirm that I have given a purge in this case when the pulse has been so low that it could hardly be felt, and the debility extreme, yet both one and the other have been restored by it " (pp. 228, 229). The weaker the subject, the greater the necessity tor full pur- gation. 389. Here I paused. A new train of ideas suddenly broke in upon weak my mind. I supposed that my want of success, in several of the cases E^ 8 U9e " in which I attempted the cure by purging, was owing to the feebleness of my purges (ib., p. 230). effects of full 2>ur//(tl'V7) — the seeming- ly dead re- stored to life. 390. By full and continued puraation I cured perfectly four out of Astonishing i r> r* ^ J . • «.l , T r> <1 l l efftx'ta nf full the first foe patients, notwithstanding some ot them were advanced sev- eral davs in the disease. One gentleman had passed twelve hours with- out a pulse, and with a cold sweat on his limbs. His relations had given him over. Dr. MitcheWs account of the effect of purging in raising the pulse excited a hope that he might be saved, provided his bowels could be opened. Purges were given to him three or four times a day ; at length they operated and produced two copious fetid stools. His pidse * rose immediately. A universal moisture on his skin .succeeded. In a few days he was out of danger, and soon afterwards appeared in the streets in good health (p. 232). . . In three days he had taken eighty grains of calomel, and rather more than that quantity of rhubarb and jalap (ibid.) 391. This practice could be said to be almost uniformly effectual in calomel with all those cases which I was able to attend. . . Many used calomel in opium "use- connection with bark, wine, and laudanum, without any good effects. I can never forget the transport with which Br. Pennington ran across Third Street to inform me " that after he began to give strong purgatives the disease yielded in every case" (ibid., p. 235). 392. Never did I experience such sublime joy as I now felt in con- templating the success of my remedies. It repaid mo lor all the toils and studies of my life. The reader will not wonder at this joyful state of my mind when I add a short extract from my note-book of the 10th September: "Thank God! out of one hundred patients, whom I have visited or prescribed for, this day, J home lost none I" (Ibid., p. 234.) Dr. Pen- nington and strong purges. Dr. Ruxh re. ioices. 100 THE DOCTRINE OF PURGATION. aii kinds of 393. My practice was, to give a purge every day while the fever con- fhSfreatob- tinned. I used castor-oil, salts, cream of tartar, rhubarb. Calomel and p^\tSa j a ^ a P were often ineffectual, then I added gamboge. The purges seldom da v- answered the intention for which they were given unless they produced four or five stools a day (ibid., p. 240). . . When purges were rejected or slow in their operation, I always directed opening clysters every two hours (ibid., p. 241). The advan- 394 The effects of purging were as follows : pwrgation se?en te prop - 1- It raised the pulse when low, and reduced it when it was preter- sitions. naturally tense or full. 2. It revived and strengthened the patient. This was evident in many cases in the facility with which patients who had staggered to a close-stool walked back to their bed after a copious evacuation. 3. It abated the painful symptoms of the fever. 4. It frequently produced sweating, when given on the first or second day of the fever, after the most powerful sudorifics had been given to no purpose. 5. It sometimes checked the vomiting which occurred in the begin- ning of the disease, and it always assisted in preventing the more alarm- ing occurrence of that symptom about the fourth and fifth day. 6. Removed obstruction from the lymphatic system. 7. Discharged the bile through the bowels as soon and fast as it was secreted, and prevented, in most cases, yellowness of the skin (ibid., p. 243). Sympathy. 395 Q ne f the laws of sensation is, that certain impressions which excite neither sensation nor motion in the part of the body to which they are applied, excite both in another part. Thus worms, which are not partluffeS? fel* m the stomach or bowels, often produce a troublesome sensation in the throat. . . In like manner the irritants which produce fever, in ordinary cases pass through the bloodvessels, and convey their usual morbid effects into a remote part of the body, which has been prepared to receive them by previous debility (ibid., pp. 60, 61). No amount 396. It is not an easy thing to affect life, or even suhsequent health, uL p Sh- by copious or frequent purging. Dr. Kirkland (Treatise on Inflamma ous. tory Rheumatism, vol. I., p. 407) mentions a remarkable case of a gen- tainedby tleiuan who was cured of a rheumatism b y a purge which gave him Ss large oetween forty and fifty stools. This patient " had been previously affected by his disease sixteen or eighteen weeks." Dr. Mosely not only proves the safety, but establishes the efficacy of numerous and copious stools in the yellow fever. Dr. Say probably owes his life to three-and-t/went/y stools, procured by a dose of calomel and gamboge, taken by my advice. Dr. Redman was purged until he fainted by a dose of the same medi- cine (ibid., pp. 243, 244). Diarrhaa 397 But wao can suppose that a dozen or twentv stools in a day never fetus, n t j • A 7 7 but the dis- could endanger life that has seen a diarrhoea continue for several months, the e <5aus C e o? attended with fifteen or twenty stools a day, without making even a mate- ^heeaT" r ^ breach in the constitution f Hence Dr. Hillary (Diseases of Bar- THE DOCTRINE OF PURGATION. 101 badoes, p. 212) has justly remarked, that " it rarely or never happens that the purging in this disease, though violent, takes the patient off, out the fever ami inflammation of the bowels." Dr. Clark (Diseases in Voyages to the Hot Climates, vol. II., p. 322) in like manner remarks that evacu- ations do not destroy life in the dysentery, but the fever, with the emacia- tion and mortification which attend and follow the disease (ibid., p. 245). 398. I have remarked in the history of this fever that it was often cured on the first or second day by a copious sweat. It would be absurd to suppose that the miasmata which produced the disease were discharged in this manner from the body. The sweat seemed to cure the fever only by lessening the quantity of the fluids, and thus gradually removing the depression of the system. . . The reason why a few strong purgatives cured the disease at its first appearance was, because they abstracted in a gradual manner some of the immense portion of stimulus under which the arterial system labored, and thus gradually relieved it from its low and weakening degrees of depression. . . Bleeding was fatal in these cases, probably because it removed this depression in too sudden a man- ner (ibid., pp. 277-279). Sweats (crises) and purges. Bleeding fatal. 399. Baron Humboldt informed me that Dr. Caristo had assured him that bark hastened death in every case in which it was given in the yel- low fever of Vera Cruz. If, in any instance, it was inoffensive or did service in our fever, I suspect it must have acted upon the bowels as a purgative. Dr. Sydenham says that bark cured intermittents by this evacuation, and W?n. Bruce says it operated in the same way when it cured the bilious fevers at Massuat (ibid., p. 293). Bark destructive except when it acts as purgative. 400. The result Bark, wiue, I and lauda- num. Clerical evi- dence in fa- vor of purga- tion. Whilst Dr. Bush was working from eighteen to twenty hours a day healing and saving by hundreds, the old-school physicians, who derided his innovations, persisted in the use of bark, wine, and laudanum, and thus succeeded in killing their patients ''''secundum artemP 401. The JRev. Mr. Fleming, one of the ministers of the Catholic church, carried the purging powders in his pocket, and gave them to his poor parishioners with great success. He informed me that he had ad- vised four of our physicians, whom he had met a day or two before, " to renounce the pride of science, and to adopt the new mode of practice, for that he had witnessed its good effects in many cases" (ibid., p. 314). 402. Reason and humanity awake from their lone; repose in medi- Rwon and , ., . . . . « 7 J _, . ., . .. . • -, ,p x * ,., humanity erne, ana mute in proclaiming that it is time to take trie cure ot pestilen- are opposed tial epidemics out of the hands of physicians, and to place it into the ^mSjgSvy- ha/nds of the pjeople. . . The safety of consigning to the people the cure of pestilential fevers, especially the yellow fever and the plague, is established by the simplicity and uniformity of their causes and of their remedies. Popular com io pared with had no physician recovered from the fever than of those who had the tr^fment. 403. Dr. Lin/1 has remarked that a greater proportion of sailors wh< 102 THE DOCTRINE OF PURGATION. The worst best medical attendance. The fresh air of the deck of a ship, a purge thf^impS of salt water, and the use of cold water, probably triumphed over the to cure. cordial juleps of the physician (ibid., p. 319). °tker medt- 404. For a long while air, water, and even the light of the sun, were ues consid- dealt out by physicians to their patients with a sparing hand. They the?? hum possessed for several centuries the same monopoly of many artificial nou^Qced remedies. But a new order of things is rising in medicine (ibid., p. 320). It is not more necessary that a patient should be ignorant of the medicine he takes, to be cured by it, than the business of government should be conducted with secrecy in order to secure obedience to just laws. Much less is it necessary that the means of life should be pre- scribed in a dead language, or dictated with the solemn pomp of a ne- cromancer. The effects of imposture in anything are like the artificial health produced by the use of ardent spirits. Its vigor is temporary, and is always followed by misery and death (ibid., p. 3 L J1). die uno ^^' ^ wcm W as soon believe that ratafia was intended by the author nopoiy fur- of nature to be the only drink of man, instead of water, as believe that ther consid- ^ Q k now ] e( ]g e () f w h a t relates to the health and lives of a whole city or nation should be confined to one, and that a small and privileged order of men. But what have physicians, and what have universities and medical societies done, after the labor and studio;; of so many centuries, Medical ig- towards lessening the mortality of pestilential fevers? They have either norance and copied or contradicted each other in all their publications. Plagues and contradic- -T,. , ., 1%1 , , , . , l . „ , yO tions. malignant levers are still leagued with war and famine m their ravages upon human life (ibid., p. 323 ; cf. Asclepiades, 63). 406. A Mohammedan and a Jew might as well attempt to worship why Dr. the Supreme Bein l ' ., • • i i never "con- same ceremonies, as physicians ot opposite principles and practice at- ^hebari? tempt to confer about the life of the same patient. What is done in wine and iau- consequence of such negotiations (for they are not consultations) is the ineffectual result of neutralized opinions; and, wherever they take place, should be considered as the effect of a criminal compact between physi- cians to assess the property of the patients, by a shameful prostitution of the dictates of their consciences. . . The extremity of wrong in medicine, as in morals and governments, is often a less mischief than that mixture of right and wrong which serves, by palliating, to perpetuate the evil (ibid., p. 349). 407. In one very malignant case the most drastic purgatives brought BLAciVlml) away, by fifty evacuations, nothing but natural stools. The purges were F Js-^m] continued, and finally black fasces were discharged, which produced im- fear'not and me diate relief (ibid., p. 375). « 408. I observed the same relief from large evacuations of fetid bile in This plan the epidemic of 1797 that I have remarked in the fever of 1793. Mr. move? debit Bryce has taken notice of the same salutary effects from similar evacua- ity; tions in yellow fever on board the Busbridge Indiaman in 1793. "It was observable that the more dark colored and fetid such discharges were the more early and certainly did the symptoms disappear. Their good THE DOCTRINE OF PURGATION. 103 effects were so instantaneous that I have often seen a man carried upon deck, perfectly delirious with subsultus tendinum, and in a state of the greatest apparent debility, who, after one or two copious evacuations of this kind, has returned of himself, astonished at his newly-acquired strength " (Annals of Medicine, p. 123). 409. Very different are the effects of tonic remedies when given to re- move this apparent debility. The clown who supposes the crooked ap- whilst tonic pearance of a stick, when thrust into a pail of water", to be real, does not su-oy.^*^ de err more against the laws of light than that physician errs against a law of the animal economy who mistakes the debility which arises from oppression for an exhausted state of the system, and attempts to remove it by stimulating medicines (vol. IV., p. 38). INTERESTING ARTICLE. Baklow, Edward, M. D., Pathological and Practical Observations. Path, 1S10. See Edinb. Med. and Surg. Journ., 1814, Vol. X. 410. Purgatives are of three sorts : some evacuating the fecal con- Purgative* tents of the intestines ; others acting on their exhalent arteries, and pro- caY CU maner~ ducing copious watery stools — and a third class stimulating the mucous fery^ooit follicles which so abundantly line the intestines and causing them to ex P el mu - ' expel the mucous matters they so copiously secrete. When the bowels first, m mac- are merely inactive, their secretions healthy, and no constitutional disease th«T n bowds, present, the simple aperients of the first class suffice to obviate costive- eJjJSjjJJSS. ness and prevent feculent accumulations. The second are requisite .second, in when, in addition to unloading the intestines, it is desirable to abate Son o/fevet internal action or allay fever, by reducing the quantity of the circulating r c ?rc3ng e fluid ; and the third are required either when the mucous secretions are S^morbS so morbid as to give rise to diseases, or when they are too copiously gen erated in consequence of increased action of the vascular system (pp 431,432). ' F1 Brandreth's Pills in one medicine accomplish the three indications required. In doses of from one to four Pills, they evacuate the fecal contents of the intestines ; from four to six they operate upon the exhalent arteries and produce copious watery stools ; in doses of from six to ten pills they stimulate the mucous follicles which so abundantly line the intestines, causing stools of pure mucous. In headaches, dyspepsia, apoplectic and paralytic symp- toms, and in gout and rheumatism, no cure can be obtained without the expulsion of large quantities of this mucous, which Brandreth's Pills effect with entire safety. 411. When it is considered that the diseases of repletion are by far Diseases of the most numerous that the human body is liable to; that the alimenta- ^rf^viV ry canal affords one of the most important outlets for discharffino; the c ,annot b f i j?i_i ± iiy'i-i • • i i' & • & . t dispensed reuundancy ot the system ; that it is also a principal one lor getting rid with to re- of the excrementitious impurities, with which in such diseases the blood 'Tementf-*' is speedily adulterated, and that the diseased secretions which accumu- "^onTthe" late within it are oftentimes a means of continuing, of complicating, i>i»wl. and even of creating various diseases in different parts of the body, tlie value of purgatives cannot fail to be duly appreciated. It remains for me to show that such morbid secretions do exist within „ u . -i in* • it ii i i«i . Morbid se- ttle stomach and intestines, and that they do produce therein the effects cretions in now attributed to them, being the direct cause of some local complaint s, ESs^ef 11 while they beget also, by remote sympathies 5 diseases in distant parts (p. sympathy. in morbidity or super- abundance of mucou3 secretions. Examine the 104 THE DOCTRINE OF PURGATION. ■ 412. Of the existence of superabundant mucous in the stomach and intestines during inflammatory complaints, sufficient proof will be oMntesKs afforded merely by inspecting the discharges brought off by particular and stomach, evacuants, or occasionally by the natural efforts. With respect to the stomach this examination may mislead, if only superficial ; for the mucous being clear and colorless, is not readily distinguishable from the watery fluid surrounding it ; if, however, a rod or wire is passed through the liquor, and elevated, it will raise the mucous existing therein, and sufficiently manifest its dense and viscid nature (p. 433). J"?™™ 413. It is this mucous that is produced by increased arterial action, ud,iih mucous / - y> ._ ii^»i i • creates dis- affecting the mucous glands oi t lie stomach in common with all the ■j;A\;y. other parts. To it, and to the action which produces it, superseding the healthy action of these parts, do I attribute the incipient nausea of fever purgatives anc [ f constitutional inflammation ; and its expulsion I deem important tion of the both as removing an injurious accumulation, and as enabling the secret- se ex P e iiing in ing vessels, thus disencumbered, to continue those efforts, whose direct mucous. tendency is to relieve the general circulation, however inadequate they may be, when unassisted, to accomplish this purpose. Similar secretions are going forward also at such times throughout the whole course of the intestinal canal, and are evidenced by the quantity of mucous which a dose of calomel or antimony, administered under such circumstances uniformly expels (ibid). Howtose- 414. The want of sufficient attention being given to the peculiar galivelf-" effcct P ro( luced by different purgatives, may perhaps suffice to account whenthemu- for the uncertainty and indecision which still prevail in their employ- i ? 8° U of decent ment. If this mucous matter is recently formed, and in no great abund- dZmcfmf- ance > a common purgative of the drastic kind will suffice to remove it, fi<*i together with all such fecal lodgments as may have taken place in the intestines. A source of injurious irritation is thus removed • the various secreting and excreting vessels are left free to perform their natural func- tions / and the progress of nature, in her force to restore health, goes for- when it is of ward uninterruptedly. If the mucous secretions are of older formation , pmoet- and consequently more viscid, more tenacious and more difficultly expelled, '" the common purgatives fail to give relief, and a doubt is cast on the pro- priety of employing them, and on the veracity of previous reports of successful cures. The error here, however, is in employing a purgative salts me&ec inadequate to producing the effect required. . . . If saline purgatives are given with the expectation of cleansing the intestines when loaded with mucous secretions, they will very imperfectly effect this purpose (pp. 433, 434). mS%t™t- 415. The quantity of this mucous secreted in acute diseases is very cous from considerable. It lines both the stomach and intestines, and causes many e'asesVndcr powerful medicines to pass through them without .producing their ordi- of m?Dy a pu° nary effects ; for, in consequence of the interposed mucous, the medic/ ties gatives. come only imperfectly or not at all in contact with the living fibre, which alone they are capable of stimulating. It passes through, therefore, as if either the living fibre were torpid, or the medicine inert, when neither supposition is correct / and- to mistake and accident we are occasionally tion ful purga tual. THE DOCTRINE OF PURGATION. 105 indebted for illustration of this subject, which perhaps regular prac- tice would more slowly and imperfectly afford us. For the errors of dispensers and the stupidity of patients have not unfrequently afforded me instances of inordinate doses of purgative medicines being given, with only moderate and salutary operation (p. 434). Large doses often have but moder- ate opera- 416. Case of scarlatina given. — Purgatives were, in consequence, Scarlatina. thenceforward more freely employed, and the effect regarded more than and noTtfae the dose necessary for producing it ; and although the inflammatory considered. fever ran high, and was not allayed for many days, there did not occur a speck of ulceration on either tonsil. Neither did any of the ordinary sequelae attend the disease, but the recovery was progressive and com- plete. We may hence infer the difficulty of establishing the precise dosea of medicines to be admitted, and must be conscious of the superior ad- vantage of attending solely to the sensible operation, when this is capable of being ascertained, disregarding altogether the quantity of medicine- necessary for effecting it. This is always possible with respect to purga- tive medicines, and to be accomplished by regular inspection of the alvine inspection evacuations, without which the practitioner must remain in much doubt ^^free- concerning some of the most important operations going forward within ommended. the body, and must labor under great disadvantages in accurately apply- ing the remedies it is necessary to employ (p. 435). ter in the oc- casions gas- tric dis- eases. Gastro- 417. Morbid secretions are very frequently formed in the stom- Morbid mat- ach, which occasion a large proportion of gastric diseases. To par- stomach ° ticularize only one. Conceiving the pain in gastrodynia to proceed from a contractile effort of the stomach to throw off from its surface the mucous which offends it, I have for many years laid aside the use of dynia. opium and stimulants, which merely repress the effect, without at all re- moving the cause, and which even tend to add to this by stimulating the s f^uiantf glands to increased secretion of the offending mucous, and have trusted d ° uot ™- solely to such medicines as act by expelling that matter, to whose presence cause— pw- I attribute the complaint. . . ga ^S%J t ' I own I am averse to relieving the pain by opium, or by any means °^ e a D t ^ s but a removal of the offending matter — as the relief to pain consequent upon such evacuation may be relied on as annmincing the radical care of the complaint. In some hundred cases that I have now treated on these principles I have in no instance given a grain of opium, or failed in giving decided relief iVlmost the only medicine I employ as a purga- tive compound consists of extract of colocynth, calomel, and antimonial powder (p. 436). 418. The disease of colic I believe to he, precisely analogous with gas- Goiio-WA trodynia, both in its pathology and treatment, and to differ only in being treatment - more prone to pass into inflammation. The remote sympathies which different parts of the body evince under disordered condition of the stomach and digestive organs have often engaged the attention of prac- titioners (p. 437). 419. I have mentioned that in all complaints attended with fever, or conXtion- constitutional inflammation, the gastric and intestine secretions arc ^ a ^;H'" u ' Morbid se- cretions and 106 THE DOCTEINE OF PURGATION. quickly increased. Accumulations of morbid secretions oftentimes take place in the alimentary canal, of slow and gradual formation, and not increased ar- referable by any well-marked connection to a state of generally increased arterial action. The former state may even be superinduced upon the latter, and thus an additional complication, both of diseased action and of diseased condition, ensue. A disease, in which this morbid state of the secretions exerts considerable influence, is rheumatism (ibid.) Cases Bheuma- „ -,-, N J turn. tollow : Gout. 420. Admitting, then, the pathology to be correct which attributes Cure°iy' gout to the existence of a state of plethora and inflammation in the blood- yurqatwes. ves8e i s ^ anc [ the influence of vitiated secretions within the alimentary canal — which latter may be regarded in a great degree as the natural product of the former — does it not seem to be fully within our power to bring this hitherto intractable disease under the control of rational prac- tice ? And may we not hope to treat it as effectually, and much more safely, by the well-ascertained powers of such a remedy as a combina- tion of colocynth, calomel, and antimony presents us with, as by the less manageable means of white hellebore, or the precarious and uncertain Coichicwn. « eau medicinale," i. e. % " colchicum f n (P. 441.) Applicable to 421. The means I would recommend are advocated not for their Bm piiit Ws possessing any secret or unexplained power ov^r disease, but from their being pointed out by a rational pathology, and fully established, both with respect to their safety and efficacy, by extensive expei-ience (ibid.) B. G. B., Observations on the Treatment of the Sick returned from Corunna. See Edlnb. Med. and Surg. Journ., 1810, Vol. VI. Mvers. 4-22. There appears too great a desire of discovering something like M Si™*ir a specific for fever to the very great neglect of obtaining evacuations. can never su- -l i i i t • 1 • i • i it persede pur- (Jalomel seems to be regarded m this way, and is abundantly employed cure^— some 6 - with a view of producing some particular irritation of the system that aTapurga- w ^ arrest the progress of or remove the complaint. twe. Whatever this medicine may do, after evacuations have been prom- ised, I feel certain of one thing, that it will never supersede the neces- sity of evacuations in fever ; and I question very much if its good effects in fever, and in all inflammatory complaints, do not depend tipou its evacuating qualities (p. 170). Dr. Freind 423. Those, however, who attempt to cure inflammato7 v y fever, or in- on fevers- -flammation. by any other means than by evacuation of some sort or other. evacuations J -> v J p J , > alone can will lose many an opportumty for doing good j and, m confirmation 01 ^utmTm— this opinion, 1 will quote the authority of the very learned Dr. Freind: death. a jj oc umim libi spondeo te experiundo comprobaturum, quod silicet ex febribus multsG evacuantibus solis, etiam si haud alio fueris remedio usus, cedere consuescant ; vix ullas antem, quae paulo vehementius in- valuerint, medicina qualiqunque, si ab hoc evacuandi instituto decesseris, restingui possint." (Commentaries on 1st and 3d books Hippocrates.) Dr. Freind here observes tluvt many fevers will yield to evacuations alone, when no other remedy is used / but scarcely any will be removed, Bilimis fe- ver. THE DOCTRINE OF PURGATION. 107 when the fever is great , by any remedy whatever, if evacuations are not employed. I have no hesitation in saying, when this plan is speedily adopted, that the most beneficial effects will generally result, and that a great many cases of inflammatory fever which would otherwise have ended fatally, or become putrid, and have been protracted for a fort- night or three weeks, or even longer, will by this system terminate favor- ably in a week (pp. 170, 171). Tuomet, Martin, M. D., A Treatise on the Principal Diseases of Dub- lin. Dublin, 1810. 421. Bilious fever. — Purgatives must be steadily persevered in throughout the complaint, for it is upon them we must chiefly rely for success ; and as the accumulation of foul matters in the alimentary canal is constantly and copiously produced, so there is no disease in which the free and regular use of purgatives causes less distress or gives more* uni- form relief It frequently happens that from the operation of a purga- copious tive a large quantity of foul excrements come away ; and yet in ten or ^ a cuaUoL twelve hours after there is another large evacuation, so as often to cause ^jjSuJnt just surprise how so much could be generated in so short a time ; and induce no these copious and foul evacuations continue for several successive days without inducing proportionate weakness, but, on the contrary, they procure great mitigation of the symptoms. Even delicate and young females are relieved, without being exhausted, by these evacuations (p. 8). 425. So far from producing weakness, we have often observed with Fvaoua . pleasure the renewal of strength, which these evacuations occasion, when Hona give a languor or depression of the animal powers, even to faintness, had pre- remove de- viously existed. But we have likewise remarked that, as soon as the blllty ' alvine excretions have assumed a natural appearance, a much smaller evacuation has actually produced a considerable reduction of strength (p. 9). Dark forces . 426. It is remarkable that we are disappointed of any substantial improvement in the state of our patient whilst the dark f wees remain are critical, behind, notwithstanding the quantity of the evacuations procured (ibid). BtrcHAN, A. P., M. D., Bisnomia. London, 1811. 427. Is it credible that a human infant should be so imperfectly or- Chiwwod ganized that it cannot pass over the years of childhood, naturally the oaiomO. most healthy period of life, except the biliary system be ever and anon expurgated by calomel? or that the early and habitual use of this min- eral poison can be unattended with injurious consequences? Perhaps the time may come, when the most judicious plan of curing^ internal as timelo^ome well as external complaints,will be acknowledged to consist in removing all impediments to the natural exertions made by the vital energy to re- store health (p. 71). 108 THE DOCTRINE OF PURGATION. Clark, Joseph, M. D., On the Bilious Colic and Convulsions of Early Infancy. Dublin, 1811. See Transactions of the Royal Irish Academy, 1811, Vol. XL childhood- 428. In the beginning of my practice, as long as I pursued the beaten Co ™bI s aA 8 track of employing mixtures of rhubarb and magnesia, solution of man- practice fatal na { n fennel-water, chalk, musk, opium, and blisters, recovery from con- the cure, pulsions in early infancy was a rare occurrence. After six years' close attention to the subject I am convinced that in colic and convulsions nothing but a brisk expulsion of the contents of the bowels is likely to afford permanent relief. A dose or two of castor-oil, or a common pur- gative enema, may remove slight attacks of this nature. It is in general after the failure of such measures that a physician's advice is required (p. 124). Hons—i astke ^29. The purgation must be very active and continuous to be efficient. quantity so I n the course of recovery the quantity of evacuation seldom fails to as- tonish the attendants, who cannot well comprehend whence it all can be derived. The relief obtained is uniformly proportioned to ths quantity discharged (ibid.) Armstrong, John, M. D. Observations on tlie Origin, Nature and Treatment of Tyvhus Fever — m Medical Intelligencer, 1812. Man^oT'its 430. The want of due decarbonization of the blood is the cause of symptoms many of the most remarkable symptoms attendant on typhus. Blood ™Z^rhon^ not duly decarbonized, operates more or less as a narcotic on the brain, Mood. OJil>e an d tends materially to influence the animal heat and the heart's action ; and hence partly arise the muddled shite of the brain, the smothered Jieat of the surface, and the soft, compressible pulse, &c. Why typhus-fever intermittent assumes in one person an intermittent, and in another the remittent or 0T }o™n— nt continued form, is most probably owing to the dose of the poison, or the causes of. condition of the recipient, or both conjoined (Med. Int., No. 30, May, 1812).* Tlie Morbid Anatomy of the Bowels* Liver and Stomach. London, 1828. Smaii-pon, 431. Tlie contagions of small-pox, measles and scarlatina first ope- rate on the blood, and that fluid being thereby changed, the solids are specifically affected, especially the skin and mucous membranes of the air-passages ; and these affections, too, if left to themselves, and even Nature com- often in despite of medical applications, have a determinate course, the tiuai e flowin g blood apparently, like the water of the Thames, requiring a certain lime river. y or fa purification, which it effects, perhaps, by throwing off the effete and superfluous matters, through the secretions and excretions (Art. I, p. 10). Letter to Dr. Boot, contained in Dr. Boot's edition of Armstrong's Works. Much learn- 132. I have never yet met with a learned physician who was a good fSfiyfn e prac- practitioner. At the bedside such men are lost in the conflict of au- tical matters, thority. measles, scarlatina — ?>lood-dis- eases. THE DOCTRINE OF PURGATION. 109 Hartz, William, M. T>. On the use of Purgatives in Purpura. Dublin. 1813. See Ediotb. Surg, and Med. Journ., Vol. IX. 433. Purpura. — Convinced by my previous ill success of tne ineffi- cacy of mere tonics in bad cases, and favorably impressed by the occur- rence of cholera previous to the appearance of the petechia?, I determined in this case to direct my whole attention to the state of the abdominal viscera, and accordingly prescribed brisk purgatives. From the good effects of the first, I directed its repetition for a few successive nights. To my surprise the hemorrhage soon ceased, the spots rapidly disap- peared, and in less than ten days the patient recovered, under every possible disadvantage of constitution, of air, and of diet. Encouraged by the unexpected result of this unpromising case, I no longer hesitated in employing purgatives, and trusting to them only in both species of the complaint. It was often necessary, however, to purge to a great extent (p. 186). Purpura— the regular practice un- successful — purgation cures. Important case. Full and free purgation re- quired. 4:34. It appears from the observations of Burserius, that Strach sup- poses petechias, to originate/Wwi vitiated bile in the prima} vice, and from a tenacious mucus adhering to the intestines, * and that he accordingly proposed strong cathartics as the proper remedy for the disease. . I have carried this theory farther, and have, not without advantage, allowed it to influence my practice in typhus, when petechias are present, and many very desperate cases have appeared to me to owe their recovery, almost from the jaws of death, to tJie powerful and repeated interposition of purgatives (p. 187). Typhus. Petechias from vitiated bile. Medicus. Vol. XL On Pathology. — See Edinb. Med. & Surg. Jour. 1815. 435. Disordered actions of the human body arc, generally speaking, the means which nature employs for the expulsion or removal of offend- ing agents ; thus if the stomach be excited to vomit, the cause producing that disturbance is removed by that action ; thus also diarrhmas carry off noxious matters ; and the emunctories of the body are generally cleared out for the same purpose (p. 335). ■ As a machine, the human body may be said to " go,^ at the same time that it includes powers for repairing all injuries that otherwise would prevent its going, and these reparatory processes include almost all the symptoms of disease (p. 336). Natural cure by vom- iting, diar- rhoea, etc. 436. We will suppose, for example, that the stomach, unable to per- form healthy digestion, presents to the liver, as it passes to the duodenum, ;m ill-concocted chyme or chyle. Does it nut become necessary thai the liver should pour forth a bile suited to the purpose it has to answer I a purpose far different from what would be required if a healthful digestion had taken place in the stomach. Such a bile cannot be deemed improper, since it answers the purpose for which it was intended, name •f carrying through the bowels what was noxious, -and of effectually Thculnniach — vicarious function of the liver. 110 THE DOCTRINE OF PURGATION. assisting in assimilating such parts as are healthy and proper. To attack the liver, therefore, because it has done its duty, would be adding to the Mi faSic^ ev ^ s wn ^ cn already excited its powers, and would be exhausting those checking the means of resistance and reaction which were appointed for the most functfon°pro- benelicent of purposes. To oblige, by medicine, the stomach to retain tompiaZT' SUC ^ substances as, in a state undisturbed by medicine, it would reject, is the readiest conceivable method of calling forth the symptoms of " liver affection" and a general disturbance of the alimentary functions. And thus it happens that the more extended reactions of the constitution follow these circumstances, and thus, by a very easy process of reasoning, shall we arrive at those causes which produce gout, asthma, cutaneous diseases, and in short a long train of grievous maladies (p. 336.) Purgatives 437. During healthful digestion, feelings are excited far different from those which arise when the meal has not been regulated by mode- re!tore ca ration and sobriety ; and how often are means applied to appease the he ges h t[on. dl " tumult occasioned at such times, and thus so many noxious agents are introduced, which become all the causes of great and extended future mischief (p. 337). 438. It has been said that foulness of the bowels is a common cause a^botoeis— of disease. It appears to me that when the bcnvels 2>roduce the foulness, curative. so ft en observed, such fotdness proves curative. It is a reaction of the liver (?) against a constitutional disturbance, which in the end proves curative. Immediately on discovering this foulness, we feel satisfied that on its removal the various symptoms of disease will disappear (p. 339). 439. There is a balance in the constitution consistent with every nat- tending *tT ural effort ; it may be called the diathesis, such as gout, and a variety of the a cons°tuS- other inflammatory affections, and these states of balance involve their tion. own series of phenomena. Thus the head may be oppressed with a super- abundance of blood, and may be liable to affections under one form or series ; another may involve rheumatism ; another, gout, &c. ; and all of them, extended reactions of the system, tending towards a reparation of the constitution. It may be observed that foulness of the bowels cannot exist to the full extent at which it appears at any one period ; for the quantity that on some occasions is discharged would be more than the canal was capa- ble of containing. It must, therefore, be the result of successive deposi- tions from some great secreting organs. For instance, during the exist- ence of disease, wherein there are great determinations of blood, ape- rient medicines bring away evacuations of no particular character; but after a little time the circumstances of the case alter y heavy, lumpy, and' discolored evacuations begin to appear, and contin ue to be parted with. As soon as these appearances arise, the symptoms of the original disorder begin to diminish, and, in the course of a short time, disappear altogether. It must have occurred to every practitioner who has strictly examined these circumstances, that he has found a difficulty in accounting for the quality and extent of this collection of foulness (p. 339). THE DOCTRINE OF PURGATION. Ill 440. It must also have been frequently observed that affections of fSid h e lat the head, epilepsy, chorea, local diseases of various kinds, and great and br 7 "ak°tbe extended affections of the shin, have all given tody as soon as the vowels power of ais- have expelled a quantity of foul and fetid evacuation. During the ^ce^eSc?" progress, however, of these maladies, the bowels have not shown the same tIons " character until the disorders have attained a particular stage, and then the progress towards health is decided. Could we succeed in bringing about this stage, many very grievous maladies might be cured ; that is, we might induce thereby the various organs of the alimentary canal to render the more extended reaction of the system unnecessary. I do not mean to deny that there is occasionally a very great accumulation in the bowels, so foul a state of them that toorms occur, wdxieli appear there to worms. have found a proper nidus ; and that other great sympathetic affections take place arising from these accumulations (ibid). 441. If we trace these affections, we shall find many natural efforts The natural made to remove such accumulations and foulness ; and even that many ^nT7e di c- very distant reactions occur tending to relieve the body of the griev- tion. ance. Thus the blood returning through the " venaportw," is delayed, and as the heart acts uniformly, more blood flows to the head than usu- T ^t^^~ ally, in consequence of this remora in the return of blood from the lower circulation. This fullness of blood in the head, occasions many reactions, amongst which we may rank epilepsy, which shakes the whole Epilepsy. body in convulsions, and is the means of removing worms and other foul- ness from the bowels, as under the influence of that disorder the alvine and urinary excretions are violently expelled (pp. 338, 339). 442. Why disease and cure are units, physiologically accounted for. IMmur- gativeSi 447. I consider the introduction of the free use of evacuating reme- dies into the treatment of nervous diseases as one of the greatest im- provements of the medical art which has taken place of late years. Imperfect as our knowledge confessedly is with respect to the pathology of nervous diseases, and inadequate as our remedies frequently prove themselves to be, we have yet the satisfaction of perceiving that we are evidently in the right path ; and that, when we have not the means of cure in our power, we can at least often palliate, without incurring the Epilepsy, risk of making matters worse cures of epilepsy given. than we found them (p. 459). — Cases of Neurosis. Mania. 448. I have tried the use of evacuant remedies in several other dis- orders of the class neurosis with success / but in none with more singu- lar advantage than in mania, in which distemper I have had extensive opportunities of witnessing their effects, having been for some years one of the physicians to a hospital where a great number of lunatics were admitted. I am firmly persuaded that if medical practitioners would depend more on physical and less on moral remedies, they would succeed THE DOCTRINE OF PURGATION. 113 a greater proportion of cases, especially recent ones, than generally happens (p. 456). m 449. Indications to be obtained by the use of purgatives are : 1. By removing sordes from the intestinal canal. indications I am every day surprised at the prodigious accumulation of iu!L ga ' fecal matters which I find to take place in the intestinal canals of patients of all years. 2. As depleting the system. 3. As determining the fluids from the head. 4. As setting up a new action in the system. 5. Purging is a powerful means of stimulating the absorbent sys- tem, as we witness its effects on dropsical patients. 6. A course of moderate purgation is one of the most efficient methods of invigorating the digestive organs, improving appe- tite, and removing visceral obstructions (p. 466). Dickson, D. J. H., M. D., Superintending Physician to the Russian Fleet. On the Utility of Depletion in a Fever among the Russian Sailors. See Edinb. Med. and. Surg. Journ., 1816, Vol. XII. 450. It is now well understood that the value of purgatives is not limited to the mere removal of the fecal contents of the bowels, but that they may be so managed as to obviate or relieve a tendency to topical congestions elsewhere, and also to produce a considerable effect upon the general system, by the increased quantity of fluids they cause the various glands and exhalent arteries to pour into the intestines. Thus they be- come more universally useful in diseases in general, in proportion as they are more uniformly applicable. . . . They were here considered not only indispensably requisite in the first instance, and assisted by enemas, when necessary ; but they were liberally exhibited throughout the disease ; and very often the bowels could not be kept sufficiently active unless they were repeated day after day (p. 175). 451. Though not a new, it is a very important observation, that all uncertainty as to their full operation can only be removed by inspection, without which the practitioner is very apt to be led to imagine by the patient from his own report, or that of the nurse, that he has been suffi- ciently purged, when, at most, he may have had only two or three par- tial scanty dejections. . . While we are producing foul, dark, fetid evacuations, we may naturally expect that we are benefiting and relieving the patient. By those that have not had much acquaintance with fevers it is hardly possible to calculate the quantity of medicine sometimes re- quired to overcome t?te torpor of the intestinal canal, the morbid accumu- lations that have been discharged after repeated purgations, and in some cases the speediness of their reproduction (p. 175). 452. In tropical fevers especially, I have seen very striking exam- ples of the abatement of fever and delirium after the operation of pur- gatwes, and it is therefore of great consequence to be aware that the febrile symptoms are often maintained or renewed by the retention of Purgatives — their value unlimited. Action on glands and evhalent ar- teries. Inspect the evacuation in order to exact suffi- cient pur- gation. Tropical fevers. 114 THE DOCTRINE OF PURGATION. Purges vitiated secretions, or other morbid contents of the intestines, as also of tkmed 6 untii the quantity of dark-colored offensive matter that is often discharged natural after the patient has been, thought sufficiently purged, and its speedy ac- stools ensue. *> 7 ,• • • i , a.* 1 r\ L . L -i • i ^ cumulation %n some cases, in order to estimate the extent to which it may be necessary to persist in the use of evacuations (p. 176). Naval Surgeon. Medical Tocography of New Orleans-, with an account of the principal diseases that affected our Fleet and Army on the last Expedition against that City. See Edinb. Med. & Surg. Journ., 1816, Vol. Xll Dysentery— its origin from the liver. Morbid mat- ters the cause which must be re- moved. They injure the fabric of the cause flux, ulcerations, etfc. 453. Dysentery. — In short, to give a condensed view of the whole matter, the phenomena of the cases that recovered, as well as the mor- bid appearances of those that died, impressed upon my mind a convic- tion that the diseased condition of the liver was the soil from which dysentery drew its malignant growth, strength, and nurture. This was the " fons et origo mali," by it the dysentery was excited, and only by its removal could the disease be removed. 1 can readily conceive that from the disease of any gland, the fluid it secretes may acquire acrimo- nious properties suflicient to injure the fabric of the passages through which it is destined to pass. We generally observe in dyspeptic complaints, or after a period of constipation, when the bile, from remora in the bowels, becomes morbid in quantity or quality, either that spontaneous diarrhoea comes on, or, after a brisk cathartic has been exhibited, that the dislodged bile excites a sensation in the rectum, as if boiling lead were voided. When the state of the liver is still more morbid, may not the bile acquire the property of exciting flux, and of excoriating and ulcerating the villous coat of the colon and rectum f (Pp. 142, 143.) Typhus and the bugbear " debilty." Calomei and James' pow- der. Neglect of evacuation — its conse- quence in ty- phus. Bark, wine, opium. 454. The imaginations of professional men in tropical climates were formerly held in subjection by that bugbear, debility, and its train of needless horrors. Systems of nosology had been pleased to style the dis- order " typhus icterodes ; " consequently active depletion was carefully shunned. The practitioner stood fidgeting with his calomel and his James' powder. The disease took its hue from the species of treatment employed at first. The neglect of evacuation allowed the excitement to riot and revel unchecked; hence came petechial, hemorrhages, &c. . . Then indeed the disease was pronounced " malignant, pestilent, and highly putrescent," and the golden opportunity occurred for throwing in — as the phase is — his bark, his wine, and his opium against that de- bility, about which at a wrong time he was over-solicitous. That caba- listical word " typhus," I verily believe, has slain its thousands and its tens of thousands (pp. 147, 148). Dropes, Richard L., Surg., Remarks on some Remedies which are Used in levers. london, 1817. See Edinb. Med. and Surg. Journ., 1817, Vol. XIII Fevers.— 455. Fevers. — Emetics, I am convinced from experience, have most oSapilVet- frequently proved injurious, and have seldom failed to aggravate the ice,&n&pur- sum pf; 0ms m a very obvious manner. The great concussion they give THE DOCTRINE OF PURGATION. 115 the whole system, particularly the brain, almost invariably increased the %£il escom ' violent pain so often felt in the head, and especially over the eyeballs; thesuprem- and this, it is to be presumed, by increasing the morbid action of the latter main- vessels of the encephalon. The only cases in which emetics are admissi- ^ed. and Me are those in- which an obstinate vomiting takes place, owing to some crudities in the stomach, which require to be evacuated (p. 59). 456. Diaphoretics. — I believe that it is on the principle of the heat sudoriflcs of the body being morbidly increased, owing to obstructed perspiration, rfoS'andby that sudoriflcs are prescribed for the purpose of removing this obstruc- no means apt tion, and lowering the temperature. However, I conceive this practice a°cuJe S ° is not well founded. Diaphoretics, before they can have the desired effect, almost always increase the morbid action, and most obviously have an injurious tendency. Besides, we have other means of lessening vas- cular action and reducing morbid heat without being attended with the same inconvenience as sudoriflcs. Every day we see patients attacked with fever completely recover without there being the smallest tendency to a diaphoresis through its whole course. When these medicines have been chiefly relied on, I have always observed the disease to be much pro- tracted, and the cure extremely tedious (p. 60). 457. Purgatives. — The generality of physicians place too little de- th^oX^i? pendence on these, and trust too much to other remedies. I know of no awe remedy, general means attended with so much success as the liberal employment in large of cathartics. They should be given in large doses, and often repeated, repeated!* 4611 till the patient becomes convalescent, which is generally in a few days from their first employment (ibid.) 458. When given merely as aperients their effects are only trifling; A p er ientand but when administered with sufficient freedom, with a determination of £"H purga- .7 •«* / y. /», , . 7 • tlve action reducing inflammation, their curatwe powers are ojten astonishing contrasted. (P- 61). Wilson, Andrew, M. D., Practical Observations on the Action of Mor- bid Sympathies. Edinburgh, 1818. 459. Nerves possess muscular fibers and blood-vessels, and are subject mrvms to foreign influences ; and the condition of the blood must influence their fromtmpure actions by influencing their secretion (text condensed from pp. 20, 21, blood - and 82). 460. There is no department of the nervous system by which, if cer- Sympathy tain or peculiar irritating causes are applied, some other department of ° the same system may not be influenced, so as to draw the organ to which they belong into morbid action by sympathetic affinity (pp. 165, 166). 461. Certain acrimonious matters applied to the extremities of the mr £^ in gastric and alvine nerves gwe a variety of deranged actions of the brain, ^ stomach although otherwise in a sound state, and the accelerated pulse of the ders of 8 °the whole arterial system, from inflammation found in a small portion of its U re 3 %to rict " capillary branches, is at once perceptible both to the eye and touch. . . 116 THE DOCTRINE OF PURGATION. Gastric irritation gives spasmodic affections of the bladder and kid- neys. . . Irritation of the lower extremities will excite nausea and vom- iting (pp. 166, 167). The body a 462. Of all the organs of the human body the gastric and alvine de- bid^Srs partment is that which is most extensively and constantly exposed to the derange any action of these causes ; a surface which extends from the cardia to the pa?t of ve tL rectum, every part of which is provided with nerves of the greatest sen- body - sibility (pp. 167, 168). Fever— its 463. Fever is excited by acrimonious irritation in the alimentary canal, or by the increased secretions which take place in the liver and other abdominal glands (p. 19). Heart-Ms- from as organs. 464. The natural and healthy action of the heart and the whole vas tue e digestiv« cular system is impaired and reduced below its natural standard, &i exhibited in palpitations, languid pulse, torpor of the limbs, syncope, and even death itself, in consequence of the mere application of a peculiar offensive substance to the digestive organs (p. 19). This paragraph applies to and explains the action of poisons. Typhus and yellow-feoer caused by infection act- ing on impurities. Purge xoith- out delay. 465. The approach of typhus and yellow fever is at all times attended by decided symptoms of an existing diseased state of the stomach and bowels, i. e., with those signs which are known to point out their con- tents to be of a morbid, irritating nature ; but whenever the alimentary canal happens to be loaded with irritating matter, some derangement of the healthy operation, either of the general system or of some particular organ of the body, is the certain result ; and when this state happens to be united with any other cause of fever (as infections), its effects are always thereby much aggravated. It is therefore reasonable to use every exertion in such cases to expel it as quickly as possible (pp. 107, 108). Malignant fevers. Experience from experience as the most advantageous is by discharging fror> 3ache3/^r- p r i mC B vio3, as expeditiously as possible, their irritating and offe 466. The method which the most eminent practitioners have adopted 7 rom the __ ? ensive copious de- contents, and in reducing the febrile heat by cold applications (p. 128). ^cate^cure It is also worthy of remark, as it further demonstrates the agei>cy of by removing t j ie con tents of the stomach and intestines, in producing organic inflam- a superven- . . 7 • i r n 777 ing cause of mation, that in these cases which terminate most favorably the stools are all along abundant and bilious, with some occasional bilious vomiting ; and that by these free discharges, the intestinal contents being carried out of the body as they are collected, their agency as a supervening cause of the febrile state is greatly removed, and they are not left to ac- quire that degree of acrimony which is necessary to the establishment of inflammation (pp. 129, 130). 467. A powerful morbid sympathy is called into action (in acute rheumatism), and becomes established betwixt the irritated digestive iv^orgS' organs and the ligaments of the joints ; the adjoining tendonous expan- Acute rheu- matism " a result of irri primary cause is re- moved. THE DOCTRINE OF PURGATION. 117 sions, the membrane of the muscles, and occasionally the muscles them- Paina con- selves, often forming organic obstructions, and exhibiting all the severe thT e phenomena of acute rheumatism (p. 210). . . The primary cause in the digestive organs is entirely overlooked, and so is left to continue its action with full vigor ; consequently the daily repetition of the spas- modic paroxj T sm depending upon it, keeps up the local inflammation on the sympathizing membranes, and often extends it (p. 220). 46S. These shiftings of the pains, and change of place from one part Atomcrheu- of the body to another, depend on the occasional change of place of the Pain^Xift, irritating matter contained in the intestines, to one with which some J? d tlie J? or " other distinct part of the body has a more direct sympathetic affinity change their than that which the pam has left (p. 249). location. 469. The character of atonic rheumatism consists in a painful aifec- rh ^^u sm tion of some muscular parts, or of their membranes. The pains are not —its charac- 90 severe as in acute rheumatism; they very frequently wander from one part of the body to another, although it often happens that they re- main fixed in one part for a long time. . . A particular muscle, or a portion of its fibers, become frequently so affected by the sympathetic spasm as to be impeded in its free action ; the pain being constantly aggravated by the slightest movement of the part, although quite easy when the muscle is at rest (p. 247). 470. The remote cause of these phenomena is decidedly seated in the Tb f 1 c 'J: h ^ of digestive organs in atonic as well as in acute rheumatism. They are in matic com- their nature spasmodic, only the seat of the morbid sympathy most com- p Jhe D «%!s«J- n monly appears to be one less susceptible of that inflammation which iV6 or, ^ns. forms the secondary disease of acute rheumatism (p. 248). 471. In the treatment of acute rheumatism muoh attention is due to th g Ja'SthI the state and circumstances attending the primary gastric fever. Expe- rnostfrea , .. . . S ' • 7 • evacuation rience has supported the opinion that, in proportion as the primary is required, cause of disease is removed, the sympathetic effect on the membranes of the joints begins also to subside (p. 221). In order to accomplish this object the most free evacuations from the stomach and intestines are re- quired, and the patient generally bears them well (p. 222). 472. But of a much more painful nature than the atonic rheumatism . Lumia^, -, n 7 7 .. L . 7 7 ■. .7.7. nip ihxeaxe, are the cases 01 Lumbago, sciatica, tic douloureux, and periodical or inter- ami uc-dim- mitting rheumatism. They are with great certainty to be traced from from dST' the same remote cause, and, like the former, are only sometimes attended mlntary with gastric fever, but are uniformly associated with decided signs of a nal diseased state of the alimentary canal (p. 249). 473. All local applications, independent of clearing the alimentary fijgagSJ canal from its contained acrimony, can go no further than merely to pal- °n'y paiu- liate the effect of this cause, but without curing the disease, which will cause" must not happen while the power of the other remains in action (p. 257). Jj c ;?™ oved laease of the all- 118 THE DOCTRINE OF PURGATION. Erysipelas. 474. Erysipelas is intimately connected with the state of the diges- removing tive organs, which is clearly demonstrated by the well-known fact of its th caus°e bld appearing in various degrees on the skin, in consequence of certain kinds of food having teen taken into the stomach, and this not only in too short a space of time after to admit of the chyle impregnated by them to be taken into the circulation, but while they as yet remained in the stomach, and the inflammation disappearing as soon as those contents were thrown off (p. 371). Sore-throat 475. From the great similarity of the general symptoms exhibited in l fJer a Som scarlet fever to those exhibited in typhus fever, it will be obvious that stomach- the treatment here ought to be very similar to that adopted to those vapors. • an ^ er typhus ; which is, in the first place, pointed to the mitigation of the two great supervening causes of fever — irritation in the primce, vim and excess of caloric — especially to that which is seated within the diges- tive organs ; the very exhalations from which, ascending to the fauces, do, beyond a doubt, tend to keep up the inflammation, and, consequently, the ulcerated state (pp. 142, 143). rurgaUon 476. That free evacuations increase debility is in reality an un- binty? 53 and foimded apprehension. . , Whatever will act upon the morbid cause, so strength as ^- evacua te it from the body, so far from weakening, will assuredly tend to restoration of the strength • and this is a fact which unvarying experience has proved in every instance where nature has not been already exhausted by other means (pp. 60, 61). The advan- 477. The intention is not merely to preserve the bowels soft, but to pSrgaUm! discharge from the intestines a lurking cause of disease ; to accomplish which purpose very full evacuations are always necessary, procured by Examina- the help of the most active purgatives administered in appropriate doses ; jections. " remarking the nature of what comes off till it puts on a healthy ap- pearance (p. 62). impurities 478. To restore health, purgatives must be perseveringly applied (in imping tyP nus fever), as it is certain that the retention of any sort of noxious than the matter in the primce vim, the tendency of which is in general to lessen u gation pur " the energy of the nervous system, is infinitely more debilitating to the human frame than the temporary fatigue attendant on the moderate operation either of an emetic or purgative medicine, besides the harm which may ensue from the noxious matters being partially reabsorbed (pp. 110, 111). ifeaste*. 479. That a state of morbid sympathy betwixt the stomach and between 7 lungs does actually exist in many cases of measles I believe to be cer- 8t iSn^-^ d tain. My belief is founded on the very great relief from pneumonic purge' the symptoms received by a free discharge of acrid matter from the stomach acrid mat* J .£, . i • /v i • i -\ " i n p it ters away, and intestines — a reliei wmcli can be accounted tor trom no other law of the animal economy. Repeated bleedings will, no doubt, tend to me and ng lessen the vascular action, but probably in no high degree, while the miidpurga- secondary cause of fever continues to give its irritation to the nerves of useies^and the stomach and bowels ; and it is obvious that venesection cannot act as why * a means of removing this cause, neither, indeed, are the more lenient THE DOCTRINE OF PURGATION, 119 cathartics to be depended on for this purpose ; for although they will to a certainty open the bowels, yet they very frequently pass along and leave the offending cause behind. It is the more active powers of drastic pur- gatives alone which are here to be confided in (pp. 136, 137). Hamilton, Jr., John. On the Use and Abuse of Mercurial Remedies. Edinburgh, 1819. 480. In pleurisy, from the time that the influence of mercury be- Pleurisy— comes evident, the general strength rapidly declines (p. 7). eKf 1 ^ mercury. 4:81. If there be ulcerations in any part of the body, they must as uicers— certainly degenerate into malignant sores, under the influence of mer- S^Unt by cury, as* blistered surfaces or scarifications mortify in cases where the m6rour v> living powers are much exhausted (p. 9). Johnson, James, M. D. Critical and Explanatory Remarks in his Periodical, Medico-Chiruegical Review, established in 1819. 482. Purgatives in intestinal inflammation have been objected to intestinal on the ground that they are quickly rejected by vomiting ; but this ob- %nfl uoT a ~ jection is not valid. . . If the first purgative be rejected, it is repeated G t iv| a unuf" by Dr. Pring in an hour or two, and so on, with various forms of pur- the .stomach gatives, until the bowels are opened, when in general we find the ball and the cure at our own feet (vol. IV., 1823, p. 259). is effected - 483. Dr. Pring says, " typhus has two origins, one from external Typhus— affection, and the other from a spontaneous generation of disease in the. lts ongin * subject affected by it " (ibid., p. 250). 484. His favorite practice is purgation of a very active kind (Pr., p. {r f pop ^ xy 102) ; has seen his patients stimulated into fatal apoplexy (ibid., p. lants. 251). 485. In the treatment of any form of chronic disease, whether in chronic dis- the digestive organs or elsewhere, purgatives frequently increase the JfeVt'o/ symptoms at first, an effect which is rather desirable than otherwise, 8 Cifng™the and it proves that the remedy has a relation with the disease, and is , remed y *> i i j» i • i • • n • -in /y> • i 7/» have a rela- capable ot subverting this state, ij continued j or a sufficient length of «©» with the time (ibid., p. 275). • dlsoase - By the use of Brandreth's Pills the vital forces change chronic affections into acute. Then further purgation with them soon effects a cure. 486. Dr. Abercrombie is of opinion that the only remedies of real ^p 1 ' 16 ?*?: efficacy in epilepsy are purgatives and a strict vegetable diet, with total purgative*. abstinence from strong liquors (ibid., pp. 127, 128). 487. Constipation in Pregnancy. — De Lemazurien was sent for on constipa- the 8th of July, 1823, to see a woman in the seventh month of her pregnancy. Abdomen much distended, transverse arch of the colon 120 THE DOCTRINE OF PURGATION. greatly distended, pulse and appetite feeble, dyspnoea, sleeplessness, F qiSices n of" faintness, pains in the loins. Lavements were ordered, but it was deter- th o} iurgT* mme d to wait till the accouchment was over before the evacuation of tioninpreg- the bowels should be attempted. After child-birth, clysters being employed, the fecal accumulation appeared to break up, and there was an evacuation of two or three pounds of hard brown fetid matter, but there remained a collection too large for expulsion. The patient was worn down by nausea, fever, col- icky and other pains, and died 21st September. The colon from the caecum to the rectum was found to be intensely inflamed. It was a foot in circumference throughout its whole length, was filled with gas and with 13^ pounds (French) of solid faeces (1824, vol. I., pp. 233, 234). This case was simple. Two or three doses of Brandreth's Pills would have certainly re- lieved, by thoroughly removing all the fecal contents of the bowels. And no danger incur- red at any period of gestation to either mother or child by the use of this safe but certain medicine. Epilepsy. 488. Epilepsy. — The views of Dr. Chapman coincide with those of The cause Dr. PrUchard, in placing the cause of apoplexy very frequently in the seated in the bowels. He was led to the use of purgatives by the total failure of the re°moved by ordinary plans of treating the disease : " it will not do, however" he says, purgauot. tt merely to evacuate the bowels ; cathartics must be repeated day after day without interruption, unless absolutely forbid by circumstances " (vol. IV., 1823, p. 73). 489. The retention of biliary, urinary, intestinal and cutaneous from" excretions is often the remote cause of diseases of the nervous system, Nervous diseases retained ex- cretions, as well of the neuralgic as of the spasmodic and maniacal groups (New Series, 1852, vol. X., p. 97). Neuralgia 490. Whenever there exists " induced local susceptibility " morbid from morbid elements in the blood act most obviously in inducing neuralgia. Mala- matterinthe . ,. ,« / - 1 -i-i-i . biood, which rta m&j be present therein, yet remain latent and harmless until this part predis^ state occurs. So also the materies morbi of rheumatism or gout may Sue?' ^ocai n } r aD0U t until it is specially manifested in some locality rendered disease. more susceptible by predisposing causes. It may be observed that poisons in general have a specific elective affinity for certain portions of the nervous system (New Ser., 1852, vol. X. p. 103). aii our 491. We find that under certain circumstances a drug does good, and medTdnf e is we employ it when those conditions present themselves. The modus rie™ce. exper operandi is often totally unknown, and though it would be very satisfac- tory to know it, yet we can dispense with it, and from experience alone prescribe our remedies with very considerable success (New Ser., 1851, vol. VEIL, p. 204). Erysipelas 492. The condition of the alimentary canal should be carefully e r d 0m and ta pS- watched in erysipelas, for we have long suspected that it arises more trid/ceees. frequently from its derangement than the generality of the profession are aware. Excreiyientitious matter allowed to putrvfy in the fecal tube will not only operate as an irritant upon the whole system, but from the close and constant sympathy which holds between the cutaneous and THE DOCTRINE OF PURGATION. 121 mucous surfaces, may be expected to exert a deleterious influence more immediately upon the skin. Hence the erysipelas bilcosum and gastri- cum of many writers (p. 371, Ser. I., 1828, vol. IX). 493. In the concluding stages of the putrid fe 1 been long neglected before assistance was pr the most tedious and inveterate forms of the disease (ibid). ^evers, when the bowels Putrid had been long neglected before assistance was procured, we have seen Sat* from* neglect of bowels. Boyle, James, Surg., A Treatise on Epidemic Cholera in India. Lo n- don, 1821. 494. It sometimes happens, after patients are despaired of, they have a critical evacuation of viscid bile. When this circumstance takes place the patient invariably recovers. I have known it to occur in cases when the pulse had been almost imperceptible for twenty-four hours. I looked on the obstruction of the biliary ducts as a source of irritation to the nervous system generally, and the nausea and sickness of the stomach as an effort of nature to free herself from an unaccustomed evil. These views and a general want of success in practice induced me to embrace ideas perfectly new on the subject. Emetics and purgatives were adopted as the most likely means to answer the various purposes of clearing the stomach, removing obstructions of the biliary ducts, and exciting a new action in the vascular system (pp. 51-61, condens.). Many successful cases given. The very course I pursued in London in 1831, and again adopted in New York in 1849, 1853, and 1866. Chapman, N"., M. D., President of Academy of Medicine in Philadel- phia. The Elements of Therapeutics anci Materia Medica, 2 Vols. Philadelphia, 1821. Cholera— its cause, and purgation its cure. 495. Gout. — My impression, very concisely stated, is, that this dis- ease, if not originating m, has a most intimate connection with, certain state of the alimentary canal. It generally commences with those symp- toms which denote a depraved condition of the stomach and bowels (p. 190). 496. I have now for many years habitually employed purgatives in the paroxysms of gout, and with unequivocal advantage. Not content with simply opening the bowels, I completely evacuate by active purging the whole alimentary canal. This being accomplished, all the distress- ing sensations of the stomach which I have mentioned are removed, the pain and inflammation of the limb gradually subside, and the paroxysm, thus broken, speedily passes away. To effect these purposes, however, it is often necessary to recur to the remedy frequently (ibid.) 497. Palsy. — Dissatisfied with this course (the-usual routine of bleed- ing, blistering, and stimulating embrocations to which he formerly had recourse) I have for many years abandoned it, and rely now almost ex- clusively on evacuating the bowels by the drastic purgatives. Of the propriety of the change I can entertain no doubt, the success having Gout— its origin. Cure : by powerful purgation. Palsy. Bleeding re- jected. Purgation hi 'g/ili/ suc- cessful. 122 THE DOCTRINE OF PURGATION. exceeded my most sanguine expectations. To do justice to the practice, it should be steadily persevered in, and aided by such remedies as the case may from time to time demand (p. 193). Llotd ? Eusebius, A., M. D., Treatise on Scrofula. London, 1821. Serofuia. 498. The very great influence which evacuations from the bowels have over the rest of the body cannot be denied by any impartial ob- Purgation serV er i it is therefore certain that by increasing or diminishing them we — its action ' „pli- cations and 124 THE DOCTRINE OF PURGATION. its distribution, as the loss of power is probably owing to some affection of a part of the nerve after the two sets of filaments, by which it arises, are united together (pp. 13, 14, 15). — ■ It may here be observed that Mr. Shaw was a pupil of Sir Charles Bell's, and that his treatise was based upon the latter's opinion, given in a short " Essay on the Anatomy of the Brain," printed and distributed among his friends in 1809 or 1811. (See A. Shaw, p. 14.) Pklng, Daniel, M. D., An Exposition of the Principles of the Path- ology and of the Treatment of Diseases. London, 1823. *5f pS£ 505. In enteritis and peritonitis I have trusted more to purgatives n testin n a < i- a * tnan to Weeding, and I have no reason to regret this confidence. The purge use of purgatives, it has been objected, must increase injlammation : the without fear m » -f J • ,z • f j j.v ' . . • ,. J . of increasing effect, nowev er ; vs otherwise • and the testimony ol experience must on mation" fl and tliis as on other occasions, supersede all a priori reasonings. But as a why not. matter of reasoning, the conclusion against purgatives on this ground is not legitimate (p. 219). ortgfnaT e and 506. It does not follow, that an agent which is related with a secret- ^fateS. 7 m g function so as to increase it, should also be so related with inflam- mation, which frequently suspends secretion, as to augment its intensity. The, danger On the contrary, in the way of reasoning, it would appear that if secre- ^uTging tion is suspended by inflammation, that which restores secretion must wi cient l ef- diminish inflammation. ergy. Setting reasoning for the present aside, I suspect that in cases in which purgatives have been supposed to increase intestinal inflammation, it is because these means were inadequately employed (ibid.). Dyspepsia. 59^ Dyspepsia, whether simple or accompanied by disordered func- tion of the liver, chronic pains in the side, &c. When the inconvenience attending purgation has passed away, then an improved state of the di- gestive organs succeeds (pp. 307-309, condensed). Chorea. 508. Chorea. — In the few cases which have occurred to me of this Uaithy disease, some of which were severe ones, it has yielded to purgatives in sto pear. ap " about three weeks. The stools have commonly in about this period assumed a healthy appearance, and the spasmodic action of the muscles has quickly ceased (p. 245). Chronic rheumatism — cured by 509. A gentleman had chronic rheumatism, chiefly affecting his knees and shoulders. He went out on a cold damp day ; in the evening freTpnrga- \\q had rigors ; the rheumatic pains left the extremities, and he was taken with something like syncope, sense of constriction at the bottom of the throat, of weight in the chest, with a fluttering irregular pulse of 160 a minute. I gave him a full dose of calomel, salts, senna and jalap, which produced eight or ten stools in as many hours. The next day he was able to lie flat in his bed. The purgings were continued. In four days his pulse came down to 60, and in a few days he began to recover rapidly (p. 217). THE DOCTRINE OF PURGATION 125 510. Humoral Pathology may be said to have been perfected by mcmorai Boerhaave (Preface, p. 1). pa W0Qy ' 511. So unsettled is the state of pathology that those who read are Medical ig- skeptics in all its doctrines ; and those who do not read are left to the trance, guidance of a sort of intuition, which is not always productive of happy results, but very frequently suggests, through the course of a long life, only reiteration of the same error (p. 1). 512. It appears to me, then, in the case of the " peccant humors," n ^^ nt that their phenomena are not produced by a mechanical agency. It is . original more agreeable with the results of analytical inquiry to conclude that Tie Ict?on. eir the animal poisons contain latent properties of a vital hind, which are related with those of the same hind in living bodies / that the phenomena of disease or death, which ensue from the operation of the animal poi- sons in living bodies, are according to the nature of the properties which are engaged in this relation (p. ii.). 513. In my own experience it has been invariably the case, that B i Mdi ng\n- those who have sustained great losses of blood suffer more or less from duces deter- what is called determination to the head. The symptoms most common- wood. ly are intense pain and throbbing in the forehead or back of the head, with a pulse seldom under 90 (p. 23). 514. It is common in severe and threatening forms of cerebral dis- Bleeding in orders, notwithstanding previous loss of blood, to resort to the lancet, and orders /aS to repeat copiously and frequently, if the symptoms continue. I have observed that this practice has generally had a fatal termination (p. 86).. 515. I have been in the habit of confiding in purgatives to the almost total neglect of the lancet ; but these purgatives have not been of a af^el milk-and-water kind. I have given 6 grains of calomel, 6 grains of Fu '3''£ mp 0I altered and morbid hue, as evinced by the color of the faeces (ibid., p. 159). 525. The lungs are also in many instances apt to associate in the morbid action of the digestive organs, when it has become chronic, and to produce a peculiar variety of consumption — dyspeptic phthisis (ibid., p. 160). It must be obvious that, if the chyle which originates in the stomach should be conveyed to the lungs in an unhealthy condition, its peculiar stimulus must be changed in its mode or degree of action, and the lungs, in consequence, suffer (ibid., p. 163). The medical treatment : We must restore the debilitated organs to thelr proper tone (ibid., p. 164). The lungs are impli- cated ; bad blood is made, and consump- tion fol- lows. 526. Colica — colic. — Among the chief causes, acrid, cold, or indi- gestible esculents, worms, calculous or other balls congested in the in- testines and obstructing their passage, as scybala and indurated faeces (ibid., p. 195). Cure. — Warm fomentations — clysters. Purgatives should be at- tempted by the mouth, though the vomiting is sometimes so incessant that we can get little or nothing to stay on the stomach. But the at- tempt must be made, and steadxly persevered in (ibid., p. 196). 527. Constipation. — As the fasces are forced forward by the peristal- tic action of the intestines, it is obvious, whenever this action is weakened, there must necessarily be a retardation, and, consequently, an accumu- lation of faeces. In some instances this accumulation is prodigious. . . In one case which ended in death, the cause being mistaken for preg- nancy, the colon measured in circumference twenty inches, and on dis- section was found to contain three gallons of fasces (ibid., pp. 232, 233). Colic from acrid mat- ters. Persevere in purgatives. Constipa- tion — mor- bid matters in the intes- tines. Interesting case of dis- tended colon. 128 THE DOCTRINE OF PURGATION. variety of 528. Effects of constipation, when long continued : pains in the head, manifesto- nausea, febrile irritation, general uneasiness in the abdominal region, constipation congestion in the abdominal organs, and hence an impeded circulation of the blood, piles, varices of the lower limbs, colic (ibid., p. 234). Powerful purgatives. 529. If laxatives fail, the more powerful purgatives must be had re- course to, till the patient can habituate himself to evacuate the bowels at a certain hour every day (ibid., p. 235). Diarrhoea from acrid ingesta ; — purge. 530. Diarrhoea. — Chief causes: u acrid ingesta" and obstructed bile. Often antecedently to the looseness there is a sense of sickness, and per- haps a few slight torminal pains. But if the disorder do not prove its own remedy, it is easily removed by any common purgative medicine (ibid., p. 240> Astringents 531. It requires to be restrained with caution/ for a sudden cure, n^mf da™^* an d especially a sudden transfer to a state of costiveness, has often pro- duced some severe complaints, and, in one or two instances, epilepsy and phthisis (ibid.) Worms. Purge— and why. 532. Worms. — Dr. Heberden says : " Till some more certain remedy shall be discovered, nothing will be more serviceable than to keep the bowels loose. By their irritation they augment the secretion of mucous, in which also they involve themselves." By keeping the bowels loose we prevent the accumulation of this slimy material in which the worm burrows, and, if we have reason to believe that such accumulation has taken place, the best plan is to give active purgatives (ibid., p. 329). Piles- physiology. 533. Piles derive their existence perhaps in every instance from a turgid and varicose state of t/ie anal veins, covered with a slight thick- ening of the inner membrane of the rectum (ibid., p. 363). Retained faeces the /> cause. J( 534. Causes: — Local irritation produced by indurated and retained congested state of the liver and adjoining viscera, &c. If left to themselves, they swell into tumors, and become so painful as to pre- vent walking or sitting (ibid). ^mlnett. ^35. Jaundice is easily reproduced in those who are subject to it, symptoms in- by flatulence, acrimonious or indigestible food. The bowels are for the 1C cure. e most part costive and moved with difficulty (ibid., p. 390). Yellow-gum —purge. 536. Yellow-gum— jaundice of infants. — A dose of any active pur- gative will generally be sufficient to remove the obstruction (ibid., p. 404). Fever — 1 [ippocratic definition. 537. Fever. — It was the opinion of Hippocrates that fever is an effort of nature to expel something hurtful from the body, either ingen- erated or introduced from without (vol. II., p. 44). THE DOCTRINE OF PURGATION. 129 538. There is no writer of the present day, perhaps, who has carried this view of the subject farther, or even so far, as Professor Frank, who regards typhus, plague, petechias, and all pestilential fevers, and indeed nervous fevers of any hind, whether continued or remittent, not only as proceeding from specific contagions in the same manner as ex- anthemas, but from contagions producing a like leaven in the system, and matured and thrown oft' through the various outlets of the body, by the same process of depuration (ibid., pp. 45, 46). 539. Typhus. — The term is derived from Hippocrates, and means to smoulder, or burn and smoke without vent. When a typhus has once arisen, the effluvium from the living body during its action is loaded with miasms of the same kind, completely elaborated as it passes off (ibid., p. 224). 540. Dr. Hay garth and Dr. Bancroft show from numerous cases, p Xn2tent that the miasmatic poison of typhus, when received into the body, con- for seven tinues in a latent state at least for seven days from the time of exposure purgation to the contagion, before the fever commences. . . . remove ref the A peculiar state of the body gives a peculiar tendency both to gene f t i s g °eiabora e . rate and receive typhus, whilst some seem to be favored almost with a ted. natural immunity (ibid., pp. 227, 228). "All fevers are from im- purities from without meeting with impurities from with- in." Dr. Frank's opinion. Typhus. The body exhales miasms. 541. Dysentery : — primary a disorder of the colon, so considered by Sydenham and Dr. Cheyne; — first gripings, then dejections, and the fever follows. Sydenham's chief remedy was active purgation twice every other day, with warm diaphoretics on the days when the aperient was not employed (ibid., pp. 552-556, cond.). Dysentery, from the co- lon ; — cure : active ptir- gation. 542. Eruptive fevers. — Whenever any diseased action is taking place internally, there is a constant effort exhibited in the part, oi in the sys- tem generally, to lead it to the surface, where it can do but little mis- chief. . . It is by means of the fever that the disease works its own cure, for it is hereby that a general determination is made to the sur- face, and the morbid poison is thrown off from the system ; but the fever may be too violent, and from accidental causes of the wrong kind (vol. III.; p. 5). 543. The grand principle in the treatment of small-pox, as of all the- other exanthemas, is to moderate and keep under the fever ; and how ever the plans that may have been most celebrated for their success may have varied in particular points, they have uniformly made tin's principle their polar star, and have consisted in different modifications of cold water, acid liquors, and purgative medicines — heat, cordials, and other stimulants having been abundantly proved to be the most effectual means of exasperating the disease and endangering life (ibid., p. 109). Dr. Mead seems to have been almost indifferent as to the kind of purgatives employed, and certainly gave no preference to mercurial pre- parations. His idea was, that all were equally beneficial that would tend to lower the system ; and in this manner he accounts for the mild- ness of the disease after any great evacuation, natural or artificial (ibid., p. 110). Eruptive fe- vers— a, nat- ural effort to rid the sys- tem of mor- bid matter. The benefit of putff't- tion pal- pable. Small-pox. The fever kept under by purga- tives. Strong evacuation the principle of euro. Stimulants increase the power of 130 THE DOCTRINE OF PURGATION. Hypochon- 544. Hypochondria. — " The digestive organs are almost always tor- causes Indf- pidP Some kind of acrimony is also almost found in the stomach, and cate the cure, particularly that of acidity. The pain in the epigastrium may be re- lieved by the pressure of a belt broad enough to support the whole of the lower belly. Congestions in one or more of the abdominal viscera are a frequent result, and not unfrequently a primary cause. . . Hence we see why the bleeding piles are. often so serviceable as to have obtained the name of " medicina hypochondriacorum " (vol. IV., pp. 158, 159). Paris, J. A., M. B., Pharmacology, 6th Ed., London, 1825. HaBSen- ^45. Purgatives. — The extent of their importance and value were, dor 3 ed. however, never justly appreciated until the valuable publication of Dr. Hamilton on this subject. . . . His practice has clearly proved that a state of bowels may exist in many diseases, giving rise to a retention of feculent matter, which will not be obviated by the occasional adminis- , tration of a purgative, but which requires a continuation of the alvine stimulant, until the healthy action of the bowels is re-established. Since this view of the object has been adopted, numerous diseases have re- ceived alleviation from the use of purgatives that were formerly treated with a different class of remedies, and which were not supposed to have any connection with the state of alvine evacuations (p. 167, vol. IX Fever. 546. Thus in fever the peristaltic motion of the intestines is dimin- £c e m2?i3 ished, and their feculent contents are unduly retained, and, perhaps, in diminished. p ar t absorbed, becoming of course a source of morbid irritation. This fact has been long understood, and the practice of administering cathar- tic medicines under such circumstances has been very generally adopted. Emptying 547. But until the publication of Dr. Hamilton, physicians were intestines not aware of the necessity of carrying the plan to an extent beyond that n cie S nt ffi * of merely emptying the prima vim, and they did not continue the free use of these remedies through the whole progress of the disease (ibid). purgatives 548. Cathartics are essentially serviceable, also, in several diseases of ^neurosis™ the class neurosis, which are generally intimately connected with a mor- bid condition of the alimentary passages (p. 168, ibid). %fteHa' ^^' Chorea and hysteria have been very successfully treated in this chlorosis; manner. The diseases incident to puberty in both sexes are also best re- ("Emmena- Ueved by a course of purgative medicines, and their effects in chlorosis gogues.") have conferred upon many of them the specific title of Emmenagogues (ibid). aiso good as 550. But the therapeutical utility of cathartics extends beyond the *%3t£ffi mqpe fectdent evacuations which they may occasion. In consequence of the stimulating action which some of them exert upon the exhalent ves- sels, they abstract a considerable portion of fluid from the general current of the circulation, and are, on that account, beneficial as antiphlogistics (ibid). Dr. Paris is sciolistic as to the history of purgatives ; their use was better understood in the time of Parey (1620) than when Hamilton wrote (1794). THE DOCTRINE OF PURGATION. 131 551. For the same reason they may act as powerful promoters of ab- They pro- sorption, for there exists an established relation between the powers of «0D? a sorp " exhalation and absorption, so that when the action of one is increased, that of the other is augmented. Certain purgatives, as I have just stated, exert their influence upon the neighboring organs, and are calculated not only to remove divine sordes, but to detach and eliminate foul con- gestions from the biliary ducts and pores (ibid., p. 169). Why not say the truth, and also remove congestions and relieve pain in the most distant organs. 552. There is no principle in physiology better established than that Chemical remedies in climates and seasons. which considers vitality as a power engaged in a continual conflict with conflict with the physical, chemical and mechanical laws to which every species of inanimate matter is invariably subject (ibid., p. 209). — And yet chemical remedies are constantly prescribed by the " SCIENTIFIC " physician! Alxsle, Whltelaw, M. D., Materia Indica. London, 1826. 553. Hepatitis. — A viscid and badly prepared bile, producing ob- ti In ^ a y m t %' struction and irritation, is the most immediate source of evil, and so nvl>\ from constantly does neglected constipation precede an attack of hepatitis, and Stl & at hot that we cannot for a moment deny but that it must powerfully contri- bute towards hurrying on the organic derangement by binding up what should daily be carried off (p. 549). Monat and Henderson, Surgs., Narrative of the March of the 13lh Regiment of Foot, from JVuddeah to Berhampoor, in 1826. See Madras Journal, vol. II 554. Two individuals who were largely bled became convulsed and Bloodletting died, and after death it was found that, though the heart was empty, the SSiu^Su vessels of the head were loaded with blood. It was thus clearly indicated that, whatever it was that excited the hearts inordinate action, blood- letting vioidd not subdue it / for, as long as a drop of blood remained, it was sent to the head (Journ., p. 327). Andral, Jr., Gk, M. D., Clinique Medicate. Paris, 1827. 555. In indigestion (embarras gastrique), consisting of loss of appe- ^digestion. tite, bad taste in the mouth, loaded tongue, irregularity of the bowels, sensation of constriction or weight at the epigastrium, and occasional wcnes do nausea. This train of symptoms we have often seen to resist the appli- ^Sn^ 6 cation of leeches to the epigastrium, low diet, diluents, etc., and rapidly pwgatiak give VKiy to the exhibition of a brisk purgative. Do purgatives, by ex- citing the stomach and bowels together with the auxiliary neighboring organs, re-establish the power of digestion f Do these remedies change, in some unknown way, the mode of secretion in the liver and pancreas ? We know not. But this we know, that the treatment above mentioned is very efficacious, and that the antiphlogistic treatment is useless, if not twf^mi. injurious (chap. IY. f)- 0U8> . 132 THE DOCTRINE OF PURGATION. Illustrative, case. Nature shows the way to cure. 556. Andral, in illustration, gives many cases ; "No. YI. is se- lected. A young man entered the hospital with high fever, violent pulsating pain in the head, obstinate costiveness, and other symptoms. Leeches, the pendiluvium, lavements, and tisans were employed to no purpose. On the tenth day the patient was seized with spontaneous vomiting of a large quantity of green bile, which was followed by a smart purging of yellow liquid matter. Next day every symptom of his malady was gone. The patient was discharged, " cured by Dame Nature." — Andral asks, " Would not a brisk purgative or two in the beginning have cured the disorder ? " "Why of course they would. Six Brandreth's Pills given on the first or second day would have done it. ^SoSSmu ^^' P ur 9 a ti ves -> by revulsion, diminish the activity with which the the current fluids tend to the part originally irritated and congested. . . But another moMfy *S« influence which has been less noticed, is that which they may have upon ITxSiooS the composition of the blood, which they must modify by means of the materials which they extract from it. It may be asked, what is the nature of their influence upon the blood, according to whether they chiefly excite the flow of perspiration, of mucous, or of bile, and what changes of composition they may occasion in the blood ? This is un- doubtedly an interesting subject for investigation (Quoted in Copland's Diet., p. 250, vol. I, Art. Blood, § 160). Chambers, William, M. D., Physician to St. George's Hospital. On Continued Fever. See Beit, and For. Med. Eev., 1827, Vol. VI Fever. 558. Continued Fever. — Those who have been in the habit of treat- Ea $teady d m g ^ s di sea se must have observed that in most instances, when pur- purgation. gatives have been early and steadily administered, all the symptoms have in a short time yielded to them (Eev., p. 161). Scudamore, Charles, M. D. A Treatise on ilie Nature and Cure of Rheumatism. London, 1827. See British and For. Med. Eev. 1839, Vol. VII. 559. In no way is a degeneracy into chronic symptoms so certainly introduced as by that injudicious employment of general bleeding which changes enfeebles the constitution and still leaves the rheumatic disposition in chrontcrheu- great force (p. 70 — Brit, and For. Med. Eev., p. 343). matism. Purgatives replace bleeding. Rlieuma- tism. we Continue purgation until evacu- ations are healthy. Examine stools and urine. 560. In proportion as we employ purgatives with judgment, so do diminish the necessity of using the lancet (ibid). 561. In regard to the freedom and continuance of this treatment, we shall inform ourselves in great measure by the nature of the excre- tions, alvine and urinary ; for, while the faces are unnaturally dark, and the urme is dense, of a deep color, &c, it is incumbent upon us to make daily employment of purgative medicines (p. 96 — Eev., p. 344). Also continue purgation with Brandreth's Pills while severe pain continues, even if the stools are healthy. 562. A course of sarsaparilla often proves useful in that kind of chronic rheumatism which is accompanied by general derangement of the constitution without the particular affection of any internal organ. THE DOCTRINE OF PURGATION. 133 We see that, as the health of the system improves, morbid irritability lessens, the flesh of the patient increases, his looks and strength improve, and the rheumatic pains pass away (p. 370 — Rev. 353). Abercrombie, John, M. D., Pathological and Practical Researches on Diseases of the Stomach, <&c. Edinburgh, 1828. 563. It has become a kind of fashion to refer symptoms to morbid conditions of the liver, without any good ground for considering them as being really connected with that organ. But as a practical man, anxious to be guided by observation alone, there are three classes of facts whicli have appeared to me worthy of much attention in reference to this sub- ject, namely : 1. That I have frequently seen such complaints get well under very mild treatment, as regulation of the bowels, and a little attention to diet ; 2. That I have seen such patients put through long and ruinous courses of mercury without any benefit, and afterwards found the com- plaint removed by a course of mild laxatives ; and 3. That I have known patients die of other diseases while these alleged affections of the liver were going on, without being able to dis- cover in the liver, upon dissection, the smallest deviation from healthy structure (p. 320). 564. In chronic inflammation of the liver free and continued purging is expressly recommended (p. 361). Aitoesly, James, M. D., Researches into the Causes, Nature, and Treatment of Prevalent Diseases in India. Edinburgh, 1828. See Med. Chtr. Rev., 1828, Vol. VIIL, Ser. I. 565. Thus, in recruits and other strangers to the climate, on their arrival in India, when the biliary secretion is much increased, the tem- porary obstruction produced by exposure, wet, &c, often occasion the most formidable symptoms of disease, and when the obstruction is over- come, an immense quantity of vitiated bile is passed. It is reasonable to suppose, if the gall-bladder and ducts be over-distended with their contents, then vital contractility may be weakened, and thus the evil will be increased, until some internal or external cause supervenes, which shall enable the organ to throw off the load which oppresses it, and dis- charge its morbid secretion (Rev., p. 419). if- 566. The accumulation of mucous on the internal surfaces of the duodenum may also obstruct the mouth of the common duct, and pre- vent the flow of bile into the alimentary canal, until the obstruction be overcome or removed (p. 307). Dyspepsia and'sopposED chronic in- flammation of the liver cured by PURGATION. Mercury useless. Real chron- ic inflam- mation of the Iver — PURGE FREE- LY AND CON- TINUALLY. Fevers in the East Li- dies. . Natural or artificial purgation alone can Mucous ob- struction a cause of fe- ver ; remove it by purga- tion. Bayle, M., M. D., On the Influence of Gastric Affections in the Produc- tion of Mental Maladies. See Revue Medicale. Paris, 1828. 567. Mr. Bayle proves by numerous cases that chronic inflammation insanity of tfte mucous membrane of the stomach and bowels produced various d«S5£isto£- forms of insanity, and that the form of the mental hallucination was ach - often determined by the physical malady in the stomach. . 134 THE DOCTRINE OF PURGATION. Malaria produces many dis- eases, ac- cording to dilation. Brown, John, M. D., Medical Essays on Fever, dec. London, 1828. 568. Malaria produces intermittent and remittent fevers, cholera, dys- pepsia, bilious diarrhoea, liver disease, jaundice ; and Dr. McOulloch adds, rheumatism and neuralgia (p. 46). Cooke, William, Surg., A Practical and Pathological Inquiry into the Sources and Effects of Derangement of the Digestive Organs. Lon- don, 1828. Fatal accu- _. • 1 "/• ■» 7 •>/» mutations— 569. In disease there will sometimes be /a^ accumulation of ja&ces upon reports in the intestines, when both the patient and attendants report that the tfon, buTSt °owels are freely relieved (p. 129). Constipa- tion. Loose stools not sufficient — examina- tion re- quired; — NO "half meas- ures. " Case. Fever. 570. Various diseases arising from constipation cured by full purga- tion. In cases of constipation we must be careful that the discharge of loose motion does not deceive us, for this may happen without the bowels being sufficiently acted upon. We ought never to be satisfied, in any serious case, without careful examination with the hand ; for it will fre- quently happen, even after fluid dejections, that a large accumulation of faeces shall exist. On the 12th of December, 1818, I was consulted respecting a little boy four years of age, who for several days had been unwell. I pre- scribed a dose of calomel, which, in the course of the day, affected his bowels three times, the motions being loose and yellow. His diet con- sisted chiefly of fluid aliment, and of this he took but little. On the morning of the 13th he had considerable/^r remaining. A powerful purgation (calomel and jalap) was given. Early next morning he voided an excessive quantity of formed and hardened faces, some parts of which were of a black color. After this evacuation the febrile symp- toms speedily subsided (p. 129). Impaired digestion cured by FULL PUR- GATION. 571. I was consulted by an elderly gentleman who had been suffer- ing under chronic and protracted derangement of the digestive organs, and who believed that he had kept his bowels freely open by ordinary domestic aperients. A more efficient purgative was, however, prescribed, and to his surprise and comfort he voided as much solid excrement of a brown color as would more than half fill a large pot-de-chambre (p. 130). Active pur- gation — its usefulness. 572. Active purgatives are not only merely required in cases of accu- mulated faeces, but are sometimes useful by instituting morbid action, by setting up a temporary disease through the alimentary canal. Something may be attributed to the increased secretion, but the main- tenance of morbid action has sometimes considerable influence in con- trolling functional affections which did not originate from gastric dis- ease (pp. 131, 132). palpitation 573. In evidence of this view is given a case of palpitation of the oftnebeart. fa ar f CU red by purgation (p. 132). THE DOCTRINE OF PURGATION. 135 574* A case is given of peritoneal inflammation cured by full purga- Peritoneal tion, when " both the practitioner and the nurse informed me that the bowels were quite open " (p. 130). inflamma- tion. 575. In the summer of 1824, 1 was called upon by a maiden lady ao-ed 34. She informed me that for some months she had been in such a"state of distress, from mental depression, that life had become com- pletely burdensome. She had neither inclination for food nor exercise. She slept but little and passed restless nights. I prescribed laxatives and sea air for a few weeks. She grew worse. On her return to the city, powerful purgatives were employed three times a day, and in a week she felt quite a different creature (pp. 192, 193). Mental depression cured by powerful picrgation. 576. In 1816, I attended a lady who had "not been well " for two years, during which period she had been under the care of a respectable medical gentleman without deriving advantage. She was also subject to pains in her right side, appetite impaired, countenance yellow, rest disturbed. Employed active purgation (calomel and jalap). The first day she had twelve dejections, the others six or seven each. The pain soon ceased, appetite was good, countenance cheerful, and she was again feeling comfortable. She was now desired to take half the former dose of opening medi- cine every third night. In this case the constipation had existed so long that it seemed pru- dent to act freely on the bowels at first, and gradually lessen the strength of the purgative (pp. 232, 233). Amenor- rhea cured by full pur- gation. Continua- tion of the purgative treatment. 577. A lady in the seventh month of pregnancy had been affected for some time with what was considered a quotidian ague. Every day, at nearly the same time, she was attacked with rigor and violent shiver- ings which continued for half or three-quarters of an hour, and was succeeded by hot and sweating stages. On being consulted I deemed it expedient to administer some opening medicine before other steps were taken. The bowels being freely acted upon in the course of the next twenty-four hours, the fever did not return (pp. 285, 286). Quotidian ague during pregnancy cured by purgation. Case. 578. A gentleman informed me that he was recently consulted re- specting a family with ague. Bark had been frequently given without success. Finding that their bowels were much disordered he prescribed some opening remedies, intending to give quinine afterwards, but the ague had ceased (p. 286). Another case of ague. Bark useless. Monro, Alexander, M. D., Morbid Anatomy of the Brain. London, 1828. See Med. Chir. Rev., Ser. 7, Vol. VIII, 1828. 579. Hydrocephalus. — Brisk cathartics are to be administered regu- W/iroceph- larly, especially at the outset and during the first period of the disease ; by retained for the quantity of feculent matter contained within the intestines in w«ylpJ'J« many cases is really surprising. One instance now occurs to us. The ^ ull i / patient was a young lady who, after an attack of fever, during whiV freely. 136 THE DOCTRINE OF PURGATION. Case. fetid stools. head symptoms predominated, and had not been opportunely nor suffi- ciently overcome, was seized with all the signs of water in the head ; and as her bowels had been rather disposed to astringency throughout the fever, they became exceedingly torpid, indeed almost unmanage- able, on the establishment of hydrocephalus. Five or six common doses of drastic purgatives were required before the bowels would answer, said fetid and bulky stools were daily passed for three weeks under this stimulation , without any solid food having been taken during that time (p. 38 — Rev. p. 385). 580. And instituting a new and healthy action in the secretory appa- ratus by a degree of warmth and local remedies adapted to the sensibility of the part affected (ibid). McKenzie, William, M. D., A Sketch of the Natural Cure of Dis- eases ; in Glasgow Medical Journal, February, 1829. See Beit. & For. Med. Key., 1847, Vol. XXIII. The Mood, ever chang- ing and ever new, and disease. 581. The body is almost altogether fluid ; nine-tenths of it are so, and only one-tenth solid. The fluid pnrts are in a perpetual state of change, being decomposed by one set of functions and recomposed by another. . . . Our fluids, by means of digestion, absorption, circula- tion, respiration, and secretion, are in a constant revolution. By these processes there is effected an uninterrupted decay and restoration of the body ; and one can not doubt that the natural cure of diseases depends very much on the existence and on the perfection of this revolution. N"ay, it is extremely probable, that one of the principal intentions served in this mode of carrying on life is the prevention and removal of dis- ease (Rev. p. 587). By purgation with Brandreth's Pills we can change the entire body in from a third to half the time it is changed in the ordinary course of nature, and with entire safety. Case of Stephens, Henry, Surg. Treatise on Inflamed and Obstructed Hernia, london, 1829. See Med. Cher. Eev. Ser. I, 1829, Vol. XI. strangu- 582. Mr. Lawrence has, under the head of " slow strangulation," lat irim } vf a ' described a state of obstructed hernia from fecal accumulation, and tamed faeces, without doubt such a state often exists (p. 62 — Rev. p. 112). Brandreth's Pills to this poor patient would have been the complete doctor, producing certain relief, and, in all probability, would have cured the rupture. Stoker, William, M. D. 1829. Treatise on Continued Fevers, dec. Dublin, Typhus fever. 583. Typhus fever is connected with morbid changes that previously take place in the fluids, and produce morbid actions, and sometimes permanent change of structure in the solid parts. These changes are THE DOCTRINE OF PURGATION. 137 distinguishable from those which occur in inflammation, and the morbid Dr. stoker's action excited relatively by these changes in the blood are also distinct. In inflammatory fever, increased action ; in typhus fever, debility is almost the immediate consequence (p. 74). The remedies employed by me in mixed and typhoid fevers, and arranged according to their relative importance, are : Mixed fevers — cleanliness, ventilation, cool regimen, plentiful dil- uents, and purgatives. Typhoid fevers — yeast, wine, and aperients (p. 113). and modus procedendi, with pur gat ire medicines. 584. In both ague and intermittent neuralgia, I believe the disor- dered function of digestion, and the consequent morbid condition of the chyle and of the other contents of the stomach, whether ultimately absorbed or carried into the sanguiferous system, or carried downward by theprinm vice, become in their transit a chief cause of all the succeed,- ing symptoms (p. 357). Ague and neuralgia from re- tained im- purities. 5 S 5. When these periodic diseases become, however, more estab- These impu- Ushed, it is probable that not only the fluids are further affected, but ca u? e eS of h ^r- that consequent changes are excited, and hence the morbid condition of aanic dis - the fluids may be the primary source of organic disease (ibid). The following quotations establish the absolute necessity of having by us a purgative to which we may always apply with safety for relief; and we have it in Brandreth's Pills. Copland, James, M. D. Dictionary of Practical Medicine. London, 1830. New York Ed. by Dr. Ch. A. Lee, 1846-1852. 586. A belief is too generally entertained that fecal matters and sordes will not accumulate in the colon unless the patient has been con- stipated. But they may collect in its cells, the more central part of the canal allowing daily evacuation / and they may even remain there for a considerable period, producing much irritation, and even a relaxed state of the bowels, thereby misleading the judgment of the prac- titioner as to the pathological state constituting the disorder. ... In many cases, when the morbid collections have become acrimonious, an irritative diarrhoea continues for some time, or recurs at intervals, before the morbid matters are fully thrown off, owing to spasmodic constric- tions of parts of the bowels. . . On these occasions the evacuation is often preceded bv gripes, tenesmus, or a scalding sensation in the anus (vol. I., p. 450, Art. Colon, § 6). Fecal matter may accumulate where there is no con- stipation — watch and purge. Effects. 587. Purgations are used in order to occasion a local determination of blood, and thus derive it from the seat of disease, to evacuate the vis- — BSE ac- cera, increase the discharge from the mucous surface, secretions in adjoining organs (ibid., p. 218). and augment the tion aims. and 588. The fetor, &c, of the breath, and of the perspiration, &c, con- InUr ru P ted secretion — sequent upon interruption of the abdominal secretions, indicate that im purities have accumtdated in the circulation, and that they are being action of the eliminated by the lungs and the shin. So long as the vital energy is secretory or- gans. 138 THE DOCTRINE OF PURGATION. Causes of disease. sufficient for the due performance and harmony of the functions, inju- rious matters are seldom allowed to accumulate in the blood to the ex- tent of vitiating its constitution, without being discharged from it by means of one or more organs. But as soon as this energy languishes, or is depressed by external influences and agents, and the blood is thereby either imperfectly formed or insufficiently animalized and depurated, some one of its ultimate elements or proximate constituents become ex- cessive, and the chief cause of disorder, which terminates either in the removal of the morbid accumulation, or in a train of morbid actions and lesions (vol. L, p. 23 8, Art. Blood, § 116). Defective secretion causes ab- sorption of morbid mat- ter vitiating the blood and produc- ing disease. 589. Thus it will appear that changes in' the secretions and in the blood itself are most influential in the production, perpetuation, and aggravation of disease. . . Thus, also, it will appear not only that hurt- ful matters carried into the circulation, and ultimate elements or proxi- mate constituents allowed to accumulate in it, owing to the imperfect performance of some alimentary function, will be removed from it when the vital influence is sufficient for the task, but that both kinds of inju- rious agents will, according to their nature, become productive of a viti- ated state of the blood, of the secretions formed from it, and even of the various tissues themselves, when the state of vital manifestation is insuffi- cient to remove them from the frame (ibid., p. 239, § 117, ibid.) Defective se- cretion, if not counteracted by vicarious action, pro- duces vitia- ted blood. 590. I consider the grand pathological inference to be fully estab- lished : that the interruption or obstruction of any important secreting or eliminating function, if not compensated by the increased or modified action of some other organs, vitiates the blood more or less ; and if such vitiation be not soon removed, by the restoration of the function prima- rily affected, or by the increased exercise of an analogous function, that still more important changes are produced in the blood, and ultimately in the soft solids, if the energies of life are insufficient to expel the cause of disturbance, to oppose the progress of change, and to excite actions of salutary tendency (ibid., p. 240, § 124, ibid.) Miasma — action on organic life, impairing the matura- tion of the blood. Reaction if there is suffi- cient energy — course of disease, if not. 591. Miasmata produce a morbid impression on the nerves of organic life, followed by depression of the vital influence; the functions of diges- tion and secretion languish, and, owing to the imperfect performance of secretion and assimilation, the necessary changes are not fully effected in the blood, and thus the irritating and otherwise injurious matters ac- cumulate in it. . . The vascular system becomes excited by the quantity and quality of its contents ; and when the vital energies are not too far depressed for its production, the excitement becomes general. The ac- celerated circulation has the effect of exciting the organic functions, of restoring the secretions which were impeded or interrupted, and thereby of removing the morbid state of the circulating fluid, after which the return of health is rapid. Wlien, however, salutary reaction is not brought about, owing to the morbid depression of the vital energies and to changes which had taken place in the blood, the vitiation of the blood proceeds ; the secretions are also vitiated, the solids affected, one or more vital organs suffer in an especial manner, the energies of life are exhausted, and various organic lesions are induced, having reference to THE DOCTRINE OF PURGATION. 139 the previous state of the system, the kind of changes produced in the blood, and the agencies in operation during the progress of the disease (ibid., p. 240, § 125, ibid.) 592. M. Andral states that " he has often found in the blood-vessels Morw/or- a curdy, friable matter, of a dirty-gray color, and resembling either the XebSdJhS semi-concrete pus of chronic abscesses, or the sanies of malignant ulcers, SterT b to or cephaloid matter, broken down and mixed with blood." And similar the Mood. instances are recorded by Bichat, Beclard, and Veljpeau. In all these cases, abscesses, tubercles, or other morbid formations, also existed in some part of the body (ibid., p. 246, § 144, ibid.) 593. Morbid secretions should he frequently evacuated, in order that Evacuate vital power may not be further reduced by their morbid impression on ™L\o Se p T rt the nerves and mucous digestive smface, and that the possibility of the Jon'o? imp£ absorption of any part of them into the circulation may be thereby avoided (ibid, p. 249, § 158, ibid.) rities. morbid mat- ters. 594. In all the alterations of the blood resulting from the introduc- Bloodletting tion or absorption of morbid matters from parts previously diseased, sorption A of whatever tends to lower nervous and vital power, or to promote absorption — more particularly blood-letting, which operates in both these ways — ought to be guarded against, and a diametrically opposite plan of cure adopted, not neglecting the promotion of the depurative and excreting functions (ibid., § 159, ibid.) Fecal mat- ter in the 595. Fecal matters collected in the ccecum often induce inflammation, or the paroxysms of pain are very acute, sometimes attended by vomit- ca&cmn ing and all the symptoms of the most severe colic, or even those of ileus various and (§ 10). The symptomatic disorders, when the viscus is much distended sequ^nce^of either by fecal or by other matters, or by flatus, are numbness of the ^J^^g 0110 right thigh, oedema of the right foot and ankle, sometimes retraction of the testicle, or frequent calls to empty the bladder, and sometimes hemorrhoides, uneasiness and pain in the right iliac region, often extend- ing to the bypochondrium, various dyspeptic symptoms, costive or irregu- lar state of the bowels, occasionally diarrhoea, with scanty, offensive, and mucous stools (§ 11). The efforts made to evacuate the bowels are often attended by severe tormina and even retching. I have seen several cases of varicose veins of the leg, or indolent ulcers, and a case of disease of the bones of the foot, the occurrence of which was evidently connected with great disturbance and accumulations in the ccecum. . . The com- plexkm is deficient in clearness, and with the surface often covered with an oily or dirty moisture ; the perspiration becomes fetid and the breath offensive ; the soft solids lose their elasticity, and are slightly emaciated ; . . . and at an advanced stage the symptoms more clearly manifest that the blood is imperfectly depurated, or that it is affected by the absorp- tion of a portion of the excrementitious matter retained in the caecum. In addition to these symptoms, general debility and disinclination to any physical or mental exertion are often complained of (§§ 10, 11, 12; Art. Colon, p. 330, ibid.) from secretions ; — remove these by purga- tion. move cause 140 THE DOCTRINE OF PURGATION. cholera,- 596. Even in cholera, in which the eruption of an increased quantity of morbid secretions into the duodenum occasions copious discharges from the stomach and bowels, with cramps, &c, we are not justified in concluding that any organic change is present beyond simple irritation of a temporary kind, excited in the villous surface by the acrid state of the secretions passing along it (ibid., p. 624; Art. Digestive Canal, § IT, B). ohorm-its 597. Among the chief predisposing causes of chorea is a neglected state of the bowels, leading to accumulations of deranged secretions in the primae vise, torpid functions of the liver, and other secreting and as- similating organs. The most exciting causes are the irritations of worms, of morbid matters accumulated in the bowels (Stoll, Baldinger, and Wendt), and fright, improper employment of lead, mercury, &c. (Be Haen), suppressed eruptions and discharges (Thilenius, Darwin, and Wendt.) (Ibid., p. 389 ; Art. Chorea, § 12, III. 13 B.) cure:-re- 598. Purgatives have been recommended in chorea by Sydenham, mse by Whylt, Hamilton, Cheyne, and others (ibid., p. 392, § 23, VL, ibid.) purgatives. ^he fl rst indication is to remove morbid secretions said fecal accumu- lations, the usual cause of the irritation of the organic nerves (ibid. p. 394, § 29, B, ibid.) Diarrhea. 599. Idiopathic diarr/iwa, when recent, requires demulcents or dilu- morbid a mat d - eTi ^ merely, in order to facilitate the discharge of acrid or accumulated ter ur S ld he matt er. This having been accomplished, disorder soon ceases. But the away, irritating substances may be partly retained and keep up a prolonged or remittent state of the disease, with griping pains and scanty stools, which may be partly feculent, mucous, or serous — the latter predominating, when the irritation is considerable. In this case much discrimination is requisite in selecting the aperient which is obviously required ; for, if it be insufficient, the disorder will be prolonged (ibid., p. 609 ; Art. Diarrhoea, § 25, VII.) Brandretu's Pills are all that is needed, and discrimination is not required. crisis— nius- 600. Illustration of Crises. — A person exposed to the causes of autumnal fever of a bilious and remittent form, experiences during the earlier stages the usual symptoms of impeded or interrupted secretion, and general vascular excitement. In consequence of interrupted action bid of the emunctories the blood contains an increasing proportion of effete the^tem. * materials, particularly of the elements out of which bile is formed. These for a while increase and modify the vascular excitement, or, when excessive in quantity, or especially noxious in quality, even tend to ex- haust or depress it. But they at the same time being appropriate stimuli to the biliary and depuratory viscera, serve to restore their impeded functions, to turn the balance of excitement in favor of them, thereby to reduce the morbid vascular action, to cleanse the circulating fluid from its impurities, and to change in other respects its condition, and thus * the disease terminates with an apparent collapse, followed by a copious discharge from the bowels, consisting of morbid bile and of the excretions from the intestinal mucous surface — the products of the noxious matters which had accumulated in the blood, but which is now tration o;. The removal of mor matter out of ease quietly follows. THE DOCTRINE OF PURGATION. 141 being eliminated from it, by a renovated as well as an increased secret- ing and excreting function. Now, this procession of morbid phenom- ena shows, that the ancients were not so far wrong as many of the moderns suppose, when they believed that critical evacuations were bene- ficial, chiefly because they conveyed a morbid matter out of the system (ibid., p. 516, Art, Crises, § 15). 601. As the office of the excreting organs is to expel those elements , in disease which ai % e effete, and would be injurious to the frame if retained in the Swirl blood, it nmst necessarily follow, that any. interruption to their function ^proper must be highly injurious. The dropsical effusions in various cavities emnmctoHes following interruption to the action of the kidneys, folly illustrate this, ly ; if not As a large quantity of ingested matters is carried into the blood, either uwev, SS* directly from the stomach or along with the chyle, and discharged from it by the emunctories, it is evident not only that the kind of ingesta will aifect very remarkably the properties of the excretions, but that obstruc- tion or interruption of any one of them will be followed by serious effects, unless some other organ perform an additional office vicarious of that which is suppressed, and even in this case disease will generally ulti- mately arise (ibid., p. 668, Art. Diseases, § 99). 602. "WTiat are most diseases, hut either suppression or excess in the what disease secretions or excretions f (ibid.) 603. Dropsy from Disease of the Kidneys. — In a very great major- ^™J^~/™ ity of instances, where effusion proceeds from this cause, the irritating thus fluid nature of the fluid poured out, superinduces inflammation of the mem- quanty^th? branes and cellular tissues containing it, and thereby aggravates the thTdisUs? disease, and accelerates a fatal issue / for if it be considered that when the functions of the kidneys are interrupted, excrementitious or serous plethora will be the result ; and that the watery parts of the blood which are effused from this cause must necessarily contain a considerable quantity of the injurious matters usually eliminated by these organs, the irritating quality of the accumulating fluid here contended for will be admitted (ibid., p. 705, Art. Dropsy on the Chest. § 52). 604. Purgatives are very applicable in dropsies generally, on account Purgative*, of their deobstruent operation when uninterruptedly continued, or of moving tile their influence in deriving from the seat of effusion, in draining the ca S«^" fluid parts of the blood from that circulating in the intestinal tubes, in every fonn thereby lessening excrementitious or serous plethora, and favoring the the disease. absorption of the effused fluid. They constitute a most important part of the treatment of every form and state of the disease (ibid., p. 710, § Cj6, ibid.). In hydrothorax, cathartics and purgatives, especially the hydra- gogues, often afford speedy relief (ibid., p. 739, § 172, ibid.). 605. Frequentlv affection of the brain is induced by irritation of the stomach gastro-enteric surface. In children this is remarkably common, and disordc.) causes even in adults a slight degree of disorder of the stomach is often fol- SSTo?a lowed by headaclie, somnolency and imcapahility of mental exertion. The occasional dependence of epilepsy in adults, and of convidsions in nervotlS character. 142 THE DOCTRINE OF PURGATION. children, upon morbid action in the digestive canal is well known. In- flammation of the membranes or of the substance of the brain, and acute hydrocephalus sometimes also supervene upon gastro-intestine irritation, and in the course of their development render obscure, or entirely mask, the previous ailment. For, as Lallemand has remarked, as soon as the cerebral affection even partially obscures sensibility the existence of dis- order in the digestive canal is ascertained with great difficulty. In my opinion, the majority of cases denominated "spinal irritation" are caused by gastro-enteric disorder (vol. II., p. 30, Art. (lastro-enteric Disease, § 3). —\ tS a ?udi* ^06. A judicious exhibition of purgatives will frequently remove cious use re- irritation of the digestive canal, especially if it be caused by unwhole- Stuseofdis- some ingesta or morbid secretions, or fecal accumulations; and even ea how. nd when it cannot be referred to either of these, but rather to the state of vascular action in the digestive surface, the augmented secretion pro- cured by refrigerent or mild purgatives may promote its resolution or diminish its intensity (ibid., § 4. ibid.). S^dT°at a s ^7. ^ ven tne occurrence of pneumonia may be favored by disorder of the sun of the digestive canal (ibid., p. 31, § 7, ibid.). samTsoSce. Its connection with diseases of the shin, is much more general than practitioners suppose. It is chiefly owing to the irritation of the diges- Arsenicm- tive mucous surface, that the cutaneous affections resist so long the treat- tane°ous m dis- ment prescribed for their removal. I have repeatedly seen arsenical ease - .and other irritating medicines exhibited in no small quantities ; and although they were evidently exasperating both the internal and external affections they were continued with a perfect belief in their applicability (ibid., p. 33, § 15, IY., ibid.). impure, 608. When the disorder of the gastro-intestinal surface is attended diseases of with a crowing or morbidly excited appetite, food is taken in larger quan- kWneys^and tity than it can be digested, and much imperfectly formed chyle is sMn. carried into the blood where it excites diswder of the liver, of the kid- neys, and often of the shin, in the course of the excretion of the unas- similated matters by these organs (ibid., p. 34, § 16, ibid.). Manydis- 609. The suppression of the excreting functions of the shin may be one^cause- followed — especially if the kidneys do not perform a vicariously increased oPtulwL function — by catarrh, or by rheumatism, or by inflammation of the produced l un gs or pleura, or by diarrhoea, or by dysentery, or by enteritis, accord- ice^/??? ing as the predisposition of parts may determine the morbid action. The cause or causes, whether exposure to cold or to influences depressing vital power, occasion, first, interruption of the depurating functions of the skin, and next, more or less congestion of, or vascular determination to, internal viscera or parts ; and, in addition to this latter effect, and as a consequence of the suppression of the cutaneous function, the blood is loaded with these excremenlitious elements which the healthy action of the skin eliminates. The resulting conditions of the blood and of the circulation are such, in many cases, as kindle diseases, either those above mentioned or others of a slighter or severer nature (vol. III., p. 1137, Art. Therapeutics, § 44). function of THE SKIN THE DOCTRINE OF PURGATION. 143 610. What has been said respecting the functions of the skin, applies The same is likewise to the other excreting and secreting functions. Of all excreting ^hlr ° f secr h e- or depurating functions, those performed by the kidneys are the most ex C i ?etor- and rapidly fatal when impaired (ibid., p. 1138, § 47, ibid.). 611. Tlie cure. — It is believed by many that the regular and daily constant oi- evacuation of the bowels is quite sufficient * but this may not always be Evacuations the case, as to either the fecal discharge or the biliary secretion, or even S why 7 ' as to both. . . Hence the importance of observing accurately the ap- pearance of the intestinal excretion, both in health and in disease, and This applies of having recourse to such means as those appearances, the frequency brandreth's of the evacuation, and the associated state of the disease will suggest. PlLLS - The several substances employed as purgatives and cathartics should be suited to the peculiarities of each case, and be conjoined with others of the same class, or with such as may either correct or promote their ope- ration (ibid., § 48, ibid.). With Brandreth's Pills you can obtain any desired effect upon the bowels or general system. 612. The promotion of the several secreting and excreting functions, changes in whenever they are torpid or impaired, is requisite to the prevention of from retted many contingent evils during states of vital depression, by whatever refuuK? cause produced ; but it has a still more general application, for, in all f * om a f e &- circumstances, in states of excitement and increased vascular action, as Cl s™retin g e well as in those of depression, these functions are very often either tor- excZmg pid, or impaired, or even interrupted, and require restoration ; other- /un ^ ns ' wise additional or more severe and dangerous changes result, and the vice versa - blood, loaded with excrementitious materials, occasions the most delete- rious effects in vital organs (ibid., p. 1137, § 42, ibid). 613. Next to the sedative or depressing effects produced by the cwvr.-— by causes of disease, the impairment of depurating functions closeiy fol- lmpSfs! he lows, the latter being very frequently the cause of the former. These functions are often restored by the same means as are employed to remove the primary morbid impression (ibid., § 43, ibid). 614. In chronic, malignant, and structural maladies, the constitu- Chronicdis- tional or vital power is impaired, and the blood is altered more or less tmpoveriT- as these maladies advance, especially cancer, tubercle, rickets, &c, the e The cure b alteration of the blood becomes more or less evident, this fluid being promotion <£ thinner, poorer, or deficient in red globules. Hence the necessity of sup- tfonSSro- porting the powers of life by means which will neither excite nor irri- * r r ^ \iSng tate them, and of preserving the healthy state of the blood by conjoin- Brandreth's ing with those means such as will correct or prevent alterations of this fluid, and will, at the same time, promote the conversion of the color- less or chyle globules of the blood into red globules — will promote the processes of sanguification and nutrition (ibid., p. 1142, § 63, ibid). 615. A person is exposed to causes, as infections, which depress or- Effects of ganic nervous energy, and thereby impair or suppress the more import- inttiemok ant depurating and secreting functions. The consequences as respects the blood are obvious. This fluid soon abounds in effete and injurious elements, increasing both the amount of the vascular contents, and 144 THE DOCTRINE OF PURGATION. Brandreth's oppressing and irritating the whole vascular system, although certain ?me S atth wm organs may manifest these effects in a more prominent manner than the ely S ystim others, until a salutary crisis is observed, and the morbid state of the into a blood is removed, or until the soft solids are changed, their vital cohesion di«on. y con * is loosened, and disorganization ensues (ibid., p. 1046, Art. Sympathy, The mutual 616. There is very intimate connection existing between the state of excrTting or- the blood and the depurating offices of the mucous surface of the intes- taSSexSe- tines, especially of the large intestines. This surface, and more partic- tions pro- ularlv the follicular glands, mav he considered as eliminating: from the duce, among - •' o ' V i i i -i -i i i -i/v other effects, blood redundant or decomposed blood globules, and much enete mate- °case—L d e?~ rials, and as thereby contributing, with the other emunctories, to the Change? P ur ity an d healthy condition of this fluid. The connection subsisting between the functions of excreting viscera, not only as altering the con- dition of the blood, but also as affecting each other individually • the influence which the state of one depurating function exerts upon the others through the medium of the blood, as well as through that of the organic nervous system, and the mutual and conjoint operation of all these functions, not merely in changing the physical appearance and constitution of the blood and the states of vital influence, but also in occasioning structural alterations, are among the most important topics comprised by a rational system of pathology (ibid., p. 1045, § 96, ibid). mucous pituitoua ^enTcious 111 ®^- Predisposing causes of worms should, as much as possible, be and removed or counteracted. In furtherance of this indication, the diet and sordes! 3 the treatment should be adopted that are most efficacious in promoting the organic nervous force and the tone of the digestive organs, and in removing tenacious mucous and pituitous sordes, which often adhere to the digestive mucous surface, and which often forms the nidus in winch the ova of parasites are lodged and hatched. It will generally be no- ticed that the secretions anol excretions which in all persons form the principal part of the fecal discharge are seldom thrown off from the se- creting surfaces so quickly and entirely in the delicate and debilitated as in the robust and healthy, but remain or are retained in the former class of subjects, and become the soil in which these animals are reared (ibid., p. 1547, Art. Worms, § 158, B). Spasms. g-^g Spasms of the voluntary or involuntary muscles. — Purgatives Cure m pwr " are g enera Uy beneficial, more especially when the liver or brain is con- gested, and when the spasm is connected with acidity and flatulence of the digestive canal, or with accumulation of morbid secretions, excre- tions and fecal matters, as when spasms occur in colic, or in the course of gout, rheumatism, hysteria, hypochondria, &c. In these, as well as in some cases of other diseases, not only are morbid excretions thus liable to accumulate, but the Mood becomes more or less contaminated by effete materials, which the impaired functions of the emunctories fail of removing. JOmy&L* 619. In these circumstances purgatives should be selected with this the bowels view, not merely ot evacuating the contents oi the bowels, but also of ^oimi promoting the functions of the excretory organs. When cerebral con- THE DOCTRINE OF PURGATION. 145 gestion is connected with the spasms, then active derivative purgatives ought to be exhibited by the mouth and in enema (ibid., p. 931, Art. Spasms, § 31, C). 620. But the most remarkable cause of the slow progress of the ther- SSSS^S! apeutical science is to be found in the highest and most legitimate ranks of theknowi- of the medical profession — in the physicians themselves (§ 9) ; in wrong dies, and of estimates of the efficacy of particular medicines and agents (§ 7, D) ; in t£ere£ behef erroneous, limited, or one-sided views of the causes, seats, nature and procession of diseases ; of medical doctrine (§ 4, 1.) ; medical jealousies and contentions; opposing systems ; plans on means of cure; jarring views as to the efficacy or operation of certain medicines ; opposite opinions in courts of justice, or otherwise appearing in public ; the publicity given to medical discussions have an unfavorable influence on the pub- lic, and prevent many from trusting to medical treatment (ibid., pp. 1130, 1131, Art. Therapeutics, § 12, 1). 621. The blood is found altered in disease : 1. By a change in the proportion of its constituent elements ; 2. By the addition of foreign matters (+) (cf. G. Harvey). How the blood be- comes im- pure. AN HONEST PEOFESSOK. Marx, K. Z., M. D. Professor in the University of Gcettingen. eral Pathology. Gcettingen, 1833. Gen- 622. The conscientious practitioner can resort but to few remedies ; for whenever the choice lies between what is harmless and what " heroic," he must unconditionally employ the former (Preface). Mciteria medica. Chomel, M.,M. D., Clinical Lectures on Typhoid Fever. Paris, 1834. See Brit, and For. Med. Rev., 1836, Vol. II. 623. In the stools of patients, at the commencement of recovery from Typhoid typhoid fever, there are always scybalce; on which stools 'o7con- Dr. John Conolly observes : If medicine had produced the same a i V wiy S 3 ce con- effect earlier, wliich nature did eventually, the symptoms would have taineeyoaia. been milder, although the course of the disease would not have been cut short (Rev., p. 40). " The course of the disease •would not have been cut short" may admit of a " perhaps." Laexnkc, R. T. EL, M. D., A Treatise on Disease of the Chest. Trans- lated by John Forbes, M. D. London, 1834. 624. I would therefore lay it down as a valuable practical rule in chronic affections of the heart, that previously to having recourse to any remedies intended to act directly on it, we ought to be assured that the digestive organs arc in a healthy state, that their mucous surfaces Chronic ht>,art-diH- easa. The first step (, factorily proved that most if not all of the agents which exert such destructive energy on the nervous system (as poisons) do it through the medium of the circulation, as shown by the experiments of Christison and Ooindet, of Brodie, Viborg, and others. And we are much mis- taken if future researches do not prove this equally of what we term the true puerperal fever. . . The entire absence of coagulum, the per- fect fluidity of the blood, apparently both in color and consistence to thin watery claret, tends to confirm these views (Rev. 1836, Yol. II., p. 484). 633. How many medicinal agents have been indebted for their rep- ^meMca- a utation to fortuitous circumstances. It would be easy to show from the Ind S fui\ ar o C f f° rmer history of diseases that the medicine employed in the treatment useless drugs had no influence whatever in effecting the cure, but that the result was dangerous entirely owing to the efforts of nature. A physician, for example, em- ploys a certain medicine in a few cases and finds his patients recover ; hence he concludes that the treatment and the cure stand to one another in the relation of cause and effect. Misapprehensions of this sort pro- duce a very false and injurious impression upon the minds of students, leading them in their future practice to bleeding, blistering, and treating " heroically " all affections that appear to be violent and intractable (Eev. 1842, Yol. XIIL, p. 55). results in practice. In tumors, &c, Bkaotxreth's Pills affect firstly and chiefly the MORBID GROWTH. Tumors. Another rea- son why Brandketh\s Pills remove only impu- rities. 634. " Nature gives up in the first instance that which is extraneous and parasitical, in preference to what is normal both in structure and in degree of development i. w This is an important law, observable in a thousand cases, without the auspicious operation of which indeed one- half of our labors would be in vain (ibid., pp. 330, 331). Acute ft ™ the only control we can possess over assertion, the only medicine. test for opinion. Its application to a sufficient number of facts, must inevitably give us the most exact and best possible knowledge of those facts, and we would ask the individual who believes that science is founded on facts, what more he would require ? (p. 28.) By the numerical method we would be judged. Let this method be applied to effects Brandreth's Pills produce upon disease; and what an amount of suffering and sorrow would soon terminate ! No inflammation, no cholera, no fever, no pleurisy, no rheumatism, or any pain would cause alarm, because it would be known that a few Brandreth's Pills would soon restore any and every organ to health. Moore, G-., Surg., An Inquiry into the Pathology, Causes and Treat- ment of Puerperal Fever; which obtained the Fothergdilian Gold Medal, March, 1835. London, 1836. Puerperal 644. Puerperal Fever. — That early purgation is indeed an essential ■£u*rgluon riy auxiliary in the treatment, is amply testified by those who have been most successful (p. 223). THE DOCTRINE OF PURGATION, 151 In every case of puerperal fever I have seen, where purgation was used at once when the violent pain in the womb admonished that inflammation had commenced, was cured. The purgative was Brandreth's Pills. Every other case where other remedies than purga- tive were applied was lost. In fact, forty years ago it was generally understood that puer- peral fever meant — death. In 1840 a friend of mine, a physician, lost seventeen cases of this fever one after another. I recommended purgation, i. e. Brandreth's Pills. He followed my plan and gave the pills, and never after lost a case. Paeise, M. R., M. D. Pathology of Rheumatism. See Bulletin General de Theeapeuttque, July, 1835, and Brit, and For. Med. Eev., 1836, Vol. I. 645. Rheumatism. — Its change of situation does not change its na-. ture, although it goes by different names. Thus it is the same disease which in the head is called gravedo, in the neck torticollis {wry-neck), in the side pleurodynia, in the loins lumbago, and along the sciatic nerve sciatica (Kev., p. 255). CURE OF INFLAMMATORY RHEUMATISM. De. Brandreth : Sing Sing, Jan. 25, 1867. For some years I have been subject to attacks of inflammatory rheumatism, which usually come on every three or four months. My physicians were of the highest reputation. By their advice I took colchicum, citric acid, and other celebrated remedies, but none relieved me or shortened the attacks, which lasted for weeks at a time. In my last attack 1 con- cluded to try your famous pills. I was lying upon my bed at the time, suffering the severest pains in my feet and ankles, which no pen can describe. The first dose of six pills was so effective that in a few hours the pain and swelling sen- sibly abated, and in forty -eight hours were all gone, and I was cured and have had no return. I send you this testimonial for the benefit of others who, suffering in a similar manner, may know how they can find certain relief. I am respectfully yours, J, D. DUDLEY. Rheuma- tism,. The same dis- ease under various names according to location. FURTHER PROOF. To Dr. Brandreth: Brooklyn, Oct. 5, 1866. It gives me pleasure to state the good I have experienced from your pills. Since I com- menced their use I have felt in all respects like a new man, and the rheumatism I took them to relieve has entirely disappeared. At first I was prejudiced against them, because their operation was attended with severe griping; but on a further experience I am convinced such pains were only caused by the medicine struggling with and removing certain obstruc- tions in the bowels. I commenced with taking five pills every night on going to bed, and by an increase of one pill every evening ran the quantity up to twelve pills, which number I continued to take for ten days, aud then gradually reduced to five pills at a dose. With the exception of the first three doses I have experienced no pain or griping, but the opera- tion was both easy and pleasant. I took the pills for twenty-four days, and noticed that I passed a great quantity of black, bilious-looking, offensive matter, which I am glad to have got clear of. The Brandreth Pills take right hold of all that is deleterious in the bowels ; and, as I said before, I now feel like a new man, and deem it my duty to express ray grati- tude to you. Sincerely your friend, FRANKLIN L. HAWLEY, 238 Classon Avenue. McIlwain, Geoege, Surg., Remarks on the Unity of the Body, dec. Zvndon, 1836. See Beit, and Foe. Med. Kev., 1836, Vol. II. 180). 64:6. The whole of the body sympathizes with all its parts (Kev., p. Axiom. 152 THE DOCTRINE OF PURGATION. "Williams, Robert, M. D., Physicicm to St. Thomas Hospital. Elements of Medicine. London, 1836. rit y the so m the 647. Certain diseases — as typhus, scarlatina, varioli, erysipelas, &c, disease, are produced by morbid poisons. These have definite specific actions — oftheniS^ latent periodicity — the phenomena varying according to the dose and upo/tKS predisposition of the individual. Generally these poisons act with an a uru f ofme i^ensity proportioned to the feebleness of the patient (Preface). blood. Bleeding 648. Bleeding. — From a careful comparison of such evidence as d ™«™°«,I e " exists, Dr. Williams concludes, that since the evidence against bleeding move the ? .,,'..,, . ° n P cause of dis- m lever so greatly outweighs that m its tavor, it seems demonstrated, "scarlet- ' and by the most practical experience as yet before the public on any fever, etc. ji S p 0se( j medical question, that bleeding in the cure of fewer is the ex- ception, not the rule / . . that the cause of the disease being a poison, it is necessary to remove the poison from the body in order to stop the dis- ease (p. 171). The benefit 649. The most effective treatment was found to be as follows : lnd. ax( Lje 6 c- Ten grains of rhubarb, or a scruple, at whatever stage the patient uom. was a d m itted, and barley-water enemas, night and morning, with half an ounce of syrup of poppies added. Success is the only criterion in medicine, and certainly this practice has effected the cure of a much larger proportion of cases than any other mode I have witnessed (p. 93). How infinitely superior Brandreth's Pills are to this treatment, as all who know them will admit. fcartef/evw ^50. The results obtained by the practice of bleeding in scarlet fever, proved to be as well as by abstracting from it, are given in the following table : by fl 43c cases. Of 121 per sons, treated in the Foundling Hospital, in 1786, by bleed- ing, 19 died, being about one in six. Of 60 persons, treated at the London Fever Hospital in 1829, by bleeding, 10 died, being the same average ; whilst Of 125 persons, treated by purgatives and emetics, only 10 died. And if Brandreth's Pills had been the purgative, not five out of a hundred would have died. Lawrence, William, Surg., Treatise on Hernia. London, 1838. stwmguia- 651. Strangulated Hernia. — The notions that purgatives are capable e pwrgaZ'es of exciting the mucous membrane of the alimentary passages, and thus :ica Ter producing an aggravating inflammation of the stomach and bowels, is groundless ; and the practical precepts founded on this theoretical and imaginary foundation, have always appeared to me a signal triumph of doctrine over the most unequivocal results of experience and the plain- est dictates of common sense (p. 323). If the bowels should not be relieved three or four hours after the operation, a pill of calomel, or of calomel and extract of colocynth, may THE DOCTRINE OF PURGATION. 153 be given, followed by a drachm or two of sulphate of magnesia in mint or plain water, and this repeated every three or four hours until the towels are freely relieved. If this do not succeed, a large common injection, with four or six ounces of infusion of senna, or an ounce of castor-oil 5 should be administered (ibid.) Give six or eight Brandreth's Pills; they will certainly relieve the bowels, and if given early will probably save the pain and danger of the operation. Kennedy, Hentjy, Surg., Editor Dublin Medical Press. Sept. 23, 1840. 652. As soon as a quantity of blood is abstracted, that moment the system commences to supply the deficiency. So impatient is nature at the loss, that if the food taken is insufficient for her purpose, she takes back whatever may have previously been poured out — such as serum, lymph, or possibly even pus. (Cases in proof are given from Drs. McDowell, Stoker, and by the author.) Nature ab- hors blood- letting; — in- stead of re- moving im- purities, it restores them to the circulation. Never bleed. " Thou shalt not kill." Morgan, G. F., M. A. First Principles of Surgery. London, 1840. 653. The influence of the blood on the vital functions is proved by Goodbiood the fact that the vigor and activity of animal life depend principally on f e ' M y as - the condition of the circulating fluid ; and according to the qualities of covery from the mass, when inflammation sets in after severe injuries, are the subse- accidents - quent constitutional phenomena in a great measure regulated (p. 179 +). 654. There are two principal morbid varieties of constitution in which local injuries produce peculiar and extraordinary effects. The one is that of general plethora, attributable to over-repletion of the vas- cular system ; the other arises from an impoverished stale of the blood, coupled, in the worst cases, with a disturbed condition of the nervous system (p. 144). Morbid state of the blood from two causes. 055. Nothing at the commencement (of inflammation) will suffice ivflamma- but free and general depletion with purgatives ; and we have by these Fr'eT'and means known consciousness restored after an unfavorable prognosis had r/ ;S"^ 7 J e " been passed (p. 147). quired. 656. If we regard the morbid alterations in the composition of the blood as the primary source of fevers, we can easily explain the subse- quent derangement in the functions of the organs, and the vitiation of the different secretions during their continuance. In all cases the in- creased discharge has the effect of relieving the congested state of the mucous membrane (p. 1 TlJ -f). Fevers and vitiated secretions from impure blood. The believer in the efficacy of purgatives will thank Dr. Morgan for this testimony. 154 THE DOCTRINE OF PURGATION. Canst adt, Charles, M. D., Professor in the University of Erlangen. Special Pathology and Therapeutics founded on Cknical Observa- tions. Erlangen, 1841. See Burr. & Foe. Med. Eev., 1842 Vol. XIII. iodine— hs 657. The modus operandi of iodine consists in undermining the uni- action. versal process of nutrition (vol. I., p. 11 — Rev., p. 331). As the Mood, so the nerv- ous 658. An. asthenic condition of the nervous system is an affection always coincident with anemia; since, on the one hand, a normal con- dition of that system is indispensable to a right formation of the blood, as on the other normal blood is essential to a healthy state of the nervous system (ibid., p. 33— Rev., p. 332). Blood and pus. 659. Severe suppuration produces precisely the same effects as ex- cessive venesection ; while precisely the same means which improve the condition of the blood produce a similar effect on that of the pus (ibid., p. 87— Rev., p. 336). Inflamma- tion. Nature's at- tempt to cure — she may overdo it. 660. The phenomena of inflammation are not morbid movements, but consist chiefly of energetic endeavors of nature to oppose or rid her- self of an injurious agent or influence. Death may in this way inci- dentally occur from salutary efforts of nature herself, as when hemor- rhagic apoplexy of the brain or lungs ensues from the reaction instituted to repel or extrude some morbific agent or influence operating on these organs or elsewhere (ibid., p. 96 — Rev., p. 337). Mercury — producing salivation — no medicine but a poison aggravating . the inflam- mation. 661. Dr. Alison of Edinburgh (Library of Medicine) denies " that mercury administered so as to affect the gums possesses any power of controlling inflammation and its consequences." And on this point the present writer, after considerable experience, reiterates an opinion he formerly expressed, that he has more frequently seen inflammatory symptoms aggravated or transferred to other parts, on that event {saliva- tion) taking place, than relieved by it (ibid., p. 3 — Rev., 338). Grists — an- other view. 662. The discharges {sweats) which occasionally signalize the crisis do not contain the materia peccans. The crisis itself is the recovery, the discharges being nothing but the effects and proof of the regeneration of the unhealthy functions (ibid., p. 260 — Rev., p. 342). Hypertro- phy. 663. Hypertrophy. — Blood-letting, if practised in moderation, is apt to prove fruitless ; if energetically employed, it is more likely to pro- Bieeding in- mote anemia, dropsy, and debility than to cure hypertrophy (ibid., p. 10 chlorosis 664. The multifarious symptoms of chlorosis do not require separate fromSmp^r- attention ; since, depending on a common lesion, to wit, the deficient THE DOCTRINE OF PURGATION. 155 crasts* of blood, tliey simultaneously disappear wlien that fluid is brought fectiy eiabo- to its normal state (ibid., p. 40 ; Kev. p. odd). Huenefeldt, F. L.,M. D., Chemistry and Medicine in Close Co-operation. Berlin. 1841. G65. In the cmcum there is carried on to a certain extent a repetition of what takes place in the stomach and small intestines. In the colon are found the insoluble matters of the food, the bronze coloring matter of the bile, mucous, fat, soluble and insoluble salts, various azotized matters, etc., besides fetid volatile productions (p. 110). Digestion continued in the ca3cum. These matters being retained and reabsorbed through constipation, what an amount of evil is produced ! Let those who are costive beware. The bowels must be evacuated once at least in the day, or there can be no health and no safety. Munnelet, Thomas, Surg. A Treatise on the Nature, Cause and Treat- ment of Erysipelas. London, 1811. C)66. It is an easy thing for the purpose of producing an immediate effect, or " knocking the disease on the head," as it is often termed, to take from a man two, three or four pounds of blood ; but should he sur- vive, the probability is that he will not for several years, if forever, be the sound man he was before the shock his system has had inflicted upon it by such heroic proceedings (p. 220). 667. Purgatives, in by far the majority of cases, if properly used, Er v^ di completely ^obviate the necessity of venesection, especially if they have Bloodletting been preceded by an emetic (p. 230). and purga- tion com- pared. This is sound doctrine. Ceicuton, Sir Alexander, M. D., Commentaries on some Doctrines of a Dangerous Tendency in Medicine, and on the General Principles of safe Practice. London, 1812. See Brit, and For. Med. Rev., 1813, Vol. XV. 668. • In typhus, bleeding is useless and reprehensible. Nature's prin- ciple of curing this disease is the same as that by which the paroxysm of an intermittent is terminated ; she reduces the quantity of circulating fluids until she brings about an erpiilibrium between them and the en- feebled moving powers by excrementitious evacuations (Rev., p. 405). 669. The Liebig theory of the action of contagious and other animal poisons is, that if the exciting agent be a compound body, it will repro- ecause the hurtful power is of such a nature, or so situated, as to re- quire for its expulsion a greater effort than the vital machinery will bear ; so that the recomposing process is never re-established, and the colliqua- tion goes on until the dissolution of the organism, or death, takes placo (sect. ii). 158 THE DOCTRINE OF PURGATION. ciiEr STht ^^' Medicines only assisting the healthy action of nature in throw- to act. ing off the hurtful power (ibid.) And this is what Brandreth's Pills produce. No more: no less. Schultz, C. H., M. D., Professor in the University of Berlin. On the Renewal of Human Life, Berlin, 1842. See Beit, and For. Med. Key., 1845, Vol. XVI1L The Hood— its develop- ment. Chlorosis and 680. It is necessary that the organic constituents ot v the blood pass through their embryo state, just as the embryo itself, before they can be perfectly developed ; and as the lymphatic glands are the gills and pla- centae of the system, if these perform their functions imperfectly, as in scrofulous constitutions, a deposit from the unripe blood takes place. Hence the development of chlorosis and phthisis (p. 142; Rev., p. 392). Elements of General Pathology. Berlin, 1844-45. For. Med. He v., ibid. See Brit, and arieties diseases. 681. The state of the blood circulating through the secretiug organs varieties "of influences their diseases. (Predispositions in the glandular and secreting systems.) (Rev., p. 345.) By a stoppage of the depurative process in the liver the whole mass of the blood gets charged with impurities. The dead vesicles show a tendency even to chemical decomposition, as in stinking secretions, nau- seous cutaneous affections, &c. . . The blood acts injuriously on the nervous and muscular system ; it is deficient in the stimulating property of healthy blood. Thus the brain, nerves of the senses, and muscles, are imperfectly acted on, are weakened, and at last paralyzed. Apoplexy, intermittent fever, spectral illusions, and even paralysis of the senses, are the result of this state. (Predispositions of the blood.) (Rev., p. 343.)' Defective excretion;— a fruitful source of dis- Morbid mat- ters, etc., re- tained. Williams, Charles J. B., M. D., Principles of Medicine. London, 1843. See Brit. and. For. Med. Rev., 1844, Vol. XVII. 682. The excretions are defective in many idiopathic and symptom- a,tic fevers, and there can be little doubt that many of the constitutional effects of these fevers are, in a great measure, due to this important ele- ment. The positively noxious properties which excrementitious matters retained in the blood are Jcnown to possess, mast be taken into- account, when we attempt to explain the state of constitutional irritation and de- pression, with perversion of functions, which fevers so generally present. The changes in the blood may also be in part referred to defective elimi- nation of effete matter y and it is when the secreting organs recover their power, and a diarrhoea occurs, or a copious discharge of highly-colored urine, that these appearances cease (p. 81 ; Rev., p. 479). Disease from ^83. ^ ne causes °f disease are changes in the due proportions of the changeinthe blood, and otherwise, by respiration, secretion, nutrition, and by foreign matters (ibid.) THE DOCTRINE OF PURGATION. 159 6S4. In the treatment of this element of disease— -foreign morbid matters in the blood — the two indications which present themselves arc, first, to counteract the injurious operation of these matters / and second, to expel them from the system. We do not possess chemical antidotes which CAN ACT ON THE FOREIGN MATTER IN THE BLOOD WITHOUT INJURING THE blood itself. The other indication is more generally pursued, although little recognized by practitioners, to expel tlie offending matter from the system. The excretory organs, especially the hidneys and the alimentary canal, are the natural emunctories through which foreign and offending matters are expelled from the blood. Let ns bear in mind how often fevers and other serious ailments seem to be carried off by spontaneous diarrhoea, diuresis, or perspiration (ibid., p. 122; Eev., p. 485). All chemical antidotes INJURE THE BLOOD, although they may expel morbid mat- ters from it. Expel these as nature does. Cozzi, L., Professor of Chymistry. Analysis of the Blood in a Case of Lead Colic, in Journal de Pharmacie. Paris, February, 1844. See Edinburgh Medical and Surgical Journal, 1844, Vol. LXII 685. Professor Cozzi, in analyzing the blood of a person severely Painters' affected with lead colic, discovered that the lead existed in the state of a Poison"' of salt, or of an oxyde of the metal, in the albumen of the blood (Ed. l Journ., p. 553). blood. Houston, John, M. D., Introductory Lecture in Surgery. Dublin, 1844. 686. The great mind of John Hunter saw and believed that the blood possessed in itself an independent life even while circulating loosely in the blood-vessels, but he knew not the nature and the seat of that vitality. The discovery was reserved for the physiologists of our days. There are particles, called globules, floating in this liquid, about the 3000th part of an inch in diameter, or so small that myriads of them are contained in a single drop. It has been ascertained respecting these globules that they are, each and all, endowed with a definite and uni- form shape, and with a development, in virtue of which they pass by successive transitions from a condition of origin to one of final evolu- tion — a veritable organization, in other words — properties which give them a claim to the title life, as much as those which justify the appli- cation of that term to the ovum, from which proud man himself dates his being. The atomic particles of which the blood is composed being thus individually alive, collectively they form a mass of which it may literally, as well as allegorically be said : " For it is the life of all flesh ; the Hood of it is for the life thereof ; for the life of the flesh is in the blood" The globules are themselves, each and all, possessed of an independ- ent life. I have repeatedly watched them, and have shown them to others, when burst from their cell-membrane, performing sundry inde- pendent and apparently voluntary evolutions in the field of the micro- scope, until to the eve the whole looked like a moving mass of creeping things. In this view, then, the blood is doubly alive as exhibited — first in its forming and taking part in the repairs of the animal machine, and The Hood. Physiology. Red corpus- cles. Description of their indi- vidual vital- ity ; proved by micro- scopical ob- servation. The globules possessed of independent motion. 160 THE DOCTRINE OF PURGATION. secondly, in the independent movements possessed by the ultimate par- ticles of its matter (Lancet, Amer. Edit. 1845, vol. I., p. 214, +). Produce:, John, M. D., On the Treatment of Indolent and Irritable Ulcers. London. 1844. See Lancet, 1844, Vol. II. Ulcers- natural out- 687. I regard the ulcer as a natural outlet or issue for the escape of Te a ts.° ut ' certain morbid principles from the blood, the retention or suppression of Purre till wn i cn would have occasioned diseases of a more dangerous tendency. . . the discharge If the ulcer or the issue emit a disgusting odor and discharge freely, the when ea the y y necessity for such a drain is unequivocal ; it cannot be closed without iy Xl h£i! ural " r i s k °f a worse disorder. But when the odor of the ulcer, or the issue, ceases to be disagreeable, and the discharge is moderate in quantity, and of a healthy quality, it admits of cure with perfect safety (Lane, p. 405). Baetlett, Elisha, M. D., Professor of Medicine in the University of Maryland; Philosophy of Medicine, Philadelphia, 1845. On' the recent Progress and future Prospects of Practical Medicine. See Brit, and For. Med. Eev., 1846, Vol. XXII. The materia ^88. ^ e Articles of the Materia Medica. — There is probably no medica. man more entirely sceptical in regard to their alleged properties and virtues than I am. There is no man who has been in the habit of using a smaller number of them. My own opinion is, that the number of substances endowed with active and peculiar or characteristic reme- dial properties is small. . . In many cases of disease all medicines, using the word in its common signification, are evils, and that they may be dispensed with, not merely with negative safety, but to the actual bene- fit of the subjects. . . The golden axiom of Chomel — that it is only the second law of therapeutics to do good, its first law being this, to do no harm — is gradually finding its way into the medical mind, preventing an incalculable amount of positive ill (Rev. p. 237). Assist nature 689. It is coming every day to be more clearly seen that perhaps the orietthedis- most universal and beneficial function of medical art consists in the removal and avoidance of those agents the action of which is to occasion or to aggravate disease, thus giving the recuperative energies of the sys- tem their full sc >pe and action, and trusting to them when thus unem- barrassed and free for the cure of disease (ibid). Btjdd, George, M. D., Professor of Medicine, King^s College, London. On Diseases of the Liver. London, 1845. Limr-dis- 690. In this countrv mercury has g;enerallv been resorted to, when the local symptoms have led to the suspicion that the liver was dis- eased; but I fear with no benefit to the patients. It has been well ob- served by Abercrombie : " On the liver-diseases of this country, mercury ease — and mercury, blood is ab- stracted, Hie fewer are the chances THE DOCTRINE OF PURGATION. 101 is often used in an indiscriminate manner, and with very undefined Ambiguous notions as to certain specific influence which it is supposed to exert faction X over all the morbid conditions of this organ. If the liver be supposed mercur y- to be in a state of torpor, mercury is given to excite it ; if in a state of acute inflammation, mercury is given to moderate the inflammation and reduce its action " (p. 99). GorEMAN, Edward, Surg., A Collection of Cases of Apoplexy, with an Explanatory Introduction. London, 1845. See Lancet, 1845, Vol. I. 691. The following collection of cases is published with the view of A P°vie®y- furnishing sufficient data for determining the comparative merits of dif- ferent modes of treating apoplexy, and for judging of the expediency fatal 9 of resorting to bleeding for the cure of that disease (Introduction). Here follow 250 cases. The conclusion is, that bleeding, generally speaking, is so ineffectual ^ The more a means of preventing the fatal termination of apoplexy, that it scarcely deserves the name of a remedy for this disease ; that the treatment without loss of blood was attended with the most success, and that of recovery, the mortality of the disease increased in proportion to the extent to which the Heeding was carried ; the more copious the loss of blood the more fatal the disease (pp. 198, 199 ; Lane, p. 533). Mackin, Charles T., M. D., On the Acute form of Gout, with Remarks on its similarity to Acute Rheumatism. In Lancet, American- Edi- tion, Vol. I, 1845. 692. In a well-defined attack of qouk the pre-existing and graduallv Oout;—a, progressing derangement of all the organs which subserve the purposes from of digestion and nutrition, coupled with the very remarkable increase 0™ *S* of nervous irritability observable (as far as my experience goes) inva- i/ve ° r v ans - riably antecedent to a paroxysm, are sufficient, in a great measure, to warrant the conclusion that it is one of the most prominent examples of a local disease, depending solely for its origin on constitutional disturb- ance (p. 312). 693. It is, in the established rules of modern practice, to be taken Modern by storm, to be driven from the system " vi et armis," and all the means P ractlce - which an already overgrown materia medica places within our reach, have been and are brought to bear against it. Patients are cured ; " they get well." . . . From the first recipe traced on sand by the staff of Anaximander or TJierecydes (the inventors of writing) up to the last ci& ^ p ^: " fiat mistura," have we one which we can positively say will produce a ionofhfeart. certain and definite effect? No, not one. Medicine is then, as yet, nothing save a nice balance of contingencies (pp. 312, 313). A knowledge of Brandreth's I'illn would have changed this opinion. 004. The premonitory signs of its approach are generally to be found The precw- of a well-marked and definite character, so much so that in many in- JJXaKS- stances he who has undergone a previous attack, can foretell with unci-- 'i;'',, 1 "\, f £% 11 162 THE DOCTRINE OF PURGATION. tc \tomadt* r i n g certainty the coming of a "fit" as it is termed, some time anterior ana intes- to the appearance of the unwelcome visitor. The first symptom which removal of excites observation, is a considerable increase of nervous irritability, matur° rU &. an d a general peevishness and hastiness of manner. The sleep is restless stftute* The arLC ^ unrefreshing, disturbed with frightful dreams, tossing of the limbs, cure. etc. The appetite (though not invariably)/^,? off. There is gastroin- testinal derangement, with a sense of fullness and oppression subsequent to meals ; dyspepsia and heartburn are pretty constantly present. As the symptoms become aggravated, the patient is annoyed v^ith. flatulence, accompanied with sour eructations. . . . There is a bitter, or at all events, a vitiated taste in the mouth, espe- cially on first rising in the morning ; headache 'in those of plethoric habit ; the bowels are costive or relaxed — in either case the secretions are dark and offensive. The urine is of a saffron tinge, often scanty in quantity, and charged with lithic acid. These form the more remarka- ble prodromata, and, curiously enough, are observed to possess a distinctly intermittent character (p. 313). — These are, as the author expresses himself in another place, " not the ' hints,' but the ' positive directions,' laid down for the man- agement of the disease, for our guidance and instruction, by Dame Na- ture " (Lancet, A. E., Vol. I., p. 672). The last 695. Of the near approach of the "fit" the patient is warned by warmng. ^emg seized at intervals with flying or transitory pains in different parts of the body, mostly affecting those portions of the frame already weakened by previous illness (ibid.). Theparox- §§Q m A mos t remarkable fact connected with the disappearance of ysm a salu- _ , . .,i,i > i* i • tary process the paroxysm is that the patient, with the exception ot being more or °cur6. atural less crippled for a time, experiences a sort of general renovation of the system, and his state of health is better and more vigorous subsequently than prior to the fit. It seems as if the localization of this disease were a salutary process instituted by the " vis vitse " for the more effectual and complete removal of the cumulative disturbance of the general economy (ibid). The disease 697. I have also observed that very slight causes will bring about the Its ' g appear- development of the elements of gouty inflammation, with xvhich the sys- ances local. t m i appears to be charged. I have known so trivial an accident as striking the great toe against a stone in walking produce a paroxysm. This peculiarity is often witnessed in those who are of confirmed gouty diathesis. Indeed, a man constitutionally subject to the disorder ap- pears " to wear his heart upon his sleeve," slight accidents, otherwise of no moment, being sufficient to induce an attack of this extraordinary disease (p. 314). Saka, Roberts, Professor of Medicine in the University of Milan. Sui Pregi 6 Doveri del Medico. Milan, 1845. simplb reme- 698. A physician of no great reputation would positively compromise dies t e kj s interests, if he limited himself to the prescription of simple remedies. obtain. THE DOCTRINE OF PURGATION. 163 The general ignorance obliges him to be a proselyte of the polyphar- Humbug es- macia y and indeed it is very easy to unite to any medicine a greater or "profession.^ less number of substances which are quite incapable of modifying its properties. And it is also useful frequently to vary the medicines, because the public readily disbelieves in the knowledge of a physician who always prescribes the same remedies (p. 115). 699. The principal means of obtaining success in practice is to limit success in one's self to a reasonable system of expectation, and to prescribe in cases E^to - in which no active medicine is clearly indicated, substances incapable of exciting remarkable changes in the animal economy (p. 120). Taylor, J., M. D., Clinical Remarks on Cancer. See Report of the University College Hospital in Lancet, 1845, Vol. II. TOO. The commonest way in which cancer is propagated is by the circu- lation of the cancer-cells in the blood, and the arrest of them in the capil- laries, when they multiply and form tumors. In this case (the reported "X ye and one) there was no ulceration. The organs that are secondarily affected by cancer have always some connection with the seat of the primary disease. TVe can easily see the connection between cancer in the breast Sea." and lungs. In passing through the pulmonary capillaries the cancer- cells are arrested, and thus the cancer is formed (p. 602). Yog-el, Julius, M. D., The Pathological Anatomy of the Human Body, leipzig, 1845. See Brit, and For. Med. Kev., 1846, Vol. XXII. 701. Gases may be developed in the human body from two distinct Foul gases sources — horn food in the intestinal canal in the act of decomposition po S Tti d n ecom * and from decomposition of the tissues of the body itself. The gases produced in the intestinal canal occasionally permeate through its walls into the peritoneal cavity (Rev., p. 324). Waddy, J. M., M. D., On Puerperal Fever. See Lancet, 1845, Vol. I. 702. When the intestines are burdened with fecal accumulations the Effects of re _ constitution becomes affected in various ways ; thus cerebral and vis- tained f£KCes - ceral congestions, phlebitis, &c, may be the result of pressure on the larger vessels. The intestines are distended beyond their tone, and give rise to flatulency, anorexia, indigestion, and there is probably absorption of putrid matters, which may all tend to promote a highly unfavorable state of the general system (p. 674). Cancer — cells in the blood. removing prevent their accumulation the arte- 703. The phenomena of the typhoid and ataxic {nervous) fevers, Fever~\he whether common or puerperal, will be best explained as the consequences JJJJtoSffi of poison — either generated within or introduced from without — the nate poison. fever being strictly an effort of nature to throw off injurious matter from the living body (pp. 698, 699). 164 THE DOCTEINE OF PURGATION. Remittents. 704. Remittent and intermittent fevers — the consequence of nature' 's endeavors to eliminate a poison from the system by the biliary organs (ibid.) IMPOKTANT QUESTIONS. Rapidity of 705. Does the rapidity of pulse (in fever) depend upon a law of na- the puise. ^ure to make up, by rapidity of distribution and change, for a deficiency of vital principle in the blood, or is the heart directly stimulated into increased action by morbid matter in the blood f (Ibid.) Clendinning, Dr., Report to the Royal Medical and Chirurgical Soci- ety, January 13, 1846. See Lancet, 1846, Vol. L Hydroceph- 706. T. S. .Allen, Surgeon to St. Marylebone Infirmary, has seen in more than 500 cases of dtarrhma in children, whose aces varied from 3 SUPPRHSSED DIARRHCEA. months to 3 years, that in at least 6 to 1 the diarrhoea was symptomatic — a salutary effort of nature to relieve the system — to suppress which, by opiates and absorbents, was to invite Iiead-symptoms, hydrocephalus, convulsions, and death (p. 101). Hall, Marshall, M. D., Practical Observations and Suggestions. London, 1846. (+) refu|l of g ig* 707. That invariable refuge of the timid and ignorant — the lancet! norance. * to ~ V * V~V «* *«. — ~ ^. Miik-fever- 708. I am of opinion that what is designated " mill 'fever" is fre- pS5on y with quently symptomatic of the condition of the mammae. The remedy for nature's this febrile state is therefore depletion of the milk-ducts. As a preven- ^urgaii-mf tion of milk-abscess and milk-fever, and with other hygienic objects, the infant should be put to the breast at the moment it is born. If, in spite of this, the breasts become in the slightest degree tumid, or febrile action is set up, another and a stronger infant should be applied without delay. This is nature } s mode of relief, and infinitely more efficacious than the application of leeches. . . The patient must take barley-water as her sole nourishment, and the bowels must be freely purged. Harrison, J. B., Surg., Essays on General Pathology. London, 1846- 47. (+) 709. In the first place, it is manifest that the presence of foreign become matter in the blood must • induce a state of derangement. In the next thr P ee ie diffeT- place, it is equally clear that if the blood do not undergo those changes, ent modes. ^Jq^ ft [ s destined to receive during its transmission through the lungs, it can no longer preserve its healthy constitution. In the third place, the blood itself may be imperfectly elaborated (No. Y.) The Mood mav 710. It is well known that the faculty do not themselves take medi- have /smaii cines in the same manner that they prescribe them to betaken. They own "VeS- have not, it must be owned, that large credence which they require from dies * others. There is not with them the regular taking of spoonfuls at stated intervals, and the expectancy and confidence of the forthcoming result, which they ask of others. Medical men THE DOCTEINE OF PURGATION. 165 Leeson, John, M. R. C. S. E. Liebig's Philosophy applied in the Treatment of Functional Derangement and Organic Disease. London, 1846. Til. There are about four hundred and ten preparations in the pharmacopoeia of the Royal College of Physicians. Now, any practical man of ten or twenty years' standing must have found that four hund- red of these preparations are of little or no value whatever in the treat- ment of any form of disease, and that about the remaining ten might have assisted him in reducing, at one time or other, cases occurring in every department of his practice. Nearly all the waters, confections, decoc- tions, extracts, infusions, liquids, mixtures, essential oils, spirits, tinctures, have little or no influence over any form of disease, when used as inter- nal or external remedies. Many of the mineral preparations are abso- lutely injurious in their effects under every circumstance, while the retention of other remedies is burlesque and nonsense (pp. 10, 11). The phar- macopoeia. 712. Fancy aluminum, antimony, silver, arsenic, barium, bismuth, calcium, copper, iron, mercury, magnesia, lead, potassium, sodium, zinc (all of which are to be found in the London pharmacopoeia of one hund- red years' standing, with the exception of barium and bismuth), as medical agents which are yet authoritatively retained, and which have been at one time or other plied as sovereign remedies for many invet- erate forms of disease, although most of them, if not all, are abandoned by every practitioner of standing and experience as the most dangerous applications for any kind of medical purposes (pp. 12, 13). Metallic remedies. Magendie, M., M. D. 1846 See Lancet, 1816, Introductory Lecture in the College de France, Vol. I. 713. When disease requires assistance, we may still by well-judged Assist nature intervention assist nature in overcoming the functional derangements by art * which gave rise to the disease (p. 238). 714. Tartar emetic, when brought into contact with the blood, has the power of dissolving the globules' ($. 363, citation in the paper of Butler Lane, Surgeon). Tartar- emetic. Wilson, J. A., M. D., On the True Character of Acute Rheumatism; in Lancet. 1846. (+) 715. Inflammation is but an expression of the nutritive function endered difficult for the time in particular structures. Inflamma- tion originates no movement, creates no function, brings no new elements into operation; it is not an acquired principle, but an innate faculty held in trust by every living structure from the beginning, for the means of self-protection, and as a security under injury for redress. Thus considered the arthritis of acute rheumatism is respected by the physicians as salutary under circumstances, and as working with the fever to a cure. Inflamma- tion — not a disease, but nature's warning. Rheuma- tisi/i. 166 THE. DOCTRINE OF PURGATION. Acute rheu- Opium and lancet ; — poison and bloodshed denounced. Localisation of fe/vers according to the poisonous matter in the general cir- culation. Disease from change in the propor- tion of the natural ele- ments of the blood. The blood feels and lives. 716. Opium in acute rheumatism. — The healthy relations of this drug with the blood (and it is prescribed on no other indication) are not such as to authorize its employment in a disease whose principle of cure is one .of unrestrained spontaneous action. 717. These approved principles of cure by poison and Woodshed rest professedly on more than conjectural science for their authority ; they are not set forth diffidently, as the experimental, misgivings, by small induction, of a theory yet to be realized, but are proclaimed as the dicta of a bold and successful experience ; they are blazoned as heroic mottoes above the vulgar host, that seeing them we may know our leaders and be prepared to follow them. 718. As the scarlet-fever localizes itself especially in the throat, the measles in the mucous lining membrane of the lungs, the epidemic typhus in the cmcum and lower ilium, and the erysipelas fever in the integuments of the head and face, so is the rheumatic fever determined by special effects of inflammation to the larger joints of the body and the surrounding articular structures ; but the heat, swelling, and redness thus induced are no more the cause of the constitutional disturbance in acute rheumatism than the scarlet-rash, or the small-pox pustule of the fevers that bear their respective names. They are but the partial expression, by impaired nutrition, of a disorder that is general to the system. 719. Assuming the evil was in the blood, not so much from impuri- ties as a change in the relative proportions of its necessary elements, we might rationally expect the composition of some structures or products to be more influenced than others by an excess or deficiency of prin- ciples important to their very existence, since the greater frequency with which particular parts are affected only indicates that the tissues of which they are composed, and the fluids which permeate to them, are such as to be especially affected by a morbific cause which prevails to a greater or less degree throughout the system. 720. There is in the blood an independent faculty of sensation which by physiologists is not as yet acknowledged. In disease, as in health, it is sentient of its own. states, as it is inceptive of its own actions, and through it we feel much of what, in idle phrase, is made exclusive to the nerve. Acute rheu- mat sm can cure itself. Bleeding, opium, and c.iloniel, if they do not kill, compli- cate the dis- order. 721. The fever of acute rheumatism is competent to the task of its own cure. Yet the patient is made to pay by the lancet for its acuteness, and swallows every specific for gout and neuralgia in right of his rheu- matism. . . From this practice, there is reason to believe that many of the dangerous complications so frequent of late years in the pathology of acute rheumatism do in truth proceed. In the well known combin- ation of opium and calomel, this mischievous diligence of treatment receives its most frequent illustration. The objects proposed in this heroic formula are the immediate and complete extinction of fever, pain, and inflammation. It is a rude and empirical practice which seldom succeeds, and fail- ing of success is most injurious to the patient ; it has destroyed very THE DOCTKINE OF PURGATION. 167 many who, under less popular and energetic methods of treatment, cuJ^kJari- would have recovered. . . °"? 5 An *° the There is more wisdom, for there is less cruelty, in homoeopathy, hydro- pathy, or animal magnetism. Yet the courage is with those who refuse to prescribe. Let young medical men ponder. patient. ity. 722. Purgation. — Its simplicity ill accords "with the impatient vio- JSSpiiS lence and affected combinations of modern therapeutics; yet of consti- tutional methods of cure, no one, by long practical experience, has been more thoroughly approved. Forced sweat. 723. To secure effects by perspiration, opium, antimony, ipecacuanha, ammonia, have been unsparingly added to the system, already tasked by an active disturbing principle, to its utmost means of resistance. Hence, from undue haste, violence, and inconsistency of action, a great loss of the credit which would otherwise have attached to the sweating practice in rheumatic fever. Imperfect sweating causes offensive matters to remain in the ducts and pores. Sweating to be beneficial must come on spontaneously, with no aid from drugs,, Dick, Robert, M. D., The Treatment of Dyspepsia. See Lancet, 1847. Vol. I. 724. Cajcum. — In all cases of constipation or torpor of the bowels, cw*-_ attention to the caecum is important. It is here that fecal accumulations Sse ? \n~the are, on several accounts, apt to take place. The circumstance of the large JjJJJJjigE! bowel here forming a cul-de-sac, out of which, moreover, the fecal mat- flammation ter, during 14 or 16 out of the 24 hours, can only escape by a course dmTd/^ce's. counter to gravity, disposes not a little to the collection there of excre- ment. And indeed, in most cases of constipation, in cases of chlorosis, &c, we shall generally both see and feel a fullness of this part, some- times of remarkable and even alarming extent and hardness. . . . And I have no doubt that in not a few cases a state of chronic irritation of (sub-) inflammation and even of ulceration of the mucous membrane of the caecum, is induced from the long contact with hardened faeces which, moreover, have become preternaturally fetid and undergone certain irri- tating chemical decompositions. In such circumstances either round or irregular masses of a fatty looking substance may often be detected in the evacuations. This consists of inspissated mucus, secreted by a sur- face highly irritated or {sub-) inflamed. A slight prolongation "or increase of such irritation will convert this inspissated discharge into a purulent one (Lane, p. 32). 725. In impure states of the fluids we prescribe purgatives on the The following assumption, namely, that if we, by artificial means, afford ^SIT*' 8 nature trie opportunity, she will, by emunctories whose action we excite, discharge herself of morbid principles, retaining those that are healthy. This, indeed, is the grand general law, in faith of which we venture, ^n any case, artificially to meddle with, nature (ibid. p. 88). 168 THE DOCTRINE OF PURGATION, Sherwood, John Burdett, M. D., On Dyspepsia. London, 1847. Unity of dis- 726. I am of opinion that the proximate cause of all diseases con- sists in some alteration in the force, quantity, or quality of the circulat- ing fluid ; and that, of those affecting the general system, vitiation of the blood is an in/variable accompaniment (Preface). Johnson, Edward, M. D., On Dfe, Health, and Disease. American Edition. New York, 1850. *■ Purgation ^27. Purgation, like exercise, accelerates what Liebig calls the change accelerates f matter — that is, the daily disorganization and reorganization of the the change <\ /•i-i-it -i • i i '77 77 . of matter, elements 01 the blood and vital organs, by more rapidly expelling the old and worn out material and supplying its place with new (p. 96). oid ageytie 728. There is but one legitimate cause of death, and that is old age. nSrte le caus«> If an V nian die while any of his organs is unimpaired, he dies pre- of death. maturely, and before he has fulfilled the final cause of his existence (p. 08). 729. The health of the body depends upon the healthy performance of the nutritive actions, and disease consists in the unhealthy perform- mate effects IleiiHh and disease. All the legiti- me ance of these- actions, or of one or more of them. Medicines, therefore, attained by ] mve no rea i va i ue nor power over disease, excepting as they have the ■purgatives. power of increasing or diminishing the activity of tlie nutritive actions, absorption, secretion, circulation, dec. (p. 88). n from indi- 730. We cannot derive any benefit from what we eat except from that overfeeding portion of it which in due course becomes blood. ^1/^that we eat, there- our food does fore, beyond what can be converted into blood, is either changed into fat. not become blood, the system is ^ filled with O gases, etc i' is left in the stomach and bowels to run into fermentation, serving no tlier purpose than to distend these organs with all sorts of pernicious and offensive gases (pp. 81, 82). digestion — (constipa- tion) — how- it impover- ishes and poisons the blood. Good illus- tration. 731. The result of improper digestion is that the necessary change which should be wrought upon the food in order that it may nourish our bodies, is very imperfectly effected — the chyme is of unsound quality. The next result is this : the chyme, by admixture with certain other juices which it meets with in the bowels, is destined to become chyle. But the chyme being of vicious quality, the chyle which is formed from it must also be vicious. At all events it must be deficient in quantity ; certainly it is impossible to suppose that as much perfect chyle can be elaborated out of bad chyme as of good. You might as well hope to make as much good butter out of bad cream, or out of cream and water, as oat of pure cream. The chyle, therefore, is deficient in quantity; but this chyle is destined to become blood. The chyle, therefore, being deficient, the blood resulting from it must also be deficient (p. 125). TheMood the nutri- ment of the body. 732. But the blood is in fact the real food on which the body feeds, and this food being scantily supplied, the strength of course is ill-sup- ported. But there is another mischievous result of this condition of the stomach and bowels, beyond that of unhealthy and deficient gastric THE DOCTRINE OF PURGATION. 109 juice. In that condition of the health which I am endeavoring to describe, the stomach aud^ bowels actually secrete air. It is a thoroughly established fact that air-wind— flatus — is actually formed from the blood, ed^^Tits and poured into the stomach and bowels by those arteries which ought eff ects. to form only gastric juice. Now, this wind not only does no good in the stomach and bowels, but it does a vast deal of harm. For, besides the evil effects which it produces by its pernicious qualities, it violently distends these organs, stretching and separating, and thus greatly iveaJc- ening and destroying the firmness and compactness of their ultimate tissue (pp. 125, 126). William, M. D., Observations Relating to the Science and Art Wegg of Medicine London, 1851. 733. A highly important action of 'medicines upon the intestinal sur- face remains to be noticed, as affecting its excretory function. I do not mean the process which eliminates from the villous surface a fluid largely composed of water, containing the remains of the epithelium, &c, and which almost any irritating cause may excite, but the excretory function of the glands which thickly stud the surfaces of the bowels, and espe- cially those of the large intestines. Although the lungs, liver, kidneys, and skin contribute largely to the depuration of the body, there is little doubt that these glands contribute greatly to the same result, very proba- bly by expelling matter different from that which those other depurating organs eliminate (p. 213). Purgative, medicines — their action on the colon. EEaspel, A., M. D., Medical Staff of the Algerian Army. Paris, 1852. See Med. Chlr. VAlgerie. Vol. X. Be v., New Maladies de Sen, 1852, 734. In this season of the year (autumn in Algiers) every individual seems to be endowed with an especial susceptibility to the development of typhoid symptoms, when he becomes the subject of dysentery, inter- m Ittent or remittent fever. But these accessory phenomena, the stupefied countenance, the restlessness., heat of the belly, &c, quickly disappear, at the same time with the principal disease, under the influence of an evacuating plan of treatment. We must distrust the fulness of pulse, the false plethora, which manifest themselves during the prevalence -of the great heats, and which seem to call for bleeding. If we yield to this perfidious indication, we find our patients fall into a state of adynamia, without the dysentery undergoing any amendment ; or, if the abstraction of blood produce any relief, it is but temporary, to be speedily followed by a sensible aggravation of all the symptoms (p. 58). Malignant fevers abound. Purgation the cure. Bleeding kills. 735. Mr. Haspel refers to the advantages derivable from purgatives, recorded by the. old writers, and considers that their disuse in recent times has arisen rather from the prevalence of theoretical views of the inflammatory nature of diseases than as a result of experience. He speaks highly of emetics at the very outset of these diseases (pp. 9, 11, 39 ; Rev., pp.' 106 sq.) Theory and practice. resists all CONTAGION 170 THE DOCTRINE OF PURGATION. Carpenter, C. William B., M. D., Principles of Humcm Physiology. London , 1853. Purebiood 736. I firmly believe that if the blood of a person of sound constitu- tion be kept in a state of perfect purity by the moderate use of whole- some food and drink, by the respiration of pure air, by adequate exer- cise not pushed to over-fatigue, and by personal cleanliness, he is as completely protected against the invasion of cholera as he who has been effectually and recently vaccinated is proof against small-pox. . . The same is true of all contagions and diseases, and hence the universal value of purgatives, which quickly restore the above conditions, if any aber- ration has taken place (chap. IV.) Dickson, Samuel IT., M. D., Professor Med. College of South Carolina. Elements of Medicine. Philadelphia, 1855. ?ow & n°bt~ ^37. The blood is often indirectly poisoned by the influence of con- comes im- tingencies which prevent the elimination of such effete matters as must siTeV dis- be got rid of to keep it in a normal condition. We have reason to infer eased). ^ e existence within it of injurious ingredients, whose presence we can- not demonstrate by the ultimate results. The blood may thus become, so to speak, passively diseased (p. 111). and^fflSJJS ^^- ^ n ^ ne cure °f i n fl uen z a , purgatives aid in reducing to its proper twes. level the vascular excitement; while we "derive" from the head and throat by determining to the gastric intestinal surface (p. 313). The wood— 739. The blood is found altered in disease:. it W beJomes 1- ^7 a change in the proportion of its constituent elements ; impure. 2. By the addition of foreign matters (p. 111). Demands careful attention. ei^matteVs ^^' ^ g rea t variety of foreign matters may be absorbed into, mixed chymists with, and detected in the blood. Kramer found in it silver, after the \nthellood. nitrate and chlorate had been taken. (Esterlein discerned globules of mercury in it, as well as in the saliva and urine of persons who had been taking mercurials. Heller found iodine and bromine in the blood of patients to whom these remedies had been administered. Nitrate, hy- driodate, and carbonate of potass, antimony, and carbonate and sulphate of iron have been found in similar circumstances. Quinine may be dis- covered in the urine, which it must reach through the vessels / and lead is shown in the gums and in the brain of those poisoned by that metal ■ (p. 111). CONSEQUENCES. other impu- 741. The foreign matters which, as causes of diseases, enter the blood, are not always, however, to be thus exhibited by chemical tests and re- agents; but their presence can be inferred as indisputably though less palpably. . . Blood thus poisoned becomes in its turn poisonous. The glands are irritated by it, and the secretions and excretions become mor- bid (p. 112). THE DOCTRINE OF PURGATION. 171 742. The sugar excites the kidney into diabetes, the carbon and urea . various i -i • M Tj. i • • i i ,• ,1 . • forms of dis- oppress the brain with coma. Its chemico- vital relation to the tissues ease induced undergoes essential changes, and infiltration and exudation, congestion, ties.™"®"™" dropsy, and hemorrhage follow. It ceases to be nutritious, and atrophy and marasmus follow, or its nutrition is perverted and morbid, and we have hypertrophy, or deposition of scrofulous, tubercular, typhus or cancerous matter (ibid.) Bennett, John Henry, M. D., Editor of Edinburgh Medical and Surgical Journal. 743. The mortality from pneumonia has diminished since large Bleedin in bleedings have been abandoned. (Present state of theory and practice pneumonia. of medicine. Journ., Yol. I., 1856, p. 19.) 744. Pericarditis. — Some few years gone by, the practice was to Perimr- meet the violence of the inflammation by the extremest antiphlogistic measures ; the lancet was plied with a most unsparing hand, and with the most unhesitating faith in the propriety of its use. But where are Blood]ettin the believers in, or imitators of, such a practice now ? This " heroic and and mercury certain method," as it was called, of arresting the destructive agent — of condenmed - exterminating the disease — has been convicted of error, and condemned by a late authority as " uncertain and very dangerous." Again : " after blood-letting, rapid induction of the mercurial influence is of the greatest consequence," wrote an authority in a most unhesitating style some fif- teen years ago. But now we find one of the most observing and practical physicians* among us admitting, that the firm faith which he himself once reposed in the efficacy of the remedy had been undermined by the truth-telling effects of further experience. In short, "the errors and absurdities," says Dr. Markham, " into which men have been led through this hastening to be wise — the fallacious and extraordinary proceedings in practice it has involved them in — he who is desirous of learning will find recorded on every page of the history of medicine. By thus casting dust in the eyes of others, and perverting our own wisdom, we raise up positive barriers to the advance of true knowledge ; for now the mist of delusion which our faulty haste has generated must be swept away before the honest face of the simple fact can be made available to light our slow steps along the difficult passes of new knowledge (Journ., vol. I., 1856, pp. 1038, 1039). 745. The very discordant opinions which equally honest and equally Medical skilled observers maintain — observers not living in separate ages, or in HKJHS^ different countries, or in separate cities, but exercising their art upon ' stubbom - the same disease, under the same roof, in the same public hospitals — must have a meaning. Is it not one which is oftener than we care for to confess, responded to by our consciences at the bedside of the patient ? (ibid., p. 1039). * W. 0. Markham, M. D., in his "Diseases of the Heart, their Pathology, Diagnosis, a"nd Treatment." London, 1856. novo.' 172 THE DOCTRINE OF PURGATION. inflamma- 746. ISTone but men ignorant of pathology now talk of " knocking tS'weed- down " inflammation with blood letting, or with mercury. Indeed, why cu?y cu™s!" these remedies are employed at all, has, to use the word of Dr. Mark- ham, " yet to be shown " (ibid., p. 1042). Bennett, J. Hughes, M. D., Professor of Medicine m the University of Edinburgh. Observations on the Results of an Advanced Diag- nosis and Pathology, etc. Edinburgh, 1856. See Edestb. Med. and Surg. Journ., Vol. L, 1856. Pastexpe- 747. Medicine is not a scientific art, which is dependent for its theories— of principles on the study of and commentary on the older writers. . . On n me U dfcai n the contrary, it is the book of n/itwrn, which is open to all, that we ought SS- to P eruse an d study; and why should we read it through the eyes of the begin "de sages of former times, when the light of science was comparatively feeble and imperfect ? . . . The lesson which a careful study of the history of medicine has forced upon me, is the necessity of reinvestigating, with all our improved modern appliances, the correctness or incorrect- ness of existing dogmas, in order to establish an improved practice for the future (Propos. I. ; Journ., p. 773). Smaii-pox. 748. Dr. Wm. Addison (Cell-therapeutics, 1856) correctly points out The pustules that in the distinctive eruptive fevers, such as small-pox, the numerous —the matter small abscesses in the skin eliminate the morbid poison, which formerly creted^m existed in the blood, and are in this way essential to the cure. This provident action he denominates " Cell-t/ierapeutics." In all such cases experience has shown that time and a natural sequence of changes is is injurious" necessary for a restoration to health, and that the idea of cutting short such changes by bleeding is alike erroneous in theory and injurious in practice (Propos. III. ; Journ., p. 777). — tne^thetr 6 ' ^^' ^ ar g e an d early bleedings have been practiced under the idea far more ap- that by diminishing the amount of the circulating fluid — pwgJion. 1. The materies morbi in the blood would be diminished y 2. Less blood would now into the inflamed parts ; 3. That the increased quantity of blood in the parts would be les- sened ; and 4. That the character of the pulse was the index as to the amount of fluid that ought to be drawn (ibid. ; Journ., p. 776). B mo e ves S thT ^0. The careful investigations of chemists, and especially those of good^ and Andral and Gavarret, Simon, Becqueril and Rodier, and others, have further shown us, that whilst venesections greatly deteriorate the blood, rendering it poorer in corpuscles and richer in water, they have no effect in eliminating morbid products, and that in the vast majority of cases elimination is impeded by blood-lettlng (ibid. ; Journ., p. 778). the blood. Bloodletting allows the bad to re- main. Liflamma- 751. Inflammation having occurred, the great work now to be accom- %S/-«/and plished is to break up the exudation that has poured out, to remove the uve cure lie pressure it exerts on the nerves and blood-vessels, and render the whole same. capable of being eliminated from the economy, either directly, by dis- charge externally, or indirectly, first, by passage into the blood, and secondly, by excretion -through the emunctories (ibid. ; Journ., p. 779). THE DOCTRINE OF PURGATION. 173 Inflamma- tory action described — bloodletting useless — in- dication for purgatives. 752. Now, it requires to be shown that draining the body of blood cannot in the slightest degree influence the congestion in the inflamed part. There the vessels are enlarged, the current of blood is arrested, the blood-corpuscles are closely aggregated together and distend the vascular tube, and are in no way affected by the arterial current, even when increased in its neighborhood. That opening a vein can alter this state of matters is scarcely to be conceived ; and if it could, how would this assist in removing the exudation which has coagulated outside the vessels ? (ibid. ; Journ., p. 780.) 753. So far from getting rid- of inflammation by weakening the pulse, we not only fail to do so, hut prolong the time for the transformation of the exudation. This, indeed, is acknowledged by Louis, Chomel and Grisolle^ who distinctly show that the progress of a pneumonia is never shortened by bleeding (ibid. ; Journ., p. 781). 754. It is injurious to diminish by bleeding the nutritive processes Bleeding themselves, when they are busily engaged in operating on the exudation, recovery. •and eliminating the morbid products (ibid. ; Journ., p. 781). Bleeding prolongs 755. The phenomena of fever and excitability following inflamma- tion, have been wrongly interpreted. In themselves they are sanative, and indicate the struggle which the economy is engaged in, when at- tempting to get rid of the diseased processes ; and we only diminish the chances of that struggle terminating favorably, by lessening the vital powers at such a critical juncture (ibid. ; Journ., p. 782). The crisis must not be interrupted by bleeding. 756. Assuming it as granted that in some cases the pain is for a time relieving by bleeding, and that in pneumonia the respiration tempora- rily becomes more free — at what cost are these advantages obtained, should the patient be so weakened as to be unable to rally % Even if he does rally, a large bleeding almost always prolongs the disease (ibid.). Bleeding a dangerous palliative which pro- longs the disease. 757. Clinical Lectures on the Principles and Practice of Medicine, turn of the lungs. New York Ed., 1860. In all hepatization, the object of nature is to reconvert the solid exu- dation once again into fluid, whereby it can be partly evacuated from the bronchi, but principally absorbed into the blood, and excreted from the economy. Gradually the solid amorphous mass is converted into a fluid crowded with cells. This is pus. The cells, after passing through their natural life, die and break down, whereby the exudation is again reduced to a condition susceptible of absorption through the vascular walls, and once again mingles with the blood, but in an altered chemical condition. After undergoing various changes in the blood, the exudation is finally removed from the economy (pp. 265, 266). The natural and the pur- gative cure the same. Pickfoed, J. II., M. D. LLygiene. London, 1858. 758. Malaria is modified by altitude. If the elevation be consider- Dilute the able, the temperature will necessarily restrict the fever to the intermit- im P urit y und 174 THE DOCTRINE OF PURGATION. the cUseMe ^ en * f° rm 5 whilst in the plain beneath, the same noxious emanations would produce, in tropical climates, remittent or yellow fever, plague or pestilential cholera (§ 966, p. 172. Cf. Brown). 576,000 rea ons for amount analogy with 759. A healthy adult respires twenty times in a minute, and takes purgation into his lungs, at each respiration, twenty cubic inches of air, or 576,000 eptdemfcs, cubic inches in twenty-four hours. This respired air comes into contact, maiari' at each inspiration, with 201,600 square inches of mucous surface of influences, air-passages and cells. Is it, therefore, matter of surprise that atmos- pheric air, contaminated by infectious or contagious matter, or poisoned by malarious, miasmatic or paludal emanations, should exert its baneful influence on the blood and on the organic nervous system, through the nerves distributed to the enormous superficies with which it comes in contact at each inspiration % The wonder is, that any of us escape ! (§932, p. 165.) insensible 760. The sum of the cutaneous and pulmonary secretions amounts, %Z^Ats according to the best authorities, to two pounds, eleven ounces, three drachms, and twelve grains in twenty-four hours. The cutaneous mine! exhalation is a true secretion from the blood, somewhat analogous to that of the urine, of those matters which, at the tern per ature of the body, are capable of assuming the gaseous form, as carbonic acid and water (§§ 1101, 1102, p. 206). Hazard, Thomas R., of Vaucluse, R. I. Purgatives. 761. Doctors' and undertakers' fees are so high that it is very incon- venient for persons of small means to be sick or die in these times. That most of the maladies that prevail in our climate may be prevented by proper care I have no doubt ; and that most of the sicknesses that do occur may be cured at a trifling expense and loss of time, I am, after half a century's observation and experience, equally certain. I think men and women would now. survive to the average age of seventy, instead of half that term of years, if they would live and practice in harmony with the laws of their being ; which, like all [Nature's works, are ever found to be as simple as they are grand, when understood. 762. Moses was inspired to utter a great truth when he declared that " The life of the flesh is in the blood." Action is life ; and the blood is the organ by which it is communicated to every member of the body. It follows that if the organ be out of tune, the music or har- mony of life cannot be complete, however cunningly it may be piped upon. If there is discordancy in the instrument, it is not the fault of the law — which is ever perfect in itself — but it is the fault of man's animal propensities that transgress the law. 763. The blood that imparts life and nourishment to the system feeds upon the food we eat, the fluids we drink, and the air we breathe. To preserve its purity we should eat to live, rather than live to eat. Eat slowly, chew the food well, drink sparingly, even of water, and be temperate in all things, and one half of the primary causes of disease THE DOCTRINE OF PURGATION. 175 will be removed. Hilarity and cheerful conversation whilst at the table greatly assists digestion. A hearty, prolonged, explosive laugh will well nigh split a pine-knot on its passage to the stomach. See to it, as far as is practicable, that you breathe un contaminated air ; for every breath we draw comes in contact with the blood, and imparts to it its own quality, whether it be the savour of life to life or of death to death. Look especially to your sleeping-rooms that they are daily (and if small nightly) ventilated. Avoid beds, and particu- larly pillows, that are filled with blood-shotten feathers. Keep the pores of the body open and clean by frequent bathing, for each of these are pipes that gives tone to life's organ. Above all things look to it that there is no decaying vegetable matter of any kind near or under your sleeping apartments, for probably more sickness occurs from this cause than any one other. If at any time you begin to feel dull and heavy and good for nothing— -if you lose animation, and your flesh feels numb and sore ; if your mouth grows clammy, and your tongue furs / if your eyes feel as if they had sticks in them, or your head, or side, or back. begins to ache, or old sores and weak points of the system grumble ; if you snuffle, or your voice grows husky, accompanied with a hacking as if to clear the throat — lose no time in ascertaining and removing the local cause, if possible, before you are stricken down by disease. Proceed first to your cellar, especially if you sleep on the ground-floor. Examine it well in every nook and corner. You may, in your researches through its dark labyrinths, perchance stumble upon a dead cat, and perhaps some festering rats ; but heed them not. Their aroma is not pleasant, but it is not deadly poisonous ; but, if you should fall in with a rotten turnip or potato, or cabbage, or any other decom- posing vegetable, eject it at once a stone's-throw from your house, with every vestige of its remains, even to the earth it has impregnated ; for the miasma that arises from a peck of decomposing vegetables of any kind, if inhaled into the lungs, and consequently blood, especially during sleep, is sufficient, with the aid of the lancet or of a little morphine, to kill a regiment of hardy men, and the stronger and more robust they are the more certain will be their doom. I have myself known, many years since when the lancet was in vogue, scores of hardy young men and women perish under si*ch circumstances in a single country town of this State, whose lives might have been easily saved, I am entirely confident, under a different mode of treatment. I have now in my recollection a certain Doctor Sangrado, who then practiced in that town, of whom it might with truth be said " Death followed after him." He seldom entered a family at the season of year when these morbid attacks were most rife, without sending one, two, or three, and even five in one instance, to their graves. Weakly patients, whose strength of constitution was not competent to carry any considerable portion of morbid matter in their blood before it gave way, stood some chance of life under the bleeding treatment of that day, but those of strong constitutions stood but little. These, when attacked, generally kept about until their blood became so thick and sluggish that it coursed with difficulty through the thousands of little ducts and vessels tli at carry life to the surface and extremities of the body, and were unconscious of their danger until the morbid matter in the blood — precipitated perhaps by the scratch of a briar or pin, or a draft of cold 176 THE DOCTRINE OE PURGATION. air or other trifling exposure — began to clot or congest in the intricate recesses of the brain, the liver, the pleura, or some other weak or deli- cate point, accompanied, of course, with pain or distress. Dr. Sangrado was then called, who proceeded at once to draw a heavy portion of the best blood from the system in order to relieve the suffering ; and, having thus paralyzed the vital forces, they were next stimulated by a dose of mercury and expected to perform double duty, with their instrument (the blood) just crippled by the lancet. In other words, the horse that was striving, with all his might, to extricate a heavy load from the mire was first knocked on the head to prevent his injuring the wagon by his efforts, and then a shoulder was placed to the wheel in the vain expectation that the additional stimulus would enable the dying steed to drag it through the mud. The loss of the best blood the system could afford neutralized the otherwise good effect of the mercury, gave momentary relief to the patient just so far as life had been obstructed, relaxed the efforts that Nature was making to dispel the poisonous miasma from the blood which, in its weakened" flow, went on congesting or clotting with accelerated speed. The pain or distress soon returned, and again the lancet was resorted to, alternately with doses of calomel, until the patient's whole body, deprived of its life- principle, became a mass of inert and putrid matter; and "Died of typhus fever " was generally the verdict of Death's coroner. 764. The practice of blood-letting has been, finally, pretty much abandoned, and one less revolting, but little less fatal in its operation, has been substituted by many physicians in its place, viz. : that of relieving effects at the expense of aggravating the cause by the use of opium. Instead of knocking the horse on the head under the circum- stances before narrated, his efforts are paralyzed before the shoulder is put to the wheel by dosing him with poison. 765. To illustrate by another homely comparison : If a piece of cloth be run through water saturated with fustic, logwood, or other dye-wood, it will come out stained or colored. Rinse this in a brook, and the coloring-matter will quickly disappear; but drop a small lump of alum, vitriol, or other mordant in the dye- vat before the cloth is passed through it, and all the water of the lakes will not suffice to wash it white again. So, when the blood, by neglect, exposure, or abuse, has become surcharged with unhealthy matter, sufficient to interrupt its healthy flow, and begins to clot or congest, a little stimulus applied in the same direction that the law of our nature is already striving to impel the vital forces, will enable them to dislodge the congestion and expel the morbid matter from the blood. But introduce an opium pill or the smallest portion of morphine into the blood, and all the mercury or other cleansing stimulants on earth will scarcely purge it clean. 766. A bullock's hide once accidentally lodged on a shoal (Veak point) in the River Tiber — the great artery of Rome. Against this the impurities and drifts of the river gradually congested, until it became a ast-anchored island. When first deposited it is probable a housewife THE DOCTRINE OF PURGATION m might, with a mere swash of her broom in the direction of the current, have so far stimulated its force as to have removed the hide (congestion) and prevented the formation of the island. 767. Before applying such a mercurial remedy, to be consistent with his practice as applied to the cleansing the channels of the blood, Dr. Sangrado would have first withdrawn from the Tiber sufficient water to nave left the bullock's hide high and dry in the sand, and then set the woman to work with her broom ; whilst Dr. Morphina should have advised that the swashing process should be deferred until the waters of the river were congealed by frost, or thickened by some ingenious process to the like consistency imparted to the blood by opium or other narcotics. 768. What I have said so far is mostly theory, which readers will, of course, estimate at what it is worth. What I am now about to say is fact, derived from more than thirty years' observation and experience applied to multitudes of cases with, as far as I am advised, uniform success, including bilious colic, bilious fevers, and all that class of mala- dies that, under the ordinary medical treatment, end in slow fevers called in the books Typhus or Typhoid, Pleurisy, common colds and sore-throat, Indigestion, and its first-born child Headache, Croup (if ap- plied in an early stage), Dysentery, Diarrhoea, Fever Sores, and running sores generally (the fountain of which is ever the blood), cuts and bruises of the flesh (if applied immediately after the accident occurs), and, in fact, almost every acute ailment common to our climate, that commences with pain in the head, body, or limbs, or at the commencement of which the patient remarks, in a languid tone, " I donH feel well" with the exception, perhaps, of scarlet and lung fevers, which the remedy I shall describe greatly benefits, and lays the foundation for a certain cure, as far as my limited experience in these complaints extends, by applying additional simple treatment, viz., packing in the former, and certain vegetable cordials or decoctions in the latter complaint. 769. At a period when the reputation of the Mood-letting physician I have referred to was at its height (and it was great in proportion to the scores of his victims that died, those that recovered being held in popular estimation that his skill had miraculously rescued from an other- wise mortal distemper), a hired girl living in my father's family was smitten with the usual symptoms of the prevailing malady, and Doctor Sangrado was sent for. He told my father that the girl's case was ex- ceedingly dubious, that her organization was unfavorable, and that Ire had but little hopes of her recovery ; still he would do all that medical skill could do to save her life. My father was opposed to blood-letting, and the doctor deferred the use of the lancet until the next day. In the meantime my father gave the girl a dose of what was then known as Aldrich]s Pills, accompanied with a sweat. The next afternoon the doctor called again, and, after sitting a little while, inquired after the girl's health. My father told him what had been done, and that she was then apparently well and at work in the kitchen. Upon this an- nouncement the doctor mused a few moments, and after remarking in a soliloquizing tone that " those pills are devilish things," he took up his 178 THE DOCTRINE OF PURGATION. saddle-bags, lancet, blue pills (sure to be followed by rheumatism), opium, mercury, blisters and all, and departed, " never to return" 770. About this period manufacturers in the town alluded to, of which I was one, were seriously incommoded by the annual prevalence of the complaint, dubbed by Sangrado as typhus, but popularly known as fall fever. Business was sometimes brought nearly to a stand-still from the number of hands that were taken out of employ in consequence of long, and, in very many cases, fatal sickness. A young man or woman would leave the mill, complaining, perhaps, of a pain in the head, neck, shoulders, back, or side, or difficulty in breathing, send for Doctor Sangrado, experience momentary relief from the free use of the lancet, and, in consequence, be prostrated on a bed of languishing for weeks or months, and probably die. I was fully satisfied, in my own mind, that both the sicknesses and deaths were, in a great majority of cases, the result of improper treatment, rather than the normal character of the malady, and greatly to the disgust of Dr. Sangrado, gave free and wide utterance to my convictions. I finally resolved to practice medicine myself, so far as I could obtain patients, from among those in my immediate neighborhood and employ, gratis ; and from that day to this, a period of more than thirty years, out of many hundreds of cases of almost every type of disease, I have never known a death to occur among those who have relied solely on the simple remedies I have fur- nished, nor have I known of a serious case among them all of Dysentery, Pleurisy, Typhus or Typhoid, Brain, Congestive, Bilious, or any other fever, except scarlet or lung fevers, of which last, as before said, my experience has been slight, and confined to my own family, in which there has been five cases of scarlet fever ; one of which was treated by two of the most renowned physicians in New York, and died in great apparent agony on the seventh day. Two of the other cases were equally severe, but all recovered without the interference or aid of the faculty. 771. For some time I relied on the " devilish pills " only in light at- tacks, and gave from 12 to 15 grains of calomel, with a good sweat in severe cases. I generally attended to the sweating process (which I shall hereafter describe) myself; and never, to my recollection, failed to obtain the desired sweat. The mercury stimulated the interior powers of the system, whereby the morbid matter is (as I suppose) forced from the blood into the bowels, and thus passes ofl'; whilst the sweat, operating on the external pores of the body, in like manner as the stimulating mercury acts on the internal pores or ducts, the two forces sympathize and assist each other ; and the congestion and other causes of disease (unless it has become chronic) are wholly expelled at one operation, leaving the system as free from poisonous or unhealthy matter as is that of a new-born babe. 772. It is now nearly thirty years since I entirely abandoned the use of calomel, for which I substituted " Brandretli's Pills," which I have found, after long and varied experience, produce all the good effects of mercury, with none of its bad. Too much care cannot, however, be ob- served in obtaining them, as a large proportion of the pills sold in New THE DOCTRINE OF PURGATION. 179 England are spurious, notwithstanding their close resemblance to the genuine and the oaths of the unprincipled men who vend them. To make sure of the genuine, I always obtain them from Dr. Benjamin Brandreth's own office, which is at the " corner of Broadway and Canal Street, New York," and who sends them to order, free of charge for ex- press, for two dollars per dozen boxes. One or two boxes (or not over twenty-five cents' worth) sufficing generally to keep a family of ordinary size in health for a year. 773. Thus any man, by an expenditure of two dollars, may keep his own family, and those of some five or six of his neighbors, in health for a year, and that with very little if any loss of time, and not a farthing's expense for medical aid. This, as a general rule, I pledge my word I know to be true by actual practice and observation — although I suppose it will not be so regarded by most readers. These pills are as efficacious in cases of hurts, bruises, cuts, sores, &c, as in other maladies. By im- mediately cleansing the blood they remove all danger of lock-jaw, fester- ing sores, or congestion of the blood, at the wounded or ailing points — and nature speedily restores the injured parts. Not unfrequently, from the use of opium in some of its varied forms, or other malpractice, the morbid matter in the blood seeks to escape through vents called fever- sores. I have known instances of this kind wherein, after the patient has been in acute pains for weeks, a few doses of Brandreth's Pills have turned this current of morbid matter from the sores to the bowels, through which it has been passed off, and the patient healed almost at once. But I do not mean to be understood to say that this is the rule ; as when the system has been surcharged and weakened by poisonous and stupefying drugs, nature's vital forces cannot always be rallied by any treatment that I am acquainted with. 774. I will close this long (and, as doctors will doubtlessly say, ab- surd and foolish) article, with a simple recipe, which, if adhered to in all its requirements, I know will heal at one operation a great majority of the ills we are liable to in this country, and I believe in all other coun- tries. 775. I know that it has been used with entire effect in cases of yel- low fevers; and I now have in my possession a certificate, signed by every member of a company who were nine months in the Army of the Potomac, at a time when thousands were dying around them with small-pox, and swamp fevers, and dysentery — the health of every one of whom (without an exception) was preserved, without the aid of a physi- cian, simply by relying solely on " Brandreth's Pills," a quantity of which had been presented to the Company, with directions for using them, by their fellow-townsman, Dr. Benjamin Brandreth. EECIPE. 776. In cases of slight hurts, cuts, bruises, punctures, &c, or slight in- disposition, take from one to six Brandeetij's Pills, according to age and constitution; say one pill for a child one year old, two for a child of three years old, and four or more for adults. 180 THE DOCTRINE OE PURGATION* 777. Where any malady has made such progress as to cause difficulty of breathing, oppression, or severe pain in any part of the body, head or limbs, place the feet of the patient in water as hot as it can by any pos- sibility be borne, and throw a blanket over the knees to keep in the steam. Do not let the feet remain in the bath to exceed four minutes. Wipe the feet dry as quickly as possible, and rub them hard with a dry towel. Then get at once to bed, and take from one to six pills as above. (In cases of intense bilious colic or pleurisy, give six, eight, or even more, until relief is obtained, but by no means attempt to remove the pain at the expense of the life by blood-letting or narcotics.) After swallowing the pills, drink a glass of weak lemonade (or molasses and water, if lemonade is not to be had) made almost boiling, and so hot that it can only be taken in sips ; then cover warm and a sweat will shortly ensue. This treatment will set all the vital forces of life to work, both internal and external, and not only remove the effects but the cause of the distemper, as the most ignorant cannot fail to perceive, not only by the relief that will be experienced, but from the offensive character of the matter that passes from the bowels, a large portion of which proceeds from the blood, liver, or other vital intestines. Water-gruel alone should be taken for eighteen hours after taking the pills, after which, as far as my experience has extended, patients, as a general rule, will be restored to complete health, and in a situation to eat and exercise as usual, with- out danger of relapse, for the simple reason that the blood, the seat and. organ of life, is freed from all impurities, and consequently there is nothing in the system to cause a relapse ; nor can sickness again ensue until the blood again becomes surcharged with extraneous and morbid matter. 778. Some readers may possibly suppose that, in accordance with general usage, I may have some interest other than that of a desire for the good of others in recommending "Brandreth's Pills" (which, by the by, are always inclosed in a certificate and directions folded around each separate box, with a government stamp on the envelope). For the benefit of such readers I will just say, that I have never received from Dr. Brandreth or any other person a farthing for anything done by me in relation to his pills ; that I have always paid full price for every box I have had ; that I have never received a farthing for any disposition I have made of them, although I have probably administered and given away hundreds of boxes — that I esteem a judicious distribution of them in a charitable point of view as of more value than an hundred-fold of the same value bestowed in money ; that in case of leaving my family for any considerable season, I should do it with an easier mind if satis- fied that they would on any and all occasions — of accident or disease — resort to the foregoing prescription for cure, than I should were they left in a position to command the best medical advice (apart therefrom) in the world ; and this assurance has been derived from a long and varied experience, that has fully satisfied me that there is no necessity that one life should be lost in New England, where there is now ten by what is called Typhus or Typhoid Fever — which, in fact, as a general rule, is but the ebbing away with a slow fever of the life from the blood in conse- quence of the impurities it is forced to consort with, first engendered by breathing foul air, gluttonous and hasty feeding, and other causes and THE DOCTRINE OF PURGATION. 181 exposures, and subsequently aggravated by the malpractices of physi- cians — among the most prominent of which was the former practice of bleeding and parching to death with thirst, which practices were only abandoned by the faculty in consequence of an outside popular pressure, since which morphines and other narcotics have been substituted for the lancet with almost equal fatal effect, and which will be doubtlessly per- severed in so long as ignorant patients measure the doctor's skill by his ability to relieve effects at the expense of aggravating the disease, instead of working them off by removing their cause. APPENDIX. CURES BY PURGATION Cure of Abram Van Wart, of Sing Sing, of Bright's Disease of the Kidneys. Sing Sing, Oct. 14th, 1863. Dr. Brandreth, My Dear Sir: I was taken sick two years ago with a most severe pain in my right arm and elbow. Dr. A. K. Hoffman, of this place, pronounced it neuralgia. He treated me for some time, but getting no better, advised electricity ; I consented, but the shock nearly killed me, and I received no ben- efit whatever. After this my legs became numb and paralyzed, and my back and kidneys were tormented with most intense and continued pain. Dr. A. K. Hoffman and other physicians told me I had Bright's Disease of the Kidneys. They treated me for a long time, but finally pronounced my case hopeless. Other eminent physicians then treated me but did me no good, and gave my friends to understand that my case was incurable. So, at length, I gave up all hope, the lower half of my body being totally paralyzed and much swollen ; and I suffered terrible pain in the upper part of my body. My bowels were completely constipated from the paralysis, and no medicine produced a passage, and my urine was full of albumen. This was my condition five months ago, when my wife's sister, Sally Ann Storms, begged me to take Brandreth's Pills, as she had used them herself and in her family for many years with the best effect. Induced by her and my wife, I swallowed nine Brandreth's Pills. They operated twelve hours afterward, slightly. I continued taking nine every day for several weeks, their operation constantly improving. Finding myself a great deal better, I diminished the dose one pill a day, until I got to five. One afternoon, at 3 o'clock, about three months ago, I took five pills ; at 9 they commenced operating vigorously ; suddenly I felt as if something gave way inside, and the stools were like egg and water mixed, several quarts of which came away, of a most disagreeable odor. The next day I felt very faint, and my neighbors came to see me die ; but as soon as the faintness passed I was much better, and, for the first time in nearly two years, I was able to move and stand upon my legs. I continued taking the pills, and, in a very few days, was able to walk across my room, and now am able to walk quite a distance. I have taken altogether nineteen boxes of Brandreth's Pills, and now one pill a day is all I require. My health is nearly restored, my appetite is good, and I suffer hardly any pain anywhere, and every day I grow stronger. My neigh- bors look upon me as one risen almost from the dead, and I desire you to pub- lish my case, that those suffering from paralysis and kidney diseases may know how easily they may be cured by Brandreth's Pills. ABRAM VAN WART. 184 CURES BY PURGATION. We, neighbors and relatives, certify that the foregoing statement of Abram Van Wart is true. A. B. REYNOLDS, Supervisor of the Town of Ossining. DAVID McCORD, Ex-Loan Commissioner. J. MALCOLM SMITH, Justice and Clerk Board of Supervisors. ABRAM HYATT, United States Assessor, Tenth District. JAMES McCORD, Loan Commissioner. RACHEL CYPHER, RACHEL ANN SLATER, WILBUR F. FOSHAY, LETITIA VAN WART, SARAH A. CYPHER, WM. SNIFFIN. The Methodist Society have heard the above facts stated in meeting from the mouth of Mr. Van Wart. Mr. John Archer, Ticket Agent at the Hudson River Railroad Station at Sing Sing, permits reference, he being fully acquainted with Mr. Van Wart and all particulars. In Epilepsy Brandreth's Pills Seldom Fail to cure, because they purify the blood. If we are sick from any cause we owe it to ourselves to use this remedy which Providence places within the reach of all. New York, July 8, 1861. Dr. Brandreth, Sir : A boy of mine was subject to fits from his infancy — his case was con- sidered hopeless by the doctors, who thought he would be subject to them for life. After they had given him up, I was recommended to try your Pills, and without much faith did try them, using them according to your printed direc- tions. Four years ago I commenced giving them to him, and to my great joy and relief he has had but one return only of his affliction since. I consider him now perfectly cured. The extraordinary benefit they did him makes me always recommend them to my friends, and I would be glad if everybody knew their value. The cause was the worst possible ; he would have been helpless and almost uselessly unfit for any kind of business from the length and severity of each attack — often lasting a whole night, and leaving him, for two or three days afterwards, en- tirely prostrate from weakness. Every kind of treatment was also externally applied that was professionally advised. You may, therefore, judge what good reason I have for letting you have this statement in . acknowledgment for the benefit received, and for the purpose of letting those who may be hesitating under similar circumstances have my testimony in confirmation of the relia- bility of the other certificates, and perfect confidence like myself in the value of the Pills. Yours respectfully, JOHN WEBB, 18 Beehman Street. CURES BY PURGATION. 185 Letter from General Paez, the Washington of Venezuela, / in favor of Brandreth's Pills. New York, May 30, 1865. Hon. B. Brandreth, My Dear Sir : I have received the supply of your invaluable Pills which you have so kindly sent me. I have not only used them myself in South America, as well as in this country, for the last thirty years, never allowing myself to be without them, but have purchased them by the gross to distribute to persons upon my estates and elsewhere, having found them efficacious in almost every variety of disease, especially those peculiar to the Southern con- tinent. I esteem, therefore, very highly the supply you now send me, and thank you very cordially for the kind words in which you convey your generous and friendly sentiments. I am, very respectfully, your obedient servant, JOSE A. PAEZ. Debility and Costiveness Cured. This certifies that I ha've used Benjamin Brandreth's Vegetable Universal Pills more than three years, and I do affirm that having used a great deal of medicine of various kinds I have found none so beneficial to my health as the above-mentioned pills. I have been unhealthy from a child, and have had the advice and attention of the most eminent physicians, who did for awhile alleviate my sufferings, but at last their skill proved unsuccessful, and I was sinking into rapid decay, given up by my physicians, and bending over the tomb without a jot of a prospect for recovering. While in that condition a friend recommended Brandreth's Pills to me. I sent immediately and got a box, and the first dose gave me so much relief that I repeated it, and after several doses, finding my health im- proving, I continued to take them two or three times a week for twelve months. At the expiration of six months I thought that my health was perfectly restored, but still my bowels were irregular and dormant, so I continued to take them as before, until the expiration of six months more, when I found, by gradually quitting, I did not need them more than once a month ; and since I betook my- self to the use of Dr. Brandreth's Pills, I have had no need of a physician, except in two cases, both of which needed skill more than medicine. During the first year after I commenced using these Pills I was very cau- tious both in the quality and quantity of my diet, but since that time I have generally eaten what was set before me. The Pills are the mildest in their operation of any medicine that I have ever taken ; they also produce the most powerful and free discharges of any medicine that I have ever used. And I speak from experience, that continued Use will not render them ineffectual in their operation. If I take a dose and they do not operate, I continue to take them, increasing the number of Pills in each dose, until powerful discharges ensue without any pain, and in a few hours I feel perfectly well and able to attend to business. Having derived so much benefit from the use of Brandreth's Pills, I would recommend them to all who are sick, whatever may be their diseases or com- plaint ; for it is manifest that nothing is more important- in any case of illness than to keep the bowels regular, and it is also evident, in my own opin- ion, that no better medicine than Brandreth's Pills can be obtained to keep the system in a healthy condition. R. DUNN, No. 22 Third Street, Cincinnati. June 1, 1860, 186 CURES BY PURGATION. Remittent Fever, of the Island of St. Thomas, Cured by Bran- dreth's Pill?. New York, May 31, 1856. Dr. Benjamin Brandreth, Dear Sir : It seems to me to be a duty to say that, when I was United States Consul at St. Thomas, in 1849, I used your Pills with very great advan- tage. I was taken with the fever peculiar to that island ; the doctor bled me, and I was in very great danger of dying from that fever and the depleting. The inward fever was so great that no quantity of drinks seemed to relieve it. I was considered in very great danger, and I felt that my hold of life was really very feeble. In this condition I was recommended to use your pills. I at once took eight. Their effect was surprising. They seemed to be actuated by intel- ligence. I could feel them searching all round my stomach, even up to my throat ; every recess of the body was aroused to action. I continued to use them daily until I had taken two boxes, containing; twenty-five pills each, when I was quite recovered to my usual health. Governor Oxholm expressed to me the opinion that the Brandreth Pills were the best medicine he had ever known ; that he entirely relied upon them when he or his family were sick. He would not be* without them for any money ; that he believed you had been the means, by introducing them, of saving many valuable lives — a sentiment in which I concur most cordially. I desire, my dear Doctor, if you deem the above of any service, you will not be aTraid to publish it. I am, very truly, your friend, CHARLES H. DELAVAN, Late United States Consul for the Island of St. Thomas, West Indies. Cure of Dyspepsia of Ten Years' Standing by Brandreth's Pills. Bushwick, Kings Co., L. I., March 1, 1843. This is to certify that I was taken ill during the season of the cholera, in the year 1832, and continued ailing until the spring of 1842, during which time I was severely troubled with dyspepsia, and all its various train of suffering. I became extremely emaciated, melancholy, and worn out with suffering, so that life itself seemed burdensome. I, in the meantime, applied to a number of the best physicians, who prescribed for me ; and many were the bitter doses of medicine that I took, but without avail. At last I yielded to despair. The idea of taking the prescriptions of physicians any longer was useless, and I was bitterly opposed to taking pills. My friends became alarmed ; often solicited me to try Brandreth's Pills, asserting that they had derived great benefits from their use. At last I was tempted to give them a trial, and it is but just to say that, after using them a short time, I began to recover, and soon was entirely restored to health : and I think it a duty I owe to the world, and to Doctor Brandreth, to make this public acknowledgment. N. BLISS. Mr. Bliss will be pleased to testify as to the merits of Brandreth's Pills, after an acquaintance with them of twenty-three years. July, 1866. B. B. CURES BY PURGATION. 187 Cure of Consumption and Dyspepsia. "Hammonton, New Jersey, May 7th, 1866. " Dr. Brandreth, " Dear Sir : I have long wanted to write to you and express my gratitude for the beneficial effects that have been experienced in my own family, and in hundreds, aye, thousands of others, by the use of Brandreth's Pills. The first year my lamented friend Brockway sold your pills in Boston (1838) I called at his office. I was then in a declining state of health, and my friends, as well as myself, supposed my earthly voyage would soon terminate. Mr. Brockway urged me to take the Brandreth Pills, but having used so much medicine, with no good effect, I was more inclined to let nature take its course, and calmly submit to my fate. Mr. B. offered to give me one dozen boxes if I would try them as prescribed. By this I saw he had great faith in them, and I finally consented to take them, but not as a gift. I went home and went at it, almost hopelessly. After taking one box 1 began to feel better. Well, sir, when I had used up my twelve boxes, I was apparently a well, healthy man, my weight having gone from 131 pounds up to 152 pounds. I then ordered a supply, and between that time and the present I have retailed three thousand dollars worth of these invaluable pills, and am quite sure that I have thereby been instru- mental in saving, not hundreds, but thousands of lives. I have given them to my oxen, horses, pigs, fowls, cats, dogs, and always with the desired effect. I have a wife and nine children, most of them born since I have used the pills. A more healthy family cannot be found. We are frequently asked how it is our children look so healthy. My wife replies that ' We raise them on Brand- reth's Pills.' Now, my children overload their stomachs, get cold and out of order, like others, but they have been taught the remedy, and go and take the pills of their own accord. This I consider an important branch of their educa- tion, and feel assured, as they shove off upon the voyage of life, that they know how to take care of themselves. I was in trade at my last residence, North Lincoln, Me., for 29 years. I have been here about seven years ; I am, therefore, well known, and my statements can be verified by hundreds. " Yours. "C. J. FAY, P. M." Certificate of Twenty-eight Years' Use. Newcastle, Westchester Co., N. Y., Aug. 11, 1861. Dr. B. Brandreth, My Dear Sir : I am now seventy-nine years old, and for the last twenty- eight years have been a constant user of your Vegetable Universal Pills when sick, fully realizing the advantage of enforcing purgation with a medicine, which, while harmless in its nature, removes all impurities. I can safely say that the vigorous old age I now enjoy has been caused mainly by the timely use of Brandreth's Pills. I have had, in these last twenty-eight years, several fits of sickness, and occasionally some infirmity of age would press upon me. At these times I have always found your Pills a sure remedy, giving me not only health but strength. I consider them, therefore, invaluable as a tonic, with qualities possessed by no other medicine known to me. I have never, during these last twenty-eight years, used any other medicine whatever, being convinced, by experience, that none was as good. Brandreth's Pills have also been freely used by my neighbors in every kind of sickness, and have never been known to fail when promptly administered. Yours truly, NATHANIEL HYATT, Justice of the Peace for Forty Years in Westchester County, N. Y. 188 CURES BY PURGATION, A Man Saves His Leg. Sing Sing, Westchester Co., N. Y., Aug. 24, 1860. Dr. B. Brandreth, Dear Sir : Some years since a bad swelling appeared on my knee, and sev- eral physicians attended me. I kept growing worse and worse, until I was confined to my bed, a helpless cripple. Large quantities of matter kept coming from my leg, from six deep holes, together with pieces of bone. I lay in bed over one year, when the doctor came to me and said I had a very bad white swelling, and that the leg must be cut off or I would die. They wanted to cut it off then, and had brought all their instruments. I said, " No ; I would die first." So they left me. Despairing of cure, I took your pills. I began with four a day, and took them every day for a month, when my knee appeared a little better. This encouraged me, and though still in bed, I con- tinued taking your pills for four months more. I was now able to get up and go about a little with a crutch. I used the pills for three months more, when the sores all healed, and pain ceased, and I was well. I threw away my crutch, and now for the last four years I have been a well and healthy man, my leg being strong and my body sound. Words fail to express my gratitude to you. Yours truly, RICHARD T. BAKER. Westchester County, ss. : Richard T. Baker, being duly sworn, says, that the foregoing statement of his cure by Brandreth's Pills is true in every particular. RICHARD T. BAKER. Sworn before me, this 24th ) day of August, 1800. J A. Jackson Hyatt, Justice of the Peace, Dyspepsia Cured. "Bennington, Vt., Dec. 5th, 1843. " Dear Sir : I wish you to add my testimony to the host of others that you have in favor of your valuable pills. In the year 1838, I was attacked with that disagreeable complaint, the dyspepsia, which so affected me that I could not take the least particle of food without the most unpleasant and un- comfortable sensations in my chest, head, and bowels. My chest was so sore that I could not bear the slightest pressure without giving me pain. My health was most miserable ; many physicians told me they thought I was in the con- sumption, and that if I did not give up my business, and change climate, I could live but a short time. " I tried everything in the shape of medicine, and consulted the most skilL ful physicians, but found no permanent relief. I became, discouraged, gloomy, sad, and sick of life ; and probably, ere this, should have been in my grave, had I not fell in with your precious medicine. A friend of mine, who had been sick of the same complaint, advised me to try your pills : but, having tried most other medicines without obtaining any relief, I had but little faith that your pills would be of benefit to me ; but at his earnest solicitation, I pro- cured a box and commenced taking them. " The first box produced little or no effect, and I began to despond, for fear CURES BY PURGATION. 189 that your medicine would prove like others that I had taken ; but my friends urged that one was not a fair trial, and I purchased a second, and before I had taken the whole box I began to experience a change ; the pain in my chest began to be less painful, and my food did not distress me as much as formerly. I went on taking them until I had taken six boxes, and my Dyspepsia was gone, and my expectation of an early death vanished, and I felt like a ' new creature.' I was then, .and am now, a healthy man ; I have never since been troubled with Dyspepsia. I have administered your pills to the members of my family, and to my friends, and in all cases with good success. You can publish this if it will be of any use to you. " I am, dear sir, truly yours, "J. L. COOK, " Publisher of the State Banner" Remarkable Case in which Fifty-two Pills were Used before the Bowels were Opened. John Pickett, living at 553 First Avenue, New York, aged 27, of robust constitution, from a severe wrench was Jaid up. His back pained him as if the muscles were torn. His bowels, kidneys, and bladder seemed paralyzed. For seven days nothing passed his bowels, spite of all the remedies administered by his three doctors, who told his wife they could do no more, and he would die. She was advised, as a last effort to save him, to give him Brandreth's Pills. So she procured a box, and gave him four pills every four hours. She rubbed the pills down to powder under a knife on a plate, and then mixed with molasses. - She continued this treatment until she had administered fifty-two pills, when they operated, and the man's life was saved. Observation Particular in respect to above Case. It is right here to call attention to the fact that while, in the first instance, this great quantity of Brandreth's Pills were required to produce a thorough cleansing of this man's PARALYZED BOWELS, two pills every day thereafter were all-sufficient to keep them open until his health was established. Thus we see how important a medicine Brandreth's Pills are ; suitable for the most trying emergencies of bodily affliction, as for the most simple disorder. Always safe yet always sure. They are indeed a century in advance of all other purgatives. Fever and Ague Cured. Mr. John Y. Ilaight. Supervisor of New Castle, Westchester County, New York, desires the attention of those interested. He says : " I was, about two - ago, attacked with fever and ague, which, notwithstanding the best medi- cal advice, continued to sorely affliet me for six tedious months; I became yel- low as saffron, and reduced to skin and bone. Medicine and physicians were 190 CURES BY PURGATION. abandoned in despair. As an experiment, I concluded to try a single dose of six of Brandreth's Universal Vegetable Pills on an empty stomach, early in the morning. The first dose seemed to arouse all the latent energies of my ex- hausted frame. Their purgative effect was different from anything I had ever used or heard of. At length this effect ceased, and I seemed lighter and breathed freer. That evening I was indeed sensibly better and slept soundly all night. The next day I followed the same course and took the same number of pills. I continued to take the pills in this way about three weeks, when J found myself entirely cured. It was two years ago, and I have had no return. My health has been surprisingly good, and I have used no medicine since. Mr. Carpenter, of Gouverneur, New York, sixty-four years of age, says he has used Brandreth's pills for thirty-four years ; administered them first to his coachman, who had Fever and Ague ; gave eight the day after the chill ; chill and fever less severe ; gave eight more the next day, and so every other day, until the chill and fever did not return, which was in about eight days from the first attack. He then gave four every other day another week, when the man was entirely restored to his usual good health. He was himself attacked, took them in the same way, and was cured in less time ; has used no other medicine for thirty-four years ; found them always every way reliable for himself and for his family when sick ; has recommended them to thousands with the best results ; feels confident that every family would have a larger average of health if these pills were used in the place of calomel and other hurtful remedies. The following is an extract of a letter from Hon. Caleb Lyon, of Lyons- dale, now Governor Lyon of Idaho, to Dr. Brandreth : " My sincere thanks are due you for the boxes of Brandreth's Pills that you were so kind as to send me previous to my departure for the East; and a more efficient medicine as a preventive of disease upon the miasmatic shores of the Danube, or the plague-stricken cities of Egypt and Asia Minor, I do not believe was ever used. My whole party took them freely, and while others were ill and delayed, we kept well. Enclosed you will find the translation of a letter from Achmet Hallilla, an Arab Sheik, to whom I presented several boxes. " ' Peace be unto you and length of days ; thy medicine (Brandreth's Pills) was a fierce foe to Azrael, both in pestilence and caravan sickness ; the little orbs were rich with the wine of health ; let the maker wear this golden circle, that he may know I was wounded with the arrows of disease, but am now healed. " : May he grow in the sunshine, and dispensing blessings be the most blest. (Signed) " < ACHMET HALLILLA.' " , Brandreth's Pills are both sugar-coated and plain. Paralysis of the Legs, of Seventeen Years' Duration, Cured by Brandreth's Pills Alone. Extract of Consul Graham's Letter to Dr. JBrandreth, on file at 294 Canal Street. General T. has a brother over forty years of age, whose legs have been paralyzed for seventeen years, so that he could not walk a step. He has tried all sorts of remedies, and been under the care of various physicians, all of CURES BY PURGATION. 191 whom have pronounced his case incurable. I gave my friend a box of Bran- dreth's Vegetable Universal Pills, with the printed instructions ;' his brother took them, and was so pleased with the effect that he prevailed upon Messrs. Zimmerman & Frazer to let him have a few dozen boxes. He has now taken some thirty or forty boxes, and is so far recovered that he can walk with a cane, and has full faith that he will recover entirely. He is so enthusiastic in favor of the pills, that he has cut your likeness from some of the package-labels and has posted it over his tablg, and frequently burns a candle before it (he is a Catholic) ; and when his friends come in he points to it, saying that this is the true "saint," "my saint; all the rest I value nothing in comparison." This gentleman entirely recovered the use of his limbs, and is now one of the healthiest and soundest men in Buenos Ayres. Captain Berry, formerly of the New York Custom House, had also lost the use of his legs, and was obliged to use crutches. He resorted to Brandreth's Pills ; three months' vigorous use cured him of his rheumatism entirely. Cancer Cured. Mary H., wife of L. D. Grosvenor, of the United Society, Harvard, Mass., was cured of a cancer of many years' standing. " The prospect of ter- minating my life by the ravages of that insufferable scourge of humanity, the cancerous tumor, was certainly prevented by the timely and persevering use of Dr. Brandreth's Medicine, and a wonderful cure effected." Isaac "W. Briggs, of 145 Suffolk Street, New York, says he has used Bran- dreth's Pills for thirty years, having commenced to use them in February, 1836, for dyspepsia and affection of the kidneys. He took Brandreth's Pills every day for thirteen months, and in March, 1837, became a perfectly sound, healthy man. Mr. Briggs will be pleased to answer any questions on this subject. July, 1866. United States Sanitary Commission, ) Wethersfield, Wyoming County, N. Y., June 27, 1865. j Doctor Brandreth : — This certifies that I have used your celebrated Pills for over twenty years, personally and in my family. When we are sick, in- stead of sending for a doctor, we use Brandreth's Pills. I believe if every one would adopt the same course, the doctors would have but little to do. I have traveled in fifteen States, and been in the army sixteen months, and necessarily exposed to much disease, yet by the use of your Pills occasionally, have secured my health through the biting winter's frost and the scorching summer's heat. 192 CURES BY PURGATION. In fact, Doctor, I feel, with your Pills in my pocket, safe from the attacks of disease. They seem to cleanse the blood and regulate the system, whether it be troubled with dizziness, diarrhoea, or costiveness. When out of sorts, I use them, and they always cure me. I would not be without them for four times their cost. I send this to you that others who know me may profit by it, wishing to do good to my fellow-beings. N. HIGLEY. Dyspepsia and Costiveness Cured. D. J. TENNY'S CASE.-^iV^ York Mentor, January 14, I860.— Whether the Brandreth's Pill is ever convertible into blood we will not now discuss. But our chief object at this time is to give a statement of a gentleman who says he has taken one of the Brandreth Pills for at least sixteen months, daily, or about 480 days in succession, and who says that at the end of that time he considered himself cured of Dyspepsia, attended by a constant costive state of the bowels, which had troubled him for a long time. This gentleman, Mr. Daniel Tenny, resides at the Astor House, in this city, and has been in the enjoyment of excellent health ever since he was cured by this treatment. He is an intelligent man, and there is no doubt of the truth of his statement. This proves, at least, that as many as one of the Pills prepared by Dr. Brandreth can be taken for nearly 500 days in succession without harm, and at the end of that time a dyspeptic and costive habit of body may be per- fectly cured. This could not be said of any of the cathartics in use by those who style themselves the Regular Faculty. Asthma Cured by Dr. Brandreth's Pills. The following cure of Asthma by the use of Dr. Benjamin Brandreth's Pills is authenticated by seventeen well-known respectable citizens of Green- wich, Conn. : This will certify that Thomas S. Brown, who had been for some time pre- vious much affected with asthmatical symptoms, was taken suddenly worse on the 12th of June last : he began to cough and raise phlegm, and in the course of twenty-four hours expectorated nearly two quarts of thick white jelly-looking matter. Three physicians pronounced it a nervous humid spasmodic Asthma, and after prescribing for some time, to no effect, the three consulted together, and finally declared that they could do him no good ; it would and must result in consumption, and death would ensue, and that in a very short time. The pain was excessive in all parts of his body; and the difficulty of breathing was such as almost to cause strangulation. He was reduced to a mere skeleton, and finally gave himself up to death. After being in this miserable state nearly two months, he saw an advertisement of Dr. Brandreth's Vegetable Universal Pills, and immediately sent by Captain J. Waring, of Greenwich, for a 25-eent box, and found relief in the course of a few days. It is proper to say that he commenced with two pills at night, and two in the morning ; he found relief the second day, and encouraged thus to persevere with larger doses, he was soon able to sleep comfortable, and now, having taken them for about four months, according to the directions, is entirely recovered, and so far as we can judge, CURES BY PURGATION. 193 entirely in consequence of taking the above Pills, which we have also used in our families, and have found them invaluable. James R. Mean, James Moore, Daniel S. Betts, Hannah Hitchcock. John H. Reynolds, James Mead, Abel Palmer, Thomas Bertram, Rev. R. Palmer, Isaac Olmsted, John R. Palmer, P. V. T. Jessup, Henry Bewslev, Stephen Waring, Samuel Jessup, Augustus Lyon, John Limpry. Mrs. Mary Blanchard, 206 Clermont Avenue, Brooklyn, was cured of Asthma of long standing by BRANDRETH'S PILLS. She is acquainted with other cases of persons cured of Asthma by the same remedy, and kindly permits reference. Painters' Colic Cured. Dr. Brandreth, Sir: — I am a painter by trade, and have frequently been troubled with slight attacks of colic, arising from contact with lead in the forms it is used in my business. My eyes have also been made somewhat weak from the same cause. Your pills have been my only medicine, and they have never failed to restore my health. For all the diseases incident to a painter, I think Bran- dreth's Pills a certain remedy. My journeymen, by my advice, always take them whenever their arms become paralyzed, or their bowels constipated, and they have been cured by a few doses. Painters will find your pills invaluable. Yours, &c, DENNIS NORTON. Sing Sing, March 23, 1865. Saint Vitus' Dance Cured, of Twenty-five Years' Standing, with Brand- reth's Vegetable Universal Pills. Sir : With the most grateful feelings and the highest consideration for you, I sit down to state one of the most remarkable cures perhaps you have ever received, and effected, sir, entirely with your never-to-be sufficiently praised Vegetable Universal, and, I might add, life-restoring Pills. The gratitude I feel makes me scarcely able to state the case, which would not, I am sure, be believed, were it not universally known in the town of Ware- ham, where we reside, and the miserable condition my dear wife, Lucy Hooker, has been in for the last twenty-five years, now restored to health and to her family, when for so many years she was considered to be beyond all human aid. For the last twenty-five years my wife has suffered from Saint Vitus' Dance, and a complication of diseases which the doctors only seemed to continue to make worse instead of better. Calomel and bleeding, tonics and blisters, then calomel and bleeding, tonics and blisters again. Every doctor round the coun- try at all famed was tried, until finally, she receiving no benefit, I thought I would try the mineral doctors no more, and therefore took her to Boston to Dr. Thomson. She went through several courses of his treatment, and ap- peared to gain some thereby. But alas ! she soon became as sick as ever. I 13 194 CURES BY PURGATION. then was obliged, she becoming suddenly worse, to send for two of the Ware- ham doctors again. They told me candidly she was beyond the powers of medicine, and that she must soon sink under her diseases. What was I to do ? I had often been recommended your pills, but always held them in contempt. One medicine and one disease I could not understand. I told your agent, Abishia Barrows, of Wareham, what the doctors said. Again he strongly recommended the pills. 1 talked to my wife about them ; she said she would try, if there was any hope — hoped they might be blessed to her, but that she was resigned. I went for a box, and when I returned one of her doctors was in the room. He made a deal to do about it, said she could not bear them, they were too strong for her, she could not bear any kind of physic, that she would die in all probability from the effects of the first dose. The more he said in opposition the. more Lucy was determined to try them, and actually took a dose of four pills in his presence, and while he was holding forth against them. Away went the doctor and reported through the town that J was killing my wife by giving her those Brandreth's Pills — those Prince of Quack's Pills — those Im- postor's Pills — and created quite an excitement. In the meantime she was receiving the benefit. The first dose of four had a most wonderful effect — no wonder at the state she was in. The corruption was indeed dreadful. She took six the next night, and the same results. Instead of their causing weakness, she became stronger, and able to sit up a little. She persevered, sometimes taking as many as twelve at night and 'seven in the morning. When her pains were severe she took larger doses, and she did the same if the appearance of the evacuations was bad • — in fact we followed your printed directions most carefully. Sometimes she became worse — all the worst symptoms of the disorder pre- sented themselves. Often at such times have I trembled lest she should die ; but by persevering with the pills she soon recovered ; and after every attack of this kind she seemed to be more firmly established in the recovery of her health, or rather her health seemed stronger after each of these attacks. At first, not only the doctors opposed her using the pills, but all her friends and relations ; they all considered that the pills would surely accelerate her death. But long since the tide of opinion has changed, and those who most opposed now most strongly recommend them. It is about sixteen months since she took the first dose. She has used in all one hundred and fifty-two boxes, all purchased of your agent in this place, Abi- shia Barrows. I consider that she is like one raised from the grave, to bless myself and family, and give your pills and a kind Providence all the praise. She has not enjoyed so good a state of health since she was a child, certainly not since we were married. The doctor w T ho saw her take the first dose, I understand is entirely con- verted to your principles of curing diseases by continued purgation, and is try- ing to find out what your pills are made of. But I believe he uses your pills in his practice — in fact I feel sure of it. The cures which have been made in our region since my wife's recovery are truly surprising. Every one that feels sick thinks of no other medicine than Dr. Brandreth's Pills. I hope, sir, you will come and favor our town by a visit ; you will find many grateful hearts to welcome you. In the hope that you will live long to benefit mankind, I and my wife join in our mutual kind wishes and grateful feelings, and remain, Very respectfully, WILLIAM HOOKER, LUCY HOOKER. Wareham, Barnstable Co., Mass., May 23, 1838. CURES BY PURGATION. 195 Yellow Fever Cured. A gentleman, with whom I am well acquainted, writes as follows : " In 1S88, at New Orleans, at the St. Charles Hotel, while at table taking dinner, before the soup was removed, I was taken with dizziness, dimness of sight, and confusion of ideas ; in short, all the symptoms of yellow fever, though well five minutes before. I asked a waiter to lead me up to my room, for the confusion of mind and dizziness was so great, that I could never have found the way alone. When there, I took eight Brandreth's Vegetable Universal Pills, and laid down. I was watched carefully, and for three or four hours was partly delirious ; but in four hours the pills began to work, and my mind was clear enough to know my danger. Bleeding was recommended. ' Do you think,' said I to the doctor, ' I want depleting V ' Your life is not safe without it,' was the reply. ' Then I will take eight more Brandreth's Pills,' said I. Those on the top of the first eight, with plenty of Indian meal gruel, carried me out of all danger, and half a dozen medium doses cured me entirely in less than a week. Those who want to be safe, should take a few doses of pills as a pre- ventive." Tenea, or Tapeworms, Entirely Eradicated with Brandreth's Pills. Reading, Fairfield County, Conn. Dr. Benjamin Brandreth : Dear Sir — I have been troubled with the tape worms for twelve years; many have come from me, from twenty to thirty feet long — more or less every day of shorter ones — every two or three weeks I had a sick time from them — pressure at stomach — heavy load — many have crawled from me while at work — injured my health so much that I was not able to work one half the time — spent a great deal of time and money in consulting physicians and taking their prescriptions — have been reduced very low by taking medicine, without effect — last fall heard of Brandreth's Pills as a Cure All — had but little faith in them, but was determined to try any, everything, I could find at all probable to cure, thinking that without some remedy I must be destroyed by them. I procured one box, took one dose, and one worm came from me ten feet long ; took the second and third, which cleaned them all out, and I have not had one since. I have, however, taken several boxes of pills since, but have seen no appearance of worms. It is now ten months since, and I have gradually recovered my health, and am now able to attend to my business as usual, and have no doubt that they are all extinct. When I was afflicted with worms, I wanted to con- sume three times as much food as I would if in good health. Now I take my regular meals, and am hearty and enjoying good health, and able to do a good day's work. The last worm that came from me was twelve feet long. I have not the least doubt that it was Brandreth's Pills (your valuable Vegetable Med- icine) that effected the cure, as everything else that I could hear of was tried without effect. Yours very respectfully, and grateful servant, AARON T. DIMON. June 20, 1838. The above person is well known in Fairfield County. John B. Sanford, of Bridgeport, Conn., has assured me of his respectability. 196 CURES BY PURGATION. Cure of Pimples on the Face of Three Years' Continuance. Dr. Brandreth : Dear Sir : For some considerable period I have been troubled with an impurity or acridity of the blood, which seemed to be past cure. My face, in consequence, presented an unseemly collection of pimples. I was abstemious, and seldom tasted any beverage stronger than water, and yet, with all my care as to diet, my blood got no better, and my appearance continued the same. My face all the time seemed as if it was held near a fire ; it seemed as if something was on it that might be brushed off. It was very annoying, and caused me much anxiety, not because it interfered with my personal appearance, which it did, but because it more or less affected my health, which was beginning to break down. I took very little medicine ; but when the above state of things had remained about the same for three years, I was induced to use your pills. I took them, in all, about one month — every day, or nearly so — taking no higher dose than five pills, and sometimes only one. I think, altogether, I did not use over four boxes. They cured me completely. My face is free from all pim- ples and inflammation, and my complexion perfectly clear. Gratitude has in- duced me to render this account, which you may publish. I am, with respect, yours, &c, N. H. BAKER. Sing Sing, March 30, 1855. The following modest note from Mr. Bemis, of Dudley, Mass., for a supply, tells its own story : Dudley, December 7, 1853. B. Brandreth : Dear Sir — I have sold all the Pills I had of yours, and the money is ready when you will send my receipt. Please to send more Pills as soon as you can — send to Webster Station. I have sold $117 worth of your Pills, and they give universal satisfaction. Yours, with respect, PIIINEAS BEMIS. Brandreth's Pills Never Failing in Diarrhoea and Dysentery. Read. Battery Anderson, Sept. 9, 18G4. Dr. Brandreth, New York : Please find one dollar enclosed, for which send me that worth of your Pills, as I have used and given all I had. These Pills have cured all who took them for the diarrhoea in a few days. Some had the disease two or three months. The army doctors had failed to cure in all of these cases. I have found your Pills to be never-failing in diarrhoea, bilious affections, headache, and costiveness. How is it the Sanitary people do not give out your Pills? Yours, with great respect, PAUL P. DUFOUP, Co. A, Thirteenth Heavy Artillery, Bermuda Hundred, Va. CURES BY PURGATION. 197 Captain Isaac Smith, of Sing Sing, says, thirty of Brandreth's Pills, taken according to directions, cured him of a very severe bronchial affection, after other means had failed, and he wishes his numerous friends to know the fact. Extract from a letter dated Dawson, Iowa, April 24, 1866, to Dr. Brand- reth, from Andrew Logan, Esq. : " My wife became an invalid. Our physician represented her case as in- curable. I then called two other physicians, and the three held a consultation and pronounced her case consumption. I then discharged all the physicians and determined to trust to your Pills. I got five boxes, which she took accord- ing to the printed directions. By the time these were used up, there appeared a change in her condition for the better. I then bought fifteen boxes, and she continued to take them for three months, when her health was entirely re- stored." Original letter at 294 Canal Street. Persevere in the Good Work. The Rev. Ezra Wilmarth, East Wilson, N. H., says : " He has seen the salutary effects of Brandreth's Pills in many cases, and is fully convinced of their great value ;" that he " thinks it his duty to recommend them wherever he knows there is sickness, and is confident that they are calculated to promote the general health of mankind." Nervous Debility and Bilious Headache. Mr. Webber, whose case is mentioned below, is still living, a fine healthy man of over 67 years : William Wood Webber, of Grigg Street, Southsea, in the Borough of Portsmouth, England, bell-hanger, voluntarily cometh before me and maketh oath and saith, that he was for five years and upward dreadfully afflicted with a nervous debility of his whole system, attended with a bilious headache which prevented him (deponent) from attending to his business the greater part of that time. He (deponent) has sometimes been so violently affected as to fall down senseless, which had nigh once put an end to his existence. In this mel- ancholy state he was recommended ' to take Brandreth's Vegetable Universal Pills, and after taking them for four or five weeks, according to the directions, he was perfectly cured. It is necessary and essential to observe that after taking them six or eight times he was much worse ; but Dr. Brandreth informed him that such would be the symptoms, and prevailed upon him (deponent) to persevere, which he did ; he therefore went on, as above stated, and the most beneficial results followed. It is now six months since deponent was quite cured, and he has had no return of the said disorder, but keeps in the enjoyment of perfect health, which he entirely attributes to Brandreth's Pills, the Vegeta- ble Universal Medicine. WILLIAM WOOD WEBBER. Sworn at Portsea, in the said borough, this 15th ) day of December, 1831, before me, j D. Spicer, Mayor, 198 CURES BY PURGATION. Indigestion and Disordered Liver. Brandroth's Pills are warranted free from all mercury. or other mineral. A gentleman writes : " I have for years been afflicted with disordered liver- and indigestion, and have been restored after years of suffering, merely by the use of some fifteen boxes of the Brandreth Pills. For several years I have been more dead than alive ; I have crawled about, for my locomotion could not be dignified by say- ing I walked. I had the best advice, but was blistered, bled, took blue pill and calomel until my mouth was sore, dieted, and drank mineral waters. At last I saw hope wiped out of my doctor's and relatives' looks — it was clear I was doomed. In fact this was to be expected ; for when I did get up in the morn- ing, I was more dead than alive ; I was unable to attend to any business, and exertion of any kind seemed too much for me to endure. In this sad state I read J. W. Webber's case, and also Mr. Cooke's, of Bennington ; these letters, with the advice of a friend, induced me to give the Brandreth Pills a trial. I began with only two pills, which purged gently ; in a few days I took two more, they also operated mildly : then I took four, feeling some apprehension about my bowels ; they operated finely, bringing away very slimy stools. I rested for a day or two, and then took two more ; then I took six, and at last I became fully convinced of the efficacy of purgation, as a cure for disease. I have taken as high as eight pills in twelve hours — but the dose must be in pro- portion to the sickness — inflammatory cases require strong doses, and all serious sickness where pain is present, the same. But with weak persons the plan is to begin easily, and sort of feel your way, taking larger doses as you proceed. This method in the use of Brandrcth's Pills has cured me, and re- stored to health one who had prepared himself for the grave." Letter from Arnold Buffum, THE PHILANTHROPIST. Cincinnati, Ohio, April 15, 1843. Dr. Brandreth : In the course of my life I have suffered often and much from sickness ; I think I have been under the care of physicians more than twenty different times, for weeks at a time. But for the last five years I have employed a physician but once, and then only for a single day ; not, however, because I have been exempt from frequent illness, but because I have found a fir more speedy and effectual remedy in thy Pills, than I ever found in the medicines administered to me by my physicians. Wherever I go, I constantly carry a box of them with me, or at least a few of them wrapped in a paper in my vest pocket ; and whatever illness comes upon me, I invariably find relief from the use of them. Having been much occupied m travelling and public speaking, I have frequently taken severe cold, which before I used these pills, invariably resulted eness of the throat and chest, and a severe coueh : but latterly, though in sor , wiiu c* uv.wv v,v« & j more exposed than ever, when I have taken a cold, by taking one or two pills at a time for two or three nights, I have invariably succeeded in removing all soreness of the throat and chest, and in effectually preventing the cold from set- tling on my lungs so as to produce a cough. Once during last winter, while travelling on horseback, and subject to much exposure, I was suddenly seized with a very sore throat, high fever, and entire prostration of strength and spirits, — by the use of two doses of the pills, CURES BY PURGATION. 199 and drinking freely of cold water, a copious perspiration was kept up, and in forty-two hours one of the most severe attacks which I ever experienced gave way ; and in two days more I was able to pursue my journey. At another time, continual exposure and daily exercise in public speaking brought on a severe lameness in the small of the back and kidneys, which became so exceedingly painful that I was forced to speak sitting ; not being able to stand on my feet ; at length the soreness extended quite through me, and the pain became so severe that I never closed my eyes during a whole night, and several times during that night I had serious doubts whether I would live till morning. I took seven pills, which went to the seat of the disease, and as by magic, seemed to lay hold of it, and carried it all off, so that I attended a meeting on the same evening, and spoke without pain for more than two hours, and the pain has not returned since. I regard this as one of the most extraordinary cures that I have ever known, and I can truly say that, in a similar case, I would not exchange Brandreth's Pills for all the medicine of the drug store. I have used the Pills, and administered them to others on various other occasions, and, as far as I know, in no case without complete success. Especially have I found them altogether superior to any other medicine I have ever tried for colds, coughs, and soreness of the lungs. I consider that the maker of them especially serves the great cause of humanity, and I shall recommend them wherever I go. Thine respectfully, A. BUFEUM. In October 1843, Aaron Hamilton of Sing Sing, Westchester county, was taken suddenly sick in the night with great pain in his bowels and stomach. He took six Brand reth Pills, and in two hours took four more. In a little time he threw up two worms, and passed several downwards. He has enjoyed good health since. Dear Sir : St. Vitus' Dance and Scrofula Cured. Sing Sing, 3d January, 1843. It is with gratitude and esteem that I address you for the purpose of in- forming you of the beneficial effects which your Pills and External Remedy have had in restoring one of my sons to health, who had been sorely afflicted winter before last with St. Vitus' Dance, and for a period of ten months he was entirely helpless from the terrible disorder. He was also subject to the Scrofula in his neck. By the use of your Pills freely, and also applying the the External Remedy to the enlargements upon his neck, he has become en- tirely cured. He has been now well over a year ; and I trust, by the blessing of Divine Providence, he will continue so. You are at perfect liberty to make what use you please with this commu- nication. I consider it a duty I owe to you to make it, and hope it may be the means of extending the usefulness of your most excellent medicines. I remain yours, respectfully, H. M. REQUA. To Dr. Benjamin Brandreth, Spring Hill, Sing Sing. 200 CURES BY PURGATION. Indigestion and Bilious Affection Cured. Sing Sing-, January 14, 1843. Dear Sir : This will certify that I have used your Vegetable Universal Pills for in- digestion and bilious complaint which had almost proved fatal to me. I had been under what was supposed good medical treatment, and used various advertised remedies, but without any good effect. I then made trial of your celebrated pills, which gave me immediate relief, and soon effected a perfect cure. I have since used them in my family with the best effect. They are the best and easiest purgative we ever used. I am, respectfully, yours, NICHOLAS FOWLER. Dr. B. Brandreth, Spring Hill, Sing Sing. Sing Sing State Prison, Feb. 4, 1843. Dr. Brandreth, Dear Sir : About four years since, I had a very severe attack of the piles. 1 tried almost every remedy, but without any good effect upon my painful disease. I thought I would try one box of your Vegetable Universal Pills. I done so ; and before I had taken all the pills it contained, I began to feel the good effects of them ; and by the time I had taken four boxes of pills, I was entirely cured, and have never since been troubled with the painful and truly unpleasant disease. I entirely attribute my cure to your valuable and inestimable pills. Very truly yours, R. LENT, Architect, Sing Sing State Prison. Sing Sing, Jan. 24th, 1843. Dr. B. Brandreth, Dear Sir : If you alone were concerned in the present statement, the greater inducement for making it would be removed, for of course no testimony can strengthen you in your convictions in relation to the value and efficiency of your Pills, which have already proved such a blessing to the thousands who have used them ; but I have looked out upon this vast expanse of creation, en- circling in its arms, as it does, thousands bowed down with sufferings similar to my own, who would gladly hasten to the same source that restored my health, if they were persuaded that they would meet with the same happy result. Therefore, Sir, it is that those thousands may be convinced, and profit by their conviction, as I have done, that induces me to state before the world a period of suffering, such as few have, and I hope few ever will know, and the permanent relief I received from your Pills ; but how to begin, I hardly know, to describe those extreme tortures that seized upon my arms, shoulders, side and face, having about ten years since contracted a very severe cold, causing a very severe fit of sickness, attended with an affection of the Liver, as was supposed, which was the consequence of my taking a great quantity of medicine — and I must say, I have not seen a well day since, until I commenced taking Brandreth's Pills. For the last ten years I have been afflicted with CURES BY PURGATION. 201 what is commonly called Salt Rheum and Erysipelas, at times covering and seeming determined to devour my whole body, and by making use of various means was enabled to check the disease from time to time, until early in June, 1841, my disease assumed a very different appearance; and unpleasant as the task now is to me, I will, for the sake of spreading light and knowledge in the world, give a few of the particulars of my case : swelling and painful affections of the joints, tumors formed under the skin with burning lacerating pains, and finally coming out in horrible sores, covering nearly the whole of the right arm, and penetrating almost to the bone, and spreading to my face, covering nearly half including the nose, making for the time an entire wreck of that organ ; from thence to my shoulder and side, and my whole body and limbs swollen in the most frightful manner. Residing at this time in one of the western cities of New York State, I had recourse to most of the eminent Phy- sicians of that part of the country ; and the most that they could do was to pronounce the disease a scrofulous affection, which it seems they were not pre- pared to combat. A change of air and climate was recommended, and in travel- ing I became acquainted with a lady from Sing Sing. She advised the use of Brandreth's Pills — but supposing that they could be of no use to me, as I had tried so many things, I thought little more of them at that time ; but after having endured the most excruciating tortures, and incurring great expense, I was, thank God, about six months since, by reading one of Dr. B.'s advertisements, and what I had heard about them, induced to purchase a box of Brandreth's Pills. Jealous of the article, I resolved not to have my imagination at all busy, but nevertheless to give them a fair trial, which I did, by taking accord- ing to the directions accompanying each box, as far as my feeble state would admit, two or three boxes. Overjoyed at the discovery of an article which I well knew improved my health, used them secretly for a few weeks, but be- coming convinced that Brandreth's Pills would cure me, I made bold to declare it. Sir, are you alone concerned to know it % I think not, for I know that the medicine that possesses the power to cure me is capable of conferring the same blessings upon thousands of others suffering, perhaps dying ; therefore, these are all concerned to know that they can be cured. In fact, all are concerned in the discovery of anything that tends to promote the happiness of the human race, for we are social beings and cannot suffer alone. Persons may doubt this statement as I have doubted similar ones, but be assured it is but too true ; and in giving it, I have unsolicited, to you, sir, and the world, if you choose to publish it, discharged a duty which I felt incumbent upon me in making it known for the benefit of those who choose to believe it, as I believe that I have been cured of a scrofulous affection of the worst possible character and of long stand- ing, by the use of less than twenty boxes of Brandreth's Universal Vegetable Pills, at an expense of less than Five Dollars, instead of chasing phantoms at a greater advance in fees, without any good results ; and when I look into the past, upon these solitary days and sleepless nights, I thank a kind Providence that it is as well with me as it i», and I thank you, sir, that you are enabled by your scientific researches to minister to our infirmities. RACHEL TURRELL. Fits Cured. This may certify that my son, of five years old, was attacked with epileptic fits, in 1837, and continued to be troubled with them for more than one year. After every other remedy ha'd failed I tried the Brandreth's Pills, which effected a cure in about six months, and he has not been troubled with -them since. DAVID CHAFFEE. Grafton Street, August 2, 1843. 202 CURES BY PURGATION. Mr. Wilson, of 135 Christie Street, for twelve years was afflicted with Chronic Rheumatism, and for the last three years was not able to walk ; has taken twelve boxes, the pain has entirely left his feet and knees, so that he is able to walk with comfort. Miss W*****, a young lady residing in Hubert Street, had a severe pain in her knee, from which she suffered excruciating pains for upwards of three years, which confined her to bed almost all the time. Dr. Mott and several others of the faculty had bled, leeched, and blistered to no effect ; by taking Brand- reth's Pills she has perfectly recovered the use of her knee. Observations on the above would be superfluous. Mr. G. Miller, of Harlaem, in September last, was dreadfully afflicted with Fever and Ague ; the attack generally came on him every day about 12 o'clock ; the disease had debilitated him in such a manner that his recovery was doubt- ful. A gentleman who has tested the goodness of Brandreth's Pills, in his own family, persuaded him to try the medicine. After the first box the Fever was perfectly cured, and by continuing taking the medicine for about six weeks, per- fect health was restored. Benj. Weeks, of Westchester, was violently afflicted with Dyspepsia; he could not take any food without the most unpleasant sensations in his chest, head, and bowels. His chest was so sore that the slightest pressure gave him pain ; his life was most miserable ; numerous were the medicines used ; and the skill of the first physicians tried in vain ; as a last recourse he took Brandreth's Universals, and in two months they etfected a perfect cure. Worms. A young woman a short time since took these Pills for a violent pain in her side. After three doses she parted with a worm fourteen inches in length and one inch round ; she has since been perfectly well, and has kindly allowed Dr. B. to refer any one to her. It is a fact that there are good remedies, but it is very doubtful whether there are many good physicians. Extraordinary cures in which Brandreth's Pills have effected a perfect cure after the most eminent medical men had altogether failed : Mrs. Luther, of North Third Street, near Second Street, Williamsburg, for seventeen years was seriously afflicted with a violent pain in her left side, which often became very bad.' The side was wearing to all appearance away, and just over the seat of the pain was a place you might have laid an egg in. Extreme debility and general bad feelings were the consequence ; she could do nothing for herself and family with pleasure ; no relief was experienced from anything used until July last, when Brandreth's Universals were recommended, and im- mediate relief was experienced, and on the 31st of. December she assured Dr. B. the Pills had perfectly restored her health, and that her side was become like unto the other. Mrs. L. stated many other particulars, which, were there space, would be mentioned. CURES BY PURGATION. 203 Cure of Terrible Ulceration. Second House from Tenth Avenue, Twenty-eighth Street, ) New York, Nov. 2, 1842. j Dear Sir : Last January I was taken suddenly with pain in my left side in the night, and my wife had to get up and steam it, but the pain got no better ; I then sent for Dr. Adams. He ordered a poultice of bread and yeast, and then a lump began to form about six inches from my arm-pit. Dr. Adams gave me pills which did me no good, and the pain still became more severe. At this period Dr. Adams brought another doctor with him, but I still continued to get worse, and although several other physicians came to see me, yet I continued to grow worse and worse. Dr. Adams opened at one time the abscess which first com- menced under my arm, and which had extended to my hip-bone and thence to the small of my back, and from thence to my shoulder-blades. Being poor, I sent for the dispensary doctors, and they attended me, but I continued to get worse, and the ulcers were some of them, such as I could see, more than half an inch deep. The doctors, both dispensary and the others who visited me, Only a few days before you called upon me, told me it was ten thousand to one whether I recovered or not — that I might not live through the night. This was in the early part of February. I had not been out of bed since the beginning of Jan- uary. At this time, the latter part of February, my wife went to see you, and beg you to come and see me. You dressed my ulcers for me that night — it took a yard of linen to dress them once. You left me two boxes of pills, which I used as you directed me, and my wife dressed me with your Universal Salve, and rubbed the callous places with the Liniment. In two months I walked to your office in Broadway, from Twenty-eighth Street, corner of Tenth Avenue. I came after that, seven or eight times for you, to see how my back got on, and to receive your further advice. I went on getting better every day, and my ulcers one after another got well, until the latter part of July, when I went to work, being a sound man, with the exception of having nearly lost the sight of my right eye, during my sickness, which, however, gradually gets better and better from the use of your pills. I send you this letter that you may publish it ; and should. any one wish to inquire any particulars of my extraordinary cure, they can see me where I live, which is the second house from the corner of Tenth Avenue, in Twenty-eighth Street. I remain, dear sir, Yours very respectfully, PATRICK BRALLEY. To Dr. Benj. Brandreth, 241 Broadway, New York. Edmeston, Otsego Co., Jan. 4, 1839. Dr. Brandreth : Dear Sir : I feel it a duty I owe to tne public, as well as yourself, to inform you of the astonishing efficacy of your truly valuable pills. I was attacked about the 1st of November last with the prevailing bilious or typhus fever, violently. The pain in my head and bad* was most excruciating. I took first six of your pills, then eight, ten and twelve at a dose twice a day, yet found no relief. My wife then . read your directions to me, after which I took seventeen, then twenty and twenty-two. I continued to take twenty morning and evening for four days, when I found the disease yielding and the fever liter- ally broken up; I then gradually diminished the quantities according to your directions. In two weeks I was out again.* I used no medicine but the pills. * Others who pursued the ordinary course were confined from six to twelve and fourteen weeks. 204 CURES BY PURGATION. There has since been a number of cases of the same fever in my neighborhood, where the patients have followed the same course. J. E. used no medicine except your pills, according to your directions in " violent diseases," with the same happy effect. I took fifteen boxes ; another twelve, and others ten and down to four. Some used drafts upon the feet. Yours truly, WATERMAN BURLINGHAM. Melbourne, Victoria, 1st June, 1858. Mr. Blandford, Agent for Brandretli's Pills, Melbourne : Dear Sir : Having had a severe attack of inflammatory rheumatism, by which I was confined to my bed for several days, during which time I suffered the most agonizing pains in my side, back and limbs, and was fearful that I should be confined to my bed for a long time, my husband brought me one of Dr. Brandreth's pamphlets ; after reading it carefully, I concluded that I would try the pills, which I used as directed. I have been using them three weeks, and I am happy to say that to Dr. Brandreth's Pills I owe my recovery to health and strength. I feel stronger and better than I have done for a long time, and I am convinced that the disease is eradicated from my system. If you deem this letter of any use, please publish it. I am, dear sir, Very respectfully yours, MANDY WAYMAN. Little Bay Street, Sandidge. Melbourne, 1st Aug., 1858, Mr. J. T. Blandford : Dear Sir : I am a mason by trade, and for some time past have felt almost unable to attend to my business. Three weeks ago, on my way home in the evening, I stepped into a water hole and got quite wet, from the effect of which I took a severe cold, my whole body became much swollen, my breath- ing became very difficult. I had sharp pains in my chest, and in fact when I called on you at your office I considered myself in very great danger. I bought two boxes of Dr. Brandreth's Pills, and took six pills in the office and six more on my return home. In about five or six hours I discharged several quarts of water, and felt greatly relieved. I have continued to take the pills, and am happy to say am quite well. I consider the Brandreth Pills the means of sav- ing my life. I have heard them called the Poor Man's Medicine of America, where they are so celebrated. I trust they will be known as such here. I will never be without Brandreth's Pills as long as I can obtain them. Please publish this letter. I am anxious that the people here snould know where to get a medicine that they can rely on. I remain, dear sir, Yours respectfully, JOHN FLANNIGAN. Howard Street, North Melbourne. Park Street, South Yarra, Aug. 20th, 1858. Sir : This morning, having mislaid my spectacles when the morning's Age arrived, I took it up merely to endeavor to read the large type of the leading article, but judge my astonishment when I could, with facility, peruse the small- est type. This extraordinary fact I attribute to the use of Dr. Brandreth's Vegetable Universal Pills. Make any use you please of this communication. Yours very truly, JOHN HARRISON. CURES BY PURGATION. 205 Letter of the Rev. Ezra Wilmarth, in favor of the Brandreth Pills. East Wilton, N. H., July 27, 1836. Dr. Brandreth : My Dear Sir : Having recently become acquainted with your valuable pills, and seen their salutary effects in a great variety of cases, I take the liberty of addressing you, stating my conviction of their value. Although I have heretofore been unfavorable to nostrums, I am fully convinced of the value of yours. I am a minister of the Gospel, of tne Baptist aenomination, in this town, and pastor of a church, and am well known ; therefore, I hope my recommendation of your Pills will be of some use in causing those who know me to make trial of them, as I feel confident they are calculated to promote the general health of mankind. Wishing you abundant success in your attempts to benefit the world, I am, with high respect, Your obedient servant, EZRA WILMARTH. I Bilious Remitting Fever and Dysentery Cured. Paterson (New Jersey), Aug. 18th, 1836. Sir : I write this out of respect to you for your excellent Pills, for both I and my family think it a great blessing that we have met with them again in this country, because we knew them to be excellent and good ; when at Leeds, in England, there it was always said if any person was sick, get a box of Bran- dreth's Pills and they will cure you. ■ Sir, I have been sick of a bilious and remitting fever, for which I got three boxes, and they have done me more good than all the physic ever I took in my life ; for before I took them I was almost gone with a liver complaint ; and now I am as well as ever 1 was in my life. In my family we have had three attacked with the dysentery; they (the Pills) cured them in two days, so that we have all of us great occasion to praise Dr. Brandreth's Pills. I am, sir, yours very truly, And greatly obliged, RICHARD HAMPSHIRE. Asthma Cured. Mr. John Benist, of No. 69 Chapel Street, New York, was afflicted with a dreadful asthma for nine years, during which time he was unable to lie down in bed, and frequently was gasping for breath, expecting every coming hour would be his last. He applied to several of the first physicians in New York, none of whom gave him the least relief. At last, Brandreth's Universals were strongly recommended, and in the course of a short time he found great benefit, and by continuing the Pills, he is now quite well, and able to attend to his business ; indeed he is perfectly restored to health. 206 CURES BY PURGATION. Dyspepsia Cured. Newburgh, N. Y., Feb. 14, 1836. Dr. Brandreth— Sir : The many flatter- ing notices you ■ have received from respectable individuals, of the success of your Vegetable Universal Pills, render it unnecessary for me individually to eulogize, or those who are ignorant of the specific to censure. Having had ocular demonstration as well as bodily, J cannot refrain from expressing and publicly acknowledging the signal result and final cure of that dreadful disease known as Dyspepsia ; hoping such persons as may be afflicted with the above disease, this notice may influence some to make the experiment. You are at liberty to refer them to me voluntarily on my part. I remain your friend, JOHN A. STEVENS. Rheumatism. A gentleman who had lost the use of his limbs with Inflammatory Rheu- matism, and was so miserably afflicted that he could not turn in bed without assistance — the pains were violent in all parts of his body, but especially in his breast, back, arms and feet. This person took no other medicine than Brandreth's Pills — for two weeks he took 12 pills per day, and often as many as 20, and in three weeks he was able to get out ; and now, having persevered with them so as to produce copious evacuations every day, is at this time per- fectly cured ; it is not two months since he was first taken ill. Now, Dr. Brandreth would ask, would this have been the case with your bled man ? with the man to whom mercury has been administered 1 No ! he would have been in bed months, and his convalescence would have been tedious. The above gentleman is highly respectable, and can be referred to. A Running Ulcer of Three Years entirely removed with Eight Boxes of Brandreth's Pills. Edward Brown, son of Mr. James Brown, St. James Street, Kingston, Ulster County, for three years had a running ulcer in his hip, which obliged him to be carried about ; the doctors were in daily attendance, and the best advice was had from New York. All did not relieve the poor child, who was not expected to recover. Brandreth's Pills were commenced with* four months ago, and a decided change was effected before the third box was finished, and now, having taken eight boxes, 'is quite well. A little boy, aged four years, swallowed a pin, and, as a matter of course, his parents were much alarmed. His father called on Dr. Brandreth, who recommended him to give the child five or six pills per day, and no bad con- sequence would arise. This advice was taken, and on the fourth day powerful evacuations having been kept up, the pin was discharged, and not in the least corroded. Reference will be given to the parents, who are highly respectable. Mrs. S., in East Broadway, has been afflicted for nearly eight years with a bad leg, which prevented her going about. The sore was larger than the palm of the hand — she had had recourse to various doctors, who frequently healed it up, but in a few weeks was as bad as ever. Brandreth's Pills were recom- mended, and in a short time her leg was perfectly healed, and she is again able to walk with pleasure and comfort, and the leg has every appearance of being perfectly sound. Reference as to the above can be made to Mr. Aaron Swartz, grocer, corner of Pike Street and East Broadway. CURES BY PURGATION. 207 Difficulty of Breathing Cured. Danbury, Conn., March 8, 1836. — Dr. Brandreth — Sir : Will you be good enough to send us some more of your Vegetable Universal Pills ? there are many persons here taking them for every complaint, and all find relief. . I can say they are the best medicine I ever took, and I have tried almost everything, but found no relief until I took your Pills. My difficulty of breathing is greatly relieved, and I am getting well. Many are taking them here for the same com- plaint, and find them very good. Yours, respectfully, ELIZA MORRIS. Piles Cured. Messrs. Coggershall & Walters, of New Bedford, have forwarded me the following facts of that most painful and unpleasant disease, the Piles. The original letter can be seen at 187 Hudson Street. Mr. MeFarlane, of New Bedford, has been laboring under that most dreadful disease, the Piles ; he has had them upwards of two years — has tried various things from different doc- tors, to no effect. Brandreth's Vegetable Universal Pills were had recourse to, and a complete cure is effected. He is now quite well. (Irom the Louisville inquirer.) Liver Complaint Cured. Newark, Dec. 25, 1836. Dr. B. Brandreth. Dear Sir : Having been afflicted for ten years with a most dreadful liver complaint and dropsy^ and tried every remedy that could be thought of, I gave up all hope, went into the country, left my business, to die in peace ; but hear- ing of your invaluable medicine, I was induced to try it, not expecting to be any better. To my surprise, I had scarcely taken one box before I felt relief. I have since taken three boxes, and now I am well, by the blessing of God and the use of your medicine. If you think this will be any service to let suffering people know this fact, you are at liberty to publish the above. Yours, with kind respect, (Signed,) LEWIS TOMPKINSON. Dysentery and Deafness Cured. August 20th, 1835. Sir : Allow me to express my grateful feelings for the benefit I have expe- rienced in your Vegetable Universal Pills in the cure of Deafness, which I have been subject to nearly thirty years. I have frequently been under eminent aurists in London, who have invariably syringed me, and who have all said no other mode of treatment would be of service. The latter part of May 1 again lost my hearing, with continual unpleasant noises in my head. It was with difficulty I could hear any one speak ; knowing you were an English surgeon, I 208 CURES BY PUEGATION. applied to you to be syringed, thinking that was the only remedy ; yon refused to operate, but told me a box of your pills would have the desired effect, and I was induced to try them, especially when I found that many persons had been cured of the same complaint. I have taken two boxes, which cost me fifty cents, and am happy to say, am completely cured. The dose I took was two or three at night, and twice during the time I took five. They never incon- venienced me in the least, and were remarkably easy in their operation — I certainly can recommend them to any one laboring under the same unpleasant disease. Permit me likewise to say my "eldest daughter, two weeks since, had a dreadful Diarrhoea or Dysentery on her, which in two or three days reduced her frame, and I thought would have sent her to the grave. I immediately applied to you to know if the Vegetable Universal Pills would have the same beneficial effect on her as they had on myself; you told, me to persevere and they would make a cure — I had confidence in them, and am happy to say, by her taking from four to eight pills every night, the dreadful disease left in about a week. She is now well, and getting up her strength very fast. She took no other medicine whatever ; she continues occasionally one or two pills at night. My family had used the Hygeian Medicine for upwards of twelve months, and found they could not leave them off, as Costiveness and Piles were sure to fol- low. Thank God, your Pills leave no such enemies behind them. I have no hesitation in saying, that your Vegetable Universal Pills are the safest and best medicine myself or family ever took. Make what use you think proper of this communication, and you arc at liberty to refer any one to me, and I think I am only doing my duty in thanking you, through divine mercy, for the benefit received. I am, sir, yours very truly, JAMES LANCE, 250 Eighteenth Street, near Broadway. Certificate of Joseph Goulden, who has known the above Pills forty years : / hereby certify, that I have known Brandreth's Vegetable Universal Pills for upwards of forty years ; they were used in my family connections, in the County of Dorset, England, since the year 179G, many of whom they cured of old standing complaints. JOSEPH GOULDEN. Bridgeport, Feb. 18, 1836. ' Disease of the Prostate Gland Cured. Henry Lathrop, of Edmonston, Otsego County, New York State, a respect- able farmer, was afflicted for more than a year with this most painful, and gen- erally incurable disease. Some of our highest medical men pronounced his case incurable, and advised him to settle his affairs, and patiently await the result, as it was not in the power of medicine to save him. Mr. Lathrop, before he went home, called upon me, and having stated his symptoms, I told him what his disease was, and in this I agreed with the doctors who had said he was incurable. But I also told him I felt confident that if he would persevere with my Pills they would cure him. Mr. Lathrop proved his confidence by purchasing six dozen boxes, which he took home with him, and in about three months he returned to me in New York City a cured man, having used the Pills CURES BY PURGATION. 209 as I directed. In fact, he said he never was better in his life. This was in 1835. Since that period Mr. Lathrop has administered the pills to upward of a thousand persons, all of whom, he assures me, have derived the most aston- ishing benefit from their use. New Bedford, Nov. 7, 1835. Dr. Brandreth — Sir : About eight weeks past I saw some of your Pills, and read one of your wrapping-papers, but thought it was, as thousands of such things are now- a-days, a mere speculative, money-catching thing — still I was advised to try them by persons who said they were most righteous Pills. I was, however, faithless of their value ; but my complaint grew so violent that I purchased two boxes, took them according to the directions, and found that they helped me much. My neighbors, knowing how long I had been afflicted, were anxious to know the result, and I informed them that I had received great benefit from the two boxes, which would induce me to purchase more. My wife for a long time had been in a poor state of health. She also took some, and found great ben- efit. And now, sir,»excuse me while I detail some of my complaints, the main body of which seem as though the main springs of life were all fettered. DYSPEPSIA or INDIGESTION, Weakness of the Lungs, Nervousness, Rheumatism, SICK-HEADACHE, ASTHMA, GREAT LOSS OF APPE- TITE, LANGUOR, TREMOR, COSTIVENESS, etc., etc. Such have been my varied symptoms, but I must and will say, that I never took such medicine as your Pills, which seem to touch all parts of my complaints. I intend to persevere with them, and you may send me 500 boxes, which you must charge at the wholesale price. I am, sir, yours respectfully, SAMUEL S. ALBRO. Piles Cured. Messrs. Coggershall & Walters, of New Bedford, have forwarded me the following facts of that most painful and unpleasant disease, the Piles — the original letter can be seen at 187 Hudson Street. Mr. McFarlaue, of New Bed- ford, has been laboring under that most dreadful disease, the Piles. He has had. them upward of two years — has tried various things from different doctors to no effect. Brandreth's Vegetable Universal Pills were had recourse to, and a complete cure is effected — he is now quite well. Newburoh, N. Y., Nov. 4, 1835. Dr. Brandreth — Sir : I was induced some time since, by the persuasion of a friend, to try a box of your Pills. From the immediate relief and happy result I have re- ceived from the same, I cannot but recommend them to my friends, and par- ticularly to all invalids who may be afflicted with costiveness, not to despair until they have given your Vegetable Medicine a trial. Hoping you may be the means of making us poor creatures happy, and add to your popularity and wealth, I remain your friend, J. W. SWIFT. You may refer, or make what use you please of this letter. — J. W. S. 14 210 CURES BY PURGATION. Extraordinary Cure of Rheumatism, Diarrhoea, and Affection of the Lungs. John Shaw, of Pembroket, Washington County, Maine, being duly sworn, says that he was taken violently sick about six months since. The pains in his head, breast, back, left side, and instep bein^; so bad that he was unable to help himself, and was taken into the Chelsea Hospital in the City of Boston. That after being in said hospital five weeks, Dr. Otis said he did not know what was the matter with him, and that he could do nothing for him, nor could he prescribe any medicine. That he, therefore, was conveyed from the Chelsea Hospital to the Sailor's Retreat on Staten Island. That he was there physicked with all sorts of medicine for a period of four months, suffering all the time the most heart-rending misery. That, besides the affection of his bones, he was troubled much with a disease of the lungs. Sometimes he would spit a quart of phlegm in the day. Besides this affection he had a bad diarrhoea, which had more or less attended him from the commencement of his sickness. That at times he dreaded a stool worse than he would have dreaded death. That he can compare the feeling to nothing save that of knives passing through his bowels. After suffer- ing worse than death at the Sailor's Retreat on Staten Island, the doctor told him that medicine was of no use to him — that he must try to stir about. At this time he was suffering the greatest misery. That his bones were so tender he could not bear the least pressure upon the elbow or upon the knee ; that his instep was most painful; that, as the doctor said he would give him no more medicine, he determined to procure some of Dr. Brandreth's Pills, which he did from 241 Broadway, New York. That he commenced with five pills, and sometimes increased the dose to eight. The first week's use so much ben- efited him that the doctor, not knowing what he was using, said, " Now, Shaw, you are looking like a man again. If you improve in this way you will soon be well." That he found every dose of the Brandreth Pills relieved him ; first, they cured him of the pain when at stool ; that they next cured the diarrhoea, and finally the pain in his bones. That the medicine seemed to add strength to him every day. He told the doctor yesterday, the 11th inst., that he felt himself well, and also that he owed his recovery to Brandreth's Pills, under Providence — that he had taken the medicine every day for nineteen days. That the doctor told him if he had known he had been taking that medicine, he should not have stayed another day in the house. He considers it his duty to make this public statement for the benefit of all similarly afflicted, that they may know where to find a medicine that will cure them. JOHN SHAW. John Shaw, being by me duly sworn this 12th day of April, 1842, did depose and say, that the foregoing statement is true. JOHN D. WHEELER, Commissioner of Deeds. Cure of Insanity. Newark, March 8, 1838. Respected Sir : I have long felt it resting on my mind as a duty, to com- municate by way of letter to you, sir, the great benefit I have received from using your invaluable Pills ; they have proved a great blessing to my health. Eor the last two years I have had my health renewed by taking them after other physicians had failed in their efforts to relieve me of a disease that was fast tending to dropsy, and bordering on to madness of mind — insomuch I was pronounced insane by most all who saw me. As I was incapable of having CURES BY PURGATION. 211 any charge of my family for nearly one year, a number of times I made an effort to take my life, but was prevented from so doing by that ever-watchful Eye that never slumbers nor sleeps. I am a living monument of the free mercy of the Lord to all who were witnesses of the disordered state that I was in when your medicine was thrown within my reach, and faith was given me to believe that it would relieve. I commenced taking it every night, and the first change I perceived about me was on the night after taking three doses. I felt a singular sensation in my ear, and on rubbing it, something gave way, that proved to be hard congealed wax. I felt such a relief of distress from my head, that I knew not what it could mean for some time, for the sound of my own voice appeared like another, and all sounds seemed different to my hear- ing from what they had for years past ; and for two weeks following the quan- tity of wax that came from out my ears would to many be pronounced too incredible to be relied on, unless they had seen for themselves, and my blood began to circulate more freely through my system, by gradually taking the pills which before had nearly ceased to move through my veins, and it appeared to me that my life was at times departing from the body. I could find nothing that animated or cheered my mind ; any way life had become a burden to me, but as my confidence strengthened in persevering with the pills, I found my life daily returning, and invigorating both body and mind, to the unspeakable joy of my family and friends ; and since they have proved such a blessing to me, I have felt it my duty to recommend them to all with whom I have intercourse. Standing myself as a witness of their virtue in producing health of body, which, beyond a shadow of doubt, will give clearness of mind and ideas, which can- not be clear if those organs where knowledge lies are obstructed by disease, which thousands of our fellow-creatures are suffering under, and are still made worse by the treatment of our most popular physicians of the present day, by taking blood, and giving many things that are daily undermining and ruining the constitution forever, from having that strength that is natural for us, if we pursue the right course to obtain it by simple remedies instead of those of another kind, which is so unnatural as bleeding. The argument you lay before the public, and the experience I have had for myself on this important subject wherein life is at stake, has thoroughly convinced me that bleeding is injurious, and can and ought to be dispensed with, as it has been ascertained to a certainty that other means have been discovered that have the desired effect in producing health without proving so pernicious to the constitution as those mentioned. I have been instrumental of convincing many to take them, but the most are bound by that strong cord of prejudice which will not so much as admit plain facts to be true, but endeavor to paint them in a different color from the original ones given ; but I am encouraged that the time is nigh at hand, that people are awaking from their slumbers, and seeking after truth in all things respecting this life, as well as the life to come. It is true that error abounds on all sides, but we know that truth is of divine origin, and will prevail in spite of all opposition that is thrown in its way by all who love not our Lord Jesus in sincerity of heart, and are making every effort to amass wealth by imposing on the public in various ways to deceive the unwary ; but let them beware and take heed to themselves, that the curse of the Lord is upon their riches if their eye is not single to His glory and the good of their fellow-men. It is love that has urged me to speak in so plain a manner to one who is an entire stranger to me, and I hope it may be received by you, sir, as coming from one whose mind has been freed from prejudice, knowing that the motive I have in view is the good of my fellow-beings, whose welfare I feel deeply concerned in. Although moving in a very humble and obscure sphere of life, to which many are placed, may the Lord greatly bless and strengthen your efforts in the cause that you are engaged in, is the prayer of my heart. You are at liberty to make use of these lines as you think best. MARGARET E. A. SIIATLAND. Dii. Bkandretii, New York. 212 CURES BY PURGATION. St. Louis, November 28th, 1837. Gentlemen : I deem it a duty which I justly owe, not only to you, but to the whole community, to acknowledge the beneficial effects which have resulted to myself from the use of that highly serviceable medicine, Dr. Brandreth's Vegetable Universal Pills. About eight months since I was suddenly taken with the Dropsy in my feet, the surface of which was likewise covered with the Tetter. I had repeatedly taken the advice, and followed the prescriptions of several eminent physicians of St. Louis, but derived no benefit therefrom. I had also tried many experiments, and used every medicine that could be suggested, but without any visible abatement of the swelling, and they remained in this unnatural situation until my sufferings were alleviated by the aid of Dr. Brandreth's Pills. Shortly after 1 had commenced taking your medicine I dis- covered a visible alteration for the better ; the swelling gradually subsided, the Tetter entirely left, my bodily health daily improved, and my feet once more returned to their natural size. Two months have elapsed since my cure, and my feelings now warrant me in saying that through your instrumentality I have exchanged a painful disor- der for a good sound state of health. That suffering humanity may read, and benefit from this disclosure, I beg to subscribe myself, yours gratefully, MARGARET BROWN, St. Charles Street, St. Louis. To Messrs. Tousey & Michael, St. Louis^ Mo. Carrolton, Greene County, 111., Oct. 5, 1837. Gentlemen : I beg leave to inform you that my sister was taken about three weeks since with a violent intermittent fever ; at my request she took two of Dr. Brandreth's Pills, which did not affect her otherwise than by creating a faint sickness at the stomach. The next day she increased the dose, which operated powerfully. She took the third and fourth doses, after which she had no return of the fever, her strength increased rapidly, and her health has been good since. A sister of my wife had been in a decline for several months with strong symptoms of a confirmed consumption. She commenced taking Dr. Brand- reth's Pills, and before she had taken two small boxes in doses of three and four per day, a decided change for the better appeared. She still continues their use, and the glow of health is fast taking the place of her late consump- tive expression of countenance. She will persevere in their use from a positive conviction that her health will be perfectly re-established thereby. Other indi- vidual cases I could mention. Suffice it to say, that all who have used the Pills to my knowledge praise them. Very respectfully yours, M rp . n aj T . LUCIUS S. NORTON. Messrs. Tousey & Co., St. Louis. New Orleans, 14th Jan., 1838. " He that is wise is wise for himself, and he that scoffeth (at Dr. Brand- reth's Pills) alone must bear it." — Listen, oh, ye incredulous ! hearken unto the voice of your friend, and neglect not the counsels of those who have learned wisdom from experience. Know, you that are slow of heart to believe, that I am a man who has suffered many afflictions from a hereditary diseased system. CURES BY PURGATION. 213 From my youth up I have never known 'what it was to enjoy a moment op health, till lately. My disease has been a chronic headache and a severe de- bilitating weakness and faintness at the pit of the stomach, which diseases have been in a great measure removed by taking only TWO BOXES of Dr. Brandreth's Pills. I can now say, and with truth too, that I know what health is by experience ; and I would that I could raise my voice so high that all the earth might hear. Then would I proclaim the virtues of this invaluable medi- cine. But what is my aim in all this ? Is it that I am interested in the sale of Dr. B.'s Pills 1 Most assuredly, no ; I am in no way connected with their rise or downfall ; but I recommend them for the benefit of mankind, and especially to those who are to receive the most benefit from their use, my fellow- citizens of the South. S. FRIEND. Grand Gulf, March 6, 1838. Mr. Joseph B. Brockway, Dear Sir : We wish you to send us some more of Dr. Brandreth's Pills, for we are entirely out. Since the people have found out we keep them they are called for every day. Send them by the first opportunity, and Oblige yours, &c, WHITEMAN & McFARREN. Mr. J. B. Brockway Warrenton, Miss., March 1, 1838: Agent for the sale of Brandrettts Pills. Dear Sir : Enclosed we hand you ten dollars, the amount of the bill with which you furnished us some time since. The pills we find very saleable, and the demand for them is very great ; in fact, so great is their reputed efficacy and virtue here, that we should feel ourselves in some degree guilty of crime, if we were to deprive them of so valuable a medicine. We wish you to send to us by some safe conveyance — by the captain or clerk of some boat in the trade — fifty dozen boxes Brandreth's Pills, and forward your bill "to us on the usual terms. Very respectfully, your obedient servants, JOS. TEMPLETON & CO. Port Gibson, Feb. 27, 1838. Mr. Joseph B. Brockway, Dear Sir : Enclosed you have ten dollars in payment for fifty boxes of Brandreth's Pills, left with me some time since by your agent. For some length of time after receiving the agency, there was but little demand for the article, as people were afraid of some deception ; but since it has become known, the demand for it is rapidly increasing. I am now nearly destitute of the article, and as I have daily calls for it, wish you would send me a supply by Mr. O'Neilly — 20 doz. boxes would not be too large a quantity. Respectfully yours, D. Y. THOMAS. Mrs. Elwell's Case. MRS EL WELL, then of Middlefield, Otsego Co., N. Y., was seriously attacked with inflammation of the stomach and bowels. She was given over by her physician, and a consultation of doctors was called. The decision was that she must di*. She, however, partially recovered, but her stomach was in 214 CURES BY PURGATION. a very deranged state. Very little action could be produced on the bowels by the most skillful of the profession. She continued for many months under the treatment of one doctor after another, gradually growing worse, and so truly deplorable was her situation for four months before she tried the Brandreth Pills, that nothing passed her bowels except by the .aid of the most powerful cathartics. Sometimes eighteen of one kind of pills were.given to her, then say a dozen of another, and a portion of some other medicine, before action could be 'produced, and then so great was her distress that, for the whole of the four months above alluded to, she invariably fainted when anything passed her bowels. In January, 1837, she thought she would try Brandreth' s Pills, and sent to my office in Cooperstown for a box. She took four pills. On going to bed, her husband enquired as to the effect of her new medicine. She replied, " that she did not feel any effect at all." lie then said, that in the morning, if she took a dozen more, he guessed they would operate like all the rest of her medicine. She answered, she did not know but it would, for she did not expect anything would cure her. However, early in the morning her bowels were moved, and without pain or distress, and consequently without fainting, to the utter astonishment of Mr. Elwell, and the great joy of his wife. In the course of a few hours, they operated four times equally easy, and the consequence was she did not lie down through the day more than one hour. She had not for months been able to sit up one hour in a day. The next evening she took another dose of four pills with the same happy effects. On the third evening Mr. Elwell called on me and purchased a large supply of the pills, related the above facts, and said he never would be without the pills in his house if they could be obtained. It is now two years since the above facts occurred, and Mr. Elwell informs me that his wife soon recovered her health, that he has never had occasion to call in a doctor for her since, and that her health is now very good. ELISHA FOOTE. Cooperstown, Feb. 22, 1839. Annual Report of Mr. Sinclair Tousey, General Brandrethian Agent. Louisville, October 18, 1837. Dr. Brandreth : Dear Sir : It is now one year since I opened an office in this city for the ex- clusive sale of your Vegetable Universal Pills, the sale of which since that period has increased beyond my most sanguine expectations ; I have been compelled to establish an additional office in the city of St. Louis, Missouri, for the more convenient supplying of that section of country. I was induced to become your agent here in consequence of being convinced of the unrivalled health-producing qualities of your pills. My aunt they effectually cured of what is commonly called a Sick Headache, of about thirteen days' standing, which had cften con- fined her to her bed for several weeks at a time. My mother they entirely cured of a violent pain in her side, with which she had been afflicted for several years ; myself they completely cured of habitual costiveness. These, together with numerous other cases that came under my observation while at New York, convinced me of their efficacy in every form and symptom of the only one disease, for I am a firm believer now in Brandrethianism. The pleasure I feel in making them known to my fellow-beings is more than I can well describe. 1 presume, sir, that you are aware that your Pills were not known to any extent anywhere to the West of the Alleghany Mountains previous to my introducing them in Louisville ; taking this into consideration, together with the fact that I CURES BY PURGATION. 215 am located in a fortress of M. D.'s (there is a medical college here) it makes my success and their unprecedented sale appear truly surprising. It affords me great pleasure to state that in every town where I have intro- duced these valuable pills that they have generally been received favorably, and their sale and popularity have invariably increased beyond all precedence, until scarcely any other medicine is used or thought of. The thousands of cures that have been effected by their use, together with thousands of testimonials received in their favor, have not only gone beyond my expectations, but they have perfectly astonished the bigoted enemies of the Brandrethian theory, and has, I am very happy to inform you, caused many, very many, who were formerly its bitterest enemies, to become its most zealous advocates. More than thirty-seven hundred of the most respectable of our citizens have voluntarily come forward and testified to the virtues of your medi- cine from their own experience. It now becomes my duty (which I think a pleasure), as your general agent for this section of country, to transmit you testimonials of a few of the very nu- merous cures effected by the use of your pills which have come under my own observation, and had I the liberty to use the name of every individual who has testified to their extraordinary virtues, it would not only astonish the Regulars, but it would cause the foundations of Esculapian practice to quake with fear, besides filling at least one large volume. This, however, is not at all necessary, as the fame of the medicine is now spreading with such unparalleled rapidity that ere long its happy influence will be universally appreciated throughout the civilized world, and the only question invalids will ask will be, " Where can I get Dr. Brandreth's Genuine Pills V 9 Case I.— BILIOUS FEVER. Louisville, November 16, 1837. Mr. S. Tousey — Sir : I feel it a duty which I owe, not only to you but to the public generally, to acknowledge the great benefit which I have derived from the use of the Pills for which you are agent. I was attacked about six weeks since with chills and fever, from which I recovered in about three weeks, when I was almost immediately attacked with a bilious fever, from which I had great doubts of ever recovering. Fortunately, I was induced by some of my friends to give Brandreth's Pills a trial ; and I now find myself, after the free use of these Pills for a few days, perfectly restored in health and able to attend to my business as usual. After finding the happy effects of these Pills upon myself, I was induced to give them to one of my children — a girl eight years old — who had been ill for some time, apparently in a decline. It gives me pleasure to inform you that she is gradually getting better since we first used the Pills, and I hope in another week to apprise you of her complete recovery. I am, sir, very respectfully yours, FELIX WOOD. Case II.— DISEASE OF THE LUNGS. Mr. Summers, City Pump Maker, has been afflicted with the above com- plaint for seven years ; he tried a great many medicines before commencing with Brandreth's Vegetable Universal Pills, but never derived any benefit com- pared to what he received from them. He strongly recommended them to all as the best family medicine he ever used. Mr. Summers is well known in Louisville. 216 CURES BY PURGATION. Case III.— FEVER AND AGUE. Mr. H. Humphrey was violently attacked with the Fever and Ague, and after using but four boxes of the Pills he found himself perfectly cured and able to attend to his business right off. Such is the extraordinary efficacy of your health-restoring medicine, which makes friends of, and creates health in, all who use it. Long life to its maker. N. B. — Mr. H. resides in Third Street. Case IV.— ERUPTION OF THE SKIN. Mr. James Conklin was afflicted with an eruption of the skin, together with severe pains in all parts of his body. He used several highly recommended medicines previous to trying our Pills, but all to no purpose ; he has used only a few boxes of them, and is now entirely free from all eruptions, his skin being now perfectly cured, and his body is quite healthy in every respect — no pains, appetite good, sleeps well. As many as fifty or sixty cases of eruptions of the skin have occurred where your Pills have been used and cures effected in this city. Case V.— GENERAL DEBILITY. Mr. John Downing's wife has been troubled wiun a general debility for a length of time ; she has tried a few boxes of Brandreth's Vegetable Universal Pills, and finds them of great benefit. She is encouraged to persevere with them, being convinced that they are the best medicine she ever tried — the opinion of all. Case VI.— DYSPEPSIA. Mr. James Allen, residing in Clark Co., Indiana, has been afflicted with Dyspepsia for several years ; he has tried but three 25-cent boxes and is much better, his appetite being restored, and his chest is free from pain with which he was troubled so much. His digestive organs are become healthy — that is all, but that is everything. Mr. Stockton, the writer of the following letter, 's well known in this quar- ter of the country. Case VII.— CHILLS AND FEVER Mr. S. Tousey : I am compelled by an impulse of gratitude to acknowledge, not only to you, but to the public generally, the beneficial effects produced upon my son by the free use of Dr. Brandreth's Vegetable Universal Pills, for which you are agent. About six months since, my son, 15 years of age, was very suddenly attacked by that vile disease called Chills and Fever. He was occa- sionally so violently stricken with it, that I. had given him up, and thought all medical aid was useless. I was prevailed upon by my friends and acquaint- ances to give Brandreth's Pills a trial, but it was a long time ere I was con- vinced of their efficacy ; I almost detested the idea, but my friends perse- veringly persuaded until I was compelled to yield, and I am happy to inform you that after the free use of these pills only thirteen days, he was thoroughly cured and restored to sound health, and I am now perfectly convinced that they are the best medicine extant. Very respectfully yours, E. F. STOCKTON. Louisville, 20th September, 1837. CURES BY PURGATION. 217 Cask Vni'.— SWELLED LIMBS. Mr. H h has been afflicted for about 5 years with swelled limbs, accom- panied by very violent pains in every part of his body ; he was unable to attend to any business or obtain any rest by night. These symptoms were pro- duced by an excessive use of calomel. He used several bottles of Swain's Panacea and other remedies, but to little or no effect. He commenced with your Pills a short time since, and a few days ago he informed me the swellings had subsided, and the pain entirely left him. The Pills, to use his own words, ^ made him feel like a new man." In addition to the above, I would state, I have known a great many other cases similar to the above, where Brandreth's Pills have been used with the same happy results, all of which go to prove the extraordinary power of your medicine in removing the most inveterate diseases from the system. Case IX.— LIVER COMPLAINT. Morgan County, Kentucky, Aug. 19, 1837. Mr. L. Tousey, Sir : It becomes my duty to acknowledge to you, and through you to the public, the great benefit my wife has derived from the use of Brandreth's Vege- table Universal Pills.- About three years since my wife was brought very low with an attack of the Liver Complaint. A physician was employed, and after prescribing some time to no effect, he gave us this consoling information, that he could do her no good, and he thought nothing else would. After continuing in this miserable state some months, I was induced, from an advertisement which I read in the Louisville Journal, to give her some of Brandreth's Pills, thinking they could do her no harm if they done her no good ; and it gives me pleasure to inform you that, contrary to our expectations (for we considered her beyond the reach of medicine), she began to recover, and is now quite well. Should you consider this of any service to you, you are at liberty to publish it. Respectfully yours^ &c., T. smith. Case X.— INFLAMMATORY RHEUMATISM, LOSS OF APPETITE, &c. Mr. James Johnson, residing in Grant County, Indiana, suffered for about three years with Inflammatory Rheumatism ; at times his feet were so much swollen that he could not get on his shoes ; besides this he was troubled with costiveness, being sometimes three or four days without a passage. In addition to this he had scarcely any appetite ; he had advice and medicine from several physicians, but without any benefit, except for a short time. He expected he never would again be blessed with good health. After reading numerous testi- monials in favor of Brandreth's Pills, and hearing them very highly recom- mended by some of his neighbors who had used them, he was persuaded to give them a trial, and now, after having used them about five weeks, he finds him- self able to put his shoes on and walk about as he used to do. Besides this his appetite is perfectly restored, his bowels also being regular and healthy. He says that he has an excellent appetite, and thinks Dr. B. should have a monu- ment erected to his memory for discovering so good a medicine. The following letter, from the Rev. M. W. Sellers, will no doubt be read with interest. Mr. Sellers is well known to numbers of our citizens here : 218 CURES BY PURGATION. Case XL Mr. S. Tousey, Dear Sir : I send you the following account of my case, and hope it may be of service to you in prevailing upon other persons to give Dr. Brandreth's Pills a trial. In the fall of 1833 I was attacked with a severe pain in my breast, which continued to increase until a pain in my stomach and side took place, which brought me very low. I took different medicines to remove it, but to no effect. I then applied to Drs. Luster and Constant, of Louisville. They pronounced it a severe case of Dyspepsia and Liver Complaint. I com- menced using their medicines, and found great relief in my side and stomach. I was in hopes a cure was effected, but the pain in my breast still remained. They then tried external applications to great length, with no success ; and last winter the pain had become more violent. Mr. R. Barnett, of your city, informed me of Brandreth's Pills. I told him I had tried the Hygeian Pills without deriving any benefit ; he told me BRANDRETH'S PILLS were the best. I then applied to you, as you may recollect, for some of these pills. It appeared to me at the time that my strength was so fast declining that I could not live long without some relief. I commenced using the Pills, and shortly afterwards I was attacked with the pleurisy ; and as bleeding had become such a habit I was persuaded to be bled, but mended slowly, and at length I was more violently attacked with the same complaint again. It seemed to me that I could not live long. However, I took eight of Brandreth's Pills, and in the course of a few hours I felt better. I then took twelve more, and have had no pain in my side since. This encouraged me to continue their use for the pain in my breast, and I mended very fast. In one month I gained ten pounds in weight. I enjoy good health at present, and feel myself perfectly restored. I can say that Brandreth's Pills were the first medicine that appeared to relieve the pain in my breast, and in any case of sickness I would rather use these val- uable pills than any other medicine that I know of. By experience of said pills in my family, particularly in my own case, I know them to be good. My mother who lives with me, nearly seventy years of age, has been afflicted with a urinary complaint for about ten years, and by using these Pills during the last summer is now entirely well. I have known several cases of fever and ague, two or three cases of scarlet fever, and other diseases that the human family is daily subject to, cured by the use of these pills ; several of my neighbors are using them for the breast complaint, and all find relief. I have no doubt but a great many other cures would have been effected by perseverance with the pills, but there is one great difficulty they labor under — timid purchasers com- mence using them and take one or two small doses, just about enough to make them feel a little queer, and get frightened and then away to the doctor, who takes great care to cry down the pills, knowing it stands them in hand to do so. I reside in Lettersburgh, Clark County, Indiana ; I have been a resident of said county more than twenty years, eleven years of that time I have been a minister of the Gospel, of the Baptist denomination. I am aware of the great opposition these pills labor under ; but let me ask one question, viz. : What food is best suited to our nature and health ? I think the answer is, the vege- table. Then do not let us be opposed to the vegetable kingdom for our medicine. October 22, 1837. M. W. SELLERS. Annexed I send you extracts from letters received from my agents, whjeh make the proof in favor of your Vegetable Universal Pills almost over- whelming. CUBES BY PURGATION. 219 The following extract is from the Postmaster at Henderson, Kentucky, dated Henderson, October 14, 1837. The fame of Brandreth's Pills is on the increase here, and I am daily receiving assurances of their efficacy in every complaint — fever and ague of a most aggravated nature has been in almost every case speedily and effectually cured. Yours, &c, &c, (Signed,) P. II. H. The following is from the Postmaster at Hutsonville, a small village in Illinois, dated August 16th, 1837 : As regards Brandreth's Pills, I believe they give universal satisfaction ; at all events, I cannot keep them on hand long — almost every person who has bought of them recommend them to their friends and continue themselves to use them — the last lot you sent me of fifteen dozen boxes did not last sales of two weeks. I have sold upwards of ten dollars' worth in one day, at retail. The above speaks volumes in their praise. Another agent writes : They are deservedly becoming so popular that I shall be able to vend a great quantity of them. I could furnish you a valuable receipt of their efficacy from expe- rience in my own family. Not only this, but the whole neighborhood bear testimony of their beneficial effects. In conclusion, I send you the annexed letter from H. Foster, Esq., my agent at New Albany, five miles below Louisville : New Albany, November 23d, 1839. Case XII. Mr. S. Touset : Your favor of 20th ult. was duly received as to the success of Dr. Brandreth's Pills ; I can state, in general terms, that I have sold about 160 dozen boxes of these pills, and have made a great deal of inquiry of those that have used them, and find they have been very beneficial to this community. I can recommend them with the utmost confidence. I can here state that last fall, when I became an agent, my wife was in a very low state of health, and had a very distressing cough ; she was apparently on the eve of going into a con- sumption — the use of ten boxes of the pills entirely restored her, and she has never failed since that time, when indisposed, to receive benefit from a single dose. I am yours, &c, HUGH FOSTER. You will perceive by the above testimonials that your medicine is justly in high repute in this part of the country, as it must be everywhere where it is introduced. I could, as I stated above, had I time and space, extend the list of testimonials of its efficacy to several hundred pages. I would state that I have sold, during the year past, nearly eighty-five thousand boxes of your Vegetable Universal Pills, and have not the least doubt but I shall be able to dispose of more than double this quantity during the coming year, as those that have been sold have established a reputation for them that will last as long as the body of man is subject to indisposition. My office in Louisville is 99 Fourth Street, near Jefferson ; and in St. Louis at 56^ Market Street, near Third. Wishing you every success, I remain, sir, Respectfully yours, S. TOUSEY. To Dr. Benjamin Brandretu, New York. 220 CURES BY PURGATION. Pleasantville, Mt. Pleasant, Westchester Co., June 10, 1859. Dr. B. Brandreth, My Dear Sir : I have long been a friend of yours, because I verily believe your valuable pills saved my life. I have recommended them for nearly twenty years, and don't want any others in my store. In 1849 I took a heavy cold, and being much exposed for some days afterwards, it settled on my lungs. For three months I was terribly troubled with a hacking cough and profuse-, night sweats, and reduced almost to a skeleton. • I took various syrups and cor- dials, but found no relief. At last a friend, Jesse Baker, of Miles' Square, Westchester Co., said, " Hammond, why don't you try Brandreth's Pills, they may help you." I bought a box, and took some. They purged me freely — my last dejection being a thick, viscid, yellow matter. I found myself greatly relieved at once, and within a week got entirely well. I recommend your pills to everybody, and they always do good. I shall always sell them, and I think they are the best medicine in the world for coughs, colds, consumption, and all kinds of sickness, for I know them by experience, having administered them to over one hundred cases of disease, and always cured. Yours truly, W. H. HAMMOND. Jaundice Cured. Mr. Benj. J. Stebbins, a highly respectable and well-known farmer of Pawlina, Dutchess County, N. Y., writes July 9th, 1859, that he was pros- trated with jaundice every spring and fall for years, in spite of all the efforts of physicians ; that he was cured by a few doses of Brandreth's Pills, and " has never suffered from the disease since." See page 21 for testimonial from Supervisor Bissell, of Newcomb, as to cures of small pox ; also, page 46, from sixty soldiers ; and page 151 as to cures of rheumatism. These testimonials are selected running through a period of nearly forty years, and to those who would learn have significance. B. BRANDRETH. INDEX OF DISEASES. PARAGRAPHS. Abscesses 28, 30, 140, 67, 97, 329 Acute Disease 4, 20, 59, 191', 220 Ague 577, 578 Amenorrhea 576 Anemia 658, 668 Angina Pectoris 522 Anorexia 344, 702 Apoplexy 41, 143, 144, 181, 256, 278, 332, 354, 484, 552, 691 Asthma , 209 Autumnal Disease 17, 112, 160, 221 Blindness 41, 99 Buboes 90, 109,240 Bright's Disease Preface. Cseliac Passion 129. 135 Cachexia „ 114,625 Cancer 71, 614, 700 Carbuncles 109 Cardialgia 524 Carus 144 Catarrh 609 Cerebral Diseases 514, 619, 702 Chlorosis 307, 315,664, 680 Cholera 162, 484, 568, 596 Chorea 311, 321, 508, 549, 597 Chronic Diseases 155, 159, 317, 485, 614 Colic 65, 82, 138, 255, 418, 526, 428,618, 685 Concussion of Brain 99 Constipation 291, 292, 487, 527, 528, 570, 724 Consumotion 323,370,382, 626, 627 Convulsions 41, 428, 706 Costiveness 246, 305, 307, 524 Cramps 210, 217 Croup 218 Deafness ; . s 27 Debility. .* . .169, 223, 234, 241, 246, 279, 303, 323, 344, 409, 454, 585, 663 Delirium 183, 452 Diabetes 81, 362 Diarrhea. . .2, 13, 69, 135, 142, 215, 252, 362, 397, 435, 630, 599 Dropsy 35, 38, 73, 211, 304, 362, 374, 603, 663 Dysentery 38, 136, 198, 214, 221, 253, 285, 352, 453, 541 Dyspepsia 244, 507, 563, 131, 333, 555, 668,731 Enteritis 609 Enterocele 83 Epilepsy 150, 231, 306, 355, 440, 447, 486, 488 Ervsipe'las 77, 474, 492, 667 Eruptions of the Skin 247, 542 Eruptive Fevers 274, 54:3 Eve Disease 36, 80 PARAGRAPHS. Fever. ... 30, 31, 37, 45, 51, 67, 87, 106, 114, 152, 153, 159, 182, 190, 191, 194, 196, 202, 203, 204, 208, 212, 245, 280, 282, 301, 349, 362, 363, 368, 369, 370, 387, 419,422,423,424, 452, 455,463,466, 493, 518, 537, 538, 646, 547, 558, 565, 630, 632, 638, 644, 656, 668, 678, 703, 708, 718, 734. Fits , 350 Flatulency .' 73, 82, 85 138, 151 Fractures .100, 222, 228 Foul Gases 701 Gangrene 78 Gastritis 370 Gastrodynia 417 Gout. , 40, 84, 85, 86, 158, 377, 378, 379,420, 436, 439, 495, 522, 671, 692 to 697 Gravedo 645 Gravel 524 Gripings , 21, 24, 599 Headache 181, 605 Head Disease 132, 442 Heart Disease 464 Hemiplegia 201, 332 Hemorrhoides 71, 180 Hepatic Complaint 216 Hepatitis 653 Hernia 230, 326, 343, 582, 651 Hydrocephalus, . 225, 227, 232, 238, 353, 579 706 Hydrophobia 95, 313 Hypertrophy 663 Hypochondria 544 Hysteria.,.., 310, 549,618 Iliac Passion 137 Indigestion 131, 333,555,731 Infantile Diseases 226, 235, 428 Inflammation. .. 72, 81, 89, 114, 141, 136, 218, 482, 639, 653,655, 660, 715, 746, 751, 664, 574, 641. Influenza 257, 258, 738 Insensible Perspiration 102, 105, 706 Insanity 567 Intestinal Inflammation 482 Jaundice 254, 535, 536, 668 King's Evil 192 Leprosy. 94 Lethargy 144 Lientery 38, 128, 135 Liver Disease 568, 690 Local Disease 331, 440 222 INDEX OF DISEASES. PARAGRAPHS. Lumbago 472, 645 Malaria 668 Malignant Diseases 383, 384, 385 Malignant Fever. . . ; . .67, 106, 229, 399, 400 Mania 41, 148, 448 Marasmus 305, 315 Measles 64, 92, 271, 379, 479 Melancholy 147 Menorrhagia 362 Menstruation 33 Mental Depression 575 Mercurial Diseases 226, 242, 243 Mesenteric Affection 141, 223 Miasmata 281, 591 Milk Fever. ,,,,,,., ,336, 606, 632 Nausea 138, 240, 344 Nephritis 370 Nervous Diseases 120, 447, 459, 489 Neuralgia 460, 490, 568 Neurosis 448-548 Obstruction 413 Ophthalmia 36, 80, 239, 274 Pains 22,52, 137, 138,184 Pains in the Back 138, 141 Palpitation 314, 464, 573 Palsy 76, 151, 159, 181, 201, 497 Paralysis 341 Paraplegia 201 Paraphrenias 146 Pericarditis 744 Peripneumonia Peritonitis 505 Phthisis 18 Phrenitis 146 Piles 180, 633 Plethora. % 15, 50, 104 Pleurodynia 645 Pleurisy 92, 166, 480, 521 Paeumony 380, 381, 607, 638, 743, 753 PARAGRAPHS. Prickly Heat 262 Purpura 433 Plague 96, 109, 240 Puerperal Fever 208, 632, 644 Rheumatism 370, 379,419,467-471, 509, "559- 562, 568, 609, 635, 645, 674, 715, 716, 721 Ringworm 91, 517 Scarlet Fever 164, 277, 303, 416 Sciatica 88, 472, 645 Scrofula 498 Scirrhus 73 Small Pox 64, 92, 379, 431, 543, 748 Spasmodic Diseases 217, 350, 366, 618 Squinancy 92 Sore Throat .72,475 Strangury 89, 285 Structural Diseases Syphilis 638,639, 668-9 Sweats, 43, 105, 182, 190, 193, 195, 205, 206, ■ 207, 398, 723 Synocha 218, 237 Tetanus 75, 312, 340, 365,367 Toothache 523 Torpor of Intestines 134, 345 Torticollis Tumors 34, 67, 70, 634 Tetters 91 517 Typhus . ,218, 233, 297, 358, 428 430, 434, 454, 300, 303 483, 520, 539, 540, 583, 623, 647, 668. Ulcers 49, 79, 140, 329, 481, 687 Vertigo 145 Vitiated Blood 122 Worms 93, 355, S56, 357, 532, 617 Yellow Fever, 229, 249, 260, 261, 262, 263, 264, 370, 385, 402 INDEX OF AUTHORS QUOTED. PARAGRAPH. Abercrombie 563, 564 Abernethy 315, 341 Addison 749 African Savage 383 Ainsie 553 Allen Alison 661 Andral 550, 555, 556, 557, 592 Annesly 565, 566 Aretaeus 256 Armstrong 430, 432 Asclepiades 63 Auld 245, 246 Avicenna 65 Badger 247, 248 Bancroft 540 Bardsley 257 Barlow 410, 421 Bartlett 688, 689 Bayle 567 Bache 209 Beclard 592 Bell, Benj 228 Bell, John 228 Bennet, J. Henry 743-746 Bennet, J. H'ghs 747-757 Bennion 282-284 B. G. B 422, 423 Bichat 592 Blegborough ". 342 Boyle 494 Bradley 343 Briggs 365-367 Brown, John 568 Bryce 408 Buchan 417 Budd 690 Burserius 434 Canstadt 657-664 Carpenter 736 Caristo Carson 226, 227 Chambers 558 Chapman, John N 228 Chapman, N 495-497 Cheyne 350-353 Chomel 623 Clark, Dr 397 Clark, Thomas 285 Clark, James 625, 626 Clark, Joseph 428, 429 Cleghorn 384 Clendenning 706 Collins 127-151 Combe 628,629 PARAGRAPH. Connoly 627 Conradi 210 Cooke 569-578 Copeman 691 Copland 586-621 Cozzi 685 Crampton 517 Crichton 668, 669 Cullen 202 Currie 249, 251 Denman 211 Dick 724, 725 Dickson, D. J. H 450,454 Dickson, S. H 737-742 Dropes 455-458 Forbes 630-640 Fowle 229 Frank 538 Franklin 385 Friend 423 Fricke 559 Galen 79 Gregory 218 Gay ." 354 Geoghegan 230 Good 523-544 Gully 670 Halliday 355-358 Hall 707, 708 Hamilton, James 286, 319 Hamilton, John 480, 481 Harrison 709, 710 Hartz.. 433, 434 Harvey, William 121-126 Harvey, Gideon 167-182 Harvey, James 183-191 Haspel 734, 735 Haygarth 540 Hazard 761-776 Heberden 252-255 Heller 740 Henderson 212-217 Hillary 397 Hippocrates 1-62 Hosack 518-522 Houston 686 Huenefeldt 665 Huggan 218 Humboldt 399 Hunter 325 Jones 671 Johnson. Ed 727-732 224 INDEX OF AUTHORS QUOTED. PARAGRAPH. Johnson, Jas 482, 493 Kennedy 652 Kingslake 258, 259 Kirkland 396 Kramer 740 Laennec 624 Lane Lanza 672-673 Lawrence 651 Leeson 711, 712 Lemazurein 467 Liebig .727 Lind 403 Lloyd 498 Louis, Ch. A 641, 642 Louis, E. H 643 Mackin 692-697 Magendie 713, 714 Markham. . „ Magennis 231 Marx 622 Martin 424,426 Mcllwain 646 McCullock 568 McKenzie 581 McLeod - 674 Mead 543 Meterius 87 E. Miller 219, 220 Mitchell 390 Moore, I... 237 McMullen 320-324 Medicus, Pathology 435-446 Medicus 277 Miller 205-207 Monat and Henderson 579, 580 Moore, G 644 Morgan, Chas 344-348 Morgan, G. F 653-656 Mosely 396 Manneley 666, 667 Mckoll 499 Nooth 221 O'Berne '. 260-279 (Esterlein 740 Parey 66-100 Paris 545-552 Parise 645 Patterson 278 Pearson. 279-281 Pennington 391 Philip PARAGRAPH. Pickford 758-760 Pidduck 687 Pott 228 Potter 271-273 Power 274, 275 Pring 505-516 Pringle 193-201 Pricards 238 Pritchard 447-449 Redman 396 Reeve 232 Rhazes 64 Richter 675-679 Robertson 203, 204 Rush 368-409 Sanctorius ■ 101-120 Sara 698, 699 Savaresi 239 Say ...396 Schultz 680, 681 Scudamore 559-562 Selle 208 Shaw 500, 504 Sherwood 726 Skimshire 222 Stephens 582 Stoker 583, 585 Strack 434 Sutton ..223,224 Sydenham 152-166 Taylor 700 Tuomey 424-426 Tainsh 240 Tyro 256 Unwins 323, 324 Yage 241, 244 Yandeswieter 256 Yelpeau 592 Vogel 701 Waddley 276 Waddy 702, 705 Walsh 349 Watt 359-364 ^egg ?33 White 225 Whydt 598 Willan , 192 Williams, C. J. B 682-684 Williams, Robert 647-650 Wilson, Andrew 459-479 Wilson, J. A 715-723 Woodward 235, 236