INAUGURAL DISSERTATION Oltf THE DISEAS: 
 
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AN 
 
 INAUGURAL DISSERTATION 
 
 ON 
 
 THE DISEASES OF OLD AGE. 
 
 AS CONNECTED WITH 
 
 A PLETHORIC STATE 
 
 OF 
 
 •,AAa,a 
 
 THE SYSTEM. 
 
 ■ 
 
 BY JOHN SCUDDER, A. M. 
 
 UXMBIR OF TIIR MSDICO-CHIRUIHJICAL SOCIETY OF TMK 
 UNIVKHSITV OF NEW-YORK. 
 
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AIT 
 INAUGURAL DISSERTATION 
 
 ON 
 
 THE DISEASES OF OLD AGE, 
 
 AS CONNECTKD WITH 
 
 4 PLETHORIC STATE OF THE SYSTEM: 
 
 SUBMITTED 
 TO THE PUBLIC EXAMINATION 
 
 TRUSTEES OF THE COLLEGE OF PHYSICIANS AND SURGEONS OF 
 THE UNIVERSITY OF THE STATE OF NEW- YORK, 
 
 SAMUEL BARD, M, D. PRESIDENT, 
 
 FOR 
 
 The Degree of Doctor of Medicine, 
 
 On the 2d day of May, 181S. 
 
i r /ilduaj ^l^yk. & 
 
 
 un~ 
 
xo 
 
 JOSEPH SCUDDER, ESQ. A. M. 
 
 THIS 
 
 DISSERTATION IS INSCRIBED, 
 
 A TESTIMONY 
 
 OF 
 
 THE HIGHEST ESTEEM AND GRATITUDE, 
 
 EY 
 
 HIS AFFECTIONATE SON 
 
TO 
 
 DR. SAMUEL FORMAN, 
 
 President of the New-Jersey Medical Society. 
 
 Sir, 
 
 Having commenced my medical education under your 
 direction, permit me thus publicly to express my obligations 
 as well for the instruction received while under your care 
 as for the many marks of friendship you have manifested- 
 toward me. 
 
 With feelings of the highest respect 
 I am, &.c. 
 
 JOHN SCUDDER. 
 
TO 
 
 DAVID HOSACK, M. D. 
 
 Professor of Ike Theory and Practice of Physic and Clinical Medicine in tin. 
 
 College of Physicians and Surgeons of the University of the 
 
 State of Nero- York, £c. fyc. 
 
 THIS 
 
 DISSERTATION IS DEDICATED. 
 
 WITH 
 
 SENTIMENTS OF THE HIGHEST RESPECT 
 
 FOR 
 
 HIS DISTINGUISHED TALENTS AND PRIVATE WORTH, 
 
 BY 
 
 HIS PUPIL, 
 
 JOHN SCUDDER. 
 
TO 
 
 JOHN W. FRANCIS, M. D. 
 
 Professor of Materia Medica in the College of Physicians and Surgeons of the 
 University of the State of Nem- York, fyc. t(C. 
 
 THIS 
 
 DISSERTATION IS INSCRIBED, 
 
 in 
 
 TESTIMONY 
 
 OF THK 
 
 REGARD AND FRIENDSHIP 
 
 THE AUTHOR. 
 
AN 
 
 INAUGURAL DISSERTATION 
 
 ON THE 
 
 DISEASES OF OLD AGE, &c, 
 
 The discovery of the circulation of the blood 
 is an era from which we may date a more rapid 
 advancement in medical science than was ever 
 effected from the time of Hippocrates to that 
 of Harvey. During the long period intervening 
 between the appearance of these distinguished 
 characters, neither the ingenuity of anatomists, 
 nor the speculations of physiologists tended to 
 throw much light upon this important function 
 of the animal economy ; and, as physicians were 
 unacquainted with it, they could have no correct 
 rules to guide them in fulfilling some of the most 
 important indications of cure. The discovery 
 
14 
 
 of Harvey, by dispelling, in a great measure, the 
 darkness which enveloped this part of anatomy, 
 so far as it related to pathological knowledge* 
 has rendered the science of medicine of greater 
 utility to mankind, by augmenting the number, 
 and rendering more certain, the principles of 
 practice. 
 
 But notwithstanding the various improvements 
 in the treatment of disease which have been con- 
 sequent upon the discovery of the circulation, 
 the fluids of the human body are sources of 
 many disorders, the causes of which are too 
 often overlooked, and which depend either upon 
 an excess of the circulating mass, or upon certain 
 changes which it may have undergone ; circum- 
 stances which may take place equally in old age 
 as in early life. 
 
 That plethora is a disease of advanced life, is 
 positively denied by the generality of practition- 
 ers, and the lancet as dogmatically proscribed. 
 Evacuations at this period, say they, are abso- 
 lutely and altogether improper; and were we 
 guided by their arguments, we would necessari- 
 ly believe such persons rather the subjects of 
 
15 
 
 inanition than otherwise. But this is generally 
 far from being the case, for " although the system 
 may be debilitated by age, it should be recollect- 
 ed that the secretions are also impaired from di- 
 minished exercise at that period of life, and that 
 an accumulation takes place in the larger vessels, 
 rspecially in the venous system."* 
 
 In addition to this, the degree of appetite 
 which belongs to old age, the quality of the food 
 taken, and the sedentary habit which is generally 
 connected with it, all concur to produce that state 
 of the system which requires blood letting ; and 
 again this " increase of appetite in old people, 
 their inability to use sufficient exercise, whereby 
 the blood vessels become relaxed, plethoric, and 
 excitable, and, above all, the translation of the 
 strength of the muscles to the arteries, and of 
 plethora to the veins, all indicate bleeding to be 
 more necessary in equal circumstances in old 
 than in middle-aged people, f 
 
 * Vide Hoback and Francis' Amcr. Med. and PhiloB. 
 Register, vol 4. 
 ■}• Ri on'* Enquiries, vol. I 
 
16 
 
 It is supposed that the veins in youth are 
 stronger than the arteries ; but that the latter, 
 in consequence of the distention and pressure 
 they undergo from the action of the heart, be- 
 come of increased strength and thickness, and 
 even more dense than the veins themselves. 
 Hence venous plethora more particularly takes 
 place, as is manifested by the appearance of the 
 veins, which become larger, more relaxed, and, 
 consequently, more replete with blood, as per- 
 sons advance in life. 
 
 In addition to the reasons mentioned we may 
 observe, that in advanced life, the symptoms of 
 plethora are particularly manifested by an inor- 
 dinate pulsation in the arteries, dulness, disincli- 
 nation to motion, propensity to sleep, by a heavy 
 disagreeable weight, and sense of stricture about 
 the prsecordia. The extreme vessels frequent- 
 ly become reddened; cephalalgia, an inabili- 
 ty to articulate distinctly, numbness in the 
 extremities, dizziness, and vertigo take place. 
 The pulse is " sometimes strong and hard ; but 
 more frequently obscure or oppressed, and often 
 
17 
 
 apparently weak and low:"* but if we have re- 
 course to the method recommended by Mr. 
 Bromfield, of applying four fingers to it, and 
 suddenly raising them all except the one next 
 to the patient's hand, the impulse given will con- 
 vince us of its fulness, and point out the existence 
 of plethora. The mind frequently participate* 
 in this diseased condition of the body ; being un- 
 fit to direct itself to its ordinary pursuits. In 
 consequence of the body being deprived of its ac- 
 customed exercise, and the excretions being dimi- 
 nished from the diminished action of the excreto- 
 ry vessels, obesity takes place, which is often fol- 
 lowed by apoplexy, palsy, hydrothorax, ascites, 
 and anasarca, which are only to be cured by 
 early recourse to depletion, followed by tonics. 
 Females, after the cessation of the menses, 
 are, caeteris paribus, more subject to plethora 
 than the male sex ; and if we do not have re- 
 course to depletion when the symptoms, such 
 as vertigo, numbness, and an oppressed state of 
 the lungs, resembling asthma, indicate such ple- 
 thora, a foundation will frequently be laid for 
 
 ' Dtckmak on the Pathology of the Human Fluids. 
 
many of the diseases incident to old age. Their 
 complaints at this time demand our particular 
 attention, and more especially if there be the 
 slightest predisposition to phthisis ; as it is not an 
 uncommon occurrence for the overloaded state 
 of the blood vessels to vent itself upon the lungs. 
 When this occurs blood letting will be proper, 
 even when the condition of the system in other 
 respects contra-indicates this remedy. 
 
 That plethora takes place in old age, is farther 
 proved by persons at this period being more sub- 
 ject to gout than at any other time of life, this 
 disease being rarely known to affect the young ; 
 and when it does, it arises from intemperance 
 producing a plethoric state of the system. Gout 
 has, by most physicians, been considered as inde- 
 pendent of plethora; but the authorities of 
 Sydenham, Rush, and Hamilton, (the last of 
 whom, himself having been the subject of it, had 
 a fair opportunity of witnessing the good ef- 
 fects of the plan he recommends,*) have set the 
 
 * Vide Letters on the causes and treatment of Gout Also 
 extracts from the work published in the Edinburgh Med. and 
 Surg. Journal, vol. 6. p. 361. 
 
19 
 
 question for ever at rest, and satisfactorily prov- 
 ed that it arises in ninety-nine cases out of a hun- 
 dred, from this state of the system. 
 
 To the celebrated authorities just mentioned, 
 I may here add that of my preceptor, Dr. 
 Hosack, whose pathological reasoning on this 
 subject, and the issue of the practice resulting 
 therefrom, are strong corroborating circum- 
 stances in favour of the opinion, that gout is a 
 disease of plethora.* 
 
 The causes of gout prove it to depend on 
 plethora. It is rarely known to attack those in 
 the humble walks of life, where a scanty pit- 
 tance only is procured, and this by severe bodi- 
 ly exercise, the effect of which is to keep the 
 excretions of the body constantly open. On 
 the contrary, it affects those of sedentary ha- 
 bits; those who are indolent, who indulge freely 
 in animal food, and the condiments of the table ; 
 and who, at the same time, partake largely of 
 
 * American Med. and Philos. Register, vol. 4. MS. note* 
 on Hosack's Lectures on the Theory and Practice of Phy- 
 sic and Clinical Medicine, delivered in the University of the 
 State of New-York. 
 
20 
 
 spirituous and vinous liquors, particularly acid 
 wines, which not only replete the blood vessels, 
 but debilitate the system. It was owing to the 
 use of the latter, that this disease was observed 
 by Sennertus to be endemic in Moravia.* 
 
 Gout seldom attacks females who live tempe- 
 rately; and when it does, it usually appears 
 after the cessation of the menses. This was par- 
 ticularly observed by Hippocrates ;f and this it 
 might readily be anticipated would be the case, 
 as by this discharge, that plethora, of the sys- 
 tem, which takes place after its cessation, is pre- 
 vented. 
 
 Gout is usually considered as a disease of de- 
 bility, and doubtless debility is produced from 
 the long continued plethora, which the applica- 
 tion of fresh stimuli is constantly increasing. 
 The equilibrium between the solids and fluids 
 
 * Arthiidem in Moravia esse endemiam, ob acrimoniam 
 acidam et austeram hujus loci vinis, prse caeteris inditam : 
 Tract, de Arthride, cap. 2. 
 
 f Tuvn a'tt woia.'y^ix h jW» t* &ttsva,p.mitt. tturt » \%\iir*, Aph. 29. 
 
 sect. 6. 
 
21 
 
 is gradually destroyed, and the fluids being dis- 
 proportioned to the strength of the solids, the 
 disease vents itself upon the weakest parts, pro- 
 ducing that violent pain and inflammation 
 which always attend this affection. But this is 
 no argument against the use of bloodletting; 
 for this remedy, as remarked by Dr. Rush, " is 
 sometimes indicated in a larger quantity in 
 weakly than in robust people, by the plethora 
 which is more easily induced in their relaxed 
 and yielding blood vessels. Thus it is more ne- 
 cessary to throw overboard a large part of the 
 cargo of an old and leaky vessel in a storm, than 
 of a new and strong one." 
 
 The termination of gout proves it to be a dis- 
 ease of plethora. When it goes off*, after a short 
 attack, the patient falls into a gentle sweat,* and 
 this by relieving the surcharged vessels from 
 their distention procures relief. Wintringham 
 lias attributed the case procured, solely to the 
 
 * Btutorea per cutis glanriulas erumpunt, ct placidus som- 
 _to solatium, el quietum addueii Wwtrim&ham, dc 
 igra i» n 
 
22 
 
 diminution of plethora in the part. " Glandula- 
 rum omnium cutanearum orificia antea diminuta 
 augebuntur, et larga materiae perspirabilis copia 
 ejicietur; unde diminuta quantitate liquidi in 
 omnibus vasis ultimis, liberius per ea transibet 
 liquidum, et canales non adeo infarcientur, nee 
 aequae ultra tonum distendentur, et per conse- 
 quens ulterius diminuetur dolor, et fiet remissio 
 symptomatum, sive cessabit paroxysimus parti- 
 cularism"* 
 
 Depositions of earthy matter also occur from 
 the plethora of the blood vessels, and these to the 
 greatest degree where the inflammation has been 
 greatest, in consequence of the blood which 
 abounds with this lithic matter, being there de- 
 termined in such large quantities, and the thin- 
 ner parts being carried away, while the thicker 
 are left behind. 
 
 Gout also terminates in apoplexy, preceded, 
 frequently, by oppression and swimming in the 
 head, with other symptoms of fulness. Van 
 
 * De Podagra, p. 109, 
 
23 
 
 Swieten observes that he could fortel it by these 
 symptoms.* 
 
 The method of preventing this disease also 
 proves it to depend on plethora. This consists 
 in abstinence from strong stimulants, confine- 
 ment to a low diet, and keeping the different 
 excretory vessels pervious It is owing to a 
 free perspiration that persons so generally es- 
 cape the gout in the summer season; and if 
 exercise be added, it gives tone to the system, 
 and renders it less liable to a succeeding attack. 
 Van Swieten relates the case of a priest who had 
 long suffered with gout, induced by a rich living 
 which he enjoyed ; but being taken by the pi- 
 rates of Barbary and detained in a state of slave- 
 ry for two years, and being obliged to work in 
 the gallies with a very spare diet, he was com- 
 pletely and permanently cured. 
 
 The occasional use of bloodletting will also 
 prevent this disease, and even in those who will 
 not renounce their intemperate habits.t 
 
 Angina pectoris is a disease frequently oc- 
 
 * Commentariea 011 1010 Aph. of Boerhaave. 
 \ MS. Noteaou Hosack'b LectureB. 
 
24 
 
 curring in advanced life: it usually attacks 
 those who have short necks, who are disposed 
 to corpulency, and who, at the same time, are 
 of inactive or sedentary habits. It is attended 
 with great anxiety, giddiness, and numbness of 
 the extremities, violent palpitations, laborious 
 breathing, and a sense of suffocation, pain in the 
 region of the breast and prsecordia ; all of which 
 are symptoms of plethora. Dr. Hosack has re- 
 marked that all the cases of this disorder which 
 have come under his notice, occurred to persons 
 of a full condition of the blood vessels, and most 
 generally in the advanced periods of life. 
 
 The morbid changes which manifest them- 
 selves upon inspection after death, also demon- 
 strate, that plethora is the primary agent in the 
 production of this disease. See Dr. Bogart's 
 Inaugural Dissertation on Angina Pectoris, and 
 Dr, Dyckman's learned and elaborate Disserta- 
 tion on the Pathology of the Human Fluids. 
 
 Another concuring circumstance is that blood 
 letting and other antiphlogistic means have, in 
 many cases, removed this alarming complaint.* 
 
 * MS. Notes on Hosack's Lectures. 
 
25 
 
 A strongly-marked instance of angina pectoris 
 in a subject about sixty-five years of age, lately 
 fell under the observation of Dr. Francis ; the 
 paroxysms of which were uniformly removed by 
 copious venesection and other antiphlogistic 
 means. 
 
 Dropsy is a disease of frequent occurrence in 
 old age, and is often dependent on increased ex- 
 halation, the effect of plethora, as is proved from 
 the symptoms of the disorder and the state of the 
 system preceding its formation ; but we by no 
 means pretend to say that it is always induced 
 by this cause ; on the contrary, it occasionally 
 arises from diminished absorption, the conse- 
 quence of the debility of the absorbents, and 
 instead of depletion by the lancet, we must have 
 recourse to stimulants and tonics. 
 
 Having, as I trust, shown, that the diseases 
 which have been mentioned, arise frequently 
 from a plethoric state of the system, and that 
 plethora exists particularly in old age ; I shall 
 mention a few cases to prove that depletion, 
 instead ef* being disadvantageous, has, in many 
 instances, been attended with ^thc greatest 
 
benefit, and has tended to prolong life. " I am 
 sure," says Dr. Rush, "that I have seen many 
 of the chronic complaints of old people mitigated 
 by blood letting, and I have more than once seen 
 it used with obvious advantage in their inflam- 
 matory diseases."* Several instances of the good 
 effects of bloodletting, are mentioned by him in 
 persons far advanced in life, and from my own 
 observation I have seen it repeatedly used with 
 great success in similar cases. Many striking 
 cases might here be mentioned, calculated, 
 as I think, to lessen the influence of that too 
 popular opinion, that the lancet ought not to be 
 employed in persons of advanced age ; an opi- 
 nion the pernicious effects of which we have 
 almost daily evidence in the numerous cases of 
 sudden deaths which occur in our city from 
 plethora, apoplexy, palsy, gout, fyc. But two or 
 three cases of this nature, which fully show the 
 salutary effects of depletion, and which have 
 recently occurred in the practice of the writer's 
 preceptors, must suffice. 
 
 * Rush's Inquiries. 
 
27 
 
 Dr. Hosack relates the case of an old lady 
 In the eighty-fifth year of her age, who, in 
 the course of three days, lost by hemorrhage 
 from the lungs, atthe least calculation, two quarts 
 of blood. Very nearly as much more was taken 
 from her arm in the same period of time, when 
 the hemorrhage ceased. She recovered without 
 any injury to her constitution, from the loss of 
 blood she sustained."* 
 
 In an old lady above seventy years of age,lately 
 under the care of Drs. Hosack and Francis, 
 and who formerly had a discharge from her he- 
 morrhodial vessels, and had been subject to re- 
 peated attacks of apoplexy, in consequence of 
 the cessation of this discharge, the lancet was 
 used with the most decided success, even to 
 the number of thirty times in a year. The 
 consequence is, that she now enjoys a much bet- 
 ter state of health than before, and the recurrence 
 of her fits is far less frequent. 
 
 A gentleman of this city, a Mr. C, about 
 sixty years old, was unable to lie down for nearly 
 
 American Med. ami Philo?. Register, Vol. 3. 
 
28 
 
 three months, owing to the accumulation of wa- 
 ter in his chest, attended with cough, laborious 
 respiration, and diminished secretion of urine, ac- 
 companied at the game time with a degree of 
 anasarcous swelling of the lower extremities: 
 but by means of repeated bleeding, and the com- 
 bination of calomel and squills, the symptoms 
 above mentioned totally disappeared ; and by 
 the subsequent use of tonics, he so far recover- 
 ed his strength, as to return to his usual active 
 occupation. 
 
 In another case, in Dr. Hosack's practice, 
 a patient in his seventy-seventh year, of a 
 plethoric habit of body, was attacked both 
 with ascites and anasarca combined, attended 
 with all the characteristic symptoms of those dis- 
 eases. As these were induced from the want of 
 exercise, the patient at the same time taking his 
 customary food and stimulating drinks, the de- 
 pleting treatment was deemed expedient. Four- 
 teen ounces of blood were accordingly taken 
 from the arm, followed with repeated doses of 
 rhubarb and the sulphate of potash. During 
 the use of these remedies, his usual drink, which 
 
29 
 
 consisted of spirits or brandy and water, as well 
 as the use of animal food, was continued, but 
 in less quantity than ordinary. The tumor of 
 the belly, and swelling of the extremities, were 
 sensibly diminished by the evacuations procured, 
 and by the subsequent use of chalybeates, and 
 other tonics, his health was perfectly re-establish- 
 ed.* 
 
 Having endeavoured to show that the diseases 
 which have been mentioned, arise frequently 
 from a plethoric state of the system, and that 
 plethora exists, particularly in old age 5 ,' I shall 
 now endeavour to prove, that paralysis, which is 
 generally considered as a disease of debility, also 
 frequently arises from the same causes as the 
 other diseases I have mentioned, and requires 
 the same treatment. 
 
 Palsy is a disease occurring at every period 
 of life, in the young and in the aged, but more 
 generally in the latter, and is divided into three 
 kind?: I. Hemiplegia, where the whole of the 
 muscles on one side of the bodv are afFeeted. 
 
 * H<.- *< k's Quarterly Report of the Diseases of the city 
 of New- York, In American Med. and PhiloB. Register, vol. 8. 
 
 4 
 
36 
 
 2. Paraplegia, where the lower half of the 
 body only is affected. 
 
 3, Partialis, which usually affects the head 
 and extremities, but is exclusively confined to no 
 particular part. 
 
 With respect to paralysis, produced by the 
 poison of mercury, lead, and arsenic, by pressure 
 on the nerves, by tumors, by distortions of the 
 spine, by the " thickening of the ligaments that 
 connect the vertebrae together," by fractures 
 and wounds, we shall make no observations. Our 
 remarks will be confined more particularly to 
 that kind which arises from plethora of the 
 blood vessels, adding, at the same time, a few on 
 that species which proceeds from debility. 
 
 Plethora producing palsy, arises from a va- 
 riety of causes. In young persons of the san- 
 guine temperament, where there is generally a 
 large quantity of circulating fluids, the attack 
 is frequent. In old age, those usually are the 
 subjects of it who are fat, who indulge much in 
 the use of animal food and stimulating drinks, 
 and who are inactive in consequence of the tor- 
 por which arises from the surcharged state of 
 
31 
 
 their blood vessels ; this surcharged state causing 
 such pressure as to destroy the action of the 
 nerves, and produce paralysis. That this pres- 
 sure does exist, the symptoms preceding an at- 
 tack of palsy clearly manifest: these are numb- 
 ness, coldness, sensations of tingling in the extre- 
 mities, or of deadness in the flesh, numbness and 
 vertigo, the last being much increased by stoop- 
 ing; a derangement of the faculties of the mind, 
 memory, imagination, and judgment; a depriva- 
 tion of feelings, to such a degree, as to render 
 the patient insensible to the impression of exter- 
 nal bodies ; weakness, and disinclination to mo- 
 tion ; a sense of stricture under the clavicles ; 
 loss of speech, hearing, seeing, and the other 
 symptoms which we before mentioned. 
 
 The resemblance between apoplexy and palsy 
 is so great, that these diseases have been classed 
 under the same head. Aret^eus observes, " Apo- 
 plexia paraplegia, paresis, paralysis omnia gene- 
 r t eadem sunt, aut enim motionis, nut tactus, aut 
 utriusque, defectus est."* Van Swieten has 
 
 !»<• c;t\jih et signis Morb. duituni. lib. 1. cap. 2. p. 33. 
 
32 
 
 likewise observed, that " as an apoplexy is a ces- 
 sation of all voluntary motion, it may be consi- 
 dered as a kind of general palsy."* They pro- 
 ceed from the same cause, are usually confined 
 to the same period of life, are preceded by the 
 same symptoms, and affect the same constitu- 
 tions : " Hemiplegia," says Cltllen, " usually be- 
 gins with, or follows a paroxysm of apoplexy; 
 and when the hemiplegia, after subsisting for 
 some time becomes fatal, it is commonly by 
 passing again into a state of apoplexy."t 
 
 From this great similarity between the two 
 diseases, occasional remarks will be made on 
 apoplexy, and should any particular causes of 
 the latter be mentioned, they are to be consider- 
 ed as applicable to palsy. 
 
 Palsy often arises from the suppression of ac- 
 customed discharges. The case of apoplexy 
 which was formerly mentioned, arose from an 
 accustomed hemorrhoidal discharge being stop- 
 ped. Eoerhaave observes, that " a palsy may 
 
 * Comment, on 1059. Aph. of Boerhaave. 
 f Cuuuen's First Lines. 
 
33 
 
 have for its cause an apoplexy, a retention of the 
 hemorrhoids, and menstrua;"* and it is not an 
 uncommon occurrence for this disorder to super- 
 vene, when long continued ulcers are dried up ; 
 when the system, from being deprived of its cus- 
 tomary discharges, becomes plethoric. A very 
 valuable life was not long since lost by the im- 
 prudent stoppage of a discharge from an ulcer 
 which had existed for many years, f Facts of 
 this kind have long since been noticed ; and it 
 has been recommended as a preventive, very pro- 
 perly, to substitute a discharge elsewhere. 
 
 Eruptive diseases often occur at the decline 
 of life, under a variety of circumstances: they 
 are affections which we cannot repel with impu- 
 nity, as they frequently are connected with a 
 plethoric state of the system. 
 
 The celebrated Dr. Lettsom supposes that 
 even as simple a disease as "the prurigo podicis, 
 may be considered as a preventive of other 
 diseases, having observed man) persons after va- 
 rious long indispositions relieved by its appear- 
 
 *Aph. 1060. 
 
 } MS. Notes on Hosack'b Lecture*. 
 
34 
 
 ance ;" doubtless by removing the plethora which 
 existed. " A gentleman sixty-eight years of age," 
 he observes, " who had long laboured under a 
 disorder of the chest, attended with a weak and 
 intermitting pulse, was perfectly relieved from 
 these symptoms by the prurigo podicis. A fa- 
 vourable termination of the same kind happened 
 in the case of a person who had been for upwards 
 of three months affected with vertigo, and other 
 strong symptoms of approaching apoplexy." He 
 relates the case of "another patient who was re- 
 lieved in the same manner, after having been 
 much debilitated by frequent fits of the gout ; 
 but imprudently endeavouring to allay the 
 troublesome sensation of itching, by a strong sa- 
 turnine solution ; he, after having applied it a 
 few days, suddenly expired in his chair."* 
 
 Women, after the cessation of the menses, are 
 liable to be affected with a species of prurigo, 
 more especially in summer or autumn. " The 
 skin between the nates is rough, papulated, and 
 
 * Vide Memoirs of the Med. Society of London, vol. 5. 
 Also, Willan on Cutaneous Diseases, p. 92. 
 5 
 
35 
 
 sometimes scaly. With this complaint there 
 is often an itching papulous eruption on the neck, 
 breast, and back, a swelling and inflammation of 
 the ears, with a discharge of matter from behind 
 them, and from the external meatus auditori- 
 us." By repelling such eruptions the greatest 
 danger is incurred of producing apoplexy, palsy, 
 and other diseases, as they generally, though not 
 always, arise from a plethoric state of the sys- 
 tem, and are efforts of nature to relieve herself. 
 When we recollect that fatal consequences, pal- 
 sies, severe head-achs, loss of sight, and epileptic 
 fits, have proceeded from the removal of that 
 cutaneous inflammation which so often affects 
 the face, we should be extremely cautious in re- 
 moving those of greater magnitude, unless we 
 substitute a discharge in some other part of the 
 body, as an outlet to the superfluous mass of 
 fluids. 
 
 Palsy sometimes comes on instantaneously, 
 without any previous warning, and deprives the 
 patient of motion and sensation. At other times 
 
 ' Wili an ou Culaneous Diseases. 
 
36 
 
 it is preceded by those general sympsorns of ful- 
 ness which have already been mentioned. When 
 the head is much affected, the eye and mouth 
 are drawn to one side, the memory and judg- 
 ment are impaired, and the speech is difficult 
 and indistinct. 
 
 When a person is first attacked with palsy we 
 must have immediate recourse to blood letting, 
 if the disease has not been preceded by great 
 debility, proportioning the discharge to the 
 age, sex, habit, and temperament of the patient. 
 The large evacuations to which some have re- 
 course in apoplexy,* are equally improper here ; 
 for it should be remembered that the vessels are 
 already weakened, torpid, and paralysed, from 
 over distention, and that by subtracting too large 
 
 * In apoplexy we are directed to bleed ad deliquium ; but 
 it should be remembered that the brain has not the control 
 of its vessels. There appears to be an extraordinary dila- 
 tation of the arteries, which large blood letting does riot often 
 diminish, as experience proves ; for after bleeding to the ut- 
 most extent, the pulse has remained full. " Even in the most 
 athletic habits, such sudden evacuations and consequent pros- 
 tration of power of life, cannot be justified by reasoning or 
 practice" 
 
37 
 
 a quantity of blood, they are left in such a state 
 of collapse and inaction, that recovery after- 
 wards is frequently impossible.* 
 
 The pulse in this disease is sometimes per- 
 fectly natural, sometimes full, frequent, and jerk- 
 ing, without tension. In either case we are to 
 bleed freely. 
 
 Dr. Thomas, in his chapter on this disease, 
 condemns the use of the lancet in the strongest 
 terms in advanced life, confining it exclusively 
 to the young and plethoric: " When this dis- 
 eased he observes, " arises in a young person of 
 a plethoric habit, comes on suddenly, and the 
 head appears to be much affected, or seems to 
 arise from the causes producing apoplexy, it will 
 be advisable to take away some blood; but in 
 old age neither bleeding nor purging should be 
 
 * The same observation may be made respecting blood- 
 letting during pregnancy, when abortion is threatened. By 
 taking away a sufficient quantity to remove the oppressed 
 state of vascular action, when plethora is present, our at- 
 tempts to prevent abortion will be frequently successful : but 
 by bleeding Immoderately, such B degree of relaxation ia 
 produced, thnt \vc effect the very object dreaded. 
 
 5 
 
38 
 
 resorted to. Where costiveness prevails in such 
 habits, it may be avoided by some stomachic laxa- 
 tive, such as the tinctura rhabarb. composita."* 
 Even if it were allowed that blood letting was 
 generally improper in the paralysis of advanced 
 life, we ought by no means to proscribe it alto- 
 gether, as cases occur where fatal consequences 
 may immediately result from neglecting to have 
 recourse to it. Should we follow the above di- 
 rections, though the vessels be overloaded with 
 blood, though the symptoms be such as to pre- 
 dict a state of apoplexy, we are not to bleed; 
 but resort to stimulants which are calculated to 
 replete the vessels still more, and to add greatly 
 to the disease. 
 
 It is to be regretted that the science of medi- 
 cine, which, next to religion, is the noblest, and 
 most calculated to benefit mankind, should ever 
 be disgraced by the spirit of dogmatism, and es- 
 pecially where there is no reasonable ground 
 upon which it may be justified. Experience has 
 proved that blood letting in old age is not only 
 useful, but absolutely necessary ; and the dread- 
 
 * Modern Practice of Physic. 
 
39 
 
 ful consequences we have witnessed from the 
 neglect of it, have made an impression upon our 
 minds, which the unwarranted assertions of a 
 few individuals can never efface. 
 
 On the first attack of paralysis, as has been 
 before said, we should resort to blood letting. 
 This practice has been sanctioned by the respec- 
 table authority of Hunter, who remarks, that 
 in palsy " we ought to bleed at once very 
 largely, till the patient begins to show signs of 
 recovery, and to continue it till he might begin 
 to become faintish."* That this evacuation is 
 serviceable, is proved by the manner in which 
 nature sometimes cures the disease, which is by 
 discharges from the bowels. Dr. Thomas himself 
 lias observed that it is sometimes cured by a diarr- 
 hoea; Boerhaave, that nature has cured the dis- 
 ease by carrying it off by a plentiful and long- 
 continued diarrhoea; and Van Swieten, that, a 
 plentiful, and long-continued diarrhoea carries 
 offthe " morbific matter."t From the salutary ef- 
 
 St<- Treatise on the Blood, pari 2. r.hap. I. 
 f Commentaries on Bokuhaave. 
 
40 
 
 forts of nature, important instruction is to be ob- 
 tained, as they teach us to imitate her opera- 
 tions. Van Swieten has observed " that physic 
 is never of greater service to mankind, than when 
 it can follow the footsteps of nature in the cure 
 of diseases:" and, again, "it has frequently been 
 remarked before, in describing the cure of dis- 
 eases, that prudent physicians ought to consider, 
 with the greatest attention possible, those salu- 
 tary attempts of nature, by which the most ob- 
 stinate diseases are sometimes cured ; and these 
 being observed and understood, they ought to 
 attempt to imitate by art those things which, 
 happening spontaneously, they observe to be of 
 service." 
 
 As palsy is a disease so alarming in its conse- 
 quences, it is of the utmost importance to pre- 
 vent it, if possible, whenever the premonitory 
 symptoms point out its approach. These, it 
 may be repeated, are numbness of the extremi- 
 ties, vertigo, affections of the mind, fyc. " Ob- 
 servavi in pluribus," says Willis, " quod cum 
 cerebro primum indisposito mentis hebetudine, 
 et oblivione, et deinde stupiditate et ,««§»«■« affice- 
 
41 
 
 rentur postea in paralysin, (quod etiam praedi- 
 cere solebam) incidebant."* Even the numb- 
 ness of one of the fingers points out an attack. 
 Dr. Hosack relates the case of a lady who was 
 affected with this partial paralysis, while at her 
 piano, and first became sensible of it by an ina- 
 bility to use her finger. Had she not been bled, 
 in all probability it would have terminated 
 either in complete paralysis, or in the loss of the 
 functions of the part. 
 
 In all such cases, by the prudent use of the 
 lancet, we may generally prevent the disease; 
 and experience having proved its utility, we 
 have no hesitation in recommending it. 
 
 The following cases, selected from many 
 others of a similar kind, as they tend to esta- 
 blish the correctness of the doctrines advanced, 
 and are immediately in point, it may not be 
 amiss to insert. 
 
 De Paralysi, p. 145. 
 
42 
 
 I. 
 
 Edward Swain, aged seventy-four, of the 
 phlegmatic temperament, was, some time since, 
 attacked with fever, accompanied with pain, 
 for which he was bled six times After having 
 recovered he came into the Aims-House, where 
 he had a renewal of his fever, and was again re- 
 peatedly bled. Some time afterwards he felt a 
 numbness in his left side, extending down to his 
 ankle, with dizziness and vertigo in his head, 
 accompanied with the loss of smelling and taste. 
 His taste was so much impaired that, to use his 
 own expression, he " could not tell a tablespoon 
 of salt from one of sugar." His complaint caused 
 him frequently to fall. He was on the stimu- 
 lating treatment when he came under my care; 
 from which receiving no benefit, he was bled 
 twenty ounces, and was cured of the dizziness 
 and numbness in his head. Not receiving reliei 
 for the numbness in his extremity, the carb. 
 ammon. and other stimulants, both externally 
 and internally, were resorted to. He has since 
 
 recovered so far as to leave the house. 
 5 
 
43 
 
 II. 
 
 Joseph Miller, aged seventy-three, feels con- 
 siderable numbness in his head, and is unable 
 to articulate distinctly, is feeble, and cannot walk 
 as well as usual. His mind appears to partake 
 of the diseased condition of the body, being in- 
 capacitated to perform its proper functions. Let 
 him be bled. Bleeding has entirely relieved him, 
 and he is as well as formerly. 
 
 III. 
 
 C. Williams, aged forty-eight, has felt a ge- 
 neral numbness for some time past, which he 
 attributes to his having caught cold. The phy- 
 sician, whom he consulted, notwithstanding he 
 was afflicted with the sick headach, was flighty, 
 and sometimes in danger of falling when not sup- 
 ported, condemned the lancet in the strongest 
 terms, asserting that he had no blood to lose ; 
 that he rather wanted blood than otherwise. He 
 came into the Aims-House with diarrhoea. 
 
44 
 
 (caused, in all probability, by plethora,) and was 
 prescribed for with little benefit. Complaining 
 of numbness, and a sense of deadness in his flesh, 
 I proposed blood letting, to which he assented. 
 Next morning, to use his own expression, "he 
 felt like another man ;" his numbness being com- 
 pletely removed. The diarrhoea was soon cured, 
 
 IV. 
 
 Ann Horneke, aged thirty-four, has laboured 
 under a discharge from her bowels for several 
 weeks, and taken various remedies without ef- 
 fect. She complains of vertiginous affection of 
 the head, numbness of the arms and feet, with an 
 oppressive weight about her breast, palpitation, 
 fluttering, and such a degree of weakness as to 
 be unable to walk. She was bled freely, which 
 proved of material service, as it considerably re- 
 moved her weakness, doubtless by removing that 
 oppressed state of action, from the relaxed con- 
 dition of the system which existed, and restoring 
 the equilibrium between the solids and fluids. 
 Soon afterwards, again feeling numbness, blood 
 
45 
 
 letting was resorted to with advantage, and she 
 soon recovered.* 
 
 The same principles which direct us in our re- 
 course to blood letting, lead also to the adminis- 
 tration of purgatives : even in the most debilitat- 
 ed habits, the bowels must always be kept open. 
 Boerhaave laid particular stress upon purging, 
 doubtless being led to it, by observing the man- 
 ner in which nature sometimes carried off the dis- 
 ease ; and experience must have proved to him, 
 during his extensive practice, that they were 
 among the most valuable remedies. He recom- 
 mends the strong hydragogue purges in large 
 doses, and repeated several times successively ; 
 by means of which a plentiful and lasting diar- 
 
 * Sometimes blood letting will not permanently relieve 
 the numbness and fulness in the head, which are among the 
 worst of the premonitory symptoms of palsy. In 9uch 
 eases we should endeavour to make a determination else- 
 (There, by the constant exhibition of purgative medicines, 
 and if piles can be produced, in all probability, relief 
 will be obtained. Blisters should be applied behind the 
 in tin- arms, for the latne purpose 
 
46 
 
 rhoea may be produced.* In what cases they 
 may be given to the extent here recommended* 
 the physician's judgment must direct; certain 
 it is, that in many habits they will prove valua- 
 ble auxiliaries to the lancet, in promoting the 
 cure.t 
 
 But the remedy vastly superior to all others 
 after blood letting, is friction. The utility of fric- 
 tion has long since been noticed, and certainly it 
 is the most powerful restorative of that action to 
 the nerves, which was lost by the over-distention 
 and plethora of the blood vessels. The good 
 effects of this remedy were noticed particularly 
 by Celsus, who observes that when a limb has 
 become paralytic, it is strengthened by friction,^ 
 and even when the limb is wasted, it will be 
 good'ad alendum id, quod tenue et infirmum 
 
 est."§ 
 
 — — — i .... . f . . 
 
 * Aphorism, 1068. 
 
 f A valuable paper by Dr. Sherrill, on the efficacy of 
 blood letting and cathartics in this disease, may be found iu 
 the 14th volume of the Medical Repository, p. 35. 
 
 J Membrum aliquod resolutum, ipsius frictione confirms* 
 tur. Lib. 2. cap. 14. 
 
 ft Lib. 2. cap. 14, 
 
47 
 
 Notwithstanding friction was strongly re- 
 commended, it never has been employed with 
 the assiduity and attention required. Its suc- 
 cess is in proportion to its early use, and by 
 immediate recourse to it, our exertions, if suffi- 
 ciently long persisted in, will almost invariably 
 terminate in the restoration of the parts to which 
 it is applied. It was remarked to me by a gen- 
 tleman, who resided some length of time in the 
 Aims-House in this city, that with the exception 
 of one, all the cases of paralysis occurring to him, 
 while there, were effectually cured by this re- 
 medy ; and of these there were only two who 
 were not restored in the space of two hours. In 
 many of these the cure was perfected without 
 recourse to the lancet. 
 
 Various external applications have been re- 
 commended for the purpose of restoring para- 
 lytic parts. Celsus ordered, in addition to fric- 
 tion, fretting the skin, or whipping it with net- 
 tles* the application of mustard seed,* and resin- 
 
 * Prodest etiain torpentis membri summam cutem exas- 
 pcrasse, vel urticis cttsam, vcl imposito sinapi, sic ut, ubi 
 rubere cceperit corpus ba:c removeantur. Lib. 3. c.ip. 27 
 
ous plasters. Galen made use of pricking for 
 the purpose of attracting the blood in greater 
 quantity to the part. # For the same purpose 
 the e^ot/sw, or beating, was used, this being per- 
 formed by small light rods, well oiled, with 
 which they beat the wasted part, till it began to 
 grow red and swell. But the most powerful 
 remedy made use of was the whipping with net- 
 tles, by which palsy was sometimes suddenly 
 and perfectly cured. Alpinus affirms that the 
 Egyptians had even attempted the cure of apo- 
 plexy, palsy, and epilepsy, successfully by burn- 
 ing.? 
 
 From these different remedies which have 
 been mentioned, we may conclude the utility of 
 stimulants to paralyzed parts ; but it is not ne- 
 cessary to have recourse to a great variety. 
 The flesh-brush, occasionally impregnated with 
 aq. ammoniae. flowers of mustard, or cowage 3 
 will answer the purpose. 
 
 * Method. Medendi, lib. 14. cap. 16. 
 f Med. Egyptior. lib. 3. cap. 12. 
 
49 
 
 The friction must steadily be persisted in, un- 
 til we can perceive its good effects, and for this 
 purpose a number of assistants should be present 
 to relieve each other, whose efforts are to be con- 
 tinued, notwithstanding they may create such 
 pain to the patient, that humanity would in- 
 cline us to desist. The pain of a few hours is more 
 than counterbalanced by the good effects which 
 result from it; as we are enabled to rescue the 
 unhappy victim from the most abject state in 
 which human nature can exist. The deplorable 
 condition of the paralytic can be best realized 
 in those public charities, where they are usually 
 to be met with in great numbers, and where 
 they are doomed to drag out their lives, not 
 only with the loss of the functions of the body, 
 but frequently with derangement of the faculties 
 of the mind. 
 
 The following case, which was furnished me 
 by my friend, Dr. Schenck, points out the utility 
 of friction, and the surprising manner in which 
 paralytic parts have their action restored by 
 this remedy. 
 
 " JBktfky Lawrence, aged twenty-two, was at- 
 
50 
 
 tacked with hemiplegia. After blood letting, 
 frictions were resorted to, by means of a stiff 
 brush applied to the affected parts, and in one 
 hour the parts on which the frictions were dili- 
 gently employed, were restored. At first her 
 sensibility was so far lost, that the prick of a pin 
 excited no sensation whatever. In fifteen mi- 
 nutes after the brushes were applied, she com- 
 plained of pain in her arm, and requested us to 
 desist, as it became intolerable. She could then 
 raise to her head that arm which before hung 
 motionless by her side. Her fingers, and espe- 
 cially the extremities of them, still remained in- 
 sensible, which, however, were restored by a few 
 vigorous applications of the brush. In the same 
 manner her lower extremity was recovered ; but 
 not so quickly, as from motives of delicacy, she 
 would not permit the frictions to be employed 
 by her male attendants, and their continuance 
 devolving upon the females, they did not employ 
 them with as much diligence and assiduity as the 
 case required. A blister was afterwards ap- 
 plied to the wrist and another to the ankle, to 
 
51 
 
 keep up the irritation. She has since remained 
 entirely free from any paralytic affection." 
 
 If our endeavours to restore patients by these 
 means prove unsuccessful, we are by no means 
 to conclude their condition hopeless. On the 
 contrary, it will be proper to keep up a constant 
 excitement both by the internal and external use 
 of stimulants. The internal, most generally in 
 use, are mustard seed, horse radish, ammonia, 
 and others of this kind. The volatile tincture 
 of guaiac has been attended with great advan- 
 tage in the practice of Dr. Hosack. The exter- 
 nal are horse radish, mustard,* garlic, blisters, 
 Indication, electricity, (the latter being some- 
 times of material service, and frequently attend- 
 ed with very happy effects,) galvanism, and fric- 
 tion, with different stimulating liniments, all of 
 
 ' The external application of mustard seems calculated to 
 do much good,aa it makes a very powerful impression upon 
 the sy.:4cm, and creates even a much greater degree of imi- 
 tation than Miatera. See Jackson's Dissertation on Exter- 
 nal Applications, in Caldwell's Collection. 
 
52 
 
 which are to be had recourse to at different 
 times, when one or the other fails. 
 
 The operation of internal stimulants upon the 
 system is to be carefully watched, and occasion- 
 ally the lancet interposed in some habits, where 
 there is a great disposition to the regeneration 
 of plethora, and where the symptoms of it are 
 manifested, otherwise they will produce the very 
 object they were intended to obviate. 
 
 Warm bathing is often an important auxiliary 
 in the cure of paralysis ; but the indiscriminate 
 use of it is altogether unjustifiable. When the 
 disease proceeds from a plethoric state of the 
 system, or has the marks of plethora without 
 previous blood letting, it is calculated to do 
 much injury by the expansion which it necessa- 
 rily must produce. Its principal use appears 
 to be in cases from worn-out excitement, as 
 sometimes occurs in the advanced stages of dis- 
 ease : but it should never be used without the 
 addition of brandy, aq. ammonia?, or some other 
 strong stimulant. The cold bath in some cases 
 where it can be borne, is very useful, as by its 
 
53 
 
 stimulating effects it imparts tone to the system, 
 and thus removes the disease. 
 
 Diaphoretics form a valuable class of reme- 
 dies, and may be administered with the greatest 
 benefit in every stage of the disease ; but differ- 
 ent kinds must be used according to the cause of 
 the complaint. 
 
 Exercise is a very important remedy, and where 
 it is not altogether impracticable, it should 
 never be neglected. Nothing is calculated to 
 restore lost action to paralyiiic parts sooner ; as, 
 in addition to the good effects of motion, per- 
 spiration is constantly kept up by the excretory 
 vessels being kept in a pervious state. Flannel 
 should always be worn next the skin. 
 
 In palsy of long standing, the occasional use 
 of blood letting, when the symptoms of plethora 
 exist, will be absolutely necessary. By neglect- 
 ing it the patient will be threatened with the most 
 imminent danger of being carried off by an apo- 
 plexy, or complete palsy. A case of hemiplegia, 
 of several years continuance, was under my care 
 some time since, where Hie overloaded state of 
 
 Mi'- blood vessels was manifested hv numbness 
 
 7 
 
54 
 
 oppression at the breast, and languor of the in- 
 tellectual powers: by blood letting, the patient 
 was completely relieved. Had I improperly 
 had recourse to stimulants in this case, in all pro- 
 bability, fatal consequences would have been 
 produced. 
 
 Palsy from debility, seldom or never occurs 
 in persons in good health, no matter at what age 
 it takes place: it generally arises in the ad- 
 vanced stages of disease, when the excitement of 
 the system has been worn out, and usually ap- 
 pears in the form of partial paralysis. It also 
 may occur in persons not, affected with a ful- 
 ness of the vessels, who are weak and languid, 
 and whose digestive powers are impaired, in 
 whom blood letting might be productive of 
 injury. In these cases, by restoring tone to 
 the system by means of nourishing diet, wine, 
 porter, iron, and other tonics, the disease may be 
 permanently cured. 
 
 It remains, lastly, to make a few observations 
 on the partial palsies, which are usually con- 
 fined to the head and extremities. We will, 
 however, mention those only affect ing the optic 
 
55 
 
 and auditory nerves, both of which are sometimes 
 produced by plethora. The first is divided into 
 two kinds, which are differently named accord- 
 ing to the degrees of blindness produced. When 
 there is a diminution, or total loss of sight, the 
 disease is called amaurosis; and when the pow- 
 ers of vision are merely deficient at night, it is 
 called nyctalopia. That plethora produces this 
 disease, it is reasonable to suppose from the 
 anatomy of the parts involved in the affection. 
 
 The only difference between amaurosis and 
 nyctalopia appears, at least in many instances, 
 to be in the degree of plethora which exists : 
 in the former it is so great as completely to 
 paralyze the nerve, and render it insensible to 
 any impression; and in the latter, being so light 
 as not to impair vision during the day, in con- 
 sequence of the stimulus of light, more than 
 counterbalancing the effects produced by the 
 compression; but at night this stimulus being, 
 in a great measure, withdrawn, and what little 
 there is being disproportioned to the pressure, 
 
 i< ii '■, I >tally obscured. 
 
 The treatment "f these two diseases, when 
 
56 
 
 arising from plethora, consist in blood letting* 
 blistering, purging, small alterative doses of mer- 
 cury, &c. In the second stage, stimulants, both 
 general and local, will be absolutely necessary, 
 Mr. Ware mentions the Cayenne pepper as $ 
 powerful stimulant in such cases. 
 
 The following case points out the utility of 
 blood letting in nyctalopia. 
 
 Betsey Bowers, aged thirty-four, had nycta- 
 lopia for some time, in consequence, no doubts 
 of the retention of her menstrual discharge, as ; 
 she was not afflicted in this manner before. 
 Being of a delicate habit of body, and her 
 pulse natural, there were apparently no symp- 
 toms which called for the lancet; but supposing 
 her loss of sight to arise from pressure on the 
 nerve, in consequence of the plethora of the 
 vessels of the part, I bled her largely, and ap- 
 plied blisters behind her ears. From this 
 treatment she received signal relief, as vi- 
 sion at night began to be more distinct. She 
 continued to see alternately better and worse s 
 but relapsing entirely, or nearly so, she was 
 again bled. The relaxation produced by the 
 
57 
 
 blood letting, brought on a profuse flow of her 
 menses, and after this evacuation, she could see 
 as well as previously to her attack. This affec- 
 tion of her vision continued nearly four weeks, 
 when she again relapsed ; but on the re-appear- 
 ance of her menses, her sight was again restored, 
 and has since remained good. 
 
 This practice does not accord with the recom- 
 mendation of Dr. Thomas. "Evacuation," he 
 observes, " both by bleeding and purging, has 
 been recommended by such writers as have ta- 
 ken notice of this disorder; but as it is suppos- 
 ed to depend upon a relaxed state of the optic 
 nerves, or retina, these remedies appear to be im- 
 proper, and those we employ ought to be 
 such as will strengthen the tone of the parts." 
 That it may sometimes depend upon the relax- 
 ed state of the nerve, upon pressure by tumours, 
 and the like, we will not deny; but that pletho- 
 ra is sometimes the cause, the above-mentioned 
 pase proves. 
 
 Palsy of the auditory nerve also arises from 
 plethora, as is proved by the following case : 
 Jam: IV.a.mk, aged forty-six, of the nervous 
 
58 
 
 temperament, was, on the fourth of February 
 last, attacked with numbness of half the body. 
 She was unable to raise the affected arm to the 
 top of her head, and was totally deprived of the 
 sense of hearing on that side. In this way she 
 continued until the eighth, when consenting- to 
 be bled, I took away a large quantity, and be- 
 fore the orifice was closed, her hearing was per- 
 fectly restored. Her numbness and coldness, 
 which existed without relief from warm applica- 
 tions, were soon completely cured, and she has 
 since remained well. 
 
 Having finished our observations on the dis- 
 eases of old age, as connected with a plethoric 
 State of the system, it remains only to make a few 
 remarks on the means of preventing this plethora, 
 as there are few states of the system in which 
 irritability is so troublesome. "Plethora oc- 
 curs chiefly in the luxurious female whose pam- 
 pered appetite prepares a superabundance of 
 blood, whose distensiie vessels yield with little 
 resistance, and whose secretions from inactivity 
 are slow and inconsiderable. The lax habits, 
 which in weak resistance approach the female, 
 
59 
 
 equally suffer, and the phlegmatic temperaments 
 are also over w helmed by a load of fluids."* The 
 pulse frequently gives an imperfect idea of the 
 cause. It is often apparently weak; but by hav- 
 ing recourse to the method recommended by 
 Mr. Brom field, as before mentioned, we may 
 frequently detect it. When this fails, our opi- 
 nion is to be formed from other circumstance's. 
 "To relieve plethora," the learned Dr. Parr 
 observes, "is very difficult; bleeding, some- 
 limes attended with a little temporary relief, is 
 occasionally followed by fainting; and after a 
 little time the former fulness, and the debililv 
 with the irritability are increased. Evacuations 
 by stool, and a more feeble diet occasion faint- 
 ness, and exercise produces great fatigue. No 
 other plans, however, will succeed, and each must 
 be used in such a gradual guarded manner, as to 
 prevent uneasiness. At first a meal may be lea- 
 ned, soon after abridged. A feeble diet, fee- 
 ble in ii- alimentary powers, must be slowly sub- 
 Lituted; and Lhe exercise, at firs! in a carriage. 
 
 • 
 
60 
 
 must afterwards be supplied by the horse. After" 
 the vessels have been in part emptied in this way, 
 tonics, or the cold bath may be safely used." 
 
 I shall conclude by again adverting to the 
 propriety, utility, and absolute necessity of blood 
 letting in the diseases of advanced life when con- 
 nected with plethora. Experience has again and 
 again taught us, that numerous diseases of this 
 period of life are relieved by it, and therefore 
 we have no hesitation in recommending it. 
 "I have nothing to say upon the diseases of 
 old people," says Dr. Rush, " but what is to be 
 found in most, of our books of medicine, except 
 to recommend bleeding in those of them which 
 are attended with plethora, and an inflammatory 
 action in the pulse. 5 ' " Experience proves it to 
 be more necessary under equal circumstances 
 in that stage of life than in any other."* 
 
 * For some very valuable remarks on the plethora of ad- 
 vanced life the excellent Inaugural Dissertation of Dr. Dyck- 
 man, on the Human Fluids, may be consulted with advantage; 
 
 FINIS, 
 
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