Medical advice to the consumptive and asthmatic people of England
Stern, Philip
1 UPWik g~~lglij jfgjrc ’'^J7j8 jT/ ■* W&£Sp*l tigS/^jr M» M'jfly l|^® *\ ^ y W _ \j.'i •■* MmMWLl ^1 m vi& iSSnwyJb '^MK\v1 wMW//^arvV'w<^\ 1^ l!r^s^^y£w/ MiW j , J,V 8|ia\'j| Cs®jg§»*J j|Jisl •. (JljjySSH N ( v i / \ I ' l f \ \ / I < \ 'll V ') I [ \ v i i "V / \ \ I > i I ) / / \ r \ ' ) t \ *< I / i , , . 1 t ) ) Digitized by the Internet Archive in 2019 with funding from Wellcome Library \ \\ _ r i https://archive.org/details/b30504089 Consumptive and Asthmatic People of England. [Price One Shilling.] » 9 9 ^ ^ i. rr - * v L a - c ■ * - » < /■ V l f \ * ■* ■ • */•■ * <•• ( ■■. • •• • • • .. • ■ - . . • . . • i / ■ # i MEDICAL ADVICE ) TO THE Consumptive and Asthmatic People of England; WHEREIN THE PRESENT METHOD OF TREATING DISORDERS of the LUNGS IS SHEWN TO BE Futile and fundamentally wrong, AND A N e w and Easy METHOD of CURE, PROPOSED BY PHILIP STERN, M. D. ~ J'he third edition. ~ LONDON: Printed for J. Almon, oppofite Burlington Houfe, in Piccadilly. M DCC LX VII. ^ r t 3 ] <*** * ll I r i -. medical advice To the CONSUMPTIVE People of England. IF it fhould be afked, why I add refs my-* felf to the Patient, rather than to the Phyfician, I anfwer, that, having offended the Dodtor in my title-page, I prefume he will give but little attention to my reafon-* ing 5 for we liflen very unfavourably to the advice of a man who begins by afferting, that we are fundamentally wrong . But with the Patient, the cafe is different : recollect ting that confumptions, in the prefent mode of practice, are very rarely cured, he al« moft affents to the truth of my affertion, even before he has heard the arguments upon which it is founded. I fpeak, there** fore, not immediately to the Phyfician, be- caufe 1 do not like that a man fhould turn his back on me when I am talking to him. If the Dodtor chufes, whilft I am converg¬ ing with my Patient, to look another way* yet Jquint an ear to my babbling, he is very welcome ; provide he will not condemn my B pradtic^, \ [ 4 1 practice, till he hath proved its futility by experience. Now though I write not dire&Jy to Me¬ dical Gentlemen, I efteem it neverthelefs neceffary to proceed methodically, and ac¬ cordingly fhall premife as much of the ana¬ tomical and phyfiological deicription of the Jongs, as will be fufficient to enable thofe, who have not had a medical education, to comprehend my arguments. I fhall then, enquire into the predifpoiing ana immedi¬ ate caufes ot Confumptions 5 fhall indicate the fymptoms by which the patient may be certain of his diiorder, and fhall laftly proceed to confider the cure, upon rational principles. The trunk of the human body is divided, by a membrane called the diaphragm, into two diftincft cavities, the lower of which is called the ctbdowicfi , or Delly, and the up¬ per, the thorax , or cheft. The latter of thefe cavities contains the heart and the lungs. rI he lungs are divided into two principal lobes, which are inciofed in two diftinbt bags, formed by a membrane called the pleura fo that the right and left lobe of the lungs have not the leaf! communi¬ cation. The adhefion of thefe bags near the middle of the cheft, forms a perpen¬ dicular membrane called the mediajlinum ; but receding from each other as they go .lower down, they form a third bag, called the is 3 the pericardium , which contains the heart : fo that the cheft is divided into three fepa- rate cavities. The lungs are compofed of blood veffels, air veffels, lymphatic or water veffels, nerves and cellular membrane. The blood veffels are arteries and veins ; but thefe are of two diftindt kinds : the firft receive and return the whole mafs of blood, which circulates thro’ the lungs, before it is thrown into the other parts of the body, and the fecond were intended only for the fupport and nourishment of the lungs them- felves. The air veffels are infinitely fmall branches continued from the wind-pipe, with which, in a found ft ate, they have a free commu¬ nication, fo as at every infeparation to be filled with air. The lymphatic veffels are diftributed or the furface of the lungs, and convey the lymph, which they imbibe, to a certain dudt, whence it is returned to the mafs of blood. The nerves are exceeding fmall branches, which proceed chiefly from what is called the eighth pair. The cellular membrane, which fills the intermediate parts between the veffels, is compofed of fibres or lamina, which are neither vafcular, nor endowed with fenfi- The 2 The afpera-arteria , or wind-pipe, is that tube which conveys the air paffing thro' the mouth, or nofe, to and from the lungs. It is compofed of alternate cartilaginous and flefhy rings, behind which are an infi- „ nite number of fmall glands, which fup- ply the wind-pipe with a thin pellucid mu¬ cus lining its internal furface, which con-* lifts of a membrane of exquifite fenfibility. Thus much being premifed, we fhall now proceed to the office and utility of the lungs, which are neceffary to be underftood, be¬ fore we fpeak of its difeafes. The organs of refpiration are fo indif- penfably neceffary to our exiftence, it is no wonder that phyfiologifts fhould have taken uncommon pains to difcover the real defign of nature in their formation. Various have been the conjectures of authors on this fub- jedt. Some have fuppofed, that the blood in paffing thro5 the lungs acquires its red colour 5 others have been of opinion, that the intention of refpiration is to receive a certain quantity of air, which they ima¬ gined neceffary to be mixed with the vital Muid ; with many other fuppofitions equal¬ ly without foundation. That nature, by firft circulating the blood thro5 the lungs, after the reception of frefh chyle, intend fome neceffary preparation may be con¬ cluded without farther examination ; and that this preparation is effected by throw- I l 7) ing off a certain quantity of noxious mat¬ ter, imbibed by the air which is received by the lungs, feems evident from the ex¬ periments which prove, that air once fatu- rated with this noxious matter, is unfit for refpiration. The notion that animals, when confined to breathe the fame air, die be- caufe the elafticity of the air is deftroyed, is entirely without foundation ; it being very eafy to prove, that the elafticity of the air is not in the leaft diminilhed. The ufe therefore of refpiration, is to relieve the body from a certain matter, perfpirable on¬ ly from the lungs, which, if entirely re¬ tained, is incompatible with exiftance, and, when retained in part, is productive of dif- eafe. It is feparated from the blood by means of fmail dudts palling from the pul¬ monary arteries to the air veflels, where it is diffolved and carried off by the air. The exiftence of thefe dudts is eafily demonftra- ted, by injecting aim oft any liquor into the pulmonary artery, which liquor may, with¬ out much difficulty, be made thus to fill the branches of the wind-pipe. Suppofing that we are now pretty well acquainted with the fabric and office of the lungs, we may, I think, with fafety, pro¬ ceed to the more immediately objedt of our attempt. The general predifpofing caufes of a con- fumption of the lungs are to be fought for in fcarce been clofed a moment, before thd perfpirable matter, falling upon the mem¬ brane which lines the note, caufes, by its Irritation, that convulfive motion which we call Sneezing. It returns upon the glands about the wind-pipe, and ifiuing thence excites another convulfive motion, called a Cough ; which are different efforts of na¬ ture to rid herfelf of the offending caufe. In oozing down the wind-pipe, it deftroys the mucus, therefore we are hoarfe ; and by inflaming the membrane which lines the trachia , occafions that fenfation of forenefs In the breaft, which we feel in a few hours after taking cold. Thus continually def- cending, it enters the branches of air vef- fels, and diffufing itfelf to every part of the lungs, occafions the cough, which we fa eafily diftinguifh from that which proceeds from an irritation in the upper part of the wind-pipe, and which we call a tickling cough. We are not however to imagine, that this acrid lymph, which falls from above, is the foie caufe of irritation in the lungs. On the contrary, it is more probable, that they are principally offended by the acri¬ mony of that which iffues from their own peculiar glands ; for in fevere colds, that is, when the obftruffion of perfpiration is aim oft univerfal, for it is never entirely fo ; in fuch cafes, I fay, every humour in the I 9 1 body is contaminated ; and that very mucii§ which, in health, prevents irritation in the air veffels of the lungs, is now the princi¬ pal caufe. Inflammation is the natural confequence of this continued irritation, which as na¬ turally produces a fuperabundant fecretion of mucus, and which, if not conftantly fpit up, fuffbcates the patient. When thefe fymptoms are violent, the difeafe is called a peripneumony. But if this inflamma¬ tion continues beyond a certain time, the veffels are defrayed, and become diffolved in a kind of matter called pus. Thus we are arrived at the immediate, or proximate, caufe of a Confumption of the fubftance of the lungs. But here it may naturally be afked, how it happens, when a part of an organ, fo indifpenfibly neceffary to life, is deftroyed, that the pa¬ tient does not immediately die ? I anfwer, that Nature, in this inftance, has been par¬ ticularly kind to us ; for the two lobes of the lungs having no communication, are not immediately affeded by each other’s dif¬ eafe s ; befldes, every minute branch of the fame lobe is fo contrived, as to perform its office independent of the reft ; therefore every Angle veil'd continues to receive and return its portion of air, till it be adualiy deftroyed. Hence it is, that in diffeding of bodies which have died confumptive, we C * fre- I 10 ] frequently find a confiderable part of the lungs entirely deftroyed. Indeed the ap¬ pearance of the lungs in thofe who have died of this difeafe, is fo various, that tho5 it may be but of one genus, the number of fpecies are extremely numerous, if we may conclude from the diverfity of phenomena upon diftedtion. . Sometimes we find the texture of a part of the lungs entirely de¬ ftroyed, and nothing but a colleftion of purulent matter in its place, communicat¬ ing with the wind-pipe, fo as to fill it on laying the head downward. At other times, we difcover a quantity of matter inclofed in a kind of bag. Sometimes this matter is contained in a number of fmall follicles, and at others, it may be fqueezed from every part, and the texture of the lungs but little injured. In lbme cafes, we find a num¬ ber of fmall hard lumps ; in others, large indurations, and fometimes tumours that are abfolutdy cancerous. In fhort, as I have before obferved, the variety of ap¬ pearances is infinite, efpecially if we in¬ clude colour. However, notwithftanding this great di¬ verfity, the proximate caufe of that fpecies of Confumption which is fo frequent, and fo fatal, in this kingdom, is an ulcer in the lungs, in confequence of inflammation, oc- cafioned by a cold, or, in other words, by a greater flux of acrid perfpirabie matter to the I r n ] the lungs, than can be abforbed and car¬ ried off by the air. It is alfo poffible, that a part of this matter may be confined near the extremities of the air veffels, by a fpaf- modic conftridion in the upper part, occa- iioned by the fudden ad million of cold air. When this is the cafe, an inclofed ulcer, or vomica, is the confequence. Having proceeded thus far in the confi- deration of our fubjed, and, I think, with¬ out draining our text, we are now naturally led from the caufe, to the cure of our dif- eafe. And firft it may not be amifs to en¬ quire a little into the foundation of the ge¬ neral pradice. The firft thought, which naturally oc¬ curs, is, that this general pradice is gene¬ rally unfuccefsful ; and we thence as natu¬ rally conclude, that it muft be fundamen¬ tally wrong. If the inflammation be violent, compar¬ ing it with inflammations in other parts of the body, and reafoning from analogy, the firft thing we do is to bleed, and fo far we are right, as by leffening the quantity of blood, we leffen the impetus of the remain¬ ing part, and thereby retard the progrefs of the difeafe for a time ; but alas ! the time is very fhort. The pulfe foon recovers its velocity and ftrength. Well ; but then we adminifter a quantity of faccharine, oily and mucilaginous medicines, in the form C a of t 12 1 of an emulfion, or otherwife, intending, no doubt, thereby to flieathe and obtund the acrimony which caufes the irritation in the lungs. The intention is certainly lau¬ dable ; but it happens unfortunately that thefe balfamics go down, not into the lungs, but into the ftomach, where they imme¬ diately undergo fuch a change, as to carry but little of their balfamic qualities even a into the intefti-nes, where they are hill far¬ ther mixed and adulterated, particularly by the addition of a certain quantity of bile, immediately on quitting the ftomach. But to proceed. Let us fuppofe thefe demulcents already in the inteftines. What becomes of them ? They niuft either be received by the ladteal vefiels, or pafs off per anmn ; the latter of which is the way chofen by the greateft part of them, con¬ trary to the intention of the phyfician. Happily for mankind, thefe- ladteal vefiels are endowed with a kind of 'mechanical fagacity, which enables them to felect from that heterogeneous niafs of food and medi¬ cines, conftantly prefented to them by the ftomach, fuch matter only, under the de¬ nomination of chyle, as is lit to be afiimu* lated with the blood. Here I {hall be interrupted with an ob¬ jection, that the ladteals are capable of ad¬ mitting {foifonous matter, and conveying it to the heart, to the immediate deftrudtion of [ i3 1 *, _ j- . V of the body. To this objection (having firft hinted, that moft poifons are deft mo¬ tive from their immediate addon on the nerves in the ftomach) 1 anfwer, that Na¬ ture adts, not by partial, but by general laws. Thofe who are incapable of apply¬ ing this argument, deferve no other reply. Let us now fuppofe, that a fmall portion of our balfamics has gained admittance through the mouths of the ladleals. Thence it is conveyed into the glands of the me- fentery, and having been fecerned through feveral of thefe, it rifes into a certain re- A ceptacle, whence it is conducted into a vein under the left arm, and thus mixes with the blood. It now foon reaches the heart, and from thence, thus mingled with blood, it paffes thro5 the lungs. I fay through the lungs ; becaufe it is immediately returned to the heart, thence to be diftributed thro* the reft, of the body. Now it muft be remembered, that the feat of the diforder which, by thefe heal¬ ing medicines, we are endeavouring to cure, is not in the blood veffels, but in the air veffels of the lungs j and that thefe air vef¬ fels have no communication with the arte¬ ries, except by means of tubes or pores fo extremely fmall, as not to admit the red globules of the blood , confequently the conftituent particles of our medicine muft be fmaller than thefe, otherwife no part of [14] it can poffibly be thus applied to the part injured. But we have faid, that a liquor may, by injection through the pulmo¬ nary artery, be forced into the bronchia : true ; but this liquor pafles colourlefs, al¬ ways depofiting in its paffage the matter with which it was tinged. Thefe things being properly coniidered, let me now ask the reader, whether he thinks it probable, that even the lead: be¬ nefit can rationally be expected from fac- charine, oily, mucilaginous, or balfamic medicines, thus applied ? What then is to be done ? Has Nature been fo unkind, particularly to the inhabi¬ tants of this ifland, as to afflidt us with a difeafe for which there is no remedy ? I verily believe fhe has net been, fo unkind. The fault is not in Nature, but in ourfelves , or, perhaps, rather in the difficulty of the task : for we cannot fuppofe, in the prefent improved ft ate of chemiftry and anatomy, that all thinking men are not perfedly fen- fible of the improbability, 1 had almoft faid impoffibility, of applying demulcents to the lungs through the alimentary canal : nor is it more reasonable to fuppofe them forget¬ ful, that the only poffible way of applying medicines diredily to the lungs, is through the wind- pipe. But, as I have before ob¬ served, they have been prevented from at¬ tempting [ i5 ] tempting this obvious method* by the dif¬ ficulties which occurred in the execution. To convey any palpable folid or liquid fubftance through the wind-pipe into the lungs* we know to be impoffible ; for that if the leaft crumb of bread, or drop of any liquor, happens by accident to enter the glottis , a violent cough is immediately ex¬ cited, till the offending matter be rejected. But we alfo know, that impalpable volatile matter is inceffantly carried to and from the lungs, along with the air ; every fubftance therefore that can be volatilized, may be conveyed diredlly to the lungs. Aqueous liquors may be eafily converted into vapour, and vapour may be impregnated with great variety of medicinal fubftances. On thefe confiderations, it iliould now feem, that the whole myftery is at once difcovered, and that we have nothing more to do, than to convert our proper medicines into vapour, and fo convey them diredtly to the difeafed part. Alas ! there are many confiderable obftacles yet to furmount, as will appear from a chemical view of the medicines in queftion. Let us fuppofe, that our patient, having caught a fevere cold, labours under an- in¬ flammation of that membrane or skin which is continued from the mouth, down the wind-pipe, into the bronchia , and that this inflam- [ 16 ] inflammation is chiefly in the lungs. Or let us fuppofe, that the irritating matter is not fufficiently acrid to produce much in¬ flammation ; but only, a fuperabundant Ac¬ cretion of acrid mucus. Or, let us farther fuppofe, that the lungs are a&ualJy ulce¬ rated. In thefe feveral ftages, or degrees of the diforder, what are the indications ? Our endeavours to reilore the ohftrudled perfpiration, is undoubtedly rational ; but our medicines, given with this intention, commonly fail. They excite indeed a co¬ pious fweat but the fluid thus determined to the furface of the body, is totally dif¬ ferent from that volatile matter which, in. a found flate, exhales particularly from the lungs, and to the diminution of which ex¬ halation, the difeafe in queftion is folely to be attributed. But what is the prefent danger ? It is, that the inflammation may end in fuppuration ; or that the acrid mat¬ ter rm?y be ohftrudled by mucus, or fpafm* and fo corrode, indurate, or deftroy the fubftance of the lungs. The immediate indication therefore is, if pofiible, to pre¬ vent thefe confequences ; which I prefume can only be effedted, by the application of antifeptic (that is medicines which refill putrefaction) antifpafmodic, attenuating, and balfamic medicines, directly to the part affedled. With [ *9 1 With regard to the firft, viz. antifeptice, there is no difficulty, the mod: powerful of them (I fpeak from experience) being in their nature volatile. Antifpafmodics and attenuants are equally eafy of conveyance i fo that the foie difficulty lies in our balfa- * mic medicines, which are very refractory, but of great importance* Gums, mucilages, and expreft oils, are, by no means, volatile : nor would I, in the prefent cafe, give one farthing to find them otherwife ; as they would, at any rate, be totally unfit for our prefent purpofe. Our whole attention therefore is fixed on the refinous native balfams ; but not indifcri- minately. Thofe who have be {lowed fo much attention on them as myfelf, will find them extremely different in their che-%< mical properties and effects on the human body. Befides, they are rarely to be met with genuine ; and a thorough knowledge of them is only to be acquired by long ex« - perience and frequent examination. The chief of the liquid balfams are, Bal- fam of Gilead, of Copaiba, of Peru, of To¬ lu, of Canada ; and the dry balfams are Benjoine, Storax, Labdanum, Myrrh and Maftich, and the Terpentines. But though thefe feveral fubftances are much alike in their chemical properties, yet they differ ef» fentially in their medical virtues, which is eafiiy accounted for, from the difference in [ 20 3 quantity and quality of the etherial oil which they contain. The chemical properties, as far as they are commonly known, of thefe fragrant refins or balfams are, that they are inflam¬ mable, difloluble in redtified fpirits, but not in water. Now, this being the cafe, fuppofing, even after a thoufand experi¬ ments, that we have fixed upon thofe whofe oils are leaft acrid, and which, in every refpedt, are heft fitted for our purpofe, how fhall we pofiibly contrive to convey them to the lungs in a proper vehicle ? They will not diffplve in water, and the vapour of fpirit of wine is much too ardent and in¬ flammatory. if indeed we had remained fatisfied with thefe general properties, without farther enquiry, we Ihould ftill have believed, with our neighbours, that the attempt was im¬ practicable ^ that it was impoffible to apply an efficacious remedy diredtly to the lungs, and confequently that confumptions were incurable. Ever fi nee I was capable of enquiry, it hath been a conftant maxim with me, to take nothing for granted, upon any autho¬ rity whatfoever. Upon this principal, I be¬ gan my experimental difquifitions relative to the fubjedt in queftion, being fully per- fuaded, for reafons which will hereafter appe ar, that if I could 'find means to con¬ vey Vey the belt of thefe native fragrant bal- fams to the lungs, in a mild and truely bal~ famic ftate, the confiimptive people of this ifl'arid might expedtconfiderable benefit from my fuccefs* Were I to relate the many fruitlefs ex¬ periments I have made, fince I firlt en¬ gaged in this enquiry, the reader would be furprized at my patience and perfeve- rance ; but it would anfwer no other pur- pofe. Let it fuffice therefore to tell him, that I, at iaft, hit upon a certain chemi¬ cal liquor, which, to my great aftonifh- ment, difiblved at leaft double the quan¬ tity, of the ballamic refins which I had fe- leCted, to any menftruum which I had ever tried or heard of. The pleafure I felt upon this difcovery, can only be conceived by thofe who have had the happinefs to extend, in any degree, the path of know¬ ledge. It immediately occurred to me, that the difcovery of fo powerful a men¬ ftruum, would not only be a confiderable flep in my prefect purfuit, but might pro¬ bably prove of lingular advantage to me¬ dicine in general. But what added greatly to my expectations was, that this liquor happens to be of exceeding volatility, not at all inflammatory, and remarkably anti- feptic, and antifpafmodic. Thus far, I had obtained every thing that I could wifh. My folution, however, was too ftrong for the purpofe I intended* Da I there- I therefore, by way of experiment, drop¬ ped a few drops of it into boiling water, and found, beyond all poffibility of a doubt, that the fleam was richly impregnated, both with the antifpafmodic and antifeptic qua¬ lities of the menftruum, and alfo with the balfamic and falubrious principles of the fragrant refins. This vapour I drew in with rny breath, for a confiderable time, and found it not in the leaft irritating ; but, on the contrary, extrearnly mild and agreeable. Being now defirous to afcertain the quanti¬ ty of the diffolved refins, which thus rofe with the vapour, I poured half an ounce of my folution into a quantity of hot water, and after evaporating the whole, I found remaining in the veflel a very fmall propor¬ tion of the weight of balfam which had been diffolved in that quantity, and confe- quently by much the greateft part had rifen with the vapour. 9 Let me now afk the reader, whether he is not of opinion, that the happieft effedts may rationally be expected, from fuch a medicine thus applied, by means of the fleam of hot water, diredtly to the injured lungs ? Whether he does not think it pro¬ bable, that the acrimony of the irritating fluid will be thus obtunded, either in a recent cold, or more advanced ftate of the difeafe ? Whether the fpafmodic conftriq- tion of the veflels will not thus be relaxed, and [ S3 1 and the coniequence of obitrudllons pre¬ vented ? Whether the progrefs of putri- faction may not thus be flopped, and whe¬ ther, in that cafe, even in the advanced Itage of a confumption, we may not hope for a cure ? When a confiderable part of the fubftance of both lobes of the lungs is deftroyeda the difeafe is ’doubtlefs incurable ; but we know from diffedtion, that commonly one lobe only is principally affedted. If there¬ fore we can thus flop the progrefs of pe¬ trifaction in the difeafed lobe, the other may continue to perform its office, and the patient fuffer but little inconveniencv. #*i~i • < *-*«*#^,^'*v**tf Ihere remains yet another argument in favour of this new method of applica¬ tion, which, I think, will appear to be a powerful one. We know that many peo¬ ple who have been far gone in a confump¬ tion, have recovered by removing to hap¬ pier climates. We cannot rationally attri¬ bute their recovery to any other caufe, than a difference in the air they breathe, which difference muft arife from its being impregnated with certain falubrious, anti- feptic, or balfamic effluvia. Since there¬ fore this natural application of faluliferous air to the part affeded, will produce that which medicines taken into the ftomach had attempted in vain, are we not thereby naturally led to conclude, that the beft way of ; 1 24 1 of adminiftering to the lungs, Is by means of the air ? It were ridiculous to attribute the recovery of confumptive people on their migration to a milder climate, mere¬ ly to increafe of heat, which might be in- creafed to any degree in the patients cham¬ ber at home. On the contrary, we know that heat remarkably accelerates putrifac- tion ; fo that in a putrid ftate of the lungs, if it were not for fome powerful counter¬ acting caufe, the difeafe, by travelling fouthward, mu ft neceflarily be increafed. With regard to the manner of applying ‘this medicine it is extremely eafy. I ufu- ally into about half a pint of boiling water, immediately after it is taken from the fire, ordering the patient to hold his mouth over the veffel fo as to draw in with his breath, as much as poftible of the vapour, continuing the operation as long as the fleam will rife. I then or*- der him to drink the water as foon as it is cold enough for that purpofe : for tho’ I depend entirely on the vapour for the cure of the lungs, yet as all the juices in the body may be in fome degree affeded, by the matter abforbed from the lungs, this balfaniic water received into the ftomach, will be of fome advantage. This fimple method of application will be abundantly fufficient in common colds, hoarfenefs, but when there is realbn f 25 ] to fufped, that the lungs are dangeroufly affeded, and that the difeafe is adually merging towards aconfumption, a more copi¬ ous application is neceflary. For this purpofe I have contrived a Ample machine, by means of which a much greater quantity of the balfamic effluvium is received into the lungs. The figure of this veflel may be ieenin the plate facing the title-page. It holds about a pint. Haifa pint of boiling water, mull be poured in, and the medicine immediately dropped into the water. The head being then fixed upon it, the patient applies his mouth to the pipe, and thus draws in the fleam with his breath, removing the pipe from his lips at every expiration. The veflel is made of pewter. Thofe who are acquaint¬ ed with the nature of evaporation will not be at a lofs to account for the conic form of the veflel. The reader now naturally expeds, that I fliould tell him the ingredients and man¬ ner of preparing the medicine ; otherwife, he is determined to pronounce me a quack, and, notwithftanding all I have faid, to believe that my book is intended merely to promote the fale of a medicine for my own emolument. I mu ft intreat him, however, to hear the reafons which have determined me to keep this preparation a fecret. Give me leave to fuppofe for a moment, that this medicine, thus applied, may be of I 26 3 of infinite fervice to a confiderable number of people in this kingdom. If I were to snake it publick, fo as that it might be prepared by every apothecary in the nation, what would be the confequence ? The con- fequence would be, that, notwithftanding Its excellence, it would be neglected, and a number of people thereby deprived of a benefit which, fo long as it remains a fe- cret, they may reafonabiy expedt ; nothing being more certain than that mankind na¬ turally defpife thofe things which are com¬ monly known and too eaiily obtained. Oi this truth I could produce a thoufand ex¬ amples. Some of the heft medicines that ever were contrived have funk into obli¬ vion, for no other reafon, than becaufe their compofition was made known. Does any one believe that Dr. James’s powder would have been fo univerfally beneficial, if he had publifhed his fecret to the world r If this anfwer be thought infufficient, I confefs that I have no better to give. With regard to the medicine in queftion, I think I have faid enough to convince the patient, that his hopes of relief from its effedts are rationally founded, and that though it will not perform miracles, he may neverthelefs expedt from its balfamic quality, that it will deftroy the acrimony of the irritating fluid; from its attenuating and antifpafmodie principles, that it will remove obftrudtions ; r 27 ] and from its antifeptic power, that it will prevent putrifadtion, or flop its progrefs when begun, and thus preferve the found part of the lungs, and give an opportunity to nature to regenerate the parts that were already deftroyed. What ! fays the fagacious reader, do you imagine, if a part of the lungs be ac¬ tually deflroyed, that it can ever be re- ftored ! — Sir, it is a maxim v/ith me, ne¬ ver to affirm any thing which I cannot prove; but I know no reafon why nature fhould not as eafily reftore a part of the lungs, as a part of an external mufde, or a part of the external fkin, which is con¬ tinued into the lungs, and which is as vafcular as the lungs themfelves. I fhall now beg leave to add a few words concerning the diet, &c. of confumptive people ; for, though our opinion of a me¬ dicine be ever fo great, it were certainly imprudent to negledt fuch other means as may contribute to its fuccefs ; and indeed, if the difeafe be far advanced, iittle is to be expedted from any medicine whatfoever, unlefs the patient will adhere implicitly to the rules prefcribed by his phyfician, rela¬ tive to his diet and manner of living. Fir ft, with regard to exercife. Our im¬ mortal Sydenham was fo ftrongly prepof- felfed in favour of riding on horfe-back, that he conftantly recommended that exer- E cife [28] cife in every ftage of a confumption. It is, however, with this, as with moft effi¬ cacious medicines ; if it does no good, it certainly does harm. The patient himfelf will be able to determine whether its ef¬ fects be falutary or otherwife, by obferving the following dire&ions. Firft, unlefs the weather be hot, let his cloathing be fome-> *what warmer than ufual, as he will other- wife grow chilly. Let him ride not more than an hour at a time, and that very gent¬ ly. If it be in fpring or autumn, he muft ride from eleven to twelve, or from twelve to one. If in the hotter months, let it be from nine to ten in the morning. But in moift or cold weather let him not ride at all. If after this gentle exercife, he finds himfelf in better fpirits, his appetite in- creafed, his breathing eafy, and his Ikin cool and foft, he may certainly conclude that riding is of fervice to him, and ought therefore to be continued as often as the weather will permit. If on the contrary, he finds himfelf fatigued, his breathing more frequent and more difficult, his fkin parched and dry, the palms of his hands hot, his cheeks fluffied, his tongue dry, and in himfelf an inclination to drink rather than eat, he may then conclude that rid¬ ing is improper in the prefent ftate of his diforder, and that taking the air in a car¬ riage will have better effe&s. If never- thelefs, [29] thelefs, he finds no alteration for the bet¬ ter, I advife him, by all means, to have recourfe to a fea voyage, from which, with the continuance of the medicine here re¬ commended, I venture to promife him every thing that human art can poffibly fup- ply. It may not be improper to obferve, that though I have above, in fpeaking of riding, limited the patient to an hour at a time, I mean that, in proportion to his in¬ crease of ftrength, and benefit received, the time fhould be prolonged, and the de¬ gree of exercife augmented. We come now to aliment, which is of infinite importance. The firft general rule which I give to my confumptive patients is, that, regardlefs of all ftated hours, he is to eat as often as he has an appetite, but never much at a time. If, when he rifes in a morning, he finds no appetite for his breakfaft, let him walk a little into the air, and wait an hour or two before he takes any food. As to tea, I abfolutely forbid it, becaufe it is an enemy to weak nerves, but more efpecially on account of the warm water, which greatly relaxes the ftomach. A fea bifcuit with a pint of cold almond milk, made with barley water or whey, is a good breakfaft for a confumptive perfon ; or a few almonds blanched and ground in a mortar with a little cold water, and then piixed, by little at a time, with two E 2 thirds [ 3° 1 thirds of milk from the cow, is Hill bet¬ ter, where more nouriffiment is required. This admixture of almonds renders the curd, which feparates in the ftomach, much lefs tenacious, and eafier of digeftion. I mention cows miik, becaufe it is moll ea- lily obtained ; otherwife, affes milk is cer¬ tainly preferable, becaufe it contains much lefs of curd, which is both difficult of di¬ geftion, and putrefcent. Goat’s milk con¬ tains even a greater proportion of curd than cows milk, and therefore highly improper, tho’ frequently prefcribed. Eggs are by no means to be allowed, on account of their putrifa&ive tendency. In ffiort, animal food is in general to be a- voided ; though, if the patient be weak, I allow a little boiled white meat once or twice a week, and now and then a little veal or chicken broth with a fmall quanti¬ ty of lemon juice lqueezed into it. Po¬ tatoes, turnips, carrots, parfneps, beans, fpinach, broccoli, fallets, bread and rice, conftitute our general bill of fare. As to drink, if the patient has much heffic fever, I confine him entirely to al¬ mond milk, barley water, or milk and wa¬ ter ; otherwife, befides thefe, he is per¬ mitted to drink one or two glades of mountain wine every day ; or in cafe that cannot be afforded, now and then a draught of ale, porter, or table beer. If t 3i 1 If the patient complains of a naufia, weight, or uneafinefs at his ftomach, I or¬ der him ten grains of Ipecacoanha, with chamomile tea, to be repeated once in tea days, or a fortnight, if the fymptoms re¬ turn. With regard to bleeding, as I expedt no¬ thing more from it than a little prefent relief, I never order it, unlefs when the fever runs too high, and then I feldom ex¬ ceed five ounces. If the patient be coftive, I order him a folution of manna, with alittlefoluble tartar; if the contrary, I give him occafionally a few drops of the Thebaic tindture in a little fimple cinnamon water. If he fweats towards morning, which is often the cafe, I order him to go to bed in good time, to rife very early, and to re- pofe a little after dinner. If his fweat ffcill continue, I give him 20 or 30 drops of the acid elixir of vitriol in a glafs of cold water twice a day. As to the Peruvian bark on this occafion, I believe it to be an excellent medicine ; but I diflikejk in fub- ftance for many reafons, and am no lefs diffatisfied with all the known preparations of it. I h ave lately begun a courfe of te¬ dious experiments, with an intention to difcover the parts in which its virtues actu¬ ally refide, and to diveft it of thofe which are inert. If I am not much miftaken in my [ 32 ] my conjectures, it is poffible to condenceits aCtive principles into a very fmall compafs, and thereby to render it a much more agreeable and efficacious medicine. If I fucceed, poffibly the publick may in fome future time expeCt to be made acquainted with the refult of my enquiries. There remains yet one piece of advice, to which the patient, if he regards his own fafety, will be particularly attentive. It concerns the pofition of his body. Con- fumptive people, from an indolence pecu¬ liar to their diforder, are very apt, whether fitting, walking, or riding, to fuffer the body to bend forward, for want of a pro¬ per exertion of thofe mufcles by which it fhould be kept ereCt. In this drooping pofition the cheft is never fufficiently en¬ larged, nor the lungs fully expanded. I, therefore, conftantly advife my patients to keep themfelves upright, and, efpecial- ly when in the open air, to endeavour to bring their breaft as forward as poffible. In this, my intention is, to expand the fmall ramifications of the bronchus to their extre¬ mities, and to open a free paffage for the blood from and to the heart j both which will affift our endeavours to remove ob- flruCtions, and prevent thofe adhefions of the lungs to the pleura , which are general¬ ly found on diffeClion of confumptive bo¬ dies My * See Morgagni, de Sedib. & Caufis Morborum. [ 33 ] My afthmatic patients, no doubt, begin to think me tedious, or rather imagine that I have quite forgot them. That, however, is not the cafe. By an afthma we mean that diforder, the chief fymptom of which is a difficulty of breathing. It is either continued or by fits. Now, tho* the caufe of this difeafe is frequently in the lungs, yet it is fometimes owing to a morbid af-> fedtion of fome pf the other organs of refpiration, as the diaphragm, the inter- coftal mufcles, or the wind- pipe, or fome of the neighbouring vifcera . How it hap¬ pens that the balfamic medicines, which are recommended as a cure for confump- tions, are at the fame time recommended in afthmatic complaints, is amazing, and muft proceed either from confummate ig¬ norance, or unpardonable difhonefty. If, as we have feen above, thefe balfamics, taken into the ftomach, can do nothing towards the cure of a confumption, how much lefs likely are they to relieve an afth¬ matic patient ? For if they could even be ap¬ plied immediately to the part affedted, they poflefs no one virtue that might authorize fuch expectation. 