SOME REFLECTIONS UPON THE Modern Practiſers of Phyſick, In Relation to the SMALL POX.

SYDENHAM ^(a) was a great Admirer of Hippocrates; ne⯑vertheleſs, we muſt not al⯑low him to have been either the cloſeſt, or the moſt ſuc⯑ceſsful Follower of him; as will appear by the follow⯑ing Account I ſhall give of one that was his [2]great Crony and Cotemporary; I mean the good Dr. Mapletoft. I had Occaſion to wait upon this Reverend, and very Venerable Per⯑ſon the laſt Year, and to diſcourſe with him ſomething about the Small Pox, which was no uncommon Subject then, nor now, in London. He told me, That he once thought he underſtood that Diſtemper himſelf; for in Six Years that he was a Practiſer (of conſiderable ^(a) Emi⯑nence in London) he loſt not one Patient by the Small Pox. At length, he ſaid, two or three died under his Hands; which (tho' there were other Phyſicians, whom he nam'd, em⯑ploy'd with him in thoſe Patients) it gave him that Concern, as to haſten the leaving off his Practice of Phyſick; which was gain⯑ful enough to him, being better worth than a Thouſand Pounds a Year, as he aſſur'd me; and which he did not probably expect the ſame Profit from his Pains in Divinity, to which Calling nevertheleſs he ſaid he had a greater Inclination than to the other: and during his Employment in Phyſick, was as conſtant in Publick Acts of Devotion as ſince.

This whole Relation was very much ſur⯑priſing to me; eſpecially from one of his Character: The perfect Veracity of whoſe Words I could no ways ſcruple or make a Doubt of. And it gave me Occaſion to en⯑quire of him, what were his Ways or Me⯑thods in the Cure of the Small Pox. He ve⯑ry [3]frankly told me, That his general Way, was to do nothing at all; That a Patient of his, when his Apothecary's Bill was brought in, it came but to Three Pence; another's, (which was accidently view'd by him at the ſame Time,) amounting to Ten Pounds: that Perſon died. This laſt Account was not al⯑together ſo ſurpriſing. But that the Doctor's good Succeſs ſhould continue for ſo many Years, when 'tis probable there were diffe⯑rent Seaſons and Conſtitutions of thoſe Years, and ſome more dangerous than others to this Diſtemper, as well as has been ſince; that the Doctor's Method, the ſame I preſume with Hippocrates's, viz. a proper ^(a) Diet pre⯑ſcrib'd, and a Regulation in the other ^(b) Non-Naturals, ſhould ſo infallibly ſucceed, when a Multitude of Medicines then and ſince given by others has prov'd either inef⯑fectual, noxious, or deadly, deſerves a tho⯑rough Conſideration: And before my Depar⯑ture [4]I could not forbear telling the Doctor my Sentiments, That the Practice of the Town ſeem'd to be far different from his. He confeſs'd it was ſo; and that the Phyſi⯑cians now made uſe of Bleeding, Bliſtering, &c. by which, they told him, they ſav'd the Lives of many. I anſwer'd him, that I thought Matter of Fact was too plainly a⯑gainſt their Practice; and if they ſav'd the Lives of many, they deſtroy'd far more.

To all this, and likewiſe what Sydenham mentions concerning the Poor's generally eſcaping well in this Diſtemper, there can be, I think, but one plauſible Anſwer given: which tho' it may be ſo to this latter of Sy⯑denham's, yet can ſcarce be allow'd to the foregoing. 'Tis this; That whoever con⯑cerns himſelf with Phyſick, ought always to conſider, that there is a very great difference in the Conſtitutions of moſt Perſons, which makes the very ſame Diſtemper ſevere and dangerous to one, yet mild and very eaſy to to be born in another: that nothing appears more plainly than this Obſervation in the Small Pox. And from hence we are told, we ought to infer for a generat Reaſon, why the Poor, who uſe little or no Phyſick in this Diſtemper, yet commonly eſcape well in it: That it is from the lowneſs of their Diet, and their different ways of Living from the Rich; which cauſes their Bodies to be of another Nature, and not liable to the Virulency, or high Malignity of the Di⯑ſeaſe: But the Rich are ſubject to it, and [5]therefore they muſt uſe Means, and all the Powers of Art to quell, leſſen and deſtroy it in their Bodies, or to prevent it. And after all that can be done for them, if great Num⯑bers of theſe latter miſcarry in the Hands of their Phyſicians, notwithſtanding their ut⯑moſt Care and Medicines, 'tis not to be im⯑puted to their Fault: for they cannot alter Nature ſo very ſpeedily, and create a good and ſtrong Conſtitution or Habit of Body, where it was not at all to be found in the Patient before. This has paſs'd, with ma⯑ny, for a good Anſwer to what Sydenham has ſaid, relating to the Poor's eſcaping better than the Rich, tho' they us'd no Phy⯑ſick, nor Methods of Art in the Small Pox; but will not ſerve, I think, to what Dr. Ma⯑pletoft's conſtant Practice prov'd, viz. that the ſame Methods being us'd to both, were ſucceſsful alike; except we ſuppoſe he had no Rich Patients: which, after what I have but now related of him, 'twere a mere Ab⯑ſurdity to imagine.

This therefore is ſome Proof of what I hinted at in my Title-page and Preface; but ſhall make out more fully in a larger Piece concerning Phyſick's being grown in this Age too much an Art or Craft, it being us'd too much, and not to a right Intention, in the preſent Caſe before us.

But leaſt I ſhould be any ways miſtaken, in either the receiving, or delivering of theſe Matters; or I may ſeem to my Reader [6]to have over-weighted them with Conſe⯑quences, which, in his Opinion, they will not ſo very well bear, I ſhall go on; and take a View of the other part of Hippocrates's Practice, in the Exceptions againſt his gene⯑ral Rule of Diet only. For ſo we may pro⯑perly call them; Exceptions; being but few, and not to be met with in many Pages of his Works, eſpecially of his Practice. 'Tis cer⯑tain however, that he made uſe both of Eva⯑cuations, and other Means or Medicines, in Acute and Chronical Diſtempers: tho' not near ſo often in the former, as the latter: Nature being generally better able, of her ſelf, to bring Matters to a Criſis without them. I deſign to conſider ſeveral of theſe, but at preſent can only go upon one of them, without ſwelling this Piece to too large a Bulk: But 'tis pretty material, namely, the Evacuation of Bleeding; to ſee upon what Reaſons or Tokens (ſcarcely upon ſlight ones) Hippocrates made uſe of it.

The firſt Indication in him, taken notice of by a certain Author ^(a), who has under⯑taken to put them in Order, is a Plethora, or over-fulneſs of the Blood Veſſels, in which Caſe, he uſed Bleeding to evacuate, or take away the Superfuity of what was in them.

This I own is highly requiſite, where the Caſe by certain or very numerous Indicati⯑ons, is manifeſt. But where not, 'tis as in⯑diſpenſibly neceſſary to let alone or omit it: for by Bleeding we moſt certainly weak⯑en [7]Nature, if we do not relieve her. Nay, tho we do, as is moſt certainly known in ma⯑ny Caſes, and ought to be well noted in Di⯑ſtempers that are both long and violent, as this we are now treating of, at preſent moſt commonly is.

But, ſay ſome of our Modern Practiſers in defence of their own Ways and Methods, tho' not ſucceſsful; The Gentry or rich Perſons who have Plenty of every thing, are apt to indulge themſelves to exceſs, and ſo muſt needs be full of Blood and Humours, which renders Evacuations neceſſary to them.

This Aſſertion I hold to contain very con⯑ſiderable Falſities; and to be moſt pernicious in its Conſequences, as I ſhall make appear both by Reaſons and Facts themſelves. And for that purpoſe, ſhall enter upon a brief Conſideration and Account of the general ways of living, both of the Rich and Poorer Sort, and what are the common Diet and Delights of both.

The common Diet both of thoſe whoſe Circumſtances are good and plentiful, as alſo of almoſt the meaneſt Mechanick here in London, is Butchers Meat, little differently dreſs'd, excepting ſome few, who delight in made Diſhes, Sauces, &c. but neither in this nor in the variety of Courſes, do the Gene⯑rality of Wealthy Perſons exceed thoſe of the Poorer, or Commonalty, who dine at the [8]Cooks Shops in London. This then can make no great Difference in their Conſtitutions, either for good or bad. We ſhall deſcend therefore to the Deliciae, the Entertainments of the Gentry, or richer Sort, amongſt one another. In this there is a conſiderable Dif⯑ference and Diſtinction of them from the meaner ſort. The Entertainments of the Firſt, where they give any in their Viſits, being with Coffee, Tea, Chocolate, a Cup of Cordial Waters, or a ſingle Glaſs of Wine, and the like. Now whoever conſiders theſe, and compares them with the good roaſt Beef, Ale and Cheeſe which the meaner ſort, both in City and Country, are apt to ſet be⯑fore their Friends or Viſitors at all Hours, will think, there is no Compariſon in the Subſtantialneſs of the Treat, and that the latter is much more likely to fill the Body with Blood and Humours, than the former. For to conſider of Coffee, 'tis a noted Dry⯑er up of the Blood and Humours; of Tea, the Green firſt, 'tis an Evacuator both by U⯑rine and Sweat; this laſt by its own Heat, and by being drank in a faſhionable manner, that is, in large Quantities and exceſſive hot. The Bohea Tea is ſomething of another Na⯑ture, being reckon'd good in Conſumptions by many: Yet no Perſon that I have met with, has complain'd of their growing too groſs, bulky, or Plethorick by feeding on it, or that it put too much Blood in their Faces, as is the Complexion of thoſe who too much abound with it. This might make it become altogether an unfaſhionable Liquor, which I [9]do not hear that it is at leaſt upon this ac⯑count.

The third thing I have mention'd is, Cho⯑colate; which tho' not ſo often us'd in Viſits, is yet drank conſtantly by many; and this to be ſure will be reckon'd an high Diet; Yet I cannot find, that thoſe Perſons, who take it (even in Bed, which way it ſhould be moſt nouriſhing) are obliged to make uſe of any Evacuations, as bleeding, purging, vomit⯑ing once a Month, or Quarter, upon that account.

I need not mention the Nature or Effects of the other two Liquors, which People of Faſhion and Sobriety, eſpecially the Ladies, tho' they may taſte of, yet we muſt believe 'tis ſparingly enough. And as for thoſe Gen⯑lemen, who make too free with their own Conſtitutions by an over-liberal Uſe of Wine and other Liquors, this does not always ren⯑der them Plethorick, or too abounding with Blood, Spirits and Humours in their Veins and Nerves: ſuch Perſons rather wanting them, and even a natural Heat in their Bo⯑dies upon any Intermiſſion of their uſual Debauch. To theſe the greateſt ^(a) Caution [10]therefore ought to be us'd, how we too much impair their Spirits by any Exhauſtion; when nothing but even a Riot can repair them again; ſo much is Cuſtom a ſecond Nature, and as hardly to be put off as the firſt.

Theſe are but ſhort Hints, which might be clear'd and enlarg'd upon very much: but ſuch as they are at preſent, they are e⯑nough to ſhew, That this Suppoſal of a Ple⯑thora, or fulneſs of Blood in rich Perſons, rather than in the poor, or middle ſort, has no good Foundation. And another thing that may plainly convince us of this Miſtake is, the very Countenances, as well as Shape of Body, of ſuch as live nicely and delicately in the City, compar'd with thoſe who live more hardily and in the Country: For in the firſt 'tis thin, pale, and without Colour; but in the other Sanguine and full: which made one of our beſt Poets, when he brings in two City-Ladies ridiculing the Country-Gentle⯑man's ill-bred Daughters, to mention their being ^(a) Plump, Cherry-Cheek'd, and Fat as Barn-Door-Fowl: which none doubts was na⯑turally, tho' ſatyrically expreſs'd in him.

I ſhall go not much farther, nor uſe many more Arguments at preſent in this thing; being not ſo far ſway'd in my own Judgment and Opinion, (tho' grounded upon Reaſon [11]and Obſervation) as to disbelieve there are any Plethorick Perſons at all amongſt the Rich; who may need Evacuations in the very beginning of this, as well as other Di⯑ſtempers: but I am nearly of Opinion, that there may at leaſt as many be found among the poorer or middle ſort of People, and of ſuch as live upon a plainer Diet too, than any I have yet mention'd. I ſhall give the following Inſtances.

There was, ſome Years ſince, living in Cotherſtock, near Oundle in Northamptonſhire, a Family of the Whiteings, conſiſting of the Grandmother, three Grandſons and a Daugh⯑ter. The four young Perſons were pretty well grown up, when the eldeſt of them, a⯑bout Nineteen, and a very luſty Youth, freſh and ſanguine, fell ill of a Cold or Cough only; which being neglected, preſently turn'd to a Conſumption. Advice was at length call'd for him, when it was too late; but who gave it as their Opinion, That if he had been let Blood early enough, when he had only a Cough, and not a Conſum⯑ption, or waſting of the Lungs and other Parts, he had avoided this fatal Diſtemper; which, in a ſhort Time, carried him off.

About a Year after the ſecond Brother, of much the ſome Habit of Body, and not yet quite at his full Growth, fell ill of the Small Pox, and was taken with an inward Bleed⯑ing, before the Diſtemper well appear'd; which carried him off ſpeedily. The third [12]Brother caught them of this laſt; and with the ſame Symptoms, viz. voiding bloody Urine, died likewiſe. Whilſt he was yet unburied, the only now ſurviving Child, the Grand-daughter, of a clear, florid, and ſome⯑thing ſanguine Complexion, fell ill: and her they got preſently blooded in the Arm; notwithſtanding which, ſhe had a moſt violent [Haemorrhage, or] Bleeding at the Noſe; which laſted ſo long, till her Friends about her thought ſhe would have expir'd by it; they having try'd ſeveral Things in vain to ſtop it. At length they bethought themſelves of a very good Bloodſtone; which being apply'd, the Bleeding imme⯑diately ſtaid. The Small Pox however, not⯑withſtanding this (one would think) cooling of the Blood by emptying, prov'd of the worſt and moſt confluent Kind; yet ſhe eſcaped with great Difficulty, and is alive at this Day.

What I introduc'd theſe Examples for, is to ſhew, that Perſons either of a mean E⯑ſtate, or that live almoſt as frugally as poſſi⯑ble, may be over full of Blood and Hu⯑mours. The Grandmother of theſe Perſons, who was Manager and Provider of the Fa⯑mily, being noted for her Parſimonious Tem⯑per; and tho', I ſuppoſe, the Houſe did not want for Neceſſaries, having Means to pro⯑vide them, yet ſhe allowed very little Su⯑perfluities either to her ſelf, or Grand-chil⯑dren; their Diets being both plain and com⯑mon. And as for thoſe Refreſhments of [13]Coffee, Tea, Chocolate, &c. they were ſcarce at that time known in the Family, no more than Wine or Brandy, commonly us'd or permitted in it; yet theſe Perſons ſeem'd manifeſtly Plethorick in their Con⯑ſtitutions, as I have ſhew'd; and perhaps they were the more inclin'd to be ſo, for living after their plain manner, and upon a low Diet. For I remember, that commu⯑nicating theſe Caſes, and ſome others, to an old Phyſician of my Acquaintance, he ask'd me if the foremention'd Perſons fed upon a Milk-Diet. I told him, I could not directly affirm that was their conſtant Food: But that the Family kept a Dairy, and I ſuppos'd it might be a conſiderable part of it. This Phyſician told me, the Reaſon of his asking was, that he had obſerv'd Perſons who vo⯑luntarily choſe a Milk-Diet, and liv'd upon it, were generally more turgid and fuller fleſh'd than others: which we may common⯑ly obſerve of the poorer ſort, who are not over-labour'd, and eſpecially of their Chil⯑dren.

Another common Diet of the meaner ſort is Cheeſe, which tho' reckon'd by ſome not to be a nouriſhing nor good Food, yet has been reputed otherwiſe by the moſt judi⯑cious. For we find there were ſo long ſince as in Hippocrates's Days, various Opinions a⯑bout this Edible, as to the Wholefomneſs or Unwholeſomneſs of it: which in one Place he ridicules, as only given by ignorant Peo⯑ple at random, without conſidering the diffe⯑rent [14]Conſtitutions of Perſons, who may feed upon it and find different Effects, viz. an A⯑greeableneſs or Diſagreeableneſs of it. And he tells us, that for many ^(a) thin and lean Perſons 'tis found good and wholeſom Food: which argues that it ſomeways nouriſhes, and fills up ſuch Bodies.

Thus we ſee, that notwithſtanding the ſuppos'd luxuriant and riotous living of the Rich, the Poor or Meaner Sort, both may and do, abound with Blood and other Juices, at leaſt as much, or rather more, and as oft⯑en as the former: and conſequently may have as great Occaſion for Bleeding, and o⯑ther Evacuations, as thoſe firſt. But that they do make very ſeldom any uſe of them, eſpecially of Bleeding, I am pretty through⯑ly perſuaded; not only from their general and natural abhorrence to it, but a particu⯑lar one in this Diſtemper of the Small Pox; which is ſo great, that I have heard more than one Perſon affirm, they would ſooner admit a Dagger to their Hearts, than ſuffer it to be done upon any account in this Diſeaſe. Yet theſe are the ſame Perſons that ſcape the beſt, as Sydenham obſerves, and ſuf⯑fer the feweſt Miſcarriages by it.

There is one thing however, which my moſt timorous Readers will be too apt to con⯑clude from the foregoing particular Caſes [15](two of which having prov'd mortal to all appearance for want of this Precaution of Bleeding, before Nature had forc'd her way by the ſecret Paſſages) which is that this in⯑ward Bleeding, being both a very common and dangerous Symptom, we ought to uſe a Fence and Precaution againſt it; and that nothing is ſo Good and ſafe as Bleeding at the Arm. I can agree with ſuch a Perſon in none of theſe things. For firſt, were this both a very common and very fatal Sym⯑ptom, Dr. Mapletoft muſt no doubt have often met with it, and not knowing how to cure, would have loſt ſome of his Patients by it; which we do not find that he did, or by any other means, of a long time, viz. Six whole Years. If he had a certain Remedy for this Symptom, I do not queſtion but he would have communicated it to the Publick long e're this; eſpecially when he had left off his Practice. If we ſuppoſe he us'd the foremen⯑tion'd Precaution, and blooded all his Pati⯑ents in the beginning, the Suppoſition is ve⯑ry unreaſonable; for this is far from doing ^(a) Nothing. 'Tis too frequently doing Miſ⯑chief, as I have ſhewn by ſome ^(b) Argu⯑ments, and mean to do hereafter by more; but in the mean time ſhall conſider ſome⯑thing farther of this Symptom, and of a way to prevent or cure it.

This bad Symptom, as 'tis commonly and truely accounted, ſeems moſt incident to Perſons of a pretty full, but lax Habit of Bo⯑dy; whoſe Fibres have not a true Strength, Tone, and Reſiſtance, when any thing of Force or Violence is impreſs'd upon them. It ſeems to require too, that their Blood and Humours be not only pretty much abound⯑ing, but that they ſhould be of a thin and watery Conſiſtance. I ſpeak this as not only knowing one of the three Perſons aforemen⯑tion'd, who had been my Patient, to have been of this Conſtitution, from certain To⯑kens plainly diſcovering both the Solids and Fluids to be ſo conſtituted; but the other two were in outward appearance, and upon this Tryal of the Diſtemper, as we ſee, inwardly affected almoſt the ſame. Theſe things, to⯑gether with another Remark I ſhall mention by and by, have made me take ſome notice of a Reflection Dr. Liſter has thrown upon Sydenham, for his Method of uſing Dilutives, viz. Quantities of thin and ſmall Liquors in this Diſtemper. He tells us, that this cele⯑brated Author carried it to an Exceſs in that Point, and the Effect of it was, to his Know⯑ledge, very often a voiding of bloody Urine. Dr. Liſter was a Perſon of ſome conſiderable Practice, tho' far inſerior to Sydenham, and upon whom he is too ſevere in his Reflecti⯑ons. Yet if his Experience (or rather ^(a) pry⯑ing [17]Temper into the Miſcarriages of others) diſcover'd this to him, 'twas very well the diſcovering it to the World; eſpecially when Sydenham plainly ſhews himſelf at a loſs upon this Symptom.

I cannot ſay my ſelf that I have ſeen this Effect upon any one in the Small Pox: but I have ſeen a very ſudden and apparent Dia⯑betes, caus'd by a Perſon's only drinking a very large Quantity of Small Beer in the Pa⯑roxiſm or Fit of an Ague; which failing to be diſcharg'd by Vomit, as it had us'd to have been to the ſame Perſon, preſently turn'd downwards, and the Patient had at leaſt twenty diſcharges by Urine in leſs than twelve Hours: and with ſuch a Proſtration of Strength and Spirits, that Life ſeem'd to be in danger, before we could get proper Remedies in a Country-Village; which ne⯑vertheleſs this Diſtemper ſoon yielded to, when receiv'd; and the Perſon recover'd from the Ague and Diabetes, thus acci⯑dentally attending it, in a very few Days; there being no contrariety in the two Me⯑thods that I us'd for both. However, I have reflected upon it ſince; That if in ſuch a Di⯑ſtemper as a common Ague, a Diabetes ſuc⯑ceeded, by only thinning the Blood with too much Liquids, as is mention'd; In the Small Pox, which has a much greater Acrimony, the Blood it ſelf, by corroſion of the Veſſels, might be carried down with thoſe Liquids the ſame way. I am therefore altogether for a Moderation in this, as well as in other [18]Methods or Adminiſtrations for this Diſtem⯑per, and not for large Quantities of Liquors to be given, except the Patient has been long and injuriouſly detain'd from them, ſo that the exceſſive Heat and Drought of his Body does abſolutely require them: for then only they are both ſafe and uſeful. All this is by way of Precaution only againſt this Sym⯑ptom of inward Bleeding; which, if due Care be taken, I mean, if no violent Me⯑thods, or ill Regimen has been us'd, in, or immediately before the Diſtemper, few Per⯑ſons Conſtitutions, in my Opinion, would make them directly liable to it.

As for the Cure of it, I ſhall adviſe but to a ſeemingly ſlight and eaſy Method at Pre⯑ſent, which was recommended to me by a Lady; one of a very generous and charitable Diſpoſition, who viſits equally both Rich and Poor in any Diſtreſs; and in one that her own tender Sex is only lyable to, when ſhe makes a ready Viſit, ſhe tells me, ſhe ne⯑ver goes unfurniſh'd with an Herb call'd Roſ⯑folis, or Sun-dew; which has this powerful Virtue to ſtop immediately the greateſt Hoe⯑morrhages or Fluxes of Blood, that often happen in thoſe Caſes, by hanging it in a Bag upon the Breaſt of the Perſon: and that its Force is ſo great, as to hinder the Evacua⯑tion of what is neceſſary and natural after⯑wards, if it be not removed in time: For which reaſon, ſhe takes it off at the end of twelve or four and twenty Hours at fartheſt. This ſhe aſſures me ſhe has likewiſe made uſe [19]of in thoſe inward Bleedings of the Small Pox, and with perfect good Succeſs; it ſtop⯑ping them immediately, as ſhe had clearly experimented more than once, and does not doubt but it will always anſwer the ſame. However, there is one thing to be taken care of, that this Herb be pretty freſh and good, for if it be either decay'd, or has been too long or too often us'd, its Virtue is then loſt; as ſhe particularly prov'd upon Perſons who have bled at the Noſe habitually: For tho' it will both ſtop and prevent ſuch Bleed⯑ings while worn upon the Perſon, yet it muſt be renewed at the end of two or three Months at fartheſt. I have ſeen my ſelf ſome Effects of it in this latter Caſe: but have not had Opportunities of the former. However, I am far from diſcountenancing the Tryals of it, as ſome, I queſtion not, will do, who are of another Temper, as well as intellect from their great Maſter Hippocra⯑tes; who ſays, ‘"That a Phyſician ought not to be aſham'd to inform himſelf, tho' by the meaneſt People, of Remedies con⯑firm'd by Experience. By this means, in my Opinion, the Art of Phyſick grew up by degrees, that is, by amaſſing and col⯑lecting Obſervations of the ſeveral parti⯑cular Caſes one by one, which being all put together, make one entire Body."’

But to return (from this ſomething long, tho' not uſeleſs Digreſſion) to the Examina⯑tion of Hippocrates's other Reaſons for Bleed⯑ing. This firſt and chiefeſt of a Plethora [20]ſuppos'd, being not ſo common or probable a Caſe (eſpecially among the Rich) as has been miſtakenly imagin'd.

A ſecond Reaſon in LeClark's Collection of them was, ‘"to divert or Recall the Courſe of the Blood, which was going where it ought not to be."’

This might probably have been uſeful in thoſe Caſes I lately mention'd: but we are not to ſuppoſe a Neceſſity for a thing, where there is none. For this would be, like a Perſon, who having ſeen another die of an Apoplexy, and hearing it after reported, that if the deceas'd had us'd Bleeding, Vomiting, and Bliſtering, he had eſcap'd his Death; this ſhould make him upon the firſt time he was dozie, or his Head ach'd, ſend for an A⯑pothecary and a Surgion, and order himſelf to be immediately Blooded, Bliſter'd, &c. by way of Prevention: Which, if not the firſt time, yet if this Humour often took him, would infallibly ruine the beſt Conſtitution in the World, and bring upon him ſuch Weakneſſes and Diſorders, as he would ne⯑ver have been attack'd with, had he forborn thoſe Methods.

That this is a parallel Caſe, and that there is as great Hazards, and commonly as little Neceſſity (bating perhaps a little preſent Eaſe, (which might happen too in both Caſes, it commonly cauſing an Enlivening or Brisk⯑neſs) for ſuch a Practice in the one Caſe as in [21]the other; I appeal to the experienc'd and ſucceſsful Dr. Mapletoft abovemention'd, p. 1, 2. But to proceed.

A third end of Bleeding was, to procure a free Motion of the Blood and Spirits: which, tho' Dr. Le Clarke has quoted in his Hiſtory of Phyſick a long Caſe, that will not much re⯑ſemble the Small Pox, nor any Diſtemper known in England at this Day: Yet ſince there are Diſorders of the Nerves, and there may be Stagnations both of the Blood and Spirits in this preſent Diſtemper, I ſhall be told, that we are not to take theſe as ſlight Indications, or Symptoms; and I confeſs they are not, being ſuch as put not only Sy⯑denham, but many others, I believe, upon forcible Methods to remove them. Yet if we have ſhew'd that there are very great Ha⯑zards in going that way to work for the Re⯑lief of the Patient; and that there is a ſafer and better way, and one more peculiarly a⯑dapted to this Diſtemper, and that carries ſeveral great Advantages with it, of uſe in the whole courſe of it after: This is certain⯑ly to be prefer'd before any precarious or hazardous Method: And ſuch an one I pub⯑liſh'd in my laſt Treatiſe or Eſſay, which had ſo far the Approbation of two of the Greateſt Men in this Nation, one for his un⯑parallel'd Skill in Mathematicks and natural Philoſophy. The other for his equal Read⯑ing and Experience too in the practical part [22]of Phyſick. That the ^(a) firſt of them told me upon his through Peruſal of my Tenth Experiment or Caſe, with what follows up⯑on it, It was a better way than any thing elſe in the beginning; and in a ſecond Viſit he terth'd it, A very fair Propoſal and Deſign. The other ^(b) Dignified Perſon, peruſing and approving my whole Book through, told me upon the ſame Paſſage or Experiment, That he thought long till he could trye it himſelf: ſo much was he ſatisfied with the apparent Safety, and more than probable Efficacy, of it.

However, I have not yet attain'd my end of publiſhing that Piece, which was, to have the fore-mention'd, and ſome other things, fully try'd for publick Uſe. Nor have I yet, on the contrary, receiv'd an account of any the leaſt Matters of Fact, nor ſo much as Ar⯑guments (except what I have mention'd in my Preface, which I really receiv'd) urg'd againſt the whole or a part; ſo true is it (what that highly skilful Perſon in a Profeſ⯑ſion ſcarce leſs ^(c) ſacred than his own, and therefore worthy of his Study and Practice) told me, viz. That I ſhould find it an hard [23]Matter to introduce a new Invention in Medicin: The Phyſicians of the Town, as he had experienc'd, being all inclin'd tena⯑ciouſly to follow their own way; at leaſt not to admit of any that was more plain and eaſy. What Alteration this ſecond Treatiſe of mine (which I deſign'd to have been much longer) will make, I muſt wait a little while to know.

One thing more I ſhall mention here; which is, that when I laſt paid my Duty to his Lordſhip, he gave me freſh Aſſurances of the Goodneſs of his own plain Medicine, or that I call his own, he having recommended it to me: he now again commended the ſame: and told me he had done good things with it.

This I ſpeak, becauſe its having been laid aſide in common Practice, ſeems to me for little other Reaſon, but, becauſe it did not ſuit the Humour of the Town when former⯑ly publiſh'd: tho' 'tis far more ſafe, and com⯑monly effectual too, than thoſe in preſent vogue, which I have given Reaſons for in that Eſſay. But to return.

A Fourth Intention of Hippocrates in Bleed⯑ing, was, for Refreſhment or Eaſe. The In⯑ſtance there is in the Iliack Paſſion. But I have given an Inſtance where Sydenham hath us'd both that and Vomiting for the ſame In⯑tention of acquiring Eaſe and Refreſhment only, in the Small Pox; which is very often [24]better procur'd another way. See p. 81, 82, &c. of my before-mention'd Eſſay.

In the next Paragraph he tells us, That the Conduct of Hippocrates was much the ſame in Bleeding, as Purging, in reſpect of Time and Perſons. We ought, ſays he, to let Blood in acute Diſeaſes, when they are violent, and if the Party be luſty, and in the Flower of his Age.

In thoſe Inſtances I have given, pag. 11, 12. of an exceſſive Athletick [or full] Habit of Body, the Flower of Youth, &c. I ſhould not have been againſt Bleeding, but for it, for the ſpeedy taking off a Plethora, and for turning the Courſe of the Blood as ſpeedily as might be: But that this is to be done al⯑ways, and to all Perſons indifferently who have this Diſtemper, and are in Youth, I muſt deny; and once more appeal to the ſafer and better Practice of Dr. Mapletoft, who generally omitted this, as we may moſt rea⯑ſonably infer from pag. 4. As for thoſe Circumſtances of Diſeaſes acute and violent, tho' the Small Pox is both, yet we muſt not falſe⯑ly, or upon ill grounds, draw in Hippocrates's Advice or Authority, even tho' the Diſtem⯑per be attended with Pain too; which is an⯑other of his Indications for Bleeding; thoſe Diſtempers he directed it for, being Quin⯑zies, Pleuriſies, &c. (as is plain in the Ori⯑ginal) which, we know by Experience, not only admit of Alleviation or Abatement of their Pain by Bleeding, but very often of a moſt ſpeedy Cure too by that alone. But [25]the Caſe of the Small Pox is widely diffe⯑rent: For the greateſt Progreſs we can make towards its finiſhing its Courſe by this, or uſing other Evacuations, is only to bring it into Act, or to make its plain, and too com⯑monly very evil Appearance; but the Pa⯑tient is obliged to undergo almoſt the whole Courſe of it afterwards, which how tedious and haraſſing, as well as dangerous a one it is frequently in thoſe Caſes, I my ſelf have ſufficiently felt as well as ſeen. Theſe laſt therefore are no Precedents to go by; and I wiſh all who have to do in directing for the Cure of this Diſtemper, would not inſiſt up⯑on the Precepts, (eſpecially as collected by others, or taken from particular Caſes in Hippocrates, no ways parallel to ours) but would rather follow the Practice of this ſage and well experienc'd Phyſician, (which would moſt exactly ſuit this Diſtemper, as plainly appears by ^(a) Fact) and in it they would find, that he uſed the greateſt Caution a⯑gainſt Evacuations in the Beginning of all acute Diſtempers, this of bleeding eſpecial⯑ly, which Le Clark tells us he very ſeldom uſed; and that in his Firſt and Third Book of Epidemicks, (which he calls the moſt fi⯑niſhed of his Works) we find but one ſin⯑gle Inſtance, and that in a Pleuriſy. So much did he truſt to the Power of Nature, whom he endeavour'd always to ſupport, and not, by the too often falſe Reliefs of Art, to weaken and deſtroy.

There is one thing ſtill to be conſider'd, with relation to the firſt Queſtion ſtarted to my Beſt, moſt Honourable, and I preſume now, Impartial Readers, which was, Whether the Rich in this Diſtemper, did, or did not, require different Methods of Cure from the Poor in it? The Queſtion it ſelf ſuppoſing them of ſome⯑thing different Conſtitutions, and that the Rich are not quite ſo ſtrong and hardy to endure its Force as the Poor: which is the Reaſon given why they cannot likewiſe go through this Diſtemper, but fail commonly before the end of it (even when Appearances have been good, or made ſo ſeemingly by Art, in the beginning); which Suppoſition Of their being not quite ſo ſtrong naturally to bear it, we muſt perhaps grant: but then it makes highly againſt the preſent ordinary Practice, which is oppoſite to the Authority of the Great Hippocrates too; this Paſſage from him, warning or inſtructing in all vio⯑lent Methods ^(a), Si vero morbum fortiorem, aegrotum autem debilem acceperis, debilibus phar⯑macis curabis, quae ipſum morbum ſuperent & ab⯑ducant, verum aegrotum nihilo debiliorem reddant. Which plainly ſignifies, I think, thus much, That if we meet with a ſtrong Diſeaſe in a weak Patient, we ought to uſe milder ^(b)Remedies, which [27]may diminiſh or overcome the Diſtemper, but not weaken the Patient's Strength. Now 'tis to the Rich, who are either confeſs'd, or demon⯑ſtratively ('tis thought) of a weaker Nature, that we ſee daily violent and exhauſting Re⯑medies are uſed; and not to the Poorer, but more robuſt and ſtronger ſort of Perſons, who might perhaps bear them better, but do not at all care for the Tryal; as we find by their not only avoiding, but even deteſting the Phyſicians as much as may be in this Diſeaſe. And for what too apparent Rea⯑ſons they do both, is in part ſhew'd.