SECTION I. DEFINITION OF SCROPHULA.

SCROPHULA is a weakened action in the ſyſtem manifeſting itſelf by the fol⯑lowing diſeaſes, viz.

• 1. SCROPHULOUS TUMOURS and ULCERS.
• 2. PHTHISIS PULMONALIS.
• 3. TABES SCROPHULOSA.
• 4. OPHTHALMIA TARSI.
• 5. HYDARTHUS.
• 6. BRONCHOCELE.
• 7. HYDROCEPHALUS.
• 8. LUMBAR-ABSCESS.
• 9. RACHITIS.

SECTION II. Of SCROPHULOUS TUMOURS and ULCERS.

IT will be unneceſſary to give a long and tedious deſcription of ſcrophulous tumours and ulcers, ſince as the late Mr. Hunter obſerves, theſe are ſo characterized, as to be eaſily diſ⯑tinguiſhed from all others. They begin at firſt generally in the neck, affecting the con⯑globate glands^*, feel hard, are colourleſs and [18]indolent in their progreſs. Such tumours in their commencement are rarely attended with pain, or certainly not much. The abſorbed fluids, in their courſe to the veins, in Scrophula, are arreſted in the lymphatic glands, which ſwell, and after a great length of time in⯑flame and ſuppurate. Doctor Darwin^* ob⯑ſerves that theſe indolent tumours of the lym⯑phatic-glands which conſtitute Scrophula, originate from the inirritability of thoſe glands; which therefore ſooner fall into torpor after having been ſtimulated too violently by ſome poiſonous material: as the muſcles of enfee⯑bled [19]perſons ſooner become fatigued and ceaſe to act when exerted, than thoſe of ſtronger ones. On the ſame account theſe ſcrophulous glands are much larger in acquiring increaſe of motion, after having been ſtimulated into ac⯑tivity, and either remain years in a ſtate of in⯑dolence, or ſuppurate with difficulty, and ſometimes only partially.

It has been noticed by Doctor Beddoes that ſcrophulous tumours ariſe from a deficiency of oxygene, occaſioning inirritability of the ſyſtem, and when we remark the ſallow ap⯑pearance of the countenance, the ſlowneſs of the pulſe, and the torpor of the tumours in ſuch patients, we ſhall readily aſſent to this doctrine. The tumours when they break oc⯑caſion ulcers, whoſe edges are pale and flabby, and naturally diſinclined to heal, ſeldom yield⯑ing a good diſcharge. At firſt they afford a viſcid, glairy, and ſometimes whitiſh curdly [20]matter, which afterwards changes into a thin, and aqueous ſanies. After continuing in this ſtate for ſome length of time, the edges of the ſores become irregular, and ſmooth, ſometimes however theſe are elevated, and at other times are very flat. When they are healed up quick⯑ly, they ſoon break out upon ſome other parts of the body, where there is local debility, or in other words, diminiſhed action of the ſen⯑ſorial power. For this reaſon it appears, that vital-air, by invigorating the ſyſtem, en⯑creaſing the excitability both local and general, and by keeping up a gentle and univerſal ſtimu⯑lus, which pervades the whole frame, very frequently have effected a cure, when even all other remedies have failed.

At a certain age, that is between infancy and puberty, theſe tumours ſometimes diſap⯑pear, and ulcers have healed up ſpontaneouſly, though very rarely.

[21]To diſcuſs ſcrophulous tumours, and heal ſcrophulous ſores, a variety of remedies have been extolled, ſuch as preparations of Mer⯑cury both internally and externally, ſolutions of Cerus. Acetat. Aq. Veg. min. the Bark, Tar-water and Cicuta. Calomel^* by acting as a ſtimulant and increaſing the excitability of the Syſtem, has been given in ſmall doſes with evident good effects, and theſe would be augmented, by inhaling at the ſame time oxygene-gas.

Electricity as a topical remedy is ſpoken of in high terms, by thoſe who have applied, it and I think I have in ſeveral inſtances ſeen it of ſervice. Preſſure^† beyond eaſe over the [22]tumours is the beſt exciting power, by aſſiſt⯑ing weak veſſels, and promoting abſorption. This will be all that is neceſſary to be done for ſuch tumours before they break.—When ulceration has taken place, other remedies be⯑come neceſſary.

Among the foremoſt ſtands the woodſorrel (oxalis acetoſella^*) of which the reader may ſee a fuller account, with a variety of caſes in which it has been ſucceſsfully employed, by referring to "Beddoes's Conſiderations on [23]the Medicinal uſe of Factitious Airs," pages 144, 150, 152, and 158, Part IV. and Town⯑ſend's Guide to Health, Vol. 2, Page 521. A quantity of the leaves ſhould be procured freſh, pounded in a mortar, and mixed with oatmeal, and applied as a poultice to the ſores. At firſt it occaſions much pain and redneſs in the part, but the pain after two or three re⯑petitions abates, and as to the redneſs that is a beneficial effect. After the application a ſloughing comes on, and the diſcharge which was before thin and acrid is converted into good pus. Should the diſcharge be foetid, powdered charcoal, or fine mendip manganeſe reduced to an impalpable powder, ſhould be ſprinkled over the ſore previous to the poultice being applied. Thus the foetor will be cor⯑rected, and the healing proceſs forwarded at the ſame time.

[24]In the treatment of Ulcers, their diſpoſition to heal (let the means of promoting this pur⯑poſe be what they may) depends upon the matter ſecreted by them, being firſt thickened by increaſing the abſorption in them, and then leſſened, till all the matter is abſorbed which is brought by the arteries, inſtead of being depoſited in the ulcers. Scrophulous ulcers are produced, chiefly in the lymphatic-glands, by weak and relaxed veſſels, which have loſt their tone, and therefore have not vital energy ſufficient to produce inflammation, without which, as I have before ſaid, there can be neither ſuppuration nor granulation. Where their edges are very high and irregular, as they ſometimes are, I have touched them at each dreſſing with Bernhard's mixture^*, which I [25]have from experience found to be a good ap⯑plicaton. Waſhing ſcrophulous ſores with diluted citric-acid^†, before the poultice is applied, keeps up that proper irritability in the part, which is eſſential, to the formation of good matter. The action of ſorrel and lemon-juice, applied to ſcrophulous ulcers, probably ariſes in ſtimulating the languid in⯑irritable abſorbents, by means of the oxygene contained in theſe ſubſtances; juſt as acid gargles promote the abſorption of the thinner parts of the ſaliva, which is then eaſily diſ⯑lodged Theſe local applications will be ren⯑dered much more efficacious, if the patient [26]were at the ſame time to inſpire hyper-oxyge⯑nated air ^*, and take bark and chalybeates; uſing at the ſame time a moderate degree of exerciſe. The putrid appearance which ſcro⯑phulous ulcers ſometimes put on, is owing to exhauſted excitability, followed by indirect debility, which is diſcovered by the very of⯑fenſive ſmell, blackneſs, and flaccidity in the part, under theſe circumſtances, whilſt vital energy is reſtored to the part by the oxalis, or metallic oxyds, particularly that of Mercury, vigour will be imparted to the conſtitution by that natural and moſt diffuſible of all ſtimulants the vital-air!

SECTION III. Of the PULMONARY CONSUMPTION.

WHEN Phthiſis-Pulmonalis ariſes from a ſcrophulous affection, the ſeat of this diſeaſe is found clearly to exiſt in the cellular ſubſtance of the Lungs, where round firm bo⯑dies named tubercles are formed ſimilar to the ſwelling of the lymphatic-glands on the ex⯑ternal ſurface: they are of different ſizes from the ſmalleſt granule, to half an inch in dia⯑meter and often in cluſters—They adhere pretty cloſely to the ſubſtance of the lungs, and have no particular covering or capſule.— In proportion to the ſmallneſs of their ſize, is their firmneſs, and when cut into, in this ſtate, are of a white colour with a conſiſtence nearly approaching to cartilage: in ſome part of them there is always a ſmall pit or hol⯑low [37]where as they increaſe, the formation of the matter begins, and at length they paſs into vomicae. But the formation of matter is not always determined by their ſize. In ſome it begins very early. when in ſmall quantity. the conſiſtence of the matter is thick and cur⯑dy: when in greater quantity it is thinner, and more reſembling the matter of a common fore. From this view of the diſeaſe, which diſſection affords, tubercles and vomicae con⯑ſtitute the cauſes of this diſorder with its ſeveral attendant ſymptoms, and its difficulty of cure may be hence readily accounted for. Each of theſe tubercles is to be conſidered in the ſame light as that of an external lymphatic ſwelling, which in order to its termination, muſt be liable to all the ſubſequent conſequen⯑ces that either attend this, or any rupture of the teguments in other ſituations, while an additional obſtacle to the proceſs of healing is [38]here preſented from the conſtant motion of the lungs^*

The accurate inveſtigations of Doctor Stark^‡ have thrown more light upon the ſubject of tubercles than all the labours of preceding phy⯑ſicians. He ſays that tubercles whilſt ſmall are always ſolid; when large, they are ſome⯑times ſo. They approach to the hardneſs of cartilage, and when cut through appear ſmooth, ſhining, and uniform. No veſſels are to be ſeen in them, even when, after injecting the pulmonary artery and vein, they are examined with a microſcope. They are always in the cellular ſubſtances, never in the air veſſels, in which the extremities of the bronchial ramifi⯑cations terminate. They are at firſt extremely ſmall, numerous and in cluſters; but never in [39]the leaſt inflamed. When they become vomi⯑cae, it is always in the ſuperior and poſterior part of the lungs, where they form ſtrong ad⯑heſions to the Pleura.

Thoſe perſons liable to tubercles^* are ge⯑nerally of a fair complexion, ſoft ſkin, and irritable fibre, and diſpoſed to ſuffer by lym⯑phatic [40]tumours. Some other circumſtances of a local nature in addition to what has been ſaid on the ſubject, may add to the fatality of the diſeaſe in this climate, and tend to bring it on where otherwiſe there was no prediſpoſi⯑tion in the patient to become ſo. One cauſe which may aſſiſt greatly, is that paſſion, which manifeſts itſelf among our females, but which daily grows out of faſhion, of wearing tight ſtays^*, by which the circulation of the blood [41]through the lungs is impeded, the capacity of the thorax leſſened, and the ſpace which in a ſtate of health is required for the free action of the lungs, is diminiſhed. A narrow cheſt, a long neck, and prominent ſhoulders, though not occurring in all caſes of ſcrophula, may be conſidered as unfavourable marks of this diſ⯑eaſe. Mr. Townſend in his Guide to Health, [42]Vol. 2, obſerves, "that when medicines fail to effect a cure in Phthiſis Pulmonalis, a change of climate muſt be recommended, and no cli⯑mate, in his opinion, can be ſuperior to that of Valencia." Should the ſcrophulous or con⯑ſumptive patient be inclined to make the trial, he will have an eaſy route by Paris, Lyons, Montpellier, and Barcelona, and for leſs than fifteen guineas he will find himſelf tranſported into a paradiſe, in which nature exhibits an everlaſting ſpring. (Vide Townſend's Travels through Spain, Vol. I. and II.) The fame in⯑genious author obſerves, that he never met with this diſeaſe in Spain, owing as he thinks to the uniform ſtate of the weather, and heat of the climate; but I ſhall have occaſion here⯑after to ſhew, that it is a diſeaſe incident to very warm and extreme cold climates, and that contrary to the opinion of a celebrated Pro⯑feſſor, is not influenced by the ſtate of the weather.

SECTION IV. TABES SCROPHULOSA.

THIS ſpecies comprehends all caſes in which diſeaſed glands occaſion atrophy. It takes in therefore the tabes glandularis, tabes meſenterica, atrophia infantiles, with the atro⯑phia rachitica of Sauvage, and the tabes, to which inebriates are ſubject from ſchirrhous glands, whether of the liver, ſpleen, pan⯑creas, or meſentery, and is attendant on the ſpecies juſt before enlarged upon (Phthiſis Pulmonalis.) In patients who have died of this modification of the diſeaſe in queſtion, I have ſometimes found the receptaculum chyli, and ductus thoracicus affected in like manner with the meſenteric glands. ^*.

SECTION V. OPHTHALMIA TARSI.

THE eye-lids are very commonly ano⯑ther ſeat of this diſeaſe: it is very difficult to make a patient labouring under the Opthalmia Tarſi believe ſo. A very ſlight cold frequent⯑ly brings on inflammation of the eye-lids, which ultimately terminates in a diſorder of the eye, and there is no form of the diſeaſe ſo tedious to remove, or more painful in its at⯑tack, or in which a relapſe is more liable to occur than in this.

After the inflammation of the eye-lids com⯑mences, a ſwelling of the ſobaceous glands im⯑mediately follows, which terminates in ulce⯑ration, and this ulceration is generally of a troubleſome nature. A better deſcription of the progreſs of this ſpecies of Scrophula can⯑not [45]well be given than in the words of Doctor Niſbit, who obſerves, "that an acrid diſ⯑charge conſtantly takes place from it, which irritaing the eye itſelf renders it weak, and unable to bear much impreſſion either of light or heat." Frequently it is of a more viſcid na⯑ture, and glues the lids together in the night-time, leaving a gorey appearance on the lid through the day.

This form of the diſeaſe is not often acute, it is of a more chronic ſpecies, and gives a diſ⯑agreeable appearance to the ſight. The eye-lids continue always more or leſs inflamed, thickened, and raw, and the ulcerations are with difficulty healed up, or if they are, break out afreſh on any ſudden cauſe of irritation. On leaving one eye the inflammation is liable in ſuch caſes to attack the other; and wher⯑ever one attack has taken place to a degree of violence, the patient is expoſed to its recurrence [46]from the ſlighteſt cauſe. I have never found any difficulty in effecting a cure in the worſt caſes, and that even after all other remedies have failed, by directing patients to take ſmall doſes of calomel at bed-time, rubbing a little of the ung. Hydrargy. nitrat. between the lids the laſt thing at night, and inhaling the vital⯑air in the day-time in doſes ſuited to the age and conſtitution of the patient. This new mode of treatment I ſhall illuſtrate, by an ex⯑ample.

A gentleman of my acquaintance had labour⯑ed under an ulceration of both eye-lids for nearly three years, and on which account he had the advice of the moſt able oculiſts in this city. A variety of applications at different times had been uſed, and the materia-medica ſearch⯑ed all over for various alteratives. He had been at the ſea-ſide for four months, and had taken the Aqua-marin. internally during the [47]whole of that time every other morning with⯑out intermiſſion, but had derived no advan⯑tage. I recommended him ſtrongly to inhale oxygene-gas, which he did regularly every day for three months, in the proportion of eight quarts, to twelve of atmoſpherical air. As he could bear no ſharp application to the eye-lids, ſimple ſpermaceti ointment, melted in a ſpoon over a lighted candle, was introduced by means of a camel's-hair pencil between the Palpebrae every night. Under this plan of treatment in four months he was quite reco⯑vered, and has ſince had no relapſe. Change of air, plenty of exerciſe, with chalybeats, and the ung. hyd. nit. will ſeldom fail of re⯑moving this diſeaſe, and their good effects will be augmented, if the patient inhales the vital⯑air. Nouriſhing diet, with generous port⯑wine, will give vigour to the ſyſtem. Waſh⯑ing the eye-lids with cold water of a morning, is highly injurious.

SECTION VI. Of the HYDARTHUS.

^* THE Hydarthus is uſually reckoned as another ſpecies of Scrophula, which begins in the lymphatic glands about the knee-joint, [49]and is very painful and ſlow in its progreſs. It commences with a ſlight tumefaction of the cellular membrane, without any diſcolouration of the ſkin, attended with great heat and fre⯑quent pain. The ſkin appears clear and ſhi⯑ning, the joint becomes finally enlarged, the ſurrounding parts feel elaſtic, the limb gradu⯑ally waſtes, abſceſſes form in the vicinity of the joint, and a diſcharge takes place, being, as a late writer obſerves, ſometimes a viſcid glairy fluid, at other times more purulent and [50]ſometimes entirely ſanious and foetid matter. If the diſeaſe be not in this ſtage detected, and its progreſs ſtopped, it proceeds on and extends itſelf to the bone itſelf. Thus the cartilages take on ſymptoms of inflammation, and are diſſolved. The bone itſelf is not exempted from undergoing the ſame change; and the ſtructure of the joint on diſſection is found melted down, more or leſs, into one hetero⯑geneous maſs, conſiſting of a white glairy fluid mixed with matter, with pieces of carious bone of different ſizes. The patient in this laſt ſtage dies if amputation is not had recourſe to, and even the operation itſelf will not at all times prove ſalutary, as the hectic attending theſe caſes will frequently have too far reduced the ſtrength of the patient.

It will be neceſſary to diſtinguiſh properly between the Scrophulous white ſwelling and that which ariſes from a Rheumatic affection, [51]for reaſons that muſt appear obvious to the practitioner. From the unfavourable diagnoſis which Mr. Bell in his Treatiſe on Ulcers gives, a practitioner might be intimidated from uſing his utmoſt endeavours in ſaving the limb; for he obſerves, page 475, ‘that in the ſcrophu⯑lous white ſwelling, it is not probable that art will ever be able to afford much aſſiſt⯑ance.’ Since the publication of Mr. Bell's Treatiſe, our hopes are revived from the be⯑nefits to be derived from inhaling the vital air ^*. The Rev. Mr. Townſend obſerves in his in⯑valuable Guide to Health, Vol. 2. that from what he has witneſſed in the practice of his friend Doctor Thornton, ‘he is perſuaded, that in white ſwellings the inhalation of hyper-oxygenated air will produce the great⯑eſt benefit.’ For in this new mode of treat⯑ment with vital air, energetic action in the [52]part is ſupported by the ſyſtem, whereas in the old practice, with external applications only, it is kept up for a ſhort time by partial ſtimuli, on weak and diſeaſed veſſels.

I would firſt recommend leeches to be ap⯑plied, and after they have fallen off, bliſters ſhould ſucceed them. At the ſame time I ſhould adviſe bark and ſteel, with the inhala⯑tion of oxygene-gas, with a fine open air, gentle exerciſe, and cheerful company; and I make no doubt from the experience I have had in theſe caſes, that this diſeaſe is capable of being cured like other caſes of Scrophula.

SECTION VI. Of the BRONCHOCELE.

BRONCHOCELE though not uſually ranked under the head of Scrophula, partakes in every reſpect of the nature of that diſeaſe. It is generally found among perſons living in mountainous ſituations,^* as Derbyſhire, So⯑merſetſhire, &c. It comes on with a ſmall ſwelling externally about the middle of the throat, unattended with pain, and gradually increaſes in ſize till it renders both reſpiration and deglutition laborious and difficult. It has long been called the Derbyſhire neck from its [54]frequent occurrence in that country, but ſuch appearances are now very common every where. It is ſuppoſed by ſome to ariſe from an acidity in the ſtomach, and abſorbent medi⯑cines as burnt ſponge ^*. Sal. ſodae, Magneſ. [55]uſt, &c. have been preſcribed with that view. Upon the very reſpectable authority of Mr. Townſend, we are informed that in the vale of Pewſey, where it is very frequent, he never fails of curing it, in all who apply to him for advice, by giving lozenges of burnt ſponge well powdered, and made up with the Syr. Altheae. (Vide Guide to Health, Vol. II. page 462.) Finding, however, the uſual remedies preſcribed for this ſpecies of the diſ⯑eaſe ſo often fail, I was reſolved ſome time back to try the effects of the vital-air, and a caſe to try the effects of the vital-air, and a caſe ſhortly afterwards coming under my care, gave me a favourable opportunity of obſerving a very rapid progreſs under this plan of treat⯑ment.

Miſs M. P. aged 18 years, about three years ago perceived a ſmall ſoft tumour grow⯑ing about the middle of her throat, which continued gradually increaſing in ſize till the [56]latter end of the year 1797. It gave her no pain, but ſometimes affected her ſwallowing, and looked very unſightly. A variety of ap⯑plications had been made to the part, and un⯑der the care of ſeveral eminent men in this city, ſhe had taken the cicuta, burnt ſponge, and latterly ſea-watar. A ſolution of common ſalt in diſtilled water was alſo applied to the part by means of folds of linen cloth, dipped in this mixture and renewed every eight hours. But this rather did harm than good^* Elec⯑trical [57]ſhocks were alſo paſſed through the tu⯑mour every day for a month, but without any apparent advantage. This young lady was in the habit of drinking large draughts of cold [58]water. She began in February 1798 to inhale eight quarts of oxygene-gas with twelve of atmoſpherical-air daily till the latter end of [59]July when the tumour was reduced to the ſize of a pullet's egg. She now left off the vital air, finding no inconvenience from the tu⯑mour, nor has it ſince that time grown any larger.

It will be generally found that perſons who have theſe monſtrous enlargements of the thy⯑roid glands drink much cold water, and may not this chill theſe glands, and bring on this diſeaſe? It is found to conſiſt chiefly of fat; and the alkali which enters ſtrongly into the vaſcular frame uniting with this fat forms ſoap. The abſorbents being rouſed into action by the vital-air which is known to produce leanneſs^*, take up this ſaponaceous matter and [60]thus the diſeaſe is removed, cito, tuto et ju⯑cunde. The Peruvian-bark, lime-water, and kali ſometimes are of ſervice, and I have ſeen lozenges of nitre, taken in the mouth, and diſſolved gradually, of ſervice. Does this act then by imparting oxygene in the ſyſtem? It might be uſed in conjunction with the vital-air. The Flor. Zinci have lately been recom⯑mended in Germany, and ſo has the Cicuta, but neither have anſwered in the hands of me⯑dical practitioners in England, who have ſtrict⯑ly adhered to the rules laid down by the gen⯑tlemen who firſt propoſed theſe remedies. Doctor Gautieri ^* a very ingenious phyſician ſtrongly recommends the different preparations of mercury, and ſays he has cured ten caſes out of fifteen with it. I believe myſelf that in ſome caſes it might be employed with ad⯑vantage, [61]for the oxyd of mercury in paſſing through the human body, parts with its oxy⯑gene, and it is this oxygene alone, which re⯑mains combined with the ſyſtem, that the ef⯑fect produced by oxydated mercury is owing, and therefore rouſes the abſrobents to action; and if the vital air is adminiſtered at the ſame time, its operation will be quickened.

Stimulants ſhould be applied externally, as liq. c. c. vol. Electricity, ſoap plaſter, &c.

SECTION VII. HYDROCEPHALUS.

HYDROCEPHALUS is ranked by ſome as a ſpecies of Scrophula. The firſt ſymptoms are great reſtleſſneſs, violent pain in the head, generally confined to one ſide, eſpecially above the eyes and in a direction between the temples; ſickneſs at ſtomach, an itching of the noſe, loſs of appetite, a ſal⯑low and ſometimes very white complexion. The bowels are in general coſtive, and it is with difficulty that ſtools can be procured. Theſe are generally of a dark greeniſh colour, with an oilineſs, or glaſſy bile, rather than the ſlime which accompanies worms, and they are for the moſt part extremely offenſive. Febrile ſymptoms enſue which exacerbate towards [63]evening, great drowſineſs, languor and pee⯑viſhneſs. As the diſeaſe advances, the pulſe is uſually ſlow and heavy. In the commence⯑ment of the diſeaſe the pupils are very much contracted, but as the diſeaſe advances a dila⯑tation of the pupil takes place, chiefly in that eye, on which ſide the fluid is collected. The child will at intervals ſcream out, and have frightful dreams. It will pick the bed-clothes, have ſubſultus tendinum, and talk incoherently. In this ſtate I have known children to linger out a fortnight and ſometimes three weeks, occaſioning the moſt poignant diſtreſs to thoſe around. Doctor Percival obſerves that Hy⯑drocephalus derives its origin ſometimes from inflammation, but moſt frequently from ſtru⯑ma and laxity of fibre, inducing glandular obſtruction and feeble action of the lymphatic ſyſtem, all which diſpoſe to an effuſion of water in the brain. The obſervations of Bon⯑netus [64] ^* on this diſeaſe are the beſt to be found among the ancient writers, but I much doubt whether or not he ever obſerved one half the morbid appearances in the heads of thoſe per⯑ſons he opened who died in conſequence of the effuſion of water which he relates with ſo much ſcrupulous exactneſs. The theory of dropſy as eſtabliſhed by Doctor John Brown and adopted by his pupils, and thoſe who practiſe on what is vulgarly called the Brunonian Syſtem, is moſt generally found to be ſucceſsful except⯑ing in a few inſtances where it has been inju⯑diciouſly applied, for it is now proved by ra⯑tional practitioners that until the excitement is increaſed by ſuch remedies as will be here⯑after pointed out, that no juſt expectations of cure can be entertained. Accumulations of water in the brain, producing thoſe ſymptoms which characterize Hydrocephalus, are the [65]ſame with every other caſe of Aſthenia, or Idiopathic affection, depending upon pure de⯑bility, which though extended to the whole ſyſtem is more prevalent in the exhalent and abſorbent parts of it, and more eſpecially af⯑fecting the exhalents and abſorbents of the brain.

It is in the early ſtage of the diſeaſe that medicines can alone be of ſervice. When the affected ſide can be diſtinguiſhed, the tre⯑phine ſhould be applied. When the water is ſuppoſed, from the mildneſs of the ſymptoms, and their gradual progreſs, to be effuſed be⯑tween the dura and pia mater, and when a very evident fluctuation can be felt, chiefly at the bregma, we ought to puncture without heſitation the dura mater: as this can be done without danger, it may give immediate relief, and may have ſome chance of producing a cure. Should it be thought expedient to perform the [66]operation, the dura mater ſhould be punctured cautiouſly with a lancet, at the ſide of the bregma, or as far as poſſible from the ſuperior longitudinal ſinus. Thoſe who are attentive to the commencement and progreſs of the diſ⯑eaſe, will with the greateſt facility diſtinguiſh it from worm fever, to which in its early ſtage it bears a ſtrong analogy, and for which it is frequently miſtaken.

Hydrocephalus is diſtinguiſhed from Apo⯑plexy by its being attended with fever, and from nervous fever by the paroxyſms being very irregular, with perfect intermiſſions many times a day. In nervous fevers the pain of the head generally affects the middle of the fore⯑head: in Hydrocephalus it is generally on one ſide of the head. Doctor Darwin, whoſe opi⯑nion carries the greateſt weight, ſuppoſes that the great diſpoſition in perſons labouring under the diſeaſe, to lie down immediately after hav⯑ing [67]raiſed their heads from off the pillow, is owing to the preſſure of the water on the large trunks of the blood-veſſels entering the cavity, being more intolerable than on the ſmaller ones: for if the large trunks are compreſſed, it muſt inconvenience the branches alſo▪ but if ſome of the ſmall branches are compreſſed only, the trunks are not ſo immediately in⯑commoded. I think it is highly probable that where one eye is affected the diſeaſe exiſts in the ventricle of that ſide. Some authors aſſert that this diſeaſe ſeldom appears after the thir⯑teenth year, whereas it daily occurs in all ages from two years to thirty ^*, though it attacks chiefly children.

A woman in the pariſh of St. Giles's Bloomſ⯑bury was ſeized with Hydrocephalus in her [68]twenty-ſixth year. She was treated by the medical attendants in the uſual way, by having recourſe to bleeding, purging and other evacu⯑ations. She died on the twelfth day. Upon opening the head, I found the veſſels of the brain very turgid, though ſhe had loſt thirty ounces of blood. The anterior ventricles were filled with a diaphanous fluid. The foramen in the ſeptum lucidum was ſo diſtended as to admit the top of my little finger. The tuni⯑ca arachnoidea was opake and thickened. In all there were about four ounces and a half of water in the ventricles. In the pericardium there was found more fluid than is uſual in a healthy ſtate.

It is a melancholy fact, that hundreds of children die annually of this diſeaſe who might perhaps under the care of ſkilful perſons have recovered.

[69]The remedies which have been moſt com⯑monly reſorted to for the cure of this com⯑plaint, are Mercury, bliſters applied on the head, calx zinci, ſquills, opium, and digita⯑lis, and of late the fol. doron. German. Now as all theſe remedies generally fail, it is proper to propoſe ſome others.

So ſoon as this diſeaſe aſſumes the character of Hydrocephalus, the head ſhould be imme⯑diately ſhaved, and from eight to a dozen leeches applied. After they fall off, bliſters in the direction of the ſutures ought to be laid on, and electrical ſparks ſhould be paſſed through the head in all directions. The bow⯑els are beſt emptied with large doſes of hy⯑drarg. muriat. mitis. A generous diet ſhould be enjoined to invigorate the ſyſtem, and the alimentary canal in particular.

The oxygene-gas which has already been ſhewn to be ſo powerful in rouſing into action [70]that ſet of veſſels which in this diſeaſe is in⯑ert and paralytic ſhould be adminiſtered daily diluted with atmoſpherical air, ſuited to the age and conſtitution of the patient. In ſhort, whatever will rouſe the abſorbent ſyſtem to a vigorous action ſhould be employed, ſince we find by our reſearches into the animal oecono⯑my, that the abſorbents do not act by capil⯑lary attraction but with vital energy, ſo their action may be either exceſſive or diminiſhed.

Opium ^* in large doſes is found to be very beneficial as a powerful ſtimulant. Sternutato⯑ries [71]have been employed with advantage; for this purpoſe one grain hydrargy. vitriol to ten grains of liquorice powder, might be uſed as a ſnuff.

It will be unneceſſary to relate all the caſes in which the method of cure I have recom⯑mended has proved ſucceſsful; the following are ſelected from ſeveral more which were ex⯑ceeding alarming in their attack.

SECTION. VIII. RACHITIS.

THE Rachitis or Rickets, to which children are ſo peculiarly ſubject, is another modification of Scrophula^* This diſeaſe ſo deſtructive to the infant race of this country, called by the French, the Engliſh diſorder, ne⯑ver [86]appeared in Britain till manufactures began to flouriſh, and people attracted by the ſordid love of gain▪ left the country to follow ſeden⯑tary [...]pl [...]ments in great towns▪ Gliſſon defines Rachitis to be a diſeaſe jui generis ^*, I never ſaw the rickets myſelf but in thoſe children in whom veſtiges of a ſcrophulous affection could be readily traced.

It generally ſhews itſelf firſt by an enlarge⯑ment of the head, great weakneſs in the ſpine, a prominence of the forehead, and ſudden ema⯑ciation of the whole body. The muſcles feel flaccid, the ribs loſe their convexity and become flattened on the ſides, while the ſter⯑num is puſhed outward. The abdomen is tu⯑mified and feels hard, and the child is gene⯑rally coſtive. The child loſes its uſual cheer⯑fulneſs, and becomes dull and peeviſh. In [87]ſome you obſerve great acuteneſs and mature ſenſibility, while in others ſtupidity and fatui⯑ty appear. The dentition is very ſlow, and I have remarked that thoſe teeth which come out, have a very ſmooth feel, and ſoon loſe colour. Little or no fever attends this ſtage of the diſeaſe, but as it advances the pulſe is more frequent and the appetite very keen. The appearances on diſſection ſhew a melan⯑choly ſtate of the diſeaſe ^* In general all the abdominal viſcera are preternaturally enlarged. The lungs filled with tubercles and adhering to the pleura. The meſenteric-glands indu⯑rated. The brain flaccid, and all its cavities filled with an effuſion of a ſerous fluid. The bowels boaded with ſlime and mucus. The bones are ſo ſoft as to be eaſily cut through, and the muſcular parts very tender and looſe. [88]For a proximate cauſe Doctor Cullen ^* aſſigned a deficiency of oſeous matter in the fluids, de⯑pending upon a general laxity and debility of the moving fibres of the organs that perform the functions of digeſtion and aſſimilation.

Monſieur Bonhomme ^† a celebrated French chemiſt, ſuppoſes the nature of the rachitic diſorder ariſes on the one hand from the de⯑velopement of an acid approximating in its properties to the vegetable acids, particularly the oxalic, and on the other from the defect of phoſphoric-acid, of which the combination with the animal calcareous earth forms the natural baſis of the bones, and gives them their ſolidity.

From whence it follows, that the indication reſulting from this propoſition, if once adopt⯑ed, [89]would be, that the treatment of rachitis muſt depend on two principal points, namely, to prevent the developement of the oxalic-acid, and to re-eſtabliſh the combination of the phoſphoric-acid with the baſis of the bones to which they owe their ſolidity.

The author proves by experiments and ob⯑ſervations in the firſt place, that alkaline lo⯑tions to the parts affected with rachitis, con⯑tribute to their cure^*, next that the calcareous phoſphate taken internally is really tranſmitted by the lymphatic paſſages and contributes to oſſification; and laſtly, that the internal uſe of calcareous phoſphate, whether alone or com⯑bined with the phoſphate of Soda, powerfully contributes to reſtore the natural proportions in the ſubſtance of the bones, and accelerate the cure of rachitis.

[90]The effect of the action of acids upon bones, was long before known; that is to ſay, that when deprived of calcareous phoſphate and re⯑duced to the gelatinous parenchyma which forms one of their elements, they loſe their conſiſtence and become flexible. Hence it was already conjectured by various Phyſicians, that the rachitis was the effect of a peculiar acid.

Every one who is attentive to the diſeaſes of children muſt have obſerved a diſpoſition to aceſcence in the primae viae. The odour which characterizes aceſcence is often manifeſt in their breath, and even their perſpiration. The bile which is the natural cathartic of the body corrects this diſpoſition; but we gene⯑rally find a deficiency of this ſecretion in ra⯑chitic infants. It does not colour their excre⯑ments, and the acids accordingly are develop⯑ed in a very decided manner. They diſturb [91]the circulation and attack and ſoften the bones. As it is by defect of animalization that theſe acids develope themſelves, it follows that their character is analogous to the fermenteſcible vegetable acids, and more or leſs to the oxalic acid: and that on the contrary, the animal acid of phoſphoric acid ceaſes to be formed, and to unite with the animal calcareous earth; whence they are deprived of the principle of their ſolidity.

In order to eſtabliſh the doctrine of Mon⯑ſieur Bonhomme upon preciſe experiments, it is requiſite to analyze rachitic bones compara⯑tively with thoſe of healthy individuals of the ſame age: and as it is known that the urine of rachitic ſubjects depoſits a great quantity of a ſubſtance of ſparing ſolubility and earthy ap⯑pearance, it would be advantageous to make a [92]complete analyſis of this urine and its ſedi⯑ment.^*.

Doctor Darwin is of opinion that if the Theory of Monſieur Bonhomme were juſt, the ſoft parts of ſuch bones ſhould ſhew evi⯑dent marks of ſuch acidity after death, which he believes has not been obſerved. Nor is it, [93]adds he ^* analagous to other animal facts, that nutritious fluids ſecreted by the fineſt veſſels of the body ſhould be ſo little anamalized, as to retain acetous or vegetable acidity.

Bad nurſing, and an over-proportion of food for the age of the child ^‡ inattention to clean⯑lineſs; cold either without moiſture or with it, want of exerciſe, bad air and innutritious food, are the chief cauſes which bring it into action. I am inclined to think that this diſorder firſt takes its riſe from the mouths of the lacteals [94]being obſtructed by mucus; from a deficiency of bile, and the diſengagement of an elaſtic gas in the inteſtines during the proceſs of fer⯑mentation. The digeſtion then becomes im⯑paired, and a laxity and debility pervade the whole ſyſtem. Hoffman ſuppoſes it to depend on a deficiency of nutrimental juices, depraved digeſtion, ill conditioned chyle and obſtructed lacteals, and obſerves, "Quam maximè au⯑tem hoc loco accuſari etiam debet bilis defec⯑tus, vel inertia à praeternaturali hepatis conſti⯑tutione inducta, ob quam non modo digeſtio valdè laeditur, ſed oſcula quoque tunicae inteſ⯑tinorum villoſae, minus vitè à mucoſitate ſua liberata, chylum aegrius recipiunt et tranſmit⯑tunt."—Hoffman de atrophiâ infantum.

Sydenham (ſince whoſe time the region of human maladies has been more accurately ex⯑plored) no doubt from his recommending ca⯑thartics, ſuppoſed it to originate in a foul ſtate [95]of the ſtomach and bowels, and the high au⯑thority of the learned author of the Guide to Health, confirms this opinion; for he ſays that after thirty years experience in a neighbour⯑hood in which rickets abound, I do not re⯑collect a ſingle inſtance in which this ^* cathar⯑tic failed with the aſſiſtance of tonics to effect a cure.

Moſt ſcrophulous and rachitic patients are very pale, and have a blueneſs about the ends of their fingers, and under their eyes, which indicate a deficiency of oxygene in the blood, and the inirritability of the muſcles evinces this alſo; for upon reſtoring that principle either by the organs of digeſtion or through the me⯑dium [96]of the lungs, with proper cathartics, exerciſe and wholeſome air, they ſoon recover without much medicine. I have never ſeen any good derived from the whole claſs of to⯑nics with which our materia medica furniſhes us, and which Phyſicians have extolled as ſpe⯑cifics—a favourable ſubterfuge for medical ig⯑norance. The Ens-veneris, Soda, and Cicuta are mere traſh. The acidity ſo predominant in young rachitic ſubjects ſhould be corrected by giving rhubarb, magneſia and vitriolated kali. Cold bathing and exerciſe—friction all over the body with a bruſh—the bowels kept clear from ſordes by large doſes of calomel pp^t. and a plentiful ſupply of vital-air by the organs of reſpiration, will in all caſes where good can be done, effect a cure.

Of the benefits ariſing from the vital-air I have ſeen ſeveral inſtances, but the following [97]caſe the firſt in which I recommended it, de⯑ſerves notice.

Miſs G. A. aged two years, very thin and tall of her age, about nine months ago, com⯑plained of a pain in the back about the third lumbar vertebra. She was ſo weak in that part as always to require ſupport behind. A moſt ſingular enlargement took place, which was particularly conſpicuous in the extremities con⯑tiguous to the articulations, and in the bones of the cranium. Her countenance became pale—ſhe had a very craving appetite, and ſhewed a great diſpoſition to eat chalk. Her belly became tumid and hard, and her breath⯑ing laborious, which laſt ſymptom aroſe from a very ſmall thorax, much flattened in before, and at its ſides.—Emetics, cathartics, and ab⯑ſorbents were the chief medicines preſcribed as occaſion required, and in the mean time an infuſion of the Cinchonae with Tinct. Ferri [98]was given three times a day. Notwithſtand⯑ing ſhe grew daily worſe, and was ſo emaci⯑ated as ſcarcely to be recognized by her friends.

Under theſe circumſtances I recommended the vital-air which ſhe inhaled daily four quarts to ſix of common air. At night ſhe took pills compoſed of Ferr. Vitr. and Ext. Cinchonae, and five grains of Calomel at bed⯑time once a week. This plan being purſued four months in conjunction with exerciſe, nu⯑tritious diet, and a fine open air, ſhe quite recovered, and is now a healthy girl.

This caſe I related ſome time back a one of our Medical Societies in this City, where the cure was attributed by the Anti-Pneumatics (if I may be allowed the expreſſion) to the ſteel medicine, diet, &c. but as this medicine when given per ſe, is ineffectual from the ſmall [99]quantity of oxygene it depoſits in the conſti⯑tution, it certainly muſt be acknowledged that it was the ſupply by the organs of reſpiration, that reſtored the young lady to health.

There appears a propenſity in human nature to reſiſt conviction, and that propenſity is ex⯑ceedingly conſpicuous in the preſent inſtance, in which prejudice oppoſes palpable evidence. ‘And although like Naaman the Aſſyrian I cannot tell why the waters of Jordan ſhould be better than Abana and Pharpar, rivers of Damaſcus,’ yet ſince experience has proved them ſo, no reaſoning can change my opinion of the good effects the airs have on this and a variety of other diſeaſes. For

An impaired digeſtion I before mentioned as one of the primary ſymptoms of rachitis: this, [100]as the late ingenious Phyſiologiſt Mr. Hunter proved by experiments on various animals, a⯑riſes from the diminution of animal heat, which quickens the proceſs of digeſtion. Now the generation of animal heat, accord⯑ing to Doctors Goodwin and Crawford, and the Rev. Mr. Townſends, is from the de⯑compoſition of oxygene-gas in the lungs dur⯑ing reſpiration^*: thus as I ſuppoſe a part of the oxygene unites with the iron contained in the blood, and converts it into an oxyd; ano⯑ther and a greater proportion unites with the carbon brought by the venous blood to the lungs, and forms carbonic-acid gas, while [101]another portion of the oxygene unites with the hydrogene brought in the ſame manner, and forms water.

A portion of this oxygene which unites with the iron and hydrogene, becomes fixed on theſe ſubſtances, and gives out the heat which ſupported it in a gaſeous ſtate, while the remainder forming carbonic-acid gas which has a leſs capacity for heat than oxygene-gas, gives out a part of its caloric. Thus reſpira⯑tion is the cauſe of a continual extrication of heat in the lungs, which being conveyed by the blood to all parts of the body, is a con⯑ſtant ſource of heat to the animal. We may therefore conſider reſpiration as an operation in which oxygene-gas is continually paſſing from the gaſeous to the concrete ſtate: it will therefore give out at every inſtant, the heat which it held in combination.

[102]Theſe important facts enable us to explain the reaſon, why the inhalation of a larger pro⯑portion of oxygene-gas than what is received from the atmoſphere during the proceſs of reſ⯑piration, by raiſing the temperature of heat in the body, thereby accelerating digeſtion, or aſſiſting it when impaired, is of ſo much ſer⯑vice in Rachitis^*. And is not the coſtiveneſs attendant on the rickets to be attributed to a deficiency of oxygene, as well as the paleneſs and ſallow complection? Doctor Thornton obſerves, that when he made his dyſpeptic pa⯑tients breathe ſuper-oxygenated air, they not [103]only acquir'd appetite and ſpirits, but became more regular in their bowels, and roſy health appeared in their cheeks. I never inhale the vital-air myſelf but it gives me a voracious ap⯑petite, and raiſes my ſpirits much above the uſual ſtandard. We know alſo from experi⯑ence, that oxygene increaſes the ſecretions in general, and therefore may increaſe the quan⯑tity of bile, which is proved to be the natural cathartic of the body, and at the ſame time gives tone and vigour to the ſecreting veſſels; it is highly probable therefore that it may im⯑prove the quality of the ſecreted fluid. The effects alſo before ſtated well oxygenated air has in raiſing the ſpirits, is another deſireable ob⯑ject attained in this new mode of treatment; and the caſe of Mr. Atwood communicated to Doctor Beddoes, and by him preſented to the public in the ſecond edition of his ineſtimable work, entitled ‘Further Conſiderations on the Medicinal uſe, and on the production [104]of Factitious Airs,’ and that of Mr. Ruſſel, are convincing proofs of his aſſertion.

Doctor Prieſtley, whoſe loſs to this coun⯑try cannot be too deeply deplored by all friends to the inveſtigation of Philoſophical truths, ſpeaking ſomewhere of factitious airs ſays, ‘I cannot help flattering myſelf, that in time very great and medicinal uſe will be made of the application of theſe different kinds of airs to the animal ſyſtem. Let ingenious Phyſicians attend to this ſubject, and lay hold of the new handle, which is now pre⯑ſented them before it is ſeized on by raſh empirics; who by an indiſcriminate and in⯑judicious application, often ruin the credit of things and proceſſes, which might o⯑therwiſe make an uſeful addition to the materia and ars medica.’

[105]Incurvations of the ſpine ariſing from a ſcro⯑phulous affection, have already been treated of with ſo much judgment by the late Mr. Pott of St. Bartholomew's Hoſpital, that it will be unneceſſary to ſay much on the ſubject here. The mode he ſuggeſted was by apply⯑ing a cauſtic on each ſide of the projection, and afterwards eſtabliſhing a conſiderable drain, by converting them into large iſſues, a plan of treatment which every day's experience proves the propriety of—This was done with a view of exciting a new action, and by that means ſuperſeding diſeaſed action.^*

A protuberance of the ſpine proceeding from ſcrophula might be treated, by putting an iſſue on each ſide of the prominent bone, which I ſuppoſe acts by its ſtimulus: which excites into action more of the ſenſorial powers of irritation and ſenſation, and thus gives greater [106]activity to the vaſcular ſyſtem in the vicinity^* Doctor Darwin has found pills compoſed of Ext. cinchonae—ſod. phoſp. and opium combined, of ſervice. The antients re⯑commended compreſſion, ſwinging, ſlings to ſuſpend the children by a bandage round the head, and by the ſhoulders, but they all prove ineffectual. Of late years ſeveral kinds of machinery have been introduced into prac⯑tice with a view of giving ſupport to the ſpine, by taking off the preſſure of the head and ſhoulders. Monſieur Vacher, an ingenious Frenchman, invented ſome years ago a ma⯑chine of which he has given an account in the Memoires de l'Academie Royale de Chirurgie, tom. iv. accompanied with a plate. The principle upon which this machine acts is, the keeping of the head in an erect poſture, and the ſpine in as ſtraight a line as it naturally [107]does, or as it poſſibly can admit of in a diſ⯑eaſed ſtate; and in ſupporting the ſuperin⯑cumbent weight of the head, ſhoulders and upper extremities, from preſſing downwards on the diſtorted ſpine, and increaſing the cur⯑vature of it. Since that another machine, or rather an improvement on Monſieur Vacher's, has been invented by Mr. Jones, an ingenious ſtay-maker of this city, and I believe it has been of ſervice in ſome caſes. Mr. Wilkin⯑ſon, the ingenious lecturer on Experimental Philoſophy at St. Bartholomew's Hoſpital, has lately recommended to our notice a ſpinal ſtay which poſſeſſes many advantages over all the reſt, by taking off in a very adequate degree, all weight, by giving greater ſupport to the ſhoulders, neck and head. He has alſo writ⯑ten ſome excellent obſervations on diſtortions of the ſpine, well worthy the peruſal of thoſe who wiſh to attain further information on the ſubject. Men who have ſtudied Anatomy, [108]are the beſt qualified to judge of the neceſſary powers to be applied, and the mode of their application.

Of the Spina bifida I ſhall refrain from of⯑fering any obſervations at preſent. It is a true ſcrophulous affection, and is incurable by any means yet recommended. A quack in this town undertook for a trifling ſum of money laſt winter to cure a child about ſix months old, who had a tumour of this kind ſituated on the third dorſal vertebra. This he under⯑took to effect, by evacuating the contents with a lancet. When he came next day, he found the child dead, and to reconcile its diſappoint⯑ed parents to their loſs, and his ignorance, pretended that it was occaſioned by the com⯑preſſion owing to the child's laying on its back during the night. I examined the diſ⯑eaſed parts after death, and have a drawing of them by me.

[109]Having pointed out in as conciſe a manner as poſſible thoſe ſeats of the diſeaſe in the ſyſtem where we are to look for the greateſt danger, I ſhall proceed to conſider the general hiſtory of the diſorder, and examine the different opi⯑nions of the various writers on Scrophula.

Our ſchools of phyſic lay great ſtreſs on parthology, or certain appearances in the pa⯑tient, by which they ſuppoſe the nature, the ſtage, and reſult of the diſeaſe may be pointed out. Thoſe criterions are to be ſought after in the eyes, the noſe, the ſkin, the tongue, the pulſe^*, and the geſtures. That thoſe par⯑ticular [110]deviations from the patient's natural appearance during health, do appear frequent⯑ly [111]is moſt true: but the major part of them are fallacious and inconcluſive, becauſe they are often produced by oppoſite cauſe. Thus we are told by writers, that the attacks of ſcrophula are peculiar to the ſanguine: and thoſe conſtitutions which poſſes fine ſkins, a ſoft muſcular fleſh, with a roſy complexion, a thickneſs of the upper lip, and blue eyes; as alſo that thoſe perſons who have red or light coloured hair are particularly ſubject to this diſeaſe.

An Aſtronomer may as wel expect to draw a juſt concluſion of the real motions of Jupi⯑ter, or any other primary planet, from their apparent contorted and looped evolutions; or [112]a Philoſopher diſcover a law of nature in phy⯑ſics, or morals, by an appeal to the categories of Ariſtotle; or a Critic hope for fame in all the fine arts, when he breathes nothing but the rules of Ariſtotle, Quintillian and Longi⯑nus; as a Phyſician can hope to diſcover the nature and cauſes of diſeaſes, when he rears his inductions on falſe evidence, and anoma⯑lous ſigns.

The firſt attacks of Scrophula as deſcribed by ſome authors are no leſs extravagant than abſurd. The following quotation, from a re⯑cent publication will ſerve for an example.

‘The infinite variety of complaints an im⯑pure or infected ſtate of the blood induces, almoſt exceeds belief; and hence the new and deceptive forms a ſcrophulous taint puts on, which often deceives the moſt eminent of the faculty, and baffles the beſt intention [113]towards a cure. An impure or ſcrophu⯑lous taint will invade the nobleſt organs of the human frame, before the patient can be aware of his danger. In the firſt ſtage of its invincible attack, a weary pain ſeizes the joints and muſcles, attended with a waſting of the legs and loins. In the ſecond ſtage the gums ſwell, grow painful, hot and irritable, and bleed upon the ſlighteſt preſ⯑ſure: the roots of the teeth become looſe and bare, and the breath nauſeous. In the third ſtage, the gums grow putrid, and the teeth black and rotten, the ſublingular veins become varicoſe, and the breath ca⯑daverous; foetid blood diſtils from the lips, gums, mouth, noſe, and lungs, ſtomach, liver, ſpleen, pancreas, inteſtines, womb, kidnies, &c. Scabs and ulcers break out over all parts of the body, and the joints, bones, and vifcera, become morbid. In the fourth ſtage, putrid, eruptive, and ſpot⯑ted [114]fevers enſue, which end in atrophy, or elſe follow diarrhoeas, dyfentery, dropſy, conſumption, palſy, contraction, melan⯑choly and all the long and direful train of nervous diſeaſes, which to deſcribe would fill a volume.^*’ One would have ſuppoſed that this learned author had been deſcribing the ſea-ſcurvy inſtead of Scrophula, and I doubt whether the Herculean remedy which he pre⯑ſcribes for this melancholy train of human ma⯑ladies, notwithſtanding ‘the invention of which has been the reſult of a long and la⯑borious application to the ſtudy of unveil⯑ed nature—of the properties of air, fire, earth, water, and in the propagation of [115] animal and vegetable life,’ will be found effectual. (Medical Mirror, page 130.)

At what period Scrophula firſt made its ap⯑pearance in this country, I cannot preciſely fix; the hiſtory of all diſeaſes is involved in a deal of obſcurity, but particularly this. A late writer is of opinion that the morbus coxen⯑dicis of Hippocrates, is the ſcrophulous hip of the preſent day: and that thoſe particular diſeaſes mentioned by ancient authors, as hav⯑ing their origin in (what they term) cold pitu⯑itous humour, falling on a joint, and which ſometimes occaſioned luxation; as alſo the complaints denominated ſpina ventoſa, melice⯑ria, Hydarthus, and fungus articuli, are in their ſymptoms and effects very analogous to the different ſpecies of the diſeaſe which is ge⯑nerally denominated white ſwelling.

[116]Scrophula ^* does not ſhew itſelf at any par⯑ticular age, though it ſeldom appears before the ſecond year or after the twentieth, nor have I obſerved it to be aggravated by any particu⯑lar ſeaſon of the year. It is to be found in very hot and very cold climates. I have my⯑ſelf ſeen it among the natives of Balambuang, an iſland inhabited by Malays governed by a Dutch commandant, and lying almoſt on the line, in the Streights of Borneo.

[117]The Chineſe are particularly ſubject to this diſeaſe^*, nor have they been able, with all their ſubtelty and pretenſions to phyſic, to diſ⯑cover as yet any remedy for it.

Perſons afflicted with ſcrophulous ulcers walk about the ſtreets of Canton, without any application to them, and with much ſeeming indifference. They are equally ſuperſtitious and ſhew the ſame marks of fatuity with the people of this country, who truſt their cures to Empi⯑rics and Aſtrologers, with which that country is diſgracefully over-run like our own. It is [118]but doing juſtice however to add, that it is only the lower claſs of Chineſe, and not thoſe who have received a liberal education, that in⯑truſt their lives to the precarious iſſue of me⯑dicines, prepared and vended by ſuch locuſts. And it is right to add to the honour of the Chineſe Government, that notwithſtanding it is the moſt deſpotic and arbitrary on the face of the earth, it reaps no emolument, like others which boaſt more of liberty, by grant⯑ing theſe wretches licence and patents to ſlaughter mankind. Let me here anxiouſly caution the unwary of being miſled by thoſe who have obtained the KING'S LETTERS PATENT^*.

[119]The commencement and progreſs of Scro⯑phula in this country are generally as follow. The lymphatic glands become diſeaſed, and rendered inert and paralytic from the action of [120]ſome poiſonous material, probably an acid, generated during the proceſs of digeſtion. Slime by little and little adheres to the inteſ⯑tines, and plugs up the mouths of the lacteals and renders them torpid and ſchirrous. The glands then become large externally and inirrita⯑ble from being over ſtimulated. The digeſtive faculties of the ſtomach grow languid. The mouths of the lacteals will often inflame and turn to ulcers—a general relaxation and atony pervade the whole ſyſtem—Small oval or ſphe⯑rical tumours form under the ſkin, which at firſt appear like a ſmall knot, ſmooth and move⯑able, with ſome elaſticity, and they gradually increaſe in number and ſize till they form one [121]hard, large fixed tumour, chiefly in the neck and behind the ears—they do not give much pain, or is the colour of the ſkin changed—the joints of the elbows and ancles as well as of the fingers and toes become ſtiff and painful, and it very frequently happens that an anchy⯑loſis of ſome principal joint remains, though the other ſymptoms be abated. In ſome a very bad cough haraſſes the patient, which I think proceeds from a morbid ſtate of the li⯑ver. The ſour eructations ariſe from a pre⯑vailing acidity in the ſtomach and the tumid abdomen from the diſengagement of elaſtic-gas in the inteſtinal canal. The firſt effect of viſ⯑cid mucus in the alimentary canal is ſedative, as appears by the ſlow and feeble pulſe, lan⯑guor, and depreſſion of ſpirits, coldneſs of the extremities and deficiency of perſpiration, which it conſtantly produces, and which are attendant ſymptoms in the latter ſtage of the diſeaſe. Hence if proper advice is not had, [122]an atrophy enſues, and the unhappy patient will ſink under his load of grief and pain, a victim to the want of application of the prin⯑ciples of philoſophical analyſis to the ſubject of the Materia Medica.

The diſeaſe ſometimes creeps on flowly for a number of years without producing much derangement in the health of the patient, and inſtances are not wanting where it has been ſpontaneouſly cured, the ulcers healing up, and no new tumours appearing; and as Doctor Cullen has obſerved ‘that thus at length the diſeaſe ceaſes entirely leaving only ſome inde⯑lible eſchars, pale and ſmooth, but in ſome parts ſhrivelled, or where it had occupied the joints leaving the motions of theſe impared or entirely deſtroyed.’

Such is the hiſtory and progreſs of this diſ⯑eaſe, which adds more to the bills of mortality [123]than almoſt any other, and disfigures the moſt beautiful of our ſpecies.

Having before ſhewn how ineffectual thoſe remedies are, which are uſually preſcribed for Scrophula, I ſhall ſuggeſt ſome others, reſult⯑ing from our more extenſive knowledge of the principles of philoſophical Chemiſtry. In⯑deed it is to the labours of thoſe, who have ſo extenſively applied thoſe means which reſult from the cultivation of this branch of natural philoſophy, that medicine owes its rapid ad⯑vance, and when we reflect upon the impor⯑tant diſcoveries, which have reſulted to man⯑kind from the happy induſtry of the preſent age, we are to look forward with the pleaſing hopes, that the time is not far diſtant when inſtruction concerning the cauſes of the health and diſeaſe will be acknowledged to form a neceſſary part of all rational education; and the nearer w approach to this period, with [124]leſs hazard may the analyſis propoſed by John⯑ſon, with the plan ſo enlarged, and the pur⯑poſe ſo ennobled, be executed^*.

If we take a ſurvey of the progreſs of hu⯑man knowledge from the earlieſt times to the revival of learning in Europe, we ſhall diſco⯑ver in the mind of man, a ſpirit of inquiry and a zeal for emulation which nothing can re⯑ſtrain. In the hurry of his purſuits, we ſhall ſee him too commonly decide from the moſt imperfect obſervation of nature, and this leads him to form wrong notions and conceptions of things—It requires no pains to diſcover, for dialy intercourſe with the world will ſubſtan⯑ſtiate the charge, that men believe without evidence, truſt without diſcernment, and main⯑tain without moderation. The cleareſt and [125]moſt doubtful, the moſt reaſonable and the moſt abſurd propoſitions meet equally with their aſſent, provided they have been handed down from remote ages of antiquity or have obtained a currency in the world^*—With them an opinion once adopted muſt never be changed, and every opinion muſt be adopt⯑ed, which has been eſtabliſhed by preſcription, and is hung round with awful and ſacred trap⯑ings—with a view to avoid this unmanly and pernicious exceſs, other run directly into the oppoſite: They object to the plaineſt and ſim⯑pleſt truths, doubt where there is not the leaſt ſhadow of ambiguity, and ſuſpect and even condemn as guilty where there is no fraud; they refuſe to aſſent but upon the ſtricteſt de⯑monſtration, overturn every principle upon which juſtice or demonſtration can be built, [126]reaſon themſelves out of common ſenſe, if ever they poſſeſſed it, and under pretext at ar⯑riving at knowledge and liberty, involve them⯑ſelves more and more in ignorance and ſlavery, and that thoſe who boaſt moſt of the greateſt freedom, are moſt loaded with taxes, occa⯑ſioned by the wars of ambitious miniſters and their legions, ſupported by a venal repreſen⯑tion of venal electors^*. Thus while many are ſtraining every nerve to ſanction error and ſu⯑perſtition, under the deceptive appearance of truth and piety, others are equally active and ſedulous in undermining thoſe truths which Philoſophy^‡ ſuggeſted and experience has rati⯑fied, [127]under the (prima facies) of error and in⯑credulity. Both are equally extravagant and abſurd, and between them the cauſe of virtue, of liberty, and of truth, and together with it the happineſs of mankind, are continually re⯑ceiving freſh wounds, which require more the human prudence to heal them of.

Let us hope that the time is not far diſtant, when the eyes of men will be opened, and they will be able to judge for themſelves and exerciſe their own reaſon, without putting an implicit confidence in others, who will rejoice to ſee error uſurp the throne of truth—when thoſe narrow prejudices which now obſcure their underſtanding will be done away, and they will be ready to confeſs, that upon the [128]only principle on which we can be of eſſential ſervice to our profeſſion is, by accumulating uſeful facts, which are indiſputably much wanted, and in forming juſt and natural de⯑ductions from them. In compliance with this precept we ſhall unite the obſerving and rational faculties, and accommodate our con⯑duct to that of the bee; for as Lord Bacon ob⯑ſerves in his Nov. Organ. ‘It appears that thoſe who have treated the ſciences were either empirics or rationaliſts. The empirics, like ants, only lay up ſtores and uſe them; the rationaliſts, like ſpiders, ſpin webs out of themſelves; but the bee takes a middle courſe, gathering her matter from the flowers of the field and garden, and digeſting and preparing it by her native powers.’ That in like manner is the true office and work of Philoſophy, which not truſting too much to the faculties of the mind, does not lay up the matter afforded by rational [129]hiſtory and mechanical experience, entire or unfaſhioned in the memory; but treaſures it, after being firſt elaborated and digeſted in the underſtanding; and therefore we have a good reaſon to hope, from the ſtrict union of the experimental and rational faculty, which have not hitherto been united.

To return to the ſubject of Scrophula, we find that an acrimony and acidity were long ago ſuſpected to be the proximate cauſe of this diſeaſe—indeed late writers trace the whole train of ſymptoms to a prevailing acid with which children in particular are more af⯑fected than adults. Doctor Ruſſel in his Oeconomia Naturae has undertaken a very uſe⯑ful work, viz. to give a hiſtory of the changes that happen to the different parts of the ſyſtem through the different ages of life; but unluck⯑ily, when conſidering the alterations of the [130]glands, from the effects of the acid with which as I before ſaid children were particularly ſub⯑ject to, he has neglected the conglobate or lymphatic&What he has ſaid reſpecting any of the different ſtages of life, has been the in⯑vention of a fanciful imagination.

In infancy, the lymphatic ſyſtem bears a large proportion to the other parts of the bo⯑dy. This proportion gradually diminiſhes, as we advance in years. Hence we muſt na⯑turally conclude that it has a peculiar uſe in children.

Galen's theory of Scrophula was, that it aroſe from a cold pituitous humour: others attributed it to a redundancy of fluids; and as ſoon as chemiſty was cultivated, it was traced to a prevailing acidity; and this has, with ſome little difference in expreſſion, been embraced [131]by almoſt all writers on the ſubject down to the 18th century.

The theory of Boerhaave was, that it de⯑pended upon a ſpiſſitude and lentor of the flu⯑ids. Then came to be adopted the doctrine of peculiar acrimony^* Doctor Cullen was [132]of opinion that it depended upon a peculiar conſtitution of the lymphatic-ſyſtem.

Doctor Smith attributed it to a cold matter obſtructing the glands, and rendering them almoſt of a ſchirrous hardneſs.

[133]Scrophula, according to Sir Clifton Win⯑tringham, conſiſts not only in a diſeaſed ſtate of the veſſels in the part affected, but alſo in a lentor and acrimony of the fluids which paſs through them. For the cure he adviſes calo⯑mel mel pp^t. taken in ſmall quantities and at pro⯑per intervals with dilutent and ſedative decoc⯑tions of china-root, ſarſaparilla, ſaſſafras, or guaiacum.

He directs that mild cathartics ſhould be given at times, and on thoſe days which are free from purging, that the patient ſhould uſe the warm bath or emollient fomentations with friction of the part affected, in order to drive the mercury to the obſtructed veſſels. When theſe remedies have been uſed for ſome time, we are to have recourſe to mineral waters, and in order to prevent a relapſe the Peruvian Bark and ſteel ſhould be taken after the cure is com⯑pleated.

[134]Doctor Fordyce (the learned reader on the practice of phyſic in this city) conſiders Scro⯑phula as an affection of the mucus membrane, which in conſequence of matter forming from inflammation, often indeed ſo ſlight, as to be little noticed, part is abſorbed by the next lymphatic-glands, and the diſeaſe then aſſumes its real glandular form.

Mr. White conſiders a peculiar tenuity of ſurface, or firmneſs of ſkin as the cauſe of ſuſ⯑ceptibility to the diſeaſe, which is confirmed by the effect that changes of weather have on it. He obſerves that two kinds of con⯑ſtitution are diſtinguiſhed by this ſort of ſurface; the firſt is marked by large ſuperficial veins, a paleneſs of countenance, a languor in the eye and what is in general termed a want of vivacity, or conſtitutional torpor. The o⯑ther is diſtinguiſhed by a florid complexion, [135]ſkin eaſily varying its appearance on the ſlight⯑eſt changes, vivacity of eye, ſprightlineſs of manner, and great irritability and acuteneſs.

Doctor Neſbit, the next writer after Mr. White ^* offers it as his opinion that Scrophula is a diſeaſe, ariſing from a peculiar morbid ſtate of ſurface, moſt prevalent in the early pe⯑riod of life. That this ſtate of ſurface is at the ſame time connected with general laxity, flacci⯑dity, and often irritability of the ſyſtem; and that theſe circumſtances exiſt in a high degree. That in this ſtate of furface, inflammation at⯑tacking any part of the mucus membrane, it paſſes into ulceration, and the matter of this [136]ulcer being abſorbed by the next lymphatic glands, the peculiar from of the diſeaſe or the lymphatic ſwelling next takes place; and this matter then elaborated in the lymphatic gland, acquires the peculiarity which renders the diſ⯑charge ſcrophulous, or conſtitutes the pecu⯑liar acrimony of the diſeaſe. This inflamma⯑tion of the mucus membrane is often ſo ſlight, as hardly to be noticed, and the fucceeding ſwelling of the lymphatic gland is conſidered as the firſt ſymptom of the diſeaſe, and never thought to ariſe from the former cauſe. The affection of the lymphatic gland then, is pro⯑perly the ſecond ſtage of the malady; and as this matter orginally abſorbed is not ſo acrid as the venereal and others, nor the gland itſelf endued with much ſenſation, the progreſs of the diſeaſe, in it, is for a long time tardy, till it acquires a certain ſize, and affects the exter⯑nal teguments. When the diſeaſe arrives at its height, and a rupture of the teguments [137]takes place, a peculiar matter ſeems to be then formed, poſſeſſed of various degrees of acri⯑mony, from ſimple ferocity, to that of acting a real ſolvent of the animal fibre.

All writers agree that it is an affection of the lymphatic ſyſtem, producing laxity of fibre, and univerſal debility: and it is of very little conſequence what the cauſe is capable of ef⯑fecting this, ſince neceſſity points out the plan of treatment, that of giving tone to the fibre and reſtoring the general health of the patient^*. ^*

[138]It has already been ſatisfactorily ſhewn how oxygenated air quickens the action of the ab⯑ſorbents, from whence it follows, that its uſe muſt be highly beneficial in Scrophula, and experience has proved it ſo; the conſtitution muſt be prepared by proper evacuations to re⯑ceive an additional ſupply of this pabulum vitae. We might at leaſt urge the utility of this new mode of cure till a new theory is eſ⯑tabliſhed and other remedies offered.

The remedies which from time to time have been uſed for the cure of Scrophula, are no leſs multifarious than virtueleſs.

Among the earlieſt, and for near a century back the Fol. Digit. Pur. ^* was principally re⯑commended both internally and externally. This by degrees, like moſt ephemeral medi⯑cines, [139]fell into diſrepute, and then the expreſſed juice of the water-parſnep (Sium Nodiflorum L. S. P.) in doſes of two to four ounces in milk was given^* With theſe, abſorbents were given to correct the acid in the ſtomach, to which were alſo joined the different woods as guaiacum, ſarſaparil, ſaſſafras, ſerpenta⯑ria, mezereon, &c. The neutral ſalts were extolled as ſpecific, like moſt medicines to which that name is given, failed in almoſt every inſtance.

In the time of Boerhaave and Heiſter, pre⯑parations of mercury and antimony were held in high eſteem, and if the chimerical and ex⯑travagant accounts of the numerous cures which theſe medicines either ſeparately or conjunc⯑tively performed are to be credited, we need ſearch no farther for ſpecifics. Mercury is a [140]very good medicine in Scrophula, and as it comes ſo ſtrongly recommended to our notice by Mr. White, who has cured ſeveral hun⯑dreds with it, it deſerves attention; but I am inclined to think, that it is the oxygene^* which [141]by ſome proceſs, is ſeparated from it in the conſtitution which performs the cure by its ſtimulating the lymphatics, and not the mer⯑cury; for it is proved by all Phyſicians, at leaſt by all who have appealed candidly to its effects, that mercury operates as a ſtimulus; that it promotes if aided by other ſimilar pow⯑ers (particularly oxygene-gas) a vigorous per⯑ſpiration, and is inductive of other phaenome⯑na characteriſtic of the operation of a ſtimulus. It legitimately follows therefore, that the good conſequences ariſing from its uſe reſult from this ſource^*. Beſides as an additional argu⯑ment in favour of this theory, it might be urged that as OXYGENE IS THE PRINCIPLE [142]OF IRRITABILITY^*, a fact of which there does not remain a doubt in my mind; and as it has been before ſhewn that in ſcrophula under all its ſhapes and modifications, there [143]is a deficiency of this principle, the principle of life; is it therefore not wonderful, from this inference reſpecting its qualities (mercury) that means of a ſimilar nature, ſuch as the in⯑halation [144]of oxygene-gas, exerciſe, &c. are not had recourſe to during its uſe, to co-operate with it, to enlarge the baſis of our truly limit⯑ed practice, and more completely and trium⯑phantly obtain the advantages which theſe qualities intimate to us?

Cicuta has been a very faſhionable medicine with phyſicians in this complaint. Like new cloaths it has its admirers for a time. I have given it to ſeveral patients and never found it do any good. I believe myſelf that it never did any good in any one complaint. The hiſ⯑tory of this article exhibits to us a curious in⯑ſtance of neglect and inattention to the circum⯑ſtances accompanying its exhibition; as we have demonſtrable proofs of its being ſolely [145]and abſtractedly attended to till experience clearly evinces its efficacy and completely ſhews the want of an analyſis of its being ſolely and abſtractedly attended to till experience clearly evinces its efficacy and completely ſhews the want of an analyſis of its qualities and the na⯑ture of this diſeaſe; for no inference reſpect⯑ing its qualities and mode of operation is diſ⯑cernible; all that is ſuppoſed, is only that it is poſſeſſed of a ſpecific virtue.

The muriated barytes, according to the re⯑ports of Doctor Crawford, promiſed to do a good deal in arreſting the progreſs of the diſ⯑eaſe. In other hands it has failed of its boaſt⯑ed virtue, nor have I in five caſes in which I have given it, ſeen any good derived from it.

Doctor Ruſſel ſent his patients to the ſea⯑ſide, and ordered them to rub their glandular ſwellings with the alga marina; a cabbage [146]ſtump would have anſwered as well. With it he gave ſmall doſes of calomel ppt. and ſalt water, and never omitted ſea-bathing.

Doctor Cullen and the late Doctor Fother⯑gill both gave Cicuta, but never without join⯑ing mercury with it, upon which its ſucceſs principally depended. Doctor Cullen chiefly recommends the chalybeate waters, cold-bath⯑ings, cicuta, and common water in prefe⯑rence to ſea ſalt-water. He condemns the cinchona, and ſpeaks in ſtrong terms of exer⯑ciſe, friction, &c. &c.

In reſpect to ſalt-water, I never ſaw it do any good in this complaint; on the contrary I think with Doctor Neſbit, that by carrying it too far, the ſyſtem has been weakened by the diſcharge it has produced, and the diſeaſe ra⯑ther aggravated than relieved. Doctor Buchan ſays ‘that ſea-water ſhould be only given in [147]groſs habits, and then only with a view of its acting as a purgative.’ Like many re⯑medies it poſſeſſes for ſome time an undeſerv⯑ed reputation; and if it ever does ſervice it muſt rather be as a preventive, than when the diſeaſe is formed.

Steel medicines have been univerſally given and with ſucceſs; this muſt be attributed to ſomething more beſides their tonic powers. "Chalybeates," ſays the ingenious author of the Guide to Health, Vol. II. ‘have certainly a two-fold effect, for as the natural vehicle of oxygene, and the conſtituent principle of red blood, they ſtrengthen the digeſtive organs, and excite the abſorbents. Indeed all the metallic oxyds, excepting the mercu⯑rial, act in the ſame manner, only in a ſu⯑perlative degree. For this reaſon iron has maintained its empire, and whilſt we have one oxyd, which when conjoined with th [...] [148]vital-air, in theſe caſes may be regarded as nearly infallible, we need be leſs ſolici⯑tous about the reſt.’

The mineral waters on the ſame principles as I have accounted for the good effects of chaly⯑beates, ſhould be early had recourſe to, by which many of theſe ſubſequent ſtages of the diſeaſe will be obviated. The waters of Briſ⯑tol Hot-well ^* Harrowgate, Scarborough, [149]Moffatt, the Iſland of St. Michael, and moſt other ſpas in Britain, may be uſed with ad⯑vantage, but at the ſame time with precau⯑tion! I have ſeen them produce bad effects, by an indiſcriminate uſe as to quantity, and the regimen purſued at the ſame time of drink⯑ing them, by which affections of the bowels [150]have come on, followed by indigeſtion. This again leads me to ſpeak of exerciſe, which promotes the operation of mineral waters, and is neceſſary to carry them through the ſyſtem. Beſides which, it increaſes the reſpiration and promotes the oxygenation of the blood; and by this it gives vigour to the ſyſtem, and ex⯑cites the action of the abſorbents.

^* Exerciſe, ſays a learned phyſician, is almoſt the only cure we know for glandular obſtruc⯑tions; indeed it does not always ſucceed as a remedy; but there is reaſon to believe that it would ſeldom fail to prevent theſe complaints, were it uſed in due time.

[151]Van Swieten in his Commentaries on the Works of Boerhaave obſerves, that for want of exerciſe the ſtomach and bowels become internally coated with rought phlegm, but that by increaſed reſpiration and alternate action of the abdominal muſcles, theſe viſcera are ſha⯑ken, preſſed, and ſcrubbed, as it were, by at⯑trition, ſo as to be effectually cleanſed, and add, ‘Ventriculus et inteſtina, lento glutine in interna ſua ſuperficie obducuntur: valido motu dum corpus exercetur, reſpiratio aucta diaphragmatis, et muſculorum abdominali⯑um actione reciproca omnia haec viſcera mo⯑vet, premit, ad ſe mutuo quaſi affricat: et ſic deterguntur omnia § 69.’

And Boerhaave himſelf ſays that to aſſiſt the digeſtive powers of the ſtomach and bow⯑els, and the general action of the aboſorbent ſyſtem, recourſe muſt be had to air and exer⯑ciſe—‘Tum ut optime digeri queant, condi⯑mentis, [152]potu vinoſo, exercitio, aire, pro curandum § 69.’

Where the lungs are diſeaſed a ſea-voyage and exerciſe on board ſhip, have contributed to reſtore the health of ſcrophulous patients; which as Pliny obſerves depend more on the length of the voyage, than on the climate, ‘neque enim Egyptus propter longinquita⯑tem navigandi.’ Next to exerciſe in this complaint ranks cleanlineſs. We know, ſays Avicenna, of many diſeaſes which are to be cur⯑ed by it alone—In all it ought to be ſtrictly obſerved.

The levitical law of the Jews is well calcu⯑lated for the prevention of thoſe diſeaſes which ariſe from uncleanlineſs, which enforces ablutions and bathings, and makes cleanlineſs a part of the Jewiſh religion.

[153]The children of the lower claſs of people ſuffer ſeverely from an inattention to this par⯑ticular; and SAUVAGES enumerates a ſpecies of Scrophula ariſing from lice.

The bodies of ſcrophulous patients ſhould be waſhed every morning with cold water impregnated with vinegar, and immediately afterwards rubbed dry with flannel.

Cold bathing, if there ſhould be no diſpoſi⯑tion to tuberculous conſumption, is attended with many advantages, but I fear much miſ⯑chief has ariſen from an indiſcriminate uſe of it, and particularly to infants and children that are weakly. In the Orkney Iſlands it is a cuſ⯑tom to plunge children ſoon after they are born into the river.

[154] By ſtrengthening the ſolids, and promoting a free perſpiration, it gives livelineſs, warmth, and vigour to the conſtitution, and nature ſeems to have pointed out this remedy, both to the ancient, and new world. Virgil in⯑forms us, that it was a cuſtom in Italy, long before the Roman times, to dip perſons af⯑flicted with Scrophula in the cold ſtreams:

On the ſubject of diet I have before ſpoken, but here I muſt again obſerve that the moſt nutritious food ſhould be allowed children who ſhew a tendency to Scrophula; but at the ſame time, they ſhould not be allowed to gor⯑mandize. Repletion carried too far in any diſeaſe, is as bad as inanition. When their appetites have been imprudently indulged, an emetic ſhould be given; for independent [155]of its clearing the ſtomach, it will have a good effect on the conſtitution. The wiſe ſon of Sirach confirms this precept and ſays, ‘If thou haſt been forced to eat, go forth and vomit, and thou ſhalt have reſt.’ Ecclus. chap. xxxi. ver. 21; and moſt certain it is, that hundreds have loſt their lives, and thou⯑ſands have ſuffered ſickneſs and pain, from their ignorance or neglect of this rule.

Both Hippocrates and Celſus give it as their opinion, that men ſhould ſometimes in⯑dulge themſelves at feaſts ^*, and ſometimes [156]eat and drink more than is proper, but why they do not tell us. Vide Hippoc. aphoris. Lib. 2. Cels. open. omn. Lib. 4.

Salt meats ſhould be forbidden where there is the leaſt diſpoſition to enlarged glands; and perſons in years who lead lives of drunken⯑neſs ^*, ſometimes become ſcrophulous from [157]the lymphatics becoming diſeaſed from ex⯑hauſted irritability.

It is conjectured by ſome writers, that large draughts of cold water bring on a torpid ſtate of the lymphatics; and hence it has been deem⯑ed [158]prejudicial as common drink for children. Hudibras, who was no bad Phyſician ſays,

Thus the Phyſician: but the Poet recollect⯑ing, perhaps, that—‘nec vivere carmina poſſunt ſcribuntur aquae potoribus,’ pre⯑ſently ſubjoins,

[159]Next to water as common drink I ſhall ſpeak of wine ^* as a medicine, which by the learned Doctor John Brown ranks amongſt the firſt in the ſcale of ſtimuli. Scrophulous children ſhould be allowed at leaſt three glaſſes every day. It is much to be regretted that a medicine ^‡, which takes precedence of almoſt [160]all others in point of virtue, ſhould be ſo dear as to be only attainable by the rich.

"The weary," ſays Homer, ‘who knew the taſte of it well, find new ſtrength in generous wine.’ [...]. The invention of this wholeſome beve⯑rage might be juſtly ranked amongſt the greateſt improvements of man's aliment, and which well deſerves the encomium beſtowed upon it by Plutarch of being "THE MOST NOBLE OF ALL LIQUORS, THE MOST PALATABLE MEDICINE, and of all delicacies the moſt grate⯑ful to the STOMACH.

Aretaeus, alſo a Phyſician of the firſt rank among the ancients, commends wine no leſs than for the cures which it performs. I ſhall cite his own words from the elegant latin verſion of the learmed Doctor Wiggan. De morb. acut. curat. Lib. i. Cap. I. ‘Sed quum metus [161]ſit, ne in vaporem humiditatemque home diſſolvatur, unicum ſubſiduum vinum eſt: celeriter enim ſubſtantiam alendo inſtaaret: et quoque verſus ad extremitates uſque per⯑meat, robori apponit robur, et ſpiritum torpentem expergefacit, frigiditatem calore temperet, laxantem madorem aſtringit ex⯑trorſum erumpentia at que diffluentia coercet, olfactu ſuavi delectat: vires demum fulcire ad vitam prorogandam poteſt.’

Thus I have endeavoured to give as brief and conciſe a deſcription as poſſible of thoſe diſeaſes which are deemed ſcrophulous ^*: it [162]would have been in vain to attempt compreſ⯑ſing every thing that is known or has been written on the ſubject, within the narrow li⯑mits of a publication of this kind,^* which is intended merely to give the outlines of a work I ſhall ſoon publiſh on a much larger ſcale.

SECTION IX. LUMBAR-ABSCESS.

THE lumbar-abceſs moſt commonly is ſeated in the lumbar or the ſacral lymphati glands, and always in a ſcrophulous conſtitu⯑tion. Eight caſes have fallen under my obſer⯑vation, all of which were in ſcrophulous ſub⯑jects. After the matter is formed, it deſcends, and preſents itſelf, below Poupart's ligament, in the form of a tumour, along the courſe of the crural veſſels. It not unfrequently hap⯑pens, that it makes its appearance in the form of a tenſe tumour under the glutaei muſcles, and from this ſituation of the diſeaſe we are to apprehend a fatal termination. Every oppor⯑tunity I have had of inſpecting the bodies of [164]who have died of lumbar-abſceſs, confirms me in an opinion I have long held, that the whole thoracic viſcera are diſeaſed in common with the ſacro-lymphatic-glands.

I opened the body of a man laſt winter, who had lingered out nearly two years with this melancholy diſeaſe. The lungs were full of tubercles, the liver was ſchirrus; the air-ve⯑ſicles were attached to the edge of the lungs.

Mr. Abernethy, the ingenious lecturer on anatomy and ſurgery at St. Bartholemew's Hoſpital, has recommended a new mode of treatment, by gradually evacuating the matter. This practice has been adopted all over Eu⯑rope, with various ſucceſs. Scrophulous ab⯑ſceſſes ſhould be treated juſt in the ſame way^*. [165]When hectic fever has much haraſſed the pa⯑tient, I have found a decoction of the Lichen-Iſlandicus of ſervice. For a more particular account of this diſeaſe I muſt refer my readers to Hamilton on Scrophulous affections, and Abernethy's Surgical and Phyſiological Eſſays, Vol. I.

Indulging the perſuaſion, that I have traced an outline of a new branch of the Materia Me⯑dica, I ſubmit theſe obſervations to the public eye; and in the words of Seneca ſhall for the preſent take leave of the ſubject, claiming it as a piece of juſtice at the hands of mankind, [166]if they would judge of any thing I have de⯑livered, either from their own ſenſe, the cloud of authorities, or the forms of demonſtra⯑tion, which now prevail as ſo many judicial laws; that they do it not on a ſudden and with⯑out attention, but firſt maſter the ſubject, by degrees make trial of the remedies I have re⯑commended, and accuſtom themſelves to that ſubtlety of things implanted in experience; and laſtly, that by due and ſeaſonable perſe⯑verance, they correct the ill habits that cloſely adhere to the mind;—and when thus they be⯑gin to be themſelves, let them uſe their judg⯑ment and welcome.