OBSERVATIONS, &c.

THE ſcurvy, though a diſeaſe very common to the inhabitants of this iſland, has not till of late been properly aſcertained. The variety of ſymptoms which occur in it, have occa⯑ſioned it to be confounded with almoſt every chronic diſeaſe, where its nature was not properly underſtood. Of late it has been deſcribed with great accuracy and judgment by Dr. Hulme and Dr. Lind, inſomuch, that I ſhall recommend my readers to their obſervations, and at pre⯑ſent dedicate this eſſay to the ſervice and attention of thoſe who ſeem infatuated with the belief that ſea-water is their only remedy.

I ſhall endeavour to give a hiſtory of the diſeaſe as it uſually appears, and enter ſo far into the pathology, as to prove that ſea-water tends to increaſe it.

I am ſenſible, that more than half the people who viſit Margate and Bright-helmſtone, to drink the ſea-water, have not the true ſcurvy, as I have often obſerved diſeaſes of the ſkin are confounded with it. Nay, it very often happens, that in the ſpring a raſh breaks out, which, though it indicates high health, and ſhews an equal diſtribution of the blood to the ſurface, yet the patient (if I may call him ſo) has been uneaſy till he has been fre⯑quently purged by ſea-water to rectify his blood.

The ſcurvy is ofteneſt found in people of a phlegmatic habit of body, and ariſes from a luxurious way of life; it generally ap⯑pears by the colour of the face, which changes gradually from the natural clear⯑neſs, [3]and becomes yellowiſh and bloated, but theſe ſymptoms will occur from a pe⯑culiar temperament, and exiſt many years without any material alteration either for better or worſe—but when it ariſes as a ſymptom of true ſcurvy, it is attended with proſtration of ſtrength and dejec⯑tion of ſpirits, with a remarkable laſſitude and averſion to motion; upon moving ſuddenly, the patient finds a difficulty of breathing, with more or leſs of a palpi⯑tation of the heart; but before theſe ſymptoms have continued long, the diſ⯑eaſe begins to appear in the gums, they turn red and ſpongy, are attended with itching, and bleed upon the leaſt preſſure, the patient's breath becoming at the ſame time remarkably foetid; the ſkin is now covered over with ſpots of a different magnitude, of a livid colour, not unlike the appearance of a bruiſe; they are ſpread over the whole body, but affect the thighs and legs more than the face. The legs generally ſwell and become [4]oedematous near the ancles, and upon being preſſed, they leave the mark of the finger behind, much in the ſame manner as in the dropſy, but the impreſſion here continues much longer. The pulſe is uſually ſmall and irregular, and rarely exceeds the common ſtandard; the ap⯑petite is weak, and the patient upon lying in a recumbent poſture, with his mind calm and undiſturbed, finds a re⯑markable ceſſation of his more violent ſymptoms.

Before other marks of the diſeaſe ap⯑pear, and even through its courſe, the patient is attended with coſtiveneſs, but ſometimes a dyſentery will break out, which is followed with the moſt fatal conſequences. The urine is commonly of a flame colour, ſmall in quantity, ha⯑ving often a brown thick aſh-coloured ſe⯑diment, and ſometimes a ſaline pellicle is ſound floating on its ſurface; in ſome caſes the urine gives an irritation in its [5]paſſage: upon bleeding the patient, the blood is commonly found without any texture, and has every mark of being broke down. The intellectual faculties are not much affected, and indeed all the ſenſes ſeem unimpaired to the laſt, and yet the nervous ſyſtem ſeems much more irritable than when in health, as the patient is one while greatly elevated, and at others as violently depreſſed, and ſuddenly has tranſitions from the moſt extravagant boldneſs to the moſt childiſh puſillanimity.

Theſe are the moſt common ſymptoms in the firſt ſtage of the diſorder; but if from the patient's ſituation or circum⯑ſtances the diſeaſe is neglected, innu⯑merable are the ſymptoms which attend it. I ſhall give the moſt remarkable:

The legs are contracted, and the knees are attended with a painful oedematous ſwelling, fungous ulcers break out in [6]various parts, but moſtly about the legs; ſometimes dry puſtular eruptions, not unlike thoſe of the miliary kind, are ſcattered over the whole body. Wander⯑ing pains are felt every-where, but there is commonly a fixed pain in the breaſt, attended with ſtricture, which is generally increaſed upon any attempt to cough.

There is an uncommon diſcharge of ſaliva, which is greatly increaſed with the ſmalleſt doſe of mercury. In this malig⯑nant ſtage of the diſorder, the blood be⯑ing entirely diſſolved, is poured out on every hand, burſting through the ſcars of old wounds which have been healed many years; but very commonly more plenti⯑fully from the gums, noſe, and haemor⯑rhoidal veſſels—the teeth become looſe and fall out; the callus of old broken bones is diſſolved, and they begin to looſen; the difficulty of breathing is daily increaſed, and ſuch is the degree of acri⯑mony, that the leaſt wound made by [7]accident in the ſkin becomes a painful ulcer. In this ſtage of the diſeaſe, a jaun⯑dice or dropſy often ſupervenes, but much oftener, from an effuſion of ſerum in the brain, the patient upon the leaſt motion of body, or perturbation of mind, is ſeized with a palſy, which cloſes the tragedy, yet retains his faculties to the laſt. It ſeldom happens that the diſeaſe arrives to this ſtate on land, the patient having always at hand the uſe of freſh vegetables, and other means to obviate its increaſe. The common ſymptoms which attend people in London are thoſe which I have enumerated in the firſt part of the hiſtory, being commonly accom⯑panied with the moſt diſtreſſing of all diſeaſes, the hypochondriaſis; and hence I imagine it is that a journey to the ſea⯑ſide has been found ſo often of ſervice, not in removing the ſymptoms of ſcurvy, but by engaging the mind with a variety of new objects, obviates the diſpoſition which ſuch patients find of cheriſhing the idea of their ſufferings.

As I offer this eſſay to my patients by way of caution, having profeſſedly un⯑dertaken it to prove that ſea-water in ſcorbutic diſorders is not only ineffectual, but even often is attended with bad con⯑ſequences, I ſhall now trace the occa⯑ſional and proximate cauſes of the diſ⯑eaſe. I have hinted before, that people of a peculiar temperament are more ſubject to this diſeaſe than others:—what tem⯑perament I mean, is that of the melan⯑choly, where the patient lives in eaſe and opulence, having too much of the enjoy⯑ments and too little of the difficulties of life to ſtruggle with.

There is one general cauſe of ſcurvy which ſeems remarkably to prevail in theſe caſes, and which is, too great a pro⯑portion of animal diet, which is not ſo perſpirable as vegetables; but ſalted and high ſeaſoned meats, from cauſes we ſhall enumerate hereafter, tend particularly to produce it, as Lord Anſon's crew found in [9]the South-ſeas. Though the too frequent, or ſole uſe of animal food tends to pro⯑duce the ſcurvy, yet it has been obſerved, that diminiſhed perſpiration is a much more common cauſe; hence it is, that the further we travel north the more we find the ſcurvy prevail, witneſs the Natu⯑ral Hiſtory of Norway, Lapland, and Greenland; and it is a fact, that the fur⯑ther we travel north or ſouth, the more we find the ſcurvy prevail or diminiſh, and hence aroſe the common obſervation, that the people of Scotland are more ſubject to this diſeaſe than thoſe of the ſouth of England.

The ingenious Dr. Hulme, in his In⯑augural Diſſertation, printed at Edinburgh, confirms this remark, by obſerving that the ſcurvy prevailed among the ſailors (while at ſea) more or leſs according to the height of the thermometer and the ſtate of the air. He obſerved when the quickſil⯑ver was above ſeventy degrees, the diſea [10]ſeldom or rarely appeared, although the men lived upon ſalted proviſions. This eaſily explains how a viſit to Southampton will remove ſymptoms of the ſcurvy; the ſeaſon choſen as proper is the months of June and July, when the weather is warm, and the ſpot being the furtheſt ſouth, hence they are more liable to a free and plentiful perſpiration, which for the pre⯑ſent removes the diſorder, and the patient returns to town though cured, yet per⯑haps greatly reduced and weakened by large nauſeous draughts of ſea-water; and conſequently upon the approach of cold bleak eaſterly winds he will be more liable to have his diſeaſe return with renewed violence. I have with pain often obſerved whole families every ſummer pay an an⯑nual viſit to the ſea; they have continued the practice for perhaps five or ſix ſuc⯑ceſſive ſeaſons, the conſtitution every winter becoming more and more enerva⯑ted, till at length a dropſy or jaundice has been the conſequence: all which perhaps [11]might have been obviated by a little pru⯑dent management during the winter.

Authors have obſerved, that moiſture joined with cold is one great cauſe of the ſcurvy; this evidently ariſes from its effect in diminiſhing perſpiration, and this may give us one reaſon why a ſcorbutic habit is ſo prevalent in England, as I believe no country is more ſubject to ſudden changes of temperature than Great Britain; but I muſt confeſs cold without moiſture has the ſame tendency. Moiſture joined with heat is more apt to produce putrid fevers and dyſenteries.

Having thus ſhewn the occaſional cau⯑ſes of the ſcurvy, I ſhall endeavour to give an analyſis of the blood in its ſcor⯑butic ſtate, and from thence draw a proof that ſea-water muſt tend to promote every ſymptom of this diſeaſe.

Dr. Boerhaave, in his chemical lectures, has long ſince proved that the blood in its natural ſtate gave no proof of its abounding with either an acid or alkali, as he could not procure an efferveſcence with either the ſtrongeſt vinegar or a fixed alkali; he tried another experiment by digeſting the ſerum of the blood till it became putrid, and he then diſcovered a volatile alcaline ſalt; and hence the doctor drew ſome plauſible concluſions with regard to putrid diſeaſes, but his concluſions will not bear the teſt of examination, though perhaps if allowed it would be very favourable to my theory.

A volatile alkali is always found in the fluids in a neutral form, but that it is ever changed and decompoſed in the maſs of blood during life appears very doubtful; if it is evolved ſo as to exiſt in a ſeparate ſtate, it muſt be in conſequence of a putrefaction which goes further than is conſiſtent with life. Dr. Gaubius, an eminent profeſſor at [13]Leyden, in his excellent pathology, on this ſubject, conſiders it not as an alkali evolved, but rather ſeems to think it may be introduced in its ſeparate ſtate; but his arguments, however ſtrong, are eaſily ob⯑viated; as there is, for ſome purpoſe of the oeconomy, in every animal more or leſs of an acid in the ſtomach, and it is certainly ſo, nothing being more evident than that acids formally as ſuch are often introdu⯑ced into our bodies, and aceſcents ſtill more frequently. The greater portion of our aliment is vegetable, all of which, except perhaps the oily parts is plainly aceſcent, and that the acid is truly and in our ſtomachs ſeparated I have reaſon to think from the experiments of the judici⯑ous Dr. Ruſh, profeſſor of chemiſtry at Philadelphia, who has ſhewn that more or leſs of an acid is always formally preſent in the ſtomach, though not generally ob⯑ſerved: it is a queſtion with me, whether the ſymptoms we mark as the effects of acidity in the ſtomach are to be referred [14]to acidity alone, or to ſome other circum⯑ſtance that attends the generation of this, as mephitic air, &c. I much doubt whether this acid ever enters the ſyſtem further without being covered; there is no doubt it goes ſometimes into the inteſtines when the powers which ſhould cover it are defective, and hence it produces diarrhaeas, cholera, &c. by its irritation. But ſome phyſi⯑cians have aſſerted, that it enters the lacteals, and hence aſſign its effects; but I muſt confeſs I know not the leaſt ground to ſuppoſe acidity in the blood. Dr. Gau⯑bius, in proof of the exiſtence of acid, brings the ſouring of milk as an argu⯑ment. I have no doubt but there is an acid materially in the milk, but I aſſert not formally till is it evolved by ſtagnation and putrefaction.

Having thus laid the foundation for a neutral ſalt in our blood, which ariſes from the combination of an alkali in our ani⯑mal food, joined to a natural acid, I ſhall [15]endeavour to convince the reader that it is this ſaline ſtate of our fluids which tends to increaſe and promote the ſcurvy.

I have in the hiſtory of the diſeaſe ob⯑ſerved that the blood is broke down and diſſolved, and this is the peculiar effect of the ammoniacal ſalt, to diſſolve the lymph which gives conſiſtence to the blood; we have proof of this in the great quantity of ſerum and its acrid and ſaline ſtate, which is obſervable more particularly in the urine. It has commonly been ſup⯑poſed by ſome of the moſt eminent me⯑dical writers, that the ſcorbutic ſtate is the putrid ſtate of our blood, but I muſt here carefully diſtinguiſh it: I confeſs that there is reaſon to believe that this ſaline ſtate of our fluids is the firſt ſtep towards putrefaction; but the deepeſt and moſt deplorable ſcurvy furniſhes no putrid ferment, and what is more re⯑markable, it is no where contagious: but there is another argument of conſi⯑derable [16]weight, that the ſerum of ſcor⯑butic blood has been found to reſiſt pu⯑trefaction when applied to other ſub⯑ſtances; there is another circumſtance in ſcurvy which ſhews it to be very different from putrid, which overthrows the whole ſyſtem; the ſcurvy has a very ſlow pro⯑greſs, and will ſubſiſt for years in ſome perſons; and from what I have advanced we may obviate ſome confuſion that has occurred in the terms alkaleſcent and putrid. We can only ſay, that the alka⯑leſcent ſtate ſo much ſpoke of, is no other than the ammoniacal I have been de⯑ſcribing.

I flatter myſelf, that after having advanced ſufficient proof that all the ſymptoms of ſcurvy are owing to a decompoſition of the blood, the prox⯑imate cauſe of which is too great a quantity of neutral ſalts; I need uſe no further arguments to prove the bad con⯑ſequences [17]attending a too free uſe of ſea-ſalt.

The true ſcurvy (which I have deſcri⯑bed) does not exiſt on land ſo frequently as has been apprehended, at leaſt to any great degree; and indeed, we have reaſon to think that it was much more frequent formerly than at preſent, which the cele⯑brated Sir John Pringle attributes to our now making a greater uſe of vegetables. Almoſt every diſeaſe which ariſes from irregular ſecretion has been confounded with the ſcurvy, and it is this confuſion in the diſtinction of diſeaſes that has given birth to a great deal of bad practice. Phy⯑ſicians have hitherto pretty much neglected the ſtudy of cutaneous diſeaſes: they have in moſt caſes had the idea of an acrimony in the blood thrown on the ſkin. This I agree ſometimes happens, eſpecially in the ſcurvy and in putrid diſeaſes—but when we conſider that the generality of diſeaſes [18]of the ſkin occur in the winter, when the temperature of the weather is fluctuating from warm to cold, it muſt occaſion a difference in the ſecretory organs; if the perſpiration is remarkably free, we have reaſon to think an acrid matter paſſes with it, which being ſuddenly ſtopped by cold, occaſions it to ſtagnate; and this acrid mat⯑ter being effuſed under the ſkin gives a diſeaſe attended with an intolerable itch⯑ing, till a new increaſe of perſpiration carries it off.

I ſhall now enquire into the effects of ſea-water, when uſed externally in the form of a bath, in the ſcurvy and diſeaſes of the ſkin, and afterwards draw ſome favourable concluſions with regard to its uſe in ſcrophulous diſorders. The firſt queſtion that ariſes is, whether the ad⯑vantages from bathing in the ſea are ſupe⯑rior to thoſe which follow the uſe of water of the ſame temperature unimpregnated with ſea-ſalt? I muſt confeſs, that I have [19]never yet found any reaſon to ſuppoſe its effects equally advantageous to ſpring water, where a cold bath was indicated. I am ſenſible that this is a theory which will ſurprize many people who have ſuppoſed ſomething ſpecific to exiſt in a ſea-bath. I am certain from experiments that a large quantity of water may be abſorbed by bathing; but the queſtion is, whether ſea-water enters in its ſaline ſtate; if it does, the ſame objections will reſt againſt it in ſcurvy which I have advanced with regard to drinking it; if it cannot, it fol⯑lows of courſe that its effects muſt be the ſame as thoſe of ſimple water. The imme⯑diate effect of cold bathing is a gradual warmth and an increaſe of perſpiration; ſo far it is uſeful not only in diſeaſes of the ſkin, but alſo in ſcurvy; but if an increaſed warmth is the advantage ex⯑pected, this will be found more remarka⯑bly in a colder water; and therefore I ad⯑vance this as another reaſon why cold ſpring-water ſhould be preferred as a bath to ſea-water.

However, after all, I muſt acknow⯑ledge that I believe ſea-water uſed as a bath has frequently had a ſuperior effect to a freſh-water bath; the reaſon I take to be this, when a patient enters a bathing machine in the ſea, he goes with a firm perſuaſion that it is his only remedy; the warmth of the water, the agreeable va⯑riety of company, all tend to remove that natural dread which moſt people find when they are at home and obliged from a warm bed to go to a ſolitary bath, where, perhaps, they ſtand trembling on the brink till they have got a freſh cold before they can be induced to plunge in, and this in a ſhort time from being irk⯑ſome becomes terrible, and is neglected. Therefore, I am well convinced, that if people would candidly examine the matter without prejudice or partiality, they would agree with me, that in all the diſeaſes where a cold bath is indicated, ſpring⯑water, by being much colder, muſt be greatly ſuperior to that of the ſea.

I am very ſenſible that in advancing this theory I ſhall diſoblige many of the in⯑habitants of Scarborough, Margate, South⯑ampton, and other places, but in an eſſay of this kind it is neceſſary I ſhould be candid. They may perhaps conclude, that for ſome intereſted motives I write againſt ſalt-water; I muſt therefore de⯑clare that my object is truth, not intereſt. I muſt now conclude this eſſay with re⯑commending ſea-water, and more eſpeci⯑ally thoſe ſaline waters impregnated with ſulphur, in the moſt diſtreſſing and cruel of all diſeaſes, the

SCROPHULA: or, KING'S EVIL.

This diſeaſe, though it differs from the ſcurvy, yet has often been confounded with it, and therefore I ſhall give a ſhort hiſtory of it, with the ſymptoms.

By ſome authors it has been conſidered as a new diſorder, introduced with the venereal diſeaſe; but I think the ſtrumae [22]mentioned in ancient medical writings were ſuch ſwellings of the glands as we call ſcrophulous: it generally appears like a tumor of a ſmall ſize in different parts of the body without changing the colour of the ſkin, and at the ſame time is for the moſt part free from pain and inflammation; the tumor is move⯑able under the ſkin, it ſlowly advances to an inflammatory ſtate, and after ſome redneſs has come on, it is gradual in coming to a ſuppuration; and after it ſhows a fluctuation of matter, it is long in opening and changing into an ulcer. It differs very materially from what is called a phlegmon, though it is true that it ſometimes has the appearance of a pointed tumor, but it does not (like other inflammatory tumors) come always to a point and open there, but the in⯑flamed ſkin breaks at ſmall and different apertures; when it is thus become an open ſore, it affords but little purulent matter, and always with it ſomething of [23]a curd or cheeſe-like ſubſtance, with a quantity of tranſparent and gelatinous ſerum ſoon after appearing in it. The ulcer thus formed heals ſlowly, affording but a little pus, and much of a viſcid tranſpa⯑rent ſerum; the edges of ſuch ulcers are ſeldom regularly circumſcribed; being at the ſame time free from callus, and may be known by their flatneſs and ſmoothneſs: they thus ariſe on the bones near the joints, and affect them with a caries of a particular kind, for while the caries from moſt other cauſes is difficult to heal, it ſeems as if that in ſcrophulous caſes healed up as eaſily as its ulcerations in the ſoft parts: theſe tumors and their conſequences affect particular tempera⯑ments or conſtitutions; perſons of fair complexions, with light hair more fre⯑quently than thoſe of dark black hair, though ſometimes theſe latter do not eſcape; but in all the ſkin has a re⯑markable poliſh, is very ſmooth, the cuticle having a very peculiar fineneſs; [24]it attends a certain period of life, from three years old to puberty, though I have ſeen it in a child three months old, it more frequently appears from three to ſeven than afterwards—After the age of puberty, it may be doubted whether a ſwelling of the glands is of the ſcrophu⯑lous kind, though there is a ſpecies that appears about the age of puberty, but then it is always a prelude to conſumption of the lungs, and does not require to be treated as ſcrophula. Whenever ſcrophula attacks it rarely continues many years, the moſt uſual period is three or four, and then the ulcers heal; if they do not appear at the age of puberty, they ſel⯑dom continue after it. I have thus deſcri⯑bed the diſeaſe as it moſt commonly ap⯑pears. Theſe tumors moſt manifeſtly oc⯑cur in the lymphatic or conglobate glands. Every part of the body is liable to be affected, but more frequently the neck. It is a difficult matter to determine [25]whether the diſeaſe thus affecting the glands at a particular period of life is not owing to ſome change in the ſecretory ſy⯑ſtem; it is a ſerious, if not an important queſtion, and well deſerves the attention of phyſiologiſts. The general opinion is, that ſcrophulous ſwellings are owing to a morbid matter affecting the glandular ſy⯑ſtem; but if this was the caſe, why ſhould it occur at a certain period of life, and among people various in their way of living and circumſtances.

From ſcrophula being commonly at⯑tended with a thickneſs of the upper lip, ſome phyſicians have ſuppoſed that the breath was infectious; but the phaenomena of the diſeaſe by no means confirm this, as children ſleep together during the whole courſe of the diſorder without infection.

There is one circumſtance attending the diſeaſe, which confirms an opinion I have long entertained, that ſcrophula primarily [26]is owing to a diſeaſe of the glands them⯑ſelves, and not to the matter which they ſhould tranſmit; for whatever changes may be made in diet, even after the ineffectual uſe of antimonials and mercurials, the diſeaſe has remained without alteration during the ſummer, being more or leſs inveterate according to the temperature of the weather; but as the cold weather ap⯑proached it gradually went off, and in⯑tirely diſappeared at midwinter. This obſervation I have made in various caſes, and always found it hold good where the diſeaſe was recent; in ſome inſtances this fact has failed, but then I have remarked that the winter had been moiſt and warm, or the patient too much nurſed. Scro⯑phulous tumors generally appear about the neck and on the elbows; but from my own obſervations, I have reaſon to believe that in ſuch patients the meſenteric glands are more or leſs affected; this I conclude from the ſwelling and hardneſs of the abdomen, and the rapid emaciation which [27]enſues. I have frequently had an op⯑portunity of ſeeing young children in this ſituation, a remarkable inſtance occurred to me lately: a tradeſman in Whitechapel brought his ſon to me, he was about five years of age, of a thin, pale, delicate habit of body—his pulſe very rapid, being one hundred and twenty in a cool room when ſitting ſtill; his abdomen was remarkably ſwelled without any fluctuation; his legs were oedematous; he had towards evening a hectic paroxyſm which increaſed towards midnight, and went off in the morning with a copious colliquative ſweat; his ap⯑petite was natural, but he ſhewed a re⯑markable fondneſs for cold liquor, which he drank in great plenty; he was generally coſtive, except upon taking ſome laxative medicine; and his ſtools were natural, ex⯑cept having a mixture of white matter; he had no cough, nor pain in his breaſt; was cheerful and lively; his urine ſhewed no marks of purulency. He had for ſome time been under the care of an eminent [28]apothecary, who had given him calomel and rhubarb powders, ſuppoſing his diſ⯑eaſe to ariſe from worms, but without any advantage, as the child gradually grew worſe. Upon his application to me, I was convinced that the diſeaſe would in a ſhort time prove fatal, as I had reaſon to think from the celerity of his pulſe, that if an ulceration had not already taken place in the meſentery, it muſt in a ſhort time (as his chylous ſtools gave me ſufficient reaſon to believe a great degree of congeſtion exiſted in the meſenteric glands) accordingly he languiſhed a few weeks longer, and then expired without pain, the approach to death being remark⯑ably calm and gradual. At my earneſt re⯑queſt I was permitted to open the body; and agreeable to my expectation, I found the glands in the meſentery ſwelled in a moſt ſurprizing manner, ſo that the child was in fact ſtarved to death for want of a proper aſſimilation of chyle. Had this child been managed properly at firſt by [29]taking ſaline preparations, in all human probability he might have been ſaved. Upon enquiry I found that the father of this child had been ſeverely afflicted with ſcrophula in his infancy.

I am well convinced that theſe caſes oc⯑cur more frequently than is imagined; they are generally ſuppoſed to ariſe from worms, as it occurs in the ſummer, when children meet with plenty of green fruit, which has been long ſuppoſed to generate worms, though I know not on what foun⯑dation. But to return to ſcrophula in ge⯑neral:

From this diſeaſe being hereditary; from its occurring at a particular period, and attending a peculiar temperament, we may ſafely conclude it to be conſtitutional; hence I conceive that it ariſes not from a matter tranſmitted from parents to chil⯑dren, but from a peculiar form of body.

I am ſenſible, that in this opinion I differ from many learned and ingenious phyſicians, whoſe improvements will al⯑ways render their memory dear to the ſtudents of medicine. I deliver this only as my opinion, ſubmitting it to the examination of more judicious and im⯑partial men. It may perhaps ſeem a ſtrange aſſertion to ſome, that I ſhould preſume ſcrophula to depend on a peculiar forma⯑tion of the ſyſtem; but if we examine the ſeveral diſeaſes which can be traced from father to ſon, we muſt conclude, that in the various ſtages of life the ſyſtem un⯑dergoes different changes neceſſary for the animal oeconomy—if this was not the caſe, how does it happen that the gout, which is a hereditary diſeaſe, lies dormant till the fortieth year of life? or whence ariſes that wonderful change which occurs in both ſexes at the time of puberty? We every day ſee children whoſe features bear ſo ſtriking a reſemblance to the parents, that they may be known to be ſuch among [31]ſtrangers—if then it is true that a parent can tranſmit to poſterity a miniature of himſelf externally, why ſhould a ſimila⯑rity in the internal ſtructure be objected to?

Upon the whole then, I preſume that ſcro⯑phula ariſes primarily from a peculiar ſtate of the glands themſelves, and not from the matter they retain. And I preſume it will be an argument of ſome weight with my readers, if I obſerve that ſcrophula exiſts only during a certain period of life, and that it diſappears afterwards, owing to ſome change in the glands themſelves: how, or why this takes place I am uncertain; I only advance it as a fact, and leave it to the ſpe⯑culation of men of ingenuity to inveſtigate it further.

It has been aſſerted that viſcid tenacious diet, and auſtere unripe ſummer fruits (things contradictory in themſelves) have been the cauſe of ſcrophula. Inſants have been ſuppoſed to receive the infection from [32]their nurſes, but we have no facts that can be depended on to prove this; beſides, at the time of giving ſuck nurſes have ſeldom any ſymptoms of the diſeaſe.

Again, it has been imputed to humid air, to children being confined too cloſe, to a frigid phlegmatic temperament, to drinking ſnow-water, and various other cauſes, ſome of them without any founda⯑tion and others very uncertain.

I have in the preceding pages obſerved, that the meſenteric glands are generally more or leſs affected in ſcrophula: this muſt occaſion a great difference in the aſſimilating powers; and hence it is that ſuch people are generally weak and relaxed, the circulation being irregular it muſt occaſion a material difference in the lymphatic ſyſtem, and hence the phleg⯑matic conſtitution is a conſequence of the diſeaſe, and not a cauſe; and this alſo will explain why the ſummer ſeaſon is ſo very [33]unfavourable to ſcrophulous habits, and account for that phaenomenon of the diſeaſe returning at certain periods.

It may be readily ſuppoſed that I ſhall find it difficult to alter a natural conſtitu⯑tion, change and overturn an operation of nature, and conſequently that every me⯑thod of cure muſt be ineffectual. I muſt acknowledge that all diſeaſes depend⯑ing on a peculiar temperament, when they are once eſtabliſhed are very difficult to eradicate; as we find in the gout, ma⯑nia, &c. It is true, that there are ſome em⯑pirics in the world whoſe aſſurance is be⯑yond every thing; they have furniſhed the hiſtory of phyſick with a number of pre⯑tended facts that may ſeem to overthrow all dogmatic theory; but if mankind were leſs credulous, if they would examine ſuch hiſtories themſelves, they would find, I am confident, in nine caſes out of ten that ſuch diſeaſes were groſsly miſrepreſented.

Though a cure of this diſeaſe (when it is once eſtabliſhed) may be difficult, yet [34]there is no doubt but we may by a proper precaution obviate the conſequences to be expected from a ſcrophulous conſtitution, and therefore I muſt here earneſtly recom⯑mend to thoſe parents who have been ſub⯑ject to it, to make uſe of every precaution before the time when the diſeaſe occurs in children.

Although I have been ſtrenuous in ſup⯑porting a new theory of this diſeaſe, never⯑theleſs I muſt acknowledge, that in the indications of cure it is neceſſary to include thoſe remedies which may obviate the ef⯑fects of acrimony. For it would be abſurd in me to aſſert that there are no marks of acrimony in this diſeaſe; there moſt un⯑doubtedly are; but theſe I conſider as ſymptoms of inveterate ſcrophula, ariſing from a ſtagnation of that matter which ſhould be tranſmitted by the glands; and therefore the indications of cure are, [35]

• Firſt, Upon the ſuppoſition of ſome acrid matter to waſh it out of the ſyſtem.
• Secondly, To obviate debility and laxity.

With regard to the former of theſe, the idea of acrimony being the cauſe of this diſeaſe, has laid the foundation for variety of practice; various have been the remedies preſcribed, many contradictory to each other, and others ſo weak and inert in themſelves, that they could never afford relief in the ſmalleſt degree; but as a catalogue of remedies declared ineffec⯑tual muſt in the recital be diſagreeable to my readers, I ſhall paſs them over with this obſervation, that if the noſtrums re⯑commended by empirics had been infalli⯑ble in this diſorder, they never would have ſunk into neglect and contempt.

The method I have found the moſt effectual for the firſt indication, is the [36]uſe of water, which is a fluid fitted to carry out of the ſyſtem any acrid matter by the ſeveral excretories. Much is to be im⯑puted to pure elementary water; but per⯑haps water impregnated with a ſaline mat⯑ter fitted to ſtimulate and increaſe the ſe⯑cretions, is the moſt probable remedy. This ſhould be uſed during the ſpring, in ſuch quantities as the ſtomach will bear without purging.

It has been often recommended to the patients in this diſorder to drink ſea-water as a purge, in order to cleanſe the blood (as it is commonly called): this, however, is a practice always uſeleſs, and ſometimes dangerous; for I conſider it as an impoſſi⯑bility for a medicine paſſing off by ſtool to affect the blood or excretories; it is true, that the ſea-ſalt by its ſtimulus may emulge the inteſtines and carry off a great deal of mucus, and in that manner may have ſome effect on the glands of the me⯑ſentery: but here it is neceſſary to ob⯑ſerve, [37]that all purges muſt have a bad effect, which ſtimulate the inteſtines when the glands by being turgid with matter, are in a ſtate of inflammation; when this ſtate takes place it may be eaſily diſcovered by the quickneſs of the pulſe, pain, and ten⯑ſion of the belly, and alſo by the condition of the external glands on the neck, and therefore I would recommend only as much ſea-water to be drank as the patient can bear without vomiting or purging: and this will be beſt effected by drinking ſmall quantities at a time.

As this diſeaſe ſeems to have periodical revolutions, it will be beſt to aſſiſt the operations of nature by drinking ſea-water very early in the ſpring before the ſum⯑mer ſolſtice ſets in; by following this rule I have known ſcrophulous complaints in time intirely removed. But as it often happens that patients being ſituated at a diſtance from the ſea, through various circumſtances are incapable of making a [38]journey at the neceſſary period when it is common to viſit the ſea-coaſt; to ſuch I muſt obſerve, that ſalt-water can be tranſported at an eaſy expence to any inland town in good condition; there is no ſuch advantage to be had from the ſea air as many people have imagined. I have frequently found that thoſe pati⯑ents who ſtaid quietly at home and drank ſea-water, received much more ad⯑vantage than thoſe who made a journey on purpoſe; the reaſon I take to be this, thoſe who take up ſea-water on the ſhore generally get freſh water amongſt it; and therefore I give this caution to perſons who wiſh to receive benefit from ſalt-water, to let a boat be ſent off to ſome diſtance from the ſhore, and the water taken up juſt before high tide; thus the ſalt-water will be got without being diluted with any freſh; with this management, I am certain that it will be a very powerful remedy.

As this diſeaſe affects people of all ranks and conditions of life, it muſt ſometimes happen, through poverty, that the ſick are unable to bear the ſmall expence of hav⯑ing the ſea-water ſent to them at the time it is moſt wanted; to ſuch I have recom⯑mended a ſolution of three parts of Glau⯑ber's ſalt to one of common ſalt in ſpring⯑water, which will be a uſeful ſubſtitute when ſea-water cannot be had.

Having ſaid thus much on ſea-water, I ſhall now conſider our ſecond indication, viz. to obviate debility and laxity of the ſyſtem.

I have in the foregoing pages given my reaſons why patients in the ſcrophula are commonly ſo much debilitated, and therefore I muſt now remark that tonic remedies are not to be uſed till after the ſea-water has been purſued for a conſidera⯑ble time; the general practice has been to uſe them both indiſcriminately; but I have [40]never ſeen any advantages accrue from ſuch treatment. The rule I have hitherto followed in putting the patient on a courſe of ſea-water during the months of Ja⯑nuary, February, and March, and then gradually introducing the tonic remedies, as the ſummer advanced, has always been attended with remarkable ſucceſs. The remedies for this purpoſe are:

Firſt, The Peruvian bark: in the London Medical Eſſays we have ſome account of the good effects of the bark in ſcrophulous caſes; this induced me to try it, and I muſt acknowledge that I had reaſon to think it uſeful; I will not pre⯑tend to ſay how it acts on the ſyſtem in general, but I have never found it anſwer, unleſs taken in powder and in large doſes. —Dr. Fothergill ſays, he uſed a decoc⯑tion of it with ſucceſs. But when we conſider this as a conſtitutional diſeaſe, that is, which goes and comes with the ſeaſons without the uſe of remedies, it [41]renders a ſlight decoction of the bark a doubtful remedy at the beſt.

I have often thought that this circum⯑ſtance of the diſeaſe going off ſpontane⯑ouſly has been the ſole cauſe of that re⯑putation which quack medicines have ac⯑quired.

Second, Alum whey: this is a remedy which, after the uſe of ſea-water, I have found to anſwer better than the bark, or any other remedy, taken in the quantity of a tea-cup full three times a day, and continued for ſome time during the ſum⯑mer months; but I muſt here obſerve, that when the glands of the neck are painful or inflamed, this and all other tonic remedies will tend to increaſe the inflammation; tonics are only indicated in the early ſtages of the diſeaſe, when the tumors are ſmall and moveable.

In caſe the patient ſhould become coſtive by the uſe of this remedy, it may be obviated by taking a large ſpoonful of caſtor oil every morning.

Thirdly, Cold bathing: the ſea-water has by many phyſicians been conſidered as a remedy of great conſequence in ſcro⯑phulous caſes. I have no doubt but it has been often ſerviceable—but what I have ſaid on this head when treating of the ſcurvy may be applied here: I preſume its good effects are intirely to be attributed to the coldneſs of the water, and not to any impregnation of it. A gentleman of the faculty (whoſe judgment I greatly value) having ſeen the foregoing part of this eſſay before it went to the preſs, informed me that the general opinion of phyſicians with regard to the effect of ſea-water, when applied to the ſkin, was that the ſea-ſalt acted as a ſtimulus; but though this ob⯑ſervation might be allowed to have ſome weight in a warm bath made with ſea⯑water, [43]yet I flatter myſelf it will be found to have no foundation when the water is uſed cold. It is a general rule in phyſiology that a ſtrong ſedative al⯑ways deſtroys the force of a weak ſtimulus. Cold water ſuddenly applied to the body acts as a very ſtrong ſedative, and conſe⯑quently it muſt deſtroy the ſlight ſtimulus which ſea-water would otherwiſe give.

Others have obſerved that ſea-water applied to meat tends to corrugate and harden the animal fibre; hence they ſay, that it muſt be a great bracer when uſed as a cold bath—this may be very true with regard to the operation of ſea-water on meat; but ſurely there is a material dif⯑ference between the living and dead fibre —and hence I conclude that in this or any other diſeaſe, a plain bath of the coldeſt freſh-water muſt be much more effectual than the ſea.

It perhaps would be attended with con⯑ſiderable advantages if the patient after he [44]comes out of the cold bath was to be wiped dry and then rubbed for ſome time all over with a fleſh bruſh till he was thoroughly warm.

There yet remains two other remedies which have been much uſed though with very different ſucceſs; the cicuta and tuſſi⯑lago: the former has been much recom⯑mended in cancerous caſes, and indeed in indurated tumors; for my own part I muſt ſay, that I have never ſeen it attended with any advantage when uſed ſimply. The general method of combining ſeveral medi⯑cines to anſwer one intention renders all their ſingle operations uncertain, as we can⯑not in ſuch caſes diſcover which of them is efficacious. The tuſſilago is a remedy of great efficacy in this diſeaſe; the expreſſed juice, or a ſtrong decoction of the dried herb, as recommended by Dr. Fuller, in his Medicina Gymnaſtica, has remarkable effects on ſcrophulous ulcers. I have known it uſed with great ſucceſs in very inveterate caſes.

I have thus endeavoured to inveſtigate the effects of ſea-water in two diſeaſes, if not the moſt dangerous, yet the moſt diſtreſſing to mankind. I have endea⯑voured to give a plain detail of thoſe ſymptoms which occur in each diſeaſe; and though perhaps I may have digreſſed from the main ſubject in the practical part, yet I flatter myſelf it will not be found the leſs agreeable on that account to thoſe who are ſo unfortunate as to labour under either of theſe complaints. It remains now that I cloſe the ſubject, and ſubmit it to the judgment of the publick.