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MEDICAL.ESSAYS

AND

O B S E R YATION S,

k ' ' *v • , _

Publifhed by a

SOCIETY in EDINBVRGR.

VOLUME V. PARTI.

The Third Ed i wjo n,

Revt/d and Enlarged by the iU THOR S.

'

Edinburgh,

1 Printed V "VV . and T. Ruddima ns, for Meflfe Hamiton and Balfour, Bookfellers,

M, DCC. XL VII.

The PREFACE.

A Society being formed in this Place for d* the Improvement of Natural Know¬ ledge, in which all the Branches of Medicine are included j and the Members of

our Society being adopted into this new one1 the De feign ofpublfeing more Volumes of Me¬ dical Papers was dr opt feme tfme ago ,

It is now at the 'Defer e of the Gentlemen of this new Society that we caufe this fifth Volume to be printed , which is feo much en¬ larged by the Papers which they generoufey farn feed us from their Repofetoryy that we are obliged to divide it into two Parts . Vhe fir ft of thefej containing the Regifter of the Weather, Account of epidemical Difea- fes, Papers on the Materia- Medica, Che- mie, Anatomy, Animal OEconomy and Surgery, is now in your Blands y through the Impatience of the Bookfelkrs , who would not delay the Publication of this Part till the fecondy containing the Papers on the Theory and Pradlice of Medicine, the Im¬ provements made elfewhere, Lift of Books publifeedy and Nouvelles Literaires, was alfo print edy though it is ready for the Prefs .

The Comparifon of our Meteorological Re¬ gifter s and Accounts of epidemical Difeafes , with thofe made at other Places in the fame

a 2 Pm-

iy The P R E FACE.

Period of Time^ which - you fee in this fir ft Part , the general Index to all our five

Volumes , which will he put to the fecond Party are fuff dent Signs of this Collection being at an End .

The Demand for our Coiled tons at home ,, and the Tranjlaticns of them pubhjhed in i different Parts of Europe, make us f atter curfeheSy that we have not been ufelefiy em*t ployed in giving our Volumes to the Publick : ' We have good Reafon to think, that the La* • hours of the new Society , to which we shear* ■ fully yield our Place , will prove of as much greater Advantage to Mankind , ^ their Plan is more extenfive than ours .

hi Name of this Society we invite to their Correfpondence all Gentlemen of whatever Nation, who have Experiments or Oh few a* tions relating to Natural Knowledge to com — mimic at ey or who pkafe to propofe ufeful In - veftigations or Experiments to be made by the Society . The Letters defgned for them are to be addrejfed to their Secretary Dr. Andrew Plummer Profcjfor of Medicine, in the Univerfity of Edinburgh ; and whatever is delivered under fitch an Addrsfs to any oj the BookfellerSy whofe Names are on the Title-page of this Volume , will be carefully conveyed to the Society *

C O N-

V

CONTENTS.

Art.

I.

Pag.

THE Meteorological Regifler , I

II. An Account of the Difeafes that •were m.o/1 frequent in Edinburgh from May r 7 3 5 June 1736, 2 6

III. Extract from the pubiick Regifier of Bu¬ rials , 32

IV, AComparifan of the Meteorological Regi¬ fier and epidemic Difeafes at Edinburgh, Rippori, Plymouth and Norimberg, from May 1731 to June 1736, by Mr. Patrick Ker Student in Medicine , 33

V . Propofals for determining the Effidls of aflringent , of attenuating and of coagulat¬ ing Medicines , by Dr. Charles Balguy Rhyfician at Peterborough, 72

A- 1. The good Effects of fmall Dofes of Eme- iicks and Purgatives frequently repeated> by Dr. Alexander Thomlbn Phyfcian at Montrofe, 75*

VII. Powder of Tin an anthelmintic Medi¬ cine , by Dr. Charles Alfton Profeffor of Botany and Materia medica in the Univer - fty of Edinburgh, yp

Vllf. The Effedls of the Sufceus Rad.. Irid.. paluftr, by Mr. Charles Ramfay Surgeon in Edinburgh, 80

IX. Obfer rations of the EffeEls of Lignum Guiacum in Cancers , by Mr. John Love Surgeon at Greenock, 8 2

X. Of

vi CONTENT S.

Art. Pag.

X. Of the EjfeFt of the Peruvian Bark in Gangrenes , Ulcers and Small-pox , by A- lexander Monro Prof for of Anatomy in the Univerfity of Edinburgh*, and F.

R. S. " 84

XI. A Method of preparing the Extract and

Syrup of Poppies , by Mr . Thomas Ar- not Surgeon in Coupar, 90

XII. A Difjertation on Opium* by Dr.

Charles Alidon P. B. and M. M . 93

XIII. Remarks on the neutral Salts of

Plants , by Dr. John Fothergill Phyfi- cian at London,, 147

XIV. An EJfay on extracting the Acid of Sulphur , by Charles Lucas of the City

of Dublin Apothecary , 153

XV. Vitrum Antimonii Ceratum a fpeeific ' Medicine in the Dyfentery, by Dr. John Pringle Fellow of the College of Phyfi-

dans and Profejfor of Ethicks in the U- niverfity of Edinburgh* 1 6 2

XVI. A Skull uncommon for the Number

and Size of the OfTa triquetra, by Ale¬ xander Monro, P.A. 18 1

XVII. Supernumerary Teeth , by Dr. George

Thomfon Phyfi clan at Maid (tone, 182

XVIII. The Mechanifm of the Cartilages between the true Vertebra?) by Alexan¬ der Monro P. A. 184

XIX. Reflections and Obfervations on the feminal Blood-veffels , by the late Dr. George Martin Phyfician to the Ameri¬ can Expedition , 187

XX. Remarks an the fpermatic Veffels and

Scrotum

C ONTENT S. vii

Art. 5 Pag.

Scrotum with its Contents, by Alexander Monro P. A . 205

XXI. Remarks on inguinal Hernia; in Men,

by the fame, 222

XXII. Of the Tumors in the Scrotum, com¬ monly called falfe Hernia;, by the fame, 245

XXni. An impregnated Ovarium and fu- pern timer ary Ribs and Vertebra, by Mr. John Gemmil Surgeon in Irvine, 2 77

XXIV. An Account of a monflrous Child, by Dr. John Burton Phyfician at York, 278

XXV”. An EJfay on the Caries of Bones , by Alexander Monro, P. A . 279

XXVI. Of the Separation of Tendons in Sores, by Dr, Thomas Simlon Profejfor of Medicine in the Univerjity of St. An¬ drews, 320

XXVII. Hifi cries of the Cure of Lymph a- ticks opened in Wounds, tyy Alexander Monro P. A. 32 5

XXVIII. A milky Difcharge at a fmall Ori¬ fice in the Groin , by Mr. John Patch Sur¬ geon in Exeter, 328

XXIX. A PraClure of the Skull, with Lofs of Part of the Subftance of the Brain, by . Mr. Duncan Baine Surgeon in Pembroke, 330

XXX. Artificial Pajfages for natural Li¬ quors, by Alexander Monro P. A. 331

XXXI. An uncommon Tumor of the Neck

extirpated, by Dr. Thomas Simlon Pr. Med. at St. Andrews, 335

XXXII. Hifiories of Collections of bloody Lymph in canorous Breafis by Alexander Monro P. A. 237

XXXIII.

■*& v*

via

Art.

CONTE N,T S. .

Pag.

XXXIII. The Hiftory of an extraordinary Empyema , by Mr. James Jamiefon Sur¬ geon in Kelfo, 347

XXXIV". A confide ruble Share of the In'te- fines cut of after a Mortification in cl Hernia, by Mr. William GookeHey Sur¬ geon in Grediton, 351

XXXV". The Hifory of Plum and Cherry Stones evacuated ad an Ahfcefs in this .. Belly , by Mr. Jofiah Cole Accoucheur , London, 354

XXXVI. The Hiftory »/<* Gians Penis re- generated after Amputation , by Mr. James Jamiefon Surgeon in Kelfo, 3 56

XXXVII. An extraordinary Tumor imped¬ ing the Birth of a Child , by Mr. John Gemmil Surgeon in Irvine, 359

XXXVIII. The Grelarean Operation done with Succeft by a Midwife , by Mr. Dun¬ can Steuart Surgeon in Dungannon, 36a

XXXIX. The Hifory of one Child extra¬ cted by an Opening in the Abdomen , and Part of another gaffed by Stool , by Dr. - Gabriel King Phyjician at Armagh, 362

XL. A Ring- fcalpel for affifting the Delive¬ ry of Women in Child-birth , by Dr. Tho¬ mas Simfon Profeffor of Medicine in the Univerfity of St. Andrews, 365

XLI. A Hiftory of the Tibia taken out and regenerated , by Mr. William Johnfton Surgeon in Dumfries, 370

XLII. A Defcription of fever al chirurgical InftrumentSj by Alexander Monro, P.

A . ' 372

Medical

Medical Effays

AND

OBSERVATIONS.

T

ARTICLE I.

The Meteorological Regifler .

^fHE Inftruments with which the ^ Obfervations in the following Re- gifter of the 'Weather were made* are the fame as were employed for theRegifters of the former Volumes*

Voi". V,

A

JUNE

Medical EJfays

*9

JUNE 1735.

3$.

Hour.

Baro. In. D.

Ther.

in. D.

-Hyg

I. D.

Wind. Dir. For.

Weather,

1

9 a.

m.

-9

7

13

7

2

I

N. E.

2

fair

8 p.

m.

29

7

13

8

2

O

N. E.

I

fair

2

9 a.

m.

29

9

13

7

2

0

N. E.

I

Fog

8 p.

in.

29

9

12

8

2

7

N. E.

2

Fog

3

9 a.

m.

30

V3

6

2

8

N. E.

2

Fog

8p.

m.

30

013

7

2

2

N. E.

2

fail-

4

9 a.

m.

30

013

7

2

O

N. E.

I

fair

8 p.

m.

2?

9

17

1

1

9

S.

2

fail-

5

9 a.

m.

30

0

12

7

1

8

N. W.

2

cloudy

8 p.

m.

30

1

12

1

1

7

N. W.

2

cloudy

<5

9 a.

m.

30

1

13

0

1

3

N. W.

2

fair

8

7 p.

m.

3°

0

14

9

1

3

E.

2

fair

7

9 a.

m.

29

9

13

2

.1

8

E.

I

fair

7 p*

m.

29

8

14

7

1

7

W.

I

fair

8

9 a.

m.

29

8

14

8

t

7

W.

I

faii-

7 p-

m.

29

7

13

8

1

4

s. w.

2

cloudy

S>

9 cl.

m.

29

7

14

0

1

7

s. w.

2

cloudy

8p.

m.

29

6

13

6

1

4

W. b. S.

2

fair

lo

9 a.

m.

29

6

13

7

1

4

W.

I

fair

7 P-

m.

29

7

13

2

1

7

N, W,

I

cloudy

11

9 a.

m.

29

7

13

6

1

6

W.

I

doudy

7 P*

m.

29

7

14

7

i

3

w.

1

fair

12

9 a.

m.

29

8

13

7

1

6

w.

O

cloudy

7P-

m.

29

8

13

7

i

4

w.

I

cloudy

13

9 a.

m.

29

6

14

0

1

8

w.

1

faii-

7 P-

m.

29

8

13

9

1

6

w.

2

cloudy

14

9 a.

m.

29

8

13

7

1

6

w.

1

cloudy

8p.

m.

29

8

13

3

1

4

w.

0

fair

1 7

9 a.

m.

29

7

17

7

1

4

S. b. W*.

2

faii-

8 p.

m.

29

6

14

7

1

3

S. b. W*

2

cloudy

16

9 a.

m.

29

4

1 1

8

1

7

w.

2

cloudy

m.

29

4

12

6

r

7IW.

2

1 fair

and Obfermtions.

JUNE 1735.

X).

Hour.

Bare

1.

Ther.

Hyg|

Wind.

Weather

In. D-

In.

D.

I.D..

Dir. For

17

9 a.

m.

29

4

H

2

1

4

s.

2

cloudy

I J

7 P-

m.

29

4

13

3

1

7

S. E.

2

fair

9 a.

m.,

29

5

14

3

1

6

E.

2

cloudy

.9

9 P* 9 a.

m.

in.

2 9 29

6

6

13

12

4

1

T -

i

I

/

8

E.

E. b. N.

2 1

1

2

fair

Fog

6 p.

m.

29

6

13

6

I

6

E. b. N.

0

fair

-2o

9 a.

m.

29

7

13

1

2

4

N. E.

2'

Fog

8p.

m.

29

7

13

O

Jm

0

N. E.

2

Fog

21

9 a.

m.

29

8

13

8

2

4

N. E.

2

fair

8p.

m.

29

8

13

2

2

1

E. b. N.

2

cloudy

22

9 a.

m.

29

7

14

2

2

2

N. W.

2

cloudy

6 p.

m.

29

7

14

4

1

7

N. E.

2

cloudy

S3

9 a.

m.

29

8

12

2

I

8

N. E..

2

fair

8 p.

m.

29

9

13

8

I

7

N. E.

I

fair

24

9 a.

m.

29

8

14

0

I

6

w.

2

cloudy

8 p.

m.

29

7

13

8

I

7

w..

I

fair

1

SJ

9 a.

m.

2 9

7

*3

2

I

7

w.

2

cloudy

8 D.

m.

29

7

12

4

I

6

w*

2

fair

26 9 a.

m.

29

4

13

2

I

7

V/.

I

cloudy

8p.

m.

29

7

13

4

I

4

w.

3

cloudy

27

9 a.

in.

29

6

13

6

I

7

w.

2

fair

8p.

m.

29

6

13

6

I

7

w.

2

fair

28

9 a.

m.

29

6

14

7

I

7

w.

2

cloudy

18 p.

m.

29

7

13

7

I

9

S. E.

I

Rain

29 9 a.

m.

29

4

13

2

2

2

W.

2

cloudy

19 P.

m.

29

4

12

7

I

7

w.

2

fair

30,9 a.

m

29

6

13

6

I

7

N. W*

2

cloudy

18 p.

m.

29

7

13

7

I

4

w.

2

fair

Gi

. Height 30

I

17

7

2

S'

L.

Height

29

4

1 1

8

I

3

ii.atamed.29

7

13

7

I

6

Medical EJJays

JULT 1735,

P-

Hour.

Baro.

Ther.

Hyg

Wind.

Weather.

In.

D.

In.

D.

I.

D.

Dir. For

I

9. a.

m.

29

6

H

4

1

7

W.

1

Fog

3p.

m.

29

-s

H

3

1

5

W.

b.. N.

2

fair

2

9 a.

m.

29

S

14

6

1

5

s.

a. E.

j

cloudy

8P.

m.

29

4

12

5

2

8.

s.

E.

2

Fog

3

9 a.

m.

29

S

13

6

2

7

s.

W.

1

cloudy

7P-

m.

29

6

14

7

1

5

w.

2

fair

4

9 a.

m.

29

7

12

1

3

0

N.

E.

2

cloudy

8 p.

m.

29

8

12

4

2

2

N.

E.

2

cloudy

*i9 a-

m.

29

9

13

I

2-

3

N.

E.

1

cloudy

]

8p.

m.

29

9

13

0

2

S

N.

E.

1

Fog

&

9 a.

m.

30

0

13

4

2

8

N.

E.

2

Fog

7 p-

m.

2-9

9

12

3

2

6

N..

E.

2

Fog

7

9 a.

m.

29

7

14

3

3

0

N.

E.

2

cloudy

(8 p.

m.

29

7

1 S

6

3

0

N.

E.

1

cloudy

81 9 a.

m.

29

6

1 3

0

2

4

N.

b. W.

2

Rain

8 p.

m.

29

6

1 3

0

2

7

N.

b. E.

1

cloudy

9 9 a.

m.

29

7

1 3

8

I

4

N.

b. W.

•t

fair

3p„

m.

29

7

14

2

2

1

N.

2

cloudy

10 9 a.

m.

29

6

13

0

2

I

N.

E.

1

faii-

7 p*

m.

29

S

1 3

5"

2

0

W.

2

cloudy

II

9 a.

m.

29

6

1 3

I

2

Q

w.

1

fair

8 p.

m.

29

S

I 3

4

I

9

w.

0

u.

faii-

12

9 a.

m.

29

3

13

7

I

6

s.

E.

2

cloudy

8 p.

m.

29

2

13

6

I

6

S. ]

E.

2

cloudy

13

9 a.

m.

29

T

13

7

2

C r

w.

2

cloudy

8 p.

ni.

29

2

13

4

I

8

N.

W.

2

cloudy

14

9 a.

m.

29

4

13

*

I

8

w.

2

fair

8 p.

m.

29

s

13

0

I

6

w.

2

fair

is

9 a.

m.

29

4

13

3

I

8

N.

2

faii-

8 p.

m.

29

4

14

1

I

7

S.

b. E.

O

4-

cloudy

16

9 a.

m.

29

2

12

7

3

0

N.

E.

2

Rain

&p*

m.

29

2

U

3

2

8

E*

2

Ruin

and Obfervations*

JULT I73J.

D.

Hour.

Baro.

Ther.

Hyg

Wind.

Weather.

In. D.

In. D.

I. D.

Dir. For.

17

9 a.

m.

29

4

13

7

2

3

W

2

cloudy

8p.

m.

29

6

‘3

4

2

O

N.

w.

1

cloudy

18

9 a.

m.

29

8

12

7

2

0

N.

w.

1

fair

8 p.

m.

29

9

13

3

i

4

N.

w.

1

fair

19 9 a.

m.

29

9

14

4

1

6

S.

b. W.

1

fair

I

8 p.

m.

29

8

14

0

1

7

S.

t>. W.

2

cloudy

20

9 a-

m.

29

6

14

3

1

8

w

2

cloudy

18 p.

m.

29

7

14

6

1

7

N.

w.

2

fair

21;

9 a.

m.

29

9

14

2

1

6

E.

2

fair

|8p.

m.

29

9

14

4

1

7

E.

2

fair

22

9 a.

m.

29

7

14

2

1

7

S.

E.

1

fair

8 P*

m.

29

6

13

7

1

7

E.

2

Rain

23

9 a.

m.

29

7

H

1

2

4

S.

b. E.

0

cloudy

!

8 p.

m.

29

4

14

4

2

0

S.

b. E.

0

cloudy

24 9 a-

m.

29

4

13

3

1

8

w

0

cloudy

8 p.

m.

29

4

13

7

1

6

w

2

cloudy

27

9 a.

m.

29

4

14

7

1

6

s.

W.

2

pair

8 p.

m.

29

4

14

3

1

7

s.

w.

2

'fair

26

9 a.

m.

29

7

13

8

1

7

w

2

cloudy

8p.

in.

2-9

7

*4

4

r

6

w.

2

fair

27

9 a.

m.

29

8

13

-4

1

8

s.

w.

2

cloudy

8p.

m.

29

8

14

0

1

7

s.

w.

.2

fair

28

9 a.

m.

29

9

17

6

1

6

s.

w.

2

fair

8 p.

m.

29

9

n

2

1

6

s.

w.

2

fair

29

9 a.

m.

30

0

1 7

7

1

6

s.

w.

1

fair

8 p.

m.

30

0

17

7

1

6

N.

E.

1

fair

30

9 a.

m.

29

9

17

6

1

7

s.

E.

2

fair

8 p.

m.

29

9

16

0

1

4

s.

E.

0

jC.

fair

8i

9 a.

m.

.29

9

17

2

1

8

s.

E.

7

cloudy

8 p.

m

29

9

17

6

1

8

s.

E.

7

.'cloudy

Gr. Height 30

0

16

0

3

0

la

Height

29.

l

12

I

1

4

tamed .29 7 14 2

1 9

Medical Effays-

AUGUST’ 1735.

• Hour.

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Tiler. In. D.

Hyg

I. D

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1

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3

9 a.

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29

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16

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and Obfervations.

7

A U G US t 1735.

D.

Hour.

Baro.

Ther.

Hyg

Wind.

Weather

in.

D.

In. D

I.

D.

Dir. For.

*7

9 a.

m.

29

8

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6

r

7

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2

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7 p.

m.

29

6

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3

2

c

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2

Rain

1 8

9 a.

m.

29

5

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9

2

6

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2

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7 p.

m.

29

4

1 J

3

2

I

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2

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1 9

9 a.

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29

6

14

0

2

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5. W.

2

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7 p.

m.

29

6

13

4

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6

w.

2

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20

9 a.

m

29

6

14

c

1

7

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2

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7 p.

m.

29

6

13

5

1

6

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2

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21

9 a.

m.

29

4

13

6

1

9

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2

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7 p.

m.

29

4

13

7

r

5

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2

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22

9 a.

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29

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13

3

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29

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23

9 a.

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29

5

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3

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7 P*

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12

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24

9 a.

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7 p.

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29

5

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25

9 a.

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27

9 a.

m.

29

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7 P.

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2 8

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29

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29

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29

6

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7 p.

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29

8

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31

9 a.

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29

8

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29

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Medical EJfays

SEPTEMBER 1735

B.l Hour,

19 a.

\7 p. 2 9 'A.

|7 P-

5 9 a.

P P.

49 a.

5 P- 5 9 a.

|j p. 69 a.

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7 9 a.

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$ 9 a.

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5 P- lo 9 a.

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5 p. iz\9 a.

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25 9 a.

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Baro. In. D

28

29 29

m. m. m ni. j28

m 28 m.jzS

m.pp

m ! m m. m. ra m. m m m- m. m.

m. m. m. m- m m- m. m. m- m- m. m. m m-

Ther. jHyg In. D. I. D.

29

29

19 2 9 29 29

29

29

29

29

2 9

29

30 30 30 30

30

30

29

29

29

29

29

29

19

4 9 9 9 3

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6

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7

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12 12

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13 12 I 2

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11

12 12. 13 12 12

11

12 12 12

11

12

Wind. Dir. For.

9 W. 9| W. 8 W.

2

2

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1

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1

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8, W. 6,W.

9 S. W. 5 j N. W. 8: W.

9 W.

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fair fair 3 If air 3 iRain 3 [fair 3 jfair 3 jfair 2 fair 1

1

2

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1

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mid Observations

SEPTEMBER 1735.

p.

Hour.

Baro.

Ther.

Hy

(T

Wind.

Weather.

In.

D.

In.

D.

1. D.

Dir, For.

27

9

a.

m.

29

9

12

8

I

8

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2

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4 P.

m.

29

9

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4

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7

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2

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18

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30

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20

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27

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29

8

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1

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28

9

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29

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29

9

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15 p.

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29

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30 9

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16

Medical Ejjays

C-fOBER 1735.

Brir.). Th'er.

Ln.'D. In. D

Hyg

I.D.

Wind. Dir. For.

Weather.

\

29

6

rr

29

7

it

2 9

8

to

29

9

ro

30

0

10

30

0

r 1

30

1

to

30

1

to

29

8

10

29

7

to

29

8

1 1

a

II

6 E.

1 E.

4S. E.

1 S. E, Z. E. •

2 i E,

3 !§. E. 9j S. E.

3 jS. E.

3 S. E.

4 S. E.

7 S. W.

2 cloudy 2 cloudy 1 fair

z

» 4

2

2

2

2

2

1

2

cloudy

cloudy

cloudy

cloudy

cloudy

Rain

cloudy

cloudy

cloudy

mid Obferoations

\

OCTOBER 1735.

D.! Hour.

Baro. In. D.

Ther. Hyg In. D I. D.

Wind. Dir. For.

Weather.

1 79 a. m.

29

9

12

0

2

4

s. w.

2

cloudy

1

5 p. m.

30

I

12

3

2

4

s. w.

2

cloudy

is 9 a. m. j

30

2

11

2

2

6

S. E.

I

fair

1

5 p. m.

3c

3

11

5

2 .

4

S. E.

2

cloudy

19

9 a. m.

30

3

1 1

5

2 .

5

E. b. S.

O

cloudy

5 p. m.j

30

3

1 1

2

2

3

E. b. S.

I

cloudy

20

9 a. m.

30

3

9

8

2

3

E. b. S.

I

fair

5 p. m.

30

2

10

6

2

2

E. b. S,

I

fair

21

9 a. m.

30

0

10

5

2

3

S. E.

I

cloudy

5 p. m.

29

9

11

0

2

2

S. E.

I

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22

9 a. m.

29

8

1 1

6

2

6

s.

I

fair

5 p. m.

29

8

12

6

2

5

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I

cloudy

2 3

9 a. m.

3°

0

12

6

2

7

N.

2

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5 p. m.

30

0

12

2

2

6

N.

2

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24

9 a. m.

30

I

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8

3

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2

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5 p. m

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12

0

2

7

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9 a. m.

29

9

11

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2

8

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4 p. m.

29

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0

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0

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26

9 a. m.

29

4

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6

2

8

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2

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4 p. m.

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29

5

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4 p. m.

29

5

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8

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2

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28

9 a. m.

29

6

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5

2

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29

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| 29

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29

8

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29

3

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1

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4 H, at a Ried.29

9

IO $

1,2

2

12

Medical EJfays

NOVEMBER 1735.

Hour.

Baro. In D.

Ther. In. D.

Hvg

I.D.

Wind. Dir. For.

Weather.*

3

9 a.

m.

29

7

10

3

2

6

'n. W. 2

fair

4 P*

m.

29

7

io

4

2

4

N. W. 0

cloudy

2

9 a.

m.

3°

0

9

7

2

4 S. E. 0

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4 p-

m.

30

0

io

2

2

2

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3

9 a.

m.

30

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2

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30

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4

9 a.

m.

29

9

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2

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4 P*

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29

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9 a.

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29

8

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4 P*

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29

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1 1

3

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6

9 a.

m.

30

0

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fair

4p.

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3°

0

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3 s. E. 3

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7

9 a.

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29

8

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29

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3

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9

9 a.

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4p.

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29

3

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10

9 a.

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29

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2

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29

6

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11

9 a.

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2

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4p.

m.

30

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12

9 a.

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29

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4 P-

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29

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13

9 a.

m.

29

9

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3

2

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4 P*

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29

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14

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m.

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29

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9 a.

m.

29

6

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2

1

s. 3

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4p.

m.

2 9

3

12

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2

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56

9 a.

m.

2 9

3

1 1

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2

3

S. \V. 2

fair

-

4 P*

ra.

29

3

U

6

2

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mid Obfervdtms. 1 3

NOVEMBER 1 735.

D.

Hour.

Baro.

|Ther.

Hvg

Wind.

Weather.,

[n.

D.

In.

D.

I.

D.

Dir. For

17

9 a.

m.

29

4

10

4

2

4

W

•

2

fair

4 P*

m.

29

9

11

0

2

2

W

•

0

X-

cloudy

18

9 a.

m.

29

2

10

4

3

4

W

•

1

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4 P*

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28

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H.atamed.29 $

Vol. V.

14

Medical Effays

D E C E M B E R 1735.

£>.

Houn

Baro. In. D.

Ther. In. D.

Hyg

I.D.

Wind. Dir. For.

W eather.

1

9 a.

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29

6

10

0

3

3

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Rain

4 P-

m.

29

7

10

2

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7

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2

9 a.

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6

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6

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13

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and Obfervations

»5

DECEMBER 1735.

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Hyg

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In. D.

In.

D.

I.D.

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17

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9 a.

m.

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- ™ - - - - — ,

J ANU ART 1 736.

Hour,

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In. D.

In. D.

I

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29

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and Obfervations. %J

. _ _ n. . . . mr-r y - --- -i an - ni — TT"*"*"—1

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JANUARY 1736.

B.j

Hour.

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Hyg

Wind.

Weather.

In. D.

In. D.

I. D.

Dir. For.

!

w

9 a. m.

29

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20

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5 p. m.

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21

9 a. m.

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F E B R U J R T 1 736.

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and Obfervations.

F EB RU ART 1736.

D.

Hour.

Baro.

Ther.

Hyg

Wind.

Weather.

In. D.

In.

D

I. D.

Dir.

Eor.

*7

9 a. m.

29

4

8

2

2

I

N. W.

2

cloudy

5 p. m.

29

4

8

7

2

I

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19

9 a. m.

30

2

12

7

2

3

E.

2

fair

7p. m.

30

3

i3

3

I

8

E. b. N.

2

f°ggy

2o

9 a. m.

3°

3

12

3

2

9

E. b. N.

2

foggy

7 p. m.

30

2

13

3

I

6

E. b. N.

2

fair

21

9 a. m.

30

1

1 1

8

2

2

E.

2

cloudy

7P- m.

30

0

1 1

5

2

0

E.

2

cloudy

22

9 a. m.

29

9

1 r

6

I

9

E.

2

cloudy

V

7 p. m.

29

8

1 1

6

I

9

E.

2

cloudy

*3

9 a. m.

29

7

12

3

I

9

E.

1

foggy

7 P* m.

29

6

12

3

2

J

E.

2

cloudy

24

9 a. m.

29

6

13

3

2

I

E.

0

cloudy

7p. m.

29

7

13

0

I

S

W.

3

cloudy

29

9 a. m.

29

5

12

2

I

S

w.

3

fair

7 P* m.

29

5

12

6

I

I

w.

3

fair

26

9 a. m.

29

3

12

6

I

4

s. w.

2

cloudy

7 p. m.

29

3

12

6

I

4

S.' w.

2

cloudy

27

9 a. m.

29

4

13

2

I

4

E.

2

cloudy

7 p* m.

29

S

1 1

7

I

7

S. E.

2

cloudy

28

9 a. m.

29

7

12

6

2

0

N. E.

2

cloudy

7 p. m.

29

8

1 1

9

2

1

N. E.

2

fair

2.9

9 a. m.

29

8

13

1

2

0

N. E.

2

cloudy

7 P* m-

29

8

12

0

3

2

N. E.

2

foggy

30

9 a. m.

29

9

12

7

2

4

N. E.

2

'fair

7 P* m.

3o

0

13

S

I

8

E.

2

jfair

31

9 a. m.

30

0

14

2

I

6

N. E.

2

fair

7p. m.

30

0

14

9

I

5

N. E.

2

fair

Gr. Height 30

3

14

9

3

2

9

%. Height

29

3

10

0

r

2

Irl.atamed.29

£

11

8|i

7

I Vql. V . G

n. A®

Medical EJfays

2.6

II. An Account of the DISEASES that ‘ were mo ft frequent In Edinburgh from May 1735 to June 1736.

' AGUES, which we mentioned to have been common in the Spring 1735* did not al¬ together ceafe, though they were lefs frequent in the Summer, and then proved tedious, and were liable to return when the Bark was too Foon given.

About the 20 th of J u n e 1735, the Me a fie $ appeared here, and foon became very rife ; they were very frequent all July and Au¬ gust, decreafed afterwards, but did not leave the Town altogether till Spring 1736. In De¬ cember they were very univerfal in the Country about Edinburgh . The Progrefs of thefe Mea- fles along the Weft Road of England towards Edinburgh was very remarkable, for they could be traced from Village to Village ; and it was lingular, that the lirft Ferfon in Edinburgh who was feized with them was a Lady in Child-bed, who faw no body but her Nurfe and a Friend who lived in the Houle with her.

The Symptoms preceeding this Difeafe were Lard dry Cough, muddy, moift Eyes, irregu¬ lar Ihort Attacks of Liftlefnefs and Ina&ivity ; the Duration of thefe before the eruptive Fe¬ ver began was very uncertain, in fome only one Day, in others fourteen, or any interme¬ diate time. The eruptive Fever continued one, two or three Days, attended with Sneez¬ ing, itching in the Skin, Inflammation of the palate and Tonfils, fome bled at the Nofe, o»

thers

md Obfervations. ij

ihershad a Diarrhoea. The Exanthemata were of the common Form generally, but in lome they role above the Surface of the Skin, as high as the mild kind of Small-pox are gene¬ rally in the fecond Day ; none of them howe¬ ver fuppurated. Upon the Eruption, the Fe¬ ver, Gough and Angina abated, but did not go off till the Decline of the Dileale* The Eru¬ ption advanced three, four or five Days, and then began to decline, after which was the Time of greatefl Danger ; for then in feveral the Cough returned more violent, Peripneumo - ny and Diarrhoea came on ; but in mod Pa¬ tients the Dileale declined gradually without bad Symptoms, and in general the Mea/les were mild and benign during all this Sealon.

Moft of the Patients who were attended by ©ur Phyficians and Surgeons, were kept on the cool Regimen all the Time of the Difeafe ; were let Blood of and vomited before the Eru¬ ption, unlefs when the preceding Symptoms and Fever were very mild. If the Belly was cofiive, Clyfters were given. If there was a Diarrhoea , Blood-letting, Vomits and decoffi. alb. generally put it away. Emollient Pe&orals and Syrup, diacod. were of ufe in making the Cough eafier. When the Defluxion became tough. Vinegar, or Vinegar of Squills was added to the other Medicines. If the Angina was violent, emollient detergent Gargarilms and Poultices were uled. When, upon the Meafles fuddenly difappearing, P eripneunomy , Delirium or Stupor were occafioned, the Pa- i tients whofe Pulfe was high were relieved by i being let Blood ; thole who had a low Pulfe

Q 2 were

28 Medical EJfays

were bliftered, by which the Meafies were brought out, and the other bad Symptoms pealed. In fome whole Meafies fuddenly difr appeared, and who were freed of the violent Symptoms by the Methods juft now mentioned, the Exanthemata did not immediately return, but the Patients remained liftlefs ieveral Days or "Weeks, after which the Eruption came out again.' - If upon the decline of the D il¬

eal e the Peripneumony came on, Blood-letting when the Pulle was high, and bliftering when It was low, were the principal Remedies, with the Affiftance of Clyfters, laxative Purges, and attenuating Pedlorals. A Diarrhoea coming upon the Decline of the Meafies feh dom did Service, but wafted the Patients, arid Was difficult to ftop; Rhubarb and Me r cur. d? were of moft Service in removing it.

Some Days after the Meafies were gone, the ^Patients generally got two or three Dofes of Phyftck.

To thofe who feemed to be heflic, and to be threatned with a Phthifhs after this Difeafe, Vomits, Peruvian Bark, and AfTes Milk were <?f Service.

During this* Meafly Seafon, feveral People who never had had the Meafies , had all the preceding Symptoms of Meafies , which went off in a few Days without any Eruption, which they underwent Months or Years after¬ wards. Others who had undergone the Me a* (les formerly, had at this time a Fever of the eryfipelatous kind, with Eruptions like to what jetties caufe, and all the previous and conco¬ mitant

and Obfervations .

ml rant Symptoms of Meajles from the Begin-1 ning to the End of the Difeafe.

In June and July there were alio lome Pleu- rifles and (light Catarrhs.

In July feveral had a flow Fever with a low Pulfe in which a Diarrhoea either began wit& the Fever, or came towards the End of it, or continued all the Time of it. The Cure de» pended principally on Vomits and Bliflers.

Cholera and Kinkcough were pretty frequent in the Country near the Town at this Time.

In August and September there were fome few People who had Coughs, rheumatic Fevers and Squincies, which were not epidemical.

In October, November, and December, feveral had the Dyfentery , the Symptoms and Method of treating which were nearly the fame as we defcribed in our 4th Volume , in the Ac¬ count we gave of this Difeafe, which was in this Place about the fame Sealbn of the pre¬ ceding Year. Some, after Blood-letting and vomiting, gave to their Patients fmall Dofes of dquila alb. once a Day, till their Breath began to be tainted, the purging bping moderated in the mean time by Opiates, glutinous Food and Drink, and anodyne Clyflers, which were the more necelTary that the Guts were very eafily irritated, fo that ten Grains of Rhubarb fcarce durfl be given. Notwithflanding the Symptoms being violent, this Difeafe was fatal to few.

From the beginning of October 1735, to the beginning of February 1736, a Fever was very frequent in Town, the Sick had ge¬ nerally a low Pulfe on the firft two or three Daysj with great Anxiety and Uneafmefs, and

C 3 thiu

go Medical EJJays

thin crude Urine ; Delirium began about the fourth, and continued till the Fever went oif in the feventh Day, and fometimes the Difeafe was lengthened out to the 14th Day. The Approach of the Delirium could always be foretold by the Urine becoming more limpid and without Sediment. The iymptomatick Sweats which happened during the Progrefs of this Fever did for moll part harm, the Patients being very uneafy while in them, and weaker after, without any Diminution of the Fever. In fome thefe Sweats broke the Force of the Fe¬ ver, and returning feveral Times, carried it off at lafl. A large plentiful Sweat was the Crips to feveral, in others there was no Crips obfer- Ved. In the greater Number the Urine did not let fall a Sediment till feveral Days after the Fever feemed to be gone ; thofe who had a plentiful Sediment in their Urine recovered well; others were expofed to Relapfes, which Were very frequent, and rather more dangerous than the former Fever.

Blood-letting in the Beginning was of Ad¬ vantage, not only to the few who had then a flrong Pulfe, but even to thofe with a low Pulfe, which generally became ftronger after blooding, and the Sick were confiderabiy re¬ lieved from the heavy Anxiety they laboured tinder. The liberal Ufe of Blifters was what feemed principally to promote the Cure, the critical Sweats being alfo forwarded by diluent Drinks and gently Simulating Medicines, fuch as Rad. Serpentar. Valerian. Cafior. fal. fuc- rcm . dr. Clyfters were alfo given frQm time to

time*

and Ohfervations . ' 31

time, to afTift the urinary Organs, and to empty the Intedines.

After this Fever was gone off, the Sick gene¬ rally were fatigued with conftant watching, which Opiates did not remove, but ten Grains or a Scruple of Caftor affided to procure Sleep.

Catarrhs , Coughs , Squlncies , rheumatic Pains , and flight Fevers were to be feen in this Win¬ ter as well as in mod others.

Pleurijies and rheumatic Fevers were fre¬ quent in February 17^6. Blood-letting, bu¬ ffering, and diluent attenuating Drinks were the Cure.

In this Month of February a Pleurify that had fomething uncommon in it, was very fre¬ quent in Fife , and at firft proved fatal to ma¬ ny. It began with Shivering, Head-ach, trem¬ bling and bilious vomiting, which, after two Days, were fucceeded by a pungent Pain among the fhort Ribs, difficult breathing, and a ffiort Cough. If the Sick remained in Bed, the Tongue became white and foul, otherwife it continued moifh The Third: of the Sick was moderate if they were not blooded, but when as much Blood was taken as the Degree of Pain feemed to require, the Third: increafed, as did likewile the Sickneis at the Stomach till they fainted. The Pulfe was neither frequent nor full, and quickly funk on taking Blood, which was of a browniffi, yellowiffi or greeniffi Co¬ lour, and hardly coagulated. Their Belly was regular, the Spittle tough, white and mucous ; the Cheeks were alternately duffied. The Sick flept none through the whole Gourde of the

Pifeafe^

32, ' Medical E (Jay .f

Dileafe, which continued from twenty fiye to thirty two Days.

When Blood-letting was let alone, or very jfparingly ufed, and Vomits were given early, and afterwards repeated, with aperient expe¬ ctorating cooling nitrous Liquors for Drink, and attenuating Pectorals when the Stomach could bear them, the Patients generally reco¬ vered. If the Emeticks were Prong, they brought fuch a Quantity of thick Phlegm upon the Lungs as endangered Suffocation.

In March, April and May, Coughs with Fever were frequent, which brought leveral into the Danger of a Phthijis Qulmonalis . Blooding, repeated Vomits, BliPers on the Shoulders, cooling Purgatives, and the atte¬ nuating Peftorals were the Means uled to re¬ move them, and generally with Succels when timeouPy applied*

III. An Ext raff from the puhlick Regijler of Burials in Edinburgh.

173 7-

1 Men.

Women.

Child.

Still-born.

Sum.

'June -

13

22

34

3

72

July - -

14

18

7°

9

91

Auguji -

12

26

7o

2

no

September

13

28

So

S

96

October -

1 7

19

44

3

81

November

I’ 3

27

78

4

102

December

U

21

5o

10

94

1736.

January -

28

32

31

©

91

February -

26

26

27

3

82

Fl&rcb -

27

33

32

3

9>

April -

2 7

26

71

7

107

May -

19

30

43

8

100

Total

21.8

S©8

14°

SS

1 1 2 1

snd Obfervations .

IV. A Comparifon of the Meteorogical Regifters and epidemic Dileafestf/ Edinburgh, Rippon, Plymouth and Norimberg, from May 1731 to June 1736, in a Letter to Mr. Monro P. A. from Mr. Patrick Ker Student of Medicine in the Univerfty of Edinburgh.

SIR,

TN Obedience to your Commands, I have **■ made an Attempt to compare the Meteoro¬ logical Regifter and the Accompt of the epide¬ mic Difeafes published by the Society at Edin¬ burgh , with the Rippon , Plymouth and Norim¬ berg Obfervations of the fame kind, and made in the fame Period of Time, as they are related by Dr. Hilary in the Appendix to his pra£lical Eifay on the Small-pox, by Dr. Huxham in his Treatife De a'ere et morbis epidemicis , and in the Commercium literarium Norimbergenfe .

The firft Art. of Vol. I. Medical Effay s gives a very exa£t Account of Edinburgh , I can find no fuch accurate Defcription of the other Places.

Rippon is an Inland Town in Torkfhire , fi- tuated i° 43' farther South, i° 30' farther Eafl than Edinburgh , between 80 and 100 Miles diflant from the German Ocean on the one Side and the Iriftx Sea on the other.

Plymouth , a Sea-port in Devon fire, is 50 25' South of Edinburgh , and 1° 20' Weft of it, fituated near the Chops of the Britifli Chan¬ nel, which is to the South of it.. By the Si¬ tuation therefore of Edinburgh , Rippon and Plymouth they would feem to be very proper

34 Medical BJfays

for making Obfervations, by comparing which together, fome AffiStance might be got for ac¬ counting for the Changes in our Briiijh Atmo¬ sphere and Bodies.

Norimberg , a large City of Franconia , is a- bout 6° South, and i/pEaft of Edinburgh , Si¬ tuated at a great Distance from any Sea, the neareSt not being within 300 Miles of it.

By either comparing the Heights of the Mer¬ cury in the Barometer at Edinburgh and Norim - berg, as they are marked in the .Regift ers for the Same Days ; or by calculating the Height at a Medium of all the Observations, it appears that the Barometer at Norimberg is placed about 700 Feet higher than the one at Edinburgh ; So that the People of Norimberg live in an Atmo¬ sphere, which is about jj lighter than that of Edinburgh . Dr. Huxham tells us, that his Ba¬ rometer Stands, Since July 1733, at 3° 5^et above the Level of the Sea, but formerly it flood at 4 6, which is about 230 lower than the Edinburgh one.

The Heat of the different Climates of thefe Places is very difficult to be determined ; none of the Obfervations in any of them being ac¬ curately calculated for determining the hotteSl and coldeit Times of each Day ; and though I can compare Dr. HuxhanC s Thermometer with the Edinburgh one, by the Help of Dr. Martin ’s ElTay towards comparing different i heimometers, yet ProfeSIor Dopplemaier' s • Thermometer, which is called Fahrenheitia - num maximum, and with which the Norimberg Obfervations are made, is constructed in fuch a way, and fo little is faid of any fixed Points in

and Obfervations. 35

it, that it is not poftible for me to make a juft Companion. In it there is only a Point of Heat called temperate , marked o, from which De¬ grees afcend and defcend, of which nothing is determined. I judge that temperate Point to anfwer nearly to the Edinburgh 1 1 Inches, be- caufe the greateft Degree of Heat in Summer, and of Cold in Winter at Edinburgh , railed or depreffed the Surface of the Spirits in the Tube to near equal Diftances from 1 1 Inches, as the Liquor in the Norimberg Thermometer did from the Point o. If I was warranted to {up- pole the Heat and Cold of the Climates in ge¬ neral nearly the lame, what I have now ob- ferved would make the Companion eafy ; but my Books, as well as the different Latitudes, tell me they have warmer Summers and colder Winters than we have ; and I am more con¬ firmed in it, by obferving fitch a Difference be¬ tween Dr. Huxham' s Obfervations and theirs, tho’ Plymouth is only about one Degree diffe¬ rent in Latitude from Norimberg.

The Moifture of the Air in thefe different Places is worfe to compare ; for the Norimberg Gentlemen have no hygrofcopical Obfervations, and Dr. Huxham' s Hygrofcope has not two fixt Points; fo that I could only guefs at a Gomparifon, by which it appears that Plymouth is more moift than Edinburgh. At Edinburgh the greateft Moifture is when the Wind blows from the Eafterly Quarter, and the drieft Air is with North-weft Winds. At Plymouth the Eaft and North-eaft Winds are the drieft, and the South-eaft, South and South-weft are the tnoft moift.

Neither

3 6 Medical EJJays

Neither Dr. Hilary, nor the Norirriberg So¬ ciety has any Meafure for Rain. By Dr. Hux* ham's Obfervations, compared with thofe at Edinburgh, it appears that more Rain falls at Plymouth than at Edinburgh . At a Medium of four Years, the Rain of Plymouth was to that at Edinburgh as 30.909 Inch, to 22.518 Inch,

At Edinburgh the Winds are generally from the Weft, South-weft or North-weft, only in the Months of March, April, May and June the eafterly Winds are frequent. At Norim - berg the eafterly Winds blowoftner in OSlober, November, December and January than in any other Months ©f the Year ; the wefterly, foti- therly, and northerly Winds prevailing at o- ther Times. The ftrongeft Winds both at Edinburgh and Plymouth are generally from the South-weft.

Having premifed thele general Remarks, I fhall proceed to a Comparifon of the Obierva- tions in each Month, endeavouring to contrail them in the Way of Tables, ufing the Abbre¬ viations employed in the Edinburgh Regifter, and putting Ed. inftead of at Edinburgh, PL for Plymouth , Nor. for Norimberg , and V. for Wind.

June 1731.

Barom.

Therm.

\

\

Med at Ed. 29 5 G. Height 30 1 L. Height 29 1 Med. - 13 2

G. Height 16 o L. Height 10 6

at PI. 29 4 %

■ • 3°

29 I

- *5 5

1 6 o

* 14 5

Air'

Air

md Observations.

'Ed. to 12. Day dry V. S. W. and W. aft ter. moift V. E. and N. E.

)Pl. to 20 d. dry. V. E. and N. after, moift. V. S. W.

Rain, Ed. 2.055, PL 2* 148.

I

July.

Med. Ed.

29

7

PL 29

1

J 2?

G.H.

3°-

0

29

8

L.H.

29

4

29

3

Med.

14

2

16

0

G.H.

16

2

17

1 1

L.H.

12

6

*4

7

.. f Ed. dry V. W. and S. W,

\ PL dry - - - - variable

Rain, Ed. 1.5 41. PL 1.300.

Augu ft.

^Med. Ed.

29 7

Bar. '

\G. H.

30 1

£l. h.

29 4

- Med.

13 5

Ther.^

>G.H.

*5 7

Il.u.

11 9

PL 29 4y| 29 9 29 o

16

17

14 4

cEd. to 9. d. moift, V. E. to 18 d. dry Air. «) V. N. "W. and W, aft. moift V. E0 l Pl. dry V. E. aft. moift, V. S. E.

Rain. Ed. 1. 857. PL 1. 988.

During the Months of June , July and till towards the End of Auguft , at Rippon the "Wind Was very variable, and the Seafon was in ge¬ neral cool, fometimes intermixt with a good deal of Rain for a Day or two, and then be¬ came more temperate again. y oi. V . D Bar %

l

38

Medical EJJays

September. c Med. Ed. 29 6 PL 29 5‘f Bar . <G. H. 30 2 30

CL. H. 29 o 29 2

f Med. 12 9 15 5

TherAc. H. 147 *5 7

1 L. H. 10 7 139

C£</. dry, V. W. and N. W. or S. W. "Air <PL dry begin V. S. AT. after 11 d. E*

( Rip. moift V. S.

Rain, Ed. 2. 021. PL 1. 300.

OElober.

Dr. Huxham having mentioned neither the Height of Barometer nor Thermometer this Month, I have no Comparifon of them at E - dinburgh to make with any other.

V Ed. to 20. dry, V. W. and S. W. tot Air end moift, V. S. and S. E.

t PL to 1 1 . V. AV\ to 2 7. S. E. to end S* AVT

Rain, Ed. 1. 4 79- pl- 2- 366-

November .

Med. Ed. 29 8 PL

29 6}§

» G. H.

3° 3

30 2

iL. H.

28 0

28 7

r Med.

9 8

12 7

)g.h.

12 6

14 3

[L. H.

7 4

10 3

rEd. moift, V. W. & S. W. andfom. E; Air J PP dry, V. to 5. AT. to 1 2. E. to 23. NJ C AT. or S. \T. to the end N. E.

Rain, Ed. 1. 422. P/. 2. 356.

December.

{ Med. Ed. 29 5 P/. 29 8 Bar* < G. H. 30 2 302

<L. H. 28 9 29 4

77xt

and Qbftrvatioris

If Med. 90 11 8

Ther.*) G. H. 11 7 14 8

L. H. 57 102

Ed. moid, V. W. and S. W. fbmetimes E. PL dry. V . N. W. N. E. fomet. S. W.

Rain, Ed. 3. 125. PL 1. 4^2.

January 1732.

!

C Med. Ed .

, 29

3

PL

29

6 Aftr.

28

68

ifor. -

\ G. H.

3°

2

3°

0

29

01

1

^L. H.

28

9

28

9

28

33

r Med.

8

8

1 1

5

> G. H.

1 1

5

12

7

C L. H.

6

8

9

5

~ Ed. moifl F.

to

7. E

.&

S. E. and N

. E.

\ to I I.

W.

S.

W.

to 20 E. to end

W.

\Pl. dry,

V. in begin

„ N

. E. afterw.

s.

'AV. P. to 1 1. N. E. to 15 N. to end N. E. and N. N. E.

Rain, Ed. 1. 283. PL 3. 564.

February.

CMed. Ed.

Bar. )G. H. tL. H. r* Med.

Tber.} G. H.

2l. H.

{Ed. to 20. moift, then drier. V. $. W* Air < Pl. V. W.

£ Nor. V. variable.

Rain, Ed. 2. 409. PL 3. 564.

March.

CMed. Ed. 29 6 PL 29 63 1 Ar. 28 JZ

Bar. \G. H. 30 1 30 2 29

H. 29 2 28 8 28 r

D 2 Tfor,

29

4

P/. 29

7

Afcr. 28

7

30

2

3°

1

29

z

28

7

2 9

1

28

34

10

4

12

8

12

8

13

7

..

8

6

11

8

'Medical Ejjays

cMed. io 4 12 8

nerAc.n. 1 36 13 8

* L. H. 7 x6 104 Ed. mean. V . variable.

|P/. dry, F. variable N.

\Nor. V. to 15. W. N.W. and N. N. W. to end. N. E. N. N. E.

Rain, Ed* o. 793. PL 3. 174.

. v , ► > ■ \ . .t,

April .

CMed. 29 5 /V. 29 4“f A7-. 28 65

'iftr

jfor < G. H.

CL. H.

C Med,

CL.H.

30 o 29 1 10 8 13 2

9 0

29 7 29 2 13 7

*4 5 12 3

28 9 28 32

[ (Ed. to 13. moid V. E. to i3. dry V. N. W. to end moid, E, N. E. or S. E.

Lr J EL in begin. & end dry, from 18. to 24. ' tr | moid V. S.

I Nor. to 1 2. V. N. E. N. N. E. to end. V \ I W. and N. N. W.

Kain^ Ed, 3. 106. PI. 2. 196.

May.

1

rMed. Ed.

29

5

Pl. 29 4 N. 28

7

SarJ

> G.H.

29

9

29 7 28

97

fv * - 1

t L. H.

29

0

28 8 28

23

\

r Med.

12

2

14 2

•• ■ *

Ther.M

} G.H.

14

6

14 8

CL.H.

9

1

12 7

r Ed. dry V. variable. iAir p PL from 6. to 22. dry.

I Nor. V. variable.

Rain, Ed. 4. -627. PL 2.424.

and Obfervations ,

41

ifor. J G. H. (L. H. rMed. T/kr.PG.H. ^L. H.

June.

Med. Ed. 29 8 P/. 29 6 2) N. 28 ,8

3° 3 29 4

14 1

J5 9 12 o

30 o 29 o

1 5 6

16 5 14 2

28 95

28 55

Ed. very dry, P. variable.

P/. to the 18. v. dry, from the 5. to 12? V. E. from 19. to 22. P. W. aft. N*

& Nor. V. W, S.W, N.W.

Rain, Ed. 1. 196. PI. 1. 270.

July.

. Med.

Ed. 29

7 PL

29

5k\U.

28

82

Bar.

g.h.

3°

1

29

8

29

0

i

EL. H.

29

2

2 9

O

28

55

rMed.

*3

9

15

8

Ther. ,

)g. h.

16

1

16

7

} L. H,

1 1

7

14

5

• P*/. dry P. W,

, S. W

, N. W.

\P/. in

begin . and end v. dry, P. N. from

L 8. to 14. P.

s.

S. W, N. W.

Rain, PW. 3. 199. PI. 2. 2 88.

Augujl.

( Med. Ed. 29 9 P/. 29 5jl iV. 28 85

ifor. G. H. 3 1 1 299

L. H. 29 3 29 2

{Med. 13 3 16 1

Ther.^G. H. 156 168

L. H. 1 15 14 5

29 13 28 73

4Z Medical Effays

Ed. gen. dry. V. variable.

PL in begin, and end. v. dry, V . E. 'Air from g to 26 V. variable.

Nor. to 8th V . N. W. to 16. V. S. E. to 22. V. N. E. to end variable. Rain, Ed. 1. 625. PL o. 362.

September.

^Med. Ed. 29 6 Pl. ig 6 Nor. 28 84

26

Bar. ',G.H.

3° 3

30 1

29

£ L. H.

28 3

29 0

28

r Med.

12 2 ‘

IS 0

'fferJG.H.

14 6

15 9

CL. H.

9 8

13 6

Ah

Ed. dry, V. W. S. W. N. W. i7. to" 10. F. N. E. to 20. V. S. W, N. W.

Nor. to 9. V. E, N. E. to end V . W , S.AV . Rain, Ed. No Regifter of Rain was kept this Month at Edinburgh.

Oclober .

i

Med. Ed. 20 3 PL 29 2.V1 N. 28 38

Bar. 1

\G.H.

30 1

29 8 29 2

l

1 L. H.

28 9

28 7 28 54

1

c Med.

1 1 1

14 5

Ther. ’

dG.H.

12 7

15 i

CL. H.

9 4

12 4

Air $pi. V. in gen. S. end dry. V. N. E.

C Nor. V. E, S.E, N. E.

Rain, Ed. 2. 523. PL 6. 342.

November.

C Med. Ed. 29 8 PL 29 9 A^r. 28 74

sG.H. 30 4 30 4 29 1.6

XL, JL 29 4 29 4 28 27

Tfar.

and ObfervationSo

CMed. 93 12 o

Ther.*\G. H. 10 6 13 o

cL. H. 72 107

>Ed. to 17. moifl, V. S. S. E. W. to 21* dry, V. N. W. to end moifl, V. ¥, Air <?P/. very dry V. E. N.

fNor. to 15. V* E, N. E. to end V* S.W.

w, s. w.

Rain, Ed . o. 415. PL o. 584.

At Rippon , in the latter end of November , there was a little Snow, with Frofl, for two Weeks ; after which it was uncommonly warm, dry and pleafant, till the latter end of Decem¬ ber, when there was a little Frofl and Snow again.

December.

CMed. Ed.

29

8

pi.

29

5l* M

28

74

Bar. '

KG. H.

3°

4

3°

2

29

*3

CL. H.

28

2

28

8

28

33

CMed.

9

I

12

7

Tier.

<G.H.

1 1

8

13

7

tL. H.

6

6

10

4

CEd. to 18.

moifl;

,F.

variable to 26. very

moifl,/7'. S. E. to end moifl,/7'. S. W. W. Air *\Pl. in begin, v. dry, V. N. E, E. from 16 to end moifl V. S. W. S.

•Nor. V : E, N. E.

Rain, Ed. 3. 617. PI. 4. 91 8,

January 1733.

r Med. Ed.

29.

8 Pl.

2 9

7 .1?

/ 3 t

iV. 28

Bar.*

>G. H.

30

2

3°

2

29

fL. H.

29

0

29

3

28

CMed.

9

6

12

6

Tkr* '

<G.H.

12

1

13

2

w

tL.H.

7

0

10

8

Sih*

44

Air

Medical EJJays

Ed. moifl- V. S. W,

PL in begin, moifl, from 16. to 25 dry, V. E.

Nor. V. E, N. E, S. E.

Rain, Ed. 1. 370. PI. 2. 384.

At Rippon there was very little Rain, and the Weather was uncommonly warm and plea- fant.

February.

(•Med. Ed. 29 6 PL 29 1 6}} N. 28 87 1 29 8 30 o

Bar. JG.H. [L. H. Med.

Jg.h.

1 L.H.

28 8

9 9

1 1 7

8 5

29 2 12 3 12 9 11 2

29 25 28 4

2?

Air

Ed. moifl, r. S.W.

>/7. moifl, /A W.

jiVbr. V. W, S. W, N. W. from 20. to? 25. V. E, N. E.

Rain, Ed. 2. 525. PI. 3. 734.

March .

f Med. Ed. 29 6 PL 29 4|sW. 28 55;

ifor. <^G.H. cL.H. r Med. • T^r.^G.H. £L.H.

30 2 29 1

9 9 12 5

7 4

30 2 28 9 12 4

*3 7 10 8

29 05; 27 99

very moifl, V. E. S. E. j,> j PL from 8. to 22. dry, V. N. after, moifl A j V. S. E.

( Nor. V. W, S. W,N. W. fomet. E, N. E» Rain. 2. 638. P/. 3. 098.

. ^

ApriL

Bar. JG.H. < L. H. r Med. Ther. ) G . H. iL.H.

and Obfervations .

April.

Med. Ed. 29 7 PI. 29 6 TVbr.

jp

20 2 29 2 11 6 13 4 10 3

30 o 29 1

13 8

14 5 12 7

23 54

29 04

28 47

Ed. moift, P. E, N.E, S. E.

^/r 3 P/. dry, P. E.

1 TVbr. to 21. P. variable, to end N. WT Rain, P<7. o. 818. P/. 2. 284.

May.

f Med.

Ed. 29

8 Pl.

29

c’ “

0 2 7

TV. 28

7©

Bar . .

3g. H.

3°

2

29

8

29

07

i L. H.

29

9

29

2

28

43

rMed.

12

7

14

4

Ther.

Jg.h.

l5

9

16

1

S V

*

CL.H.

10

7*

13

5

-.P*/. dry P. E,

N. E,

S.

E,

Air ,

< Pl- v.

dry V.

E.

. - .

€ Nor. V. N. W. ■

Rain, P^/. o. 083. PL 1. 010.

June .

Bar.

Ther.

Air

Med.

Ed. 29

8

P/. 29

Ai s

4js

TV. 28

9 6

G.H.

3°

0

2 9

8

29

Qp

L.H.

28

9

28

8

28

55

Med.

14

2

16

1

G.H.

16

1

16

7

L.H.

12

6

9

PV v. dry to 13, Z7. E. toendS.W, "WV P/. in begin, and end dry. V . frequently E. often W.

A&r. V. N. W.

Rain, Ed. 2. 138* PL 1. 534.

4<5

Medical EJJays

July.

r Med.

Ed. 29 7 P/. 29 4jf

N. 28

8 r r

2tar. ^G. H.

30 1

29 7

28

97'

£L.H.

29 4

29 0

28

5l[

r Med,

14 6

16 7

Tfor. 9 G. H.

15 8

18 0

£L.H.

12 2

15 1

r Ed. dry, V. W.

» Vv-. v- d>

N. E, K.

W. fame--

times S.

| UliAV,w U •

(Nor. V. N. W, S. W, W.

Rain, Ed. o. 638. PL o. 77 2.

Ther.

Air

Augufl.

Med. Ed.

29

6 P/.

29

. 2 5 4j 0

iV. 28

7T

G.H.

29

8

29

9

28

99

L.H.

29

1

29

0

28

431

Med.

13

2

15

7

G.H.

15

O

16

7

L.H.

12

I

L3

8

PV. dry, F variable.

, but generally W,

\PL mean. F W.

fAk F W, S. W, N. ¥, Rain, Ed. 2. 675. P/. 4. 500.

September.

s

Pur. J

rMed. Ed.

29 6 P/.

29

6f| TV. 28 831

L.H.

3° 2

3°

1 29 15;

(L.H.

28 4

29

0 28 277

. j

r Med .

12 2

14

7

/G.H.

13 8

15

2

I L.H.

10 5

12

9

Air

Ah

and Obfcrvations . 47

Ed. to 14. dry, to 20 v. moift, to the end dry, F variable.

PL dry F variable, but from 9 to 18. E.

Nor. F W, N. W. from 13* to 16. E. Rain, Ed. 1. 835, PL 1. 978.

At Rippony during the Months of March , A- prily May , June , JW/, Augufl, and till after the middle of September , the Weather was ve¬ ry dry, and the Mercury at a great Height ; af¬ terwards the Weather was cold, and very rai¬ ny, and the Mercury funk.

October.

Med. Ed. 29. 8 PL 29 7I- Ar. 28 86

f Med. Bar . <G.H. cL. H.

Med.

r^r.JG.H.

(L.H.

30 2 28 8

13 1

14 7 13 8

29 27 28 3^

3° 4 28 9 10 9 13 7 8 9

c Ed. mean F W, S. W, H. W. yffr J P/. dry, V. E, N. E.

I Nor. F N, N. W.

Rain, Ed . 1. 083. PA 2. 026.

November.

,Med. 29 7 P/. 29 7-ff TV. 28 02

. Jg.h.

1 L. H.

3° 3 3° 2. 29 23

29 1 29 r 28 09

10 8 13 1

12 7 13 7

82 1 1 6

.Ed. moift F W, S. W. iPL end moiR, F W.

\Nor. F. W, N. W, S. W. fometimes E, N. E.

Rain* Ed. . 0. 326. PL 4. 688.

At

Med. Ther. 3 G. H. 1 L. H.

Medical BJJays

At Rip'pon the "Weather continued to be much the fame as before, till the latter end of No¬ vember, when the Mercury role, the Spirits in the Thermometer fell, and then was a fharp Froft for leveral Nights.

December .

|f N, 28 90 29 1 6 28 67

r Med . Ed.

29

5

PL 29

5

Bar. -

CG.H.

3°

2

3°

1

« L. H,

28

8

29

1

C Med.

10

*7

/

12

9

Ther. '

qG. H,

12

6

13

8

(L. H.

8

9

10

8

cEd. very moift, V* W, S. W.

Air PI. V. S . W.

( Nor. V- gen. S.W. but freq. E. & N. E. Rain, Ed. 3. 629. Pl. 4. 688.

At Rippon it was uncommonly warm, even more fo than the Winter before, and continued till the latter end of the Month, when the Mercury funk low, and there was a good deal of Rain.

January 1734.

C Med. Ed Bar . sG.H.

H. f Med.

TherAG. H.

1 Lo H.

'Ed. moifl V. W, S. W,

)Pl. dry, V. N. E.

)Nor. JS. generally W, S. W, N. W. but frequently E. N. E.

Rain, Ed. o. 593. PL 1. 480.

At Rippon there was a little Rain the 17th, then three Days offerene Weather, then three

Days

29 9

P/> 29 9’f W 28 91

30 6

3° 4 29 19

29 2

29 4 28 18

8 8

11 2

5

12 1

6 2

9 4

Air

{-■'<

and Obfervations. 49

Days of Rain ; afterwards the Mercury role high, the Weather became warm and pleafant, and continued fo all the remaining part of the Winter and Spring, till May »

Bar ,

Ther.

Air

CMed. Ed. <G,H.

"l. H. Med. G.H.

L. H.

February .

29 6 PL 29 6 jl'Ncr. 28 78

30 3 30 4 29 28

28 6 28 5 28 15

10 5 12 3

12 2 12 7

10 6 10 8

\Ed. moift, V. W, S. W. < PL V. W, N. W. <Nor.V. W, S. W, N. W*

Rain, o. 595. P/. 5. 554.

March.

(

CMed. Ed.

29

5 PI-

29

5 N.

28

78

ifor. <

CG. H.

29

9

30

O

28

98

1

II. h.

29

1

29

0

28

45

rMed.

1 1

1

13

y..

•t

Ther.*

)G.H.

12

5

13

6

* L. H.

9

5

1 1

8

( Ed. dry V. variable.

Air ^ Pl. moift. V. W.

UVbr. K. generally W, S. W, N. W. Rain, Ed. 2. 122. PL 2. 812.

April.

f

^ Med.

29

8 P/.

29

Bar. <

G. H.

3°

2

3°

O

-L. H.

29

4

29

4

1

CMed.

12

2

13

8

Ther. '

<G.H.

14

7

M

7

^L.H.

9

4

12

7

Yot.

V.

E

N, 28 82 29 12 28 57

50 Medical Ejffays

SEd. dry F. variable.

PL middle dry, V. E. to 12. 'N. W i from 23. to end S. W.

( Nor. V. generally W, S. W, N. W. Rain, Ed. 1. 006. PL 2. 126.

May.

*Ther.

Med. Ed.

29

8

Pl. 29

4t

t N.

28

72

G.H.

3°

1

29

9

29

0 r

L. H.

29

3

29

0

28

5i

Med.

12

i

J3

9

G.H.

9

14

7

IL.H.

9

8

12

5

Ed. dry to

' 26

. V

. variable,

from

26.

to

’Air

end moifh V. E.

)Pl. V. gen. W. fometimes S. E. CNor. V. W, S. W, N. W.

Rain, Ed. 3. 313. Pl. 1. 764.

June.

Med. Ed. 29 8 PI. 29 4zj Bar. G. H. 300 29 7

Il.h.

f Med. TherMG. H. cL. H.

29 5

13 8 17 4

10 1

29 1

15 <5

16 5 14 2

TV. 28 88 29 02 28 33

Air

Ed. mean, V. E, N. E, S. E.

PL in begin, and end V. N. W. in the middle E. -

CNor. V. N. W, W. fometimes N, N. E. Rain, Ed. 2. 2 10. Pl. 3. 208.

During the Months of May and June , at Rippon the Weather was moflly much colder than in the two preceding Months, and much more variable. .

jay

and Obfervations.

J*

Bar

The

July .

Med. Ed. 29 7 PL 29 4n 28 77

G. H. 30 1 29 8 28 94

L. H. 29 3 28 9 28 53

14 * 15 5

16 5 16 7

12 6 14 5

G. H.

L. H.

iiV. in begin, dry, F. variable, from 26”. •to end very moift, Pi E.

. P/. very moift; P. generally N. in the ) middle S. -W.

C Nor. V. W, S. W. N. W.

Rain, Ed. o. 709. PL 2. 982.

At Rtppon the 'Weather was very changeable.

A/7

- Med, Ed. 29 6 PL 29 3}; N. 28 88

Bar. <

)G. H,

30 1 29 8

28 94

l L. H.

28 7 28 7

28 58

c Med .

13 3 G 5

Them -

SG.H.

15 6 16 7

( L. H.

12 5 13 7

* Ed. dry.

V. variable.

Air *

jPl. in begin, dry, V. N. E.

after, moift.

) V. S.

W.

War. K. W, S. W.N.W. fomet. N. E, Rain, Ed. 1. 285. P/. 4. 022.

At Rippon in the beginning of this Month the Mercury was high, and alfo the Spirits in the Thermometer, and the Seafon was dry, warm and pleafant, which continued till the middle; when the Barometer fell again, and there was almoft daily frequent Rain, which continued the remaining Part of this, and du** ring thq Months of September and October.

R 2

J2 Medical Effays

September.

CMed, Ed. 29 6 PI . 29 62--7Nor. 28 76

itar. ^G.H. 30 o 30 o 29 15

^L.H. 28 7 29 o 28 57

rMed. 12 o 14 3

Ther.^G. H. 14 4 14 9

CL. H. 99 122

t Ed. generally dry, V. variable.

Sr <Pl. moift, r. W.

1 Nor. V. W, S. W, N. W.

Bain, Ed. 1. 172. /V. 1. 752.

QElober.

Med. Ed. 29 5 PI. 29. 5ff iV. 28 58

^r. Jg.H. 30 2 30 3 28 93

4L. H. 28 8 28 8 38 ii

cMed. 10 3 12 6

Ther.<G. H, 12 4 13 8

tL.H, 90 10 6

' ( Ed. moiil:, V. variable, but gen, W, S, | W, N. W.

J PI. moll in beginning V. S. W\ from ] 15. to 23. N E, after N. W.

j Nor. V. in gen. W, S. W, N. W, and \ frequently N. E. and E.

Bain, Ed. 1. 321. PI. 3. 154.

November.

Med. Ed, 29 9 PL 29 8^ N. 28 87

Sr

CMed.

. <G. H. CL. H. CMed. .<G. H. CL. H.

3° 4 28 8

29 25 28 10

3° 4 29 3

9 3 n 5 T^er.^G.H. 11 7 12 4

L. H. 77 99

moift, F. W, S. W.

3^- drY to die 2°* betwixt E. and N,

Sr

A^r. K, variable.

Rain,

and Obfervattons •

Rain, Ed. i. 608. PL 2. 068.

53

December .

t Med. Ed.

29 0 PA 29 3t?

Nor. 28 49

<G. Ho

29 8 30 0

28 98

CL, H.

28 0 28 2

27 8©

C Med.

91 11 4

<G.H.

11 5 12 5

£ L. H*

74 10 6

^ £j a. monr, y . w, o. v <• Pl. moift, P.S.W.

I Nor. V. E, S. E. N. E, Rain, Ed. 2. 322. P/. 6. 192=

January 1735.

r Med. Ed,

29.

5 JV.

29

6fi

a

10

00

51

Pftr. .

JG. h.

3°

3

3°

5

29

i?

CL. H.

28

2

28

1

28

05

\ Med.

9

2

1 1

2

Tier.

^g.h.

1 1

6

12

2

G.h.

7

6

9

6

- • j - 7 7 - '

P/. oft, v. moift, F in begin. N. middle < S. W. end N. E.

'Nor. V. W, S. W. N. W. fometimes E, S. E, N. E.

Rain, Ed. 2. 995. P/. 2. 52 6.

February.

•Med. Ed.

29 0 P/.

29 7|» TV". 28 8 1

Bar. ^

>G.H.

3° 5

30 5 29 iR

>L. IL

28 8

29 0 28 33

~Med.

9 0

11 4

T7?<fr. 3

1 G.H.

12 4

12 1

J

:l.h>

7 4

95

E 3

Air

. .j

J4

Medical Ejjays

5 Ed. moift, V. W, S.W.

Pi moifl, Tome times dry, V. to the 1 6, N. end S.

.. Nor. V. W, S. W, N. \VL Rain, Ed. 3. 507. PL 1. 978.

March.

r Med. Ed.

29

3

P/. 29

oie.

D3 0

iY. 28

49

)g.h.

20

2

3°

O

29

02

Ih.n.

29

0

28

7

28

12

r Med.

9

9

1 1

7

)g.h.

1 1

9

12

4

£ L. H.

8

5

10

4

SEd. vaftly moifl, V. variable.,

PL moifl in beginning, V. S. W. from *) 6. to 17. S. E. after. N. E, N. W.

€ Nor. V. W, S. W,N. W. frequent. NJE.. Rain. Ed. 5. 375. PL 2. 234.

April.

^ Med.

Ed.

29

7

PL 29

5

\~Ncr. 28

71

^r. ,

JG. H.

3°

1

29

9

29

°3

« L. EL

29

0

28

8

28

36

c Med.

1 1

2

r3

5

Ther.

)g.e.

4

13

5

13

7

t L.H.

9

7

12

1

*Ed. va

ftiy

moifl,

to r

2.

V. E, to .

end

1 W,.

s.

W,

N.

W.

tv

Air *

SP/. moifl,

from

2. to

10.

. V. E. after*.

variable.

•Nor. KW, S. W, N. ¥.

Rain, Ed. 1. 630. PL 2. 252*

May .

Med. Ed. 29 8 PL 29 6j \ N. 28

Mar. Jg. H. 30 2 30 1 28 99

vi L. II, 29 2. 29 1 28 30

Ther-i.

and Observations,

.Med. 12 i 13 8

Ther^G. H. 14 7 14 9

/L.H, 9 5 12 1

f.Ed. mean, V. inconflant.

Air PL to 24. V> N. E, N. AV. after $. E l Nor. V . AV, S. W, N. W.

Rain, Ed. o. 720.. PL 1. 646.

June.

Med. Ed.

29 7

PI. 29 5-if iV.

28 75

Bar .

Jg.h.

30 i

29 9

28 98

7l.h.

29 4

29 I

28 52

„ Med.

if

13 5

14 9

Ther. ,

\g. h.

15 5

15 I

•

( L.H.

11 8

J3 7

r Ed . dry in

beginning and middle

moiR,.

k V.E, N

E.

Air ,

Jpi. moiR,

V. N.

AV, Sometimes

S. AV,

from 19. to 22. S. E.

Nor. V. AV, S. AV, N. AV.

No RegiRer of Rain after May 1735 is pu¬ blished at Edinburgh .

July .

^ Med. Ed. 29 7 £7. 29 4Tf TV. 28 76.

29 05 28 47

3° 0 29 1

14 2 16 o 12 1

29 7 28 9 15 1 *5 9 13 7

ifor. ^G. H.

^L.H. r Med.

Ther.JG. H.

£L. H.

r Ed. dry frequent, moiR, V. inconRantv Air J PI. very moiR, V. AV, S, and fomet. E, 2 A^r. V. S. AV, AV.

Augufl ..

r Med. jEW. 29 8 P/. 29 6 Aor. 28 94

Bar. ^G. H. 30 3 29 9 29 17

CL.EL 29 2 29 2 28 66i

Ther*.

Medical Effays

c Med. 13 8 15 5

Tber.JG. H. 17 o 16 5

^L.H, 11 5 13 9

Ed. dry, V. E. to 1 1 . after S W, W* Air J PL very moift, from 2. to 13. V* E* Nor. V . W, S. W, N. W.

September .

\

.Med. Ed.

f

29

6 PL

29

6,1

N. 28

91

Bar. „

) G.H.

3°

0

29

9

29

*3

Il.h.

28

7

29

2

28

58

Med.

12

0

14

9

Ther. t

) G.H.

14

4

t5

7

]l.h.

9

9

13

1

^/r

Ed. dry, VEW, S. W.

>P/. moift, K. N. W. fometimes S. ¥. frequently E.

'iVar. N.S.W, N. W. freq. E, N. E, S, E,

GElober .

c Med. Ed. 29. 9 P/. 29 6'fyN. 28 82 Jfor. <G.H. 30 3 30 1 29 17

tE.H, 29 3 29 1 28 24

, Med. 10 1 13 2

Ther.l G.H. 12 7 14 2

CL.H. 81 10 6

Ed. mold: from li. to 22. V. E. and S. E. afterwards W.

| PL V. E.

Nor. JA. variable.

November .

<

Med-. Ed.

49

5

P/. 29

4yl

28

&x

Bar. «

G.H.

3°

0

3°

0

29

28

1

f L. H.

28

8

28

4

28

20

<

-Med.

10

5

12

8

T^er. 4

Jg.el

12

1

J3

7

l f . li »-

7

7

1 1

5

Air

and Objervatiens .

r Ed. moiil V. inconllant.

Air 3 P/. moiil, V. S.

I Nor. V. variable.

December.

57

Ther.

Med. Ed.

29

7 /V.

29

6 * U2 7

iv: 28

67

G.H.

3°

2

3°

O

29

16

L.H.

29

0

29

O

28

31

; Med.

9

6

12

I

|G.H.

1 1

5

13

3

L. H.

7

5

IQ

4

Air

cEd. very moiil, V. variable.

vaftly moiil, V. E. and S. E. Nor. to 22. variable, to end E.

January 1736.

1

' Med. Ed. 29 3

FI 29 2fi 3V. 28 58

Bar. <

>G.H.

29 7

29 8 29 01

(

>L. H.

28 9

28 7 28 09

c Med.

9 2

11 8

Ther. *

S G. H.

11 7

12 7

* L.H.

7 3

10 4

-£V. moiil S

W, W.

Air «

\P1. very moiil,

F. S.

VV&r. V. E. S.

E. N. E. fometimes S*

S. W, N, ¥,

February .

1

r Med. EV.

29

4

PI. 2 9

0 < 0

3 2*

iV. 28.

28

Bar. «

>G. h.

3°

1

30

0

28

77

4 L.H.

29

0

28

5

27

95

1

t Med.

8

5

1 1

2

Ther.*

G. H.

10

3

1 1

8

* L. H.

6

3

9

3

moiil.

, v.

variable.

1

Air <

>P/. E. N.

E.

not lb moiil as

lall Month.

Nor , V. variable.

March

)

5 8 Medical BJJays

March.

Med. EV.

29

6

/>/.

29

'4jt ^

28

59)

Bar .

3g. h.

3°

2

3°

O

29

OK

(L. H.

28

9

28

8

28

241

c Med.

10

5

12

6

Ther.

< G.H.

14

7

13

6

C L. H.

8

8

10

4

r moifi;

r ^

E,

S.

E,

N. E.

Air

3 -£V. dry, V.

, E.

I Nor. V. variable.

April.

Bar. JG. H, l L. H.

c Med. Tier. J G. H.

I L. H.

Med. Ed. 29 8 PL 29 7^- Nor. 28

3°

1

3

3° 3 28 9

” 5

*4 5 8 5

cEd. moift V. variable. dir API, V. E, N. W, fometimes N. E. tNor, V. W, S. W, N, W.

29 13 8

1 5 5

I I C

29 *3

28 59 1

May.

5 Med. Ed.

29 8

PL 29

5 Nor.

28

$5

Bar.

< G.H.

3° 3

29

8

29

01

^ L. H.

29 3

29

1

28

3°

( Med.

11 8

14

4

Ther.

\ G. H.

14 9

16

4

< L.H.

10 Q

12

4

r Ed. dry V. E.

Air

J PL V. E.

fometimes T<

L E, N.

W.

1 Nor. V. N. Wx

S. MG

Of

Jh

md Obfepvati-ons.

Of the epidtmick Difeafes at Edinburgh, Rip- pon, Plymouth and Norimberg,

T Shall divide the Difeafes, which were fre- quent during thefe five Years at thofe Places, into four ClafTes.

1. Difeafes of nearly the fame kind, which were in feveral of thefe Places about the fame time.

2. Difeafes of nearly the fame kind, which were at feveral Places in different Years, or dif¬ ferent times of the fame Year.

3. Difeafes of different kinds that were at nearly the fame time in feveral Places.

4. Difeafes which were in any one of the Places mentioned, and not in any of the o- ; thers.

I. Difeafes of nearly the fame kind , 'which 'were in feveral Places about the fame time.

1 Small¬ pox,

Intermit¬ ting Fe-

f Edin. and Nor. from Spring 1733, ^ to March 1734.

^Nor. and Plym. in March 1732.

' Ed. PI. Rip. July 1731.

Ed. PL Nor. May, June 1733, A- pril 1734.

Ed. PI. May, June 1734, June < *735*

vers.

Ed. Nor. April, May, July 1732, March 1734.

PL Nor. July 1733.

\Nor* Rip. September 1733.

Slow

6o Medical Effays

Slow Fev. Ed. PL Auguft 1732.

cEd. Pl. March, April 1732, March

pt^nfW ^ -T733> February 1736.

I k Junes. Afar. Febr. 1 733, July 1735.

(*P'L Nor-. April 1733, Febr. 1735. A Cholera, Ed. Rip. Auguft 1731.

K Ed. PL Nor. January 1732*

Angina. ^ Ed. Nor. October 1733.

Scarlet

Fevers.

1

> j*

A Rheu matifrn.

Mealies.

PL Nor. February 1732.

Ed. Nor. September, October 1 73;

Ed. Pl. Nor. March 1732.

Ed. Nor. Nov. 1732, Feb. 1733.

PL Nor. Apr. 1732, March 1734.

Rip. Nor. Sept. 1733, Jan- I734*

f PL Nor. Auguft, September, 0£h>

L ber 1732, February 1733.

, c Ed. PL May 1732, May, July. Ivink-cough. j J /J ' J J

Cold and its ^ Ed. Pl. April, December 1732, Effects. 2 Jan. 1733, PL Nor. Feb. 1734*.

CPL Rip. Nor. February 1733, Catarrhs and J Ed. Nor. July 1735.

Catarrhal Fe- KPl. Nor . March, April 1733;;. vers. J October 1734. *

, Rip . Nor. November 1733*

Colick. PL Nor . February 1732. j

And Obfervations.

ting

II. Dileales of nearly the fame kind, which were at fever al Places in different Tears , Tt different Times of the fame Year .

. > S - J - * A

*»

f P/. from June to Septemb. 1731, Au¬ guft 1732, from Auguft to Decern. Small- 1734, and from Jan. to Sept. 1735. pox, j Rip. from Autumn 1732, to January

I 1 7 3 3 - ' ' : ,

f Nor. January, May, June 1732.

(Ed. June 1732, March, April 1733, from February to May 1735, and that Summer.

Intermit- Pl. Auguft 1732, July, September Fev. ^ 1734, October 1735.

Rip. June, Auguft 1731, and latter end of Summer 1732.

TNor. October 1732.

(Ed. from November 1731 to Fe¬ bruary 1732, and Decern. 1732, January, March 1733.

PI. March 1733, Auguft, Septem¬ ber, October 1734, and October, November, December 1735.

Rip. June, July, Auguft 1731, Ja¬ nuary, February 1733.

Ed. October 1731, that Winter, May 1732, and June 1735.

PL February, March 1735, and A- Pleuri- ^ pril, May 1736. lies. Rip. September, December 1733,

and January, May, June 1734.

_ Nor. Octob. Novemb. 1732, Feb. C. April 1734, December 1735, Vol. F Cholera’

Slow Fe vers.

6 2 Medical Effays

rCEd. November 1732, July 1735. PL Sept. Oft. 1731, May 1732?

ChElm from July tC> °&ober 1 733^ SeP" tember 1734, Auguft, Sep, 1735.

[Rip. latter end of Summer 1 733,

‘ June, July 1734.

If Ed. Decemb. 17.31, Novem. 1732, I July, Auguft, September 1733. k . IP/. December 1732, March 1733, Angina. ^ from February to October 1734?

April 1735, Feb. x^pril 1736.

. yAbr. November 1 733*

Eryfipe-

latousFe-

ver.

'Ed. June, July, Septem. O&ober, November, December 1735, Ja¬ nuary, February 1736,

PL January 1735.

f r

Rheuma- 1 trim. j

I

1

A

Ed. February 1736.

PL December 1734.

Nor. January, Febr. May, June, September, October, 1732, Ja¬ nuary, March, May, June, Aug. November, Decemb. 1733, O* ftober 1734, Novem. 1735.

Mealies.

*C..

K ?

Ed. from June 1 735 to Spring 1736. PL Aug. Novem. 1732, Jan. 1733. Nor. January, Febr. july 1732.

: V I . ..

Kink-

» .

cough.

’Ed. March, April 1732, June, Au¬ guft, September, October 1734? and all Winter.

}PL Auguft 1731, February 1732. Nor. from June to Septemb. 1733.

Catarrhs,

Catarrhs and Ca- tarrhous Fevers.

Univerfal Fever of< the Cold.

and Obfevvations. 63

Ed. June 1 73-5, and that Winter. Nor . Jan. Febr. March, Apr. June 1732, May, Sept. Oaob. 1733, Feb. March, Apr. Odt. Dec. 1734* Jan. 1735-

f Ed. BeganDecemb. 17. 1732, from the 25th till the middle of Jan. univerfal, end. Feb. 1733.

PL began 12. Feb. 1733, univerfal by 15. end. April.

Rip. began Feb. 3. 1733, end. five or fix Weeks thereafter.

Nor. began Septem. 1732, univerfal L December, end. Febr. 1733.

PI. October 1733, March, Novem¬ ber 1734, March, May 1735, Ja¬ nuary 1736.

Nor. Feb. 1732.

Pl. March, April 1732, March, A- pril, Qftober, December 1 733, January^, February, March 1734, Febr. March 1735, February, March, April, May 1736.

VRip. September 1733.

DIfeafes C ^atter Part Summer, Au« of the < tumn> an(J forepart of Winter

Breaft.

Apople¬

xy.

Peripneu-

xnony.

tumn, 1 73 3'

^ Nor. January, Feb. March 1733. Putrid %PL December 1734.

Fever. LRip. September 1734. ?

Eryfipe- f Ed. July, Augufl 1731. las. \ PL June 1731.

Fev. with cEd. December 1731, January, A- D pril, May, 1732, July 1735.

K Rip. December 1722.

F z Swell*

a Diar rhoea.

&4 Medical EJJays

Swell, of C Ed. June, July, Augufl 1731. Salivary < PL November, December 1735, Glands. L January 1736. r . C Ed. Offober 1734, from October

nuedFev. V/735, t0 February I736’

CAer. May 1733.

Fxanthe- r PL Augufl, Sept. 1731, June 1732, matous 3 Sept. 1734, January, June 1735, Fevers* \ Rip. July 1734.

Ed. January 1732.

PL May, Augufl 1732, from June to Odlober 1733, Augufl 1735* Rip. Augufl 1731*

Nor. July 1733..

Ed. June, July 1733, and that Winter.

Nor. December 1735.

C Ed. July, Augufl 1731. yPL March, April, June, 1734, t / ■ January 1735, April 1736.

Hyfler. & December 1733.

hypochon. <( R. Feb g y

Symptoms., s J DD

Pl. 061. Nov. Decern. 1731, Jan. 1732, Ocl. Nov. Dec. 1733, Jan. Ocl. Noyem. 1734.

Nor. March, June, Novem. 1732.

( Ed. Novemb. 1732, Spring 1733, | Pl. January, February, March, Septem. October 1732, Sept. Decern. 1733, January, Febru¬ ary, March, April 1734, Janu«. ary, September 1735, January, Febmary 1736.

Ill, DU-

Diarrhoea.

Scarlet

Fevers.

Ophthal-

Colick.

Cold and its Effe&s.

L

V.

and Obfervations.

III. Difeafes of different kinds , which were nearly at the fame Time in fever al Places .

SEd. Swelling on the Face and falivary Glands.

T73*

JwKi

)Pl. Small-pox, Erydpelas.

July.

jrl.

^ Rip . intermitting Fevers.

Ed. Ophthalmy, Rheumatilm, ery- fipelatous Swelling on the Face and falivary Glands.

PI. Small -pox.

Rip. intermitting Fevers.

( Ed. Ophthalmy, Rheumatifm, ba- ilard Small-pox, eryllpelatous Swelling on the Face and falivary Augufl. ^ Glands.

J PL Febres miliares rubrse, Kink- 1 cough, Small-pox.

LRip. Diarrhoea, intermitting Fevers. ” Ed. Pleuriiy.

PL Cholera.

Ed. Pleuriiy, Fever, with a Diarrh.

Ocioh.

1732.

Jan.

Effects of Cold.

CEd JPL

JNor. Small-pox, - Meades, Haemo- ^ ptoe, Catarrhs, Rheumatidn. CEd. Pleuriiy.

r> r . JPL the Effects of Cold. c ; * )Nor. the dime Difeafes as lad Month, £ Apoplexy, Colick, Stone and Gout. CEd. Erydpelas Oedematodes, Fever J amongd the Children, Kink-cough. March. *\PL Effects of Cold, Peripneumony. /Nor. Colick, Stone and Gout, Ca- tarrhous Fevers.

F 3

/fril

April .

May .

June*.

Medical Efjays

Ed. Fever with a Diarrhoea, Kink” cough, Eryflpelas Oedematodes.

PL Small-pox, Peripneumony.

Nor. Catarrhs.

Ed. Pleurify, &c. as laffc Month,

Pl. Cholera.

Nor . Rheumatifm, Small-pox.

Ed. Intermitting Fevers,

PI. Febres miliares compofitse, Ru¬ beola" .

Nor. Rheumatifm, Small-pox, Co*

1 lick, Catarrhs. rEd. Slow Fever.

Sept. P Nor. Rheumatifm.

I Rip. Small-pox.

SEd. Slow Fevers.

Nor. Intermitting Fevers, Pleurify,,

l Rip. Small-pox.

£ Aguilh Fits among!! Children.

-T \Nor. Pleurifies, Colick, Stone and Novem.J Gouf

C Rip. Small-pox. r E d. Slow Fevers.

Decern. ^P/. Effe£ls of Cold.

I Rip. Small-pox.

£-Ed. Slow Fever, Pleurify.

1733 jPL Meafles.

7 an. \ Nor . Difeafes of the Breaft, Rheuma*

£ tifm.

5 Ed. Tertian Agues.

PI Angina, Peripneumony.

— yNor. Difeafes of the Breaf!, Ha:* C moptoe.

5 Ed. Baftard Small-pox, l Nor. Rheumatifm.

June

Ms-4

«. f f June. P

July. K

and Ohfervations. 6y

Ed. Scarlet Fevers and fore Throats, Nor. King-cough, Gout.

( Ed. Scarlet Fevers, with a Diarrhoea in feveral, Anginas. .

PI, Cholera, Diarrhoea.

Augufl.

Sept.

GElob.

Rip. Cholera.

Nor. Small-pox, Kink-cough, Diaf- C rhoea, intermitting Fevers.

Ed. Scarlet Fevers and fore Throats. PI. Cholera, Diarrhoea.

Nor. Rheumatifm, Kink-cough,

PI. Cholera, Diarrhoea.

Rip. Pleuriiy, Peripneumoriy.

Nor. Catarrhs, Kink-cough, Gout,

PL Cholera, Diarrhoea, Apoplexy, Peripneumony, Rubeolas, Colick. CNor. Catarrhs.

r Ed. Scarlet Fevers and fore Throats. Novem. ) PI. Rubeolas, Colick.

I Nor . Anginas, Rheumatifhi.

Ed. Scarlet Fevers and fore Throats. Pi. Colick, Peripneumony, Cough, Hyft. and Hypochon.

Nor. Hasmoptoe, Gout.

Rip. Pleunfy, Fever with a Loolenels. PL Coughs, Peripneumony, Colick. Rip. Inflammation of the Intefrines, Pieurifles.

Nor. Stone, Gout.

{PL Peripneumony, Anginas,

Nor. Pleurify, Catarrhs.

Ed. Intermitting Fevers.

/If ’ * h <d°ughs? fore Throats, OphthaK ■ ; C ' ^ my, Rheumatifm^ Peripneumony,

Apoplexy,

April,,

Decern .

17 34 Jan .

Febr.

68

April.

May.

June.

July.

Augu ft. Sept.

QElob.

Nov.

Dec.

1 735* Jan.

Medical Effays

PL Ophthalmy, fore Throats, Apo¬ plexy, anginqus Fever.

Nor. Pleurify, Rheumatifm. c PL Anginous Fever.

I Rip. Pleurify.

. Ed. Kink-cough, Ophthalmy.

< PL Anginous Fever.

* Rip. Pleurify.

{PL Inter. Fevers, anginous Fever.

Rip. Exanthematous Fever, Cholera, , Ed.. Kink-cough.

yPL Anginous Fever, Ophthalmy, j flow Fevers, Small-pox, Itch. i Rip. Putrid Fever.

. Ed. Kink-cough, Dyfentery.

<PL Anginous Fever, Small-pox, Cho- l lera, flow Fevers, inter. Fevers. Ed. Kink-cough, Dyfentery, Fevers. PL Sma'11-pox, Colick, fore Throats, flow Fever, anginous Fever, Fe¬ bris. miliaris.

Nor. Rheumatifm, Gout.

\ Ed. Kink-cough, Dyfentery.

7 PL Small-pox, Colick, Apoplexy. Ed. Kink-cough, Dyfentery.

PL Small-pox, putrid Fevers, Rheu¬ matifm,

[Nor. Catarrhs, febris peteehizans. Ed. Kink-cough, Dyfentery.

PL Small -pox, Ophthalmy, Coughs, Rheumatifm, febres miiiares Ery- ^ iipelatofle, <£olick.

Nor. Febris Catarrhalis Peteehizans, Catarrhs, Pvheumatifln, Stone and Gout.

Febr »

Ieh\

and Observations* 6g

.Ed. Tertian Agues.

PI . Peripneumony, Small-pox, con¬ tagious Fever.

)Nor. Febris catarr. Petechizans, Ca« tarrhous Fever.

Ed. Tertian Agues.

March . J PL Small-pox, Pleuriiy, Peripneu¬ mony, Apoplexy.

Ed. Tert. Agues, Fevers amongH Children.

PI. Small-pox, contagious Fever.. Nor, Febris catarrh, petechizansv

r Ed. Tertian Agues. yPL Small-pox, Apoplexy, contagi- l ous Fever.

.Ed. Meafles, Pleurify, Catarrhs> e« ryfipelatous Fever.

I PL Small-pox, febris miliaris rubra* contagious Fever.

~Ed. Meafles, Kink-cough, Cholera, 3 eryfipelatous Fever.

(PI. Small-pox, contag. Fever, Itch.,

, Ed. Meafles, Dylentery.

3 PL Small-pox, Cholera, Diarrhoea,. I contagious Fever, Itch.

r Ed. Meafles, eryfipelatous Fever. dPl. Small-pox, Cholera, Diarrhoea^ l contagious Fever, Coughs.

Ed. Meafles, Dylentery, Fever, ery¬ fipelatous Fever.

Odlob. *\PL Slow and inter. Fevers, an Aflh- ma, which changed into a Swel¬ ling of the Legs and Abdomen,

April.

May.

June.

July.

Aug.

Sept.

70

Nov,

Dec .

I736-

Jan,

Eebr*

Medical Ffdys

Ed. Meaftes, Dyfentery, Fever, Ef- \ fedls of Gold, eryfipelatous Fever, -J P/. Epilepfy, Swelling of the Saliva- !' ry Glands, flow Fevers.

Nor, Rheumatifm, Gout.

Ed. Mealies, Dyfentery, Fever, Ef¬ fects of Cold, eryfipelatous Fever. PL Nervous putrid Fever, Coughs. Nor. Haemoptoe, Catarrhous Fever ^ with Pleurify,

-eEd, Mealies, Fever, Effects of Cola** N eryfipelatous Fever. yPL Apoplexy, fwelling of the fall- C vary Glands, Coughs.

Ed. Mealies, Pleurilies, rheumatidc: i Fevers, eryfipelatous Fever. fl. Angina/ Pleurify, Peripneumo- ny, Kibs of the Feet..

IN, Difeales which happened at any one of the Places mentioned , and not at the others .

f Baft. Small-pox, Auguffc 1731, May1

Ed,

1 7 3 3”

Dyfenteries y Auguft 1731, Harvefy Months 1733, Septem. October 1734, that Winter, October, No- ^ vember, December 1735*

Eryjlpelas OedennatodeSy March,. A-*- pril, May 1 732.

Fever among ji Children. March 1732,

. I April 1735.

.-.tQ,

PL

and Observations* 71

Rubeolce , June 1732, Oftober, Novem¬ ber 1733,

Contagious Fever, from February to September 1735.

PI ^ Itch, July, Auguil 1735, Jan. 1736.

' EpHepfy, November 1735.

Afthma, which changed into a Swel¬ ling of the Feet, and Abdomen, O- clober 1735.

h Perniones, February* March 1736. f Haemoptce, Jan. July, 1732, March* j December 1733, l^ec* I735*

^ Stone and Gout, Febr. March, June, Nov. 1732, March 1733, January C 1734? January 1735.

Rip. Inflam . of the Inte f ines, January 1734,

-

Your Orders to make only a Companion of the Changes in the Atoiniphere, and of the Dilealesin thele feveral Places during the Years when Regillers were kept, I underitand as a Caution not to pretend to determine the Rela¬ tion between the obfervahle Changes of the At» mofphere and Dileafes, which requires to be -tonfidered by one of much more Knowledge and Experience than

Tour mofl obedient Servant *

V* Propofah

Medical Effays

i

V. Propofols for determining the Effects o f a* Aringent, of attenuating and of coagulating Medicines; by Dr. Charles Balguy Pby~- Jician at Peterborough.

Gentlemen ,

I Could have wilhed to have had your Opinion of the EBay towards afcertaining the Doles of vomiting and purging Medicines published m your VoL IV. Art. 5. becaule, if it is rights it may be made more general, and extended to Evacuants of all kinds. I now beg leave to propofe a more Ample, as well as more certain Way of determining the Dofes of lome other Medicines.

Dr. Hales (a) delcribes a very ingenious Ex¬ periment for determining the proportional Force of aflringent Medicines : Having emptied all the Velfels of any Animal of Blood, by let¬ ting them firfl bleed to Death, and then pour¬ ing warm Water through a long Glafs Tube fixed into the Aorta defenders , while the In* teflines are flit open from one end to the other; he then poured different aflringent Liquors by the lame Tube, obferving accurately the dif¬ ferent Times in which the fame Quantity of Water and of the aflringent Liquors pafs out at the cut VefTels of the Inteflines: But this worthy Gentleman informs me of a more ealy Method which he has thought of to try the dif¬ ferent Degrees of Reftringency of Medicines, viz. by moiflning long animal Fibres with

them,

{a) Hacmalfatics, p. 127,

mid Obfervations. 73

them, when Weights juft fufticient to make them ftraight are hung to them. He thinks Hairs of the Head the moft proper for the Pur-* pofe, as being the moft fimple uniform animal Fibres of any that he knows, and which may be had nearly of the fame Strength. That ve¬ ry fhiail Degrees of Contraction may be the more fenfible, the Hair a r J a

may be fixed to the Lever h cy made of

' # 1 ♦

a fine knitting Needle; which Lever being fixed to a cer¬ tain Point at b , the Contracti¬ on of the Fibre ^ a r, if but a T‘5oth Part of an Inch, may make the Le¬ ver rife -t'5th at the end c. By this Means he has found a long flender untwdfted Fibre of Hemp to lengthen on moiftning, and not to fhorten, as it is commonly Paid vegetable Fibres do, becaufe twifted Ropes do fo for obvious Reafons.

To determine the Dofes of attenuating Me¬ dicines, and of fuch as thicken or coagulate the Blood ; diffolve the fame Quantities of the dif¬ ferent Medicines in the fame Quantity of their leveral proper Menftrua : Put a determined Quantity of one of thefe Solutions into a Phial, Vo l> V » G and

74 Medical EJfays '

and then fill it up with Blood to the Top, into which a capillary Tube of Glafs is immediately to be luted ; fo that no Blood can rile out of the Bottle but through the Tube. It is eafy to fee that the leaf!; Rarefaction will be perceivable by the Blood’s afcending in the Tube. The like Experiment being made with each Medi¬ cine, and the Degrees of Afcent being noted down in each Experiment, you have the exact Proportion which they bear to each other. To prevent any Inaccuracy which the Difference of Heat and Cold might occafion in thefe Experi¬ ments, the Solution fhould be brought previ- oufly to the animal Standard of Heat; the Blood fhould be immediately let out of a Vein into the Bottle, and the fame Bleat fhould be continued by the Help of warm Water or a Stove regulated by a Thermometer.

Dr. Hales , to whom I communicated this Method of trying the Degrees of Expanfion of the Blood by Medicines, and confequently their attenuating Force, propofes to have at the fame time the like Quantity of attenuated Blood in an open VefTel, on which a Glafs Bubble (fuch as the lpecifick Gravity of Liquors is taken with) is put, whereby the Alteration of the fpe» cific Gravity of the Blood may be feen ; and the two Methods may thus mutually give Light to each other.

If this Scheme is approved, I hope thole Gentlemen whofe Inclinations lead them this Way will lend me their Affiftance ; for fo ma¬ ny Experiments as are neceffary would be too great an Undertaking for one JPerfon, who can¬ not

and Obfervations . 7 j

not pretend to lay out his Time wholly on fuch Amuferaents.

VI. The good EjfeSls of fm all Dofes of Emeticks and Purgatives frequently repeated ; by Dr. Alexander Thomson Phyfcian at Mon- trofe.

YN various Indige (lions in the Stomach, and Fluxions of degenerated Humours to the chylopoietick Organs, as alio in the Foulnelles of the Lungs from a fimple Gough or Afthma thro1 their whole Train of morbid Conlequen- ces, where Emetics and Purgatives given in the common fall Dofes have done no Service,.! have often found the lame Medicines taken fre¬ quently in fmali Doles, of the greateh Benefit, without being attended with any Inconveni¬ ence.

The two Medicines I have generally made Ufe of in this Way are the Emetic Wine among the Emetics, and the Tindlure of Hiera pier a y of the Clafs of Purgatives.

The general Rule I oblerve In ordering thele Medicines, is to divide into a Number of finall Dofes as much of either of the Medicines as would be preferibed to the Patient for a full Dofe ; all which fmali Dofes are to be taken with proper Intervals in twenty-four Hours, mixed with any proper Vehicle fuited to the Nature of the Difeale. I continue this Method daily. If the Medicine occafions Naufea , puk¬ ing or Grips, or if the Patient chufes Pome In¬ termillion, I forbear to give them a Day.

G z To

y6 Medical EJfays

To explain my Meaning, I fhall mention two or three of the many Cafes I have treated in this Manner.

A Girl between nine and ten Years of Age jufed toward Night, and fometimes in the ^Morning, to throw up a viicid, ropy Phlegm or Mucus from her Stomach and from her Lungs ; her Fldh became flabby, and her whole Body weak and in Diforder. She got fometimes the Emetic and at other Times the Purgative in the Manner defcribed above, which cured her ; and having the fame good Effect in feveral Relapfes, brought her at lafl to perfect Health, which the has now enjoyed a great ma¬ ny Years.

A poor Man coughing mixt ulcerous Matter, and emaciated to a great Degree with the heCtic Symptoms, had fix Drachms of Emetic Wins mixed with Lib. 2. Inf if Succ . Liquor . nigr, given him, which he drank daily, in the Nychthemeron . He had at Times a tranflent Naufea , puked and expectorated plentifully. After he was accuflomed fome Days to his Me¬ dicine, the Naufea ceafed, and the Expectora¬ tion decreafed. I increafed his daily Dole of Emetic Wine to an Ounce, intermitting a Day fometimes. The purulent Expectoration gra¬ dually went off, and he recovered.

A Lady of a bad Habit of Body and low Spi¬ rits had long laboured under ropy variegated Vomitings in the Mornings, with Expectora¬ tion fuited thereto. After I had treated her with Emetics, Purgatives and other Medicines in the ordinary Way to little Purpofe, I gave tier in twenty-four Hours different fmail Doles

~ of

and Obfervations. Jf

of the Infuf Hierce pierce , till from a fmall Spoonful I increafed the Quantity {he took in the Day to a Spoonful and a half and two Spoon¬ fuls, always refraining the Ufe of it when lhe found any Stirrings in her Belly, till they ceafed* Sometimes likewife I mixed a little Daffie’s E- lixir. By thefe Means flie recoverd. Lately fie fell again into the fame Way, tried the Purgatives in common Dofes without Succefs, but recovered again by the Ufe of the fmall Doles.

VII. Powder of Tin an Anthelmintic Medi¬ cine'; -by Dr. Charles Alston Profeffor of Botany and Materia medica in the Univerfty of Edinburgh.

*T^HE Powder of Tin has been ufed here for many Years as a Remedy againf! Worms, and particularly the flat kinds, which often- . times elude the Force of all other Medicines ; but few being acquainted with the proper Dofe, and Manner of adminiftrating it, upon which chiefly its Succefs depends, it is hill lefs regard¬ ed than it deferves.

In 1 7 1 9 the following empiriek Receipt came into my Hands, and was the Occafion of my trying the Effects of this Powder ; which were fo remarkable, that tho* I never concealed it, I think it not improper to publifh it more effe¬ ctually, and to recommend it as a molt va¬ luable Remedy for this loathfom Difeafe.

A Receipt for the Pluck Worm.

Take an Ounce and an half of Pewther Met¬ tle, and grind it [mail to Powder ; take half a

G 3 Mutch-

7$ Medical Eft ays

Mutchkin of Treacle, and take your Powder and mix both together. The Friday before the Change of the Moon take one half of it , and the Day thereafter take the half of the other half and the Sunday thereafter the reft of it j on the Monday purge.

Thus I life it for the Taenia inteftinorum, prirtia Plateri , or Tape-worm , and Taenia al¬ tera ejufdem, ( Prax . 3. c. 14. p. 897.) that is, the Gourd-worm, or Finch worm. To full grown Peribns I give two Ounces of the Pow¬ der of pure unmixed or Block Tin put through the fined Hair Sieve or Search, mixed with eight Ounces of the common Treacle or Molojfts , as directed in the Receipt, having fird purged the Patient the preceeding Thurfday with an Infu- fion of Senna and Ma/nna in a DecoCtion of Grafs Roots to empty the Guts. On Friday Morning I give to the Patients, with an empty* Stomach, an Ounce of the Powder, in four Ounces of the Molofies. On Saturday Morning I make them take half an Ounce of the Tin in two Ounces of the Molofies, and as much on Sunday Morning. On Monday they are purged again with the fame Infiifion. Though pro¬ bably there is nothing in the Day, yeti thought it not amifis at firfi: to follow in this the Dire¬ ctions in the Receipt, and finding the Medicine lucceeded beyond Expectation, I never altered it*

I had only once an Opportunity of giving it for the Tape -worm \ it was to a Woman about thirty, who having been long troubled with this Difeafe, had taken many Medicines for it, and among the red fmall Quantities of this Powder frequently* ghe had oftentimes paf-

&<$

and Obfervations.

led Fragments of the 'Worm, and was far gone in a Heftie Confumption, The Powder Teem¬ ed to bring away all that remained of this Tce~ nia ; for {he was never more troubled with it ; the Confumption however continuing, at fait carried her off.

I have prefcribed it feveral Times for the Gourd Worm , and it never failed to completer the Cure. I fhall mention one remarkable In- fiance. A Man of about thirty fix Years of Age, who had laboured under this Diftemper for many Years, and had taken almoft the whole Clafs of Anthelmintics y by a late very learned Phyfician’s Order, to no Purpole ; for,, as he told me, he always paft fewer Worms when he took his Medicines than at other times*. By my Advice he got the Powder as a- bove, and was cured in five Days. The firfl Purgative brought away a few : None appeared the three Days he took the Powder and Molof fes, nor with the firft Stool after the lecond Purgative ; but in the fecond Stool, he laid he thought all his Guts were coming away, and it •was all crawling full of thefe ugly Vermin,, For his own Satisfaction I made him repeat the Courfe a Moon after, but not fo much as one Worm was to be feen in his Stools, nor did he ever obferve any afterwards.

I need fay nothing of the Ufe of this Powder againft the Lumbrici teretes , or long and round Worms ; it being fufficiently known and com¬ mon in Practice.. One Thing however de» ferves to be remarked, viz. That it is the mold immediate Cure for the Pain in the Stomachy which Worms fome times caufe3 that I know,,

, ‘ though

So Medical Effays %

though it brings them not away for fame Days after.

The Dole of this Medicine for Children is to be regulated by the lame Rules, as Purga¬ tives and other Medicines are.

Though the Powder of Tin may be feveral ways hurtful to Worms, yet its Efficacy feems chiefly to depend on its getting betwixt them and the inner Coat of the Stomach and Inte- dines, fo as to make them quit their Hold ; lb that Purgatives may eaflly carry them away with the Forces.

VIII. The EffeSls of the Succus Rad. Ir id. Pa- luftr. ohferved by Mr. Charles Rams at Surgeon in Edinburgh.

A Bout the middle of April 1736, John Mur- dock, formerly an healthy Man, going fome Miles into the Country, went into a low damp Houfe, and happened to drink fome lour Ale, when he was a little warm. A few Days after he complained of a general Stifnefs over his Body, and an cedematous Swelling on his Face and Bread, which was carried off for that Time with proper Diaphoretics and Hydra- gogues.

Towards the middle of Auguft thereafter, the Swelling recurred, affecting his whole Bo¬ dy, and was brought on by a fevere Cold he got at Sea. Drs. Rutherford and Dundas at¬ tending him, ordered a great many Hydra - gogues, Diuretics, <&c. which only ferved to mitigate the Symptoms, but never effected any thing like a Cure..

By

and Qhfemations . Si

By the 20th of September the Difeafe encrea- fed fo falf, as to render his Body of fo huge a Size as fcarce to be known by his Acquaintance to be the fame Man.

On the 25th, he turned very feverifh, deli¬ rious, adhmatic, and was affeCted with epile¬ ptic Fits, and fo mondroufly big and did, as not to be able to move any Joint in his Body, excepting when he had a Fit.

Immediately he had large Bliders applied to his Head and Back, Incidons made in his Scro - turn. Legs and Arms ; from all which there was a plentiful Evacuation.

By this Tune the dronged Cathartics, fuch as Jalap and Mercury , Gamboge, <&c. were turned quite ineffectual: Whereupon Dr. Ru¬ therford ordered to make Trial of the Succus radicls Iridis pain fir 1$, which was directed to be given, drd to the Quantity of 80 Guts eve¬ ry Hour or two, in a little Syrup of Buckthorn, which had very immediate EffeCts, making him pafs feveral Scots Pints of Water by Stool that very Night.

Next Morning it began to lofe its Effe£ts, and was gradually encreafed to the Quantity of two Drachms every two or three Hours, and at lad, mixed with a fourth part of Syrup of Buckthorn, was given by Spoonfuls, as he was able to fubdd under the purging : So that in the Space of three Days we computed (from the Bliders, Incidons 'and purging) he might have paffed near thirty Scots Pints of watery Stuff.

Several Days after the Juice \yas continued in fmaller Quantity, till by the purging and

other

82 Medical EJptys

other Evacuations, he was reduced to a perfect Skeleton : Afterwards he was laced in Flannel, fmoaked with Amber and Maffick, gotdrength- ning Medicines, pickt up, and continued pret¬ ty eafy, till the latter end of November , when he relap fed, turned feverifh* and died apo¬ plectic.

IX. Observations of the Effects of Lignum Guiacum in Cancers ; by Mr. John Lova Surgeon at Greenock.

*“F HE Virtues of the Lignum Guiacum in the Cure af venereal Diforders, particularly in Ulcers from that Caufe, have been much commended, but I don’t know that it has been thought to have lb good Effedls in cancrous Sores . I diall not lay that in ffich Cafes the Guiac will generally make a Cure ; but from what I oblerved in two Patients, I fhould think it worth while to make Trial of it.

Ifabel Chambers , about thirty Years of Age, had been long in a bad Habit of Body, having had feveral running Sores upon her ; After they were healed up, a very large hard indolent Tumor formed in her left Bread:, which in eight Months increafed to a great Bulk, broke, and became a plain ulcerated Cancer, for which? I amputated the whole Bread.

Several Days after the Operation, die fweated plentifully ; and the Suppuration went very well on ; the Sweating then ceafed, and dome Days after, the lower Part of the Wound look¬ er! in a gangrenous way, which I got removed with great Difficulty, by Scarifications, and by

the

and QbJhrvations . 83

theUfe of Rrong antifeptic Fomentations and -Cataplafms, and by giving the Bark and fome Claret ; but the Matter of the Sore continued ichorous, and a little Knot of a white Colour rofe a little below ; upon opening of which, in* Bead o £ Pus, I found a Subflance refembling Cheefe. This little Sore put on an Appearance between Gangrene and Cancer , with a Swelling between it and the larger ’Wound, which was now about the Breadth of a Crown Piece. I purfuedthe fame Method which had been fuc* ceisful before in the larger Sore, and tried fove* ral other Medicines, but with lb little Succels, that this lefler Sore became more painful, worfo coloured, and an Inflammation and Hardnefs were brought on the lurrounding Teguments.

I then made her drink flx Pounds a Day of a Deco&ion of Guiac , in whieh four Ounces of the Rafpings were long boiled, till the Deco* £tion was four Pound, and I gave her fome Theriac at Night to make her fweat. Thefo Medicines not having the Effect I defired in three Days, I purged her with Pilul. coch. gr. xxv. Mercur . d. gr. v. continuing Bill the De¬ coction of Guiac. After this her Sweating re¬ turned plentifully with the Ufe of the Guiac. InRead of the former Fomentations and Pul- tice, I now applied the following, Rt Rafur . lig. Guiac. unc. viii. Herb, aromat. M. vi. M. coq. ex aq. font. q.f. ad colatur. lib. iv. p,fotu. RE colatur. hujufce unc. vi. acet. vin . alb. unc . 11. Farin. fern. lin. unc. ii. Fcenugrec. unc. i. a » ven. f. q. coq. ad confftent. cataplafm. and I put a Pledgit fpread with Liniment. Arceei p part. viii. 01. Terebinth, part. i. on the Sore. Te. . By

§4 Medical Effap

By the ufe of this Liniment, Pultice and Fo* mentation, a Skin was brought on the Parts in a little Time.

A Woman about the Time of Life when the . Menfes generally leave that Sex, had feveral hard, painful, itchy Tumors in the Orifice of the Vagina ; feveral of them fuppurated, but left a hard Stool behind them, at laft befides fe¬ veral fmaller ones, the Size of Peas, one in- creafed to the Bulk of a fmall Walnut ; its Co¬ lour was livid, and it was very hard ; file had fuch itching and Pain in it, that fhe could fcarce refrain from tearing herfelf to Pieces ; by fcratch- ing fhe broke the Surface of it, which difcharg’d a bloody-coloured ferum .

By the Ufe of the Deception, Fomentation and Cataplafm mentioned in the foregoing Cafe, except that I added a little Sal Ammoniac to the Pultice, fhe was cured.

X. Of the EffeB of the Peruvian Bark in Gan¬ grenes , Ulcers and Small-pox ; by Alexan¬ der Monro Profejfor of Anatomy in the Univerfty of Edinburgh, and F. R. S.

THat no Man ought to be tempted, by any \ View of private Reputation or Gain, to con¬ ceal what can be for the general Benefit of Man¬ kind, is a Principle which I know the Gentle¬ men of your Society maintain, and their Pra¬ ctice is conform to it. Letters which I have re¬ ceived from feveral Gentlemen at a Difiance from this, informing me that X have got an in¬ fallible Secret for the Small-pox, and begging I would fend them fome of the Medicine, what-

and Ofrfervations. 85

ever Price it is, make me afraid of having' a Charatter you jufily think fo condemnable/ Relating what I know on the Subjett in publick LeHures and private Converfetion, is not fui> ficient, it feems, to keep away this Imputation from me ; I am therefore obliged to apply to you to publish the Obfervations I have made on the Ufe of the Peruvian Bark in the Small- pox, which is the only Medicine I have em¬ ployed in this Difeafe that is not commonly preferibed.

After the good Effe&s of the Bark in Gan¬ grenes were known, I had occafion to ufe it fe- veral times in that Difeafe with Succefe, and fometimes by Neceifity or Choice gave it in art Injection by the Anus , rather than by the Mouth, as I had likewife formerly done in A- gues. The Quantities given in ClyBers were larger, but the Effe&s were the feme. One Cure of a Gangrene made, I think, by the Bark in Clyfters, feems to me fo remarkable, that I muft tell you the Hifiory of it.

A young Gentleman, very healthy in Ap¬ pearance, had Brained his left Hand, but had no Uneallnefs in it for ten or twelve Days, ; at the End of which he was fuddenly feized with a very fharp Pain near the Os Pififorme of the ’WriB, and foon after the Teguments on the anterior part of the metacarpal Bone of the little Finger (welled : He neglected to ask Advice for two Days ; then feme Student who few it, ob- ferving a Mortification begun, fearified the Skin, fomented the Part, and applied feme digefiing Ointment with Oil of Turpentine ; which. Dreffmgs were continued alfe the Third Day. Vol. V, H Oa

8(5 Medical EJfays

On the fourth Day when I law him frit, the Teguments covering the fhort Mufcles of the little Finger were all mortified ; his Pulfe was (b low’, that with Difficulty I could feel it, and it was lo quick that I could not number the Beats of it. He had a general Tremor over ail Bis Body, the fubfultus tendinum was very fre¬ quent ; he had a conffant Anxiety, Refflefiefs and delirium % his Tongue was parched and dry, and whatever Food or Drink hefwallowed, was vomited before it almoff got down to his Stomach. The gangren’d Parts were again icarified and fomented, their Edges were dref- led with warm Ung. Bafdicon , to which a fmali Proportion of Oil of Turpentine was added, and a Pultice of Theriaca Andromach. was put over all. Soon after his great Guts were em¬ ptied by a laxative Clyffer, and as foon as the Operation of this was done, five Ounces of warm Milk, and a Drachm of the Powder of 'Peruvian Bark were injected, which he retain¬ ed. Four Hours after the Milk and Bark were repeated, and two fuch more Injections were given in the Night-time.

Next Morning he had no Raving, Tremor y Subfultus or Vomiting, and his Pulfe was ftronger and flower. The Hand was dreffed as the proceeding Day, and the Injection with the Bark was repeated. In the Afternoon it was changed, upon the Patient’s Defire, fora Bolus of half a Drachm of the Bark, which was re¬ peated every four or five Hours. The Fever ceafed, the gangren’d Parts began to feparate next Day ; and the Bark being continued feve- ral Days, the Cure went on without any further

• . Aeci-

and Obfervations.

Accident, except that he was put to a good deal of Pain one Day by an Application of ill pre¬ pared Aqua phagedenic a. This I mention to have an Opportunity of warning the younger Surgeons not to make ule of that Medicine, un- lefs when the Lime Water is Prong enough to make the Solution of the corro/ive fublimate Mercury to turn turbid, and to precipitate in Form of a very fine red Powder ; for if the Lime Water is effete, and remain clear after the Sublimate is mixed with it, infiead of a very mild Medicine, they are to expedt all theEffedls of unaltered corrojive Mercury.

In all the Gangrenes where the Bark was gi¬ ven with Succefs, I obferved that it brought on a mild Suppuration, which I faw become worfe when the Ufe of the Bark was interrupted, and then turned of a good kind, when the Bark was again given. This made me join in Opinion . with others, that it would alfo be of good Ser¬ vice in feveral Sores where the Suppuration was faulty ; Experience proved we judged right ; fb that the Bark became a common and a benefi¬ cial Medicine in this Town for fuch Sores.

This Effedt of the Bark in procuring a kind¬ ly mild Suppuration, led me to imagine it might be ferviceable in the Small-pox of a bad kind, where either a right Suppuration did not come into the Puftules, or Petechia? fhewed a Difpo- fition to a Gangrene ; and I had the Pleafure to fee the Effects I expedled from it in leveral va¬ riolous Patients to whom I gave the Bark ; the empty Veficles filled with Matter, watery Sanies changed into thick white Pus, Petechice became gradually more pale-coloured, and at

H 2 fail

88 Medical EJJays

lad difappeared; the Blackning of the Pox be¬ gan fooner than was expelled. I no fooner had the good Effects of the Bark in the Small-pox afcertained by Trials, than I (poke of it to o- ther Gentlemen in PrafHce here, (ome of whom had realbned in the (ame Way I had done, and had been giving it to their Patients with Suc- cefs, fince which I have had Thanks fromfome of my Friends in the Country to whom I re¬ commended this Practice,

I gave at fird the Deco£lion, and then the Extract of the Bark ; afterwards I forfook thefe Weaker Preparations for the fine Powder, which Was mixed with (ome mild rich Syrup, and an aromatic didilled Water, both which may be varied as the Patient prefers one fort of Tade to another. In this Form from ten to forty Grains were ordered to be fwallowed every four or five Hours.

But as (everal Children could not be pre¬ vailed on to take it by the Mouth, in any Form I could contrive, and, through Fear of having this Medicine given, would tade neither Food or Drink, there was a Necelfity of ufing the other Form of Clyders. Previous to giving the Bark this Way, the great Guts were un¬ loaded by a laxative Injection ; and then from half a Drachm to two Drachms of the Jefuits Powder was inje&ed, with a .final! Quantity of warm Milk, to which fome Diafcord or Syrup of Poppies was added, if the Clyders were re¬ tained too fhort time. Thefe Injeflions were repeated Morning and Evening or oftncr.

I have hitherto only given the Bark in the Small-pox after the Eruption, and contiuned it

m

and Obfervations. 8$

till the Blackning was compleated, but am per- fwaded, from the Effects I law of it in mitiga¬ ting the lecondary Fever, that if it is given during the eruptive Fever, it might be of ule in determining the Small-pox to be of a fa- .. vourable kind.

I hope what I have laid will not be under- Hood as if I recommended the Bark as an in¬ fallible univerlal Remedy in thole Difeafes,and the only one that needs to be employed in them* So far from meaning any luch thing, I allure you I have leen it fail more than once in both. Gangrenes and Small-pox, and in general, I know no Medicine which is not capable of do¬ ing Hurt to Patients under lome particular Cir- cumflances of the very Dileale for which it is given with the moASuccefs ; thus in the Small¬ pox, when the Lungs are violently infarCled, I would not confent to give the Bark: I have feen Patients in this Condition almofl luffoca- ted after a fmall Dole of it.- — They would al- . lb, in my Opinion, do very ill who would trull . entirely to the Bark, neglecting the other Me¬ dicines which have been uled to Advantage in the different Circumltances of this Dileale. The Bark would not furely moderate a very high, full, hard Pulle with high Breathing and in- . flamed Brain, in either eruptive or lecondary Fever of the Small-pox, as Blood-letting would .do. — —The Bark could not clear the Stomach, and Bronchia of vifcid Phlegm as an Emetic

wou’d. - It would not Angle calm the general

Spafln or relax the Skin to make way for the

Eruption, as when aflifted by a tepid Bath : - -

Nor would it raife a linking jfulfe, or difcharge V . ti 3 a Load

/

<j© Medical Effays

a Load of vifcid Humours* as the Stimulus of a Bliffer, and the Suppuration after it will fre¬ quently do. In fhort, I pretend to recommend it no further than as an excellent Affiflant to Mature in what the Ancients called the Conco - £ii on and Maturation of the morbid Matter , the Effe&s of which appear in moderating the Fever, and bringing a kindly mild Suppura¬ tion, which are indeed grand Articles in the Cure of Gangrenes, Ulcers and Small-pox.

XI. A Method of preparing the Extract and Sy¬ rup of Poppies ; by Mr, Thomas A knot Surgeon in Gowpar.

A Fter having had the Experience of the good Effects of an Extradi of the Poppies which grow in this Country, beyond what I have ob« ferved in Opium brought from Turky> and fee¬ ing what different Strength the Syrup of Pop¬ pies is of, as it is commonly prepared, whereas its Strength, and confequently its Dofe may al¬ ways be certainly known, if it was to be pre¬ pared by all in the Way I have praftifed, I thought an Account of the Method of preparing 1 this Britijh Opium might not be difagreeable to you.

That this Medicine may be got to the grea- teft Advantage both as to Quantity and Quali¬ ty, the Culture and Management of the Pop¬ pies are to be taken care of. What I have found mofl fuccefsful, is to trench a Spot of new rich Ground, where Poppies had not grown the preceeding Year ; for if they are continued feveral Years on the fame Ground

they

and Obfervdthns . pr

they degenerate ; • and chufing the ripeft and whited: Seed of the great fingle-dowered Turky Poppy, I low it in the Month of March very' thin and fuperficially in Drills at two Foot Di¬ fiance each, to allow Place for Weeding, <bc,. As loon as the young Plants fpring up* I take moft of them away, leaving only the ftrongeft mod: thriving Plants at about a Foot didant from each other. When the Heads of thefe come to their full Growth, but before they are ripe, I chufe a calm, warm Sun-fhine Day to cut them off, at an Inch or lefs Didance from the Top of the Stalk, going backwards front the End of the Rows I begin the loping at, to the other End. The Defign of this Caution is* to fave the milky Liquor which rifes to the cut part of the Stalk, from being fpilt by the Mo¬ tion which the Wind or my Clothes would make, and that the Heat of the Sun may make it thicken loon. What Heads are final 1, and with the Appearance of growing larger, are left to be cut afterwards. All the Heads thus cut off are put into a Basket as they are taken off* and are allowed to ly there together two or: three Days, till the Drops of Liquor which runs out of them thicken* and thereby are laved, after which they may be Ipread out on a Floor, or hanged up on Strings to dry.. Two or three Days after, I in the fame manner lop off fuch other Heads of the Poppies as are be¬ come large enough, and at the fame time cut off Pieces of two or three Inches length from the Stalks of thofe formerly cut.. This cutting of Heads and Pieces of Stalks I perform every fecond or third Day, till I obferve no more

pi Medical EJJays

Juice rife in the Stalks, keeping them always in a Bafket feme Days, and drying them after¬ wards as the lird Heads were, that all the Juice may be laved, only preferring feme few of the bed grown Heads, and allowing them to ripen fully that I may have Seed for fewing next Year.

The dried Heads and Stalks being cut and bruifed, I infufe them feme Hours in boiling- hot Water, and then boil them three or four Hours ; after which I drain the Liquor drong- ly out, and allow it to depurate, by the grolfer Parts fubfiding for a Day or two. The clear Liquor, which is poured off, I clarify with Whites of Eggs, and boil in the common Way - of making ExtraHs, till it comes to the Con¬ fidence of Honey. Some of it 1 keep in this Form, but I put the greater Part near to a Fire, or in balneo arence , till it becomes as thick as the Extrari of Opium , taking great Care that it fhall contract no Empyreuma. Out of live or fix Pounds of the dried Heads and Cuttings of the Stalks, I have had a Pound of the Extrad 7, which is of much lels Price than Opium .

The Dofe of this Extract mud be double of i what one would give of Turky Opium to anlwer the lame Intentions, which it does, without in¬ clining Patients to thofe Ravings, or giving them the naufea and Giddinefs which common . Opium does. This I attribute to the groder vifeoas Parts being feparated by febfiding, and with the Whites of the Eggs.

I prefer the Syrup of Poppies made with this Extract to any made in the common Way ; for befidts thatj X can make it with much lels

Trouble

and Ob few at ions. pj

Trouble than the common Syrup, and there¬ fore prepare it frefh more frequently than A- pothecaries will incline to make the common Syrup, fo that mine has no Chance of turning fowr, or of candying ; mine has other Advan¬ tages, for it does not ferment as the other does when moved, or in a warm Place ; and what principally makes me prefer it is, that I am certain to have it always of the fame Strength ; whereas the Dole of the other mull: be very un¬ certain, lince different Poppies have very dif¬ ferent Proportions of the narcotic Juice.

In preparing the Syrup with this Extraff, I mix luch a Proportion as that an Ounce of the Syrup Ihall contain two Grains of the Extra£l9 equal to a Grain of common T urky Opium .

That Part of the DecoCtion which I menti¬ oned to be prelerved in the Confiftence of Ho¬ ney, is nearly half lo powerful as the ExtraEl, and is kept to fave the Trouble and Time of diffolving Opium or the Extract, when prelcri- bed in Electuaries, Liniments, Plailters, where the Opium requires to be intimately and equally mixed with the other Ingredients of the Compodtion.

XII. A Differ tat ion on Opium ; by Dr. Charles Alston Profeffor o/'Botany and Materia Me- dica in the Univerjity of Edinburgh.

#T“’ HERE has been lo much written on Opi~ um already by Men of great Figure in Learning, efpecially within thele hundred Years, that it may be thought Prefumption in me to attempt any thing on the Subjedt ; a Subjedb , which

54 Medical Effays

which the Treaties of Hartmannus , Sala , Et-

■ mullerus, Wedelius, Jones , Mead , F. Hof man¬ nas 9 Hecquet , <&c. may well be fuppofed to: have exhaufied ; to fay nothing of the number- lefs Writers of Botany , Materia Medica , Phy— fich, &c. who have bellowed no fmall Pains: upon it. Yet this is fo far from being the Cafe,, that there are many Things relating to its Hi- flory, as well as to its Effe&s, either not at alii touched, or ill vouched, by any Author I have?

- leen ; fo that many Controverfies about it fUlll fubfifE Thefe I have endeavoured to determine, by Experiments and Obfervations in the fol¬ lowing Paper, fubmitted to your Cenfure, The; Method might be amended, but I chufe to re¬ tain it, becaufe it is the fame in which I deli¬ vered an Abftradl of it for many Years in my

■ private Colleges, and which I follow on all the? Simples.

SECT. I.

Opium is the proper or milky Juice , w hie hi ifjiies from Incijions made in white Poppy Heads , thickned in the open Air, into a folid , hut foft- ijh , refinous Gum, of a dark reddifh-brown Co¬ lour; and of a very hot hitter Tafte , and ftrong, heavy , or fo poriferous Smell , brought from the Levant and Eafl-Indies, in round flat Cakes , or more irregular Loaves of different Sizes , from four Ounces to a Pound and upwards in Weight , and covered with Leaves or other vegetable Stuff, \ to prevent their running and flicking to¬ gether.

So

and Observations . 95

So little is the Hiflory of Opium , even at this Day, fufficiently known, that in this fhort De» feription there is fcarcely one Thing afferted, which is not contradicted by famous Authors ; and therefore I am under a Neceffity to explain and confirm each Part of it.

1 . It is well known that a milky Juice flows ' from Poppy Heads , when hurt or wounded ; that this bears a very fmall Proportion to the Juices got by Expreffion, and widely differs from them in Tafte, Smell and Qualities; al- fo, that the Opium of the Ancients was made of the Milk, and their Meconium of expreffed Jui¬ ces, or of the DecoCtion of one and the fame Plant ; and that in their Opinion the Meconi¬ um was multum opio ignavius. But it is difpu- ted whether the Opium now ufed is the true 0- pium or the Meconium only.

On the one Hand, it is affirmed by Garcias ab Horto , Bellonius , Mandelflo , Tavernier, and, to name no more, by Dr. Kempfer , that our Opium is the Milk drawn from Poppy Heads by Incifion, or is the fame Way prepared as was die Opium of the Ancients, according to the Account Diofcorides and Pliny have given of it. The Manner of collecting and preparing the Opium being more circumftantial in Kemp - fer’s Amoenitates exotica ?, (which is not in eve¬ ry one’s Hand) than in any Author I have met with, I have tranferibed it on the Margin in his own Words (a). This Author having lived

two

(a) “ Papaveris albi fativi fuccum Europa Opium, Alia u cum iEgypto Ajiuun 8z Ofiuun vocat. Perfia idem prae- t* paratum, ex reyerentia, appdlat X heriaki, i, e. Theria-

“ cam ;

$6 Medical Effays

two Years in Perjia, and, being a diligent and curious Enquirer, could not but know how 0m plum is made there ; and his Character forbids in the leaft to fufpedt his Veracity.

And

n cam ; nam kgc illis eft Poetarum ilia Gakne, Hilare 8c *l .Endios, id eft, medicina animo ferenitatem, hilaritatem tl 8c tranquillitatem conferens: quo olim tergemino elogio ie theriacale antidotum Andromachi appellatum legimus. (i In Perfide colle&io ejus celebratur per ineuntem aeftatem, , 6£ propinqua maturitati capita decuffatim fauciando per fu- ■ (i perficiem. Culter negotio fervit quintuplici acie inftru- <£ ftus, qui una fe£tione quinque infligit vulnera longa pa^ 4£ rallela. Ex vulnufculis promanans fuccus poftridie fcal-- il pro abftergitur, 8c in vafculum, abdomini pradigatum, . cc colligitur. Turn altera capitum facies eodem modo vul- 154 neratur, ad liquorem pariter proli'ciendum. At hasc col~ <£ lectio, ob capitum impar incrementum 8c magnitudi-- <£ nem, aliquoties in eodem arvo inftituenda eft. Solent <£ in plantis nimium ramofis fuperflua capita prius amputa- i( ri : ftc reliqua magis grandefcunt, & fucco implentur ma- “ joris efficacis. Primas colleftionis lacryma, Gobaar di~ <£ £la, prajftantior eft, 8c graviori pollet cerebrum demul- t£ cendi virtute, colorem exhibens albidum, vel ex lutco “ pallentem ; fed qui color ex longiori infolatione 8c ari- <£ ditate infufcari folet. Altera colle&io fuccum promit, <£ priori, ut virtute, ita pretio inferiorem, coloris plerum- u que obfcuri, vel ex rufo nigricantis. Sunt qui 8c tertian!' <£ inftituunt, qua obtinetur lacryma nigerrima 8c exiguse; <£ virtutis. Prseparatio Opii potiftimum in eo conftftit, ut, 1 aquse pauxillo hume&atum, fpatha crafsalignea continue1 u 8c fortiter ducatitr 8c reducatur in patina lignea 8c plana, <£ donee elaboratifllmae picis confiftentiam, tenacitatem 8c a nitorem induat. Ita diu multumque fubaftum, ad ulti- u mum manu nonnihil pertrattatur nuda, 8c demum, ill' <l cylindros breves rotatum, venale.exponitur ; forcipe di« il videndum, cum particulas emptores petunt. Hac ferie <£ pertraftatum opium appellatur Theriaak malideh, i. e. the- <£ riaca molendo praeparata, vel etiam Theriaak afiuun , id eft, il theriaca opiata, ad differential!! theriacas Andromachi^ u quam illi vocant Theriaak Faruuk. MafTa haec fsepe nu- u mero, non aqua, fed melle fubigitur, ea copia admiffo, « quae non/iccitatem modo, fed & amaritiem temperet: 8c i; “ haecc

► and Obfervations. 97

And on the other Hand, it is as pofitively afferted by not a few Authors of Name, That the Opium of the Shops is nothing but a Meco¬ nium. Thus Profper Alpinus , a noted Botanifc, who was three Years in Egypt, fays, Opiumy quo o?nnes utuntur, ex locis Saieth , ubi olim Thebarum urbs erat pnvclariffima, deferunt ; ibi enim nigra papavera copiojijjhrie proveniant y cceterifque omnibus facultate prccflant , ex quo¬ rum capitibus fuccum exprimunt , quern foie fie- cant, at cue ad ufumfervant, Med. AEgyp. 1. 4. c. 2. Again, according to Mr. Lemery, the 0- pium en larme ne fe trouve en aucune endroit ; Vol. V. I No

hxc fpecialiter appellatur BArs. fnfignior praeparatio £* eft, qua inter agitandum adduntur nux Myriftica, carda- <■< momum, cinnamomum 8c macis, in pulverem fubtilifti- “ mam redafta; qualiter praeparatum opium cordi & cere- <« bro infigniter prodeffe creditin’. Vocatur in fpecie Po/e- « nia, vel, ut alii pronunciant, Folonia , puta Phllonlum Pcr~ « ficum, fen Mefue . Alii omiftis aroma t'ibus, tan turn cro- «■ co & ambra raaffam infarciunt. Prater hoc triplicis prae* “ parationis opium, quod fola pilularum forma deglutitur, « proftat, vel etiam a domefticis conficitur, liquor Celebris a nominis Coconar diftus, Grsecorum quod puto <• ac Homerianum Nepenthes, quod a bibaculis propinaii 11 affatim per horarum intervalla folet. Parant hujus (huric) il liquoreni alii ex foliis, aqua fimplici per brevem morani a coquendis; alii ex capitibus contufis infufione maceran- dis, vel iifdcm fupra filtrum repofitis, aquam eandera « fepties oftiefve fuperfundendo : admixtis pro cujufcun- u que placito, quae fapori gratiam concilient. Tertium u addo opiati genus, Eledtuarium laetificans dc lstificando iC inebrians'; cujusbafin idem opium etiam conftituit, quod iL a feplafiariis 8c medicis, prout quilquis ingenio pollet, “ varie elaboratur, ac diverfis ingredientibus ad roboran- tc dos 8c exhilarandos fpiritus dirigitur ; unde variae ejus *l extant deferiptiones; quarum primaria & famofiillma eft quae debetur inventori Hasjem begi, quandoquidem come- “ dentis animum miris perfundere gaudiis, & magicis ce- il rebrum demulcere ideis & voluptatibus dicitur.” Kem^ fsr. dmxn, wot, Fafc, 3. Qbf 1$. p. 639. & 642, 3, 4.

$8 Medical EJfays

Ho Traveller, fays he, boafts of his having met with it among the Curious ; all who have feen the Turks of the bell Quality take Opium 9 fay, it did not appear different from what is brought to us, Ac. and concludes, That there Is no other Opiu??i than the Meconium , or the Extract of the Leaves and Heads of the Poppies of Egypt , which is fent to us under the Name of Opium. , formed into Cakes or Loaves, co¬ vered with Poppy-leaves, (y. Did. des Drog.in cpiumP) Mr. Savary in his Dick, de Commerce , is of the fame Opinion. And to mention no more, Mr. de la Condamine alio affirms, that no true Opium , that is, the juice of Poppy- heads drawn by Incifion, is to be found at Conflaniinople . u I am aiTured, lays he, by i( thole who ought to know it bell, that it is <( all an Extract of a Decoflion of the Poppy. u The Opium moft efleemed is of a penetrating <c Smell, of a very deep greenilh-browm Co- lour ( verd-brun ires fonce) on the out-fide t( before it is dried ; but yellower and clearer within. The greatef; Part of that fold at: *( Conflaniinople is brought from Natalia. 0 - u pium grows alio in the Territory of Thebes i in Egypt ; but even there the Natolian is pre-J €{ ferred, and lells for double the Price of that of the Country.” ( Vid. Mem. Acad. Roy. An. 1732, p. 421.) To thele Tellimonies if; we add from Pet. Bellonius (who travelled for two Years in Natalia , Egypt , Ac. and declares he relates nothing but what he faw) the Marks pf the beft Opium (£), and its low Price, we

will

m Opium optimum eft amarurn, guku caliido fauces.

u in-. •

and Obfervations .

99

will be ready to conclude we have nothing but the Meconium.

But that our Opium is neither an Extract, nor un in (pirated exprefTed Juice of Poppies, may be demondrated by Arguments which to me appear unanfwerable* For i. The milky Juice drawn by Incifion from Poppy-heads, and thickned either in the Sun or Shade, even in this Northern Country, has all the Characters of good Opium ; its Colour, Confidence, Tade, Smell, Faculties, Phenomena are all the fame, only, if carefully collected, it is more pure, and more free of Feculencies. To obtain this Tear, I fil'd followed the Directions of Diofco~ rides , and, on a clear dry Day, before Noon, cut off the Afterisk, as he calls it, {capite llum? „ operculum , tuba, or ftigma among the Bota- nifts) or Crown of the Poppy-heads, fo as to avoid penetrating into the Cavity of the Fruit, and collected the pure Milk, with a little Silver Spoon and my Finger, into a Chi¬ na Tea-cup. I made Choice for this' Purpofe of Poppy-heads come to their full Bignefs, and before they began to harden or dry. The juice foon thickens (a fmall Quantity in a Day or fo) to the Confidence of Opium , in the open Air. It was of a fiery, hot and very bitter Tade, and foporiferous Smell ; both hotter* and more drong-fcented than the common 0~ plum ; of a dark, yellowifh-brown Colour on

the

I 2

i’’ incendens, fiavefcens, Leoninorum pilorum ftiodoj in li maffam veluti ex granulis divert! coloris eoa&um. Le- tl gendo eriim opium ea grana in papaveris capitibus colle- u fta coherent, & in placentulam quodainmodo coeunU^ Lib. 3, Obf. is.

300 •’ Medical 'EM ays

the outTide, fomewhat lighter within when broken, and not all of the lame Colour, but as it were compofed of Drops. I have of it by me, and though now more than ten Years old, it retains both its Colour and Tafle, tho’ it is not fo ftrong fmell’d as when new. This was the firfl Specimen of Bellonlus^ Opium o- ftimum that I ever law ; may it not be called 0- pium en larme ? .And if it may, fure I am it may be found every where. This was from the Papaver hortenfe , femme albo ; fatlvum Qiofcoridi ; album Piinio. C. B. Phi. 170, ojr White-poppy. About the fame Time I ga¬ thered Opium alfo Dom the Papaver vulgare, eujiis capitula foraminibus hiant, femme incano j fhyp/oTgpo*' DiofcGridi. C. B. Pin. 170, or Wild? poppy. It was a little lighter-coloured ; bu$ this I thought accidental only, for the Milk turns foon black on the Knife, and lo may co lour fome Part of the Juice more than another 5 and in nothing elfe they differed.

I made Trial afterward of the P erf an Way <>f making Opium. I had not the five-edged Knife, but as quickly as I could, fuperficially fcarified one Side of the Poppy-heads in four, five or fix Places, according to their Bignefs, Next Day, when the Juice was as hard as Opi¬ um, I fcraped it off, and kned it together, fb could not difcover any thing like Drops in it. Notwithstanding all my Caution, I fome times penetrated the Head, and fome few Drops fell to the Ground, both which would have pro¬ bably been prevented, had I been furnifhed with a right Perfan Knife. Yet I found that I was able to collect coufiderably more this way

in

and Ob few at ions.. ioi>

the lame Time than in Diofcorides' s way. That I might have the true Tear as clean, free of Duff and fair as poftible, I cut oft' the Star of feveral Heads, and bending them down, fiif- fered the Milk to drop into a Tea-cup ; then fefc it in a Window, being well covered with Pa¬ per ; when it was as folid as Opium , I leraped it out, and prefted it into a Lump. It is altoge¬ ther of the fame Colour, and the whiteft I ever faw. I made ule of the white Poppy for thele Experiments alfo, and repeated them on leve- ral Varieties of the Poppy, both with the white and with the black Seed, without obferving a- ny Difference in the Juice.

Secondly , Both the ExtraC: and the thickned exprefted juice differ very much from 0plum9 yea fcarcely any way referable it. I cauled both to be prepared, but neither of them has fo much of the Tafte or Smell of Opium , that any one could know thereby that they were all got from the lame Plant. The "brown Extract is black when dried, as is alfo the green infpiftated Juice ; but when diluted* the former is brown, the other green. The Extract is pretty tough and flicking ; the Juice is rough and more friable. Both were evapora¬ ted in a gentle Sand-heat ; the juice beginning to turn mouldy in two Days after ExpreD fion, though kept in a dry Place and broad Ba~ fon. I own fame Part of either of thefe may be mixed, in fome Places, with the true Opium . Mr. Condamlne' s Verd-brun Opium may per¬ haps have fame of the exprefted Juice in it* but it cannot be much for the Reafons follow¬ ing } and probably it is fame other aromatick

I 3 Sub-

soa Medical Effays

SubPance that gives it the penetrating Smell* which it cannot derive from the Poppy.

‘ Thirdly , The common Opium contains more Rofin or fulphurous Parts than either the ex- preffed infpifTated Juice, or Extract of Poppies can polfibly do. For, as will appear below, a- bout the third Part of the. common Opium , a§ Well as of what I made, is Rofin or Sulphur. Of the Ext raft and thickned exprefled juice. Hot a 10th Part is fulphurous ; for tho’ Alcohol extrafted fomewhat more than -foth, yet it was fcarce tinftured by them, and precipitated no¬ thing in Water.

■ Fourthly , If Opium was not the true Tear, tbere needed not be fo many large Fields fown with Poppies as there are in Natolia , Egypt , Perfia , &c. Neither would Opium be ib Prong a Medicine as it is ; its Virtues, as an Anodyne, depending chiefly, if not entirely, on the pro¬ per milky Juice.

The Objeftion taken from the Price of Opium appears to be of no Force ; becaufe I could have collefted here, without the P erf an Knife, and that Dexterity which can be acquired only by Ufe, notwithPanding the Climate, and the conlequent Smalnefs of our Poppy-heads, in an Hour’s Time about a Drachm, or fo, of 0» piwn. I Prould wonder therefore that none of stheie French Gentlemen tried to make the OpU mm and Meconium at home, Bellonius having given the Hint, and Quercetan proved it pra¬ cticable. In the mean time I conclude, That Opium is, at leajl for the far greatej} Part, the true Tear of the Poppy.

Ado 2 AnpijKi GQAU'gyerfy is^ Whstta Opium

and Observations. 1 03

got from the White Poppy or from the Black . The Antients fee m to have believed it was pre¬ pared from the Black ; Pliny fays exprefly, Al¬ ter um genus eft pqpaveris nigrum , cujus fcapo incifo ladle us fuccus excipitur. (/. 19. c. 8) and elfewhere, (/. 20. c. 18.) E nigro papavere fa- por (or fop or) gignitur, fcapo incifo . The learn¬ ed Dalecampius , in his Annotations on this lafl: cited Place, remarks, that E nigro potius quam albo papavere , Opium fieri nufquam Diofcorides fcribit. Valentins, E nigro colligi veriftmile eft , imbed llius ex albo . Bo dee us a Stapel. in Theophr . ( p , 1 100) -is of the fame Mind, and many o- thers : Yet Diofcorides not only writes, that the Poppy with the black Seed is called by fome, folds 5 did to pP iv ctvrns t ov beruv becaule the Juice flows from it ; but alfo, after giving the Virtues of the Seed, tys ftikams i**x,a>vo<9 of the Black Poppy , he immediately adds? 0 cNottg*

Hell ctVTOS fvyjov iTTlTTkioV , Kctl TT CL'gyV UV , tfSil

But the Juice itfelf is more cool¬ ing and incraflating and drying, fee. viz. than the Seed of the fame Black Poppy ; hence, fince he no where lays that the 'Ottos is got from the White , Pliny (if he copied Diofcorides') feems to have underflood him as well as thefe modern Criticks. But whatever is in this, I think it of no Confequence, whether from the Black Poppy or White with regard to the Medi¬ cine, tho’ of great Confequence with regard to the Opium- maker ; every Poppy-head yields the fame Juice, but every Poppy-head does not yield the fame Quantity ; a fmall Head cannot contain as much as a big one. Intereft therefore will difeft every where to cultivate for Opium only " ' fuch

104 Medical Effays"

fuch Poppies as bear the largeft and mofl juicy Heads in the Country , and confequently, fb far as I know, the White : And we find in Faff, that it is from the White Poppy they get the Opium in Cambay a ( Garcias ) in Per fa , (. Kempfer) ill Paphlagonia , Cappadocia , Cilicia , and other Places of Natalia , ( Bellonius ) and probably al- fo in Egypt ; for Bellonius , who was in Egypt , takes no Notice of the Opium of that Country being got from a different kind of Poppy ; and what Alpinus relates is not as from his own pro¬ per ^Knowledge, confequently, he might be mifinformed, as he was in the manner of ma¬ king Opium , fo alfb in the Plant that affords it ; or he might run into the Miftakeby implicitely following Pliny , Apuleius or Avicenna ,

3 tio. As to the Choice of Opium , I fhall pafs it as known, (V. Wedel.Opiol. 1. i. c. 4.) alfb the Controverfies concerning it, as whether foft or hard, brown or black, old or new Opi¬ um, &c. is to be preferred, as of no Moment, and eafily determined by the following Experi¬ ments. But fmee Diofcorides writes that Opium is fophiflicated feveral Ways, and Bellonius tells us, that the Merchants Opii quantitatem augeant before it is diflributed among the Provinces ; it may be asked, whether all the Opium we ufe is from the Poppies, or whether any other Drug is mixed with it, fuch as Glaucium, Gum , juice of wild Lettuce, and Suet or Tallow, all men¬ tioned by Diofcorides ? Tho’ I cannot anfwer this Queflion with Certainty, yet I think it pro¬ bable that nothing is mixed with it, if it be not a fmall Quantity offome innocent Liquid, or a mil¬ ky Juice Qf the fame Nature with that of Poppies,

other*

mid Obferoattons. 1 05

otherwife it would be weakened, or not fo drong as what we make here. I know not the Glau- cium of the Antients, nor did I ever fee any Opium that I had reafon to fufpeft as adultera¬ ted with Gum or Suet ; but the wild Lettuce, that is, the ladhica fylveftrls , odore virofo , G. R. Pin. 123. abounds more than any Poppy I -know with a Milk of the fame Tade and Smell ; perhaps therefore this, if it can be more eafily collefted, may dill in fome Places be mixed with Opium , and the Medicine be nothing the worfe for it, the Milk even of the common Let¬ tuces being anodyne and fomniferous, as well as that of the Poppies.

4 to, I laid Opium comes to us covered with Poppy Leaves, drc. becaufe every Author fays lb ; but what I have feen here is covered with the Flowers, Seeds, chaffy Husks, dm. dript from the Stalks of fome of the Lapatha or Dock kind.

SECT. II.

Opium dr Opium Thebcilcum , Off. 'Orrof ■Mi \nmoi dr t Wvuuaov M mmtov9 Hippocrat. Morb. Mul. 1.2. M 6kwo< o-Trot, Diofcorid. 1. 4. c. 65. Galeni, Simpl. Med . /. 7. c. 12. § 13. Ori- bafii, /. 15. Oplon. Plinii, /. 20. c. 18. O Tnoty Galeni, de Comp. Med. §. loc. lib. 3. c. 1. Pau¬ li, /. 7. Opium. A cods Cluf. Exot. 257. Bel- lonii, ibid. 178. C. B. Pin. 494. I. B. 3. 392. R. H. 854. Opium Mauritanls dr Indis Ofiumy Lufitanis Amfiam Garcise, Cluf. Exot. 134. Opium , quod Ajia cum Egypto Ajiuun dr Ofiuwi vocai . Kempfer. Amount at. Exot. 642. Opium .

Papa*

io6 Medical E fays

Papaver , 6* papaver album. Off. Papaver hortenfe fernine albo , fativum Diofcoridi , album Plinio, G. B. Pin. 170. papaver fativum . Dod. 445. I. B. 3. 390. R. H. 853. papaver fa - iivum , album, Ger. emac. 369, papaver fim~ plex, fativum, album. Park. Tbeat. 3 65. pa - paver hortenfe. H. Ox. 2. 275. papaver al» ■ bum , fativum, Kempf. Amcen. Exot. 639. pa • paver foliis Jimplicibus glabris incijis * Lin. EL 200. The White Poppy.

Opium or Opion, now the moR commOI) Name of this Juice, was, I believe, given it by Pliny, Galen being the firfl among th$ Greeks I have feen that ules it. For the Etymo¬ logy and various Significations of ottos, pwav, &c. I refer to Uedelius (Opiolog. 1. 2. c. i.)and Bodeuus a Stapel . (in Theophr. p. 591, 965, 1097, 6r.) If there was any Difference be¬ tween the Wls {xyizco vos. and vttiuukov M nadvioy of Hippocrates, the lajft probably was the Me- conium of Diofcorides, or rather of Pliny .

That Opium was known to the Ancients no ■ body denies ; but whether the Greeks or Egy~ ptians were the Inventors is a Queflion not yet determined ; what feems molt probable is, that this Honour is due to the Greeks, and that its foporiferous Quality at leaf! was difcovered,

. if not by Hippocrates himfelf, not long before him ; for tho’ he mentions the ottos , and vtticotmqi' .(j-v^clviov too, yet it is only in one Page, {viz. De morb. mul. 1. 2.p. 670. lin. 24. and 27. Edit. Foes) and in the fame Difi- eafe Suffocatio Uteri, that he notices the inter¬ nal Ufe of either*. Again, tho’ the anodyne

Qua-

and Qhfervations . icy

Quality of Opium recommended it very early in fome Diftempers of the Eyes and Ears, yet Diagoras , who was a Dilciple of Democritus , and coniequently almoft contemporary with Hippocrates , condemned this Practice as Diofco- rides informs ns, to djpfiVvsoorss tivcti aal tcapdr wav, becaufe it dims the Sight, and cauies a Lethargy or a continual Deli re of Peeping, Hence I think Opium was then a new Medicine, and its Virtues not well known, otherwife Hip¬ pocrates would not fo feldom have uied it, nor Diagoras made its ibporiferous Quality an Ar¬ gument againft its Application. I might add, that Heraclides of Tarentum , who flourifhed 2 or 300 Years after Hippocrates , is generally owned to be the fir ft on Record who prelcribed Opium with thefe Intentions.

I know it is the Opinion of many learned Men, (of whom, fo far as I know, Theodoras Zvoingerus , who died about 1588, was the firft) that Opium was the Nepenthes of Homer , (Odyf. 4. v. 217, 6r.) which Helena had learned of the Egyptian Poly damn a, the Wife of Thon ; and the Defcription the Poet gives of this [j.ctH,ov NzorzvfH $ ci^oKovTiy Medicine for Grief^ Pain and Anger, agreeing fo well with the known Qualities and Effects of Opium , for which Egypt was long famous, feems to make this Conjecture not improbable : Yet there are Prong Reafons again ft it ; for, to pais what might be faid of Poetic Exaggerations, of Fa¬ bles being infeparable from Poetry, of the juft, as well as extravagant Encomiums on Wine, 6'c. imO) Neither Theophraftus nor Pliny, who both mention Homer's Nepenthes , nor any of

the

$o8 Medical EJJays

the Ancients I know, took it for Opium, or tell' ns what it was. 2 do, One of Homer's Avvv'pa- 7ci pap/xctm anodyne Medicines, he calls ex-* prefly pifav a bitter Root, (/A A. v>-

845.) Now the Helenium not only takes its* Name from Helena, and is called by the. Poets^ bitter emphatically, but had alfo the Virtues of the Nepenthes aicribed to it of old : Pie lent uni, , fays P liny, ab Helena, ut diximus , natum , fa — vere credit nr former .——Attribuunt A hilar i ta¬ ils ejfetlum eidem potee in vino, eumque quem: habuerit Nepenthes illud prerdicatum ab Homer 0,, quo trijlitia omnis aboleatur. (1. 21. c. 21.)

Nepenthes alii Bugloffum, Helenium aliiejfe tc tradunt. V erjimilior eft opinio pofterior H Bod. in Theophr. p. 1118.

3 ti°, "I he Egyptian, Arabian, P erf an and’ Indian Names of this Juice are all evidently de¬ rived from O tfiov, as Ofiun, An fan, Ofiuun, A- fuun, Affion , Amfion , Ac. yea, as a great Gri- tick, (V. Cius. Exot. p. 244.) obferves, are pro¬ nounced Opion by the Arabians . Boutins in-- deed derives the Greek Name from the Ara «• bian (a), but he might as juftly derive fheriaca,, and Thermo a Andromachi, from Theriaki and( Theriak Faruuk of the Perfans : and it doesi not appear that the Arabians of old had fb good* an Opinion of Opium as the Eaflern Nations

have*

V. • :

(r) “ Affion , ac quibufdam Amphion Arabibus & Indis, 6£ Opium Grascorum eft ; indeque magis adducor ut credam, ii Grsculos a vetuftiftimo populo vocabulum Opii derivaf-' 61 fe, cum ab omni memoria iili uft ftnt; Grseci verb tan-- (i turn noxas hujus mcdicamenti, videntur novifte, ufum tl veto ac virtutes ej us plane divinas non iatis explQtatas €i habuille.y Ammad . in Garcia, c. 4.

and Qbfervations, lop

have now (d) ; or that they knew any thing more of it than the Greeks , from whom they derived and borrowed its lateffi Name, as well as all their Learning. Now Wine being for¬ bidden by Mahomet ; the Reafon is plain why his Followers, fo loon as they became acquaint¬ ed with Opium , indulged themfelves fo much, in the exceffive Ufe of it. Upon the whole, as I cannot affirm that Helenium was the Nepen¬ thes , fo if it was Opium , one would think fome of the antient Phyficians, who were neither Strangers to Egypt nor to Homer's Works, would have made this Difcovery long before the fixteenth Century.

As for the Opium Plant, i mo, It is very evi¬ dent, that on fome Account or other it was carefully cultivated long before Hippocrates li¬ ved; fox Homer, ( U . 0. v. 306.) in defcribing the Death of Gorgythion , makes ufe of a very beautiful Simile, taken from the M imm hi or Garden Poppy; and the Papaverum capita in Tarquin the Proud’s Gardens are recorded by Titus Livius (1. t. c. 53.) and all the Roman Hiftorians ; hence fays Pliny , Papaver fuiffe m honore apud Romanos femper indicio eft Tarqui- nius Superbus , qui legatis a filio mijjis , decuti - endo papavera in horto altiffima , Janguinarium Mud refponfum , hac fadli ambage , reddidit. (L 1. c. 53.) yea the Invention of it is attributed to Ceres , and fo acceptable was it believed to be to that Goddefs, that fhe was named Meco - ne ; that Cereale was a common Epithet of the Vol. V. K Papa*

{d) “ Omnibus ftupefacientibus fortius eft Opium.” A- vtcen , /, 1, f^n, 4'. c, 30*

HO Medical E [Jays

Papaver among the Poets ; that it was offered to her in her facred Rites, and that fhe was re- prefented holding it in her Hand ; To much Ho¬ nour could never have been done to a narcotick Vegetable, efpecially by the Romans , had it not been otherwife very ufeful, and reckoned one of the Frumenta which Ceres firft taught the Greeks at Attica how to cultivate and ufe, for which (lie was deify’d after Death. That the Seed of the Papaver was ufed in Food by the Antients, and particularly in Deferts, will not be denied by any in the lead: acquainted with their Writings : This D. Le Clerc acknow¬ ledges, but he thinks it was on fome other ac¬ count than for Nouridiment, or that the Man¬ ner of dreffing it divefted it of the fomniferous and noxious Qualities ( Hijl . de la Med. p. 2 1 1 .) but I muft be of a contrary Opinion, and think it nouridring, and not fomniferous or noxious ; for even in Hippocrates' s Works ( De Dieta , /. 2.) it is called nouridiing( lyctpi^bv PI Kai fov Q and without depending on the T edimony of the Antients, Poppy Seed is of a more deli¬ cious Tade than fweet Almonds, it is oily and: farinaceous, and I have eaten large Quantities .. of it frequently, of the black Seed as well as of the white, and never found it fomniferous or noxious ; befides, it is dill ufed in Food in fome Places, as well as the expreffed Oil, which is as innocent and wholfom as Oil Olive, (ff. Mat thiol, p. y/\6.Gejoffr. M.M. vol. 2 .p. 713.) If this Seed was noxious, baking would not free jt of its bad Qualities, the narcotick Part of Poppies being very fixed, and not at all volatile; hence is confirmed what was Paid above, viz.

that

and Qbfcrvaticns. ill

that the anodyne and foporiferous Virtues of the Poppy is lodged in the Milk, and in it on¬ ly ; in this it is not fmgular, for the proper Juice in many Plants differs much in Nature from the common Juices, e. g. the Milk of the common Garden Lettuces is hypnotick, while all the Plant belides is cooling, diluent and nou- rifhin^.

It is alfo certain, a do, That our Garden Poppy is not fpecifically different from the M rut,vv or Papaver of the Ancients; for altho’ we could not make a tolerable botanical De- fcription of this Plant out of all they have left us concerning if; yet we find in their Works fb many Marks of it as are fufficient to diflinguifli it from all others : For Inftance, we learn from Theophraftus , (who mentions the umm in fix different Places) that it is an Herb, does not caff its Leaves, contains a milky Juice, has ve¬ ry fmall Seeds contained in Heads, from which the milky Juice is collected : And from Diofco- rides, that it is cultivated in Gardens, has white Seeds in oblong Heads, or Seed-bags called with an Afterisk on their Top, whence by Scarification is got the ottos or 0 -

plum, which Characters agree to no other Plant. And if we add to them what Diofcorides writes of the Juice of Poppies, and the Fame of the Mithridatuim and Theriaca in all Ages, it will be evident beyond all Contradiction, that our Poppy is the Papaver of the Ancients, and consequently, that their Opium and ours is the fame Juice. This may appear to fome a meer hiftorical Nicety ; but if the Identity of the Medicine be not flrft demonflrated, we cannot

K 2, b@

in Medical EJJays

be benefited by the Experience and Obfervation of former Ages. Happy had it been for Phy- lick, if the fame Nicety had been obferved in every Simple to which we give Greek or Latin Names.

I have made OpiumThebaicum a Shop-name of this juice, becaufe the Reputation it had of old, of being the beR of the Kind, made Phy- licians commonly ufe it in Prefcription ; and it frill Rands in Pome Competitions in many Au¬ thors. But in reality the Egyptian Opium is not a bit better than the Natoliany if lb good. Opium Thebaicum therefore is the fame with plum elePlum or optimum.

I fhould conclude this Sefrion with a botani¬ cal Defcription of the O/wm -Plan tor Papaver ; but fince it could be little elfe than a Tranicript of that in the Plantarum hiftoria 0 xonienjis > added to the incomparable Carolus Linnaeus his Character of the Genus , I pafs it with this one -Remark, That though Morifon deferibes the ’white Poppy as a Species different from the Pa- paver hortenfe , nigro femine , fylveflre Diofco - ridiy nigrum Plinio , C. B. Pin. or the black Poppy ; yet the Papaver fativum. I. B . includes not thefe two only, but feven more named in C. B . Pin. as different Species, and confequent- ly the firR twenty fix Species in Mr. Tourne - forf s Inftitutiones , thefe being only accidental Variations of one and the fame Species.

SECT. in.

Opium eafes Pain , procures Sleep , promotes Perfpirationf but checks all other Evacuations ,

chears

and Obfervations. 113

chears the Spirits, incraffates the Humours , and relaxes the Fibres. Hence it is recommended in intenfe Pains, Watchings, Spafms, Spleen, Va~ pours, Fluxes, FLumorrhagies , Tenefmus’s , yea, in all the Difeafes proceeding from Ten fi 'on or Irritation of the Nerves, irregular Motions of the Spirits, or from Thinnefs or Acrimony of the Fluids.

It would be too tedious here to recount the various Opinions of Authors concerning Opium. Let itfuffice to hint briefly at fuch afterwards as are contradi&ed by plain Experiment. For I thought it neceflary to examine it every man¬ ner of way I could think of, whereby the Qua¬ lities of Bodies, and their Influence on us are difcoverable, in order to find out that particu¬ lar Change it makes on the Fluids or Solids, which I ufe to call the primary, or if you pleafe, the moft mechanical Effect of a Medicine ; from which, and the Mechanifm of our Bodies, the fecondary and more obfervable Virtues or EE fe£ts do proceed. This obliged me to make a Variety of Experiments, which I have as much as poffible abridged in the following Propofitions or Obfervations.

1 mo, Opium is acrid, bitter, and ftrongly o~ doriferous. Diofcorides fays it is bitter in Tafle and carotic or foporiferous in Smell ; Matthio - lus, that it ulcerates the Tongue and Palate, if kept for fome Time in the Mouth. Some call the Smell virofus, others gr avis, teter, penetrans , and fo on. If one attentively tafles Opium, he will perceive, firfl, a naufeous and diffuflve jBitte/nds j then, in half a Minute or a

K 3 pun-

1 14 Medical Effays

pungent Heat, affecting BrB and principally the Tongue, then the Palate, and laB of all the Lips, in a lower Degree. The Heat continues more than fifteen Minutes, the Bitternefs Bill longer, provoking a plentiful Difcharge of the Saliva. It heats and irritates alio the Nofe, and creates an Inclination to fheeze.

Hence were we to judge of the Virtues of 0 - pium. by its Effects in the Mouth or Nofe, or by its TaBe and Smell, we would reckon it an a- crid diaphoretic, nervine, and cathartic Medi¬ cine. It certainly is diaphoretic, and properly enough may be called nervine, but not purga¬ tive, tho’ by Accident it fbmetimes has that Effeff. Erafius thinks, that if it were not for its vis fiupefaciens , it would always prove ca¬ thartic. (V. JVedel. OpiologA. 2. § i. c. 7.) Ac¬ cording to him therefore, the narcotic Virtue has no Dependence upon the above fenfible Qualities. This will appear the more probable, if we confider that fbme Narcotics are acrid, ci¬ thers mild ; fome bitter, others fweet ; fome odoriferous, others not ; fome purge, others Bop fuch Evacuations, drc. and yet all of them are anodyne, and almoB equally narcotic and virulent, if the Dofe be proportioned to their Strength. And alfo that there are not a few Cathartics as acrid, bitter and Brong-Onelled as Opium , which are no ways narcotic. Confe- quently we ought to diBinguifh between the Bimulating and narcotic Qualities of Opium ; at leaft we may conceive of them as different.

Thefe fenfible or Bimulating Qualities, in the Opinion of fome, fufficiently confute the old Notion, of the refrigerating Faculty of Opi- . - urn %

and Obfervations * iij

um, and prove it to be a very hot Medicine, and certainly in one refpect it is fo. But it is as certain, that its Effects in diminifhing pre¬ ternatural Heat, obfervable in a Variety of Ca¬ fes, alfo evince its cooling Virtue ; in fo much that if the Controverfy was of any Moment, it would not be difficult to prove that Opium may more properly be faid to cool than to heat.

'ido, Opium conjifts of Gum , Rojin , and terreflrial Parts , in fuch Proportion , that in twelve Parts of Opium there are about five Parts of Gum , four of Rofin , and three of terreflrial Feculencies , neither diffolvable in watery or fpirituous Menflruums .

I diffiolved Opium in Water, Wine, Vinegar, Spirit of Vinegar and Brandy ; and drew a Tinfhare from it with Spirit of Wine, recti¬ fied with Salt of Tartar , or Alcohol , keeping al¬ ways the Proportion of one Part of Opium to twelve Parts of the Menftruum, and found that (<t) Alcohol diffiolved four twelfths of Opi¬ um, there remaining eight twelfths, of which Water diffiolved five twelfths, and left three twelfths of Forces. (3) Water diffiolved eight twelfths ; and of four twelfths remaining. Al¬ cohol diffiolved one, leaving of earthy Parts as above. It muft be owned the Proportions were not always exadlly the fame, but did not vary much. Hence Water diffiolves about three Fourths of the Sulphur of Opium. I found al¬ fo (v) that Water diffiolves Opium as well and as foon as Wine, Vinegar, or Spirit of Vine¬ gar ; only the Solution in Water, in three or four Days, becomes turbid, and foon after mouldy, feparating from it a whitiih Subfiance*

con?

1 1 6 Medical E flays

containing Part of the diffolved Rofm. (d) That Brandy, or Proof Spirits, diflolves both the gummy and refmous Parts of Opium , that is; all that Water and Alcohol leparately can dif: folve, and that even without Heat, leaving no¬ thing but the feculent Part. Hence there being' in twelve Parts of Brandy, about eight Parts of Water, fo much Water, Wine or Vinegar is a lufficient Mendruum for one Part of Opium . But though I tried this Proportion of eight to one, and it anfwered, yet becaule twelve to one compleated the Solution fooner, I kept by it. For (s) Water, Wine, Vinegar and Bran¬ dy, in the Proportion of twelve to one, took but four or five Days for the Solution without Heat, if frequently drake n ; but Water in the Proportion of eight to one took ten or twelve Days. Alcohol requires about a Month. And (f), , the Rejiduum of a Solution of Opium in cold Water contains nothing which boiling Water can extrafh Suppofing therefore that the Ro¬ fm or Sulphur of Opium is as good or as much wanted as the Gum, or the mucilaginous Part, Brandy is certainly the bed Menftruum .

3 tioy The Gum of Opium has the fa?ne T aft e , and Smell r with the Juice ; hut the Roftn has no i Tafle , and fmells rather mufty than of Opium, fo far as my Senfes informed me. This is ta¬ ken notice of alfo in the Col. Chym. Leid. c. 310. where the Remainder of the Solution o £ Opium in Water is called, Maffa tenax inftar picisy omnis fere odoris <& faporis expers j quae poll - ea in fpiritu vim tindluram fuam deponit ; at nullius fere ufus , nijl in extends eft. Faeces ecedem reft antes interne magnas anfietates dr-

and Qbfervatms. i 1 7

ca preucordia efficere felent, fine ullo dolor is le~ vamine. Bat of the Extract with Water, and mixed with Pome Aromatics, the Author fays, Eft anodynum optimum , quod nunquam anxiet ci¬ tes circa preecordia , neque obfirucliones uteri , neque ph ant a ji as conciliate This Rofin is very much condemned by Dr. Jones , & c. and charged with all the ill Effefls of Opium. I wifli they had given more convincing Evidence of the Mifchiefs it does. The World is too cautious now to believe implicitely every general Affertion .

It is well known that the Solution of Opium in Water is anodyne and foporiferous, has all the good Qualities of the Juice, and operates in as> (mail a Dole ; and yet that Opium in Sub- fiance is lometimes preferable to it ; that al¬ lowing the half of the Sulphur of Opium only to be Rofin, even thus, one half of it is in all the aqueous Solutions and Extracts ; and that a few Grains of the moR tenacious, tough and flicking Rofin, cannot do much Prejudice if not otherwife hurtful, far lefs the third or fourth of a Grain. Common Aloes is fully as refinous as Opium , and its Rofin as flicking. This Ro- fm of Aloes has generally been blamed for cau- fing the Tenefmus h tumor rhoidalis , &c. by its irritating Acrimony. But a late Member of the Royal Academy, (who afierted allb Rhubarb was not aflringent) has attempted to prove it not only innocent, but very friendly to Nature, and the bell Correflor of the Acrimony of the Gum. Left this fliould be the Cafe with Opi¬ um 9 I made Experiment upon rnyfelf with a Tinflure of the Refiduum of Opium diffolved in Water, extracted by Alcohol . I took at firffc

1 1 8 Medical EJfays

ten Drops, then fifteen, and lafl of all twenty five ; and rauft own that it tailed flrongly of Opium , and was fomniferous ; • but I was not t fenfible of any bad Effects of it. I might add,. That the balfamum anodynum is found to be. really anodyne internally as well as externally,, though the Tinflure is extracted with rectified Spirit. But whatever is in this, Crude Opiumi may be preferable to the Solution, as it does; not fb (bon dilfolve in the Stomach, or as it in-* creaies the diaphoretic Quality, or oil accounts of fome Singularity in the Conflitution. But for the moil part, what does not dilfolve ini Water may be wanted. Hence I infer, that* the narcoticVirtueof Opium does not depend oni its vaporofum fulphur (<?), nor on its fulphur craffum admodum rarefcibile, a-kin to that off Crocus , Caflory &c. (/). Few vegetable Sub-* fiances have lefs Sulphur than Crocus ( g). It* yields all to Water, nothing to Oil. And II

might*

( e ) Frid. Hoffmantius cle opiat. p. iji.

(/) Geojfr. M. M. Tom. 2. p. 693 <6-701. 11 Sulphur r “ c radii m quod in opio deprebenditur admodum rarefcibi- <{ le eft, ut liquet ex opii diftillationibus, vehementi odore i( opii refperfis : & ab hoc fulphure condenfato, 8c fummae : il raritatis capaci ejus virtutem pendere exiftimo, ( Geoffr . ' 11 p. 693,) Quseret aliquis, quasnam tint principia quibus u opium hanc infignem fanguinis dilTolutionem, 8z expan- ii fionem excitare valent? Cui refpondeo, opium falibus ; “ turn acido, turn alcali urinofo, & fulphure cralTo pluri- tl mum condenfato, fed fummae di v ifibili tatis & expanfio- ti nis capaci componi. At verb non tam a falibus qnam a “ fulphure, ejus vim foporiferam pendere exiftimo ; quam • a doquidem obfervamus corpora fimili fulphure turgida, , “ ut funt Crocus, Nux mofehata, Caftoreum, 8c c. in fo- il porem inducere.” Id. p. 701.

(g) Oleum eftentiale croci nullibi extare legimus, Z-welf. Ph. Reg. 704. Crocus analyfi ehymicaperparum olei dat, Qeoffrop M . M. Tom. 2. p. 284.

and Observations. up

might add, That Caftor and Aromatics are commonly reckoned Correctors of Opium .

4 to, Though Opium is rather alcalefcent than acefcent , yet it cannot be called an Alcali, This I learned by many Experiments : For (<*)

I dropt into a Solution of Opium in Water, in different Glaffes and feparately, fpiritus aceti , cornu cerviy vitrioli oleum T art ari per de- Uquium. None of them caufed the fmallefl: E- buliition or EfFervefcence ; the Acids only di¬ luted the Solution ; but the Alcali turned it milky, the Mixture foon feparating into two Parts ; below it was clear and tranfparent as be¬ fore, and the milky Part gathered above, like a thick Cream, which, on fhaking the Glafs, fub- Tided, leaving the upper Part clear ; yet this did not always happen ; for, on repeated Con- cuifions of the Glafs, the Cream fometimes re¬ turned to the upper Part of the Solution. The Solution with the Oil of Tartar in it fuelled fomewhat urinous. The Cream feparated by Filtration, and dried, melted and flamed with Heat, and diflolved in Alcohol , but not in Wa¬ ter ; and confequently was Part of the Sulphur of Opium , which the Water had diflolved. To be more certain of this, I dropt oleumTartari , and fpiritus cornu cerviy into feparate Portions of a Solution in Water of the Refiduum , after extracting the Rofin of Opium with Alcohol ; and found that neither the volatile nor fixed Alcali caufed the leaf! Separation, or Precipitation, but only diluted the Mixture, Alcohol having diflolved and extrafted all this Sulphur.

(3) I mixed the Solution of Opium in Water with an Infuflon of Violets ; it did not turn

red

120 Medical EJJays

red, or undergo any Change, except what ne- ceffarily follows the conjoining of two Colours fo different, when the one does not deProy the other. Tin&ure of Saffron in Water had the; fame Effect. I infufed in the faid Solution a Piece of blue Paper, with which Sugar Loaves are commonly covered, and poured fome of it upon another Piece of the fame Paper, till both were throughly wetted with the Solution; and tho’ at firfb when it was covered with the red So- • lution, the Paper appeared redder than before ; yet, when dried, it was fo far from being redder, that it had loll its native reddifh Gaft, and was become of a worn-out, or faded blue, rather greenifh than reddifh. I mixed alfb the Solu¬ tion of Opium with the Tincture of Tournfol in Water, and it turned of a bright red Colour. The aqueous Tincture of Saffron made the fame Change. The Tincture of Tournfol betwixt the Eye and the Light, is of a deep Crimfon, but when it dries on the Glafs, is blue like the Juice. What dried on the Glafs of that mix¬ ed with Opium , continued a bright red. This muff be owing to fomewhat elfe than the Colour of the Solution, fince the Water diftil- led from Opium has the fame Effeft, (as is noti¬ ced below) and confequently to the Acid in 0- piuni ; and thus only we difcover any Acid in it ; which cannot be very Prong, Pnce not on¬ ly Sal Ammoniac , but even Borax , redden the Turnfole ; and this fame Solurion of Opium turned a Solution of corrojive fublimate milky, and curdled it ,• Spirit of Vitriol made it again clear. In a Word, this Solution of Opium gave

more

md Obfervations. ill

more Phenomena of an Alcali than of an Acid . (Jo)

(>) Thefe Experiments ( ) and (3) were made alfo with the Opium I collected here, and likewife with the Solutions of common Opium in Wine, Vinegar, Spirits, &c. with the fame Event, except in fo far as the Menflruum made a Difference, e. g. Spir. Vitrioli precipitated the fp i r i t u o u s T i n ft u r e s ; oleum Tartarii p. d. would not mix or incorporate with them, tho’ often well fhaken together, <&c.

(d) I poured a few Drops of the oL Tartarh p . d . on crude Opium, but could obferve nothing like an Ebullition or Effervefcence, which feme have afferted. It became indeed a little whitifh when dried, and fmelled fomewhat urinous, by reafbn of the Alcalfs Aflion on the Sulphur and eiTential Salt. The Gccafon of this Ex¬ periment, which might othenvife feem fuper- fluous, was becaufe Prof. Hoffman attributes this Change of Colour and Smell to the Con- grefs of the Alcali with the acid Sulphur. Though he denies that the Blood can be coagu- la ted, or that the animal Spirits can be fixed by it. Opiat. p. 143, and 146.

(«) Blue Vitriol turned a Solution of Opium in Water, whitifh and opake, or milky ; but this fubfiding, the upper Part was transparent, and of a beautiful green Colour. Green and •white Vitrioh made it black like a dirty Ink. Vol.V L To

(/;) a Quod acidus fal etiam in opio reperiatur, & qui- c< dem potens, probatur turn per analyfin ; turn etiam Ci u folutio opii in Heliotropii tinfturam affundatur ; colo- <£ rem enim rubrum igneutn huic tinfturs conciliat,” Geof, M, Tom, 2 . p, 6p 2,

122 Medical EJJays

To fee whether this was owing to the heteroge¬ neous Subftances which the Opium was covered with, I drew a Tincture from them feparately, and mixed it with a Solution of green Vitriol ; but it did not in the leaft make it black.

From thefe Mixtures I may infer, i tno, That the ejfential Salt of Opium is Ammoniac aL *ldo , That Opium contains a very fmall Pro¬ portion of an Acid. Andi^tio, That it is fome- what aftringent, or makes the fame Change on Chalybeats that vegetable Aftringents do.

gtOy The moft affiive Principles of Opium &re not volatile as the Chymifls /peak , but very fixed. For 0?) it keeps well. I have of it forty Years old, which is ftill hard, folid, and retains its Taffe. (/;) I kept Opii Drach. i. in ihe Heat of boiling Water for five Hours ; and though frefh and pretty foft, it fcarcely lofi one Grain and an half in Weight, (c) I had Opi¬ um difiblved in Water, fermented and diftilled in the Laboratory, but got no Proof Spirits from it, tho’ Opii Unc.Y iii. were ufed. The firft four Ounces of Spirit that came over were hot to the Tafie, and had a peculiar Smell and Fla¬ vour, very different from that of Opium, and not bitter ; the fecond four Ounces were much weaker, and the laft four almoft taftelefs. The firft and fecond Spirits, or Waters rather, were mixed and rectified by Difiillation ; and I got from them about three Ounces, which I thought would have been a Proof Spirit ; but, on T rial, it appeared weaker than the firft four Ounces, - and was not inflammable. Then, having fil¬ trated what remained after the firft Diftillation, I dried the rejinous. Rejiduum^ aud had as much

fully

mid Obfervations. 1 2$

fully as If no Fermentation had preceded. The filtrated Liquor I evaporated to an Extract ; but before it was cold, the Veftel in which it was being broken by Accident, I loft Part of it ; but fo far as I could guefs, I would have had a Quantity of Extract and Rejiduum , very near equal to the Quantity of Opium I employed. The Extra SI had nothing of the Smell of 0 - pium , but the Rejiduum ftiil retains a little of it, tho’ it is near five Years fince the Experi¬ ment was made.

Hence, 1 mo. Old Opium is little worfe or weaker than new *, nor can it be called better becaufe weaker, fince weakening a Medicine is the wrong "Way to improve it. 2 do, Toaft- mg Opium on a Plate of Iron with Defign to correct it by divefting it of its narcotic Part, which was long praftifed, and much commend- ed by Authors, may burn it, but cannot make it better ; Mirum ej ?, (fays Wedelius , OpioL p. 54.) quod author es nonnulli liberari Opium contendant a fulphure fuo narcotico , cum ta- men illam ipfam intend ant, qucerantque <& ex¬ pedient virtutem ex Opio . Non cafirandum eft Opium virtute ndrcotica , non fulphur narcoti - cum feparandum , alias evanidum fiet , 6* nulla - rum virtutum ; Jed hceterogenea funt femovenda . 3 tio, Opium affords little or nothing by Diftil- lation ; would we therefore have the Virtues of the Theriaca in a liquid Form, we muft infufe it in Wine, or rather Brandy.

6to , By a Chemical Analyfis , Phlegm, uri¬ nous Spirit, Oil, Volatile as well as fixed Salt, and Earth, may be got from Opium. Altho® it muft be acknowledged that fgme Simples,

\ 2 P

124 Medical Ejfay »

as different in Figure, Nature and Qualities^ poffibly can be, afford the very fame Principles by a Chemical Diflillation, e. g. Deadly Night- Shade and Cabbage (i) ; and confequently that very little of the Virtues of Opium can be thus either invefligated or explained : Yet feeing Tome by the Analyfis pretend to prove that the Effefls of Opium depend on its Sulphur, others on its Volatile Salt, others that its Sulphur is narcotic, and Salt diaphoretic, <bc. ( k ) I thought it not amifs to repeat this Procefs three Times, having theUle of the Laboratory and Dr. Plum r trier* s friendly Afliftance ; and we found thafc fixteen Ounces of Opium diftilled by itfelf in a Glafs-Retort, with a Sand Heat gradually i% created, gave

(^) of Phlegm an Ounce and Drachm . if This Phlegm was very fetid andempyreumatic, like that from Muflard Seed ; it effervefeed on bubbled neither with Spirit of Vitriol nor with Oil of Tartar , nor did it change the Colour of Syrup of Violets, but turned the Tindlure of Turnfol into a pretty bright red, which Oil of ^Tartar again changed into blue ; it alfo whiten* ed and precipitated a Solution of Corrofive Sub¬ limate.

(3) of Spirit and Oil Unc. vi. Drachm in that is Spiritus Unc. iv. Drachm ii. and Olei Unc. ii. The Spirit was very fetid and acrid, and made a' great Ebullition with Spirit of Vi¬ triol, the Oil black and lights partly thin, and partly thick.

(?)

(z) V. Hombergin M. Acad. R. 1701.

\k) V. Wedel. Opiol. 1. i.V. 1. c. 9. Pitcarcdi DifT. ckt ^cui, fang. p. 134. Geoffrey M. M. 2- 692.

and Obfervations . 11$

(y) of Volatile Salt , adhering to the Neck of the Retort, about gr . iv.

(/) of Caput mortuum Unc. vi. So we loft it# the Operation about Unc. ii. Drach . iii.gr. Ivi* The bell Method I could devife to find how much Volatile Salt was contained in this Spirit (no Author having lo much as guefled at it) was to compare its Strength with the Strength, of Sal. C. C. in enervating the Spirit of Vitriol 9 and finding that one Part of Sal. C. C. dif* folved in Water, faturated as much Spirit of V itrlol as eighteen Parts of Spirit of Opium , I thought I might conclude that in Spirit us Opii Drachm xxxiv. there was not more than 114 Grains of Volatile Salt , which with the fouc Grains in the Retort, made Drachm, i. gr. lviii. that is., all the Volatile Salt we could obtain from Opii Unc. xvi. andconfequently one Grain o £ Volatile Salt from fixty fix Grains of Opium, Hence and from N°. 4. and 5. it appears that the Virtues of Opium do not depend on its vo¬ latile Salt or Spirit , far lefs on its fpirituous and volatile Parts, coagulating the Blood as Sp. Urince does Sp. Vini , which was Cranius’$ Opinion. V. Hoffman , Diff. de Opiat. 143.

The Caput mortuum , by long and repeated Calcinations in a Crucible, was reduced to Drachm, iv. gr. xlix. I made a Lixivium of it with boiling Water, filtrated it, and dried the Earth, which weighed Drachm, ii. gr. li. fo Water extracted Drachm, i. gr. Iviii. This Lixive tailed Salt, did not effervefce with Spi rit of Vitriol nor with Oil of Tartar p. d. nei* ther made any Change on Syrup of Vio&ts Tin&ure of Turn fop or Solution of corrofiv?

£4 3 SublinuUct

ti6 Medical Effays

Sublimate . I evaporated it over the Fire to a Pellicle, and to Drynefs in a Delft-plate in the Air, and had of a pretty white Salt in Powder,, with numerous fmall priftnatic Cryftals in it, Drachm, i gr. xiii. ftill neither Alcali nor A- cid by any Experiment. The Earth I again Calcined for three Hours, by which it loft about gr. vi. in Weight, and being elixiviate and dried, it was diminiftied gr. xx. more, but the Remainder of the Lixivium , evaporated to Dry* Tiefs, gave only about ten Grains of a Salt like the former, though not at all alcaline, but whi¬ ter, fo of the calcined Caput mortuum Water extra£led Drachm ii. gr. xviii. which with the gr. vi. loft in the laft Calcination, lubftracled from Drachm, iv. gr. xlix. gives Drachm ii. gr. xxv. as the Quantity of Earth contained in a Pound of Opium. The Quantity of the Salt is not equal to the Subftance diifolved in the Water, becaule Part of the Lixivium was em¬ ployed otherwife.

The Proportions of Salt and Earth were much the fame in the caput mortuum of all the three Analyfes, and alfo in the Afhes of tome Opium I calcined by itfelf, none of them af¬ fording any fixed Alcali ; but having by me a little of the fixed Salt of the fecond Analyfis, which was made about five Years ago, by eva¬ porating the Lixivium in a Tea-cup in a Cham* ber Window, and was in finall lome what priD mafic, but irregular and yellowifti Cryftals ; I difioived it in Water, filtrated and cryftallized it without Heat as formerly, and had a Salt like brown Sugar-candy, which is a true fixed Al¬ cali by every Experiment, During the five

Yearf

and Obfervations . ? 27

Tears it had loft about an eighth Part of its Weight, and the Paper was moiR in which I kept it ; it does not melt or run p d. but is Hull perfectly dry; to account for this it requires more Experiments.

In the firR Analyfis we increafed the Fire flowly, and changed the Recipient fo foon as all the Phlegm was come over; in the fecond we did not change the Recipient, but railed the Heat to the greateR Degree the Retort could bear, as fall as we could, and continued it for ten Hours ; in the third we firR kept the Re¬ tort in Balneo Mar ice, or boiling Water, for the greater Part of a Day, and then changed the Recipient, and gave it the Sand Heat. Thus we had two Drachms lefs of Water than in the firR Analyfis; neither of them effervelced with Acids or Alcalies, but the Water in this third Procels, which was almoR tafielefs, fimel- led more of Opium , and was lefs empyreuma* tic, precipitated a Solution of corrofive Subli¬ mate, and diluted only Syrup of Violets, but redened, as did the Solution above, the Tin¬ cture of Turnfol. Hence Opium contains but little Acid, or a very weak Acid, though Mr* G eoffroy found in it a fal acidus & quidem po- tens .

A Pound of Opium , by a chemical Analyfis,, gave, according to Dr. Pitcairn , Spiritus Brack* xlv. Olei Drachm, x. 3. Capitis mortui Drachm .. Ixii. and there was loR in the Difiillatiort Drachm . x. 3. according to Mr. Geoffrey, Spi¬ ritus Drachm . xlix, Olei Drachm, ix. 3. Cap . mort. Drachm. Ixii. LoR Drach. vii. 3. and the Cap. mort. calcined to Drachm . viii. gr. xxv.

yielded

1 28 Medical EJfays

yielded Salts fixi mere Ale all , Drach . ii. gr, xxviii. 3* con fequently there remained of Earth Drachm, vi. gr. vi. 3. but by our Proceffes Phlegmatls Drachm, xlii. gr. vi. Sails volati - Us Drachm, i. gr. lviii. Old Drachm, xvi. Sa¬ ils fixi Drachm, ii. gr. xviii. Terr re Drachm . ii. gr. xxv. and there evaporated in the Diffil- lation, perhaps of Air, Drachm, xix. gr. lvi. and confumed in Calcination of Oil, <bc. Drach, xliii. gr. xv ii.

jmo , The EffAs of Opium on other Ani¬ mals are not much different from Its EffeAs on Men , or It is to fame of them at leaf, Innocent, hurtful , or Polfon , according to the Dofe.

(*) In the Phyfick Garden at Holyroodhoufie (where all the Experiments on Frogs were made) I one Evening put a big flrong Paddock into a Pot of Water, wherein a fmall Quantity of Opium was dilfolved ; it foon appear’d to be uneafy, by making ftrong Efforts to get out of it, but in a fhort time it flag’d or grew dull, making very little Motion, and next Morning ' it was dead and much (welled.

(3) In Prefence of, and affifted by Mr. Ro¬ bert Fullar ton, a curious Gentleman, and very dextrous in Microlcopical Qb(ervations, (in Au- guft 1733) I conveyed through a fmall Glafs Tube a few Drops of a Solution of Opium in Water into a Frog’s Stomach, and putting the Animal into a Glafs Cylinder, adapted it fo to a good Microfcope, that we had a diftincl: View of a part of the Membrane betwixt the Toes of its hinder Foot, where the Circulation of the Blood may eadly be feen. My Defign was, ipee I found Opium killed Frogs, to obferve if

there

and Obfervat ions. saf

-.there was any vifible Change made by it in the Blood itfelfy or in its Motion ; neither of u9 could indeed fee any Alteration of the Blood as to its Confidence, Colour of the Serum^ Magnitude, Figure or Colour of the red Glo¬ bules ; but we very diAinFtly faw a furprizing Diminution of the Blood’s Velocity, for it did not move half fo fwiftly as it ufes to do in thefe Creatures. We alternately looked at it again and again, and in lefs than half an Hour faw the Velocity of the Blood gradually increafe, the uneafy Frog recover its wonted Vigour, and the Blood its common Celerity; upon which we took out the Paddock, put it in a Bafon of dean Water, and allowed it half an Hour to re- frefh itfelf, then gave it another Dofe of Opi¬ um, fixed it to the Microfeope with all Expe¬ dition, and viewed it as before; the Blood, then moved yet flower than it did the firfh Time, and, its Velocity gradually decreafmg, at length it flagnated, firA in the fmaller then in the larger Veflels, and in about a Quarter of an Hour the Animal expired. One thing was very obfervable all along, viz. That notwith- Aanding the diminifhed Velocity of the Blood, there was no fenfible Diminution of the Fre¬ quency of the Pulfe ; yea, when there was no Circulation or progreflive Motion of the Blood in this Part, the Pulfe was vifible by an undu- latory Motion ; that is, the Blood returned as far back at every Diaflole of the Heart as it was protruded by the preceeding Sy/h^» this con¬ tinued till the Frog wac 'iuIie dead, or at leafl appeared m. When we had loA all Hope

Wus Recovery I open’d it, and found nothing

i 30 Medical B/Jays

in its Stomach but a clear Mucus like a Geliy,' a little coloured with the Opium , of , which it was full ; every thing elfe feemed perfectly na¬ tural. This Experiment we frequently re¬ peated, and it had always the fame Appear¬ ances and Event. The Recovery, however, of one of the Frogs, which for a confiderable Time Teem’d to be dead, is not to be omitted. My Friend and I one Evening killed, as above,, a couple of Frogs with Opium; one of them,, which was the ftrongeft, I laid half in Water on a Tile, in the Bottom of a Water-pot, that if it recovered it might fit either wet Ox dry as. it liked beft; the other I left on the Earth dry under a Hedge. Next Morning, when I re¬ turned to the Garden, I found the one under the Hedge dead as I left it, but the other in the; Water-pot was alive, and appeared to be Lli perfeCt Health. t

While we were thus employed, another thing occurred, which, though foreign to the ; prefent Subject, it may not be amifs to men¬ tion. One of the Frogs we got for the a» bove Experiments, had not the ufe of one of its hinder Legs, which was of a pale reddifh ! Colour. This made me defirous to obferve by the Microfcope the Circiimflances of the Circu¬ lation in this paralytick, and apparently in-' flamed Member; and we found that the red Globules were entirely diffolved ; that the Blood-velfels were diftended with a reddifh ho¬ mogeneous i~?q,uid, as if the Part had been in¬ jected with a bloocty wq ter ; and that neither Senfe or Motion remained in n.

(>) My- Gollegue Mr. Monro was fo goou ^

at

and Obfervations , 13 $

at my Defire, to injeft into the crural Vein of an old Dog, of forty two Pound Weight or thereby, half an Ounce of Opium , diffolved in four Ounces of Water filtrated, and of the fame Warmth or Heat with the Blood of the Ani¬ mal; and at three different times : The firil time he threw in about Drach. xv. and very flowly. It had no obfervable Effeff. About an Hour after he injected, alfo flowly, Drach . viii. more, and immediately the Dog was feiz- ed with ftrong Convulfions ; the Pulfe was fre¬ quent and fmall, and, after fome time he foamed at the Mouth. But there appearing no Signs of immediate Death, after we had waited an Hour more, he threw in as quickly as he could the lafl Drach . ix. upon which the Pulfe became full and flow, and, in a Minute or fo, the Dog expired. Opening his Thorax, we found the Lungs found, but very fmall and white, without any Blood in them ; the Heart very big, and all its great YefTels much diflen- ed with Blood. In this State they continued till next Day, when, on opening them, clot¬ ted Blood ran out from the right Ventricle, and venae cavce ; the Blood in the left Ventricle and Aorta being much more coagulated. But we could obferve nothing in the Brain or Ab¬ domen preternatural. I mentioned the Filtra¬ tion and Heat of the Solution ; and Slownefs of the Inje&ion, becaufe fome Days before, two young Gentlemen Students, had made the fame Experiment with a Solution neither fil¬ trated nor warmed, which they pufhed in very forcibly ; upon which the Dog fell immediate-

13- Medical Ejjays

ly into violent Convulfions, and died in three" Minutes, V. Dr. Freind Emmenolog. cap. 14.

( i ) We gave alfb to a little Dog of about t fifteen Pound Weight (as we gueffed, for by an Overligbt of a Servant he was not weighed) at different times, but all in the Space of a few Minutes, and wrapt up in the Crum of new Bread, opil drach. ii. Being very hungry, he ■(wallowed it greedily, without Brewing any In¬ clination to vomit. We watched him about an Hour, but obferving no Alteration, or EE feft of the Opium , and it being late, we left him in fafe Cuftody. Next Morning he was not Beeping, but had loft the Power of his Limbs, and would neither eat nor drink. In this State he continued four Days more, with¬ out tailing any thing, and then perfectly re¬ covered. The fame Quantity of Opium dif- folved in boiling Water, had more fudden and more fatal Effects on the Dog mentioned by Dr. Mead , in his elegant EITay of Opium.

§vq, Opium externally applied, is difcuti - ent, anodyne , and foporiferous ; yea , has aU moft the fame Effedls as when taken inwardly. One of the Inconveniencies following the im¬ moderate Application of Opium , Mandragora , and Hyofcyamus, for Pains of the Eyes, taken notice of by Galen ( Method . med . /. 3. c. 2.) is the Mydriafis , or a preternatural Dilatation of the Papilla. And Mr. Ray was Witnefs to a notable Inftance of this Kind. A AToman having applied Part of a Leaf of the Solanum let hale Park. ox deadly Night fade, to a cance¬ rous Ulcer a little below her Eye ; in one Right’s Time the Uvea loft entirely its mufcu-

and Obfervations, 133

lar Force, and was fo relaxed, that the Pupil- la in the cleared: Light, remained four times bigger than that of the other Eye : But, on re« moving the Leaf, the tunica uvea recovered its Tone by Degrees, Et ne quis (fays he) cafiii imputet , tribus dijlinclis vicibus , in fe ipfa ex¬ pert a ej ?, me quoque tunc temp oris forte fortu- nd pr refute <& Jpedlante ; Chirurgus qui can - crum eradicaveraty 6* ulcus fanaverat , foliz particulam loco impofuit ad humores repellendos ; verum ob fymptoma prcedidlum eandem remo- vere coadius fuit. R. H . p. 68o. That Opium gives Eale in Pains of the Teeth and Ears, in. Colicks, Inflammations, yea in cancerous Ul¬ cers externally applied, is well known ; but that it ftupifies the Part to which it is applied, fo as to make it infenfible of any Pain, with¬ out the Intervention of Sleep, is not fo evident* Nos nunquam ftuporem partis (fays Wedelius9 Opiolog. 1. 2. § 3. c. 1.) ab impofitione opiato- rum obfervare potuimus. I applied it by way of Plaifter round my little Finger, alio to my Arm immediately above the internal Condyle for a whole Night ; it grew foft, and fuck faff to thole Parts, but neither ftupified nor inflam’d them, nor had any Effect that I could obferve. I have alfo feveral Times applied a Solution of Opium in Water, to Parts excoriated, and fu- perfkial Wounds, and found it always hot and irritating like weak Spirits, the Pain continuing for fome Minutes.

Hence, 1. Opium is not, properly (peaking, narcotic externally ; and there may be Pains which it cannot remove as aTopick. Platerus found it ineffectual even in the Gout, ( Prax . Vox.. V, M '• L 1*

134 Medical EJjays

/.i. c. 5. p. 159.) If therefore the common Cauftick prepared with Opium , gives no Pain when ufed, it is a pretty extraordinary Pheno¬ menon. I never tried it, not becaufe I feared a Gangrene, but becaufe the FaCt is improbabie(^). 2. That Narcotics, at leafl fometimes, impair the Tone of the Mufcles, yea caufe for a Time a refolutio nervorum , or Palfy about the Place to which they are applied externally.

gno, Opium rather coagulates or • thickens , than dijolves or attenuates the Blood. I mix¬ ed a Solution of Opium in Water, with Milk, Serum of the Blood, and Blood itfelf, drawn frefb. from Arteries as well as Veins. It made no obfervable Change on Milk, yet after the Mixture Hood ibrne Days there was a Separa¬ tion ; a white grumous Part fubfided, it had a Cream above, and between thefe it was clear, and of the Colour of the Solution. It turned the Serum fanguinis more thick and whitifh, and curdled it a little ; it alfo had the lame Ef¬ fect on the Blood itfelffrefh drawn, which al¬ ways precipitated a fort of whitifh coagulum.; and fo left what was uppermoft rather, though not much thinner. Sydenham's Laudanum made the Blood from a Vein appear more Grimfon-coloured, but next Day it was darker; there was a greyifh Precipitation, and the up¬ per Part was not coagulated, as ufual, perhaps becaufe fhaken and diluted by an uncoagulable liquid. Thefe Trials agree, tho’ not perfect¬ ly, with Dr. Frtind’s Experiments, ( Emmen. c. 14.) yea, and feem to favour in fbme mealure

what

( l ) See Hildejhelmius , as cited by Wedditts, Ofiolog. I, 2.

3 , c, 1 j 2. ....

and Obfervations . i 35

■what is affirmed for Fact in fome Authors, to wit, that the Blood has been found congealed and frozen, as they exprefs it, about the Heart of fuch as have been killed by Opium. ( See Wedelii Opiol. 1. 1. §. 1. c. 5.) There wasagru- mous Blood in the upper Part of the Brain of the Dog, which Dr. Mead mentions. Mech . Account Poif. p. 152.

lomo, Habit , or cuflomary Ufe makes that Quantity of Opium fafe, yea beneficial , which would other-wife be Poifin. A few Grains of Opium are Death to any Perfon in Health, and unaccufiomed to it ; but, if one beginning with fmall Doles, habituate himfelf to it by Degrees, he will not only in time be able to bear a much greater Quantity, but alfo at length, find it as neceffiary as Wine or Spirits are to Ti piers (jn). I faid in Health, becaule fome Dileales, e. g. Madnefs , in a great Meafure e- nervate the Force of this Medicine : But that a much fmaller Quantity than fome take every Day, may prove mortal, cannot be doubted ; and we had here a melancholy Infiance of it not long ago : A Woman about forty Years of Age, big and corpulent, was one Day liberally blooded, and ordered a purgative Bolus next Morning ; infiead of the purgative, a Servant, by Mifiake, gave her Part of a Liniment Ihe commonly applied for the Haemorrhoids. The Liniment was originally compofed of Myrrh ao Drach. ii. Opii Drach. i. 01. Rof. Codf. Unc.fem . She had made ufe of two Thirds or more of it for the Piles, and took the Remain-

M 2 der

(m) Vid. Phil. Tranf, No, 221. p. 2 3t»

l$6 Medical Effays

der about feven in the Morning. The fatal* Miftake being difcovered, her Phylician order* ed a Vomit ; but though it was no more than: three Quarters of an Hour after Ihe had got the Liniment, the Mulcles were lb paraly tick that ihe could lwallow nothing. In a 'Word, no¬ thing that was done fucceeded. Her Pulfe,,, which was large, equal, and not very frequent, , about half an Hour after eight, funk, and be¬ gan to intermit, and a Quarter of an Hour be¬ fore nine hie died, without any Convulfions. Her Phyfician told me, that when he firh law her, her Face was very pale, lhe could not: fpeak, and appeared like one mortally drunk, , On the other hand, among the Eahern Na¬ tions, a Drachm of Opium is but a moderate Dole ; Garcias knew one who every Day took Drach. x. and more. Et licet , lays he, ftupi - dus <& dormitabundus Jemper videretur, aptif jime tamen 6* do die de omnibus dijputabat. Tan - • turn pot eft confuetudo , 1. c. And it is very re- > markable, that notwithhanding this excelfive Ule of Opium , the Turks are generally long lived (#).

i imoy The Adi ion of Opium it very analo¬ gous to that of IVine , or vinous Spirits , except¬ ing only in fo far as it depends on the Quantity requifite for the fame Effedf. For, i mo, Wme is the belt Remedy for the Inconveniencies fol¬ lowing the Difule of Opium. Acofla gives a me¬ morable Inftance of this ; “ There were, lays he, lorne Turkifh , Perfian and Arabian Cap- tives aboard the Ship in which I returned

u from

(») Vide Belion, L 3. Obf. 14 & ijj*

and Observations* 137

*( from the Indies to Portugal, who had a fin all u Quantity of Opium concealed, and ufed it “ only as a Medicine, When they had con- fumed it all, one of them, a Turk of Aden , u laid to me, Since you have here the Care of* “ the Sick, I mufl let you know, that unlefs 6i you give me and my Companions Opium, we <£ cannot outlive two Days, I denied I had any. The only Remedy then, faid the Turk9 u whereby we, who have been accufiomed to (< eat Opium, can be recovered, is, to give each u of us a Draught of pure Wine every Morn- u ing. Tho’ this is very hard and uneafy to c‘ us, being contrary to our Law, yet, fince <( our Health depends on it, we muft of Ne~ u ceffity bear it. By his Advice I gave them u all Wine > they recovered, and in a Month’s (( Time would tafie no more Wine, and nei- ther needed nor defired Opium A Profper Alpinus al'fo obferved among the Egyptians r that thofe who did eat Opium confiantly, iF they wanted it but one Day, became very un- eafy at the Time they ufed to take it (o)» 2 do. Both the good and ill Effe£ls of Opium are very little different from the good and ill Efc fe£ls of Wine: It would be too long to enu¬ merate thefe here. Wedelius may be confult- cd on this Head, and Mr. Geoffrey in his M. M*

M 3 who

(e) 11 Animi fiquidern deliquio faftidlofifTimo ipfi'tentan- u tur nulloque auxilio fie tuto liberantur, quam rurfus opi* a um devorantes; and adds, Multos ab hac fervitute libera- 41 tos vidi, fi in hora, qua foliti funt ipfum capere, largius ex vino Cretico, pipere atque aliis aromatibus alterato^ u potej TUT Mg . I, 4. £.

I

138 Medical Ejtfays

who has abridged and fomewhat amended Dr. Jones without naming him. I fhall only ob- ferve, that Vinum, toufe Angelas Said1 s "Words, fecundum omnes authores , imo ipfam experien - tiam , abufn phrenefln , maniam , rabiem , furo- rem, ftupiditatem , lethargiam , paralyfin , aliofl que deteflandos ajfedius, iemporis face eff tone parit , non minus quam opium. Opiolog. c. 3, p. 531. and that vinous Spirits are To anodyne externally as to remove in an Inftant the Pain even of Burnings, if the Cuticle be not fepara- ted. And, 3 tio, Vinegar is as much an Anti¬ dote to Opium as it is to Wine ; no Wonder then that Platerus (Qutefl. Therap. 88. and 89.) fhould affirm Wine to be a real Narcotic, and Sydenham , that Opium is the moft excellent Cordial in Nature (JSett, 4. c. 3.). Hence Wine cannot be faid to correct Opium , nor can Opium be faid to a& by ratifying the Blood, fince Spirits which coagulate it produce much the fame Effects.

1 2mof The Virtues of Opium, internally ta¬ ken, depend chiefly on its Action or Influence on ihe Stomach . I have often obferved a violent Tenefmus removed in a Moment by a few Drops of Liquid Laudanum, Vomiting ftopt, Pain eafed^ yea and Sleep procured the fame Way, and ah mod as loon. There are many Infiances in Wepfer ( De cicuta aquatic a') of very terrible Symptoms, and Death itfelf, caufed by Narco¬ tics before they went out of the Stomach, and without fb much as inflaming it, or undergo¬ ing any vifible Change in it, far lefs vitiating the Mafs of Blood ; and alfo of the fame Sym¬ ptoms being removed, and Death

prevented

and Obfervations, 139

by vomiting. A Glafs of fimple Spearmint Water new drawn threw a ftrong Man into e- pileptick Fits, and almoft coft his Life. HyR fop Water had the fame EffeCt on a Woman not many Years fince ; fome have died of Sur¬ feits while eating, and Excefs would kill many more than it does if the Stomach did not diR burden itfelf.

Several other Pra?cognita might be here in¬ filled on, as, That, 1 mo, in Pain, there is a pre¬ ternatural Contraction of the fenfile Fibres, and in Sleep a Relaxation, eras it were Palfy of the Organs of Senfation and voluntary Motion. ido, The molt inconfiderable or minute mecha¬ nical Impulfe on the Nerves, or unufual ImpreR fion on the Mind, may be the Caufe of the greatefl Changes in the Animal OEconomy. 3 thy The Virtues of many Medicines depend folely on their ACtion on the Nerves or ner¬ vous Fibres. 4 to. The fame Force or Impref fion on the Nerves of one Part, has very different EifeCts from what it has on the Nerves of ano¬ ther ; yea, often at one Time from what it has at anotherTime, on the fame Part, e. g. Afarum in the Nofe and in the Stomach, Tobacco at firft, and after it is habitually ufed . gto> This ACtion. on the Nerves being, many times, no otherwife difcoverable than by its Confequences, the prz- maryand fecondaryYjffztAs of Medicines may be9 and are too often, confounded. And, 6to , As the primary EffeCts of a Medicine have frequent¬ ly feveral fecondary ones, fo the fame Simple fometimes differently affeCfs the fame Nerve, or at lead different Nerves of the fame Part, fo as to produce EffeCts altogether independent off

on©

I

1 40 Medical Ejfays ;

one another; this our Tafte in many Inffance^ can difcover, and the Tafte of Opium , compa¬ red with that of other Narcotics, Sufficiently e- vince it to be the Cafe here ; that is, that the {Si¬ mulating Qualities of Opium have very different Effedts from the narcotic Part ; and if we com- pare the Efledts of wholfom Aromatics with thole of the mod virulent Narcotics, we may add, J>mo, That the dimulating or aromatic Part of Opium isfo intimately united to the narcotic as thereby to mitigate it in fome mealure, and render it more friendly to Nature than the Nar¬ cotics that want it are, fuch as the Hyofcyamus major vel niger , G. OB. Pin. or Henbane, Slum Eruca ? Folio. G. B. Pin. or Gejtter* s Water Hem¬ lock, and many others ; white both ftimulating and narcotic Parts contribute notably to the hypnotic and other Qualities of this famous Me¬ dicine. Thele, I fay, and the like Truths, might be further infilled on ; but, left I be too long, I lhall fbppofe them elfewhere fufficiently explained, and conclude this Sedtion with a few Inferences from the whole. I infer therefore,

1 mo, That the anodyne and hypnotic Virtues; of Opium do not depend on its Add on on the Brain or on the Blood, whether externally or internally uled.

2 doy That it affedls Hrft and principally the Nerves to which it is applied ; next fuch as are more immediately connected or communi¬ cate with them \ then thofe which ferve for Senfadon and voluntary Motion ; and lall of all,, by Gonlent, the whole nervous Syftem.,

3 tioy That this Impreffion, Adlion or Influ- ei3.ce on the Nerves; differently affedts the Senfo-

mum

and Objervatims . 1 41

rlum commune and the Mind, according to its Degree and the Nature and Fun&ion of the Nerves primarily afred upon.

“ Thefe who take a moderate Dofe of Opium, 46 efpecially if not long accudomed to it, are fb 4i tranfported with the pleafmg Senfe it mdu- <c ces, that they are, as they often exprefs them- €i felves, in Heaven *, and tho’ they do not al- u ways fleep, yet they enjoy fo perfeft an Indo- ii lence and Quiet, that no Happinefs in the *c World canfurpals the Charms of this agree- ci able Extaly.” Mead, of Op. p. 146. Which therefore, cceteris paribus , mud remarkably promote a free Circulation and Perlpiration, and, by removing Impediments, dilpofe to deep; for Pericharia corpora efficit leviora . Leu t it i a Diaftolen dr Syftolen efficit faciliores , mcuftitia dijfciliores . Nihil magis reddit libe - ram perfpirationem, quam animiconfolatio. Lee* titia moderata infenfi 'biliter evacuat folum fuper* flunm , immod?rata fuperfluum dr utile , are known Aphorifms of Sandlorius . But if the Dole be immoderate or excelTive, and the Im- preflion exceeds the Bounds preferibed by Na¬ ture, as in Drunkennefs, thele Tranfports of Joy degenerate into ridiculous Mirth, DeliiiouB nefs, dm. or end in profound Sleep, Lethargy, dm. or a Pally, Apoplexy or Bidden Death fmilh. the Tragedy according to Circumdances ; whereas the Effects of Opium in the Mouth and Nofe, on Parts fore or excoriated, dm. are ve¬ ry different, as has been formerly obferved. The anodyne Virtue of Opium externally ap¬ plied therefore cannot be the EfFedl of any de¬ lightful Senfation in tire Part ; Pleafure may well

1 42. Medical EJfays

be the Confequence, but it does not appear to be the Cayfe of the Removal of Pain.

4 to9 That the primary or firfl obfervable Ef¬ fect of the mechanical ImprefTion or Aftion of' the narcotic Part, of Opium on the Nerves, is the Relaxation of their Fibres.

* Whether this Relaxation is thePhyfical Action of Opium on the Nerves themfelves, or only the Effeft of the Impreffion thereby made on the $ enforium cormnune ; that is, whether Opium is immediately or only mediately the Caufe of it,

I (hall not pofitively determine. It may per- haps be as difficultly explained how the Aftion of Narcotics on the Nerves caufes a paralytic Re¬ laxation, as how the Images painted on the Re - tina caufe Viflon ; there is a non plus ultra in all Phyflcal Enquiries.

Neither can I fay that the Simulating or aro¬ matic Part of Opium does not contribute to its eafi ng Pains ; for Spirit of Wine is anodyne, but it caufes no Relaxation of the Part, or near it, to which it is applied, in which it evidently differs from Narcotics.

Now as this Relaxation of the Nerves, and confequently of the moving Fibres, demon- flrates Opium to be more than a palliative Reme¬ dy in a great many Difeafes ; fo it is not diffi¬ cult by it to account for its bad as well as good Effects, for, by relaxing to certain Degrees, it may prove anodyne, cordial, diaphoretic, hypnotic, <bc. or caufe Stagnations, Deliriums, Lethargies, Apoplexies, Death.

I have hitherto on Purpofe taken little no¬ tice of Opium's ratifying the Blood, tho’ aliened by Authors whom I very much efleem, not on-

and Obferv aliens . 1 43

iy becaufe, by the foregoing Experiments and Obfervations, it appears to have no fuch EfFeCt, at leaf!, that the ACtion or Operation of Opium cannot depend on it ; but alio becaufe, were this Theory admitted, it might be of badCon- fequence, and lead into dangerous Errors in Practice ; e. g. if Rarifraction of the Blood be admitted as the Caufe of the direful Symptoms which the Abufe of Opium fometimes occafions, the Remedy indicated would be VenaefeCtion ; whereas fome Authors affirm that it is Death to open a Vein, even the Day after a Narcotic has been taken ; (p) and poffibly the Woman, whofe Cafe I mentioned, (No. 10.) having been the Day before liberally blooded, was one Rea- fon of fo fmall a Quantity of Opium' s proving fo fuddenly mortal. Befides, if it rarified the Blood, how could it be fo ufeful in Hasmorrha- gies, Small-pox, <bc. as it is found to be ?

It is by no means necefiary now to anfwer the Objections again ft the Ufe of this Medicine in different Ages, fince it has at laid triumphed over all Opposition, if it be not the groundlefs Prejudices of the ignorant vulgar, and is not only of more univerfal Ufe, but does alfo more Honour to Medicine than any Remedy whatfo- ever. What could a Phyfician do without 0 - plum in many obflinate and terrible Difeafes, .as in violent Pains, Want of Sleep, exceffive Evacuations, Choleras , Dyfenteries, Diforders of the Nerves, 6r. ? How beneficial is it in various Fevers, Gravel, Gout, Cough, Con- fumption, fcc. In a Word, though I by no

means

(£) Vid, Wcdel. opiol. 1. 2. f. 3*. c. 3.

144 Medical EJfays

means think it a Panacea , yet I may fay there are not many Diftempers in which Opium has not been fometimes given with good Succefs, It a neceffarium eft Opium , (fays Sydenham ) ini hominis periti manu organum, ut fine illo man - ca jit <& claudicet niedicina ; qui verb eodem in - • Jlrulius fuerit, majora prfftabit, quam quis ab uno remedio facile fperaverit.

SECT. IV.

Opium is commonly given to adult Perfons nnaccuflomed to it, from half a Grain to three $ but to fuch as ufe to take it, to four, five or more Grains, till it produce the defined Effedf. The ufual Preparations are, the Ext raft. Tin* Ehtre, Sydenham’^ Liquid Laudanum, anodyne Balfam, and Pacific Pills ; and it is the Bafis tf the Storax Pills , Mithridat. Theriac, Dia- fcordium,

*

With relation to the Dole, the general Rule, viz. That it is fafer to give too little than too much of efficacious Medicines, is in no In fi ance more to be obferved than in the Adminiftrati* on of Opium, efpecially feeing its Effects appear io foon, that the Defeft may much more eafily be fupplied than the Excefs can be remedied % For if too much Opium is taken, the Mufcles become foon paralytic, fo that nothing can be {wallowed, and all we can do is to endeavour to provoke vomiting by tickling the Throat, or by Glyfiers and Cataplafms of Tobacco, and fuch emetic Applications, and at the fame time to rouze Nature by ftrong Sinapifms, drc. If

: . • •' thus

and Obfervations. 145

thus the unfortunate Patient is enabled to take Medicines, after emptying the primer vice, Di¬ aphoretics mixed with Vinegar, and fuch like Acids, will feldom fail to complete the Cure.

Extradlum Opii , vel Opium preeparatum, Off*. is Opium dilTolved in Water filtrated and eva¬ porated to the Confifience of Honey. Opium non codium (fays F, Hoffman de Opiat. p. 128.) longe promptius fordnum movet , dolor es miti - gat, quam ft diuturna codiione , vaporabili fuo principio orbatum fuerit. This principium va¬ por abile is called by others hmnoderata <h nod - va vis Opii narcotic a, which they think by all means ought to be Separated ; our College is a- fraid of neither, and want only to feparate the Feculencies or heterogeneous ufelefs Subfiances, a&d Part of the Rofin. This Extract, if brought to the Confifience o £ Opium, is about a fourth Part fironger than crude Opium itfelf.

Tindtura Opii , vel Laudanum Li quid urn, Off. is a Solution of one Part of crude Opium in ten Parts of Sherry or Spanifb Wine filtrated ; con- fequently, eleven Grains of this Laudanwn is equal in Strength to one Grain of the Extraft.

Laudanum Liquidum Sydenhami , Off. differs from the former in being aromatifed with Safi fron, Cloves and Cinnamon, which rather in- creafe than diminifh its Virtues ; and at the fame time correct both Tafie and Smell. Bal- famum anodynum Bated, Off. is a Tinflure of Opium , Saffron, <foc. in rectified Spirit of Wine, and is an ufeful Medicine in many Cafes, both externally and internally applied.

Pilule? pacific e?, vulgo Mattheri, Off. differ much from the Pilule? Matthcei , alias Star hi, Vo l. V. N of

146 Medical EJfays

of Bates, and alfo from the Pilules Starlit, which Mr. JVilfon lays he had from Dr. Star¬ key's own Mouth in the Year 1 665 ; who then told him the Receipt he gave to Matthews was for a little Money, but that which he commu¬ nicated to Mr. Wilfon was what he ufed himfelf. This Account is not much to Starkey's Honour, for neither the black nor white Hellebore is in Wilfon's Receipt, and lo probably Starkey had no Experience of the Effect of the Compof ti~ on. Neverthelels Matthews' s Pills, with both the Hellebores, gained great Reputation abroad, as well as at home. F. Hoffman calls them ma - gnes fames remedium , and adds, Quod uti fes - plus animadvertimus, alvum folutum presfiat , fit dor em ejficaciter movet, <& nunquam facile porporem gravativum, ficuti fibi relidia Opiata ejfciunt, pofl fe relinquit . (Opiat. 139.) Yet Bates fays, lome dillike the black Hellebore; Quincey leaves out the white ; and our College rejects both. Thefe Pills are all too ref nous to be eafly dilfolved in the Stomach. There is a Grain of the Extract of Opium in about ten Grains of the Pil. Matthesi Bateanes 6* Edin - burgenfes ; in eleven Grains of this Pill accord¬ ing to Quincey' s Difpenfatory ; in about fix Grains of Starkey's according to Wilfon; and in nine Grains or fo of our Pilules e Sty- race.

It is oblerved by Gefnerus, Platerus, 8c c. that the Mithridatium , without Opium, is not fudorife. If this be true of this Compoftion, whereof half an Ounce does not contain one Grain of Opium, much more mult it be lo of another framed after the fame Model, and not

other*

and Obfervations . 147

other wife materially different, viz. the Theri - aca Andromacht , of which at lead: feventy fix Grains contain one Grain of this Juice. The fame may be faid of the Trypheras , Philoniums9 OrvietanwnSy and the like numberlefs fefquipe- dalia anti-dot a, with which Authors both and- ent and modern too much abound.

To conclude, I am very fenfible that Opium is an edged Tool, and may do Hurt ; but it is alio a divine Remedy, and may do much good. A Phyfician may be too timorous as well as too bold in Pra&ice, and the Sick oftentimes fuffer the one Way as well as the other. As there¬ fore I fee no Reafon abfolutelv to condemn the giving of Opium to Infants, to weak, plethoric or aged Perfons, to pregnant Women, or in malignant Difeafes ; fo on the other Hand, if removing Pain, procuring Sleep, checking E- vacuations, preventing a falutary Haemorrhage, or the like, be dangerous or unfafe j he muffc either be ignorant of the methodus medendi , ol* of the Nature of Opium , who in fuch Cafes rafhly prefcribes it.

Auream quifquis mediocritatem Dili git y tutus y - - -

XIII. Remarks on the neutral Salts of Plants 9 and on Terra foliata Tartari; by Dr. JoHM Fothergill Phyfician at London.

jO H E M I S T S, who prepare the lixivia! Salts of Vegetables, generally take care, by the Means of hot Water, and fometimes repeated Affufions of it, to get every Thing out of the Afhes that is foluble, and when they evaporate

N z

148 Medical Ejffays

this Solution, they employ the Salt which is ob¬ tained from it as a pure Alcali in other Opera¬ tions, either not knowing or neglecting the neu¬ tral Salt, which Boerhaave fays (a) is mixed with it, and is fui generis. In an Operation which I was lately employed in, the Neceffity of confidering the EffeCts of this neutral Salt v/as evident, and I could determine the Genus to which the greater Part of it belonged.

An ingenious Chemift of my Acquaintance, intending to make a large Quantity of Terra foliata Tart art , ufed for that Purpofe the HxF vial Salt of Ferny carefully made in the Coun¬ try by a Perfon well skill’d in practical Chemi- flry, careful and exaCt. Some of this Salt was flux’d, the reft was a clean lixivial Salt ; each Kind was faturated by itfelf with ftrong diftilled ^Vinegar, eight or nine Times the Weight of the Salt being fufficient of the Vinegar to fully faturate the Alcali of both Parcels ; whereas u- fually fourteen or fifteen Times the Weight of the Salt is requifite of the Vinegar to make 3 jperfeCl Saturation.

The faturated Liquors being filtrated, and carefully evaporated to a mellaginous Confi- ftence, hifs’d and crackled where it hardned on the Sides of the Veffel, and did more fo the Clearer they came to Drynefs, fhewing hardly any Marks of a Difpofition to flow, which com¬ monly happens when the faline Liquor is fb far evaporated.

No Methods which the Operator, who is a very expert Artifi, could then fall upon, ferv’d to make the Procefs fucceed.

The

(*) Chem. Froc. 14.

and Obfervations. 149

The Chemift having inform’d me of the Cafe, •we could difcover no Fault in the Materials, Veflels or Operation ; but iufpeCling the neutral Salt to be the Caufe of the Procefs not flicceed- ing, we diffolved all the refractory Mafs in warm Water, let it to cool, and had a confiderable Quantity of neutral Cryftals, feveral of them exactly refembling thofe Cryftals delineated in Tab. I. of your Vol. I. which were procured by D r. Plummer from MoffafW ater ; only ours were more perfeCt, which was owing probably to the large Quantities of Materials we had. Moft of the Cryftals were cubical, which joined diffe¬ rently, and mixed with other Salts made a fur- prifing Variety of Figures, which cannot well be described in Words; but I have fent fome of them of different Shapes in a Box. It was plain from their Figure and Tafte, and by Ex¬ periment, that common Sal marinum made up a great Part of what we had, the reft might not imjuftly be called partly a Sal Polychrefi , part¬ ly the eflential Salt of the Plant.

We were obliged to repeat this Operation for obtaining thofe Cryftals, before we could obtain a Salt which flowed and foliated ; the Cryftals depofited each Time were more bitter and more pungent, tho’ in Form refembling the flrft we got ; the Terra foliata did not flow nor foliate fo freely, nor were the Foliations ib large or fo white as ufual.

It is with Reafbn then that Boerhaave orders (£) a Sal Ale ali purijfimum to be ufed in the preparation of Tartarus regeneratus or Terra

N 3 foliata

Q>) Cliem, froc. 67,

f 50 Medical EJfays

foliata Tartari ; and the Difpenfatories which order Sal Tartari direct the Chemifts to a more certain Procefs than when they are left at Li¬ berty to employ what they will. The Chemiils in Town here moftly ule the Cineres clavellati in this Procefs, and fucceed very well, or make the Salt with large Foliations, and white ; and perhaps this is the only one of all the neutral feponaceous Salts, which is more efficacious the Whiter and purer it is.

The principal Realbn why Chemiils ffic- <eeed better in making Terra foliata Tarta¬ ri with Cineres clavellati than with any o- ther of the lixivial Salts, fee ms to be, be- caufe thole who prepare the Potafh content themfelves with letting cold Water run through 'large Tubs or Vats filled with Afhes, till it lias waffied lo much from them as to make a Lixivium fupport an Egg, by which Operati¬ on little of the neutral Salts are diftblved to mix with the Lixivium ; and probably in drying the Lixivium , what of the neutral Salt is in it Is forced by the Fire to the Surface, to form that Cruft which it takes in burning the Straw that is wetted with it.

That the Allies which remain after the Pot - ajhes or Salts are extracted contain much of the neutral Salt, is evident from their ferving lo well the Purpofes of Agriculture, being prefer¬ able to Sea-falt for all fuch Purpofes.

How fuch a Quantity of Sea-falt Ihould be contained in Vegetables is an Enquiry foreign to your Defign, and therefore I ffiall not men¬ tion my Opinion of this Phenomenon ; I be¬ lieve it wiU not, however, be unneceftary to

remark,

and Obfervations. i ji

mark, that Phyficians ought to conflder, that the Proportion of this neutral Salt, mixed in alcaline ones, is often different; the more is thus mixed, the lefs Acid is required to fa- turate a given Quantity : Hence it frequently happens, that the Medicine we intend fhould be perfe&ly neutral, is very acid, and entirely difappoints our Expectations (c).

With refpeCl to the Procefs for making the regenerated Tartar , it may not perhaps be without fome Ufe to obferve, that the more Vi¬ negar is put to it, the Foliations v/ill appear lar¬ ger and whiter, though it is the more expen- five, becaufe whatever Vinegar is bellowed on it, the Operator mull expeCl very little more

Salt

(c) ’Tis common here to prefcribe one Scruple of Sal. Abfuith. to half an ounce of Juc. Limon. To learn how far this Proportion was juft, I procured ftx Parcels of Salt of Wormwood, and fix of Salt of Tartar, from Shops in diffe¬ rent Parts of the Town : I procured likewife a Quantity of Limon Juice, fufficient for all the Trials I intended. Half an Ounce of this Juice was faturated with 18 Grains of one of thefe Parcels, and required 32 of another to reduce it to the fame Degree of Neutrality. This Difference was ow¬ ing to the neutral Salt contained in the laft, which was real¬ ly procured from Wormwood Allies, and carefully lixivia¬ ted with hot Water.

The Specimens of Salt Tartar were more alike, they va¬ ried only from 18 or 19 Grains to 25 or 24. The freih Salt of Tartar is a pure alcaline Salt ; if it is expofed to the Air, It abforbs the Acid contained in it, and thus becomes neu¬ tral in proportion to the Time it has been kept, or as it ha$ been expofed to the Air.

Wherefore, in directing the common faline Draughts, it would feem that 24 Gr. is a much more fuitable Proporti¬ on than one Scruple ; and if to this Mixture we add a Scruple of fome Abforbent, as Crab’s Eyes , &c. we Ihall probably have a Mixture more perfe&ly neutral, than we Ihall be able in common to obtain by any other Method of prefer*-

I Medical Effays

Salt than the Weight of the Alcali made ufe o£

The Addition of forne more than the ordi¬ nary Proportion of Vinegar not only contri¬ butes to render the Salt finer, as by repeated Trials we found it did, but alfo prevents it from becoming too alcaline ; for was it to be brought to an exadt pun Slum faturationis before it is committed to the Fire, the Heat neceffary to evaporate the Liquor and flux the Mais would render it more of an alcaline corrofive than of a neutral faponaceous Nature. This induced me to remark, that its Whitenefs may be e- fleemed as a Mark of its Goodnefs ; it arguing that a proper Quantity of Vinegar has been u- fed, and it may be rendered whiter and more pure by repeating the Diflolution, Evaporation and Fluxion .

The Tartarus regeneratus taken from the Quantity of half a Drachm to two Drachms is an excellent Alterative and Diuretic; and from three to fix Drachms is a very mild Cathartic, that never finks the Spirits, or railes any vio¬ lent Diforder, and particularly is ferviceable to leveral dropfical Patients ; of its Service this Way allow me to mention one Hiflory.

A married Gentlewoman 48 Years old, child- lefs, a little corpulent, was repeatedly afie&ed with an immoderate Difcharge of the Menfes ; foon after her Belly began to fwell, her Legs grew oedematous, all the Symptoms of a Drop- -ly appeared. She was treated with the firong and gentler Cathartics, Diuretics, Aperients and Corroborants ; but this bad CircumAance always attended Evacuants either by Stool or Uriae, that they aeyer failed to produce a Dif¬ charge

and Obfervations . 1 33

charge of Blood from the Vagina , which funk her prodigioufly. Corroborants, efpecial- ly of the aftringent kind, foon flopt the Flux, but at the fame time contributed to increafe the Swelling, by lefTening the Difcharge by Urine and Stool. She then began to take three Drachms of the Terra foliata Tartari once or twice a Week ; it gave her two or three Stools, with a large Evacuation of Urine, without ex¬ citing the mendrual Difcharge, or affe&ingher Strength ; fhe continued the Ufe of it for up¬ wards of a Year, without increafing the Dofe, or attempting any other Relief than what that gave her, which was very great ; whether it would have made a compleat Cure I can¬ not fay, for having taken a rough Purgative fhe had her Days fhortened by it.

XIV. An Effay on extracting the Acid of Sul¬ phur ; by Charles Lucas of the City of

Dublin Apothecary .

*TTHE high Edeem and great Repute the Acid, -*• commonly called Oil or Spirit of Sulphur , has been held in by many of the mod: celebra¬ ted Authors, as well ancient as modern, toge¬ ther with the repeated Calls of fome eminent Phyficians among us for the genuine, induced me to confider of fome Means of making it with more Expedition andlefs Trouble and Ex¬ pence than by any of the ordinary Methods hi¬ therto prefcribed.

The firft Method I find directed for extract¬ ing this Acid, and indeed the mod: univerfaily received, is that called, Per campanam, by the

Bell

1^4 Medical EJfays

Bell ; which is liable to fo great Uncertainty, fa much Trouble, tedious, irkfbme and danger¬ ous Attendance upon the Procefs, that few or none have ever reckoned it worth while to pre¬ pare it after this Manner.

To obviate fomeof the Difficulties attending Operation, I got a kind of Bell made with its Verge inverted, and a Spout drawn from it, af¬ ter the manner of a Moor’s-head ; this I obfer- ved collected the Liquor more purely, but was ftill fubjeft to the chief Inconveniency of the plain or common Bell : For, at a proper Di- flance from the burning Sulphur, above half the Fumes efcaped and were loB ; and remo¬ ved nearer, it foon grew fo hot that none could condenfe till the Sulphur was extinguished, or the Glafs removed from the Fire ; which, befides the great Wafte, muft confiderably retard the Operation.

Both the Methods prefcribed by M. Charas (, a ) I found liable to as many Uncertainties and Inconveniencies, as well as that recommended by the late ingenious M. Homb ergo? Paris, and communicated to the Academie Roy ale de Sci¬ ences ( b ), which any Operator will readily per¬ ceive, upon Trial, as I have often experienced.

I considered at length that if a Method could be hit on, analagous -to the ordinary Method of diftilling other Mineral Acids, giving the burn¬ ing Sulphur Air enough to fupport a full clear Flame, (which muft always be obferved) the Intention may be anfwered ; and accordingly I

' con-

(a) Pharmacop. royal, p. 883. & feq.

{h) Mem. de PAcad, An. 1703. p, 351.

and Obfervations .

*55

contrived the following Machine, delineated Tab, I. which I now ufe to my great Satisfacti¬ on. It confifts of,

1. A large Retort A, with a wide Neck B, land a round Hole G, proportionable, cut in the Bottom of the Boll, D. A round-boiled Gal- ' Ion Retort will admit of a Perforation about fix

Inches in Diameter.

2. A large Receiver E, with a Spout F, which. ;not only ferves for this Operation, but is alio very convenient for any ordinary DiRillation by a Retort, efpeciaily where a given Quantity is ito be diftilled : For then, by turning the Spout

I to the lowed: Part, and placing any Glafsof an equal even Bore level under the Spout, with a Scale of Drachms, Ounces or Pounds marked jupon the Side of it, the intended Quantity can tbe drawn off to the utmoR Nicety and ExaCl- nefs, which cannot be well gueffed at in the or¬ dinary Receiver.

3. A Crucible, or round earthen Pot for j burning the Sulphur in G.

4, A flat-bottom’d Gally-pot H.

5. A concave Glafs or earthen glaffed Plate I, perforated in the middle i.

6. A Glafs Mortar as a fecond Receiver K. Thele I place in the Order expreffed in the Fi« fgure. Thus,

Having adapted the Receiver to the Retort, I 1 place it upon a common round, or a Bed of ■Sand L, with the Spout turned upwards, fuf spending the Boll of the Retort by the Neck,

( lodged in a Nich N, in the Frame M, for that iPurpofe, with its Neck inclining fo much to

15S Medical EJJays

the Receiver that the Drops may juft fall In* to it.

I place the Glafs Mortar K, under' the Ori¬ fice G of the Boll of theRetort A, covering it with the concave Plate I, with the Gaily -pot H inverted on the Perforation in the Plate. Upon this I fet the Crucible G, with about three Ounces of Flowers of Sulphur in it. I fet Fire to the Sul¬ phur, by throwing a bit of lighted Coal into > it, and then gradually raile the Glafs Mortar K, till the Crucible G is juft received within the O- rifice in the Boll of the Retort. Having ano¬ ther Crucible in readinefs, affoon as the Sul¬ phur is burnt in the firft, I put this in its Place, with the lame Quantity of new lighted Sulphur ; . and fo proceed till I have acquired as much of the Acid as delired.

In this Procefs it is obfervable,

1 . That it is neceffary to bedew the Glafies with the Steam of boiling Water, before you 1 fet Fire to the Sulphur.

2. That the Operation fucceeds beft in calm, Hill, cold, wet Weather, and in a damp Gel-- iar or Vault: But if in dry Weather there’ fhould be occalion for it, by conveying the * Fumes of boiling Water to the Orifice in the: Boll of the Retort, the Defeft of Moifture in the Air may in lome meafiire be fupplied. Afterwards the Liquor may be defiegmated atr Fleafure to any Standard required by the com¬ mon Method.

3. That by the Make and Pofition of the* Glafies, the acid Fumes are eonfiantly riling; into them, (as they are propelled by the Fire m ordinary DiftUfation) in fb much that they

foom

I

■ . V

-«-V-

.

•TT '

-•A

■>: . -•***

r *

a

■

\

H' '■ - ;• i

*■ .>**•••* •>*

*<• ■ ->7

-j.S .

y

'S:5

jmw.

•i »i.

:.X"

*v«. *

-V', ?;•

P

8

«■*-

* \ ' \ >

and Qbfervations. 157

foon Teem opaque with Cloud s, which in a fhor't time begin to condenfe and trickle down the Sides of the Glaffes in full heavy Drops.

4. That the Sulphur has Air enough to make it burn clearly without any Interruption, for want of which the Acid would be fpoiled by a great Quantity of white fuliginous Matter, that would be elevated in the Nature of Flowers, and flick to the Sides of the Glades.

5. That the Acid thus extracted is of three different Degrees of Strength or Acidity : As, 1. that which condenles in the Boll of the Re¬ tort, and lo falls into the lower Receiver, befbre it Bands long enough in the open Air to aug¬ ment its Weight (as all this kind of Acids are known to do) is not much inferior in Strength to the acid Stagma or Oil of Vitriol. 2 dly7 That which condenfes in the Neck of the Re¬ tort, and in the Receiver, is a Degree lower. And, 3 dly, By fufpending a Bell or Moor’s- head over the Spout of the upper Receiver, ibme light Fumes may be caught, andconden- fed into a fmall Quantity of Liquor, fpecifically lighter, and confequently more llightly acid than either.

I have often endeavoured to calculate the Pro¬ portion of Acid a given Quantity of Sulphur yields ; but fuch almofl infinite Variety arifes from the Temperament of the Air, (on which it chiefly depends) or from one Accident or o~ ther, that I could never be able to afcertain it ; But from the jufteft and mold moderate Compu¬ tation, I judge a Pound of Flowers of Sulphur may be burned in about feven or eight Hours: tinder a Gallon Retort, with a fuitable Recei- Vo-i.V. O ver

X

1 58 Medical EJJdys

ver, and will yield about feven Drachms or an Ounce of pure Acid. And as this Acid cannot be collected without fome adventitious Moifture, and as the Air chiefly fupplies that Moifture, the larger the Glafles are for this Purpofe, the better, for very obvious Reafons.

In this Procefs I ufe the Flowers inflead of crude Sulphur, which is moll commonly pre- feribed, for the following Reafons, 1 . I cannot fold by any Experiment, that Sublimation di- vefts the Flowers of any part of the native A- cid of the Sulphur: If it fliould, fublimed Sul¬ phur (z. e. Flowers) would no longer retain the natural Form, nor indeed any of the Charadte- riflics of mineral Sulphur; and we find that the Rejiduum, after Sublimation of pure mine¬ ral Sulphur, is no more than a Ample, infipid, argillaceous Earth.

2. As it is certain that crude mineral Sulphur Is often tainted with Metals and fuch like foreign Matter, fo it is highly probable fome Particles may be raifed or elevated in burning, which might otherwife have efcaped the fubliming Heat ; and confequently the Acid extra&ed from quick or crude Sulphur, may not be ib Ample and homogene as that from the fublimed, or Flowers of Sulphur.

3. Moreover the crude Sulphur will not bum clearly without frequent Agitation, which is both tedious and irkfome ; and I could never find any fo pure as to yield an equal Proporti¬ on of Acid with the Flowers.

To expatiate upon the Virtues and Ules of this once famed Medicine, would be launching out of my proper Sphere, and mull protradt

this

and Obfervattons . Jjt)

this Paper beyond the intended Scope ; there¬ fore I leave that to the learned in Phyflck, whole Bulinefs it is, mine being only to pre¬ pare, not to prefcribe or adminifter Medicines, except ?ne did juJJit (<:). But foreign as it may be to the Intention of thefe E flays, I mull beg leave to make fome Ihort Remarks upon fome Afperfions thrown upon this Acid by fome late Authors.

The firfl and moll confiderable Prejudice I find railed again!! the Acid of Sulphur, is by that learned Phyfician and ingenious Chemift Stahll (d)9 who fays it does not pre-exill in the Sulphur, and confequently mull be a Creature of the Fire.

How a Man of his extenfive Learning and Knowledge fhould advance fuch a Notion! can¬ not conceive, fince we find the contrary de~ monllrable various ways.

1. It is very well known to ChemiBs that Copper or Iron Plates, {Ratified with Sulphur, are in a Ihort Space of Time corroded, and may by that means be converted into Vitriol, which is only done by Acid menftrua.

2. We find that plain Flowers of Sulphur are not at all affe£led with rectified Spirit of Wine, but upon the predominant Acid’s being deftroyed or overcome by the Admixture of an alcalious Salt, (as in the Hepar Sulpburis) the truly fulphurous Parts will readily diffolve in it* Here it is obfervable, that the terbinthinated

O 2 Bal-

(c) Joh. Daniel Horftii inftitut. Pharmaceut. part. cap. 2. p. 2.

(d) Fundament, chym, dogmat, Experiment, p. pj, 8z feqq.

1 60 Medical EJfays

Balfam. of Sulphur, as commonly made, is but little better than an empyreumatic Oil of Tur¬ pentine ; but if made with Hepar Sulphuris in- flead of the fimple Flowers, it acquires a Wrong¬ er and deeper Impregnation and Colour, and a better Confidence.

3. Making artificial Sulphur is an Experi¬ ment familiar to Naturalids ; the Compofition confids of fome fat, oily or bituminous Sub- jfiance, mixed with any mineral acid Salt ; and this is found to produce a Mafs in every reipeft anfwering the Chara&eridicks of common mi¬ neral Sulphur.

From which it (eems reasonable to infer, that the Acid pre-exids in the Sulphur.

Some Moderns advanc^, That all mineral Acids differ only fecundipn majus & minus.

That this Maxim may hold good, primoge- nially confidered, may, I believe, be allowed, but notwithstanding I think it evidently de- jnondrable, that all mine|al Acids differ not only fecundum majus 6' nipnts, according to their greater or leder Degr^s of Strength and Acidity, but alfo from the (everal different Mi¬ nerals they are extrafted frpm.

1. The acid Stagma improperly called Oil, extrafled by a mod intenfe Heat from blue Vi¬ triol (which is of Copper^ is of a dark-brown Colour, and the fighter Ajcid called Spirit (with equal Impropriety) is ajfo fomewhat tinged ; and their Tade is perceptibly more audere and corrugating than that of green or martial Vi¬ triol. - Since then we find that all imperfect

Metals and Metafiles contain fome Parts that may be elevated or Separated from them by

“Fire

and Obfervations . 161

Fire, and fince the Acid of Vitriols can only be feparated by a moil: intenfe Degree of Heat, it is reafonable enough to fuppofe, nay believe, that this Acid cannot be drawn from any Vi- trio!, (which is but a Solution of (ome particu¬ lar Metal or Metallic in a certain Portion of a primogenial Acid, as the learned Stahll before- mentioned elegantly exprefes it) without fame Particles of the Metal or Metallic adhering to it. Hence it probably is, That

2. The learned F. Hoffman (e) observes. That martial Medicaments prepared with the Acid of Vitriol are rough, auftere and aPrin- gent, and fo difigreeabie to the Stomach, that they fometimes occafion vomiting ; whereas thofe prepared with that of Sulphur are endued with more excellent Virtues, and are fweet, pleafant and grateful to the Stomach, He at the fame time reafonably allbws, that the Dif¬ ference between the Acids of Vitriol and Sul¬ phur is more accidental than ePPential ; the for¬ mer being more grofs, impure fand terrene, but the latter pure and homogene : Which Opini¬ on that great Phyfcian and mop accurate Che- mid, Dr. Boerhaave (/'), feems to favour. From this the Weaknefs of their APertion ap¬ pears, who fay, that one is a fuiphurous Spirit of Vitriol, and the other a vitriolic Spirit of Sulphur. Such feem to be but ill acquainted with the component Parts of either Vitriol or Sulphur.

O 3 3. The

(?) Clavis Pharmaceut. Schrod p. 373.

Element, cfem. Tom. 2, Hoc. 151,

l6l Medical Effays

3. The further Difparity of mineral Acids Is experimentally illufirated by the ingenious Bo - relit (g), to whofe Experiments on live Dogs, with the Acid of Sulphur, Nitre, ere. I refer the Reader.

Since then there is fo efiential and evident a Difference between the Acid of Sulphur, and its too frequent Succedaneum that of Vitriol, and fince the former is recommended and ex¬ tolled by many of the mod eminent Practitio¬ ners in Phyfick, I conceive a Method of ma¬ king it more expeditiouily, more cheap, and in a greater Quantity than any yet made pu- blick, will not be unacceptable to the Learned, to whofe Candour and Judgment I fubmit this Elfay.

XV. Several Accounts of the Succefs of the Vi- trum ceratum antimonii, collected by Dr. Pringle, and read to the Philofophical So¬ ciety.

A Receipt of the Medicine , and Obfervations upon its Operation ; by Dr. Young.

A K E Glafs of Antimony in Powder one Ounce, Bees-wax one Drachm, nielt the Wax in an Iron-laddle, then add the Powder; fet them on a flow Fire without Flame, for the Space of half an Hour, continually ftirring them with a Spat-hula ; then take it from the Fire, pour it upon a Piece of clean white Paper, pow¬ der it, and keep it for Ufe,

When

(j) Dc motu animal, p. 11, Prop.224,

and Obfervations. 2 63

When I prepared this Quantity, it loft a Drachm of its Weight. The Glafs melts in the Wax with a very flow Fire.

I was at firft lb fcrupulous in preparing the Medicine, that I wiflied the Degree of Heat had been affigned, as well as the Space of Time neceffary in the Preparation ; but I have fince found, that I both vary the Time and Degree of Heat, without perceiving any Difference in the Operation of the Medicine.

After it has been about twenty Minutes on the Fire, it begins to change the Colour, and in ten more, comes pretty near the Colour of Snuff ; by that Colour I know it is fufliciently prepared, without attending to the Degree of Heat, or Space of Time.

The ordinary Dole for an Adult, is ten or twelve Grains ; but, for the greater Safety, I commonly begin with fix ; to a flrong Man I have given a Scruple, which fome times works fo mildly, that I have thought it too weak.

To weakly Conflitutions give five or fix, in° creafing the Dole afterwards, according to the Operation.

To a Boy of ten Years of Age give three or four Grains.

To a Child of three or four Years two or three.

This Medicine has been pra&ifed with Sue- cefs for the Dyfentery, and the Preparation o€ it kept a Secret for many Years.

When firfl it was communicated to me, I thought it fo harfh and dangerous a Medicine, that I had no Courage to try it for fome Years, and even then I began the Dofe with one

Grain*

t&4 Medical Effdys

Grain, and increafed it gradually to twenty, which is the largeft I have yet given ; afibon as I was convinced by a Number of Experi¬ ments that it was both mild and efficacious in curing the Dyfentery, I publiffied the Receipt in our Edinburgh News -papers, being under no Promile of Secrecy with regard to this, and be¬ ing refolved never to make a Secret of any Me¬ dicine whatever.

I do not expeH that any Phyfician will in¬ cline to give a full Dofe at ftrft, without better Authority than 1 can give to Strangers ; but the Cautious may give a fmall Dofe as they pleafe, and make fir ft Trials almoft in any Difeafe where Purgatives will do no Harm, and increafe it gradually as they find it operate.

I gave it in Dyfenteries with or without Fe¬ ver, whether epidemic or not.

I have tried it often both where Blooding and Vomits have been premifed, and where they have not, with very good Succefs.

I never chufe to give Opiates in the Begin¬ ning, efpecially where there is great Sicknels ; becaule although Opium gives great Relief to Ibme, yet at other Times I have thought both the Sicknefs and Purging thereby increafed the following Day.

I never began with a larger Dofe than ten Grains becaule it frequently operates as violent¬ ly at firft, as twenty Grains at laft, even upon

the fame Patient.

In its Operations it lometimes makes the Pa¬ tient lick and vomits ; it purges almoft every Per fon, but I have known it cure without any f enfible Evacuation or Sicknefs j nay in violent

Dyfen-

and Obfervations. 1 65

Dyfetlteries they purge feldomer with it than without it.

If it purge fufliciently, or fatigue the Patient any Way, I intermit a Day or two betwixt each Dole, the fame Way as I do with other Purga¬ tives.

As I have cured lome.with one Dofe, I have been obliged to give others five or lix, efpeci- ally when the firfl Doles have been too mild ; and I have often thought a weak Dole did no good in chronic Cafes.

After the feeond or third Dofe, the Stools. are feldom bloody, the Grips and Sicknefs are much abated, and the mucous Stools are lefs vifcid.

Give it with an empty Stomach, for then X think it operates moft mildly.

Forbid drinking any Thing after it for three Hours, unlefs th^ Patient is very fick or difpo- fed to vomit, in which Cafe give warm Water as in other Vomits.

Beware of giving it for a Diarrhoea in the End of a Confumption . I have cured fome other Diarrhoea's of long handing with large Doles of it; but it has failed oftner here than in Dy~ f enterics.

I forbid the Ufe of all fermented Liquors, and recommend a Milk Diet with Rice or Bread, Chicken-broth or Water-gruel.

I give nothing cold, unlefs it be a Tea-fpoon- ful of Geliy of Hartfhorn as often as the Pati¬ ents plea le, and fometimes I indulge them with the Geliy of Currans to refrefh their Tongue.

It may be given fafely to Women with Child ; and to Children on the Breah you may give half a Grain. G. Y.

The

1 66 Medical EJJdys

The next TESTIMONY is two Cafes which I found among my Uncle Dr. Francis Pringle's Papers, wrote with his own Hand, and one of which I remember to have been Witnefs to.

A Gentleman’s Servant about thirty Years of Age was taken ill of a Dyfentery , about the middle of January 1735.

He was blooded, had a Vomit of the Ipeca~ cuanha , and a Bolus of Rhubarb with fiueei Mercury, paregoric Pills at Night after the Vo¬ mit and Purgative, and afterwards an ajlrin« gent paregoric Mixture, which he took from time to time ; from all which he had fome Re¬ lief, and the Difiemper feemed to yield in fome meafure, but Rill returned with greater Vio¬ lence.

On the 24th or 25th of January , he was lei- Zed with a violent Stitch in his Side, for which he was blooded, and on the 26th he got in the Morning the Vitrum Antimonii ceratum, which was to have been given him the Day before, but was delayed on account of the Stitch. This Medicine purged him briskly all that Day, but eafily enough, without Naufea , Grips, Te* nefm, or Blood, the Stools being moflly ferous ; that Evening he got at Bed-time 10 Grains of the Pit. Matthcei, was pretty eafy next Day, and had only two Stools ; but the Pain in his Side returning again, he was once more blooded.

28th, The Anti-dyfenteric Medicine was re¬ peated in the Morning, it puk’d him more than the firfl, and purged him immenfely from Morn¬ ing to Night, to about, as he exprefs’d it, a hundred times ; his Stools were ferous, with¬ out Blood or Grips ; that Night the paregoric

Pills

and Ob fcr vat ions. 167

Pills were renewed ; he Jflept well, without Grips or purging.

29th, He was very eafy, and altogether co* £live.

30th, He went abroad, and returned to his Mailer’s Houle, where the Air being a little cold¬ er, and more piercing, he had next Day lome Grips, with a Tendency to purging, but ha¬ ving taken his paregoric Pills at Night, he was pretty well next Day,

Some Days thereafter he had a Return of the Dlleale ; and the antimonial Medicine having been again given him to gr. xii. for the third time, he recovered perfectly, and had no Re- lapfe.

Mr. - -was feized with a Loolenefs, No*>

v ember 29. 1735? attended with a flight De¬ gree of Fever, Drowth, Sicknefs at Stomach, Pains in his Belly, elpecially below the Navel, his Stools were frequent, for the moll part bloody, elpecially in the beginning.

He was blooded, was twice vomited, had Rhubarb with Calomel once, afterwards without Calomel , Paregoricks every Night, and an a~ jlringent paregoric Mixture in the Day-time, as alio anodyne and aflringent Xnje6lions.

Notwithllanding all which the Difeafe conti¬ nued lefs or more violent, tho’ for the moll part, after the beginning, without Blood.

December nth, He got in the Morning levers. Grains of the Vitrum Antimonii ceratum in a Bolus with Conferve of Rofes9 which purged him chat Day twenty three Times, but eaflly enough without Grips, Blood, or much Tenefn *• that Night he got 1 2 Grains of the PiL Matth.

which

l68 Medical Ejfays

which checked the purging a few Hours ; but next Day he had near twenty Stools, but ferous, and without Blood or Grips : That Night he got gr. xiv. of the P/7. Matth . and next Morn¬ ing ( December 13.) he got gr. viii. of the P7- trurn Ant. cer. which purged him as before a- bout twenty four times, only the Stools had more of a Confidency, and more like natural ; at Night he got gr. xv. of the P/7. Matth.

December 14th, his purging, which had Hopped by Means of the Pills , from ten till three in the Morning, retdrned, and he had that Day about twenty Stools ; at Bed-time the paregoric Pills were repeated ; he had fome Reft, and was free in fome meafu re of the pur¬ ging, till feven in the Morning, about which time he took a third Dole of the anti-dyfenteric Medicine , confiding of gr. x. this purged him plentifully as formerly ; that Night he got on¬ ly gr. viii. of the P/7. Matth. purged eighteen times next Day, but eafily ; had gr. viii. of the pacific Pills again at Night, and next Day {De¬ cember 17.) had gr. xii. of the anti-dyfenteric Medicine, had 1 3 Stools that Day, feveral of j which were pretty natural, and of a Confidence, and he was pretty well and hearty.

18 th9 Having taken eight gr. of the P/7. Matth. the Night before, he had no Stool from 1 1 at Night till 8- in the Morning, his Drought and Fever were lefs, he was eafy, dronger, had an Appetite, and purged fometimes that Day, but his Stools were more natural, and had fome- what of a Confidency ; took at Bed-time gr. iriii. of the pacific Pill, and had a good Night.

• 1.9th, He got, for the fifth time, a ^Doie of

and Obfermt ions. 169

the V it rum Antimonii ceratum to gr. xii. this purged him about ten times that Day, but very eafily ; that Night he took no Paregoric, yet flept pretty well,

20 thy He had feveral Stools, took that Night the pacific Pills, had a good Night, and purged but twice.

2 ifiy Omitted that Night the pacific Pills, fiept well.

22 dy He took afixthDofeof the anti-dyfente- ric Medicine , coniifiing of gr. xv. which agreed well with him ; from that time he continued in a way of Recovery, feidom purging above twice a Day.

3 1 He was fo well that in all Appearance he feem’d to have got altogether free of his In- difpofition, and continued fo without any Re- lapfe tihatl have heard of.

A Letter from Mr. Andrew Brown Surgeon in

Dalkeith.

Sir9

TN Obedience to your Requefl I fend you an Account of two Trials I made of Dr. Young's anti- dyf enteric Powder with Succefs, which was all I had Opportunity to make.

The firfl was on William Loudoun at Cran fton aged about forty Years ; he was fo reduced by the Dyfentery that he could not walk through his Houfe, and, thro’ torturing Gripes, could not fit in an ere£t Poflure. I faw him firfl: on May 2 iff laft Year in this Diflrefs ; judging him be¬ yond blooding, through Weaknefs, T vomited him with Ipecachuan , and purged him with Vol.V. P Rku-

I Jo Medical EJJays

Rhubarb , ordered his Diet and Drink as ulual, to no Purpofe. I then lent for Dr. Young* s Pozuders, and on the 25th I gave him three Do- fes, of nine Grains each, one to be taken every other Day, and ordered him a Regimen, which three Dofes effe&ually carried off the Dyfente- ry ; and the remaining Diarrhoea and Weak¬ ness was removed by a Rrengthning Diet.

The other Trial was on a young Man about 17 or 18 Years of Age, labouring Servant to 3VIr. Cleghorn Farmer at Eafi-houfes of New - bottle ; he had laboured under the Dyfentery for near three Months preceeding March laft, continuing at his W ork, till, being laid afide therefrom, his Mafter applied to me. I vifited him on the 25th of that Month; being young I caufed him to be blooded ; he had the com-' mon Symptoms attending the Dyfentery, with torturing Gripes and Lofs of Appetite, but was able to Rep about. Being a Servant, and Seed¬ time in View, I immediately gave him three Doles of Dr. Young* s Powder , fix Grains for a Dole, which lupprels’d the Dyfentery ; but not being quite conquer’d, on the third of April I gave him three Doles more, nine Grains each, which effeflually carried off the Dyfentery , lb that the young Man recovered and returned to his Labour at the End of the Month.

N. B. He took his Doles as the other did, one every other Day, and the Regimen during the taking was according to Dr. Young's Dire6U- 011 to me, and lo far as I remember, it did not vomit them, nor were they fo much as lick.

Dalkeith , Jan . 30 th, 1738.

A

and Obfervations •

171

^ Letter from Dr. Thomas Simpfbn, Chandos Profeffor of Medicine in the Univerjity of St. Andrews.

Dear Do£lor>

THAD yours two Weeks ago, wherein you "*■ defire my Obfervations upon the Stibium fpecificum made publick by our Friend Dr. Young ; but my being much in the Country fince that Time prevented my writing them out till now.

The firft I gave it to was William Jervy Te¬ nant in Pilldajff, a young Man lomewhat a- bove twenty Years of Age ; for ordinary he complained much of nephritic Pains, and laft Harvefi: of a Cough’. January 16th 1735 he was feized with the Dyfentery moil feverely ; I was lent for upon the 20th, when I found, that the Night before he fcarce had had any Interrup¬ tion in his purging, attended with great Anguifh and Sicknefs, whereby he was fo much defeat¬ ed that he look'd like a dying Man. I gave him immediately fourteen Grains of the Sii~ hium ; the following 24 Hours he was eafier ; next Day he got a Clyfter of Cows Whey and Camomel Flowers, but was worfe : The third Day I gave the Stibium with out obfervable Sue- cefs \ but this I aferibed to Cold in going to Stool, which he did with his Feet on an earth¬ en Floor. I had much ado to perfwade him to a third Dole, being quite difpirited with the Severity of his Difeafe, but two Days after I at length prevailed ; he was fenfible of the good EiFe&s of this, which made him the eafier take

P 2 a fourth

tjz Medical EJJays

a fourth Dole, which of all relieved him mofl; fb that after that I had little to do but to fecure him againfl a Relapfe, which I did by a fifth Dole, and the Regulation of the Non-naturals*

I had no other Patient under that Difeafe un¬ til December , when a 'Woman in Town, the Wife of one Andrevj Murray, took it formally with Horror , Gripes, Sicknefs, Drowth, <bc. I faw her after the had been pretty feverely handled with it for ten Days ; I gave her ten Grains die- bus alternis ; three Doles recovered her.

In the beginning of April 1736, a young Lady had taken for a Vomit Mercur . Prczcipit . Wurtz. Gr . vii. at eight in the Morning, which at eleven had vomited her five times, but fhe continuing very fick for twelve Hours, it began again to vomit and purge her at the fame time ; and in this Cafe fhe continued till nine next Morning, when I was fent for. I gave her a Dole of Laud . liquid . which made her eafier that Day ; but next Day her purging returning with Blood and Gripes, I immediately gave her Vitr. Antimon. cerat . Gr, vi. It was fix Hours before fhe had a Stool, and then it was free of Blood, and taking its natural Form.

One Wilfon , a Boy about fourteen, Son of one of the Tenants in Magus , for a whole Year had been fubjefl to the Dyfentery , tho* in an eafy manner, being Hill able to keep his Feet. I obliged him to come to Town that I might fee him from day to day. When I gave him the firft Dofe he was under one of his world Fits. Six Grains, or ten at mofl, was the ut- moft I went to now with any Patient, finding the leffer Dofes anfwer heft. I gave him only

fix

and Ohjeroationf. 1 73

fix Grains for a Dofe ; the firft Day his firffc Stools were bloody,, but the laft untinged ; the fiecond Day he kept eafy ; the third his Stools were again bloody ; the fourth he got a lecond Dole, but purged none, and was free of Gripes ; next Day his Stools appeared to form, tho’ in- terfperled with Blood, and after this the Blood quite dilappeared ; neverthelefs before he left the Town I gave him two other Doles to fe- cure him againft a Relapfe ; and, when I en¬ quired about him fome time after, he was in good Health.

About the fame time I gave two Doles, of fix Grains each, to Deacon Addifony an old Man about 70, and cur’d him under a pretty fevere Attack of that Difeafe.

In June I gave it to David Taylor's Wife, Tenant in the Brake , in the fifth Month of her Pregnancy, violently attacked with a Dyfen- tery and Tenejmus . The third Dole carried off the Dyfentery , and the remaining Tenefmus yielded to Clyfters of Milk and Camomile Flowers.

Mr. Tod's Wife of Balmungo , who had got the Difeafe by Fatigue and Cold, was quite cu¬ red by three Doles.

February lfl, 1737, William Wllfon in the Tofh took the Dyfentery after the epidemic Fever, and was cured by three Dofes, Gr . vi. About this time it turned epidemic to the Eaft> ward of St. Andrews , particularly about Kings- barns and Craill ; many of the Boys of this laffc Town were feized ; the firft who were leized with it were cured by blooding and purging; with Rhubarb ; but upon Stibium being intros--

P 3 ducedl

1 74 Me dual Effays

duced amongft them the Cure was much more ipeedy. I had fever al of the Country People- under this Difeafe at this Time, none of which required above the third Dole. Its Succefsnow was fo obfervable, that fbme of the Gentle¬ men in the Parts where it raged moil applied to me for Doles of it to give their Poor in the Neighbourhood, and I received Letters of Thanks, with Accounts of its obfervable Suc¬ cefs, which indeed was fo great, that none ever doubted of it where I gave it.

I gave it April 9th to a TradefmaiTs Wife in Drumcarci the 10th Day after Child-bed with Succefs.

In May> Alexander Pride's Wife in the Chaunch died of the Difeafe, but fhe was. brought very low before fire got it, and drank under it large Quantities of cold Water, as fhe had done from the firft ; fo that none blamed the Medicine, which at the fame time recover- ed her Husband.

I tried the Medicine likewife in the uterine Heemorrhagiesy as you acquainted me Dr. Toung had done, and that with equal Succefs.

David Sympforts Wife in the Tents -Muirr after a Mifearriage of three Months, continued flooding eafily for four W eeks the fifth it be¬ came fo violent that fhe fainted perpetually,, and feemki ready to expire. I fent out two Dofes Gr. vi by her Husband, who acquainted me of her Cafe. He returned the fourth Day after, and told me that upon taking the flrffc Dole fhe found it fenfebly working thro’ every Part of her Body, and that in lefs than half an Hour the Hemorrhagic abated y and thus fhe

and Obfermtions w.

recruited Co quickly,, that he left her in the Field with the Labourers quite free of her Dif eafe„

I gave it to an old "Woman under an uterine Hcrmorrhagie , that had fometime. been familiar to her, with equal Succefs.

The Wife of Andrew Turpie Shoemaker had been abortive, without palling all the After¬ burden ; flie continued three Months after al¬ ways lofing Blood, but in a fmall Quantity ; at length it increafed to a plain Eruption, pailing fbmetimes a Pound at a time, with Faintings- and great Uneafmefs, Tho' I was; fatisfied that the Womb's Diflention v/as the Caufe,. yet I gave her the Stibium Gr*. vk It gave her more Diflurbance in her Belly than I found in any other Cafe, and thereupon a large Quanti¬ ty of the Placenta came away, loaded with Grape -like Hydatides. Now whether the for¬ cing this Foreigner was only accidental^ fur¬ ther Trials in fuch like Cafes mult fatisfy us.

An old Minifter in the Neighbourhood, agedi 70, had been troubled with Gripes for feven or eight Months, with nowand, then a loofe Belly* and at laft came to pals pure Blood, to the Quan¬ tity at lead: of two or three Gills a .Day., After continuing four or five Days in this way, upon his fending for me I gave him Gr . vk The fir if Dofe leffen’d the Haemorrhagie, the fecond quite cured it.,

I gave it to Nurfes, who contrary to their Wifh menflruated ;■ it put the Menflrua off fome Weeks, but they dill returned again j. what a more conflant Ufe of it would have done I could not determine*

Thus

I j6 Medical EJfays

Thus you find in what different Cafes I have given this Medicine, and how effectually, in Dyfenteries of long and fhort Continuance, e« pidemical and others, and in the Hasmorrha- gies of the Uterus and Intefiines, in which I could not define more certain Proofs of its Suc- cefs than I have had : That there are many Ca¬ fes in both Difeafes in which it will not fucceed, no Body will doubt, confidering the different Kinds we are fubjeCt to : But that it is a true and fiuccefisful Specific in mofi: is as certain .as that the Bark cures Agues and Gangrenes . So that in my Order of Medicines I have made it the fiecond for its true and obfiervable Qualities ; for a Specific I muff term it, fmce I find that fix Grains, without purging or the leaf! Diffur- bance, anfwers our Intentions in molt Cafes. How much the World is indebted to Dr. Young for making it publick, every one who has tried It muff be forced to confefs.

St, Andrews y Jan, 2. 1738.

A Letter from Mr, John. Paifley Surgeon in Glafgow.

Sir ,

‘TT OUR laudable Endeavours to promote the Art of Medicine, and particularly in re¬ commending the Stibium ceratum, not only in. Fluxes , but in uterine Hcemorrhagies , which I had an Account of a good Time ago from my Coufim Dr. Simpfon at St. Andrews , and from other good Hands fince, make me hope you will more eafily pardon the Freedom I take of acquainting you with the Succefs I have had in

ufing

/

' and Observations * ij"f

ufmg it, though I have not the Happinefs of your Acquaintance ; and beg the Favour, if you can fpare fo much Time, as to let me have an Anfwer to a Query or two I fubjoin.

When I at firft ufed that Medicine, I procu¬ red it from Edinburgh by means of Mr. Ste¬ phen Surgeon to General IVhetham’s Regiment, who can vouch for its Effects in a great many Cafes, where he and I attended jointly both fome of the Town’s People and his own Men. At firft we gave only feven Grains in a Dole, and to fome Prong Perfons increafed it by De¬ grees to 13 or 14 Gr. and proportionally lefs to weak and younger Patients, made up in a Bolus with Conferv. rofar. Diafcord. Theriac Edinenf. allowing for Drink Water-gruel, fbme- times with, fometimes without Milk ; at other Times Emulfion, Tea, or weak Broth, and al¬ ways an Opiate after the Operation. It fome¬ times vomited, always purged, and without griping, or but very gently. When it occafi- oned vomiting, it made them very fick before the Operation, but fo foon as it wrought down¬ wards, that went off.

When the Parcel I had from Edinburgh was done, I made it by the Directions given in the Edinburgh Courant , making ufe of 'white Wax to befmear the Laddie, and did not bruife the Stibium : After keeping it on the Fire the Time ordered, I could not rub off any Wax : AVhen it was cold I rubbed it fine in a Marble Mortar. Of this Kind I gave only three Grains, and ne¬ ver above five even to ftrong Perfons, and found it wrought as well as what I had from Edinburgh , and in the fame Manner, notwith-

ftand^

1 78 Medical EJJdys

{landing the Difproportion in the Doles. I did not keep a Lid: of all the Patients to whom I gave it, but I am certain I gave it to above for¬ ty, who all recovered except three, where I could not blame the Medicine.

As the Dileafe was epidemic, and the Patients generally were leized with a Fever, at the Be¬ ginning, in mod of them I took away fome Ounces of Blood before ufmg of it, giving it every other Day, and in the intermediate Days a light Cordial ; and if there was great Pain in the lower Belly or Re Slum, an emollient Gly- fler, with the Yolk of an Egg. Four or five Doles perfected the Cure for mod Part, when taken in Time. In others, where it was of long danding, I have been obliged to go the Length of twelve or fideen Doles, and never once faw any bad Effeft from it. I have tried it in Diarrhoea’s , Dyfenteries, and Colick-pains from vifcid Stuff in the Intedines, and found it in all thele Cafes a lafe ealy Purgative, and fometimes a gentle Emetick, and a much furer and fpeedier Cure than the ordinary Methods, which I ufed with a great many Patients at the fame time, &c.

Glafgow, Feb. 6. 1738.

A Letter from Mr. James Stephen, Surgeon to

General WhethamY Regiment.

Sir, ,

BEING informed you wanted to know the Succefs of the Vitrum Antimonii given in Dyfenteries , is the Realon of my lending you this. For thefe three lad Years Dyfenteries have

been

and Obfervations. iyp

been epidemical not only in the Regiment, but in all the Places where it has been quartered ; and not finding the defired Succefs from the common Method of Cure, put me on making all the Enquiry I could for an Improvement. I at laft happily met with the Vitrum Antimonii in an Apothecary’s Shop in this Town; and the Character that was then given me of it encou¬ raged me to make a Trial of it. On my Return to the Regiment, then at Glafgoiv , in Decern - her 1735, I communicated my Defign to Mr* John Paijley Surgeon, who defired to be pre¬ fen t on making the Experiment, and who, to my Knowledge, has conflantly pra&ifed it ever Jlnce.

Our firff Patient was a Labourer in a Sugar- houfe, (thefe People are very fubjeft to that Difeafe) he had been confined to his Room fix Weeks, and to his Bed ten Days before we faw him ; his Pulfe was low and frequent, his Stools bloody, with a conflant griping and Tenejmus\ We began with giving him two Grains of the Medicine, which gave him one Puke, and five or fix Stools that Day; he had an Opiate in the Evening. Next Morning the griping and Tenefmus was much abated. We repeated the Medicine every other Day, till it was augment¬ ed to nine Grains, by adding a Grain to every Dole, with an Opiate always that Evening he took the Medicine, which entirely cured him ; and in fix Weeks from the firff Beginning of the Cure, I faw him working in the Sugar- houfe, and he has continued well ever fince.

Since December 1735, I have had an hun¬ dred and ninety patients in Dyfenttrks, who

were

Medical Effdys

were all treated after the fame Method as above*, : •of which I loft but one, who turned he<ftic, and died about the thirty fixth Day of his being ta- ken ill.

N. B. I never gave it where there was a ftrong Fever, he<ftic Difpofition, or Signs of a Diarrhoea colliquativa.

Ganongate, Feb. 6. 1738.

I fliall conclude by reading the ftrongeft Te» ilimony of all, in a Letter wrote to me by Mr, John Gordon of Glafgoiv , whom I am not ac¬ quainted with, but whofe Character we know to be that of an eminent Surgeon, and an ho¬ med Man.

Sir,

T Give you the Satisfaction you defire with a great deal of Pleafure. In the Harveft 1736, we had a great many People afflicted with the Diarrhoea and Dyfentery , which carried off fe- verals. At that Time I began to try the Stibi¬ um ceratum , and gave it to fome hundreds, and Jlnce never miffed of Succefs, excepting one or two Cafes, where the Patients were quite ex- haufted before they got it,

I prepared it as fine as we do Calomel; three Grains of this fine Powder is an ordinary Dole ; I never exceeded five ; one or two Doles fre¬ quently perfected the Cure, and feldom I gave three ; they got the Dole in the Morning, and were often two Hours before it operated ; fome it only purged, others it both purged and vo¬ mited, and made them pretty fick for fix or eight Hours; always at Night I gave a good

Dofe

and Obfervatlons. iSr

Dole o f Opium. Lately a Boy often Years of Age had tried for fome Weeks the common Me¬ thod, with Ipecacuan , Rhubarb , and Decoct. Diafcord. to be cured of a very bad Diarrhoea , to no Purpofe, his Loofenefs Bill returning; he was cured with one Grain of the fine Pow¬ der, and a Dole of Lip. Laud, and continues well.

Glafgow, Jan . 18. 1738.

XVI, A Skull uncommon for the Number and Size of the Oifa triquetra ; by Alexander Monro, P. A.

Y T is, you know, my Bufinefs in teaching, to (hew the young Gentlemen, my Pupils, not only the Structure which generally obtains, but likewife as many of the ufeful lufus nature v as I can. By ufeful, I mean all fuch as can ailiffc them in explaining the animal Oeconomy and Difeales, or can prevent their committing Mis¬ takes in Praflice. Among thefe Deviations from the ordinary Structure, I reckon the Offa tri:- quetra , which are fometimes feen in the feveral Sutures of the Cranium , but tnore frequently in •the Lambdoid than in any other; for without being acquainted with them, one may judge a Bight Wound of a Perfon, who had fuch Bones? to be a violent Fracture of the Skull. 5

Among the different Skulls in my Pofieflion, there is one which has thefe Bones more re¬ markable than any I have feen ; and therefore feveral Years ago I caufed Mr. Cooper clo engrave the Figure of it in Copper, which I now fend you to infert in your Effays, if you think fit. Vol. V. Q Tab.

1 82 Medical EJJays

Tab. Fig. 1 . reprefents the poflerior View of the Cranium , where the feveral pricked Lines from A A terminate in OJfa triquetra , placed! in the upper part of the Lambdoid Suture. B B are the Holes in the parietal Bones, much lar¬ ger than in moll: Skulls.

It was needlefs to caufe the two other Fi¬ gures which are on the fame Plate to be de¬ leted, and therefore I had as well mention what they reprefent.

Fig. 2, Is the JVomer of a young Child, in nearly the natural Situation ; a is the lower Part which refls on the Palate-plates of the Pa¬ late and maxillary Bones ; b the poflerior Edge between the back Part of the Palate and the Bale of the Skull ; c the wide Hollow for re¬ ceiving the thick fpongy proceffiis Azygos of the Os fphenoides ; d , <?, the ferrated fuperior Edges receiving the cartilaginous nafal Plate of the Os ethmoides : From ef to the Point f, this Plate is cartilaginous even in Adults.

Fig 3. is another View of the fame Vomer, where the fame Letters point to the fame things, only the inferior Side a is put uppermoft, and brought in View to fhew the little Rifing in its middle z which enters between the Palate- plates, while the Sides are deprefied.

XVII. Supernumerary Teeth ; by Dr. Ge o r g e

Th omson Phyfician at Maidftone.

THE Hiftories of double Rows of Teeth in the human Head, and the Obfervations of fupernumerary Teeth fometimes feen are ge¬ nerally fo inaccurate, that there is no judging

how

and Obfervations. 183

how they were placed, or what Advantage or Impediment they were in the Functions of the Mouth ; a Figure taken from a Skull which has fuch fupernumerary Teeth, where their Situation can be obferved exactly, may not therefore be unacceptable.

Fig. 1. is the anterior View of the Bones of the upper Jaw. Upon comparing the two Of - fa maxillaria here, one fees how much of the right Os maxi llare is taken away to allow the Tooth B to be feen.

Fig , 2. is the Part of the right Os maxillare below the crofs Line A in Fig. 1 . cut olF and viewed on the pofterior Part, that the Socket B, where the Tooth D, Fig . 1. was lodged, might be feen.

E the Tooth, which has all the Characters

of a Dens caninus .

Fig. 3 . is a View of the under Part of the 1 maxillary Bones of the fame Skull where the Tooth G reprefented in the former Figures ap¬ pears in the right Side, and the Tooth H is feen : coming through the Palate Lamella of the left • maxillary Bone.

The two uncommon Teeth which were both 'of the fame Form with the canini had their i Roots fet flanting obliquely upwards ; fb that jt their Points were very near contiguous with the ^natural Dog-teeth.

Thefe Teeth Handing out thus from the Roof 5 of the Mouth, muff have been exceedingly itroublefome in chewing, {peaking, 1 be, the Tongue being in conflant Danger of being wounded by them, notwithstanding which,

. their Situation and Form would have made the

Q_ Z pulling

1 §4 Medical Effays

pulling of them a very difficult Operation? which mu ft have had troublefome Coniequen- ces, becaufe the Palate Lamella of the maxil¬ lary Bones would almoft neceffiarily have been broken, before the Teeth could have been got out ; how much of thefe Lamellee would have come away with the Teeth? or how far the Fra&ure in them might have been extended?, would have been altogether uncertain, and a Communication larger or fmaller might have been made between the Mouth and Noftrils? the Effeft of which might have been as bad as to fpeaking, Deglutition, drr. as we fee when there is a natural Deleft of Bone, or an Erofion of the Palate by an Ulcer.

Iffuch Teeth lurk within the Membrane of the Palate, might not they oceafion feveral Dis¬ orders which we could not know how to re¬ gno ve, unlels we difcovered the Caule of them, and cut through the Membrane, to make Way to thefe irritating, pain-giving Bodies ? Should not we then examine carefully whether Teeth growing in an unnatural Way do not form the Tumors which are fometimes miflaken for Ex~ cJlofeSf or hard Schirrhufes of the Palate ?

XVIII. TheMechanifm of the Cartilages between

the true Vertebras ; Alexander Monro,

P. A.

CEveral of you, Gentlemen, faw what ^ was hie wed here laid Winter as a Arange uncommon Fifh, by a Soldier ; it confiAed of two round Plates of Bone, with flexible tough SubAance about i j Inch thick interpofed be¬ tween

and Obfervations. 1 85

tween them and con nefting them ; no PrefTure could force the middle centrical .Part of the Plates nearer, but upon prefling any Side of either- of the Plates they approach’d each other, the interveening Subfiance at the prefTed Part riling outwards into a Convexity, while the oppofite Side where the Plates were feparated firetched confiderably ; all thefe Motions feem- ktg to be performed upon a folid firm Sub¬ fiance placed in the Center.

Some of the young Gentlemen who fiudied under my Care fearched along the Sea-fhore, till, near to Grant on , where a young Whale was call afhore a few Years ago, they found fuch another Body, and feeing the Vertebra ? of the Whale near to it, they were fo obliging as to bring it, with one of the Vertebra ?, to me.

Upon comparing the Surfaces of the Plates with the flat Surfaces of the Body of the Verte¬ bra it was at firft Sight obvious, that the Plates were no other than Epiphyfes feparated from two adjacent Vertebrae- , and the intermediate Subfiance was the Cartilage interpofed between the Vertebra . Upon cutting the loft ligamen¬ tous Subfiance its concentrical Fibres fhewed themfelves, and it became fofter gradually till in the Center, where it had refilled all PrefTure formerly, it was altogether in a liquid Form.

The View of the Play of thefe two Plates, by means of the interpofed Ligament, with a Liquor in the middle of it, ferved to explain to me the Defign of the Structure of the Carti¬ lages between our Vertebtcr, which I was at a

Q, 3 koft

1 86 Medical EJfays

Lois to underfland before, tho’ it is of the greateA Advantage.

The mucous Part of this ligamentous Carti¬ lage in the human Body is placed near to the poAerior Part of the Bodies of the Vertcbree% and therefore is nearly in the Middle between, the anterior Part of the Bodies and the oblique Procefles of the Vertebrae ; fo that when we Band ereX each Vertebra refts upon a fluid Fulcrum or Sort of Pivot , the Motion upon which to any Side is eafily and quickly per¬ formed, and at the lame time is not too hafly or unequal ; for the Compreflibility of the Car¬ tilages gradually increafes from the liquid cen¬ tral incompreflible Part towards the Circumfe¬ rence. Without this central Pivot in moving the Spine from any reclined Poflure to the op- pofite one, particularly in moving forwards a Spine that was reclined far back, there would often be the greateft Danger of a moA violent Shock of one Vertebra upon another, and in¬ deed of all the Part of the Body fupported by them ; whereas this Contrivance allows a very gradual Change of the Center of Motion of each Vertebra , accommodated to the bearing of the fuperincumbent Weight in the different Defle¬ xions of the Spine from an ereX: Poflure, or in raifing it to fuch a Poflure.

This liquid Fulcrum too will bear off the great Preflhre which the Veflelsof the ligamen- to-cartilaginous SubAance would fufler in our ereX PoAure, that might be of ill Confequence, while the Abforption of this Liquor, increafed by Arong Preffure, will ferve to account in part

and Ob fern) at Ions. 1 87

for the Difference of Stature at Night and in the Morning.

XIX. Reflections and Obfervations on the Je- tninal Blood Veflels ; by the late Dr. George Martin Phyfician to the American Expe¬ dition.

T WAS long in Sulpence what to think of the ■*’ Anaflomofes of the fpermatic Veins and Arte¬ ries , which many are fo fond of, efpecialiy now that Dr. Boerhaave (a), one of Puch uni- verfal Authority and Efteem, has aflerted them in fo remarkable a manner, propofing thefe Veflels as having in this refpeft a peculiar Structure, different from all other Parts of the Body, and fo introducing a particular fort of Secretion no where elfe to be found. Ever fince I have been enquiring into the Works of Nature I have always loved and admired the Simplicity of her Ways, and confequently have not been very forward to multiply in my Mind the Methods of her afting and yet on the o* ther hand I was not a little perplexed when I confidered the great and weighty Reafons for a Singularity in this Cafe, efpecialiy if the Num¬ ber, and I may add too, the Character of the Afferters of it was to be confidered..

2. The Doctrine of thefe Anaflomofes is fo far from being new or lingular, as lome are apt to fancy, that it feems to have been a Handing Doctrine from the Refloration of Anatomy in the Beginning of the Sixteenth till beyond the

Middle

(a) Ink. med, § 26 2, 642*

1 58 Medical EJfays

Middle of the laft Century. Vefalius ( b ) talks of the fpermatic Veins and Arteries as meeting and interwoven together in a peculiar Way; Falloppio (c) feems to allow fomething of this fame kind in Men, but the reft of the Anato- mifts of that Age make no Diftinfrion, reckon¬ ing the fame thing to obtain equally in both Sexes ; and fo the great Eujlachio (//), in all the Figures of the fpermatic Veffels he had Oc- ealion to paint, whether in Men or Women, feems to fhew pretty large and vifible commu¬ nicating Canals. Realdo Colombo (e) thought the fpermatic Veins and Arteries to be fo interwoven in their Progrefs, ut vena arteriam , arteria ve~ nam ingrediatur , fitque pr ceclar a ilia , dr admi - rabilisy ac afpedlu jucundijjima , a Greeds ho* minibus vocata dv z<r t 6 pucr/ < ; quod genus dvcLciQucoazoty fi in corporum diffedionibus te ac~ curatum prceflabis , in aliis quoque partibus com - pedes, in brachiis pr refer tim dr cruribus ; all which he may leem to have borrowed from Nic. Maffa (/). And lo this, or fomething like it, continued to be the univerfally recei¬ ved Opinion, and was fo common in the Days of De Laurent (g), that he expreiTes himfelf in thele remarkable Terms : In plexibus his vafo - rum fpermaticorum confpicua eft prceclara ilia dr tantopere celehrata venarum 6" arteriarum

anaflo -

(b) De hum. corp. fabr. v. 13, is¬ le) Obf. anat. op. Tom. 1. p. 422. Sc Vefal. oper. 1 72

p. 7

(d) Tab .anat. xii. fig. 1. 3. xiii. xxv.

(e) De re anat. xi. 13.

(/) Anat. lib. introd. xix. p. 33. XXiii. p. 40, Xvii, p-31-

and Obfervatiom . 1 89

anaflomojis . And fo far down as beyond the. Middle of the lad Century, mod; Anatomills continued in the fame way of thinking, and par¬ ticularly one of thegreated of thefe Times, Do- ?ninico Marchetti (/?), fpeaking of the fperma- tic V effels, lays, Arte rice anaftomofin in pro- grefjii cum veins patentem faciunt ; fo that this leems to have been the prevailing Opi¬ nion of Anatomids until De Craaf (i) dared politively to deny that there was any fuch thing as thefe paten Anaftomofes between thefperma- tic VefTels, or even betwixt the Arteries and Veins in any other Parts of the Body ; being however cautious enough to let us underdand at the fame Time, he did not abfoluteiy deny that the ordinary Circulation of the Blood, from the very minute Arteries to the beginning V eins, might be carried on by their mutual joining or Inofculations, as now every body knows from the Oblervations of Mqlpighi , Leewenhoek and others.

3. But Leal Lealis being didatisfied with. De Graaf’s Account of this and feveral other Things, undertook to give a new Scheme of thefe Matters in his epidolary Exercitation, De partibus femen conficientibus in viroy in which he keenly defends the Exidence of the anafto- mofes betwixt the Trunks of the fpermatic Veins and Arteries againd De Graaf ; howe¬ ver, with this remarkable Difference from the preceeding Authors, that indead of patent Communications, as Marchetti and others had

repre-

(h) Anatom, vi. p. 5-8.

(£) De vir. org. &c. p. 24. & cpift. ad Sylv.

190 Medical tLJfays

reprefented them, he (though addreiung him* felf to the fame Marchetti, and loudly appro¬ ving of every thing he lays) calls themjenues, dr invijiblles fere anafiomofeis (A) ; and if he had plealed he might have kept out the modi¬ fying Particle fere, fince, notwith Handing his ordinary Impetuoulnefis, he is fo far from pre¬ tending ever to have feen them, that he open¬ ly acknowledges (/) he averted them, not at all becaufe he could perceive them with his Eyes, but by reafon of the dole Union of the femi- jiary Blood-velFels ; and chiefly that the Effects of fome particular Experiments and Phcenome - na neceflarily fuppoled fome luch Inofculations • which Experiments and Phenomena, we may be pretty well allured, neither Euftachio nor Colombo , nor any other before Harvey , ever tried or cotilidered in that Light, however la¬ borious and exa£t they might be in other things ; fince LeaP s Reafoning is entirely founded on the Circulation of the Blood in a living Animal.

4. The Subftance and Strength of Leal’s Ai> guments (rri) for his Favourite Anaftomofes of the fpermatic Veflels lands in this, that cutting oflf all Communication betwixt the Arteries and the Teflicles in a living Animal, yet the Blood, without great Difficulty, finds a Way to return by the V eins ; and this Phenomenon, Ido rea¬ dily conceive, may be eafily underflood and ex¬ plained without acknowledging the Exiftence of the extraordinary Anaftomofes in queftion, which he with fo much Aflurance deduces from Expe¬ riments

(k) De part. fem. conf. p. 20.

(/) Ibid. p. 26.

(m) Ibid. p. 13, xp, 20..

and Observations. i p i

riments of that Nature. Let us only confider that 'when one ties all the vafa prreparantia a- bove the Tefiicle, or by any other Means takes away all Communication between the Artery and Vein by the Intermediation of it, yet there is Bill left a Paffage, though a very Ilraitned one, by the common Courfe of the Circula¬ tion, without fuppofing lateral fhort Openings ; namely by the Branches of the Spermatics that arife all along in their Progrefs, and are diftri- buted to their neighbouring Membranes ; which lateral Branches Leal did not think of, though defcribed by Galen (n) and others, and careful¬ ly expreffed by Vefalius , (o) both in his Text and Figures; and now we find them finely pointed out by the inimitable and accurate E li¬ ft achio ( p ).

It is however worth while here to take No¬ tice, that this PafTage of the Blood in the lum¬ bar Membranes is not near fo free and ample as its direft Courfe thro’ the Tefticle itfelf, at leaf!, if we can give Credit to an Experiment of De Graaf (^), the Truth of which Leal (r), tho* otherwife not very favourable to him, has not offered to call in quefiion, although he was for¬ ced by a poor Shift to deny its Conclufivenefs for the Purpofe De Graaf defign’d it. He then, making a Ligature on the lower End of the corpus pyramidale in a dead. Animal, found that a Liquor inje&ed into the Trunk of the fe¬ rn in al

(n) De difle£t. ven. 8.

(o) De hum. corp. fabr. iii. 9. v. 13.

fig. 20,22,23, 2 S»

Tp 2 Medical Ejjays

initial Artery was immediately flopped ; for that it Teems it could not be puffed thro’ the limit Communications on the furrounding Mem¬ branes into the Trunk of the fpermatic Vein, through which the Liquor returned plentifully and eafily a (Toon as he took off the Ligature, ■and fo allowed it to run by the natural Paffages and Communications in the Teflicle. By which Experiment it is plain that the Inocula¬ tions of the Arteries and Veins in and about the Teflicle. are more ample than any Commu¬ nication they have all the Way downwards.

6. Since then that lateral Paffage of the Blood is fo very flrait, and fmce Leal does not pre¬ tend ever to have feen the communicating Ca¬ nals of the feminal Veins and Arteries, is it not furprifmg that Dr. Boerhaave , in the Bril E- dition of his Inffitutions (/'), and more fully in the fecond ( t ), fhould, on Leal's Engle Au¬ thority, affirm that arteria fpermatica emittit r amnios arteriofos , qui re£lay patently fatifque ■magna via , in venam comitem cruorem arterio - fam later aliter derivent verd anafomoji, in pin- mis in pyramidali corpore ? How can this patens j fatifque magna via be fairly deduced from Leal's invifible anaftomofes (u), or be reconciled with De Graaf's Experiment ? Which too evinces not only the ExiBence, but the Largenefs and Opennefs of the Veins of the Teflicle ; tho* Dr. Boerhaave (v) is pleafed to deny the Body of the TeEicle any confderable returning

Veins i

(f) § 210, 4 S'1? 4*2.

(t) § 262, 6 42.

(») Ibid. p. 2 6. .

{v) Ibid. § 644, 647,

md Obfervations. 193

Veins correfponding to its Arteries, allowing it only fome venuhv exigucu & vafcula lympha¬ tic a, according to Leaf's (w) flaunting AfFertion, when he affirms that nulla ejl vena qucv nerved membrana pertufa , teflium audeat facra invi- fere penetralia , omnibus veluti fua in nerveam memkranam terminatione content is. I (hall not take Time at prelent to examine his Reafons and Illuftrations of fuch an odd Doctrine; it is needful only to cut open and to look upon any human Tefticleto obferve a beautiful Diftri* bution of red Veflels, both Veins and Arteries, on the Inflde of the tunica albuginea , every where throwing off very confiderable Branches into the Subftance of the Tefiicle ; all which is very well defcribed by V efalius (x) and o- thers (y), andmoft elegantly delineated by Eu- fiachio (z).

7, Indeed it is the Affiertions of fo many good Anatomifls, and efpecially thofe Pictures oL Euftachio (a), which I think furnifh the bejffc Argument for afferting the controverted InoP- culations between the feminal Trunks : and fb Dr. Boerhaave, in the third Edition of his Book,

; adds the lately difcovered Tables of Eujlachio to his Citations from Leal ; but thete are ill yoked together Authorities, and not at all flowing from the fame View of things ; the Thoughts and Defign of x.« fiachio are very Vol. V. R dif-

(Vf) Ibid. p. 20, 29, 30, 34, 3J\

{x) Hum. corp. fabr. v. 13. fig. 23. Q, R. S. T. V.

{y) Sec Carter. Tab. anat. viii. 13, fig. JL?e Gfraaf, ibid. Tab iii. fig. s- Tab. tv. fig. 2.

(z) Tab. anat. xii. fig. 6, 8.

(a) Ibid, fig. J, 3* Tab, xiii, xxv9

194 Medical Effays

different from Leal’s Hypothefls of the feminal Anaflomofes. The Antients were not appriled of the Foundation of Leal’s reafoning, and he on the other hand exprefly gives up the only Reafon the Antients pretended for them, to wit, ocular Inflection ; and this Angle Confldera- tion would, I doubt not, tempt mofl unpreju¬ diced People to fufpe£t that thole Anaflomofes' were entirely fuppofltitious, and the whole to How from fomeMiAake: Would not they be ready to think, that if there really were any fuch mutual Openings, or patent communica¬ ting Canals, as the old An atom; As feem to think, and particularly Euflachio feems to de lineate, then it would have been impoflible they could have efcaped the Eyes of Leal, who fearched exprefly for them on purpofe to main¬ tain the ExiAence of Anaflomofes againA De Craaf ? But, after considering this Matter more narrowly, I cannot acquiefce in any fuch Reafon for doubting the ExaAnefs of Euflachio and other good AnatomiAs, when throughout all Leal’s Diflertation I obferve fuch an Air of Negligence, and fuch a want of Attention to the Works of Nature, and of Refpeft for the Writings of Authors better than himfelf. How¬ ever, now I think I can account for Euflachio’ s Pictures, and other AnatomiAs Books exhibi¬ ting viflble Anaflomofes , without admitting a- jiy fljch extraordinary Fabrick in the fpermatic VeRels, as is no where elfe to be found in the animal Machine I mean, without admitting patent and more than barely viflble, fhort, la¬ teral, communicating Canals betwixt the Cavi¬ ties of the arterious Trunks and of their corre-

Iponding

and Obfermtions. ipj

fponding Veins. Tho’ this Undertaking may look like a Paradox, I hope in few Words to make it good from Anatomy and Nature itfelfl 8. After having dilfefted and look’d into fe- veral Subjects particularly for this Purpofe, without any great Satisfaction, I at length, in December lad, 17 22, got the Body of a very young Girl, who before her Death had proba¬ bly laboured under an univerlal Inflamma¬ tion, or at leaf! was fo full of Blood that the Coats of almoft all the confiderable Arte¬ ries were covered over with a clofe Net- work, of red Blood-vefTels, whereof too I obferved a great many on feveral Veins, efpecially the large ones. After then I had diflefted fbme o- ther things, I turned over to the right Sperma- ticks, where I obferved that though the Arte¬ ry was but fmail, yet its Coat was covered with a vaft Number of red Veflels ; there were not indeed very many at its Beginning, but in its Progrefs downward feemed to be more and more numerous, fo that at its PafTage into the Pelvis it feemed to be entirely covered over with a thick Stratum of very fmail vafcular Canals, though Bill confpicuous, as yet keep¬ ing their red Colour ; the Number however of thefe invefting VefTels was fo very great, that the Artery feemed to be fraalleft at its Rife from the Aorta , and to be increafed in its Defcent, which Mr. Cowper (b) and D. Ketll (c) thought to hold universally in the human fpermatic Ar¬ teries. This Appearance however, I believe,

R 2 at

(b) Anat. hum. Bod. Introd. and Expl. Tab. xlii. and Tab. xlv. Fig. 2. and Phil. Tranf. Abr, v. I. p. 329*

[c) Anat. ii. 10, ij. EfT. iv. p. 1/0,

1 96 Medical Effays

al leaf! in my Subject, was entirely owing to the increafmg Thicknefs of the Sides of the Artery, by a Diftention of a greater Number of the compounding VefFels, while I think it reafonable to fuppofe that the real Capacity of this Artery was fo far from being enlarged, that it was rather confiderably diminifhed by fend¬ ing off fiich a Number of lateral Branches to the cellulous membranul cv furrounding it ; for this gradual Diminution I have vifibly obfer- ved in the Spermaticks of fome other Subjeffs, according to the common Law obferved in the arterial Syftem through all the reft of the Body. But what is more to our prefent Purpofe, and what I was prodigioufly delighted with, was, to obferve at feveral Places pretty conftderable Branches riling from the feminal Vein, and, affoon as they reached the Trunk of the femi¬ nal Artery, fpread up and down upon its Sides ; when with inexprefftble Pleafure I found the fame Appearance on the left Side of the Body. I compared this Obfervation with one I had made feme time before on the Body of a middle aged Woman, whole right feminal Artery, which I examined very carefully, was pretty large, and from which I eafily obferved in one Place a conftderable enough Branch ariftng, and juft as it reached the Vein dividing itfelf into two Twigs, which, the one going upward and the other downward, were fpread on its Sides ; juft as in the other Subject I obferved the Branches of the Vein diftributed on the Arte¬ ry. There was another Place where the fame cl' ig appeared, though more obfcurdy ; fo that i did not mind nor truft fo much to this

Ob-

and Obfervatkns. 107

Obfervation as to the other I afterwards made on the Body of the Girl.

9. Thefe fhort lateral Branches of the Sper- maticks riling from the Cavity of the one Veffel, and diflributed chiefly on the Coats of the other one, have not hitherto been taken notice of, at leaf! notfufficiently attended to by Anatomifls ; tho’, as I take it, it may have been an imper¬ fect View of them that led the old Authors I formerly mentioned into the Notion of vifible Anaftomofes , and might readily enough train any bodyelfe into the fame Miftake; yea, if 1 had not with more than ordinary Care traced the Continuation of their Colour and Diftribu- tion, I certainly fliould have thought (as I know fonie are dill apt to think) them confpicuous and patent Inofculations ; which Dr. Boerhaave does fo firmly believe, and which he and every body elfe reckon that Euftachio exhibits in all his Figures of the feminal Blood-vefTels'.

10. And yet even thefe Figures may be f>

explained as to agree very well with my Obfer- ■rations; fo that we may reckon Euftachio has only painted, and that very neatly too; as’ far as the Smalnefs of his Figures and the engrav¬ ing of that Age would allow, thole lateral Branches, both of Veins and Arteries, which do not fplit again before they reach the Sides of their correfponding Veffel, on which they are diftributed. It is eafy to obferve the fup- pofed Anaftomofes or communicating Caimls by the Angle and Direction of their Rife and Courfe, fome to be derived from the Vein and others from the Artery, as from their Trunk $ for it is a common Law in the Diftribution ot \ ft 3 dwp

!<$ Medical EJJays

the Vefiels through all the reft of the Body? that the Branches arife almoft always at acute Angles with the Diredion of their Trunks, e- fpecially if there be not a very great Difpro- portion between them. Thus then in Tab. XII. Fig. i. on the right Side we fee three of thefe pretended Anaftomofes , whereof the firft going from the internal feminal Trunk to the exter¬ nal, I judge, by comparing this with the fub- fequent Figures and the ordinary Pofition of thefe VefTels, to be an arterious Canal, going to be diftributed on the Trunk of the fperma- tic Vein, from which the two lower lateral Communications are derived to the Coats of the Artery. The only one that is painted on the left Side I take to be a Branch of the Arte¬ ry diftributed on the Surface of the Vein. And again, in Fig. 3. on the right Side we have, firft, one of thefe communicating Canals, tak¬ ing its Rile from what we evidently fee is the Artery, and thence carried obliquely down¬ ward to the Vein; and a little lower another with a contrary Courfe going from the Vein to the Artery. And then, after the fame man¬ ner, in the following xiiith Table, exhibiting the female Organs, there are on the right Side, firft, two of thefe fhort lateral Branches com¬ ing from the Vein to the Artery, from the Suh- ftance of which the Blood is carried by thefe. Communications to the Cavity of the venal Trunk ; and fomewhat lower we fee a very fmall Branch fpringing from, the Artery, and going to fupply the Coats of the Vein with Blood. In Tab, xxv. the Parts are fo fmall, tad fprne of them of Neeeftity, to make them

vifiblej

and Obfervations. i pp

viftble, fb difpropordoned, that we "need not on this Occafion mention any thing that might be deduced from it ; for there the longitudinal Dimenfions of the Body are but i of what they are in Nature, reckoning at a mean Standard ; and the forecited Figures of Tab. xii. are but j of Nature, while Tab. xiii. is defigned to fhow the Parts not much lefs in Length (per¬ haps about j or lo) than they really are in a Maid of an ordinary Stature ; fo that in it the feminal Blood -veffels are reprefented larger and nearer to their true Dimenfions than any where elfe ; b) which means there is here delineated not only the natural Courfe of the communica¬ ting Canals, as in all the reft, but I think I can obferve a Refemblance or Shadow at leaft of fomething of more Subtilty and Elegance, and that is the Mouths of them, where they open into their proper Trunks wider and fuller than at the other End, where they are tobediftribu- ted on their correfponding Veftel; which wide Openings of Branches into their refpeftive Trunks is very frequent in the vafcular Syftem? and whereof there are feveral Examples in the very Figure before us.

1 1 . From all which is there not fome Ground to imagine that even thefe communicating Ca¬ nals in Euftachia's Pictures are not perhaps de~ fign’d by the Author as Anaflomofes , but only as little Branches arifing from the Cavity of the one Trunk and diftributed on the Coats of the other ? at leaft they are well enough painted for fuch if we only regard their Rife and Pofi- tion, and in fuch Figures more is not well to be expe&ed. And leaft; any fhould think the

' *mz

a 00 Medical FJdys

apparent Openings of thefe little Canals into the Cavity of both Trunks fufftcient to deftroy this Conjecture concerning Eufiachid* s Deftgn, let fuch an one conlider how he was limited by the Smalnefs of his Figures and the Infancy of the graving Art ; and that in Confequence there¬ of, not only in this refpeCt, but in Tab. xii. Fig. i. about the middle of the Spermaticks on the left Side, and near the beginning of them in both Sides, and on the left Side in Fig. 3, and in Tab. xiii. where they have juft climbed over the Iliacks in both Sides, as likewife about the Middle of them on the left; and alfo on the left, if not on both Sides of Tab. xxv. I fay that in all thefe Places the Artery and Vein are reprefented in fuch a Manner, as that one igno¬ rant of Anatomy, and only regarding the Rules of PerfpeCtive, would judge them to be joined into one Canal, and then to be feparated again ; and yet we know, that in all the Places where Euftachio repreients thefe Conjunctions, they are not fo clofely bound together but that a Hand much lefs dextrous than his could eafily feparate them ; and then, I hope, no body will think he was fo fuperficial a Difte&or as not to know that fuch Conjunctions were not of the two Veffels into one, but only the two lying dole to one another, and ftraitly bound up in the in veiling Membranes; and in Men the feminal Artery is fo in timately woven with the perplex¬ ed Courfe of the V ein in the corpus py rami dale, that Euftachio, in Tab. xii. Fig. 1. and 3. is forced to exhibit them all as joined into one Trunk, though he (as in Fig. 3. and 5. where the Parts, are Ihowa larger) a&d aimcfl all other

and Obfervations. 201

Anatomifts knew what a Labyrinth of VefTels there is here. In the mean time, whatever be in this Conjecture about Eufiachio* s Notion of thefe communicating VefTels, I am lure Tome, from an unreafonable Fondnefs and wild Admi¬ ration of the Ancients, afcribe as difficult things to him and other old Authors, and that with a much lets Air of Probability. However, I am not very concerned whether really he had any fuch Notion or not, thinking it fufficient for my Purpofe to have ffiown that the Account I have given is confirmed by fuch a great Au¬ thor, in as far as he, who ftudied and delinea¬ ted the true Figure and Pofition of the Parts fo well, and fo agreeably to Nature, has paint¬ ed them in much the fame Pofition they ap¬ peared to me.

12. Now then I would fain hope that I have put an End to the whole Controverfy about the ybnaftomofes of the fpermatic Arteries and Veins, by ffiowing the Ground and Rile of a Notion fo extraordinary in itfelf, and which, as I faid in the Beginning, the great I>r. Boer- haave is forced to propole as a lingular Stru&ure and Secretion, to which there is nothing anala- gous in all the Body ; I humbly think that now the fo much admired Myfiery is laid open ; and here we really lee nothing more than what is confpicuous all over the Body, to wit, Arteries fending off fmall Branches to the neighbouring Membranes and the Coats of the Veins invol¬ ved in thele Membranes, and Veins doing the fame Office to their neighbouring Membranes and Arteries. ■ And fo, after confidering the whole Gaurfe of the fpermatic VefTels, wre find

no

202 Medical EJ/ays

no other Communications or Anaflomofes be¬ twixt them than what are every where elfe in all the Parts and Vifcera of an Animal, where the Arteries, after a vail: many Ramifications, turn exceeding fmall, and at length, changing their Direction, become venous or returning Canals; and thefe in their Progrefs joining to¬ gether after the ordinary Manner, form the confpicuous and commonly defcribed Veins.

P. S. The above Memoir was written in 1723, and has lyen by me ever fince almoR neglected, and very little altered, the Subfiance of it having been communicated to very ma¬ ny, and afterwards ingroffed in a much greater Work, which I dare not yet venture to publifh, I have given Things fairly as they appeared to me, and to others whom I warned to look after them in the fame Way ; fo that I fhall not fay much to my Friend Dr. Mortimer' s Oblervati- on in the Philofophical Tranfaftions, No. 415. an. 1730, which exhibits fo very different and fo extraordinary a View of Things, and which (if there be not fome Mifiake in the Matter) deferves to be confirmed by fubfequent Trials. Only, I cannot but take this Opportunity to obferve, that where fitch large Communications are fuppofed to intervene betwixt the Arteries and Veins, as hedefcribes, I cannot eafily con¬ ceive how the Circulation could well be carried on thro’ the minute Arteries to the Parts and Organs where they are difiributed. The Blood, in its ordinary Courfe, has many and great Re- fifiances to overcome, and by far the greatefi: Part of its Force is fpent before it arrive at the large returning Veins, (fee Bellini Opufc. ad

Pit -

and Observations. 203

Pitcarn , Prop. 29. and Hale's Hemaflat.Exp . 9.) So that through fuch large and patent O- penings as Dr. Mortimer defcribes, I cannot but think almofi; all the Blood fhould flip, where it has little or no Refiflance, and fcarce a Drop could be puffied forward through the narrow and difficult Paffiages of capillary Ca¬ nals, and the fmallefl: Orders of Veffiels. Be- flde, I beg leave to obferve a Difficulty in the Account ltfelf. If the Arteries were once fil¬ led with red Matter, fo fliff as a Mixture of 'W ax and Tallow, and that really ran by the Anaftomofes into the Vein, I cannot conceive how afecond blue Injeftion by the Veins could And room to repafs from them to the Artery.

iVhat if his Anaflomofes were overflretched hy the Inje£liony and ended on the Coats of the V effhls they feemed to penetrate ? The Anaflo • mofes EF and IK only tinged the Veins at F and K of a purple Hue ; which might well hap¬ pen, though the red Tinflure were conflned to the Coats of the Vein, and its Cavity Ailed with blue. The Doflor does not fry that he opened the Veffiels to examine their Contents after the Preparation. Nor is it laid that the Arteries at E and I had any Tincture from the venous InjeHion. It is remarkable too, that in Ailing the Artery A, the red Matter did not And any Paffiage into the Anaftomofis L M, though it is reprefented almofl as large as the arterious Trunk itfelf. This LM was only Ai¬ led from the Vein, and fo the Artery was made tc look purple at L, but no arterious Tinflure is pretended to have been given to the Vein at M ; A ffirong Prefumption that the Canal L M

did

a 04 Medical Effays

did not really open into the Cavity of the Ar“ tery ; but that it communicated only with its Coats or inverting Membranes ; which was the cafe of thofe feeming Communications I exa¬ mined Co carefully.

Mr. Winflow in his Anatomy printed at Pa¬ ris 1732, Tr . du has ventre , § 480, 481, fhows very well the Groundlertiefs of Leal’s Reafoning for the Anaftomofes ? though in doing it he (peaks as if Euftachio was the only Man who had known the lateral Ramifications of the ipermatic Vertels fcattered on the Peritonceum, Nor does he mention one AVord of thefe fhort Branches fpringing from the Cavity of the one Vertel to be dirtributed on the Coats of the o- ther ; tho’, if he knows them, they well defer- ved in the prefent Quertion to have been taken notice of. I know not if it be worth while to take notice of this Paffage in De Graaf de vir .

erg. p. 23. Arteria preeparans — - exiguos

admodum, A non nifi poft diuturnam arieria- rum inflationem in confpetlum venienfes, furcu- los quandoque emittity qui in membranis va fo¬ rum, praeferthn preeparantium, ita excur runty ut vifus aciem effugiant . I know this will be underrtood rather to refer to the common Mem¬ branes inverting the Vertels than to their pro¬ per Goats.

XX. Re-

4

/

mid Obfcrvations .

20j

XX. Remarks on the fpermatic VeJJels and Scrotum, vjith its Contents; ^ Alexander Monro ProfeJJbr of Anatomy in the Univer¬ sity of Edinburgh, and F. R. S.

BY the pubtick Advertisement which Valfalva gave {a) of having difcovered Duels fent from the Glandule? renales to the Tefles of Men and Ovaria of W omen, we were made to hope for considerable ASTiSlance in accounting for Generation and the Ufe of the Glandule? rena¬ les. Valfalva dying without explaining fully the Difcovery he pretended to, Morgagni f ) related what he found in Valfalva *s Papers con¬ cerning this Subject of which you have given, an Abridgment (c), but have not remarked with Morgagni , that Valfalva had not Seen what he thought to be a Duel of thofe Parts more than once in the human Subject.

Soon after Valfalva' s Aclvertiiement was pu¬ blished, Mr. Ranby (id) deScribed a Branch of the Artery of the Glandula renalis Sent down to the Tefles of Men and Ovaria of Women, which he thought Valfalva might poSfiblv ha/e mistaken for an excretory Duel: You alio took notice of this (e), and begg’d Mr. Ranby to de¬ termine, Whether fuch an Artery was confiant- ly or feldom found ? Since your Question has not been anfwered by the Gentleman to whom Vol, V. S it

{a) Giornali di literati, 1719.

(b) Comment. Acad. Bononienf. p. 579,

( c ) Medical Edays, Vol. II. Art. 33.

( d ) Philof. Tranfaft. Nam. 387. 3. Num 39^. § 12.

(e) Medical ESTays, Vol, II, Art. 33,

20 6 Medical E flays

it was put, the Remarks I have made in dilTeff- ing the fpermatic VefTels of a confiderable Num¬ ber of human Subjects, may polfibly not be, difagreeable to you.

1 . In the greater Number of human Bodies, the fpermatic Artery of each Side rifes from: the anterior Part of the Aorta , between the temulgent and inferior mefenteric Arteries, as they are painted by Eufiachius (f ), and ha¬ ving each its Courfe obliquely downwards and outwards, becomes contiguous to its Vein, a knotty membranous Subfiance connecting them , here more firmly together than any where elfe in their Progrefs. The Artery descending fends numerous fmall Branches off to the cellular Subfiance it is lodged in, and near to the Ova¬ rium in Women, or fome way above the Tejtis in Men, divides into two Branches, as painted by Swammerdam (g) and De Graaf (/;). The larger Branch in Men is bellowed on the Teftis , through the Subfiance of which its numerous Branches are difperfed every where, as may be evidently feen after a good Injedlion. The leffer Branch of the fpermatic Artery in Men is principally loflin the Epidydimis, tho’ I have frequently traced it^ very fmall Branches difper¬ fed alfo on the Teflicle. — —The larger Branch of the fpermatic Artery in Women is fent to the Ovarium , and to anaflomofe with the other uterine Arteries, the leffer. one is diflributed to the Tuba Falopiana , and ligamentum latum.

2. Numerous Veins coming out of the Teftis

. ' , and

(/) Tab 12 and 13.

(g) Miracul. natur. Tab. 1, 2, 3.

(b) De organ, gener. Tab. i, 2, 12*

and Ob fey vat ions . Hoy

and Ovarium , unite and feparate fo often as they afcend to be collected at laft with the ma¬ ny Branches they receive from the Parts they run near to, into one large Vein, as to deferve the Name of corpus varicofum or Pampinifarme* The f ingle Vein into which thefe numerous (mailer Veins unite, empties itfelf into the Pe¬ na cava , immediately below the Emulgent on the right Side, and into the emulgent Vein on the left Side.

3. "Where the Artery and Vein are conti¬ guous, the venous Branches crofs over and twifl round the Artery fo, that at firft View one would be in Hazard of thinking they uni¬ ted into one Canal, or opened by a large Ana- ftomojis into each other ; but by directing care¬ fully, and after an Injection* one fees plainly there is no fuch Anaftomofs .

4. Thefe Veffels, while in the Abdomen , are on the outfide of the Peritonaeum in their whole Courfe, lying in a cellular Subftance, o- ver the anterior Part of which the Peritonaeum is Jflretched.

5. Tho’ the Rife and Courfe of the fperma- tic Arteries are commonly as I have juft now deferibed, yet frequently there is a Variety to be obferved here ; for in fome Bodies I have feen one or both Spermaticks rife from the Aorta higher or lower than the ordinary Place ; in others I have found them coming from the Emulgents, or from the Arteries of the Gian* dulee renales ; three Bodies are all in which I found this Origin of the fpermatic Arteries from the Arteries of thefe Glands or Capfuls atrabilareSy as they are called.

S a <5. In-

2o8 Medical Effays

6. Infiead of one fpermatic Artery of each: Side, I have feen feveral times two in one or; both Sides, which had their Origins in the un¬ certain way I mentioned the fingle Artery to have.

7. When there has been one Artery of a Side, rifing from the ordinary Part of the Aor¬ ta , I have feen it in one or both Sides make an Arch upwards before it turned down to the or¬ dinary Courfe. In one Subject, a Woman, the fpermatic Artery of the Left Side afeendedl from the Aorta to pafs between the emulgentt Vein and Artery of the fame Side, and to make: a large curve to come at the anterior Part of the Vein, over which it defcended to go to the or» dinary Courle.

8. I do not know if it is worthwhile to take1 notice that I have more frequently met with thole Deviations from the ordinary Structure, or thole lufus nature v in the Left than in the Right Side of the Body.

9. Notwithflanding the Differences of Ori¬ gin or Courfe of the extraordinary Arteries, they kept generally in their further Progrefs and' Diftribution to what I clefcribed as the ordinal xy Rule, that is, the fingle Arteries became contiguous to the Vein near to the middle of the anterior Surface of the Pfoas Mufcle, and afterwards divided into two Branches to be dif* tributed in the manner in which the Branches of the fpermatic Artery commonly are difbri- buted, and where there are two Arteries on the fame Side of the Body, they approach the Vein in the ordinary Place ; the leffer one, which is commpnJy the one deviating mod:

from

and Objervations. 2 op

from the general Rule, ferving the Epidydbnis or Tuba Fallopiana , and the larger one being diflributed to the Teftis or Ovarium .

10. When the fpermatic Veilels of Men are paiTmg out of the Abdomen , they infinuate themfelves between mufcular Fibres, which may be laid either to be Part of the tranfverfe> or of the internal oblique Mufcle of the Abdo - men , or of both. What occafions the Difficul¬ ty in determining the Mufcle which thefe Fibres belong to is, that the Courfe of the Fibres of the two Mufcles is much the fame here, and that the Connexion of the Fibres to each other is fo loofe, by means of the cellular Mem¬ branes, as to allow us to feparate them as we pleafe, by either leaving them with the tranf verfe Mufcle, or raifing them with the oblique , or giving a Share of them to each Mufcle.

u. The fpermatic VefTels and Vas deferens , in going through between the Fibres now de- icribed, which form a Paffage that is very eafi- ly dilated, carry Part of the cellular Membrane in which they lay behind the P eriionaeum a- long with them, and acquire more from the cel¬ lular Membranes of the mufcular Fibres.

12. Befides the mufcular Fibres between which the Spermaticks pafs, there are others which, inffead of continuing their Courfe tranf- verfely from the Os ilium to the line a alba , fall obliquely down on the outfide of the cellular Subfiance involving the VefTels, and go out with them at the oval tendinous Ring of the external oblique Mufcle, which is compofed of firm interlaced Fibres, and is not eafily dilated.

13. In the paffage between the Mufcles, and

S 3 through

2iq Medical EJfays

through the Ring, the Spermatic Cord obtains: more cellular Subfiance, and foon is immerfed: in the common tunica cellularis under the Skin, to defcend to the Scrotum.

14. Frequently a Slip of mufcular Fibres is: lent off Rom the externaloblique Mufcle of the Abdomen , to join thole which palled thro’ the; tendinous Ring of this Mufcle, to aflifl in form¬ ing the Cremafler Mufcle of the Teflis , which lying at hrft on the outfide of the fpermatiek Cord, gradually, as it defcends into the Scro¬ tum, expands its Fibres round the Cord over the. cellular Subfiance, and at lafl is fpread on the vaginal Coat of the Teflicleto which it adheres very firmly.

15. The cellular Membranes on the infide; £>f this Mufcle, where it covers the fpermatiek Cord, lofe their cellular Appearance when cut, , in the fame way as is to be obferved in what isa called the proper Membrane of moil Mufcles, , which when flretched gently in differing the Mufcles, or by blowing Air into it, evidently Shews itfelf to be the lame fort of cellular Sub- , fiance as is Seen between the Skin and Mufcles. 1 The Membranous Appearance however which the Cells within the Cremafler Mufcle have, when collapfed or flretched longitudinally, is what continues the Opinion of there being a vaginal Coat to the human fpermatiek Cord, which was fuppofed for a long Time to be a Procefs or Sheath lent down from the Perito- nccurn in the human Body, as well as it is in Quadrupeds which were then generally differ¬ ed ; but the Difference is very considerable,. For in Men the fpermatic Veflels ly entirely be-

and Obfervations. 21 1

hind the Peritoneum, and there is not any Perforation or Production from this Membrane at the Place where the Veffels are palling be¬ tween the Fibres of the abdominal Mufcles ; whereas in many Quadrupeds, there is a Pro¬ duction of the Peritoneum , which covers the fpermatic Velfels, but allows them to ly loots in the Abdomen , analagous to what we lee the Mefentery does to the Inteflines ; and when; thefe pendulous Veheis are joined by their pen¬ dulous Vas deferens , they enter the Orifice of a Tube formed by the Peritoneum at the Aper¬ ture of the abdominal Mufcles. This Tube formed of the P eritoneum, as the Finger of a. Glove is produced from the Glove, is continued down to the Bottom of the Scrotum, and con¬ tains the fpermatick Cord and Tefticle, which are only connected to it at the poflerior Part, where its Membrane advances to furnifh them their more immediate Covering, which ferves. to keep them in a right Situation, and to ftrengthen and proteCt them,

1 6. In our erect Pofture where the Moifture of the Abdomen falls down to the lower Part of its Cavity, and where the Bowels are always prefling with confiderable Force at the Paffage in the Mufcles, fuch a Tube continued from the Abdomen , would have perpetually collected Liquor in it, and made us much more fubjeCt to Hernie, of which there is lets Danger in Quadrupeds, in whom this Orifice of the Tube is at the higheft Part of their Bellies ; but be* caufe in {training Contractions of their abdo¬ minal Mufcles, the Vifcera might be pufhed out at this Orifice^ a moveable fatty Flap is

placecf

2 1 2 Medical Effays

placed at the lower Part of the Orifice, which the Bowels p refTed upwards mud carry before them to cover the Paffage, to prevent their get¬ ting out, and at the fame time to defend the fpermatic Veffels from the Preflure of the Bow¬ els ; which PrefTure in our ereft Poflure we are much expofed to, and therefore ftand greatly in Need of, and are provided with a tenfe Pe¬ ritonaeum, to defend our fpermatic Vefiels from it, notwithftanding which, the fpermatic Veins often become varicous, when the Belly is much dretched.

17. It may be worth while to remark here, that Nature feems to attempt a Contrivance to prevent Hernie in Men, a-kin to the fatty Flap in Brutes; when ever Men are brought by Dif eafes into the Hazard of Hernie-, from the Ori¬ fice of a Tube produced from the Belly. Af¬ ter the Reduction of Hernie, a fat Subfiance has grown out from the Peritoneum, at the Rings of the abdominal Mufcles, which pre¬ vented a Relapfe (/).

1 8 . Some have thought that the membranous Bag, deferibed and painted by Schrader (k) and Btdloo (/), from a Preparation of Swammer¬ dam's, coming out from the Peritoneum along with the fpermatic VeiTels, is a Proofof the na¬ tural Production of the Peritoneum here ; but as no fuch Bag is for ordinary to be leen, and we know nothing of the Circumftances of the Perlbn to whom this Preparation belonged, while thofe who have diffe&ed feveral People

who

(?) Pave, livre 18. chap. 1 S’.

(k) Qbferr. Dec. 2. Obf j\

Aoat. Tab, xxxii. fig. 3 and 4$

and Ohjervations. 2x3

who had long wore Trufles for Hernia? tell us, they found the Remains of the Sacs of the Her- nice of the Form which Schrader defcribes (m) ; it is reafonable to think Srwa?mnerdam* s Pre¬ paration was. no other than Rich a morbid Sac.

19. In place of one membranous vaginal Coat from the Peritonaeum , fome Authors («) have defcribed three firm Membranes in-veiling the fpermatic Cord, which they fay are Aponeu - rcfes from the Mufcles, thro’ which the Cord pa-fles : But as thefe w7ere only found in the Di-jf feed on of unreduced Hernice, we may eafily i- xnagine how this Appearance might be the Ef¬ fect of the morbid State of the Parts by the thickning of flretched cellular Membranes, tho* there are no fuch firm Membranes to be feen in a found State.

20. The real Structure of the human fper- matic Cord is, that the fpermatic Veffels and vas deferens carry along with them cellular Membranes from the Out-fide of the Peritonce- um , and acquire more as they defcend, which are at firll covered only on the external Side by the Cremajler Mufcle, and then are furrounded by it, till they come down as far as the fuperior Part of the Tefticle, when the cellular Mem¬ branes terminate, and the thin Fibres of the Mufcles are fpread on the vaginal Coat of the Tefticle ; as is to be feen evidently after put¬ ting a Blow-pipe into the upper Part of the fper- made Cord, and blowing Air into the cellular

Subftance

{m) Le Dran, obferv. chirurg. Reflexions fur Pobferv.jS. («) Du Blcgny Zodiac. Medico-gallic. Ann. i. Menl. Fcbr. obf. 1. Memoires de PAcad, des fciences, 1701,

2 r 4 Medical Effays

Subfiance. Ran (o) has given us a pretty good Picture of this.

21. In tracing the fpermatic Veflels accurate¬ ly we obferve, that at the Epidydimis they pafs between two contiguous Membranes, which can be feparated ; and if we continue the Dif- fe&ion of thefe Membranes from each Side of the Teflicle, we bring off a large membranous Bag, the Part of which that immediately in¬ veils and adheres to the Tefticle goes common¬ ly by the Name of the Tunica albuginea or pro¬ pria Tejlisy while the other Part, being refle¬ cted down from the Epidydimis , forms the loole vaginal Coat, and the Part of it which covers the Epidydimis , and deicends from that to where the Cremafler Mufcle begins to be firmly fixed to it, is called by fome late "Wri¬ ters the Septum or Partition between the fper- matic Cord and Tefticle, which may be confi- derably enlarged and thickned by Difeafes and the Addition of flretched cellular Membranes, adhering to the fuperior Part of it.

In the fame manner as is here propofed for bringing away the vaginal with the proper Coat of the Tefticle in an empty Bag, the Membrane of the Heart with the Pericardium , of the Pleu¬ ra with the Membrane of the Lungs, orthePe- ritoncBum with the Mefentery expanded over the Inteflines, and with the Membranes of the other ITifcera over which it is fpread, may alfb be taken out in fo many empty Bags ; and therefore, in the flrict Way of fpeaking, none of thefe Bowels can be faid to be contained

within

(«) Rcfponf. ad Ruyfch. Tab, 2, fig. 2.

and Observations. 115

within the Membranes that are commonly faid to invert them.

22. Befides the Artery which is named fper- matick, there are two others which commonly are fent to each Terticle ; one is a Branch of the Artery which furnifh.es the Vejicula feminalis and Proftata with Blood, that runs upon the Vas deferens as far as the Epidydimis ; and fome- times I have traced its Ramifications on the Te¬ rticle after a good Injection ; De Graaf (/>) re- prefents fome Part of this Artery. The other Artery is fometimes fent down through the Rings of the Mufcles from the Epigaflric ; in other Subjects it comes out below the dupli¬ cated Tendon of the external oblique Mufcle, that goes by fo many different Names of Vefa » Hus' s, Fallopius's, or Pouparfs Ligament, Dou¬ glas's Arcade of the Peritoncuum, &c. and af¬ ter giving Branches to the Scrotum, enters the cellular Subftance of the fpermatic Cord to go to the Epidydimis and Terticle. Winjlow (y) has mentioned this Artery.

23. Some Branches of Veins coming away from the corpus pampiniforme being joined with others from the Scrotum, form a Vein which accompanies the Artery lart defcribed to empty itfelf into the external iliac Vein near to the Ring of the external oblique Mufcle ; it is ge¬ nerally confiderably enlarged by Veins return¬ ing the Blood from the Teguments of the lower Part of the Abdomen.

24. The oblong Terticles are fituated ob¬

liquely,

(p) De viror. organ. Tab. 6. fig. i. H,

(?) Bxpofition de$ arteres, § 237.

ar6 Medical Effays

liquefy* lb that their convex longefi: Surface is anterior and inferior, while the Epidy dimis fix¬ ed to the other Sid<f is luperior and pofterior ; their Extremity, where the thicker Part or Be¬ ginning of the Epidy.dimis is, being exterior and fuperior, and the vds deferens going out: from the inferior, pofterior Extremity. >

25. The Membrane connecting the Epidy - dimis to the Teflicle finks in to the Root of the. Epidy dimis at the anterior Part, and lb leaves there a Furrow between the Teflicle and Epi¬ dy dimis ; whereas on the pofterior Part the Sur¬ face is fmooth without any Deprefion. By means however of the Deprefiion on the ante¬ rior Part, the Membranes of the two Sides come very near each other, admitting the VeiTels on¬ ly between them, which therefore run to the Tefticle at the pofterior Side of th q Epidy dimis, (See De Graaf’s Tab. i. and ii.)

26. The Fibres or Threads of which princi¬ pally the Tefticle is compofed, eafily feparate from each other, and a Tingle Thread can be drawn out to a great Length. Thefe Threads :t are probably VeiTels, but I cannot determine of what Kind, never having made a coloured Li¬ quor to enter them.

27. The pellucid firmer Fibres that run through the Middle of the Tefticle from the convex Side towards the Epidy dimis , dividing if in fome Meafure into equal Portions (r), which are commonly efieemed excretory Duffs, I believe to be Blood-vefiels, having forced a

colour-

k /

(fj De Graaf, Tab, 4. fig. 4.

md Ohfervations. ^ ,t\f

Coloured Liquor into leveral of them, by injeCl* ing the fpermatic Artery.

28. The membranous Subftance under the Epidydimis (/), generally called Highmore's T>u£iy has no Cavity that ever I could perceive, which fhould certainly however be evident, if it was the common Pipe for receiving the Li¬ quor from lo many Excretories as are laid to o- pen into it : It appears to be no more than the firm Membranes connecting the Tefticle and' Epidydimis together.

29. It has been doubted whether the vas de- ferens and Epidydimis were continued Tubes or not. To be fatisfied in this, cut the vas deferens through where it lies on the Infide of the veficula feminalis , and take it and the Te- fticle away from the Body, prefs the Epidydimis from its larger towards its fmaller Extremity, and from that to the cut End of the vas defe¬ rens , till you have fqueezed out all the Liquor you can, taking care, by fqueezing with moilt Fingers, not to let thefe Parts dry too much in doing this ; then put a long Pipe into the vas deferens , and through it pour Quickfilver, the Weight of fuch a high Column of Mercury, aftifted by your Fingers preffing from time to time towards the Tefticle, will make the Quick¬ filver go forward in the tortuous Canal about half the Body of the Epidydimis y beyond which I ne¬ ver could make it pafs, being, I luppofe, ftopt there by the Liquor, of which the Canals were full. By this Preparation one lees clearly the

Vgl. V. T tubular

I '

I ' »<.-■' •; * - > * ■ . - - * * * » • «*'■

. v . , -,f 1 .

(/) Highmore difquifit. anat. Tab, 11. fig. 1. pc Graaf, Tab. 4* fig* 4*

CLl 8 jMedical EJJajs

tubular Texture of the vas deferens , and the •wonderful Convolutions of it, where it has the Kame of Epidy dimis .

30. When the lpermatic Cords pafs the Rings of the external oblique abdominal Mufcles, they are lodged in the common funic a adipofa, till, they enter"the Scrotum , where no Fat is to be £een, but the Cords and Teflicles, involved in their vaginal Coats, are immerled into a cellu¬ lar Subfiance, the Cells of which all communi¬ cate with each other, fo that Water or Air for¬ ced into either Side, or at any Part, readily dif- fufes itfeif through the whole of it ; from whence it is evident, that there- is no membranous orr carnous Partition dividing one Side of the Sera -■ turn from the other. What has been fliewedl as a Septum Scroti is the Effect of a faulty Pre¬ paration ; either the Cords and Tefles have beem violently drawn out at an Aperture in the up¬ per Part of the Scrotum , and their Places have been filled with fome Subfiance to keep the Scrotum difiended till it became dry; or the Scrotum has been flit open on each Side at its \ Forepart to takeout the Teflicles, after which 11 it has been flretched out on a Board, and the Penis has been fupported to keep the middle Subfiance flretched till all was dry. By a Pre¬ paration made in either of thefe Ways a firm Septum may be formed ; . but then it is no more than the collapfed Cells all glued together ini the drying, and fuch as can be made in any Part o* the common Tunica cellu laris under the Skin of lean People, where there is no Fat. If we cut through the Middle of the Skin of the Scrotum, and violently tear away one Teflicle

and Qbfervations.

from the other, we will be likewife led into a Miflake concerning the Structure of the Parts here ; the collapled cellular Membrane will have the Appearance of a Sac inclofing each Te- hide, and we fhall believe the two Bags were

only applied to each other. - The Way to

have a right Notion of the Structure of the Parts here is to diflend the cellular Subfiance of the Scrotum with Air, while the Scrotum is ‘entire, and the Teflicles are in their natural Place, and then to dry them ; or rather to cut the Skin all along the Middle of the Scrotum of a recent Subject, and then to draw the Skin gently to each Side, cutting gradually what we have viewed fufficiently, and bringing the Sides of the Incifi~ on nearer together from time to time ; then we will be fenfible that the Teflicles are connefl- ed by cellular Membranes which are capable of being . flretched to a very great Extent, and when collapfed go into a very fmall Space, and that the Teflicles are every where in fuch a Sub- fiance.

3 1 . What fhould prevent the VefTels of thefe Cells from feparating an oily Liquor into them, as is done generally into the Tunica cellularis elfewhere, I don’t know; but the Want of Fat here faves us the Trouble we might have from the firetching of the Skin and fpermatic Cord by its Weight, and we are not fo much expo- led to Bruifes and other hurtful Accidents, as if the Scrotum was larger by the Addition of Fat,

. , v ,

32. I had Occafion formerly ( t ) to obferve

T 2 to

(t). Medical Eflays, Vol. III. Art.

£20 Medical EJfays

to you, that the cellular Subfiance under the: Skin, when it has no Fat in it, puts on a mu- Icular Appearance and wrinkles the Skin; if does the fame here in the Scrotum , and thele collapfed Membranes entirely compofe what is lo formally delcribecl as a Mufcle under the: Name of Dart os . Whoever will number the Dartos among the Mufcles ought to reftore the 5 exploded Tunica car no fa to its Place among' the general Teguments of the Body.

33. The cellular Membranes at the upper Part of the Scrotum are firmer than lower down, and the Difference becomes much more remark* able when they are ffretched by any Dileale ; ; this depends on their being connected to the! Top of the Thigh on one Side, and to the Os pubis on the other, and Ibme Addition which feems to be made to them of Fibres from the tendinous Aponeurofis of the Fafcia lata , and from the lulpenlory Ligament of the Penis .

34. The Skin and Cuticula of the Scrotum\ are of the lame Structure as ellewhere, but the little Wrinkle called Raphe , extended along . the Middle of the Scrotum on the lower Part of , the Penis , and on the Perinceum, has been thought to delerve particular Notice ; and by the Cautions that are given to Ihun it in Ope¬ rations one would imagine it to be fomething conliderable ; to me it appears no more than the Skin ffretched a little lefs in the Interffice of the Tefticles than in other Parts, and there¬ fore making a larger Wrinkle ; for whenever Water or Air, introduced into the cellular Sub¬ stance, diffends the Scrotum equally, the Raphe difappears. An Injury done to it, I can affure

and Obfervations. Mi

you, is of no worle Confequence than when done to any other Part of the Scrotum .

35. The principal Artery of the Scrotum on each Side is what comes from the crural Arte¬ ry, and crofling over the anterior Part of the lpermatic Cord, fp reads its Branches every where in the Scrotum , and a large Branch or two is given to the Skin of the Penis. Other fmaller ones it has that come down from the Epigaftric and Pudenda , and I have leen others rile up to it from the Branch of the Hypoga- ftric, which lerves the Perineum.

36. Its principal Vein accompanies the lar¬ ger Artery, or frequently is a little higher up.

W hen I propofed to anfwer your QuelHon, Gentlemen, Whether the Artery from the Glan¬ dule renales to the Ovarium and Tefies was conilantly or feldom found, I had no De- fign of engaging mylelf in the Anatomy of the Scrotum and its Contents ; lb dangerous a Thing is it however to begin to (cribble, that not finished with writing already ten Times more than I intended, I have now the Inclina¬ tion to try what Ufe is to be made of this Piece of Anatomy in the Knowledge and Cure of DiE eales, by taking the kh\cu or Tumors of the Scrotum under Examination, I fancy Remarks might be made on thefe Dileales which might be uleful to the Students of Phyfick and Surge¬ ry, if you fhall think what I am foon to lend you of Service to the young Folks, I know you will publifh it : If you are of Opinion that my Remarks are ufelefs, you will oblige me in fup- preifing them.

T 3

XXI. Re-

222 Medical EJJays

XXI. Remarks on inguinal Herniae tn Mens by the fame.

THE Vifcera of the Abdomen cannot fall down through the Rings of the Mufdes to form a true Hernia in the Groin or Scrotum without the tenfe Peritonaeum covering thole Kings (§ 1 6.) is either broken or flretched ; the former feems to have been the prevailing Opi¬ nion in Britain when the Name of Rupture or BurRen -belly was given to this Difeafe ; the latter Opinion, to wit , that the Peritonaeum is thruR down into a blind Bag in which the Bow¬ els are contained, is what many Operations and Diffections have proved to be almofi conRantly the Gale.

The Situation of the fpermatic VefTels, (§ 4.) may let us fee that in Hernice the Sac of the Peritonaeum , with the included Vifcera muR be always placed at the anterior Part of the fpermatic Veffels, and the Defcription of the Cremafer Mufcle, (§ 14.) may teach us, that , in defending towards the Scrotum , the Sac i may either enter within the Cremafer , or may pafs over it at the internal anterior Part of the fpermatic Cord, the cellular Membranes of the Cord in the former Cafe, and of the Scrotum in the latter yielding to the force pulhing the Vif cera down.

In thefe Cafes the Form and Effeds of the Hernlce will be a little different.

When the Sac defeends within the Cremafer Mufcle, the Tumor will be more perpendicu¬ lar; more oblong and tenfe., becaufe of the

Bowels

and Observations. 223

Bowels being retrained and confined by the Muffle. The Septum, (§ 21.) will hinder it to deffend to the Tefficle, which, (§ 24.) wili be felt at the external anterior Side of the her¬ nial Tumor, and if the Sac with the Bowels is pufhed fo violently upon the Septum , as to ilretch it, a rifing Ring will be formed round the Sides of the Teflicle, and the Epidydimis is concealed.

If the hernial Sac falls without the Crema- Rer, it will deffend towards the interior Side of th z fpermatic Cord , its Form will be round¬ er, and the Sac will not be fo tenff as in the former Cafe, it may go down as far as the Te- fiicle, which, with the Epidydbnis, will be felt on its external Part. If the Hernia is very large* the Sac may be fo difiended, as almofl to fur- round the Tefficle.

The Effecls of a Hernia on the different Parts forming the Tumor will be theff.

The firetched Skin will have all its Vefiels, particularly the Veins, confiderably enlarged, which is a common Effefl of firetching the Skin any where, but muft be more remarkable here, becaufe of the Situation of the principal Vein, (§ 36.) the Trunk of which is much ex- pofed to be preffed upon.. This Diffenfion of the Veffels mufl be proportional to the Preffure on the Vein, the Largenels of the. Tumor, and the Time it has continued., A final!, . floating, recent Hernia , will not have its cutaneous Vefi fels fo much diffended as a very large ftrangu-- lated old Rupture of long Continuance..

The cellular Membranes, having their Cells applied nearer to each other by the ffretching- . become

a 24 Medic at Ejffays

become firmer ; and by continuing in this Con¬ dition, increafe their Thicknefs and Fi mi¬ ne fs in the fame Way as we obferve them to do every Day in forming the Sac of incyjfted Tu¬ mors, and in many other Cafes. Thofe of them which are annexed to firm Parts will fuffer mofl in this Way from the PrefTure ; fo that we need not be furprifed at feeing fometimes a crofs Band at the fiiperior Part of the Scrotum , (§33.) in hazard of flrangulating the Hernia , or to ob¬ ferve feveral membranous lamelice that appear to be Aponearofes from the abdominal Mufcles,

(§ 19O

What was (aid of the VefTels of the Skin, may be applied alfo to the cellular Membrane, whole enlarged VefTels will pour out Liquors in¬ to the Cells that are not violently flretched. Hence the Scrotum becomes frequently thick in Hernie , and as the Liquor is more or lefs vif« cid, the thickned Scrotum will be more or lefs hard, fb that we may obferve it in all the De¬ grees between a watery Swelling, and a firm S chirr us.

The Peritoneum will not only have the Sac containing th zVifcera affefted in the Way the Parts hitherto defcribed are, but where it is flretched within the Belly, near to the protru¬ ded Part, it may be drawn into unequal Wrinkles, which will likewife thicken, and may grow together.

The VefTels of this depending Sac will pour out their Liquors in greater Quantity, and if the abdominal Liquor is collected in Drops, they will drill down into the Bag, on which account we meet fo frequently with a Liquor

con-

and Obfervations. n j

contained in the hernial Sac. When this Li- quor is mild, it is fo far from being hurtful, that it is the bed: Prelervative againfi the Con¬ cretion of the Sac and its contained Vifcera , or of the Vifcera to each other.- - If this Li¬

quor becomes acrid it will fiimulate, give Pain, and erode the folid Parts.

The Vifcera contained in the hernial Sac9 muft draw thole they are conne&ed to within the Belly, which may make thefe Parts alfo to fufier. Thole in the Hernia being firaitned in the preternatural Sac, efpecially where the Membranes are lupported by firm Parts, which prevent their firetching as at the Ring of the external oblique Mufcle, the contracted wrink¬ led Peritonaeum , or the crofs Membrane at the top of the Scrotum , (§ 33.) their Vefiels will be prefied, and the returning Liquors being molt eafily flopped in their Courfe, all the Vefle!s be¬ low this firaitned Part will.be firetched, and the Volume of the Parts to which they belong will confequently be increaled.

All the hollow Vifcera having lome Fluid or other Subfiance contained in them, and fuch Vifcera being often engaged in Hernia?, their Contents may be retained and collected in this depending Part, by which the Vifcera are dis¬ tended, the Vefiels are more firetched, and

the Bulk of them is increaled. - — The Heat

of the Body and the Corruption, which thefe Contents of the hollow Vifcera are expofed to by ftagnating, may make a Rarefaction of thefe contained Subfiances, and confequently a greaterDiftenfion of the Parts containing them.

The Difienfion, ObfiruCtion and Irritation

may

22 6 Medical Effays

may occafion Pain ; and that Effort Nature makes for being freed of the Caufe of fuch DIP orders which we call a Fever, is raifed, from , which there is Danger of all the Diforders being; in created ; the Veffels may be more dihended, , which will increaff the Irritation and Pain ; ; the Heat and Corruption will conffquently in- - creaff, and make the Diftenfion of the Parts greater ; the Obftruclion may become complete, and therefore the Parts may mortify. What is now defcribed Surgeons call the inflamed ffrangulated State of a Hernia , the Progrefs and Symptoms of which are told accurately e* nough by moft Writers on this Subject, and therefore I /hall not give any Detail of them.

If the Effort of Nature fhould prevail, and the Obflrudtion be removed by the Fever, it muff be either in the Way of Suppuration or Refolution , Terms fb well known, that it is heedlels to explain them.

In the more favourable of theff two Caffs,* the Refolution , tn zVifcera and their contained Bag,' being, while in the inflamed Condition, prefffd cloff together, and no Liquors being poured out, are liable to grow together *, and they always acquire an Addition of Subftance which they do not quit eafily ; lb that they are thicker and firmer afterwards. - In the Sup¬

puration , befides the Danger of Concretion du¬ ring the Inflammation, the Pus not having a- ny Paffage out, may become acrid, erodes the Parts it touches, and may be taken into the Veffels to create various Diforders.

When there is no Impediment, Nature or Art can make the Bowels return into the Belly

by

and Obferv at ions. ivy

by the fame PafTage which they came out at ; and if that PafTage can be fufficiently block¬ ed up, a Return of the Difeafe may be pre¬ vented.

When the Bulk of the, Parts becomes fo great that they cannot return by the PafTage they come out at, or there js a Concretion of them to the. neighbouring Parts, they mult remain in this morbid hernial State till their Bulk di- minifhes, or the PafTage is enlarged, or their •Concretions are difu'nited.

The Bag in which the Vifcera are contained in a Hernia , having little fpringy Force or cony traflile Power, to make it thrive! itfelf up \ into the Belly, and being fo thin that artful Prefb Pure cannot be fo well applied to it, and being immediately contiguous to flretched Membranes which may grow to it ; for thefe Reafons the Bowels often return into the Belly when the Sac is left behind, and being prelfed at its up¬ per Part, by the Subfiance blocking up the PafTage through the Mufcles, is made narrow there, or its Sides may grow together, while the lower Part of it may be filled with Water from the Abdomen , or from its own VefTels (a) ; or if this does not happen, it fhrivels and di- rninifh.es . See § 18.

When the Vifcera are flraitned any where in their PafTage down to the Hernia , the fper- matic VefTels, which are placed behind the Sac containing the Vifcera , muft fufTer more or lefs, and thence a varicous corpus pampini forme, thickned fpermatic Cord from the Repletion of

its

{a) Saviard, obferv. 22* J-e Dran, obferv. 7$«

2lS Medical EJJays

its Cells with Liquors, Water collected withirir the tunica vaginalis of the Teflicle, fwelling of the Teflicle itfelf, Inflammation of all theft Parts, and all the Confequences of Inflamma¬ tion, Goncretion, Suppuration, Gangrene.

It is evident hOw varioufly thefe different Ef¬ fects of Her nice rrlay be combined, and of what different Degrees each of them may be ; and: their Defcription may ferve to make us know them when they happen to any Patient.

Though the Bowels forming a Hernia are ge¬ nerally included in a Sac formed by the protru-. ded Periionceum, yet it is not impoffible thatr the Peritoncvum rhay be tom by a violent hid¬ den Effort caufing a Hernia ( b ) ; or tho* the Peritonceum defcended at firfl, it may be burft- cd by fome external Violence (c), it may be eroded by Pus , or fall away by Gangrene (</).

Allowance being made for the Want of the* Sac, the Effe&s of this rare kind of Hernia i may be eafily underflood by what was faid of the other; and the Want of a tenfe Bag co¬ vering the Bowels, with the Hiflory of the Caufe of the Difeafe and its Progrefs, will make Surgeons judge when this is the Cafe,

What I have hitherto mentioned may hap¬ pen whatever is the Bowel that forms the Her - nia, but there are fome Specialities which at¬ tend the feveral Vifcera engaged in this fort of Tumour, that had need to be attended to.

The Inteftines and Omentum are the Parts

which

(i) Garengeot des operat. chap.

(c) Id. ibid. Mery, Memoires de PAcad. de Lienees,

t7oi.

(d) Saviard, obferv.

and Obfervations . 2,2,9

which fall moR frequently down, the Appear* ances and Gonfequences of which are well e« nough defcribed in leveral of the moft common Books.

InRead of an entire Piece of Inteftine being thruR out, which commonly is the Cafe, one Side of a Gut has been Rretched out into an Appendix caeca, which was protruded out at the Rings of the abdominal Mufcles (e). When this happens the Ingefta will not be Ropt in their PafTage towards the Anus , and the Patient will go to Stool even though a Strangulation of the Hernia Ihould come on ; whereas when the whole Diameter of the Gut is flraitned by a Strangulation, the Ingefta will be Ropt at the Hernia ; after the Guts below it are emptied, the Patient paifes no more Fasces , and the In - gefla regurgitate towards the Stomach and are vomited.

The Bladder has (ometimes been found to fall down in a Hernia (/'), the Fluctuation of a Liquor which can be preRed into the Body,, to occafion a Defire to make Water, or to run immediately out by the common urinary PaR fage, are the Symptoms by which this Species of Hernia may be difcovered.— — The man¬ ner in which the Peritoneum covers the Fundus and back Part of the Bladder, and the Way it is connected to the containing Parts of the Ab¬ domen at its lower Part, would make one rea- fonably believe that the Bladder will not carry a Sac of the Peritonaeum down before it ; but Vgl. V, , U that

(?) Littre, Memoires de PAcad. des fciences, 1700. Me¬ ry, ibid. 1701.

{/) Ruyfth, obferv. 98, Mery, Mem, de PAcad, 1713 9

2,30 Medical Ejfays

that one Side of it gradually thruft between] the ' Peritonaeum and Mufcles would be ftretch-* ed out at the Rings of the Mufcles to the Scro¬ tum, where it would ly either behind or at the internal Side of the fpermatic Cord, and if it remained there any Time, would grow to the contiguous Parts.

Though I treat only of the Tumors of the Scrotum, it may not be altogether impertinent to mention here, that the other Sex have had^ the Uterus thruft thro’ the Rings of the Mufcles to form a Hernia (g), which there would be a Difficulty to dilcover if there was no Child in it, whole ftirrings would lead us to the Know¬ ledge of the Contents of the Hernia.

If the Progrefs and Symptoms of any Tu¬ mour in the Groin and Scrotum are accurately enough examined, one who is acquainted with the Seat and Nature of the different Difeafes which happen here will feldom be in Dangen of miftaking any other Difeafe for a Hernia , or of judging a Hernia to be fome other Dift,

eafe. - One of the Cafes which would be mofti

liable to occafton a Miftake, is a Tefticle lod¬ ged either naturally at the Ring of the abdo¬ minal Mufcle (£), without having been obfer- ved till fbm'e Accident makes it fwell and be pained, or a Tefticle retraced thither by In¬ flammation or Contufton (i). - No Tefticle

being found when fought for in the Scrotum , the Figure and greater Hardnefs of the Knot in

the

( jrj Michael Doring. de hernia uterina epiftola.

(h) Pare, liv. 8. chap. 18. Jac. Oeth. lib. obf. propr, Aft. Hafn. Vol. I. obf. ij6.

(z) Bonet, fepulch, anat, lib. 3, fed. 30, gbf. 3.

and Obfervations. 2,3 1

the Groin, and the Ablence of the moA com¬ mon Symptoms of a Hernia ruffle e for making us diAinguifh this Cafe.

The Prognofes of Bernice depend on fo ma¬ ny Circumftances of the Patients and of the Symptoms, that I chufe rather to pafs them al¬ together, than to enter upon the numerous Sup- pofl lions which might be made.

That Bernice fhould be reduced affoon as pofiible all agree ; to effebluate this without cut¬ ting or eroding is what Surgeonsca.il the Taxis : For this F'urpofe fuch a Poflure of the Patient’s Body as makes the Vifcera prefs leaf! on the Rings of the abdominal Mufcles, and relaxes the Skin and Mufcles moft, is of great Advan¬ tage ; fuch is lying on the Back with the Hips and Shoulders raifed higher than the Loins, and the Thighs bended forwards, without ufing any Effort of the Mufcles: "While the Patient lies thus, the Surgeon gently pufhes the Vifce¬ ra up with his Fingers alternately applied to a fmall Part of them at once, as is commonly delcribed well enough.

If this Attempt does not fucceed, general Di¬ rections are given for removing the Impedi¬ ment to Reduction by plentiful bleeding, emol¬ lient ClyAers, Fomentations and Poultices. As all thefe are calculated for the inflamed State of Bernice , they do very ill, in my Opinion, who prefcribe no other Method ; for though Hernice , efpecially recent ones, that will not reduce, are liable to inflame and Arangulate, which ve¬ ry foon brings, the Patient into Danger of his Life, and therefore Surgeons ought to be much on the Watch to guard againA Inflammation ;

U z J yet

1^2 Medical E fays

yet an over Care to prevent it ought not t© make them do things that may retard the Re* duCtion, or make it more difficult, fence it is the mod effectual Prefervative again# all the bad Symptoms. The Directions mentioned a- bove, and almoft univerfally ordered and put in Praftice, are, I think, in this refpeCt, faul¬ ty ; if, for example, the Obftade to Reduction is the rarified Air within the Guts diftending them, would not the warm relaxing Fotufes and Cataplafms increafe the Diftenfeon ? Since the fir# Edition of this Volume, I have feen a Cafe of a Hernia related by Dr. Huxham (£), who blames the repeated Application of hot Fomentations for the vaft Expanfeon of the Rowels. I have feen cold Claret or Snow make the diflended Intedines return into the Belly after the Antiphlogiftics , as they are called, had increafed the Swelling, and the common Ef¬ forts of ReduClion had failed.- — — - In the fame way, when the Tone and Contraction of the Guts is too weak for pufhing the Inge ft a, which defcend into thePart of the Gut engaged in the Hernia , upwards, to go forwards to¬ wards the Anus , and thereby thefe Inge ft a come to be collected in the Hernia , and to piake the Intefline there too bulky for palling the Ring of the abdominal Mufeles, Blooding and relaxing Medicines will weaken the Tone of the Guts more, and fo increafe the Difeafe ; a briflc Stimulus given by the Mouth or Anus would much more effectually make a Cure. I have many times made a Rupture reduce by

giving

fe) Philof. Tranfaft. Num. 4;p. § 22,

and Obfervations v $$}

giving Powder of the Jallap Root and fweet Mercury, when neither Hands nor Emollients

did any Good. - Will not the foft flabby

Omentum , if it is lodged in the Hernia , be al- ways more relaxed, and Iwell more by the Ap¬ plication of Emollients ? What I would recom¬ mend then is to examine accurately the Cir- cumflances of the Dileale, and to vary the Me¬ thod of Cure according to the Nature of the Ob- ftacle to Reduction, whether it is Air, Faeces, increafed Growth of Parts, or overflxetched in¬ flamed Veflels, which laid only admits the Ule of the things that are prelcribed as proper in all Cafes, and, even in it, Caution is neceflary

in ufing thole Medicines. - — If a Perlon is

old and weak, the Lofs of too much Blood may link him, and make the Liquors Aagnate in the diflended Veflels, to bring fpeedily a Mortifi¬ cation. - If the Patient is of a very lax Con-

flitution, bleeding to Excels and the Applica¬ tion of Emollients may weaken the Veflels fl> as to make them continue in their diflended State.

If the Vifcera will not reduce by the Methods hitherto propofed, and the Symptoms of Stran¬ gulation come on, there is a Neceflity of- per¬ forming the Operation for the Bubonecele or complete Hernia ; the Rules for which, laid down by late Writers, are well enough accom¬ modated to the moft ordinary Circumflances of Hernice ; though it is plain, that as thefe are various, Operators mufl fometimes change their Manner of working. I {hall not there- t fore give you the Trouble of reading a Defcri- pjtion of the Operation for the Hernia in the

U 3 Groin

2.J4 Medical EJfays

Groin or Scrotum, but fhall make Tome Remarks on Parts of the Operation where there is Doubt what ought to be done, and on fome of the more uncommon Cafes.

When the Vifcera are not confined within a Sac, which I obferved was fometimes the Cafe, more than ordinary Care is to be taken in mak¬ ing the Incifion through the Teguments, left the Bowels fhould be wounded.

When the Sac is laid bare, it ought to be confidered, whether it is to be left entire and pufhed up into the Rings after the Bowels are reduced, or if it fhould then be laid open. Cir- cumftances muff determine this ; if the Difeafe is recent, with the Sac thin and not folded in¬ to Wrinkles, or flraitned where it is coming through the Paffages in the Mufcles, or grown to any other Part ; if the Bowels are found and in no Danger of Gangrene, or are not grown to the Sac ; if the Liquor in the Sac is limpid, and no Foetor or Erolion is to be obferved ; if all thefe Circumflances appear, the Reduction of the Sac entire will be of Service to block up the Paffage, and to prevent the Vifcera from being expofied to the ACtion of the external

Air.— - Where thefe Circumflances don’t

meet, the Sac ought to be opened for very ob¬ vious Reafons ; the w'rinkled or contracted Sac may continue the Strangulation after the Ring of the Mufcle has been cut (/ ), the Sac or Bow¬ els, fixed by Concretion will not reduce; an opened Gut will let out the Ingefta , and a mor¬ tified Omentum will Hough off into the Abdo-

meii*

(/), Le Dran, obfery.

and Obfervations. <13$

men, from which there is no Exit; and flag- nating there, they will corrupt more, apd do great Mifchief. The fame Effeft may be ex- peeled from the Liquor in the Sac, if already acrid.

If there is a confiderable Concretion of the Bowels to the Sac, and this is grown to the Scrotum , the Surgeon had better leave the Bow¬ els unreduced, after cutting the flrangulating Ring, than rifle the Life of his Patient by a te¬ dious Diffeflion of the concreted Parts, efpeci- ally if the Guts or Bladder are the Parts grown to the Sac ; for when the Strangulation is re¬ moved, the Vifcera may pofhbly fhrivel up, or if they continue down a Cicatrice may be brought over them, in which Condition the Patient may live a confiderable Time.

When in fiich a concreted State of the Bow¬ els the Strangulation depends on fome Piece of a Gut lately fallen down, this fhould be re¬ duced while the other Parts of the Bowels are. left down Cm).

Tho’ the Gut in a Hernia is mortified, Sur¬ geons ought not to give over the Care of their Patient, Jfince there are feveral Jnflances of fuch People furviving with either an artificial Anus at the Ring (»)> or Nature has reunited the di- Tan t Pieces (0), or fhe has been affifled by Art to join them (/>). Mr. De la Peyronie ’s Me¬ thod of Bitching the Parts of the Mefentery be-

longing

(m) Morand. in De la Faye’s Notes fur Dionis, p. 55 .

(«) Mery, Memoires de l’Acad. des fciences,. 1701. Che- felden’s Anatomy, p. m. 69. Le Dran, obf. 60.

(0) Courtial. obf. 6.. Medical Eflays, Vol. I. Art. 20.,

{p) De la Peyronie Mercure de France, Juillet 1732, ^ojirius coniinerc, Nwimberg, 1731, Spec, 26*

q.%6 Medical Effays

longing to the two Ends of the divided Gut* fee ms preferable to Ramdohrius' s Practice of Pitching the Gut itfelf, for this irritates more,, and the Threads of the Stitch will not come a-- way lb eafily, and more readily leave an O-* pening in the Gut, than when the Stitch is > made in the Mefentery.

Though nothing appears in Sight when the; Sac is opened except the Omentum , the Sur¬ geon ought to examine carefully, whether any Ply of the Inteftine is wrapped up within the Caul, that they may be difengaged from each . other, left the Gut be cut or tied, if there is Occafion to perform any fuch Operation on the Omentum .

If the Omentum is not abfolutely mortified, it fhould have the Chance of recovering by be¬ ing reduced, fince at worft no more Inconve^ nience will happen from the Separation of what Nature mortifies, than what the Ligature, which mu ft be made on the prelent Suppoft- tion, occafions.

It is a doubt with me, whether the Omentum ought to be tied before the mortified Part of it is cut off ; for by the Ligature more of it is de- ftroyed than would be if the gangrened Part fe- parated of itfelf, becaufe the Ligature is made in the found Part, and by the Thread the 0 - mentum is drawn into a Knot, which may do Hurt. Supposing the mortified Part to be cut off as near to the found Part as the Thread in a Ligature is put from the Place w ere the Gaul Is to be cut off, would the cut Veflels in the re¬ maining mortified Part bleed ? or would the Gangrene more readily fpread without a Liga¬ ture

and Obfervations. 237

tore than with it ? The Anfwer to thefe two Queflions ( which I neither have Experience, nor can I find any Obfervations of others to afc fill me to anfwer) would determine what the Practice fhould be. Since what is above was publifhed, I have read two Cafes (^), where there was no Hsemorrhagy, nor further Pro- grefs of a Gangrene, after cutting away a con- fiderable Share of the Omentum on which no Ligature had been put.

After the hernial Sac is emptied by the Re¬ duction of the Bowels, a membranous Sub- fiance will fbmetimes appear refembling a Piece of Gut (r), which is no more than a folding or doubling of the Sac, and ought to be let alone, without fatiguing the Patient with the Diffe- CHon of it.

After the Bowels are reduced in Appearance, the Surgeon ought to fearch with his Finger left there be any contracted Ringlet, crofsBars or Productions of the Peritonaeum above the Ring in the Mufcle, which might continue the Strangulation of the Gut, that they may be cut to make the Gut quiteTree (/'), Such flrangu® fating Rings are rnoft readily to be met with in People who have long wore Trulfes, wrhich have preffed the Sides of the Neck of the Sac together.

When the Intefline is opened, or there is Gangrene or Inflammation on it, that may give Reafon to expeCt it will be opened, when

the

(q) Philof. Tranfaft. Numb. 443. § 8. and Numb. 45:0® § 2.

( r ) Mery, Memoires de PAcad. des fciences, 1701*

(/) Lc jbran, obferv. j8.

238 Medical Itjfays

the Suppuration comes on after the Reduction of a Hernia, or if it is expected that any Part of the Omentum will feparate, the Peritonaeum and Ring of the Mulcle ought to be kept open, to allow the putrid Matter to be evacuated ; but the Subflance introduced into the Paffage ought neither to be fo hard as to bruife or irritate, nor lb large as to hinder Liquors to drill along it, led an Inflammation be railed, and the Pus , faeces or Aliment be pent up within the Abdo-

jnen, to the Ruin of the Patient. - But

when there is no Realbn to expedt the Eflfufion of any luch putrid Subflances into the Abdo¬ men, the looner we can (hut it up the better. If we could raife up the hernial Sac from the fpermatic Cord with little Trouble, and then ,puta Ligature round it dole by the Ring of the Mulcle, it would fliut up the Paflage mod ef¬ fectually during the Cure, and might be a Means of Security againA a Relaple.

It may be faid in general, that the antiphlo - giftic Regimen is to be oblerved after this Ope¬ ration ; but Regard mud be had to the ConAi- tution of the Patient, and CircumAances of the Diieafe in prelcribing it, for thele will lome- times oblige Pradtifers to alter the common Method.

When the Gut has been opened or divided, the Patient needs to guard againfl too full Meals for a confiderable Time after, or for all his Life, if the Gut has . been divided quite- crofs, to prevent the bad Effcdls which the Prefliire of a large Quantity of Food Popping At this Part of the Gut, which is generally draitned, might produce.

After

and Obfervations. 23 p

After the V ifcera of a Hernia have been re¬ duced, the Paffage in the abdominal Muffles, by which they effaped, mud be firaitncd or blocked up to prevent a Relapff. While this is doing, the Vifcera mud be hundred to come out by the Patient lying horizontally on his Back with his Hips a little railed, and by a proper Bandage.

The dilated Parts have iometimes been lb ilrengthned by the Application of adringent Medicines, as to keep the Bowels up (/) ; ge¬ nerally however they are infudicient for the Purpoff.

By Preffure continued long, the Sides of the Peritoneum have been made to grow together {a) ; but unlefs the Ring of the Muffle make a diffident Reddance, the Peritoneum thus fol- dered will not do it.

If the Paffage is kept a long Time from be¬ ing dilated, the Sides of it gradually contract themfelves, and become firmer, to hinder the falling down of the Bowels ; for this Purpole different Bandages have been contrived.

The Spica Bandage , with proper Compref fes, andyers the Purpofe very well, and is al¬ ways ufed where there is Wound or Ulcer, be- cauff it can be ealily cleaned ; but to People, who are to wear the Bandage long, and in the mean Time are to be out of Bed and to move, without any" Sore to dirty the Bandage, the Spica is inconvenient by the Trouble there is in applying and undoing it, and by the Turns of it

f re¬ ft) Medical EfTays, Vol. I. Art. 28,

(w) Le Dran, obferv. 77,

&40 Medical EJfays

frequently Hiding out of their Place ; where¬ fore to fuch, a compound Bandage is generally applied.

The Bolflers of mofi compound Bandages, or Truffes are much too foft, they can yield a$: much as to allow the Vifcera to come out, when the Patient makes any Prong Effort that pufhesr the Bowels upon the Bolfler; they fhould be very hard fluffed, or made of Cork or fbme fuch Subfiance, with Leather flretched over it.— « The Shape of thefe Bolflers is generally too ve¬ ry faulty; the Convexity to be applied to the Skin is either equal from the fuperior broad! Part to the inferior narrow Point, or very gra¬ dually diminifhes all the Way, by which the Point being applied upon the Os pubis , the Part of the Bolfler above it is born off from the Skin, and a Hollow is left jufl at the Ring of the Mufcle to allow the Bowels to come out, efpecially when, by bending the Body, the up¬ per End of the Bolfler is alfo forced outwards. They ought to be made with fuch a fudden Fai¬ lure of the Convexity, that they may fit dole to the Hollow immediately above the Os pubis * See fuch a Bolfler reprefented Tab. v. Fig. 8. or they ought to be made thicker below than above, applying the thickefl Part immediately above the Os pubis .

The compound Bandages which are made for Children, without any Steel or other firm Subfiance on the outer Surface of the Bolfler, can have very little Preflure on the Rings as they are commonly "applied, with the circular Belt fewed to each Side of the Bolfler, for their Convexity foon becomes all external by their

Appli-

and Ohfervations, 241

Application ; whereas if the circular Belt was brought crofs over their external Surface, the full Effett of the PreHure might be had on the Rings of the Mufcle. To bring the circular Belt thus crofs the Bolfler, the Belt muft be put low- er down than it is commonly applied.

If a right-made Bandage, that prevents the falling out of the Bowels, is kept applied feve- ral Years to Children, the Peritoneum and Ring may become fo firm, and the Vifcera may grow fo large, that the Rupture may not after¬ wards return ; but if the Bandage of Children allows the Vifcera to come out fometimes, and in x4dults, where the ftretched Peritoneum and dilated Ring cannot fo well recover their for¬ mer State, and the Bowels do not grow larger, there is always Danger of a Relapfe, if a con- Rant PrefTure is not kept on the Ring, at leaf: when the Perfon is in an ereft Poflure ; nay, I have obferved, that moil of thole who wore a Bandage for this Difeafe when Children, Buf¬ fered a Relapfe if they laid afide the Bandage when they grew up.

Formerly feveral different Operations were praftifed for blocking up the Paffage by which, the Bowels fall out, after they were reduced. The Caft ration , Punflurn aureum and cauteri¬ zing, were laid afide after Truffes came to be tolerably made, till fome Years ago the Caute¬ ry was revived here in Britain with great Eclat , notwithflanding its being pra&ifed by thofe who were altogether ignorant of the Nature of the Difeafe, and of any reaibnable Intentions of Cure. By their promifing more for its Succefs than could be performed by it, to wit, a cora- Yojl. V* X plete

24^ Medical EJfays

plete and abfolute Security againA any Return of the Difeafe, whereas it failed in moil or all Adults it was pradiled on (z;), and by the ma¬ ny Blunders thofe Ignorants committed, the Reputation of this Operation funk in a little Time fo much, that it is now negleded, tho’ it would feem capable of being performed fafe- ly, and with fbme Advantage.

What could be reafonably propoled by this Method is, after reducing the Hernia , to de- flroy the Skin and Fat covering the Ring of the external oblique abdominal Mufcle, and to make new Flelh rile round the fpermatic Cord in the Ring itfelf j by this new Flelh the Ring may be blocked up, and by bringing a firm Cicatrice immediately over the Ring, inflead of the flex¬ ible Tunica adipofa and Skin, a Sort of Bolder might be formed for refilling the Fife era when they were pulhed outwards.

The late Operators applied for this Purpole a Cauflick to the Skin, without having, fo far as I could ever learn, any Rule to know when it had eroded deep enough. If their Elchar was too fuperficial, the Deflgn of the Operation could not be anfwered ; if the Cauflick eroded too deep, the fpermatic Velfels would be de- flroyed. I have been aflured that after this O- peration was performed, the Te Aides of fome Children, who had undergone it, fhrivel’d dai¬ ly away, fo that they were efFedually caftrated. When the Cauflick penetrated fo far as the Fi¬ bres of the Crema/ler Mulcle, would not the Teflicle be drawn convulfively up towards the

Ring

(x>) See Koulton’s Hiltory of Ruptures.

and Obfervations . 243

Ring of the oblique Mufcle ? and would not a contrary Cauftick immediately Hop the further Action of the one firft applied ? ' Though it is reafonable to anfwer both thefe Queries in the Affirmative, yet never having made the Trial of the Cauftick in this Way, I ffiall defire none to praftife it, fmce they can do what I menti¬ oned to be intended, without any Risk, by pinching up the Teguments which ly over the Ring, and then making a longitudinal InciHon fome Inches in Length, the Middle of which ought to be over the Ring, the Depth of it ffich as to bring the fpermatic Cord in View ; then by the lunar Cauftick, fmall Quantities of the common Cauftick or other Effharoticks rightly applied, deftroy the fatty cellular Membranes in the Ring and under the Skin ; after which haften a Cicatrice by the Application of ardent Spirits, or Tin&ures made with them ; and by this endeavour to make the Cicatrice adhere to the Tendon in the Way Cicatrices generally do to Bones, Fart of which has caff off where there has been any Ulcer of long Handing near them. By lying a-bed to prevent the Vifcertz coming out during the Time of the Cure, which allows the Ring of the Muffle to contract, and by the Cicatrice I have feen Patients walk after- wards without the Bowels falling out, though they wore no Bandage ; but this Cure is not to be depended on, for tho’ the new Flefh which fprouts out from cellular Subffance fuppurating appears at HrH firm, yet it afterwards becomes as mere cellular Membranes as any where elff„ as every Surgeon muff have ffen who has had OccaHon to examine a Wound or Incifion made

X % where

344 Medical EJJays

where a Wound or Ulcer formerly was ; and though the Cicatrice adheres firmly at firfi: to the Tendon, yet it gradually becomes more loofe, and is itfelf more capable of ftretching, and therefore yields to the Fife era pufhing it with Violence, as it did in one of the Boys whom I faw very carefully treated in this Way ; fo that I would advife no body to throw away the Bandage after they had undergone the cau- terifing, otherwife they run an evident Risk of the Hernia returning. This Method does no more than make the Perfons who undergo it, lefs expofed to the falling out of the Vifcera , if their Bandage fhould at any Time fhuffle, or be born up off the Rings.

The laft Method I /hall mention for block¬ ing up the Rings, is by the Operation ofi the Bubonocele , concerning which I made fome Re¬ marks already. This has generally been thought to prove an abfolute Cure, but, for the Rea- fons given again# the Cautery proving fitch a Cure, I join with Dn De la Faye (u>) in Opini- ( on, that it is the fafefi: Courfe to wear a Ban- i dage likewife after this grand Operation. And Mr. Amy and tells us (x), that he has feen three or four Ihfiances of Hernicu returning after this Operation, and therefore concludes, that it is only a palliative Cure.

XXII. Of

(it>) Hotes fur Dionis, p. 61.

\x) Philof. Tranfad. Numb. 443. § 8.

and Qbfervations . 24J

XXII. Of the Tumors in the Scrotum, corn*

monly called Falfe Herniae; by the fame.

CURGEONS generally give the Name of ^ falfe Hemic? to the Tumors in the Scrotum, occafioned by any other Caufe than the falling down of the Vifcera into it ; and as thefe falfe Hemic v begin below, and rile upwards, where¬ as the true Her nice muft begin above, and de- fcend afterwards, a pretty fure Sign is thence taken, by which the true Hernia? may be di- flinguiflied from the falfe.

Becaufe thefe falfe Hernia? are of different Natures, and contain different Subfiances, they are diflinguifhed into feveral Clafles, of fome of which again there are different Species, ac¬ cording to the particular Seat or Nature of the Tumor.

To fulfil the Promife I made towards the End of the Paper I fent you on the Anatomy of the Scrotum , I have wrote the following Re¬ marks on each of the! 'e falfe Hernice, without pretending to give a full and complete Account of them, but with the View to put Surgeons on obferving more exactly the Difeafes they treat*

Of the HYDROCELE .

When Water forms a Tumor any where within the Scrotum , the Difeafe is called Hy¬ drocele ; of which there may be reckoned feve¬ ral different Kinds, according to the different Part the W ater is lodged in.

1. When Water diffufes itfelf in the cellular

X 3 Sub-

246 Medical EJfays

Subftance of the Scrotum , the Difeafe has the fame Appearances as anafarcous or leucophleg- matic Swellings in other Parts of the Body ; Allowance only being made for the loofer cel¬ lular Subftance without any Fat in the Scrotum than ellewhere.

The Caufes of this fcrotal Anafarca are very different; one of the mo ft common is a more general Anafarca fpreading from the Thighs to the Scrotum . Any Tumor preffmg the Vein of the Scrotum produces a Hydrocele of this Kind, in the fame Way as Dropfies are caufed in other Parts by a Ligature or Prefture applied to their Veins. Thus a tight Garter makes the Toot and Leg to fwell; thus the Legs of Wo¬ men with Child are often very oedematous ; thus the monftrons Swellings are caufed, which lometimes happen to the Arm when a Schirrus in the Arm-pit becomes large, dm. For this Reafon it is that often in the true Hernice, and frequently in the falfe ones, when the Tumor xifes high, the Scrotum becomes very thick. One Caufe more which I fhall mention, is the Stoppage of the Urine by a Stone, Excrefcence, or Stricture in the Urethra , when the Urine burfts through this Canal, and diffufes itfelf in¬ to all the cellular Subftance of the Scrotum , Pe - nis, and neighbouring Parts.

The Symptoms of this Kind of Hydrocele are common to any other oedematous or watery Swelling, and are well enough known by all Surgeons,

In the Cure, particular Regard is to be had to the Caufe ; for unlefs that is removed, no Cure can be expected. The more general A-

nafarca

and Obfervations . - 247

nafarca is to be cured ; the hernial Tumor is to be removed ; the Stone, Excrefcence, or Stri¬ cture is to be taken away. And then in the Oedema of the Scrotum, depending on the two former Caufes, the common Methods are to be put in Practice. But when Urine is diffufed in the cellular Subfiance, we need make no At¬ tempt to cure it by Corroborants , Hydragogues , for the Urine foon corrupts, either is not abfbrbed or re-afliimed into the Blood from the Cells, or if it could be taken up, it would pro¬ duce a general Diforder in the Body, and would leave enough of its groffer acrid Parts to raife Inflammation and all its Confequences, AbfceR fes, Gangrenes, <bc. The moft fpeedy and fafe Method of Cure in the Cafe of a Hydrocele from diffufed Urine, is foon to make numerous deep Scarifications, and to bring the Wounds to Sup¬ puration as faff as we can, otherwife we may lay our Account that at leafl feveral Abfcefles will be formed, after which there will be nu¬ merous callous flnuous Ulcers to cure, of which I have feen feveral Examples.

2. A watery Liquor may be poured into the cellular Subfiance of the fpermatic Cord , as well as into the Cells of the Scrotum and is oc- cafloned by like Caufes,. If the cellular Sub¬ fiance behind the Peritoneum becomes oedema- tous, the watery Liquor will drill down into the fpermatic Cord ; if the fpermatic or fcrotal Veins, but efpecially the fpermatic, are com- prefled ; or if any other way the Return of the Blood from the Teflicle is impeded, this Spe¬ cies of Hydrocele is formed. It is therefore of* tea to be obferved in thole who have an uni-

verfal

248 Medical Effays

verfal Oedema , in People whole Abdomen is vio¬ lently firetched by a Hydrops afcites , diftend- ed Liver, or any other Tumor in the Belly, and in fuch as have the true or falfe Her nice.

The Symptoms of this Difeafe are an oblong loft Tumor in the fpermatic Cord, which by continuing Preflure on it fome time may be di- minilhed or made to dilappear, the 'Water be- ing gradually fqueezed up into the Cells behind the Peritoneum ; by changing the Patient’s Po» ifure, its Figure changes; lying horizontally with the Scrotum fupported, it becomes more oblong, and of near equal Dimenfions from the Rings to the upper Part of the Teflicle ; by Banding ereft with the Scrotum pendulous, it becomes larger in the lower Part, and fmaller at the upper.

Generally when the Caufe of this Swelling Is removed the Tumor difappears ; if it does continue, the lame Indications of Cure are to be purfued as in the former Species depending on the two firfi: Caules I there mentioned, which are fimilar to the Caufesof this.

3. Molt incyfted Tumors are no more than a Cellule of the membrana adlpofa diftended by a Liquor fiagnating in it, and therefore we may expert that fometimes a Cell or two of the fpermatic Cord may be formed into Hydatidesf which have been taken notice of by Albuca/is (a), and one or two late Writers in Surgery, as a Species of the Hydrocele .

The Figure of this Tumor is oblong, the Gyft being confined by the Cremajier Mufcle,

the

frt) Chirurg. Part, s, cap.

and Obfervations * 249-

the firm Cyft and fluctuating Liquor are felt, and the Teflicle is fituated below it.

The general Methods of Cure are nearly the lame as are directed in the Collection of Water between the tunica vaginalis, and Albuginea of the Teflicle, which is the kind of Hydrocele mod commonly defcribed. Tho’ tapping is the palliative, and opening the Sac is the radi¬ cal Cure here, yet it is to be obferved, and in¬ deed is plain from the Seat of the Tumor in this Species of Hydrocele , that neither Trocar, Cauflic nor Knife, are to be applied at the Bot¬ tom of the Scrotum, as is done in the common Hydrocele , becaufe if the Operation was done at this Place, the Body of the Teflicle mud be pierced through before any Water could be e- vacuated : the external Side of the Scrotum is the mod convenient Part for making the Open¬ ing in this Cafe, fhunning if we can, the did tended Veins of the Scrotum.— When there are two feparate didinCl watery Cyds here, as it is faid there have been ( \b' ), one remains did tended, when the other is evacuated by an O- peration, and the Operation mud be repeated or continued to open the fecond.

The following Hidory of a Cafe of this Spe¬ cies of Hydrocele, where both Difeafe and PraClice were not in the common Way, may not be impertinently joined to an Account of a Difeafe concerning which you will find very few Obfervations.

One who had formerly been compleatly cu«

red of the common Hydrocele , or Water be<*

tweea

(J) Garengeot operat. de chirurg, obf. 28*

250 Medical E flays

tween the Goats of the Teflfcle, by opening the whole Sac, having in the Evening made merry at a Bottle, was feized in the Night-time with Pain and Swelling in the Scrotum , which being attended with a Quicknefs of the Pulfe, was believed to be of the inflammatory kind, and for feveral Days he was treated with a View to the Inflammation ; he was feveral times blooded, ant iphlogl flic Purgatives were given, he was kept on a low cooling Diet, and emollient Fomentations and Cataplafms were applied. The Scrotum fwelled greatly, the Skin of it became red, and a Tumor within it rofe as high up on the left-fide as the Ring of the external oblique abdominal Mufcle. At laft a FluTuation was felt in the Parts where the Teguments were thinned: and molt flexible* A Trocar , the Cannula of which was open in one Side, was thrufl into one of thefe Parts, and, upon withdrawing the Stilet, clearWater rufhed out. The Surgeon had introduced the Trocar fo perpendicularly, and the Teguments were fo rigid, that, notwithflanding the Ad¬ vantage of a Scoop-handle which the Cannula had, he could not turn it fo obliquely as to make ufe of it as a Directory to run a Biftoury upon for opening the Sac as he intended. In this Attempt mofl of the "Water was evacua¬ ted ; the Patient was therefore allowed to re¬ cruit his Strength fome time, in which the Sac filled again. Then a large Train of common Cau/Hc was laid upon near the whole length of the Scrotum towards the outfide ; and imme¬ diately after the Caufiic had had a fufiicient G- peration, an Incifion was made through the

Tegu-

and Observations. 051

Teguments two Inches thick into the Sac about the middle of the Tumor, and a Finger being introduced into the Opening, one of the Blades of a Pair of Scilfars was carried in upon it, by which the Sac was opened firft upwards to the King of the Mufcle, then downwards to the Septum immediately above the Tedicle. "What the Quantity of Water evacuated was, could not be exactly known, mod of it being fpilt on the Floor by Accident, but it was con fide Li¬ able. The Wound bled pretty briskly at fird, but the Hsemorrhagy flopped foon after the Ca¬ vity and Wound were filled with Charpie brute, unformed Lint ; the Scrotum was covered with Compredes, and fupported by a fufpenfory Bandage.

There being no bad Appearance of any kind, the DreJfings were not removed for three Days, when the beginning Suppuration and ouzing Water had made them wet. At the fecond Dreffing the Sac feeling of a callous Hardnefs, and there being a condderable Thicknefs be¬ tween it and the fpermatic VefTels, the DolTils to be put contiguous to it were wet with Spittle, and then rolled in fine Powder of red precipi¬ tate Mercury. The Efcar made on the Tegu¬ ments by the Caudic having fuppurating Oint¬ ments applied to it.

When the Efcar came off, the Sore of the Scrotum had a fchirrhous Appearance both in its Hardnefs and unequal Surface ; however, feeing the Caudic in this fird Application had no bad Effe<d, it was refolved to wade the Scro¬ tum with it ; for which Purpofe Pledgits wet in

Spittle

aja Medical Effays

Spittle Were prefTedon the Powder of common i Caudic, and applied to it.

The Precipitate was continued to be applied1 daily to the Sac till it became foft, granulating' Flefti rifing every where, and laudable goodl Pus coming from it. The Cauftic was renew¬ ed to the Scrotum as often as the Efcar of the: former Application fell olf, till it became near: of a natural Size and Firmnefs.

The Sac was then allowed to heal, which it; did very foon. Except a finall equal Scar no¬ thing is now to be obferved on the Scrotum and the Patient has been feveral Years, fmce. the Cure, without the lead: Symptom of F/y- drocele.

4. The Collection of Water between the: vaginal and proper Coats of the Tedicle, is lb well defcribed, and the Directions for treating:; it are Co full in the common Books of Surgery, - that I need not enter into any particular Detail of it. It may not however be amifs to obferve,, that when Tapping is to be performed for Re-i lief of this Dileale, the Skin of the Scrotum \ ought to be dretched very tenle where it is to be pierced ; and the Tumor is to be made very oblong by the Surgeon, that the Indrumentr may penetrate eafily, which it will not do when the Skin is lax, and that there may be fufficient Space between the lower Part of the Sac, where the Perforation is to be made, and the Tedicle,, to prevent any Injury being done to the T e-

flicle by the Point of the Indrument.— - —

When the Quantity of Water in this Hydro¬ cele is Email, I think the Lancet a lafer Indru- ment for making a Perforation into the Sac

with

and Ohjervatwns. 253

with than the Trocar , which always requires a Puih that makes the Teguments and Sac yield lo far, that the Point of the Stilet comes too near the Tefticle, before the Cannula is forced through.

Gonfidering how readily contiguous inflamed Parts grow together, and how many Inftances there are of People having a radical Cure made of this Hydrocele by Inflammations coming on the Parts, it would leem no unrealbnable Pra¬ ctice to endeavour a Concretion of the two Coats of the Tefticle when they are brought contiguous, after letting out the Water thro* the Cannula of a Trocar , by artfully railing a fufficient Degree of Inflammation. This to be Pure muft be done cautioufly, and fo that the Surgeon can reafonably expert to be Mafler of the Inflammation ; and therefore the Applica¬ tion of all irritating Medicines, the Operation of which he could not immediately flop, or any Angle mechanical Effort, the Effect of which he could not be fure of, are not to be employ¬ ed. Suppole the Cannula of the Trocar was ta be left in, by the Extremity of it rubbing on the Teflicle, an Inflammation might be gra¬ dually railed, the Caule of which could be taken away afloon as the Surgeon thought fit. I have never leen this Practice attempted, and there¬ fore you lee I mention it diffidently.

The following Gale of a Sac in the Ipermatlc Cord cured in this Way, may however encou¬ rage us to expe£t Succels alio where the Water is contained within the vaginal Coat of the Tefticle:

A Man who had had the P ar ace nl hefts feve- Yol. V. Y

2,54 Medical EJfays

ral times performed for the Evacuation of Wa¬ ter lodged between the vaginal and proper Coat of the Right..’ Tefticle, received a violent Brurfe on the -diflended Scrotum, by his Horfe hum¬ bling, The Pain and Inflammation occafioned by this Bruife confined him to Bed feme time, till they were removed by Evacuations, Fotu- fes, as in common inflammatory Cafes. The Hydrocele was no more oblerved after thefe Symptoms went off.

Some Years after, a Hydrocele of the third kind here mentioned, viz. a Collection of Wa¬ ter found in a Sac of the fpermatic Cord of the fame Side where the former Hydrocele had been, was plainly felt. An Incifion about an Inch long was made into the Side of the Scrotum, by which near a Pound of Water was let out. A Pipe, four Inches long, of the Shape and Dia¬ meter of a female hollow Catheter, with a fmooth fhut Extremity, and Openings in the Sides, as that Catheter commonly has, but with a Plate fixed at the other End, to ferve as Shoulders which fhould hinder it to Aide all into the Cavity where the Water had been lodged, was introduced and allowed to remain two Days _ By this Irritation fo violent an In¬

flammation was brought on as would not re- lolve but luppurated, and from it a very great Difcliarge o'i Pus was made* After the inflam¬ matory Symptoms were well 'off, the Silver Pipe was employed as a Tent introduced into the Cavity, being taken out every Day to be ’ clean’d, and again introduced1, till the Cavity filling up from the Bottom would no more ad¬ mit it ; and foon after the Sore was compleatly

i cured

and Obfervations . 255

cured, without the leaf! Return of any kind of Hydrocele afterwards.

In opening the whole Sac for making a radi¬ cal Cure of the Hydrocele , where the Water is collected between the vaginal and proper Coat of the Tefricle, I would prefer the Application of a Cauftic along the Tumor to deflroy the Skin previous to an Incifion into the Sac ; for by the Cauftic one has a larger Opening of the Teguments than by any Incifion, and a large enough external Orifice is always to be prefer¬ red in a hollow Ulcer, which this muff: become, to a confined Orifice, which puts the Patient and Surgeon both to the Uneafinefs of keeping it always open enough, and runs the Risk of ma¬ king a famous Ulcer after all. This is more efpedally necefiary where a membranous Bag is opened, and afterwards to be filled with new Flefh ; for fitch Membranes are longer in co¬ ming to Suppuration, and in fending out gra¬ nulated Flefh than other Parts are. The Time which the Efcar takes in calling off, efpedally when the Surgeon applies fpirituous Medicines to prevent its Separation, this time, I fay, wherein the Orifice of the Sore cannot contrad, compenfates for the llower Suppuration of the Sac ; and the Inflammation that continues in the obflruded neighbouring Veflels to the Efcar is frequently, in lax Habits or Parts, of ufe to promote a right Suppuration when it is needed.

I hope no body will believe that Rich rough Treatment as I mentioned the Sac of th z fper- rnatic Cord to have undergone in the Patient .whofe Hiffory I related lately,, is ever to be gi¬ ven to the Tefiicle when its tunica vaginalis

y 2 h

Medical Effays

is opened ; the T eflicle will not bear luch Irri¬ tation.

All thefe four Species of Hydrocele defcribed above are fometimes feen together, of which the following Hiflory may ferve as a good e- nough Example.

An old but otherwile healthy Man had a Hy¬ drocele of the third Species in the left Side, without any manifeft Caule that he could re¬ member, which became fo large and weighty as required an Evacuation : He would not al¬ low the Sac to be all laid open, but was tapped with a Trocar pufhed into the external Side of the Scrotum , by which more than a Pound of AVater was evacuated ; then the Thicknefs and Softnefs of the fpermatic Cord diicovered the oedematous Swelling of its other Cells. Some Months after he oblerved the Sac filling again, which it continued to do till it was as full as formerly. He delayed having any thing done to it near two Years, when all the Scrotum , but particularly the left Side, was greatly (welled ; the Teguments were very thick and firm ; a Fluctuation of Liquor however was perceived mot only at the fuperior external Part, but at the inferior Part where the Tefticle could not be felt as it had been formerly ; and there was a crols Depreilion appeared externally, which deemed to point out its being divided into two Tumors ; the alternate Prefiure of the Finger on the lower Part did not make any fenfible FluCluation in the iuperior Part of the Scrotum The Cafe was therefore judged to be a Compli¬ cation of three Species of Hydrocele , and that probably the fourth, viz* the thickning of the

and Obfermtions*

ipermatlc Cord, which had been felt In Ills for¬ mer Illnefs, would be di (covered afterwards ; the Teguments were thinned, and the Fluctua¬ tion was bed felt at the Bottom of the Scrotum 9 for which Reafon the Trocar was fird put in there, but with (ome Difficulty ; and feveral Ounces of Water being evacuated, the Patient defined any further Operation might be delay¬ ed. He went abroad fome Days, then became feverifh, with (harp Pain towards the lower Part of the Tumor ; he asked no Advice for fome Days more, in which Time an evident inflammatory Tumor had increafed confidera- bly, and the common Symptoms of Suppura¬ tion were begun, which the ulual Medicines advanced very quickly.

When the Abfcefs was fully ripe it was laid open by Incifion, about twelve Ounces of Pus were let out, and the Cavity in which it had been lodged v/as plainly leen to be formed in the Subdance of the (welled Tedicle.— r-The Ulcer was treated in the common Way, and promifed to cure quickly, the Cavity and Re¬ mainder of the Tedicle diminifhing daily ; but the fluctuating Tumor in the upper Part of the Scrotum continued tenfe, but fluctuating when

preffed. - Ten Days after opening the Abfcefs,

the Dreffings were obferved to be much more wet than ordinary, and when they were taken away clear Water dropt very fad out, and the fuperior Tumor appeared confiderably fubfided.

. This watery Difcharge continuing, the diperior Swelling went off, and then the Ulcer cured, the Patient recovered perfectly, and had no more Hydrocele ,

Y43

I have

X58 Medical EJfays

I have often feen Children, that were bom* with a Complication of Hydroceles , particular¬ ly of the firfl and fecond Species, or who were leized with them foon after Birth. They are very eafily cured with any Corroborants ; a bit of Flannel warmed with the Fumes of burn¬ ing Benzoin cures them in a few Days.

5. I formerly remarked that a Liquor is Fre¬ quently found with the Vifcera i'11 a true Her¬ nia , which may be look’d upon as a fifth kind of Hydrocele ; when the Quantity of this Li¬ quor is fmall, it is neither in hazard of leading us into a fatal Miftake of imagining the DifeafS to be only a Hydrocele of any of the preceding Species, nor does it require any particular Me¬ thod of Gure, but when the Water is in large 'Quantity with the Vifcera , we had need to be careful not to be impofed upon, otherwife in curing what we think a fimple Hydrocele , we may wound the Bowels that are in the Bag with it.

This kind of Hydrocele may be difFmguifhed t Yrom the third Species, with which it is inmoft 1 Danger of being confounded, by a Hernia al¬ ways preceding it, and by its generally yielding or diminifhing when prefTed upon, the Water in molt Cafes being thus lqueezed up into the Belly.

If the Water in this Cafe is in no great Quan¬ tity, and without much Acrimony, it may be prefTed into the Belly, from which the Medi¬ cines proper in a flight Hydrops ajciies will af- fift to difcharge it. When true Her nice can be reduced without any Aperture in theTeguments, there feldom is any more neceffary 5 but when

•f

and Obfervations

'the Fife era will not reduce thus, the Water may either become fo acrid, which moil fre¬ quently happens when the Vifcera are ftrangu- lated, or it may be in fuch Quantity that we do not chule to truft its Abforption from the Belly ; or the Bowels may have blocked up the Paffage, lb that it cannot be Iqueezed into the Belly, while by its Weight, and firetching the Parts containing it, it creates great Uneafi- nefs and Pain to the Patient, and is in Danger of occafioning Dilbrders in the neighbouring Parts. There two laft Gales are to be leen in

Her nice of long Banding. All three require the Liquor to be evacuated'.

Unlefswhen the Operation for the true Her¬ nia is performed, this Evacuation ought only to be made by a fmall PunCture, left the Bowels be expofed and hurt by the Air. Inlfead of Directions for making the PunCture, I ihall re¬ late the Hiftory of luch a Cafe.

An old Man had long laboured under a true Hernia , which had not been reduced of a great many Years ; the Tumor became at laft of a monftruous Size, defending near to his Knee, and of a proportional tranfverfe Diameter ; he was confined to ly on his Back, had very vio¬ lent. Pain both in the Tumor and his Loins, which kept him almofi' confiantly awake ; his Flelh and Strength were much wafted ; in fome Places a plain Fluctuation of Liquor was per¬ ceived with the Fingers, without any of the unequal folid Subftances felt every v7here elfe ; neither the Water nor Iblicl Subftances could be pufhed into the Belly. The Tumor being preiTed fo as to make one of thofe Parts, where

260 Medical EJJays

the Fluctuation was molt evident and the Te¬ guments were thinned:, as tenfe and promi¬ nent as poiTIble, a Trocar as fmall as a Grow Quill was thruft very flowly through the Tegu¬ ments and Gyft > whenever the Bag was pier¬ ced the Stilet was taken out, and the Cannula was p re (Ted a little forward, thro’ which fix Pounds of clear ferous Water ran out;, then the Convolutions of the Inteflines and the knotty Parts of the Omentum, were plainly felt, but none of them would reduce. The Patient was greatly relieved of his Pain, and had no Symptom of Strangulation of the Bowels.. No further Operation, was thought proper, he was: allowed to enjoy the Happinef3 he feemed to-) have by the Removal of the violent Pain during - the fhort Time he had to live.

6. I mentioned Obfervations oPSaviard and he Dr an of the hernial Sac of the Peritonce - itm remaining unreduced after the Bowels were put into their Place, the fuperior Part of which being preffed by a Trufs was 'greatly flraitned,. or the Sides of it were grown together, while the lower Part was filled with Water;, this may be accounted a fixth Species of Hydrocele - I never faw this Cafe, nor do I know how it could be diftinguifhed from the third kind which I mentioned, unlefs the preceeding Hernia led one to fufpeft its Nature. There is one great Happinefs however, that tho’ Surgeons fhould miftake one^Sort of thefe two Hydroceles for the other they could do no Hurt,, the Method of curing both being the fame.

To finifh thefe Remarks on Hydroceles , it may not be amifs to give a general Caution to

all

and Obfervaticns. 261

all young Pra&ilers in the Management of all Parts that are made to flibfide or collapfe great¬ ly and fuddenly after being violently Aretched, especially if the Tone of the Solids of the Pati¬ ent or of the difeafed Part has been greatly weakned, "which is for ordinary the Cafe in hy¬ dropic Swellings. The Caution I would give is, to imitate or fupply theEfleft of the diAend- ing Caufe that is removed, otherwiie they may expect that all the weak Veflels which were for¬ merly overftretched will be both incapable ot preventing a larger Quantity than their due Proportion of Fluids to be propelled into them, and as incapable of making it move fafl enough forward ; lb that unlefs when there is a free open Out-let or PafTage for the Liquors, the Veffels are all over-diflended with their Liquors* which are in hazard of Aagnating. In this Way the Lungs are affe&ed when People die of a P eripneumony or Afthma after a fudden Dif* charge of Liquor put of the Thorax; thus the- Vifcera of the Abdomen are varicous and in*, flamed after Tapping in the Hydrops afciies ; thus Inflammations frequently feize the Uterus after Child-bearing ; thus the common Tegu-. ments diflended by Water in the Anafarca, or by Pus in an Abfcefs become red, and fome- times mortify foon after a fudden Difcharge of the Liquor which Aretched them. — Mode¬ rate Preflure will prevent the Influx of the Li¬ quors, and Diflenfion of the Veflels; gently Aimulating and corroborant Medicines will a£ fill: the Veflels to recover their Tone more quickly, which ought therefore to be made ufe of in fuch Cafes.

When

26a Medical EJfays

"When in fuch a hidden fubfiding or collap- fing of an over-ff retched Part, there are Vef- fels opening into any Cavities, it may be ex¬ pected that, for the Reafons mentioned imme¬ diately above, the open Orifices of the Veifels will pour out their Liquors in more than ordi¬ nary Quantity, unlefs the Influx of them is pre¬ vented by the Means propofed in the former Suppofition ; and thefe Orifices are alfo prelled! fufEciently to make them refill the Momentum of the Fluids llretching them. Thus violent! Flooding after Delivery of a Child, is fome- times moderated by Preflure on the Belly., Thus when any large Abfcefs is opened, pure Pus runs out at hr ft, then it becomes more and more mixed with Blood, and at laft pure Blood is difcharged, which fometimes runs out in as great Stream, not from any one VefTel, but collected from innumerable fmall Pipes opening ; , on every Part of the Surface of the Ulcer; which Hemorrhagy flops foon after the Cavity is filled with Lint, and preffed by a Bandage. Hence the Neceflity of keeping a conflant Pref fure on a diftended Part, during and after the Evacuation of Water in a Dropfy, or of the Pus of a large Abfcefs in weak People. Hence watery Tumors laid open fend out more Li¬ quor in one Day, than was collefted in them for feveral Months, while they were fhut and firetched. Hence I imagine the Hemorrhagy has proceeded which Mr. Jamifon (c) tells us happened to a Patient of his after opening a Hydrocele.

HMMA-

(c) Medical EfTays, Vol. II. Art. 14^

and Observations.

265

H JE M A T 0 C E L E.

Blood extravafated after a Bruife, "Wound, Tumor, 6r. into any of the Parts where I mentioned Water to be collected in the Hydro¬ cele , occafions a Tumor which fome call He¬ matocele. Allowance only being made for the different Confiftence and Colour of Blood and Water, what has been faid of the Hydrocele may ferve alfo for this Ecchymojis.

PNEUMATOCELE.

Pneuma> Spirit or Air, was made ufe of by the Ancients to account for feveral Phenomena of the animal Oeconomy, and was efteemed the Caufe of feveral Difeafes ; among thefe the Hydrops ficcus or Tympanites , and the Pneu¬ matocele , or windy Tumor of the Scrotum , were as commonly deferibed in Books as the Hydrops afeites or Hydrocele ; though the Writings of Qbfervators fhew thole airy Tu¬ mors to be very uncommon, and fcarce ever to be found in the way they are for ordinary deferibed.

Air efcaping out of the Trachea arteria , or Lungs, into the Tunica cellular is , may diffufe - itfelf every Way, and among other Parts may diflend the cellular Subftance of the Scrotum

a-nd fpermatic Cord (/); - Air blown through'-

a Pipe put into a Hole made in the Skin, will - . . ' diflend

( d ) Palfyn. anat. chirurg. Traite av chap. 18. Ibttrsv Hill, de l’Acad. des fciences 1713. Mery ibid.

Medical Effays

diftend all the cellular Subftance of that Part; , as has been done fometimes to the Scrotum (e)

- When there is not lufficient Action of th<

Veffels or Circulation of the Liquors to blenc intimately the different Particles which enter into the Competition of the Blood> the Particle of Air which were retrained from running to gether, and exerting their expanfile elaftie Power, feparate from the other Particles wit! which they were wrought up into the Compo fition of the Blood, and being collefled, exer the common Effects of Air in any Part they are contained in ( f ’), and if they make then Way to any Part of the Scrotum may product the Pneumatocele . In a Scuffle in this Town a Man was wounded with a Sword in the Belly, about half way between the Navel and Cartila • go Enjiformis ; Part of the Omentum came out of the Wound, which was reduced loon after, The Patient was exceeding faint, and hisPulf 'very weak. He lived only twelve Hours after the Wound, in which Time his Scrotum be*1 came as large as his Head, with the common Signs of Pneumatocele. When his Body was ex¬ amined by the Surgeons who attended him, the Abdomen was found full of extravalated Blood, which had come from a Wound of the Vena Portarum , through which the Sword had pier¬ ced. Moil of the Veins and cellular Subfiance of the Abdomen , as well as the Scrotum , were diftended with Air. — - In fome very putrid Fe¬ vers, Small-pox and Gangrenes, I have fre- bn.,;, quentlyv

fe) Dionis operations de chirurgie, demonfir. 4.

If) Littre.Memoires de l’Acad. des fcieaces 1714.

and Obfervailofts.

quently felt fome Parts of the Skin crackle like Parchment under one’s Finger, and have heard a certain fibilus upon making Incifions through it. When GarcafTes begin to corrupt, Air e- vidently begins to generate or feparate in the VefTels and Cavities. From all which it is not tmreafbnable to conclude, that in a very cor- rupted State of the Fluids the Pneumatocele may be formed.

The Symptoms of this kind of Tumor are commonly deferibed well enough.

"When external Air is introduced into the Cells from the Trachea or Lungs, or by a Pipe % after the Accefs of more Air is prevented, that already in the Scrotum may be preffed out at Incifions made through the Skin into the cel¬ lular Subfiance, while the bad Confequences of the hidden collapfing of the ftretched Parts may be prevented by the Application of corro¬ borating Medicines ; and it may be convenient to keep up a Suppuration in the Incifions for fome time after, for dtfeharging any Remains of the Air.

When the Pneumatocele depends on internal Air, generated or feparated from the Fluids, the Patient muft be in very great Danger, for Rich a corrupted State of the Fluids, or Rich a weakned Tone of the Solids as is capable to produce this Difeafe, is fcarce to be remedied ; and Air collected in the VefTels cannot well be difeharged, and mu A terribly difturb, if not entirely Pop the Circulation.

The plentiful Ufe of antifeptic and corrobo¬ rant Medicines are plainly indicated, while the Scrotum is treated in the manner mentioned a** Vol. V. Z bove

2.66 Medical EJfays

bove, when we fuppofed the Pneumatocele to be formed by external Air.

VARICOCELE .

Any large Tumor in the Abdomen, or ex- ternal Force prefling the Veins, or any large Tumor of the Scrotum firetching the Veffels or impeding the Return of the Blood may oc» cafion the Veins of the Scrotum or the corpus pampiniforme to be greatly dilated with Blood, which being only a fymptomatical Difbrder, and going generally off when its Caufe is removed, needs no particular Direction for its Cure : But when by the Veins being long diflended by fuch a Caufe, or if from any other Caufe the Coats of the Veins are fo much weakned as to yield to their contained Blood, and appear in the Scrotum tumid and knotty, when the Dif cafe is named Cirfocele ; or when the corpus pampiniforme feels all compofed of large knot¬ ty Strings, which is the more common Cafe, to which the Name of Varicocele is applied, there is a Neceffity of ufmg fome Remedy ; o- therwife the firetching which the flagnating Blood occafions, creates Pain, the Epidydimis and Teflicle fwell, and fome Species of the Hydrocele is in Danger of being formed.

A horizontal Poflure mull be of the greatef! Service in this Difeafe, by which the Courfe of the returning Blood is made much more free ; whereas in the ere£l Poflure, fuch a high gra¬ vitating Column of Blood as is in the fperma- tic Veins, without Valves to afTiR in its Sup¬ port, mufl have very great Effect on the low¬ er

and Ob fer vat ions. 26 f

er Part of the VefTels. - When the Patient

does rife up, the Scrotum , with its Contents* ought to be well fupported by a proper Ban¬ dage, to prevent the flretching and Pain which the Weight of this pendulous Part occafions* This Precaution of fuflaining the Weight of weak tumified pendulous Parts is altogether ne- ceilary, and is conifantly to be done in all the

different Tumors of the Scrotum.- - If there

is a general Fulnefs in the Velfels of a Perion labouring under the Varicocele , they need to be a little emptied by the general Evacuations^ and topical Afr ingents, and Corroborants, are to be applied for recovering the Tone of the

Veffels. - If the Varices here give much

Pain, and threaten to caule fome other violent Diforder, they may be opened and tied in the Way commonly dire died. I never faw any Varicocele that required to be lo treated.

SPERMATOCELE.

An Excrefcence or Stri&ure at the caput Gal - linaginis foraetimes makes the Vas deferens , E- pidydimis and Teflicle itlelf to be greatly dif* tended with the fecerned Liquor contained in them; this fome Writers call Spermatocele , which is eafily diflinguifhed from the Varicoce~ le, by thefe acquainted with the diftended Parts.

If this Difeafe is recent, the Removal of the Excrefcence or Stricture cures it, but if it is al¬ lowed to continue any confiderable time, it is in danger of degenerating into a Ichirrhous or carcinomatous Tumor, which has a different Name given it, to wit, the Sarcocele.

Z 2 S ARC 0*

Medical EJfays

2.6 8

SARCOCELE .

The general Caufe of all the faffs Her nice of ■which I have hitherto treated, is a Liquor dis¬ tending the different Parts in the Scrotum . When the fblid Parts themfelves feem to in- creafe, or the Fluids lofe their fluid and put on a fblid Form, the Name given to the Difeafe is Earcocele , under which Several Difeafes may be comprehended, and therefore I am fur- prifed that fome, who have much Fondnefsfor the technical Terms, have not applied a dif¬ ferent Name to each of them, Phlegmonocele , Empyocele , Gangraenocele , Schirrhocele , Can- crocele, &c. would have made a fine String of pompous Greek Words; and then each of thefe might have been diflinguifhed according to the Difeafe being in the Scrotum , fpermatic Cord or TefHcle. The Diflin£tion between Phlegmonocele and Inflammatocele would have been juft as proper as what is commonly made between Circocele and Varicocele. I am fb far however from wifhing to multiply the Terms of Art, that on the contrary, if it was not for the Danger of the Students not underflanding readily the Books that have been wrote on this Subject, I would propofe to lay aflde the Diflin- <£tion of true and falfe Hernice altogether, and would ufe none of the Names of the falfe Her - nice, which prevailing Guflom has made me employ, but would call them by the common Name the like Difeafe would have in any other Part of the Body ; fo that I would have treated of the oedematous Tumor of the Scroturn or

fpermatic

and Obfervations .

fpermatiQ Cord ; the incyfted Dropfy of the fpermatick Cord, Coats of the Tefticle , or her- nial Sac; the Suffufio of thefe Parts; the Vari~ ces of the fcrotal or fpermatic Veins ; the tu- mified Excretories of the 'Tefticle ; the Inflam¬ mation, Suppuration, Gangrene, Schirrhus, Cancer, <&c. of the Scrotum or Tefticle s.

The different Difeafes comprehended under the Name of Sarcocele have the fame Sym¬ ptoms and require the fame Management as the like Difeafes do in other Parts, Having no Defign to enter upon any Account of fo many different Tumors, which ought rather to be done in a general Treatite, than in fuch a con¬ fined Eflay, I (hall relate the Hiflory of a Mor¬ tification in the Tefticle which I think uncom¬ mon ; then I {hall make fbme Remarks on the Operation of CdJ? ration , and fhall conclude with another uncommon Cafe, where the Ca- ftration was performed,

A middle aged Man, foon after recovering from a Fever, during which confiderable Eva¬ cuations had been u(ed, was feized with a very acute Pain in the right Tefticle, attended with a quick Pulfe, for which he asked no Advice for fome Days, during which the Tefticle, E- pidydimis and fpermatic Cord , fwelled conftde- rably; after this he was frequently let Blood, emollient Fotufes and Pultices were applied to the Part ; he was purged with cooling laxative Ptizans, and was kept under a ftriCt low cool¬ ing Diet, but without any Relief, except what Opium fometimes gave him. At length a Flu¬ ctuation being felt on the Tefticle, a Train of Cauftic was laid on the Scrotum , and as foon

Z 3 as

ayo Medical Effays

as it had its Effect, an Incifion was made thro* the Elcar into the Sac, where about two Spoon¬ fuls of thin Pus was contained ; the Tefficle being all in View, it appeared of that pale-white Colour which it has in dead Bodies.

Next Day when the Surgeon prefled the Te- fticle, the Patient was not fenfible of its being touched, and the Surgeon felt like a Fluctuati¬ on under his Finger ; but upon opening the tu¬ nica albuginea no Liquor appeared ; the con¬ voluted fibrous Subfiance of the Tefticle /fart¬ ed out in a; very foft, pappy Condition, and putrid; a confiderable Quantity of this being cut away with a Pair of ScifTars, the Sore was dreffed with warm Bajilicon , with which a few Drops of Oh Terebinth . were mixed, and a Pul- tice of the Farines, with fome difTolved Galba - Tium, was put over the whole Tumor. (

For feveral Days after more of that fibrous Subffance was cut off', till the Bulk of what was brought thus away exceeded the ordinary Size of the Tefficle in a found Man ; the Parts were well fomented, the Suppuration was encoura¬ ged, granulated Flefh iprouted out from the bides of the Cavity in the Tefficle, the Epidy - dimis gradually diminifhed, the Scrotum be¬ came thinner, and in fhort the Cure went on fuccefsfully without any Accident, till the Sore was firmly cicatrized. One cannot now know which Tefficle was difeafed, and the Patient is fenfible of no Defeat from it.

To perform the Caflration with the leaft Trouble and Dread of Hemorrhagy, pinch up the Skin in the Groin, and make a large longi¬ tudinal Xncifiorq by which the fpermatic Cord

may

and Obfervations . 27 1

may be brought in View ; then take up the Cord between the Thumb and Finger of one Hand* fo that the Nails meet at the back Pari* upon which pafs a very crooked Needle with a Thread ; or rather ufe the Aneurifm Needle with a Handle, and the Eye near the Point, (See, the Figure of Rich a Needle, Tab. vi. Fig, 5.) tie the Cord as firm as you can with flat Prong waxed Thread ; put two Knots, with¬ out any Comprefs, between them, and cut off the/uperfluous Part of the Thread with a Pair of ScifTars ; this being done, cut the Scrotum down on the Side next to the Thigh, and turn¬ ing the Edge of the Skin outwards, flitch the large fcrotal Artery, after which the fuperflu- ous Part of the Scrotum , with the Teflicle in it, may be differed away with very little Lofs of Blood, only Care mulf be taken not to hurt ' the other Teflicle, which will readily come in the Way if the afliflant Surgeon don’t be care¬ ful to hold it up in the Groin during the Ope¬ ration.— — The Part of the fpermatic Cord be¬ low the Ligature is not to be diflefted away from its membranous Adheflons, which fecure

the Ligature from Aiding afterwards. - By

what I fa v/ in two Inch Operations there is no Occafion for cutting the Ring of the external oblique abdominal Mufcle ; for there was not any Retraflion of the fpermatic Cord after the Teflicle was cut away in this Way I haye now defcribed.

Neither the common compound Sufpenfory of the Scrotum , nor a long Swath are conve¬ nient Bandages after this Operation, for they do not apply neatly ; a large Comprefs broad¬ er

0,y% Medical Bjffays

er conflderably at one End than the other, with" a round Hole in the Middle of the broad End of it for palling the Penis through, and with a large Cut in the Middle of the narrow 'End of it, to allow the two Parts to be folded over each other, ought to be applied over the un¬ made Lint with which the Wound is thick co¬ vered ; and this is to be fecured by the two Ends of the T or Sling-bandage, one Tail co¬ ming on each Side of the Scrotum to be fixed to the circular Belt, which ought to be double Linnen or Fuftian twilted, to prevent its wrink¬ ling into a round Cord, which galls the Patient.

After the Operation the Cure of the Wound is the fame as of any other common Wound.

A young Man mounting a Horfe ft ruck the right Tefticle againft the Saddle ; the Pain of the Blow was fo fharp that he almoft fainted, but becoming foon eafter he neglected it feve- ral Days, during which the Tefticle fwelled conflderably, and the Pain increafed; the Tu¬ mor and Pain were however foon put away by blooding, purging and low Diet ? He continu¬ ed free of any Uneafinefs in the Tefticle feve- ral Months, after which having rode Poft fome Days the fame Tefticle fwelled, but without Pain, which made him negleT to ask Advice for a Year and an half, and in the mean time he ufed much Exercife, and lived in a full Way. The Tefticle having then grown very large, he was preferibed Pills made of Quick - Jilver and Rofin of Guaiac with a low Diet, which he obferved to Excefs, by which he had the Addition of the low nervous Symptoms to his other Trouble. The Bulk of the Tefticle

ftiU

and Obfirvations. 273

hill increafing, and a Fluctuation of Liquor be¬ ing found at the lower Part of it, a Cauftick was applied to the Teguments there, and the Efcar pf it being cut through, fome Ounces of Water ran out, but with very little Decreafe of the Tumor ; foon after it increafed confide- rably, and he fpit fome Spoonfuls of Blood ; but as he had no Cough, Dyfpnea or Pain in his Brealt, it was doubted whether the Blood had come from his Lungs or Throat. Some time after this he complained of a Weight and Pain in his Loins in making a little Journey in a Chaife: The Tefticle became larger than a Man could contain in his two Hands, the low¬ er and pofterior Parts were as hard as a Stone to the Touch, but in the fuperior anterior Part a Fluctuation of Liquor was felt ; there was no more Space between this Tumor and the Belly than could allow a Man’s Thumb to be prelfed in between them, and in that Place the fperma- tic Cord was thick and hard ; from the Orifice formerly made by the Caufiick fungous Fle£h ftood out, which felt as if a Liquor fluctuated below, but upon a fmall Lancet being pufiied into it no Liquor was found; his Pulfe was .weak and flow, without any Symptom of he¬ ebie Fever; he could take final! Quantities of Broth and weak Spoon Food without Uneafi- nefs : But from a little while after he had made the fudden Change of Diet from full living to an Excefs of Abftemioufnefs, his Stomach could not bear Flefhes or any folid Food, fo that at this Time eating a Leg of a Chicken made him vomit. His Cafe was judged to be very defpe- rate, but that the only Chance he had for Life

was

274 Medical EJfays

was the Extirpation of this Teflicle, which O- peration he underwent with great Courage and little Lofs of Blood.

The Tunica vaginalis was grown firmly to the tunica albuginea of the Teflicle at the low-

o

er Part, but in the fuperior Part was extended into a Bag, which contained eight Ounces of Water; the Body of the Tefticle itfelf was be¬ come a mofl compact firm S chirr us, with feme few begun Suppurations in it ; it weighed near two Pounds.

The Patient paffed the Night after the Ope¬ ration calmly, but would not allow him fell to fleep through Fear of an Hemorrhagy, the Blood having ouzed through the Dreflings in the E* vening.

He was eafy all the three following Days, with rather too little Fever, only complaining of a certain Anxiety, Oppreflion and Faintnels which he fcarce knew how to exprefs, but af¬ firmed it was fuch as made him Eire he muff die loon, though there was otherwife no bad Sym¬ ptom about him.

The Dreflings being removed on the fourth Day, the Lips of the Wound were too little tu- mified, and the Suppuration fcarce was begun ; fome cordial nervous Medicines were given him from time to time, and he had Syrup of Pop¬ pies at Night.

He was again drefled two Days after, when the Lips of the Wound were rather too thick ; the Suppuration was begun, the Pulfe was flow and calm; the Wound was well fomented and dreffed with Digeflive.

Next Dav the Swelling of the Lips of the

Wound

and Ob few at ions. 2j j

Wound was fallen, but without a kindly plen¬ tiful Suppuration ; the Prepuce and the Skin of the Penis had a watery Thicknefs in them, and that uneafy Senlation, which, as I (aid, he could not find Words to exprefs, was greater*

On the eighth Day after the Operation the Wound lookt much better than it had done ; his Kidneys, his Belly, anfwered well in their Evacuation; there was no Fault in hisPulfe; he took Food, had no Heat or Third:, nor any Complaint, except that fomewhat which he did not know how to exprefs ; and though he cal¬ led it Weaknefs, yet he moved himlelf with liich Agility and Strength, that he even joked himlelf for calling it by that Name.

On the ninth Day, in the Morning, the wa¬ tery Swelling of the Penis was decreafed, the Suppuration was more plentiful ; at Noon he eat fbme Chicken, and drank a Glals of Wine ; loon after he was fieized with vomiting, then with Coldnels and fainting, which the flrongefi: Cordials did not put away; his Pulfe funk and could not be felt long before (even in the Even™ ing, when he died. He remained fenfible to the lafi, and fpoke reafonably and with a jfirong Voice till few Minutes before his Death, long after his Pulle was gone, and his Extremities } were turned cold.

When his Body was opened the Mefentery ? was found inflated with Air to a prodigious IBulk, as were all the other cellular Parts of the | Abdomen ; all the Veins, large and finall, were i in the fame Condition; the Auricles and Ven- rtricles of the Heart were greatly diflended, and - collapfed with a great JBlafl: of Air when cut.

There

Medical E flays

There was an Ounce or two of Pus in the cel» iular Subfiance near to the Origin of the right fpermatic Veffels, but below that the Cord was found, with the Ligature firm on it, lying ; without the Ring of the external oblique Mufole.. All the other Bowels were very found.

Though in confidering the Symptoms by which the feveral Sorts of Tumors in the Scro¬ tum are known, I have mentioned only thole proper to each, yet I have here and there gi¬ ven Hints that we are not to expert thefe Dif- eafes always fmgle, but that there often are Complications of them, which are to bedilco-- vercd by the different Symptoms belonging to* each ; for which Reafbn, and to lave Repetiti¬ ons, I did not take Notice of all the Complica¬ tions which might happen, and can eafily be fiippoled by any who is acquainted with the' Structure of the Parts, and knows any thing ; of the fimple Difoafes.

The Unwillingnefs People have to let it be known that they laboured under the Difeafes | of the Parts I have treated of, made me relate the Hiftories of particular Patients without Names, Dates or Witnefles, fo that the Perfons cannot be known except by thofe who are al¬ ready in the Secret. When this Paper is read in your Society, I expedt the different Gentlemen who faw the Cafes I mention along with me, will bear Teftimony to the Truth of what is told, for I have on purpofe chufed to relate on¬ ly fuch where I had Vouchers whom you could conveniently examine ; fo that your Publicati¬ on of thefe Hiftories may be a Warrant to the Publick, that the Evidence of them is not fup-

ported

nnd Obfervations. ijj

ported by my fmgle TePimony, while I don’t tranfgrefs the Part of Hippocrates's Oath, which difcharges us to reveal the fecret Difeafes of our Patients.

XXIII. An impregnated Ovarium, and fuper • numerary Ribs and Vertebra ; by Mr . John G emmil Surgeon in Irvine.

A Woman about 30 Years of Age, of a Prong ^ robuP ConfHtution, was hanged here 011 Thurjday the 16th of January 1735, for the Murder of her Child. I was informed by a lure Hand, that on the firfl of January flie had her Menjlrua , and have reafon to fufpeft that Pie was too intimate with fome of her Fellow Prifoners. In diflecVing her Body I found both the Tubes Fallopianc v greatly diPended* the left one was pale coloured, but the right Tuba ap¬ peared inflamed in its external Coat. Having gently fqueezed the left Tube, a white Body in¬ clining to an oval Figure, about the Size of a large Garden Pea, drop’d out at its Extremity, with a good deal of a whitifh. vilcid Liquor ; and having fqueezed the Tube feveral times, a coniiderable Quantity of the fame lort of Li¬ quor was prefled out ; the Membranes of the roundilh Body were Prong and tough, and com tained a tr an (parent gelatinous SubPance ; the Colour and Confidence of the white-coloured Liquor were like to the Semen virile .

The left Ovarium was more than twice the Bulk of the right one, and looked like a Bag full of a dark-brown coloured Water ; but when it was opened a tranfparent vifeid Fluid Vox.. V. A a ‘ ran,

Medical EJJays

ran out, and what remained was a reddilli Sub« fiance much of the fame Confidence as the cry- flalline Humour of the Eye has, being the greater Part of what this Ovarium contained.

There was nothing uncommon in the right Ovarium ; about half Way between it and the Extremitity of the Fallopian Tube I found in a Duplicature of the Membrane luch a Body as was fqueezed out of the left Tube, but it was fhrivel’d and decayed, with little in it of any Liquor ; the right Tube was full of the fame fort of white Matter as I fqueezed out of the : left Tube.

In the Skeleton of this Woman, which I' prelerve, there are thirteen Vertebrae of the Back, and as many Ribs on each Side, to wit, eight true and five falfe ; the Cartilages of the two lowed: true Ribs unite in the middle for a- • bout an Inch, then divide again, and are in- • ferted feparately into the Sternum ; the two lower falfe Ribs are about two Inches and a half i

XXIV. An Account of a monftrous Child ; by Dr . John Burton Phyfician at York.

V— — hi T, Spoufe to a Ship Carpen-

ter living at Kirkthorp near Wake¬ field in Torkjhire, bore a Child that had no Parts of Generation proper either to Male or Female, there not being the lead: Appearance of fuch Organs at the Place where we diould t expert to find thole Parts ; the Child in every other Part was made as is common, except a- bout half Way betwixt the Navel and Os pubis ,

where

and Obfervations , 1 79

where was a circular Orifice of about an Inch Diameter, in which was a fpongious Subfiance re (enabling the End of the Gians Penis excori¬ ated ; it did not project in the leafi from the Body, neither was it covered, but was quite bare, and very fore and tender. Through the feveral and almoft innumerable Pores or Orifi¬ ces of this fpongious Body the Urine ouzed continually, and fbmetimes Blood, and at o- ther times a reddifh-coloured Serum. The Child lived to the Age of five Years or therea¬ bouts, and died of the fmall Pox in November lafi. To the Truth of this I can bring many Certificates, as well as living Witneffes, if it was thought neceffary.

XXV. An EJJay on the Caries of Bones ; by Alexander Monro P. A .

rTiHE Nature and Seat of a Difeafe being **' known, there is no Difficulty in under- fianding what chirurgical Operation ought to be performed, and the Effects of every Part of the Operation can be demonfirated ; fo that Surgeons are inexcufable if they do not reform what is faulty in the manual Part of their Bufi- nefs. The Effects of Medicines not being near fo evident, but requiring long and accurate Ob- fervation to difcover them fully, are much more liable to be mifiaken ; People are too ha- fiy in making Conclufions ; a fingle Cafe or two has too often been the Occafion of fixing a general Rule for the Cure of Difeafes.- — — « The different Circumfiances of Difeafes and Patients are notfufficiently regarded, Medicines

A a 2 being

2 So Medical Effkys

being often ordered more for theName of theDif- eafe than for the Symptoms of the Patient.— If a Cure is made, the Succefs is attributed to the Medicines, without any Examination whe- • ther Nature has not made it in Oppofition to Medicines very improper to afTif: her.- — —Men of great Fame have been fubjeCtto fuch Errors, and they have been followed by the Generality of PraCtifers. - What People have embra¬

ced for Truths in their Youth they are unwil¬ ling to contradict afterwards, and the early Im- prelfions which our Mind receives are with Dif¬ ficulty effaced ; the human Mind is the fame it was in Horace's Days, the Quo femel eft irribu -

ta recens is fill true. - —In fo many different

Ways may People aCting with the utmoft Sin¬ cerity and bona fides , be led into Error about the Medicines they employ in Difeafes.

If Gentlemen w'ould patiently and alfiduoufly obferve the Circumftances of their Patients, and the Operation and EffeCts of Medicines ; —if, after remarking the evident fenfible Ef¬ fects of Medicines, they would reafon from one Cafe to another, by obferving the Analogy be¬ tween them, they would be convinced that the common Routine is often not to be followed, but that a more fife and effectual Method of

Cure ought to be purfued : - If no more

Credit was to be given to Writers than w'hat is fupported by not only their Multiplicity of PraCtice, but by their Accuracy in relating Cir- cumflances, and by the reafonable Indications on which their Practice appears to have been

founded:— - If, inftead of taking one or two

of our Cotemporaries as our confiant Guides,

and Observations. 28 f

we would compare feveral Writers of differ* ent Ages, to difcover whole Pradlice was moft

on a rational Foundation : - If thefe Methods

were purfued, I am perfuaded the common Practice, in a great many Cafes, would foon be changed.

General Schemes of this kind are, I know* commonly look’d upon as Words of Courfe> and as little regarded as if one was propofing a Project impofftble to be executed. An Ex¬ ample of the Practice in a particular Difeafe, va¬ ried hitherto in many different Ways, and moft of it founded on very little Reafbn, with, a Propofol of reforming it according to the Plan above-mentioned, may pofhbly have great¬ er Influence, which I fhall therefore now lay- before you.

In Compiaifance to the Defire of feveral of my Pupils I have chofen for this Example that corrupted State of Bones which Surgeons name Caries , Sphacelus , T 'ere don or T re don ; in treating which, I fhall give, in the hiflori- eal Way, a fhort Sketch of what fome of the moil eminent Writers have faid upon it : Next* I fhall defcribe the different Appearances I have had Occafion- to obierve of this Difeafe ; then I fhall examine the manifefl Effects of the dif¬ ferent Medicines- which have beenufed or pro- pofed for it : And laflly, I fhall confider what Method of, Cure appears moll reafonable ac¬ cording to the various' Circumftances.

In the Works commonly afcribed to Hip~ f ocrates the Caries is faid to be a dried Pituit between the Lamirnv of the Bones (,a)} or Earth*

A a 3 drieds

{a), Be niorb, lib- u

2,8 a Medical EJJays

dried by Keat (£), or a Defe£t of the Mucus (c). — The Account of the Symptoms is very in¬ complete ( d ). The Prognolis is as fuperfi-

cial ; for I fee no more than that in tedious Ul¬ cers the Bones are affedled and the Cicatrices are hollow (e), and livid Flefh in a difeafed Bone is a bad Sign (/). As to the Cure ; Cold is faid to be hurtful to Bones and this DIP eafe is to be treated as a Fra£ture (£).

Celfus gives no Opinion of the Caufe of the Caries , and defcribes very few of its Sym¬ ptoms, but is very particular in his DiredUons concerning the Cure.

His Application to Bones laid bare in a com¬ pound Fra£lure is Wine, Oil and Suppurants (i). In a FifTure or FraHure, where it is not neceffary to take out the Bone, he orders a ce- phalick Plaifler, foftned with Vinegar, to be applied, and propofes that the fame Plaifler, foftned with a Cerat of Rofes, fhould be ufed afterwards as an Incarner (, k ). His Medicine for flopping the Hemorrhagy, which fometimes. happens in cutting the Teguments to lay the Skull bare, and after raifing Pieces of it from the Dura mater , is Vinegar (/).

In the Caries of Bones Celfus’%. Method \ni) is

to

{!>) De carnibus,

(c) De articul.

( d ) De morb. lib. 2.

{e) Aphorifm. § 6. Aph.

(f) Ibid. § 7. Aph. 2.

(g) Ibid. § jr. Aph. 18.

(b) De morb. lib. 2,

(i) Lib. 8. cap. 8 Sz lew

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and Obfervations, 283

to lay all the carious Part bare, and if it is then doubtful how deep the Caries goes, to pierce with t\izTenebra (or pyramidal Perforative) till the Rafpings are no more black.—— If the Caries is fuperficial he orders it to be burnt once and again with a hot Iron, that a Scale may feparate from it, or to rafp it till either Drops of Blood ouzing out, or the white Sur¬ face of the Bone fliew all the carious Part to be taken away, when Nitre («) well pounded is to be fprinkled on the Bone* — - When the Caries is deep he advifes a great many Holes to be made thro’ it with the Perforative, into each of which a red-hot Iron is to be put, till the Bone is quite dry ; for thus, adds he, the cor¬ rupted Part will be brought off. - - When the

Caries penetrates to the other Side of the Bone it muft be cut out.- — When the Extent of this deep Caries is not larger than what the Head of the T repan will cover, he employs this In-

Rrument to take it out. - If the Caries is large,

he orders Holes to be made round the Edges of it with the Perforative, and then cutting the Bridges between thefe Holes through with a Rrong Knife {truck .with a Hammer, he takes away all the carious Part*

The Medicines which Diofcorides chiefly re¬ commends for bringing away the Scales of Bones, or for what is now called their Exfoli¬ ation, is rhe Powder of the Root of the Pen¬ ce danum (<?), and the Juice of Euphorbium, de¬ firing the Teguments to be defended with Li¬ niments

(n) Diofcorid. lib. 3. cap. 8. fays, Nitre and its SguWit is biting, and has the Force and burning of Sait,.

(q Bib. 3, cap. 77*

2S4 Medical EJfays

niments or Cerats , when the Euphorbium is to be applied (/).

Galen defines Bones to be the hardeft, mofE dry and terreflrious Parts of the Body (y),, whofe Qualities are cold and dry (r). He thought a Cartes in a Bone analogous to an Ul¬ cer in afoft Part ( f ), and that it was occafioned either by the adjacent Flefh. generating a bad; Sanies , with which the Bones being moiilned were corrupted (t); or that it was owing to a mucous Humor drove to the Bones (&).

In confequence of this general Doctrine con¬ cerning Bones and their Erofion, with the ge¬ neral Axiom, That Contraries are the Re?ne - • dies of Contraries (r/), Galen muft necefTarily have been led to difcharge all things which he efteemed cold (w), and to recommend.Dryers (. x ) in a Caries . He is very (paring in his Re¬ commendations of particular Medicines for this Difeafe ; Opoponax in Ulcers of Bones and Rad.. Peucedani for Exfoliation (y), with fome com¬ pounded f Enters (z), are all he mentions.

The Greek Phyficians after Galen have ad¬ ded little concerning this Difeafe, except fome

' few

(p) Ibid. cap. 8.

(q) De offib. in prooera.

(r) De element;, lib. i. cap.. 6,

(/) De caufis morb. cap. n.de medic, art. conhitut, gap. 6-.

( t ) Comment, in Hippocrat. de fra£i. lib. 2. 20.

(u) Comment;, in Hippocrat. de articl'd. lib. 3,.

\v) Comment, in Hippocrat. Aphorifm. § 5. Aph. i80

(it/) Comment, in Hippocrat. Aphor. § j. Aph. 1.8.,

(x) Ibid. § 6. Aph. 45%

(y) De fun pi . medicam. facult. lib. 8.

(2) De compof. pharmac. f. loc. lib. 10. De comp,

4k. per genera, lib. 4. cap, 13, & lib.; ^ cap ^2^.

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and Qbfervations. 285

few Medicines, anfwering Galen's Intentions of Cure. Paulas JEgineta (a) has fomething of a different Formula for making the affeffed Part of a Bone feparate ; it is a Catapkfm made of the Leaves of the wild Poppy and of the Fig- tree, with Barley-flour and 'Wine ; or inftead of it he recommends equal Parts of the Sem» Hyofciami and of Vitriol .

The Arabians added greatly to the Lift of drying Medicines, moft of them actually fo, that is, in the Form of Powders, and the grea¬ ter Number potentially fo too; that is, fucfi as, when tafted or applied to Sores, ftimulate, raiie Heat and fome Degree of Inflammation. They alfo reftored the Celjian Praflice of burn¬ ing and rafping difeafed Bones (Jb ), which had been negledled by the Greek Phyflcians, but has been generally mentioned by Writers after the Arabians .

One of the Arabians , Albucajls (c), advifes, in a compound Fracfture, where a Bone is bare, to put a Cloth dipped in black Styptic Wine into the Wound, but not to make Ufe of a Ce- rat , or any thing in which there is Oil, left it make Corruption happen to it.

Thofe who wrote on Surgery when Learn¬ ing began to be reftored in Europe , in the four¬ teenth and fifteenth Centuries, copied moftly the Arabians ; but after burning the Bone, which is the Method of Cure in the Caries , which the moft eminent of them are fondeft

they

(a) Lib. 4. cap. so.

(b) Avicen. Traft. lv. lib. 4. Fen. iv. cap. II.

(c) Chirurg. pars iii, cap. 20.

2 8 6 Medical Effays

they applied oily Medicines to the cauterized; Bone (d).

After Chemie came to be cultivated in the iixteenth Century, other Methods of cauteri¬ zing were introduced.

Angelus Bologninus ( e ) tells us, that fome in his Time made ule of fcalding hot Oil, heated Roots of the Afphodelus , kindled Brim- Rone, and the Water by which Gold is fepa- rated from Silver.

Joannes de Vigo ( f ), befides aqua regia , mentions Oil of Vitriol, Unguent urn Egyptia -■ cum , and Vitriol burnt and mixed with Aqua- vitae as Cauteries. After cauterizing he drelTed with Ung. abfkerjivum de Apio> and fays that by this Method the Separation of the difeafed Part is made in forty Days after cauterizing,

Ve [alius (g) mentions 01. Sulphuris and Eu- phorbium for the Caries , but prefers a Prepa¬ ration of Antimony, which he does not de- feribe.

Fallopius (j) agrees with Vefalius in the Form of the drying Medicines to be applied, and in .1 the Management of a Bone after it is burnt ; j the Place, fay they, immediately after being burnt, is to be frequently moiflned with Rofe- Water and the White of an Egg, that Inflam¬ mation and other Symptoms may be prevent¬ ed ; afterwards the Efcar is to be ripened with Butter or Ung, Tetrapharmacum .

Am -

( d ) Guy de Chauiiac. Traite iv.

(c) De cura ulcer, lib. 2.

(/) Pra£k medic, fecunda pars, lib. 3. De ulcere cuis ofTe corrupto.

(£) Chirurg. magn. lib. 4. cap. 14.

{/;) De alcerib. cap. 22.

and Obfervations. 287

Ambrofe Pare (/) fays more explicitely than Albucajis , that the Application of unftuous and oily, or of moift and fuppurating Medi¬ cines, corrupts Bones ; Pare ieems alio fonder of the fimple Dryers, that is, the abforbent Powders, than thofe who went before him, whofe Dryers were as much potentially fo as actually.

Fabricius ab Aquapendente ( k ) reckons A- quavita? among the ftronger Dryers, and re¬ commends the Juice of Leeks, with Salt, for drying Bones further after they are burnt.

Gulielmus Fabricius Hildanus (/) is rather more pofitive than Pare in forbidding the Ap¬ plication of all moift and oily Medicines to Bones laid bare ; he feems in one Part of his Writings (m) to expert always an Exfoliation from Bones laid bare, though in other Places (») he relates Examples of Bones laid bare be¬ ing cured without any Defquamation.

Hildanus (0) introduced the free Ule of Eu« phorbium and its Tinfture in Spirit of Wine, the Acrimony of which the Writers before him had warned their Readers to guard againfh

Marcus Aurelius Severinus ( p ) takes notice of the fhrill Sound, as if a Void was below, which a Piece of Bone has when ftruck after its Exfo¬ liation begins. He recommends Oil of Eu-

phor-

(i) Livre 19. chap. 31 & 32.

(k) Pentateuch, chirurg. lib. 3. cap. 10.

(/) De gangren. & fphacel. cap. 19.

(in) Deulcerib. cap. 22.

(«) Obferv. Cent. iv. obferv. 9s & 96.

(0) De gangr. Sc 1’phac. cap. 19. Obferv. Cent. i. obf, 92. - Cent. iv. ob(. 21 8c 95- - Cent.v. obf.2l»

(/>) De efficaci chirurg, pars ii* cap. 11,

388 Medical Effay^ ■

phorbium and of Lime as a proper Application / to corrupted Bones ( q).

Soon after Severinus's Time, that is, about the Middle of the feventeenth Century, the eflential aromatic Oils of Vegetables were in¬ troduced.

Nicolaus Ttilpiufs (r) favourite Medicine, for Exfoliation was Oil of Cinnamon with Oil of Sublimate.

In the latter Part of the laft Century not on¬ ly Variety of thefe Oils were ufed, and differ¬ ent Tin&ures in ardent Spirits and other Com- pofitions of the Dryers of the Ancients and of the aromatic Oils were contrived ; but the al- caline Salts, both fixed and volatile, fuch as Sal Tartari , Sp. Sal ammoniac . dm. came to be employed as well as the acid Spirits, 01. Sul - phur. Vitriol , dm. (/"').

While the Generality of Writers at this time were fo fond of the Aromata , Tin6hiresy £- UxirSj Spirits , dm. fome mention their ha¬ ving cured carious Bones by perforating, tre¬ panning and cutting them out (0? or by burn¬ ing and deflroying them with Caufticks (u). Others fuccefsfully employed watery Medicines Qv) and dry Lint (w).

Among

(q) Pyrotechin. chirurg. lib. 2. parti, cap. 4.

(r) Obfervat. lib. 1. obf. 31.

If) See Barbette chirurg. lib. 3. cap. 8. - Verduc Pa~

tholog. de chirurgie, chap. i. des fractures.; — Car. Mufitan* chirurg. Tom. it.*/ cap. 19.

(/) Scultet. armament, chirurg. Tab. 27. Explic.&obf, 6?. — Zodiac, medico-gallic, anni 1679. Menf. Decemb.— an. 1681. menf. Novembris.

( u ) Lamzweerd obferv. 90.

(v) Scultet. armam. obf. 42k Ruyfch. obf. 48,

(-w) Ruyfch obf. .r.

and Obfervations *

Among the "Writers of this Time, Wifeman (x) is more accurate in relating the Appearan¬ ces of carious Bones than former Authors ; # they generally remarked only the black Colour, Greafmefs, Roughnefs, fpongy Softnefs and {linking Smell, and thin brown Ichor of Bones when carious, with the fpongy Flefh growing out from them ; Wifeman oblerves that carious Bones may be of a white, brown or black Co¬ lour, and adds, “ If the white be pory, the u Caries may be deeper and more dangerous t( than if it were black and hard.”

His Method of Cure is like to Cel/us’ s in fe- veral Particulars ; he orders all the carious Part to be laid bare, with Cauflic applied to the Teguments; then to {crape the rotten Flefh a- way, or to confume it with Efcharoticks ; where that cannot be done, becaufe of large VefTels, Nerves or Tendons in the Way, he defires the Orifices of the Ulcer to be dilated with Sponge-Tent, Gentian Root, <bc. But iF the Cure of the Caries is of greater Confequence to the Patient than thele Parts are, and they are fo fituated that the Cure cannot be made without deflroying them, he advifes to cut them through to come at the Bone. - "When the ca¬

rious Bone is laid bare, if the Caries is fuperfi- cial, he would have it rafped and then to be dreRed with the milder Sarcoticks or digefling Ointment ; in few Days after the Application of which, he fays, you may fee the Flefh thrufl forth in fmall Grains, which is Callus ;

— - Burning with a hot Iron he frequently

Vol. V. B b ufed

(x) Surgery, Book ii» chap. 7,

Medical Ejjays

ufed with Suceefs for battening the Exfoliation.

. — ‘At other times he pinched away or broke off the Caries .—-His Medicines are the Dryers, chemical Oils and Efcharoticks, only that in feveral Gales where the Bone lay deep, he ufed InjeCttons compofed of the vulnerary Plants boiled in watery Liquors, with feme ardent Spirit, and a little Sp. Vitriol, dulc.

I took notice formerly that Hildanus expref- fed himfelf as if he thought Bones laid bare mull exfoliate; this came to be a general Opi¬ nion, as is evident from the Directions which Bioft ehirurgical Authors give for treating ‘W'ounds where Bones were laid bare ; and Be! - lofte { y) tells us it was the univerfal Practice in bis Time to dilate fuch Wounds and to keep them open in Expectation of the Exfoliation. He endeavours to Ihew the Abfurdity of this Practice, and recommends to Surgeons to en¬ deavour to prevent Exfoliation in fuch Cafes^ and for this Purpofe he not only advifed what fcelix Wurtz and Coe far Magatus had done be¬ fore him, to wit, to bring the Lips of the Wound near together, and to drefs feldom ; but alfo propofed, that when a confiderable Space of the Surface of fmooth firm Bones is laid bare, there fhould be a great Number of fmall Holes made with a Perforative of a Tre¬ pan as deep as the Diploe or Cancelli of the Bones, after which, he fays, flefhy Papilla rife out from tliefe Holes, and extend themfelves all ov£r the bared Surface of the Bones, and the Wound is foon cured without any Exfoliation. 1 - • This

H) Chirurgien d’hopital, chap. 12

and Ohfervatms. apj

This Practice has been approved by fome con- fiderable Men, though, fo far as i know, it has

not been general among Surgeons. - Bellojle

condemns the Application of acid Spirits tp Bones as increaling the Carles ; and being of Opinion that the Air a<ds by its Acid on Bones, die infills in rather dronger Terms than moil former Writers had done, that Bones fhould be well defended from the Air.

Mr. Petit (z) is the only Author of this pre- lent eighteenth Century whom I need to men¬ tion ; he names the feveral Difeafes in which Caries mod frequently happens, and relates the Symptoms by which it may be judged that 3 Bone is corrupted; fuch are the deep-leated Pains preceeding an Abfcefs forming near a Bone with a livid Colour and Sponginefs in the Teguments; an Ulcer continuing long near 2. Bone; the fproutiog Flelh of fuch Ulcer ap¬ pearing fpongy, of a pale Colour, ealily pene¬ trated by a Probe, and bleeding readily with¬ out giving Pain ; the Quantity of Matter being larger than commonly comes from an Ulcer of that Extent; the thin Confidence, browniih Colour and blinking Smell of the Matter; its appearing black on the Plaiflers, though there is no Lead in their Compofition ; feeling the Bone fcabrous and unequal.

Petit obferves feveral Appearances rottea Bones have, which may make fo many Species of Caries s 1. The Surface of a Bone may be corrupted, and may notwithdanding be pretty firm and fmooth, without throwing out much

B b 2 Mat*

(z) Maladies des Os, Tqm. ii, chap. i6»

2p2 Medical Effdys

Matter; he calls this a dry Carles . 2. If the;

Surface of a Bone is very unequal, with a Num¬ ber of fmall Holes difoharging large Quantities of Sanies , he names the Caries vermouille or i worm-eaten, from the Refemblance it has to Wood eroded by fmall Infers. 3. Flefh may grow in the Interfaces of the corrupted bony Fibres, and may fill up the Cavernulce . 4.

Sometimes the Bones are imperceptibly wafted an Cancers.

Mr. Petit fays, the dry Carles is generally the moft fuperficial, and cures more eafily by Exfoliation than the other Kinds, which has made him think, “ that the Exfoliation of Bones is only made readily when the carious u Part has no more Communication with the Veffels of the found Bone. This Commu- nication entirely fiopt gives Ground to be- tc lieve, that the Juices which move in the 4i Vefiels of the found Part make an Effort a- <( gainfi: the corrupted Part, and that thefo Efi <( forts, redoubled by the Refiftance, and re- peated every Moment of Life, are the Caufo <( which infonfibly foparates the corrupted Part €< of the Bone.

“ I perceive foon, fays he, Flefh rifing in te the Circumference of the corrupted Piece, €( which grows more and more. I have Rea- foil to believe that proportionally as the firfi: *( Efforts of the Liquors make the Separation, thefo nutritive Juices congeal, and form Flefh, Ki and that ir is the infonfible Growth of this Flefh which compleats the Separation of the Piece of the difoafod Bone, and thrufis it “ outwards. X am more certain Nature aefs

“ thus

and Obfervafms.

u thus, becaufa I find this granulated Fie fa in il the Place where the feparated Piece of Bone u was, and that the good Qualities of this Fie fa <e make me certain that the Bone is found be- f* low.”

The Motion of the corrupted Piece of Bone, and the Blood coming out below it, are the Symptoms by which Mr. Petit tells us, the Ex¬ foliation may be known to begin.

Our Author remarks, that the ivorm-eaten Caries y and that where Flejh riles in the Ca- vernulcUy may be of different Depths in the Bone, and are more difficult to cure than the

dry Caries. - -When the Quantity of Sanies

(which is generally bloody in the latter Species of Caries^) is very large, there is Rea fan, fays he, to fufpeef: it comes from the Cancel li, where the Marrow is contained, and where the Di£» eafa frequently begins, from which, if it does not find an Exit, it will kill the Patient.

Mr. Petit's Methods of Cure are thefa. When the Caries is very fuperficial and of the dry Kind, he dreffes it with Doffils dipt in Spi¬ rit of Wine, as he would do a found Bone laid bare, which he affirms does not always ex¬ foliate. — If the Caries is deeper, and an Ex¬ foliation muff: be haffened, he applies to it A- qua forth or Spirit of Nitre in which Qiiick- filver has been diffblved, which he recom¬ mends as as a favourite Medicine, and after¬ wards he makes uie of Spirit of Wine. - —

He difcharges the exfoliating Part to be. taken

away till it is quite loofa. - If the carious

Part cannot be faparated by thefe Means, he recommends the red-hot Iron, rafping,- the

Bb ^ Per-

2 94 Medical Effajs

Perforative and Trepan, as Celjus orders.

After the Caries is thus removed, Mr. Petit judges by the white, thick, mild Matter, firm Flefli and hollow hard Cicatrice, that the Bone is found ; or he dreads a Relapfe if the Appear¬ ances are otherwife.

The general Practice of our Surgeons is to keep Ulcers with carious Bones as much dilated as they can by Dofiils, Spunge-tent, <&c. to defixoy the fpungy Flefh with Efcaroticks, to apply Spirit of Wine, Tindture of Myrrh and Aloes, Tindture of Eupharbimn,, and luch like, to the Bone, and frequently to all the Sore, — - As thefe ardent Spirits are applied to haffen the Exfoliation in a Caries , they are applied for moft part alfo to found Bones laid bare as Prefervatives, it is Paid, againfl their Corrupti¬ on, and to prevent Exfoliation.

From this hiftorical Sketch of what Authors have faid of the Caries , it is evident how little the Circumfiances of this Difeafe have been con. fidered, and what a contradictory odd Medley of Practice has been followed ; Purely all of it. could not have been fupported by Observations' tolerably made. Of late indeed fome Species ‘of this Difeafe have been difBngu.ifb.ed, but the Practice is too uniform in all of them. To re¬ form this it will be necefiary to examine more accurately the Appearances of this Difeafe.

Previous to any Account of the Caries it will be necefiary to remark, that Bones have their Veffels and circulating Fluids,, and in fhor-t the lame general Texture which other Parts have, lb that Solidity and ftronger Cohefion of Parts are the only evident diitinguilhing Characters

and Qbfermtions. 295

of the Compofition of Bones: Of this Truth there are many Proofs, fuch as,

1 . Bones are in the State of Membranes and Cartilages before they oflify.

2. The hardefl Bones have iometimes chan- ged back again into a foft State.

3. The granulated Flefh which riles out from Bones after Fraftures, Amputations, the Tre¬ pan, or in Exfoliation, differs nothing from what would come from any foft Part, yet in feveral Cafes becomes found lolid Bone,

4. When the Texture of Bones is unravel¬ led artfully, and compared with the Texture of the fofter Parts, it appears alike in each.

5. By a chemical Analyjis the fame Prin¬ ciples are obtained from Bones as other Parts, the Proportions of thefe Principles being diffe¬ rent in different Parts.

6. By comparing the Difeaies of Bones with fimilar ones in fofter Parts, as l Shall do in con- fidering the different Species of Caries > the ge¬ neral Proposition, of Bones differing only in Solidity and Cohefion of Parts from the other fofter Organs of the Body, will be further con-

* firmed.

The Species of Caries which I have had Oc~ cafion to fee are,

I. What Mr. Petit calls the dYy Caries ^ where the Bone is pretty fmooth and firm, and throws out little Matter ; though the Surface of' the carious Part of a Bone, in this Species, is; not of a very dark Colour at firfl, yet before Exfoliation it becomes of a dark brown or blade Colour., An Exfoliation is more eafily obtain-* here than, ia. any other Kind. Before the

eats

< ^Medical Fffajs

corrupted Part can otherwife be obferved to le- parate, one will hear, as Severinus remarks, a. fMuM Sound when it is {truck with a Probe, as if it was hollow ; foon after this the Edges oi the carious Part rife a little, and Pus, or if it is prelfed, Blood is feen coming out below them; granulated Flefh then appears at thefe Edges, the Bone is more railed gradually towards the; Middle, till all the carious Part is feparatpd from the new fprouting Flefh, which rifes up on the whole Surface of the Bone below, and fee ms to pufh off the carious Squama , fo that it becomes quite loofe, and can be taken away without any Violence, The Ulcer is then a fair Way of curing, and tho’ .a eonfiderable Thicknefs of Bone has come away, yet, in forae Time after, little Depreffion is to be felt on the. Surface of the Bone, the new Flefh having gra¬ dually become harder, till it fupplies in a good Meafure what was taken away.

Whoever has feen the Separation of a gam- gren’cl Piece of Skin, or of the Efcar of a Cau- ftick applied to the Skin, where a FifTure firff appears in the Margin of the mortified Part, Pus begins to ouze out there ; the Divifion be¬ tween the found and mortified Part becomes larger, new Flefh rifes, the Separation goes on from the Circumference to the Center, till the mortified Part drops off, and the new Flefh flip- plies its Place ; whoever, I fay, has feen this, and compares it with the Pure no men a of the dry Caries, will judge that. Allowance only be¬ ing made for the Rigidity of the bony Fibres, which cannot contract as the Fibres of the Skim do, the Appearances are the fame in both Ca-

and Obfervations. 297

Tes, and therefore I would call the State of Bones defcribed above, the gangrenous Caries .

II. The fecond Kind of this Difeafe is Mr. Petit's worm-eaten Caries , in which the fpon- gy or cavernulous Texture is evident; it has not fuch a dark Colour as the former, the Quan¬ tity of Pvlatter fent out from the Cellules of the Bones is greater than in the former Kind, and is vadly increafed when the corrupted Sanies comes out from the Marrow in the Cancel It. Pieces of the rotten Bone may be broken off here, or they may fall away, but no regular Exfoliation is to be expected, unlefs when by Art it is reduced to the former Species. The gradual wading of the bony Fibres by the Sup¬ puration is often very remarkable in this Ca~ ries ; a Piece of Bone which appeared as large as the End of one’s Thumb, and of a lolid Sub- dance, (hall become lets than the Point of the little Finger, and fo fpongy that it can fcarce be touched without breaking.

The worm-eaten Caries, where the Subdance of the Bone only is affefted, may be compared to an Ulcer of the foft Parts, which has a Num¬ ber of little Sinufes in its Sides, fuch as I have frequently leen when hard Tumors had only in part fuppurated, and were not all melted down into Pus ; Drops of Matter could be feen drilling out from the numerous Orifices, of the fmall Caverns in its Sides _ When the Sani¬

es comes from the corrupted Marrow in the Cancelli, the Difeafe is analogous to an Abfcefs, the Matter of ..which has eroded a Number of fmall Holes in the Skin.

III. Frequently a Ipongy, bleeding, flefhy

Sub-

59$ Medical Effays

Subfiance rifes in all the little Caverns of the. worm-eaten Caries , when it may be called car- nous, and is much a-kin to Ulcers with Hyper • farcofis.

IV. As the fofl Parts are diffolved down in¬ to a mucaginous Subfiance, which deftroys their original Form and Texture in the white Swel- lings y as they are called, fo in this Difeafe, and fome others, the Periofleum becomes thicker, the Bone turns fofter, its Surface is eroded, a yellow-red fpongy Subfiance fprouts out, and proceeding deeper into their Subfiance, wafles: the bony Fibres.

The Difference of the Appearance of this Kind from what I called the carnous is, that in the carnous the fpongy Flefh grows out of the Caverns, while the grey or brown coloured: fpongy bony Sides of them flill remain ; where¬ as in the other, the bony Fibres difappear where- • ever the fpongy Flefh comes, fo that one can: fcarce determine by the Probe whether or nott the Bone is carious. Upon fcraping away this Bone-confuming Flefh, the Surface of the Bone 1 appears rough indeed, but not much eroded nor greatly altered in its Colour.

I have feen fome Ulcers in foft Parts where fuch a confirming fpongy Flefh rofe.

V. Frequently upon opening an Abfcefs one fhall fee at the Bottom of it a white fmooth Bone, without its Periofleum or Connexion to any of the neighbouring Parts, except by its Ligaments at its Extremities. By any Trials we can make, and by what we can judge from the Confequence of the Bone’s changing its Co¬ lour gradually as it continues expofed to the

v Air,

and Obfervations. 299

Air, and the NeceiTity of its coming all away before any Cure can be made of the Ulcer, it appears that there is no Circulation of Liquors in fuch Bones before the Abfcefs was opened.

This Way of Bones mortifying happens mold commonly in fcrophulous Patients, in whom fomething analogous to this is likewife often to be obierved in the Glands, round which a floW Suppuration is made, which leaves them ai¬ med entirely feparated from the furrounding Parts.

VI. In one Species of Exoftcfis the tumided Part of the Bone is lofter than the reft of it, and is not compofed of regular Fibres, nor ca¬ vernous, but as if the oflifying Juice had been thrown out irregularly ; over which a cartila¬ ginous or tendinous Subftance is fpread ; and from this a firm, fhining, fmooth Flefh grows out, which, after the Teguments are removed, fends forth a thin, ftinking, acrid Sanies ; the Patient complains often of throbbing Pains in It, and fbmetimes confiderable Hemorrhagies «re made from imperceptible Veffels in its Sur¬ face. May not this be compared to ulcerated Cancers of Glands ?

VII. In the fpreading eating Cancers, which all Praftifers know the Symptoms of, the Bones

re wafted as well as the foft Parts, and the Ap¬ pearances are the fame in both, unlefs that the Bones do not confume quite fo faft.

Having mentioned from Wifeman and Petit he general Symptoms by which we may fu~ fpe£d or know that a Bone is carious, and ha¬ ving deferibed what different Appearances I have feen in corrupted Bones; I fhould, if I

intend-

300 Medical Ejfays

Intended a regular Treatife, proceed to the At— tiology and Prognofis of each, but the former would lead me into too large a Field of Difpute, and the latter would require lb many Suppofi-- tions as would be tedious, or would be fo ge¬ neral as to be of little more Uie than the com¬ mon Directions laid down by practical Authors \ eafily guide one to ; I (hall therefore proceed directly to the Therapeujis.

In treating any Caries it is altogether necef- fary to examine RriCtly ail Circumftances, and to difcover, if poffible, what Caule, either ge¬ neral or topical, may have made the Corrupti¬ on of the Bones, that Endeavours may be uled to remove it, if it hill fubfihs. Seeing it would be very improper to pretend to give here Di¬ rections for the Cure of the Lues venerea , Scro- phulcz-, Scurvy , Gangrenes , Abfceffesy Wounds , Contujions , and all the other Diieafes which may occafion Caries , I muft confine myfelf to the topical Management of the Caries , without any Regard to the Habit of the Patient, or to any other Difeafe.

A fpeedy and fafe Separation of all the cor¬ rupted Part is then the principal Indication to be purfued, for executing which you have feen from the Hiffory very many Means have been propofed ; to know which of theie are prefer¬ able in the different Cafes which may be under our Care, it will be neceffary to confider the e- vident Operation and EffeCts of the leveral Me¬ dicines propofed, which may be reduced to the following Clafles :

i. The infipid terreftrious Abforbents, Rich as, Powder of Gorall, Crabs Eyes, dm. put in¬ to

and QbfervationSo

to an Ulcer, where a Bone is carious, can have little other Effect than to imbibe the Matter of the Ulcer ; if they fall into any Caver nulce of the corrupted Bone, they may remain fo long there as that the Matter they imbibe may be¬ come acrid. Char pie, Lint, is an Abforbent which has not this Difadvantage.

2. The Powders which have aromatic or o- ther acrid Particles in them, fuch as Pulv . Rad* Arifloloch. Bryon. Peucedan, Aloe, Myrrh ? Euphorhium, not only abforb Liquors, but give more or lefs Stimulus in proportion to their A- crimony ; and as the EffeCt of all Irritation is fhme Degree of Inflammation, which in Sores is principally removed by a fubfequent increa- fed Suppuration, thefe Powders may afftft to

feparate corrupted from found Parts. - Such

of them as have balfamic Particles in their Com-

pofition encourage the Suppuration mofh - .

Several of them refill the Putrefa&ion of ani¬ mal Subfiances, and therefore may preferve a carious Bone, or the Matter coming from it, from fuch a high Degree of Putrefaction./ as they might otherwife go to. — - — Befides thefe EfFeCts on the Sore, Regard mufl always be had to their Operation, if any of their Particles are abforbed into the Blood -veffels, for feme of them produce more or lefs of Fever, others be¬ come Purgatives, <bc. according to their dif¬ ferent Powers, which are known to thofe who are acquainted with the Virtues of Drugs.

3. Ardent Spirits, e. g. Aquavit fe, Sf>. V,

being liquid, can be introduced furthet into 1 carious Bone than Powders can; they flimulate Sores, refill PutrefaClion, harden the Fibres, Vol. V. C c coagu.

302 Medical EJfays

coagulate the Liquors, hinder Suppuration, and quicken the Pulfe when abforbed.

4. The Tinctures of the Powders K° 2. in the Spirits N° 3. partake of the Nature of both, but principally of the Spirit, of which the lar¬ ger Share of the Compofition confifts,

5. The ElTential Oils, 01. Cinamom. Cano - phyll. drc. flimulate, erode, refill Putrefaction, and mixed with the Blood, raife lome Degree of Fever.

6. Common Oils, Balfams, Refins, relax, increafe the PutrefaClion, and are allowed uni- verfally to be the mofl effectual Suppurants and Incarners.

7. Water relaxes the Solids and dilutes the Fluids, when nearly of the fame Heat with A- jiimals.

8. Vinegar Simulates and refills Putrefacti¬ on ; when weak enjoys alfo the Virtues of Wa¬ ter ; when flrong approaches to the 10th Clafs.

9. The natural Salts, Nitre, Sea Salt, a4l~ him, the Vitriols, have different Degrees of Pungency, and proportionally flimulate or e- rode, otherwife they preferve animal Subfian¬ ces from PutrefaCtion.

10- Acid Spirits extracted from Foffils by the - Force of Fire, fuch as, Sp. Nitr. Sal. marin . 01. Sulphur. Vitriol , fcc. coagulate the Liquids, and mortify the Solids ; by being diluted with Water they approach to Vinegar.

1 1. By diffolving metallic Subfiances in thofe acid Spirits, generally their corroding fphacela- ting Power is increafed, and fome of them

give

md Obfervations. Jcj

give fuch violent Pain as frequently to bring on Convulfions,

12. Metallic Bodies corroded by Acids ge¬ nerally erode when applied to Sores ; fome of thefe, for Example fublimate Mercury , and fome other mineral Subfiances, particularly Ar ft nick, have fhaken the whole Frame of the Body when applied externally, and the mercu¬ rial Preparations do fometimes enter the Blood to produce a Salivation,.

13. Alcaline Salts and Spirits, Sal & Sp. C» C, Sal & Sp . Sal. Ammoniac. Cineres Llavellat * Sal. Tartar. 01. Tartar . &c. flrmulate, erode and increafe Putrefa&ion ; when abfbrbed', as the volatile ones very readily are, they quicken the Pulfe. The eroding Power of thefe Salts is greatly increafed in their Preparations with Quicklime, as in the common Cauflick, which mortifies any Part of a living Animal it is ap¬ plied to, but with remarkably lefs Pain than what the Acids or their Preparations with Me¬ tals give,

14. All Bodies heated beyond a certain De¬ gree and applied to our Bodies give us Pairn^ flimulate and inflame ; when greatly heated, they mortify whatever Part of an Animal they touch .

15. The EfFefls of rafping, cutting, break¬ ing and trepanning Bones are altogether evi¬ dent.

16. In every Wound or Ulcer the Matter difcharged into it mull be the moil conflant Ap¬ plication to the Sides of the Sore ; when this Matter is laudable mild Pus , it is one of the moll powerful good Digeflers, Suppurants and

Cc 3

3 04 Medical EJJajs

Incarners ; when it Magnates too long, or when the Liquors or Veffels are faulty, it may be¬ come an acrid, Simulating, eroding Sanies \ when abfbrbed into the Blood, it infers all the Liquors, Simulates the Veflels, and is capable of producing violent Difbrders.

The Effefts I have attributed to thefe Medi¬ cines are inch as are evident to the Senfes, and what all who pra£tife know, but don’t always confider when they make ule of them, other- wife they would have adapted them better to the feveral Species of Cartes , and to the dif¬ ferent Stadia of each, to the Cure of which I Dow proceed.

Of the dry or gangrenous Caries.

When the dark Colour and dry Surface of a carious Piece of Bone Stew it to be fully mor¬ tified, efpecially if the Shrill Sound and riling Edges of it, with Pus coming out below them, dilcover the Exfoliation to be begun, Nature of herfelf, or with very little AffiSance, will make the Cure.

If the Pus is mild and in due Quantity, it will prove the beS Suppurant and Incarner for making the new Flelh thruS off the carious Piece of Bone, Care only being taken not to remove it too frequently, nor to allow it to re¬ main fo lon<7 as to become too acrid.

O

I* the Quantity of Pus is too little, it is to be Sr- plied by the Medicines whole Effects are neareS to it, fo that thole of the lixth Clafs are proper, Ung. Baft lie. Liniment, a Irccei , or fuch like every Surgeon employs to haSen the fal-

and Obfervations. 30,5

ling out of a Piece of Skin mortified by a Cau- flick. I have often employed them with equal Succefs in bringing away a Squama of a carious Bone, the Separation of which would necefia- rily be retarded by every thing which checks Suppuration and the Growth of new Flefli, as the common fivourite Medicines comprehend¬ ed under Clafs third and fourth neceflarily do % tho’, it mufl be acknowledged. Nature, with the Alfiflance of the Balfam of her own prepa® ring, Pus, will often get the better of all that Surgeons do againfl her.

While the Exfoliation is making, the ex¬ ternal Opening in the Teguments is large nough if the Pus is fo evacuated that it neither forms finuous Ulcers, nor is abforbed to taint the Blood, for otherwife it h aliens the Separa¬ tion of the carious Part of the Bone 'more by being collected upon it than when it has a free Exit.

If, by the external Orifice being fmall, ei¬ ther of the bad Gonfequences juft now mention¬ ed happens, the Aperture ought to be enlar¬ ged either by filling it with prepared Sponge, which expanding itfelf flretches the Orifice ; or* it may be enlarged by cutting with a Knife or eroding with Caullick the Teguments which cover the Caries , and they are afterwards to be kept afunder by filling the Sore with foft DoP fils, and preffing them in gently by a proper Bandage.

When the Colour of Part of a Bone is con- fiderably altered from what it fhould be in a found State, but is not fo dark as it can be jud¬ ged to be kitirely mortified, while there are no-

Ccf

306 Medical EJJays

Signs of its Separation, it may prove a very te¬ dious Task to trail the Exfoliation only to Na¬ ture; and therefore, after laying all the altered Part of it bare, if it can be done by the Me¬ thods propofed in the preceding Suppofition, the Surgeon ought to try with the Perforative or with the Rafper , how deep the Diieaie goes. If it is only fuperficial, a complete Mortificati¬ on is to be made by applying a red hot Iron or potential Cautery ; after which the Cafe and Its Management is the fame as was mentioned already.

If the Alteration in the Bone Is deeper than the A&ion of the Iron or Gauftick can reach, the Surgeon may cut off all that is fufpicious with a very iharp Inilrument ftruck with a "Wooden Mallet, which gives little Shock to the Member; after which he is to promote as much as poiHble the fprouting of granulated Tleih, fuch as riles in Exfoliations, from the whole Surface of the Bone, without which no Cure is made, but the Surface anew alters its Colour and corrupts. If it was asked Surgeons what the Medicines are which would moil rea¬ dily procure the Growth of Flefh, they would readily anfwer in general, Pus and balfamic or tmfluous Medicines, and iuch they would ap¬ ply in all fuch Cafes except where Bones are bare. For what Reaibn this Exception iliould be made I underhand not ; the Parts which yield new fprouting Flefh with the greateil Dif¬ ficulty ought, one would think, to have the moil powerful Incarners applied to them; and now, after a great many Trials, I can allure you that no Medicines fo effectually prevent

and Ohfervafms .

the Corruption of Bones laid bare, and afTift; to cover them fo foon with Flefh, as Oint» ments, Balfams, and drefling feldom, to have the Afiiflance of the moft effectual Balfam of all, Pus ; with thefe we fee daily the Extremi¬ ties of amputated Bones covered over with Flefh, and by this Method I have had the Plea- lure to lee large Parts of the Skull, Tibia and other fuch very folid Bones, covered in a little Time with granulated Flefh, after they had been laid quite bare by Wounds made even with bruiflng Xnftruments, and likewife after their exterior carious Surface had been cut ofF as directed a little above, and a complete Cure was made without the leaf! obfervable Exfo¬ liation.

5Tis plain that in the Cafe I now treat of^ where the corrupted Part of a Bone has been all cut away, or when found Bones have been, laid bare, and we wifh to make a Cure with¬ out Defquamation, that all Medicines which, can mortify the exterior Fibres, fuch are all e- roding Medicines, are to be fhunn’d ; as are alfo all fuch as harden and dry Fibres they are applied to, fo as to prevent the growing of Flefh, which ardent Spirits molt effectually do ; and therefore of all the Clafles of Medicines which 1 mentioned there are none, except the Abforbents No. i. and 2. the unCtuous and bal- famic No. 6. and Water No. 7. which are not oppofite to the Indications of Cure. The ter- reftrious Abforbents are of no Ufe ; Water dfc lutes and wafhes away the Pus, fo that fbme of the more aCtive or balfamick Powders and

tte

\

3oS Medical Effays

the un&upus Medicines can only be the proper Remedies here.

AV'hoever has taken notice of the Progrels of the Exfoliation of a Bone, or of the Cure of a Bone laid bare without Exfoliation, mull have feen the granulated Flelh riling from eve¬ ry Part of the Surface of the Bone to cover it, and that what Flelh grew out from any neigh¬ bouring Part, tho’ it may ly over the Bone and hide it from one's Sight, yet it does not grow to the Bone, and no Cure is made unlels by what rifes from every Point of the Bone ; nay very often Surgeons are obliged to deftroy luch i overlopping fpongy Flelh to promote the Cure ; from which it is reafonable to conclude, that Bellojle’s dreffmg fieldom contributed much more to the Cures he performed without Exfoliation of Bones laid bare, than the Holes he propoles; to be made with a Perforative into the Diploe or or Cancelli ; the Flelh riling from that fofter • Subfiance, overfpreading the Surface in the Circumference of the Holes, can be no better *i than the fpongy Flelh which hangs over the i Bone from the Sides of the Sore.

If, notwithstanding our Endeavours to make Flelh rile from the Surface of a found Bone laid bare, or of one that has had its mortified Surface cut off, we cannot obtain this wilh'd for Incarnation, and the Surface of the Bone fhews its beginning Corruption by a Change of Colour, it mult be treated as above directed in the Gale where we luppoled a luperficial Ca¬ rles, it mult be completely mortified.

"When the carious Part of a Bone is too thick for being feparated either by the Rafper or , Ghizzd> ,

and Obfervations. 309

Chizzel, it is to be taken out with the exfolia¬ ting Trepan, or by making a great many Holes in the Circumference of the Caries ; and then catting the Bridges between them through, the Middle of it is railed or cut off, after which the Management is the fame as in the preceed- ing Cafe.

Very often there is not Space enough in the Sore to apply right the Inftruments proper for cutting away the carious Part of a Bone, and it cannot be fafely enlarged; when this is the Cafe, we can only halfen the Exfoliation by ful¬ ly mortifying all that is fpoiled, by repeated Ap¬ plications of a red hot Iron or of potential Cau¬ teries. When the hot Iron is to be uled, the Bone ought to be previoully well dried, that the Iron may not be extinguifhed by the Moi- flure ; and we are commonly defired to guard the Sides of the Sore with wet Rags, whereas, when either the Iron is to be applied from time to time, or we can judge that the Exfoliation cannot be fpeedily made, while we veilh to con¬ tinue a large external opening, the realbnable Practice is of Defign to burn the Sides of the Sore into a fully mortified Elcar, if fbme Part is not to be hurt, the burning of which might be of very ill Conlequence ; for while this dead Elcar remains, lefs Moifiure will be thrown out to prevent the FJfeC: of the Cautery, and the fublequent Applications of the hot Iron can be made with little or no Pain to the Patient, and the Orifice does not contract — If a ca¬ rious Bone, which is to be burnt, lies deep, the hot Iron ought to be introduced through a Ca-

1

310 Medical EJfays

nula placed upon the Bone, that the Iron may be rightly directed.

If the potential Cauteries are chofen rather than the actual, the common Caufiick, prepa¬ red of Quicklime and Soap-lees , deferves the Preference to any of thofe compoled of the a*8 cid Spirits, for it gives not near lb much Pain, and is not fo apt to occafion Convulfions ; it penetrates better than the dry Forms of eroded Metals, and does not run fo much when it melts as the more liquid Acids do ; it either is not abforbed, or its Effects are not obferved in. the Blood : Whereas the mercurial Preparations frequently raife an unexpected Salivation.- — The Reafons given for burning the Sides of fuch d* Sore as I now treat of, are equally good for forming an Efcar all round the Sides with the

potential Cauteries. - This Efcar ought to be

kept from feparating as long as the Surgeon can ; the molt effectual Way of doing this is to * foak it frequently with ardent Spirits, by which Management, the Exfoliation of the Sides (par¬ don the Exprelfion which I ufe to fhew, the A- nalogy) may fometimes be near as long in ma¬ king as the Exfoliation of the Bone, if theSup- purants, Pus and digefting Balfams, are right¬ ly applied to it.

When the affeded Part of the Bone is fully mortified either of thefe Ways, the Cafe is re¬ duced to the Suppofition I firft made, and is to; be treated in the fame Way.

Though Neceffity obliges us to ufe Cauflicks in the very deep dry Caries , yet becaufe they require fo much Time and fo frequent implica¬ tions before they can pierce through any confi-

derable

and Observations, 3 j r

derable Thicknefs of a folld Bone, I would prefer the chirurgical Inflru merits with which the whole corrupted Part can be taken away at once, wherever they can be conveniently made ufe of.

After an exfoliating Piece of Bone is move- able, the Orifice of the Sore ought to be made fb large, by the Methods formerly propofed for enlarging Orifices of Sores, as the feparated Piece can eafiiy be brought out, and without leaving any confiderable hollow Ulcer under the Skin ; for thus the pricking Pain, which a loofe Piece of rotten Bone frequently occafions when ! left to work its Way through a fmall Paffage, i and the Suppurations which may be occafioned S by its remaining under the Teguments, may 1 be prevented, and there is no Danger of lea- 1 ving a finuous Ulcer, which may require more 1 Time and Labour than is otherwife neceffary : for a complete Cure of the Sore, which needs no other Treatment, after all the corrupted * Bone is brought away, and the found Part is co-

> vered with firm Flefh, than what any common | Ulcer does.

The Cafes I have fuppofed may ferve for 1 under flan ding the different Stadia of this dry

> Caries , with the Management neceffary in each, q and therefore I proceed to the fecond Species of i Caries which was mentioned.

Of the Worm-eaten Caries or Ulcer of the

Bones .

The Cells formed in the eroded Bone in this a, Species of Caries lodging and retaining the a-

crid

3 1 2 Medical EJJays

crid putrid Sanies , which increafes the Difeafe, it is neceflary todeftroy all the affedVed Part ot the Bone affoon as can conveniently be done,

• - -Wherever the proper Inftruments can be

applied, rafping, chizzelling or trepanning, according to the Depth or Extent of the Caries , will mod fpeedily anfwer the Intention. After; any of thefe Operations are performed, the Method of Cure is the fame as was propofed when we fuppofed thefe Operations to have; been performed in the dry Caries.

When the Sanies comes from the Cancelli of the Bones, the corrupted Sides ought to be ta¬ ken out by one or more Applications of the;

Trepan. - If the carious Part is of a large.

Extent, the Trepan is to be applied all round the Circumference of it, and the Bridges being- cut through, it is to be all railed up. Robert i Watfon was received into the Infirmary for a? fwelled carious Tibia ; the Teguments were all mortified by Cauftick, and then cut away, the Operation of the Trepan was performed four* ' teen times in the Circumference of the corrupt¬ ed Part, and all the anterior internal Side off the middle of the Tibia was taken out, new Flefh rofe from the Cancelli, and became firm; Bone before he went from the Hofpitai.

If lefs of the firm Sides of the Bone are found to be corrupted than what, upon open¬ ing the Cancelli , we difcover them affe&ed, Care mufl be taken that the Matter within the Bone fhould be eafily difcharged.

When, by the Orifice through the Sides of the Bone being in the lower Part of the putrid Cancelli9 the Matter eafily flows out, or all the

af'

and Obfervations.

feCted Cavity can be filled with proper DreR lings, the Cure may be made without taking any more off the lolid Sides of the Bone. The late Mr. Macgill and I were confulted about a Girl who, after the Small-pox, had an Ulcer very near the internal Malleolus , a Hole was eroded by the Matter through the Bone large enough to let one’s Finger enter, a Probe was introduced three Inches upwards within the 77- bia , without meeting any Refinance, but on directing the Probe downwards, we felt the Bone full of firm Flefh. A Pa/bill made of Myrrh , Aloes and Honey had been put every Day into the Bone, and the Girl had a conflant purging, which ceafed a Day after I ordered the Aloes to be omitted in the Dre fling of the Sore. An Injection compofed of Digeflive and Melrofe , diflblved in Water with fbme Vi¬ negar, was thrown every Day into the Bone, the Paflill of Myrrh and Honey was introdu¬ ced a little Way, the Cavity of the Bone gra¬ dually filled up with new Flefh, and a com¬ plete Cure was made.

When the Sanies Magnates becaufe of the unfavourable Situation of the Aperture in the Sides of the Bone, one or more new Openings muft be made with the Trepan, till either the Sanies has a free Exit, or all the Part of the Bone covering the putrid Cancelli is taken a- way, when the common Cures for other Ulcers are to be employed.

If we cannot perform the neceffary Opera¬ tions for removing a worm-eaten Caries , we muft burn it frequently with a red-hot Iron, ihe Directions for which Operation were alrea- Jql. V. Dd dy

314 Medical BJfays

dy given in treating of the dry Caries. The hot Iron feems to be preferable here to the potential Cauteries, becaule thele may link into the Cells and erode deeper than we in¬ cline, while they might not defiroy the exterior Part.

"When in this Species of Caries the Sanies is in great Quantity and very fetid, and the Bone cannot be come at to do what is necefiary for a free Difiharge, lo that there isReafon to be a- fraid that not only the Bone may be farther e- roded, but that the Sanies may be abforbed to occafion heflic Fever and all its fatal Conie- quences, it will be fit to encourage the Dif- charge of the Matter as much as poflible, and tb apply fitch Medicines as blunt or defiroy its Acrimony. It is therefore necefiary to drefs frequently in this Cafe, and to walh out the Sa¬ nies at each Drefiing with a proper Liquor. Ardent Spirits, the Tinflures made with them, and efiential Oils, do indeed defiroy or con¬ found the putrid Smell of fuch Sanies , and by contrafling the Vefiels of any Sore they are put into, leflen the Difiharge of the Sanies , which makes them anfwer the old Theory of their being proper Medicines for the Caries of Bones, which Difeale was fuppofid to be owing to too much Moifiure thrown upon the Bones, whofe natural Quality is dry, and there¬ fore required drying Medicines to cure them. Thele, I am perfwaded, have been the Rea- ibns why thole Medicines came to be employed for carious Bones ; but from what has been obferved of the different Circumfiances of Ca¬ ries it is evident that thele Realons cannot be

al-

and Obfervattons. 3 1 $

alledged for employing them in all Caries : And in the very Cafe which we now confider, and which is the moft favourable for ufing them, there are Objections to them which make others appear more realonable to be employed, and which, upon Trial, I have found more fuccefs- ful. The Objections are, that ardent Spirits and effential Oils in very fmall Quantity, or di¬ luted, (for when pure and in large Quantity they are cauiHc and penetrate too deep) retard the Separation of the corrupted Parts, they render all the Ulcer callous, which is indeed of lome Advantage to prevent proud Fleih while the Bone is not feparated, but is trouble- fome to remove afterwards ; they are very rea¬ dily abforbed and produce more or lefs Fever, which hurts the Patient. Some of the moft common TinClures employed, that of Aloes particularly, frequently brings on a conflant purging. Common Digeftive or Honey, or both dilfolved in Water, with which Vinegar or fome Drops of an acid Spirit have been mix¬ ed, more effectually correCt the putrid Sanies 9 and can be ufed in any Quantity to wafh it out of the Sore, without either retarding the Sepa¬ ration of the fpoilt Bone, or railing the leafl Diforder if abforbed, but on the contrary pre¬ venting the Mifchief which the abforbed Sanies

would otherwife produce. - -When the Ulcer

is deep this Medicine ought to be thrown into it from a Syringe, that it may penetrate every where, and may bring the Sanies away with it when it recoils.

D d 2

Medical EJfays

316

Of the Carnous Caries, or Ulcer of Bones 'with

Hyperfarcofis.

This Difeafe differing only from the imme¬ diately preceding in the Addition of fpongy Flefh growing in the Cells of the Bone, the general Indications of Cure alter very little ; only as this Flefh bleeds eafily and obflrufts the Surgeon’s View, the rafping, chizzelling and! trepanning cannot be fo proper here as the Cau¬ teries for deflroying the corrupted Part ; and feeing the Liquors conflantly ouzing from the fpongy Flefh foon extinguifh the hot Iron, the potential Cauteries are preferable to the affual Cautery. The Application of the Cauflick will require to be frequently repeated, becaufe this kind o £ Caries is generally very deep, and therefore it will be convenient to make an Efcar round all the Sides of the Ulcer at the firfl Ap¬ plication of the Cauflick, and to keep it as long . on as we can by foaking in ardent Spirits, that;t it may ferve as a Fence for preventing the fu¬ ture Cauflicks from fpreading too far or giving Pain. The Moiflure which the fpongy Flefh in this Difeafe fpews out, efpecially when irri¬ tated, is fo great, that I have daily dreffed with Powder of common Cauflick, removing a con- fiderable Quantity of gelatinous Stuff which colle&ed on the Surface, where the Cauflick had been applied inflead of the Efcar, which ufes to, be made in dryer Parts.— If the Cau¬ flick makes an adhering Efcar, it is in vain to apply any more Cauflick till that Efcar fepa- rates^ which is to be haftned by fuppurant

Oint-

and Obfervations. 317

Ointments, - By fuch repeated Applications

of common Gauftick I have in a very fhort time confumed a whole metatarlal Bone of the great Toe of an Adult, and have penetrated into the Cancelli in the Middle of a Tibia , the Idler and more fpongy Bones confirming looner.

What has been laid of the two former Spe¬ cies of Caries will readily make one know what further is to be done in managing the different Stadia of this Caries ; it is fufficient for my Purpofe to have mentioned what is peculiar to this Difeale.

the phagedenic Caries with Hyperfarcohs,

The Management of this Caries is nearly the lame with the former, only one or two Applications of the potential Gauftick are luf- ficient to mortify fome of the Surface of the folid Bone, which feems to reduce it to theory Caries . But I muft oblerve, that when this Caries is partial, I mean when it only leizes one Part of a Bone, which feldom is* the Gale, the Flefti which thrufts off the mortified Squa- ma is for moft part as phagedenic or bone -con¬ suming as what appeared, at firft ; and therefore, even in this moll fit vour able Suppolitiony the Surgeon fhould not promife a Cure unlefs he' has corrected the Habit or topical Indifpofitioru by internal Remedies.. ,

When this Difeafe has taken firm Roots,, it will fpread upon one End of a Bone which? was in Appearance found, when the Cure of the* ether End attacked with it was begun* and it

£) d: 3, wlH

3iS Medical EJfays

will creep along from one Bone to another, with this Difadvantage too, that it is far ad¬ vanced before one can well difcover it.

* ' \

Of the ftrophulous Caries.

The fpoilt Bones here being principally re¬ tained by their Ligaments, which we feldom can conveniently come at to cut through, and which are too ftnfible to be eroded, Sur¬ geons not only lofe their Labour, but do con- fiderable Mifthief when, in treating luch Pa¬ tients fecundum artem , they forcibly keep o- pen and dilate the Orifices of Ulcers where fuch Bones are, by cramming them with hard Dreifings kept in by a firm Bandage, and by wafting down the fpongy Flefh with Efcharo- ticks, while they are forcibly endeavouring to make the Bone come away ; fuch tender Conftitutions as theft Patients have cannot bear fitch rough Treatment, they languifh and decay under it. What I have always found of raoft Service, or rather that did the leaft Hurt, was to defrroy fully the Teguments co¬ vering the Abftefs formed on the Bone with Cauftick, to cut the Eftar through the Middle, to evacuate the collected Matter, and to fave . the Eftar on the Sides as long as I could, to or¬ der very mild Applications afterwards to the Sore, and to wafti it frequently with W ater for affiftingthe Diftharge of the Matter ; or, if the Matter became fetid, to mix a little Vinegar with the Water* Nature at laft feparates the Bone, which is to be taken gut whenever it is <quite ioofe*

and Observations * 3 1 p

Of the Schirrho-cancrous Caries.

Actual and potential Cauteries have the fame Effects here as in ulcerated Cancers of Glands ; they don’t diminifh the Tumor, create great Pain, occafion Haemorrhagies when their Efcars feparate, drc. Mod: other Medicines do Mis¬ chief, none of them do Good •, Extirpation on¬ ly can make a Cure, which may be done either by trepanning round the Root of the Excre- fcence, cutting the Bridges between the Holes, and bringing all away, or the Member is to be amputated. All of them I have yet feen were fo Situated that it was impoflible to make the partial Extirpation, fo that I cannot fay pofi- tively how it would fucceed. After Amputation of the Member the Wound cures as well as in other Difeafes, but fome of the Patients have fince been Seized with the fame Difeafe in ano¬ ther Member.

Of the fpreading canorous Caries.

This Sort of Cancer Seldom cures; it will Sometimes get a Skin upon it after cutting or burning, or with gentle drying Medicines or dry Lint, often breaks out again unexpectedly; in fhort, it is one of the opprobria medicorum which there is no certain Cure yet found for.

I never faw this Difeafe originally formed in the Bones, they are only affeCted by being in the Way of the Difeafe, fo that whatever Change the original Difeafe undergoes, the Bones par¬ take of it*

XXVI. Of

Medical FJJays

320

XXVI. Of the Separation of Tendons in Sores;

by Dr. Thomas Sim son Profejfor of Medi¬ cine in the Univerfty of St. Andrews.

TN the Cafe I fent you of John Daw, which:

you was pleafed to caufe to be infer ted a- mong the Papers of the Fourth Volume of the Edinburgh Medical EJfays, who, from a Con- tufion of one of the Flexors of the Fore-finger,, came to lofe two of its joints, and with Diffi¬ culty faved his Hand. You will find that be¬ fore the Cure was completed there was a Ten— don feparated and carried out of the Ulcer of the Metacarp. This Separation of a Tendon, or fome Part of it at lead, though not taken notice of by any chirurgical Writer treating of the Hurts of the Tendons, as far as I have yet found, has neverthelefs often occurred to me, and fome very unexpected Cures have followed upon it; fa that I thought an Account of them would be agreeable to the Publick, and might 1 contribute to enlarge our Views as to, the Na*^ ture of thefe Misfortunes that happen upon fuch Hurts,.

Eleven Years ago a Baker in St. Andrew r, after being fbmetime employed in lifting Wheat, found a violent Pain immediately above the third Joint of the Thumb, where the Flexor Tendon is inferred, and upon which the Sieve had refled. With the Puliation and Pain, which darted out at the Extremity of the Finger, he could get no Reft^ fo that next Day he asked my Advice, when I found his whole Hand fwdled., I immediately applied to the Seat, of

and Obfervations. 321

the Trouble a roafled Onion beat up with fome white Soap ; and after twenty four Hours I found a fmall Tumor rife upon that Part with Fluctuation. Laying this open with a Lancet, a bloody ferous Matter ifliied out, to encourage which X applied a Pultice of Oat-meal with Ba - Jilicon ; hence a more liberal Flux, but the Matter no way changed. On the fifth Day the whole Thumb was blifter’d round with the fame bloody Seru?ny and a fungous Flefh at the Wound ; upon this I drefled it with Tincture of Myrrh and Aloes and Arceus' s Liniment, and afterwards with warm Spirit of Turpentine. The Pain turned eafier, but there was no Ap¬ pearance of the Wound healing, till at length obferving a membranous loofe Body within it, I pulled it gently with Pincers, and without much Refinance brought it out, feveral Inches in Length ; then, by the continued Ule of the Terebinth, the fungous Flefh kept at under, and the Wound cicatrifed after a Month’s 111- nefs. I reckoned that the membranous Sub- Xlance was the Sheath of the Flexor Tendon. After this my Patient had the Ufe of his Thumb as formerly.

X had much the fame Procefs in a Fifher, af¬ ter I had cut out a Hook near the Flexor Ten¬ don of the midle Joint of the Fore-finger ; on¬ ly in him, after the Swelling had continued for fome time with fungous Flefh at the Wound, I fomented it with warm fowr Claret, upon which a long ligamentous loofe Body fhewed itfelf, and was eafily drawn out as in the for¬ mer Cafe ; after which all the Symptoms im¬ mediately abated.

I ap«

322 Medical Ejjays-

I applied the fowr Claret, having feen a fed-- den good Effect of ic in a Workman who had hurt the Flexor of his Thumb with a Glafs, upon which the whole Hand fwelled, an Ab- fcefs formed at the inner Side and middle Part of the thenar Mufcle and was laid open ; but at the fame time the Swelling fpread to the an¬ nular Ligament at the Carpus, in which Cafe I gave feven Dofes of the Bark to try if, in this inflammatory State, it would do any Service, it having leffened the Inflammation accompa¬ nying the Gangrene in John Daw ; but here it had no Effect. In the mean time I applied Fo¬ mentations of warm Claret, under which Ma¬ nagement an Abfcefs formed, as I have feen in tendinous Parts upon a clofe Application of warm Brandy, and upon opening it two Spoon¬ ful of good Pus iflued out ; neverthelefs, tho* a Cataplafm of Oat-meal was applied, the Part hardened, and a great deal of fungous Flefh, fuch as for ordinary accompanies the Wounds of the tendinous Parts, appeared; upon this applying only warm lowr Claret all fubfided., and the Hand very foon was quite reflored ; fb that I could not but obferve the different Ef¬ fects of this in fuch a Cafe from that of the molt foftning Cataplafm.

In a Woman who had an Eryjipelas over the Back of her Hand, with Horror and Fever, from feme unknown Caufe, at length an Abfeefs formed, whence I from time to time drew fe- veral Portions of Tendons, all of which, as in every other Cafe, were fomewhat round, tho* broader than thick, and plainly a diflinO: Bo-

and Obfervations. 323

dy by themfelves, being fmooth and entire all round their Surface.

I fhall finifh thefe Accounts with one I in¬ formed you ot twenty Years ago, when I was at Glafgoiv. An old Woman, who had fallen upon her Elbow, {hewed it me, with an Exco¬ riation and a fmall Orifice ; at which, probing it, I difiincfly found the Bone rough, and the Matter very fetid. This, in my early Practice, made me immediately confult Mr. Gordon , a Surgeon of great Accuracy and Judgment in that Place: He, from the fudden Caries , excef five putrid Smell, and gangrenous Flefh for the Breadth of half a Crown round the Orifice, ftt- fpedfing the worff, defired me to confult the reft of our Faculty in that Place ; and all feem- ed to agree, that an Amputation of the Part was the only Thing to be trufled to : But, con- fldering her Age and Weaknefs, they thought the Succefs doubtful ; and therefore agreed to foment it often with Aromaticks and Spirits, and give her inwardly a Prong Deco&ion of the Woods. After eight Days Management this Way, we found fmall Change in the Ap¬ pearances : But after this fomething of a loofe Body appearing at the Orifice, which was now confiderably enlarged, it was pulled out, being as thick and large as one Quarter of an ordina¬ ry Herring Milt, and fomething of the Form, 5tho’ fomewhat putrid at the Extremities, but i firm and tendinous at the Middle. After this I the Matter decreafed : But another Abfcefs ap- | pearing fbme Inches above, we opened it, which dfbon healed along with the firfl Sore, with- fiout any Lofs of the Ufe of her Arm, (which fhe

era-

324 Medical Effdys

employed in her ordinary Work for fbme Years afterward) or any apparent Exfoliation, as I have feen in other Cafes with carious Bones, e- fpecially in the Small-pox.

When thefe Cafes, to which I could have; added feveral others, are compared, I reckoru they will be allowed much of the fame Nature, , tho’ in different Parts of the Body; and that if fu.ch Cafes be ranged among the Species of the Panaris , when happening at the Fingers, they fhould be fo likewife at the Metacarpus and El- low ; tho’ I think, by fo doing, as fbme of the; Modems have done, we needlefly confound fome Difeafes proper to the Nails and others proper to the Tendons, which might eafily be kept diftinfl. But having finifhed what was the principal Defign of this Paper, to wit, to fhew how frequently fuch tendinous Bodies fe- parate in Hurts at the Joints, and under what Management they may eafily be made to fepa- rate, fo as there may be no Occafion for the dangerous Incifions directed by fome to be made1 on the inflamed tendinous Parts ; I fhall con-1 elude my Paper with obferving, that, in a found1 Body, the Tendons can be drawn out and fe- parated by Force from their Mufcles, as we fee in the flxty fecond Obfervation of Peter de Marchettis , where a Servant had the lafl Pha¬ lanx of his Thumb drawn off by a Horfe, and with it one of the Flexor Tendons, twelve In¬ ches in Length. Here I mull mention another Patient of my own, aged fifty, who having p wounded himfelf with a Hook, in cutting down i Corn, upon the Flexor of the lafl Joint of the little Finger, came to me, after the Lofs of

this

1

and Observations, 3 1$

this Joint, with its Neighbour loofe and cari¬ ous, and a fmall gangrenous Ulcer between the firffc Joint and Metacarp , where the Tendon was laid open. When I was fomenting from time to time, to curb the Progrefs of the Gan¬ grene, the Fellow himfelf, impatient under the Pain, catching the fecond Joint, pulled it off, and with it the Tendon fome Inches in Length ; after which he was very ipeedily cured, as the

others I have mentioned were.

»

XXVII. Htflories of the Cure of Lymphaticks

opened in Wounds ; by Alexander Monro*

P. A .

T Do not observe that chirurgical Writers take ■*- notice of a Phenomenon which I have feen feveral Times in the Cure of Wounds, which poffibly young Surgeons may be at a Lofs to underhand, or to know how to remedy ; it is the rifing of a fungous Subfiance, from which there is a conflant Stillicidium of Lymph, which prevents a Cure, and weakens the Patient, if it is allowed to continue long: To afRft them, I fend you here two of the molt remarkable Examples of fuch a Cafe that I have met with.

In May 1726, I extirpated a very large Stea - tom from the left Arm of a Servant of Mr. Gra¬ ham of Ktllearn. It had been occafioned by a Bite of a Horfe about twenty Years before : Its Bafe reached from the Middle of the Deltoid Mufcle to near the Elbow ; fo that the Cephalic Vein ran along the Middle of it, and was ne- ceffarily to be cut through twice in amputating the Tumor. The Cure went on very fuccefs- Vol. V. E e fully

Medical EJJays

fully, the Wound contracting very fa ft, till a i yellowifh white Subftance rofe up from a fmall Peduncle at the Part where the Under-part off the Cephalic Vein had been cut through. Froth t this Subftance fuch a Quantity of Lymph ouzel out from imperceptible Orifices, that the Dref- lings were every Day wet. I cut and eroded! this Subftance away feveral Times ; but it quick¬ ly grew again, and the Drilling of Lymph be¬ came worfe and worfe, fo that in a very little Time it dropt fo faft, that I could have gather¬ ed a Spoonful of it in a very fliort Time. What cured it at laft was, eating the fungous Stuff and a little of the Wound about with Powder o £ Roman Vitriol, and dreffmg the Efcar withi Alcohol, which kept it from feparating two Weeks, in which Time the Orifices of the fmall Pipes were foldered.

2. A Gentlewoman having been let Blood of in the Bajilic Vein in the Country, foon per¬ ceived a Tumor at the Orifice. Several Months after fhe came to Town. When I faw it, it was large as a Walnut, beating violently: I could make it difappear by Preflure ; and as I kept my Thumb on it, while I yielded to the Influx of the Blood, I had a Feeling very like to hearing the Sound of Water ruffling into a Pipe.

I tried firfl what Preflure would do in keep¬ ing the Blood from rufhing into it; but that being of no Ufe, I was obliged to perform the Operation of the Aneurifm, which I did in the Way propofed in your 17th Art. of Vol. IV. The Sac, in which nothing but liquid Blood was contained, was as thick and ffrong as the

Gyffis \

and Observations. 327

Cyflis ofincyfled Tumors commonly are, and was evidently formed in the fame Way, that is, by the firetching and thickning of a Part of the cellular Membrane. However, I cut none of it away, on Purpofe to fee what Change would come on it. As the Tumor had ex¬ tended itfeif principally outwards, it had ralfed both Median and Cephalic Vein in the Tegu¬ ments upon it; and the Cephalick lay fo ob¬ liquely over it, that I could not evite it in cut¬ ting.

I had the Pieafure to fee the hard firm Bag become every Day fofter and thinner with Pa- pillce of granulated Flefh growing out from it, till it became all the fame foft red Flefh as was in the reft of the Wound.

After a Fortnight, fuch a yellowifh white Fungus , with a drilling of Lymph as defcribed in the former Cafe, role out from the Part of the Wound where the Extremity of the cut Vein was. I burnt it with the Lunar Cauflick, and dreffed the Efcar with Alcohol; which ef¬ fectually cured it, and the Sore was skinned fully over in fome lefs than fix Weeks, and my Patient enjoyed then the full Ufe and Strength of all Parts of the Member. The Pulfe at the Wrift was plainly felt next Day after the Ope¬ ration, and is now fo flrong that no Body could know the Artery was ever tied.

The Operation of the Aneurifm has been twice more performed here ; fo that in few Years there are five Examples of its Succefs in this Place, all the Patients who underwent it having been brought from the Country.

E e 2 XXVIII. A

Medical EJfays

p 8

XXVIII. A milky Difcharge at a fmall Orifice in the Groin y by Mr. John Patch Surgeon in Exeter.

A Son of Samuel Wroth of Crediton in the County of Devon, about Eleven Years of* Age, and of a flrong and healthy Conffitution, complained to his Mother, on the 8th of Ja¬ nuary 1739-40, that the Linen in his Breeches was very wet, and he knew not the Reafon of it ; but fie thinking it to be Urine, was about to correct: him.

About two Months after, the Boy made the fame Complaint : When fhe examined him* and foon found a Liquid like unto Milk conti- nually ifluing from a fmall, almofl imperce¬ ptible Orifice near his Left Groin, which con¬ tinued for three Days ; and fie verily believed, that the whole Difcharge at that Time was not lefs than two Quarts or five Pints, which very tnuch weakned him.

A Flux of the fame Kind, and from the ve¬ ry fame Part, began again about fix Weeks af¬ ter, and wept, but not continually, efpecially towards the latter Part of the Time, for near five Weeks; from which, the Boy loft his Ap¬ petite, and was grown fo weak that he was fcarcely able to walk.

Being informed of fo remarkable a Cafe, 21- bout the Beginning of September , my Curiofi- ty led me to have a Sight of it. There being then only a little Rednefs in the Skin, about an Inch above the inguinal Gland, as if there bad been a fmall Puflule, without any Pain,

Tumor

and Obfervations . 32$

Tumor or Inflammation, made me to fufpedfc the Truth of what I had been told concerning it : However, I ordered the Boy to acquaint his Parents (they being poor) that, if his Dlfbr- der fhould return, I would readily and freely give him my utmofl Endeavours for his Cure.

Towards the End of the Month, the Boy came under my Care. Seeing it then perfectly found, and of the natural Colour of the Skin, I did nothing for him : But in few Days after three or four Spoonfuls of the Difcharge was brought to me, which appeared like fcalded. Milk; and fome of it being heated over a Candle, it ioon turned to a foft Curd. I im¬ mediately fent for the Boy, and obferved it to run from the fmall Orifice down his Thigh pretty faff ; but it was quite Aop’d next Morn¬ ing, when I applied a fmall Piece of common Cau flick on the Orifice with proper Bandage. After this Application of the Cauflick, there was never any milky Difcharge. When the Efcar feparated, which I did not endeavour to haften, I Buffered the Flefh to rife above the Skin, that the Cicatrix might be the flronger. The Sore was afterwards fanned over with the common Deficcatives, and the Boy foon recovered his Strength, and has continued ever fince in perfeft Health, without this or any o- ther Complaint.

A Week after the Application of the Cau- jflick, I drew about eight Ounces of Blood from his Arm ; (and, contrary to my Expedition, found the Serum as well as the Coagulum to be natural both in Colour and Quantity .

E e 3 XXIX. A

3 30

Medical EJfays

XXIX. A FraShire of the Skull , with Lofs of Part of the Subftance of the Brain ; by Mr.. D uncan Baine Surgeon in Pembroke.

SEVERAL Hiftories are recorded of People recovering after Wounds of the Head, where Part of the Subftance of the Brain was taken out, but ib few of them are met with in the common reading of Surgeons, that I ima¬ gine it would be of Advantage to relate more of them, whereby Surgeons might be en- CQuraged to undertake fuch Patients. With this View I fend you the following Cafe,

William Lloyd , eight Years old, plucking Hairs from a Colt’s Tail, received a Kick about an Inch above the Orbit of the left Eye, which Xlunn’d him fo much that he was taken up for dead, bleeding at Nofe, Ears and Mouth, and In this Condition was brought two Miles to Town here. The Wound extended to the letter Canthus of the Eye. In examining it I found a Fraflure of the Bone, of a triangular Form, three Quarters of an Inch long, the fu» perior Angle being depreffed and fomewhat ioole. I made an Incitton crofs the Wound to lay the Bone fufficiently bare, and then drelfing it up, let live Ounces of Blood at his Arm, or¬ dered an emollient Glytter to beinjeded, which he could not retain, and Pent him an antifpatt modic Julep, with fome Pulv. de Gutteta , to be given, of which he fwallowed a little now and then.

In the Night-time he had three fevere con- vulilve Fits. Next Morning I faw and felt the

Fracture^

and Obfervations . 331

Fracture as above defcribed. I fixed the Screw of the Trepan into the lowefi moft fixed Part of the Fracture, and in doing this raifed the upper Angle fo much, that I got the End of a thin Silver Spatula below it, without preiling on the dura mater ; then drawing the lower Part of the Bone outward with the Screw, while I raifed the upper Part with the Spatula , I took out the whole fra£tur’d Piece of Bone. In rai¬ ling the upper Angle the Boy railed his Hand to the Wound, and when the Bone was taken out he made fome incoherent Noile, which were the firfi Symptoms of Feeling he had after re¬ ceiving the Blow. I clear*ed away all the ex¬ traneous Subfiances out of the Wound, applied a Syndon wet in Sp. V . and Melrofe to the du¬ ra mater , and the other common DreJfFmgs to the Wound. In the Afternoon the Clyfier was again injected, and he retained it, and fometime after had a large Stool.

That Night he had one convulfive Fit. Next Morning he fpoke articulately and rationally* I continued to drefi him every Day, and feve- ral times brought away a Tea Spoonful of the Subfiance of the Brain ; notwithfianding which he was cured in ten Weeks, and is now a fiout lufty Youth at Service in the Country, with in¬ deed a large Scar in his Face, but with all his Senfes and Strength good and entire.

XXX. Artificial Pa (Jages for natural Liquors Alexander Monro, P. A .

*T*G keep the Promife I made in Art . xiii. of your fecond Volume, I fend you the three following Cafes, A

332, Medical EJfays

A Gentleman had been plagued with a tedi¬ ous Tooth-ach, which occafioned a very hard Tumor above the joining of the Cheek and Gums of the fecond dens molaris in the upper Jaw on the left Side. The Tumor having fup- purated broke outwardly on his Cheek, the Mat¬ ter flowing out of the Ulcer was for fome time very fetid, and feveral carious Pieces of Bone came out of it. This Ulcer continuing long,, the Patient came to this Place with Dr. Hugh Sutherland now Phyfician in Orkney.

There was then in the Ulcer a Tent about t the Size of a Goofe Quill, an Inch and an half long; when the Tent was taken out it was co¬ vered with purulent-like Matter, but upon leaning his Head forward and to the left Side,; a clear Liquor refembling glairy Spittle drop’d out. No fuch Liquor or Pus had ever run out! of his Nofe upon reclining his Head to the right Side and downwards. The Sore had no fetid offenfive Smell. A Probe gently bended1 being put into the Sore, v/as turned in differ¬ ent Dire&ions in a large Cavity formed of Bone lined with a fmooth tenfe Membrane, which covered the Bone every where that we applied the Point of the Probe. The Roots of the rotten Tooth, which began this Trouble, and had often been attempted to be drawn by different Tooth-drawers, were Rill faff in their Sockets. Dr. Sutherland and the Patient both informed me that they had feveral times obfer- ved a Thicknefs, and felt what they thought t to be a Fluctuation of Liquor in the Palate or; Roof of the Mouth, which there was not then

anx

and Obfermiions. 333

any Appearance of. The Patient was other- wile in good Health.

By cutting the Gum between the Roots of the rotten Tooth I made way for a thin Piece of Iron, which I pufhed forcibly in between thefe Roots, and then thrufling it to a Side, I priled the one Root inwards out of its Socket, and made the other lo loofe that it came after¬ wards ealily out. A fmall Gimblet being im¬ mediately put into the fartheft back Socket, I endeavoured to make it pierce into the antrum maxillare, but could not direct it fo far back. To give a Difcharge of the Mucus into the Mouth, and to prevent its running out at the Orifice in his Cheek, till the fwelling of the Palate fhould give an Opportunity of making a more effectual Drain, I laid afide the Tent, and pufhing a Shoemaker's Awl from the join¬ ing of the Gums and Cheek into the finuous Ulcer near the Aperture made into the Antrum by the former Carles , by the means of a very flexible Probe, I introduced a fmall Cord into the "Wound made with the Awl, and brought an End of it out at the external Orifice of the Ulcer, defiring the Mouth to be frequently rinfed with Brandy to render the new Wound callous foon.

The Patient’s Bufinefs obliging him to return home, he went away with this Seton, which being taken out fbme time after, this new Paf* Page fhut up as well as the external Orifice \ foon after which the Palate fwelled, and being opened by Dr. Sutherland , fbme fmall Pieces of Bone came out, and our Patient has been well ever fince.

mjK

334 Medical Effdys

Hijl. 2. In confequence of a Tooth-ach and rotten Root, a Tumor rofe in a young Gentle¬ man’s Cheek, which had been opened in the Infide of his Mouth, and a glairy dear Matter was evacuated, but the Incifion doling foon, the Tumor again appeared, and when I firft faw him, was as large as a fmall Golf-ball, fil¬ ling all the Hollow of the Cheek, and being confiderably prominent. I judged it to be of the incyfted kind, forced out the Remains of the rotten Tooth ; but the Tumor not evacua¬ ting at the Sockets, Mr. John Douglas at my Defire opened it with a Lancet within his Cheek. Clear Mucus being preffed out at the Orifice, the Tumor fubfided, when we plainly felt three Exoftofes pointing towards each other, between which the Sac had been nitched. One of the Exojlofes rofe from the Root of the na- fal Procels of the maxillary Bone. The fecond grew out from that fame Procefs, or from the anterior orbitar Procefs of the os malarum near to the Orbit. And the third, which was the large#, refembling, when felt thro’ the Tegu¬ ments, an old Cock’s Spur, role out of the Cheek-bone. We could be fenfible of no Bone being bare or fpoilt by a Probe introduced at the Wound, nor had we Reafon, from the Nature of the Matter evacuated, to judge that there was any carious Bone. A Tent with a Thread hanging to it was put into the Wound, which was continued fome Weeks, Brandy and Melrofe being frequently injefied into the em¬ pty Cyft, and the Patient rinfing that Side of the Mouth often with Brandy. After we thought the Pauage callous the Tent was no more ufed,

and Obfervations . j

and the Patient has had no Return of the Tu¬ mor.

Hlfl. 3. Upon drawing the Roots of a rot¬ ten Tooth of a young Lady who had a Tumor refernbling the one defcribed in the former Hi- ftory, a yellowi di-coloured thin Liquor flowed out of one of the Sockets ; this Liquor had a great many Particles refernbling Oil (wimming on its Top, but had no fetid Smell. The (wel¬ ling immediately fubfided, no Exoflofis was felt ; a fmall Probe introduced into the Hole of the Socket could not be made to touch any bare Bone in the Circumference of a large Ca¬ vity it was put into ; nor could we difcover the P ullage by which the Liquor came from the external Cyftis into the Socket of the Tooth. The Management of this Cafe was the fame as e preceding ; the oily Particles appeared feveral hays in the Liquor that flowed when the Tent was taken out; at length they could not be obferved. The Lady has continued well and free of (welling,

XXXI. An uncommon Tumor of the Neck ex - tir paled ; by Dr. Thomas Si ms on Profef , fir of Medicine in the Univerfity of St. An¬ drews.

tk Farmer’s Wife in this Country, after being bled nine Years ago in the jugular Vein, found a (mail Tumor forming about the Place of the Incifion, which increafed to the Bulk of her two Fifts. It broke upwards of a Year a- go, ulcerated, and ran a great deal of (link¬ ing Sanies : The Smell, which the (Irongefl

Spirits

Medical Ejjays

Spirits could not correft, was lb offenfive to her, that Hie was perepetualiy uneafy, Tick and faintilh.

"When I faw this ulcerated Tumor, it funk deep into the FoJJa on the Right-fide of the Afpera Arteria : So that, knowing its Bale muft be very near to the carotid Artery and in¬ ternal jugular Vein, I was unwilling to under¬ take the Extirpation of it; but was afterwards prevailed on to perform the Operation, as be¬ ing the only Chance the Woman had for Life,

In d life cling out this Tumor, I laid the ca¬ rotid x^rtery bare for about two Inches, and plainly law its Puliation ; as it fends out no Branches about this Part of the Neck, I wrought with the greater Refolution. From the upper Part of the Tumor a cartilaginous Prpcefs w t nr to the Larynx , to which it was flrongly at Vi¬ ed. In cutting this away, there was a ftrong Jet of Blood from an Artery, which foon R ra¬ ped after the Application of Spirit of \ it ; fo that I went on with the Diffeflion of the Tumor from the Vein downwards. After lay¬ ing the Vein bare a conliderable way, I found it confounded at the lower Part with the Sub- Ranee of the Tumor ; and therefore, putting a Ligature round the Vein, I tied it, and then cut away the remaining Part of the Tumor be¬ low, except a fmail Part, in which I thought the Vein was involved, expefling the Ligature would make this fall off : But, feeing no Ap¬ pearance of Rich a Separation, 'after eight Days I cut it thro’ immediately below the Ligature, and found Vein and all quite folid, of a carti¬ laginous Firmnefs. After this hard SubRance

was

and Obfermtwns . 337

was all taken away, the large Cavity, where the Tumor had been lodged, filled up very faff, fo that the Wound was cicatriced in fix Weeks.

\V hat are to become of a great many fmall Knots which formed in each Side from time to time, after the large Tumor increafed, I can¬ not yet determine.

XXXII, Uijlories of Collections of bloody

Lymph In cancrous Breafts ; by Alexander

Monro, P. A.

XTO Mention being generally made by Chi- rurgical Writers of a Collection of bloody Lymph in the Breads of Women, as a Confe- quence or Attendant of the fchirrhous or can¬ crous Tumors of thofe glandular Parts, I fend you the following Hiffories of fuch Cafes* which may at leaf! teach Practifers to know when they meet with fuch a Difeafe, and may five them from being accufed of deftroying ; their Patients by their Ignorance.

L A W oman about fifty Years of Age fhew- ;ed me her Right Bread, in the exterior Side of i which there was a large very hard unequal Tu- imor, in which there frequently was {harp Pain* fin the hollow of the Arm-pit was fuch another Shard Tumor: Both of them had increafed ve- | ry (lowly.

I ordered her to be let Blood of, to take a I cooling purgative Ptizan once a Week, and to dive on a fpare cooling Diet, which foon made Hthe Pains eafier. Some People however ha¬ lving promifed to make a complete Cure of her iVol. Y. F f Bread,

Medical EJJdys

Breafi, prevailed on her to apply warm fiuppu- rative Gataplafms to her Bread: ; which brought a Fluctuation of Liquor that was believed to be a complete Suppuration, till it broke, when, as the Woman and her Relations informed me, about four Pound of bloody Water ran out: After which the Woman was in conflant violent racking Pain, which made her again defire me to vifit her. Near the Arm-pit there was then an Orifice, which could admit three Fingers at once, that was the Entry to a very large hollow Ulcer, from which there was a conflant Difcharge of abominably fiinking wa¬ tery Sanies. Upon prefimg the Sac, I made feveral Spoonfuls of this Liquor to run out. The Woman was fo weak fhe could not turn herfelf in her Bed, to which fire was confined ; her Pulfe was very quick and low ; fire had a Diarrhea , Night Sweats and Gough, and was kept constantly awake by the fharp Pains of the Sore. i

To make her fomewhat eafier the firort time t fhe had to live, I made tepid Rofe-water with a little Vinegar, Brandy and liquid Laudanum , to be injeCted into the Sac frequently ; and gave her a cordial julep, with fome Laudanum, , to be taken fometimes : By which the Pain was blunted during the two Days more fire lived.

II. My Advice was asked for a middle-aged Woman living in the Country, who had been two Years fenfible of a hard Tumor in the up¬ per Part of her Left Breafi:, which was very fmall in the beginning, but was increafed gra¬ dually to a great Bulk, notwithfianding differ¬ ent Medicines fire had taken, and the Applica¬ tion

and Ohfervations . 3 3 p

ti-on of mercurial and gummous Plaiflers, <bc„ The cutaneous Veins of this Bread: were turgid ; the Skin was become red ; lancinating Pains often pierced thro’ the Tumor, which was ve¬ ry hard. At the Time of the mendrual Eva¬ cuation, the Tumor became fo large as to ap¬ pear to be fixed to the Ribs, upon plentiful Blood-letting fubfided, and was again move- able.

My Opinion was, that either the Bread fhould be extirpated ; or, if that was not con- fen ted to, by general Evacuations and a low Diet the Increafe of the Tumor fhould be re¬ tarded ; and by a cooling Lotion, fuch as A- cet. Lethargy?1' . diluted with Water, the In¬ flammation of the Skin fhould be prevented.

Some time after my Correfpondent wrote to me, that the Tumor had fuddenly increafed to a very great Bulk, with an Increafe of the Pain ; that it then became foft in fome Parts, with a Fluctuation of Liquor, while the hard Tu¬ bercles were felt at other Parts ; that at length the whole Tumor became red, loft, and full of Liquor, and had been opened at the lower Part, when two Pounds of a bloody Water, which had no Smell, were evacuated.

Next Day the Pain was much more violent than formerly ; the Wound had a cadaverous Smell, and the fuperior Part of the Bread: was dill turgid with Liquor : To evacuate which an¬ other Incifion was made ; and four Pounds of the bloody Water being let out, the Bread became very flaccid. The Pain increafed vio¬ lently, a Gangrene appeared on all the Skin

F f 2 of

34° Medical EJfays

-of the Bread, and next Morning their Patient died.

When the Bread was differed afterwards, it was found to be an empty Bag without any ra¬ mified Gland in it.

III. A middle-aged Woman, Mother of fe- V'eral Children, who had always been of a weak Habit, and fubje£l to nervous Diforders, ha¬ ving accidentally bruifed her Right Bread jflightly, felt foon after a hard Tubercle toward the exterior Side of that Breafl, which, not- withdanding fome Purgatives and aperient De- coffions that were given to her, increafed con- flderably. She was with Child when I fird law her along with feveral other Gentlemen, who thought the Extirpation proper : But her Condition prevented its then being performed, and gentle Deobdruents, with mild Food, were recommended.

The Tumor grew bigger, a fmall hard Knot formed below the Edge of the pefloral Mufcle, t .and the axillary Glands tumified and became < iiard.

She aborted in the fixth Month of her Pre¬ gnancy, and had a very plentiful Difcharge of Lochia, but without any Change being made On the Tumors. As foon as fhe had recover¬ ed from the Abortion, fhe took Rhubarb and other mild Purgatives frequently ; her Menfes returned in fufficient Quantity at the regular Periods : She was more free of the nervous Dif¬ orders than fire had been for a confiderable Time ; the Tumors however in her Breafl and Arm-pit increafed faff.

After the whole Breafl feemed to be fchir-

rhous.

and Obfervations, 341

rhous, a Fluctuation of Liquor was perceived in feveral Places toward the exterior and fupe- rior Part of the Tumor, and fhe complained of pricking Pains in it. Soon after the Breaft levelled fail:, the Fluctuation was felt every wherein it, and the Veins of the Skin became very large and varicous, the Uneafinefs from the Weight and Pain keeping the Patient ai¬ med: entirely from Sleep.

The Teguments at laft turning red, point¬ ing, and fo thin that they would fbon have been opened by the Liquor, a very finall Lan¬ cet was pufhed into a depending Part of it free from large Veins, and three Poqnds of a black - ifh red Lymph were allowed to run out; and the further Evacuation at that time was pre¬ vented by a Tent adapted to the frnall Orifice, fecured by a Piece of adhefive Plaifler.

The Liquor which was drawn off had no Smell ; and, when expofed to Heat, coagula¬ ted as the Serum of the Blood does.

The Patient bore the Evacuation Well, and was eafier than ordinary all Day.

Next Morning, when the Dreflings were re¬ moved, the Skin appeared of a natural Colour, and the Veins were all contracted ; a Pound of the fame fort of bloody Lymph flowed out of the Wound. After which the glandular Part in the Middle oc that Bread: could be diftinCtly felt, and did not feem larger than the glandu¬ lar Part of the other Bread: ; but the Tubercle at the Edge of the peCtoral Mufcle, and the hardned axillary Glands, were as large as ever.

After the fecond Drefling, the Patient com¬ plained of a fharp Pain near to the Wound ;

F f 3 . which

3 4' 2 Medical E([ays

which being fufpected to be occafioned by the Point of the Tent touching lome of the glan¬ dular Parts, now when the Breafr was collap- fed, it was changed for one no longer than would go no deeper than the Thicknefs of the Lips of the Wound.

Betwixt this third and the fourth Dr effing, the Lymph ouzed at the Sides of the Tent, and had fomewhat of a putrid Smell.

On the fourth Day after the opening, the Teguments were fo thin as to allow the origi¬ nal Tumor in the exterior Part of the Breaft to be diftinCtly felt ; and it feemed rather larger than when it began to be concealed by the Col¬ lection of Lymph.

On the fifth and fixth Day there was little Change, only the Lymph became more fetid, and more of an afby. Colour.

Seventh, the large T umor of theBreaft felt fofter.

Eighth, the Quantity of Lymph was lets, and lome tolerably good Pus came out upon the Tent. The Smell and confiant ouzing of the Lymph being unealy" to the Patient, a Sponge dipt in Jqu. Calc . and Aq. Regin . Han¬ gar. and afterwards prefs’d near dry, was laid over the Breaft.

During the eleven following Days the Ap¬ pearances mended ; for the Quantity of Liquor flowing by the Orifice decreafed, its Smell be¬ came lefs fetid, and its Confidence was nearer to that of Pus ; at the fame Time the large Tumor became lefs and fofter.

Afterwards frequent Suppurations came on in different Parts of the Teguments : The glandular Tumor iucreafing, the Pain deprived

the

and Obfervations . 34J

the Patient of Sleep, and, with the Evacuation^ wafted her, took away her Appetite, made her gradually weaker ; fo that, after differing all the Uneafinefs, which commonly attends ulce* rated Cancers, two Months more, fhe died,

IV. A Woman who had born feveral Chil¬ dren, being again with Child in 1733, the 37th of her Age, obferved the Nipple of her right Bread: drawn inwards, fo that, when fhe was brought to Bed, the Child could not catch hold of -it to fuck it.

When this Child was a Year old, the Mother was fuddenly frightned when her Menfes were on her ; which put them away, and fhe never after had any Return of them.

In March 1739 Me recovered from a dange¬ rous Fever, foon after which fhe was expofed to Gold, and was violently in Wrath, Fear and Grief, receiving at the fame time a Bruife on her right Bread:. This Shock confined her to her Bed three Months, and fbon after it fhe perceived a fmall painful red Tumor in the in¬ ferior exterior Part of the right Bread, which fhe neglefted.

In the End of July 1 740, when I faw her drd, the right Bread was very large and hard, with fuch diarp Pain that fhe dept none; the Veins of the Skin were varicous, and the Nipple was fhrunk out of Sight: I however felt a Flu- ^nation in it, and judged it to be fuch a Cafe as the proceeding.

Next Day, July 3 id:, I made a young Gentle¬ man, my Pupil, put a fmall Lancet in the in¬ ferior anterior Part, where it was thinned: and mod prominent ; He let out eight Ounces of a

bloody

344 Medical EJJays

bloody Lymph, without Smell, but fait, when tailed ; which, held in a Spoon over a Candle, coagulated. A veryfhort Tent was put into the Orifice, fecured from going into the Cavity by a Thread, and hundred to come out by adhe- five Plaiiler. She flept better that Might, ha¬ ving lefs Pain.

Augufl iib, Four Ounces of the fame Sort of Lymph ran out, the Tumor was lefs, the Skin was of a natural Colour, and the Veins were contracted. A little Lime-water and Melrofe were injected tepid into the Cavity of the Ul¬ cer.

Augufl 3d, Two Ounces and an half of Li¬ quor ran out of the Sore : This Liquor was more of a purple Colour, and lefs lalt to the Tafte. It was dreffed as formerly.

4th, The Tumor felt as if divided in the Middle, and as if it were falling to Pieces ; her Appetite was better, the Pain lefs, an Ounce of Liquor ran out ; the Dreffings the fame.

5th, She underwent what the Women call a Weed, which refembles the Paroxyfm of an Ague.. This Day the Liquor evacuated at the Sore, was in greater Quantity, thinner, darker coloured, more fetid, and, when held in a Spoon over a Candle, did not coagulate. By drinking plentifully of thin warm Liquor, fhe had a profufe Sweat, which carried off the Weed.

6th, The Tumor was harder, the Pain great¬ er, the Liquor fetid ; a little Digeflive was ad¬ ded to the InjeClion.

Two Months, Attempts were made to melt down the Hardnefs; but fo unfuccefsfully, that

it

and Qbfcrvatlons.

it increafed, became more painful, and wafted her: Yet (he abfolutely all the while refufed to let it be cut off. Her left Breaft, then inflamed, was (oon brought to Suppuration by proper Ap¬ plications, and cured in few Days.

Soon after, five {mail Tubercles were obfer- ved in the right Armpit; which dilappeared in a few Days, upon a fungous Excrefcence thruft- ing out at the Orifice in the Bread: of the fame Side, and (ome long tough Subftances coming out with the Matter.

Some Days after, a foft equal Tumor, about the Size of a large Nutmeg, without Pain or dilcolouring, ftarted up at the interior Side of the affedled Breaft, the Fungus in the Orifice having retired at the fame time, and the Lips retorting, with all the very bad Symptoms of an ulcerated Cancer; which in a ftiort Time made her fo miferable, that (he was content to fubmit to the Amputation of the Breaft ; which was done fuccefsfully by the fame young Gentle¬ man, who, under my Directions, had taken care of her from the Beginning. ■' -

Some Months after the Wound was firmly cicatriced, and (lie ftrong and well, (ome Knots began to appear in the Armpit, and at the Edge of the peCtoral Mufcle : She was frighted for more cutting, and let them increafe and fipread, till now (he feems to be in the Way of fuffering all the Miferies of a Cancer that can¬ not be taken away.

The quick Return of the eancrous Knots, af¬ ter the Extirpation of the Breaft in this Cafe, calls to my Remembrance a Problem which I have often wiflied to have a Solution of, Whe¬ ther

34 & Medical EJJays

ther ought cancrous Tumors to be extirpated, or ought the palliative Method only to be fol¬ lowed, when they cannot be refolved ?

The Refoiution of a Cancer I acknowledge to be very rare ; but having feen twro fitch Tu¬ mors, or at leaf! what I judged to be fuch, cu¬ red, I would not exclude the Suppolition alto¬ gether.

To encourage others to tell their Experience and Opinion, I fhall give you mine.

Of near fixty Cancers, which I have been prefent at the Extirpation of, only four Pati¬ ents remained free of the Difeafe for two Years. Three of thefe lucky People had occult Cancers in the Breads, and the fourth had an ulcerated Cancer of the Lip.

The Difeafe does not return always to the Part where the former Tumor was taken a- way ; but more frequently in the Neighbour¬ hood, and forne times at a confiderable Difiance.

Upon a Relapfe, the Difeafe in thole I faw was more violent, and made a much quicker Progrefs than it did in others to whom no O peration had been performed.

When an ulcerated Cancer, that can be ex¬ tirpated, is wading the Patient lo fad that it mud bring Death in a fhort Time, there fee ms little Doubt, that it ought to be taken away, as the only Means of prolonging Life.

If an occult Cancer is occafioned to a young healthy Perfon by a Bruife or fuch other exter¬ nal Caufe, the Hope of efcaping a Relapfe would p'erfwade us to extirpate it.

In all other cancrous Cafes, the earned En¬ treaty of the Patients who have had the Dan¬ ger

and Obfervations, 347

ger of a Relapfe fairly explained to them, and not the Surgeon’s Perfwafions, would make the Extirpation be undertaken.

XXXIII. The Hljiory of an extraordinary Em¬ pyema ; by Mr. James Jamieson Surgeon in Kelfo.

TN January 1725, the Wife of one William Turret in Sproufloun , of mean Gircumfian- ces, but a Woman remarkable for Strength and Vigour, fell upon a Stone, that firuck her im¬ mediately under the right Scapula , and com¬ plained for abou< four Months thereafter of Pains not only upon the Part flruck, but in¬ ternally through the whole Thorax ; notwith¬ standing which fhe went fill about her ordina¬ ry Affairs. About the Middle of the fifth Month after the Fall her Pains increafed to that De¬ gree, that fhe was reduced to ly a-bed, and a little fmall white Tumor appeared where (he firfi received the Stroke, which very gradually increafed till the Beginning of September , when I was firfi Pent for, and found her in the fol¬ lowing deplorable State, viz. with a violent internal Pain through the whole Thorax , a great Difficulty of Refpiration, a confiant Diarrhea attended with a Tenefmus , frequept colliqua¬ tive Sweatings, great Drought, and her Pulle heftic, and ffie was about four Months pre¬ gnant. The Tumor was increafed to the Big- nefs of a Child’s Head, was very hard, and of the fame Colour with the refi of her Skin, which obliged her to fit Night and Day in a bended Pofiure. la this Condition Ihe was feen fome

Days

348 Medical Ejjays

Days before by a Phyftcian and Surgeon of this Place, who both declined meddling with her, fearing immediate Death from any Operation for her Relief, which at my firfr Viftt I decli¬ ned as much as they from the fame Fears ; but, being again foliated in the moil ardent Man¬ ner by the Friends and Relations, and by the Patient, to relieve her of exquifite Torture, though at the Risk of her Life, I was prevail’d upon to make the Operation.

After having prepared fbme Dofrils and Pled¬ gets of dry Lint, Comprefres, Napkin and Sca¬ pular, I plunged a large diflefting Scalpel into the Center of the Tumor fome Inches deep be¬ fore I reach’d the Matter which flow’d from the Wound, though very large, with the Impetus of a new tapp’d Cask, till a V eflel, holding a Scots Pint, was full in about two Minutes or thereby. The Velocity of Egrefs frill continu¬ ing, I durfr allow no greater Difcharge for that Time, fearing a Leipothymia or worfe, fo drefr fed up the Wound with the Apparatus afore¬ mentioned, gave her fome Spoonfuls of a Cor¬ dial and anodyne Mixture, ordered a Decofli- 011 of the W oods with Raifrns and a little of the Cortex Peruvianas acidulated with a little of the Succus Limonumy for ordinary Drink, and Panado's, Gruels, or fuch like, with a little White-wine, for Food.

Next Day I vifited her, when fhe told me the Pains were not altogether fo intolerable, and file had llept more that Night than for ma¬ ny preceeding. I likewife viewed her Stools kept on purpofe, and found them very much mixt with Pus of the fame Colour and Confi-

frence.

and Obfervations . 34p

flcnce> which was white and well digefied, as that which came from the Wound. I likewile examined her Urine, the Sediment whereof was of the lame Nature. When the DreflingS were removed, the Pus ilfued out with the lame Force and to the fame Quantity as the Hrfl Day, the Tumor continuing notwithfianding in ft a - tu quo prius, which I drelfecl up as formerly, with only the Addition of an emollient and dif cutient Cataplafm.

At the third Vifit I found her Pulfe neither lo frequent nor depreffed as formerly, her Re- fpiration was lefs difficult, and all the other Symptoms lefs threatning. She had flept tole~ rably through the Night, though Hill in a le» dentary W ay, being unable to fiiffer any other PoAure. The Drelfings being removed, the Matter fpontaneoully flowed to the lame Quan¬ tity of a Pint or four Pound, but not with the lame Force as the two preceeding Days. It was flill laudable, and only at this Drelfing could I oblerve the Tumor yield in its Magni¬ tude. It was now confiderably lefiened, fo that by introducing my Finger I felt a pretty large Opening betwixt the feventh and eighth true Ribs. She was this Day drefled, and every Thing continued as the Day preceeding.

At my fourth Vifit every Symptom appear’d imore favourable ; and upon removing the DreU lings I found the Tumor much decrealed, but the Quantity of Matter was notwithfianding as imuch at this as any of the three foregoing D ref¬ ilings, only towards the latter End of its Egrels it drilled down her Back, and appeared to be imuch exhaufled. I now drefled with the com- Vot. V. G g men

3J0 Medical EJjays

mon Digedive mix’d with a little Balf. Peru¬ vian. and the Compredes wet in Brandy. This Night was the firft of her lying down, with the Orifice always mod depending, to encourage a free Egrefs of the Matter.

On the fifth Day I found her chearful, fhe had llept well through the Night, her Pulfe was free, with very little Frequency, and every o- ther Symptom agreed therewith, except the Diarrhea , which dill continued, though not fo much attended with the Tenefmus , nor were: her Stools and Urine fo purulent as formerly. I found the Dredings and Bed-cloaths all {bak¬ ed with Matter, but when removed there was a very fmall fpontaneous Difcharge from the: Orifice, fo I dreffed it as formerly.

On the fixth Day I found her very feeble,, riifpirited, and in a mod languifhing Conditi¬ on, from an Abortion which happened thatt Morning. She had a Coldnefs and Rigidity in: her Limbs, frequent Faintings attended with fome dight Rigors, notwithstanding which the Lochia continued to flow, tho’ in a fin all Quan-j tity. I now gave her frequently a little warm Sack-whey, with fome Gutts of the Tin Pi. Ca¬ fe or. Croc, and Spir. Satin. Jrom. mix’d toge- ther, whereby fhe recovered her Strength and Spirits daily, every thing elfe anfwering to our TViihes ; fo that in ten Days after die was able to quit the Bed and fit fome Hours upon a Chair. From this Time till the Cure was com¬ pleted, one of my Apprentices drefs’d her once in two Days, and I vifited her once, or at mod twice in the Week for about eight Weeks, when a firm Cicatrice was procured, after a fmall Ex¬ foliation.

and Qbfervations. 351

foliation from one or both of the Ribs. She has continued ever fmce free of ali Complaints* except an Ague* and has born three Children.

XXXIV. A confiderable Share of the Lite [lines cut off after a Mortification in a Hernia* and cured by Mr. William Cookesley Sur~ geon in Crediton.

Sir *

/ jBraham Pike o£ Crediton, in the County of Devon * Chimney-fweeper* aged about thir¬ ty* had laboured under an Hernia inteflinalis for leveral Years, which in the Beginning of September 1731 was increafed to fuch a Degree* by overheaving himlelf in carrying Water to help to extinguifh a Fire that happened in the Neighbourhood* that he could not reduce it as ufual when in Bed, This Misfortune was im¬ mediately aggravated by a total Strangulation of the Interline. The poor Man, through I- gnorance and Want, fullered terrible Pains in the Part for about a Fortnight, without ac¬ quainting any Body with his late Misfortune befides his Wife, till* grown at laft intolerable* Dr, Bent palTing accidentally by, was deflred to caftan Eye upon him; who finding the Tu¬ mor large, with great Inflammation tending to a livid Colour, advifed them to get a Surgeon, whofe Bufinefs it was, and in the interim to apply a warm emollient Cataplafm to it* which was accordingly done.

I was lent for the next Morning, and upon Examination found the Matter had penetrated the Goats of the Scrotum , difcharging itfelfin

G g 2 " great

35^ Medical EJJ ays

great Quantity, with putrid Sloughs filling up the whole Cavity, the greater Part of which I cut off with my Scifiars, contenting myfelf for that Time to drefs it up with a warm Dige- Ifive, till I could provide myfelf with a Fomen¬ tation and other Neceffaries, as the Cafe requi¬ red.

At the next Drefling I found his Excrements, which he had not difcharged the natural Way for above a Fortnight before, came off at the Orifice in a large Quantity.

The whole Cavity of the Wound, which was Very large, was a Confufion of Matter, Excre¬ ment, rotten Gut, and mortified Membranes.

I cut off at that Time above fix Inches of the Intefline, (all of which being fallen down into the Scrotum was entirely fphacelated) as alfo above half the right Side of the Scrotum . Ha¬ ving wafh’d off the remaining Sordes with fome of the Fomentation I had hot by me, I drefs’d at up with Pledgets fpread with a Digeflive, and dipt in the fame Liquor. This, nor any of the lucceeding Dreffings, was attended with the leaf! Hemorrhage, fo that I fuppofe the fperma - tie VeJJels and the Tcflicle were likewife mor¬ tified ; for I could find neither of thefe upon cleanfing away the flinking Sloughs that cover¬ ed them, and I believe they came off together with thole Sloughs, but; in fo rotten a State that they could not be diflinguifhed one from another.

I continued on dreffing it twice a Day ; the remaining Sloughs digefted off, and the Wound began to clean and look well ; but flill the Ex¬ crement, which fhould have been difcharged

by

and Obfervations • 353

by the Hnus, came off at the new Paflage : And how indeed could we conceive it fhould do o- therwife, when fo much of the whole annular Sub fiance of the Gut had been cut off?

Though I had always defpaired of the Life of my Patient, yet knowing Nature (ometimes brings about her Ends in a miraculous Manner, I was refolved to aifift to the utmofl of my Pow¬ er. I ordered frequent Clyjlers to be injected, which brought away the indurated Feeces, that had lain a long while in the ReClum, and by continuing this Method for fome time, the DiU charge from the Wound every Day leffened, and he had frequent Stools from the natural Paffage. Thus our Cure went hopefully on, and after above a Month’s Obftruftion from his firft Confinement, Nature returned again into its former Channel. The Difcharge at the new one gradually leflening, till at laft it perfectly flopt, the Ulcer was incarned and cicatriced with very little Trouble, and the Cure com¬ pletely fmifhed without any further Obftacle.

As the Man is cured of his Hernia , he is now in a much better Condition than he was before this Accident happened. He has been very healthy fmce that Time, and follows his Labour: He is grown fat, and looks better than he did Years before.

Thus, Sir , I have given you a full Account of this extraordinary Cafe ; a Parallel to whic;h I had not met with, nor read of, till I lately law fomething like it in the Medical Effays. I hope it will meet with your Approbation, the rather becaufe you know the greatefl Part of the Relation to be true ; you having feen it at

G g 3 firft

354 Medical Effays

firft yourfelf, and had a conHant Account o the Patient during the whole Procedure from.

Sir ,

Crediton, Your mo ft obliged

Dec . 8. 1738. bumble Servant ,

¥m. Cqqkesley. To Dr. Bent at Exeter .

I lived at Crediton when the Accident hap¬ pened; and, as I remember the Cafe very well, am fatisfied it is fairly Hated.

Geo. Bent,

XXXV. The Hi ft or y of Plum and Cherry Stones evacuated at an Abfcefs in the Belly % by Mr . Jo si an Cole Accoucheur , London.

TD Eighteen Years of Age, after being two Years diferdered with a Strait-* xiefs of Breath, heftic Fever, He. complained of a Pain in the right Side of his Abdomen a- bout the Middle of May 1739. This Pain was attended with a Hr ait Breath, reaching to Vo¬ mit and Fever, and a Tumor foon appeared to the right Side of the Navel, which fuppurated and was opened June 6th. Weil conceded Pus was firft dUcharged at the Orifice ; but af¬ terwards, by preffing the Parts, a thin Matter of a very fetid Nature followed. His Breath foon grew better ; but fb much gleety Matter was difeharged from the W ound, that it was obliged to be dreffed feveral Times a-day ; and he became very tabid and hedtic, and complain¬ ed of great Pain in his Belly,

About three Weeks after, opening the Tu¬ mor*

and Ohfervations.

mor, I obferved the Dreffing darned with a thin Excrement, which has continued to dis¬ charge that Way ever fince. When he was codive, which he frequently was, fometimes he had no Stool for a Week : The Difcharge of Excrement from the Sore was very large, and in it he obferved the Seeds of Goofeber- ries, the Stones of Raifms, &c, which he had eat fbme Hours before.

December 1 3th, The Pains of his Belly were greater, with violent Prickings near the Wound, and very little Dilcharge from it through that Day : But in the Evening the Stone of a Da- mask Prune came away, with a very great Dis¬ charge of Excrement at the Wound \ fince which, at Times, twenty Cherry and Dama- fon Stones have come away, tho’ he declares that he had eat neither Damafons nor Cherries for two Years pad.

Mr. Serjeant Amyand having vifited him,, dilcovered a Sinus, which he opened, to allow* a more free Difcharge of thofe Stones and of the Excrement. Some more Stones came a- way, and our Patient’s ill Symptoms left him; till the Wound becoming fungous, Mr. Amy¬ and fprinkled red Precipitate on it one Day, and rubb'd the lunar Caufllck on it next Day t After which he complained of violent Pain in the Sore and Belly, with a dnart Fever from four o’ Clock in the Morning till ten at Night, when he was relieved by fweattng. Next Day the Fever returned, and went off alfo with a Sweat, but without any lateritious Sediment in his Urine. I then gave him two Scruples of the Bark every three Hours, which prevented any

Return

5^6 Medical EJJays

Return of the Fever next Day. He had the Powder of the Bark every fixth Hour of the Day following. While he was taking the Bark, I faw the Powder of it on the Dreffings. When he omitted to take the Bark the third Day, the Fever returned : Which made me keep him conflantly in the Ufe of the Bark for lever al Weeks, fince which he has recovered, and at prefent ( June 1741) is in perfect Health and robuft; only the Orifice in the Gut remains open, thro’ which it continues to difcharge its Contents. He has Stools in the natural Way, but very feldom ; and, having a good Appe¬ tite, difcharges a great deal thro’ that opening in his Belly.

XXXVI. The Hiftory of a Gians Penis regene- ' rated after Amputation ; by Mr . James Ja¬ mieson Surgeon in Kelfo.

IN December 1736, a young Man about 19 or 20 Years old, who had been fix or feven Weeks under Cure of a Gonorrhcea , came to Kelfo and afked my Advice. Upon viewing the Parts, I found a Gangrene on the Prccpu- tium and Balanus the whole Penis was in¬ flamed, and fwelled fo greatly as to be threat- ned with the fame Fate, attended with moft acute Pain, and a Stillicidium from the Ure¬ thra of an ichorous and fetid Matter, attended with a full, hard and frequent Pulfe : Where¬ upon I defired him immediately to confult a Phyfician, as no Time was to be loft ; and ac¬ cordingly the ingenious Dr .Gibfon was called. We then reviewed the Parts aife&ed, and

agreed

and Observations.

agreed to try by Incifions how far the Gan¬ grene had gone ; whereby we difcovered, that both the Proeputium and Gians were irretriev¬ ably mortified, and that nothing but Extirpa¬ tion could give the Patient the fmallell Chance for Life, therefore infiantly determined to do the Operation ; and I amputated all the Parts affefted, viz, the Balanus , Proeputiuniy with a finall Portion of the Corpora cavernofa Penis.

As the Hemorrhage was but inconfider- able, we drefied the Stump with dry Lint: Then applied a Bandage and Sulpenfory, took near a Pound of Blood from his Arm, laid him in Bed, and gave him an Anodyne ; whereby he fie pt well thro’ the Night, and was much re- frelhed.

Next Morning the Fever was much abated, and the Pains were lefs levere ; but the Drought rather increaled* and his Belly was cofiive. •We bled him again, and threw up an Inje¬ ction ; then gave him a lenitive Ptizan to drink thro’ the Day, with lome Doles of the Lapis prunella ?, and repeated the Anodyne at Night. AH the Medicines performed to our Wilh.

The third Morning he was much eafier of the Pains, and his Pulle lefs frequent; but Hill a little too hard, for which he was bled a third Time, and got the Anodyne at Night. His greatefi: Complaints were now a fmarting of his Thighs, Scrotum and Perinceurn , occafioned, as we found next Day, by the difiufed Urine and Matter of the Gonorrhoea that had excori¬ ate thefe Parts, and proved very uneafy to him for feveral Days ; which was cured by bathing with warm Milk, and the Unguentum SaturnP

num

35§ Medical EJJays

num fpread upon Linen Cloths that were kept on the Parts, after being well dried, to prevent the like Gonfequence.

On the fourth Day we removed the Dreff fings, and found the Parts look frefh and well, the Digedion begun, and the Pus of a mild A- fpe<d from the Stump : But the Colour and Confidence of the Gonorrhoea die wed a great Degree of Vi rujen cy, and gave Trouble to the Patient by the Ardor Urines ; both which were removed by feveral Doles of Calomel, gentle Purgatives, laxative Decoctions, cooling Diu- reticks, and at lad was totally cured by proper Balfamicks. The Penis was this Day drefled with Lint as before.

Upon the fixth Day we again removed the Dreffings, upon account of a very large Did charge of Matter that was dill good ; but a Fun¬ gus appeared to be growing fad, which we en¬ deavoured to fupprels by the lunar Cauftick : But fitch was the Gonfequence of thefird Trial, that, by the fharp Pain it occafioned, his Fe- ( ver returned, and continued about 24 Hours, f and was carried off by further blooding and an Injection, Anodyne Medicines, proper Diet, and Plenty of cooling and diluting Drink, fitch as Whey and Barley Water, with the Juice of Limons.

At the next dre fling, which was on the ninth Day, we tried a little red Precipitate in fine Powder mixed with the Linimentum Arc cel ; which alio created fo acute Pains, that he was not able to bear it, and obliged us to renew the Dreffings in lefs than an Hour after Appli¬ cation : However, we again tried both in the

gentled

and Obfer-vations. jjp

gentlefl W; ay ; but were obliged to quit them, and take to the dry Lint again, as the dernier refort, and the only Application he could buf¬ fer, which was continued without any Altera¬ tion, till the Cure was completed unexpectedly in the following Manner.

The Fungus to Appearance f ill advancing and projecting forward in a direct Line, gave us much Uneafnef , in Expectation it would at laft obf ruct the Difcharge of Urine, and ob¬ lige a fecond Amputation : But, to our great Satisfaction, as well as Surprife, we difcovered about the fixteenth Day aftef the Operation a thin Skin begin to advance upon the Part of the Fungus next to the Penis ; and every Drefi fmg we obferved its Procedure, till by very How Degrees the whole was covered, and form¬ ed a well lhaped and proportioned Clans , with this Difference only from the natural, that the Orifice of the Urethra is a little larger.

The young Man was married in this Coun¬ try about two Years after the Cure, has had two Children, and complains not either of Want or Defect, even in Senfation : And as the Cafe is quite new to me, either from Pra¬ ctice or Reading, I fend it to be put in the Ef fays, if worthy of a Place in that Collection.

XXXVII. An extraordinary Tumor impeding the Birth of a Child ; by Mr, John Gei^mil Burgeon in Irvine.

IN the Year 1731, I was called to a Woman in Labour, whofe Child was born as far as the OJfa innominata, in which Condition it had

been

3<S° Medical EJJays

been four Hours, a Midwife endeavouring all {he could in the mean Time to bring it away, I eafily could put my Fingers round the Child as far as the Head of the Femur; but by no means could deliver the Woman, till, pufhing my Hand between the Child’s Thighs, I felt fomething adhering to the Child, thro’ which I thruff my Finger, and immediately a confider- able Quantity of Water ruihed out, after which there was no Difficulty in bringing the Ghild away.

What I had pierced with my Finger prov’d to be a Bag, larger than the Ghild which was of an ordinary Size, formed by the Skin from the Os Pubis all round the Amts. This Tu¬ mor was of the Shape of a Pear, the fmaller Part of it coming out from the Vulva and Anus. When T opened it, it was all compofed of membranous Divifions full of Water, which were difpofed in fuch a Way as to make it re¬ ferable an Orange or Limon ; in the Middle of it there was a hard Reffiy Subfiance,

The Women prefent prevented my examin¬ ing any further.

c

XXXVIII, The Gcefarean Operation done with Succefs by a Midwife ; by Mr. Duncan Stewart Surgeon in Dungannon in the County of Tyrone, Ireland.

THE Hiflories of the Ccefarean Operation being fo few, I fend you the following. Alice 0 Nealy aged about 33 Years, Wifi to a poor Farmer near Charlemont , and Motner offeveral Children, in January 1738-9 took

her

and Obfervations . 3 'fit

her Labour-Pains ; but could not be delivered of her Child by feveral Women who attempted it. She remained in this Condition twelve Days ; the Child was judged to be dead after the third Day. Mary Donally , an illiterate W oman, but eminent among the common People for extracting dead Births, being then called, tried alfo to deliver her in die common Way: And her Attempts not fucceeding, per¬ formed the Carfare an Operation , by cutting with a Razor firft the containing Parts of the Abdomen , and then the Uterus ; at the Aper¬ ture of which Are took out the Child and $e- cundines. The upper Part of the Inciilon was an Inch higher, and to a Side of the Navel, and was continued about fix Inches downwards in the Middle betwixt the right Os Ilium and the Linea alba . She held the Lips of the Wound together with her Hand, till one went a Mile and returned with Silk and the common Needles which Taylors ufe: With thele fhe joined the Lips in the Manner of the Stitch employed ordinarily for th q Hare-lip, and dref- fed the Wound with Whites of Eggs, as fie told me fome Days after, when led by Curio- fity I vifited the poor Woman who had under- , gone the Operation. The Cure was completed with Salves of the Midwife’s own compound¬ ing.

In about twenty leven Days, the Patient was able to walk a Mile on Foot, and came to me in a Farmer’s Houle, where fhe fhewed me the Wound covered with a Cicatrice ; but fhe com¬ plained of her Belly hanging outwards on the Right-fide, where I obferved a Tumor as large Vol.V. Hh as

3 6 2 Medical EJfays

as a Child’s Head ; and £he was difireffed with, the Fluor albus> for which I gave her fome Me¬ dicines, and advifed her to drink the Decofti-* ons of the vulnerary Plants, and to fupport the Side of her Belly with a Bandage. The Patient has enjoyed very good Health ever fince, manages her Family-affairs, and has frequently e walked to Market in this Town, “which is fix Miles Difiance from her own Houle.

XXXIX. The Hiftory of one Child ex traded by an opening in the Abdomen , and Part of another pajfed by Stool ; by Dr. Gabriel. King Phyfician at Armagh, Ireland.

THE Wife of a Farmer near Aughar , fifteen Miles Difiance from this Town, who had born fome Children, believed herfelf again with Child in 1726. During the greatefi Partt of the nine Months of her Pregnancy file was very fickly, but the Labour-Pains did not come:* till her Reckoning was out, at which time file 1 had fuch Midwives with her as the Country af¬ fords, who, after endeavouring all they could, left her and concluded that fhe had no Child; to bear; the fwelling of her Belly diminiflied, and fhe became able to go about her ordinary Bufinefs, though frequently fhe was fick and pained for about fix Years, when file again conceived. At the End of eight Months, ac¬ cording to her reckoning, fhe felt extraordina¬ ry Pain in the anterior Part of her Belly, and! in few Days a fmall Ulcer broke out below her Navel ; in fome Days more the Elbow of

a Child;

and Observations* 363

a Child appeared at this Orifice ; ihe brought out the whole Arm with her Bodkin, and got it cut off, but continued in great Milery fome Days longer, till a Footman to a Gentleman in the Neighbourhood, and her Relation, had the Courage to pull out the remaining Body of the Child, which two Gentlemen, who went im¬ mediately afterwards to the Place and faw the Child and Cavity from which it was brought* allured me was a full and complete Child* except the Arm which had been taken away before.

When I went about three Weeks after to lee this poor Woman die was extremely emaciated* and the Wound was almoft doled. Upon pr effing at a little Difhnce towards the left Side, from where the Wound was, I felt fmall Bones under my Fingers, which feemed to be con¬ tained in a Bag fo thin that I am perfwaded it might have been cut when the other Child was extracted, and thele Bones might have been brought out at the fame Orifice. She fhewed me feveral decayed Bones, which had evident¬ ly belonged to a human F(£tusy that fhe had palTed partly by Stool and partly with her U- rine, as die informed me, and they were then daily coming thus away.

I believed Ihe would die after leveral Vilits, but in lome time I found her walking out in the Fields, and Ihe has lived leven Years lince, her Vifcera falling often out at the old Wound, nor dares die keep them in by a broad canvafs Belt as I advifed her, becaufe when troubled with Wind, which Ihe is very frequently, from, I lii p pole, her Diet of Potatoes and fuch like,

H h 2 the

364 Medical EJJays

the Pain becomes intolerable when the Guts have not their Liberty. Some Months ago I reduced the Inteftines for her, when they had come out fo as to form a monftrous hernial Tumor.

Thefe two Children may, I think, be jud¬ ged to have been both extra-uterine : That which was brought away by the Footman I take to have been the one (he lad: conceived, and that the other had been moftly confumef ~ melted down by Putrefaction or Suppurat the fix Years it remained in her Be only the firmer Bones remained in a

There is another Woman living t m

Miles of this Place, from whom a Mid vie rook: a Child by the Ccufarean Operation near two Years ago; I law the poor Woman foon after, and drew out the Needles which the Midwife had left to keep the Lips of the Wound toge¬ ther. I perceived the Mufcles contracted into a Lump at the lower Part of the Belly, which increafed, and at laft broke and run confider- ably. This Woman is capable of doing fome- thing for her Family with the Afliftance of a large Bandage, which keeps in her Inteftines.

This Child, which I law, was not extra- uterine ; for feveral befide the Midwife allured me that a Leg of it prefented itfelf to View in the Vagina before the Operation.

Armagh , 23d Oft.

1740.

By comparing the Time , and the Diftance of Charlemont from Armagh, as mentioned in this laft Part of Dr, King’r Letter , 'with Mr. Sm¬ art’!

md Obfervations.

arfr, it probably mufl be the fame Woman' s Cafe 'which both of them relate.

XL. A Ring-fcalpel for afffling the Delivery of Women in Child-birth ; by Dr. Thomas Sim- son Profejfor of Medicine in the Univerfty of St. Andrews.

YTTHen I had the Pleafure of being lately with ’ ’ you at Edinburgh , I {poke of an Inflru- ment invented by me feme time ago for the fafe Extraction of Children from the Womb, when their Bulk was greater than what could pafs in an entire State ; now I fend you a Draught of that Inflru ment that you may lay it before the Society which publilh the Medical EJfays , to fee if they have the fame Opinion of it that i have, that it is the mofl expeditious and fafe yet propofed for managing Cafes of that Nature.

It confifls of two Parts (See Tab. iv. Fig. 1.) the broad Ring A, and the fnort Scalpel B rivet- ted into it. The Ring is made fo large, that it can pafs the firfl Joint, and no further, of the Fore-finger/ and the Scalpel is about an Inch in Length, and a third in Breadth, fmooth and blunt along the upper Side, flopping to a fharp Point. Its Ufe is, to divide the Head or any other Part of the Body which cannot pafs entire, of which Inflances occur every Day to the Practitioners in Midwifery.

When the Head comes firfl in the natural Poflure, it is not fo neceffary ; becaufe the Force of the Labour in that Cafe brings the Head generally fo far down, that fafely, with an ordina-

11 h 3 ry

3 <56 Medical EJjays

ry Scalpel or Pen-knife, you can divide the Pericranium and Dura Matery and thus get the Head opened, emptied and diminifhed, for its eafy Extraction : But when the Head falls not down fo far, as to allow you fafely to guide an ordinary Scalpel to divide it, fome o- ther Inftrument muft be taken ; it not being eafy or fafe to apply fuch Inftruments when the Head is at any confiderable Diftance from you, as frequently happens when you extract Children by the Feet, with Heads not lo well proportioned to the PafTage ; for then the Head, left by itfelf, is not kept fo low down as when the Parts about prefs upon it by the Mediation, of the red: of the Body : Nay, for the moft Part, after the Separation of the Neck and Bo** dy from the Head, the Os Uteri contracts con-* fiderably upon the Head, and with it returns to a confiderable Diftance ; fo that I have been obliged, in managing them, to ftretch my Hand more than a Foot up the Vagina and U- terus to reach them, nor could I keep the Head nearer in the Operation. In fuch Cafes , Hooks, Tiretetes and other Inflruments, are applied with much Uncertainty ; and when the Head is over large for the Paffage, to bring it away by Force undivided, mufl caufe great Contu-* fions upon the membranous Parts lying betwixt the Head and Bones of the Pelvis : To which I attribute the many bad Confluences happen¬ ing in thefe Cafes, and therefore I contrived the Scalpel-ring I have fent you the Draught of, which may be ufed fafely within the Uterus at any Diftance, which I do in the following Man¬ ner After being finished of the Bignefs of

and Ohfervations . 367

the Head, that it mu ft be brought away with an Infirument, I examine its Situation with my Hand, and where the Sutures ly : Then I put on the Ring upon my Fore-finger, with the Scalpel with its Edge facing the Palm, fo far up that it is quite over the lafi Joint. In this Si¬ tuation, bending my Finger at the middle Joint to a right Angle, the Edge of the Scalpel be¬ comes parallel with the firfi Phalanx , and is fe- cured from doing any Harm, while in this Po- fture I Hide my Hand up, dire&ing my other Fingers extended towards the Sutures I fixed upon for the Incifion, which they eafily find out again ; and, having found them, .the Thumb and thefe Fingers fix the Head, while between them, I firetch the Fore-finger, hi¬ therto bended, over the Sutures, and with it preiTes in the Scalpel, cutting thro’ the Pcricra - nlum and Dura Mater , and flitting them fo far as to let in my Fingers.. In doing this, be- eaufe the Ring is apt to be drawn off, I bend a little the laft Joint againft the Ring, and Jfb keep it fixed in the Operation. I caufed the Scalpel to be made as broad al'moft as the Ring* to make the Orifice greater as it enters.,

Some Authors feem not to allow of any Cafe: where an Infirument is necefiary : All that I fhall fay is, that they have been mofi fortunate in their Patients ; I having met with feveral, moftly indeed Women of a bad Make, and whole Bones in their Youth feem to have been difeafed, in whom the Head, however prefled or pulled, could not pafs the Bones of the Pel¬ vis ; as very lately I found in a decrepit little Wo¬ man above thirty,, when in Labour of her firfi

Child.

*■ -*1

1

Medical EJJays

Child. The Arm prefented firft, and file had been three Days in Labour before I was called. I made fome Trials to get my Hand up the Uterus, to catch the Feet, and turn the Child, as I have done fuccefsfally in other Cafes : But I could not enter the Os Uteri, which gripped fall upon the Shoulder of the Child, though I tried it often ; and therefore was obliged to bring down the Arm, which had no Signs of Life, as fir as poffible, and feparate it. After which, with a great deal of Trouble, I got my Hand up the Pelvis , and brought down firR one, and then a fecond Leg, and with them wrought out the Haunches and the Sides bit and bit ; and then brought down the fecond Arm, and wrought out the Shoulders. Now we had a good Hold to fetch the Head : But, however we drew and turned with ale Neck, and at the fame time with the lower Jaw, yet no Artifice could bring it forth ; and at length in the Operation the Neck yielded, and left the Head behind, which immediately refilled from the Straits of the Pelvis, which it could never enter. To extract the Head in this Cafe with Hook or any other Infirument, without a prior Divifion, I was fure was impracticable : I there- fore put on the Ring, after having determined the Place to be cut ; made a Slit at the Fontanel in the Manner I have delcribed, took out one of the OJJd Bregmatis, and emptied the whole Cranium : But tho’ I now could grip fail the Head, and pull firongly yet it could not pafs. And both the Woman and I being tired, I left her three Hours, acquainting her fhe was in no Hazard, and that, after fuch a Delay the Bones

would

md Qbfervations .

3%

would feparate with much lefs Trouble ; as I had experienced before in a Woman in the ct me Circum fiances, who would not confent

to my continuing to work any longer, after I •had Ipent tome time in feparating fome of the Bones, but who called for me a few Hours af¬ ter, when they feparated as eafiiy as in boiled Fleffi. The fame after three Hours happened here. I took out the fecond Os Bregmatis , flattened the Occiput and Sinciput in a Moment’s Time, and yet got the Head, thus diminiflied, difficultly to pafs: And no Wonder ; for after¬ wards, in bringing away the Placenta, my Hand grafping it was hard preffied. She kept eafy two Days, with a moderate Cleanfmg; but af¬ ter that was feized with great Pain over the whole Belly, and died in a few Days after, tho* bled and fomented with difcutient Herbs, and rubbed with camphorated Oil. I attributed her Misfortune to the bruiftng of the Parts be¬ tween the Child and the Bones of the Pelvis , which certainly buffered when the Haunches, Shoulders, and the reft of the Trunk of the Bodypafted; and therefore I ftiould think it al¬ ways reafbnable to diminifh all the Parts confl- derably in fuch Cafes.

I have been with Women no lefs unfit for Bearing, who neverthelefs had no Difficulty in a fecond Child ; but then they were younger than this Woman, and, by the Force in the firft Birth, the Junctures of the Bones of the Pelvis had ftretched, and thus had made the PaiTage eafier. In fome of them I have found the Os Coccygis thruft fo confiderably outwards, as that with Difficulty they fat upon it ; but

37° Medical EJJays

this they eafily difpenfed with for the Ad¬ vantage of an eafy Delivery : And as the Car¬ tilages are more yielding in the Young than in the Old, hence the Odds mud be deduced of the Difference there is as to the Eafinefs of their Labour. I am not of Opinion, that there is a- ny thing of a total Separation : But that the Cartilages yield fomewhat in younger Subjects, both at the OJfa Pubis and Articulations of the Ilia and Sacrum , I think mod credible, both from the Dedgn of Nature in making Articula¬ tions there, and likewife from what I once felt, as fome others had done, at the Symphifis be¬ tween the OJfa Pubis , where the Gap all along was fendble to the Touch, as I made the Mid¬ wife feel : And this could not happen without a (mall yielding of the OJJa Ilia from the Sa¬ crum ; and a fmall yielding there mud cond- derably widen the Under-parts, or allow the Os Coccygis to go back. Such an yielding we allow in the Cartilages of the Back-bone, and from it account for our greater Height in the Morning than at Night ; and why not here ? But I go too far from my fird Purpofe, which was to recommend the Ringfcalpel I have often ufed with Succefs, when I am fure other In- druments could not have been applied to much Purpofe.

XLI. A Hijl ory of the Tibia taken out and regenerated ; by Mr. William Johnston Surgeon in Dumfries.

TN November 172 6, Andrew JohnJlon , a Boy -■* 10 or n Years of Age, complained of vio¬ lent

and Obfervations. 371

lent Pain in both his Legs. Two Days after his firft Complaint I law him ; he then had no Inflammation or fwelling on them. I ordered him to drink the Decoftion of Sarfaparilla , and to rub his Legs with warm Cloths, which he could not allow, it increafed the Pain lo much.

Three Days after I faw him again, when his Pulfe was quick, he had great Third:, and a large livid Tumor appeared from the Knee of each Leg to near the Ancles. I made an Inci- don into one of them, and let out three Ounces of a bloody Sanies : Then learching with a Probe, I found the Tibia carious ; therefore enlarged the Incifion, and felt the Bone with my Finger. I applied warm Tinfture of Myrrh to the Sore. Next Day there was a large Dif- charge of bloody Sanies , with feveral livid Spots, from which the lame lort of Sanies ou- zed. I caufed the Leg to be fomented with a Decoffion of aromatic Herbs in Wine, applied Tindlure of Myrrh to the Bone, and drelfed the Lips with warm digeding Ballam. I open¬ ed the other Leg, which had much the fame Appearance, and treated it in the lame Way, and ordered him to take fome Powder of Peru¬ vian Bark in Wine, and to drink the Deco&ion of Sarfa with Lime-Boater twice a-Day.

The ninth Day after the hrll Incilion leve- ral Splinters of Bones threw off, and in Janua¬ ry 1727 the whole Tibia of the one Leg (which you will receive with this) came out: The Leg was put into a Box, and being carefully dreiled, was cicatriced before the Middle of March.

The Tibia of the other Legfeparated in fmall

Pieces^

37- Medical Effays

Pieces, and was flower in the Cure, not being cicatriced till the Beginning of May.

In June the Boy was able to walk without Crutches. In Auguft he fell from a Horfe, and broke his Thigh-bone, which cured foon ; and •the Lad has continued Well ever fince, beimr fit for any Country-work, with his Legs freight, and only a little Thicknefs at the Ancles.

Before the Bones cad: out, the Matter coming from the Sores was lo corrofive, that it buffer¬ ed whatever Part of my Hands were wet with it in dr effing him.

XLII. A Defcription of feveral Chirurgiciil

Inftruments ; ^Alexander Monro, P. A.

TOEING perfuaded that many Surgeons are in Pofleffion of Inftruments , with which O- perations in Surgery could be done with more Safety and Eafe than with thofe commonly em¬ ployed, and that thefe Gentlemen only need 1 to be acquainted how they could make them more generally known to be ferviceable to' Man¬ kind, »I fend you the inclofed Figures and De- fcriptions of feveral which I have now in my Pofleffion. If others think I have done Juftice to the Gentlemen to whom I am obliged for mod: Part of thefe, I Batter myfelf that they will allow me to ferve them in the fame Way. If they fend meufeful or ingenious Indruments, or the Pictures of them, I fhall add the De* fcriptions and Remarks, and to lay them be¬ fore your Society, to publifh, if you approve of them.

TAB.

md Obfervations .

373

TAB. IV,

Fig. 2. A Pair of Sciflars, the Blades of which are crooked in their flat Sides. The lower Figure is of the fame Size with the Seif- fars : But Mr. Cooper , not fatisfled with this Picture’s dihinguifhing them well enough from the common Sciffars that are crooked in the narrow Side of the Blades, made the final! up¬ per Figure, which fliews better where the Curve is. This Sciflars I had from Mr. John Douglas Surgeon in Edinburgh . They are very ufeful for taking off Excrefcences from hollow Parts, or for cutting in curve Lines, which the com¬ mon Sciflars cannot eafily be applied to.

Fig . 3. Is a Needle-holder , which I had from the fame Gentleman. A A two flat Shanks or Handles, BB rhe two Sides of its Mouth groo¬ ved for keeping the Needles heady, C the Hinge, D a Spring which keeps the Handles a- iiinder, and the Mouth open, till the Slip-ring or Slider is thruh towards the End of the Handles.

This Inhrument holds the Needles more firmly, and its Ring Aides more eafily than the common Needle-holders which I have feen.

Mr. Douglas obferves, that Needles of Sil¬ ver pierce more eafily in hitching Arteries af¬ ter an Amputation than the Steel ones do.

Fig. 4. A Biftoury and furrowed Directory belonging alio to Mr. Douglas. A the Handle, B the Blade of the Bifloury, C a Button at its Point, D the Handle of the Directory, whole Groove is hollowed fo as all its tranfverle Vol. V. I i Se&ion

Sections are like to what is reprefented at E ; and therefore the Button, once entred at the End of the Groove nearefl to the Handle, can¬ not come out till it palfes out at the other Ex¬ tremity.

In operating with this Inffrument, a Misfor¬ tune is furely prevented which fometimes hap¬ pens in opening famous Ulcers with the com- mon Bifloury and Dire&ory, to wit, the Bi- fioury fiarting out of the Groove of the Dire¬ ctory..

Fig. 5. The Blades of a Pair of flrong For- ceps, the Mouth A of which has on each Side two fmall fharp Teeth, which apply clofs one to another when it is jfhut* Mr. Douglas fa¬ voured me alfo with this.

In extra£fing Bullets, the Screw in a Cartula , which fome recommend, cannot be forced in¬ to the Bullet, unlefs there is the firm Refinance of a Bone on the other Side ; and the Blades of the common Forceps frequently cannot be in¬ troduced fq far as the largefl Diameter of the Bullet, without which they cannot take fuffici- ent Hold : Whereas the Forceps here reprefent¬ ed can be introduced into a Wound fafely when {hut ; and the Blades being opened immediate¬ ly behind the Bullet, the Teeth piercing into the Lead, may have fufhcient Hold to bring it out, tho’ they are not advanced fb far as the largefl Part of it.

Fig. 6. A Trepan given me by Mr. Douglas . AA two Plates of Brafs kept together by four Pillars of Brafs BB, G a Handle moving a Tooth - vjhcd which turns a Pinion , to which G the

Socket

md Obfervatlons, 37J

Socket for receiving a common Saw-head of a Trepan is fixed.

The Figure is one half the Dimensions of the Inftrument. The Saw will be turned more" equally with this Inftrument than with the Hand alone ; but whether the rattling and trembling which the Wheels make are fuffiei- ent to counterbalance this Advantage, X fliall not determine.

Fig. 7. A Levator of a deprefled Skull, which I am informed Mr. Petit Surgeon at Pa¬ ris fhewed lately in the Academy of Surgery there.

1. A the wooden Handle, B the Steel Stalk with Several Holes, in which are Female Screws, C the Lever bended down from the Stalk.

2. The Reft, with its Feet covered with Lea** ther, and a Male Screv/ fixed in the Top of its Arch, but fo as to be moved on a Joint*

3. Another Reft of the fame Make, but of a higher Arch.

4. The Instrument with its two Pieces join- ed. This Inftrument is much preferable to the common ones employed for railing depreSTed Pieces of the Skull; the Soft Feet of the Reft will fcarce bruife the Teguments, far lefs are they in Danger of breaking the Bone on which they are placed. The Force with v/hich the Inftrument a<ftsf can be increafed or diminifhed according to the different Hole of the Stalk in¬ to which the Screw of the Reft is put* The farther from the Handle, the longer is the Ve- Ftis , and the more Power the Hand moving it lias. The Screw allows the Stalk to turn round,

I i \ t and

3 y6 Medical EJfays

and the Joint makes it capable of being railed or depreffed,

T A B. V.

Fig. i , Another Levator , all of Steel, given me by Mr. Douglas.

AA the Handle, B a Male Screw, C a Wood Screw , D a Runner with a Female Screw, E a Joint by which the Stalk of the Glaw, with Teeth G, moves on the Runner.

Fig. 2. The Wood Screw C, and the End of the Claw G, to fhew the Claw of a different form, or forked.

When this Inflrument is ufed the Claw G is put under the depreffed Piece of Bone, and then the Wood Screw being fixed into the exterior Part of it, the Surgeon draws the Bone out¬ wards or to any Side at Pleafure.

In fame Cafes, where the Direffion of the force railing the Bone mull be varied, this In- {Rumen t will be preferable to Petit' s.

Fig. 3. A Scoop for making the Perforation into the Nofe in the fijlula lachrymalis , be¬ longing to Mr. Douglas.

A the Handle of Wood or Horn, B the Mouth of the Scoop, which is made very fharp.

To extract Peas, Cherry Stones, or fuch Sub- fiances, out of the Nofes or Ears of Children, Mr. Douglas employed fuccefsfully the fiiff ad- hefive Pafle put on the hollow End of a final! Piece of Wood or Ivory, with which Jewellers draw Diamonds out of the Lockets in which they are let.

Fig. 4. An Inflrument for pulling Teeth, gi¬ ven

and Obfervations. 377

ven to me by Mr. James Douglas Surgeon to the JVelJh Fuzileers , only that I have added the> wooden Handle A, where there was a Punce in the one I had from him ; B the Stalk of Steel, C the Reft, D the Claw, £ the Hinge on which the Claw moves.

When this Inflrument is ufed the Claw is put on the Inlide of the Tooth to be drawn with its Points as near to the Roots of the Tooth as they can conveniently be put. The End of the Reft is placed on the Outfide of the Gums, and a Finger being placed above the Claw to keep it from Hiding, the Patient’s Head is held by the Surgeon, who preffes down the Handle to extract the Tooth by railing the Tooth, mov’d in an Arch of a Circle, from the Socket.

Fig . 5. Another Inflrument for drawing Teeth, given to me by Dr. John Fothergill Phyfician at London . A, a Gimbiet Handle re- prefen ted too fmall in the Figure; this I ad¬ ded inflead of a fmall Crofs-bar of Iron. B the Stalk, G the convex Reft , D the Claw, E the Elinge of the Claw.

While the Claw is put as in the Figure, the Inflrument can be applied to any Tooth in the left Side of the lower Jaw, and to thole of the right Side of the upper Jaw, but by taking out the Axis and turning the Claw to the other Side it is fitted for applying to the dentes, malar es of the other Side of each Jaw.

The Claw being placed and held down as mentioned of the preceeding Inflrument, the. Gimbiet Handle is twilled round, lb that the convex Rell is applied to the Gum on the Out¬ fide of the Tooth, and then continuing the

I i 3 twifl^

37$' Medical Efjays

twilling, the Adion of the Infir ament is the fame as of the former.

This Inflrument is altogether necefiary for drawing the poflerior Grinders, efpecially in People whole Mouth is little, and whole Cheeks are thick, where the Inflrument, Fig. 4. can¬ not be applied.

They have both greatly the Advantage of the Pelican in fb far as their Aftion is not fo oblique, and they are much Ids liable to Hide.

J propos of thele Inllruments for the Teeth I mull obferve, that the Punce has much better Effe£l in pufhing from within outwards than in the common Way it is employed to thrufl the Roots of Teeth from without Inwards; this Direction being often to thrufl a Vault on its convex Side, while the former Method is act¬ ing on its concave Side ; and therefore the Stalk of Punces ought to be made longer than they are ordinarily made, that they may be put crofs the Mouth.

Fig. 6. The anterior View of a Bolfler for umbilical Hernia. AA, a Plate of Steel to which the convex Ruffed Bolfter is fowed, BB a railed fer pen tine Spring fixed to: the Plate AA at its Extremity C; DD a Crofs-bar of Steel to make the Play of the Spring equal, and to which the circular Belt is lowed.

The Patient keeping his or her Belly difiend- td} by retaining the Breath, the circular Belt is put fo. tight as to make the Spring ly flat on the Plate When the Belly is contraded the Spring riles, and nearly an equal Preflure is kept on the Navel during Infpiration and Expi¬ ration, which cannot be done without the Afi

Mancc?

and Gbfer vatic ns.

fifiance of a Spring. One Difadvantage how¬ ever of this Sort of Spring, efpecially in big- bellied People, is its rifing too high : For fuch the Spring may be made as. in the following Figure.

Fig. 7. A BolAer for the Navel. AA the. Plate of Steel, B a flat lerpentine Spring, the End G of which is fixed into the Plate, and to the other Extremity one End of the circular Belt is (owed to extend the Spring as the Belly flretches, the Spring contracting as the Belly fubfides.

Fig. 8. A Bolfier for inguinal Hemic?, con~ fiderably prominent at A, and thinner at Bj the Form of it appears better in the lateral View ; of it D.

The Advantages of this Form of a Bolfier I mentioned in an Efiay on Hemic v lent you fbme tune ago. (See p. 292.)

T A B.. VI.

Fig. 1. A Sort o FBifioire cachee in Mr. John Douglas's Pofleflion.

A, a narrow bladed Bifioury, B and C two Sheaths made of thin Plates of Silver, between which is a Groove in which the Blade of the BE floury can be lodged.

The Bifioury covered with either of them, being introduced into a Sinus , the Silver Sheath is withdrawn, and the Surgeon cuts with the Bifioury as he thinks fit.

Fig. 2. An Infirument for opening in ano , which have an external Orifice, but do not open into the Re£lum} though they run up

380 Medical Effays

on the Side of it. This Inftrument was con¬ trived by Mr. Adam Drummond Surgeon in this Place.

A the Handle, B the Blade, of the Shape of a Joiner’s Furmer, G a Nofe of elaftic flexible Steel, with a Button D at its crooked Extremi¬ ty. This Nofe I added. F a Button, FI the Handle of the Directory I, the Groove of which is made as that of Tab . IV. Fig. 4*

The furrowed Probe or Directory being in¬ troduced into the Sinus, with its Groove to¬ wards the Gut, the Button F is entred into the Groove at its Extremity, and the Furmer being pufhed forward, its Nofe is directed into the Anus, and the whole Inftrument is pufhed up¬ wards as far as it can go, that is, till its Button is ftopt by the fhut Extremity of the Groove of the Directory, the Edge cutting all the Parts placed between the Sinus and Cavity of the Gut, without any Danger of hurting any Part elfe.

One Difficulty I found in ufing this I n ft ru¬ men t was its Edge not cutting well, becaufe it was only pufhed againft the Parts, without run¬ ning along to a£i as a Saw' does, which is the only Way a cutting Inftrument has a right Ef¬ fect. To remedy this I would propofe to have the Edge oblique from E to G, where the But¬ ton fhould be put.

Fig. 3. Another Inftrument for the fame Purpofe, given to me by Dr. Charles Ay ton- Douglas of Finglaffle in Fife..

S* A the Handle, B the Blade of a fharp pointed Biftoury,C a thin Plate lodged in a narrow Sheath E of a Directory, the Handle of which is D ; F a Ringa G the cylindrical grooved Dire&ory

W hen *

and Obfervations. 38 f

When this Inflrument is employed the Blade Ox the Biftoury is introduced into the Sinus with fuch a Sheath of Silver as is reprelented Fig. 1. or by putting a Probe Point of Wax up¬ on it, the Edge of the Blade being placed to¬ wards the ReShmi, into which the furrowed Directory is introduced as far as the Ring F, which is a Stop to it. Then the Plate G is brought to fide into the Sheath E, by which the Point of the Biftoury is guided, when preft- fed into the Gut, to enter the Groove of the Directory j and, being kept there, the two In- frruments are drawn out, the Blade of the Bi¬ ftoury cutting all that is between the Sinus and Cavity of the Gut.

After defcnbing two Inftruments for this Operation of laying open Sinufes which run up on the Out-fide of the laft Gut, I rauft warn young Surgeons not to be fond of undertaking this Operation, efpecially if the Sinus goes any confiderable Way up, and there is a thick Bridge betwixt it and the Gut. The Reafon of this Caution is not fo much on account of the Ehemorrhagy which lometimes happens af¬ ter fuch an Incifion, nor thro’ Fear of the Pa¬ tient’s not retaining the Forces after the Cure ; for Surgeons generally get the Elaemorrhagy ftopt, and the new Flefh join the divided Parts of the Sphinfter fo well, that it does its Office fufficiently: But I have feveral Times feen a moil: obftinate Diarrhoea come on fome Days after the Operation, which hurried the Patient# to their Graves.

Fig. 4. Two Views of a Steel grooved Ca¬ theter for performing Lithotomy, in a Manner

a-khft

3 Si Medical EJJays

a-kin to Celfus’ s, or upon, the Gripe, invented lately, as I am informed, by Mr. Le Cat Sur¬ geon and Lithotomift at Rouen. Both Figures are one third of the Size which the Infirument ought to be made of.

The fuperior Figure reprefents the Inilru- ment when it is to be introduced into the Blad- der. A, a Female Head or fquare Socket, BB,. two Rings which ferve as Handles to it, C, the round hollow Part of the Catheter, D, a Joint, E its Point, where there is a second Joint, F a fquare Male Head which can be fixed at any Place of the Socket by the Screw-nail H, G is a Ring which ferves as a Handle to the Male Head, to the further Extremity of which a flexible Wire is fixed.

The lower Figure repreients the fame In¬ firument, when the Male fquare Head is pufhed quite down into the Socket. A, BB, G, D, E, G, H, denote the fame Parts which were- marked by them in the former Figure, I is the flexible elaflic Wire pufhed out by thrufling down the Male Head F, and railing with it the grooved Part L, to which it is joined by a Joint at K.

This Infirument is introduced into the Blad¬ der, when it is as reprefented in the Superior oF the two Figures, which, towards its Point, is nearly of the Form of a common Silver Cathe¬ ter. Then the Male Head being pufhed down, and eonfequently the moveable Part of the o- ^ther Extremity being raifed, as in the lower Figure, they are fecured in that Form by the Screw-pin H. The Infirument is gently drawn outwards, till the Part, I; being refilled by

the;

y>/

AI 'A 7f/

i

'f\r* _

and ObferKationS. 383

the Sphincter, as it is called, of the Bladder, hinders it to be drawn further out of the Urt ?- thra, when the Inftruinent is raifed up towards the Os Pubis of one Side, by which the convex furrowed Part L is made to prefs outwards, and may be felt between the Mufculus Accelerator Urine, v and ErePlor Penis ; lb that the Operator, after an Incifion thro’ the Teguments, cuts into its Groove, and upon it enlarges his Incifion, and introduces his Conductors and Forceps to 'extraCt the Stone.

Fig. 5. An Aneurifm Needle, which is fit¬ ter for that Operation, as propofed in your Vol. IV. Art. xvii. than the common one. A its Stalk fixed into a wooden Handle, which is not reprefented here. B the Curve, which is much larger than ordinary, C the Eye very near the Point, which ought to have been reprefent¬ ed Tharp, infiead.of appearing to be blunt.

The Handle allows one to hold it firmer ; the larger Curve makes it apply better to the Arte¬ ry, which lies in a Cavity ; the Eye near the Point gives occafion for pufning lefs of the In- Jfirument behind the Artery ; and the Sharp- nefs of the Point makes it pierce the thickned Membranes, which require a very ftrong Pufh of a blunt Needle.

Fig. 6. A Chifel with which the Fingers or Toes may be cut off, given me by Mr. John Douglas fo often named above.

A the concave Mouth , the Edge of which is very Tharp, B the Head, G the Handle Handing tranfverfe from the Head.

When the common Chifels, the Stalks of which are long and perpendicular to the Mouth y

are

3$4 Medical EJfays

are uled, the Surgeon is always afraid of hurt* ing his own Hand when he (trikes with the Mallet, and therefore does not probably give fuch afmart Stroke as he would otherwife: And, if he does not ftrike perpendicular, he beats the Chifel out of his own Hand, nihfes the right Amputation of the Member, and bruiles hlmfelf; all which Inconveniencies are pre^ vented when a Ghitel of the Form here reprc- fented is employed.

I could have fent you the Figures of more Chirurgical Inftrunients, which are not painted in the common Chirurgical Books: But what are above are perhaps too many for one of your Volumes; and, at lead, they may fuffice to let any Gentlemen, who are poffefTed of Inllru- ments not generally delcribed or painted, fee what Ufe I would make of them, if I could come to the Knowledge of them.

5 The End of the Firjl Path

lace

Bo the Bookbinder .

Tab. Pag.

f Jr \ f l ?6 1

I ir* 1 j 28a 1

j III. L , 284 i

I V. 383

ivi,j •

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