would seem proper to contrive that the whole of the effervescence should take place in the stomach.

162. A third means (153, 3) of determining to the surface of the body, and taking off the spasm subsisting there, is by the use of sudorific medicines, and of sweating.

163. The propriety of this remedy has been much disputed; and specious arguments may be adduced both for and against the practice.

In favour of the practice, it may be said,

1, That, in healthy persons, in every case of increased action of the heart and arteries, a sweating takes place, and is seemingly the means of preventing the bad effects of such increased action. 2, That, in fevers, their most usual solution and termination is by spontaneous sweating,

3, That, even when excited by art, it has been found manifestly useful, at certain periods, and in certain species of fever,

164. Upon the other hand, it may be urged against the practice of sweating,

1, That as in fevers a spontaneous sweating does not immediately come on, so there must be in these some circumstances different from those in the state of health, and which may therefore render it doubtful whether the sweating can be safely excited by art,

2, That, in many cases, the practice has been attended with bad consequences. The means commonly employed have a tendency to produce an inflammatory diathesis; which, if not taken off by the sweat following their use, must be increased with much danger. Thus, sweating employed to prevent the accessions of intermitting fevers, has often changed them into a continued form, which is always dangerous.

3, The utility of the practice is further doubtful, because sweating, when it happens, does not always give a final determination; as must be manifest in the case of intermittents, as well as in many continued fevers, which are sometimes in the beginning attended with sweatings that do not prove final; and, on the contrary, whether spon, taneous, or excited by art, seem often to aggravate the disease.

165. From these considerations, it is extremely doubtful if the practice of sweating can be admitted very generally; but, at the same time, it is also doubtful, if the failure of the practice, or the mischiefs said to have arisen from it, have not been owing to the improper conduct of the practitioner. With respect to this last, it is almost agreed among physicians,

1, That sweating has been generally hurtful, when excited by stimulant, heating, and inflam❤ matory medicines.

2, That it has been hurtful when excited by much external heat, and continued with a great increase of the heat of the body.

3, That it is always hurtful when it does not soon relieve, but rather increases, the frequency and hardness of the pulse, the anxiety and difficulty of breathing, the headach, and delirium.

4, That it is always hurtful, if it be urged when the sweat is not fluid, and when it is partial, and on the superior parts of the body only.

166. In these cases, it is probable, that either an inflammatory diathesis is produced which increases the spasm on the extreme vessels: or that, from other causes, the spasm is too much fixed to yield easily to the increased action of the heart and arteries; and, upon either supposition, it must be obvious, that urging the sweat, as ready to produce a hurtful determination to some of the internal parts, may be attended with very great danger.

167. Though the doubts started (164) are to be attended to, and although the practices (165), having been found hurtful, are therefore to be rejected, it still remains true,

1, That sweating has certainly been often useful in preventing the accession of fevers, when the times of this have been certainly foreseen, and a proper conduct employed.

2, That, even after fevers have in some mea

sure come on, sweating, when properly employed, either at the very beginning of the disease, or du ring its approach and gradual formation, has often prevented their further progress.

3, That, even after pyrexia have continued for some time, sweating has been sucessfully employed in curing them, as particularly in the case of rheumatism.

4, That certain fevers, produced by a very powerful sedative contagion, have been generally treated, so far as we yet know, most successfully by sweating.

168. These instances (167), are in favour of sweating, but give no general rule; and it must be left to further experience to determine how far any general rule can be established in this matter. In the meantime, if the practice of sweating is to be attempted, we can venture to lay down the following rules for the conduct of it:

1, That it should be excited without the use of stimulant inflammatory medicines.

2, That it should be excited with as little external heat, and with as little increase of the heat of the body, as possible.

3, That, when excited, it should be continued for a due length of time, not less than twelve hours, and sometimes for twenty-four or forty-eight hours; always, however, providing that it proceeds without the circumstances mentioned (165, 3, 4).

4, That for some part of the time, and as long as the person can easily bear, it should be carried on without admitting of sleep.

5, That it should be rendered universal over the whole body; and therefore, particularly, that care be taken to bring the sweating to the lower extremities.

6, That the practice should be rendered safer by moderate purging, excited at the same time. 7, That it should not be suddenly checked by any how applied to the body.

cold

169. When attention is to be given to these rules, the sweating may be excited, 1, By warm bathing, or a fomentation of the lower extremities; 2, By frequent draughts of tepid liquors, chiefly water, rendered more grateful by the addition of a light aromatic, or more powerful by that of a small quantity of wine; 3, By giving some doses of neutral salts; 4, Most effectually, and perhaps most safely, by a large dose of an opiate, joined with a portion of neutral salts, and of an emetic.

In what cases may cold water, thrown into the stomach in large quantities, be employed to excite sweating? See CELSUS, lib. iii, chap. vii,

-ix.

170. The fourth means (153, 1) of determining to the surface of the body, and thereby taking