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1. External heat, which, by rarefying the blood, produces or increases the plethoric state of the body; and the same heat, as giving a stimulus to the whole system, must urge any particular determinations before established, still further, or may urge to excess any inequality, otherwise innocent ; so that, in either way, external heat may immediately excite hæmorrhagies, to which there was a predisposition, or may form congestions where there were none before, and thereby occasion hæmorrhagy.

2. A considerable and sudden diminution of the weight of the atmosphere, which seems to occasion the same effects as heat, by producing also an expansion of the blood.

3. Whatever increases the force of the circulation, and thereby the velocity of the blood, may operate in the same manner as heat, in urging not only previous determinations with violence, but also in urging to excess inequalities, otherwise innocent. All violent exercise, therefore, and especially all violent efforts, which, not only by a larger and longer inspiration, but also by the simultaneous action of many muscles interrupting the free moţion of the blood, impel it with unusual force into the extreme vessels more generally, and, according to the different postures of the body, and mode of the effort, into certain vessels more particularly.

*Among the causes increasing the force of the circulation, anger and other violent active passions are to be reckoned.

4. The violent exercise of particular parts of the body. If these are already affected with congestions, or liable to them, such exercise may be considered as a stimulus applied to the vessels of that particular part. Thus, any violent exercise of respiration may excite hæmoptysis, or occasion its return.

5. The postures of the body increasing determinations, or ligatures occasioning accumulations of the blood in particular parts of the body.

6. A determination into certain vessels rendered habitual by the frequent repetition of hæmorrhagy from them.

7. Cold, externally applied, as changing the distribution of the blood, and determining it in greater quantity into the internal parts.


Of the Cure of Hæmorrhagy.

776. Having thus considered the proximate and remote causes of hæmorrhagy in general, our next business is, to treat of the cure of the disease in the same manner.

In entering upon this subject, the first question which presents itself, is, whether the cure of hæ

morrhagies ought to be attempted by art, or if they should be left to the conduct of nature ?

777. The latter opinion was the favourite doctrine of the celebrated Dr. Sthall and his followers. They maintained, that the human body is much disposed to a plethoric-state ; and, consequently, to many disorders which nature endeavours to obviate and relieve by exciting hæ. morrhagy: that this, therefore, is often necessary to the balance and health of the system: that it is accordingly to be generally encouraged, sometimes solicited, and is not to be suppressed, unless when it goes to great excess, or happens in parts in which it may be dangerous,

778. Much of this doctrine may be admitted. The human body upon many occasions, becomes preternaturally plethoric: and the dangerous consequences which might from thence be apprehended, seem to be obviated by an hæmorrhagy taking place; and further, the necessity of hæmorrhagy often appears from hence, that the suppression of it seems to occasion many disorders. .

All this seems to be just ; but in the conclusion drawn from it, there is a fallacy.

779. It appears to me certain, that hæmorrhagy, either upon its first attack, or upon its after recurrence, is never necessary to the health of the

body, excepting upon the supposition, that the plethoric state which seems to require the evacuation, cannot be otherwise prevented or remov. ed; and as I imagine it possible by other means to prevent or remove a plethoric state, so I do not think that hæmorrhagy is, in all cases, necessary. In general, I am of opinion, that hæmorrhagy is to be avoided :

1, Because it does not always happen in parts where it is safe ;

2, Because often, while it does relieve a ple. thoric state, it may at the same time, induce a very dangerous disease; .

3, Because it may often go to excess, and either endanger life, or induce a dangerous infirmity;

And, lastly, because it has a tendency to increase the plethoric state it was meant to relieve; to occasion its own recurrence, (721); and thereby to induce a habit, which, if left to the precarious and unequal operation of nature, may, from the frequent errors of this, be attended with much danger.

.780. It is further to be considered, that hæmorrhagies do not always arise from the necessities of the system, but often proceed from incidental causes. It appears to me, that all hæmorrhagies of the latter kind may be immediately suppressed, and the repetition of them, as it induces a plethora, and a habit not otherwise necessary, may be prevented with great advantage.

781. Upon the whole of this subject, I conclude, that every preternatural hæmorrhagy, or in other words, every one except that of the menses in females, is to be avoided, and especially the returns of it prevented ; and I therefore now proceed to mention, how hæmorrhagy, and its recur. rences, may, and should be prevented.

782. From the principles delivered above, it will immediately appear, that the prevention, either of the first attacks, or of the returns of hæmorrhagy, will chiefly, and in the first place, depend upon the preventing, or removing, any considerable degree of a plethoric state which may happen to prevail in the body. It is true, that, where the hæmorrhagy depends upon the particular conformation of certain parts, rather than upon the general plethoric state of the whole, the measures for removing or preventing the latter may not always be sufficient for preventing hæmorrhagy; but at the same time it must be evident, that determinations, in consequence of the conformation of particular parts, will always be urged more or less, in proportion to the greater or less degree of the plethoric state of the whole system ; and, therefore, that even in the cases depending upon particular conformation, the preventing or removing an unusually plethoric state, will always be a chief means of preventing hæmorrhagy. It is further to be attended to, that there may be several in. • VOL. I.

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