more moderate temperature and greater purity of the air upon the sea.

915. In order to take off any inflammatory determination of the blood into the vessels of the lungs, blisters applied to some part of the thorax often be of service; and for the same purpose, may as well as for moderating the general inflammatory state of the body, issues of various kinds may be employed with advantage.

916. The several measures to be pursued in the case of what is properly called an Incipient Phthisis, have now been mentioned; but they have seldom been employed in such cases in due time, and have therefore, perhaps, seldom proved effectual. It has more commonly happened, that after some time, an inflammation has come upon the tubercle, and an abscess has been formed, which opening into the cavity of the bronchiæ, has produced an ulcer, and a confirmed phthisis.

917. In this state of matters, some new indications different from the former may be supposed to arise; and indications for preventing absorp tion, for preventing the effects of the absorbed matter upon the blood, and for healing the ulcer, have been actually proposed. I cannot find, however, that any of the means proposed for executing these indications, are either probable or have

proved effectual. If, upon some occasions, they have appeared to be useful, it has been probably by answering some other intention.

While no antidote against the poison which es pecially operates here seems to have been as yet found out, it appears to me that too great a deof inflammation has a great share in preventgree ing the healing of the ulcer which occurs; and such inflammation is certainly what has a great share in urging on its fatal consequences. The only practice, therefore, which I can venture to propose, is the same in the ulcerated as in the crude state of a tubercle; that is, the employment of means for moderating inflammation, which have been already mentioned (909 et seq.)

918. The balsamics, whether natural or artificial, which have been so commonly advised in cases of phthisis, appear to me to have been proposed upon no sufficient grounds, and to have proved commonly hurtful. The resinous and acrid substance of myrrh, lately recommended, has not appeared to me to be of any service, and in some cases to have proved hurtful.

919. Mercury, so often useful in healing ulcers, has been speciously enough proposed in this disease; but whether that it be not adapted to the particular nature of the ulcers of the lungs occur. ring in phthisis, or that it proved hurtful because

it cannot have effect, without exciting such an inflammatory state of the whole system, as, in a hectic state, must prove very hurtful, I cannot determine. Upon many trials which I have seen made, it has proved of no service, and commonly has appeared to be manifestly pernicious.

920. The Peruvian bark has been recommended for several purposes in phthisical cases; and it is said, upon some occasions to have been useful; but I have seldom found it to be so: and as by its tonic power it increases the phlogistic diathesis of the system, I have frequently found it hurtful. In some cases, where the morning remissions of the fever were considerable, and the noon exacerbations well marked, I have observed the Peruvian bark given in large quantities, with the effect of stopping these exacerbations, and at the same time of relieving the whole of the phthisical symptoms but in the cases in which I observed this, the fever shewed a constant tendency to recur; and at length the phthisical symptoms also returned, and proved quickly fatal.

921. Acids of all kinds, as antiseptic and refrigerant, are useful in cases of phthisis; but the native acid of vegetables is more useful than the fossil acids, as it can be given in much larger quantities, and may also be given more safely than vinegar, being less liable to excite coughing.

922. Though our art can do so little towards the cure of this disease, we must, however, palliate the uneasy symptoms of it as well as we can. The symptoms especially urgent, are the cough and diarrhoea. The cough may be in some measure relieved by demulcents, (873); but the relief obtained by these is imperfect and transitory, and very often the stomach is disturbed by the quantity of oily, mucilaginous, and sweet substances, which are on these occasions taken into it.

923. The only certain means of relieving the cough, is by employing opiates. These, indeed, certainly increase the phlogistic diathesis of the system; but commonly they do not so much harm in this way, as they do service by quieting the cough and giving sleep. They are supposed to be hurtful by checking expectoration: but they do it for a short time only; and, after a sound sleep, the expectoration in the morning is more easy than usual. In the advanced state of the disease, opiates seem to increase the sweatings that occur; but they compensate this, by the ease they afford in a disease which cannot be cured.

924. The diarrhoea which happens in the advanced state of this disease, is to be palliated by moderate astringents, mucilages, and opiates.

Rhubarb, so commonly prescribed in every

VOL. I.

Hh

diarrhoea, and all other purgatives, are extremely pernicious in the colliquative diarrhoea of hectics.

Fresh subacid fruits, supposed to be always laxative, are often, in the diarrhoea of hectics, by their antiseptic quality, very useful.

CHAP. V.

OF THE HÆMORRHOIS; OR, OF THE HÆMORRHOIDAL SWELLING AND FLUX.

SECT. I.

Of the Phænomena and Causes of the Hæmorrhois. 925. A DISCHARGE of blood from small tumours on the verge of the anus, is the symptom which generally constitutes the Hæmorrhois; or, as it is vulgarly called, Hæmorrhoidal Flux. But a discharge of blood from within the anus, when the blood is of a florid colour, shewing it to have come from no great distance, is also considered as the same disease; and physicians have agreed in making two cases or varieties of it, under the names of External and Internal Hæmorrhois.