bility of the nervous power, I am of opinion, that it is always to be employed with caution, and that it is only safe when applied with moderate force, and when confined to certain parts of the body remote from the head. It is also my opinion, that its good effects are to be expected from its repetition rather than from its force, and that it is particularly suited to the cure of those palsies which have been produced by the application of narcotic powers.

1167.] Amongst the remedies of palsy, the use of exercise is not to be omitted. In a hemiplegia, bodily exercise cannot be employed; and in a more limited affection, if depending upon a compression of some part of the brain, it would be an ambiguous remedy: but, in all cases where the exercise of gestation can be employed, they are proper; as, even in cases of compression, the stimulus of such exercise is moderate, and therefore safe; and, as it always determines to the surface of the body, it is a remedy in all cases of internal congestion.

1168.] The internal stimulants employed in palsy are various, but chiefly the following.

1. The volatile alkaline salts, or spirits, as they are called, are very powerful and diffusive stimulants, operating especially on the nervous system;* and even although they operate on the sanguiferous, yet, if given in frequently repeated small rather than in large doses, their operation being transitory, is tolerably safe.

2. The vegetables of the class named Tetradynamia, are many of them powerful diffusive stimulants; and at the same time, as quickly passing out of the body, and therefore a transitory operation, they are often employed with safety. As they commonly prove diuretic, they may this way also be of service in some cases of serous palsy.

in

3. The various aromatics, whether employed in substance, in tincture, or in their essential oils, are often pow

Of these there are several formulæ in the shops, as, Spiritus volatilis aromaticus, Spiritus volatilis oleosus, Spiritus salinus aromaticus. Their dose is from ten to sixty drops. The Eau de Luce ought to be mentioned here, though it is seldom used internally, but only for smelling to, as it is extremely penetrating. It is prepared thus: Mix together in a retort forty drops of rectified oil of amber, an ounce of rectified spirit of wine, and twelve ounces of the strongest caustic volatile alkali. They must be distilled with a very moderate fire. It is seldom limpid, but has a milky appearance, owing to the imperfect solution of the oil in the spirit; and, if the alkali be not very caustic, scarcely any of the oil is dissolved.

+White mustard seeds may be given whole, in the quantity of two tea-spoonfuls in a half tea-cupful of cold water. They ought to be swallowed whole, that their acrid taste may not be perceived. The dose may be repeated twice or thrice a-day. Horse-radish is another plant of this class of vegetables that has been much recommended; it must be given in a cold watery infusion, or in an infusion in ale. The scurvy-grass is another of the same class; it may be eaten raw, or we may give forty or fifty drops of the Spiritus cochlearia, either on a piece of sugar, or mixed with half an ounce of syrup, four or five times a-day. This spirit ought to be kept well corked, as it soon loses all its activity, if it be exposed to the air.

erful stimulants; but being more adhesive and inflammatory than those last mentioned, they are therefore, in all ambiguous cases, less safe.*

4. Some other acrid vegetables have been employed; but we are not well acquainted with their peculiar virtues, or proper use.

5. Some resinous substances, as guaiacum, and the terebinthinate substances, or their essential oils, have been with some probability, employed; but they are apt to become inflammatory. Decoctions of guaiacum, and some other sudorifics, have been directed to excite sweating by the application of the fumes of burning spirit of wine in the laconicum, and have in that way been found useful.

6. Many of the fetid antispasmodic medicines have been frequently employed in palsy; but I do not perceive in what manner they are adapted to the cure of this disease, and I have not observed their good effects in any case of it.

7. Bitters and the Peruvian bark, have, also been employed; but with no propriety or advantage that I can perceive.+

1169.] With respect to the whole of these internal stimulants, it is to be observed, that they seldom prove very powerful; and wherever there is any doubt concerning the nature or state of the disease, they may readily do harm, and are often therefore of ambiguous use.

*The aromatics best adapted for stimulating, in these cases, are such as Linne calls Spirantia the chief of them are, Marum, Rosemary, Lavender, &c. Their spirituous waters are much more efficacious than the plants in substance, or in any other form; and their efficacy is considerably increased by uniting them to volatile spirits, as in some of the formulæ mentioned in the first note on this article.

+ In some cases, paralytic patients, for want of exercise, sink into a state of debility, with loss of appetite, and consequent emaciation, in which bitters, Peruvian bark, and other tonics, are frequently of some advantage.

BOOK II.

OF ADYNAMIE; OR DISEASES CONSISTING IN A WEAKNESS OR LOSS OF MOTION IN EITHER THE VITAL OR NATURAL FUNCTIONS.

1170.]

CHAPTER I.

OF SYNCOPE, OR FAINTING.

HIS is a disease in which the action of the heart and respiration become considerably weaker than usual, or in which for a certain time these functions cease altogether.

1171.] Physicians having observed that this affection occurs in different degrees, have endeavored to distinguish these by different appellations: but as it is not possible to ascertain these different degrees with any precision, so there can be no strict propriety in employing those different names; and I shall here comprehend the whole of the affections of this kind under the title of Syncope.

1172.] This disease sometimes comes on suddenly to a considerable degree, but sometimes also it comes on gradually; and in the latter case, it usually comes on with a sense of languor, and of anxiety about the heart, accompanied at the same time, or immediately after with some giddiness, dimness of sight, and sounding in the ears. Together with these symptoms, the pulse and respiration become weak; and often so weak, that the pulse is scarcely to be felt, or the respiration to be perceived; and sometimes these motions, for a certain time, cease altogether. While these symptoms take place, the face and whole surface of the body become pale, and more or less cold according to the degree and duration of the paroxysm. ry commonly at the beginning of this, and during its continuance, a cold sweat appears, and perhaps continues, on the forehead, as well as on some other parts of the body. During the paroxysm, the animal functions, both of

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sense and motion, are always in some degree impaired, and very often entirely suspended. A paroxysm of syncope is often, after some time, spontaneously recovered from; and this recovery is generally attended with a sense of much anxiety about the heart.

Fits of syncope are frequently attended with, or end in, vomiting; and sometimes with convulsions, or an epileptic fit.

1173.] These are the phenomena in this disease; and from every view of the greatest part of them, there cannot be a doubt that the proximate cause of this disease is a very weak or total ceasing of the action of the heart. But it will be a very difficult matter to explain in what manner the several remote causes operate in producing the proximate cause. This, however, I shall attempt, though with that diffidence which becomes me in attempting a subject that has not hitherto been treated with much success.

1174.] The remote causes of syncope may, in the first place, be referred to two general heads. The one is, of those causes existing and acting in the brain, or in parts of the body remote from the heart, but acting upon it by the intervention of the brain. The other general head of the remote causes of syncope, is of those existing in the heart itself, or in parts very immediately connected with it, and thereby acting more directly upon it in producing this disease.

1175.] In entering upon the consideration of the first set of those causes (1174.) I must assume a proposition which I suppose to be fully established in physiology. It is this: That, though the muscular fibres of the heart be endowed with a certain degree of inherent power, they are still, for such action as is necessary to the motion of the blood, very constantly dependent upon a nervous power sent into them from the brain.* At least this is evident, that there are cer tain powers acting primarily, and perhaps only in the brain, which influence and variously modify the action of the heart. I suppose, therefore, a force very constantly during life exerted in the brain, with respect to the moving fibres of the heart, as well as of every part of the body; which force I shall call the energy of the brain and which I suppose may be, on different occasions, stronger or weaker with respect to the heart.

*The author here differs somewhat in opinion from physiologists. He allows, indeed, that the heart possesses a vis insita in a certain degree, but he will not allow this vis insita to be sufficiently strong for carrying on the circulation; and he thinks that some energy must be imparted to the heart from the brain, in order to enable that important muscle to perform its office. In support of this opinion, we have a plain fact, which the author might have adduced, viz. that a ligature on the nerves going to the heart immediately stops its motions.

1176.] Admitting these propositions, it will be obvious, that if I can explain in what manner the first set of remote causes (1174.) diminish the energy of the brain, I shall at the same time explain in what manner these causes occasion a syncope.

1177.] To do this, I observe, that one of the most evi dent of the remote causes of syncope is a hemorrhagy, or an evacuation of blood, whether spontaneous or artificial. And as it is very manifest that the energy of the brain depends upon a certain fulness and tension of its blood-vessels, for which nature seems to have industriously provided by such a conformation of those blood-vessels as retards the motion of the blood both in the arteries and veins of the brain; so we can readily perceive, that evacuations of blood, by taking off the fulness and tension of the blood-vessels of the brain, and thereby diminishing its energy with respect to the heart, may occasion a syncope. In many persons, a small evacuation of blood will have this effect; and in such cases there is often a clear proof of the manner in which the cause operates, from this circumstance, that the effect can be prevented by laying the body in a horizontal posture; which, by favoring the afflux of the blood by the arteries, and retarding the return of it by the veins, preserves the necessary fulness of the vessels of the brain.

It is farther to be remarked here, that not only an evacuation of blood occasions syncope, but that even a change in the distribution of the blood, whereby a larger portion of it flows into one part of the system of blood-vessels, and consequently less into others, may occasion a syncope. It is thus I explain the syncope, that readily occurs upon the evacuation of hydropic waters, which had before filled the cavities of the abdomen or thorax. It is thus also I explain the syncope that sometimes happens on blood-letting, but which does not happen till the ligature which had been employed is untied, and admits a larger afflux of blood into the bloodvessels of the arm. Both these cases of syncope show, that an evacuation of blood does not always occasion the disease by any general effect on the whole system, but often merely by taking off the requisite fulness of the blood-vessels of

the brain.

1178.] The operation of some others of the remote causes of syncope, may be explained on the following princi ples. Whilst the energy of the brain is, upon different occasions, manifestly stronger or weaker, it seems to be with