ANIMADVERSIONS ON A LATE TREATISE ON THE KINK-COUGH.

[Price One Shilling and Six-pence.]

ERRATA.

  • Preface, p. v. line 6, after it, add ever.
  • Page 2, line 19, for taffis, read tuffis.
  • Page 7, — for AVICENNA, read AVICENNAE.
  • Page 14, line last, after an, read external.
  • Page 18, line 27, for taffim, read tuffim. penult. for Avicenna, read AVICENNAE.
  • Page 22, line 16, after wou'd, add often.
  • Page 23, line 19, for the, read though. line 20, after given, put a, instead of [...]
  • Page 33, line 6, for n, read In.
  • Page 39, line 3, for con, read consult.
  • Page 46, line 12, for irritated, read irritating.
  • Page 47, line 8, after in, add the. line 18, read Syr. e mecon.
  • Page 53, line 28, for when, read whence.

ANIMADVERSIONS ON A LATE TREATISE ON THE KINK-COUGH.

To which is annexed, An ESSAY on that DISORDER.

Nil praeter gelidas ausus conferre Cicutas.

LONDON, Printed for R. BALDWIN, and J. BEW, in Pater-noster Row, MDCCLXXIV.

PREFACE.

AUDI ALTERAM PARTEM.

IT is now well known with what little truth hemlock was recommended as a cure for cancers, Dr. De Haen of Vienna, physician in the same hospital with Dr. Storck, having given us a fair account of this matter.

In a letter to a physician in England, published in the third volume of the Medical Museum, he says, speaking of the Cicuta,

"I am now able to ex­plain this matter to you, from the many experiments I have made in [Page ii]consequence of an order received from high authority. The first thirty pa­tients it absolutely failed me, but confiding in the good faith of others, that they might happen to be such only as were incurable, I advanced to make further trials, as well publicly in the hospital, as privately in the city and suburbs, to the num­ber of one hundred and twenty; but, unhappily for me, after so much trouble, the result was, that not one person was cured or relieved by it; that many grew worse, and that seven unhappy women with cancers in their breasts perished un­der my hands, of whom I could have saved some of them by the knife, and in all probability others might have been preserved a long time by the palliative methods."

"I must own, sir, I am ashamed of this affair. How did I intreat [Page iii]those to whom it belonged to use more precaution, and at least to sus­pend for some time the printing of those books that praise the Cicuta, till repeated trials had been made, and by several hands, lest the pub­lic faith should be abused by a premature publication, and the au­thor rendered ridiculous in the face of the universe. But my re­monstrances were fruitless; and, to my great concern, my best friends abruptly fell out with me, and I have incurred the disgrace of the best of sovereigns."

Wherefore, three years after, in 1766, he pub­lished his Epistola de Cicuta, wherein he denies the cures which Dr. Storck said he had accomplished by this remedy, and maintains it, ‘"that many, or most of those very pa­tients Dr. Storck asserts to have been perfectly cured, died while they were taking this medicine; [Page iv]and that there was proved in reality, on a candid enquiry, no more than one that could be said to be cured by hemlock; that al­though five hundred pounds weight of Dr. Storck's extract of Cicuta had been sent to different places abroad, yet there has not been received one authentic account of a real cure of a true cancer having been ever yet performed by it in any instance where it was used."’ Which per­fectly agrees with general experience; and indeed it is amazing, that it should ever have been received as a specific in this disorder, when we reflect, that upon enquiry, by dissec­tion, into the nature of a confirmed schirrhus, the vessels ate found to be perfectly destroyed and obliterated, and the whole to be one confused mass; wherefore, any medicine cap­able of restoring a part thus diseased, must have a power of creating a new [Page v]set of vessels, and of making a new gland of the old one; and we may as well believe that it has a power of re­moving any inconvenience from am­putation, by creating a new limb, as that it cured a true schirrhus *.

But when we reflect how desti­tute we were of any medicine cap­able of curing a cancer, we shall see the reason why physicians and sur­geons should seek with avidity after a medicine recommended for this purpose by a physician of eminence [Page vi]and character; and finding it give ease in some instances, its use has been continued, not considering that it is an opiate, and that the same ad­vantage might have been received from small doses of opium; and that both opium and hemlock lull the pa­tient into a fatal security, while the necessary and proper methods are ne­glected, and the disease makes an in­curable progress.

Nevertheless, the writer of the Essay on the Kinkcough is a true disciple of Dr. Storck; and if this publication is well received, we have reason given to expect a more extensive account of the virtues of hemlock; wherefore it must be a thankful office to en­quire, how far what is already said by this writer merits attention, and whether, as he asserts, ‘"it is a spe­cific in the kinkcough, according to the most proper interpretation of [Page vii]that word,"’ to prevent our being again hastily led, in giving preference to a medicine, perhaps no ways en­titled to the encomiums bestowed on it.

Although by shewing that the cases Dr, B— has given are insuffici­ent to recommend hemlock, and that he himself does not believe what he has said in favour of this medicine to be true, we might answer all the ends proposed; yet, as theory is apt to affect practice, it will be proper to examine his doctrine previous to his cases, and more especially as it will shew this imitator of THESSALUS *, [Page viii]that he, like other men, is not quite free from imperfection; that there must be a great amendment to make, as he ex­pects his name greater in the next century than any man that ever lived; and knowing himself, he may see the necessity of still improving.

ANIMADVERSIONS ON A LATE TREATISE on the KINKCOUGH.

To Dr. B*****.

SIR,

I HAVE read your Treatise on the Kink­cough, and willingly point out to you some oversights in this work, in hopes of improving your medical knowledge, and thereby enabling you better to support the character you have so long assumed, of being "second in the profession to no man."

Indeed, sir, your stricture upon DOCTOR FO­THERGILL, in the beginning of your Preface, seems not only to be unnecessary, but a little unlucky to yourself; because, I dare say, you might have gone on in your system-building quietly, and with­out notice; whereas, from what you have there said, people will naturally be led to make a com­parison between the two writers that cannot possibly turn out to your advantage.

They will at once plainly see that you have ob­scured and perplexed your subject, by treading in the path he has avoided. Those conversant with medical books will discover, that you have served your HEMLOCK up in a hash of old materials; and that you have not advanced one new observation, or even one new thought, except some new errors, which it was quite unnecessary to add to the theory and practice of physic. Besides, I apprehend, your book will be thought to border a little upon quackery; while it must be confessed, that the DOCTOR has written like a man of science.

Whoever looks over the 30th article, in the third volume of the Medical Observations and In­quiries, will find that he recommends, from the success of himself and many of his medical ac­quaintance, a powder composed of crabs claws and emetic tartar, as a very useful medicine in the tassis convulsiva, and in preference of oxymel of squills and ipecacuanha, which have so often afforded most relief, by emptying the stomach of its contents; and he has mentioned the manner of giving it, and the diet he has found most useful on this occasion. And, surely, there can be no impropriety in his confirming, by the experience of himself and many physicians, the usefulness of a medicine which has been advised by preceding writers. And why is his giving directions about the manner of its being taken, and laying down rules for diet, unworthy of him, when so great a man as yourself has imitated him in these particulars *?

But he says, the remedy he recommends is not a certain cure in all cases; he would not be understood to suppose, that it will alone complete the cure of the whooping-cough; says he, ‘"I know it will not; and that this, as well as any other medicine, is useful or otherwise, just as it is in­dicated:"’ whereas you happen not to trouble your head about indications, but recommend hem­lock as a specific in the disorder under consideration.

A specific in the whooping-cough is a desireable remedy, if it could be obtained; but whether that you have advised is better than the flesh of fryed mice, which has been in vogue as a specific for the same purpose; may be much doubted; for such is the difference of constitutions, the variations in the same disease, and in the combinations of diseases; that no one remedy has hitherto been found out, capable of invariably curing any one disorder. Quacks, therefore, only talk of curing diseases under various circumstances by a specific: they, indeed, from a poverty of knowledge, recommend one remedy in all sorts of complaints, and bring testimony of their use from every recovery which happens where they are given. You, in like man­ner, have, for several years, been prescribing hem­lock in almost all the cases which have come be­fore you, and now ascribe effects to it of which there is no evidence. I will point out an instance, which may serve for the present. You say, it may be given in the small-pox with advantage, because it was taken by an healthy boy and girl, in the be­ginning of the eruptive fever of this disease, after emptying their bowels by senna tea, and the small-pox [Page 4]turned out a very distinct good sort. Now, if there had never before been a very distinct good sort of small-pox, in an healthy boy and girl, espe­cially after purging, the hemlock might have gain­ed some credit; but if, upon enquiry, it should be discovered, that a distinct good sort of small-pox is not unfrequent where hemlock is not given, I rather think, no other conclusion can be drawn from these instances than that, like a chip in pottage, it nei­ther did good nor harm.

Nor can Dr. STORCK shelter you, I am fearful, from the appearance of having made a random ex­periment, if even what he says be true; for, sup­posing hemlock, in some instances, to have promoted a kindly suppuration where the Peruvian bark failed; yet it does not follow, that it will promote a kindly suppuration in the small-pox; because different kinds of acrid matter require different correctives: though we no way accuse you of making a random experiment by design, but inno­cently, without knowing that matter in sores and the matter in the small-pox may require different remedies.

However, though you have been a little out in these things, yet your declaration of not being an­swerable for other peoples experiments with hem­lock, unless made with the very preparation you always use *, may screen you from reproach where [Page 5]you are not known, in case it is not found so suc­cessful in curing the kinkcough as you have repre­sented it to be; for, in justification of yourself, you may have recourse to your old practice, and say, that the blockhead of a compounder scorched the herb in drying, that he stirred the juice with a wooden skewer instead of a bit of hemlock stalk, or that there was certainly an ebullition while it was over the fire; which, if you are as successful as you have been with no better arguments, may ef­fectually stop any clamour. And who can say, though they took the utmost care, that two or three bubbles did not arise? which would be sufficient for your purpose; or you may further insist upon it, that no one can so exactly perform the method you have described, of making experiments upon people that are ill, as yourself. Nor will the pre­scriptions being written in English, hinder your forcing a trade and carrying on business, as they will be understood by every good woman, who will not have any thing to do, but, as they have already experienced, to consult you, pay their fee, and re­ceive, with directions, in a pot sealed up, your ‘" agreeable, certain, and expeditious cure for the kinkcough."’

ARNAUD wrote a book, to prove that GOULARD'S extract of lead is the best and most universal topic in surgery, and may very properly be substituted in the place of all others prescribed; that it could only be made by GOULARD himself; and that he, ARNAUD, was the only person in England intrusted with the sale of this preparation; in hopes, no doubt, of getting the whole trade in chirurgical [Page 6]applications to himself. You, in imitation, have written a book, to prove that hemlock is a remedy against almost all diseases; that it may properly be substituted for all others generally prescribed for the kinkcough; and that they must have the very preparation you use.

An anonymous writer lately attempted to ex­plode, by chemical investigation, all the febrifuge powders hitherto invented, in hopes of recom­mending the sale of his own medicine for the cure of fevers. You have endeavoured to decry, for the same purpose, the practice recommended by other physicians, and as much as lay in your power, by patching together [...]hreds from different authors, have dressed out your performance with a scientifical air, in hopes, no doubt, of seeing your doctrine and medicines more greedily swallowed. And if, by these means, you can persuade the pub­lic to believe, that whatever has been written upon the subject is erroneous, you may, perhaps, drive a great trade, and we shall then, without doubt, have the whole of your experience of hemlock as a medicine. Nevertheless, we will now see whether your book and list of cures will stand the test of inquiry; and the following are the heads of the chapters in which we shall discuss this matter.

CONTENTS.

  • CHAP. I. Of the synonyma, description, and prognostics of the kinkcough.
  • CHAP. II. Of the nature of the kinkcough.
  • [Page 7] CHAP. III. Of the seat of the kinkcough.
  • CHAP. IV. Of the causes of the kinkcough.
  • CHAP. V. Of the history of hemlock, as a cure for the kinkcough.
  • CHAP. VI. Of the cure of the kinkcough, both simple and compli­cated, supported by your own reason.
  • CHAP. VII. On hemlock, and its preparations.

CHAP. I. Of the synonyma, description, and prognostics of the kinkcough.

Of the synonyma.

The different names by which a disease is dis­tinguished being placed in one view is undoubtedly useful; but your synonymes, sir, would have been much more perfect, if you had looked back to an earlier period, and informed us by what name the Greeks and Arabians distinguished what the Eng­lish call the Whooping-cough; for both HIPPO­CRATES and AVICENNA gave it a name. And besides, there are several other synonyma *, which ought to have been taken into the catalogue to have made it complete; so that, upon the whole, the first is a very superficial section.

Of the description.

Nor is your description of the disease, and of the manner of its terminating, as we shall presently shew, less imperfect, as the most alarming and dangerous stage of it is unnoticed, and seems in­tirely to be unknown to you.

Of the prognostics,

Which have been again and again published, and now eked out by the sagacious information, ‘"that a pulmonary haemorrhage may terminate in a consumption, &c. and that the kinkcough, when complicated with another disorder, is more ha­zardous than when single and by itself."’

CHAP. II. Of the nature of the kinkcough.

It seems as unnecessary to prove, that this may be complicated with other disorders, as that light and darkness exist; and the reader will there­fore readily believe, that, perchance, you may have seen it conjoined with the measles, peripneu­monic symptoms, &c. but if he pays any regard to your book, he cannot coincide with you in opinion, that these varieties merit the most atten­tive consideration of physicians; because, hem­lock it is said is a specific against the kinkcough, both when simple and when complicated with the diseases specified; but you will have wonderful satisfaction, in reading former writers upon this [Page 9]subject, because you will find yourself supported by their authority concerning your opinion, that it is contagious; that a fever is not essential to it; that it is not an inflammatory disease, and the like: and the only misfortune in this chapter is, that, according to your own account, you have drawn a very erroneous conclusion from these pre­mises, for you do not hesitate to pronounce, that the kinkcough is a nervous spasmodic disease *. That a morbid irritability is the primary, and the spasms only a secondary affection; and yet afterwards you say, ‘"under certain circumstances of the air, &c. the various humours compos­ing the intestinal contents, may undergo an un­common degree of fermentation. The ferment­ing mass, by its unnatural stimulus, will pro­duce a vitiated secretion into that bowel. And this additional mixture will probably render the whole more and more active and exalted, till at length there are generated particles of a deleterious nature, operating on the mucous glands of the intestines in particular, whereby that secretion is increased and vitiated, and so the kinkcough is produced †."’ From all which it follows:

  • 1st, That the air under certain circumstances, is the primary cause of the disease.
  • 2dly, That the various humours composing the intestinal contents, are primarily affected.
  • 3dly, That the affection of the mucous glands, is not a primary but a secondary affection, from deleterious particles operating upon them.
  • 4thly, That the kinkcough happens in conse­quence of a disease thus brought on.

And lastly, That the kinkcough is not a dis­ease, but the symptom of a disease; of all which together with the story of fermentation, we shall take notice of, in their proper place; and shall only now observe, that if you had been so lucky, as to consider the kinkcough as a symptom, instead of a disease, your wonderful penetration in dis­covering it to be nervous and spasmodic, could not have been disputed; because coughs of all kinds, whether with or without a kink, are symptoms arising from nervous irritation and spasms; and whether by this formal declaration you have not discovered that you are not well versed in the nature of coughs in general, the reader will readily determine.

CHAP. III. Of the seat of the kinkcough.

Though you assert that arguments are fal­lacious, yet you are so destitute of plain proof, that you have not produced one fact in support [Page 11]of your opinion, that the intestinal canal is the primary seat of the disease.

That particular diseases affect particular parts, is known to every one; but you will find it a dif­ficult matter to prove, ‘"the measles chiefly affect the membrane investing the lungs, the small-pox that of the stomach, and agues that of the duodenum."’—That the intestines of children are more irritable than the other parts of the body, will be equally difficult to prove. Dentition ren­ders all the nerves in the body praeternaturally irritable; and the colic-pains, and the like, do not seem to arise from the nerves of the intestines being more irritable, but from their being more irritated, by an acid first generated in the stomach. Nor has Dr. Harris proved, that almost all the diseases of children depend on an affection of the first passages; or who would believe that the CROUP for instance, had its seat in the intestines, because he said the complaints of infants spring from an acid, their common source; and though it be allowed that a disease in the intestines can af­fect the whole, or any part of the nervous system, and that worms lodging in the intestines can pro­duce a cough, yet it does not follow, that all coughs happening to children have their primary seat in the same place: we could incontestably prove, that a violent cough took its rise from an inflammatory tumour in the hand; but, are we therefore to conclude, that the kinkcough ever had its primary seat in this member of the body?

Vomits being more serviceable, when they render the body soluble, only seems to prove, that the disease is not confined to the stomach; and if it be true, that such patients bear the action of vomits better than purges, the only conclusion that can be drawn is, that purges weaken by making a general drain from the whole body, where­as vomits do not cause so great an evacua­tion.

Nor is the king's evil, and rickets, being the consequence of an obstinate kinkcough, any more to your purpose. You acknowledge the king's-evil to have its seat in the conglobate glands; and supposing, (though it is far from being certain) that those of the mesentery are first affected, yet this is no clear proof in your favour, this disease being in another bowel. And can the kink­cough simply considered, any more produce the king's-evil, than the king's-evil the kinkcough? The rickets have followed the small-pox, which you say is a disease of the stomach; and any dis­order at a certain period in life, that greatly weakens and relaxes the fibres of children, pre­disposed to the rickets, will bring them on. You confess, that both these disorders are in con­sequence of the kinkcough's continuing a long time, and to the intestines thereby losing their contractile power. And we also think, as these disorders never follow the kinkcough, till it has long continued, that they are brought on by its obstinacy causing a general weakness and relaxa­tion, in habits previously disposed to these com­plaints, [Page 13]and not to its primary seat being in the intestines.

But surely you are much mistaken about your fourth, and what you think your most powerful argument, p. 25. For if we are to conclude from the periodical returns, that the kinkcough and in­termitting fevers have both their seat in the same place, you prove that instead of the intestines, the kinkcough may have its primary seat in the eyes, or in one of the teeth, because you have given us a clear instance of an intermittent thus situated; for the black stools we imagine were owing to their being tinctured with extract of bark; and we should have received equal information about the nature of the disease, if we had been told that the patient had black stools after eating bilberries. If you did not think the seat of this intermittent to be in the tooth, why did you direct it to be drawn? and are not local intermittents common? We believe that intermitting fevers have often their seat in the abdomen, yet we think the opi­nion of their proximate cause being in the liver, mesentery, &c. more probable than that it lodges solely in the guts; nor do your two cases prove the contrary. You have before said, p. 23. that an enlarged belly and colic are the symptoms of obstructed glands in the mesentery; and might not the pain in the first boy's belly, p. 26. arise from a similar cause, and the cure chiefly to be owing to the fomentation removing the obstruc­tion, because his colic was cured before the worms were entirely eradicated? Might not the cure of [Page 14]the second boy be accomplished by the purges producing the same effect; and would the belly have been large and hard, if the intestines only had been diseased?

In regard to the intestines being the most likely place for generating an infectious disease, we must observe, that however plausible the arguments in favour of this opinion may appear, they are very far from being conclusive; and though the dysen­tery and putrid fever, &c. spread by contagion, yet it is not a clear point, that the miasmata bring on the succeeding disease by first affecting the ali­mentary canal. The viperine poison, though deadly when infused into a wound, taken by the mouth produces no bad effect; nor will the va­riolous matter create a disease swallowed in the same manner, provided in its passage it touches not an excoriated part, though even a single atom is fully sufficient for the purpose when the cuticle is removed, and it comes in contact with the ab­sorbent vessels, seated on the surface of the body. A poor lad had a large tumour in his mouth, aris­ing from the upper jaw, which was very foul, and from which a large quantity of very offensive pu­trid matter was swallowed in the night-time, when he was asleep. It purged him gently, and, at the end of three weeks or a month, his blood seemed to be dissolved by the vibices which appeared in the skin; yet he never had the least fever, though he lived at least six or eight weeks, and at last died of extreme weakness; whereas, had the same quan­tity of matter been absorbed from an ulcer, a col­liquative [Page 15]fever would soon have been the conse­quence. From all which we would infer, that the juices in the primae viae correct and reader less active infectious matter; and that this does not seem to be the only way by which infection is com­municated. The opinion that the miasms which propagate infection, enter the habit by the lym­phatics in the lungs, and other absorbents, seems more likely to be true; for in this way, by such time as the disease makes its appearance *, they will in all probability have contaminated the bile, and the variety of humours blended in the in­testines.

But to return to the resemblance betwixt the kinkcough and intermitting fevers, which seem to arise from an accumulation and discharge of phlegm; for when the stomach is unloaded by coughing and vomiting, the patient becomes easy till a fresh quantity of phlegm is collected in the stomach sufficient to excite another fit of cough­ing; which, surely, notwithstanding your argu­ments to the contrary, is a full proof, that this bowel is immediately affected, and that unloading it is the cause of the intermission. You indeed think differently; but may we not suppose, that in intermitting fevers obscure intermissions are rendered distinct, by those medicines which remove the offending cause from the affected part? And [Page 16]why then are we not to believe a disorder, that has periodical returns, to be seated in the stomach, because vomiting affords relief?—Why truly, say you, ‘"It would seem that the interfering cause, a foulness of stomach, being thus removed, the pure intestinal symptom of intermission becomes evident and distinct:"’ which is a most futile argument, because you have not in one instance proved, that intermittents are seated in the in­testines; and we may therefore conclude, that WALDSCHMID, when he said this cough proceed­ed from the stomach, was guided by common­sense, which you, sir, have deserted; and through the whole of this chapter have had recourse to mere conjecture and hypothesis.

CHAP. IV. Of the causes of the kinkcough.

How full and true your description of the kink­cough is, we have already observed, and shall farther make appear; and how far your observa­tions have established the true seat of the disease, let every man judge. However, you have given us a clear instance, that you remember what you learnt at lecture, in so very learnedly explaining what is the predisposing, and what the proximate cause of a disease; and to be sure it required a masterly hand to point out that a disease is present, while its cause is present: but we do insist upon it, that a disease often remains after its proximate cause is removed. But wonderful information [Page 17]must accrue to the public from their now being shewn the necessity and use of being acquainted with the cause of a disease; we may add, when it can be accomplished; ‘"but so great are the difficulties of tracing out the hidden causes of the evils to which this frame of ours is subject, that the most candid of the profession have ever allow­ed and lamented how unavoidably they are in the dark;"’ and the abortiveness of your at­tempt in this respect, is one clear proof how justly they have reasoned.

Few or none will think with you in regard to the kinkcough being peculiar to childhood, be­cause it sometimes seizes grown people; and it may with truth be affirmed, that the story about the irritability of children, both in health and when diseased, has been long known and applied; and certain it is, that this disorder more commonly affects children, without being preceded by any other disease.

You say, ‘"an enumeration of the effects of the specific miasms, which produce the kink­cough, will sufficiently point out their true na­ture;"’ but not such a perplexed enumeration as you have given us. In one place you assert, p. 51. that they act upon the nervous powers, and increase the irritability of the system, a few lines after, ‘"that as far as your senses can dis­cover, they act chiefly on the mucus;"’ and then again, a few lines below, you say, ‘"it ap­pears that the kinkcough answers to the defini­tion of pestilential disorders, &c. since its [Page 18]miasms are contagious, and act chiefly on the nerves;"’ and lastly, after this confused ac­count, ‘"you hope you have sufficiently cleared up the nature of the contagious particles."’ But in what manner? For do not miasms, as different in their nature as possible, act upon the nervous power, and increase the irritability of the system, of which the miasms producing the small-pox, measles, &c. are an instance? or why do they produce different diseases? Suppose what you have said to be true, it only proves that they have an irritating property, which is far from explor­ing their nature: but all these little mistakes every considerate man will excuse, when he reflects that you do not pretend to go deeper into this matter than the limits of your understanding will permit.

But to have been consistent with yourself, you should have omitted enquiring into the origin of the contagious particles which give rise to the kinkcough, as this is certainly wading out of your depth. Indeed in this inquiry you set out very aukwardly; for not having examined into the mat­ter yourself, you are led into a mistake by copy­ing a former writer, in regard to our not having any very early account about this disorder; for Hippocrates prescribed ad tassim pueri *, and Avicenna describes, according to the Latin trans­lation, the method of curing the tussis infantum †. [Page 19]No conclusion, therefore, can be drawn as to the place of the growth of these particles, except it be true that they are bred in people's guts; and they then may be natives of Europe, and every other quarter of the globe. Even when they revisited Bar­badoes. According to your account they must escape from the guts, and we may readily suppose that some passenger carried a belly-full over, and letting fly as soon as he landed, infected the whole island. Indeed Dr. Hillary observes, that the hooping-cough appeared in Barbadoes in the month of July 1753, after a good deal of rain, often with thunder and lightning, though the in­termediate days were hot and dry; and he could not find upon the strictest enquiry, that any child or elder person brought it thither, which you may conclude is in favour of your doctrine; but you must be told, that fermentation destroys the co­hesion of all bodies upon which it acts. That tough viscid phlegm is always discharged in the first stage of the kinkcough; that there is, there­fore, no fermentation in the case, and that the whole of what you have said about creating dele­terious particles in the guts is of course chimeri­cal, and seems to be no better supported than the opinion that Spanish mares become pregnant by ascending high mountains, and swallowing with open mouth the western wind.

If so, the remainder of what you have said in this chapter, except its being sometimes propa­gated by contagion, falls to the ground, and re­quires no farther comment; though, I must con­fess, [Page 20]I much admire your arguments against the removal of children in this disorder; because, if they were removed from Derby, and its environs, the writing of your book might not answer the end designed; and yet it may be difficult to dis­prove the truth of the opinion, that pure air assists in recovering the patient. For, if ‘"the air under certain circumstances is the primary cause of this disorder,"’ how comes it to pass that the kinkcough does not depend upon the state of the atmosphere, like many epidemic diseases? Will not an air capable of producing the kinkcough be a constant fomes morbi? and, consequently, remov­ing the patient to a place where the air is pure must be rational at least.

And, though you have not only a priori, but likewise a posteriori, come to the same determina­tion, yet I question whether you have satisfactori­ly cleared up this matter; for the mucous glands of the stomach, and those of the intestines, are both of the same kind; and will it be believed that the air under certain circumstances, when taken in by the mouth, can pass through the stomach without affecting it; and is not the stomach load­ed with phlegm from the beginning? So that you have no way of maintaining your ground in regard to the guts being the primary seat of this disease, unless you give up your prior, and adhere to your posterior arguments, by proving that the fomes morbi doth not enter by the mouth but per partes posteriores.

CHAP. V. Of the history of hemlock, as a cure for the kinkcough.

What you say, sir, has been asserted about the cure of the kinkcough, may with equal truth be asserted of every disorder known, as we have not a certain cure for any of them. Where there it a multiplicity of indications in diseases (for methods of cure are not indications), it is impossible for them all to give way to specific treatment; for various circumstances will always require a combination of various remedies. Nor is the unsuccessful treatment of the kinkcough the reason why Dr. Willis's observation, ‘"that old women are oftner consulted in this disorder than physicians,"’ holds true in our own times; for people seldom apply to physicians, on account of the expence, as they do not apprehend danger, and they know the disease will commonly get well of itself in time. Nevertheless, if you can make people believe that we have as yet no certain and effectual cure for the kinkcough, nor any one medicine that ought to be used in many cases that occur, that every method hitherto followed is at best but a palliative, and that hemlock is a specific in every case that can happen, your business is done.

But whether your being convinced that the disease is spasmodic, and that hemlock is one of the best antispasmodics, will assist in recommend­ing it to the notice of practitioners in medicine, [Page 22]may be much doubted; because, as we have al­ready observed, what you have said tends to per­suade other people, that the disease is not spas­modic, but a morbid alteration of the intestinal contents; and it will easily be discovered whether medicines that clear the primae viae, and lessen irri­tability, or a medicine which acts as an antispas­modic only, are most likely to prove palliatives.

However, though your reasoning may have perplexed this matter, and though you may be mistaken about the nature and the seat of the dif­order in question, yet it does not follow that you have not found out a remedy that will cure it, the use of medicine being often discovered by acci­dent. The Indian who discovered that the bark would cure an intermitting fever, knew nothing probably of the nature of the disease; and as you have confined your practice in almost all diseases to the use of hemlock, you may by chance have found out a cure for the kinkcough, and we must, there­fore, see whether the evidence you produce will supuort the character you give it.

A specific should be able to cure the disease to which it is appropriated without any assistance; and, in order to have a clear proof of the efficacy of any medicine, it should be given simply and alone; and it is therefore impossible to say how far hemlock, and how far the other remedies might contribute to the cure in your first and fifth cases. Cantharides have always been found of great effi­cacy in the hooping-cough, whether taken in­wardly, or outwardly applied; nor have purging [Page 23]medicines, especially emetic tartar, &c. by clear­ing the primae viae, been found less serviceable.

Who can, therefore, say in Mrs. Hodgkinson's case, that the blister and emetic tartar did not at­tenuate and remove the viscid phlegm, which was manifestly the cause of the cough? Hemlock might then be serviceable, by acting as an opiate, and allaying that increased irritability, which the cause of every cough in a greater or less degree produces, and which often will occasion frequent coughing for some time after the primary disease is removed.

A. B. was better from the application of the first blister, and the effects of his purging mix­ture, which brought away slime, before hemlock was given. Lancing the gum too would lessen the increased irritability of the whole habit, espe­cially the second operation, which let out three teeth at once, and yet the hemlock was constant­ly given: we find he coughed a good deal till a second blister was applied, and then the fits were much milder, and returned scarcely once in two hours. Besides, the bowels were unloaded of slime daily, either with syrup of roses or manna; he was vomited with oxymel of squills, which rendered his breathing free; and after five weeks and four days had elapsed, in which time six teeth were bred, (and I suppose came to light) the patient was well. And it may be asked, with what pretensions could it be said in the third corol­lary, that ‘"that hemlock certainly prevented spasms, and probably convulsions, in this child?"’ [Page 24]Must not there be a strange partiality in favour of hemlock to make such a conclusion; and will not corollaries thus drawn lead to error?

But to go back to your writing to your friend in Scotland, p. 63. we may observe, that it was unlucky that the children were got well before your letter of advice arrived, otherwise hemlock might have got the whole credit of the cure; and, though this anecdote does not throw great light upon the subject, yet perhaps it may forestall any claim a pretender may make to hints given; and you will thereby avoid that censure you have be­fore experienced *, in publishing as your own a method of curing the stone by injection, when the hint came from Dr. Whytt.

The second case not being insisted on as evi­dence, I pass it over; and the third does not seem much to your purpose, because hemlock was not given by itself; and who will be hardy enough to say, that lemon juice, salt of tartar, and syrup of sugar, did not alter the properties of this remedy? and that the good effects were not produced by the manna, and a medicine very dif­ferent from hemlock when given alone? But the complete recovery seems to have been accom­plished, as often happens in this disease, by time, as nine or ten weeks elapsed before the patient was in perfect health.

Indeed, you inform us, that she was in a man­ner well in a much shorter time; but this we [Page 25]imagine was nothing more than the natural de­cline of the cough, which always happens after a certain period.

You say, ‘"a fever is not essential to the kink­cough;"’ but in the cough following the measles, a fever, with a white tongue, quick pulse, and sediment in the urine, is a common attendant: and are not this fever and cough fre­quently increased and renewed by eating things of hard digestion, or upon taking a slight cold? whence there is reason to imagine, that a great part of this child's illness was owing to acrid mat­ter remaining after the measles, upon, and irritat­ing the lungs. It is common for saline medicines, without the assistance of hemlock, to make the phlegm looser in the cough thus produced; and this hectic fever and cough have often been cured by the same remedies, and gentle purging, in a short space of time: so that, upon the whole, you may see this is not so clear a case in your favour as you have imagined.

The fourth case too, communicated to you by Mr. Smith, is liable to the same objections, as not hemlock alone, but a medicine of a very different nature was given; and from a serious perusal of the first five cases, the reader will judge, whether you had any good reason to be perfectly convinced that you had discovered ‘"an agreeable, certain, and expeditious cure for the kinkcough:"’ when, not having patients enow of your own, you wrote to Mr. Yorke to furnish you with some for your purpose.

But the first of these cases will do you very little service; for, upon enquiry, the child did not take the medicine except a few days. The mo­ther not dreading the event of the disorder, did not chuse to give it her by force, though it was regularly brought every evening about six o'clock, to be taken next day, but it was constantly thrown away. The mother says ‘"the smell of the hum­lucks scented the whole house, and was so very disagreeable, that the child could not bear it; and, she believes, it would have thrown her daughter into fits if she had persisted in the use of this medicine."’ She, therefore, bought manna * at different places, with which she kept her bowels open, and the disorder terminated, as often happens, in the space of six weeks.

It is very common for the lower class of people to omit taking medicines, even when they are to pay for them, because they are unpalatable; and, I have so often discovered, that the medicines during a whole illness have been secreted, and not taken, that I am very cautious in ascribing effects to them, unless I am very certain they have been given. The parents of these children had not thought of calling in any assistance, but were sent to, and desired to make trial of some medicine that should be given them; and common civility obliged them not to refuse the offer; but when we re­flect, that giving medicines to children is always [Page 27]troublesome, and requires great resolution to ac­complish; that the common people do not look upon this disorder as dangerous, and that they have no doubt of it in general going off of its own accord, it is reasonable to imagine, that they would not be equally vigorous with the prescriber in pursuing his method of cure, otherwise the pa­rents of HELE * would not have disused the bark shift which was given her; and, in my opinion, I think none of these cases are to be depended upon, where either the prescriber or apothecary did not see the medicines given. However, supposing them to be taken, the case of ELIZABETH and JOHN PAGE are exceptionable, because lemon-juice and salt of tartar were joined with hemlock; besides, ELIZABETH PAGE had the disorder from first to last near seven weeks; and does not it of­ten terminate of itself in this time? We may con­clude, that JOHN PAGE had the disorder very slightly, otherwise he would have kinked oftener than twice in the night.

Mary Green was not cured.

Mr. Smith, for all that we know, joined juice of lemon and salt of tartar with hemlock, in the manner he had before done; and his cases, as they at present stand, are therefore no evidence.

Thomas Newdale, who had the disorder near seven weeks, had sal polychrest and magnesia given to assist the cure.

Magnesia and sal polychrest were also given in MARY HELE'S case, but she had no permanent relief till she wore a bark shift; and after taking hemlock a month, a violent diarrhea, with puru­lent stools streaked with blood, and a tenesmus came on, and she was very restless, and vomited up her food; but, upon the hemlock mixture being omitted, and three drops of laudanum being given, and repeated every night and morning, her looseness was abated and cured, she had good nights, and her cough, which the hemlock could not subdue, was intirely removed; and, we are told, she got well: but of this hereafter.

WILLIAM TOPLIS had a variety of medicines joined to hemlock, notwithstanding which he died, though, it is said, his kinkcough was cured a few days before his death, and at a time when he appears to have been very ill; but in the fol­lowing Essay we shall have occasion to take notice of hemlock, and we shall then review this case.

Mary Langley had the disorder in all seven weeks, and magnesia and nitre were joined with hemlock; and, upon the whole we may observe, that there are only seven cases out of the twenty, in which hemlock can possibly have all the credit of the cure, because other medicines were joined along with it; and if it was imagined they would give no assistance, why were they prescribed? And even in all these seven cases, will not the sugar of sugar-candy rob the hemlock of its honour and [Page 29]glory, because sugar, vegetable juice, and water will ferment? I know that this hemlock mixture will, in a few hours become ropy, and afterwards a fermentation ensues, and it becomes vinous; and, though it may, like cowslip wine, retain something of its narcotic quality, yet it will be greatly altered. Perhaps it may be said, that the mixture being to be taken in the space of twenty-four hours, it has not time to ferment; but in the heat of May and June, when these children were ill, every body knows that this alteration will take place in a very few hours. Besides, ANNE ARCHER and ROBERT TRUSSEL were ill five weeks.

SAMUEL ARCHER one month.

ANCOR SARAH WADDLE and ELIZABETH TRUSSEL about two months. And you yourself are so well satisfied that these cases are not satis­factory, that you think it necessary to explain some circumstances in some of them:

We join you in opinion, p. 157, that the fifth case may be as remarkable as any of the rest, and yet not very remarkable in favour of hemlock. Any man must be strangely biassed in favour of this medicine, who could conclude, when so many other medicines had given relief, that it saved this patient's life; and from what has been said, it is plain you were mistaken in ascribing the cure of all the six patients to hemlock. But you seem to be easily convinced, otherwise you would not have attempted to persuade others it was effectual where the disease was not cured; for you have [Page 30]artfully numbered Mary Green among those made well by this remedy, though her case proves the contrary; and her mother says, she did not get well of at least six months after she had quite done taking this medicine. You say, ‘"I saw all the four patients cured by Mr. Yorke (Mary Green being one of them), and some of them before they were well; and I enquired very minutely into their several symptoms, and this was only that I might have every possible testi­mony for facts, which I desired to deliver to the world with the utmost consciousness of their reality."’ Surely this is straining a point, to say no worse of it, to give credit to hemlock; and how are we to believe you, when you thus solemnly attempt to impose upon us?

Curing Thomas Newdale twice in a fortnight was really extravagant; once well done would have been quite sufficient, as the disorder seizes a person but once in his life. But notwithstanding what may have been said to the contrary, (see case 17) HELE does not seem to have been cured once. Poor child! She indeed suffered much hardship, seemingly from being trifled with, when the use of the bark was so early indicated *, and if this re­medy had been sooner given, she now probably [Page 31]might have been numbered among the living in­stead of the dead, as her constitution might not have been ruined, and she might have been able to bear a blast of wind. But you were consistent with yourself in adhering to your opinion, that hemlock does not only cure the kinkcough, but the ague also; and the consequence was, that she together with TOPLIS are in heaven; and, it may be insisted on, that hemlock did good service in these instances, by standing in the place of pro­per remedies, and suffering the disorder to carry these infants into happiness.

You see, sir, how willing I am to help you out at a dead lift; and in the Essay annexed, the loose­ness which probably assisted in carrying HELE to her grave, will be accounted for, without having recourse to conjecture, and the necessity of killing and destroying worms for the purpose; though I admire your ingenious theory of these vermin, be­ing obliged by uncommon heat to seek their way out of the body by a voluntary effort, in the same manner. I suppose, as people make a voluntary effort to get out of a window, or a back door, when a house is on fire. But there is another way of ex­plaining this matter; and the reader will present­ly judge whether it ought not to have been known to one who is a fellow of a royal college of phy­sicians.

But after all, I find you have been endeavour­ing to make us give credit to what you yourself do not believe; for, if you had been perfectly convinced, that in hemlock you had discovered a [Page 32]certain and expeditious cure for the kinkcough, you would not in the last case but one, ‘"have been perpetually wavering between the influ­ence of a great name, and the suggestion of your own reason and experience."’ From this declaration it is evident, you wanted in­ward conviction from plain proof; for a man must be an errant fool indeed, who gives up a plain matter of fact, of which he is perfectly con­vinced, to the influence of any name how great soever. And we ask the opinion of those uncon­cerned in this matter, whether they think you were perfectly convinced or not?

Your laying the death of HELE to the miscon­duct of her parents, and excusing the want of speedy success to a smoaky house, &c. in TOP­LIS'S, LANGLEY'S *, and WADLEY'S cases, will avail but little in favour of your remedy, when it is called to mind, that you have long insensibly fallen into this way of excusing yourself by the most trifling evasions, when, having promised a recovery, death, by victory, has shewn the feeble­ness of the weapons by which you endeavoured to keep him at a distance.

From the whole it must appear to every un­biassed reader, that hemlock has not always been successful in the kinkcough; that other me­dicines were required, both when it was simple and when the disease was complicated, and that [Page 33]you have said more in the praise of this remedy than is true.

CHAP. VI. Of the cure of the kinkcough, both when simple and com­plicated, supported by your own reasons.

[...]n this chapter it was reasonable to expect, that the different indications in all the varities arising from complication with other disorders would have been pointed out; but if we except the measles, in which you have never given this re­medy, and lancing the gums in dentition, how­ever complicated the disorder, there is but one in­dication which is to give hemlock; and giving hem­lock, we imagine, is no indication at all, but we guess what you mean. And this principle, I ob­serve, you first lay down when you speak

Of the simple kinkcough.

And yet, two pages, after you forget yourself, and recommend a variety of purging medicines to be taken, if the patient has not two stools a day; so that the contents of the bowels being retained is another indication: and what is very curious, it seems very immaterial with you whether the pa­tient takes hemlock in a mixture, or in powder, bolus, or pills; and yet, if what we have said about sugar, vegetable juice, and water ferment­ing be true, the mixture and the powder, &c. may be as different medicines as nitre and salt of [Page 34]wormwood; and this will be looked upon as one instance, how well you consider what effect com­bination may have upon the medicines you prescribe.

Of the cure of the kinkcough with worms.

The very same means is recommended in this complication as for the simple kinkcough; be­cause a child who used to part with a great num­ber of round worms, had some come away while it was taking this medicine (see case 11.) and, for this reason, we are to believe, that hemlock will, in such cases, often supersede the use not only of laxatives, but of any other medicines whatever in the cure of both disorders.

Of the cure of the kinkcough with a dysentery.

Hemlock is here the best remedy, because opium saved a child's life under these circum­stances, when the stools had acquired a pretty na­tural appearance from the use of gentle vomits, laxatives, blisters, the Peruvian bark, &c. But we will ask the advice of those skilled in medicine, whether, notwithstanding the idle theory about the hemlock removing clotty feculent accumulations lurking in the guts, either it or opium can be given with safety, without previous evacuations, or purging medicines joined along with them? Hem­lock is allowed to act the part of an astringent in diarrhoeas; and will it not, if the advice here given is pursued, confine the fomes morbi in the [Page 35]intestines, and for the most part be the death of the patient?

The cure of the kinkcough with dentition.

In this variety too hemlock is to be depended upon, because, if both diseases are urgent, by lancing the gum you relieve the patient.

The cure of the kinkcough with an ague.

Again, hemlock is the fac totum, because ‘"it does not appear that the bark was more effica­cious than hemlock in poor HELE's case"’ (17); only that the bark shift intirely removed the ague, which was not cured while the hemlock was de­pended on as a febrifuge. Indeed, on the ninth of March it appears from the case, that she had neither ague nor fever, but on the tenth it return­ed; and on the twelfth, things were in such a state, that recourse was immediately had to the bark shift, and opium, with a good effect. But suppos­ing the ague fit to be removed for a little time previous to the use of the bark, why is this to be attributed to hemlock? The child's belly was hard and full at the onset of the disease; magnesia and sal polychrest were joined with hemlock, and purged the patient: and have not agues thus cir­cumstanced been cured by purging medicines? There is scarce a practitioner living who has not cured the ague, accompanied with a big belly in children, with a few doses of calomel and jalap; and so powerful a medicine is sal polychrest and rhubarb in this very case, that Dr. William [Page 36]Fordyce is of opinion, he might have made a for­tune by using it as a nostrum; and I am astonish­ed that any man should have his head so turned, as to draw a conclusion in favour of hemlock from such premises; and what is worse, poor HELE is dead, perhaps because earlier recourse was not had to the bark.

Of the kinkcough with the small-pox; which we have already taken notice of.

Of the cure of the kinkcough with the measles,

Which you have never treated, and therefore your recommendation of hemlock in this case does not require any comment. And we shall hereaf­ter mention a plain fact, which may perhaps de­termine whether it or other medicines ought to have the preference in cases of pregnancy *.

The corrollaries we shall hereafter have occasion to refer to; and as to the preparations of hem­lock we think them unnecessary, because we have already much safer and better medicines of the same class. Indeed it may be much questioned, whether your stewing this medicine over the fire does not render it nea [...]y effete †; for a surgeon [Page 37]gave some of the extract a considerable time with­out the least alteration in the patient, but a few spoonfuls of the juice of hemlock, being taken had a most violent and dangerous effect; and, though you are willing to have it believed, that you have availed yourself of the rule given by CELSUS, yet you have not proved that hemlock cures the kinkcough safely, certainly, expeditious­ly, and pleasantly, or even that it cures it at all. I shall, therefore, take the liberty of instructing you in the use and abuse of this medicine; and if a mind which cannot bear contradiction, should be­come boisterous upon this occasion, we will, as time and opportunity permit, explain and amend any representations in these animadversions that may displease you; and, perhaps, we may be able to present you with a dialogue from the dead be­twixt SOCRATES, HELE, and TOPLIS, who all had, while living, sufficient experience of the medicine you so earnestly recommend, and who went out of the world nearly in the same manner.

I am, Sir, Your most humble servant, The AUTHOR.
Dec. 31st, 1773.

AN ESSAY ON THE HOOPING-COUGH.

WHOEVER has a mind to see what has been said by former writers upon this sub­ject, a few of the ancients excepted, may con-Dr. MILLAR's late observations on the hooping­cough, where they will find that physicians be­fore the days of Dr. B—, had employed suc­cessfully some of their thoughts on the nature and cure of this disorder; and the following short Essay is intended to shew whether the method and medicines they recommend, or that advised by Dr. B—, is most likely to relieve the pa­tient.

For this purpose, we will begin by taking an abstract from notes made in 1749, when the hooping-cough prevailed in this place and neigh­bourhood; and we chuse to relate the symptoms [Page 40]attending those children where the disorder took its course without help from medicine, as from hence we shall learn its regular progress, and these we had many opportunities of seeing, as the common people knowing that the disorder com­monly wears off of itself in time, were not soli­citous about medical assistance, but relied on such trifling remedies as themselves thought most proper.

Early in the spring, which was moist and very cold, many children in the space of four or five miles round this place were seized with the hoop­ing-cough, about the same time, which first be­gan with a little dry cough, and sometimes the same kind of indisposition as accompanies taking cold, but soon after ropy phlegm was coughed up. After this the lungs and stomach were daily loaded with a larger quantity of phlegm, which in some became immoderate.

After some, or all of this phlegm was discharg­ed by a fit of coughing and vomiting, the child became easy till a sufficient quantity was again ac­cumulated to excite another fit of coughing, &c. during which, strong children often bled at the nose, and were black in the face: the phlegm dis­charged was sometimes streaked with blood, and the countenance in a little while acquired a luco­phlegmatic appearance.

Those children who had sense enough to spit out the phlegm at the time of coughing, got safely over the disorder; sometimes, where it was not very troublesome, in about six weeks; where more [Page 41]violent, in about two months, and sometimes it was three months, or longer, before it terminat­ed. But some younger children fared not so well, for instead of throwing the phlegm out of their mouth they swallowed it; a griping and loose stools followed, and all the parts about the anus were excoriated. At this time they became dry, had a quick small pulse, and all the other symp­toms accompanying a fever. They now daily got weaker, their legs and body became more or less oedematous, the cough gradually ceased, the difficulty of breathing became more urgent, sleepi­ness, &c. came on; and when the parents thought their children getting better, death convinced them of their mistake, by closing the scene with all the symptoms of a spurious peripneu­mony.

During the progress of this disease it often hap­pened in different parts of the neighbourhood, that the cough was better for two or three days *, and then returned again with its usual violence, but towards the latter part of summer it wholly disappeared.

These symptoms give us every reason to con­clude, with other writers, that the disorder is caused by some morbid disposition of the air, be­cause [Page 42]not only one, but many children several miles asunder were seized nearly at the same time. Nor can we account for the sudden abatement and return of the cough, but from sudden alterations in this element. Perhaps it becomes replete with miasma, which render the serous and lymphatic juices acrid; whence a larger quantity of them than ordinary is secreted in consequence of their irritating the vessels which secrete them; or per­haps the air may have the power of weakening the muscular fibres, and of rendering the fluids viscid and ropy. But Dr. B— says, miasms irritate the mucous glands alone, and cause a greater secretion of viscous matter.

In support of the first of these opinions, it may be said, that whenever the serous or lymphatic juices are extravasated, and deposited in any ca­vity in the body, they become viscid and ropy, witness the lymph which stagnates in the nose; and why, therefore, will not lymph become ropy in the same manner, when a greater quantity than ordinary is deposited upon the lungs in the stomach and in the intestines?

In support of the second opinion, it may be said, that we know a particular state of the air under a lax habit, and such are children, will render the lymph ropy, witness the spurious pe­ripneumony which children we see in this disorder fall into when the offending matter is not expelled in coughing. And in favour of both these opi­nions it may be said, the disease is not confined to the lungs, or to the alimentary canal, but that [Page 43]it is extended to the whole body; the fibres in ge­neral being relaxed, and an oedematous appear­ance evinces, that the lymph in general has ac­quired a pituitous disposition *; and, besides, it does not appear that mucus but thickened lymph is discharged.

In support of the last opinion, nothing can be said till we are certain that it is mucus alone which is discharged in the fit of coughing, and then there could be no doubt but in this disease the mucous glands are chiefly first affected. These different opinions we mention to shew what un­certainty there is in fixing the manner in which the immediate cause of this disorder acts, and what parts of the body are first affected; and, therefore, all the plain truth we can collect is, that in conse­quence of a particular state in the air, the sto­mach and lungs are loaded with a tough viscid phlegm, and that there is a weakness and a gene­ral tendency to relaxation in the fibres, and to a ropy disposition of the lymph and serum; that an affection of the stomach and lungs is the imme­diate cause of the cough, because the patient im­mediately becomes easy by vomiting and expecto­ration.

That the lungs and stomach are chiefly, and more immediately affected in the first stage of the [Page 44]disease than the intestines, seems to be plain, be­cause the phlegm does not wholly pass off by stool, but is discharged by the mouth. Besides, when it is not evacuated upwards, a new train of symptoms will arise; for accumulating in the stomach, it passes into the intestines, putrifies, and becomes very acrid; and the question is, whether if the intestines were the primary seat of the dis­ease, this putrefaction and a consequent diarrhaea would not always take place, and whether the phlegm would not all pass downward instead of upward? Whereas the truth is, unload the sto­mach and lungs as of ten as an accumulation of viscid phlegm takes place, and the bowels will not seem to be much affected.

However, it is not matter of much conse­quence in practice, whether phlegm first resides in the stomach or intestines, as the whole ali­mentary canal from its connection must be more or less affected with phlegm during the progress of the disease; and seeing that the patient becomes easy upon its being discharged, and that a general weakness and viscidity prevails, the true intentions of the cure must be, to clear repeatedly the lungs and prime viae, to attenuate viscid phlegm, to in­vigorate the blood, and to preserve the strength of the solids; and, by taking a view of preceding writers, we shall find, that the medicines which have answered these ends, have been found most serviceable in curing this disorder *.

Vomits and purges, and medicines which both vomit and purge, have been recommended as principal remedies; and can there be any doubt of these medicines relieving the patient, as they take away the immediate cause of the cough? General consent evinces, that blisters, or cantharides taken inwardly, have here been remarkably serviceable; and the cure of the hooping-cough, by inocula­tion for the small-pox, also shew that attenuants are proper assistants in the cure. And do not all agree, that the bark is in this case a most useful medicine?

Nevertheless, particular symptoms require far­ther assistance, till these medicines have had time to act upon and remove the disease itself, the prin­cipal of which is the COUGH; and this Dr. B— has, with great deliberation, declared to be ner­vous and spasmodic. We shall, therefore, for the information of this gentleman, observe, that there is an increased degree of irritability in the nerves in every cough, though but of short standing; that all coughs are brought on by the nerves of particular parts being irritated; and that, in con­sequence, a spasm of the diaphragm, and other muscles subservient to respiration, follow to shake off and expel the irritating matter, by an increased force of the air which passes out of the lungs in respiration *. So that every cough is a convul­sive [Page 46]cough, and only differs from the hooping-cough in its degree of violence; for, though in this last there is a vomiting and coughing mixed, yet when we reflect upon the action of coughing, and the parts concerned, we shall discover it to be a minor vomiting, and that of course a deeper in­spiration and greater force in coughing will ensue, when the cause is seated in the stomach than when it only resides about the lungs.

Nevertheless, there is a difference in the nature of the cause of coughs, some being entirely the consequence of irritated matter, while others arise from a disease in the nerves themselves, which ren­der them so very irritable that a fit of coughing comes on from any slight accident that may hap­pen to effect the nerves of the lungs *; but the cough of which we are now treating, is acknow­ledged to arise from the former of these causes. Nor could it ever be cured by irritating medicines if it was entirely nervous; and we shall, therefore, proceed to observe, that every cough is an effort of nature to expel the irritating matter, and though, when violent, it may always be mitigated with safe­ty and advantage, yet wherever it is accompanied with an accumulation of phlegm, or the like, it ought never to be suppressed intirely, unless we can also at the same time remove this preterna­tural flux. ‘"Opiates rather did hurt in the [Page 47]hooping-cough which raged at Edinburgh in 1734,"’ probably because they were given in the usual dole, and caused a retention of that phlegm which would have been discharged, if the coughing had not been much suppressed. Poor TOPLISS * had his cough suppressed by hemlock, which is an opiate; and he died of his other com­plaints, in same manner probably as those chil­dren we have taken notice of, where the cough was suppressed by weakness and an overload of phlegm.

Nevertheless, when we give only one, two, of three drops of laudanum in a day, without entirely suppressing the cough, it sufficiently lessens the ir­ritability of the whole habit, and gives the pa­tient relief, by preventing the nerves from being so violently affected. Dr. Hillary says, ‘"a little syr. mecon. or elix. paregoric."’ (joined with other medicines), seldom fails to render the disease more moderate, and in time takes it off: and the only deficiency I can see in the practice of physicians in general is, that they have omitted to join very small doses of opium along with the me­dicines they have given to remove the cause of the disease. Whereas Dr. B— gives an opiate joined to purges; for we shall presently shew, that hemlock, by his manner of mixing it, may be converted into a purge; and when this does not happen, he joins other purges along with it, so that while he is crying up hemlock as a specific, [Page 48]he is in a great measure carrying off the disease by medicines recommended by former writers.

We have already observed the necessity of keep­ing the primae viae and lungs clear of phlegm, and this we are not to expect from hemlock, unless by accident, for though it sometimes purges, ‘"yet it often does not sensibly affect any secretion;"’ and, therefore, is not in this case to be solely de­pended upon. When it is just mixed with sugar and water, or given in extract or powder, it, like other opiates, stops immediate secretion, and pro­motes sweat; but when the hemlock mixture has stood till it ferments, it opens the bowels in the same manner as sugar-candy and the juice of penny-royal when they have stood together some time, so that this purgative quality is not inherent in hemlock, but arises from its being in a state of fermentation; nor does it any way appear that it has an attenuating property, or that it is capable of invigorating the blood and solids, or of unload­ing the lungs when they are overcharged with phlegm; whence, though hemlock like opium may suppress the cough and vomiting, yet the dis­order is long in terminating under its use *, because it is destitute of other properties which are neces­sary to complete a cure. Peripneumonic symp­toms, bleeding at the nose and eyes, and the phlegm being streaked with blood, are surely symptoms which sometimes require the use of the [Page 49]lancet, admitting it to protract the disease, for as hemlock, by Dr. B—'s own account, is a week at least in making a cure, may not in this time a rupture of a vessel in the lungs or brain happen, and destroy the patient? It is confessed, that ac­cidental bleedings have sometimes done good; and is it not amazing, that a man who has seen pe­ripneumonic symptoms complicated with the hoop­ing-cough) should in all cases trust the life of the patient entirely to a favourite antispasmodic?

It must evidently appear from what has been said, that various remedies will here ever be neces­sary; and as an opiate of some kind or other will in this cough always be a useful ingredient, it re­mains for us to enquire, whether small doses of laudanum or hemlock ought to have the prefer­ence. For this purpose we will relate a case or two, which have fallen under our own inspection, and the reader himself may judge which is the safest and best remedy to cure the cough by lessen­ing irritability.

A gentlewoman having an incurable schirrus, took, by the advice of two eminent physicians, seven grains of hemlock twice a day, which in a little time brought on an itching of the whole body. This was succeeded by innumerable small blisters, attended by a very angry kind of inflam­mation, pain, and soreness; but upon leaving off this medicine these symptoms entirely disap­peared.

Another lady took fourteen grains of the leaves of hemlock made into a powder twice a day, and [Page 50]a poultice of the same herb was applied to an in­dolent tumour, occasioned by milk stagnating in the upper part of her breast; the same kind of itching and blisters we have mentioned followed accompanied by an inflammation resembling a malignant erysipelas, which swelled her more or less all over, but in particular her head; her eyes were affected; she sometimes complained of a ver­tigo; the breast, upon which the poultice was laid, was spread over with fiery eruptions, and indeed her whole body seemed to be poisoned. She was full of pain, had restless nights, and a fever; but upon leaving off this dangerous remedy, and tak­ing proper remedies, she narrowly escaped death, and was restored to perfect health. I have seen other similar cases; but, perhaps it may be said, it does not often produce these effects, which must be owing to some idiosyncrasy in these patients. Be it so; but may not this idiosyncrasy happen in a child, the darling of a tender mother; and would not a premature death thus brought on be inex­cuseable *, when a drop or two of laudanum; or a few drops of the elixir paregoricum, will effectu­ally ease the cough, by lessening increased irritabi­lity, without the least degree of hazard or incon­venience?

Dr. BURTON, in order attenuate and dissolve the phlegm, to corroborate and strengthen the fibres, and to prevent any farther viscidity, after [Page 51]clearing the primae viae with oxymel of squills and detersive purges, gave a medicine composed of cantharides, camphire, and extract of bark. ‘"By this medicine," says he, "I performed the cures very soon, some in five or six days, as I can produce many vouchers to witness *; particu­larly Mr. Dent, apothecary in Selby, who has used it in the present epidemic chincough, ac­cording to my prescription;"’ which is in a much shorter time than Dr. B—r pretends to have cured by his method; and I can easily be­lieve what Dr. Burton says to be true, because tincture of cantharides alone has cured this disorder. Because camphire, which the doctor added to cor­rect the cantharides, lessens increased irritability; and because I have seen bark and attenuants equal­ly successful in a more advanced period. For my own part, I have in some measure followed Dr. Burton's method in the first stage of the disease, except, that instead of cantharides I have chosen antimony as an attenuant, and I have given lau­danum in very small doses † for the purpose already mentioned.

If the child is plethoric and bleeds at the nose, or if the phlegm discharged is streaked with blood, I take some blood away from the arm to prevent any farther rupture of the vessels. But I agree with Dr. Burton and others, that blood must be taken away with great caution; for, as we see this disorder renders the fibres weak, and the juices ropy, so bleeding, by still weakening them, will increase the complaint, and therefore, too large a discharge of blood will be greatly injurious. On­ly so much blood must be then taken away as is sufficient to prevent a rupture of the vessels, and this must be judged from the violence of the cough, together with the strength of the patient.

Where the stomach, &c. are much loaded, I give a vomit of oxymel of squills, or rather some of the preparation of antimony; afterwards the child is purged gently every day with rhubarb and sal polychrest; and, at the same time, is taken three or four times a day, a dose proportioned to the strength and age of the patient, of a medicine composed of the bark decoction, essence of anti­mony, syrup of pennyroyal, and laudanum, which very soon lessens, and shortly intirely removes the whole of this complaint.

Where the child is very young, a medicine com­posed of syrup of pennyroyal, essence of antimony, and laudanum, will be more readily got down; and provided the syrup is made of expressed juice without boiling, and given while it is in a ferment­ing state, it will purge sufficiently; and, I will ven­ture to affirm, sooner relieve the patient than the [Page 53]poison with which the malefactors of the Atheni­ans were destroyed; and if the child wears at the same time a bark shift, a complete cure will soon be the consequence; though it may be sometimes requisite to add oxymel to this mixture, where a quantity of phlegm upon the lungs makes its use necessary.

Hitherto then we have only considered the cure of the first stage of the disease, and shall now pro­ceed to the second, which generally arises from neglect in not clearing the primae viae by art, when the efforts of nature to expel the offending matter by the mouth are not accomplished.

In this stage we have full evidence, that the lungs, the stomach, and the intestines are all affected, be­cause a spurious peripneumony invades the little patient, at the same time that the phlegm, which passes from the stomach into the intestines, brings on a diarrhoea that may end in a dysentery, if the child happens to live. Nevertheless, this symp­tom is not without its advantages, where the child happens to be troubled with worms, for the mat­ter which causes it is a, most powerful vermifuge. The mucus with which children's bowels are lined, is a proper nidus for the breeding and increase of these vermin, and there is not any thing more powerfully dissolves and destroys this asylum than putrid matter, when they are expelled along with the faeces.

The coming away of worms is often the con­sequence of inoculation, when the variolous mat­ter has contaminated the whole mass of humours, [Page 54]and part of it enters the intestines. A boy ac­cidentally broke a penknife blade in the nates, where part of it remained some time, and form­ed a sinous ulcer, which collected and retained a considerable quantity of matter, that became putrid by stagnation. The more active parts of this matter being absorbed, brought on a diarrhoea, in which an incredible number of worms both dead and living came away, and thus entirely cured the lad of a disease under which he had long laboured. I could indeed produce many similar instances, but these are sufficient to shew those unacquainted with these things, that the, slimy matter which comes away in fevers is not the skins of dead worms; nor are we to believe, without farther evidence, that the child has the worms, but that it is the mucus of the intestines set at liberty by putrid matter, and then discharg­ed in the common manner.

However, though we look upon putrid mat­ter in the intestines as a remedy in some cases, we are not to forget that it is a disease; and, therefore, rhubarb and spermaceti should be given as often as necessary, to clear the bowels, which may after­wards be defended from acrid matter, and healed by taking starch, mutton suet dissolved in milk, or the pulv. c. chele. e. and spermaceti mixed; and the common saline julep, with essence of antimony in it, will be found serviceable in abating the fever: but above all things, blisters are most use­ful, for when the load of phlegm upon the lungs has been excessive great, the cough ceased, and [Page 55]an oedema has appeared all over the body, I have frequently seen, after they have discharg­ed a little, the cough return with a large ex­pectoration of phlegm, and the little patient there­by snatched from the jaws of death. Nevertheless, medicines proper for the spurious peripneumony may, if needful, here take place; and when the fever is abated, and the difficulty of breathing re­moved, the blood and fibres must be invigorated, by having recourse to the bark, to which bees wax or spermaceti may be added, if an excoration of the bowels still require their use. But if the hooping-cough does depend upon some peculiar disposition in the air, surely the child should be re­moved into an air where this disposition does not prevail, any thing said to the contrary not­withstanding.

FINIS.

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