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gives some instances of the good effects of Sailing, in those dife orders, which practice Dr. Gilchrist has endeavoured to revive. Dr. W. is considerably, but very judiciously, diffuse on the use of opium, not only as a palliative, but even sometimes as a cure in certain circumstances of these diseases. He makes some very necessary practical distinctions in directing it; and with regard to its succeeding, by a very gradual exhibition of it, in such as were thought incapable of bearing it (which was true in a common dose) he usefully assures us, p. 362. as follows. Nay, this way, those who suffer most from opium may be brought at length to bear it easily; a remarkable instance of which I lately had in a lady, whom four or five drops of laudanum taken by the mouth, affected with a violent pain and cramp in her ftomach; and fixteen drops in a clyster, though it did not occasion these complaints, made her delirious for twelve hours; for this lady, having afterwards begun with one drop of Laudanum, gradually rose to twenty-five; nay, the has sometimes taken that quantity thrice a day, without feeling any of its former bad effects. In cases of great fickness, accompanied with a pain in the stomach and frequent vomiting, when the patient could not bear Laudanum inwardly, I have ordered three or four tea-spoonfuls of it to be rubbed into the stomach and belly, afterwards · applying to these parts a piece of Aannel moistened with hungary water made hot. The effect was, that all the patients complaints began to abate in less than an hour after the application of the laudanum, which I ordered to be repeated at the distance of fix or eight hours, if it was necessary.
In cases where opium disagreed, from the costiveness generally attending it, Dr. W. has experienced very good effects from the extract of Henbane, given from one grain and a half to three or four at bed-time, and repeated in a smaller quantity in the morning. After some practical remarks on camphire, castor, musk and afa fætida in these diseases, he gives a very remarkable case, p. 374 to 377. of an hypochondriac patient afficied with a violent head-ach, and a bad state of the stomach for three years, which were at last removed by opium, beginning with half a grain every night at bed-time, and gradually increasing it to i gr. and į; and sometimes to two grains in a day. The cure however was very gradual, for though he was sensibly better within a month after beginning it, and in eight or ten months free from all his most troublesome complaints, so that he then. began to lesien the dose, or take it only every other night, yet we find it was not until the third year after his beginning it, that he was so well as not to need above three doses of it in a twelvemonth. Dr. W. thinks a strong infusion of tansy may be available in
such bypochondriacal and nervous symptoms, as depend on wandering unsettled gout; as it has been found very beneficial in a manifest one: though he confesses he has had no patient who has given it a fair trial. Indeed we have personally known fome interesting instances of many hypochondriacal and nervous Iymptoms manifestly owing to a gouty cause. Our Author very honestly confeffes, p. 391. that he never fucceeded in euring one of those hypochondriacal patients, whose blood was scorbutic, which appeared from their spungy gums, laffitude and other symptoms. But he distinguishes this kind of connate scurvy, as perhaps it may be called, from that contracted at fea, or from a marthy situation, by the symptoms which attended it. Some efficacious and elegant prescriptions are interspersed throughout this valuable chapter.
Dr. W. supposes lime-water might be available in diffolving that tough phlegm in the stomach, which is one cause of these distempers, by observing that it dissolved ising-glass, and other glutinous subitances, of which he gives two experiments. With this intention he directs an English pint of it to be taken every morning on an empty ftomach, fafting two hours after it; taking also half a pint an houranda half before dinner, and before supper. He is very judiciously particular on the article of aliment in these disorders; but afterwards acknowleges, that, upon the whole, no constant rule can be given, as to the kinds of food, from the great diversity of agreements or disagreements, which different foods have with many persons. In treating of indolent obstructions or scirrhosities of the bowels, as one cause of these diseases, after mentioning many medicines, and greatly recommending gentle frictions and emollient fomentations, he mentions the extract of hemlock as follows, which we cite the more exprelly, as it may be thought a medical defideratum to arcertain the real power of this modern and highly predicated medicine.
« Of late the extract of the cicuta has been much extolled as a deobftruent; but although I have tried it, as well as the powder of hemlock, in several hard swellings, some of which were external, and others situated within the abdomen, I have only seen it do service in two cases, one of which was a large scirrhous (welling in the left breast, and the other a hardened gland in the neck. "The latter was removed by the extract of the cicuta in eight months : and the former, by the continued use, either of this medicine, or of the powder of hemlock, has not only been kept from increasing for these four years past, but is now reduced to one third of the bulk it once had.' - In the article of Exercise he justly prefers riding, which Sydenham did, near a century ago. He carefully enjoins the strictest regulation of the
Whele diford judiciouuranda
passions, and closes this chapter by the following honest acknowlegement:
Nervous or hysteric affections, from a concealed or difa appointed passion, are better cured by the fruition of the object; or, if this cannot be obtained, by proper diet, amuse. ments, and by opiates, especially at bed-time, for composing the mind, and procuring sleep, than by the whole class of nervous medicines.'
The eighth and laft chapter treats of the cure, or of the pala liation, of the most remarkable nervous, hypochondriacal, or hysteric symptoms; and through the course of it the Author frequently refers, as might be expected, to the immediately preceding chapter. Convulsive motions, or fixed spalms, of the muscles are first mentioned : and after observing, that, as they may arise from different causes, their radical cure must con. fist in the removal of such causes; and having specified the properties of such medicines as are adapted to their palliative of temporary cure, he insists more particularly on the great advantage of fomentations of warm water, and still more of bathings of the legs, in this symptom, of which he gives feven successful cases; after which he fays, p. 458.- Instead of adding more cases, I shall only observe, that I have saved more patients who appeared to be in great dạnger, in the delirious state of a fever, by the fomentations, and especially by the warm pediluvium, than by any other remedy : and even in those cases, where these applications were insufficient to compleat the cure, they, almost always, gave some present relief, by making the patients fomewhat quieter, and disposing them to sleep.'
A curious case is related of the efficacy of fear, in removing a very remarkable convulsive, though regular and alternate motion of the maffeter and temporal muscles, from no assignable cause, For on the girl's refusing to take a bolus of rhubarb and calomel, directed by our Author, from a supposition of its arising from worms, the convulsion immediately ceased, on her father's going for a horsewhip to punish her. The common cure of the cramp by grasping a roll of brimstone in the hand Dr.. · W. affirms he has often known to succeed; though he does not
fuppose, with others, the snapping of the brimstone to proceedfrom the discharge of a great quantity of electrical fluid from the patient's body, to which they ascribe the cure. He thinks the heat of the hand may be sometimes sufficient to occasion this snapping, which any heat a little exceeding that of the huo, man body will effect; and he ascribes the cure to the attention and the faith of the patient; though rather to the surprize occafioned by the snapping: adding, in confirmation of this opi., nion, he has known some in the cramp to miss of a cure, after shey were informed, the snapping of the brimstone was owing
to the heat of the hand. This article concludes with observing that, when this symptom arises from sharp humours in the ftomach or intestines, the expulsion or correction of them is ne. cessary to any durable relief. • For the removal or palliation of hysteric faintings with con: vulfions, he directs some of the anti-hysteric fætids, but de: clares he never found any thing so effectual as the pediluvium ; by which, after the vain exhibition of various medicines, he has seen the patients restored, as it were instantaneously, to their senses.
If violent pain with a cramp in the stomach be attended with an inclination to vomit, he promotes it with warm water, and then directs a glyster of six ounces of the fame, with laudanum, from fifty to eighty drops; giving also two spoonfuls of a mixture of musk, with some ftomachic and carminative water every four hours. When this symptom is owing to the true gout, blisters to the ancles are added.
Anindigestion, with vomiting and pain in the stomach, is to be treated variously according to its particular cause : Whent owing to scirrhous obstructions in the alimentary canal, palliation only can be expected. Two cases are given here of ladies cured chiefly 'or solely by laudanum, after the failure of many other medicines. In Aatulent hysteric colics, with a costive body, laxative clysters, with a drachm or two of afa foetida, are recommended. In violent vomitings, draughts of salt of wormwood with lemon juice are ordered to be taken in the act of effervescence. But Dr. W.avers, he has always succeeded in such cases, by directing a clyster of warm water, with fifty, fixty, or even eighty drops of laudanum in it; giving, in case of costiveness, some pills of aloes with calomel, whose operation ensued after that of the opium had terminated. In fatulence of the ftomach, he advises the spiritus æthereus with laudanum ; giving an instance of a lady about 45, who, in an extraordinary fatulent distension of the stomach, found nothing relieve her so immediately, as a tea-spoonful of this spirit, in two table-spoonfuls of water, which always brought up a deal of wind.
Under the article of a nervous asthma, which he observes to vary considerably in different persons, and to require a various treatment, he gives a singular case exa&ily described, in which he found the most considerable relief, and even a temporary cure, from the bark. For palpitations of the heart he directs a various treatment, according to their different causes, those arising from polypi in the heart, or its great blood-vessels, or from oflification of its valves, being capable only of palliation. Among other remedies in an immoderate flux of pale urine, fuch as bark with some cinamon, alum, &c. he recommends a tight broad belt about the patients loins, or a strengthening plaster, giving
bne instance of the success of the first, and two of the latter application. He has known á violent periodical head-ach, in à good measure prevented by a draught composed of 45 drops of laudanum, 45 of tin&ture of ipecacuanna, half an ounce of spirit of mindereruss an ounce of rose-water, and iwo drachms of fugw taken an hour before the usual approach of the paroxysm, which generally excites a plentiful sweat, while it lessens the pain. Many other remedies are directed here, according to the different causes of this afflicting symptom; the cure of whichi, when violent, he thinks, is always to be commenced with peo diluvium, &c. Low-fpirits, the last article in this chapter, are considered as resulting from four different causes, the specific treatment of each being added; though the Author very inge: nuously concludes his work, with respect to this fymptom, from the fourth cause, in the following terms. "When low spirits or melancholy have been owing to long continued grief, anxious thoughts, or other distress of the mind, nothing has done more service than agreeable company, daily exercise, and a variety of amusements.'
Thus have we given as full, and as connected an abridgment of this useful and ingenious work, as our plan admits of. The Author's frequent and modest acknowlegements of his infufficiency to account clearly for all the phænomena of this multiform disease, wholly to eradicate its various causes, many of which are inherent in the original fabric of several constitutions, or always to remove their effects; these considerations, we say, muft abundantly preclude every ingenuous Reader, from making any such obje&tions to his work, as are manifestly founded in the great limitation of the human capacity. It was impoffible for us not to observe, from this survey of the treatise, that few medical works of the same length have been conducted with a spirit more directly opposite to that of empiricism, or mean selfishness; the Author, having, we suppose, published full as many instances of his failure as of his success; whence it is
plain the love of truth must have operated in him with a great • and very amiable influence. Where he differs, either from the
particular opinions of other eminent medical writers, or from the generally received doctrines and practice in these diseases, which are not very seldom the case, it has not the air of differing for the sake of contention or through the love of novelty : since generally some very probable, and often indeed strong reasons are produced to countenance, or to confirm his difference of judgment. He seems, without the least reserve, to have faithfully communicated whatever was remarkable, and fell within his own experience, in the cure or mitigation of this class of difeases, for which the republic of medicine are the more obliged to him from their natural abstruseness, which he has conRev. Sept. 1765.