be presumed to suggest a reason of a Palsey than Apoplexy and can hardly be made out to be the cause of so sodaine a seisure since such a congestion must be slow and so the effect generally must come gradually whereas from a perfect state of health the Apoplexy on a sodaine as the name imports ordinarily seizes Besides though the passages of the spinal marrow and nerves thence arising be thus closed rather than obstructed an obstruction being generally I conceive in the common acception of the word understood to be from some matter within their tracts and not properly from it externally compressing them whereby the spirits cannot readily descend into them yet their motion in the Brain may possibly for some time be free enough and consequently the Soules exercise may be then entire for a while if not indeed exalted from the confinement those have to the Brain in that case and 't is observed many times that in a Hydrocephalus Intellection and other animal faculties fail only gradually though the Ventricles have been found upon dissection to have been much filled which they must have been long time a doing Withal what is once got into the Ventricles has no farther communication with the animal spirits being disterminated from the Brain by the interposition of the membranes But Galen seems not very consistent to himself in this notion as making the Brain it self De loc affectis lib. 3. cap. 10. to be the seate of it without there mentioning the Ventricles whereas before cap. 7. as well as in other places he only seated it in these exclusively to the substance of the Brain But that Hypothesis is now antiquated and the substance of the Brain generally owned to be the seate of it Anatomical observations having as I said made it apparent it must be seated there And tho several Authors have diversly explicated it yet there are two opinions particularly which are now adayes most celebrated and perhaps deserve to be so both on their own account as being each of them very specious though somwhat different from each other as also of their Authors the famous Wepfer and Willis These indeed seem to agree in their notion of the particular seate of it viz. both of them assigning the Medullar substance of the Brain and Cerebellum for it But they differ here in that the former considers the whole compage of them both under that name in contradistinction only to the Ventricles the now received distinction into Cortical and Medullar more properly so called having not been then thought on and therefore he seems to suppose any part of the substance may be the seate whereas the latter supposes it to be in the corpus callosum or true Medullar part according to that distinction but withal he asserts that the morbifick matter is transmitted to it through the Ambitus or Cortical the Arteries which are the conduits for conveighing it whatsoever it be either immediately or mediately passing all through it But they differ in their explication of the mode of production For Wepfer supposes that the Brain is either denied a sufficient afflux of bloud of which he assignes several causes or if it have that yet that the distribution of the spirits into the nerves is hindred either by an obstruction of them at their originals or their compression But Willis doubts whether the former of these the want of a supply of bloud can have place here since 't is known there are every where about the Brain as well as in other parts of the body mutual Inosculations of the arteries on the account of which 't is not to be supposed that all the branches of the Carotides and Vertebral can on a sodain be obstructed but that if some happen to be so yet all parts of the Brain must receive the bloud quickly enough from those which are free by means of these Anastomoses and so the nerves may be readily enough supplyed or if these arteries chance to be totally obstructed he thinks the consequent distemper will not be properly an Apoplexy but a Lipothymy or Hysterical affect From which consideration he deduces that what makes an Apoplexy must be somthing in the Brain it self that causes either a solution of continuity in it or insinuates it self into the Meditullium Cerebri or original of the nerves and there either obstructs the passage of the spirits into them or else on the account of some narcotick or other disagreeable quality dissipates or depresses them Both these notions may with much greater advantage be had from the learned Authors than a short abstract for which too under this head I should apologize this relating to the Cause but that withal it conduces to determine the Seate But though Dr. Willis have so speciously urged against that tenent of the non-admission of bloud to the Brain to produce an Apoplexy yet I suppose that with all deference to his great judgment his opinion that the proper Medullar part of it is the only or at least most frequent seate of it is somwhat too contracted not to say precarious and that on the other side though an Apoplexy may perhaps somtimes begin in the corpus callosum yet rather and much more frequently in the Cortical than there or amongst the nerves at their original For though 't is probable the Meditullium cerebri is the place where the soule principally acts and from whence she dispences her influence to the rest of the body and therefore she cannot be said to be disturbed in her actings and so a distemper be introduced till that part be disaffected yet I conceive that part is properly to be reckoned the Seate of a distemper where the Cause that influentially occasions the defection of natures due actings first fixes it self otherwise I see no reason but that Wepfers denegation of spirits which Willis oppugnes might be sufficient both to make and denominate an Apoplexy And indeed that the Cortical is most apt to receive the morbisick matter seems obvious from hence that in it the arteries are most numerous and it most lax and yielding so that when from any occasion the bloud is apt to get out of or at least distend its vessels or indeed but to exude out of them 't is probable this may be done more easily here than in the corpus callosum 'T is true it must be granted that the arteries are disseminated through all parts of it even to the inmost otherwise they could neither receive due heat nor nourishment if at least nourishment come immediately from the bloud to any parts but the roots of the Nerval tree numerously dispersed through the cortex which vessels though penetrating ever so deep if they chance either to open be broken or become relaxed whereby they may let go some of the substances they carry after the manner by and by to be alledged 't is obvious must soon supply the matter of a considerable inundation if I may so call it of the bloud or those
A PHYSICO-MEDICAL ESSAY Concerning the late frequency of APOPLEXIES Together with a general Method of their Prevention and Cure. In a Letter to a Physitian By WILLIAM COLE M.D. OXFORD Printed at the THEATER 1689. Imprimatur GILB IRONSIDE Vice-Can OXON Feb. 20. 1689. To my much esteemed Friend Samuel Kimberley Dr. in Physick Dear Sir. THough I must look on your request to have my thoughts of the cause of the greater frequency of Apoplexies these late years than formerly as only an instance of your modesty in giving a deference to the judgment of others when I doubt not your own notions if you please to draw them forth can better satisfy both your self and all men else then any I can produce yet that I may not be wanting to the friendship I have so long in reality professed for you I shall for once venture to present them to you however unaccurate which being addressed to a friend may expect to be candidly interpreted although they bring not the satisfaction you expect 'T is true I have heard the 〈◊〉 〈◊〉 〈◊〉 〈◊〉 〈◊〉 questioned it being alledged that this distemper might amongst the vulgar be ranked under some other classe in regard 't is not to be presumed they should know to assigne the right names to diseases till the fate of a Great Prince our late most gracious Soveraigne commonly reported to have dyed of it might give a general notion of the name as well as imprint apprehensions of the danger And indeed it may be suggested that such an accident happening to so great a person may make stronger impressions on mens minds than when it falls on those who make a lesser figure and thence make them take notice of what they would not otherwise have heeded Besides that the report must on that account be the more diffusive and so being conveighed amongst many of all tempers must meet with some of very apprehensive ones whose fears will easily be propagated to others it being natural to all men to reflect upon what they think carries danger especially when 't is strongly and frequently inculcated in order to prevent it if not to have their spirits depressed by it from whence perhaps such may be more disposed to receive the Idea's to speak in the language of Helmont of such a disease But if we duly consider it we may find that it hath been both known by Name and dreaded by those of all Ages For besides that all practical Authors from whom the vulgar must be presumed to have first received it treat of it ex professo by that Name the very surprize must necessarily excite a notion of it in all it being so very different in its symptoms and fatality from all other distempers So that the many accounts continually brought of great persons as well as those of a lower rank that have been snatched away by it are not to be looked upon as only the true notion of it retrived which was before mistaken but a real increase of it now and may too much justify the melancholy apprehensions of the Gentlemen you spoke off who desire an information concerning it To endeavour then to give a satisfactory answer to your question 't wil be requisite I consider though briefly the particular Seat Nature and immediate Causes of the distemper as also the Disposition of the Part where 't is seated to be affected And though this disquisition have been so often and learnedly made by many Authors yet most of them differing from others in some particulars it may hope your more favourable interpretation if I do the like from any of them who may perhaps be your favourites when by their example I shew why I do it since as the notions of all cannot be reconciled so no man is obliged to think precisely with any other be his reputation ever so great I propose not to my selfe to deliver all their opinions which your own reading supplys you with better than I can much less solemnly to refute them But I must necessarily touch on some particulars in a few of them in order to make out my own thoughts To the First 'T is agreed by the generality of Physitians that the Brain is the seate of the Apoplexy only Helmont places it in the Praecordia as most explicitely De Lithiasi Cap. 9. § 52 70. whose offence against the Schooles and contempt of Anatomy though otherwise he must be owned to be a man of great parts and learning might possibly prompt him in opposition to the Antients and their followers to take up with some opinion that presented it self with any colour that might contradict theirs rather than agree with them even in the most obvious and convictive ones though ever so clearly demonstrable too upon dissection For indeed besides Anatomical autopsy which is too clear to be contradicted all the Symptoms argue it to be seated in the Braine For even in the most sodain seysure when the persons affected have not time allowed them to declare their perceptions 't is evident that the stroke is impressed on the animal faculty in general by the immediate cessation of its functions the vital so called continuing for the most part entire for some time which must argue the cause to reside about the original of it the Brain since from thence only that faileur can so generally be effected But when it begins with less violence so that there is any interval betwixt its invasion and the total defection of the animal functions they generally complain of either a vertigo or a great oppression and paine in the head upon which presently follow stupidness somnolency dazling of the eyes a relaxation of all parts of the body and the like all which are so evidently deducible from the consideration of the nerves affected at their original that t were time lost farther to prove it But since 't is not satisfactory enough to assert in general that the Braine which is an accurately organized part in which there is a great variety of cels and vessels and a considerable difformity of parts one from another is the seate of this distemper without determining whether the whole or any particular region or part of it be especially affected Authors have employed themselves in this search The most celebrated opinion and which most have followed till this Age was that of Galen who assigned the Ventricles for the particular Seate and supposed a viscous matter got into them to be the cause of it This opinion though it might give some account of the interception of the animal spirits which according to the antient doctrine are to actuate the body by being distributed along the nerves on the account of the compression these must so undergo near their original which distribution failing all animal motion in the parts influenced by the nerves which labour under this compression must cease yet with all deference to the memory of the great Author as well as to the abbettors of it I conceive may rather
it being urged on by the impulse from the heart and then 't is obvious that all the regular motions and secretions there necessary to animality must immediately be interrupted the passages designed for carrying select substances being thus both enlarged and filled with heterogeneous and gross ones which make up the much greatest part of the Bloud So that hence Thirdly What is called the Containing cause is easy to be collected viz. some matter either discharged out of the sanguiferous vessels upon the substance of the Brain or else filling and distending them and thence compressing the sides of the passages in it This may either be 1 st the Bloud in its whole substance whether good or impure since in either constitution it may if either congested in too great quantity or too impetuously moved get out of its vessels or else so distend them as to produce the mentioned effect Or 2 dly some Viscouse matter proceeding from the Serum become less spirituous whose particles therefore are disposed to lay hold one of another and so to grow clammy and consequently unapt to pass along the usual tracts but apt to stick in the laxer interstices between the arteries and veins in the habit of the Brain to which more being continually brought by the continual motion of the Bloud may by a likeness of substance still associate it self till it come to a congestion great enough to cause such an obstruction as may at last hinder the circulation or at least the separation of such substances from the Bloud as must actuate the Brain and nerves From such a cause too Inflammations which are some of the acutest as well as the most frequent sort of distempers that assaile us often arise and 't is generally to be observed that in pleurisies anginas c. the Bloud is exceeding viscous which quality in it disposing it to obstruct must therefore when that happens cause a congestion all about the Bloud incessantly arietating against that place and thence soon an inflammation Or 3 dly a greater collection than usual of the fluid Serum in the Bloud though not disposed to viscosity but instead thereof grown too sharp which thence may be very apt to make its way through the passages in the habit of the Brain whose natural Make might keep out a less thin Serum such as belongs to the Bloud duly constituted but cannot this in regard its particles are perhaps become less than the diameter of the pores of the vessels 't is naturally carryed into or else these pores may come to be so dilated by means of the continual lancinations that the resistance of their sides may soon come to be overpowered Or 4 thly polypous concretions those infelicia aegri cordis germina as Wepfer calls them which have their construction from the fibrous parts of the Bloud whose Make being oblong and ramous numbers of them may happen to associate in the heart too strictly and being when once thus associated unapt to be dissolved must make carneous concretions there where being radicated they may grow to a considerable bulk and length and diffuse themselves all along the arteries to a great length the manner of whose production the accurate Malpighius de polypo cordis has very curiously described These Wepfer supposes may make an Apoplexy on a double account viz. either entire or broken The former way by being propagated from the heart up to the entrance of the Carotides and vertebral arteries into the skull which vessels being extensive before let the Bloud pass by these polypi up to the Brain before they reach those perforations of the skull but when once they doe that the arteries being confined by the bones through which they pass must be totally stopped by them and so the Bloud being prohibited from coming to the Brain an Apoplexy must according to him follow Which supposition indeed if it could be demonstrated would prove the greatest instance of his assertion that Apoplexy may proceed from a denegation of Bloud to the Brain But besides that 't is hard to conceive all these four arteries should be stopped at once by this cause which if they be not the Bloud coming by any one will be diffused by means of the Anastomoses all over the Brain for the continuance at least of the animal actions though perhaps in somewhat a lower degree it seems moreover probable that this should rather be ranked under the class of Cardiacal Syncope's whose symptoms are very like those of an Apoplexy and so many and large polypi as must effect this would in likelyhood kill by hindring the Circulation through the heart before they could grow to the length and bigness requisite to cause this obstruction But the other way by which he supposes an obstruction from them may come is the breaking of them off being grown fracid which happening the course of the Bloud must carry them on into those narrower passages whereby it might be presumed there would follow such a sodaine obstruction as must produce an irremediable Apoplexy did not his instance of Iames Knoll evince the contrary who though the arteries in his Brain were full of them yet had never any touch of an Apoplexy unless we should suppose those were not true polypi which as I said are generally of a carneous nature and radicated in the heart but only associations of viscous substances in the degenerated Bloud formed in those places where he found them But indeed it seems probable that if any of these broken polypi get into the narrow passages of the arteries in the Brain they may cause such a stop of the Bloud there that it not finding its usual way open may by the impetuosity of its motion make it self a new one into the substance of the Brain So that from any of these causes the Bloud in its circulation passing as I have said irregularly through the Brain may if this part happen to be more than usually susceptible of an impression from it either deflect into the lateral yielding recesses in its habit or by reason of a partial obstruction of the vessels distend them since being impelled in the usual quantity but deficiently transmitted there must quickly follow such a congestion that either a stagnation of it in the vessels must happen or an exudation of some parts of it through the widened passages or else if the impulse prove to be more violent a laceration of them from whence comes an Extravasation which will be continually increased from the continual impulse upon parts thus become unfit to resist the motion But of these causes of Apoplexies especially those which prove most fatal the Effusion of Bloud mentioned seems to be the most usual though as I see not but the distemper may as I said proceed from only a Congestion so possibly this may be that from which most recover that doe at all however by continuance it may prove as dangerous as being the beginning of that by effusion and a stop of the
duly circulate through its usual vessels in the Brain or else 3 dly disaffects the Brain whether by weakening its tone or altering the figures of its passages or straitning them too much may occasion Apoplexies and the greater urgency or violence of such antecedent causes may introduce a greater frequency of them than ordinary As to the first Besides common observation 't is obvious to any mans reason that those who indulge themselves in full meales but especially in copious drinking and use not due exercise may fall into them especially if their natural constitution incline them to breed Bloud plentifully since so it must be heaped up in too great a proportion for the vessels and thence may easily be supposed to make its way out of them upon even light occasions into the most yielding parts Besides persons given to these excesses doe frequently either voluntarily or by the necessity of the irrigation made on the Brain allow themselves likewise great liberty of sleeping and so relax the Brain whereupon the Bloud flowing more plentifully in the usual posture of it viz. lying along may be presumed without great difficulty to get out of its vessels distended on this occasion into it And it seems rather to be wondred at that no more fall into them than that some doe from this cause since there are so obvious reasons of their production from the number of those who thus indulge themselves But this seems no adequate reason of their greater frequency now than formerly since these excesses have been of a much longer date than to give occasion hence to justify the temperance of former ages comparatively to ours Therefore Secondly as to the causes of those dyserafies of the Bloud from whence the immediate continent cause of Apoplexies flowes we must seek them from without us since our Bloud has its supplyes so and its motions whether circular or intestine are excited or retarded by abundance of outward and the most of them inevitable our shallow knowledg and foresight in choosing what is proper for us and avoiding what is prejudicial and the unmanagable bent of our inclinations to what gratifies us especially considered occasions From which external causes likewise Thirdly the disposition of the Brain to fall into these distempers must proceed these being as well disposed to act on the solid as fluid substances of our Bodies as they find them fit to receive their impressions The external occasions therefore of our disorders are generally deduced from some or other of the six Non-naturals so called viz. Air Meates and Drinks Motion and Rest Sleep and Waking substances excreted or retained and the passions of the mind any of which if inordinate may produce such diseases as the Body upon some peculiar predisposition is subject to 'T is besides my subject to dilate on them particularly especially as they contribute to produce the gross of diseases neither doe I think the five latter so very applicable to my present theme as to detain me But the first seeming the most usual and efficacious as to the production of all or the greatest part of other distempers since 't is so generally influential and unavoidable so of this I am obliged to take some notice of it For we may in a great measure correct irregularities in the rest but not so in this without which we cannot live many moments neither is it in our power to correct its disorders if any thing considerable since it diffuses it self every where and must therefore if vitiated be the cause of general distempers and more especially seems to have a very prevailing energy to introduce that under consideration Its disorders are generally reduced to two heads viz. either excesses in one at least of the First qualities Heat Cold Moysture or Dryness or else Malignity in it unaccountable for from them whatever it satisfactorily be from any other vulgar notions which may be of very different kinds and so produce distempers different as to their symptoms yet of that general denomination These have been so copiously and learnedly treated of by many great Authors that 't were very impertinent in it self as well as unfit for the brevity of a letter to expatiate on them but particularly the Doctrine of Malignity seems too abstruse to be discoursed of in few words only if it be not a solecism to pretend to judge of things of which we can assigne so little reason it seems best adjusted to give an account of diseases that generally invade and where indeed surprising symptoms whose reasons cannot be assigned from known hypotheses happen as in some Epidemical feavers the Plague c. For it seems agreeable to reason that it must be somewhat more than what is deducible from the first qualities as well as very active that must so affect multitudes of people of different constitutions and of whom many have no evident predisposition to sickness with so extraordinary indispositions and that at times when the Air is free from excesses in any of the first qualities or indeed any of the rest of the sensible ones and 't is acknowledged by all how differently soever they explicate the matter that these epidemical miasmes are so But to give an account of the production of the present distemper we have no need to have recourse to this abstruser cause For first this can hardly be reckoned among Epidemical distempers however more frequent than formerly since at all but few comparatively to those who are with other distempers are assaulted with this and those not in one region but here and there in farr distant places at all times of the Year and at all seasons whether of excessive Heat Cold Moysture or Dryness though as I shall by and by observe it took its rise from one of them Secondly 't was never observed nor thought contagious as most Epidemical diseases that depend upon Malignity are those subtil steams that occasion them being as very diffusive so also determinately fermentative to the production of like substances in the Bodies they enter into which when emitted and then received by others which have a predisposition as most have a small one being sufficient in so heterogeneous Bodies as ours are and where the substances that compose them are so lax and in such an agitation to be by them acted on must affect them in the same manner Thirdly there seems nothing in the symptoms but what is constantly observable in almost all assaulted with it and agreeable to the general history of it whereas those called epidemical have generally somthing anomalous in the symptoms when ever they so invade from what has been observed in those of the same denomination at other times And fourthly it seems accountable enough for from the consideration of those more obvious qualities of the Air. So that I conceive 't is rather to be reckoned among the Sporadical diseases so called by Physitians and to proceed from some or one of these modifications of the Air which we call first qualities
as well amicably as noxiously First As to the Bloud which is most considerable as to quantity and supplys the matter to the nervous and the rest of the juyces we may take notice that though the Air may even by contact affect it in the surface of our Bodies as considerably pressing on us and so perhaps arrest or variously determine its motion in some degree yet it must principally do this by being admitted into it This admission seems obvious since 1 st living in it we cannot take any either meats or drinks but some Air will be admixed and so be conveighed into our Bloud with them Besides 2 dly it seems not improbable though it have undergone some contest that some of the finer parts of it may be admitted in inspiration farther than barely the cavities of the bronchia since it must be owned there are vessels from the little glandules dispersed throughout them which transmit from the Bloud there and whether those vessels may not receive somthing tho' not so much into them upon inspiration as well as cast forth by expiration may deserve to be considered since the Air comes into the Lungs with some violence and they being placed in so warm a situation may besides the distention upon inspiration be presumed to be as well lax enough to admit a subtil substance as eject a gross one and it seems not altogether improbable that nature might design this reciprocation of motion for that end partly But withal 3 dly the pores every where in the skin seem well enough adjusted to admit somwhat from the Air as well as conveigh forth those very gross impurities which many times if not very usually pass forth without any trouble And if it be objected that the transpiration continually proceeding from within must hinder any admission from without by the same vessels which notion heretofore seemed to me to have great weight as well in relation to these as most other vessels and liquors in the Body though upon farther thoughts it requires some limitations which belong not to this place to be laid down it may be replyed that this transpiration though it should be supposed continual is not in the same tenour still so that when it proceeds minutely there may be an admission perhaps from without between the particles of this gross and slowly moved matters in vessels patulous enough when we consider both the great pressure of the Almosphere which may easily enough be presumed on that score to intrude some particles of the Air between them to fill up the spaces left by the exhaling vapours and also the cessation in some degree of the extrusive motion whether proceeding from the expansiveness of the evaporating matter or the too much contraction of the parts both which remitting the resistance is less and the room more for the admission of those Being thus admitted 't is obvious to deduce from what was intimated before how it ordinarily operates on the Bloud viz. that partly by the insinuation of its elastical and other irregular particles among the parts of it partly the interposition as well as lancination of the nitrous the ramous and other grosser being kept in a continual agitation do both undergo due comminutions and also are hindred from too closely adhering and thence as well from stagnating in the wider vessels as obstructing the capillaries and interstices between the arteries and veins But such an agitation being necessary to it for the keeping up its vital crasis it may easily be inferred that if such Air be admitted as shall overmuch check this agitation the crasis of it must come to be much altered and those parts which were before dissociated by the briskness of their motion must being considerably ramous lay hold on one another and so either become grumous or create a viscosity in it which once begun is not soon nor easily corrected these particles clasping one another too firmly to be quickly unlocked by the permeating spirits whose activity likewise these viscous substances are apt to elude by their lubricity thence obliging them to slip by them or else inviscating them Secondly As to the nervous juyce it being made out of the Bloud must therefore in some degree undergo impressions analogous to what are made upon this from substances admixed with it whether we consider it in its due or depraved state since it may be easily imagined that some of the admitted substances of the Air before mentioned may be deposited into the nerves at their original together with the true matter of that juyce and besides if the Bloud in general be once become viscous from whatsoever cause 't is scarce possible but that some part of such a matter must in the act of secretion pass into the nerves so that the Air in some constitutions of it much disposing to viscosity its influence therefore must be interpreted to be partly on this juyce at such times But moreover I see no reason but some particles of it may when more than ordinarily abounding with such substances as are subtil and active even through the pores be admitted into this liquor our Bodies being every where permeable to subtil substances since I conceive they in a due proportion are necessary even to the due spiritualization of this juyce and therefore for its excitation towards that may require to be admitted partly a nearer way than that round-about one of the chyle But Secondly The Air 's influence must be acknowledged to be very great on the solid parts likewise as both immediately touching upon some of them and also by reason of their firmness being longer retained by them when once admitted into their porosities which by the mediation of the Bloud besides the other ways mentioned which are applicable to these as well as the liquors 't is easy to imagine its particles may than in those fluid substances So that in the forementioned suggestion of its superabounding with noxious substances they must be much disposed to be affected by it And indeed there seem to be none even of the most consistent parts of our Bodies but are pervious enough to and consequently apt to be acted on by such penetrating substances But among them all none seem so liable to receive impressions from them as the Brain on the account of its tender constitution For tho' Nature hath placed so strong fences about it that perhaps 't will hardly be admitted that the Coldness of the Ambient can greatly prejudice through them yet that it may by the mediation of the Bloud passing through it is I suppose easy enough to be allowed from what has been said But besides there seem two or three other wayes by which in such a constitution of the season it may be injured viz. First By the Air 's affecting the mammillary processes as it passes briskly by them upon inspiration which being considerably large nerves must besides the consideration of the impetuosity of the Air 's motion in that circumstance be acted on by
considerable numbers of its particles at once and so undergo a strong impression which may easily enough be conceived to be propagated to the Brain partly by disturbing their regular tonick motion which must from their tensity be continued up to their original partly by the ingress of too many of the lancinating particles of it into them which besides the fixing or dissipating the animal spirits which I conceive to be much of the nature of volatill salts may disorder the tone of these nerves first and then by the continuance of the impulse of those behind which have the same ground to attempt an entrance that of the Brain it self which being more tender than the nerves must therefore when the cause of the disaffection reaches it be proportionally injured A second way I conceive is at the ears whose outer cavity going deep seems to be in part contrived for warming the Air that it may not by its Coldness disaffect those exquisitely sensible auditory nerves and the membranes upon whose due tone and tensity as the sence of hearing seems mainly to depend so must it be much impaired if so unusual impressions are made upon it by intensly Cold Air and besides those nerves being thence so disaffected must by their contractions conveigh the like motions up to the Brain and so disturbe and weaken it And I formerly knew a very Learned person who had a total and irremediable deafness that was caused as he told me by a journey taken in a very keene frost over the Mountains in Wales to which I remember not whether any Apoplectick distemper succeeded but the instance at least evidences the great effect of intense Cold upon the nerves which had it lasted long 't is to me probable that by being propagated up to the Brain it might have produced either that or other nerval distempers Another way whereby I conceive the Cold Air may be injurious to the Brain is at the extremities of the nerves in all parts of the skin which having as must be owned I presume apertures there may possibly admit some such subtil and lancinating substances as I have supposed to be constantly but in frosty seasons more copiously carried in the Air and being once admitted may on the same ground as I have urged in relation to the olfactory Nerves by consecution come to affect the Brain it self But though their tracts are very long and small and so there cannot be a proportionable influence as in those yet their great numbers and the consideration that they are on every side pressed upon by the Air may perhaps be thought to Compensate for that defect But this pressure of the Air on the surface of our Bodies which I distinguish from that on the olfactory nerves on this consideration that in one case 't is uniform depending only on the weight of the Atmosphere or such general motions in it as make it act uniformly on all parts of the surface of them which by their make and private motions determine it not otherwise in the other some part of it is moved with a greater violence from the dilatation of the parts designed for Respiration whose cavity therefore being to be filled in proportion to that dilatation it must happen that that portion of Air that does it must have brisker agitation than the rest of its masse and make impressions accordingly this pressure I say may prove chiefly injurious to the Brain by its acting on the Nerves in the Eares Because they being terminated at a cavity which is still kept warmer than the rest by the steames continually exuding from every side of it and for some time somwhat detained there must therefore be more open and consequently more liable to injuries if an extraordinary occasion happen such as I am instancing in to make an impression on them And this must happen rather to tender Bodies and those who accustom themselves to keep much within doores than to the more robust whose employments expose them much to the Air at all seasons both on the score of the comparative flaccidity of all parts in them and the defect of a due digestion in their bloud and other liquors through want of due exercise which must dispose them to be put into confusion when violent causes come to excite it and experience shewes that such persons of all others are most obnoxious to the alterations of the Air. So that the manner of this action seems to consist in the penetration made by the Nitrous particles principally of the Aire upon the Fibres of the Brain for that as well as all other solid parts must consist of Fibres which thereby undergo some however small solution of continuity and either the little cavities of those Fibres for I think the Aeconomy of our Bodies can hardly be mechanically made out without supposing them all to be Vessels though our sensories cannot determine it become straitned or their sides perforated on the account of either of which they cannot duly either receive or retain and consequently not regularly transmit the substances destined to each part which is to be respectively supplyed by them In that continuity due confirmation repletion of them I suppose the Tone of the parts to consist and therefore when any thing perverts any of these requisites to it as in our present case all the consequences emergent from the impulse of the bloud or other liquors disturbed in their motion may be expected Now such an Atony happening to be in so very tender a part as the Brain cannot therefore easily be rectifyed but may continue much longer than if it happen to other parts whose Fibres being stronger and functions fewer must on both scores caeteris paribus sooner and more easily return to their natural constitution And not only the reason of the thing but dayly experience shews it that whereas most other parts of our Bodies having once received any injurious impression as by falls blows c. do after fit remedies used return to their due tone quickly the cause once removed the Brain on the contrary long retaines its weakness if once injured though for the present releived in some degree as for instance those that have had an Apoplectick fit once doe many times on whatsoever light occasion either find a return of it or at least undergoe a considerable weakness of their intellectual faculties not to be corrected but by a long and constant regularity if it be at all and the like is observable concerning those who have been seized by Vertiginous and Hypochondriacal distempers which I take to be properly Nerval and to spring from the Brain or its liquor disaffected from which few happen to be perfectly freed their imagination indeed being disturbed disposing them to be too immorigerous So that I conceive it may be inferred that if the Ambient Air come to have a great degree of Coldness especially if it continue long both the forementioned disposition of the Bloud to supply matter for Apoplexies must be
cause can introduce it And as to what is urged of the French Pox c. being put in under this Class the answer is the same since the same reasons have always been for the concealment and 't is known the Pox and its infamy too has been considerably longer in the world than Weekly Bills which are not of an Hundred years standing From these considerations put together you see my sence of the question proposed to which I am sure you expected not so tedious an answer And I assure you I designed not this prolixity but several deductions still falling in which to me seemed requisite to clear the notion I am sure you will not expect apologies for my doing that which your self have occasioned But since you farther require the methods of Prevention and Cure of this distemper which I have either used or think requisite Though after what so many Authors and particularly Dr. Willis have written on this subject it seems altogether superfluous to say any thing yet to let you see how ready I am to comply with you in this as well as your other desire I shall venture at least to give you my thoughts in general concerning them together with my reasons such as they are of the administrations to be proposed to justify my dissent from such who in any of the particulars think differently from me But first though not pretending to write an exact treatise of Apoplexies but only to give an answer to your questions you are not to expect I should congest Prognosticks according to the custome of Authors when they propose to write solemnly concerning any diseases yet I conceive 't is requisite I should lay down or rather recapitulate one or two that respect the fatality more indeed to excuse Physitians who are generally liable to be taxed if success attend not their endeavours than for any solid and useful information they can bring since the cause of it cannot be certainly known but upon dissection And First if an Apoplexy proceed from any considerable effusion of bloud in Specie 't is as I intimated before altogether incurable since the tenderness of the part is such that it cannot resist the force of the portrusion behind And since even any stop in the Sanguiferous vessels will if not presently removed by Phlebotomy or other due remedies so distend them that either an eruption or stagnation must quickly follow 't is not at all to be wondred at that so few escape since so few are convinced of what I take to be the true remedy where there is a possibility of recovery Secondly that likewise which proceeds from a Polypus must needs prove as fatal both from the difficultly dissoluble nature of that substance and the shortness of time medcines if such there were that should effect the dissolution are allowed to exert themselves in the bloud as I just now said for want of motion quickly stagnating and growing grumous in any part where 't is stopped and so hindring the motion of and alike affecting the rest To which yet thirdly give me leave to subjoyne that if the Pulse continue any thing strong the probability of recovery is much the greater since 't is an argument the Brain is not wholly overflowed but that the mass of bloud yet continues in its channels and produces the distemper only by distention so that when they shall by due administrations be freed from it there is hope the Brain may return to its pristine condition at least in some degree But yet Fourthly that those who have escaped one fit are in very great danger of a return since as I have before alledged the Brain having been once injured is by reason of its tender make so difficultly reducible in all respects to its former Tone and therefore from any even slight occasion be afresh more easily disordered Therefore it very much concerns those who have once escaped that danger or even that of a great Vertigo or other Cephalick distempers to use a good regulation of themselves for the future and also to persist long in the use of such corroborating means as may at last Deo annuente perfectly restore it as well as keep the bloud in a due crasis and prevent all antecedent causes Which advice yet very few are apt to follow two many being apt when once in some degree recovered to imagine and suggest too that Physitians urge that more for their owne advantage than theirs Which premised I conceive first for Prevention that these two general Indications ought to be proposed The removing the Antecedent cause and the corroborating the Brain The former is to be answered 1 st by general evacuations of humours whether Laudable if they be congested in too great a quantity or Peccant 2 ly by keeping up or if it be depraved restoring the bloud to its due crasis 1 st As to evacuations Phlebotomy seems to deserve the first consideration since as I have endeavoured to make it out 't is either the congestion of the bloud in the sanguiferous vessels of the Brain or its inundation upon it that is the most general containing cause of it So that all persons of a Plethorick habit of Body if fearful of this distemper Fear by occasioning the contraction of the Brain the seat of our apprehensions if not determining the bloud to it at least causing a check of its motion through it and so a congestion in or effusion out of its vessels as well as those whose bloud from other symptoms or the emission of some of it may be collected to be viscous especially if they happen with distention of the Veines and Lassitudes to be vertiginous or inclined to pains in the head ought to take so much away as may in probability prevent too great a distention here and this not only at such times of the year when the bloud is more apt than usual to rise into a Turgescency as in the Spring and Summer but at any time when they occasionally find it to be so disposed And though many may are indeed used to urge that not letting bloud at all they have hitherto escaped this as well as other distempers when some have been ceased and dyed too notwithstanding such their care which argument too by the way may be urged by many of vigorous constitutions against all precaution against all diseases and for a liberty for all debaucheries Yet since many have fallen into it who might probably by Phlebotomy have prevented it as well as that many have by it found present relief when actually ceased 'tis but a secure caution to use the most probable meanes of prevention since though all constitutions are not alike and some may be sensible of weakness for the present which yet quickly goes off by a little subsequent care yet experience shewes there are very few but find though they loose very large quantities of bloud they quickly regain it as to omit the reasons of it as less proper for this place beside
though as I said if Acids abound not the others I should think would be the most effectual The second general Indication The Coroborating the Brain may be answered in a great measure by the last mentioned administrations viz. the use of Chalybeates whose effect is generally owned to extend it self to all the consistent parts in the Body as well as the bloud nay must more to those than this since their action upon this is but transient but those may be presumed to arrest and detain them though not all yet as many as their Pores can conveniently receive For not only their Vitriolate particles but also the grosser ones which remain after the abruption of those as in Crocus Martis Astringens which is made by the avolation of the Vitriol upon a long and intense calcination are confessedly styptical and therefore being carried in circulation as well as acting on the Nerves in the Stomack to the remotest recesses in the Body and amongst them those in the Brain may be presumed by their lancinations as forcing them thereby to gentle contractions to rectify their tone when too lax which I have supposed before to be a main condition toward producing the distemper under consideration And this faculty they must most exert upon those parts whose indigencies are greatest those whose tone is firm not being fitted to receive or at least be affected by them So that when the Brain has been debilitated they must exert that action principally there But beside these a frequent use of the generally owned Cephalicks as Rosemary Sage Betony Lilly of the Valley c. may possibly much conduce to corroborate the Brain and may without trouble or offence be used in the Form that Tea is the general custome having denizon'd such a use of drinks and those whose apprehensions are greater might besides have those Ingredients fermented with their usual drinks But amongst all the drinks in common use if you will not suspect the Character given by one who loves it so well as you know I doe but who withal have dranke it near thirty years not only innoxiously but I seriously affirme many times to my great advantage especially when indisposed either at my stomack or head that of Coffee may perhaps contribute as much to a prevention of the distemper as any and that on a double account First by helping the stomack to digest which it may effect partly by reason of a gentle Stypticity the particles which make the Tincture have from the torrefaction of the berries partly from the actual heat 't is usually dranke with both which but more effectually when conjoyned conduce much to corroborate the tone of it so that digestion being well performed here and good Bloud thence produced much of the antecedent cause both of Apoplexies and other distempers must be by such administrations prevented Secondly by the action it performes I conceive on the Brain it self for by means of the moderate torrefaction the aqueous parts of the berry are carried away and the viscous are altered in their texture whereby the sulplureous and saline I dispute not whether preexistent or made by the preparation upon the alteration of texture associating with the terrence come to constitute little irregular masses which are not immediately dissoluble however those particles may be in a tendency to avolation too by reason of their not very strict combination but when diluted in the water after the known manner of preparing the drinke may be presumed to be carryed through the mass of Bloud in circulation to the Brain and there entring into the pores of it both keep them open for a free passing of the spirits and withal especially if daily but moderately used keep up the due tone of the Brain by the gentle vellication such particles may make upon it by which last means it becoms I conceive principally useful in the present instance Therefore for I will not appropriate it to all it seems to me agreeably to Dr. Willis's notion Pharm rat most proper for those who have too lax a constitution of the Brain as whose intellects or memories generally are slow and who are much given to sleeping or to have a dull pain in their heads especially upon free eating and drinking or such as are apt to vertigoes from to humid a constitution or to Catarrhs But 't is scarce proper that you may see how little partial I am for such as are of an overwatchful temper of very keene apprehensions with a thin habit of Body though I have known some of that habit with whom it has very well agreed and that observation of agreeableness ought by prudent persons to be consulted not only in relation to this but most other medecines and even meats since experience shews that from undiscoverable or at least from our shallow insight into things undiscovered causes very probable administrations ought to be superseded as well as the contrary used and withal for those that are apt to convulsive symptoms upon light occasions though I conceive where besides the irritative matter that makes convulsions there happens too great a laxity of the Brain Coffee by fortifying the one may in great measure prevent the admission of the other All which to me shew the nervosum genus to be of a texture in such persons considerably compact and comparatively dry with which these particles may too much correspond and it may be observed that such persons many times contract an unsteadiness or numness of their hands and other parts as well as a general indisposedness and uneasiness by its even as to others moderate use And from these effects upon the inconsiderate use of it as 't is common to have any though the best remedies abused when grown popular it has amongst many got the imputation of being a Paralytick drink and disposing to Apoplexies such never reflecting what multitudes of others comparatively to the few it injuries receive advantage by it Perhaps too you will expect my opinion concerning my other favourite Tobacco Concerning which I must say that though I know many have an opinion of its being Narcotick or otherwise injurious to the Brain and consequently disposing to Apoplexies yet to say nothing of my having used it and not sparingly for many years without finding any such effect of it the very common custome of taking it for so many scores of years since it began to be in vogue must have made such a quality if it had it evidently taken notice of and consequently common prudence would have obliged people to have left it off long agoe as deleterious if experience did not evidence the contrary for there is no man but if laying aside prejudices he will give himself the trouble to observe may easily find that very many live to great years in as great a state of health as those who take it not that have long used it even immoderately It must indeed be owned that it is not agreeable to all constitutions but the same may
be said of almost any thing else whether food or Physick And I presume no wise man will conclude from a few instances of the disagreeableness of any thing to some men when vast numbers of them on the contrary side may be brought to warrant its use that it ought universally to be avoided or branded with a note of infamy My sense of it is that in those persons with whom 't is found to agree 't is a very good drainer of humors and so may supply the place of Fontanels or at least that fewer of these may be necessary to those who abound with moysture For by its irritating and occasionally from the great afflux of the Saliva enlarging the secretory ducts in the glaudules about the Mouth as 't is evident there must be a great discharge so a great diversion from the Brain tho' I own the greatest part of the matter comes not immediately from thence but out of the Bloud in which case 't is advisable that the persons that take it should drink but moderately least otherwise they do themselves more hurt by the supply than they can receive benefit by the discharge of moysture from this or any other evacuations But there seems another reason why Tobacco may be useful to those who are disposed to Apoplexies under the supposition of its agreeableness viz. that by reason of the vellication the smoke of it impresses on the nerves in the Mouth it makes them contract themselves and so by consecution the whole Brain comes to be analogously affected So that if the Brain happen to be more lax than ordinary and thereby disposed to receive an afflux of Bloud or Serum as I take it to be especially after a person has had and escaped one Fit as well indeed as in many other cases of preceding nerval indispositions I see nothing but it may prove a very useful administration toward restoring the tone of it and 't is known to be very advantageous to many Hysterical persons of which though perhaps other reasons may be assigned as the altering the texture of the Fermentative particles by the association of those of the smoke to them as they chance to be admitted and so those of other figures and bulks may hence emerge or else the determination of the nerves to other motions by the action of this smoke impressed on the mammillary processes or other nerves about the Mouth or parts adiacent yet this seems to me none of the least probable that by corroborating the tone of the Brain it prevents the admission of those too elastical or otherwise heterogeneous particles into the tubes of the nerves which are the cause of the symptoms Also the frequent use of Volatile Salts may conduce much to a prevention under the limitations alledged for the use of Coffee such as are spirits of Sal Armoniac Harts-horne Soot c. which are but such Salts diluted as being I conceive so congenerous to those called Animal Spirits that they must needs excite them in us when too torpid or supply them when wanting unless the constitution of the Nerves be too dry or apt to be irritated by them And their effects have in many instances of nerval distempers found been so remarkable that they are now adays become of very familiar use though somtimes likewise abused But there are two specious administrations much cryed up and used by many which deserve to be taken notice of viz. Apoplectick Balsams whose principal use is to be smelt to composed of perfumes Aromaticks and other ingredients reputed Cephalicks and Snush Concerning the former of which give me leave to say I think them so farr from being useful for prevention that they most ordinarily prove very prejudicial For by reason of their grateful smell and the great activity of their odorous particles but without any troublesom irritation some of them may easily enough be presumed to be admitted into the Brain at the extremities of the olfactory nerves with the Air in inspiration and being once so are so farr from assisting it to contract it self that they much relax and expand it and consequently dispose it to admit an afflux of bloud especially when before fitted as I have said to be congested in or make its way forth of its vessels in the Brain And their influence seems to me to be very great likewise upon the fluid substances in the Brain which have all some lentor and therefore these admitted substances by reason of their activity may easily exagitate them whereby the passages must come to be enlarged and so become capable of an afflux or congestion I own indeed that in some cases of Headache they may be and have proved a very effectual remedy as perhaps when the matter that causes it may be acrimonious but not in the degree or kind to produce convulsive symptoms all sorts of aculeated particles being not fit to produce one effect which the soft particles of these may by their adhesion so blunt or sheathe that their lancination must therefore immediately be taken off But as these cases are but rare so also there ought to be a distinction made between the administration of medecines upon an emergency and their common use when no cause requires it which last the present caution refers too for then there is reason to suspect they meeting with no hostile particles may too much relax and open the pores of the Brain and so give occasion to the suggested inconveniences If the experiment of convulsive symptoms which imply contractions ordinarily excited by these medicines in those who are disposed to Hysterick fitts be urged against this notion which supposes the distemper under consideration to proceed from a laxity I answer first that it seems probable that these convulsive symptoms proceed from a kind of Explosion according to the sense of Dr. Willis which must first inferr an Expansion of them and then a contraction when the due requisites to it concurr for Secondly the Aromatick particles though of themselves very soft and agreeably entring at the pores of the nerves yet finding after their admission heterogeneous and fermentative substances in the Braines of some persons may be very much inclined from their congress first to agitate and then in return be agitated by them from whence the Brain being vellicated is forced into contractions to expel them upon which lucta too such corpuscles must in probability be formed as may prove very vellicating on a second score and so continue these fitts as being uncapable to be sodainly expelled Whereas when they happen to be applyed to persons not abounding with such fermentative particles they may only relax the tone of the Brain and so dispose to Apoplexies on the forementioned account On the same score I conceive Snush especially made as 't is usually with Aromaticks and Perfumes and so mild either on the account of its ingredients or from frequent use as not to cause Sternutation to be prejudicial instead of being advantageous to the health