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
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
Bloud even in the vessels for any considerable time necessarily kils both from what appears upon dissection not only Wepfers before mentioned but others observations evincing it and I my self happened to observe the same in the dissection of a very worthy Lady the Lady Pakington the relation whereof was published in the Philosophical Transactions Num. 173. A. D. 1675. as also in regard it seems difficult to make out how from a slow congestion if viscous matter be the cause or from an exudation of Serum the diffusion whereof though somewhat more speedy than in the supposition of viscosity is yet comparatively slow to the sodainness of the invasion much more from so very slow a congestion as must produce a fleshy substance as the polypus is unless on the occasion of its dislodging even now mentioned all the Animal functions from a perfect exercise of them as is most usually observable should so instantaneously be destroyed Whereas the effusion of the Bloud out of its vessels may rationally yield an account of this defection with as great swiftness as can be imagined the Bloud as I said before once got out of its channels being propelled by means of the impulse from the heart so as to diffuse it self immediately over the whole substance of the Brain so farr as the investing membrane will permit And though only one Lobe of it chance to be disaffected yet the commerce being broken off betwixt the spirits in this and the rest it seeming probable though from the disproportion of our organs to discern those extremely small passages not autoptically demonstrable that there is a constant one by some small Meatus through the whole Brain the action of the whole must cease since 't is observable that for preforming regularly the actions which are the province of any organ all the parts of that organ must be duly constituted and therefore much more ought this to be observed in the Brain whose action is so much more considerable and nice than any of the rest as influencing the whole Body as well as its texture is more curious and substance more tender The Fourth thing proposed to be considered was the Disposition of the part where the distemper is seated to be affected which having endeavoured to make out to be the Brain we are to reflect that much of the invasion of the distemper as was before insinuated is owing to the vitiated organization of it and not all to the perluent liquors For if it be firme in its tone and otherwise rightly constituted there is reason to suppose it may caeteris paribus much resist morbifick impressions whereas if it have been before weakned 't is obvious 't will easily yield to them We see in Feavers that the Bloud runnes rapidly enough through it and in an Anasarca and cachectical habits the Serum makes up much the greatest part of the Bloud which might therefore be presumed apt to overflow that tender part so also 't is observable that the Bloud many times appears extremely viscous as in Pleurisies Rheumatismes c. Yet in none of these cases ordinarily are the persons inclined to Apoplexies so that though the irregularities of the liquors may sometimes occasion them without this predisposition oft he Brain yet when it appears they invade more frequently than otherwise they use to doe there seems considerable reason to suppose that it deflects some way or other in its Organization from what is natural to it This defect I deny not may perhaps sometimes consist in too great a Closeness of its texture whereby a partial obstruction of its vessels may be made by degrees from the adhesion of some viscouse matter deposited by little and little by the circulating Bloud about the capillary arteries and so the Bloud behind comes indeed only to be retarded here whilst no disturbance happens to it but takes its course to some other region of the Body but if it once come to be more than ordinarily exagitated it may become so determined in its motion as at last to flow impetuously hither too but not being able to get through its usual channels must produce the effects before suggested of an irruption into the substance of the Brain but yet ordinarily I conceive it depends upon too great Laxity of it whereby when any forcible impulse happens it may too readily yield to it and so be sodainly overwhelmed This laxity may be considered to consist not only in a greater inteneration of its substance than usual and thence its easiness to yield to the force of the impelled Bloud to which in its due constitution it bears a proportion but likewise in the greater openness of its pores than is natural though the fibres that constitute it have their due degree of firmness whereby it becomes capable of receiving other and more bulky particles than usual as is consequential upon that texture so depraved which may possibly as in too serous and acrimonious a dyscrasy of the Bloud proceed from the abrasion of some of the looser particles that constitute the habit of the part by the perluent juyce supplyed by such Bloud and I suppose might be the case of the Lady before mentioned who being endued with an extraordinary acumen a great evidence of an exquisite constitution of the Brain yet abounded with exceedingly sharp substances in her Bloud or other liquors as many of her symptoms declared Which pores likewise may acquire other figures than are proper for them these concurring particularly to determine almost any of the Secretions whether simple or mixed that happen in our Bodies So that when the Brain happens to have its Organization thus vitiated and the other causes concurr an Apoplexy may in probability easily enough be produced So that to recapitulate I conceive the part effected may either be the whole Brain or any considerable part of it and either the Cortical or Medullar but especially or at least first the Cortical from whence the disaffected matter is transmitted to the parts of it which lye deeper where the animal spirits principally exert themselves the Nature of the distemper to consist in the sodaine abolition of the due excrasie and distribution of them thence the immediate cause most usually when unavoidably fatal an effusion of Bloud out of its vessels upon the substance of the Brain though I conceive a bare distention of the arteries there may occasion it as also may perhaps a congestion of viscous or serous matter when it comes to a considerable degree and becomes freshly excited or else Polypous concretions or if we can suppose it any other obstructing matter deposited in it may at last produce it and the predisposition of the Brain to it to consist usually in the more than ordinary laxity or openness of it These things premised I consider to advance a little farther toward the solution of the Probleme that whatsoever either 1 st causes a congestion of Bloud or 2 dly otherwise so indisposes it that it cannot readily and
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
introduced and also such a debility may be impressed on the tone of the Brain that they may much more readily invade if the ordinary though at other times innoxious for the most part at least occasions happen to bring these dispositions to effect Now 't is known that the Winter of the year 1683 from which I date my Aera of this frequency of Apoplexies was so intensly cold and that cold of so long continuance that no mans memory living could supply him with a parallel year and there was no need to repair to the Northern Region to make experiments of freezing spirituous liquors in order to find out the extent of this effect of it since which time it may be observed that this distemper has been so rife But since 't is requisite the Assertion should be established as much as posible by due observations it came into my thoughts to examine the London Bills of Mortality which may be presumed to be a standard for all the Kingdom as well as all other places where the same constitution of the Air has happened And though it may be urged that the accounts of diseases in them are taken by persons who are not Judges of those things yet many diseases carrying by their obvious symptoms such evidences of their nature that 't is almost impossible to mistake them and above all Apoplexies as before was suggested if the matter of fact whereof the Searchers are Judges as to the number of those that dye sodainly and 't is great odds those for much the greatest part dye of Apoplexies be cleare as I suppose 't is acknowledged by all I see nothing but it may be brought to establish the Hypothesis Having therefore looked into the general Bills for near Twenty years past I find the account of those that dyed of Apoplexies and sodain death which are there and I conceive may passably enough be reckoned under the same class to stand thus An. Dom. Apop sud 1670 79. 1671 63. 1672 65. 1673 84. 1674 101. 1675 86. 1676 84. 1677 66. 1678 83. 1679 103. 1680 95. 1681 94. 1682 100. 1683 108. 1684 152. 1685 112. 1686 129. 1687 110. From whence I think the probability at least of my Aera may be inferred whatever may be thought of the notions that are brought to give a reason of it For the great increase of number in the year 1684 must evidence that and it seems obviously deducible that as some great and general cause from the constitution of the season must influence such accidents so that assigned from the Coldness may have that energy here since both 't was so remarkable and nothing else appeared either upon my own or any others observation or notion so farr as I have yet learnt fit to stand in competition with it And from comparing the accounts of the subsequent years with those which went before there seems reason enough to suppose that since the indisposition lasted but in somwhat a lower degree though the external occasion have ceased the weakness impressed on the nervosum genus according to what has been before deduced is not yet obliterated And indeed if we take notice of a disease of another denomination in the same papers which by the dreadfulness of its symptoms is almost as evident as the Apoplexy viz. the class of Convulsions we may observe the effect of that impression on the Brain to be so farr from vanishing that it rather seems to be in the increase tho' the symptoms that declare it are altered that class standing thus An. Dom. Convuls 1670 1695. 1671 1650. 1672 1965. 1673 1761. 1674 2256. 1675 1961. 1676 2363. 1677 2357. 1678 2525. 1679 2837. 1680 3055. 1681 3270. 1682 3404. 1683 3235. 1684 3772. 1685 3420. 1686 3731. 1687 3967. So that though the flaceidity impressed on the Brain from that occasion may be in good measure by this time abated and unless the like or some as forcible causes happen again may 't is to be hoped quite cease and I suppose it may be observed that the forementioned frequency of Apoplexies is a late somwhat abated yet it may however have been so disordered in its tone as to make secretions of substances out of the alluent Bloud which carries matter for those of very many sorts which may become so disagreeable to the nervous liquor as necessarily to produce those terrible symptoms which tho' they kill not so immediately yet many times prove as certainly fatal at long running And the great numbers of vertiginous and other nerval indispositions which I presume other Physitians as well as my self usually meet with may very well argue some considerable indisposition impressed on the Brain more of late than formerly which must give a rise to them And indeed if we observe it we may find at least I have that most Feavers of late years and even at this time have been attended with nerval Symptoms as either Tremors or Convulsive motions in the Tendons or else Comatous affects Deliria for the most part slow or some others of this original And the Symptoms mentioned by that most curious observer of the changes of diseases my Learned and Worthy Friend Dr. Sydenham in his Schedula monitoria de novae Febris ingressu to discriminate the Feaver of this new Constitution from those foregoing are obviously those of the Brain or Nerves affected as may be easily collected by those that cast their eye on the History of it he layes down So that the notion is not to be restrained to Apoplexies but ought to be carryed farther to many if not most other nerval indispositions which I conceive may be occasioned by the same general cause For if it be determined to act on the Brain to its weakning as I have endeavoured to demonstrate intense Cold is the constitution of it and its appendices being very much differing in several persons it must follow that diseases of various kinds and denominations may happen according as the organization of either the Brain or the Systema Nervosum which may be possibly concluded to be the whole Body except the liquors and Parenchymata happens to be different in some from what it is in others And indeed the Brain in all persons who have even the most firm constitution of it being yet of too tender a one to resist all impressions made by so powerful a cause as the forementioned disposition of the Air was being so hard to be restored when once injured if that be not fully done easy to be afresh affected even by much less powerful causes of many other kinds which frequently happen upon the various mutations of the Air 't is no wonder that the Bills should be so filled with Convulsions aswell as that other nerval indispositions should now adays so much invade But in relation to the numerousness of Convulsions mentioned as I said in the weekly Bills it being objected that their fatality happens probably most to Children which having been born since that frosty
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