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
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
But from which of them 't is requisite we enquire To consider first the Passive qualities of the Air Dryness and Moysture it may perhaps seem probable that they may in order to produce this as well as some other distempers indispose the Brain the former by hardning the tone of the sanguiferous vessels in general and consequently contracting their tubes and so causing an acceleration of the motion of the Bloud through them which must if propelled with the same force at its original runne more swiftly through vessels when thus straitned than whilst having their usual dilatation whereby it may be presumed that when cast forth of the arteries into the interstices between them and the veins at their extremities it may make its way into the more yielding substances it is any where to pass through and the Brain being confessedly more so than any other part of the Body is therefore most likely to be affected on such occasion the latter which is countenanced by the great Hippocrates Sect. 3. Aph. 16. by intenerating the Brain so much beyond its usual constitution that it may thence become more than naturally susceptible of the always briskly circulating Bloud Next as to the most efficacious of the Active ones Heat it may perhaps be urged that the Bloud though otherwise well enough constituted being much heated and rarifyed by that excess of the Ambient might be inclined to make its way out of the vessels in the Brain especially on the account of its forementioned tenderness But besides that experience warrants none of these suppositions perhaps it can hardly be made out 1 st That so great a dryness as must effect this can be introduced into our Bodies which are continually irrigated not only by the circulating Bloud but other secondary liquors 2 dly That a great excess of moisture in the Air should produce Apoplexies unless those more rare ones as I suppose they are from the Serum and that generally after other distempers which have weakned the crasis of the Bloud as well as the tone of the Brain since such a dyscrasy impressed on the Bloud seems to make it more torpid by clogging the spirits in it and so less apt to inundations and besides relaxes the vessels as well as the substance of the Brain and so favors its ready passage along them and 3 dly That the excess of outward heat should cause this eruption since by it the solid parts may be as well presumed to be invigorated to resist as the Bloud excited to attempt it besides that the transpiration that is occasioned by this heat may sufficiently compensate for the accelerated motion of the Bloud its quantity which may in that case be principally dangerous being thence diminished It remains then to attribute this frequency of Apoplexies to the Coldness of the Air as the most adequate occasion which when it happens to be intensly so may I conceive be made out to give a probable reason of it That Cold is a great enemy to the Brain is both the general sense and confirmed by the authority of Hippocrates Sect. 5. Aph. 18. and all Physitians since and therefore we may possibly inferr that the great Architect fenced this part with so strong a wall scarce more to protect it from other injuries than this to which 't would otherwise be exposed But how Cold affects it so injuriously may require a little explication In order to it give me leave Sr to consider without pretending to discuss it so minutely as men of more Philosophical heads and better accomplished in such speculations might the nature of Cold as being requisite to be known in some measure to the understanding its relative effects Which attempt indeed might appear very presumptuous after that the exquisite Mr. Boyle has not thought fit to determine in the matter but that you may perhaps find that the short deductions I make however unartificially are either taken from or I conceive reducible to what he has delivered and so farr from being positively asserted that they are only submitted to the censure of your and others better judgments To which purpose three or four general considerations seem not unfit so farr as belongs to our present disquisition to be taken notice of to give an account of its manner of affecting us In the first place then it may be considered that though neither Cold nor Heat nor any of the rest of the sensible qualities have any real Being but only in relation to our perception insomuch that were there no sensitive Beings there could be no such things yet they must be founded on somthing that does really exist as all accidents besides are So that though they cannot be reckoned amongst the general affections of matter as motion though they depend upon it or its contrary Rest Bulk Figure c. are which would still be where matter is tho' there were no sensitive Beings yet are consequent upon it but determined by these and associated to somwhat that has perception Secondly That 't is evident our sensories are affected by Cold that is have some impression made on them Now nothing can affect but by approaching to that which it does so affect and to approach requiring motion it must follow that motion must go to constitute the nature of Cold. Which though it may seem not so evident since Cold is reckoned contrary to Heat and this consisting obviously in motion it may be urged that should in Rest Yet it may be returned that tho' it be necessarily to be inferred there is motion where there is Heat yet not always that there is Heat where motion so that 't is not motion simply but considered with some adjunct viz. motion in such or such a degree and with relation to sensitive Beings that constitutes Heat and consequently that 't is not to be inferred that Cold consists in absolute Rest because contrary to Heat but in a different degree of motion though other mechanical affections must concurr to determine it which recedes on one hand from a middle degree of it in our sensory as that which makes Heat does on the other Which too may be evinced from hence that each of them having a great latitude of degrees must be founded in what admits of degrees which motion does but Rest not Thirdly that motion here being not to be considered abstractedly but together with the subjects of it and as occasioned by and produced in some Bodies we may take notice that as 't is evident the Bodies without us which excite our sensation are moved so our organs which are designed to receive the impressions of these extraneous objects and transmit them to the Soul can hardly be presumed to do it any more indeed than prove a fit mansion for her without having their particles whether consistent or fluid for both are necessary to their construction in motion and not only so but endued with a determinate degree of it This degree ought not to be violent for so the
many contumacious distempers which by calming instead of exagitating the Bloud a little disturbed would quickly have gone of so 't is fitting that those should be admonished of the ill consequences of such a method who I will beleive out of charity which yet would be more fitly employed otherways adventure upon it especially near the beginning of feaverish indispositions before the morbifick matter is digested and fitted to secede as well as the multitude of pretenders to Physick who without a due knowledg of the grounds of Physick which those that industriously study it know are not easy to be attained make this their sacred anchor when they know not what to doe Another sort of evacuations for prevention may be proposed viz. By Fontanells But though these look speciously and many are fond of them and indeed they may be possibly useful to such who have escaped out of one fit as a constant draine to divert some humours from the Brain which by too much relaxing or otherwise indisposing it might occasion returns this part requiring thence as I have deduced a long time and diligent regulation to recover its native tone and so may need all manner of diversions as well as other assistances Yet to persons free from other indispositions that require them I should think them if not in some degree prejudiciall by drawing away some part of what should be retained at least superfluous the humour evacuated at them bearing usually but a small proportion to the dayly supplyes brought into the bloud which therefore may become much depraved for all the assistance these can give especially in regard the evacuation is not of a peccant humour in general but made up of any sorts of particles that can get out of the apertures of the divided vessels and much different from what is of natures designation in parts fitly by her Organized upon the first construction For I cannot conceive it otherwise elective than as those apertures which on the score of the Incision or Erosion of the Vessels must be large can only discharge some such sufficiently for the most part complex substances from the bloud as are of a bulk and figure commensurate to them or less without any relation to them as disagreeable to the rest of the masse and so from that largeness of the apertures there must be transmitted a much greater number of useful than truly excrementitious substances To say nothing of the disturbance which the pain must occasion in a Body otherwise sound Whereas most of the useful evacuating administrations except Phlebotomy which produces its effect mainly by the quantity 't is used in make or presuppose a laxity and separation of parts in the substances from whence the evacuation is to be had as well as effect it at emissaries fitly framed and disposed to let go such or such determinate humours Secondly As to the corroborating the Crasis of the bloud Though those who are in perfect health need it not and medecines of that tendency may perhaps make it ferment too highly and so perhaps occasionally introduce the distemper which the pretext of giving them is to prevent yet to valetudinary persons or those whose bloud upon emission appears viscous or is otherwise depraved I suppose such administrations are very necessary And to such I would universals premised propose a course of bitter medcines both at Spring and Fall if they are of cold and Phlegmatick constitutions as I would advise others whose bloud is too apt on light occasions to be exagitated the familiar use of appropriate calming medcines But to all Chalybeates to be diversified and given with different vehicles according to the several constitutions of persons may be of most extensive use and have this to recommend them that they need no strict regulation nay their effect is depressed by confinement stirring and changing the Air both actuating them and exciting and fermenting the bloud as also strengthning the tone of the parts Of these the Chalybeat waters as those of Tunbridge Astrap and which I believe is second to none Ilmington in your neighbourhood and the like drank in Summer and perhaps at other seasons but that custom has not authorized it here though Henricus ab Heer 's as great a judge of that as any man in his Spadacrene Prescribed them with as good success in the midst of Winter as at any time besides for a month or longer are as the most familiar and confirmed by the practise of the greatest Physitians of many ages so perhaps the most efficacious of any preparation of Steel as being taken up by the water running through the Minera whilst the mettal is yet in solutis principiis as the Chymists speak and so most subtil and active if so be the Brain happen not before to have been too much intenerated in which case perhaps the water it self Symbolizing with the indisposition especially the quantity considered may predominate over the power of the Vitriol dissolved in it to constringe the before weakned part And the diversion to be used at the Wells may not a little conduce to the effect of rectifying the bloud by exciting the Spirits But as to the several Chalybeate preparations give me leave so much to digress if you will call it a digression as to say that I think if the parts of our body and crasis of the bloud are only to be strengthned and no store of Acids abound those of them that have been opened by Acids and so reduced to a Vitriol are most useful since they may easily and immediately be distributed without the trouble given to Nature which is not always able to actuate a stubborn medecine that needs a strong key to unlock it farther to prepare them to be fit to enter into the recesses of the body But if Acids abound in us the judicious Dr. Sydenhams method of giving the brae limature unaltered for I believe his Extractum Absynthii can have little of the effect of an Acid upon it must be the most prevalent of all since both the intentions viz. of absorbing Acids and then strengthning the crasis of the bloud and the tone of the parts are by it answered the Acids in the Stomack proving perhaps as fit a menstruum for making a Vitriol for those uses as those in the Chymists hands whereas the intention of absorbing if it have place can hardly be satisfied if the medecine have been before satiated And indeed Acids being apt to be so predominant in us especially in Hypochondriacal distempers which are so very frequent as not only very common eructations and vomitings of that kind but the effect of Urinous Salts testaceous medecines the usual antiscorbuticks which are generally found to abound with volatil Salts and other obsorbers of Acids evince besides the rationale of such distempers which is speciously deducible from the predominancy of Acids that great persons proposal of it in that though gross yet frequently very effectual preparation seems to be the most universally solid
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
of those that immoderately use it and more perhaps then the Apoplectick Balsoms because both the matter of it is more gross and thence apt to lye longer about the extremity of the Olfactory nerves and so continually to affect them and also the custome of many is as I have often observed ever and anon to be supplying more whereby the pores of those nerves are kept continually open And I must suspect that should any Pestilential Season invade which God avert such persons as much accustome themselves to these pouders would caeteris paribus be in more danger of receiving infection than others since from the symptoms delivered by Authors the pestilence appears to seyze the Brain particularly and the sodain fate recorded of those that without any preceding indisposition have whilst that raged fallen down dead in the streets seems not so easily accountable for any other occasion than that the pestilential Miasmes are admitted at those nerves since all other ways to the Brain the source of sense and motion and indeed of all the actions of life is the most likely seate of this sodain prostration 'T is true it may be urged that many which use it receive no apparent injury and indeed some are of so firm a constitution of the Brain as well as of the whole Body that comparatively great occasions of sickness will have little or no influence on them whereas others are affected by very small ones But I think the objection may as well be urged as on another score I a little before intimated by those who having long indulged themselves in immoderate drinking have yet lived to a great age when 't is obvious that many more much shorten their Lives by it But though not Apoplexies yet Vertigoes and other distempers which shew the Brain debilitated may hence perhaps arise Secondly as to the Cure of an Apoplexy It consists according to my notion before alledged of the Cause chiefly in copious Phlebotomy since nothing else seems capable of dislodging at least sodainly and this distemper of all others requires a Sodain remedy the morbifick matter For the distention both of the Sanguiferous vessels and habit of the parts being by a good depletion taken off sodainly the Fibres which constitute both must be presumed to contract themselves by their Tonick motion but especially those in the habit the Elastical pressure of the Ambient as concurring ordinarily So in this case especially when the resistance within is abated So that when what is nearest the Heart runs into it with some impetuosity the rest both finding roome enough in the Veines and being urged on not only by the arterial bloud behind rushing into the veins the faster when it has more roome but also by the Systaltick motion now the distention is taken off must leave its former recesses and be restored to circulation Which action is quickly propagated to the Brain and that put into Analogous contractions But this may be presumed most effectually to happen whilst the Vessels are only distended before the bloud hath made its way forth into the habit of the Brain which if it once hath at least in any considerable quantity the distemper seems scarce at all remediable either by this or any other administrations both on the account of the forementioned difficulty if not impossibility of its getting out of those recesses into the veines again and also the yeildingness of the Brain to the Pulsifick protrusion of the bloud behind This Phlebotomy I conceive ought to be administred to Thirty Fourty Fifty or Sixty or perhaps more ounces at a time some persons requiring more to be taken away some less according as the congestion and obstruction happens to be greater or less and the quantity of bloud to abound in the Body if the Pulse which should be tryed during the bleeding fail not Otherwise considering the great quantity we have in our Bodies 't will not satisfy the indication And by such an evacuation viz. to at least Sixty ounces at once D. Gibbons of Oxon a person whom you as well as I know to be besides his great parts and general Learning of that sagacity and judgment in Physick that his example must much justify the practise cured an Apoplexy there some time since thought deplorable as if you question the relation from me you may be satisfied both from himself and his Chirurgeon and also several others that were present And were it proper for me I could alledge Analogous instances of such profuse if you will call them so evacuations of that kind in my own observation attempted with great advantage to my Patients And if the first bleeding secure not the Patient it ought after a few hours to be repeated and so if need be several times there being much more danger from the disease than loss of bloud which has usually been observed to have been spent as I a little before noted upon wounds or Spontaneous Haemorhages in much greater quantity without loss of Life and the consequent weakness has soon been corrected by a due regimen of diet or perhaps some other assistances Nay even Old Age ought not to supersede this remedy however the assertion be like to be censured for very bold by many who more consult their own fears than the reason of the thing For besides that such antient persons who are inclined to Apoplexies generally abound enough with bloud theirs is more apt to grow viscous from their decay in some degree of spirits and their inability to a sufficiently brisk action requisite to spiritualize and keep it in a due crasis so that when apt to distend or get out of its vessels it ought to be taken away in good quantities both in regard the decayed strength of the part affected is not proportionally to what it formerly was sufficient to manage it and return it into its proper vessels or its usual circulation in them and also because if it be in them once grown viscous 't is scarce possible it can be corrected for the forementioned reasons and therefore according to the sense of the deservedly famous Botallus ought to be taken away that better from the supervening nourishment may be substituted in the roome of it the sanguifying power though upon a considerable abatement of the quantity being in the rest sufficient even in the eldest persons to transmute the appelling Chyle which from its previous preparations we feeding on nothing but vegetable or animal substances which must be highly digested and exalted to be brought to either of those estates and those farther exalted generally either by Elixation assation or fermentation wants little of the perfection of Bloud even before its admission into the mass of it as if prejudices were laid aside might be collected from instances which now and then occurr of old people who by wounds or haemorhages loose great quantities of it and yet recover nay many times increase the vigor they had before these accidents and I see no reason why what
nature or chance authorize to be innoxious may not be attempted by art when great indications occurr which intimate how unsafe 't is to permit them to goe unsatisfyed And to countenance this opinion give me leave to subjoyne though 't were not hard for me to bring many more instances of this kind that 't is near two years since a very worthy Lady the Lady Yate of Harvington in Worcester-Shire of the age then of 77 years was taken Apoplectical and though the imminent danger of it were taken off before Phlebotomy was administred yet it left so great a vertigo and so general a weakness on the Brain and all the Body her Ladyship though before very vigorous considering her age and endued with a very great understanding and memory as all that have the honour to converse with her must testify being reduced to the condition not to turn her self in her bed besides a great decay of the intellectual faculties that to comply with my judgment and the duty thence resulting to my patients who put their lives under my conduct I caused assoon as leave could be obtained between twenty and thirty ounces of Bloud to be taken away with great and immediate success and the like was done again in the same quantity within a week after upon a fresh increase of the symptoms without any debilitation from it but on the contrary with remarkable advantage both in relation to her recovery of memory and understanding and also strength of Body Since which time her Ladyship using due medecines and regulation has farther attained so great a degree of these powers as at these years is much above the expectation of any that were witnesses of her indisposition I conceive indeed to endeavour to evince a little the utility of Phlebotomy in ancient people if you will not call it an excursion Old Age to consist more in the Induration of the Solid parts than in the absumption vappidness depauperation or any other depression of the spirits in the Fluids or what we call the Humidum radicale for these fluids are daily repaired and would be in as high a degree spirituous as ever considering the previous exaltations just now mentioned were the solid parts equally disposed to impress due motions on them and the Strainers and other passages fitted as formerly for their transmission and Secretions Whereas those once growing harder can neither undergoe their due contractive motions as they were wont nor thence sufficiently effect a division of the particles of these wherein Spiritualization consists only the finer and more spirituous if agreeable the substances are that are brought to them by the Chyle the more they must be a new intenerated and so become more fit to perform their office toward the adapting these for the functions of life And as to what concernes the celebrated notion of a Humidum radicale which begins with our life and continues individually the same tho' in quantity diminished and allayed which diminution must on the same account before it arrives at its utmost periods cause Old Age I can hardly think that Considering the comparative tenderness of our Bodies the motions both of our Bloud and other fluids within us and of the Atmosphere that in more than one sense unfathomable menstruum for the dissolution of Bodies without us the daily supplies of aliments whose particles are sufficiently on the score of their texture agitable and the openness of the pores every where any particles that constituted them at first can continue for any number of years but must be all one after another in no long time thrust forth as these causes come to act on them to make way for fresh ones that bring with them a sutableness to the parts which they on those accounts must have lost For I cannot apprehend any other difference according to the slenderness of my capacity between the Spiritus insiti Influentes Humidum nativum if these be corporeal as I know not 't was ever doubted and the Rest of the grosser substance that makes up the Body than what depends upon the Figure Magnitude Contexture and Relations thence resulting so that the more fine and subtil any of these substances are I conceive they are so much the more easily dissipable and therefore far from being so durable as the supposition of the Humidum radicale requires When therefore on any occasion the Bloud in those who have this induration of the parts becomes unapt to be duly moved as 't was wont it seems very requisite that it should be taken away in some such quantity as to render the motion of the rest more placid the distention of the vessels being thus taken off so to make roome for what is more fine and apt enough to be quickly spiritualized and to become a fitter matter for nutrition and if you please supplyes of the Humidum radicale whereby also that degree of rigidness of the parts by the appulse of this softer Bloud may be corrected and so besides the satisfying many times a present and urgent indication Life prolonged if this administration were more frequently but prudently used to a considerably longer date than for the most part it has But to returne If we make but a reflection on the quantity of bloud which very able Physitians have concluded to be naturally in our Bodies viz. from about 16 to 25 pounds according to the bulk and constitutions of persons which too by full feeding and want of due exercise may possibly at some times be considerably increased and withall how that many not only live under great fastings for many days whether for want of appetite or constraint which Evacuations proceeding notwithstanding at least that of Transpiration which according to the observations of the accurate Sanctorius is much the greatest of them all must necessarily diminish the quantity of bloud much below the proportion that any Physitian by bleeding dares though for reasons not so proper for this place and the brevity of a letter already swelled too much the advantages thence resulting in many cases equall not those of a free Phlebotomy and yet afterwards recover to as good a state of health as ever they enjoyed we ought to lay aside those panick fears of a comparatively plentiful evacuation this way especially when the distemper seems hardly superable without it and a little delay and oversight in this point as well as in war puts the matter past retriving I know large bleedings nay even in Pleurisies Peripneumonias Anginas c. are much dreaded by many not only of the unconsidering vulgar but even persons of all degrees and education and even by many Physitians of great name And 't were easy to cite great Authors who have either expressed their fears of it or so mince the matter that their apprehensions are obvious enough and he that frequently uses it cannot escape aspersions expertus loquor be the advantage to the patient ever so remarkable and must expect notwithstanding that alwayes to be dreaded