Part 3

These arise from the same Cause as the Preceeding, the great inward Heat being a constant _Stimulus_ to the nervous Parts, and obliging the Sick to seek continual Change of Place and Posture, in order to abate this uneasy Sensation. These therefore indicate the use of such Medicines as specifically correct the Acrid and Stimulating Particles, restrain the inordinate Effervescence of the Circulating Fluids, and attenuate the Viscous Cohesions, of which kind are diluting and attenuating Acids, temperate Cordials and Anodynes, in such Doses and Proportions as are agreeable to the Age, Strength, and other Circumstances of the Patient.

[Sidenote: _Delirium._]

This arises from the Inordinate Influx of the _Liquidum Nervorum_, occasioned from its Acrimony, Viscosity, and Quantity, different from those in a healthful State. Whence the Reflux of the Spirits to the Brain will be altogether irregular, and the Representations brought by them Irrational and Inconsistent. As this Symptom may arise as well from the increased as lessen'd Quantity, and different Texture of the Fluids, and Springyness of the Solids; so Regard must be had to the particular State of the Solids and Fluids in every Individual, for the abating of this Symptom.

[Sidenote: _Stupor._]

This Symptom necessarily supposes the Flux of the Spirits thro' the Brain and Nerves in some Measure intercepted or diminished, and consequently as the preceeding may arise from different and even contrary Causes, but generally in these Cases shews a greater Degree of Coagulation in the Juices than the former, and consequently of greater Danger from the more numerous Obstructions in the Capillary and Nervous Vessels. Agreeable to which is that Observation of Dr. _Hodges_, That they who were attended with this Symptom rarely recover'd.

[Sidenote: _Trembling, Faultering in the Speech._]

These depend on the same Cause as the former, _viz._ On the Diminution or Obstruction of the _Liquidum Nervorum_, whereby the Muscles are involuntarily and weakly contracted. As these suppose a more torpid Motion and greater Viscosity of the Fluids, and less Degree of Elasticity in the solid Parts, so the Method taken herein ought to be more active and stimulating than in any of the foregoing Symptoms. Whence Epispasticks, and the most Volatil Attenuating Medicines are more necessarily required, and ought to be oftner repeated, than in preceeding Symptoms.

[Sidenote: _Pain in the Head._]

This is Occasioned by the Obstruction of some of the Capillary Vessels of the Brain by the Coagulated Part of the Blood, and the wounding of the Nervous Filaments by the Poisonous Saline _Spiculæ_. Whence the Blood being resisted in its Motion, must press more strongly against the Sides of the Vessels, and distend them beyond their Natural Diameters, and produce a shooting and throbbing Pain; and if the Obstruction continue or increase, a Phrensy, Inflammation, Suppuration, and Gangreen of the Part affected. Why this Symptom should be one of the first, as well as a constant Attendant thro' the whole Course of the Disease, appears from _Prop. 2_.

[Sidenote: _Carbuncles, Buboes_, &c.]

Hence likewise appears the Reason of Carbuncles, Boboes, Vesications, and the like, which take their Rise from the same Cause, and are different only in Proportion to the Viscosity or Acrimony of the obstructing Matter, and the Situation and Structure of the Part affected.

[Sidenote: _Purple spots, Hemorrhages_]

These show the greatest Corrosion and Acrimony imaginable in the Circulating Fluids, so as to be able to break and destroy the very Vessels themselves, and consequently certain Signs of a speedy Dissolution of the whole Animal Oeconomy.

[Sidenote: _Dissections of such as have died of Malignant and Pestilential diseases._]

The Dissections of such as have died of these Diseases are a farther Confirmation of the foregoing Theory, inasmuch as they demonstrate a greater Acrimony and Coagulation in the Juices than other Diseases, by the numerous Obstructions Inflammations, and Mortifications of different Parts of the Body. Thus the Stomach and Intestines are commonly highly Inflamed, and frequently Gangreen'd. The Lungs, Diaphragm, and several of the _Viscera_ inflamed, obstructed, and beset with Carbuncles and Purple Spots. The Arteries of the _Dura_ and _Pia Mater_ obstructed, and stuff'd with Grumous Blood, and often mortified. The Arteries of the whole Body in general fuller than ordinary, the Veins more empty. The Vessels about _Præcordia_ much obstructed, highly inflamed, and often Gangreen'd. The membranous Parts of the Body in general more dry and rigid than in most other Diseases.

[Decoration]

CHAP. VI.

_Of the_ SMALL-POX.

From what has been said of the Nature of Malignant and Pestilential Diseases it will follow, that the Contagious Matter producing the Small-Pox does likewise Coagulate the Blood, and increase the Bulk of its constituent Particles, and that in such a Proportion as are capable of obstructing only the ultimate and perspirable Vessels, as appears, in that it principally, if not solely affects the membranous Parts of the Body, as well External as Internal. Now these Parts being formed of such Vessels, the Pustules could not happen in these more than other Parts of the Body, were not their Vessels thus obstructed, and obstructed they cou'd not be, but from the increased Bulk of the Sanguineous Particles, and that in such a Proportion as renders them capable of penetrating into, but not passing thro' the Cavities of the ultimate Vessels, as appears from the preceeding Propositions, and consequently, the contagious Matter producing the Small-Pox, must be indued with this peculiar Property. And indeed if we allow the different Degrees of Coagulation in these Contagious Diseases, and which appear even to our Senses, it will appear, that the Principal if not the sole Difference proceeds only from the greater or less Bulk and Number of the Coagulated _Moleculæ_, and Acrimony of the Coagulating Matter. Thus we see that in Pestilential Diseases, where the Degree of Coagulation and Acrimony of the Juices are superior to the rest, the Obstructions happen in the larger Glands, as are those of the Armpits, Groin, _&c._ The Circulation of the Blood being obstructed, or at lest much retarded in the Capillary Blood Vessels, as appears from the weak Pulse, Coldness of the Extremities, and the like, which constantly accompany it; And consequently the _Moleculæ_ form'd by the Coagulation of the Animal Juices must be larger, than these in the Small Pox, which proceed to the ultimate Vessels before the Obstructions are formed. The _Measles_ are another Confirmation of this Theory, whose _Moleculæ_ are still less than the preceeding, as appears by their Eruption with greater Flatness, and less Extension of the Obstructed Vessels. Thus also we see that in all these Diseases where the Contagious Matter is more Virulent than ordinary, or the Constitution of the Year more productive of these Diseases, or join'd with a Hot Tense and Scorbutic Disposition, Diarrhea's, Dysenteries, Purple Spots, Hemorrhages, Phrensies, Convulsions, Inflammations, _&c._ equally accompany these as Pestilential Diseases.

From what has been said in this and the foregoing Chapters may be deduced the Reasons of the greater or less Virulency of the Small-Pox, Measles, _&c._ in some Years more than others; As also why these Diseases shou'd rage with the greatest Violence when join'd with, or immediately preceeding a Pestilential Constitution of the Air. Hence also appears the Reason why Pains of the Head, Stomach, Loins and Back, preceed the Eruption of the Pustules, these Parts as nearest the Heart being soonest obstructed, and the _Impetus_ of the Blood against the obstructed Canals much greater than in the rest of the Body. As also why the Pustules should appear so much sooner in the Face, Neck and Breast, than other Parts of the Body, as appears from _Prop. 2_.

Hence likewise appears the Reason why the Fever, Vomiting, Pains, _&c._ preceeding the Eruption of the Pustules should cease or be much diminish'd upon their Appearance; The _Moleculæ_, by the Force of the Circulating Fluids, being driven into and fixt in the Cutaneous Glands, and Secretory Vessels, whereby the Capillary Arteries being freed from them, a more easy Passage is allowed to the Circulating Fluids. Hence also appears the Reason why the Fever gradually increases with the Augmentation of the Pustules, the Contiguous Vessels being compress'd by their Distention, and the Obstructions in the Secretory Vessels made more Numerous; whence the Quantity of the Perspirable Matter being Diminished, and the Canals streightned, the Vessels will be more full, and the Pulse more strong and frequent. Hence likewise it will follow, that the more numerous the Obstructions are, and more pungent the Contagious Matter, the more Violent the Symptoms will be, and the Matter of the Pustules when suppurated become an Acrid and pungent gleety Substance, or Laudable _Pus_. As also why the Time of Suppuration shou'd vary in Proportion to the Virulency of the obstructing Matter; and consequently the Reason of the Difference between the _Distinct_ and _Confluent Small-Pox_. Hence also it will appear, that Bleeding, in the Beginning of the Disease, ought only to be Administred where the _Impetus_ of the Circulating Fluids is so great, that notwithstanding the Diminution of the Force of the Blood by it, the protrusive Force of the Circulating Mass will exceed the _Impetus_ made on the Obstructing Matter by the Vibrations of the _Fibres_, and likewise why on its imprudent Use in the Beginning of the Disease, the Pustules shou'd disappear, and be driven back into the sanguineous Vessels. Hence also may be deduced the Reason of the Flux by the Salival Glands, the Swelling of the Face, Hands, and Feet, in the height of the Disease, the Vessels being at this time Turgid by the Suppression of the perspirable Matter; And likewise the Necessity of such Evacuations, as may reduce the Pressure of the Fluids upon them to such a Proportion, as the Tone of the _Fibres_ may be able to resist; And why where this is neglected, a _Peripneumonia_, Phrensy, Delirium, _&c._ do frequently succeed.

_Lastly_, Hence may be deduced the Reason why the Small-Pox shou'd rarely seize those twice, who have had a Competent Number of them. For the Ultimate Perspirable Vessels being distended much beyond their Natural Tone, by the Bulk of the Obstructing _Moleculæ_, the Secretory Vessels must be left wider than before, and consequently less subject to be obstructed by Particles of this Size; Agreeable to this is that Observation of Dr. _Sydenham_ and others, That in those Constitutions of the Air where the Small-Pox were very _Epidemic_, many (especially such as attended the Sick) who before had been affected with this Disease, were seized with a Fever in all Respects the same with that attending the Small-Pox, except only the Eruption of the Pustules, and the Symptoms which necessarily attend on them.

THE APPENDIX.

The Pressure of the Atmosphere on the internal Surface of the Lungs, as computed in the foregoing Pages, so much exceeding that made by the ingenious Dr. _Kiel_, in the last Edition of his Book of Animal Secretion, it may not be amiss for the farther Illustration of it, to show that the Weight computed by that Learned Author is not really the whole Pressure of the Atmosphere, but the Force of the Lungs in Expiration, by which they exceed the Pressure of the Air upon them. For let the Tube A B be inserted into the Vessel C D E F of any given Dimension, and both the Tube and Vessel fill'd with Water or any other Fluid, it is evident from the Writers in Hydrostatics, that the Vessel C D E F will be pressed upon on every Part of its Internal Surface equal to the Basis of the Tube, by the Weight of a Column of the contained Fluid of the same Height with the Fluid, and whose Base is equal to that of the Tube, and consequently every Inch Square on the Internal Surface of the Lungs will be pressed upon by a Column of Air, whose Height is equal to that of the Atmosphere, and base one Inch Square, which will amount to the aforesaid Sum. _Vide Pag._ 34 & 35. Now if we suppose the Tube X inserted into the Neck of the Bladder Y and the Air forced into the Bladder in Expiration, to an equal Density with that of the incumbent Atmosphere, it is evident that the Air will not go out by the Tube without some external Force, being in _Æquilibrio_ with the Atmosphere, and consequently the Force by which it is expressed thro' the Tube, must be that by which it exceeds the Pressure of the Atmosphere, upon the Orifice of the Tube.

If any one think that I have allowed too large a Quantity of Air to be taken into the Lungs in an Ordinary Inspiration, That is sufficiently recompensed by supposing the Diameter of the _Larynx_ equal to O.5 and its Orifice O.19 which is more than it can be, for the Diameter does not exceed O.4, and consequently its Orifice will be but O.12. Now it being demonstrated by the Writers in Hydrostatics, that Weights forcing equal Quantities of the same Fluid out of the same Orifice, are to each other as the Squares of the Times in which the Fluid is forced out, and that in equal Times and Quantities of the same Fluid forced thro' unequal Orifices, the weights are Reciprocally as the Orifices; The Powers forcing an equal Quantity of Air thro' the Orifices O.19 and O.12 must be to each other in a Reciprocal Proportion, compounded of the Squares of the Times and Orifices of the Tubes; Which will be found sufficient to answer any Objection of this kind, by any who will give himself the Trouble to compute it.

_FINIS._

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Transcriber Notes:

Passages in italics were indicated by _underscores_.

Small caps were replaced with ALL CAPS.

Throughout the document, the oe ligature was replaced with "OE".

Errors in punctuation, spelling, and hyphenation were not corrected unless otherwise noted. Many of the spellings look strange by modern standards, but then the rules for spelling changed since 1721.

Footnotes were moved to after the paragraph they were referenced in. The footnote identifiers are the same as in the book, with the identifier "s" being used twice,

On page 38, "Convnlsions" was replaced with "Convulsions".