gives fome inftances of the good effects of Sailing, in those dif orders, which practice Dr. Gilchrift has endeavoured to revive. Dr. W. is confiderably, but very judiciously, diffuse on the use of opium, not only as a palliative, but even fometimes as a cure in certain circumstances of these difeafes. He makes fome very neceffary practical diftinctions in directing it; and with regard to its fucceeding, by a very gradual exhibition of it, in fuch as were thought incapable of bearing it (which was true in a common dofe) he usefully affures us, p. 362. as follows. Nay, this way, those who fuffer most from opium may be brought at length to bear it eafily; a remarkable inftance of which I lately had in a lady, whom four or five drops of laudanum taken by the mouth, affected with a violent pain and cramp in her ftomach; and fixteen drops in a clyfter, though it did not occafion thefe complaints, made her delirious for twelve hours; for this lady, having afterwards begun with one drop of Laudanum, gradually rofe to twenty-five; nay, fhe has fometimes taken that quantity thrice a day, without feeling any of its former bad. effects. In cafes of great fickness, accompanied with a pain in the ftomach and frequent vomiting, when the patient could not bear Laudanum inwardly, I have ordered three or four tea-spoonfuls of it to be rubbed into the ftomach and belly, afterwards applying to these parts a piece of flannel moistened with hungary water made hot. The effect was, that all the patients complaints began to abate in less than an hour after the application of the laudanum, which I ordered to be repeated at the distance of fix or eight hours, if it was necessary.'

In cafes where opium disagreed, from the coftiveness generally attending it, Dr. W. has experienced very good effects from the extract of Henbane, given from one grain and a half to three or four at bed-time, and repeated in a smaller quantity in the morning. After fome practical remarks on camphire, caftor, musk and afa fætida in these diseases, he gives a very remarkable cafe, p. 374 to 377. of an hypochondriac patient afflicted with a violent head-ach, and a bad ftate of the ftomach for three years, which were at last removed by opium, beginning with half a grain every night at bed-time, and gradually increafing it to I gr. and, and fometimes to two grains in a day. cure however was very gradual, for though he was fenfibly better within a month after beginning it, and in eight or ten months free from all his moft troublesome complaints, fo that he then. began to leffen the dose, or take it only every other night, yet we find it was not until the third year after his beginning it, that he was fo well as not to need above three dofes of it in a twelvemonth.

The

Dr. W. thinks a ftrong infufion of tanfy may be available in

fuch

##

fuch hypochondriacal and nervous fymptoms, as depend on wandering unfettled gout; as it has been found very beneficial in a manifeft one: though he confeffes he has had no patient who has given it a fair trial. Indeed we have perfonally known fome interefting inftances of many hypochondriacal and nervous fymptoms manifeftly owing to a gouty caufe. Our Author very honeftly confeffes, p. 391. that he never fucceeded in curing one of thofe hypochondriacal patients, whofe blood was fcorbutic, which appeared from their fpungy gums, laffitude and other fymptoms, But he distinguishes this kind of connate scurvy, as perhaps it may be called, from that contracted at fea, or from a marthy fituation, by the fymptoms which attended it. Some efficacious and elegant prefcriptions are interspersed throughout this valuable chapter.

Dr. W. fuppofes lime-water might be available in diffolving that tough phlegm in the ftomach, which is one cause of these diftempers, by obferving that it diffolved ifing-glass, and other glutinous fubitances, of which he gives two experiments. With this intention he directs an English pint of it to be taken every morning on an empty ftomach, fafting two hours after it; taking alfo half a pint an houranda half before dinner, and before supper. He is very judiciouffy particular on the article of aliment in thefe diforders; but afterwards acknowleges, that, upon the whole, no constant rule can be given, as to the kinds of food, from the great diverfity of agreements or difagreements, which different foods have with many perfons. In treating of indolent obftructions or fcirrhofities of the bowels, as one cause of thefe diseases, after mentioning many medicines, and greatly recommending gentle frictions and emollient fomentations, he mentions the extract of hemlock as follows, which we cite the more exprefly, as it may be thought a medical defideratum to ascertain the real power of this modern and highly predicated medicine.

Of late the extract of the cicuta has been much extolled as a deobftruent; but although I have tried it, as well as the powder of hemlock, in feveral hard fwellings, fome of which were external, and others fituated within the abdomen, I have only seen it do fervice in two cafes, one of which was a large fcirrhous fwelling in the left breast, and the other a hardened gland in the neck. The latter was removed by the extract of the cicuta in eight months and the former, by the continued ufe, either of this medicine, or of the powder of hemlock, has not only been kept from increafing for thefe four years paft, but is now reduced to one third of the bulk it once had.'-In the article of Exercife he justly prefers riding, which Sydenham did, near a century ago. He carefully enjoins the ftricteft regulation of the

paffions,

paffions, and closes this chapter by the following honest acknowlegement:

Nervous or hyfteric affections, from a concealed or dif appointed paffion, are better cured by the fruition of the object; or, if this cannot be obtained, by proper diet, amufements, and by opiates, especially at bed-time, for compofing the mind, and procuring fleep, than by the whole clafs of nervous medicines.'

The eighth and laft chapter treats of the cure, or of the palliation, of the most remarkable nervous, hypochondriacal, or hyfteric fymptoms; and through the courfe of it the Author frequently refers, as might be expected, to the immediately preceding chapter. Convulfive motions, or fixed fpafms, of the muscles are first mentioned: and after obferving, that, as they may arise from different causes, their radical cure muft confift in the removal of fuch caufes; and having specified the properties of such medicines as are adapted to their palliative or temporary cure, he infifts more particularly on the great advantage of fomentations of warm water, and ftill more of bathings of the legs, in this symptom, of which he gives feven successful cafes; after which he fays, p. 458.- Instead of adding more cafes, I fhall only obferve, that I have faved more patients wha appeared to be in great danger, in the delirious ftate of a fever, by the fomentations, and especially by the warm pediluvium, than by any other remedy: and even in those cafes, where thefe applications were infufficient to compleat the cure, they, almost always, gave some prefent relief, by making the patients fomewhat quieter, and disposing them to fleep.'

A curious cafe is related of the efficacy of fear, in removing a very remarkable convulfive, though regular and alternate motion of the maffeter and temporal muscles, from no affignable caufe. For on the girl's refufing to take a bolus of rhubarb and calomel, directed by our Author, from a fuppofition of its arifing from worms, the convulfion immediately ceased, on her father's going for a horsewhip to punish her. The common cure of the cramp by grafping a roll of brimftone in the hand Dr. W. affirms he has often known to fucceed; though he does not fuppofe, with others, the snapping of the brimstone to proceed from the discharge of a great quantity of electrical fluid from the patient's body, to which they afcribe the cure. He thinks the heat of the hand may be fometimes fufficient to occasion this fnapping, which any heat a little exceeding that of the human body will effect; and he afcribes the cure to the attention and the faith of the patient; though rather to the furprize occafioned by the fnapping: adding, in confirmation of this opi nion, he has known fome in the cramp to mifs of a cure, after they were informed, the fnapping of the brimftone was owing

to

to the heat of the hand. This article concludes with obferving, that, when this fymptom arifes from fharp humours in the fto mach or inteftines, the expulfion or correction of them is neceffary to any durable relief.

For the removal or palliation of hyfteric faintings with convulfions, he directs fome of the anti-hyfteric fœtids, but declares he never found any thing fo effectual as the pediluvium; by which, after the vain exhibition of various medicines, he has feen the patients restored, as it were inftantaneously, to their fenfes.

If violent pain with a cramp in the ftomach be attended with an inclination to vomit, he promotes it with warm water, and then directs a glyfter of fix ounces of the fame, with laudanum, from fifty to eighty drops; giving alfo two fpoonfuls of a mixture of mufk, with fome ftomachic and carminative water every four hours. When this fymptom is owing to the true gout, blifters to the ancles are added.

An indigeftion, with vomiting and pain in the ftomach, is to be treated varioufly according to its particular caufe: When owing to fcirrhous obftructions in the alimentary canal, palliation only can be expected. Two cafes are given here of ladies cured chiefly or folely by laudanum, after the failure of many other medicines. In flatulent hyfteric colics, with a coftive body, laxative clyfters, with a drachm or two of afa fætida, are recommended. In violent vomitings, draughts of falt of wormwood with lemon juice are ordered to be taken in the act of effervefcence. But Dr. W. avers, he has always fucceeded in such cafes, by directing a clyfter of warm water, with fifty, fixty, or even eighty drops of laudanum in it; giving, in cafe of coftivenefs, fome pills of aloes with calomel, whofe operation ensued after that of the opium had terminated. In flatulence of the ftomach, he advifes the fpiritus æthereus with laudanum; giving an inftance of a lady about 45, who, in an extraordinary flatulent diftenfion of the ftomach, found nothing relieve her fo immediately, as a tea-spoonful of this fpirit, in two table-spoonfuls of water, which always brought up a deal of wind.

Under the article of a nervous afthma, which he obferves to vary confiderably in different perfons, and to require a various treatment, he gives a fingular cafe exactly defcribed, in which he found the moft confiderable relief, and even a temporary cure, from the bark. For palpitations of the heart he directs a various treatment, according to their different causes, those arifing from polypi in the heart, or its great blood-veffels, or from offification of its valves, being capable only of palliation. Among other remedies in an immoderate flux of pale urine, fuch as bark with fome cinamon, alum, &c. he recommends a tight broad belt about the patients loins, or a ftrengthening plafter, giving

one

one inftance of the fuccefs of the first, and two of the latter application. He has known a violent periodical head-ach, in a good measure prevented by a draught compofed of 45 drops of laudanum, 45 of tincture of ipecacuanna, half an ounce of fpirit of mindererus, an ounce of rofe-water, and two drachms of fuga Laken an hour before the ufual approach of the paroxyfm, which generally excites a plentiful fweat, while it leffens the pain. Many other remedies are directed here, according to the different caufes of this afflicting fymptom; the cure of which, when violent, he thinks, is always to be commenced with pe diluvium, &c. Low-fpirits, the laft article in this chapter, are confidered as refulting from four different caufes, the specific treatment of each being added; though the Author very ingenuously concludes his work, with respect to this fymptom, from the fourth cause, in the following terms. When low fpirits or melancholy have been owing to long continued grief, anxious thoughts, or other diftrefs of the mind, nothing has done more service than agreeable company, daily exercife, and a variety of amufements.'

Thus have we given as full, and as connected an abridgment of this useful and ingenious work, as our plan admits of. The Author's frequent and modeft acknowlegements of his infuffi ciency to account clearly for all the phænomena of this multiform disease, wholly to eradicate its various caufes, many of which are inherent in the original fabric of several constitutions, or always to remove their effects; these confiderations, we fay, muft abundantly preclude every ingenuous Reader, from making any fuch objections to his work, as are manifeftly founded in the great limitation of the human capacity. It was impoffible for us not to observe, from this furvey of the treatise, that few medical works of the fame length have been conducted with a spirit more directly oppofite to that of empiricifm, or mean selfishness; the Author, having, we fuppofe, publifhed full as many inftances of his failure as of his fuccefs; whence it is plain the love of truth muft have operated in him with a great . and very amiable influence. Where he differs, either from the particular opinions of other eminent medical writers, or from the generally received doctrines and practice in thefe difeafes, which are not very feldom the cafe, it has not the air of differing for the fake of contention or through the love of novelty: fince generally fome very probable, and often indeed ftrong reafons are produced to countenance, or to confirm his difference of judgment. He feems, without the leaft referve, to have faithfully communicated whatever was remarkable, and fell within his own experience, in the cure or mitigation of this clafs of diseases, for which the republic of medicine are the more obliged to him from their natural abftrufenefs, which he has conREV. Sept. 1765.

tributed