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
substances of it which are apt to secede upon these parts of the Brain to which they reach from the impetuous protrusion from the heart and the vessels being here tenderest as all vessels not only are at their extremities but especially when they runn deepest and proportionally farthest because then they are smallest 't is no wonder that a congestion should soon be made where this is But yet if we consider their comparatively small number to those in the Cortical and how they must be better fenced and supported by their being distributed through a more compact substance as the corpus callosum is there seems less danger of either a congestion or extravasation in this region the strength of the tone of any part mainly conducing to the ready transmission of the perluent liquor And that this happens most usually in the cortical region three of the four instances alledged by Wepfer seem to evince in which I conceive it is easy to gather that they were the extime parts of the Brain that were most disaffected and therefore there seems reason to suppose must be primarily so But from hence Secondly The Nature of the distemper may be deduced And it seems to me probable that it consists indeed in the defect of that matter which should be supplyed to the nerves for the exercise of the animal functions but occasioned from the vitiated organization of the parts and vessels of the Brain from whence a due secretion which I have heretofore Tr. de secretione animali endeavoured to make probable to be here performed by a simple colature in the Cortical glandules of the nervous liquor out of the bloud cannot be made but that either from the forementioned distention of the sanguiferous vessels the secretory ducts cannot readily admit the matter to be separated the confusion of the masse emergent upon such a congestion prohibiting a regular secession or else the grosser substance of the bloud not moved as 't was wont being brought to the beginnings of the nerves must needs obstruct them and so cause an immediate cessation of motion in all parts below as well as by disturbing the regular motion of the spirits in the Brain hinder the exertion not only of the Intellectual but also sensitive faculties For though Intellection and possibly Sence belong only to the Soul as such which is a substance distinct in it self from the Body yet the exercises of it so long as the soul continues united to the body cannot be had but by its mediation our bodies being very fitly resembled to Hydraulick Engines whose structure disposes them to exhibit a great number of various phaenomena when filled with a due liquor and set on work by a mover distinct from them whether within or without 't is not material which as they whilst in order very regularly perform all the motions their fabrick directs to so if they happen to be either accidentally broken or disordered in any part or else the liquor they carry comes to be so gross as to obstruct them or corrosive or otherwise vitiated as to make its way through them must either undergo a total loss of their motion or at least a very great disorder in the several performances that the organical design requires Agreeably to which the Bloud appears to be the principal liquor for the motion of this curious engine of our body as being universally and uncessantly carried through all parts of it Not to make a comparison betwixt this and the Nervous juice which though it may be designed for more noble and perhaps much more extensive proximate uses than the gross masse of the bloud yet must be owned on the account of its small quantity and slow motion to be not fit for this design otherwise than to spiritualize and give an instinct to that and the Heart that impels it adde that 't is made out of the bloud Now if through the fault of its pipes the arteries and veines it make its way out of them it must of necessity extremely disaffect the parts in which this happens especially when they are designed for the nobler sort of uses Indeed Life as well from arguments of Reason as the Divine Oracles which tho' they teach many things above yet none against Reason and I conceive ought to be construed literally when the analogy of reason and nature countenances it though many things in them are owned to be spoken according to mens common apprehensions holy scripture being designed not to teach Philo but Theosophy seems to consist originally and therefore principally in the motion of the Bloud its first indicia being from the punctum saliens for which therefore so exquisite pipes are made to distribute it to all parts of the body and return it back again to its first source for reiterated motions and those so adapted to the secretory parts for the separating of substances from it for several uses that as all vital actions must needs be placidly performed whilst they are thus duly disposed so if any of them happen to be broken or opened at least in any considerable measure whereby this vital stream gets forth of its boundaries that due and regular motion thence ceasing Life must too But this must most effectually come to pass if this disturbance of the motion of the bloud chance to be in the Brain where the Soul sits by the consent of almost all inthroned and from whence she gives laws to all the Body so that if this her Royal seate happen to be overwhelmed with such a deluge and her intercourse with the rest of the body which her Empire over it requires intercepted 't is no wonder she leaves her province and mansion thus become so unfit for her residence But I must beg your pardon for these allegorical excursions which yet the luxuriancy of the subject readily affords This fault in the due Organization of the Brain consists either in an Obstruction of the passages or a Solution of the continuity either of which may easily occasion any of the symptoms For the former 't is impossible but that since there is a necessity of a due proportion between the cavity of the vessels and the liquors as well here as in innumerable instances every where to be met with to the performing of regular motions if any obstruction happen the Liquors must either move more sparingly than is requisite or be congested there or else the course of them must be diverted into other channels and so natures designation to be discerned by the known effects must be altered from any of which occasions as there must happen a defect of spirits to actuate the Brain and nerves and that proportionally to the greatness of the obstruction so if this happen sodainly and be total 't is evident that there must follow both a total and sodaine abolition of the animal functions In the latter the Bloud flowing out of its vessels must in so tender a part as the Brain quickly overflow a great part of
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
though as I said if Acids abound not the others I should think would be the most effectual The second general Indication The Coroborating the Brain may be answered in a great measure by the last mentioned administrations viz. the use of Chalybeates whose effect is generally owned to extend it self to all the consistent parts in the Body as well as the bloud nay must more to those than this since their action upon this is but transient but those may be presumed to arrest and detain them though not all yet as many as their Pores can conveniently receive For not only their Vitriolate particles but also the grosser ones which remain after the abruption of those as in Crocus Martis Astringens which is made by the avolation of the Vitriol upon a long and intense calcination are confessedly styptical and therefore being carried in circulation as well as acting on the Nerves in the Stomack to the remotest recesses in the Body and amongst them those in the Brain may be presumed by their lancinations as forcing them thereby to gentle contractions to rectify their tone when too lax which I have supposed before to be a main condition toward producing the distemper under consideration And this faculty they must most exert upon those parts whose indigencies are greatest those whose tone is firm not being fitted to receive or at least be affected by them So that when the Brain has been debilitated they must exert that action principally there But beside these a frequent use of the generally owned Cephalicks as Rosemary Sage Betony Lilly of the Valley c. may possibly much conduce to corroborate the Brain and may without trouble or offence be used in the Form that Tea is the general custome having denizon'd such a use of drinks and those whose apprehensions are greater might besides have those Ingredients fermented with their usual drinks But amongst all the drinks in common use if you will not suspect the Character given by one who loves it so well as you know I doe but who withal have dranke it near thirty years not only innoxiously but I seriously affirme many times to my great advantage especially when indisposed either at my stomack or head that of Coffee may perhaps contribute as much to a prevention of the distemper as any and that on a double account First by helping the stomack to digest which it may effect partly by reason of a gentle Stypticity the particles which make the Tincture have from the torrefaction of the berries partly from the actual heat 't is usually dranke with both which but more effectually when conjoyned conduce much to corroborate the tone of it so that digestion being well performed here and good Bloud thence produced much of the antecedent cause both of Apoplexies and other distempers must be by such administrations prevented Secondly by the action it performes I conceive on the Brain it self for by means of the moderate torrefaction the aqueous parts of the berry are carried away and the viscous are altered in their texture whereby the sulplureous and saline I dispute not whether preexistent or made by the preparation upon the alteration of texture associating with the terrence come to constitute little irregular masses which are not immediately dissoluble however those particles may be in a tendency to avolation too by reason of their not very strict combination but when diluted in the water after the known manner of preparing the drinke may be presumed to be carryed through the mass of Bloud in circulation to the Brain and there entring into the pores of it both keep them open for a free passing of the spirits and withal especially if daily but moderately used keep up the due tone of the Brain by the gentle vellication such particles may make upon it by which last means it becoms I conceive principally useful in the present instance Therefore for I will not appropriate it to all it seems to me agreeably to Dr. Willis's notion Pharm rat most proper for those who have too lax a constitution of the Brain as whose intellects or memories generally are slow and who are much given to sleeping or to have a dull pain in their heads especially upon free eating and drinking or such as are apt to vertigoes from to humid a constitution or to Catarrhs But 't is scarce proper that you may see how little partial I am for such as are of an overwatchful temper of very keene apprehensions with a thin habit of Body though I have known some of that habit with whom it has very well agreed and that observation of agreeableness ought by prudent persons to be consulted not only in relation to this but most other medecines and even meats since experience shews that from undiscoverable or at least from our shallow insight into things undiscovered causes very probable administrations ought to be superseded as well as the contrary used and withal for those that are apt to convulsive symptoms upon light occasions though I conceive where besides the irritative matter that makes convulsions there happens too great a laxity of the Brain Coffee by fortifying the one may in great measure prevent the admission of the other All which to me shew the nervosum genus to be of a texture in such persons considerably compact and comparatively dry with which these particles may too much correspond and it may be observed that such persons many times contract an unsteadiness or numness of their hands and other parts as well as a general indisposedness and uneasiness by its even as to others moderate use And from these effects upon the inconsiderate use of it as 't is common to have any though the best remedies abused when grown popular it has amongst many got the imputation of being a Paralytick drink and disposing to Apoplexies such never reflecting what multitudes of others comparatively to the few it injuries receive advantage by it Perhaps too you will expect my opinion concerning my other favourite Tobacco Concerning which I must say that though I know many have an opinion of its being Narcotick or otherwise injurious to the Brain and consequently disposing to Apoplexies yet to say nothing of my having used it and not sparingly for many years without finding any such effect of it the very common custome of taking it for so many scores of years since it began to be in vogue must have made such a quality if it had it evidently taken notice of and consequently common prudence would have obliged people to have left it off long agoe as deleterious if experience did not evidence the contrary for there is no man but if laying aside prejudices he will give himself the trouble to observe may easily find that very many live to great years in as great a state of health as those who take it not that have long used it even immoderately It must indeed be owned that it is not agreeable to all constitutions but the same may
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
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
duly circulate through its usual vessels in the Brain or else 3 dly disaffects the Brain whether by weakening its tone or altering the figures of its passages or straitning them too much may occasion Apoplexies and the greater urgency or violence of such antecedent causes may introduce a greater frequency of them than ordinary As to the first Besides common observation 't is obvious to any mans reason that those who indulge themselves in full meales but especially in copious drinking and use not due exercise may fall into them especially if their natural constitution incline them to breed Bloud plentifully since so it must be heaped up in too great a proportion for the vessels and thence may easily be supposed to make its way out of them upon even light occasions into the most yielding parts Besides persons given to these excesses doe frequently either voluntarily or by the necessity of the irrigation made on the Brain allow themselves likewise great liberty of sleeping and so relax the Brain whereupon the Bloud flowing more plentifully in the usual posture of it viz. lying along may be presumed without great difficulty to get out of its vessels distended on this occasion into it And it seems rather to be wondred at that no more fall into them than that some doe from this cause since there are so obvious reasons of their production from the number of those who thus indulge themselves But this seems no adequate reason of their greater frequency now than formerly since these excesses have been of a much longer date than to give occasion hence to justify the temperance of former ages comparatively to ours Therefore Secondly as to the causes of those dyserafies of the Bloud from whence the immediate continent cause of Apoplexies flowes we must seek them from without us since our Bloud has its supplyes so and its motions whether circular or intestine are excited or retarded by abundance of outward and the most of them inevitable our shallow knowledg and foresight in choosing what is proper for us and avoiding what is prejudicial and the unmanagable bent of our inclinations to what gratifies us especially considered occasions From which external causes likewise Thirdly the disposition of the Brain to fall into these distempers must proceed these being as well disposed to act on the solid as fluid substances of our Bodies as they find them fit to receive their impressions The external occasions therefore of our disorders are generally deduced from some or other of the six Non-naturals so called viz. Air Meates and Drinks Motion and Rest Sleep and Waking substances excreted or retained and the passions of the mind any of which if inordinate may produce such diseases as the Body upon some peculiar predisposition is subject to 'T is besides my subject to dilate on them particularly especially as they contribute to produce the gross of diseases neither doe I think the five latter so very applicable to my present theme as to detain me But the first seeming the most usual and efficacious as to the production of all or the greatest part of other distempers since 't is so generally influential and unavoidable so of this I am obliged to take some notice of it For we may in a great measure correct irregularities in the rest but not so in this without which we cannot live many moments neither is it in our power to correct its disorders if any thing considerable since it diffuses it self every where and must therefore if vitiated be the cause of general distempers and more especially seems to have a very prevailing energy to introduce that under consideration Its disorders are generally reduced to two heads viz. either excesses in one at least of the First qualities Heat Cold Moysture or Dryness or else Malignity in it unaccountable for from them whatever it satisfactorily be from any other vulgar notions which may be of very different kinds and so produce distempers different as to their symptoms yet of that general denomination These have been so copiously and learnedly treated of by many great Authors that 't were very impertinent in it self as well as unfit for the brevity of a letter to expatiate on them but particularly the Doctrine of Malignity seems too abstruse to be discoursed of in few words only if it be not a solecism to pretend to judge of things of which we can assigne so little reason it seems best adjusted to give an account of diseases that generally invade and where indeed surprising symptoms whose reasons cannot be assigned from known hypotheses happen as in some Epidemical feavers the Plague c. For it seems agreeable to reason that it must be somewhat more than what is deducible from the first qualities as well as very active that must so affect multitudes of people of different constitutions and of whom many have no evident predisposition to sickness with so extraordinary indispositions and that at times when the Air is free from excesses in any of the first qualities or indeed any of the rest of the sensible ones and 't is acknowledged by all how differently soever they explicate the matter that these epidemical miasmes are so But to give an account of the production of the present distemper we have no need to have recourse to this abstruser cause For first this can hardly be reckoned among Epidemical distempers however more frequent than formerly since at all but few comparatively to those who are with other distempers are assaulted with this and those not in one region but here and there in farr distant places at all times of the Year and at all seasons whether of excessive Heat Cold Moysture or Dryness though as I shall by and by observe it took its rise from one of them Secondly 't was never observed nor thought contagious as most Epidemical diseases that depend upon Malignity are those subtil steams that occasion them being as very diffusive so also determinately fermentative to the production of like substances in the Bodies they enter into which when emitted and then received by others which have a predisposition as most have a small one being sufficient in so heterogeneous Bodies as ours are and where the substances that compose them are so lax and in such an agitation to be by them acted on must affect them in the same manner Thirdly there seems nothing in the symptoms but what is constantly observable in almost all assaulted with it and agreeable to the general history of it whereas those called epidemical have generally somthing anomalous in the symptoms when ever they so invade from what has been observed in those of the same denomination at other times And fourthly it seems accountable enough for from the consideration of those more obvious qualities of the Air. So that I conceive 't is rather to be reckoned among the Sporadical diseases so called by Physitians and to proceed from some or one of these modifications of the Air which we call first qualities
considerable numbers of its particles at once and so undergo a strong impression which may easily enough be conceived to be propagated to the Brain partly by disturbing their regular tonick motion which must from their tensity be continued up to their original partly by the ingress of too many of the lancinating particles of it into them which besides the fixing or dissipating the animal spirits which I conceive to be much of the nature of volatill salts may disorder the tone of these nerves first and then by the continuance of the impulse of those behind which have the same ground to attempt an entrance that of the Brain it self which being more tender than the nerves must therefore when the cause of the disaffection reaches it be proportionally injured A second way I conceive is at the ears whose outer cavity going deep seems to be in part contrived for warming the Air that it may not by its Coldness disaffect those exquisitely sensible auditory nerves and the membranes upon whose due tone and tensity as the sence of hearing seems mainly to depend so must it be much impaired if so unusual impressions are made upon it by intensly Cold Air and besides those nerves being thence so disaffected must by their contractions conveigh the like motions up to the Brain and so disturbe and weaken it And I formerly knew a very Learned person who had a total and irremediable deafness that was caused as he told me by a journey taken in a very keene frost over the Mountains in Wales to which I remember not whether any Apoplectick distemper succeeded but the instance at least evidences the great effect of intense Cold upon the nerves which had it lasted long 't is to me probable that by being propagated up to the Brain it might have produced either that or other nerval distempers Another way whereby I conceive the Cold Air may be injurious to the Brain is at the extremities of the nerves in all parts of the skin which having as must be owned I presume apertures there may possibly admit some such subtil and lancinating substances as I have supposed to be constantly but in frosty seasons more copiously carried in the Air and being once admitted may on the same ground as I have urged in relation to the olfactory Nerves by consecution come to affect the Brain it self But though their tracts are very long and small and so there cannot be a proportionable influence as in those yet their great numbers and the consideration that they are on every side pressed upon by the Air may perhaps be thought to Compensate for that defect But this pressure of the Air on the surface of our Bodies which I distinguish from that on the olfactory nerves on this consideration that in one case 't is uniform depending only on the weight of the Atmosphere or such general motions in it as make it act uniformly on all parts of the surface of them which by their make and private motions determine it not otherwise in the other some part of it is moved with a greater violence from the dilatation of the parts designed for Respiration whose cavity therefore being to be filled in proportion to that dilatation it must happen that that portion of Air that does it must have brisker agitation than the rest of its masse and make impressions accordingly this pressure I say may prove chiefly injurious to the Brain by its acting on the Nerves in the Eares Because they being terminated at a cavity which is still kept warmer than the rest by the steames continually exuding from every side of it and for some time somwhat detained there must therefore be more open and consequently more liable to injuries if an extraordinary occasion happen such as I am instancing in to make an impression on them And this must happen rather to tender Bodies and those who accustom themselves to keep much within doores than to the more robust whose employments expose them much to the Air at all seasons both on the score of the comparative flaccidity of all parts in them and the defect of a due digestion in their bloud and other liquors through want of due exercise which must dispose them to be put into confusion when violent causes come to excite it and experience shewes that such persons of all others are most obnoxious to the alterations of the Air. So that the manner of this action seems to consist in the penetration made by the Nitrous particles principally of the Aire upon the Fibres of the Brain for that as well as all other solid parts must consist of Fibres which thereby undergo some however small solution of continuity and either the little cavities of those Fibres for I think the Aeconomy of our Bodies can hardly be mechanically made out without supposing them all to be Vessels though our sensories cannot determine it become straitned or their sides perforated on the account of either of which they cannot duly either receive or retain and consequently not regularly transmit the substances destined to each part which is to be respectively supplyed by them In that continuity due confirmation repletion of them I suppose the Tone of the parts to consist and therefore when any thing perverts any of these requisites to it as in our present case all the consequences emergent from the impulse of the bloud or other liquors disturbed in their motion may be expected Now such an Atony happening to be in so very tender a part as the Brain cannot therefore easily be rectifyed but may continue much longer than if it happen to other parts whose Fibres being stronger and functions fewer must on both scores caeteris paribus sooner and more easily return to their natural constitution And not only the reason of the thing but dayly experience shews it that whereas most other parts of our Bodies having once received any injurious impression as by falls blows c. do after fit remedies used return to their due tone quickly the cause once removed the Brain on the contrary long retaines its weakness if once injured though for the present releived in some degree as for instance those that have had an Apoplectick fit once doe many times on whatsoever light occasion either find a return of it or at least undergoe a considerable weakness of their intellectual faculties not to be corrected but by a long and constant regularity if it be at all and the like is observable concerning those who have been seized by Vertiginous and Hypochondriacal distempers which I take to be properly Nerval and to spring from the Brain or its liquor disaffected from which few happen to be perfectly freed their imagination indeed being disturbed disposing them to be too immorigerous So that I conceive it may be inferred that if the Ambient Air come to have a great degree of Coldness especially if it continue long both the forementioned disposition of the Bloud to supply matter for Apoplexies must be
cause can introduce it And as to what is urged of the French Pox c. being put in under this Class the answer is the same since the same reasons have always been for the concealment and 't is known the Pox and its infamy too has been considerably longer in the world than Weekly Bills which are not of an Hundred years standing From these considerations put together you see my sence of the question proposed to which I am sure you expected not so tedious an answer And I assure you I designed not this prolixity but several deductions still falling in which to me seemed requisite to clear the notion I am sure you will not expect apologies for my doing that which your self have occasioned But since you farther require the methods of Prevention and Cure of this distemper which I have either used or think requisite Though after what so many Authors and particularly Dr. Willis have written on this subject it seems altogether superfluous to say any thing yet to let you see how ready I am to comply with you in this as well as your other desire I shall venture at least to give you my thoughts in general concerning them together with my reasons such as they are of the administrations to be proposed to justify my dissent from such who in any of the particulars think differently from me But first though not pretending to write an exact treatise of Apoplexies but only to give an answer to your questions you are not to expect I should congest Prognosticks according to the custome of Authors when they propose to write solemnly concerning any diseases yet I conceive 't is requisite I should lay down or rather recapitulate one or two that respect the fatality more indeed to excuse Physitians who are generally liable to be taxed if success attend not their endeavours than for any solid and useful information they can bring since the cause of it cannot be certainly known but upon dissection And First if an Apoplexy proceed from any considerable effusion of bloud in Specie 't is as I intimated before altogether incurable since the tenderness of the part is such that it cannot resist the force of the portrusion behind And since even any stop in the Sanguiferous vessels will if not presently removed by Phlebotomy or other due remedies so distend them that either an eruption or stagnation must quickly follow 't is not at all to be wondred at that so few escape since so few are convinced of what I take to be the true remedy where there is a possibility of recovery Secondly that likewise which proceeds from a Polypus must needs prove as fatal both from the difficultly dissoluble nature of that substance and the shortness of time medcines if such there were that should effect the dissolution are allowed to exert themselves in the bloud as I just now said for want of motion quickly stagnating and growing grumous in any part where 't is stopped and so hindring the motion of and alike affecting the rest To which yet thirdly give me leave to subjoyne that if the Pulse continue any thing strong the probability of recovery is much the greater since 't is an argument the Brain is not wholly overflowed but that the mass of bloud yet continues in its channels and produces the distemper only by distention so that when they shall by due administrations be freed from it there is hope the Brain may return to its pristine condition at least in some degree But yet Fourthly that those who have escaped one fit are in very great danger of a return since as I have before alledged the Brain having been once injured is by reason of its tender make so difficultly reducible in all respects to its former Tone and therefore from any even slight occasion be afresh more easily disordered Therefore it very much concerns those who have once escaped that danger or even that of a great Vertigo or other Cephalick distempers to use a good regulation of themselves for the future and also to persist long in the use of such corroborating means as may at last Deo annuente perfectly restore it as well as keep the bloud in a due crasis and prevent all antecedent causes Which advice yet very few are apt to follow two many being apt when once in some degree recovered to imagine and suggest too that Physitians urge that more for their owne advantage than theirs Which premised I conceive first for Prevention that these two general Indications ought to be proposed The removing the Antecedent cause and the corroborating the Brain The former is to be answered 1 st by general evacuations of humours whether Laudable if they be congested in too great a quantity or Peccant 2 ly by keeping up or if it be depraved restoring the bloud to its due crasis 1 st As to evacuations Phlebotomy seems to deserve the first consideration since as I have endeavoured to make it out 't is either the congestion of the bloud in the sanguiferous vessels of the Brain or its inundation upon it that is the most general containing cause of it So that all persons of a Plethorick habit of Body if fearful of this distemper Fear by occasioning the contraction of the Brain the seat of our apprehensions if not determining the bloud to it at least causing a check of its motion through it and so a congestion in or effusion out of its vessels as well as those whose bloud from other symptoms or the emission of some of it may be collected to be viscous especially if they happen with distention of the Veines and Lassitudes to be vertiginous or inclined to pains in the head ought to take so much away as may in probability prevent too great a distention here and this not only at such times of the year when the bloud is more apt than usual to rise into a Turgescency as in the Spring and Summer but at any time when they occasionally find it to be so disposed And though many may are indeed used to urge that not letting bloud at all they have hitherto escaped this as well as other distempers when some have been ceased and dyed too notwithstanding such their care which argument too by the way may be urged by many of vigorous constitutions against all precaution against all diseases and for a liberty for all debaucheries Yet since many have fallen into it who might probably by Phlebotomy have prevented it as well as that many have by it found present relief when actually ceased 'tis but a secure caution to use the most probable meanes of prevention since though all constitutions are not alike and some may be sensible of weakness for the present which yet quickly goes off by a little subsequent care yet experience shewes there are very few but find though they loose very large quantities of bloud they quickly regain it as to omit the reasons of it as less proper for this place beside
abundance of instances that might be brought of those who free from the too general apprehensions of the danger of loosing it have had it designedly taken away in large quantities Spontaneous Haemorrhages and those from large wounds might convince persons unbiassed by their own or others unaccountable fears Therefore I should propose that any persons who dread this disease whose bloud has not been depauperated by preceding ones especially if their appetites be generally good and they use not store of exercise filling their veins by the one and not taking care proportionally to empty them by the other should take away bloud at least every Spring though oftner if occasion require and much the rather if they accustom themselves to that frequently fatal custome of much drinking of Strong liquors so to keep both the sanguiferous vessels from too large a distention and the bloud more calme Twenty ounces I take to be about a middle proportion for most to loose which may I suppose bear the proportion of about a twentieth part to that in most Bodies and not very much less in most and I believe can do none under the forementioned circumstances any hurt but much good to most by securing them from the danger of this as well as many other distempers Besides Phlebolomy I take moderate Purging to be requisite in order to carry of viscid and other humors that from the foresaid impressions made on the Bloud as well as the Brain are apt to be congested especially in the Bodies of sedentary persons This may be done usually Spring and fall provided that it be neither attempted with too violent medcines nor too long continued nor too oft repeated which ill custome yet many Hypochondriacal persons I have met with will not be dissuaded from least instead of taking a way the luxuriant humors these medcines by too much exagitating and disturbing the Bloud introduce the distemper they are given to prevent But if the stomack be oppressed 't is requisite it should be discharged upwards before medcines of the contrary tendency be given since catharticks as they can only carry a way thence a small part of that clogge that causes the symptom their irritation not being sufficient in comparison with the emeticks to make it contract it self for a total discharge so may likewise take a long with them part of that into the Bloud in regard they themselves must be carryed into it by the way of the Chyle to effect the separations of those substances we find they occasion a discharge of from it And indeed the effects of vomiting are very extensive towards the preventing these as well as many other especially nerval distempers For besides the freeing the stomack from any oppressing matter which 't is very apt to congest and which whilst lying there perverts digestion by either hindring the eruption of or allaying or else depraving the liquor designed to exude out of the glaudulous coate of it into the cavity which I suppose to be the principal digestive ferment so that digestion being by the removal of this matter rightly performed from the depravation of which most diseases spring the cause of them is thus cutt off I conceive the irritation and concussion made by an emetick upon the nerves not only belonging to the stomack but by the consent of the whole nervous systeme all the Body over and upon the Brain it self must occasion them to contract themselves to the discharging of whatsoever fills or is disagreeable to them Evacuations by Urine may be likewise procured by those who are of a gross habit of Body or whose Bloud is of too close a texture or too viscous and may be used by such familiarly premising those forementioned either by impregnating drinks for common use with diureticks of which practical Authors have store or by taking fixt volatil or acid salts all which are diuretical in relation to some or other constitutions or other more complex ones as the particular constitution of each person requires even with our common meats and drinks they if fitted to the several dyscrasies for all are not proper for all indiscriminately those who abound with acid humors needing alcalizate salts either fixed or volatil to retund them or others of an analogous effect as others whose Bloud by reason of its too highly exalted sulphureous parts is apt to be overmuch exagitated as also those in whom even the volatil salts are too brisk and acrimonious require acids to mortify them raising generally no commotion in our Bloud but diverting the course of it from the Brain which 't is too apt to take For partly by the congruity their particles have to the secretory passages in the Kidneys in order to enter into and open them more than those in the other secretory parts partly by the fusion they make of the Bloud and the reducing many parts of it to such bulkes and figures as fit them to enter likewise partly by their action upon the nerves and their liquor which I suppose to be the determining ferment in all mixt secretions on the account of their angles which fit them to vellicate and incide as also to accelerate the motion of any liquors they come to be mixed with partly by absterging from that inciding power any obstructing matter that may lye in the habit of the Brain as well as any other parts between the extremities or term of denomination if they are but continued vessels of the arteries and veines they may very well I conceive both make the Bloud more apt to circulate more universally and also direct the course of it to the Kidneys in regard some parts of it being continually and more copiously than usual thus taken off from it the rest must take its course from other parts where 't was apt to stop hither it being known that it flowes most thither where it finds apertures fit to let it either in specie or any of its parts goe forth Those evacuations likewise by sweat may perhaps be somtimes attempted with due caution but neither indiscriminately by all persons not at all times and require more than most others the judgment of a Physitian to regulate them For if medecines to procure it be given when the Bloud is of a texture not open enough which both frequently it is especially near the beginnings of most distempers and which all persons are not judges of or when too heterogeneous substances abound in it they dispose it many times more readily to fix upon the Brain and nerves than to part with its noxious particles at the designed secretory parts and a brisker motion being thence impressed on it the confusion of its parts must be increased and so if not an Apoplexy yet other distempers as certainly though more slowly deadly at least very dangerous and hard to be removed may be introduced But this ill custome of forcing meats whether by inward medcines or outward application being so common nowadayes as I am satisfyed that to this regulation are owing
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
for a Physitian but must at least be sure to be greatly censured if either through the greatness of the distemper or the very common unmanagableness of the Patient either from his own inclination or others suggestion success attend it not But certainly he must have a strict account to give who taking charge of Lives will to their loss or at least hazard be rather swayed by others or his own fear than his judgment but a much stricter if a prospect of Interest by complying with peoples inclinations which I am afraid is too common amongst pretenders to Physick tempt him to deflect from it And therfore he ought not be concerned at these Bruta Fulmina but follow the dictates of his reason and conscience For my own part though I am farr from thinking Phlebotomy proper for the cure of all diseases or even to be largly administred in most but that a solid judgment which I am sure the greatest number of the censurers of it have not from substantial grounds in Physick ought to determine when it is to be advised and when not yet I think it might be more frequently and in many cases much more copiously used than at least in the place where I live it is or will be permitted to be And I should be obliged to him that should convince me of my mistake in this notion having hitherto thought I had Reason but I am sure I have had Experience to confirm me in a good opinion of it particularly in relation to Apoplexies as having not been so happy in my reading to meet with that satisfaction Or shall propose such other certain remedies or methods of cure as would supersede its use in this or other cases that I think require it But I must subjoyne that I cannot but much wonder that Barbette a Physitian of Considerable reputation and whose Praxis is in the hands of all Physitians should have those ill notions of Phlebotomy as to reflect upon it as the cause of the miscarriage of the Apoplectical patients he instances in when both 't is probable from what he says there was but very little bloud taken away and also 't is easy to be collected he never durst try the remedy in its due latitude but in complyance to his prejudices would rather let them dye under a without this unpromising method than attempt a cure by it against which whatever he could he does not urge any reason of moment As to the place where Phlebotomy ought to be administred though there being a Circulation of the blould any part of the Body where a Veine can be readily come at may be proper enough since the Vessels being considerably emptyed any where the remaining bloud will 't is known come from all others especially that where 't is too much congested to fill them again and so keep up the proportion every where and the forementioned Systaltick motion must whem the Plethora is taken off assist the brisker circulation through parts before distended Yet the Iugular if it can be met with is the most proper Veine for this discharge since it evacuates immediately only from the head whereas those of the Limbs doe it but mediately as requiring a good quantity to be taken away before what lyes in the Brain can come to be extruded according to the known laws of Circulation And this may recommend it self the more to the timorous Assistants since so 't is likely the relief will be as the more speedy so with less expence of bloud But besides but especially after Phlebotomy I conceive other remedies ought to be with all speed used as Vesicatories Cupping glasses Sternutations or other Errhines Apophlegmatismes acrimonious Cataplasmes to the feet and wrists Volatil salts or Assa foetida or the like in odour and any other Administrations in order to excite and make the Brain contract it self to expel the morbid matter as well as to divert the course of it as also that inwardly be given spirit of Sal-armoniack or other Volatil salts Castor and other brisk Nerval remedies which may so irritate as to cause a corroboration of its tone that so the effused or congested matter may come to be extruded and at last resumed by the veines To this intent likewise Vomitories and Purgatives of which as of the rest Authors have store as for the due administration of them the presence and judgment of a Physitian is necessary ought as occasion is to be brought into use And if the distemper begin once to yeild to the efficacy of these remedies As I before intimated so I must again suggest that corroborating ones should for a long time be insisted on to restore the Brain and the Nerves to their pristine tone After all give me leave to subjoyne that you may collect a great Specimen of my deference to you from hence that for the satisfaction which yet I am afraid they 'l think not given of some of your Friends as you suggest to whom the Latin tongue is not so easy I publish this against the advice of some great ones of my own and those great Judges in our own Language when most of the speculations had been perhaps as easily but more fitly delivered in that and withall give me leave to say several of them so much out of the way of those that understand only the English tongue that few such will perhaps relish them And indeed though nothing here brought can be pretended at all instructive either to your self or other great Physitians of this Age than which none ever enjoyed numbers of them of greater if equal abilities but must be looked on as very jejune as being drawn up by one who is so very conscious of his own inabilities that it may be construed arrogance to appear at all thus publickly yet since I must so far dissent from you as to believe 't is likely the Discourse may meet with not many Readers but those of the Faculty of Physick who perhaps out of curiosity may give themselves that trouble though but to censure the composer it ought at least to have been written in the Language in which you are most accustomed to imploy your selves But I must needs say the argument you urge from the example of the very great Mr. Boyle Dr. Henshaw and several other great as well Physitians as Philosophers not to urge that of former Ages both of our own and neighbouring Nations who have thought fit to write in their own Language particularly the very learned Dr. Tho. Burnet who has been pleased to oblige his own Nation by publishing his most curious Theory and that much improved in its own after he had done it first in Latin has enough in it to plead my excuse to those who advise the contrary But indeed there may be one reason of moment I conceive alledged why 't is fitting somthing should be written in the language of each country concerning this more than any other Disease viz. because this of all requires the speediest relief and Physitians not being always at hand Charity obliges that all should have such remedies made known to them as may put a stop to the danger till farther help can be had And Phlebotomy being that great and almost certain not to say only one when there is any hope of recovery as 't is fitting the generality of people should be convinced of it as well as their danger without it though indeed it may be suspected so great are the prejudices most have not very many will and therefore if any be seyzed others should have immediate recourse to it for them without staying for a Physitian so it may be some farther Apology for my adventuring to gratify you since no Body else that I know of has in English written ex professo of it singly at least with those convictions which I have upon me of the necessity of this Remedy However I must herein own your friendship that since you will have me write you would have me do it with that advantage to my reputation not to expose my weakness by attempting it in the Learned Language wherein you must be conscious from former instances how much I am deficient If any of my notions here delivered suit not with yours I expect in return your sense upon them which If convincing to my understanding shall be gratefully acknowledged and subscribed to by Sir Your most Faithfull Friend and Servant WILLIAM COLE Worcester Aug. 20. 1688. ERRATA PAg. 43. line 17. for Excrasie â—â—ad Exercise p. 76. l. â—â— we may p. 129. l. 10. r. may from p. 142. l. 3. r. Sweats p. 151. ult r. absumption p. 170. l. 4. after Brain r. seems farther about and I suppose 't will be allowed that the Brain FINIS
it being urged on by the impulse from the heart and then 't is obvious that all the regular motions and secretions there necessary to animality must immediately be interrupted the passages designed for carrying select substances being thus both enlarged and filled with heterogeneous and gross ones which make up the much greatest part of the Bloud So that hence Thirdly What is called the Containing cause is easy to be collected viz. some matter either discharged out of the sanguiferous vessels upon the substance of the Brain or else filling and distending them and thence compressing the sides of the passages in it This may either be 1 st the Bloud in its whole substance whether good or impure since in either constitution it may if either congested in too great quantity or too impetuously moved get out of its vessels or else so distend them as to produce the mentioned effect Or 2 dly some Viscouse matter proceeding from the Serum become less spirituous whose particles therefore are disposed to lay hold one of another and so to grow clammy and consequently unapt to pass along the usual tracts but apt to stick in the laxer interstices between the arteries and veins in the habit of the Brain to which more being continually brought by the continual motion of the Bloud may by a likeness of substance still associate it self till it come to a congestion great enough to cause such an obstruction as may at last hinder the circulation or at least the separation of such substances from the Bloud as must actuate the Brain and nerves From such a cause too Inflammations which are some of the acutest as well as the most frequent sort of distempers that assaile us often arise and 't is generally to be observed that in pleurisies anginas c. the Bloud is exceeding viscous which quality in it disposing it to obstruct must therefore when that happens cause a congestion all about the Bloud incessantly arietating against that place and thence soon an inflammation Or 3 dly a greater collection than usual of the fluid Serum in the Bloud though not disposed to viscosity but instead thereof grown too sharp which thence may be very apt to make its way through the passages in the habit of the Brain whose natural Make might keep out a less thin Serum such as belongs to the Bloud duly constituted but cannot this in regard its particles are perhaps become less than the diameter of the pores of the vessels 't is naturally carryed into or else these pores may come to be so dilated by means of the continual lancinations that the resistance of their sides may soon come to be overpowered Or 4 thly polypous concretions those infelicia aegri cordis germina as Wepfer calls them which have their construction from the fibrous parts of the Bloud whose Make being oblong and ramous numbers of them may happen to associate in the heart too strictly and being when once thus associated unapt to be dissolved must make carneous concretions there where being radicated they may grow to a considerable bulk and length and diffuse themselves all along the arteries to a great length the manner of whose production the accurate Malpighius de polypo cordis has very curiously described These Wepfer supposes may make an Apoplexy on a double account viz. either entire or broken The former way by being propagated from the heart up to the entrance of the Carotides and vertebral arteries into the skull which vessels being extensive before let the Bloud pass by these polypi up to the Brain before they reach those perforations of the skull but when once they doe that the arteries being confined by the bones through which they pass must be totally stopped by them and so the Bloud being prohibited from coming to the Brain an Apoplexy must according to him follow Which supposition indeed if it could be demonstrated would prove the greatest instance of his assertion that Apoplexy may proceed from a denegation of Bloud to the Brain But besides that 't is hard to conceive all these four arteries should be stopped at once by this cause which if they be not the Bloud coming by any one will be diffused by means of the Anastomoses all over the Brain for the continuance at least of the animal actions though perhaps in somewhat a lower degree it seems moreover probable that this should rather be ranked under the class of Cardiacal Syncope's whose symptoms are very like those of an Apoplexy and so many and large polypi as must effect this would in likelyhood kill by hindring the Circulation through the heart before they could grow to the length and bigness requisite to cause this obstruction But the other way by which he supposes an obstruction from them may come is the breaking of them off being grown fracid which happening the course of the Bloud must carry them on into those narrower passages whereby it might be presumed there would follow such a sodaine obstruction as must produce an irremediable Apoplexy did not his instance of Iames Knoll evince the contrary who though the arteries in his Brain were full of them yet had never any touch of an Apoplexy unless we should suppose those were not true polypi which as I said are generally of a carneous nature and radicated in the heart but only associations of viscous substances in the degenerated Bloud formed in those places where he found them But indeed it seems probable that if any of these broken polypi get into the narrow passages of the arteries in the Brain they may cause such a stop of the Bloud there that it not finding its usual way open may by the impetuosity of its motion make it self a new one into the substance of the Brain So that from any of these causes the Bloud in its circulation passing as I have said irregularly through the Brain may if this part happen to be more than usually susceptible of an impression from it either deflect into the lateral yielding recesses in its habit or by reason of a partial obstruction of the vessels distend them since being impelled in the usual quantity but deficiently transmitted there must quickly follow such a congestion that either a stagnation of it in the vessels must happen or an exudation of some parts of it through the widened passages or else if the impulse prove to be more violent a laceration of them from whence comes an Extravasation which will be continually increased from the continual impulse upon parts thus become unfit to resist the motion But of these causes of Apoplexies especially those which prove most fatal the Effusion of Bloud mentioned seems to be the most usual though as I see not but the distemper may as I said proceed from only a Congestion so possibly this may be that from which most recover that doe at all however by continuance it may prove as dangerous as being the beginning of that by effusion and a stop of the
as well amicably as noxiously First As to the Bloud which is most considerable as to quantity and supplys the matter to the nervous and the rest of the juyces we may take notice that though the Air may even by contact affect it in the surface of our Bodies as considerably pressing on us and so perhaps arrest or variously determine its motion in some degree yet it must principally do this by being admitted into it This admission seems obvious since 1 st living in it we cannot take any either meats or drinks but some Air will be admixed and so be conveighed into our Bloud with them Besides 2 dly it seems not improbable though it have undergone some contest that some of the finer parts of it may be admitted in inspiration farther than barely the cavities of the bronchia since it must be owned there are vessels from the little glandules dispersed throughout them which transmit from the Bloud there and whether those vessels may not receive somthing tho' not so much into them upon inspiration as well as cast forth by expiration may deserve to be considered since the Air comes into the Lungs with some violence and they being placed in so warm a situation may besides the distention upon inspiration be presumed to be as well lax enough to admit a subtil substance as eject a gross one and it seems not altogether improbable that nature might design this reciprocation of motion for that end partly But withal 3 dly the pores every where in the skin seem well enough adjusted to admit somwhat from the Air as well as conveigh forth those very gross impurities which many times if not very usually pass forth without any trouble And if it be objected that the transpiration continually proceeding from within must hinder any admission from without by the same vessels which notion heretofore seemed to me to have great weight as well in relation to these as most other vessels and liquors in the Body though upon farther thoughts it requires some limitations which belong not to this place to be laid down it may be replyed that this transpiration though it should be supposed continual is not in the same tenour still so that when it proceeds minutely there may be an admission perhaps from without between the particles of this gross and slowly moved matters in vessels patulous enough when we consider both the great pressure of the Almosphere which may easily enough be presumed on that score to intrude some particles of the Air between them to fill up the spaces left by the exhaling vapours and also the cessation in some degree of the extrusive motion whether proceeding from the expansiveness of the evaporating matter or the too much contraction of the parts both which remitting the resistance is less and the room more for the admission of those Being thus admitted 't is obvious to deduce from what was intimated before how it ordinarily operates on the Bloud viz. that partly by the insinuation of its elastical and other irregular particles among the parts of it partly the interposition as well as lancination of the nitrous the ramous and other grosser being kept in a continual agitation do both undergo due comminutions and also are hindred from too closely adhering and thence as well from stagnating in the wider vessels as obstructing the capillaries and interstices between the arteries and veins But such an agitation being necessary to it for the keeping up its vital crasis it may easily be inferred that if such Air be admitted as shall overmuch check this agitation the crasis of it must come to be much altered and those parts which were before dissociated by the briskness of their motion must being considerably ramous lay hold on one another and so either become grumous or create a viscosity in it which once begun is not soon nor easily corrected these particles clasping one another too firmly to be quickly unlocked by the permeating spirits whose activity likewise these viscous substances are apt to elude by their lubricity thence obliging them to slip by them or else inviscating them Secondly As to the nervous juyce it being made out of the Bloud must therefore in some degree undergo impressions analogous to what are made upon this from substances admixed with it whether we consider it in its due or depraved state since it may be easily imagined that some of the admitted substances of the Air before mentioned may be deposited into the nerves at their original together with the true matter of that juyce and besides if the Bloud in general be once become viscous from whatsoever cause 't is scarce possible but that some part of such a matter must in the act of secretion pass into the nerves so that the Air in some constitutions of it much disposing to viscosity its influence therefore must be interpreted to be partly on this juyce at such times But moreover I see no reason but some particles of it may when more than ordinarily abounding with such substances as are subtil and active even through the pores be admitted into this liquor our Bodies being every where permeable to subtil substances since I conceive they in a due proportion are necessary even to the due spiritualization of this juyce and therefore for its excitation towards that may require to be admitted partly a nearer way than that round-about one of the chyle But Secondly The Air 's influence must be acknowledged to be very great on the solid parts likewise as both immediately touching upon some of them and also by reason of their firmness being longer retained by them when once admitted into their porosities which by the mediation of the Bloud besides the other ways mentioned which are applicable to these as well as the liquors 't is easy to imagine its particles may than in those fluid substances So that in the forementioned suggestion of its superabounding with noxious substances they must be much disposed to be affected by it And indeed there seem to be none even of the most consistent parts of our Bodies but are pervious enough to and consequently apt to be acted on by such penetrating substances But among them all none seem so liable to receive impressions from them as the Brain on the account of its tender constitution For tho' Nature hath placed so strong fences about it that perhaps 't will hardly be admitted that the Coldness of the Ambient can greatly prejudice through them yet that it may by the mediation of the Bloud passing through it is I suppose easy enough to be allowed from what has been said But besides there seem two or three other wayes by which in such a constitution of the season it may be injured viz. First By the Air 's affecting the mammillary processes as it passes briskly by them upon inspiration which being considerably large nerves must besides the consideration of the impetuosity of the Air 's motion in that circumstance be acted on by
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