this method of practice brought into fuch difrepute as to be entirely laid afide; whilft at other times, in a milder distemper, it has been used successfully.

"When the fudorific courfe has been neglected, or cannot be attempted with fafety, on account of the fudden and violent fymptoms, height of the fever, plethoric habit, or load of humours in the ftomach and inteftines, or other abdominal vifcera, or has not been fo fuccefsful as might be expected: then the only relief, that I could ever find from any application, is from mild relaxing chologogue apozems, taken frequently in fuch quantities as to keep up a conftant diarrhea, rather than speedy purgation, till there remains no further danger of an inflammation. This is often the first thing neceffary to be done; for the great quantity of humours proceeding from the diffolution of the blood, which now poffeffes a greater fpace than when compacted into red globules, and the quantity of choler which is generally poured out of its ducts, joined with the other impurities of the first passages, which add much to its quantity and ill effects: these, I say, cause such a turgefcency of the morbid matter, as it is called, at the beginning, that nature is never able to rid herself of these two loads, unless they are partly drained off at first by vomiting or purging. This is the practice of both the ancients and moderns in like cafes: for, in this case, fudorifics endanger an inflammation which can hardly be avoided in the use of them, wherever there is a plethora of the vessels, or any fulness of the body; for which reafon, all those who abound with humours of another kind, or have a great proportion of fluids to their folid parts, ftand in need of this timely evacuation and this is the condition of most of your well fed Englishmen and other new-comers to America, who have not undergone the fudorific course of our fummers.

"But it must be observed, that this evacuation is more necessary in this, than in most other fevers; even fo as to become more beneficial than any other, as I have experienced; although it is generally neglected in other malignant fevers, for which reafon, I fhall fum up in a few words the principal

reafons and obfervations, which fhew its usefulness. The abdominal vifcera are the parts principally affected in this disease; but by this timely evacuation, their feculent corruptible contents are discharged before they corrupt and produce any ill effects; and their many emunctories and fecerning veffels are fet open, so as to allow a free discharge of their contents, and confequently a fecurity to the parts themfelves, during the course of the difeafe. By this evacuation likewife, great part of the offenfive over-abounding ferum of the blood is discharged in time. The very minera of this disease proceeding from the putrid miasma, fermenting with the falivary, bilions and other inquiline humours of the body, is fometimes eradicated by timely emptying the abdominal vifcera, on which it first fixes; after the discharge of which, a gentle fweat, does, as it were, nip it in the bud. Where the primæ viæ, but especially the stomach, is loaded with an offenfive matter, or contracted and convulfed with the irrita tion of its stimulus, there is no procuring a laudable sweat, till that is removed; after which a neceffary quantity of fweat breaks out of its own accord; thefe parts promoting it, when by an obfterging medicine, they are eafed of the burden or ftimulus which oppreffes them. Hence I have often feen a more laudable and copious relieving sweat break out after such a deterging medicine, given even in the height of this disease, than after a fudorific. Premature evacuations are generally dreaded in moft fevers, efpecially fuch as proceed from a depravation of the inquiline humours of the body; but these contagious malignant fevers proceed from a venomous miasma received ab extrà; which, like all other poisons, ought to be discharged as foon as poffible, qua data porta. The morbid matter in other peftilentials may be most easily and conveniently discharged by fweats; but this fever requires discharges from thofe parts, which fecern the most vifcid humours from the blood, either to prevent or carry off the vifcid humours which caufe the yellow effufion, which we have fhewn to be bile, or of the nature of bile: and the rule for evacuations, quæ educere oportet, quò maximè vergunt, eo ducito, per loca convenientia,'

(Hippocr. Aph. 21. § 1.). But bilious humours are only to be discharged by ftools or urine, which are the paffages by which nature rids herself of this disease, as we fhall fee below. (Galen Com. in l. c.)

"This is only the inverted method of the alexipharmac, in which we first sweat and afterwards purge, whereas in this method we make discharges of the redundant humours, which opprefs the parts principally affected, after which, fweat breaks out of its own accord, or is more easily procured by art. All concerned in the cure of this fever will find both thefe evacuations neceffary; but which ought to precede the other, the skilful " may be helped to determine from thefe confiderations, joined to the following obfervations.

"There are not wanting many other practical obfervations to support these reasons for timely purging in this disease. 1. This method I was directed to by nature herself. I obferved that moderate, thin bilious ftools, raised by nature for a day or two, at the beginning, prevented in a great measure the yellowness at the height of the diftemper, which then terminated by sweats. And endeavouring to imitate these efforts of nature, I obtained the fame good effects, from the like ftools procured by lenitives. This is the best guide and furest warrant for physicians to direct their practice by, whose business it is to imitate nature by art. 2. Several, treated in this manner, had no relapfes, which all had here in Virginia in the winter and spring seasons, that were treated in any other manner. Does not the doctrine of Hippocrates confirm this practice? untimely discharges in diftempers, or thofe things that are left behind after a crifis, occafion relapfes. (Epidem. 1. 4. 1132.) 3. Where the crisis is by fweat, relapfes are dangerous and frequent; but where the bilious humours are carried off by ftools or turbid icteritious urine, at any time in the disease; the relapse is but flight, and seldom or ever mortal. 4. In young perfons under the age of puberty, of whom I have cured many, and in whom fweating cannot fafely be attempted, this fever is as easily fubdued, for the most part, and in the fame manner, as

who tells us, that improper and

their other fevers, which proceed from a load and corruption of the humours in primis viis, generally are; to wit, by abforbents, attemperants and antifpafmodics, mingled with clyfters and lenitives, at any time in the difeafe; by thefe, the fatal convulfions and hemorrhages in those and other tender people are prevented. 5. Sweating can only be fafely attempted in the first hours of the difeafe, whilft the matter is fluxile; which fhort-lived opportunity is generally let flip, and fometimes does not offer; after which, the only fecurity against an inflammation of the vifcera, is to be expected from lenitives given in the remiffions, but not in the paroxyfms of the fever. But it must be observed, that however thefe evacuations may prevent, yet neither one nor the other cures fuch inflammations till after concoctions; and that purgatives are offenfive on account of their stimulating, as fudorifics are for their heating quality; for which reafon they ought not to be given after any figns of an irritation of the veffels, or spasms about the præcordia, severe anxieties, contractions of the hypochondres, or convulfive motions of the stomach and none but the mildest diluting laxatives are ever proper, fuch as whey made with cremor tartar?, or tamarinds, potions of manna and rhubarb, or folutive fyrup of roses, a mixture of rhubarb, fal. nitr. in broth or gruel, or aperient relaxing apozems given in divided dofes.

"But it is not thefe or any other method of cure commonly ufed, that will always prevent the mortification of the vifcera, which ever seemed to be the fatal catastrophe of this disease; and was ever found to be in all the dead bodies that were looked into. For this reafon it behoves every one, who has a regard for the art, or welfare of mankind, to look out for new remedies, to prevent fuch a fatal iffue, not only of this, but likewife of other peftilential diseases. When I first perceived that the event and tendency of this disease was to a mortification, I thought of the bark, the antiseptic virtue of which has been fo well demonftrated and expofed to the world; and which I have known some instances of in Virginia. Had I at the fame time known of its good effects in the fmall-pox, which I have been face

informed of, from the Edinburgh Medical Effays, (as well as by Dr. John Fothergill in London, who advised me to the use of the bark in it, from the refemblance, that this disease bears to the fmall-pox; and informed me of three cafes of a difeafe like this in Minorca,) I should have been more bold in such a practice, which feems the only known way of fnatching many from the jaws of inevitable ruin. For the effects of the bark in grangrenes feemed to be to promote a laudable fuppuration, which would avail but little in the parts affected in this disease. But we are informed (Edinb. Med. Effays, vol. 5th.) that in the fmall-pox it promotes the maturation and concoction of the morbid matter and abates the fever. This is what is wanted, when this disease tends to its fatal iffue; and I can affert from my own obfervations of both, that both the fymptoms, causes and effects feem to be much the fame; at least not unlike in both thefe diseases, when they tend to their fatal iffue, for want of this due concoction of the morbid matter, for which the bark has been fuccefsfully given in the small-pox. But does the good effects of the bark in that diftemper proceed entirely from bringing a kindly fuppuration into the puftules? Surely there is nothing more wanted in all these malignant contagious dif tempers, such as both these are, than to preserve the tone of the fibres and craffis of the blood, both which feem to be destroyed in these difeafes, especially this I treat of, when they tend to a gangrenous state; but nothing feems to be so effectual for this as the bark. It is the common practice, to endeavour to remedy this deplorable cafe, or to fatisfy this vital indication by heating cordials, as they are called; the fame was the practice in much the like circumstances in gangrenes from internal causes, before the more efficacious use of the bark was known. But these are the most pernicious of all medicines, even in these circumstances of this disease, as I have seen by many inftances. It is true, in other fevers these stimulating attenuating medicines become necessary towards their decline; when the mortal laxity of the fibres and grumofity of the fluids threaten a stagnation, even where they were little lefs than poifons at the beginning.