of the distemper, and the best adapted to answer the intentions of cure. Were we difpofed to cavil, we might, perhaps, find fault with what probably coft Dr. Hillary the greateft labour, namely a display of learning, even to affectation; we might likewife object to a certain redundancy of words, and repetitions which might have been omitted: but when a work is intended to promote ufeful knowlege, and executed with candor, we avoid dwelling on blemishes of this kind.

Of all the difeafes to which the Europeans are liable, on their first arrival in the Weft-Indies, the Yellow-Fever is the most dangerous, and perhaps the most frequent. With this the Doctor begins; and after an accurate hiftory of the appearances throughout the feveral ftages of the difeafe, he comes to the curatory indications, which are,

Firft, To moderate the too great and rapid motion of the fluids, and abate the too great heat and violence of the fever, in the two firft days of the difeafe, as fafely, and as much as we can.

2dly, To evacuate and carry out of the body, as much of that putrid bile, and thofe putrid humours, as expeditioufly and as fafely as we poffibly can.

And, 3dly, To put a stop to the putrefcent difpofition of the fluids, and prevent the gangrenes from coming on, by fuitable Antifceptics."

For the firft of thefe he recommends bleeding once or twice, only on the firft or fecond day, if the fever is high.

For the fecond intention, he advises to evacuate the putrid humours, by copious draughts of any thin diluting liquor, fuch as warm water; fometimes with an addition of Oxymel, green Tea, &c. and afterwards to compofe the stomach with Extract. Thebaic. gr. 1, vel ils. keeping the body open with a gentle purging clyfter, &c.

In regard to the third indication of cure, we fhall give his own words; and the rather on account of his remarks on the indifcriminate ufe of Blifters, which we do not hesitate to affirm, are often as injudicioufly applied, and are as productive of extenfive mifchiefs in London as in Barbadoes. After obferving, that however proper the Bark may be to put a ftop to the putrefcent Diathefts of the fluids, and prevent gangrenes from coming on, yet chufing to lay the ufe of it afide, on account of its conftantly difagreeing with the ftomach, he proceeds.

The Radix Serpentaria Virginiana, is the next best Antiseptic, whofe extraordinary effects in ftopping the progrefs of gangrenes, has been known for many years; wherefore I tried it mixed with fome others, in the following manner, and with much better fuccefs than I could hope for, or durft expect: for I found that a light infusion of this root, not only fat eafily on their ftomachs, but it moderately raised the pulfe and fever, which were now funk too low, and kept them in an equal moderate ftate, if prudently given; which is a thing of the greatest importance at this time of the fever, as on that chiefly depends the recovery of the patient, therefore fhould be diligently attended to by the attending Phyfician; and as foon as ever he perceives that the pulfe begins to abate and fink lower, either on the thirdday, or fooner, he muft immediately begin to give the antifceptic and warmer medicines, to fupport the Vis Vitæ. I have found the following form both the most agreeable to their weak ftomach, and the moft powerful antifceptic, and, indeed, the moft fuccefsful medicine.

R Rad. Serpent. Virg. 3ij. Croci Angl. zís, m. et infund. vafe claufo in Aq. Bul. q. f. per Horam unam ut Col. Zvi. adde Aq. Mentha Simp. Zij. Vini Maderienf. Ziv. Syr. Croci, vel. Syr. è Mecon. Zi. Elix. Vitrioli Acid. gut. q. f. ad gratam acidior. Saporem; m. exhibe Cochl. duo vel tria fingulis • horis vel bihoris, vel fæpius pro re nata.

This very rarely fails to fit light and eafily on their ftomachs, even when the faline anti-emetic mixtures will not; and often when every thing elfe is rejected. By the ufe of this, and proper nourishment, taken in small quantities, and often, (for when it is given in larger quantities, the flomach too often rejects it, and the Patients fink for want of support;) and their food or whey should now be made a little ftronger of the wine than before, or than usual in other fevers by this method the pulfe is raised, and ufually kept up, and the fever rendered moderate, and the Coma, and other bad fymptoms, greatly abated, and the Patient ufually goes on well. But if after taking this a little while, we find that the Pulfe does not rife, and the heat become equal all over the body, and moderate; but, on the contrary, a coldness of the extreme parts comes on, and increafes, thefe medicines must be made more warming, either by increafing the quantity of the Rad. Serpent. and Saffron, or by adding Vinum Croceum, or Confec. Cardiac. or fome fuch like medicines, till the Pulfe is raifed, and the heat equally expanded all over the body; and then the • fever

fever may be kept in a moderate ftate, by giving the before⚫ mentioned antifeptic Julep, or fuch like medicine: but not by the use of volatile Alkaline Salts, or Spirits, as Sal, et Spir. C. C. Salis Ammoniac. Vol. Spir. Vol. Aromat. &c. which diffolve and increase the putrefcent state of the animal fluids, as is well known both by obfervation and experiments, not made on pieces of dead flefh, or dead ftagnating animal fluids, but by giving these alkaline volatile falts and spirits to the living, which when they are taken into, and mixed with the circulating blood, do greatly attenuate and diffolve it, and with the heat of the body, do bring on aputrefcent Diathefis,, and a putrid Colliquation of the fluids, ⚫ and confequently must be greatly prejudicial in this fever, which arifes from a putrefcent bilious acrimony, and wherein the fluids are already really in a diffolved putrid gangrenescent state: whereas the Rad. Serpent. Crocus, & Elix. Vitrioli, are very powerful antifeptics, and prevent the diffolution and putrefaction of the blood; and confequently prevent or ftop the Hemorrhages alfo, which usually come 'on in this second state of the disease.

It may be expected, that the low Pulfe, Coma, Delirium, and the coldnefs of the extreme parts, with the Tremors and convulfive fpafms, &c. fhould induce me to think that Veficatories are indicated, and that I fhould both use and advise them. I allow that they feem at the first view, to be indicated, but a further enquiry into the caufe and nature of these symptoms, and a due confideration of the diffolved colliquative ftate which the fluids are in, in this fever; and an examination into the effects of the alkaline falts of the Cantharides, when carried into our blood, will clearly demonftrate and fufficiently convince us of the contrary. For this Coma, low Pulfe, coldnefs of the extreme parts, Delirium, Tremors, and the other bad fymptoms attending this fever, do not proceed from a Lentor and vifcidity of the circulating fluids, as in fome other fevers, as the flow Nervous Fever, and fome others; but from a dissolution of the red globules of the blood, and their being carried into fuch small veffels as do not naturally admit them, whence anError loci fluidorum in Cerebro, &c. is produced, and a due fecretion of the nervous and other fine fluids, or Animal Spirits in the brain, is obftructed or hindered, and a diminished Momentum of the blood, the confequence of the former, at the fame time. The application of Veficatories muft increase all these, and render very bad, much worfe. But in other fevers, where thefe fymptoms arife from a Lentor, and vifcidity of the fluids, which retard Cc 4 • and

6

and hinder their free circulation, and due fecretion; Blif ters being applied, the falts of the Cantharides pafs into the circulating fluids, as the ftranguries and increased motion of the blood demonftrate, and attenuate, and diffolve that Lentor and vifcidity, and fo remove the caufe of those fymptoms, and produce almoft furprizing good effects, as we often fee when they are judicioufly applied in fuch cafes. For the fame reafons, the application of Veficatories in this fever, muft diffolve the blood more, which was in a diffolved putrid state before, and render the disease, and all its fymptoms, worse.

⚫ents.

The truth of this is confirmed by obfervation and experience; but fuch is the unreasonable fondnefs of [for] Blifters, in this island, and fome other countries alfo, almost in every • cafe where pain and a fever feize, that they are too often applied even in Dyfenteries, and in the beginning of inflammatory fevers, and much too often in this fever, even in the last state of it, to the great prejudice of their PatiThere are some few who practife there, who know better, but in general from the want of reading fuch Authors as would inform them better, they ignorantly follow the practice of their Fathers and Mafters, who read very little, and themfelves read lefs, and follow cuftom, which has rendered the ufe of Bliftering almoft facred, and the fear of reproach for not ufing them almoft unavoidable, if the Practitioners have not fortitude and judgment fufficient to oppofe this their unwarrantable and pernicious ufe.

This has but too often given me an opportunity of fecing their bad effects, especially in this fever; where I have ob ferved, that the Coma, Tremors, Subfultus Tendinum, the Coldness of the extreme Parts, and the low Pulfe, (tho' this fometimes has been rendered a little quicker, but not more full) have not only not been relieved by their application, but have been increafed thereby, and the Hmorrhage, which ufually attends this fever, has been hast⚫ened on, or if come on before, it has been increased by their application: and I have fcen a Veficatory, which I ordered to be taken off, as I ufually do as foon as I come in this fever, that the part where it is laid was turned black, and perfectly spacelated; and if the fpine and ends of the ribs had not hindered, a large fquare paffage into the cavity of the Thorax would have been opened, if the Patient had lived a few hours after it, but he died two hours after I came, And the reflection that I have never ordered any Veficatories to be applied in this fever, and have always

• strictly

ftrictly forbidden their application in it, I must fay, gives me great fatisfaction.'

If the anxiety, with the burning pain and tenfenefs of the Præcordia and fides return, either alone or accompanied with a Coma and Delirium, fymptoms arifing from an accumulation of putrid bilious humours, he advifes to repeat two or three times fuch an antifceptic purge as the following, which (he fays) feldom fails to remove these bad symptoms.

R Manne Calab. Zils vel Zij. Tamarind. cond. Zi. Tart. Vitriolat. gr. x. m. folve in Sero Lactis Vino Maderienf. per vi. et Cola, adde Tinet. Sen. Zis. m. dividet. in tres vel quatuor partes, de quibus capiat Eger unum omni bor. donec incipiat purgare.

By this method of treating the Bilious Fever, our Author affures us, he feldom failed, to fubdue this formidable difeafe, in a fhort time.

The next difeafe our Author mentions, is the Dry BellyAch, or Dry Gripes; which, both in the fymptoms and manner of cure, greatly refembles the Morbus Colicus Damnoniorum, defcribed by Dr. Huxham. The indications and method of cure recommended by Dr. Hillary, is, firft, to abate the pain, and take off the irritation of the Nerves, from whence the convulfive fpafms arife. This is effected chiefly by Opiates. Secondly, To procure a free paffage through the bowels, and carry off the morbid matter that way, without increafing the irritation. Here all draftic purges are prejudicial, or whatever adds to the ftimulus. A foft lenient eccoprotic, with the opiate frequently repeated, and joined with Balf. Peruv. Anodine emollient fomentations or linaments applied to the belly, or a clyfter of the fame kind, are beft calculated to answer this end. After the convulfive fpafms of the inteftines are removed, and a free paffage to the fæces restored, it is proper to ftrengthen the bowels by moderate riding, and cordial corroborating medicines. It must be obferved, that this difcafe often terininates in a Palfey, especially of the hands. To illuftrate the fuddenMeteftafis of the fubtle humour or caufe of this disease, we are prefented with the following remarkable cafe.

A Gentleman who had laboured under this painful difcafe fome years in Maryland, which at laft rendered his hands and arms paralytic; and they had continued in that ufelefs ftate two years, without any pain in them all that time; he had no ftrength, and little motion, but a toler⚫able degree of numb fenfation in them, and during these two years, he was pretty free from any pain in his bowels.

.

• He