An essay on the bite of a mad dog: in which the claim to infallibility of the principal preservative remedies against the hydrophobia is examined. By John Berkenhout, M.D.

AN ESSAY ON THE Bite of a Mad Dog, &c.

1. I Know not of any human attempt which bears a better resemblance to the knight of La Mancha's attack of a wind-mill, than that of combating vulgar errors; of reasoning against received opi∣nions. The most powerful and pointed arguments generally fall to the ground, when opposed by the impenetrable shield of common prejudice. Nevertheless, in the present age, when science is hourly making such rapid advances towards the discovery of truth; when knowledge is so much more universally diffused than in

former times, it seems not unreasonable to hope, that mankind may be persuaded to bestow a few moments unbiassed atten∣tion on a subject confessedly of the highest medical importance.

2. This subject hath indeed been amply and learnedly treated by ancient and mo∣dern physicians, in various countries and languages; in this kingdom particularly, by the celebrated Dr. Mead, and the no less famous Dr. James; the latter of whom published, in the year 1760, an en∣tire volume on Canine Madness. Ancient authors were less diffuse, and were gene∣rally satisfied with transcribing from each other. Most of these writers I have con∣sidered with attention, and acknowledge myself much obliged to them for many important facts: I cannot, however, avoid observing, that their labours have a mani∣fest tendency to confirm the fatal preju∣dice which I most devoutly wish to eradi∣cate; I therefore think myself justified in adding a small pamphlet to the volumi∣nous tracts already written on the disease commonly, but improperly, called the hydrophobia, or dread of water. I say

improperly, because this aversion to water, or to drink of every kind, is only one symptom of the disease in question, and that not constantly nor exclusively; for there are many examples on record, suf∣ficiently authenticated, of this symptom, this hydrophobia, in patients not bitten by a dog, or by any other animal.

3. I am even inclined to assert, that the hydrophobia is not generally a symptom of the disease produced by the bite of a mad dog. It rarely happens that the patient has any aversion to water or other liquid; until by experience he finds an insuperable difficulty in swallowing. He then dreads the approach of water, having already found that the attempt to swallow any liquid produces a violent and painful con∣vulsion; so that the symptom in question is rather a real difficulty of swallowing liquids, than a dread of water. As far as my own experience reaches, I can, with great truth, aver, that I have never yet met with a single patient, who expressed any aversion to the sight, sound, or mention of water, until he had found, by experi∣ence, that drinking gave him pain.

4. Some years ago, I was sent for to a young gentleman, who, about six weeks before, had been bit in the arm by one of his father's hounds. A few hours before his death, he stept into a tub of warm water without fear, sat down, and continued in it half an hour. I shall, in its proper place, relate his case circumstantially: I mention it at present only to prove, that the hydrophobia is improperly considered as a diagnostic symptom of this disease.

5. I am equally inclined to dispute the propriety of the denomination rabies ca∣nina, canine madness; for though persons thus unhappily afflicted are often violently agitated during a short time previous to their death, yet they generally retain their reason to the last moment: this disease, therefore, is improperly considered as a species of madness, if by madness we un∣derstand, a distraction, suspension, or per∣version of the reasoning faculties.

6. Writers, fond of searching into an∣tiquity for what is not worth finding, have taken great pains to discover the most an∣cient authors that have written on canine

madness. Hippocrates, most certainly, has not said a single word on the subject, whatever some of his wise commentators may have imagined. A learned list of ancient authors, who have written on the hydrophobia, may be collected from vari∣ous modern writers; but we search in vain for useful information on this sub∣ject among the remains of high antiquity.

7. But if the disease we are about to investigate be neither a species of rabies, nor hydrophobia, what shall we call it!— It were idle to dispute about a mere name; but when a misnomer conveys a false idea, it is no longer a matter of indifference. The fatal disorder communicated to the human species by the bite of a mad dog is doubtless a spasm of the organs of de∣glutition and respiration; a species of an∣gina convulsiva, vel suffocativa. The generic term Angina, is thus defined by the learned Boerhaave, in his 783d apho∣rism—Impedita valde, dolens admodum, vel et impedita et dolens simul, deglutitio atque respiratio, quae contingit a causa morbosa agente in partes binis his functionibus inser∣vientes, supra pulmones et supra stomachum

positas, Angina vocatur; and in aphorism 818, he says,—Si convulsionum causa quae∣cunque musculos pharingis laryngesve oc∣cupaverit, oritur subita suffocativa an∣gina.

8. As I am here writing particularly to medical readers, it is unnecessary to translate the above quotation. Such read∣ers, after comparing these definitions with the symptoms of the hydrophobia, as it is called, will, I believe, acknowledge their surprise, that Boerhaave should not rather have classed it as a species of angina than of mania. Later nosologists seem equally un∣fortunate in point of arrangement. In the system of the celebrated Sauvages, we find Hydrophobia in the class Vesaniae, and order Morositates. His definition of the class is, error in imaginatione, appetitu, vel juditio; of the order, cupiditates aut aversiones depravatae. Now, I appeal, not to systematic writers, but to those who have attended patients suffering under this dreadful distemper; and I request them to recollect, whether erroneous imagina∣tion, appetite, or judgment, or depraved desires or aversions, were among the symp∣toms

they observed? As to the patient's refusing to drink, it proceeds not from an imaginary aversion to water, but from a real, a painful convulsion in the organs of deglutition, excited by every effort to swallow liquids.

9. Linneus divides the disease in ques∣tion into two distinct genera, viz. Rabies, and Hydrophobia: the first he defines in these words, Desiderium mordendi laceran∣dique innocuos; the second, thus, Aver∣satio potulentorum cum rigore et sardiasi, adding, soepius praecedenti maritata. He places them in the class Mentales, and order Pathetici, where, from what I have said above, they must appear to have no business.

10. In Vogel's arrangement, under the class of Febres, and order continuae, we find the Hydrophobia thus characterized, Febris cum aversatione liquidorum, singultu, convulsione, et delirio. The absurdity of making the hydrophobia a continued fever is so obvious, that it requires no comment.

11. Dr. Cullen denominates his second class of diseases, neuroses, which he de∣fines— Sensus et motus laesi, sine pyrexia et sine morbo locali. Spasmi constitute the third order of this class, and of this order, the last genus is hydrophobia, thus defined — Potionis cujuslibet, ut convulsionem pha∣ryngis dolentem cientis, fastidium et horror; plerumque e morsu animalis rabidi. Of this genus he admits two species, viz. vulgaris, and spontanea, the first of which is the immediate object of our present consideration.

12. Dr. Cullen, with his usual saga∣city, saw the error of former medical writers, who mistook this spasm in the organs of deglutition, for a species of madness.

13. But by what name soever we dis∣tinguish this dreadful disease, previous to our enquiry concerning its symptoms in the human species, let us endeavour to ascertain those by which it may be known in the brute, where it originates.

Authors have amused themselves with learned disquisitions concerning the cause

of this rabies in dogs, wolves, foxes, &c. Some accuse worms within the cranium, or under the tongue. Dr. Cheyne ascribed it to a superabundance of animal salts, and Dr. James was of opinion that ex∣tream heat, want of water,* 1.1 and putrid animal food, are generally the cause of this madness in dogs, which he calls a fever.

14. The usual symptoms which indi∣cate approaching madness in a dog, are, first, an evident diminution of his natural keen appetite for food. He eats, indeed, and laps his milk or water, but with obvious indifference. His eyes have lost their usual lustre; he drops his ears and tail, shews no sign of hilarity at the ap∣proach of his master, and his whole aspect exhibits a picture of melancholy, perfectly intelligible to those who are accustomed to observe this animal with attention. In a day or two more, he refuses both meat and drink, shuns the society of other dogs, and is equally, after a short reconnoitre, avoided by them. He now quits his ha∣bitation, runs forward, evidently without having any thing in pursuit, snaps at every

animal that comes in his way, and within forty-eight hours dies convulsed.

15. Such are the symptoms of this dis∣temper in the brute creation; and these symptoms are so constant and unequivocal, that all danger might easily be prevented, by the smallest degree of attention. In the first stage of the disorder, the dog has no propensity to bite, so that he may be seized and tied up without fear.

16. Boerhaave has collected from Fra∣castorius and other writers, a catalogue of symptoms more numerous, and somewhat different from those above enumerated; but as it was not the result of his own obser∣vation, his description of this, as of many other diseases, should be read, cum grano salis.

17. Pliny,* 1.2 in his chapter de medicina animalium, tells us, that there is a worm under the tongues of dogs, which if ex∣tracted when they are whelps prevents their running mad. This doubtless was a vulgar error of the times in which he wrote, and thus the universal prevalence

of this absurd opinion down to the pre∣sent age is accounted for. Dr. James very justly ridicules this idea of a worm under the tongue.* 1.3—

"I take it (says the Doctor) to be a nerve; and this con∣tracting when recently taken away, the ideots fancy it stirs, and believe it a worm, towhich it bears no manner of resemblance."

—He is certainly right in believing it not to be a worm; but he is mistaken in supposing it a nerve, for a reason which himself hath adduced, name∣ly, its contraction; nerves are not elastic. He is also wrong in saying, it bears no resemblance to a worm.* 1.4 Morgagni pro∣bably was nearer the truth, in calling it a tendinous ligament. Be it what it may, it is certainly of use to the dog and its extirpation answers no salutary purpose.

18. Let us now trace the progress of this fatal disease in those of the human species who have the misfortune to be bit by a mad dog or cat. The wound, on immediate inspection, discovers no signs of malignity. If it be so superficial as scarcely to have drawn blood it generally heals without the least inflammation, and

in that case there is little or no danger: on the second day it seems a mere scratch, and on the third it is hardly visible. But if, on the second morning, we observe an inflamed circle spreading from the wound, resembling that which surrounds the puncture when inoculation for the small-pox has taken effect, there is reason to believe that part of the poisonous saliva of the enraged animal is absorbed, and the consequent symptoms may be rationally expected.

19. Meanwhile the patient takes the Ormskirk, or some other equally infallible medicine, is hurried away to the sea, in which he is two or three times dipped and half drowned; the wound heals, and all his apprehensions vanish. Unhappily, this delusion also vanishes in the space of five or six weeks, about which period he feels a* 1.5 pain in the part where he was bit, gradually extending over the whole limb. He now recollects his misfortune. The horrible stories he has heard rush upon his mind, and the hourly expectation of

madness and death fill his whole soul. Under such apprehensions it is no wonder that he should discover symptoms of impatience, anxiety, and even of delirium. But these symptoms proceed from, and are always in proportion to, his appre∣hensions. His reasoning faculties continue unimpaired; his pulse becomes irregular and quick; but there is no preternatural heat, foul tongue, nor any other febrile symptom. He complains of a fullness and prickling in his throat, and swallows his spittle with difficulty. So far from ex∣pressing any aversion to water, he calls for drink; but in the attempt to swallow it he is convulsed, and, after two or three painful efforts, the approach, or even the sight of any liquid produces horror. He continues some time longer to swallow solid food without much pain or difficulty. At last even that is impossible. He now becomes sensible of an irresistable inclination to struggle, and wishes to be held; he breathes quick and with great difficulty, and in a few hours after dies convulsed, as if he were strangled with a cord.

20. Such, and such only, are the proper diagnostic symptoms of this fatal disorder: they are amply sufficient to distinguish it from any other, and are therefore all that are necessary to be generally known; but as a disease so frequently mortal cannot be too well understood, I shall proceed to mention the symptoms above omitted, as I find them enumerated by the principal authors that have written on this subject.

21. Coelius Aurelianus, who collected his history of the hydrophobia from Eudemus, Soranus, and other writers with whom we are little acquainted, tells us that the hydrophobia is immediately pre∣ceded by extreme irritability, unusual motions of the body, disturbed sleep or absolute wakefulness, indigestion, stretch∣ings, yawning, nausea, imaginary notions of bad weather, and no appetite for drink. To these symptoms, according to the same author, succeed, when the hydro∣phobia begins, a desire to drink* 1.6, with terror at the sight, sound, or name of water. The patient is afraid even of

fomentations with oil; his pulse is dense (densus) small and irregular: sometimes a small degree of fever, convulsive motions of the stomach, spasms in the precordia, numbness of the joints, and torpor of the intestinal canal; frequent inclination to make water; trembling and catchings of the limbs; voice hoarse, resembling the barking of a dog; spiral posture of the body, like that of a dog lying on the ground; anxiety when any person enters the room, as if apprehensive that he should bring water; redness of the face and eyes; body emaciated, the superior parts pale and sweating; veretri frequens tensio cum seminis involuntario jactu, &c.

22. To the symptoms above mentioned Boerhaave adds the following—Lassitude,* 1.7 weight, and indolence in every muscle of the body; disturbed sleep, frequent startings, frightful dreams, convulsions; constant inquietude, depression, sighing, and love of solitude. If the patient be bled, the blood exhibits no morbid ap∣pearance. He now complains of a squeez∣ing about his heart. He is terrified not only at the sight of any fluid, but even of

any pellucid or reflecting body. He vomits viscid bilious phlegm or poraceous bile; grows hot and feverish. To a gradual exacerbation of these symptoms are now accumulated a dry projected tongue, open foaming mouth, extreme thirst, an irresistable inclination to spit at, and bite those that are near him; cold sweats, complete rabies, and on the fourth day the patient dies.

23. Dr. Mead copies Boerhaave without any material alteration, except in saying that death relieves the patient in two days after the first symptom of hydrophobia.

Sauvages, in his Nosologia, adds no other symptom to those above related; but from Dr. James we learn the following very curious and material proof of the salutary instinct of dogs, namely, that they fly from persons actually infected by the bite of a mad animal.

24. Such readers as are not acquainted with medical authors, and particularly with the writings of the celebrated Leyden professor, will wonder why he

should have exhibited so numerous a catalogue of symptoms, if it be true, that so few of them really occur in patients afflicted with this malady. But his wonder will cease, when he is told that Boer∣haave, when he began the study of physic, found the science a mere chaos. He immediately conceived the idea of re∣ducing it to method, and, after much reading, condensed and arranged his materials in the form of aphorisms, con∣stituting a new system of physic, which aphorisms he used as the text of his acade∣mical lectures. All his symptoms very seldom occur in the same patient: they were collected from a variety of authors, and are to be remembered by physicians, rather as possible phenomena than as abso∣lute diagnostics.

25. Having thus attended our unfortu∣nate patient to the final period of his life, let us proceed to examine the morbid appearances in his body upon dissection.

26. Cappivacci, an Italian, was, I be∣lieve, the first anatomist who published

an account of any dissection of this kind. His observations, together with those of Zwingerus, Brechtfeld, and other writers, were republished in the Sepulchretum, and thence collected by Boerhaave, and con∣densed into a single aphorism, which, for the sake of the English reader, I will translate.* 1.8 —

"The morbid phenomena discoverable in the body by dissection are generally the organs of deglutition somewhat in∣flamed, bilious gluten in the stomach, the gall-bladder full of black bile, the pericardium dry, the lungs incredibly distended with blood, the heart full of blood almost dry, the arteries full, the veins empty, blood in the arteries ex∣tremely liquid, and scarce coagulating in the air, all the muscles, viscera, brain, and spinal marrow, dryer than usual."

27. Zwingerus,* 1.9 in a body which he dissected, found the membraneous inter∣stices between the cartilaginous circles of the aspera arteria intensely red, and the stomach and intestines sprinkled with red spots.

28. Brechtfeld found the entire tract of the oesophagus narrow,* 1.10 and in a state of constriction.

29. M. Tauvry, a French anatomist,* 1.11 found the gula and aspera arteria in a state of inflammation.

30. Morgagni tells us of an hydro∣phobic patient whose body,* 1.12 though dis∣sected sixteen hours after death, in a cold season, was intolerably putrid. Black bile was found in the gall-bladder; the lungs were also black, and very offensive. The right auricle of the heart was much dilated, the left very narrow. The blood-vessels of the brain were all full; the brain was rather dry.

31. The same author relates another history of a man who died about a month after being bit by a mad dog,* 1.13 and whose body, which was dissected about twenty-four hours after death, in the hottest season of the year, was much less offensive than the former. His neck had a livid appearance; the blood-vessels of the stomach were as full as if they had been

injected; the stomach was distended with air, and contained besides a yellow and greenish water; part of the liver was livid, and the gall-bladder was full of brown bile; the diaphragm was a little inflamed; the lungs on the posterior part were tumid with blood, and black; the upper part of the oesophagus, aspera arteria, pharynx, and larynx seemed nearly gan∣grenous; in the head, the vessels of the meninges were distended with blood, and the internal substance of the brain was dotted with red points; the internal ven∣tricles contained a reddish serum.

32. In a third dissection the stomach was found to contain a viscid cineritious fluid,* 1.14 and the gall-bladder a small quan∣tity of yellow bile; the illiac veins were violently distended with blood, and their corresponding arteries quite empty; lungs stuffed full with crassamentum, and in part almost in a gangrenous state; the heart contained a small quantity of blood re∣sembling melted pitch; the organs of deglutition shewed no other signs of in∣flammation than a slight redness at the top of the pharynx; but the membrane which

invests the epiglottis was crisp and shrivel∣led; all the vessels of the meninges were immoderably full of black blood; neither the cerebrum, cerebellum, spinal marrow, viscera of the thorax and abdomen, nor any of the muscles were more dry than they generally are; in the ventricles of the brain were about three ounces of yellowish serum.

33. Morgagni,* 1.15 after comparing these observations with those of Mead, Plancus, Fabbri, Brogiani, &c. concludes, that the bodies after death differ more from each other than when living:

"For (says he) whilst alive, they all drink with great difficulty, and most of them not with∣out horror; but, upon dissection, we find no one phenomenon common to every subject. As to that dryness of the parts, so generally observed, it is by no means universal; nor does it seem to deserve much consideration, because the violent agitations of the pa∣tient, and the consequent evacuations, sensible and insensible; the frequent exhibition of alexipharmics, and long

abstinence from liquids, are sufficient to account for it."

34. On the authority, therefore, of Morgagni, who was a man of most ex∣tensive anatomical reading and experience, we must conclude, that dissections have not hitherto discovered the part, or parts, of the human body particularly affected, or injured, and consequently no curative indication can thence be deduced. He is of opinion, nevertheless, that the seat of the disorder is in the nerves and brain. Democritus and Gajus,* 1.16 two of the most ancient writers on this subject, were of the same opinion; as were also the dis∣ciples of Asclepiades. Some of the anci∣ents accused the diaphragm, some the stomach and intestines, and some the heart.

35. Boerhaave,* 1.17 from the history and comparison of the hydrophobia with other diseases, was induced to believe, that it is first an affection of the nerves; that con∣vulsions of the viscera are thence produc∣ed; that the blood and humours thence become vitiated; but that the primary seat of the disorder is in the region of the

stomach. In this last part of his theory, he followed the opinion of Arthemidorus,* 1.18 Artorius, and the disciples of Asclepiades.

36. Dr. Mead was persuaded,* 1.19 that the seat of the disease is in the nervous fluid, contaminated by the saliva of the dog act∣ing as a ferment, and gradually assimilat∣ing the whole to its own degree of morbid acrimony.

37. Dr. James ridicules these opinions, and roundly declares,* 1.20 that

"he does not believe one syllable of the modern doctrine of nervous juices and nervous distempers."

Previous to the display of his own theory, in order to render it intelligible to readers unacquainted with anatomy, he translates, from Boerhaave's preface to his collection of authors on the venereal disease, a minute description of the cellular membrane; to which he adds two pages more, on the same subject, from Cheselden. The first of these begins thus—

"This membrane is of a vascular contexture,"

&c. This is certainly not true. If Dr. James had ever read so com∣mon a book as Haller's Primae Lineae, he

would not have quoted Boerhaave and Cheselden on this occasion. His theory, however, is briefly this—The poison con∣tained in the saliva of the mad dog is communicated through the wound made by his teeth to the fat contained in the cellular membrane, which fat, by fer∣mentation with the saliva, is assimilated into a poison; now this fat being mixt with the blood, and conveyed to the liver, by the vena portarum, the bile is contami∣nated, and necessarily produces all the symptoms observable in canine madness.

38. To render this theory more intel∣ligible, the Doctor informs the ignorant reader,* 1.21

"that there is a perpetual inter∣course betwixt the blood vessels and the cellular membrane, and conse∣quently between the contents of both, the blood and fat."

—It is somewhat singular, that this poisoned fat should, in its passage to the liver, mix with the blood without injuring that fluid, which throughout the entire progress of the dis∣ease is found to differ in nothing from that of a person in health. This obsta∣cle was too obvious to escape the Doctor;

but he tumbles over it very clumsily: he supposes, notwithstanding appearances, that the blood must be ultimately viti∣ated by the bile; so that the blood first vitiates the bile, and the bile returns the compliment to the blood.

39. Thus, then, according to Dr. James, the liver is the primary seat and fountain of the hydrophobia, which vis∣cus, he tells us,* 1.22

"supplies the rest of the body with bile in immense quantities."

In what physiological school the Doctor learnt that the rest of the body is supplied with bile in immense quantities is diffi∣cult to imagine. I know of no part of the body which is supplied with bile except the duodenum, where, mixing with the di∣gested aliment issuing from the stomach, part of it is converted into chyle, and thereby bereft of all its bilious qualities, and the remainder carried through the intestinal canal, and finally ejected: so that no bile, quasi bile, is absorbed, and consequently no part of the body except the intestinal canal is supplied with this fluid.

40. But, if it be true that the liver is the part of the body chiefly affected in the human species, we may, I think, fairly conclude, that this viscus is also the pri∣mary seat of the disorder in dogs. Now, it is very certain, that the liver of a mad dog, supposed to be an infallible remedy against canine madness, hath been frequently eaten without any bad effect.

41. There is yet another objection to Dr. James's hypothesis, which the ana∣tomical reader will probably think of some weight.—Page 78 of his treatise, he tells us, that

"the poisonous saliva ad∣hering to the tooth of a dog is im∣mediately communicated to the fat re∣siding in one or more of the cells of the cellular membrane;" that "a scratch is sufficient, if it only raise the cuticle, without drawing a drop of blood;" for (continues the Doctor) this subtile poison, as well as the venereal venom, is capable of entering the cellular mem∣brane when applied to any part not covered by the cuticula."

42. Is it possible that Dr. James, the author of a medical dictionary in three folio volumes, should not have known, that there is no external part of the hu∣man body which is not covered by the cuticle. That he was really ignorant of this fact is still more evident from the following passage in his 16th page—After relating a case from Van Swieten, who quotes it from Palmarius, of several chil∣dren having caught the hydrophobia by kissing their father, who had been bit by a mad dog, he says—

"In this case it is very possible that some of the frothy saliva might be conveyed to the lips or the mouth of the children, which, not being defended by the cuticle, might communicate the contagion, as it hap∣pens with respect to the venereal poi∣son."

—Now, it is not only certain that the glans penis, the lips, and mouth, are covered by the cuticle, but that it is continued through the fauces, oesophagus and intestinal canal.

43. But the Doctor assures us that, for the saliva of the dog to poison the fat,

"a scratch is sufficient, if it only raises the

cuticle."

Surely, the Doctor had for∣got, that the cellular membrane, with which he took so much pains to make his readers acquainted, and in which the fat resides, adheres to the internal surface of the cutis vera, which therefore must ne∣cessarily be perforated before the saliva can be brought into contact with the fat.

44. If Dr. James had been at all ac∣quainted with the absorbent lymphatic vessels, whose extremities perforate the cuticle in every part of the surface of the body, he would not have deemed those parts only which he supposed destitute of this external shield susceptible of the canine poison. Though the medical world be much indebted to the minute enquiries of Doctors Monro and Hunter for a more perfect intelligence of the lymphatic system, yet the absorption of fluids through the pores of the skin hath been generally known, even prior to the days of Galen, who, as a proof of this fact,* 1.23 says—Si sitiens balneum ineat, illi sitis sedabitur. Innumerable experiments have been made by later writers in order to establish this doctrine, particularly by

Boyle, Bellini, and many others.* 1.24 In the Philosophical Transactions we read of men working in quicksilver mines, whose bodies had imbibed so much of that metal, that they changed the colour of brass by rubbing it with their hands, or even by breathing upon it. We know that by handling turpentine the urine acquires a violet smell; that tobacco will vomit, and aloes purge, when externally ap∣plied; but the fact most universally known is the constant effect of mercu∣rial unction.

45. Hence it is evident that the cuti∣cula, or epidermis, as it was called by the Greeks, is no defence against the canine, or any other poison, if the application be continued sufficiently to give time for its absorption: it is therefore necessary, when the saliva of a mad dog touches any part of the skin, to wipe it off immediately, and wash the spot. The examples, indeed, of persons thus infected without a wound are not numerous, because those on whose hand or face the saliva rests naturally wipe it off before it can be absorbed.

46. But, in defence of Dr. James it may be urged, that, whether the cuticle be pervious or not, or in whatsoever manner the canine poison pass the cutis, it proves nothing against that part of his hypothesis which establishes the fat as the immediate receptacle of the poison, and its future vehicle to the liver.

47. In reply to this defence, it will be sufficient to observe, that the bibulous lymphatics, by which fluids on the surface of the body are absorbed, do not discharge their contents into the cellular texture, but, creeping along its membranes, com∣municate with larger veins which ter∣minate in the receptaculum chyli, the thoracic duct, or jugular vein; so that the canine poison, or any other fluid, absorbed from the surface of the body, cannot remain in a state of extravasation with the fat in the cellular web, but must neces∣sarily be thrown into the general mass of circulating fluids* 1.25.

48. Dr. James's theory, therefore, being contradicted by anatomical demonstration, necessarily falls to the ground. The hypo∣thesis of Boerhaave, Mead, and others, who supposed the seat of the disease to be in the nervous fluid, is equally insup∣portable, because no such fluid circulates in the nerves, which are not tubes but solid fibres, whose extremities therefore are incapable of absorption.

49. If these theories be false, those who read for information will ask, where lies the truth? If such readers have sufficiently attended to the 47th paragraph they will easily conceive that the poisonous saliva of the dog is absorbed by the capillary lymphatic veins, whose ramifications ex∣pand to every part of the surface of the human body; those veins which imbibe the matter communicated by inoculation, the venereal virus, water, and infectious miasmata from the air.

50. But, if this be true, why is it necessary, in order to communicate the small pox by inoculation, that the cuticle should be raised?—I answer: It is not necessary; but that by this operation the communication of the disease is rendered more certain, because the matter being lodged under the cuticle, by re∣taining its moisture, continues longer in a fit state for absorption.

51. If it should be further asked, why the canine poison, thus introduced, con∣tinues circulating in the body five or six weeks before it produces that disease, of a single paroxism, called the hydrophobia? —I answer, that in this it differs from other inoculated diseases only in point of time, In all inoculations there is an in∣tervention of some days between the cause and effect; but why that of canine madness requires a longer time for assimilation and maturity must remain a mystery, until we are better acquainted with na∣ture's modus operandi. Probably there are other contagious diseases whose malignant miasmata may be equally slow in their progress from admission to efficiency.

52. Some attempts have been made to discover the nature of this canine poison by the help of microscopes and chemical experiments; but to no purpose. Dr. Mead supposed it to consist of fiery saline particles.* 1.26 Dr. Heysham believes it to be an acid; but this is mere conjecture. All we know of the matter is, that it is a poison sui generis, which, being absorbed by the lymphatic veins, produces certain effects in the human body; no mecha∣nical nor chemical theory, therefore, can assist us in the invention of a remedy against the bite of a mad dog. Analogy may possibly be of some use. Chance, the great inventor of medicines, hath not, I think, been successful in the present case. Let us, however, proceed to the most important, the therapeutic division of our essay.

53. Mithridates, king of Pontus, about two thousand years ago, is said to have invented that farrago of more than forty ingredients called by his name. Historians tell us that, believing it to be an universal antidote, he took a dose of it every morning. In justice however to his

Pontic majesty, I must not suppress what Samonicus writes on this subject.

"When Pompy (says he) took the baggage of Mithridates, he found, among his papers, the prescript for compounding the famous antidote against all poisons, invented by that king: he was much surprised to find that it consisted only of twenty leaves of rue, two walnuts, two figs, and a little salt."

To whose inventive genius we are indebted for the forty ingredients which were afterwards added I know not, unless to that of Damocrates, under whose name this cele∣brated antidote shines conspicuous even in the last edition of the London Phar∣macopoeia.

54. Andromachus, a native of Crete, cotemporary with Galen, not satisfied with an antidote of forty-five ingredients, com∣posed one of more than sixty, which he called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 (serenitas) from its sedative or anodyne effect. This impertinent jumble of stuff was afterwards called Theriaca, from the Greek word 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, fera, a wild beast, being an antidote against the invenomed bite of mad or poisonous

animals. This notable hodge-podge is also to be found even in the last edition of the London Dispensatory; and, what is more extraordinary, there are, I am told, some physicians who continue to use these theriacas in their prescriptions: with what intention is best known to themselves.

55. If the inventors of theriacas had any ideas at all, they probably thought that, in so great a number of ingredients, it was possible some one of them might hit the mark they aimed at, for the same reason that sportsmen prefer a number of small shot to a single bullet; but I am rather inclined to think them the inven∣tion of some arch apothecary's apprentice, who had a mind to try what sort of a medicine he could produce by jumbling together every drug in the shop. Be their origin however what it might, they are certainly the oldest antidotes upon record, and, from the proportion of opium they contain, might possibly alleviate the spasmodic symptoms incidental to the bite of a viper, or of a mad dog.

56. Dioscorides wrote a treatise on the Theriaca, in the second chapter of which he recommends, as a medicine that might be depended on for the bite of a mad dog, two spoonfuls of the ashes of the river crab, with half the quantity of gentian, to be taken in a large glass of wine.* 1.27 Galen prescribes the same medicine, with the addition of a small quantity of frankin∣cense: the crabs he burnt alive in a copper dish, after the rising of the star Sirius, when the sun was in the constellation Leo, and on the eighteenth day of the moon. This invaluable secret he learnt from old Aeserion the emperic, who, being Galen's master, must have lived cotem∣porary with Dioscorides, and might pro∣bably be the inventor of this infallible medicine, for so it was esteemed by these physicians.

57. Dr. Mead is of opinion that this remedy is recommended by the ancients upon rational grounds, because it is a diuretic;

"For (says he) "the surest reme∣dies in all ages against this venom have been such as provoke a great discharge by urine."

Reflecting on this circum∣stance,

this Esculapius of his times, con∣ceived the great idea of recommending to the world his infallible Pulvis Antylissus, which, at the doctor's request, was ho∣noured with a place in the London Pharmacopoeia.

58. Whence did Dr. Mead conclude that this powder of calcined river crabs, or crawfish (for such he supposes them to have been) would promote a great discharge of urine? He certainly thought that this calcination, like the incineration of vege∣tables, would produce an alkaline salt. If he had possessed the least degree of chemical knowledge, he would have known that the animal itself would burn to a mere earth, totally inert, and that its shell would be converted into quick lime, of which consequently, with a very small proportion of earth, this specific must consist.

59. Dr. James's chemical knowledge appears to have been not much inferior to that of Dr. Mead, whom he thinks to∣tally wrong in translating the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 of Dioscorides, and Galen, River Crawfish. He is clearly of opinion, and

takes some pains to prove, that these authors meant a species of river crab, and not crawfish. Dr. James prudently ob∣serves, that we ought to be very accurate in our quotations from ancient authors,

"lest the medicine recommended be mistaken for something that may not possess the same virtues."

This is doubtless a wise observation; but any chemist's boy would have told him, that the virtues, whatever they may be, of a calcined crawfish, crab, or oister, are exactly the same; that all shells are calca∣rious earth, and consequently burn to quick lime, in no respect different from that produced by the calcination of chalk, lime-stone, or marble. But, that Dr. James, as well as Dr. Mead, supposed that this calcination of river crabs produced an alkaline salt is evident from the following passage. Speaking of this powder, he says —

"I believe it may have some efficacy in preventing the canine madness,* 1.28 though none that can be depended upon. This opinion is founded on its being an highly alkaline substance; and all or most of the pretended specifics for this distemper are alkaline, and destroyers of

acids; as the celebrated pancake made of oister-shells, mentioned by Dessault, Armenian Bole, Tin, and many other."

These last words put the doctor's skill in chemistry quite out of doubt.

60. But, as we can hardly suppose that Dioscorides and Galen ventured to give their patients two spoonfuls of quick lime, it is probable that they did not calcine these crabs, or crawfish, sufficiently to convert the shells into lime, though long enough to dissipate the volatile parts of the animal. On this supposition this specific powder becomes a mere absorbent earth, a pulvis è chelis cancrorum, possessed of no diuretic virtue; yet Galen pro∣nounces it infallible.* 1.29

61. The next diuretic antidote of the ancients,

"recommended (as Dr. Mead thinks) upon rational grounds,"

is the Spongia Cynorrhodi, sponge of the dog∣rose,

"Which (says the Doctor) is so celebrated an antidote, that P. Boccone, who has written a whole discourse upon its virtues, tells us it is called in Sicily Sanatodos, or All-heal."

We also in this country have a common plant dig∣nified

with the same name, and equally insignificant in its medical capacity. These panaceas are generally good for nothing. But Dr. Mead ranks this gall of the briar among his animal diuretics, because Mr. Ray found it to be the nidus of a fly.—

"Now (says the Doctor) all insects abound with a diuretic salt."

—If the lie direct were admissible in polite conver∣sation, I would say, this is not true. But I marvel exceedingly that he did not ob∣serve that this Sanatodos of the Sicilians is called in England a Dog-rose, because it produces a medicine for a mad-dog: also, that he forgot to inform his readers, that this celebrated antidote originated in the dream of an old woman, as he must have read in Pliny.

62. Dr. Mead, after specifying, from the ancients, other diuretics, which cer∣tainly are not diuretics, proceeds to the recommendation of his infallible Pulvis Antilyssus, which he declared never failed of success, though he had used it a thou∣sand times.

"I have often wished (adds the Doctor) that I knew so certain a remedy in any other disease."

—Surely

such testimony, from so great a physician, must be more than sufficient to establish the infallibility of any medicine beyond all suspicion: and yet two greater men, Boerhaave and Van Swieten,* 1.30 are of opinion that it is good for nothing; and Dr. James assures us, that

"it has been given,* 1.31 without success, to a great number of people and animals in many parts of the kingdom."

63. This infallible Pulvis Antilyssus is prescribed by Dr. Mead in the following words—

"Take of the herb called, in Latin, Lichen cinereus terrestris, in English, Ash-coloured ground-liver∣wort, cleaned, dried, and powdered, half an ounce; of black pepper pow∣dered, two drachms. Mix these toge∣ther, and divide the powder into four doses, one of which must be taken every morning fasting for four morn∣ings successively in a pint of cows milk."

—I have now before me a London Dispensatory with manuscript notes by my worthy friend Dr. Longfield, a physician deservedly distinguished for his sound judgement, and extensive me∣dical

knowledge. On the blank leaf op∣posite to the Pulvis Antilyssus, he wrote—

"This is Dr. Mead's famous powder: it is most certain that it never cured one person bit by a m••d dog."

64. A moderate share of experience in the medical powers of plants is sufficient to determine à priori the virtue of this Lichen, which, together with the rest of its tribe, discovers no other sensible qua∣lity than a slight degree of astringency, and therefore can have no other effect than what may be expected from any other medicine, astringent in the same degree; unless we admit the doctrine of specifies, to which Dr. Mead would doubtless have objected, being himself a sectator of the mechanical Belini.* 1.32 — Insipidae et inodorae vim medicam vix exercent, is an aphorism of Linnaeus.

"This rule (says Dr. Cullen) seems to be without exception; and it is on this account, and not on any proper experience, that many plants are expunged from the Materia Medica, as having no taste or odour which should point out in them any active quali∣ties."

—After such evidence, we may,

I think, justly proceed to the condemna∣tion of the infallible Pulvis Antilyssus.

65. But Dr. Mead, in order to con∣vince the world that he had not adopted this medicine without proper scientific investigation, informs his readers, that he examined the Lichen cinereus terrestris by distillation, and that the result of his ana∣lysis was, some acid water, some oil, and some coal that contained fixt salt. A bunch of docks, of nettles, of thistles, or of any other common weed, would have yielded the same. This sort of analysis can be of no use in discovering the medi∣cal virtues of plants. The receipt to make this celebrated Pulvis Antilyssus was first brought to England by Captain Dampier, who called the plant Jew's Ear (Tremella auricula of Linnaeus) a kind of ash-coloured fungus, which is frequently found on the trunks of old trees. But it seems Sir Hans Sloane was of opinion that the Cap∣tain was mistaken; that he certainly meant the ash-coloured Liverwort, which, on the authority of so great a naturalist, was ac∣cordingly adopted. Is it not probable from this history, that, in rejecting the

original Jew's Ear, Dr. Mead seized the ear of the wrong sow?

66. The next infallible medicine I shall examine is that which, about thirty years ago, was brought from Tonquin by Sir George Cobb, when he returned from the East Indies. It consists of native and factitious Cinnabar each twenty-four grains, with sixteen grains of Musk, powdered and mixt well together. This dose is to be taken in a glass of Arrack once only, and repeated after an interval of thirty days The absurdity of making any distinction between native and factiti∣ous Cinnabar, which are precisely the same thing, is too obvious to need a commen∣tary: it proves, however, the ignorance of the Chinese old woman who probably invented the medicine, and of all those who in prescribing this powder have con∣tinued to observe the same ridiculous dis∣tinction. But, in the composition of this specific, there is another absurdity of more importance. All the cinnabars, whether native, factitious, or of cinnabar of anti∣mony, are mere powder of post; abso∣lutely inert.

67.

"Factitious cinnabar (says Dr. James) is made of three parts of mer∣cury to one of sulphur; and,* 1.33 as I re∣member, a pound of good native cin∣nabar yields near fourteen ounces of fluid mercury; and therefore it seems that the good effects of this medicine ought to be principally, if not entirely, ascribed to mercury."

—Dr. James, hav∣ing resolved to sport a preparation of mer∣cury as the only specific for canine mad∣ness, was quite satisfied with this sort of reasoning: but we must come nearer to the point.

68. Native cinnabar is the ore of mer∣cury; that is, mercury mineralized by sulphur, in the proportion of about six, seven, or eight parts of the former to one of the latter.—Sulphur possesses the singu∣lar property, in combination with mer∣cury or antimony, of rendering both these violent metallic substances inactive. It is particularly well known of antimony that it is more or less mild in proportion as the regulus is combined with more or less sulphur. This chemical fact Dr. James must have known, if he had understood

the process for making his own fever-powder. But mercury, before it can ex∣ert its stimulant power, must not only be completely extricated from the sulphur with which it formed cinnabar, but must afterwards be divided by trituration, or dissolved in a mineral acid. Now, the only means of decomposing cinnabar is by fire, in, what is called by chemists, the dry way. In the human body, therefore, it is impossible; but if we could suppose the mercury actually separated from the sulphur, not being dissolved by a mineral acid, or otherwise divided, it would still remain in a state of total inactivity: a priori, therefore, cinnabar may be pro∣nounced inert.

69. But, lest the advocates for this Tonquin medicine should deem this sort of philosophical argument inconclusive, let us take the opinions of a few eminent chemists on the subject.* 1.34—Dr. Cullen, in his Lectures on Materia Medica, speaking of mercurial preparations, says—

"Crude mercury, and the combination in cin∣nabar and Aethiops mineralis, to which may be added Aethiops antimonialis, in

so far as it contains mercury, can only by accident, or indirectly, prove medi∣cines."

—

"Triturated with sulphur,* 1.35 mercury becomes an inert substance. This I could determine à priori, whe∣ther it was in the form of Aethiops mineral, or native or factitious cinna∣bar."

—Dr. Lewis in his Dispensatory tells us, that

"cinnabar, like Aethiops,* 1.36 is inactive."

—Cartheuser, having given a large quantity to a dog, says, that it pro∣duced no sensible effect, but that part of it passed through the intestines unaltered, and that the remainder was found in the stomach and bowels.—Dr. Longfield, whom I have before mentioned, wrote the following note on the article cinnabaris factitia in the Pharm. Col. Reg. Med. Londinensis—

"It is a shame that the cin∣nabars are not totally exploded: they have not the least title to the character of nervous medicines; they are both inert."

—But it were unfair to conceal from the reader, that a famous German chemist of the last century was of a dif∣ferent opinion. He considered cinnabar as an efficacious medicine, and ascribed its virtue to its beautiful colour, with which

Archeus is so charmed as to neglect the disease which he was employed in exiting; for it seems this Archeus, this creature of Van Helmont's distempered brain, is won∣derfully delighted with the colour red.

70. In answer to all this reasoning à priori, I shall be told, that experience is the only test, and that the instances upon record, of the hydrophobia being cured or prevented by the Tonquin powder are innumerable. In reply to this answer— First, there are examples upon record of persons having died of the hydrophobia after taking it, particularly in two cases related in the London Medical Obser∣vation:* 1.37 Secondly, many other medicines, equally infallible and equally extolled, have deservedly sunk into contempt: Thirdly, no attestation of facts will con∣vince a rational being that an effect was produced without a sufficient cause: now, a substance which is demonstrably inert can produce no effect in an animal body, and therefore can cure no disease.

71. Cinnabar being thus, I think, fairly dispatched, if there be any anti∣dotal

power in the Tonquin medicine, it must be attributed to to the antispasmodic virtue of the musk: Dr. James ascribes it to its alkaline quality—

"Musk (he tells us) is an animal substance, and conse∣quently of an alkaline nature; and as alkalies have in all ages been recom∣mended in this case, it seems at least to be not prejudicial."

—This is damning musk with faint praise. But what did the Doctor mean by ascribing to it an alkaline quality because it is an animal substance? Had he forgot that animal matter wants the assistance of fire to pro∣duce alkali? If every species of animal matter be an alkaline medicine, the parings of his own nails would have done as well. Musk, however, is doubtless a powerful antispasmodic, and for that reason may be of service in the hydrophobia.

72. This Tonquin powder is ordered to be taken in a glass of Arrack, doubtless with no other intention than to cover the taste of the musk. This vehicle, how∣ever, suggests an idea, which, though I may think it extravagant, I will commu∣nicate. Suppose, when the symptoms of

the fatal disease in question first appear, previous to the difficulty of swallowing liquids, the patient were to drink to in∣toxication of any strong liquor he may chuse. Who, without trying it, will pretend to circumscribe the antispasmodic effect of this remedy? It is certainly not contra-indicated by any febrile or mani∣acal symptoms. In a forlorn hope no at∣tempt can be too extravagant. It will at least answer one good purpose: I mean that of relieving the patient from several hours of the most horrid anxiety that can possibly be conceived.

73. I now beg leave to call the reader's attention to the mercurial preparation so strenuously recommended by Dr. James in his Treatise on Canine Madness. It is called Turpith mineral; it is a precipitate of mercury from its solution in the Vitri∣olic acid, by which it was not only dis∣solved but calcined. Whether it be a pure calx of mercury, without any adhesion of vitriolic salt, is a matter of dispute among chemists of the first reputation. Monsieur Baumè declares positively,* 1.38 que, ce precipitè est absolument privé de toute acide, lorsqu'il

a été lavé à plusieurs reprises dans de l'eau bouillante—Nevertheless, from the effect of the medicine, I presume he is mistaken. It is a very rough mercurial, fit only for dogs, to which animals Dr. James seems to have given it with success. As to its effect on the human species, he produces no more than one single case of a patient bit by a mad dog, and cured under his own immediate care by Turpith mineral, He relates, indeed, three or four other cases in support of his specific, on the authority of persons of his acquaintance; but hear-say evidence in this case, as in courts of justice, is inadmissable.—Dr. Raymond,* 1.39 physician at Marseilles gave seven boluses, containing each four grains of Turpith mineral, to a patient bit by a mad dog: the patient died.

74. The Ormskirk medicine, which in many parts of this kingdom, particularly in the North, is deemed infallible, ap∣pears, from the report of Dr. Black and Dr. Heysham, to consist of,* 1.40 Powder of chalk, half an ounce; Armenian bole, three drachms; Allum, ten grains; Powder of elecampane root, one drachm; Oil of anise,

six drops.—Now, though the chemical enquiries of these gentlemen may not be admitted as proof positive, yet when the result of experiments made by two able chemists, at different times, is precisely the same; when a medicine composed of the supposed ingredients has the same colour, taste, and smell, we have the strongest presumptive evidence that our conjectures are well founded; especially, when there is no discoverable difference between the effect of the real and sup∣posed composition.

75. As to the medical virtues of the ingredients above-mentioned, they are suf∣ficiently known.—Chalk is a mere absor∣bent earth, without any other power than that of destroying the acid it may meet with in the primae viae, and, during the effervescence, of producing a little calca∣rious gas, commonly called fixt air.— Armenian bole, such as is generally sold by the druggists, is nothing more than a lump of pipe-clay, coloured with a little red ochre or rust of iron.* 1.41—Allum is an

astringent, and nothing more.—Elecam∣pane-root hath been generally ranked among the Alexipharmics; it is said to assist expectoration, and, in large doses, to act as a diuretic and cathartic: it is, how∣ever, in no estimation, and in so small a dose, mixt with the other ingredients, can produce no effect.—As to the six drops of oil of aniseed, I presume their efficacy, in the present case, will hardly be insisted on.

76. Possibly I may be told, that, though these several ingredients, separately taken, may possess no extraordinary medical powers, yet, like other compounds they may, when united, form a medicine of considerable virtue.—I acknowledge that a powerful medicine may be formed by a judicious combination of simple ingre∣dients, prescribed on chemical principles; but I am very certain, that an ignorant jumble of chalk, clay, allum, and elecam∣pane, will form nothing but an hetero∣generous mass of dirt, that may do harm, but cannot possibly do good in any disease whatsoever.

77. But, say the advocates for the Orm∣skirk powder, what signifies reasoning against facts? Are there not a thousand examples of the hydrophobia prevented by taking this medicine? Would the sa∣gacious inhabitants of the northern coun∣ties have such faith in a mere ignis fatuus? —Far be it from me, to doubt the sa∣gacity of the northern counties: they are by no means singular in mistaking shad∣dows for realities. All quack-medicines, and more than half the medicines used in regular practice, are ignes fatui. What are all the vaunted panaceas, theriacas, antidotes, and specifics, but ignes fatui, deceptions, chimeras?

78. The several specifics above consi∣dered have all successively had their day of infallibility, and have all been equally supported by experience, the true test of medical virtue: that is, a number of people bitten, or supposed to be bitten, by dogs supposed to be mad, have taken the Ormskirk, or any other infallible powder, and have escaped the hydro∣phobia. But in the London Medical Ob∣servations,* 1.42 &c. we have, on the authority

of Dr. Fothergill, an incontestable proof that the Ormskirk medicine is not infal∣lible: Mrs. Bellamy, who was bit by a mad cat, took it, and

"conformed to the directions given by the vender in every respect,"

yet died of the hydro∣phobia about four months after, as, I make no doubt, would all the patients that ever took the Ormskirk medicine, if they had been really infected by the canine poison.

79. This censure I do not confine to the Ormskirk, nor yet to any of the medi∣cines above-mentioned: it comprehends every prophylactic remedy taken inter∣nally. Can any thing be more absurd than to imagine, that a disease received into the body by inoculation; a poison absorbed by the lymphatic veins, and mixed with the general mass of circu∣lating fluids, can be destroyed by a medi∣cine taken into the stomach? Is there any analogy in the history of physic to autho∣rize such expectations? Will any powder, pill, or bolus, stop the progress of the small-pox by inoculation, or prevent it from taking effect? Was there ever a phy∣sician

weak enough to attempt to prevent any other infectious disorder, after the poisonous liquid or miasmata were actually absorbed?

80. Having thus, I hope not unfairly, considered the pretensions to infallibility of the specifics introduced and recom∣mended by particular men, we are come at last to that sovereign remedy extolled by every writer on canine madness, ancient and modern, and used in all countries, in every age, from the days of Celsus to the present moment—I mean bathing in cold water. To this part of our subject I beg the reader's particular attention, because I am very certain that many lives have been lost by a foolish dependence on this broken reed. I have said that all writers on canine madness, ancient and modern, have recommended cold-bathing; but I must except Dr. Falck, the author of The Seaman's Medical Instructor, and Dr. Fo∣thergill, who wrote a paper in the London Medical Observations,* 1.43 purposely to prove the inefficacy of bathing in the sea.

81. The physician last mentioned was of opinion, that the practice of bathing

in salt-water, as a preservative, originated in a mistake. Celsus directs the patient,* 1.44 actually labouring under the hydrophobia, to be thrown unexpectedly into a fish∣pond: if he cannot swim, he is to be suffered to flounce and drink, raising him a little now and then, so as to keep him from drowning; but, if he can swim, he is to be frequently ducked, that in spite of himself he may be satiated with water:

"Thus (says Celsus) his thirst and dread of water will be cured at the same time."

82. Celsus was mistaken in supposing that he could force the patient to drink by holding him under water, or that, after being half drowned, he would look on water with less horrour, or swallow liquids with greater ease. The latter part of this discipline is daily practised, by the old women at the watering places, on the wretched creatures that are sent by old women, male and female, from the inland country. This practice of drowning the patient in order to cure him of an aversion to water, absurd as it is, was probably taken from Celsus, who, though a sensible

man, possibly without experience or much reflexion, prescribed it on the authority of some Greek writer; but why the sea was substituted for a fish-pond, and how it came to pass that what Celsus ordered as a cure for the hydrophobia actually present, should be applied as a prophy∣lactic, a preservative remedy, is difficult to conceive.

83. Who was the inventor of this im∣mersion in salt water I cannot determine. I am inclined to think that it originated in Holland or Flanders, in the days of panaceas, charms, witches, and hob∣goblins. That it was a common practice in the Netherlands in the sixteenth century appears from the following passage from Van Helmont; which, as his books are not in every library, and, I believe, were never done into English, I shall endeavour to translate literally.—

"There is a fortress on the sea-coast, about four leagues from Ghent, called Sluce. There I saw a ship passing by, and in it an old man, naked, bound, and weights fastened to his feet. Under his arms they had tied a rope, the other end of

which was fixed to the yard-arm of the vessel. I asked the meaning of this spectacle, and was answered by one of the sailors, that the old man had got the hydrophobia, having, some time ago, been bit by a mad dog. Why, I asked, is he brought to the sea? Whe∣ther they meant to drown him? 'No, no, (said the sailor) he will soon be cured; such is the blessing of God upon the sea, that it will instantly cure this kind of madness.' At my request they took me on board. We had scarce sailed a mile, when the sailors, by pulling out a plug in the bottom of the ship, let in the water, till she sunk almost to the edge of the gunwale. This sea-water they collected for the purpose of making salt. The plug being now re-adapted, two men hauled down the opposite end of the yard, and thus hoisted the old man into the air. They then let him drop into the sea, and he remained under water ad spatium Miserere. They repeated this operation twice more, keeping him each time under water ad spatium Salutationis Angelicae."

84. Some profane readers may possibly be inclined to comment ludicrously on this spatium Salutationis Angelicae; but, choosing rather to treat the matter se∣riously, I requested a friend to read over the Miserere,* 1.45 and found by my stop-watch, that he performed it in one minute and thirty-five seconds; and the Salutatio An∣gelica in ten seconds. Van Helmont is not sufficiently explicit in this important part of his narrative. Whether this was only a method of computing time, or whether these psalms were actually re∣peated during the immersion, does not ap∣pear. I am inclined to think they were: if so, this capital omission in our old women on the sea coast sufficiently ac∣counts for their fallibility. But to pro∣ceed with Van Helmont's story.

85.

"They then laid him on his back across a barrel, and covered him with a watch-coat. I concluded he was dead; but the sailors ridiculed my ap∣prehensions. Being now released from his bonds, he discharged all the water which he had inspired, and presently revived. He was a cooper from Ghent,

and being cured of his hydrophobia, continued perfectly well."

86. If the poor cooper remained long in that position, supino dorso super vas teres, I marvel that he ever recovered. That the Dutch sailors should believe that his lungs were full of water is no great wonder: Van Helmont should have known better. There are, indeed, writers of some reputation, who tell us that they have found water in the lungs and stomach of drowned subjects; but, waving the improbability of the fact, later experi∣ments prove incontestably that drowning animals rarely imbibe any water; certainly no quantity to do them any injury. Mor∣gagni drowned guinea-pigs, hedge-hogs,* 1.46 dormice, and other animals, and found on dissection little or no water in the lungs or stomach of any of them. The opinion that drowned persons are full of water, erroneous as it certainly is, prevails so universally among the ignorant, that I am persuaded many have been prevented from recovering by holding them up by the heels, or laying them on the side of a hill, with the head downwards.

87. These Dutch skippers told Van Helmont, that a salt herring applied imme∣diately to the wound was an infallible cure for the bite of a mad dog, and that half drowning in salt water was only ne∣cessary when this remedy had been neglected; so that we have neither the au∣thority of Celsus, nor the practice of the Netherlands, to plead in favour of sea-bathing as a preservative. The case of this cooper, if we believe that he was really so mad as to require being fettered, affords a singular example of the hydrophobia actually cured by immersion in salt water: it is indeed so singular, that I can pro∣duce but one more on any tolerable au∣thority. The instances in which it has failed, as a prophylactic remedy and cure for the hydrophobia, are innumerable.

88. Morgagni, Epistle viii. Art. 23. tells us, that an hydrophobiac patient was thrown into a cold bath, and held some time under water: he died the night after. —In Art. 25, we read of another who died soon after he was taken out of the bath. —Art. 26. After mentioning Van Hel∣mont's cooper, and the case of a girl

recorded in the history of the Academy of Sciences at Paris,* 1.47 Morgagni writes thus:

"Immersion in cold water must have succeeded very differently with others; since, beside Baccius, and him whom Parry pointed out, not only Salius has written that he, after several times experience, had found no advantage from this remedy, but also Caelius Aure∣lianus expressly discommended it, as injurious. But Palmarius has admo∣nished us, that it was certain, from the experience of many, that this method of treatment had been very unsuccess∣ful."

89. Boerhaave's directions for bathing the patient in the sea, or in a river,* 1.48 are very singular.—

"Immediately after in∣fection, with great preparation, ex∣citing fear, and after frequent threat∣nings, at last throw him into the water."

—He then repeats the orders given by Celsus for half-drowning the patient:

"for (he adds) the cure is effected by the perturbation of the mind (spiritum tur∣bando) agitation of the animal spirits, and not by the salt water, as we learn

from the deplorable exit of the man who, after being bitten by a mad dog, was ship-wrecked and swam a long time in the sea, frequently covered by the waves, yet died of the hydropho∣bia."

—This being the case, threatning to hang the patient would answer the same purpose. Here, I think, sea-bathing seems to be fairly given up.

90. Dr. Mead, speaking of sea-bathing as a preservative, says,

"I have known many to have died raving mad who had undergone this treatment."

—

"I will not (says Dr. James) pretend to de∣termine how much more effectual bath∣ing in the sea may be than in cold fresh water.* 1.49 It is certain that many that have been almost drowned in the sea have soon after died of the hydro∣phobia; and I knew a gentleman who took thirty couple of fox-hounds to the sea, and had them dipped with all manner of caution; notwithstanding which, he lost several hounds every day he took out the pack."

—In the Edinburgh Medical Essays, we read of a boy, bit by a mad dog, who was ten times

dipt in the sea, yet died of the hydrophobia some months after.—Dr. Fothergill, in his Additional Remarks on the treatment of per∣sons bit by mad animals, addressed to the editors of the Medical Observations, &c. says:

"I have heard of diverse instances,* 1.50 and I have no doubt but you are as well satisfied as myself; and perhaps from your own observation, that this process (sea-bathing) is by no means a preser∣vative from the fatal consequences of the bite of mad animals."

—Desault, a physician at Bourdeaux, in his treatise sur la Rage gives his opinion on this subject in the following words:

"When I am applied to by a person bit by a mad animal, I order him to bathe in the sea, though I have no dependance on this remedy, since the many proofs we have had of its inefficacy in the course of the present year."

—Choisel, a Jesuit re∣siding at Pondicherry, in a pamphlet pub∣lished at Paris in 1756, in which he relates many examples of canine madness cured by mercurial friction, says:

"Bathing in the sea has hitherto been considered as an infallible preservative from this disorder. My own experience proves

the futility of that opinion. Not one of those who depended solely on this remedy survived the bite more than thirty-three days."

91. I presume the reader is, by this time, satisfied as to the efficacy of bathing. The reason why it continues, in the present age, to be used as a prophylactic remedy for the bite of a mad dog, is the same which may be assigned for a thousand other foolish customs—our fathers did so before us; and their reason was, that their fathers did so before them: but from what theory the inventor of this remedy deduced his prescription is not easily imagined. All medicines must have ori∣ginated either in reasoning à priori, or from some fortuitous event. The first, I think, is, in this case, out of the question: I conclude, therefore, that some person bit by a dog, supposed to be mad, ac∣cidentally fell into a horse-pond. He continued well; ergo, the hydrophobia was prevented by a ducking. The repu∣tation of some other medicines in constant use for other diseases is not a whit better supported.

92. Aurelianus, in his chapter enti••led Quomodo curandi sunt hydrophobi,* 1.51 exhibits the various prescriptions of all the authors he had read upon this subject. Most of them deserve no notice. I shall select a few however which, doubtless, the reader will think too important to be neglected: —

"Let the patient's chamber be to∣lerably warm and lightsome.—Let the part that was bitten be covered with a piece of clean warm flannel.—If it be necessary to bleed him, let the blood be received in the hand of the assistant, lest the noise of its falling into the bason should affect the patient.—Talk to him about washing and drinking, and, if he hears this patiently, you may then give him something to drink; if not, you may let him suck through the spout of a tea-pot, covering his eyes or darkening the room.—Let his nurses be discrete and not* 1.52 loquacious.— Let his head be shaved.—Let him be exercised in a hammock or a sedan.— If he refuses to take any liquid in at his mouth, force it into the other end of him; but, take care that you do not

administer too great a quantity, lest it squirt in your face. This perilous operation being happily accomplished, you are then to squeese his, or her, belly, so as to force the contents up∣wards, and thereby quench the patient's thirst. Tullius Bassus (says our author) besides clysters gave his patients a pinch or two of snuff; whose friend Dr. Black gave white hellebore, of which some physicians order a cataplasm to the patient's backside."

93.

"Paracelsus (says Van Helmont) affirmed,* 1.53 that the hydrophobia might be cured by acrid purgatives. His pro∣mises, however, are not justified by the event. Our good Catholics, therefore, despairing of relief from the faculty, repair to St. Hubert, at whose shrine, by virtue of certain ceremonies, they are cured; but, it is worthy of remark, that if these ceremonies are not strictly observed, the latent rabies immediately breaks out, and they become irreco∣verably hydrophobic. There is a vest∣ment of St. Hubert's, which is pre∣served in a chest, secured by six locks,

the keys of which are kept by six dif∣ferent Vergers. For these fourscore years past they have been continually cutting off pieces from this holy vest∣ment; nevertheless it remains, to this day, perfectly entire. Now, it is im∣possible there should be any imposture in the case; for they have never been able to discover whether this miraculous robe be of linen, woollen, or of silk, consequently it cannot be annually re∣newed. They cut off a piece of the robe, and incarnate a thread between the skin of the patient's forehead. Hence another miracle; for a person thus cured becomes possessed of a power to postpone the hydrophobia during forty days in any of his acquaintance, who, after being bitten, may not have leisure immediately to visit St. Hubert: on this condition, however, that if they exceed the forty days ever so little, without applying for a prorogation of the term, they go mad irrecoverably."

94. Those who are conversant with books on this subject, will ask, why I have taken no notice of the celebrated

powder invented by Palmerius?—I have two reasons: first, because it deserves no notice; secondly, because it is never pre∣scribed in this kingdom, and therefore can do no mischief. I have omitted several other infallible medicines for the same reason. An idle display of medical eru∣dition on so trite a subject were ridiculous. I sat down solely with a design to con∣vince the less informed part of the com∣munity, that their opinions concerning the prevention of canine madness, or hydrophobia, are fatally erroneous, inas∣much as that dependence precludes the application of more rational means. I determined to employ a few leisure hours on this subject, because Boerhaave, Mead, and other physicians of high reputation, have authorised such irrational dependence.

95. But this is not the sole mischief of which the erroneous opinions of eminent men are productive. Dr. Mead, fully persuaded of the all-sufficiency of his Pulvis Antilyssus, endeavours most irra∣tionally, to divert his readers from an attention to the wound. These are his words—

"The ancient physicians,* 1.54 who are

followed in this by the moderns, advise, where the place will admit of it, to enlarge the wound by incision; to ap∣ply a cupping-glass; to burn it with a hot iron, and to keep a discharge from the ulcer for many days. I cannot but say, that I think all this severity use∣less."

—

"It happens in most cases that the wound, being small,* 1.55 is healed up before the patient seeks for help. For this reason, and because it is of no great consequence whether it be cured or not, in the paper which I printed and dispersed some years since, entitled, A certain cure for the bite of a mad dog, I took no notice of any outward appli∣cation."

—I will, without hesitation, venture to pronounce this the most per∣nicious doctrine that ever was taught by any physician ancient or modern. It af∣fords one of the most flagrant examples in the annals of medicine, of a sensible man and a scholar sacrificing his reason, his common sense, to a preconceived hypothesis. He imagined that the poison contained in the saliva of the inraged ani∣mal contaminated a nervous fluid—which has no existence; and that this poison

might be carried off by a diuretic medi∣cine —which is certainly neither diuretic nor any thing else. He advised cold bathing, because, on mechanical prin∣ciples, he supposed that the external pres∣sure of the water, by constringing the vascular system, would determine the se∣gregated poison to the kidneys, and so assist the operation of his Pulvis Antilyssus.

96. Before I prescribe that which I conceive to be the only rational means of preventing the fatal effect of the bite of a mad dog, it is necessary that I should answer a very natural question.—If (says the reader) the several specifics above con∣demned are really good for nothing, how comes it that so many persons bit by mad dogs are daily cured by the Ormskirk medicine, bathing in the sea, &c.? —If this were not what is called begging the question, I should be distressed for an answer; but the truth is, that all those who believe themselves cured by these futile preservative remedies were never infected; and consequently no harm would have happened, whether they had used them or not. Fortunately for mankind,

not one in fifty of the dogs supposed to be mad are really mad; and of those few that are so, their teeth are often wiped clean by the clothing of the person bit, and consequently no inoculation takes place. It happens also, as in all other infectious diseases, that the body is frequently not disposed to receive the infection. These, and these only, are the causes of all the transitory reputation which the various infallible medicines have from time to time acquired.

97. Nevertheless, as the case is always doubtful—as possibly the dog may be actually mad, and the poison really im∣bibed, nothing can be more imprudent than to depend on the chance of its being otherwise: we are, therefore, to act as if we were certain that dog was a mad dog. The person bit must immediately apply his mouth to the wound, and con∣tinue to suck it during ten minutes or a quarter of an hour, frequently spitting out, and washing his mouth after each time with water, warm or cold, no matter which. If the wound be in a part of his body which he cannot reach with his

mouth, possibly he may prevail on some rational friend to do him this kind office; especially when I assure him, positively assure him, that it may be done without the least danger. My own son, then about eight years old, in returning from school, was bit by a dog in the thigh. My eldest daughter, being informed of the accident, without the least hesitation immediately sucked the wound. She had heard me say it might be done with safety. The dog was certainly not mad; but I relate the story in justice to her affectionate intrepidity, which, in a young girl, was somewhat extraordinary.

98. Neither ancient nor modern writ∣ers, if I remember right, have advised sucking the wound received by the bite of a mad dog:* 1.56 yet Galen, in his book de Temperaments, says, that the saliva of this animal is not equally dangerous when ad∣mitted into the stomach; therefore, it is probable that, in some part of his volu∣minous writings, he may have mentioned this experiment. But, in the bite of a venomous serpent,* 1.57 Celsus, and after him Dr. Mead, lays great stress on this pre∣servative

application. It is very extra∣ordinary, that in one case the Doctor should deem it of so much, and in the other, of so little importance. The first of these authors assures us, that the Psylli, a people who pretended to an hereditary and exclusive power of curing the bite of serpents by suction, owed their success solely to their resolution; for, says he, Venenum non gustu, sed in vulnere nocet; adding,

"whoever, therefore, sucks the wound after the example of these Psylli, will save his friend, and do himself no injury."

99. Dr. Mead was informed by a sur∣geon who lived in Virginia,* 1.58 that the Indians there cure the bite of the rattle∣snake by first sucking the wound* 1.59, and then swallowing a large quantity of a decoction of the rattle-snake root, so as to vomit plentifully. Now, that the de∣coction contributes nothing towards the cure, I presume will be readily admitted; sucking the wound, therefore, is the sole remedy, which was certainly dictated by

the natural sagacity of this people. That this cure is effectual is confirmed by the case of a man in London, who, being bit by a rattle-snake brought from Virginia, sucked the wound, and recovered.

"As the poison (says Dr. Mead) of this snake is more quick and deadly than any other that we know,* 1.60 a remedy for this will most certainly prove effectual against that of smaller vipers, and all other creatures of this kind"

—and why not of every other kind? Was not the analogy sufficiently obvious? If the poison of a serpent may be sucked from a wound, is there any reason to imagine that the virus in the saliva of a dog may not? But then the infallible Pulvis Antilyssus would have been of no use. Seriously, I believe, that if this simple operation were immediately and resolutely performed, no other remedy would be required. The best medicines are often the most simple, and those which are nearest at hand. We are too apt superciliously to overlook the simple dictates of nature and common sense, to the discredit of our profession, and the loss of our patients. Art, chemistry, com∣pounds, and systems, are the hobby-horses

of young physicians; and it is not till they have grown old in the profession, that they return to Nature and Hippocrates.

100. But, though I have great de∣pendence on this simple preservative re∣medy, we cannot be provided with too many weapons; offensive and defensive, against so formidable an enemy. Those who want resolution to attack the foe personally, will be glad of a substitute. That substitute is a cupping glass, or any other vessel that will answer the same pur∣pose. If no surgeon be present take a pretty large piece of paper; twist it gently, so that it may easily be thrust into a narrow-mouthed jug; light the paper well, and, having put it into the vessel, fix it tight over the wound, and let it remain in that position till it may be easily taken off. Repeat this operation three or four times.

101. Ancient and modern writers on this subject have generally advised searing the wound with a hot iron; partly with a design to destroy the poison, but particu∣larly with an intention to produce an

ulcer. This, I think not only an unne∣cessary, but a pernicious act of cruelty. Let us suppose that a particle of the poison, sufficient to communicate the disease, is absorbed by a lymphatic vein, what will be the effect of the application of a red hot iron to the extremity of that vein, after such absorption? Will it not imme∣diately shrink and shrivel? and will not the reduction of the poisonous fomes, by any external application, be thus effectually prevented?

102. The wound being now wiped dry with lint or tow, let two drachms of mercurial ointment be rubbed into it, and let the part be then covered by a blistering plaster somewhat longer than the wound. As soon as a bladder is perceived to have risen under the plaister, raise the edge of it, and let out the lymph; and, in order to keep it running, let it be daily dressed, during fourteen days or longer, with an ointment composed of equal parts of Emplastrum vesicatorium, and Unguentum coerubeum fortius, P. L. melted together in a very gentle heat. Let a drachm of mer∣curial ointment be rubbed into the fore

part of the legs of the patient every other night, and on the nights intervening let him take a bolus, composed of three or four grains of Calomel, six grains of Camphore, and a drachm of Conserve of Roses. If any signs of salivation should appear, it must be checked by a day or two's suspension, and a dose of Glauber's Salt.

103. It may possibly be asked, on what foundation I have differed from so many eminent writers in not advising immediate scarification?—I answer, because they ad∣vised scarification on a groundless suppo∣sition. They imagined that the canine virus was communicated to the blood; therefore they wisely ordered the blood thus contaminated to be drawn away; but I conceive the poisonous fomes to be ab∣sorbed by the lymphatic vessels, and, there∣fore, I prefer blistering the part.

104. Every person who, from the bite of a dog really mad, has received the fatal poison, whose constitution is at that time disposed for such infection, and who has ignorantly depended on sea-bathing, or

on any specific taken internally, will, most certainly, in the space of a few weeks, perceive symptoms of the approaching catastrophy, called hydrophobia. In this stage of the disease I fear there is very little probability of recovery. I have, in paragraph 72, perhaps rather wantonly, advised intoxication; I am still of opinion that it is an experiment worth trying. It can certainly do no harm. I remember somewhere to have read of opium, in large doses, being successfully administered; but I do not find this practice confirmed by experience. Powerful anti-spasmodics are certainly indicated.

105. In the 4th paragraph of this essay, I mentioned the case of a young gentleman, whom I attended in the last stage of this horrible disorder. He had been bitten by one of his father's hounds, six or seven weeks before. A day or two before I saw him he complained of a pain in the arm which had been bitten, gradually extending towards his shoulder. He had taken many doses of the expressed juice of Ribwort, which in that country was universally deemed a specific, and had

bathed every day in the river. I saw him about ten in the morning. He com∣plained of nothing but a pain in his arm, and some little difficulty in swallowing. I ordered a warm bath to be prepared, in which he sat half an hour with great com∣posure. I rubbed a considerable quantity of mercurial ointment into each arm, and gave him a grain of crude opium every hour, till nine or ten o'clock at night, without the least effect. About eleven he became extremely restless, and died at twelve, retaining his senses to the last moment, without any symptoms of mad∣ness, or propensity to bite his attendants.

106. This pamphlet, inconsiderable as it may appear to some readers, was not written stans pede in uno; it was nearly finished before the publication of Dr. Cullen's third volume of First Lines of the Practice of Physic. I saw, in that volume, with infinite satisfaction, my own opinion, concerning the cure of the disease in que∣stion, confirmed by that of my venerable preceptor, who concludes his chapter on canine madness with these words.—

"Whilst the state of our experience, with

respect to several remedies now in use, is uncertain, I cannot venture to assert that any of these is absolutely inef∣fectual; but I can give it as my opinion, that the efficacy of mercury given very largely, and persisted in for a long time, both as a means of preventing the disease, and of curing it when it has actually come on, is better vouched by experience than that of any other remedy now proposed, or commonly employed."

107. This Essay may possibly be read by persons who live in the country, at some distance from an apothecary, and consequently, in case of an accident, it may be many hours before any mercurial ointment can be procured. Such readers will necessarily ask, what then is to be done?—Whilst the person bit is sucking the wound, let a spoonful of lard, or tallow, or fat of any kind, be melted, and immediately, with the hand, rubbed into the part, continuing the operation until the fat be entirely absorbed. Let him then take his horse and ride leisurely to the nearest apo∣thecary, who will proceed as above directed.

108. On the testimony of Dessault, and the Jesuit Choisel, particularly the latter, mercury appears to be a certain antidote for the poison of a mad dog. The first used mercury only in the ointment: Choisel, besides using the ointment, gave also a mercurial bolus. They both suc∣ceeded. From Dessault's practice we learn, that mercury externally applied is sufficient; but evidence is wanting to prove that mercury taken internally, with∣out the external application of the oint∣ment, will prevent the hydrophobia. May we not, therefore, hazard a conjecture, that the lard or fat of which the mercu∣rial ointment is made is the real preserva∣tive? Is not this conjecture powerfully supported by the analogy between the canine poison and that of a viper, which is effectually destroyed by viper's fat, or oil of any kind, applied to the part? I mention this merely as a conjecture, future experiments may possibly discover it to be a fact: meanwhile, when mercu∣rial ointment can be had, doubtless it ought to be preferred.

THE END.

Notes

• * 1.1

  Treat. on canine madness, p. 20
• * 1.2

  Hist. nat. Lib. 29, c. 5.
• * 1.3

  On can. mad. p. 203.
• * 1.4

  De sed. & caus. morb. lib. 1. ess. viii. art. 35.
• * 1.5

  This symptom is said to have been first mentioned by Salius.
• * 1.6

  Appetentia bibendi, which Dr. James translates, a violent and insatiable thirst.—Treat. On Can, Madn. p. 55.
• * 1.7

  Aphor. 1138.
• * 1.8

  Aph. 1140.
• * 1.9

  Epb. N.C. dec. 3. a 2. obs. 104.
• * 1.10

  Sepulc. Anat.
• * 1.11

  Hist. R. Acad. an. 1699.
• * 1.12

  De. Sed. et Caus. Morb. ep. viii. art. 23.
• * 1.13

  Ib. art. 25.
• * 1.14

  Ib. art. 27.
• * 1.15

  Ib. art. 32.
• * 1.16

  Coel. Au∣rel. Lib. iii. c. 14.
• * 1.17

  Aph. 1142.
• * 1.18

  Coel. Au∣rel. Lib. iii. c. 14.
• * 1.19

  Mechan. Acc. of Poisons. Essay, 3.
• * 1.20

  P. 37.
• * 1.21

  P. 77.
• * 1.22

  P. 82.
• * 1.23

  Gal. de usu puls. c. 5.
• * 1.24

  Phil. Tr. No. II.
• * 1.25

  "I shall avail myself (says Dr. James) of but one more argument to illustrate the probability of the canine venom being received and fostered in the mem∣brane which contains the fat, or rather in the fat itself. And this I draw from the method of cure; for that very medicine which cures the venereal disease, whose residence is in the fat, is also found effectual in preventing and even curing canine madness."

  — Unfortunately for this argument the venereal disease does not reside in the fat.
• * 1.26

  Dissert. Med. de rab. can. Edinb. 1771.
• * 1.27

  De simpl. med. facul.
• * 1.28

  P. 215.
• * 1.29

  De simpl. med facul. L. 3. c. 34.
• * 1.30

  Aph. 1147.
• * 1.31

  Pa. 227.
• * 1.32

  Pb. botan. Frag. meth. ••at. Mat. Mid. p. 161.
• * 1.33

  Pa. 155.
• * 1.34

  Pa. 451.
• * 1.35

  Pa. 444.
• * 1.36

  Pa. 331.
• * 1.37

  Page 195, and apen∣dix, p. 3.
• * 1.38

  vol. ii. p. 403.
• * 1.39

  Med. Obs. append. p. 3.
• * 1.40

  Med. Com. Vol. v. p. 50.
• * 1.41

  This English or Dutch Armenian bole is, in no respect, inferior to the true Oriental, or to any other bole, for medical purposes.
• * 1.42

  Vol. v. p. 195.
• * 1.43

  Vol. v. p. 290.
• * 1.44

  Cels. lib. v. c. 27.
• * 1.45

  Psalm LI.
• * 1.46

  Ep. xix. art. 41.
• * 1.47

  Ann. 1699.
• * 1.48

  Aph. 1143.
• * 1.49

  Page 235.
• * 1.50

  P. 290.
• * 1.51

  Cap. 16.
• * 1.52

  Aurelianus did not mean female nurses.
• * 1.53

  Demen's idea, p. 287.
• * 1.54

  P. 88.
• * 1.55

  P. 89.
• * 1.56

  Lib. III. c. 2.
• * 1.57

  Lib. V. c. 27. P. 37.
• * 1.58

  Mead, P. 40.
• * 1.59

  This is also a common practice in the Highlands of Scotland. See Pennant's Tour. append. p. 275.
• * 1.60

  Mead, p. 38.