Observations on the tussis convulsiva: or hooping cough, as read at the Lyceum Medicum Londinense. ... By John Gale Jones.

A TREATISE ON THE TUSSIS CONVULSIVA.

BEING called upon by this Society rather sooner than I expected, to furnish a paper for their discussion; and anxious to comply with their requisition, although not sufficiently pre∣pared, I have endeavoured to bring forward to their notice, a Treatise on the Tussis Convulsiva; or, as it is more frequently denominated, the Hooping Cough: and this, not with a view, pre∣sumptuously to advance any positive or decided Opinion, but from a sincere desire to excite the attention, and provoke the discussion of those, whose abilities and experience, while they entitle them to superior respect, afford them also, the means of superior information!

The Tussis Convulsiva, is a disease, which, al∣though well known, has been seldom described; few authors having given us any regular description

of it, or, till lately, recommended any peculiar plan of treatment: nor do they seem to have dis∣criminated it from any other cough, excepting only by that distinguishing symptom, which has given it the name of Hooping Cough. Specifics, in∣deed, have been proposed, and cicuta, by some practitioners, hath been highly extolled: Opium, also, has been esteemed of superior efficacy, and Emetics have been almost universally employed.

As the express purpose of my introducing this subject to the Society, was to combat some pre∣vailing opinions, and to endeavour to controvert some peculiar prejudices, which I conceive to have been adopted; it will unavoidably happen, that I may seem to deliver my sentiments too freely, and to be guilty of great temerity in ven∣turing to oppose the solitary testimony of the youth∣ful practitioner, to the respectable authority of the experienced Physician!

But it will, I hope, be remembered, that altho' a just deference should certainly be paid to the researches of Antiquity, and to the observations of Experience; yet it is, surely, a very dangerous experiment, to desist from enquiry, and grow weary of investigation: the discovery of truth has seldom or never been completely effected by

the labours of one, but by the collective and united industry of many: what, therefore, has escaped the wisdom of the former, may happily have been granted to the perseverance of the latter; and of the republic of letters, at least, it may be said, that the only Road to improvement, is through the Path of Innovation!

If, however, in what I have to offer, I should seem essentially to differ in opinion and practice from the majority of this Society, I entreat them to acquit me of any imputation of obstinate pre∣sumption, or affected singularity; and I solemnly assure them that it is from a full conviction of the truth of what I shall assert, and from a sense of the duty I owe to this Society in particular, as a member, and to the public in general as a medical practitioner, that I bring forward to their notice the consideration of a disease, frequent in occur∣rence, always hazardous, and often fatal: in the progress of which, conscious of the Inaccuracies and sensible of the Defects, but too visible in this composition; I feel it necessary, while I solicit their attention, to claim also, their usual Indul∣gence.

I was, insensibly, led to this digression, because, upon mature deliberation, I cannot but entertain

very different notions of the nature and properties of the Cause and Cure of this Disease, and have been induced, consequently, to adopt a very different treatment. I shall endeavour to give the Society, as far as I am enabled, my opinion of the disease itself, shew what are its usual causes and effects, and by relating to them some remarkable Cases, demonstratively prove, what plan of treatment I have found to be successful.

The Tussis Convulsiva is that disease, which, together with the symptoms, usually attendant upon pulmonary affections, is accompanied with a Contagion of a peculiar and malignant nature; hence it has also obtained the name of Tussis Feri∣na. I shall not hesitate here, to define it to be, a disease of clear and evident debility; and one which never takes place, but in those who have either been previously weakened by some other disease, or who from some unknown or unforeseen cause are predisposed to this state.

The persons most liable to it are those who pos∣sess a weak, lax fibre; who use little exercise; and in fine, those who, from whatever cause, have a deficient perspiration. Hence Children from 4 months to 12 years, are in a remarkable manner affected by it: and indeed, I have seen

but one instance of its taking place in any one of riper years; and this was in a young Lady of a very delicate habit, who might be about nineteen years of age.

Its primary cause is contagion, which, whether it be sui generis, or of the same nature with that, whereby all infectious diseases are produced, and which, differing only in modification, or degree, occasions sometimes Small Pox, or Measles, sometimes Typhus, or Hooping Cough, is at pre∣sent suggested, I confess, as conjecture only; yet perhaps not unreasonably, since in a family where the Measles have prevailed, the Hooping Cough has frequently followed; and in the same child, I have experienced both diseases to be at one and the same time present, causing however no essential difference in the treatment.

The proximate causes will be found to be all such as tend to induce debility: hence at a moist season, and in a damp situation, it is found to rage with the utmost violence: frequently indeed, no other cause than this can be traced, as I lately expe∣rienced in attending three children, whose parents had just removed to a new and damp habitation: together with this, a relaxed habit, where the pores being more patulous, are most liable to the

impression of Contagion, Pulmonary Affections in general, and in fine, any cause capable of inducing a languid state of the system.

Its immediate seat is in the exhalant and mucous arteries: the secreted Fluids of which, being in∣spissated by stagnation in the Bronchia, form the matter of Expectoration. In this, as in any other Cough, it is the serous and mucous Fluids, that chiefly flow to the Bronchia, which continue to bear their pressure for a while, till distended by the load, they can bear it no longer: the unplea∣sant sensation of the stimulus, excites a commotion in the vitality of the labouring part, and rouzes the whole excitement; a Cough arises and throws off its cause, the collected humours* 1.1.

At this time, and during a fit of Coughing, the air is violently expelled; and as an animal cannot exist, for any considerable interval without the admission of air, as soon as possible, it instinctively makes an effort of inspiration; when the air suddenly rushing as it were into a vacuum, causes that remarkable found, which from its supposed resemblance to the articulation of the word Hoop, has given it the name of Hooping Cough.

Hence it is easy to account for the effects pro∣duced by this disease. They are indeed, of a very formidable nature, and are frequently of a most alarming and fatal tendency: sometimes after a violent fit of Coughing, the Patient is seized with convulsions and instantly expires. This may hap∣pen from two causes; first from the continued action of the Lungs urged by the Irritation of the Cough, preventing Inspiration, and thus inducing strangulation; or secondly, from the lungs, being unable to recover their tone, yielding to the im∣pulse of the external atmosphere, and being over∣whelmed by its sudden intromission. An instance of which I knew in a beautiful Child of about three years of age whose Mother had not the least apprehension of her child's being in any danger. Sometimes, on account of the continued obstruction of the circulation, the lungs being violently distend∣ed, yield to the impetus of the shock, a Blood Vessel bursts, and the patient is cut off. If, however, the patient have the good fortune to escape these dangers, the disease by gaining ground, and the cough returning more frequently, continue to weary and exhaust, till he gradually sink under its pressure.

In tracing the rise and progress of this dis∣ease, it will not, I hope, be deemed foreign to the subject, to say a few words respecting conta∣gion, more espicially, as I think it will tend to

illustrate what I have hitherto constantly kept in view, viz. the being guided in the treatment of a disease, more by the general state of the patient than by any particular symptom or set of symp∣toms.

Contagion is a certain subtle, imperceptible matter, of an unknown nature, resembling most natural phenomena, which are only in any measure open to our enquiry by their evident effects. Taken from the body of one affected with it, or from gross substance (such as cloathes, or furniture, where it happens to have been lurk∣ing) and received into a healthy body; it ferments without any change of the solids or fluids, fills all the vessels, and is gradually ejected by the pores; passing out more copiously or scantily, in propor∣tion as the perspiration is more free or impeded* 1.2.

As the issue of the matter is here promoted, by inducing a free perspiration, so whatever part of it be obstructed, and detained below the cuticle, acquires by this delay, a certain acrimony produ∣cing little inflammations, and conducting them when produced to suppuration. Upon this princi∣ple, are the small pox, measles, and other exan∣thematous diseases to be accounted for.

As contagion however requires a certain time for its transmission; it follows, that the most favour∣able state for this purpose, will be that where the different secretions are most perfectly performed, and where, consequently, the system comes the nearest to the healthy state: for it is very evident from daily experience, that in weakened or vitiated habits, where the functions are ill performed, and where perspiration is deficient, it is capable, by its detention, of infecting peculiar fluids, and con∣verting them into a matter, similar to itself.

Yet as contagion, by its subtle and peculiar nature, is found to be imbibed by all habits (per∣fect health perhaps alone excepted) I am unwilling to allow, that it possesses any share in producing general diathesis; but that it kindles up only a symptomatic pyrexia, strictly entitled to the ap∣pellation of local disease, and, by its entrance into a healthy, or unhealthy constitution, produces those different effects, which are seen to proceed from it.

And this imperceptibly leads me to the conside∣ration of specifics. A medicine is denominated spe∣cific, when it is applied for the cure of any peculiar disease, and is supposed to be the only

medicine, possessed of the power of removing or eradicating that disease.

As poisons applied, or admitted into the sys∣tem, were found to produce certain mechanical effects, and seemed in some degree, to act in an uniform manner; the restless spirit of curiosity and active ingenuity of mankind, prompted them to researches after some antidote which might be peculiarly adapted to it, and prove efficacious in its dispersion: hence Mercury, by proving success∣ful in the cure of lues venerea, has been denomi∣nated its specific, and some Practitioners have not hesitated to declare cicuta to be, a certain specific for the Hooping Cough. Yet I conceive it will readily be granted, that for a medicine to be fairly entitled to the denomination of a specific, it is necessary that it should be uniform in its operation and certain in its success: now beside the great difficulty of actually proving the existence of a specific in nature, several cases are upon record of lues venerea resisting the most vigorous applica∣tions of mercury, in all its forms and varieties, and yielding to medicines of a very different nature. With respect to cicuta* 1.3 so warmly praised by some

and recommended by others, I must frankly con∣fess that it becomes me to speak of it with doubt and hesitation, having partly through fear, and partly through incredulity, seldom or never em∣ployed it.

This disease then originating from contagion, will be found like all others of that class to produce in its incipient state no material change or altera∣tion. A cough is the first symptom, which differs very little from any common cough or cold. The appetite is not in general impaired; the countenance remains in its usual state; nor is it sometimes known, that this disease is present, except by a knowledge of its having prevailed at any place, whence it might be supposed to be imbibed. As it proceeds, however, it becomes more clearly marked; the excretory vessels of the lungs, being crammed with a colluvies of fluids, create a sense of tightness in the sternum, and great difficulty of breathing; the stomach begins to reject its contents, and together with these, great quantities of viscid phlegm are either vomited or coughed up. The countenance grows pale, alternate heats and chills with other hectic symptoms take place, and the sound resembling the word hoop is now distinctly observed.

In the last stage, the symptoms become more urgent and distressing: putrid symptoms, the usual consequence of contagion, manifestly appear; foul breath, crude dark coloured feces or violent diarrhoea; spasmodic twitches of the tendons, but particularly a convulsive motion of the nostrils; great anxiety, with high and laborious respiration, all but too clearly foretel the approach of death; and every day's experience brings with it some sad monument of the tyranny of this dreadful disease.

To apply a suitable remedy in the treatment of a disease, nothing more seems to be necessary than to possess a competent knowledge of its cause: since if the cause be exactly ascertained, the effects resulting from it will be better understood: and as identity of known cause always produces identity of known effect, if the cause be uniform, the effect will be uniform also.

Unfortunately, however, in treating the diseases incident to humanity, we are too apt to lose sight of this general and fundamental principle, and depart from the guidance of reason: confiding in hidden powers, which have no existence, and relying on miracles which cannot take place, we sometimes expect from a random and contradictory treatment, the most complete and unequivocal success.

Hence while Hooping Cough has been generally admitted to be a disease of debility, the practice of vomiting has been warmly recommended and followed; and the evacuation of an already exhaust∣ed system has been, by some, esteemed the most infallible method of restoring health and vigour!

An emetic, if it act according to its intention, operates by a discharge of the contents of the stomach and of some of the mucous fluids; and this it does, either by some mechanical power which it possesses, of acting on the nervous sensi∣bility of its inner surface, or by that relaxant property, of rendering the stomach unable to retain its contents.

Yet as the immediate seat of this disease is in the mucous vessels of the lungs, and as the stomach is already in a relaxed and weakened state; a parti∣cular medicine applied solely to that organ, and one whose professed object is to evacuate, must surely be pernicious and useless. For although by its local effect, and by the exertion of straining, expectoration may be promoted, and a temporary relief be obtained; yet the cause being increased which gave rise to this collection, and a rude shock being given to an already weakened system; the exhibition of an emetic, however it may seem at

first to relieve, must eventually tend to exasperate the disease.

The cause of the collection which takes place in the vessels of the lungs, is, as we have already stated, a deficient perspiration, wherein the system is unable to throw off its redundant fluids: by stagnation they inspissate and form mucus; and by occupying more space than is natural create a difficulty of breathing. Now if deficient perspira∣tion be the effect of debility, debility will be the original cause; and any medicine capable of pro∣ducing that effect, will be capable also of en∣creasing the cause.

An emetic by depriving the stomach of its contents, deprives it of that which might enable it to resist the disease. It exhausts and weakens an organ which requires support and nourishment, and encreases that debility which was already too pre∣valent: mucus or phlegm as it is termed, it is true, is during the action of vomiting discharged; but in trifling proportion, and with considerable disadvantage, the thinner parts alone being rejected and the denser retained.

But if any one should take occasion to say, "we admit the truth of what you have asserted, that

this is a disease of debility, and that emetics though they afford a temporary relief, ultimately debilitate; yet as these fluids are already collected, and as the patient is in a state of fuffocation by their retention; what remedy can be found to supply the place of an emetic, and succeed so well in discharging them from the system?" To this I immediately answer; strengthen the system and the fluids will be dispersed; encrease the perspiration and they will be resolved; prescribe cordials and they will be expelled.

This disease then being admitted to be a disease of debility, any medicine capable of invigorating the whole system will be found to be beneficial; and it is upon this principle and no other that bark, opium, cicuta, and other remedies have proved successful. That they frequently fail, arises perhaps from this cause, that they are depended upon sin∣gly, and considered as specifics; but as I have already endeavoured to shew the non-existence of a specific in nature, if my position be granted, it will be easy to prove that where the principle is false, the success must be uncertain.

It has been observed by the late Dr. Johnson, that nothing has ever been well done by a receipt; and I must confess that I have attended patients

with the Hooping Cough, where neither bark, opium, nor cicuta have been employed, and where notwithstanding the recovery was complete.

It is not from any one particular form or system that diseases are to be eradicated and health estab∣lished; yet as example is at all times more effica∣cious than precept, a few authentic Cases, while they demonstrate a plan of treatment, may serve to explain the principles upon which that treatment was founded.

And as I have ever deemed it to be the indispen∣sible duty of a Practitioner to give a faithful relation of facts though they may include events of an unpleasant nature; so have I always thought that the relation of unsuccessful cases is more than ever requisite, when any consideration of importance or means of improvement are to be deduced from them.

CASE I.

On the 26th of August 1793, I was desired to send an emetic to a child of about four years of age, who was troubled with the Hooping Cough; as I never before had an opportunity of seeing a complete case of this disease, and as I had some doubts respecting the propriety of emetics, I con∣sidered this as a favourable opportunity of watching the progress and event; and as I attended in the Family, profited by the occasion. The child possessing a tolerable share of health, and with the exception of the cough having no other particular symptom of disease, had rendered any previous attendance unnecessary. Upon calling the next day I was informed that the emetic had been given, and as usual, had brought up a considerable quan∣tity of phlegm; the cough, however, was more troublesome, and the patient very restless. The following medicine was immediately prescribed.

I.

℞. Conf. Arom. Gr. xv. Syr. Croc. Sp. N. M. ā ʒj. Aq. Men. Pip. ℥iss. ♏. Coch. Med. statim et 4^tis horis capiend.

On the 28th the child was something better.

On the 29th Measles began to appear, and as he seemed somewhat feverish the following was pre∣scribed.

II.

℞. Aq. Ammon. acet. ʒij Syr. Croc. Sp. N. M. ā ʒj Aq. Men. Sat. ℥iss. ♏. Ut ante capiend.

On the evening of this day the child's breathing being much obstructed, the mother procured a leech and applied it to his breast. The ill conse∣quence of this, was but too soon visiblē; at night I was sent for, and found the patient in a very alarming and dangerous situation; the leech had caused a profuse Hemorrage, and round the orifice was a livid circle. The breathing was become high and laborious; the countenance pale, and the convulsive motion of the nostrils was very evident; together with these formidable symptoms, a violent Diarrhoea came on, and it seemed to be the general opinion that the patient could not survive. The following medicines were immediately pre∣scribed.

III.

Emp. Cantharid. Stern. ℞. Conf. Arom. ℈j. Syr. Croc. Sp. N. M. ā ʒj. T^ra Lav. C. Gutt. x. — Opii. Gutt. xx. Aq. Men. Pip. ℥iss. Coch. med. stat. & 2^nd quaq. hor. capiend.

A clyster of mutton broth was directed to be given warm; a pap-spoonful of red port between each dose of the mixture; and the feet to be put into warm water.

On the 30th the symptoms much the same.

IV.

℞. Mist. Camp. ℥iss. T^ra Card. Comp. Syr. Simp. ā ʒj. T^ra Lav. Comp. ʒss. — Opii. Gutt. xx. M. Coch. Med. 2^nd quaq. hor. capiend.

Diet ordered to be strong beef tea, sago, with wine, &c. &c.

31st. Slight alteration for the better, but diarrhoea very violent.

Contin. Miss. Card. ℥ij.

1st of September the breathing very difficult and the diarrhoea still continues.

V.

℞. Conf. Arom. ℈j. Syr. Croc. Sp. N. M. ā ʒj. T^ra Lav. C. ʒj. — Gentian. C. ʒss. — Opii. Gutt. xx. Aq. Men. Pip. ℥iss. Coch. Med. 2^nd quaq. hor. capiend.

2nd. The Patient considerably better, the purging less violent, the countenance more lively, and he began for the first time to speak and call for vari∣ous things.

VI.

℞. Conf. Arom. ℈j. Syr. Croc. Tinct. Cinnam. ā ʒj. — Lav. C. Gutt. xx. — Opii. Gutt. x. Aq. Men. Pip. ℥iss. ♏. Coch. Med. dum. alv. deject. contin. capiend.

On the 3d still mending.

And on the 4th so much better that I judged it expedient for him to take his medicine at greater intervals.

On the 6th he took his medicines, with the Omission of T^r Opii. and

On the 7th discontinued them; and being sent into a neighbouring village for a short time, for the benefit of a change of air, has since returned and is at this time in perfect health.

CASE II.

On the 20th of September, I was called to a child of about 8 months old with the Hooping Cough. He was of a weak puny habit from the birth, and had a severe illness some time before.

VII.

℞. Conf. Arom. Gr. xv. Syr. Croc. Sp. N. M. ā ʒj. T^ra Lav. C. Gutt. x. Aq. Men. Pip. ℥j. ♏. Coch. min. stat. et 2^nd quaq. hor. capiend.

21st. The cough very troublesome.

VIII.

℞. Conf. Arom. Gr. xv. Syr. Croc. Sp. N. M. ā ʒj. Tinct. Opii. Gutt. x. — Lav. C. Gutt. v. Aq. Men. Pip. ℥j. ♏. Coch. Min. urg. Tuss. capiend.

22nd. Being better the medicine was neglected.

23d. Breathing difficult and cough bad.

IX.

℞. T^ra Card. C. Syr. Croc. ā ʒj. T^ra Lav. C. Gutt. xx. — Opii. Camp. Gutt. x. Aq. Men. Pip. ℥j. ♏. ut ante capiend.

24th. Cough still continues.

X.

℞. Conf. Arom. Gr. xv. Syr. Croc. Sp. N. M. ā ʒj T^ra Gentian. C. Gutt. xx. — Lav. C. Gutt. x. — Opii. Gutt. v. Aq. Men. Pip. ℥j. Coch. min. 2^nd quaq. hor. capiend.

On the 25th the breathing being very labo∣rious,

Emp. Cantharid. Ventrical.

26th. Contin. Miss. Card.

27th. A little better.

Contin. Miss. Card. ℥j ā T^r Opii. Gutt. xv.

28th. A clyster of mutton broth directed to be given.

29th. The child considerably better, but on the

30th, a relapse. Breathing very laborious, and countenance pale with diarrhoea: weather very rainy.

XI.

Emp. Cantharid. Stern. ℞. Mist. Camp. ℥iss. T^ra Card. C. Syr. Simp. ā ʒj. T^ra Asae. Foetid. Gutt. xx. — Opii. Gutt. x. ♏. Coch. Min. Omni. hor. capiend. Contin. Enem.

1st October. A little better.

Contin. Miss. Card. ā T^r Opii. Gutt. xx.

3d. Much better, begins to suck, which he had before been unable to do; and to conclude, in the course of about a fortnight at farthest, by a con∣tinuance of cordial medicines with small doses of P. Rhab. the Patient completely recovered, and has been well ever since.

I have particularized this case, not because I think that there was any thing very remarkable in it, but because it was confidently asserted that the child could not recover; the mother and nurse had at one time given it up as hopeless, and but for my persuasion would have left it to its fate, and because no emetic had been given from the commencement to the conclusion of the disease.

On the 3d of October I was called to a Family where four children had the Hooping Cough; but as I think it would be needless to enter into a parti∣cular detail of the medicines which were given, it will be sufficient to say, that with the assistance of temperate cordials, light and nourishing diet, gentle exercise, and clear air, they all completely recovered.

I have since attended several children, who by the same treatment, and with the exclusion of emetics, have all recovered; but I must pass them over to come to a Case which proved unsuccessful.

On the 1st of December, I visited a child about four years old with this disease: he was very restless and rather costive.

XII.

℞. Conf. Arom. Gr. xv. P. Rhab. Gr. v. Syr. Croc. Sp. N. M. ā ʒj. Aq. Men. Pip. ℥iss. ♏. Coch. Med. 4^tis horis capiend.

2nd. The cough being troublesome, I was solicited for an emetic, but gave an evasive answer, expressing my doubt of its efficacy. The medicine was continued; but on the

3d. As the patient seemed to be very much op∣pressed in his breathing, and choaked with phlegm, I yielded to solicitation, and an emetic was sent. From that time the patient gradually drooped, and notwithstanding the utmost vigilance and attention, and the most vigorous application of medicines of the most powerful kind, on the 7th in the even∣ing died.

I am so well convinced in this case of the eme∣tic's proving pernicious, that I shall never consent to hazard the experiment a second time; and if any one should assert that he has given an emetic for a cough, and experienced its efficacy, I shall answer, "It is possible you may have cured a cough by emetics, but I do not believe that cough was the Hooping Cough."

The last case which I shall offer is that of an infant of something more than three months old; who from being in a very imminent state of danger, was happily recovered in less than a fortnight's time.

The medicines were of the cordial kind; clysters were given; nutritive broths with a moderate quantity of wine: and I can here with truth and confidence assert, that (excepting the one I have mentioned) I have never had a case of Hooping Cough which did not yield to this plan of treat∣ment.

As I have rather exceeded the limits of a paper, I must hasten to a conclusion. To those who may think that I have been presumptuous in my opi∣nions and confident in my assertions, I shall beg

leave to oppose the authority of a celebrated Physi∣cian.

"In Hooping Cough,"

says he,

"change of climate is an idle tale, and the practice of vomiting death."

I have said that this disease is rapid in its pro∣gress and fatal in its effects; and I cannot bring a better instance than that of a child who going to a baker's, in whose family it prevailed, to purchase a roll, caught it, returned home, and being seized with a fit of coughing, burst a blood-vessel and instantly expired: and that of a mother who was bereft of two children, both of whom were cut off in somewhat less than eight and forty hours, with∣out having received any treatment: and no other medicine than that abominable custom, which can∣not be too strongly reprobated, and which is so pre∣valent among the Poor especially, viz. of giving their children repeated doses of Vin. Antim. or Tart. Emet. without either knowledge to assist, or judgment to direct them: so bigotted indeed are they to these medicines, that they think them uni∣versal nostrums; and I am acquainted with a family where Vin. Antim. is regularly administered to the children once or twice a week; by way, as it is termed, of clearing the bile from their stomachs! Good God! are there not already sufficient calami∣ties for suffering humanity, that we should so

studiously endeavour to create diseases, where none previously existed, and thus dig pitfalls for our own destruction!

It is not with medicine, as with other arts and sciences, where a mistake may be rectified, and an amendment adopted: alas! dear-bought experience frequently comes too late, and the nature and cause of a complaint may be discovered when the occasion for it is past.

I call therefore upon this Society, in their indivi∣dual as well as in their collective capacity, to dis∣countenance and check the imprudent exhibitions of em••tics. I have brought forward proofs of their in••••••••••acy and ill effects: I have shewn the success of a different plan of treatment: and I conjure them, by all that is valuable and sacred, to let not these testimonies be brought in vain.

Notes

• * 1.1

  El. Med.
• * 1.2

  El. Med.
• * 1.3

  Dr. W— B— will, I trust, excuse me for this obser∣vation; he has long since pronounced me a confirmed heretic, he cannot, therefore, be surprized at my want of faith.