A continuation of the account of the nature causes, symptoms and cure of the distempers that are incident to seafaring people illustrated with some remarkable instances of the sicknesses of the fleet during the last summer, historically related : to which is prefix'd an essay concerning the quantity of blood that is to be evacuated in fevers : being the third part of the work / by William Cockburn ...

Observation XXVII.

John Davis, was taken suddenly with a loss of his Speech, he fell down as if he had been thunder-struck,

and fast asleep, without feel∣ing or any motion, except Respira∣tion, the motion of the Heart, and consequently that of the Pulse: yet, the Respiration and Pulse were so very small, that the sick person seem'd to be dead for a great many hours, his breathing was high, as when a man snores, and he foam'd a little at the mouth.

'Tis certain, that this is a Fit of an Apoplexy, a Disease not necessa∣rily occasion'd by our way of living at Sea, and therefore not to be mi∣nutely and particularly accounted for, in this place; yet to make the me∣thod of cure to be better understood, 'twill be necessary to say something, in the general, of its production: and therefore, let us only consider what we observe upon this and the like occasions; we have here a sud∣den and universal deprivation of sense and motion, except those already mentioned in the foregoing History; so that whatsoever is capable of pro∣ducing this universal and sudden De∣privation, is the immediate cause of this Disease. Again, let us remem∣ber that when I prov'd in my O Econ.

Anim. that there was a liquor pro∣pell'd through the Nerves which we might call Animal Spirits, I did it upon an experiment of a part's losing its sense and motion by making a ligature upon the nerve with which that part is provided; and now since we see that a member, or a particular muscle may lose their sense and mo∣tion by making ligatures upon their Nerves; if so many ligatures or something that produces the same effect, be suppos'd to affect every Nerve and ail its parts, or all the Nerves in their Original, which may be more easily done, 'twill not be difficult to apprehend this universal and sudden deprivation of sense and motion, which is requir'd.

Now any thing that may depress the small and tender Nerves in their rise, in the Brain, and Medulla oblon∣gata, will hinder this derivation of animal spirits thro the Nerves and cause an Apoplexy; whether the sides of the Arteries be stuff'd with too much blood (thro its vis••idity, too great quantity, or its being too much rarefied) bending outward

with greater force than these Nerves have resistance; or whether these Nerves are thus deprest, by any of the vessels of the Brain being broken, and their liquors driven thro all the brain by the force that propell'd those liquors; extraneous bodies bred in the brain, a depression of the skull, which compresses these vessels, and the whole substance of the brain; all which may produce the required effect.

Now if the compression be of such a kind that either few animal spirits are derived, or none at all; if the last, the consequence is death, because of the absolute and perfect want of those spirits that distribute sense over all the body, and motion to all its vessels and liquors: but when these spirits are conveyed in a very small quantity, they go with no unequal force into all the muscles, and consequently they effect equally, as to our observa∣tion, the whole muscles; and because the muscles of the whole body are counterpoised by their Antagonistical Muscles, except the Heart which has no Antagonistical

Muscle, and they being equally affected with this small quan••ity of animal spirits, their powers will be equal, and all detain'd in equi∣librio, except the Heart whose faint motion, from so few spirits, does continue; and the pulse too, which depends upon the motion of the Heart. Now from this Theory 'twere easy to establish the Cure, according to the different ways of the production of this Disease; as that an Apoplexy from extravasated liquors or extraneous bodies bred in the brain is incu∣rable, because we know of no way to bring back these liquors into their vessels, or to destroy these growing and compressing bodies in the brain: and that that from a depression of the skull requires the raising of the skull, and a practice according to the hurt the brain has receiv'd by this depression. But the Cure of that which is occasioned by the stag∣nating of the blood in the Arte∣ries of the Brain, and Medulla Oblongata, can only be perform'd by such means as may put this

blood into motion, and empty those vessels from the extraordi∣nary quantities; upon which views, straight come into our mind all sorts of Evacuations, as Bleeding, Vomiting, Purges, Clysters, Sweating Medicins, &c. then such Medicins as cause pain, which occasions the vessels and muscles to be more violently contracted, that so the stuffing liquors may be the more easily cast off. Now, tho Authors do mightily depend upon such evacuating Medicins for curing the paroxysm of an Apoplexy, yet it were easy to demonstrate the un∣successfulness of that practise, by proving how such Medicins can∣not affect the body in this cir∣cumstance, and therefore can afford but a very weak help; but this not being my design, I will only put 'em in mind of an instance of daily experience, and defer other Arguments to a more proper oc∣casion; and that is, if we give a very strong Vomit to any one in a Quartan Ague when the cold fit is begun, we find it never has

its effect till the cold fit, which may last three or four hours, is over; the vomitive parts of any medicin not being capable to affect the Blood or animal Spirits, in this viscid state of the Blood, or when it has a slower motion in the cold fit of an Ague, so as to produce their natural and constant effect; yet so soon as that is over, we find that, in a reasonable time, this small quantity of a medi∣cin that has been in reserve, for some hours, in a place, that uses to digest our most solid food, and trans∣mit its healthful juices into the blood for our sustenance in less time, at length, and then only begins to move us; and since this is the constant fate of vomits taken in such circumstances, 'twill be very plain to those that can see into the reason of this obvious observation, what we are to expect from this medicin in the fit of an A∣poplexy, where all feeling and sense seem to be at a final period, the equable and exact motion of our Li∣quors interrupted, the Pitcher broken at the Fountain, and the spring and origin of motion taken off:

And if all this happens to vomits, the medicins, that of all others have the most violent effects up∣on us, what must the weaker helps of the other medicins be thought to perform? just nothing; and if we can cram them into him, 'tis only to plague him after he has recovered without our help. Now, if this is all that internal medicins can do, even when we are to use violence upon our Patients to make 'em receive them; we must certainly depend upon external o∣perations, for any service we can expect to do, as anointings, which can do least, smelling at things that may affect our Senses and create pain, which may do more; but if we can hinder a greater afflux of Blood to that which already stagnates, and even take off some of the stagnating power, we may reasonably hope that the Heart may recover such force, as may propel the stag∣nating Liquors in the Brain, and Medulla Oblongata, or that we may relieve our Patients with a

great deal of certainty and in a short time, and to put him in a condition to reap advantage from internal Medicins that could do him no service be∣fore: And this may be done by such ways of bleeding, where∣by the blood being determined more to one part than another, more to the place where there is no cause for obstruction, than to one where it already is, there may be some of the obstru∣cting force taken off, or it may be done by Revulsion and Deriva∣tion, a practice so confirmed by daily experience, as well as by that of the Ancients of all Ages; tho its reason was never to be assigned, but by supposing Harvey's most no∣ble Theorem, the Circulation of the blood, Whatever; contrary use some of our Modern Physi∣tians have pleas'd to make of it, without any reason. For, if the Blood's motion is quicker by bleed∣ing, and in that Vessel where the wound is made, than it is in any other Vessel of

the opposite side, and that has no communion with this, or even in the same Vessel; before the bleeding; 'Tis cer∣tain that there will a great∣er quantity of blood flow thro that Vessel than there does in its opposite Vessel in the same space of time, or did throw it self before the Ve••esection; and that if this emissary is made upon a Vein that is continued with an obstructed Artery, this new out∣let of the Blood will take off some hundreds of degrees of resistance that it had from the blood contained in its Channel; or by the different ways of bleeding there will be Re∣vulsion and Derivation as was to be proved. Now the blood's motion must be quicker, because the powers that propel the blood, or rather the blood it self, does not communicate, or does not lose, by a great deal, so much of its force, when it moves thorough a Vessel, or its processes even to the Heart, as where there is an emissary made, where there is none. This is most evident upon

this account, because the parts of blood that are next to the Heart pro∣pelling the parts that are more re∣mote, lose a thousand times more of their motion when they propel the blood thorough a whole Chan∣nel, than when the Vessel has a large emissary made upon it, the propor∣tion betwixt the column of blood as it runs in a continued course (the parts of blood being contiguous one to another in their motion from the left Ventricle of the Heart, till they return into the right) and as it runs thorough an emissary into the air being as 1 to 1000, or by some calculations as 1 to 1200 or there∣abouts. But not to insist upon this, and that some who are accustomed to more nice calculations, may be capable to conceive the truth of this proposition we advance; let them but call into their thoughts what happens constantly in bleeding; where we may see run out of one Vein some ten or twelve ounces of blood in little more than a minute, and shewing such quantities over all the body, then considering the Mass

and bigness of the Vessels, and so he'll find this excessive velocity is either to be allowed, or else his quantity of Blood must grow in∣finitely upon him, and extraordina∣rily beyond a reasonable allowance. And now it being clear, that not on∣ly the Doctrin of Revulsion and Deri∣vation is to be accounted for by sup∣posing the Circulation of the Blood, but even that they who believe that this Doctrin is contrary to this Pro∣position, are perfectly ignorant of this noble Theory, the Circulation of the Blood, and its great Effects; I will proceed to the Cure of the Pa∣tient in the Fit of the Apoplexy; and because things could not be got ready soon enough for a more consi∣derable Revulsion by Bleeding him in the Foot, I caus'd eight Ounces to be taken out of his Arm, through a large Orifice, and thereafter, because he had abundance of Blood, ℥xvj. were taken out of his right jugular, because they convey the Blood im∣mediatly from the Sinns of the Brain, into which these Arte••i••s dis∣charge themselves; which Operation, with smelling at some strong Spirit

of Hart's horn, brought him out of the Fit while the Surgeon was Bleed∣ing him; after the Fit was over, he had a Clyster, not at all stronger than usually, and took now and then three spoonfuls of this Ju∣lep.

℞ aq. lact. al••xiter. ℥v. spirit. vin. ℥ij. aq. theriacal. ℥j. Tinctur. Castor. ʒj. M. ac cum. syr. fl. caryophyl ℥j. f. julap. Cujus bibat 〈◊〉〈◊〉. iij. tertia quaque hora.

He had a Seton in his Neck for one Month, and his ordinary drink was the following decoction.

℞ lign. Guaiac. ℥vj. Cortic. ejus∣dem ℥ij. santal. rub. citrin. an. ʒvj. Coq. & digerant. l. a. in s. q. aq. sont. ad lbvj. Circa finem addend. passul. major. integr. ℥v. Colatura servetur usui.

All this time he had suffer'd no re∣lapse, nor since as I can learn.