102 PRACTICE OF PHYSIC. 



eral and topical, burning, blistering, and issues : but these 

 appear to me to be chiefly, perhaps only useful when the dis- 

 ease still partakes of acute rheumatism. 



" Dr. Boerhaave has said that the lumbago and ischias are 

 to be cured in the same manner as the acute rheumatism ; 

 and that the principal remedy of this is blood-letting : but this 

 is unguarded ; and we allege bleeding is never proper, never 

 successful in chronic rheumatism. We have formerly shewn 

 that general bleeding is only effectual where the system is af- 

 fected, which is not the case here. If bleeding, therefore, is ad- 

 missible, it is the topical only ; and even this is doubtful, as 

 there is no increased impetus nor inflammatory spasm. What 

 bleeding will do in the contraction of the chronic rheumatism, 

 may be doubtful ; but, as the animal power is weakened, it 

 should do harm. This I think, appears from experience ; and 

 if the contrary happens, it is in recent cases, where the acute 

 rheumatism is not gone, where swelling recurs, and where some 

 evening fever is at the bottom. 



" With regard to purging, we have given our opinion, that 

 it is not a very powerful or convenient remedy in the acute, and 

 it must be still less so in the chronic rheumatism. The general 

 effects of the evacuation are not proper : the evacuation of an 

 acrimony is imaginary. If it has upon occasions been useful, 

 I believe it must have been owing to the mercurials employed, 

 or to other medicines acting as universal stimulants. 



" But there was a singular practice of the ancients the use 

 of glysters in ischias. From the vicinity of the parts, they pre- 

 sumed that an evacuation from the rectum might draw humours 

 from the neighbouring parts. This, with respect to the acri- 

 mony, is not correct ; but certain it is that the arteries of the 

 rectum are branches from the same trunks that furnish arteries 

 to all the muscles about the hip-joint ; and, therefore, blood 

 drawn from the first may relieve any congestion in the latter. 

 But the glysters can do no more than the topical bleeding 

 from the muscles themselves, except on the supposition that 

 the pains of the joint arise from a suppression or emansion of 

 the haemorrhoidal flux. To this purpose, Galen has this re- 

 markable observation, c Novi ischiadas una die sanatas, facta 

 ex cruribus evacuatione sanguinis, nimirum ubi non ex frig- 



