The Second Distemper which I shall consider as subject to these Measures, is one Species of the Dropsie; that is, the Anasarcous Kind, from which likewise I except those, which are attended with a hard Liver, or a remarkable Obstruction of some of the Viscera.

This kind of Dropsie, thus circumstantiated, does at first View, seem not to need the Assistance of any extraordinary means to help towards a Cure, it being the most Curable of all Dropsies; and we have daily Instances of its giving way to Common Medicines, nevertheless there are such exceptions in this most Favourable Case, as give trouble enough to a Physician sometimes, and requires more than usual Application; as for Instance; sometimes a Person happens to be brought so low by an Unseasonable Purge, that afterwards Diureticks and Corroboratives will have no effect upon him, but the Case becomes deplorable, without the Rupture of any Lympheducts or other the like Difficulty.

Secondly, when People decline in Years, there are some extraordinary means requisite to make the Remedies exert themselves with like Success, as they do in Younger Persons.

Thirdly, in Hysterick Women it is difficult to carry off the load of Water by common means, without some such Method as I shall hereafter mention; because their Spirits are so low, that they can bear no considerable Evacuation.

Fourthly, when a Dropsie comes upon an Asthmatick Person, there are particular Difficulties arise, and the singular Advantages of constant and gentle Exercise in this Case are universally known.

These four different Circumstances of this Distemper, may suffice to shew that I have Colour enough for my calling in the Gymnastick Method into this Case, and ’tis the first of the Exceptions, I mean the ill Effects, which sometimes follow upon the Use of Purgatives, which have chiefly occasion’d me to inquire, whether we ought in this plain Case, thus circumstantiated to halt between two Opinions, between Purgatives and Diureticks, without endeavouring to establish a certain Praxis upon Just Foundations.

There are none will deny, but Diureticks are the most proper and natural Remedies in this Case, if they would always succeed, because directed to the proper Emunctory, the Kidneys, and because they can go hand in hand, with the Corroborative Medicines to be given at the same time; I take it for granted therefore, that whenever Purgatives are us’d in this Case, it is because the Diureticks don’t take quick enough, or in order to carry off the load of Serum, that the Diureticks may the sooner display their good effects, because it will be alledg’d that the Serum becomes so Ropy and Glutinous in the Passages and Capillary Parts, that the Diuretick cannot always act upon it. But tho’ this is granted, it will not suffice to warrant the Use of the stronger Purgatives, because their manner of Acting cannot agree with this Distemper, and because those difficulties objected, may be overcome by other means.

First, the very Nature of strong Purgers, makes against this Case, it seems very preposterous, to have recourse to such Deleterious Drugs, to those Mortis CatapultÆ (as Ludovicus calls the Esula’s and such like Purgatives) in Order to the Restoring an impoverish’d Blood; if they acted only by Stimulating the Intestines, something might be said; but since it is indisputable that they pass into the Blood, and act powerfully upon it, there is no doubt to be made, but they fuze and divide it, and break its Globules, and consequently make as much Water as they carry off, which is the very Reason why Sweating is laid aside, and Salivation, tho’ they both seem so proper to carry off Watery Humours; I know it may be alledg’d in Defence of these Medicaments, that the 36th and 37th Aphorisms, of the Second Section seem to imply, that a Sick Person would receive less Harm from ’em, than one that is in Health; but yet this will not excuse their Use in our Case, because tho’ the Viscousness of the Serum, may blunt the Particles of those Drugs for a time, and hinder ’em from working so quickly, yet when once they are throughly imbib’d, and begin to exert their Force, they ravage the very Principles of Life, and can by no means be fit for a Person in so low a condition. But admit that the Water is carry’d off by these means, the Blood will be left as poor at least as it was before the Dropsie first appear’d; and then how can we be sure the Waters will not rise again? Suppose an Anasarca follows upon an HÆmorrhage, which is very common, and you draw off the Water by Purging; will not the Person be just in Statu quo, upon supposition that the Medicines in their working did not impair Nature? but that is not to be granted, because it is impossible to suppose, that such Drastick Medicines, should not prey upon Nature, even while they are assisting her; and can we be assur’d that the Blood will not run into the same Colliquation it did before? Besides, may there not be some reason to suspect that the very quantity of the Serum, supposing it is not too Turgid indeed, may sometimes be serviceable, to the promoting the activity of the Diuretick, even as we find in the true Ascites, it is of some use in the Cavity of those Persons, because they often can’t spare it, without certain Ruine? We don’t know how much the confidence of the Fluid may conduce to the keeping its homogeneous Particles combin’d, and we ought to be very tender of doing any thing, that might tend to dissolve the Crassamentum, the Globules, which are as it were the very Semen Sanguinis (if I may so speak); for how far Nature would endure such measures, before the Sanguification would be totally subverted, would require a Dissertation, longer than my Scope will permit; but that this is sometimes done is not improbable, and I take this to be the Case of a Young Fellow I knew, who falling into a slight Dropsie, goes to an Empirick somewhere about White-Chappel, from whom he had a Dose of Pills, which gave him about 30 Stools, which sunk him so much that his Nails turn’d black, and he died in two or three days time; Here ’tis very likely the Signification was entirely extinct, and the Blood chang’d into a Preternatural Fluid, and all by the great Power of these Deleterious Drugs; and tho’ ’tis likely the Quack did not know the proper Dose of his Medicines, yet one would think, this was no more than what might be expected from Ten Grains of Elaterium, which yet has been allow’d by an Eminent Writer.

Besides the weak State of the Blood, the Ventricle is always more or less impair’d in this Distemper, and consequently unable to be put to bear the violent Stimuli of the stronger Purgers, without Danger of having its Tone irrecoverably ruin’d.

It may likewise be Prudent to forbear Purging in this Case, left happily there should be some greater Obstruction in the Liver, than we are aware on, for then it might be follow’d with ill Consequences; ’tis true, if that Bowel is really Schirrous, it may be discern’d, or a great Tendency toward it, will shew it self sometimes in the Greeness and Virulency of the Bile mixt in the Excrements, together with other Indications; but a slight disorder there, is not always regarded, and Brick-colour’d turbid Urines are so common in all kind of Dropsies, that we may not discern that the Blood does abound too much with Bile, and so a Purge given at such a time may do a great deal of Mischief, for the Bile is of a light Nature in Comparison of the Phlegm, and moves easily, and no Man knows what he does when he rouzes it; I knew an ill accident happen once upon a Purge, given by a very Eminent Physician, to a Gentleman in a Jaundice, which put him into the most extravagant and fatal Hypercatharsis: thus bold Administrations to such weak Subjects, may be attended with Tragical Accidents, but the milder and gradual measures may succeed, without such dangerous Risks, if we consider what have been the Difficulties which have lay in the way, and hindred the Operation of our Diureticks.

The ill Success of our Diuretick Method in this Distemper, is very much owing to our giving those Medicines in so small a Quantity, and to our not changing ’em for some of a quite different Nature, when one sort us’d pertinaciously does not take; that the quantity must be encreas’d, there needs no better Argument, than what is brought for the use of Purgers; for if the Blood can dispense with the Particles of a Purgative, it will certainly bear a great quantity of those which are Diuretick only. What Wonders has that Golden Remedy of Pythagoras done, the Acetum Scylliticum, when given to a proper quantity? And what may not be expected from the Sal Succini, which may be given to a Dose large enough to irritate the Fibres of the Stomach, and in some measure supply the place of a gentle Purger; but when it is come into the Blood it may prove Cordial as well as inciding? And now I am speaking of augmenting the Quantity of our Diureticks, I can here affirm a very strange Effect that follow’d upon an excessive Dose of Millepedes in an odd kind of a Rheumatick Case, for the Cure of which, several things had been try’d in Vain, by very good Advice; the Millepedes were given to a quantity scarce credible, to several Ounces, and gave a Relief in a little time that exceeded all expectation. This with other instances something of the like nature, every where to be met with, may convince, us that we ought to advance the quantity of these Medicines, to which if we apply the Use of Exercise, the highest Advantages may be expected: For to grant as much as the favourers of the Purging Method can demand, that by reason of the foremention’d Ropiness of the Serum, the Diureticks and Chalybeates will but distend the parts, and make the Juices grow Turgid. Is there no way to remove the Dam, but by shaking all Nature at the same time? Must we blow up the House to get the Enemy out? To what purpose do we talk so much of the Animal Oeconomy, if we reduce its Rules to Practice no more than we do? We are taught the Benefit arising from the Constriction of the Muscles upon the Vessels; and can there be any Case which does more apparently call for it than this? When it is hazardous to attempt by inward Violence to dislodge the Viscous Concretions, certainly it is high time to do it by Muscular Force. This Hippocrates seems to be experimentally convinc’d of, by his frequent inculcating the Use of Exercises in this Distemper, ?e? ta?a?p???e?? you must labour, is his constant Expression, whenever he speaks of the Dropsie; which, whoever considers the Conciseness that is in all the Writings of that Great Man, will be apt to imagine that it carries its Weight with it, and implies the absolute necessity of acting upon the Lentor of the Phlegm, by the playing of the Muscles. Besides Exercise will help to restore the Tone of the Parts, which is sometimes spoil’d by too great a Distension, even so much as to be in a manner benum’d, which Helmont seems to lay much stress on, when he, according to his odd fantastick way, calls it the Anger of the ArchÆus, that won’t let the Waters pass; and if there is this kind of Spasmodick Affect in the Parts leading to the Kidneys, then certainly there is as much Reason for one in a Dropsie to get into a Coach upon his taking his Medicines, that the frequent jolting may assist their Operation, as there is for one in a Fit of the Gravel so to do. The Heat that is acquir’d by the Motion of the Body, must needs comfort the Parts, and rarifie a great deal of the Moisture, so that it may the more easily pass the Membranes, as they are dilated by Exercise; and if we can by squeezing, make Water pass through Leather, the whole Skin dry’d and prepar’d, may it not much more easily pass the Membranes of a living Animal, when work’d and stretch’d by Motion, and assisted by the Warmth which that Motion produces? These may be thought little things by some, but they will be found to be of great Consequence; by such minute Measures, Nature can produce great Effects; and by a Neglect of these things, many a great Life has been lost, in Dependence upon something of a greater Name, that has had no Relation to the Genuine proceedings of Nature.

These are some of the Reasons which have convinc’d me of the Preference of the Diuretick Course, and which I think can’t be overthrown, by all the Examples of the Success of Purgers, because if we compute the Ill Effects of ’em likewise, and set ’em to balance the good, the very Cures done by ’em, will seem but as so many Splendida Peccata. We ought not hastily to quit safe Means for those which are dangerous, only because they are a little more expeditious; when a Case is within our Reach, we ought to Establish our Prognosticks upon sure ground, tho’ they may not be so quick as could be wish’d; we have other Dropsies that are dubious enough, but in this Case we ought to study to bring things to a certainty as much as possible; which how can we do unless our Methods are Uniform? It behoves the Patrons of Purgatives to assign some certain Rule, to render the Use of ’em alwayes safe, which seems impossible to be done; and it behoves those who are for insisting on Diureticks, to find out some such Measures, as may make these milder Medicines always Efficacious; which is what I have been attempting to do; and which, if I don’t flatter my self, I think I have made to appear plain and obvious; for if we can’t arrive at some comfortable certainty in this Case, I don’t know in what we can do so; for we are so happy as to have those things as will certainly act upon such a Crasis of the Blood, as will revive and enrich it, when decay’d, tho’ not always in the like space of time; and when they act too slowly, we can enforce their Virtue, by these ways I have been speaking of.

These things are no Figment of mine, they have been the Practice of Ancient Times, and are so natural a Result from a due Consideration of the Animal Oeconomy, that I cannot enough wonder that in so many Discourses upon those Fundamental Rules, there has been so little Notice taken of the Effects of the Motion of the whole individual, as superinduc’d to the internal Motions, that make up the Oeconomy; for if this had been duly regarded, it could not but have been reduc’d to Practice, and apply’d particularly to the Cure of this Distemper.

Lastly, I know these are hard Sayings to some People, who send for a Physician, as for one that deals in Charms, and can remove all their Afflictions, while they are wholly Passive; and they would take it very ill that they should be compell’d to a sort of Labour, while they carry about ’em a Load in their Limbs; but yet for all this, Nature will be Nature still; and if this be her Voice it must be obey’d. He that is in a Dropsie ought to be Alarm’d, and look upon himself as in something the like Case with those Criminals whom the Dutch, upon their refusing to Work, confine to a Cellar, and let the Water in upon ’em, that they may be in a Necessity either of Pumping or Drowning. And I believe there are but few, but who, upon their being convinc’d of the real and surprising Benefit of these Means, would readily undergo the Fatigue of ’em; and things may be so manag’d, that Exercise may not be so troublesome as the Sick imagine; an easie Pad will quickly grow familiar; and where the Legs happen to be so very much distended, that there may be some danger, lest the Skin should be rub’d off, a Chaise may serve the turn.